EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2018500682
Title
Patient-Controlled Analgesia After Cardiac Surgery With Median Sternotomy:
No Advantages of Hydromorphone When Compared to Morphine.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Wehrfritz A.; Senger A.-S.; Just P.; Albart M.; Munchsmeier M.; Ihmsen H.;
Schuttler J.; Jeleazcov C.
Institution
(Wehrfritz, Senger, Just, Albart, Munchsmeier, Ihmsen, Schuttler,
Jeleazcov) Department of Anesthesiology, University Hospital Erlangen,
Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
Publisher
W.B. Saunders
Abstract
Objectives: To compare the efficacy, safety, and side effects of
hydromorphone and morphine administered as patient-controlled analgesia
(PCA) for postoperative pain therapy after cardiac surgery with median
sternotomy. <br/>Design(s): A retrospective analysis of data from 2
prospective, single-blinded, randomized trials. <br/>Setting(s): A
single-center intensive care unit at a university hospital.
<br/>Participant(s): Forty-one adult patients undergoing cardiac surgery
with median sternotomy. <br/>Intervention(s): Postoperative pain therapy
at the intensive care unit was performed by PCA with intravenously
administered bolus doses of 0.2 mg of hydromorphone (n = 21) or 2 mg of
morphine (n = 20). <br/>Measurements and Main Results: Pain at rest and
under deep inspiration regularly was assessed using the 11-point numerical
rating scale (NRS). Blood pressure, heart rate, cardiac output, oxygen
saturation, and respiratory rate were monitored, and adverse events were
registered. The median (range) NRS rating at rest was 1.5 (0-5) after
hydromorphone and 0.5 (0-5) after morphine, respectively (p = 0.41). The
median NRS rating under deep inspiration was 3 (0-6) after hydromorphone
and 4 (0-7) after morphine, respectively (p = 0.074). The dose ratio of
morphine to hydromorphone during PCA was 5.7 (95% confidence interval:
2.9-7.6). Hemodynamics and respiration were stable and did not differ
significantly. Postoperative nausea and vomiting were the most frequent
adverse events, which were observed in 29% of the patients after
hydromorphone and in 35% after morphine, respectively (p = 0.74).
<br/>Conclusion(s): There were no significant differences in analgesic
efficacy and safety between hydromorphone and morphine when used for
postoperative pain therapy with PCA after cardiac surgery with median
sternotomy.<br/>Copyright &#xa9; 2022 Elsevier Inc.

<2>
Accession Number
2015408718
Title
Postoperative outcomes in surgical patients with obstructive sleep apnoea
diagnosed by sleep studies: a meta-analysis and trial sequential analysis.
Source
Anaesthesia. 77(7) (pp 818-828), 2022. Date of Publication: July 2022.
Author
Pivetta B.; Sun Y.; Nagappa M.; Chan M.; Englesakis M.; Chung F.
Institution
(Pivetta, Sun) Department of Anaesthesia and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Nagappa) Department of Anaesthesia and Peri-Operative Medicine, London
Health Sciences Centre and St. Joseph Health Care, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong
(Englesakis) Library and Information Services, University Health Network,
Toronto, ON, Canada
(Chung) University Health Network, University of Toronto, Toronto, ON,
Canada
Publisher
John Wiley and Sons Inc
Abstract
Identifying surgical patients with obstructive sleep apnoea may assist
with anaesthetic management to minimise postoperative complications. Using
trial sequential analysis, we evaluated the impact of obstructive sleep
apnoea diagnosed by polysomnography or home sleep apnoea testing on
postoperative outcomes in surgical patients. Multiple databases were
systematically searched. Outcomes included: total postoperative
complications, systemic complications (cardiovascular, respiratory,
neurological, renal, infectious) and specific complications (atrial
fibrillation, myocardial infarction, combined hospital and intensive care
unit re-admission, mortality). The pooled odds ratios of postoperative
complications were evaluated by the Mantel-Haenszel method random-effects
model. Meta-analysis and meta-regression were conducted, and the GRADE
approach was used to evaluate the certainty of evidence. Twenty
prospective cohort studies with 3756 patients (2127 obstructive sleep
apnoea and 1629 non-obstructive sleep apnoea) were included (9 in
non-cardiac surgery and 11 in cardiac surgery). Postoperative
complications were almost two-fold higher with obstructive sleep apnoea,
OR (95%CI) 1.92 (1.52-2.42), p < 0.001; certainty of evidence, moderate.
Obstructive sleep apnoea was associated with a 1.5 times increased risk of
postoperative cardiovascular complications, OR (95%CI) 1.56 (1.20-2.02), p
= 0.001; certainty of evidence, moderate; an almost two-fold increase in
respiratory complications, OR (95%CI) 1.91 (1.39-2.62), p < 0.001;
certainty of evidence, moderate; and hospital and ICU re-admission, OR
(95%CI) 2.25 (1.21-4.19), p = 0.01; certainty of evidence, low. Trial
sequential analysis showed adequate information size for postoperative
complications. Baseline confounding factors were adjusted by
meta-regression, and the sub-group analysis did not materially change our
results. This increased risk occurred especially in patients in whom
obstructive sleep apnoea had been newly diagnosed, emphasising the
importance of pre-operative screening.<br/>Copyright &#xa9; 2022
Association of Anaesthetists.

<3>
Accession Number
637051676
Title
The effect of ultrasound-guided bilateral thoracic retrolaminar block on
analgesia after pediatric open cardiac surgery: a randomized controlled
double-blind study.
Source
Korean journal of anesthesiology. 75(3) (pp 276-282), 2022. Date of
Publication: 01 Jun 2022.
Author
Abdelbaser I.; Mageed N.A.; Elfayoumy S.I.; Magdy M.; Elmorsy M.M.;
ALseoudy M.M.
Institution
(Abdelbaser, Mageed, Magdy, ALseoudy) Department of Anesthesia and
Surgical Intensive Care, Faculty of Medicine, Mansoura University,
Mansoura, Egypt
(Elfayoumy) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Portsaid University, Egypt
(Elmorsy) Department of Anesthesia and Surgical Intensive Care, Faculty of
Medicine, Damietta University, Damietta, Egypt
Publisher
NLM (Medline)
Abstract
BACKGROUND: The thoracic retrolaminar block (TRLB) is a relatively new
regional analgesia technique that can be used as an alternative to the
thoracic paravertebral block. This study aimed to evaluate the
postoperative analgesia effects of ultrasound-guided TRLB in children
undergoing open cardiac surgery via median sternotomy incision.
<br/>METHOD(S): Sixty-six patients aged 2-8 years were recruited. In the
TRLB group, 0.25% bupivacaine 0.4 ml/kg was injected into the retrolaminar
space on both sides at the level of the T4 lamina. Patients in the control
group were injected with 0.9% saline. The primary outcome measure was
fentanyl consumption in the first 24 h post-extubation. The secondary
outcome measures were the total intraoperative fentanyl consumption,
postoperative modified objective pain score (MOPS), and time to
extubation. <br/>RESULT(S): The total intraoperative fentanyl requirements
and fentanyl consumption in the first 24 h post-extubation were
significantly lower (P < 0.001) in the TRLB group (9.3 +/- 1.2; 6.9 +/-
2.1 mug/kg, respectively) than in the control group (12.5 +/- 1.4; 16.6
+/- 2.8, respectively). The median (Q1, Q3) time to extubation was
significantly shorter (P < 0.001) in the TRLB group (2 [1, 3] h) than in
the control group (6 [4.5, 6] h). The MOPS was significantly lower (P <
0.05) in the TRLB group than in the control group at 0, 2, 4, 8, 12 and 16
h post-extubation. <br/>CONCLUSION(S): Bilateral ultrasound-guided TRLB is
effective in providing postoperative analgesia in children undergoing open
cardiac surgery via median sternotomy incision.

<4>
Accession Number
636373746
Title
Regional analgesia techniques for video-assisted thoracic surgery: a
frequentist network meta-analysis.
Source
Korean journal of anesthesiology. 75(3) (pp 231-244), 2022. Date of
Publication: 01 Jun 2022.
Author
Jo Y.; Park S.; Oh C.; Pak Y.; Jeong K.; Yun S.; Noh C.; Chung W.; Kim
Y.-H.; Ko Y.K.; Hong B.
Institution
(Jo, Oh, Pak, Jeong, Yun, Noh, Chung, Kim, Ko, Hong) Department of
Anesthesiology and Pain Medicine, Chungnam National University Hospital,
Daejeon, South Korea
(Jo, Oh, Pak, Yun, Noh, Chung, Kim, Ko, Hong) Department of Anesthesiology
and Pain Medicine, College of Medicine, Chungnam National University,
Daejeon, South Korea
(Park) Department of Nursing, College of Nursing, Chungnam National
University, Daejeon, South Korea
(Ko, Hong) Biomedical Research Institute, Chungnam National University,
Daejeon, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Various regional analgesia techniques are used to reduce
postoperative pain in patients undergoing video-assisted thoracic surgery
(VATS). This study aimed to determine the relative efficacy of regional
analgesic interventions for VATS using a network meta-analysis (NMA).
<br/>METHOD(S): We searched the Medline, EMBASE, Cochrane Controlled Trial
Register, Web of Science, and Google Scholar databases to identify all
randomized controlled trials (RCTs) that compared the analgesic effects of
the following interventions: control, thoracic paravertebral block (TPVB),
erector spinae plane block (ESPB), serratus plane block (SPB), and
intercostal nerve block (INB). The primary outcome was opioid consumption
during the first 24-h postoperative period. Pain scores were also
collected during three different postoperative periods: the early (0-6 h),
middle (6-18 h), and late (18-24 h) periods. <br/>RESULT(S): A total of 21
RCTs (1391 patients) were included. TPVB showed the greatest effect on
opioid consumption compared with the control (mean difference [MD] = -13.2
mg; 95% CI [-16.2, -10.1]). In terms of pain scores in the early period,
ESPB had the greatest effect compared to control (MD = -1.6; 95% CI [-2.3,
-0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB
and INB had superior analgesic effects compared to controls, while SPB did
not. <br/>CONCLUSION(S): TPVB had the best analgesic efficacy following
VATS, though the analgesic efficacy of ESPBs was comparable. However,
further studies are needed to determine the optimal regional analgesia
technique to improve postoperative pain control following VATS.

<5>
Accession Number
638085401
Title
Thromboembolic events in left ventricular non-compaction: Comparison
between children and adults - A systematic review and meta-analysis.
Source
Open Heart. 9(1) (no pagination), 2022. Article Number: e001908. Date of
Publication: 25 May 2022.
Author
Hirono K.; Takarada S.; Miyao N.; Nakaoka H.; Ibuki K.; Ozawa S.; Origasa
H.; Ichida F.
Institution
(Hirono, Takarada, Miyao, Nakaoka, Ibuki, Ozawa, Origasa) Department of
Pediatrics and Biostatistics and Clinical Epidemiology, University of
Toyama, Toyama, Japan
(Ichida) Department of Pediatrics, International University of Health and
Welfare, Otawara, Japan
Publisher
BMJ Publishing Group
Abstract
Objective Left ventricular non-compaction (LVNC) is morphologically
characterised by excessive trabeculations and deep recesses in the
ventricular wall. The risk of thromboembolic disease in the paediatric
patients with LVNC has not been clearly established. We conducted this
systematic review to evaluate the prevalence and incidence of
thromboembolism (TE) in paediatric and adult patients with LVNC and
searched for risk factors for TE to explore management strategies. Methods
The primary outcome was the prevalence and incidence of TE in the patients
with LVNC. The secondary outcome was the TE and mortality and heart
transplantation rates between paediatric and adult patients with LVNC. We
searched for studies published in MEDLINE, Embase and Cochrane Central
Register of Controlled Trials between January 1950 and December 2020. A
systematic search of keywords related to LVNC,
anticoagulants/antiplatelets and TE was conducted. Studies that did not
present original research, non-human studies, duplicated studies were
excluded. Results Fifty-seven studies met the inclusion criteria. A total
of 726 paediatric and 3862 adult patients were included. The mean
prevalence rates of TE in the paediatric and adult patients with LVNC were
2.6% and 6.2% (I 2 =0%; p<0.450 and I 2 =73.7%; p<0.001), respectively.
The mean annual incidences of TE in paediatric and adult patients with
LVNC were 1.4% and 2.9% (I 2 =99.4%; p<0.001 and I 2 =99.5%; p<0.001),
respectively. Multivariate logistic regression analysis showed that TE was
associated with left ventricular ejection fraction in <40% of paediatric
patients (OR, 9.47; 95% CI, 1.35 to 188.23; p=0.0225). Conclusions The
prevalence and incidence rates in paediatric patients were lower than
those in adult patients. TE was associated with a reduced systolic
function in paediatric patients with LVNC.<br/>Copyright &#xa9;

<6>
Accession Number
2017583506
Title
DOACs in Mechanical and Bioprosthetic Heart Valves: A Narrative Review of
Emerging Data and Future Directions.
Source
Clinical and Applied Thrombosis/Hemostasis. 28 (no pagination), 2022. Date
of Publication: 2022.
Author
Ryu R.; Tran R.
Institution
(Ryu) Western University of Health Sciences, College of Pharmacy,
Department of Pharmacy, Pomona, CA, United States
(Tran) Keck Graduate Institute, School of Pharmacy and Health Sciences,
Department of Clinical and Administrative Sciences, Claremont, CA, United
States
Publisher
SAGE Publications Inc.
Abstract
In the recent years, there has been significant transformation in the
management of valvular heart disease (VHD), as a result of new minimally
invasive technologies, such as the transcatheter aortic valve implantation
(TAVI). Conventionally, mechanical heart valves require anticoagulation
with warfarin to prevent thrombogenic events. Lately, there has been an
uptrend in the usage of direct-acting oral anticoagulants (DOACs) in both
mechanical and bioprosthetic heart valves. In clinical practice, there has
shown to be notable heterogeneity in the antithrombotic regimen for
patients. Recommendations from clinical guidelines and emerging data on
DOAC use in these settings will be critically reviewed here. Future large,
randomized-controlled trials are warranted to delineate the role of DOACs
in patients receiving a bioprosthetic valve/TAVI or mechanical heart
valve, with and without a baseline indication for anticoagulation or
antiplatelets. Until clinical trial data from well-designed studies are
available, providers must remain vigilant about DOAC use in patients with
VHD, especially in patients with a bioprosthetic or mechanical heart
valve.<br/>Copyright &#xa9; The Author(s) 2022.

<7>
Accession Number
2018441259
Title
How Effective Is Aerobic Exercise Training in Improving Aerobic Capacity
after Heart Transplant? A Systematic Review and Meta-analysis.
Source
Cardiopulmonary Physical Therapy Journal. 32(3) (pp 114-128), 2021. Date
of Publication: 01 Jul 2021.
Author
Groen K.; Robison P.; Xiong A.; Irwin K.E.; Stein A.B.; Evans C.C.
Institution
(Groen, Robison, Xiong, Irwin, Evans) Physical Therapy Program, College of
Health Sciences, Midwestern University, 555 31st Street, AH 340E, Downers
Grove, IL 60515, United States
(Stein) Bioclinical Statistics Department, Office of Research and
Sponsored Programs, Midwestern University, Glendale, AZ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose:Studies suggest that additional exercise (Ex) training beyond
"usual care"increases peak VO2 in people post-heart transplant (HTx);
however, no recent studies have quantified improvements or compared
moderate-intensity aerobic Ex (MOD) to high-intensity interval training
(HIIT). The purpose of this study was to quantify improvements in VO2 for
patients post-HTx undergoing additional Ex training and compare
effectiveness of MOD to HIIT. <br/>Method(s):Inclusion criteria were:
randomized clinical trials, systematic reviews, or meta-analyses published
between 2008 to 2018, subjects post-HTx, participated in an aerobic Ex
program beyond usual care, and reported peak VO2. <br/>Result(s):A total
of 242 records were obtained and 7 randomized clinical trials were
reviewed. The average PEDro score was 4.86 (range 2-7). The within-group
weighted mean difference (WMD) in peak VO2 comparing baseline to
post-training for the Ex group = 3.3 (0.5) ml/kg/min and for the control
group = -0.2 (0.2) ml/kg/min. The between-group WMD in peak VO2 = 3.5
(7.9) ml/kg/min, Hedge's g = 0.606 (95% confidence intervals =
0.337-0.874), P <.001, favoring Ex. Comparison between Ex protocols
indicated that there was no difference between HIIT and MOD (Q = 1.83, P
=.176). <br/>Conclusion(s):Physical therapists should challenge patients
post-HTx with aerobic Ex that goes beyond usual post-HTx care and should
consider incorporating HIIT into the treatment plan or home program to
maximize the benefits of rehabilitation when possible. <br/>Copyright
&#xa9; Cardiovascular and Pulmonary Section, APTA.

<8>
Accession Number
638174025
Title
The Relation of Grit and Surgical Specialty Interest Among Medical
Students.
Source
Journal of surgical education. (no pagination), 2022. Date of
Publication: 01 Jun 2022.
Author
Huo B.; Dow T.; Helyer L.
Institution
(Huo) Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
(Dow) Division of Plastic Surgery, Department of Surgery, Dalhousie
University, Halifax, NS, Canada
(Helyer) Division of General Surgery, Department of Surgery, Dalhousie
University, Halifax, NS, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The assessment of Grit among medical students applying to
surgical residency programs may be useful, but the relationship between
student Grit and surgical specialty interest is not clear. This study
investigated whether medical student Grit differs based on interest in
direct-entry surgical specialties. DESIGN: A literature search informed
the development of a cross-sectional study assessing medical student
ratings of the validated 6-item Short-Grit scale. Medical students also
indicated their career preferences. SETTING: Faculty of Medicine,
Dalhousie University, Halifax, NS, Canada; a tertiary medical center.
PARTICIPANTS: Surgical specialty interest and Grittiness were assessed
among 297 (50.4%) pre-clerkship medical students in their first or second
year of training. Data was collected from program applicants over 4 years.
<br/>RESULT(S): Medical students had high levels of Grit (M=4.029,
SD=0.517). There was a significant difference in Grit level between
medical students interested in cardiac surgery ([M=4.197, SD=0.471 vs
M=3.919, 0.518]; t(295)=4.674, p < 0.001; Cohen's D=0.556), general
surgery ([M=4.178, SD=0.466 vs M=3.916, 0.527]; t(295)=4.434, p < 0.001;
Cohen's D=0.520), neurosurgery ([M=4.238, SD=0.457 vs M=3.950, 0.518];
t(295)=4.412, p < 0.001; Cohen's D=0.575), plastic surgery ([M=4.138,
SD=0.497 vs M=3.967, 0.520]; t(295)=2.747, p=0.006; Cohen's D=0.333), and
vascular surgery (M=4.248, SD=0.368 vs M=3.948, 0.541); t(295)=4.570, p <
0.001; Cohen's D=0.501). <br/>CONCLUSION(S): Medical students with a
career interest in "poor lifestyle" surgical specialties have higher Grit
than their peers. These findings may be noteworthy for surgical residency
programs with high rates of attrition and burnout.<br/>Crown Copyright
&#xa9; 2022. Published by Elsevier Inc. All rights reserved.

<9>
Accession Number
638165136
Title
Corticosteroids in patients undergoing cardiac surgery: A meta-analysis of
12,559 patients.
Source
Perfusion. (pp 2676591221106324), 2022. Date of Publication: 03 Jun 2022.
Author
Chen L.; Xiang F.; Hu Y.
Institution
(Chen, Xiang, Hu) Department of Pharmacy, 26452The Second Affiliated
Hospital of Wenzhou Medical University, Wenzhou, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Corticosteroids can attenuate the inflammatory response to
cardiopulmonary bypass, but their benefits on clinical outcomes are
unclear. We conducted a meta-analysis to evaluate whether corticosteroid
therapy affects outcomes in patients undergoing cardiac surgery.
<br/>METHOD(S): We searched PubMed, Embase, EBSCO and Cochrane databases
from 1 January 2010 to 14 March 2022 for randomized controlled trials
(RCTs) that assessed corticosteroid versus non- corticosteroid therapy in
patients undergoing cardiac surgery. The primary outcome was in-hospital
mortality. Secondary outcomes were renal failure, infection, delirium,
intensive care unit (ICU) and hospital stay. <br/>RESULT(S): Four RCTs
including 12,559 patients (6265 randomized to corticosteroid therapy and
6294 to non-corticosteroid therapy) were included. One-hundred and 92 of
6265 patients (3.1%) randomized to the corticosteroid group versus 221 of
6294 patients (3.5%) randomized to the non-corticosteroid group
experienced death during hospitalization. Compared the control group,
corticosteroid therapy did not significantly reduce in-hospital mortality,
with an RR of 0.87 (0.72-1.06), p = .16. There was no difference in the
incidence of infection (RR 0.78 (0.56-1.10), p = .16), delirium during
hospitalization (RR 1.01 (0.90-1.14), p = .85), or the length of hospital
stay (MD -0.13 (-0.32 to 0.05), p = .17). However, corticosteroid therapy
significantly reduced the risk of renal failure ( RR 0.82 (0.67-0.99), p =
.04), and the length of ICU stay (MD -0.41 (-0.65 to -0.17), p < .01).
<br/>CONCLUSION(S): Corticosteroids did not significantly reduce the rates
of in-hospital mortality, infection, or delirium, but reduce the incidence
of renal failure and the length of ICU stay.

<10>
Accession Number
638176439
Title
Early and mid-term outcomes of transcatheter tricuspid valve repair:
systematic review and meta-analysis of observational studies.
Source
Revista espanola de cardiologia (English ed.). (no pagination), 2022.
Date of Publication: 02 Jun 2022.
Author
Alperi A.; Avanzas P.; Almendarez M.; Leon V.; Hernandez-Vaquero D.; Silva
I.; Valle D.F.D.; Fernandez F.; Diaz R.; Rodes-Cabau J.; Moris C.; Pascual
I.
Institution
(Alperi, Almendarez, Diaz) Area del Corazon, Hospital Universitario
Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigacion
Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
(Avanzas, Hernandez-Vaquero, Moris, Pascual) Area del Corazon, Hospital
Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de
Investigacion Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain;
Universidad de Oviedo, Oviedo, Spain
(Leon, Silva, Valle, Fernandez) Area del Corazon, Hospital Universitario
Central de Asturias, Oviedo, Asturias, Spain
(Rodes-Cabau) QCCanada
Publisher
NLM (Medline)
Abstract
INTRODUCTION AND OBJECTIVES: Severe tricuspid regurgitation (TR) is
associated with poor prognosis when left untreated, and a growing number
of studies on transcatheter tricuspid valve repair (TTVr) have been
published over the last few months. <br/>METHOD(S): We performed a
comprehensive systematic review of published literature providing clinical
data on TTVr for patients with significant TR. Early and mid-term clinical
and echocardiographic outcomes were evaluated. Risk ratios (RR) or mean
differences (MD) were obtained when comparing pre- and postprocedural
data. A sensitivity analysis was also performed according to the main
approach for repair (edge-to-edge vs annuloplasty). <br/>RESULT(S): A
total of 19 studies (all observational or single-arm trials) and 991
patients who underwent isolated TTVr were included. Thirty-day mortality
and stroke rates were 2.8% and 0.2%, respectively. Pooled random-effects
resulted in a significant reduction of >= severe TR (RR, 0.33; 95%CI,
0.26-0.42; P < .001), vena contracta width (MD, 5.9 mm; 95%CI, 4-7.9; P <
.001), right ventricular end-diastolic diameter (MD, 3.5 mm; 95%CI,
2.5-4.5; P < .001), and New York Heart Association (NYHA) class 3 or 4 at
last follow-up (RR, 0.32; 95%CI, 0.27-0.37; P < .001). Bleeding
complications and residual >= severe TR were numerically higher in the
annuloplasty-like group compared with edge-to-edge repair (13.3% vs 2.8%
for bleeding and 40.4% vs 27.9% for residual severe TR).
<br/>CONCLUSION(S): Among 991 patients comprising the early experience for
several TTVr devices, there was a statistically significant reduction in
>= severe TR, NYHA class 3-4, vena contracta width and right ventricular
end-diastolic diameter after TTVr. Thus far, the edge-to-edge approach
seems to be associated with a better safety profile.<br/>Copyright &#xa9;
2022 Sociedad Espanola de Cardiologia. Published by Elsevier Espana,
S.L.U. All rights reserved.

<11>
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.
<br/>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.<br/>Copyright &#xa9; 2021 Lippincott Williams
and Wilkins. All rights reserved.

<12>
Accession Number
2018380689
Title
Confounders and co-interventions identified in non-randomized studies of
interventions.
Source
Journal of Clinical Epidemiology. 148 (pp 115-123), 2022. Date of
Publication: August 2022.
Author
Pufulete M.; Mahadevan K.; Johnson T.W.; Pithara C.; Redwood S.; Benedetto
U.; Higgins J.P.T.; Reeves B.C.
Institution
(Pufulete, Reeves) Bristol Trials Centre (Clinical Trials and Evaluation
Unit), Bristol Medical School, University of Bristol, Bristol, United
Kingdom
(Pufulete, Higgins, Reeves) NIHR Biomedical Research Centre at University
Hospitals Bristol and Weston NHS Foundation Trust and the University of
Bristol, Bristol, United Kingdom
(Mahadevan, Johnson, Benedetto) Bristol Heart Institute, Bristol, United
Kingdom
(Pithara, Redwood, Higgins) The National Institute for Health Research
Applied Research Collaboration West (NIHR ARC West) at University
Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
(Higgins) Population Health Sciences, Bristol Medical School, University
of Bristol, Bristol, United Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: To identify potential confounders and co-interventions
systematically to optimise control of confounding for three non-randomized
studies of interventions (NRSI) designed to quantify bleeding in
populations exposed to different dual antiplatelet therapy (DAPT). Study
Design and Setting: Systematic review, interviews, and surveys with
clinicians. We searched Ovid Medline, Ovid Embase, and the Cochrane
Library to identify randomized-controlled trials and cohort studies of
DAPT interventions. Two researchers independently screened citations,
identified eligible studies and extracted data. We conducted individual
semi-structured interviews with six cardiologists and six cardiac surgeons
to elicit factors clinicians consider when they prescribe DAPT. We
administered two online surveys for members of professional cardiology and
cardiac surgery organisations. <br/>Result(s): We screened 2,544 records,
identified 322 eligible studies, and extracted data from 47. We identified
10 co-interventions and 70 potential confounders: review 31 (91%);
interviews 19 (56%); surveys 31 (91%). 16/34 (47%) were identified by all
three methods while, 3/34 (9%) were picked up by one method only.
<br/>Conclusion(s): The review identified the majority of factors, but the
interviews identified hard-to-measure factors such as perceived patient
adherence and local prescribing culture. The methods could, in principle,
be widely applied when designing or reviewing non-randomized studies of
interventions (NRSI).<br/>Copyright &#xa9; 2022

<13>
Accession Number
2016536040
Title
Bi-level Positive Airway Pressure Versus Nasal CPAP for the Prevention of
Extubation Failure in Infants After Cardiac Surgery.
Source
Respiratory Care. 67(4) (pp 448-454), 2022. Date of Publication: 01 Apr
2022.
Author
Zheng Y.-R.; Lin W.-H.; Lin S.-H.; Xu N.; Cao H.; Chen Q.
Institution
(Zheng, Lin, Lin, Xu, Cao, Chen) Department of Cardiac Surgery, Fujian
Branch of Shanghai Children's Medical Center, Fuzhou, China
(Zheng, Lin, Lin, Xu, Cao, Chen) Fujian Children's Hospital, Fuzhou, China
(Zheng, Lin, Lin, Xu, Cao, Chen) Fujian Maternity and Child Health
Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
(Zheng, Lin, Lin, Xu, Cao, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Extubation early in the postoperative period is beneficial to
the recovery and rehabilitation of patients. This study compared the
postoperative extubation failure rates among infants who received
postextubation respiratory support by either bi-level positive airway
pressure (BPAP) or nasal CPAP following cardiac surgery. <br/>METHOD(S):
This was a single-center randomized controlled trial registered at the
Chinese Clinical Trial Registry (number ChiCTR2000041453) and was
conducted between January 2020 and March 2021. Ventilated infants who
underwent cardiac surgery were randomized to either a BPAP or a nasal CPAP
group for ventilatory support following extubation. The primary outcome
measure was the extubation failure rate within 48 h. <br/>RESULT(S): The
analyses included 186 subjects. Treatment failure necessitating
re-intubation was noted in 14 of the 93 infants (15%) in the BPAP group
and in 11 of the 93 infants (12%) in the nasal CPAP group (P 5 .52).
Moreover, there were no statistically significant differences between the
2 groups regarding the duration of noninvasive ventilation (P 5 .54),
total enteral feeding time (P 5 .59), or complications (P 5 .85). We found
that both the BPAP group and the nasal CPAP group showed significantly
improved oxygenation and relief of respiratory distress after treatment.
However, the P<inf>aCO2</inf> level within 24 h was significantly lower in
the BPAP group (P 5 .001) than in the CPAP group. Additionally, the
P<inf>aO2</inf>/F<inf>IO2</inf> in the BPAP group was significantly higher
than in the nasal CPAP group at 6 h, 12 h, and 24 h after treatment (P <
.001). <br/>CONCLUSION(S): The introduction of BPAP for postextubation
respiratory support was not inferior to nasal CPAP in infants after
cardiac surgery. Moreover, BPAP was shown to be superior to nasal CPAP in
improving oxygenation and carbon dioxide clearance.<br/>Copyright &#xa9;
American Association for Respiratory Care. All rights reserved.

