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

Total documents retrieved: 113

Results Generated From:
Embase <1980 to 2022 Week 31>
Embase Weekly Updates (updates since 2022-07-29)

<1>
[Use Link to view the full text]
Accession Number
2015915801
Title
Relationship between septo-valvular angle and risk of pacemaker
implantation after transcatheter aortic valve implantation: A preliminary
study.
Source
Journal of Cardiovascular Medicine. 22(9) (pp 716-722), 2021. Date of
Publication: 2021.
Author
de Stasio V.; Cavallo A.U.; Spiritigliozzi L.; Pugliese L.; Presicce M.;
Donna C.D.; Tosto F.D.; Pasqualetto M.; D'Errico F.; Benelli L.; Sbordone
F.P.; Grimaldi F.; Cerimele C.; Vanni G.; Romeo F.; Floris R.; Garaci F.;
Chiocchi M.
Institution
(de Stasio, Cavallo, Spiritigliozzi, Pugliese, Presicce, Donna, Tosto,
Pasqualetto, D'Errico, Benelli, Sbordone, Grimaldi, Cerimele, Floris,
Garaci, Chiocchi) Department of Diagnostic Imaging and Interventional
Radiology, Molecular Imaging and Radiotherapy, Radiology Division,
Policlinico Tor Vergata University, Rome, Italy
(Romeo) Department of Medical Sciences, Cardiology Division, Policlinico
Tor Vergata University, Rome, Italy
(Vanni) Breast Unit, Department of Surgical Science, Policlinico Tor
Vergata University, Rome, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Aim Pre-transcatheter aortic valve implantation (TAVI) computed tomography
(CT) has proven to be crucial in identifying pre- and post-procedural
predicting factors predisposing the onset of major arrhythmias that
require permanent pacemaker (PPM) implantation caused by the compressive
effects of the prostheses on the conduction system at the membranous
septum (MS) and the muscular crest of the interventricular septum. Our
analysis aims to verify if the pre-TAVI assessment of the angle between
the MS and the aortic annulus (SVA) might be a predictive factor for the
onset of arrhythmias that requires PPM. Methods Two cardiovascular
specialist radiologists retrospectively and double-blind evaluated a
randomized list of preprocedural CT of 57 patients who underwent TAVI with
a self-expandable valve from April 2019 to February 2020. Two anatomical
features were measured by readers: width of the SVA and MS length (MSL).
Results A PPM was implanted in 18 patients (31%) after the procedure.
There was no significant difference in the anatomical measurements
performed between the two observers, regarding both anatomical
measurements (intraclass correlation coefficient was 0.944 for the SVA and
0.774 for the MSL]. Receiver-operating characteristic curves (ROC)
performed for both measurements have documented: for the SVA sensitivity
94% and Negative predictive value (NPV) 96% (area under the curve: 0.77;
95% confidence interval 0.66 - 0.90). The MSL ROC was not significant. The
mean SVA value stratified for patients who did not undergo PPM
implantation and patients who did resulted as significant (P < 0.005).
Conclusion Measurement of the SVA performed in preprocedural CT scans has
proven to be related to the onset of major arrhythmias after TAVI
requiring permanent pacemaker implantation with high sensitivity (94%) and
NPV (96%). Copyright © 2021 Italian Federation of Cardiology -
I.F.C. All rights reserved.

<2>
Accession Number
2015978516
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass grafting in left main coronary artery disease: an
individual patient data meta-analysis.
Source
The Lancet. 398(10318) (pp 2247-2257), 2021. Date of Publication: 18 Dec
2021.
Author
Sabatine M.S.; Bergmark B.A.; Murphy S.A.; O'Gara P.T.; Smith P.K.;
Serruys P.W.; Kappetein A.P.; Park S.-J.; Park D.-W.; Christiansen E.H.;
Holm N.R.; Nielsen P.H.; Stone G.W.; Sabik J.F.; Braunwald E.
Institution
(Sabatine, Bergmark, Murphy, Braunwald) Thrombolysis in Myocardial
Infarction Study Group, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, United States
(Sabatine, Bergmark, Murphy, O'Gara, Braunwald) Division of Cardiovascular
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Smith) Department of Surgery (Cardiothoracic), Duke University School of
Medicine, Duke Clinical Research Institute, Durham, NC, United States
(Serruys) Department of Cardiology, National University of Ireland Galway,
Galway, Ireland
(Serruys) National Heart and Lung Institute, Imperial College London,
London, UK, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Park, Park) Department of Cardiology, Asan Medical Center, Seoul, South
Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Nielsen) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Stone) The Zena and Michael A Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Background: The optimal revascularisation strategy for patients with left
main coronary artery disease is uncertain. We therefore aimed to evaluate
long-term outcomes for patients treated with percutaneous coronary
intervention (PCI) with drug-eluting stents versus coronary artery bypass
grafting (CABG). Method(s): In this individual patient data
meta-analysis, we searched MEDLINE, Embase, and the Cochrane database
using the search terms "left main", "percutaneous coronary intervention"
or "stent", and "coronary artery bypass graft*" to identify randomised
controlled trials (RCTs) published in English between database inception
and Aug 31, 2021, comparing PCI with drug-eluting stents with CABG in
patients with left main coronary artery disease that had at least 5 years
of patient follow-up for all-cause mortality. Two authors (MSS and BAB)
identified studies meeting the criteria. The primary endpoint was 5-year
all-cause mortality. Secondary endpoints were cardiovascular death,
spontaneous myocardial infarction, procedural myocardial infarction,
stroke, and repeat revascularisation. We used a one-stage approach; event
rates were calculated by use of the Kaplan-Meier method and treatment
group comparisons were made by use of a Cox frailty model, with trial as a
random effect. In Bayesian analyses, the probabilities of absolute risk
differences in the primary endpoint between PCI and CABG being more than
0.0%, and at least 1.0%, 2.5%, or 5.0%, were calculated. Finding(s):
Our literature search yielded 1599 results, of which four RCTs-SYNTAX,
PRECOMBAT, NOBLE, and EXCEL-meeting our inclusion criteria were included
in our meta-analysis. 4394 patients, with a median SYNTAX score of 25.0
(IQR 18.0-31.0), were randomly assigned to PCI (n=2197) or CABG (n=2197).
The Kaplan-Meier estimate of 5-year all-cause death was 11.2% (95% CI
9.9-12.6) with PCI and 10.2% (9.0-11.6) with CABG (hazard ratio 1.10, 95%
CI 0.91-1.32; p=0.33), resulting in a non-statistically significant
absolute risk difference of 0.9% (95% CI -0.9 to 2.8). In Bayesian
analyses, there was an 85.7% probability that death at 5 years was greater
with PCI than with CABG; this difference was more likely than not less
than 1.0% (<0.2% per year). The numerical difference in mortality was
comprised more of non-cardiovascular than cardiovascular death.
Spontaneous myocardial infarction (6.2%, 95% CI 5.2-7.3 vs 2.6%, 2.0-3.4;
hazard ratio [HR] 2.35, 95% CI 1.71-3.23; p<0.0001) and repeat
revascularisation (18.3%, 16.7-20.0 vs 10.7%, 9.4-12.1; HR 1.78,
1.51-2.10; p<0.0001) were more common with PCI than with CABG. Differences
in procedural myocardial infarction between strategies depended on the
definition used. Overall, there was no difference in the risk of stroke
between PCI (2.7%, 2.0-3.5) and CABG (3.1%, 2.4-3.9; HR 0.84, 0.59-1.21;
p=0.36), but the risk was lower with PCI in the first year after
randomisation (HR 0.37, 0.19-0.69). Interpretation(s): Among patients
with left main coronary artery disease and, largely, low or intermediate
coronary anatomical complexity, there was no statistically significant
difference in 5-year all-cause death between PCI and CABG, although a
Bayesian approach suggested a difference probably exists (more likely than
not <0.2% per year) favouring CABG. There were trade-offs in terms of the
risk of myocardial infarction, stroke, and revascularisation. A heart team
approach to communicate expected outcome differences might be useful to
assist patients in reaching a treatment decision. Funding(s): No
external funding. Copyright © 2021 Elsevier Ltd

<3>
Accession Number
636600006
Title
Antithrombotic treatment following coronary artery bypass surgery: a
network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2021(12) (no pagination), 2021.
Article Number: CD014817. Date of Publication: 08 Dec 2021.
Author
Abbasciano R.G.; Gradinariu G.; Kourliouros A.; Lai F.; Langrish J.;
Murphy G.; Quarto C.; Radhakrishnan A.; Raja S.; Rogers L.J.; Townend J.;
Tyson N.; Vaja R.; Verdichizzo D.; Wynne R.
Institution
(Gradinariu) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Kourliouros, Langrish, Verdichizzo) Oxford Heart Centre, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Quarto, Raja, Vaja) Department of Cardiac Surgery, Royal Brompton and
Harefield Hospital, London, United Kingdom
(Radhakrishnan) Department of Cardiology, New Cross Hospital,
Wolverhampton, United Kingdom
(Rogers) Bristol Heart Institute, University Hospitals Bristol and Weston
NHS Foundation Trust, Bristol, United Kingdom
(Townend) Department of Cardiology, Queen Elizabeth Hospital, University
Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
(Tyson) Trent Cardiac Centre, Nottingham University Hospitals NHS Trust,
Nottingham, United Kingdom
(Wynne) Western Sydney Nursing & Midwifery Research Centre, Western Sydney
University, Sydney, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. Primary objective To assess the clinical
effectiveness of antithrombotic agents in reducing all-cause mortality
after CABG surgery. Secondary objectives To evaluate the effect of
antithrombotic agents on graft patency, cardiovascular morbidity and
bleeding after CABG surgery. To present ranking probabilities of
antithrombotic agents in relation to all-cause mortality and
bleeding. Copyright © 2021 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<4>
Accession Number
2018372327
Title
Effectiveness of early cardiac rehabilitation in patients with heart valve
surgery: a randomized, controlled trial.
Source
Journal of International Medical Research. 50(7) (no pagination), 2022.
Date of Publication: July 2022.
Author
Xue W.; Xinlan Z.; Xiaoyan Z.
Institution
(Xue, Xinlan, Xiaoyan) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China
Publisher
SAGE Publications Ltd
Abstract
Objective: Complications of heart valve surgery lead to physical
inactivity and produce harmful effects. This study aimed to investigate
the role of a cardiac rehabilitation program and its long-term effect in
patients after heart valve surgery. Method(s): We performed a
single-blind, randomized, controlled trial. Patients with heart valve
surgery were randomly assigned to receive early cardiac rehabilitation
(intervention group, 44 patients) or the usual care (control group, 43
patients). The intervention group performed sitting, standing, and walking
exercises, followed by endurance training. The control group received
usual care and did not engage in any physical activity. Physical function
was assessed by the Short Physical Performance Battery (SPPB) and other
measurement tools. Result(s): The intervention group showed a
significant beneficial effect regarding physical capacity as shown by the
SPPB and the 6-minute walking test at hospital discharge, and a better
long-term effect was achieved at 6 months compared with the control group.
An improvement in physical function (e.g., the SPPB) after hospital
discharge predicted follow-up mortality (odds ratio = 0.416, 95%
confidence interval: 0.218-0.792). Conclusion(s): Early cardiac
rehabilitation appears to be an effective approach to improve the physical
function and survival of patients with heart valve surgery. Copyright
© The Author(s) 2022.

<5>
Accession Number
2018357125
Title
The use of sutureless and rapid-deployment aortic valve prosthesis in
patients with bicuspid aortic valve: A focused review.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
King M.; Stambulic T.; Payne D.; Fernandez A.L.; El-Diasty M.
Institution
(King, Stambulic) Queen's School of Medicine, Kingston, ON, Canada
(Payne, El-Diasty) Division of Cardiac Surgery, Queen's University,
Kingston, ON, Canada
(Fernandez) Cardiac Surgery Department, University of Santiago de
Compostela, Santiago, Spain
Publisher
John Wiley and Sons Inc
Abstract
Objective: The objective of this scoping review is to describe the
postoperative outcomes and complications of patients with bicuspid aortic
valve (BAV) treated with sutureless or rapid-deployment prosthesis.
 Background(s): The use of sutureless and rapid-deployment prostheses
is generally avoided in patients with BAV due to anatomical concerns and
the elevated risk of para-prosthetic leaks. Multiple studies have reported
the use of these prostheses into patients with BAV with varying degrees of
success. The focus of this review is to consolidate the current available
evidence on this topic. Method(s): A scoping review was conducted
using a comprehensive search strategy in multiple databases (Medline,
Embase, Cochrane Central Register of Controlled Clinical Trials) for
relevant articles. All abstracts and full texts were screened by two
independent reviewers according to predefined inclusion and exclusion
criteria. Thirteen articles, including case reports and case series were
ultimately included for analysis. Result(s): Of 1052 total citations,
44 underwent full text review and 13 (4 case reports, 6 retrospective
analyses, and 3 prospective analyses) were included in the scoping review.
Across all 13 studies, a total of 314 patients with BAV were used for data
analysis. In sutureless and rapid-deployment prostheses, the mean
postoperative aortic valvular gradients were less than 15 mmHg in all
studies with mean postoperative aortic valvular areas all greater than 1.3
cm.2 There were 186 total complications for an overall
complication rate of 59%. Individual complications included new onset
atrial fibrillation (n = 65), required pacemaker insertion (n = 24),
intraprosthetic aortic regurgitation (n = 20), new onset atrioventricular
block (n = 18), and new onset paravalvular leakage (n = 10).
 Conclusion(s): The use of sutureless and rapid deployment prostheses
in patients with BAV showed comparable intraoperative and implantation
success rates to patients without BAV. Postoperative complications from
using these prostheses in patients with BAV included new onset atrial
fibrillation, intraprosthetic aortic regurgitation, new onset
atrioventricular block, and required pacemaker insertion. Various
techniques have been described to minimize these complications in patients
with BAV receiving sutureless or rapid deployment
prostheses. Copyright © 2022 Wiley Periodicals LLC.

<6>
Accession Number
2018350800
Title
Transcatheter aortic valve implantation and frailty.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2022. Date
of Publication: 2022.
Author
Shimura T.; Yamamoto M.
Institution
(Shimura, Yamamoto) Department of Cardiology, Gifu Heart Center, 4-14-4
Yabutaminami, Gifu, Gifushi 500-8384, Japan
(Shimura, Yamamoto) Department of Cardiology, Toyohashi Heart Center, 21-1
Gobutori, Oyamacho, Aichi, Toyohashishi 441-8530, Japan
(Yamamoto) Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
Publisher
Springer
Abstract
Over the last decade, transcatheter aortic valve implantation (TAVI) has
emerged as a treatment option for patients with severe aortic stenosis.
With exponential increase in the number of TAVI procedures, frailty
assessments have been considered important for patients undergoing TAVI,
and a number of studies have indicated a relationship between the frailty
and post-TAVI outcomes. In this review, using studies searched
systematically in the PubMed database, we review important frailty
assessment tools that can be used as prognostic factors for patients
before TAVI. The assessment tools were categorized as quantitative single
marker, semi-quantitative single marker, or quantitative combined marker.
Studies were further stratified by whether they used frailty markers to
predict patients' prognosis pre-TAVI or to evaluate frailty improvement
post-TAVI. The Clinical Frailty Scale (CFS), a semi-quantitative
assessment, is one of the frailty assessment tools discussed. It may be
easily used even in an outpatient consultation room. The CFS classifies
patients' activity into nine categories, based on a simple interview and
the patient's appearance. Gait speed and serum albumin levels were
considered as qualitative frailty assessment tools. Compared to other
methods, the Essential Frailty Toolset had the highest inter-rater
reliability for accuracy in predicting mortality, thereby allowing better
identification of vulnerable old age people and optimization of outcomes.
A few studies have also focused on changes in frailty pre- and post-TAVI.
Serum albumin-level measurements are important for assessing the frailty
improvement in the chronic phase. Each frailty assessment tool had its own
characteristics, strengths, and weaknesses, and therefore, these tools
need to be selected based on where they are being used and the patient's
condition. Copyright © 2022, The Author(s) under exclusive
licence to Japanese Association of Cardiovascular Intervention and
Therapeutics.

<7>
Accession Number
2018331969
Title
Percutaneous coronary intervention versus coronary artery bypass graft
surgery in dialysis-dependent patients: A pooled meta-analysis of
reconstructed time-to-event data.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Tasoudis P.T.; Varvoglis D.N.; Tzoumas A.; Doulamis I.P.; Tzani A.; Michel
P. S.; Kampaktsis P.N.; Gallo M.
Institution
(Tasoudis, Varvoglis) Department of Cardiothoracic Surgery, School of
Health Sciences, University of Thessaly, Larisa, Greece
(Tzoumas) Department of Internal Medicine, University of Cincinnati
Medical Center, Cincinnati, OH, United States
(Doulamis) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Tzani) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Michel P.) Department of Cardiothoracic Surgery Research, Lankenau
Institute for Medical Research, Wynnewood, PA, United States
(Kampaktsis) Department of Medicine, Division of Cardiology, New York
University Langone Medical Center, New York, NY, United States
(Gallo) Department of Cardiac Surgery, Cardiocentro Ticino, Lugano,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Objective: Tomicron perform a systematic review with meta-analysis of
published data comparing outcomes between a percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) in
dialysis-dependent patients. Method(s): We searched PubMed, Scopus,
and Cochrane databases for studies including dialysis-dependent patients
who underwent either CABG or PCI. This meta-analysis follows the
recommendations of the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses statement. We conducted one-stage and two-stage
meta-analysis with Kaplan-Meier-derived individual patient data for
overall survival and meta-analysis with the random-effects model for the
in-hospital mortality and repeat revascularization. Result(s): Twelve
studies met our eligibility criteria, including 13,651 and 28,493 patients
were identified in the CABG and PCI arms, respectively. Patients who
underwent CABG had overall improved survival compared with those who
underwent PCI at the one-stage meta-analysis (hazard ratio [HR]: 1.12, 95%
confidence interval [CI]: 1.09-1.16, p <.0001) and the two-stage
meta-analysis (HR: 1.15, 95% CI: 1.08-1.23, p <.001, I2 =
30.0%). Landmark analysis suggested that PCI offers better survival before
the 8.5 months of follow-up (HR: 0.96, 95% CI: 0.92-0.99, p =.043), while
CABG offers an advantage after this timepoint (HR: 1.3, 95% CI: 1.22-1.32,
p <.001). CABG was associated with increased odds for in-hospital
mortality (odds ratio [OR]: 1.70, 95% CI: 1.50-1.92, p <.001,
I2 = 0.0%) and decreased odds for repeat revascularization (OR:
0.22, 95% CI: 0.14-0.34, p <.001, I2 = 58.08%).
 Conclusion(s): In dialysis-dependent patients, CABG was associated
with long-term survival but a higher risk for early mortality. The risk
for repeat revascularization was higher with PCI. Copyright ©
2022 Wiley Periodicals LLC.

<8>
Accession Number
2017955628
Title
Transposition physiology in the setting of concordant ventriculo-arterial
connections.
Source
Journal of Cardiac Surgery. 37(9) (pp 2823-2834), 2022. Date of
Publication: September 2022.
Author
Chowdhury U.K.; Anderson R.H.; Spicer D.E.; George N.; Sankhyan L.K.;
Pandey N.N.; Goja S.; Chandhirasekar B.
Institution
(Chowdhury, George, Goja, Chandhirasekar) Department of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Anderson) Institute of Biomedical Sciences, Newcastle University,
Newcastle-upon-Tyne, United Kingdom
(Spicer) Department of Pediatric Cardiology, Heart Institute, Johns
Hopkins All Children's Hospital, University of Florida, Gainesville, FL,
United States
(Sankhyan) Department of Cardiothoracic Surgery, All India Institute of
Medical Sciences, Bilaspur, India
(Pandey) Cardiac Radiology, All India Institute of Medical Sciences,
Bilaspur, India
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim: To review the anatomical details, diagnostic
challenges, associated cardiovascular anomalies, and techniques and
outcomes of management, including re-interventions, for the rare instances
of transposition physiology with concordant ventriculo-arterial
connections. Method(s): We reviewed clinical and necropsy studies on
diagnosis and surgical treatment of individuals with transposition
physiology and concordant ventriculo-arterial connections, analyzing also
individuals with comparable flow patterns in the setting of isomerism.
 Result(s): Among reported cases, just over two-thirds were diagnosed
during surgery, after initial palliation, or after necropsy. Of the
patients, four-fifths presented in infancy with either cyanosis or
congestive cardiac failure, with complex associated cardiac malformations.
Nearly half had ventricular septal defects, and one-fifth had
abnormalities of the tricuspid valve, including hypoplasia of the
morphologically right ventricle. A small minority had common
atrioventricular junctions We included cases reported with isomerism when
the flow patterns were comparable, although the atrioventricular
connections are mixed in this setting. Management mostly involved
construction of intraatrial baffles, along with correction of coexisting
anomalies, either together or multistaged. Overall mortality was 25%, with
one-fifth of patients requiring pacemakers for surgically-induced heart
block. The majority of survivors were in good functional state.
 Conclusion(s): The flow patterns produced by discordant
atrioventricular and concordant ventriculo-arterial connections remain an
important, albeit rare, indication for atrial redirection or
hemi-Mustard's procedure with bidirectional Glenn. The procedure recruits
the morphologically left ventricle in the systemic circuit, producing good
long-term functional results. The approach can also be used for those with
isomeric atrial appendages and comparable hemodynamic
circuits. Copyright © 2022 Wiley Periodicals LLC.

<9>
Accession Number
2017872048
Title
The management of paravalvular leaks post aortic valve replacement.
Source
Journal of Cardiac Surgery. 37(9) (pp 2786-2798), 2022. Date of
Publication: September 2022.
Author
Kananathan S.; Perera L.A.; Mohanarajan M.; Sherif M.; Harky A.
Institution
(Kananathan, Perera, Mohanarajan) Dnipro Medical Institute of Traditional
and Non-Traditional Medicine, Dnipro, Ukraine
(Sherif) Department of Cardiothoracic Surgery, Northern General Hospital,
Sheffield, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Paravalvular leak (PVL) is uncommon but can lead to severe
complications after surgical or transcatheter aortic valve implantation.
Conditions associated with PVLs such as heart failure, hemolysis, and
infective endocarditis can lead to catastrophic results if not treated
promptly; the therapeutic goals differ according to the presentation. It
is vital that PVLs are diagnosed early using various imaging modalities.
Different approaches have been studied in managing PVLs; there is an
increased interest in the transcatheter aortic valve closure procedure as
it is minimally invasive and decreases the occurrence of further
reinterventions. Aim(s): To discuss the classification of PVLs,
diagnostic approaches, and available management options. Method(s): A
literature review was performed using 28 studies. Result(s): This
review evaluated the relationship between the time of diagnosis,
management of PVL and the resulting outcomes. Discussion(s): Patients
with PVL should be assessed through a multidisciplinary team approach and
a patient-selective plan should be in place. Conclusion(s): Open
surgical intervention is reserved for complex cases where minimally
invasive techniques cannot be utilized. Copyright © 2022 Wiley
Periodicals LLC.

<10>
Accession Number
2017828372
Title
Intraoperative hyperoxygenation may negatively affect postoperative
cognitive functions in coronary artery bypass graft operations: A
randomized controlled study.
Source
Journal of Cardiac Surgery. 37(9) (pp 2552-2563), 2022. Date of
Publication: September 2022.
Author
Onur T.; Karaca U.; Ata F.; Sayan H.E.; Onur A.; Yilmaz C.; Balkaya A.N.;
Eris C.
Institution
(Onur, Karaca, Ata, Sayan, Onur, Yilmaz, Balkaya) Departmant of
Anesthesiology and Reanimation, University of Health Sciences Bursa Yuksek
Ihtisas Training and Research Hospital, Bursa, Turkey
(Eris) Departmant of Cardiovascular Surgery, University of Health Sciences
Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
Publisher
John Wiley and Sons Inc
Abstract
Objective: In this study, it was aimed to compare various parameters
during surgery and postoperative cognitive functions in patients
undergoing coronary artery bypass graft (CABG) surgery using different
levels of perioperative oxygen. Method(s): One hundred patients
scheduled for elective CABG surgery were included in the study. The
patients were divided into two groups according to arterial oxygen levels
during surgery. In the normoxia group (NG) (n = 50), partial arterial
oxygen pressure (PaO<inf>2</inf>) was between >=100 and <180 mmHg with at
least 40% fraction of inspired oxygen (FiO<inf>2</inf>) mechanical
ventilation (MV), and in the hyperoxia group (HG) (n = 50),
PaO<inf>2</inf> was >=180 mmHg with 100% FiO<inf>2</inf> MV. Hemodynamic
parameters, peripheral oxygen saturation (SpO<inf>2</inf>), regional
cerebral oxygen saturation (rSO<inf>2</inf>) measured from bilateral
sensors, and blood gas values were recorded at the planned measurement
times. Postoperative features (mortality and infection rates, length of
stay in the hospital, and intensive care unit) and complications of the
patients have been recorded (low cardiac output syndrome, renal failure,
delirium). Mini-Mental State Examination (MMSE) test was applied to the
patients before and at the 12th, 24th hours; on the first, third, sixth
months after surgery. Result(s): Extubation time was found to be
shorter in NG (p <.05). Between the groups, rSO<inf>2</inf> and mean
arterial pressure were found to be significantly lower in HG at the time
of T4 measurement (p =.042, p =.038, respectively). MMSE values of the
groups at the first, third, and sixth months were found to be
significantly higher in NG (p =.017, p =.014, p =.002, respectively).
 Conclusion(s): Hyperoxemia application during CABG may be associated
with worse postoperative late-term cognitive functions. Copyright
© 2022 Wiley Periodicals LLC.

<11>
Accession Number
2017595332
Title
Comparison of Analgesic Effects of Different Regional Blocks in
Video-assisted Thoracic and Breast Surgeries: A Network Meta-analysis and
Systematic Review.
Source
Pain Physician. 25(5) (pp 339-354), 2022. Date of Publication: August
2022.
Author
Luo G.; Tao J.; Zhu J.; Xie K.; Ni C.
Institution
(Luo, Tao, Zhu, Xie) Department of Anesthesiology and Pain Research
Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
(Ni) Department of Anesthesiology, The First Affiliated Hospital of
Wenzhou Medical University, Wenzhou, China
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Postoperative pain management in breast surgery and
video-assisted thoracic surgeries (VATS) remains challenging. Oral or
intravenous infusion of opioids were early treatments, but they can result
in gastrointestinal reactions, respiratory inhibition, and other adverse
reactions. In recent years, various regional block techniques have been
employed for postoperative analgesia of these surgeries. However, a
pair-wise meta-analysis cannot comprehensively rank and evaluate the
analgesic effects and adverse events of various regional blocks.
 Objective(s): The purpose of this network meta-analysis (NMA) was to
compare the analgesic effects and adverse events of different regional
block techniques after breast surgery and VATS. Study Design: NMA of
randomized controlled trials (RCTs) for comparing multiple regional block
techniques in breast surgery and VATS. Method(s): Pubmed, Embase, and
Cochrane databases were searched systematically for RCTs comparing
analgesic effects and adverse events after breast surgery and VATS. After
critical appraisal, a random-effects NMA was mainly used to compare all
the regional blocks' analgesic effects and adverse events. The Population,
Interventions, Comparators, Outcomes, and Study design (PICOS) framework
was used to build the search strategies and present the results according
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement guidelines. The primary endpoint was opioid consumption
within 24 hours after the operation; secondary endpoints included dynamic
and static pain scores and the incidence of nausea and vomiting. This
study is registered in the Prospective Register of Systematic Reviews
(PROSPERO) with a PROSPERO number of CRD42021283907. Result(s): A
total of 21 clinical trials, including 1,284 patients and 6 different
regional block techniques (paravertebral block pectoral nerve block
serratus anterior plane block [SAPB], intercostal nerve block [ICNB],
erector spinal plane block and thoracic epidural anesthesia), were
included and analyzed. There was no significant difference between the
consistent and the inconsistent models. Based on limited evidence, SAPB
may be the most effective regional block technique for relieving
postoperative pain, while ICNB had the lowest probability of nausea and
vomiting. There was no significant difference in the pair-wise
comparisons. In this study, we found no obvious publication bias.
 Limitation(s): Limitations include: morphine milligram equivalents
were not used to calculate opioid consumption; the scales used in the
studies were different; the number of studies and total sample size
included was limited; non-English literature and gray literature were not
included; more databases were not searched. Conclusion(s): After a
comprehensive evaluation of postoperative analgesic effects and adverse
events based on the NMA, we hypothesize that SAPB and ICNB have distinct
advantages in postoperative analgesia and reduce the incidence of nausea
and vomiting, respectively. However, conclusions drawn from more RCTs may
be more convincing. Copyright © 2022, American Society of
Interventional Pain Physicians. All rights reserved.

<12>
Accession Number
2017593878
Title
Mortality and morbidity of surgical and transcatheter mitral valve repair
in octogenarians: A systematic review.
Source
Journal of Cardiac Surgery. 37(9) (pp 2752-2760), 2022. Date of
Publication: September 2022.
Author
Watkins A.R.; Fialka N.; EL-Andari R.; Kang J.J.H.; Bozso S.J.; Moon M.C.;
Nagendran J.
Institution
(Watkins, Fialka, EL-Andari) Faculty of Medicine and Dentistry, University
of Alberta, Edmonton, AB, Canada
(Kang, Bozso, Moon, Nagendran, Nagendran) Division of Cardiac Surgery,
Department of Surgery, University of Alberta, Edmonton, AB, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Valvular heart disease (VHD) is a prominent problem in
healthcare today with mitral regurgitation (MR) being the leading cause of
VHD in the elderly population. While mitral valve repair (MVr) surgery is
one of the only options for the end-stage disease, octogenarians are often
denied MVr due to concerns with operative mortality and postoperative
morbidity. To provide information on this underrepresented group of
surgical patients, a systematic approach was taken to review the mortality
and morbidity rates of octogenarians who received MVr. Method(s):
Pubmed and Medline were searched for articles containing outcomes of
octogenarians receiving surgical mitral valve repair (SMVr) or
transcatheter mitral valve repair (TMVr) published after 2000. Ten
articles met the inclusion criteria for a total of 7968 patients included
in the analysis using Microsoft Excel, Version 2105. Result(s):
Short-term mortality rates for SMVr and TMVr were 2.6% and 1.4% for
in-hospital, and 7.8% and 3.3% for 30 days, respectively. The average
incidence of stroke, acute kidney injury, infection, and major bleeding
for SMVr were 3.2%, 11.2%, 7.7%, and 24%, respectively, and 0.3%, 6.7%,
2.7%, and 7.9% for TMVr, respectively. Conclusion(s): Octogenarians
receiving SMVr or TMVr experienced similar rates of short-term mortality
and morbidity as younger populations, and when considering life
expectancy, midterm mortality was also similar. With these results,
denying octogenarians MVr operations based on age alone should be
reconsidered. Depending on risk factors and comorbidities, either SMVr or
TMVr is a viable and relatively safe option for octogenarians with severe
MR. Copyright © 2022 Wiley Periodicals LLC.

<13>
Accession Number
638610257
Title
Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing
Elective Cardiac Surgery, a Systematic Review and Meta-Analysis.
Source
Medicina (Kaunas, Lithuania). 58(7) (no pagination), 2022. Date of
Publication: 08 Jul 2022.
Author
Shahood H.; Pakai A.; Kiss R.; Eva B.; Szilagyi N.; Sandor A.; Verzar Z.
Institution
(Shahood) Doctoral School of Health Sciences, Faculty of Health Sciences,
University of Pecs, 7624 Pecs, Hungary
(Pakai) Basic Health Sciences and Health Visiting, Institute of Nursing
Sciences, Faculty of Health Sciences, University of Pecs, 7621 Pecs,
Hungary
(Kiss, Eva, Szilagyi, Sandor) Heart Institute, Medical School, University
of Pecs, 7624 Pecs, Hungary
(Verzar) Institution of Nutritional Science and Dietetics, Faculty of
Health Sciences, University of Pecs, 7621 Pecs, Hungary
Publisher
NLM (Medline)
Abstract
Background and Objectives: Patients undergoing cardiac surgery are
particularly vulnerable for developing postoperative pulmonary
complications (PPCs). This systematic review and meta-analysis aimed to
evaluate the role of preoperative chest physiotherapy in such patients.
 Material(s) and Method(s): All original articles that assessed
patients undergoing elective cardiac surgery, with preoperative chest
physiotherapy, and compared them to patients undergoing elective cardiac
surgery, without preoperative chest physiotherapy, were included. Animal
studies, studies conducted prior to the year 2000, commentaries, or
general discussion papers whose authors did not present original data were
excluded. Studies assessing physiotherapy regimens other than chest
physiotherapy were also excluded. The search was performed using the
following electronic resources: the Cochrane Central Register of
Controlled Trials, the PubMed central database, and Embase. The included
studies were assessed for potential bias using the Cochrane
Collaboration's tool for assessing the risk of bias. Each article was read
carefully, and any relevant data were extracted. The extracted data were
registered, tabulated, and analyzed using Review Manager software.
 Result(s): A total of 10 articles investigating 1458 patients were
included in the study. The studies were published from 2006 to 2019. The
populations were patients scheduled for elective CABG/cardiac surgery, and
they were classified into two groups: the interventional (I) group,
involving 651 patients, and the control (C) group, involving 807 patients.
The meta-analysis demonstrated no significant differences between the
interventional and control groups in surgery time and ICU duration, but a
significant difference was found in the time of mechanical ventilation and
the length of hospital stay, favoring the interventional group. A
significant difference was shown in the forced expiratory volume in 1s
(FEV1% predicted), forced vital capacity (FVC% predicted), and maximum
inspiratory pressure (Pi-max), favoring the interventional group.
 Conclusion(s): This study is limited by the fact that one of the
included ten studies was not an RCT. Moreover, due to lack of the
assessment of certain variables in some studies, the highest number of
studies included in a meta-analysis was the hospital stay length (eight
studies), and the other variables were analyzed in a fewer number of
studies. The data obtained can be considered as initial results until more
inclusive RCTs are conducted involving a larger meta-analysis. However, in
the present study, the intervention was proved to be protective against
the occurrence of PPCs. The current work concluded that preoperative chest
physiotherapy can yield better outcomes in patients undergoing elective
cardiac surgery.

<14>
Accession Number
637370221
Title
Efficacy and safety of proton pump inhibitors versus histamine-2 receptor
blockers in the cardiac surgical population: insights from the PEPTIC
trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 62(2) (no pagination),
2022. Date of Publication: 11 Jul 2022.
Author
van Diepen S.; Coulson T.; Wang X.; Opgenorth D.; Zuege D.J.; Harris J.;
Agyemang M.; Niven D.J.; Bellomo R.; Wright S.E.; Young P.J.; Bagshaw S.M.
Institution
(van Diepen, Opgenorth, Bagshaw) Department of Critical Care Medicine,
University of Alberta, Alberta Health Services, Edmonton, AB, Canada
(van Diepen) Division of Cardiology, Department of Medicine, University of
Alberta, Edmonton, AB, Canada
(Coulson) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Coulson, Bellomo, Young) Australian and New Zealand Intensive Care
Research Centre, Department of Epidemiology and Preventive Medicine,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, VIC, Australia
(Coulson, Bellomo, Young) Department of Critical Care, University of
Melbourne, Parkville, VIC, Australia
(Wang) Health Services Statistical and Analytic Methods, Alberta Health
Services, Calgary, AB, Canada
(Zuege, Niven) Department of Critical Care Medicine, University of
Calgary, Alberta Health Services, Calgary, AB, Canada
(Zuege, Bagshaw) Critical Care Strategic Clinical Network, Alberta Health
Services, Calgary, AB, Canada
(Harris) Alberta Health Services, Calgary, AB, Canada
(Agyemang, Niven) Department of Community Health Sciences, University of
Calgary, Calgary, AB, Canada
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Bellomo) Data Analytics Research & Evaluation Centre, University of
Melbourne and Austin Hospital, Melbourne, VIC, Australia
(Wright) Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne,
United Kingdom
(Young) Medical Research Institute of New Zealand, Wellington, New Zealand
(Young) Intensive Care Unit, Wellington Regional Hospital, Wellington, New
Zealand
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The comparative effectiveness and safety of proton pump
inhibitors (PPIs) versus histamine-2 receptor blockers for stress ulcer
prophylaxis in the cardiac surgical intensive care unit population is
uncertain. Although the Proton Pump Inhibitors versus Histamine-2 Receptor
Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC)
trial reported a higher risk of mortality in the PPI arm with no
difference in gastrointestinal bleeding, detailed information on surgical
variables and clinically relevant surgical subgroups was not available.
 METHOD(S): The analysis included all Canadian cardiac surgery
patients enrolled in the PEPTIC trial. Data were electronically linked
using unique patient identifiers to a clinical information system.
Outcomes of interest included in-hospital mortality, gastrointestinal
bleeding, Clostridium difficile infections, ventilator-associated
conditions and length of stay. RESULT(S): We studied 823 (50.6%)
randomized to PPIs and 805 (49.4%) to histamine-2-receptor blockers. In
the intention-to-treat analysis, there were no differences in hospital
mortality [PPI: 4.3% vs histamine-2 receptor blockers: 4.8%, adjusted odds
ratio (aOR) 0.97, 95% confidence interval (CI) 0.55-1.70],
gastrointestinal bleeding (3.9% vs 4.8%, aOR 1.09, 95% CI 0.66-1.81), C.
difficile infections (0.9% vs 0.1%, aOR 0.18, 95% CI 0.02-1.59),
ventilator-associated conditions (1.6% vs 1.7%, aOR 0.92, 95% CI
0.85-1.00) or median length of stay (9.2 vs 9.8 days, adjusted risk ratio
1.06, 85% CI 0.99-1.13). No significant treatment differences were
observed among subgroups of interest or per-protocol populations.
 CONCLUSION(S): In a secondary analysis of cardiac surgery patients
enrolled in the PEPTIC trial in Canada, no differences in effectiveness or
safety were observed between use of PPIs and histamine-2 receptor blockers
for stress ulcer prophylaxis. CLINICAL TRIAL REGISTRATION NUMBER:
anzctr.org.au identifier: ACTRN12616000481471. Copyright © The
Author(s) 2022. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<15>
Accession Number
637207132
Title
Mechanical versus biological valve prostheses for left-sided infective
endocarditis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 62(2) (no pagination),
2022. Date of Publication: 11 Jul 2022.
Author
Kahrovic A.; Angleitner P.; Herkner H.; Kocher A.; Ehrlich M.; Laufer G.;
Andreas M.
Institution
(Kahrovic, Angleitner, Kocher, Ehrlich, Laufer, Andreas) Department of
Cardiac Surgery, Medical University of Vienna, Vienna, Austria
(Herkner) Department of Emergency Medicine, Medical University of Vienna,
Vienna, Austria
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Our aim was to analyse outcomes after implantation of
mechanical versus biological valve prostheses in patients presenting with
left-sided infective endocarditis. METHOD(S): We conducted a
retrospective single-centre cohort study, analysing adults requiring valve
surgery for left-sided infective endocarditis between January 2009 and
December 2018 at the Department of Cardiac Surgery, Medical University of
Vienna. The primary outcome variable was all-cause mortality. Secondary
outcome variables included the occurrence of a combined event (death,
stroke, intracerebral bleeding or reoperation) and the risk of
re-endocarditis. RESULT(S): Among 220 patients, 76 (34.5%) underwent
mechanical valve replacement, while 144 (65.5%) underwent biological valve
replacement. Recipients of mechanical valve prostheses were younger at the
time of surgery and presented with lower European System for Cardiac
Operative Risk Evaluation II values. In patients <55 years of age,
implantation of a mechanical valve prosthesis was independently associated
with significantly lower risk of all-cause mortality (adjusted hazard
ratio 0.35, 95% confidence interval 0.15-0.80, P = 0.013). Moreover, this
group was at significantly lower risk of a combined event (adjusted hazard
ratio 0.38, 95% confidence interval 0.19-0.76, P = 0.006). Implantation of
a mechanical valve prosthesis was not associated with increased risk of
re-endocarditis. The presence of an annular abscess significantly
increased the risk of re-endocarditis (adjusted hazard ratio 3.06, 95%
confidence interval 1.40-6.71, P = 0.005). CONCLUSION(S): In patients
presenting with left-sided infective endocarditis <55 years of age,
implantation of a mechanical valve prosthesis is associated with superior
outcomes. A prospective randomized controlled trial is warranted to
confirm these results. Copyright © The Author(s) 2022. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<16>
Accession Number
2018346259
Title
Discordant Post-natal Patterns in Fetuses With Heterotaxy Syndrome: A
Retrospective Single-Centre Series on Outcome After Fetal Diagnosis.
Source
Frontiers in Pediatrics. 10 (no pagination), 2022. Article Number: 908505.
Date of Publication: 14 Jul 2022.
Author
Seidl-Mlczoch E.; Kasprian G.; Kitzmueller E.; Zimpfer D.; Steiner I.;
Jowett V.; Stuempflen M.; Wielandner A.; Ulm B.; Michel-Behnke I.
Institution
(Seidl-Mlczoch, Kitzmueller, Stuempflen, Wielandner, Michel-Behnke)
Department of Pediatrics and Adolescent Medicine, Division of Pediatric
Cardiology, Pediatric Heart Center, Medical University of Vienna, Vienna,
Austria
(Kasprian) Department of Biomedical Imaging and Image-Guided Therapy,
Division of Neuroradiology and Musculoskeletal Radiology, Medical
University of Vienna, Vienna, Austria
(Zimpfer) Department of Cardiac Surgery, Pediatric Heart Center Vienna,
Medical University of Vienna, Vienna, Austria
(Steiner) Section for Medical Statistics, Center for Medical Statistics,
Informatics and Intelligent Systems, Medical University of Vienna, Vienna,
Austria
(Jowett) Department of Fetal Cardiology, Great Ormond Street Hospital,
London, United Kingdom
(Ulm) Department of Obstetrics and Gynaecology, Division of Obstetrics and
Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
Publisher
Frontiers Media S.A.
Abstract
Objective: Cardiac and extra-cardiac anomalies in 46 pre-natally diagnosed
cases of heterotaxy were compared to post-natal anatomical patterns in
order to reveal discordant findings. Second, the outcome of these fetuses
was evaluated. Method(s): Fetuses with heterotaxy, diagnosed in a
tertiary referral centre, were analysed retrospectively. Based on the
foetal abdominal situs view, right atrial isomerism (RAI) and left atrial
isomerism (LAI) were defined as foetal sub-types. Post-natally, discordant
anatomical patterns for broncho-pulmonary branching, atrial appendage
morphology, and splenic status were further clarified with CT scans. In
summary, the spectrum of pre-natally and post-natally detected cardiac and
extra-cardiac anomalies is systematically reviewed. Necessary surgical
interventions and mid-long-term outcomes were compared between the two
sub-types in surviving infants. Result(s): A total of 46 fetuses with
heterotaxy were included; LAI was diagnosed in 29 (63%) fetuses and RAI
was diagnosed in 17 (37%) fetuses. Extra-cardiac anomalies were noted in
35% of fetuses. Seven out of the 29 fetuses (24%) with LAI had
atrio-ventricular block (AVB) and four of these cases presented with
hydrops. Twenty nine out of the 46 participating fetuses (63%) were live
births, with 62% in the LAI group and 65% in the RAI group. Five fetuses
were lost to follow-up. At the age of 1 year, the overall survival of live
births [estimate (95% CI)] was 67% (48; 92%) in patients with LAI and 55%
(32; 94%) in patients with RAI. At the age of 5 years, the estimates were
67% (48; 92%) in the LAI group and 46% (24-87%) in the RAI group. The
median survival (first quartile; third quartile) was 11.1 (0.1; 14) years
for patients with LAI and 1.3 (0.09; NA) years for patients with RAI. Of
17 children who had undergone cardiac surgery, five (29%) children
achieved a bi-ventricular repair and 12 (70%) children achieved a
uni-ventricular palliation. Three were primarily palliated, but converted
to bi-ventricular thereafter. Foetal subtype definition of heterotaxy
based on the abdominal situs and post-natal thoracic imaging studies
showed a discordant pattern of broncho-pulmonary branching and atrial
appendage anatomy in 40% of our live-born children. Conclusion(s):
Heterotaxy is a rare and complex condition with significant morbidity and
mortality related to severe cardiac and extra-cardiac associations.
Accurate pre-natal diagnosis can help identify the fetuses at risk and
allow for timely intervention in a multi-disciplinary setting. Further
studies are warranted to shed light on the exact sub-type definition in
fetuses with heterotaxy and the presence of discordant post-natal
patterns. Copyright © 2022 Seidl-Mlczoch, Kasprian, Kitzmueller,
Zimpfer, Steiner, Jowett, Stuempflen, Wielandner, Ulm and Michel-Behnke.

