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<1>
Accession Number
2020399589
Title
Is hormonal manipulation after surgical treatment of catamenial
pneumothorax effective in reducing the rate of recurrence? A systematic
review and meta-analysis.
Source
European Journal of Obstetrics and Gynecology and Reproductive Biology.
278 (pp 141-147), 2022. Date of Publication: November 2022.
Author
Elsayed H.H.; Hassaballa A.S.; Mostafa M.H.; El Ghanam M.; Ahmed M.H.;
Gumaa M.; Moharram A.A.
Institution
(Elsayed) Thoracic Surgery Department, Ain Shams University, Cairo, Egypt
(Hassaballa, El Ghanam, Ahmed) Cardiothoracic Surgery Department, Ain
Shams University, Cairo, Egypt
(Mostafa) Obstetrics and Gynecology Department, Ain Shams University,
Cairo, Egypt
(Gumaa) TRUST Research Centre, Cairo, Egypt
(Moharram) Department of Anaethesia, Intensive Care and Pain Management,
Ain Shams University, Cairo, Egypt
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: Catamenial pneumothorax CP is a rare form of spontaneous
pneumothorax in females forming part of thoracic endometriosis syndrome.
Studies have suggested possible benefit from postoperative hormonal
administration. As this treatment is inconsistent, we aimed at performing
the first meta-analysis to study the efficacy of adding hormonal treatment
after surgery to reduce the chances of recurrent catamenial pneumothorax.
 Method(s): CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were
systematically searched from inception up to December 15, 2021. Studies
reporting five or more patients with end point outcome were included. The
main outcome assessed was postoperative recurrence of CP after hormonal
manipulation. Baseline, procedural, outcome, and validity data were
systematically appraised and pooled with random-effect methods. meta-
regression for the effect of patient age and follow up period were tested.
Publication bias was examined. This trial was registered with PROSPERO
under registration number CRD42022325377. Result(s): Our electronic
search retrieved 644 citations, 48 of which were selected for full-text
review. Eleven studies with a combined population of 111 patients
fulfilled the inclusion criteria. All patients reached an endpoint of
follow up for postoperative recurrence of catamenial pneumothorax after
receiving hormonal treatment. Overall study validity was acceptable, with
a median score of 6 on the Newcastle Ottawa scale NOS appraising the
quality of observational studies. CP is almost always a right-side disease
(107/111 = 96.3 %). The risk of postoperative recurrence with hormonal
treatment was 17.3 % (8.9 - 25.8 %) with moderate non-significant
heterogeneity (I2 = 40.85 %; P = 0.076). The cumulative risk of recurrence
for all patients not receiving postoperative hormonal therapy included in
our study was 54.2 % (19/35 patients). Meta regression showed age to be a
significant predictor of postoperative recurrence (p = 0.03). As the age
increases one year, the risk of recurrence decreases by 6 % (0.2 - 3 %).
Publication bias was detected by visualizing the funnel plot of standard
error, Egger's test with p < 0.01 and Begg & Mazumdar test with p < 0.01.
 Conclusion(s): The study included the largest number of CP patients
with outcome findings of postoperative recurrence with hormonal treatment
despite the small number of studies, non-randomised fashion and
publication bias. Our findings recommend the use of hormonal manipulation
after thoracic surgical intervention for catamenial pneumothorax unless
evident contraindications. Younger patients are at a higher risk of
recurrence after surgery. Copyright © 2022 Elsevier B.V.

<2>
Accession Number
2019181794
Title
Nicorandil Improves Left Ventricular Myocardial Strain in Patients With
Coronary Chronic Total Occlusion.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 864223. Date of Publication: 12 May 2022.
Author
Chen S.; Ma C.; Feng X.; Cui M.
Institution
(Chen, Feng, Cui) Department of Cardiology and Institute of Vascular
Medicine, Peking University Third Hospital, Key Laboratory of
Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of
Health, Key Laboratory of Molecular Cardiovascular Science, Ministry of
Education, Beijing Key Laboratory of Cardiovascular Receptors Research,
Beijing, China
(Ma) Healthcare Department, National Center of Gerontology, Beijing
Hospital, Beijing, China
(Ma) Institute of Geriatric Medicine, Chinese Academy of Medical Sciences,
Beijing, China
Publisher
Frontiers Media S.A.
Abstract
Background: Nicorandil is recommended as a second-line treatment for
stable angina; however, randomized-controlled trials to evaluate the
benefit of nicorandil for patients with chronic total occlusion (CTO) are
lacking. Objective(s): To determine whether nicorandil can improve
left ventricular (LV) myocardial strain in patients with CTO.
 Method(s): Patients with CTO were included and randomized to the
nicorandil group (n = 31) and the control group (n = 30). Nicorandil was
given orally at 15 mg/day for 3 months in the nicorandil group.
Three-dimensional speckle-tracking echocardiography and the Seattle Angina
Questionnaire (SAQ) survey were performed at baseline and at 3 months. The
primary study endpoint was the LV global area strain (GAS) at 3 months.
 Result(s): The nicorandil and the control groups were well-matched at
baseline, including the mean GAS and SAQ scores. At 3 months, GAS in the
nicorandil group was significantly higher than that in the control group
(-23.7 +/- 6.3% vs. -20.3 +/- 5.6%, respectively; p = 0.033). There were
no significant differences in LV global longitudinal strain, global
circumferential strain, global radial strain, LV ejection fraction, LV
end-diastolic volume, and LV end-systolic volume at 3 months between the
two groups. At 3 months, the SAQ scores for angina stability, angina
frequency, and treatment satisfaction in the nicorandil group were
significantly higher than those in the control group. Conclusion(s):
Nicorandil treatment can improve GAS and angina symptoms in patients with
CTO. Clinical Trial Registration: www.ClinicalTrials.gov, identifier:
NCT05087797. Copyright © 2022 Chen, Ma, Feng and Cui.

<3>
Accession Number
2019170847
Title
Perioperative Pain Management With Bilateral Pecto-intercostal Fascial
Block in Pediatric Patients Undergoing Open Cardiac Surgery.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 825945. Date of Publication: 22 Jun 2022.
Author
Zhang Y.; Min J.; Chen S.
Institution
(Zhang, Min, Chen) Department of Anesthesiology, First Affiliated Hospital
of Nanchang University, Nanchang, China
Publisher
Frontiers Media S.A.
Abstract
Purposes: Pediatric open cardiac surgical patients usually suffer from
acute pain after operation. The current work aimed to explore the impact
of bilateral PIFB in children suffering from open cardiac surgery.
 Method(s): This work randomized altogether 110 child patients as
bilateral PIFB (PIF) and non-nerve block (SAL) groups. This work adopted
post-operative pain at exercise and rest statuses as the primary endpoint,
whereas time-to-drain removal/extubation/initial defecation,
intraoperative/post-operative fentanyl use, and length of ICU and hospital
stay as the secondary endpoints. Result(s): MOPS were significantly
higher at 24-h post-operatively at coughing and rest statuses in SAL group
compared with PIF group. Meanwhile, PIF group exhibited markedly lower
intraoperative/post-operative fentanyl use amounts, as well as markedly
reduced time-to-extubation/initial flatus, and length of ICU/hospital
stay. Conclusion(s): Bilateral PIFB in pediatric open cardiac
surgical patients provide effective analgesia and lower the length of
hospital stay. Copyright © 2022 Zhang, Min and Chen.