<14>
Accession Number
2016475543
Title
A multicenter, randomized, double-blind, placebo-controlled study to
evaluate the efficacy of immunosuppression in biopsy-proven virus-negative
myocarditis or inflammatory cardiomyopathy (IMPROVE-MC).
Source
Cardiology Journal. 29(2) (pp 329-341), 2022. Date of Publication: 07 Apr
2022.
Author
Ozieranski K.; Tyminska A.; Marchel M.; Januszkiewicz L.; Maciejewski C.;
Glowczynska R.; Marcolongo R.; Caforio A.L.P.; Wojnicz R.; Mizia-Stec K.;
Grzybowski J.; Gasior M.; Nowalany-Kozielska E.; Pawlak A.; Kaczmarek K.;
Zegarska J.; Paczek L.; Balsam P.; Opolski G.; Grabowski M.
Institution
(Ozieranski, Tyminska, Marchel, Januszkiewicz, Maciejewski, Glowczynska,
Balsam, Opolski, Grabowski) 1stDepartment of Cardiology, Medical
University of Warsaw, Poland
(Marcolongo, Caforio) Division of Cardiology, Department of Cardiac
Thoracic Vascular Sciences and Public Health, University of Padova, Italy
(Marcolongo) Hematology and Clinical Immunology Unit and Cardio-immunology
outpatient Clinic, University of Padova, Italy
(Wojnicz) Department of Histology and Cell Pathology in Zabrze, School of
Medicine with the Division of Dentistry, Medical University of Silesia in
Katowice, Poland
(Mizia-Stec) 1stDepartment of Cardiology, School of Medicine in Katowice,
Medical University of Silesia, Katowice, Poland
(Grzybowski) Department of Cardiomyopathy, National Institute of
Cardiology, Warsaw, Poland
(Gasior) 3rdDepartment of Cardiology, Faculty of Medical Sciences in
Zabrze, Medical University of Silesia, Katowice, Poland
(Nowalany-Kozielska) 2ndDepartment of Cardiology, Faculty of Medical
Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
(Pawlak) Department of Invasive Cardiology, Central Clinical Hospital of
the Ministry of the Interior and Administration, Warsaw, Poland
(Kaczmarek) Department of Electrocardiology, Central University Hospital,
Medical University of Lodz, Poland
(Zegarska, Paczek) Department of Immunology, Transplant Medicine and
Internal Medicine, Medical University of Warsaw, Poland
Publisher
Via Medica

<15>
Accession Number
2016475331
Title
Prevention of Cardiovascular Events with Pitavastatin is Associated with
Increased Serum Lipoprotein Lipase Mass Level: Subgroup Analysis of the
TOHO-LIP.
Source
Journal of Atherosclerosis and Thrombosis. 29(4) (pp 451-463), 2022. Date
of Publication: 01 Apr 2022.
Author
Nagayama D.; Saiki A.; Watanabe Y.; Yamaguchi T.; Ohira M.; Sato N.;
Kanayama M.; Moroi M.; Miyashita Y.; Shirai K.; Tatsuno I.
Institution
(Nagayama) Nagayama Clinic, Tochigi, Japan
(Nagayama, Saiki, Watanabe, Yamaguchi, Ohira, Tatsuno) Center of Diabetes,
Endocrine and Metabolism, Toho University Sakura Medical Center, Chiba,
Japan
(Sato, Kanayama) Pharmaceutical Unit, Toho University Sakura Medical
Center, Chiba, Japan
(Moroi) Division of Cardiovascular Medicine (Ohashi), Department of
Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
(Miyashita) Medical Correction Center in East Japan, Tokyo, Japan
(Shirai) Department of Internal Medicine, Mihama Hospital, Chiba, Japan
Publisher
Japan Atherosclerosis Society
Abstract
Aim: To clarify the mechanism by which pitavastatin reduced cardiovascular
(CV) events more effectively than atorvastatin in the TOHO Lipid
Intervention Trial Using Pitavastatin (TOHO-LIP), the changes in (DELTA)
non-heparinized serum level of lipoprotein lipase mass (LPL mass) during
administration of the respective statins were investigated.
<br/>Method(s): From TOHO-LIP data, 223 hypercholesterolemic patients with
any CV risks followed at Toho University Sakura Medical Center were
analyzed. The patients were randomized to pitavastatin (2 mg/day) group
(n=107) or atorvastatin (10 mg/day) group (n =116), and followed for 240
weeks. In this subgroup study, the primary and secondary end points were
the same as those in TOHO-LIP, and 3-point major adverse cardiovascular
events (3P-MACE) was added. The relationship between DELTALPL mass during
the first year and the incidences of each end point was analyzed.
<br/>Result(s): The lipid-lowering effect was not different between the
two statins. Cumulative 240-week incidence of each end point was
significantly lower in pitavastatin group (primary: 1.9% vs. 10.3%,
secondary: 4.7% vs. 18.1%, 3P-MACE: 0.9% vs. 6.9%). Mean LPL mass (64.9 to
69.0 ng/mL) and eGFR (70.1 to 73.6 ml/ min/1.73m²) increased in
pitavastatin group, but not in atorvastatin group during the first year.
Cox proportional-hazards model revealed that DELTALPL mass (1 ng/mL or
1SD) contributed to almost all end points. <br/>Conclusion(s):
Pitavastatin administration reduced CV events more efficaciously than
atorvastatin despite similar LDL cholesterol-lowering effect of the two
statins. Increased LPL mass during the first year by pitavastatin
treatment may be associated with this efficacy.<br/>Copyright &#xa9;2022
Japan Atherosclerosis Society.

<16>
Accession Number
2013951042
Title
Effect of ideal protein versus low-fat diet for weight loss: A randomized
controlled trial.
Source
Obesity Science and Practice. 8(3) (pp 299-307), 2022. Date of
Publication: June 2022.
Author
Fernandez C.A.; Potts K.; Bazzano L.A.
Institution
(Fernandez, Potts, Bazzano) Department of Epidemiology, Tulane University
School of Public Health and Tropical Medicine, New Orleans, LA, United
States
(Fernandez) Center for Sport, Tulane University School of Medicine, New
Orleans, LA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Current guidelines call for peer-reviewed evidence of efficacy
and safety for commercial weight loss programs to be recommended as
options for those seeking to lose weight. <br/>Objective(s): This study
investigated the Ideal Protein (IP) system, a commercial weight loss
program, compared to a guideline-based, low-calorie/low-fat (LCLF) dietary
behavioral intervention on body weight and CVD risk factors in adults with
obesity. <br/>Method(s): In this randomized, assessor-blinded,
parallel-group trial, 192 participants with body mass index (BMI) >=30 and
<=49 kg/m² were assigned to either the IP Phase I diet or LFLC
diet interventions. The IP Phase I is focused on lean protein and
vegetables with avoidance of fruit and dairy, while the LFLC diet goals
include <30% of daily energy from fat, <7% from saturated fat, 55% from
carbohydrate, and an energy deficit of 500 kcal/day. The primary endpoint
was change in body weight at 3 months. Secondary endpoints included change
in waist circumference (WC), hip circumference (HC), total cholesterol
(TC), low-density lipoprotein cholesterol (LDL-C) and high-density
lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting glucose (FG),
systolic blood pressure (SBP) and diastolic blood pressure (DBP).
<br/>Result(s): The mean +/- SD of change in weight at 3 months was -9.6
+/- 12.7 kg in the IP group as compared to -1.6 +/- 27.2 kg in the LFLC
group. The mean between-group difference in change at 3 months was -8.1 kg
(95% confidence interval [CI] -16.6 to 0.6; p = 0.05). Additional
significant between-group differences included WC, HC, TC, and TG levels,
all favoring the IP group. There were no serious adverse events during the
intervention period. <br/>Conclusion(s): The present findings demonstrate
the efficacy and safety of the IP weight loss program as compared to a
guideline-based LCLF dietary behavioral intervention among black and white
adults with obesity and CVD risk factors, providing support for the
effectiveness of the program.<br/>Copyright &#xa9; 2021 The Authors.
Obesity Science & Practice published by World Obesity and The Obesity
Society and John Wiley & Sons Ltd.

<17>
Accession Number
638076882
Title
Management of asymptomatic severe aortic stenosis: a systematic review and
meta-analysis.
Source
Open Heart. 9(1) (no pagination), 2022. Article Number: e001982. Date of
Publication: 17 May 2022.
Author
Tsampasian V.; Grafton-Clarke C.; Gracia Ramos A.E.; Asimakopoulos G.;
Garg P.; Prasad S.; Ring L.; McCann G.P.; Rudd J.; Dweck M.R.; Vassiliou
V.S.
Institution
(Tsampasian, Grafton-Clarke, Garg, Vassiliou) Cardiology, Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Tsampasian, Grafton-Clarke, Garg, Vassiliou) Norwich Medical School,
University of East Anglia, Norwich, United Kingdom
(Gracia Ramos) Departamento de Medicina Interna, Centro Medico Nacional
"la Raza", Imss, Ciudad de Mexico, Mexico
(Gracia Ramos) Seccion de Estudios de Posgrado e Investigacion, Escuela
Superior de Medicina, Instituto Politecnico Nacional, Mexico City, Mexico
(Asimakopoulos, Prasad) Cardiology, Royal Brompton and Harefield Nhs
Trust, London, United Kingdom
(Asimakopoulos, Prasad) School of Medicine, Imperial College London,
London, United Kingdom
(Ring) Cardiology, West Suffolk Hospital Nhs Trust, Bury Saint Edmunds,
United Kingdom
(McCann) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(McCann) Leicester Nihr Biomedical Research Centre, Glenfield Hospital,
Leicester, United Kingdom
(Rudd) Division of Cardiovascular Medicine, University of Cambridge,
Cambridge, United Kingdom
(Dweck) British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives The management of severe aortic stenosis mandates consideration
of aortic valve intervention for symptomatic patients. However, for
asymptomatic patients with severe aortic stenosis, recent randomised
trials supported earlier intervention. We conducted a systematic review
and meta-analysis to evaluate all the available data comparing the two
management strategies. Methods PubMed, Cochrane and Web of Science
databases were systematically searched from inception until 10 January
2022. The search key terms were asymptomatic', severe aortic stenosis'
and intervention'. Results Meta-analysis of two published randomised
trials, AVATAR and RECOVERY, included 302 patients and showed that early
intervention resulted in 55% reduction in all-cause mortality (HR=0.45,
95% CI 0.24 to 0.86; I 2 0%) and 79% reduction in risk of hospitalisation
for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I 2 15%). There was no
difference in risk of cardiovascular death between the two groups
(HR=0.36, 95% CI 0.03 to 3.78; I 2 78%). Additionally, meta-analysis of
eight observational studies showed improved mortality in patients treated
with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I 2 77%).
Conclusion This meta-analysis provides evidence that, in patients with
severe asymptomatic aortic stenosis, early intervention reduces all-cause
mortality and improves outcomes compared with conservative management.
While this is very encouraging, further randomised controlled studies are
needed to draw firm conclusions and identify the optimal timing of
intervention. PROSPERO registration number CRD42022301037.<br/>Copyright
&#xa9; 2022 BMJ Publishing Group. All rights reserved.

<18>
[Use Link to view the full text]
Accession Number
2017431166
Title
Effects of perioperative erythropoietin administration on acute kidney
injury and red blood cell transfusion in patients undergoing cardiac
surgery: A systematic review and meta-analysis.
Source
Medicine (United States). 101(9) (pp E28920), 2022. Date of Publication:
04 Mar 2022.
Author
Shin H.J.; Ko E.; Jun I.; Kim H.J.; Lim C.H.
Institution
(Shin, Ko, Jun, Lim) Department of Anesthesiology and Pain Medicine, Korea
University Anam Hospital, Korea University College of Medicine, Seoul,
South Korea
(Kim) Department of Preventive Medicine, Institute for Evidence-based
Medicine Cochrane Korea, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background:The renoprotective effects of erythropoietin (EPO) are
well-known; however, the optimal timing of EPO administration remains
controversial. Red blood cell (RBC) transfusion is an independent risk
factor for cardiac surgery-associated acute kidney injury (CSA-AKI). We
aimed to evaluate the efficacy of EPO on CSA-AKI and RBC transfusion
according to the timing of administration. <br/>Method(s):We searched the
Cochrane Library, EMBASE, and MEDLINE databases for randomized controlled
trials. The primary outcome was the incidence of CSA-AKI following
perioperative EPO administration, and the secondary outcomes were changes
in serum creatinine, S-cystatin C, S-neutrophil gelatinase-associated
lipocalin, urinary neutrophil gelatinase-associated lipocalin, length of
hospital and intensive care unit (ICU) stay, volume of RBC transfusion,
and mortality. The subgroup analysis was stratified according to the
timing of EPO administration in relation to surgery. <br/>Result(s):Eight
randomized controlled trials with 610 patients were included in the study.
EPO administration significantly decreased the incidence of CSA-AKI (odds
ratio: 0.60, 95% confidence interval [CI]: 0.43-0.85, P = .004;
I² = 52%; P for heterogeneity = .04), intra-operative RBC
transfusion (standardized mean difference: -0.30, 95% CI: -0.55 to -0.05,
P = .02; I² = 15%, P for heterogeneity = .31), and hospital
length of stay (mean difference: -1.54 days, 95% CI: -2.70 to -0.39, P =
.009; I² = 75%, P for heterogeneity = .001) compared with
control groups. Subgroup analyses revealed that pre-operative EPO
treatment significantly reduced the incidence of CSA-AKI, intra-operative
RBC transfusion, serum creatinine, and length of hospital and ICU stay.
<br/>Conclusion(s):Pre-operative administration of EPO may reduce the
incidence of CSA-AKI and RBC transfusion, but not in patients administered
EPO during the intra-operative or postoperative period. Therefore,
pre-operative EPO treatment can be considered to improve postoperative
outcomes by decreasing the length of hospital and ICU stay in patients
undergoing cardiac surgery.<br/>Copyright &#xa9; 2022 Lippincott Williams
and Wilkins. All rights reserved.

<19>
Accession Number
2014785569
Title
Coronary stent infection: Are patients amenable to surgical treatment? A
systematic review and narrative synthesis.
Source
International Journal of Cardiology. 344 (pp 40-46), 2021. Date of
Publication: 01 Dec 2021.
Author
Pisani A.; Braham W.; Borghese O.
Institution
(Pisani) Department of Cardiovascular Surgery, Pineta Grande Hospital,
Castel Volturno, Italy
(Braham) Department of Cardiovascular Surgery, Bichat Claude Bernard
Hospital, Paris, France
(Borghese) Sapienza University, Rome, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Coronary stent infection is a fearsome complication with high
mortality rate. Since antibiotics may have only partial efficacy, invasive
surgery may be needed. We present a systematic review about outcomes
achieved by surgical versus medical treatment in this scenario.
<br/>Method(s): A literature search through Medline and Google Scholar was
performed over a 30-years period according to PRISMA guidelines.
Demographics, clinical data, imaging findings and treatment modalities
were collected. Outcomes were analysed according to treatment.
<br/>Result(s): Among 1727 articles identified, after duplicate removal
the title/abstract screening excluded 821 articles. After full-text
screening, 31 studies were included totalling 34 patients (n 28, 82.4%
male, mean age 61.7 SD +/- 10 years old). The majority of infection were
sustained by S. Aureus (n 28, 82.4%), occurred within one month (median 7
days, range 1-1440) from stenting and mostly over drug-eluting stents
(n21, 61.8%). The majority of patients (n30, 88.2%) underwent antibiotics
at first: 12 patients (35.3%) didn't undergo additional treatment because
they died, were unfit or refused major surgery or responded favorably to
medical treatment; surgery was scheduled in a total of 20 patients
(58.8%), as an emergent approach (n2) or after failure of antibiotics
(n18). More than half of patients medically treated died (n6/11, 54.5%)
versus 35% (n7/20) in surgery group. <br/>Conclusion(s): Coronary stent
infections are associated with high morbi-mortality rate. Medical
treatment may be the only possible approach in extremely fragile patients,
however timely surgical referral is the only definitive treatment, and it
is recommended whenever possible.<br/>Copyright &#xa9; 2021 Elsevier B.V.

<20>
Accession Number
2014655126
Title
The use of basilica technique to prevent coronary obstruction in a
tavi-tavi procedure.
Source
Journal of Clinical Medicine. 10(23) (no pagination), 2021. Article
Number: 5534. Date of Publication: December-1 2021.
Author
Tagliari A.P.; Saadi R.P.; Medronha E.F.; Saadi E.K.
Institution
(Tagliari, Saadi, Saadi) Postgraduate Program in Cardiology and
Cardiovascular Science, Universidade Federal do Rio Grande do Sul, Porto
Alegre 90035-002, Brazil
(Tagliari, Saadi) Cardiac Sergery Department, Hospital Sao Lucas da
PUC/RS, Porto Alegre 90619-900, Brazil
(Tagliari, Medronha, Saadi) Cardiac Sergery Department, Hospital de
Clinicas de Porto Alegre, Porto Alegre 90035-903, Brazil
(Saadi, Saadi) Cardiac Surgery and Radiology Department, Hospital Mae de
Deus, Porto Alegre 90880-0481, Brazil
Publisher
MDPI
Abstract
Transcatheter aortic valve implantation (TAVI) to manage structural
bioprosthetic valve deterioration has been successful in mitigating the
risk of a redo cardiac surgery. However, TAVI-inTAVI is a complex
intervention, potentially associated with feared complications such as
coronary artery obstruction. Coronary obstruction risk is especially high
when the previously implanted prosthesis had supra-annular leaflets and/or
the distance between the prosthesis and the coronary ostia is short. The
BASILICA technique (bioprosthetic or native aortic scallop intentional
laceration to prevent iatrogenic coronary artery obstruction) was
developed to prevent coronary obstruction during native or valve-in-valve
interventions but has now also been considered for TAVI-in-TAVI
interventions. Despite its utility, the technique requires a not so widely
available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique
and how to perform it using more widely available tools, which could
spread its use.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<21>
[Use Link to view the full text]
Accession Number
635247743
Title
High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial
Infarction A Stepped-Wedge Cluster Randomized Controlled Trial.
Source
Circulation. 143(23) (pp 2214-2224), 2021. Date of Publication: 08 Jun
2021.
Author
Anand A.; Lee K.K.; Chapman A.R.; Ferry A.V.; Adamson P.D.; Strachan F.E.;
Berry C.; Findlay I.; Cruikshank A.; Reid A.; Collinson P.O.; Apple F.S.;
McAllister D.A.; Maguire D.; Fox K.A.A.; Newby D.E.; Tuck C.; Harkess R.;
Keerie C.; Weir C.J.; Parker R.A.; Gray A.; Shah A.S.V.; Mills N.L.
Institution
(Anand, Lee, Chapman, Ferry, Adamson, Strachan, Fox, Newby, Shah, Mills)
BHF Centre for Cardiovascular Science, University of Edinburgh, United
Kingdom
(Tuck, Harkess, Keerie, Weir, Parker) Edinburgh Clinical Trials Unit,
University of Edinburgh, United Kingdom
(Gray, Shah, Mills) Usher Institute, University of Edinburgh, United
Kingdom
(Adamson) Christchurch Heart Institute, University of Otago, Christchurch,
New Zealand
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
United Kingdom
(Findlay) Department of Cardiology, Royal Alexandra Hospital, Paisley,
United Kingdom
(Cruikshank, Reid) Department of Biochemistry, Queen Elizabeth University
Hospital, Glasgow, United Kingdom
(Collinson) Departments of Clinical Blood Sciences and Cardiology, St.
George's University Hospitals NHS Trust, St. George's University of
London, United Kingdom
(Apple) Department of Laboratory Medicine and Pathology, Hennepin
Healthcare and University of Minnesota School of Medicine, Minneapolis,
United States
(Maguire) Emergency Medicine Department, Glasgow Royal Infirmary, United
Kingdom
(Gray) Emergency Medicine Research Group Edinburgh, Royal Infirmary of
Edinburgh, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: High-sensitivity cardiac troponin assays enable myocardial
infarction to be ruled out earlier, but the safety and efficacy of this
approach is uncertain. We investigated whether an early rule-out pathway
is safe and effective for patients with suspected acute coronary syndrome.
<br/>METHOD(S): We performed a stepped-wedge cluster randomized controlled
trial in the emergency departments of 7 acute care hospitals in Scotland.
Consecutive patients presenting with suspected acute coronary syndrome
between December 2014 and December 2016 were included. Sites were
randomized to implement an early rule-out pathway where myocardial
infarction was excluded if high-sensitivity cardiac troponin I
concentrations were <5 ng/L at presentation. During a previous validation
phase, myocardial infarction was ruled out when troponin concentrations
were <99th percentile at 6 to 12 hours after symptom onset. The coprimary
outcome was length of stay (efficacy) and myocardial infarction or cardiac
death after discharge at 30 days (safety). Patients were followed for 1
year to evaluate safety and other secondary outcomes. <br/>RESULT(S): We
enrolled 31 492 patients (59+/-17 years of age [mean+/-SD]; 45% women)
with troponin concentrations <99th percentile at presentation. Length of
stay was reduced from 10.1+/-4.1 to 6.8+/-3.9 hours (adjusted geometric
mean ratio, 0.78 [95% CI, 0.73-0.83]; P<0.001) after implementation and
the proportion of patients discharged increased from 50% to 71% (adjusted
odds ratio, 1.59 [95% CI, 1.45-1.75]). Noninferiority was not demonstrated
for the 30-day safety outcome (upper limit of 1-sided 95% CI for adjusted
risk difference, 0.70% [noninferiority margin 0.50%]; P=0.068), but the
observed differences favored the early rule-out pathway (0.4% [57/14 700]
versus 0.3% [56/16 792]). At 1 year, the safety outcome occurred in 2.7%
(396/14 700) and 1.8% (307/16 792) of patients before and after
implementation (adjusted odds ratio, 1.02 [95% CI, 0.74-1.40]; P=0.894),
and there were no differences in hospital reattendance or all-cause
mortality. <br/>CONCLUSION(S): Implementation of an early rule-out pathway
for myocardial infarction reduced length of stay and hospital admission.
Although noninferiority for the safety outcome was not demonstrated at 30
days, there was no increase in cardiac events at 1 year. Adoption of this
pathway would have major benefits for patients and health care
providers.<br/>Copyright &#xa9; 2021 The Authors. Circulation is published
on behalf of the American Heart Association, Inc., by Wolters Kluwer
Health, Inc.

<22>
[Use Link to view the full text]
Accession Number
635173630
Title
Randomized Clinical Comparison of the Dual-Therapy CD34 Antibody-Covered
Sirolimus-Eluting Combo Stent with the Sirolimus-Eluting Orsiro Stent in
Patients Treated with Percutaneous Coronary Intervention: The SORT OUT X
Trial.
Source
Circulation. 143(22) (pp 2155-2165), 2021. Date of Publication: 01 Jun
2021.
Author
Jakobsen L.; Christiansen E.H.; Freeman P.; Kahlert J.; Veien K.; Maeng
M.; Raungaard B.; Ellert J.; Villadsen A.B.; Kristensen S.D.; Ahlehoff O.;
Christensen M.K.; Terkelsen C.J.; Erik Botker H.; Aaroe J.; Thim T.;
Thuesen L.; Aziz A.; Eftekhari A.; Jensen R.V.; Stottrup N.B.; Rasmussen
J.G.; Junker A.; Jensen S.E.; Hansen H.S.; Jensen L.O.
Institution
(Jakobsen, Christiansen, Maeng, Kristensen, Terkelsen, Erik Botker, Thim,
Eftekhari, Jensen, Stottrup) Department of Cardiology, Aarhus University
Hospital, Denmark
(Kahlert) Department of Clinical Epidemiology, Aarhus University Hospital,
Denmark
(Freeman, Raungaard, Villadsen, Christensen, Aaroe, Thuesen, Rasmussen,
Jensen) Department of Cardiology, Aalborg University Hospital, Denmark
(Veien, Ellert, Ahlehoff, Aziz, Junker, Hansen, Jensen) Department of
Cardiology, Odense University Hospital, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Target lesion failure remains an issue with contemporary
drug-eluting stents. Thus, the dual-therapy sirolimus-eluting and CD34+
antibody-coated Combo stent (DTS) was designed to further improve early
healing. This study aimed to investigate whether the DTS is noninferior to
the sirolimus-eluting Orsiro stent (SES) in an all-comers patient
population. <br/>Method(s): The SORT OUT X (Combo Stent Versus Orsiro
Stent) trial, was a large-scale, randomized, multicenter, single-blind,
2-arm, noninferiority trial with registry-based follow-up. The primary end
point target lesion failure was a composite of cardiac death, myocardial
infarction, or target lesion revascularization within 12 months, analyzed
using intention-to-treat. The trial was powered for assessing target
lesion failure noninferiority of the DTS compared with the SES with a
predetermined noninferiority margin of 0.021. <br/>Result(s): A total of
3146 patients were randomized to treatment with the DTS (1578 patients;
2008 lesions) or SES (1568 patients; 1982 lesions). At 12 months,
intention-to-treat analysis showed that 100 patients (6.3%) assigned the
DTS and 58 patients (3.7%) assigned the SES met the primary end point
(absolute risk difference, 2.6% [upper limit of 1-sided 95% CI, 4.1%]; P
(noninferiority)=0.76). The SES was superior to the DTS (incidence rate
ratios for target lesion failure, 1.74 [95% CI, 1.26-2.41]; P=0.00086).
The difference was explained mainly by a higher incidence of target lesion
revascularization in the DTS group compared with the SES group (53 [3.4%]
vs. 24 [1.5%]; incidence rate ratio, 2.22 [95% CI, 1.37-3.61]; P=0.0012).
<br/>Conclusion(s): The DTS did not confirm noninferiority to the SES for
target lesion failure at 12 months in an all-comer population. The SES was
superior to the DTS mainly because the DTS was associated with an
increased risk of target lesion revascularization. However, rates of
death, cardiac death, and myocardial infarction at 12 months did not
differ significantly between the 2 stent groups. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03216733.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins.
All rights reserved.

<23>
[Use Link to view the full text]
Accession Number
634795242
Title
One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding With a
Balloon-Expandable Transcatheter Aortic Valve.
Source
Circulation. 143(12) (pp 1267-1269), 2021. Date of Publication: 23 Mar
2021.
Author
Kim W.-K.; Walther T.; Burgdorf C.; Mollmann H.; Linke A.; Redwood S.;
Thilo C.; Hilker M.; Joner M.; Thiele H.; Conzelmann L.; Conradi L.;
Kerber S.; Schymik G.; Prendergast B.; Husser O.; Blumenstein J.;
Stortecky S.; Heg D.; Kunzi A.; Juni P.; Windecker S.; Pilgrim T.; Lanz J.
Institution
(Kim) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery,
University Hospital Frankfurt, Germany
(Burgdorf) Heart and Vascular Center, Bad Bevensen, Germany
(Mollmann, Husser, Blumenstein) Department of Internal Medicine I,
St-Johannes-Hospital, Dortmund, Germany
(Linke) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Technische Universitat Dresden, Germany
(Redwood, Prendergast) Department of Cardiology, St Thomas' Hospital,
London, United Kingdom
(Thilo) Department of Cardiology, Klinikum, Augsburg, Germany
(Hilker) Department of Cardiothoracic Surgery, University Medical Center,
Regensburg, Germany
(Joner) Deutsches Herzzentrum Munchen, Cardiology and Technische
Universitat Munchen, German Center for Cardiovascular Research (DZHK),
partner site Munich Heart, Alliance, Germany
(Thiele) Heart Center Leipzig, University of Leipzig, Leipzig Heart
Institute, Germany
(Conzelmann) Department of Cardiac Surgery, Helios Klinik, Karlsruhe,
Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Center,
Hamburg, Germany
(Kerber) Department of Cardiology, Cardiovascular Center Bad, Neustadt,
Germany
(Schymik) Department of Cardiology, Stadtisches Klinikum, Karlsruhe,
Germany
(Stortecky, Windecker, Pilgrim, Lanz) Department of Cardiology,
Inselspital, Bern University Hospital, Switzerland
(Heg, Kunzi) Clinical Trials Unit, University of Bern, Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael`s Hospital, Department of Medicine, Institute of Health Policy,
Management and Evaluation, University of Toronto, ON, Canada
Publisher
Lippincott Williams and Wilkins

<24>
[Use Link to view the full text]
Accession Number
634815058
Title
Bariatric Surgery and Cardiovascular Outcomes in Patients with Obesity and
Cardiovascular Disease: A Population-Based Retrospective Cohort Study.
Source
Circulation. 143(15) (pp 1468-1480), 2021. Date of Publication: 13 Apr
2021.
Author
Doumouras A.G.; Wong J.A.; Paterson J.M.; Lee Y.; Sivapathasundaram B.;
Tarride J.-E.; Thabane L.; Hong D.; Yusuf S.; Anvari M.
Institution
(Doumouras, Lee, Hong, Anvari) Division of General Surgery, McMaster
University, Hamilton, ON, Canada
(Wong, Yusuf) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Paterson) Department of Family Medicine, McMaster University, Hamilton,
ON, Canada
(Tarride, Thabane) Department of Health Research Methods, Evidence, and
Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Tarride) Center for Health Economics and Policy Analysis, McMaster
University, Hamilton, ON, Canada
(Doumouras, Paterson, Sivapathasundaram, Hong, Anvari) ICES, Toronto, ON,
Canada
(Wong, Thabane, Yusuf) Population Health Research Institute, Hamilton
Health Sciences and McMaster University, ON, Canada
(Paterson) Institute of Health Policy, Management, and Evaluation,
University of Toronto, ON, Canada
(Tarride) Programs for Assessment of Technology in Health, The Research
Institute of St Joe's Hamilton, St Joseph's Healthcare, Hamilton, ON,
Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Bariatric surgery has been shown to significantly reduce
cardiovascular risk factors. However, whether surgery can reduce major
adverse cardiovascular events (MACE), especially in patients with
established cardiovascular disease, remains poorly understood. The present
study aims to determine the association between bariatric surgery and MACE
among patients with cardiovascular disease and severe obesity.
<br/>METHOD(S): This was a propensity score-matched cohort study using
province-wide multiple-linked administrative databases in Ontario, Canada.
Patients with previous ischemic heart disease or heart failure who
received bariatric surgery were matched on age, sex, heart failure
history, and a propensity score to similar controls from a primary care
medical record database in a 1:1 ratio. The primary outcome was the
incidence of extended MACE (first occurrence of all-cause mortality,
myocardial infarction, coronary revascularization, cerebrovascular events,
and heart failure hospitalization). Secondary outcome included 3-component
MACE (myocardial infarction, ischemic stroke, and all-cause mortality).
Outcomes were evaluated through a combination of matching via propensity
score and subsequent multivariable adjustment. <br/>RESULT(S): A total of
2638 patients (n=1319 in each group) were included, with a median
follow-up time of 4.6 years. The primary outcome occurred in 11.5%
(151/1319) of the surgery group and 19.6% (259/1319) of the controls
(adjusted hazard ratio [HR], 0.58 [95% CI, 0.48-0.71]; P<0.001). The
association was notable for those with heart failure (HR, 0.44 [95% CI,
0.31-0.62]; P<0.001; absolute risk difference, 19.3% [95% CI,
12.0%-26.7%]) and in those with ischemic heart disease (HR, 0.60 [95% CI,
0.48-0.74]; P<0.001; absolute risk difference, 7.5% [95% CI, 4.7%-10.5%]).
Surgery was also associated with a lower incidence of the secondary
outcome (HR, 0.66 [95% CI, 0.52-0.84]; P=0.001) and cardiovascular
mortality (HR, 0.35 [95% CI, 0.15-0.80]; P=0.001). <br/>CONCLUSION(S):
Bariatric surgery was associated with a lower incidence of MACE in
patients with cardiovascular disease and obesity. These findings require
confirmation by a large-scale randomized trial.<br/>Copyright &#xa9; 2021
American Heart Association, Inc.

<25>
[Use Link to view the full text]
Accession Number
2018654034
Title
Coronary Revascularization for Patients with Diabetes Mellitus.
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
Lippincott Williams and Wilkins
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. <br/>Background(s):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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2022 Lippincott
Williams and Wilkins. All rights reserved.

<26>
Accession Number
2016962039
Title
Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in
Adults With Congenital Heart Disease: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Heart Association. 10(24) (no pagination), 2021.
Article Number: e022909. Date of Publication: 21 Dec 2021.
Author
Van den Eynde J.; Callahan C.P.; Rito M.L.; Hussein N.; Carvajal H.;
Guariento A.; Ruhparwar A.; Weymann A.; Budts W.; Gewillig M.; Sa M.P.;
Kutty S.
Institution
(Van den Eynde, Kutty) Helen B. Taussig Heart Center, The Johns Hopkins
Hospital and School of Medicine, Baltimore, MD, United States
(Van den Eynde) Department of Cardiovascular Sciences, Department of
Cardiovascular Diseases, KU Leuven, University Hospitals Leuven, Leuven,
Belgium
(Callahan, Guariento) Division of Cardiovascular Surgery, The Hospital for
Sick Children, Toronto, Canada
(Rito) Department of Congenital Cardiac Surgery, IRCCS Policlinico San
Donato, San Donato Milanese, Italy
(Hussein) Department of Congenital Cardiac Surgery, Yorkshire Heart
Centre, Leeds General Infirmary, United Kingdom
(Carvajal) Section of Pediatric Cardiothoracic Surgery, Department of
Surgery, Washington University School of Medicine in St. Louis/St. Louis
Children's Hospital, Saint Louis, MO, United States
(Ruhparwar, Weymann) Department of Thoracic and Cardiovascular Surgery,
West German Heart and Vascular Center Essen, University Hospital of Essen,
University Duisburg-Essen, Essen, Germany
(Budts) Department of Cardiovascular Sciences, Congenital and Structural
Cardiology, Catholic University Leuven, University Hospitals Leuven,
Leuven, Belgium
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Sa) Department of Cardiac Surgery, Lankenau Heart Institute, Main Line
Health, Wynnewood, PA, United States
(Sa) Department of Cardiac Surgery Research, Lankenau Institute for
Medical Research, Main Line Health, Wynnewood, PA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Tricuspid regurgitation (TR) is a common finding in adults
with congenital heart disease referred for pulmonary valve replacement
(PVR). However, indications for combined valve surgery remain
controversial. This study aimed to evaluate early results of concomitant
tricuspid valve intervention (TVI) at the time of PVR. METHODS AND
RESULTS: Observational studies comparing TVI+PVR and isolated PVR were
identified by a systematic search of published research. Random-effects
meta-analysis was performed, comparing outcomes between the 2 groups. Six
studies involving 749 patients (TVI+PVR, 278 patients; PVR, 471 patients)
met the eligibility criteria. In the pooled analysis, both TVI+PVR and PVR
reduced TR grade, pulmonary regurgitation grade, right ventricular
end-diastolic volume, and right ventricular end-systolic volumes. TVI+PVR,
but not PVR, was associated with a decrease in tricuspid valve annulus
size (mean difference, -6.43 mm, 95% CI, -10.59 to -2.27; P=0.010).
Furthermore, TVI+PVR was associated with a larger reduction in TR grade
compared with PVR (mean difference, -0.40; 95% CI, -0.75 to -0.05;
P=0.031). No evidence could be established for an effect of either
treatment on right ventricular ejection fraction or echocardiographic
assessment of right ventricular dilatation and dysfunction. There was no
evidence for a difference in hospital mortality or reoperation for TR.
<br/>CONCLUSION(S): While both strategies are effective in reducing TR and
right ventricular volumes, routine TVI+PVR can reduce TR grade to a larger
extent than isolated PVR. Further studies are needed to identify the
subgroups of patients who might benefit most from combined valve
surgery.<br/>Copyright &#xa9; 2021 The Authors.