<17>
Accession Number
2019520563
Title
Thoracic meningocele in patients with neurofibromatosis type 1: A review
of literature with illustration of a novel surgical challenge, and
insights from histology.
Source
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management.
30 (no pagination), 2022. Article Number: 101624. Date of Publication:
December 2022.
Author
Elsayed A.A.; Rajabian A.; Nabi A.; Du Plessis D.; Joshi George K.
Institution
(Elsayed, Rajabian, Nabi, Du Plessis, Joshi George) Salford Royal
Foundation Trust, Salford, Manchester M6 8HD, United Kingdom
Publisher
Elsevier B.V.
Abstract
Background: 69% of thoracic meningoceles are associated with
Neurofibromatosis type 1(NF1). Pathology is debated between being a
saccular protrusion of dysplastic meninges through a vertebral defect, or
a forme fruste of neurofibroma, with no pathological evidence to the
later. Treatment is usually conservative, however surgical intervention is
sometimes indicated. Surgical options include thoracotomy, endoscopic
plication of the cyst, or CSF diversion. After excision of the
meningocele, watertight closure of the dura is difficult and meningoceles
often reform, so dural reinforcement is indicated. Objective(s): A
literature review on thoracic meningocele in NF1 patients: pathological
hypothesis, presentation including rupture and hemothorax in large
meningoceles, management strategies, and surgical challenges. The review
also includes an illustrative case discussing the surgical challenges with
giant meningoceles. Case presentation. A 46 year old male, NF1, with a
known thoracic meningocele, presented with dyspnoea due to enlarging
thoracic meningocele. The meningocele was successfully excised via
thoracotomy in a challenging surgery with a novel surgical technique and
unique insight on histology. Result(s): 10 cases of giant
meningoceles in NF1 patients have been reported in literature, surgery was
performed in 9 of them. 1 patient died, and there was recurrence or no
change in 6 them. Histology in our illustrative case showed diffuse
population of schwann cells. Also, Buttress plates achieved reinforced
dural closure with no recurrence. Conclusion(s): Our study concluded
that in in large thoracic meningocele(s) surgery via thoracotomy is
advised, and dural reinforcement with buttress plates proved to be
successful. Our study also concluded that meningoceles in NF1 patients is
likely a forme fruste of neurofibroma, or a giant cystic neurofibroma
rather than due to dysplastic dura. Copyright © 2022

<18>
Accession Number
2019498378
Title
Transcatheter Tricuspid Valve Replacement for Tricuspid Regurgitation: A
Systematic Review and Meta-analysis.
Source
Anatolian Journal of Cardiology. 26(7) (pp 505-519), 2022. Date of
Publication: July 2022.
Author
Bugan B.; Cekirdekci E.I.; Onar L.C.; Barcin C.
Institution
(Bugan, Barcin) Department of Cardiology, Gulhane Training and Research
Hospital, Ankara, Turkey
(Cekirdekci) Department of Cardiology, University of Kyrenia, Kyrenia,
Cyprus
(Onar) Department of Cardiovascular Surgery, Dr. Ismail Fehmi Cumalioglu
Government Hospital, Tekirdag, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Background: The present data aim to evaluate the feasibility of the
orthotopic transcatheter tricuspid valve replacement devices,
echocardiographic, functional improvements, and mortality rates following
replacement in patients with significant tricuspid valve regurgitation.
 Method(s): We systematically searched for the studies evaluating the
efficacy and safety of transcatheter tricuspid valve replacement for
significant tricuspid valve regurgitation. The efficacy and safety
outcomes were the improvements in New York Heart Association functional
class, 6-minute walking distance, all-cause death, and periprocedural and
long-term complications. In addition, a random-effect meta-analysis was
performed comparing outcomes before and after transcatheter tricuspid
valve replacement. Result(s): Nine studies with 321 patients were
included. The mean age was 75.8 years, and the mean European System for
Cardiac Operative Risk Evaluation II score was 8.2% (95% CI: 6.1 to 10.3).
Severe, massive, and torrential tricuspid valve regurgitation was
diagnosed in 95% of patients (95% CI: 89% to 98%), and 83% (95% CI: 73% to
90%) of patients were in New York Heart Association functional class III
or IV. At a weighted mean follow-up of 122 days, New York Heart
Association functional class (risk ratio = 0.20; 95% CI: 0.11 to 0.35; P <
.001) and 6-minute walking distance (mean difference = 91.1 m; 95% CI:
37.3 to 144.9 m; P < .001) significantly improved, and similarly, the
prevalence of severe or greater tricuspid valve regurgitation was
significantly reduced after transcatheter tricuspid valve replacement
(baseline risk ratio = 0.19; 95% CI: 0.10 to 0.36; P < .001). In total, 28
patients (10%; 95% CI: 6% to 17%) had died. Pooled analyses demonstrated
non-significant differences in hospital and 30-day mortality and >30-day
mortality than predicted operative mortality (risk ratio = 1.03; 95% CI:
0.41 to 2.59; P= .95, risk ratio = 1.39; 95% CI: 0.69 to 2.81; P= .35,
respectively). Conclusion(s): Transcatheter tricuspid valve
replacement could be an emerging treatment option for patients with severe
tricuspid regurgitation who are not eligible for transcatheter repair or
surgical replacement because of high surgical risk and poor
prognosis. Copyright © 2022 Turkish Society of Cardiology. All
rights reserved.

<19>
Accession Number
2019540199
Title
Eicosapentaenoic Acid for Cardiovascular Events Reduction- Systematic
Review and Network Meta-Analysis of Randomized Controlled Trials: EPA and
cardiovascular outcomes.
Source
Journal of Cardiology. (no pagination), 2022. Date of Publication: 2022.
Author
Yokoyama Y.; Kuno T.; Morita S.X.; Slipczuk L.; Takagi H.; Briasoulis A.;
Latib A.; Bangalore S.; Heffron S.P.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Kuno, Slipczuk, Latib) Division of Cardiology, Montefiore Medical Center,
Albert Einstein College of Medicine, New York, NY, United States
(Morita) Division of Cardiology, Department of Medicine, Columbia
University Irving Medical Center/New York-Presbyterian Hospital, New York,
NY, United States
(Takagi) Department of Cardiovascular Surgery, Medical Center, Sunto-gun,
Shizuoka, Shizuoka, Japan
(Briasoulis) Division of Cardiovascular Diseases, University of Iowa
Hospitals and Clinics, Iowa City, IA, United States
(Bangalore, Heffron) Leon H. Charney Division of Cardiology, Department of
Medicine, NYU Grossman School of Medicine, New York, NY, United States
(Heffron) NYU Center for the Prevention of Cardiovascular Disease, New
York Langone Health, New York, NY, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Randomized clinical trials (RCTs) investigating the impact of
omega-3-fatty acid supplementation on cardiovascular events have largely
shown no benefit. However, there is debate about the benign nature of the
placebo in these trials. We aimed to conduct a network meta-analysis of
RCTs to compare the outcomes of omega-3 fatty acid supplementation to
various placebo oils. Method(s): MEDLINE and EMBASE were searched
through May, 2021 to identify RCTs investigating cardiovascular outcomes
with omega-3-fatty acid formulations [eicosapentaenoic acid (EPA),
decosahexanoic acid (DHA), or the combination] versus placebo or standard
of care controls. Result(s): Our analysis included 17 RCTs that
enrolled a total of 141,009 patients randomized to EPA (n=13,655), EPA+DHA
(n=56,908), mineral oil placebo (n=5,338), corn oil placebo (n =8,876),
olive oil placebo (n=41,009), and controls (no placebo oil; n=15,223).
Rates of cardiovascular death [hazard ratio (HR) (95% confidence interval,
CI) =0.80 (0.65-0.98); p =0.033], myocardial infarction [HR (95% CI) =0.73
(0.55-0.97); p=0.029] and stroke [HR (95% CI) =0.74 (0.58-0.94); p=0.014]
were significantly lower in those receiving EPA compared to those
receiving mineral oil, but were not different from rates in those
receiving other oils or controls. Rates of coronary revascularization were
significantly lower in those receiving EPA than in those receiving either
EPA+DHA, mineral oil, corn oil, or olive oil placebo, but not controls.
All-cause death was similar among all groups, but combined EPA+DHA was
associated with reduced risk of cardiovascular death compared to controls
[HR (95%CI): 0.83 (0.71-0.98)]. Conclusion(s): Our analyses
demonstrate that although EPA supplementation lowers risk of coronary
revascularization more than other oils, there may not be a benefit
relative to standard of care. Further, EPA reduces the risk of
cardiovascular events only in comparison to mineral oil and not when
compared with other placebo oils or controls. In contrast, combined
EPA+DHA was associated with reduced risk of cardiovascular death compared
to controls. Copyright © 2022 Elsevier Ltd

<20>
Accession Number
638627847
Title
Early surgical aortic valve replacement in asymptomatic patients with
severe aortic stenosis: a systematic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2022. Date of Publication: 21 Jul 2022.
Author
Ferlini M.; Munafo A.R.; Lanzillo G.; Aiello M.; Gazzoli F.; Mirizzi A.M.;
Magrini G.; Pelenghi S.; Visconti L.O.
Institution
(Ferlini, Mirizzi, Magrini, Visconti) Division of Cardiology, Fondazione
IRCCS Policlinico San Matteo
(Munafo, Lanzillo) Department of Molecular Medicine, Unit of Cardiology,
University of Pavia, Pavia, Italy
(Aiello, Gazzoli, Pelenghi) Division of Cardiac Surgery, Fondazione IRCCS
Policlinico San Matteo
Publisher
NLM (Medline)

<21>
Accession Number
638627168
Title
Perioperative electroencephalography in cardiac surgery with hypothermic
circulatory arrest: a narrative review.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2022.
Date of Publication: 29 Jul 2022.
Author
McDevitt W.M.; Gul T.; Jones T.J.; Scholefield B.R.; Seri S.; Drury N.E.
Institution
(McDevitt, Seri) Department of Neurophysiology, Birmingham Children's
Hospital, Birmingham, United Kingdom
(Gul) School of Biomedical Sciences, University of Birmingham, Birmingham,
United Kingdom
(Gul, Jones, Drury) Department of Paediatric Cardiac Surgery, Birmingham
Children's Hospital, Birmingham, United Kingdom
(Jones, Drury) Institute of Cardiovascular Sciences, University of
Birmingham, Birmingham, United Kingdom
(Scholefield) Institute of Inflammation and Ageing, University of
Birmingham, Birmingham, United Kingdom
(Scholefield) Paediatric Intensive Care Unit, Birmingham Children's
Hospital, Birmingham, United Kingdom
(Seri) College of Health and Life Sciences, Aston University, Birmingham,
United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Cardiac surgery with hypothermic circulatory arrest is
associated with neurological morbidity of variable severity and
electroencephalography is a sensitive proxy measure of brain injury. We
conducted a narrative review of the literature to evaluate the role of
perioperative electroencephalography monitoring in cardiac surgery
involving hypothermic circulatory arrest. METHOD(S): MEDLINE, EMBASE,
CENTRAL and LILACS databases were searched to identify studies utilising
perioperative electroencephalography during surgery with hypothermic
circulatory arrest in all age groups, published since 1985 in any
language. We aimed to compare electroencephalography use with no use but
due to the lack of comparative studies, we performed a narrative review of
its utility. Two or more reviewers independently screened studies for
eligibility and extracted data. RESULT(S): 40 single-centre studies
with a total of 3,287 patients undergoing surgery were identified. Most
were observational cohort studies (34, 85%) with only one directly
comparing electroencephalography use with no use. Electroencephalography
continuity (18, 45%), seizures (15, 38%), and electrocerebral inactivity
prior to circulatory arrest (15, 38%) were used to detect, monitor,
prevent, and prognose neurological injury. Neurological dysfunction was
reported in almost all studies and occurred in 0-21% of patients. However,
the heterogeneity of reported clinical and electroencephalography outcome
measures prevented meta-analysis. CONCLUSION(S):
Electroencephalography is used to detect cortical ischaemia, seizures,
predict neurological abnormalities and may guide intraoperative cerebral
protection. However, there is a lack of comparative data demonstrating
benefit of perioperative electroencephalography monitoring. Use of a
standardised methodology for performing electroencephalography and
reporting outcome metrics would facilitate the conduct of high-quality
clinical trials. Copyright © The Author(s) 2022. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<22>
Accession Number
638624265
Title
The use of objective assessments in the evaluation of technical skills in
cardiothoracic surgery. A systematic review.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2022.
Date of Publication: 28 Jul 2022.
Author
Hussein N.; Van den Eynde J.; Callahan C.; Guariento A.;
Gollmann-Tepekoylu C.; Elbatarny M.; Loubani M.
Institution
(Hussein, Loubani) University of York, United Kingdom
(Hussein, Loubani) Department of Cardiothoracic Surgery, Castle Hill
Hospital, Cottingham, United Kingdom
(Van den Eynde) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Callahan) Department of Surgery, Washington University School of
Medicine, St. Louis, MO, United States
(Guariento) Pediatric and Congenital Cardiac Surgery Unit, Department of
Cardiac, Thoracic, Vascular Sciences and Public Health, University of
Padua, Italy
(Gollmann-Tepekoylu) Department of Cardiac Surgery, Medical University of
Innsbruck, Austria
(Elbatarny) Department of Cardiac Surgery, University of Toronto, Toronto,
ON, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: With reductions in training time and intraoperative exposure
there is a need for objective assessments to measure trainee progression.
This systematic review focuses on the evaluation of trainee technical
skill performance using objective assessments in cardiothoracic surgery
and its incorporation into training curricula. METHOD(S): Databases
(EBSCOHOST, Scopus and Web of Science)and reference lists of relevant
articles for studies that incorporated objective assessment of technical
skills of trainees/residents in cardiothoracic surgery were included. Data
extraction included task performed; assessment setting and tool used;
number/level of assessors; study outcome and whether the assessments were
incorporated into training curricula. The methodological rigor of the
studies were scored using the Medical Education Research Study Quality
Instrument(MERSQI). RESULT(S): Fifty-four studies were included for
quantitative synthesis. Six were randomised-controlled trials. Cardiac
surgery was the most common speciality utilising objective assessment
methods with coronary anastomosis the most frequently tested task.
Likert-based assessment tools were most commonly used(61%). Eighty-five
percent of studies were simulation-based with the rest being
intraoperative. Expert surgeons were primarily used for objective
assessments(78%) with 46% using blinding. Thirty(56%) studies explored
objective changes in technical performance with 97% demonstrating
improvement. The other studies were primarily validating assessment tools.
Thirty-nine percent of studies had established these assessment tools into
training curricula. The mean+/-standard deviation MERSQI score for all
studies was 13.6+/-1.5 demonstrating high validity. CONCLUSION(S):
Despite validated technical skill assessment tools being available and
demonstrating trainee improvement, their regular adoption into training
curricula is lacking. There is a need to incorporate these assessments to
increase the efficiency and transparency of training programmes for
cardiothoracic surgeons. Copyright © The Author(s) 2022.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<23>
Accession Number
638620109
Title
The Effect of Female Sex on Short-Term Outcomes of Patients Undergoing
Off-Pump Versus On-Pump Coronary Artery Bypass Grafting.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2022. Date
of Publication: 27 Jul 2022.
Author
Fan J.; Luo S.-L.; Pan Y.-C.; Wu T.-Y.; Chen Y.; Li W.-J.
Institution
(Fan, Luo, Pan, Wu, Chen, Li) Department of Cardiology, Guangzhou First
People's Hospital, School of Medicine, South China University of
Technology, Guangzhou, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: According to the American Heart Association guideline for
coronary artery bypass grafting (CABG), female patients undergoing on-pump
CABG (ONCAB) are at higher risk of short-term adverse outcomes than male
patients. However, whether off-pump CABG (OPCAB) can improve the
short-term outcome of female patients compared to ONCAB remains unclear.
 METHOD(S): We conducted a meta-analysis to study the effect of the
female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115
patients were enrolled in 12 studies, including 20,245 females who
underwent ONCAB and 10,910 females who underwent OPCAB. RESULT(S):
The in-hospital mortality in female patients who underwent OPCAB was
significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%;
odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without
(OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The
incidence of postoperative stroke in female patients who underwent OPCAB
was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI
0.48-0.73) before cardiovascular risk factor adjustment but was not
significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no
significant difference in the incidence of postoperative myocardial
infarction between women who underwent OPCAB and those in the ONCAB group
(1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43). CONCLUSION(S): In
contrast to the American Heart Association CABG guideline, female patients
who had OPCAB don't have unfavorable outcomes compared with the ONCAB
group.

<24>
Accession Number
638619950
Title
Biocompatibility of the Oxygenator on Pulsatile Flow by Electron
Microscope.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2022. Date
of Publication: 26 Jul 2022.
Author
Ulus A.T.; Guray T.; Urpermez E.; Ozyalcin S.; Taner A.; Haberal E.;
Kocakulak M.
Institution
(Ulus, Ozyalcin) Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas
Research and Training Hospital, Ankara, Turkey
(Ulus) Cardiovascular Surgery Department, Hacettepe University, Ankara,
Turkey
(Guray, Urpermez, Haberal) Biomedical Engineering Department, Baskent
University, Ankara, Turkey
(Taner) Department of Cardiology, Aksaray Hospital, Aksaray, Turkey
(Kocakulak) Biomedical Engineering Department, Izmir Democracy University,
Karabaglar, Izmir,Turkey
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Extracorporeal perfusion flow type requires further
investigation. The aim of this study is to compare the effects of
pulsatile and nonpulsatile flow on oxygenator fibers that were analyzed by
scanning electron microscope (SEM) and to extensively study patients'
coagulation profiles, inflammatory markers, and functional blood tests.
 METHOD(S): Twelve patients who had open heart surgery were randomly
divided into two groups; the nonpulsatile flow (group NP, six patients)
and pulsatile flow (group P, six patients) groups. Both superficial view
and axial sections of the oxygenator fiber samples were examined under SEM
to compare the thickness of absorbed blood proteins and amount of blood
cells on the surface of oxygenators. Platelet count, coagulation profile,
and inflammatory predictors were also studied from the blood samples.
 RESULT(S): Fibrinogen levels after cardiopulmonary bypass were
significantly lower in group NP (group P, 2.57+/-2.78 g/L; group NP;
2.39+/-0.70 g/L, P=0.03). Inflammatory biomarkers such as C-reactive
protein, interleukin (IL)-6, IL-12, apelin, S100beta, and tumor necrosis
factor alpha were comparable in both groups. Axial sections of the
oxygenator fiber samples had a mean thickness of 45.2 microm and 46.5
microm in groups P and NP, respectively, and this difference is
statistically significant (P=0.006). Superficial view of the fiber samples
showed obviously lower platelet, leukocyte, and erythrocyte levels in
group P. CONCLUSION(S): Our study demonstrated that both cellular
elements and protein adsorption on oxygenator fibers are lower in the
group P than in the group NP. Pulsatile perfusion has better
biocompatibility on extracorporeal circulation when analyzed by SEM
technique.

<25>
Accession Number
2019459747
Title
Interpectoral-pectoserratus plane (PECS II) block in patients undergoing
trans-axillary thoracic outlet decompression surgery; A prospective
double-blind, randomized, placebo-controlled clinical trial.
Source
Journal of Clinical Anesthesia. 82 (no pagination), 2022. Article Number:
110939. Date of Publication: November 2022.
Author
van den Broek R.J.C.; Goeteyn J.; Houterman S.; Bouwman R.A.; Versyck
B.J.B.; Teijink J.A.W.
Institution
(van den Broek, Bouwman, Versyck) Department of Anesthesiology and Pain
medicine, Catharina hospital, Michelangelolaan 2, Eindhoven 5623 EJ,
Netherlands
(van den Broek, Goeteyn, Teijink) Faculty of Health, Medicine and Life
Sciences, Department of Epidemiology, CAPHRI School for Public Health and
Primary Care, Maastricht University, Universiteitssingel 40, Maastricht
6229 ER, Netherlands
(Goeteyn, Teijink) Department of Vascular Surgery, Catharina hospital,
Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Houterman) Department of Education and Research, Catharina Hospital,
Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Bouwman) Department of Electrical Engineering, Eindhoven University of
Technology, Groene Loper 19, Eindhoven 5612 AP, Netherlands
(Versyck) Department of Anesthesiology and Pain Medicine, AZ Turnhout,
Steenweg op Merksplas 44, Turnhout 2300, Belgium
Publisher
Elsevier Inc.
Abstract
Study objective: To investigate if an interpectoral-pectoserratus plane
(PECS II) block decreases postoperative pain, postoperative nausea and
vomiting and improves quality of recovery in patients with neurogenic
thoracic outlet syndrome (NTOS) undergoing trans-axillary thoracic outlet
decompression surgery. Design(s): A prospective single center double
blinded randomized placebo-controlled trial. Setting(s):
Perioperative period; operating room, post anesthesia care unit (PACU) and
hospital ward. Patient(s): Seventy patients with NTOS, undergoing
trans-axillary thoracic outlet decompression surgery.
 Intervention(s): Patients were randomized to an interventional arm,
receiving the block with 40 ml ropivacaine 0.5% (concentration was
adjusted if the patient's weight was <66 kg), and a placebo group,
receiving a sham block with 40 ml NaCl 0.9%. The
interpectoral-pectoserratus plane block was performed ultrasound guided;
the first injection below the pectoral minor muscle and the second below
the pectoral major muscle. The hospitals' pharmacist prepared the study
medication and was the only person able to see the randomization result.
The study was blinded for patients, researchers and medical personnel.
Measurements: Primary outcome parameters were postoperative pain, measured
by numeric rating scale on the PACU (start and end) and on the ward on
postoperative day (POD) 0 and 1, and postoperative morphine consumption,
measured on the PACU and on the ward during the first 24 h. Secondary
outcome parameters were postoperative nausea and vomiting, and quality of
recovery. Main Result(s): There was no statistically significant
difference in NRS on the PACU at the start (ropivacaine 4.9 +/- 3.2 vs
placebo 6.2 +/- 3.0, p = .07), at the end (ropivacaine 4.0 +/- 1.7 vs
placebo 3.9 +/- 1.7, p = .77), on the ward on POD 0 (ropivacaine 4.6 +/-
2.0 vs placebo 4.6 +/- 2.0, p = 1.00) or POD 1 (ropivacaine 3.9 +/- 1.8 vs
placebo 3.6 +/- 2.0, p = .53). There was no difference in postoperative
morphine consumption at the PACU (ropivacaine 11.0 mg +/- 6.5 vs placebo
10.8 mg +/- 4.8, p = .91) or on the ward (ropivacaine 11.6 mg +/- 8.5 vs
placebo 9.6 mg +/- 9.4, p = .39). Conclusion(s): The
interpectoral-pectoserratus plane block is not effective for postoperative
analgesia in patients with NTOS undergoing trans-axillary thoracic outlet
decompression surgery. Copyright © 2022 Elsevier Inc.

<26>
Accession Number
2019424655
Title
Efficacy, efficiency and safety of a cardiac telerehabilitation programme
using wearable sensors in patients with coronary heart disease: The
TELEWEAR-CR study protocol.
Source
BMJ Open. 12(6) (no pagination), 2022. Article Number: e059945. Date of
Publication: 01 Jun 2022.
Author
Antoniou V.; Xanthopoulos A.; Giamouzis G.; Davos C.; Batalik L.; Stavrou
V.; Gourgoulianis K.I.; Kapreli E.; Skoularigis J.; Pepera G.
Institution
(Antoniou, Kapreli, Pepera) Clinical Exercise Physiology and
Rehabilitation Research Laboratory, Physiotherapy Department, University
of Thessaly School of Health Sciences, Lamia, Greece
(Xanthopoulos, Giamouzis, Skoularigis) Cardiology, University of Thessaly
Faculty of Medicine, Larissa, Greece
(Davos) Cardiovascular Research, Biomedical Research Foundation of the
Academy of Athens, Athens, Greece
(Batalik) Department of Rehabilitation, University Hospital Brno, Brno,
Czechia
(Batalik) Department of Public Health, Masaryk University Brno, Brno,
Czechia
(Stavrou, Gourgoulianis) Laboratory of Cardio-Pulmonary Testing,
Department of Respiratory Medicine, University of Thessaly Faculty of
Medicine, Larissa, Greece
Publisher
BMJ Publishing Group
Abstract
Introduction Exercise-based cardiac rehabilitation (CR) is a beneficial
tool for the secondary prevention of cardiovascular diseases with,
however, low participation rates. Telerehabilitation, intergrading mobile
technologies and wireless sensors may advance the cardiac patients'
adherence. This study will investigate the efficacy, efficiency, safety
and cost-effectiveness of a telerehabilitation programme based on
objective exercise telemonitoring and evaluation of cardiorespiratory
fitness. Methods and analysis A supervised, parallel-group, single-blind
randomised controlled trial will be conducted. A total of 124 patients
with coronary disease will be randomised in a 1:1 ratio into two groups:
intervention telerehabilitation group (TELE-CR) (n=62) and control
centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants
will receive a 12-week exercise-based rehabilitation programme, remotely
monitored for the TELE-CR group and standard supervised for the CB-CR
group. All participants will perform aerobic training at 70% of their
maximal heart rate, as obtained from cardiopulmonary exercise testing
(CPET) for 20 min plus 20 min for strengthening and balance training,
three times per week. The primary outcomes will be the assessment of
cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the
CPET test and the 6 min walk test. Secondary outcomes will be the physical
activity, the safety of the exercise intervention (number of adverse
events that may occur during the exercise), the quality of life, the
training adherence, the anxiety and depression levels, the nicotine
dependence and cost-effectiveness. Assessments will be held at baseline,
end of intervention (12 weeks) and follow-up (36 weeks). Ethics and
dissemination The study protocol has been reviewed and approved by the
Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the
Ethics Committee of the General University Hospital of Larissa
(3780/31-01-2022). The results of this study will be disseminated through
manuscript publications and conference presentations. Trial registration
number NCT05019157. Copyright © 2022 BMJ Publishing Group. All
rights reserved.

<27>
Accession Number
2017537928
Title
Surgical applications of ultrasound use in low- and middle-income
countries: A systematic review.
Source
Australasian Journal of Ultrasound in Medicine. 25(2) (pp 80-97), 2022.
Date of Publication: May 2022.
Author
Navarro S.M.; Shaikh H.; Abdi H.; Keil E.J.; Odusanya S.; Stewart K.A.;
Tuyishime E.; Mazingi D.; Tuttle T.M.
Institution
(Navarro, Abdi, Keil, Odusanya, Tuttle) Department of Surgery, University
of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, United States
(Shaikh) Department of Orthopaedics, University of Rochester, 601 Elmwood
Avenue, Rochester, NY 14642, United States
(Stewart) Department of Anaesthesia, Critical Care, and Emergency
Medicine, University of Rwanda, KN 4 Ave, Kigali, Rwanda
(Tuyishime) Department of Anaesthesia, University of Toronto, 123 Edward
Street, Toronto, ON M5G 1E2, Canada
(Tuyishime) Department of Obstetrics and Gyenecology, University of
Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, United States
(Mazingi) Department of Surgery, University of Zimbabwe, Mazowe Street
A168, Harare, Zimbabwe
Publisher
John Wiley and Sons Inc
Abstract
Background: Ultrasound is a portable technology able to deploy health care
effectively in low resource settings. This study presents a systematic
review to determine trends in the utility and applicability of this
technology in low- and middle-income countries (LMIC), specifically for
surgical applications. The review includes characterising and evaluating
trends in the geographic and specialty-specific use of ultrasound
pertaining to surgical disease. Method(s): The databases such as
Medline OVID, EMBASE and Cochrane were searched from 2010 through March
2019 for studies available in English, French and Spanish. Commentaries,
opinion articles, reviews and book chapters were excluded. A categorical
analysis of ultrasound use for surgical disease in LMICs was conducted.
 Result(s): A total of 6276 articles were identified, with 4563
studies included for the final review. A total of 221 studies were
selected researching ultrasound use in LMICs to treat surgical disease.
Most studies identified ultrasound usage focused on general surgery, acute
care surgery and surgical ICU topics (52%, 115) followed by computed
tomography surgery studies (20%, 44). Most studies were retrospective in
nature, with 81% (180) of research studies generated in four countries
(India, Pakistan, Nigeria and Egypt). Ultrasound proved to be a feasible
technique for utility in pre-operative diagnosis, cost-effectiveness and
prediction of surgical outcomes. Findings are limited by the limited
number of randomised clinical trials reported. Conclusion and global
health implications: Our systematic literature review of ultrasound use in
LMICs demonstrates the growing utilisation of this relatively low-cost,
portable imaging technology in low resource settings for surgical
disease. Copyright © 2022 Australasian Society for Ultrasound in
Medicine.

<28>
Accession Number
2014191647
Title
Mitral regurgitation severity predicts one-year therapeutic benefit of
Tendyne transcatheter mitral valve implantation.
Source
EuroIntervention. 15(12) (pp E1065-E1071), 2019. Date of Publication:
December 2019.
Author
Badhwar V.; Sorajja P.; Duncan A.; Thourani V.; Schaefer U.; Grayburn P.;
Dumonteil N.; Babaliaros V.; Garatti A.; Leipsic J.; Chuang M.; Blanke P.;
Muller D.
Institution
(Badhwar) West Virginia University, Morgantown, WV, United States
(Sorajja) Abbott Northwestern Hospital, Minneapolis, MN, United States
(Duncan) Royal Brompton Hospital, London, United Kingdom
(Thourani) MedStar Heart and Vascular Institute, Georgetown University,
School of Medicine, Washington, DC, United States
(Schaefer) University Heart Center Hamburg, Hamburg, Germany
(Grayburn) Baylor Research Institute, Dallas, TX, United States
(Dumonteil) Clinique Pasteur, Toulouse, France
(Babaliaros) Emory University, School of Medicine, Atlanta, GA, United
States
(Garatti) IRCCS Policlinico San Donato, Milan, Italy
(Leipsic, Blanke) StPaul's Hospital, University of British Columbia,
Vancouver, BC, Canada
(Chuang) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Muller) St Vincent's Hospital, Darlinghurst, NSW, Australia
Publisher
Europa Group
Abstract
Aims: Longitudinal outcomes of transcatheter therapies for secondary
mitral regurgitation (MR) have been variable. This study examined
predictors of one-year outcome following transcatheter mitral valve
implantation (TMVI) with the Tendyne device. Methods and Results: The
first 100 consecutive patients with moderate-severe or severe MR enrolled
in the Tendyne CE Mark trial were examined. Multivariable analyses
assessed the impact of preoperative clinical and echocardiographic
characteristics on one-year freedom from death or heart failure
hospitalisation (HFH). All 100 patients underwent Tendyne TMVI without
operative mortality. Univariate analysis was performed on implanted
subjects, followed by multivariate analysis in those with complete
predictive variable data. Patient characteristics: 76.5% male, 60.8% NYHA
Class III/IV, age 75.6+/-7.5 years and Society of Thoracic Surgeons
predicted risk of mortality of 8.5+/-6.1%. Increased left ventricular
end-diastolic dimension was associated with one-year Tendyne benefit
following univariate analysis (OR 0.35, p=0.010). Following multivariable
adjustment, only severe MR, defined as a composite of effective
regurgitant orifice area >=0.3 cm2 or regurgitant volume >=45 ml, was
associated with freedom from death or HFH at one year (OR 0.16, p=0.032).
 Conclusion(s): Preoperative severe MR was predictive of improved
one-year outcome following Tendyne TMVI. These results may inform therapy
selection for the management of secondary MR and left ventricular
dilatation. Copyright © Europa Digital & Publishing 2019.

<29>
Accession Number
637699542
Title
Efficacy of ultrasound-guided parasternal block in adult cardiac surgery:
a meta-analysis of randomized controlled trials.
Source
Minerva anestesiologica. 88(9) (pp 719-728), 2022. Date of Publication: 01
Sep 2022.
Author
Li J.; Lin L.; Peng J.; He S.; Wen Y.; Zhang M.
Institution
(Li, Peng, He) Department of Anesthesiology, People's Hospital of Yilong
County, China
(Lin) Department of Anesthesiology, The General Hospital of Western
Theater Command Hospital, Chengdu, China
(Wen) Department of Anesthesiology, Traditional Chinese Medicine Hospital
of Nanchong, China
(Zhang) Department of Neurology, People's Hospital of Yilong County, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Pain after cardiac surgery is a common and severe
postoperative complication. As a new regional nerve block method,
ultrasound-guided parasternal block (PSB) has been increasingly used to
supplement the analgesic effects of opioids in order to eliminate
opioid-related adverse drug events, but its efficacy still remains
controversial. In the present meta-analysis, we aim to screen all eligible
randomized controlled trials (RCTs) and give a comprehensive summary of
the clinical value of PSB after adult cardiac surgery. EVIDENCE
ACQUISITION: We searched all RCTs about PSB after cardiac surgery in the
database of PubMed, Embase, Cochrane, CNKI and Wanfang with no limitation
of language from inception to September 2021. Two reviewers were
independently involved in the process of data extraction. Meta-analysis
was performed by using Review Manager software. The quality of included
RCTs were assessed by using Cochrane's risk of bias assessment tool, and
funnel plots were drawn to assess publication bias. EVIDENCE SYNTHESIS: A
total of 12 RCTs with 366 patients in PSB group and 364 patients in
control group were included in the present meta-analysis. Pooled analysis
revealed that intraoperative and postoperative consumption of sufentanil
were significantly decreased with the addition of PSB (P<0.05). Numerical
rating scale (NRS) scores in PSB group were found to be significantly
lower than that of control group at extubation, postoperative 4 h and 8 h
(P<0.05) instead of postoperative 24 h or longer. PSB could reduce the
incidence of postoperative nausea and vomiting (PONV) (P<0.05). In
addition, we demonstrated that PSB was significantly related to decreased
mechanical ventilation time, total length of ICU stay and hospital days
(P<0.05). CONCLUSION(S): Through decreasing the consumption of
opioids, ultrasound-guided PSB could relieve pain and limit opioid-related
complications. Clinical outcomes, such as mechanical ventilation time,
total length of ICU stay and hospital days, will also be improved. Our
findings prove that ultrasound-guided PSB is an effective regional
analgesic method after adult cardiac surgery.

<30>
Accession Number
2019418739
Title
Transcatheter edge-to-edge repair for acute mitral regurgitation with
cardiogenic shock secondary to mechanical complication.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2022. Date of
Publication: 2022.
Author
So C.-Y.; Kang G.; Lee J.C.; Frisoli T.M.; O'Neill B.; Wang D.D.; Eng
M.H.; O'Neill W.; Villablanca P.A.
Institution
(So, Kang, Lee, Frisoli, O'Neill, Wang, Eng, O'Neill, Villablanca) Center
for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, United
States
(So) Divison of Cardiology, Department of Medicine and Therapeutics,
Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR,
Hong Kong
Publisher
Elsevier Inc.
Abstract
Introduction: Acute MR due to mechanical mitral valve (MV) complications
frequently results in cardiogenic shock and requires emergency surgical
intervention. There was limited evidence for alternative treatment like
MitraClip for patients at prohibitive surgical risk. We aimed to study the
technical features and outcomes of emergency transcatheter edge-to-edge
repair (TEER) using the MitraClip system for patients with cardiogenic
shock (CS) secondary to acute mitral regurgitation (MR) and mechanical MV
complication. Material(s) and Method(s): We performed institutional
review and systemic literature review to identify all TEER for CS patients
due to acute mitral regurgitation and mechanical MV complication. Clinical
endpoints included device success rate assessed at the end of procedure,
ability to wean off MCS, all-cause and cardiovascular mortality at 30-day.
 Result(s): Eight patients were identified from institutional review.
Detail anatomical analysis found that patients with mechanical MV
complications related to myocardial infarction had a lower transseptal
height achieved during MitraClip (3.6 +/- 0.1 cm vs 4.3 +/- 0.3 cm, p =
0.03) than those not related. Pooled analysis for cases from institutional
review (n = 8) and systemic literature review (n = 16) was performed. The
device success rate was 68.8 %. Seventy-five percent (n = 18) cases
required mechanical circulatory support (MCS), and 94.4 % were able to
wean off MCS. At 30-day, the cardiovascular mortality was 4.5 % and the
all-cause mortality was 9.1 %. Conclusion(s): In CS patients due to
acute MR and mechanical MV complications, TEER with/without MCS was
feasible with a reasonable device success rate. Copyright © 2022
Elsevier Inc.

<31>
Accession Number
2017379553
Title
The Effect of Erythrocyte-Containing Donor Blood Components in the Priming
of the Cardiopulmonary Bypass Circuit on the Development of Systemic
Inflammation During Correction of Congenital Heart Defects in Children.
Source
Obshchaya Reanimatologiya. 18(3) (pp 30-37), 2022. Date of Publication:
2022.
Author
Borisenko D.V.; Ivkin A.A.; Shukevich D.L.; Kornelyuk R.A.
Institution
(Borisenko, Ivkin, Shukevich, Kornelyuk) Research Institute of Complex
Problems of Cardiovascular Disease, 6 Sosnovy bulvar, Kemerovo 650002,
Russian Federation
Publisher
V.A. Negovsky Research Institute of General Reanimatology
Abstract
Various pathological factors accompanying any cardiac surgery can cause
intraoperative systemic inflammatory responses (SIR). As the number of
cardiac surgical interventions grows worldwide, the issue of SIR
prevention appears highly relevant. Aim of the study. To determine the
effect of not using donor blood components in the priming of the
cardiopulmonary bypass circuit in children with septal congenital heart
defects, operated under cardiopulmonary bypass, on the severity of SIR.
Material and methods. A prospective, randomized study included 40 children
with a median age of 14 [12-22.5] months and weight of 8.8 [7.25-11] kg.
All patients underwent radical correction of septal defect under
cardiopulmonary bypass. The patients were divided into two groups
depending on the use of donor blood components for priming the CPB. The
severity of SIR was assessed using four specific serum biomarkers such as
interleukin 1b (IL-1b), interleukin 6 (IL-6), interleukin 10 (IL-10), and
tumor necrosis factor alpha (TNF-alpha), measured before the operation,
after the CPB and 16 hours after the surgery. In addition, the intra-and
postoperative periods were evaluated. Results. The safety of the proposed
strategy of skipping the donor blood was confirmed by lack of any organ
dysfunction in all patients, as well as a significant difference in the
balance of oxygen delivery and consumption. In addition, the levels of
systemic inflammation markers after CPB were significantly higher in
patients who had transfusion: IL-1b was 3.3 [3.2-3.48] pg/mL vs 2.86
[2.7-3.11] pg/mL (P=0.003) and TNF-alpha reached 1.81 [1.37-3.3] pg/mL vs
1.33 [1.26-1.76] pg/mL (P=0.034). Meanwhile, 16 hours post surgery, IL-6
and IL-10 levels were significantly higher in the group using donor blood
components with IL-6 being 48.91 [33.89-57.6] pg/mL vs 31.56 [26.83-48.89]
pg/mL (P=0.087) and IL-10 reaching 0.8 [0.76-1.43] pg/mL vs 0.69
[0.6-0.83] pg/mL (P=0.005). Conclusion. The study demonstrates and
confirms the safety and efficacy of cardiopulmonary bypass without using
donor blood components to reduce the severity of the systemic inflammatory
response in children undergoing correction of septal congenital heart
defects. Copyright © 2022, V.A. Negovsky Research Institute of
General Reanimatology. All rights reserved.

<32>
Accession Number
2017617684
Title
Prognostic Significance of Elevated Troponin in Adult Heart Transplant
Recipients: A Systematic Review and Meta-Analysis.
Source
Experimental and Clinical Transplantation. 20(7) (pp 633-641), 2022. Date
of Publication: 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, Australia
(Penny-Dimri, Smith) Department of Surgery, School of Clinical Sciences at
Monash Health, Monash University, Clayton, Australia
(Overmars) Infection and Immunity Theme, Murdoch Children's Research
Institute, Parkville, Australia
(Plummer) Department of Intensive Care Medicine, Royal Melbourne Hospital,
Parkville, Australia
(Plummer, Segal) Department of Critical Care, University of Melbourne,
Parkville, Australia
Publisher
Baskent University
Abstract
Objectives: Cardiac troponin is a highly specific biomarker of myocardial
injury that is of prognostic significance in a range of cardiovascular
diseases. However, the prognostic value of elevated troponin in cardiac
transplant recipients is uncertain. We aimed to evaluate the prognostic
value of elevated cardiac troponin in predicting adverse recipient
outcomes following heart transplant. Material(s) and Method(s): We
searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from
inception until December 2020 and included studies reporting associations
between elevated recipient troponin and outcomes after cardiac transplant.
We generated summary odds ratios for associations with short-and long-term
adverse events and used descriptive analyses where meta-analyses were
inappropriate. Result(s): We included 15 studies involving 1830
patients undergoing cardiac transplant. The risk of primary graft failure
was greater in recipients with elevated troponin than in those without
(odds ratio = 3.09; 95% CI, 1.08-8.87). Considerable interstudy
heterogeneity (I2 statistic 98%) was partially explained by variations in
study design, troponin subtype, and overall risk of bias. Descriptive
analyses suggested associations between elevated recipient troponin and
long-term adverse cardiac events, coronary artery disease, and mortality.
 Conclusion(s): Elevated cardiac troponin in cardiac transplant
recipients may be prognostic for primary graft failure, adverse cardiac
events, coronary artery disease, and mortality. Further high-quality,
prospective, and multicenter research is needed to demonstrate the
clinical applicability of these findings. Copyright © Baskent
University 2022.

<33>
Accession Number
2018369570
Title
Cardiac cephalalgia: a case series of four patients and updated literature
review.
Source
International Journal of Emergency Medicine. 15(1) (no pagination), 2022.
Article Number: 33. Date of Publication: December 2022.
Author
Kobata H.
Institution
(Kobata) Osaka Mishima Emergency Critical Care Center, 11-1
Minamiakutagawa-cho Takatsuki, Osaka 569-1124, Japan
Publisher
BioMed Central Ltd
Abstract
Background: Cardiac damage is common in patients with acute brain injury;
however, little is known regarding cardiac-induced neurological symptoms.
In the International Classification of Headache, Third Edition (ICHD-III),
cardiac cephalalgia is classified as a headache caused by impaired
homeostasis. Method(s): This report presents four patients with acute
myocardial infarction (AMI) who presented with headache that fulfilled the
ICHD-III diagnostic criteria for cardiac cephalalgia. A systematic review
of cardiac cephalalgia using the Preferred Reporting Items for Systematic
Reviews and Meta-analyses guidelines is also presented. Result(s):
Case 1: A 69-year-old man with a history of percutaneous coronary
intervention (PCI) developed sudden severe occipital pain, nausea, and
cold sweating. Coronary angiography (CAG) revealed occlusion of the right
coronary artery (RCA). Case 2: A 66-year-old woman complained of
increasing occipitalgia and chest discomfort while riding a bicycle. CAG
demonstrated 99% stenosis of the left anterior descending artery. Case 3:
A 54-year-old man presented with faintness, cold sweating, and
occipitalgia after eating lunch. CAG detected occlusion of the RCA. Case
4: A 72-year-old man went into shock after complaining of a sudden severe
headache and nausea. Vasopressors were initiated and emergency CAG was
performed, which detected three-vessel disease. In all four,
electrocardiography (ECG) showed ST segment elevation or depression and
echocardiography revealed a left ventricular wall motion abnormality. All
patients underwent PCI, which resulted in headache resolution after
successful coronary reperfusion. A total of 59 cases of cardiac
cephalalgia were reviewed, including the four reported here. Although the
typical manifestation of cardiac cephalalgia is migraine-like pain on
exertion, it may present with thunderclap headache without a trigger or
chest symptoms, mimicking subarachnoid hemorrhage. ECG may not always show
an abnormality. Headaches resolve after successful coronary reperfusion.
 Conclusion(s): Cardiac cephalalgia resulting from AMI can present
with or without chest discomfort and even mimic the classic thunderclap
headache associated with SAH. It should be recognized as a neurological
emergency and treated without delay. Copyright © 2022, The
Author(s).