<4>
Accession Number
2019169752
Title
Jailed Balloon Technique Is Superior to Jailed Wire Technique in Reducing
the Rate of Side Branch Occlusion: Subgroup Analysis of the Conventional
Versus Intentional StraTegy in Patients With High Risk PrEdiction of Side
Branch OccLusion in Coronary Bifurcation InterVEntion Trial.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 814873. Date of Publication: 31 Mar 2022.
Author
Zhang D.; Zhao Z.; Gao G.; Xu H.; Wang H.; Liu S.; Yin D.; Feng L.; Zhu
C.; Wang Y.; Zhao Y.; Yang Y.; Gao R.; Xu B.; Dou K.
Institution
(Zhang, Zhao, Gao, Xu, Wang, Liu, Yin, Feng, Zhu, Yang, Gao, Xu, Dou)
State Key Laboratory of Cardiovascular Disease, Beijing, China
(Zhang, Zhao, Gao, Xu, Wang, Liu, Yin, Feng, Zhu, Yang, Gao, Dou)
Department of Cardiology, National Center for Cardiovascular Diseases, Fu
Wai Hospital, Beijing, China
(Zhang, Zhao, Gao, Xu, Wang, Liu, Yin, Feng, Zhu, Yang, Gao, Xu, Dou)
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Wang, Zhao) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases, Beijing, China
(Xu) Catheterization Laboratories, Fu Wai Hospital, Beijing, China
Publisher
Frontiers Media S.A.
Abstract
Objective: Jailed balloon technique (JBT) is an active side branch (SB)
protection strategy and is considered to be superior to the jailed wire
technique (JWT) in reducing SB occlusion. However, no randomized trials
have proved that. We aim to investigate whether JBT could decrease the SB
occlusion rate. Method(s): Conventional versus Intentional straTegy
in patients with high Risk prEdiction of Side branch OccLusion in coronary
bifurcation interVEntion (CIT-RESOLVE) (NCT02644434, registered on
December 31, 2015) (https://clinicaltrials.gov) is a randomized trial that
assessed the effects of different strategies on SB occlusion rate in
patients with a high risk of SB occlusion. The present subgroup analysis
enrolled bifurcation lesions (2 mm <= reference vessel diameter of SB <
2.5 mm) with Visual estimation for Risk prEdiction of Side branch
OccLusion in coronary bifurcation intervention (V-RESOLVE) score >= 12
points. The primary endpoint is SB occlusion. One-year clinical events
were compared. Result(s): A total of 284 subjects at 16 sites were
randomly assigned to the JBT group (n = 143) or the JWT group (n = 141).
The rate of SB occlusion (9.1 vs. 19.9%, p = 0.02) and periprocedural
myocardial infarction (defined by WHO, 7 vs. 14.9%, p = 0.03) is
significantly lower in the JBT group than in the JWT group. The JBT and
JWT groups showed no significant differences in cardiac death (0.7 vs.
0.7%, p = 1), myocardial infarction (MI, 6.3 vs. 7.1%, p = 0.79), target
lesion revascularization (TLR, 1.4 vs. 2.1%, p = 0.68), and major cardiac
adverse events (MACE, a composite of all-cause death, MI, or TLR, 8.4 vs.
10.6%, p = 0.52) during a 1-year follow-up. Conclusion(s): In
patients with a high risk of SB occlusion (V-RESOLVE score >= 12 points),
JBT is superior to JWT in reducing SB occlusion. However, no significant
differences were detected in 1-year MACE. Copyright © 2022 Zhang,
Zhao, Gao, Xu, Wang, Liu, Yin, Feng, Zhu, Wang, Zhao, Yang, Gao, Xu and
Dou.

<5>
Accession Number
2019169381
Title
The Role of Multimodality Imaging for Percutaneous Coronary Intervention
in Patients With Chronic Total Occlusions.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 823091. Date of Publication: 02 May 2022.
Author
Melotti E.; Belmonte M.; Gigante C.; Mallia V.; Mushtaq S.; Conte E.;
Neglia D.; Pontone G.; Collet C.; Sonck J.; Grancini L.; Bartorelli A.L.;
Andreini D.
Institution
(Melotti, Belmonte, Gigante, Mallia, Mushtaq, Conte, Pontone, Grancini,
Bartorelli, Andreini) Centro Cardiologico Monzino, Istituto di Ricerca e
Cura a Carattere Scientifico (IRCCS), Milan, Italy
(Neglia) Fondazione Toscana G. Monasterio, Pisa, Italy
(Neglia) Istituto di Scienze della Vita Scuola Superiore Sant'Anna, Pisa,
Italy
(Collet, Sonck) Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
(Sonck) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Bartorelli, Andreini) Department of Biomedical and Clinical Sciences
"Luigi Sacco", University of Milan, Milan, Italy
Publisher
Frontiers Media S.A.
Abstract
Background: Percutaneous coronary intervention (PCI) of Chronic total
occlusions (CTOs) has been traditionally considered a challenging
procedure, with a lower success rate and a higher incidence of
complications compared to non-CTO-PCI. An accurate and comprehensive
evaluation of potential candidates for CTO-PCI is of great importance.
Indeed, assessment of myocardial viability, left ventricular function,
individual risk profile and coronary lesion complexity as well as
detection of inducible ischemia are key information that should be
integrated for a shared treatment decision and interventional strategy
planning. In this regard, multimodality imaging can provide combined data
that can be very useful for the decision-making algorithm and for planning
percutaneous CTO recanalization. Aim(s): The purpose of this article
is to appraise the value and limitations of several non-invasive imaging
tools to provide relevant information about the anatomical characteristics
and functional impact of CTOs that may be useful for the pre-procedural
assessment and follow-up of candidates for CTO-PCI. They include
echocardiography, coronary computed tomography angiography (CCTA), nuclear
imaging, and cardiac magnetic resonance (CMR). As an example, CCTA can
accurately delineate CTO location and length, distal coronary bed, vessel
tortuosity and calcifications that can predict PCI success, whereas stress
CMR, nuclear imaging and stress-CT can provide functional evaluation in
terms of myocardial ischemia and viability and perfusion defect
extension. Copyright © 2022 Melotti, Belmonte, Gigante, Mallia,
Mushtaq, Conte, Neglia, Pontone, Collet, Sonck, Grancini, Bartorelli and
Andreini.

<6>
Accession Number
2019168611
Title
Multivessel vs. Culprit Vessel-Only Percutaneous Coronary Intervention for
ST-Segment Elevation Myocardial Infarction in Patients With Cardiogenic
Shock: An Updated Systematic Review and Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 735636. Date of Publication: 15 Apr 2022.
Author
Xiong B.; Yang H.; Yu W.; Zeng Y.; Han Y.; She Q.
Institution
(Xiong, Yang, Yu, Zeng, Han, She) Department of Cardiology, The Second
Affiliated Hospital of Chongqing Medical University, Chongqing, China
Publisher
Frontiers Media S.A.
Abstract
Background: The optimal revascularization strategy in patients with
ST-segment elevation myocardial infarction (STEMI) complicating by
cardiogenic shock (CS) remains controversial. This study aims to evaluate
the clinical outcomes of multivessel percutaneous coronary intervention
(MV-PCI) compared to culprit vessel-only PCI (CO-PCI) for the treatment,
only in patients with STEMI with CS. Method(s): A comprehensive
literature search was conducted. Studies assessed the efficacy outcomes of
short (in-hospital or 30 days)/long-term mortality, cardiac death,
myocardial reinfarction, repeat revascularization, and safety outcomes of
stroke, bleeding, acute renal failure with MV-PCI vs. CO-PCI in patients
with STEMI with CS were included. The publication bias and sensitivity
analysis were also performed. Result(s): A total of 15 studies were
included in this meta-analysis. There was no significant difference in
short- and long-term mortality in patients treated with MV-PCI compared to
CO-PCI group [odds ratio (OR) = 1.17; 95% confidence interval (CI),
0.92-1.48; OR = 0.86; 95% CI, 0.58-1.28]. Similarly, there were no
significant differences in cardiac death (OR = 0.67; 95% CI, 0.44-1.00),
myocardial reinfarction (OR = 1.24; 95% CI, 0.77-2.00), repeat
revascularization (OR = 0.75; 95% CI, 0.40-1.42), bleeding (OR = 1.53; 95%
CI, 0.53-4.43), or stroke (OR = 1.42; 95% CI, 0.90-2.23) between the two
groups. There was a higher risk in acute renal failure (OR = 1.33; 95% CI,
1.04-1.69) in patients treated with MV-PCI when compared with CO-PCI.
 Conclusion(s): This meta-analysis suggests that there may be no
significant benefit for patients with STEMI complicating CS treated with
MV-PCI compared with CO-PCI, and patients are at increased risk of
developing acute renal failure after MV-PCI intervention. Copyright
© 2022 Xiong, Yang, Yu, Zeng, Han and She.

