EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 117

Results Generated From:
Embase <1980 to 2022 Week 27>
Embase Weekly Updates (updates since 2022-07-01)

<1>
Accession Number
2015117751
Title
Higher intensity of 72-h noninvasive cardiac test referral does not
improve short-term outcomes among emergency department patients with chest
pain.
Source
Academic Emergency Medicine. 29(6) (pp 736-747), 2022. Date of
Publication: June 2022.
Author
Mark D.G.; Shan J.; Huang J.; Ballard D.W.; Vinson D.R.; Kene M.V.; Sax
D.R.; Rauchwerger A.S.; Reed M.E.
Institution
(Mark) Departments of Emergency Medicine and Critical Care Medicine,
Kaiser Permanente Oakland Medical Center, Oakland, CA, United States
(Mark, Shan, Huang, Ballard, Vinson, Sax, Rauchwerger, Reed) Division of
Research, Kaiser Permanente Northern California, Oakland, CA, United
States
(Shan) School of Medicine, University of California San Francisco, San
Francisco, CA, United States
(Ballard) Department of Emergency Medicine, Kaiser Permanente San Rafael
Medical Center, San Rafael, CA, United States
(Vinson) Department of Emergency Medicine, Kaiser Permanente Roseville
Medical Center, Roseville, CA, United States
(Kene) Department of Emergency Medicine, Kaiser Permanente San Leandro
Medical Center, San Leandro, CA, United States
(Sax) Department of Emergency Medicine, Kaiser Permanente Oakland Medical
Center, Oakland, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: It is unclear whether referral for cardiac noninvasive testing
(NIT) following emergency department (ED) chest pain encounters improves
short-term outcomes. Method(s): This was a retrospective cohort study
of patients presenting with chest pain, without ST-elevation myocardial
infarction or myocardial injury by serum troponin testing, between 2013
and 2019 to 21 EDs within an integrated health care system. We examined
the association between NIT referral (within 72 h of the ED encounter) and
a primary outcome of 60-day major adverse cardiac events (MACE). Secondary
outcomes were 60-day MACE without coronary revascularization (MACE-CR) and
60-day all-cause mortality. To account for confounding by indication for
NIT, we grouped patient encounters into ranked tertiles of NIT referral
intensity based on the likelihood of 72-h NIT referral associated with the
initially assigned emergency physician, relative to local peers and within
discrete time periods. Associations between NIT referral-intensity tertile
and outcomes were assessed using risk-adjusted multivariable logistic
regression. Result(s): Among 210,948 eligible patient encounters,
72-h NIT referral frequency was 11.9%, 18.3%, and 25.9% in low,
intermediate, and high NIT referral-intensity encounters, respectively.
Compared with the low referral-intensity tertile, there was a higher risk
of 60-day MACE within the high referral-intensity tertile (odds ratio [OR]
= 1.11, 95% confidence interval [CI] = 1.04 to 1.17) due to more coronary
revascularizations without corresponding differences in MACE-CR or
all-cause mortality. In analyses stratified by patients' estimated risk
(HEART score; 50.5% lower risk, 38.7% moderate risk, 10.8% higher risk),
the difference in 60-day MACE was primarily attributable to moderate-risk
encounters (OR = 1.15, 95% CI = 1.08 to 1.24), with no differences among
either lower- (OR = 1.10, 95% CI = 0.92 to 1.31) or higher- (OR = 1.01,
95% CI = 0.90 to 1.14) risk encounters. Conclusion(s): Higher
referral intensity for 72-h NIT was associated with higher risk of
coronary revascularization but no difference in adverse events within 60
days. These findings further call into question the urgency of NIT among
ED patients without objective evidence of myocardial injury. Copyright
© 2022 Society for Academic Emergency Medicine.

<2>
Accession Number
2018451352
Title
Ultrasound-guided erector spinae plane block improve opioid-sparing
perioperative analgesia in pediatric patients undergoing thoracoscopic
lung lesion resection: a prospective randomized controlled trial.
Source
Translational Pediatrics. 11(5) (pp 706-714), 2022. Date of Publication:
May 2022.
Author
Yuan Z.; Liu J.; Jiao K.; Fan Y.; Zhang Y.
Institution
(Yuan, Liu, Fan, Zhang) Department of Anesthesiology, Tianjin Children's
Hospital, Tianjin, China
(Jiao) Operating Room, Tianjin Children's Hospital, Tianjin, China
Publisher
AME Publishing Company
Abstract
Background: Pediatric patients often experience severe pain after thoracic
surgery, especially in the early postoperative period. Recently, the focus
has been on regional analgesia with the introduction of ultrasound-guided
erector spinae plane blocks. We assumed that preoperative erector spinae
plane block (ESPB) in children undergoing video-assisted thoracoscopic
surgery (VATS) would reduce the consumption of perioperative opioids.
 Method(s): This randomized, double-blind study enrolled 60 children
aged 1-3 years who underwent thoracoscopic lung lesion resection. The
patients were enrolled in the study and randomly divided into two groups.
The general anesthesia (GA) group received GA alone, and the GA + ESPB
group received ESPB. The consumptions of remifentanil and sufentanil were
recorded, and the children's face, legs, activity, cry, consolability
(FLACC) scores were assessed after awakening. The time to first rescue
analgesia, length of hospital stay, parental satisfaction and adverse
events were also recorded. Result(s): The consumptions of
remifentanil and sufentanil in the GA + ESPB group were significantly
lower than those in the GA group, mean difference [95% confidence interval
(CI)]: -26.57 (-31.98 to -21.17) and -0.21 (-0.27 to -0.17), respectively,
(both P<0.001); while the time to first rescue analgesia and parental
satisfaction scores were significantly longer and higher, respectively, in
the GA + ESPB group than those in the GA group, mean difference (95% CI):
2.37 (1.77 to 2.97) and 2.47 (1.79 to 3.15), respectively, (both P<0.001).
The FLACC scores in the GA + ESPB group were significantly lower than
those in the GA group 1 to 24 hours postoperatively (P=0.023 at 1 h, and
P<0.001 at 3 h, 6 h, 12 h, 18 h, 24 h), but not at immediate admission to
the post-anesthesia care unit (PACU) (P=0.189 at 0 h). The GA + ESPB group
had significantly lower incidence rates of postoperative nausea and
vomiting (P=0.037 and P=0.020). Conclusion(s): In pediatric
Thoracoscopic surgery, the results of this study confirm our hypothesis
that ESPB decreases the consumptions of intraoperative remifentanil and
postoperative sufentanil in 24 hours and demonstrates better postoperative
analgesia compared with a control group. Trial Registration: Chinese
Clinical Trial Registry ChiCTR2200056166. Copyright ©
Translational Pediatrics. All rights reserved.

<3>
Accession Number
2016115655
Title
Misdiagnosis of aortic dissection: A systematic review of the literature.
Source
American Journal of Emergency Medicine. 53 (pp 16-22), 2022. Date of
Publication: March 2022.
Author
Lovatt S.; Wong C.W.; Schwarz K.; Borovac J.A.; Lo T.; Gunning M.; Phan
T.; Patwala A.; Barker D.; Mallen C.D.; Kwok C.S.
Institution
(Lovatt, Wong, Lo, Gunning, Phan, Patwala, Barker, Kwok) Department of
Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United
Kingdom
(Schwarz) Karl Landsteiner University of Health Sciences, Department of
Internal Medicine 3, University Hospital St. Polten, Krems, Austria
(Borovac) Clinic for Heart and Cardiovascular Diseases, University
Hospital of Split, Split, Croatia
(Mallen, Kwok) School of Medicine, Keele University, Stoke-on-Trent,
United Kingdom
Publisher
W.B. Saunders
Abstract
Background: Aortic dissection is a rare but potentially catastrophic
condition. Misdiagnosis of aortic dissection is not uncommon as symptoms
can overlap with other diagnoses. Objective(s): We conducted a
systematic review to better understand the factors contributing to
incorrect diagnosis of this condition. Method(s): We searched MEDLINE
and EMBASE for studies that evaluated the misdiagnosis of aortic
dissection. The rate of misdiagnosis was pooled and results were
narratively synthesized. Result(s): A total of 12 studies with were
included with 1663 patients. The overall rate of misdiagnosis of aortic
dissection was 33.8%. The proportion of patients presenting with chest
pain, back pain and syncope were 67.5%, 24.8% and 6.8% respectively. The
proportion of patients with pre-existing hypertension was 55.4%, 30.5%
were smokers while the proportion of patients with coronary artery
disease, previous cardiovascular surgery or surgical trauma and Marfan
syndrome was 14.7%, 5.8%, and 3.7%, respectively. Factors related to
misdiagnosis included the presence of symptoms and features associated
with other diseases (such as acute coronary syndrome, stroke and pulmonary
embolism), the absence of typical features (such as widened mediastinum on
chest X-ray) or concurrent conditions such congestive heart failure.
Factors associated with more accurate diagnosis included more
comprehensive history taking and increased use of imaging.
 Conclusion(s): Misdiagnosis in patients with an eventual diagnosis of
aortic dissection affects 1 in 3 patients. Clinicians should consider
aortic dissection as differential diagnosis in patients with chest pain,
back pain and syncope. Imaging should be used early to make the diagnosis
when aortic dissection is suspected. Copyright © 2021

<4>
Accession Number
2017921594
Title
Perioperative Analgesic Efficacy of Yamamoto New Scalp Acupuncture for
Canine Mastectomy Combined with Ovariohysterectomy: a Randomized,
Controlled Clinical Trial.
Source
JAMS Journal of Acupuncture and Meridian Studies. 15(1) (pp 121-129),
2022. Date of Publication: 2022.
Author
Bacarin C.D.C.; Nicacio G.M.; Cerazo L.M.D.L.; Peruchi L.G.; Cassu R.N.
Institution
(Bacarin, Nicacio, Cerazo, Peruchi, Cassu) Department of Veterinary
Surgery and Anestesiology, Faculty of Veterinary Medicine, Universidade do
Oeste Paulista, SP, Presidente Prudente, Brazil
Publisher
Medical Association of pharmacopuncture Institute
Abstract
Background: Yamamoto New Scalp Acupuncture (YNSA) is a therapy based on
the stimulation of points on the scalp and applied to treat different
states of pain. Objective(s): To investigate the analgesic efficacy
of YNSA for dogs undergoing radical unilateral mastectomy with
ovariohysterectomy. Method(s): Twenty-four dogs were randomly
distributed into two treatments (n = 12, per group): bilateral stimulation
of basic B, D, and E points (YNSA group) and no application of acupuncture
(control group). All dogs were sedated with morphine; anesthesia was
induced with propofol and maintained with isoflurane. Fentanyl was
intraoperatively administered to control cardiovascular responses to
surgical stimulation. Postoperative pain was assessed using an interactive
visual analog scale (IVAS) and the short-form of the Glasgow Composite
Pain Scale (CMPS-SF). Morphine was administered as rescue analgesia. Data
were analyzed using t-tests, Fisher's exact test, Mann-Whitney U test, and
Friedman test (p < 0.05). Result(s): Intraoperatively, the number of
dogs requiring supplemental analgesic and the number of doses of fentanyl
were lower in the YNSA group than in the control group (p = 0.027-0.034).
The IVAS pain scores recorded from 0.5 h to 1 h post-extubation in the
YNSA group were lower than those in the control group (p = 0.021-0.023).
Postoperative rescue analgesia and CMPS-SF pain scores did not differ
between the groups. Conclusion(s): YNSA decreases intraoperative
fentanyl requirements and provides minimal postoperative analgesic
benefits to dogs undergoing unilateral mastectomy with
ovariohysterectomy. Copyright © 2022. Medical Association of
Pharmacopuncture Institute (MAPI). All Rights Reserved.

<5>
[Use Link to view the full text]
Accession Number
2017900073
Title
Antifibrinolytic Drugs for the Prevention of Bleeding in Pediatric Cardiac
Surgery on Cardiopulmonary Bypass: A Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. 134(5) (pp 987-1001), 2022. Date of Publication:
01 May 2022.
Author
Siemens K.; Sangaran D.P.; Hunt B.J.; Murdoch I.A.; Tibby S.M.
Institution
(Siemens, Sangaran, Murdoch, Tibby) Pediatric Intensive Care Evelina
London Children's Hospital St Thomas' Hos ital London, United Kingdom
(Hunt) Department of Hematology, St Thomas' Hospital, London, United
Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Bleeding is one of the commonest complications affecting
children undergoing cardiac surgery on cardiopulmonary bypass.
Antifibrinolytic drugs are part of a multifaceted approach aimed at
reducing bleeding, though sufficiently sized pediatric studies are sparse,
and dosing algorithms are heterogeneous. Our objective was to evaluate the
efficacy and safety of antifibrinolytic agents as well as the
effectiveness of different dosing regimens in pediatric cardiac surgery
using cardiopulmonary bypass. METHOD(S): We performed a systematic
review and meta-analysis evaluating randomized controlled trials published
between 1980 and 2019, identified by searching the databases MEDLINE,
EMBASE, PubMed, and CENTRAL. All studies investigating patients <18 years
of age without underlying hematological disorders were included. The
primary outcome was postoperative bleeding; secondary end points included
blood product transfusion, mortality, and safety (thromboses, anaphylaxis,
renal or neurological dysfunction, and seizures). Different dosing
regimens were compared. Studies were dual appraised, outcomes were
reported descriptively and, if appropriate, quantitatively using the
Review Manager 5 (REVMAN 5) software (The Cochrane Collaboration).
 RESULT(S): Thirty of 209 articles were included, evaluating the
following drugs versus control: aprotinin n = 14, tranexamic acid (TXA) n
= 12, and epsilon-aminocaproic acid (EACA) n = 4. The number of
participants per intervention group ranged from 11 to 100 (median, 25;
interquartile range [IQR], 20.5) with a wide age span (mean, 13 days to
5.8 years) and weight range (mean, 3.1-26.3 kg). Methodological quality
was low to moderate. All agents reduced mean 24-hour blood loss compared
to control: aprotinin by 6.0 mL/kg (95% confidence interval [CI], -9.1 to
-3.0; P = .0001), TXA by 9.0 mL/kg (95% CI, -11.3 to -6.8; P < .00001),
and EACA by 10.5 mL/kg (95% CI, -21.1 to 0.0; P = .05). Heterogeneity was
low for TXA (I2 = 29%; P = .19), moderate for aprotinin
(I2 = 41%; P = .11), and high for EACA (I2 = 95%; P
< .00001). All agents also reduced 24-hour blood product transfusion.
There was no clear dose-response effect for TXA nor aprotinin. Studies
were underpowered to detect significant differences in mortality,
thromboses, anaphylaxis, and renal or neurological dysfunction.
 CONCLUSION(S): The available data demonstrate efficacy for all 3
antifibrinolytic drugs. Therefore, the agent with the most favorable
safety profile should be used. As sufficient data are lacking, large
comparative trials are warranted to assess the relative safety and
appropriate dosing regimens in pediatrics. Copyright © 2021
International Anesthesia Research Society

<6>
Accession Number
2013891006
Title
Getting immunosuppression just right: the role of clinical biomarkers in
predicting patient response post solid organ transplantation.
Source
Expert Review of Clinical Pharmacology. 14(12) (pp 1467-1479), 2021. Date
of Publication: 2021.
Author
Brunet M.; Millan O.
Institution
(Brunet, Millan) Pharmacology and Toxicology Section, CDB, IDIBAPS,
Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
(Brunet, Millan) Biomedical Research Center in Hepatic and Digestive
Diseases (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Actually, immunosuppression selection isn't based on
individual immune alloreactivity, and immunosuppressive drug dosing is
mainly based on the development of toxicity and the achievement of
specific target concentrations. Since a successful outcome requires
optimal patient risk stratification and treatment, several groups have
evaluated candidate biomarkers that have shown promise in the assessment
of individual immune responses, the prediction of personal pharmacodynamic
effects of immunosuppressive drugs and the prognosis and diagnosis of
graft outcomes. Areas covered: This review includes biomarkers that the
Scientific Community in Solid Organ Transplantation currently considers to
have potential as diagnostic and prognostic biomarkers of graft evolution.
We have focused on recent scientific advances and expert recommendations
regarding the role of specific and non-specific pharmacodynamic biomarkers
that are mainly involved in the T-cell-mediated response. Expert opinion:
Integral pharmacologic monitoring that combines pharmacokinetics,
pharmacogenetics and predictive pharmacodynamic biomarkers may provide
crucial information and allow personal adjustment of immunosuppressive
drugs at an early stage before severe adverse events ensue. Multicentre,
randomized, prospective and interventional trials are needed to fine tune
the established cut-off values for each biomarker and the optimal
monitoring frequency for each biomarker and to accurately evaluate
possible clinical confounding factors to enable correct clinical
qualification. Copyright © 2021 Informa UK Limited, trading as
Taylor & Francis Group.

<7>
Accession Number
2015004597
Title
Rigid Ring Versus Flexible Band for Tricuspid Valve Repair in Patients
Scheduled for Mitral Valve Surgery: A Prospective Randomised Study.
Source
Heart Lung and Circulation. 30(12) (pp 1949-1957), 2021. Date of
Publication: December 2021.
Author
Bogachev-Prokophiev A.V.; Ovcharov M.A.; Sapegin A.V.; Lavinykov S.O.;
Astapov D.A.; Ivanzov S.M.; Sharifulin R.M.; Afanasyev A.V.; Demin I.I.;
Zeleznev S.I.
Institution
(Bogachev-Prokophiev, Ovcharov, Sapegin, Lavinykov, Astapov, Ivanzov,
Sharifulin, Afanasyev, Demin, Zeleznev) Heart Valves Surgery Department,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
Publisher
Elsevier Ltd
Abstract
Background: Tricuspid valve repair for functional regurgitation is
effectively performed with different annuloplasty devices. However, it
remains unclear whether there are advantages associated with rigid rings
compared to flexible bands. This prospective randomised study aimed to
compare results of using a flexible band ring versus a rigid ring for
functional tricuspid regurgitation in patients undergoing mitral valve
surgery. Method(s): A single-centre randomised study was designed to
allocate patients with functional tricuspid regurgitation undergoing
mitral valve surgery to be treated with a flexible band or rigid ring.
These patients were analysed by echocardiographic follow-up. The primary
outcome was freedom from recurrent tricuspid regurgitation at 12-months
follow-up. Secondary outcomes were 30-day mortality, survival, freedom
from tricuspid valve reoperation, right ventricular reverse remodelling,
and rate of major adverse events. Result(s): A total of 308 patients
were allocated to receive concomitant tricuspid valve annuloplasty with
the flexible band or rigid ring. There was no between-group difference in
freedom from recurrent tricuspid regurgitation: 97.3% in Rigid group (95%
CI, 93.0-98.8) and 96.2% in the Flexible group (95% CI, 92.0-98.5) at
12-months follow-up (log-rank, p=0.261). Early mortality, survival,
freedom from tricuspid valve reoperation, and global right ventricle
systolic function were also comparable in both groups of patients.
However, the flexible band had advantage in restoring regional right
ventricle function (Doppler-derived systolic velocities of the annulus
[S], tricuspid annular plane systolic excursion) at 12-months follow-up.
 Conclusion(s): Both the rigid ring and flexible band offered
acceptable outcomes for functional tricuspid regurgitation correction
without significant differences, as assessed at 12-months
follow-up. Copyright © 2021 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<8>
Accession Number
2013650574
Title
Comparison of figure of eight and traditional simple wire closure method
to prevent dehiscence after sternal closure.
Source
Journal of the Pakistan Medical Association. 70(11) (pp 2001-2006), 2020.
Date of Publication: November 2020.
Author
Asghar A.; Talha K.M.; Amanullah M.; Shahabuddin S.
Institution
(Asghar, Talha) Medical Student, Aga Khan University, Karachi, Pakistan
(Amanullah) National Institute of Cardiovascular Diseases, Karachi,
Pakistan
(Shahabuddin) Aga Khan University, Karachi, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: To investigate significant differences, if any, between
figure-of-eight method and simple wire closure technique in reducing the
incidence of infectious and non-infectious sternal dehiscence in patients
undergoing sternal closure. Method(s): The systematic review was
conducted in the Cardiothoracic Surgery Department at Aga Khan University
from 1st December 2015 to 13th December 2017. The review was registered
with PROSPERO, the International Prospective Register of Systematic
Reviews. Pubmed, Cochrane Library (Wiley) and Scopus databases were
searched for articles published up to December 13, 2017. The search was
limited to randomised control trials, clinical trials, retrospective
cohort studies, journal analyses, systematic reviews and meta analyses.
Cadaveric or animal studies and articles published in languages other than
English were excluded. Result(s): Of the 286 articles retrieved,
265(92.6%) were excluded on the basis of study title and abstract. Another
15(5.2%) were excluded for being irrelevant to the topic n hand, and
6(2.1%) formed the final sample. Of them, 4(66.6%) studies showed no
significant difference between the two techniques, while 2(33.3%) found
figure-of-eight technique to be superior of the two. Conclusion(s):
There was no significant difference between the figure-of-eight method and
the simple wire technique in reducing the risk of dehiscence in patients
undergoing sternal closure. Copyright © 2020 Pakistan Medical
Association. All rights reserved.

<9>
Accession Number
2013525345
Title
Clinical outcomes of the Portico transcatheter aortic valve delivered via
alternative access: 30-Day and 1-Year results of the Portico ALT study.
Source
Journal of Invasive Cardiology. 32(11) (pp 405-411), 2020. Date of
Publication: November 2020.
Author
van Wely M.; Bruschi G.; Bedogni F.; Thiele H.; Jeger R.V.; van der Wulp
K.; Soendergaard L.; Kempfert J.; Schlensak C.; Linke A.
Institution
(van Wely, van der Wulp) Universitair Medisch Centrum St. Radboud,
Nijmegen, Netherlands
(Bruschi) Ospedale Niguarda Ca'Granda, Milan, Italy
(Bedogni) IRCCS Policlinico San Donato Milan, Milan, Italy
(Thiele) Heart Center Leipzig, University of Leipzig, Leipzig, Germany
(Jeger) Car-diology University Hospital Basel, University of Basel, Basel,
Switzerland
(Soendergaard) De-partment of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Kempfert) Deutsches Herzzentrum Berlin, Klinik fuer Herz-, Thorax- und
Gefaesschirurgie, Berlin, Germany
(Schlensak) Universitaetsklinikum Tuebingen, Universitaetsklinik fuer
Thorax-, Herz- und Gefaesschirurgie, Tubingen, Germany
(Linke) Technische Universitat Dresden, Universitatsklinik, Department of
Internal Medicine and Cardiology, Heart Center Dresden, Fetscherstrase 76,
Dresden 01307, Germany
Publisher
Cliggott Publishing Co.
Abstract
Objective. The aim of this study was to report the 30-day and 1-year
outcomes and performance from the Portico Alternative Access study to
obtain CE approval of the alternative access delivery system. Methods. The
Portico Alternative Access study is a multicenter, prospective,
non-randomized, investigational study (www.clinicaltrials.gov identifier,
NCT03056573) describing 45 patients with severe symptomatic aortic valve
stenosis (AS) treated with the self-expanding Portico device using
subclavian/axillary access. Results. Forty-five subjects (81.7 +/- 5.9
years; 57.8% female; Society of Thoracic Surgeons score, 5.4 +/- 4.7%)
with severe, symptomatic AS had a Portico bioprosthetic aortic valve
implantation attempt via axillary/subclavian access. Implantation was
successful in 97.8% of subjects. At 30 days, the rate of major vascular
complications at the subclavian/axillary access site was 4.4%. All-cause
mortality was 2.2% at 30 days and 4.4% at 1 year. Conclusion. The Portico
transcatheter aortic valve can be safely delivered by axillary or
subclavian access with high implant success rate and low complication
rates. Copyright © 2020 HMP Communications. All rights reserved.

<10>
Accession Number
2019027402
Title
Epidemiology of persistent postoperative opioid use after cardiac surgery:
a systematic review and meta-analysis.
Source
British Journal of Anaesthesia. (no pagination), 2022. Date of
Publication: 2022.
Author
Liu Z.; Karamesinis A.D.; Plummer M.; Segal R.; Bellomo R.; Smith J.A.;
Perry L.A.
Institution
(Liu, Segal, Perry) Department of Anaesthesia and Pain Management, Royal
Melbourne Hospital, Parkville, VIC, Australia
(Liu, Plummer, Segal, Bellomo, Perry) Department of Critical Care,
Melbourne Medical School, Faculty of Medicine, Dentistry and Health
Sciences, University of Melbourne, Parkville, VIC, Australia
(Karamesinis) Department of Anaesthesia, Peninsula Health, Frankston, VIC,
Australia
(Plummer) Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA,
Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Heidelberg, VIC,
Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Melbourne, VIC, Australia
(Bellomo) Monash University School and Public Health and Preventive
Medicine, Monash University, Clayton, VIC, Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Heidelberg, VIC, Australia
(Smith) Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Clayton, VIC, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Clayton, VIC,
Australia
Publisher
Elsevier Ltd
Abstract
Background: The epidemiology of persistent postoperative opioid use at
least 3 months after cardiac surgery is poorly characterised despite its
potential public health importance. Method(s): We searched MEDLINE,
Embase, and Google Scholar from inception to December 2021 and included
studies reporting the rate and risk factors of persistent postoperative
opioid use after cardiac surgery in opioid-naive and opioid-exposed
patients. We recorded incidence rates and odds ratios (ORs) with 95%
confidence intervals (CIs) for risk factors from individual studies and
used random-effects inverse variance modelling to generate pooled
estimates. Result(s): From 10 studies involving 112 298 patients, the
pooled rate of persistent postoperative opioid use in opioid-naive
patients was 5.7% (95% CI: 4.2-7.2%). Risk factors included female sex (OR
1.18; 95% CI: 1.09-1.29), smoking (OR 1.34; 95% CI: 1.06-1.69), alcohol
use (OR 1.43; 95% CI: 1.17-1.76), congestive cardiac failure (OR 1.17; 95%
CI: 1.08-1.27), diabetes mellitus (OR 1.21; 95% CI: 1.07-1.37), chronic
lung disease (OR 1.42; 95% CI: 1.16-1.75), chronic kidney disease (OR
1.35; 95% CI: 1.08-1.68), and length of hospital stay (per day) (OR 1.03;
95% CI: 1.02-1.04). Conclusion(s): Persistent postoperative opioid
use after cardiac surgery affects at least one in 20 patients. The
identification of risk factors, such as female sex, smoking, alcohol use,
congestive cardiac failure, diabetes mellitus, chronic lung disease,
chronic kidney disease, and length of hospital stay, should help target
interventions aimed at decreasing its prevalence. Copyright ©
2022 British Journal of Anaesthesia

<11>
Accession Number
2018122430
Title
A spray-as-you-go airway topical anesthesia attenuates cardiovascular
responses for double-lumen tube tracheal intubation.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 203. Date
of Publication: December 2022.
Author
Chen C.; Wen D.; Wang Y.; Li H.; Yu Q.; Li M.
Institution
(Chen, Wen, Wang, Li, Yu, Li) Department of Anesthesiology, Affiliated
Hospital of North Sichuan Medical College, Nanchong 637000, China
Publisher
BioMed Central Ltd
Abstract
Background: Spray-as-you-go (SAYGo) airway topical anesthesia and nerve
block are common techniques used during awake tracheal intubation.
However, their effects have not been described during double-lumen tube
intubation. We report on a prospective randomized study that aimed to
compare the intubation effects of SAYGo and nerve block patients
undergoing thoracic surgery. Method(s): Sixty-six American Society of
Anesthesiologists (ASA) physical status I and II patients were scheduled
to undergo double-lumen tube (DLT) tracheal intubation for thoracic
surgery. The patients were randomly assigned into control (Group C),
ultrasound (Group U), and flexible intubation scope (Group F) groups with
22 cases in each group. Patients in Group C were induced with a standard
anesthetic regimen. Patients in Groups U and F were treated with superior
laryngeal nerve (SLN) block combined with transtracheal injection (TTI)
and given a SAYGo airway topical anesthesia before intubation. Hemodynamic
variables during intubation process were recorded as the primary outcome.
Additional patient data were recorded including the occurrence of adverse
events, the level of hoarseness, the occurrence of sore throats, memory
function and the level of patient satisfaction with anesthesia.
 Result(s): The blood pressure (BP) and heart rate (HR) of patients in
group C was significantly increased 1 min after tracheal intubation (P <
0.05) compared to before anesthesia. The BP and HR of patients in Groups U
and F remained stable. 10 cases of hypertension were observed in Group C,
6 cases in Group U and 1 case in Group F. In Group C, tachycardia was
observed in 9 patients along with 9 cases in Group U and 4 cases in Group
F. In Group U, 4 patients experienced puncture and bleeding were and 8
patients had a poor memory of TTI. No significant differences were found
in the incidence of hoarseness, sore throats, and satisfaction with
anesthesia in postoperative follow-up. Conclusion(s): SAYGo airway
topical anesthesia and SLN block combined with the TTI technique can
inhibit the cardiovascular response during DLT tracheal intubation. The
SAYGo technique has fewer complications and more advantages compared to
other approaches. Copyright © 2022, The Author(s).

<12>
Accession Number
2019048428
Title
Kernohan Woltman notch phenomenon caused by subdural chronic hematoma:
Systematic review and an illustrative case.
Source
Annals of Medicine and Surgery. 79 (no pagination), 2022. Article Number:
104006. Date of Publication: July 2022.
Author
Laaidi A.; Hmada S.; Naja A.; Lakhdar A.
Institution
(Laaidi, Hmada, Naja, Lakhdar) NEUROSURGERY Department, University
Hospital Center IBN ROCHD, Casablanca, Morocco
Publisher
Elsevier Ltd
Abstract
Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial
lesion pressing the contralateral cerebral peduncle against the free edge
of the tentorium of the cerebellum. It is manifested by neurological signs
of ipsilateral localization; cerebral MRI is the most sensitive
examination for KWNP. Our patient is a 50-year-old woman, operated in 2011
for aortic and mitral valve replacement by mechanical prosthesis, under
oral anticoagulant, consults for headaches evolving for 20 days without
any notion of head trauma with installation of a progressively worsening
left hemibody deficit. Glasgow coma scale was 14 (E3 V5 M6) with left
anisocoria 4mm left/2mm right with left hemiplegia. CT shows a chronic
left hemispheric subdural hematoma 13.5mm thick with subfalcorial and
ipsilateral temporal involvement of the deficit. The cardiovascular
examination as well as the biological assessment was unremarkable. The
patient was operated on with a total recovery in 12 days, the
anticoagulant is resumed on day 20 postoperatively, with close monitoring.
KWNP may contribute to misdiagnosis in patients with bilateral
corticospinal tract lesions, and anticoagulation poses a problem in
stopping and restarting treatment due to the risk of bleeding on one side
and thrombosis on the other side. Copyright © 2022

<13>
Accession Number
2018873601
Title
Warm humidified CO<inf>2</inf> insufflation improves pericardial integrity
for cardiac surgery: a randomized control study.
Source
Journal of Cardiovascular Surgery. 63(3) (pp 369-375), 2022. Date of
Publication: June 2022.
Author
Segal R.; Mezzavia P.M.; Krieser R.B.; Sampurno S.; Taylor M.; Ramsay R.;
Kluger M.; Lee K.; Loh F.L.; TaToulis J.; O'Keefe M.; Chen Y.; Sindoni T.;
Ng I.
Institution
(Segal, Mezzavia, Krieser, Kluger, Lee, Loh, TaToulis, O'Keefe, Chen,
Sindoni, Ng) Department of Anesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Australia
(Segal, Ramsay, Lee, TaToulis, O'Keefe, Ng) University of Melbourne,
Melbourne, Australia
(Sampurno, Taylor, Ramsay) Peter MacCallum Cancer Centre, Melbourne,
Australia
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Flooding the surgical field with dry cold CO<inf>2</inf>
during open-chamber cardiac surgery has been used to mitigate air
entrainment into the systemic circulation. However, exposing epithelial
surfaces to cold, dry gas causes tissue desiccation. This randomized
controlled study was designed to investigate whether the use of humidified
warm CO<inf>2</inf> insufflation into the cardiac cavity could reduce
pericardial tissue damage and the incidence of micro-emboli when compared
to dry cold CO<inf>2</inf> insufflation. METHOD(S): Forty adult
patients requiring elective open-chamber cardiac surgery were randomized
to have either dry cold CO<inf>2</inf> insufflation via a standard
catheter or humidified warm CO<inf>2</inf> insufflation via the HumiGard
device (Fisher & Paykel Healthcare, Panmure, Auckland, New Zealand). The
primary endpoint was biopsied pericardial tissue damage, assessed using
electron microscopy. We assessed the percentage of microvilli and
mesothelial damage, using a damage severity score (DSS) system. We
compared the proportion of patients who had less damage, defined as DSS<2.
Secondary endpoints included the severity of micro-emboli, by visual
assessment of bubble load on transesophageal echocardiogram; lowest near
infrared spectroscopy; total de-airing time; highest cardio-pulmonary
bypass sweep speed; hospital length of stay and complications.
 RESULT(S): A higher proportion of patients in the humidified warm
CO<inf>2</inf> group displayed conserved microvilli (47% vs. 11%, P=0.03)
and preserved mesothelium (42% vs. 5%, P=0.02) compared to the control
group. There were no differences in the secondary outcomes.
 CONCLUSION(S): Humidified warm CO<inf>2</inf> insufflation
significantly reduced pericardial epithelial damage when compared to dry
cold CO<inf>2</inf> insufflation in open-chamber cardiac surgery. Further
studies are warranted to investigate its potential clinical
benefits. Copyright COPYRIGHT© 2022 EDIZIONI MINERVA MEDICA

<14>
Accession Number
2018873596
Title
Hybrid revascularization vs. coronary bypass for coronary artery disease:
A systematic review and meta-analysis.
Source
Journal of Cardiovascular Surgery. 63(3) (pp 353-368), 2022. Date of
Publication: June 2022.
Author
Hinojosa-Gonzalez D.E.; Bueno-Gutierrez L.C.; Salan-Gomez M.;
Tellez-Garcia E.; Ramirez-Mulhern I.; Sepulveda-Gonzalez D.; Ramonfaur D.;
Roblesgil-Medrano A.; Flores-Villalba E.
Institution
(Hinojosa-Gonzalez, Bueno-Gutierrez, Salan-Gomez, Tellez-Garcia,
Ramirez-Mulhern, Sepulveda-Gonzalez, Roblesgil-Medrano, Flores-Villalba)
School of Medicine and Health Sciences TecSalud ITESM, Monterrey, Mexico
(Ramonfaur) Harvard Medical School, Boston, MA, United States
(Flores-Villalba) School of Engineering and Sciences TecSalud ITESM,
Monterrey, Mexico
(Flores-Villalba) Laboratorio Nacional de Manufactura Aditiva y Digital
(MADIT), Monterrey, Apodaca, Mexico
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Coronary artery bypass graft is the mainstay of treatment
for multivessel coronary artery disease and is superior to percutaneous
coronary intervention. Combined approaches such as hybrid coronary
revascularization integrate coronary artery bypass grafting with
percutaneous coronary intervention during the same procedure or weeks
apart. These attempt to improve surgical morbidity and long-term outcomes.
EVIDENCE ACQUISITION: Per PRISMA criteria, a systematic review of keywords
"Hybrid Revascularization," "Hybrid Coronary Revascularization,"
"Surgical," "Surgery," "Treatment," "CABG," "HCR" and "PCI" was conducted
in PubMed, EMBASE and SCOPUS. Studies comparing this technique's
performance on either single or two-stage approach against traditional
multiple vessel coronary artery bypass grafting were screened and analyzed
for our review. EVIDENCE SYNTHESIS: Twenty-two studies totaling 6981
participants were ultimately included for analysis. Mean differences in
operative time, bleeding, ventilator time and length of stay were
significantly lower in the hybrid coronary revascularization group. Odds
ratios in transfusions and in-hospital myocardial infarction were also
lower in the hybrid coronary revascularization group. Results for
in-hospital and all-cause mortality, major adverse cardiac events (MACE),
stroke, reintervention, and complete revascularization were not
significantly different. CONCLUSION(S): Our analysis shows hybrid
coronary revascularization is a feasible alternative to traditional
coronary artery bypass grafting. Short-and long-term outcomes including
mortality, MACE, and postoperative morbidity are similar between both
groups, while hybrid approaches are associated with decreased
perioperative morbidity. Copyright © 2022 EDIZIONI MINERVA MEDICA

<15>
Accession Number
2017978537
Title
Elevated Cardiac Troponin to Detect Acute Cellular Rejection After Cardiac
Transplantation: A Systematic Review and Meta-Analysis.
Source
Transplant International. 35 (no pagination), 2022. Article Number: 10362.
Date of Publication: 08 Jun 2022.
Author
Liu Z.; Perry L.A.; Penny-Dimri J.C.; Handscombe M.; Overmars I.; Plummer
M.; Segal R.; Smith J.A.
Institution
(Liu, Perry, Handscombe, Segal) Department of Anaesthesia, Royal Melbourne
Hospital, Parkville, VIC, Australia
(Penny-Dimri, Smith) Department of Surgery, School of Clinical Sciences at
Monash Health, Monash University, Clayton, VIC, Australia
(Overmars) Infection and Immunity Theme, Murdoch Children's Research
Institute, Parkville, VIC, Australia
(Plummer) Department of Intensive Care Medicine, Royal Melbourne Hospital,
Parkville, VIC, Australia
(Plummer, Segal) Department of Medicine, University of Melbourne,
Parkville, VIC, Australia
Publisher
European Society for Organ Transplantation
Abstract
Cardiac troponin is well known as a highly specific marker of
cardiomyocyte damage, and has significant diagnostic accuracy in many
cardiac conditions. However, the value of elevated recipient troponin in
diagnosing adverse outcomes in heart transplant recipients is uncertain.
We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from
inception until December 2020. We generated summary sensitivity,
specificity, and Bayesian areas under the curve (BAUC) using bivariate
Bayesian modelling, and standardised mean differences (SMDs) to quantify
the diagnostic relationship of recipient troponin and adverse outcomes
following cardiac transplant. We included 27 studies with 1,684 cardiac
transplant recipients. Patients with acute rejection had a statistically
significant late elevation in standardised troponin measurements taken at
least 1 month postoperatively (SMD 0.98, 95% CI 0.33-1.64). However,
pooled diagnostic accuracy was poor (sensitivity 0.414, 95% CrI
0.174-0.696; specificity 0.785, 95% CrI 0.567-0.912; BAUC 0.607, 95% CrI
0.469-0.723). In summary, late troponin elevation in heart transplant
recipients is associated with acute cellular rejection in adults, but its
stand-alone diagnostic accuracy is poor. Further research is needed to
assess its performance in predictive modelling of adverse outcomes
following cardiac transplant. Systematic Review Registration: identifier
CRD42021227861 Copyright © 2022 Liu, Perry, Penny-Dimri,
Handscombe, Overmars, Plummer, Segal and Smith.