<34>
Accession Number
2018356562
Title
Effect of electrophysiological mapping on non-transmural annulus ablation
and atrial fibrillation recurrence prediction after 6 months of Cox-Maze
IV procedure.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 931845. Date of Publication: 15 Jul 2022.
Author
Sun Z.; Fan C.; Song L.; Zhang H.; Jiang Z.; Tan H.; Sun Y.; Liu L.
Institution
(Sun, Fan, Song, Zhang, Jiang, Tan, Sun, Liu) Department of Cardiovascular
Surgery, The Second Xiangya Hospital, Central South University, Changsha,
China
Publisher
Frontiers Media S.A.
Abstract
Objective: The objective of this study was to observe the safety and
efficacy of electrophysiological mapping following the Cox-Maze IV
procedure and to investigate whether a correlation exists between
recurrence of atrial fibrillation (AF) with the completeness of
bidirectional electrical isolation and the inducibility of AF immediately
after the Cox-Maze IV procedure. Method(s): Totally, 80 consecutive
patients who suffered from aortic valve or mitral valve disease and
persistent AF were randomly enrolled into the control group and
electrophysiological mapping following the Cox-Maze IV group
(Electrophysio-Maze group). In the Electrophysio-Maze group, patients
underwent concomitant Cox-Maze procedure and following
electrophysiological mapping of ablation lines in mitral isthmus, left
atrial "box," and tricuspid annulus. If the bidirectional electrical
isolation of tricuspid annulus ablation line is incomplete, whether to
implement supplementary ablation will be independently decided by the
operator. Before and after the Cox-Maze IV procedure, AF induction was
performed. All patients in both groups were continuously followed-up and
underwent electrocardiogram Holter monitoring after 6 months.
 Result(s): In total, 42 Electrophysio-Maze patients and 38 controls
were enrolled. Compared with patients in the control group, there were
shorter hospital stay, better cardiac remodeling changes, and higher
relief from AF during the follow-up period of 6 months in the
Electrophysio-Maze group. Within the Electrophysio-Maze group, the rate of
incomplete the bidirectional electrical isolation of "box" ablation lines
was zero, and the rate of incomplete bidirectional electrical isolation of
mitral isthmus ablation line or tricuspid annulus ablation line was 23.8%.
After two cases of successful complementary ablation on the tricuspid
annulus ablation line, the final incomplete bidirectional electrical
isolation of annulus ablation lines was 19.0%. There were correlations
between late AF recurrence after 6 months with incomplete bidirectional
electrical isolation of annulus ablation lines and AF induction
immediately after the Cox-Maze IV procedure. Conclusion(s):
Electrophysiological mapping following the Cox-Maze procedure is safe and
effective. Electrophysiological mapping in the Cox-Maze procedure can find
out the non-transmural annulus ablation lines by assessing the
completeness of bidirectional electrical isolation of ablation lines,
guide supplementary ablation, and predict AF recurrence after 6
months. Copyright © 2022 Sun, Fan, Song, Zhang, Jiang, Tan, Sun
and Liu.

<35>
Accession Number
2018314018
Title
Surgical Strategies for Preservation of Pulmonary Valve Function in a
Radical Operation for Tetralogy of Fallot: A Systematic Review and
Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 888258. Date of Publication: 13 Jul 2022.
Author
Yi K.; Wang D.; Xu J.; Zhang X.; Gao J.; Wang W.; You T.; Tian J.
Institution
(Yi, Xu, Tian) Evidence-Based Medicine Center, School of Basic Medical
Sciences, Lanzhou University, Lanzhou, China
(Yi, You) Department of Cardiovascular Surgery, Gansu Provincial Hospital,
Lanzhou, China
(Yi, Zhang, Wang, Gao, Wang, You, Tian) Gansu International Scientific and
Technological Cooperation Base of Diagnosis and Treatment of Congenital
Heart Disease, Lanzhou, China
(Wang) Department of Geriatric Medicine, Xiangya Hospital, Central South
University, Changsha, China
(Zhang, Wang) The First School of Clinical Medicine, Gansu University of
Chinese Medicine, Lanzhou, China
(Gao, Wang) The First Clinical Medical College, Lanzhou University,
Lanzhou, China
(Tian) Key Laboratory of Evidence Based Medicine and Knowledge Translation
of Gansu Province, Lanzhou University, Lanzhou, China
Publisher
Frontiers Media S.A.
Abstract
Objective: To evaluate the efficacy and safety of different surgical
strategies to preserve pulmonary valve function. Surgical procedures
evaluated include intraoperative balloon pulmonary valvuloplasty (IBPV),
pulmonary valve reconstruction, and commissurotomy and pulmonary cusp
augmentation (PCA) in patients who underwent a radical operation for
Tetralogy of Fallot (ToF). Material(s) and Method(s): The five
databases searched in the current study included the Cochrane Library,
PubMed, China National Knowledge Infrastructure, VIP, and WanFang data. A
systematic search for control trials was performed in each database from
the start date of each database until December 2021. The Newcastle-Ottawa
Scale (NOS) was used to evaluate the quality of included studies.
 Result(s): A total of 15 retrospective studies with a total number of
1,396 participants were included in this study. In subgroup 1 (IBPV vs.
TAP), patients undergoing IBPV had a less degree of regurgitation at 1-2
years after the surgery. The reintervention rate increased in the IBPV
group at 5 years. In subgroup 2 (pulmonary valve reconstruction vs. TAP),
the degree of regurgitation decreased in the pulmonary valve
reconstruction group at 1 month after the surgery. In subgroup 3
(valve-sparing operation vs. TAP), the comparison demonstrated decreased
rates for surgical mortality and reintervention at 5-10 years after the
surgery. Conclusion(s): We proposed that pulmonary valve function in
a radical operation for ToF was preserved. IBPV, pulmonary valve
reconstruction, and commissurotomy and PCA can be performed during the
surgical procedure based on the developmental status and anatomical
characteristics of the right ventricular outflow tract (RVOT), pulmonary
valve, and pulmonary artery. Systematic Review Registration:
[https://www.crd.york.ac.uk/prospero/], identifier
[CRD42022300987]. Copyright © 2022 Yi, Wang, Xu, Zhang, Wang,
Gao, Wang, You and Tian.

<36>
Accession Number
2018314011
Title
High-Energy Enteral Nutrition in Infants After Complex Congenital Heart
Surgery.
Source
Frontiers in Pediatrics. 10 (no pagination), 2022. Article Number: 869415.
Date of Publication: 13 Jul 2022.
Author
Ni P.; Chen X.; Zhang Y.; Zhang M.; Xu Z.; Luo W.
Institution
(Ni, Chen, Zhang, Zhang, Xu) Department of Thoracic and Cardiovascular
Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai
Jiao Tong University, Shanghai, China
(Luo) Nursing Department, Shanghai Children's Medical Center, School of
Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
Frontiers Media S.A.
Abstract
Background: Malnutrition is common in complex congenital heart disease
(CCHD). The purpose of this study was to compare the safety and efficacy
of early initiation of high-energy enteral nutrition (EN) with regular
energy EN in infants after surgery for CCHD. Method(s): This is a
subgroup analysis of a randomized controlled trial (RCT) which was
conducted in the cardiac intensive care unit (CICU) of the largest
pediatric heart center in China. Eighty children with CCHD after surgery
were from two groups, the intervention group (n = 40) was given
high-energy EN and the control group (n = 40) was given regular energy EN.
We analyzed the effects of the two interventions on outcomes such as
caloric attainment rate, gastrointestinal intolerance, duration of
mechanical ventilation, and anthropometry at discharge. Result(s):
There was no difference in the daily milk intake between the two groups,
but the calorie intake (50.2 vs. 33.4, P < 0.001), protein intake (1.1 vs.
0.9, P < 0.001) and caloric attainment rate were higher in the
intervention group (77.5 vs. 45.0%, P = 0.003). In addition, the incidence
of pneumonia (P = 0.003) and duration of mechanical ventilation (P =
0.008) were less in the intervention group, and biceps circumference and
triceps skinfold thickness at hospital discharge were greater than those
in the control group (P < 0.001). We have not found statistical
differences in gastrointestinal intolerance, glycemic fluctuations,
incidence of pressure ulcers, length of CICU stay and postoperative
hospital days between the two groups. Conclusion(s): Early initiation
of high-energy EN may be safe and effective in infants after complex
cardiac surgery. Low doses high-energy EN did not increase
gastrointestinal intolerance or glycemic fluctuations and also improved
post-operative nutrition by increasing caloric and protein intake without
increasing fluid intake. Copyright © 2022 Ni, Chen, Zhang, Zhang,
Xu and Luo.

<37>
Accession Number
2019504861
Title
The physiological insight of Coenzyme-Q10 administration in preventing the
incidence of reperfusion arrhythmia among patients undergoing coronary
artery bypass grafting surgery.
Source
Journal of Basic and Clinical Physiology and Pharmacology. (no
pagination), 2022. Date of Publication: 2022.
Author
Wardhani L.F.K.; Dewi I.P.; Putra K.N.S.; Andrianto A.; Soemantri D.
Institution
(Wardhani, Dewi, Putra, Andrianto, Soemantri) Faculty of Medicine,
Airlangga University, Surabaya, Indonesia
(Wardhani, Dewi, Putra, Andrianto, Soemantri) Department of Cardiology and
Vascular Medicine, Dr. Soetomo General Hospital, Surabaya, Indonesia
(Dewi) Faculty of Medicine, Duta Wacana Christian University, Yogyakarta,
Indonesia
Publisher
De Gruyter Open Ltd
Abstract
Reperfusion arrhythmia following cardiac surgery has long been studied as
part of myocardial damage. Reperfusion injury is thought to be exacerbated
by oxygen-free radicals, whereas arrhythmogenic oscillations in membrane
potential are mediated by reactive oxygen. Coenzyme Q10 is a lipid-soluble
antioxidant that inhibits lipid peroxidation in biological membranes and
supplies ATP cell synthesis, required as the organism's primary energy
source. This process explains how Coenzyme Q10 helps stabilize membranes
and avoids critical metabolite depletion that may relate to reperfusion
arrhythmia. There is a reduction of iatrogenic Coenzyme Q10 after coronary
artery bypass surgery (CABG). On the other hand, there is an increased
inflammatory process and cellular demand post CABG procedure. It leads to
ischemia that can be manifested as arrhythmia. Reperfusion arrhythmia was
less common in patients who took Coenzyme Q10. These findings suggest that
Coenzyme Q10 supplementation might help patients with heart surgery avoid
reperfusion arrhythmia. However, a higher-quality randomized controlled
study is needed to determine the effect of Coenzyme Q10 in preventing
reperfusion arrhythmia in cardiac surgery patients. Copyright ©
2022 Walter de Gruyter GmbH, Berlin/Boston 2022.

<38>
Accession Number
2019495186
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: 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, Park-Hansen, Clausen, Norskov, Dominguez) Department of
Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg,
Copenhagen, Denmark
(Madsen, Clausen, Norskov, Dominguez) Department of Biomedical Science,
University of Copenhagen, Copenhagen, Denmark
(Holme, Carranza) Department of Cardio-Thoracic Surgery, Copenhagen
University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
(Irmukhamedov) Department of Heart, Lung, and 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
W.B. Saunders
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
left atrial appendage closure by surgery (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 (standard deviation (SD)) age was 68 (9)
years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation.
Median [interquartile range (IQR)] CHA<inf>2</inf>DS<inf>2</inf>-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 9 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. Copyright © 2022 The Author(s)

<39>
Accession Number
638608073
Title
Evaluating the utility of colchicine in acute coronary syndrome: A
systematic review and meta-analysis.
Source
Journal of cardiovascular pharmacology. (no pagination), 2022. Date of
Publication: 22 Jun 2022.
Author
Bao Y.-L.; Gu L.-F.; Du C.; Wang Y.-X.; Wang L.-S.
Institution
(Bao) Department of Cardiology, First Affiliated Hospital of Nanjing
Medical University, Nanjing 210029, China
Publisher
NLM (Medline)
Abstract
ABSTRACT: Colchicine has demonstrated promising effects in inhibiting
local and systemic inflammation during acute coronary syndrome (ACS).
However, the efficacy of colchicine in ACS is controversial. We performed
a meta-analysis to assess the utility of colchicine in ACS by
systematically searching randomized controlled trials (RCT). Recurrent
myocardial infarction (MI), coronary revascularization, and stroke were
included as efficacy endpoints parameters whereas safety endpoints chosen
were all-cause mortality, cardiovascular mortality, infectious events, and
gastrointestinal (GI) adverse events. Nine identified studies were
included (n = 7207 participants). Colchicine may reduce the risk of
coronary revascularization by 54% [relative risk (RR) 0.46, 95% confidence
interval (CI) 0.29-0.73; P < 0.01] and stroke by 61% (RR 0.39, 95%CI
0.18-0.81; P = 0.01). We observed no significant difference in all-cause
mortality (RR 1.25, 95%CI 0.70-2.24; P = 0.46), cardiovascular mortality
(RR 0.99, 95%CI 0.58-1.69; P = 0.98), recurrent MI (RR 0.75, 95%CI
0.49-1.14; P = 0.18), and infectious events (RR 0.67, 95%CI 0.08-5.52; P =
0.71). Colchicine increased the risk of GI adverse reactions (RR 1.89,
95%CI 1.25-2.84; P < 0.01). Subgroup analysis of loading doses did not
reveal significant differences in all endpoints (all P > 0.05), while
subgroup analysis of follow-up periods showed a lower risk of GI adverse
reactions with longer follow-up (P < 0.01), which may be related to
establishing tolerability. Trial sequential analysis (TSA) suggested that
further data was needed before definitive conclusions can be drawn.
Colchicine may decrease the occurrence of stroke and revascularization in
ACS whereas slightly increasing the risk of GI reactions. The loading
doses probably did not significantly improve the prognosis of
patients. Copyright © 2022 Wolters Kluwer Health, Inc. All rights
reserved.

<40>
Accession Number
2013803367
Title
A pilot randomized clinical trial of cryopreserved versus liquid-stored
platelet transfusion for bleeding in cardiac surgery: The cryopreserved
versus liquid platelet-New Zealand pilot trial.
Source
Vox Sanguinis. 117(3) (pp 337-345), 2022. Date of Publication: March 2022.
Author
McGuinness S.; Charlewood R.; Gilder E.; Parke R.; Hayes K.; Morley S.;
Al-Ibousi A.; Deans R.; Howe B.; Johnson L.; Marks D.C.; Reade M.C.
Institution
(McGuinness, Gilder, Parke) Cardiothoracic and Vascular Intensive Care
Unit, Auckland City Hospital, Auckland, New Zealand
(McGuinness, Parke) Medical Research Institute of New Zealand, Wellington,
New Zealand
(McGuinness, Parke, Howe, Reade) Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Charlewood, Morley, Al-Ibousi) New Zealand Blood Service, Auckland, New
Zealand
(Gilder, Parke) School of Nursing, The University of Auckland, Auckland,
New Zealand
(Hayes) Greenlane Department of Cardiothoracic Anaesthesia, Auckland City
Hospital, Auckland, New Zealand
(Deans, Reade) Faculty of Medicine, University of Queensland, Royal
Brisbane and Women's Hospital, Herston, QLD, Australia
(Johnson, Marks) Australian Red Cross Lifeblood, Alexandria, NSW,
Australia
(Reade) Joint Health Command, Australian Defence Force, Canberra, ACT,
Australia
Publisher
John Wiley and Sons Inc
Abstract
Background and Objectives: Platelets for transfusion have a shelf-life of
7 days, limiting availability and leading to wastage. Cryopreservation at
-80degreeC extends shelf-life to at least 1 year, but safety and
effectiveness are uncertain. Material(s) and Method(s): This single
centre blinded pilot trial enrolled adult cardiac surgery patients who
were at high risk of platelet transfusion. If treating clinicians
determined platelet transfusion was required, up to three units of either
cryopreserved or liquid-stored platelets intraoperatively or during
intensive care unit admission were administered. The primary outcome was
protocol safety and feasibility. Result(s): Over 13 months, 89
patients were randomized, 23 (25.8%) of whom received a platelet
transfusion. There were no differences in median blood loss up to 48 h
between study groups, or in the quantities of study platelets or other
blood components transfused. The median platelet concentration on the day
after surgery was lower in the cryopreserved platelet group (122 x
103/mul vs. 157 x 103/mul, median difference 39.5
x103/mul, p = 0.03). There were no differences in any of the
recorded safety outcomes, and no adverse events were reported on any
patient. Multivariable adjustment for imbalances in baseline patient
characteristics did not find study group to be a predictor of 24-h blood
loss, red cell transfusion or a composite bleeding outcome.
 Conclusion(s): This pilot randomized controlled trial demonstrated
the feasibility of the protocol and adds to accumulating data supporting
the safety of this intervention. Given the clear advantage of prolonged
shelf-life, particularly for regional hospitals in New Zealand, a
definitive non-inferiority phase III trial is warranted. Copyright
© 2021 International Society of Blood Transfusion.

<41>
Accession Number
638446292
Title
Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days
in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC
Randomized Clinical Trial.
Source
JAMA. 328(1) (pp 38-47), 2022. Date of Publication: 05 Jul 2022.
Author
Schlapbach L.J.; Gibbons K.S.; Horton S.B.; Johnson K.; Long D.A.; Buckley
D.H.F.; Erickson S.; Festa M.; D'Udekem Y.; Alphonso N.; Winlaw D.S.;
Delzoppo C.; Van Loon K.; Jones M.; Young P.J.; Butt W.; Schibler A.
Institution
(Schlapbach, Gibbons, Johnson, Long, Alphonso) Child Health Research
Centre, The 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, And 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, 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, 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, The Children's Hospital at Westmead,
Westmead, NSW, Australia
(Winlaw) Sydney Children's Hospital Network, 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) The 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
American Medical Association
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. Copyright © 2022 American
Medical Association. All rights reserved.

<42>
Accession Number
2015452219
Title
Endovascular treatment of ischemic stroke due to isolated internal carotid
artery occlusion: ETIS registry data analysis.
Source
Journal of Neurology. 269(8) (pp 4383-4395), 2022. Date of Publication:
August 2022.
Author
ter Schiphorst A.; Peres R.; Dargazanli C.; Blanc R.; Gory B.; Richard S.;
Marnat G.; Sibon I.; Bourcier R.; Denier C.; Spelle L.; Labreuche J.;
Consoli A.; Lapergue B.; Costalat V.; Arquizan C.; Gascou G.; Lefevre
P.-H.; Derraz I.; Riquelme C.; Gaillard N.; Mourand I.; Corti L.; Cagnazzo
F.; Wang A.; Evrard S.; Maya.Tchikviladze; Ajili N.; Weisenburger-Lile D.;
Gorza L.; Buard G.; Coskun O.; Di Maria F.; Rodesh G.; Zimatore S.; Leguen
M.; Gratieux J.; Pico F.; Rakotoharinandrasana H.; Tassan P.; Poll R.;
Marinier S.; Bracard S.; Anxionnat R.; Braun M.; Derelle A.-L.; Tonnelet
R.; Liao L.; Zhu F.; Schmitt E.; Planel S.; Humbertjean L.; Mione G.;
Lacour J.-C.; Riou-Comte N.; Audibert G.; Voicu M.; Alb L.; Reitter M.;
Brezeanu M.; Masson A.; Tabarna A.; Podar I.; Gariel F.; Barreau X.; Berge
J.; Veunac L.; Menegon P.; Lucas L.; Olindo S.; Renou P.; Sagnier S.; Poli
M.; Debruxelles S.; Rouanet F.; Tourdias T.; Liegey J.-S.; Briau P.;
Pangon N.; Detraz L.; Daumas-Duport B.; Alexandre P.-L.; Roy M.; Lenoble
C.; Desal H.; Guillon B.; de Gaalon S.; Preterre C.; Piotin M.; Redjem H.;
Escalard S.; Desilles J.-P.; Delvoye F.; Smajda S.; Maier B.;
SoleneHebert; Mazighi M.; Obadia M.; Sabben C.; Seners P.; Raynouard I.;
Corabianu O.; de Broucker T.; Manchon E.; Taylor G.; Maacha M.B.;
Laurie-Anne T.; Augustin L.; Julien S.; Chalumeau V.; Caroff J.; Chassin
O.; Venditti L.
Institution
(ter Schiphorst, Arquizan) Department of Neurology, CHRU Gui de Chauliac,
University Hospital of Montpellier, 80 Avenue Augustin Fliche, Montpellier
34295, France
(Peres, Obadia) Department of Neurology, Fondation Rothschild Hospital,
Paris, France
(Dargazanli, Costalat) Department of Interventional Neuroradiology, CHRU
Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
(Blanc) Department of Interventional Neuroradiology, Fondation Rothschild
Hospital, Paris, France
(Gory) Department of Diagnostic and Therapeutic Neuroradiology, INSERM
U1254, Universite de Lorraine, CHRU-Nancy, Nancy 54000, France
(Richard) Department of Neurology, Stroke Unit, INSERM U1116, Nancy 54000,
France
(Marnat) Department of Diagnostic and Interventional Neuroradiology,
University Hospital of Bordeaux, Bordeaux, France
(Sibon) Department of Neurology, Stroke Center, University Hospital of
Bordeaux, Bordeaux, France
(Guillon) Department of Neurology, University Hospital of Nantes, Nantes,
France
(Bourcier) Department of Neuroradiology, University Hospital of Nantes,
Nantes, France
(Denier) Department of Neurology, CHU Bicetre, Le Kremlin Bicetre, France
(Spelle) Department of Interventional Neuroradiology, CHU Bicetre, Le
Kremlin Bicetre, France
(Labreuche) ULR 2694-METRICS: Evaluation des Technologies de Sante et des
Pratiques Medicales, Universite de Lille, CHU Lille, Lille 59000, France
(Consoli) Department of Neuroradiology, Foch Hospital, Suresnes, France
(Lapergue) Department of Neurology, Foch Hospital, Suresnes, France
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The best treatment for acute ischemic stroke (AIS) due to
isolated cervical internal carotid artery occlusion (CICAO) (i.e., without
associated occlusion of the circle of Willis) is still unknown. In this
study, we aimed to describe EVT safety and clinical outcome in patients
with CICAO. Method(s): We analyzed data of all consecutive patients,
included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry
between 2013 and 2020, who presented AIS and proven CICAO on angiogram and
underwent EVT. We assessed carotid recanalization, procedural
complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h
post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS <= 2
or equal to the pre-stroke value). Result(s): Forty-five patients
were included (median age: 70 years; range: 62-82 years). The median NIHSS
before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%)
patients. Carotid recanalization at procedure end and on control imaging
was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1
post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12
(29%) patients had early neurologic deterioration (NIHSS >= 4 points). The
rate of procedural complications was 36%, including stent thrombosis (n =
7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage
(n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10
(22%) were dead. Conclusion(s): Our study suggests that EVT in AIS
patients with moderate/severe initial deficit due to CICAO led to high
rate of recanalization at day 1, and a 40% rate of favorable outcome at 3
months. There was a high rate of procedural complication which is of
concern. Randomized controlled trials assessing the superiority of EVT in
patients with CICAO and severe deficits are needed. Copyright ©
2022, The Author(s), under exclusive licence to Springer-Verlag GmbH
Germany.

<43>
Accession Number
2014948489
Title
High-speed rotational atherectomy in coronary artery calcification: The
randomized ROTAXUS and PREPARE-CALC trials.
Source
Catheterization and Cardiovascular Interventions. 100(1) (pp 61-71), 2022.
Date of Publication: July 1, 2022.
Author
Liang B.; Gu N.
Institution
(Liang) Nanjing University of Chinese Medicine, Nanjing, China
(Gu) Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University
of Chinese Medicine, Nanjing, China
Publisher
John Wiley and Sons Inc
Abstract
Background: The clinical outcomes of high-speed rotational atherectomy
(RA) to optimize target lesion preparation in coronary artery
calcification (CAC) have been examined in several trials. Aim(s):
This study was conducted to evaluate the safety and efficacy of RA for
CAC. Method(s): Patient data were pooled from ROTAXUS and
PREPARE-CALC. The primary endpoint was the in-stent late lumen loss and
major adverse cardiac events at 9 months. Secondary endpoints included
in-segment late lumen loss, binary restenosis, strategy success,
procedural duration, and contrast amount. Result(s): Four hundred and
forty patients were enrolled from Germany in this study, 220 patients were
randomized to the RA group and 220 patients were randomized to the Control
group. Despite similar baseline characteristics, significantly more
patients in the Control group were crossover (14.1% vs. 2.3%, p < 0.0001),
resulting in higher strategy success in the RA group (95.0% vs. 82.3%, p <
0.0001). At 9 months, in-stent late lumen loss was higher in the RA group
(0.34 +/- 0.52 mm vs. 0.24 +/- 0.47 mm, p = 0.03) and procedural duration
was longer in the RA group (76.3 +/- 41.8 min vs. 67.0 +/- 38.8 min, p =
0.02). major adverse cardiac events (17.8% vs. 25.2%, p = 0.06),
in-segment late lumen loss (0.28 +/- 0.66 mm vs. 0.17 +/- 0.55 mm, p =
0.05), binary restenosis (7.3% vs. 8.2%, p = 0.71 in-stent; 7.7% vs. 9.0%,
p = 0.62 in-segment), and contrast amount (215.5 +/- 112.5 ml vs. 203.7
+/- 96.5 ml, p = 0.24) were similar in both groups. Conclusion(s):
Lesion preparation with upfront RA before drug-eluting stent implantation
is feasible in CAC, is more strategy successful, and is associated with
excessive in-stent late lumen loss and excellent clinical outcomes at 9
months although longer procedural duration. Copyright © 2022
Wiley Periodicals LLC.

<44>
[Use Link to view the full text]
Accession Number
2019315146
Title
Cost-Effectiveness of Percutaneous Coronary Intervention Versus Bypass
Surgery for Patients with Left Main Disease: Results from the EXCEL Trial.
Source
Circulation: Cardiovascular Interventions. 15(7) (pp E011981), 2022. Date
of Publication: 01 Jul 2022.
Author
Magnuson E.A.; Chinnakondepalli K.; Vilain K.; Serruys P.W.; Sabik J.F.;
Kappetein A.P.; Stone G.W.; Cohen D.J.
Institution
(Magnuson, Chinnakondepalli, Vilain) Saint Luke's Mid America Heart
Institute, Kansas City, MO, United States
(Magnuson) University of Missouri, Kansas City, United States
(Serruys) National Heart and Lung Institute, Imperial College London,
United Kingdom
(Sabik) Department of Surgery, University Hospitals, Cleveland Medical
Center, OH, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University,
Medical Center, Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone, Cohen) Cardiovascular Research Foundation, New York, NY, United
States
(Cohen) Saint Francis Hospital, Heart Center, Roslyn, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The EXCEL trial (Evaluation of XIENCE Versus Coronary Artery
Bypass Surgery for Effectiveness of Left Main Revascularization)
demonstrated in patients with left main coronary artery disease, no
significant difference between coronary artery bypass graft surgery (CABG)
and percutaneous coronary intervention (PCI) with everolimus-eluting
stents for the composite end point of death, stroke, or myocardial
infarction at 5 years. However, all-cause mortality at 5 years was higher
with PCI. Long-term cost-effectiveness of these 2 strategies has
heretofore not been evaluated. Method(s): From 2010 to 2014, 1905
patients with left main coronary artery disease were randomized to CABG
(n=957) or PCI (n=948). Costs ($2019) were assessed over 5 years using
resource-based costing and Medicare reimbursement rates. Health utilities
were assessed using the EuroQOL 5-dimension questionnaire. Five-year EXCEL
data in combination with US lifetables were used to develop a Markov model
to evaluate lifetime cost-effectiveness. An incremental cost-effectiveness
ratio <$50 000 per quality-adjusted life year (QALY) gained was considered
highly cost-effective. Result(s): Index revascularization procedure
costs were $4,850/patient higher with CABG, and total costs for the index
hospitalization were $17 610/patient higher with CABG ($32 297 versus $19
687, P<0.001). Cumulative 5-year costs were $20 449/patient higher with
CABG. CABG was projected to increase lifetime costs by $21 551 while
increasing quality-adjusted life expectancy by 0.49 QALYs, yielding an
incremental cost-effectiveness ratio of $44 235/QALY. In a post hoc
sensitivity analysis using mortality hazard ratios from a meta-analysis of
all randomized CABG versus PCI in left main disease trials, the gain
associated with CABG was 0.08 to 0.14 QALYs, resulting in an incremental
cost-effectiveness ratio of $139 775 to $232 710/QALY gained.
 Conclusion(s): Based on data from the EXCEL trial, CABG is an
economically attractive revascularization strategy compared with PCI over
a lifetime horizon for patients with significant left main coronary artery
disease. However, this conclusion is sensitive to the long-term mortality
rates with the 2 strategies, and CABG is no longer highly cost-effective
when substituting the pooled treatment effect from the 4 major PCI versus
CABG trials for left main disease. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT01205776. Copyright © 2022 Lippincott Williams and Wilkins.
All rights reserved.

<45>
Accession Number
2018690753
Title
Prognostic value of pre-interventional cerebral oxygen saturation in
transcatheter aortic valve replacement: a prespecified secondary analysis
of the SOLVE-TAVI trial.
Source
British Journal of Anaesthesia. 129(2) (pp e35-e37), 2022. Date of
Publication: August 2022.
Author
Heringlake M.; Berggreen A.E.; Baumgartel R.; Kurz T.; Vigelius-Rauch U.;
Treskatsch S.; Ender J.; de Waha-Thiele S.; Desch S.; Thiele H.;
Feistritzer H.-J.; Stachel G.; Hartung P.; Lurz P.; Eitel I.; Marquetand
C.; Nef H.; Doerr O.; Lauten A.; Landmesser U.; Abdel-Wahab M.; Sandri M.;
Holzhey D.; Borger M.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.;
Fach A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.;
Funkat A.-K.
Institution
(Heringlake, Berggreen, Baumgartel) Department of Anaesthesiology and
Intensive Care Medicine, Heart and Diabetes Center, Karlsburg Hospital,
Mecklenburg-Western Pomerania, Karlsburg, Germany
(Kurz) Department of Cardiology, University Clinic Schleswig-Holstein and
University Heart Center Lubeck, Lubeck, Germany
(Vigelius-Rauch) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Marburg/Giesen, Giesen, Germany
(Treskatsch) Charite - Universitatsmedizin Berlin, Corporate Member of
Freie Universitat and Humboldt Universitat zu Berlin, Department of
Anesthesiology and Intensive Care Medicine, Charite Campus Benjamin
Franklin, Berlin, Germany
(Ender) Department of Anaesthesiology, Heart Center Leipzig at University
of Leipzig, Leipzig, Germany
(de Waha-Thiele) Department of Cardiac Surgery, Heart Center Leipzig at
University of Leipzig, Leipzig, Germany
(Desch, Thiele) Department of Cardiology, Heart Center Leipzig at
University of Leipzig, Leipzig, Germany
Publisher
Elsevier Ltd

<46>
Accession Number
2017718153
Title
Meta-Analysis of Randomized Trials Comparing Distal Transradial Versus
Conventional Transradial Approach for Coronary Procedures.
Source
American Journal of Cardiology. 173 (pp 147-149), 2022. Date of
Publication: 15 Jun 2022.
Author
Elbadawi A.; Elgendy I.Y.; Jia X.; Hamed M.; Shnoda M.; Eid M.; Rahman F.;
Khalid U.; Paniagua D.; Jneid H.
Institution
(Elbadawi, Jia, Rahman, Khalid, Paniagua, Jneid) Section of Cardiology,
Baylor College of Medicine, Texas, Houston
(Elgendy) Department of Medicine, Weill Cornell Medicine-Qatar, Doha,
Qatar
(Hamed) Division of Internal Medicine, Florida Atlantic University, Boca
Raton, Florida, United States
(Shnoda) Department of Internal Medicine, Allegheny General Hospital,
PittsburghPennsylvania
(Eid) Department of Internal Medicine, Lincoln Medical Center, New York,
New York, United States
Publisher
Elsevier Inc.

<47>
Accession Number
2014191667
Title
Characterisation of lesions undergoing ischaemia-driven revascularisation
after complete revascularisation versus culprit lesion only in patients
with STEMI and multivessel disease: A DANAMI-3-PRIMULTI substudy.
Source
EuroIntervention. 15(2) (pp 172-179), 2019. Date of Publication: June
2019.
Author
De Backer O.; Lonborg J.; Helqvist S.; Warnoe J.; Klovgaard L.; Holmvang
L.; Pedersen F.; Tilsted H.-H.; Raungaard B.; Jorgensen E.; Kober L.;
Hofsten D.E.; Kelbaek H.; Engstrom T.
Institution
(De Backer, Lonborg, Helqvist, Warnoe, Klovgaard, Holmvang, Pedersen,
Tilsted, Jorgensen, Kober, Hofsten, Engstrom) The Heart Center,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Tilsted, Raungaard) Department of Cardiology, Aalborg University
Hospital, Aalborg, Denmark
(Kelbaek) Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
Publisher
Europa Group
Abstract
Aims: Treatment of the infarct-related artery only (IRA only) in
ST-segment elevation myocardial infarction (STEMI) is associated with a
significantly higher rate of ischaemia-driven revascularisation (ID-RV)
during follow-up than fractional flow reserve-guided complete
revascularisation (FFR-CRV). This study aimed to characterise all lesions
which underwent ID-RV in the DANAMI-3-PRIMULTI trial with respect to
location, stenosis grade and functional significance. Methods and
Results: The study included 627 patients with STEMI and multivessel
disease; 313 patients were randomised to treatment of the IRA only versus
314 undergoing staged FFR-CRV during the index admission. Rates of
admission for suspected cardiac ischaemia (17%) were similar in both
groups; however, ID-RV was significantly less frequent in the FFR-CRV
group than in the IRA-only group (5% vs. 17%; p<0.001). In both groups,
the primary reason for ID-RV was related to non-culprit, non-treated
lesions (N=71/82 lesions in IRA-only; N=13/26 in FFR-CRV). De novo lesions
or revascularisation of previously treated lesions were rarely causes of
ID-RV. In the IRA-only group, there was a trend towards a higher ID-RV
rate for lesions with a higher stenosis grade and located in more proximal
segments - in particular, >=80% stenosis of the left anterior descending
and right coronary artery also led to angina class IV/ unstable angina. In
the FFR-CRV group, an FFR value <=0.80 was shown to be an appropriate
threshold for revascularisation. Conclusion(s): FFR-CRV in STEMI is
associated with a significantly lower rate of ID-RV at follow-up than
treatment of the IRA only. This is due to a difference in non-culprit,
non-treated lesions between both groups and not in de novo lesions or
repeat revascularisation of previously treated lesions. Further
considerations are warranted in case of high-grade non-culprit stenosis at
proximal coronary segments, borderline FFR values and/or anticipated
complex PCI. Copyright © Europa Digital & Publishing 2019.

<48>
Accession Number
2018851232
Title
The Effects of Targeted Changes in Systemic Blood Flow and Mean Arterial
Pressure on Urine Oximetry During Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(9) (pp 3551-3560),
2022. Date of Publication: September 2022.
Author
Hu R.; Yanase F.; McCall P.; Evans R.; Raman J.; Bellomo R.
Institution
(Hu, McCall) Department of Anaesthesia, Austin Health, Heidelberg, VIC,
Australia
(Hu, McCall) Department of Critical Care, Melbourne Medical School, The
University of Melbourne, VIC, Australia
(Yanase, Bellomo) Department of Intensive care unit, Austin Health,
Heidelberg, VIC, Australia
(Yanase) Australian and New Zealand Intensive Care Research Centre, Monash
University, Melbourne, VIC, Australia
(Evans) Cardiovascular Disease Program, Biomedicine Discovery Institute
and Department of Physiology, Monash University, Melbourne, VIC, Australia
(Evans) Pre-clinical Critical Care Unit, Florey Institute of Neuroscience
and Mental Health, University of Melbourne, Melbourne, VIC, Australia
(Raman) Department of Cardiac Surgery, St. Vincent's Hospital & Austin
Health, Melbourne, VIC, Australia
(Raman) Department of Surgery, University of Melbourne, Melbourne, VIC,
Australia
Publisher
W.B. Saunders
Abstract
Objectives: Poor medullary oxygenation is implicated in the evolution of
acute kidney injury. The authors sought to determine if increasing
systemic flow and mean arterial pressure could improve urine oxygen
tension (PuO<inf>2</inf>) measured in the bladder, a surrogate of kidney
medullary oxygenation, in patients undergoing on-pump cardiac surgery.
 Design(s): Randomized crossover study. Setting(s):
University-affiliated hospital. Participant(s): Twenty adult patients
undergoing cardiopulmonary bypass (CPB) with expected cross-clamp time of
>60 minutes and estimated glomerular filtration rate of >30
mL/min/1.73m2. Intervention(s): Sequential 20-minute
periods of 2 interventions: Intervention H ("High") or Intervention N
("Normal"). The order of interventions was determined by randomization.
Intervention H: targeted CPB flow 3.0 L/min/m2 and mean
arterial pressure (MAP) 80 mmHg. Intervention N: targeted CPB flow 2.4
L/min/m2 and MAP 65 mmHg. Measurements and Main Results:
PuO<inf>2</inf> was measured by an oxygen sensor introduced into the
bladder via a urinary catheter. Clear separation was achieved in CPB flow
and MAP between intervention periods (p < 0.001 for group-time
interaction). PuO<inf>2</inf> during Intervention H was higher than during
Intervention N (p < 0.001 for group-time interaction). After 17 minutes,
PuO<inf>2</inf> was statistically higher in Intervention H at each time
point. There were no differences in markers of hemolysis between
interventions. Conclusion(s): PuO<inf>2</inf> was higher when
systemic flow and MAP were increased during CPB. These findings suggest
that PuO<inf>2</inf> is responsive to changes in hemodynamics and that
higher flow and pressure may improve medullary oxygenation. Copyright
© 2022

<49>
Accession Number
2018500682
Title
Patient-Controlled Analgesia After Cardiac Surgery With Median Sternotomy:
No Advantages of Hydromorphone When Compared to Morphine.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(9) (pp 3587-3595),
2022. Date of Publication: September 2022.
Author
Wehrfritz A.; Senger A.-S.; Just P.; Albart M.; Munchsmeier M.; Ihmsen H.;
Schuttler J.; Jeleazcov C.
Institution
(Wehrfritz, Senger, Just, Albart, Munchsmeier, Ihmsen, Schuttler,
Jeleazcov) Department of Anesthesiology, University Hospital Erlangen,
Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
Publisher
W.B. Saunders
Abstract
Objectives: To compare the efficacy, safety, and side effects of
hydromorphone and morphine administered as patient-controlled analgesia
(PCA) for postoperative pain therapy after cardiac surgery with median
sternotomy. Design(s): A retrospective analysis of data from 2
prospective, single-blinded, randomized trials. Setting(s): A
single-center intensive care unit at a university hospital.
 Participant(s): Forty-one adult patients undergoing cardiac surgery
with median sternotomy. Intervention(s): Postoperative pain therapy
at the intensive care unit was performed by PCA with intravenously
administered bolus doses of 0.2 mg of hydromorphone (n = 21) or 2 mg of
morphine (n = 20). Measurements and Main Results: Pain at rest and
under deep inspiration regularly was assessed using the 11-point numerical
rating scale (NRS). Blood pressure, heart rate, cardiac output, oxygen
saturation, and respiratory rate were monitored, and adverse events were
registered. The median (range) NRS rating at rest was 1.5 (0-5) after
hydromorphone and 0.5 (0-5) after morphine, respectively (p = 0.41). The
median NRS rating under deep inspiration was 3 (0-6) after hydromorphone
and 4 (0-7) after morphine, respectively (p = 0.074). The dose ratio of
morphine to hydromorphone during PCA was 5.7 (95% confidence interval:
2.9-7.6). Hemodynamics and respiration were stable and did not differ
significantly. Postoperative nausea and vomiting were the most frequent
adverse events, which were observed in 29% of the patients after
hydromorphone and in 35% after morphine, respectively (p = 0.74).
 Conclusion(s): There were no significant differences in analgesic
efficacy and safety between hydromorphone and morphine when used for
postoperative pain therapy with PCA after cardiac surgery with median
sternotomy. Copyright © 2022 Elsevier Inc.

<50>
Accession Number
2015354507
Title
A systematic review and meta-analysis of the cerebrovascular event
incidence after transcatheter aortic valve implantation.
Source
Clinical Research in Cardiology. 111(8) (pp 843-858), 2022. Date of
Publication: August 2022.
Author
Meertens M.M.; Macherey S.; Asselberghs S.; Lee S.; Schipper J.H.; Mees
B.; Eitel I.; Baldus S.; Frerker C.; Schmidt T.
Institution
(Meertens, Macherey, Lee, Schipper, Baldus) Department III of Internal
Medicine, University Hospital of Cologne, Cologne, Germany
(Asselberghs, Mees) Department of Pathology, Cardiovascular Research
Institute Maastricht, Maastricht University Medical Center, Maastricht,
Netherlands
(Meertens, Asselberghs, Mees) Department of Vascular Surgery, Maastricht
University Medical Center, Maastricht, Netherlands
(Eitel, Frerker, Schmidt) Department of Cardiology, Angiology and
Intensive Care Medicine, University Heart Center Lubeck, University
Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lubeck 23538, Germany
(Eitel, Frerker, Schmidt) DZHK (German Centre for Cardiovascular
Research), Partner Site Hamburg/Kiel/Lubeck, Lubeck, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: Periinterventional stroke is one of the most feared potential
complication, among patients treated with transcatheter aortic valve
implantation (TAVI). The purpose of this review was to investigate the
incidence of cerebrovascular events and the influence of
postinterventional neurologic check-up in patients undergoing TAVI.
 Method(s): A systematic review and meta-analysis were conducted
according to the PRISMA guideline. Three separate electronic searches of
the public domains Medline and Clinicaltrials.gov were performed to
identify the 30-day incidence of stroke within randomized controlled
trials (RCTs) and registries for patients undergoing a TAVI procedure. A
meta-analysis was conducted to evaluate the 30-day incidence of stroke
within RCTs. Furthermore, we pooled the RCTs in which a scheduled
neurological check-up was conducted or not to investigate the effect of
this intervention. Result(s): Twenty-three studies including 399,491
TAVI patients were included, 6370 from RCTs, 833 from cerebral-embolic
protection device RCTs and 392,288 were adopted from registries. The mean
30-day incidence of stroke among all reviewed studies was 2.33%. In RCTs
evaluating TAVI the pooled stroke incidence was 3.86%, among RCTs focused
CEP the incidence was 6.36% and in registries the incidence was 2.29%. Ten
RCTs conducted scheduled neurological check-ups, the incidence in these
was 4.03% and among the remaining RCTs it was 2.47%. In the meta-analysis,
the pooled 30-day stroke incidence was 3.61% (95% CI 2.57-4.79%).
 Conclusion(s): This systematic review demonstrates that the stroke
incidences following TAVI differ strongly according to the study design
and neurological follow-up. Intense neurological testing increases the
incidence of a stroke after TAVI. Graphical abstract: [Figure not
available: see fulltext.] Copyright © 2022, The Author(s), under
exclusive licence to Springer-Verlag GmbH Germany.