<27>
Accession Number
638163452
Title
Antithrombotic strategies after transcatheter aortic valve implantation: A
systematic review and network meta-analysis of randomized controlled
trials.
Source
International journal of cardiology. (no pagination), 2022. Date of
Publication: 30 May 2022.
Author
Ke Y.; Wang J.; Wang W.; Guo S.; Dai M.; Wu L.; Bao Y.; Li B.; Ju J.; Xu
H.; Jin Y.
Institution
(Ke) Discipline of Pharmacy Administration, Anqing Medical Center
affiliated to Anhui Medical University(Anqing Municipal Hospital), Anqing,
Anhui, China.; School of Pharmacy, Anhui Medical University, Hefei, Anhui,
China
(Wang) Department of Pharmacy, The Friendship Hospital of ILY Kazak
Autonomous Prefecture, Xinjiang, Yili, China.; Discipline of Pharmacy
Administration, Anqing Medical Center affiliated to Anhui Medical
University(Anqing Municipal Hospital), Anqing, Anhui, China
(Wang) Department of Gastroenterology, Anqing Medical Center affiliated to
Anhui Medical University(Anqing Municipal Hospital), Anqing, Anhui, China
(Guo) Department of Pharmacy, People's Hospital of Guangxi Zhuang
Autonomous Region, Nanning, Guangxi, China
(Dai) School of Pharmacy, China Pharmaceutical University, Nanjing,
Jiangsu 210000, China
(Wu, Bao) School of Pharmacy, Anhui Medical University, Hefei, Anhui,
China
(Li) School of Public Health, Anhui Medical University, Hefei, Anhui,
China
(Ju) Department of Equipment, Anqing Medical Center affiliated to Anhui
Medical University(Anqing Municipal Hospital), Anqing, Anhui, China
(Xu) Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to
Nanjing University Medical School, Nanjing, Jiangsu, China
(Jin) School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
Publisher
NLM (Medline)
Abstract
AIMS: Meta-analyses comparing different antithrombotic strategies were
conducted to determine the optimal therapeutic regimen post transcatheter
aortic valve implantation (TAVI). However, there were restricted
high-quality direct comparisons across the different antithrombotic
therapeutic regimens. We sought to explore the safety and efficacy of
different antithrombotic therapy strategies after TAVI using network
meta-analyses of randomized controlled trials (RCTs). <br/>METHOD(S): We
searched CENTRAL, PubMed, Embase and Medline through August 2021 for RCTs
that directly compared different antithrombotic schemes in adults who had
undergone TAVI. We conducted a pairwise and network meta-analysis
measuring all-cause mortality, stroke, myocardial infarction, all bleeding
and life-threatening or major bleeding events. The surface under the
cumulative ranking (SUCRA) curve was estimated to rank the therapies. We
evaluated the risk of bias and graded the quality of the evidence using
established methods. <br/>RESULT(S): Six RCTs of 2824 patients who
underwent TAVI were analysed. The risk of all bleeding [relative risk (RR)
1.88 (1.34-2.64)] and life-threatening or major bleeding [RR 2.03
(1.27-3.24)] was significantly higher for dual antiplatelet therapy (DAPT)
than single antiplatelet therapy (SAPT), whereas there was no significant
difference in the risk of all-cause mortality [RR 1.01 (0.61-1.68)]
between DAPT and SAPT. Oral anticoagulant (OAC)+SAPT (OACSAPT) had
significantly higher rates of all bleeding and life-threatening or major
bleeding events compared with SAPT ([RR 3.46 (2.23-5.36)], [RR 2.86
(1.50-5.45)]). The risk of all-cause mortality [RR 1.72 (1.14-2.59)] and
all bleeding [RR 1.84 (1.38-2.44)] were significantly higher for OACSAPT
than DAPT, whereas there was no significant difference in the risk of
life-threatening or major bleeding events [RR 1.41 (0.89-2.23)] between
DAPT and OACSAPT. There was no significant difference in stroke or
myocardial infarction among the different antithrombotic strategies (SAPT,
DAPT and OACSAPT). Additionally, patients receiving OACSAPT had the
highest risks for all-cause mortality (SUCRA 3.5%) and life-threatening or
major bleeding (SUCRA 2.3%). SAPT seemed to be superior to DAPT in terms
of all-cause mortality (SUCRA SAPT: 76.7%, DAPT: 69.8%) and stroke (SUCRA
69.6%, 59.7%). <br/>CONCLUSION(S): Except for OACSAPT having a higher
all-cause mortality than DAPT, patients who underwent TAVI had similar
all-cause mortality, stroke and myocardial infarction rates among
different antithrombotic regimens. Patients on SAPT had a significantly
lower bleeding risk than those on DAPT and OACSAPT. Our study indicates
that SAPT is the preferred therapeutic strategy when there is no
indication for OAC or DAPT. Furthermore, the application of OACSAPT was
ranked the worst among all antithrombotic regimens and should be averted
due to an increased risk of all-cause mortality and all
bleeding.<br/>Copyright &#xa9; 2022 Elsevier Ireland Ltd. All rights
reserved.

<28>
Accession Number
638163444
Title
Cardiovascular computed tomography in pediatric congenital heart disease:
A state of the art review.
Source
Journal of cardiovascular computed tomography. (no pagination), 2022.
Date of Publication: 06 May 2022.
Author
Cohen J.; Asrani P.; Lee S.; Frush D.; Han B.K.; Chelliah A.; Farooqi K.M.
Institution
(Cohen) Department of Pediatrics, Division of Pediatric Cardiology, Icahn
School of Medicine at Mount Sinai, NY, NY, United States
(Asrani) Division of Pediatric Cardiology, Department of Pediatrics, New
York Presbyterian/Columbia University Irving Medical Center, NY, NY,
United States
(Lee) Department of Pediatrics, The Heart Center, Nationwide Children's
Hospital, The Ohio State University, Columbus, OH, USA
(Frush) Division of Pediatric Radiology, Department of Radiology, Medical
Physics Graduate Program, Duke University Medical Center, Durham, United
States
(Han) Children's Heart Clinic at The Children's Hospitals and Clinics of
Minnesota, MN, Minneapolis, United States
(Chelliah) Division of Pediatric Cardiology, Department of Pediatrics, New
York Presbyterian/Columbia University Irving Medical Center, New York, NY,
USA; Division of Pediatric Cardiology, Goryeb Children's Hospital,
Atlantic Health System, Morristown, NJ, USA
(Farooqi) Division of Pediatric Cardiology, Department of Pediatrics, New
York Presbyterian/Columbia University Irving Medical Center, NY, NY,
United States
Publisher
NLM (Medline)
Abstract
Cardiac computed tomography (CCT) has increasingly been used in the
assessment of both children and adults with congenital heart disease
(CHD), in part due to advances in CCT technology and an increased
prevalence of adults with palliated CHD. It serves as a complimentary
modality to echocardiography, cardiac magnetic resonance imaging and
cardiac catheterization. CCT can provide unique diagnostic information, is
less invasive and less likely to require sedation compared to other
modalities. Detailed knowledge of individual patient cardiac anatomy,
physiology, surgical repair and possible residual lesions are paramount to
optimal CCT imaging. This comprehensive review details the use of CCT both
pre- and postoperatively for the most common CHD diagnoses. We also aim to
highlight some new and innovative technologies that have become available
and can further optimize CCT imaging for CHD patients.<br/>Copyright
&#xa9; 2022 Society of Cardiovascular Computed Tomography. Published by
Elsevier Inc. All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
631070851
Title
A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute
Coronary Syndromes: The Rapid Assessment of Possible Acute Coronary
Syndrome in the Emergency Department with High-Sensitivity Troponin T
Study (RAPID-TnT).
Source
Circulation. 140(19) (pp 1543-1556), 2019. Date of Publication: 05 Nov
2019.
Author
Chew D.P.; Lambrakis K.; Blyth A.; Seshadri A.; Edmonds M.J.R.; Briffa T.;
Cullen L.A.; Quinn S.; Karnon J.; Chuang A.; Nelson A.J.; Wright D.;
Horsfall M.; Morton E.; French J.K.; Papendick C.
Institution
(Chew, Blyth, Seshadri, Karnon, Chuang, Morton) College of Medicine and
Public Health, Flinders University of South Australia, Adelaide, Australia
(Chew, Chuang, Nelson) South Australian Health and Medical Research
Institute, Adelaide, Australia
(Chew, Lambrakis, Blyth, Seshadri, Edmonds, Wright, Horsfall, Papendick)
South Australian Department of Health, Adelaide, Australia
(Nelson) School of Medicine, University of Adelaide, Australia
(Briffa) School of Population and Global Health, University of Western
Australia, Perth, Australia
(Cullen) Department of Emergency Medicine, Royal Brisbane and Women's
Hospital, Australia
(Cullen) School of Public Health, Queensland University of Technology,
Brisbane, Australia
(Cullen) School of Medicine, University of Queensland, Brisbane, Australia
(Quinn) Department of Statistics, Data Science and Epidemiology, Swinburne
University of Technology, Melbourne, Australia
(French) Department of Cardiology, University of New South Wales, Sydney,
Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: High-sensitivity troponin assays promise earlier
discrimination of myocardial infarction. Yet, the benefits and harms of
this improved discriminatory performance when incorporated within rapid
testing protocols, with respect to subsequent testing and clinical events,
has not been evaluated in an in-practice patient-level randomized study.
This multicenter study evaluated the noninferiority of a 0/1-hour
high-sensitivity cardiac troponin T (hs-cTnT) protocol in comparison with
a 0/3-hour masked hs-cTnT protocol in patients with suspected acute
coronary syndrome presenting to the emergency department (ED).
<br/>Method(s): Patients were randomly assigned to either a 0/1-hour
hs-cTnT protocol (reported to the limit of detection [<5 ng/L]) or masked
hs-cTnT reported to <=29 ng/L evaluated at 0/3-hours (standard arm). The
30-day primary end point was all-cause death and myocardial infarction.
Noninferiority was defined as an absolute margin of 0.5% determined by
Poisson regression. <br/>Result(s): In total, 3378 participants with an
emergency presentation were randomly assigned between August 2015 and
April 2019. Ninety participants were deemed ineligible or withdrew
consent. The remaining participants received care guided either by the
0/1-hour hs-cTnT protocol (n=1646) or the 0/3-hour standard masked hs-cTnT
protocol (n=1642) and were followed for 30 days. Median age was 59 (49-70)
years, and 47% were female. Participants in the 0/1-hour arm were more
likely to be discharged from the ED (0/1-hour arm: 45.1% versus standard
arm: 32.3%, P<0.001) and median ED length of stay was shorter (0/1-hour
arm: 4.6 [interquartile range, 3.4-6.4] hours versus standard arm: 5.6
(interquartile range, 4.0-7.1) hours, P<0.001). Those randomly assigned to
the 0/1-hour protocol were less likely to undergo functional cardiac
testing (0/1-hour arm: 7.5% versus standard arm: 11.0%, P<0.001). The
0/1-hour hs-cTnT protocol was not inferior to standard care (0/1-hour arm:
17/1646 [1.0%] versus 16/1642 [1.0%]; incidence rate ratio, 1.06 [
0.53-2.11], noninferiority P value=0.006, superiority P value=0.867),
although an increase in myocardial injury was observed. Among patients
discharged from ED, the 0/1-hour protocol had a negative predictive value
of 99.6% (95% CI, 99.0-99.9%) for 30-day death or myocardial infarction.
<br/>Conclusion(s): This in-practice evaluation of a 0/1-hour hs-cTnT
protocol embedded in ED care enabled more rapid discharge of patients with
suspected acute coronary syndrome. Improving short-term outcomes among
patients with newly recognized troponin T elevation will require an
evolution in management strategies for these patients. Clinical Trial
Registration: URL: https://www.anzctr.org.au. Unique identifier:
ACTRN12615001379505.<br/>Copyright &#xa9; 2019 American Heart Association,
Inc.

<30>
Accession Number
637726207
Title
Hybrid coronary revascularization in multivessel coronary artery disease:
A systematic review.
Source
Future Cardiology. 18(3) (pp 219-234), 2022. Date of Publication: March
2022.
Author
Nenna A.; Nappi F.; Spadaccio C.; Greco S.M.; Pilato M.; Stilo F.;
Montelione N.; Catanese V.; Lusini M.; Spinelli F.; Chello M.
Institution
(Nenna, Greco, Stilo, Montelione, Catanese, Lusini, Spinelli, Chello)
Cardiovascular Surgery, Universita Campus Bio-Medico di Roma, Via Alvaro
del Portillo 200, Rome 00128, Italy
(Nappi) Cardiac Surgery, Centre Cardiologique du Nord, Rue des Moulins
Gemeaux 32, Saint Denis, Paris 93200, France
(Spadaccio) Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon
St, Clydebank, Glasgow G814DY, United Kingdom
(Greco, Pilato) Cardiac Surgery, ISMETT-IRCCS, Via Ernesto Tricomi 5,
Palermo 90127, Italy
Publisher
Future Medicine Ltd.
Abstract
Aim: Hybrid coronary revascularization (HCR) for multivessel coronary
artery disease (CAD) integrates coronary artery bypass grafting (CABG) and
percutaneous intervention in a planned revascularization strategy. This
systematic review summarizes the state of this art of this technique.
<br/>Method(s): Major databases searched until October 2021.
<br/>Result(s): The available literature on HCR includes three randomized
trials, ten meta-analysis and 27 retrospective studies. The greatest
benefits are observed in patients with low-to-intermediate risk and less
complex coronary anatomy; highly complex disease and the presence of risk
factors favored conventional CABG in terms of adverse events and survival.
<br/>Conclusion(s): HCR is an interesting approach for multivessel CAD but
should not be considered a 'one-size-fits-all' procedure. Further studies
will specify the subset of patients likely to benefit most from this
hybrid approach.<br/>Copyright &#xa9; 2022 Future Medicine Ltd.

<31>
Accession Number
2015778057
Title
Contrast-induced Nephropathy in Non-cardiac Vascular Procedures, A
Narrative Review: Part 1.
Source
Current Vascular Pharmacology. 20(1) (pp 3-15), 2022. Date of Publication:
January 2022.
Author
Raffort J.; Lareyre F.; Katsiki N.; Mikhailidis D.P.
Institution
(Raffort) Clinical Chemistry Laboratory, University Hospital of Nice,
France
(Raffort, Lareyre) Universite Cote d'Azur, CHU, Inserm U1065, C3M, Nice,
France
(Lareyre) Department of Vascular Surgery, University Hospital of Antibes,
Juan-les-Pins, France
(Katsiki) First Department of Internal Medicine, Diabetes Center, Division
of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki,
Greece
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Hospital
Campus, University College London Medical School, University College
London (UCL), London NW3 2QG, United Kingdom
Publisher
Bentham Science Publishers
Abstract
Contrast-induced Nephropathy (CIN) is animportant complication of
iodinated Contrast Medium (CM) administration, being associated with both
short- and long-term adverse outcomes (e.g., cardiorenal events, longer
hospital stay and mortality). CIN has been mainly studied in relation to
cardiac procedures but it can also occur following non-cardiac vascular
interventions. This is Part 1 of a narrative review summarizing the
available literature on CIN after non-cardiac vascular diagnostic or
therapeutic procedures for aortic aneurysm and carotid stenosis. We
discuss the definition, pathophysiology, incidence, risk factors,
biomarkers and consequences of CIN in these settings, as well as
preventive strategies and alternatives to limit iodinated CM use.
Physicians and vascular surgeons should be aware of CM-related adverse
events and the potential strategies to avoid it. Clearly, more research in
this important field is required.<br/>Copyright &#xa9; 2022 Bentham
Science Publishers.

<32>
[Use Link to view the full text]
Accession Number
2017431150
Title
Tranexamic acid reduces postoperative blood loss in Chinese pediatric
patients undergoing cardiac surgery: A PRISMA-compliant systematic review
and meta-analysis.
Source
Medicine (United States). 101(9) (pp E28966), 2022. Date of Publication:
04 Mar 2022.
Author
Zou Z.-Y.; He L.-X.; Yao Y.-T.
Institution
(Zou, He) Department of Anesthesiology, Fuwai Yunnan Cardiovascular
Hospital, Kunming, China
(Yao) Anesthesia Center, Fuwai Hospital, NCCD, PUMCandCAMS, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Tranexamic acid has been increasingly used for blood
conservation in cardiac surgery. However, the evidence supporting the
routine use of tranexamic acid in Chinese pediatric patients undergoing
cardiac surgery remains weak. This meta-analysis aimed to systematically
review the efficacy of tranexamic acid when applying to Chinese pediatric
patients undergoing cardiac surgery. <br/>Participant(s):Chinese pediatric
patients undergoing cardiac surgery. <br/>Intervention(s):Tranexamic acid
or control drugs (saline/blank). <br/>Method(s):PUBMED, Cochrane Library,
EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Data, and
VIP Data till May 4, 2021, database search was updated on August 1.
Primary outcomes of interest included postoperative bleeding, allogeneic
transfusion, and reoperation for bleeding. Secondary outcomes of interest
included postoperative recovery. For continuous/dichotomous variables,
treatment effects were calculated as weighted mean difference (WMD)/odds
ratio and 95% confidence interval. <br/>Result(s):A database search
yielded 15 randomized controlled trials including 1641 patients, where 8
studies were allocated into non-cyanotic congenital group, 5 were
allocated into cyanotic congenital group, and the other 2 were allocated
into combined cyanotic/non-cyanotic group. This meta-analysis demonstrate
that tranexamic acid administration can reduce the postoperative 24 hours
blood loss in non-cyanotic, cyanotic, and combined cyanotic/non-cyanotic
patients, the red blood cell transfusion in non-cyanotic and cyanotic
patients, and the fresh frozen plasma transfusion in non-cyanotic and
combined cyanotic/non-cyanotic patients. <br/>Conclusion(s):This
meta-analysis demonstrates that tranexamic acid is highly effective in
reducing the blood loss in Chinese pediatric cardiac surgery, but it
behaves poorly when it comes to the transfusion requirement. To further
confirm this, more well-designed and adequately-powered randomized trials
are needed.<br/>Copyright &#xa9; 2022 Lippincott Williams and Wilkins. All
rights reserved.

<33>
Accession Number
2017367206
Title
Atrial nitroso-redox balance and refractoriness following on-pump cardiac
surgery: A randomized trial of atorvastatin.
Source
Cardiovascular Research. 118(1) (pp 184-195), 2022. Date of Publication:
01 Jan 2022.
Author
Jayaram R.; Jones M.; Reilly S.; Crabtree M.J.; Pal N.; Goodfellow N.;
Nahar K.; Simon J.; Carnicer R.; Desilva R.; Ratnatunga C.; Petrou M.;
Sayeed R.; Roalfe A.; Channon K.M.; Bashir Y.; Betts T.; Hill M.; Casadei
B.
Institution
(Jayaram, Reilly, Crabtree, Pal, Goodfellow, Nahar, Simon, Carnicer,
Channon, Casadei) Division of Cardiovascular Medicine, Radcliffe
Department of Medicine, University of Oxford, L6, West Wing, Oxford OX3
9DU, United Kingdom
(Jones, Bashir, Betts) Cardiology, Oxford Heart Centre, Oxford University
Hospitals Nhs Foundation Trust, Oxford, United Kingdom
(Desilva, Ratnatunga, Petrou, Sayeed) Cardiothoracic Surgery, Oxford Heart
Centre, Oxford University Hospitals Nhs Foundation Trust, Oxford, United
Kingdom
(Roalfe) Nuffield Department of Primary Care Health Sciences, University
of Oxford, Oxford, United Kingdom
(Hill) Clinical Trial Service Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: Systemic inflammation and increased activity of atrial
NOX2-containing NADPH oxidases have been associated with the new onset of
atrial fibrillation (AF) after cardiac surgery. In addition to lowering
LDL-cholesterol, statins exert rapid anti-inflammatory and antioxidant
effects, the clinical significance of which remains controversial.
<br/>Methods and Results: We first assessed the impact of cardiac surgery
and cardiopulmonary bypass (CPB) on atrial nitroso-redox balance by
measuring NO synthase (NOS) and GTP cyclohydrolase-1 (GCH-1) activity,
biopterin content, and superoxide production in paired samples of the
right atrial appendage obtained before (PRE) and after CPB and reperfusion
(POST) in 116 patients. The effect of perioperative treatment with
atorvastatin (80 mg once daily) on these parameters, blood biomarkers, and
the post-operative atrial effective refractory period (AERP) was then
evaluated in a randomized, double-blind, placebo-controlled study in 80
patients undergoing cardiac surgery on CPB. CPB and reperfusion led to a
significant increase in atrial superoxide production (74% CI 71-76%, n =
46 paired samples, P < 0.0001) and a reduction in atrial
tetrahydrobiopterin (BH4) (34% CI 33-35%, n = 36 paired samples, P <
0.01), and in GCH-1 (56% CI 55-58%, n = 26 paired samples, P < 0.001) and
NOS activity (58% CI 52-67%, n = 20 paired samples, P < 0.001).
Perioperative atorvastatin treatment prevented the effect of CPB and
reperfusion on all parameters but had no significant effect on the
postoperative right AERP, troponin release, or NT-proBNP after cardiac
surgery. <br/>Conclusion(s): Perioperative statin therapy prevents
post-reperfusion atrial nitroso-redox imbalance in patients undergoing
on-pump cardiac surgery but has no significant impact on postoperative
atrial refractoriness, perioperative myocardial injury, or markers of
postoperative LV function. Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT01780740.<br/>Copyright &#xa9; 2020
The Author(s) 2020. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<34>
Accession Number
2016477515
Title
Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic
Review of Non-Invasive Ways of Risk Stratification, Especially in Patients
Undergoing Transcatheter Aortic Valve Replacement.
Source
Journal of Personalized Medicine. 12(4) (no pagination), 2022. Article
Number: 603. Date of Publication: April 2022.
Author
Boxhammer E.; Berezin A.E.; Paar V.; Bacher N.; Topf A.; Pavlov S.; Hoppe
U.C.; Lichtenauer M.
Institution
(Boxhammer, Paar, Bacher, Topf, Hoppe, Lichtenauer) Department of Internal
Medicine II, Division of Cardiology, Paracelsus Medical University of
Salzburg, Salzburg 5020, Austria
(Berezin) Internal Medicine Department, State Medical University of
Zaporozhye, Zaporozhye 69035, Ukraine
(Pavlov) Department of Clinical Laboratory Diagnostics, State Medical
University of Zaporozhye, Zaporozhye 69035, Ukraine
Publisher
MDPI
Abstract
Patients with severe aortic valve stenosis and concomitant pulmonary
hypertension show a significantly reduced survival prognosis. Right heart
catheterization as a preoperative diagnostic tool to determine pulmonary
hypertension has been largely abandoned in recent years in favor of
echocardiographic criteria. Clinically, determination of
echocardiographically estimated systolic pulmonary artery pressure falls
far short of invasive right heart catheterization data in terms of
accuracy. The aim of the present systematic review was to highlight
noninvasive possibilities for the detection of pulmonary hypertension in
patients with severe aortic valve stenosis, with a special focus on
cardiovascular biomarkers. A total of 525 publications regarding
echocardiography, cardiovascular imaging and biomarkers related to severe
aortic valve stenosis and pulmonary hypertension were analyzed in a
systematic database analysis using PubMed Central. Finally, 39
publications were included in the following review. It was shown that the
current scientific data situation, especially regarding cardiovascular
biomarkers as non-invasive diagnostic tools for the determination of
pulmonary hypertension in severe aortic valve stenosis patients, is poor.
Thus, there is a great scientific potential to combine different
biomarkers (biomarker scores) in a non-invasive way to determine the
presence or absence of PH.<br/>Copyright &#xa9; 2022 by the authors.
Licensee MDPI, Basel, Switzerland.

<35>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2022, The Author(s).

<36>
[Use Link to view the full text]
Accession Number
635771374
Title
Cardiac Troponin Thresholds and Kinetics to Differentiate Myocardial
Injury and Myocardial Infarction.
Source
Circulation. 144(7) (pp 528-538), 2021. Date of Publication: 17 Aug 2021.
Author
Wereski R.; Kimenai D.M.; Taggart C.; Doudesis D.; Lee K.K.; Lowry M.T.H.;
Bularga A.; Lowe D.J.; Fujisawa T.; Apple F.S.; Collinson P.O.; Anand A.;
Chapman A.R.; Mills N.L.
Institution
(Wereski, Taggart, Doudesis, Lee, Lowry, Bularga, Fujisawa, Anand,
Chapman, Mills) BHF, University Centre for Cardiovascular Science, Royal
Infirmary of Edinburgh, University of Edinburgh, Edinburgh EH16 4SA,
United Kingdom
(Kimenai, Doudesis, Mills) Usher Institute, University of Edinburgh,
United Kingdom
(Lowe) University of Glasgow, School of Medicine, United Kingdom
(Apple) Department of Laboratory Medicine and Pathology, Hennepin
Healthcare/Hennepin County Medical Center, University of Minnesota,
Minneapolis, United States
(Collinson) Department of Clinical Blood Sciences and Cardiology, St.
George's University of London, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although the 99th percentile is the recommended diagnostic
threshold for myocardial infarction, some guidelines also advocate the use
of higher troponin thresholds to rule in myocardial infarction at
presentation. It is unclear whether the magnitude or change in troponin
concentration can differentiate causes of myocardial injury and infarction
in practice. <br/>Method(s): In a secondary analysis of a multicenter
randomized controlled trial, we identified 46 092 consecutive patients
presenting with suspected acute coronary syndrome without
ST-segment-elevation myocardial infarction. High-sensitivity cardiac
troponin I concentrations at presentation and on serial testing were
compared between patients with myocardial injury and infarction. The
positive predictive value and specificity were determined at the
sex-specific 99th percentile upper reference limit and rule-in thresholds
of 64 ng/L and 5-fold of the upper reference limit for a diagnosis of type
1 myocardial infarction. <br/>Result(s): Troponin was above the 99th
percentile in 8188 patients (18%). The diagnosis was type 1 or type 2
myocardial infarction in 50% and 14% and acute or chronic myocardial
injury in 20% and 16%, respectively. Troponin concentrations were similar
at presentation in type 1 (median [25th-75th percentile] 91 [30-493] ng/L)
and type 2 (50 [22-147] ng/L) myocardial infarction and in acute (50
[26-134] ng/L) and chronic (51 [31-130] ng/L) myocardial injury. The 99th
percentile and rule-in thresholds of 64 ng/L and 5-fold upper reference
limit gave a positive predictive value of 57% (95% CI, 56%-58%), 59%
(58%-61%), and 62% (60%-64%) and a specificity of 96% (96%-96%), 96%
(96%-96%), and 98% (97%-98%), respectively. The absolute, relative, and
rate of change in troponin concentration were highest in patients with
type 1 myocardial infarction (P<0.001 for all). Discrimination improved
when troponin concentration and change in troponin were combined compared
with troponin concentration at presentation alone (area under the curve,
0.661 [0.642-0.680] versus 0.613 [0.594-0.633]). <br/>Conclusion(s):
Although we observed important differences in the kinetics, cardiac
troponin concentrations at presentation are insufficient to distinguish
type 1 myocardial infarction from other causes of myocardial injury or
infarction in practice and should not guide management decisions in
isolation. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT01852123.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<37>
Accession Number
2015797838
Title
Rationale and design of the BA-SCAD (Beta-blockers and Antiplatelet agents
in patients with Spontaneous Coronary Artery Dissection) randomized
clinical trial.
Source
Revista Espanola de Cardiologia. 75(6) (pp 515-522), 2022. Date of
Publication: June 2022.
Author
Alfonso F.; de la Torre Hernandez J.M.; Ibanez B.; Sabate M.; Pan M.;
Gulati R.; Saw J.; Angiolillo D.J.; Adlam D.; Sanchez-Madrid F.
Institution
(Alfonso) Departamento de Cardiologia, Hospital Universitario de La
Princesa, Instituto de Investigacion Sanitaria Princesa (IIS-IP),
Universidad Autonoma de Madrid, Madrid, Spain
(Alfonso, Ibanez, Sabate, Sanchez-Madrid) Centro de Investigacion
Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
(de la Torre Hernandez) Departamento de Cardiologia, Hospital
Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
(Ibanez) Departamento de Cardiologia, IIS-Fundacion Jimenez Diaz, Centro
Nacional Investigaciones Cardiovasculares (CNIC), Madrid, Spain
(Sabate) Departamento de Cardiologia, Instituto Cardiovascular, Hospital
Clinic, IDIBAPS, Barcelona, Spain
(Pan) Departamento de Cardiologia, Hospital Universitario Reina Sofia,
Universidad de Cordoba, IMIBIC, Cordoba, Spain
(Gulati) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
Minnesota, United States
(Saw) Division of Cardiology, Vancouver General Hospital, University of
British Columbia, Vancouver, BC, Canada
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, Florida, United States
(Adlam) Department of Cardiovascular Sciences and National Institute for
Health Research, Leicester Biomedical Research Centre, Glenfield Hospital,
United Kingdom
(Sanchez-Madrid) Departamento de Inmunologia, Hospital Universitario de La
Princesa, Instituto de Investigacion Sanitaria Princesa (IIS-IP),
Universidad Autonoma de Madrid, Madrid, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction y objectives: Spontaneous coronary artery dissection (SCAD)
is a rare cause of acute coronary syndrome. Most patients are empirically
treated with beta-blockers and antiplatelet drugs. The Beta-blockers and
Antiplatelet agents in patients with Spontaneous Coronary Artery
Dissection (BA-SCAD) is an academic, pragmatic, prospective, randomized,
open-label, blinded-endpoint clinical trial, performed under the auspices
of the Spanish Society of Cardiology, to assess the efficacy of
pharmacological therapy in patients with SCAD. <br/>Method(s): Using a 2 x
2 factorial design, 600 patients will be randomized (1:1/1:1) to: a)
beta-blockers (yes/no) and b) "short" (1 month) vs "prolonged" (12 months)
antiplatelet therapy. Only patients with preserved left ventricular
ejection fraction will be randomized to beta-blockers (yes/no) because
patients with reduced left ventricular ejection fraction will receive
beta-blockers according to current guidelines. Similarly, only
conservatively managed patients (ie, no coronary intervention) will be
randomized to the antiplatelet stratum, as patients requiring coronary
interventions will receive 1-year dual antiplatelet therapy. The primary
efficacy endpoint includes a composite of death, myocardial infarction,
stroke, coronary revascularization, recurrent SCAD, and unplanned
hospitalization for acute coronary syndrome or heart failure at 1 year.
The primary safety endpoint will be bleeding. All patients will be
clinically followed up yearly. A comprehensive set of additional
substudies (clinical, imaging, revascularization, biomarkers,
inflammatory, immunologic, pharmacogenetics, and genetic) will be
conducted to ensure a holistic view of this unique and challenging
clinical entity. <br/>Conclusion(s): The results of the BA-SCAD randomized
clinical trial will advance our knowledge in the treatment of patients
with SCAD. The study was registered at ClinicalTrials.gov (Identifier:
NCT04850417).<br/>Copyright &#xa9; 2021 Sociedad Espanola de Cardiologia

<38>
Accession Number
2013991878
Title
"Tailored" antiplatelet bridging therapy with cangrelor: moving toward
personalized medicine.
Source
Platelets. 33(5) (pp 687-691), 2022. Date of Publication: 2022.
Author
Valenti R.; Muraca I.; Marcucci R.; Ciatti F.; Berteotti M.; Gori A.M.;
Carrabba N.; Migliorini A.; Marchionni N.; Valgimigli M.
Institution
(Valenti, Muraca, Ciatti, Carrabba, Migliorini, Marchionni) Interventional
Cardiology Unit, Cardiovascular Department, Careggi University Hospital,
Florence, Italy
(Marcucci, Berteotti, Gori) Department of Clinical and Experimental
Medicine, University of Florence, Florence, Italy
(Valgimigli) Division of Cardiology, Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale (Eoc), Lugano, Switzerland
(Valgimigli) Department of Cardiology, University of Bern, Bern,
Switzerland
Publisher
Taylor and Francis Ltd.
Abstract
In the setting of patients with indication to receive dual antiplatelet
therapy undergoing surgery or invasive procedures, the risk of
perioperative cardiac ischemic events, particularly stent thrombosis, is
high, because surgery has a prothrombotic effect and antiplatelet therapy
is withdrawn in order to avoid bleeding complications. Cangrelor, an
intravenous P2Y<inf>12</inf> receptor antagonist, has been tested in a
randomized trial as a "bridge" to cardiac surgery from discontinuation of
oral P2Y<inf>12</inf> receptor antagonists. Thus, a consensus document
extended its off-label use in this setting and before non-cardiac surgery.
Currently, despite the implementation of a standardized bridging protocol
with cangrelor, a residual risk of adverse outcome mainly due to bleeding
events, still persist during the perioperative phase. Accordingly, a
personalized management driven by platelet reactivity serial measurements
and careful assessment of ischemic and bleeding risks has potential to
optimize outcomes and costs as compared to a standardized bridging
protocol, based on average pharmacodynamic data of oral P2Y<inf>12</inf>
inhibitors. While specific indications for bridging have been extensively
addressed in the aforementioned consensus statement, the aim of the
present document is the proposal of a "tailored" clinical decision-making
algorithm inspired to the principle of personalized medicine dealing with
complex clinical scenarios.<br/>Copyright &#xa9; 2021 Taylor & Francis
Group, LLC.