<16>
Accession Number
638386401
Title
Risk Factors for Post-Repair Elevated Mitral Gradient: A Post-Hoc Analysis
of a Randomized Trial.
Source
The Annals of thoracic surgery. (no pagination), 2022. Date of
Publication: 29 Jun 2022.
Author
Hibino M.; Pandey A.; Chan V.; Mazer C.D.; Rumman R.; Dhingra N.K.;
Bonneau C.; Verma R.; Yokoyama Y.; Quan A.; Teoh H.; Cheema A.; de
Varennes B.E.; Yanagawa B.; Leong-Poi H.; Connelly K.A.; Bisleri G.; Verma
S.
Institution
(Hibino) Division of Cardiac Surgery, University Hospitals Cleveland
Medical Center, Case Western Reserve University, Cleveland, OH, US;
Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University
of Toronto, ON, Canada
(Pandey) Michael G. DeGroote School of Medicine, McMaster University, ON,
Hamilton, Canada
(Chan) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive
Medicine, University of Ottawa, Ottawa, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and
Pain Medicine, University of Toronto, ON, Canada; Department of
Physiology, University of Toronto, Toronto, ON, Canada
(Rumman) Division of Cardiology, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, ON, Toronto, Canada
(Dhingra, Quan) Division of Cardiac Surgery, Li Ka Shing Knowledge
Institute of St. Michael's Hospital, ON, Toronto, Canada
(Bonneau) Division of Cardiac Surgery, McGill University, QC, Montreal,
Canada
(Verma) Royal College of Surgeon in Ireland, Dublin, Ireland
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
PA, United States
(Teoh) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and
Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, ON, Canada
(Cheema) Division of Cardiology, Southlake Regional Health Centre, ON,
Newmarket, Canada
(de Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University Health Center, QC, Montreal, Canada
(Yanagawa, Bisleri) Division of Cardiac Surgery, Li Ka Shing Knowledge
Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of
Surgery, University of Toronto, ON, Canada
(Leong-Poi) Division of Cardiology, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada; Department of Medicine,
University of Toronto, ON, Canada
(Connelly) Department of Physiology, University of Toronto, Toronto, ON,
Canada; Division of Cardiology, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, Canada; Department of Medicine,
University of Toronto, ON, Canada
(Verma) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery,
University of Toronto, ON, Canada; Department of Pharmacology and
Toxicology, University of Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pre-discharge elevated mean mitral gradients (>5mmHg) may
occur after repair for degenerative mitral regurgitation. We sought to
identify risk factors associated with elevated gradients as well as to
evaluate its impact on functional outcomes at 12 months in this
sub-analysis of the Canadian Mitral Research Alliance (CAMRA) CardioLink-2
trial. METHOD(S): 104 degenerative mitral regurgitation patients
undergoing mitral repair were randomized to either a leaflet resection or
preservation strategy. Logistic regression was used to identify risk
factors associated with an elevated gradient. Functional outcomes at 12
months were compared between participants with and without elevated
gradients. RESULT(S): Elevated gradients was identified in 15
participants (14.4%), which was not significantly different based on
allocation to each repair strategy (p=0.10). Patients with elevated
gradients were more likely to be female (OR 4.28 [95%CI:1.29-14.19]
p=0.02) and had a lower preoperative hemoglobin level (0.93 [0.89-0.98]
p=0.01) and smaller inter-commissural diameter (0.86 [0.76-0.97] p=0.02)
and mitral annuloplasty size (0.71 [0.57-0.87] p=0.001). The ratio of
inter-commissural diameter to annuloplasty size was similar between those
with and without elevated gradients (both 0.8+/-0.1; p=0.69). At 12
months, those with elevated gradients had worse NYHA functional status
(p=0.0001), lower peak oxygen saturation in exercise test (p=0.01),
smaller body weight-walk distance product (p=0.02) and higher Borg Scale
(p=0.01) in 6-minute walk test. CONCLUSION(S): Female gender, smaller
mitral anatomy sizes and lower preoperative hemoglobin levels were
associated postoperative elevated mitral gradients, which was in turn
associated with reduced functional status. Further research is warranted
to investigate these potential risk factors. Copyright © 2022 The
Society of Thoracic Surgeons. Published by Elsevier Inc. All rights
reserved.

<17>
Accession Number
638385169
Title
Randomized Trial of Surgical Left Atrial Appendage Closure: Protection
Against Cerebrovascular Events.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2022.
Date of Publication: 28 Jun 2022.
Author
Madsen C.V.; Park-Hansen J.; Holme S.J.V.; Irmukhamedov A.; Carranza C.L.;
Greve A.M.; Al-Farra G.; Riis R.G.C.; Nilsson B.; Clausen J.S.R.; Norskov
A.S.; Kruuse C.; Truelsen T.C.; Dominguez H.
Institution
(Madsen, Clausen, Norskov, Dominguez) Department of Cardiology, Copenhagen
University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark;
Department of Biomedical Science, University of Copenhagen, Copenhagen,
Denmark
(Park-Hansen) Department of Cardiology, Copenhagen University Hospital -
Bispebjerg and Frederiksberg, Copenhagen, Denmark
(Holme, Carranza) Department of Cardio-Thoracic Surgery, Copenhagen
University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
(Irmukhamedov) Department of Heart, Lung, Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Greve) Department of Clinical Biochemistry, Copenhagen University
Hospital - Herlev and Gentofte, Herlev, Denmark
(Al-Farra) Department of Radiology, Copenhagen University Hospital -
Herlev and Gentofte, Herlev, Denmark
(Riis) Department of Radiology, Copenhagen University Hospital -
Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
(Nilsson) Department of Cardiology, Copenhagen University Hospital -
Amager and Hvidovre, Hvidovre, Denmark
(Kruuse) Department of Neurology, Neurovascular Research Unit, Copenhagen
University Hospital - Herlev and Gentofte, Herlev, Denmark
(Truelsen) Department of Neurology, Copenhagen University Hospital -
Rigshospitalet-Glostrup, Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
Following open-heart surgery, atrial fibrillation and stroke occur
frequently. Left atrial appendage closure added to elective open-heart
surgery could reduce the risk of ischemic stroke. We aim to examine if
routine closure of the left atrial appendage in patients undergoing
open-heart surgery provides long-term protection against cerebrovascular
events independently of atrial fibrillation history, stroke risk, and oral
anticoagulation use. Long-term follow-up of patients enrolled in the
prospective, randomized, open-label, blinded evaluation trial entitled
LAACS (NCT02378116). Patients were stratified by oral anticoagulation
status and randomized (1:1) to left atrial appendage closure in addition
to elective open-heart surgery vs. standard care. The primary composite
endpoint was ischemic stroke events, transient ischemic attacks, and
imaging findings of silent cerebral ischemic lesions. Two neurologists
blinded for treatment assignment adjudicated cerebrovascular events. In
total, 186 patients (82% males) were reviewed. At baseline, mean (SD) age
was 68 (9) years and 13.4% (n=25/186) had been diagnosed with atrial
fibrillation. Median [IQR] CHA2DS2-VASc was 3 [2,4] and 25.9% (n=48/186)
were receiving oral anticoagulants. Mean follow-up was 6.2 (2.5) years.
The left atrial appendage closure group experienced fewer cerebrovascular
events; intention-to-treat 11 vs 19 (p=0.033, n=186) and per-protocol nine
vs 17 (p=0.186, n=141). Left atrial appendage closure as an add-on
open-heart surgery, regardless of pre-surgery atrial fibrillation and oral
anticoagulation status, seems safe and may reduce cerebrovascular events
in long-term follow-up. More extensive randomized clinical trials
investigating left atrial appendage closure in patients without atrial
fibrillation and high stroke risk are warranted (Figure 1). Copyright
© 2022. Published by Elsevier Inc.

<18>
Accession Number
638384872
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 & pain medicine. (pp 101119), 2022. Date of
Publication: 28 Jun 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, Chen, Chu) Department of Anaesthesiology, Chi Mei Medical
Centre, Tainan, Taiwan (Republic of China)
(Sun) Department of Emergency Medicine, E-Da Hospital, Kaohsiung city,
Taiwan; College of Medicine, I-Shou University, Kaohsiung city, Taiwan
(Wang, Lin) Department of Anaesthesiology, Chi Mei Medical Centre, Tainan,
Taiwan; Department of Hospital and Health Care Administration, College of
Recreation and Health Management, Chia Nan University of Pharmacy and
Science, Tainan city, Taiwan
(Chang) Department of Anaesthesiology, Chi Mei Medical Centre, Tainan,
Taiwan; Department of Recreation and Health-Care Management, College of
Recreation and Health Management, Chia Nan University of Pharmacy and
Science, Tainan city, Taiwan
(Hsing) Department of Anaesthesiology, Chi Mei Medical Centre, Tainan,
Taiwan; Department of Medical Research, Chi-Mei Medical Centre, Tainan,
Taiwan
(Hung) Department of Anaesthesiology, Chi Mei Medical Centre, Tainan,
Taiwan; Department of Hospital and Health Care Administration, College of
Recreation and Health Management, Chia Nan University of Pharmacy and
Science, Tainan city, Taiwan. Electronic address: ed102605@gmail.com
Publisher
NLM (Medline)
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 24h
[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
36-72h, 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). Published by Elsevier Masson SAS. All rights reserved.

<19>
Accession Number
2014325495
Title
Transarterial Embolization for the Treatment of Chronic Musculoskeletal
Pain: A Systematic Review of Indications, Safety, and Efficacy.
Source
ACR Open Rheumatology. 4(3) (pp 209-217), 2022. Date of Publication: March
2022.
Author
Kishore S.; Sheira D.; Malin M.L.; Trost D.W.; Mandl L.A.
Institution
(Kishore) Palo Alto Veterans Affairs Healthcare System, Palo Alto, CA,
United States
(Kishore) Department of Radiology, Stanford University, Palo Alto, CA,
United States
(Kishore) Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY, United States
(Sheira, Mandl) Division of Rheumatology, Hospital for Special Surgery,
New York, NY, United States
(Malin) Wesleyan University, Middletown, CT, United States
(Trost) Department of Radiology, Weill Cornell Medicine, New York, United
States
(Mandl) Department of Medicine, Weill Cornell Medicine, New York, NY,
United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The study objective was to evaluate the safety and efficacy of
transcatheter arterial "embolization" (TAE) in the treatment of chronic
"musculoskeletal pain" refractory to standard therapy. Method(s):
PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were
searched for original research articles evaluating TAE in patients with
musculoskeletal conditions from database inception to January 21, 2020.
Search terms employed were as follows: "embolization", "pain", "knee
osteoarthritis", joint replacement, epicondylitis, tenderness,
inflammation, WOMAC (Western Ontario and McMaster Universities
Osteoarthritis Index), microspheres, Embozene, geniculate artery,
neovascularity, transcatheter, embolic, imipenem/cilastatin sodium,
angiogenesis, and "musculoskeletal". Studies involving particle
"embolization" for painful musculoskeletal conditions were included.
Studies of TAE for hemarthrosis or malignancy-related "musculoskeletal
pain" were excluded. Result(s): The primary search yielded 1,099
sources; 7 articles and 4 abstracts were included for data extraction. All
were cohorts or case series, with low risk of bias and moderate to poor
level of evidence. Heterogeneity between studies was high, precluding
meta-analysis. The reviewed studies reported the safety and efficacy of
TAE for the treatment of "knee osteoarthritis"; adhesive capsulitis of the
shoulder; tendinopathy/enthesopathy of the knee, shoulder, elbow, and
ankle; and cervical myalgia. All TAEs were reported as technically
successful without major complications or subsequent serious adverse
events, including no reported osteonecrosis, cutaneous ulceration, limb
ischemia, cartilage degeneration, or myotendinous injury. TAE
significantly reduced pain and improved function for all of the treated
conditions, with durable response up to 24 months post procedure.
 Conclusion(s): TAE appears to be a safe and effective treatment for
some types of chronic refractory "musculoskeletal pain". Randomized
placebo-controlled studies are necessary to confirm these
findings. Copyright © 2021 The Authors. ACR Open Rheumatology
published by Wiley Periodicals LLC on behalf of American College of
Rheumatology.

<20>
Accession Number
2016797563
Title
Erector Spinae Plane Block for Children Undergoing Cardiac Surgeries via
Sternotomy: A Randomized Controlled Trial.
Source
Anesthesiology and Pain Medicine. 12(2) (no pagination), 2022. Article
Number: e123723. Date of Publication: Apr 2022.
Author
Gado A.A.; Alsadek W.M.; Ali H.; Ismail A.A.
Institution
(Gado, Alsadek, Ali, Ismail) Anesthesia Department, Faculty of Medicine,
Cairo University, Giza, Egypt
Publisher
Kowsar Medical Institute
Abstract
Background: Ineffective management of postoperative pain following
pediatric cardiac surgeries adversely affects a patient's postoperative
course. The erector spinae plane (ESP) block has been described in the
literature regarding perioperative pain manage-ment. We hypothesized that
bilateral ESP blocks in pediatric patients would decrease intraoperative
fentanyl consumption, reduce the need for postoperative morphine
consumption, and improve pain scores. Objective(s): The aim of this
double-blinded randomized controlled trial was to assess the efficacy and
safety of bilateral ESP blocks in pediatric patients undergoing cardiac
surgeries through a median sternotomy. Method(s): The study involved
98 children aged 6 months to 7 years who were American Society of
Anesthesiologists (ASA) II and III and scheduled for cardiac surgery
through a median sternotomy. Patients were divided randomly into 2 groups:
the ES group (n = 50) who received bilateral ultrasound-guided ESP blocks,
and the N group (n = 48) who received no block. The primary outcome was
the total dose of administered fentanyl intraoperatively. Secondary
outcomes included morphine consumption in the first 24 hours
postoperatively; the length of time before the first need for
postoperative analgesia; and FLACC (face, legs, activity, consolability,
and cry) scores at the first and second hours postoperatively and every 4
hours, with readings taken for a period of 24 hours. Result(s): There
were statistically significantly higher levels of administered fentanyl
intraoperatively (6.7 +/- 3 vs 4.3 +/- 1.9 microg.kg-1) and
postoperative morphine consumption (0.5 +/- 0.2 vs 0.4 +/- 0.2
mg.kg-1) in the N group compared with the ES group (P < 0.001).
Moreover, the timing of the first rescue analgesia was significantly
delayed in the ES group compared with the N group (231.6 +/- 104.5 vs
108.8 +/- 47.8 minutes). Conclusion(s): Bilateral ultrasound-guided
ESP blocks can be used to reduce perioperative opioid consumption in
pediatric patients undergoing cardiac surgery through a sternotomy. It
also can be used to decrease postoperative pain scores. Copyright
© 2022, Author(s).

<21>
Accession Number
2016663062
Title
Evaluating the Effect of Acetazolamide on the Prevention of Post-operative
Acute Kidney Injury after Coronary Artery Bypass Grafting Surgery: A
Randomized, Open-labeled Clinical Trial.
Source
Iranian Journal of Pharmaceutical Research. 20(4) (pp 71-79), 2021. Date
of Publication: Oct 2021.
Author
Afzal G.; Aval Z.A.; Monfared M.B.; Khesali H.; Ziaie S.; Barati S.;
Dastan F.
Institution
(Afzal, Ziaie, Barati, Dastan) Department of Clinical Pharmacy, School of
Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Aval) Clinical Research and Development Center at Shahid Modarress
Hospital, Department of Cardiac Surgery, Shahid Beheshti of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Monfared, Khesali) Department of Cardiovascular Surgery, Shahid Modarres
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ziaie) Department of Nephrology and Kidney Transplantation, Shahid
Labbafinejad Medical Center, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Dastan) Chronic Respiratory Diseases Research center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Brieflands
Abstract
Acute kidney injury (AKI) is a common complication after coronary artery
bypass grafting (CABG) surgery and can be linked to the increased
morbidity and mortality. Therefore, in the present study, the effect of
preoperative administration of acetazolamide was evaluated to investigate
whether it could prevent occurrence of post-operative AKI after CABG
surgery. In this randomized controlled clinical trial, 130 patients who
were candidates to undergo elective CABG surgery from January 21, 2020 to
February 8, 2021 were randomly allocated to intervention group (receiving
500 mg of acetazolamide orally 2 h preoperatively) and control group. The
patients were evaluated for AKI based on the kidney disease-improving
global outcomes (KDIGO) criteria based on their serum creatinine (SCr)
level and urine output until 7 days postoperatively. There was no
significant difference in baseline demographics between the two groups.
The total incidence of AKI was measured as 43%. Analysis of post-operative
AKI incidence showed no statistically significant difference between the
two groups (P = 0.860). Mean post-operative SCr level on day 1 was
significantly higher in the acetazolamide group (P = 0.036). A significant
difference was found in length of hospitalization stay between the groups,
which was higher in the control group (P = 0.006). Our results did not
demonstrate a significant protective effect of acetazolamide on incidence
of post-operative AKI in the patients undergone elective on-pump CABG
surgery. Copyright © 2021, Briefland. All rights reserved.

<22>
Accession Number
2015178815
Title
Effect of high-flow nasal Oxygen on respiratory parameters and pulmonary
complications after early extubation following pediatric heart surgery.
Source
Journal of Comprehensive Pediatrics. 12(3) (no pagination), 2021. Article
Number: e116104. Date of Publication: August 2021.
Author
Enayati F.; Amini S.; Gerdrodbari M.G.; Jarahi L.; Ansari M.
Institution
(Enayati) Sabzevar University of Medical Sciences, Sabzevar, Iran, Islamic
Republic of
(Amini) Department of Anesthesia, School of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Gerdrodbari, Ansari) Department of Nursing, Nursing & Midwifery School,
Sabzevar University of Medical Sciences, Sabzevar, Iran, Islamic Republic
of
(Jarahi) Community Medicine Department, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Objectives: The aim of this study was to evaluate the effect of high-flow
nasal cannula (HFNC) after early extubation on children undergoing cardiac
surgery. Method(s): This randomized controlled clinical trial was
performed among 92 children aged 1 to 24 months undergoing cardiac surgery
from March 5 to August 30, 2020, in a pediatric post-cardiac surgery
intensive care unit (ICU). The patients were randomized to receive either
HFNC or conventional oxygen therapy after extubation. Arterial blood
samples were collected after anesthesia induction, after the end of the
surgery, at the time of entering the ICU while they were intubated, 6
hours after entering the ICU, before removing the endotracheal tube,
immediately after extubation, as well as 1, 6, 12, 24, and 36 hours after
extubation. The patients were compared regarding PaCO2, PaO2/FiO2 ratios,
respiratory failure, need for reintubation, development of atelectasis,
pneumothorax, pleural effusion, and length of ICU stay. Result(s):
The patients were similar regarding demographic characteristics, the
duration of surgery, and mechanical ventilation (P > 0.05). On the first
and second days after the surgery, the mean modified radiologic
atelectasis score (m-RAS) was lower in the HFNC group compared to the
conventional oxygen therapy group (P < 0.05). The frequency of respiratory
failure did not differ in the groups before and after the surgery (P >
0.05). PaCO2 was lower in the HFNC group than in the control group after
extubation (P < 0.001). PaO2/FIO2 ratio was significantly higher in the
HFNC group one hour after extubation and afterward in comparison to the
control group (P < 0.001). The need for re-intubation (P < 0.013) and the
length of ICU stay (P < 0.001) were significantly lower in the HFNC group
compared to the control group. Conclusion(s): It was found that HFNC
could improve the respiratory parameters and reduce postoperative
pulmonary complications in infants following a congenital heart
surgery. Copyright © 2021, Author(s).

<23>
Accession Number
2014097512
Title
Effect of different loading doses of dexmedetomidine on controlled
hypotension and the incidence of bradycardia during rhinoplasty: A
clinical trial.
Source
Anesthesiology and Pain Medicine. 11(4) (no pagination), 2021. Article
Number: e118857. Date of Publication: August 2021.
Author
Motlagh S.D.; Rokhtabnak F.; Ghodraty M.R.; Delarestaghi M.M.; Saadat S.;
Araghi Z.
Institution
(Motlagh, Rokhtabnak, Ghodraty, Saadat, Araghi) Department of
Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University
Hospital, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Delarestaghi) Department of Otolaryngology Head and Neck Surgery,
Firoozgar University Hospital, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Delarestaghi) Department of ENT and Head and Neck Research and the Five
Senses Institute, Firoozgar University Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Controlled hypotension, with a mean arterial pressure (MAP) of 60 mmHg-70
mmHg, provides a bloodless and visible surgical field during rhinoplasty.
It has been shown that dexmedetomidine, an alpha2-adrenoreceptor agonist,
is a suitable choice in this regard. One of the disadvantages of this drug
is the possibility of severe bradycardia during infusion. Therefore, we
compared lower intravenous (IV) loading doses to determine whether the
hypotensive effect of the drug was preserved and the bradycardia incidence
decreased. In this randomized, double-blinded clinical trial, 81 patients
aged 18 to 50 years with the American Society of Anesthesiologists
physi-cal status (ASA-PS) class I and II, scheduled for rhinoplasty
randomly received 1.0, 0.9, and 0.8 microg/kg (named as groups 1.0, 0.9,
and 0.8, respectively) of IV dexmedetomidine before the induction of
anesthesia followed by infusion (0.3-0.7 microg/kg/h) during operation.
The patients' heart rate (HR), MAP, the requirements for nitroglycerin
(NTG) and extra fentanyl, as well as the incidence of bradycar-dia, were
recorded. Bleeding and visibility of the surgical field were scored by the
surgeon using a 6-point visual scale. MAPs, HRs, and consumption of NTG
and extra fentanyl were similar in the studied groups. The surgical field
was more visible and bloodless in group 1.0 compared to group 0.8 (P <
0.001); the differences were not significant between groups 1.0 and 0.9 (P
= 0.605). The incidence (P = 0.027) and the severity of bradycardia (P =
0.017) were higher in the groups with higher loading doses. We concluded
that dexmedetomidine is an acceptable agent to provide controlled
hypotension. A loading dose of 0.9 microg/kg, but not 0.8 microg/kg,
provides similar surgical field conditions as the dose of 1 microg/kg.
Furthermore, despite the decrease in the incidence of bradycardia, the
hypotensive effect of the drug is preserved. Copyright © 2021,
Author(s).

<24>
Accession Number
2013009866
Title
Cardiorespiratory parameters in intermittent positive pressure ventilation
versus spontaneous ventilation in under one-year-old pediatrics: A
randomized trial.
Source
Iranian Journal of Pediatrics. 31(3) (no pagination), 2021. Article
Number: e109382. Date of Publication: 2021.
Author
Zare A.; Ghanbari A.; Nasiri A.; Nooralishahi B.; Arani H.Z.
Institution
(Zare, Ghanbari, Nasiri, Arani) Young Researchers and Elite Club, Tehran
Medical Sciences, Islamic Azad University, Tehran, Iran, Islamic Republic
of
(Nooralishahi) Department of Anesthesia, Children's Medical Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Cardiac catheterization is a useful method for determining the
anatomy and pressure in cardiac vessels and chambers. The use of
anesthesia methods with minimal hemodynamic and respiratory effects can
increase diagnostic accuracy. Objective(s): Since there are a few
exclusive pediatric angiography centers, scarce studies have been done in
this area. Accordingly, this study determined the effects of intermittent
positive pressure ventilation (IPPV) versus spontaneous ventilation on
cardiorespiratory parameters in less than one-year-old pediatric patients
undergoing angiography with general anesthesia. Method(s): In this
interventional study that was performed as a double-blind, randomized
clinical trial, 60 children younger than one year were enrolled. The
pulmonary, renal, hepatic, and metabolic background diseases, previous
cardiac and thoracic surgery, requiring over two ketamine doses, and
receiving sedative or anti-convulsant therapeutics were excluded. The
patients were randomly assigned to two groups, including IPPV and
spontaneous ventilation. Their vital signs were also recorded before and
after anesthesia induction and needling, as well as during measurements of
pulmonary parameters and systemic blood pressure. All measurements were
done by a single operator using the same device for each variable.
 Result(s): It was seen that SPO<inf>2</inf>, as well as
PCO<inf>2</inf> after anesthesia had significant alterations among the
study variables. Nausea and vomiting, pain, and agitation were not
different across the groups (P-value > 0.05). Conclusion(s): In this
study, we found that IPPV and spontaneous ventilation have the same
effects on respiration. Both techniques can be used in children with
different cardiovascular catheterization conditions to increase accuracy
and reduce alterations in cardiopulmonary parameters. Copyright ©
2021, Author(s).

<25>
Accession Number
2007173473
Title
Efficacy of dexmedetomidine versus morphine as an adjunct to bupivacaine
in caudal anesthesia for pediatric thoracic surgeries: A randomized
controlled trial.
Source
Anesthesiology and Pain Medicine. 11(2) (no pagination), 2021. Article
Number: e112296. Date of Publication: April 2021.
Author
Ismail A.A.; Hamza H.M.; Gado A.A.
Institution
(Ismail, Hamza, Gado) Lecturer of Anesthesia and Pain Management,
Anesthesia Department, Faculty of Medicine, Cairo University, Egypt
Publisher
Kowsar Medical Institute
Abstract
Background: Caudal anesthesia is an effective method of pain management,
which can be successfully employed to minimize post-thoracotomy pain in
pediatric patients. However, its main disadvantage is the short
postoperative analgesic period, which can be prolonged by the concurrent
administration of one of many adjuvants. Objective(s): This
prospective randomized, blinded study aimed to compare the efficacy of
dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal
anesthesia for thoracic surgeries in pediatric patients. Method(s):
Fifty patients were randomly allocated into two equal groups. To achieve
caudal epidural block anesthesia, the patients in group M (n = 25) were
administered morphine and bupivacaine, while group D (n = 25) received a
mixture of dexmedetomidine and bupivacaine. The primary outcome of this
study was the postoperative analgesic duration achieved. The secondary
outcomes included morphine administration in the first 24 hours following
caudal block anesthesia, the face, legs, activity, cry, consolability
(FLACC) scale scores, and adverse effects, including vomiting, itching,
bradycardia, hypotension, and respiratory depression. Result(s): The
results showed that patients who had received dexmedetomidine achieved a
longer postoperative analgesia as compared to those who had received
morphine (P < 0.001). Postoperatively, the heart rate, blood pressure,
pain score, and mean consumption of morphine were lower in group D as
compared to the group M. There was no significant difference in the
adverse effects between the two groups. Conclusion(s): The use of
dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during
pediatric thoracic surgeries induced better and prolonged postoperative
analgesia as compared to morphine. Copyright © 2021, Author(s).

<26>
Accession Number
2014634466
Title
Aminophylline for prevention and/or treatment of post-dural puncture
headache: A systematic review and meta-analysis study protocol.
Source
Anesthesiology and Pain Medicine. 11(6) (no pagination), 2021. Article
Number: e119674. Date of Publication: 2021.
Author
Safarpour A.R.; Mehrabi M.; Tarkesh F.; Ashrafizadeh H.; Keshtkar A.;
Askari H.; Abazari D.; Amini A.; Barati-Boldaji R.
Institution
(Safarpour, Tarkesh, Askari, Barati-Boldaji) Gastroenterohepatology
Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Mehrabi) Department of E-Learning, Virtual School, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ashrafizadeh) Department of Nursing, School of Nursing and Midwifery,
Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran, Islamic
Republic of
(Keshtkar) Department of Health Sciences Education Development, School of
Public Health, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Abazari) Department of Cellular & Physiological Sciences & the Brain
Research Center, University of British Columbia, Vancouver, Canada
(Amini) Department of Anesthesiology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Objectives: Post-dural Puncture Headache (PDPH) is prevalent among
individuals undergoing lumbar punctures. The non-invasive effect of some
drugs, such as aminophylline on PDPH has been investigated in several
clinical studies. As there is no comprehensive systematic review and
meta-analysis about the preventive and therapeutic effects of
aminophylline on PDPH in the literature, the clinical effectiveness of
this drug on the prevention and/or treatment of PDPH will be assessed in
this study. Method(s): PubMed/MEDLINE, Embase, WoS (Clarivate
Analytics), the Cochrane Central Register of Controlled Trials (CENTRAL),
CINAHL Complete, Scopus, and Google Scholar as electronic databases will
be precisely searched for clinical studies that assessed the effect of
aminophylline on PDPH. Studies between 01-01-1980 and 30-06-2020 will be
evaluated in this study, and there will not be any language restrictions.
Contradictions between the reviewers within any phase of the study
(screening, selecting, quality assess-ment, and data extraction) will be
resolved by consensus; in case of unsolved disagreements, a third reviewer
will eventually decide. The combination method will be applied according
to the methodological resemblance in the selected articles using the
Random Effect Model or the Fixed Effect Model. Also, for the included
articles, forest plots will be drawn. For assessing statistical
heterogene-ity, the I2 statistic and the Q-statistic test will
be applied. In addition, funnel plots will be used for assessing
non-significant study effects and potential reporting bias. Furthermore,
Egger's and Begg's tests will be done, and publication bias will be
indicated by significant findings (P < 0.05). Conclusion(s): It is
expected that the results of this study will be of benefit to researchers
and clinicians for managing PDPH, and will be reported in conferences and
publications. Copyright © 2021, Author(s).

<27>
Accession Number
2005605020
Title
The effect of erythropoietin administration on the serum level of ykl-40,
pro-bnp and il-6 in coronary surgery patients.
Source
Iranian Journal of Pharmaceutical Research. 19(3) (pp 430-439), 2020. Date
of Publication: 2020.
Author
Foroughi M.; Mohammadi Z.; Tehrani M.M.; Bakhtiari M.; Dabbagh A.;
Molahoseini M.H.
Institution
(Foroughi, Mohammadi, Tehrani) Cardiovascular Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bakhtiari) Clinical Research and Development Center, Shahid Modarres
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Dabbagh) Anesthesiology Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Molahoseini) Department of Immunology, School of Medicine, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Iranian Journal of Pharmaceutical Research
Abstract
Cardiopulmonary bypass and aortic clamping evokes the obligatory global
myocardial ischemia and dysfunction with a significant inflammatory
response. The discrepancy about cardioprotective effects of erythropoietin
still exist. The aim of this study was to assess the clinical
immunomodulatory effects of Erythropoietin (EPO) on serum inflammatory
biomarkers (YKL-40, IL-6) and cardiac biomarkers, (pro-BNP, CK-MB and
troponin). In this randomized double blind clinical trial, 132 patients
admitted for elective coronary surgery with Cardiopulmonary Bypass (CPB)
were randomly assigned in one of three groups: 1-group EPO-A (n = 35)
infusion of 300 IU/Kg EPO after anesthesia induction and before undergoing
CPB; 2-group EPO-CPB (n = 31) the same intervention during CPB; 3-placebo
group (n = 66) saline infusion in the same volume. Cardiac enzymes and
serum biomarkers were measured at intervals. There was a sharp increase in
serum YKL-40 with a 24 h delay after CPB in all groups without significant
difference. The increase in serum IL-6 was significant in EPO-CPB group
compared with both other groups (p = 0.001 and p = 0.001, respectively).
Serum pro-BNP reached maximum level 24 h after operation in all groups; in
group A significantly less than others (p = 0.008). CK-MB increased
significantly in all groups (p < 0.001), less prominently in CPB-A group
(p = 0.03). EPO administration before induced ischemia may be
cardioprotective in terms of cardiac biomarkers in patients undergoing
CABG with CPB. Copyright © 2020, Iranian Journal of
Pharmaceutical Research. All rights reserved.

<28>
Accession Number
2005082603
Title
Effect of sequential compression device on hemodynamic changes after
spinal anesthesia for caesarean section: A randomized controlled trial.
Source
Anesthesiology and Pain Medicine. 10(5) (pp 1-6), 2020. Article Number:
e104705. Date of Publication: 2020.
Author
Javaherforooshzadeh F.; Pipelzadeh M.R.; Akhondzadeh R.; Adarvishi S.;
Alghozat M.
Institution
(Javaherforooshzadeh, Pipelzadeh, Akhondzadeh, Adarvishi) Ahvaz
Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Alghozat) Menopause Andropause Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: The benefit of sequential compression device (SCD) for the
prevention of hypotension after spinal anesthesia in cesarean sections has
not been determined. Objective(s): In this study, an attempt was made
to determine whether SCD can prevent hemodynamic changes following spinal
anesthesia for cesarean sections. Method(s): In a prospective
clinical trial, 76 parturient women undergoing elective cesarean sections
under spinal anesthesia were randomly divided into SCD or control groups.
The maternal hemodynamic changes within 75 min after spinal anesthesia,
nausea, vomiting, and neonatal Apgar score at 1 and 5 min were compared
between the groups. Result(s): There were no significant differences
between the groups in the patients' characteristics, maximum sensory
block, skin incision to delivery time, spinal anesthesia to delivery time
(min), and the total duration of surgery. Concerning heart rate changes,
RM ANOVA showed a significant difference in the effect of time, groups,
and the interaction of the two factors (P < 0.0001, P < 0.0001, and P <
0.0001, respectively). Tukey post hoc test showed that 3 min after spinal
anesthesia, diastolic blood pressure was significantly higher in the SCD
group than in the control group (P < 0.05). The SCD group had meaningfully
lower rates of nausea (P = 0.005) and vomiting (P = 0.001) than the
control group. The SCD group also demonstrated a significantly lower mean
ephedrine dosage per patient (4.1 mg against 17.1 mg, P = 0.001). However,
no significant difference was observed between the groups in terms of
neonatal Apgar scores at 1 and 5 minutes. Conclusion(s): This study
showed that SCD could reduce extensive changes in diastolic blood pressure
as an important hemodynamic parameter and the incidence of nausea and
vomiting. Thus, SCD can be used in spinal anesthesia care practices for
elective cesarean sections. Copyright © 2020, Author(s).

