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<1>
Accession Number
368100868
Title
Additive effect of phosphodiesterase inhibitors in control of pulmonary
hypertension after congenital cardiac surgery in children.
Source
Iranian Journal of Pediatrics. 23(1) (pp 19-26), 2013. Date of
Publication: February 2013.
Author
Farah P.; Ahmad-Ali A.; Hanane G.; Abbas E.
Institution
(Farah, Hanane) Department of Pediatrics, Islamic Azad University, Kazerun
Branch, Kazerun, Iran, Islamic Republic of
(Ahmad-Ali) Department of Surgery, Division of Cardiovascular Surgery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Abbas) Department of Medicine, New York Medical College, Valhalla, NY,
United States
Publisher
Brieflands
Abstract
Objective: Control of residual pulmonary arterial hypertension (PAH) after
closure of left to right shunts in children is still a challenging issue.
The purpose of this study was to compare the effect of two
phosphodiesterase inhibitors in pediatric cardiac surgical patients.
 Method(s): A total of 48 postoperative children were enrolled in the
study between 2008 and 2010. Patients were stratified based upon choice of
pulmonary vasodilator into three equal groups (n=16); Milrinone group
received intravenous milrinone (0.75 mu/kg/min), Sildenafil group received
oral sildenafil (0.3 mg/kg every 3 hours) and the Combination group
received both medications. Finding(s): Demographic variables and
types of congenital anomalies were not different among the 3 groups.
Patients in the Combination group had higher preoperative pulmonary artery
to aortic (PA/AO) pressure ratios compared to other two groups (P=0.001).
Postoperatively, patients in Milrinone group incurred lower systolic PA
and PA/AO pressures compared to Sildenafil group (P=0.014, 0.003), but it
was the same in Sildenafil and Combination group (P=0.2; 0.330
respectively). Pulmonary hypertensive crisis was noted in 6 patients in
Sildenafil group, and 3 patients in Combination group (P=0.02).
Significant rise in PA pressure was noticed after discontinuation of drug
in Milrinone group (P=0.001), which was not observed in the Combination
group (P= 0.6). No mortality was noticed in any of the groups.
 Conclusion(s): Intravenous milrinone is more effective than oral
sildenafil in control of postoperative PAH and elimination of pulmonary
hypertensive crisis. Combination of two drugs reduces the risk of rebound
pulmonary arterial hypertension after discontinuation of milrinone. ©
2013 by Pediatrics Center of Excellence, Children's Medical Center, Tehran
University of Medical Sciences, All rights reserved.

<2>
Accession Number
365863684
Title
Platelets in pulmonary hypertension: A causative role or a simple
association?.
Source
Iranian Journal of Pediatrics. 22(2) (pp 145-157), 2012. Date of
Publication: June 2012.
Author
Zanjani K.S.
Institution
(Zanjani) Pediatric Center of Excellence, Children's Medical Center,
Tehran University of Medical Sciences, No 62, Dr Gharib St, 14194 Tehran,
Iran, Islamic Republic of
Publisher
Brieflands
Abstract
Pathophysiology of pulmonary arterial hypertension is based on three basic
mechanisms: thrombotic pulmonary vascular lesions, vasoconstriction and
vascular remodeling. Platelets are related to all of these mechanisms by
their aggregation, production, storage and release of several mediators.
The role of platelets is more prominent in some types of pulmonary
arterial hypertension, including those which are secondary to inflammatory
and infectious diseases, hemoglobinopathies, essential thrombocythemia,
drugs, thromboembolism, and cardiac surgery. Most pulmonary
antihypertensive drugs have a negative effect on platelets. In this
review, the mechanisms of platelets association with pulmonary arterial
hypertension, those types of pulmonary arterial hypertension with greatest
platelet contribution to their pathophysiology, and the effects of
pulmonary antihypertensive drugs on platelets are summarized. © 2012
by Pediatrics Center of Excellence, Children's Medical Center, Tehran
University of Medical Sciences.

<3>
Accession Number
637304553
Title
Ten-Year Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Grafting
in the Department of Veterans Affairs: A Randomized Clinical Trial.
Source
JAMA Surgery. 157(4) (pp 303-310), 2022. Date of Publication: April 2022.
Author
Quin J.A.; Wagner T.H.; Hattler B.; Carr B.M.; Collins J.; Almassi G.H.;
Grover F.L.; Shroyer A.L.
Institution
(Quin) Department of Surgery, Veterans Affairs Boston Healthcare System,
West Roxbury, MA, United States
(Wagner) Research Office, Veterans Affairs Health Economics and Research
Center, Palo Alto, CA, United States
(Wagner) Department of Surgery, Stanford University, Palo Alto, CA, United
States
(Hattler) Department of Medicine, Rocky Mountain Regional Veterans Affairs
Medical Center, Aurora, CO, United States
(Hattler) Division of Cardiology, Department of Medicine, University of
Colorado, School of Medicine, Aurora, United States
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester, MN,
United States
(Collins) Research Office, Veterans Affairs Cooperative Studies Program,
Perry Point, MD, United States
(Almassi) Department of Surgery, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, WI, United States
(Almassi) Division of Cardiothoracic Surgery, Department of Surgery,
Medical College of Wisconsin, Milwaukee, United States
(Grover) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado, School of Medicine, Aurora, United States
(Grover) Department of Surgery, Rocky Mountain Regional Veterans Affairs
Medical Center, Aurora, CO, United States
(Shroyer) Research and Development Office (151), Northport Veterans
Affairs Medical Center, 79 Middleville Rd, Northport, NY 11768, United
States
(Shroyer) Department of Surgery, Stony Brook University, Renaissance
School of Medicine, Stony Brook, NY, United States
Publisher
American Medical Association
Abstract
Importance: The long-term benefits of off-pump ("beating heart") vs
on-pump coronary artery bypass grafting (CABG) remain controversial.
 Objective(s): To evaluate the 10-year outcomes and costs of off-pump
vs on-pump CABG in the Department of Veterans Affairs (VA) Randomized
On/Off Bypass (ROOBY) trial. Design, Setting, and Participant(s):
From February 27, 2002, to May 7, 2007, 2203 veterans in the ROOBY trial
were randomly assigned to off-pump or on-pump CABG procedures at 18
participating VA medical centers. Per protocol, the veterans were observed
for 10 years; the 10-year, post-CABG clinical outcomes and costs were
assessed via centralized abstraction of electronic medical records
combined with merges to VA and non-VA databases. With the use of an
intention-to-treat approach, analyses were performed from May 7, 2017, to
December 9, 2021. Intervention(s): On-pump and off-pump CABG
procedures. Main Outcomes and Measures: The 10-year coprimary end
points included all-cause death and a composite end point identifying
patients who had died or had undergone subsequent revascularization (ie,
percutaneous coronary intervention [PCI] or repeated CABG); these 2 end
points were measured dichotomously and as time-to-event variables (ie,
time to death and time to composite end points). Secondary 10-year end
points included PCIs, repeated CABG procedures, changes in cardiac
symptoms, and 2018-adjusted VA estimated costs. Changes from baseline to
10 years in post-CABG, clinically relevant cardiac symptoms were evaluated
for New York Heart Association functional class, Canadian Cardiovascular
Society angina class, and atrial fibrillation. Outcome differences were
adjudicated by an end points committee. Given that pre-CABG risks were
balanced, the protocol-driven primary and secondary hypotheses directly
compared 10-year treatment-related effects. Result(s): A total of
1104 patients (1097 men [99.4%]; mean [SD] age, 63.0 [8.5] years) were
enrolled in the off-pump group, and 1099 patients (1092 men [99.5%]; mean
[SD] age, 62.5 [8.5] years) were enrolled in the on-pump group. The
10-year death rates were 34.2% (n = 378) for the off-pump group and 31.1%
(n = 342) for the on-pump group (relative risk, 1.05; 95% CI, 0.99-1.11; P
=.12). The median time to composite end point for the off-pump group (4.6
years; IQR, 1.4-7.5 years) was approximately 4.3 months shorter than that
for the on-pump group (5.0 years; IQR, 1.8-7.9 years; P =.03). No
significant 10-year treatment-related differences were documented for any
other primary or secondary end points. After the removal of conversions,
sensitivity analyses reconfirmed these findings. Conclusions and
Relevance: No off-pump CABG advantages were found for 10-year death or
revascularization end points; the time to composite end point was lower in
the off-pump group than in the on-pump group. For veterans, in the absence
of on-pump contraindications, a case cannot be made for supplanting the
traditional on-pump CABG technique with an off-pump approach. Trial
Registration: ClinicalTrials.gov Identifier: NCT01924442. Copyright
© 2022 American Medical Association. All rights reserved.

<4>
Accession Number
2013509676
Title
A randomized non-inferiority pilot study on the use of methoxyflurane
(Penthrox) for pain control in the emergency department.
Source
Hong Kong Journal of Emergency Medicine. 29(4) (pp 203-211), 2022. Date of
Publication: July 2022.
Author
Wong K.Y.; Lau J.S.K.; Siu A.Y.C.; Kan P.G.
Institution
(Wong) Accident and Emergency Department, Pamela Youde Nethersole Eastern
Hospital, Chai Wan, Hong Kong
(Lau, Siu, Kan) Accident and Emergency Department, Ruttonjee Hospital, Wan
Chai, Hong Kong
Publisher
SAGE Publications Ltd
Abstract
Background: Patients commonly visit the emergency department for pain
after musculoskeletal injury, but the problem of oligoanalgesia is
prevalent. Methoxyflurane (Penthrox) is an inhalational
analgesic for moderate to severe trauma-associated pain in stable and
conscious patients. It is a fast-acting, effective analgesic that can be
readily administered via a non-invasive route, making it an attractive
agent for managing acute pain in the emergency departments.
 Objective(s): The aim was to assess the analgesic efficacy of
methoxyflurane in patients with acute traumatic pain by comparing it to
ketorolac, a standard analgesic treatment for moderate pain in emergency
departments in Hong Kong. Method(s): This was a single-center,
open-label, randomized controlled, parallel-group, non-inferiority pilot
study that enrolled adult patients with moderate trauma-associated pain in
an emergency department in Hong Kong. Patients were randomized 1:1 to the
methoxyflurane group or the ketorolac group. The primary outcome was the
change in pain intensity measured by visual analogue scale from baseline
to 5, 15, 30, and 60 min after drug administration. Result(s): Twenty
patients received methoxyflurane, and twenty patients received ketorolac.
There were significant reductions in pain score over 60 min in both
groups. The pain reduction at 5 min was significantly greater for the
methoxyflurane group (-13.912 mm; 95% confidence interval = -20.008 to
-7.817) than for the ketorolac group (-4.888 mm; 95% confidence interval =
-10.983 to 1.208), with the treatment effect (-9.025 mm; 95% confidence
interval = -17.656 to -0.393; p = 0.041) demonstrating superiority of
methoxyflurane. The treatment effect at 15 and 30 min demonstrated
non-inferiority of methoxyflurane versus ketorolac. Conclusion(s):
Methoxyflurane provided non-inferior analgesia in the first 30 min with a
faster onset of action when compared with ketorolac in moderate traumatic
pain. It can be considered a non-invasive, rapid-acting, and effective
first-line alternative to currently available analgesics for traumatic
pain in emergency settings. Copyright © The Author(s) 2021.

<5>
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). Copyright © 2021 American
Society for Parenteral and Enteral Nutrition.

<6>
Accession Number
2015070972
Title
Effect of proximal optimization technique on coronary bifurcation stent
failure: Insights from the multicenter randomized PROPOT trial.
Source
Catheterization and Cardiovascular Interventions. 99(4) (pp 1047-1058),
2022. Date of Publication: March 1, 2022.
Author
Murasato Y.; Watanabe Y.; Yamawaki M.; Kinoshita Y.; Okubo M.; Yumoto K.;
Masuda N.; Otake H.; Aoki J.; Nakazawa G.; Numasawa Y.; Ito T.; Shite J.;
Okamura T.; Takagi K.; Lefevre T.; Chevalier B.; Louvard Y.; Suzuki N.;
Kozuma K.
Institution
(Murasato) Department of Cardiology and Clinical Research Center, National
Hospital Organization Kyushu Medical Center, Fukuoka, Japan
(Watanabe, Kozuma) Department of Medicine, Teikyo University School of
Medicine, Tokyo, Japan
(Yamawaki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Kinoshita) Department of Cardiology, Toyohashi Heart Center, Toyohashi,
Japan
(Okubo) Department of Cardiology, Gifu Heart Center, Gifu, Japan
(Yumoto) Department of Cardiology, Yokohama Rosai Hospital, Yokohama,
Japan
(Masuda) Department of Cardiology, Ageo Central General Hospital, Ageo,
Japan
(Otake) Department of Cardiology, Kobe University Graduate School of
Medicine, Kobe, Japan
(Aoki) Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
(Nakazawa) Department of Cardiology, Tokai University School of Medicine,
Isehara, Japan
(Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga Hospital,
Ashikaga, Japan
(Ito) Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
(Shite) Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Okamura) Department of Medicine and Clinical Science, Yamaguchi
University Graduate School of Medicine, Ube, Japan
(Takagi) Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
(Kozuma) Department of Biostatistics, The University of Tokyo, Tokyo,
Japan
(Lefevre, Chevalier, Louvard) Department of Cardiology, Ramsay Generale de
Sante, Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques Cartier,
Massy, France
(Suzuki) Division of Cardiology, Teikyo University Mizonokuchi Hospital,
Kawasaki, Japan
Publisher
John Wiley and Sons Inc
Abstract
Objective: We investigated the effect of proximal optimization technique
(POT) on coronary bifurcation stent failure (BSF) in cross-over stenting
by comparing with the kissing balloon technique (KBT) in a multicenter
randomized PROPOT trial. Background(s): POT is recommended due to
increased certainty for optimal stent expansion and side branch (SB)
wiring. Method(s): We randomized 120 patients treated with crossover
stenting into the POT group, which was followed by SB dilation (SBD), and
the KBT group. Finally, 52 and 57 patients were analyzed by optical
coherence tomography before SBD and at the final procedure, respectively.
Composite BSF was defined as a maximal malapposition distance of >400 mum,
or malapposed and SB-jailed strut rates of >5.95% and >21.4%,
respectively. Result(s): Composite BSF before SBD in the POT and KBT
groups was observed in 29% and 26% of patients, respectively. In the POT
group, differences in stent volumetric index between the proximal and
distal bifurcation (odds ratio [OR] 60.35, 95% confidential interval [CI]
0.13-0.93, p = 0.036) and between the proximal bifurcation and bifurcation
core (OR: 3.68, 95% CI: 1.01-13.40, p = 0.048) were identified as
independent risk factors. Composite BSF at final in 27% and 32%, and
unplanned additional procedures in 38% and 25% were observed,
respectively. Composite BSF before SBD was a risk factor for the former
(OR: 6.33, 95% CI: 1.10-36.50, p = 0.039) and the latter (OR: 6.43, 95%
CI: 1.25-33.10, p = 0.026) in the POT group. Conclusion(s): POT did
not result in a favorable trend in BSF. Insufficient expansion of the
bifurcation core after POT was associated with BSF. Copyright ©
2022 Wiley Periodicals LLC.

<7>
Accession Number
2018025383
Title
Real-time ultrasound-guided versus anatomic landmark-based thoracic
epidural placement: a prospective, randomized, superiority trial.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 198. Date
of Publication: December 2022.
Author
Pakpirom J.; Thatsanapornsathit K.; Kovitwanawong N.; Petsakul S.;
Benjhawaleemas P.; Narunart K.; Boonchuduang S.; Karmakar M.K.
Institution
(Pakpirom, Thatsanapornsathit, Kovitwanawong, Petsakul, Benjhawaleemas,
Narunart, Boonchuduang) Department of Anesthesiology, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
(Karmakar) Department of Anaesthesia and Intensive Care, Faculty of
Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital,
Shatin, New Territories, SAR, Hong Kong
Publisher
BioMed Central Ltd
Abstract
Background: Thoracic epidural placement (TEP) using the conventional
anatomic landmark-based technique is technically challenging, may require
multiple attempts, and is associated with a high failure rate (12-40%). We
hypothesized that real-time ultrasound guidance would be superior in the
"first-pass" success rate of TEP, when compared with the conventional
technique. Method(s): This prospective, randomized, superiority trial
was conducted in a University hospital, and recruited 96 patients
undergoing elective major abdominal or thoracic surgery and scheduled to
receive a TEP for postoperative analgesia. Patients were randomly
allocated to receive TEP using either the conventional technique (Gp-Conv,
n = 48) or real-time ultrasound guidance (Gp-Usg, n = 48). The success of
TEP was defined as eliciting loss of resistance technique and being able
to insert the epidural catheter. The primary outcome variable was the
"first-pass success rate" meaning the successful TEP at the first needle
insertion without redirection or readvancement of the Tuohy needle. The
secondary outcomes included the number of skin punctures, number of
attempts, the overall success rate, TEP time, and total procedure time.
 Result(s): The first-pass success rate of TEP was significantly
higher (p = 0.002) in Gp-Usg (33/48 (68.8%); 95%CI 55.6 to 81.9) than in
Gp-Conv (17/48 (35.4%); 95%CI 21.9 to 49.0). There was no statistically
significant difference (p = 0.12) in the overall success rate of TEP
between the 2 study groups (Gp-Usg; 48/48 (100%) vs. Gp-Conv; 44/48
(91.7%); 95%CI 83.9 to 99.5). Ultrasound guidance reduced the median
number of skin punctures (Gp-Usg; 1 [1, 1] vs Gp-Conv; 2 [1, 2.2], p <
0.001) and attempts at TEP (Gp-Usg; 1 [1, 2] vs Gp-Conv; 3 [1, 7.2], p <
0.001) but the procedure took longer to perform (Gp-Usg; 15.5 [14, 20] min
vs Gp-Conv; 10 [7, 14] min, p < 0.001). Conclusion(s): This study
indicates that real-time ultrasound guidance is superior to a conventional
anatomic landmark-based technique for first-pass success during TEP
although it is achieved at the expense of a marginally longer total
procedure time. Future research is warranted to evaluate the role of
real-time ultrasound guidance for TEP in other groups of patients. Trial
registration: Thai Clinical Trials Registry;
http://www.thaiclinicaltrials.org/; Trial ID: TCTR20200522002,
Registration date: 22/05/2020. Copyright © 2022, The Author(s).

<8>
Accession Number
2017808261
Title
Impact of percutaneous coronary intervention on chronic total occlusion in
the non-infarct-related artery in patients with STEMI: a systematic review
and meta-analysis.
Source
Scandinavian Cardiovascular Journal. 56(1) (pp 157-165), 2022. Date of
Publication: 2022.
Author
Hu M.-J.; Li X.-S.; Yang Y.-J.
Institution
(Hu, Li, Yang) State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing, China
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: We sought to compare the clinical outcomes between
culprit-only percutaneous coronary intervention (PCI) versus multivessel
PCI (MV-PCI) in patients with ST-segment elevation myocardial infarction
(STEMI) accompanied by chronic total occlusion (CTO) in the
non-infarct-related artery(non-IRA). Design(s): Studies that compared
culprit-only PCI versus MV-PCI in patients with STEMI accompanied by CTO
in the non-IRA were included. Random odds ratio (OR) and 95% confidence
interval (CI) were calculated. Result(s): Eight studies with 2,259
patients were included. The results suggested that in patients with STEMI
accompanied by CTO in the non-IRA, culprit-only PCI was associated with
higher risks of all-cause mortality (OR: 2.89; 95% CI: 2.09-4.00; I
2 = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05-4.75; I
2 = 16.8%), stroke (OR: 2.80; 95% CI: 1.04-7.53; I 2
= 0.0%), major adverse cardiovascular event (MACE; OR: 2.06; 95% CI:
1.39-3.06; I 2 = 54.0%), and heart failure (OR: 1.99; 95% CI:
1.22-3.24; I 2 = 0.0%) compared with staged MV-PCI, which were
mainly derived from retrospective studies. No differences were observed in
myocardial infarction or revascularization. Pooled multivariable adjusted
results consistently indicated that staged MV-PCI was superior to
culprit-only PCI. Conclusion(s): For patients with STEMI accompanied
by CTO in the non-IRA, staged MV-PCI may be better compared with
culprit-only PCI due to potential reduced risks of all-cause mortality,
cardiac death, stroke, MACE, and heart failure. Meanwhile, further
randomized trials are warranted to confirm or refute our
findings. Copyright © 2022 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<9>
Accession Number
2017722786
Title
The impact of COVID-19-related quarantine on psychological outcomes in
patients after cardiac intervention: a multicenter longitudinal study.
Source
Translational Psychiatry. 12(1) (no pagination), 2022. Article Number:
235. Date of Publication: December 2022.
Author
Patron E.; Messerotti Benvenuti S.; Ponchia A.; Del Piccolo F.; Gentili
C.; Palomba D.
Institution
(Patron, Messerotti Benvenuti, Gentili, Palomba) Department of General
Psychology, University of Padua, Padua, Italy
(Messerotti Benvenuti, Gentili, Palomba) Padova Neuroscience Center (PNC),
University of Padua, Padua, Italy
(Ponchia) Unit of Cardiac Rehabilitation, ULSS 6 Euganea, Padua, Italy
(Del Piccolo) Unit of Cardiac Rehabilitation, San Marco Hospital, Venice,
Italy
Publisher
Springer Nature
Abstract
Mandatory quarantine during the COVID-19 pandemic had substantial negative
consequences on psychological health in the general population.
Depression, anxiety, and insomnia were reported to increase the morbidity
and mortality risk in cardiac patients after cardiac interventions.
Nonetheless, a gap in the evidence appeared regarding the effects of
COVID-19-related quarantine on psychological outcomes in patients after
cardiac interventions. The present study aimed to longitudinally
investigate the effects of quarantine on depressive, anxiety, and insomnia
symptoms in a group of patients who underwent cardiac intervention.
Seventy-three patients admitted for cardiac rehabilitation completed a
psychological assessment before and a reassessment after the quarantine
and were included in the quarantine group. The control group included 76
patients who completed both evaluations before the quarantine. Depressive
(Beck Depression Inventory-II; BDI-II), anxiety (Beck Anxiety
Inventory-II; BAI), and insomnia (Sleep Condition Indicator; SCI) symptoms
were evaluated in both groups at one (assessment) and eight (reassessment)
months after cardiac intervention. The statistical analyses revealed that
at reassessment, the quarantine group showed higher global depressive,
anxiety, and insomnia symptoms than the control group and increased
cognitive symptoms of depression. A higher presence of clinically relevant
depressed patients was seen in the quarantine group. The present results
showed that the COVID-19-related mandatory quarantine negatively affected
psychological outcomes in patients after cardiac intervention, increasing
the probability for these patients to be depressed. This, in turn, could
influence patients' health in a critical period for morbidity and
mortality risk. This underlines the priority of integrating and improving
targeted mental health support as the pandemic continues, especially for
cardiac patients. Copyright © 2022, The Author(s).

<10>
Accession Number
2013506146
Title
A randomized controlled clinical trial on therapeutic effects of
teicoplanin and vancomycin after cardiac surgery due to MRSA infective
endocarditis in ICU patients.
Source
Iranian Red Crescent Medical Journal. 23(1) (no pagination), 2020. Article
Number: e69. Date of Publication: 2020.
Author
Khoundabi B.; Behzadnia N.; Ahmadi Z.H.; Chitsazan M.; Tabarsi P.; Jamaati
H.; Bahadorbeigi A.; Hashemian S.M.R.
Institution
(Khoundabi) Iran Helal Institute of Applied Science and Technology,
Tehran, Iran, Islamic Republic of
(Khoundabi) Research Center for Health Management in Mass Gathering, Red
Crescent Society of the Islamic Republic of Iran, Tehran, Iran, Islamic
Republic of
(Behzadnia, Ahmadi) Lung Transplant Research Center, National Research
Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Chitsazan, Jamaati, Bahadorbeigi, Hashemian) Chronic Respiratory Diseases
Research Center, National Research Institute of Tuberculosis and Lung
Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Tabarsi) Clinical Tuberculosis and Epidemiology Research Center, National
Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Infective endocarditis (IE) is a relatively rare disease but
with significant rates of morbidity and mortality. Vancomycin and
teicoplanin are bacteriostatic glycopeptide antibiotics used for the
treatment of methicillin-resistant Staphylococcus aureus (MRSA)
infections. Objective(s): The current study aimed to compare the
efficacy and adverse effects of vancomycin and teicoplanin in the
treatment of patients with MRSA-IE. Method(s): This parallel,
randomized, and controlled trial study was carried out on the efficacy and
safety of teicoplanin versus vancomycin in the treatment of MRSA
endocarditis within August 2012 and April 2017. The present study
recruited adult patients with a definite or possible diagnosis of IE based
on the Modified Duke Criteria. Vancomycin was intravenously administered
at a dose of 30 mg/kg/day in two doses. Teicoplanin was administered at a
loading dose of 6-12 mg/kg every 12 h in four doses and then continued
once a day. Result(s): Out of 86 patients with suspected IE, 66
patients were randomly assigned to the vancomycin (n=33) and teicoplanin
(n=33) groups. The mean age values of the study subjects were 41+/-11.8
and 39+/-13.1 years in the vancomycin and teicoplanin groups,
respectively. In addition, 27 patients (81.8%) in the vancomycin group met
the criteria for microbiological cure, compared to 25 subjects (89.3%) in
the teicoplanin group. In this regard, the observed difference was not
statistically significant (P=0.41). Overall, the patients in the
vancomycin group experienced more adverse events in comparison to those of
the teicoplanin group (P=0.04). The rate of acute kidney injury over time,
especially in the first week of therapy, was higher in the vancomycin
group than that reported for the teicoplanin group (P=0.05).
 Conclusion(s): It was concluded that the administration of vancomycin
or teicoplanin does not significantly change the outcome of patients
undergoing empirical treatment for MRSA-IE. Copyright © 2021,
Author(s).

<11>
Accession Number
638439780
Title
3D-PRINTING FOR ABLATION PLANNING IN PATIENTS UNDERGOING ATRIAL
FIBRILLATION ABLATION (3D-GALA TRIAL).
Source
Journal of Hypertension. Conference: 31st Scientific Meeting of the
European Society of Hypertension, ESH 2022. Athens Greece. 40(Supplement
1) (pp e68), 2022. Date of Publication: June 2022.
Author
Xydis P.; Printzios D.T.; Gourgouli I.; Tampakis K.; Andrikopoulos G.;
Vlachopoulos C.
Institution
(Xydis, Printzios, Gourgouli, Vlachopoulos) First Department of
Cardiology, National and Kapodistrian University of Athens, Athens, Greece
(Tampakis, Andrikopoulos) 1st Clinic of Cardiology / Cardiac
Electrophysiology and Pacing, Henry Dunant Hospital Center, Athens, Greece
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Atrial fibrillation (AF) remains one of the major causes of
cardiovascular morbidity. Ablation techniques are becoming more appealing
after latest results of andomised trials showing the overall clinical
benefit. On the other hand imaging techniques and the frontier application
of 3D printing are emerging as valuable ally for cardiac procedures.
However, no andomised trial has directly assessed the impact of
preprocedural imaging and especially 3D printing guidance for AF ablation.
The present study is designed to investigate for the first time the effect
of 3Dprinting of the heart on the safety and effectiveness of the ablation
procedure. Design and method: The 3D-GALA trial is a andomised, open-
label, controlled, multicentre clinical trial of 2 parallel groups
designed to enrol a total of 100 patients undergoing ablation using
cryo-balloon for paroxysmal and persistent AF. Patients will be andomised
with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the
heart and 3D printing of left atrium and pulmonary veins and cryoablation
versus standard cryoablation without imaging. Patients will be followed up
to 6 months after the index procedure Results: The primary outcome measure
is the reduction of radiation dose and contrast amount during pulmonary
veins isolation. Secondary endpoints will include the percentage of atrial
fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6
months after initial treatment. Conclusion(s): To our knowledge, the
3D-GALA trial will be the first study to provide evidence about the
clinical impact of preprocedural imaging and 3D printing before
cryoablation.

<12>
Accession Number
638439673
Title
GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS DO NOT DECREASE THE RISK FOR
CORONARY REVASCULARIZATION IN PATIENTS WITH TYPE 2 DIABETES: A
META-ANALYSIS OF CARDIOVASCULAR OUTCOME TRIALS.
Source
Journal of Hypertension. Conference: 31st Scientific Meeting of the
European Society of Hypertension, ESH 2022. Athens Greece. 40(Supplement
1) (pp e164), 2022. Date of Publication: June 2022.
Author
Patoulias D.; Katsimardou A.; Imprialos K.; Stavropoulos K.; Siskos F.;
Kassimis G.; Petidis K.; Papadopoulos C.; Karagiannis A.; Doumas M.
Institution
(Patoulias, Katsimardou, Imprialos, Stavropoulos, Siskos, Petidis,
Papadopoulos, Karagiannis, Doumas) Aristotle University of Thessaloniki,
Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
(Kassimis) Aristotle University of Thessaloniki, Second Department of
Cardiology, Thessaloniki, Greece
(Doumas) Aristotle University of Thessaloniki, Third Department of
Cardiology, Thessaloniki, Greece
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Cardiovascular disease (CVD) is common among subjects with type
2 diabetes mellitus (T2DM), while it represents the main cause of death,
accounting for half of deaths in this population. Prevalence of coronary
artery disease (CAD) among diabetic subjects is relatively high, more than
20%. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of
antidiabetics with established cardiovascular benefits for patients with
T2DM, have been shown to decrease the risk for major adverse
cardiovascular events, cardiovascular and all-cause mortality, while they
have been shown to decrease the risk for fatal or non-fatal myocardial
infarction; therefore they have been suggested as second-line treatment
option for patients with T2DM and established atherosclerotic
cardiovascular disease. Design and method: We searched PubMed from
inception to September 1st, 2021, for the relevant cardiovascular outcome
trials with GLP-1RAs in patients with T2DM, to pool data concerning
coronary revascularization. We searched both published reports and
supplementary appendices. We evaluated the surrogate outcome of coronary
revascularization with GLP-1RAs versus placebo. Result(s): We pooled
data from 5 trials in a total of 41,355 subjects with T2DM. GLP-1RA
treatment compared to placebo did not have a significant effect on the
risk for coronary revascularization (risk ratio = 0.95, 95% CI; 0.81 -
1.11, I2 = 77%, p = 0.51). No significant differences were observed during
various subgroup analyses. Conclusion(s): Despite their established
cardioprotective effects in high-risk patients with T2DM, GLP-1RAs do not
seem to confer a significant risk reduction in terms of coronary
revascularization. Additional analyses according to the type of
revascularization procedure might provide interesting insights.

<13>
Accession Number
638439604
Title
EFFECT OF MOBILE APPLICATIONS FOR PHYSICAL ACTIVITY TRACKING ON EXERCISE
TOLERANCE IN PATIENTS WITH HYPERTENSION AND CORONARY ARTERY DISEASE.
Source
Journal of Hypertension. Conference: 31st Scientific Meeting of the
European Society of Hypertension, ESH 2022. Athens Greece. 40(Supplement
1) (pp e163), 2022. Date of Publication: June 2022.
Author
Tsygankova O.; Ponkin S.; Veretyuk V.
Institution
(Tsygankova, Veretyuk) Novosibirsk State Medical University, Department of
Urgent Internal Medicine,Endocrinology and Occupational Medicine,
Novosibirsk, Russian Federation
(Tsygankova) Research Institute of Therapy and Preventive Medicine, Branch
of the Institute of Cytology and Genetics of RAS, Novosibirsk, Russian
Federation
(Ponkin) Resort-Hotel Sosnovka, Berdsk, Russian Federation
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To assess the effect of smartphone applications designed for
physical activity tracking on exercise tolerance of patients with arterial
hypertension (HTN) and coronary artery disease (CAD) during rehabilitation
program. Design and method: We examined 464 patients with HTN (men 176,
37.9%) aged 61.7 +/- 11.0 who attended rehabilitation programs in 5 days
to 6 months after myocardial infarction (median 24 [6; 92] days) in health
campus. Most of the patients undergone coronary revascularization: 371
(80.0%) - percutaneous coronary intervention and 75 (16.1%) coronary
artery bypass grafting; 18 patients (3.9%) had non-invasive management.
Patients were randomized in two groups: I (n = 238, 51.3%) were using
mobile apps with activity trackers and II (control, n = 226, 48.7%)
without intervention. The six-minute walk test (6MWT) was performed at the
time of admission, in the middle of the rehabilitation course (the 6th
day) and before discharge (the 12th day) (6MWT1, 6MWT2 and 6MWT3,
respectively). We compared groups using Mann-Whitney U test and assessed
changes in 6MWT distance as the difference between measurements
(delta6MWT2-1 = 6MWT2 - 6MWT1 and delta6MWT3-1 = 6MWT3 - 6MWT1).
 Result(s): The 6MWT1 distance on admission did not differ between the
experimental and control groups (440.1 +/- 82.3 m vs 421.3 +/- 78.1 m, p =
0.81). The 6MWT distance increased over time in both groups. In the middle
and at the end of the course difference between the groups became
statistically significant: 6MWT2 in I group 499.3 +/- 88.5 m vs 446.0 +/-
82.7 in group II, p < 0.001; 6MWT3 was 570.6 +/- 89.5 m vs 473.6 +/- 88.3
m, respectively, p < 0.001. Experimental group had a more pronounced
increase in 6MWT after the 2nd measurement (delta6MWT2-1 59.1 +/- 26.3 m
vs 25.6 +/- 17.7m, p < 0.001) and the 3rd measurement (delta6MWT3-1 was
130.5 +/- 45.2 m vs 52.5 +/- 30.6 m, p < 0.001). Conclusion(s): The
use of mobile apps for physical activity tracking in patients with HTN and
CAD after MI was associated with an increase in the 6MWT distance on the
6th and 12th day of cardiac rehabilitation program compared with the
control group. (Figure Presented).

