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<1>
Accession Number
2018150450
Title
Perioperative Anemia, Gender, Blood Transfusion and Urine Output during
Cardiopulmonary Bypass: Risk Factors for Acute Kidney Injury.
Source
Pakistan Journal of Medical and Health Sciences. 16(4) (pp 270-272), 2022.
Date of Publication: April 2022.
Author
Hassan A.; Younas A.; Farogh A.; Ahmed N.; Bashir T.; Iftikhar S.; Afshan
S.
Institution
(Ahmed) Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
(Hassan, Younas, Farogh, Bashir, Iftikhar) QAMC, Bahawalpur, Pakistan
(Afshan) Punjab Institute of Cardiology, Lahore, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Objective: The aim of current study was to find out the factors causing
Acute Kidney Injury (AKI) in the postoperative period of cardiac surgery.
This prospective study, Peri-operative Anemia, Urine Output, gender, need
for Intra-operative blood transfusion were analyzed for association of
AKI. Material(s) and Method(s): The study was conducted at Cardiac
Center, QAMC Bahawalpur from January, 2019 to June, 2021. A total of 180
patients who underwent cardiopulmonary bypass for IHD and Valve surgery
were studied. CPB hemoglobin levels, Blood Transfusion in OR, Gender
specificity, Peri-operative urine output (Group1 UO <4ml/kg/hr: Group 2 UO
> 4ml/kg/hr) were correlated to establish their relationship in causing
post-operative Acute Kidney Injury. The patients were divided into two
groups one who had Acute Kidney Injury other who don't. Result(s):
Acute kidney injury developed in 20 out of 180 patients, current study
showed insignificant relation between CPB time, X clamp time, Gender,
Surgery type, MAP and Postoperative Acute Kidney Injury. Acute Kidney
Injury was more associated with diabetes, need of blood transfusion,
perioperative hemofiltration and reduced urine output. Conclusion(s):
Current study showed that Acute Kidney injury is an avoidable complication
if hemoglobin levels are kept above 8-9 gm/dl to ensure proper oxygen
supply and need of Intraoperative hemofiltration and BT is reduced by
reducing circuit length thus hemodilution and found a urine output less
than 4 ml/kg/hr during cardiopulmonary bypass carries major risk for
AKI. Copyright © 2022 Lahore Medical And Dental College. All
rights reserved.

<2>
Accession Number
2017566195
Title
Meta-Analysis of Bilateral Versus Single Internal Thoracic Artery Grafting
in Patients >=70 Years of Age.
Source
American Journal of Cardiology. 173 (pp 48-55), 2022. Date of Publication:
15 Jun 2022.
Author
Mulder B.S.; Candura D.; Schoones J.W.; Etnel J.R.G.; Schouten G.N.; de
Weger A.; Tomsic A.; Klautz R.J.M.
Institution
(Mulder) Department of Cardiothoracic Surgery, St. Antonious Hospital,
Nieuwegein, Netherlands
(Candura, de Weger, Tomsic, Klautz) Department of Cardiothoracic Surgery,
Leiden University Medical Centre, Leiden, Netherlands
(Schoones) Directorate of Research Policy, Leiden University Medical
Centre, Leiden, Netherlands
(Etnel, Schouten) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
The optimal choice of graft material in patients >=70 years of age
undergoing coronary artery bypass grafting remains unknown. A systematic
review of literature was conducted by searching PubMed, Embase, Web of
Science, and Cochrane Library databases for original publications that
compared bilateral internal thoracic artery (BITA) grafting with single
internal thoracic artery grafting in patients >=70 years of age. Data were
extracted by 2 independent investigators and meta-analyzed with the use of
random effects. A total of 10 studies, including 11,185 patients, met the
inclusion criteria. No differences in early mortality and morbidity, with
the exemption of sternal wound complications which were more frequently
observed in the BITA group (odds ratio 1.72, 95% 1.00 to 2.96 confidence
interval [CI], p = 0.05; propensity score-matched population odds ratio
1.58, 95% CI 1.09 to 2.29, p = 0.02), were observed. Overall survival was
superior in the overall patient population (hazard ratio [HR] 0.76, 95% CI
0.66 to 0.86, p <0.001), after applying a blanking period of 3 months to
the overall patient population (HR 0.77, 95% CI 0.64 to 0.92, p = 0.005)
as well as in the matched population (HR 0.72, 95% CI 0.58 to 0.89, p =
0.002); in all cases, a benefit was readily seen within a few years after
surgery. The difference in freedom from major adverse cardiac and
cerebrovascular events failed to reach statistical significance (overall
patient population HR 0.55, 95% CI 0.27 to 1.13, p = 0.10; matched
population HR 0.52, 95% CI 0.23 to 1.16, p = 0.11). In conclusion, BITA
grafting can be safely performed in patients >=70 years of age as late
clinical benefits are expected to manifest themselves readily within a few
years after surgery. Copyright © 2022 The Author(s)

<3>
Accession Number
2017194570
Title
Nonthyroidal Illness Syndrome: To Treat or Not to Treat? Have We Answered
the Question? A Review of Metanalyses.
Source
Frontiers in Endocrinology. 13 (no pagination), 2022. Article Number:
850328. Date of Publication: 10 May 2022.
Author
Sciacchitano S.; Capalbo C.; Napoli C.; Anibaldi P.; Salvati V.; De Vitis
C.; Mancini R.; Coluzzi F.; Rocco M.
Institution
(Sciacchitano, De Vitis, Mancini) Department of Clinical and Molecular
Medicine, Sapienza University of Rome, Rome, Italy
(Sciacchitano) Laboratory of Biomedical Research, Niccolo Cusano
University Foundation, Rome, Italy
(Capalbo) Unit of Medical Oncology, Sant'Andrea University Hospital, Rome,
Italy
(Capalbo) Department of Molecular Medicine, Sapienza University of Rome,
Rome, Italy
(Napoli, Rocco) Department of Surgical and Medical Science and
Translational Medicine, Sapienza University of Rome, Rome, Italy
(Anibaldi) Health Management Director, Sant'Andrea University Hospital,
Rome, Italy
(Salvati) Scientific Direction, IRCCS Regina Elena National Cancer
Institute, Rome, Italy
(Coluzzi, Rocco) Unit of Anesthesia, Intensive Care and Pain Medicine,
Sant'Andrea University Hospital, Rome, Italy
(Coluzzi) Department Medical and Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Polo Pontino, Latina, Italy
Publisher
Frontiers Media S.A.
Abstract
Background and Objective: Nonthyroidal Illness Syndrome (NTIS) occurs in
approximately 70% of patients admitted to Intensive Care Units (ICU)s and
has been associated with increased risk of death. Whether patients with
NTIS should receive treatment with thyroid hormones (TH)s is still
debated. Since many interventional randomized clinical trials (IRCT)s were
not conclusive, current guidelines do not recommend treatment for these
patients. In this review, we analyze the reasons why TH treatment did not
furnish convincing results regarding possible beneficial effects in
reported IRCTs. Method(s): We performed a review of the metanalyses
focused on NTIS in critically ill patients. After a careful selection, we
extracted data from four metanalyses, performed in different clinical
conditions and diseases. In particular, we analyzed the type of TH
supplementation, the route of administration, the dosages and duration of
treatment and the outcomes chosen to evaluate the results. Result(s):
We observed a marked heterogeneity among the IRCTs, in terms of type of TH
supplementation, route of administration, dosages and duration of
treatment. We also found great variability in the primary outcomes, such
as prevention of neurological alterations, reduction of oxygen
requirements, restoration of endocrinological and clinical parameters and
reduction of mortality. Conclusion(s): NTIS is a frequent finding in
critical ill patients. Despite several available IRCTs, it is still
unclear whether NTIS should be treated or not. New primary endpoints
should be identified to adequately validate the efficacy of TH treatment
and to obtain a clear answer to the question raised some years
ago. Copyright © 2022 Sciacchitano, Capalbo, Napoli, Anibaldi,
Salvati, De Vitis, Mancini, Coluzzi and Rocco.

<4>
Accession Number
2015260958
Title
Comparison of Warfarin Initiation at 3 mg Versus 5 mg for Anticoagulation
of Patients with Mechanical Mitral Valve Replacement Surgery: A
Prospective Randomized Trial.
Source
Clinical Drug Investigation. 42(4) (pp 309-318), 2022. Date of
Publication: April 2022.
Author
Sabry S.; El Wakeel L.M.; Saleh A.; Ahmed M.A.
Institution
(Sabry) The Cardiovascular Hospital, Ain Shams University, Cairo, Egypt
(El Wakeel, Ahmed) Department of Clinical Pharmacy, Faculty of Pharmacy,
Ain Shams University, 8/4 Badr Street from Al Gazaer Street, New Maadi,
Cairo, Egypt
(Saleh) Department of Cardiology, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
Publisher
Adis
Abstract
Background: The increased warfarin sensitivity observed after mechanical
mitral valve replacement (MVR) operations dictates clinical discretion in
warfarin dose initiation. Evidence is still lacking with regard to
anticoagulation management of MVR patients. Objective(s): This study
aimed to compare initiating warfarin at the recommended dosing regimen
versus empirically lowered doses intended to account for the variation in
warfarin sensitivity. Method(s): A prospective, single-blind,
randomized, comparative study was conducted in postoperative MVR patients.
Patients were randomly assigned to either the 5 mg group (n = 25) or the 3
mg group (n = 25) and were initiated on a 5 or 3 mg warfarin dose,
respectively. Time to target international normalized ratio (INR), time in
therapeutic range, occurrence of bleeding/thromboembolic events, and cost
of bridging with enoxaparin were assessed for both groups. Result(s):
Target INR was achieved earlier in the 5 mg group than in the 3 mg group
(p = 0.033), with a mean +/- SD of 5.3 +/- 2.0 and 6.6 +/- 2.0,
respectively (95% confidence interval of the mean difference 1.022-1.890).
Bleeding events did not differ significantly between the two groups. The
cost of enoxaparin consumption per patient was significantly higher in the
3 mg group versus the 5 mg group (p = 0.002). Conclusion(s): The
initiation of warfarin at a 5 mg dose in MVR patients was more efficacious
than the 3 mg dose in terms of time to reach the target INR. Moreover, the
cost of enoxaparin bridging was significantly reduced with a 5 mg warfarin
initiation dose. Bleeding events were comparable. ClinicalTrials.gov ID:
NCT04235569, 22 January 2020. Copyright © 2022, The Author(s).

<5>
Accession Number
638001941
Title
Clinical Outcomes of Different Warfarin Self-Care Strategies: A Systematic
Review and Network Meta-Analysis.
Source
Thrombosis and Haemostasis. 122(4) (pp 492-505), 2022. Date of
Publication: 01 Apr 2022.
Author
Dhippayom T.; Boonpattharatthiti K.; Thammathuros T.; Dilokthornsakul P.;
Sakunrag I.; Devine B.
Institution
(Dhippayom, Boonpattharatthiti, Thammathuros, Sakunrag) Department of
Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan
University, Phitsanulok, Thailand
(Boonpattharatthiti) Division of Clinical Pharmacy, Faculty of
Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand
(Dilokthornsakul) Department of Pharmacy Practice, Center of
Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences,
Naresuan University, Phitsanulok, Thailand
(Devine) The Comparative Health Outcomes, Policy, and Economics Institute,
School of Pharmacy, University of Washington, Seattle, WA, United States
Publisher
Georg Thieme Verlag
Abstract
Aim To compare the effects of different strategies for warfarin self-care.
Methods PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses,
and OpenGrey were searched from inception to August 2021. Randomized
controlled trials (RCTs) of warfarin self-care, either patient
self-testing (PST) or patient self-management (PSM), were included.
Self-care approaches were classified based on the TIP framework (theme,
intensity, provider): (1) PST >=1/week via e-Health (PST/High/e-Health);
(2) PST >=1/week by health care practitioner (PST/High/HCP); (3) PST
<1/week via e-Health (PST/Low/e-Health); (4) PSM >=1/week by e-Health
(PSM/High/e-Health); (5) PSM >=1/week by patient (PSM/High/Pt); (6) PSM
<1/week by patient (PSM/Low/Pt); and (7) PSM with flexible frequency by
patient (PSM/Flex/Pt). Mean differences (MDs) and risk ratios (RRs) with
95% confidence interval (CI) were estimated using frequentist network
meta-analyses with a random-effects model. The certainty of evidence was
evaluated using CINeMA (Confidence in Network Meta-Analysis). Results
Sixteen RCTs involving 5,895 participants were included. When compared
with usual care, time in therapeutic range was higher in PSM/High/Pt and
PST/High/e-Health with MD [95% CI] of 7.67% [0.26-15.08] and 5.65%
[0.04-11.26], respectively. The certainty of evidence was rated as
moderate for these findings. The risk of thromboembolic events was lower
in the PSM/Flex/Pt group when compared with PST/High/e-Health (RR: 0.39
[0.20-0.77]) and usual care (RR: 0.38 [0.17-0.88]) with low and very low
level of evidence, respectively. There was no significant difference in
the proportion of international normalized ratio (INR) values in range,
major bleeding, and all-cause mortality among different self-care
features. Conclusion Patient self-care (either PST or PSM) by measuring
INR values at least once weekly is more effective in controlling the INR
level. Copyright © 2022 Georg Thieme Verlag. All rights reserved.

<6>
Accession Number
2016756225
Title
Meta-Analysis of Mitral Valve Repair Versus Replacement for Rheumatic
Mitral Valve Disease.
Source
Heart Lung and Circulation. 31(5) (pp 705-710), 2022. Date of Publication:
May 2022.
Author
Liao Y.-W.B.; Wang T.K.M.; Wang M.T.M.; Ramanathan T.; Wheeler M.
Institution
(Liao, Wang, Wang, Ramanathan, Wheeler) Green Lane Cardiovascular Service,
Auckland City Hospital, Auckland, New Zealand
(Wang, Wang) Department of Medicine, University of Auckland, Auckland, New
Zealand
Publisher
Elsevier Ltd
Abstract
Background: Rheumatic heart disease remains one of the leading causes of
heart valve disease worldwide despite being a preventable condition.
Mitral valve repair is superior to replacement in severe degenerative
mitral valve disease, however its role in rheumatic valve disease remains
controversial. This meta-analysis compared mitral valve repair and
replacement in rheumatic heart disease. Method(s): Medline, EMBASE,
Cochrane and Scopus were searched from January 1980 to June 2016 for
original studies reporting outcomes of both mitral valve repair and
replacement in rheumatic heart disease in adults, children or both. Two
(2) authors independently assessed studies for inclusion, followed by data
extraction and analysis. Result(s): The search yielded 930 articles,
with 98 full-texts reviewed after initial screening and 13 studies
subsequently included for analysis, totalling 2,410 mitral valve repairs
and 3,598 replacements. Pooled rates and odds ratio (95% confidence
interval) for operative mortality of repair versus replacement was 3.2%
versus 4.3%, 0.68 (0.50-0.92; p=0.01). Pooled odds ratios (95% confidence
interval) were for long-term mortality 0.41 (0.30-0.56; p<0.001);
reoperation 3.02 (1.72-5.31; p<0.001); and bleeding 0.26 (0.11-0.63;
p=0.003). There was a trend towards lower thrombo-embolism 0.42
(0.17-1.03; p=0.06), and no significant difference in endocarditis
(p=0.76), during follow-up. Conclusion(s): Mitral valve repair is
associated with reduction in operative and long-term mortality and
bleeding, so is recommended in rheumatic mitral valve disease where
feasible, but it does entail a higher rate of reoperation during
follow-up. Copyright © 2021

<7>
Accession Number
2016514159
Title
Prognostic Value of Pulmonary Hypertension, Right Ventricular Function and
Tricuspid Regurgitation on Mortality After Transcatheter Mitral Valve
Repair: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 31(5) (pp 696-704), 2022. Date of Publication:
May 2022.
Author
Meijerink F.; de Witte S.M.; Limpens J.; de Winter R.J.; Bouma B.J.; Baan
J.
Institution
(Meijerink, de Witte, de Winter, Bouma, Baan) Department of Cardiology,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Limpens) Medical Library, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
Publisher
Elsevier Ltd
Abstract
Background: Pulmonary hypertension (PH), right ventricular (RV)
dysfunction, and tricuspid regurgitation (TR) are commonly present in
patients with mitral regurgitation (MR) and known to impair prognosis.
This systematic review and meta-analysis aimed to determine the prognostic
value of PH, RV function, and TR on mortality after transcatheter mitral
valve repair (TMVR). Method(s): A systematic search was performed to
identify studies investigating PH, RV function, or TR in patients who
underwent TMVR. Studies were included for pooled analysis if hazard ratios
(HR) for all-cause mortality were given. Result(s): A total of 8,672
patients from 21 selected studies were included (PH, 11 studies; RV
function, nine studies; TR, 10 studies). Mean follow-up was 2.7+/-1.6
years. The HRs and 95% CIs for all-cause mortality of PH (dichotomised: HR
1.70, 95% CI 1.00-2.87; per 10 mmHg increase in systolic PAP: HR 1.17, 95%
CI 1.07-1.29), RV function (dichotomised: HR 1.86, 95% CI 1.45-2.38; per 5
mm decrease in TAPSE: HR 1.18, 95% CI 0.97-1.43) and TR (HR 1.51, 95% CI
1.28-1.79) indicated a significant association. Conclusion(s):
Prognosis after TMVR is worse in patients with significant MR when
concomitant PH, RV dysfunction, or TR are present. Careful assessment of
these parameters should therefore precede clinical decision-making for
TMVR. The current results encourage investigation into whether (1)
intervention at an earlier stage of MR reduces incidence of PH, RV
dysfunction, and TR; and (2) transcatheter treatment of concomitant TR can
improve clinical outcome and prognosis for these patients. Copyright
© 2021 The Author(s)

<8>
Accession Number
2011540294
Title
Real world coronary artery ostia full accessibility after last generation
transcatheter aortic valve implantation.
Source
Asian Cardiovascular and Thoracic Annals. 30(3) (pp 276-284), 2022. Date
of Publication: March 2022.
Author
Rigatelli G.; Zuin M.; Roncon L.; Nanjiundappa A.; Daggubati R.
Institution
(Rigatelli, Roncon) Division of Cardiology, Rovigo General Hospital,
Rovigo, Italy
(Zuin) Department of Translational Medicine, Section of Internal and
CardioRespiratory Medicine, University of Ferrara, Ferrara, Italy
(Nanjiundappa) Center of Vascular Excellence, Virginia University Medical
School, West Charlstone, United States
(Daggubati) West Virginia University School of Medicine, Heart and
Vascular Institute, Morgantown, United States
Publisher
SAGE Publications Inc.
Abstract
Aim: We evaluate, performing a pooled meta-analysis, the current coronary
artery accessibility rate in transcatheter aortic valve implantation
(TAVI) patients during the follow-up. Full coronary artery accessibility
after TAVI has not been adequately addressed by the current literature.
 Method(s): According to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines, data on coronary artery access were
obtained from the ratio between in the full coronary engagement (n) and
the number of coronary angiography and/or percutaneous coronary
intervention (N). Data were synthesized using random-effects
meta-analyses. Result(s): Out of 7048 TAVI patients, 276 (3.9%) (mean
age 76.8 years, 111 (40.2%) females) were analysed. Full coronary artery
accessibility for coronary angiographies and percutaneous coronary
interventions were obtained in 83.0% (95% confidence interval (CI):
0.66-0.92, p = 0.001, I2: 88.2%) and 96.0% (95% CI: 0.90-0.98,
p < 0.0001, I2: 0) of cases (p for difference <.0.001). Left
coronary artery (n = 219) was easily fully engaged compared to the right
one (90.9% (95% CI: 0.80-0.96, p < 0.0001, I2: 58.4% and 82.0%
(95% CI: 0.60-0.93, p = 0.006, I2: 83.2%), respectively, (p for
difference < 0.001). Using age as moderator variable, meta-regression
revealed a positive and negative correlation with coronary artery
accessibility in patients treated with Sapien-Edwards (p = 0.008) and
CoreValve (p = 0.010) platforms, respectively. Conversely, a negative
correlation (p = 0.01) was found between coronary artery accessibility and
mean time after Sapien-Edwards platform implantation (p = 0.01).
 Conclusion(s): Full coronary artery accessibility during coronary
angiographies and/or percutaneous coronary interventions results
suboptimal for both coronary artery ostia and worse for right compared to
left coronary artery after TAVI. Copyright © The Author(s) 2021.

<9>
Accession Number
638101470
Title
The prognostic significance of postoperative hyperbilirubinemia in cardiac
surgery: systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 17(1) (pp 129), 2022. Date of
Publication: 26 May 2022.
Author
Raveendran D.; Penny-Dimri J.C.; Segal R.; Smith J.A.; Plummer M.; Liu Z.;
Perry L.A.
Institution
(Raveendran, Segal, Liu, Perry) Department of Anaesthesia and Pain
Management, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC,
3050, Australia
(Raveendran, Liu) Melbourne Medical School, University of Melbourne,
Parkville, Australia
(Penny-Dimri, Smith) Department of Surgery, School of Clinical Science,
Monash University, Clayton, Australia
(Penny-Dimri) Department of Surgery, Barwon Health, Geelong, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Clayton,
Australia
(Plummer) Centre for Integrated Critical Care, University of Melbourne,
Parkville, Australia
(Plummer) Intensive Care Unit, Royal Melbourne Hospital, Parkville,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Hyperbilirubinemia following cardiac surgery is a common
phenomenon and is of emerging interest in prognostic factor research. This
systematic review and meta-analysis evaluated the association between
post-operative hyperbilirubinemia (PH) and mortality and morbidity in
cardiac surgery patients. METHOD(S): Ovid Medline and Ovid Embase
were searched from inception to July 2020 for studies evaluating the
prognostic significance of PH following cardiac surgery. Maximally
adjusted odds ratios (OR) with associated confidence intervals were
obtained from each study and pooled using random effects inverse variance
modelling to assess in-hospital mortality. Standardised mean differences
were pooled to assess Intensive Care Unit (ICU) and hospital length of
stay (LOS). Qualitative analysis was performed to assess ventilation
requirements and long-term mortality. Meta-regression was used to assess
inter- and intra-study heterogeneity. RESULT(S): 3251 studies
satisfied the selection criteria, from which 12 studies incorporating 3876
participants were included. PH significantly predicted in-hospital
mortality with a pooled OR of 7.29 (95% CI 3.53, 15.09). Multiple
pre-defined covariates contributed to the prognostic significance of PH,
however only aortic cross-clamp time (p<0.0001) and number of transfusions
(p=0.0001) were significant effect modifiers. PH significantly predicted
both ICU LOS (Mean difference 1.32 [95% CI 0.04-2.6]) and hospital LOS
(Mean difference 1.79 [95% CI 0.36-3.21]). Qualitative analysis suggested
PH is associated with increased post-operative ventilation requirements
and reduced long-term survival rates. CONCLUSION(S):
Hyperbilirubinemia is a cost-effective, widely available prognostic marker
of adverse outcomes following cardiac surgery, albeit with residual
sources of heterogeneity. Copyright © 2022. The Author(s).

<10>
Accession Number
637125080
Title
Coronary Revascularization for Patients with Diabetes Mellitus: A
Contemporary Systematic Review and Meta-Analysis.
Source
Annals of surgery. 275(6) (pp 1058-1066), 2022. Date of Publication: 01
Jun 2022.
Author
El-Andari R.; Bozso S.J.; Fialka N.M.; Kang J.J.H.; Nagendran J.
Institution
(El-Andari, Fialka) Faculty of Medicine and Dentistry, University of
Alberta, Edmonton, AB, Canada
(Bozso, Kang, Nagendran, Nagendran) Division of Cardiac Surgery,
Department of Surgery, University of Alberta, Edmonton, AB, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: This systematic review and meta-analysis aims to review the
contemporary literature comparing CABG and PCI in diabetic patients
providing an up-to-date perspective on the differences between the
interventions. BACKGROUND: Diabetes is common and diabetic patients are at
a 2-to-4-fold increased risk of developing coronary artery disease.
Approximately 75% of diabetic patients die of cardiovascular disease.
Previous literature has identified CABG as superior to PCI for
revascularization in diabetic patients with complex coronary artery
diseas. METHOD(S): PubMed and Medline were systematically searched
for articles published from January 1, 2015 to April 15, 2021. This
systematic review included all retrospective, prospective, and randomized
trial studies comparing CABG and PCI in diabetic patients. 1552 abstracts
were reviewed and 25 studies were included in this review. The data was
analyzed using the RevMan 5.4 software. RESULT(S): Diabetic patients
undergoing CABG experienced significantly reduced rates of 5-year
mortality, major adverse cardiovascular and cerebrovascular events,
myocardial infarction, and required repeat revascularization. Patients who
underwent PCI experienced improved rates of stroke that trended toward
significance. CONCLUSION(S): Previous literature regarding coronary
revascularization in diabetic patients has consistently demonstrated
superior outcomes for patients undergoing CABG over PCI. The development
of 1st and 2nd generation DES have narrowed the gap between CABG and PCI,
but CABG continues to be superior. Continued investigation with large
randomized trials and retrospective studies including long term follow-up
comparing CABG and 2nd generation DES is necessary to confirm the optimal
intervention for diabetic patients. Copyright © 2022 Wolters
Kluwer Health, Inc. All rights reserved.

<11>
[Use Link to view the full text]
Accession Number
635767384
Title
Relationship between Residual Mitral Regurgitation and Clinical and
Quality-of-Life Outcomes after Transcatheter and Medical Treatments in
Heart Failure: COAPT Trial.
Source
Circulation. 144(6) (pp 426-437), 2021. Date of Publication: 10 Aug 2021.
Author
Kar S.; Mack M.J.; Lindenfeld J.; Abraham W.T.; Asch F.M.; Weissman N.J.;
Enriquez-Sarano M.; Lim D.S.; Mishell J.M.; Whisenant B.K.; Rogers J.H.;
Arnold S.V.; Cohen D.J.; Grayburn P.A.; Stone G.W.
Institution
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, CA, United States
(Mack) Baylor Scott & White Heart Hospital, Plano, TX, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, United States
(Asch, Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Asch, Weissman) Georgetown University, Washington, DC, United States
(Enriquez-Sarano) Mayo Clinic, Rochester, MN, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, CA, United States
(Whisenant) Intermountain Heart Center, Salt Lake City, UT, United States
(Rogers) University of California, Davis Medical Center, Sacramento,
United States
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Cohen) University of Missouri-Kansas City, School of Medicine, United
States
(Lim) St Francis Hospital, Roslyn, NY, United States
(Lim) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the randomized COAPT trial (Cardiovascular Outcomes
Assessment of the MitraClip Percutaneous Therapy for Heart Failure
Patients With Functional Mitral Regurgitation), among 614 patients with
heart failure with 3+ or 4+ secondary mitral regurgitation (MR),
transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR,
heart failure hospitalizations, and mortality and improved quality of life
compared with guideline-directed medical therapy (GDMT) alone. We aimed to
examine the prognostic relationship between MR reduction and outcomes
after TMVr and GDMT alone. Method(s): Outcomes in COAPT between 30
days and 2 years were examined on the basis of the severity of residual MR
at 30 days. Result(s): TMVr-treated patients had less severe residual
MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%,
19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [P<0.0001]).
The rate of composite death or heart failure hospitalizations between 30
days and 2 years was lower in patients with 30-day residual MR of 0/1+ and
2+ compared with patients with 30-day residual MR of 3+/4+ (37.7% versus
49.5% versus 72.2%, respectively [P<0.0001]). This relationship was
consistent in the TMVr and GDMT arms (P<inf>interaction</inf>=0.92). The
improvement in Kansas City Cardiomyopathy Questionnaire score from
baseline to 30 days was maintained between 30 days and 2 years in patients
with 30-day MR <=2+ but deteriorated in those with 30-day MR 3+/4+
(-0.3+/-1.7 versus -9.4+/-4.6 [P=0.0008]) consistently in both groups
(P<inf>interaction</inf>=0.95). Conclusion(s): In the COAPT trial,
reduced MR at 30 days was associated with greater freedom from death or
heart failure hospitalizations and improved quality of life through 2-year
follow-up whether the MR reduction was achieved by TMVr or GDMT.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT01626079. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<12>
Accession Number
2017519946
Title
Intelligence outcome of pediatric intensive care unit survivors: a
systematic meta-analysis and meta-regression.
Source
BMC Medicine. 20(1) (no pagination), 2022. Article Number: 198. Date of
Publication: December 2022.
Author
de Sonnaville E.S.V.; Konigs M.; van Leijden O.; Knoester H.; van Woensel
J.B.M.; Oosterlaan J.
Institution
(de Sonnaville, Knoester, van Woensel) Amsterdam UMC, University of
Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive
Care, Amsterdam Reproduction and Development research institute,
Meibergdreef 9, Amsterdam, Netherlands
(de Sonnaville, Konigs, van Leijden, Oosterlaan) Amsterdam UMC, University
of Amsterdam, Emma Children's Hospital, Department of Pediatrics,
Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam
Reproduction and Development research institute, Meibergdreef 9,
Amsterdam, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Long-term morbidity after pediatric intensive care unit (PICU)
admission is a growing concern. Both critical illness and accompanying
PICU treatments may impact neurocognitive development as assessed by its
gold standard measure; intelligence. This meta-analysis and
meta-regression quantifies intelligence outcome after PICU admission and
explores risk factors for poor intelligence outcome. Method(s):
PubMed, Embase, CINAHL and PsycINFO were searched for relevant studies,
published from database inception until September 7, 2021. Using
random-effects meta-analysis, we calculated the standardized mean
difference in full-scale intelligence quotient (FSIQ) between PICU
survivors and controls across all included studies and additionally
distinguishing between PICU subgroups based on indications for admission.
Relation between demographic and clinical risk factors and study's FSIQ
effect sizes was investigated using random-effects meta-regression
analysis. Result(s): A total of 123 articles was included, published
between 1973 and 2021, including 8,119 PICU survivors and 1,757 controls.
We found 0.47 SD (7.1 IQ-points) lower FSIQ scores in PICU survivors
compared to controls (95%CI -0.55 to -0.40, p <.001). All studied PICU
subgroups had lower FSIQ compared to controls (range 0.38-0.88 SD). Later
year of PICU admission (range 1972-2016) and longer PICU stay were related
to greater FSIQ impairment (R2 = 21%, 95%CI -0.021 to -0.007, p
<.001 and R2 = 2%, 95%CI -0.027 to -0.002, p =.03,
respectively), whereas male sex and higher rate of survivors were related
to smaller FSIQ impairment (R2 = 5%, 95%CI 0.001 to 0.014, p
=.03 and R2 = 11%, 95%CI 0.006 to 0.022, p <.001,
respectively). Meta-regression in PICU subgroups showed that later year of
PICU admission was related to greater FSIQ impairment in children admitted
after cardiac surgery and heart- or heart-lung transplantation. Male sex
was related to smaller FSIQ impairment in children admitted after cardiac
surgery. Older age at PICU admission and older age at follow-up were
related to smaller FSIQ impairment in children admitted after heart- or
heart-lung transplantation. Conclusion(s): PICU survivors,
distinguished in a wide range of subgroups, are at risk of intelligence
impairment. Length of PICU stay, female sex and lower rate of survivors
were related to greater intelligence impairment. Intelligence outcome has
worsened over the years, potentially reflecting the increasing percentage
of children surviving PICU admission. Copyright © 2022, The
Author(s).