<29>
Accession Number
2004569049
Title
The comparison of direct laryngoscopy and video laryngoscopy in pediatric
airways management for congenital heart surgery: A randomized clinical
trial.
Source
Anesthesiology and Pain Medicine. 10(3) (pp 1-6), 2020. Article Number:
e99827. Date of Publication: June 2020.
Author
Javaherforooshzadeh F.; Gharacheh L.
Institution
(Javaherforooshzadeh) Department of Anesthesia, Ahvaz Anesthesiology and
Pain Research Center, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran, Islamic Republic of
(Gharacheh) Student Research Center, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Gharacheh) Student Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Airway management in patients with hereditary heart disease is
an important therapeutic intervention. Objective(s): The purpose of
this study was to compare direct laryngoscopy (DL) with video laryngoscopy
(VL) in pediatric airways management for congenital heart surgery.
 Method(s): This study was designed as a prospective randomized
clinical trial. Two consecutive groups of 30 patients undergoing elective
noncyanotic congenital heart surgery. The patients were divided into
direct laryngoscopy versus video laryngoscopy for intubation of the
trachea. The main outcomes were the number of success rate in the first
attempt, and the secondary outcomes were the duration of successful
intubation and complications, such as desaturation and bradycardia.
 Result(s): Intubation procedure time was measured as 51.13 +/- 17.88
seconds for the group with direct laryngoscopy and 59.66 +/- 45.91 seconds
for group with VL that was significant (P = 0.006). In DL group, 22
patients were intubated on the first attempt, 8 patients on the second
attempt, and 6 patients on the third attempt, compared to 24, 6, and 2
respectively, in VL group. The differences were significant only in the
third attempt between groups (P = 0.033). The important difference
established in heart rate (HR) and SpaO<inf>2</inf> amounts between the
two groups at any time (P < 0.05). Conclusion(s): VL can produce
better visualization for intubation of trachea in congenital heart
disease, but this is time-consuming. Indeed, training in the use of the VL
should be increased to reduce the time required for performance. Moreover,
further studies are recommended to approve these helpful
findings. Copyright © 2020, Author(s).

<30>
Accession Number
2004441045
Title
Effect of dexmedetomidine combined with inhalation of isoflurane on
oxygenation following one-lung ventilation in thoracic surgery.
Source
Anesthesiology and Pain Medicine. 10(1) (no pagination), 2020. Article
Number: e95287. Date of Publication: 2020.
Author
Asri S.; Hosseinzadeh H.; Eydi M.; Marahem M.; Dehghani A.; Soleimanpour
H.
Institution
(Asri, Hosseinzadeh, Eydi, Dehghani) Department of Anesthesiology, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Marahem) Department of Physiology, Tabriz University of Medical Sciences,
Tabriz, Iran, Islamic Republic of
(Soleimanpour) Emergency Medicine Department, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: One-lung ventilation (OLV) is commonly used during thoracic
surgery. At this time, hypoxemia is considered one of the remarkable
consequences of the anesthesia management. Hypoxic pulmonary
vasoconstriction (HPV) is the defense mecha-nism against hypoxia.
 Objective(s): The aim of the present study was to investigate the
effect of infusion of dexmedetomidine on improving the oxygenation during
OLV among the adult patients undergoing thoracic surgery. Method(s):
A total of 42 patients undergoing OLV by general anesthesia with
isoflurane inhalation were randomly assigned into two groups: IV infusion
of dexmedetomidine at 0.3 microgram/kg/h (DISO) and IV infusion of normal
saline (NISO). Three Arterial Blood Gas (ABG) samples were obtained
throughout the surgery. Hemodynamic parameters, PaO<inf>2</inf>,
PaCO<inf>2</inf>, and complications at recovery phase were recorded. The
collected information was analyzed using SPSS software version 22.
 Result(s): In the dexmedetomidine group, the mean hemodynamic
parameters had a significant reduction at 30 and 60 minutes following OLV.
Administration of dexmedetomidine resulted in a significant increase in
the PaCO<inf>2</inf> and a reduction in the PaO<inf>2</inf> when changing
from two-lung ventilation to OLV, where PaO<inf>2</inf> reached its
maximum value within 10 minutes after OLV in the DISO group, and it began
to gradually increase to the end of operation. The duration of the
recovery phase, also complications at the recovery phase decreased
significantly in DISO group. Conclusion(s): The results of the study
showed that, dexmedetomidine may improve arterial oxygenation during OLV
in adult patients undergoing thoracic surgery, and can be a suitable
anesthetic agent for thoracic surgery. Copyright © 2020,
Author(s).

<31>
Accession Number
631475474
Title
Serum trace elements in coronary artery bypass graft surgery: The
relationship between trace element supplementation and period of
mechanical ventilation in a randomized double-blind placebo-controlled
trial.
Source
Jundishapur Journal of Natural Pharmaceutical Products. 14(4) (no
pagination), 2019. Article Number: 68735. Date of Publication: 01 Nov
2019.
Author
Amirizadeh M.; Salehifar E.; Habibi M.; Shokrzadeh M.; Soleimani A.;
Charati J.Y.; Ghaffari R.; Habibi V.; Eslami G.
Institution
(Amirizadeh, Salehifar) Department of Clinical Pharmacy, Pharmaceutical
Sciences Research Center, Faculty of Pharmacy, Mazandaran University of
Medical Sciences, Sari, Iran, Islamic Republic of
(Habibi, Soleimani) Department of Anesthesiology, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Shokrzadeh) Department of Toxicology, Faculty of Pharmacy, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Charati) Department of Biostatics, Health Sciences Research Center,
Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
(Ghaffari, Habibi) Department of Cardiac Surgery, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Eslami) Department of Clinical Pharmacy, Faculty of Pharmacy,
Cardiovascular Research Center, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Coronary artery bypass graft surgery (CABG) may cause a
substantial decrease in trace elements of whole blood during the
operation, as well as increased oxidative stress and result in lung
damage. Objective(s): This study aimed to evaluate the effect of
Addamel, as a complete mixture of trace elements, in reducing the period
of mechanical ventilation following the cardiac surgery. Method(s):
In this randomized, double-blind, placebo-controlled trial, two hundred
patients receiving CABG were randomized to receive three doses of either
Addamel or normal saline. Selenium, zinc, copper, ferrous, and manganese
serum levels were measured before the operation, on days one and two in
all groups. Besides, the effects of Addamel on the mechanical ventilation
period were evaluated. Result(s): The mean length of stay on the
mechanical ventilator was lower in the supplemented patients (21.98 +/-
8.4 days) than the control patients (25.16 +/- 8.44 days), and the
difference was statistically significant (P = 0.009). Conclusion(s):
A substantial number of patients undergoing CABG may benefit from
supplementation with Addamel, as a source of trace elements. Copyright
© 2019, Jundishapur Journal of Natural Pharmaceutical Products. This
is an open-access article distributed under the terms of the Creative
Commons Attribution-NonCommercial 4.0 International License
(http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and
redistribute the material just in noncommercial usages, provided the
original work is properly cited.

<32>
Accession Number
628635919
Title
The preventive role of selenium in inflammatory response during coronary
artery bypass graft surgery: A randomized, controlled clinical trial.
Source
Jundishapur Journal of Natural Pharmaceutical Products. 14(1) (no
pagination), 2019. Article Number: e14158. Date of Publication: 2019.
Author
Sedighinejad A.; Imantalab V.; Mirmansouri A.; Jouryabi A.M.; Nabi B.N.;
Kanani G.; Atrkarroushan Z.; Biazar G.
Institution
(Sedighinejad, Imantalab, Mirmansouri, Jouryabi, Nabi, Biazar)
Anesthesiology Research Center, Guilan University of Medical Sciences
(GUMS), Rasht, Iran, Islamic Republic of
(Kanani) Department of Cardaic Surgery, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Atrkarroushan) Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Coronary artery bypass graft surgery (CABG) with
cardiopulmonary bypass (CPB) triggers a profound systemic inflammatory
response and sympathetic nervous system activation translated into
post-operative adverse outcomes. Objective(s): The current study
aimed at determining whether preparative use of selenium could reduce the
severity of inflammatory reaction to surgery. Method(s): The current
randomized, double-blind clinical trial was conducted at the Department of
Cardiac Surgery of Dr. Heshmat Hospital; a referral center affiliated to
Guilan University of Medical Sciences (GUMS), Rasht, Iran. From May 2015
to September 2015 one hundred and fourteen patients who were candidates
for elective CABG were randomly recruited to receive either an intravenous
bolus of 600 ?g Se before induction of anesthesia in the group S (n = 56)
or normal saline as placebo in the group C (n = 58). To measure white
blood cells (WBC) serum levels, blood samples were collected
preoperatively (T0) and three times after CPB initiation immediately after
the end of CPB (T1), as well as 24 (T2) and 48 hours (T3) after surgery.
Statistical tests including chi-square, the Kruskal-Wallis, and
independent t tests, as well as repeated measurement ANOVA were used to
analyze the data. Result(s): There was no significant difference
between the two groups regarding the baseline characteristics (P =
0.0512). There was no significant difference between the two groups in
other four time points; T0 (P = 0.0512), T1 (P = 0.571), T2 (P = 0.974),
and T3 (P = 0.215), although the trend of changes was statistically
significant in each group (P = 0.0001), the intergroup comparisons showed
no significant changes (P = 0.166). Conclusion(s): There was no
strong evidence that a single-dose of Se could reduce inflammation
following CABG surgery. Copyright © 2019, Jundishapur Journal of
Natural Pharmaceutical Products.

<33>
Accession Number
2003253536
Title
Comparison effect of tranexamic acid (TA) and tranexamic acid combined
with vitamin C (TXC) on drainage volume and atrial fibrillation arrhythmia
in patients undergoing cardiac bypass surgery: Randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 9(5) (no pagination), 2019. Article
Number: e96096. Date of Publication: 2019.
Author
Ghorbaninezhad K.; Bakhsha F.; Yousefi Z.; Halakou S.; Mehrbakhsh Z.
Institution
(Ghorbaninezhad) Department of Anesthesia, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Bakhsha, Yousefi, Halakou) Department of Paramedical School, Golestan
University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Mehrbakhsh) Department of Biostatistics, Faculty of Healt, Golestan
University of Medical Sciences, Gorgan, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Tranexamic acid and vitamin C are potent antifibrinolytic and
oxidative stress agents that reduce blood loss and transfusion blood in
cardiopulmonary bypass (CPB). Objective(s): The aim of this study was
to evaluate the efficacy of tranexamic acid (TA) and tranexamic acid
combined with vitamin C (TXC) on drainage volume (blood loss) and atrial
fibrillation (AF) in patients undergoing cardiac bypass surgery in Gorgan,
Shafa hospital, Iran. Method(s): This study is a double-blind
randomized clinical trial. A sample size of 120 candidates of cardiac
bypass surgery were included in this prospective study. Patients were
randomly assigned to treatments in two groups. In both groups, 50 mg/kg
tranexamic acid was administered intravenously directly before sternotomy:
group A (N = 58) patients received tranexamic acid (TA) only and group B
(N = 62) tranexamic acid with vitamin C (TXC) half an hour before surgery
and 2 g vitamin C with 100 mL 0.9% saline were injected. Subsequently,
during 4 days after surgery, 1000 mg of vitamin C and 100 cc 0.9% saline
was infused every day. Intraoperative and postoperative blood loss (volume
of blood in the drain) and atrial fibrillation complications were recorded
for 24 hours after the operation. Result(s): The patients who
received vitamin C had less bleeding during operation and in the early
hours post-operation. Patients in (TA) group had mean drainage of 34.41
milliliter more than patients in (TXC) group (P < 0.001). Chi-square test
showed that arrhythmia (AF) condition was the same in the two groups
during 14 times of study (four times during operation and ten times up to
24 hours after the operation), and AF arrhythmia in the two groups was
less than 5%. Conclusion(s): In this study tranexamic acid with
vitamin C have a positive effect on the amount of drainage (blood loss)
and there was no significant difference in the incidence of AF between two
groups. Copyright © 2019, Author(s).

<34>
Accession Number
2003247648
Title
Investigating the effect of fibrinogen injection on bleeding in coronary
artery bypass surgery: A clinical trial.
Source
Anesthesiology and Pain Medicine. 9(4) (no pagination), 2019. Article
Number: e92165. Date of Publication: August 2019.
Author
Zadeh F.J.; Janatmakan F.; Soltanzadeh M.; Zamankhani M.
Institution
(Zadeh, Janatmakan, Soltanzadeh, Zamankhani) Department of Anesthesia,
Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Prevention and optimal treatment of postoperative bleeding are
of great clinical importance in various types of surgeries including
coronary artery bypass graft (CABG). Reducing the amount of bleeding will
reduce the complications subsequent to blood transfusion. The positive
effects of coagulation factors, especially fibrinogen, after
cardiovascular bypass could have beneficial effects due to reduced
bleeding and less need for blood transfusion. However, different studies
have reported controversial findings. Objective(s): The present study
aimed to evaluate the effect of prophylactic administration of fibrinogen
on blood loss in patients undergoing CABG surgery to achieve more accurate
clinical outcomes. Method(s): This was a double-blind randomized
clinical trial conducted on 36 patients hospitalized in Ahvaz Imam
Khomeini Hospital for coronary artery bypass graft. Patients were
randomized to receive either fibrinogen concentrate (n = 18) or placebo (n
= 18). Hemoglobin, hematocrit, international normalized ratio, prothrombin
time, partial thromboplastin time, and fibrinogen were checked
preoperatively. The transfusion of allogeneic blood components and the
volume of blood loss were recorded and compared between the groups.
 Result(s): Prophylactic fibrinogen injection reduced the need for
blood transfusion, blood products, and postoperative hypotension in the
fibrinogen group when compared to the control group (P <= 0.005). There
was a significant difference between the two groups in terms of the amount
of bleeding during operation (P <= 0.005). Conclusion(s): Fibrinogen
plays a key role in preventing and stopping the bleeding. Accordingly,
fibrinogen decreases bleeding and the need for paced cell in patients in
CABG. Given the adverse outcomes of bleeding and coagulopathy in patients
undergoing surgery, we conclude that the use of fibrinogen could be
beneficial as a prophylactic in hemorrhagic surgery. Copyright ©
2019, Author(s).

<35>
Accession Number
2004441040
Title
Slow positive end-expiratory pressure titration during general anesthesia
with muscle paralysis improves lung function without compromising
hemodynamic stability in preschool children: A randomized control clinical
trial.
Source
Iranian Journal of Pediatrics. 29(6) (no pagination), 2019. Article
Number: e92269. Date of Publication: 2019.
Author
Mandras A.D.; Soldatovic I.; Sujica M.; Stevanovic V.; Markovic D.;
Paunovic Z.; Minic P.
Institution
(Mandras, Sujica, Stevanovic) Department of Anesthesiology and Intensive
Care Therapy, Institute for Mother and Child Health Care, Belgrade, Serbia
(Soldatovic) Institute for Medical Statistics and Informatics, Medical
Faculty, University of Belgrade, Belgrade, Serbia
(Markovic) Department of Anesthesiology, Clinic for Cardiovascular
Surgery, Clinical Center of Serbia, Belgrade, Serbia
(Paunovic) Department of Orthopedics, Institute for Mother and Child
Health Care, Belgrade, Serbia
(Minic) Depratment of Pulmonolgy, Institute for Mother and Child Health
Care, Belgrade, Serbia
Publisher
Kowsar Medical Institute
Abstract
Background: Mechanical ventilation impairs oxygenation and increases
intrapulmonary shunt. Positive end-expiratory pressure (PEEP) slows
derecruitment, improves lung function but can compromise hemodynamics.
 Objective(s): To asses slow PEEP titration effect on intrapulmonary
shunt, oxygenation and hemodynamics in preschool children on mechanical
ventilation under general anesthesia. Method(s): This was a single
tertiary care center an open-label, randomized parallel group controlled
clinical trial. Study included 70 children, 3-7 years, ASA I and II, under
general anesthesia for non-cardiothoracic surgery. Children were randomly
allocated either to receive PEEP titration 5-11 cmH<inf>2</inf>O 20
minutes before the end of anesthesia (intervention group) or to be
ventilated until the end of anesthesia with constant positive
end-expiratory pressure of 3 cmH<inf>2</inf>O (control group). Main
outcome measures were changes in oxygenation index
(PaO<inf>2</inf>/FiO<inf>2</inf>) and alveolar-arterial gradient
(P(A-a)O<inf>2</inf>) between and within groups and changes in systolic
blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) in
interventional group during PEEP trial. Result(s): Seventy children
were recruited and analyzed. P(A-a)O<inf>2</inf> and
PaO<inf>2</inf>/FiO<inf>2</inf> improved in interventional group comparing
to control as consequence of PEEP titration
(PaO<inf>2</inf>/FiO<inf>2</inf>-30.3 vs. 0.52; P < 0.001;
P(A-a)O<inf>2</inf> 6.7 vs.-1.0; P < 0.001) and within interven-tional
group before and after PEEP titration (PaO<inf>2</inf>/FiO<inf>2</inf>
522.0 vs. 552.3; P < 0.01; P(A-a)O<inf>2</inf> 20.1 vs. 13.3; P < 0.001).
Hypotension and bradycardia were not documented. Conclusion(s): Slow
PEEP titration up to 11 cmH<inf>2</inf>O improves oxygenation, reduces
intrapulmonary shunt without causing hemodynamic instability in preschool
children during general anesthesia. Copyright © 2019, Author(s).

<36>
Accession Number
2000825445
Title
Dabigatran in patients with myocardial injury after non-cardiac surgery
(MANAGE): an international, randomised, placebo-controlled trial.
Source
The Lancet. 391(10137) (pp 2325-2334), 2018. Date of Publication: 09 Jun
2018.
Author
Devereaux P.J.; Duceppe E.; Guyatt G.; Tandon V.; Rodseth R.; Biccard
B.M.; Xavier D.; Szczeklik W.; Meyhoff C.S.; Vincent J.; Franzosi M.G.;
Srinathan S.K.; Erb J.; Magloire P.; Neary J.; Rao M.; Rahate P.V.;
Chaudhry N.K.; Mayosi B.; de Nadal M.; Iglesias P.P.; Berwanger O.; Villar
J.C.; Botto F.; Eikelboom J.W.; Sessler D.I.; Kearon C.; Pettit S.;
Connolly S.J.; Bangdiwala S.I.; Rao-Melacini P.; Hoeft A.; Yusuf S.; Pogue
J.; Di Diodato S.; Gasic Z.; Mastrangelo L.J.; Molnar S.H.; Swanson J.L.;
Tosh M.L.; Wells J.R.; Diaz R.; Chow C.K.; Gonzales B.; Vasquez S.; Jansky
P.; Dusek R.; Coriat P.; Wittmann M.; Yonga G.; Mathur N.; Seletti E.;
Malaga G.; Tumanan-Mendoza B.A.; Tagle M.P.A.; Alonso-Coello P.; Popova
E.; Shields M.; Le Manach Y.; Moayyedi P.; van Zanten S.; Fleischmann E.;
Garg A.; Karaye K.; McFalls E.; Sigamani A.; Belley-Cote E.; Biedron G.;
Borges F.; Frosi Stella S.; Haarmark Nielsen C.; Leong D.P.; Spence J.;
Tran A.; Wawrzycka-Adamczyk K.; Yang S.S.; Yung T.; Wyse D.G.; Cheng D.;
Johnstone D.E.; Wells G.A.; Joseph P.; Patel A.; Gregus K.; Lawrence K.;
Doharris L.; Conen D.; Cheung J.; Douketis J.; Wright D.; Wikkerink S.;
Dechert W.; Panju M.; Azzam K.; Rapanos T.; Van Helder T.; Shroff A.; Hare
J.; Kidane B.; Nguyen T.; Leydier L.; Bayaraa V.; Parlow J.; DuMerton
D.A.; Thakrar A.; Shelley J.; Deligne B.; Carling R.D.; Mrkobrada M.;
Dresser G.K.; Jacka M.J.; Hornstein D.; Winkelaar G.B.; Haider Z.H.;
Lanjewar P.P.; Varughese V.; Calton R.; Ahuja H.; George P.; Sharma A.;
Bhatt K.S.; Mangukiya D.O.; Nandaniya K.V.; Parekh V.V.; Pillai A.B.;
Menon V.P.; Desai S.C.; Sidhu R.S.; Gupta S.K.; George R.K.; Gurunath
T.R.; Drummond L.W.; Torborg A.M.; Kusel B.S.; Naidoo P.; Naidoo D.P.;
Rajah C.; Farina Z.; von Rahden R.P.; Gumede S.; Chishala C.; Coetzee E.;
Dyer R.A.; Diedericks J.; Bielanski P.; Kaczmarek B.; Studzinska D.;
Zaniewski M.; Libura M.J.; Zacharias-Nalichowski T.M.; Sega A.A.S.; Salwa
J.; Kozka M.; Gorka J.; Wludarczyk A.; Nowak-Kozka I.; Grudzien P.S.;
Gucwa J.W.; Slowiaczek M.P.; Dobosz P.P.D.; Gogenur I.; Eriksen J.R.;
Borup T.; Kirkegaard T.; Isbye D.; Sonne A.; Rasmussen L.S.; Pedersen S.;
Troensegaard H.; Duus C.L.; Halle B.M.; Gundel O.N.; Bernholm K.F.;
Martinsen K.R.; Itenov T.S.; Camio E.; Vazquez C.; Matarin S.; Cano E.;
Alvarez-Garcia J.; India I.; Gonzalez-Osuna A.; Vives M.; Rossello E.;
Serrano A.B.; Turiel M.; Drago L.; Colombo C.; Marra F.; Mos L.; Arteni
F.; Lembo R.; Ortalda A.; Passarani S.; Mokini Z.; Figueiredo E.L.; Werner
G.F.; Petriz J.L.; Maia L.N.; Bergo R.R.; Precoma D.B.; Saraiva J.F.K.;
Vilamajo O.G.; Allegrini E.; Benzadon M.; Parody M.L.; Duronto E.A.;
Ingaramo A.C.; Parra G.A.; Novoa D.; Miller S.A.; Thomas S.; Karlapudi
S.P.; Bourji M.H.; Banerjee S.; Gupta A.; Opole I.O.; Fischer M.; Mendoza
V.L.; Reyes E.B.; Pierson R.J.; Shields M.O.; Piriou V.; Zacharowski K.;
Rotta-Rotta A.; Paper M.; Rahate P.; Chaudhry N.; Paniagua Iglesias P.;
Sharma M.
Institution
(Devereaux, Duceppe, Guyatt, Kearon, Bangdiwala, Yusuf) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Devereaux, Guyatt, Tandon, Magloire, Neary, Eikelboom, Kearon, Sharma,
Connolly, Yusuf) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Devereaux, Vincent, Pettit, Sharma, Connolly, Bangdiwala, Rao-Melacini,
Yusuf) Population Health Research Institute, Hamilton, ON, Canada
(Duceppe) Department of Medicine, University of Montreal, Montreal, QC,
Canada
(Rodseth) Department of Anaesthesia, University of KwaZulu-Natal,
Pietermaritzburg, South Africa
(Biccard) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and University of Cape Town, Cape Town, South Africa
(Mayosi) Department of Medicine, Groote Schuur Hospital and University of
Cape Town, Cape Town, South Africa
(Xavier, Rao) Department of Pharmacology, St John's Medical College and
Research Institute, Bangalore, India
(Szczeklik) Department of Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg and
Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Franzosi) Department of Cardiovascular Research, IRCCS Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Erb) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Rahate) Department of Surgery, Rahate Surgical Hospital, Nagpur, India
(Chaudhry) Department of Surgery, Christian Medical College Hospital,
Ludhiana, India
(de Nadal) Department of Anesthesiology, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
(Iglesias) Department of Anesthesiology, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Berwanger) Instituto de Ensino e Pesquisa do Hospital do Coracao
(IEP-HCor), Sao Paulo, Brazil
(Villar) Departamento de Investigaciones, Fundacion
Cardioinfantil-Instituto de Cardiologia (Bogota) and Facultad de Ciencias
de la Salud, Universidad Autonoma de Bucaramanga, Colombia
(Botto) Estudios Clinicos Latinoamerica (ECLA), Rosario and Hospital
Austral, Pilar, Argentina
(Sessler) Department of Outcomes Research, Cleveland Clinic,
Anesthesiology Institute, Cleveland, OH, United States
(Hoeft) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Myocardial injury after non-cardiac surgery (MINS) increases
the risk of cardiovascular events and deaths, which anticoagulation
therapy could prevent. Dabigatran prevents perioperative venous
thromboembolism, but whether this drug can prevent a broader range of
vascular complications in patients with MINS is unknown. The MANAGE trial
assessed the potential of dabigatran to prevent major vascular
complications among such patients. Method(s): In this international,
randomised, placebo-controlled trial, we recruited patients from 84
hospitals in 19 countries. Eligible patients were aged at least 45 years,
had undergone non-cardiac surgery, and were within 35 days of MINS.
Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally
twice daily or matched placebo for a maximum of 2 years or until
termination of the trial and, using a partial 2-by-2 factorial design,
patients not taking a proton-pump inhibitor were also randomly assigned
(1:1) to omeprazole 20 mg once daily, for which results will be reported
elsewhere, or matched placebo to measure its effect on major upper
gastrointestinal complications. Research personnel randomised patients
through a central 24 h computerised randomisation system using block
randomisation, stratified by centre. Patients, health-care providers, data
collectors, and outcome adjudicators were masked to treatment allocation.
The primary efficacy outcome was the occurrence of a major vascular
complication, a composite of vascular mortality and non-fatal myocardial
infarction, non-haemorrhagic stroke, peripheral arterial thrombosis,
amputation, and symptomatic venous thromboembolism. The primary safety
outcome was a composite of life-threatening, major, and critical organ
bleeding. Analyses were done according to the intention-to-treat
principle. This trial is registered with ClinicalTrials.gov, number
NCT01661101. Finding(s): Between Jan 10, 2013, and July 17, 2017, we
randomly assigned 1754 patients to receive dabigatran (n=877) or placebo
(n=877); 556 patients were also randomised in the omeprazole partial
factorial component. Study drug was permanently discontinued in 401 (46%)
of 877 patients allocated to dabigatran and 380 (43%) of 877 patients
allocated to placebo. The composite primary efficacy outcome occurred in
fewer patients randomised to dabigatran than placebo (97 [11%] of 877
patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to
placebo; hazard ratio [HR] 0.72, 95% CI 0.55-0.93; p=0.0115). The primary
safety composite outcome occurred in 29 patients (3%) randomised to
dabigatran and 31 patients (4%) randomised to placebo (HR 0.92, 95% CI
0.55-1.53; p=0.76). Interpretation(s): Among patients who had MINS,
dabigatran 110 mg twice daily lowered the risk of major vascular
complications, with no significant increase in major bleeding. Patients
with MINS have a poor prognosis; dabigatran 100 mg twice daily has the
potential to help many of the 8 million adults globally who have MINS to
reduce their risk of a major vascular complication. Funding(s):
Boehringer Ingelheim and Canadian Institutes of Health
Research. Copyright © 2018 Elsevier Ltd

<37>
Accession Number
624967933
Title
Feasibility of on-table extubation after cardiac surgery with
cardiopulmonary bypass: A randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 8(5) (no pagination), 2018. Article
Number: e80158. Date of Publication: October 2018.
Author
Totonchi Z.; Azarfarin R.; Jafari L.; Ghavidel A.A.; Baharestani B.;
Alizadehasl A.; Alasti F.M.; Ghaffarinejad M.H.
Institution
(Totonchi, Ghavidel, Baharestani, Ghaffarinejad) Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Azarfarin, Alizadehasl) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Jafari, Alasti) Anesthesiologist, Faculty of Medicine, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: The use of short-acting anesthetics, muscle relaxation, and
anesthesia depth monitoring allows maintaining sufficient anesthesia
depth, fast recovery, and extubation of the patients in the operating room
(OR). We evaluated the feasibility of extubation in the OR in cardiac
surgery. Method(s): This clinical trial was performed on 100 adult
patients who underwent elective noncomplex cardiac surgery using
cardiopulmonary bypass. Additional to the routine monitoring, the
patients' depth of anesthesia and neuromuscular blocked were assessed by
bispectral index and nerve stimulator, respectively. In the on-table
extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15
microg/kg/h) and inhalational anesthetics were used for early waking. In
the control group (n = 50), the same anesthesia-inducing drugs were used
but the dose of sufentanil during the operation was 0.7-0.8 microg/kg/h.
After the operation, cardiorespiratory parameters and ICU stay were
documented. Result(s): Demographic and clinical variables were
comparable in both study groups. In the OTE group, we failed to extubate
two patients in the OR (success rate of 96%). There were no significant
differences between the two groups in terms of systolic and diastolic
blood pressure at the time of entering the ICU (P > 0.05). Heart rate was
lower in the OTE than in the control group at ICU admission (89.4 +/- 13.1
vs. 97.6 +/- 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE
group (34 (21.5-44) vs. 48 (44-60) h; P = 0.001). Conclusion(s):
Combined inhalational-intravenous anesthesia along with using multiple
anesthesia monitoring systems allows reducing the dose of total
anesthetics and maintaining adequate anesthesia depth during noncomplex
cardiac surgery with cardiopulmonary bypass. Thus, extubation of the
trachea in the OR is feasible in these patients. Copyright ©
2018, Author(s).

<38>
Accession Number
624967922
Title
Effect of acupressure on pain severity in patients undergoing coronary
artery graft: A randomized controlled trial.
Source
Anesthesiology and Pain Medicine. 8(5) (no pagination), 2018. Article
Number: e82920. Date of Publication: October 2018.
Author
Narimani M.; Jaberi A.A.; Bonabi T.N.; Sadeghi T.
Institution
(Narimani) Department of Medical Surgical Nursing, Students Research
Committee, Faculty of Nursing and Midwifery, Rafsanjan University of
Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Jaberi) Department of Psychiatric and Mental Health Nursing, Social
Determinants of Health Research Center, Faculty of Nursing and Midwifery,
Rafsanjan University of Medical Sciences, Rafsanjan, Iran, Islamic
Republic of
(Bonabi) Department of Community Health Nursing, Social Determinants of
Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Sadeghi) Department of Pediatric Nursing, Non-Communicable Disease
Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of
Medical Sciences, Rafsanjan, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Considering the contradictory results on the role of
complementary therapies in correcting post-operative side effects, the aim
of this study was to evaluate the effect of acupressure on pain severity
in patients undergoing coronary artery graft admitted to a coronary care
unit. Method(s): In this double-blind, randomized, clinical trial, 70
patients were selected randomly after coronary artery bypass grafting
(CABG) surgery based on inclusion criteria and then assigned to two groups
(35 in acupressure and 35 in control) randomly by the minimization method.
The intervention group received acupressure at the LI4 point for 20
minutes in 10-second pressure and 2-second resting periods. In the control
group, only touching was applied without any pressure in the same pattern
as the intervention group. Pain severity was measured before, immediately,
and 20 minutes after applying pressure and touch in both groups using the
visual analogue scale. Result(s): The results of repeated measures
analysis of variance (ANOVA) showed a decrease in the pain score in the
intervention group (group effect) during multiple measurements (time
effect) and a reduction in the mean pain score in the various measurements
taking into account the groups (the interaction between time and group; P
= 0.001). Conclusion(s): Acupressure can be used as a complementary
and alternative therapeutic approach to relieve post-operative pain in
CABG patients. Copyright © 2018, Author(s).

<39>
Accession Number
614565935
Title
Effect of selenium on stress response in coronary artery bypass graft
surgery: A clinical trial.
Source
Anesthesiology and Pain Medicine. 7(1) (no pagination), 2017. Article
Number: e43864. Date of Publication: February 2017.
Author
Mirmansouri A.; Imantalab V.; Jouryabi A.M.; Kanani G.; Nabi B.N.; Farzi
F.; Biazar G.; Tehran S.G.; Tarbiat M.
Institution
(Mirmansouri, Imantalab, Jouryabi) Fellowship of Anesthesia in Cardiac
Surgery, Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Kanani) Department of Cardaic Surgery, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Nabi) Fellowship of Anesthesia and Pain (FIPP), Anesthesiology
Department, Anesthesiology Research Center, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Farzi, Biazar, Tehran) Anesthesiology Research Center, Guilan University
of Medical Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Tarbiat) Department of Anesthesiology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: In spite of significant improvements in surgical and
anesthetic techniques, acute stress response to surgery remains a main
cause of mortality and morbidity in coronary artery bypass graft (CABG)
surgery patients. Therefore, doing research to find safe and effective
modalities with more cardio protective properties seems necessary.
 Objective(s): In this study, we sought to determine whether
intravenous injection of 600 mug Selenium (Se) prior to surgery would
limit stress response measured by blood sugar. Method(s): This double
blind clinical trial was conducted at a referral center of cardiac surgery
affiliated to Guilan University of Medical Sciences (GUMS) from June 2015
to October 2015. 73 eligible patients candidate for elective isolated CABG
surgery were enrolled in the trial. They were randomly allocated to either
Se group (n = 36) receiving 600 mug Se prior to surgery or control group
(n = 37). Our evaluation was based on blood sugar (BS) which was measured
at four point times, including before induction of anesthesia (T0), at the
end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery.
 Result(s): The data obtainedfrom 73 patients in group S
(n=36)andgroupC(n=37) were analyzed. Therewasnosignificant difference
between the two groups regarding the baseline characteristics. In both
groups, a sharp rise in BS levels was observed following CPB (P = 0.0001).
Although the trend of BS changes was remarkable in both groups (P =
0.0001), there was no statistically significant difference between the
groups at all point times including T0 (P = 0.45), T1 (P = 0.48), T2 (P =
0.92), and T3 (P = 0.42). Within the study time, our patients were
monitored for any adverse effect but nothing was observed.
 Conclusion(s): This investigation showed that intravenous single dose
of 600 mug Se was safe in CABG patients, but had no positive effect on
stress response to surgery. Copyright © 2016, Iranian Society of
Regional Anesthesia and Pain Medicine (ISRAPM).

<40>
Accession Number
619604755
Title
Comparing the effectiveness of patient control analgesia pump and bolus
morphine in controlling pain after cardiopulmonary bypass graft surgery.
Source
Anesthesiology and Pain Medicine. 7(5) (no pagination), 2017. Article
Number: e12756. Date of Publication: October 2017.
Author
Imantalab V.; Mirmansouri A.; Mohammadzadeh Jouryabi A.; Naderi Nabi B.;
Kanani G.; Nassiri Sheikhani N.; Atrkarroushan Z.; Ghazanfar Tehran S.;
Samadpour N.
Institution
(Imantalab, Mirmansouri, Mohammadzadeh Jouryabi, Naderi Nabi, Ghazanfar
Tehran) Anesthesiology Research Center, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Kanani, Nassiri Sheikhani) Department of Cardiac Surgery, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Atrkarroushan) Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
(Samadpour) Anesthesiology and Critical Care Research Center, Guilan
University of Medical Sciences (GUMS), Rasht, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Postoperative pain is a complex process commonly caused by
surgical trauma. It is one of the major concerns of patients undergoing
heart surgery. Despite new techniques and modern analgesic treatments,
postoperative pain is still one of the most important controversial
issues. Method(s): 68 patients scheduled for elective CABG with CPB
were included in a prospective, double-blind clinical trial. They were
randomly divided into two groups. One group received PCA pump including
morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose
of 1 mg, lockout time of 15 minutes, and amaximumof 4 bolus of 0.02 mg/kg
for one hour and the other group received morphine bolus (group B). Three
patients were excluded from the study, and 33 and 32 patients participated
in the groups P and B, respectively. Variables including age, gender, pump
time, aortic clamp time, duration of surgery, complications (nausea and
vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid
consumption, hemodynamic, and sedation status were measured in both
groups. Result(s): There wasnosignificant difference between the
groups regarding age, gender,pumptime, clamp time, duration of surgery,
complication, sedation score, and hemodynamic status in most of the
assessment periods. By assessing the pain severity in the groups at
different periods, results showed a significant difference between the
groups except at enrollment, and a lower severity of pain was noted in the
group P compared to the group B. The consumed opioid was significantly
higher in the group P than in the group B. However, higher doses of
diclofenac and paracetamol were administered in the group B compared to
the group P. Conclusion(s): Results showed that higher morphine would
be used in patients with PCA pump after extubation following heart
surgery, and this increased dose of opioid was associated with better pain
control and lack of complication. Therefore, PCA pump with underlying
infusion could be effectively used in patients undergoing CABG that are
directly assessed in intensive care unite. Copyright © 2017,
Anesthesiology and Pain Medicine.