<7>
Accession Number
2018287456
Title
Comparison of the Efficacy of ECMO With or Without IABP in Patients With
Cardiogenic Shock: A Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 917610. Date of Publication: 07 Jul 2022.
Author
Zeng P.; Yang C.; Chen J.; Fan Z.; Cai W.; Huang Y.; Xiang Z.; Zhang J.;
Yang J.
Institution
(Zeng, Yang, Fan, Cai, Huang, Xiang, Yang, Zhang, Yang) Department of
Cardiology, The First College of Clinical Medical Science, Three Gorges
University and Yichang Central People's Hospital, Yichang, China
(Chen) Hubei Key Laboratory of Cardiology, Department of Cardiology,
Cardiovascular Research Institute, Renmin Hospital, Wuhan University,
Wuhan, China
Publisher
Frontiers Media S.A.
Abstract
Objective: Studies on extracorporeal membrane oxygenation (ECMO) with and
without an intra-aortic balloon pump (IABP) for cardiogenic shock (CS)
have been published, but there have been no meta-analyses that compare the
efficacy of these two cardiac support methods. This meta-analysis
evaluated the outcomes of these two different treatment measures.
 Method(s): The PubMed, Embase, Cochrane Library, Web of Science, and
Clinical Trials databases were searched until March 2022. Studies that
were related to ECMO with or without IABP in patients with CS were
screened. Quality assessments were evaluated with the methodological index
for nonrandomized studies (MINORS). The primary outcome was in-hospital
survival, while the secondary outcomes included duration of ECMO, duration
of ICU stay, infection/sepsis, and bleeding. Revman 5.3 and STATA software
were used for this meta-analysis. Result(s): In total, nine
manuscripts with 2,573 patients were included in the systematic review. CS
patients who received ECMO in combination with IABP had significantly
improved in-hospital survival compared with ECMO alone (OR = 1.58, 95% CI
= 1.26-1.98, P < 0.0001). However, there were no significant differences
in the duration of ECMO (MD = 0.36, 95% CI = -0.12-0.84, P = 0.14),
duration of ICU stay (MD = -1.95, 95% CI = -4.05-0.15, P = 0.07),
incidence of infection/sepsis (OR = 1.0, 95% CI = 0.58-1.72, P = 1.0), or
bleeding (OR = 1.28, 95% CI = 0.48-3.45, P = 0.62) between the two groups
of patients with CS. Conclusion(s): ECMO combined with IABP can
improve in-hospital survival more effectively than ECMO alone in patients
with CS. Copyright © 2022 Zeng, Yang, Chen, Fan, Cai, Huang,
Xiang, Yang, Zhang and Yang.

<8>
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Accession Number
2020368901
Title
Society of Cardiovascular Anesthesiologists Clinical Practice Update for
Management of Acute Kidney Injury Associated with Cardiac Surgery.
Source
Anesthesia and Analgesia. 135(4) (pp 744-756), 2022. Date of Publication:
01 Oct 2022.
Author
Peng K.; McIlroy D.R.; Bollen B.A.; Billings F.T.; Zarbock A.; Popescu
W.M.; Fox A.A.; Shore-Lesserson L.; Zhou S.; Geube M.A.; Ji F.; Bhatia M.;
Schwann N.M.; Shaw A.D.; Liu H.
Institution
(Peng, Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health, Sacramento, CA, United States
(Peng, Ji) First Affiliated Hospital of Soochow University, Suzhou, China
(McIlroy, Billings) Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, TN, United States
(Bollen) Department of Anesthesiology, The International Heart Institute
of Montana, Missoula, MT, United States
(Zarbock) Department of Anesthesiology and Intensive Care Medicine,
University Hospital of Muenster, Muenster, Germany
(Popescu) Department of Anesthesiology, Yale University, School of
Medicine, Easton, CT, United States
(Fox) Department of Anesthesiology and Pain Management, University of
Texas, Southwestern Medical Center, Dallas, TX, United States
(Shore-Lesserson) Department of Anesthesiology, Northwell Health,
Manhasset, NY, United States
(Zhou) Department of Anesthesiology, University of Texas Medical School,
Sugar Land, TX, United States
(Geube) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Bhatia) Department of Anesthesiology, University of North Carolina,
Chapel Hill, NC, United States
(Schwann) Department of Anesthesiology, Lehigh Valley Health Network,
Allentown, PA, United States
(Shaw) Department of Intensive Care and Resuscitation, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Cardiac surgery-associated acute kidney injury (CS-AKI) is common and is
associated with increased risk for postoperative morbidity and mortality.
Our recent survey of the Society of Cardiovascular Anesthesiologists (SCA)
membership showed 6 potentially renoprotective strategies for which
clinicians would most value an evidence-based review (ie, intraoperative
target blood pressure, choice of specific vasopressor agent, erythrocyte
transfusion threshold, use of alpha-2 agonists, goal-directed oxygen
delivery on cardiopulmonary bypass [CPB], and the "Kidney Disease
Improving Global Outcomes [KDIGO] bundle of care"). Thus, the SCA's
Continuing Practice Improvement Acute Kidney Injury Working Group aimed to
provide a practice update for each of these strategies in cardiac surgical
patients based on the evidence from randomized controlled trials (RCTs).
PubMed, EMBASE, and Cochrane library databases were comprehensively
searched for eligible studies from inception through February 2021, with
search results updated in August 2021. A total of 15 RCTs investigating
the effects of the above-mentioned strategies on CS-AKI were included for
meta-analysis. For each strategy, the level of evidence was assessed using
the Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) methodology. Across the 6 potentially renoprotective strategies
evaluated, current evidence for their use was rated as "moderate," "low,"
or "very low." Based on eligible RCTs, our analysis suggested using
goal-directed oxygen delivery on CPB and the "KDIGO bundle of care" in
high-risk patients to prevent CS-AKI (moderate level of GRADE evidence).
Our results suggested considering the use of vasopressin in vasoplegic
shock patients to reduce CS-AKI (low level of GRADE evidence). The
decision to use a restrictive versus liberal strategy for perioperative
red cell transfusion should not be based on concerns for renal protection
(a moderate level of GRADE evidence). In addition, targeting a higher mean
arterial pressure during CPB, perioperative use of dopamine, and use of
dexmedetomidine did not reduce CS-AKI (a low or very low level of GRADE
evidence). This review will help clinicians provide evidence-based care,
targeting improved renal outcomes in adult patients undergoing cardiac
surgery. Copyright © 2022 Lippincott Williams and Wilkins. All
rights reserved.

<9>
Accession Number
2011514624
Title
The impact of exogenous nitric oxide during cardiopulmonary bypass for
cardiac surgery.
Source
Perfusion (United Kingdom). 37(7) (pp 656-667), 2022. Date of Publication:
October 2022.
Author
Loughlin J.M.; Browne L.; Hinchion J.
Institution
(Loughlin, Hinchion) Department of Cardiothoracic Surgery, Cork University
Hospital, Cork, Ireland
(Browne) Department of Clinical Perfusion, Cork University Hospital, Cork,
Ireland
Publisher
SAGE Publications Ltd
Abstract
Objectives: Cardiac surgery using cardiopulmonary bypass frequently
provokes a systemic inflammatory response syndrome. This can lead to the
development of low cardiac output syndrome (LCOS). Both of these can
affect morbidity and mortality. This study is a systematic review of the
impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary
bypass (CPB) circuit during cardiac surgery, on post-operative outcomes.
It aims to summarise the evidence available, to assess the effectiveness
of gNO via the CPB circuit on outcomes, and highlight areas of further
research needed to develop this hypothesis. Method(s): A
comprehensive search of Pubmed, Embase, Web of Science and the Cochrane
Library was performed in May 2020. Only randomised control trials (RCTs)
were considered. Result(s): Three studies were identified with a
total of 274 patients. There was variation in the outcomes measures used
across the studies. These studies demonstrate there is evidence that this
intervention may contribute towards cardioprotection. Significant
reductions in cardiac troponin I (cTnI) levels and lower vasoactive
inotrope scores were seen in intervention groups. A high degree of
heterogeneity between the studies exists. Meta-analysis of the duration of
mechanical ventilation, length of ICU stay and length of hospital stay
showed no significant differences. Conclusion(s): This systematic
review explored the findings of three pilot RCTs. Overall the hypothesis
that NO delivered via the CPB circuit can provide cardioprotection has
been supported by this study. There remains a significant gap in the
evidence, further high-quality research is required in both the adult and
paediatric populations. Copyright © The Author(s) 2021.