<13>
Accession Number
2017488981
Title
Lung ultrasound is non-inferior to bronchoscopy for confirmation of
double-lumen endotracheal tube positioning: a randomized controlled
noninferiority study.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 168. Date
of Publication: December 2022.
Author
Kanavitoon S.; Raksamani K.; Troy M.P.; Suphathamwit A.; Thongcharoen P.;
Suksompong S.; Oh S.S.
Institution
(Kanavitoon, Raksamani, Suphathamwit, Suksompong) Department of
Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University,
2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
(Troy, Oh) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Medicine, David Geffen School of Medicine at UCLA, Los
Angeles, CA, United States
(Thongcharoen) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Publisher
BioMed Central Ltd
Abstract
Background: Appropriate placement of left-sided double-lumen endotracheal
tubes (LDLTs) is paramount for optimal visualization of the operative
field during thoracic surgeries that require single lung ventilation.
Appropriate placement of LDLTs is therefore confirmed with fiberoptic
bronchoscopy (FOB) rather than clinical assessment alone. Recent studies
have demonstrated lung ultrasound (US) is superior to clinical assessment
alone for confirming placement of LDLT, but no large trials have compared
US to the gold standard of FOB. This noninferiority trial was devised to
compare lung US with FOB for LDLT positioning and achievement of lung
collapse for operative exposure. Method(s): This randomized,
controlled, double-blind, noninferiority trial was conducted at the
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand from October 2017 to July 2019. The study enrolled 200 ASA
classification 1-3 patients that were scheduled for elective thoracic
surgery requiring placement of LDLT. Study patients were randomized into
either the FOB group or the lung US group after initial blind placement of
LDLT. Five patients were excluded due to protocol deviation. In the FOB
group (n = 98), fiberoptic bronchoscopy was used to confirm lung collapse
due to proper positioning of the LDLT, and to adjust the tube if
necessary. In the US group (n = 97), lung ultrasonography of four
pre-specified zones (upper and lower posterior and mid-axillary) was used
to assess lung collapse and guide adjustment of the tube if necessary. The
primary outcome was presence of adequate lung collapse as determined by
visual grading by the attending surgeon on scale from 1 to 4. Secondary
outcomes included the time needed to adjust and confirm lung collapse, the
time from finishing LDLT positioning to the grading of lung collapse, and
intraoperative parameters such has hypotension or hypertension, hypoxia,
and hypercarbia. The patient, attending anesthesiologist, and attending
thoracic surgeon were all blinded to the intervention arm. Result(s):
The primary outcome of lung collapse by visual grading was similar between
the intervention and the control groups, with 89 patients (91.8%) in the
US group compared to 83 patients (84.1%) in the FOB group (p = 0.18)
experiencing adequate collapse. This met criteria for noninferiority per
protocol analysis. The median time needed to confirm and adjust LDLT
position in the US group was 3 min (IQR 2-5), which was significantly
shorter than the median time needed to perform the task in the FOB group
(6 min, IQR 4-10) (p = 0.002). Conclusion(s): In selected patients
undergoing thoracic surgery requiring LDLT, lung ultrasonography was
noninferior to fiberoptic bronchoscopy in achieving adequate lung collapse
and reaches the desired outcome in less time. Trial Registration: This
study was registered at clinicaltrials.gov, NCT03314519, Principal
investigator: Kasana Raksamani, Date of registration:
19/10/2017. Copyright © 2022, The Author(s).

<14>
Accession Number
2013245659
Title
Balloon Post-Dilatation Improves Long-Term Valve Performance After
Balloon-Expandable Valve Implantation.
Source
Cardiovascular Revascularization Medicine. 37 (pp 15-22), 2022. Date of
Publication: April 2022.
Author
Nara Y.; Watanabe Y.; Kataoka A.; Nakashima M.; Hioki H.; Kawashima H.;
Nagura F.; Kozuma K.; Yashima F.; Shirai S.; Tada N.; Yamawaki M.;
Naganuma T.; Yamanaka F.; Ueno H.; Tabata M.; Mizutani K.; Takagi K.;
Yamamoto M.; Hayashida K.
Institution
(Nara, Watanabe, Kataoka, Nakashima, Hioki, Kawashima, Nagura, Kozuma)
Division of Cardiology, Department of Internal Medicine, Teikyo
University, Tokyo, Japan
(Yashima) Department of Cardiology, Saiseikai Utsunomiya Hospital,
Tochigi, Japan
(Yashima, Hayashida) Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
Japan
(Tada) Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi,
Japan
(Yamawaki) Department of Cardiovascular Medicine, Yokohama City Eastern
Hospital, Kanagawa, Japan
(Naganuma) New Tokyo Hospital, Interventional Cardiology Unit, Chiba,
Japan
(Yamanaka) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Ueno) The Second Department of Internal Medicine, Toyama University
Hospital, Toyama, Japan
(Tabata) Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical
Center, Chiba, Japan
(Mizutani) Department of Cardiovascular Medicine, Osaka City University
Graduate School of Medicine, Osaka, Japan
(Takagi) Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
(Yamamoto) Division of Cardiovascular Medicine, Toyohashi Heart Center and
Nagoya Heart Center, Aichi, Japan
Publisher
Elsevier Inc.
Abstract
Background: The impact of balloon post-dilatation (BPD) on short- and
long-term valve performance after Sapien 3 (S3) implantation is unknown.
This study aimed to evaluate the impact of balloon post-dilatation (BPD)
on short- and long-term valve performance after the implantation of S3.
 Method(s): A total of 846 patients implanted with S3 from the
OCEAN-TAVI registry were included in this study. The patients were divided
into BPD and non-BPD groups. The clinical outcomes and valve functions
were compared. Result(s): The BPD group included 173 (20.4%) patients
and the non-BPD group comprised 673 (79.6%) patients. The
prosthesis-patient mismatch (PPM) rates were significantly lower in the
BPD group than in the non-BPD group before and after propensity score
matching at in-hospital follow-up (before matching: 12 [7.1%] vs. 108
[16.3%], p = 0.002; after matching: 8 [6.3%] vs. 19 [14.8%], p = 0.027)
and at 1-year follow-up (before matching: 14 [12.5%] vs. 112 [23.6%], p =
0.010; after matching: 9 [10.5%] vs. 19 [22.1%], p = 0.039). The rates of
acute kidney injury, cardiac tamponade, and in-hospital cardiovascular
death were significantly higher in the BPD group than in the non-BPD group
(acute kidney injury: 22 [12.7%] vs. 33 [4.9%], p < 0.001; cardiac
tamponade: 3 [1.7%] vs. 2 [0.3%], p = 0.028; in-hospital cardiovascular
death: 4 [2.3%] vs. 3 [0.4%], p = 0.016). After matching, these clinical
outcomes were similar between the BPD and non-BPD groups.
 Conclusion(s): The BPD group demonstrated better short- and long-term
valve performance. Caution is needed to avoid procedure-related
complications in patients undergoing BPD. Copyright © 2021
Elsevier Inc.

<15>
Accession Number
2017665058
Title
American College of Gastroenterology-Canadian Association of
Gastroenterology Clinical Practice Guideline: Management of Anticoagulants
and Antiplatelets during Acute Gastrointestinal Bleeding and the
Periendoscopic Period.
Source
Journal of the Canadian Association of Gastroenterology. 5(2) (pp
E39-E56), 2022. Date of Publication: 01 Apr 2022.
Author
Abraham N.S.; Barkun A.N.; Sauer B.G.; Douketis J.; Laine L.; Noseworthy
P.A.; Telford J.J.; Leontiadis G.I.
Institution
(Abraham) Division of Gastroenterology and Hepatology, Department of
Medicine, Mayo Clinic, Scottsdale, AZ, United States
(Barkun) Division of Gastroenterology, Department of Medicine, McGill
University, Montreal, QC, Canada
(Sauer) Division of Gastroenterology and Hepatology, University of
Virginia, Charlottesville, VA, United States
(Douketis) Department of Medicine, St. Joseph's Healthcare Hamilton and
McMaster University, Hamilton, ON, Canada
(Laine) Yale School of Medicine, New Haven, CT, United States
(Laine) Virginia Connecticut Healthcare System, West Haven, CT, United
States
(Noseworthy) Department of Cardiovascular Diseases, Electrophysiology,
Mayo Clinic, Rochester, MN, United States
(Telford) Division of Gastroenterology, Department of Medicine, University
of British Columbia, Vancouver, BC, Canada
(Leontiadis) Division of Gastroenterology and Farncombe Family Digestive
Health Research Institute, Department of Medicine, McMaster University,
Hamilton, ON, Canada
Publisher
Oxford University Press
Abstract
We conducted systematic reviews of predefined clinical questions and used
the Grading of Recommendations, Assessment, Development and Evaluations
approach to develop recommendations for the periendoscopic management of
anticoagulant and antiplatelet drugs during acute gastrointestinal (GI)
bleeding and the elective endoscopic setting. The following
recommendations target patients presenting with acute GI bleeding: For
patients on warfarin, we suggest against giving fresh frozen plasma or
vitamin K; if needed, we suggest prothrombin complex concentrate (PCC)
compared with fresh frozen plasma administration; for patients on direct
oral anticoagulants (DOACs), we suggest against PCC administration; if on
dabigatran, we suggest against the administration of idarucizumab, and if
on rivaroxaban or apixaban, we suggest against andexanet alfa
administration; for patients on antiplatelet agents, we suggest against
platelet transfusions; and for patients on cardiac acetylsalicylic acid
(ASA) for secondary prevention, we suggest against holding it, but if the
ASA has been interrupted, we suggest resumption on the day hemostasis is
endoscopically confirmed. The following recommendations target patients in
the elective (planned) endoscopy setting: For patients on warfarin, we
suggest continuation as opposed to temporary interruption (1-7 days), but
if it is held for procedures with high risk of GI bleeding, we suggest
against bridging anticoagulation unless the patient has a mechanical heart
valve; for patients on DOACs, we suggest temporarily interrupting rather
than continuing these; for patients on dual antiplatelet therapy for
secondary prevention, we suggest temporary interruption of the P2Y12
receptor inhibitor while continuing ASA; and if on cardiac ASA monotherapy
for secondary prevention, we suggest against its interruption. Evidence
was insufficient in the following settings to permit recommendations. With
acute GI bleeding in patients on warfarin, we could not recommend for or
against PCC administration when compared with placebo. In the elective
periprocedural endoscopy setting, we could not recommend for or against
temporary interruption of the P2Y12 receptor inhibitor for patients on a
single P2Y12 inhibiting agent. We were also unable to make a
recommendation regarding same-day resumption of the drug vs 1-7 days after
the procedure among patients prescribed anticoagulants (warfarin or DOACs)
or P2Y12 receptor inhibitor drugs because of insufficient
evidence. Copyright © 2022 The Authors, 2022. This article is a
co-publication between the Journal of the Canadian Association of
Gastroenterology and The American Journal of Gastroenterology.

<16>
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.

<17>
Accession Number
2015421676
Title
Current trends in minimally invasive valve-sparing aortic root
replacement-Best available evidence.
Source
Journal of Cardiac Surgery. 37(6) (pp 1684-1690), 2022. Date of
Publication: June 2022.
Author
Sef D.; Bahrami T.; Raja S.G.; Klokocovnik T.
Institution
(Sef, Bahrami, Raja) Department of Cardiac Surgery, Harefield Hospital,
Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS
Foundation Trust, London, United Kingdom
(Klokocovnik) Department of Cardiovascular Surgery, University Hospital
Center Ljubljana, Ljubljana, Slovenia
Publisher
John Wiley and Sons Inc
Abstract
Background: Valve-sparing aortic root replacement such as the
reimplantation (David) procedure is becoming increasingly popular. Despite
the fact that the procedure is technically more complex, long-term studies
demonstrated that excellent clinical outcomes in selected patients with
durable repair are achievable. Benefits of minimal access cardiac surgery
have stimulated enthusiasm in the use of this access for valve-sparing
aortic root replacement. Method(s): We have reviewed available
literature on the topic of valve-sparing aortic root replacement (David
procedure) via minimally invasive access through upper hemisternotomy in
an attempt to assess current trends and to recognize potential advantages
of this technique. Patient selection and preoperative work-up play
important role in performing minimally invasive David procedure safely.
Surgical technique corresponds to the standard David procedure, with a few
exceptions related to the minimal access, and is performed via upper
ministernotomy. Results and Conclusion(s): Evidence from
nonrandomized observational and comparative studies demonstrated excellent
clinical outcomes of minimally invasive David procedure in selected
patients with comparable perioperative mortality and outcomes to the
conventional technique. To date, David procedure with a minimal access
technique has been performed in carefully selected patients. We believe it
could be particularly beneficial to provide younger patients (Marfan
syndrome and bicuspid aortic valve) with minimally invasive David
procedure as it can allow faster recovery with improved cosmesis with
excellent outcomes. A decision to perform minimally invasive David
procedure should be individualized to each patient and based on the
experience of the team. Further large prospective randomized studies with
long-term follow-up are still needed to confirm durability of minimal
access technique. Copyright © 2022 Wiley Periodicals LLC.

<18>
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.

<19>
Accession Number
2018358708
Title
Postoperative outcomes in older surgical patients with preoperative
cognitive impairment: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 80 (no pagination), 2022. Article Number:
110883. Date of Publication: September 2022.
Author
Chen L.; Au E.; Saripella A.; Kapoor P.; Yan E.; Wong J.; Tang-Wai D.F.;
Gold D.; Riazi S.; Suen C.; He D.; Englesakis M.; Nagappa M.; Chung F.
Institution
(Chen, Au, Saripella, Kapoor, Yan, Wong, Riazi, Suen, Chung) Department of
Anesthesia and Pain Management, Toronto Western Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Wong) Department of Anesthesiology and Pain Medicine, Women's College
Hospital, Toronto, ON, Canada
(Tang-Wai) Division of Neurology, Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Gold) Department of Psychiatry, Krembil Brain Institute, University of
Toronto, Toronto, ON, Canada
(He) Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital,
University of Toronto, Toronto, ON, Canada
(Englesakis) Library & Information Services, University Health Network,
Toronto, ON, Canada
(Nagappa) Department of Anesthesia & Perioperative Medicine, Schulich
School of Medicine and Dentistry, Western University, London, ON, Canada
Publisher
Elsevier Inc.
Abstract
Study objective: To determine the effect of cognitive impairment (CI) and
dementia on adverse outcomes in older surgical patients. Design(s): A
systematic review and meta-analysis of observational studies and
randomized controlled trials (RCTs). Various databases were searched from
their inception dates to March 8, 2021. Setting(s): Preoperative
assessment. Patient(s): Older patients (>= 60 years) undergoing
non-cardiac surgery. Measurements: Outcomes included postoperative
delirium, mortality, discharge to assisted care, 30-day readmissions,
postoperative complications, and length of hospital stay. Effect sizes
were calculated as Odds Ratio (OR) and Mean Difference (MD) based on
random effect model analysis. The quality of included studies was assessed
using the Cochrane Risk Bias Tool for RCTs and Newcastle-Ottawa Scale for
observational cohort studies. Result(s): Fifty-three studies (196,491
patients) were included. Preoperative CI was associated with a significant
risk of delirium in older patients after non-cardiac surgery (25.1% vs.
10.3%; OR: 3.84; 95%CI: 2.35, 6.26; I2: 76%; p < 0.00001).
Cognitive impairment (26.2% vs. 13.2%; OR: 2.28; 95%CI: 1.39, 3.74;
I2: 73%; p = 0.001) and dementia (41.6% vs. 25.5%; OR: 1.96;
95%CI: 1.34, 2.88; I2: 99%; p = 0.0006) significantly increased
risk for 1-year mortality. In patients with CI, there was an increased
risk of discharge to assisted care (44.7% vs. 38.3%; OR 1.74; 95%CI: 1.05,
2.89, p = 0.03), 30-day readmissions (14.3% vs. 10.8%; OR: 1.36; 95%CI:
1.00, 1.84, p = 0.05), and postoperative complications (40.7% vs. 18.8%;
OR: 1.85; 95%CI: 1.37, 2.49; p < 0.0001). Conclusion(s): Preoperative
CI in older surgical patients significantly increases risk of delirium,
1-year mortality, discharge to assisted care, 30-day readmission, and
postoperative complications. Dementia increases the risk of 1-year
mortality. Cognitive screening in the preoperative assessment for older
surgical patients may be helpful for risk stratification so that
appropriate management can be implemented to mitigate adverse
postoperative outcomes. Copyright © 2022 Elsevier Inc.

<20>
Accession Number
2017525595
Title
Impact of oral or enteral nutritional support on clinical outcomes of
patients subjected to cardiac surgery: A systematic review.
Source
Clinical Nutrition ESPEN. 49 (pp 28-39), 2022. Date of Publication: June
2022.
Author
Avancini L.; de abreu Silva L.; da Silva V.R.; Duarte C.K.
Institution
(Avancini, da Silva) Unidade Multiprofissional e Reabilitacao - Nutricao
Clinica, Hospital das Clinicas da Universidade Federal de Minas Gerais,
Brazil
(de abreu Silva, Duarte) Departamento de Nutricao da Escola de Enfermagem
da Universidade Federal de Minas Gerais, Brazil
Publisher
Elsevier Ltd
Abstract
Background: Cardiovascular diseases represent the leading cause of death
worldwide, in addition to having a direct negative impact on quality of
life, functional capacity and nutritional status. Studies show high
prevalence of malnutrition in patients undergoing cardiac surgery. It is
known that cardiac surgery can also lead to changes in nutritional status,
through surgical trauma, systemic inflammation and, often, delay in the
initiation of nutritional support. On the other hand, the role of
nutritional support as a driver of clinical outcomes in different surgical
populations is well described in the literature. Objective(s): To
review the literature in order to assess the effect of perioperative oral
or enteral nutritional support on clinical outcomes of cardiac patients
undergoing cardiac surgery. Methodology: The search was conducted in
February 2021 in the following databases: EMBASE, PubMed/MEDLINE, Scopus
and Web of Science. Randomized clinical trials (RCT) and retrospective
studies were selected, carried out with patients with heart disease,
undergoing cardiac surgery and aged 18 years or over. The Outcomes of
interest were: length of hospital stay, length of stay in the ICU, time on
ventilatory support, mortality rate, clinical complications and use of
vasoactive drugs in the postoperative period. Result(s): Ten studies
were included in this systematic review, of which 7 were RCTs and 3 were
cohorts. The most prevalent surgery was myocardial revascularization. Six
studies evaluated oral nutritional support, two enteral nutritional
support and two analyzed both. Two studies found a significant reduction
in the length of hospital and ICU staying associated with preoperative
intake of carbohydrate-based beverages. Only one study observed a
significant reduction in the requirement for ventilatory support after
cardiac surgery, after preoperative carbohydrate-based drinks and early
postoperative enteral nutrition. There was no influence of nutritional
support on mechanical ventilation length and mortality.
 Conclusion(s): Most studies showed that nutritional support did not
reduce hospital and ICU staying. Nutritional support benefits were
demonstrated in studies that offered preoperative oral carbohydrate
drinks. No association was observed between nutritional support and
duration of mechanical ventilation or mortality rate. Most studies did not
find any influence of nutritional support on the need and/or dosage of
vasoactive drugs in the postoperative period of cardiac
surgery. Copyright © 2022 European Society for Clinical Nutrition
and Metabolism

<21>
Accession Number
634795761
Title
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart
Disease: Executive Summary: A Report of the American College of
Cardiology/American Heart Association Joint Committee on Clinical Practice
Guidelines.
Source
Circulation. 143(5) (pp E35-E71), 2021. Date of Publication: 02 Feb 2021.
Author
Otto C.M.; Nishimura R.A.; Bonow R.O.; Carabello B.A.; rwin J.P.; Gentile
F.; Jneid H.; Krieger E.V.; Mack M.; McLeod C.; O'Gara P.T.; Rigolin V.H.;
Sundt T.M.; Thompson A.; Toly C.
Publisher
Lippincott Williams and Wilkins
Abstract
Aim: This executive summary of the valvular heart disease guideline
provides recommendations for clinicians to diagnose and manage valvular
heart disease as well as supporting documentation to encourage their use.
 Method(s): A comprehensive literature search was conducted from
January 1, 2010, to March 1, 2020, encompassing studies, reviews, and
other evidence conducted on human subjects that were published in English
from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality
Reports, and other selected database relevant to this guideline.
Structure: Many recommendations from the earlier valvular heart disease
guidelines have been updated with new evidence and provides newer options
for diagnosis and treatment of valvular heart disease. This summary
includes only the recommendations from the full guideline which focus on
diagnostic work-up, the timing and choice of surgical and catheter
interventions, and recommendations for medical therapy. The reader is
referred to the full guideline for graphical flow charts, text, and tables
with additional details about the rationale for and implementation of each
recommendation, and the evidence tables detailing the data considered in
developing these guidelines. Copyright © 2021 Lippincott Williams
and Wilkins. All rights reserved.

<22>
Accession Number
2018451352
Title
Ultrasound-guided erector spinae plane block improve opioid-sparing
perioperative analgesia in pediatric patients undergoing thoracoscopic
lung lesion resection: a prospective randomized controlled trial.
Source
Translational Pediatrics. 11(5) (pp 706-714), 2022. Date of Publication:
May 2022.
Author
Yuan Z.; Liu J.; Jiao K.; Fan Y.; Zhang Y.
Institution
(Yuan, Liu, Fan, Zhang) Department of Anesthesiology, Tianjin Children's
Hospital, Tianjin, China
(Jiao) Operating Room, Tianjin Children's Hospital, Tianjin, China
Publisher
AME Publishing Company
Abstract
Background: Pediatric patients often experience severe pain after thoracic
surgery, especially in the early postoperative period. Recently, the focus
has been on regional analgesia with the introduction of ultrasound-guided
erector spinae plane blocks. We assumed that preoperative erector spinae
plane block (ESPB) in children undergoing video-assisted thoracoscopic
surgery (VATS) would reduce the consumption of perioperative opioids.
 Method(s): This randomized, double-blind study enrolled 60 children
aged 1-3 years who underwent thoracoscopic lung lesion resection. The
patients were enrolled in the study and randomly divided into two groups.
The general anesthesia (GA) group received GA alone, and the GA + ESPB
group received ESPB. The consumptions of remifentanil and sufentanil were
recorded, and the children's face, legs, activity, cry, consolability
(FLACC) scores were assessed after awakening. The time to first rescue
analgesia, length of hospital stay, parental satisfaction and adverse
events were also recorded. Result(s): The consumptions of
remifentanil and sufentanil in the GA + ESPB group were significantly
lower than those in the GA group, mean difference [95% confidence interval
(CI)]: -26.57 (-31.98 to -21.17) and -0.21 (-0.27 to -0.17), respectively,
(both P<0.001); while the time to first rescue analgesia and parental
satisfaction scores were significantly longer and higher, respectively, in
the GA + ESPB group than those in the GA group, mean difference (95% CI):
2.37 (1.77 to 2.97) and 2.47 (1.79 to 3.15), respectively, (both P<0.001).
The FLACC scores in the GA + ESPB group were significantly lower than
those in the GA group 1 to 24 hours postoperatively (P=0.023 at 1 h, and
P<0.001 at 3 h, 6 h, 12 h, 18 h, 24 h), but not at immediate admission to
the post-anesthesia care unit (PACU) (P=0.189 at 0 h). The GA + ESPB group
had significantly lower incidence rates of postoperative nausea and
vomiting (P=0.037 and P=0.020). Conclusion(s): In pediatric
Thoracoscopic surgery, the results of this study confirm our hypothesis
that ESPB decreases the consumptions of intraoperative remifentanil and
postoperative sufentanil in 24 hours and demonstrates better postoperative
analgesia compared with a control group. Trial Registration: Chinese
Clinical Trial Registry ChiCTR2200056166. Copyright ©
Translational Pediatrics. All rights reserved.

<23>
Accession Number
638076617
Title
Deep neuromuscular block for minimally invasive lung surgery: a protocol
for a systematic review with meta-analysis and trial sequential analysis.
Source
BMJ Open. 12(5) (no pagination), 2022. Article Number: e056816. Date of
Publication: 24 May 2022.
Author
Zheng J.; Du L.; Deng X.; Zhang L.; Wang J.; Chen G.
Institution
(Zheng, Deng, Zhang, Wang, Chen) Department of Anesthesiology, Sichuan
University West China Hospital, Sichuan, Chengdu, China
(Du) Department of Anesthesiology, Sichuan Cancer Hospital and Institute,
Sichuan Cancer Center, School of Medicine, University of Electronic
Science and Technology of China, Sichuan, Chengdu, China
Publisher
BMJ Publishing Group
Abstract
Introduction Minimally invasive lung surgery (MILS) gradually became the
primary surgical therapy for lung cancer, which remains the leading cause
of cancer death. Adequate muscle relaxation by deep neuromuscular block
(NMB) is particularly necessary for MILS to provide a satisfactory
surgical field. However, deep NMB for MILS remains controversial, as
one-lung ventilation may provide an acceptable surgical field. Then, we
will perform a protocol for a systematic review and meta-analysis to
identify the efficacy of deep NMB for MILS. Methods and analysis We will
search the PubMed, Cochrane Library, Embase, Ovid Medline, Web of Science,
Chinese BioMedical Literature, China National Knowledge Infrastructure,
VIP and Wanfang databases from inception to March 2022 to identify
randomised controlled trials of adult participants undergoing MILS with
deep NMB. Studies published in English or Chinese will be considered. The
primary outcome will be the surgical conditions according to the surgeon's
perspective. Secondary outcomes will be the incidence of perioperative
events and perioperative mortality. Heterogeneity will be assessed by the
chi 2 test and I 2 statistic. Data will be synthesised by both a
fixed-effect and a random-effects meta-analysis, with an intention to
present the random-effects result if there is no indication of funnel plot
asymmetry. Otherwise, metaregression will be used. The Cochrane
risk-of-bias tool, trial sequential analysis and Grading of
Recommendations Assessment, Development and Evaluation will be used to
assess the evidence quality and control the risks of random errors. Funnel
plots and Egger's regression test will be used to assess publication bias.
Ethics and dissemination Ethical approval was not required for this
systematic review protocol. The results will be disseminated through
peer-reviewed publications. PROSPERO registration number CRD42021254016.
 Copyright © 2022 BMJ Publishing Group. All rights reserved.

<24>
Accession Number
638040894
Title
Comparison of the efficacy of novel two covering methods for spontaneous
pneumothorax: A multi-institutional study.
Source
BMJ Open Respiratory Research. 9(1) (no pagination), 2022. Article Number:
e001231. Date of Publication: 28 Apr 2022.
Author
Oda R.; Okuda K.; Yamada T.; Yukiue H.; Fukai I.; Kawano O.; Matsui T.;
Tatematsu T.; Yokota K.; Nakanishi R.
Institution
(Oda, Okuda, Matsui, Tatematsu, Yokota, Nakanishi) Department of Oncology
Immunology and Surgery, Graduate School of Medical Sciences, Nagoya City
University, Nagoya, Japan
(Yamada, Yukiue) Department of Thoracic Surgery, Kariya Toyota General
Hospital, Kariya, Japan
(Fukai, Kawano) Department of Thoracic Surgery, Suzuka General Hospital,
Suzuka, Japan
Publisher
BMJ Publishing Group
Abstract
Objectives The postoperative recurrence rate after thoracoscopic
bullectomy for primary spontaneous pneumothorax (PSP) is not satisfactory.
This retrospective study was conducted to elucidate an effective technique
for improving the postoperative recurrence rate. Methods The present study
included 373 patients who underwent thoracoscopic bullectomy for PSP at
three hospitals from January 2013 to May 2020. We compared the recurrence
rate according to two methods that were used to cover the staple line
after thoracoscopic bullectomy. Group A (146 patients) was treated with an
absorbable polyglycolic acid (PGA) sheet plus fibrin glue and oxidised
regenerated cellulose (ORC). Group B (227 patients) was treated with ORC
alone. Results There was no significant difference in preoperative
characteristics of the patients. The postoperative recurrence rate of
pneumothorax was 3.4% (5/146) in Group A and 17.2% (39/227) in Group B,
respectively. Among 23 patients (Group A, n=3 and Group B, n=20) who
received reoperation for recurrent pneumothorax, the site of recurrence
was around the stapler line of the first operation in 1 of 5 (20%)
patients in Group A and 28 of 39 (71.8%) patients in Group B. The 1-year
recurrence-free rate was 97.4% (median follow-up period, 73 days (range,
2-3952 days)) in Group A and 80.9% (median follow-up period, 71 days
(range 2-2648 days)) in Group B. Conclusions Coverage with a PGA sheet may
prevent the postoperative recurrence of PSP. A large-scale prospective
randomised study should be conducted to clarify the most effective
treatment for PSP. Copyright © Author(s) (or their employer(s))
2022.

<25>
Accession Number
638040565
Title
Ventilatory weaning strategies for predicting extubation success in
children following cardiac surgery for congenital heart disease: a
protocol for a systematic review and meta-analysis.
Source
BMJ Open. 12(4) (no pagination), 2022. Article Number: e054128. Date of
Publication: 29 Apr 2022.
Author
Garcia A.A.A.; Vieira A.G.D.S.; Kuramoto D.A.B.; Leite I.G.; Freitas
T.R.D.; Reicher M.E.; Trevisani V.F.M.; Guedes Neto H.J.; Flumignan
R.L.G.; Amorim J.E.D.; Nakano L.C.U.
Institution
(Garcia, Vieira, Trevisani) Evidence-based Health Program, Federal
University of Sao Paulo, Sao Paulo, Brazil
(Kuramoto, Leite, Freitas, Reicher, Guedes Neto, Flumignan, Amorim,
Nakano) Division of Vascular and Endovascular Surgery, Department of
Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil
Publisher
BMJ Publishing Group
Abstract
Introduction Congenital heart disease (CHD) comprises the anatomic
malformations that jeopardise the structure and function of the heart. It
can be extremely complex and serious, corresponding to 30% of all deaths
in the first month of life. The surgical approach for adequate treatment
requires postoperative mechanical ventilation. The most critical decision
related to the postoperative management of patients submitted to cardiac
surgery is the right time for extubation, especially because not only
abrupt or inadequate discontinuation of ventilatory support can lead to
clinical decline and necessity of reintubation but also extended time of
mechanical ventilation, which can lead to complications, such as
pneumonia, atelectasis, diaphragm hypertrophy, and increasing morbidity
and mortality. Methods and analysis This systematic review plans to
include individual parallel, cross-over and cluster randomised controlled
trials regarding any breathing trial test to predict extubation success in
children submitted to cardiac surgery due to CHD. Studies with paediatric
patients submitted to cardiac surgery for congenital cardiopathy repair,
attended at a critical care unit, and under mechanical ventilatory support
will be included. The main outcomes analysed will be success of
extubation, reduction of pulmonary complications and time reduction of
mechanical ventilation. Ethics and dissemination We will not treat
patients directly; therefore, ethics committee approval was not necessary
because it is not a primary study. We expect that this study may improve
healthcare and medical assistance, helping healthcare professionals with
routine daily decisions regarding the correct time for extubation.
PROSPERO registration number CRD42021223999. Copyright ©

<26>
Accession Number
2017848294
Title
Design and methods for the training in exercise activities and motion for
growth (TEAM 4 growth) trial: A randomized controlled trial.
Source
International Journal of Cardiology. 359 (pp 28-34), 2022. Date of
Publication: 15 Jul 2022.
Author
Lambert L.M.; Pemberton V.L.; Trachtenberg F.L.; Uzark K.; Woodard F.;
Teng J.E.; Bainton J.; Clarke S.; Justice L.; Meador M.R.; Riggins J.;
Suhre M.; Sylvester D.; Butler S.; Miller T.A.
Institution
(Lambert) Division of Pediatric Cardiothoracic Surgery, University of
Utah, Salt Lake City, UT, United States
(Pemberton) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, NIH, Bethesda, MD, United States
(Trachtenberg, Teng) HealthCore Inc., Watertown, MA, United States
(Uzark) Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor,
MI, United States
(Woodard) Division of Pediatric Cardiology, Medical University of South
Carolina, Charleston, SC, United States
(Bainton) Division of Cardiology, The Hospital for Sick Children,
University of Toronto, Toronto, ON, Canada
(Clarke) Division of Cardiology, Emory University School of Medicine,
Children's Healthcare of Atlanta, Atlanta, GA, United States
(Justice, Suhre) Division of Cardiology, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Meador) Division of Cardiology Pediatric Anesthesiology, Texas Children's
Hospital, Baylor College of Medicine, Houston, TX, United States
(Riggins) Division of Cardiovascular Surgery, Riley Hospital for Children
at IU Health, Indianapolis, IN, United States
(Sylvester) Division of Cardiology, The Children's Hospital of
Philadelphia, Perelman School of Medicine, Philadelphia, PA, United States
(Butler) Department of Psychiatry, Children's Hospital Boston, Boston, MA,
United States
(Miller) Division of Cardiology, Maine Medical Center, Portland, ME,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Growth is often impaired in infants with congenital heart
disease. Poor growth has been associated with worse neurodevelopment,
abnormal behavioral state, and longer time to hospital discharge.
Nutritional interventions, drug therapy, and surgical palliation have
varying degrees of success enhancing growth. Passive range of motion
(PROM) improves somatic growth in preterm infants and is safe and feasible
in infants with hypoplastic left heart syndrome (HLHS), after their first
palliative surgery (Norwood procedure). Method(s): This multicenter,
Phase III randomized control trial of a 21-day PROM exercise or standard
of care evaluates growth in infants with HLHS after the Norwood procedure.
Growth (weight-, height- and head circumference-for-age z-scores) will be
compared at 4 months of age or at the pre-superior cavopulmonary
connection evaluation visit, whichever comes first. Secondary outcomes
include neonatal neurobehavioral patterns, neurodevelopmental assessment,
and bone mineral density. Eligibility include diagnosis of HLHS or other
single right ventricle anomaly, birth at >=37 weeks gestation and Norwood
procedure at <30 days of age, and family consent. Infants with known
chromosomal or recognizable phenotypic syndromes associated with growth
failure, listed for transplant, or expected to be discharged within 14
days of screening are excluded. Conclusion(s): The TEAM 4 Growth
trial will make an important contribution to understanding the role of
PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with
complex cardiac anomalies, who are at high risk for growth failure and
developmental concerns. Copyright © 2022 Elsevier B.V.