<41>
Accession Number
619583227
Title
Evaluation of the effect of aminophylline in reducing the incidence of
acute kidney injury after cardiac surgery.
Source
Anesthesiology and Pain Medicine. 7(4) (no pagination), 2017. Article
Number: e21740. Date of Publication: August 2017.
Author
Shahbazi S.; Alishahi P.; Asadpour E.
Institution
(Shahbazi, Alishahi, Asadpour) Anesthesiology and Critical Care Research
Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
Kowsar Medical Institute
Abstract
Objectives: Acute renal failure is a common complication of major
cardiovascular surgeries (One-third of patients). Adenosine release as a
vascular vasodilator increases after cardiac surgery, which reduces renal
and glomerular blood flow and subsequently causes kidney ischemic damage.
The present study aimed at evaluating the impact of aminophylline as an
adenosine receptor antagonist on renal function after cardiac surgery
hoping to find an appropriate method to reduce acute kidney injury.
 Method(s): The patients in the intervention group received 5 mg/kg
aminophylline bolus after induction of anesthesia; then, 0.25 mg/kg/hr of
the drug was administered intraoperatively and up to 48 hours after
surgery in the ICU cardiac surgery. Similar volume of normal saline was
injected to the patients of the second group. Serum BUN, Cr, and GFR were
measured pre- and postoperatively and 3 days postsurgery. Patients' 24-
hour urine output and RIFLE were also calculated. Result(s): Those
patients who received medication were extubated earlier (P = 0.018) and
received lower amount of inotropic drugs (P < 0001). According to the
RIFLE criteria, most of the patients experienced no change or even
improved GFR and Cr amounts compared to the control group (p < 0.05). GFR
and Cr value of all the patients with Cleveland score, less and more than
6, showed a significant difference between the 2 groups (P = 0.001 and P =
0.01, respectively). According to the RIFLE criteria, most of the patients
experienced no change or even improved GFR. Conclusion(s):
Aminophylline in cardiac surgery can reduce the frequency of acute kidney
injury according to RIFLE criteria and could be used in the prevention of
AKI as a safe and efficient modality in high-risk patients. Also, the use
of this drug may reduce the need for inotropic medication at the time of
surgery, intensive care unit stay length, and extubation
time. Copyright © 2017, Anesthesiology and Pain Medicine.

<42>
Accession Number
619243556
Title
An assessment of renal function with pulsatile perfusion during proximal
graft using cardiac contraction in coronary artery bypass graft surgery.
Source
Nephro-Urology Monthly. 9(5) (no pagination), 2017. Article Number:
e14324. Date of Publication: September 2017.
Author
Amouzegar S.M.; Lak M.
Institution
(Amouzegar, Lak) Department of Anesthesiology, School of Medical Sciences,
Baqiyatallah University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Short-term pulsatile perfusion during cardio pulmonary bypass
has shown higher protection for renal physiology, following standard
preservation of glomerular filtration and reduction of renal tissue
damage. Method(s): In this randomized clinical trial study, 70
patients, who had undergone CABG surgery were divided to 2 groups;
pulsatile and non-pulsatile groups. The researchers transferred continuous
blood flow to pulsatile blood flow during proximal graft using cardiac
contraction. Patients' laboratory tests, such as blood urea nitrogen (BUN)
and creatinine were checked preoperatively, at the arrival of the open
heart intensive care unit (ICU-OH), and 24 and 48 hours after admission.
 Result(s): Both case and control groups had significantly increased
BUN and creatinine. Increased creatinine on the first and second
postoperative day was significantly higher in the control group.
Furthermore,BUNincreased on the second day in the control group and was
significantly higher than the case group Conclusion(s): Despite the
rise inBUNand creatinine in the 2 groups, there werenocases of renal
failure in the patients. However, the results of this study regarding
creatinine and BUN criteria were supported by the pulsatile perfusion
method during the proximal graft by using a cardiac contraction in CABG
surgery. Copyright © 2017, Nephro-Urology Monthly.

<43>
Accession Number
617602232
Title
Adaptive support ventilation reduces the incidence of atelectasis in
patients undergoing coronary artery bypass grafting: A randomized clinical
trial.
Source
Anesthesiology and Pain Medicine. 7(3) (no pagination), 2017. Article
Number: e44619. Date of Publication: June 2017.
Author
Moradian S.T.; Saeid Y.; Ebadi A.; Hemmat A.; Ghiasi M.S.
Institution
(Moradian, Hemmat, Ghiasi) Baqiyatallah University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Saeid) Nursing Faculty, Baqiyatallah University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Ebadi) Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Pulmonary complications are common following cardiac surgery
and can lead to increased morbidity, mortality, and healthcare costs.
Atelectasis is the most common respiratory complication following cardiac
surgery. One of the most important methods for reducing pulmonary
complications is supportive care with protective ventilation strategies.
In this study, we aimed to assess the effect of adaptive support
ventilation (ASV) on atelectasis in patients undergoing cardiac surgery.
 Method(s): In this single-blind randomized clinical trial, 115
patients, undergoing coronary artery bypass grafting, were randomly
allocated into 2 groups: 57 patients in the intervention and 58 patients
in the control group. Patients in the intervention group were weaned with
ASV, while patients in the control group were managed using synchronized
intermittent mandatory ventilation (SIMV) and pressure support. The
incidence of atelectasis, duration of mechanical ventilation, manual
ventilator setting, arterial blood gas measurements, and length of
hospital stay were compared between the groups. Result(s): The
incidence of atelectasis, number of changes in the manual ventilator
setting, number of alarms, and length of hospital stay reduced in the
intervention group. However, duration of mechanical ventilation and number
of ABG measurements were not significantly different between the groups.
 Conclusion(s): The ASV mode could reduce the incidence of atelectasis
and length of hospital stay. However, it did not reduce the duration of
mechanical ventilation. It seems that ASV is not a superior mode for
faster extubation. Copyright © 2017, Iranian Society of Regional
Anesthesia and Pain Medicine (ISRAPM).

<44>
Accession Number
607154474
Title
Comparing the effects of 5% albumin and 6% hydroxyethyl starch 130/0.4
(Voluven) on renal function as priming solutions for cardiopulmonary
bypass: A randomized double blind clinical trial.
Source
Anesthesiology and Pain Medicine. 6(1) (pp 1-6), 2016. Article Number:
e30326. Date of Publication: February 2016.
Author
Maleki M.H.; Derakhshan P.; Sharifabad A.R.; Amouzeshi A.
Institution
(Maleki, Sharifabad, Amouzeshi) Atherosclerosis and Coronary Artery
Research Center, Birjand University of Medical Sciences, Birjand, Iran,
Islamic Republic of
(Derakhshan) Department of Anesthesiology, Rasoul Akram Hospital, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: The ideal strategy to prime the cardiopulmonary bypass (CPB)
circuit in adult cardiac surgery is still a matter of debate.
 Objective(s): In this retrospective study, we examined Albumin
solution and hydroxyethyl starch (HES) for priming the CPB circuit and
evaluated the differences in kidney function and bleeding and coagulation
status in the two groups of patients. Patients and Methods: Sixty
consecutive patients undergoing elective coronary artery bypass grafting
were studied. Patients were excluded due to emergency surgery, history of
cardiac surgery, history of receiving medication with antiplatelet agents
except ASA 80 (mg/day) within the previous five days, preoperative
coagulation disorder, left ventricular ejection fraction less than 50%,
preoperative renal dysfunction (serum creatinine > 1.4 mg/dL),
preoperative hepatic dysfunction (serum aspartate/alanine amino
transferase > 60 U/l), preoperative electrolyte imbalance, known
hypersensitivity to HES and chronic diuretic therapy. The patients were
divided randomly into two groups of HES (n = 30) and Albumin (n = 30).
Hemodynamic parameters, serum creatinine concentrations and glomerular
filtration rate, PT, PTT and INR were measured. Early bleeding was
measured according to the first 24-hour drainage from the tube.
Hemodynamics and all laboratory measurements were performed after
induction of anesthesia and at the morning of the first, second and third
postoperative days in the ICU. Result(s): GFR differences were
statistically lower in Albumin group in comparison with Group B at 24, 48
and 72 hours postoperation. Platelet count difference and postoperative
bleeding were significantly lower in Albumin group. Conclusion(s):
Administration of Albumin compared to HES in patients with a normal renal
function results in a lower drop of GFR and platelet count, less bleeding
and lower rise of serum creatinine. Copyright © 2015, Iranian
Society of Regional Anesthesia and Pain Medicine (ISRAPM).

<45>
Accession Number
613927676
Title
Comparing the effects of isoflurane-sufentanil anesthesia and
propofol-sufentanil anesthesia on serum cortisol levels in open heart
surgery with cardiopulmonary bypass.
Source
Anesthesiology and Pain Medicine. 6(6) (no pagination), 2016. Article
Number: e42066. Date of Publication: December 2016.
Author
Sedighinejad A.; Imantalab V.; Mirmansouri A.; Nabi B.N.; Tarbiat M.;
Sadeghi A.M.; Sheikhani N.N.; Haghighi M.; Varag Z.S.
Institution
(Sedighinejad, Imantalab, Mirmansouri, Tarbiat) Anesthesiology Research
Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran, Islamic
Republic of
(Nabi) Anesthesiology Department, Anesthesiology Research Center, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Sadeghi, Sheikhani) Department of Cardiology, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Haghighi) Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Varag) Department of Anesthesiology, Anesthesiology Research Center,
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Major surgeries such as open-heart surgery with
cardiopulmonary bypass are associated with a complexity of stress response
leading to post-operative complications. Studies have confirmed that
anesthesia can mitigate the surgically induced stress response.
 Objective(s): The aim of this study was to compare the effects of
propofol and isoflurane, both supplemented with Sufentanil, on the stress
response in coronary artery bypass graft surgery with cardiopulmonary
bypass, using cortisol as a biochemical marker. Method(s): This
double-blind randomized clinical trial was conducted on 72 patients who
underwent coronary artery bypass grafting (CABG) with cardiopulmonary
bypass meeting the inclusion criteria. The subjects were randomly divided
into two groups of isoflurane (n = 36) and propofol (n = 36) both
supplemented with sufentanil. Serum cortisol levels were measured and
compared between the groups; 30 minutes before the surgery (T0), at the
end of the cardiopulmonary bypass (T1), and 24 hours after the surgery
(T2). Result(s): Compared to the baseline (T0), at the end of
cardiopulmonary bypass (T1), both groups demonstrated a decrease in plasma
cortisol levels with no statistical significant difference (P = 0.4). At
T2 measuring time point, the level of plasma cortisol significantly
increased in both groups (P = 0.02), however this increase was less in the
Isoflurane group. Conclusion(s): In CABG with cardiopulmonary bypass,
using plasma cortisol level as a measure, Isoflurane-Sufentanil
significantly reduces the stress response to the surgery, when compared to
propofol-Sufentanil. Copyright © 2016, Iranian Society of
Regional Anesthesia and Pain Medicine (ISRAPM).

<46>
Accession Number
613927661
Title
Paracetamol instead of ketorolac in post-video-assisted thoracic surgery
pain management: A randomized trial.
Source
Anesthesiology and Pain Medicine. 6(6) (no pagination), 2016. Date of
Publication: December 2016.
Author
Fard A.J.; Farzanegan B.; Khalili A.; Ahmadabad N.E.; Kakhaki A.D.; Parsa
T.; Mahjoobifard M.; Khabiri M.; Eraghi M.G.
Institution
(Fard, Kakhaki) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Farzanegan) Tracheal Diseases Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Khalili, Ahmadabad, Parsa) Anesthesiology Research Center, Masih
Daneshvari Hospital, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Mahjoobifard) Children and Adolescent Health Research Center,
Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences,
Zahedan, Iran, Islamic Republic of
(Khabiri) Anesthesiology Research Center, Taleghani Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Eraghi) Chronic Respiratory Diseases Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Video-assisted thoracic surgery (VATS) is a minimally invasive
procedure that is growing more common around the world. Despite causing
less pain compared open thoracic surgery, postoperative pain management is
still important. Objective(s): The aim of the present study was to
compare the analgesic effects of paracetamol and ketorolac in VATS
patients. Method(s): This was a double-blinded randomized clinical
trial conducted on 70 patients undergoing lobectomy or segmentectomy due
to lung masses, using video-assisted methods. The patients were randomly
divided into two groups (each n = 35): the ketorolac (K) group and the
paracetamol (P) group. The K group received ketorolac 30 mg IV stat at the
end of surgery and then a 90 mg/24 h infusion. The P group received
paracetamol 1 g IV stat at the end of surgery and then a 3 g/24 h
infusion. Pain scores were recorded during recovery and 2, 4, 8, 12, and
24 hours after drug administration. Pain scores, total doses of rescue
analgesics, and patient satisfaction levels were compared between the
groups. Result(s): There was no significant difference between the K
and P groups in pain scores in any of the evaluations. Seventeen (48.6%)
and 9 (25.7%) patients in the K and P groups, respectively, did not
require any rescue analgesia (P = 0.047). The mean doses of rescue
analgesia in the K and P groups were 3.129+/-4.27 mg and 4.38+/-3.69 mg,
respectively, which were similar (P = 0.144). There was no significant
difference between the groups in satisfaction scores (P = 0.175).
 Conclusion(s): Paracetamol 1 g stat + 3 g/24 h infusion is as
effective as ketorolac 30 mg stat + 90 mg/24 h infusion in post-VATS pain
management, with good tolerability and a low incidence of adverse
effects. Copyright © 2016, Iranian Society of Regional Anesthesia
and Pain Medicine (ISRAPM).

<47>
Accession Number
612722028
Title
The effect of desmopressin on the amount of bleeding in patients
undergoing coronary artery bypass graft surgery with a cardiopulmonary
bypass pump after taking anti-platelet medicine.
Source
Anesthesiology and Pain Medicine. 6(5) (no pagination), 2016. Article
Number: e39226. Date of Publication: October 2016.
Author
Mirmansoori A.; Farzi F.; Sedighinejad A.; Imantalab V.; Mohammadzadeh A.;
Roushan Z.A.; Tehran S.G.; Nemati M.; Dehghan A.
Institution
(Mirmansoori, Farzi, Sedighinejad, Imantalab, Mohammadzadeh, Tehran,
Nemati, Dehghan) Anesthesiology Research Center, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Roushan) Department of Statistics, Guilan University of Medical Sciences,
Rasht, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Coronary artery bypass grafting (CABG) is a common surgical
intervention at the end-stages of coronary artery occlusion disease.
Despite the effectiveness of CABG, it may have particular complications,
such as bleeding during and after surgery. So far, there have been many
drugs used to reduce bleeding. Objective(s): This study aimed at
investigating the effects of desmopressin on the amount of bleeding in
patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who
were taking anti-platelet medicine. Method(s): One hundred patients
scheduled for elective CABG with a CPBP were included in a prospective,
placebo-controlled, double-blinded clinical trial study. They were
randomly divided into two groups. One group received desmopressin (40 mug)
and the other group received a placebo (isotonic saline). Seven patients
were excluded from the study, and 47 and 46 patients participated in the
desmopressin and control groups, respectively. The methods of monitoring
and the anesthetic techniques were similar in both groups, and all
surgeries were performed by one surgeon. Variables including age, gender,
pump time, aortic clamp time, duration of surgery, complications (e.g.,
nausea and vomiting, blood pressure changes), the necessity to receive
blood products, and coagulation tests (prothrombin time, partial
thromboplastin time, international normalized ratio, and bleeding time)
were assessed. Data were statistically analyzed with SPSS software version
17. Result(s): There wasnosignificant difference between the groups
regarding age, gender, pumptime, clamp time, duration of surgery,
complications, and the changes in hemoglobin and coagulation test
measurements (P > 0.05). No significant difference was noted between the
groups regarding the rate of bleeding after surgery (359.3 +/- 266.2 in
group D vs. 406.3 +/- 341.6 in group P (control group); P = 0.208).
However, the platelet changes after surgery in both groups were
significantly different. The analysis revealed that the rate of
thrombocytopenia after surgery was higher in the control group (P =
0.012). Conclusion(s): Our study showed that desmopressin could not
reduce the amount of blood loss after CABG. Also, desmopressin did not
have a significant effect on coagulation status. Therefore, based on the
results of our study, it seems that the use of this medication cannot be a
helpful for patients with any indication for CABG. Copyright ©
2016, Kowsar Medical Publishing Company. All rights reserved.

<48>
Accession Number
612721942
Title
Ultrasound for localization of central venous catheter: A good alternative
to chest X-ray?.
Source
Anesthesiology and Pain Medicine. 6(5) (pp 1-7), 2016. Article Number:
e38834. Date of Publication: October 2016.
Author
Kamalipour H.; Ahmadi S.; Kamali K.; Moaref A.; Shafa M.; Kamalipour P.
Institution
(Kamalipour, Ahmadi) Anesthesiology and Critical Care Research Center,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Kamali) Medical Imaging Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Moaref) Department of Cardiology, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Shafa) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Kamalipour) Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Chest radiography after central venous catheter (CVC)
insertion is the mainmethod of verifying the catheter location. Despite
the widespread use of radiography for detecting catheter position, x-ray
may not always be readily available, especially in the operating room.
 Objective(s): We aimed to compare contrast-enhanced ultrasonography
(CEUS) and chest radiography for detecting the correct location of CVCs.
 Method(s): One hundred sixteen consecutive patients with indications
for CVC before cardiac surgery were enrolled in this observational study.
After catheter insertion, CEUS was performed. Portable radiography was
obtained postoperatively in the intensive care unit. Sensitivity,
specificity, and predictive values were determined by comparing the
ultrasonography results with radiographic findings as a reference
standard. Result(s): Chest radiography revealed 16 CVC misplacements:
two cases of intravascular and 14 cases of right atrium (RA) misplacement.
CEUS detected 11 true catheter malpositionings in the RA, while it could
not recognize seven catheter placements correctly. CEUS showed two false
RA misplacements and five falsely correct CVC positions. A sensitivity of
98% and specificity of 69% were achieved for CEUS in detecting CVC
misplacements. Positive and negative predictive values were 95% and 85%,
respectively. The interrater agreement (kappa) between CEUS and
radiography was 0.72 (P < 0.001). Conclusion(s): Despite close
concordance between ultrasonography and chest radiography, CEUS is not a
suitable alternative for standard chest radiography in detecting CVC
location; however, considering its high sensitivity and acceptable
specificity in our study, its usefulness as a triage method for detecting
CVC location on a real-time basis in the operating room cannot be
ignored. Copyright © 2016, Kowsar Medical Publishing Company. All
rights reserved.

<49>
Accession Number
611418394
Title
The effect of pre-emptive dexmedetomidine on the incidence of
post-thoracotomy pain syndrome in patients undergoing coronary artery
bypass grafting.
Source
Anesthesiology and Pain Medicine. 6(3) (no pagination), 2016. Article
Number: e36344. Date of Publication: June 2016.
Author
Jabbary Moghaddam M.; Barkhori A.; Mirkheshti A.; Hashemian M.; Amir
Mohajerani S.
Institution
(Jabbary Moghaddam, Mirkheshti, Amir Mohajerani) Department of
Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Barkhori, Hashemian) Department of Anesthesiology and Pain Medicine,
Kerman University of Medical Sciences, Kerman, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Post-thoracotomy pain syndrome (PTPS) is pain that recurs or
persists along a thoracotomy incision for at least two months following
surgery. Dexmedetomidine (dex) is an alpha-2 agonist that also has
analgesic, sedative-hypnotic, and sympatholytic properties.
 Objective(s): To determine the effect of pre-emptive dexmedetomidine
on the incidence of PTPS in patients undergoing coronary artery bypass
grafting (CABG). Patients and Methods: This randomized clinical trial
enrolled 104 candidates for elective coronary artery bypass grafting
(CABG) and randomly assigned them to either a dex group or a control
group. In the dex group, dexmedetomidine 0.5 microg/kg/hour was infused
from the initiation of anesthesia until postoperative extubation in the
intensive-care unit. Two months after surgery, the patients were contacted
by telephone and interviewed to determine the presence of pain at the
thoracotomy scars. Result(s): Fifty-four patients were placed in the
control group, and 50 patients were assigned to the dex group. The age,
sex, and body mass index were not significantly different between the two
groups of study (P> 0.05). The incidence of PTPS was 11/50 (22%) patients
in the dex group and 28/54 patients (52%) in the control group. A
chi-square test revealed a significant difference in the incidence of PTPS
after two months between the dex and control groups (P = 0.032).
 Conclusion(s): PTPS is a common problem following CABG, and
pre-emptive therapy with dex may decrease neuropathic pain. Copyright
© 2016, Iranian Society of Regional Anesthesia and Pain Medicine
(ISRAPM).

<50>
Accession Number
611418389
Title
The effect of green tea gargle solution on sore throat after coronary
artery bypass grafting: A randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 6(3) (no pagination), 2016. Article
Number: e32108. Date of Publication: June 2016.
Author
Jafari H.; Ariaeifar M.R.; Charati J.Y.; Soleimani A.; Nasiri Formi E.
Institution
(Jafari) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Ariaeifar) Student Research Center, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Charati) Department of Biostatistics, School of Health, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Soleimani) Department of Anesthesiology, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Nasiri Formi) Department of Anesthesiology, School of Paramedical,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Tracheal intubation is an essential method of keeping the
airway open in patients under general anesthesia. Sore throat is a
prevalent complication after endotracheal intubation. Objective(s):
The aim of this study was to investigate the effect of green tea gargling
on sore throat after coronary artery bypass grafting (CABG). Patients
and Methods: This was a single-blind, randomized clinical trial, in which
121 patients who had undergone CABG were divided into two groups: those
who gargled distilled water and those who gargled a green tea solution. An
hour after extubation, the patients of the intervention group were asked
to gargle 30 cc of green tea, and the patients of the control group were
asked to gargle 30 cc of distilled water, every 6 hours for up to 24 hours
(four times per patient). A sore throat questionnaire was filled out 6,
12, and 24 hours after endotracheal extubation. Result(s): The
results showed that there were no significant differences between the two
groups with regard to patient age, sex, body mass index, smoking
background, and duration of anesthesia. There was no significant
difference between the two groups in terms of sore throat before the
intervention (P = 0.461) and 6 hours after the intervention (P = 0.901).
However, a significant difference was observed between the two groups in
terms of sore throat 12 hours (P = 0.047) and 24 hours (P < 0.001) after
removing the endotracheal tube. Conclusion(s): Gargling a green tea
solution, an anti-inflammatory, natural, and harmless substance, can
reduce the pain of sore throat in patients after endotracheal
extubation. Copyright © 2016, Iranian Society of Regional
Anesthesia and Pain Medicine (ISRAPM).

<51>
Accession Number
611418386
Title
Preemptive oral clonidine provides better sedation than intravenous
midazolam in brachial plexus nerve blocks.
Source
Anesthesiology and Pain Medicine. 6(3) (no pagination), 2016. Article
Number: e28768. Date of Publication: June 2016.
Author
Mosaffa F.; Mohajerani S.A.; Aminnejad R.; Solhpour A.; Dabir S.; Mohseni
G.R.
Institution
(Mosaffa, Mohajerani, Aminnejad, Solhpour, Dabir, Mohseni) Department of
Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Preemptive analgesia is the blocking of pain perception
afferent pathways before noxious painful stimuli. Clonidine is an alpha
agonist drug that is partially selective for alpha-2 adrenoreceptors.
Clonidine is used as anti-anxiety medication and an, analgesic, and it
prolongs the duration of the block in the brachial plexus block.
 Objective(s): To compare the effect of preemptive clonidine with
midazolam on intraoperative sedation, duration of block, and postoperative
pain scores. Patients and Methods: In a randomized clinical trial, 80
patients with orthopedic fractures of an upper extremity who underwent
supraclavicular nerve block were randomly assigned to receive 0.2 mg oral
clonidine or 2 mg oral midazolam. Intraoperative sedation was measured at
one hour after the start of urgery and again in the PACU (Post-Anesthesia
Care Unit) using the Ramsay scale. The duration of sensory blockade was
measured. Postoperative pain scores were measured using the VAS (Visual
Analogue Scale) after entrance to recovery up to 2 hours. Result(s):
The percentages of patients in the calm and sedated scale were
significantly higher in clonidine group (35 and 42.5%, respectively),
compared to the midazolam group (17.5 and 17.5%, respectively) (P = 0.042,
0.029; respectively). Those administered fentanyl in the clonidine group
105+/-30.8 was significantly lower than that for the midazolam group
165+/-34.5 (P = 0.0018). The percentages of patients in the calm scale
were significantly higher in the clonidine group (52.5), compared to the
midazolam group (17.5) (P = 0.001) in the post-operative period. VAS
scores were significantly lower at one (P = 0.01) and two hours (P =
0.001) after operation in the clonidine group, compared to the midazolam
group. Conclusion(s): Preemptive clonidine has many marvelous
advantages over midazolam, including better sedation inside the operating
room and then in the post-operative care unit, lower fentanyl doses are
required during surgery, more stable heart rate and blood pressure are
observed during the procedure, and patients report lower post-operative
pain scores. Copyright © 2016, Iranian Society of Regional
Anesthesia and Pain Medicine (ISRAPM).

<52>
Accession Number
605498874
Title
Heparinized and saline solutions in the maintenance of arterial and
central venous catheters after cardiac surgery.
Source
Anesthesiology and Pain Medicine. 5(4) (no pagination), 2015. Article
Number: e23963. Date of Publication: 01 Aug 2015.
Author
Ziyaeifard M.; Alizadehasl A.; Aghdaii N.; Sadeghi A.; Azarfarin R.;
Masoumi G.; Golbargian G.
Institution
(Ziyaeifard, Alizadehasl, Aghdaii, Sadeghi, Azarfarin, Golbargian) Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Masoumi) Department of Anesthesiology, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Heparinized saline solution is used to prevent occlusion in
the arterial catheters and central venous pressure monitoring catheters.
Even at low dose, heparin administration can be associated with serious
complications. Normal saline solution can maintain patency of arterial
catheters and central venous pressure monitoring catheters.
 Objective(s): The current study aimed to compare the efficacy of
normal saline with that of heparinized one to maintain patency of arterial
and central venous catheters after cardiac surgery. Patients and
Methods: In the current randomized controlled trial, 100 patients, with an
age range of 18 - 65 years of valve and coronary artery surgery were
studied in Rajaie heart center, Tehran, Iran. Patients were randomized to
receive either heparinized saline (n = 50) or normal saline flush
solutions (n = 50). In the study, arterial catheters and central venous
pressure monitoring catheters were daily checked for any signs of
occlusion in three postoperative days as primary end-point of the study.
 Result(s): According to the information obtained from the study, four
(8%) arterial catheters in the saline group (P value: 0.135) and three
(6%) arterial catheters in the heparin group (P value = 0.097) were
obstructed. Statistical analysis showed that the incidence of obstruction
and changes in all other parameters between the two groups during the
three-day follow-up was not significant (all P values > 0.05).
 Conclusion(s): It seems that there is no difference in the use of
heparinized and normal saline solutions to prevent catheter occlusion of
arterial and central venous pressure. Copyright © 2015, Iranian
Society of Regional Anesthesia and Pain Medicine (ISRAPM).

<53>
Accession Number
605185305
Title
Hemodynamic responses to two different anesthesia regimens in compromised
left ventricular function patients undergoing coronary artery bypass graft
surgery: Etomidate-midazolam versus propofol-ketamine.
Source
Anesthesiology and Pain Medicine. 5(3) (no pagination), 2015. Article
Number: e27966. Date of Publication: 22 Jun 2015.
Author
Aghdaii N.; Ziyaeifard M.; Faritus S.Z.; Azarfarin R.
Institution
(Aghdaii, Ziyaeifard, Faritus, Azarfarin) Rajaie Cardiovascular Medical
Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Various methods have been suggested to prevent hemodynamic
instability caused by propofol and adverse effects caused by etomidate
induction. The current study evaluated hemodynamic effects of
propofol-ketamine mixture in comparison to etomidate-midazolam mixture
during anesthesia induction. Objective(s): The aim of this study was
to evaluate the hemodynamic effects of etomidate-midazolam by comparing it
with propofol-ketamine for the induction of anesthesia in patients with
left ventricular dysfunction undergoing coronary artery bypass graft
surgery. Patients and Methods: One-hundred patients aged between 40
and 65 with coronary artery disease and low ejection fraction scheduled
for elective coronary artery bypass surgery participated in this study.
The patients were randomly allotted to one of the two groups to receive
either propofol-ketamine or etomidate-midazolam combination. Two groups
were compared for pain on injection and myoclonus, Heart Rate (HR),
Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean
Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular
Resistance (SVR), before and one minute after induction of anesthesia, and
one, three and five minutes after intubation. Result(s): Incidence of
pain on injection (2 - 4%) and myoclonus (10%) was less in both groups.
The hemodynamic response was similar in the two groups for all variables
over the time interval, except for CI at one and three minutes after
intubation (P = 0.024 and P = 0.048, respectively), and SVR in five
minutes after intubation (P = 0.009), with differences being statistically
significant. Conclusion(s): Both anesthetic regimens were acceptable
for induction in patients with coronary artery disease and left
ventricular dysfunction undergoing coronary artery bypass graft
surgery. Copyright © 2015, Iranian Society of Regional Anesthesia
and Pain Medicine (ISRAPM).

<54>
Accession Number
604876213
Title
Oral dexmedetomidine versus midazolam as anesthetic premedication in
children undergoing congenital heart surgery.
Source
Anesthesiology and Pain Medicine. 5(3) (no pagination), 2015. Article
Number: e25032. Date of Publication: 01 Jun 2015.
Author
Faritus S.Z.; Khazaee-Koohpar M.; Ziyaeifard M.; Mehrabanian M.J.
Institution
(Faritus, Khazaee-Koohpar, Ziyaeifard, Mehrabanian) Rajaie Cardiovascular,
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Premedication is required for reducing anxiety and child's
struggling against mask acceptance on anesthesia in pediatric surgery for
congenital heart disease. Midazolam has been widely used for this purpose,
but because of its side effects, finding an effective replacement with
less complication is necessary. Objective(s): In the present study,
we compared the efficacy of oral midazolam versus dexmedetomidine in terms
of anxiolysis and mask acceptance behavior. Patients and Methods:
Sixty children aged between 2 and 12 years, and scheduled for on-pump
surgery due to a congenital heart disease were randomly assigned into two
groups. Oral midazolam (0.5 mg/kg up to 15 mg per patient) and
dexmedetomidine (2 mug/kg) were administered 45 minutes pre-anesthesia.
Children's anxiety, mask acceptance behavior, hemodynamic measures, and
cardiopulmonary outcomes were recorded and compared. Result(s): The
mean age of patients was 3.96 +/- 2.04 years. Twenty-eight (46.7%)
patients were females. Two drugs have similar effects on cardiopulmonary
outcomes and hemodynamic measures (P > 0.05). They equally relieved the
children's anxiety (mean sedation score 1.93 +/- 0.63 and 2.0 +/- 0.63 for
midazolam and dexmedetomidine groups, respectively; P > 0.05), while
dexmedetomidine showed a better effect on improving the mask acceptance
behavior (mean mask acceptance score 2.58 +/- 0.6 and 1.6 +/- 0.67 for
midazolam and dexmedetomidine, respectively; P < 0.05).
 Conclusion(s): It appears reasonable to apply oral premedication with
dexmedetomidine 45 minutes before transferring the patient to the
operating room when he or she is more prone to resist inhalation
anesthesia induction. Copyright © 2015, Iranian Society of
Regional Anesthesia and Pain Medicine (ISRAPM).

<55>
Accession Number
638187189
Title
Lidocaine Infusion for the Management of Postoperative Pain and Delirium
(LIMPP): protocol for a randomised control trial.
Source
BMJ Open. 12(6) (no pagination), 2022. Article Number: e059416. Date of
Publication: 06 Jun 2022.
Author
Buren M.A.; Theologis A.; Zuraek A.; Behrends M.; Clark A.J.; Leung J.M.
Institution
(Buren, Zuraek, Behrends, Leung) Anesthesia and Perioperative Care,
University of California San Francisco, San Francisco, CA, United States
(Theologis) Orthopedic Surgery, University of California San Francisco,
San Francisco, CA, United States
(Clark) Neurological Surgery, University of California San Francisco, San
Francisco, CA, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium is a frequent adverse event following
elective non-cardiac surgery. The occurrence of delirium increases the
risk of functional impairment, placement to facilities other than home
after discharge, cognitive impairment at discharge, as well as in-hospital
and possibly long-term mortality. Unfortunately, there is a dearth of
effective strategies to minimise the risk from modifiable risk factors,
including postoperative pain control and the analgesic regimen. Use of
potent opioids, currently the backbone of postoperative pain control,
alters cognition and has been associated with an increased risk of
postoperative delirium. Literature supports the intraoperative use of
lidocaine infusions to decrease postoperative opioid requirements,
however, whether the use of postoperative lidocaine infusions is
associated with lower opioid requirements and subsequently a reduction in
postoperative delirium has not been investigated. Methods and analysis The
Lidocaine Infusion for the Management of Postoperative Pain and Delirium
trial is a randomised, double-blinded study of a postoperative 48-hour
infusion of lidocaine at 1.33 mg/kg/hour versus placebo in older patients
undergoing major reconstructive spinal surgery at the University of
California, San Francisco. Our primary outcome is incident delirium
measured daily by the Confusion Assessment Method in the first three
postoperative days. Secondary outcomes include delirium severity, changes
in cognition, pain scores, opioid use, incidence of opioid related side
effects and functional benefits including time to discharge and improved
recovery from surgery. Lidocaine safety will be assessed with daily
screening questionnaires and lidocaine plasma levels. Ethics and
dissemination This study protocol has been approved by the ethics board at
the University of California, San Francisco. The results of this study
will be published in a peer-review journal and presented at national
conferences as poster or oral presentations. Participants wishing to know
the results of this study will be contacted directly on data publication.
Trial registration number NCT05010148. Copyright © Author(s) (or
their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial
re-use. See rights and permissions. Published by BMJ.