<10>
Accession Number
638202792
Title
Uniportal Video-Assisted Thoracic Surgery in a Pediatric Hospital: Early
Results and Review of the Literature.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 32(6) (pp
713-720), 2022. Date of Publication: 01 Jun 2022.
Author
Ugolini S.; Coletta R.; Lo Piccolo R.; Dell'otto F.; Voltolini L.;
Gonfiotti A.; Morabito A.
Institution
(Ugolini, Coletta, Lo Piccolo, Dell'otto, Morabito) Department Of
Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence,
Italy
(Coletta) School Of Environment And Life Science, University Of Salford,
Salford, United Kingdom
(Dell'otto, Morabito) Department Of Neurosciences Psychology Drug Research
And Child Health (NEUROFARBA), University Of Florence, Florence, Italy
(Voltolini, Gonfiotti) Department Of Thoracic Surgery, University Hospital
Careggi, Florence, Italy
(Voltolini, Gonfiotti) Department Of Experimental And Clinical Medicine
(DMSC), University Of Florence, Florence, Italy
Publisher
Mary Ann Liebert Inc.
Abstract
Background: Uniportal video-assisted thoracic surgery (U-VATS) is an
implemented technique in adult surgery that may aid to extend offer the
benefits of thoracoscopy to a wide number of pediatric patients.
 Material(s) and Method(s): Consecutive cases treated between July
2019 and July 2021 were retrospectively analyzed. Simultaneously, a
MEDLINE systematic search was conducted. Result(s): Twelve patients
(median age 13 years, median weight 44.5 kg) underwent 4 major procedures
(n = 2 lobectomy, n = 2 segmentectomy) and 11 minor procedures (n = 1
bronchogenic cyst resection, n = 4 apical wedge resections and pleurodesis
for pneumothorax, n = 4 wedge resections for lung nodules, and n = 2
debridement for empyema). The median observed operative time was 77
minutes. We recorded one conversion to biportal VATS. No intraoperative
complications or 30-day morbidity-mortality was reported. A rate of 40%
adverse postoperative events was observed (Clavien-Dindo grade I-IVa).
Visual analog scale for postoperative pain recorded a median value of 0 on
days 1, 2, and 3. The systematic review provided 15 full-text articles
reporting 76 pediatric interventions (4 major and 72 minor procedures);
among them, 1 biportal conversion, 3 mild postoperative complications, and
1 redo surgery are presented. Conclusion(s): As emerged from the
literature review, U-VATS remains scarcely adopted by pediatric surgeons.
Its feasibility is supported by the four reported major lung resections
plus the four cases added on by our series. Thanks to a more rapid
learning curve over conventional VATS, the uniportal technique could be
accessible to a wider number of centers. Copyright © 2022, Mary
Ann Liebert, Inc., publishers.

<11>
Accession Number
636850684
Title
Fast vs. ultraslow thrombolytic infusion regimens in patients with
obstructive mechanical prosthetic valve thrombosis: a pilot randomized
clinical trial.
Source
European heart journal. Cardiovascular pharmacotherapy. 8(7) (pp 668-676),
2022. Date of Publication: 29 Sep 2022.
Author
Sadeghipour P.; Saedi S.; Saneei L.; Rafiee F.; Yoosefi S.; Parsaee M.;
Siami R.; Saberi M.; Pouraliakbar H.; Ghadrdoost B.; Bakhshandeh H.;
Peighambari M.M.; Farrashi M.; Mohebbi B.; Naderi N.; Amin A.; Maleki M.;
Khajali Z.; De Caterina R.
Institution
(Sadeghipour, Mohebbi, Maleki) Cardiovascular Intervention Research
Center, Rajaie Cardiovascular, Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sadeghipour, Ghadrdoost, Bakhshandeh) Clinical Trial Center, Rajaie
Cardiovascular, Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Saedi, Saneei, Rafiee, Yoosefi, Siami, Saberi, Pouraliakbar, Ghadrdoost,
Bakhshandeh, Peighambari, Naderi, Amin, Khajali) Rajaie Cardiovascular,
Medical and Research Center, Iran University of Medical Sciences, Niyayesh
Blvd, Vali-Asr Ave, Tehran 1996911101, Iran, Islamic Republic of
(Parsaee, Farrashi) Echocardiography Research Center, Rajaie
Cardiovascular, Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(De Caterina) University Cardiology Division, Pisa University Hospital,
University of Pisa, Via Paradisa 2, Pisa 56124, Italy
(De Caterina) Fondazione Villa Serena per la Ricerca, Citta Sant'Angelo,
Pescara, Italy
Publisher
NLM (Medline)
Abstract
AIMS: Thrombolysis is an alternative to surgery for mechanical prosthetic
valve thrombosis (MPVT). Randomized clinical trials have yet to test the
safety and efficacy of a proposed ultraslow thrombolytic infusion regimen.
METHODS AND RESULTS: This single-centre, open-label, pilot randomized
clinical trial randomized adult patients with acute obstructive MPVT to an
ultraslow thrombolytic regimen [25 mg of recombinant tissue-type
plasminogen activator (rtPA) infused in 25 h] and a fast thrombolytic
regimen (50 mg of rtPA infused in 6 h). If thrombolysis failed, a repeated
dose of 25 mg of rtPA for 6 h was administered in both groups up to a
cumulative dose of 150 mg or the occurrence of a complication. The primary
outcome was a complete MPVT resolution (>75% fall in the obstructive
gradient by transthoracic echocardiography, <10degree limitation in
opening and closing valve motion angles by fluoroscopy, and symptom
improvement). The key safety outcome was a Bleeding Academic Research
Consortium type III or V major bleeding. Overall, 120 patients, including
63 (52.5%) women, at a mean age of 36.3 +/- 15.3 years, were randomized.
Complete thrombolysis success was achieved in 51 patients (85.0%) in the
ultraslow-regimen group and 47 patients (78.3%) in the fast-regimen group
[odds ratio 1.58; 95% confidence interval (CI) 0.25-1.63; P = 0.34]. One
case of transient ischaemic attack and three cases of intracranial
haemorrhage (absolute risk difference -6.6%; 95%CI -12% -0.3%; P = 0.07)
were observed only in the fast-regimen group. CONCLUSION(S): The
ultraslow thrombolytic regimen conferred a high thrombosis resolution rate
without major complications. Such findings should be replicated in more
adequately powered trials. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<12>
Accession Number
2019386964
Title
A structured narrative review of clinical and experimental studies of the
use of different positive end-expiratory pressure levels during thoracic
surgery.
Source
Clinical Respiratory Journal. (no pagination), 2022. Date of Publication:
2022.
Author
Yueyi J.; Jing T.; Lianbing G.
Institution
(Yueyi, Lianbing) The Affiliated Cancer Hospital of Nanjing Medical
University, Nanjing, China
(Jing, Lianbing) Department of Anesthesiology, Jiangsu Cancer Hospital,
Nanjing, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This study aimed to present a review on the general effects of
different positive end-expiratory pressure (PEEP) levels during thoracic
surgery by qualitatively categorizing the effects into detrimental,
beneficial, and inconclusive. Data source: Literature search of Pubmed,
CNKI, and Wanfang was made to find relative articles about PEEP levels
during thoracic surgery. We used the following keywords as one-lung
ventilation, PEEP, and thoracic surgery. Result(s): We divide the
non-individualized PEEP value into five grades, that is, less than 5, 5,
5-10, 10, and more than 10 cmH<inf>2</inf>O, among which 5
cmH<inf>2</inf>O is the most commonly used in clinic at present to
maintain alveolar dilatation and reduce the shunt fraction and the
occurrence of atelectasis, whereas individualized PEEP, adjusted by test
titration or imaging method to adapt to patients' personal
characteristics, can effectively ameliorate intraoperative oxygenation and
obtain optimal pulmonary compliance and better indexes relating to
respiratory mechanics. Conclusion(s): Available data suggest that
PEEP might play an important role in one-lung ventilation, the
understanding of which will help in exploring a simple and economical
method to set the appropriate PEEP level. Copyright © 2022 The
Authors. The Clinical Respiratory Journal published by John Wiley & Sons
Ltd.