<27>
Accession Number
638115270
Title
Large animal model of vein grafts intimal hyperplasia: A systematic
review.
Source
Perfusion. (pp 2676591221091200), 2022. Date of Publication: 27 May 2022.
Author
Fashina O.; Abbasciano R.G.; McQueen L.W.; Ladak S.; George S.J.; Suleiman
S.; Punjabi P.P.; Angelini G.D.; Zakkar M.
Institution
(Fashina, Abbasciano, McQueen, Ladak, Zakkar) Department of Cardiovascular
Sciences, University of Leicester, Glenfield Hospital, Leicester, United
Kingdom
(George, Suleiman, Angelini) Bristol Heart Institute and Translational
Biomedical Research Centre, Bristol Medical School, University of Bristol,
Bristol Royal Infirmary, Bristol, United Kingdom
(Punjabi) Department of Cardiovascular Sciences, Imperial College,
Hammersmith Hospital, London, United Kingdom
Publisher
NLM (Medline)
Abstract
Coronary artery bypass grafting remains the treatment of choice for a
large cohort of patients with significant coronary disease. Despite the
increased use of arterial grafts, the long saphenous vein remains the most
commonly used conduit. Long-term graft patency continues to be the
Achilles heel of saphenous vein grafts. This is due to the development of
intimal hyperplasia, a chronic inflammatory disease that results in the
narrowing and occlusion of a significant number of vein grafts. Research
models for intimal hyperplasia are essential for a better understanding of
pathophysiological processes of this condition. Large animal models
resemble human anatomical structures and have been used as a surrogate to
study disease development and prevention over the years. In this paper, we
systematically review all published studies that utilized large animal
models of vein graft disease with a focus on the type of model and any
therapeutic intervention, specifically the use of external stents/mesh.

<28>
Accession Number
638103031
Title
Total Cardiovascular and Limb Events and the Impact of Polyvascular
Disease in Chronic Symptomatic Peripheral Artery Disease.
Source
Journal of the American Heart Association. (pp e025504), 2022. Date of
Publication: 27 May 2022.
Author
Szarek M.; Hess C.; Patel M.R.; Jones W.S.; Berger J.S.; Baumgartner I.;
Katona B.; Mahaffey K.W.; Norgren L.; Blomster J.; Rockhold F.W.; Hsia J.;
Fowkes F.G.R.; Bonaca M.P.
Institution
(Szarek, Hess, Hsia, Bonaca) CPC Clinical Research Aurora CO
(Szarek, Hess, Hsia, Bonaca) Department of Medicine University of Colorado
Aurora CO
(Szarek) SUNY Downstate Health Sciences University Brooklyn NY
(Patel, Jones, Rockhold) Duke Clinical Research Institute Durham NC
(Patel, Jones) Division of Cardiology Duke University Medical Center
Durham NC
(Berger) New York University School of Medicine New York NY
(Baumgartner) Swiss Cardiovascular CenterInselspitalBern University
HospitalUniversity of Bern Switzerland, Switzerland
(Katona) AstraZeneca Gaithersburg Gaithersburg MD
(Mahaffey) Stanford Center for Clinical Research Stanford University
School of Medicine Stanford CA
(Norgren) Faculty of Medicine and Health Orebro University Orebro Sweden,
Sweden
(Blomster) Turku University Hospital Turku Finland, Finland
(Fowkes) Usher Institute of Population Health Sciences and Informatics
University of Edinburgh Edinburgh UK
Publisher
NLM (Medline)
Abstract
Background Peripheral artery disease (PAD) is associated with heightened
risk for major adverse cardiovascular and limb events, but data on the
burden of risk for total (first and potentially subsequent) events, and
the association with polyvascular disease, are limited. This post hoc
analysis of the EUCLID (Examining Use of Ticagrelor in Peripheral Artery
Disease) trial evaluated total cardiovascular and limb events among
patients with symptomatic PAD, overall and by number of symptomatic
vascular territories. Methods and Results In the EUCLID trial, patients
with symptomatic PAD (lower extremity revascularization >30 days before
randomization or ankle-brachial index <=0.80) were randomized to treatment
with ticagrelor or clopidogrel. Relative effects on total events
(cardiovascular death; nonfatal myocardial infarction and ischemic stroke;
acute limb ischemia, unstable angina, and transient ischemic attack
requiring hospitalization; coronary, carotid, and peripheral
revascularization procedures; and amputation for symptomatic PAD) were
summarized by hazard ratios (HRs), whereas absolute risks were estimated
by incidence rates and mean cumulative functions. Among 13 885 randomized
patients, 7600 total cardiovascular and limb events occurred during a
median 2.7 years of follow-up, translating to 60.0 and 62.5 events per 100
patients through 3 years for the ticagrelor and clopidogrel groups,
respectively (HR, 0.96; 95% CI, 0.89-1.03; P=0.27). Among 1393 patients
with disease in 3 vascular territories, event accrual rates through 3
years for the ticagrelor and clopidogrel groups were 87.3 and 97.7 events
per 100 patients, respectively. Absolute risk reductions for ticagrelor
relative to clopidogrel at 3 years were -0.2, 6.7, and 10.3 events per 100
patients for 1, 2, and 3 affected vascular territories, respectively
(Pinteraction=0.09). Conclusions Patients with symptomatic PAD have nearly
double the number of total events than first events, with rates reflecting
the number of affected vascular territories. These findings highlight the
clinical relevance of quantifying disease burden in terms of total events
and the need for long-term preventive treatments in high-risk patient
populations. Registration URL: https://clinicaltrials.gov/; Unique
identifier: NCT01732822.

<29>
Accession Number
638102931
Title
Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac
Transplantation.
Source
Circulation. (pp 101161CIRCULATIONAHA121057006), 2022. Date of
Publication: 27 May 2022.
Author
Anthony C.; Imran M.; Pouliopoulos J.; Emmanuel S.; Iliff J.; Liu Z.;
Moffat K.; Ru Qiu M.; McLean C.A.; Stehning C.; Puntmann V.; Vassiliou V.;
Ismail T.F.; Gulati A.; Prasad S.; Graham R.M.; McCrohon J.; Holloway C.;
Kotlyar E.; Muthiah K.; Keogh A.M.; Hayward C.S.; Macdonald P.S.; Jabbour
A.
Institution
(Anthony, Imran, Pouliopoulos, Emmanuel, Iliff, Ru Qiu, Graham, McCrohon,
Holloway, Kotlyar, Muthiah, Keogh, Hayward, Macdonald, Jabbour) Heart and
Lung Transplant Unit, M.I., R.M.G., C.H., C.S.H., P.S.M., St. Vincent's
HospitalK.M., Sydney, S.E, Macao
(Pouliopoulos, Emmanuel, Graham, Hayward, Macdonald, Jabbour) Victor Chang
Cardiac Research Institute, R.M.G., C.S.H., P.S.M., Sydney, S.E, Macao
(Pouliopoulos, Graham, Keogh, Macdonald, Jabbour) UNSW, R.M.G., P.S.M.,
Sydney, Canada
(Liu) Stats Central, Mark Wainwright Analytical Centre, UNSW, Sydney,
Canada
(Moffat) Medical Imaging Department, St. Vincent's Hospital, Sydney,
Canada
(McLean) Alfred Health and Monash University, Melbourne
(Stehning) Philips GmbH Innovative Technologies, Germany (C.S.), Hamburg,
Germany
(Puntmann) Institute for Experimental and Translational Cardiovascular
Imaging, Goethe University Hospital, Germany (V.P.), Frankfurt
(Vassiliou, Gulati, Prasad) CMR, Royal Brompton Hospital, Imperial College
London, A.G.
(Vassiliou) Norwich Medical School, University of East Anglia
(Ismail) King's College London
Publisher
NLM (Medline)
Abstract
BACKGROUND: Endomyocardial biopsy (EMB) is the gold standard method for
surveillance of acute cardiac allograft rejection (ACAR) despite its
invasive nature. Cardiovascular magnetic resonance (CMR)-based myocardial
tissue characterization allows detection of myocarditis. The feasibility
of CMR-based surveillance for ACAR-induced myocarditis in the first year
after heart transplantation is currently undescribed. METHOD(S):
CMR-based multiparametric mapping was initially assessed in a prospective
cross-sectional fashion to establish agreement between CMR- and EMB-based
ACAR and to determine CMR cutoff values between rejection grades. A
prospective randomized noninferiority pilot study was then undertaken in
adult orthotopic heart transplant recipients who were randomized at 4
weeks after orthotopic heart transplantation to either CMR- or EMB-based
rejection surveillance. Clinical end points were assessed at 52 weeks.
 RESULT(S): Four hundred one CMR studies and 354 EMB procedures were
performed in 106 participants. Forty heart transplant recipients were
randomized. CMR-based multiparametric assessment was highly reproducible
and reliable at detecting ACAR (area under the curve, 0.92; sensitivity,
93%; specificity, 92%; negative predictive value, 99%) with greater
specificity and negative predictive value than either T1 or T2 parametric
CMR mapping alone. High-grade rejection occurred in similar numbers of
patients in each randomized group (CMR, n=7; EMB, n=8; P=0.74). Despite
similarities in immunosuppression requirements, kidney function, and
mortality between groups, the rates of hospitalization (9 of 20 [45%]
versus 18 of 20 [90%]; odds ratio, 0.091; P=0.006) and infection (7 of 20
[35%] versus 14 of 20 [70%]; odds ratio, 0.192; P=0,019) were lower in the
CMR group. On 15 occasions (6%), patients who were randomized to the CMR
arm underwent EMB for clarification or logistic reasons, representing a
94% reduction in the requirement for EMB-based surveillance.
 CONCLUSION(S): A noninvasive CMR-based surveillance strategy for ACAR
in the first year after orthotopic heart transplantation is feasible
compared with EMB-based surveillance. REGISTRATION: HREC/13/SVH/66 and
HREC/17/SVH/80. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY:
ACTRN12618000672257.

<30>
Accession Number
638102791
Title
Overview of mitral valve replacement versus mitral valve repair due to
ischemic papillary muscle rupture: A meta-analysis inspired by a case
report.
Source
Cardiology journal. (no pagination), 2022. Date of Publication: 27 May
2022.
Author
Pala B.; Romaniello A.; Cristiano E.; D'Angelo A.; Grimaldi M.C.;
Figliuzzi I.; Tonelli E.; Volpe M.
Institution
(Pala) Division of Cardiology, Department of Clinical and Molecular
Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome,
Rome, Italy
(Romaniello) Division of Cardiology, Sant' Andrea Hospital, Sapienza
University of Rome, Rome, Italy
(Cristiano, D'Angelo, Grimaldi, Figliuzzi, Volpe) Division of Cardiology,
Department of Clinical and Molecular Medicine, Faculty of Medicine and
Psychology, Sapienza University of Rome, Rome, Italy
(Tonelli) Department of Cardiac Surgery, Sant 'Andrea Hospital, Sapienza
University of Rome, Rome, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Papillary muscle rupture (PMR) is an infrequent but
catastrophic complication after myocardial infarction (MI). Surgical
procedure is considered the optimal treatment, despite high risk. However,
the gold standard technique is still a major dilemma. Therefore, a
meta-analysis was carried out to assess and provide an overview comparing
mitral valve replacement (MVR) and mitral valve repair (MVr) for PMR
post-MI. METHOD(S): A systematic literature search was performed.
Data were extracted and verified using a standardized data extraction
form. Meta-analysis was realized mainly using RevMan 5.4 software.
 RESULT(S): From four observational studies 1640 patients were
identified; 81% underwent MVR and 19% MVr. Operative mortality results
were significantly higher in MVR group than the MVr group. MVR was
performed under emergency conditions and patients admitted in cardiogenic
shock or who required the use of mechanical cardiac support underwent MVR.
MVr had shorter time of hospitalization and similar incidence of
postoperative complications than MVR. No significant differences existed
between the two procedures regarding cardiopulmonary bypass time.
 CONCLUSION(S): Mitral valve repair appears to be a viable alternative
to MVR for post-MI PMR, given that it has lower operative mortality,
shorter time of hospitalization and similar incidence of short-term
postoperative complications than MVR. However, it needs to be pointed out
that MVR was associated with the most critical clinical condition
following PMR. There is uncertainty regarding the overall survival and
improvement of the quality of life between the procedures. Nevertheless,
further completed investigation is required.

<31>
Accession Number
638100645
Title
Deep sternal wound infection and mortality in cardiac surgery: A
meta-analysis.
Source
The Annals of thoracic surgery. (no pagination), 2022. Date of
Publication: 23 May 2022.
Author
Perezgrovas-Olaria R.; Audisio K.; Cancelli G.; Rahouma M.; Ibrahim M.;
Soletti G.; Chadow D.; Demetres M.; Girardi L.N.; Gaudino M.
Institution
(Perezgrovas-Olaria, Audisio, Cancelli, Rahouma, Soletti, Chadow, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York City, NY, USA
(Ibrahim) Department of General Surgery, Maimonides Medical Center.
Brooklyn, NY, United States
(Demetres) Weill Cornell Medicine, Samuel J. Wood Library and C.V. Starr
Biomedical Information Centre, NY, NY
Publisher
NLM (Medline)
Abstract
BACKGROUND: Deep sternal wound infection (DSWI) is a rare but severe
complication after cardiac surgery and has been associated with increased
early morbidity and mortality. Studies reporting long-term outcomes in
patients with DSWI have shown contradictory results. We performed a
study-level meta-analysis evaluating the impact of DSWI on short- and
long-term clinical outcomes. METHOD(S): A systematic literature
search was conducted to identify studies comparing short- and long-term
outcomes of cardiac surgery patients who developed DSWI and patients who
did not. The primary outcome was overall mortality. Secondary outcomes
were in-hospital mortality, follow-up mortality, major adverse
cardiovascular events (MACE), myocardial infarction , and repeat
revascularization. Postoperative outcomes were also investigated.
 RESULT(S): Twenty-four studies totaling 407,829 patients were
included. Overall, 6,437 (1.6%) patients developed DSWI. Mean follow-up
was 3.5 years. DSWI was associated with higher overall mortality
(incidence rate ratio [IRR] 1.99, 95% confidence interval [CI] 1.66-2.38,
P<0.0001), in-hospital mortality (odds ratio 3.30, 95% CI 1.88-5.81,
P<0.0001), follow-up mortality (IRR 2.02, 95% CI 1.39-2.94, P=0.0002), and
MACE (IRR 2.04, 95% CI 1.60-2.59, P<0.0001). No differences in myocardial
infarction and repeat revascularization were found, but limited studies
reported those outcomes. DSWI was associated with longer postoperative
hospitalization, stroke, myocardial infarction, respiratory and renal
failure. Sensitivity analyses on isolated coronary artery bypass grafting
studies and by adjustment method were consistent with the main analysis.
 CONCLUSION(S): When compared to patients who did not develop DSWI,
patients with DSWI after cardiac surgery had increased risk of mortality
as well as short- and long-term adverse clinical outcomes. Copyright
© 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc.
All rights reserved.

<32>
Accession Number
2018264887
Title
Early and midterm outcomes of transcatheter aortic-valve replacement with
balloon-expandable versus self-expanding valves: A meta-analysis:
Balloon-expandable vs. self-expanding TAVR.
Source
Journal of Cardiology. (no pagination), 2022. Date of Publication: 2022.
Author
Zhang X.-L.; Wei Z.-H.; Wang H.-W.; Xu W.; Wang Y.; Xu B.
Institution
(Zhang, Wei, Xu, Xu) Department of Cardiology, Affiliated Drum Tower
Hospital, Nanjing University School of Medicine, Nanjing, China
(Wang, Wang) State Key Laboratory of Chemistry for Life Science, Jiangsu
Key Laboratory of Molecular Medicine, Medical School, Nanjing University,
Nanjing, China
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Current guidelines provide recommendation for transcatheter
aortic-valve replacement (TAVR) in severe aortic stenosis without emphasis
on valve systems. The comparative performances of balloon-expandable
valves (BEV) and self-expanding valves (SEV) remain unclear. We aim to
compare the early (30-day) and midterm (1-year) mortality and
cardiovascular outcomes of BEV with SEV. Method(s): PubMed, CENTRAL,
and EMBASE were searched from inception to February 13, 2020 for
randomized controlled trials (RCTs) and propensity-score matched (PSM)
studies. Odds ratios (ORs) for binary outcomes and mean differences for
continuous outcomes were pooled using random-effect models
(DerSimonian-Laird method) with Hartung-Knapp-Sidik-Jonkman variance
correction. Primary outcomes were early and midterm all-cause mortality.
 Result(s): We included 3 RCTs (1418 patients) and 12 PSM studies
(36,540 patients). Compared with SEV, BEV was associated with
significantly lower mortality at 30 days (OR 0.76, 95% CI 0.67-0.85, p <
0.001, I2 = 0) and 1 year (OR 0.87, 95% CI 0.77-0.99, p = 0.04, I2 =
20.4%) in PSM studies, but not RCTs with insufficient power. Similar
findings were found in subgroups analysis based on valve generations and
SEV types. The 30-day and 1-year cardiovascular mortality, 30-day
incidences of moderate to severe paravalvular leak, procedural contrast
agent volume, and procedure time were lower, but transvalvular pressure
gradient was higher in BEV than SEV in PSM studies. The 30-day incidences
of permanent pacemaker implantation (PPI), acute kidney injury, stroke,
major bleeding, major vascular complications, and rehospitalization were
not statistically different between BEV and SEV. Early-generation SEV was
associated with a higher 30-day PPI risk than corresponding BEV
comparators. PPI risk was lower in ACURATE neo (Boston Scientific, Natick,
MA) but higher in Evolut R SEV (Medtronic Inc., Minneapolis, MN), both
compared with SAPIEN 3 BEV (Edwards Lifesciences, Irvine, CA).
 Conclusion(s): PSM studies suggest lower early and midterm mortality
in BEV than SEV, but the contribution of unmeasured confounders cannot be
excluded. Results from adequately powered RCTs with long-term follow-up
are critically needed to confirm these findings. Copyright © 2021
Elsevier Ltd

<33>
Accession Number
2017540939
Title
The effect of Hugo point acupressure massage on respiratory volume and
pain intensity due to deep breathing in patients with chest tube after
chest surgeries.
Source
Contemporary Clinical Trials Communications. 27 (no pagination), 2022.
Article Number: 100914. Date of Publication: June 2022.
Author
Fasihi S.M.; Karampourian A.; Khatiban M.; Hashemi M.; Mohammadi Y.
Institution
(Fasihi) Department of Nursing and Midwifery, Hamadan University of
Medical Sciences, Hamadan, Iran, Islamic Republic of
(Karampourian) Urology and Nephrology Research Center, Chronic Diseases
(Home Care) Research Center, School of Nursing and Midwifery, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Khatiban) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Mother and Child Care Research Center, Hamadan University of
Medical Sciences, Hamadan, Iran, Islamic Republic of
(Hashemi) Department of Persian Medicine, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Mohammadi) Department of Public Health, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Introduction: Hugo point is the most important pain control point in the
body, so the study was performed to determine the effect of Hugo point
massage on respiratory volume and the pain intensity after chest tube
placement. Material(s) and Method(s): The study was performed as a
randomized crossover clinical trial on 61 patients with a chest tube.
Patients were placed in every 2 h through the ternary permutation block
once under a false point pressure, once under a Hugo point pressure, and
once without intervention. Data were collected using a questionnaire of
demographic, clinical information, the Numerical Pain Rating Scale, and
spirometry. Analysis of variance with repeated measures was used to
analyze the data. Finding(s): There was no significant difference in
the pain intensity before and during the intervention between the three
groups. However, after the intervention, the mean pain intensity in the
control group was higher than the Hugo and placebo groups (P < 0.001), and
the mean pain intensity in the placebo group was higher than in the Hugo
group (P < 0.001). There was no significant difference between the three
groups in terms of the rate of ascent and retention time of spirometry
ball the three times before, during, and after the intervention.
 Conclusion(s): Hugo point massage reduces the pain intensity;
however, has no significant effect on their respiratory volume. Hugo point
massage is recommended to reduce the severity of pain in patients with
chest tube. Copyright © 2022

<34>
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).

<35>
Accession Number
2014759838
Title
The impact of intraoperative blood pressure variability on the risk of
postoperative adverse outcomes in non-cardiac surgery: a systematic
review.
Source
Journal of Anesthesia. 36(2) (pp 316-322), 2022. Date of Publication:
April 2022.
Author
Putowski Z.; Czok M.; Krzych L.J.
Institution
(Putowski, Czok) Students' Scientific Society, Department of
Anaesthesiology and Intensive Care, Faculty of Medical Sciences in
Katowice, Medical University of Silesia, Medykow 14 Street, Katowice
40752, Poland
(Krzych) Department of Anaesthesiology and Intensive Care, Faculty of
Medical Sciences in Katowice, Medical University of Silesia, Katowice,
Poland
Publisher
Springer Japan
Abstract
Hemodynamic stability during surgery seems to account for positive
postoperative outcomes in patients. However, little is known about the
impact of intraoperative blood pressure variability (IBPV) on the
postoperative complications. The aim was to investigate whether IBPV is
associated with the development of postoperative complications and what is
the nature of this association. We conducted a systematic search in
PubMed, Medical Subject Headings, Embase, Web of Science, SCOPUS,
clinicaltrials.gov, and Cochrane Library on the 8th of April, 2021. We
included studies that only focused on adults who underwent primarily
elective, non-cardiac surgery in which intraoperative blood pressure
variation was measured and analyzed in regard to postoperative,
non-surgical complications. We identified 11 papers. The studies varied in
terms of applied definitions of blood pressure variation, of which
standard deviation and average real variability were the most commonly
applied definitions. Among the studies, the most consistent analyzed
outcome was a 30-day mortality. The studies presented highly heterogeneous
results, even after taking into account only the studies of best quality.
Both higher and lower IBPV were reported to be associated for
postoperative complications. Based on a limited number of studies, IBPV
does not seem to be a reliable indicator in predicting postoperative
complications. Existing premises suggest that either higher or lower IBPV
could contribute to postoperative complications. Taking into account the
heterogeneity and quality of the studies, the conclusions may not be
definitive. Copyright © 2022, The Author(s).

<36>
Accession Number
2018179344
Title
Major adverse cardiovascular events in homozygous familial
hypercholesterolaemia: a systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 29(5) (pp 817-828), 2022. Date
of Publication: 01 Mar 2022.
Author
Kramer A.I.; Akioyamen L.E.; Lee S.; Belanger A.; Ruel I.; Hales L.;
Genest J.; Brunham L.R.
Institution
(Kramer, Brunham) Department of Medicine, University of British Columbia,
Vancouver V5Z 1M9, Canada
(Akioyamen) Department of Medicine, University of Toronto, Toronto, ON M5S
1A8, Canada
(Lee) Department of Internal Medicine, Yale University School of Medicine,
New Haven, CT 06510, United States
(Belanger, Ruel, Genest) Research Institute of the McGill University
Health Centre, Montreal, QC H4A 3J1, Canada
(Hales) McGill University Health Center Medical Libraries, Montreal, QC
1H3G 1A4, Canada
(Brunham) Centre for Heart Lung Innovation, University of British
Columbia, 1081 Burrard Street - Room 166, Vancouver V6Z 1Y6, Canada
Publisher
Oxford University Press
Abstract
Aims: Homozygous familial hypercholesterolaemia (HoFH) is a genetic
condition characterized by extremely elevated levels of low-density
lipoprotein cholesterol and premature atherosclerotic cardiovascular
disease and death. Due to its rarity, accurate assessment of
cardiovascular outcomes associated with HoFH and how they have changed
over time has been challenging. The goal of this study was to assess the
prevalence and age-of-onset of major adverse cardiovascular events (MACE)
among patients with HoFH. Methods and Results: We searched MEDLINE,
EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, Scopus,
Africa-Wide, Google Scholar, Open Grey, and various clinical trial
registries from inception to February 2020 to identify studies reporting
on MACE in HoFH patients. We determined the pooled prevalence and mean
age-of-onset of MACE outcomes individually using a random effects inverse
variance model. We identified 94 studies that met our eligibility
criteria. Myocardial infarction and coronary revascularization were common
with a prevalence of 15.1% [95% confidence interval (95% CI) 10.7-20.0]
and 28.3% (95% CI 22.5-34.3), respectively. The mean age-of-onset was 24.5
(95% CI 19.2-29.8) years for myocardial infarction and 32.2 (95% CI
26.6-37.8) years for revascularization. Sub-group analyses based on the
year of publication revealed significant delays in the onset of MACE
outcomes post-1990 compared to pre-1990. Egger's regression suggested
possible bias, likely due to small study effects. Conclusion(s):
Atherosclerotic cardiovascular disease is common among HoFH patients and
occurs at a young age. Age-of-onset of myocardial infarction was delayed
by more than a decade from pre-1990 to post-1990, likely attributable to
widespread use of statins and other therapies, reflecting substantial
progress in the management of this rare but severe disorder. Copyright
© 2021 Published on behalf of the European Society of Cardiology. All
rights reserved.

<37>
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.

<38>
Accession Number
2018123915
Title
Early outcomes of transcatheter mitral valve replacement with the Tendyne
system in severe mitral annular calcification.
Source
EuroIntervention. 17(18) (pp 1523-1531), 2022. Date of Publication: April
2022.
Author
Gossl M.; Thourani V.; Babaliaros V.; Conradi L.; Chehab B.; Dumonteil N.;
Badhwar V.; Rizik D.; Sun B.; Bae R.; Guyton R.; Chuang M.; Blanke P.;
Sorajja P.
Institution
(Gossl, Sun, Bae, Sorajja) Valve Science Center, Minneapolis Heart
Institute Foundation, Minneapolis, MN, United States
(Thourani) Department of Cardiovascular Surgery, Marcus Valve Center,
Piedmont Heart Institute, Atlanta, GA, United States
(Babaliaros, Guyton) Emory Structural Heart and Valve Center, Atlanta, GA,
United States
(Conradi) University Heart & Vascular Center Hamburg, Hamburg, Germany
(Chehab) Ascension Via Christi Hospital, Wichita, KS, United States
(Dumonteil) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
(Badhwar) West Virginia University Heart, Vascular Institute, Morgantown,
WV, United States
(Rizik) HonorHealth, Scottsdale, AZ, United States
(Chuang) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Blanke) Department of Radiology, St. Paul's Hospital, University of
British Columbia, Vancouver, BC, Canada
Publisher
Europa Group
Abstract
Background: Treatment of mitral regurgitation (MR) associated with severe
mitral annular calcification (MAC) is challenging due to the high risk of
fatal atrioventricular groove disruption and significant paravalvular
leak. Aim(s): The aim of this study was to evaluate the outcomes of
transcatheter mitral valve replacement (TMVR) with the Tendyne valve
(Abbott Structural) in patients with MR and MAC. Method(s): Twenty
patients (mean age 78 years; 11 women) who were treated with the Tendyne
valve, either compassionate use (CU; closed) or as part of The Feasibility
Study of Tendyne in MAC (NCT03539458), had reported outcomes in a median
follow-up duration of 368 days. Result(s): In all patients, a valve
was implanted with no procedural mortality and successful hospital
discharge. Two embolic events occurred, including one with mesenteric
ischaemia and one non-disabling stroke. At 30 days and one year, all-cause
mortality occurred in one (5%) and eight patients (40%), respectively. At
one year, six patients had been hospitalised for heart failure (30%).
There was no prosthetic dysfunction, and MR remained absent in all
patients at one year. Clinical improvement, measured by New York Heart
Association Functional Class, occurred in 11 of 12 patients who were alive
at one year. Among seven survivors with Kansas City Cardiomyopathy
Questionnaire (KCCQ) data, mean increase in KCCQ score was 29.9+/-26.3 at
one year with improvement of >=10 points in five (71.4%) patients.
 Conclusion(s): In patients with MR and severe MAC, TMVR with the
Tendyne valve was associated with encouraging acute outcomes, midterm
durability, and clinical improvement. Dedicated TMVR therapy may have a
future role in these anatomically challenging, high-risk
patients. Copyright © Europa Digital & Publishing 2022. All
rights reserved.

<39>
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.

<40>
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.

<41>
Accession Number
2016607616
Title
Colchicine for Secondary Prevention after Acute Myocardial Infarction: A
Systematic Review and Meta-Analysis.
Source
World Heart Journal. 13(4) (pp 537-547), 2021. Date of Publication: 2021.
Author
Buda K.G.; Megaly M.S.; Padniewski J.; Nyembo P.F.; Assali M.; Shabtaie
S.A.; Sandoval Y.; Nasr R.; Garcia S.; Simegn M.
Institution
(Buda, Padniewski) Division of Internal Medicine, Hennepin Healthcare,
Minneapolis, MN, United States
(Megaly) Division of Cardiology, Banner University Medical Center,
University of Arizona, Phoenix, AZ, United States
(Nyembo) Division of Internal Medicine, Kigali University Teaching
Hospital, CHUK, Kigali, Rwanda
(Assali, Garcia) Minneapolis Heart Institute, Abbott Northwestern
Hospital, Minneapolis, MN, United States
(Shabtaie, Sandoval) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Nasr) Rheumatology Division, Department of Internal Medicine, Hennepin
Healthcare, Minneapolis, MN, United States
(Assali, Simegn) Cardiology Division, Department of Internal Medicine,
Hennepin Healthcare, Minneapolis, MN, United States
Publisher
Nova Science Publishers, Inc.
Abstract
Aims: There are limited and conflicting data regarding the safety and
efficacy of colchicine for secondary prevention in patients presenting
with acute myocardial infarction (AMI). Method(s): We performed a
systematic review and meta-analysis of randomized controlled trials (RCT)
reporting colchicine vs. placebo outcomes in patients presenting with AMI.
 Result(s): The meta-analysis included four studies (5,821 patients,
2,904 on colchicine). During a median follow-up of 12 months (range 1-24
months), colchicine did not impact all-cause mortality (odds ratio [OR]
2.22; 95% CI: [0.29, 17.26], p = 0.45, I2 = 75%), cardiac death
(OR 0.99, 95% CI: [0.42, 2.31], p = 0.98, I2 = 15%), myocardial
infarction (OR 0.74, 95% CI: [0.49, 1.13], p = 0.17, I2 =
16%%), or re-hospitalization (OR 1.34; 95% CI: [0.84, 2.12], p = 0.22,
I2 = 27%). Colchicine use was safe, without an increase in
adverse events (OR 0.99; 95% CI: [0.86, 1.13], p = 0.85, I2 =
0%) or gastrointestinal side effects (OR 1.22; 95% CI: [0.82, 1.82], p =
0.33, I2 = 63%) compared to placebo. Conclusion(s): The
use of colchicine after AMI did not reduce all-cause mortality, cardiac
death, MI, or re-hospitalization in patients presenting with AMI, but was
not associated with significantly increased adverse events. Copyright
© Nova Science Publishers, Inc.