<56>
Accession Number
2016140820
Title
Effect of Cyclosporine on Cytokine Production in Elective Coronary Artery
Bypass Grafting: A Sub-Analysis of the CiPRICS (Cyclosporine to Protect
Renal Function in Cardiac Surgery) Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(7) (pp 1985-1994),
2022. Date of Publication: July 2022.
Author
Grins E.; Ederoth P.; Bjursten H.; Dardashti A.; Bronden B.; Metzsch C.;
Erdling A.; Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson
L.; Shrestha N.M.; Jovinge S.
Institution
(Grins, Ederoth, Dardashti, Bronden, Metzsch, Erdling, Algotsson)
Department of Cardiothoracic Anesthesia and Intensive Care, Department of
Clinical Sciences, Lund University, Skane University Hospital, Lund,
Sweden
(Bjursten, Nozohoor, Mokhtari) Department of Cardiothoracic Surgery,
Department of Clinical Sciences Lund University, Skane University
Hospital, Lund, Sweden
(Hansson, Elmer) Mitochondrial Medicine, Department of Clinical Sciences
Lund, Lund University, Lund, Sweden
(Shrestha, Jovinge) DeVos Cardiovascular Research Program, Fredrik Meijer
Heart and Vascular Institute Spectrum Health/Van Andel Institute, Grand
Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Palo Alto, CA
Publisher
W.B. Saunders
Abstract
Objectives: The augmented inflammatory response to cardiac surgery is a
recognized cause of postoperative acute kidney injury. The present study
aimed to investigate the effects of preoperative cyclosporine treatment on
cytokine production and delineate factors associated with postoperative
kidney impairment. Design(s): A randomized, double-blind,
placebo-controlled, single-center study. Setting(s): At a tertiary
care, university hospital. Participant(s): Patients eligible for
elective coronary artery bypass grafting surgery; 67 patients were
enrolled. Intervention(s): Patients were randomized to receive 2.5
mg/kg cyclosporine or placebo before surgery. Cytokine levels were
measured after the induction of anesthesia and 4 hours after the end of
cardiopulmonary bypass. Measurements and Main Results:
Tissue-aggressive (interleukin [IL]-1beta, macrophage inflammatory protein
[MIP]-1beta, granulocyte colony-stimulating factor [G-CSF], IL-6, IL-8,
IL-17, MCP-1), as well tissue-lenient (IL-4) cytokines, were significantly
elevated in response to surgery. Changes in cytokine levels were not
affected by cyclosporine pretreatment. Conclusion(s): Elective
coronary artery bypass grafting surgery with cardiopulmonary bypass
triggers cytokine activation. This activation was not impacted by
preoperative cyclosporine treatment. Copyright © 2021 Elsevier
Inc.

<57>
Accession Number
2018357814
Title
Effect of S-ketamine on Postoperative Quality of Recovery in Patients
Undergoing Video-Assisted Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Part B. 36(8) (pp
3049-3056), 2022. Date of Publication: August 2022.
Author
Cheng X.; Wang H.; Diao M.; Jiao H.
Institution
(Cheng, Wang, Diao, Jiao) Department of Anesthesiology, The Affiliated
Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, China
Publisher
W.B. Saunders
Abstract
Objectives: S-ketamine is associated with effective postoperative
analgesia and enhanced quality of recovery (QoR). The study aimed to
investigate the effect of perioperative S-ketamine on postoperative
quality of recovery in patients undergoing video-assisted thoracic surgery
(VATS). Design(s): A prospective, randomized, double-blinded,
placebo-controlled trial. Setting(s): Single institution, tertiary
university hospital. Participant(s): Eighty adult patients aged
18-to-65 undergoing VATS were eligible for participation.
 Intervention(s): Patients enrolled in this study were randomized to
receive either S-ketamine (a bolus of 0.25 mg/kg, followed by an infusion
of 0.125 mg/kg/h until 15 minutes before the end of the surgical
procedure), or identical volumes and rates of 0.9% saline.
 Measurements and Main Results: Postoperative quality of recovery was
measured with QoR-40 score 48 hours after surgery. The postoperative pain
was assessed postoperatively using the numeric rating scale at 0.5, 6, 24,
and 48 hours. Hospital Anxiety and Depression Scale Depression subscale
(HADS-D) scores and other secondary outcomes also were recorded. The final
analysis included 77 patients. The global QoR-40 score at 48 hours
postoperatively was higher in the S-ketamine group compared with the
saline group (median [interquartile range]: 181.5 [178-184] v 174.5
[169-177]), estimated median difference 7 (95% confidence interval 5-10, p
< 0.001). Patients who received S-ketamine treatment had lower pain scores
at rest (p = 0.017 and p = 0.006, respectively) and coughing (p < 0.001
and p = 0.007, respectively) at 24 and 48 hours postoperatively than those
who received saline treatment. The requirement and consumption of opioid
for rescue analgesic were lower in the S-ketamine (p = 0.045 and p =
0.047, respectively). Compared with the saline group, S-ketamine reduced
HADS-D scores (p = 0.003) at 48 hours after surgery. Conclusion(s):
The present study's findings suggested that perioperative S-ketamine
enhanced the quality of recovery in patients undergoing VATS. S-ketamine
also improved postoperative analgesia and postoperative
depression. Copyright © 2022 Elsevier Inc.

<58>
[Use Link to view the full text]
Accession Number
2018362125
Title
Tranexamic acid rapidly inhibits fibrinolysis, yet transiently enhances
plasmin generation in vivo.
Source
Blood Coagulation and Fibrinolysis. 32(3) (pp 172-179), 2021. Date of
Publication: 01 Apr 2021.
Author
Draxler D.F.; Zahra S.; Goncalves I.; Tran H.; Hanafi G.; Ho H.; Keragala
C.B.; Ilich A.; Key N.S.; Myles P.S.; Medcalf R.L.
Institution
(Draxler, Zahra, Goncalves, Tran, Hanafi, Ho, Keragala, Medcalf)
Australian Centre for Blood Diseases, Monash University, Melbourne, VIC,
Australia
(Ilich, Key) Division of Hematology, Blood Research Center, Department of
Medicine, University of North Carolina, Chapel Hill, NC, United States
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital, Australia
(Myles) Department of Anaesthesiology and Perioperative Medicine, Monash
University, Melbourne, VIC, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Tranexamic acid (TXA) is a lysine analogue that inhibits plasmin
generation and has been used for decades as an antifibrinolytic agent to
reduce bleeding. Recent reports have indicated that TXA can paradoxically
promote plasmin generation. Blood was obtained from 41 cardiac surgical
patients randomly assigned to TXA or placebo before start of surgery
(preOP), at the end of surgery (EOS), then again on postoperative day 1
(POD-1) as well as POD-3. Plasma levels of tissue-type plasminogen
activator (t-PA), urokinase (u-PA), the plasmin-antiplasmin (PAP) complex,
as well as t-PA and u-PA-induced clot lysis assays were then determined.
Clot lysis and PAP complex levels were also assessed in healthy volunteers
before and at various time points after taking 1 g TXA orally. Surgery
induced an increase in circulating t-PA, yet not u-PA at EOS. t-PA levels
were unaffected by TXA; however, u-PA levels were significantly reduced in
patients on POD-3. t-PA and u-PA-induced clot lysis were both inhibited in
plasma from TXA-treated patients. In contrast, PAP complex formation,
representing plasmin generation, was unexpectedly enhanced in the plasma
of patients administered TXA at the EOS time point. In healthy volunteers,
oral TXA effectively blocked fibrinolysis within 30 min and blockade was
sustained for 8 h. However, TXA also increased PAP levels in volunteers 4
h after administration. Our findings demonstrate that TXA can actually
augment PAP complex formation, consistent with an increase in plasmin
generation in vivo despite the fact that it blocks fibrinolysis within 30
min. This may have unanticipated consequences in vivo. Copyright
© 2021 Lippincott Williams and Wilkins. All rights reserved.

<59>
Accession Number
2012324775
Title
Computed tomography derived predictors of permanent pacemaker implantation
after transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 98(6) (pp E897-E907),
2021. Date of Publication: 15 Nov 2021.
Author
Maier O.; Piayda K.; Afzal S.; Polzin A.; Westenfeld R.; Jung C.; Zeus T.;
Antoch G.; Kelm M.; Veulemans V.
Institution
(Maier, Piayda, Afzal, Polzin, Westenfeld, Jung, Zeus, Kelm, Veulemans)
Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich
Heine University, Medical Faculty, Dusseldorf, Germany
(Antoch) Department of Diagnostic and Interventional Radiology, Heinrich
Heine University, Medical Faculty, Dusseldorf, Germany
(Kelm) Heinrich Heine University, Medical Faculty, CARID (Cardiovascular
Research Institute Dusseldorf), Dusseldorf, Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This meta-analysis sought to assess predictors of permanent
pacemaker implantation (PPI) after transcatheter aortic valve replacement
(TAVR) with focus on preprocedural multi-slice computed tomography (MSCT)
derived data. Background(s): Transcatheter aortic valve replacement
(TAVR) has expanded to a well-established treatment for severe symptomatic
aortic stenosis at high and intermediate surgical risk. PPI after TAVR
remains one of the most frequent procedure-related complications and
appears to be influenced by several factors. Method(s): The authors
conducted a literature search in PubMed/MEDLINE and EMBASE databases to
identify studies that investigated preprocedural MSCT data and the rate of
PPI following TAVR with new-generation devices. Result(s): Ten
observational studies (n = 2707) met inclusion criteria for the final
analysis. PPI was performed in 387 patients (14.3%) after TAVR. Patients
requiring PPI had a larger annulus perimeter (MD: 1.66 mm; p <.001) and a
shorter membranous septum length (MD: -1.1 mm; p <.05). Concerning
calcification distribution, patients with requirement for new pacemaker
implantation showed increased calcification of the left coronary cusp (MD:
47.6 mm3; p <.001), and the total left ventricular outflow
tract (MD: 24.42 mm3; p <.01). Lower implantation depth (MD:
0.95 mm; p <.05) and oversizing (MD: 1.52%; p <.05) were procedural
predictors of PPI following TAVR. Conclusion(s): Besides the
well-known impact of electrocardiographic and procedure-related factors on
conduction disturbances, MSCT derived distribution of the aortic valve and
left ventricular outflow tract calcification, as well as membranous septum
length, are associated with an increased risk of PPI following
TAVR. Copyright © 2021 The Authors. Catheterization and
Cardiovascular Interventions published by Wiley Periodicals LLC.

<60>
Accession Number
638341678
Title
Coronary sinus reducer for the treatment of chronic refractory angina
pectoris.
Source
Future cardiology. 18(7) (pp 523-537), 2022. Date of Publication: 01 Jul
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, Cotignola 48033, Italy
Publisher
NLM (Medline)
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.

<61>
Accession Number
638272363
Title
Costs of Endoscopic vs Open Vein Harvesting for Coronary Artery Bypass
Grafting: A Secondary Analysis of the REGROUP Trial.
Source
JAMA Network Open. 5(6) (pp E2217686), 2022. Date of Publication: 21 Jun
2022.
Author
Wagner T.H.; Hattler B.; Stock E.M.; Biswas K.; Bhatt D.L.; Bakaeen F.G.;
Gujral K.; Zenati M.A.
Institution
(Wagner, Gujral) Health Economics Resource Center, Veterans Affairs Palo
Alto Health Care System, 795 Willow Rd, 152-MPD, Menlo Park, CA 94025,
United States
(Wagner) Department of Surgery, Stanford University, Stanford, CA, United
States
(Hattler) Rocky Mountain Regional Veterans Affairs Medical Center, Aurora,
CO, United States
(Hattler) Division of Cardiology, University of Colorado, Denver, United
States
(Stock, Biswas) Office of Research and Development, VA Cooperative Studies
Program Coordinating Center, Perry Point, MD, United States
(Bhatt) Division of Cardiovascular Medicine, Brigham and Women's Hospital
and Harvard Medical School, Boston, MA, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Zenati) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Zenati) Veterans Affairs Boston Healthcare System, Boston, MA, United
States
Publisher
American Medical Association
Abstract
Importance: Value-based purchasing creates pressure to examine whether
newer technologies and care processes, including new surgical techniques,
yield any economic advantage. Objective(s): To compare health care
costs and utilization between participants randomized to receive
endoscopic vein harvesting (EVH) or open vein harvesting (OVH) during a
coronary artery bypass grafting (CABG) procedure. Design, Setting,
and Participant(s): This secondary economic analysis was conducted
alongside the 16-site Randomized Endo-Vein Graft Prospective (REGROUP)
clinical trial funded by the Department of Veterans Affairs (VA)
Cooperative Studies Program. Adults scheduled for urgent or elective
bypass involving a vein graft were eligible. The first participant was
enrolled in September 2013, with most sites completing enrollment by March
2014. The last participant was enrolled in April 2017. A total of 1150
participants were randomized, with 574 participants receiving OVH and 576
receiving EVH. For this secondary analysis, cost and utilization data were
extracted through September 30, 2020. Participants were linked to
administrative data in the VA Corporate Data Warehouse and activity-based
cost data starting with the index procedure. Intervention(s): EVH vs
OVH, with comparisons based on intention to treat. Main Outcomes and
Measures: Discharge costs for the index procedure as well as follow-up
costs (including intended and unintended events; mean [SD] follow-up time,
33.0 [19.9] months) were analyzed, with results from different statistical
models compared to test for robustness (ie, lack of variation across
models). All costs represented care provided or paid by the VA,
standardized to 2020 US dollars. Result(s): Among 1150 participants,
the mean (SD) age was 66.4 (6.9) years; most participants (1144 [99.5%]
were male. With regard to race and ethnicity, 6 participants (0.5%)
self-reported as American Indian or Alaska Native, 10 (0.9%) as Asian or
Pacific Islander, 91 (7.9%) as Black, 62 (5.4%) as Hispanic, 974 (84.7%)
as non-Hispanic White, and 6 (0.5%) as other race and/or ethnicity; data
were missing for 1 participant (0.1%). The unadjusted mean (SD) costs for
the index CABG procedure were $76607 ($43 883) among patients who received
EVH and $75368 ($45900) among those who received OVH, including facility
costs, insurance costs, and physician-related costs (commonly referred to
as provider costs in Centers for Medicare and Medicaid and insurance
data). No significant differences were found in follow-up costs; per
90-day follow-up period, EVH was associated with a mean (SE) added cost of
$302 ($225) per patient. The results were highly robust to the statistical
model. Conclusions and Relevance: In this study, EVH was not
associated with a reduction in costs for the index CABG procedure or
follow-up care. Therefore, the choice to provide EVH may be based on
surgeon and patient preferences. Trial Registration: ClinicalTrials.gov
Identifier: NCT01850082. Copyright © 2022 American Medical
Association. All rights reserved.

<62>
Accession Number
2019010269
Title
Impact of cardiopulmonary bypass duration on efficacy of fibrinogen
replacement with cryoprecipitate compared with fibrinogen concentrate: a
post hoc analysis of the Fibrinogen Replenishment in Surgery (FIBRES)
randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2022. Date of
Publication: 2022.
Author
Bartoszko J.; Martinez-Perez S.; Callum J.; Karkouti K.; Farouh M.E.;
Scales D.C.; Heddle N.M.; Crowther M.; Rao V.; Hucke H.-P.; Carroll J.;
Grewal D.; Brar S.; Brussieres J.; Grocott H.; Harle C.; Pavenski K.;
Rochon A.; Saha T.; Shepherd L.; Syed S.; Tran D.; Wong D.; Zeller M.
Institution
(Bartoszko, Martinez-Perez, Karkouti) Department of Anesthesia and Pain
Management, University Health Network, Sinai Health System, Women's
College Hospital, University of Toronto, Toronto, ON, Canada
(Bartoszko, Karkouti) Peter Munk Cardiac Centre and Toronto General
Hospital Research Institute, University Health Network, Toronto, ON,
Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre, Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Toronto, ON, Canada
(Karkouti) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Ltd
Abstract
Background: Coagulopathy in cardiac surgery is frequently associated with
acquired hypofibrinogenaemia, which can be treated with either purified
fibrinogen concentrate (FC) or cryoprecipitate. Because the latter is not
purified and therefore contains additional coagulation factors, it is
thought to be more effective for treatment of coagulopathy that occurs
after prolonged cardiopulmonary bypass (CPB). We examined the impact of
CPB duration on the efficacy of the two therapies in cardiac surgery.
 Method(s): This was a post hoc analysis of the Fibrinogen
Replenishment in Surgery (FIBRES) RCT comparing FC (4 g) to
cryoprecipitate (10 U) in adult patients undergoing cardiac surgery and
experiencing bleeding with acquired hypofibrinogenaemia (n=735). The
primary outcome was allogeneic blood products transfused within 24 h after
CPB. Subjects were stratified by CPB duration (<=120, 121-180, and >180
min). The interaction of treatment assignment with CPB duration was
tested. Result(s): Subjects with longer CPB duration experienced more
bleeding and transfusion. With CPB time <=120 min (FC, n=134;
cryoprecipitate, n=146), the ratio of least-squares means between the FC
and cryoprecipitate groups for total allogeneic blood products at 24 h was
0.90 (one-sided 97.5% confidence interval [CI]: 0.00-1.12); P=0.004. For
subjects with CPB time 121-180 min, it was 1.00 ([one-sided 97.5% CI:
0.00-1.22]; P=0.03], and for CPB time >180 min it was 0.91 ([one-sided
97.5% CI: 0.00-1.12]; P=0.005). Results were similar for all secondary
outcomes, with no interaction between treatment and CPB duration for all
outcomes. Conclusion(s): The haemostatic efficacy of FC was
non-inferior to cryoprecipitate irrespective of CPB duration in cardiac
surgery. Clinical trial registration: NCT03037424. Copyright ©
2022 British Journal of Anaesthesia

<63>
Accession Number
2018831639
Title
Lack of Clinical Equipoise Renders Randomized-Trial Execution of Ross vs
Prosthetic Valves an Impossible Task.
Source
Journal of the American College of Cardiology. 80(1) (pp e7), 2022. Date
of Publication: 05 Jul 2022.
Author
Jahanyar J.; Mastrobuoni S.; Said S.M.; El Khoury G.; de Kerchove L.
Publisher
Elsevier Inc.

<64>
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

<65>
Accession Number
2003253092
Title
Comparison the effect of active cyclic breathing technique and routine
chest physiotherapy on pain and respiratory parameters after coronary
artery graft surgery: A randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 9(5) (no pagination), 2019. Article
Number: e94654. Date of Publication: 2019.
Author
Derakhtanjani A.S.; Jaberi A.A.; Haydari S.; Bonabi T.N.
Institution
(Derakhtanjani) Department of Medical Surgical Nursing, School of Nursing
and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,
Islamic Republic of
(Jaberi) Department of Psychiatric and Mental Health Nursing, School of
Nursing and Midwifery, Rafsanjan University of Medical Sciences,
Rafsanjan, Iran, Islamic Republic of
(Jaberi, Bonabi) Social Determinants of Health Research Center, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran, Islamic Republic of
(Haydari) Department of Fundamental Nursing, Geriatric Care Research
Center, School of Nursing and Midwifery, Rafsanjan University of Medical
Sciences, Rafsanjan, Iran, Islamic Republic of
(Bonabi) Department of Community Health Nursing, School of Nursing and
Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,
Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: There are limited reports available on preferred chest
physiotherapy methods in patients with coronary artery graft (CABG)
surgery. Objective(s): The aim of this study was to compare the
effect of active cyclic breathing technique (ACBT) and routine chest
physiotherapy on pain and respiratory parameters in patients undergoing
CABG surgery. Method(s): This randomized clinical trial was carried
out from July to November 2018. Seventy patients were selected randomly
after CABG according to inclusion criteria and then assigned in two groups
(35 in ACBT and 35 in routine physiotherapy) by random minimization
method. The arterial blood gas levels, pain, heart rate, and respiratory
rate were measured for both groups before and after the intervention on
two consecutive days after surgery. Data were analyzed by SPSS software
V.22, at a significance level of 0.05. Result(s): The two groups were
similar in terms of demographic variables. In within group comparison in
the physiotherapy group, the level of PaO<inf>2</inf>, HR, RR, and pain
increased significantly on both days (P = 0.001), SaO<inf>2</inf> on the
first day (P = 0.005) and second day (P = 0.001), and PaCO<inf>2</inf> on
the first day (P = 0.02). In ACBT group, the level of SaO<inf>2</inf>, HR,
RR, and pain increased significantly on both days (P = 0.001),
HCO<inf>3</inf> on the first day (P = 0.021), and PaO<inf>2</inf> on the
second day (P = 0.001) post intervention. In between group comparison, on
the first day, the level of PH (P = 0.034), and on the second day
HCO<inf>3</inf> (P = 0.032) decreased, while RR (P = 0.011) increased
significantly in the physiotherapy group, at post-intervention phase.
 Conclusion(s): ACBT and routine physiotherapy had similar effects on
arterial oxygenation, HR, and pain perception following CABG surgery. The
physiotherapy on the second day increased the RR to an abnormal
range. Copyright © 2019, Author(s).

<66>
Accession Number
2019052519
Title
Regional anesthesia and acute perioperative pain management in thoracic
surgery: a narrative review.
Source
Journal of Thoracic Disease. 14(6) (pp 2276-2296), 2022. Date of
Publication: June 2022.
Author
Hamilton C.; Alfille P.; Mountjoy J.; Bao X.
Institution
(Hamilton, Alfille, Mountjoy, Bao) Department of Anesthesia Critical Care
and Pain Medicine, Massachusetts General Hospital, Boston, MA, United
States
Publisher
AME Publishing Company
Abstract
Background and Objective: Thoracic surgery causes significant pain which
can negatively affect pulmonary function and increase risk of
postoperative complications. Effective analgesia is important to reduce
splinting and atelectasis. Systemic opioids and thoracic epidural
analgesia (TEA) have been used for decades and are effective at treating
acute post-thoracotomy pain, although both have risks and adverse effects.
The advancement of thoracoscopic surgery, a focus on multimodal and
opioid-sparing analgesics, and the development of ultrasound-guided
regional anesthesia techniques have greatly expanded the options for acute
pain management after thoracic surgery. Despite the expansion of surgical
techniques and analgesic approaches, there is no clear optimal approach to
pain management. This review aims to summarize the body of literature
regarding systemic and regional anesthetic techniques for thoracic surgery
in both thoracotomy and minimally invasive approaches, with a goal of
providing a foundation for providers to make individualized decisions for
patients depending on surgical approach and patient factors, and to
discuss avenues for future research. Method(s): We searched PubMed
and Google Scholar databases from inception to May 2021 using the terms
"thoracic surgery", "thoracic surgery AND pain management", "thoracic
surgery AND analgesia", "thoracic surgery AND regional anesthesia",
"thoracic surgery AND epidural". We considered articles written in English
and available to the reader. Key Content and Findings: There is a wide
variety of strategies for treating acute pain after thoracic surgery,
including multimodal opioid and non-opioid systemic analgesics, regional
anesthesia including TEA and paravertebral blocks (PVB), and a recent
expansion in the use of novel fascial plane blocks especially for
thoracoscopy. The body of literature on the effectiveness of different
approaches for thoracotomy and thoracoscopy is a rapidly expanding field
and area of active debate. Conclusion(s): The optimal analgesic
approach for thoracic surgery may depend on patient factors, surgical
factors, and institutional factors. Although TEA may provide optimal
analgesia after thoracotomy, PVB and emerging fascial plane blocks may
offer effective alternatives. A tailored approach using multimodal
systemic therapies and regional anesthesia is important, and future
studies comparing techniques are necessary to further investigate the
optimal approach to improve patient outcomes. Copyright © 2022
AME Publishing Company. All rights reserved.

<67>
Accession Number
2019052518
Title
Risk factors of wound infection after lung transplantation: a narrative
review.
Source
Journal of Thoracic Disease. 14(6) (pp 2268-2275), 2022. Date of
Publication: June 2022.
Author
Qian W.; Sun W.; Xie S.
Institution
(Qian, Sun) Division of Pulmonary and Critical Care Medicine, Sichuan
Academy of Medical Sciences, Sichuan Provincial People's Hospital,
University of Electronic Science and Technology of China, Chengdu, China
(Xie) Department of Thoracic Surgery, Sichuan Academy of Medical Sciences,
Sichuan Provincial People's Hospital, Chengdu, China
Publisher
AME Publishing Company
Abstract
Background and Objective: The incidence of incision infection after lung
transplantation is prominently high which affect the prognosis.
Summarizing the risk factors related to incision infection after lung
transplantation contribute to the control of incision infection by
pre-controlling the risk factors. The objective is to summarize risk
factors related to wound infection after lung transplantation.
 Method(s): PubMed was used to research the literature relating to the
risk factors to incision infection after lung transplantation through 1990
to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms
combined entry terms. Two researchers conducted the literature retrieval
independently. Two researchers independently evaluate the quality of the
literature and summarize the indicators. Key Content and Findings: A total
of 98 researches were collected from PubMed and 8 articles described the
related risk factors of incision infection after lung transplantation. All
of the 8 articles were retrospective studies, of which 4 articles were
grouped by the delayed chest closure (DCC) execution and the other 4
articles were grouped by the surgical site infection (SSI) occurred. Two
articles performed multivariate regression analysis to determine the
independent risk factors of SSI after lung transplantation and the other 6
articles compared the SSI rate in different patients population. The
integrated results showed that bronchoalveolar lavages (BALs), smoking
status, body mass index (BMI), diabetes, operation duration, thoracic
drainage tube placement time and DCC were related to the SSI after lung
transplantation. Conclusion(s): BALs, smoking status, BMI, diabetes,
operation duration, thoracic drainage tube placement time and DCC were
related to the SSI after lung transplantation. Copyright © 2022
AME Publishing Company. All rights reserved.

<68>
[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.

<69>
Accession Number
2019010286
Title
Benefits of icosapent ethyl for enhancing residual cardiovascular risk
reduction: A review of key findings from REDUCE-IT.
Source
Journal of Clinical Lipidology. (no pagination), 2022. Date of
Publication: 2022.
Author
Gaba P.; Bhatt D.L.; Mason R.P.; Miller M.; Verma S.; Steg P.G.; Boden
W.E.
Institution
(Gaba, Bhatt, Mason) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115,
United States
(Mason) Elucida Research LLC, Beverly, MA, United States
(Miller) Crescenz Veterans Affairs, University of Pennsylvania School of
Medicine, Philadelphia, PA, United States
(Verma) Division of Cardiac Surgery, University of Toronto, Toronto,
Canada
(Steg) Universite de Paris-Cite, FACT (French Alliance for Cardiovascular
Trials), Assistance Publique-Hopitaux de Paris, Hopital Bichat, INSERM
Unite, Paris 1148, France
(Boden) VA Boston Healthcare System, Division of Cardiovascular Medicine,
Boston University School of Medicine, Boston, MA, United States
Publisher
Elsevier Ltd
Abstract
Background. REDUCE-IT was a multinational, double-blind trial that
randomized 8179 statin-treated patients with controlled low-density
lipoprotein cholesterol and moderately elevated triglycerides to icosapent
ethyl (IPE) or placebo. IPE was associated with a substantial reduction in
the primary composite endpoint of death from cardiovascular causes,
nonfatal myocardial infarction, nonfatal stroke, coronary
revascularization, or unstable angina requiring hospitalization. Since the
original publication of the trial, there have been a myriad of additional
analyses confirming the benefit of IPE in various patient groups. Our
objectives in this review are to summarize the key findings of the
REDUCE-IT trial and its subsequent analyses as well as to call for the
reevaluation and expansion of current guidelines to incorporate IPE as a
therapy for patients at elevated cardiovascular risk with mild or moderate
hypertriglyceridemia. Copyright © 2022

<70>
Accession Number
2018975238
Title
Significant Valvular Dysfunction and Outcomes in Cardiogenic Shock:
Insights From the Randomized DOREMI Trial.
Source
Canadian Journal of Cardiology. (no pagination), 2022. Date of
Publication: 2022.
Author
Parlow S.; Weng W.; Di Santo P.; Jung R.G.; Lepage-Ratte M.F.; Motazedian
P.; Prosperi-Porta G.; Abdel-Razek O.; Simard T.; Chan V.; Labinaz M.;
Froeschl M.; Mathew R.; Hibbert B.
Institution
(Parlow, Weng, Di Santo, Jung, Lepage-Ratte, Motazedian, Prosperi-Porta,
Abdel-Razek, Labinaz, Froeschl, Mathew, Hibbert) CAPITAL Research Group,
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON,
Canada
(Parlow, Weng, Di Santo, Motazedian, Prosperi-Porta, Abdel-Razek, Labinaz,
Froeschl, Mathew, Hibbert) Division of Cardiology, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(Di Santo) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
(Jung, Hibbert) Department of Cellular and Molecular Medicine, University
of Ottawa, Ottawa, ON, Canada
(Jung) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Lepage-Ratte) Department of Medicine, University of Ottawa, Ottawa, ON,
Canada
(Simard) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, Rochester, MN, United States
(Chan) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Patients with cardiogenic shock (CS) suffer high rates of
in-hospital mortality, with little evidence guiding management. The impact
of valvular heart disease in patients with CS remains unclear. We
therefore conducted a post hoc analysis of the randomized Dobutamine
Compared to Milrinone (DOREMI) trial to determine the impact of valvular
disease on outcomes in patients with CS. Method(s): We defined
significant valvular disease as moderate to severe or greater valvular
stenosis or regurgitation and divided participants into a group of those
with significant valvular disease and those without. Our primary outcome
was all-cause in-hospital mortality. Secondary endpoints included
resuscitated cardiac arrest; cardiac transplantation or mechanical
circulatory support; nonfatal myocardial infarction; stroke; initiation of
renal replacement therapy; as well as changes in renal function,
perfusion, and hemodynamics over time. Result(s): One hundred
eighty-nine (98.4%) participants from the DOREMI trial were included in
our analysis, and 74 (39.2%) had significant valvular dysfunction.
Thirty-six (48.7%) patients with valvular disease died in hospital,
compared with 37 (32.2%) in the comparator group (relative risk, 1.5; 95%
confidence interval 1.06-2.15; P = 0.02). Patients with aortic stenosis
(2.42, 1.56-3.75; P < 0.01) and patients with mitral regurgitation (1.63,
1.1-2.43; P = 0.02) also had increased incidence of in-hospital mortality.
There was no significant difference in any secondary outcomes among
groups, apart from variances in mean arterial pressure observed in
patients with valvular disease (P < 0.01). Conclusion(s): Significant
valvular dysfunction is associated with increased in-hospital mortality in
patients with CS. Randomized clinical trial data are needed to further
elucidate the role of transcatheter valvular interventions as a
therapeutic target in this population. Copyright © 2022 Canadian
Cardiovascular Society

<71>
Accession Number
2018974245
Title
Long-Term Outcomes of Ross Procedure versus Mechanical Aortic Valve
Replacement: Meta-Analysis of Reconstructed Time-To-Event Data.
Source
Trends in Cardiovascular Medicine. (no pagination), 2022. Date of
Publication: 2022.
Author
Sa M.P.; Van den Eynde J.; Jacquemyn X.; Tasoudis P.; Erten O.; McDonald
C.; Weymann A.; Ruhparwar A.; Clavel M.-A.; Pibarot P.; Calhoon J.;
Ramlawi B.
Institution
(Sa, Ramlawi) Department of Cardiothoracic Surgery, Lankenau Heart
Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA,
United States
(Sa, Tasoudis, Erten, Ramlawi) Department of Cardiothoracic Surgery
Research, Lankenau Institute for Medical Research, Wynnewood, PA, United
States
(Van den Eynde, Jacquemyn) Department of Cardiovascular Sciences, Leuven,
KU Leuven, Belgium
(McDonald, Calhoon) Department of Cardiothoracic Surgery, University of
Texas Health Science Center at San Antonio, Long School of Medicine, San
Antonio, TX, United States
(Weymann, Ruhparwar) Department of Thoracic and Cardiovascular Surgery,
West German Heart and Vascular Center Essen, University Hospital of Essen,
University of Duisburg-Essen, Essen, Germany
(Clavel, Pibarot) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Clavel, Pibarot) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, Quebec, Canada
Publisher
Elsevier Inc.
Abstract
In the era of lifetime management of aortic valve disease, the Ross
procedure emerged as an alternative to prosthetic heart valves for young
adults; however, more long-term data are warranted. We performed a
meta-analysis of reconstructed time-to-event data to compare long-term
outcomes between the Ross procedure and mechanical aortic valve
replacement (mAVR) in young adults. PubMed/MEDLINE, EMBASE and
GoogleScholar were searched for studies comparing Ross procedure with mAVR
that reported mortality/survival rates and/or reoperation rates
accompanied by at least one Kaplan-Meier curve for any of the outcomes.
Six observational studies (5 with propensity score matching) including
5024 patients (Ross: 1737; mAVR: 3287) met our inclusion criteria.
Patients who underwent Ross had a significantly lower risk of mortality in
the overall population (HR 0.38, 95%CI 0.30-0.49, P<0.001; median
follow-up of 7.2 years) and in the propensity score matched cohorts (HR
0.55, 95%CI 0.42-0.73, P<0.001; median follow-up of 10.2 years); however,
the incidence function for the cumulative risk of reoperation was higher
for the Ross procedure (HR 1.91, 95%CI 1.36-2.70, P<0.001; median
follow-up of 9.3 years). Data from observational studies suggest that the
Ross procedure is associated with lower all-cause mortality compared with
mAVR; however, there is a higher risk of reoperation. Besides serving as
basis to inform patients about benefits and risks involved in this choice,
these results call for further randomized clinical trials to determine
whether the Ross procedure can achieve its potential benefits in young
patients in need of AVR. Copyright © 2022

<72>
Accession Number
2015363045
Title
A randomised controlled feasibility trial of a clinical protocol to manage
hypotension during major non-cardiac surgery.
Source
Anaesthesia. 77(7) (pp 795-807), 2022. Date of Publication: July 2022.
Author
Wijeysundera D.N.; Duncan D.; Moreno Garijo J.; McCluskey S.A.;
Pazmino-Canizares J.; Carroll J.; Poonawalla H.; Beattie W.S.; Clarke
H.A.; Kulkarni G.; Sellers D.; Vidal E.; Wei A.; Jerath A.; Meineri M.;
Garijo J.M.; Parotto M.; Wasowicz M.
Institution
(Wijeysundera) Department of Anesthesia, St. Michael's Hospital, Toronto,
ON, Canada
(Wijeysundera, Duncan, Moreno Garijo, Jerath, Meineri, Parotto, Wasowicz,
McCluskey) Department of Anesthesiology and Pain Medicine, University of
Toronto, ON, Canada
(Meineri) Department of Anaesthesia and Intensive Care, Heart Centre
Leipzig, Germany
Publisher
John Wiley and Sons Inc
Abstract
Intra-operative hypotension is a risk factor for postoperative morbidity
and mortality. Minimally invasive monitors that derive other haemodynamic
parameters, such as stroke volume, may better inform the management of
hypotension. As a prelude to a multicentre randomised controlled trial, we
conducted a single-centre feasibility trial of a protocol to treat
hypotension as informed by minimally invasive haemodynamic monitoring
during non-cardiac surgery. We recruited adults aged >=40 years with
cardiovascular risk factors who underwent non-cardiac surgery requiring
invasive arterial pressure monitoring. Participants were randomly
allocated to usual care, or a clinical protocol informed by an arterial
waveform contour analysis monitor. Participants, outcome assessors,
clinicians outside operating theatres and analysts were blinded to
treatment allocation. Feasibility was evaluated based on: consent rate;
recruitment rate; structured feedback from anaesthesia providers; and
between-group differences in blood pressure, processes-of-care and
outcomes. The consent rate among eligible patients was 33%, with 30
participants randomly allocated to the protocol and 30 to usual care.
Anaesthesia providers rated the protocol to be feasible and acceptable.
The protocol was associated with reduced fluid balance and hypotension
exposure in the peri-operative setting. Postoperative complications
included: acute myocardial injury in 18 (30%); acute kidney injury in 17
(28%); and surgical site infection in 7 (12%). The severity of
complications was rated as moderate or severe in 25 (42%) participants. In
summary, this single-centre study confirmed the feasibility of a
multicentre trial to assess the efficacy and safety of a physiologically
guided treatment protocol for intra-operative hypotension based on
minimally invasive haemodynamic monitors. Copyright © 2022
Association of Anaesthetists.