<39>
Accession Number
638140995
Title
Histidine-tryptophan-ketoglutarate solution versus multidose cardioplegia
for myocardial protection in cardiac surgeries: a systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 17(1) (pp 133), 2022. Date of
Publication: 31 May 2022.
Author
Albadrani M.
Institution
(Albadrani) Department of Family and Community Medicine, College of
Medicine, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi
Arabia, Saudi Arabia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Surgical procedures in the heart requires protection of the
heart from ischemia-reperfusion injury. Cardioplegia is the primary
myocardial protective method in use. Histidine-tryptophan-ketoglutarate
(HTK) solution is an intracellular cardioplegic solution that was
initially used to preserve organs for transplantation. <br/>METHOD(S): A
systematic electronic search was conducted in July 2021, in four
databases; PubMed, Scopus, Web of Science, and Cochrane Library for
eligible randomized controlled trials. The results were screened and the
eligible trials were identified. Thereafter, the relevant data were
extracted and pooled as mean difference or risk ratio, and 95% confidence
interval in an inverse variance method using RevMan software.
<br/>RESULT(S): This review included 12 trials (n=1327). HTK solution has
resulted significantly in shorter intensive care unit stay (MD=-0.09; 95%
CI [-0.15, -0.03], p=0.006), and shorter hospital stay (MD=-0.51; 95% CI
[-0.71, -0.31], p<0.00001). Moreover, the patients who received the HTK
solution had significantly lower levels of creatine kinase (after 4-7 h
(MD=-157.52; 95% CI [-272.31, -42.19], p=0.007), and 24 h (MD=-136.62; 95%
CI [-267.20, -6.05], p=0.04)), as well as creatine kinase muscle brain
band (after 44-48 h (MD=-3.35; 95% CI [-5.69, -1.02], p=0.005)).
<br/>CONCLUSION(S): HTK solution had the same efficacy and safety as other
cardioplegic solutions in most of the clinical parameters. Furthermore,
the solution showed superiority in fastening the recovery and protecting
the myocardium at the biochemical level. HTK solution provides longer
myocardial protection; therefore, it limits surgical interruption. HTK
solution can be used as an alternative to the currently used cardioplegic
solutions.<br/>Copyright &#xa9; 2022. The Author(s).

<40>
Accession Number
636993780
Title
Letter on Incidence and prognosis of COVID-19 among heart transplant
recipients: a systematic review and meta-analysis.
Source
European journal of preventive cardiology. 29(7) (pp e263), 2022. Date of
Publication: 25 May 2022.
Author
Shoar S.
Institution
(Shoar) Department of Clinical Research, 7900 Cambridge Street, Houston,
United States
Publisher
NLM (Medline)

<41>
Accession Number
633144289
Title
Long-Term Results of the RAPCO Trials.
Source
Circulation. 142(14) (pp 1330-1338), 2020. Date of Publication: 06 Oct
2020.
Author
Buxton B.F.; Hayward P.A.; Raman J.; Moten S.C.; Rosalion A.; Gordon I.;
Seevanayagam S.; Matalanis G.; Benedetto U.; Gaudino M.; Hare D.L.
Institution
(Buxton, Raman, Moten, Seevanayagam, Matalanis) Department of Cardiac
Surgery, Austin Hospital, Melbourne, Australia
(Buxton, Hayward, Raman, Rosalion, Seevanayagam, Hare) Faculty of Medicine
Dentistry and Health Sciences, University of Melbourne, Level 5 HSB,
Austin Hospital, Studley Road, Heidelberg, VIC 3084, Australia
(Gordon) Statistical Consulting Centre, University of Melbourne, Australia
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
(Hare) Department of Cardiology, Austin Health, Melbourne, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: An internal thoracic artery graft to the left anterior
descending artery is standard in coronary bypass surgery, but controversy
exists on the best second conduit. The RAPCO trials (Radial Artery Patency
and Clinical Outcomes) were designed to compare the long-term patency of
the radial artery (RA) with that of the right internal thoracic artery
(RITA) and the saphenous vein (SV). <br/>Method(s): In RAPCO-RITA (the
RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or
<60 years of age if they had diabetes mellitus) were randomized to receive
RA or free RITA graft on the second most important coronary target. In
RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients >=70
years of age (or >=60 years of age if they had diabetes mellitus) were
randomized to receive RA or SV graft. The primary outcome was 10-year
graft failure. Long-term mortality was a nonpowered coprimary end point.
The main analysis was by intention to treat. <br/>Result(s): In the RA
versus RITA comparison, the estimated 10-year patency was 89% for RA
versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI,
0.23-0.88]). Ten-year patient survival estimate was 90.9% in the RA arm
versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI,
0.30-0.95]). In the RA versus SV comparison, the estimated 10-year patency
was 85% for the RA versus 71% for the SV (hazard ratio for graft failure,
0.40 [95% CI, 0.15-1.00]), and 10-year patient survival estimate was 72.6%
for the RA group versus 65.2% for the SV group (hazard ratio for
mortality, 0.76 [95% CI, 0.47-1.22]). <br/>Conclusion(s): The 10-year
patency rate of the RA is significantly higher than that of the free RITA
and better than that of the SV. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT00475488.<br/>Copyright &#xa9; 2020 Lippincott Williams and Wilkins.
All rights reserved.

<42>
Accession Number
633144280
Title
Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet
Resection Versus Leaflet Preservation on Functional Mitral Stenosis: The
CAMRA CardioLink-2 Study.
Source
Circulation. 142(14) (pp 1342-1350), 2020. Date of Publication: 06 Oct
2020.
Author
Chan V.; Mazer C.D.; Ali F.M.; Quan A.; Ruel M.; De Varennes B.E.; Gregory
A.J.; Bouchard D.; Whitlock R.P.; Chu M.W.A.; Dokollari A.; Mesana T.;
Bhatt D.L.; Latter D.A.; Zuo F.; Tsang W.; Teoh H.; Juni P.; Leong-Poi H.;
Verma S.
Institution
(Chan, Ruel, Mesana) Division of Cardiac Surgery, University of Ottawa
Heart Institute, H3405-40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
(Chan, Ruel, Mesana) School of Epidemiology, Public Health and Preventive
Medicine, University of Ottawa, ON, Canada
(Ruel) Department of Cellular and Molecular Medicine, University of
Ottawa, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Ali, Tsang, Leong-Poi) Division of Cardiology, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, ON, Canada
(Quan, Dokollari, Latter, Teoh, Verma) Division of Cardiac Surgery, Li Ka
Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON
M5B 1W8, Canada
(Zuo, Juni) Applied Health Research Centre, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, ON, Canada
(Mazer) Department of Physiology, University of Toronto, ON, Canada
(Latter, Verma) Department of Surgery, University of Toronto, ON, Canada
(Tsang, Juni, Leong-Poi) Department of Medicine, University of Toronto,
ON, Canada
(Juni) Institute of Health Policy Management and Evaluation, University of
Toronto, ON, Canada
(Verma) Department of Pharmacology and Toxicology, University of Toronto,
ON, Canada
(De Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University, Health Center, Montreal, QC, Canada
(Gregory) Department of Anesthesiology Perioperative and Pain Medicine,
Cumming School of Medicine, University of Calgary, AB, Canada
(Gregory) Department of Anesthesiology Perioperative and Pain Medicine,
Libin Cardiovascular Institute of Alberta, Calgary, Canada
(Bouchard) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, QC, Canada
(Whitlock) Division of Cardiac Surgery, McMaster University, Hamilton, ON,
Canada
(Whitlock) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
(Whitlock) Population Health Research Institute, Hamilton, ON, Canada
(Chu) Division of Cardiac Surgery, London Health Sciences Center,
University of Western Ontario, Canada
(Bhatt) Brigham and Women's Hospital Heart, Vascular Center, Harvard
Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Equipoise exists between the use of leaflet resection and
preservation for surgical repair of mitral regurgitation caused by
prolapse. We therefore performed a randomized, controlled trial comparing
these 2 techniques, particularly in regard to functional mitral stenosis.
<br/>Method(s): One hundred four patients with degenerative mitral
regurgitation surgically amenable to either leaflet resection or
preservation were randomized at 7 specialized cardiac surgical centers.
Exclusion criteria included anterior leaflet or commissural prolapse, as
well as a mixed cause for mitral valve disease. Using previous data, we
determined that a sample size of 88 subjects would provide 90% power to
detect a 5-mm Hg difference in mean mitral valve gradient at peak
exercise, assuming an SD of 6.7 mm with a 2-sided test with =5% and 10%
patient attrition. The primary end point was the mean mitral gradient at
peak exercise 12 months after repair. <br/>Result(s): Patient age,
proportion who were female, and Society of Thoracic Surgeons risk score
were 63.9+/-10.4 years, 19%, and 1.4+/-2.8% for those who were assigned to
leaflet resection (n=54), and 66.3+/-10.8 years, 16%, and 1.9+/-2.6% for
those who underwent leaflet preservation (n=50). There were no
perioperative deaths or conversions to replacement. At 12 months, moderate
mitral regurgitation was observed in 3 subjects in the leaflet resection
group and 2 in the leaflet preservation group. The mean transmitral
gradient at 12 months during peak exercise was 9.1+/-5.2 mm Hg after
leaflet resection and 8.3+/-3.3 mm Hg after leaflet preservation (P=0.43).
The participants had similar resting peak (8.3+/-4.4 mm Hg versus
8.4+/-2.6 mm Hg; P=0.96) and mean resting (3.2+/-1.9 mm Hg versus
3.1+/-1.1 mm Hg; P=0.67) mitral gradients after leaflet resection and
leaflet preservation, respectively. The 6-minute walking distance was
451+/-147 m for those in the leaflet resection versus 481+/-95 m for the
leaflet preservation group (P=0.27). <br/>Conclusion(s): In this
adequately powered randomized trial, repair of mitral prolapse with either
leaflet resection or leaflet preservation was associated with similar
transmitral gradients at peak exercise at 12 months postoperatively. These
data do not support the hypothesis that a strategy of leaflet resection
(versus preservation) is associated with a risk of functional mitral
stenosis. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier NCT02552771.<br/>Copyright &#xa9; 2020 Lippincott Williams and
Wilkins. All rights reserved.

<43>
Accession Number
638149685
Title
Cardiovascular events, serious infections, and neoplasia through 5 years
of tildrakizumab exposure in 2 Phase 3 clinical trials.
Source
Australasian Journal of Dermatology. Conference: 54th Annual Scientific
Meeting of the Australasian College of Dermatologists. Adelaide, SA
Australia. 63(SUPPL 1) (pp 7), 2022. Date of Publication: May 2022.
Author
Song E.; Trickett C.; Gebauer K.; Vender R.; Gniadecki R.; Cather J.;
Kivelevitch D.; West D.; Rozzo S.J.; Dhawan S.
Institution
(Song) North Sound Dermatology, Mill Creek, WA, United States
(Trickett) University of Texas Southwestern Medical Center, University of
North Texas Health Science Center, TX, United States
(Gebauer) Fremantle Dermatology, Fremantle, Australia
(Vender) Department of Medicine, Division of Dermatology, McMaster
University, Hamilton, ON, Canada
(Gniadecki) Division of Dermatology, University of Alberta, Edmonton, AB,
Canada
(Cather) Modern Research Associates, Dallas, TX, United States
(Kivelevitch) Baylor Scott and White Health, Dallas, TX, United States
(West) Spectrum Dermatology, Scottsdale, AZ, United States
(Rozzo) Sun Pharmaceutical Industries, Inc, United States
(Dhawan) Center for Dermatology Cosmetic and Laser Surgery, Department of
Dermatology, Stanford University, Stanford, CA, United States
Publisher
Blackwell Publishing
Abstract
Aim: Tildrakizumab (TIL) is an anti-interleukin-23p19 monoclonal antibody
approved for treatment of plaque psoriasis. We assessed incidence of
cardiovascular events, infections, and neoplasia in patients receiving TIL
for up to 5 years in reSURFACE 1 and reSURFACE 2
(NCT01722331/NCT01729754). <br/>Method(s): reSURFACE 1/2 were 3-part,
randomised, double- blind, placebo-controlled, Phase 3 trials with
optional long-term extensions evaluating TIL 100 (TIL100) or 200 mg
(TIL200) monotherapy at week (W)0, W4, and every 12 W thereafter in adults
with moderate to severe chronic plaque psoriasis. This post hoc analysis
reports exposure-adjusted incidence rates (EAIR) of positively adjudicated
cardiovascular events, infections, and neoplasia as cumulative incidence
per 100 patient-years (100PY) of exposure to TIL100 or TIL200 in patients
receiving >=1 dose of tildrakizumab during the extensions. <br/>Result(s):
In the reSURFACE 1/2 extensions, 239/381 patients received TIL100 with
total exposure of 1164.8/1671.3 PY and 267/349 patients received TIL200
with total exposure of 1365.8/1567.5 PY. In patients receiving TIL100 in
reSURFACE 1/2, the EAIRs were 0.5/0.3 per 100PY for both major adverse
cardiovascular events (MACE) and extended MACE (including unstable angina,
coronary revascularisation, and resuscitated cardiac arrest). For
reSURFACE 1/2 patients receiving TIL200, EAIRs were 0.4/0.6 per 100PY for
MACE and 0.7/0.6 per 100PY for extended MACE. The EAIRs of serious adverse
event (SAE) infections were 0.8/0.9 per 100PY for patients receiving
TIL100 and 1.0/1.0 per 100PY for patients receiving TIL200 in reSURFACE
1/2; EAIRs for serious neoplasia in reSURFACE 1/2 were 1.6/0.8 per 100PY
following TIL100 and 0.8/1.1 per 100PY following TIL200.
<br/>Conclusion(s): Through 5 years of reSURFACE 1 and reSURFACE 2, EAIRs
of MACE, SAE infections, and neoplasia were low and similar between TIL
doses.

<44>
Accession Number
638149505
Title
Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve
Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A
Randomized Clinical Trial.
Source
JAMA - Journal of the American Medical Association. 327(19) (pp
1875-1887), 2022. Date of Publication: 17 May 2022.
Author
Toff W.D.; Hildick-Smith D.; Kovac J.; Mullen M.J.; Wendler O.; Mansouri
A.; Rombach I.; Abrams K.R.; Conroy S.P.; Flather M.D.; Gray A.M.;
MacCarthy P.; Monaghan M.J.; Prendergast B.; Ray S.; Young C.P.; Crossman
D.C.; Cleland J.G.F.; De Belder M.A.; Ludman P.F.; Jones S.; Densem C.G.;
Tsui S.; Kuduvalli M.; Mills J.D.; Banning A.P.; Sayeed R.; Hasan R.;
Fraser D.G.W.; Trivedi U.; Davies S.W.; Duncan A.; Curzen N.; Ohri S.K.;
Malkin C.J.; Kaul P.; Muir D.F.; Owens W.A.; Uren N.G.; Pessotto R.;
Kennon S.; Awad W.I.; Khogali S.S.; Matuszewski M.; Edwards R.J.; Ramesh
B.C.; Dalby M.; Raja S.G.; Mariscalco G.; Lloyd C.; Cox I.D.; Redwood
S.R.; Gunning M.G.; Ridley P.D.
Institution
(Toff, Kovac, Mariscalco) Department Of Cardiovascular Sciences,
University Of Leicester, Leicester, United Kingdom
(Toff, Kovac, Mariscalco) National Institute For Health Research Leicester
Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
(Hildick-Smith, Trivedi) Sussex Cardiac Centre, Brighton And Sussex
University Hospitals Nhs Trust, Brighton, United Kingdom
(Mullen) Institute Of Cardiovascular Science, University College London,
London, United Kingdom
(Wendler) Department Of Cardiothoracic Surgery, King's College Hospital
Nhs Foundation Trust, London, United Kingdom
(Mansouri, Rombach) Oxford Clinical Trials Research Unit, Nuffield
Department Of Orthopedics, Rheumatology, And Musculoskeletal Sciences,
University Of Oxford, Oxford, United Kingdom
(Abrams) Centre For Health Economics, University Of York, York, United
Kingdom
(Abrams) Department Of Statistics, University Of Warwick, Coventry, United
Kingdom
(Abrams, Conroy) Department Of Health Sciences, University Of Leicester,
Leicester, United Kingdom
(Flather) Norwich Medical School, University Of East Anglia, Norwich,
United Kingdom
(Gray) Health Economics Research Centre, Nuffield Department Of Population
Health, University Of Oxford, Oxford, United Kingdom
(MacCarthy, Monaghan) Department Of Cardiology, King's College Hospital
Nhs Foundation Trust, London, United Kingdom
(Prendergast) Department Of Cardiology, St Thomas' Hospital, London,
United Kingdom
(Ray) Department Of Cardiology, Manchester University Nhs Foundation
Trust, Manchester, United Kingdom
(Young) Department Of Cardiothoracic Surgery, St Thomas' Hospital, London,
United Kingdom
(Crossman) School Of Medicine, University Of St Andrews, Scotland, Fife,
United Kingdom
(Cleland) Robertson Centre For Biostatistics And Glasgow Clinical Trials
Unit, Institute Of Health And Wellbeing, University Of Glasgow, Scotland,
Fife, United Kingdom
(De Belder) National Institute For Cardiovascular Outcomes Research, Barts
Health Nhs Trust, London, United Kingdom
(Ludman) Institute Of Cardiovascular Sciences, Birmingham University,
Birmingham, United Kingdom
(Jones) Surgical Intervention Trials Unit, Nuffield Department Of Surgical
Sciences, University Of Oxford, Oxford, United Kingdom
(Densem) Department Of Cardiology, Royal Papworth Hospital, Cambridge,
United Kingdom
(Tsui) Department Of Cardiothoracic Surgery, Royal Papworth Hospital,
Cambridge, United Kingdom
(Kuduvalli) Department Of Cardiothoracic Surgery, Liverpool Heart And
Chest Hospital Nhs Foundation Trust, Liverpool, United Kingdom
(Mills) Department Of Cardiology, Liverpool Heart And Chest Hospital Nhs
Foundation Trust, Liverpool, United Kingdom
(Banning) Department Of Cardiology, John Radcliffe Hospital, Oxford
University Hospitals Nhs Foundation Trust, Oxford, United Kingdom
(Sayeed) Department Of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford University Hospitals Nhs Foundation Trust, Oxford, United Kingdom
(Hasan) Department Of Cardiothoracic Surgery, Manchester University Nhs
Foundation Trust, Manchester, United Kingdom
(Fraser) Department Of Cardiovascular Medicine, University Of Manchester,
Manchester, United Kingdom
(Davies, Duncan) Cardiac Department, Royal Brompton Hospital, Royal
Brompton And Harefield Nhs Foundation Trust, London, United Kingdom
(Curzen, Ohri) Wessex Cardiothoracic Centre, University Hospital
Southampton, Southampton, United Kingdom
(Malkin) Department Of Cardiology, Leeds Teaching Hospitals Nhs Trust,
Leeds, United Kingdom
(Kaul) Department Of Cardiac Surgery, Leeds Teaching Hospitals Nhs Trust,
Leeds, United Kingdom
(Muir) Department Of Cardiology, James Cook University Hospital, South
Tees Hospitals Nhs Foundation Trust, Middlesbrough, United Kingdom
(Owens) Department Of Cardiothoracic Surgery, James Cook University
Hospital, South Tees Hospitals Nhs Foundation Trust, Middlesbrough, United
Kingdom
(Uren, Pessotto) Edinburgh Heart Centre, Royal Infirmary Of Edinburgh,
Scotland, Edinburgh, United Kingdom
(Kennon, Awad) Barts Heart Centre, Barts Health Nhs Trust, London, United
Kingdom
(Khogali, Matuszewski) Heart And Lung Centre, New Cross Hospital,
Wolverhampton, United Kingdom
(Edwards, Ramesh) Cardiothoracic Department, Newcastle Upon Tyne
Hospitals, Newcastle upon Tyne, United Kingdom
(Dalby) Department Of Cardiology, Harefield Hospital, Royal Brompton And
Harefield Nhs Foundation Trust, London, United Kingdom
(Raja) Department Of Cardiac Surgery, Harefield Hospital, Royal Brompton
And Harefield Nhs Foundation Trust, London, United Kingdom
(Lloyd) Department Of Cardiothoracic Surgery, Derriford Hospital,
Plymouth, United Kingdom
(Cox) Department Of Cardiology, Derriford Hospital, Plymouth, United
Kingdom
(Redwood) Cardiovascular Division, King's College London, British Heart
Foundation Centre Of Research Excellence, Rayne Institute, St Thomas'
Hospital, London, United Kingdom
(Gunning) Cardiology Department, Royal Stoke University Hospital,
Stoke-on-Trent, United Kingdom
(Ridley) Department Of Cardiothoracic Surgery, Royal Stoke University
Hospital, Stoke-on-Trent, United Kingdom
Publisher
American Medical Association
Abstract
Importance: Transcatheter aortic valve implantation (TAVI) is a less
invasive alternative to surgical aortic valve replacement and is the
treatment of choice for patients at high operative risk. The role of TAVI
in patients at lower risk is unclear. <br/>Objective(s): To determine
whether TAVI is noninferior to surgery in patients at moderately increased
operative risk. <br/>Design, Setting, and Participant(s): In this
randomized clinical trial conducted at 34 UK centers, 913 patients aged 70
years or older with severe, symptomatic aortic stenosis and moderately
increased operative risk due to age or comorbidity were enrolled between
April 2014 and April 2018 and followed up through April 2019.
<br/>Intervention(s): TAVI using any valve with a CE mark (indicating
conformity of the valve with all legal and safety requirements for sale
throughout the European Economic Area) and any access route (n = 458) or
surgical aortic valve replacement (surgery; n = 455). <br/>Main Outcomes
and Measures: The primary outcome was all-cause mortality at 1 year. The
primary hypothesis was that TAVI was noninferior to surgery, with a
noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI
for the absolute between-group difference in mortality. There were 36
secondary outcomes (30 reported herein), including duration of hospital
stay, major bleeding events, vascular complications, conduction
disturbance requiring pacemaker implantation, and aortic regurgitation.
<br/>Result(s): Among 913 patients randomized (median age, 81 years [IQR,
78 to 84 years]; 424 [46%] were female; median Society of Thoracic
Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%)
completed follow-up and were included in the noninferiority analysis. At 1
year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%)
in the surgery group, with an adjusted absolute risk difference of-2.0%
(1-sided 97.5% CI,- to 1.2%; P <.001 for noninferiority). Of 30
prespecified secondary outcomes reported herein, 24 showed no significant
difference at 1 year. TAVI was associated with significantly shorter
postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8
days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were
significantly fewer major bleeding events after TAVI compared with surgery
(7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI,
0.24 to 0.45]) but significantly more vascular complications (10.3% vs
2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances
requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95%
CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%)
aortic regurgitation (adjusted odds ratio for mild, moderate, or severe
[no instance of severe reported] aortic regurgitation combined vs none,
4.89 [95% CI, 3.08 to 7.75]). <br/>Conclusions and Relevance: Among
patients aged 70 years or older with severe, symptomatic aortic stenosis
and moderately increased operative risk, TAVI was noninferior to surgery
with respect to all-cause mortality at 1 year. <br/>Copyright &#xa9; 2022
American Medical Association. All rights reserved.

<45>
Accession Number
638147057
Title
Periprocedural Management during Therapeutic Cardiac Catheterization in
Patients with Sleep Apnea Syndrome: Report of Three Cases and Review of
Literature.
Source
Journal of Cardiac Critical Care. 6(1) (pp 48-53), 2022. Date of
Publication: 01 Jun 2022.
Author
Choudhury M.; Sharma A.; Kapoor P.M.
Institution
(Choudhury, Sharma, Kapoor) Department of Cardiac Anaesthesia and Critical
Care, Cardiothoracic Sciences Centre, All India Institute of Medical
Sciences, New Delhi 110029, India
Publisher
Thieme India
Abstract
Most of the patients with sleep apnea syndrome (SAS) also known as sleep
disordered breathing are not diagnosed before undergoing any cardiac
interventional procedure. Many of them can safely undergo outpatient
procedure under sedation or anesthesia. Few of them with moderate to
severe grade of SAS, who are not optimized medically, may create problem
and need special consideration. We managed three such cases in cardiac
catheterization laboratory; two of them were not diagnosed before. The
periprocedural problems we faced in these patients are narrated in this
article along with review of literature. Some suggestions for management
of such patients undergoing therapeutic cardiac catheterization are also
highlighted.<br/>Copyright &#xa9; 2022 Thieme India. All rights reserved.

<46>
Accession Number
2017683597
Title
Mechanical or biologic prostheses for mitral valve replacement: A
systematic review and meta-analysis.
Source
Clinical Cardiology. (no pagination), 2022. Date of Publication: 2022.
Author
Yu J.; Qiao E.; Wang W.
Institution
(Yu, Qiao, Wang) Department of Structural Heart Disease, Fu Wai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Either a mechanical or bioprosthetic valve is used in patients undergoing
mitral valve replacement (MVR). However, the optimal mitral prosthesis
remains controversial. The aim of this meta-analysis was thus to compare
outcomes between mechanical mitral valve replacement (MVRm) and
bioprosthetic mitral valve replacement (MVRb) for MVR patients. We
searched Embase, PubMed, Web of Science, and Cochrane Library databases
from January 1, 2000 to October 31, 2021 for studies that directly
compared surgical outcomes of MVRm and MVRb. A total of 22 studies with 35
903 patients were included in the meta-analysis (n = 23 868 MVRm and n =
12 035 MVRb). The MVRm group displayed lower long-term all causes
mortality (HR, 0.84; 95% confidence interval [CI]: 0.77-0.91; p <.0001; I2
= 51%), and fewer mitral reoperation (hazard ratio [HR]: 0.34; 95% CI:
0.23-0.50; p <.00001; I2 = 74%) than MVRb group. However, the MVRm group
was associated with a greater risk of major bleeding events (HR: 1.21; 95%
CI: 1.14-1.29; p <.00001; I2 = 0%), stroke and systemic embolism (HR:
1.20; 95% CI: 1.10-1.32; p <.0001; I2 = 0%) in matched or adjusted data.
No significant difference was observed between MVRm and MVRb on operative
mortality in matched/adjusted group (risk ratios: 0.83; 95% CI: 0.66-1.05;
p =.12; I2 = 0%). The results were consistent with patients aged under 70
years old. Patients who received a MVRm is associated with 16% lower risk
of long-term mortality and 66% lower risk of mitral reoperation, but 20%
greater risk of stroke or systemic embolism, 21% greater risk of major
bleeding compared with MVRb in matched/adjusted studies group, which were
consistent to patients younger than the age of 70 years who underwent
MVR.<br/>Copyright &#xa9; 2022 The Authors. Clinical Cardiology published
by Wiley Periodicals LLC.