<14>
Accession Number
638439392
Title
THE INFLUENCE OF SHORT-TERM EXERCISE TRAINING ON ARTERIAL BLOOD PRESSURE
AND QT DISPERSION IN PATIENCE AFTER SURGICAL AORTIC VALVE REPLACEMENT.
Source
Journal of Hypertension. Conference: 31st Scientific Meeting of the
European Society of Hypertension, ESH 2022. Athens Greece. 40(Supplement
1) (pp e293), 2022. Date of Publication: June 2022.
Author
Stoickov V.; Deljanin Ilic M.; Stoickov M.; Tasic I.; Stoickov I.; Kostic
S.; Marinkovic D.; Simonovic D.
Institution
(Stoickov, Deljanin Ilic, Tasic) University of Nis, Medical Faculty,
Institute of Cardiology Niska Banja, Nis, Serbia
(Stoickov, Kostic, Marinkovic, Simonovic) Institute of Cardiology Niska
Banja, Nis, Serbia
(Stoickov) Human Polyclinic, Nis, Serbia
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The aim of this study was to establish the influence of
short-term exercise training on arterial blood pressure and QT dispersion
in patients after surgical aortic valve replacement (SAVR). Design and
method: The study involved 103 patients after SAVR, in the sinus rhythm
without AV blocks or branch blocks. Average age of patients was 60.8
years. Patients were randomly divided into the physical training group
(training group: 85 patients) and control group (non-training group: 18
patients). Patients were similar as to age and baseline stress test
duration. In all subjects clinical examination, standard ECG and exercise
test on treadmill according to Bruce protocol were performed and after
that training group patients were included in physical training program
for three weeks. Training group patients were instructed to follow a
training program using the bicycle ergometer (10 min, 2 times a day),
gymnastic exercises and walking. The patients continued to take the same
medicaments in same doses. From standard ECG corrected QT dispersion
(QTdc) was calculated. Result(s): After three weeks, we have found
significant reduction of QTdc from 79.1 +/- 19.7 to 70.8 +/- 20.4 ms; p <
0.02 in the training group. Also, in the training group, we have found
significant reduction of heart rate from 78.6 +/- 7.1 to 65.9 +/- 6.1
beats/min (p < 0.001), of systolic blood pressure from 137.4 +/- 13.1 to
127.7 +/- 11.5 mmHg (p < 0.025), of diastolic blood pressure from 87.8 +/-
8.9 to 84.2 +/- 7.5 mmHg (p < 0.01) and of double product from 11996.7 +/-
1162.4 to 10518.8 +/- 794.3 beat/min x mmHg; p < 0.001. In contrast, the
non-training group showed no significant changes. Conclusion(s): The
study showed that short-term exercise training have favourable effects on
arterial blood pressure and QT dispersion in patients after SAVR. Physical
training led to the significant decrease of myocardial oxygen uptake at
rest and probably decreased the possibility of arrhythmia events in
patients after SAVR.

<15>
Accession Number
638439295
Title
THE DANTON STUDY - DISCONTINUATION OF ANTIHYPERTENSIVE TREATMENT IN OLDER
PEOPLE WITH DEMENTIA LIVING IN A NURSING HOME: RESULTS OF A RANDOMIZED
CONTROLLED TRIAL.
Source
Journal of Hypertension. Conference: 31st Scientific Meeting of the
European Society of Hypertension, ESH 2022. Athens Greece. 40(Supplement
1) (pp e1), 2022. Date of Publication: June 2022.
Author
Bogaerts J.; Gussekloo J.; De Jong-Schmit B.; Achterberg W.; Poortvliet R.
Institution
(Bogaerts, Gussekloo, De Jong-Schmit, Achterberg, Poortvliet) Leiden
University Medical Center, Department of Public Health and Primary Care,
Leiden, Netherlands
(Gussekloo) Leiden University Medical Center, Department of Internal
medicine, Section Gerontology and Geriatrics, Leiden, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Neuropsychiatric symptoms (NPS), such as apathy and agitation,
are highly prevalent in nursing home (NH) residents with dementia.
Literature suggests an association of both cerebral hypoperfusion and
antihypertensive treatment (AHT) with NPS in patients with dementia.
Therefore, we investigated whether discontinuation of AHT in NH residents
with dementia reduces NPS and improves quality of life (QoL). Design and
method: Randomized, single-blinded trial conducted in 26 Dutch NH
organisations. Residents with moderate-severe dementia and a systolic
blood pressure < 160 mmHg during AHT were randomized in an intervention
(semiprotocolized discontinuation) and control (continuation) group during
a period of 8 months. Exclusion criteria were heart failure
NYHA-class-III/IV, angina pectoris, a recent cardiovascular
event/reperfusion procedure, or a life-expectancy < 4 months. Co-primary
endpoints were NPS (Neuropsychiatric Inventory-Nursing Home version) and
QoL (Qualidem) at 4 months. Secondary endpoints include cognitive
function, care dependency, general daily functioning and falls.
 Result(s): Between December 2018 and May 2021, 205 NH residents with
dementia (median age 86 years-79.5% women) were randomized, of which 177
(86.3%) reached the primary endpoint at 4 months. During trial, 63 severe
adverse events occurred in 61 residents. On advice of the Data Safety
Monitoring Board, the study was preliminary finished in December 2021 due
to futility based on the coprimary endpoints. Definitive results for all
endpoints measured at 4 and 8 months follow-up will be available in April
2022. Conclusion(s): This is, to our knowledge, the largest AHT
deprescription trial in NH residents with dementia. Based on preliminary
results of this study, the benefits of deprescribing AHT in NH residents
with dementia for reduction of NPS and improvement of QoL, are unclear and
may not be without any potential risk.

<16>
Accession Number
638438963
Title
Insights from Meta-analysis of Studies Using Machine Learning to Predict
Mortality or Acute Kidney Injury after Coronary Artery Bypass Graft.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: Scientific
Sessions of the American Heart Association's Quality of Care and Outcomes
Research, QCOR 2022. Reston, VA United States. 15(Supplement 1) (no
pagination), 2022. Date of Publication: May 2022.
Author
Ahmed M.A.; Zhang Z.; McGranaghan P.; Rubens M.; Ramamoorthy V.; Saxena
A.; Chaparro S.; Jimenez J.; Veledar E.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Machine learning (ML) may enhance prediction of outcomes such
as mortality or acute kidney injury (AKI) among cardiac patients after
coronary artery bypass graft (CABG). In this study, we used meta-analyses
of reported ML models to assess what ML has been able to accomplish in
this field, by evaluating the model performance in studies with CABG
patients. Method(s): We performed a literature search using Google
Scholar and included studies that reported AUC and 95% CI for various
models in our analysis. In addition, total participants, year of
publication, type of analytical method (gradient boosting, random forest,
etc.) and type of outcome (mortality or AKI) were extracted. We combined
effect sizes using random effects model, and tested for heterogeneity, and
publication bias. Result(s): 5 models from 5 studies were included in
the analysis (patients= 35,152; with outcome mortality =3,080, AKI=933).
Combined mean AUC was 0.796 (95% CI: 0.776, 0.815). Test of heterogeneity
showed high variation between studies (I2= 66.7%). Egger's test
intercept was-1.03 (95% CI:-7.22, 5.17, p >.25) indicating no small study
bias. Meta regression showed newer publications had a positive association
(coef = 0.003) and number of variables in the study had a negative
association with higher AUC values (coef =-0.0002). In subgroup analysis,
the pooled AUC values for mortality and AKI groups were 0.795 and 0.805
respectively. The highest individual AUC was from ensemble model
predicting AKI with AUC 0.84 and lowest was from gradient boosting model
predicting mortality with AUC 0.77. Conclusion(s): Among the
presented models for CABG ensemble methods performed well, but
surprisingly methods with lesser number of variables tended to have higher
predictive power. In near future, ML-based models may form the basis to
build intelligent decision support systems for patient selection and risk
stratification prior to CABG and could be applied to other cardiac
surgeries.

<17>
Accession Number
638438880
Title
Understanding Baseline Physical Activity in Cardiac Rehabilitation
Enrollees Using Mobile Health Technologies.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: Scientific
Sessions of the American Heart Association's Quality of Care and Outcomes
Research, QCOR 2022. Reston, VA United States. 15(Supplement 1) (no
pagination), 2022. Date of Publication: May 2022.
Author
Golbus J.R.; Gupta K.; Stevens R.; Swetha Jeganathan V.; Luff E.;
Kohnstamm S.; Nallamothu B.K.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac rehabilitation (CR) improves physical activity (PA)
and reduces morbidity for patients with cardiovascular disease. We
understand little of baseline PA as patients initiate CR, particularly
when outside of CR. We used mobile health (mHealth) technology to
understand baseline PA of patients initiating CR within a clinical trial
to potentially inform personalized care. Method(s): The Virtual
AppLication-Supported Environment to INcrease Exercise During Cardiac
Rehabilitation Study (VALENTINE) Study is a prospective,
randomized-controlled, remotely administered trial designed to evaluate an
mHealth intervention to supplement CR for low-and moderate-risk patients.
Participants are randomized after 2 CR sessions; all receive a smartwatch
and usual care. Remotely administered baseline PA outcomes include
6-minute walk distance, step count, and exercise minutes. Baseline PA was
assessed for 7-days after study enrollment for compliant days, defined by
>8 hours of watch wear/day. Multivariable linear regression identified
features associated with baseline PA. Result(s): From October 19,
2020 to January 31, 2022, 180 participants enrolled. Participants are
mostly White [156 (86.7%)]; 59 (32.8%) are female and 69 (38.3%) are > 65
years old. Most enrolled in CR after coronary revascularization [114
(64.4%)] or valve intervention [40 (22.2%)]. Comorbidities include
hypertension (65.0%), valve disease (35.6%), and heart failure (17.8%).
Participants were compliant for 91.4% of days with 15.3 (4.0)
hours/compliant day. Baseline PA included 6-minute walk distance of 491.8
(147.8) meters, daily step count of 6818 (3386), and exercise minutes of
36.0 (33.4). Substantial variation in baseline PA assessed by 6-minute
walk distance was noted across age and gender but not CR indication.
 Conclusion(s): Understanding baseline PA as participants enroll in CR
may be useful in personalizing CR programs at initiation and designing
mHealth interventions.

<18>
Accession Number
638438877
Title
Application of Machine Learning in Predicting Clinical Adverse Events
after Transcatheter Aortic Valve Replacement Procedure: Insights from A
Systematic Review and Meta-analysis of Studies.
Source
Circulation: Cardiovascular Quality and Outcomes. Conference: Scientific
Sessions of the American Heart Association's Quality of Care and Outcomes
Research, QCOR 2022. Reston, VA United States. 15(Supplement 1) (no
pagination), 2022. Date of Publication: May 2022.
Author
McGranaghan P.; Meyer A.; Rubens M.; Ahmed A.; Zhang Z.; Saxena A.;
Veledar E.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Identifying patients at high risk of AE after TAVR is essential
to prolong their survival. Current prediction models for AE after TAVR
suffer from a lack of accuracy and external validation. Modern ML
approaches can account for higher-dimensional relationships among
variables, potentially improving the prediction of outcomes. We performed
a systematic review and meta-analysis to estimate the discriminative
ability of recently developed ML-based models, which predict various AE
after TAVR. Method(s): We searched Pubmed, Google Scholar, and Web of
Science for studies (Jan 2019 to Jan 2022) that used ML approaches to
predict AE after TAVR. Inputs in the meta-analysis were study-reported
c-index values and 95% CI. Subgroup analyses separated models by outcome
(mortality or clinical AE). Combined effect sizes using a random-effects
model, test for heterogeneity, and Egger's test to assess publication bias
were considered. Result(s): Eight studies were included in the
systematic review (patients = 26,023; outcomes = 1,014), of which five
models had sufficient data for the meta-analysis. The number of features
included in each model ranged from 6 to 107. The two most common models
were random forest (n=2) and logistic regression (n=2). The most common
outcome was mortality (n=5). The meta-analysis showed that models
predicting mortality performed better (0.90; 95% CI: 0.81, 1.01) than
models predicting clinical AE (0 80; 95% CI: 0.79 0.95). The combined mean
c-index was 0.87 (95% CI: 0.79-0.95). Test of heterogeneity showed high
variation among studies (/2=98.5%). Egger's test did not
indicate publication bias (s = 1.48; 95% CI:-18.14, 21.09, p = 0.848).
 Conclusion(s): Although relatively few studies have applied ML for
predicting AE after TAVR, the results are very promising. The time of
complex sophisticated models has arrived with improved predictive accuracy
through advanced ML methods able to help identify patients who are at risk
for clinical AE early in their care.

<19>
Accession Number
2017450137
Title
Overview of mitral valve replacement versus mitral valve repair due to
ischemic papillary muscle rupture: A meta-analysis inspired by a case
report.
Source
Cardiology Journal. 29(4) (pp 680-690), 2022. Date of Publication: 04 Jul
2022.
Author
Pala B.; Romaniello A.; Cristiano E.; D'angelo A.; Grimaldi M.C.;
Figliuzzi I.; Tonelli E.; Volpe M.
Institution
(Pala, Cristiano, D'angelo, Grimaldi, Figliuzzi, Volpe) Division of
Cardiology, Department of Clinical and Molecular Medicine, Faculty of
Medicine and Psychology, Sapienza University of Rome, Italy
(Romaniello) Division of Cardiology, Sant' Andrea Hospital, Sapienza
University of Rome, Italy
(Tonelli) Department of Cardiac Surgery, Sant' Andrea Hospital, Sapienza
University of Rome, Italy
Publisher
Via Medica
Abstract
Background: Papillary muscle rupture (PMR) is an infrequent but
catastrophic complication after myocardial infarction (MI). Surgical
procedure is considered the optimal treatment, despite high risk. However,
the gold standard technique is still a major dilemma. Therefore, a
meta-analysis was carried out to assess and provide an overview comparing
mitral valve replacement (MVR) and mitral valve repair (MVr) for PMR
post-MI. Method(s): A systematic literature search was performed.
Data were extracted and verified using a standardized data extraction
form. Meta-analysis was realized mainly using RevMan 5.4 software.
 Result(s): From four observational studies 1640 patients were
identified; 81% underwent MVR and 19% MVr. Operative mortality results
were significantly higher in MVR group than the MVr group. MVR was
performed under emergency conditions and patients admitted in cardiogenic
shock or who required the use of mechanical cardiac support underwent MVR.
MVr had shorter time of hospitalization and similar incidence of
postoperative complications than MVR. No significant differences existed
between the two procedures regarding cardiopulmonary bypass time.
 Conclusion(s): Mitral valve repair appears to be a viable alternative
to MVR for post-MI PMR, given that it has lower operative mortality,
shorter time of hospitalization and similar incidence of short-term
postoperative complications than MVR. However, it needs to be pointed out
that MVR was associated with the most critical clinical condition
following PMR. There is uncertainty regarding the overall survival and
improvement of the quality of life between the procedures. Nevertheless,
further completed investigation is required. (Cardiol J 2022; 29, 4:
680-690). Copyright © 2022 Via Medica.

<20>
Accession Number
638438784
Title
Silent Brain Infarction, Delirium, and Cognition in Three Invasive
Cardiovascular Procedures: a Systematic Review.
Source
Neuropsychology review. (no pagination), 2022. Date of Publication: 08
Jul 2022.
Author
Gerstenecker A.; Norling A.M.; Jacob A.; Lazar R.M.
Institution
(Gerstenecker) Department of Neurology, University of Alabama at
Birmingham, Birmingham, AL, USA. atgers@uabmc.edu
(Gerstenecker) Alzheimer's Disease Center, University of Alabama at
Birmingham, Birmingham, AL, USA. atgers@uabmc.edu
(Gerstenecker) Evelyn F. McKnight Brain Institute, University of Alabama
at Birmingham, Birmingham, AL, USA. atgers@uabmc.edu
(Norling, Lazar) Department of Neurology, University of Alabama at
Birmingham, Birmingham, AL, USA
(Norling, Lazar) Evelyn F. McKnight Brain Institute, University of Alabama
at Birmingham, Birmingham, AL, USA
(Jacob) Department of Psychology, University of Alabama at Birmingham,
Birmingham, AL, USA
Publisher
NLM (Medline)
Abstract
Silent brain infarctions (SBIs) are brain lesions noted on neuroimaging
that are not associated with clinical symptoms. SBIs are associated with a
number of vascular risk factors and are common following invasive
cardiovascular procedures such as atrial fibrillation (AF) ablation,
coronary artery bypass graft (CABG), and transcatheter aortic valve
replacement (TAVR). Although not eliciting signs of clinical stroke, SBIs
are associated with increased frailty, and motor and mood features. Less
is known, however, about the relationship between SBI, cognition, and
delirium following invasive cardiac procedures and most investigations
into these relationships have been reported in large-scale epidemiological
studies. In the current paper, we conducted a systematic review to
evaluate evidence of a relationship between SBI, delirium, and cognitive
decline following CABG, AF ablation, and TAVR. Twenty studies met
inclusion criteria. In general, our review identified conflicting results
for each cardiac procedure, with some studies suggesting a relationship
between SBI, cognitive impairment, and delirium, whereas others showed no
relationship between SBI, cognitive impairment, and delirium. Potential
reasons for this discrepancy as well as suggestions for future research
are discussed. Copyright © 2022. The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<21>
Accession Number
2019193749
Title
Coronary artery bypass grafting versus medical therapy in patients with
stable coronary artery disease: An individual patient data pooled
meta-analysis of randomized trials.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2022.
Date of Publication: 2022.
Author
Gaudino M.; Audisio K.; Hueb W.A.; Stone G.W.; Farkouh M.E.; Di Franco A.;
Rahouma M.; Serruys P.W.; Bhatt D.L.; Biondi Zoccai G.; Yusuf S.; Girardi
L.N.; Fremes S.E.; Ruel M.; Redfors B.
Institution
(Gaudino, Audisio, Di Franco, Rahouma, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Hueb) Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, Mass, United States
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Yusuf) Population Health Research Institute, McMaster University,
Hamilton Health Sciences, Hamilton, ON, Canada
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Ruel) University of Ottawa Heart Institute, University of Ottawa, Ottawa,
ON, Canada
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Redfors) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: It is unclear whether coronary artery bypass grafting (CABG)
improves survival compared with medical therapy (MT) in patients with
stable coronary artery disease (CAD). The aim of this analysis was to
perform an individual-patient data-pooled meta-analysis of contemporary
randomized controlled trials that compared CABG and MT in patients with
stable CAD. Method(s): A systematic search was performed in January
2021 to identify randomized controlled trials enrolling adult patients
with stable CAD, randomized to CABG or MT. Only trials using at least
aspirin, beta-blockers, and statins in the MT arm were included.
Individual patient data were obtained from all eligible studies and
pooled. The primary outcome was all-cause mortality. Result(s): Four
trials involving 2523 patients (1261 CABG; 1262 MT) were included with a
median follow-up of 5.6 (4.0-9.2) years. CABG was associated with
increased risk of all-cause mortality within 30 days (hazard ratio [HR],
4.81; 95% confidence interval [CI], 1.95-11.83) but subsequent reduction
in the long-term risk of death (HR, 0.79; 95% CI, 0.69-0.89). As such, the
cumulative 10-year mortality rate was lower in patients treated with CABG
compared with MT (45.1% vs 51.7%, respectively; odds ratio, 0.70; 95% CI,
0.58-0.85). Age and race were significant treatment effect modifier
(interaction P = .003 for both). Conclusion(s): In patients with
stable CAD, initial allocation to CABG was associated with greater
periprocedural risk of death but improved long-term survival compared with
MT. The survival advantage for CABG became significant after the fourth
postoperative year and was particularly pronounced in younger and
non-White patients. Copyright © 2022 The American Association for
Thoracic Surgery

<22>
Accession Number
2015643522
Title
Prevalence of Feeding and Swallowing Disorders in Congenital Heart
Disease: A Scoping Review.
Source
Frontiers in Pediatrics. 10 (no pagination), 2022. Article Number: 843023.
Date of Publication: 05 Apr 2022.
Author
Norman V.; Zuhlke L.; Murray K.; Morrow B.
Institution
(Norman, Murray) Division of Communication Sciences and Disorders,
Department of Health and Rehabilitation Sciences, University of Cape Town,
Cape Town, South Africa
(Norman, Morrow) Department of Paediatrics and Child Health, University of
Cape Town, Cape Town, South Africa
(Zuhlke) Division of Paediatric Cardiology, Department of Paediatrics and
Child Health, Red Cross Children's Hospital, University of Cape Town, Cape
Town, South Africa
(Zuhlke) Division of Cardiology, Department of Medicine, Groote Schuur
Hospital, University of Cape Town, Cape Town, South Africa
Publisher
Frontiers Media S.A.
Abstract
Feeding and swallowing difficulties are commonly reported as comorbidities
in infants and children with congenital heart disease. These difficulties
have negative health consequences for the child and impact the quality of
life of both the child and caregivers. This scoping review presents an
integrated summary of the published literature on the prevalence of
feeding and swallowing difficulties in congenital heart disease. Fifteen
peer-reviewed articles, written in English and published in the last 25
years, were included in the review, following a search of relevant
databases. The studies reported on a total of 1,107 participants across
the articles ranging in age from premature infants to children aged 17
years. An overall pooled prevalence of 42.9% feeding and swallowing
difficulties was reported, with a prevalence of 32.9% reporting
aspiration. A wide prevalence range of feeding and swallowing difficulties
was reported across the articles and factors that contributed to this
included the ages of participants, and the definition and assessment of
feeding and swallowing difficulties used in the studies. The review
confirms that feeding and swallowing difficulties are common in infants
and children with congenital heart defects, and that assessment and
management of these difficulties should be considered part of the standard
of care. Copyright © 2022 Norman, Zuhlke, Murray and Morrow.

<23>
Accession Number
2015850154
Title
Calcium supplementation in colorectal cancer prevention: A systematic
meta-analysis of adverse events.
Source
Biocell. 46(3) (pp 759-767), 2022. Date of Publication: 2022.
Author
Luo X.M.; Khan S.; Malik A.; Aldakheel F.M.; Chaudhary A.A.; Bazarbashi
S.; Tabatabaie F.
Institution
(Luo) Department of General Surgery, Mianzhu People's Hospital of Sichuan,
Mianzhu, China
(Khan, Malik) Department of Pharmaceutics, College of Pharmacy, King Saud
University, Riyadh, Saudi Arabia
(Khan) Department of Biosciences, Shri Ram Group of College (SRGC),
Muzaffarnagar, India
(Khan) Department of Health Sciences, Novel Global Community Educational
Foundation, Sydney, Australia
(Aldakheel) Department of Clinical Laboratory Sciences, College of Applied
Medical Sciences, King Saud University, Riyadh, Saudi Arabia
(Chaudhary) Department of Biology, College of Science, Imam Mohammad Ibn
Saud Islamic University (IMSUI), Riyadh, Saudi Arabia
(Bazarbashi) Oncology Center, King Faisal Specialist Hospital and Research
Center, Riyadh, Saudi Arabia
(Tabatabaie) Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
Tech Science Press
Abstract
Despite the multiple systematic reviews and meta-analyses accumulating
evidence on the preventive effect of calcium supplementation for
colorectal cancer, most of the associated adverse effects are not
systematically analyzed. The aim of the study is evaluating adverse events
associated with calcium supplementation for colorectal cancer prevention
through a systematic meta-analysis. We searched Medline, PubMed Central,
EMBASE (Excerpta Medica database), Scopus, Cochrane Central Register of
Controlled Trials, and Web of Science published in English from database
inception up to 31 July 2019. In the current systematic meta-analysis, we
included human studies (including cohort studies, clinical trials,
case-control studies) on supplementation of calcium in patients with or at
risk of colorectal cancer. Assessment of the quality of included studies
was performed by Jadad score. Information on the patient population,
number of enrolled subjects in each group, dose of calcium
supplementation, duration of calcium supplementation, and reported adverse
events were gathered. The data were pooled for incidence rates for any
adverse event during the study period regardless of causality association.
We identified 6 studies, comprising 4583 participants that met the
inclusion criteria. Meta-analysis on pooled incidence rates for adverse
event during study period showed no statistically significant increased
risk for cancer (OR = 0.92, 95% CI: 0.70-1.21, P = 0.577; I2 =
0.0%, P = 0.731), coronary revascularization (OR = 1.12, 95% CI:
0.79-1.59, P = 0.492; I2 = 0.0%, P = 0.957), myocardial
infarction (OR = 0.81, 95% CI: 0.34-1.91, P = 0.634; I2 =
67.9%, P = 0.047), stroke (OR = 0.75, 95% CI: 0.42-1.33, P = 0.332,
I2 = 0.00%, P = 0.717), Transient Ischemic Attack (TIA) (OR =
1.37, 95% CI: 0.28-6.51, P = 0.692, I2 = 81.9%, P = 0.002),
urolithiasis (OR = 1.23, 95% CI: 0.75-2.01, P = 0.410; I2 =
0.0%, P = 0.851), fracture (OR = 0.98, 95% CI: 0.70-1.37, P = 0.938;
I2 = 37.8%, P = 0.152) and death (OR = 1.05, 95% CI: 0.71-1.56,
P = 0.786, I2 = 12.2%, P = 0.317) in patients receiving calcium
supplementation for colorectal cancer prevention compared to control.
Based on the results of Egger test, publication bias was not observed
among the studies (P = 0.262). The current result of the meta-analysis on
human studies reporting adverse events associated with calcium
supplementation for the prevention of colorectal cancer demonstrated no
statistically significant increased risk for the development of adverse
events compared to control groups. Copyright © 2022 Centro
Regional de Invest. Cientif. y Tecn.. All rights reserved.

<24>
Accession Number
2016163662
Title
The effect of dexmedetomidine on myocardial ischemia/reperfusion injury in
patients undergoing cardiac surgery with cardiopulmonary bypass: A
meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 25(23) (pp
7409-7417), 2021. Date of Publication: 2021.
Author
ZHANG G.-R.; PENG C.-M.; LIU Z.-Z.; LENG Y.-F.
Institution
(ZHANG, LIU, LENG) Department of First Clinical Medical College, Lanzhou
University, Lanzhou, China
(PENG) Department of Basic Medicine, Qinghai Institute of Health Sciences,
Xining, China
(LENG) Department of Anesthesiology, the First Hospital of Lanzhou
University, Lanzhou, China
Publisher
Verduci Editore s.r.l
Abstract
OBJECTIVE: The purpose of this study was to evaluate the effect of
dexmedetomidine administration on myocardial ischemia/ reperfusion (I/R)
injury in patients undergoing cardiac surgery with cardiopulmonary bypass
(CPB). MATERIALS AND METHODS: Online databases including PubMed, the
Cochrane Library, Web of Science, Medline, and EMBASE were searched for
clinical trials that investigated the application of dexmedetomidine in
CPB patients prior to May 2021. A total of 17 studies involving 866
patients were included in this study. RESULT(S): The result of the
meta-analysis showed that there was a significant difference in serum
creatinine-kinase-MB (CK-MB) between the dexmedetomidine group and the
control group at the end of the operation and 24 h after the operation.
Compared to the control group, cardiac troponin I (cTn-I) concentration in
the dexmedetomidine group was significantly decreased at the end of the
operation, 24 h after the operation, and 48 h after the operation. There
was also a significant difference between the dexmedetomidine group and
the control group in the length of a patient's ICU stay.
 CONCLUSION(S): Dexmedetomidine can reduce CK-MB and cTn-I
concentrations and shorten the length of ICU stays for patients undergoing
cardiac surgery with CPB. It can also provide myocardial protection from
I/R injury. Copyright © 2021 Verduci Editore s.r.l. All rights
reserved.

<25>
Accession Number
2007801153
Title
Early experience with transcatheter mitral valve replacement: A systematic
review.
Source
Journal of the American Heart Association. 8(17) (no pagination), 2019.
Article Number: e013332. Date of Publication: 03 Sep 2019.
Author
Del Val D.; Ferreira-Neto A.N.; Wintzer-Wehekind J.; Dagenais F.; Paradis
J.-M.; Bernier M.; O'connor K.; Beaudoin J.; Freitas-Ferraz A.B.;
Rodes-Cabau J.
Institution
(Del Val, Ferreira-Neto, Wintzer-Wehekind, Dagenais, Paradis, Bernier,
O'connor, Beaudoin, Freitas-Ferraz, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, QC, Canada
Publisher
American Heart Association Inc.
Abstract
Background--Transcatheter mitral valve replacement (TMVR) has emerged as
an alternative therapeutic option for the treatment of severe mitral
regurgitation in patients with prohibitive or high surgical risk. The aim
of this systematic review is to evaluate the clinical procedural
characteristics and outcomes associated with the early TMVR experience.
Methods and Results--Published studies and international conference
presentations reporting data on TMVR systems were identified. Only records
including clinical characteristics, procedural results, and 30-day and
midterm outcomes were analyzed. A total of 16 publications describing 308
patients were analyzed. Most patients (65.9%) were men, with a mean age of
75 years (range: 69-81 years) and Society for Thoracic Surgery Predicted
Risk of Mortality score of 7.7% (range: 6.1-8.6%). The etiology of mitral
regurgitation was predominantly secondary or mixed (87.1%), and 81.5% of
the patients were in New York Heart Association class III or IV. A
transapical approach was used in 81.5% of patients, and overall technical
success was high (91.7%). Postprocedural mean transmitral gradient was 3.5
mm Hg (range: 3-5.5 mm Hg), and only 4 cases (1.5%) presented residual
moderate to severe mitral regurgitation. Procedural and all-cause 30-day
mortality were 4.6% and 13.6%, respectively. Left ventricular outflow
obstruction and conversion to open heart surgery were reported in 0.3% and
4% of patients, respectively. All-cause and cardiovascular-related
mortality rates were 27.6% and 23.3%, respectively, after a mean follow-up
of 10 (range: 3 to 24) months. Conclusions--TMVR was a feasible, less
invasive alternative for treating severe mitral regurgitation in patients
with high or prohibitive surgical risk. TMVR was associated with a high
rate of successful valve implantation and excellent hemodynamic results.
However, periprocedural complications and all-cause mortality were
relatively high. Copyright 2019 The Authors.

<26>
Accession Number
2018177589
Title
Surgical site wound infection, and other postoperative problems after
coronary artery bypass grafting in subjects with chronic obstructive
pulmonary disease: A meta-analysis.
Source
International Wound Journal. (no pagination), 2022. Date of Publication:
2022.
Author
Gao J.; Wang H.; Liu X.; Song X.; Zhong X.
Institution
(Gao, Wang, Zhong) Department of Respiratory and Critical Care Medicine,
The First Affiliated Hospital of Guangxi Medical University, Nanning,
China
(Gao, Liu, Song) Department of Rheumatism and Immunology, The Fourth
Affiliated Hospital of Guangxi Medical University, Liuzhou, China
Publisher
John Wiley and Sons Inc
Abstract
We performed a meta-analysis to evaluate the effect of chronic obstructive
pulmonary disease on surgical site wound infection, and other
postoperative problems after coronary artery bypass grafting. A systematic
literature search up to April 2022 was performed and 37 444 subjects with
coronary artery bypass grafting at the baseline of the studies; 4320 of
them were with the chronic obstructive pulmonary disease, and 33 124 were
without chronic obstructive pulmonary disease. Odds ratio (OR), and mean
difference (MD) with 95% confidence intervals (CIs) were calculated to
assess the effect of chronic obstructive pulmonary disease on surgical
site wound infection, and other postoperative problems after coronary
artery bypass grafting using the dichotomous, and contentious methods with
a random or fixed-effect model. The chronic obstructive pulmonary disease
subjects had a significantly higher surgical site wound infection (OR,
1.27; 95% CI, 1.01-1.60, P = 0.04), respiratory failure (OR, 1.84; 95% CI,
1.55-2.18, P < 0.001), mortality (OR, 1.61; 95% CI, 1.37-1.89, P < 0.001),
pneumonia (OR, 2.30; 95% CI, 1.97-2.68, P < 0.001), pleural effusion (OR,
1.78; 95% CI, 1.12-2.83, P = 0.02), stroke (OR, 1.99; 95% CI, 1.17-3.36, P
= 0.01), and length of intensive care unit stay (MD, 0.73; 95% CI,
0.19-1.26, P = 0.008) after coronary artery bypass grafting compared with
subjects without chronic obstructive pulmonary disease. However, chronic
obstructive pulmonary disease subjects did not show any significant
difference in length of hospital stay (MD, 0.83; 95% CI, -0.01 to 1.67, P
= 0.05), and pneumothorax (OR, 1.59; 95% CI, 0.98-2.59, P = 0.06) after
coronary artery bypass grafting compared with subjects without chronic
obstructive pulmonary disease. The chronic obstructive pulmonary disease
subjects had a significantly higher surgical site wound infection,
respiratory failure, mortality, pneumonia, pleural effusion, stroke, and
length of intensive care unit stay, and no significant difference in
length of hospital stay, and pneumothorax after coronary artery bypass
grafting compared with subjects without chronic obstructive pulmonary
disease. The analysis of outcomes should be with caution because of the
low sample size of 1 out of 11 studies in the meta-analysis and a low
number of studies in certain comparisons. Copyright © 2022 The
Authors. International Wound Journal published by Medicalhelplines.com Inc
(3M) and John Wiley & Sons Ltd.

<27>
Accession Number
2018177077
Title
Titrated versus conventional anticoagulation management for thrombin
generation in cardiac surgery: a randomized controlled trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2022. Date of
Publication: 2022.
Author
Li H.; Bartoszko J.; Serrick C.; Rao V.; Karkouti K.
Institution
(Li, Serrick) Perfusion Services, University Health Network, Toronto, ON,
Canada
(Bartoszko, Karkouti) Department of Anesthesia and Pain Management, Sinai
Health System, Women's College Hospital, University Health Network,
Toronto, ON, Canada
(Bartoszko, Karkouti) Department of Anesthesiology and Pain Medicine,
University of Toronto, Toronto, ON, Canada
(Rao) Cardiovascular Surgery, University Health Network and University of
Toronto, Toronto, ON, Canada
(Bartoszko, Rao, Karkouti) Peter Munk Cardiac Centre, University Health
Network, Toronto, ON, Canada
(Karkouti) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
(Karkouti) Institute for Health Policy, Management, and Evaluation,
University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: Optimal heparin titration during cardiopulmonary bypass (CPB) may
reduce coagulation system activation and preserve hemostatic function
post-CPB. Our objective was to assess if the Heparin Management System
(HMS) Plus improves heparin titration, thereby leading to higher thrombin
generation post-CPB compared with activated clotting time (ACT)-guided
management. Method(s): We conducted a randomized controlled trial of
100 patients undergoing cardiac surgery with CPB at a single center. A
total of 50 patients were randomized to conventional ACT-guided
management, and 50 to the HMS Plus system. The primary outcome was change
in thrombin generation post-CPB compared with baseline, as assessed by
calibrated automated thrombography. Secondary outcomes included
intraoperative blood loss, chest drain output up to 72 hr, and
transfusions. In an exploratory analysis, we compared the quintile of
patients with the highest average heparin concentration on CPB (>= 4.0
mgkg-1) with the rest of the cohort. Result(s): A total of
100 patients were included in an intent-to-treat analysis. We observed no
difference in post-CPB thrombin generation or secondary outcomes. However,
patients in the HMS Plus group had higher average heparin concentrations
while on CPB than patients in the conventional management group did (mean
difference, -0.21; 95% confidence interval, -0.42 to -0.01). The quintile
of patients with the highest average heparin concentration (4.0
mgkg-1) had higher thrombin generation post-CPB than the rest
of the cohort did. Conclusion(s): The HMS Plus system did not show
significant benefits in thrombin generation, bleeding outcomes, or
transfusion in patients undergoing cardiac surgery with CPB. Higher
average heparin concentrations on CPB were associated with higher post-CPB
thrombin generation. Study registration: www.ClinicalTrials.gov
(NCT03347201); first submitted 12 October 2017. Copyright © 2022,
Canadian Anesthesiologists' Society.