<73>
Accession Number
638045845
Title
Stroke volume variation for predicting responsiveness to fluid therapy in
patients undergoing cardiac and thoracic surgery: A systematic review and
meta-analysis.
Source
BMJ Open. 12(5) (no pagination), 2022. Article Number: e051112. Date of
Publication: 18 May 2022.
Author
Huan S.; Dai J.; Song S.; Zhu G.; Ji Y.; Yin G.
Institution
(Huan, Dai, Song, Zhu, Yin) Department of Anesthesiology, Nanjing Second
Hospital, Jiangsu, Nanjing, China
(Huan, Ji, Yin) Nanjing Hospital Affiliated to Nanjing University of
Chinese Medicine, Nanjing University of Chinese Medicine, Jangsu, Nanjing,
China
(Ji) Department of Critical Medicine, The Second Hospital of Nanjing,
Jiangsu, Nanjing, China
(Yin) College of Public Health, Nanjing Medical University, Jiangsu,
Nanjing, China
Publisher
BMJ Publishing Group
Abstract
Objective To evaluate the reliability of stroke volume variation (SVV) for
predicting responsiveness to fluid therapy in patients undergoing cardiac
and thoracic surgery. Design Systematic review and meta-analysis. Data
sources PubMed, EMBASE, Cochrane Library, Web of Science up to 9 August
2020. Methods Quality of included studies were assessed with the Quality
Assessment of Diagnostic Accuracy Studies-2 tool. We conducted subgroup
analysis according to different anaesthesia and surgical methods with
Stata V.14.0, Review Manager V.5.3 and R V.3.6.3. We used random-effects
model to pool sensitivity, specificity and diagnostic odds ratio with 95%
CI. The area under the curve (AUC) of receiver operating characteristic
was calculated. Results Among the 20 relevant studies, 7 were conducted
during thoracic surgery, 8 were conducted during cardiac surgery and the
remaining 5 were conducted in intensive critical unit (ICU) after cardiac
surgery. Data from 854 patients accepting mechanical ventilation were
included in our systematic review. The pooled sensitivity and specificity
were 0.73 (95i 1/4... CI: 0.59 to 0.83) and 0.62 (95i 1/4... CI: 0.46 to
0.76) in the thoracic surgery group, 0.71 (95i 1/4... CI: 0.65 to 0.77)
and 0.76 (95i 1/4... CI: 0.69 to 0.82) in the cardiac surgery group, 0.85
(95i 1/4... CI: 0.60 to 0.96) and 0.85 (95i 1/4... CI: 0.74 to 0.92) in
cardiac ICU group. The AUC was 0.73 (95% CI: 0.69 to 0.77), 0.80 (95% CI:
0.77 to 0.83) and 0.88 (95% CI: 0.86 to 0.92), respectively. Results of
subgroup of FloTrac/Vigileo system (AUC=0.80, Youden index=0.38) and large
tidal volume (AUC=0.81, Youden index=0.48) in thoracic surgery, colloid
(AUC=0.85, Youden index=0.55) and postoperation (AUC=0.85, Youden
index=0.63) in cardiac surgery, passive leg raising (AUC=0.90, Youden
index=0.72) in cardiac ICU were reliable. Conclusion SVV had good
predictive performance in cardiac surgery or ICU after cardiac surgery and
had moderate predictive performance in thoracic surgery. Nevertheless,
technical and clinical variables may affect the predictive value
potentially. Copyright © 2022 Authors.

<74>
Accession Number
2017057095
Title
Regional analgesia techniques for video-assisted thoracic surgery: a
frequentist network meta-analysis.
Source
Korean Journal of Anesthesiology. 75(3) (pp 231-244), 2022. Date of
Publication: June 2022.
Author
Jo Y.; Park S.; Oh C.; Pak Y.; Jeong K.; Yun S.; Noh C.; Chung W.; Kim
Y.-H.; Ko Y.K.; Hong B.
Institution
(Jo, Oh, Pak, Jeong, Yun, Noh, Chung, Kim, Ko, Hong) Department of
Anesthesiology and Pain Medicine, Chungnam National University Hospital,
282 Munhwa-ro, Jung-gu, Daejeon 35015, South Korea
(Jo, Oh, Pak, Yun, Noh, Chung, Kim, Ko, Hong) Department of Anesthesiology
and Pain Medicine, College of Medicine, Chungnam National University,
South Korea
(Park) Department of Nursing, College of Nursing, Chungnam National
University, South Korea
(Ko, Hong) Biomedical Research Institute, Chungnam National University,
Daejeon, South Korea
Publisher
Korean Society of Anesthesiologists
Abstract
Background: Various regional analgesia techniques are used to reduce
postoperative pain in patients undergoing video-assisted thoracic surgery
(VATS). This study aimed to determine the relative efficacy of regional
analgesic interventions for VATS using a network meta-analysis.
 Method(s): We searched the Medline, EMBASE, Cochrane Controlled Trial
Register, Web of Science, and Google Scholar databases to identify all
randomized controlled trials (RCTs) that compared the analgesic effects of
the following interventions: control, thoracic paravertebral block (TPVB),
erector spinae plane block (ESPB), serratus plane block (SPB), and
intercostal nerve block (INB). The primary outcome was opioid consumption
during the first 24 h postoperative period. Pain scores were also
collected during three different postoperative periods: the early (0-6 h),
middle (6-18 h), and late (18-24 h) periods. Result(s): A total of 21
RCTs (1,391 patients) were included. TPVB showed the greatest effect on
opioid consumption compared with the control (mean difference [MD]: -13.2
mg, 95% CI [-16.2, -10.1]). In terms of pain scores in the early period,
ESPB had the greatest effect compared to control (MD: -1.6, 95% CI [-2.3,
-0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB
and INB had superior analgesic effects compared to controls, while SPB did
not. Conclusion(s): TPVB had the best analgesic efficacy following
VATS, though the analgesic efficacy of ESPBs was comparable. However,
further studies are needed to determine the optimal regional analgesia
technique to improve postoperative pain control following
VATS. Copyright © The Korean Society of Anesthesiologists, 2022.

<75>
Accession Number
2013963051
Title
A systematic review and meta-analyses of regional perfusion in donation
after circulatory death solid organ transplantation.
Source
Transplant International. 34(11) (pp 2046-2060), 2021. Date of
Publication: November 2021.
Author
De Beule J.; Vandendriessche K.; Pengel L.H.M.; Bellini M.I.; Dark J.H.;
Hessheimer A.J.; Kimenai H.J.A.N.; Knight S.R.; Neyrinck A.P.; Paredes D.;
Watson C.J.E.; Rega F.; Jochmans I.
Institution
(De Beule, Jochmans) Transplantation Research Group, Department of
Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
(Vandendriessche, Rega) Department of Cardiovascular Sciences, Cardiac
Surgery, KU Leuven, Leuven, Belgium
(Pengel, Knight) Nuffield Department of Surgical Sciences, Centre for
Evidence in Transplantation, University of Oxford, Oxford, United Kingdom
(Bellini) Department of Emergency Medicine and Surgery, Azienda
Ospedaliera San Camillo Forlanini, Rome, Italy
(Dark) Faculty of Medical Sciences, Translational and Clinical Research
Institute, Newcastle University, Newcastle, United Kingdom
(Hessheimer) Department of General Digestive Surgery, Institut Clinic de
Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic, IDIBAPS,
CIBERehd, University of Barcelona, Barcelona, Spain
(Kimenai) Division of Transplant Surgery, Department of Surgery, Erasmus
MC University Medical Center, Rotterdam, Netherlands
(Knight) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
(Neyrinck) Department of Cardiovascular Sciences, Anesthesiology and
Algology, KU Leuven, Leuven, Belgium
(Neyrinck) Department of Anesthesiology, University Hospitals Leuven,
Leuven, Belgium
(Paredes) Donation and Transplant Coordination Unit, Hospital Clinic,
University of Barcelona, Barcelona, Spain
(Watson) Department of Surgery, Addenbrooke's Hospital, University of
Cambridge, Cambridge, United Kingdom
(Watson) The NIHR Cambridge Biomedical Research Centre, Cambridge, United
Kingdom
(Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven,
Belgium
(Jochmans) Department of Abdominal Transplant Surgery, University
Hospitals Leuven, Leuven, Belgium
Publisher
John Wiley and Sons Inc
Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional
perfusion (RP) restores circulation to a region of the body following
death declaration. We systematically reviewed outcomes of solid organ
transplantation after RP by searching PubMed, Embase, and Cochrane
libraries. Eighty-eight articles reporting on outcomes of liver, kidney,
pancreas, heart, and lung transplants or donor/organ utilization were
identified. Meta-analyses were conducted when possible. Methodological
quality was assessed using National Institutes of Health (NIH)-scoring
tools. Case reports (13/88), case series (44/88), retrospective cohort
studies (35/88), retrospective matched cohort studies (5/88), and
case-control studies (2/88) were identified, with overall fair quality. As
blood viscosity and rheology change below 20 degreeC, studies were grouped
as hypothermic (HRP, <=20 degreeC) or normothermic (NRP, >20 degreeC)
regional perfusion. Data demonstrate that RP is a safe alternative to in
situ cold preservation (ISP) in uncontrolled and controlled DCDs. The
scarce HRP data are from before 2005. NRP appears to reduce
post-transplant complications, especially biliary complications in
controlled DCD livers, compared with ISP. Comparisons for kidney and
pancreas with ISP are needed but there is no evidence that NRP is
detrimental. Additional data on NRP in thoracic organs are needed. Whether
RP increases donor or organ utilization needs further
research. Copyright © 2021 Steunstichting ESOT. Published by John
Wiley & Sons Ltd

<76>
Accession Number
2018075780
Title
Transcatheter aortic valve replacement in aortic stenosis and cardiac
amyloidosis: a systematic review and meta-analysis.
Source
ESC Heart Failure. (no pagination), 2022. Date of Publication: 2022.
Author
Cannata F.; Chiarito M.; Pinto G.; Villaschi A.; Sanz-Sanchez J.; Fazzari
F.; Regazzoli D.; Mangieri A.; Bragato R.M.; Colombo A.; Reimers B.;
Condorelli G.; Stefanini G.G.
Institution
(Cannata, Chiarito, Pinto, Villaschi, Condorelli, Stefanini) Department of
Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4,
Pieve Emanuele-Milan, Italy
(Cannata, Chiarito, Pinto, Villaschi, Fazzari, Regazzoli, Mangieri,
Bragato, Colombo, Reimers, Condorelli, Stefanini) IRCCS Humanitas Research
Hospital, Rozzano-Milan, Italy
(Sanz-Sanchez) Hospital Universitario y Politecnico La Fe, Valencia, Spain
(Sanz-Sanchez) Centro de Investigacion Biomedica en Red (CIBERCV), Madrid,
Spain
Publisher
John Wiley and Sons Inc
Abstract
Aims: Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical
diseases of the elderly. Up to 16% of older adults with severe AS referred
to transcatheter aortic valve replacement (TAVR) have a concomitant
diagnosis of CA. CA-AS population suffers from reduced functional capacity
and worse prognosis than AS patients. As the prognostic impact of TAVR in
patients with CA-AS has been historically questioned and in light of
recently published evidence, we aim to provide a comprehensive synthesis
of the efficacy and safety of TAVR in CA-AS patients. Methods and
Results: We performed a systematic review and meta-analysis of studies:
(i) evaluating mortality with TAVR as compared with medical therapy in
CA-AS patients and (ii) reporting complications and clinical outcomes of
TAVR in CA-AS patients as compared with patients with AS alone. A total of
seven observational studies were identified: four reported mortality with
TAVR, and four reported complications and clinical outcomes after TAVR of
patients with CA-AS compared with AS alone patients. In patients with
CA-AS, the risk of mortality was lower with TAVR (n = 44) as compared with
medical therapy (n = 36) [odds ratio (OR) 0.23, 95% confidence interval
(CI) 0.07-0.73, I2 = 0%, P = 0.001, number needed to treat =
3]. The safety profile of TAVR seems to be similar in patients with CA-AS
(n = 75) as compared with those with AS alone (n = 536), with comparable
risks of stroke, vascular complications, life-threatening bleeding, acute
kidney injury, and 30 day mortality, although CA-AS was associated with a
trend towards an increased risk of permanent pacemaker implantation (OR
1.76, 95% CI 0.91-4.09, I2 = 0%, P = 0.085). CA is associated
with a numerically higher rate of long-term mortality and
rehospitalizations following TAVR in patients with CA-AS as compared with
those with AS alone. Conclusion(s): TAVR is an effective and safe
procedure in CA-AS patients, with a substantial survival benefit as
compared with medical therapy, and a safety profile comparable with
patients with AS alone except for a trend towards higher risk of permanent
pacemaker implantation. Copyright © 2022 The Authors. ESC Heart
Failure published by John Wiley & Sons Ltd on behalf of European Society
of Cardiology.

<77>
Accession Number
2018072753
Title
S097: a single, peri-operative antibiotic can persistently alter the
post-operative gut microbiome after Roux-en-Y gastric bypass.
Source
Surgical Endoscopy. (no pagination), 2022. Date of Publication: 2022.
Author
Fernando D.G.; Saravia F.L.; Atkinson S.N.; Barron M.; Kirby J.R.; Kindel
T.L.
Institution
(Fernando, Barron, Kindel) Department of Surgery, Medical College of
Wisconsin, 8900 W. Doyne Avenue, Milwaukee, WI 53226, United States
(Saravia, Atkinson, Kirby) Department of Microbiology & Immunology,
Medical College of Wisconsin, 8900 W. Doyne Avenue, Milwaukee, WI 53226,
United States
(Atkinson) Center for Microbiome Research, Medical College of Wisconsin,
8900 W. Doyne Avenue, Milwaukee, WI 53226, United States
Publisher
Springer
Abstract
Introduction: Roux-en-Y gastric bypass (RYGB) significantly alters the gut
microbiome and may be a mechanism for post-operative cardiovascular
disease improvement. We have previously found an association between the
class of peri-operative, intravenous antibiotic administered at the time
of RYGB and the resolution rate of hypertension suggesting the gut
microbiome as a mechanism. In this study, we performed a prospective study
of RYGB to determine if a single intravenous antibiotic could alter the
gastrointestinal microbial composition. Method(s): Patients
undergoing RYGB were randomized to a single, peri-operative antibiotic of
intravenous cefazolin (n = 8) or clindamycin (n = 8). Stool samples were
collected from four-time points: 2 weeks pre-op (- 2w), 2 days pre-op (-
2d), 2 weeks post-op (+ 2w) and 3 months post-op (+ 3m). Stool samples
were processed for genomic DNA followed by Illumina 16S rRNA gene
sequencing and shotgun metagenomic sequencing (MGS). Result(s): A
total of 60 stool samples (- 2w, n = 16; - 2d, n = 15; + 2w, n = 16; + 3m,
n = 13) from 16 patients were analyzed. 87.5% of patients were female with
an average age of 48.6 +/- 12.2 years and pre-operative BMI of 50.9 +/-
23.3 kg/m2. RYGB induced statistically significant differences
in alpha and beta diversity. There were statistically significant
differences in alpha diversity at + 2w and beta diversity at + 3m due to
antibiotic treatment. MGS revealed significantly distinct gut microbiota
with 11 discriminatory metagenomic assembled genomes driven by antibiotic
treatment at 3 months post-op, including increased Bifidobacterium spp.
with clindamycin. Conclusion(s): RYGB induces significant changes in
the gut microbiome at 2 weeks that are maintained 3 months after surgery.
However, the single peri-operative dose of antibiotic administered at the
time of RYGB induces unique and persisting changes to the gut microbiome
that are antibiotic-specific. Increased Bifidobacterium spp. with
clindamycin administration may improve the metabolic efficacy of RYGB when
considering gut-microbiome driven mechanisms for blood pressure
resolution. Graphical abstract: [Figure not available: see
fulltext.] Copyright © 2022, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<78>
Accession Number
2017779522
Title
Statistical Evaluation of Transformation Methods Accuracy on Derived
Pathological Vectorcardiographic Leads.
Source
IEEE Journal of Translational Engineering in Health and Medicine. 10 (pp
1-8), 2022. Date of Publication: 2022.
Author
Vondrak J.; Penhakert M.
Institution
(Vondrak, Penhakert) Faculty of Electrical Engineering and Computer
Science, VSB-Technical University of Ostrava, Ostrava 708 33, Czechia
Publisher
Institute of Electrical and Electronics Engineers Inc.
Abstract
Objective: Vectorcardiography (VCG) as an alternative form of ECG provides
important spatial information about the electrical activity of the heart.
It achieves higher sensitivity in the detection of some pathologies such
as myocardial infarction, ischemia and hypertrophy. However,
vectorcardiography is not commonly measured in clinical practice, and for
this reason mathematical transformations have been developed to obtain
derived VCG leads, which in application in current systems and subsequent
analysis can contribute to early diagnosis and obtaining other useful
information about the electrical activity of the heart. Methods and
procedures: The most frequently used transformation methods are compared,
namely the Kors regression method, the Inverse Dower transformation, QLSV
and the Quasi-orthogonal transformation. These transformation methods were
used on 30 randomly selected records with a diagnosis of myocardial
infarction from the Physikalisch-Technische Bundesanstalt (PTB) database
and their accuracy was evaluated based on the calculation of the mean
square error (MSE). MSE was subjected to statistical evaluation at a
significance level of 0.05. Result(s): Based on statistical testing
using the nonparametric multiselective Kruskall-Wallis test and subsequent
post-hoc analysis using the Dunn method, the Kors regression as a whole
method achieved the most accurate transformation. Conclusion(s): The
results of statistical analysis provide an evaluation of the accuracy of
several transformation methods for deriving orthogonal leads, for possible
application in measuring and evaluation systems, which may contribute to
the correct choice of method for subsequent analysis of electrical
activity of the heart at orthogonal leads to predict various diseases.
 Copyright © 2013 IEEE.

<79>
Accession Number
637496800
Title
Effectiveness of music during cardiac catheterization on children's pain,
fear, anxiety and vital signs: A randomized, blind controlled trial.
Source
Journal of pediatric nursing. 65 (pp e56-e62), 2022. Date of Publication:
01 Jul 2022.
Author
Karakul A.; Akgul E.A.; Yaliniz R.; Mese T.
Institution
(Karakul) Tarsus University, Faculty of Health Sciences, Department of
Nursing, Mersin, Turkey
(Akgul) Izmir Katip Celebi University, Faculty of Health Sciences,
Department of Pediatric Nursing, Izmir, Turkey
(Yaliniz, Mese) Dr. Behcet Uz Child Diseases and Surgery Teaching and
Research Hospital, Department of Pediatric Cardiology, Izmir, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aims to examine the effectiveness of music during
pediatric cardiac catheterization procedure on children's pain, fear,
anxiety and vital signs. DESIGN AND METHODS: This randomized, blind
controlled study was conducted with the guidelines of Consolidated
Standards of Reporting Trials (CONSORT). The sample of children was
allocated to the Control Group, the Classic Music Group, and the
Self-Selected Group. Pain, fear, and anxiety levels were measured before
and after the pediatric cardiac catheterization procedure. Vital signs
were measured before, during, and after the pediatric cardiac
catheterization procedure. RESULT(S): There was no significant
difference between the groups in terms of demographic status, pain, fear,
or anxiety levels and vital signs before the procedure. In post pediatric
cardiac catheterization measurement in the recovery phase, pain, fear
levels, anxiety levels, heart rate, systolic and diastolic blood pressure
of children in the musical intervention groups were lower than the control
group. No statistical difference was found in terms of pain, fear and
anxiety levels of the children in groups Classic and Self-Selected.
CONCLUSION AND PRACTICE IMPLICATIONS: The result of this research reveals
that musical intervention applied during the pediatric cardiac
catheterization procedure in children affects the reduction of pain, fear
and anxiety levels and stabilization of vital signs. This intervention
could be an effective nonpharmacological method to improve outcomes.Nurses
can improve children's comfort by using musical interventions. CLINICAL
REGISTRATION: This study was registered at the U.S. National Library of
Medicine Clinical Trials (code: NCT04316754). Copyright © 2022
Elsevier Inc. All rights reserved.

<80>
Accession Number
638363477
Title
Replaced Right Hepatic Artery Pseudoaneurysm Rupture and Hemorrhagic
Cholecystitis: A Case of Chicken or the Egg.
Source
Surgical Endoscopy. Conference: Scientific Session of the Society of
American Gastrointestinal and Endoscopic Surgeons, SAGES 2022. Denver, CO
United States. 36(1 SUPPL) (pp S129), 2022. Date of Publication: May 2022.
Author
Grundman K.; Wanat K.; Schmidt M.; Vera D.
Institution
(Grundman, Wanat, Vera) Franciscan Health, United States
(Schmidt) Midwestern University Chicago College of Osteopathic Medicine,
United States
Publisher
Springer
Abstract
Introduction: Replaced right hepatic artery pseudoaneurysm rupture and
hemorrhagic cholecystitis are extremely rare and life-threatening
complications that have never before been reported concomitantly. We
present the case of an 82 year old male with hemoperitoneum secondary to a
replaced right hepatic artery pseudoaneurysm rupture and hemorrhagic
cholecystitis that was successfully treated. A comprehensive literature
review on visceral artery pseudoaneurysm rupture and hemorrhagic
cholecystitis as well as a treatment algorithm will be provided. Case
Report: An 82-year-old male with a past medical history significant for
coronary artery disease and endocarditis complicated by vegetations status
post recent coronary artery bypass graft and heart valve repair,
paroxysmal atrial fibrillation on eliquis, gastroesophageal reflux disease
and hypertension presents from cardiac rehab to the emergency department
for syncope, chest pain, and abdominal pain. On presentation the patient
is afebrile, hypotensive to the 70 s systolic, tachycardic, and
tachypneic. On physical exam his abdomen is soft, mildly distended with
right upper quadrant tenderness to palpation. His labs include a
hemoglobin 9.9, uptrending troponin, lactic acid 5.57, and grossly
unremarkable liver function enzymes and bilirubin. A CT angiogram shows
active arterial extravasation from a replaced right hepatic pseudoaneurysm
as well as intracholecystic hemorrhaging. The patient is given Kcentra and
resuscitated with intravenous fluid and blood products. The patient
undergoes successful coil embolization of the replaced right hepatic
artery and subsequent laparoscopic cholecystectomy the following day. The
patient recovers well and is discharged on hospital day five.
 Conclusion(s): We presented a case of successful treatment of a
replaced right hepatic artery pseudoaneurysm rupture and hemorrhagic
cholecystitis in a patient with a significant cardiac history on eliquis.
We believe this to be the first such case reported in medical literature,
however other similar cases involving hemorrhagic cholecystitis and other
visceral artery pseudoaneurysm ruptures have also been reported. It is
difficult to discern whether nearby visceral artery pseudoaneurysms arise
as a consequence of inflammation from cholecystitis or if hypotension
secondary to blood loss from an arterial pseudoaneurysm rupture can cause
ischemia to the gallbladder resulting in cholecystitis. Given the existing
but limited literature, a timely diagnosis of this rare and potentially
fatal condition is critical and involves an integrated approach including
adequate resuscitation, coagulopathy reversal, arterial embolization and
cholecystectomy.

<81>
Accession Number
2017294373
Title
Coaxial Drainage versus Standard Chest Tube after Pulmonary Lobectomy: A
Randomized Controlled Study.
Source
Current Oncology. 29(7) (pp 4455-4463), 2022. Date of Publication: July
2022.
Author
Bassi M.; Mottola E.; Mantovani S.; Amore D.; Pagini A.; Diso D.; Vannucci
J.; Poggi C.; De Giacomo T.; Rendina E.A.; Venuta F.; Anile M.
Institution
(Bassi, Mottola, Mantovani, Amore, Pagini, Diso, Vannucci, Poggi, De
Giacomo, Venuta, Anile) Division of Thoracic Surgery, Department of
General Surgery and Organ Transplant "PARIDE STEFANINI", Policlinico
Umberto I, Sapienza University of Rome, Rome 00161, Italy
(Rendina) Thoracic Surgery Unit, Sant'Andrea Hospital, Universita La
Sapienza, Rome 00189, Italy
Publisher
MDPI
Abstract
Chest tubes are routinely inserted after thoracic surgery procedures in
different sizes and numbers. The aim of this study is to assess the
efficacy of Smart Drain Coaxial drainage compared with two standard chest
tubes in patients undergoing thoracotomy for pulmonary lobectomy.
Ninety-eight patients (57 males and 41 females, mean age 68.3 +/- 7.4
years) with lung cancer undergoing open pulmonary lobectomy were
randomized in two groups: 50 received one upper 28-Fr and one lower 32-Fr
standard chest tube (ST group) and 48 received one 28-Fr Smart Drain
Coaxial tube (SDC group). Hospitalization, quantity of fluid output, air
leaks, radiograph findings, pain control and costs were assessed. SDC
group showed shorter hospitalization (7.3 vs. 6.1 days, p = 0.02), lower
pain in postoperative day-1 (p = 0.02) and a lower use of analgesic drugs
(p = 0.04). Pleural effusion drainage was lower in SDC group in the first
postoperative day (median 400.0 +/- 200.0 mL vs. 450.0 +/- 193.8 mL, p =
0.04) and as a mean of first three PODs (median 325.0 +/- 137.5 mL vs.
362.5 +/- 96.7 mL, p = 0.01). No difference in terms of fluid retention,
residual pleural space, subcutaneous emphysema and complications after
chest tubes removal was found. In conclusion, Smart Drain Coaxial chest
tube seems a feasible option after thoracotomy for pulmonary lobectomy.
The SDC group showed a shorter hospitalization and decreased analgesic
drugs use and, thus, a reduction of costs. Copyright © 2022 by
the authors. Licensee MDPI, Basel, Switzerland.

<82>
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

<83>
Accession Number
2019049249
Title
Prophylactic levosimendan in patients with low ejection fraction
undergoing coronary artery bypass grafting: A pooled analysis of two
multicentre randomised controlled trials.
Source
Anaesthesia Critical Care and Pain Medicine. 41(4) (no pagination), 2022.
Article Number: 101107. Date of Publication: August 2022.
Author
Caruba T.; Charles-Nelson A.; Alexander J.H.; Mehta R.H.; Heringlake M.;
Toller W.; Yavchitz A.; Sabatier B.; Chatellier G.; Cholley B.
Institution
(Caruba, Charles-Nelson, Yavchitz, Sabatier, Chatellier, Cholley) AP-HP,
Hopital Europeen Georges Pompidou, Paris F-75015, France
(Alexander, Mehta) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, NC, United States
(Heringlake) Dept. of Anaesthesiology and Intensive Care Medicine, Heart-
and Diabetes Center, Karlsburg, Germany
(Toller) Medical University of Graz, Graz, Austria
(Sabatier) Inserm UMR_1138, centre de Recherche des Cordeliers, Sorbonne
Universite, universite de Paris Cite, F-75006 Paris, France and Inria,
HeKA, PariSanteCampus, Paris, France
(Chatellier) Universite de Paris, Paris F-75006, France
(Cholley) Universite de Paris, INSERM UMR_S 1140 "Innovations
Therapeutiques en Hemostase", Paris F-75006, France
Publisher
Elsevier Masson s.r.l.
Abstract
Objectives: To assess the effect of preoperative levosimendan on mortality
at day 90 in patients with left ventricular ejection fraction (LVEF) <=
40%, and to investigate a possible differential effect between patients
undergoing isolated coronary artery bypass grafting (CABG) versus CABG
combined with valve replacement surgery. Design(s): Pooled analysis
of two multicentre randomised controlled trials (RCT) investigating
prophylactic levosimendan versus placebo prior to CABG surgery on
mortality at day 90 in patients with LVEF <= 40%. A meta-analysis of all
RCT investigating the same issue was also conducted. Result(s): A
cohort of 1084 patients (809 isolated CABG, and 275 combined surgery)
resulted from the merging of LEVO-CTS and LICORN databases. Seventy-two
patients were dead at day 90. The mortality at day 90 was not different
between levosimendan and placebo (Hazard Ratio (HR): 0.73, 95% CI:
0.41-1.28, p = 0.27). However, there was a significant interaction between
the type of surgery and the study drug (p = 0.004). We observed a decrease
in mortality at day 90 in the isolated CABG subgroup (HR: 0.39, 95% CI:
0.19-0.82, p = 0.013), but not in the combined surgery subgroup (HR: 1.73,
95% CI: 0.77-3.92, p = 0.19). The meta-analysis of 6 RCT involving 1441
patients confirmed the differential effect on mortality at day 30 between
the 2 subgroups. Conclusion(s): Preoperative levosimendan did not
reduce mortality in a mixed surgical population with LV dysfunction.
However, the subgroup of patients undergoing isolated CABG had a reduction
in mortality at day 90, whereas there was no significant effect in
combined surgery patients. This finding requires confirmation with a
specific prospective trial. Copyright © 2022 Societe francaise
d'anesthesie et de reanimation (Sfar)

<84>
Accession Number
2018953611
Title
Infant's difficult temperament characteristics predict poor quality of
life in parents of infants with complex congenital heart defects
post-cardiac surgery.
Source
Cardiology in the Young. (no pagination), 2022. Date of Publication:
2022.
Author
Golfenshtein N.; Lisanti A.J.; Medoff-Cooper B.
Institution
(Golfenshtein) University of Haifa, Department of Nursing, 199 Abba Hushi
Ave., Haifa 3498838, Israel
(Golfenshtein, Lisanti, Medoff-Cooper) University of Pennsylvania, School
of Nursing, 418 Curie Blvd, Claire M. Fagin Hall, Philadelphia, PA 19104,
United States
(Lisanti) Children's Hospital of Philadelphia, 3401 Civic Center Blvd,
Philadelphia, PA 19104, United States
Publisher
Cambridge University Press
Abstract
Background & Aims: Parents of infants with complex congenital heart
defects (CHD) often describe their infants as especially fussy, irritable,
and difficult to sooth, which together with the illness caretaking
demands, add to their stress. Little is known about how the behavioral
style or temperament in the early months after discharge relates to
parental quality of life. This study aimed to explore the associations
between early infant temperament characteristics and parental quality of
life in parents of infants with complex congenital heart disease.
 Method(s): This descriptive, cross-sectional study, utilized data
collected in a previously described multisite randomized clinical trial in
the United States. Multivariable linear regression models were used to
examine the associations of interest. Finding(s): Results
demonstrated negative significant associations between most infant
temperament subscales and parental quality of life. Higher scores on the
Activity (beta=-3.03, P=0.021), Approach (beta=-1.05, P=0.021),
Adaptability (beta=-3.47, P=0.004), Intensity (beta=-2.78, P=0.008), Mood
(beta= -4.65, P<0.001), and Distractibility (beta=-3.36, P=0.007 were all
significantly associated with lower parental quality of life scores,
adjusting for parental dyadic adjustment, insurance type, number of
medications, and number of unscheduled cardiologist visits.
 Conclusion(s): Parental perceptions of infant's difficult behavioral
style or temperament characteristics appear to be associated with poorer
quality of life in parents of infants with complex CHD post-cardiac
surgery. Findings can be used in the screening process of families at
potential risk of increased stress and poor illness adaptation and in the
design of interventions to target parental mental health in this
vulnerable patient population. Copyright © The Author(s), 2022.
Published by Cambridge University Press.

<85>
Accession Number
638367084
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: 30 Jun 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 Medicine Detroit Medical Center, MI,
Detroit, United States
(Ullah) Thomas Jefferson University, Philadelphia, PA; USA
(Suleiman, Abdalrazzak) Wayne State University School of Medicine, MI,
Detroit, United States
(Rabbat) Internal medicine, Baptist hospital, Miami, FL, United States
(Alraiyes) Vernon Hills High School ,Vernon Hills, United States
(Sattar) Division of cardiology, West Virginia University, Morgantown,
United States
(Bagur) London Health Sciences Centre, Western University, London, ON,
Canada
(Paul) Department of Medical Education, University of Tennessee at
Nashville, TN, Nashville, 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, MI, Detroit, United States
Publisher
NLM (Medline)
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). On 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.

<86>
Accession Number
2013462220
Title
The recanalization after thrombolysis as surrogate for clinical outcomes
in patients with ST-segment elevation acute myocardial infarction: A
systematic review and meta-regression analysis of data from randomized
controlled trials.
Source
British Journal of Clinical Pharmacology. 88(2) (pp 490-499), 2022. Date
of Publication: February 2022.
Author
Zhu Y.; Chen S.; Zhao X.; Qiao S.; Yang Q.; Gao R.; Wu Y.
Institution
(Zhu, Chen, Wu) Peking University Clinical Research Institute, Peking
University First Hospital, Beijing, China
(Zhao) Department of Cardiology, Beijing Jishuitan Hospital, The Fourth
Clinical Medical College of Peking University, Beijing, China
(Qiao, Gao) Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing, China
(Yang) Guangzhou Recomgen Biotech Co., Ltd, Guangzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Aims: Thrombolytic therapy has been known to be effective in reducing
clinical outcomes and increasing recanalization rate among patients with
ST-segment elevation acute myocardial infarction (STEMI). However, whether
post-thrombolysis recanalization could be used as a surrogate for clinical
outcomes is unknown. Method(s): We systematically searched PubMed,
EMBASE and the Cochrane Library database to identify randomized controlled
trials (RCT) that examined effects of thrombolytic agents in STEMI.
Recanalization was defined as TIMI grade 2 or 3 flow. The primary outcome
was in-hospital all-cause mortality. Secondary outcomes included
in-hospital and 30-day recurrent myocardial infarction (re-MI), composite
of death and re-MI, major bleeding and all bleeding. Random-effects
meta-regression was used for analysis. Result(s): We identified 111
eligible study arms and 52 eligible comparisons from 58 RCTs involving 16
536 patients. Our analyses showed that among study arms recanalization
rate was significantly inversely associated with the incidence of
in-hospital all-cause mortality (beta: -0.07, 95% confidence interval
[CI]: -0.13 to -0.02), re-MI (beta: -0.09, 95%CI: -0.18 to -0.01) and the
composite of death and re-MI (beta: -0.17, 95%CI: -0.28 to -0.05), and
positively associated with in-hospital all bleeding but not with major
bleeding. Among paired comparisons, the difference in recanalization rate
was associated with the corresponding difference in incidence of
in-hospital all-cause mortality (beta: -0.15, 95%CI: -0.28 to -0.01) but
the relationship was not significant for any other outcome.
 Conclusion(s): Pooled evidence from RCTs suggest the potential use of
recanalization as a surrogate for clinical outcomes in evaluating the
efficacy of thrombolysis among patients with STEMI. Copyright ©
2021 British Pharmacological Society

<87>
Accession Number
2015701745
Title
Infective endocarditis following heart transplantation: A systematic
review.
Source
Transplantation Reviews. 36(1) (no pagination), 2022. Article Number:
100672. Date of Publication: January 2022.
Author
Jordan A.M.; Tatum R.; Ahmad D.; Patel S.V.; Maynes E.J.; Weber M.P.; Moss
S.; Royer T.L.; Tchantchaleishvili V.; Massey H.T.; Rame J.E.; Zurlo J.J.;
Aburjania N.
Institution
(Jordan, Tatum, Ahmad, Patel, Maynes, Weber, Tchantchaleishvili, Massey)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Moss, Royer, Zurlo, Aburjania) Division of Infectious Disease, Thomas
Jefferson University, Philadelphia, PA, United States
(Rame) Department of Cardiology, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
W.B. Saunders
Abstract
Purpose: Infective endocarditis (IE) is a rare but potentially fatal
complication following heart transplantation (HTx). There is a lack of
literature regarding the patterns and clinical course of IE development
following HTx. We sought to pool the existing data in regards to defining
characteristics, management options, and outcomes of IE following HTx.
 Method(s): An electronic search of Cochrane Central Register of
Controlled Trials, Cumulative Index to Nursing and Allied Health
Literature, Ovid Medline, and the Scopus databases were performed to
identify all articles in the English literature that report IE following
HTx in adult patients. Patient-level data were extracted and analyzed.
 Result(s): Systematic search yielded 57 patients from 32 articles.
Median patient age was 52 [IQR 43, 59] and 75% of patients (43/57) were
male. Median time to IE presentation post-HTx was 8.4 [IQR 3.0, 35.8]
months. IE of the mitral valve was observed in 36.8% (21/57) of patients,
followed by mural IE in 24.6% (14/57), and tricuspid valve IE in 21.1%
(12/57). The most common organisms were Staphylococcus aureus in 26.3%
(15/57), Aspergillus fumigatus in 19.3% (11/57), Enterococcus faecalis in
12.3% (7/57), and an undetermined or unspecified organism in 14.0% (8/57)
patients. Overall case fatality was 44.6% (25/56). Fungal IE was
associated with a significantly higher case fatality 75.0% (9/12) than
that of bacterial IE 36.1% (13/36) (p = 0.02). Surgical management of
post-HTx IE was observed in 35.1% (20/57) of patients. This included valve
surgery for 70.0% (14/20), including the mitral valve in 50.0% (7/14),
aortic valve in 35.7% (5/14), and the tricuspid valve in 14.3% (2/14) of
patients. Conclusion(s): In addition to bacterial organisms, fungi
also represent a frequent cause of IE in post-HTx patients. Overall HTx
patient survival in the setting of IE is poor and may be worse if caused
by A. fumigatus. Copyright © 2021 Elsevier Inc.