<42>
Accession Number
2017401179
Title
Cost-effectiveness of the MitraClip device in German heart failure
patients with secondary mitral regurgitation.
Source
European Journal of Health Economics. (no pagination), 2022. Date of
Publication: 2022.
Author
Estler B.; Rudolph V.; Seleznova Y.; Shukri A.; Stock S.; Muller D.
Institution
(Estler, Stock) Institute for Health Economics and Clinical Epidemiology,
University of Cologne, Albertus-Magnus-Platz, Cologne 50923, Germany
(Rudolph) Heart & Diabetes Centre NRW, General and Interventional
Cardiology/Angiology, University Hospital of the Ruhr University Bochum,
Bad Oeynhausen, Chelsea, Germany
(Seleznova, Shukri, Muller) Institute for Health Economics and Clinical
Epidemiology, University of Cologne, Gleueler Str. 176-178, Cologne 50935,
Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aim: To evaluate the cost-effectiveness of the MitraClip device
(MitraClip) in addition to optimal medical therapy (OMT) in patients with
heart failure and secondary mitral regurgitation in Germany. Methods
and Results: A model-based economic evaluation was performed to estimate
the incremental cost per quality-adjusted life-years (QALYs) for patients
with a moderate-to-severe or severe secondary mitral regurgitation
receiving MitraClip plus OMT compared with OMT alone from the statutory
health insurance (SHI) perspective. Transition probabilities, data on
survival rates, and hospitalization rates were obtained from the COAPT
trial, a randomized-controlled multicenter trial. Data on health utility
and costs were taken from published evidence. To assess parameter
uncertainty, several deterministic and probabilistic sensitivity analyses
were performed. The incremental costs per QALY gained were 59,728
(costs/incremental life years gained: 42,360). The results were most
sensitive to the transition probabilities and the hospitalization rates.
The probabilistic sensitivity analysis showed that the MitraClip strategy
was cost-effective with a probability of 80% at a willingness-to-pay
threshold of 67,000/QALY. Conclusion(s): Depending on the
willingness-to-pay threshold, for patients with heart failure and a
moderate-to-severe or severe secondary mitral regurgitation the MitraClip
can be cost-effective from the perspective of the German SHI. Graphical
abstract: [Figure not available: see fulltext.]. Copyright ©
2022, The Author(s).

<43>
Accession Number
2017381137
Title
Percutaneous Coronary Intervention Pre-TAVR: Current State of the
Evidence.
Source
Current Cardiology Reports. (no pagination), 2022. Date of Publication:
2022.
Author
Keller L.S.; Panagides V.; Mesnier J.; Nuche J.; Rodes-Cabau J.
Institution
(Keller, Panagides, Mesnier, Nuche, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, QC G1V 4G5,
Canada
Publisher
Springer
Abstract
Purpose of Review: This review intends to give an up-to-date overview of
the current state of evidence in the treatment of coronary artery disease
(CAD) in patients undergoing transcatheter aortic valve replacement
(TAVR), focusing on percutaneous coronary interventions (PCI) pre-TAVR.
Recent Findings: The recently published ACTIVATION trial is the 1st
randomized trial comparing coronary revascularization (PCI) versus medical
treatment in patients with significant CAD undergoing TAVR. With the
caveat of several major limitations of the trial, the results of this
study raised the question about the appropriateness of the common practice
to routinely revascularize coronary stenosis before TAVR. Summary:
Aortic valve stenosis is the most common valvular heart disease among the
elderly and it often co-occurs with CAD. TAVR is increasingly considered
an alternative to surgical aortic valve replacement not only in the
elderly population but also in younger and lower-risk patients. The impact
of co-existing CAD on clinical outcomes as well as the optimal timing of
PCI in TAVR candidates is still unclear and the subject of ongoing
randomized trials. Meanwhile, it is common practice in many centers to
routinely perform invasive coronary angiography and PCI for significant
coronary disease as part of the TAVR workup. While computed tomography
angiography has emerged as a possible alternative to the invasive coronary
angiography in patients with low pre-test probability for CAD, the value
of functional invasive assessment of coronary lesions in the pre-TAVR
setting has still to be clarified. Also, there is an increasing interest
in the clinical relevance and optimal management of the potentially
challenging coronary access post-TAVR, requiring further
research. Copyright © 2022, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<44>
Accession Number
2018357814
Title
Effect of S-ketamine on Postoperative Quality of Recovery in Patients
Undergoing Video-Assisted Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Cheng X.; Wang H.; Diao M.; Jiao H.
Institution
(Cheng, Wang, Diao, Jiao) Department of Anesthesiology, The Affiliated
Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, China
Publisher
W.B. Saunders
Abstract
Objectives: S-ketamine is associated with effective postoperative
analgesia and enhanced quality of recovery (QoR). The study aimed to
investigate the effect of perioperative S-ketamine on postoperative
quality of recovery in patients undergoing video-assisted thoracic surgery
(VATS). Design(s): A prospective, randomized, double-blinded,
placebo-controlled trial. Setting(s): Single institution, tertiary
university hospital. Participant(s): Eighty adult patients aged
18-to-65 undergoing VATS were eligible for participation.
 Intervention(s): Patients enrolled in this study were randomized to
receive either S-ketamine (a bolus of 0.25 mg/kg, followed by an infusion
of 0.125 mg/kg/h until 15 minutes before the end of the surgical
procedure), or identical volumes and rates of 0.9% saline.
 Measurements and Main Results: Postoperative quality of recovery was
measured with QoR-40 score 48 hours after surgery. The postoperative pain
was assessed postoperatively using the numeric rating scale at 0.5, 6, 24,
and 48 hours. Hospital Anxiety and Depression Scale Depression subscale
(HADS-D) scores and other secondary outcomes also were recorded. The final
analysis included 77 patients. The global QoR-40 score at 48 hours
postoperatively was higher in the S-ketamine group compared with the
saline group (median [interquartile range]: 181.5 [178-184] v 174.5
[169-177]), estimated median difference 7 (95% confidence interval 5-10, p
< 0.001). Patients who received S-ketamine treatment had lower pain scores
at rest (p = 0.017 and p = 0.006, respectively) and coughing (p < 0.001
and p = 0.007, respectively) at 24 and 48 hours postoperatively than those
who received saline treatment. The requirement and consumption of opioid
for rescue analgesic were lower in the S-ketamine (p = 0.045 and p =
0.047, respectively). Compared with the saline group, S-ketamine reduced
HADS-D scores (p = 0.003) at 48 hours after surgery. Conclusion(s):
The present study's findings suggested that perioperative S-ketamine
enhanced the quality of recovery in patients undergoing VATS. S-ketamine
also improved postoperative analgesia and postoperative
depression. Copyright © 2022 Elsevier Inc.

<45>
Accession Number
638091171
Title
Physiology or Angiography-Guided Coronary Artery Bypass Grafting: A
Meta-Analysis.
Source
Arquivos brasileiros de cardiologia. 117(6) (pp 1115-1123), 2021. Date of
Publication: 01 Dec 2021.
Author
Martins J.; Afreixo V.; Santos L.; Fernandes L.; Briosa A.
Institution
(Martins, Santos, Briosa) Baixo Vouga Hospital Centre, Portugal
(Afreixo) University of Aveiro, Portugal
(Fernandes) Centre for Health Economics, University of York, York - Reino
Unido
Publisher
NLM (Medline)

<46>
Accession Number
638045845
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) (no pagination), 2022. Article Number: e051112. 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, Jiangsu, Nanjing, China
(Huan, Ji, Yin) Nanjing Hospital Affiliated to Nanjing University of
Chinese Medicine, Nanjing University of Chinese Medicine, Jangsu, Nanjing,
China
(Ji) Department of Critical Medicine, The Second Hospital of Nanjing,
Jiangsu, Nanjing, China
(Yin) College of Public Health, Nanjing Medical University, Jiangsu,
Nanjing, China
Publisher
BMJ Publishing Group
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. Methods 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. Results 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 (95i 1/4... CI: 0.59 to 0.83) and 0.62 (95i 1/4... CI: 0.46 to
0.76) in the thoracic surgery group, 0.71 (95i 1/4... CI: 0.65 to 0.77)
and 0.76 (95i 1/4... CI: 0.69 to 0.82) in the cardiac surgery group, 0.85
(95i 1/4... CI: 0.60 to 0.96) and 0.85 (95i 1/4... 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 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 © 2022 Authors.

<47>
Accession Number
2016906770
Title
Intrauterine Valvuloplasty in Severe Aortic Stenosis-A Ten Years Single
Center Experience.
Source
Journal of Clinical Medicine. 11(11) (no pagination), 2022. Article
Number: 3058. Date of Publication: June-1 2022.
Author
Walter A.; Strizek B.; Weber E.C.; Gottschalk I.; Geipel A.; Herberg U.;
Gembruch U.; Berg C.
Institution
(Walter, Strizek, Geipel, Gembruch, Berg) Department of Obstetrics and
Prenatal Medicine, University of Bonn, Bonn 53127, Germany
(Weber, Gottschalk, Berg) Division of Prenatal Medicine, Gynecological
Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology,
University of Cologne, Cologne 50937, Germany
(Herberg) Department of Pediatric Cardiology, University of Bonn, Bonn
53127, Germany
Publisher
MDPI
Abstract
Objective: To assess the course and outcome of fetal aortic valvuloplasty
(FAV) in fetuses with severe aortic stenosis (SAS) in a single center.
 Method(s): All fetuses with a prenatal diagnosis of SAS with
subsequent FAV were retrospectively collected in one tertiary center for
fetal medicine over a period of 10 years. In the study, period fetuses
with SAS were considered suitable for FAV in the presence of markedly
elevated left ventricular pressures (maximum velocity of mitral
regurgitation (MR Vmax) >250 cm/s and/or maximum velocity of aortic
stenosis (AS Vmax) >250 cm/s), retrograde flow in the transverse aortic
arch and a left ventricular length Z-score >-1. Result(s): In the
study period 29 fetuses with AS were treated with 38 FAV. If
reinterventions are included 82.7% of fetuses received a technically
successful FAV. Procedure related death occurred in three (10.3%) cases,
spontaneous fetal death in 2 (6.9%), and termination of pregnancy was
performed in 3 cases (10.3%). Among the 21 live births (72.4%), four died
in infancy. Among the remaining survivors, 8/17 (47.1%) had a
biventricular outcome at the age of one year, 8/17 (47.1%) were
univentricular and one infant (5.9%) is biventricular at the age of eight
months. Fetuses with biventricular outcome had significantly greater left
ventricular (LV) length Z-scores (p = 0.031), and lower tricuspid to
mitral valve (TV/MV) ratios (p = 0.003). Conclusion(s): FAV has a
high technical success rate and a low rate of procedure related mortality
if performed in experienced hands. The success rate of biventricular
circulation at the age of one year is moderate and seems to depend rather
on the center's experience and postnatal surgical strategies than solely
on prenatal selection criteria. In the absence of randomized controlled
trials, FAV remains an experimental intervention. Copyright ©
2022 by the authors. Licensee MDPI, Basel, Switzerland.

<48>
Accession Number
2016895187
Title
Ticagrelor Monotherapy or Dual Antiplatelet Therapy After Drug-Eluting
Stent Implantation: Per-Protocol Analysis of the GLOBAL LEADERS Trial.
Source
Journal of the American Heart Association. 11(10) (no pagination), 2022.
Article Number: e024291. Date of Publication: 17 May 2022.
Author
Gragnano F.; Zwahlen M.; Vranckx P.; Heg D.; Schmidlin K.; Hamm C.; Steg
P.G.; Gargiulo G.; McFadden E.P.; Onuma Y.; Chichareon P.; Benit E.;
Mollmann H.; Janssens L.; Leonardi S.; Zurakowski A.; Arrivi A.; Van Geuns
R.J.; Huber K.; Slagboom T.; Calabro P.; Serruys P.W.; Juni P.; Valgimigli
M.; Windecker S.
Institution
(Gragnano, Windecker) Department of Cardiology, Inselspital, University of
Bern, Switzerland
(Gragnano, Chichareon) Department of Translational Medical Sciences,
University of Campania "Luigi Vanvitelli", Naples, Italy
(Zwahlen, Schmidlin) Institute of Social and Preventive Medicine,
University of Bern, Bern, Switzerland
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, University of Hasselt,
Hasselt, Belgium
(Heg) Clinical Trials Unit, University of Bern, Bern, Switzerland
(Hamm) Heart Center, Campus Kerckhoff of Justus-Liebig-University,
Giessen, Germany
(Hamm) German Center for Cardiovascular Research (DZHK), Partner Site
Rhine-Main, Germany
(Steg) Universite de Paris, French Alliance for Cardiovascular Trials
AP-HP, Hopital Bichat, Institut National de la Sante et de la Recherche
Medicale UMR1148, Paris, France
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(McFadden) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(McFadden) Department of Cardiology, Cork University Hospital, Cork,
Ireland
(Onuma) Department of Cardiology, National University of Ireland Galway,
Galway, Ireland
(Chichareon) Department of Internal Medicine, Faculty of Medicine,
Cardiology Unit, Prince of Songkla University, Songkhla, Thailand
(Benit) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Mollmann) Department of Cardiology, St. Johannes Hospital, Dortmund,
Germany
(Janssens) Heart Center, Imelda Ziekenhuis, Bonheiden, Belgium
(Leonardi) University of Pavia and Fondazione, IRCCS Policlinico San
Matteo, Pavia, Italy
(Zurakowski) Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
(Zurakowski) American Heart of Poland, Chrzanow, Poland
(Arrivi) Department of Cardiology, Azienda Ospedaliera S. Maria, Terni,
Italy
(Van Geuns) Department of Cardiology, Radboudumc, Nijmegen, Netherlands
(Huber) Wilhelminenhospital, III Department of Medicine, Cardiology and
Intensive Care Medicine Medical Faculty, Sigmund Freud University, Vienna,
Austria
(Slagboom) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Calabro) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Serruys) Department of Cardiology, National University of Ireland,
Galway, Ireland
(Juni) Department of Medicine, Applied Health Research Centre, Li Ka Shing
Knowledge Institute of St Michael's Hospital, University of Toronto, ON,
Canada
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Lugano, Switzerland
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In the GLOBAL LEADERS trial, ticagrelor monotherapy beyond 1
month compared with standard antiplatelet regimens after coronary stent
implantation did not improve outcomes at intention-to-treat analysis.
Considerable differences in treatment adherence between the experimental
and control groups may have affected the intention-to-treat results. In
this reanalysis of the GLOBAL LEADERS trial, we compared the experimental
and control treatment strategies in a per-protocol analysis of patients
who did not deviate from the study protocol. METHODS AND RESULTS: Baseline
and postrandomization information were used to classify whether and when
patients were deviating from the study protocol. With logistic
regressions, we derived time-varying inverse probabilities of nondeviation
from protocol to reconstruct the trial population without protocol
deviation. The primary end point was a composite of all-cause mortality or
nonfatal Q-wave myocardial infarction at 2 years. At 2-year follow-up,
1103 (13.8%) of 7980 patients in the experimental group and 785 (9.8%) of
7988 patients in the control group qualified as protocol deviators. At
per-protocol analysis, the rate ratio for the primary end point was 0.88
(95% CI, 0.75-1.03; P=0.10) on the basis of 274 versus 325 events in the
experimental versus control group. The rate ratio for the key safety end
point of major bleeding was 1.00 (95% CI, 0.79-1.26; P=0.99). The
per-protocol and intention-to-treat effect estimates were overall
consistent. CONCLUSION(S): Among patients who complied with the study
protocol in the GLOBAL LEADERS trial, ticagrelor plus aspirin for 1 month
followed by ticagrelor monotherapy was not superior to 1-year standard
dual antiplatelet therapy followed by aspirin alone at 2 years after
coronary stenting. REGISTRATION: URL: https://www.clinicaltrials.gov;
Unique identifier: NCT01813435. Copyright © 2022 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<49>
Accession Number
2016894956
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) (no pagination), 2022.
Article Number: e024401. 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
Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, Jena 07747,
Germany
(Schlattmann) Department of Medical Statistics, Computer Science and Data
Science, Jena University Hospital, Friedrich-Schiller-University Jena,
Jena, Germany
(Caldonazo, Kirov, Doenst, Diab) Department of Cardiothoracic Surgery,
Jena University Hospital, Friedrich-Schiller-University Jena, Jena,
Germany
Publisher
American Heart Association Inc.
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). CONCLUSION(S): 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. Copyright © 2022 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<50>
Accession Number
638090424
Title
Does Down Syndrome influence the outcomes of congenital cardiac surgery? A
systematic review and meta-analysis.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2022. Date of Publication: 24 May 2022.
Author
Wang B.; Verrocchi J.; Liew D.; Zentner D.
Institution
(Wang, Zentner) Cardiology Department, Royal Melbourne Hospital,
Melbourne, Australia
(Verrocchi) Monash Health, Melbourne, Australia
(Liew) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Zentner) Department of Medicine, University of Melbourne, Melbourne
Australia, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Congenital cardiac surgery for individuals with Down Syndrome
(DS) has historically occurred at reduced frequency. Little data is
available regarding long-term post congenital cardiac surgical outcomes.
Limited sample sizes and clinical heterogeneity require a pooled analysis
approach. OBJECTIVE(S): To compare long-term outcomes post-congenital
heart surgery between adults with and without Down Syndrome.
 METHOD(S): Databases (Medline, Embase and Pubmed) were searched
utilising terms related to DS and congenital heart disease.Studies that
enrolled adults (>18 years) with operated congenital heart disease and
compared long term outcomes with respect to DS presence were included. All
study designs were included, but those with limited/peri-operative
follow-up, non-English texts, case studies and literature reviews
excluded.Blinded screening, data extraction and quality assessment were
independently conducted by two reviewers. QUIPS criteria were used for
risk of bias analysis. Both random and fixed effects models were used for
meta-analysis. RESULT(S): Twenty-three studies (n = 10466) were
included. Risk of bias was frequently high due to unblinded retrospective
study designs and analyses limited in adjustment for other prognostic
factors.Meta-analysis demonstrated no effect of DS on long-term mortality
(HR 0.86, 95% CI 0.6-1.23), to a maximum described follow-up of 38 years.
Lower cardiac reoperation risk (HR 0.6, 95% CI 0.46-0.78) for individuals
with DS was found on pooled analysis. Meta-analysis was limited by
between-study variation. CONCLUSION(S): DS does not affect post
congenital cardiac surgical survival in adulthood. Reduced reoperation may
reflect challenges in assessing functional and symptomatic status and/or
concerns regarding perceived reoperation difficulties or likely
benefits. Copyright © The Author(s) 2022. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<51>
Accession Number
638089106
Title
Response to 'Efficacy of parasternal block to decrease intraoperative
opioid use in coronary artery bypass surgery via sternotomy: a randomized
controlled trial' by Bloc et al.
Source
Regional anesthesia and pain medicine. (no pagination), 2022. Date of
Publication: 24 May 2022.
Author
Kim S.C.; Anwar S.
Institution
(Kim, Anwar) Department of Perioperative Medicine, St Bartholomew's
Hospital, London, United Kingdom
Publisher
NLM (Medline)

<52>
Accession Number
2000825445
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
The Lancet. 391(10137) (pp 2325-2334), 2018. Date of Publication: 09 Jun
2018.
Author
Devereaux P.J.; Duceppe E.; Guyatt G.; Tandon V.; Rodseth R.; Biccard
B.M.; Xavier D.; Szczeklik W.; Meyhoff C.S.; Vincent J.; Franzosi M.G.;
Srinathan S.K.; Erb J.; Magloire P.; Neary J.; Rao M.; Rahate P.V.;
Chaudhry N.K.; Mayosi B.; de Nadal M.; Iglesias P.P.; Berwanger O.; Villar
J.C.; Botto F.; Eikelboom J.W.; Sessler D.I.; Kearon C.; Pettit S.;
Connolly S.J.; Bangdiwala S.I.; Rao-Melacini P.; Hoeft A.; Yusuf S.;
Eikelboom J.; Pogue J.; Di Diodato S.; Gasic Z.; Mastrangelo L.J.; Molnar
S.H.; Swanson J.L.; Tosh M.L.; Wells J.R.; Diaz R.; Chow C.K.; Gonzales
B.; Vasquez S.; Jansky P.; Dusek R.; Coriat P.; Wittmann M.; Yonga G.;
Mathur N.; Seletti E.; Malaga G.; Tumanan-Mendoza B.A.; Tagle M.P.A.;
Alonso-Coello P.; Popova E.; Shields M.; Le Manach Y.; Moayyedi P.; van
Zanten S.; Fleischmann E.; Garg A.; Karaye K.; McFalls E.; Sigamani A.;
Belley-Cote E.; Biedron G.; Borges F.; Frosi Stella S.; Haarmark Nielsen
C.; Leong D.P.; Spence J.; Tran A.; Wawrzycka-Adamczyk K.; Yang S.S.; Yung
T.; Wyse D.G.; Cheng D.; Johnstone D.E.; Wells G.A.; Joseph P.; Patel A.;
Gregus K.; Lawrence K.; Doharris L.; Conen D.; Cheung J.; Douketis J.;
Wright D.; Wikkerink S.; Dechert W.; Panju M.; Azzam K.; Rapanos T.; Van
Helder T.; Shroff A.; Hare J.; Kidane B.; Nguyen T.; Leydier L.; Bayaraa
V.; Parlow J.; DuMerton D.A.; Thakrar A.; Shelley J.; Deligne B.; Carling
R.D.; Mrkobrada M.; Dresser G.K.; Jacka M.J.; Hornstein D.; Winkelaar
G.B.; Haider Z.H.; Lanjewar P.P.; Varughese V.; Calton R.; Ahuja H.;
George P.; Sharma A.; Bhatt K.S.; Mangukiya D.O.; Nandaniya K.V.; Parekh
V.V.; Pillai A.B.; Menon V.P.; Desai S.C.; Sidhu R.S.; Gupta S.K.; George
R.K.; Gurunath T.R.; Drummond L.W.; Torborg A.M.; Kusel B.S.; Naidoo P.;
Naidoo D.P.; Rajah C.; Farina Z.; von Rahden R.P.; Gumede S.; Chishala C.;
Coetzee E.; Dyer R.A.; Diedericks J.; Bielanski P.; Kaczmarek B.;
Studzinska D.; Zaniewski M.; Libura M.J.; Zacharias-Nalichowski T.M.; Sega
A.A.S.; Salwa J.; Kozka M.; Gorka J.; Wludarczyk A.; Nowak-Kozka I.;
Grudzien P.S.; Gucwa J.W.; Slowiaczek M.P.; Dobosz P.P.D.; Gogenur I.;
Eriksen J.R.; Borup T.; Kirkegaard T.; Isbye D.; Sonne A.; Rasmussen L.S.;
Pedersen S.; Troensegaard H.; Duus C.L.; Halle B.M.; Gundel O.N.; Bernholm
K.F.; Martinsen K.R.; Itenov T.S.; Camio E.; Vazquez C.; Matarin S.; Cano
E.; Alvarez-Garcia J.; India I.; Gonzalez-Osuna A.; Vives M.; Rossello E.;
Serrano A.B.; Turiel M.; Drago L.; Colombo C.; Marra F.; Mos L.; Arteni
F.; Lembo R.; Ortalda A.; Passarani S.; Mokini Z.; Figueiredo E.L.; Werner
G.F.; Petriz J.L.; Maia L.N.; Bergo R.R.; Precoma D.B.; Saraiva J.F.K.;
Vilamajo O.G.; Allegrini E.; Benzadon M.; Parody M.L.; Duronto E.A.;
Ingaramo A.C.; Parra G.A.; Novoa D.; Miller S.A.; Thomas S.; Karlapudi
S.P.; Bourji M.H.; Banerjee S.; Gupta A.; Opole I.O.; Fischer M.; Mendoza
V.L.; Reyes E.B.; Pierson R.J.; Shields M.O.; Piriou V.; Zacharowski K.;
Rotta-Rotta A.; Paper M.; Rahate P.; Chaudhry N.; Paniagua Iglesias P.;
Sharma M.
Institution
(Devereaux, Duceppe, Guyatt, Kearon, Bangdiwala, Yusuf) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Tandon, Magloire, Neary, Eikelboom, Kearon, Sharma,
Connolly, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Devereaux, Vincent, Pettit, Sharma, Connolly, Bangdiwala, Rao-Melacini,
Yusuf) Population Health Research Institute, Hamilton, ON, Canada
(Duceppe) Department of Medicine, University of Montreal, Montreal, QC,
Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. Method(s): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. Finding(s): Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). Interpretation(s): Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 100 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication. Funding(s):
Boehringer Ingelheim and Canadian Institutes of Health
Research. Copyright © 2018 Elsevier Ltd

<53>
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.

<54>
Accession Number
2015306848
Title
Renal Restrictive Index (RRI) Versus Urinary Neutrophil
Gelatinase-Associated Lipocalin (uNGAL) for early prediction of acute
kidney injury (AKI) in adults undergoing elective cardiac surgeries with
cardiopulmonary bypass: A prospective randomized observational study.
Source
Egyptian Journal of Anaesthesia. 38(1) (pp 166-173), 2022. Date of
Publication: 2022.
Author
Dawood H.F.A.; Abd Rabbih A.A.R.; Fouad H.A.; El-Shafei M.M.; Hussein H.W.
Institution
(Dawood) Anaesthesia and Surgical Intensive Care, Kafrelsheikh Faculty of
Medicine, Kafrelsheikh, Egypt
(Abd Rabbih, Fouad, Hussein) Anaesthesia and Surgical Intensive Care,
Alexandria Faculty of Medicine, Alexandria, Egypt
(El-Shafei) Radiology and Intervention, Alexandria Faculty of Medicine,
Alexandria, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: Acute kidney injury (AKI) complicates most cardiac surgery
patients. This study assessed the accuracy of urine neutrophil
gelatinase-associated lipocalin (uNGAL) and Renal Resistive Index (RRI) to
early predict (AKI) after cardiopulmonary bypass (CPB). Method(s):
This work enrolled 57 cases of elective cardiac surgery with CPB. Urinary
NGAL and RRI were measured preoperatively and at 1, 6 and 24 h
postoperatively. The primary outcome was AKI, defined by Acute Kidney
Injury Network Classification (AKIN) System. The secondary aim was to
assess the diagnostic accuracy, cut-off point of uNGAL and RRI, and their
relation with AKI severity. AKI developed in 22 patients (38.5%), with 2
cases required dialysis. Mean uNGAL significantly increased by 10 folds at
1h and 15 folds at 6h postoperatively. Result(s): As regard uNGAL,the
1 h diagnostic accuracy was 94.8%, The area under the curve (AUC) was
0.888, using a cut-off value of 194.3 ng/ml. The 6 h diagnostic accuracy
was 96.5%, AUC was 0.995 at a cut-off value 67.1 ng/ml. The 1 and 6 h
uNGAL were unrelated to AKI severity. As regard RRI, AKI patients had
significantly higher 1 h and 6 h RRI. The diagnostic accuracy at 1 h was
93.0%, AUC was 0.991, using a cut-off value of 0.72. The diagnostic
accuracy at 6 h was 94.8%, AUC 0.995 at a cut-off value of 0.71. Values of
RRI were significantly related only to severe cases requiring dialysis.
 Conclusion(s): Urinary NGAL and RRI are early accurate indicators of
AKI. High RRI can predict dialysis-requirement. Copyright © 2022
The Author(s). Published by Informa UK Limited, trading as Taylor &
Francis Group.

<55>
Accession Number
2013310689
Title
Mycophenolic acid and cancer risk in solid organ transplant recipients:
Systematic review and meta-analysis.
Source
British Journal of Clinical Pharmacology. 88(2) (pp 476-489), 2022. Date
of Publication: February 2022.
Author
Hirunsatitpron P.; Hanprasertpong N.; Noppakun K.; Pruksakorn D.;
Teekachunhatean S.; Koonrungsesomboon N.
Institution
(Hirunsatitpron, Hanprasertpong, Teekachunhatean, Koonrungsesomboon)
Department of Pharmacology, Faculty of Medicine, Chiang Mai University,
Thailand
(Hirunsatitpron) Master's Degree Program in Pharmacology, Faculty of
Medicine, Chiang Mai University, Thailand
(Noppakun) Division of Nephrology, Department of Internal Medicine,
Faculty of Medicine, Chiang Mai University, Thailand
(Noppakun) Pharmacoepidemiology and Statistics Research Center, Faculty of
Pharmacy, Chiang Mai University, Thailand
(Pruksakorn, Koonrungsesomboon) Musculoskeletal Science and Translational
Research Center, Faculty of Medicine, Chiang Mai University, Thailand
(Pruksakorn) Omics Center for Health Science, Faculty of Medicine, Chiang
Mai University, Thailand
(Pruksakorn) Biomedical Engineering Institute, Chiang Mai University,
Thailand
Publisher
John Wiley and Sons Inc
Abstract
Aim: Mycophenolic acid (MPA) is an immunosuppressive drug commonly used
for prophylaxis of graft rejection in solid organ transplant recipients.
The main concern with the prolonged use of immunosuppressive drugs is the
risk of developing cancer. However, it remains unclear whether the
immunosuppressive regimens containing MPA confer an increased degree of
cancer risk. The present study aimed to determine the association between
MPA exposure and the incidence of cancer in solid organ transplant
recipients. Method(s): A systematic search was performed on the
PubMed, EMBASE and Cochrane Library databases. Relevant articles that had
findings on the incidence (or event) of cancer in cohorts with and without
MPA exposure were retrieved for data extraction. A meta-analysis was
conducted by means of the random-effects model, and the relative risk (RR)
and its 95% confidence interval (95% CI) were used as a summary effect
measure. Result(s): A total of 39 studies were eligible for
inclusion, with 32 studies that enabled meta-analysis. MPA exposure was
significantly associated with a lower risk of cancer when compared to
azathioprine exposure (RR = 0.66, 95% CI = 0.53-0.81, P <.001) or no
exposure to any additional treatments (RR = 0.85, 95% CI = 0.73-0.99, P
=.04). There was no significant difference in cancer risk for the
comparison between MPA exposure and mammalian target of rapamycin (mTOR)
inhibitor exposure (RR = 1.54, 95% CI = 0.96-2.46, P =.07).
 Conclusion(s): MPA exposure was not associated with an increased risk
of cancer and may even be associated with a lower risk of cancer when
compared to azathioprine or no treatment. Copyright © 2021
British Pharmacological Society

<56>
Accession Number
2010496735
Title
Aspirin Versus Dual Antiplatelet Therapy in Patients Undergoing
Trans-Catheter Aortic Valve Implantation, Updated Meta-Analysis.
Source
Cardiovascular Drugs and Therapy. 36(2) (pp 279-283), 2022. Date of
Publication: April 2022.
Author
Alkhalil M.; Edwards R.; Puri R.; Kalra A.; Zaman A.; Das R.
Institution
(Alkhalil, Edwards, Zaman, Das) Department of Cardiothoracic Services,
Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
(Puri, Kalra) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Zaman) Newcastle University, Newcastle-upon-Tyne, United Kingdom
(Das) Northumbria University, Newcastle upon Tyne, United Kingdom
Publisher
Springer
Abstract
Background: The Antiplatelet Therapy for Patients Undergoing Transcatheter
Aortic-Valve Implantation (POPular TAVI) trial reported comparable
composite endpoints of ischemic events using aspirin compared to dual
antiplatelet therapy (DAPT). However, this trial was not powered to detect
individual differences in ischemic events. We sought to conduct a
meta-analysis to compare aspirin to DAPT on ischemic and bleeding events
following TAVI. Method(s): The MEDLINE database was searched from
inception until September 2020 and only randomized clinical trials of
patients receiving antiplatelet therapy following TAVI were included. The
treatment effect was reported as rate ratios (RRs) with 95% confidence
intervals. Result(s): Four randomized clinical trials of 1086 TAVI
patients were included. There was a 51% reduction in major or
life-threatening bleeding with aspirin compared with DAPT [RR 0.49, (95%CI
0.31 to 0.78)]. Aspirin was not associated with an increased risk of death
[RR 1.01, (95%CI 0.62 to 1.65)], cardiovascular death [RR 1.15, (95%CI
0.56 to 2.36)], ischemic stroke [RR 0.93, (95%CI 0.51 to 1.70)], or MI [RR
0.53, (95%CI 0.18 to 1.57)]. Conclusion(s): This meta-analysis
supports the use of aspirin as the optimal antiplatelet strategy following
TAVI procedures in reducing bleeding without an increase in ischemic
events compared with dual antiplatelet therapy. Copyright © 2021,
Springer Science+Business Media, LLC, part of Springer Nature.