<47>
Accession Number
2017683184
Title
Implementation of patient-reported outcome measures in a heart transplant
recipient registry: First step toward a patient-centered approach.
Source
Clinical Transplantation. (no pagination), 2022. Date of Publication:
2022.
Author
Mahmoudi R.; Moitie T.; Dorent R.; Guillemin F.; Couchoud C.
Institution
(Mahmoudi, Moitie, Dorent, Couchoud) Direction medicale et scientifique,
Agence de la biomedecine, Saint Denis La Plaine, France
(Dorent) Departement de cardiologie, Hopital Bichat - Claude-Bernard,
Assistance Publique Hopitaux de Paris, Paris, France
(Guillemin) Universite de Lorraine, APEMAC, Nancy, France
Publisher
John Wiley and Sons Inc
Abstract
Background: Heart transplantation (HTX) is a well-established treatment
for suitable patients with end-stage heart failure, intended to prolong
their survival and improve their health-related quality of life (HR-QoL).
No international consensus exists, however, about the preferred
patient-reported outcomes (PROs) and their measures (PROMs) for heart
transplant recipients. The purpose of this study, the first step in a
mixed-method investigation, was to review the PROMs developed and used in
this population to identify the instruments for measuring HR-QoL and
adherence to immunosuppressive medications most appropriate for heart
transplant patients. <br/>Method(s): This systematic search of the
literature in the PubMed database focused on the assessment of PROMs for
patients after HTX. We analyzed 66 studies with cross-sectional, 28 with
longitudinal, and 2 with mixed-methods designs, as well as 6 literature
reviews. <br/>Result(s): These 102 articles used 115 different PROMs,
which we categorized as generic HR-QoL instruments (n = 19),
domain-specific instruments (n = 71), heart disease-specific instruments
(n = 9), and heart transplant-specific instruments (n = 16). They cover
different dimensions of HR-QoL and of immunosuppressive-drug experience,
with diverse numbers of items, types of scales, and psychometric
properties. <br/>Conclusion(s): Despite the abundance of instruments,
PROMs for HTX can be improved to meet other patient expectations (i.e., by
including important issues such as coping strategies, employment, social
support, sexual relationships, spirituality, and beliefs), while paying
attention to ease of use, reliability, validity, and the contribution of
new technologies. A qualitative approach will complete our project of
developing a patient-centered instrument for HTX patients.<br/>Copyright
&#xa9; 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

<48>
Accession Number
638147498
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. Article
Number: rapm-2022-103731. Date of Publication: 2022.
Author
Kim S.C.; Anwar S.
Institution
(Kim, Anwar) Department of Perioperative Medicine, St Bartholomew's
Hospital, London EC1A 7BE, United Kingdom
Publisher
BMJ Publishing Group

<49>
Accession Number
638142048
Title
Presentation cardiac troponin and early computed tomography coronary
angiography in patients with suspected acute coronary syndrome: a
pre-specified secondary analysis of the RAPID-CTCA trial.
Source
European heart journal. Acute cardiovascular care. (no pagination), 2022.
Date of Publication: 01 Jun 2022.
Author
Wang K.-L.; Roobottom C.; Smith J.E.; Goodacre S.; Oatey K.; O'Brien R.;
Storey R.F.; Curzen N.; Keating L.; Kardos A.; Felmeden D.; Thokala P.;
Mills N.L.; Newby D.E.; Gray A.J.
Institution
(Wang, Mills, Newby) Centre for Cardiovascular Science, University of
Edinburgh, Chancellor's Building ,49 Little France Crescent, Edinburgh
EH16 4SB, United Kingdom
(Wang) School of Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan (Republic of China)
(Wang) General Clinical Research Center, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
(Roobottom) Department of Radiology, University Hospitals Plymouth NHS
Trust, Plymouth, United Kingdom
(Smith) Emergency Department, University Hospitals Plymouth NHS Trust,
Plymouth, United Kingdom
(Goodacre, Thokala) School of Health and Related Research, University of
Sheffield, Sheffield, United Kingdom
(Oatey) Edinburgh Clinical Trials Unit, University of Edinburgh,
Edinburgh, United Kingdom
(O'Brien, Gray) Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, Southampton,
United Kingdom
(Curzen) Department of Cardiology, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
(Keating) Department of Emergency Medicine, Royal Berkshire NHS Foundation
Trust, Reading, United Kingdom
(Kardos) Translational Cardiovascular Research Group, Milton Keynes
University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom
(Kardos) Faculty of Medicine and Health Science, University of Buckingham,
Buckingham, United Kingdom
(Felmeden) Department of Cardiology, Torbay and South Devon NHS Foundation
Trust, Torquay, United Kingdom
(Mills, Gray) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: To evaluate the potential associations between presentation cardiac
troponin and the clinical impact of early computed tomography coronary
angiography (CTCA) in intermediate-risk patients with suspected acute
coronary syndrome. METHODS AND RESULTS: In a large multicentre randomized
controlled trial of patients with intermediate-risk chest pain due to
suspected acute coronary syndrome, early CTCA had no effect on the primary
outcome-death or subsequent Type 1 or 4b myocardial infarction-but reduced
the rate of invasive coronary angiography. In this pre-specified secondary
analysis, cardiovascular testing and clinical outcomes were compared
between those with or without cardiac troponin elevation at presentation.
Of 1748 patients, 1004 (57%) had an elevated cardiac troponin
concentration and 744 (43%) had a normal concentration. Patients with
cardiac troponin elevation had a higher Global Registry of Acute Coronary
Events score (132 vs. 91; P<0.001) and were more likely to have
obstructive coronary artery disease (59 vs. 33%; P<0.001), non-invasive
(72 vs. 52%; P<0.001) and invasive (72 vs. 38%; P<0.001) testing, coronary
revascularization (47 vs. 15%; P<0.001), and the primary outcome (8 vs.
3%; P=0.007) at 1 year. However, there was no evidence that presentation
cardiac troponin was associated with the relative effects of early CTCA on
rates of non-invasive (Pinteraction=0.33) and invasive (Pinteraction=0.99)
testing, coronary revascularization (Pinteraction=0.57), or the primary
outcome (Pinteraction=0.41). <br/>CONCLUSION(S): Presentation cardiac
troponin had no demonstrable associations between the effects of early
CTCA on reductions in non-invasive and invasive testing, or the lack of
effect on coronary revascularization or the primary outcome in
intermediate-risk patients with suspected acute coronary
syndrome.<br/>Copyright &#xa9; The Author(s) 2022. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<50>
Accession Number
2013342731
Title
Variability and Reproducibility of the SYNTAX Score for Triple-Vessel
Disease.
Source
Cardiovascular Revascularization Medicine. 37 (pp 86-89), 2022. Date of
Publication: April 2022.
Author
Basman C.; Levine E.; Tejpal A.; Thampi S.; Rashid U.; Barry R.; Stoffels
G.; Kliger C.A.; Coplan N.; Patel N.; Scheinerman S.J.; Singh V.P.
Institution
(Basman, Levine, Tejpal, Thampi, Rashid, Barry, Stoffels, Kliger, Coplan,
Patel, Scheinerman, Singh) Department of Cardiothoracic Surgery and
Cardiovascular Medicine, Lenox Hill Heart and Lung, Northwell Health
System, 130 East 77th Street, Black Hall 4th floor, New York, NY 10075,
United States
(Basman, Rashid, Singh) Department of Cardiovascular Medicine, Northern
Westchester Hospital, Northwell Health System, 400 E. Main St, Mt Kisco,
NY 10549, United States
Publisher
Elsevier Inc.
Abstract
Background: The SYNTAX score (SX) is an angiographic grading system to
determine the burden and complexity of coronary artery disease (CAD) and
to guide operators as to the appropriateness of percutaneous coronary
intervention (PCI) vs coronary artery bypass grafting (CABG). However,
variability of the SX may exist since the assessment relies on individual
clinicians to visually interpret lesion severity and characteristics. We
therefore aimed to assess SX variability and reproducibility among
interpreting physicians. <br/>Method(s): Fifty patient angiograms were
randomly selected from a registry of patients with multi-vessel CAD
(treated with PCI or CABG) completed at our institution during the years
2011-2018. Each angiogram was evaluated by 6 clinicians on 2 separate
occasions (minimum 8 weeks between occasions) for a total of 600 SX. Our
goal was to evaluate both inter- and intra- observer reliability of SX
scores. Variation in both raw score as well as risk classification (low,
intermediate or high SX) was observed. Inter- and intra-observer
reliability were assessed using the intra-class correlation coefficient
(ICC), Cohen's weighted Kappa, and Fleiss' Kappa. <br/>Result(s): SYNTAX
scores on both assessments and across all 6 cardiologists had a mean score
of 25.3. On the first assessment, the ICC for the inter-observer
reliability of SX scores was 0.61 (95% CI: 0.50, 0.73). Across the 6
observers, only 16% of angiograms were classified in the same risk
classification by all observers. 34% of angiograms had less than a
majority agreement (3 or less observers) on risk classification. The
weighted Kappa for intra-observer reliability of risk classification
scores ranged from 0.30 to 0.81. Across the 6 observers, the proportion of
angiograms classified as the same risk classification between each
observer's 1st and 2nd assessment ranged from 46% to 84%.
<br/>Conclusion(s): This study shows a wide inter- and intra- user
variability in calculating SX. Our data indicates a significant limitation
in using the SX to guide revascularization strategies. Further studies are
needed to determine more reliable ways to quantitate burden of
CAD.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<51>
Accession Number
2015352107
Title
Effect of preoperative administration of atenolol to dogs with pulmonic
stenosis undergoing interventional procedures.
Source
Journal of Veterinary Internal Medicine. 36(3) (pp 877-885), 2022. Date of
Publication: May/June 2022.
Author
Gomart S.; MacFarlane P.; Payne J.R.; Hezzell M.J.; Borgeat K.
Institution
(Gomart) Highcroft Veterinary Referrals, CVS Group, Bristol, United
Kingdom
(MacFarlane, Payne, Borgeat) Langford Vets, University of Bristol,
Bristol, United Kingdom
(Hezzell) Bristol Vet School, University of Bristol, Bristol, United
Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Beta-blockade is sometimes used in dogs with pulmonic stenosis
with the intent of reducing frequency of ventricular arrhythmias during
right heart catheterization. <br/>Objective(s): To evaluate if
pretreatment with atenolol reduces frequency of ventricular arrhythmias,
anesthetist interventions, or shortens procedure time. Animals: Thirty
dogs with pulmonic stenosis scheduled for interventional procedures.
<br/>Method(s): Single center, prospective, randomized, open-label study.
Dogs were randomized to treatment with atenolol or no treatment
preoperatively for a minimum of 10 days. Variables recorded included heart
rate, arrhythmias and complexity, total procedure time and administration
of antiarrhythmic treatment, vasopressors, positive chronotropes, or fluid
boluses. <br/>Result(s): Fifteen dogs were enrolled in each group. Dogs
receiving atenolol had lower mean heart rates during the procedure
(atenolol 100 +/- 11 bpm vs untreated 115 +/- 19 bpm, P =.01). There were
no significant differences between the atenolol and untreated groups in
the frequency of ventricular ectopic complexes (535 [6-5296] vs 553
[79-2863], P =.9), ventricular couplets (46 [0-481] vs 29 [3-121], P
=.59), ventricular triplets (20 [0-265] vs 16 [1-82], P =.67), ventricular
tachycardia (8 [0-224] vs 8 [1-118], P =.99), proportion exhibiting R-on-T
phenomenon (11/15 vs 14/15, P =.33), proportion receiving intraoperative
lidocaine (1/15 vs 3/15, P =.6), vasopressors/positive chronotropes (11/15
vs 5/15, P =.06), or fluid boluses (12/15 vs 7/15, P =.13). The procedure
time was similar (atenolol 41 [23-68] min vs untreated 35 [18-98] min, P
=.91). Conclusions and Clinical Importance: No benefit of preoperative
atenolol treatment was identified in this small group of
dogs.<br/>Copyright &#xa9; 2022 The Authors. Journal of Veterinary
Internal Medicine published by Wiley Periodicals LLC on behalf of American
College of Veterinary Internal Medicine.

<52>
Accession Number
2017706582
Title
Access-site hematoma in distal and conventional transradial access: a
randomized trial.
Source
Minerva Cardiology and Angiology. 70(2) (pp 129-137), 2022. Date of
Publication: April 2022.
Author
Lucreziotti S.; Persampieri S.; Gentile D.; Barbieri L.; Salerno-Uriart
D.; Valli F.; Sabatelli L.; Panzacchi G.; Centola M.; Carugo S.
Institution
(Lucreziotti, Persampieri, Gentile, Barbieri, Salerno-Uriart, Valli,
Sabatelli, Panzacchi, Centola, Carugo) Division of Cardiology, Department
of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan,
Italy
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Distal transradial access (dTRA) has been recently proposed as
an innovative access for coronary procedures and a valuable alternative to
conventional transradial access (cTRA). The aim of this study was to
assess the safety of dTRA versus cTRA in patients undergoing percutaneous
coronary angiography and intervention. <br/>METHOD(S): In this
single-center randomized trial, consecutive patients admitted for stable
cardiac condition or acute coronary syndrome (ACS) were assigned to dTRA
or cTRA. The primary endpoint was an early discharge after transra- dial
stenting of coronary arteries (EASY) grade =II access-site hematoma (ASH).
Vascular access failure, radial artery occlusion (RAO) at hospital
discharge, 30-day rates of death, myocardial infarction, stroke and
bleeding not related to coronary artery bypass grafting were considered as
secondary endpoints. <br/>RESULT(S): A total of 204 patients were included
and randomized to dTRA (N.=100) or cTRA (N.=104). The two populations were
similar, except for a higher percentage of ACS in the dTRA than in the
cTRA group (38% versus 24%, P=0.022). The rate of EASY grade >=II ASH was
lower in dTRA than in cTRA patients, but the difference was not
statistically significant (4% versus 8.4%, respectively, P=0.25). Vascular
access failure was more frequent in dTRA patients than in cTRA patients
(34% versus 8.7%, P<0.0001). We detected no case of RAO at hospital
discharge and similar rates of 30-day adverse events in both groups.
<br/>CONCLUSION(S): DTRA is safe and feasible. When compared to cTRA, dTRA
is technically more demanding and limited by more frequent crossover to an
alternative vascular access.<br/>Copyright &#xa9; 2021 EDIZIONI MINERVA
MEDICA.

<53>
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.<br/>Copyright &#xa9;

<54>
Accession Number
2017600381
Title
Femoral or Radial Approach in Treatment of Coronary Chronic Total
Occlusion: A Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. 15(8) (pp 823-830), 2022. Date of
Publication: 25 Apr 2022.
Author
Gorgulu S.; Kalay N.; Norgaz T.; Kocas C.; Goktekin O.; Brilakis E.S.
Institution
(Gorgulu, Kalay, Norgaz) Cardiology Department, Acibadem University
Medical Faculty, Istanbul, Turkey
(Kocas) Cardiology Department, Biruni University Medical Faculty,
Istanbul, Turkey
(Goktekin) Cardiology Department, Memorial Bahcelievler Hospital,
Istanbul, Turkey
(Brilakis) Minneapolis Heart Institute and Minneapolis Heart Institute
Foundation, Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare transradial access (TRA)
with transfemoral access (TFA) for chronic total occlusion (CTO)
percutaneous coronary intervention (PCI). <br/>Background(s): TRA reduces
the risk for vascular access complications but may make complex PCI, such
as CTO PCI, more challenging. <br/>Method(s): FORT CTO (Femoral or Radial
Approach in the Treatment of Coronary Chronic Total Occlusion)
(NCT03265769) was a prospective, noninferiority, randomized controlled
study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural
success, defined as technical success without any in-hospital major
adverse cardiovascular events. The secondary study endpoint was major
access-site complications. <br/>Result(s): Between 2017 and 2021, 610 of
800 patients referred for CTO PCI at 4 centers were randomized to TRA (n =
305) or TFA (n = 305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1
+/- 0.1 vs 2.2 +/- 0.1; P = 0.279), PROGRESS CTO (Prospective Global
Registry for the Study of Chronic Total Occlusion Intervention) (1.3 +/-
0.9 vs 1.1 +/- 1.0; P = 0.058) and PROGRESS CTO complication (2.4 +/- 1.8
vs 2.3 +/- 1.8; P = 0.561) scores and use of the retrograde approach (11%
vs 14%; P = 0.342) were similar in the TRA and TFA groups. TRA was
noninferior to TFA for procedural success (84% vs 86%; P = 0.563) but had
fewer access-site complications (2.0% vs 5.6%; P = 0.019). There was no
difference between TFA and TRA in procedural duration, contrast volume, or
radiation dose. COnclusions: TRA was noninferior to TFA for CTO PCI but
had fewer access-site complications.<br/>Copyright &#xa9; 2022 American
College of Cardiology Foundation

<55>
Accession Number
2015843007
Title
Quality of Life of Mothers of Infants Subjected to Neonatal Cardiac
Surgery: The Importance of Psychosocial Factors.
Source
World Journal for Pediatric and Congenital Heart Surgery. 13(3) (pp
324-331), 2022. Date of Publication: May 2022.
Author
Lisanti A.J.; Golfenshtein N.; Marino B.S.; Huang L.; Hanlon A.L.; Lozano
A.J.; Curley M.A.Q.; Medoff-Cooper B.
Institution
(Lisanti, Curley, Medoff-Cooper) Research Institute, Children's Hospital
of Philadelphia, Philadelphia, PA, United States
(Lisanti, Golfenshtein, Huang, Medoff-Cooper) Department of Family and
Community Health, School of Nursing, University of Pennsylvania,
Philadelphia, PA, United States
(Golfenshtein) Haifa University, Haifa, Israel
(Marino) Department of Pediatric Cardiology, Cleveland Clinic Children's,
Cleveland, OH, United States
(Hanlon, Lozano) Center for Biostatistics and Health Data Science,
Department of Statistics, Virginia Tech, Blacksburg, VA, United States
(Curley) Nursing and Clinical Care Services, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
Publisher
SAGE Publications Inc.
Abstract
Background: The World Health Organization acknowledges quality of life
(QOL) as subjectively perceived overall well-being by the individual and
recognizes it as an essential construct for overall health and wellness.
The purpose of this study was to examine the association of infant,
environmental, and parental factors with the QOL of mothers of infants at
four months post-hospital discharge from cardiac surgery. <br/>Method(s):
Secondary analysis of prospectively collected data from the REACH
randomized clinical trial of telehealth home monitoring. The sample
included mothers (n = 148) of infants with congenital heart disease who
provided data at four months post-discharge. Ten imputations were
generated using fully conditional specification methods to address missing
data and were combined. All analyses were performed on the imputed data.
Mothers' QOL was the main outcome of the analysis, as measured by the Ulm
Quality of Life Inventory for Parents. Predictors on QOL were identified
based on the World Health Organization QOL framework which recognizes the
multidimensional domains influencing QOL that include personal factors,
environmental factors, and physical factors related to disease and
functioning. <br/>Result(s): The treatment and control groups did not
differ on any study variable, thus data were collapsed and analyzed
together. Final multivariable model found that the combination of dyadic
adjustment, social support, parenting stress, and post-traumatic stress
symptoms explained approximately three-quarters of the variance in QOL
scores. <br/>Conclusion(s): QOL for mothers of infants with congenital
heart disease is largely influenced by psychosocial factors. Future
research targeted toward improving maternal QOL should include
psychosocial interventions that address social networks and
stress.<br/>Copyright &#xa9; The Author(s) 2022.

<56>
Accession Number
2015519623
Title
Twelve-Month Cognitive and Functional Outcomes Following Cardiac Surgery:
The DEXACET Trial of Intravenous Acetaminophen Versus Placebo.
Source
Frontiers in Pharmacology. 13 (no pagination), 2022. Article Number:
803903. Date of Publication: 22 Mar 2022.
Author
Khera T.; Helfand J.; Kelly L.; Mueller A.; Shankar P.; Marcantonio E.R.;
Subramaniam B.
Institution
(Khera, Helfand, Kelly, Mueller, Shankar, Subramaniam) Center for
Anesthesia Research Excellence, Department of Anesthesia, Critical Care
and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA,
United States
(Mueller) Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Marcantonio) Department of Medicine, Divisions of General Medicine and
Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
Publisher
Frontiers Media S.A.
Abstract
Background: Delirium, an acute decline in attention and global cognitive
dysfunction, occurs frequently following cardiac surgery and has been
demonstrated to be significantly associated with cognitive dysfunction and
reduced functional ability. In the DEXACET trial, we demonstrated a
significant reduction in postoperative in-hospital delirium with
intravenous (IV) acetaminophen when compared with placebo. In this
analysis we examined whether this protective association also extended to
12 month cognitive and functional outcomes. <br/>Method(s): This study was
a prospective, randomized, placebo-controlled, triple-blinded, factorial
design trial conducted at Beth Israel Deaconess Medical Center, approved
by the IRB. In this trial, 120 older cardiac surgical patients were
randomly assigned to receive either intravenous (IV) acetaminophen or
placebo in addition to propofol or dexmedetomidine. Those receiving IV
acetaminophen displayed a significant reduction in in-hospital delirium.
We collected cognitive, mood and functional outcome data using the
Montreal Cognitive Assessment, telephone version (T-MoCA), Geriatric
Depression Scale (GDS) and the Basic and Instrumental Activities of Daily
Living (ADLs, IADLs) at 1 month and 12 months after surgery.
<br/>Result(s): Of the 120 enrolled patients in the primary trial, 93
(77.5%) and 83 (69.2%) patients responded to assessments at 1 month and 12
months, respectively. No statistically significant differences in median
T-MoCA scores were observed between acetaminophen and placebo groups at 1
month (18.0 vs.18.0, p = 0.52) or 12 months (19.0 vs.18.0, p = 0.62)
following surgery. There were similarly no differences in GDS, ADLs or
IADLs between treatment groups. Losses to follow-up limited the sample
sizes and 10 of the 23 (45%) original study participants who had
postoperative delirium were lost to follow up. <br/>Conclusion(s):
Administration of intravenous acetaminophen was not associated with a
difference in long term cognitive or functional status following cardiac
surgery. Additional research on long-term outcomes following postoperative
delirium with a larger sample size and improved cohort retention
strategies will be needed to address this important area.<br/>Copyright
&#xa9; 2022 Khera, Helfand, Kelly, Mueller, Shankar, Marcantonio and
Subramaniam.

<57>
[Use Link to view the full text]
Accession Number
635507144
Title
Ten-Year All-Cause Death According to Completeness of Revascularization in
Patients With Three-Vessel Disease or Left Main Coronary Artery Disease:
Insights From the SYNTAX Extended Survival Study.
Source
Circulation. 144(2) (pp 96-109), 2021. Date of Publication: 13 Jul 2021.
Author
Takahashi K.; Serruys P.W.; Gao C.; Ono M.; Wang R.; Thuijs D.J.F.M.; Mack
M.J.; Curzen N.; Mohr F.-W.; Davierwala P.; Milojevic M.; Wykrzykowska
J.J.; De Winter R.J.; Sharif F.; Onuma Y.; Head S.J.; Kappetein A.P.;
Morice M.-C.; Holmes D.R.
Institution
(Takahashi, Ono, Wykrzykowska, De Winter) Department of Cardiology,
Amsterdam University Medical Center, University of Amsterdam, Netherlands
(Serruys, Onuma) Department of Cardiology, National University of Ireland,
Galway (NUIG), Ireland
(Gao, Wang) Department of Cardiology, Radboudumc, Nijmegen, Netherlands
(Thuijs, Milojevic, Head, Kappetein) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Mack) Department of Cardiothoracic Surgery, Baylor Scott and White
Health, Dallas, TX, United States
(Curzen) Department of Cardiology, University Hospital Southampton Nhs Ft,
United Kingdom
(Mohr, Davierwala) University Department of Cardiac Surgery, Heart Centre
Leipzig, Germany
(Davierwala) Division of Cardiovascular Surgery, Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, ON, Canada
(Milojevic) Department of Cardiothoracic Surgery, Dedinje Cardiovascular
Institute, Belgrade, Serbia
(Wykrzykowska) Department of Cardiology, University Medical Centre
Groningen, University of Groningen, Netherlands
(Sharif) Curam, Cardiovascular Research and Innovation Centre (CVRI),
BioInnovate Ireland, Department of Cardiology, Galway University Hospital
and National University of Ireland, Ireland
(Morice) Departement of Cardiologie, Hopital Prive Jacques Cartier,
Generale de Sante Massy, France
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Ten-year all-cause death according to incomplete (IR) versus
complete revascularization (CR) has not been fully investigated in
patients with 3-vessel disease and left main coronary artery disease
undergoing percutaneous coronary intervention (PCI) versus coronary artery
bypass grafting (CABG). <br/>Method(s): The SYNTAX Extended Survival study
(Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended
Survival [SYNTAXES]) evaluated vital status up to 10 years in patients who
were originally enrolled in the SYNTAX trial. In the present substudy,
outcomes of the CABG CR group were compared with the CABG IR, PCI CR, and
PCI IR groups. In addition, in the PCI cohort, the residual SYNTAX score
(rSS) was used to quantify the extent of IR and to assess its association
with fatal late outcome. The rSS of 0 suggests CR, whereas a rSS>0
identifies the degree of IR. <br/>Result(s): IR was more frequently
observed in patients with PCI versus CABG (56.6% versus 36.8%) and more
common in those with 3-vessel disease than left main coronary artery
disease in both the PCI arm (58.5% versus 53.8%) and the CABG arm (42.8%
versus 27.5%). Patients undergoing PCI with CR had no significant
difference in 10-year all-cause death compared with those undergoing CABG
(22.2% for PCI with CR versus 24.3% for CABG with IR versus 23.8% for CABG
with CR). In contrast, those with PCI and IR had a significantly higher
risk of all-cause death at 10 years compared with CABG and CR (33.5%
versus 23.7%; adjusted hazard ratio, 1.48 [95% CI, 1.15-1.91]). When
patients with PCI were stratified according to the rSS, those with a
rSS<=8 had no significant difference in all-cause death at 10 years as the
other terciles (22.2% for rSS=0 versus 23.9% for rSS>0-4 versus 28.9% for
rSS>4-8), whereas a rSS>8 had a significantly higher risk of 10-year
all-cause death than those undergoing PCI with CR (50.1% versus 22.2%;
adjusted hazard ratio, 3.40 [95% CI, 2.13-5.43]). <br/>Conclusion(s): IR
is common after PCI, and the degree of incompleteness was associated with
10-year mortality. If it is unlikely that complete (or nearly complete;
rSS<8) revascularization can be achieved with PCI in patients with
3-vessel disease, CABG should be considered. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT00114972. URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03417050.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins.
All rights reserved.

<58>
[Use Link to view the full text]
Accession Number
635505479
Title
Achieving Complete Revascularization for Multivessel Coronary Artery
Disease.
Source
Circulation. 144(2) (pp 110-112), 2021. Date of Publication: 13 Jul 2021.
Author
Mehta S.R.
Institution
(Mehta) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, ON, Canada
Publisher
Lippincott Williams and Wilkins

<59>
Accession Number
634775405
Title
Finerenone and Cardiovascular Outcomes in Patients with Chronic Kidney
Disease and Type 2 Diabetes.
Source
Circulation. 143(6) (pp 540-552), 2021. Date of Publication: 09 Feb 2021.
Author
Filippatos G.; Anker S.D.; Agarwal R.; Pitt B.; Ruilope L.M.; Rossing P.;
Kolkhof P.; Schloemer P.; Tornus I.; Joseph A.; Bakris G.L.
Institution
(Filippatos) National and Kapodistrian University of Athens, School of
Medicine, Department of Cardiology, Attikon University Hospital, Greece
(Anker) Department of Cardiology, Berlin Institute of Health Center for
Regenerative Therapies, German Centre for Cardiovascular Research Partner
Site Berlin, Charite Universitatsmedizin, Germany
(Agarwal) Richard L. Roudebush VA Medical Center, Indiana University,
Indianapolis, United States
(Pitt) Department of Medicine, University of Michigan School of Medicine,
Ann Arbor, United States
(Ruilope) Cardiorenal Translational Laboratory, Hypertension Unit,
Institute of Research imas12, Madrid, Spain
(Ruilope) Biomedical Research Networking Center on Cardiovascular
Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
(Ruilope) Faculty of Sport Sciences, European University of Madrid, Spain
(Rossing) Steno Diabetes Center Copenhagen, Gentofte, Denmark
(Rossing) Department of Clinical Medicine, University of Copenhagen,
Denmark
(Kolkhof) Research and Development, Preclinical Research Cardiovascular,
Bayer AG, Wuppertal, Germany
(Schloemer) Research and Development, Statistics and Data Insights, Bayer
AG, Wuppertal, Germany
(Tornus, Joseph) Cardiology and Nephrology Clinical Development, Bayer AG,
Wuppertal, Germany
(Bakris) Department of Medicine, University of Chicago Medicine, IL,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure
and Disease Progression in Diabetic Kidney Disease) evaluated the effect
of the nonsteroidal, selective mineralocorticoid receptor antagonist
finerenone on kidney and cardiovascular outcomes in patients with chronic
kidney disease and type 2 diabetes with optimized renin-angiotensin system
blockade. Compared with placebo, finerenone reduced the composite kidney
and cardiovascular outcomes. We report the effect of finerenone on
individual cardiovascular outcomes and in patients with and without
history of atherosclerotic cardiovascular disease (CVD). <br/>Method(s):
This randomized, double-blind, placebo-controlled trial included patients
with type 2 diabetes and urine albumin-to-creatinine ratio 30 to 5000 mg/g
and an estimated glomerular filtration rate >=25 to <75 mL per min per
1.73 m², treated with optimized renin-angiotensin system
blockade. Patients with a history of heart failure with reduced ejection
fraction were excluded. Patients were randomized 1:1 to receive finerenone
or placebo. The composite cardiovascular outcome included time to
cardiovascular death, myocardial infarction, stroke, or hospitalization
for heart failure. Prespecified cardiovascular analyses included analyses
of the components of this composite and outcomes according to CVD history
at baseline. <br/>Result(s): Between September 2015 and June 2018, 13 911
patients were screened and 5674 were randomized; 45.9% of patients had CVD
at baseline. Over a median follow-up of 2.6 years (interquartile range,
2.0-3.4 years), finerenone reduced the risk of the composite
cardiovascular outcome compared with placebo (hazard ratio, 0.86 [95% CI,
0.75-0.99]; P=0.034), with no significant interaction between patients
with and without CVD (hazard ratio, 0.85 [95% CI, 0.71-1.01] in patients
with a history of CVD; hazard ratio, 0.86 [95% CI, 0.68-1.08] in patients
without a history of CVD; P value for interaction, 0.85). The incidence of
treatment-emergent adverse events was similar between treatment arms, with
a low incidence of hyperkalemia-related permanent treatment
discontinuation (2.3% with finerenone versus 0.8% with placebo in patients
with CVD and 2.2% with finerenone versus 1.0% with placebo in patients
without CVD). <br/>Conclusion(s): Among patients with chronic kidney
disease and type 2 diabetes, finerenone reduced incidence of the composite
cardiovascular outcome, with no evidence of differences in treatment
effect based on preexisting CVD status. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT02540993.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins.
All rights reserved.

<60>
Accession Number
634770256
Title
Response by Navarese et al to Letters Regarding Article, "comparative
Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome:
Network Meta-Analysis of 52 816 Patients from 12 Randomized Trials".
Source
Circulation. 143(6) (pp E236-E237), 2021. Date of Publication: 09 Feb
2021.
Author
Navarese E.P.; Khan S.U.; James S.
Institution
(Navarese) Interventional Cardiology and Cardiovascular Medicine Research,
Department of Cardiology and Internal Medicine, Nicolaus Copernicus
University, Bydgoszcz, Poland
(Khan) Department of Internal Medicine, West Virginia University,
Morgantown, United States
(James) Department of Medical Sciences, Uppsala Clinical Research Center,
Uppsala University Hospital, Sweden
Publisher
Lippincott Williams and Wilkins

<61>
[Use Link to view the full text]
Accession Number
634770055
Title
Cardiovascular Disease in Chronic Kidney Disease Pathophysiological
Insights and Therapeutic Options.
Source
Circulation. 143(11) (pp 1157-1172), 2021. Date of Publication: 16 Mar
2021.
Author
Jankowski J.; Floege J.; Fliser D.; Bohm M.; Marx N.
Institution
(Jankowski) Institute for Molecular Cardiovascular Research, University
Hospital, Rheinisch-Westfalische Technische Hochschule Aachen (RWTH),
Aachen, Germany
(Floege) Division of Nephrology and Clinical Immunology, University
Hospital, Rheinisch-Westfalische Technische Hochschule Aachen (RWTH),
Aachen, Germany
(Marx) Department of Internal Medicine I (Cardiology), University
Hospital, Rheinisch-Westfalische Technische Hochschule Aachen (RWTH),
Aachen, Germany
(Jankowski) School for Cardiovascular Diseases, Maastricht University,
Netherlands
(Fliser) Department of Nephrology, Saarland University Medical Centre,
Homburg, Germany
(Bohm) Department of Cardiology, Angiology and Intensive Care Medicine,
Saarland University Medical Centre, Homburg, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Patients with chronic kidney disease (CKD) exhibit an elevated
cardiovascular risk manifesting as coronary artery disease, heart failure,
arrhythmias, and sudden cardiac death. Although the incidence and
prevalence of cardiovascular events is already significantly higher in
patients with early CKD stages (CKD stages 1-3) compared with the general
population, patients with advanced CKD stages (CKD stages 4-5) exhibit a
markedly elevated risk. Cardiovascular rather than end-stage kidney
disease (CKD stage 5) is the leading cause of death in this high-risk
population. CKD causes a systemic, chronic proinflammatory state
contributing to vascular and myocardial remodeling processes resulting in
atherosclerotic lesions, vascular calcification, and vascular senescence
as well as myocardial fibrosis and calcification of cardiac valves. In
this respect, CKD mimics an accelerated aging of the cardiovascular
system. This overview article summarizes the current understanding and
clinical consequences of cardiovascular disease in CKD.<br/>Copyright
&#xa9; 2021 The Authors.