<88>
Accession Number
2015519442
Title
Analgesic effect of inhaled lavender essential oil for frenotomy in
healthy neonates: a randomized clinical trial.
Source
World Journal of Pediatrics. 18(6) (pp 398-403), 2022. Date of
Publication: June 2022.
Author
Maya-Enero S.; Fabregas-Mitjans M.; Llufriu-Marques R.M.; Candel-Pau J.;
Garcia-Garcia J.; Lopez-Vilchez M.A.
Institution
(Maya-Enero, Fabregas-Mitjans, Llufriu-Marques, Candel-Pau, Garcia-Garcia,
Lopez-Vilchez) Department of Neonatology, Service of Pediatrics, Hospital
del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Maritim
25-29, Barcelona 08003, Spain
Publisher
Institute of Pediatrics of Zhejiang University
Abstract
Background: Neonatal pain may affect long-term neurodevelopment and must
be treated. Frenotomy is a painful procedure wherein a common strategy to
relieve pain (sucking) cannot be used because the technique is performed
on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic
properties and has been successfully used to treat pain during heel
puncture and vaccination. Our aim was to demonstrate if the use of inhaled
LEO is effective in reducing pain during frenotomy in healthy, full-term
neonates. Method(s): We conducted a randomized clinical trial in
neonates who underwent a frenotomy between August 2020 and April 2021. We
assessed pain using pre and post-procedure heart rate and oxygen
saturation, crying time and Neonatal Infant Pain Scale (NIPS) score.
Patients with type 3 tongue tie were randomized into the "experimental
group" and "control group". In both groups, we performed swaddling,
administered oral sucrose, and let the newborn suck for two minutes. In
the experimental group, we also placed a gauze pad with one drop of LEO
under the neonate's nose for two minutes prior to and during the
frenotomy. Result(s): We enrolled 142 patients (71 per group). The
experimental group showed significantly lower NIPS scores (1.88 vs 2.92)
and cried almost half the amount of time (14.8 vs. 24.6 seconds, P =
0.006). Comparing with the control group, we observed no side effects in
either of the groups. Conclusion(s): We observed a significant
decrease in crying time and lower NIPS scores in the neonates who received
inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we
recommend using inhaled LEO during neonatal frenotomies. Copyright
© 2022, Children's Hospital, Zhejiang University School of Medicine.

<89>
Accession Number
2018880514
Title
Long-term safety and efficacy of anacetrapib in patients with
atherosclerotic vascular disease.
Source
European Heart Journal. 43(14) (pp 1416-1424), 2022. Date of Publication:
07 Apr 2022.
Author
Sammons E.; Hopewell J.C.; Chen F.; Stevens W.; Wallendszus K.;
Valdes-Marquez E.; Dayanandan R.; Knott C.; Murphy K.; Wincott E.; Baxter
A.; Goodenough R.; Lay M.; Hill M.; Macdonnell S.; Fabbri G.; Lucci D.;
Fajardo-Moser M.; Brenner S.; Hao D.; Zhang H.; Liu J.; Wuhan B.;
Mosegaard S.; Herrington W.; Wanner C.; Angermann C.; Ertl G.; Maggioni
A.; Barter P.; Mihaylova B.; Mitchel Y.; Blaustein R.; Goto S.; Tobert J.;
Delucca P.; Chen Y.; Chen Z.; Gray A.; Haynes R.; Armitage J.; Baigent C.;
Wiviott S.; Cannon C.; Braunwald E.; Collins R.; Bowman L.; Landray M.
Institution
(Sammons) REVEAL Central Coordinating Office, Clinical Trial Service Unit,
Epidemiological Studies Unit, Nuffield Department of Population Health,
University of Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: REVEAL was the first randomized controlled trial to demonstrate that
adding cholesteryl ester transfer protein inhibitor therapy to intensive
statin therapy reduced the risk of major coronary events. We now report
results from extended follow-up beyond the scheduled study treatment
period. Methods and Results: A total of 30 449 adults with prior
atherosclerotic vascular disease were randomly allocated to anacetrapib
100 mg daily or matching placebo, in addition to open-label atorvastatin
therapy. After stopping the randomly allocated treatment, 26 129 survivors
entered a post-trial follow-up period, blind to their original treatment
allocation. The primary outcome was first post-randomization major
coronary event (i.e. coronary death, myocardial infarction, or coronary
revascularization) during the in-trial and post-trial treatment periods,
with analysis by intention-to-treat. Allocation to anacetrapib conferred a
9% [95% confidence interval (CI) 3-15%; P = 0.004] proportional reduction
in the incidence of major coronary events during the study treatment
period (median 4.1 years). During extended follow-up (median 2.2 years),
there was a further 20% (95% CI 10-29%; P < 0.001) reduction. Overall,
there was a 12% (95% CI 7-17%, P < 0.001) proportional reduction in major
coronary events during the overall follow-up period (median 6.3 years),
corresponding to a 1.8% (95% CI 1.0-2.6%) absolute reduction. There were
no significant effects on non-vascular mortality, site-specific cancer, or
other serious adverse events. Morbidity follow-up was obtained for 25 784
(99%) participants. Conclusion(s): The beneficial effects of
anacetrapib on major coronary events increased with longer follow-up, and
no adverse effects emerged on non-vascular mortality or morbidity. These
findings illustrate the importance of sufficiently long treatment and
follow-up duration in randomized trials of lipid-modifying agents to
assess their full benefits and potential harms. Trial registration:
International Standard Randomized Controlled Trial Number (ISRCTN)
48678192; ClinicalTrials.gov No. NCT01252953; EudraCT No.
2010-023467-18. Copyright © 2021 The Author(s). Published by
Oxford University Press on behalf of the European Society of Cardiology.

<90>
Accession Number
2017999978
Title
Interdisciplinary and cross-sectoral perioperative care model in cardiac
surgery: implementation in the setting of minimally invasive heart valve
surgery (INCREASE)-study protocol for a randomized controlled trial.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 528. Date of
Publication: December 2022.
Author
Klotz S.G.R.; Ketels G.; Behrendt C.A.; Konig H.-H.; Kohlmann S.; Lowe B.;
Petersen J.; Stock S.; Vettorazzi E.; Zapf A.; Zastrow I.; Zollner C.;
Reichenspurner H.; Girdauskas E.
Institution
(Klotz, Ketels) Department of Physiotherapy, University Medical Center
Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
(Behrendt) Research Group GermanVasc, Department of Vascular Medicine,
University Heart and Vascular Center, University Medical Center
Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
(Konig) Department of Health Economics and Health Services Research,
University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg
20246, Germany
(Kohlmann, Lowe) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg
20246, Germany
(Petersen, Reichenspurner) Department of Cardiovascular Surgery,
University Heart and Vascular Center, University Medical Center
Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
(Stock, Girdauskas) Department of Cardiothoracic Surgery, University
Hospital Augsburg, Stenglinstr. 2, Augsburg 86156, Germany
(Vettorazzi, Zapf) Department of Medical Biometry and Epidemiology,
University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg
20246, Germany
(Zastrow) Department of Patient and Care Management, University Medical
Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
(Zollner) Department of Anesthesiology, Center of Anesthesiology and
Intensive Care Medicine, University Medical Center Hamburg-Eppendorf,
Martinistr. 52, Hamburg 20246, Germany
Publisher
BioMed Central Ltd
Abstract
Background: Valvular heart diseases are frequent and increasing in
prevalence. Minimally invasive heart valve surgery embedded in an
interdisciplinary enhanced recovery after surgery (ERAS) program may have
potential benefits with regard to reduced length of stay and improved
patient reported outcomes. However, no prospective randomized data exist
regarding the superiority of ERAS program for the patients' outcome.
 Method(s): We aim to randomize (1:1) a total of 186 eligible patients
with minimally invasive heart valve surgery to an ERAS program vs.
standard treatment at two centers including the University Medical Center
Hamburg-Eppendorf, Germany, and the University Hospital Augsburg, Germany.
The intervention is composed out of pre-, peri-, and postoperative
components. The preoperative protocol aims at better preparation for the
operation with regard to physical activity, nutrition, and psychological
preparedness. Intraoperative anesthesiologic and surgical management are
trimmed to enable an early extubation. Patients will be transferred to a
specialized postoperative anesthesia care unit, where first mobilization
occurs 3 h after surgery. Transfer to low care ward will be at the next
day and discharge at the fifth day. Participants in the control group will
receive treatment as usual. Primary endpoints include functional discharge
at discharge and duration of in-hospital care during the first 12 months
after index surgery. Secondary outcomes include health-related quality of
life, health literacy, and level of physical activity. Discussion(s):
This is the first randomized controlled trial evaluating the effectiveness
of an ERAS process after minimally invasive heart valve surgery.
Interprofessional approach is the key factor of the ERAS process and
includes in particular surgical, anesthesiological, physiotherapeutic,
advanced nursing, and psychosocial components. A clinical implication
guideline will be developed facilitating the adoption of ERAS model in
other heart teams. Trial registration: The study has been registered in
ClinicalTrials.gov (NCT04977362 assigned July 27, 2021). Copyright
© 2022, The Author(s).

<91>
Accession Number
2017955121
Title
Can the prophylactic administration of tranexamic acid reduce the blood
loss after robotic-assisted radical prostatectomy? Robotic Assisted
Radical Prostatectomy with tranEXamic acid (RARPEX): study protocol for a
randomized controlled trial.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 508. Date of
Publication: December 2022.
Author
Balik M.; Kosina J.; Husek P.; Pacovsky J.; Brodak M.; Cecka F.
Institution
(Balik, Kosina, Husek, Pacovsky, Brodak) Department of Urology, Charles
University, Faculty of Medicine in Hradec Kralove, Simkova 870, Hradec
Kralove 500 03, Czechia
(Cecka) Department of Surgery, Charles University, Faculty of Medicine in
Hradec Kralove, Simkova 870, Hradec Kralove 500 03, Czechia
Publisher
BioMed Central Ltd
Abstract
Background: The prophylactic administration of tranexamic acid reduces
blood loss during procedures at high risk of perioperative bleeding.
Several studies in cardiac surgery and orthopedics confirmed this finding.
The aim of this prospective, double-blind, randomized study is to evaluate
the effect of tranexamic acid on peri-and postoperative blood loss and on
the incidence and severity of complications. Methods/design: Based on the
results of our pilot study, we decided to conduct this prospective,
double-blind, randomized trial to confirm the preliminary data. The
primary endpoint is to analyze the effect of tranexamic acid on
perioperative and postoperative blood loss (decrease in hemoglobin levels)
in robotic-assisted radical prostatectomy. The additional endpoint is to
analyze the effect of tranexamic acid on postoperative complications and
confirm the safety of tranexamic acid in robotic-assisted radical
prostatectomy. Discussion(s): No study to date has tested the
prophylactic administration of tranexamic acid at the beginning of
robotic-assisted radical prostatectomy. This study is designed to answer
the question of whether the administration of tranexamic acid might lower
the blood loss after the procedure or increase the rate and severity of
complications. Trial registration: ClinicalTrials.gov NCT04319614.
Registered on 25 March 2020. Copyright © 2022, The Author(s).

<92>
Accession Number
2017913205
Title
Transplant Trial Watch.
Source
Transplant International. 35 (no pagination), 2022. Article Number: 10580.
Date of Publication: 01 Jun 2022.
Author
Knight S.R.
Institution
(Knight) Oxford Transplant Centre, Churchill Hospital, Oxford, United
Kingdom
(Knight) Centre for Evidence in Transplantation, Nuffield Department of
Surgical Sciences, University of Oxford, Oxford, United Kingdom
Publisher
European Society for Organ Transplantation

<93>
Accession Number
2017527510
Title
Effects of Landiolol on Macrocirculatory Parameters and Left and Right
Ventricular Performances Following Cardiac Surgery: A Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Part B. 36(8) (pp
2864-2869), 2022. Date of Publication: August 2022.
Author
Ferraris A.; Jacquet-Lagreze M.; Cazenave L.; Fornier W.; Jalalzai W.;
Rousseau-Saine N.; Pozzi M.; Fellahi J.-L.
Institution
(Ferraris, Jacquet-Lagreze, Cazenave, Fornier, Jalalzai, Rousseau-Saine,
Fellahi) Service d'Anesthesie-Reanimation, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
(Jacquet-Lagreze, Pozzi, Fellahi) Laboratoire CarMeN, Lyon, France
(Pozzi) Service de Chirurgie Cardiaque, Hopital Louis Pradel, Hospices
Civils de Lyon, Lyon, France
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative atrial fibrillation (POAF) is a major
complication after cardiac surgery, and an early postoperative
introduction of beta-blockers is recommended to reduce its incidence.
Landiolol, a new intravenous short-acting beta-1 blocker, could present a
useful and safe macrohemodynamic profile after cardiac surgery. Detailed
metabolic and hemodynamic effects of landiolol on cardiac performance,
however, remain poorly documented. The authors aimed to investigate the
dose-dependent hemodynamic and metabolic effects of landiolol in that
specific setting. Design(s): A prospective, randomized, double-blind
study versus placebo. Setting(s): A tertiary university hospital.
 Participant(s): Adult patients scheduled for elective cardiac surgery
with cardiopulmonary bypass. Intervention(s): Incremental doses of
intravenous landiolol (0.5, 1, 2, 5, and 10 mug/kg/min) were given within
the 2 hours after arrival in the intensive care unit. Macrocirculatory
parameters and cardiac performances were derived from transpulmonary
thermodilution and transthoracic echocardiography. Metabolic data were
obtained from arterial blood tests. Measurements and Main Results:
From January to November 2019, 58 patients were analyzed and divided into
a landiolol group (n = 30) and a control group (n = 28). Heart rate
significantly decreased in the landiolol group (p < 0.01), whereas mean
arterial pressure and stroke volume remained unchanged. No significant
modification was found in both left and right systolic and diastolic
performances. Metabolic variables were similar in both groups. New-onset
POAF occurred in 9 (32%) versus 5 (17%) patients in the control and
landiolol groups, respectively (p = 0.28). Conclusion(s): Infusion of
landiolol in the range of 0.5-to-10 mug/kg/min during the early
postoperative period presents a good macrohemodynamic safety profile in
cardiac surgical patients and could be useful to prevent
POAF. Copyright © 2022 Elsevier Inc.

<94>
Accession Number
2017526732
Title
Whole Blood Adsorber During CPB and Need for Vasoactive Treatment After
Valve Surgery in Acute Endocarditis: A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Part B. 36(8) (pp
3015-3020), 2022. Date of Publication: August 2022.
Author
Holmen A.; Corderfeldt A.; Lannemyr L.; Dellgren G.; Hansson E.C.
Institution
(Holmen, Corderfeldt, Lannemyr, Hansson) Department of Cardiothoracic
Surgery, Sahlgrenska University Hospital, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Lannemyr) Department of Anesthesia and Intensive Care, Institution of
Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Dellgren) The Transplant Institute, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden
(Dellgren, Hansson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objectives: Patients with endocarditis requiring urgent valvular surgery
with cardiopulmonary bypass are at a high risk of developing systemic
inflammatory response syndrome and septic shock, necessitating intensive
use of vasopressors after surgery. The use of a cytokine hemoadsorber
(CytoSorb, CytoSorbents Europe GmbH, Germany) during cardiac surgery has
been suggested to reduce the risk of inflammatory activation. The study
authors hypothesized that adding a cytokine adsorber would reduce cytokine
burden, which would translate into improved hemodynamic stability.
 Design(s): A randomized, controlled, nonblinded clinical trial.
 Setting(s): At a university hospital, tertiary referral center.
 Participant(s): Nineteen patients with endocarditis undergoing valve
surgery. Intervention(s): A cytokine hemoadsorber integrated into the
cardiopulmonary bypass circuit. Measurements and Main Results: The
accumulated norepinephrine dose in the intervention group was half or less
at all postoperative time points compared to the control group, although
it did not reach statistical significance; at 24 and 48 hours (median 36
[25-75 percentiles; 12-57] mug v 114 [25-559] mug, p = 0.11 and 36 [12-99]
mug v 261 [25-689] mug, p = 0.09). There was no significant difference in
chest tube output, but there was a significantly lower need for the
transfusion of red blood cells (285 [0-657] mL v 1,940 [883-2,148] mL, p =
0.03). Conclusion(s): There was no statistically significant
difference between the groups with regard to vasopressor use after surgery
for endocarditis with the use of a cytokine hemoadsorber during
cardiopulmonary bypass. Additional, larger randomized controlled trials
are needed to definitely assess the potential effect. Copyright ©
2022 Elsevier Inc.

<95>
Accession Number
2017049955
Title
Role of Hypothermia in Adult Cardiac Surgery Patients: A Systematic Review
and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(7) (pp 1883-1890),
2022. Date of Publication: July 2022.
Author
Abbasciano R.G.; Koulouroudias M.; Chad T.; Mohamed W.; Leeman I.; Pellowe
C.; Kunst G.; Klein A.; Murphy G.J.
Institution
(Abbasciano, Koulouroudias, Chad, Mohamed, Murphy) Department of
Cardiovascular Sciences, Clinical Sciences Wing, Glenfield Hospital,
University of Leicester, Leicester, United Kingdom
(Leeman, Pellowe) National Cardiac Surgery Clinical Trials Initiative,
Case Study Group 5 -Organ Protection, University of Leicester, Leicester,
United Kingdom
(Kunst) Department of Anaesthetics and Pain Medicine, King's College
Hospital NHS Foundation Trust, School of Cardiovascular Medicine &
Sciences, King's College London British Heart Foundation Centre of
Excellence, London, United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: To review studies that assessed systemic hypothermia as an
organ protection strategy in adults undergoing cardiac surgery with
cardiopulmonary bypass. Design(s): A systematic review and
meta-analysis. Setting and Participants: Randomized controlled trials,
irrespective of blinding, language, publication status, and date of
publication, were identified by searching the Cochrane Central register of
Controlled Trials, MEDLINE, and Embase until November 2020. Risk of bias
assessment was performed according to Cochrane methodology. Treatment
effects were expressed as risk ratios and 95% confidence intervals.
Heterogeneity was expressed as I2. Intervention(s):
Systemic hypothermia. Measurements and Main Results: Forty-eight
trials enrolling 6,690 patients were included in the analysis.
Methodologic quality of the studies included was low, mostly due to
insufficient allocation concealment or blinding. Random-effects
meta-analysis did not resolve uncertainty as to the risks and benefits for
hypothermia versus normothermia for key primary and secondary outcomes,
including mortality (1.21, 0.94 to 1.56, I2 = 0%) and brain
injury (0.87, 0.67 to 1.14, I2 = 0%). Sensitivity analyses
restricted to trials at low risk of important bias demonstrated higher
mortality with hypothermia (1.70, 1.05 to 2.75, I2 = 0%), with
little or no treatment effect on brain injury (1.01, 0.69 to 1.49,
I2 = 0%). There was no interaction between cardioplegia
temperature and the effects of cardiopulmonary bypass temperature on
outcomes. There was insufficient evidence to assess the effects of
hypothermia in noncoronary artery bypass graft surgery.
 Conclusion(s): The existing evidence for an organ-protective effect
of hypothermia in adult cardiac surgery is of low quality and
inconsistent. Copyright © 2022 Elsevier Inc.

<96>
Accession Number
2017039103
Title
A comparative study between Thoracic Epidural Anesthesia in non-intubated
video-assisted thoracoscopes and the conventional general anesthesia with
one lung ventilation.
Source
Egyptian Journal of Anaesthesia. 38(1) (pp 284-290), 2022. Date of
Publication: 2022.
Author
Ashour M.R.; AbdelLatif S.A.; Altaher W.A.M.; ElSayed H.H.; Koraitim A.F.;
Alhadidy M.A.
Institution
(Ashour, AbdelLatif, Altaher, Koraitim, Alhadidy) Department of
Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain
Shams University, Cairo, Egypt
(ElSayed) Department of Thoracic Surgery, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) refers to the
minimally invasive thoracic surgeries performed by video cameras to avoid
the invasive conventional open thoracotomy. The majority necessitate
one-lung ventilation. Regional anesthesia is involved to avoid the risks
of general anesthesia(GA) and one-lung ventilation and promote efficient
recovery of these vulnerable populations. Objective(s): To assess the
feasibility of non-intubated VATS with Thoracic Epidural Anesthesia (TEA)
compared to the conventional GA in terms of hemodynamic and ventilatory
parameters, postoperative pain control, opiate consumption, ambulation,
and length of hospital stay. Patients and Methods: This study is a
prospective randomized clinical study conducted in Ain Shams University
Hospitals over 2 years, with a sample size of 40 patients in 2 groups. The
GA group, after induction of anesthesia, double-lumen endotracheal tube
was inserted to facilitate one-lung ventilation. The TEA group, an
epidural catheter was inserted between T3 and T4 orT4 and T5
intervertebral space, local anesthetic dose titrated aiming to achieve
sensory and motor block between C7-T7 levels. Result(s): The findings
revealed no statistically significant difference between groups throughout
the perioperative period (p >0.05) regarding ventilatory and circulatory
parameters besides opiate consumption. Conversely, in terms of
postoperative ambulation and length of hospital stay (LOS), p-value=0.013
and 0.001 respectively for each favoring the TEA group. Similar results
were denoted for postoperative pain control, there was statistically
significant difference between groups in VAS score at 3 hours (P =0.004).
 Conclusion(s): The feasibility of nonintubated VATS with TEA was
tested with respect to safety and efficiency compared to the conventional
GA. The results of both groups are comparable in terms of hemodynamics and
ventilatory parameters. Despite similar overall opiate consumption in both
groups, the TEA group demonstrated promising results regarding the
enhanced recovery parameters in terms of better early postoperative pain
control, earlier ambulation, and decreased length of hospital
stay. Copyright © 2022 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<97>
Accession Number
2017159263
Title
Sodium-Glucose Cotransporter 2 Inhibitors and Heart Failure: A
Bedside-to-Bench Journey.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 810791. Date of Publication: 2021.
Author
Cappetta D.; De Angelis A.; Bellocchio G.; Telesca M.; Cianflone E.;
Torella D.; Rossi F.; Urbanek K.; Berrino L.
Institution
(Cappetta, De Angelis, Bellocchio, Telesca, Rossi, Berrino) Department of
Experimental Medicine, University of Campania" Luigi Vanvitelli", Naples,
Italy
(Cianflone) Department of Medical and Surgical Sciences,
University"MagnaGraecia"of Catanzaro, Catanzaro, Italy
(Torella, Urbanek) Department of Experimental and Clinical Medicine,
University"Magna Graecia"of Catanzaro, Catanzaro, Italy
Publisher
Frontiers Media S.A.
Abstract
Type 2 diabetes mellitus (T2DM) and heart failure (HF) are multifactorial
diseases sharing common risk factors, such as obesity, hyperinsulinemia,
and inflammation, with underlying mechanisms including endothelial
dysfunction, inflammation, oxidative stress, and metabolic alterations.
Cardiovascular benefits of sodium-glucose cotransporter 2 (SGLT2)
inhibitors observed in diabetic and non-diabetic patients are also related
to their cardiac-specific, SGLT-independent mechanisms, in addition to the
metabolic and hemodynamic effects. In search of the possible underlying
mechanisms, a research campaign has been launched proposing varied
mechanisms of action that include intracellular ion homeostasis,
autophagy, cell death, and inflammatory processes. Moreover, the research
focus was widened toward cellular targets other than cardiomyocytes. At
the moment, intracellular sodium level reduction is the most explored
mechanism of direct cardiac effects of SGLT2 inhibitors that mediate the
benefits in heart failure in addition to glucose excretion and diuresis.
The restoration of cardiac Na+ levels with consequent positive
effects on Ca2+ handling can directly translate into improved
contractility and relaxation of cardiomyocytes and have antiarrhythmic
effects. In this review, we summarize clinical trials, studies on human
cells, and animal models, that provide a vast array of data in support of
repurposing this class of antidiabetic drugs. Copyright © 2021
Cappetta, De Angelis, Bellocchio, Telesca, Cianflone, Torella, Rossi,
Urbanek and Berrino.

<98>
[Use Link to view the full text]
Accession Number
634814107
Title
Safety and Efficacy of Human Chorionic Gonadotropin Hormone-Derivative
EA-230 in Cardiac Surgery Patients: A Randomized Double-Blind
Placebo-Controlled Study.
Source
Critical Care Medicine. 49(5) (pp 790-803), 2021. Date of Publication: 01
May 2021.
Author
Van Groenendael R.; Beunders R.; Hemelaar P.; Hofland J.; Morshuis W.J.;
Van Der Hoeven J.G.; Gerretsen J.; Wensvoort G.; Kooistra E.J.; Claassen
W.J.; Waanders D.; Lamberts M.G.A.; Buijsse L.S.E.; Kox M.; Van Eijk L.T.;
Pickkers P.
Institution
(Van Groenendael, Beunders, Hemelaar, Van Der Hoeven, Gerretsen, Kooistra,
Claassen, Waanders, Lamberts, Buijsse, Kox, Pickkers) Department Of
Intensive Care Medicine, Radboud University Medical Center, Nijmegen,
Netherlands
(Van Groenendael, Beunders, Hemelaar, Van Der Hoeven, Gerretsen, Kooistra,
Kox, Van Eijk, Pickkers) Radboud Center For Infectious Diseases (RCI),
Radboud University Medical Center, Nijmegen, Netherlands
(Van Groenendael, Beunders, Van Der Hoeven, Kooistra, Kox, Van Eijk,
Pickkers) Radboud Institute For Molecular Life Sciences (RIMLS), Radboud
University Medical Center, Nijmegen, Netherlands
(Van Groenendael, Hofland, Van Eijk) Department Of Anesthesiology, Pain
And Palliative Medicine, Radboud University Medical Center, Nijmegen,
Netherlands
(Morshuis) Department Of Cardiothoracic Surgery, Radboud University
Medical Center, Nijmegen, Netherlands
(Wensvoort) Exponential Biotherapies, Inc. (EBI), The Hague, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: To determine the safety and efficacy of human chorionic
gonadotropin hormone-derivative EA-230 in cardiac surgery patients.
Cardiac surgery induces systemic inflammation and may impair renal
function, affecting patient outcome. EA-230 exerted immunomodulatory and
renoprotective effects in preclinical models and was safe and showed
efficacy in phase I and II human studies. DESIGN: Double-blinded,
placebo-controlled, randomized study. SETTING: Collaboration of the
Cardiothoracic Surgery, Anesthesiology, and the Intensive Care departments
of a tertiary hospital in the Netherlands. PATIENTS: One hundred eighty
patients undergoing an on-pump coronary artery bypass procedure with or
without concomitant valve surgery. INTERVENTIONS: Ninety mg/kg/hr EA-230
or placebo administered during surgery. MEASUREMENTS AND MAIN RESULTS:
During the study, no safety concerns emerged. EA-230 did not modulate
interleukin-6 plasma concentrations (area under the curve 2,730 pg/mL x hr
[1,968-3,760] vs 2,680 pg/mL x hr [2,090-3,570] for EA-230 and placebo
group, respectively; p = 0.80). Glomerular filtration rate increased
following surgery (mean +/- sem increase in the EA-230 vs placebo groups:
glomerular filtration rateiohexol measured using iohexol plasma clearance:
19 +/- 2 vs 16 +/- 2 mL/min/1.73 m2; p = 0.13 and estimated glomerular
filtration rate with the Modification of Diet in Renal Disease equation
using creatinine: 6 +/- 1 vs 2 +/- 1 mL/min/1.73 m2; p = 0.01). The
"injury"stage of the Risk, Injury, Failure, Loss of kidney function, and
End-stage kidney disease criteria for acute kidney injury was 7% in the
EA-230 group versus 18% in the placebo group (p = 0.07). In addition,
EA-230-treated patients had a less positive fluid balance compared with
placebo-treated patients (217 +/- 108 vs 605 +/- 103 mL; p = 0.01), while
the use of vasoactive agents was similar in both groups (p = 0.39).
Finally, hospital length of stay was shorter in EA-230 treated patients (8
d [7-11] vs 10 d [8-12]; p = 0.001). Efficacy results were more pronounced
in patients that had longer duration of surgery and thus longer duration
of study drug infusion. CONCLUSION(S): EA-230 was safe in patients
undergoing on-pump cardiac surgery. It did not modulate interleukin-6
plasma concentrations but appeared to exert beneficial renal and
cardiovascular effects and shortened in-hospital length of
stay. Copyright © 2021 The Author(s).

<99>
Accession Number
2014561274
Title
Drug-eluting or bare-metal stents for left anterior descending or left
main coronary artery revascularization.
Source
Journal of the American Heart Association. 10(20) (no pagination), 2021.
Article Number: e018828. Date of Publication: 19 Oct 2021.
Author
Piccolo R.; Bonaa K.H.; Efthimiou O.; Varenne O.; Urban P.; Kaiser C.;
Raber L.; de Belder A.; Remkes W.; Van'T Hof A.W.J.; Stankovic G.; Lemos
P.A.; Wilsgaard T.; Reifart J.; Rodriguez A.E.; Ribeiro E.E.; Serruys
P.W.J.C.; Abizaid A.; Sabate M.; Byrne R.A.; de la Torre Hernandez J.M.;
Wijns W.; Esposito G.; Juni P.; Windecker S.; Valgimigli M.
Institution
(Piccolo, Esposito) Department of Advanced Biomedical Sciences, University
of Naples Federico II, Naples, Italy
(Bonaa, Wilsgaard) Department of Community Medicine, University of Tromso,
The Arctic University of Norway, Tromso, Norway
(Efthimiou) Institute of Social and Preventive Medicine
(Raber, Windecker, Valgimigli) Department of Cardiology, Bern University
Hospital, Switzerland
(Efthimiou) University of Bern, Switzerland
(Varenne) Department of Cardiology, Hopital Cochin, AP-HP, Paris, France
(Varenne) Faculte de Medecine, Universite de Paris, France
(Urban) Hopital de la Tour, Geneva, Switzerland
(Kaiser) Department of Cardiology, University Hospital Basel, University
of Basel, Switzerland
(de Belder) Department of Cardiology, Sussex Cardiac Centre, Brighton and
Sussex University Hospitals, Brighton, United Kingdom
(Remkes) Department of Cardiology, Isala Heart Centre, Zwolle, Netherlands
(Van'T Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
(Van'T Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
(Stankovic) Department of Cardiology, Clinical Center of Serbia,
University of Belgrade, Serbia
(Lemos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Lemos) Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
(Reifart) Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires School of
Medicine, Buenos Aires, Argentina
(Ribeiro) Instituto do Coracao (INCOR), Sao Paulo, Brazil
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College, London, United Kingdom
(Abizaid) Department of Invasive Cardiology, Institute Dante Pazzanese of
Cardiology, Sao Paulo, Brazil
(Sabate) Cardiology Department, Cardiovascular Institute (ICCV) and
Hospital Clinic, IDIBAPS, University of Barcelona, Spain
(Byrne) Dublin Cardiovascular Research Institute, Mater Private Hospital,
Dublin, Ireland
(Byrne) School of Pharmacy and Biomolecular Sciences, Royal College of
Surgeons in Ireland, Dublin, Ireland
(de la Torre Hernandez) Hospital Marques de Valdecilla, Santander, Spain
(Wijns) The Lambe Institute for Translational Medicine and Curam, Galway,
Ireland
(Wijns) Department of Cardiology, National University of Ireland Galway,
Galway, Ireland
(Juni) Department of Medicine, Applied Health Research Centre of the Li Ka
Shing Knowledge Institute, St Michael's Hospital, University of Toronto,
ON, Canada
(Valgimigli) CardioCentro Ticino, Lugano, Switzerland
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: New-generation drug-eluting stents (DES) reduce target-vessel
revascularization compared with bare-metal stents (BMS), and recent data
suggest that DES have the potential to decrease the risk of myocardial
infarction and cardiovascular mortality. We evaluated the treatment effect
of DES versus BMS according to the target artery (left anterior descending
[LAD] and/or left main [LM] versus other territories [no-LAD/LM]). METHODS
AND RESULTS: The Coronary Stent Trialist (CST) Collaboration gathered
individual patient data of randomized trials of DES versus BMS for the
treatment of coronary artery disease. The primary outcome was the
composite of cardiac death or myocardial infarction. Hazard ratios (HRs)
with 95% CIs were derived from a 1-stage individual patient data
meta-analysis. We included 26 024 patients across 19 trials: 13 650
(52.4%) in the LAD/LM and 12 373 (47.6%) in the no-LAD/LM group. At 6-year
follow-up, there was strong evidence that the treatment effect of DES
versus BMS depended on the target vessel (Pinteraction=0.024). Compared
with BMS, DES reduced the risk of cardiac death or myocardial infarction
to a greater extent in the LAD/LM (HR, 0.76; 95% CI, 0.68-0.85) than in
the no-LAD/LM territories (HR, 0.93; 95% CI, 0.83-1.05). This benefit was
driven by a lower risk of cardiac death (HR, 0.83; 95% CI, 0.70-0.98) and
myocardial infarction (HR, 0.74; 95% CI, 0.65-0.85) in patients with
LAD/LM disease randomized to DES. An interaction (P=0.004) was also found
for all-cause mortality with patients with LAD/LM disease deriving benefit
from DES (HR, 0.86; 95% CI, 0.76-0.97). CONCLUSION(S): As compared
with BMS, new-generation DES were associated with sustained reduction in
the composite of cardiac death or myocardial infarction if used for the
treatment of LAD or left main coronary stenoses. Copyright © 2021
The Authors.

<100>
Accession Number
2015318072
Title
Left main coronary artery compression by dilated pulmonary artery in
pulmonary arterial hypertension: a systematic review and meta-analysis.
Source
Clinical Research in Cardiology. 111(7) (pp 816-826), 2022. Date of
Publication: July 2022.
Author
Badea R.; Dorobantu D.M.; Sharabiani M.T.A.; Predescu L.M.; Coman I.M.;
Ginghina C.
Institution
(Badea, Predescu, Coman, Ginghina) Cardiology Department, Carol Davila
University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest,
Romania
(Dorobantu) Children's Health and Exercise Research Centre (CHERC),
University of Exeter, Exeter, United Kingdom
(Dorobantu) School of Population Health Sciences, University of Bristol,
Bristol, United Kingdom
(Sharabiani) Department of Primary Care and Public Health, School of
Public Health, Imperial College of London, London, United Kingdom
(Predescu, Coman, Ginghina) Cardiology Department, Prof. Dr. C. C. Iliescu
Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: Pulmonary arterial hypertension (PAH) can lead to left main
coronary artery compression (LMCo), but data on the impact, screening and
treatment are limited. A meta-analysis of LMCo cases could fill the
knowledge gaps in this topic. Method(s): Electronic databases were
searched for all LMCo/PAH studies, abstracts and case reports including
pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis
was used to evaluate LMCo-associated factors. Specificity, sensitivity and
accuracy of PA size thresholds for diagnosis of LMCo were calculated.
Treatment options and outcomes were summarized. Result(s): A total of
five case-control cohorts and 64 case reports/series (196 LMCo and 438
controls) were included. LMCo cases had higher PA diameter (Hedge's g 1.46
[1.09; 1.82]), PA/aorta ratio (Hedge's g 1.1 [0.64; 1.55]) and probability
of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA
pressure or vascular resistance. A 40 mm cut-off for the PA diameter had
balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for
LMCo diagnosis, while a value of 44 mm had higher accuracy (81.7%), higher
specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after
non-conservative treatment (n = 150, predominantly stenting) was 2.7% at
up to 22 months of mean follow-up, with 83% survivors having no angina at
follow-up. Conclusion(s): PA diameter, PA/aorta ratio and CHD are
associated with LMCo, while hemodynamic parameters are not. Data from this
study support that a PA diameter cut-off between 40 and 44 mm can offer
optimal accuracy for LMCo screening. Preferred treatment was coronary
stenting, associated with low mid-term mortality and symptom relief.
Graphical abstract: Diagnosis and management of left main coronary artery
compression (LMCo) in patients with pulmonary arterial hypertension (PAH).
[Figure not available: see fulltext.] Copyright © 2022, The
Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

<101>
Accession Number
2018028699
Title
Surgery for Anomalous Aortic Origin of a Coronary Artery (AAOCA) in
Children and Adolescents: A Meta-Analysis.
Source
World Journal for Pediatric and Congenital Heart Surgery. 13(4) (pp
485-494), 2022. Date of Publication: July 2022.
Author
Ponzoni M.; Frigo A.C.; Padalino M.A.
Institution
(Ponzoni, Padalino) Pediatric and Congenital Cardiac Surgery Unit, Veneto,
Padova, Italy
(Frigo) Unit of Biostatistics, Department of Cardiac, Vascular Sciences,
and Public Health, University of Padova Medical School, Thoracic, Italy
Publisher
SAGE Publications Inc.
Abstract
We conducted a systematic review and meta-analysis of the literature to
assess the outcomes of surgery for the anomalous aortic origin of a
coronary artery in children and young adults (<30 years). Thirteen
publications were selected, including a total of 384 patients. Unroofing
of the intramural segment was adopted in 92% (95% CI: 81%-98%) of cases,
with pooled early and late mortality of 0% (95% CI: 0%-0.3%) and 0.1% (95%
CI: 0%-1%), respectively. Reoperation for aortic regurgitation was
anecdotal. Surgical management of anomalous aortic origin of coronary
arteries can be achieved with excellent results in pediatric patients, but
concerns remain about the durability of surgery. Copyright © The
Author(s) 2022.