<57>
Accession Number
637903245
Title
Very early invasive angiography versus standard of care in higher-risk
non-ST elevation myocardial infarction: study protocol for the prospective
multicentre randomised controlled RAPID N-STEMI trial.
Source
BMJ Open. 12(5) (no pagination), 2022. Article Number: e055878. Date of
Publication: 03 May 2022.
Author
Kite T.A.; Banning A.S.; Ladwiniec A.; Gale C.P.; Greenwood J.P.; Dalby
M.; Hobson R.; Barber S.; Parker E.; Berry C.; Flather M.D.; Curzen N.;
Banning A.P.; McCann G.P.; Gershlick A.H.
Institution
(Kite, Banning, Ladwiniec, Parker, McCann, Gershlick) Department of
Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom
(Gale, Greenwood) Leeds Institute of Cardiovascular and Metabolic
Medicine, University of Leeds, The Department of Cardiology Leeds Teaching
Hospitals Nhs Trust, Leeds, United Kingdom
(Dalby) Royal Brompton and Harefield Nhs Foundation Trust, London, United
Kingdom
(Hobson, Barber) Leicester Clinical Trials Unit, University of Leicester,
Leicestershire, Leicester, United Kingdom
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, University
Hospital Southampton Nhs Trust, Southampton, United Kingdom
(Banning) Oxford Heart Centre, Oxford University Hospitals Nhs Foundation
Trust, Oxford, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background There are a paucity of randomised data on the optimal timing of
invasive coronary angiography (ICA) in higher-risk patients with non-ST
elevation myocardial infarction (N-STEMI). International guideline
recommendations for early ICA are primarily based on retrospective
subgroup analyses of neutral trials. Aims The RAPID N-STEMI trial aims to
determine whether very early percutaneous revascularisation improves
clinical outcomes as compared with a standard of care strategy in
higher-risk N-STEMI patients. Methods and analysis RAPID N-STEMI is a
prospective, multicentre, open-label, randomised-controlled, pragmatic
strategy trial. Higher-risk N-STEMI patients, as defined by Global
Registry of Acute Coronary Events 2.0 score >=118, or >90 with at least
one additional high-risk feature, were randomised to either: very early
ICA+/-revascularisation or standard of care timing of
ICA+/-revascularisation. The primary outcome is the proportion of
participants with at least one of the following events (all-cause
mortality, non-fatal myocardial infarction and hospital admission for
heart failure) at 12 months. Key secondary outcomes include major bleeding
and stroke. A hypothesis generating cardiac magnetic resonance (CMR)
substudy will provide mechanistic data on infarct size, myocardial salvage
and residual ischaemia post percutaneous coronary intervention. On 7 April
2021, the sponsor discontinued enrolment due to the impact of the COVID-19
pandemic and lower than expected event rates. 425 patients were enrolled,
and 61 patients underwent CMR. Ethics and dissemination The trial has been
reviewed and approved by the East of England Cambridge East Research
Ethics Committee (18/EE/0222). The study results will be submitted for
publication within 6 months of completion. Trial registration number
NCT03707314; Pre-results. Copyright ©

<58>
[Use Link to view the full text]
Accession Number
2017899973
Title
Short-Term Postoperative Use of Rivaroxaban to Prevent Radial Artery
Occlusion after Transradial Coronary Procedure: The RESTORE Randomized
Trial.
Source
Circulation: Cardiovascular Interventions. 15(4) (pp E011555), 2022. Date
of Publication: 01 Apr 2022.
Author
Liang D.; Lin Q.; Zhu Q.; Zhou X.; Fang Y.; Wang L.; Xiang G.; Zheng K.I.;
Huang W.; Shan P.
Institution
(Liang, Lin, Zhu, Zhou, Fang, Wang, Xiang, Huang, Shan) Department of
Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou,
Medical University, Zhejiang, China
(Zheng) NAFLD Research Center, Department of Hepatology the First
Affiliated Hospital of Wenzhou, Medical University, Zhejiang, China
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Adequate procedural anticoagulation is crucial for radial
artery occlusion (RAO) prevention in patients undergoing transradial
access coronary catheterization, although the effect of postprocedural
anticoagulation lack thorough investigation. The aim of this study was to
evaluate the clinical value of short-term postoperative anticoagulation
with rivaroxaban for 24 hours and 1-month RAO prevention in patients who
received transradial coronary procedures. METHOD(S): A total of 382
patients were randomized to receive either placebo (control group) or
rivaroxaban 10 mg once daily for a period of 7 days (rivaroxaban group) to
evaluate the effect of the rivaroxaban in the prevention of 24 hours and
1-month RAO assessed by Doppler ultrasound. RESULT(S): There was no
significant difference in the incidence of 24-hour RAO (8.9% versus 11.5%;
P=0.398) between the rivaroxaban group and control group (odds ratio, 0.75
[95% CI, 0.39-1.46]; P=0.399). In contrast, the 1-month RAO (3.8% versus
11.5%; P=0.011) was significantly reduced in patients who received
rivaroxaban as compared with those who did placebo (odds ratio, 0.22 [95%
CI, 0.08-0.65]; P=0.006). For patients with 24-hour RAO, the rivaroxaban
group was associated with higher recanalization rate of the radial artery
(69.2% versus 30.0%; P=0.027) compared with the control group. No
significant differences can be observed between the 2 groups for
access-site complications or bleeding events. CONCLUSION(S):
Short-term postoperative anticoagulation with rivaroxaban did not reduce
the rate of 24-hour RAO but improved 1-month RAO, because of higher
recanalization of the radial artery. However, larger clinical trials are
needed to prove our results. Copyright © 2022 American Heart
Association, Inc.

<59>
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

<60>
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).

<61>
[Use Link to view the full text]
Accession Number
2017047111
Title
The Analgesic Effect of Ultrasound-guided Bilateral Pectointercostal
Fascial Plane Block on Sternal Wound Pain after Open Heart Surgeries: A
Randomized Controlled Study.
Source
Clinical Journal of Pain. 38(4) (pp 279-284), 2022. Date of Publication:
07 Apr 2022.
Author
Hamed M.A.; Abdelhady M.A.; Hassan A.A.S.M.; Boules M.L.
Institution
(Hamed, Abdelhady, Hassan, Boules) Department of Anesthesiology, Faculty
of Medicine, Fayoum University, Fayoum 63511, Egypt
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: We aimed to evaluate the analgesic efficacy of
ultrasound-guided bilateral pectointercostal fascial plane block after
open heart surgeries. Method(s): Seventy patients aged above 18 years
and scheduled for on-pump coronary artery bypass grafting or valve
replacement or both through median sternotomy were enrolled in this study.
Patients were randomly allocated into 2 groups of 35 (block group or
control group). The block group had the block performed through 20 ml of a
solution of 0.25% bupivacaine plus epinephrine (5 mcg/mL), and the control
group received dry needling. The primary outcome was the 24-hour
cumulative morphine consumption. The secondary outcomes were time to the
first analgesic request, pain score, quality of oxygenation, intensive
care unit stays, and hospital stay. Result(s): The cumulative
morphine consumption in the first 24 hours was significantly lower in the
block group, with a mean difference of -3.54 (95% confidence
interval=-6.55 to -0.53; P=0.015). In addition, the median estimate time
to the first analgesic request was significantly longer in the block group
than in the control group. Finally, during the postoperative period (4 to
24 h), mean sternal wound objective pain scores were, on average, 0.58
units higher in the block group. Conclusion(s): pectointercostal
fascial block is an effective technique in reducing morphine consumption
and controlling poststernotomy pain after cardiac surgeries. Also, it may
have a role in better postoperative respiratory outcomes. Copyright
© 2022 Lippincott Williams and Wilkins. All rights reserved.

<62>
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).

<63>
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.

<64>
Accession Number
2017454595
Title
A Comparison on Effects of High Dose Rosuvastatin versus High Dose
Atorvastatin on Lipid Profile and CRP Level in Patients Undergoing
Percutaneous Coronary Intervention: A Randomized Study.
Source
Pharmaceutical Sciences. 27(4) (pp 568-574), 2021. Date of Publication:
December 2021.
Author
Darban M.; Yusefabadi E.; Khani M.M.; Sohrabi B.; Bagheri B.
Institution
(Darban) Department of Internal Medicine, Kowsar Hospital, Semnan
University of Medical Sciences, Semnan, Iran, Islamic Republic of
(Yusefabadi) Student Research Committee, Kowsar Hospital, Semnan
University of Medical Sciences, Semnan, Iran, Islamic Republic of
(Khani) Social Determinates of Health Research Center, Semnan University
of Medical Sciences, Semnan, Iran, Islamic Republic of
(Khani) Department of Epidemiology and Biostatistics, Semnan University of
Medical Sciences, Semnan, Iran, Islamic Republic of
(Sohrabi) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Bagheri) Cancer Research Center, Semnan University of Medical Sciences,
Semnan, Iran, Islamic Republic of
(Bagheri) Center for Molecular Cardiology, University of Zurich,
Schlieren, Switzerland
Publisher
Tabriz University of Medical Sciences
Abstract
Background: Statins are the most common drugs used for reducing
low-density lipids (LDL). In addition to their lipid-lowering effects,
they have well-documented anti-inflammatory actions. The goal of this
study was to compare the effects of high dose atorvastatin and
rosuvastatin on lipid profiles and high sensitivity C Reactive Protein
(hs-CRP) in patients undergoing percutaneous coronary intervention (PCI).
 Method(s): The study was done between October 2017 and September 2018
in Semnan Kowsar Hospital. In this randomized trial, 69 patients with
atherosclerotic coronary artery disease were randomly assigned 1:1 to
receive atorvastatin (80 mg daily) or rosuvastatin (40 mg daily) for 4
months. Levels of hs-CRP and lipid profiles including cholesterol,
triglyceride, low-density lipids (LDL), and high-density lipids (HDL) were
measured and compared before and after the treatments. Lipid profiles were
measured at baseline, 2 months, and 4 months of the treatment.
 Result(s): Sixty patients completed the study. The mean age was 61.1
+/- 6.6 years with an excess of males. After 4 months, both drugs could
significantly reduce LDL levels, however, the between-group differences
were not statistically significant. Rosuvastatin significantly increased
HDL levels (p < 0.05). In addition, triglyceride levels had a significant
reduction in both groups, yet the differences were not significant. Both
drugs caused significant reductions in hs-CRP levels (p < 0.05). Moreover,
the effects of treatments were seen in drug naive patients as well as
patients who were on statins prior to the trial. Conclusion(s): The
results indicate that high dose therapies with atorvastatin and
rosuvastatin have similar effects on lipid profiles and hs-CRP levels in
patients undergoing PCI. Copyright © 2021 The Author(s).

<65>
Accession Number
2014024581
Title
Cardiovascular disease and its management among Pacific people: a
systematic review by ethnicity and place of birth.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
515. Date of Publication: December 2021.
Author
Winter-Smith J.; Selak V.; Harwood M.; Ameratunga S.; Grey C.
Institution
(Winter-Smith, Selak, Ameratunga, Grey) Section of Epidemiology and
Biostatistics, Faculty of Medical and Health Sciences, The University of
Auckland, Auckland Mail Centre, Private Bag 92019, Auckland 1142, New
Zealand
(Harwood) Department of General Practice and Primary Health Care, Faculty
of Medical and Health Sciences, The University of Auckland, Auckland Mail
Centre, Private Bag 92019, Auckland 1142, New Zealand
(Ameratunga) Population Health Directorate, Counties Manukau Health,
Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
(Grey) Performance Improvement, Auckland District Health Board, Auckland
Mail Centre, Private Bag 92189, Auckland 1142, New Zealand
Publisher
BioMed Central Ltd
Abstract
Background: Pacific people experience a disproportionate burden of
cardiovascular disease (CVD), whether they remain in their country of
origin or migrate to higher-income countries, such as Australia, Aotearoa
New Zealand or the United States of America. We sought to determine
whether the CVD health needs of Pacific people vary according to their
ethnicity or place of birth. Method(s): We conducted a systematic
review of medical research databases and grey literature to identify
relevant data published up to 2020. Texts were included if they contained
original data stratified by Pacific-specific ethnicity or place of birth
on the burden or management of CVD, and were assessed as having good
quality using a National Heart, Lung, and Blood Institute quality
assessment tool. The protocol for this review was registered with the Open
Science Forum (https://doi.org/10.17605/OSF.IO/X7NR6). Result(s): Of
3679 texts identified, 310 full texts were reviewed and the quality of 23
of these assessed, using the pre-defined search strategy. Six items (four
reports, one article, one webpage) of good quality met the review
eligibility criteria. All included texts provided data on epidemiology but
only one reported on the management of CVD. Four texts were of Pacific
populations in Pacific Island countries and two were of Pacific diaspora
in other countries. Data from the Global Burden of Disease study, which
provided estimates for the greatest number of Pacific countries, showed
substantial differences in mortality rates between Pacific countries for
every CVD type. For example, the mortality rate per 100,000 for ischemic
heart disease (IHD) ranged from 103.41 in the Cook Islands to 430.35 in
the Solomon Islands. A New Zealand-based report showed differences in CVD
rates by Pacific ethnicity (e.g. the age-standardised prevalence of IHD
per 1,000 population in Auckland ranged from 107.8 (Niuean) to 138 among
Cook Islands Maori (p < 0.001)). Conclusion(s): This review of
published studies reveals that the epidemiology of CVD among Pacific
people varies by specific ethnic groups, place of birth, and country of
residence. There is a critical need for high-quality contemporary
ethnic-specific Pacific data to respond to the diverse CVD health needs in
these underrepresented groups. Copyright © 2021, The Author(s).

<66>
Accession Number
635788737
Title
Complete Revascularization in Patients Undergoing a Pharmacoinvasive
Strategy for ST-Segment-Elevation Myocardial Infarction: Insights From the
COMPLETE Trial.
Source
Circulation: Cardiovascular Interventions. 14(8) (pp E010458), 2021. Date
of Publication: 01 Aug 2021.
Author
Dehghani P.; Cantor W.J.; Wang J.; Wood D.A.; Storey R.F.; Mehran R.;
Bainey K.R.; Welsh R.C.; Rodes-Cabau J.; Rao S.; Lavi S.; Velianou J.L.;
Natarajan M.K.; Ziakas A.; Guiducci V.; Fernandez-Aviles F.; Cairns J.A.;
Mehta S.R.
Institution
(Dehghani) Prairie Vascular Research Network, University of Saskatchewan,
Regina, Canada
(Cantor) Toronto Southlake Regional Health Centre, University of Toronto,
Ontario, Canada
(Wang, Velianou, Natarajan, Mehta) Hamilton Health Sciences, McMaster
University, Ontario, Canada
(Mehta) Population Health Research Institute (PHRI), Hamilton Health
Sciences, General Division, Dbcvsri, 237 Barton St E, Hamilton, ON L8L
2X2, Canada
(Wood, Cairns) Centre for Cardiovascular Innovation, St. Paul's and
Vancouver General Hospitals, University of British Columbia, Canada
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, United Kingdom
(Mehran) The Zena A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Bainey, Welsh) Mazankowski Alberta Heart Institute, University of
Alberta, Edmonton, Canada
(Rodes-Cabau) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Canada
(Rao) Duke University Medical Center, Durham, NC, United States
(Lavi) London Health Sciences Centre, University of Western Ontario,
Canada
(Ziakas) Ahepa University Hospital, Aristotle University of Thessaloniki,
Greece
(Guiducci) Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
(Fernandez-Aviles) Hospital General Universitario Gregorio Maranon,
Madrid, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The COMPLETE trial (Complete Versus Culprit-Only
Revascularization to Treat Multi-Vessel Disease After Early PCI for STEMI)
demonstrated that staged nonculprit lesion percutaneous coronary
intervention (PCI) reduced major cardiovascular events in patients with
ST-segment-elevation myocardial infarction and multivessel coronary artery
disease. It is unclear whether consistent benefit is observed in patients
undergoing a pharmacoinvasive strategy compared with primary PCI.
 Method(s): Following culprit lesion PCI, 4041 patients with
ST-segment-elevation myocardial infarction and multivessel coronary artery
disease were randomized to either routine nonculprit lesion PCI or culprit
lesion only PCI. In a prespecified analysis, we determined the treatment
effect in 303 patients undergoing a pharmacoinvasive strategy versus 3738
patients undergoing primary PCI on the first coprimary outcome of
cardiovascular death or new myocardial infarction and the second coprimary
outcome of cardiovascular death, new myocardial infarction, or
ischemia-driven revascularization. Result(s): The first coprimary was
reduced with complete revascularization both in the patients undergoing a
pharmacoinvasive strategy (2.1%/y versus 4.7%/y, hazard ratio, 0.45 [95%
CI, 0.21-0.97]) and in patients undergoing primary PCI (2.7%/y versus
3.6%/y, hazard ratio, 0.77 [95% CI, 0.62-0.95]; interaction P=0.18). The
second coprimary outcome was reduced with complete revascularization in
patients undergoing a pharmacoinvasive strategy (2.3%/y versus 8.5%/y,
hazard ratio, 0.28 [95% CI, 0.14-0.56]), and in patients undergoing
primary PCI (3.2%/y versus 6.0%/y, hazard ratio, 0.53 [95% CI, 0.44-0.64],
interaction P=0.07). Conclusion(s): Among patients with
ST-segment-elevation myocardial infarction and multivessel disease,
complete revascularization with multivessel PCI consistently reduces major
cardiovascular events in patients undergoing an initial pharmacoinvasive
strategy as well as in those undergoing primary PCI. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT01740479. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<67>
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.

<68>
[Use Link to view the full text]
Accession Number
635567522
Title
Impact of Predilation during Transcatheter Aortic Valve Replacement:
Insights from the PARTNER 3 Trial.
Source
Circulation: Cardiovascular Interventions. 14(7) (pp E010336), 2021. Date
of Publication: 01 Jul 2021.
Author
Ternacle J.; Al-Azizi K.; Szerlip M.; Potluri S.; Hamandi M.; Blanke P.;
Leipsic J.; Dahou A.; Salaun E.; Vincent F.; Rogers E.; Alu M.C.; Lu M.;
Yu X.; Thourani V.H.; Hahn R.T.; Leon M.B.; Pibarot P.; Mack M.J.
Institution
(Ternacle, Salaun, Vincent, Pibarot) Institut Universitaire de Cardiologie
et de Pneumologie de Quebec, Universite Laval/Quebec Heart and Lung
Institute, Laval University, Canada
(Al-Azizi, Szerlip, Potluri, Hamandi, Mack) Department of Cardiology,
Baylor Scott and White, Heart Hospital Plano, TX, United States
(Al-Azizi, Szerlip, Potluri, Hamandi) Baylor Research Institute, Baylor
Scott and White, Plano, TX, United States
(Blanke, Leipsic) St Paul's Hospital, Vancouver, BC, Canada
(Dahou, Alu, Hahn, Leon) Columbia University Medical Center/New
York-Presbyterian Hospital, United States
(Dahou, Vincent, Alu, Hahn, Leon) Cardiovascular Research Foundation, New
York, NY, United States
(Rogers, Lu, Yu) Edwards Lifesciences, Irvine, CA, United States
(Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute,
Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The use of predilation during transcatheter aortic valve
replacement (TAVR) is variable, and its association with outcomes remains
unknown. We evaluated the impact of predilation versus no predilation
(direct TAVR) in the low-risk population enrolled in the PARTNER 3 trial
(Placement of Aortic Transcatheter Valves). Method(s): In the PARTNER
3 trial, 495 patients with severe symptomatic aortic stenosis underwent
TAVR with the SAPIEN 3 valve. The use of predilation was left to operator
discretion. The primary end point was a composite of all-cause death,
stroke, or rehospitalization. Secondary end points included valve
hemodynamic performance and the need for postdilation. Propensity score
matching was performed. Result(s): Predilation and direct TAVR were
performed in 286 (57.8%) and 209 (42.2%) patients, respectively. Before
matching, the primary end point occurrence at 30 days (3.8% versus 4.8%,
P=0.604) and 1 year (8.7% versus 8.1%, P=0.831) was similar in the
predilation versus direct TAVR groups. Similar results were observed after
matching (202 patients in each groups). Incidence of >= mild paravalvular
regurgitation was similar in both groups. Incidence of severe
prosthesis-patient mismatch was low but higher in the predilation group
versus the direct TAVR group (8.2% versus 2.6%, P=0.023). Compared with
direct TAVR, the use of predilation was associated with longer procedure
duration (63.2 versus 51.4 minutes, P=0.001), while the rate of
postdilation did not differ between the 2 groups (24.8% versus 18.8%,
P=0.150). Conclusion(s): Predilation and direct TAVR are safe in
patients with low surgical risk and favorable aortic valve anatomy. Direct
TAVR decreased the procedure duration and did not predispose to more
postdilation. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT02675114. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<69>
[Use Link to view the full text]
Accession Number
635566190
Title
Utilization, Costs, and Outcomes of Conscious Sedation Versus General
Anesthesia for Transcatheter Aortic Valve Replacement.
Source
Circulation: Cardiovascular Interventions. 14(7) (pp E010310), 2021. Date
of Publication: 01 Jul 2021.
Author
Herrmann H.C.; Cohen D.J.; Hahn R.T.; Babaliaros V.C.; Yu X.; Makkar R.;
McCabe J.; Szerlip M.; Kapadia S.; Russo M.; Malaisrie S.C.; Webb J.G.;
Szeto W.Y.; Kodali S.; Thourani V.H.; Mack M.J.; Leon M.B.
Institution
(Herrmann, Szeto) Perelman School of Medicine of the University of
Pennsylvania, Philadelphia, PA, United States
(Cohen) Cardiovascular Research Foundation, New York, NY, United States
(Hahn, Kodali, Leon) Columbia University Medical Center, New York, NY,
United States
(Babaliaros) Emory University, Atlanta, GA, United States
(Yu) Edwards Lifesciences, Inc, Irvine, CA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(McCabe) University of Washington, Seattle, WA, United States
(Szerlip, Mack) Baylor Scott and White Health, Plano, TX, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Russo) Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Malaisrie) Northwestern University Hospital, Chicago, IL, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The potential advantages for conscious sedation (CS) as
compared to general anesthesia (GA) have not been evaluated in studies
with core laboratory echocardiographic assessments and monitored end
points. We compared CS versus GA for SAPIEN 3 transcatheter aortic valve
replacement in patients at intermediate-and low-surgical risk.
 Method(s): This analysis included patients in the PARTNER 2
(Placement of Aortic Transcatheter Valve Trial) intermediate-risk registry
and the PARTNER 3 randomized low-risk study. CS was compared to GA with
respect to death, stroke, bleeding, paravalvular regurgitation, length of
stay, and costs. Outcomes were assessed by a core echocardiographic
laboratory, and clinical events were independently adjudicated.
 Result(s): Baseline characteristics were similar between the CS and
GA groups. Postprocedure hospital length of stay was significantly shorter
for CS versus GA both in intermediate-risk patients (4.4+/-0.2 and
5.2+/-0.2 days, respectively, P<0.01) and low-risk patients (2.7+/-0.1 and
3.4+/-0.2 days, respectively, P<0.001). There were no significant
differences between CA and GA patients in either the 30-day or 1-year
rates of death, stroke, rehospitalization, or paravalvular aortic
regurgitation >=moderate. In the intermediate-risk cohort, adjusted 30-day
health care costs were $3833 lower per patient in the CS group.
 Conclusion(s): The selective use of CS is associated with shorter
procedure times, shorter intensive care unit and hospital length of stay,
lower costs, and no difference in clinical outcomes to 1 year, including
>=moderate paravalvular regurgitation. Our data demonstrate similar safety
profiles with both approaches and support the continued use of CS for most
patients undergoing the procedure. Registration: URL:
https://www.clinicaltrials.gov; Unique identifiers: NCT03222128 and
NCT02675114. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<70>
[Use Link to view the full text]
Accession Number
635311309
Title
Health-Related Quality of Life and Angina in Fractional Flow
Reserve-Versus Angiography-Guided Coronary Artery Bypass Grafting: FARGO
Trial (Fractional Flow Reserve Versus Angiography Randomization for Graft
Optimization).
Source
Circulation: Cardiovascular Quality and Outcomes. 14(6) (pp E007302),
2021. Date of Publication: 01 Jun 2021.
Author
Thuesen A.L.; Riber L.P.; Veien K.T.; Christiansen E.Ho.; Jensen S.E.;
Modrau I.; Andreasen J.J.; Borregaard B.; Junker A.; Mortensen P.E.;
Jensen L.O.
Institution
(Thuesen, Veien, Borregaard, Junker, Jensen) Department Of Cardiology,
Odense University Hospital, Denmark
(Riber, Mortensen) Department Of Cardiothoracic Surgery, Odense University
Hospital, Denmark
(Christiansen) Department Of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Modrau) Department Of Cardiothoracic Surgery, Aarhus University Hospital,
Skejby, Denmark
(Jensen) Department Of Cardiology, Aalborg University Hospital, Denmark
(Andreasen) Department Of Cardiothoracic Surgery, Aalborg University
Hospital, Denmark
(Andreasen, Borregaard) Department Of Clinical Research, Aalborg
University, Denmark
(Jensen) Department Of Clinical Research, University Of Southern Denmark,
Odense, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In coronary artery bypass grafting (CABG), the use of
fractional flow reserve (FFR) is insufficiently investigated. Stenosis
assessment usually relies on visual estimates of lesion severity. This
study evaluated health-related quality of life (HRQoL) and angina after
FFR-versus angiography-guided CABG. Method(s): One hundred patients
referred for CABG were randomized to FFR-or angiography-guided CABG. In
the FFR group, lesions with FFR>0.80 were deferred, while the surgeon was
blinded to the FFR values in the angiography group. Before and 6 months
after CABG, HRQoL was assessed by the health state classifier EQ-5D of the
EuroQoL 5-level instrument and angina status based on the Canadian
Cardiovascular Society classification system were registered.
 Result(s): Six-month angiography included FFR evaluations of deferred
lesions. In total, completed EQ-5D of the EuroQoL 5-level instrument
questionnaires were available in 86 patients (43 in the FFR versus 43 in
the angiography-guided group). HRQoL was significantly improved and angina
significantly decreased from baseline to 6 months after CABG with no
difference between the randomization groups. Graft failure rates and
clinical outcomes were similar in both groups. Patients with graft failure
or FFR<0.80 of the previous deferred lesions had significantly lower
visual analogue scale scores (78.7+/-14.2 versus 86.8+/-14.7, P=0.004) and
more angina compared with patients without graft failure or FFR>=0.80 at
6-month follow-up. Conclusion(s): FFR-versus angiography-guided CABG
demonstrated similar improvements in HRQoL and angina 6 months after CABG.
Graft failure or low FFR in deferred lesions were associated with low
HRQoL and angina. Registration: URL: https://www.clinicaltrials.gov;
Unique identifier: NCT02477371. Copyright © 2021 Lippincott
Williams and Wilkins. All rights reserved.

<71>
[Use Link to view the full text]
Accession Number
635085890
Title
Accuracy of Cardiovascular Trial Outcome Ascertainment and Treatment
Effect Estimates from Routine Health Data: A Systematic Review and
Meta-Analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. 14(5) (pp E007903),
2021. Date of Publication: 01 May 2021.
Author
Rodrigues C.; Odutayo A.; Patel S.; Agarwal A.; Da Costa B.R.; Lin E.; Yeh
R.W.; Juni P.; Goodman S.G.; Farkouh M.E.; Udell J.A.
Institution
(Rodrigues, Patel, Lin, Udell) Women's College Research Institute,
Toronto, Canada
(Rodrigues) School Of Medicine, Queen's University, Kingston, Canada
(Odutayo, Da Costa, Juni, Goodman, Farkouh) Applied Health Research
Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto,
Canada
(Agarwal) Department Of Medicine, Faculty Of Medicine, University Of
Toronto, Toronto, Canada
(Da Costa) Institute Of Health Policy, Management, And Evaluation,
University Of Toronto, Toronto, Canada
(Da Costa) Institute Of Primary Health Care (BIHAM), University Of Bern,
Switzerland, Switzerland
(Lin) Faculty Of Medicine, University Of Ottawa, Canada
(Yeh) Smith Center For Outcomes Research, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Farkouh) Peter Munk Cardiac Centre, University Health Network, Toronto,
Canada
(Udell) Ices, Toronto, Canada
(Udell) Cardiovascular Division, Department Of Medicine, Women's College
Hospital, Toronto, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Registry-based randomized controlled trials allow for outcome
ascertainment using routine health data (RHD). While this method provides
a potential solution to the rising cost and complexity of clinical trials,
comparative analyses of outcome ascertainment by clinical end point
committee (CEC) adjudication compared with RHD sources are sparse. Among
cardiovascular trials, we set out to systematically compare the incidence
of cardiovascular events and estimated randomized treatment effects
ascertained from RHD versus traditional clinical evaluation and
adjudication. Method(s): We searched MEDLINE (1976 to August 2020)
for studies where outcome ascertainment was performed by both RHD and CEC
adjudication to compare the incidence of cardiovascular events and
treatment effects. We derived ratios of hazard ratios to compare treatment
effects from RHD and CEC adjudication. We pooled ratios of hazard ratios
using an inverse variance random-effects meta-analysis. Result(s):
Nine studies (1988-2020; 32 156 patients) involving 10 randomized control
trials compared outcome ascertainment with RHD and CEC in patients with or
at risk of cardiovascular disease. There was a high degree of agreement
and interrater reliability between CEC and RHD outcome determination for
all-cause mortality (agreement percentage: 98.4%-100% and kappa: 0.95-1.0)
and cardiovascular mortality (agreement percentage: 97.8%-99.9% and kappa:
0.66-0.99). For myocardial infarction, the kappa values ranged from
0.67-0.98, and for stroke the values ranged from 0.52-0.89. In contrast,
the kappa value for peripheral artery disease was low (kappa: 0.27). There
was little difference in the randomized treatment effect derived from CEC
and RHD ascertainment of events based on the ratios of hazard ratio, with
pooled ratios of hazard ratios ranging from 0.93 (95% CI, 0.63-1.39) for
cardiovascular mortality to 1.27 (95% CI, 0.67-2.41) for stroke.
 Conclusion(s): Clinical outcome ascertainment using retrospectively
acquired RHD displayed high levels of agreement with CEC adjudication for
identifying all-cause mortality and cardiovascular outcomes. Importantly,
cardiovascular treatment effects in randomized control trials determined
from RHD and CEC resulted in similar point estimates. Overall, our review
supports the use of RHD as a potential alternative source for clinical
outcome ascertainment in cardiovascular trials. Validation studies with
prospectively planned linkage are warranted. Copyright © 2021
Lippincott Williams and Wilkins. All rights reserved.