<62>
Accession Number
2017637641
Title
Analgesia in Unilateral Breast Surgeries Using Ultra Sound-Guided Serratus
Plane Block With Dexmedetomidine versus fentanyl with bupivacaine.
Source
Journal of Cardiovascular Disease Research. 12(6) (pp 819-826), 2021. Date
of Publication: 2021.
Author
Hawas A.M.; Elhossary Z.E.; El Desouky M.I.; Zakzouk M.M.A.A.
Institution
(Hawas, Elhossary, El Desouky, Zakzouk) Department of anesthesia &
surgical intensive care and pain management, Faculty of Medicine, Zagazig
University, Egypt
Publisher
EManuscript Technologies
Abstract
Background: A large number of patients undergoing major surgical
procedures for the management of breast cancer complain of acute
postoperative pain. Many regional analgesic techniques are trying to
decrease the side effects associated with general anaesthesia and opioid
consumption.The aim of the present study was to find better achievement of
high quality of anesthesia and analgesia with haemodynamic stability for
patients undergoing unilateral breast surgeries. <br/>Patients and
Methods: This comparative prospective randomized double blinded controlled
clinical trial were conducted 60 patients who underwent for breast surgery
and carried out at Zagazig University Hospitals and aimedto find better
achievement of analgesia for these patients. Patients were divided into
three equal groups (20 patients in each), Group(C) received general
anesthesia (GA) only, Group (D) received US guided serratus plane block
using 30 ml of bupivacaine 0.25% plus 1mug /kg dexmedetomidine before
induction of GA. Group (F) who received USguided serratus plane block
using30 ml bupivacaine 0.25% plus 25mug fentanyl before induction of GA.
Routine laboratory investigations were applied. Patients were familiar
with the use of VAS score, identifying 0 as no pain and 10 as worst
imaginable pain. Routine monitoring, including ECG, noninvasive blood
pressure, HR, pulse oximetry in the preanesthesia room (base line data)
and every 5 minute for 15 minute then 10 minute till the end of surgery.
<br/>Result(s): All the 60 patients participated in the study completed
the study as shown in the study flow diagram. As regard patients
characteristic, there were no statistically significant difference between
the studied groups as regards age, BMI and duration of surgery and
anesthesia. Post-operative MAP(mmHg) showed all studied groups had
increased mean arterial pressure postoperative with less mean arterial
pressure on group D than Group F than group C group. Post-operative heart
rate (beat/min), the three studied groups had increased heart rate
postoperative with less heart rate on group D than Group F than group C
group. At 18th and 24 hours postoperative, the heart rate returned to
normal with no statistically significant difference among the three
studied groups. The total postoperative pethidine requirement in the first
24 hours was statistically significant lower in group D than group F than
group C. <br/>Conclusion(s): Addition of dexmedetomidine to bupivacaine in
US-guided serratus plane block during breast surgery provide better
intraoperative and postoperative analgesia, delays time of first analgesic
request, reduces intraoperative and postoperative analgesic consumptions
compared with addition of fentanyl as an adjuvant to
bupivacaine.<br/>Copyright &#xa9; 2021 EManuscript Technologies. All
rights reserved.

<63>
[Use Link to view the full text]
Accession Number
2015426522
Title
Studying Stroke Thrombus Composition After Thrombectomy: What Can We
Learn?.
Source
Stroke. 52(11) (pp 3718-3727), 2021. Date of Publication: 01 Nov 2021.
Author
Staessens S.; Francois O.; Brinjikji W.; Doyle K.M.; Vanacker P.;
Andersson T.; De Meyer S.F.
Institution
(Staessens, De Meyer) Laboratory for Thrombosis Research, Ku Leuven Campus
Kulak Kortrijk, Belgium
(Francois, Andersson) Department of Medical Imaging, Az Groeninge,
Kortrijk, Belgium
(Vanacker) Department of Neurology, Az Groeninge, Kortrijk, Belgium
(Brinjikji) Department of Radiology, Mayo Clinic, Rochester, MN, United
States
(Doyle) CURAM-Centre for Research in Medical Devices, National University
of Ireland Galway, Ireland
(Vanacker) Department of Neurology, University Hospitals Antwerp, Belgium
(Vanacker) Department of Translational Neuroscience, University of
Antwerp, Belgium
(Andersson) Department of Neuroradiology, Karolinska University Hospital
and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Publisher
Lippincott Williams and Wilkins
Abstract
The composition of ischemic stroke thrombi has gained an increasing amount
of interest in recent years. The implementation of endovascular procedures
in standard stroke care has granted researchers the unique opportunity to
examine patient thrombus material. Increasing evidence indicates that
stroke thrombi are complex and heterogenous, consisting of various
biochemical (eg, fibrin, von Willebrand Factor, and neutrophil
extracellular traps) and cellular (eg, red blood cells, platelets,
leukocytes, and bacteria) components. This complex composition may explain
therapeutic limitations and also offer novel insights in several aspects
of stroke management. Better understanding of thrombus characteristics
could, therefore, potentially lead to improvements in the management of
patients with stroke. In this review, we provide a comprehensive overview
of the lessons learned by examining stroke thrombus composition after
endovascular thrombectomy and its potential relevance for thrombectomy
success rates, thrombolysis, clinical outcomes, stroke etiology, and
radiological imaging.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<64>
Accession Number
2018452289
Title
Outcome after percutaneous coronary intervention with contemporary stents
in patients with concomitant peripheral arterial disease: A patient-level
pooled analysis of four randomized trials.
Source
Atherosclerosis. (no pagination), 2022. Date of Publication: 2022.
Author
Pinxterhuis T.H.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; Schotborgh C.E.;
Anthonio R.L.; Roguin A.; Danse P.W.; Benit E.; Aminian A.; Stoel M.G.;
Linssen G.C.M.; Geelkerken R.H.; von Birgelen C.
Institution
(Pinxterhuis, Ploumen, Zocca, Stoel, von Birgelen) Department of
Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede,
Netherlands
(Pinxterhuis, Ploumen, Doggen, von Birgelen) Department of Health
Technology and Services Research, Faculty BMS, Technical Medical Centre,
University of Twente, Enschede, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Anthonio) Department of Cardiology, Treant Zorggroep, Scheper Hospital,
Emmen, Netherlands
(Roguin) Department of Cardiology, Hillel Yaffe Medical Center, Hadera and
B. Rappaport-Faculty of Medicine, Institute of Technology, Israel, Haifa,
Israel
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Benit) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo,
Hengelo, Netherlands
(Geelkerken) Department of Vascular Surgery, Medisch Spectrum Twente,
Enschede, Netherlands
(Geelkerken) Department of Multi-modality Medical Imaging (M3I) Group,
Faculty of Science and Technology, Technical Medical Centre, University of
Twente, Enschede, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: A considerable number of patients who undergo
percutaneous coronary intervention (PCI) also have peripheral arterial
disease (PAD) - a signal of more advanced atherosclerosis. After bare
metal and early-generation drug-eluting coronary stent implantation, PAD
patients showed inferior outcome. As stents and medical treatment were
further improved, we aimed to assess the impact of PAD on outcome of PCI
with contemporary new-generation stents. <br/>Method(s): We analyzed
3-year pooled patient-level data from 4 large-scale randomized
new-generation stent trials to compare all-comer patients with and without
(core lab-verified) history of symptomatic PAD, defined as obstructive
lesions in peripheral locations including lower and upper extremities,
carotid, vertebral, mesenteric and renal arteries. Main endpoint was
target vessel failure: cardiac death, target vessel-related myocardial
infarction, or clinically indicated target vessel revascularization.
<br/>Result(s): Of all 9204 patients, 695 (7.6%) had a history of
symptomatic PAD. They were older and had more often diabetes, renal
failure, hypertension, hypercholesterolemia, and prior stroke. PAD was an
independent risk factor for target vessel failure (adjusted-HR:1.42,
95%-CI:1.12-1.73, p = 0.001). Target vessel revascularization
(adjusted-HR:1.37, 95%-CI:1.04-1.80, p = 0.026), death (adjusted-HR:1.52,
95%-CI:1.17-1.99, p = 0.002), and major adverse cardiovascular event risks
(adjusted-HR:1.36, 95%-CI:1.13-1.64, p = 0.001) were also substantially
higher. <br/>Conclusion(s): A history of symptomatic PAD still allows to
simply identify patients with increased risk of unfavorable clinical
outcome after PCI, including a higher risk of repeated coronary
revascularization, despite using contemporary stents. In clinical
practice, this knowledge about higher event risks of PAD patients is
helpful both during Heart Team discussions and when informing patients
about the procedural risk.<br/>Copyright &#xa9; 2022 The Authors

<65>
Accession Number
2015635006
Title
Complete transcatheter versus complete surgical treatment in patients with
aortic valve stenosis and concomitant coronary artery disease: Study-level
meta-analysis with reconstructed time-to-event data.
Source
Journal of Cardiac Surgery. 37(7) (pp 2072-2083), 2022. Date of
Publication: July 2022.
Author
Michel Pompeu S.; Sun T.; Fatehi Hassanabad A.; Awad A.K.; Van den Eynde
J.; Malin J.H.; Sicouri S.; Torregrossa G.; Ruhparwar A.; Weymann A.;
Ramlawi B.
Institution
(Michel Pompeu, Sun, Torregrossa, Ramlawi) Department of Cardiothoracic
Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line
Health, Wynnewood, PA, United States
(Michel Pompeu, Sicouri, Torregrossa, Ramlawi) Department of
Cardiothoracic Surgery Research, Lankenau Institute for Medical Research,
Wynnewood, PA, United States
(Fatehi Hassanabad) Section of Cardiac Surgery, Department of Cardiac
Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
(Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Van den Eynde) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Van den Eynde) Helen B. Taussig Heart Center, The Johns Hopkins Hospital
and School of Medicine, Baltimore, MD, United States
(Malin) Philadelphia College of Osteopathic Medicine, Bala Cynwyd, PA,
United States
(Ruhparwar, Weymann) Department of Thoracic and Cardiovascular Surgery,
West German Heart and Vascular Center Essen, University Hospital of Essen,
University Duisburg-Essen, Essen, Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To compare outcomes of complete transcatheter (TAVI plus PCI)
versus complete surgical (SAVR plus CABG) approach to treat patients with
aortic stenosis (AS) and concomitant coronary artery disease (CAD).
<br/>Method(s): Study-level meta-analysis with reconstructed time-to-event
data including studies published by November 2021. The primary endpoints
were 30-day mortality, overall survival, and major adverse cardiovascular
and cerebrovascular events (MACCE). The secondary endpoints were 30-day
stroke, myocardial infarction, and permanent pacemaker implantation (PPI);
in-hospital major vascular events and acute kidney injury (AKI).
<br/>Result(s): Eight studies met our eligibility criteria, including a
total of 33,286 patients (3448 for TAVI plus PCI and 29,838 for SAVR plus
CABG). The pooled risk of 30-day mortality was lower for TAVI plus PCI (OR
0.63; 95% CI 0.51-0.80; p <.001). Patients undergoing TAVI plus PCI had
lower risk of in-hospital AKI (OR 0.49; 95% CI 0.28-0.85; p =.01),
however, higher risk of major vascular events (OR 7.33; 95% CI 1.80-29.85;
p =.005) and higher risk of PPI (OR 2.96; 95% CI 1.80-4.85; p <.001). No
statistically significant difference was observed for myocardial
infarction and stroke between the groups. In the follow-up analyses, we
observed a higher risk of mortality (HR 1.64, 95% CI 1.36-1.96, p <.001)
and MACCE with TAVI plus PCI (HR 1.35 (95% CI 1.08-1.69, p =.009).
<br/>CONCLUSION(S): Patients who undergo TAVI plus PCI (in comparison with
SAVR plus CABG) initially experience lower rates of in-hospital death and
AKI; however, they experience significantly lower survival rates and more
MACCE at 5-year follow up. Structural heart surgeons and interventional
cardiologists should consider these aspects when referring patients for
one approach or the other.<br/>Copyright &#xa9; 2022 Wiley Periodicals
LLC.

<66>
Accession Number
2015575936
Title
Ticagrelor versus aspirin 2 years after coronary bypass: Observational
analysis from the TARGET trial.
Source
Journal of Cardiac Surgery. 37(7) (pp 1969-1977), 2022. Date of
Publication: July 2022.
Author
Kulik A.; Abreu A.M.; Boronat V.; Kouchoukos N.T.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Division of Cardiac Surgery, Department of
Clinical Research, Boca Raton Regional Hospital, Florida Atlantic
University, Boca Raton, FL, United States
(Kouchoukos) Division of Cardiovascular and Thoracic Surgery, Missouri
Baptist Medical Center, St. Louis, MO, United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Compared to conventional aspirin therapy, ticagrelor did not
improve vein graft patency 1 year after coronary bypass surgery (CABG) in
the ticagrelor antiplatelet therapy to reduce graft events and thrombosis
(TARGET) trial. However, it is unknown whether ticagrelor may impact graft
patency long-term following surgery. <br/>Method(s): In the TARGET
multicenter trial, 250 CABG patients were randomized to aspirin 81 mg or
ticagrelor 90 mg twice daily. In this observational analysis, 2 years
after surgery, vein graft occlusion and clinical events were compared
among subjects who agreed to a second year of double-blind study drug
administration (N = 156). <br/>Result(s): Two-year graft assessment was
performed for 142 patients (80 aspirin patients, 62 ticagrelor patients,
425 total grafts), with an overall 2-year graft occlusion rate of 10.6%.
Vein graft occlusion at 2 years, the primary outcome of this study, did
not significantly differ between the two groups (15.7% vs. 13.2%, aspirin
vs. ticagrelor, p =.71). The incidence of vein grafts with any disease
(stenosis or occlusion) did not significantly differ between the groups
(19.4% vs. 19.8%, aspirin vs. ticagrelor, p = 1.00), and the number of
patients with vein graft disease did not significantly differ between the
groups (30.0% vs. 29.0%, aspirin vs. ticagrelor, p = 1.00). Vein grafts
developing new disease did not significantly differ between the two groups
(1.5% vs. 3.8%, aspirin vs. ticagrelor, p =.41). Freedom from major
adverse cardiovascular events at 2 years was similar between the groups (p
=.75). <br/>Conclusion(s): Compared to conventional aspirin therapy,
ticagrelor did not significantly reduce vein graft disease 2 years after
CABG.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC.

<67>
Accession Number
2014440544
Title
Effect of energy- and/or protein-dense enteral feeding on postoperative
outcomes of infant surgical patients with congenital cardiac disease: A
systematic review and meta-analysis.
Source
Nutrition in Clinical Practice. 37(3) (pp 555-566), 2022. Date of
Publication: June 2022.
Author
Singal A.; Sahu M.K.; Trilok Kumar G.; Kumar A.
Institution
(Singal) Department of Food and Nutrition, Institute of Home Economics,
University of Delhi, New Delhi, India
(Sahu) Department of Cardiothoracic and Vascular Surgery, CT Centre, All
India Institute of Medical Sciences, New Delhi, India
(Trilok Kumar) Institute of Home Economics, University of Delhi, New
Delhi, India
(Kumar) Department of Neurology, All India Institute of Medical Sciences,
New Delhi, India
Publisher
John Wiley and Sons Inc
Abstract
Infants with congenital heart disease (CHD) are malnourished because of
poor dietary intakes and increased requirements. Energy requirements are
higher due to increased resting energy expenditure. There are lacunae of
nutrition recommendations for these infants. Therefore, this systematic
review and meta-analysis was conducted to determine the effect of energy-
and/or protein-dense feeds in postoperative CHD infants as compared with
the standard feeding. An online literature search was performed on four
databases by using different English-language keywords between 2000 and
2020. The inclusion criteria were peer reviewed journals and open access
original articles on the feeding practices in infants undergoing
congenital heart surgery. Exclusion criteria were editorials,
commentaries, discussion papers, conference abstracts, reviews, duplicate
studies, and articles on preterm infants and preoperative nutrition. A
total of five studies matched the inclusion criteria. The standard mean
difference (SMD) of energy intake (SMD = 13.40 kcal, P = 0.001), protein
intake (SMD = 2.37 g, P = 0.001), and weight (SMD = 4.99 g, P = 0.001) was
significantly higher in the intervention group. The SMD of ventilation
duration (SMD = -0.18 h, P = 0.90), intensive care unit (ICU) length of
stay (LOS) (SMD = -0.25 d, P = 0.70), and hospital LOS (SMD = -0.20 d, P =
0.67) were not statistically significant between the two groups. Enriched
enteral nutrition for the postoperative pediatric patients with cardiac
disease helps in achieving energy and protein goals and improves the
overall postoperative outcomes (ie, ventilation duration, maintenance of
weight, ICU LOS, and hospital LOS).<br/>Copyright &#xa9; 2021 American
Society for Parenteral and Enteral Nutrition.

<68>
Accession Number
2017791462
Title
Intraoperative transesophageal echocardiography following mitral valve
repair: a systematic review.
Source
Brazilian Journal of Anesthesiology (English Edition). 72(3) (pp 379-397),
2022. Date of Publication: 01 May 2022.
Author
Zamper R.; Prempeh A.; Iglesias I.; Fayad A.
Institution
(Zamper, Prempeh, Iglesias, Fayad) Western University, Schulich School of
Medicine and Dentistry, Department of Anesthesia and Perioperative
Medicine, London, Canada
Publisher
Elsevier Editora Ltda
Abstract
Objective: We aimed to examine the recent evidence and search for novel
assessments on intraoperative TEE following mitral valve repair that can
impact short and long-term outcomes. <br/>Method(s): The Ovid MEDLINE,
PubMed, and EMBASE databases were searched from January 1, 2008, until
January 27, 2021, for studies on patients with severe Mitral Valve
Regurgitation (MR) undergoing Mitral Valve (MV) repair surgery with
intraoperative Transesophageal Echocardiography (TEE) performed after the
repair. Additional searches were conducted using Google search engine, Web
of Science, and Cochrane Library. <br/>Result(s): After reviewing 302
records, 8 retrospective and 22 prospective studies were included (n =
30). Due to clinical and methodological diversity, these studies are
noncomparable and data were not amenable to quantitative synthesis.
<br/>Conclusion(s): Although technological advances allowed the objective
assessment of geometric and dynamic alterations of the MV, the impact of
the use of these technologies on short- or long-term outcomes was not
studied. There is uncertainty and conflicting evidence on the ideal method
and metrics to evaluate MV patency post-repair. Few isolated studies
validated methods to assess coaptation surface and LV function
post-repair.<br/>Copyright &#xa9; 2022 Sociedade Brasileira de
Anestesiologia

<69>
Accession Number
2017766572
Title
Hybrid coronary revascularization versus coronary artery bypass grafting
for multivessel coronary artery disease: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 359 (pp 20-27), 2022. Date of
Publication: 15 Jul 2022.
Author
Dixon L.K.; Akberali U.; Di Tommaso E.; George S.J.; Johnson T.W.; Bruno
V.D.
Institution
(Dixon) Bristol Medical School, Public Health Science, University of
Bristol, Bristol, United Kingdom
(Akberali, Di Tommaso, George, Johnson, Bruno) Bristol Medical School,
Translational Health Science, University of Bristol, Bristol, United
Kingdom
(Johnson, Bruno) Bristol Heart Institute, University Hospitals of Bristol
and Weston NHS Foundation Trust, Bristol, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Hybrid coronary revascularization (HCR) combines the benefits
of a left internal mammary artery to left anterior descending artery
anastomosis, via a mini thoracotomy, with percutaneous coronary
intervention (PCI) for other diseased coronaries. <br/>Aim(s): The aim of
this meta-analysis is to compare the short- and long-term outcomes of HCR
with those of coronary artery bypass grafting (CABG) for multi-vessel
coronary artery disease (MCAD). <br/>Method(s): We performed a
meta-analysis with a primary outcome of short-term mortality and secondary
outcomes of mid-term survival, length of hospital stay, stroke, renal
failure and mid-term MACE rate. <br/>Result(s): 3399 patients (HCR = 1164,
CABG = 2235) were included, with no significant difference in short-term
mortality between groups (OR = 1.50, 95% CI = [0.90,2.49], p = 0.11),
although a higher mortality rate was seen in the HCR group (0.73% vs
0.64%). The average length of stay in intensive care unit was
significantly shorter following HCR than CABG (mean difference = -15.52 h,
CI = [-22.47,-8.59], p<0.001) and overall hospital stay was also shorter
in this group, although not statistically significant (mean difference =
-3.15 days, 95% CI = [-6.55, 0.25], p = 0.07). HCR was associated with a
reduced odds of blood transfusion (OR = 0.34, 95% CI = [0.22,0.54], p <
0.001). There was not a significant difference in mid-term survival (OR =
0.86, 95% CI = [0.62,1.21], p = 0.39) or MACE rate (OR = 0.82, 95% CI =
[0.55,1.23], p = 0.34). No differences were found between HCR and CABG for
post-operative stroke (OR = 1.36, 95% CI = [0.87, 2.13], p = 0.16) or
renal failure (OR = 0.71, 95% CI = [0.43,1.16], p = 0.14).
<br/>Conclusion(s): HCR has a higher incidence of short-term mortality
compared to CABG in patients with MCAD, although this difference is not
statistically significant. Similar rates of mid-term survival and other
short term post-operative complications were found between the two groups.
HCR has a shorter ICU stays and reduced requirement for blood
transfusion.<br/>Copyright &#xa9; 2022 Elsevier B.V.

<70>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2022, The
Author(s).

<71>
[Use Link to view the full text]
Accession Number
2018477932
Title
Quality of Life after Fractional Flow Reserve-Guided PCI Compared with
Coronary Bypass Surgery.
Source
Circulation. 145(22) (pp 1655-1662), 2022. Date of Publication: 31 May
2022.
Author
Fearon W.F.; Zimmermann F.M.; Ding V.Y.; Zelis J.M.; Piroth Z.;
Davidavicius G.; Mansour S.; Kharbanda R.; Ostlund-Papadogeorgos N.;
Oldroyd K.G.; Wendler O.; Reardon M.J.; Woo Y.J.; Yeung A.C.; Pijls
N.H.J.; De Bruyne B.; Desai M.; Hlatky M.A.
Institution
(Fearon, Hlatky) Division of Cardiovascular Medicine, Stanford
Cardiovascular Institute, Stanford University, CA, United States
(Ding, Yeung, Desai) Quantitative Sciences Unit, Stanford University, CA,
United States
(Woo) Department of Cardiothoracic Surgery, Stanford University, CA,
United States
(Hlatky) Department of Health Policy, Stanford University, CA, United
States
(Fearon) VA Palo Alto Health Care System, CA, United States
(Zimmermann, Zelis, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Piroth) Gottsegen National Cardiovascular Center, Hungary
(Davidavicius) Clinic of Cardiac and Vascular Diseases, Institute of
Clinical Medicine, Vilnius University, Lithuania and Vilnius University
Hospital, Santaros Klinikos, Lithuania
(Mansour) Centre Hospitalier, Universite de Montreal, Canada
(Kharbanda) Oxford University Hospital National Health Service Trust,
United Kingdom
(Ostlund-Papadogeorgos) Danderyd University Hospital, Karolinska
Institutet, Solna, Sweden
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Wendler) Kings College Hospital, London, United Kingdom
(Reardon) Houston Methodist Hospital, TX, United States
(De Bruyne) Cardiovascular Center Aalst, Belgium
(De Bruyne) Lausanne University Centre Hospital, Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Previous studies have shown that quality of life improves
after coronary revascularization more so after coronary artery bypass
grafting (CABG) than after percutaneous coronary intervention (PCI). This
study aimed to evaluate the effect of fractional flow reserve guidance and
current generation, zotarolimus drug-eluting stents on quality of life
after PCI compared with CABG. <br/>Method(s): The FAME 3 trial (Fractional
Flow Reserve Versus Angiography for Multivessel Evaluation) is a
multicenter, international trial including 1500 patients with 3-vessel
coronary artery disease who were randomly assigned to either CABG or
fractional flow reserve-guided PCI. Quality of life was measured using the
European Quality of Life-5 Dimensions (EQ-5D) questionnaire at baseline
and 1 and 12 months. The Canadian Cardiovascular Class angina grade and
working status were assessed at the same time points and at 6 months. The
primary objective was to compare EQ-5D summary index at 12 months.
Secondary end points included angina grade and work status.
<br/>Result(s): The EQ-5D summary index at 12 months did not differ
between the PCI and CABG groups (difference, 0.001 [95% CI, -0.016 to
0.017]; P=0.946). The trajectory of EQ-5D during the 12 months differed
(P<0.001) between PCI and CABG: at 1 month, EQ-5D was 0.063 (95% CI, 0.047
to 0.079) higher in the PCI group. A similar trajectory was found for the
EQ (EuroQol) visual analogue scale. The proportion of patients with
Canadian Cardiovascular Class 2 or greater angina at 12 months was 6.2%
versus 3.1% (odds ratio, 2.5 [95% CI, 0.96-6.8]), respectively, in the PCI
group compared with the CABG group. A greater percentage of younger
patients (<65 years old) were working at 12 months in the PCI group
compared with the CABG group (68% versus 57%; odds ratio, 3.9 [95% CI,
1.7-8.8]). <br/>Conclusion(s): In the FAME 3 trial, quality of life after
fractional flow reserve-guided PCI with current generation drug-eluting
stents compared with CABG was similar at 1 year. The rate of significant
angina was low in both groups and not significantly different. The
trajectory of improvement in quality of life was significantly better
after PCI, as was working status in those <65 years old. Registration:
URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02100722.<br/>Copyright &#xa9; 2022 Lippincott Williams and Wilkins.
All rights reserved.

<72>
[Use Link to view the full text]
Accession Number
2018477929
Title
Effects of Long-term Metformin and Lifestyle Interventions on
Cardiovascular Events in the Diabetes Prevention Program and Its Outcome
Study.
Source
Circulation. 145(22) (pp 1632-1641), 2022. Date of Publication: 31 May
2022.
Author
Goldberg R.B.; Orchard T.J.; Crandall J.P.; Boyko E.J.; Budoff M.; Dabelea
D.; Gadde K.M.; Knowler W.C.; Lee C.G.; Nathan D.M.; Watson K.; Temprosa
M.
Institution
(Goldberg) University of Miami Miller, School of Medicine, FL, United
States
(Orchard) University of Pittsburgh, Graduate School of Public Health, PA,
United States
(Crandall) Albert Einstein College of Medicine, Bronx, NY, United States
(Boyko) VA Puget Sound Health Care System, Seattle, WA, United States
(Budoff) Los Angeles Biomedical Research Institute, Torrance, CA, United
States
(Dabelea) University of Colorado, Anschutz Medical Campus, Aurora, United
States
(Gadde) Pennington Biomedical Research Center, Baton Rouge, LA, United
States
(Knowler) National Institute of Diabetes and Digestive and Kidney
Diseases, Phoenix, AZ, United States
(Lee) National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health, Bethesda, MD, United States
(Nathan) Massachusetts General Hospital, Harvard Medical School, Boston,
United States
(Watson) David Geffen School of Medicine at UCLA, Los Angeles, CA, United
States
(Temprosa) Biostatistics Center, Milken Institute School of Public Health,
George Washington University, Rockville, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Lifestyle intervention and metformin have been shown to
prevent diabetes; however, their efficacy in preventing cardiovascular
disease associated with the development of diabetes is unclear. We
examined whether these interventions reduced the incidence of major
cardiovascular events over a 21-year median follow-up of participants in
the DPP trial (Diabetes Prevention Program) and DPPOS (Diabetes Prevention
Program Outcomes Study). <br/>Method(s): During DPP, 3234 participants
with impaired glucose tolerance were randomly assigned to metformin 850 mg
twice daily, intensive lifestyle or placebo, and followed for 3 years.
During the next 18-year average follow-up in DPPOS, all participants were
offered a less intensive group lifestyle intervention, and unmasked
metformin was continued in the metformin group. The primary outcome was
the first occurrence of nonfatal myocardial infarction, stroke, or
cardiovascular death adjudicated by standard criteria. An extended
cardiovascular outcome included the primary outcome or hospitalization for
heart failure or unstable angina, coronary or peripheral
revascularization, coronary heart disease diagnosed by angiography, or
silent myocardial infarction by ECG. ECGs and cardiovascular risk factors
were measured annually. <br/>Result(s): Neither metformin nor lifestyle
intervention reduced the primary outcome: metformin versus placebo hazard
ratio 1.03 (95% CI, 0.78-1.37; P = 0.81) and lifestyle versus placebo
hazard ratio 1.14 (95% CI, 0.87-1.50; P = 0.34). Risk factor adjustment
did not change these results. No effect of either intervention was seen on
the extended cardiovascular outcome. <br/>Conclusion(s): Neither metformin
nor lifestyle reduced major cardiovascular events in DPPOS over 21 years
despite long-term prevention of diabetes. Provision of group lifestyle
intervention to all, extensive out-of-study use of statin and
antihypertensive agents, and reduction in the use of study metformin
together with out-of-study metformin use over time may have diluted the
effects of the interventions. Registration: URL:
https://www.clinicaltrials.gov; Unique identifiers: DPP (NCT00004992) and
DPPOS (NCT00038727).<br/>Copyright &#xa9; 2022 Lippincott Williams and
Wilkins. All rights reserved.

<73>
Accession Number
638142383
Title
Differences among clinical trials and registries on surgical and
percutaneous coronary interventions.
Source
The Annals of thoracic surgery. (no pagination), 2022. Date of
Publication: 25 May 2022.
Author
Chadow D.; Audisio K.; Perezgrovas-Olaria R.; Cancelli G.; Robinson N.B.;
Rahouma M.; Soletti G.J.; Angiolillo D.J.; Metkus T.S.; Gaudino M.F.
Institution
(Chadow, Audisio, Perezgrovas-Olaria, Cancelli, Robinson, Rahouma,
Soletti) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY,
NY, United States
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, FL, Jacksonville, United States
(Metkus) Departments of Medicine and Surgery, Divisions of Cardiology and
Cardiac Surgery Johns Hopkins University School of Medicine, MD,
Baltimore, United States
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
NY, NY, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: No systematic evaluation of the differences in baseline
characteristics and early outcome between patients enrolled in randomized
controlled trials (RCTs) and clinical practice has been performed for
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI). <br/>METHOD(S): Systematic searches were conducted to
identify RCTs comparing CABG vs PCI and CABG or PCI registries. Sixteen
predefined baseline characteristics and 30-day mortality were extracted
from the included studies. Pooled proportion and mean with 95% confidence
interval were calculated for binary and continuous outcomes respectively
using random-effect model. <br/>RESULT(S): Fourteen RCTs and 10 registries
including over 2 million patients were included. Registry patients who
underwent CABG had a higher prevalence of hypertension, smoking, reduced
left ventricular ejection fraction (LVEF), and prior myocardial
infarction, but a lower prevalence of single vessel disease when compared
to CABG patients included in RCTs. Regarding PCI, hypertension,
hyperlipidemia, left main coronary disease, triple-vessel coronary
disease, and NYHA class < IV were significantly more prevalent among RCTs
patients, while age, reduced LVEF, and smoking, were more represented
among registry PCI patients. Thirty-day mortality was higher in registries
for both PCI and CABG patients. <br/>CONCLUSION(S): There were significant
differences in baseline characteristics and thirty-day mortality between
patients enrolled in RCTs comparing CABG vs PCI and CABG and PCI
registries, however results were mixed, and the discrepancy was less than
seen in other fields.<br/>Copyright &#xa9; 2022 The Society of Thoracic
Surgeons. Published by Elsevier Inc. All rights reserved.