<51>
Accession Number
2015142899
Title
Real-world anticoagulatory treatment after percutaneous mitral valve
repair using MitraClip: a retrospective, observational study on 1300
patients.
Source
Clinical Research in Cardiology. 111(8) (pp 889-899), 2022. Date of
Publication: August 2022.
Author
Hohmann C.; Ludwig M.; Walker J.; Iliadis C.; Schipper J.-H.; Baldus S.;
Pfister R.
Institution
(Hohmann, Iliadis, Schipper, Baldus, Pfister) Faculty of Medicine,
Department III for Internal Medicine, Heart Center, University Hospital of
Cologne, Kerpener Str. 62, Cologne 50937, Germany
(Ludwig, Walker) InGef - Institute for Applied Health Research Berlin
GmbH, Berlin, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: This study sought to investigate current anticoagulatory treatment
patterns and clinical outcome in patients undergoing transcatheter mitral
valve repair (MitraClip). Methods and Results: In a retrospective
study of a German claims database (InGef research database),
anticoagulatory treatment regimens were assessed using any drug
prescription post discharge within the first 90 days after MitraClip
procedure. Clinical events between 30 days and 6 months were examined by
treatment regime. The study population comprised 1342 patients undergoing
MitraClip procedure between 2014 and 2018. 22.4% received antiplatelet
monotherapy, 20.8% oral anticoagulation (OAC) plus antiplatelet therapy,
19.4% OAC monotherapy, 11.7% dual antiplatelet therapy, 2.8% triple
therapy and 21.0% did not receive any anticoagulatory drugs. 63% of
patients with OAC received non-vitamin-K antagonist oral anticoagulants
(NOAC). A total of 168 patients were newly prescribed OAC after MitraClip,
of whom 12 patients (7.1%) had no diagnosis of atrial fibrillation or
venous thromboembolism. 40% of patients with OAC prior to MitraClip did
not have any OAC after MitraClip. The adjusted risk of all-cause mortality
was significantly increased in patients with no anticoagulatory treatment
(HR 3.84, 95% CI 2.33-6.33, p < 0.0001) when compared to antiplatelet
monotherapy whereas the other regimes were not significantly different.
 Conclusion(s): This large real-world data analysis demonstrates a
heterogeneous spectrum of prescriptions for anticoagulant therapies after
MitraClip. Considering relevant differences in clinical outcome across
treatment groups, major effort is warranted for controlled trials in order
to establish evidence-based recommendations on anticoagulatory treatment
after percutaneous mitral valve repair. Graphical abstract: [Figure not
available: see fulltext.] Copyright © 2022, The Author(s).

<52>
Accession Number
638581346
Title
Effect of High-vs Low-Dose Tranexamic Acid Infusion on Need for Red Blood
Cell Transfusion and Adverse Events in Patients Undergoing Cardiac
Surgery: The OPTIMAL Randomized Clinical Trial.
Source
JAMA. 328(4) (pp 336-347), 2022. Date of Publication: 26 Jul 2022.
Author
Shi J.; Zhou C.; Pan W.; Sun H.; Liu S.; Feng W.; Wang W.; Cheng Z.; Wang
Y.; Zheng Z.
Institution
(Shi, Zhou, Sun, Liu, Feng, Wang, Zheng) Department of Cardiovascular
Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, No. 167 Beilishi Rd, Xicheng
District, Beijing 100037, China
(Pan) Department of Anesthesiology, Baylor College of Medicine, Texas
Heart Institute, Houston, United States
(Wang) Department of Anesthesiology, First Affiliated Hospital of Wenzhou
Medical University, Wenzhou, China
(Cheng) Department of Cardiovascular Surgery, Henan Province People's
Hospital, Fuwai Central China Cardiovascular Hospital, Henan
Cardiovascular Hospital, Zhengzhou University, Zhengzhou, China
(Zheng) National Health Commission Key Laboratory of Cardiovascular
Regenerative Medicine, Fuwai Central China Hospital, Central China Branch
of National Center for Cardiovascular Diseases, No. 1 Fuwai Ave, Zhengdong
New District, Zhengzhou 451464, China
Publisher
American Medical Association
Abstract
Importance: Tranexamic acid is recommended for reducing blood loss and
transfusion in cardiac surgery. However, it remains unknown whether a high
dose of tranexamic acid provides better blood-sparing effect than a low
dose without increasing the risk of thrombotic complications or seizures
in cardiac surgery. Objective(s): To compare the efficacy and adverse
events of high-dose vs low-dose tranexamic acid in patients undergoing
cardiac surgery with cardiopulmonary bypass. Design, Setting, and
Participant(s): Multicenter, double-blind, randomized clinical trial among
adult patients undergoing cardiac surgery with cardiopulmonary bypass. The
study enrolled 3079 patients at 4 hospitals in China from December 26,
2018, to April 21, 2021; final follow-up was on May 21, 2021.
 Intervention(s): Participants received either a high-dose tranexamic
acid regimen comprising a 30-mg/kg bolus, a 16-mg/kg/h maintenance dose,
and a 2-mg/kg prime (n = 1525) or a low-dose regimen comprising a 10-mg/kg
bolus, a 2-mg/kg/h maintenance dose, and a 1-mg/kg prime (n = 1506).
 Main Outcomes and Measures: The primary efficacy end point was the
rate of allogeneic red blood cell transfusion after start of operation
(superiority hypothesis), and the primary safety end point was a composite
of the 30-day postoperative rate of mortality, seizure, kidney dysfunction
(stage 2 or 3 Kidney Disease: Improving Global Outcomes [KDIGO] criteria),
and thrombotic events (myocardial infarction, ischemic stroke, deep vein
thrombosis, and pulmonary embolism) (noninferiority hypothesis with a
margin of 5%). There were 15 secondary end points, including the
individual components of the primary safety end point. Result(s):
Among 3079 patients who were randomized to treatment groups (mean age,
52.8 years; 38.1% women), 3031 (98.4%) completed the trial. Allogeneic red
blood cell transfusion occurred in 333 of 1525 patients (21.8%) in the
high-dose group and 391 of 1506 patients (26.0%) in the low-dose group
(risk difference [RD],-4.1% [1-sided 97.55% CI,- to-1.1%]; relative risk,
0.84 [1-sided 97.55% CI,- to 0.96; P =.004]). The composite of
postoperative seizure, thrombotic events, kidney dysfunction, and death
occurred in 265 patients in the high-dose group (17.6%) and 249 patients
in the low-dose group (16.8%) (RD, 0.8%; 1-sided 97.55% CI,- to 3.9%; P
=.003 for noninferiority). Fourteen of the 15 prespecified secondary end
points were not significantly different between groups, including seizure,
which occurred in 15 patients (1.0%) in the high-dose group and 6 patients
(0.4%) in the low-dose group (RD, 0.6%; 95% CI,-0.0% to 1.2%; P =.05).
 Conclusions and Relevance: Among patients who underwent cardiac
surgery with cardiopulmonary bypass, high-dose compared with low-dose
tranexamic acid infusion resulted in a modest statistically significant
reduction in the proportion of patients who received allogeneic red blood
cell transfusion and met criteria for noninferiority with respect to a
composite primary safety end point consisting of 30-day mortality,
seizure, kidney dysfunction, and thrombotic events. Trial Registration:
ClinicalTrials.gov Identifier: NCT03782350. Copyright © 2022
American Medical Association. All rights reserved.

<53>
Accession Number
2019495371
Title
Distal Radial Artery Access in comparison to Forearm Radial Artery Access
for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA
Trial).
Source
Journal of Interventional Cardiology. 2022 (no pagination), 2022. Article
Number: 7698583. Date of Publication: 2022.
Author
Daralammouri Y.; Nazzal Z.; Mosleh Y.S.; Abdulhaq H.K.; Khayyat Z.Y.;
Hamshary Y.E.; Azamtta M.; Ghanim A.; Awwad F.; Majadla S.; Maree M.;
Hamaida J.; Ismail Y.
Institution
(Daralammouri, Mosleh, Abdulhaq, Khayyat, Hamshary, Azamtta, Ghanim,
Awwad, Majadla, Maree, Hamaida, Ismail) Department of Medicine, Faculty of
Medicine and Health Sciences, An-Najah National University, Nablus,
Palestine
(Daralammouri, Azamtta, Majadla, Ismail) Department of Cardiology,
An-Najah National University Hospital, Nablus, Palestine
(Nazzal) Department of Family and Community Medicine, Faculty of Medicine
and Health Sciences, An-Najah National University, Nablus, Palestine
(Hamshary) Department of Internal Medicine, An-Najah National University
Hospital, Nablus, Palestine
(Ghanim, Maree, Hamaida) Department of Radiology, An-Najah National
University Hospital, Nablus, Palestine
Publisher
Hindawi Limited
Abstract
Background. In our clinical practice, conventional radial access has been
employed routinely for coronary procedures. The distal radial artery (DRA)
access site has recently emerged as a novel technique in cardiac
procedures. Objectives. This study compares distal radial access to
standard forearm radial access (FRA) in terms of feasibility, outcomes,
and complications. Method. This prospective, randomized trial was
conducted at a single center. The patients were chosen from An-Najah
National University Hospital's catheterization laboratory between December
2019 and November 2020. A total of 209 patients were randomized into two
groups: DRA group (n = 104) and FRA group (n = 105). Results. Access was
successful in 98% of patients in both the groups. The DRA group had a
longer puncture duration and a higher number of attempts (duration: 56.6
+/- 61.1 s DRA vs. 20.0 +/- 18.4 s FRA, p<0.001, attempts: 1.9 +/- 1.3 DRA
vs. 1.2 +/- 0.60 FRA, p<0.001). Puncture-associated pain was greater in
the DRA group (4 +/- 2.2 DRA vs. 3 +/- 2.1 FRA, p=0.001). There were two
radial artery occlusions in the FRA group and none in the DRA group
(p=0.139). Percutaneous coronary intervention (PCI) was performed in 26%
of the DRA group and 37.1% of the FRA group. The DRA group had
significantly shorter procedure times (p=0.006), fluoroscopy times
(p=0.002), and hemostasis times (p=0.002). Over time, the learning curve
demonstrated improved puncture duration and a decrease in the number of
puncture attempts. Conclusions. DRA is a safe and practical alternative to
FRA for coronary angiography and intervention. The overtime learning curve
is expected to improve puncture-related outcomes. Copyright ©
2022 Yunis Daralammouri et al.

<54>
Accession Number
638602761
Title
Perioperative Fully Closed-Loop Insulin Delivery in Patients Undergoing
Elective Surgery: An Open-Label, Randomized Controlled Trial.
Source
Diabetes care. (no pagination), 2022. Date of Publication: 26 Jul 2022.
Author
Herzig D.; Suhner S.; Roos J.; Schurch D.; Cecchini L.; Nakas C.T.; Weiss
S.; Kadner A.; Kocher G.J.; Guensch D.P.; Wilinska M.E.; Raabe A.;
Siebenrock K.A.; Beldi G.; Gloor B.; Hovorka R.; Vogt A.P.; Bally L.
Institution
(Herzig, Suhner, Roos, Schurch, Bally) Department of Diabetes,
Endocrinology, Nutritional Medicine and Metabolism, University Hospital of
Bern, Bern, Switzerland
(Cecchini, Guensch, Vogt) Department of Anaesthesiology and Pain Medicine,
University Hospital of Bern, Bern, Switzerland
(Nakas) Laboratory of Biometry, School of Agriculture, University of
Thessaly, Greece
(Nakas) University Institute of Clinical Chemistry, University Hospital of
Bern, Bern, Switzerland
(Weiss, Kadner) Department of Cardiovascular Surgery, University Hospital
of Bern, Bern, Switzerland
(Kocher) Department of General Thoracic Surgery, University Hospital of
Bern, Bern, Switzerland
(Wilinska, Hovorka) Wellcome-MRC Institute of Metabolic Science,
University of Cambridge, Cambridge, United Kingdom
(Raabe) Department of Neurosurgery, University Hospital of Bern, Bern,
Switzerland
(Siebenrock) Department of Orthopaedic Surgery and Traumatology,
University Hospital of Bern, Bern, Switzerland
(Beldi, Gloor) Department of Visceral Surgery and Medicine, University
Hospital of Bern, Bern, Switzerland
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Perioperative management of glucose levels remains challenging.
We aimed to assess whether fully closed-loop subcutaneous insulin delivery
would improve glycemic control compared with standard insulin therapy in
insulin-requiring patients undergoing elective surgery. RESEARCH DESIGN
AND METHODS: We performed a single-center, open-label, randomized
controlled trial. Patients with diabetes (other than type 1) undergoing
elective surgery were recruited from various surgical units and randomly
assigned using a minimization schedule (stratified by HbA1c and daily
insulin dose) to fully closed-loop insulin delivery with fast-acting
insulin aspart (closed-loop group) or standard insulin therapy according
to local clinical practice (control group). Study treatment was
administered from hospital admission to discharge (for a maximum of 20
days). The primary end point was the proportion of time with sensor
glucose in the target range (5.6-10.0 mmol/L). RESULT(S): Forty-five
patients were enrolled and assigned to the closed-loop (n = 23) or the
control (n = 22) group. One patient (closed-loop group) withdrew from the
study before surgery and was not analyzed. Participants underwent
abdominal (57%), vascular (23%), orthopedic (9%), neuro (9%), or thoracic
(2%) surgery. The mean proportion of time that sensor glucose was in the
target range was 76.7 +/- 10.1% in the closed-loop and 54.7 +/- 20.8% in
the control group (mean difference 22.0 percentage points [95% CI 11.9;
32.0%]; P < 0.001). No episodes of severe hypoglycemia (<3.0 mmol/L) or
hyperglycemia with ketonemia or any study-related adverse events occurred
in either group. CONCLUSION(S): In the context of mixed elective
surgery, the use of fully closed-loop subcutaneous insulin delivery
improves glucose control without a higher risk of
hypoglycemia. Copyright © 2022 by the American Diabetes
Association.

<55>
Accession Number
638600394
Title
A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of
Preoperative Antithrombin Supplementation in Patients at Risk for
Antithrombin Deficiency After Cardiac Surgery.
Source
Anesthesia and analgesia. (no pagination), 2022. Date of Publication: 25
Jul 2022.
Author
Moront M.G.; Woodward M.K.; Essandoh M.K.; Avery E.G.; Reece T.B.;
Brzezinski M.; Spiess B.; Shore-Lesserson L.; Chen J.; Henriquez W.;
Barcelo M.; Despotis G.; Karkouti K.; Levy J.H.; Ranucci M.; Mondou E.
Institution
(Moront) From the, Department of Cardiothoracic Sugery, Promedical Toledo
Hospital, Toledo, Ohio
(Woodward, Chen, Henriquez, Barcelo, Mondou) Bioscience Research Group,
Grifols, Barcelona, Spain
(Essandoh) Department of Anesthesiology' Wexner Medical Center, Ohio State
University, Columbus, OH, United States
(Avery) Department of Anesthesiology and Perioperative Medicine,
University Hospital Case Medical Center, Cleveland, OH, United States
(Reece) Department of Surgery' Division of Cardiothoracic Surgery,
University of Colorado, Aurora, CO, United States
(Brzezinski) Department of Anesthesiology and Perioperative Care,
University of California, San Francisco, CA, United States
(Brzezinski) San Francisco Veterans Affairs Health Care System, San
Francisco, CA, United States
(Spiess) Department of Anesthesiology, University of Florida College of
Medicine, Gainesville, FL, Puerto Rico
(Shore-Lesserson) Department of Anesthesiology, North Shore University
Hospital, NY, United States
(Despotis) Departments of Pathology, Immunology and Anesthesiology,
Washington University School of Medicine, St. Louis, MO, United States
(Karkouti) Department of Anesthesia and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Levy) Department of Anesthesiology and Critical Care, Duke University
School of Medicine, Durham, NC, United States
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care, IRCSS Policlinico San Donato, Milan, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Antithrombin (AT) activity is reduced during cardiac
operations with cardiopulmonary bypass (CPB), which is associated with
adverse outcomes. Preoperative AT supplementation, to achieve >58% and
<100% AT activity, may potentially reduce postoperative morbidity and
mortality in cardiac operations with CPB. This prospective, multicenter,
randomized, double-blind, placebo-controlled study was designed to
evaluate the safety and efficacy of preoperative treatment with AT
supplementation in patients at risk for low AT activity after undergoing
cardiac surgery with CPB. METHOD(S): A total of 425 adult patients
were randomized (1:1) to receive either a single dose of AT (n = 213) to
achieve an absolute increase of 20% above pretreatment AT activity or
placebo (n = 212) before surgery. The study duration was approximately 7
weeks. The primary efficacy end point was the percentage of patients with
any component of a major morbidity composite (postoperative mortality,
stroke, acute kidney injury [AKI], surgical reexploration, arterial or
venous thromboembolic events, prolonged mechanical ventilation, and
infection) in the 2 groups. Secondary end points included AT activity,
blood loss, transfusion requirements, duration of intensive care unit
(ICU), and hospital stays. Safety was also assessed. RESULT(S):
Overall, 399 patients (men, n = 300, 75.2%) with a mean (standard
deviation [SD]) age of 66.1 (11.7) years, with the majority undergoing
complex surgical procedures (n = 266, 67.9%), were analyzed. No
differences in the percentage of patients experiencing morbidity composite
outcomes between groups were observed (AT-treated 68/198 [34.3%] versus
placebo 58/194 [29.9%]; P = .332; relative risk, 1.15). After AT infusion,
AT activity was significantly higher in the AT group (108% [42-143])
versus placebo group (76% [40-110]), and lasted up to postoperative day 2.
At ICU, the frequency of patients with AT activity >=58% in the AT group
(81.5%) was significantly higher (P < .001) versus placebo group (43.2%).
Secondary end point analysis did not show any advantage of AT over placebo
group. There were significantly more patients with AKI (P < .001) in the
AT group (23/198; 11.6%) than in the placebo group (5/194, 2.6%). Safety
results showed no differences in treatment-emergent adverse events nor
bleeding events between groups. CONCLUSION(S): AT supplementation did
not attenuate adverse postoperative outcomes in our cohort of patients
undergoing cardiac surgery with CPB. Copyright © 2022
International Anesthesia Research Society.

<56>
Accession Number
615452596
Title
Cardiovascular efficacy and safety of bococizumab in high-risk patients.
Source
New England Journal of Medicine. 376(16) (pp 1527-1539), 2017. Date of
Publication: 20 Apr 2017.
Author
Ridker P.M.; Revkin J.; Amarenco P.; Brunell R.; Curto M.; Civeira F.;
Flather M.; Glynn R.J.; Jukema J.W.; Karpov Y.; Kastelein J.J.P.; Koenig
W.; Lorenzatti A.; Manga P.; Masiukiewicz U.; Miller M.; Mosterd A.; Murin
J.; Nicolau J.C.; Nissen S.; Ponikowski P.; Santos R.D.; Schwartz P.F.;
Soran H.; White H.; Wright R.S.; Vrablik M.; Yunis C.; Shear C.L.; Tardif
J.-C.; Conde D.; Colquhoun D.; Missault L.; Gregoire J.; Gao R.; Urina M.;
Solar M.; Jensen H.K.; Grobbee D.; Savolainen M.; Schiele F.N.;
Montalescot G.; Edes I.; Blake G.; Lotan C.; Maggioni A.; Savonitto S.;
Lee C.W.; Leiva Pons J.L.; Dan G.A.; Cortada J.B.; Mellbin L.; Kahan T.;
Noble S.; Hwang J.J.; Sritara P.; Tokgozoglu L.; Tarasenko L.; Borer J.S.;
Black H.; Carmena R.; Furie K.L.; McMurray J.; Neaton J.; Zannad F.;
O'Neill B.; Welty F.; McNamara R.; Chun H.; Abbott J.D.; Jacoby D.;
McPherson C.; Jadbabaie F.; Pinto D.; McCullough L.; Silverman I.E.;
Sansing L.H.; Dearborn-Tomazos J.; Foody J.; Schindler J.; Piazza G.;
Chakrabarti A.; Pride Y.; Gelfand E.; Baultrukonis D.; Chaudhuri S.;
Frederich R.; Johnson M.; Mridha K.; Powell C.; Wang E.; Wei C.; Anderson
P.; Buonanno M.; Epsley C.; Evans B.; Frolova M.; Goetsch M.; Hessinger
D.; Ikehara E.; Ivanac K.; Kizko J.; Le K.; McNally-Dufort C.; Morocco T.;
Nadkarni S.; Nye R.; Pak R.; Pence D.; Redifer P.; Sattler C.; Schade R.;
Sullivan B.; Wegner J.; Alvarez C.A.; Budassi N.; Vogel D.R.; Avaca H.;
Conde D.G.; Estol C.C.; Gelersztein E.; Glenny J.A.; Hershson A.R.; Bruno
R.L.; Maffei L.E.; Soler J.M.; Zaidman C.J.; Carnero G.S.; Colombo H.R.;
Jure H.O.; Luquez H.A.; Ramos H.R.; Resk J.H.; Rusculleda M.M.; Ulla M.R.;
Caccavo A.; Farias E.F.; Wenetz L.M.; Cabella P.R.; Cuadrado J.A.; Chahin
M.; Mackinnon I.J.; Zarandon R.B.; Schmidberg J.; Fernandez A.A.; Montana
O.; Codutti O.R.; Gorosito V.M.; Maldonado N.; Sala J.; De La Fuente R.A.;
Casabella T.E.; Di Gennaro J.P.; Guerrero R.A.; Alvarez M.S.; Berli M.;
Botta C.E.; Montenegro E.E.; Vico M.L.; Begg A.; Lehman R.; Gilfillan
C.P.; d'Emden M.; Markovic T.P.; Sullivan D.; Aroney C.; Stranks S.N.;
Crimmins D.S.; Arstall M.; Van Gaal W.; Davis T.; Aylward P.E.; Amerena
J.; William M.; Proietto J.; Purnell P.W.; Singh B.; Arya K.W.; Dart A.M.;
Thompson P.; Davis S.M.; Carroll P.A.; De Looze F.; Jayasinghe R.; Bhindi
R.; Buysschaert I.; Sarens T.; van de Borne P.; Scott B.P.; Roosen J.;
Cools F.; Missault L.H.; Debroye C.; Schoors D.F.; Hollanders G.; Schroe
H.H.; De Sutter J.; Hermans K.; Carlier M.; van Landegem P.; Verwerft J.;
Mulleners T.; Delforge M.D.; Soufflet V.; Elegeert I.; Descamps O.S.;
Janssens S.; Lemmens R.C.; Desfontaines P.; Scheen A.; Heijmans S.; Capiau
L.; Vervoort G.; Carlier S.G.; Faes D.; Alzand B.; Keuleers S.; De Wolf
L.; Thoeng J.; De Bruyne L.; de Santos M.O.; Felicio J.S.; Areas C.A.;
Figueiredo E.L.; Michalaros Y.L.; Neuenschwander F.C.; Reis G.; Saad J.A.;
Kormann A.P.; Nascimento C.V.; Precoma D.B.; Abib E.; dos Santos F.R.;
Mello Y.G.; Saraiva J.F.; Rech R.L.; Cerci R.; Fortes J.A.; Rossi P.R.; de
Lima e Silva F.A.; Hissa M.; Silva R.P.; de Souza W.K.; Guimaraes Filho
F.V.; Mangili O.C.; de Oliveira Paiva M.S.; Tumelero R.; Abrantes J.A.;
Caramori P.R.; Dutra O.P.; Leaes P.E.; Manenti E.R.; Polanczyk C.A.;
Bandeira e Farias F.A.; de Moraes Junior J.B.; Russo L.A.; Alves A.R.;
Dracoulakis M.D.; Ritt L.E.; Saporito W.F.; Herdy A.H.; Maia L.N.;
Sternieri M.V.; Ayoub J.C.; Bianco H.T.; da Costa F.A.; Eliaschewitz F.G.;
Fonseca F.A.; Nakandakare E.R.; Bonansea T.C.; Castro N.M.; de Barros e
Silva P.G.; Smith P.; Botelho R.V.; Resende E.S.; Barbieri D.S.; Hernandes
M.E.; Bajaj H.; Beaudry P.; Berlingieri J.C.; Salter T.J.; Ajala B.;
Anderson T.J.; Nanji A.; Ross S.; Pandey S.; Desrosiers D.; Gaudet D.;
Moran G.; Csanadi M.A.; St-Amour E.; Cusimano S.; Halperin F.A.; Babapulle
M.; Vizel S.; Petrella J.; Spence J.D.; Gupta N.; Tellier G.; Bourgeois
R.; Gregoire J.C.; Wesson T.; Zadra R.; Twum-Barima D.Y.; Cha J.Y.;
Hartleib M.C.; Bergeron J.; Chouinard G.; McPherson T.P.; Searles G.;
Peterson S.R.; Mukherjee A.; Lepage S.; Conway J.R.; Kouz S.M.; Dion D.;
Pesant Y.; Cheung S.S.; Goldenberg R.M.; Aronson R.; Gupta A.K.; O'Mahoney
M.; Pliamm L.; Teitelbaum I.; Hoag G.N.; Nadra I.J.; Yared Z.; Yao L.C.;
Nguyen T.; Saunders K.K.; Potthoff S.; Varleta P.; Assef V.; Godoy J.G.;
Olivares C.; Roman O.; Vejar M.; Montecinos H.; Pincetti C.; Li Y.; Wang
D.; Li J.; Yang X.; Du Y.; Wang G.; Yang P.; Zhang X.; Xu P.; Zhao Y.;
Chen J.; Li S.; Li W.; Zhang L.; Zhu Y.; Zhang Y.; Zhou C.; Wang Y.; Liu
F.; Ma Y.; Ti Z.; Zeng X.; Zhou Y.; Cui G.; Li D.; Xue L.; Jiang J.; Lian
Y.; He Y.; Mendoza J.A.; Bonfanti J.A.; Dada F.A.; Urina-Triana M.A.;
Rodriguez W.R.; Sanchez M.L.; Lozno H.Y.; Triana E.H.; Arambula R.M.;
Rico-Carrillo A.E.; Gallo H.J.; Catano J.S.; Jattin F.G.; Plazas J.A.;
Gomez J.E.; Botero-Lopez R.; Gomez N.I.; Munoz C.F.; Pelaez S.V.; Eraso
A.M.; Goyes A.R.; Elbl L.; Fiserova N.; Vesely J.; Wasserburger B.; Blaha
V.; Vojacek J.; Maskova P.; Hutyra M.; Vrkoc J.; Hala T.; Vodnansky P.;
Bocek P.; Cifkova R.; Bufka V.; Ceska R.; Machkova M.; Zidkova E.; Lukac
M.; Mikusova T.; Kellnerova I.; Kuchar L.; Ferkl R.; Cech V.; Zemek S.;
Monhart Z.; Davidsen F.; Joensen A.; Lihn A.S.; Rasmussen T.K.; Wiggers
H.; Lindgren L.M.; Schmidt U.; Galatius S.; Sillesen H.; Bronnum Schou J.;
Thomsen K.K.; Urhammer S.; Jeppensen J.; Schou M.; May O.; Steffensen R.;
Nielsen W.B.; Nielesen T.; Jepsen J.M.; Rai A.; Sykulski R.; Andersen
L.T.; Rickers H.; Frost L.; Lomholdt J.; Egstrup K.; Wermuth S.; Klausen
L.; Lassus J.; Palomaki A.; Khari J.; Tatlisumak T.; Kekki S.; Vanttinen
E.; Strandberg A.; Valtonen M.; Sia S.M.; Nerg O.; Puhakka M.; Strand J.;
Timonen M.; Levola J.; Arstila L.; Taurio J.; Kantola I.; Suomi J.;
Humaloja K.; Askonen K.; Schiele F.; Sibon I.; Zemour G.; Goube P.; Petit
C.; Chati Z.; Range G.; Rabahi F.; Rihani R.; Bergerot C.; Roubille F.;
Boye A.; Probst V.; Ferrari E.; Cayla G.; Thouvenot E.; Delarche N.;
Couffinhal T.; Coisne D.; Paillard F.; Elbaz M.; Decoulx E.; Angoulvant
D.; Agraou B.; Caudmont S.; Berrouschot J.; Lauer B.; Schoell I.; Trenk
D.; Derwahl K.M.; Khariouzov A.; Proepper F.; Stawowy P.; Da Stephan U.;
Stoessel J.; Voehringer H.F.; Dorsel T.; Stellbrink C.; Rinke A.;
Northroff J.; Bourhaial H.; Stratmann M.; Wetzel T.; Axthelm C.; Guenzel
A.; Weigmann I.; Faghih M.; Hagemann D.; Schaefer A.; Weber D.; Luedemann
J.; Contzen C.; Kornmann M.O.; Winkelmann B.; Simon J.; Felix S.; Brauer
C.; Laufs U.; Schmidt E.; Marten I.; Licka M.; Heisters J.; Appel K.F.;
Kleinecke-Pohl U.; Klein C.; von Hodenberg E.F.; Maus O.; Sigal H.;
Taeschner H.; Schwimmbeck P.; Lemke B.; Perings C.; Illies G.; Pfuetzner
A.; Salbach P.; Hengstenberg C.; Kohler A.; Mudra H.; Behnke T.; Baar M.;
Jeserich M.; Scholz G.; Naudts I.; Voller H.; Herrmann H.J.; von
Engelhardt C.B.; Gerke S.; Pohlmeier L.; Schaufele T.; Woehrle J.;
Al-Zoebi A.; Horacek T.; Peterfai E.; Kemeny V.; Lakatos F.; Bod E.;
Andrassy P.; Andreka P.; Balo T.; Davidovits Z.; Laszlo Z.; Nagy K.; Papp
A.; Somogyi A.; Toldy-Schedel E.; Vertes A.; Voros P.; Paragh G.; Martyin
T.; Hajdu C.; Deak L.; Farago K.; Nagy A.; Kirschner R.; Koszegi Z.;
Zilahi Z.; Toth K.; Wittmann I.; Bajcsi D.; Reiber I.; Toth L.; Benczur
B.; Nagy L.; Sydo T.; Lupkovics G.; Oroszlan T.; Crean P.; Mahon N.G.;
McAdam B.; MacNeill B.; Katz A.; Tsalihin D.; Vazan A.; Eitan A.; Lewis
B.S.; Gavish D.; Wainstein J.; Mosenzon O.; Mosseri M.; Vishlitzky V.;
Atar S.; Nseir W.B.; Brenner H.; Elis A.; Fuchs S.; Shimon I.; Solodky A.;
Goldhaber A.; Tanne D.; Knobler H.; Kracoff O.H.; Hussein O.; Auriel E.;
Chorin E.; Sharir T.; Bitzur R.; Shechter M.; Antonicelli R.; Franceschini
E.; Porcu M.; Sesti G.; Maggiolini S.; Salvioni A.; Filardi P.P.; Trimarco
B.; Averna M.; Pasqualini L.; Pirro M.; Pantaleoni M.; Piovaccari G.; Arca
M.; Fedele F.; Roncon L.; Anselmi M.; Sganzerla P.; Morocutti G.; Bonora
E.; Dimas A.L.; Esperon G.A.; Morales-Villegas E.; Isunza J.M.; Beltran
L.G.; Molina C.A.; Garcia D.K.; Ruiz L.A.; Reyna L.S.; De los Rios Ibarra
M.O.; Soto J.R.; Gonzalez-Ortiz M.; Herrera-Marmolejo M.; Ramos S.A.;
Ramos-Lopez G.A.; Stobschinski C.A.; AguilarSalinas C.A.; Alpizar-Salazar
M.; Jimenez-Sanchez M.; Sanchez Mijangos J.H.; Elizondo Moreno E.R.;
Garcia Castillo A.; Garcia Hernandez P.A.; Gonzalez-Gonzalez J.G.; Riojas
Charles C.M.; Valdez Lopez H.G.; Nuriulu Escobar P.L.; Lechuga Martin del
Campo A.; Castro Montes B.E.; Mendez Bucio A.; Rodriguez-Briones I.; Torre
Amione G.; Violante Ortiz R.; Luna Ceballos R.I.; Lopez Rosas E.; Bax
W.A.; Alhakim M.; van de Wiel A.; Liem S.S.; Groutars R.G.; Herrman J.P.;
Hovingh G.K.; van de Wetering M.L.; van Royen N.; Groenemeijer B.E.;
Hoedemaker G.; Schaap J.; Ronner E.; Angun M.; Mairuhu A.T.; Van Alem
A.P.; Martens F.M.; Heijmeriks J.A.; van Hal J.M.; Schoofs M.W.; den
Hartog F.R.; Kentgens S.; Post J.C.; Louwerenburg J.W.; van Rossum P.;
Viergever E.P.; Donders S.H.; Kamphuisen P.W.; van Beek E.; Nijmeijer R.;
Lenderink T.; Schreuder T.; Kuijper A.F.; The S.H.; Van het Hof-Wiersma
J.J.; Tichelaar P.; Westerndorp I.; Breedveld R.W.; Karalis I.; Romer
T.J.; Bogaard K.; Van Koningsbruggen P.; Kroon A.A.; Hoogslag P.A.;
Rensing B.J.; Cramer E.; Remmen J.J.; Riksen N.P.; Bokern M.J.; Cabezas
M.C.; Mulder H.; Nierop P.R.; van Kempen W.W.; Zoet-Nugteren S.K.; van
Daele M.E.; Swart H.P.; van der Zwaan C.T.; Hermans W.R.; Magro M.; van de
Wal R.M.; Hassink R.J.; Visseren F.; Veenendaal A.; De Nooijer C.; Troquay
R.P.; Imholz B.P.; van der Meer P.; Visser R.P.; van Leendert R.J.;
Gosselink M.A.; Baker J.; Benatar J.R.; Kerr J.; Pryke J.R.; Scott R.S.;
Millar-Corte G.D.; Williams M.; Montgomery B.; Venter D.J.; Ternouth I.F.;
DeCaigney S.C.; Hart H.H.; Corin A.; Garden P.I.; Sheahan D.; Harding
S.A.; Korecki J.; Supronik J.; Styczkiewicz M.; Bijata-Bronisz R.; Rusicka
T.; Walczak M.; Krolikowski Z.; Ostrowski J.; Lukaszewicz M.;
Przekwas-Jaruchowska M.; Zieba B.; Miekus P.; Orkwiszewska-Nalewajko A.;
Piepiorka M.; Kubalski P.; Wychota K.; Blach E.; Ochala A.; Okopien B.;
Wronska D.; Janion M.; Czarnecka D.; Kolodziejczyk J.; Konieczynska M.;
Landa K.; Mirek-Bryniarska E.; Necki M.; Pasternak D.A.; Rozpondek P.;
Trebacz J.; Walczewska J.; Sidor M.; Broncel M.; Drozdz J.; Kosmider M.;
Saryusz-Wolska M.; Kucharska D.; Opalinska E.; Pijanowski Z.; Wozniak I.;
Banaszkiewicz K.; Klecha A.; Horodecki M.; Piskorz-Wapinska J.;
Kobielusz-Gembala I.; Kim M.H.; Kim D.K.; Cho B.R.; Kim K.S.; Her S.H.;
Lee S.Y.; Rhee M.Y.; Kim K.; Kang W.C.; Kim D.H.; Cho Y.S.; Kim S.H.; Rim
S.J.; Tahk S.J.; Jeon H.K.; Yoon J.; Mociran M.; Pop C.F.; Minescu B.;
Andrei L.D.; Radoi M.; Calin A.; Ciomag R.M.; Copaci I.; Fruntelata A.G.;
Popescu M.; Tivadar S.; Roman G.; Avram R.I.; Mistodie C.V.; Morosanu M.;
Popa A.R.; Popescu M.L.; Popoviciu M.S.; Tase A.; Busegeanu M.; Popescu
A.; Szilagyi I.; Sitterli-Natea C.N.; Maximov D.M.; Munteanu M.; Negrisanu
G.D.; Kuzin A.; Popov D.; Shapovalova J.; Vishneva E.; Shutemova E.;
Pasechnik E.; Bogdanov E.; Khasanov N.; Barbarash O.L.; Shangina O.A.;
Tarasov N.; Solonev O.; Kosmacheva E.; Chernyatina M.A.; Ginzburg M.;
Blokhin A.; Bulanova N.; Drapkina O.M.; Gordeev I.G.; Libov I.A.; Lomakin
N.; Panchenko E.; Shogenov Z.S.; Zateyshchikov D.; Klein G.; Motylev I.;
Belenkiy D.I.; Demin A.; Nikolaev K.Y.; Oleynikov V.; Zrazhevskiy K.;
Katelnitskiy I.; Khaisheva L.; Aksentiev S.; Nedoshivin A.; Popova V.B.;
Agafina A.S.; Ballyuzek M.; Baranova E.; Burova N.; Eryshev S.; Filippov
A.; Goloshchekin B.M.; Konstantinov V.; Kostenko V.A.; Simanenkov V.I.;
Volkova A.; Duplyakov D.; Reshetko O.; Shvarts Y.; Kuznetsov V.A.;
Samoylova Y.G.; Tolkacheva V.; Shalaev S.V.; Khokhlov A.L.; Malygin A.;
Shilkina N.P.; Yakusevich V.V.; Margoczy R.; Zubek V.; Dzupina A.; Dubrava
J.; Dulkova K.; Fabryova L.; Gaspar L.; Kamensky G.; Kokles M.; Raslova
K.; Soosova I.; Stevlik J.; Strbova J.; Sumbal J.; Uhliar R.; Micik J.;
Truban J.; Fedacko J.; Pastrnakova E.; Pella D.; Fazekas F.; Ambrovicova
V.; Kycina P.; Martinka E.; Nociar J.; Belicova M.; Banik M.; Kanderkova
D.; Hranai M.; Duris T.; Krahulec B.; Benacka J.; Vinanska D.; Roskova E.;
Skripova D.; Macek V.; Vohnout B.; Buganova I.; Engelbrecht J.M.;
Pretorius M.M.; Ebrahim I.O.; Bayat J.; Ganesh S.; Ranjith N.; Coetzer
T.F.; Jacovides A.; Distiller L.A.; Hellig F.S.; Engelbrecht I.V.; Mahomed
A.A.; Blignault S.C.; Burgess L.J.; Kotze H.J.; van Nieuwenhuizen E.;
Musungaie D.B.; Emanuel S.; van der Walt E.; Pretorius C.E.; Roos J.S.;
Roux S.M.; Badat A.E.; Fouche L.; Vahed Y.A.; Jansen van Resburg D.; van
Zyl L.J.; Soto Gonzalez A.; Diaz J.L.; Segura T.; Botella Serrano M.;
Botas Rodrigues J.; Molto-Jorda J.M.; Dominguez Escribano J.R.; Sogorb
Garri F.; Blanco Coronado J.L.; Gaztambide Saenz M.S.; Brotons Cuixart C.;
Bruguera Cortada J.; Garcia-Moll Marimon X.; Gonzalbez Morgaez J.D.;
Maisterra Santos O.; Roquer Gonzalez J.; Sobrino-Martinez J.; Chueca
Fernandez J.E.; Narejos S.; Suarez Garcia S.; Perez Martinez P.; Figueras
Camos R.; Medrano Martinez V.; Bellido Guerrero D.; Martinez Deben F.;
Vila Belmonte A.; Mediavilla Garcia J.D.; Romero Hinojosa J.A.; Martorell
Mateu E.; Cequier Fillat A.R.; Pinto Sala X.; Adroer Martori R.; Bueno
Diez M.; Lopez Cano C.; Worner Diz F.; Gonzalez Juanatey C.; Alvarez-Sala
Walther L.A.; De Dios Garcia Diaz J.; Garcia Puig J.; Jodar Gimeno E.;
Plaza Perez I.; Suarez-Fernandez C.; Tunon J.; Zamorano Gomez J.L.; Brito
Sanfiel M.A.; Escudier Villa J.M.; de Mora Martin M.; Dominguez Lopez M.;
Hernandez Garcia J.M.; Tinahones Madueno F.J.; Perez Paredes M.; Aracil
Villar J.; Barreda Gonzalez M.J.; Ripoll Vera T.V.; Tofe Povedano S.;
Sanchez Alvarez J.; Martinez Via L.; Robles Iniesta A.; Masana L.;
Vinyoles Bargallo E.; Calvo Gomez C.; Gonzalez Juanatey J.R.; Cruz
Fernandez J.M.; De La Cuesta Mayor C.; Duran Garcia S.; Jimenez Hernandez
M.D.; Morales Portillo C.; Muniz Grijalvo O.; De Castro R.; Taverna
Llaurado E.; Pons Amate J.M.; Terns Riera M.; Linderfalk C.; Curiac D.;
Saldeen-Nilehn K.; Koskinen P.; Khalili P.; Tortensson I.; Lindholm C.J.;
Luts A.; Koskinen P.T.; Gottsater A.; Persson B.E.; Mooe T.; Larnefeldt
H.; Boman K.; Crisby M.; Rasmanis G.; Tengmark B.O.; Witt N.; Hagstrom E.;
Viklund J.; Muller C.; Mach F.; Burnier M.; Nanchen D.; Wuerzner G.;
Banyai M.; Moccetti T.; Miserez A.R.; Bilz S.; Weber K.; Lai W.T.; Chang
K.C.; Ueng K.C.; Tsai W.C.; Chiang C.E.; Hou C.; Pei D.; Krittayaphong R.;
Kiatchoosakun S.; Srimahachota S.; Boonyavarakul A.; Jintapakorn W.; Gullu
H.; Onrat E.; Erkan A.F.; Demirci D.; Sari R.; Ceyhan C.; Ari H.; Araz M.;
Degertekin M.; Goktekin O.; Uresin A.Y.; Yigit Z.; Akdeniz B.; Comlekci
A.; Kayikcioglu M.; Sahin T.; Ozcan T.; Durakoglugil E.; Asamoah-Owusu N.;
Reed R.; Bakhai A.; Dixon L.; Sharma R.; Avornyo A.A.; Jones A.F.; Lip G.;
Clark R.; Banerjee M.; Wakeling J.; Arden C.; Blagden M.D.; Walukiewica
P.; Marshall A.; Maxwell T.G.; Gunstone A.E.; Kadr H.H.; Patle R.; Arif
I.; Jhund P.S.; McKaig G.; Douglas F.; Mierzejewski L.; Turner W.;
Sathyapalan T.; Ivan P.; Manoj A.; Rice S.; Collier D.J.; Nair D.R.; Thom
S.; Fiore G.; De Belder M.; Price D.; Sobolewska J.; Martin S.; Takhar A.;
Moriarty A.; Kondagunta V.; Myhill T.; Gibson J.M.; Cecil J.T.; Halcox J.;
Annamalai N.; Gorog D.A.; McCormack T.; Pegge N.; Field A.; Adams F.;
Klein J.J.; Busch R.S.; Bretton E.M.; Jaffrani N.; Salacata A.;
Assadourian A.; Gogia H.S.; Dyke C.K.; Rubenfire M.; Essandoh L.K.; Welker
J.A.; Ledesma G.; Lupovitch S.; Delgado J.P.; Hendrix E.L.; Quyyumi A.A.;
Riesenberg R.A.; Robertson D.G.; Weinstein D.L.; Weiss R.; Casaubon L.;
Gammon R.S.; Brar H.S.; Bittar G.D.; Guarnieri T.T.; Ince C.S.; Quraishi
A.M.; Saeed S.; Albert M.; Sotolongo R.P.; Bernard J.V.; Karlsbergg R.P.;
Lepor N.E.; Kirby W.E.; McLean B.; Ovalle F.; Townsend J.C.; Beckett P.L.;
Eaves W.B.; West S.H.; Kosinski E.J.; Zarich S.W.; Mahal S.S.; Maw K.;
Maynard K.M.; Chen J.C.; Gelormini J.; Gottlieb D.W.; Gabra N.W.; Narayan
P.; Sparks J.; Field J.C.; Willits V.L.; O'Steen M.B.; Pasquini J.A.;
Sensebrenner J.W.; Yarows S.A.; Hiotis L.; Jagielo T.J.; Levinson D.J.;
Diller P.M.; Kereiakes D.J.; Turner T.A.; Vincent S.; Camp A.D.; Denker
P.S.; Manning M.B.; Rocco M.B.; Stamps H.B.; Strader J.R.; Uusinarkaus
K.T.; Kennett J.D.; Leichter S.B.; McNeil D.L.; Schumacher D.R.; Chang
A.R.; Ellison H.S.; Updegrove J.D.; Hamroff G.S.; Kay J.S.; Marar I.E.;
Flores E.; Saini S.; Abdullah S.; Berk M.R.; Fordan S.; Joshi P.H.;
McCullough P.A.; Reynolds R.D.; Rosenstock J.; Sachson R.A.; Shammas N.;
Fishbein G.J.; Randall W.J.; Henderson D.A.; Nash M.L.; Barker B.A.; Cohen
S.S.; Seidman B.; Odekirk L.L.; Grillo R.S.; Martinez L.M.; Multani P.;
Alwine L.K.; McGarvey J.F.; Mollerus M.E.; Miller A.B.; Kotek L.W.;
Changlani M.; Zavaro S.H.; Munoz F.; Mehta P.M.; Helm R.J.; Farhat N.Z.;
Farsad R.; Raoof T.J.; Shultz J.H.; Geohas J.G.; Allaw M.A.; Dela Llana
A.; Gutmann J.E.; Inzerello A.T.; Alappat P.; George A.R.; Haddad T.M.;
Lillestol M.J.; Grodman R.; Peniston J.H.; Wadud K.; Garcia B.; Hamilton
M.E.; Lerman S.; Perloff D.E.; Graff A.; Saxena S.; Alvarado O.P.; Malik
A.; Reddy R.D.; Kinzfogl G.; Cornett G.M.; Norwood P.C.; Gilbert J.M.;
Willis J.G.; McGrew F.; Sharma S.; Castro M.A.; Cucher F.H.; Altafullah
I.M.; Khurana S.; Knutson T.J.; Kinnaman S.J.; Stuckey T.; Pudi K.K.;
Mayfield R.K.; Funk G.S.; Nixon W.A.; Dor I.; Boyett B.E.; Srivastava S.;
Elosegui A.M.; Isserman S.M.; Cheek H.B.; Promisloff S.D.; Tami L.F.; Zeig
S.; fitz-Patrick D.; Dave K.N.; Ahmad A.; Arain S.; Ballantyne C.M.; Doshi
A.; El Hafi S.E.; Feldman J.; Fragoso V.G.; Gilford T.; Hoffman A.S.;
Pouzar J.E.; Vivekananthan K.; Ansari S.H.; Strzinek R.A.; Crater T.A.;
Robinson J.G.; Fulmer J.J.; Patel A.M.; Pereira E.S.; Stich M.A.; Sultan
S.; Geskin G.; Ruoff G.E.; Gillespie E.; Bybee K.A.; Moriarty P.M.; Savin
V.; Agaiby J.M.; Melucci M.B.; Jantzi C.M.; Davidson E.; Smith W.B.;
Treasure C.B.; Wakefield P.H.; Deck K.; Edris M.A.; Gilmore R.M.; Seep
M.K.; Andersen J.L.; Detweiler R.O.; Rosenfeld J.C.; Strobl D.J.;
Steinhoff J.P.; Adams A.; Estevez R.; Molin C.J.; Kim C.Y.; Dy J.; Fox
K.E.; Farris N.R.; Wayne J.D.; Whitney R.T.; Randhawa P.M.; Mego D.M.;
MacDolnald L.; Caputo R.P.; Rigolosi R.; VanNatta B.; Pacheco T.R.;
El-Shahawy M.; Gonzalez E.J.; Guice M.J.; Cherlin R.S.; Bays H.E.;
Shoukfeh M.; Morris F.H.; Loy J.; Vora S.K.; Staab P.K.; Frisoli A.;
Kimmel M.A.; Cohen A.J.; Green C.B.; Whitlock L.; Butuk D.J.; McCartney
M.J.; Ables L.R.; Acosta R.; Alvarez J.G.; Barrera C.M.; Benitez O.;
Berenguer R.A.; Breton C.F.; Chiong R.; Delgado M.I.; Dufreny A.; Fialkow
J.A.; Franczek S.; Frias J.J.; Iglesias C.; Landron-Garcia L.; Llerena
S.N.; Martinez R.F.; Miranda A.A.; Morytko J.A.; Rodriguez I.J.; Sotolongo
R.; Suarez-Sarmiento A.; Terrelonge A.E.; Vaca C.E.; Venereo J.M.; Verdeza
C.; Zeno M.L.; Chilka S.; Felten W.R.; Hartman A.N.; Shayani S.S.; Duprez
D.; Knickelbine T.; Chambers J.D.; Cone C.L.; Broughton R.; Napoli M.C.;
Seaton B.L.; Smith S.K.; Reedy M.A.; Kesani M.K.; Nicol P.R.; Stringam
S.O.; Talano J.V.; Barnum O.; Desai V.; Montero M.; Jacks R.K.; Kostis
J.B.; Owen J.G.; Makam S.K.; Grosman I.; Underberg J.A.; Masri B.E.;
Peters S.S.; Serje J.; Lenhard M.J.; Glover R.; Paraboschi C.F.; Lim E.H.;
Connery L.; Kipgen W.; Bravo P.; DiGiovanna M.J.; Tayoum H.; Gabriel J.D.;
Ariani M.K.; Robinson M.F.; Clemens P.C.; Corder C.N.; Schifferdecker B.;
Tahirkheli N.K.; Hurling R.T.; Rendell M.S.; Shivaswamy V.; Madu I.J.;
Dahl C.F.; Ayesu K.; Kim C.; Barettella M.B.; Jamidar H.A.; Bloom S.A.;
Vora K.N.; Ong S.T.; Aggarwala G.; Sack G.; Blaze K.; Krichmar P.; Murcia
A.; Teltser M.; Villaman-Bencosme Y.; Fahdi I.E.; Williams D.G.; Lain
E.L.; Garcia H.L.; Karim S.N.; Francyk D.M.; Gordon M.B.; Palchick B.A.;
McKenzie M.E.; Gimness M.P.; Greiff J.; Ruiz-R L.; Vazquez-Tanus J.B.;
Schlager D.; Connelly T.; Soroka E.; Hastings W.L.; O'Dea D.J.; Purdy
D.A.; Jackson B.; Arcanese M.L.; Strain J.E.; Schmedtje J.F.; Davis M.G.;
Prasada S.; Scott D.L.; Vukotic G.; Akhtar N.; Larsen D.C.; Rhudy J.M.;
Zebrack J.S.; Bailey S.R.; Grant D.C.; Mora A.; Perez J.A.; Reyes R.G.;
Sutton J.C.; Brandon D.M.; First B.P.; Risser J.A.; Claudio J.;
Figueroa-Cruz W.L.; Sosa-Padilla M.A.; Tan A.E.; Traboulssi M.A.; Morcos
N.C.; Glaser L.A.; Bredlau C.E.; El Shahawy M.; Ramos M.J.; Kandath D.D.;
Kaluski E.; Akright L.; Rictor K.W.; Pluto T.M.; Hermany P.R.; Bellingar
B.; Clark G.B.; Herrod J.N.; Goisse M.; Hook M.; Barrington P.; Lentz
J.D.; Singal D.K.; Gleason G.P.; Lipetz R.S.; Schuchard T.N.; Bonner J.H.;
Forgosh L.B.; Lefebvre G.C.; Pierpoint B.E.; Radin D.M.; Stoller S.R.;
Segall N.; Shah S.A.; Ramstad D.S.; Nisnisan J.M.; Trippett J.M.; Benjamin
S.A.; Labissiere J.C.; Nashed A.N.; Maaieh M.; Aslam A.A.; Mandviwala M.;
Budoff M.J.; French W.J.; Vlach J.J.; DeStefano P.; Bayron C.J.; Fraser
N.J.; Sandberg J.H.; Fagan T.C.; Peart B.C.; Suryanarayana P.G.; Gupta
D.K.; Lee M.W.; Bertolet B.D.; Hartley P.A.; Kelberman M.; Behmanesh B.;
Buynak R.J.; Chochinov R.H.; Steinberg A.A.; Chandna H.; Bjasker K.R.;
Perlman R.L.; Ball E.M.; Pock J.; Singh S.; Baldari D.; Kaster S.; Lovell
J.P.; Horowitz B.S.; Gorman T.A.; Pham D.N.; Landzberg J.S.; Mootoo K.I.;
Moon E.; Krawczyk J.; Alfieri A.D.; Janik M.J.; Herrington D.M.;
Koilpillai R.N.; Waxler A.R.; Hoffman D.A.; Sahul Z.H.; Gumbiner B.; Cropp
A.; Fujita K.; Garzone P.; Imai K.; Levisetti M.; Plowchalk D.; Sasson S.;
Skaggs J.; Sweeney K.; Vincent J.
Institution
(Ridker, Glynn) Center for Cardiovascular Disease Prevention, Brigham and
Women's Hospital, Harvard Medical School, 900 Commonwealth Ave., Boston,
MA 02215, United States
(Revkin, Brunell, Curto, Masiukiewicz, Schwartz, Yunis, Shear) Pfizer, New
York, United States
(Amarenco) Paris-Diderot Sorbonne Paris Cite University, Paris, France
(Civeira) Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
(Flather) University of East Anglia, Norwich, United Kingdom
(Soran) Central Manchester University Hospital, Manchester, United Kingdom
(Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Kastelein) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Mosterd) Meander Medical Center, Amersfoort, Netherlands
(Karpov) Russian Cardiology Research and Production Center, Moscow,
Russian Federation
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich Heart Alliance, Munich, Germany
(Lorenzatti) Cordoba Hospital, Cordoba, Argentina
(Manga) University of the Witwatersrand, Johannesburg, South Africa
(Miller) University of Maryland, Baltimore, United States
(Murin) University of Comenius, Bratislava, Slovakia
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Santos) Lipid Clinic Heart Institute, University of Sao Paulo Medical
School Hospital, Sao Paulo, Brazil
(Nissen) Cleveland Clinic Foundation, Cleveland, United States
(Ponikowski) Wroclaw Medical University, Wroclaw, Poland
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wright) Mayo Clinic, Rochester, MN, United States
(Vrablik) First Faculty of Medicine, Charles University, Prague, Czechia
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Bococizumab is a humanized monoclonal antibody that inhibits
proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels
of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the
efficacy of bococizumab in patients at high cardiovascular risk. METHODS
In two parallel, multinational trials with different entry criteria for
LDL cholesterol levels, we randomly assigned the 27,438 patients in the
combined trials to receive bococizumab (at a dose of 150 mg)
subcutaneously every 2 weeks or placebo. The primary end point was
nonfatal myocardial infarction, nonfatal stroke, hospitalization for
unstable angina requiring urgent revascularization, or cardiovascular
death; 93% of the patients were receiving statin therapy at baseline. The
trials were stopped early after the sponsor elected to discontinue the
development of bococizumab owing in part to the development of high rates
of antidrug antibodies, as seen in data from other studies in the program.
The median follow-up was 10 months. RESULTS At 14 weeks, patients in the
combined trials had a mean change from baseline in LDL cholesterol levels
of -56.0% in the bococizumab group and +2.9% in the placebo group, for a
between-group difference of -59.0 percentage points (P<0.001) and a median
reduction from baseline of 64.2% (P<0.001). In the lower-risk,
shorter-duration trial (in which the patients had a baseline LDL
cholesterol level of >=70 mg per deciliter [1.8 mmol per liter] and the
median follow-up was 7 months), major cardiovascular events occurred in
173 patients each in the bococizumab group and the placebo group (hazard
ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the
higher-risk, longer-duration trial (in which the patients had a baseline
LDL cholesterol level of >=100 mg per deciliter [2.6 mmol per liter] and
the median follow-up was 12 months), major cardiovascular events occurred
in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to
0.97; P = 0.02). The hazard ratio for the primary end point in the
combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site
reactions were more common in the bococizumab group than in the placebo
group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials
comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no
benefit with respect to major adverse cardiovascular events in the trial
involving lower-risk patients but did have a significant benefit in the
trial involving higher-risk patients. Copyright © 2017
Massachusetts Medical Society. All rights reserved.