<13>
Accession Number
2019386519
Title
Surgical atrial appendage closure: time for a randomized study.
Source
Herzschrittmachertherapie und Elektrophysiologie. (no pagination), 2022.
Date of Publication: 2022.
Author
Rufa M.; Gobel N.; Franke U.F.W.
Institution
(Rufa, Gobel, Franke) Department of Cardiovascular Surgery, Robert Bosch
Hospital Stuttgart, Auerbachstrase 110, Stuttgart 70376, Germany
Publisher
Springer Medizin
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is assumed to
affect more than 30 million people worldwide. Studies report that the left
atrial appendage (LAA) plays an important role in thrombus formation and
is considered the embolic source in 90% of affected patients with
non-valvular and 57% with valvular AF. Oral anticoagulants have been the
standard of care for stroke prevention in patients with AF for decades.
However, bleeding complications and noncompliance are barriers to
effective embolic protection. Therefore, as an alternative to conventional
anti-thrombotic therapy, surgical LAA occlusion, which may lead to a
reduced risk of thromboembolism, has received increasing attention.
However, the procedure can be associated with additional risks such as
prolonged operation time, damage to the circumflex coronary artery, and
incomplete LAA occlusion. This review discusses some of the observational
studies that have examined the impact of LAA occlusion on stroke, the
LAAOS III (Left Atrial Appendage Occlusion Study) trial, which provided
definitive evidence for the benefit of surgical LAA occlusion on ischemic
stroke, which surgical methods are safe and effective for LAA occlusion,
and whether oral anticoagulation can be stopped after surgical removal of
the LAA. Copyright © 2022, The Author(s), under exclusive licence
to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

<14>
Accession Number
2019354098
Title
Coronary artery involvement in type A aortic dissection: Fate of the
coronaries.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Kayali F.; Jubouri M.; Al-Tawil M.; Tan S.Z.C.P.; Williams I.M.; Mohammed
I.; Velayudhan B.; Bashir M.
Institution
(Kayali) School of Medicine, University of Central Lancashire, Preston,
United Kingdom
(Jubouri) Hull York Medical School, University of York, York, United
Kingdom
(Al-Tawil) Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
(Tan) Barts and The London School of Medicine and Dentistry, Queen Mary
University of London, London, United Kingdom
(Williams) Department of Vascular Surgery, University Hospital of Wales,
Cardiff, United Kingdom
(Mohammed, Velayudhan) Institute of Cardiac and Aortic Disorders (ICAD),
SRM Institutes for Medical Science (SIMS Hospital), Tamil Nadu, Chennai,
India
(Bashir) Vascular and Endovascular Surgery, Velindre University NHS Trust,
Health Education and Improvement Wales (HEIW), Cardiff, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Type A aortic dissection (TAAD) involves a tear in the intimal
layer of the thoracic aorta proximal to the left subclavian artery, and
hence, carries a high risk of mortality and morbidity and requires urgent
intervention. This dissection can extend into the main coronary arteries.
Coronary artery involvement in TAAD can either be due to retrograde
extension of the dissection flap into the coronaries or compression and/or
blockage of these vessels by the dissection flap, possibly causing
myocardial ischemia. Due to the emergent nature of TAAD, coronary
involvement is often missed during diagnosis, thereby delaying the
required intervention. Aim(s): The main scope of this review is to
summarize the literature on the incidence, mechanism, diagnosis, and
treatment of coronary artery involvement in TAAD. Method(s): A
comprehensive literature search was performed using multiple electronic
databases, including PubMed, Ovid, Scopus and Embase, to identify and
extract relevant studies. Result(s): Incidence of coronary artery
involvement in TAAD was seldom reported in the literature, however, some
studies have described patients diagnosed either preoperatively,
intraoperatively following aortic clamping, or even during autopsy. Among
the few studies that reported on this matter, the treatment choice for
coronary involvement in TAAD was varied, with the majority revascularizing
the coronary arteries using coronary artery bypass grafting or direct
local repair of the vessels. It is well-established that coronary artery
involvement in TAAD adds to the already high mortality and morbidity
associated with this disease. Lastly, the right main coronary artery was
often more implicated than the left. Conclusion(s): This review
reiterates the significance of an accurate diagnosis and timely and
effective interventions to improve prognosis. Finally, further large
cohort studies and longer trials are needed to reach a definitive
consensus on the best approach for coronary involvement in
TAAD. Copyright © 2022 Wiley Periodicals LLC.

<15>
Accession Number
2014160428
Title
Dysphagia aortica.
Source
European Surgery - Acta Chirurgica Austriaca. 54(5) (pp 228-239), 2022.
Date of Publication: October 2022.
Author
Grimaldi S.; Milito P.; Lovece A.; Asti E.; Secchi F.; Bonavina L.
Institution
(Grimaldi, Milito, Lovece, Asti, Secchi, Bonavina) Department of
Biomedical Sciences for Health, Division of General and Foregut Surgery,
IRCCS Policlinico San Donato, University of Milan, Piazza Edmondo Malan,
San Donato Milanese, Milan 20097, Italy
(Secchi) Department of Radiology, IRCCS Policlinico San Donato, University
of Milan, Milan, Italy
Publisher
Springer Medizin
Abstract
Background: Dysphagia aortica is an umbrella term to describe swallowing
obstruction from external aortic compression secondary to a dilated,
tortuous, or aneurysmal aorta. We performed a systematic literature review
to clarify clinical features and outcomes of patients with dysphagia
aortica. Material(s) and Method(s): We searched PubMed, EMBASE, Web
of Science, and the Cochrane Library. The terms "aortic dysphagia,"
"dysphagia aortica," "dysphagia AND aortic aneurysm" were matched. We also
queried the prospectively updated database of our esophageal center to
identify patients with aortic dysphagia referred for diagnosis and
treatment over the past two decades. Result(s): A total of 57 studies
including 69 patients diagnosed with dysphagia aortica were identified,
and one patient from our center was added to the database. The mean age
was 72 years (range 22-98), and the male to female ratio 1.1:1. Of these
70 patients, the majority (n= 63, 90%) had an aortic aneurysm,
pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an
operative treatment (81.1% a vascular procedure, 13.5% a digestive tract
procedure, 5.4% both procedures). Thoracic endovascular aortic repair
(TEVAR) accounted for 60% of all vascular procedures. The postoperative
mortality rate was 21.2% (n= 7/33). The mortality rate among patients
treated conservatively was 55% (n= 11/20). Twenty-six (45.6%) studies were
deemed at a high risk of bias. Conclusion(s): Dysphagia aortica is a
rare clinical entity with high morbidity and mortality rates and no
standardized management. Early recognition of dysphagia and a high
suspicion of aortoesophageal fistula may be lifesaving in this patient
population. Copyright © 2021, The Author(s).