<28>
Accession Number
638427499
Title
Etiology, Pathophysiology and Mortality of Shock in Children in Low
(Middle) Income Countries: A Systematic Review.
Source
Journal of tropical pediatrics. 68(4) (no pagination), 2022. Date of
Publication: 06 Jun 2022.
Author
Assies R.; Snik I.; Kumwenda M.; Chimalizeni Y.; Langton J.; van Woensel
J.B.M.; Doctor A.; Calis J.C.J.
Institution
(Assies, Snik, van Woensel, Calis) Amsterdam UMC location University of
Amsterdam, PICU, Emma Children's Hospital, Meibergdreef 9, Amsterdam, the
Netherlands
(Assies, van Woensel, Calis) Amsterdam Centre for Global Child Health,
Amsterdam, Netherlands
(Assies, Kumwenda, Chimalizeni, Langton, Calis) Department of Paediatrics
and Child Health, Kamuzu University of Health Sciences KUHeS Malawi,
Blantyre, Malawi
(Doctor) University of Maryland School of Medicine, MD, Baltimore, United
States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Shock is a life-threatening condition in children in low- and
middle-income countries (LMIC), with several controversies. This
systematic review summarizes the etiology, pathophysiology and mortality
of shock in children in LMIC. METHOD(S): We searched for studies
reporting on children with shock in LMIC in PubMed, Embase and through
snowballing (up to 1 October 2019). Studies conducted in LMIC that
reported on shock in children (1 month-18years) were included. We excluded
studies only containing data on neonates, cardiac surgery patients or
iatrogenic causes. We presented prevalence data, pooled mortality
estimates and conducted subgroup analyses per definition, region and
disease. Etiology and pathophysiology data were systematically collected.
 RESULT(S): We identified 959 studies and included 59 studies of which
six primarily studied shock. Definitions used for shock were classified
into five groups. Prevalence of shock ranged from 1.5% in a pediatric
hospital population to 44.3% in critically ill children. Pooled mortality
estimates ranged between 3.9-33.3% for the five definition groups.
Important etiologies included gastroenteritis, sepsis, malaria and severe
anemia, which often coincided. The pathophysiology was poorly studied but
suggests that in addition to hypovolemia, dissociative and cardiogenic
shock are common in LMIC. CONCLUSION(S): Shock is associated with
high mortality in hospitalized children in LMIC. Despite the importance
few studies investigated shock and as a consequence limited data on
etiology and pathophysiology of shock is available. A uniform bedside
definition may help boost future studies unravelling shock etiology and
pathophysiology in LMIC. Copyright © The Author(s) [2022].
Published by Oxford University Press. All rights reserved. For
permissions, please email: journals.permissions@oup.com.

<29>
Accession Number
638420458
Title
Ultrasound-Guided Oblique Sagittal Anterior Quadratus Lumborum Block in
Total Hip Arthroplasty: A Randomized Controlled Trial.
Source
Pain physician. 25(4) (pp E609-E617), 2022. Date of Publication: 01 Jul
2022.
Author
Wang N.; Ruan B.; Wang M.; Chen L.; Ying T.; Ye W.; Li H.
Institution
(Wang, Ruan, Ying, Ye, Li) Department of Anesthesiology, Taizhou Hospital
of Zhejiang Province, Wenzhou Medical University, China
(Wang, Chen) Department of Anesthesiology, Taizhou Hospital of Zhejiang
Province Affiliated to Wenzhou Medical University, Zhejiang Province,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The anterior quadratus lumborum block (QLB) is gaining
popularity in total hip arthroplasty (THA) surgeries for postoperative
pain management and this technique rarely results in lower limb muscle
weakness. However, no studies have described the range of its blockade.
 OBJECTIVE(S): The aim of the study was to confirm the range of cold
temperature sensory blockades, observe the opioid consumption after THA
surgery, assess the pain of the patients, and assess the safety of this
technique. STUDY DESIGN: Randomized controlled study. SETTING: Taizhou
Hospital of Zhejiang Province. METHOD(S): Patients who underwent
primary THAs were randomized to take an oblique sagittal anterior QLB with
30 mL of 0.375% ropivacaine (QLB+G group) or with 30 mL of 0.9% saline (G
group). The main purpose of the study was to confirm the range of cold
hypoesthesia. The other aim included the average blood pressure, heart
rate, surgical pleth index, and bispectral index values fluctuation during
the intraoperative period of expanding the medullary cavity, the
sufentanil, and remifentanil consumption during the operation, the amount
of time the patients stayed in the Postanesthesia Care Unit, the 8 hours,
16 hours, and 24 hours total dosage of oxycodone, the resting and exercise
Visual Analog Scale (VAS) pain scores at 8 hours, 16 hours, and 24 hours
after surgery, postoperative adverse events, and safety. RESULT(S):
The QLB+G group identified areas of cold hypoesthesia after the block, but
there were no areas of cold hypoesthesia in the G group. The consumption
of oxycodone in the 8 hours, 16 hours, and 24 hours after the surgery and
the consumption of sufentanil during the surgery were significantly
smaller in the QLB+G group (P < 0.05). The QLB+G group have lower pain
scores at the resting 8 hours and exercise 8 hours, 16 hours, and 24 hours
after the surgery (P < 0.05). The 2 groups have comparable safety in the
study. LIMITATIONS: This study only tested the areas of cold hypoesthesia
after the QLB, but not tested the area of sensory loss. Using ice to test
for hypoesthesia is subjective, and may not reflect the actual area of the
block. CONCLUSION(S): Ultrasound-guided oblique sagittal anterior QLB
can reduce the analgesics required after and during THA and the
postoperative VAS pain scores, but it rarely affects muscle strength.

<30>
Accession Number
638417964
Title
Transcatheter Tricuspid Valve Replacement for Tricuspid Regurgitation: A
Systematic Review and Meta-analysis.
Source
Anatolian journal of cardiology. 26(7) (pp 505-519), 2022. Date of
Publication: 01 Jul 2022.
Author
Bugan B.; Cekirdekci E.I.; Onar L.C.; Barcin C.
Institution
(Bugan, Barcin) Department of Cardiology, Gulhane Training and Research
Hospital, Ankara, Turkey
(Cekirdekci) Department of Cardiology, University of Kyrenia, Turkish
Republic of Northern Cyprus, Kyrenia, Cyprus
(Onar) Department of Cardiovascular Surgery, Dr. Ismail Fehmi Cumalioglu
Government Hospital, Tekirdag, Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: The present data aim to evaluate the feasibility of the
orthotopic trans- catheter tricuspid valve replacement devices,
echocardiographic, functional improve- ments, and mortality rates
following replacement in patients with significant tricuspid valve
regurgitation. METHOD(S): We systematically searched for the studies
evaluating the efficacy and safety of transcatheter tricuspid valve
replacement for significant tricuspid valve regurgitation. The efficacy
and safety outcomes were the improvements in New York Heart Association
functional class, 6-minute walking distance, all-cause death, and
periprocedural andlong-term complications. In addition, a random-effect
meta-analysis was performed comparing outcomes before and after
transcatheter tricuspid valve replacement. RESULT(S): Nine studies
with 321 patients were included. The mean age was 75.8 years, and the mean
European System for Cardiac Operative Risk Evaluation II score was 8.2%
(95% CI: 6.1 to 10.3). Severe, massive, and torrential tricuspid valve
regurgitation was diagnosed in 95% of patients (95% CI: 89% to 98%), and
83% (95% CI: 73% to 90%) of patients were in New York Heart Association
functional class III or IV. At a weighted mean follow-up of 122 days, New
York Heart Association functional class (risk ratio = 0.20; 95% CI: 0.11
to 0.35; P < .001) and 6-minute walking distance (mean difference = 91.1
m; 95% CI: 37.3 to 144.9 m; P < .001) significantly improved, and
similarly, the prevalence of severe or greater tri- cuspid valve
regurgitation was significantly reduced after transcatheter tricuspid
valve replacement (baseline risk ratio = 0.19; 95% CI: 0.10 to 0.36; P <
.001). In total, 28 patients (10%; 95% CI: 6% to 17%) had died. Pooled
analyses demonstrated non-significant differ- ences in hospital and 30-day
mortality and >30-day mortality than predicted operative mortality (risk
ratio = 1.03; 95% CI: 0.41 to 2.59; P = .95, risk ratio = 1.39; 95% CI:
0.69 to 2.81; P = .35, respectively). CONCLUSION(S): Transcatheter
tricuspid valve replacement could be an emerging treatment option for
patients with severe tricuspid regurgitation who are not eligible for
transcath-eter repair or surgical replacement because of high surgical
risk and poor prognosis.

<31>
Accession Number
2019117347
Title
Anesthetics to Prevent Lung Injury in Cardiac Surgery: A Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
O'Gara B.P.; Shaefi S.; Gasangwa D.V.; Patxot M.; Beydoun N.; Mueller
A.L.; Sagy I.; Novack V.; Banner-Goodspeed V.M.; Kumaresan A.; Shapeton
A.; Spear K.; Bose S.; Baedorf Kassis E.N.; Gosling A.F.; Mahmood
F.-U.-D.; Khabbaz K.; Subramaniam B.; Talmor D.S.
Institution
(O'Gara, Shaefi, Gasangwa, Patxot, Beydoun, Banner-Goodspeed, Bose,
Baedorf Kassis, Mahmood, Subramaniam, Talmor) Beth Israel Deaconess
Medical Center, Department of Anesthesia, Critical Care, and Pain
Medicine, Boston, MA
(Mueller) Massachusetts General Hospital, Department of Anesthesia,
Boston, MA
(Sagy, Novack) Clinical Research Center, Soroka University Medical Center,
Beer-Sheva, Israel
(Kumaresan) Keck Medical Center, Department of Anesthesiology, Los
Angeles, CA
(Shapeton) Veterans Affairs Boston Healthcare, West Roxbury, MA, United
States
(Spear) Beth Israel Deaconess Medical Center, Department of Perfusion,
Boston, MA
(Gosling) Duke University Medical Center, Department of Anesthesia,
Raleigh, NC
(Khabbaz) Beth Israel Deaconess Medical Center, Department of Surgery,
Division of Cardiac Surgery, Boston, MA
Publisher
W.B. Saunders
Abstract
Objectives: To investigate if sevoflurane based anesthesia is superior to
propofol in preventing lung inflammation and preventing postoperative
pulmonary complications. Design(s): Randomized controlled trial.
 Setting(s): Single tertiary care university hospital.
 Participant(s): Forty adults undergoing cardiac surgery with
cardiopulmonary bypass. Intervention(s): Patients were randomized in
a 1:1 ratio to anesthetic maintenance with sevoflurane or propofol.
 Measurements and Main Results: Blood and bronchoalveolar lavage fluid
was sampled before and after bypass to measure pulmonary inflammation
using a biomarker panel. The change in bronchoalveolar lavage
concentration of tumor necrosis factor alpha (TNFalpha) was the primary
outcome. Secondary outcomes included lung inflammation defined as changes
in other biomarkers and postoperative pulmonary complications. There were
no significant differences between groups in the change in bronchoalveolar
lavage TNFalpha concentration (median [IQR] change, 17.24 [1.11-536.77] v
101.51 [1.47-402.84] pg/mL, sevoflurane v propofol, p = 0.31). There was a
significantly lower postbypass concentration of plasma interleukin 8
(median [IQR], 53.92 [34.5-55.91] v 66.92 [53.03-94.44] pg/mL, p = 0.04)
and a significantly smaller postbypass increase in the plasma receptor for
advanced glycosylation end products (median [IQR], 174.59 [73.59-446.06] v
548.22 [193.15-852.39] pg/mL, p = 0.03) in the sevoflurane group compared
with propofol. The incidence of postoperative pulmonary complications was
100% in both groups, with high rates of pleural effusion (17/18 [94.44%] v
19/22 [86.36%], p = 0.39) and hypoxemia (16/18 [88.88%] v 22/22 [100%], p
= 0.11). Conclusion(s): Sevoflurane anesthesia during cardiac surgery
did not consistently prevent lung inflammation or prevent postoperative
pulmonary complications compared to propofol. There were significantly
lower levels of 2 plasma biomarkers specific for lung injury and
inflammation in the sevoflurane group. Copyright © 2022 Elsevier
Inc.

<32>
Accession Number
2018189859
Title
Systematic Review of Venous Stent Migration to the Heart.
Source
Journal of Vascular Surgery. Conference: VAM 2022. Boston United States.
75(6) (pp e234-e235), 2022. Date of Publication: June 2022.
Author
Alameddine D.; Ali S.H.; Brackett A.; Attaran R.; Mojibian H.; Tonnessen
B.H.; Guzman R.J.; Ochoa Chaar C.I.
Institution
(Alameddine, Brackett) Yale University, New Haven, Conn
(Ali) Yale New Haven Hospital, New Haven, Conn
(Attaran, Mojibian, Tonnessen, Guzman, Ochoa Chaar) Yale University School
of Medicine, New Haven, Conn
Publisher
Elsevier Inc.
Abstract
Objective: Venous stent migration to the heart is a potentially
life-threatening complication and has recently led to device withdrawal
from the market. A review of the literature was conducted to better
characterize factors associated with this serious complication and its
management. Method(s): A systematic review of the literature using
the term "venous stent migration" was performed. All articles describing
patients with this complication were reviewed. Patient characteristics,
indication, time to discovery of migration, and management were
summarized. Venous stents that migrated from the lower body to the heart
were compared with venous stents that migrated from the upper body.
 Result(s): A total of 73 papers with 84 patients reported venous
stent migration to the heart or through the heart to the pulmonary artery.
The number of papers reporting this phenomenon increased from 6 in the
period of 1991-1995 to 20 in the period of 2016-2020 (Fig). The incidence
of venous stenting migration varied mostly between 0.4% and 4.5%. Patients
with migration from lower body were significantly younger (49.1 vs 56.9, P
=.05). There were significant differences in indications for stenting with
most patients with upper body migration being treated for dialysis access
maintenance while patients with lower body migration treated for venous
insufficiency/thrombosis (P <.001). Of the cases of venous stent
migrations from lower body, 20% (8 of 41) were due to Nutcracker syndrome
as an indication. There was no difference in stent characteristics in
terms of type (86% self-expanding) or size. The implanted stents were
relatively small (mean diameter = 14 mm) and short (mean length = 4.5 mm).
After venous stent migration, most patients presented with symptoms (60%),
with no difference in mean time to presentation. Patients with upper body
stent migration were significantly more likely to be treated with no
surgery or endovascular intervention compared with those with lower body
stent migration, which was more likely to be treated with an open surgery
(P =.014) (Table). At least 12% (n = 3 of 25) of patients requiring open
surgery required valve replacement. The overall mortality related to stent
migration to the heart was 3.6% (n = 3 of 84). Conclusion(s): There
is a rise in reporting of venous stent migration to the heart in the
literature. Stent migration from the lower body seems to be less amenable
to endovascular therapy compared with migration from the upper body. This
complication carries significant mortality likely in excess of 3.6%
because of underreporting. [Formula presented] [Formula
presented] Copyright © 2022

<33>
Accession Number
638432564
Title
Intubation with vivasight double-lumen tube versus conventional
double-lumen tube in adult patients undergoing lung resection: A
retrospective analysis.
Source
Annals of cardiac anaesthesia. 25(3) (pp 279-285), 2022. Date of
Publication: 01 Jul 2022.
Author
Granell M.; Petrini G.; Kot P.; Murcia M.; Morales J.; Guijarro R.; de
Andres J.A.
Institution
(Granell, de Andres) Department of Anesthesia, Critical Care and Pain
Medicine, University General Hospital Consortium of Valencia; University
of Valencia, Spain
(Petrini) Department of Anesthesia, Critical Care and Pain Medicine, Citta
della Salute e della Scienza, Torino, Italy
(Kot, Murcia, Morales) Department of Anesthesia, Critical Care and Pain
Medicine, University General Hospital Consortium of Valencia, Spain
(Guijarro) University of Valencia; Department of Thoracic Surgery,
University General Hospital Consortium of Valencia, Spain
Publisher
NLM (Medline)
Abstract
Objectives: The present study was designed to compare outcomes in patients
undergoing thoracic surgery using the VivaSight double-lumen tube (VDLT)
or the conventional double-lumen tube (cDLT). Design(s): A
retrospective analysis of 100 patients scheduled for lung resection
recruited over 21 consecutive months (January 2018-September 2019).
 Setting(s): Single-center university teaching hospital investigation.
 Participant(s): A randomized sample of 100 patients who underwent
lung resection during this period were selected for the purpose to compare
50 patients in the VDLT group and 50 in the cDLT group.
 Intervention(s): After institutional review board approval, patients
were chosen according to inclusion and exclusion criteria and we created a
general database. The 100 patients have been chosen through a random
process with the Microsoft Excel program (Microsoft 2018, Version
16.16.16). Measurements and Main Results: The primary endpoint of the
study was to analyze the need to use fiberoptic bronchoscopy to confirm
the correct positioning of VDLT or the cDLT used for lung isolation.
Secondary endpoints were respiratory parameters, admission to the
intensive care unit, length of hospitalization, postoperative
complications, readmission, and 30-day mortality rate. The use of
fiberoptic bronchoscopy was lower in the VDLT group, and the size of the
tube was smaller. The intraoperative respiratory and hemodynamics
parameters were optimal. There were no other preoperative, intraoperative,
or postoperative differences between both groups. Conclusion(s): The
VDLT reduces the need for fiberoptic bronchoscopy, and it seems that a
smaller size is needed. Finally, VDLT is cost-effective using disposable
fiberscopes.

<34>
Accession Number
638432324
Title
Effect of perioperative use of oral triidothyronine for infants undergoing
complex congenital cardiac surgeries under cardiopulmonary bypass: A
double-blinded randomised controlled study.
Source
Annals of cardiac anaesthesia. 25(3) (pp 270-278), 2022. Date of
Publication: 01 Jul 2022.
Author
Karri S.; Mandal B.; Kumar B.; Puri G.; Thingnam S.; Kumar H.;
Unnikrishnan V.S.
Institution
(Karri, Mandal, Kumar, Puri) Department of Cardiac Anaesthesia, PGIMER,
Chandigarh, India
(Thingnam) Department of Cardiothoracic Surgery, PGIMER, Chandigarh, India
(Kumar) Department of Cardiothoracic Surgery ICU, PGIMER, Chandigarh,
India
(Unnikrishnan) Department of Pediatric Cardiac Surgery ICU, PGIMER,
Chandigarh, India
Publisher
NLM (Medline)
Abstract
Background: Thyroid hormone metabolism disrupts after cardiopulmonary
bypass both in adults and pediatric patients. This is known as Euthyroid
sick syndrome, and it is more evident in pediatric patients who were
undergoing complex cardiac surgeries compared to adults. This decrease in
serum T3 levels increases the incidence of low cardiac output, requirement
of inotropes, prolonged mechanical ventilation, and prolonged intensive
care unit (ICU) stay. Aims and Objectives: The primary objective was to
compare the mean Vasoactive-inotropic score (VIS) at 72 hours
postoperatively between T3 and Placebo groups. Material(s) and
Method(s): One hundred patients were screened, and 88 patients were
included in the study. Triidothyronine 1 mic/kg 10 doses 8th hourly was
given orally postoperatively to cases and sugar sachets to controls. The
blood samples for analysis of FT3, FT4, and TSH were taken every 24 hours
postoperatively, and baseline values were taken after induction. Mean VIS
scores, ejection Fraction (EF), Left ventricular outflow tract velocity
time integral (LVOT VTi), hemodynamics and partial pressure of oxygen/
fraction of inspired oxygen(PaO2/FiO2) were recorded daily.
 Result(s): The Mean VIS scores at 72 Hours postoperatively were
significantly less in the T3 group (5.49 +/- 6.2) compared to the Placebo
group (13.6 +/- 11.7). The PaO2/FiO2 ratios were comparatively more in the
T3 group than the Placebo group. The serum levels of FT3 FT4 were
significantly higher in the T3-supplemented group than the Placebo group.
The VIS scores were significantly lower from 48 hours postoperatively in
children < 6 months of age. Conclusion(s): In this study, we observed
that supplementing T3 postoperatively decreases the ionotropic requirement
from 72 hours postoperatively. This is more useful in children <6 months
of age undergoing complex cardiac surgeries.

<35>
Accession Number
638431669
Title
Preoperative anxiety among cardiac surgery patients and its impact on
major adverse cardiac events and mortality- A randomized, parallel-group
study.
Source
Annals of cardiac anaesthesia. 25(3) (pp 293-296), 2022. Date of
Publication: 01 Jul 2022.
Author
Mudgalkar N.; Kandi V.; Baviskar A.; Kasturi R.R.; Bandurapalli B.
Institution
(Mudgalkar) Department and Anaesthesia and Cardiac Anaesthesia, Prathima
Institute of Medical Sciences, Nagnur Road, Karimnagar, Telangana, India
(Kandi) Department and Microbiology, Prathima Institute of Medical
Sciences, Nagnur Road, Karimnagar, Telangana, India
(Baviskar) Department and Cardiac Surgery, Prathima Institute of Medical
Sciences, Nagnur Road, Karimnagar, Telangana, India
(Kasturi) Department and Cardiology, Prathima Institute of Medical
Sciences, Nagnur Road, Karimnagar, Telangana, India
(Bandurapalli) Department and Cardiac Anaesthesia, Prathima Institute of
Medical Sciences, Nagnur Road, Karimnagar, Telangana, India
Publisher
NLM (Medline)
Abstract
Background: Patients undergoing elective cardiac surgery often experience
pre-operative anxiety. Preoperative anxiety influences surgical outcome.
There are very few studies which have assessed the impact of clonidine and
Gabapentin in the treatment of anxiety especially in Indian populations
and its implications on major adverse cardiac events (MACE) and 30 days
mortality. Material(s) and Method(s): Adult patients aged 18 to 80
years old who were scheduled to have an elective coronary artery by-pass
graft (CABG) were included in the study. Those who satisfied the inclusion
criteria were given either Gabapentin (800 mg) or Clonidine (300 mcg)
90-120 minutes before the induction. State trait anxiety inventory (STAI)
was used to assess anxiety in baseline and taking just before operating
room. The primary endpoint was a reduction in the STAI associated with the
study drug, while the secondary endpoint was the incidence of MACE in the
perioperative period (30 days), which included composite episodes of
non-fatal cardiac arrest, chaotic rhythm, acute myocardial infarction,
congestive heart failure, cardiac arrhythmia, angina, and death.
 Result(s): A total of 75 patients were considered for the statistical
analysis. The demographic and clinical features of the study participants
were similar in both groups. Nearly 75-80% of participants had severe
anxiety in the preoperative period while 10-20% had moderate anxiety.
While both the drugs showed a reduction in the anxiety levels, the
clonidine group fared better (statistically insignificant). The incidence
of MACE was similar in both groups. Conclusion(s): The preoperative
anxiety levels were high among cardiac surgery patients. Both clonidine
and gabapentin were equally effective in reducing the levels of
preoperative anxiety. Preoperative STAI scores in the range of 32-53 is
not associated with MACE and 30-day mortality among cardiac surgery
patients.

<36>
Accession Number
2018145169
Title
Efficacy of N-acetylcysteine in Preventing Acute Kidney Injury and Major
Adverse Cardiac Events After Cardiac Surgery: A Meta-Analysis and Trial
Sequential Analysis.
Source
Frontiers in Medicine. 9 (no pagination), 2022. Article Number: 795839.
Date of Publication: 22 Jun 2022.
Author
Zhao J.; Li M.; Tan C.
Institution
(Zhao, Tan) Hebei Yanda Hospital, Langfang, China
(Li) No. 988th Hospital of Joint Logistic Support Force of PLA, Zhengzhou,
China
Publisher
Frontiers Media S.A.
Abstract
Background: The effect of N-acetylcysteine (NAC), an antioxidant, on
preventing acute kidney injury (AKI) and major adverse cardiac events
(MACE) remains controversial. Therefore, we conducted this meta-analysis
and trial sequential analysis to evaluate its efficacy on cardiac
surgery-related adverse events. Method(s): PubMed, Embase, and
Cochrane Library were searched for relevant studies from inception to June
2021. We selected randomized controlled trials comparing NAC with controls
in patients undergoing cardiac surgery. Result(s): Twenty-five
studies including 2,444 patients met the inclusion criteria. The pooled
results showed that there was no significant difference in the incidence
of AKI between the NAC and control groups [relative risk (RR) = 0.91, 95%
confidence interval (CI) = 0.77, 1.08, P = 0.28], but the trial sequential
analysis (TSA) could not confirm this result. No difference was observed
in the need for renal replacement therapy (RRT), all-cause mortality,
MACE, length of stay in the intensive care unit (ICU), and length of stay
in the hospital. Results of subgroup analysis results showed that
intravenous infusion instead of oral NAC could significantly reduce the
incidence of AKI and arrhythmia (RR = 0.84, 95% CI = 0.71, 0.99, P = 0.03,
I2 = 3% and RR = 0.74, 95% CI = 0.61, 0.91, P = 0.004,
I2 = 48%, respectively). Conclusion(s): Intravenous
administration of NAC can reduce the incidence of AKI and arrhythmia in
patients after cardiac surgery, but cannot reduce all-cause mortality,
AMI, cardiac insufficiency, and the number of patients using RRT. Oral NAC
has no significant effect on the outcomes of patients after cardiac
surgery. Copyright © 2022 Zhao, Li and Tan.

<37>
Accession Number
2019164047
Title
Radial artery versus saphenous vein versus right internal thoracic artery
for coronary artery bypass grafting.
Source
European Journal of Cardio-thoracic Surgery. 62(1) (no pagination), 2022.
Article Number: ezac345. Date of Publication: 01 Jul 2022.
Author
Gaudino M.; Audisio K.; Di Franco A.; Alexander J.H.; Kurlansky P.;
Boening A.; Chikwe J.; Devereaux P.J.; Diegeler A.; Dimagli A.; Flather
M.; Lamy A.; Lawton J.S.; Tam D.Y.; Reents W.; Rahouma M.; Girardi L.N.;
Hare D.L.; Fremes S.E.; Benedetto U.
Institution
(Gaudino, Audisio, Di Franco, Rahouma, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Alexander) Department of Medicine, Division of Cardiology, Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States
(Kurlansky) Department of Surgery, Center for Innovation and Outcomes
Research, Columbia University Medical Center, New York, NY, United States
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Giesen, Germany
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Devereaux, Lamy) Departments of Health Research Methods, Evidence, and
Impact (HEI) and Medicine, Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Diegeler, Reents) Department of Cardiac Surgery, Cardiovascular Center
Bad Neustadt/Saale, Bad Neustadt, Saale, Germany
(Dimagli, Benedetto) Department of Cardiac Surgery, Bristol Heart
Institute, University of Bristol, Bristol, United Kingdom
(Flather) Norwich Clinical Trials Unit, Norwich Medical School, University
of East Anglia, Norwich, United Kingdom
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Tam, Fremes) Department of Cardiac Surgery, Schulich Heart Centre
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON,
Canada
(Hare) Department of Cardiology, University of Melbourne, Melbourne, VIC,
Australia
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: We used individual patient data from 4 of the largest
contemporary coronary bypass surgery trials to evaluate differences in
long-term outcomes when radial artery (RA), right internal thoracic artery
(RITA) or saphenous vein graft (SVG) are used to complement the left
internal thoracic artery-to-left anterior descending graft.
 METHOD(S): Primary outcome was all-cause mortality. Secondary outcome
was a composite of major adverse cardiac and cerebrovascular events
(all-cause mortality, myocardial infarction and stroke). Propensity score
matching and Cox regression were used to reduce the effect of treatment
selection bias and confounders. RESULT(S): A total of 10 256 patients
(1510 RITA; 1385 RA; 7361 SVG) were included. The matched population
consisted of 1776 propensity score-matched triplets. The mean follow-up
was 7.9 +/- 0.1, 7.8 +/- 0.1 and 7.8 +/- 0.1 years in the RITA, RA and SVG
cohorts respectively. All-cause mortality was significantly lower in the
RA versus the SVG [hazard ratio (HR) 0.62, 95% confidence interval (CI):
0.51-0.76, P = 0.003] and the RITA group (HR 0.59, 95% CI 0.48-0.71, P =
0.001). Major adverse cardiac and cerebrovascular event rate was also
lower in the RA group versus the SVG (HR 0.78, 95% CI 0.67-0.90, P = 0.04)
and the RITA group (HR 0.75, 95% CI 0.65-0.86, P = 0.02). Results were
consistent in the Cox-adjusted analysis and solid to hidden confounders.
 CONCLUSION(S): In this pooled analysis of 4 large coronary bypass
surgery trials, the use of the RA was associated with better clinical
outcomes when compared to SVG and RITA. Copyright © 2022 The
Author(s) 2022. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<38>
Accession Number
2019194733
Title
Effect of High-Frequency Oscillatory Ventilation, Combined With Prone
Positioning, in Infants With Acute Respiratory Distress Syndrome After
Congenital Heart Surgery: A Prospective Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Zheng Y.-R.; Chen Y.-K.; Lin S.-H.; Cao H.; Chen Q.
Institution
(Zheng, Chen, Lin, Cao, Chen) Department of Cardiac Surgery, Fujian Branch
of Shanghai Children's Medical Center, Fuzhou, China
(Zheng, Chen, Lin, Cao, Chen) Fujian Children's Hospital, Fuzhou, China
(Zheng, Chen, Lin, Cao, Chen) Fujian Maternity and Child Health Hospital
College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics,
Fujian Medical University, Fuzhou, China
(Zheng, Chen, Lin, Cao, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
Publisher
W.B. Saunders
Abstract
Objectives: This study aimed to evaluate the effect of high-frequency
oscillatory ventilation, (HFOV) combined with prone positioning, on
oxygenation and pulmonary ventilation in infants with acute respiratory
distress syndrome (ARDS) after congenital heart surgery. Design(s): A
randomized controlled trial. Setting(s): A single-center study at a
tertiary teaching hospital. Participant(s): Patients with
postoperative ARDS after congenital heart disease were divided randomly
into the following 2 groups: HFOV combined with prone position (HFOV-PP),
and HFOV combined with supine position (HFOV-SP). Intervention(s):
The primary outcomes were the PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>
ratio and the oxygenation index after the intervention, and the secondary
outcomes were respiratory variables, hemodynamics, complications, and
other short-term outcomes. Result(s): Sixty-five eligible infants
with ARDS were randomized to either the HFOV-PP (n = 32) or HFOV-SP (n =
33) group. No significant difference in baseline data was found between
the 2 groups (p > 0.05). Oxygenation was improved in both groups after
HFOV intervention. Compared with the HFOV-SP group, the HFOV-PP group had
significantly increased PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> and
oxygenation index and a shorter duration of invasive ventilation and
length of cardiac intensive care unit stay. No serious complications
occurred in the 2 groups. Conclusion(s): HFOV-PP significantly
improved oxygenation in infants with ARDS after cardiac surgery and had no
serious complications. Copyright © 2022 Elsevier Inc.

<39>
Accession Number
2019194096
Title
The effect of melatonin on cardiac biomarkers after coronary artery bypass
graft surgery: A double-blind, randomized pilot study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Nasseh N.; Khezri M.B.; Farzam S.; Shiravandi S.; Shafikhani A.A.
Institution
(Nasseh, Khezri, Shiravandi) Department of Anesthesiology, Faculty of
Medicine, Metabolic Diseases Research Center, Qazvin University of Medical
Sciences, Shahid Bahonar Ave., PO Box 3419759811, Qazvin, Iran, Islamic
Republic of
(Farzam) Department of Cardiovascular surgery, Faculty of Medicine, Qazvin
University of Medical Sciences, Qazvin, Iran, Islamic Republic of
(Shafikhani) Department of Occupational safety and Health Engineering,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
W.B. Saunders
Abstract
Objectives: Melatonin has emerged as an anti-inflammatory agent, potent
direct free-radical scavenger, and an indirect antioxidant in preventing
ischemia-reperfusion injury. This study aimed to evaluate melatonin's
effect on cardiac biomarkers after coronary artery bypass grafting (CABG).
 Design(s): A double-blind, randomized placebo-controlled pilot
clinical study. Setting(s): Booali Sina Hospital, Qazvin University
of Medical Sciences, Qazvin, Iran. Participant(s): One hundred
patients undergoing elective CABG. The patients were divided randomly into
control (C) and melatonin (M) groups (50 patients per group).
 Intervention(s): The M group received 3 mg of melatonin the night
before surgery, 3 mg in the morning, and routine cardiac surgery
medications. The C group received 1 placebo tablet rather than melatonin.
After surgery, the patients in the M group received 3 mg of melatonin, and
the C group received 1 placebo tablet at bedtime until the third day after
CABG. Measurements and Main Results: In both groups, creatine
kinase-MB (CPK-MB), cardiac troponin I, erythrocyte sedimentation rate
(ESR), and C-reactive protein (CRP) were measured before surgery and on
the first, second, and third postoperative days. Serum CPK-MB levels on
the second and third day after CABG were significantly lower in the M
group than in the C group (p < 0.05). Regarding cardiac troponin I, CRP,
and ESR markers, there were no significant changes in serum concentration
before surgery and on the first, second, and third days after surgery
between the 2 groups (p > 0.05). The mean length of hospitalization in the
ICU was lower in the M group (3.4 +/- 1.05) compared with the C group
(3.96 +/- 1.06, p = 0.01). Conclusion(s): Melatonin reduced the
postoperative level of CPK-MB and the length of hospitalization in the ICU
in patients who underwent cardiac surgery. Copyright © 2022

<40>
Accession Number
2019051770
Title
Staged Versus Synchronous Carotid Endarterectomy and Coronary Artery
Bypass Grafting: A Meta-Analysis and Systematic Review.
Source
Annals of Vascular Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Peng C.; Yang Y.-F.; Zhao Y.; Yang X.-Y.
Institution
(Peng, Yang, Zhao, Yang) Department of Neurosurgery, Tianjin Medical
University General Hospital, Tianjin, China
Publisher
Elsevier Inc.
Abstract
Background: There are several treatment options for patients with
concomitant carotid and coronary artery disease, and it is difficult to
identify an optimal treatment strategy that has consensus. Here, we
performed a meta-analysis to compare the early and long-term outcomes of
staged and synchronous carotid endarterectomy and coronary artery bypass
grafting approaches. Method(s): We performed a meta-analysis that
compared staged and synchronous carotid endarterectomy and coronary artery
bypass grafting approaches between July 1976 and September 2021. PubMed,
EMBASE, and the Cochrane Library were systematically searched for related
articles. Result(s): Nineteen studies were identified with a total of
39,269 and 30,066 patients in the synchronous and staged groups,
respectively. Early mortality was lower in the staged group than in the
synchronous group (odds ratio OR 1.256, 95% confidence interval CI
1.006-1.569, P= P < 0.05, I2 = 54.5%), and stroke rates were
significantly higher in the synchronous group (OR 1.356, 95% CI
1.232-1.493, P < 0.05, I2 = 33.3%). The rate of myocardial
ischemia was significantly higher in the staged group than in the
synchronous group (OR 0.757, 95% CI 0.635-0.903, P < 0.05, I2 =
51.5%), and this meta-analysis also showed a significantly higher risk of
transient ischemic attacks (TIAs) in the synchronous group (OR 1.335, 95%
CI 1.055-1.688, P < 0.05, I2 = 0.00%). The secondary outcomes,
including the rate of reoperation, were significantly lower for the staged
procedure than for the synchronous procedure (OR 1.177, 95% CI
1.052-1.318, P < 0.05, I2 = 4.2%), and the rate of wound
infection was significantly higher in the synchronous group than in the
staged group (OR 0.457, 95% CI 0.403-0.519, P < 0.05, I2 =
0.0%). There was no significant difference in the rate of cardiac
arrhythmia between the two groups (OR 0.544, 95% CI 0.265-1.117, P > 0.05,
I2 = 12.7%). There was also no statistical significance in the
long-term results regarding the incidence of stroke, myocardial ischemia,
and mortality between the synchronous and staged groups (P > 0.05).
 Conclusion(s): Patients treated with the synchronous approach had a
significantly higher risk of early mortality, stroke, TIA, wound
infection, and reoperation and a lower risk of myocardial ischemia than
those treated with the staged approach. There was no significant
difference in the long-term results between the 2 groups. Copyright
© 2022 Elsevier Inc.