<57>
Accession Number
609203018
Title
Predicting reinterventions after open and endovascular aneurysm repair
using the St George's Vascular Institute score.
Source
Journal of Vascular Surgery. 63(6) (pp 1428-1433.e1), 2016. Date of
Publication: 01 Jun 2016.
Author
Karthikesalingam A.; Holt P.J.; Thompson M.M.; Blankensteijn J.D.; Bak
A.A.A.; Pattynama P.M.; Van Voorthuisen A.E.; Grobbee D.E.; Hunink M.G.;
Van Engelshoven J.M.; Jacobs M.J.H.M.; De Mol B.A.J.M.; Van Bockel J.H.;
Reekers J.; Tielbeek X.; Boekema N.; Heuveling L.M.; Sikking I.; Cuypers
P.W.M.; De Bruin J.L.; Baas A.F.; Prinssen M.; Buth J.; Tielbeek A.V.;
Balm R.; Reekers J.A.; Van Sambeek M.R.H.M.; Pattynama P.; Verhoeven
E.L.G.; Prins T.; Van Der Ham A.C.; Van Der Velden J.J.I.M.; Van
Sterkenburg S.M.M.; Ten Haken G.B.; Bruijninckx C.M.A.; Van Overhagen H.;
Tutein Nolthenius R.P.; Hendriksz T.R.; Teijink J.A.W.; Odink H.F.; De
Smet A.A.E.A.; Vroegindeweij D.; Van Loenhout R.M.M.; Rutten M.J.; Hamming
J.F.; Lampmann L.E.H.; Bender M.H.M.; Pasmans H.; Vahl A.C.; De Vries C.;
MacKaay A.J.C.; Van Dortmont L.M.C.; Van Der Vliet A.J.; Schultze Kool
L.J.; Boomsma J.H.B.; Van H.R.; De Mol Van Otterloo J.C.A.; De Rooij
T.P.W.; Smits T.M.; Yilmaz E.N.; Wisselink W.; Van Den Berg F.G.; Visser
M.J.T.; Van Der Linden E.; Schurink G.W.H.; De Haan M.; Smeets H.J.;
Stabel P.; Van Elst F.; Poniewierski J.; Vermassen F.E.G.
Institution
(De Bruin, Blankensteijn) Division of Vascular Surgery, Department of
Surgery, VU University Medical Center, Amsterdam, Netherlands
(De Bruin, Karthikesalingam, Holt, Thompson) Division of Vascular Surgery,
St George's Vascular Institute, St George's Healthcare NHS Trust, St James
Wing, Blackshaw Rd, London SW17 0QT, United Kingdom
(Prinssen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
Publisher
Elsevier Inc.
Abstract
Background Identifying patients at risk for aneurysm rupture and sac
expansion after open and endovascular abdominal aortic aneurysm (AAA)
repair (EVAR) may help to attenuate this risk by intensifying follow-up
and early detection of problems. The goal of this study was to validate
the St George's Vascular Institute (SGVI) score to identify patients at
risk for a secondary intervention after elective aneurysm repair. Methods
A post hoc on-treatment analysis of a randomized trial comparing open AAA
repair and EVAR was performed. In this multicenter trial, 351 patients
were randomly assigned to undergo open AAA repair or EVAR. Information on
survival and reinterventions was available for all patients at 5 years
postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair
was completed in 173 patients and EVAR in 171, based on an on-treatment
analysis. Because 17 patients had incomplete anatomic data, 327 patients
(157 open repair and 170 EVAR) were available for analysis. During 6 years
of follow-up, 78 patients underwent at least one reintervention. The SGVI
score, which is calculated from preoperative AAA morphology using aneurysm
and iliac diameter, predictively dichotomized patients into groups at
high-risk or low-risk for a secondary intervention. The observed freedom
from reintervention was compared between groups at predicted high-risk and
predicted low-risk. Results The 20 patients in the high-risk group were
indeed at higher risk for a secondary intervention compared with the 307
patients predicted to be at low risk (hazard ratio [HR], 3.82; 95%
confidence interval [CI], 2.05-7.11; P <.001). Discrimination between
high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI,
1.93-8.51; P <.001) and for open repair (HR, 3.41; 95% CI, 1.02-11.4; P
=.033). Conclusions The SGVI score appears to be a useful tool to predict
reintervention risk in patients after open repair and EVAR. Copyright
© 2016 Society for Vascular Surgery.

<58>
Accession Number
2014405921
Title
Biological Equivalence of GGTA-1 Glycosyltransferase Knockout and Standard
Porcine Pericardial Tissue Using 90-Day Mitral Valve Implantation in
Adolescent Sheep.
Source
Cardiovascular Engineering and Technology. 13(3) (pp 363-372), 2022. Date
of Publication: June 2022.
Author
McGregor C.; Salmonsmith J.; Burriesci G.; Byrne G.
Institution
(McGregor, Byrne) Institute of Cardiovascular Science, University College
London, London, United Kingdom
(McGregor, Salmonsmith, Byrne) Department of Surgery, University of
Minnesota, 8195B, MMC 195 Mayo, Minneapolis, MN 55455, United States
(Salmonsmith, Burriesci) Department of Mechanical Engineering, University
College London, London, United Kingdom
(Burriesci) Ri.MED Foundation, Bioengineering Group, Palermo, Italy
Publisher
Springer
Abstract
Objective: There is growing interest in the application of genetically
engineered reduced antigenicity animal tissue for manufacture of
bioprosthetic heart valves (BHVs) to reduce antibody induced tissue
calcification and accelerated structural valve degeneration (SVD). This
study tested biological equivalence of valves made from Gal-knockout
(GalKO) and standard porcine pericardium after 90-day mitral valve
implantation in sheep. Method(s): GalKO (n = 5) and standard (n = 5)
porcine pericardial BHVs were implanted in a randomized and blind fashion
into sheep for 90-days. Valve haemodynamic function was measured at 30-day
intervals. After explantation, valves were examined for pannus,
vegetation, inflammation, thrombus, and tissue calcification.
 Result(s): Nine of 10 recipients completed the study. There was no
difference between study groups for haemodynamic performance and no
adverse valve-related events. Explanted BHVs showed mild pannus
integration and minimal thrombus, with no difference between the groups.
Limited focal mineral deposits were detected by x-ray. Atomic spectroscopy
analysis detected tissue calcium levels of 1.0 microg/mg +/- 0.2 for GalKO
BHVs and 1.9 microg/mg +/- 0.9 for standard tissue BHVs (p = 0.4),
considered to be both low and equivalent. Conclusion(s): This is the
first demonstration of biological equivalence between GalKO and standard
pig pericardium. The GalKO mutation causes neither intrinsic detrimental
biological nor functional impact on BHV performance. Commercial adaptation
of GalKO tissue for surgical or transcatheter BHVs would remove the
clinical disparity between patients producing anti-Gal antibody and BHVs
containing the Gal antigen. GalKO BHVs may reduce accelerated tissue
calcification and SVD, enhancing patient choices, especially for younger
patients. Graphical Abstract: [Figure not available: see
fulltext.]. Copyright © 2021, The Author(s).

<59>
Accession Number
635866431
Title
Effect of Remote Ischemic Conditioning on Bleeding Complications in
Surgery: A Systematic Review and Meta-Analysis.
Source
Seminars in Thrombosis and Hemostasis. 48(2) (pp 229-239), 2022. Date of
Publication: 01 Mar 2022.
Author
Krag A.E.; Hvas C.L.; Kiil B.J.; Hvas A.-M.
Institution
(Krag, Hvas) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
(Krag, Hvas) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
(Krag, Kiil) Department of Plastic and Breast Surgery, Aarhus University
Hospital, Denmark
(Hvas) Department of Anesthesiology and Intensive Care, Aarhus University
Hospital, Denmark
Publisher
Thieme Medical Publishers, Inc.
Abstract
Remote ischemic conditioning (RIC) is administered with an inflatable
tourniquet by inducing brief, alternating cycles of limb ischemia and
reperfusion. RIC possibly impacts the hemostatic system, and the
intervention has been tested as protective therapy against
ischemia-reperfusion injury and thrombotic complications in cardiac
surgery and other surgical procedures. In the present systematic review,
we aimed to investigate the effect of RIC on intraoperative and
postoperative bleeding complications in meta-analyses of randomized
controlled trials including adult patients undergoing surgery. A
systematic search was performed on November 7, 2020 in PubMed, Embase, and
the Cochrane Central Register of Controlled Trials. Randomized controlled
trials comparing RIC versus no RIC in adult patients undergoing surgery
that reported bleeding outcomes in English publications were included.
Effect estimates with 95% confidence intervals were calculated using the
random-effects model for intraoperative and postoperative bleeding
outcomes. Thirty-two randomized controlled trials with 3,804 patients were
eligible for inclusion. RIC did not affect intraoperative bleeding volume
(nine trials; 392 RIC patients, 399 controls) with the effect
estimate-0.95 [-9.90; 7.99] mL (p = 0.83). RIC significantly reduced
postoperative drainage volume (seven trials; 367 RIC patients, 365
controls) with mean difference-83.6 [-134.9;-32.4] mL (p = 0.001). The
risk of re-operation for bleeding was reduced in the RIC group (16 trials;
838 RIC patients, 839 controls), albeit not significantly, with the
relative risk 0.65 [0.39; 1.09] (p = 0.10). In conclusion, RIC reduced
postoperative bleeding measured by postoperative drainage volume in this
meta-analysis of adult patients undergoing surgery. Copyright ©
2021 Thieme. All rights reserved. Thieme Medical Publishers, Inc.

<60>
Accession Number
2018855731
Title
Longer term benefits of exercise and escitalopram in the treatment of
anxiety in patients with coronary heart disease: Six month follow-up of
the UNWIND randomized clinical trial.
Source
American Heart Journal. 251 (pp 91-100), 2022. Date of Publication:
September 2022.
Author
Blumenthal J.A.; Smith P.J.; Jiang W.; Hinderliter A.; Watkins L.L.;
Hoffman B.M.; Kraus W.E.; Mabe S.; Liao L.; Davidson J.; Sherwood A.
Institution
(Blumenthal, Smith, Jiang, Watkins, Hoffman, Mabe, Davidson, Sherwood)
Department of Psychiatry and Behavioral Sciences, Duke University Medical
Center, Durham, NC
(Hinderliter) Department of Medicine, University of North Carolina at
Chapel Hill, Chapel Hill, NC, United States
(Kraus, Liao) Department of Medicine, Duke University Medical Center,
Durham, NC
Publisher
Elsevier Inc.
Abstract
Background: Anxiety is a common comorbidity in patients with coronary
heart disease (CHD) and is associated with worse prognosis. However,
effective treatment for anxiety in CHD patients is uncertain. The UNWIND
randomized clinical trial showed that 12-week treatment of escitalopram
was better than exercise training or placebo in reducing anxiety in
anxious CHD patients. The longer-term benefits of treatment for anxiety
are not known. Method(s): Patients were randomized to 12 weeks of
Escitalopram (up to 20 mg), Exercise (3 times/wk), or placebo pill. At the
conclusion of treatment, participants were followed for 6-months to
determine the persistence of benefit on the primary anxiety endpoint
assessed by the Hospital Anxiety and Depression Scale-Anxiety scale
(HADS-A) and to assess the effects of treatment on major adverse cardiac
events over a follow-up period of up to 6 years. Result(s): Of the
128 participants initially randomized, 120 (94%) were available for
follow-up. Participants randomized to the Escitalopram condition exhibited
lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to
Exercise (5.5 [4.6, 6.3]) (P =.007) and Placebo (5.3 [4.1, 6.5]) (P
=.053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were
29 adverse events but no significant between-group differences.
 Conclusion(s): In the UNWIND trial, 12 weeks of escitalopram
treatment was effective in reducing anxiety. These beneficial effects were
sustained for 6 months posttreatment. Although moderate or vigorous
physical activity has a number of health benefits, exercise was not an
effective treatment for anxiety in patients with CHD. Copyright ©
2022 Elsevier Inc.

<61>
Accession Number
2016092562
Title
Valve-in-valve transcatheter aortic valve replacement or re-surgical
aortic valve replacement in degenerated bioprostheses: A systematic review
and meta-analysis of short and midterm results.
Source
Catheterization and Cardiovascular Interventions. 100(1) (pp 122-130),
2022. Date of Publication: July 1, 2022.
Author
Bruno F.; Elia E.; D'Ascenzo F.; Marengo G.; Deharo P.; Kaneko T.; Cuisset
T.; Fauchier L.; De Filippo O.; Gallone G.; Andreis A.; Fortuni F.;
Salizzoni S.; La Torre M.; Rinaldi M.; De Ferrari G.M.; Conrotto F.
Institution
(Bruno, Elia, D'Ascenzo, Marengo, De Filippo, Gallone, Andreis, Fortuni,
De Ferrari, Conrotto) Division of Cardiology, Department Cardiovascular
and Thoracic, Citta della Salute e della Scienza Hospital, University of
Turin, Turin, Italy
(Deharo, Cuisset) Departement de Cardiologie, CHU Timone, Marseille,
France
(Deharo, Cuisset) INSRRM, INRA, Aix Marseille University, Marseille,
France
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Fauchier) Service de Cardiologie, Centre Hospitalier Trousseau, Tours,
France
(Salizzoni, La Torre, Rinaldi) Division of Cardiosurgery, Department of
Cardiovascular and Thoracic, Citta della Salute e della Scienza Hospital,
University of Turin, Turin, Italy
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Despite limited to short and midterm outcomes,
valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has
emerged as a valid alternative to re-surgical aortic valve replacement
(re-SAVR) for high- and intermediate-risk patients with degenerated
surgical bioprosthesis. Method(s): All studies comparing multivariate
adjustment between ViV TAVI and re-SAVR were screened. The primary
end-points were all-cause and cardiovascular (CV) mortality at 30 days and
at Midterm follow-up. Short-term complications were the secondary
endpoints. Result(s): We obtained data from 11 studies, encompassing
8570 patients, 4224 undergoing ViV TAVI, and 4346 re-SAVR. Four studies
included intermediate-risk patients and seven high-risk patients. 30-day
all-cause and CV mortality were significantly lower in ViV (odds ratio
[OR] 0.43, 95% confidence intervals [CIs] 0.29-0.64 and OR 0.44, 0.26-0.73
respectively), while after a mean follow-up of 717 (180-1825) days, there
was no difference between the two groups (OR 1.04, 0.87-1.25 and OR 1.05,
0.78-1.43, respectively). The risk of stroke (OR 1.03, 0.59-1.82), MI (OR
0.70, 0.34-1.44), major vascular complications (OR 0.92, 0.50-1.67), and
permanent pacemaker implantation (OR 0.67, 0.36-1.25) at 30 days did not
differ, while major bleedings and new-onset atrial fibrillation were
significantly lower in ViV patients (OR 0.41, 0.25-0.67 and OR 0.23,
0.12-0.42, respectively, all 95% CIs). Conclusion(s): In high- and
intermediate-risk patients with degenerated surgical bioprostheses, ViV
TAVI is associated with reduced short-term mortality, compared with
re-SAVR. Nevertheless, no differences were found in all-cause and CV
mortality at midterm follow-up. PROSPERO CRD42021226488. Copyright
© 2022 Wiley Periodicals LLC.

<62>
Accession Number
2015888685
Title
Tissue Doppler echocardiography in children with OSA before and after
tonsillectomy and adenoidectomy: A systematic review and meta-analysis.
Source
International Journal of Pediatric Otorhinolaryngology. 152 (no
pagination), 2022. Article Number: 111002. Date of Publication: January
2022.
Author
Poupore N.S.; Gudipudi R.; Nguyen S.A.; Pecha P.P.; Pecha T.J.; Carroll
W.W.
Institution
(Poupore, Gudipudi, Nguyen, Pecha, Carroll) Medical University of South
Carolina, Department of Otolaryngology - Head and Neck Surgery, 135
Rutledge Avenue, MSC550, Charleston, SC 29425, United States
(Poupore) University of South Carolina School of Medicine Greenville, 607
Grove Road, Greenville, SC 29605, United States
(Gudipudi) Case Western Reserve University School of Medicine, 9501 Euclid
Ave, Cleveland, OH 44106, United States
(Pecha) Medical University of South Carolina, Department of Anesthesia and
Perioperative Medicine, 167 Ashley Avenue, MSC912, Charleston, SC 29425,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: When to order an echocardiogram in children with obstructive
sleep apnea (OSA) is debated. Studies evaluating the utility of
pre-operative standard echocardiography are inconsistent. Tissue Doppler
imaging (TDI) is an additional technique that quantifies the velocity of
myocardial motion to assess cardiac function. The utility of TDI in
pediatric OSA remains unclear. Method(s): A systematic review and
meta-analysis were performed in accordance with PRISMA guidelines using
PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of
echocardiographic findings using TDI in children with polysomnogram
confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were
included. 1,423 studies were screened, and 4 studies met inclusion
criteria. Meta-analysis of echocardiographic findings was performed.
 Result(s): Data from 560 children were analyzed. Study groups
included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A
S' wave at the tricuspid annulus (S' RV) was decreased with a mean
difference of -1.04 [95% CI -1.57, -0.52, p < 0.001] and E'/A' ratio at
the mitral annulus (E'/A' LV) was decreased with a mean difference of
-0.74 [95% CI -0.85, -0.64, p < 0.001] when compared to controls. These
variables were not statistically different when comparing post-T&A to
controls. Conclusion(s): TDI appears to successfully detect
subclinical changes in cardiac function in children with OSA. However,
echocardiography parameters of post-T&A and non OSA control children were
similar. Further prospective studies stratified by OSA severity are needed
with both TDI and standard echocardiography to define the utility of
pre-operative cardiac imaging. Copyright © 2021 Elsevier B.V.

<63>
Accession Number
2018298413
Title
Clinical and Echocardiographic Outcomes of Transcatheter Tricuspid Valve
Interventions: A Systematic Review and Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 919395. Date of Publication: 11 Jul 2022.
Author
Sannino A.; Ilardi F.; Hahn R.T.; Lancellotti P.; Lurz P.; Smith R.L.;
Esposito G.; Grayburn P.A.
Institution
(Sannino, Smith, Grayburn) The Heart Hospital Baylor Plano, Plano, TX,
United States
(Sannino, Ilardi, Esposito) Department of Advanced Biomedical Sciences,
University Federico II, Naples, Italy
(Ilardi) Mediterranea Cardiocentro, Naples, Italy
(Hahn) Division of Cardiology, Columbia University Irving Medical Center,
New York, NY, United States
(Lancellotti) Department of Cardiology and Radiology, GIGA Cardiovascular
Sciences, CHU SartTilman, University of Liege Hospital, Liege, Belgium
(Lancellotti) Gruppo Villa Maria Care and Research, Lugo, Italy
(Lurz) Department of Internal Medicine/Cardiology, Heart Center Leipzig at
University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
Publisher
Frontiers Media S.A.
Abstract
Background: Medically managed tricuspid regurgitation (TR) has detrimental
outcomes. Transcatheter tricuspid valve interventions (TTVIs) represent an
alternative to surgery in high-risk patients; however, only early
experiences exist. Aim(s): The aim of this study was to analyze the
clinical and echocardiographic outcomes of TTVI. Method(s): MEDLINE,
ISI Web of Science, and SCOPUS databases were searched for studies
published up to June 2021. Studies reporting data on outcome post-TTVIs
were included. This study was designed according to Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The
primary endpoint was all-cause mortality at 30-day and 1-year post-TTVI.
 Result(s): Out of 2,718 studies, 27 were included. Notably, 30-day
and 1-year all-cause mortalities were 5% (95% confidence interval [CI]:
4-8%, p < 0.001) and 25% (95% CI: 12-45%, p = 0.016). Procedural success
was associated with a 58% risk reduction in 1-year mortality vs. lack
thereof (odds ratio 0.42, 95% CI: 0.27-0.66, p < 0.001). TTVI is
associated with a significant reduction in TR severity (TR EROA, mean
difference [MD] 0.31 cm2; 95% CI: 0.23-0.39 cm2, p <
0.001; regurgitant volume, MD 23.54 ml; 95% CI: 17.4-29.68 ml, p = 0.03)
and increase in forward stroke volume (FSV, MD 3.98 ml; 95% CI: 0.11-7.86
ml, p = 0.04). Conclusion(s): TTVI significantly reduces TR severity
and increases FSV and is associated with improved survival at 1 year
compared with patients without procedural success. Long-term outcomes
compared with medical therapy await the results of ongoing pivotal trials;
nonetheless, TTVIs appear to be a promising alternative to surgery for
TR. Copyright © 2022 Sannino, Ilardi, Hahn, Lancellotti, Lurz,
Smith, Esposito and Grayburn.

<64>
Accession Number
2017453491
Title
Reply to comment on "Cardiovascular safety of febuxostat compared to
allopurinol for the treatment of gout: A systematic and meta-analysis".
Source
Clinical Cardiology. 45(7) (pp 687-690), 2022. Date of Publication: July
2022.
Author
Gao L.; Wang B.; Cheng R.
Institution
(Gao, Wang, Cheng) Department of Comprehensive Surgery, General Hospital
of Chinese People's Liberation Army & National Clinical Research Center
for Geriatric Disease, Beijing, China
Publisher
John Wiley and Sons Inc

<65>
Accession Number
2015455465
Title
Heart Team risk assessment with angiography-derived fractional flow
reserve determining the optimal revascularization strategy in patients
with multivessel disease: Trial design and rationale for the DECISION QFR
randomized trial.
Source
Clinical Cardiology. 45(6) (pp 605-613), 2022. Date of Publication: June
2022.
Author
Miyata K.; Asano T.; Saito A.; Abe K.; Tanigaki T.; Hoshino M.; Kobayashi
T.; Takaoka Y.; Kanie T.; Yamasaki M.; Yoshino K.; Wakabayashi N.; Ouchi
K.; Kodama H.; Shiina Y.; Tamaki R.; Nishihata Y.; Masuda K.; Suzuki T.;
Nonaka H.; Emori H.; Katagiri Y.; Miyazaki Y.; Sotomi Y.; Yasunaga M.;
Kogame N.; Kuramitsu S.; Reiber J.H.C.; Okamura T.; Higuchi Y.; Kakuta T.;
Misumi H.; Komiyama N.; Matsuo H.; Tanabe K.
Institution
(Miyata, Asano, Saito, Takaoka, Kanie, Kodama, Shiina, Nishihata, Masuda,
Suzuki, Komiyama) Department of Cardiovascular Medicine, St. Luke's
International Hospital, St. Luke's International University, Tokyo, Japan
(Abe, Yamasaki, Yoshino, Tamaki, Misumi) Department of Cardiovascular
Surgery, St. Luke's International Hospital, St. Luke's International
University, Tokyo, Japan
(Tanigaki, Matsuo) Department of Cardiovascular Medicine, Gifu Heart
Center, Gifu, Japan
(Hoshino, Kakuta) Division of Cardiovascular Medicine, Tsuchiura Kyodo
General Hospital, Ibaraki, Japan
(Kobayashi, Yasunaga, Higuchi) Department of Cardiology, Osaka Police
Hospital, Osaka, Japan
(Wakabayashi, Ouchi) Department of Radiology, St. Luke's International
Hospital, St. Luke's International University, Tokyo, Japan
(Nonaka, Tanabe) Division of Cardiology, Mitsui Memorial Hospital, Tokyo,
Japan
(Emori) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Katagiri) Department of Cardiovascular Medicine, Sapporo Higashi
Tokushukai Hospital, Sapporo, Japan
(Miyazaki, Okamura) Division of Cardiology, Department of Medicine and
Clinical Science, Yamaguchi University Graduate School of Medicine,
Yamaguchi, Japan
(Sotomi) Department of Cardiovascular Medicine, Osaka University Graduate
School of Medicine, Osaka, Japan
(Kogame) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, Tokyo, Meguro, Japan
(Kuramitsu) Department of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Reiber) Department of Radiology, Leiden University Medical Center,
Leiden, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
In patients with multivessel disease (MVD), functional information on
lesions improves the prognostic capability of the SYNTAX score.
Quantitative flow ratio (QFR) is an angiography-derived fractional flow
reserve (FFR) that does not require a pressure wire or pharmacological
hyperemia. We aimed to investigate the feasibility of QFR-based patient
information in Heart Teams' discussions to determine the optimal
revascularization strategy for patients with MVD. We hypothesized that
there is an acceptable agreement between treatment recommendations based
on the QFR approach and recommendation based on the FFR approach. The
DECISION QFR study is a prospective, multicenter, randomized controlled
trial that will include patients with MVD who require revascularization.
Two Heart Teams comprising cardiologists and cardiac surgeons will be
randomized to select a revascularization strategy (percutaneous coronary
intervention or coronary artery bypass graft) according to patient
information either based on QFR or on FFR. All 260 patients will be
assessed by both teams with reference to the anatomical and functional
SYNTAX score/SYNTAX score II 2020 derived from the allocated physiological
index (QFR or FFR). The primary endpoint of the trial is the level of
agreement between the treatment recommendations of both teams, assessed
using Cohen's kappa. As of March 2022, the patient enrollment has been
completed and 230 patients have been discussed in both Heart Teams. The
current trial will indicate the usefulness of QFR, which enables a
wireless multivessel physiological interrogation, in the discussions of
Heart Teams to determine the optimal revascularization strategy for
MVD. Copyright © 2022 The Authors. Clinical Cardiology published
by Wiley Periodicals, LLC.

<66>
Accession Number
2017088168
Title
Genetically Encoded ATP Biosensors for Direct Monitoring of Cellular ATP
Dynamics.
Source
Cells. 11(12) (no pagination), 2022. Article Number: 1920. Date of
Publication: June-2 2022.
Author
White D.; Yang Q.
Institution
(White, Yang) Cardiovascular Center of Excellence, Louisiana State
University Health Sciences Center, New Orleans, LA 70112, United States
(White, Yang) Department of Pharmacology and Experimental Therapeutics,
School of Graduate Studies, Louisiana State University Health Sciences
Center, New Orleans, LA 70112, United States
(White) School of Medicine, Louisiana State University Health Sciences
Center, New Orleans, LA 70112, United States
Publisher
MDPI
Abstract
Adenosine 5'-triphosphate, or ATP, is the primary molecule for
storing and transferring energy in cells. ATP is mainly produced via
oxidative phosphorylation in mitochondria, and to a lesser extent, via
glycolysis in the cytosol. In general, cytosolic glycolysis is the primary
ATP producer in proliferative cells or cells subjected to hypoxia. On the
other hand, mitochondria produce over 90% of cellular ATP in
differentiated cells under normoxic conditions. Under pathological
conditions, ATP demand rises to meet the needs of biosynthesis for
cellular repair, signaling transduction for stress responses, and
biochemical processes. These changes affect how mitochondria and cytosolic
glycolysis function and communicate. Mitochondria undergo remodeling to
adapt to the imbalanced demand and supply of ATP. Otherwise, a severe ATP
deficit will impair cellular function and eventually cause cell death. It
is suggested that ATP from different cellular compartments can dynamically
communicate and coordinate to adapt to the needs in each cellular
compartment. Thus, a better understanding of ATP dynamics is crucial to
revealing the differences in cellular metabolic processes across various
cell types and conditions. This requires innovative methodologies to
record real-time spatiotemporal ATP changes in subcellular regions of
living cells. Over the recent decades, numerous methods have been
developed and utilized to accomplish this task. However, this is not an
easy feat. This review evaluates innovative genetically encoded biosensors
available for visualizing ATP in living cells, their potential use in the
setting of human disease, and identifies where we could improve and expand
our abilities. Copyright © 2022 by the authors. Licensee MDPI,
Basel, Switzerland.

<67>
Accession Number
2018219792
Title
Home-based prehabilitation with exercise to improve postoperative recovery
for older adults with frailty having cancer surgery: the PREHAB randomised
clinical trial.
Source
British Journal of Anaesthesia. 129(1) (pp 41-48), 2022. Date of
Publication: July 2022.
Author
McIsaac D.I.; Hladkowicz E.; Bryson G.L.; Forster A.J.; Gagne S.; Huang
A.; Lalu M.; Lavallee L.T.; Moloo H.; Nantel J.; Power B.;
Scheede-Bergdahl C.; van Walraven C.; McCartney C.J.L.; Taljaard M.
Institution
(McIsaac, Bryson, Gagne, Lalu, McCartney) Department of Anesthesiology &
Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON,
Canada
(McIsaac, Hladkowicz, Bryson, Forster, Gagne, Huang, Lalu, Lavallee,
Moloo, Power, van Walraven, McCartney, Taljaard) Clinical Epidemiology
Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
(McIsaac, Taljaard) School of Epidemiology & Public Health, University of
Ottawa, Ottawa, ON, Canada
(Hladkowicz) School of Rehabilitation Therapy, Queen's University,
Kingston, ON, Canada
(Forster) Division of General Internal Medicine, University of Ottawa and
the Ottawa Hospital, Ottawa, ON, Canada
(Huang, Power) Division of Geriatric Medicine, University of Ottawa and
the Ottawa Hospital, Ottawa, ON, Canada
(Lavallee) Division of Urology and University of Ottawa and the Ottawa
Hospital, Ottawa, ON, Canada
(Moloo) Division of General Surgery, University of Ottawa and the Ottawa
Hospital, Ottawa, ON, Canada
(Nantel) School of Human Kinetics, Faculty of Health Sciences, University
of Ottawa, Ottawa, ON, Canada
(Scheede-Bergdahl) Department of Kinesiology and Physical Education,
McGill University, Montreal, QC, Canada
(van Walraven) Department of Medicine, University of Ottawa and the Ottawa
Hospital, Ottawa, ON, Canada
(van Walraven) Institute for Clinical Evaluative Sciences, University of
Ottawa, Ottawa, ON, Canada
Publisher
Elsevier Ltd
Abstract
Background: Frailty is a state of vulnerability as a result of decreased
reserves. Prehabilitation may increase reserve and improve postoperative
outcomes. Our objective was to determine if home-based prehabilitation
improves postoperative functional recovery in older adults with frailty
having cancer surgery. Method(s): This double blind randomised trial
enrolled people >=60 yr having elective cancer surgery and >=3 weeks from
enrolment to surgery as eligible. Participation in a remotely supported,
home-based exercise prehabilitation program plus nutritional guidance was
compared with standard care plus written advice on age-appropriate
activity and nutrition. The primary outcome was 6-min walk test (6MWT)
distance at the first postoperative clinic visit. Secondary outcomes
included physical performance, quality of life, disability, length of
stay, non-home discharge, and 30-day readmission. Result(s): Of 543
patients assessed, 254 were eligible and 204 (80%) were randomised (102
per arm); 182 (94 intervention and 88 control) had surgery and were
analysed. Mean age was 74 yr and 57% were female. Mean duration of
participation was 5 weeks, mean adherence was 61% (range 0%-100%). We
found no significant difference in 6MWT at follow-up (+14 m, 95%
confidence interval -26-55 m, P=0.486), or for secondary outcomes.
Analyses using a prespecified adherence definition of >=80% supported
improvements in 6MWT distance, complication count, and disability.
 Conclusion(s): A home-based prehabilitation program did not
significantly improve postoperative recovery or other outcomes in older
adults with frailty having cancer surgery. Program adherence may be a key
mediator of prehabilitation efficacy. Clinical trial registration: NCT
02934230. Copyright © 2022

<68>
Accession Number
2017978415
Title
Pharmacokinetics and Safety of Erenumab after a Single Subcutaneous
Injection Dose in Healthy Chinese Subjects.
Source
Clinical Drug Investigation. 42(7) (pp 623-630), 2022. Date of
Publication: July 2022.
Author
Shen Q.; Jin Y.; Di X.; Hu C.; Liu R.; Qi X.; Wang Y.; Wang Z.
Institution
(Shen, Jin, Di, Hu, Liu, Wang, Qi, Wang, Wang) Clinical Trial Center/NMPA
Key Laboratory for Clinical Research and Evaluation of Innovative Drug,
West China Hospital of Sichuan University, No.5 Telecom Road, Wuhou
District, Chengdu 610041, China
Publisher
Adis
Abstract
Background and Objective: Erenumab is the first-in-class, selective, and
competitive human monoclonal antibody antagonist of the calcitonin
gene-related peptide (CGRP) receptor that has been shown to be effective
and well-tolerated in the preventive therapy of episodic and chronic
migraine. The pharmacokinetics of erenumab may be affected by differences
in race and ethnicity, which can lead to suboptimal outcomes. The present
study was conducted to assess the single-dose pharmacokinetics and safety
of erenumab in healthy Chinese subjects. Method(s): This was an
open-label, randomized, parallel group, non-confirmatory, single-dose
study in healthy Chinese subjects. A total of 24 healthy Chinese subjects
of both sexes aged between 14 and 45 years were administered a single
subcutaneous injection of erenumab 70 mg or 140 mg. The serum
concentration of erenumab was quantified using a validated enzyme-linked
immunosorbent assay method and pharmacokinetic parameters were determined
using non-compartmental models. Safety was also assessed. Result(s):
A total of 55 subjects were screened for eligibility and 25 subjects were
randomized to receive study treatments (12 subjects to the 70-mg erenumab
group and 13 subjects to the 140-mg erenumab group). Erenumab was absorbed
slowly with maximum serum concentration (C<inf>max</inf>) occurring 3-11
days after administration. The mean C<inf>max</inf> and area under the
serum concentration versus time curve from time 0 to infinity with
extrapolation of the terminal phase (AUC<inf>0-</inf>) were 9.20 microg/mL
and 296 day.microg/mL for the 70 mg dose group, and 15.6 microg/mL and 569
day.microg/mL for the 140 mg dose group, respectively. Serum
concentrations of erenumab exhibited low to high variability, with
variable coefficients ranging from 17.1 to 72.2% for the 70-mg dose and
32.5 to 88.5% for the 140-mg dose. All adverse events were mild or
moderate in intensity, and all resolved without intervention.
 Conclusion(s): Erenumab was safe and well tolerated after a single
subcutaneous injection in healthy Chinese subjects. The systemic exposure
in Chinese subjects in terms of AUC<inf>0-</inf> was 70% higher than that
in White subjects as previously reported. Chinese Clinical Trial Registry
no.: ChiCTR2000032435. Copyright © 2022, The Author(s), under
exclusive licence to Springer Nature Switzerland AG.