<16>
Accession Number
639158952
Title
Effect of a patient education video and prehabilitation on the quality of
preoperative person-centred coordinated care experience: protocol for a
randomised controlled trial.
Source
BMJ open. 12(9) (pp e063583), 2022. Date of Publication: 29 Sep 2022.
Author
Wong S.S.Y.; Cheung H.H.T.; Ng F.F.; Yau D.K.W.; Wong M.K.H.; Lau V.N.M.;
Leung W.W.; Mak T.W.C.; Lee A.
Institution
(Wong) Faculty of Medicine, Chinese University of Hong Kong, Hong Kong,
China
(Cheung, Ng, Yau, Lee) Anaesthesia and Intensive Care, Chinese University
of Hong Kong, Hong Kong, China
(Wong, Lau) Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong
Kong, China
(Leung, Mak) Division of Colorectal Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Multimodal prehabilitation, an emerging field within the
Perioperative Medicine specialty, requires close multidisciplinary team
coordination. The goal is to optimise the patient's health status in the
4-8 weeks before elective surgery to withstand surgical stress. Most
patients are unfamiliar with the concept of prehabilitation but are
interested in participating in such a programme after explanation. The
objective of this randomised controlled trial is to evaluate the effect of
prehabilitation (patient education video and multimodal prehabilitation)
on the preoperative patient-centred coordinated care experience. METHOD
AND ANALYSIS: One hundred patients undergoing major elective surgery
(cardiac, colorectal, hepatobiliary-pancreatic and urology) will be
recruited into a two-group, parallel, superiority, single-blinded
randomised controlled trial. Patients will be randomised to receive either
preoperative patient education comprising of a video and prehabilitation
programme with standard care (intervention) or standard care (control).
The primary outcome measure will be the quality of preoperative patient
care experience using the 11-item Chinese version of the Person-Centred
Coordinated Care Experience Questionnaire (P3CEQ) before surgery.
Secondary outcomes will include the change in Hospital Anxiety and
Depression Scale (HADS) score from trial enrolment to before surgery,
Quality of Recovery Score (QoR-15) on third day after surgery and Days
Alive and At Home within 30 days after surgery (DAH30). Intention-to-treat
and per-protocol analyses will be performed. ETHICS AND DISSEMINATION: The
Joint CUHK-NTEC Clinical Research Ethics Committee approved the study
protocol (CREC Ref. No. 2021.518-T). The findings will be presented at
scientific meetings, in peer-reviewed journals and to study participants.
TRIAL REGISTRATION NUMBER: ChiCTR2100053637. Copyright ©
Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<17>
Accession Number
2019352905
Title
An Updated Meta-Analysis of DOACs vs. VKAs in Atrial Fibrillation Patients
With Bioprosthetic Heart Valve.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 899906. Date of Publication: 17 Jun 2022.
Author
Cao Y.; Zheng Y.; Li S.; Liu F.; Xue Z.; Yin K.; Luo J.
Institution
(Cao) Department of Cardiology, Guizhou Provincial People's Hospital,
Guiyang, China
(Zheng, Li) Second Clinical Medical College, Nanchang University,
Nanchang, China
(Liu, Luo) Department of Cardiology, The Affiliated Ganzhou Hospital of
Nanchang University, Ganzhou, China
(Xue, Yin) Department of Critical Care Medicine, the First Affiliated
Hospital of Gannan Medical University, Ganzhou, China
Publisher
Frontiers Media S.A.
Abstract
Background: Current guidelines recommend the utilization of direct-acting
oral anticoagulants (DOACs) in patients with non-valvular atrial
fibrillation (AF). However, the optimal anticoagulation strategy for AF
patients with bioprosthetic heart valves (BPHV) remains controversial.
Therefore, we conducted this meta-analysis to explore the effect of DOACs
versus vitamin K antagonists (VKAs) in this population. Method(s): We
systematically searched the PubMed and Embase databases until November
2021 for studies reporting the effect of DOACs versus VKAs in AF patients
with BPHV. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs)
were pooled using the random-effects model with an inverse variance
method. Result(s): We selected four randomized clinical trials and
seven observational studies (2236 DOAC- and 6403 VKAs-users). Regarding
the effectiveness outcomes, there were no significant differences between
DOACs and VKAs in stroke or systemic embolism (RR = 0.74, 95%CI:
0.50-1.08), ischemic stroke (RR = 1.08, 95%CI: 0.76-1.55), all-cause death
(RR = 0.98, 95%CI: 0.86-1.12), and cardiovascular death (RR = 0.85, 95%CI:
0.40-1.80). In terms of the safety outcomes, DOACs was associated with
lower risks of major bleeding (RR = 0.70, 95%CI: 0.59-0.82) and
intracranial bleeding (RR = 0.42, 95%CI: 0.26-0.70), but the risks of any
bleeding (RR = 0.85, 95%CI: 0.65-1.13) and gastrointestinal bleeding (RR =
0.92, 95%CI: 0.73-1.17) are not significantly different when compared with
VKAs. The subgroup analysis with follow-up as a covariate revealed that
the DOACs had lower risks of SSE (RR = 0.59, 95%CI: 0.37-0.94) and major
bleeding (RR = 0.69, 95%CI: 0.58-0.81) in patients with a mean follow-up
of more than 24 months, but no statistical differences were found in
patients with the follow-up less than 24 months (SSE: RR = 1.10, 95%CI:
0.92-1.32; major bleeding: RR = 0.91, 95%CI: 0.42-2.01).
 Conclusion(s): In AF with BPHV, patients on DOACs experienced a
reduced risk of major bleeding and intracranial bleeding compared with
VKAs, while the risks of stroke, cardiovascular death, and all-cause
mortality were similar. Copyright © 2022 Cao, Zheng, Li, Liu,
Xue, Yin and Luo.

<18>
Accession Number
2013254800
Title
Optimal Frequency for Changing Single-Use Enteral Delivery Sets in Infants
after Congenital Heart Surgery: A Randomized Controlled Trial.
Source
Journal of the American Nutrition Association. 41(2) (pp 140-148), 2022.
Date of Publication: 2022.
Author
Zhang L.; Shi H.; Li J.; Du N.; Chen X.; Wang J.; Gao X.; Si W.; Cui Y.
Institution
(Zhang, Du, Chen, Cui) Cardiac Intensive Care Unit, the Heart Center,
Guangzhou Women and Children Medical Center, Guangzhou Medical University,
Guangzhou, China
(Shi, Li, Si) Institute of Pediatrics, Guangzhou Women and Children
Medical Center, Guangzhou Medical University, Guangzhou, China
(Wang, Gao) Microbiology Laboratory, Guangzhou Women and Children Medical
Center, Guangzhou Medical University, Guangzhou, China
Publisher
Routledge
Abstract
Objective We aimed to assess the optimal frequency for changing single-use
enteral delivery sets during postoperative enteral feeding in infants with
congenital heart disease (CHD). Methods We enrolled 120 CHD infants who
were fed using an enteral nutrition pump directly connected to a milk
bottle with a single-use enteral delivery set in a four-arm randomized
controlled trial (ChiCTR2000039544). Patients were randomized into four
groups based on the replacement frequency of the enteral delivery set (6
h, 12 h, 18 h, and 24 h groups). The primary outcome was the percentage of
contaminated enteral delivery sets (overgrowth of microbiota and
colonization of pathogenic bacteria). Secondary outcomes included evidence
of infection, gastrointestinal tolerance, intestinal microflora dysbiosis,
and healthcare costs. Results The percentages of microbial overgrowth
detected in the 6 h, 12 h, 18 h, and 24 h groups were 6.7%, 30.0%, 46.7%,
and 80%, respectively (P < 0.001). Significant differences were observed
between the 6 h and 18 h groups (P < 0.001), the 6 h and 24 h groups (P <
0.001), and the 18 h and 24 h groups (P = 0.007). Meanwhile, pathogenic
bacterial colonization was detected in 0, 4, 6, and 11 delivery sets in
the 6 h, 12 h, 18 h, and 24 h groups, respectively (P = 0.002). No
difference in clinical symptoms was found among the four groups. The total
cost per patient in the 12 h group and the 18 h group was 340.2 RMB and
226.8 RMB, respectively. Conclusion Taking into consideration both
microbial overgrowth and cost-effectiveness, the results of this study
indicate that for children receiving continuous enteral feeding following
CHD surgery, the optimal frequency for changing the single-use enteral
delivery set when formula reconstituted from powder is used is 18
hours. Copyright © 2020 American College of Nutrition.

<19>
Accession Number
2020496320
Title
Mechanical Circulatory Support in Cardiovascular Surgical Patients: Single
Center Practice and Experience.
Source
Reviews in Cardiovascular Medicine. 23(9) (no pagination), 2022. Article
Number: 291. Date of Publication: September 2022.
Author
Han X.; Yao Y.-T.
Institution
(Han, Yao) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy
of Medical Sciences, Beijing 100037, China
(Han) Department of Anesthesiology, Lishui People's Hospital, Sixth
Affiliated Hospital of Wenzhou Medical University, First Affiliated
Hospital of Lishui University, Zhejiang, Lishui 323000, China
Publisher
IMR Press Limited
Abstract
Background: In view of the role of mechanical circulatory support in
patients with severe cardiac insufficiency during perioperative period, we
searched the relevant articles on mechanical circulatory support at Fuwai
Hospital, and analyzed the indications and complications of different
mechanical circulatory support methods. Method(s): Relevant studies
were identified by computerized searches of PubMed, Ovid, Embase, Cochrane
Library, Wanfang Data, VIP Data, Chinese BioMedical Literature & Retrieval
System (SinoMed), and China National Knowledge Infrastructure (CNKI),
using search words ("intra-aortic balloon counter pulsation" OR "IABP" OR
"extracorporeal membrane oxygenation" OR "ECMO" OR "ventricular assist
device" OR "VAD") AND ("Fuwai" OR "fuwai"). All studies concerning the
application of IABP, ECMO, and VAD at Fuwai Hospital were included,
exclusion criteria included: (1) studies published as review, case report
or abstract; (2) animal or cell studies; (3) duplicate publications; (4)
studies lacking information about outcomes of interest. Result(s): A
total of 36 literatures were selected for analysis. The specific
mechanical circulatory support methods of ECMO and VAD retrieved from the
studies were VA-ECMO and LVAD. The number of cases using IABP, ECMO, LVAD
was 1968, 972, 67; and the survival rate was 80.4%, 54.9%, 56.7%,
respectively. The major complications of IABP, ECMO and LVAD were
hemorrhage (1.2%, 35.9% and 14.5%), infection (3.7%, 12.7% and 9.7%),
acute kidney injury (9.1%, 29.6% and 6.5%), the secondary complications
were limb ischemia, neurological events, cardiovascular events and
thrombosis. Conclusion(s): The present study suggested that, IABP,
ECMO and VAD, either alone or in combination, were effective and safe
mechanical circulation support when managing cardiovascular surgical
patients with severe hemodynamic instability at Fuwai
Hospital. Copyright © 2022 The Author(s). Published by IMR Press.