<72>
Accession Number
2014388766
Title
Nocturnal dexmedetomidine alleviates post-intensive care syndrome
following cardiac surgery: a prospective randomized controlled clinical
trial.
Source
BMC Medicine. 19(1) (no pagination), 2021. Article Number: 306. Date of
Publication: December 2021.
Author
Dong C.-H.; Gao C.-N.; An X.-H.; Li N.; Yang L.; Li D.-C.; Tan Q.
Institution
(Dong, Li, Tan) Department of Cardiac Surgery, Shandong Provincial
Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi
Road, Jinan, Shandong 250021, China
(Gao) Department of Biostatistics, School of Public Health, Cheeloo
College of Medicine, Shandong University, Jinan, Shandong 250012, China
(Gao) Healthcare Big Data Institute of Shandong University, Jinan,
Shandong 250000, China
(An) Department of Anesthesiology, Shandong Provincial Hospital Affiliated
to Shandong First Medical University, Jinan, Shandong 250021, China
(Li) Department of Gynecology, Shandong Provincial Hospital Affiliated to
Shandong First Medical University, Jinan, Shandong 250021, China
(Yang) Department of Cardiology, Shandong Provincial Hospital Affiliated
to Shandong First Medical University, Jinan, Shandong 250021, China
(Tan) Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo
College of Medicine, Shandong University, Jinan, Shandong 250021, China
Publisher
BioMed Central Ltd
Abstract
Background: Dexmedetomidine is a sedative agent that may have the
potential to reduce the risk of post-intensive care syndrome (PICS). This
study aimed to establish whether prophylactic nocturnal dexmedetomidine
safely reduces postoperative PICS incidence and to develop an easy-to-use
model for predicting the risk of PICS following cardiac surgery.
 Method(s): This was a single-center, double-blind, randomized,
prospective, placebo-controlled trial. Patients undergoing cardiac surgery
were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline)
groups between January 2019 and July 2020. Dexmedetomidine or a similar
volume of saline was administered, with an infusion rate up to 1.2
mug/kg/h until the RASS remained between - 1 and 0. The primary study
endpoint was PICS incidence at 6 months follow-up, as defined by
cognitive, physical, or psychological impairments. Result(s): We
assessed 703 individuals for eligibility, of whom 508 were enrolled. Of
these, there were 251 in the dexmedetomidine group and 257 in the placebo
group that received the trial agent, forming a modified intention-to-treat
population. PICS incidence at 6-month follow-up was significantly
decreased in the dexmedetomidine group (54/251, 21.5%) relative to the
placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665-0.945;
p = 0.014). Psychological impairment was significantly reduced in the
dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR
0.806, CI 0.672-0.967, p = 0.029). However, dexmedetomidine treatment was
associated with a higher rate of hypotension. A nomogram revealed that
age, education, a medical history of diabetes and smoking, dexmedetomidine
treatment, postoperative atrial fibrillation, and sequential organ failure
assessment scores at 8 h post-surgery were independent predictors of PICS.
 Conclusion(s): Prophylactic nocturnal dexmedetomidine administration
significantly reduced PICS incidence by a marked reduction in
psychological impairment within a 6-month follow-up period. Trial
registration: ChiCTR, ChiCTR1800014314. Registered 5 January 2018,
http://www.chictr.org.cn/index.aspx. Copyright © 2021, The
Author(s).

<73>
Accession Number
2017205988
Title
A physiology-based trigger score to guide perioperative transfusion of
allogeneic red blood cells: A multicentre randomised controlled trial.
Source
Transfusion Medicine. (no pagination), 2022. Date of Publication: 2022.
Author
Lu K.; Huang Z.; Liang S.; Pan F.; Zhang C.; Wei J.; Wei H.; Wang Y.; Liao
R.; Huang A.; Huang Y.
Institution
(Lu, Liang, Wei, Huang) Department of Anesthesiology, The Third Affiliated
Hospital of Guangxi Medical University, Guangxi, Nanning, China
(Huang, Pan, Zhang) Department of Anesthesiology, Affiliated Hospital of
Youjiang Medical University for Nationalities, Guangxi, Baise, China
(Wei, Wang, Huang) Department of Anesthesiology, People's Hospital of
Guangxi Zhuang Autonomous Region, Guangxi, Nanning, China
(Liao) Department of Anesthesiology, West China Hospital, Sichuan
University, Sichuan, Chengdu, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Restrictive blood transfusion is recommended by major
guidelines for perioperative management, but requires objective assessment
at 7-10 g/dl haemoglobin (Hb). A scoring system that considers the
physiological needs of the heart may simply the practice and reduce
transfusion. Method(s): Patients (14-65 years of age) undergoing
non-cardiac surgery were randomised at a 1:1 ratio to a control group
versus a Perioperative Transfusion Trigger Score (POTTS) group. POTTS
(maximum of 10) was calculated as 6 plus the following: adrenaline
infusion rate (0 for no infusion, 1 for <=0.05
mug.kg-1.min-1, and 2 for higher rate),
FiO<inf>2</inf> to keep SpO<inf>2</inf> at >=95% (0 for <=35%, 1 for
36%-50%, and 2 for higher), core temperature (0 for <38degreeC, 1 for
38-40degreeC, and 2 for higher), and angina history (0 for no, 1 for
exertional, and 2 for resting). Transfusion is indicated when actual Hb is
lower than the calculated POTTS in individual patients. Transfusion in the
control group was based on the 2012 American Association for Blood Banks
(AABB) guideline. The primary outcome was the proportion of the patients
requiring transfusion of allogeneic red blood cells (RBCs) during the
perioperative period (until discharge from hospital), as assessed in the
intention-to-treat (ITT) population (all randomised subjects).
 Result(s): A total of 864 patients (mean age 44.4 years, 244 men and
620 women) were enrolled from December 2017 to January 2021 (433 in the
control and 431 in the POTTS group). Baseline Hb was 9.2 +/- 1.8 and 9.2
+/- 1.7 g/dl in the control and POTTS groups, respectively. In the ITT
analysis, the proportion of the patients receiving allogeneic RBCs was
43.9% (190/433) in the control group versus 36.9% (159/431) in the POTTS
group (p = 0.036). Lower rate of allogeneic RBCs transfusion in the POTTS
group was also evident in the per-protocol analysis (42.8% vs. 35.5%, p =
0.030). Transfusion volume was 4.0 (2.0, 6.0) and 3.5 (2.0, 5.5) units
(200 ml/unit) in the control and POTTS groups, respectively (p = 0.25).
The rate of severe postoperative complications (Clavien-Dindo grade IIIa
and higher) was 3.9% in the control group versus 1.2% in the POTTS group
(p = 0.010). Conclusion(s): Transfusion of allogeneic RBCs based on
the POTTS was safe and reduced the transfusion requirement in patients
undergoing non-cardiac surgery. Copyright © 2022 The Authors.
Transfusion Medicine published by John Wiley & Sons Ltd on behalf of
British Blood Transfusion Society.

<74>
Accession Number
2016081482
Title
Advances in Clinical Cardiology 2021: A Summary of Key Clinical Trials.
Source
Advances in Therapy. 39(6) (pp 2398-2437), 2022. Date of Publication: June
2022.
Author
Savage P.; Cox B.; Linden K.; Coburn J.; Shahmohammadi M.; Menown I.
Institution
(Savage, Cox, Linden, Coburn, Shahmohammadi, Menown) Craigavon Cardiac
Centre, Southern Health and Social Care Trust, Northern Ireland,
Craigavon, United Kingdom
Publisher
Adis
Abstract
Introduction: Over the course of 2021, numerous key clinical trials with
valuable contributions to clinical cardiology were published or presented
at major international conferences. This review seeks to summarise these
trials and reflect on their clinical context. Method(s): The authors
reviewed clinical trials presented at major cardiology conferences during
2021 including the American College of Cardiology (ACC), European
Association for Percutaneous Cardiovascular Interventions (EuroPCR),
European Society of Cardiology (ESC), Transcatheter Cardiovascular
Therapeutics (TCT), American Heart Association (AHA), European Heart
Rhythm Association (EHRA), Society for Cardiovascular Angiography and
Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular
Research Technologies (CRT). Trials with a broad relevance to the
cardiology community and those with potential to change current practice
were included. Result(s): A total of 150 key cardiology clinical
trials were identified for inclusion. Interventional cardiology data
included trials evaluating the use of new generation novel stent
technology and new intravascular physiology strategies such as
quantitative flow ratio (QFR) to guide revascularisation in stable and
unstable coronary artery disease. New trials in acute coronary syndromes
focused on shock, out of hospital cardiac arrest (OOHCA), the impact of
COVID-19 on ST-elevation myocardial infarction (STEMI) networks and
optimal duration/type of antiplatelet treatment. Structural intervention
trials included latest data on transcatheter aortic valve replacement
(TAVR) and mitral, tricuspid and pulmonary valve interventions. Heart
failure data included trials with sodium-glucose cotransporter 2 (SGLT2)
inhibitors, sacubitril/valsartan and novel drugs such as mavacamten for
hypertrophic cardiomyopathy (HCM). Prevention trials included new data on
proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In
electrophysiology, new data regarding atrial fibrillation (AF) screening
and new evidence for rhythm vs. rate control strategies were evaluated.
 Conclusion(s): This article presents a summary of key clinical
cardiology trials published and presented during the past year and should
be of interest to both practising clinicians and
researchers. Copyright © 2022, The Author(s).

<75>
Accession Number
2015519442
Title
Analgesic effect of inhaled lavender essential oil for frenotomy in
healthy neonates: a randomized clinical trial.
Source
World Journal of Pediatrics. 18(6) (pp 398-403), 2022. Date of
Publication: June 2022.
Author
Maya-Enero S.; Fabregas-Mitjans M.; Llufriu-Marques R.M.; Candel-Pau J.;
Garcia-Garcia J.; Lopez-Vilchez M.A.
Institution
(Maya-Enero, Fabregas-Mitjans, Llufriu-Marques, Candel-Pau, Garcia-Garcia,
Lopez-Vilchez) Department of Neonatology, Service of Pediatrics, Hospital
del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Maritim
25-29, Barcelona 08003, Spain
Publisher
Institute of Pediatrics of Zhejiang University
Abstract
Background: Neonatal pain may affect long-term neurodevelopment and must
be treated. Frenotomy is a painful procedure wherein a common strategy to
relieve pain (sucking) cannot be used because the technique is performed
on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic
properties and has been successfully used to treat pain during heel
puncture and vaccination. Our aim was to demonstrate if the use of inhaled
LEO is effective in reducing pain during frenotomy in healthy, full-term
neonates. Method(s): We conducted a randomized clinical trial in
neonates who underwent a frenotomy between August 2020 and April 2021. We
assessed pain using pre and post-procedure heart rate and oxygen
saturation, crying time and Neonatal Infant Pain Scale (NIPS) score.
Patients with type 3 tongue tie were randomized into the "experimental
group" and "control group". In both groups, we performed swaddling,
administered oral sucrose, and let the newborn suck for two minutes. In
the experimental group, we also placed a gauze pad with one drop of LEO
under the neonate's nose for two minutes prior to and during the
frenotomy. Result(s): We enrolled 142 patients (71 per group). The
experimental group showed significantly lower NIPS scores (1.88 vs 2.92)
and cried almost half the amount of time (14.8 vs. 24.6 seconds, P =
0.006). Comparing with the control group, we observed no side effects in
either of the groups. Conclusion(s): We observed a significant
decrease in crying time and lower NIPS scores in the neonates who received
inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we
recommend using inhaled LEO during neonatal frenotomies. Copyright
© 2022, Children's Hospital, Zhejiang University School of Medicine.

<76>
Accession Number
2014741083
Title
Morbidity and mortality in patients managed with high compared with low
blood pressure targets during on-pump cardiac surgery: a systematic review
and meta-analysis of randomized controlled trials.
Source
Canadian Journal of Anesthesia. 69(3) (pp 374-386), 2022. Date of
Publication: March 2022.
Author
McEwen C.C.; Amir T.; Qiu Y.; Young J.; Kennedy K.; Grocott H.P.; Kashani
H.; Mazer D.; Brudney S.; Kavosh M.; Jacobsohn E.; Vedel A.; Wang E.;
Whitlock R.P.; Belley-Cote E.P.; Spence J.
Institution
(McEwen) Department of Surgery (Cardiac Surgery), McMaster University,
Hamilton, ON, Canada
(Amir, Qiu, Wang) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Young) Health Sciences Library, McMaster University, Hamilton, ON, Canada
(Kennedy) Department of Health Research Methods, Evaluation, and Impact,
McMaster University, Hamilton, ON, Canada
(Grocott, Kashani, Kavosh) Department of Anesthesia and Perioperative
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Brudney, Jacobsohn) Departments of Medicine (Critical Care) and
Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg,
MB, Canada
(Vedel) Department of Cardiothoracic Anesthesiology, Copenhagen University
Hospital, Copenhagen, Denmark
(Whitlock) Departments of Surgery (Cardiac Surgery) and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
(Whitlock, Belley-Cote, Spence) Perioperative Research Division,
Population Health Research Institute, Hamilton, ON, Canada
(Belley-Cote) Departments of Medicine (Cardiology and Critical Care) and
Health Research Methods, Evaluation, and Impact, McMaster University,
Hamilton, ON, Canada
(Spence) Departments of Anesthesia and Critical Care and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
Publisher
Springer
Abstract
Purpose: Many believe that blood pressure management during cardiac
surgery is associated with postoperative outcomes. We conducted a
systematic review and meta-analysis of randomized controlled trials (RCTs)
to determine the impact of high compared with low intraoperative blood
pressure targets on postoperative morbidity and mortality in adults
undergoing cardiac surgery on cardiopulmonary bypass (CPB). Our primary
objective was to inform the design of a future large RCT. Source: We
searched MEDLINE, EMBASE, Web of Science, CINAHL, and CENTRAL for RCTs
comparing high with low intraoperative blood pressure targets in adult
patients undergoing any cardiac surgical procedure on CPB. We screened
reference lists, grey literature, and conference proceedings. Principal
findings: We included eight RCTs (N =1,116 participants); all examined the
effect of blood pressure management only during the CPB. Trial definitions
of high compared with low blood pressure varied and, in some, there was a
discrepancy between the target and achieved mean arterial pressure. We
observed no difference in delirium, cognitive decline, stroke, acute
kidney injury, or mortality between high and low blood pressure targets
(very-low to low quality evidence). Higher blood pressure targets may have
increased the risk of requiring a blood transfusion (three trials; n = 456
participants; relative risk, 1.4; 95% confidence interval, 1.1 to 1.9; P =
0.01; moderate quality evidence) but this finding was based on a small
number of trials. Conclusion(s): Individual trial definitions of high
and low blood pressure targets varied, limiting inferences. The effect of
high (compared with low) blood pressure targets on other morbidity and
mortality after cardiac surgery remains unclear because of limitations
with the body of existing evidence. Research to determine the optimal
management of blood pressure during cardiac surgery is required. Study
registration: PROSPERO (CRD42020177376); registered: 5 July
2020. Copyright © 2022, Canadian Anesthesiologists' Society.

<77>
Accession Number
2013292614
Title
Feasibility and efficacy of cryoneurolysis analgesia in robotic-assisted
thoracoscopic surgery (CARTS): a pilot study.
Source
Journal of Robotic Surgery. 16(3) (pp 597-600), 2022. Date of Publication:
June 2022.
Author
Tung J.; Patel R.; Rajwani T.; Han S.; Hanson N.; Sternbach J.; Hubka M.
Institution
(Tung, Patel, Rajwani, Han, Hanson, Sternbach, Hubka) Virginia Mason
Medical Center, Virginia Mason Hospital, Seattle, WA, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Opioid therapy has been the mainstay therapy of post-operative pain
management in thoracic surgery patients. With the high incidence of
chronic pain in thoracic surgery patients and adverse effects of opioids,
we examined the safety and efficacy of cryoneurolysis as an adjunct for
narcotic-free pain management in robotic-assisted thoracoscopic
lobectomies. Ten consecutive patients undergoing robotic-assisted
(DaVinci) pulmonary resection and cryoneurolysis were compared to ten
patients managed without intraoperative cryoneurolysis. All patients
received multimodal pain regimen including paravertebral blocks as per our
institutional enhanced recovery pathway. Patients with chronic pain and
chronic opioid use were excluded. We compared inpatient and outpatient
opioid consumption measured in morphine equivalents (mme), incidence of
opioid-free outpatient recovery, and adverse events. The two groups did
not differ significantly in terms of baseline demographics. Both inpatient
(88.13 vs 26.92 mme) and outpatient (118.5 vs 34.5 mme) use of narcotics
were significantly lower in the cryoneurolysis group (p < 0.05) with seven
of ten patients receiving cryoneurolysis able to recover without the use
of opioids in the outpatient setting, compared to two in the control
group. One patient reported post-operative neuralgia in each
cryoneurolysis and control group. There were no readmissions in either
group and mean length of stay was identical at 1.7 days in control group
and 1.1 days in experimental group (p = 0.33). The use of intraoperative
intercostal cryoneurolysis may safely reduce the utilization of outpatient
opioids in patients undergoing robotic-assisted thoracoscopic surgery. A
randomized controlled trial is warranted to validate these findings in a
larger cohort of patients. Copyright © 2021, The Author(s), under
exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

<78>
Accession Number
2007545174
Title
Cerebral oximetry in adult cardiac surgery to reduce the incidence of
neurological impairment and hospital length-of-stay: A prospective,
randomized, controlled trial.
Source
Journal of the Intensive Care Society. 23(2) (pp 109-116), 2022. Date of
Publication: May 2022.
Author
Bennett S.R.; Smith N.; Bennett M.R.
Institution
(Bennett) King Faisal Cardiac Center, National Guard Hospital, King
Abdulaziz Medical City, Jeddah, Saudi Arabia
(Smith) Department of Anaesthesia and Intensive Care, Castle Hill
Hospital, Hull and East Yorkshire Hospital Trust, Cottingham, United
Kingdom
(Bennett) Department of Medicine, Manchester University Foundation Trust,
Manchester, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has
been shown to reduce neurological dysfunction and hospital length-of-stay
after adult cardiac surgery in some but not all studies. We audited
maintaining cerebral saturations at or above baseline and showed improved
neurological and length-of-stay outcomes. Our hypothesis for this study
was that our NIRS protocol would improve neurological and length-of-stay
outcomes. Method(s): This prospective, single centre, double-blinded
controlled study randomized 182 consecutive patients, scheduled for
cardiac surgery using cardiopulmonary bypass. Participants were randomized
by concealed envelope prior to anaesthesia. NIRS study group were managed
perioperatively using our NIRS protocol of 8 interventions, increase
cardiac output, normocapnia, increase mean arterial pressure, increase
inspired oxygen, depth of anaesthesia, blood transfusion, correction of
bypass cannula, change of surgical plan to restore levels equal to or
above baseline. The control group had standard management without NIRS.
Primary outcomes were neurological impairment (early and late) and
hospital length-of-stay. Secondary outcomes were ventilation times,
intensive care length-of-stay, major organ dysfunction and mortality.
 Result(s): 91 patients entered each group. There was a significant
improvement in self-reported six-month general functionality in the NIRS
group (p = 0.016). Early neurological dysfunction and hospital
length-of-stay was the same in both groups. Of the secondary outcomes only
Intensive Care length-of-stay was statistically significant, being shorter
in the NIRS group (p = 0.026). Conclusion(s): Maintaining cerebral
saturations above baseline reduces time spent in Intensive Care and may
improve long term functional recovery but not stroke, major organ
dysfunction and mortality. Copyright © The Intensive Care Society
2020.

<79>
[Use Link to view the full text]
Accession Number
635248280
Title
Cerebral Embolic Protection and Outcomes of Transcatheter Aortic Valve
Replacement.
Source
Circulation. 143(23) (pp 2229-2240), 2021. Date of Publication: 08 Jun
2021.
Author
Butala N.M.; Makkar R.; Secemsky E.A.; Gallup D.; Marquis-Gravel G.;
Kosinski A.S.; Vemulapalli S.; Valle J.A.; Bradley S.M.; Chakravarty T.;
Yeh R.W.; Cohen D.J.
Institution
(Butala, Secemsky, Yeh) Smith Center for Outcomes Research in Cardiology,
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Butala) Massachusetts General Hospital, Harvard Medical School, Boston,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Gallup, Marquis-Gravel, Kosinski, Vemulapalli) Duke Clinical Research
Institute, Durham, NC, United States
(Valle) University of Colorado School of Medicine, Aurora, United States
(Valle) Michigan Heart and Vascular Institute, Ann Arbor, United States
(Bradley) Minneapolis Heart Institute, MN, United States
(Cohen) Cardiovascular Research Foundation, New York, United States
(Cohen) St. Francis Hospital, Roslyn, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Stroke remains a devastating complication of transcatheter
aortic valve replacement (TAVR), which has persisted despite refinements
in technique and increased operator experience. While cerebral embolic
protection devices (EPDs) have been developed to mitigate this risk, data
regarding their impact on stroke and other outcomes after TAVR are
limited. METHOD(S): We performed an observational study using data
from the Society for Thoracic Surgeons/American College of Cardiology
Transcatheter Valve Therapy Registry. Patients were included if they
underwent elective or urgent transfemoral TAVR between January 2018 and
December 2019. The primary outcome was in-hospital stroke. To adjust for
confounding, the association between EPD use and clinical outcomes was
evaluated using instrumental variable analysis, a technique designed to
support causal inference from observational data, with site-level
preference for EPD use within the same quarter of the procedure as the
instrument. We also performed a propensity score-based secondary analysis
using overlap weights. RESULT(S): Our analytic sample included 123
186 patients from 599 sites. The use of EPD during TAVR increased over
time, reaching 28% of sites and 13% of TAVR procedures by December 2019.
There was wide variation in EPD use across hospitals, with 8% of sites
performing >50% of TAVR procedures with an EPD and 72% performing no
procedures with an EPD in the last quarter of 2019. In our primary
analysis using the instrumental variable model, there was no association
between EPD use and in-hospital stroke (adjusted relative risk, 0.90 [95%
CI, 0.68-1.13]; absolute risk difference, -0.15% [95% CI, -0.49 to 0.20]).
However, in our secondary analysis using the propensity score-based model,
EPD use was associated with 18% lower odds of in-hospital stroke (adjusted
odds ratio, 0.82 [95% CI, 0.69-0.97]; absolute risk difference, -0.28%
[95% CI, -0.52 to -0.03]). Results were generally consistent across the
secondary end points, as well as subgroup analyses. CONCLUSION(S): In
this nationally representative observational study, we did not find an
association between EPD use for TAVR and in-hospital stroke in our primary
instrumental variable analysis, and found only a modestly lower risk of
in-hospital stroke in our secondary propensity-weighted analysis. These
findings provide a strong basis for large-scale randomized, controlled
trials to test whether EPDs provide meaningful clinical benefit for
patients undergoing TAVR. Copyright © 2021 American Heart
Association, Inc.

<80>
Accession Number
2018337209
Title
Acute acalculous cholecystitis and cardiovascular disease, which came
first? After two hundred years still the classic chicken and eggs debate:
A review of literature.
Source
Annals of Medicine and Surgery. 78 (no pagination), 2022. Article Number:
103668. Date of Publication: June 2022.
Author
Sarago M.; Fiore D.; De Rosa S.; Amaddeo A.; Pulitano L.; Bozzarello C.;
Iannello A.M.; Sammarco G.; Indolfi C.; Rizzuto A.
Institution
(Sarago, Fiore, De Rosa, Amaddeo, Pulitano, Bozzarello, Iannello,
Sammarco, Indolfi, Rizzuto) Department of Medical and Surgical Sciences,
University Magna Graecia of Catanzaro, Italy
Publisher
Elsevier Ltd
Abstract
The existence of a close association between disease of the biliary tract
and disease of the heart is known from the mists of time. Acute acalculous
cholecystitis (AAC) can be defined as an acute necro inflammatory disease
of the gallbladder in the absence of cholelithiasis. AAC is a challenging
diagnosis. The atypical clinical onset associated to a paucity and
similarity of symptoms and to laboratory data mimicking cardiovascular
disease (CVD) often results in under and misdiagnosed cases. Moreover, AAC
has commonly a fulminant course compared to calculous cholecystitis and it
is often associated with gangrene, perforation and empyema as well as
considerable morbidity and mortality (up 50%). Early diagnosis is crucial
to a prompt treatment in order to avoid complications and to increase
survivability. Even today, although scientific evidence dating two hundred
years has shown a close association between AAC and CVD, due to the lack
of RCT, there is still a lot of confusion regarding the relationship and
consequently the clinical management AAC and CVD. In addition, emergency
physicians are not always familiar with transient ECG changes with AAC.
The aim of this review was to provide evidence regarding epidemiology,
pathophysiology, clinical presentation and treatment of the complex
association between AAC and CVD. Our main findings indicate that AAC
should be suspected after each general disease leading to hypoperfusion
such as cardiovascular diseases or cerebrovascular diseases or major heart
or aortic surgery. ECG changes in absence of significant laboratory data
for IMA (Acute myocardial infarction) could be related to a misdiagnosed
AAC. US - Ultrasonography-plays a key role in the early diagnosis and also
in the follow up of AAC. Cholecystostomy and cholecystectomy as unique or
sequential represent the two prevailing treatment options for
AAC. Copyright © 2022

<81>
Accession Number
2017108954
Title
Evolocumab administration prior to Coronary Artery Bypass Grafting in
patients with multivessel coronary artery disease (EVOCABG): study
protocol for a randomized controlled clinical trial.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 430. Date of
Publication: December 2022.
Author
Na H.R.; Kwon O.S.; Kang J.K.; Kim Y.H.; Lim J.Y.
Institution
(Na, Kim, Lim) Department of Cardiothoracic Surgery, The Catholic
University of Korea Seoul St. Mary's Hospital, Seoul, South Korea
(Kwon) Department of Cardiology, The Catholic University of Korea
Eunpyeong St. Mary's Hospital, Seoul, South Korea
(Kang) Department of Cardiothoracic Surgery, The Catholic University of
Korea Eunpyeong St. Mary's Hospital, Seoul, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Despite advances in surgical and postoperative care,
myocardial injury or infarction (MI) is still a common complication in
patients undergoing coronary artery bypass surgery (CABG). Several studies
that aimed to reduce postoperative myocardial injury, including those
investigating statin loading, have been conducted but did not indicate any
clear benefits. Evolocumab, a PCSK9 inhibitor, has been reported to lower
lipids and prevent ischemic events in various medical conditions. However,
the effect of evolocumab in cardiovascular surgery has not been evaluated.
The objective of this trial is to evaluate the cardioprotective effects of
evolocumab in elective CABG patients with multivessel coronary artery
disease. Method(s): EVOCABG is a prospective, randomized, open,
controlled, multicenter, superiority, phase III clinical trial. Patients
with multivessel coronary artery disease without initial cardiac enzyme
elevation will be recruited (n=100). Participants will be randomly
allocated into two groups: a test group (evolocumab (140mg) administration
once within 72 h before CABG) and a control group (no administration). The
primary outcome is the change in peak levels of serum cardiac marker
(troponin-I) within 3 days of CABG surgery compared to the baseline.
Secondary outcomes include post-operative clinical events including death,
myocardial infarction, heart failure, stroke, and atrial fibrillation.
 Discussion(s): This trial is the first prospective randomized
controlled trial to demonstrate the efficacy of evolocumab in reducing
ischemic-reperfusion injury in patients undergoing CABG. This trial will
provide the first high-quality evidence for preoperative use of evolocumab
in mitigating or preventing ischemic-reperfusion-related myocardial injury
during the surgery. Trial registration: Clinical Research Information
Service (CRIS) of the Republic of Korea KCT0005577. Registered on 4
November 2020. Copyright © 2022, The Author(s).

<82>
Accession Number
2017077080
Title
Anticholinergic Drug Exposure Increases the Risk of Delirium in Older
Patients Undergoing Elective Surgery.
Source
Frontiers in Medicine. 9 (no pagination), 2022. Article Number: 871229.
Date of Publication: 06 May 2022.
Author
Herrmann M.L.; Boden C.; Maurer C.; Kentischer F.; Mennig E.; Wagner S.;
Conzelmann L.O.; Forstner B.R.; Rapp M.A.; von Arnim C.A.F.; Denkinger M.;
Eschweiler G.W.; Thomas C.
Institution
(Herrmann, Maurer) Department of Neurology and Neurophysiology, Medical
Center, University of Freiburg, Freiburg, Germany
(Herrmann, Boden, Eschweiler, Thomas) Geriatric Center and Department of
Psychiatry and Psychotherapy, Tubingen University Hospital, Tubingen,
Germany
(Maurer, Kentischer) Center for Geriatrics and Gerontology, University
Medical Center Freiburg, Freiburg, Germany
(Mennig, Thomas) Department of Geriatric Psychiatry and Psychotherapy,
Stuttgart, Germany
(Wagner) Department of Anesthesiology, Stuttgart, Germany
(Wagner) Department of Anesthesia, Critical Care and Pain Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(Conzelmann) Helios Clinic for Cardiac Surgery, Karlsruhe, Karlsruhe,
Germany
(Forstner, Rapp) Department of Social and Preventive Medicine, University
of Potsdam, Potsdam, Germany
(von Arnim) Department of Geriatrics, University Medical Center Gottingen,
Georg August University, Gottingen, Germany
(Denkinger) Geriatric Center, Agaplesion Bethesda Clinic Ulm, Ulm, Germany
(Denkinger) Institute for Geriatric Research, Ulm University Medical
Center, Ulm, Germany
Publisher
Frontiers Media S.A.
Abstract
Introduction: Postoperative delirium (POD) is a common and serious adverse
event of surgery in older people. Because of its great impact on patients'
safety and quality of life, identification of modifiable risk factors
could be useful. Although preoperative medication intake is assumed to be
an important modifiable risk factor, the impact of anticholinergic drugs
on the occurrence of POD seems underestimated in elective surgery. The aim
of this study was to investigate the association between preoperative
anticholinergic burden and POD. We hypothesized that a high preoperative
anticholinergic burden is an independent, potentially modifiable
predisposing and precipitating factor of POD in older people.
 Method(s): Between November 2017 and April 2019, 1,470 patients of 70
years and older undergoing elective orthopedic, general, cardiac, or
vascular surgery were recruited in the randomized, prospective,
multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899
patients, who did not receive a multimodal intervention for preventing
POD, was assessed by two different tools at hospital admission: The
established Anticholinergic Risk Scale (ARS) and the recently developed
Anticholinergic Burden Score (ABS). POD was detected by confusion
assessment method (CAM) and a validated post discharge medical record
review. Logistic regression analyses were performed to evaluate the
association between anticholinergic burden and POD. Result(s): POD
was observed in 210 of 899 patients (23.4%). Both ARS and ABS were
independently associated with POD. The association persisted after
adjustment for relevant confounding factors such as age, sex,
comorbidities, preoperative cognitive and physical status, number of
prescribed drugs, surgery time, type of surgery and anesthesia, usage of
heart-lung-machine, and treatment in intensive care unit. If a patient was
taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold
higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional
point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). Conclusion(s):
Preoperative anticholinergic drug exposure measured by ARS or ABS was
independently associated with POD in older patients undergoing elective
surgery. Therefore, identification, discontinuation or substitution of
anticholinergic medication prior to surgery may be a promising approach to
reduce the risk of POD in older patients. Copyright © 2022
Herrmann, Boden, Maurer, Kentischer, Mennig, Wagner, Conzelmann, Forstner,
Rapp, von Arnim, Denkinger, Eschweiler and Thomas.