<41>
Accession Number
2014418102
Title
Understanding treatment-subgroup effect in primary and secondary
prevention of cardiovascular disease: An exploration using meta-analyses
of individual patient data.
Source
Journal of Clinical Epidemiology. 139 (pp 160-166), 2021. Date of
Publication: November 2021.
Author
Torres Roldan V.D.; Ponce O.J.; Urtecho M.; Torres G.F.; Belluzzo T.;
Montori V.M.; Liu C.; Barrera F.; Diaz A.; Prokop L.; Guyatt G.
Institution
(Torres Roldan, Ponce, Urtecho, Montori, Barrera) Knowledge and Evaluation
Research Unit, Mayo Clinic, Rochester, MN, United States
(Torres, Liu) School of Medicine, Cayetano Heredia Peruvian University,
Lima, Peru
(Belluzzo) Internal Medicine, Jablonec nad Nisou Hospital, Jablonec nad
Nisou, Czechia
(Barrera, Diaz) Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER
Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon,
Monterrey, Nuevo Leon, Mexico
(Prokop) Department of Library-Public Services, Mayo Clinic, Rochester,
MN, United States
(Guyatt) McMaster University, Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background and Objective: Recommendations for preventing cardiovascular
(CV) disease are currently separated into primary and secondary
prevention. We hypothesize that relative effects of interventions for CV
prevention are not different across primary and secondary prevention
cohorts. Our aim was to test for differences in relative effects on CV
events in common preventive CV interventions across primary and secondary
prevention cohorts. Methods and Results: A systematic search was
performed to identify individual patient data (IPD) meta-analyses that
included both primary and secondary prevention populations. Eligibility
assessment, data extraction, and risk of bias assessment were conducted
independently and in duplicate. We extracted relative risks (RR) with 95%
confidence intervals (95% CI) of the interventions over patient-important
outcomes and estimated the ratio of RR for primary and secondary
prevention populations. We identified five eligible IPDs representing
524,570 participants. Quality assessment resulted in overall
low-to-moderate methodological quality. We found no subgroup effect across
prevention categories in any of the outcomes assessed. Conclusion(s):
In the absence of significant treatment-subgroup interactions between
primary and secondary CV prevention cohorts for common preventive
interventions, clinical practice guidelines could offer recommendations
tailored to individual estimates of CV risk without regard to membership
to primary and secondary prevention cohorts. This would require the
development of reliable ASCVD risk estimators that apply across both
cohorts. Copyright © 2021

<42>
Accession Number
2010583128
Title
Uniportal and three-portal video-assisted thoracic surgery pulmonary
lobectomy for early-stage lung cancer (UNIT trial): study protocol of a
single-center randomized trial.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 163. Date of
Publication: December 2021.
Author
Mendogni P.; Mazzucco A.; Palleschi A.; Rosso L.; Righi I.; Carrinola R.;
Damarco F.; Privitera E.; Fumagalli J.; Bonitta G.; Nosotti M.; Tosi D.
Institution
(Mendogni, Mazzucco, Palleschi, Rosso, Righi, Carrinola, Damarco,
Privitera, Bonitta, Nosotti, Tosi) Thoracic Surgery and Lung Transplant
Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,
University of Milan, Via Francesco Sforza 35, Milan, Italy
(Fumagalli) Department of Anesthesia and Critical Care, Fondazione IRCCS
Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Nosotti) Department of Pathophysiology and Transplantation, Universita
degli Studi di Milano, Milan, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) lobectomy is
currently the recommended approach for treating early-stage non-small cell
lung cancer (NSCLC). Different VATS approaches have been proposed so far,
and the actual advantages of one technique over the other are still under
debate. The aim of our study is to compare postoperative pain and
analgesic drug consumption in uniportal VATS and triportal VATS for
pulmonary lobectomy in early-stage lung cancer patients. Method(s):
This study is a single-center, prospective, two-arm, parallel-group,
randomized controlled trial. It is designed to compare uniportal
video-assisted thoracic surgery (u-VATS) and three-port video-assisted
thoracic surgery (t-VATS) in terms of postoperative pain. The trial will
enroll 120 patients with a 1:1 randomization. The primary outcome is the
assessment of analgesic drug consumption. Secondary outcomes are
postoperative pain measurement, evaluation of postoperative pulmonary
function, and metabolic recovery after pulmonary lobectomy.
 Discussion(s): The choice of which VATS approach to adopt for
treating patients undergoing pulmonary resection mostly depends on the
surgeon's preferences; therefore, it is hard to prove whether one VATS
technique is superior to the other. Moreover, postoperative analgesic
protocols vary consistently among different centers. To date, only a few
studies have evaluated the effects of the most popular VATS techniques.
There is no evidence about the difference between multiport VATS and
u-VATS in terms of postoperative pain. We hope that the results of our
trial will provide valuable information on the outcomes of these different
surgical approaches. Trial registration: ClinicalTrials.gov NCT03240250.
Registered on 07 August 2017; retrospectively registered. Copyright
© 2021, The Author(s).

<43>
Accession Number
51726129
Title
Effects on 11-year mortality and morbidity of lowering LDL cholesterol
with simvastatin for about 5 years in 20 536 high-risk individuals: A
randomised controlled trial.
Source
The Lancet. 378(9808) (pp 2013-2020), 2011. Date of Publication: 10 Dec
2011.
Author
Bulbulia R.; Bowman L.; Wallendszus K.; Parish S.; Armitage J.; Peto R.;
Collins R.; Meade T.; Sleight P.; Youngman L.; Buxton M.; De Bono D.;
George C.; Fuller J.; Keech A.; Mansfield A.; Pentecost B.; Simpson D.;
Warlow C.; McNamara J.; O'Toole L.; Doll R.; Wilhelmsen L.; Fox K.M.; Hill
C.; Sandercock P.
Institution
(Bulbulia, Bowman, Wallendszus, Parish, Parish, Armitage, Armitage, Peto,
Collins, Collins, Meade, Sleight, Youngman, Buxton, De Bono, George,
Fuller, Keech, Mansfield, Pentecost, Simpson, Warlow, McNamara, O'Toole,
Doll, Wilhelmsen, Fox, Hill, Sandercock) Clinical Trial Service Unit,
Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF,
United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Findings of large randomised trials have shown that lowering LDL
cholesterol with statins reduces vascular morbidity and mortality rapidly,
but limited evidence exists about the long-term efficacy and safety of
statin treatment. The aim of the extended follow-up of the Heart
Protection Study (HPS) is to assess long-term efficacy and safety of
lowering LDL cholesterol with statins, and here we report cause-specific
mortality and major morbidity in the in-trial and post-trial periods. 20
536 patients at high risk of vascular and non-vascular outcomes were
allocated either 40 mg simvastatin daily or placebo, using minimised
randomisation. Mean in-trial follow-up was 5.3 years (SD 1.2), and
post-trial follow-up of surviving patients yielded a mean total duration
of 11.0 years (SD 0.6). The primary outcome of the long-term follow-up of
HPS was first post-randomisation major vascular event, and analysis was by
intention to treat. This trial is registered with ISRCTN, number 48489393.
During the in-trial period, allocation to simvastatin yielded an average
reduction in LDL cholesterol of 1.0 mmol/L and a proportional decrease in
major vascular events of 23 (95 CI 19-28; p<0.0001), with significant
divergence each year after the first. During the post-trial period (when
statin use and lipid concentrations were similar in both groups), no
further significant reductions were noted in either major vascular events
(risk ratio [RR] 0.95 [0.89-1.02]) or vascular mortality (0.98
[0.90-1.07]). During the combined in-trial and post-trial periods, no
significant differences were recorded in cancer incidence at all sites
(0.98 [0.92-1.05]) or any particular site, or in mortality attributed to
cancer (1.01 [0.92-1.11]) or to non-vascular causes (0.96 [0.89-1.03]).
More prolonged LDL-lowering statin treatment produces larger absolute
reductions in vascular events. Moreover, even after study treatment
stopped in HPS, benefits persisted for at least 5 years without any
evidence of emerging hazards. These findings provide further support for
the prompt initiation and long-term continuation of statin treatment. UK
Medical Research Council, British Heart Foundation, Merck & Co, Roche
Vitamins. © 2011 Elsevier Ltd.

<44>
Accession Number
354115477
Title
The safety of aprotinin and lysine-derived antifibrinolytic drugs in
cardiac surgery: A meta-analysis.
Source
CMAJ. Canadian Medical Association Journal. 180(2) (pp 183-193), 2009.
Date of Publication: 20 Jan 2009.
Author
Henry D.; Carless P.; Fergusson D.; Laupacis A.
Institution
(Henry, Carless) School of Medicine and Public Health, University of
Newcastle, Australia
(Fergusson) Ottawa Health Research Institute, Ottawa Hospital, Ottawa, ON,
Canada
(Laupacis) Keenan Research Centre, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Canada
(Henry, Laupacis) Institute for Clinical Evaluative Sciences, University
of Toronto, Toronto, ON, Canada
(Henry, Laupacis) Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Henry) Institute for Clinical Evaluative Sciences, Sunnybrook Health
Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
Publisher
Canadian Medical Association
Abstract
Background: Because of recent concerns about the safety of aprotinin, we
updated our 2007 Cochrane review that compared the relative benefits and
risks of aprotinin and the lysine analogues tranexamic acid and epsilon
aminocaproic acid. Method(s): We searched electronic databases,
including CENTRAL, MEDLINE, EMBASE, Google and Google Scholar for trials
of antifibrinolytic drugs used in adults scheduled for cardiac surgery.
Searches were updated to January 2008. By comparing aprotinin and the 2
lysine analogues to control, we derived indirect head-to-head comparisons
of aprotinin to the other drugs. We derived direct estimates of risks and
benefits by pooling estimates from head-to-head trials of aprotinin and
tranexamic acid or epsilon aminocaproic acid. Result(s): For indirect
estimates, we identified 49 trials involving 182 deaths among 7439
participants. The summary relative risk (RR) for death with aprotinin
versus placebo was 0.93 (95% confidence interval [CI] 0.69-1.25). In the
19 trials that included tranexamic acid, there were 24 deaths among 1802
participants. The summary RR was 0.55 (95% CI 0.24-1.25). From the risk
estimates derived for individual drugs, we calculated an indirect summary
RR of death with use of aprotinin versus tranexamic acid of 1.69 (95% CI
0.70-4.10). To calculate direct estimates of death for aprotinin versus
tranexamic acid, we identified 13 trials with 107 deaths among 3537
participants. The summary RR was 1.43 (95% CI 0.98-2.08). Among the 1840
participants, the calculated estimates of death for aprotinin compared
directly to epsilon aminocaproic acid was 1.49 (95% CI 0.98-2.28). We
found no evidence of an increased risk of myocardial infarction with use
of aprotinin compared with the lysine analogues in either direct or
indirect analyses. Compared with placebo or no treatment, all 3 drugs were
effective in reducing the need for red blood cell transfusion. The RR of
transfusion with use of aprotinin was 0.66 (95% CI 0.61-0.72). The RR of
transfusion was 0.70 (95% CI 0.61-0.80) for tranexamic acid, and it was
0.75 (95% CI 0.58-0.96) for use of epsilon aminocaproic acid. Aprotinin
was also effective in reducing the need for reoperation because of
bleeding (RR 0.48, 95% CI 0.34-0.67). Interpretation(s): The risk of
death tended to be consistently higher with use of aprotinin than with use
of lysine analogues. Aprotinin had no clear advantages to offset these
harms. Either tranexamic acid or epsilon aminocaproic acid should be
recommended to prevent bleeding after cardiac surgery. © 2009
Canadian Medical Association or its licensors.

<45>
Accession Number
354977452
Title
Smoking cessation initiated during hospital stay for patients with
coronary artery disease: A randomized controlled trial.
Source
CMAJ. Canadian Medical Association Journal. 180(13) (pp 1297-1303), 2009.
Date of Publication: 23 Jun 2009.
Author
Smith P.M.; Burgess E.
Institution
(Smith) Human Science Division, Northern Ontario School of Medicine,
University of Calgary, Calgary, AB, Canada
(Burgess) Department of Medicine, University of Calgary, Calgary, AB,
Canada
Publisher
Canadian Medical Association
Abstract
Background: Programs for smoking cessation for cardiac patients are
underused in Canada. We examined the efficacy of an intervention for
smoking cessation for patients admitted to hospital for coronary artery
bypass graft (CABG) or because of acute myocardial infarction (MI).
 Method(s): Nurses randomly assigned 276 sequential patients admitted
because of acute MI or for CABG who met the inclusion criteria.
Participants received an intensive or minimal smoking-cessation
intervention. The minimal intervention included advice from physicians and
nurses and 2 pamphlets. The intensive intervention included the minimal
intervention plus 60 minutes of bedside counselling, take-home materials
and 7 nurse-initiated counselling calls for 2 months after discharge. The
outcomes were point prevalence of abstinence at 3, 6 and 12 months after
discharge. Result(s): The 12-month self-reported rate of abstinence
was 62% among patients in the intensive group and 46% among those in the
minimal group (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.2-3.1).
Abstinence was confirmed for 54% of patients in the intensive group and
35% in the minimal group (OR 2.0, 95% CI 1.3-3.6). Abstinence was
significantly lower among those who used pharmacotherapy than among those
who did not (p < 0.001). Continuous 12-month abstinence was 57% in the
intensive group and 39% in the minimal group (p < 0.01). It was
significantly higher among patients admitted for CABG than among those
admitted because of acute MI (p < 0.05). Interpretation(s): Providing
intensive programs for smoking cessation for patients admitted for CABG or
because of acute MI could have a major impact on health and health care
costs. © 2009 Canadian Medical Association or its licensors.

<46>
Accession Number
354603840
Title
A pragmatic-explanatory continuum indicator summary (PRECIS): A tool to
help trial designers.
Source
CMAJ. Canadian Medical Association Journal. 180(10) (pp E47-E57), 2009.
Date of Publication: 12 May 2009.
Author
Thorpe K.E.; Zwarenstein M.; Oxman A.D.; Treweek S.; Furberg C.D.; Altman
D.G.; Tunis S.; Bergel E.; Harvey I.; Magid D.J.; Chalkidou K.
Institution
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada
(Zwarenstein) Department of Health Policy, Management and Evaluation,
University of Toronto, Toronto, ON, Canada
(Zwarenstein) Centre for Health Services Sciences, Sunnybrook Research
Institute, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
(Oxman, Treweek) Preventive and International Health Care Unit, Norwegian
Knowledge Centre for the Health Services, Oslo, Norway
(Treweek) Division of Clinical and Population Sciences and Education,
University of Dundee, Dundee, United Kingdom
(Furberg) Division of Public Health Sciences, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
(Altman) Centre for Statistics in Medicine, University of Oxford, Oxford,
United Kingdom
(Tunis) Center for Medical Technology Policy, Baltimore, United States
(Bergel) UNDP/UNFPA/WHO/World Bank Spec. Programme of Res., Devmt. and
Res. Training in Human Reproduction, Department of Reproductive Health and
Research, World Health Organization, Geneva, Switzerland
(Harvey) Faculty of Health, University of East Anglia, Norwich, United
Kingdom
(Magid) Institute for Health Research, Departments of Preventive Medicine
and Biometrics and of Emergency Medicine, University of Colorado Health
Sciences Center, Denver, CO, United States
(Chalkidou) National Institute for Health and Clinical Excellence, London,
United Kingdom
(Thorpe) Dalla Lana School of Public Health, University of Toronto, Health
Sciences Building, 155 College St., Toronto, ON M5T 3M7, Canada
Publisher
Canadian Medical Association

<47>
Accession Number
2017330218
Title
Comparison Between the Effect of Albumin and Fresh Frozen Plasma in the
Cardiopulmonary Bypass Prime Solution on the Clinical and Laboratory
Outcomes of Children Undergoing Congenital Cardiac Disease Surgery.
Source
Iranian Heart Journal. 23(3) (pp 33-41), 2022. Date of Publication: July
2022.
Author
Dehaki M.G.; Gorjipour F.; Hosseinzadeh M.; Kachoueian N.; Nia S.H.;
Javanmard A.
Institution
(Dehaki, Hosseinzadeh, Nia) Rajaie Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Gorjipour) Iranian Scientific Society of Extracorporeal Technology,
Rajaie Cardiovascular Medical and Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Kachoueian) Department of cardiac surgery, Imam Hossein Educational
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Javanmard) Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Iranian Heart Association
Abstract
Background: A decrease in blood oncotic pressure following hemodilution
due to cardiopulmonary bypass (CPB) in cardiac surgery results in fluid
shift and organ dysfunction. The present comparative study evaluated the
effects of adding albumin and fresh frozen plasma (FFP) to the priming
solution of a CPB system on clinical and laboratory outcomes in pediatric
congenital cardiac surgery candidates. Method(s): The present
clinical trial study recruited 2 groups of 50 pediatric patients
(weight<10 kg) scheduled for the elective surgical repair of congenital
heart diseases. The study population was randomly assigned to 2 groups:
FFP and albumin. The patients' hemodynamic parameters, diuresis, chest
tube drainage, transfusion, and inotropic drugs, as well as laboratory
tests, including the erythrocyte sedimentation rate (ESR), C-reactive
protein, blood urea nitrogen, creatinine, lactate, hemoglobin, and
hematocrit, were measured as the trial's primary outcome. Result(s):
ESR was significantly higher in the FFP group (P<0.05). Blood urea
nitrogen and creatinine were remarkably lower in the albumin group
(P<0.05). No significant differences in hemodynamic variables, the volume
of the red blood cell transfusion, the volume of the inotropic infusion,
and clinical outcomes were observed between the 2 groups.
 Conclusion(s): In patients with FFP in the prime solution, a higher
ESR value was observed. While there was no significant difference between
the 2 groups regarding hemostasis, albumin offered the advantages of
better kidney, liver, and cardiac functions. (Iranian Heart Journal 2022;
23(3): 33-41). Copyright © 2022, Iranian Heart Association. All
rights reserved.

<48>
Accession Number
2017330135
Title
Insulin Resistance Improvement After Cardiac Surgery by Preoperative
Carbohydrate Loading: A Randomized Controlled Trial.
Source
Iranian Heart Journal. 23(3) (pp 49-58), 2022. Date of Publication: July
2022.
Author
Shariatpanahi Z.V.; Maleki M.; Noohi F.; Totonchi Z.; Mahdieh N.; Hosseini
S.
Institution
(Hosseini, Shariatpanahi) Department of Clinical Nutrition and Dietetics,
Faculty of Nutrition and Food Technology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Maleki, Noohi) Cardiovascular Intervention Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Totonchi, Mahdieh) Rajaie Cardiovascular Medical and Research Center,
Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Heart Valve Disease Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Iranian Heart Association
Abstract
Background: The idea of preoperative overnight fasting was challenged and
verified to have no benefits compared with drinking clear liquids up until
2 hours before surgery. In this study, we explored the possible effects of
preoperative oral carbohydrate loading (OCL) on insulin resistance and the
clinical outcomes of patients undergoing cardiac surgery. Method(s):
Totally, 260 patients were recruited and allocated randomly to
intervention (n=130) and control (n=130) groups. The intervention group
received 250 mL of an oral carbohydrate fluid containing 25 g of glucose,
and the control group received standard care. Insulin resistance, glycemic
indices, and clinical outcomes were assessed before and after surgery.
 Result(s): Totally, 107 patients in the intervention group and 103 in
the control group completed the study and were, thus, included in the
final analysis. Preoperative OCL 2 hours before surgery improved
postoperative fasting blood sugar and clinical outcomes after cardiac
surgery including thirst, hunger, anxiety, pain, the length of stay in the
hospital, and the length of stay in the ICU (all Ps<0.05).
 Conclusion(s): OCL administered preoperatively seems to be beneficial
in improving the biochemical and clinical outcomes of patients undergoing
cardiac surgery. Notably, preoperative OCL as a safe, simple, and
cost-benefit approach is associated with no or negligible harm and,
therefore, could be recommended in the setting of cardiac surgery, with
careful attention to contraindications. (Iranian Heart Journal 2022;
23(3): 49-58). Copyright © 2022, Iranian Heart Association. All
rights reserved.

<49>
Accession Number
2017252144
Title
Transcatheter Aortic Valve Implantation With and Without Resheathing and
Repositioning: A Systematic Review and Meta-analysis.
Source
Journal of the American Heart Association. 11(12) (no pagination), 2022.
Article Number: e024707. Date of Publication: 21 Jun 2022.
Author
Moroni F.; Azzalini L.; Sondergaard L.; Attizzani G.F.; Garcia S.; Jneid
H.; Mamas M.A.; Bagur R.
Institution
(Moroni) Division of Cardiology, Pauley Heart Center, Virginia
Commonwealth University, Richmond, VA, United States
(Azzalini) Division of Cardiology, Department of Medicine, University of
Washington, Seattle, WA, United States
(Sondergaard) The Heart Centre, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Attizzani) Harrington Heart and Vascular Institute, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
(Garcia) The Carl and Edyth Lindner Center for Research and Education, The
Christ Hospital, Cincinnati, OH, United States
(Jneid) Division of Cardiology, Baylor School of Medicine and the Michael
E. DeBakey VAMC, Houston, TX, United States
(Mamas, Bagur) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, Keele University,
Stoke-on-Trent, United Kingdom
(Bagur) Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, Western University, 339 Windermere Road, London, ON
N6A 5A5, Canada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: There is a concern that resheathing/repositioning of
transcatheter heart valves during transcatheter aortic valve implantation
(TAVI) may lead to an increased risk of periprocedural complications. We
aimed to evaluate the short-and long-term impact on clinical outcomes of
resheathing for repositioning of transcatheter heart valves during TAVI
procedures. METHODS AND RESULTS: We conducted a systematic search of
Embase, MEDLINE, and Cochrane Central Register of Controlled Trials
databases to identify studies comparing outcomes between patients
requiring resheathing/repositioning during TAVI and those who did not.
Random-effects meta-analyses were used to estimate the association of
resheathing compared with no resheathing with clinical outcomes after
TAVI. Seven studies including 4501 participants (pooled mean age,
80.9+/-7.4 years; 54% women; and 1374 [30.5%] patients requiring
resheathing/repositioning) were included in this study. No significant
differences between the 2 groups were identified with regards to safety:
30-day mortality (n=3125; odds ratio [OR], 0.74 [95% confidence interval
[CI], 0.41-1.33]; I2=0%), stroke (n=4121; OR, 1.09 [95%
confidence interval [CI], 0.74-1.62]; I2=0%), coronary
obstruction (n=3000; OR, 2.35 [95% CI, 0.17-33.47]; I2=75%),
major vascular complications (n=3125; OR, 0.92 [95% CI, 0.66-1.33];
I2=0%), major bleeding (n=3125; OR, 1.13 [95% CI, 0.94-2.01];
I2=39%), acute kidney injury (n=3495; OR, 1.30 [95% CI,
0.64-2.62]; I2=44%), and efficacy outcomes: device success
(n=1196; OR, 0.77 [95% CI, 0.51-1.14]; I2=0%), need for a
second valve (n=3170; OR, 2.86 [95% CI, 0.96-8.48]; I2=62%),
significant (moderate or higher) paravalvular leak (n=1151; OR, 1.53 [95%
CI, 0.83-2.80]; I2=0%), and permanent pacemaker implantation
(n=1908; OR, 1.04 [95% CI, 0.68- 1.57]; I2=58%). One-year
mortality was similar between groups (n=1972; OR, 1.00 [95% CI,
0.68-1.47]; I2=0%). CONCLUSION(S): Resheathing of
transcatheter heart valves during TAVI is associated with similar
periprocedural risk compared with no resheathing in several
patient-important outcomes. These data support the safety of current
self-expanding transcatheter heart valves with resheathing features.
REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique
identifier: CRD42021273715. Copyright © 2022 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<50>
Accession Number
2017231015
Title
Outcomes with revascularization and medical therapy in patients with
coronary disease and chronic kidney disease: A meta-analysis.
Source
Atherosclerosis. 351 (pp 41-48), 2022. Date of Publication: June 2022.
Author
Leszek A.; Poli L.; Zbinden S.; Godoy L.C.; Reny J.-L.; Farkouh M.E.;
Charytan D.M.; Mavrakanas T.A.
Institution
(Leszek, Poli, Zbinden, Reny) Department of Medicine, Geneva University
Hospitals and Faculty of Medicine, Geneva, Switzerland
(Godoy, Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Godoy) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Charytan) Department of Medicine, New York University Langone Medical
Center & New York University Grossman School of Medicine, New York, NY,
United States
(Mavrakanas) Department of Medicine, McGill University Health Centre,
Montreal, QC, Canada
(Mavrakanas) Research Institute of the McGill University Health Centre,
Montreal, QC, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: Chronic kidney disease (CKD) confers a high risk for
poor cardiovascular outcomes. We conducted a systematic review and
meta-analysis to estimate the effects of revascularization as the initial
management strategy compared with medical therapy among patients with CKD
and coronary artery disease. Method(s): A Medline/PubMed literature
research was conducted to identify randomized studies comparing early
coronary revascularization with optimal medical therapy or medical therapy
alone in patients with CKD (estimated glomerular filtration rate <60
mL/min/1.73 m2 or maintenance dialysis). The primary outcome
was myocardial infarction. The secondary outcomes were all-cause mortality
or progression to kidney failure. The risk ratio (RR) was estimated using
a random-effects model. Result(s): Eleven randomized trials were
included (3422 patients). Revascularization was associated with lower
incidence of myocardial infarction compared with medical therapy in
patients with CKD: RR 0.71 (95% confidence interval [CI] 0.54-0.94;
p=0.02). This result was mainly driven from a significantly lower
incidence of myocardial infarction with early revascularization among
patients with stable coronary artery disease: RR 0.59; 95% CI 0.37-0.93. A
similar incidence of all-cause mortality was observed with both treatment
strategies: RR 0.88 (95% CI 0.72-1.08; p=0.22). A trend towards lower
incidence of all-cause mortality was observed with revascularization in
the subgroup of patients presenting with NSTE-ACS: RR 0.73 (95% CI
0.51-1.04; p=0.08) but not among patients with stable coronary disease.
There was no difference in progression to kidney failure between the two
strategies. Conclusion(s): Coronary revascularization may be superior
to medical therapy among patients with CKD and coronary
disease. Copyright © 2022

<51>
[Use Link to view the full text]
Accession Number
2018842882
Title
Effect of ulinastatin on the inflammatory response after video-assisted
thoracic lobectomy in patients with lung cancer: a randomized controlled
study.
Source
Chinese Medical Journal. 135(7) (pp 806-812), 2022. Date of Publication:
05 Apr 2022.
Author
Hwang W.J.; Joo M.A.; Joo J.; Ni J.
Institution
(Hwang, Joo, Joo) Department of Anesthesiology and Pain Medicine, Seoul
St. Mary's Hospital, College of Medicine, Catholic University of Korea,
222, Banpo-daero, Seocho-gu, Seoul 06591, South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background:The first-line treatment for lung cancer is surgical resection,
and one-lung ventilation (OLV) is the most basic anesthetic management
method in lung surgery. During OLV, inflammatory cytokines are released in
response to the lung tissue damage and promote local and contralateral
lung damage through the systemic circulation. We designed a randomized,
prospective study to evaluate the effect of the urinary trypsin inhibitor
(UTI) ulinastatin on the inflammatory response after video-assisted
thoracic lobectomy in patients with lung cancer. Method(s):Adult
patients aged 19 to 70 years, who were scheduled for video-assisted
thoracic lobectomy surgery to treat lung cancer between May 2020 and
August 2020, were enrolled in this randomized, prospective study. UTI
(300,000 units) mixed with 100 mL of normal saline in the ulinastatin
group and 100 mL of normal saline in the control group was administered
over 1 h after inducing anesthesia. Result(s):The baseline (T0)
interferon-gamma (IFN-gamma)/interleukin-4 (IL-4) ratio was not different
between the groups (6941.3 +/- 2778.7 vs. 6954.3 +/- 2752.4 pg/mL,
respectively; P > 0.05). The IFN-gamma/IL-4 ratio was significantly higher
in ulinastatin group at 30 min after entering the recovery room than
control group (20,148.2 +/- 5054.3 vs. 6674.0 +/- 2963.6, respectively;
adjusted P < 0.017). Conclusion(s):Administering UTI attenuated the
anti-inflammatory response, in terms of INF-gamma expression and the
IFN-gamma/IL-4 ratio, after video-assisted thoracic surgery in lung cancer
patients.Trial registration:Clinical Research Information Service of Korea
National Institute of Health (CRIS), KCT0005533. Copyright © 2022
Lippincott Williams and Wilkins. All rights reserved.

<52>
[Use Link to view the full text]
Accession Number
2019042593
Title
Rationale and Design of the Randomized Controlled Trial of New Oral
Anticoagulants Versus Warfarin for Post Cardiac Surgery Atrial
Fibrillation: The NEW-AF Trial.
Source
Annals of Surgery. 276(1) (pp 200-204), 2022. Date of Publication: 01 Jul
2022.
Author
Osho A.A.; Moonsamy P.; Ethridge B.R.; Leya G.A.; D'alessandro D.A.;
Jassar A.S.; Villavicencio M.A.; Melnitchouk S.I.; Tolis G.; Langer N.B.;
Funamoto M.; Li S.S.; Colon K.M.; Mohan N.; Locascio J.J.; Lubitz S.A.;
Akeju O.; Sundt T.M.
Institution
(Osho, Moonsamy, Leya, D'alessandro, Jassar, Villavicencio, Melnitchouk,
Tolis, Langer, Funamoto, Li, Mohan, Sundt) Division of Cardiac Surgery,
Massachusetts General Hospital, Boston, MA, United States
(Ethridge, Colon, Akeju) Department of Anesthesia, Massachusetts General
Hospital, Boston, MA, United States
(Locascio) Harvard Catalyst Biostatistical Group, Harvard Medical School,
Boston, MA, United States
(Lubitz) Division of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:This manuscript describes the rationale and design of a
randomized, controlled trial comparing outcomes with Warfarin vs Novel
Oral Anticoagulant (NOAC) therapy in patients with new onset atrial
fibrillation after cardiac surgery. Background(s):New onset atrial
fibrillation commonly occurs after cardiac surgery and is associated with
increased rates of stroke and mortality. in nonsurgical patients with
atrial fibrillation, NOACs have been shown to confer equivalent benefits
for stroke prevention with less bleeding risk and less tedious monitoring
requirements compared with Warfarin. However, NOAC use has yet to be
adopted widely in cardiac surgery patients. Method(s):The NEW-AF
study has been designed as a pragmatic, prospective, randomized controlled
trial that will compare financial, convenience and safety outcomes for
patients with new onset atrial fibrillation after cardiac surgery that are
treated with NOACs versus WarfarinResults:Study results may contribute to
optimizing the options for stroke prophylaxis in cardiac surgery patients
and catalyze more widespread application of NOAC therapy in this patient
population. Conclusion(s):The study is ongoing and actively enrolling
at the time of the publication. The trial is registered with
clinicaltrials.gov under registration number NCT03702582. Copyright
© 2022 Lippincott Williams and Wilkins. All rights reserved.

<53>
Accession Number
2016185798
Title
Comment on "Evaluating the cardiovascular safety of sclerostin inhibition
using evidence from meta-analysis of clinical trials and human genetics".
Source
Science Translational Medicine. 13(622) (no pagination), 2021. Article
Number: abe8497. Date of Publication: 01 Dec 2021.
Author
Holm H.; Sulem P.; Tragante V.; Thorsteinsdottir U.; Gudbjartsson D.F.;
Stefansson K.
Institution
(Holm, Sulem, Tragante, Thorsteinsdottir, Gudbjartsson, Stefansson) deCODE
genetics, Amgen Inc., Reykjavik 102, Iceland
(Thorsteinsdottir, Stefansson) Faculty of Medicine, University of Iceland,
Reykjavik 101, Iceland
(Gudbjartsson) School of Engineering and Natural Sciences, University of
Iceland, Reykjavik 101, Iceland
Publisher
American Association for the Advancement of Science

<54>
Accession Number
2011531356
Title
The effects of functionally monocular patients' emotional reactions during
phacoemulsification under topical anesthesia.
Source
Arquivos Brasileiros de Oftalmologia. 84(2) (pp 103-106), 2021. Date of
Publication: 2021.
Author
Kataguiri P.; Gracia M.P.; Murrer G.; Toledo A.S.; Rehder J.R.C.L.; Loduca
V.; Kara-Junior N.
Institution
(Kataguiri, Gracia, Murrer, Toledo, Rehder, Loduca) Department of
Ophthalmology, Faculdade de Medicina do ABC, Santo Andre, SP, Brazil
(Kara-Junior) Department of Ophthalmology, Universidade de Sao Paulo, Sao
Paulo, SP, Brazil
Publisher
Conselho Brasileiro De Oftalmologia
Abstract
Purpose: To evaluate the relationship between the incidence of
complications and functionally monocular patients' emotional reactions
during phacoemulsification under topical anesthesia. Method(s): We
enrolled 22 functionally monocular patients (11 males and 11 females;
group 1) and 19 age-and sex-matched controls (6 males and 13 females;
group 2) in this prospective, interventional, cross-sectional, case
control study. Demographics data, including age, sex, and educational
background, were collected. Surgeries were performed by the same surgeon,
and during surgery, the patients' vital signs (blood pressure and heart
rate) and surgical events (duration, body movements, signs of increased
vitreous cavity pressure, difficulty in performing capsulorhexis, and
complications) were noted. Pre-and postoperative visual acuity was also
analyzed. Result(s): The mean age of group 1 was 73.05 +/- 13.31
years and of group 1 was 69.74 +/- 16.81 years. There was no significant
between-group difference in systolic and diastolic blood pressures. The
average heart rate was similar in both groups, too. During surgery, the
surgeon's perception of excessive eye, eyelid, or head movements in both
groups was similar, in addition to signs of increased vitreous cavity
pressure. Conclusion(s): It is safe to perform phacoemulsification
under topical anesthesia in functionally monocular patients, who
apparently behave similarly to binocular patients. Copyright ©
2021. All Rights Reserved.