<20>
Accession Number
2020423582
Title
Inhaled Milrinone via HFNC as a Postextubation Cardiopulmonary Elixir:
Case Series and Review of Literature.
Source
Journal of Cardiac Critical Care. 6(2) (pp 126-130), 2022. Date of
Publication: 21 Sep 2022.
Author
Bansal N.; Magoon R.; Kalaiselvan J.; Shri I.; Kohli J.K.; Kashav R.C.
Institution
(Bansal, Magoon, Kalaiselvan, Shri, Kashav) Department of Cardiac
Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS),
Dr. Ram Manohar Lohia (RML) Hospital, Baba Kharak Singh Marg, New Delhi,
India
(Kohli) Department of Cardiac Anaesthesia, Dr. Ram Manohar Lohia (RML)
Hospital, Baba Kharak Singh Marg, New Delhi, India
Publisher
Thieme Medical and Scientific Publishers Pvt Ltd
Abstract
Pulmonary hypertension (PH) often complicates perioperative course
following pediatric cardiac surgery, often presenting unique challenges to
the attending cardiac anesthesiologist. Apart from difficult weaning from
cardiopulmonary bypass, PH can often compound weaning from mechanical
ventilation in this postoperative subset. From pathophysiological
standpoint, the former can be attributed to concurrent detrimental
cardiopulmonary consequences of PH as a multisystemic syndrome. Therefore,
with an objective to address the affected systems, that is, cardiac and
pulmonary simultaneously, we report combined use of inhaled milrinone (a
pulmonary vasodilator) through high-frequency nasal cannula (oxygen
reservoir and continuous positive airway pressure delivery device),
purported to complement each other's mechanism of action in the management
of PH, thereby hastening postoperative recovery. This article additionally
presents a nuanced perspective on the advantages of combining the
aforementioned therapies and hence proposing the same as a possible
postoperative cardiopulmonary elixir. Copyright © 2022. Official
Publication of The Simulation Society (TSS), accredited by International
Society of Cardiovascular Ultrasound (ISCU). All rights reserved.

<21>
Accession Number
2019265764
Title
Updates in the management of congenital heart disease in adult patients.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2022. Date of
Publication: 2022.
Author
Massarella D.; Alonso-Gonzalez R.
Institution
(Massarella, Alonso-Gonzalez) Department of Cardiology, University Health
Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, ON,
Canada
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Adults with congenital heart disease represent a highly
diverse, ever-growing population. Optimal approaches to management of
problems such as arrhythmia, sudden cardiac death, heart failure,
transplant, application of advanced therapies and unrepaired shunt lesions
are incompletely established. Efforts to strengthen our understanding of
these complex clinical challenges and inform evidence-based practices are
ongoing. Areas Covered: This narrative review summarizes evidence
underpinning current approaches to congenital heart disease management
while highlighting areas requiring further investigation. A search of
literature published in 'Medline,' 'EMBASE,' and 'PubMed' using search
terms 'congenital heart disease,' 'arrhythmia,' 'sudden cardiac death,'
'heart failure,' 'heart transplant,' 'advanced heart failure therapy,'
'ventricular assist device (VAD),' 'mechanical circulatory support (MSC),'
'intracardiac shunt' and combinations thereof was undertaken. Expert
Opinion: Application of novel technologies in the diagnosis and management
of arrhythmia has and will continue to improve outcomes in this
population. Sudden death remains a prevalent problem with many persistent
unknowns. Heart failure is a leading cause of morbidity and mortality.
Improved access to specialist care, advanced therapies and cardiac
transplant is needed. The emerging field of cardio-obstetrics will
continue to define state-of-the-art care for the reproductive health of
women with heart disease. Copyright © 2022 Informa UK Limited,
trading as Taylor & Francis Group.

<22>
[Use Link to view the full text]
Accession Number
639163962
Title
Sugammadex for reversing neuromuscular blockages after lung surgery: A
systematic review and meta-analysis.
Source
Medicine. 101(39) (pp e30876), 2022. Date of Publication: 30 Sep 2022.
Author
Yang J.-L.; Chen K.-B.; Shen M.-L.; Hsu W.-T.; Lai Y.-W.; Hsu C.-M.
Institution
(Yang, Chen, Hsu, Hsu) Department of Anesthesiology, China Medical
University Hospital, Taichung, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, College of Medicine, China Medical
University, Taichung, Taiwan (Republic of China)
(Shen) Department of Anesthesiology, Taichung Tzu-Chi Hospital, Taichung,
Taiwan (Republic of China)
(Lai) Department of Nursing, China Medical University Hospital, Taichung,
Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
BACKGROUND: This study determined whether sugammadex was associated with a
lower risk of postoperative pulmonary complications and improved outcomes
in lung surgeries. METHOD(S): A systematic literature search was
conducted using PubMed, Embase, Web of Science, and the Cochrane Library
from January 2000 to March 2022. The characteristics of lung surgeries
using sugammadex treatment compared with control drugs and postoperative
outcomes were retrieved. The primary outcome was estimated through a
pooled odds ratio (OR) and its 95% confidence interval (CI) was identified
using a random-effects model. RESULT(S): From 465 citations, 7
studies with 453 patients receiving sugammadex and 452 patients receiving
a control were included. The risk of postoperative pulmonary complication
(PPCs) was lower in the sugammadex group than in the control group. Also,
it showed that the effect of sugammadex on PPCs in the subgroup analysis
was significantly assessed on the basis of atelectasis or non-atelectasis.
Furthermore, subgroup analysis based on the relationship between high body
mass index (BMI) and PPCs also showed that sugammadex had less occurrence
in both the high BMI (defined as BMI >= 25) and low BMI groups. No
difference in length of hospital stay (LOS) between the two groups was
observed. CONCLUSION(S): This study observed that although reversing
neuromuscular blockages with sugammadex in patients undergoing thoracic
surgery recorded fewer PPCs and shorter extubation periods than
conventional reversal agents, no difference in LOS, postanaesthesia care
unit (PACU) stay length and chest tube insertion duration in both groups
was observed. Copyright © 2022 the Author(s). Published by
Wolters Kluwer Health, Inc.

<23>
Accession Number
639163429
Title
Use of vasoactive agents in non-cardiac surgery: protocol for a scoping
review.
Source
Acta anaesthesiologica Scandinavica. (no pagination), 2022. Date of
Publication: 01 Oct 2022.
Author
Baekgaard E.S.; Moller M.H.; Vester-Andersen M.; Krag M.
Institution
(Baekgaard, Krag) Department of Anaesthesia and Intensive Care, Holbaek
Hospital, Zealand, Denmark
(Moller) Department of Intensive Care, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Moller, Vester-Andersen, Krag) Collaboration for Research in Intensive
Care (CRIC), Copenhagen, Denmark
(Moller, Krag) Department of Clinical Medicine, University of Copenhagen,
Denmark
(Vester-Andersen) Department of Anaesthesia and Intensive Care,
Herlev-Gentofte Hospital, Herlev, University of Copenhagen, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: An increasing number of patients undergo surgical procedures
worldwide each year, and despite advances in quality and care, morbidity
and mortality rates remain high. Perioperative hypotension is a
well-described condition, and is associated with adverse outcomes. Both
fluids and vasoactive agents are commonly used to treat hypotension,
however, whether one vasoactive agent is preferable over another has yet
to be explored. METHOD(S): In accordance with the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses extension for Scoping
Reviews (PRISMA-ScR) statement, we plan to conduct a scoping review of
studies assessing the use of vasoactive agents in patients undergoing
non-cardiac surgery. We will provide an overview of indications, agents
used, and outcomes assessed. We will assess and report the certainty of
evidence according to the Grading of Recommendations Assessment,
Development and Evaluation (GRADE) approach. RESULT(S): We will
provide descriptive analyses of the included studies accompanied by
tabulated results. CONCLUSION(S): The outlined scoping review will
provide a summary of the body of evidence on the use of vasoactive agents
in the non-cardiac surgical population. This article is protected by
copyright. All rights reserved.