<83>
Accession Number
2017039103
Title
A comparative study between Thoracic Epidural Anesthesia in non-intubated
video-assisted thoracoscopes and the conventional general anesthesia with
one lung ventilation.
Source
Egyptian Journal of Anaesthesia. 38(1) (pp 284-290), 2022. Date of
Publication: 2022.
Author
Ashour M.R.; AbdelLatif S.A.; Altaher W.A.M.; ElSayed H.H.; Koraitim A.F.;
Alhadidy M.A.
Institution
(Ashour, AbdelLatif, Altaher, Koraitim, Alhadidy) Department of
Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain
Shams University, Cairo, Egypt
(ElSayed) Department of Thoracic Surgery, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) refers to the
minimally invasive thoracic surgeries performed by video cameras to avoid
the invasive conventional open thoracotomy. The majority necessitate
one-lung ventilation. Regional anesthesia is involved to avoid the risks
of general anesthesia(GA) and one-lung ventilation and promote efficient
recovery of these vulnerable populations. Objective(s): To assess the
feasibility of non-intubated VATS with Thoracic Epidural Anesthesia (TEA)
compared to the conventional GA in terms of hemodynamic and ventilatory
parameters, postoperative pain control, opiate consumption, ambulation,
and length of hospital stay. Patients and Methods: This study is a
prospective randomized clinical study conducted in Ain Shams University
Hospitals over 2 years, with a sample size of 40 patients in 2 groups. The
GA group, after induction of anesthesia, double-lumen endotracheal tube
was inserted to facilitate one-lung ventilation. The TEA group, an
epidural catheter was inserted between T3 and T4 orT4 and T5
intervertebral space, local anesthetic dose titrated aiming to achieve
sensory and motor block between C7-T7 levels. Result(s): The findings
revealed no statistically significant difference between groups throughout
the perioperative period (p >0.05) regarding ventilatory and circulatory
parameters besides opiate consumption. Conversely, in terms of
postoperative ambulation and length of hospital stay (LOS), p-value=0.013
and 0.001 respectively for each favoring the TEA group. Similar results
were denoted for postoperative pain control, there was statistically
significant difference between groups in VAS score at 3 hours (P =0.004).
 Conclusion(s): The feasibility of nonintubated VATS with TEA was
tested with respect to safety and efficiency compared to the conventional
GA. The results of both groups are comparable in terms of hemodynamics and
ventilatory parameters. Despite similar overall opiate consumption in both
groups, the TEA group demonstrated promising results regarding the
enhanced recovery parameters in terms of better early postoperative pain
control, earlier ambulation, and decreased length of hospital
stay. Copyright © 2022 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<84>
[Use Link to view the full text]
Accession Number
2018383981
Title
The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes
after Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized
Controlled Trials.
Source
Annals of Surgery. 275(5) (pp 864-871), 2022. Date of Publication: 01 May
2022.
Author
Singh A.; Brenna C.T.A.; Broad J.; Kaustov L.; Choi S.
Institution
(Singh, Broad, Kaustov, Choi) Department of Anesthesia, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
(Singh, Brenna, Kaustov, Choi) Perioperative Brain Health Centre,
Sunnybrook Research Institute, Toronto, ON, Canada
(Brenna, Choi) Department of Anesthesiology & Pain Medicine, University of
Toronto, Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:The purpose of this systematic review and meta-analysis is to
examine the effect of DEX on delayed dNCR (cognitive dysfunction >= 1 week
postoperative) after cardiac surgery. Background(s):DEX has salutary
effects on cognitive outcomes following cardiac surgery, however, studies
are limited by inconsistent assessment tools, timing, and definitions of
dysfunction. It is imperative to identify accurate point estimates of
effect of DEX on clinically relevant changes in cognitive function.
 Method(s):Randomized trials of adults undergoing cardiac surgery
comparing perioperative DEX to placebo or alternate sedation and assessing
cognitive function >= 1 week postoperative were included. Data was
abstracted by three reviewers independently and in parallel according to
PRISMA guidelines. The primary outcome is dNCR. To classify as dNCR,
cognitive function must decrease by at least the minimal clinically
important difference or accepted alternate measure (eg, Reliable Change
Index >=1.96). Bias was assessed with the Cochrane Collaboration tool.
Data was pooled using a random effects model. Result(s):Nine trials
(942 participants) were included in qualitative analysis, of which seven
were included in the meta-analysis of dNCR. DEX reduced the incidence of
dNCR (OR 0.39, 95% CI 0.25-0.61, P < 0.0001) compared to placebo/no DEX.
There was no difference in the incidence of delirium (OR 0.69, 95% CI
0.35-1.34, P = 0.27) or incidence of hemodynamic instability (OR 1.14, 95%
CI 0.59-2.18, P = 0.70) associated with perioperative DEX.
 Conclusion(s):DEX reduced the incidence of dNCR 1 week after cardiac
surgery. Although this meta-analysis demonstrates short term cognitive
outcomes are improved after cardiac surgery with perioperative DEX, future
trials examining long term cognitive outcomes, using robust cognitive
assessments, and new perioperative neurocognitive disorders nomenclature
with objective diagnostic criteria are necessary. Copyright ©
2022 Lippincott Williams and Wilkins. All rights reserved.

<85>
[Use Link to view the full text]
Accession Number
2018383954
Title
Amiodarone with or without N -Acetylcysteine for the Prevention of Atrial
Fibrillation after Thoracic Surgery: A Double-blind, Randomized Trial.
Source
Anesthesiology. 136(6) (pp 916-926), 2022. Date of Publication: 01 Jun
2022.
Author
Amar D.; Zhang H.; Chung M.K.; Tan K.S.; Desiderio D.; Park B.J.; Pedoto
A.; Roistacher N.; Isbell J.M.; Molena D.; Milne G.L.; Meyers B.F.;
Fischer G.W.; Rusch V.W.; Jones D.R.
Institution
(Amar) Department of Anesthesiology and Critical Care Medicine, Memorial
Sloan Kettering Cancer Center, Weill Cornell Medical College, New York,
United States
(Chung) Department of Cardiovascular Medicine, Heart, Vascular and
Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Tan) Department of Epidemiology and Biostatistics, Memorial Sloan
Kettering Cancer Center, New York, NY, United States
(Roistacher) Department of Medicine, Memorial Sloan Kettering Cancer
Center, New York, NY, United States
(Milne) Department of Medicine, Division of Clinical Pharmacology,
Vanderbilt University Medical Center, Nashville, TN, United States
(Meyers) Department of Surgery, Washington University Medical Center, St.
Louis, MO, United States
(Fischer) Department of Anesthesiology and Critical Care Medicine,
Memorial Sloan Kettering Cancer Center, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative atrial fibrillation may identify patients at
risk of subsequent atrial fibrillation, with its greater risk of stroke.
This study hypothesized that N-acetylcysteine mitigates inflammation and
oxidative stress to reduce the incidence of postoperative atrial
fibrillation. Method(s): In this double-blind, placebo-controlled
trial, patients at high risk of postoperative atrial fibrillation
scheduled to undergo major thoracic surgery were randomized to
N-acetylcysteine plus amiodarone or placebo plus amiodarone. On arrival to
the postanesthesia care unit, N-acetylcysteine or placebo intravenous
bolus (50 mg/kg) and then continuous infusion (100 mg/kg over the course
of 48 h) was administered plus intravenous amiodarone (bolus of 150 mg and
then continuous infusion of 2 g over the course of 48 h). The primary
outcome was sustained atrial fibrillation longer than 30 s by telemetry
(first 72 h) or symptoms requiring intervention and confirmed by
electrocardiography within 7 days of surgery. Systemic markers of
inflammation (interleukin-6, interleukin-8, tumor necrosis factor alpha,
C-reactive protein) and oxidative stress (F<inf>2</inf>-isoprostane
prostaglandin F<inf>2alpha</inf>; isofuran) were assessed immediately
after surgery and on postoperative day 2. Patients were telephoned monthly
to assess the occurrence of atrial fibrillation in the first year.
 Result(s): Among 154 patients included, postoperative atrial
fibrillation occurred in 15 of 78 who received N-acetylcysteine (19%) and
13 of 76 who received placebo (17%; odds ratio, 1.24; 95.1% CI, 0.53 to
2.88; P = 0.615). The trial was stopped at the interim analysis because of
futility. Of the 28 patients with postoperative atrial fibrillation, 3
(11%) were discharged in atrial fibrillation. Regardless of treatment at 1
yr, 7 of 28 patients with postoperative atrial fibrillation (25%) had
recurrent episodes of atrial fibrillation. Inflammatory and oxidative
stress markers were similar between groups. Conclusion(s): Dual
therapy comprising N-acetylcysteine plus amiodarone did not reduce the
incidence of postoperative atrial fibrillation or markers of inflammation
and oxidative stress early after major thoracic surgery, compared with
amiodarone alone. Recurrent atrial fibrillation episodes are common among
patients with postoperative atrial fibrillation within 1 yr of major
thoracic surgery. Copyright © 2022 Lippincott Williams and
Wilkins. All rights reserved.

<86>
Accession Number
2016850446
Title
The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a
Left-sided Double-lumen Tube on the Intubation Performance Compared with
the Conventional Method Using a Macintosh Laryngoscope.
Source
Open Anesthesia Journal. 14 (pp 115-122), 2020. Date of Publication: 2020.
Author
Lim J.A.; Kim I.-Y.; Byun S.H.
Institution
(Lim, Kim, Byun) Department of Anesthesiology and Pain Medicine, Catholic
University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil,
Nam-gu, Daegu 42472, South Korea
Publisher
Bentham Science Publishers
Abstract
Background: The accurate placement of the double-lumen endotracheal tube
is imperative for effective one-lung ventilation in thoracic surgery.
Malpositioning and repositioning of a misplaced tube may cause excessive
trauma. Objective(s): We hypothesized that the fiberoptic
bronchoscope-guided method for double-lumen endotracheal tube placement
would reduce the incidence of malpositioning as compared to the
conventional method using the Macintosh laryngoscope. Method(s):
Fifty patients scheduled to undergo elective thoracic surgery were
recruited and randomly assigned to the fiberoptic bronchoscope-guided
[n=25; Group F] and conventional [n=25; Group C] method groups, according
to the method of double-lumen endotracheal tube placement. The primary
outcome was the incidence of double-lumen endotracheal tube malpositioning
observed under the fiberoptic bronchoscope after initial placement.
Secondary outcomes included the times for placement, confirmation, and
total procedure of double-lumen endotracheal tube intubation.
 Result(s): The incidence of malpositioning after initial double-lumen
endotracheal tube placement was significantly lower in Group F than in
Group C (20.0% vs 68.0%). In addition, the time for placement was
significantly higher in Group F than in Group C, and that for confirmation
was significantly lower in Group F than in Group C. Conclusion(s):
The fiberoptic bronchoscope-guided method for double-lumen endotracheal
tube placement can reduce the incidence of malpositioning after initial
placement and expedite the intubation process with a double-lumen
endotracheal tube in thoracic surgery. Copyright © 2020 Lim et
al.

<87>
Accession Number
638088437
Title
Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A
Randomized Controlled Trial.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992).
(no pagination), 2022. Date of Publication: 24 May 2022.
Author
Blanco-Morillo J.; Salmeron Martinez D.; Morillo-Cuadrado D.V.;
Arribas-Leal J.M.; Puis L.; Verdu-Verdu A.; Martinez-Molina M.;
Tormos-Ruiz E.; Sornichero-Caballero A.; Ramirez-Romero P.; Farina P.;
Canovas-Lopez S.
Institution
(Blanco-Morillo) From the Cardiovascular Surgery, Extracorporeal Therapies
Group, Virgen de la Arrixaca University Hospital, Murcia, Spain
(Blanco-Morillo) Biomedical Research Institute of Murcia (IMIB), Murcia,
Spain
(Salmeron Martinez) Department of Health and Social Sciences, Murcia
University, Murcia, Spain
(Salmeron Martinez) IMIB-Arrixaca, Murcia, SpainCIBER Epidemiology and
Public Health CIBERESP, Madrid, Spain
(Morillo-Cuadrado) Network-Based Biomedical Research Consortium, Carlos
III Health Institute, Area of Mental Health (CiberSAM), Madrid, Spain
(Morillo-Cuadrado) World Health Organization Collaborating Centre for
Research and Training in Mental Health, Department of Psychiatry,
Autonomous University of Madrid, Spain
(Arribas-Leal, Canovas-Lopez) Cardiovascular Surgery, Virgen de la
Arrixaca University Hospital, Murcia, Spain
(Puis) Department of ExtraCorporeal Circulation, KU Leuven, UZ
Gasthuisberg, Belgium
(Verdu-Verdu, Martinez-Molina, Tormos-Ruiz, Sornichero-Caballero)
Cardiovascular Surgery, Extracorporeal Therapies Group, Virgen de la
Arrixaca University Hospital, Murcia, Spain
(Ramirez-Romero) General and Experimental Surgery and Transplantation
Departments, Virgen de la Arrixaca University Hospital, University of
Murcia, Murcia, Spain
(Farina) Cardiovascular Surgery, Agostino Gemelli University Policlinc,
Rome, Italy
Publisher
NLM (Medline)
Abstract
Particulate and gaseous microemboli (GME) are side effects of cardiac
surgery that interfere with postoperative recovery by causing endothelial
dysfunction and vascular blockages. GME sources during surgery are
multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic
load. Hematic antegrade repriming (HAR) is a novel procedure that combines
the benefits of repriming techniques with additional measures, by
following a standardized procedure to provide a reproducible hemodilution
of 300 ml. To clarify the safety of HAR in terms of embolic load delivery,
a prospective and controlled study was conducted, by applying Doppler
probes to the extracorporeal circuit, to determine the number and volume
of GME released during CPB. A sample of 115 patients (n = 115) was
considered for assessment. Both groups were managed under strict
normothermia, and similar clinical conditions and protocols, receiving the
same open and minimized circuit. Significant differences in GME volume
delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and
high embolic volume exposure (>1 ml) were found between the groups (CG =
30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not
represent an additional embolic risk and provided a four-fold reduction in
the embolic volume delivered to the patient (coefficient, 0.24; 95% CI,
0.08-0.72; p = 0.01), which appears to enhance GME clearance of the
oxygenator before CPB initiation. Copyright © 2022 The Author(s).
Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.

<88>
Accession Number
638077818
Title
Cardiac Surgery 2021 Reviewed.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2022. Date of
Publication: 2022.
Author
Doenst T.; Schneider U.; Can T.; Caldonazo T.; Diab M.; Siemeni T.; Farber
G.; Kirov H.
Institution
(Doenst, Schneider, Can, Caldonazo, Diab, Siemeni, Farber, Kirov)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of
Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Georg Thieme Verlag
Abstract
PubMed displayed more than 35,000 hits for the search term cardiac surgery
AND 2021. We used the PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-analyses) approach and selected relevant publications for
a results-oriented summary. As in recent years, we reviewed the fields of
coronary and conventional valve surgery and their overlap with their
interventional alternatives. COVID reduced cardiac surgical activity
around the world. In the coronary field, the FAME 3 trial dominated
publications by practically repeating SYNTAX, but with modern stents and
fractional flow reserve (FFR)-guided percutaneous coronary interventions
(PCIs). PCI was again unable to achieve non-inferiority compared with
coronary artery bypass graft surgery (CABG) in patients with triple-vessel
disease. Survival advantages of CABG over PCI could be linked to a
reduction in myocardial infarctions and current terminology was criticized
because the term myocardial revascularization is not precise and does not
reflect the infarct-preventing collateralization effect of CABG. In
structural heart disease, new guidelines were published, providing
upgrades of interventional treatments of both aortic and mitral valve
disease. While for aortic stenosis, transcatheter aortic valve
implantation (TAVI) received a primary recommendation in older and
high-risk patients; recommendations for transcatheter mitral edge-to-edge
treatment were upgraded for patients considered inappropriate for surgery.
For heart team discussions it is important to know that classic aortic
valve replacement currently provides strong signals (from registry and
randomized evidence) for a survival advantage over TAVI after 5 years.
This article summarizes publications perceived as important by us. It can
neither be complete nor free of individual interpretation, but provides
up-to-date information for decision-making and patient
information. Copyright © 2022 Georg Thieme Verlag. All rights
reserved.

<89>
Accession Number
2017451943
Title
5-Year Follow-Up From the PARTNER 2 Aortic Valve-in-Valve Registry for
Degenerated Aortic Surgical Bioprostheses.
Source
JACC: Cardiovascular Interventions. 15(7) (pp 698-708), 2022. Date of
Publication: 11 Apr 2022.
Author
Hahn R.T.; Webb J.; Pibarot P.; Ternacle J.; Herrmann H.C.; Suri R.M.;
Dvir D.; Leipsic J.; Blanke P.; Jaber W.A.; Kodali S.; Kapadia S.; Makkar
R.; Thourani V.; Williams M.; Salaun E.; Vincent F.; Xu K.; Leon M.B.;
Mack M.
Institution
(Hahn, Kodali, Leon) Columbia University Medical Center/New
York-Presbyterian Hospital, New York, NY, United States
(Webb, Leipsic, Blanke) University of British Columbia and St. Paul's
Hospital, Vancouver, Canada
(Pibarot, Ternacle, Salaun) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec/Quebec Heart and Lung Institute, Department of
Medicine, Laval University, Quebec, Canada
(Ternacle) Heart Valve Unit, Haut-Leveque Cardiologic Hospital, Bordeaux
University, Pessac, France
(Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Suri, Jaber, Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Dvir) Jesselson Integrated Heart Center, Shaare Zedek Medical Centre,
Hebrew University, Jerusalem, Israel
(Makkar) Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles,
CA, United States
(Thourani, Williams) Department of Cardiothoracic Surgery, Piedmont Heart
Institute, Atlanta, GA, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Vincent, Leon) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Vincent) Department of Cardiology, Institut Pasteur de Lille, CHU Lille,
Lille, France
(Xu) Edwards Lifesciences, Irvine, CA, United States
(Mack) Baylor Scott & White Health, Dallas, TX, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to report the outcomes of
valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) at 5
years. Background(s): TAVR for degenerated surgical bioprostheses in
patients at high risk for reoperative surgery is an important treatment
option that may delay or obviate the need for surgical intervention;
however, long-term outcomes of this procedure are unknown. Method(s):
The PARTNER (Placement of Aortic Transcatheter Valves) 2 ViV and continued
access registries prospectively enrolled patients with failed surgical
bioprostheses at high risk for reoperation. Five-year clinical and
echocardiographic follow-up data were obtained in 95.9% of patients.
 Result(s): In 365 (96 registry and 269 continued access) patients,
the mean age was 78.9 +/- 10.2 years, the mean Society of Thoracic
Surgeons predicted risk of surgical mortality score was 9.1 +/- 4.7%, and
New York Heart Association functional class was III or IV in 90.4%. At 5
years, the Kaplan-Meier rates of all-cause mortality and any stroke were
50.6% and 10.5%, respectively. Using Valve Academic Research Consortium 3
definitions, the incidence of structural valve deterioration, related
hemodynamic valve deterioration, or bioprosthetic valve failure at 5 years
was 6.6%. Aortic valve re-replacement was performed in 6.3% (n = 14), the
majority of which was due to stenosis (n = 6) and combined aortic
insufficiency/paravalvular regurgitation (n = 3). The mean gradient,
Doppler velocity index, paravalvular regurgitation, and quality of life
measured by Kansas City Cardiomyopathy Questionnaire scores in survivors
remained stable from 30 days postprocedure through 5 years.
 Conclusion(s): At the 5-year follow-up, TAVR for bioprosthetic aortic
valve failure in high surgical risk patients was associated with sustained
improvement in clinical and echocardiographic outcomes. Copyright
© 2022 American College of Cardiology Foundation

<90>
Accession Number
2017440522
Title
Associated factors and clinical outcomes in mechanical circulatory support
use in patients undergoing high risk on-pump cardiac surgery: Insights
from the LEVO-CTS trial.
Source
American Heart Journal. 248 (pp 35-41), 2022. Date of Publication: June
2022.
Author
Verma S.; Rathwell S.; Fremes S.; Zheng Y.; Mehta R.; Lopes R.D.;
Alexander J.H.; Goodman S.G.; Diepen S.V.
Institution
(Verma, Diepen) Department of Critical Care Medicine, University of
Alberta, Edmonton, AB, Canada
(Rathwell, Zheng, Goodman, Diepen) Canadian VIGOUR Centre, University of
Alberta, Edmonton, AB, Canada
(Fremes) Sunnybrook Health Sciences Center, University of Toronto,
Toronto, ON, Canada
(Mehta, Lopes, Alexander) Duke Clinical Research Institute, Duke
University Medical Center, NC, Durham
(Goodman) Terrence Donnelly Heart Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Diepen) Division of Cardiology, Department of Medicine, University of
Alberta, Edmonton, AB, Canada
Publisher
Elsevier Inc.
Abstract
Background: We describe variables and outcomes associated with
peri-operative mechanical circulatory support (MCS) utilization among
patients enrolled in the Levosimendan in patients with Left Ventricular
Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary
Bypass (LEVO-CTS) trial. Method(s): In the LEVO-CTS trial, MCS
utilization (defined as intra-aortic balloon pump, extracorporeal membrane
oxygenation, or surgical ventricular assist device) within 5 days of
surgery was examined. The association between MCS use and outcomes
including 90-day mortality, 30-day renal-replacement therapy, and hospital
and critical stay length of stay were determined. Result(s): Among
the 849 patients from 70 centers randomized to levosimendan or placebo, 85
(10.0%) patients were treated with MCS (71 intra-aortic balloon pump, 7
extracorporeal membrane oxygenation, 7 ventricular assist device); with
89.4% started on post-operative day 0. Inter-institutional use ranged from
0% to 100%. Variables independently associated with MCS utilization
included combined coronary artery bypass grafting and valve surgery
(adjusted odds ratio [OR] 2.73, 95% confidence interval [CI] 1.70-4.37, P
< .001), history of lung disease (OR 1.70, 95% CI 1.06-2.70, P = .029),
and history of heart failure (OR 2.44, 95% CI 1.10-5.45, P = .027).
Adjusted 90-day mortality (22.4% vs 4.1%, hazard ratio 6.11, 95% CI
3.95-9.44, P < .001) was higher, and median critical care length of stay
(8.0 vs 4.0 days, P < .001) was longer in patients managed with MCS.
 Conclusion(s): In a randomized controlled trial of high-risk cardiac
surgical patients in North America, we observed patient, and surgical
variables associated with MCS utilization. MCS use was associated with a
higher risk of post-operative mortality. Copyright © 2022
Elsevier Inc.

<91>
Accession Number
2017898713
Title
Process of Care Assessment in Patients with Chronic Total Occlusion.
Source
Circulation Journal. 86(5) (pp 808-810), 2022. Date of Publication: 2022.
Author
Inohara T.; Kohsaka S.
Institution
(Inohara, Kohsaka) Department of Cardiology, Keio University of School of
Medicine, Tokyo, Japan
Publisher
Japanese Circulation Society

<92>
Accession Number
2016752768
Title
Dilated cardiomyopathy as the initial presentation of Becker muscular
dystrophy: a systematic review of published cases.
Source
Orphanet Journal of Rare Diseases. 17(1) (no pagination), 2022. Article
Number: 194. Date of Publication: December 2022.
Author
Del Rio-Pertuz G.; Morataya C.; Parmar K.; Dubay S.; Argueta-Sosa E.
Institution
(Del Rio-Pertuz, Morataya, Parmar) Department of Internal Medicine, Texas
Tech University Health Sciences Center, 3601 4th St, Lubbock, TX 79430,
United States
(Dubay) Department of Clinical and Diagnostic Sciences, University of
Alabama at Birmingham, Birmingham, AL 35294, United States
(Argueta-Sosa) Division of Cardiology, Texas Tech University Health
Sciences Center, Lubbock, TX 79430, United States
Publisher
BioMed Central Ltd
Abstract
There are scarce publications regarding the presentation and outcome of
Becker muscular dystrophy in adulthood when idiopathic dilated
cardiomyopathy is the initial disease manifestation. We performed a
systematic review using Medline, Embase, Cochrane, and Scopus to identify
cases of adults with idiopathic dilated cardiomyopathy who were
subsequently diagnosed with Becker muscular dystrophy from inception
through August 2020. Six cases were found. We identified young males
(Median age: 26 years) with Becker muscular dystrophy who first presented
with dilated cardiomyopathy. Most patients initially presented with
congestive heart failure symptoms (5/6, 83%), and had a median left
ventricular ejection fraction of 23%. One case did have calf
pseudohypertrophy. Musculoskeletal symptoms later appeared one to six
years after the initial dilated cardiomyopathy presentation. Heart
transplantation was the most common management strategy (4/6, 67%). A left
ventricular assist device was used in one case as a bridge to heart
transplant. Dilated cardiomyopathy can be the initial presentation of
Becker muscular dystrophy in the third to fourth decades of life in adult
patients, and musculoskeletal symptoms can be subclinical. Copyright
© 2022, The Author(s).

<93>
Accession Number
2010472486
Title
Aspirin Alone Versus Dual Antiplatelet Therapy after Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Drugs and Therapy. 36(2) (pp 271-278), 2022. Date of
Publication: April 2022.
Author
Lin X.; Wang S.; Wang L.; Guan Y.; Huang J.
Institution
(Lin, Guan) Zhejiang Chinese Medical University, Hangzhou, China
(Lin, Wang, Wang, Guan, Huang) Affiliated Hangzhou First People's
Hospital, Zhejiang University School of Medicine, Stress: No. 261, Huansha
Road, Hangzhou 310006, China
Publisher
Springer
Abstract
Background: The current American College of Cardiology and American Heart
Association (ACC/AHA) guidelines recommend dual antiplatelet therapy
(DAPT) with aspirin and clopidogrel for 6 months followed by lifelong
aspirin after transcatheter aortic valve replacement (TAVR). However,
studies that have DAPT with aspirin following TAVR have questioned this
recommendation as DAPT has been associated with more bleeding events
compared to aspirin. We performed a systematic review and meta-analysis of
all the RCTs comparing DAPT (aspirin plus clopidogrel) with aspirin alone
as antithrombotic treatment following transcatheter aortic valve
replacement. Method(s): The databases of Embase, PubMed, and Cochrane
library were searched from inception to Oct 1, 2020, and randomized
controlled trials (RCTs) reporting aspirin plus clopidogrel with aspirin
alone as antithrombotic treatment after TAVI were included. Revman 5.3 was
used to conduct the analysis. Result(s): After screening 152
articles, four studies involving 1086 patients (541 patients in the
aspirin group and 545 patients in the DAPT group) were included. The
results demonstrated that, at 30 days follow-up, compared with DAPT,
aspirin was not associated with a statistically significant difference in
the rate of bleeding events (RR = 1.22, 95% CI 0.62 to 2.39, P = 0.57),
all-cause mortality (RR = 1.21, 95% CI 0.52 to 2.84, P = 0.66), stroke (RR
= 0.81, 95% CI 0.24 to 2.79, P = 0.74), and MI (RR = 4.00, 95% CI 0.45 to
35.22, P = 0.21). However, at the 6 to 12 months follow-up, DAPT appeared
to increase the risk of bleeding events compared with aspirin alone (RR =
1.67, 95% CI 1.24 to 2.24, P < 0.001), and there was no significant
difference in the rate of all-cause mortality (RR = 0.89, 95% CI 0.53 to
1.48, P = 0.65), stroke (RR = 1.04, 95% CI 0.57 to 1.92, P = 0.90), and MI
(RR = 1.65, 95% CI 0.52 to 5.26, P = 0.40) among the two groups.
 Conclusion(s): Our systematic review and meta-analysis suggested that
aspirin alone could decrease the risk of bleeding and was not associated
with higher risk of mortality, stroke or myocardial infarction compared
with DAPT. Copyright © 2021, Springer Science+Business Media,
LLC, part of Springer Nature.

<94>
Accession Number
2015657545
Title
Cost-Effectiveness Analysis of SAPIEN 3 Transcatheter Aortic Valve
Implantation Procedure Compared With Surgery in Patients With Severe
Aortic Stenosis at Low Risk of Surgical Mortality in France.
Source
Value in Health. 25(4) (pp 605-613), 2022. Date of Publication: April
2022.
Author
Gilard M.; Eltchaninoff H.; Iung B.; Lefevre T.; Spaulding C.; Dumonteil
N.; Mutuon P.; Roussel C.; Candolfi P.; de Pouvourville G.; Green M.;
Shore J.
Institution
(Gilard) Centre Hospitalier Regional et Universitaire de Brest, Brest,
France
(Eltchaninoff) Department of Cardiology, CHU Rouen, UNIROUEN, Normandie
Univ, Rouen, France
(Iung, Mutuon) Hopital Bichat Claude-Bernard (APHP), Paris, France
(Lefevre) Hopital Prive Jacques Cartier, Ramsay-generale de sante, Massy,
France
(Spaulding) Hopital Europeen Georges-Pompidou (APHP), Paris, France
(Dumonteil) Clinique Pasteur de Toulouse, Toulouse, France
(Roussel) Edwards Lifesciences, Paris, France
(Candolfi) Edwards Lifesciences, Nyon, Switzerland
(de Pouvourville) ESSEC Business School, Cergy Pontoise, France
(Green, Shore) York Health Economics Consortium, University of York,
England, York, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: The clinical and cost-saving benefits of transcatheter aortic
valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in
patients with severe aortic stenosis who are at high or intermediate risk
of surgical mortality are supported by a growing evidence base. The
PARTNER 3 trial (Placement of AoRTic TraNscathetER Valve Trial)
demonstrated clinical benefits with SAPIEN 3 TAVI compared with SAVR in
selected patients at low risk of surgical mortality. This study uses
PARTNER 3 outcomes in combination with a French national hospital claim
database to inform a cost-utility model and examine the cost implications
of TAVI over SAVR in a low-risk population. Method(s): A 2-stage
cost-utility analysis was developed to estimate changes in both direct
healthcare costs and health-related quality of life using TAVI with SAPIEN
3 compared with SAVR. Early adverse events associated with TAVI were
captured using the PARTNER 3 data set. These data fed into a Markov model
that captured longer-term outcomes of patients, after TAVI or SAVR
intervention. Result(s): TAVI with SAPIEN 3 offers meaningful
benefits over SAVR in providing both cost saving (12 742 per patient) and
generating greater quality-adjusted life-years (0.89 per patient). These
results are robust with TAVI with SAPIEN 3 remaining dominant across
several scenarios and deterministic and probabilistic sensitivity
analyses. Conclusion(s): This model demonstrated that TAVI with
SAPIEN 3 was dominant compared with SAVR in the treatment of patients with
severe symptomatic aortic stenosis who are at low risk of surgical
mortality. These findings should help policy makers in developing informed
approaches to intervention selection for this patient
population. Copyright © 2021 International Society for
Pharmacoeconomics and Outcomes Research, Inc.

<95>
Accession Number
637811941
Title
Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients
with Drug-Refractory Hypertrophic Obstructive Cardiomyopathy.
Source
JAMA Cardiology. 7(5) (pp 529-538), 2022. Date of Publication: May 2022.
Author
Zhou M.; Ta S.; Hahn R.T.; Hsi D.H.; Leon M.B.; Hu R.; Zhang J.; Zuo L.;
Li J.; Wang J.; Wang B.; Zhu X.; Han Y.; Li X.; Xu B.; Zhang L.; Hou L.;
Han C.; Liu J.; Liu L.
Institution
(Zhou, Ta, Hu, Zhang, Zuo, Li, Wang, Wang, Zhu, Liu, Han, Li, Zhang, Han,
Liu) Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound,
Xijing Hospital, Fourth Military Medical University, 127 Changle W Rd,
Shaanxi, Xi'an 710032, China
(Hahn, Leon) Columbia University Medical Center, New York Presbyterian
Hospital, University of Columbia, College of Physicians and Surgeons, New
York, United States
(Hsi) Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United
States
(Hsi) University of Columbia, College of Physicians and Surgeons, New
York, NY, United States
(Zhang) Department of Ultrasound, Xi'An New Changan Maternity Hospital,
Shaanxi, Xi'an, China
(Xu, Liu) Xijing Hypertrophic Cardiomyopathy Center, Department of Cardiac
Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle
W Rd, Shaanxi, Xi'an 710032, China
(Zhang) Department of Cardiology, Xi'An No. 3 Hospital, Northwest
University, Shaanxi, Xi'an, China
(Hou) Xijing Hypertrophic Cardiomyopathy Center, Department of
Anesthesiology, Xijing Hospital, Fourth Military Medical University,
Shaanxi, Xi'an, China
Publisher
American Medical Association
Abstract
Importance: Patients with hypertrophic obstructive cardiomyopathy (HOCM)
and drug-refractory symptoms and outflow gradients have limited
nonsurgical treatment options. The feasibility of percutaneous
intramyocardial septal radiofrequency ablation (PIMSRA) has been reported
previously; however, procedural and medium-term outcomes are unknown.
 Objective(s): To describe the safety and medium-term outcomes of
PIMSRA in a large patient cohort with drug-refractory HOCM. Design,
Setting, and Participant(s): This was a single-arm, open-label study of
PIMSRA in patients with drug-refractory HOCM. Patients presenting to the
Xijing Hospital in Xi'an, China, between October 2016 to June 2020 with
hypertrophic cardiomyopathy. Of 1314 patients presenting with HOCM, 244
fulfilled inclusion criteria of severe resting/provoked outflow gradients
of 50 mm Hg or higher, and symptoms of New York Heart Association
functional class of II or higher refractory to maximum tolerated
medications. After discussion among the heart team, 40 patients underwent
surgical or alcohol septal reduction therapy and 4 required treatment of
significant coronary artery disease. Intervention(s): PIMSRA
performed in patients. Main Outcomes and Measures: The primary
outcome was 30-day major adverse clinical events: death, emergency
surgery, severe effusion requiring intervention, procedure-related stroke,
bleeding, and stroke. Secondary outcomes included 30-day technical success
and 90-day improvement in outflow obstruction. Result(s): The mean
(SD) age of 200 patients was 46.9 (14.0) years, and 125 (62.5%) were men.
Resting or provoked left ventricular outflow tract gradients were 50 mm Hg
or higher. The median (IQR) follow-up for all patients was 19 (6-50)
months. Thirty-day major adverse clinical events rate was 10.5% (n = 21):
there were 2 in-hospital/30-day deaths (1.0%), 7 patients (3.5%) with
pericardial effusion requiring mini-thoracotomy, 12 patients (6%) with
pericardial effusion requiring pericardiocentesis, and no bleeding or
strokes. Other periprocedural complications included permanent right
bundle branch block in 5 patients (2.5%), resuscitated ventricular
fibrillation in 2 (1.0%), and septal branch aneurysm in 2 (1.0%). There
were no permanent pacemaker implantations. At follow-up, maximum septal
thickness was reduced from a mean (SD) of 24.0 (5.1) mm to 17.3 (4.4) mm
(P <.001), and left ventricular outflow tract gradient was decreased from
a mean (SD) of 79.0 (53.0) mm Hg to 14.0 (24.0) mm Hg (P <.001). Overall,
190 patients (96%) with HOCM were in New York Heart Association functional
class I or II at last follow-up. Conclusions and Relevance: This
study found that PIMSRA in patients with drug-refractory HOCM may be an
effective procedure for relief of left ventricular outflow tract
obstruction and symptoms with acceptable complication rates. These results
are encouraging and support the design of a randomized clinical trial
against well-established septal reduction therapies. Copyright ©
2022 American Medical Association. All rights reserved.