<55>
Accession Number
2013482841
Title
Integrative echocardiographic assessment of patients with secondary mitral
regurgitation undergoing transcatheter edge-to-edge repair.
Source
Catheterization and Cardiovascular Interventions. 98(7) (pp 1404-1412),
2021. Date of Publication: 01 Dec 2021.
Author
Brugger N.; Kassar M.; Siontis G.C.M.; Widmer S.; Okuno T.; Winkel M.G.;
Corpataux N.; Grani C.; Bullesfeld L.; Hunziker L.; Pilgrim T.; Windecker
S.; Praz F.
Institution
(Brugger, Kassar, Siontis, Widmer, Okuno, Winkel, Corpataux, Grani,
Hunziker, Pilgrim, Windecker, Praz) Department of Cardiology, Inselspital,
University of Bern, Bern, Switzerland
(Bullesfeld) Department of Internal Medicine and Cardiology, GFO Hospitals
Bonn, Bonn, Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To investigate whether the integrative echocardiographic
criteria used in the cardiovascular outcomes assessment of the mitraclip
percutaneous therapy (COAPT) for heart failure patients with functional
mitral regurgitation study predict outcomes after edge-to-edge
trancatheter mitral valve repair (TMVr) for the treatment of secondary
mitral regurgitation (SMR). Background(s): Two randomized controlled
trials comparing TMVr to medical treatment reported conflicting findings.
Differences in patient selection criteria may have contributed to these
diverging results. Method(s): Patients undergoing TMVr were
stratified following the integrative COAPT echocardiographic criteria in
noneligible and eligible patients who were further classified into three
tiers according to effective regurgitant orifice (EROA) (Tier 1: EROA >=
0.3cm2; Tier 2: EROA 0.2cm2 and 0.29cm2;
Tier 3: EROA<0.2cm2) combined with several other severity
criteria. We assessed between group differences in all-cause mortality,
successful SMR reduction, and symptom relief from baseline to 2-year
follow-up. Result(s): Between March 2011 and March 2018, 138 patients
(mean age 75 years) satisfying the inclusion criteria underwent TMVr for
treatment of symptomatic SMR. The mean EROA area was 0.35 +/- 0.17
mm2. Ten patients (7%) died within 30 days, 29 (21%) within 12
months, and 41 (30%) within 2 years. After stratification according to the
COAPT echocardiographic criteria that were fulfilled in 72% of the studied
population, Tier 2 patients (45%), as well as noneligible patients (38%)
had a higher mortality rate compared to those in Tier 1 (19%).
 Conclusion(s): SMR patients stratified into tiers according to the
COAPT integrative echocardiographic criteria have diverging prognostic and
symptomatic benefit after edge-to-edge TMVr. Copyright © 2021
Wiley Periodicals LLC.

<56>
Accession Number
2013410248
Title
Direct oral anticoagulants in patients with atrial fibrillation and
bioprosthetic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 98(7) (pp E1007-E1016),
2021. Date of Publication: 01 Dec 2021.
Author
Lacy S.C.; Saint Croix G.R.; Porter K.; Latib A.; Beohar N.
Institution
(Lacy) Loyola University Medical Center, Maywood, IL, United States
(Saint Croix, Beohar) Columbia University Division of Cardiology at Mount
Sinai Medical Center, Miami Beach, FL, United States
(Porter) Jackson Memorial Hospital/University of Miami Hospital, Miami,
FL, United States
(Latib) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This systematic review and meta-analysis compares direct oral
anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients
with atrial fibrillation and bioprosthetic valve replacement or repair
(BVR). Background(s): The optimal anticoagulation therapy for
patients with atrial fibrillation and a history of bioprosthetic valve
replacement or repair (BVR) is not well understood. Method(s): We
performed a systematic literature review to identify clinical studies that
compared anticoagulation therapies for patients with atrial fibrillation
and BVR. The primary outcomes of stroke, major bleeding, and mortality
were reported as random effects risk ratio (RR) with 95% confidence
interval. No prior ethical approval was required since all data is public.
 Result(s): Our search yielded 101 potential studies. We included six
studies reporting on 1911 patients. There was a lower risk of stroke and
major bleeding in patients with atrial fibrillation after BVR treated with
DOACs when compared to VKAs with risk ratios of 0.44 (95% CI 0.24-0.82, p
< 0.01) and 0.53 (95% CI 0.34-0.83, p < 0.01), respectively. There was no
statistically significant difference in mortality between patients with
atrial fibrillation after BVR treated with DOACs compared to patients
treated with VKAs with a risk ratio of 1.12 (95% CI 0.73-1.74, p = 0.60).
 Conclusion(s): This systematic review and meta-analysis suggests that
DOACs are superior to VKAs with respect to stroke and major bleeding in
patients with atrial fibrillation and BVR. Copyright © 2021 Wiley
Periodicals LLC.

<57>
Accession Number
2007863240
Title
Staged percutaneous intervention for concurrent chronic total occlusions
in patients with st-segment-elevation myocardial infarction: A systematic
review and meta-analysis.
Source
Journal of the American Heart Association. 7(8) (no pagination), 2018.
Article Number: e008415. Date of Publication: 17 Apr 2018.
Author
Villablanca P.A.; Olmedo W.; Weinreich M.; Gupta T.; Mohananey D.;
Albuquerque F.N.; Kassas I.; Briceno D.; Sanina C.; Brevik T.A.; Ong E.;
Ramakrishna H.; Attubato M.; Menegus M.; Wiley J.; Kalra A.
Institution
(Villablanca, Kassas, Attubato) Division of Cardiology, Department of
Medicine, New York University School of Medicine, New York, NY, United
States
(Olmedo, Weinreich, Gupta, Sanina, Brevik, Ong, Menegus, Wiley) Division
of Cardiology, Department of Medicine, Montefiore Medical Center, Albert
Einstein College of Medicine, New York, NY, United States
(Mohananey) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Albuquerque) Division of Cardiology, Department of Medicine, University
of Miami Miller School of Medicine, Miami, FL, United States
(Briceno) Division of Cardiology, Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, United
States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic, Phoenix, AZ, United States
(Kalra) Division of Cardiovascular Medicine, Department of Medicine, Case
Western Reserve University School of Medicine, Cleveland, OH, United
States
Publisher
American Heart Association Inc.
Abstract
Background--Studies have shown that chronic total occlusion (CTO) in a
noninfarct-related artery in patients with ST-segment- elevation
myocardial infarction is linked to increased mortality. It remains unclear
whether staged revascularization of a noninfarct-related artery CTO in
patients with ST-segment-elevation myocardial infarction translates to
improved outcomes. We performed a meta-analysis to compare outcomes
between patients presenting with ST-segment-elevation myocardial
infarction with concurrent CTO who underwent percutaneous coronary
intervention of noninfarct-related artery CTO versus those who did not.
Method and Results--We conducted an electronic database search of all
published data. The primary end point was major adverse cardiovascular
events. Secondary end points were all-cause mortality, cardiovascular
mortality, myocardial infarction, repeat revascularization with either
percutaneous coronary intervention or coronary artery bypass grafting,
stroke, and heart failure readmission. Odds ratios (ORs) and 95%
confidence intervals (CIs) were computed. Random effects model was used
and heterogeneity was considered if I2 >25. Six studies (n=1253
patients) were included in the analysis. There was a significant
difference in major adverse cardiovascular events (OR, 0.54; 95% CI,
0.32-0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20-0.95), and
heart failure readmissions (OR, 0.57; 95% CI, 0.36-0.89), favoring the
patients in the CTO percutaneous coronary intervention group. No
significant differences were observed between the 2 groups for all-cause
mortality (OR, 0.47; 95% CI, 0.22-1.00), myocardial infarction (OR, 0.78;
95% CI, 0.41-1.46), repeat revascularization (OR, 1.13; 95% CI,
0.56-2.27), and stroke (OR, 0.51; 95% CI, 0.20-1.33). Conclusions--In this
meta-analysis, CTO percutaneous coronary intervention of the
noninfarct-related artery in patients presenting with ST-segment-elevation
myocardial infarction was associated with a significant reduction in major
adverse cardiovascular events, cardiovascular mortality, and heart failure
readmissions. Copyright © 2018 The Authors.

<58>
Accession Number
2007027586
Title
The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass
Vasoplegia.
Source
Cardiovascular Drugs and Therapy. 36(4) (pp 739-748), 2022. Date of
Publication: August 2022.
Author
Papazisi O.; Palmen M.; Danser A.H.J.
Institution
(Papazisi, Palmen) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Danser) Department of Internal Medicine, Division of Pharmacology,
Erasmus Medical Center, Rotterdam, Netherlands
Publisher
Springer
Abstract
Purpose: Vasoplegia is a common complication after cardiac surgery and is
related to the use of cardiopulmonary bypass (CPB). Despite its
association with increased morbidity and mortality, no consensus exists in
terms of its treatment. In December 2017, angiotensin II (AII) was
approved by the Food and Drug Administration (FDA) for use in vasodilatory
shock; however, except for the ATHOS-3 trial, its use in vasoplegic
patients that underwent cardiac surgery on CPB has mainly been reported in
case reports. Thus, the aim of this review is to collect all the
clinically relevant data and describe the pharmacologic mechanism,
efficacy, and safety of this novel pharmacologic agent for the treatment
of refractory vasoplegia in this population. Method(s): Two
independent reviewers performed a systematic search in PubMed, Embase, Web
of Science, and Cochrane Library using relevant MeSH terms (Angiotensin
II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures).
 Result(s): The literature search yielded 820 unique articles. In
total, 9 studies were included. Of those, 2 were randomized clinical
trials (RCTs) and 6 were case reports and 1 was a retrospective cohort
study. Conclusion(s): AII appears to be a promising means of
treatment for patients with post-operative vasoplegia. It is demonstrated
to be effective in raising blood pressure, while no major adverse events
have been reported. It remains uncertain whether this agent will be
broadly available and whether it will be more advantageous in the clinical
management of vasoplegia compared to other available vasopressors. For
that reason, we should contain our eagerness and enthusiasm regarding its
use until supplementary knowledge becomes available. Copyright ©
2020, The Author(s).

<59>
Accession Number
638412406
Title
Feasibility and preliminary efficacy of perioperative interventions in
patients undergoing coronary artery bypass grafting: the randomized
controlled I-COPE trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 62(1) (no pagination),
2022. Date of Publication: 15 Jun 2022.
Author
Sadlonova M.; Nagel J.; Becker S.; Neumann S.; Staab J.; Meyer T.; Celano
C.M.; Amonoo H.L.; Fangauf S.V.; Herrmann-Lingen C.; Kutschka I.;
Friedrich M.
Institution
(Sadlonova, Nagel, Becker, Neumann, Staab, Meyer, Fangauf,
Herrmann-Lingen) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Centre Gottingen, Gottingen, Germany
(Sadlonova, Kutschka, Friedrich) Department of Cardiovascular and Thoracic
Surgery, University Medical Centre Gottingen, Gottingen, Germany
(Sadlonova, Staab, Meyer, Herrmann-Lingen, Kutschka, Friedrich) DZHK
(German Centre for Cardiovascular Research), Partner Site ,Gottingen,
Germany
(Sadlonova, Celano) Department of Psychiatry, Massachusetts General
Hospital, MA, Boston, United States
(Sadlonova, Celano, Amonoo) Department of Psychiatry, Harvard Medical
School, MA, Boston, United States
(Amonoo) Department of Psychiatry, Brigham and Women's Hospital, MA,
Boston, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Patients undergoing coronary artery bypass graft (CABG)
surgery are exposed to multiple treatment-related stressors, which can
impact coping and health-related quality of life (HRQoL). The objective of
this trial was to analyse the feasibility and preliminary efficacy of a
multi-component intervention that combines psychological support and
reduction of hospital-specific stressors on HRQoL, length of hospital and
intensive care unit stay, self-efficacy, and plasma interleukin (IL)-6 and
-8 levels in CABG patients. METHOD(S): This three-arm, randomized
controlled, single-centre pilot trial assessed the Intervention for CABG
to Optimize Patient Experience in 88 patients undergoing elective CABG.
Standard medical care (SMC, n = 29) was compared with 2 intervention
groups: (i) psychological interventions to optimize treatment expectations
(IA group, n = 30) and (ii) multi-component intervention (IB group, n =
29) with psychological interventions plus an additional treatment package
(light therapy, noise reduction, music, and if desired, 360degree images
delivered via virtual reality). RESULT(S): The implementation of
psychological interventions in routine medical treatment was feasible
(91.5% of participants completed all intervention sessions). Both
interventions were associated with significantly shorter hospital stay
compared to SMC (IA/IB 9.8/9.3 days vs SMC 12.5 days). Self-efficacy
expectations at post-surgery were significantly higher compared to SMC
both in the IA group (P = 0.011) and marginally in the IB group (P =
0.051). However, there were no treatment effects of the interventions on
HRQoL and plasma levels of IL-6 or IL-8 after CABG. CONCLUSION(S): A
perioperative multi-component intervention may lead to shorter hospital
stay and higher self-efficacy after CABG. Further studies are needed to
determine its impact on HRQoL and inflammation. CLINICAL TRIAL
REGISTRATION NUMBER: Ethical approval (# 21/2/18) for the study was
obtained from the Research Ethics Committee of the University of Gottingen
Medical Center, and the trial was registered in the German Clinical Trials
Register (DRKS00015309,
https://www.drks.de/drks_web/setLocale_EN.do). Copyright © The
Author(s) 2022. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<60>
Accession Number
638346532
Title
Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days
in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC
Randomized Clinical Trial.
Source
JAMA. 328(1) (pp 38-47), 2022. Date of Publication: 05 Jul 2022.
Author
Schlapbach L.J.; Gibbons K.S.; Horton S.B.; Johnson K.; Long D.A.; Buckley
D.H.F.; Erickson S.; Festa M.; d'Udekem Y.; Alphonso N.; Winlaw D.S.;
Delzoppo C.; van Loon K.; Jones M.; Young P.J.; Butt W.; Schibler A.
Institution
(Schlapbach, Gibbons, Johnson, Long, Alphonso) Child Health Research
Centre, University of Queensland, Brisbane, QLD, Australia
(Schlapbach, Johnson) Paediatric Intensive Care Unit, Queensland
Children's Hospital, Children's Health Queensland, Brisbane, QLD,
Australia
(Schlapbach) Department of Intensive Care and Neonatology, Children's
Research Center, University Children's Hospital Zurich, University of
Zurich, Zurich, Switzerland
(Horton) Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, VIC,
Australia
(Horton, d'Udekem, Delzoppo, Butt) Faculty of Medicine, Department of
Paediatrics, University of Melbourne, Melbourne, VIC, Australia
(Horton, Butt) Clinical Sciences Theme, Murdoch Children's Research
Institute, Melbourne, VIC, Australia
(Long) School of Nursing, Centre for Healthcare Transformation, Queensland
University of Technology, Brisbane, QLD, Australia
(Buckley) Paediatric Intensive Care Unit, Starship Children's Hospital,
Auckland, New Zealand
(Erickson) Paediatric Critical Care, Perth Children's Hospital, Western
Australia and The University of Western Australia, Crawley, WA, Australia
(Festa) Kids Critical Care Research, Paediatric Intensive Care Unit,
Children's Hospital at Westmead, Westmead, NSW, Australia
(Festa) Sydney Children's Hospital Network, Sydney, NSW, Australia
(d'Udekem) Children's National Hospital and The George Washington
University School of Medicine and Health Sciences, Seattle, WA, United
States
(d'Udekem) Heart Research, Murdoch Children's Research Institute,
Melbourne, VIC, Australia
(Alphonso) Cardiac Surgery, Queensland Children's Hospital, Brisbane, QLD,
Australia
(Alphonso) School of Medicine, Children's Health Clinical Unit, University
of Queensland, Brisbane, QLD, Australia
(Winlaw) Heart Centre for Children, Children's Hospital at Westmead,
Westmead, NSW, Australia
(Winlaw) Sydney Children's Hospital Network and Faculty of Medicine and
Health, University of Sydney, Sydney, NSW, Australia
(Delzoppo, Butt) Paediatric Intensive Care Unit, Royal Children's Hospital
Melbourne, Melbourne, VIC, Australia
(van Loon) Department of Anaesthesiology, University Medical Center
Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
(Jones) Institute of Evidence Based Healthcare, Bond University, Gold
Coast, Australia
(Young) Intensive Care Research Programme, Medical Research Institute of
New Zealand, Wellington, New Zealand
(Butt) Department of Critical Care, Melbourne Medical School University of
Melbourne, VIC, Australia
(Butt) Central Clinical School Faculty of Medicine Monash University,
Melbourne, VIC, Australia
(Schibler) Critical Care Research Group, Wesley Medical Research, St
Andrew's War Memorial Hospital, Brisbane, QLD, Australia
Publisher
NLM (Medline)
Abstract
Importance: In children undergoing heart surgery, nitric oxide
administered into the gas flow of the cardiopulmonary bypass oxygenator
may reduce postoperative low cardiac output syndrome, leading to improved
recovery and shorter duration of respiratory support. It remains uncertain
whether nitric oxide administered into the cardiopulmonary bypass
oxygenator improves ventilator-free days (days alive and free from
mechanical ventilation). Objective(s): To determine the effect of
nitric oxide applied into the cardiopulmonary bypass oxygenator vs
standard care on ventilator-free days in children undergoing surgery for
congenital heart disease. Design, Setting, and Participant(s):
Double-blind, multicenter, randomized clinical trial in 6 pediatric
cardiac surgical centers in Australia, New Zealand, and the Netherlands. A
total of 1371 children younger than 2 years undergoing congenital heart
surgery were randomized between July 2017 and April 2021, with 28-day
follow-up of the last participant completed on May 24, 2021.
 Intervention(s): Patients were assigned to receive nitric oxide at 20
ppm delivered into the cardiopulmonary bypass oxygenator (n=679) or
standard care cardiopulmonary bypass without nitric oxide (n=685).
 Main Outcomes and Measures: The primary end point was the number of
ventilator-free days from commencement of bypass until day 28. There were
4 secondary end points including a composite of low cardiac output
syndrome, extracorporeal life support, or death; length of stay in the
intensive care unit; length of stay in the hospital; and postoperative
troponin levels. Result(s): Among 1371 patients who were randomized
(mean [SD] age, 21.2 [23.5] weeks; 587 girls [42.8%]), 1364 (99.5%)
completed the trial. The number of ventilator-free days did not differ
significantly between the nitric oxide and standard care groups, with a
median of 26.6 days (IQR, 24.4 to 27.4) vs 26.4 days (IQR, 24.0 to 27.2),
respectively, for an absolute difference of -0.01 days (95% CI, -0.25 to
0.22; P=.92). A total of 22.5% of the nitric oxide group and 20.9% of the
standard care group developed low cardiac output syndrome within 48 hours,
needed extracorporeal support within 48 hours, or died by day 28, for an
adjusted odds ratio of 1.12 (95% CI, 0.85 to 1.47). Other secondary
outcomes were not significantly different between the groups.
 Conclusions and Relevance: In children younger than 2 years
undergoing cardiopulmonary bypass surgery for congenital heart disease,
the use of nitric oxide via cardiopulmonary bypass did not significantly
affect the number of ventilator-free days. These findings do not support
the use of nitric oxide delivered into the cardiopulmonary bypass
oxygenator during heart surgery. Trial Registration: anzctr.org.au
Identifier: ACTRN12617000821392.

<61>
Accession Number
637919893
Title
Coronary Artery Revascularization in Heart Transplant Patients: A
Systematic Review and Meta-Analysis.
Source
Cardiology. 147(3) (pp 348-363), 2022. Date of Publication: 2022.
Author
El-Andari R.; Bozso S.J.; Fialka N.M.; Kang J.J.H.; MacArthur R.G.G.;
Meyer S.R.; Freed D.H.; Nagendran J.
Institution
(El-Andari, Fialka) Faculty of Medicine and Dentistry, University of
Alberta, Edmonton, AB, Canada
(Bozso, Kang, MacArthur, Meyer, Freed, Nagendran) Division of Cardiac
Surgery, Department of Surgery, University of Alberta, Edmonton, AB,
Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is the primary cause of
late mortality after heart transplantation. We look to provide a
comprehensive review of contemporary revascularization strategies in CAV.
 METHOD(S): PubMed and Web of Science were systematically searched by
3 authors. 1,870 articles were initially screened and 24 were included in
this review. RESULT(S): PCI is the main revascularization technique
utilized in CAV. The pooled estimates for restenosis significantly favored
DES over BMS (OR 4.26; 95% CI: 2.54-7.13; p < 0.00001; I2 = 4%). There
were insufficient data to quantitatively compare mortality following DES
versus BMS. There was no difference in short-term mortality between CABG
and PCI. In-hospital mortality was 0.0% for CABG and ranged from 0.0 to
8.34% for PCI. One-year mortality was 8.0% for CABG and 5.0-25.0% for PCI.
CABG had a potential advantage at 5 years. Five-year mortality was 17.0%
for CABG and ranged from 14 to 40.4% following PCI. Select measures of
postoperative morbidity trended toward superior outcomes for CABG.
 CONCLUSION(S): In CAV, PCI is the primary revascularization strategy
utilized, with DES exhibiting superiority to BMS regarding postoperative
morbidity. Further investigation into outcomes following CABG in CAV is
required to conclusively elucidate the superior management strategy in
CAV. Copyright © 2022 S. Karger AG, Basel.

<62>
Accession Number
637832532
Title
Sex-Related Differences in Transcatheter Mitral Valve Repair: A Systematic
Review and Meta-Analysis.
Source
Cardiology. 147(3) (pp 337-347), 2022. Date of Publication: 2022.
Author
El-Andari R.; Bozso S.J.; Kang J.J.H.; Adams C.; Nagendran J.
Institution
(El-Andari) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(Bozso, Kang, Nagendran) Division of Cardiac Surgery, Department of
Surgery, University of Alberta, Edmonton, AB, Canada
(Adams) Section of Cardiac Surgery, Department of Cardiac Sciences, Libin
Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB,
Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Inequalities in postoperative outcomes between males and
females are well described with females often experiencing inferior
outcomes after heart valve surgery. The recent literature has demonstrated
equivalent or improved outcomes for females after transcatheter aortic
valve replacement. Transcatheter mitral valve repair (TMVr) and
replacement (TMVR) is a relatively newer field with significantly less
literature comparing sex differences. This systematic review and
meta-analysis looks to provide a comprehensive summary of the published
literature comparing outcomes between males and females undergoing
transcatheter MV interventions. METHOD(S): PubMed, MEDLINE, and
Scopus were systematically searched for all studies comparing outcomes
between males and females undergoing TMVr and TMVR. A total of 2,178
English manuscript titles and abstracts were reviewed. Articles were
excluded if data were not provided regarding sex differences,
transcatheter MV intervention, full-length text was not accessible, or if
insufficient data was provided. A total of 2,170 articles were excluded,
and 8 articles were included in this study. RESULT(S): Pooled
estimates of outcomes demonstrated rates of acute kidney injury (OR 1.28
[95% CI, 1.14-1.44; p < 0.0001]) favored females, while rates of major
bleeding favored males (OR 0.85 [95% CI 0.76-0.96; p = 0.01]). Rates of
mortality, postoperative MI, and stroke did not differ significantly.
 CONCLUSION(S): A trend has emerged in heart valve interventions with
males tending to have improved outcomes after surgical intervention and
females experiencing equivalent or improved outcomes after transcatheter
interventions. This meta-analysis identified increased rates of acute
kidney injury for males, increased rates of major bleeding for females,
and otherwise comparable morbidity and mortality in males and females
undergoing TMVr. Copyright © 2022 S. Karger AG, Basel.

<63>
Accession Number
2017537888
Title
Iron homeostasis in heart transplant recipients randomized to ferric
derisomaltose or placebo.
Source
Clinical Transplantation. 36(7) (no pagination), 2022. Article Number:
e14695. Date of Publication: July 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. 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. 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. 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. Copyright © 2022 John Wiley & Sons A/S. Published by John
Wiley & Sons Ltd.

<64>
Accession Number
2018955749
Title
CO105 Does Preoperative Chest Physiotherapy Affect the Postoperative
Pulmonary Complications and Lung Functions in Patients Undergoing Elective
Cardiac Surgery? a Systematic Review and Meta-Analysis.
Source
Value in Health. Conference: ISPOR 2022: The Future of HEOR in
Patient-Driven Digital Healthcare Systems. Virtual, Online. 25(7
Supplement) (pp S323-S324), 2022. Date of Publication: July 2022.
Author
Shahood H.; Pakai A.; Kiss R.; Bory E.; Szilagyi N.; Sandor A.; Boncz I.;
Verzar Z.
Institution
(Shahood) University of Pecs, vienna, Austria
(Pakai) University of Pecs, ZA, Pecs, Hungary
(Kiss, Bory, Szilagyi, Sandor, Boncz, Verzar) University of Pecs, Pecs,
Hungary
Publisher
Elsevier Ltd
Abstract
Objectives: This systematic review and meta-analysis aimed to evaluate the
role of preoperative chest physiotherapy in patients undergoing elective
cardiac surgeries. Method(s): A systematic review and
meta-analysis.the included studies were those evaluating the value of
preoperative chest physiotherapy in adult patients undergoing elective
cardiac surgery. The search was performed using the standardized
electronic resources. After articles screening based on the eligibility
criteria, data were extracted and analyzed. 10 articles investigating 1458
patients were including were included in the study. They were classified
into two groups; interventional (I) group involving 651 patients and
control (C) group involving 807 patients. Result(s): The
meta-analyses demonstrated no significant differences between
interventional and control groups in the surgery time and the ICU duration
and significant differences in the time of mechanical ventilation and the
hospital stay length, with favouring of the interventional group.
Significant differences were shown in the FEV1%predicted, FVC %predicted,
and Pi-max, with favouring of the interventional group. The intervention
was protective against the occurrence of PPCs. Conclusion(s): The
current work concluded that preoperative chest physiotherapy can yield
better outcome in patients undergoing elective cardiac
surgery. Copyright © 2022

<65>
Accession Number
2018955485
Title
The Effect of Preoperative Chest Physiotherapy on Oxygenation and Lung
Functions Among Cardiac Surgery Patients: A Randomized Controlled Study.
Source
Value in Health. Conference: ISPOR 2022: The Future of HEOR in
Patient-Driven Digital Healthcare Systems. Virtual, Online. 25(7
Supplement) (pp S306), 2022. Date of Publication: July 2022.
Author
Shahood H.; Pakai A.; Kiss R.; Bory E.; Szilagyi N.; Sandor A.; Boncz I.;
Verzar Z.
Institution
(Shahood) University of Pecs, vienna, Austria
(Pakai) University of Pecs, ZA, Pecs, Hungary
(Kiss, Bory, Szilagyi, Sandor, Boncz, Verzar) University of Pecs, Pecs,
Hungary
Publisher
Elsevier Ltd
Abstract
Objectives: This study aimed to assess the preoperative chest
physiotherapy effects of on oxygenation and lung functions among patients
undergoing open heart surgeries. Method(s): A randomized controlled
study was made at the Clinical Centre, Heart Institute, University of
Pecs, Hungary. This study was conducted in the period between 04.2019 and
10.2019. 100 adult patients with planned open heart surgery were blindly
and randomly allocated into two groups by using prepared opaque sealed
envelopes, containing either number 1 or number 2; one group included
patients who underwent the intervention in the form of home chest
physiotherapy program for one week preoperative in addition to the
traditional postoperative program, and the other group included patients
who underwent only the traditional postoperative program. Exclusion
criteria were Patients with a history of strokes, musculoskeletal
disorders, or psychological disorders. The numerical data were presented
as mean (standard deviation), while the categorical data were presented as
a percentage. Chi-square test, T-test (unpaired) and ANOVA test were
performed with the help of the SPSS 22.0 and (P<0.05). Result(s): A
total of 100 people underwent open heart surgery were included in the
trial and had preoperative chest physiotherapy (n = 45) or not (n =
55).The patients' age ranged between 40 and 83 years. The main type of
operation in the study patients was coronary artery bypass graft (64%). No
significant differences were noted between both study groups in the
preoperative outpatient clinic and day 0 respiratory functions
measurements (FVC, FEV1)or O2 saturation (P >.05), while Significant
differences regarding the same measures in the postoperative 7 days
measurements (P<0.05) were evident. The postoperative hospital stay length
ranged from 7 to 20 days, with a high significant increase noted in group
2. Conclusion(s): Preoperative chest physiotherapy is effective in
improving respiratory functions following the open heart
surgery. Copyright © 2022

<66>
Accession Number
2018954489
Title
HTA20 A Systematic Review and Statistical Analysis of Factors Influencing
the Cost-Effectiveness of Transcatheter Aortic Valve Implantation (TAVI)
for Severe Symptomatic Aortic Stenosis.
Source
Value in Health. Conference: ISPOR 2022: The Future of HEOR in
Patient-Driven Digital Healthcare Systems. Virtual, Online. 25(7
Supplement) (pp S507), 2022. Date of Publication: July 2022.
Author
Heathcote L.; Candolfi P.; Kearns B.; Sarmah A.; Srivastava T.; Sutton A.
Institution
(Heathcote) The University of Sheffield, SHEFFIELD, United Kingdom
(Candolfi) Edwards Lifesciences, Inc., Irvine, CA, United States
(Kearns) University of Sheffield, School of Health and Related Research,
Sheffield, United Kingdom
(Sarmah) Edwards Lifesciences SA, VD, Nyon, Switzerland
(Srivastava) ScHARR - University of Sheffield, Sheffield, United Kingdom
(Sutton) University of Sheffield, Sheffield, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: TAVI is a disruptive technology that is often recommended as
the standard of care for patients with symptomatic severe aortic stenosis
(sSAS). Whilst there have been many published economic evaluations of TAVI
across all surgical groups, there is little evidence on the relative
importance of different factors that influence cost-effectiveness. This
study sought to identify these factors and quantify their role.
 Method(s): A systematic literature review was conducted in Medline,
Embase, Econlit, NHS EED, and the Tufts CEA registry to identify published
economic evaluations of TAVI. This was supplemented by health technology
assessment reports. Evidence on key characteristics was extracted and
analysed using statistical methods (penalised logistic regression). The
primary outcome was TAVI's cost-effectiveness. Secondary outcomes were
TAVI being dominant and the incremental health gains of TAVI.
 Result(s): Forty-two studies, reporting 65 unique analyses, were
identified. Relative to its comparators, TAVI was found to be
cost-effective and dominant in 74% and 20% of analyses, respectively. The
largest driver of cost-effectiveness results was device generation, with
the latest generation valves the most likely to be cost-effective. TAVI is
most likely to be cost-effective in low-risk populations, and when
performed via transfemoral access route. Cost-effectiveness was also found
to be influenced by the modelling approach taken. Studies that found TAVI
to be dominant always compared it to surgery and typically considered the
latest generation valves. Largest health benefits were observed for the
inoperable surgical risk group. Conclusion(s): For patients with
sSAS, TAVI seems to be a cost-effective treatment option. There are
important differences by device generation, risk group and access route.
It is crucial to consider these differences when appraising the health
economic evidence-base for TAVI. Copyright © 2022

<67>
Accession Number
2018954330
Title
EE229 Potential Budget Impact of Iodophor Impregnated Incise Drape Versus
Clear Incise Drape in Cardiac Surgery across Selected Countries in Latin
America.
Source
Value in Health. Conference: ISPOR 2022: The Future of HEOR in
Patient-Driven Digital Healthcare Systems. Virtual, Online. 25(7
Supplement) (pp S378), 2022. Date of Publication: July 2022.
Author
Campos D.; Reuter H.; Topachevskyi O.; Palka-Santini M.
Institution
(Campos) 3M Costa Rica S.A, Heredia, Costa Rica
(Reuter) 3M Deutschland GmbH, Neuss, Germany, Neuss, Germany
(Topachevskyi) Digital Health Outcomes LLC, Kyiv, Ukraine
(Palka-Santini) 3M Deutschland GmbH, NW, Neuss, Germany
Publisher
Elsevier Ltd
Abstract
Objectives: This study was designed to estimate the potential budget
impact of use of iodine impregnated drapes vs clear incise drapes in
cardiac surgery across selected countries in Latin America.
 Method(s): A previously published economic model was used. The model
calculates the potential budget impact based on cost and risk of surgical
site infection (SSI) from perspective of private health care in Brazil and
public health care in Mexico, Colombia and Chile. The model considers an
SSI risk of 1.9% for the iodine impregnated drape and 6.6% for the control
(p=0.001). Local material costs have been applied. A systematic review on
the cost of SSI for these countries yielded no results, therefore a
micro-costing methodology was used for Brazil, Colombia and Chile. For
Mexico, applicable diagnosis related groups (DRGs) have been used for SSI
cost estimation. A probabilistic sensitivity analysis was performed to
characterize uncertainty of SSI risk and cost of SSI. All calculations
have been performed in local currency and have been translated to US
dollars. Result(s): The micro-costing method provides an SSI cost of
$4,395 for Chile, $5,098 for Colombia and $9,768 for Brazil. The SSI cost
for Mexico was $3,279. The corresponding total cost reduction for 1000
patients using iodine impregnated incise drapes was $197,215 (64.0%) for
Chile, $252,285 (68.7%) for Colombia, $460,177 (68.2%) for Brazil and
$154,784 (69.5%) for Mexico. The probabilistic sensitivity analysis
demonstrated a 100% probability of cost saving for all countries.
 Conclusion(s): The use of iodine impregnated incise drapes in cardiac
surgery is likely to be cost saving for hospital budgets for all countries
included in this analysis. Savings are also expected in countries like
Mexico, where the used micro-costing approach provided a relatively low
SSI cost. Copyright © 2022

<68>
Accession Number
2018198248
Title
Long-term effects of cardiac rehabilitation after heart valve surgery -
results from the randomised CopenHeart<inf>VR</inf> trial.
Source
Scandinavian Cardiovascular Journal. 56(1) (pp 247-255), 2022. Date of
Publication: 2022.
Author
Sibilitz K.L.; Tang L.H.; Berg S.K.; Thygesen L.C.; Risom S.S.; Rasmussen
T.B.; Schmid J.-P.; Borregaard B.; Hassager C.; Kober L.; Taylor R.S.;
Zwisler A.-D.
Institution
(Sibilitz, Berg, Risom, Hassager, Kober) Department of Cardiology, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Tang, Zwisler) REHPA-The Danish Knowledge Centre for Rehabilitation and
Palliative Care and University of Southern Denmark, Odense, Denmark
(Tang) Department of Physiotherapy and Occupational Therapy,
Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
(Tang) Department of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Berg, Risom, Rasmussen) Department of Clinical Medicine, Faculty of
Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
(Thygesen, Taylor) National Institute of Public Health, University of
Southern Denmark, Copenhagen, Denmark
(Risom) Institute for Nursing and Nutrition, University College
Copenhagen, Tagensvej, Denmark
(Rasmussen) Department of Cardiology, Herlev and Gentofte University
Hospital, Copenhagen, Denmark
(Schmid) Swiss Cardiovascular Centre Bern, Cardiovascular Prevention and
Rehabilitation Unit, University Hospital, Bern, Switzerland
(Borregaard) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Borregaard) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Taylor) Institute of Health and Well Being, University of Glasgow,
Glasgow, United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Zwisler) Department of Cardiology, Odense University Hospital, University
of Southern Denmark, Odense, Denmark
Publisher
Taylor and Francis Ltd.
Abstract
Aims. The CopenHeart<inf>VR</inf> trial found positive effects of cardiac
rehabilitation (CR) on physical capacity at 4 months. The long-term
effects of CR following valve surgery remains unclear, especially
regarding readmission and mortality. Using data from he
CopenHeart<inf>VR</inf> Trial we investigated long-term effects on
physical capacity, mental and physical health and effect on mortality and
readmission rates as prespecified in the original protocol. Methods. A
total of 147 participants were included after heart valve surgery and
randomly allocated 1:1 to 12-weeks exercise-based CR including a
psycho-educational programme (intervention group) or control. Physical
capacity was assessed as peak oxygen uptake (VO<inf>2</inf> peak) measured
by cardiopulmonary exercise testing, mental and physical health by Short
Form-36 questionnaire, Hospital Anxiety and Depression Scale, and
HeartQol. Mortality and readmission were obtained from hospital records
and registers. Groups were compared using mixed regression model analysis
and log rank test. Results. No differences in VO<inf>2</inf> peak at 12
months or in self-assessed mental and physical health at 24 months (68% vs
75%, p =.120) was found. However, our data demonstrated reduction in
readmissions in the intervention group at intermediate time points; after
3, 6 (43% vs 59%, p =.03), and 12 (53% vs 67%, p =.04) months,
respectively, but no significant effect at 24 months. Conclusions.
Exercise-based CR after heart valve surgery reduces combined readmissions
and mortality up to 12 months despite lack of improvement in exercise
capacity, physical and mental health long-term. Exercise-based CR can
ensure short-term benefits in terms of physical capacity, and lower
readmission within a year, but more research is needed to sustain these
effects over a longer time period. These considerations should be included
in the management of patients after heart valve surgery. Copyright
© 2022 The Author(s). Published by Informa UK Limited, trading as
Taylor & Francis Group.