<102>
Accession Number
2017281382
Title
Cell Salvage at the ICU.
Source
Journal of Clinical Medicine. 11(13) (no pagination), 2022. Article
Number: 3848. Date of Publication: July-1 2022.
Author
Schmidbauer S.L.; Seyfried T.F.
Institution
(Schmidbauer) Department of Anesthesiology, University Hospital
Regensburg, Regensburg 93053, Germany
(Seyfried) Department of Anesthesiology, Ernst von Bergmann Hospital,
Potsdam 14467, Germany
Publisher
MDPI
Abstract
Patient Blood Management (PBM) is a patient-centered, systemic and
evidence-based approach. Its target is to manage and to preserve the
patient's own blood. The aim of PBM is to improve patient safety. As
indicated by several meta-analyses in a systematic literature search, the
cell salvage technique is an efficient method to reduce the demand for
allogeneic banked blood. Therefore, cell salvage is an important tool in
PBM. Cell salvage is widely used in orthopedic-, trauma-, cardiac-,
vascular and transplant surgery. Especially in cases of severe bleeding
cell salvage adds significant value for blood supply. In cardiac and
orthopedic surgery, the postoperative use for selected patients at the
intensive care unit is feasible and can be implemented well in practice.
Since the retransfusion of unwashed shed blood should be avoided due to
multiple side effects and low quality, cell salvage can be used to reduce
postoperative anemia with autologous blood of high quality. Implementing
quality management, compliance with hygienic standards as well as training
and education of staff, it is a cost-efficient method to reduce allogeneic
blood transfusion. The following article will discuss the possibilities,
legal aspects, implementation and costs of using cell salvage devices in
an intensive care unit. Copyright © 2022 by the authors. Licensee
MDPI, Basel, Switzerland.

<103>
Accession Number
638359681
Title
Prothrombin Complex Concentrate vs Plasma for Post-Cardiopulmonary Bypass
Coagulopathy and Bleeding: A Randomized Clinical Trial.
Source
JAMA surgery. (no pagination), 2022. Date of Publication: 29 Jun 2022.
Author
Smith M.M.; Schroeder D.R.; Nelson J.A.; Mauermann W.J.; Welsby I.J.;
Pochettino A.; Montonye B.L.; Assawakawintip C.; Nuttall G.A.
Institution
(Smith, Nelson, Mauermann, Nuttall) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic College of Medicine and Science,
Rochester, MN
(Schroeder) Department of Biomedical Statistics and Informatics, Mayo
Clinic College of Medicine and Science, Rochester, MN
(Welsby) Department of Anesthesiology, Duke University Medical Center,
Durham, NC
(Pochettino) Division of Cardiovascular Surgery, Department of Surgery,
Mayo Clinic College of Medicine and Science, Rochester, MN
(Montonye) Anesthesia Clinical Research Unit, Mayo Clinic College of
Medicine and Science, Rochester, MN
(Assawakawintip) Department of Anesthesiology, Wetchakarunrasm Hospital,
Bangkok, Thailand
Publisher
NLM (Medline)
Abstract
Importance: Post-cardiopulmonary bypass (CPB) coagulopathy and bleeding
are among the most common reasons for blood product transfusion in
surgical practices. Current retrospective data suggest lower transfusion
rates and blood loss in patients receiving prothrombin complex concentrate
(PCC) compared with plasma after cardiac surgery. Objective(s): To
analyze perioperative bleeding and transfusion outcomes in patients
undergoing cardiac surgery who develop microvascular bleeding and receive
treatment with either PCC or plasma. Design, Setting, and
Participant(s): A single-institution, prospective, randomized clinical
trial performed at a high-volume cardiac surgical center. Patients were
aged 18 years or older and undergoing cardiac surgery with CPB. Patients
undergoing complex cardiac surgical procedures (eg, aortic replacement
surgery, multiple procedures, or repeated sternotomy) were preferentially
targeted for enrollment. During the study period, 756 patients were
approached for enrollment, and 553 patients were randomized. Of the 553
randomized patients, 100 patients met criteria for study intervention.
 Intervention(s): Patients with excessive microvascular bleeding, a
prothombin time (PT) greater than 16.6 seconds, and an international
normalized ratio (INR) greater than 1.6 were randomized to receive
treatment with either PCC or plasma. The PCC dose was 15 IU/kg or closest
standardized dose; the plasma dose was a suggested volume of 10 to 15
mL/kg rounded to the nearest unit. Main Outcomes and Measures: The
primary outcome was postoperative bleeding (chest tube output) from the
initial postsurgical intensive care unit admission through midnight on
postoperative day 1. Secondary outcomes were PT/INR, rates of
intraoperative red blood cell (RBC) transfusion after treatment, avoidance
of allogeneic transfusion from the intraoperative period to the end of
postoperative day 1, postoperative bleeding, and adverse events.
 Result(s): One hundred patients (mean [SD] age, 66.8 [13.7] years; 61
[61.0%] male; and 1 [1.0%] Black, 1 [1.0%] Hispanic, and 98 [98.0%] White)
received the study intervention (49 plasma and 51 PCC). There was no
significant difference in chest tube output between the plasma and PCC
groups (median [IQR], 1022 [799-1575] mL vs 937 [708-1443] mL). After
treatment, patients in the PCC arm had a greater improvement in PT (effect
estimate, -1.37 seconds [95% CI, -1.91 to -0.84]; P<.001) and INR (effect
estimate, -0.12 [95% CI, -0.16 to -0.07]; P<.001). Fewer patients in the
PCC group required intraoperative RBC transfusion after treatment (7 of 51
patients [13.7%] vs 15 of 49 patients [30.6%]; P=.04); total
intraoperative transfusion rates were not significantly different between
groups. Seven (13.7%) of 51 patients receiving PCCs avoided allogeneic
transfusion from the intraoperative period to the end of postoperative day
1 vs none of those receiving plasma. There were no significant differences
in postoperative bleeding, transfusions, or adverse events.
 Conclusions and Relevance: The results of this study suggest a
similar overall safety and efficacy profile for PCCs compared with plasma
in this clinical context, with fewer posttreatment intraoperative RBC
transfusions, improved PT/INR correction, and higher likelihood of
allogeneic transfusion avoidance in patients receiving PCCs. Trial
Registration: ClinicalTrials.gov Identifier: NCT02557672.

<104>
Accession Number
2018058027
Title
Late Outcomes After Aortic Root Enlargement During Aortic Valve
Replacement: Meta-Analysis With Reconstructed Time-To-Event Data.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Part B. 36(8) (pp
3065-3073), 2022. Date of Publication: August 2022.
Author
Sa M.P.; Van den Eynde J.; Amabile A.; Malin J.H.; Jacquemyn X.; Tasoudis
P.; Sicouri S.; Schena S.; Torregrossa G.; Ramlawi B.
Institution
(Sa, Torregrossa, Ramlawi) Department of Cardiothoracic Surgery, Lankenau
Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood,
Panama
(Sa, Tasoudis, Sicouri, Torregrossa, Ramlawi) Department of Cardiothoracic
Surgery Research, Lankenau Institute for Medical Research, Wynnewood,
Panama
(Van den Eynde, Jacquemyn) Department of Cardiovascular Sciences, KU
Leuven, Leuven, Belgium
(Amabile) Division of Cardiac Surgery, Department of Surgery, Yale School
of Medicine, New Haven, CT
(Malin) Philadelphia College of Osteopathic Medicine, Bala Cynwyd, PA
(Schena) Division of Cardiac Surgery, The Johns Hopkins Hospital,
Baltimore, Moldova
Publisher
W.B. Saunders
Abstract
Objectives: The present authors aimed to assess the late outcomes of
patients undergoing aortic root enlargement (ARE) at the time of surgical
aortic valve replacement (SAVR). Design(s): Study-level meta-analysis
with reconstructed time-to-event data. Setting(s): Follow-up of
patients after surgical procedure. Participant(s): Adult patients
with aortic valve disease requiring surgery. Intervention(s): SAVR
with ARE versus SAVR without ARE. Measurements and Main Results: This
study followed the Preferred Reporting Items for Systematic Reviews and
Meta-analyses reporting guideline. The following databases were searched
for studies meeting the authors' inclusion criteria and published by
November 30, 2021: PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL,
and Google Scholar. Nine nonrandomized studies met the authors'
eligibility criteria. All studies were nonrandomized. A total of 213,134
patients (SAVR with ARE: 7,556 patients; SAVR without ARE: 205,578
patients) were included from studies published from 1997 to 2021. The
total rate of AAE was 3.7%, varying in the studies from 2.9% to 28.1%. The
studies consisted of patients whose mean age varied from 63 to 79 years.
Patients in the SAVR with ARE group had a significantly better overall
survival (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.90-0.99,
p = 0.016) in the unmatched populations, but the matched analysis revealed
no difference between SAVR with/without ARE in terms of overall survival
(HR, 1.06; 95% CI, 0.90-1.25; p = 0.474). Conclusion(s): In the
context of patients undergoing SAVR with or without ARE, patients who
undergo ARE do not experience worse late outcomes. Further randomized
controlled trials are needed to confirm or refute the authors' current
findings. Copyright © 2022 Elsevier Inc.

<105>
Accession Number
2017057140
Title
The effect of ultrasound-guided bilateral thoracic retrolaminar block on
analgesia after pediatric open cardiac surgery: a randomized controlled
double-blind study.
Source
Korean Journal of Anesthesiology. 75(3) (pp 276-282), 2022. Date of
Publication: June 2022.
Author
Abdelbaser I.; Mageed N.A.; Elfayoumy S.I.; Magdy M.; Elmorsy M.M.;
Alseoudy M.M.
Institution
(Abdelbaser, Mageed, Magdy, Alseoudy) Department of Anesthesia and
Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2
El-Gomhouria Street, Mansoura 35516, Egypt
(Elfayoumy) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Portsaid University, Portsaid, Egypt
(Elmorsy) Department of Anesthesia and Surgical Intensive Care, Faculty of
Medicine, Damietta University, Damietta, Egypt
Publisher
Korean Society of Anesthesiologists
Abstract
Background: The thoracic retrolaminar block (TRLB) is a relatively new
regional analgesia technique that can be used as an alternative to the
thoracic paravertebral block. This study aimed to evaluate the
postoperative analgesic effects of ultrasound-guided TRLB in children
undergoing open cardiac surgery via median sternotomy incision.
 Method(s): Sixty-six patients aged 2-8 years were recruited. In the
TRLB group, 0.25% bupivacaine 0.4 ml/kg was injected into the retrolaminar
space on both sides at the level of the T4 lamina. Patients in the control
group were injected with 0.9% saline. The primary outcome measure was
fentanyl consumption in the first 24 h post-extubation. The secondary
outcome measures were the total intraoperative fentanyl consumption,
postoperative modified objective pain score (MOPS), and time to
extubation. Result(s): The total intraoperative fentanyl requirements
and fentanyl consumption in the first 24 h post-extubation were
significantly lower (P < 0.001) in the TRLB group (9.3 +/- 1.2; 6.9 +/-
2.1 mug/kg, respectively) than in the control group (12.5 +/- 1.4; 16.6
+/- 2.8, respectively). The median (Q1, Q3) time to extubation was
significantly shorter (P < 0.001) in the TRLB group (2 [1, 3] h) than in
the control group (6 [4.5, 6] h). The MOPS was significantly lower (P <
0.05) in the TRLB group than in the control group at 0, 2, 4, 8, 12 and 16
h post-extubation. Conclusion(s): Bilateral ultrasound-guided TRLB is
effective in providing postoperative analgesia in children undergoing open
cardiac surgery via median sternotomy incision. Copyright @ 2022 The
Korean Society of Anesthesiologists, 2022.

<106>
Accession Number
2016005077
Title
Novel oral anticoagulants versus vitamin K antagonists in patients with
atrial fibrillation after transcatheter aortic valve replacement: A
systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 99(7) (pp 2101-2110),
2022. Date of Publication: June 1, 2022.
Author
Memon M.M.; Siddiqui A.A.; Amin E.; Shaikh F.N.; Khan M.S.; Doukky R.;
Krasuski R.A.
Institution
(Memon, Siddiqui, Amin, Shaikh) Department of Medicine, Dow University of
Health Sciences, Karachi, Pakistan
(Khan, Krasuski) Division of Cardiology, Duke University Medical Center,
Durham, NC, United States
(Doukky) Division of Cardiology, Cook County Health and Hospitals System,
Chicago, IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The efficacy and safety of novel oral anticoagulants (NOACs)
compared to the current guideline-recommended vitamin K antagonists (VKAs)
in atrial fibrillation (AF) patients undergoing transcatheter aortic valve
replacement (TAVR) has not been well established. We pooled evidence from
all available studies to assess the risks and benefits of this drug class.
 Method(s): We queried electronic databases (MEDLINE, Scopus, and
Cochrane central) up until January 28th, 2022 for studies comparing NOACs
to VKAs in AF patients undergoing TAVR. Results from studies were
presented as risk ratios (RR) and pooled using a random-effects model.
Subgroup analysis by study design and meta-regression analysis were
performed to explore heterogeneity. Result(s): A total of 12 studies
(3 RCTs and 9 observational) containing 12,203 patients (mean age 81.2
years; 50.5% men) were identified and included in the analysis. Pooled
analysis revealed no significant difference between NOACs and VKAs in
terms of stroke or systemic embolism (RR: 0.78; p = 0.18), major bleeding
(RR: 0.84; p = 0.32), intracranial hemorrhage (RR 0.61; p = 0.06),
all-cause mortality (RR: 0.69; p = 0.07), and myocardial infarction (RR:
1.60; p = 0.24) at a mean length of follow-up of 15.1 months. RCTs and
observational studies did not significantly differ across outcomes on
subgroup analysis. Meta-regression analysis found heterogeneity in
all-cause mortality to be significantly explained by percentage of males
(coefficient: 0.049, p = 0.007), mean age (coefficient: 0.221, p < 0.001),
and CHA2DS2-VASc score (coefficient: -1.657, p < 0.001).
 Conclusion(s): This meta-analysis suggests that outcomes with NOACs
do not significantly differ compared to VKAs following TAVR in patients
with AF. Copyright © 2022 Wiley Periodicals LLC.

<107>
Accession Number
2015797838
Title
Rationale and design of the BA-SCAD (Beta-blockers and Antiplatelet agents
in patients with Spontaneous Coronary Artery Dissection) randomized
clinical trial.
Source
Revista Espanola de Cardiologia. 75(6) (pp 515-522), 2022. Date of
Publication: June 2022.
Author
Alfonso F.; de la Torre Hernandez J.M.; Ibanez B.; Sabate M.; Pan M.;
Gulati R.; Saw J.; Angiolillo D.J.; Adlam D.; Sanchez-Madrid F.
Institution
(Alfonso) Departamento de Cardiologia, Hospital Universitario de La
Princesa, Instituto de Investigacion Sanitaria Princesa (IIS-IP),
Universidad Autonoma de Madrid, Madrid, Spain
(Alfonso, Ibanez, Sabate, Sanchez-Madrid) Centro de Investigacion
Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
(de la Torre Hernandez) Departamento de Cardiologia, Hospital
Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
(Ibanez) Departamento de Cardiologia, IIS-Fundacion Jimenez Diaz, Centro
Nacional Investigaciones Cardiovasculares (CNIC), Madrid, Spain
(Sabate) Departamento de Cardiologia, Instituto Cardiovascular, Hospital
Clinic, IDIBAPS, Barcelona, Spain
(Pan) Departamento de Cardiologia, Hospital Universitario Reina Sofia,
Universidad de Cordoba, IMIBIC, Cordoba, Spain
(Gulati) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
Minnesota, United States
(Saw) Division of Cardiology, Vancouver General Hospital, University of
British Columbia, Vancouver, BC, Canada
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, Florida, United States
(Adlam) Department of Cardiovascular Sciences and National Institute for
Health Research, Leicester Biomedical Research Centre, Glenfield Hospital,
United Kingdom
(Sanchez-Madrid) Departamento de Inmunologia, Hospital Universitario de La
Princesa, Instituto de Investigacion Sanitaria Princesa (IIS-IP),
Universidad Autonoma de Madrid, Madrid, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction y objectives: Spontaneous coronary artery dissection (SCAD)
is a rare cause of acute coronary syndrome. Most patients are empirically
treated with beta-blockers and antiplatelet drugs. The Beta-blockers and
Antiplatelet agents in patients with Spontaneous Coronary Artery
Dissection (BA-SCAD) is an academic, pragmatic, prospective, randomized,
open-label, blinded-endpoint clinical trial, performed under the auspices
of the Spanish Society of Cardiology, to assess the efficacy of
pharmacological therapy in patients with SCAD. Method(s): Using a 2 x
2 factorial design, 600 patients will be randomized (1:1/1:1) to: a)
beta-blockers (yes/no) and b) "short" (1 month) vs "prolonged" (12 months)
antiplatelet therapy. Only patients with preserved left ventricular
ejection fraction will be randomized to beta-blockers (yes/no) because
patients with reduced left ventricular ejection fraction will receive
beta-blockers according to current guidelines. Similarly, only
conservatively managed patients (ie, no coronary intervention) will be
randomized to the antiplatelet stratum, as patients requiring coronary
interventions will receive 1-year dual antiplatelet therapy. The primary
efficacy endpoint includes a composite of death, myocardial infarction,
stroke, coronary revascularization, recurrent SCAD, and unplanned
hospitalization for acute coronary syndrome or heart failure at 1 year.
The primary safety endpoint will be bleeding. All patients will be
clinically followed up yearly. A comprehensive set of additional
substudies (clinical, imaging, revascularization, biomarkers,
inflammatory, immunologic, pharmacogenetics, and genetic) will be
conducted to ensure a holistic view of this unique and challenging
clinical entity. Conclusion(s): The results of the BA-SCAD randomized
clinical trial will advance our knowledge in the treatment of patients
with SCAD. The study was registered at ClinicalTrials.gov (Identifier:
NCT04850417). Copyright © 2021 Sociedad Espanola de Cardiologia

<108>
Accession Number
2015702271
Title
The Prognostic Performance of Ferritin in Patients with Acute Myocardial
Infarction: A Systematic Review.
Source
Diagnostics. 12(2) (no pagination), 2022. Article Number: 476. Date of
Publication: February 2022.
Author
Brinza C.; Floria M.; Popa I.V.; Burlacu A.
Institution
(Brinza, Floria, Popa, Burlacu) Faculty of Medicine, University of
Medicine and Pharmacy, Iasi 700115, Romania
(Brinza, Burlacu) Institute of Cardiovascular Diseases, Iasi 700503,
Romania
(Floria) Military Emergency Clinical Hospital, Iasi 700483, Romania
Publisher
MDPI
Abstract
The potential benefit of ferritin evaluation resides in its association
with adverse outcomes in patients with various pathological conditions. We
aimed to conduct the first systematic review evaluating the association
between ferritin levels and adverse cardiovascular outcomes in patients
with acute myocardial infarction (AMI) during short-or long-term
follow-up. Seven studies investigating various endpoints (mortality, major
adverse cardiovascular events-MACE, the decline of the left ventricular
ejection fraction-LVEF, left ventricular aneurysm development-LVA) were
included. AMI patients with low or increased ferritin values tended to
have higher in-hospital and 30-day mortality rates. Low and high ferritin
levels and chronic kidney disease were independently associated with
increased risk of LVA formation. High ferritin concentrations were linked
to an accentuated LVEF decline in ST-elevation myocardial infarction
patients treated by percutaneous coronary intervention. Both low and high
ferritin values were also associated with the duration of hospitalization
in patients with AMI during hospital stay and at more extended follow-up.
Ferritin evaluation represents a simple investigation that could identify
high-risk patients with AMI who might benefit from closer monitoring and
specific therapeutic interventions. These data should be confirmed in
large trials in the context of currently available therapies for heart
failure and AMI. Copyright © 2022 by the authors. Licensee MDPI,
Basel, Switzerland.

<109>
Accession Number
2017138103
Title
DEXMEDETOMIDINE ALONE OR WITH KETAMINE IN ADDITION TO ROUTINE FENTANYL
ADMINISTRATION IN POST CARDIAC SURGERY PATIENTS: A RANDOMIZED CONTROLLED
TRIAL.
Source
Journal of Postgraduate Medical Institute. 36(1) (pp 39-43), 2022. Date of
Publication: 31 Mar 2022.
Author
Rai S.A.; Furqan A.; Khan M.I.; Farwa K.U.; Adnan A.; Afzal W.
Institution
(Rai, Furqan, Khan, Farwa, Adnan, Afzal) Department of Anaesthesia and
Critical Care, Ch. Pervaiz Elahi Institute of Cardiology, Punjab, Multan,
Pakistan
Publisher
Postgraduate Medical Institute
Abstract
Objective: To compare the effects of dexmedetomidine alone (DA) with
dexmedetomidine plus ketamine (KD) combination in addition to routine
fentanyl administration in post-cardiac surgery patients Methodology: The
trial was conducted at the Department of Anaesthesia and Critical Care,
Chaudhary Pervaiz Elahi Institute of Cardiology Multan, from July 2020 to
December 2020. A total of 40 patients planned for elective coronary artery
bypass grafting (CABG) were randomized by lottery method for
dexmedetomidine alone (Group DA, n=20) or dexmedetomidine plus Ketamine
(Group KD, n=20) to maintain Ramsay sedation score >=4 during assist-ed
ventilation. All patients received fentanyl for postoperative analgesia.
The mean arterial blood pressure, heart rate, sedation score, pain score,
and mean extubation time were compared between two groups and analyzed by
using SPSS version 23. Result(s): Total fentanyl dose was 45.65 +/-
8.23 microg in group KD and 146.01 +/- 14.18 microg in group DA (p
<0.001). The time of weaning was 344.65 +/- 43.89 minutes and 446.60 +/-
73.75 minutes in groups KD and DA, respectively (p <0.001). The time of
Extubation was 389.90 +/- 35.89 minutes and 535.30 +/- 36.25 minutes in
groups KD and DA, respectively (p <0.001). The ICU stay, heart rate, mean
arterial pressure, Ramsay score, and non-verbal Pain score was comparable
in both study groups (p>0.05). Conclusion(s): Utilizing Ketamine plus
dexmedetomidine for sedation post-Coronary Artery Bypass Graft (CABG)
procedure gave a brief term of mechanical ventilation and early extubation
with less fentanyl requirement than dexmedetomidine alone. Hemodynamic
stability was present in both groups. Copyright © 2022,
Postgraduate Medical Institute. All rights reserved.

<110>
Accession Number
2017103678
Title
The Effect of Erector Spinae Plane Block and Combined Deep and Superficial
Serratus Anterior Plane Block on Acute Pain After Video-Assisted
Thoracoscopic Surgery: A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Part B. 36(8) (pp
2991-2999), 2022. Date of Publication: August 2022.
Author
Zengin M.; Sazak H.; Baldemir R.; Ulger G.; Alagoz A.
Institution
(Zengin, Sazak, Baldemir, Ulger, Alagoz) University of Health Sciences,
Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research
Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
Publisher
W.B. Saunders
Abstract
Objective: The study aimed to compare the analgesic effects of erector
spinae plane block (ESPB) and a combination of the deep and superficial
serratus anterior plane block (C-SAPB) methods in patients who underwent
video-assisted thoracoscopic surgery (VATS). Design(s): A
prospective, randomized study. Setting(s): At a single-center,
high-volume, tertiary thoracic surgery center. Participant(s): Adult
patients undergoing VATS. Intervention(s): Ultrasound-guided ESPB and
C-SAPB. Measurements and Main Results: Patients were assigned to ESPB
(group 1) or C-SAPB (group 2) groups according to the analgesia protocol.
All interventions were performed with single-needle insertion. Multimodal
analgesia was achieved via paracetamol, dexketoprofen, and intravenous
morphine for both study groups. Pain scores were assessed by the visual
analog scale (VAS). Morphine consumption, rescue analgesic requirements,
and side effects were recorded postoperatively for 24 hours. The primary
outcome was determined as VAS scores at rest and coughing. The secondary
outcomes of this study were postoperative morphine consumption and the
requirement of rescue analgesics. There was no statistically significant
difference between the groups in terms of VAS scores (p > 0.05). The
groups also were similar in terms of demographic characteristics, side
effects, morphine consumption, additional analgesic use, and duration of
block procedures (p > 0.05). There also were comparable results in terms
of hemodynamic variables (p > 0.05). Conclusion(s): Patients who
underwent VATS receiving ESPB or C-SAPB had similar pain scores, opioid
consumption, and side effects during the first postoperative 24 hours. At
the same time, the fact that the duration of the block procedure was
similar in both groups showed that multisite serratus anterior plane block
can be an effective alternative method in analgesic treatment after VATS,
considering that it easily can be applied. The authors here think that
C-SAPB can be a good alternative to ESPB because the outcomes of both
applications are similar, and C-SAPB easily can be seen and applied with
ultrasound. Copyright © 2022 Elsevier Inc.

<111>
Accession Number
2018036135
Title
Educational approaches for patients with heart surgery: a systematic
review of main features and effects.
Source
BMC Cardiovascular Disorders. 22(1) (no pagination), 2022. Article Number:
292. Date of Publication: December 2022.
Author
Shahmoradi L.; Rezaei N.; Rezayi S.; Zolfaghari M.; Manafi B.
Institution
(Shahmoradi, Rezayi) Health Information Management Department and Medical
Informatics, School of Allied Medical Sciences, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Rezaei) Medical Library and Information Science, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Rezaei) Department of Medical Library and Information Science, School of
Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan,
Iran, Islamic Republic of
(Zolfaghari) Department of eLearning in Medical Education, Virtual School
of Tehran University of Medical Sciences, Naderi Street, Keshavarz Blvd,
Tehran, Iran, Islamic Republic of
(Manafi) Department of Heart Surgery, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Introduction: Patients who undergo heart surgery are exposed to mental and
physical difficulties after discharge from hospital. They often need
support and follow-up after discharge. The use of educational approaches
or solutions before or after heart surgery can increase patients'
knowledge on the post-operative complications and self-care. The main
purpose of this systematic review is to determine the applications of
educational approaches and investigate the effects of these approaches on
patients with heart surgery. Method and materiel: A thorough search was
conducted in Medline (through PubMed), Scopus, ISI web of science to
select related articles published between 2011 and May 2022. All of the
retrieved papers were screened according to the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
 Result(s): A total of 29 articles were obtained from the search,
which included in this systematic review after being assessed based on
inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%)
had been conducted in Canada and Iran, with the most significant number
published in 2016. Out of 29 studies, 23 were experimental studies, and
six were observational-analytical studies. The number of participants in
the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In
28 (96.55%) studies, the educational approaches had a significant effect
on clinical, economic or patient-reported outcomes. The greatest effect
reported by the studies was related to clinical outcomes such as patient
care improvement or change in clinical practice. The most effects in the
patient-reported outcomes were related to improving patient satisfaction
and patient knowledge. In terms of global rating scores, 17.24% of the
included studies were considered as weak, 20.68% as moderate, and 62.06%
as strong. Conclusion(s): The results of systematic review showed
that the use of educational approaches by patients before and after heart
surgery can have significant effects on reducing stress and financial
burden, and increasing the quality of care and level of knowledge in
patients. Copyright © 2022, The Author(s).

<112>
Accession Number
638331218
Title
Autologous bone marrow stem cell transplantation for patients undergoing
coronary artery bypass grafting: a meta-analysis of 22 randomized
controlled trials.
Source
Journal of cardiothoracic surgery. 17(1) (pp 167), 2022. Date of
Publication: 25 Jun 2022.
Author
Song J.; He K.; Hou J.
Institution
(Song, He, Hou) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Chengdu, Sichuan 610041, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although the safety and feasibility of coronary artery bypass
grafting (CABG) and bone marrow stem cell (BMSC) transplantation have been
established, the effectiveness of this approach compared with CABG alone
remains controversial. The aim of this updated meta-analysis of randomized
controlled trials was to evaluate the efficacy of this procedure.
 METHOD(S): A random-effects meta-analysis was conducted using studies
sourced from the PubMed, Embase, and Cochrane literature databases to
compare patients who received isolated CABG (CABG group) and BMSC
transplantation with CABG (BMSC group). 22 studies were included.
 RESULT(S): A total of 22 relevant publications with 820 patients were
included. 432 patients received BMSC transplantation with CABG and 388
patients received isolated CABG. Compared with the CABG group, the BMSC
transplantation group exhibited an improvement in the left ventricular
(LV) ejection fraction (mean difference (MD)=3.87%; 95% confidence
interval (CI): 1.93-5.80%; P<0.001). CONCLUSION(S): The present
evidence suggests that autologous BMSC transplantation for patients
undergoing CABG appears to be associated with an improvement in LV
function compared with CABG alone. However, heterogeneity in the data
suggests that patients respond differently to this therapy. Further
research is needed to understand these differences. Copyright ©
2022. The Author(s).

<113>
Accession Number
623698432
Title
Syphilitic aortic aneurysm.
Source
Zeitschrift fur Rheumatologie. 77(8) (pp 741-748), 2018. Date of
Publication: October 2018.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital Fujian Medical University, 389 Longdejing Street,
Chengxiang District, Fujian Province, Putian 351100, China
Publisher
Springer Medizin

<114>
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.

<115>
Accession Number
2018886897
Title
Effectiveness of Acapella along with institutional based chest
physiotherapy techniques on pulmonary functions and airway clearance in
post-operative CABG patients.
Source
Hong Kong Physiotherapy Journal. (no pagination), 2022. Date of
Publication: 2022.
Author
Jage B.; Thakur A.
Institution
(Jage, Thakur) School of Physiotherapy, D. Y. Patil University Navi
Mumbai, Maharashtra, India
Publisher
World Scientific
Abstract
Background: Patients undergoing Coronary Artery Bypass Graft (CABG)
surgery often develop pulmonary complications in the early post-operative
period as result of decreased lung function and impaired cough.
Conventional physiotherapy in early post-operative period aims at
increasing lung volumes and airway clearance. Objective(s): This
study aimed to determine the effectiveness of the addition of Acapella to
conventional chest physiotherapy in improving lung volumes and secretion
clearance in early post-operative CABG patients. Method(s): Twenty
patients of both genders (40-70 years) who had undergone CABG and were in
Phase I of Cardiac Rehabilitation were involved in this pilot randomized
control trial (9 control, 11 experimental). Post-surgery intervention
commenced on post-operative day 2 (POD 2) and continued till POD 6.
Patients in the control group were given conventional physiotherapy that
included breathing exercises, incentive spirometry and manual techniques.
Patient in the experimental group used an Acapella device along with the
conventional intervention. Outcome measures considered were pulmonary
function parameters (FVC, FEV1 & PEFR) and amount of sputum expectorated.
 Result(s): A significant increase in lung volumes was observed in
both the groups on POD 6 as compared to POD 2 (both<0.01). However, the
increase was significantly greater on POD 6 in experimental group than the
control group [mean difference (95% CI) FVC: 0.44L (0.24-0.63), FEV1:
0.43L (0.19-0.66), PEFR: 0.86L/s (0.57-1.14)]. The amount of sputum
expectoration significantly greater in the experimental group as compared
to the control group [2.71mL (0.53-4.90)]. Conclusion(s): The
addition of Acapella enhanced the effect conventional physiotherapy in
improving lung volumes and airway clearance in the early post-operative
period for CABG patients. Copyright © 2022 Hong Kong
Physiotherapy Association. Hong Kong Physiotherapy Association.

<116>
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. (no pagination), 2022. Date of Publication: 27 Jun 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.

<117>
Accession Number
638339170
Title
Trunk stabilising exercises promote sternal stability in patients after
median sternotomy for heart valve surgery: a randomised trial.
Source
Journal of physiotherapy. (no pagination), 2022. Date of Publication: 23
Jun 2022.
Author
Essam El-Sayed Felaya E.; Abd Al-Salam E.H.; Shaaban Abd El-Azeim A.
Institution
(Essam El-Sayed Felaya) Department of Physical Therapy for Internal
Medicine, Faculty of Physical Therapy, Cairo University, Giza, Egypt
(Abd Al-Salam) Department of Diagnostic Imaging, National Heart Institute,
Giza, Egypt
(Shaaban Abd El-Azeim) Department of Basic Science, Faculty of Physical
Therapy, Cairo University, Giza, Egypt
Publisher
NLM (Medline)
Abstract
QUESTION: What is the effect of trunk stabilising exercises on sternal
stability in women who have undergone heart valve surgery via median
sternotomy? DESIGN: Randomised controlled trial with concealed allocation,
assessor blinding and intention-to-treat analysis. PARTICIPANTS:
Thirty-six women aged 40 to 50 years who had undergone heart valve surgery
via median sternotomy 7 days before enrolment. INTERVENTION: All
participants in both groups received cardiac rehabilitation during
hospitalisation and three times per week for 4 weeks after discharge. In
addition, participants in the experimental group were prescribed a regimen
of trunk stabilising exercises to be performed three times per week for 4
weeks. At each exercise session, each of 11 exercises were to be performed
with five to ten repetitions. OUTCOME MEASURES: The primary outcome was
sternal separation (the distance between the two halves of the bisected
sternum). The secondary outcome was the Sternal Instability Scale from 0
(no instability) to 3 (an unstable sternum with substantial movement or
separation). Measures were taken before and after the 4-week intervention
period. RESULT(S): After the 4-week intervention period, the
experimental group had a greater decrease in sternal separation by 0.09 cm
(95% CI 0.07 to 0.11). The experimental group was twice as likely to
improve by at least one grade on the Sternal Instability Scale by 4 weeks
(RR 2.00, 95% CI 1.07 to 3.75). The experimental group was almost three
times as likely to have a clinically stable sternum (grade 0 on the
Sternal Instability Scale) by 4 weeks (RR 2.75, 95% CI 1.07 to 7.04).
 CONCLUSION(S): Trunk stabilising exercises were an effective and
feasible method of promoting sternal stability in women who underwent
heart valve surgery via median sternotomy. TRIAL REGISTRATION:
NCT04632914. Copyright © 2022 Australian Physiotherapy
Association. Published by Elsevier B.V. All rights reserved.

EPICORE Embase Updates

Saturday, July 9, 2022

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

No comments:

Post a Comment

Followers

Blog Archive

About Me