<69>
Accession Number
2017683597
Title
Mechanical or biologic prostheses for mitral valve replacement: A
systematic review and meta-analysis.
Source
Clinical Cardiology. 45(7) (pp 701-716), 2022. Date of Publication: July
2022.
Author
Yu J.; Qiao E.; Wang W.
Institution
(Yu, Qiao, Wang) Department of Structural Heart Disease, Fu Wai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Either a mechanical or bioprosthetic valve is used in patients undergoing
mitral valve replacement (MVR). However, the optimal mitral prosthesis
remains controversial. The aim of this meta-analysis was thus to compare
outcomes between mechanical mitral valve replacement (MVRm) and
bioprosthetic mitral valve replacement (MVRb) for MVR patients. We
searched Embase, PubMed, Web of Science, and Cochrane Library databases
from January 1, 2000 to October 31, 2021 for studies that directly
compared surgical outcomes of MVRm and MVRb. A total of 22 studies with 35
903 patients were included in the meta-analysis (n = 23 868 MVRm and n =
12 035 MVRb). The MVRm group displayed lower long-term all causes
mortality (HR, 0.84; 95% confidence interval [CI]: 0.77-0.91; p <.0001; I2
= 51%), and fewer mitral reoperation (hazard ratio [HR]: 0.34; 95% CI:
0.23-0.50; p <.00001; I2 = 74%) than MVRb group. However, the MVRm group
was associated with a greater risk of major bleeding events (HR: 1.21; 95%
CI: 1.14-1.29; p <.00001; I2 = 0%), stroke and systemic embolism (HR:
1.20; 95% CI: 1.10-1.32; p <.0001; I2 = 0%) in matched or adjusted data.
No significant difference was observed between MVRm and MVRb on operative
mortality in matched/adjusted group (risk ratios: 0.83; 95% CI: 0.66-1.05;
p =.12; I2 = 0%). The results were consistent with patients aged under 70
years old. Patients who received a MVRm is associated with 16% lower risk
of long-term mortality and 66% lower risk of mitral reoperation, but 20%
greater risk of stroke or systemic embolism, 21% greater risk of major
bleeding compared with MVRb in matched/adjusted studies group, which were
consistent to patients younger than the age of 70 years who underwent
MVR. Copyright © 2022 The Authors. Clinical Cardiology published
by Wiley Periodicals LLC.

<70>
Accession Number
2018294523
Title
The Safety and Efficacy of Inspiratory Muscle Training for Patients With
Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention:
Study Protocol for a Randomized Controlled Trial.
Source
Frontiers in Cardiovascular Medicine. 7 (no pagination), 2021. Article
Number: 598054. Date of Publication: 12 Jan 2021.
Author
Liu Y.; Dai Y.; Liu Z.; Zhan H.; Zhu M.; Chen X.; Zhang S.; Zhang G.; Xue
L.; Duan C.; Chen J.; Guo L.; He P.; Tan N.
Institution
(Liu, Dai, Liu, Zhan, Zhu, Chen, Zhang, Zhang, Xue, Chen, Guo, He, Tan)
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong
Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong
Provincial People's Hospital, Guangdong Academy of Medical Sciences,
Guangzhou, China
(Duan) Department of Biostatistics, School of Public Health, Southern
Medical University, Guangzhou, China
Publisher
Frontiers Media S.A.
Abstract
Background: Uncommonly high rates of pneumonia in patients with acute
myocardial infarction (AMI) undergoing primary percutaneous coronary
intervention (PCI) have been observed during recent years. Inspiratory
muscle training (IMT) could reduce pneumonia in patients undergoing
coronary artery bypass grafting and other cardiac surgeries. The
relationship between IMT and AMI is unknown. Here, we describe the
feasibility and potential benefit of IMT in patients at high risk for
pneumonia with AMI who have undergone primary PCI. Method(s): Our
study is a prospective, randomized, controlled, single-center clinical
trial. A total of 60 participants will be randomized into an IMT group and
control group with 30 participants in each group. Participants in the IMT
group will undergo training for 15 min per session, twice a day, from 12
to 24 h after primary PCI, until 30 days post-randomization; usual care
will be provided for the control group. The primary endpoint is the change
in inspiratory muscle strength, the secondary endpoint included
feasibility, pneumonia, major adverse cardiovascular events, length of
stay, pulmonary function tests measure, and quality of life.
 Discussion(s): Our study is designed to evaluate the feasibility of
IMT and its effectiveness in improving inspiratory muscle strength in
participants with AMI who have undergone primary PCI. Clinical Trial
Registration: www.ClinicalTrials.gov, identifier:
NCT04491760. Copyright © 2021 Liu, Dai, Liu, Zhan, Zhu, Chen,
Zhang, Zhang, Xue, Duan, Chen, Guo, He and Tan.

<71>
Accession Number
2018264887
Title
Early and midterm outcomes of transcatheter aortic-valve replacement with
balloon-expandable versus self-expanding valves: A meta-analysis.
Source
Journal of Cardiology. 80(3) (pp 204-210), 2022. Date of Publication:
September 2022.
Author
Zhang X.-L.; Wei Z.-H.; Wang H.-W.; Xu W.; Wang Y.; Xu B.
Institution
(Zhang, Wei, Xu, Xu) Department of Cardiology, Affiliated Drum Tower
Hospital, Nanjing University School of Medicine, Nanjing, China
(Wang, Wang) State Key Laboratory of Chemistry for Life Science, Jiangsu
Key Laboratory of Molecular Medicine, Medical School, Nanjing University,
Nanjing, China
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Current guidelines provide recommendation for transcatheter
aortic-valve replacement (TAVR) in severe aortic stenosis without emphasis
on valve systems. The comparative performances of balloon-expandable
valves (BEV) and self-expanding valves (SEV) remain unclear. We aim to
compare the early (30-day) and midterm (1-year) mortality and
cardiovascular outcomes of BEV with SEV. Method(s): PubMed, CENTRAL,
and EMBASE were searched from inception to February 13, 2020 for
randomized controlled trials (RCTs) and propensity-score matched (PSM)
studies. Odds ratios (ORs) for binary outcomes and mean differences for
continuous outcomes were pooled using random-effect models
(DerSimonian-Laird method) with Hartung-Knapp-Sidik-Jonkman variance
correction. Primary outcomes were early and midterm all-cause mortality.
 Result(s): We included 3 RCTs (1418 patients) and 12 PSM studies
(36,540 patients). Compared with SEV, BEV was associated with
significantly lower mortality at 30 days (OR 0.76, 95% CI 0.67-0.85, p <
0.001, I2 = 0) and 1 year (OR 0.87, 95% CI 0.77-0.99, p = 0.04, I2 =
20.4%) in PSM studies, but not RCTs with insufficient power. Similar
findings were found in subgroups analysis based on valve generations and
SEV types. The 30-day and 1-year cardiovascular mortality, 30-day
incidences of moderate to severe paravalvular leak, procedural contrast
agent volume, and procedure time were lower, but transvalvular pressure
gradient was higher in BEV than SEV in PSM studies. The 30-day incidences
of permanent pacemaker implantation (PPI), acute kidney injury, stroke,
major bleeding, major vascular complications, and rehospitalization were
not statistically different between BEV and SEV. Early-generation SEV was
associated with a higher 30-day PPI risk than corresponding BEV
comparators. PPI risk was lower in ACURATE neo (Boston Scientific, Natick,
MA) but higher in Evolut R SEV (Medtronic Inc., Minneapolis, MN), both
compared with SAPIEN 3 BEV (Edwards Lifesciences, Irvine, CA).
 Conclusion(s): PSM studies suggest lower early and midterm mortality
in BEV than SEV, but the contribution of unmeasured confounders cannot be
excluded. Results from adequately powered RCTs with long-term follow-up
are critically needed to confirm these findings. Copyright © 2022
Elsevier Ltd

<72>
Accession Number
2018037573
Title
Low serum albumin: A neglected predictor in patients with cardiovascular
disease.
Source
European Journal of Internal Medicine. 102 (pp 24-39), 2022. Date of
Publication: August 2022.
Author
Manolis A.A.; Manolis T.A.; Melita H.; Mikhailidis D.P.; Manolis A.S.
Institution
(Manolis) Patras University School of Medicine, Patras, Greece
(Manolis) Aiginiteio University Hospital, Athens University School of
Medicine, Athens, Greece
(Melita) Central Laboratories, Onassis Cardiac Surgery Center, Athens,
Greece
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Hospital
Campus, University College London Medical School, London, United Kingdom
(Manolis) First Department of Cardiology, Athens University School of
Medicine, Athens, Greece
Publisher
Elsevier B.V.
Abstract
Albumin, the most abundant circulating protein in blood, is an essential
protein which binds and transports various drugs and substances, maintains
the oncotic pressure of blood and influences the physiological function of
the circulatory system. Albumin also has anti-inflammatory, antioxidant,
and antithrombotic properties. Evidence supports albumin's role as a
strong predictor of cardiovascular (CV) risk in several patient groups.
Its protective role extends to those with coronary artery disease, heart
failure, hypertension, atrial fibrillation, peripheral artery disease or
ischemic stroke, as well as those undergoing revascularization procedures
or with aortic stenosis undergoing transcatheter aortic valve replacement,
and patients with congenital heart disease and/or endocarditis.
Hypoalbuminemia is a strong prognosticator of increased all-cause and CV
mortality according to several cohort studies and meta-analyses in
hospitalized and non-hospitalized patients with or without comorbidities.
Normalization of albumin levels before discharge lowers mortality risk,
compared with hypoalbuminemia before discharge. Modified forms of albumin,
such as ischemia modified albumin, also has prognostic value in patients
with coronary or peripheral artery disease. When albumin is combined with
other risk factors, such as uric acid or C-reactive protein, the
prognostic value is enhanced. Although albumin supplementation may be a
plausible approach, its efficacy has not been established and in patients
with hypoalbuminemia, priority is focused on diagnosing and managing the
underlying condition. The CV effects of hypoalbuminemia and relevant
issues are considered in this review. Large cohort studies and
meta-analyses are tabulated and the physiologic effects of albumin and the
deleterious effects of low albumin are pictorially
illustrated. Copyright © 2022 European Federation of Internal
Medicine

<73>
Accession Number
2017381137
Title
Percutaneous Coronary Intervention Pre-TAVR: Current State of the
Evidence.
Source
Current Cardiology Reports. 24(8) (pp 1011-1020), 2022. Date of
Publication: August 2022.
Author
Keller L.S.; Panagides V.; Mesnier J.; Nuche J.; Rodes-Cabau J.
Institution
(Keller, Panagides, Mesnier, Nuche, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, QC G1V 4G5,
Canada
Publisher
Springer
Abstract
Purpose of Review: This review intends to give an up-to-date overview of
the current state of evidence in the treatment of coronary artery disease
(CAD) in patients undergoing transcatheter aortic valve replacement
(TAVR), focusing on percutaneous coronary interventions (PCI) pre-TAVR.
Recent Findings: The recently published ACTIVATION trial is the 1st
randomized trial comparing coronary revascularization (PCI) versus medical
treatment in patients with significant CAD undergoing TAVR. With the
caveat of several major limitations of the trial, the results of this
study raised the question about the appropriateness of the common practice
to routinely revascularize coronary stenosis before TAVR. Summary:
Aortic valve stenosis is the most common valvular heart disease among the
elderly and it often co-occurs with CAD. TAVR is increasingly considered
an alternative to surgical aortic valve replacement not only in the
elderly population but also in younger and lower-risk patients. The impact
of co-existing CAD on clinical outcomes as well as the optimal timing of
PCI in TAVR candidates is still unclear and the subject of ongoing
randomized trials. Meanwhile, it is common practice in many centers to
routinely perform invasive coronary angiography and PCI for significant
coronary disease as part of the TAVR workup. While computed tomography
angiography has emerged as a possible alternative to the invasive coronary
angiography in patients with low pre-test probability for CAD, the value
of functional invasive assessment of coronary lesions in the pre-TAVR
setting has still to be clarified. Also, there is an increasing interest
in the clinical relevance and optimal management of the potentially
challenging coronary access post-TAVR, requiring further
research. Copyright © 2022, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<74>
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.

<75>
Accession Number
2015881163
Title
The impact of the COVID-19 pandemic on care delivery and quality of life
in lung cancer surgery.
Source
Journal of Surgical Oncology. 126(3) (pp 407-416), 2022. Date of
Publication: September 1, 2022.
Author
Teteh D.K.; Barajas J.; Ferrell B.; Zhou Z.; Erhunmwunsee L.; Raz D.J.;
Kim J.Y.; Sun V.
Institution
(Teteh) Department of Health Sciences, Crean College of Health and
Behavioral Sciences, Chapman University, Orange, CA, United States
(Barajas, Ferrell, Zhou, Sun) Division of Nursing Research and Education,
Department of Population Sciences, City of Hope Comprehensive Cancer
Center, Duarte, CA, United States
(Erhunmwunsee, Raz, Kim, Sun) Department of Surgery, City of Hope
Comprehensive Cancer Center, Duarte, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) (COVID-19) pandemic and associated restrictions have altered
the delivery of surgical care. The purpose of this study was to explore
the impact of COVID-19 on care delivery and quality of life (QOL) from the
perspectives of lung cancer surgery patients, family caregivers (FCGs),
and thoracic surgery teams. Method(s): Patients/FCGs enrolled in a
randomized trial of a self-management intervention for lung cancer surgery
preparation/recovery were invited to participate in this qualitative
study. Patients/FCGs data were collected separately 1-month postdischarge.
Interviews were also conducted with thoracic surgery team members. Content
analysis approaches were used to develop themes. Result(s): Forty-one
respondents including 19 patients, 18 FCGs, three thoracic surgeons, and
one nurse practitioner participated in the study. Patient themes included
isolation, psychological distress, delayed/impacted care, and financial
impact. FCGs themes included caregiving challenges, worry about COVID-19,
financial hardship, isolation, and physical activity limitations. Surgical
team themes included witnessing patient/FCG's distress, challenges with
telehealth, communication/educational challenges, and delays in treatment.
 Conclusion(s): COVID-19 had a varied impact on care delivery and QOL
for lung cancer surgery dyads. Some dyads reported minimal impact, while
others experienced added psychological distress, isolation, and caregiving
challenges. Surgical teams also experienced challenges in the approach
used to provide care. Copyright © 2022 The Authors. Journal of
Surgical Oncology published by Wiley Periodicals LLC.

<76>
Accession Number
637208213
Title
Long-term clinical impact of permanent pacemaker implantation in patients
undergoing transcatheter aortic valve implantation: a systematic review
and meta-analysis.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 24(7)
(pp 1127-1136), 2022. Date of Publication: 21 Jul 2022.
Author
Zito A.; Princi G.; Lombardi M.; D'Amario D.; Vergallo R.; Aurigemma C.;
Romagnoli E.; Pelargonio G.; Bruno P.; Trani C.; Burzotta F.; Crea F.
Institution
(Zito, Princi, Lombardi, D'Amario, Vergallo, Aurigemma, Romagnoli,
Pelargonio, Bruno, Trani, Burzotta, Crea) Department of Cardiovascular and
Thoracic Sciences, Universita Cattolica del Sacro Cuore, L.go A. Gemelli
1, Rome 00168, Italy
(D'Amario, Vergallo, Aurigemma, Romagnoli, Pelargonio, Bruno, Trani,
Burzotta, Crea) Department of Cardiovascular Medicine, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Publisher
NLM (Medline)
Abstract
AIMS: The aims of this study is to assess by an updated meta-analysis the
clinical outcomes related to permanent pacemaker implantation (PPI) after
transcatheter aortic valve implantation (TAVI) at long-term (>=12 months)
follow-up (LTF). METHODS AND RESULTS: A comprehensive literature research
was performed on PubMed and EMBASE. The primary endpoint was all-cause
death. Secondary endpoints were rehospitalization for heart failure,
stroke, and myocardial infarction. A subgroup analysis was performed
according to the Society of Thoracic Surgeon-Predicted Risk of Mortality
(STS-PROM) score. This study is registered with PROSPERO (CRD42021243301).
A total of 51 069 patients undergoing TAVI from 31 observational studies
were included. The mean duration of follow-up was 22 months. At LTF, PPI
post-TAVI was associated with a higher risk of all-cause death [risk ratio
(RR) 1.18, 95% confidence interval (CI) 1.10-1.25; P < 0.001] and
rehospitalization for heart failure (RR 1.32, 95% CI 1.13-1.52; P <
0.001). In contrast, the risks of stroke and myocardial infarction were
not affected. Among the 20 studies that reported procedural risk, the
association between PPI and all-cause death risk at LTF was statistically
significant only in studies enrolling patients with high STS-PROM score
(RR 1.25, 95% CI 1.12-1.40), although there was a similar tendency of the
results in those at medium and low risk. CONCLUSION(S): Patients
necessitating PPI after TAVI have a higher long-term risk of all-cause
death and rehospitalization for heart failure as compared to those who do
not receive PPI. Copyright Published on behalf of the European Society
of Cardiology. All rights reserved. © The Author(s) 2022. For
permissions, please email: journals.permissions@oup.com.

<77>
Accession Number
636943201
Title
A randomised controlled trial of intrapleural balloon intercostal chest
drains to prevent drain displacement.
Source
The European respiratory journal. 60(1) (no pagination), 2022. Date of
Publication: 01 Jul 2022.
Author
Mercer R.M.; Mishra E.; Banka R.; Corcoran J.P.; Daneshvar C.; Panchal
R.K.; Saba T.; Caswell M.; Johnstone S.; Menzies D.; Ahmer S.; Shahidi M.;
Clive A.O.; Gautam M.; Cox G.; Orton C.; Lyons J.; Maddekar N.; De Fonseka
D.; Prior K.; Barnes S.; Robinson G.; Brown L.; Munavvar M.; Shah P.L.;
Hallifax R.J.; Blyth K.G.; Hedley E.; Maskell N.A.; Gerry S.; Miller R.F.;
Rahman N.M.; Kemp S.V.
Institution
(Mercer, Hallifax, Hedley, Rahman) University of Oxford Respiratory Trials
Unit, Churchill Hospital, Oxford, United Kingdom
(Mercer, Banka, Hallifax, Hedley, Rahman) Oxford Centre for Respiratory
Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
(Mishra, Banka) Dept of Respiratory Medicine, Norfolk and Norwich
University Hospitals, Norwich, United Kingdom
(Corcoran, Daneshvar) University Hospitals Plymouth NHS Trust, Plymouth,
United Kingdom
(Panchal, Johnstone) Institute for Lung Health, University Hospitals of
Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom
(Saba, Caswell) Blackpool Teaching Hospitals NHS Foundation Trust,
Blackpool, United Kingdom
(Menzies, Ahmer) Glan Clwyd Hospital, Rhyl, United Kingdom
(Shahidi) Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
(Clive, Maskell) Academic Respiratory Unit, Bristol Medical School,
Southmead Hospital, University of Bristol, Bristol, United Kingdom
(Gautam) Dept of Respiratory Medicine, Royal Liverpool and Broadgreen
University Hospital, Liverpool, United Kingdom
(Cox) King's Mill Hospital, Mansfield, United Kingdom
(Orton, Shah, Kemp) Royal Brompton Hospital, London, United Kingdom
(Lyons) North West Lung Centre, Manchester University NHS Foundation
Trust, Manchester, United Kingdom
(Maddekar) University Hospitals of North Midlands, Stoke-on-Trent, United
Kingdom
(De Fonseka) Dept of Respiratory Medicine, Sheffield Teaching Hospitals,
Sheffield, United Kingdom
(Prior) University Hospitals Morecambe Bay, Kendal, United Kingdom
(Barnes) Somerset Lung Centre, Musgrove Park Hospital, Taunton, United
Kingdom
(Robinson) Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
(Brown) North Manchester General Hospital, Manchester, United Kingdom
(Munavvar) Lancashire Teaching Hospitals NHS Foundation Trust, Preston,
United Kingdom
(Shah, Kemp) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Blyth) Queen Elizabeth University Hospital, Glasgow/Institute of Cancer
Sciences, University of Glasgow, Glasgow, United Kingdom
(Gerry) Centre for Statistics in Medicine, Nuffield Dept of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,
United Kingdom
(Miller) Institute for Global Health, University College London, London,
United Kingdom
(Rahman) NIHR Oxford Biomedical Research Centre, University of Oxford,
Oxford, United Kingdom
(Rahman, Kemp) Contributed jointly
Publisher
NLM (Medline)
Abstract
BACKGROUND: Chest drain displacement is a common clinical problem that
occurs in 9-42% of cases and results in treatment failure or additional
pleural procedures conferring unnecessary risk. A novel chest drain with
an integrated intrapleural balloon may reduce the risk of displacement.
 METHOD(S): A prospective randomised controlled trial comparing the
balloon drain to standard care (12 F chest drain with no balloon) with the
primary outcome of objectively defined unintentional or accidental chest
drain displacement. RESULT(S): 267 patients were randomised (primary
outcome data available in 257, 96.2%). Displacement occurred less
frequently using the balloon drain (displacement 5 of 128, 3.9%; standard
care displacement 13 of 129, 10.1%) but this was not statistically
significant (OR for drain displacement 0.36, 95% CI 0.13-1.0, Chi-squared
1 degree of freedom (df)=2.87, p=0.09). Adjusted analysis to account for
minimisation factors and use of drain sutures demonstrated balloon drains
were independently associated with reduced drain fall-out rate (adjusted
OR 0.27, 95% CI 0.08-0.87, p=0.028). Adverse events were higher in the
balloon arm than the standard care arm (balloon drain 59 of 131, 45.0%;
standard care 18 of 132, 13.6%; Chi-squared 1 df=31.3, p<0.0001).
 CONCLUSION(S): Balloon drains reduce displacement compared with
standard drains independent of the use of sutures but are associated with
increased adverse events specifically during drain removal. The potential
benefits of the novel drain should be weighed against the risks, but may
be considered in practices where sutures are not routinely
used. Copyright ©The authors 2022. For reproduction rights and
permissions contact permissions@ersnet.org.

<78>
Accession Number
638584011
Title
Trend over three decades of the stated practice pattern on the hemoglobin
(Hb) threshold that would guide red blood cell (RBC) transfusion practice
in pediatric intensive care units.
Source
Annals of Intensive Care. Conference: French Intensive Care Society
International Congress 2022. Paris France. 12(Supplement 1) (no
pagination), 2022. Date of Publication: June 2022.
Author
Anne G.; Marisa T.; Stephane L.; Avishay S.; Samiran R.; Simon S.;
Patricia F.; Atsushi K.G.H.; Pierre D.; Thierre D.; Jacques L.; Genevieve
D.P.-T.
Institution
(Anne, Marisa, Jacques, Genevieve) Division of Pediatric Critical Care
Medicine, Department of Pediatrics, CHU Sainte-Justine, Universite de
Montreal, Montreal, Canada
(Stephane) Reanimation et Surveillance Continue Pediatriques, Hopital
Jeanne de Flandre, CHRU Lille, Lille, France
(Avishay) Department of Pediatrics, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Samiran) Department of Pediatrics, Great Ormond Street Hospital, London,
United Kingdom
(Simon) Transfusion Medicine, Department: Haematology, NHS Blood,
Transplant/Oxford Radcliffe Hospitals, Oxford, United Kingdom
(Patricia) Pediatric Critical Care, Departments of Pediatrics and of
Epidemiology0Biostatistics, and Occupational Health, Montreal Children's
Hospital, McGill University, Montreal, Canada
(Atsushi) Pediatric Intensive Care Unit, Tokyo Women's Medical University,
Department of Intensive Care Medicine, Tokyo, Japan
(Pierre) Pediatric intensive care unit, Department of Pediatrics, CHC
Liege, Liege, Belgium
(Thierre) Unite de recherches cliniques appliquees, Research Centre, CHU
Sainte-Justine, Montreal, Canada
Publisher
Springer
Abstract
Rationale: To determine the trend over three decades of the stated
practice pattern of pediatric intensivist on the Hb threshold that guides
their RBC transfusion practice. Patients and methods/Materials and
methods: Three scenariobased self-administered questionnaires were filled
by 163, 125 and 132 respondents in 19971, 20102 and 2021, respectively.
Three scenarios were similar in these surveys: 1) previously healthy
4-year-old boy mechanically-ventilated after a severe multiple trauma; 2)
idem with septic shock; 3) 5-month-old boy admitted to a Pediatric
Intensive Care Unit (PICU) following corrective surgery for tetralogy of
Fallot. Patients were hemodynamically stable in all scenarios. The
question asked after each scenario was: what Hb concentration would prompt
you to prescribe an RBC transfusion to this patient? Results: Figure 1
reports the practice pattern stated in 1997, 2010 and 2021. For all
scenarios, all respondents (100%) should have chosen to prescribe an RBC
transfusion only if the Hb level was Conclusion(s): The TRIPICU
study, a non-inferiority randomized controlled trial (RCT) led by Lacroix
et al. (N Engl J Med 2007;356:1609-19), enrolled 637 hemodynamically
stable critically ill children who had Hb concentration <= 9.5 g/dL; it
showed that a Hb threshold of 7 g/dL for RBC transfusion is not inferior
to a threshold of 9.5 g/dL (absolute risk reduction with the restrictive
strategy, 0.4%; 95% confidence interval, -4.6 to 5.4) and that it can
decrease transfusion requirements in PICU patients without increasing
adverse outcomes. The main recommendation of TRIPICU was not giving an RBC
transfusion to hemodynamically stable PICU patients if their Hb
concentration is >= 7 g/dL. The RCT led by Cholette et al. (Ann Thorac
Surg 2017;103:206-14) that enrolled 134 cardiac children weighing <= 10 kg
undergoing biventricular repair cardiac surgery and the RCT led by Holst
et al. (N Engl J Med 2014;371:1381-91) that enrolled 1005 adults in septic
shock with an Hb concentration <= 9 g/dL recommended the same Hb threshold
(7 g/ dL). The gaps in 2021 between the expected proportion of respondents
who should have chosen a Hb threshold of 7.0 g/dL (100%) and the
proportion who chose a higher Hb threshold remained important in 2021.

<79>
Accession Number
638583945
Title
Effect of moderate hypothermia vs normothermia on 30-day mortality in
patients with cardiogenic shock receiving venoarterial extracorporeal
membrane oxygenation: a randomized clinical trial.
Source
Annals of Intensive Care. Conference: French Intensive Care Society
International Congress 2022. Paris France. 12(Supplement 1) (no
pagination), 2022. Date of Publication: June 2022.
Author
Bruno L.; Nicolas G.; Tar Alexandre O.A.; Alain C.
Institution
(Bruno, Nicolas) CHU Nancy, Vandoeuvre Les Nancy, France
(Tar Alexandre) CHU Bordeaux, Department Of Anaesthesia And Critical Care,
Magellan Medico-Surgical Centre, France
(Alain) APHP, Paris La Pitie Salpetriere, Mir, France
Publisher
Springer
Abstract
Rationale: The optimal approach to the use of venoarterial extracorporeal
membrane oxygenation (VA-ECMO) during cardiogenic shock is uncertain.
Patients and methods/Materials and methods: To determine whether early use
of moderate hypothermia (33-34 degreeC) compared to strict normothermia
(36-37 degreeC) improves mortality in patients with cardiogenic shock
receiving VA-ECMO. Multicenter, unblinded, parallel-group, randomized
clinical trial in the intensive care units (ICU) of 20 French Cardiac
Shock Care Centers Patients were eligible if they were endotracheally
intubated and had been receiving VA-ECMO for cardiogenic shock for < 6 h.
Of 786 eligible patients, 374 were randomized. The primary outcome was
mortality at 30 days. There were 21 secondary outcomes including mortality
at days 7, 60, and 180; a composite outcome of death, cardiac transplant,
stroke or escalation to left ventricular assist device (LVAD) at days 30,
60 and 180, ventilatory-and kidney replacement therapy-free days between
inclusion and days 30, 60 and 180. Adverse events included rates of severe
bleeding, sepsis and number of packed red blood cells transfused during
VA-ECMO. Result(s): 334 patients completed the trial (mean age, 57
[SD 12] years. At 30 days, 71 of the 168 patients (42%) in the moderate
hypothermia group and 84 of the 166 patients (51%) in the normothermia
group had died (adjusted odds-ratio = 0.71; 95% confidence interval 0.45-
1.13, p = 0.15; risk difference -8.3% (-16.3 to -0.3%)). The odds-ratio of
the composite outcome of death, cardiac transplant, escalation to LVAD and
stroke in the hypothermia group, as compared with the control group, was
0.61 (95% CI 0.39-0.96, p = 0.03) at day 30 (risk difference -11.5% (-23.2
to 0.2%)). Of the 27 secondary outcomes, 26 were inconclusive. The
incidence of severe or moderate bleeding was 34% in the hypothermia group
and 36% in the normothermia group. The incidence of infections was 52% in
both groups. Conclusion(s): In patients with refractory cardiogenic
shock treated with VA-ECMO, early application of moderate hypothermia for
24 h did not significantly increase survival compared with normothermia.
However, because the confidence interval was wide and included a
potentially clinical important effect size, these findings should be
considered inconclusive.

<80>
Accession Number
638583816
Title
Critically ill patients with infective endocarditis, neurological failure
and indication for cardiac surgery: a multicenter propensity-adjusted
study.
Source
Annals of Intensive Care. Conference: French Intensive Care Society
International Congress 2022. Paris France. 12(Supplement 1) (no
pagination), 2022. Date of Publication: June 2022.
Author
Alexandre G.; Olivier G.Y.; Benjamin S.; Xavier P.; Renaud P.; Arthur O.;
Sebastien P.; Yoan L.-B.; Elisabeth C.; Remi C.; Delphine M.; Raphael M.;
Fukutomi H.; Didier G.; Thomas T.; Alexandre B.
Institution
(Alexandre, Olivier, Benjamin, Xavier, Renaud, Arthur, Fukutomi, Didier,
Thomas, Alexandre) CHU Bordeaux, Bordeaux, France
(Sebastien) CHU Lille, Lille, France
(Yoan) CHU Toulouse, Toulouse, France
(Remi) CHU Poitiers, Poitiers, France
(Delphine) CHU Nantes, Nantes, France
(Raphael) CHU Rennes, Rennes, France
(Elisabeth) CHU Clermont-Ferrand, Clermont-Ferrand, France
Publisher
Springer
Abstract
Rationale: The benefit-risk balance and/or optimal timing of surgery for
infective endocarditis (IE) with neurological events (ischemic or
haemorrhagic stroke) remain debated, especially in critically ill
patients. Our hypothesis is that these patients should still benefit from
surgery. The main objective of this study was to compare their
neurological functional outcome whether they received surgery or not.
Patients and methods/Materials and methods: We conducted a retrospective
(2010-2017), French multi-center study of critically ill patients with
acute IE. They were included if they met the following criteria: (i)
left-sided IE according to the modified Duke criteria, (ii) with cerebral
complications documented by cerebral imaging before cardiac surgery and
(iii) with Sequential Organ Failure Assessment score (SOFA) >= 3; one of
these justifying admission to ICU. Exclusion criteria were isolated right
endocarditis, in-hospital acquired endocarditis and patients who developed
cerebral complications only after cardiac surgery. All patients were
explored with brain imaging before surgery. The primary analysis consisted
in a propensity score adjusted logistic regression of surgery as an
independent variable of the primary outcome, i.e. modified Rankin score
(mRS) at 6 months. The 1-year mortality rate was the main secondary
outcome. Result(s): 192 patients were included whom 67 patients had
medical treatment (35%) and 125 underwent cardiac surgery (65%). Delayed
surgery according to theoretical recommended timing was decided in 62/125
(50%). Ischemic stroke was the most prevalent neurological complications
(74.5%) followed by hemorrhagic lesion (15.6%). In the propensity
score-adjusted logistic regression, the odds ratio (OR) for favorable
6-month functional outcome was 0.08 (95% CI 0.03-0.13) in favor of
surgery. One-year mortality was strongly reduced with surgery in the
fixed-effect propensity adjusted cox model (Hazard Ratio 0.23; 95% CI
0.14-0.36; p < 0.001). These effects remained whether the patients
received delayed surgery or not and whether they were deeply comatose or
not (Glasgow score > 10). Conclusion(s): In this study of critically
ill patients with simultaneous infectious endocarditis, indication for
surgery and cerebral events, a better propensity-adjusted functional
outcome was associated with surgery compared with medical treatment,
whatever the deepness of coma. A delayed surgery should be considered in
severe acute regurgitations. In the absence of randomized study precluded
for ethical concerns, an individualized strategy remains highly suggested.

<81>
Accession Number
638582574
Title
Nitric Oxide and its Novel Applications.
Source
Pediatric Pulmonology. Conference: 21st International Congress of
Pediatric Pulmonology. Online. 57(Supplement 2) (pp S72-S74), 2022. Date
of Publication: June 2022.
Author
Grasemann H.
Institution
(Grasemann) Department of Pediatrics, Division of Respiratory Medicine The
Hospital for Sick Children, University of Toronto, Toronto, Canada
Publisher
John Wiley and Sons Inc.
Abstract
Introduction The simple signaling molecule nitric oxide (NO) is involved
in the control of countless biological functions in the body. NO is the
product of enzymatic conversion of L-arginine and oxygen by NO synthases
(NOS), and the three isoforms of NOS (NOS1 or neuronal NOS, NOS2 or
inducible NOS, and NOS3 or endothelial NOS) are expressed by different
cell types. In the respiratory system, NO has been shown to have
regulatory effects on several functions such as vascular and airway smooth
muscle tone, airway inflammation and host defense against infection with
pathogens including certain bacteria and viruses. Fraction of exhaled NO
(FENO) as a biomarker NO produced within the lungs and airways can be
measured in breath, and the fraction of exhaled NO (FENO) is often
increased in allergic asthma, correlates with eosinophilic inflammation
and epithelial expression of inducible NOS (NOS2) in airway epithelium and
normalizes with anti-inflammatory therapy. Therefore, FENO is an
established biomarker to help diagnose asthma characterized by type 2
inflammation. Increased FENO may be helpful in predicting response to
inhaled corticosteroids and to identifying those eligible for effective
biologic therapies targeting type 2 asthma (1). In an official American
Thoracic Society (ATS) clinical practice guideline, a conditional
recommendation for FENO-based care was made for patients with asthma in
whom treatment is being considered (2). The benefit of FENO measurements
in guiding asthma treatment in children however is uncertain. In a recent
multicenter phase 3 trial that included more than 500 children with asthma
6-15 years of age (RAACENO), no reduction in exacerbation rate was found
when adding FENO to symptom-guided treatment. Therefore, according to this
study, symptoms remain the only tool for guiding treatment decisions in
children with asthma (3). In contrast to asthma, the production of NO in
cystic fibrosis (CF) airways is usually decreased. While the mechanisms
leading to NO deficiency in people living with CF are not fully
understood, studies in CF patients and cystic fibrosis transmembrane
conductance regulator (CFTR) gating mutations had shown that the CFTR
modifier ivacaftor leads to an increase in FENO in treated patients.
Similar results have now been reported in patients with CFTR F508del
mutation treated with elexacaftor/tezacaftor/ivacaftor (4). This may
suggest that the NO deficiency in CF airways is directly linked to CFTR
dysfunction. Salt-mediated induction and release of interleukin-1 beta
(IL-1beta) by airway epithelial cells is a potential mechanism. One other
way of increasing airway NO production, and potentially improving
bacterial killing, is by inhibition of arginase, an enzyme that regulates
NOS activity by controlling the availability of L-arginine for NOS. The
concentration of neutrophil-derived arginase is high in CF airway
secretions. Whether an oral arginase inhibitor (CB-280) increases
Larginine availability and subsequently airway NO production in people
with CF is currently being investigated in a Phase 1b doseescalation trial
(5). Strategies to increase airway NO availability Inhaled NO (iNO) is a
selective pulmonary vasodilator and is widely used in intensive care units
to help control conditions including persistent pulmonary hypertension of
the newborn (PPHN) or pulmonary hypertension and hypoxemic respiratory
failure after congenital heart surgery. Outside of these indications, iNO
may also be effective in treating respiratory infections. Studies had
shown that iNO can lead to disruption of for example P. aeruginosa
biofilms. There is an increasing number of publications now on successful
use of high-dose adjuvant iNO therapy in small numbers of patients with CF
treated for a variety of pulmonary infections including P. aeruginosa and
non-tuberculous mycobacteria (NTM). Larger, randomized clinical trials to
determine the safety and efficacy of high-dose iNO as an anti-infective
are currently ongoing. Respiratory syncytial virus (RSV) causes serious
lower respiratory tract infections in mostly smaller children, but
treatment options are usually limited to supportive therapy. A previous
study in infants with respiratory failure due to RSV bronchiolitis had
demonstrated no bronchodilator effect of iNO given at 20 to 60 parts per
billion (ppm). However, it is well documented that exogenous NO displays
antiviral activity against RSV and other viruses. In a treatment trial
enrolling 65 infants with acute bronchiolitis, intermittent high dose iNO
(160 ppm) plus oxygen/air for 30 min five times/day up to five days was
compared to oxygen/air alone. Treatment with iNO was safe, welltolerated,
reduced length of hospitalization and showed earlier improvement of oxygen
saturation, compared to the standard therapy (6). Recent studies have also
suggested beneficial effects of iNO on coronavirus disease 2019
(COVID-19)-induced acute respiratory distress syndrome (ARDS). Other
strategies that have been developed to increase NO levels in airways
include those of exogenous compounds able to release NO once inhaled. Some
of these molecules are now in pre-clinical and clinical studies and
include for example cephalosporindiazeniumdiolates, that show dual
antibacterial and antibiofilm effects against P. aeruginosa, and nebulized
NO-generating solutions to treat chronic infection with Mycobacterium
abscessus in patients with CF.