<69>
Accession Number
2018986612
Title
Aortic thrombosis: The forgotten source of ischemic stroke. A case report
and systematic review of the literature.
Source
Monaldi Archives for Chest Disease. 92(3) (no pagination), 2022. Article
Number: 2090. Date of Publication: 2022.
Author
Basile C.; Mancusi C.; Gargiulo P.; Filardi P.P.; Perrino C.; Canciello
G.; Losi M.A.; Esposito G.
Institution
(Basile, Mancusi, Gargiulo, Filardi, Perrino, Canciello, Losi, Esposito)
Department of Advanced Biomedical Science, Federico II University
Hospital, Naples, Italy
Publisher
Page Press Publications
Abstract
Ischemic stroke represents one of the most important health problems in
industrialized countries, both for epidemiological and socio-economic
impact. The presence of thrombi in the aorta is rare and its treatment has
not been uniquely defined. Here we report the case of an 82-years-old man
with aortic thrombosis and acute ischemic stroke. © Copyright:
the Author(s), 2021

<70>
Accession Number
638425878
Title
Coronary sinus reducer for the treatment of chronic refractory angina
pectoris.
Source
Future Cardiology. 18(7) (pp 523-537), 2022. Date of Publication: July
2022.
Author
Ponticelli F.; Giannini F.
Institution
(Ponticelli) Humanitas University, Milan, Italy
(Giannini) Interventional Cardiology Unit, Gvm Care & Research Maria
Cecilia Hospital, Via Madonna di Genova 1, RA, Cotignola 48033, Italy
Publisher
Future Medicine Ltd.
Abstract
Refractory angina represents the final stage of chronic coronary artery
disease, where anginal symptoms persist despite complete epicardial
coronary artery revascularization and maximally tolerated pharmacological
therapy. Percutaneous narrowing of the coronary sinus with the coronary
sinus reducer (Reducer, Neovasc, Inc., Richmond, Canada) device was first
attempted in humans in 2005 and has been shown to improve angina symptoms
and the quality of life of patients suffering chronic refractory angina.
It was recently included in the European guidelines for the management of
chronic coronary syndrome and is progressively gaining popularity. The
authors hereby provide a review of current literature on the topic,
intending to facilitate insights and to promote further research on this
device and its clinical applications. Copyright © 2022 Future
Medicine Ltd.

<71>
Accession Number
2018199925
Title
Lung transplantation and concomitant cardiac surgical procedures: A
systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Meng E.; Jiang S.M.; Servito T.; Payne D.; El-Diasty M.
Institution
(Meng, Jiang, Servito, Payne, El-Diasty) Division of Cardiac Surgery,
Queen's University, Kingston, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Lung transplantation is an effective treatment option for
end-stage lung diseases. In some cases, these patients may also have
underlying cardiac disease which may require surgical intervention before
or during transplantation. Concomitant cardiac surgery may often be
preferred, as reduced lung function precludes these patients from
pre-transplant surgery. Our meta-analysis sought to examine the impact of
lung transplantation paired with concomitant cardiac surgery on long-term
mortality. Method(s): We conducted a systematic review of the
MEDLINE, Embase, and Cochrane databases. Our primary outcome was overall
mortality. Secondary outcomes included length of stay (LOS) in hospital
and serious postoperative complication rates. We used a meta-analytic
model to determine the differences in the above outcomes between patients
who underwent lung transplantation with or without concomitant cardiac
surgery. Result(s): Out of the 1876 articles screened, 7 met our
pre-determined inclusion criteria. Lung transplantation with concomitant
cardiac surgery was not associated with increased mortality compared to
lung transplantation alone (hazard ratio = 1.02; 95% confidence interval
[CI] = 0.80-1.31; I2 = 0%; p =.99). LOS in hospital was not
significantly different between groups (standardized mean difference =
0.32; 95% CI = -0.91 to 1.55). Postoperative complication rates were also
reported but not analyzed due to missing data. Conclusion(s): There
was no significant difference in mortality rates in patients undergoing
lung transplantation with or without concomitant cardiac surgery at 1, 3,
and 5 years. However, postoperative complication rates were higher in the
concomitant group. The decision to perform concomitant procedures should
be tailored to each patient's clinical condition. Copyright ©
2022 Wiley Periodicals LLC.

<72>
Accession Number
601554983
Title
Efficacy and safety of LDL-lowering therapy among men and women:
Meta-analysis of individual data from 174 000 participants in 27
randomised trials.
Source
The Lancet. 385(9976) (pp 1397-1405), 2015. Date of Publication: 01 Jan
2015.
Author
Fulcher J.; O'Connell R.; Voysey M.; Emberson J.; Blackwell L.; Mihaylova
B.; Simes J.; Collins R.; Kirby A.; Colhoun H.; Braunwald E.; La Rosa J.;
Pedersen T.R.; Tonkin A.; Davis B.; Sleight P.; Franzosi M.G.; Baigent C.;
Keech A.; De Lemos J.; Blazing M.; Murphy S.; Downs J.R.; Gotto A.;
Clearfield M.; Holdaas H.; Gordon D.; Koren M.; Dahlof B.; Poulter N.;
Sever P.; Knopp R.H.; Fellstrom B.; Jardine A.; Schmieder R.; Zannad F.;
Goldbourt U.; Kaplinsky E.; Betteridge D.J.; Durrington P.N.; Hitman G.A.;
Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.;
Hawkins C.M.; Kjekshus J.; Wedel H.; Wikstrand J.; Barter P.; Tavazzi L.;
Maggioni A.; Marchioli R.; Tognoni G.; Bloomfield H.; Robins S.; Armitage
J.; Parish S.; Peto R.; Ridker P.M.; Holman R.; Meade T.; MacMahon S.;
Marschner I.C.; Shaw J.; Serruys P.W.; Nakamura H.; Knatterud G.; Furberg
C.; Byington R.; Macfarlane P.; Ford I.; Murphy M.; Blauw G.J.; Packard
C.; Shepherd J.; Wilhelmsen L.; Cannon C.; Bowman L.; Landray M.; Rossouw
J.; Probstfield J.; Cobbe S.; Flather M.; Kastelein J.; Newman C.; Shear
C.; Tobert J.; Varigos J.; White H.; Yusuf S.; Barnes E.H.; Herrington
W.G.; Holland L.E.; Reith C.
Institution
(Simes, Kirby, Keech, Marschner, Barnes) CTC, University of Sydney,
Australia
(Emberson, Blackwell, Mihaylova, Collins, Baigent, Herrington, Holland,
Reith) CTSU, University of Oxford, United Kingdom
Publisher
Elsevier B.V.
Abstract
Background: Whether statin therapy is as effective in women as in men is
debated, especially for primary prevention. We undertook a meta-analysis
of statin trials in the Cholesterol Treatment Trialists' (CTT)
Collaboration database to compare the effects of statin therapy between
women and men. Method(s): We performed meta-analyses on data from 22
trials of statin therapy versus control (n=134 537) and five trials of
more-intensive versus less-intensive statin therapy (n=39 612). Effects on
major vascular events, major coronary events, stroke, coronary
revascularisation and mortality were weighted per 1.0 mmol/L reduction in
LDL cholesterol and effects in men and women compared with a Cox model
that adjusted for non-sex differences. For subgroup analyses, we used 99%
CIs to make allowance for the multiplicity of comparisons. Findings 46 675
(27%) of 174 149 randomly assigned participants were women. Allocation to
a statin had similar absolute effects on 1 year lipid concentrations in
both men and women (LDL cholesterol reduced by about 1.1 mmol/L in statin
vs control trials and roughly 0.5 mmol/L for more-intensive vs
less-intensive therapy). Women were generally at lower cardiovascular risk
than were men in these trials. The proportional reductions per 1.0 mmol/L
reduction in LDL cholesterol in major vascular events were similar overall
for women (rate ratio [RR] 0.84, 99% CI 0.78-0.91) and men (RR 0.78, 99%
CI 0.75-0.81, adjusted p value for heterogeneity by sex=0.33) and also for
those women and men at less than 10% predicted 5 year absolute
cardiovascular risk (adjusted heterogeneity p=0.11). Likewise, the
proportional reductions in major coronary events, coronary
revascularisation, and stroke did not differ significantly by sex. No
adverse effect on rates of cancer incidence or non-cardiovascular
mortality was noted for either sex. These net benefits translated into
all-cause mortality reductions with statin therapy for both women (RR
0.91, 99% CI 0.84-0.99) and men (RR 0.90, 99% CI 0.86-0.95; adjusted
heterogeneity p=0.43). Interpretation In men and women at an equivalent
risk of cardiovascular disease, statin therapy is of similar effectiveness
for the prevention of major vascular events.

<73>
Accession Number
52015679
Title
The effects of lowering LDL cholesterol with statin therapy in people at
low risk of vascular disease: Meta-analysis of individual data from 27
randomised trials.
Source
The Lancet. 380(9841) (pp 581-590), 2012. Date of Publication: 01 Aug
2012.
Author
Mihaylova B.; Emberson J.; Blackwell L.; Keech A.; Simes J.; Barnes E.H.;
Voysey M.; Gray A.; Collins R.; Baigent C.; De Lemos J.; Braunwald E.;
Blazing M.; Murphy S.; Downs J.R.; Gotto A.; Clearfield M.; Holdaas H.;
Gordon D.; Davis B.; Koren M.; Dahlof B.; Poulter N.; Sever P.; Knopp
R.H.; Fellstrom B.; Jardine A.; Schmieder R.; Zannad F.; Goldbourt U.;
Kaplinsky E.; Colhoun H.M.; Betteridge D.J.; Durrington P.N.; Hitman G.A.;
Fuller J.; Neil A.; Wanner C.; Krane V.; Sacks F.; Moye L.; Pfeffer M.;
Hawkins C.M.; Kjekshus J.; Wedel H.; Wikstrand J.; Barter P.; Tavazzi L.;
Maggioni A.; Marchioli R.; Tognoni G.; Franzosi M.G.; Bloomfield H.;
Robins S.; Armitage J.; Parish S.; Peto R.; Sleight P.; Pedersen T.R.;
Ridker P.M.; Holman R.; Meade T.; MacMahon S.; Marschner I.; Tonkin A.;
Shaw J.; Serruys P.W.; Nakamura H.; Knatterud G.; Furberg C.; Byington R.;
MacFarlane P.; Cobbe S.; Ford I.; Murphy M.; Blauw G.J.; Packard C.;
Shepherd J.; Wilhelmsen L.; Cannon C.; Bowman L.; Landray M.; La Rosa J.;
Rossouw J.; Probstfi Eld J.; Flather M.; Kastelein J.; Newman C.; Shear
C.; Tobert J.; Varigos J.; White H.; Yusuf S.; Mellies M.; McGovern M.;
Barclay J.; Belder R.; Mitchel M.Y.; Musliner T.; Ansquer J.-C.; Llewellyn
B.M.; Pharma N.; Bortolini M.; Brandrup-Wognsen G.; Bryzinski B.; Olsson
G.; Pears J.; DeMicco D.; Baxter A.; Bhala N.; Buck G.; Herrington W.G.;
Holland L.E.; Kearney P.M.; Kirby A.; Lewis D.A.; Pollicino C.; Reith C.;
Sourjina T.
Institution
(Baigent, Marschner, Baxter, Bhala, Buck, Herrington, Holland, Kearney,
Kirby, Lewis, Pollicino, Reith, Sourjina) National Health and Medical
Research Council (NHMRC), Clinical Trial Centre, University of Sydney,
Mallett Street Campus M02, NSW 2006, Australia
Publisher
Elsevier B.V. (E-mail: cususerv@lancet.com)
Abstract
Background Statins reduce LDL cholesterol and prevent vascular events, but
their net effects in people at low risk of vascular events remain
uncertain. Methods This meta-analysis included individual participant data
from 22 trials of statin versus control (n=134 537; mean LDL cholesterol
difference 1.08 mmol/L; median follow-up 4.8 years) and five trials of
more versus less statin (n=39 612; difference 0.51 mmol/L; 5.1 years).
Major vascular events were major coronary events (ie, non-fatal myocardial
infarction or coronary death), strokes, or coronary revascularisations.
Participants were separated into five categories of baseline 5-year major
vascular event risk on control therapy (no statin or low-intensity statin)
(<5%, >=5% to <10%, >=10% to <20%, >=20% to <30%, >=30%); in each, the
rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.
Findings Reduction of LDL cholesterol with a statin reduced the risk of
major vascular events (RR 0.79, 95% CI 0.77-0.81, per 1.0 mmol/L
reduction), largely irrespective of age, sex, baseline LDL cholesterol or
previous vascular disease, and of vascular and all-cause mortality. The
proportional reduction in major vascular events was at least as big in the
two lowest risk categories as in the higher risk categories (RR per 1.0
mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81],
0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86],
and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant
reductions in these two lowest risk categories in major coronary events
(RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74,
p<0.0001) and in coronary revascularisations (RR 0.52, 99% CI 0.35-0.75,
and 0.63, 99% CI 0.51-0.79; both p<0.0001). For stroke, the reduction in
risk in participants with 5-year risk of major vascular events lower than
10% (RR per 1.0 mmol/L LDL cholesterol reduction 0.76, 99% CI 0.61-0.95,
p=0.0012) was also similar to that seen in higher risk categories (trend
p=0.3). In participants without a history of vascular disease, statins
reduced the risks of vascular (RR per 1.0 mmol/L LDL cholesterol reduction
0.85, 95% CI 0.77-0.95) and all-cause mortality (RR 0.91, 95% CI
0.85-0.97), and the proportional reductions were similar by baseline risk.
There was no evidence that reduction of LDL cholesterol with a statin
increased cancer incidence (RR per 1.0 mmol/L LDL cholesterol reduction
1.00, 95% CI 0.96-1.04), cancer mortality (RR 0.99, 95% CI 0.93-1.06), or
other non-vascular mortality. Interpretation In individuals with 5-year
risk of major vascular events lower than 10%, each 1 mmol/L reduction in
LDL cholesterol produced an absolute reduction in major vascular events of
about 11 per 1000 over 5 years. This benefi t greatly exceeds any known
hazards of statin therapy. Under present guidelines, such individuals
would not typically be regarded as suitable for LDL-lowering statin
therapy. The present report suggests, therefore, that these guidelines
might need to be reconsidered.

<74>
Accession Number
2011613973
Title
Bioreactance and fourth-generation pulse contour methods in monitoring
cardiac index during off-pump coronary artery bypass surgery.
Source
Journal of Clinical Monitoring and Computing. 36(3) (pp 879-888), 2022.
Date of Publication: June 2022.
Author
Ylikauma L.A.; Ohtonen P.P.; Erkinaro T.M.; Vakkala M.A.; Liisanantti
J.H.; Satta J.U.; Juvonen T.S.; Kaakinen T.I.
Institution
(Ylikauma, Ohtonen, Erkinaro, Vakkala, Liisanantti, Satta, Juvonen,
Kaakinen) Medical Research Center Oulu, Research Group of Surgery,
Anesthesiology and Intensive Care Medicine, Oulu University Hospital and
University of Oulu, Oulu, Finland
(Ohtonen) Division of Operative Care, Oulu University Hospital, Oulu,
Finland
(Juvonen) Department of Cardiac Surgery, Heart and Lung Center, Helsinki
University Central Hospital, Helsinki University Hospital, Helsinki,
Finland
Publisher
Springer Science and Business Media B.V.
Abstract
The pulmonary artery catheter (PAC) is considered the gold standard for
cardiac index monitoring. Recently new and less invasive methods to assess
cardiac performance have been developed. The aim of our study was to
assess the reliability of a non-invasive monitor utilizing bioreactance
(Starling SV) and a non-calibrated mini-invasive pulse contour device
(FloTrac/EV1000, fourth-generation software) compared to bolus
thermodilution technique with PAC (TDCO) during off-pump coronary artery
bypass surgery (OPCAB). In this prospective study, 579 simultaneous intra-
and postoperative cardiac index measurements obtained with Starling SV,
FloTrac/EV1000 and TDCO were compared in 20 patients undergoing OPCAB. The
agreement of data was investigated by Bland-Altman plots, while trending
ability was assessed by four-quadrant plots with error grids. In
comparison with TDCO, Starling SV was associated with a bias of 0.13 L
min-1 m-2 (95% confidence interval, 95% CI, 0.07 to
0.18), wide limits of agreement (LOA, - 1.23 to 1.51 L min-1
m-2), a percentage error (PE) of 60.7%, and poor trending
ability. In comparison with TDCO, FloTrac was associated with a bias of
0.01 L min-1 m-2 (95% CI - 0.05 to 0.06), wide LOA
(- 1.27 to 1.29 L min-1 m-2), a PE of 56.8% and poor
trending ability. Both Starling SV and fourth-generation FloTrac showed
acceptable mean bias but imprecision due to wide LOA and high PE, and poor
trending ability. These findings indicate limited reliability in
monitoring cardiac index in patients undergoing OPCAB. Copyright
© 2021, The Author(s).

<75>
[Use Link to view the full text]
Accession Number
2018953024
Title
Compounding Benefits of Cholesterol-Lowering Therapy for the Reduction of
Major Cardiovascular Events: Systematic Review and Meta-Analysis.
Source
Circulation: Cardiovascular Quality and Outcomes. 15(6) (pp E008552),
2022. Date of Publication: 01 Jun 2022.
Author
Wang N.; Woodward M.; Huffman M.D.; Rodgers A.
Institution
(Wang, Woodward, Huffman, Rodgers) George Institute for Global Health,
University of New South Wales, Sydney, Australia
(Wang) Sydney Medical School, University of Sydney, Australia
(Woodward, Rodgers) George Institute for Global Health, School of Public
Health Imperial College, London, United Kingdom
(Woodward) Department of Epidemiology, Johns Hopkins University,
Baltimore, MD, United States
(Huffman) Feinberg School of Medicine, Departments of Preventive Medicine
and Medicine, Northwestern University, Chicago, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Mendelian randomization studies use genetic variants as
natural experiments to provide evidence about causal relations between
modifiable risk factors and disease. Recent Mendelian randomization
studies suggest each mmol/L reduction in low-density lipoprotein
cholesterol (LDL-C) sustained over a lifetime can reduce the risk of
cardiovascular disease by more than half. However, these findings have not
been replicated in randomized clinical trials, and the effect of treatment
duration on the magnitude of risk reduction remains uncertain. The aim of
this article was to evaluate the relationship between lipid-lowering drug
exposure time and relative risk reduction of major cardiovascular events
in randomized clinical trials. Method(s): We conducted a systematic
review and meta-analysis of randomized clinical trials of statins,
ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors
that report LDL-C levels and effect sizes for each year of follow-up. The
primary end point was major vascular events, defined as the composite of
cardiovascular death, myocardial infarction, stroke, and coronary
revascularization. Hazard ratios during each year of follow-up were
meta-analyzed using random-effects models. Result(s): A total of 21
trials with 184 012 patients and an average mean follow-up of 4.4 years
were included. Meta-regression showed there was greater relative risk
reduction in major vascular events with increasing duration of treatment
(P<0.001). For example, each mmol/L LDL-C lowered was associated with a
relative risk reduction in major vascular events of 12% (95% CI, 8%-16%)
for year 1, 20% (95% CI, 16%-24%) for year 3, 23% (95% CI, 18%-27%) for
year 5, and 29% (95% CI, 14%-42%) for year 7. Conclusion(s): The
benefits of LDL-C lowering do not seem to be fixed but increase steadily
with longer durations of treatment. The results from short-term randomized
trials are compatible with the very strong associations between LDL-C and
cardiovascular events seen in Mendelian randomization
studies. Copyright © 2022 Lippincott Williams and Wilkins. All
rights reserved.

<76>
Accession Number
2017277595
Title
Analgesic efficacy of ultrasound guided unilateral erector spinae plane
block for laparoscopic inguinal hernia repair: a randomized controlled
study.
Source
Turkish Journal of Medical Sciences. 52(3) (pp 631-640), 2022. Date of
Publication: 2022.
Author
Altinsoy S.; Ozkan D.; Akelma F.K.; Ergil J.
Institution
(Altinsoy, Ozkan, Akelma, Ergil) Department of Anaesthesiology and
Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital,
University of Health Sciences, Ankara, Turkey
Publisher
Turkiye Klinikleri
Abstract
Background/aim: Although laparoscopic inguinal herniorrhaphy is associated
with faster return to daily activity, inadequate postoperative pain
control can cause prolonged hospital stays and patient discomfort. Erector
spinae plane block (ESP) can be administered for postoperative pain
management in abdominal and thoracic surgery. We investigated the effects
of unilateral ESP block application in laparoscopic hernia surgery.
 Material(s) and Method(s): A total of 60 patients who were scheduled
for laparoscopic inguinal hernia surgery were included. ESP block was
performed in group E (n = 30) after induction of anesthesia. There was no
intervention in Group C (n = 30). Postoperative pain was assessed by the
patient using the numeric rating scale (NRS) at postanesthetic care unit
(PACU),1, 4, 6, 12, and 24 h after surgery. The quality of postoperative
functional recovery was evaluated using the quality of recovery-40
questionnaire. Result(s): NRS scores were lower in Group E (n = 30)
than in Group C (n = 30) at PACU, 1th, 4th,
6th hours in both rest and movement. Total tramadol consumption
was reduced at postoperative 24 h by the ESP block [median(IQR), 60(40)
versus 85(30)]. Quality of recovery score of the patients after operation
was better in the ESP group than in the control group [mean(SD),
177.9(6.5) in group E and 173.2(7.09) in group C with mean differences:
4.633 and CI: 95% (1.11 to 8.15) respectively]. Conclusion(s):
Unilateral ESP blocks in laparoscopic inguinal hernia surgery reduce both
postoperative pain levels and analgesic consumption. In addition, the ESP
block could be used safely in pain management of this type of surgery and
improve the quality of recovery. Copyright © 2022, TUBITAK

<77>
Accession Number
2017189256
Title
Influence of perioperative dexmedetomidine on the incidence of
postoperative delirium in adult patients undergoing cardiac surgery.
Source
British Journal of Anaesthesia. 129(1) (pp 67-83), 2022. Date of
Publication: July 2022.
Author
Patel M.; Onwochei D.N.; Desai N.
Institution
(Patel, Onwochei, Desai) Department of Anaesthesia, Guy's and St Thomas'
NHS Foundation Trust, London, United Kingdom
(Onwochei, Desai) Honorary Senior Clinical, Lecturer, King's College
London, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Delirium is a common neurocognitive complication after cardiac
surgery. The aim of this systematic review was to determine whether the
administration of dexmedetomidine in the perioperative period decreases
the incidence of postoperative delirium in adult patients undergoing
cardiac surgery. Method(s): Central, CINAHL, Ovid Embase, Ovid
Medline, and Web of Science databases were searched for RCTs of adult
patients undergoing cardiac surgery where participants received i.v.
dexmedetomidine or control in the perioperative period. The methods
included systematic review, meta-analysis, and trial sequential analysis.
The primary outcome was the incidence of postoperative delirium.
Dichotomous outcomes were presented as risk ratio (RR) using the
Mantel-Haenszel method, and continuous variables were presented as mean
difference with the inverse variance method. Result(s): Thirty
trials, comprising 4090 patients, were included. With unselected inclusion
of trials, dexmedetomidine vs control was associated with decreased
incidence of postoperative delirium (12.4% vs 16.2%; RR=0.62; 95%
confidence interval 0.44-0.86; P=0.005; I2=61%). If trials at
high risk of bias were excluded, the incidence of postoperative delirium
was not significantly different between groups (RR=0.71; 95% confidence
interval 0.49-1.03; P=0.070; I2=58%). Postoperative delirium
was not a reliably determined outcome across trials because of
methodological and reporting limitations, including the heterogeneity of
delirium diagnostic approach. Trial sequential analysis revealed that the
optimal information size was not reached, and the Z-curve did not cross
the trial sequential boundaries for benefit or futility. With respect to
safety concerns, dexmedetomidine was not significantly associated with
incident bradycardia or hypotension, or with the duration of mechanical
ventilation. Conclusion(s): When trials at high risk of bias were
excluded, the use of perioperative dexmedetomidine was not associated with
decreased incidence of postoperative delirium. PROSPERO registration
number: CRD 42021252779. Copyright © 2022 British Journal of
Anaesthesia

<78>
[Use Link to view the full text]
Accession Number
2018384221
Title
Consideration Regarding the Analysis of Randomized Controlled Trials in
the Era of Evidence-based Medicine.
Source
Journal of Cardiovascular Pharmacology. 79(5) (pp 605-619), 2022. Date of
Publication: 22 May 2022.
Author
Ennezat P.V.; Alavi Z.; Le Jemtel T.H.; Hansen M.R.
Institution
(Ennezat) Department of Cardiology, Centre Hospitalier Universitaire Henri
Mondor, Creteil, France
(Alavi) Inserm, Cic 1412, Centre Hospitalier Universitaire de Brest,
Brest, France
(Le Jemtel) Tulane University Heart and Vascular Institute, New Orleans,
LA, United States
(Hansen) Clinical Pharmacology and Pharmacy, Department of Public Health,
University of Southern Denmark, Odense, Denmark
(Hansen) Department of Clinical Biochemistry and Pharmacology Odense
University Hospital, Odense, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Analysis of randomized controlled trials (RCTs) is the cornerstone of
evidence-based medicine, therapeutic guidelines and ultimately daily
practice. However, 2 issues contribute to cloud the analysis of RCTs.
Industry-sponsored RCTs aim at capturing as large indications as possible
and clinicians rely excessively on P value statistical significance for
the evaluation of the findings. To be most valuable to practitioners,
analysis of RCTs needs to provide absolute risk reduction, number of
patients needed to treat, fragility index along with the estimation of
lost to follow-up patients, and outcome postponement (gain in survival
time). We analyzed few major cardiovascular RCTs and assessed the
robustness of their findings. Our suggested analytic parameters may be
further used in future systematic reviews and meta-analyses. Copyright
© 2022 Lippincott Williams and Wilkins. All rights reserved.

<79>
[Use Link to view the full text]
Accession Number
634935132
Title
Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic
Review.
Source
ASAIO Journal. 67(5) (pp 476-484), 2021. Date of Publication: 01 May 2021.
Author
Willers A.; Swol J.; Kowalewski M.; Raffa G.M.; Meani P.; Jiritano F.;
Matteucci M.; Fina D.; Heuts S.; Bidar E.; Natour E.; Sels J.W.; Delnoij
T.; Lorusso R.
Institution
(Willers, Kowalewski, Meani, Jiritano, Matteucci, Fina, Heuts, Bidar,
Natour, Lorusso) The Ecls Centrum, Cardio-Thoracic Surgery Department And
Cardiology Department, Heart & Vascular Centre, Maastricht University
Medical Centre, Maastricht, Netherlands
(Swol) Department Of Pulmonology, Intensive Care Medicine, Paracelsus
Medical University, Nuremberg, Germany
(Raffa) Department For The Treatment And Study Of Cardiothoracic Diseases
And Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy
(Sels, Delnoij) Cardiology Department, Maastricht University Medical
Centre (MUMC), P. Debyelaan 25, Maastricht 6229 HX, Netherlands
(Sels, Delnoij) Intensive Care Department, Maastricht University Medical
Centre (MUMC), Maastricht, Netherlands
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
Extracorporeal life support (ECLS) is indicated in refractory acute
respiratory or cardiac failure. According to the need for anticoagulation,
bleeding conditions (e.g., in trauma, pulmonary bleeding) have been
considered a contraindication for the use of ECLS. However, there is
increasing evidence for improved outcomes after ECLS support in
hemorrhagic patients based on the benefits of hemodynamic support
outweighing the increased risk of bleeding. We conducted a systematic
literature search according to the PRISMA guidelines and reviewed
publications describing ECLS support in hemorrhagic conditions.
Seventy-four case reports, four case series, seven retrospective database
observational studies, and one preliminary result of an ongoing study were
reviewed. In total, 181 patients were identified in total of 86
manuscripts. The reports included patients suffering from bleeding caused
by pulmonary hemorrhage (n = 53), trauma (n = 96), postpulmonary
endarterectomy (n = 13), tracheal bleeding (n = 1), postpartum or cesarean
delivery (n = 11), and intracranial hemorrhage (n = 7). Lower targeted
titration of heparin infusion, heparin-free ECLS until coagulation is
normalized, clamping of the endotracheal tube, and other ad hoc
possibilities represent potential beneficial maneuvers in such conditions.
Once the patient is cannulated and circulation restored, bleeding control
surgery is performed for stabilization if indicated. The use of ECLS for
temporary circulatory or respiratory support in critical patients with
refractory hemorrhagic shock appears feasible considering tailored ECMO
management strategies. Further investigation is needed to better elucidate
the patient selection and ECLS management approaches. Copyright ©
ASAIO 2020.