<74>
Accession Number
638142039
Title
Effect of Ascorbic Acid on Cardiac Surgery-Associated Acute Kidney Injury
Incidence.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2022. Date of
Publication: 28 May 2022.
Author
Djordjevic A.; Susak S.; Kotnik P.; Gorenjak M.; Knez Z.; Antonic M.
Institution
(Djordjevic, Antonic) Department of Cardiac Surgery, University Medical
Centre Maribor, Maribor, Slovenia
(Susak) Department of Cardiovascular Surgery, Institute of Cardiovascular
Diseases of Vojvodina, Sremska Kamenica, Vojvodina, Serbia
(Kotnik, Gorenjak, Knez) Faculty of Medicine, University of Maribor,
Maribor, Slovenia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Acute kidney injury (AKI) is associated with higher
perioperative mortality and morbidity. Oxidative stress has been proposed
as a cause of postoperative AKI. Ascorbic acid (AA) supplementation was
suggested as a novel and promising antioxidant. The aim of this study was
to evaluate the capability of AA to reduce the incidence of postoperative
AKI in cardiac surgery patients. <br/>METHOD(S): A prospective randomized
trial was conducted in patients scheduled for on-pump cardiac surgery.
Subjects in the AA group received 2g of AA intravenously during the
induction of anesthesia, 2g before aortic cross-clamp removal and 1g every
8hours for five postoperative days (the JERICA protocol). Postoperatively,
the patients were monitored for AKI and other complications.
Malondialdehyde levels were monitored in a subpopulation of 100 patients
to evaluate the effect of AA on oxidative stress level. <br/>RESULT(S):
The AA and control group consisted of 163 and 169 patients, respectively.
The groups were well matched for baseline demographics and had similar
intraoperative characteristics. The incidence of AKI in the AA and control
group was 20.9 and 28.4%, respectively (p=0.127). The estimated glomerular
filtration rate did not differ between the study groups in the entire
postoperative period. There was a trend toward higher malondialdehyde
values with statistical significance on postoperative day 1 and lower
in-hospital mortality in the AA group (0.6 vs. 4.1%, p=0.067).
<br/>CONCLUSION(S): Our results do not support the effectiveness of AA
supplementation in reducing the incidence of postoperative AKI in on-pump
cardiac surgery patients. CLINICAL REGISTRATION NUMBER: This study was
registered with the ISRCTN Registry under the trial registration number
ISRCTN98572043.<br/>Copyright The Author(s). This is an open access
article published by Thieme under the terms of the Creative Commons
Attribution-NonDerivative-NonCommercial License, permitting copying and
reproduction so long as the original work is given appropriate credit.
Contents may not be used for commercial purposes, or adapted, remixed,
transformed or built upon.
(https://creativecommons.org/licenses/by-nc-nd/4.0/

<75>
Accession Number
638141641
Title
Prophylactic levosimendan in patients with low ejection fraction
undergoing coronary artery bypass grafting: A pooled analysis of two
multicentre randomised controlled trials.
Source
Anaesthesia, critical care & pain medicine. (pp 101107), 2022. Date of
Publication: 25 May 2022.
Author
Caruba T.; Charles-Nelson A.; Alexander J.H.; Mehta R.H.; Heringlake M.;
Toller W.; Yavchitz A.; Sabatier B.; Chatellier G.; Cholley B.
Institution
(Caruba, Charles-Nelson, Yavchitz) AP-HP, Hopital Europeen Georges
Pompidou, Paris F-75015, France
(Alexander, Mehta) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, United States
(Heringlake) Dept. of Anesthesiology and Intensive Care Medicine, Heart-
and Diabetes Center, Karlsburg, Germany
(Toller) Medical University of Graz, Graz, Austria
(Sabatier) AP-HP, Hopital Europeen Georges Pompidou, F-75015 Paris,
France; Inserm UMR_1138 "Personalized medicine therapeutic optimization",
Paris, France
(Chatellier) AP-HP, Hopital Europeen Georges Pompidou, F-75015 Paris,
France; Universite de Paris, F-75006 Paris, France
(Cholley) AP-HP, Hopital Europeen Georges Pompidou, F-75015 Paris, France;
Universite de Paris, INSERM UMR_S 1140 "Innovations Therapeutiques en
Hemostase", F-75006 Paris, France
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To assess the effect of preoperative levosimendan on mortality
at Day-90 in patients with left ventricular ejection fraction (LVEF) <=
40%, and to investigate a possible differential effect between patients
undergoing isolated coronary artery bypass grafting (CABG) versus CABG
combined with valve replacement surgery. DESIGN: Pooled analysis of two
multicentre randomised controlled trials (RCT) investigating prophylactic
levosimendan versus placebo prior to CABG surgery on mortality at Day-90
in patients with LVEF<=40%. A meta-analysis of all RCT investigating the
same issue was also conducted. <br/>RESULT(S): A cohort of 1084 patients
(809 isolated CABG, and 275 combined surgery) resulted from the merging of
LEVO-CTS and LICORN databases. Seventy-two patients were dead at day 90.
The mortality at day 90 was not different between levosimendan and placebo
(Hazard Ratio (HR): 0.73, 95% CI: 0.41-1.28, p = 0.27). However, there was
a significant interaction between the type of surgery and the study drug
(p= 0.004). We observed a decrease in mortality at day 90 in the isolated
CABG subgroup (HR: 0.39, 95% CI: 0.19-0.82, p = 0.013), but not in the
combined surgery subgroup (HR: 1.73, 95% CI: 0.77-3.92, p = 0.19). The
meta-analysis of 6 RCT involving 1441 patients confirmed the differential
effect on mortality at day 30 between the 2 subgroups. <br/>CONCLUSION(S):
Preoperative levosimendan did not reduce mortality in a mixed surgical
population with LV dysfunction. However, the subgroup of patients
undergoing isolated CABG had a reduction in mortality at day 90, whereas
there was no significant effect in combined surgery patients. This finding
requires confirmation with a specific prospective trial.<br/>Copyright
&#xa9; 2022. Published by Elsevier Masson SAS.

<76>
Accession Number
638140459
Title
Risk for post-operative delirium related to comorbidities in older adult
cardiac patients: An integrative review.
Source
Journal of clinical nursing. (no pagination), 2022. Date of Publication:
31 May 2022.
Author
Ramos M.D.; Vergara F.H.; Shackleford J.; Briggs C.; Gomez C.; Mofazali
M.; Preston J.
Institution
(Ramos, Shackleford, Briggs, Gomez, Mofazali, Preston) WellStar School of
Nursing, Kennesaw State University, Kennesaw, GA, United States
(Vergara) HCA Florida Fawcett Hospital, Port Charlotte, FL, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Delirium is defined as a sudden onset of confusion due to
disruption in normal brain functioning. Although it is highly prevalent in
post-operative patients, most significantly the older adult population,
limited information exists explaining why its onset occurs. PURPOSE: This
integrative review aimed to synthesise specific comorbidities that can
contribute to the development of post-operative delirium in older adult
cardiac surgical patients. <br/>METHOD(S): PRISMA statement was used to
report the identification, selection, appraisal and synthesis of articles
and the PRISMA diagram reports the selection process. The Johns Hopkins
Evidence-Based Practice Tools were used as guide in literature review,
critical analysis, levelling of evidence and quality rating. PubMed,
ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and
Cochrane databases were searched from 2015 to 2020. <br/>RESULT(S): The
initial search yielded 1529 articles. Following the removal of duplicates
and screening, 14 articles were included for this review. The following
comorbidities were identified in the studies: Diabetes mellitus, atrial
fibrillation, depression, impaired olfaction, pre-existing cerebrovascular
disease, pre-existing cardiovascular disease, insomnia and frailty.
<br/>CONCLUSION(S): There was a strong indication of the development of
post-operative delirium among older adult cardiac surgical patients with
comorbidities. RELEVANCE TO CLINICAL PRACTICE: Awareness of the impact of
comorbidities in developing post-operative delirium may help healthcare
providers to plan and implement proper care management among older adult
cardiac surgical patients with comorbidities.<br/>Copyright &#xa9; 2022
John Wiley & Sons Ltd.

<77>
Accession Number
638139094
Title
Combined epicardial and endocardial approach for redo radiofrequency
catheter ablation in patients with persistent atrial fibrillation: a
randomized clinical trial.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. (no
pagination), 2022. Date of Publication: 31 May 2022.
Author
Lee K.-N.; Kim D.Y.; Boo K.Y.; Kim Y.G.; Roh S.-Y.; Shim J.; Choi J.-I.;
Kim Y.-H.
Institution
(Lee) Department of Cardiology, Ajou University School of Medicine,
Suwon-si, Yeongtong-gu, South Korea
(Kim) Division of Cardiology, Department of Internal Medicine, Hallym
University Dongtan Sacred Heart Hospital, South Korea
(Boo) Division of Cardiology, Department of Internal Medicine, Jeju
National University Hospital, Aran 13-gil 15, South Korea
(Kim, Shim, Choi, Kim) Division of Cardiology, Department of Internal
Medicine, Korea University Anam Hospital, Seongbuk-gu, Seoul 02841, South
Korea
(Roh) Division of Cardiology, Department of Internal Medicine, Korea
University Guro Hospital, Guro-gu, Gurodong-ro 148, Seoul 08308, South
Korea
Publisher
NLM (Medline)
Abstract
AIMS: An epicardial approach is an effective means to detect and eliminate
residual potentials in non-transmural lesions created during prior
endocardial ablation. We sought to determine the impact of a combined
epicardial and endocardial approach compared with a conventional
endocardial approach, on recurrence-free survival after redo ablation.
METHODS AND RESULTS: Participants with recurred persistent atrial
fibrillation after prior endocardial ablation were randomized (1:1) to
undergo treatment with the combined approach (epicardial followed by
endocardial ablation) for the treatment group or conventional approach
(endocardial ablation only) for the control group. The primary outcome was
the time to recurrence of atrial fibrillation or atrial tachycardia
following a 90-day blanking period within 12 months after the procedure.
The secondary safety outcome was the occurrence of procedure-related
complications within 24 h after the procedure. Of 100 randomized
participants {median age, 59.0 [(interquartile range (IQR): 53.8-64.3]
years, including 16% women, with one prior ablation (IQR: 1-1)}, 93 (93%)
completed the trial. Events relevant to the primary outcome occurred in 16
patients in the treatment group and in 21 patients in the control group
{Kaplan-Meier estimator percentages, 32 vs. 42%; hazard ratio, 0.71 [95%
confidence interval (CI): 0.37-1.37]}. The periprocedural complication
rate was lower in the treatment group [2 vs. 16%; odds ratio, 0.11 (95%
CI: 0.00-0.87)] with similar achievement of the procedural endpoint in the
two groups. <br/>CONCLUSION(S): In the redo procedure for persistent
atrial fibrillation, the combined approach had no significant difference
of recurrence-free survival and a lower procedural complication rate
compared with the conventional approach.<br/>Copyright &#xa9; The
Author(s) 2022. Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved. For permissions,
please email: journals.permissions@oup.com.

<78>
Accession Number
2017428106
Title
Large animal model of vein grafts intimal hyperplasia: A systematic
review.
Source
Perfusion (United Kingdom). (no pagination), 2022. Date of Publication:
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
SAGE Publications Ltd
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.<br/>Copyright &#xa9; The Author(s) 2022.

<79>
Accession Number
2017632589
Title
Intravenous iron supplement for iron deficiency in patients with severe
aortic stenosis scheduled for transcatheter aortic valve implantation:
Results of the IIISAS randomised trial.
Source
European Journal of Heart Failure. (no pagination), 2022. Date of
Publication: 2022.
Author
Kvaslerud A.B.; Bardan S.; Andresen K.; Klove S.F.; Fagerland M.W.;
Edvardsen T.; Gullestad L.; Broch K.
Institution
(Kvaslerud, Bardan, Andresen, Edvardsen, Gullestad, Broch) Faculty of
Medicine, University of Oslo, Oslo, Norway
(Kvaslerud, Andresen, Klove, Edvardsen, Gullestad, Broch) Department of
Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
(Kvaslerud, Gullestad, Broch) KG Jebsen Center for Cardiac Research and
Center for Heart Failure Research, University of Oslo, Oslo, Norway
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Oslo, Norway
Publisher
John Wiley and Sons Ltd
Abstract
Aims: The aim of this trial was to evaluate whether intravenous iron could
provide benefit beyond transcatheter aortic valve implantation (TAVI) in
iron-deficient patients with severe aortic stenosis. <br/>Methods and
Results: In this randomised, placebo-controlled, double-blind,
single-centre trial, we enrolled patients with severe aortic stenosis and
iron deficiency (defined as ferritin <100 microg/L, or 100-299 microg/L
with a transferrin saturation <20%) who were evaluated for TAVI. Patients
were randomly assigned (1:1) to receive intravenous ferric derisomaltose
or placebo ~3 months before TAVI. The primary endpoint was the
between-group, baseline-adjusted 6-min walk distance measured 3 months
after TAVI. Secondary outcomes included quality of life, iron stores, hand
grip strength, New York Heart Association (NYHA) class, and safety.
Between January 2020 and September 2021, we randomised 74 patients to
ferric derisomaltose and 75 patients to placebo. The modified
intention-to-treat population comprised the 104 patients who completed the
6-min walk test at baseline and 3 months after successful TAVI. Iron
stores were restored in 76% of the patients allocated to iron and 13% of
the patients allocated to placebo (p < 0.001). There was no difference in
the baseline-adjusted 6-min walk distance between the two treatment arms
(p = 0.82). The number of serious adverse events, quality of life, hand
grip strength, and NYHA class did not differ between the treatment arms.
<br/>Conclusion(s): Treatment with intravenous iron did not provide
clinical benefit beyond TAVI in iron-deficient patients with severe aortic
stenosis. Clinical Trial Registration: ClinicalTrials.gov
NCT04206228.<br/>Copyright &#xa9; 2022 The Authors. European Journal of
Heart Failure published by John Wiley & Sons Ltd on behalf of European
Society of Cardiology.

<80>
[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. <br/>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.
<br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9;
2022 Lippincott Williams and Wilkins. All rights reserved.

<81>
Accession Number
2018150448
Title
Base Excess or Hyperlactatemia: Identifying the Superior Risk Factor for
Increased Morbidity and Mortality in Cardiac Surgery.
Source
Pakistan Journal of Medical and Health Sciences. 16(4) (pp 263-266), 2022.
Date of Publication: April 2022.
Author
Farogh A.; Younas A.; Hassan A.; Ahmed N.; Bashir T.; Iftikhar S.; Afshan
S.
Institution
(Farogh) Cardiac Surgery Cardiac Centre, QAMC, Bahawalpur, Pakistan
(Younas, Hassan, Iftikhar) Cardiac Centre, QAMC, Bahawalpur, Pakistan
(Ahmed) Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
(Bashir) QAMC, Bahawalpur, Pakistan
(Afshan) Punjab Institute of Cardiology, Lahore, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Objective: Cardiopulmonary bypass in cardiac surgery is often associated
with metabolic changes. So, we conducted this study in order to find the
supremacy between two risk factors base excess and hyperlactatemia in
early prediction of morbidity and mortality in ICU after cardiac surgery.
<br/>Material(s) and Method(s): Intraoperative data of total of 100
patients who had cardiac surgery was recorded. Intraoperative and
postoperative data of base excess and lactate levels were recorded at
1^st, 6^th, 12^th and 24^th hour
in ICU. Two perioperative groups for B.E(Group 1 B.E < +/-2.5 mmol: Group
2 B.E >+/- 2.5 mmol) and lactate (Group 1 Lactate < 3 mmol: Group 2
Lactate>mmol) were created, Two post-operative groups for B.E(Group 1 B.E
< +/-5.0 mmol: Group 2 B.E >+/- 5.0 mmol) and lactate(Group 1 Lactate
<5mmol: Group 2 Lactate>5mmol)were created to find their correlation with
early postoperative complications. <br/>Result(s): In our study ICU
morbidity and mortality was more related to the lactate and base excess
values in the early 24 hours. Progressive Hyperlactatemia and constant
negative base excess values were both significantly associated with ICU
complications. In the CPB period subgroup negative base excess was more
superior in predicting ICU prognosis than Lactate. (P-value 0.001)
similarly patients divided in subgroup BE >+/- 5mmol/l had demonstrated
superiority in making such prediction. Both CPB (0.013) and X.C (0.036)
time were associated independently with ICU prognosis. .Longer ventilation
times were also associated with bad ICU prognosis. <br/>Conclusion(s): Our
study found negative base excess values in the early postoperative period
to be superior in predicting ICU morbidity and mortality when studied at
subgroup level both peri-operatively and postoperatively.<br/>Copyright
&#xa9; 2022 Lahore Medical And Dental College. All rights reserved.

<82>
Accession Number
2017960755
Title
Meta-Analysis of Catheter Ablation Outcomes in Patients With Cardiac
Sarcoidosis Refractory Ventricular Tachycardia.
Source
American Journal of Cardiology. 174 (pp 136-142), 2022. Date of
Publication: 01 Jul 2022.
Author
Adhaduk M.; Paudel B.; Liu K.; Ashwath M.; Giudici M.
Institution
(Adhaduk, Paudel) Division of General Internal Medicine
(Liu, Ashwath, Giudici) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Iowa, Iowa City, IA, United States
Publisher
Elsevier Inc.
Abstract
Cardiac sarcoidosis (CS) frequently leads to ventricular tachycardia (VT),
which is often refractory to antiarrhythmic and/or immunosuppressive
medications and requires catheter ablation. We conducted a systematic
review and meta-analysis to evaluate the role of catheter ablation in
patients with refractory VT undergoing catheter ablation. We searched
PubMed, Embase, and Scopus databases from their inception to December 31,
2021 with search terms "cardiac sarcoidosis" AND "electrophysiological
studies OR ablation." Fifteen studies were ultimately included for
evaluation. Patient demographics, VT mapping, and acute and long-term
procedural outcomes were extracted. A total of 15 studies were included in
our meta-analysis, with a total of 401 patients, of whom 66% were male,
with ages ranging from 39 to 64 years. A total of 95% of patients were on
antiarrhythmics and 79% of patients were on immunosuppressants. Left
ventricular ejection fraction ranged from 35% to 49% and procedure
duration ranged from 269 to 462 minutes. Ablation was reported using both
irrigated and nonirrigated catheter tips. A total of 25% of patients
(84/339) underwent repeat ablation. Acute procedural success was achieved
in 57% (161/285). Procedure complications occurred in 5.7% (17/297)
procedures. VT recurrence after first ablation was 55% (confidence
interval 48% to 63%, 213/401); VT recurrence after multiple ablations was
37% (81/220). The composite end point of death, heart transplant, and left
ventricular assist device implantation was 21% (confidence interval 14% to
30%, 55/297). In conclusion, catheter ablation is a useful modality in
patients with CS with refractory VT. However, patients with CS presenting
with refractory VT after undergoing VT ablation carry a poor
prognosis.<br/>Copyright &#xa9; 2022 Elsevier Inc.

<83>
Accession Number
2017710600
Title
Leaflet Resection vs Preservation for Degenerative Mitral Regurgitation:
Functional Outcomes and Mitral Stenosis at 12 Months in a Randomized
Trial.
Source
Canadian Journal of Cardiology. 38(6) (pp 808-814), 2022. Date of
Publication: June 2022.
Author
Hibino M.; Pandey A.; Chan V.; Mazer C.D.; Dhingra N.K.; Bonneau C.; Verma
R.; Quan A.; Teoh H.; Cheema A.; Yanagawa B.; Leong-Poi H.; Connelly K.A.;
Bisleri G.; Verma S.
Institution
(Hibino, Dhingra, Quan, Teoh, Yanagawa, Bisleri, Verma) Division of
Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital,
Toronto, ON, Canada
(Hibino, Yanagawa, Bisleri, Verma) Department of Surgery, University of
Toronto, ON, Canada
(Pandey) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Chan) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Chan) School of Epidemiology, Public Health and Preventive Medicine,
University of Ottawa, Ottawa, Ontario, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of St
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, ON, Canada
(Mazer, Connelly) Department of Physiology, University of Toronto,
Toronto, ON, Canada
(Bonneau) Division of Cardiac Surgery, McGill University, Montreal, QC,
Canada
(Verma) Royal College of Surgeons in Ireland, Dublin, Ireland
(Teoh) Division of Endocrinology and Metabolism, Li Ka Shing Knowledge
Institute of St Michael's Hospital, Toronto, ON, Canada
(Cheema) Division of Cardiology, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Leong-Poi, Connelly) Division of Cardiology, Li Ka Shing Knowledge
Institute of St Michael's Hospital, Toronto, ON, Canada
(Leong-Poi, Connelly) Department of Medicine, University of Toronto, ON,
Canada
(Verma) Department of Pharmacology and Toxicology, University of Toronto,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Mitral valve repair is the gold standard treatment for
degenerative mitral regurgitation (MR). The Canadian Mitral Research
Alliance (CAMRA) CardioLink-2 trial showed no significant association
between repair strategy, that is, leaflet resection vs preservation, and
risk of functional mitral stenosis. In this subanalysis, we compared
outcomes and functional tests at 12 months. <br/>Method(s): CAMRA
CardioLink-2 was a multicentre randomized controlled trial that allocated
patients with degenerative MR and posterior leaflet prolapse to leaflet
resection (n = 54) or preservation (n = 50). Stress echocardiography and
functional status assessments, including the 6-minute walk test, were
compared 12 months after repair. <br/>Result(s): Baseline demographics,
stress echocardiographic findings, and mitral annuloplasty prosthesis size
(33.0 +/- 3.0 vs 33.6 +/- 3.4 mm; P = 0.4) were similar between the two
groups. There were no readmissions for heart failure or deaths during the
follow-up period. At 12 months, a larger percentage of patients were in
NYHA functional class >= 2 in the resection group compared with the
preservation group (P = 0.01). Exercise capacity, rate-pressure product,
6-minute walk distance, and mean mitral valve gradients were not
significantly different between the groups at 12 months. A more prominent
increase in mean mitral gradient with smaller annuloplasty sizes was
observed in the resection group at both rest (P = 0.03) and peak exercise
(P = 0.005) in the linear regression model. <br/>Conclusion(s): At 12
months, there were no significant differences in mitral valve gradient,
exercise capacity, and 6-minute walk test between repair strategies.
Leaflet preservation may offer a larger mitral valve orifice with improved
gradients in patients requiring smaller annuloplasty sizes.<br/>Copyright
&#xa9; 2022 Canadian Cardiovascular Society

<84>
Accession Number
2016133072
Title
Predicting outcomes of mesenteric ischemia postcardiac surgery: A
systematic review.
Source
Journal of Cardiac Surgery. 37(7) (pp 2025-2039), 2022. Date of
Publication: July 2022.
Author
Kayali F.; Sarodaya V.; Shah H.I.; Hayat M.Y.; Leung M.S.T.; Harky A.
Institution
(Kayali) UCLan Medical School, University of Central Lancashire, Preston,
United Kingdom
(Sarodaya) Department of Critical Care Medicine, Barts Health NHS Trust,
London, United Kingdom
(Shah) UCL Medical School, University College London, London, United
Kingdom
(Hayat) Faculty of Medicine, St George's Hospital Medical School, London,
United Kingdom
(Leung) Department of Surgery, Imperial Healthcare Trust, London, United
Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Objective: This systematic review aims to identify predictors of outcomes
of mesenteric ischemia in patients following cardiac surgery.
<br/>Method(s): A comprehensive literature search was done on EMBASE,
PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia
and cardiac surgery. Database search results were screened by at least two
authors and 32 articles were selected for inclusion in this review.
<br/>Result(s): Data on 1907 patients were analyzed. The mean age was 70.0
+/- 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced
age was a significant risk factor. 63.16% of patients reported were men,
and 58.4% of patients died in hospital. There was heterogeneity in the
reported significance of the following preoperative risk factors:
hypertension, smoking status, type 2 diabetes mellitus, end-stage renal
disease, preoperative left ventricular ejection fraction <35%.
Cardiopulmonary bypass (CPB) time, preoperative/operative intra-aortic
balloon pump (IABP) support, and inotrope usage were significantly
associated with the development of mesenteric ischemia; however, other
intraoperative factors including the type of cardiac surgery and duration
of aortic cross-clamping had varying levels of reported significance.
There were discrepancies in the reported significance of leukocytosis and
metabolic acidosis (pH <7.3) as postoperative markers. Postoperative
vasopressor use, prolonged ventilation time, and elevation in lactate,
transaminases, creatinine, and intestinal fatty acid-binding protein
(IFABP) levels were found to be strongly associated with bowel ischemia.
<br/>Conclusion(s): This systematic review found the strongest
associations of mesenteric ischemia postcardiac surgery to be advanced
age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP
support, vasopressor, and inotrope use as well as prolonged ventilation
were strongly linked too.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC.

<85>
Accession Number
2015929575
Title
Cardiac surgery in the morbidly obese.
Source
Journal of Cardiac Surgery. 37(7) (pp 2060-2071), 2022. Date of
Publication: July 2022.
Author
Djouani A.; Smith A.; Choi J.; Lall K.; Ambekar S.
Institution
(Djouani, Smith, Choi, Lall, Ambekar) The Department of Cardiac Surgery,
St Bartholomew's Hospital, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Obesity rates globally continue to rise and in turn the body
mass index (BMI) of patients undergoing cardiac surgery is set to mirror
this. Patients who are Class III obese (BMI >= 40) pose significant
challenges to the surgical teams responsible for their care and are also
at high risk of complications from surgery and even death. To improve
outcomes in this population, interventions carried out in the
preoperative, operative, and postoperative periods have shown promise.
Despite this, there are no defined best practice national guidelines for
perioperative management of obese patients undergoing cardiac surgery.
<br/>Aim(s): This review is aimed at clinicians and researchers in the
field of cardiac surgery and aims to form a basis for the future
development of clinical guidelines for the management of obese cardiac
surgery patients. <br/>Method(s): The PubMed database was utilized to
identify relevant literature and strategies employed at various stages of
the surgical journey were analyzed. <br/>Conclusion(s): Data presented
identified the benefits of preoperative respiratory muscle training,
off-pump coronary artery bypass grafting where possible, and early
extubation. Further randomized controlled trials are required to identify
optimal operative and perioperative management strategies before the
introduction of such guidance into clinical practice.<br/>Copyright &#xa9;
2022 Wiley Periodicals LLC.

<86>
[Use Link to view the full text]
Accession Number
634795228
Title
Restrictive Transfusion Strategy after Cardiac Surgery: Role of Central
Venous Oxygen Saturation Trigger: A Randomized Controlled Trial.
Source
Anesthesiology. 134(3) (pp 370-380), 2021. Date of Publication: 01 Mar
2021.
Author
Zeroual N.; Blin C.; Saour M.; David H.; Aouinti S.; Picot M.-C.; Colson
P.H.; Gaudard P.
Institution
(Zeroual, Blin, Saour, David, Colson, Gaudard) Department of
Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital,
Montpellier, France
(Aouinti, Picot) Clinical Research and Epidemiology Unit, University
Hospital of Montpellier, Montpellier, France
(Colson) Institute of Functional Genomics, Montpellier, France
(Gaudard) PhyMedExp, Montpellier University, National Institute of Health
and Medical Research, National Center for Scientific Research,
Montpellier, France
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Recent guidelines on transfusion in cardiac surgery suggest
that hemoglobin might not be the only criterion to trigger transfusion.
Central venous oxygen saturation (Svo<inf>2</inf>), which is related to
the balance between tissue oxygen delivery and consumption, may help the
decision process of transfusion. We designed a randomized study to test
whether central Svo<inf>2</inf>-guided transfusion could reduce
transfusion incidence after cardiac surgery. <br/>Method(s): This single
center, single-blinded, randomized controlled trial was conducted on adult
patients after cardiac surgery in the intensive care unit (ICU) of a
tertiary university hospital. Patients were screened preoperatively and
were assigned randomly to two study groups (control or Svo<inf>2</inf>) if
they developed anemia (hemoglobin less than 9 g/dl), without active
bleeding, during their ICU stay. Patients were transfused at each anemia
episode during their ICU stay except the Svo<inf>2</inf>patients who were
transfused only if the pretransfusion central Svo<inf>2</inf>was less than
or equal to 65%. The primary outcome was the proportion of patients
transfused in the ICU. The main secondary endpoints were (1) number of
erythrocyte units transfused in the ICU and at study discharge, and (2)
the proportion of patients transfused at study discharge. <br/>Result(s):
Among 484 screened patients, 100 were randomized, with 50 in each group.
All control patients were transfused in the ICU with a total of 94
transfused erythrocyte units. In the Svo<inf>2</inf>group, 34 (68%)
patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P <
0.001 vs. controls), with a total of 65 erythrocyte units. At study
discharge, eight patients of the Svo<inf>2</inf>group remained
nontransfused and the cumulative count of erythrocyte units was 96 in the
Svo<inf>2</inf>group and 126 in the control group. <br/>Conclusion(s): A
restrictive transfusion strategy adjusted with central Svo<inf>2</inf>may
allow a significant reduction in the incidence of
transfusion.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins.
All rights reserved.