<82>
Accession Number
638580218
Title
Keynote Lecture: Treatment of Stage D Heart Failure - Devices, Drugs,
Biology and Genes: Evidence and Guidelines.
Source
Interventional Cardiology Review. Conference: 6th Annual Acute Cardiac
Unloading and Recovery Symposium, A-CURE 2022. Virtual. 17(Supplement 1)
(pp 15-17), 2022. Date of Publication: 2022.
Author
Yancy C.
Institution
(Yancy) Northwestern University, Feinberg School of Medicine, Chicago, IL,
United States
Publisher
Radcliffe Cardiology
Abstract
Dr Yancy opened his lecture by reviewing the American College of
Cardiology (ACC)/American Heart Association (AHA) guideline for Stage D
heart failure (HF) management.1 By the modern definition, HF is
partitioned into various stages by the level of left ventricular ejection
fraction (LVEF) exhibited.2 In particular, Dr Yancy aimed to illustrate
how unloading the left ventricle (LV) can improve LVEF in HF with
mid-range ejection fraction and HF with improved ejection fraction
(HFimpEF). By definition, HFimpEF patients must have received
guideline-directed medical therapy (GDMT) and subsequently improved LVEF
at least 10 percentage points to >=40% from a previously reduced
baseline.3 This improvement is not thought to be a measurement phenomenon,
but rather represents a distinct biological phenotype with corresponding
clinical outcomes. As such, the new definition of HF accounts for the
specific symptoms and signs of HF, and these symptoms and signs must be
corroborated by either elevated natriuretic peptide levels, objective
evidence of cardiogenic, pulmonary or systemic congestion or both.2 This
altered definition, which provides quantifiable metrics for determining
the stage of HF, changes the algorithm for the use of GDMT to include the
concept of HF in remission. Dr Yancy emphasised that patients with Stage D
HF are a population with a number of unmet needs, including effective
treatments to improve longterm survival (Figure 1).4 Current therapeutic
options for select patients with advanced HF include heart transplant,
mechanical circulatory support (MCS) as a bridge to transplant or bridge
to candidacy and long-term MCS as destination therapy (DT). Dr Yancy
highlighted that current ACC/AHA guidelines do not contain any Class I
recommendations for the use of MCS in HF; however, there are several Class
IIa recommendations in place. He noted the current evidence level in
support of MCS is rated 'B'; more robust data are needed to move that
recommendation to Class I. In order to achieve recovery in these patients,
clinicians must focus not only on the macro effects of LV unloading, such
as flow rate, or the incidence of complications, like thrombosis, but also
study the micro effects of unloading. In particular, consideration must be
given to the biological changes in myocytes, changes to the myocardial
tissue and changes in circulating systemic markers.5 In a recent study,
five HF patients with an LV assist device (LVAD) were analysed with
pairwise tissue sampling at the time of LVAD implementation and LVAD
removal at autopsy to compare proteomic and metabolomic alterations.6 The
researchers found significantly decreased expression of genes associated
with fibrosis, extracellular signalregulated kinase 1/2 regulation and
immune response at LVAD implantation, whereas the expression of genes
associated with tissue regeneration, heart morphogenesis, vacuolar
transplant and myocyte metabolism was significantly increased after >=1
year of LVAD support (Figure 2). Of note, connexin-43, a gene involved in
the development of gap junctions between cells, was among those
significantly increased with LVAD support, and may be a marker of
recovery. This was further supported by improved transverse tubule
(t-tubule) histology, t-tubules being invaginations of the cell membrane
critical to the process of excitation-contraction in cardiomyocytes. After
LVAD, the t-tubules were observed to have structurally recovered,
indicating the patient experienced restored biological function in the
myocardium.6 Dr Yancy emphasised how using these types of analyses is more
sophisticated and informative than a simplified list of clinical symptoms,
and that examining these types of datasets can help more precisely refine
study populations in future studies. Although there is a paucity of
large-scale randomised control trials (RCTs) on Impella and LVAD, Dr Yancy
highlighted two ongoing trials that are addressing this issue. The Danish
Cardiogenic Shock Trial (DanShock) aims to determine whether Impella
provides a benefit in the context of acute myocardial infarction with
cardiogenic shock (AMICS). Meanwhile, the Impella-supported PCI in
High-Risk Patients with Complex Coronary Artery Disease and Reduced Left
Ventricular Function (PROTECT IV) trial is of an adaptive design,
investigating Impella use during high-risk percutaneous coronary
intervention (PCI) in patients with reduced leftsided heart function. Dr
Yancy also highlighted another trial that examined intramyocardial
injection of mesenchymal precursor cells and subsequent temporary weaning
from LVAD support in patients with advanced HF.7 Although no benefit was
observed in that study, it still functioned as a proof of concept for
combining device and biological interventions in clinical trials.
Furthermore, data presented as supplementary material for that publication
showed a signal that patients with ischaemic cardiomyopathy had better
success rate than those with non-ischaemic disease, suggesting that
recalibration of the patient population to target specific patients, such
as that performed by Shahinian et al.,6 could reveal more information on
this form of potential therapy. The recent first pig-to-human heart
transplant has also opened up further discussion on the subject of
xenotransplantation. This concept comes with numerous crucial targets,
including the prevention of hyperacute rejection, delayed xenograft
rejection and the prevention of injection transmission.8 However, the
long-term function of these xenotransplantations poses new questions,
including whether the heart will adapt to cardiometabolic stress demands,
whether sufficient graft tolerance will allow for reduced
immunosuppression, how this transplant will compare to outcomes of human
cardiac transplants and other support methods and whether there will be
novel ethical considerations. A recent successful kidney xenotransplant
into a brain-dead patient revealed the kidney could function normally, and
was a successful proof of concept for future investigations and
applications.9 Dr Yancy next discussed the hurdles to receiving
endorsement for novel devices and tools from the ACC, AHA, Heart Failure
Society of America and, ultimately, the Food and Drug Administration
(FDA). The level of RCT evidence required for the highest class of
recommendation (A) has decreased, whereas that for the second (B) class of
evidence has increased and that for the third class (C) has markedly
decreased.10 Thus, the bar for Class A is deliberately very high, and
achieving these recommendations requires careful calibration of studies.
Meanwhile, there are several paths to FDA approval, including: 510(k),
which is the most common and involves an iterative process demonstrating
that new devices are as safe and effective as prior approved devices; de
novo, which is for innovative, lower-risk devices that are not comparable
to preexisting devices; and pre-market approval (PMA), which has the most
stringent data requirements, is reserved for high-risk devices or when
controls cannot be written and that usually uses performance to
demonstrate safety and efficacy. To help researchers navigate these
considerations, Dr Yancy provided insight from his 10 years at the FDA
(Box 1). Dr Yancy stated that there must truly be an unmet need, and not
simply a market opportunity, and there must be at least some historical or
observation comparator data. In addition, although placebo-controlled data
are the preferred standard, an alternative could be 'objective performance
criteria' (OPC), which can be derived from previous case reports or data.
The mode of analysis is also important, and a Bayesian analysis is the
preference, as is an intention-to-treat population analysis rather than
per-protocol analysis. Finally, as always, the therapy must be safe and
reasonably effective. It is worth noting that currently there is no
ventricular assist device that is both Class I recommended and FDAapproved
via PMA. Dr Yancy proposed that as biological targets evolve and devices
improve, the type, quality and precision of evidence should also evolve.
Traditional forms of evidence, such as case reports/series, observation
studies and phased trials, are slow and expensive, often with small
numbers, hidden safety signals and bias. More contemporary forms of
evidence, such as single-arm trials with OPC, Bayesian analyses and
quality-of-life endpoints, are promising but unproven. The preference
remains with RCT design, and the default endpoints remain morbidity and
mortality. Dr Yancy anticipates that the future will include more genomic
analyses, such as identification of at-risk phenotypes, treatment with
induced pluripotent stem cells, gene therapy and genetic engineering. He
foresees that data science, Mendelian randomisation, network
meta-analyses, 'n of 1' trials, and bioengineering will be at the
forefront. These tools may help better collate patient cohorts and speed
the process of clinical trials. However, the costs, evidence requirements
and implementations of these new frontiers and tools remain to be
determined. (Figure Presented).

<83>
Accession Number
638583344
Title
Lactate/Pyruvate ratio as a marker of tissue hypoxia in cardiac surgery.
Source
Annals of Intensive Care. Conference: French Intensive Care Society
International Congress 2022. Paris France. 12(Supplement 1) (no
pagination), 2022. Date of Publication: June 2022.
Author
Hichem K.; Wael J.; Anas K.; Bouthaina S.; Mahdi F.; Salma K.; Hichem C.;
Zied T.; Dhouha Z.; Dana J.; Manel N.; Fatma A.
Institution
(Hichem, Wael, Anas, Bouthaina, Mahdi, Salma, Hichem, Zied, Dhouha, Dana,
Manel, Fatma) Centre Hospitalo, Universitaire Habib Bourguiba, Sfax,
Tunisia
Publisher
Springer
Abstract
Rationale: Cardiac surgery with cardiopulmonary bypass (CPB) has a high
risk to induce tissue hypoperfusion and oxygenation impairment. This can
lead to complications and organ failure. Blood lactate elevation is a
classic marker of anaerobic metabolism and hypoperfusion. But lactate
increasing can result from aerobic glycolysis acceleration or impaired
clearance. Lactate/Pyruvate ratio (L/P) was studied in septic shock and
seems to have a better specificity of anaerobic metabolism. The aim of
this study is to assess whether the L/P is associated with adverse outcome
after cardiac surgery. Patients and methods/Materials and methods: This is
a prospective, observational, monocentric clinical study being performed.
We included 26 patients over 18 years undergoing cardiac surgery with CPB,
from October 2021. We have an objective of 80 patients. We did not include
patients with severe hepatocellular impairment, preoperative hemodynamic
instability, or severe renal failure. We have excluded patients who have
died during surgery, patients who can only leave the operating room with a
circulatory assistance technique. Arterial blood lactate and pyruvate were
collected, lactate in sodium fluoride tube, pyruvate in perchloric acid
tube. The samples were transported at 4 degreeC, and then analyzed by
enzymatic colorimetric reaction for lactate and spectrophotometry for
pyruvate. We have analyzed receiving operating curve (ROC) of L/P for
complications occurring. We tested then the correlation of the variables
with prognosis interest to L/P by Spearman test. Result(s):
Complications rate was 46.2%. Mortality rate was 26.9%. Mean age was 61.96
+/- 9.34. Median Euroscore II was 1.5 (1.09; 2.13). 23 patients have
lactate level > 2 mmol/l. Only 18 (78.26%) of these patients have L/P > 16
(a cutoff used previously in septic shock). L/P was predictive of
complications with area under ROC 0.857, higher than area under ROC of
lactate which was 0.777. Best threshold was 20.34. LP median was
significantly higher in group with complications and in non survivor
group. We found that L/P is correlated to Euroscore II, duration of CPB
and SAPSII at one and two days postoperative. Conclusion(s): We
conclude that L/P is associated with poor outcome after cardiac surgery.
L/P is more efficient than lactate to predict postoperative complications.
L/P could be used as an additional tool to identify patients with high
risk of adverse outcome after cardiac surgery. Nevertheless, these results
should be confirmed in larger multicentric studies. A randomized trial
comparing a standard therapy strategy with a strategy based on L/P is
needed to allow clinicians to make a therapy decision using LP.

<84>
Accession Number
638583305
Title
How central venous oxygen saturation can be used as a prognostic tool in
cardiac surgery?.
Source
Annals of Intensive Care. Conference: French Intensive Care Society
International Congress 2022. Paris France. 12(Supplement 1) (no
pagination), 2022. Date of Publication: June 2022.
Author
Kolsi H.; Jawadi W.; Keskes M.; Sellami B.; Ketata S.; Amouri S.; Derbel
R.; Cheikhrouhou H.; Triki Z.
Institution
(Kolsi, Jawadi, Keskes, Sellami, Ketata, Amouri, Derbel, Cheikhrouhou,
Triki) Centre hospitalo-universitaire Habib Bourguiba, Sfax, Tunisia
Publisher
Springer
Abstract
Rationale: Cardiac surgery with cardiopulmonary bypass (CPB) is known to
be a lifesaving procedure. Nevertheless, CPB induces systemic inflammatory
response and oxygenation impairment. Central venous oxygen saturation (
ScvO<inf>2</inf>) is a classic marker of dysoxia. Low and high
ScvO<inf>2</inf> are associated with adverse outcome. However, there are
no studies defining clearly abnormal values of ScvO<inf>2</inf> and
assessing the prognostic interest of ScvO<inf>2</inf> in cardiac surgery.
The aim of this study was to investigate the impact of increase and
decrease of values of ScvO<inf>2</inf> on mortality and morbidity after
cardiac surgery, and to define optimal thresholds of high and low
ScvO<inf>2</inf> to predict complications. Patients and Methods/Materials
and methods: This was a prospective, observational, monocentric clinical
study. We included 156 patients over 18 years undergoing cardiac surgery
with CPB from September 2018 to January 2020. We have excluded patients
who have died during surgery, patients who leave the operating room with a
circulatory assistance technique and patients with misplacement of central
venous catheter (CVC). Venous blood gas was collected from middle line of
CVC. Population was divided into 2 groups: group H with ScvO<inf>2</inf> >
75% and group L with ScvO<inf>2</inf> <= 75%. In group H, we analyzed
receiving operating curve (ROC) of ScvO<inf>2</inf> for occurring of
postoperative complications. In group L, we analyzed ROC
of-ScvO<inf>2</inf> for occurring of postoperative complications. We
tested then the correlation of the variables with prognosis interest to
ScvO<inf>2</inf> by Spearman test. Result(s): Median age was 62 (53;
68). Complications rate was 37.8%. Mortality rate was 18.6%. In group H,
we have found that ScvO<inf>2</inf> predicts complications with area under
ROC 0.776. The best threshold was 80.6%. Moreover, we found that
ScvO<inf>2</inf> is significantly correlated with CPB time, mechanical
ventilation time and majority of postoperative prognosis scores. In group
L, the area under ROC of-ScvO<inf>2</inf> concerning complications was
0.774. The best threshold was 69.7%. We found a significant negative
correlation of ScvO<inf>2</inf> to CPB time, mechanical ventilation time
and majority of postoperative prognosis scores. Conclusion(s): We
conclude that both low and high ScvO<inf>2</inf> are associated with
adverse outcome after cardiac surgery. For patients with supranormal or
low ScvO<inf>2</inf>, we should use additional hemodynamic monitoring to
facilitate adequate therapy in the postoperative course. Nevertheless, to
place as a target for postoperative resuscitation algorithm, a randomized
trial comparing a conventional resuscitation strategy with a strategy
based on defined levels of ScvO<inf>2</inf> is essential.

<85>
[Use Link to view the full text]
Accession Number
638581349
Title
Systematic Review of Graft Patency after Robotically Assisted Coronary
Artery Bypass Grafting Surgery.
Source
Journal of the American College of Surgeons. Conference: American College
of Surgeons 2021 Annual Clinical Congress. Washington, DC. 233(5
Supplement 2) (pp e21-e22), 2021. Date of Publication: November 2021.
Author
Sherazee E.A.; Guenther T.M.; Kiaii B.
Institution
(Sherazee, Guenther, Kiaii) Department of Surgery, Division of General
Surgery, UC Davis Medical Center, Sacramento, CA Department of General
Surgery, David Grant USAF Medical Center, Travis AFB, Fairfield, CA
Department of Surgery, Division of Cardiac Surgery, UC Davis Medical
Center, Sacramento, CA
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: Robotically assisted coronary artery bypass grafting surgery
(RACABG) avoids the morbidities of a sternotomy and cardiopulmonary bypass
and is becoming increasingly popular. Robotically assisted minimally
invasive direct CABG (RMIDCAB) and totally endoscopic CABG (TECAB) have
been shown to have similar patency rates compared to conventional CABG
(Left internal mammary artery patency: 98%, 95%, 88% at 5, 10 and 15
years, respectively). A systematic review was performed to evaluate graft
patency and clinical outcomes in patients who underwent RACABG.
 METHOD(S): A systematic review of studies reporting graft patency
after RACABG was performed using PubMed, Google Scholar, and Embase.
 RESULT(S): Between June 1998 and August 2018, 4,316 patients
underwent RACABG, either by RMIDCAB (2,643) or TECAB (1,673) approach.
Compared to RMIDCAB, those that underwent TECAB were more frequently
evaluated for graft patency (70.6% vs 65.1%). The average graft patency at
short- (<1 month), mid- (<5 years) and long-term (>=5 years) follow up was
97.6%, 95.4% and 93.2% for RMIDCAB, respectively and 98%, 95.6% and 94%
for TECAB, respectively. Rates of 30-day mortality, conversion to
sternotomy and post op reintervention for an occluded graft were 0.3%,
2.3% and 2.2%, respectively. CONCLUSION(S): RACABG has comparable
patency rates to conventional CABG with a low rate of reintervention.
Short term patency rates are well documented in the literature; however,
there are only a few studies reporting on the mid- and long-term outcomes.
Although the initial data is very encouraging, further investigation is
warranted to further assess this minimally invasive technique for surgical
coronary artery revascularization.

<86>
[Use Link to view the full text]
Accession Number
638580898
Title
Enhanced Pain Control after Reduction Mammaplasty with Combination
Bupivacaine and Dexamethasone Regional Block: A Double-Blind Randomized
Controlled Trial.
Source
Journal of the American College of Surgeons. Conference: 2021 Owen H
Wangensteen Scientific Forum of the American College of Surgeons.
Washington, DC. 233(5 Supplement 1) (pp s198), 2021. Date of Publication:
November 2021.
Author
Taylor G.A.; Panichella J.C.; Vazquez D.; Neusner A.; Lo A.L.; Cannon H.;
Zhao H.; Livelsberger J.; Trehan G.; Gassman A.A.
Institution
(Taylor, Panichella, Vazquez, Neusner, Lo, Cannon, Zhao, Livelsberger,
Trehan, Gassman) Temple University Hospital, Philadelphia, PA Lewis Katz
School of Medicine at Temple University, Philadelphia, PA Lahey Clinic,
Burlington, MA Penn State Milton S Hershey Medical Center, Hershey, PA
PRMA Plastic Surgery, San Antonio, TX
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: Pain management can be challenging in reduction mammaplasty.
A preoperative bupivacaine regional block controls pain relatively
inexpensively ($0.07/mL), but lasts only 8 hours. A liposomal bupivacaine
formulation lasts 72 hours but is costly ($14.25/mL). Orthopaedic and
thoracic operations have demonstrated that dexamethasone ($0.95/mL) plus
bupivacaine can prolong analgesia. We conducted a double-blind, randomized
controlled trial to determine whether dexamethasone plus bupivacaine
regional block improves postoperative pain control, reduces inpatient
narcotic use, and improves patient satisfaction. METHOD(S): Female
patients were randomized into control and experimental groups. Both groups
received preoperative PECS2 blocks: bupivacaine plus saline (control) or
bupivacaine plus dexamethasone (experimental). Postoperative pain regimens
were standardized. Vital signs, pain scores, narcotic consumption, and
anti-emetic use were recorded throughout the hospitalization.Quality of
life surveys were distributed at the first postoperative visit.
 RESULT(S): Fifty-one patients completed the study: 25 control and 26
experimental group patients. The experimental group averaged lower pain
scores, although there was no statistically significant difference overall
or at each 4-hour interval. Postoperative narcotic use was significantly
lower in the experimental group (mean 23.2 vs 36.6 oral morphine
equivalents per patient; p = 0.026). There were no differences in 4-hour
interval vital signs, antiemetic use, or length of stay. Survey results
showed enhanced quality of life in the experimental group, but this was
not statistically significant. CONCLUSION(S): The addition of
dexamethasone to bupivacaine in the PECS2 block before bilateral reduction
mammaplasty resulted in significantly less narcotic consumption in the
hospital. This addition can be a cost-effective adjunct for postoperative
pain control.

<87>
[Use Link to view the full text]
Accession Number
638582023
Title
Tool-tissue Forces in Surgery: A Systematic Review.
Source
Journal of the American College of Surgeons. Conference: American College
of Surgeons 2021 Annual Clinical Congress. Washington, DC. 233(5
Supplement 2) (pp e70), 2021. Date of Publication: November 2021.
Author
Golahmadi A.K.; Khan D.Z.; Mylonas G.; Marcus H.
Institution
(Golahmadi, Khan, Mylonas, Marcus) Imperial College London, London, United
Kingdom The National Hospital for Neurology and Neurosurgery, London,
United Kingdom
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: Excessive tool-tissue interaction forces in surgery may
result in tissue damage and intraoperative complications, while
insufficient forces prevent the completion of the task. METHOD(S): A
systematic review of studies exploring tool-tissue forces applied during
surgery was performed in accordance with PRISMA guidelines.
 RESULT(S): 45 studies discussing tool-tissue forces during surgical
procedures or tasks were included. Mean forces per speciality were as
follows: ophthalmology (0.04N), vascular (0.7N), neurosurgery (0.68N),
cardiothoracic surgery (1.5N), general surgery (4.7N), otorhinolaryngology
(8.5N), obstetrics & gynaecology (mean 8.7N), urology (9.8N) and
orthopaedic surgery (210N). Senior surgeons applied 25% less force than
novice surgeons, and feedback (haptic, visual or audio) reduced force
application by 40% - across specialities and tasks. Nervous tissue
required the least amount of force to manipulate (0.4N, n=17), followed by
epithelial (3.8N, n=18), muscle (4.1N, n=4) and connective tissue (45.8,
n=10). For manoeuvres, retraction-with-grasping recorded the highest
forces (3.65N, n=13), whilst vessel clamping recorded the lowest (0.5N,
n=2). CONCLUSION(S): The measurement of tool-tissue forces is a novel
but rapidly expanding field. Knowledge of the safe range of surgical
forces will improve surgical safety whilst maintaining effectiveness.
Measuring surgical forces may provide an objective metric for training and
assessment. Development of smart instruments, robotics and integrated
feedback systems will facilitate this.

<88>
[Use Link to view the full text]
Accession Number
638582591
Title
Off- Vs On-pump Coronary Revascularization: A Single Surgeon Study.
Source
Journal of the American College of Surgeons. Conference: American College
of Surgeons 2021 Annual Clinical Congress. Washington, DC. 233(5
Supplement 2) (pp e20), 2021. Date of Publication: November 2021.
Author
Tasnim S.; Roughneen P.T.
Institution
(Tasnim, Roughneen) University of Texas Medical Branch, Galveston, TX,
United States
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: Multi-center, multi-surgeon randomized controlled trials
have reported that off-pump coronary artery bypass grafting (OPCAB) has
either equivalent or inferior outcomes compared to on-pump arrested heart
coronary artery bypass grafting (PCAB-A). We present a single-surgeon
observational study to remove the confounding bias of multiple surgeon
expertise and multiple center cost variations. METHOD(S): A
retrospective review of 129 patients that underwent coronary artery bypass
grafting (CABG) between September 2015- January 2019 was analyzed.
Fifty-one patients underwent OPCAB and 78 underwent PCAB-A according to
the surgeon's discretion. Quality and cost metrics were analyzed.
 RESULT(S): A higher percentage of OPCAB patients had previous
coronary artery stents before undergoing CABG compared to PCAB-A (35% vs.
17%, p=0.02). The number of grafts and OR time in the OPCAB group was
significantly less than PCAB-A: 2.2 vs. 3.15, p=0 (grafts), and 298.24 vs.
357.69 min, p=0 (OR time), respectively. OPCAB had a shorter ICU length of
stay (2.08 vs. 2.44 days, p=0.273), shorter total ventilation time (1.18
vs. 1.54 days, p=0.055), and required less pRBC compared to PCAB-A (41%
vs. 64%, p=0.715). OPCAB also had lower revascularization rate at one year
(7% vs. 13%, p=0.355) and significantly lower OR cost ($8,657 vs. $13,247
p=0). The cost difference between the two groups for the entire length of
the hospitalization was $5,152. CONCLUSION(S): We found significant
quality and cost differences between OPCAB and PCAB-A when performed by an
experienced surgeon. OPCAB can be more or equally effective and
cost-friendly when performed by experienced surgeons on the appropriate
patient population.

<89>
Accession Number
638572614
Title
Qualitative Analysis of Surgical Studies Using Extracted Data from the
Manufacturer and User Facility Device Experience (MAUDE) Database.
Source
Journal of the American College of Surgeons. Conference: American College
of Surgeons 2020 Annual Clinical Congress. Virtual. 231(4 Supplement 2)
(pp e267), 2020. Date of Publication: October 2020.
Author
Zaepfel C.; Ziapour B.; Iafrati M.D.; Salehi P.
Institution
(Zaepfel, Ziapour, Iafrati, Salehi) Tufts Medical Center, Cardiovascular
center, Division of vascular surgery, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: To evaluate the limitations of using the Manufacturer and
User Facility Device Experience (MAUDE) database in surgical studies, we
analyzed the quality of studies having ever used MAUDE in the field of
cardiovascular surgery. METHOD(S): We systematically searched the
Cochrane Library, PubMed, EMBASE, and Google Scholar for randomized and
nonrandomized studies. Two authors evaluated the quality of the retrieved
observational studies, according to the National Institute of Health
quality assessment tool for either case-series or crosssectional studies.
 RESULT(S): Fifty-eight from 172 identified studies were eligible for
final qualitative review. Thirty two were case series, 8 were abstracts of
case-series, and 13 were reviews or case discussion with an included
series from MAUDE. Also, five articles were crosssectional studies. 26
(81.3%) of 32 formal case-series, as well as 4 (80%) of five
cross-sectional studies, were assessed as having poor quality.
 CONCLUSION(S): The majority of studies using the MAUDE database are
of case series or cross-sectional design, and are mostly of poor quality,
partly because of MAUDE limitations. Investigators are encouraged to
extract as much details as possible from MAUDE entries and use available
quality assessment tools to improve the quality of these studies. Using
medical case report standards during the process of reporting and indexing
adverse events in MAUDE can improve the database quality. Also, indexing
event-free cases of all used devices can provide a denominator to
calculate the prevalence of each adverse event and may transform the
database into a useful and authoritative source for analytic research.

<90>
Accession Number
2018315961
Title
Cost-Effectiveness of the Pharmacist-Managed Warfarin Therapy vs. Standard
Care for Patients With Mechanical Mitral Valve Prostheses: An Egyptian
Healthcare Perspective.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 889197. Date of Publication: 13 Jul 2022.
Author
Batran R.A.; Sabri N.A.; Ali I.; Fahmy S.F.
Institution
(Batran, Sabri, Fahmy) Department of Clinical Pharmacy, Faculty of
Pharmacy, Ain Shams University, Cairo, Egypt
(Ali) Department of Cardiothoracic Surgery, Cardiothoracic Surgery
Academy, Ain Shams University, Cairo, Egypt
Publisher
Frontiers Media S.A.
Abstract
Background: Despite warfarin therapy had been used for decades for
patients with mechanical mitral valve prostheses (MMVPs), serious and
life-threatening complications are still reported worldwide with a
significant economic burden. This study is aimed at assessing the clinical
and the cost-effectiveness of adopting pharmacist-managed warfarin therapy
(PMWT) services for optimizing warfarin treatment in Egypt.
 Method(s): A prospective randomized trial in which 59 patients with
MMVPs were randomly assigned to receive the PMWT services or the standard
care and followed up for 1 year. The primary outcome was percentage time
in the therapeutic range (TTR). For the cost-effectiveness analysis, a
Markov cohort process model with nine mutually exclusive health states was
developed from a medical provider's perspective. A lifetime horizon was
applied. All costs and outcomes were discounted at 3.5% annually.
 Result(s): The study results revealed a significantly higher median
TTR in the intervention group as compared to the control group; 96.8%
[interquartile range (IQR) 77.9-100%] vs. 73.1% (52.7-95.1%),
respectively, p = 0.008. A significant association between standard care
and poor anticoagulation control (p = 0.021) was demonstrated by the
multivariate regression analysis. For the cost-effectiveness analysis, the
total cumulative quality-adjusted life-years (QALYs) and total costs per
patient were 21.53 and 10.43; 436.38 and 1,242.25 United States dollar
(USD) in the intervention and the control groups, respectively, with an
incremental cost-effectiveness ratio (ICER) of -72.5796 for the
intervention group. Conclusion(s): The PMWT strategy was proven to
provide a significantly better anticoagulation control and to be a
cost-saving approach in Egyptian patients with MMVPs. Nevertheless, the
dominance of this strategy is sustained by maintaining the therapeutic
International Normalized Ratio (INR) control within the recommended range.
Our findings will benefit Egyptian policy-makers who may seek novel health
strategies for better resource allocation. Clinical Trial Registration:
[ClinicalTrials.gov], identifier [NCT04409613]. Copyright © 2022
Batran, Sabri, Ali and Fahmy.

<91>
Accession Number
2017608051
Title
Successful Mitral Valve Replacement in an Infant with Neonatal Marfan
Syndrome due to a Novel Missense Mutation of the FBN1 Gene A Case Report
and Review of Literature.
Source
International Heart Journal. 63(4) (pp 777-781), 2022. Date of
Publication: 2022.
Author
Motonaga T.; Ohnishi Y.; Okada S.; Suzuki Y.; Furuta T.; Kawamura M.;
Okayama N.; Suehiro Y.; Hasegawa S.
Institution
(Motonaga, Ohnishi, Okada, Suzuki, Furuta, Kawamura, Hasegawa) Department
of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube,
Japan
(Motonaga, Kawamura) Department of Pediatrics, Yamaguchi-ken Saiseikai
Shimonoseki General Hospital, Shimonoseki, Japan
(Okayama) Division of Laboratory, Yamaguchi University Graduate School of
Medicine, Ube, Japan
(Suehiro) Department of Oncology and Laboratory Medicine, Yamaguchi
University Graduate School of Medicine, Ube, Japan
Publisher
International Heart Journal Association
Abstract
Marfan syndrome is an autosomal dominant genetic disorder of the fibrous
connective tissue caused by pathogenic mutations in the fibrillin-1 gene.
Neonatal Marfan syndrome is a rare type of Marfan syndrome that is
genotypically and phenotypically different from classical Marfan syndrome
and has a poor prognosis. Most patients with neonatal Marfan syndrome die
during infancy due to severe and rapidly progressive cardiovascular
disorders. Here, we present a case of an 11-year-old girl with neonatal
Marfan syndrome due to a novel missense mutation in exon 27 of the
fibrillin-1 gene. Her condition was critical due to progressive mitral and
tricuspid regurgitation. Mitral valve replacement, performed at the age of
6 months, improved her critical condition. Our case suggests that early
mitral valve replacement may lead to better outcomes in patients with
neonatal Marfan syndrome. Copyright © 2022, International Heart
Journal Association. All rights reserved.

<92>
[Use Link to view the full text]
Accession Number
2019434957
Title
Understanding Baseline Physical Activity in Cardiac Rehabilitation
Enrollees Using Mobile Health Technologies.
Source
Circulation: Cardiovascular Quality and Outcomes. 15(7) (pp E009182),
2022. Date of Publication: 01 Jul 2022.
Author
Golbus J.R.; Gupta K.; Stevens R.; Jeganathan V.S.; Luff E.; Boyden T.;
Mukherjee B.; Klasnja P.; Kheterpal S.; Kohnstamm S.; Nallamothu B.K.
Institution
(Golbus, Stevens, Jeganathan, Luff, Kheterpal, Nallamothu) Division of
Cardiovascular Diseases, Department of Internal Medicine, University of
Missouri, Kansas City, United States
(Golbus, Nallamothu) Michigan Integrated Center for Health Analytics and
Medical Prediction (MiCHAMP), University of Missouri, Kansas City, United
States
(Mukherjee) School of Public Health, University of Missouri, Kansas City,
United States
(Klasnja) School of Information, University of Missouri, Kansas City,
United States
(Kohnstamm) Department of Anesthesiology, University of Missouri, Kansas
City, United States
(Gupta) University of Missouri, Kansas City, United States
(Boyden, Nallamothu) Division of Cardiovascular Diseases, Department of
Internal Medicine, Spectrum Health, MI, United States
(Nallamothu) The Center for Clinical Management and Research, Ann Arbor VA
Medical Center, MI, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Baseline physical activity in patients when they initiate
cardiac rehabilitation is poorly understood. We used mobile health
technology to understand baseline physical activity of patients initiating
cardiac rehabilitation within a clinical trial to potentially inform
personalized care. Method(s): The VALENTINE (Virtual
Application-Supported Environment to Increase Exercise During Cardiac
Rehabilitation Study) is a prospective, randomized-controlled, remotely
administered trial designed to evaluate a mobile health intervention to
supplement cardiac rehabilitation for low- and moderate-risk patients. All
participants receive a smartwatch and usual care. Baseline physical
activity was assessed remotely after enrollment and included (1) 6-minute
walk distance, (2) daily step count, and (3) daily exercise minutes, both
over 7 days and for compliant days, defined by >8 hours of watch wear
time. Multivariable linear regression identified patient-level features
associated with these 3 measures of baseline physical activity.
 Result(s): From October 2020 to March 2022, 220 participants enrolled
in the study. Participants are mostly White (184 [83.6%]); 67 (30.5%) are
female and 84 (38.2%) are >65 years old. Most participants enrolled in
cardiac rehabilitation after percutaneous coronary intervention (105
[47.7%]) or coronary artery bypass surgery (39 [17.7 %]). Clinical
diagnoses include coronary artery disease (78.6%), heart failure (17.3%),
and valve repair or replacement (26.4%). Baseline mean 6-minute walk
distance was 489.6 (SD, 143.4) meters, daily step count was 6845 (SD,
3353), and exercise minutes was 37.5 (SD, 33.5). In a multivariable model,
6-minute walk distance was significantly associated with age and sex, but
not cardiac rehabilitation indication. Sex but not age or cardiac
rehabilitation indication was significantly associated with daily step
count and exercise minutes. Conclusion(s): Baseline physical activity
varies substantially in low- and moderate-risk patients enrolled in
cardiac rehabilitation. Future studies are warranted to explore whether
personalizing cardiac rehabilitation programs using mobile health
technologies could optimize recovery. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT04587882. Copyright © 2022 Lippincott Williams and Wilkins.
All rights reserved.

<93>
Accession Number
2019465651
Title
Does Dexmedetomidine Reduce the Risk of Atrial Fibrillation and Stroke
After Adult Cardiac Surgery? A Systematic Review and Meta-analysis of
Randomized Controlled Trials.
Source
Anatolian Journal of Cardiology. 26(5) (pp 354-365), 2022. Date of
Publication: May 2022.
Author
Jing C.; Lin L.; Zhou T.; Li Y.L.; Fu L.; Gao M.Q.
Institution
(Jing, Lin, Zhou, Gao) Department of Intensive Care Unit, Beijing Shijitan
Hospital, Capital Medical University, Beijing, China
(Li, Fu) The Eighth Affiliated Hospital, Sun Yat-Sen University,
Guangdong, Shenzhen, China
Publisher
Turkish Society of Cardiology
Abstract
Background: Postoperative atrial fibrillation is a common consequence of
cardiac surgery with increased stroke complications and mortality.
Although dexmedetomidine is thought to prevent postoperative atrial
fibrillation and stroke because of its sympatholytic and anti-inflammatory
properties, data from different studies show the effect of dexmedetomidine
on postoperative atrial fibrillation and stroke uncertain in adult
patients with cardiac surgery. Method(s): A database including
EMBASE, PubMed, and Cochrane CENTRAL was searched for randomized
controlled trials comparing dexmedetomidine with placebo or other
anesthetic drugs in adult cardiac surgery. The primary outcome was the
incidence of postoperative atrial fibrillation. The secondary outcomes
were the incidence of postoperative stroke, mechanical ventilation
duration, intensive care unit length of stay, hospital length of stay, and
mortality. Result(s): Eighteen trials with a total of 2933 patients
were enrolled in the meta-analyses. Compared with controls,
dexmedetomidine significantly reduced the incidence of postoperative
atrial fibrillation [odds ratio, 0.82; 95% CI, 0.69-0.98; P = .03]. There
was no significant difference between groups in stroke (odds ratio, 1.36;
95% CI, 0.59-3.16; P = .47), mechanical ventilation duration [weighted
mean difference, -0.17; 95% CI, -0.35 to 0.14; P = .39], intensive care
unit length of stay (weighted mean difference, -0.03; 95% CI, -0.93 to
0.87; P = .95), hospital length of stay (weighted mean difference, -0.04;
95% CI, -0.40 to 0.32; P = .83) and mortality (odds ratio, 0.72; 95% CI,
0.32-1.60; P = .42). Conclusion(s): Perioperative dexmedetomidine
reduced the incidence of postoperative atrial fibrillation in adult
patients undergoing cardiac surgery. But there was no significant
difference in the incidence of stroke, mechanical ventilation duration,
intensive care unit length of stay, hospital length of stay, and
mortality. Copyright © 2022 Turkish Society of Cardiology. All
rights reserved.

<94>
Accession Number
638580239
Title
Colchicine for cardiovascular medicine: A systematic review and
meta-analysis.
Source
Future Cardiology. 18(8) (pp 647-659), 2022. Date of Publication: August
2022.
Author
Casula M.; Andreis A.; Avondo S.; Vaira M.P.; Imazio M.
Institution
(Casula, Andreis, Avondo, Vaira) University Cardiology, A.O.U. Citta Della
Salute E Della Scienza Di Torino, Turin, Italy
(Imazio) Cardiology, Cardiothoracic Department, University Hospital "santa
Maria Della Misericordia", Asufc, Udine, Italy
Publisher
Future Medicine Ltd.
Abstract
Aim: Colchicine, a microtubule-disassembling (antitubulin) agent used for
centuries for the treatment of gout and autoimmune diseases, is a drug of
growing interest in the cardiovascular field. While in the last decades it
has become cornerstone of pericarditis treatment, it has also emerged in
the last few years as a promising drug in the management of coronary
artery disease, atrial fibrillation and heart failure. This systematic
review and meta-analysis aimed to assess the efficacy of colchicine in
patients with cardiovascular diseases. Method(s): Systematic search
in electronic databases (MEDLINE/PubMed, Scopus, BioMed Central, the
Cochrane Collaboration Database of Randomized Trials, ClinicalTrials.gov,
EMBASE, Google Scholar) was performed to identify randomized controlled
trials (RCTs) up to February 2021. Random-effects meta-analysis was
performed to assess the risk of cardiovascular events, defined according
to clinical setting. Result(s): Among 15,569 pooled patients from 21
RCTs, colchicine was superior to placebo in the reduction of
cardiovascular events. In the setting of pericardial diseases, it was
associated with a lower risk of recurrent pericarditis (17 vs 34%, RR =
0.50, 95% CI: 0.42-0.60, I2 = 10%). In other studies assessing coronary
artery disease patients, colchicine was associated with a reduced risk of
major adverse cardiovascular events (MACE) such as myocardial infarction,
stroke, cardiovascular death, coronary revascularisation and
hospitalization (6.3 vs 9%, RR = 0.67, 95% CI: 0.54-0.84, I2 = 55). Among
patients with atrial fibrillation, it was associated with lower rates of
recurrence (20 vs 30%, RR = 0.68, 95% CI: 0.58-0.81, I2 = 0). In the
single RCT on heart failure, colchicine was not associated with improved
NYHA class. Conclusion(s): Colchicine is a valuable anti-inflammatory
agent for the prevention of cardiovascular events in patients with
inflammatory cardiac conditions such as pericardial diseases, coronary
artery disease and atrial fibrillation. Copyright © 2022 Future
Medicine Ltd.

<95>
Accession Number
638592579
Title
Percutaneous Repair of Mitral Regurgitation: A Comprehensive Review of
Literature.
Source
Current problems in cardiology. (pp 101338), 2022. Date of Publication:
21 Jul 2022.
Author
Salehin S.; Hasan S.M.; Mai S.; Rasmussen P.; Shahzad A.; Abdelmaseih R.;
Jazar D.A.; Shalaby M.; Motiwala A.; Gilani S.; Khalife W.I.
Institution
(Salehin) Internal Medicine, University of Texas Medical Branch,
Galveston, TX, United States
(Hasan, Shahzad, Abdelmaseih, Shalaby, Motiwala, Gilani, Khalife)
Cardiology, University of Texas Medical Branch, Galveston, TX, United
States
(Mai, Rasmussen, Jazar) Internal Medicine, University of Texas Medical
Branch, Galveston, TX, United States
Publisher
NLM (Medline)
Abstract
Mitral regurgitation is the most common valvular disease in the US and the
second most common worldwide. Left untreated, it can lead to the
development of heart failure, giving rise to increased mortality rates.
Mitral valve intervention is usually indicated in severe mitral
regurgitation at the onset of symptoms, even if the function of the left
ventricle is preserved. A surgical approach is generally favored according
to current guidelines, with excellent clinical outcomes. However, the
emergence of novel data from contemporary trials indicates that
percutaneous, catheter-based approach may have similar improvements in
mortality outcomes while maintaining a superior safety profile when
compared to the surgical approach. Here, we discuss transcatheter mitral
valve repair as a treatment option for mitral regurgitation and summarize
the major clinical trials which were recently conducted on transcatheter
repair. Copyright © 2022. Published by Elsevier Inc.

<96>
Accession Number
2018289763
Title
Is Intestinal Dysbiosis-Associated With Immunosuppressive Therapy a Key
Factor in the Pathophysiology of Post-Transplant Diabetes Mellitus?.
Source
Frontiers in Endocrinology. 13 (no pagination), 2022. Article Number:
898878. Date of Publication: 07 Jul 2022.
Author
Faucher Q.; Jardou M.; Brossier C.; Picard N.; Marquet P.; Lawson R.
Institution
(Faucher, Jardou, Brossier, Picard, Marquet, Lawson) University of
Limoges, Inserm U1248, Pharmacology Transplantation, Limoges, France
(Picard, Marquet) Department of pharmacology, toxicology and
pharmacovigilance, Centre Hospitalier Universitaire (CHU) Limoges,
Limoges, France
Publisher
Frontiers Media S.A.
Abstract
Post-transplant diabetes mellitus (PTDM) is one of the most common and
deleterious comorbidities after solid organ transplantation (SOT). Its
incidence varies depending on the organs transplanted and can affect up to
40% of patients. Current research indicates that PTDM shares several
common features with type 2 diabetes mellitus (T2DM) in non-transplant
populations. However, the pathophysiology of PTDM is still poorly
characterized. Therefore, ways should be sought to improve its diagnosis
and therapeutic management. A clear correlation has been made between PTDM
and the use of immunosuppressants. Moreover, immunosuppressants are known
to induce gut microbiota alterations, also called intestinal dysbiosis.
Whereas the role of intestinal dysbiosis in the development of T2DM has
been well documented, little is known about its impacts on PTDM.
Functional alterations associated with intestinal dysbiosis, especially
defects in pathways generating physiologically active bacterial
metabolites (e.g., short-chain fatty acids, trimethylamine N-oxide, indole
and kynurenine) are known to favour several metabolic disorders. This
publication aims at discussing the potential role of intestinal dysbiosis
and dysregulation of bacterial metabolites associated with
immunosuppressive therapy in the occurrence of PTDM. Copyright ©
2022 Faucher, Jardou, Brossier, Picard, Marquet and Lawson.

<97>
Accession Number
2018040770
Title
Minimally invasive surgery or stenting for left anterior descending artery
disease - meta-analysis.
Source
IJC Heart and Vasculature. 40 (no pagination), 2022. Article Number:
101046. Date of Publication: June 2022.
Author
Gianoli M.; de Jong A.R.; Jacob K.A.; Namba H.F.; van der Kaaij N.P.; van
der Harst P.; J.L Suyker W.
Institution
(Gianoli, de Jong, Jacob, Namba, van der Kaaij, J.L Suyker) Department of
Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht,
Netherlands
(van der Harst) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Minimally invasive direct coronary artery bypass (MIDCAB) surgery and
percutaneous coronary intervention (PCI) are both well-established
minimally invasive revascularization strategies in patients with proximal
left anterior descending (LAD) lesions. We aimed to evaluate the 20-years'
experience by performing a systematic review and meta-analysis comparing
MIDCAB versus PCI in adults with proximal LAD disease. We searched
MEDLINE, EMBASE and Cochrane on October 1st, 2021 for articles published
in the year 2000 or later. The primary outcome was all-cause mortality.
Secondary outcomes included cardiac mortality, repeat target vessel
revascularization (rTVR), myocardial infarction (MI), and cerebrovascular
accident (CVA). Outcomes were analysed at short-term, mid-term, and
long-term follow-up. Random effects meta-analyses were performed. Events
were compared using risk ratios (RR) with 95% confidence intervals (CI).
Our search yielded 17 studies pooling 3847 patients. At short-term
follow-up, cardiac mortality was higher with MIDCAB than with PCI (RR
7.30, 95% CI: 1.38 to 38.61). At long-term follow-up, MIDCAB showed a
decrease in all-cause mortality (RR 0.66, 95% CI: 0.46 to 0.93). MIDCAB
showed a decrease in rTVR at mid-term follow-up (RR 0.16, 95% CI: 0.11 to
0.23) and at long-term follow-up (RR 0.25, 95% CI: 0.17 to 0.38). MI and
CVA comparisons were not significant. In conclusion, in patients with
proximal LAD lesions, MIDCAB showed a higher short-term mortality in the
RCTs, but the cohort studies suggested a lower all-cause mortality at
long-term follow-up. We confirm a decreased rTVR at mid-term follow-up in
the RCTs and long-term follow-up in the cohort studies. Copyright
© 2022 The Author(s)

<98>
Accession Number
2019272951
Title
Percutaneous Coronary Intervention of Native Artery Versus Bypass Graft in
Patients with Prior Coronary Artery Bypass Graft Surgery.
Source
Reviews in Cardiovascular Medicine. 23(7) (no pagination), 2022. Article
Number: 232. Date of Publication: 2022.
Author
Farag M.; Brilakis E.S.; Gasparini G.L.; Spratt J.C.; Egred M.
Institution
(Farag, Egred) Cardiothoracic Department, Freeman Hospital, Newcastle upon
Tyne NE7 7DN, United Kingdom
(Farag) School of Life and Medical Sciences, University of Hertfordshire,
Hertfordshire AL10 9AB, United Kingdom
(Brilakis) Minneapolis Heart Institute Foundation, Minneapolis, MN 55407,
United States
(Gasparini) Department of Invasive Cardiology, Humanitas Clinical and
Research Center IRCCS, Rozzano, Milan 20089, Italy
(Spratt) Department of Cardiology, St George's University Hospitals NHS
Foundation Trust, London SW17 0QT, United Kingdom
(Egred) Newcastle University Translational and Clinical Research
Institute, Newcastle upon Tyne NE1 7RU, United Kingdom
Publisher
IMR Press Limited
Abstract
Background: Percutaneous coronary intervention (PCI) is common in patients
with prior coronary artery bypass graft surgery (CABG), however, there is
limited data on the association between the PCI target-vessel and clinical
outcomes. In this article, we provide a state-of-the-art overview of the
contemporary management of patients with prior CABG and a clear indication
for revascularization. Method(s): We performed a structured
literature search of PubMed and Cochrane Library databases from inception
to March 2021. Relevant studies were extracted and synthesized for
narrative review. Result(s): Twenty-six observational studies
focusing on PCI of bypass graft versus native coronary artery lesions in
366,060 patients with prior CABG were included. The data from
observational studies suggest that bypass graft PCI is associated with
higher short- and long-term major adverse cardiac events compared to
native coronary artery PCI. Conclusion(s): Whenever feasible, native
coronary artery PCI should be the prioritized treatment for saphenous vein
graft failure. Prospective randomized trials are needed to elucidate the
optimal revascularization strategy for patients with prior
CABG. Copyright © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

<99>
Accession Number
2019251029
Title
Neurological outcomes of transcatheter aortic valve implantation with or
without cerebral embolic protection devices: A meta-analysis.
Source
Journal of Stroke and Cerebrovascular Diseases. 31(9) (no pagination),
2022. Article Number: 106605. Date of Publication: September 2022.
Author
Perez-Camargo D.; Travieso A.; Carnero-Alcazar M.; Taramasso M.;
Cobiella-Carnicer J.; Maroto-Castellanos L.C.
Institution
(Perez-Camargo, Carnero-Alcazar, Cobiella-Carnicer, Maroto-Castellanos)
Cardiac Surgery Department, Hospital Universitario Clinico San Carlos,
Madrid, Spain
(Travieso) Cardiology Department, Hospital Universitario Clinico San
Carlos, Madrid, Spain
(Taramasso) HerzZentrum Hirslanden Zurich, Zurich, Switzerland
Publisher
W.B. Saunders
Abstract
Introduction: Cerebral embolic protection devices (CEPDs) are designed to
prevent embolization of debris during transcatheter aortic valve
implantation (TAVI). Current evidence from randomized clinical trials
(RCTs) and observational studies is controversial. Aim(s): The
purpose of this meta-analysis was to study the influence of CEPDs on
stroke, silent ischemic lesions and neurocognitive function.
 Method(s): A systematic search was conducted including RCTs or
adjusted observational studies comparing TAVI with or without CEPDs.
Pooled odds ratios, risk ratios or standardized mean differences with 95%
confidence intervals were calculated using the inverse of variance method.
Risk of bias sensitivity analyses and meta regression for CEPD type were
also conducted. Result(s): Five RCTs and five adjusted observational
studies were included (n= 159,865). Mean age of the patients was 81.1 (SD
1.04) years in CEPDs and 81 (SD 1.86) in non-CEPD. The overall quality of
evidence using the GRADE system for each endpoint was low to very low,
mainly due to serious risk of bias, inconsistency and imprecision. Random
effects meta-analysis detected no significant differences between CEPD and
non-CEPD (OR= 0.74; 95% CI 0.51-1.07; P= 0.105; I2= 82.1%) for
30-day stroke. This finding was consistent in meta regression for CEPD
type and subgroup analyses by study type and CEPD type. No significant
differences between groups were observed in cerebral DW-MRI assessment and
neurocognitive function evaluation. Conclusion(s): In the present
meta- analysis of five RCTs and five adjusted observational studies, the
use of a CEPD during TAVI was not associated with a significant benefit on
30- day stroke, total lesion volume per patient, number of ischemic
lesions per patient and neurocognitive function assessments. Copyright
© 2022 Elsevier Inc.