<80>
Accession Number
2013565103
Title
Application of modern clinical risk scores in the global assessment of
risks related to the diagnosis and treatment of acute coronary syndromes
in everyday medical practice.
Source
International Journal of Environmental Research and Public Health. 18(17)
(no pagination), 2021. Article Number: 9103. Date of Publication:
September 2021.
Author
Gawinski L.; Engelseth P.; Kozlowski R.
Institution
(Gawinski) Department of Management and Logistics in Health Care, Medical
University of Lodz, Lodz 90-237, Poland
(Engelseth) Tromso School of Business and Economics, University of Tromso,
Narvik Campus, Narvik 8505, Norway
(Kozlowski) Center of Security Technologies in Logistics, Faculty of
Management, University of Lodz, Lodz 90-237, Poland
Publisher
MDPI
Abstract
This article presents an overview of contemporary risk assessment systems
used in patients with myocardial infarction. The full range of risk
scales, both recommended by the European Society of Cardiology and others
published in recent years, is presented. Scales for assessing the risk of
ischemia/death as well as for assessing the risk of bleeding are
presented. A separate section is devoted to systems assessing the
integrated risk associated with both ischemia and bleeding. In the first
part of the work, each of the risk scales is described in detail,
including the clinical trials/registers on the basis of which they were
created, the statistical methods used to develop them, as well as the
specification of their individual parameters. The next chapter presents
the practical application of a given scale in the patient risk assessment
process, the timing of its application on the timeline of myocardial
infarction, as well as a critical assessment of its potential advantages
and limitations. The last part of the work is devoted to the presentation
of potential directions for the development of risk assessment systems in
the future. Copyright: © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<81>
Accession Number
2014936783
Title
Efficacy of pulsatile flow perfusion in adult cardiac surgery: Hemodynamic
energy and vascular reactivity.
Source
Journal of Clinical Medicine. 10(24) (no pagination), 2021. Article
Number: 5934. Date of Publication: December-2 2021.
Author
Dodonov M.; Onorati F.; Luciani G.B.; Francica A.; Tessari M.; Menon T.;
Gottin L.; Milano A.D.; Faggian G.
Institution
(Dodonov, Onorati, Luciani, Francica, Tessari, Menon, Faggian) Cardiac
Surgery, Department of Surgery, University of Verona Medical School,
Verona 37126, Italy
(Gottin) Anesthesiology, Department of Surgery, University of Verona
Medical School, Verona 37126, Italy
(Milano) Cardiac Surgery, Department of Emergency and Organ Transplants,
University of Bari Medical School, Bari 70124, Italy
Publisher
MDPI
Abstract
Background: The role of pulsatile (PP) versus non-pulsatile (NP) flow
during a cardiopulmonary bypass (CPB) is still debated. This study's aim
was to analyze hemodynamic effects, endothelial reactivity and
erythrocytes response during a CPB with PP or NP. Method(s):
Fifty-two patients undergoing an aortic valve replacement were
prospectively randomized for surgery with either PP or NP flow.
Pulsatility was evaluated in terms of energy equivalent pressure (EEP) and
surplus hemodynamic energy (SHE). Systemic (SVRi) and pulmonary (PVRi)
vascular resistances, endothelial markers levels and erythrocyte
nitric-oxide synthase (eNOS) activity were collected at different
perioperative time-points. Result(s): In the PP group, the resultant
EEP was 7.3% higher than the mean arterial pressure (MAP), which
corresponded to 5150 +/- 2291 ergs/cm3 of SHE. In the NP group,
the EEP and MAP were equal; no SHE was produced. The PP group showed lower
SVRi during clamp-time (p = 0.06) and lower PVRi after protamine
administration and during first postoperative hours (p = 0.02). Lower SVRi
required a higher dosage of norepinephrine in the PP group (p = 0.02).
Erythrocyte eNOS activity results were higher in the PP patients (p =
0.04). Renal function was better preserved in the PP group (p = 0.001),
whereas other perioperative variables were comparable between the groups.
 Conclusion(s): A PP flow during a CPB results in significantly lower
SVRi, PVRi and increased eNOS production. The clinical impact of increased
perioperative vasopressor requirements in the PP group deserves further
evaluation. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<82>
Accession Number
638397926
Title
Comparative Efficacy of Local and General Anesthesia for Transcatheter
Aortic Valve Implantation: A Meta-Analysis and Systematic Review.
Source
The heart surgery forum. 25(3) (pp E364-E373), 2022. Date of Publication:
31 May 2022.
Author
Gao L.; Jin B.; Chao C.; Wang B.; Zhang X.; Shen J.
Institution
(Gao, Shen) Department of Anesthesiology, Third Affiliated Hospital of
Soochow University, Changzhou 213000, China
(Jin) NO.971 Hospital of The People's Liberation Army Navy, China
(Chao, Wang, Zhang) Department of Cardiothoracic Surgery, Third Affiliated
Hospital of Soochow University, Changzhou 213000, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: This meta-analysis aimed to compare the potential effects of
local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic
valve implantation (TAVI). MEASUREMENTS: All relevant studies were
searched from Pubmed, EMbase, Web of Science, and the Cochrane Library
(January 1, 2016, to June 1, 2021). The main outcomes of this literature
meta-analysis were 30-day mortality, procedural time, new pacemaker
implantation, total stay in the hospital, use of the vasoactive drug, and
intra-and postoperative complications and emergencies, including
conversion to open, myocardial infarction, pulmonary complication,
vascular complication, renal injury/failure, stroke, transesophageal
echocardiography, life-threatening/major bleeding, cardiac tamponade, and
emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together
with a 95% confidence interval (CI) were calculated. RESULT(S): A
total of 17 studies, including 20938 patients, in the final analysis,
fulfilled the inclusion criteria. Intra-and postoperative complications
(myocardial infarction, vascular complication, renal injury/failure,
stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under
GA do not offer a significant difference compared with LA. No differences
were observed between LA and GA for new pacemaker implantation, total stay
in the hospital, transesophageal echocardiography, and emergency PCI. LA
has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary
complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR
0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P =
0.746). LA has many advantages, including a shorter procedure duration
(MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR
0.57, P = 0.000). CONCLUSION(S): For TAVI, both LA with or without
sedation and GA are feasible and safe. LA appears a feasible alternative
to GA for AS patients undergoing TAVI.

<83>
Accession Number
2018146572
Title
Practice patterns of ABO-matching for cryoprecipitate and patient outcomes
after ABO-compatible versus incompatible cryoprecipitate.
Source
Vox Sanguinis. (no pagination), 2022. Date of Publication: 2022.
Author
Raycraft T.; Bartoszko J.; Karkouti K.; Callum J.; Lin Y.
Institution
(Raycraft) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Bartoszko, Karkouti) Department of Anesthesiology and Pain Medicine,
University of Toronto, Toronto, ON, Canada
(Bartoszko, Karkouti) Department of Anesthesia and Pain Management, Sinai
Health System, Women's College Hospital, University Health Network,
Toronto, ON, Canada
(Karkouti) Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
(Karkouti) Interdepartmental Division of Critical Care, Department of
Medicine, University of Toronto, Toronto, ON, Canada
(Karkouti) Institute for Health Policy, Management, and Evaluation,
University of Toronto, Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre and Queen's University, Kingston, ON, Canada
(Callum, Lin) University of Toronto Quality in Utilization, Education and
Safety in Transfusion Research Program, Toronto, ON, Canada
(Lin) Precision Diagnostics and Therapeutics Program, Sunnybrook Health
Sciences Centre, Toronto, ON, Canada
(Lin) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background and Objectives: This sub-study of the FIBRES trial sought to
examine the patterns of ABO-compatible cryoprecipitate administration and
to identify adverse consequences of ABO-incompatible cryoprecipitate.
 Material(s) and Method(s): This was a post hoc analysis of data
collected from the FIBRES randomized clinical trial comparing fibrinogen
concentrate with cryoprecipitate in the treatment of bleeding related to
hypofibrinogenemia after cardiac surgery. The primary outcome was the
percentage of administered cryoprecipitate that was ABO-compatible.
Secondary outcomes were adverse events at 28 days. A follow-up survey was
distributed to the FIBRES participating sites to examine the rationale
behind the identified cryoprecipitate ABO-matching practice patterns.
 Result(s): A total of 363 patients were included: 53 (15%) received
ABO-incompatible cryoprecipitate and 310 (85%) received ABO-compatible
cryoprecipitate. There was an increased incidence of post-operative
anaemia in the ABO-incompatible group (15; 28.3%) in comparison to the
ABO-compatible (44; 14.2%) group (p = 0.01) at 28 days, which was
unrelated to haemolysis, without a significant difference in transfusion
requirement. In the multivariable logistic regression models accounting
for clustering by site, there was no observed statistically significant
association between the administration of ABO-incompatible cryoprecipitate
and any other adverse outcomes. Nine out of 11 sites did not have a policy
requiring ABO-matched cryoprecipitate. Conclusion(s): This sub-study
demonstrated that most cryoprecipitate administered in practice is
ABO-compatible, despite the absence of guidelines or blood bank policies
to support this practice. A signal towards increased risk of
post-operative anaemia may be explained by higher rates of urgent surgery
(vs. elective) in the ABO-incompatible group. Future studies should
prospectively examine the impact of ABO-compatible versus incompatible
cryoprecipitate to conclusively establish if there is a meaningful
clinical impact associated with the administration of ABO-incompatible
cryoprecipitate. Copyright © 2022 International Society of Blood
Transfusion.

<84>
Accession Number
2018145475
Title
Transcranial electric stimulation motor evoked potentials for cervical
spine intraoperative monitoring complications: systematic review and
illustrative case of cardiac arrest.
Source
European Spine Journal. (no pagination), 2022. Date of Publication: 2022.
Author
Revilla-Pacheco F.; Watanabe S.; Rodriguez-Reyes J.; Sanchez-Torres C.;
Shkurovich-Bialik P.; Herrada-Pineda T.; Rodriguez-Salgado P.;
Franco-Granillo J.; Calderon-Juarez M.
Institution
(Revilla-Pacheco, Watanabe, Herrada-Pineda, Rodriguez-Salgado) Department
of Neurosurgery, ABC Medical Center, Mexico City, Mexico
(Rodriguez-Reyes, Sanchez-Torres) Department of Anesthesiology, ABC
Medical Center, Mexico City, Mexico
(Shkurovich-Bialik) Department of Neurophysiology, ABC Medical Center,
Mexico City, Mexico
(Franco-Granillo) Intensive Care Unit, ABC Medical Center, Mexico City,
Mexico
(Calderon-Juarez) Plan de Estudios Combinados en Medicina, Faculty of
Medicine, National Autonomous University of Mexico, Circuto Escolar 411A,
Coyoacan, Mexico City 04360, Mexico
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: We show a systematic review of known complications during
intraoperative neuromonitoring (IONM) using transcranial electric
stimulation motor evoked potentials (TES-MEP) on cervical spine surgery,
which provides a summary of the main findings. A rare complication during
this procedure, cardiac arrest by cardioinhibitory reflex, is also
described. Method(s): Findings of 523 scientific papers published
from 1995 onwards were reviewed in the following databases: CENTRAL,
Cochrane Library, Embase, Google Scholar, Ovid, LILACS, PubMed, and Web of
Science. This study evaluated only complications on cervical spine surgery
undergoing TES-MEP IONM. Result(s): The review of the literature
yielded 13 studies on the complications of TES-MEP IONM, from which three
were excluded. Five studies are case series; the rest are case reports.
Overall, 169 complications on 167 patients were reported in a total of
38,915 patients, a global prevalence of 0.43%. The most common
complication was tongue-bite in 129 cases, (76.3% of all complication
events). Tongue-bite had a prevalence of 0.33% (CI 95%, 0.28-0.39%) in all
patients on TES-MEP IONM. A relatively low prevalence of severe
complications was found: cardiac-arrhythmia, bradycardia and seizure, the
prevalence of this complications represents only one case in all the
sample. Alongside, we report the occurrence of cardiac arrest attributable
to TES-MEP IONM. Conclusion(s): This systematic review shows that
TES-MEP is a safe procedure with a very low prevalence of complications.
To our best knowledge, asystole is reported for the first time as a
complication during TES-MEP IONM. Copyright © 2022, The
Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part
of Springer Nature.

<85>
Accession Number
638405778
Title
A Novel Active Airway Humidification Technology Device (RespirAq) for
Ventilated Patients: A Feasibility Study.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
International Conferenceof the American Thoracic Society, ATS 2022. San
Francisco, CA United States. 205(1) (no pagination), 2022. Date of
Publication: May 2022.
Author
Moylan M.; Martynoga R.; McCormack D.; Cunningham H.; Grau Bartual S.
Institution
(Moylan, Cunningham, Grau Bartual) Auckland University of Technology,
Auckland, New Zealand
(Martynoga, McCormack) Waikato District Health Board, Hamilton, New
Zealand
Publisher
American Thoracic Society
Abstract
RATIONALE: Supplementary humidification is necessary to prevent
hypothermia, disruption of airway epithelium, bronchospasm, atelectasis,
and airway obstruction when patients are invasively and non-invasively
ventilated.The RespirAq active humidifier is a novel heated humidifier,
which utilizes a smart fabric that humidifies without supplemental water.
Within 100 milliseconds, the humidifier can switch between a
super-hydrophilic state to capture moisture during expiration, and a
super-hydrophobic state which returns the moisture during inspiration. The
device has been designed to deliver 37degreeC fully humidified (95%
relative humidity) respiratory gases for invasively mechanically
ventilated patients.The study aimed to provide feasibility data for a
subsequent pivotal trial, examining the impact of RespirAq active
humidifier on scheduled cardiothoracic surgical patients, during invasive
mechanical ventilation (IMV). We previously confirmed that the device met
EN ISO 80601-2-74:2020 during bench testing and in healthy volunteers
during non-invasive ventilation (NIV). The primary endpoint was to meet EN
ISO 80601-2-74:2020 standards in IMV patients. The outcomes of the study
informed appropriate/additional device design for a pivotal trial to
investigate the safety and efficacy of the RespirAq active humidifier in
all non-contraindicated patient populations on IMV. METHOD(S):
Scheduled coronary artery bypass surgery (CABG) patients requiring
invasive mechanical ventilation post-surgery at the Waikato District
Health Board in Hamilton, New Zealand were recruited into the study.
Safety was assessed by evidence of serious adverse and adverse events
during the study period. RESULT(S): Twenty-three patients (mean age
61.65 +/- 11.36, 91.3% male), were recruited. There were no device or
procedure related serious adverse or adverse events. Time on the RespirAq
active humidifier ranged between 1.5 and 23.5 hours (mean 5.12 +/- 5.03
hrs). The airflow temperature significantly increased from 29.75 +/-
2.408degreeC (without RespirAq humidification), to 36.40 +/- 3.078 degreeC
(mean +/- SD, n=23, p<0.0001) with the active humidifier. Absolute
humidity significantly increased from 23.99 +/- 3.636 mg/L to 38.86 +/-
2.124 mg/L (mean +/- SD, n=23, p<0.0001). No rain-out condensation or
secretions were observed, nor was any additional suctioning required, in
any patient during the study period. CONCLUSION(S): Results show that
the device meets the 33 mg/L absolute humidity established by the EN ISO
80601-2-74:2020 standards in IMV patients (p<0.0001) and suggest that the
RespirAq active humidifier may deliver the performance of a heated
humidifier at the size, reliability, and ease-of-use of a heat and
moisture exchanger. A prospective randomized clinical trial is warranted
to confirm these findings.

<86>
Accession Number
638404905
Title
Impact of Flexible versus Restrictive Intensive Care Unit Visitation Hours
on Patient Outcomes - Meta-Analysis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
International Conferenceof the American Thoracic Society, ATS 2022. San
Francisco, CA United States. 205(1) (no pagination), 2022. Date of
Publication: May 2022.
Author
Reddy R.; Hubel K.; Robinson J.; Gautam S.; Gorneva M.; Maheshwari A.;
Enomoto M.; Zayed Y.
Institution
(Reddy, Hubel, Robinson) Pulmonary,Allergy and Critical Care Medicine,
Oregon Health and Science University, Portland, OR, United States
(Gautam) Sunset High School, Portland, OR, United States
(Gorneva, Maheshwari, Enomoto) Anesthesiology and Perioperative Medicine,
Oregon Health and Science University, Portland, OR, United States
(Zayed) Pulmonary,Critical Care and Sleep Medicine, University of Florida,
Gainesville, FL, United States
Publisher
American Thoracic Society
Abstract
Rationale: The impact of family visitation and their participation in the
care of critically ill patients is unclear. Whether flexible versus
restrictive intensive care unit (ICU) visitation hours will improve
various clinical outcomes remain controversial and studies have found
conflicting results. Therefore, we conducted a meta-analysis to examine
the impact of flexible versus restrictive ICU visitation hours on patient
outcomes. Method(s): We performed a literature search using two
search terms in MEDLINE - ("visitation" OR "visiting") AND ("critical
care" OR "intensive care" OR "ICU") and (ICU OR critical illness) AND
(family OR caregiver) NOT infant NOT child. Flexible visitation policy was
defined as visitation allowance up to 12 hours/day and restrictive
visitation policy as allowance for <6 hours/day. Observational and
randomized control trials (RCT) were included. Delirium, ICU length of
stay (LOS), hospital LOS and mortality were compared. ICU infections
between the two groups was not compared as only two studies reported it.
Pooled risk ratios (RR) with their corresponding 95% confidence intervals
(CI) for dichotomous data were calculated using the random Mantel-Haenszel
method. We calculated weighted mean difference (MD) and their 95%
corresponding CI for continuous variables using an inverse variance test.
 Result(s): Seven studies were included in the final analysis (six RCT
and one observational) totaling 4066 patients. Study participants included
medical ICU, surgical ICU and cardiothoracic ICU patients. Flexible family
visitation was associated with a significant reduction in incidence of
delirium (RR 0.73 (95% CI 0.55 to 0.97), P=0.03), reduction in ICU LOS (MD
-0.21 (95% CI -0.41 to -0.01), P=0.04) and reduction in hospital LOS (MD
-0.19 (95% CI -0.3 to -0.08), P=0.0005) (Figure 1). Despite the trend
toward increased mortality in the flexible family visitation group, the
difference did not reach statistical significance. (RR 1.22 (95% CI 0.99
to 1.51), P=0.06) (Figure 1). Discussion(s): Amongst critically ill
patients, flexible visitation was associated with reduction in risk of
delirium and shorter ICU and hospital LOS. Flexible visitation likely
leads to higher number of hours with family. This familiarity in a new
environment may contribute to reduction in delirium. Interestingly, we
found higher mortality risk in the flexible visitation group. This could
be due to participants in the flexible visitation group choosing comfort
measures more often; in addition, this was driven by findings from a
single study. Family participation in patient care is a low-cost
intervention and could be a useful therapeutic.

<87>
Accession Number
638403480
Title
Efficacy of Dexmedetomidine Versus Propofol Sedation in Critically Ill
Adults Requiring Mechanical Ventilation: A Systematic Review and
Meta-Analysis of Randomized Trials.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
International Conferenceof the American Thoracic Society, ATS 2022. San
Francisco, CA United States. 205(1) (no pagination), 2022. Date of
Publication: May 2022.
Author
Heybati K.; Zhou F.; Ali S.; Deng J.
Institution
(Heybati) Alix School of Medicine, Mayo Clinic Rochester, Rochester, MN,
United States
(Zhou, Ali, Deng) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
Publisher
American Thoracic Society
Abstract
Rationale: The 2018 Clinical Practice Guidelines for the Prevention and
Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep
Disruption (PADIS) recommended the use of dexmedetomidine or propofol, and
propofol monotherapy, for sedation of post-cardiac surgery and
medical/noncardiac surgery patients, respectively. However, there is a
lack of clarity on the efficacy of dexmedetomidine versus propofol.
Therefore, we aimed to determine the efficacy and safety of
dexmedetomidine versus propofol sedation in mechanically ventilated,
critically ill adults across different ICU types. Method(s): This
review was conducted according to PRISMA guidelines, and prospectively
registered on PROSPERO (CRD42021253050). Literature searches were
conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Scopus,
and through citations of past reviews. Screening, extraction, RoB2, and
GRADE were completed independently and in duplicate. Our primary outcome
was ICU length of stay (LOS). Secondary outcomes included the duration of
mechanical ventilation (MV), incidence and duration of ICU delirium,
all-cause mortality, incidence of bradycardia, tachycardia, hypertension,
and hypotension. Subgroup analyses based on age (<65/>=65) and dosage
(high dose was defined as dexmedetomidine >0.7 mug/kg/hr; propofol >=5
mg/kg/hr) were conducted. Result(s): Forty-one (N=3,948) studies with
post-cardiac surgical, medical/other surgical, septic, neurological, or a
combination of ICU patients were included, and 38 (N=3,825) were
quantitatively analyzed. Across all types of ICU patients (N=1,753),
dexmedetomidine sedation shortened ICU LOS (MD -10.52 hours; 95% CI -19.14
to -1.91 hours). However, this was not significant among the specific ICU
patient types (Figure 1). Among post-cardiac surgery patients (N=491),
dexmedetomidine reduced the duration of MV (MD -0.67 hours; 95% CI: -1.31
to -0.03 hours) and the odds of ICU delirium (OR 0.40; 95% CI: 0.21 to
0.77). However, dexmedetomidine was associated with greater odds of
bradycardia (OR 2.23; 95% CI: 1.56 to 3.21) across all patients (N=2,239),
as well as among specific ICU patient types. In post-cardiac surgery
patients receiving dexmedetomidine, those who were <65 had significantly
greater odds of bradycardia compared with those >=65 (P<0.01). There were
no significant differences across other outcomes or subgroup interactions.
 Conclusion(s): When compared to propofol, dexmedetomidine sedation
may shorten ICU LOS, and decrease the duration of MV and the odds of ICU
delirium among post-cardiac surgery patients. However, it could increase
the odds of bradycardia. Therefore, the potential benefits of
dexmedetomidine must be carefully considered alongside possible adverse
events. Larger clinical trials are required to improve the certainty of
findings and provide further insights into patient types and dosages.

<88>
Accession Number
638403160
Title
The Effect of Sedation with Inhaled Anesthetics on Cognitive and
Psychiatric Outcomes in Critically Ill Adults: A Systematic Review.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
International Conferenceof the American Thoracic Society, ATS 2022. San
Francisco, CA United States. 205(1) (no pagination), 2022. Date of
Publication: May 2022.
Author
Cuninghame S.; Jerath A.; Gorsky K.; Sivajohan A.; Francoeur C.;
Withington D.; Burry L.; Slessarev M.
Institution
(Cuninghame, Slessarev) Critical Care Medicine, Western University,
London, ON, Canada
(Jerath, Gorsky) Anesthesia and Critical Care, University of Toronto,
Toronto, ON, Canada
(Sivajohan) Medicine, Western University, London, ON, Canada
(Francoeur) Pediatrics and Critical Care, Universite Laval, Quebec City,
QC, Canada
(Withington) Pediatric Critical Care and Anesthesia, McGill University,
Montreal, QC, Canada
(Burry) Pharmacy, University of Toronto, Toronto, ON, Canada
Publisher
American Thoracic Society
Abstract
Rationale: The COVID-19 pandemic has renewed interest in the use of
inhaled anesthetics for sedation of ventilated critically ill patients.
Compared to intravenous sedatives, inhaled anesthetics reduce lung
inflammation, time to extubation, and ICU length of stay. However, their
impact on cognitive and psychiatric outcomes is less clear. In this
systematic review we summarize the impact of inhaled sedatives on
cognitive and psychiatric outcomes in ventilated critically ill patients.
 Method(s): We searched MEDLINE, EMBASE, and PsychINFO for studies
from 1970 - 2021 that assessed cognitive and psychiatric outcomes in
critically ill adult patients sedated with inhaled anesthetics. We
included case series, observational, cohort, and randomized controlled
trials. Outcome(s) of interest included cognition, anxiety, depression,
hallucinations, psychomotor recovery, and PTSD, as well as instruments for
assessing these outcomes. Result(s): We identified a total of twelve
studies that examined at least one of our outcomes of interest (16 total
outcomes). Four studies were in post cardiac arrest survivors, three in
post-operative (non-cardiac) patients, two in post-operative cardiac
patients, and three more in mixed medical-surgical patients. Seven studies
reported incidence of delirium, two assessed neurologic recovery post
cardiac-arrest, and two examined ICU memories. One study reported on each
of anxiety, depression, hallucinations, PTSD, psychomotor recovery, and
long-term cognitive dysfunction more than 3 months following ICU
discharge. Of the seven studies reporting on delirium, only one reported
an increase in delirium for those sedated with intravenous sedation
compared to volatile. The remaining studies did not report any difference
in delirium incidence between modes of sedation. Similarly, no difference
between sedation methods were observed for neurologic recovery following
cardiac arrest, anxiety, depression, hallucinations, PTSD, psychomotor
recovery, or long-term cognitive dysfunction. The most commonly used tool
used was the CAM-ICU tool (delirium outcome; 3 studies). Five studies used
subjective chart review to assess their outcome of interest, or did not
report their method of assessment. Conclusion(s): Few studies
examined cognitive and psychiatric outcomes in critically ill adults
sedated with volatile anesthetics. As volatile anesthetics offer a
promising alternative mode of sedation in the ICU, future studies should
incorporate assessment of these important patientcentered outcomes using
validated objective tools during and following hospital stay.

<89>
Accession Number
638407871
Title
Pulmonary Cement Emboli: An Underreported Phenomenon or Rare Kyphoplasty
Complication.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
International Conferenceof the American Thoracic Society, ATS 2022. San
Francisco, CA United States. 205(1) (no pagination), 2022. Date of
Publication: May 2022.
Author
Cimino A.; Alchakaki A.
Institution
(Cimino) Internal Medicine, Beaumont Health, Farmington Hills, MI, United
States
(Alchakaki) Pulmonary and Critical Care, Beaumont Health, Trenton, MI,
United States
Publisher
American Thoracic Society
Abstract
Kyphoplasty is an intervention to treat and stabilize painful vertebral
compression fractures by injecting Polymethymethacrylate (PMMA) cement in
the vertebral cavity. It has become increasingly important procedure in
pathologic compression fracture treatment. Pulmonary cement embolism (PCE)
happens by leakage of cement through the venous plexus or retrograde
migration in the arterial vessels to aorta. It was reported as a rare
complication of this procedure (3.5%) but others have suggested that
because of paucity in symptoms, PCE is often overlooked and can happen in
up to 28.6% of kyphoplasty patients. PCE cause a wide spectrum of symptoms
ranging from asymptomatic to mild non-specific subacute symptoms, and
rarely, observed to cause morbid events like cardiac tamponade,
perforation, or obstructive shock from large size embolism. There are no
standard diagnosis modality or treatment modalities universally agreed on
currently.Diagnosis is established with clinical history and
characteristic radiographic findings. Chest x-ray shows PCE as
radio-opaque line in the distribution of the pulmonary arteries.
Noncontrasted chest CT they are recognized as a hyperdense deposit. Adding
contrast CT can detect superimposed endovascular thrombi triggered by the
cement and the turbulent flow.The limited number of published reports
related to PCE, and lack of satisfactory analyzed data, lead to lack of
robust recommendations for PCE treatment. Many reports and systematic
review consider a strategy that counts on symptoms, size and location of
the emboli for treatment.We present a 67- year-old woman presented with
sudden onset chest pain and shortness of breath after kyphoplasty few days
prior. EKG showed ST elevation myocardial infarction and left cardiac
catheterization revealed no obstructive disease. Chest CT pulmonary
embolism study showed foreign body and pulmonary angiogram was done for
retrieval and identified MMA cement in the pulmonary artery. Procedure was
complicated by obstructive shock and cardiac tamponade resulting in
pericardiocentesis and pericardial window. Patient was anticoagulated and
discharged in stable condition. PCE can be mistaken for STEMI, thrombotic
emboli, COPD exacerbation and there is a need for a higher index of
suspicion for PCE where there is a history of kyphoplasty or evidence of
kyphoplasty on imaging so appropriate diagnostic imaging can be obtained.
Timely treatment can be initiated according to the current recommendations
despite the lack of robust studies. In addition there needs to be
awareness that kyphoplasty related complications exist and risks of
procedure are appropriately disclosed. (Figure Presented).

<90>
Accession Number
638407498
Title
Use of a New Stapling Device in General Thoracic Surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
International Conferenceof the American Thoracic Society, ATS 2022. San
Francisco, CA United States. 205(1) (no pagination), 2022. Date of
Publication: May 2022.
Author
Dutly A.; Katona K.; Has A.; Grups J.; Leskow P.J.
Institution
(Dutly, Katona, Has, Grups, Leskow) Division of Thoracic Surgery,
Kantonsspital St. Gallen, St. Gallen, Switzerland
Publisher
American Thoracic Society
Abstract
RATIONALE Stapling devices are used extensively for various thoracic
surgeries. These multi-purpose tools must be safe, easy to use, and
provide value to the hospital. A new stapler, AEON Endostapler, has
previously been tested and proven as safe and effective for bariatric
surgery. The stapler was also found to have improved hemostasis in a
randomized, multi-center study. We wanted to test the safety and efficacy
of this stapler in our general thoracic surgery practice. METHODS A
prospective study was conducted between March and September 2021 with 80
consecutive thoracic cases in which staplers were used by two surgeons at
Kantonsspital St. Gallen. Ethics approval and patient consent was obtained
for this study. Stapler usage data, intraoperative outcomes, and 30-day
post-operative outcomes were evaluated. RESULTS Eighty patients (42 male,
38 female) were included. Mean patient age was 64.8 years. Procedures
included video-assisted thoracoscopic surgery (VATS) wedge (n=29), VATS
lobectomy (n=24), open wedge (n=8), and open lobectomy (n=19). A total of
81 handles (55 short, 26 medium) and 454 reloads were successfully
deployed, and no misfire occurred. No staple line bleeding was observed.
In one case the surgeon decided to add a suture on the staple line to
prevent an air leak. No other intraoperative or post-operative
complications were detected. On average, the chest tube was removed after
2.1 days, and the length of stay in hospital was 3.8 days. CONCLUSIONS The
new stapler AEON from Lexington Medical appears to be safe in general
thoracic surgery and presents a new cost-effective option. The devices
have several advantages over previously used or tested devices, namely the
option to change gears to facilitate dissection of thicker structures.
Another advantage was the fact that staples that are not within the tissue
remain in the reload - meaning they do not soil the surgical site. (Table
Presented).

<91>
Accession Number
2019145161
Title
Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and
Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A
Prospective, Randomized, Controlled Trial.
Source
International Journal of Clinical Practice. 2022 (no pagination), 2022.
Article Number: 6924489. Date of Publication: 2022.
Author
Zhang J.-G.; Jiang C.-W.; Deng W.; Liu F.; Wu X.-P.
Institution
(Zhang, Wu) Department of Infectious Disease, The First Affiliated
Hospital of Nanchang University, Jiangxi, Nanchang, China
(Zhang) Departments of Critical Care Medicine, Linyi People's Hospital,
Shandong, Linyi, China
(Zhang, Liu) Department of Critical Care Medicine, The First Affiliated
Hospital of Nanchang University, Jiangxi, Nanchang, China
(Jiang, Deng) Department of Anesthesiology and Pain Medicine, The
Affiliated Hospital of Jiaxing University, Zhejiang, Jiaxing, China
Publisher
Wiley-Hindawi
Abstract
Background. Thoracic surgery is one of the most painful surgical steps. An
important tool for managing postoperative pain is effective postoperative
analgesia. This research aimed at comparing the analgesic roles of three
new fascial block techniques in the postoperative period after
video-helped thoracoscopic operation (VATS). Methods. We randomly
allocated ninety patients into three teams experiencing
ultrasound-directed serratus plane block, erector spinae plane block, and
the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL
was received by all groups. Outcomes. At 0-12 hours, sufentanil
consumption was significantly lower in the RIB (35.2 +/- 3.3 mg) and ESP
(35.4 +/- 2.8 mg) groups than that in the SAB (43.3 +/- 2.7 mg) group
P<0.001, and no obvious diversity in sufentanil consumption was shown
between the RIB and ESP groups P=0.813. At 12-24 hours, sufentanil
consumption was greatly lower in the RIB and ESP groups than that in the
SAB group P<0.001, and no great diversity in sufentanil consumption was
found between the RIB and ESP groups P=0.589. No great diversity in
sufentanil consumption was shown between the RIB (50.4 +/- 1.4 mg), ESP
(50.4 +/- 1.5 mg), and SAB (51.0 +/- 1.7 mg) groups at 24-48 hours
P=0.192. At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores
were significantly lower in the RIB and ESP groups than in the SAB group
(P<0.05 for all contrasts). Nevertheless, no great diversity was observed
in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours
after the surgery across the three groups. No statistical diversity was
found in the postoperative NRS mark between groups RIB and ESP within 48
hours after surgery in case of active patients (P<0.05 for all contrasts).
At 24 hours after surgery, a significant difference in IL-1beta and IL-6
inflammatory factor concentrations was found between RIB and ESP compared
with SAB block (P<0.05 for all contrasts). However, no great diversities
were observed in IL-1beta, and IL-6 inflammatory factor concentrations
between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours
postoperatively (P<0.05 for all comparisons). Conclusion. The dosage of
sufentanil can be effectively reduced by ultrasound-directed rhomboid
intercostal block and erector spinae plane block within 24 hours after
VATS surgery, and pain can be relieved effectively within 24 hours by
comparing with serratus plane block. Copyright © 2022 Jian-Guo
Zhang et al.