<87>
[Use Link to view the full text]
Accession Number
634794542
Title
Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove
Cytokines, Chemokines, and Cell-derived Microvesicles: A Clinical
Feasibility Study.
Source
Anesthesiology. 134(3) (pp 395-404), 2021. Date of Publication: 01 Mar
2021.
Author
Welsby I.J.; Norris P.J.; Mauermann W.J.; Podgoreanu M.V.; Conn C.M.;
Meade L.; Cannon T.; Keating S.M.; Silliman C.C.; Kehler M.; Schulte P.J.;
Kor D.J.
Institution
(Welsby, Podgoreanu, Cannon) Department of Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Norris, Keating) Vitalant Research Institute, Departments of Laboratory
Medicine and Medicine, University of California, San Francisco, San
Francisco, CA, United States
(Mauermann, Meade, Kor) Department of Anesthesiology and Perioperative
Medicine, United States
(Conn) Transfusion Medicine Services, United States
(Schulte) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Silliman, Kehler) Vitalant Research Institute, Departments of Pediatrics
and Surgery, School of Medicine, University of Colorado, Aurora, CO,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Removal of cytokines, chemokines, and microvesicles from the
supernatant of allogeneic erythrocytes may help mitigate adverse
transfusion reactions. Blood bank-based washing procedures present
logistical difficulties; therefore, we tested the hypothesis that
on-demand bedside washing of allogeneic erythrocyte units is capable of
removing soluble factors and is feasible in a clinical setting.
<br/>Method(s): There were in vitro and prospective, observation cohort
components to this a priori planned substudy evaluating bedside allogeneic
erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory
data were collected from the first 75 washed units given to a subset of
patients nested in the intervention arm of a parent clinical trial. Paired
pre- and postwash samples from the blood unit bags were centrifuged. The
supernatant was aspirated and frozen at -70degreeC, then batch-tested for
cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and
neutral lipids (all previously associated with transfusion reactions) and
cell-free hemoglobin (possibly increased by washing). From the entire
cohort randomized to the intervention arm of the trial, bedside washing
was defined as feasible if at least 75% of prescribed units were washed
per protocol. <br/>Result(s): Paired data were available for 74 units.
Washing reduced soluble CD40 ligand (median [interquartile range]; from
143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to
2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90
[4.10 to 20.0] to 0.83 [0.33 to 2.80] x 10⁶), while cell-free
hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to
210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on
neutral lipids. Bedside washing was determined as feasible for 80 of 81
patients (99%); overall, 293 of 314 (93%) units were washed per protocol.
<br/>Conclusion(s): Bedside erythrocyte washing was clinically feasible
and greatly reduced concentrations of soluble factors thought to be
associated with transfusion-related adverse reactions, increasing
concentrations of cell-free hemoglobin while maintaining acceptable (less
than 0.8%) hemolysis.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<88>
[Use Link to view the full text]
Accession Number
634773715
Title
Reduction in Revascularization With Icosapent Ethyl Insights From
REDUCE-IT Revascularization Analyses.
Source
Circulation. 143(1) (pp 33-44), 2021. Date of Publication: 05 Jan 2021.
Author
Peterson B.E.; Bhatt D.L.; Steg Ph.G.; Miller M.; Brinton E.A.; Jacobson
T.A.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz C.;
Gibson C.M.; Pinto D.; Giugliano R.P.; Budoff M.J.; Tardif J.-C.; Verma
S.; Ballantyne C.M.
Institution
(Peterson, Bhatt, Giugliano) Brigham and Women's Hospital Heart and
Vascular Center, Harvard Medical School, Boston, MA, United States
(Steg) Universite de Paris, AP-HP (Assistance Publique-Hopitaux de Paris),
Hopital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM,
U-1148, France
(Miller) Department of Medicine, University of Maryland, School of
Medicine, Baltimore, United States
(Brinton) Utah Lipid Center, Salt Lake City, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University, School of Medicine, Atlanta, GA, United
States
(Ketchum, Juliano, Jiao, Doyle, Granowitz) Amarin Pharma, Inc (Amarin),
Bridgewater, NJ, United States
(Gibson, Pinto) Baim Clinical Research Institute, Boston, MA, United
States
(Budoff) David Geffen School of Medicine, Lundquist Institute, Torrance,
CA, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, ON, Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine, Center
for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Patients with elevated triglycerides despite statin therapy
have increased risk for ischemic events, including coronary
revascularizations. <br/>METHOD(S): REDUCE-IT (The Reduction of
Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a
multicenter, double-blind, placebo-controlled trial, randomly assigned
statin-treated patients with elevated triglycerides (135-499 mg/dL),
controlled low-density lipoprotein (41-100 mg/dL), and either established
cardiovascular disease or diabetes plus other risk factors to receive
icosapent ethyl 4 g/d or placebo. The primary and key secondary composite
end points were significantly reduced. Prespecified analyses examined all
coronary revascularizations, recurrent revascularizations, and
revascularization subtypes. <br/>RESULT(S): A total of 8179 randomly
assigned patients were followed for 4.9 years (median). First
revascularizations were reduced to 9.2% (22.5/1000 patient-years) with
icosapent ethyl versus 13.3% (33.7/1000 patient-years) with placebo
(hazard ratio, 0.66 [95% CI, 0.58-0.76]; P<0.0001; number needed to treat
for 4.9 years=24); similar reductions were observed in total (first and
subsequent) revascularizations (negative binomial rate ratio, 0.64 [95%
CI, 0.56-0.74]; P<0.0001), and across elective, urgent, and emergent
revascularizations. Icosapent ethyl significantly reduced percutaneous
coronary intervention (hazard ratio, 0.68 [95% CI, 0.59-0.79]; P<0.0001)
and coronary artery bypass grafting (hazard ratio, 0.61 [95% CI,
0.45-0.81]; P=0.0005). <br/>CONCLUSION(S): Icosapent ethyl reduced the
need for first and subsequent coronary revascularizations in
statin-treated patients with elevated triglycerides and increased
cardiovascular risk. To our knowledge, icosapent ethyl is the first
non-low-density lipoprotein-lowering treatment that has been shown to
reduce coronary artery bypass grafting in a blinded, randomized
trial.<br/>Copyright &#xa9; 2020 The Authors

<89>
[Use Link to view the full text]
Accession Number
635499245
Title
Long-term Survival after Combined Epidural-General Anesthesia or General
Anesthesia Alone: Follow-up of a Randomized Trial.
Source
Anesthesiology. 135(2) (pp 233-245), 2021. Date of Publication: 01 Aug
2021.
Author
Du Y.-T.; Li Y.-W.; Zhao B.-J.; Guo X.-Y.; Feng Y.; Zuo M.-Z.; Fu C.; Zhou
W.-J.; Liu Y.-F.; Cheng T.; Mu D.-L.; Zeng Y.; Liu P.-F.; Li Y.; An H.-Y.;
Zhu S.-N.; Li X.-Y.; Li H.-J.; Wu Y.-F.; Wang D.-X.; Sessler D.I.; Li J.;
Shan G.-J.; Ma Q.; Kong H.; Huang D.; Deng C.-M.; Zhao Y.; Zheng X.-Y.;
Zhang Y.; Zhang D.-F.; Li M.-H.; Liang X.-Q.; Liu C.; He S.-T.; Huang
S.-M.; Xu S.-C.; Hu X.-Y.; Wang R.; Xiao L.; Zhang J.; Yang W.-Z.; Liu
W.-P.; Han W.-Y.; Yu Y.; Zhang H.-Y.; Hua Z.; Zhang J.-J.; Ji P.; Liu Q.;
Fu S.-Q.; Su X.; Yan X.-Y.; Yu Y.-P.; Wang M.-R.
Institution
(Du, Li, Fu, Zhou, Li, Liu, Cheng, Mu, Zeng, Wang, Sessler, Li, Shan, Ma,
Kong, Huang, Deng, Zhao, Zheng, Zhang, Zhang, Li, Liang, Liu, He, Huang,
Xu) Department of Anesthesiology and Critical Care Medicine, Peking
University First Hospital, Beijing, China
(Zhao, Liu) The Department of Anesthesiology, Beijing Shijitan Hospital,
Capital Medical University, Beijing, China
(Guo, Li) The Department of Anesthesiology, Peking University Third
Hospital, Beijing, China
(Feng, An) The Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Zuo) The Department of Anesthesiology, Beijing Hospital, National Center
of Gerontology, Institute of Geriatric Medicine, Chinese Academy of
Medical Sciences, Beijing, China
(Zhu, Li) The Department of Biostatistics, Peking University First
Hospital, Beijing, China
(Li, Wu) The Peking University Clinical Research Institute, Peking
University Health Science Center, Beijing, China
(Wang, Sessler) The Outcomes Research Consortium, Cleveland, OH, United
States
(Sessler) The Department of Outcomes Research, Cleveland Clinic,
Cleveland, OH, United States
(Hu, Wang, Xiao, Zhang, Yang) Department of Anesthesiology, Beijing
Shijitan Hospital, Capital Medical University, Beijing, China
(Liu, Han) Department of Anesthesiology, Peking University Third Hospital,
Beijing, China
(Yu) Department of Anesthesiology, Peking University People's Hospital,
Beijing, China
(Zhang, Hua, Zhang) Department of Anesthesiology, Beijing Hospital,
National Center of Gerontology, Institute of Geriatric Medicine, Chinese
Academy of Medical Sciences, Beijing, China
(Ji, Liu, Fu, Su, Yan, Yu, Wang) Peking University Clinical Research
Institute, Peking University Health Science Center, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Experimental and observational research suggests that combined
epidural-general anesthesia may improve long-term survival after cancer
surgery by reducing anesthetic and opioid consumption and by blunting
surgery-related inflammation. This study therefore tested the primary
hypothesis that combined epidural-general anesthesia improves long-term
survival in elderly patients. <br/>Method(s): This article presents a
long-term follow-up of patients enrolled in a previous trial conducted at
five hospitals. Patients aged 60 to 90 yr and scheduled for major
noncardiac thoracic and abdominal surgeries were randomly assigned to
either combined epidural-general anesthesia with postoperative epidural
analgesia or general anesthesia alone with postoperative intravenous
analgesia. The primary outcome was overall postoperative survival.
Secondary outcomes included cancer-specific, recurrence-free, and
event-free survival. <br/>Result(s): Among 1,802 patients who were
enrolled and randomized in the underlying trial, 1,712 were included in
the long-term analysis; 92% had surgery for cancer. The median follow-up
duration was 66 months (interquartile range, 61 to 80). Among patients
assigned to combined epidural-general anesthesia, 355 of 853 (42%) died
compared with 326 of 859 (38%) deaths in patients assigned to general
anesthesia alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 to 1.24; P =
0.408. Cancer-specific survival was similar with combined epidural-general
anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859
[34%]): adjusted hazard ratio, 1.09; 95% CI, 0.93 to 1.28; P = 0.290.
Recurrence-free survival was 401 of 853 [47%] for patients who had
combined epidural-general anesthesia versus 389 of 859 [45%] with general
anesthesia alone: adjusted hazard ratio, 0.97; 95% CI, 0.84 to 1.12; P =
0.692. Event-free survival was 466 of 853 [55%] in patients who had
combined epidural-general anesthesia versus 450 of 859 [52%] for general
anesthesia alone: adjusted hazard ratio, 0.99; 95% CI, 0.86 to 1.12; P =
0.815. <br/>Conclusion(s): In elderly patients having major thoracic and
abdominal surgery, combined epidural-general anesthesia with epidural
analgesia did not improve overall or cancer-specific long-term mortality.
Nor did epidural analgesia improve recurrence-free survival. Either
approach can therefore reasonably be selected based on patient and
clinician preference.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<90>
[Use Link to view the full text]
Accession Number
635498339
Title
Delirium in Older Patients after Combined Epidural-General Anesthesia or
General Anesthesia for Major Surgery: A Randomized Trial.
Source
Anesthesiology. 135(2) (pp 218-232), 2021. Date of Publication: 01 Aug
2021.
Author
Li Y.-W.; Li H.-J.; Zhao B.-J.; Guo X.-Y.; Feng Y.; Zuo M.-Z.; Yu Y.-P.;
Kong H.; Zhao Y.; Huang D.; Deng C.-M.; Hu X.-Y.; Liu P.-F.; Li Y.; An
H.-Y.; Zhang H.-Y.; Wang M.-R.; Wu Y.-F.; Wang D.-X.; Sessler D.I.; Zeng
Y.; Mu D.-L.; Liu Y.-F.; Zhou W.-J.; Shan G.-J.; Ma Q.; Zheng X.-Y.; Fu
C.; Zhang Y.; Liang X.-Q.; Liu C.; He S.-T.; Cheng T.; Huang S.-M.; Du
Y.-T.; Xu S.-C.; Wang R.; Xiao L.; Zhang J.; Yang W.-Z.; Liu W.-P.; Han
W.-Y.; Yu Y.; Hua Z.; Zhang J.-J.
Institution
(Li, Li, Kong, Zhao, Huang, Deng, Wang, Zeng, Mu, Liu, Zhou, Shan, Ma,
Zheng, Fu, Zhang, Liang, Liu, He, Cheng, Huang, Du, Xu) Department of
Anesthesiology and Critical Care Medicine, Peking University First
Hospital, Beijing, China
(Li, Yu, Wang, Wu) The Peking University Clinical Research Institute,
Peking University Health Science Center, Beijing, China
(Zhao, Hu, Liu) The Department of Anesthesiology, Beijing Shijitan
Hospital, Capital Medical University, Beijing, China
(Guo, Li) The Department of Anesthesiology, Peking University Third
Hospital, Beijing, China
(Feng, An) The Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Zuo, Zhang) The Department of Anesthesiology, Beijing Hospital, National
Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of
Medical Sciences, Beijing, China
(Sessler) The O Utcomes R Esearch C Onsortium, Cleveland, OH, United
States
(Sessler) The Department of O Utcomes R Esearch, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
(Wang, Xiao, Zhang, Yang) Department of Anesthesiology, Beijing Shijitan
Hospital, Capital Medical University, Beijing, China
(Liu, Han) Department of Anesthesiology, Peking University Third Hospital,
Beijing, China
(Yu, Hua) Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Zhang) Department of Anesthesiology, Beijing Hospital, National Centre of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Delirium is a common and serious postoperative complication,
especially in the elderly. Epidural anesthesia may reduce delirium by
improving analgesia, reducing opioid consumption, and blunting stress
response to surgery. This trial therefore tested the hypothesis that
combined epidural-general anesthesia reduces the incidence of
postoperative delirium in elderly patients recovering from major
noncardiac surgery. <br/>Method(s): Patients aged 60 to 90 yr scheduled
for major noncardiac thoracic or abdominal surgeries expected to last 2 h
or more were enrolled. Participants were randomized 1:1 to either combined
epidural-general anesthesia with postoperative epidural analgesia or
general anesthesia with postoperative intravenous analgesia. The primary
outcome was the incidence of delirium, which was assessed with the
Confusion Assessment Method for the Intensive Care Unit twice daily during
the initial 7 postoperative days. <br/>Result(s): Between November 2011
and May 2015, 1,802 patients were randomized to combined epidural-general
anesthesia (n = 901) or general anesthesia alone (n = 901). Among these,
1,720 patients (mean age, 70 yr; 35% women) completed the study and were
included in the intention-to-treat analysis. Delirium was significantly
less common in the combined epidural-general anesthesia group (15 [1.8%]
of 857 patients) than in the general anesthesia group (43 [5.0%] of 863
patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number
needed to treat 31). Intraoperative hypotension (systolic blood pressure
less than 80 mmHg) was more common in patients assigned to epidural
anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to
1.65; P < 0.001), and more epidural patients were given vasopressors (495
[58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P <
0.001). <br/>Conclusion(s): Older patients randomized to combined
epidural-general anesthesia for major thoracic and abdominal surgeries had
one third as much delirium but 50% more hypotension. Clinicians should
consider combining epidural and general anesthesia in patients at risk of
postoperative delirium, and avoiding the combination in patients at risk
of hypotension.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins.
All rights reserved.

<91>
[Use Link to view the full text]
Accession Number
2018427504
Title
Treatment Failures of Direct Oral Anticoagulants.
Source
American Journal of Therapeutics. 28(1) (pp E87-E95), 2021. Date of
Publication: 01 Jan 2021.
Author
Kajy M.; Mathew A.; Ramappa P.
Institution
(Kajy) Department of Internal Medicine, Detroit Medical Center, Wayne
State University School of Medicine, Detroit, MI, United States
(Mathew) Department of Cardiology, University of Toledo Medical Center,
Toledo, OH, United States
(Ramappa) Department of Cardiology, Detroit Medical Center, John D.
Dingell Va Medical Center, Wayne State University School of Medicine,
Detroit, MI, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Use of direct oral anticoagulants (DOACs) has increased over
the years, because they have become a safe and effective alternative to
the Vitamin-K antagonists in various clinical scenarios. With their
increased use, reports have emerged describing their failure.Study
Question:What are the patient characteristics and clinical settings in
which DOAC treatment failure manifests?Data Sources:We searched published
reports in Google Scholar, PubMed, MEDLINE, and Embase from the
introduction of DOACs in any therapy until March 2019. <br/>Study
Design:Information on patient characteristics, comorbidities, primary
anticoagulation indications, pharmacologic treatment, and outcomes were
collected. Primary endpoints were new thrombus formation, failure of
resolution of an existing thrombus, or discovery of subtherapeutic drug
level. Other endpoints were time to treatment failure, manifestations of
treatment failure, and new treatment after DOAC failure.
<br/>Result(s):Our search yielded 51 manuscripts, describing 79 patients
who exhibited DOAC failure. The most common treatment failures were in
patients with antiphospholipid syndrome (44.3%), atrial fibrillation
(30.4%), and deep venous thrombosis (6.3%). There was a trend toward
higher failure rate for rivaroxaban (65.8%) followed by dabigatran
(27.8%), apixaban (7.6%), and then edoxaban (1.3%). Each agent had
different median failure times. Most common manifestations of treatment
failure were stroke/transient ischemic attack (20.3%), pulmonary embolism
(19.0%), and deep venous thrombosis (19.0%). More than half of patients
were transitioned to a Vitamin-K antagonist after DOAC failure (55.7%).
<br/>Conclusion(s):Our analysis illustrates that DOACs may fail in the
setting of Food and Drug Administration and non-Food and Drug
Administration- approved indications. In clinical practice, it may be best
to choose between available anticoagulant drugs on a case-by-case
basis.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins. All
rights reserved.

<92>
Accession Number
2018417401
Title
Does neoadjuvant chemoradiotherapy increase survival in patients with
resectable oesophageal cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24(1) (pp 115-119), 2017.
Date of Publication: 01 Jan 2017.
Author
Buderi S.I.; Shackcloth M.; Page R.D.
Institution
(Buderi, Shackcloth, Page) Department of Cardiothoracic Surgery, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether trimodal therapy
[neoadjuvant chemoradiotherapy (nCRT) in addition to surgery] improves
survival in patients with resectable oesophageal cancer. Altogether 565
studies were identified using the below-mentioned search. Eleven
represented the best evidence to answer the clinical question. The author,
journal, date and country of publication, patient group, relevant outcomes
and weaknesses are tabulated. All 11 studies were randomized controlled
trials comparing surgery with trimodal therapy, 5 of which showed a
survival advantage with combined treatment. The remaining six randomized
controlled trials showed no difference between trimodal therapy and
surgery alone. The 3-year survival for trimodal treatment varied between
19.3 and 58% compared with that for surgery alone which varied between 7
and 53%. Five of these studies compared trimodal therapy with surgery in
terms of resection margins, three of which showed that trimodal therapy
led to increased R0 resection rate. One study focused on the differences
between adenocarcinoma and squamous cell tumours, and described equivalent
effects of trimodal therapy in terms of survival. One randomized
controlled trial showed improved survival in patients with complete
regression of their tumour following induction treatment. Two studies
suggested that induction treatment may lead to a higher operative
mortality; however, an increase in disease-free survival was noted in one
of the two studies. We conclude that trimodal therapy for resectable
oesophageal cancer offers similar or even improved results compared with
surgery alone in terms of survival. Furthermore, it is likely that there
is an advantage for those patients who have a complete pathological
response following induction treatment.<br/>Copyright &#xa9; 2017 Oxford
University Press. All rights reserved.

<93>
Accession Number
2018452039
Title
Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery
for Left Main Disease Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Jarrett C.M.; Pelletier M.; Abu-Omar Y.; Baeza C.; Elgudin Y.; Markowitz
A.; Vega P.R.; Dressler O.; Kappetein A.P.; Serruys P.W.; Stone G.W.;
Sabik J.F.
Institution
(Jarrett, Pelletier, Abu-Omar, Baeza, Elgudin, Markowitz, Vega, Sabik)
Department of Surgery, University Hospitals Cleveland Medical Center,
Cleveland, Ohio
(Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, New York
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Stone) NewYork-Presbyterian Hospital, Columbia University Medical Center,
New York, New York
Publisher
Elsevier Inc.
Abstract
Background: We investigated outcomes of coronary artery bypass grafting
(CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH)
within the Evaluation of XIENCE Versus CABG (EXCEL) trial. <br/>Method(s):
All patients in EXCEL randomized to CABG were included in this study. For
this analysis, the primary end points were ischemia-driven
revascularization (IDR) and graft stenosis or occlusion at 5 years.
Additional end points were as follows: a composite of death from any
cause, stroke, or myocardial infarction; bleeding; blood product
transfusion; major arrhythmia; and infection requiring antibiotics. Event
rates were based on Kaplan-Meier estimates in time-to-first-event
analyses. <br/>Result(s): Of the 957 patients randomized to CABG, 686
(71.7%) received at least 1 venous graft with 257 (37.5%) patients in the
EVH group and 429 (62.5%) patients in the OVH group. At 5 years, IDR was
higher (11.5% vs 6.7%; P = .047) in the EVH group. At 5 years, rates of
graft stenosis or occlusion (9.7% vs 5.4%; P = .054) and the primary end
point (17.4% vs 20.9%; P = .27) were similar. In-hospital bleeding (11.3%
vs 13.8%; P = .35), in-hospital blood product transfusion (12.8% vs 13.1%;
P = .94), and infection requiring antibiotics within 1 month (13.6% vs
16.8%; P = .27) were similar between EVH and OVH patients. Major
arrhythmia in the hospital (19.8% vs 13.5%; P = .03) and within 1 month
(21.8% vs 15.4%; P = .03) was higher in EVH patients. <br/>Conclusion(s):
IDR at 5 years was higher in the EVH group. EVH and OVH patients had
similar rates of graft stenosis or occlusion and the composite of death,
stroke, or myocardial infarction at 5 years.<br/>Copyright &#xa9; 2022 The
Society of Thoracic Surgeons

<94>
Accession Number
2017537888
Title
Iron homeostasis in heart transplant recipients randomized to ferric
derisomaltose or placebo.
Source
Clinical Transplantation. (no pagination), 2022. Date of Publication:
2022.
Author
Brautaset Englund K.V.; Ostby C.M.; Broch K.; Ueland T.; Aukrust P.; Gude
E.; Andreassen A.K.; Gullestad L.
Institution
(Brautaset Englund, Broch, Aukrust, Gullestad) Institute of Clinical
Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(Brautaset Englund, Ostby, Broch, Gude, Andreassen, Gullestad) Department
of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Brautaset Englund, Broch, Gude, Andreassen, Gullestad) K.G. Jebsen
Cardiac Research Center and Center for Heart Failure Research, Faculty of
Medicine, University of Oslo, Oslo, Norway
(Ueland, Aukrust) Research Institute of Internal Medicine, Oslo University
Hospital Rikshospitalet, Oslo, Norway
(Aukrust) Department of Rheumatology, Dermatology and Infectious Disease,
Oslo University Hospital, Oslo, Norway
Publisher
John Wiley and Sons Inc
Abstract
Introduction: The randomized IronIC trial evaluated the effect of
intravenous ferric derisomaltose on physical capacity in iron-deficient,
maintenance heart transplant (HTx) recipients. Iron deficiency was defined
as in heart failure with high cut-points for ferritin to compensate for
inflammation. However, intravenous iron did not improve physical capacity
except in patients with ferritin <30 mug/L. We aimed to explore
determinants of iron status in the 102 IronIC participants to better
define iron deficiency in the HTx population. <br/>Method(s): We assessed
key governors of iron homeostasis, such as hepcidin, soluble transferrin
receptor (sTfR), and interleukin-6 (IL-6). We also measured growth factors
and inflammatory markers with relevance for iron metabolism. The results
were compared to those of 21 healthy controls. <br/>Result(s): Hepcidin
did not differ between HTx recipients and controls, even though markers of
inflammation were modestly elevated. However, HTx recipients with ferritin
<30 mug/L or sTfR above the reference range had significantly reduced
hepcidin levels suggestive of true iron deficiency. In these patients,
intravenous iron improved peak oxygen uptake. Hepcidin correlated
positively with ferritin and negatively with sTfR. <br/>Conclusion(s): HTx
recipients with iron deficiency as defined in heart failure do not have
elevated hepcidin levels, although inflammatory markers are modestly
increased. The high ferritin cut-offs used in heart failure may not be
suitable to define iron deficiency in the HTx population. We suggest that
hepcidin and sTfR should be measured to identify patients with true iron
deficiency, who might benefit from treatment with intravenous
iron.<br/>Copyright &#xa9; 2022 John Wiley & Sons A/S. Published by John
Wiley & Sons Ltd.

<95>
Accession Number
2016149290
Title
Concomitant Surgical Left Atrial Appendage Occlusion: a Review.
Source
Current Cardiology Reports. (no pagination), 2022. Date of Publication:
2022.
Author
Whitlock R.P.; Belley-Cote E.P.
Institution
(Whitlock) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, 237 Barton
Street E, Hamilton, ON L8L 2X2, Canada
(Belley-Cote) Divisions of Cardiology and Critical Care, Department of
Medicine, McMaster University, Hamilton, ON, Canada
Publisher
Springer
Abstract
Purpose of Review: In this review, we discuss some of the observational
studies that examined the impact of left atrial appendage occlusion on
stroke, the Left Atrial Appendage Occlusion Study (LAAOS) III research
program that provided definitive evidence for the benefit of surgical left
atrial appendage occlusion on ischemic stroke, and high priority studies
in the field that should be pursued by the surgical community. Recent
Findings: Atrial fibrillation is common in patients undergoing cardiac
surgery. Oral anticoagulants are effective at preventing strokes related
to atrial fibrillation; they have been the standard of care for stroke
prevention in patients with atrial fibrillation for decades. Most strokes
in patients with atrial fibrillation originate from the left atrial
appendage. LAAOS III, a large randomized controlled trial, has recently
demonstrated that concomitant left atrial appendage occlusion in patients
undergoing cardiac surgery for another indication reduces the risk of
stroke or systemic embolism on top of oral anticoagulation. <br/>Summary:
Surgical left atrial appendage occlusion reduces the risk of ischemic
stroke and systemic embolism in patients with atrial fibrillation and a
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >= 2 undergoing cardiac surgery
for another indication. The role of surgical left atrial appendage
occlusion with patients without atrial fibrillation, as a substitute to
anticoagulation and as a standalone procedure, remains
unclear.<br/>Copyright &#xa9; 2022, The Author(s), under exclusive licence
to Springer Science+Business Media, LLC, part of Springer Nature.

<96>
Accession Number
638127474
Title
Bioresorbable flow diverters for the treatment of intracranial aneurysms:
review of current literature and future directions.
Source
Journal of neurointerventional surgery. (no pagination), 2022. Date of
Publication: 30 May 2022.
Author
Oliver A.A.; Carlson K.D.; Bilgin C.; Arturo Larco J.L.; Kadirvel R.;
Guillory Ii R.J.; Dragomir Daescu D.; Kallmes D.F.
Institution
(Oliver) Biomedical Engineering and Physiology, Mayo Clinic Graduate
School of Biomedical Sciences, Rochester, MN, United States
(Oliver, Bilgin, Kadirvel, Kallmes) Radiology, Mayo Clinic, Rochester, MN,
United States
(Oliver, Carlson, Dragomir Daescu) Physiology and Biomedical Engineering,
Mayo Clinic, Rochester, MN, United States
(Arturo Larco) Neurosurgery, Mayo Clinic, Rochester, MN, United States
(Guillory Ii) Biomedical Engineering, Michigan Technological University,
Houghton, MI, United States
(Dragomir Daescu, Kallmes) Biomedical Engineering and Physiology, Mayo
Clinic Graduate School of Biomedical Sciences, Rochester, MN, United
States
Publisher
NLM (Medline)
Abstract
The use of flow diverters is a rapidly growing endovascular approach for
the treatment of intracranial aneurysms. All FDA-approved flow diverters
are composed of nitinol or cobalt-chromium, which will remain in the
patient for the duration of their life. Bioresorbable flow diverters have
been proposed by several independent investigators as the next generation
of flow diverting devices. These devices aim to serve their transient
function of occluding and healing the aneurysm prior to being safely
resorbed by the body, eliminating complications associated with the
permanent presence of conventional flow diverters. Theoretical advantages
of bioresorbable flow diverters include (1) reduction in device-induced
thrombosis; (2) reduction in chronic inflammation and device-induced
stenosis; (3) reduction in side branch occlusion; (4) restoration of
physiological vasomotor function; (5) reduction in imaging artifacts; and
(6) use in pediatric applications. Advances made in the similar
bioresorbable coronary stenting field highlight some of these advantages
and demonstrate the feasibility and safety of bioresorbable endovascular
devices in the clinic. The current work aims to review the progress of
bioresorbable flow diverters, identify opportunities for further
investigation, and ultimately stimulate the advancement of this
technology.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2022. No
commercial re-use. See rights and permissions. Published by BMJ.

<97>
Accession Number
638125644
Title
Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic
Review.
Source
Seminars in thrombosis and hemostasis. (no pagination), 2022. Date of
Publication: 30 May 2022.
Author
Okholm S.H.; Krog J.; Hvas A.-M.
Institution
(Okholm, Hvas) Department of Clinical Medicine, Health, Aarhus University,
Aarhus C, Denmark
(Krog) Department of Anesthesiology and Intensive Care, Aarhus University
Hospital, Aarhus C, Denmark
(Hvas) Department of Clinical Biochemistry, Aarhus University Hospital,
Aarhus C, Denmark
Publisher
NLM (Medline)
Abstract
Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for
reducing blood loss in patients with major bleedings. Animal and cell
studies have shown that TXA might modulate the inflammatory response by
either enhancing or inhibiting cytokine levels. Furthermore, recent human
studies have found altered inflammatory biomarkers in patients receiving
TXA when compared with patients who did not receive TXA. In this
systematic review we investigated the effect of TXA on inflammatory
biomarkers in different patient groups. A systematic literature search was
conducted on the databases PubMed and Embase to identify all original
articles that investigated inflammatory biomarkers in patients receiving
TXA and compared them to a relevant control group. The review was
performed according to the PRISMA guidelines, and the literature search
was performed on November 29, 2021. Thirty-three studies were included,
among which 14 studies compared patients receiving TXA with patients
getting no medication, another 14 studies investigated different dosing
regimens of TXA, and finally five studies examined the administration form
of TXA. The present review suggests that TXA has an anti-inflammatory
effect in patients undergoing orthopaedic surgery illustrated by decreased
levels of C-reactive protein and interleukin-6 in patients receiving TXA
compared with patients receiving no or lower doses of TXA. However, the
anti-inflammatory effect was not found in patients undergoing cardiac
surgery, pediatric craniosynostosis patients, or in rheumatoid arthritis
patients. The inflammatory response was not affected by administration
form of TXA (oral, intravenous, or topical). In conclusion, an
anti-inflammatory effect of TXA was consistently found among orthopaedic
patients only.<br/>Copyright Thieme. All rights reserved.

<98>
Accession Number
638124938
Title
A systematic review and meta-analysis of coronary artery disease and
revascularization in lung transplant patients.
Source
Coronary artery disease. (no pagination), 2022. Date of Publication: 30
May 2022.
Author
Fialka N.M.; Bozso S.J.; El-Andari R.; Kang J.J.; Laing B.; Meyer S.R.;
Nagendran J.
Institution
(Fialka, El-Andari) Faculty of Medicine and Dentistry
(Bozso, Kang, Meyer, Nagendran, Nagendran) Division of Cardiac Surgery,
Department of Surgery
(Laing) Department of Surgery, University of Alberta, Edmonton, AB, Canada
Publisher
NLM (Medline)
Abstract
Coronary artery disease (CAD) is common in candidates for lung
transplantation (LTx) and has historically been considered a relative
contraindication to transplantation. We look to review the outcomes of LTx
in patients with CAD and determine the optimum revascularization strategy
in LTx candidates. PubMed, Medline and Web of Science were systematically
searched by three authors for articles comparing the outcomes of LTx in
patients with CAD and receiving coronary revascularization. In total 1668
articles were screened and 12 were included in this review.Preexisting CAD
in LTx recipients was not associated with significantly increased
postoperative morbidity or mortality. The pooled estimates of mortality
rate at 1, 3 and 5years indicated significantly inferior survival in LTx
recipients with a prior history of coronary artery bypass grafting (CABG)
[odds ratio (OR), 1.84; 95% confidence interval (CI), 1.53-2.22;
P<0.00001; I2=0%; OR, 1.52; 95% CI, 1.21-1.91; P=0.0003; I2=0%; OR, 1.62;
95% CI, 1.13-2.33; P=0.008; I2=71%, respectively). However, contemporary
literature suggests that survival rates in LTx recipients with CAD that
received revascularization either by percutaneous coronary intervention
(PCI), previous or concomitant CABG, are similar to patients who did not
receive revascularization. Trends in postoperative morbidity favored CABG
in the rates of myocardial infarction and repeat revascularization,
whereas rates of stroke favored PCI. The composite results of this study
support the consideration of patients with CAD or previous coronary
revascularization for LTx. Prospective, randomized controlled trials with
consistent patient populations and outcomes reporting are required to
fully elucidate the optimum revascularization strategy in LTx
candidates.<br/>Copyright &#xa9; 2022 Wolters Kluwer Health, Inc. All
rights reserved.