<100>
Accession Number
2014217288
Title
Restrictive versus liberal transfusion in patients with diabetes
undergoing cardiac surgery: An open-label, randomized, blinded outcome
evaluation trial.
Source
Diabetes, Obesity and Metabolism. 24(3) (pp 421-431), 2022. Date of
Publication: March 2022.
Author
Mistry N.; Shehata N.; Carmona P.; Bolliger D.; Hu R.; Carrier F.M.;
Alphonsus C.S.; Tseng E.E.; Royse A.G.; Royse C.; Filipescu D.; Mehta C.;
Saha T.; Villar J.C.; Gregory A.J.; Wijeysundera D.N.; Thorpe K.E.; Juni
P.; Hare G.M.T.; Ko D.T.; Verma S.; Mazer C.D.
Institution
(Mistry) Department of Anesthesia, St. Michael's Hospital, Institute of
Medical Sciences, University of Toronto, Toronto, ON, Canada
(Shehata) Division of Hematology, Departments of Medicine, Laboratory
Medicine and Pathobiology, Institute of Health Policy Management and
Evaluation, University of Toronto, Mount Sinai Hospital, Toronto, ON,
Canada
(Carmona) Department of Anesthesia and Critical Care, Hospital
Universitari and Politecnic La Fe, Valencia, Spain
(Bolliger) Clinic for Anaesthesia, Intermediate Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital Basel, Basel,
Switzerland
(Hu) Department of Anesthesia, Austin Hospital, Melbourne, VIC, Australia
(Carrier) Department of Anesthesiology & Department of Medicine, Critical
Care Division, Centre hospitalier de l'Universite de Montreal, Montreal,
QC, Canada
(Carrier) Carrefour de l'innovation et sante des populations, Centre de
recherche du CHUM, Montreal, QC, Canada
(Alphonsus) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and Faculty of Health Sciences, University of Cape Town,
Cape Town, South Africa
(Tseng) Division of Adult Cardiothoracic Surgery, Department of Surgery,
University of California San Francisco and San Francisco VA Medical
Center, San Francisco, CA, United States
(Royse, Royse) Department of Surgery, The Royal Melbourne Hospital,
Parkville, VIC, Australia
(Royse, Royse) Department of Surgery, The University of Melbourne,
Melbourne, VIC, Australia
(Royse) Outcomes Research Consortium, The Cleveland Clinic, Cleveland, OH,
United States
(Filipescu) Department of Cardiac Anaesthesia and Intensive Care Medicine,
Emergency Institute for Cardiovascular Diseases, Carol Davila University
of Medicine and Pharmacy, Bucharest, Romania
(Mehta) Department of Cardiac Anaesthesia, Epic Hospital, Ahmedabad, India
(Saha) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Kingston, ON, Canada
(Villar) Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota,
Colombia
(Villar) Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
Libin Cardiovascular Institute, Cumming School of Medicine, University of
Calgary, Calgary, AB, Canada
(Wijeysundera) Department of Anesthesia, St. Michael's Hospital, Li Ka
Shing Knowledge Institute, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(Thorpe) Applied Health Research Centre, Li Ka Shing Knowledge Institute
of St. Michael's Hospital, Dalla Lana School of Public Health, University
of Toronto, Toronto, ON, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Department of Medicine, University of Toronto,
Toronto, ON, Canada
(Hare) Department of Anesthesia, St. Michael's Hospital, Li Ka Shing
Knowledge Institute, Department of Physiology, University of Toronto,
Toronto, ON, Canada
(Ko) Division of Cardiology, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, Institute of Health Policy, Management and Evaluation
University of Toronto, ICES, Toronto, ON, Canada
(Verma) Division of Cardiac Surgery, St. Michael's Hospital, Li Ka Shing
Knowledge Institute, Department of Surgery, Department of Pharmacology and
Toxicology, University of Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, St. Michael's Hospital, Li Ka Shing
Knowledge Institute, Institute of Medical Sciences, Department of
Physiology, University of Toronto, Toronto, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Aim: To characterize the association between diabetes and transfusion and
clinical outcomes in cardiac surgery, and to evaluate whether restrictive
transfusion thresholds are harmful in these patients. Material(s) and
Method(s): The multinational, open-label, randomized controlled TRICS-III
trial assessed a restrictive transfusion strategy (haemoglobin [Hb]
transfusion threshold <75 g/L) compared with a liberal strategy (Hb <95
g/L for operating room or intensive care unit; or <85 g/L for ward) in
patients undergoing cardiac surgery on cardiopulmonary bypass with a
moderate-to-high risk of death (EuroSCORE >=6). Diabetes status was
collected preoperatively. The primary composite outcome was all-cause
death, stroke, myocardial infarction, and new-onset renal failure
requiring dialysis at 6 months. Secondary outcomes included components of
the composite outcome at 6 months, and transfusion and clinical outcomes
at 28 days. Result(s): Of the 5092 patients analysed, 1396 (27.4%)
had diabetes (restrictive, n = 679; liberal, n = 717). Patients with
diabetes had more cardiovascular disease than patients without diabetes.
Neither the presence of diabetes (OR [95% CI] 1.10 [0.93-1.31]) nor the
restrictive strategy increased the risk for the primary composite outcome
(diabetes OR [95% CI] 1.04 [0.68-1.59] vs. no diabetes OR 1.02
[0.85-1.22]; P<inf>interaction</inf> =.92). In patients with versus
without diabetes, a restrictive transfusion strategy was more effective at
reducing red blood cell transfusion (diabetes OR [95% CI] 0.28
[0.21-0.36]; no diabetes OR [95% CI] 0.40 [0.35-0.47];
P<inf>interaction</inf> =.04). Conclusion(s): The presence of
diabetes did not modify the effect of a restrictive transfusion strategy
on the primary composite outcome, but improved its efficacy on red cell
transfusion. Restrictive transfusion triggers are safe and effective in
patients with diabetes undergoing cardiac surgery. Copyright ©
2021 John Wiley & Sons Ltd.

<101>
Accession Number
2017379564
Title
The Efficacy and Safety of Automatic Modes During Respiratory Support
After Cardiac Surgery.
Source
Obshchaya Reanimatologiya. 18(3) (pp 21-29), 2022. Date of Publication:
2022.
Author
Yeremenko A.A.; Komnov R.D.; Koshek E.A.
Institution
(Yeremenko, Komnov, Koshek) B.V. Petrovsky Russian Research Center for
Surgery, 2 Abrikosov Lane, Moscow 119435, Russian Federation
Publisher
V.A. Negovsky Research Institute of General Reanimatology
Abstract
Aims. To compare the efficacy and safety of semiautonomous Adaptive
Support Ventilation (ASV) and fully automated (closed-loop,
Intellivent-ASV) mechanical ventilation and oxygenation versus
conventional mechanical ventilation mode during respiratory support in
cardiac surgery patients. Material and methods. In this study, 40 adult
patients were ventilated by conventional mechanical ventilation managed by
8 physicians (control group), whereas other two groups patients were
ventilated by Intel-livent-ASV (n=40) or in a semiautomatic ASV mode
(n=40). The groups received standard care, except for the modes of
ventilation. Results. In the Intellivent-ASV group, the number of manual
changes in ventilator settings was significantly lower: 0 (0-0) versus 2
(2-3) (ASV) and 4 (3-5) in the control group (P<0.0001). There were
significant differences in the duration of respiratory support in ICU
which was 226+/-31 min (Intellivent group) vs 259+/-66 (ASV) and 271+/-78
min (control) (P=0.0042; P<inf>1-2</inf>=0.0167; P<inf>1-3</inf>=0.009).
The Intellivent-ASV group patients received more pro-tective ventilation
than patients in the semiautomated and physician-controlled groups (lower
values of driving pressure (6 (6-7) cm H<inf>2</inf> O vs. 6 (6-7) and 7
(7-9) cm H<inf>2</inf> O (P<0.0001)), tidal volume (6 (6-7) vs. 7 (7-7.7)
and 7 (7-8) ml/kg/PBW (P<0.0001)), FiO<inf>2</inf> (26 (24-30)% vs. 34
(30-35)% and 34 (30-38)%) with no differences between the groups in
paO<inf>2</inf>/FiO<inf>2</inf>. There were no significant differences
between the groups in frequency of undesirable events and duration of ICU
stay. Conclusion. The use of intelligent technologies makes it possible to
interactively individualize respiratory support, significantly reducing
clinician's involvement in this process without compromising patient
safety and the quality of ventilation. Copyright © 2022, V.A.
Negovsky Research Institute of General Reanimatology. All rights reserved.

<102>
Accession Number
2016871052
Title
Frequency of Intravitreal Anti-VEGF Injections and Risk of Death: A
Systematic Review with Meta-analysis.
Source
Ophthalmology Retina. 6(5) (pp 369-376), 2022. Date of Publication: May
2022.
Author
Reibaldi M.; Fallico M.; Avitabile T.; Marolo P.; Parisi G.; Cennamo G.;
Furino C.; Lucenteforte E.; Virgili G.
Institution
(Reibaldi, Marolo, Parisi) Department of Surgical Sciences, Eye Clinic
Section, University of Turin, Turin, Italy
(Fallico, Avitabile) Department of Ophthalmology, University of Catania,
Catania, Italy
(Cennamo) Department of Public Health, University of Naples Federico II,
Naples, Italy
(Furino) Department of Ophthalmology, University of Bari, Bari, Italy
(Lucenteforte) Department of Clinical and Experimental Medicine,
University of Pisa, Pisa, Italy
(Virgili) Department of Neurosciences, Psychology, Drug Research and Child
Health (NEUROFARBA), University of Firenze and Careggi, Italy
(Virgili) Centre for Public Health, Queen's University of Belfast,
Northern Ireland, United Kingdom
Publisher
Elsevier Inc.
Abstract
Topic: To investigate whether an increasing number of intravitreal
anti-VEGF injections is associated with a higher mortality risk. Clinical
Relevance: The issue of systemic safety of intravitreal anti-VEGF therapy
has been long discussed. Evidence from meta-analyses of randomized studies
has shown no increased risk of mortality in the overall population,
whereas some warning signals of higher mortality were found in patients
with diabetes exposed to intense and prolonged treatment. Concerns have
been raised about whether an increasing number of anti-VEGF injections
could be associated with a higher mortality. Method(s): Randomized
clinical trials enrolling arms with different intensities of anti-VEGF
therapy were searched. The primary outcome measure was the incidence rate
ratio (IRR) of death with 95% confidence interval (CI) for receiving 5
injections. The relationship between the number of injections and
all-cause mortality was investigated. Separate regression analyses were
conducted to investigate this relationship in subgroups of studies with
different diseases and drugs. Result(s): Fifty-two trials were
included. Overall mortality rates of 1.02% and 3.36% were recorded at 12
and 24 months, respectively. Univariate regression showed that a larger
number of injections was not associated with a significant increase in
mortality both at 12 months (IRR, 1.16; 95% CI, 0.87-1.53; P = 0.31) and
at 24 months (IRR, 1.05; 95% CI, 0.95-1.15; P = 0.34). According to
subgroup analyses, in diabetic macular edema (DME) studies, a higher risk
was marginally associated with an increasing number of injections at 24
months (IRR, 1.17; 95% CI, 1.02-1.33; P = 0.03). Conclusion(s): No
significant influence of anti-VEGF treatment intensity on mortality was
shown, supporting a message of reassurance over safety concerns of this
therapy. Marginal evidence of a higher risk associated with a more intense
treatment was found in patients with DME. Copyright © 2021
American Academy of Ophthalmology

<103>
Accession Number
2018294350
Title
Multi-Modality Imaging for Interventions in Tricuspid Valve Disease.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 638487. Date of Publication: 09 Feb 2021.
Author
Fortuni F.; Hirasawa K.; Bax J.J.; Delgado V.; Ajmone Marsan N.
Institution
(Fortuni, Hirasawa, Bax, Delgado, Ajmone Marsan) Department of Cardiology,
Leiden University Medical Center, Leiden, Netherlands
Publisher
Frontiers Media S.A.
Abstract
Several studies have demonstrated that severe tricuspid regurgitation (TR)
has a significant negative impact on morbidity and mortality. Nowadays,
several therapeutic options to treat TR are available and patients at high
surgical risk can also be treated with transcatheter procedures. For the
management of patients with TR, an accurate assessment of the tricuspid
valve and its surrounding structures is therefore of crucial importance
and has gained significant interest in the medical community. Different
imaging modalities can provide detailed information on the tricuspid valve
apparatus, right ventricle, right atrium, and coronary circulation which
are fundamental to define the timing and anatomic suitability of surgical
and percutaneous procedures. The present review illustrates the role of 2D
and 3D echocardiography, cardiac magnetic resonance, and multidetector row
computed tomography for the assessment of the tricuspid valve and right
heart with a particular focus on the data needed for planning and guiding
interventional procedures. Copyright © 2021 Fortuni, Hirasawa,
Bax, Delgado and Ajmone Marsan.

<104>
Accession Number
2014424492
Title
The effects of erector spinae plane block on perioperative opioid
consumption and rehabilitation in video assisted thoracic surgery.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 313. Date
of Publication: December 2021.
Author
Zhang S.; Han X.; Zhou D.; Sun M.; Cang J.; Miao C.; Liang C.
Institution
(Zhang, Han, Zhou, Sun, Cang, Miao, Liang) Department of Anesthesiology,
Zhongshan Hospital, Fudan University, Shanghai 200032, China
Publisher
BioMed Central Ltd
Abstract
Background: This study aimed to determine whether ultrasound-guided
continuous erector spinae plane block (ESPB) had an effect on opioid
consumption and postoperative rehabilitation in patients undergoing
video-assisted thoracic surgery (VATS). Method(s): In this
prospective study, 120 patients aged 20-70 years who underwent elective
VATS were randomly allocated to one of three groups: group C (general
anesthesia with patient-controlled intravenous analgesia [PCIA]), group T
(general anesthesia with patient-controlled epidural analgesia [PCEA]), or
group E (general anesthesia with continuous ESPB and PCIA). Perioperative
opioid consumption, visual analog scale (VAS) scores, preoperative and
postoperative Quality of Recovery-15 scores, and postoperative
opioid-related adverse events were all assessed. Result(s):
Intraoperative sufentanil consumption in groups T and E was significantly
lower than that in group C (both P < 0.001), and the postoperative
sufentanil consumption in group E was also significantly lower than that
in group C (P = 0.001). Compared with group C, the VAS scores at rest or
during coughing immediately out of the post-anesthesia care unit at 6 h,
12 h, and 24 h postoperatively were significantly lower in group T (P <
0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in
group E were lower than those of group C (P < 0.05), but were
significantly higher than those of group T at all study times (P < 0.05).
 Conclusion(s): Ultrasound-guided continuous ESPB significantly
reduced perioperative opioid consumption during VATS and improved
postoperative rehabilitation. However, these effects were inferior to
those of thoracic epidural anesthesia. Trial registration: The present
study was prospectively registered at http://www.chictr.org/cn
/(registration number: ChiCTR1900023050); registration date: May
82,019. Copyright © 2021, The Author(s).

<105>
Accession Number
2018829050
Title
SAFETY OF BIOLOGIC THERAPY FOR INFLAMMATORY BOWEL DISEASE AMONG SOLID
ORGAN TRANSPLANT RECIPIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Gastroenterology. Conference: DDW 2022. San Diego United States. 162(7
Supplement) (pp S-820), 2022. Date of Publication: May 2022.
Author
Taneja V.; Anand R.; El-Dallal M.; Dong J.; Desai N.; Taneja I.;
Feuerstein J.D.
Publisher
W.B. Saunders
Abstract
Background: Many patients with Inflammatory Bowel Disease (IBD) undergo
solid organ transplant for concomitant liver disease such as PSC, chronic
kidney disease, as well as for other conditions. There are no specific
guidelines regarding initiating or continuing biologic therapy in this
subset of post-transplant patients. This study sought to evaluate the
safety of biologic therapy for the treatment of IBD among solid organ
transplant recipients. Method(s): Medline, Embase and Web of Science
databases were systematically searched for all articles reporting on
safety outcomes associated with the use of biologic therapy (infliximab,
adalimumab, certolizumab, golimumab, vedolizumab, ustekinumab and
tofacitinib) in patients with IBD post solid organ transplant (liver,
kidney, heart, lung, pancreas). The primary outcome was infectious
complications. Secondary outcomes included serious infections, colectomy,
and discontinuation of biologic therapy. Subgroup analyses were conducted
by type of biologic, type of IBD, and type of organ transplant.
Sensitivity analyses were conducted by full text articles. A priori, we
decided to only include studies with 5 or more patients in the
meta-analysis. IBD related steroid use was recorded separately and
included in meta-regression. Steroids used as part of antirejection
regimens were not included in the analysis. Result(s): A total of 797
articles were identified for screening, yielding 16 articles (including 5
abstracts) for the meta-analyses with information on 163 patients.
Anti-TNFs (infliximab and adalimumab) were used in 8 studies, vedolizumab
was used in 6 studies, and a combination of vedolizumab and anti-TNFs was
utilized in 2 studies. One study each reported outcomes after kidney and
cardiac transplant, the rest of the studies included patients with liver
transplant. The rates of all infectious complications and serious
infections were 0.20 per person year (PY) (95% CI 0.12-0.33 per PY,
I2:54%) and 0.18 per PY (95% CI 0.12- 0.26 per PY,
I2:21%) respectively. The rates of colectomy and biologic
medication discontinuation were 0.13 per PY (95% CI 0.06-0.25 per PY,
I2:34%) and 0.19 per PY (95% CI 0.09-0.40 per PY,
I2:74%) respectively. The rate of infectious complications
associated with vedolizumab was 0.35 per PY (95% CI 0.19-0.66 per PY,
I2:0%) as compared to 0.08 per PY (95% CI 0.04-0.14 per PY,
I2:0%) for anti-TNFs. No cases of VTE or death attributable to
biologic use were reported. Conclusion(s): Our study characterizes
the safety profile of biologic therapy for IBD in solid organ transplant
recipients for the first time. Limited evidence shows that vedolizumab may
be associated with a higher risk of infections as compared to anti-TNFs.
Long term studies are needed to better define the role of specific
agents.(Figure Presented) Figure 1: Forest plot of all infectious
complications associated with biologic use for IBD in solid organ
transplant recipients. (Figure Presented)Figure 2: Forest plot of serious
infections associated with biologic use for IBD in solid organ transplant
recipients Copyright © 2022, AGA Institute.

<106>
Accession Number
638557636
Title
Paediatric brain MRI findings following congenital heart surgery: A
systematic review.
Source
Journal of Cerebral Blood Flow and Metabolism. Conference: 30th
International Symposium on Cerebral Blood Flow, Metabolism and Function
and the 15th International Conference on Quantification of Brain Function
with PET. Glasgow United Kingdom. 42(1 Supplement) (pp 120-121), 2022.
Date of Publication: June 2022.
Author
Alablani F.
Institution
(Alablani) University of Leicester, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Objective: This systematic review aimed to establish the relative
incidence of new post-operative brain MRI findings following paediatric
congenital cardiac surgery. Design(s): To distinguish perioperative
changes from preexisting MR findings, our systematic search strategy
focused on identifying original research studies reporting both pre- and
post-surgery brain MRI scans. Patient demographics, study methods, and
brain MR findings were extracted. Result(s): Twenty-one eligible
publications, including two case-control, and one randomised controlled
trial were identified. Pre-existing brain MRI findings were noted in 43%
(513/1205) of neonates prior to surgery; mainly white matter injuries
(WMI). Surgery was performed at a median age of 8 days with comparison of
pre- and postoperative MR scans revealing additional new postoperative
findings in 51% (550/1075) of patients; mainly WMI. Four studies adopted a
brain injury scoring system, but the majority did not indicate the
severity or time course of findings. In a sub-group analysis approximately
32% of patients with pre-existing lesions went on to develop additional
new lesions post-surgery. Preexisting findings was not found to confer a
higher risk of acquiring brain lesions post-operatively. No evidence was
identified linking new MR findings with neurodevelopmental delay.
 Conclusion(s): This review and meta-analysis suggests that surgery
approximately doubles the number of patients with new brain lesions.

<107>
Accession Number
638557165
Title
Outcomes after Free Fibula Flaps for Pediatric Mandibular Reconstruction:
A Systematic Review.
Source
Journal of the American College of Surgeons. Conference: 2019 Owen
Wangensteen Scientific Forum of the American College of Surgeons. San
Francisco, CA United States. 229(4 Supplement 1) (pp S226-S227), 2019.
Date of Publication: October 2019.
Author
Firriolo J.M.; Dang R.R.; Nuzzi L.C.; Caldroney S.J.; Labow B.I.
Institution
(Firriolo, Dang, Nuzzi, Caldroney, Labow) Boston Children's Hospital,
Harvard Medical School, Boston, MA; Boston Medical Center, Boston, MA;
University of California, Davis Medical Center, Sacramento, CA
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: The purpose of this study is to describe the outcomes of
pediatric patients who have undergone mandibular reconstruction using free
fibular flaps. METHOD(S): We performed a comprehensive literature
review and selected articles relevant to pediatric mandibular
reconstruction using free fibula flaps. RESULT(S): A total of 403
English-language articles were identified in the initial query. Of those,
23 articles met the inclusion criteria. Our analyses included 129
pediatric patients who underwent mandibular reconstruction using a total
of 131 free fibular flaps. Most mandibular defects were caused by either
neoplasia (68.2%) or congenital anomalies (16.3%). Mean patient age at the
time of reconstruction was 10.2 +/- 4.4 years; patients were followed
postoperatively for a median of 49 months (interquartile range 24 to 60
months). The overall flap success rate was 96.9%; 4 patients experienced
flap failure (aged 6 to 18 years; 3 with neoplastic pathology and 1 with
an arteriovenous malformation). Approximately 12% of patients experienced
postoperative complications. A total of 4 patients died: 3 due to
progression of malignancy, the other after a heart transplantation.
Information on postoperative occlusion was available for only 60 patients,
of which 11.6% (n = 7) experienced malocclusion. There was insufficient
information on eating and speaking outcomes. CONCLUSION(S): Pediatric
mandibular reconstruction with free fibular flaps is safe and reliable.
However, long-term outcomes data are limited in the current literature.
Additional research to better characterize these outcomes is necessary to
improve surgical decision- making and to better inform patients and their
families.

<108>
Accession Number
638559559
Title
Early and Late Outcomes in Coronary Artery Bypass Grafting in 428 Patients
with End- Stage Renal Disease: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Surgeons. Conference: American College
of Surgeons 2018 Annual Clinical Congress. Boston, MA United States. 227(4
Supplement 2) (pp e88-e89), 2018. Date of Publication: October 2018.
Author
Tam D.Y.; Gaudino M.F.L.; Karkhanis R.; Fremes S.E.
Institution
(Tam, Gaudino, Karkhanis, Fremes) University of Toronto, Toronto, ON,
Canada
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: Patients with end-stage renal disease (ESRD) on dialysis
undergoing coronary artery bypass grafting (CABG) are at high-risk of
perioperative mortality and morbidity. Studies comparing a bilateral
(BIMA) vs single internal mammary artery (SIMA) grafting strategy are
limited by sample size to detect outcome differences. We sought to
determine the safety and efficacy of BIMA compared to SIMA in this high
risk population. METHOD(S): MEDLINE and EMBASE were searched from
inception to 2017 for studies directly comparing BIMA to SIMA in patients
with ESRD undergoing CABG. The primary outcome was early mortality;
secondary outcomes were stroke, deep sternal wound infection (DSWI), and
late mortality. The effects of IMA skeletonization was assessed for DSWI
in a meta-regression. RESULT(S): Five studies (2 adjusted [n=142] and
3 unadjusted observational studies [n=286]) were included in the analysis.
There was no difference in early mortality (relative risk [RR]: 0.84, 95%
CI: 0.36, 1.98, p=0.70), perioperative stroke (RR: 1.97, 95% CI: 0.58,
6.66, p=0.28), and DSWI (RR: 1.56, 95% CI: 0.60,4.07, p=0.36) between BIMA
and SIMA. All studies reported adjusted late mortality which was similar
between BIMA and SIMA (incident rate ratio: 0.81, 95% CI: 0.59,1.11) at
mean 3.7-year follow-up. Reported IMA skeletonization ranged from 41% to
100% (median-100%) and did not impact DSWI outcomes in a meta-regression
(p=0.84). CONCLUSION(S): BIMA grafting is safe in ESRD patients
although there was no late survival benefit. Additional studies with
longer follow-up is required to determine the potential late benefits of
BIMA grafting in ESRD patients.

<109>
Accession Number
2019424620
Title
Alpha-2-adrenergic receptor agonists for the prevention of delirium and
cognitive decline after open heart surgery (ALPHA2PREVENT): Protocol for a
multicentre randomised controlled trial.
Source
BMJ Open. 12(6) (no pagination), 2022. Article Number: e057460. Date of
Publication: 01 Jun 2022.
Author
Neerland B.E.; Busund R.; Haaverstad R.; Helbostad J.L.; Landsverk S.A.;
Martinaityte I.; Norum H.M.; Raeder J.; Selbaek G.; Simpson M.R.; Skaar
E.; Skjaervold N.K.; Skovlund E.; Slooter A.J.C.; Svendsen O.S.; Tonnessen
T.; Wahba A.; Zetterberg H.; Wyller T.B.
Institution
(Neerland, Selbaek, Wyller) Department of Geriatric Medicine, Oslo
University Hospital, Oslo, Norway
(Busund) Department of Cardiothoracic and Vascular Surgery, University
Hospital of North Norway, Tromso, Norway
(Busund, Martinaityte) Institute of Clinical Medicine, UiT the Artic
University of Norway, Tromso, Norway
(Haaverstad, Skaar) Department of Heart Disease, Haukeland University
Hospital, Bergen, Norway
(Haaverstad) Institute of Clinical Science, University of Bergen, Bergen,
Norway
(Helbostad) Department of Neuromedicine and Movement Science, Norwegian
University of Science and Technology, Trondheim, Norway
(Landsverk, Norum, Raeder) Department of Anaesthesiology, Oslo University
Hospital, Oslo, Norway
(Martinaityte) Department of Geriatric Medicine, University Hospital of
North Norway, Tromso, Norway
(Norum) Department of Research and Development, Oslo University Hospital,
Oslo, Norway
(Raeder, Selbaek, Tonnessen, Wyller) Institute of Clinical Medicine,
University of Oslo, Oslo, Norway
(Selbaek) Norwegian National Advisory Unit on Ageing and Health, Tonsberg,
Norway
(Simpson, Skovlund) Department of Public Health and Nursing, Norwegian
University of Science and Technology, Trondheim, Norway
(Skjaervold, Wahba) Department of Circulation and Medical Imaging,
Norwegian University of Science and Technology, Trondheim, Norway
(Skjaervold) Department of Anesthesia and Intensive Care Medicine,
Trondheim University Hospital, Trondheim, Norway
(Slooter) Department of Intensive Care Medicine, University Medical Centre
Utrecht, Utrecht, Netherlands
(Slooter) Department of Neurology, Uz Brussel and Vrije Universiteit
Brussel, Brussel, Brussel, Belgium
(Svendsen) Department of Anesthesia and Intensive Care, Haukeland
University Hospital, Bergen, Norway
(Svendsen) Department of Clinical Medicine, University of Bergen, Bergen,
Norway
(Tonnessen) Department of Cardiothoracic Surgery, Oslo University
Hospital, Oslo, Norway
(Wahba) Clinic of Cardiothoracic Surgery, Trondheim University Hospital,
Trondheim, Norway
(Zetterberg) Department of Psychiatry and Neurochemistry, University of
Gothenburg Sahlgrenska Academy, Goteborg, Sweden
(Zetterberg) Department of Neurodegenerative Disease, Ucl Institute of
Neurology, London, United Kingdom
(Zetterberg) Uk Dementia Research Institute, Ucl, London, United Kingdom
(Zetterberg) Hong Kong Center for Neurodegenerative Diseases, Hong Kong
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium is common in older cardiac surgery
patients and associated with negative short-term and long-term outcomes.
The alpha-2-adrenergic receptor agonist dexmedetomidine shows promise as
prophylaxis and treatment for delirium in intensive care units (ICU) and
postoperative settings. Clonidine has similar pharmacological properties
and can be administered both parenterally and orally. We aim to study
whether repurposing of clonidine can represent a novel treatment option
for delirium, and the possible effects of dexmedetomidine and clonidine on
long-term cognitive trajectories, motor activity patterns and biomarkers
of neuronal injury, and whether these effects are associated with frailty
status. Methods and analysis This five-centre, double-blind randomised
controlled trial will include 900 cardiac surgery patients aged 70+ years.
Participants will be randomised 1:1:1 to dexmedetomidine or clonidine or
placebo. The study drug will be given as a continuous intravenous infusion
from the start of cardiopulmonary bypass, at a rate of 0.4 mug/kg/hour.
The infusion rate will be decreased to 0.2 mug/kg/hour postoperatively and
be continued until discharge from the ICU or 24 hours postoperatively,
whichever happens first. Primary end point is the 7-day cumulative
incidence of postoperative delirium (Diagnostic and Statistical Manual of
Mental Disorders, fifth edition). Secondary end points include the
composite end point of coma, delirium or death, in addition to delirium
severity and motor activity patterns, levels of circulating biomarkers of
neuronal injury, cognitive function and frailty status 1 and 6 months
after surgery. Ethics and dissemination This trial is approved by the
Regional Committee for Ethics in Medical Research in Norway (South-East
Norway) and by the Norwegian Medicines Agency. Dissemination plans include
publication in peer-reviewed medical journals and presentation at
scientific meetings. Trial registration number NCT05029050. Copyright
© 2022 BMJ Publishing Group. All rights reserved.

<110>
Accession Number
2019423794
Title
Feasibility study of a randomised controlled trial of preoperative and
postoperative nutritional supplementation in major lung surgery.
Source
BMJ Open. 12(6) (no pagination), 2022. Article Number: e057498. Date of
Publication: 01 Jun 2022.
Author
Kerr A.; Lugg S.T.; Kadiri S.; Swift A.; Efstathiou N.; Kholia K.; Rogers
V.; Fallouh H.; Steyn R.; Bishay E.; Kalkat M.; Naidu B.
Institution
(Kerr, Kadiri, Kholia, Rogers, Fallouh, Steyn, Bishay, Kalkat, Naidu)
Department of Thoracic Surgery, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, United Kingdom
(Lugg, Naidu) Birmingham Acute Care Research Group, Institute of
Inflammation and Ageing, University of Birmingham, Birmingham, United
Kingdom
(Swift, Efstathiou) Institute of Clinical Sciences and School of Nursing,
University of Birmingham, Birmingham, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives Malnutrition and weight loss are important risk factors for
complications after lung surgery. However, it is uncertain whether
modifying or optimising perioperative nutritional state with oral
supplements results in a reduction in malnutrition, complications or
quality of life. Design A randomised, open label, controlled feasibility
study was conducted to assess the feasibility of carrying out a large
multicentre randomised trial of nutritional intervention. The intervention
involved preoperative carbohydrate-loading drinks (4x200 mL evening before
surgery and 2x200 mL the morning of surgery) and early postoperative
nutritional protein supplement drinks two times per day for 14 days
compared with the control group receiving an equivalent volume of water.
Setting Single adult thoracic centre in the UK. Participants All adult
patients admitted for major lung surgery. Patients were included if were
able to take nutritional drinks prior to surgery and give written informed
consent. Patients were excluded if they were likely unable to complete the
study questionnaires, they had a body mass index <18.5 kg/m 2, were
receiving parenteral nutrition or known pregnancy. Results All patients
presenting for major lung surgery were screened over a 6-month period,
with 163 patients screened, 99 excluded and 64 (41%) patients randomised.
Feasibility criteria were met and the study completed recruitment 5 months
ahead of target. The two groups were well balanced and tools used to
measure outcomes were robust. Compliance with nutritional drinks was 97%
preoperatively and 89% postoperatively; 89% of the questionnaires at 3
months were returned fully completed. The qualitative interviews
demonstrated that the trial and the intervention were acceptable to
patients. Patients felt the questionnaires captured their experience of
recovery from surgery well. Conclusion A large multicentre randomised
controlled trial of nutritional intervention in major lung surgery is
feasible and required to test clinical efficacy in improving outcomes
after surgery. Trial registration number ISRCTN16535341. Copyright
© Author(s) (or their employer(s)) 2022.

<111>
Accession Number
638557345
Title
Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in
Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A
Randomized Clinical Trial.
Source
JAMA. 328(3) (pp 251-258), 2022. Date of Publication: 19 Jul 2022.
Author
Pesonen E.; Vlasov H.; Suojaranta R.; Hiippala S.; Schramko A.; Wilkman
E.; Eranen T.; Arvonen K.; Mazanikov M.; Salminen U.-S.; Meinberg M.;
Vahasilta T.; Petaja L.; Raivio P.; Juvonen T.; Pettila V.
Institution
(Pesonen, Vlasov, Suojaranta, Hiippala, Schramko, Wilkman, Arvonen,
Mazanikov, Meinberg, Petaja, Pettila) Department of Anesthesiology,
Intensive Care and Pain Medicine, University of Helsinki, Helsinki
University Hospital, Helsinki, Finland
(Eranen) HUS Pharmacy, University of Helsinki, Helsinki University
Hospital, Helsinki, Finland
(Salminen, Vahasilta, Raivio, Juvonen) Department of Cardiac Surgery,
Heart and Lung Center, University of Helsinki, Helsinki University
Hospital, Helsinki, Finland
Publisher
American Medical Association
Abstract
Importance: In cardiac surgery, albumin solution may maintain hemodynamics
better than crystalloids and reduce the decrease in platelet count and
excessive fluid balance, but randomized trials are needed to compare the
effectiveness of these approaches in reducing surgical complications.
 Objective(s): To assess whether 4% albumin solution compared with
Ringer acetate as cardiopulmonary bypass prime and perioperative
intravenous volume replacement solution reduces the incidence of major
perioperative and postoperative complications in patients undergoing
cardiac surgery. Design, Setting, and Participant(s): A randomized,
double-blind, single-center clinical trial in a tertiary university
hospital during 2017-2020 with 90-day follow-up postoperatively involving
patients undergoing on-pump coronary artery bypass grafting; aortic,
mitral, or tricuspid valve surgery; ascending aorta surgery without
hypothermic circulatory arrest; and/or the maze procedure were randomly
assigned to 2 study groups (last follow-up was April 13, 2020).
 Intervention(s): The patients received in a 1:1 ratio either 4%
albumin solution (n = 693) or Ringer acetate solution (n = 693) as
cardiopulmonary bypass priming and intravenous volume replacement
intraoperatively and up to 24 hours postoperatively. Main Outcomes
and Measures: The primary outcome was the number of patients with at least
1 major adverse event: death, myocardial injury, acute heart failure,
resternotomy, stroke, arrhythmia, bleeding, infection, or acute kidney
injury. Result(s): Among 1407 patients randomized, 1386 (99%; mean
age, 65.4 [SD, 9.9] years; 1091 men [79%]; 295 women [21%]) completed the
trial. Patients received a median of 2150 mL (IQR, 1598-2700 mL) of study
fluid in the albumin group and 3298 mL (IQR, 2669-3500 mL) in the Ringer
group. The number of patients with at least 1 major adverse event was 257
of 693 patients (37.1%) in the albumin group and 234 of 693 patients
(33.8%) in the Ringer group (relative risk albumin/Ringer, 1.10; 95% CI,
0.95-1.27; P =.20), an absolute difference of 3.3 percentage points (95%
CI, -1.7 to 8.4). The most common serious adverse events were pulmonary
embolus (11 [1.6%] in the albumin group vs 8 [1.2%] in the Ringer group),
postpericardiotomy syndrome (9 [1.3%] in both groups), and pleural
effusion with intensive care unit or hospital readmission (7 [1.0%] in the
albumin group vs 9 [1.3%] in the Ringer group). Conclusions and
Relevance: Among patients undergoing cardiac surgery with cardiopulmonary
bypass, treatment with 4% albumin solution for priming and perioperative
intravenous volume replacement solution compared with Ringer acetate did
not significantly reduce the risk of major adverse events over the
following 90 days. These findings do not support the use of 4% albumin
solution in this setting. Trial Registration: ClinicalTrials.gov
Identifier: NCT02560519. Copyright © 2022 American Medical
Association. All rights reserved.

<112>
Accession Number
2019347447
Title
Effect of Volatile Anesthesia Versus Total Intravenous Anesthesia on
Postoperative Pulmonary Complications in Patients Undergoing Cardiac
Surgery: A Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
He L.-L.; Li X.-F.; Jiang J.-L.; Dai S.-H.; Jing W.-W.; Yu H.
Institution
(He, Li, Jiang, Yu, Dai, Yu) Department of Anesthesiology, West China
Hospital, Sichuan University, Chengdu, China
(He) Department of Anesthesiology, Sichuan Jinxin Women and Children's
Hospital, Chengdu, China
(Jing) Department of Anesthesiology, West China Second University
Hospital, Sichuan University, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: The purpose of this study was to evaluate the effect of
volatile anesthesia and propofol-based total intravenous anesthesia (TIVA)
on postoperative pulmonary complications (PPCs) among patients undergoing
cardiac surgery. Design(s): Parallel-group, randomized controlled
trial. Setting(s): Single-center tertiary care hospital.
 Participant(s): Five hundred twenty-four patients undergoing cardiac
surgery with cardiopulmonary bypass. Intervention(s): The patients
were assigned randomly (1:1) to receive anesthesia maintenance with a
volatile anesthetic (sevoflurane or desflurane) or propofol-based TIVA.
 Measurements and Main Results: The primary outcome was a composite of
postoperative pulmonary complications within the first 7 postoperative
days. The PPCs occurred in 118 of 262 patients (45.0%) in the volatile
anesthesia group compared with 105 of 262 patients (40.1%) in the
propofol-based intravenous anesthesia group (relative risk: 1.17 [95% CI
0.96-1.42], p = 0.123). There were no significant differences in the
severity of PPCs within 7 days postoperatively, the occurrence and
severity grade of PPCs within 30 days, the incidence of hypoxia, and
30-day mortality. Conclusion(s): In adult patients undergoing cardiac
surgery with cardiopulmonary bypass, general anesthesia with a volatile
anesthetic compared with propofol-based TIVA had not reduced pulmonary
complications within the first 7 days after surgery. Copyright ©
2022 Elsevier Inc.

<113>
Accession Number
2019347431
Title
Euglycemic Diabetic Ketoacidosis Associated With Sodium-Glucose
Cotransporter-2 Inhibitors After Cardiac Surgery: A Review of Current
Literature.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Branco A.; Fatima R.; Liblik K.; Jackson R.; Payne D.; El-Diasty M.
Institution
(Branco, Liblik) School of Medicine, Queen's University, Kingston, ON,
Canada
(Jackson) Department of Cardiology, Queen's University, Kingston, ON,
Canada
(Fatima, Payne, El-Diasty) Department of Cardiac Surgery, Queen's
University, Kingston, ON, Canada
Publisher
W.B. Saunders
Abstract
There is growing evidence to support the use of sodium-glucose
cotransporter-2 (SGLT2) inhibitors for type 2 diabetes mellitus (T2DM) and
the management of heart failure. As such, more patients undergoing cardiac
surgery are on SGLT2-inhibitor therapy. Despite the numerous benefits of
SGLT2 inhibitors on cardiac health, they can be associated with an
increased risk of diabetic ketoacidosis, often with normal glucose levels
(euglycemic diabetic ketoacidosis or EDKA), which potentially can be
detrimental in this vulnerable patient population. In this narrative
review, the authors discuss 17 papers that described EDKA in perioperative
cardiac surgical patients. The authors discuss suggested preventative
measures and management options, with a particular emphasis on raising the
clinical awareness of the care teams toward this complication. SGLT2
inhibitor-induced EDKA is a medical emergency that can be difficult to
identify in the postcardiac surgical patient due to the overlap of signs
and symptoms with other frequent scenarios in these patients. A reduction
in SGLT2 inhibitor-associated EDKA can be mitigated by the appropriate
perioperative discontinuation of the medication, clinical awareness, and
early investigation to diagnose the condition, with emphasis on serum
beta-hydroxybutyrate. Future quality improvement initiatives are needed to
assist in reducing EDKA in patients taking SGLT2 inhibitors in the
perioperative surgical setting. Copyright © 2022 Elsevier Inc.

EPICORE Embase Updates

Saturday, August 6, 2022

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

No comments:

Post a Comment

Followers

Blog Archive

About Me