<92>
Accession Number
2019080536
Title
Impact of combined epidural anaesthesia/analgesia on postoperative
cognitive impairment in patients receiving general anaesthesia: a
meta-analysis of randomised controlled studies.
Source
Anaesthesia Critical Care and Pain Medicine. 41(5) (no pagination), 2022.
Article Number: 101119. Date of Publication: October 2022.
Author
Teng I.-C.; Sun C.-K.; Ho C.-N.; Wang L.-K.; Lin Y.-T.; Chang Y.-J.; Chen
J.-Y.; Chu C.-C.; Hsing C.-H.; Hung K.-C.
Institution
(Teng, Ho, Wang, Lin, Chang, Chen, Chu, Hsing, Hung) Department of
Anaesthesiology, Chi Mei Medical Centre, Tainan, Taiwan (Republic of
China)
(Sun) Department of Emergency Medicine, E-Da Hospital, Kaohsiung city,
Taiwan (Republic of China)
(Sun) College of Medicine, I-Shou University, Kaohsiung city, Taiwan
(Republic of China)
(Wang, Lin, Hung) Department of Hospital and Health Care Administration,
College of Recreation and Health Management, Chia Nan University of
Pharmacy and Science, Tainan city, Taiwan (Republic of China)
(Chang) Department of Recreation and Health-Care Management, College of
Recreation and Health Management, Chia Nan University of Pharmacy and
Science, Tainan city, Taiwan (Republic of China)
(Hsing) Department of Medical Research, Chi-Mei Medical Centre, Tainan,
Taiwan (Republic of China)
Publisher
Elsevier Masson s.r.l.
Abstract
Background: To investigate the efficacy of combined epidural
anaesthesia/analgesia (EAA) against postoperative delirium/cognitive
dysfunction (POD/POCD) in adults after major non-cardiac surgery under
general anaesthesia (GA). Method(s): The databases of PubMed, Google
Scholar, Embase and Cochrane Central Register were searched from inception
to November 2021 for available randomised controlled trials (RCTs) that
assessed the impact of EAA on risk of POD/POCD. The primary outcome was
risk of POD/POCD, while the secondary outcomes comprised postoperative
pain score, length of hospital stay (LOS), risk of complications, and
postoperative nausea/vomiting (PONV). Result(s): Meta-analysis of
eight studies with a total of 2376 patients (EAA group: 1189 patients;
non-EAA group: 1187 patients) revealed no difference in risk of POD/POCD
between the EAA and the non-EAA groups [Risk ratio (RR): 0.68; 95% CI:
0.41 to 1.13, p = 0.14, I2 = 73%], but the certainty of
evidence was very low. Nevertheless, the EAA group had lower pain score at
postoperative 24 h [mean difference (MD): -1.49, 95% CI: -2.38 to -0.61;
I2 = 98%; five RCTs; n = 476] and risk of PONV (RR = 0.73, 95%
CI: 0.57 to 0.93, p = 0.01, I2 = 0%; three RCTs, 1876 patients)
than those in the non-EAA group. Our results showed no significant impact
of EAA on the pain score at postoperative 36-72 h, LOS, and risk of
complications. Conclusion(s): This meta-analysis demonstrated that
EAA had no significant impact on the incidence of POD/POCD in patients
following non-cardiac surgery. Copyright © 2022 Societe francaise
d'anesthesie et de reanimation (Sfar)

<93>
Accession Number
2018993974
Title
Continuous Pecto-Intercostal Fascial Block Provides Effective Analgesia in
Patients Undergoing Open Cardiac Surgery: A Randomized Controlled Trial.
Source
Pain Medicine (United States). 23(3) (pp 440-447), 2022. Date of
Publication: 01 Mar 2022.
Author
Zhang Y.; Min J.; Chen S.
Institution
(Zhang, Min, Chen) Department of Anesthesiology, First Affiliated Hospital
of Nanchang University, Nanchang, China
Publisher
Oxford University Press
Abstract
Background: The optimal analgesia regimen after open cardiac surgery has
been unclear. The aim of this study was to investigate the beneficial
effects of continuous pecto-intercostal fascial blocks (PIFB) initiated
before surgery on outcomes after open cardiac surgery. Method(s): A
group of 116 patients were randomly allocated to receive either bilateral
continuous PIFB (PIF group) or the same block with saline (SAL group). The
primary endpoint was postoperative pain at 4, 8, 16, 24, 48, and 72 hours
after extubation at rest and during exercise. The secondary outcome
measures included analgesia requirements (sufentanil and flurbiprofen
consumption), time to extubation, length of stay in the intensive care
unit, incidence of postoperative nausea and vomiting, time until return of
bowel function, time to mobilization, time to urinary catheter removal,
and the length of hospital stay. Result(s): The length of stay in the
intensive care unit (29 +/- 7 hours vs 13 +/- 4 hours, P < 0.01) and
length of hospital stay (8.9 +/- 0.9 days vs 6.5 +/- 1.1 days, P < 0.01)
were significantly longer in the SAL group than in the PIF group. Resting
pain scores (2 hours after extubation: 1.1 vs 3.3, P < 0.01; 4 hours after
extubation: 1.0 vs 3.5, P < 0.01; 8 hours after extubation: 1.2 vs 3.7, P
< 0.01; 16 hours after extubation: 1.3 vs 3.7, P < 0.01; 24 hours after
extubation: 1.4 vs 2.8, P < 0.01; 48 hours after extubation: 0.9 vs 2.2, P
< 0.01; 72 hours after extubation: 0.8 vs 2.1, P < 0.01) and dynamic pain
scores (2 hours after extubation: 1.4 vs 3.7, P < 0.01; 4 hours after
extubation: 1.3 vs 3.8, P < 0.01; 8 hours after extubation: 1.4 vs 3.5, P
< 0.01; 16 hours after extubation: 1.2 vs 3.4, P < 0.01; 24 hours after
extubation: 1.1 vs 3.1, P < 0.01; 48 hours after extubation: 1.0 vs 2.9, P
< 0.01; 72 hours after extubation: 0.9 vs 2.8, P < 0.01) were
significantly lower in the PIF group than in the SAL group at all time
points. The PIF group required significantly less intraoperative
sufentanil consumption (123 +/- 32 mug vs 63 +/- 16 mug, P < 0.01),
postoperative sufentanil consumption (102 +/- 22 mug vs 52 +/- 17 mug, P <
0.01), and postoperative flurbiprofen consumption (350 +/- 100 mg vs 100
+/- 100 mg, P < 0.01) than the SAL groups. Time to extubation (8.9 +/- 2.4
hours vs 3.2 +/- 1.3 hours, P < 0.01), time to first flatus (43 +/- 6
hours vs 30 +/- 7 hours, P < 0.01), time until mobilization (35 +/- 5
hours vs 24 +/- 7 hours, P < 0.01), and time until urinary catheter
removal (47 +/- 9 hours vs 31 +/- 4 hours, P < 0.01) were significantly
earlier in the PIF group than in the SAL group. The incidence of
postoperative nausea and vomiting was significantly lower in the PIF group
(9.1% vs 27.3%, P < 0.01). Conclusion(s): Bilateral continuous PIFB
reduced the length of hospital stay and provided effective postoperative
pain relief for 3 days. Copyright © 2021 The Author(s). Published
by Oxford University Press on behalf of the American Academy of Pain
Medicine. All rights reserved.

<94>
[Use Link to view the full text]
Accession Number
2019092245
Title
Interventional treatment of acute myocardial infarction-related
cardiogenic shock.
Source
Current Opinion in Critical Care. 27(4) (pp 433-439), 2021. Date of
Publication: 01 Aug 2021.
Author
Josiassen J.; Moller J.E.; Holmvang L.; Hassager C.
Institution
(Josiassen, Moller, Holmvang, Hassager) Department of Cardiology,
Copenhagen University Hospital, Rigshospitalet, Denmark
(Moller) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Holmvang, Hassager) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of reviewAcute revascularization is with some evidence the only
intervention proven to improve the prognosis in myocardial
infarction-related cardiogenic shock but several interventions are
continuously being investigated in order to increase survival among these
patients. In this review, several aspects related to the interventional
treatment of cardiogenic shock are discussed chronologically from symptom
debut to leaving the cardiac catheterization laboratory.Recent findingsIn
the randomized CULPRIT-SHOCK trial, a culprit-only revascularization
strategy was reported superior to immediate complete revascularization
among patients with multivessel disease. Recent large-scale observational
data underline the marked prognostic importance of time from medical
contact to revascularization in acute myocardial infarction-related
cardiogenic shock. Moreover, studies suggest a potential beneficial effect
of a transradial vascular access as well as early initialization of
mechanical circulatory support in carefully selected patients. This,
however, needs further validation.SummaryAcute revascularization remains a
crucial part of the initial management of acute myocardial
infarction-related cardiogenic shock. Among cardiogenic shock patients
presenting with multivessel disease, a culprit-only approach should be the
routine strategy. Time to revascularization plays a crucial role in the
setting of cardiogenic shock, why prehospital optimization and triaging
may be the most important factors in order to improve prognosis in
AMI-related cardiogenic shock. Copyright © 2021 Lippincott
Williams and Wilkins. All rights reserved.

<95>
Accession Number
2018149385
Title
Safety and efficacy of transcatheter aortic valve implantation in stenotic
bicuspid aortic valve compared to tricuspid aortic valve: a systematic
review and meta-analysis.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2022. Date of
Publication: 2022.
Author
Zghouzi M.; Osman H.; Ullah W.; Suleiman A.-R.; Razvi P.; Abdalrazzak M.;
Rabbat F.; Alraiyes M.; Sattar Y.; Bagur R.; Paul T.; Matetic A.; Mamas
M.A.; Lakkis N.; Alraies M.C.
Institution
(Zghouzi, Osman, Razvi) Department of Internal Medicine, Detroit Medical
Center, Detroit, MI, United States
(Ullah) Thomas Jefferson University, Philadelphia, PA, United States
(Suleiman, Abdalrazzak) Division of Cardiology, Wayne State University
School of Medicine, Detroit, MI, United States
(Rabbat) Division of Cardiolog, Internal medicine, Baptist hospital,
Miami, FL, United States
(Alraiyes) Division of Cardiology, Vernon Hills High School, Vernon Hills,
IL, United States
(Sattar) Division of cardiology, West Virginia University, Morgantown, WV,
United States
(Bagur) Division of Cardiology, London Health Sciences Centre, Western
University, London, ON, Canada
(Paul) Department of Medical Education, University of Tennessee at
Nashville, Nashville, TN, United States
(Matetic, Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Keele University, Stoke-on-Trent, United Kingdom
(Lakkis, Alraies) Division of cardiology, Wayne State University, Detroit
Medical Center, Detroit, MI, United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
a safe and effective alternative to surgical replacement for tricuspid
aortic valve (TAV) stenosis. However, utilization of TAVI for aortic
stenosis in bicuspid aortic valve (BAV) compared to TAV remains
controversial. Method(s): We queried online databases with various
keywords to identify relevant articles. We compared major cardiovascular
events and procedural outcomes using a random effect model to calculate
odds ratios (OR). Result(s): We included a total of 22 studies
comprising 189,693 patients (BAV 12,669 vs. TAV 177,024). In the pooled
analysis, there were no difference in TAVI for BAV vs. TAV for all-cause
mortality, cardiovascular mortality, myocardial infarction (MI), vascular
complications, acute kidney injury (AKI), coronary occlusion, annulus
rupture, and reintervention/reoperation between the groups. The incidence
of stroke (OR 1.24; 95% CI 1.1-1.39), paravalvular leak (PVLR) (OR 1.42;
95% CI 1.26-1.61), and the need for pacemaker (OR 1.15; 95% CI 1.06-1.26)
was less in the TAV group compared to the BAV group, while incidence of
life-threatening bleeding was higher in the TAV group. Subgroup analysis
mirrored pooled outcomes except for all-cause mortality.
 Conclusion(s): The use of TAVI for the treatment of aortic stenosis
in selective BAV appears to be safe and effective. Copyright ©
2022 Informa UK Limited, trading as Taylor & Francis Group.

<96>
Accession Number
638420097
Title
Levosimendan in paediatric cardiac anaesthesiology: A systematic review
and meta-analysis.
Source
European journal of anaesthesiology. (no pagination), 2022. Date of
Publication: 06 Jul 2022.
Author
Lapere M.; Rega F.; Rex S.
Institution
(Lapere) From the Department of Anaesthesiology, University Hospitals
Leuven (ML, Department of Cardiovascular Sciences, SR) and Department of
Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: Low cardiac output syndrome (LCOS) after congenital cardiac
surgery has an incidence of up to 25%. Preventing and treating LCOS is of
pivotal importance as LCOS is associated with excess morbidity and
mortality. OBJECTIVE(S): This systematic review assesses the safety
and efficacy of peri-operative levosimendan administration in the setting
of paediatric cardiac surgery. DESIGN: Systematic review of randomised
controlled trials. Meta-analyses were performed on efficacy and
exploratory outcomes. DATA SOURCES: Literature was searched in the
following databases (MEDLINE, EMBASE, Web of Science and CENTRAL) from
inception to July 2021. ELIGIBILITY CRITERIA: Randomised controlled trials
comparing levosimendan with other inotropes or placebo in children younger
than 18 years of age undergoing cardiac surgery. RESULT(S): Nine
studies enrolling a total of 539 children could be included in the
systematic review. All trials study the prophylactic administration of
levosimendan in comparison with placebo (n = 2), milrinone (n = 6) or
dobutamine (n = 1). Levosimendan dosing varied considerably with only
three studies using a loading dose. Levosimendan reduced the incidence of
LCOS [risk ratio (RR) 0.80] [95% confidence interval (CI), 0.40 to 0.89, P
= 0.01] and increased cardiac index (MD 0.17 l min-1 m-2) (95% CI, 0.06 to
0.28, P = 0.003) without affecting other outcomes (mortality, ICU length
of stay, hospital length of stay, duration of mechanical ventilation,
serum lactate, central venous oxygen saturation, serum creatine or acute
kidney injury). CONCLUSION(S): The prophylactic use of levosimendan
in children undergoing cardiac surgery reduced the incidence of LCOS and
increased cardiac index compared with other inotropes or placebo. This
effect did not translate into an improvement of other clinical
endpoints. Copyright © 2022 European Society of Anaesthesiology
and Intensive Care. Unauthorized reproduction of this article is
prohibited.

<97>
[Use Link to view the full text]
Accession Number
2018928650
Title
Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac
Transplantation.
Source
Circulation. 145(25) (pp 1811-1824), 2022. Date of Publication: 21 Jun
2022.
Author
Anthony C.; Imran M.; Pouliopoulos J.; Emmanuel S.; Iliff J.; Liu Z.;
Moffat K.; Ru Qiu M.; McLean C.A.; Stehning C.; Puntmann V.; Vassiliou V.;
Ismail T.F.; Gulati A.; Prasad S.; Graham R.M.; McCrohon J.; Holloway C.;
Kotlyar E.; Muthiah K.; Keogh A.M.; Hayward C.S.; MacDonald P.S.; Jabbour
A.
Institution
(Anthony, Imran, Pouliopoulos, Emmanuel, Iliff, Moffat, Ru Qiu, Graham,
McCrohon, Holloway, Kotlyar, Muthiah, Keogh, Hayward, MacDonald, Jabbour)
Heart And Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia
(Moffat, Muthiah) Medical Imaging Department, St. Vincent's Hospital,
Sydney, Australia
(Pouliopoulos, Emmanuel, Graham, Hayward, MacDonald, Jabbour) Victor Chang
Cardiac Research Institute, Sydney, Australia
(Pouliopoulos, Graham, Keogh, MacDonald, Jabbour) Unsw, Sydney, Australia
(Stehning) Philips GmbH Innovative Technologies, Hamburg, Germany
(Puntmann) Institute For Experimental And Translational Cardiovascular
Imaging, Goethe University Hospital, Frankfurt, Germany
(Vassiliou, Gulati, Prasad) Cmr, Royal Brompton Hospital, Imperial
College, London, United Kingdom
(McLean) Alfred Health And Monash University, Melbourne, Australia
(Ismail) King's College, London, United Kingdom
(Liu) Stats Central, Mark Wainwright Analytical Centre, Unsw, Sydney,
Australia
(Vassiliou) Norwich Medical School, University Of East Anglia, United
Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Endomyocardial biopsy (EMB) is the gold standard method for
surveillance of acute cardiac allograft rejection (ACAR) despite its
invasive nature. Cardiovascular magnetic resonance (CMR)-based myocardial
tissue characterization allows detection of myocarditis. The feasibility
of CMR-based surveillance for ACAR-induced myocarditis in the first year
after heart transplantation is currently undescribed. Method(s):
CMR-based multiparametric mapping was initially assessed in a prospective
cross-sectional fashion to establish agreement between CMR-and EMB-based
ACAR and to determine CMR cutoff values between rejection grades. A
prospective randomized noninferiority pilot study was then undertaken in
adult orthotopic heart transplant recipients who were randomized at 4
weeks after orthotopic heart transplantation to either CMR-or EMB-based
rejection surveillance. Clinical end points were assessed at 52 weeks.
 Result(s): Four hundred one CMR studies and 354 EMB procedures were
performed in 106 participants. Forty heart transplant recipients were
randomized. CMR-based multiparametric assessment was highly reproducible
and reliable at detecting ACAR (area under the curve, 0.92; sensitivity,
93%; specificity, 92%; negative predictive value, 99%) with greater
specificity and negative predictive value than either T1 or T2 parametric
CMR mapping alone. High-grade rejection occurred in similar numbers of
patients in each randomized group (CMR, n=7; EMB, n=8; P=0.74). Despite
similarities in immunosuppression requirements, kidney function, and
mortality between groups, the rates of hospitalization (9 of 20 [45%]
versus 18 of 20 [90%]; odds ratio, 0.091; P=0.006) and infection (7 of 20
[35%] versus 14 of 20 [70%]; odds ratio, 0.192; P=0,019) were lower in the
CMR group. On 15 occasions (6%), patients who were randomized to the CMR
arm underwent EMB for clarification or logistic reasons, representing a
94% reduction in the requirement for EMB-based surveillance.
 Conclusion(s): A noninvasive CMR-based surveillance strategy for ACAR
in the first year after orthotopic heart transplantation is feasible
compared with EMB-based surveillance. Registration: HREC/13/SVH/66 and
HREC/17/SVH/80. Australian New Zealand Clinical Trials Registry:
ACTRN12618000672257. Copyright © 2022 American Heart Association,
Inc.

<98>
Accession Number
2018012948
Title
Recent advances in potential of Fisetin in the management of myocardial
ischemia-reperfusion injury-A systematic review.
Source
Phytomedicine. 101 (no pagination), 2022. Article Number: 154123. Date of
Publication: July 2022.
Author
Prem P.N.; Sivakumar B.; Boovarahan S.R.; Kurian G.A.
Institution
(Prem, Sivakumar, Boovarahan, Kurian) Vascular Biology lab, School of
Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, India
(Kurian) School of Chemical and Biotechnology, SASTRA Deemed University,
Tamil Nadu, Tirumalaisamudram, Thanjavur 613401, India
Publisher
Elsevier GmbH
Abstract
Background: The primary therapeutic strategy in managing ischemic heart
diseases is to restore the perfusion of the myocardial ischemic area by
surgical methods that often result in an unavoidable injury called
ischemia-reperfusion injury (IR). Fisetin is an effective flavonoid with
antioxidant and anti-inflammatory properties, proven to be
cardioprotective against IR injury in both in-vitro and invivo models,
apart from its promising health benefits against cancer, diabetes, and
neurodegenerative ailments. Purpose(s): The potential of fisetin in
attenuating myocardial IR is inconclusive as the effectiveness of fisetin
needs more understanding in terms of its possible target sites and
underlying different mechanisms. Considering the surge in recent
scientific interests in fisetin as a pharmacological agent, this review
not only updates the existing preclinical and clinical studies with
fisetin and its underlying mechanisms but also summarizes its possible
targets during IR protection. Method(s): We performed a literature
survey using search engines Pubmed, PMC, Science direct, Google, and
research gate published across the years 2006-2021. The relevant studies
were extracted from the databases with the combinations of the following
keywords and summarized: myocardial ischemia-reperfusion injury, natural
products, flavonoid, fisetin, PI3K, JAK-STAT, Nrf2, PKC, JNK, autophagy.
 Result(s): Fisetin is reported to be effective in attenuating IR
injury by delaying the clotting time, preserving the mitochondrial
function, reducing oxidative stress, and inhibiting GSK 3beta. But it
failed to protect diseased cardiomyocytes challenged to IR. As discussed
in the current review, fisetin not only acts as a conventional antioxidant
and anti-inflammatory agent to exert its biological effect but may also
exert modulatory action on the cellular metabolism and adaptation via
direct action on various signalling pathways that comprise PI3K, JAK-STAT,
Nrf2, PKC, JNK, and autophagy. Moreover, the dosage of fisetin and
co-morbidities like diabetes and obesity are found to be detrimental
factors for cardioprotection. Conclusion(s): For further evaluation
and smooth clinical translation of the fisetin molecule in IR treatment,
researchers should pay close attention to the potential of fisetin to
possibly alter the key cardioprotective pathways and dosage, as the
efficacy of fisetin is tissue and cell type-specific and varies with
different doses. Copyright © 2022 Elsevier GmbH

<99>
Accession Number
2016827802
Title
Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients
With Heart Failure: Analysis From COAPT.
Source
JACC: Cardiovascular Interventions. 15(4) (pp 397-407), 2022. Date of
Publication: 28 Feb 2022.
Author
Song C.; Madhavan M.V.; Lindenfeld J.; Abraham W.T.; Kar S.; Lim D.S.;
Grayburn P.A.; Kapadia S.R.; Kotinkaduwa L.N.; Mack M.J.; Stone G.W.
Institution
(Song, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York,
New York, United States
(Madhavan, Kotinkaduwa, Stone) Clinical Trials Center, Cardiovascular
Research Foundation, New York, New York, United States
(Madhavan) NewYork-Presbyterian Hospital/Columbia University Irving
Medical Center, New York, New York, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Departments of Medicine, Physiology, and Cell Biology, Division
of Cardiovascular Medicine, and the Davis Heart and Lung Research
Institute, The Ohio State University, Columbus, OH, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, Texas, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Mack) Baylor Scott and White Heart Hospital - Plano, Dallas, Texas,
United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the impact of age on
outcomes in patients undergoing transcatheter edge-to-edge repair (TEER)
from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip
Percutaneous Therapy for Heart Failure Patients with Functional Mitral
Regurgitation) trial. Background(s): In the COAPT trial, TEER with
the MitraClip device in patients with heart failure (HF) and moderate to
severe or severe secondary mitral regurgitation (SMR) reduced the risk for
HF hospitalization (HFH) and all-cause mortality compared with maximally
tolerated guideline-directed medical therapy (GDMT) alone. There are
limited data regarding the effectiveness of MitraClip therapy in elderly
patients. Method(s): Patients (n = 614) were grouped by median age at
randomization (74 years) and by MitraClip treatment vs GDMT alone. The
primary endpoint was the 2-year rate of death or HFH assessed by
multivariable Cox regression. Result(s): Death or HFH within 2 years
occurred less frequently after treatment with the MitraClip vs GDMT alone
in patients <74 years of age (37.3% vs 64.5%; adjusted HR: 0.41; 95% CI:
0.29-0.59) and >=74 years of age (51.7% vs 69.6%; adjusted HR: 0.58; 95%
CI: 0.42-0.81) (P<inf>int</inf> = 0.17). Mortality was also consistently
reduced with MitraClip treatment in young and elderly patients
(P<inf>int</inf> = 0.42). In contrast, elderly patients treated with the
MitraClip vs GDMT alone tended to have a lesser reduction of HFH than
younger patients (P<inf>int</inf> = 0.03). Younger and older patients had
similar improvements in quality of life after treatment with the MitraClip
compared with GDMT alone. Conclusion(s): In the COAPT trial,
MitraClip treatment of moderate to severe and severe SMR reduced the
composite risk for death or HFH and improved survival and quality of life
regardless of age. As such, young and elderly patients with HF and severe
SMR benefit from TEER, although elderly patients may not have as great a
benefit from the MitraClip device in reducing HFH. Copyright ©
2022

<100>
Accession Number
2018143076
Title
Infective endocarditis by Nocardia species: a systematic review.
Source
Journal of Chemotherapy. (no pagination), 2022. Date of Publication:
2022.
Author
Velidakis A.; Degaitis F.; Tsorbatzoglou G.; Ioannou P.
Institution
(Velidakis, Degaitis, Tsorbatzoglou, Ioannou) Department of Internal
Medicine & Infectious Diseases, University Hospital of Heraklion,
Heraklion, Greece
Publisher
Taylor and Francis Ltd.
Abstract
Nocardiosis, is a potentially life-threatening disease, especially in
immunocompromised individuals where it manifests as a disseminated
disease. Infective Endocarditis (IE) is a rare disease with significant
morbidity and mortality. Importantly, even though there are scarce data of
IE by Nocardia spp. in the literature, a review adequately summarizing
systematically all available evidence on the topic is lacking. The aim of
this study was to systematically review all cases of IE by Nocardia spp.
and describe the epidemiology, microbiology, clinical characteristics,
treatment and outcomes of this infection. A systematic review of PubMed,
Scopus and Cochrane library (through 7 December 2021) for studies
providing epidemiological, clinical, microbiological as well as treatment
data and outcomes of patients with IE by Nocardia spp. was performed. A
total of 25 studies providing data for 26 patients were included. A
prosthetic valve was present in 30.8%, while the most common microorganism
was N. asteroides. Aortic valve was the most commonly infected
intracardiac site, followed by the mitral valve. Diagnosis was most
commonly performed with transthoracic echocardiography, while the
diagnosis was made at autopsy in 11.5%. Co-trimoxazole, aminoglycosides
and carbapenems were the most commonly used antimicrobials. Clinical cure
was noted in 73.1%, while mortality was 26.9%. This systematic review
thoroughly describes IE by Nocardia and provides information on
epidemiology, clinical presentation, treatment and outcomes. Copyright
© 2022 Edizioni Scientifi che per l'Informazione su Farmaci e
Terapia.

<101>
Accession Number
638400666
Title
Mortality and adverse events of hemoadsorption with CytoSorb in critically
ill patients: a systematic review and meta-analysis of randomized
controlled trials.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2022. Date of
Publication: 05 Jul 2022.
Author
Heymann M.; Schorer R.; Putzu A.
Institution
(Heymann, Schorer, Putzu) Division of Anesthesiology, Department of Acute
Medicine, Geneva University Hospitals, Geneva, Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: The effects and safety of extracorporeal hemoadsorption with
CytoSorb in critically ill patients with inflammatory conditions are
controversial. METHOD(S): We performed a systematic review with
meta-analysis and trial sequential analysis (TSA) of randomized-controlled
trials to assess the mortality and safety of CytoSorb therapy in
critically ill patients with inflammatory conditions. Electronic databases
were searched up to April 2022. The primary outcome was mortality at
longest follow-up and secondary outcomes included various adverse event
(AE) outcomes. Conflict of interest and funding of each trial were
assessed. We calculated relative risk (RR) and 95% confidence interval
(CI). RESULT(S): Fourteen published (n=764) and 4 unpublished (n=111)
trials were included. Eight trials were performed in medical ICU patients
and 10 in complex cardiac surgery. Ten trials had significant industrial
funding or an author conflict of interest. Hemoadsorption with CytoSorb
was associated with higher mortality at latest follow-up (16 trials,
n=807, 120 of 402 [29.85%] patients in the CytoSorb group vs. 98 of 405
[24.20%] patients in the control group, RR=1.24 [95% CI, 1.04 to 1.49],
p=0.02, [TSA-adjusted CI, 0.92 to 1.68]) and at 30-days or in-hospital (11
trials, n=727; RR=1.41 [95% CI, 1.06 to 1.88], p=0.02, [TSA-adjusted CI,
0.44 to 4.62]). Only one trial reported the definition of adverse event,
while detailed results were reported in 3 trials; the risk of adverse
events was not higher with CytoSorb. Certainty of evidence ranged from low
to very low. CONCLUSION(S): Low certainty of evidence showed that the
use of CytoSorb might increase mortality in critically ill patients with
inflammatory conditions. Adverse events were frequent but underreported
and not systematically evaluated. Industrial funding and conflict of
interest were common. Considerable uncertainty about the findings does not
allow firm conclusions and suggests a need for high-quality randomized
trials to clarify mortality and adverse events related to
CytoSorb. Copyright This article is protected by copyright. All rights
reserved.

<102>
Accession Number
638399218
Title
The Australia and New Zealand Congenital Outcomes Registry for Surgery
(ANZCORS): methodology and preliminary results.
Source
ANZ journal of surgery. (no pagination), 2022. Date of Publication: 05
Jul 2022.
Author
Marathe S.P.; Suna J.; Betts K.S.; Merlo G.; Konstantinov I.E.; Iyengar
A.J.; Venugopal P.; Alphonso N.
Institution
(Marathe, Suna, Venugopal, Alphonso) Queensland Paediatric Cardiac Service
(QPCS), Queensland Children's Hospital, Brisbane, QLD, Australia
(Marathe, Suna, Venugopal, Alphonso) Child Health Research Centre,
University of Queensland, Brisbane, QLD, Australia
(Marathe, Suna, Venugopal, Alphonso) School of Clinical Medicine,
Children's Health Queensland Clinical Unit, University of Queensland,
Brisbane, QLD, Australia
(Betts) School of Population Health, Curtin University, Perth, WA,
Australia
(Merlo) Primary Care Clinical Unit, University of Queensland, Brisbane,
QLD, Australia
(Konstantinov) Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC,
Australia
(Konstantinov) Heart Research, Murdoch Children's Research Institute,
Melbourne, VIC, Australia
(Iyengar) Green Lane Paediatric & Congenital Cardiac Service, Starship
Children's Hospital, Auckland, New Zealand
(Iyengar) Department of Surgery, University of Auckland, Auckland, New
Zealand
Publisher
NLM (Medline)
Abstract
BACKGROUND: Analysis of multi-institutional data and benchmarking is an
accepted accreditation standard in cardiac surgery. Such a database does
not exist for congenital cardiac surgery in Australia and New Zealand
(ANZ). To fill this gap, the ANZ Congenital Outcomes Registry for Surgery
(ANZCORS) was established in 2017. METHOD(S): Inclusion criteria
included all cardiothoracic and extracorporeal membrane oxygenation (ECMO)
procedures performed at five participating centres. Data was collected by
data managers, validated by the surgical team, and securely transmitted to
a central repository. RESULT(S): Between 2015 and 2019, 9723
procedures were performed in 7003 patients. Cardiopulmonary bypass was
utilized for 59% and 9% were ECMO procedures. Fifty-seven percent (n =
5531) of the procedures were performed in children younger than 1 year of
age. Twenty-four percent of procedures (n = 2365) were performed in
neonates (<=28days) and 33% (n = 3166) were performed in children aged
29days to 1 year (infants). The 30-day mortality for cardiac cases (n =
6572) was 1.3% and there was no statistical difference between the
participating centres (P = 0.491). Sixty-nine percent of cases had no
major post-operative complications (5121/7456). For cardiopulmonary bypass
procedures (n = 5774), median stay in intensive care and hospital was
2days (IQR 1, 4) and 9days (IQR 5, 18), respectively. CONCLUSION(S):
ANZCORS has facilitated pooled data analysis for paediatric cardiac
surgery across ANZ for the first time. Overall mortality was low.
Non-risk-adjusted 30-day mortality for individual procedures was similar
in all units. The continued evaluation of surgical outcomes through
ANZCORS will drive quality assessment in paediatric cardiac surgery across
ANZ. Copyright © 2022 The Authors. ANZ Journal of Surgery
published by John Wiley & Sons Australia, Ltd on behalf of Royal
Australasian College of Surgeons.

<103>
Accession Number
638398104
Title
Colchicine for cardiovascular medicine: a systematic review and
meta-analysis.
Source
Future cardiology. (no pagination), 2022. Date of Publication: 05 Jul
2022.
Author
Casula M.; Andreis A.; Avondo S.; Vaira M.P.; Imazio M.
Institution
(Casula, Andreis, Avondo, Vaira) University Cardiology, A.O.U. Citta della
Salute e della Scienza di Torino, Turin, Italy
(Imazio) Cardiology, Cardiothoracic Department, University Hospital "Santa
Maria della Misericordia", Udine, Italy
Publisher
NLM (Medline)
Abstract
Aim: Colchicine, a microtubule-disassembling (antitubulin) agent used for
centuries for the treatment of gout and autoimmune diseases, is a drug of
growing interest in the cardiovascular field. While in the last decades it
has become cornerstone of pericarditis treatment, it has also emerged in
the last few years as a promising drug in the management of coronary
artery disease, atrial fibrillation and heart failure. This systematic
review and meta-analysis aimed to assess the efficacy of colchicine in
patients with cardiovascular diseases. Method(s): Systematic search
in electronic databases (MEDLINE/PubMed, Scopus, BioMed Central, the
Cochrane Collaboration Database of Randomized Trials, ClinicalTrials.gov,
EMBASE, Google Scholar) was performed to identify randomized controlled
trials (RCTs) up to February 2021. Random-effects meta-analysis was
performed to assess the risk of cardiovascular events, defined according
to clinical setting. Result(s): Among 15,569 pooled patients from 21
RCTs, colchicine was superior to placebo in the reduction of
cardiovascular events. In the setting of pericardial diseases, it was
associated with a lower risk of recurrent pericarditis (17 vs 34%, RR =
0.50, 95% CI: 0.42-0.60, I2 = 10%). In other studies assessing coronary
artery disease patients, colchicine was associated with a reduced risk of
major adverse cardiovascular events (MACE) such as myocardial infarction,
stroke, cardiovascular death, coronary revascularisation and
hospitalization (6.3 vs 9%, RR = 0.67, 95% CI: 0.54-0.84, I2 = 55). Among
patients with atrial fibrillation, it was associated with lower rates of
recurrence (20 vs 30%, RR = 0.68, 95% CI: 0.58-0.81, I2 = 0). In the
single RCT on heart failure, colchicine was not associated with improved
NYHA class. Conclusion(s): Colchicine is a valuable anti-inflammatory
agent for the prevention of cardiovascular events in patients with
inflammatory cardiac conditions such as pericardial diseases, coronary
artery disease and atrial fibrillation.

<104>
Accession Number
638389022
Title
Effectiveness and Safety of Early Initiation of Poststernotomy Cardiac
Rehabilitation Exercise Training: The SCAR Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2022. Date of Publication: 2022.
Author
Ennis S.; Lobley G.; Worrall S.; Evans B.; Kimani P.K.; Khan A.; Powell
R.; Banerjee P.; Barker T.; McGregor G.
Institution
(Ennis, McGregor) Warwick Clinical Trials Unit, Warwick Medical School,
University of Warwick, Coventry CV4 7AL, United Kingdom
(Ennis, Lobley, Worrall, Evans, Powell, McGregor) Department of
Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University
Hospital Coventry, Warwickshire National Health Service Trust, Coventry,
United Kingdom
(Kimani, Khan, Banerjee) Warwick Medical School, University of Warwick,
Coventry, United Kingdom
(Powell, McGregor) Centre for Sport, Exercise and Life Sciences, Research
Institute for Health & Wellbeing, Coventry University, Coventry, United
Kingdom
(Banerjee) Department of Cardiology, University Hospital Coventry,
Warwickshire National Health Service Trust, Coventry, United Kingdom
(Barker) Department of Cardiothoracic Surgery, University Hospital
Coventry, Warwickshire National Health Service Trust, Coventry, United
Kingdom
Publisher
American Medical Association
Abstract
Importance: Guidelines recommend that cardiac rehabilitation (CR) exercise
training should not start until 6 weeks after sternotomy, although this is
not evidence based. Limited data suggest that starting earlier is not
detrimental, but clinical trials are needed. Objective(s): To compare
the effectiveness and safety of CR exercise training started either 2
weeks (early CR) or 6 weeks (usual-care CR) after sternotomy. Design,
Setting, and Participant(s): This was an assessor-blind, noninferiority,
parallel-group, randomized clinical trial that conducted participant
recruitment from June 12, 2017, to March 17, 2020. Participants were
consecutive cardiac surgery sternotomy patients recruited from 2
outpatient National Health Service rehabilitation centers: University
Hospital, Coventry, UK, and Hospital of St Cross, Rugby, UK.
 Intervention(s): Participants were randomly assigned to 8 weeks of
twice-weekly supervised CR exercise training starting either 2 weeks
(early CR) or 6 weeks (usual-care CR) after sternotomy. Exercise training
adhered to existing guidelines, including functional strength and
cardiovascular components. Main Outcomes and Measures: Outcomes were
assessed at baseline (inpatient after surgery), after CR (10 or 14 weeks
after sternotomy), and 12 months after randomization. The primary outcome
was the change in 6-minute walk test distance from baseline to after CR.
Secondary outcomes included safety, functional fitness, and quality of
life. Result(s): A total of 158 participants (mean [SD] age, 63
[11.5] years, 133 male patients [84.2%]) were randomly assigned to study
groups; 118 patients (usual-care CR, 61 [51.7%]; early CR, 57 [48.3%])
were included in the primary analysis. Early CR was not inferior to
usual-care CR (noninferiority margin, 35 m); the mean change in 6-minute
walk distance from baseline to after CR was 28 m greater in the early CR
group (95% CI, -11 to 66; P =.16). Mean differences for secondary outcomes
were not statistically significant, indicating noninferiority of early CR.
There were 46 vs 58 adverse events and 14 vs 18 serious adverse events in
usual-care CR and early CR, respectively. There was no difference between
the groups in the likelihood of participants having an adverse or serious
adverse event. Conclusions and Relevance: Starting exercise training
from 2 weeks after sternotomy was as effective as starting 6 weeks after
sternotomy for improving 6-minute walk distance. With appropriate
precautions, clinicians and CR professionals can consider starting
exercise training as early as 2 weeks after sternotomy. Trial
Registration: ClinicalTrials.gov Identifier: NCT03223558. Copyright
© 2022 American Medical Association. All rights reserved.

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