<96>
Accession Number
637420373
Title
Bariatric surgery and cardiovascular disease: a systematic review and
meta-analysis.
Source
European heart journal. 43(20) (pp 1955-1969), 2022. Date of Publication:
21 May 2022.
Author
van Veldhuisen S.L.; Gorter T.M.; van Woerden G.; de Boer R.A.; Rienstra
M.; Hazebroek E.J.; van Veldhuisen D.J.
Institution
(van Veldhuisen, Hazebroek) Department of Surgery/Vitalys Clinic,
Rijnstate Hospital Arnhem, Arnhem, Netherlands
(van Veldhuisen) Department of Surgery, University of Amsterdam,
Amsterdam, Netherlands
(Gorter, van Woerden, de Boer, Rienstra, van Veldhuisen) Department of
Cardiology, University of Groningen, University Medical Centre Groningen,
PO Box 30.001, RB Groningen 9700, Netherlands
(Hazebroek) Division of Human Nutrition and Health, Wageningen University
& Research, Wageningen, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Obesity is a global health problem, associated with significant
morbidity and mortality, often due to cardiovascular (CV) diseases. While
bariatric surgery is increasingly performed in patients with obesity and
reduces CV risk factors, its effect on CV disease is not established. We
conducted a systematic review and meta-analysis to evaluate the effect of
bariatric surgery on CV outcomes, in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guideline.
METHODS AND RESULTS: PubMed and Embase were searched for literature until
August 2021 which compared bariatric surgery patients to non-surgical
controls. Outcomes of interest were all-cause and CV mortality, atrial
fibrillation (AF), heart failure (HF), myocardial infarction, and stroke.
We included 39 studies, all prospective or retrospective cohort studies,
but randomized outcome trials were not available. Bariatric surgery was
associated with a beneficial effect on all-cause mortality [pooled hazard
ratio (HR) of 0.55; 95% confidence interval (CI) 0.49-0.62, P < 0.001 vs.
controls], and CV mortality (HR 0.59, 95% CI 0.47-0.73, P < 0.001). In
addition, bariatric surgery was also associated with a reduced incidence
of HF (HR 0.50, 95% CI 0.38-0.66, P < 0.001), myocardial infarction (HR
0.58, 95% CI 0.43-0.76, P < 0.001), and stroke (HR 0.64, 95% CI 0.53-0.77,
P < 0.001), while its association with AF was not statistically
significant (HR 0.82, 95% CI 0.64-1.06, P = 0.12). CONCLUSION(S): The
present systematic review and meta-analysis suggests that bariatric
surgery is associated with reduced all-cause and CV mortality, and lowered
incidence of several CV diseases in patients with obesity. Bariatric
surgery should therefore be considered in these patients. Copyright
© The Author(s) 2022. Published by Oxford University Press on behalf
of European Society of Cardiology.

<97>
Accession Number
2017692196
Title
Robotic cardiac surgery training during residency: Preparing residents for
the inevitable future.
Source
Laparoscopic, Endoscopic, and Robotic Surgery. 5(2) (pp 75-77), 2022. Date
of Publication: June 2022.
Author
Vinck E.E.; Smood B.; Barros L.; Palmen M.
Institution
(Vinck) Department of Cardiovascular Surgery, Cardio VID Clinic,
Pontifical Bolivarian University, Medellin, Colombia
(Smood) Department of Surgery, Division of Cardiothoracic Surgery,
University of Pennsylvania, PA, United States
(Barros) Department of Cardiovascular Surgery, Santa Casa of Sao Paulo,
Sao Paulo, Brazil
(Palmen) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
Publisher
KeAi Communications Co.
Abstract
Unlike other surgical residency training programs including thoracic
surgery, robotic cardiac surgery skill training is minimal or absent in
residency curricula. A review was conducted to identify residents'
exposure to robotic cardiac surgery training based on databases including
PubMed, MEDLINE and Google Scholar. Published papers and cardiothoracic
surgical societies with robotic cardiac surgery training courses were
reviewed. Robotic cardiac surgery training for residents is almost
non-existent. Strategies to establish proper robotic cardiac surgical
training for residents include implementing simulation training,
implementing hour requirements and establishing wet/dry lab model training
in a progressive fashion. As robot-assisted cardiac surgery becomes
increasingly commonplace, it will be imperative to provide training for
residents with dedicated opportunities to develop their skills in robotic
cardiac surgery. Copyright © 2022 Zhejiang University

<98>
Accession Number
2015688804
Title
Myocardial injury after major noncardiac surgery: A secondary analysis of
a randomized controlled trial.
Source
Surgery (United States). 171(6) (pp 1626-1634), 2022. Date of Publication:
June 2022.
Author
Ellenberger C.; Schorer R.; Diaper J.; Jeleff A.; Luise S.; Hagermann A.;
Licker M.
Institution
(Ellenberger, Schorer, Diaper, Jeleff, Luise, Hagermann, Licker)
Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency
Medicine, University Hospital of Geneva, Switzerland
(Ellenberger, Licker) Faculty of Medicine, University of Geneva,
Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Myocardial injury after noncardiac surgery frequently occurs
and may influence survival. The aims of this study were to examine the
association between myocardial injury after noncardiac surgery and patient
and procedural factors as well as its impact on postoperative clinical
outcome. Method(s): A retrospective analysis was conducted from data
collected in adults enrolled in a randomized trial in elective major open
abdominal surgery. Preoperative patient characteristics, intraoperative
hemodynamic changes, and postoperative adverse events were analyzed, and
Kaplan-Meier curves were built for postoperative survival probability.
After adjustment for baseline patient and procedural characteristics, the
effect of myocardial injury after noncardiac surgery on postoperative
outcomes was analyzed in a propensity score matched cohort.
 Result(s): Among 394 patients, myocardial injury after noncardiac
surgery was reported in 109 (27.7%) and was associated with a higher
cardiovascular risk profile, prolonged surgery (333 +/- 111 min vs 295 +/-
134 min, P = .010), greater need for transfusions (41.3% vs 19.3%, P <
.001), higher incidence of major adverse cardiac events (22.9% vs 6.7%, P
< .001), pulmonary complications (31.2% vs 17.9%, P = .004), acute kidney
injury (30.3% vs 18.2%, P = .009), and systemic inflammatory syndrome
(28.4% vs 13.0%, P < .001). After propensity score matching, the operative
time and the need for blood transfusion remained higher among myocardial
injury after noncardiac surgery patients who experienced more frequent
major adverse cardiac events and acute kidney injury. In both the entire
and matched cohorts, survival up to 30 months after surgery was determined
mainly by the presence of cancer. Conclusion(s): The burden of
cardiovascular disease and operative stress surgery is predictive of
myocardial injury after noncardiac surgery and, in turn, with a higher
incidence of cardiac adverse events, whereas the presence of cancer is
associated with poor survival in patients undergoing major open abdominal
surgery. Further studies are needed to determine whether myocardial injury
after noncardiac surgery can be prevented by better control of the
patient's cardiovascular condition and implementation of less invasive of
surgical procedures. Copyright © 2021 The Author(s)

<99>
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. 41(6) (pp 1873-1887), 2022. Date of Publication:
June 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).

<100>
Accession Number
2010885862
Title
Velocity-pressure loops can estimate intrinsic and pharmacologically
induced changes in cardiac afterload during non-cardiac surgery. An
observational study.
Source
Journal of Clinical Monitoring and Computing. 36(2) (pp 545-555), 2022.
Date of Publication: April 2022.
Author
Le Gall A.; Gayat E.; Joachim J.; Cohen S.; Hong A.; Mateo J.; Buxin C.;
Millasseau S.; Mebazaa A.; Vallee F.
Institution
(Le Gall, Gayat, Joachim, Cohen, Hong, Mateo, Buxin, Mebazaa, Vallee)
Department of Anaesthesiology and Intensive Care, Lariboisiere - Saint
Louis Hospitals, 02 rue Ambroise Pare, Paris 75010, France
(Gayat, Mebazaa, Vallee) Inserm, UMRS-942, Paris Diderot University, 02,
rue Ambroise Pare, Paris 75010, France
(Le Gall, Vallee) M3DISIM, Inria-Saclay, Palaiseau, France
(Le Gall, Vallee) LMS, Ecole Polytechnique, CNRS, Palaiseau, France
(Millasseau) Pulse Wave Consulting, 72 B rue de Montignon, Saint Leu La
Foret 95320, France
Publisher
Springer Science and Business Media B.V.
Abstract
Purpose: Continuous measurement of aortic pressure and aortic flow
velocity signals in the operating theatre allows us to draw
velocity-pressure (Vel-Pre) loops. The global afterload angle (GALA),
derived from the Vel-Pre loops, has been linked to cardiac afterload
indicators. As age is the major determinant of constitutive arterial
stiffness, we aimed to describe (1) the evolution of the GALA according to
age in a large cohort of anesthetized patients and (2) GALA variations
induced by haemodynamic interventions. Method(s): We included
patients for whom continuous monitoring of arterial pressure and cardiac
output were indicated. Fluid challenges or vasopressors were administered
to treat intra-operative hypotension. The primary endpoint was the
comparison of the GALA values between young and old patients. The
secondary endpoint was the difference in the GALA values before and after
haemodynamic interventions. Result(s): We included 133 anaesthetized
patients: 66 old and 67 young patients. At baseline, the GALA was higher
in the old patients than in young patients (38 +/- 6 vs. 25 +/- 4 degrees;
p < 0.001). The GALA was positively associated with age (p < 0.001), but
the mean arterial pressure (MAP) and cardiac output were not. The GALA did
not change after volume expansion, regardless of the fluid response, but
it did increase after vasopressor administration. Furthermore, while a
vasopressor bolus led to a similar increase in MAP, phenylephrine induced
a more substantial increase in the GALA than noradrenaline (+ 12 +/-
5degree vs. + 8 +/- 5degree; p = 0.01). Conclusion(s): In non-cardiac
surgery, the GALA seems to be associated with both intrinsic rigidity
(reflected by age) and pharmacologically induced vasoconstriction changes
(by vasopressors). In addition, the GALA can discriminate the differential
effects of phenylephrine and noradrenaline. These results should be
confirmed in a prospective, ideally randomized, trial. Copyright
© 2021, The Author(s), under exclusive licence to Springer Nature
B.V.

<101>
Accession Number
2018016997
Title
A Study focusing Emerging Risk Factors in Patients of Acute Myocardial
Infarction in Bihar.
Source
European Journal of Molecular and Clinical Medicine. 9(3) (pp 4681-4686),
2022. Date of Publication: December 2022.
Author
Mishra G.N.; Kumar D.; Kumar C.
Institution
(Mishra, Kumar) Department of Medicine, Narayan Medical College &
Hospital, Jamuhar, Bihar, Sasaram, India
(Kumar) Department of Cardiology, Narayan Medical College & Hospital,
Jamuhar, Bihar, Sasaram, India
Publisher
EJMCM, International House
Abstract
Aim: To determine the risk factors associated with patients of acute
myocardial infarction. Material(s) and Method(s): This study was a
nested case-control study was conducted in the Department of Medicine,
Narayan Medical College & Hospital Sasaram, Bihar. The patients were
selected from the OPD/in-hospital patients. A total of 1300 patients who
fulfilled the inclusion criteria were included in the study. Study
participants were randomly allocated to two groups: cases (n=650) &
control (n=650) groups respectively. The study duration was one year.
 Result(s): Case patients had a mean (SD) age of 65.4 (11.2) years and
control individuals had a mean (SD) age of 65.7 (11.8) years. Compared
with controls, in-hospital AMI cases were significantly more likely to
occur in intensive care unit settings (24.8% vs. 8.2%) and to have a
history of atherosclerotic disease (i.e., myocardial infarction,
percutaneous coronary intervention, coronary artery bypass graft,
cerebrovascular disease, or peripheral vascular disease). Coronary disease
risk factors of hypertension, hyperlipidemia, and diabetes were also more
common in patients with AMI. Conclusion(s): From case - control
design, factors associated with an increased risk of in-hospital AMI
included history of atherosclerosis, traditional atherosclerotic risk
factors, and markers of physiological stress. Additional research to
define risk reduction and optimal treatment strategies of in-hospital AMI
are needed to address this common and high-risk condition. Copyright
© 2022 Ubiquity Press. All rights reserved.

<102>
Accession Number
638074723
Title
Safety and performance of a novel cerebral embolic protection device for
transcatheter aortic valve implantation: the PROTEMBO C Trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2022. Date of Publication: 24 May 2022.
Author
Jagielak D.; Targonski R.; Frerker C.; Abdel-Wahab M.; Wilde J.; Werner
N.; Lauterbach M.; Leick J.; Grygier M.; Misterski M.; Erglis A.; Narbute
I.; Witkowski A.R.; Adam M.; Frank D.; Gatto F.; Schmidt T.; Lansky A.J.
Institution
(Jagielak, Targonski) Department of Cardiac & Vascular Surgery,
Uniwersyteckie Centrum Kliniczne, Gdansk, Poland
(Frerker, Schmidt) Universitatsklinikum Lubeck, Lubeck, Germany
(Abdel-Wahab, Wilde) Heart Center Leipzig, University of Leipzig, Leipzig,
Germany
(Werner, Lauterbach, Leick) Krankenhaus der Barmherzigen Bruder Trier,
Trier, Germany
(Grygier, Misterski) 1st Department of Cardiology, Poznan University of
Medical Sciences, Poznan, Poland
(Erglis, Narbute) Pauls Stradins Clinical University Hospital, University
of Latvia, Riga, Latvia
(Witkowski) National Institute of Cardiology, Warsaw, Poland
(Adam) University Hospital Cologne, Cologne, Germany
(Frank) UKSH University Medical Center Schleswig-Holstein, Kiel, Germany
(Frank) DZHK Partner Site Hamburg/Kiel/Lubeck, Germany
(Gatto) HerzZentrum Saar, Volklingen, Germany
(Lansky) Section of Cardiovascular Medicine, Yale School of Medicine, CT,
New Haven, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Stroke remains a feared complication associated with TAVI.
Embolic cerebral injury occurs in the majority of TAVI cases and can lead
to cognitive dysfunction. AIMS: The PROTEMBO C Trial evaluated the safety
and performance of the ProtEmbo Cerebral Protection System in TAVI
patients. METHOD(S): Forty-one patients were enrolled in this
single-arm study conducted at 8 European centres. The primary safety
endpoint was the rate of VARC 2-defined major adverse cardiac and
cerebrovascular events (MACCE) at 30 days; the primary performance
endpoint was the composite rate of technical success versus performance
goals (PG). Secondary endpoints included brain diffusion-weighted magnetic
resonance imaging (DW-MRI), new lesion volume, and the rate of death or
all strokes compared to historical data. RESULT(S): Thirty-seven of
41 enrolled patients underwent TAVI with the ProtEmbo device
(intention-to-treat [ITT] population). Both primary endpoints were met.
MACCE at 30 days was 8.1% (upper limit of the 95% confidence interval
[CI]: 21.3% vs PG 25%; p=0.009), and technical success was 94.6% (lower
limit of the 95% CI: 82.3% vs PG 75%; p=0.003). New DW-MRI lesion volumes
with ProtEmbo were smaller than in historical data, and 87% of patients
completing MRI follow-up had no single lesion >150 mm3. There was 1 stroke
in a patient in whom the device was removed prematurely before TAVI
completion. CONCLUSION(S): The PROTEMBO C Trial met its primary
safety and performance endpoints compared to prespecified historical PGs.
Patients had smaller brain lesion volumes on DW-MRI compared to prior
series and no larger single lesions. These results warrant further
evaluation of the ProtEmbo in a larger randomised controlled trial (RCT).

<103>
Accession Number
638071672
Title
Infective Endocarditis after Transcatheter Aortic Valve Implantation: A
Systematic Review.
Source
Cardiology in review. (no pagination), 2022. Date of Publication: 23 May
2022.
Author
Hassanin A.; Afify H.; Zook S.; Frishman W.H.; Aronow W.S.
Institution
(Hassanin) Ahmed Hassanin, MD, MPH; Department of Cardiology, Westchester
Medical Center and New York Medical College, Valhalla, New York, email:
(Afify) Hesham Afify, M.D.; Department of Internal Medicine, University of
Central Florida College of Medicine, Orlando, FL and Division of
Cardiovascular Medicine, Department of Medicine, University of Louisville
School of Medicine, Louisville, KY, email:
(Zook) MD, Houston Methodist DeBakey Heart & Vascular Center
(Frishman, Aronow) Ahmed Hassanin, MD, MPH; Department of Cardiology,
Westchester Medical Center and New York Medical College, Valhalla, New
York, email: ahmed.hassanin@WMCHealth.org
Publisher
NLM (Medline)
Abstract
Infective endocarditis (IE) after transcatheter aortic valve implantation
(TAVI) is a rare but potentially fatal event. In this systematic review we
searched PubMed and Embase for large TAVI studies and registries to
identify the incidence, presentation, microbiology, risk factors and
outcomes of IE in this population. After application of the selection
criteria and quality assessment, 8 studies representing 255,310 TAVR cases
and 4218 cases of IE qualified for this review. IE following TAVI is
uncommon with an incidence of 0.87 to 1.7 events per 100 person years.
Most events occur in the first year following valve implantation.
Staphylococcus, Enterococcus, and Streptococcus species are the most
common pathogens. Risk factors include age, sex, concomitant
co-morbidities, and procedural factors. Outcomes are dismal and surgical
intervention is rare in this population. Copyright © 2022 Wolters
Kluwer Health, Inc. All rights reserved.

<104>
Accession Number
638068148
Title
The Trial to Assess Chelation Therapy 2 (TACT2): Rationale and Design.
Source
American heart journal. (no pagination), 2022. Date of Publication: 19
May 2022.
Author
Lamas G.A.; Anstrom K.J.; Navas-Acien A.; Boineau R.; Kim H.; Rosenberg
Y.; Stylianou M.; Jones T.L.Z.; Joubert B.R.; Santella R.M.; Escolar E.;
Aude Y.W.; Fonseca V.; Elliott T.; Lewis E.F.; Farkouh M.E.; Nathan D.M.;
Mon A.C.; Gosnell L.; Newman J.D.; Mark D.B.
Institution
(Lamas, Escolar, Mon) Division of Cardiology, Mount Sinai Medical Center,
FL, Miami Beach
(Anstrom) Gillings School of Global Public Health, University of North
Carolina, Chapel Hill
(Navas-Acien, Santella) Columbia University Mailman School of Public
Health, NY, NY
(Boineau) National Center for Complementary and Integrative Health,
National Institutes of Health, MD, Bethesda, United States
(Kim, Gosnell, Mark) Duke Clinical Research Institute, Duke University,
Durham
(Rosenberg, Stylianou) National Heart, Lung and Blood Institute, National
Institutes of Health, MD, Bethesda, United States
(Jones) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, MD, Bethesda, United States
(Joubert) National Institute of Environmental Health Sciences, National
Institutes of Health, Durham
(Aude) TX, Heart and Vascular Specialists of South Texas, McAllen, United
States
(Fonseca) Tulane University School of Medicine, LA, New Orleans, United
States
(Elliott) BC Diabetes, Vancouver, Canada
(Lewis) Stanford University School of Medicine, Palo Alto, CA
(Farkouh) Peter Munk Cardiac Centre, University of Toronto, ON
(Nathan) Massachusetts General Hospital, Harvard Medical School, MA,
Boston
(Newman) New York University School of Medicine, NY, NY
Publisher
NLM (Medline)
Abstract
The Trial to Assess Chelation Therapy 2 (TACT2) is an NIH-sponsored,
randomized, 2x2 factorial, double masked, placebo-controlled, multicenter
clinical trial testing 40 weekly infusions of a multi-component edetate
disodium (disodium ethylenediamine tetra-acetic acid, or Na2EDTA)-based
chelation solution and twice daily oral, high-dose multivitamin and
mineral supplements in patients with diabetes and a prior myocardial
infarction (MI). TACT2 completed enrollment of 1000 subjects in December
2020, and infusions in December 2021. Subjects are being followed for 2.5
to 5 years. The primary endpoint is a composite of the time to first
occurrence of all-cause mortality, MI, stroke, coronary revascularization,
or hospitalization for unstable angina. The trial is designed to have >85%
power to detect a 30% relative reduction in the primary endpoint for each
active treatment versus placebo comparison. TACT2 also includes a Trace
Metals and Biorepository Core Lab, which will test the novel hypothesis
that the prognostic benefits of chelation, if present, are due to removal
of lead and cadmium from patients. Most of the design features of TACT2
were chosen to replicate selected features of the first TACT trial, which
demonstrated a statistically significant reduction in cardiovascular
outcomes in the EDTA chelation arm compared with placebo among patients
with a prior MI, with the largest effect in patients with diabetes.
Results from TACT2, if concordant with TACT, will provide definitive
evidence of the benefit of edetate disodium-based chelation on
cardiovascular outcomes, as well as the possible clinical importance of
longitudinal changes in toxic metal levels of participants. Copyright
© 2022. Published by Elsevier Inc.

<105>
Accession Number
2018200860
Title
Does early extubation after cardiac surgery lead to a reduction in
intensive care unit length of stay?.
Source
Interactive Cardiovascular and Thoracic Surgery. 34(5) (pp 731-734), 2022.
Date of Publication: 01 May 2022.
Author
Taylor M.; Apparau D.; Mosca R.; Nwaejike N.
Institution
(Taylor, Apparau, Nwaejike) Department of Cardiothoracic Surgery,
Manchester University NHS Foundation Trust, Wythenshawe Hospital,
Southmoor Road, Manchester M23 9LT, United Kingdom
(Mosca) Department of Cardiothoracic Anaesthesia, Manchester University
Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United
Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether early extubation
(EE) after cardiac surgery leads to a reduction in intensive care unit
(ICU) length of stay (LOS)? A total of 564 papers were found using the
reported search, of which 4 were randomized trials and hence represented
the best evidence to answer the clinical question. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these papers are tabulated. EE was
defined as extubation in theatre (n = 2), within 6 h of surgery (n = 1)
and within 8 h of surgery (n = 1). EE was associated with significantly
reduced ICU LOS in all studies. Despite the Society of Thoracic Surgeons
using extubation <6 h after surgery as a measure of quality, this study
has demonstrated that no standardized definition for EE currently exists.
The body of evidence identified in this work has demonstrated that for
appropriately selected patients (avoiding patients with multiple
comorbidities, advanced age and undergoing complex non-elective surgery)
early tracheal extubation is associated with a reduction in ICU LOS
without an increase in the rate of postoperative complications.
 Copyright © 2022 The Author(s) 2022. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<106>
Accession Number
2016850565
Title
Radial Artery Versus Saphenous Vein as Third Conduit in Coronary Artery
Bypass Graft Surgery for Multivessel Coronary Artery Disease: a Ten-Year
Literature Review.
Source
Acta Biomedica. 93(2) (no pagination), 2022. Article Number: e2022049.
Date of Publication: 2022.
Author
Maestri F.; Formica F.; Gallingani A.; Gripshi F.; Nicolini F.
Institution
(Maestri, Gallingani) Department of Cardio-Thoracic and Vascular Surgery,
Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera
Universitaria" of Parma, Parma, Italy
(Formica, Gripshi, Nicolini) Department of Cardio-Thoracic and Vascular
Surgery, Cardiac Surgery Unit, University Hospital "Azienda
Ospedaliera-Universitaria" of Parma, University of Parma, Parma, Italy
Publisher
Mattioli 1885
Abstract
Coronary artery bypass grafting is the gold standard strategy for
obtaining complete coronary revascularization in patients with multivessel
coronary artery disease. The recent AHA and EACTS guidelines on myocardial
revascularization recommend total arterial revascularization, especially
in younger patients, whenever possible. However, the use of saphenous vein
grafts in association with single or bilateral internal thoracic artery
(SITA, BITA) instead of arterial grafts (radial arteries, right
gastroepiploic artery and inferior epigastric artery) is widespread. We
analyzed literature from the last ten years (January 2010 to December
2020) looking for evidence in favour of the use of a radial artery
compared to a saphenous vein in association with BITA. We identified nine
studies (4 Systematic Reviews and Meta-analyses and 6 large cohort
observational studies with propensity score-matching) that compared
arterial with saphenous grafts as third conduit. The main finding of the
review is the higher rate of freedom from any cardiac adverse event in the
population which reached Total Arterial myocardial Revascularization
(TAR). A probable reason for the limited application of TAR as a strategy
is the shortage of Randomized Controlled Trials (RCTs).
(www.actabiomedica.it). Copyright © 2022, Mattioli 1885. All
rights reserved.

<107>
Accession Number
2017014146
Title
Evaluation of indigenously developed closed-loop automated blood pressure
control system (claps): a preliminary study.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2022. Date
of Publication: 2022.
Author
Kumar S.; Puri G.D.; Mathew P.J.; Mandal B.
Institution
(Kumar, Puri, Mathew, Mandal) Department of Anaesthesia & Critical Care,
Postgraduate Institute of Medical Education & Research, Chandigarh, India
(Kumar) Nehru Hospital, Postgraduate Institute of Medical Education &
Research, , Anaesthesia Office 4th Floor, Chandigarh 160012, India
Publisher
Springer Science and Business Media B.V.
Abstract
Closed-loop systems have been designed to assist anesthetists in
controlling anesthetic drugs and also maintaining the stability of various
physiological variables in the normal range. In the present study, we
describe and clinically evaluated a novel closed-loop automated blood
pressure control system (CLAPS) in patients undergoing cardiac surgery
under cardiopulmonary bypass. Forty ASA II-IV adult patients undergoing
elective cardiac surgery were randomly allocated to receive adrenaline,
noradrenaline, phenylephrine and nitroglycerine (NTG) adjusted either
through CLAPS (CLAPS group) or manually (Manual group). The desired target
mean arterial blood pressure (MAP) for each patient in both groups was set
by the attending anesthesiologist. The hemodynamic performance was
assessed based on the percentage duration of time the MAP remained within
20% of the set target. Automated controller performances were compared
using performance error criteria of Varvel (MDPE, MDAPE, Wobble) and
Global Score. MAP was maintained a significantly longer proportion of time
within 20% of the target in the CLAPS group (79.4% vs. 65.5% p < 0.001,
't' test) as compared to the manual group. Median absolute performance
error, wobble, and Global score was significantly lower in the CLAPS
group. Hemodynamic stability was achieved with a significantly lower dose
of Phenyepherine in the CLAPS group (1870 mug vs. 5400 mug, p < 0.05, 't'
test). The dose of NTG was significantly higher in the CLAPS group (3070
mug vs. 1600 mug, p-value < 0.05, 't' test). The cardiac index and left
ventricular end-diastolic area were comparable between the groups.
Automated infusion of vasoactive drugs using CLAPS is feasible and also
better than manual control for controlling hemodynamics during cardiac
surgery. Trial registration number and date This trial was registered in
the Clinical Trial Registry of India under Registration Number
CTRI/2018/01/011487 (Retrospective; registration date; January 23,
2018). Copyright © 2022, The Author(s), under exclusive licence
to Springer Nature B.V.

<108>
Accession Number
638061508
Title
Balloon- Versus Self-Expanding Valve Systems for Treating Small Failed
Surgical Aortic Bioprostheses: The LYTEN Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2022.
Date of Publication: 13 May 2022.
Author
Rodes-Cabau J.; Abbas A.; Serra V.; Vilalta V.; Nombela-Franco L.;
Regueiro A.; Al-Azizi K.M.; Iskander A.; Conradi L.; Forcillo J.; Lilly
S.; Calabuig A.; Fernandez-Nofrerias E.; Mohammadi S.; Panagides V.;
Pelletier-Beaumont E.; Pibarot P.
Institution
(Rodes-Cabau, Mohammadi, Panagides, Pelletier-Beaumont, Pibarot) Quebec
Heart & Lung Institute, Laval University, Quebec City, Canada
(Abbas) Beaumont Hospital, Royal Oak, MI, United States
(Serra, Calabuig) Hospital Universitari Vall d'Hebron, Barcelona, Spain
(Vilalta, Fernandez-Nofrerias) Hospital Universitari Germans Trias i
Pujol, Badalona, Spain
(Nombela-Franco) Hospital Clinico San Carlos, Madrid, Spain
(Regueiro) Hospital Clinic Barcelona, Barcelona, Spain
(Al-Azizi) Baylor Scott & White The Heart Hospital Plano, TX, United
States
(Iskander) SJH Cardiology Associates, NY, United States
(Conradi) University Heart Center, Hamburg, Germany
(Forcillo) Centre Hospitalier Universitaire de Montreal, Montreal, Canada
(Lilly) OSU Heart and Vascular Research Organization, Richard M Ross
Hospital, Columbus, OH, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Data comparing valve systems in the valve-in-valve
transcatheter aortic valve replacement (ViV-TAVR) field has been obtained
from retrospective studies. OBJECTIVE(S): To compare the hemodynamic
results between the balloon-expandable SAPIEN (3/ULTRA) (BEV) and
self-expanding Evolut (R/PRO/PRO+) (SEV) valves in ViV-TAVR.
 METHOD(S): Patients with a failed small (<=23 mm) surgical valve.
were randomized to receive a BEV or a SEV. The primary endpoint was valve
hemodynamics (maximal/mean residual gradients; severe prosthesis patient
mismatch [PPM] or moderate-severe aortic regurgitation [AR]) at 30 days as
evaluated by Doppler-echocardiography. RESULT(S): A total of 102
patients were randomized, and of these, 98 patients finally underwent a
ViV-TAVR procedure (BEV: 46, SEV: 52). The procedure was successful in all
cases, with no differences in clinical outcomes at 30 days between groups
(no death or stroke events). Patients in the SEV group exhibited lower
mean and maximal transvalvular gradient values (15+/-8 vs 23+/-8 mmHg,
p<0.001; 28+/-16 vs 40+/-13 mmHg, p <0.001), and a tendency towards a
lower rate of severe PPM (44% vs. 64%, p=0.07). There were no cases of
moderate-severe AR. 55 consecutive patients (SEV: 27, BEV: 28) underwent
invasive valve hemodynamic evaluation during the procedure, with no
differences in mean and peak transvalvular gradients between both groups
(p=0.41 and p=0.70, respectively). CONCLUSION(S): In patients with
small failed aortic bioprostheses, ViV-TAVR with a SEV was associated with
improved valve hemodynamics as evaluated by echocardiography. There were
no differences between groups in intra-procedural invasive valve
hemodynamics and 30-day clinical outcomes (NCT03520101). Copyright
© 2022. Published by Elsevier Inc.

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