<24>
Accession Number
639161788
Title
Preventive Effect of Berberine on Postoperative Atrial Fibrillation.
Source
Circulation. Arrhythmia and electrophysiology. (pp
101161CIRCEP122011160), 2022. Date of Publication: 30 Sep 2022.
Author
Zhang J.; Wang Y.; Jiang H.; Tao D.; Zhao K.; Yin Z.; Han J.; Xin F.; Jin
Y.; Wang H.
Institution
(Zhang, Wang, Jiang, Tao, Zhao, Yin, Han, Xin, Jin, Wang) Department of
Cardiovascular Surgery, General Hospital of Northern Theater Command,
Liaoning, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is one of the most
common complications of cardiac surgery, but the underlying factors
governing POAF are not well understood. The aim of this study was to
investigate the efficacy of berberine administration on POAF.
 METHOD(S): We conducted a randomized, double-blind,
placebo-controlled trial with patients who underwent isolated coronary
artery bypass grafting in China to study the impact of oral berberine on
the incidence of POAF. A total of 200 patients who underwent coronary
artery bypass grafting were randomized into the berberine group (n=100)
and the placebo group (n=100). All patients underwent 7-day continuous
telemetry and Holter monitoring. RESULT(S): The primary outcome was
the incidence of POAF at 7 days. Secondary outcomes included clinical
outcomes, POAF burden, intestinal endotoxin, and serum inflammatory
biomarker levels. The POAF incidence was reduced from 35% to 20% under
berberine treatment (hazard ratio, 0.5 [95% CI, 0.29-0.78]; P=0.0143).
Perioperative mortality and morbidity did not differ between the 2 groups.
POAF burden and the dose of amiodarone were significantly reduced in the
berberine group. Oral berberine significantly decreased
lipopolysaccharide, CRP (C-reactive protein), and IL (interleukin)-6
levels. Elevated lipopolysaccharide after surgery has been associated with
POAF. CONCLUSION(S): Our results showed that administration of
berberine may be effective for reducing the occurrence of POAF after
coronary artery bypass grafting. REGISTRATION: URL:
https://www.chictr.org.cn; Unique identifier: ChiCTR2000028839.

<25>
Accession Number
639161646
Title
Managing CHD in Tertiary NICU in Collaboration with a Cardiothoracic
Center.
Source
Pediatric cardiology. (no pagination), 2022. Date of Publication: 30 Sep
2022.
Author
Chee Y.-H.; Dunning-Davies B.; Singh Y.; Yates R.; Kelsall W.
Institution
(Chee) Addenbrooke's Hospital, Paediatrics, Cambridge University Hospitals
NHS Foundation Trust, Cambridge, United Kingdom
(Dunning-Davies, Singh, Kelsall) Rosie Neonatal Unit, Cambridge University
Hospitals NHS Foundation Trust, Cambridge, United Kingdom
(Yates) Paediatric Cardiology, Great Ormond Street Hospital, London,
United Kingdom
Publisher
NLM (Medline)
Abstract
Increasingly non-cardiac tertiary neonatal intensive care units (NCTNs)
manage newborns with CHD prior to planned transfer to specialist cardiac
surgical centres (SCSC). It improves patient flow in SCSCs, enables
families to be nearer home, and improves psychological well-being Parker
et al. (Evaluating models of care closer to home for children and young
people who are ill: a systematic review, 2011). This practice has
gradually increased as the number of SCSCs has decreased. This study
examines the effectiveness of this expanding practice. The management
provided, length of stay in the NCTN and outcomes are described for one UK
NCTN situated at a significant distance from its SCSC. A retrospective
observational study of cardiac-related admissions to a NCTN between
January 2010 and December 2019 was conducted. 190 neonates were
identified: 41 had critical CHD; 64 had major CHD. The cohort includes
babies with a wide range of cardiac conditions and additional
complexities. 23.7% (n=45) required transfer to a specialist center after
a period of stabilization and growth ranging from several hours to 132
days. 68% (n=130) were discharged home or repatriated to a local NICU. Of
the remaining 15 babies, 13 were transferred to other specialties
including the hospice. Two died on NICU. The mortality was consistent with
the medical complexity of the group Best and Rankin (J Am Heart Assoc
5:e002846, 2016), Laas et al. (BMC Pediatr 17:124, 2017). 8.9% (n=17) died
before age 2. Nine babies had care redirected due to an inoperable cardiac
condition or life-limiting comorbidities. Our study demonstrates a complex
neonatal cohort with CHD can be managed effectively in a NCTN, supporting
the current model of care. The NCTN studied was well supported by
pediatricians with expertise in cardiology alongside visiting pediatric
cardiologists. Copyright © 2022. The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<26>
Accession Number
639160311
Title
Nutritional management of postoperative chylothorax in children with CHD.
Source
Cardiology in the young. (pp 1-9), 2022. Date of Publication: 30 Sep
2022.
Author
Fogg K.L.; Trauth A.; Horsley M.; Vichayavilas P.; Winder M.; Bailly D.K.;
Gordon E.E.
Institution
(Fogg) Department of Pediatrics, Division of Pediatric Cardiology, Medical
University of South Carolina, Charleston, SC, United States
(Trauth, Horsley) Division of Nutrition Therapy, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Vichayavilas) Department of Clinical Nutrition, Children's Hospital
Colorado, CO, United States
(Winder) Department of Pediatrics, Division of Pediatric Cardiology,
University of Utah, Salt Lake City, UT, United States
(Bailly) Department of Pediatrics, Division of Pediatric Critical Care,
University of Utah, Salt Lake City, UT, United States
(Gordon) Department of Pediatrics, Division of Pediatric Critical Care,
University of Texas Southwestern, Dallas, TX, United States
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Chylothorax after congenital cardiac surgery is associated
with increased risk of malnutrition. Nutritional management following
chylothorax diagnosis varies across sites and patient populations, and a
standardised approach has not been disseminated. The aim of this review
article is to provide contemporary recommendations related to nutritional
management of chylothorax to minimise risk of malnutrition.
 METHOD(S): The management guidelines were developed by consensus
across four dietitians, one nurse practitioner, and two physicians with a
cumulative 52 years of experience caring for children with CHD. A PubMed
database search for relevant literature included the terms chylothorax,
paediatric, postoperative, CHD, chylothorax management, growth failure,
and malnutrition. RESULT(S): Fat-modified diets and nil per os
therapies for all paediatric patients (<18 years of age) following cardiac
surgery are highlighted in this review. Specific emphasis on strategies
for treatment, duration of therapies, optimisation of nutrition including
nutrition-focused lab monitoring, and supplementation strategies are
provided. CONCLUSION(S): Our deliverable is a clinically useful guide
for the nutritional management of chylothorax following paediatric cardiac
surgery.

<27>
Accession Number
639158880
Title
Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and
Meta-Analysis.
Source
Seminars in thrombosis and hemostasis. (no pagination), 2022. Date of
Publication: 29 Sep 2022.
Author
Jakobsen C.; Larsen J.B.; Fuglsang J.; Hvas A.-M.
Institution
(Jakobsen, Larsen) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Aarhus C, Denmark
(Larsen, Fuglsang) Department of Clinical Medicine, Aarhus University,
Aarhus C, Denmark
(Fuglsang) Department of Obstetrics and Gynecology, Aarhus University
Hospital, Aarhus C, Denmark
(Hvas) Faculty of Health, Aarhus University, Aarhus C, Denmark
Publisher
NLM (Medline)
Abstract
Anticoagulant therapy is essential in pregnant women with mechanical heart
valves to prevent valve thrombosis. The risk of bleeding complications in
these patients has not gained much attention. This systematic review and
meta-analysis investigate the prevalence of bleeding peri-partum and
post-partum in women with mechanical heart valves and also investigate
whether bleeding risk differed across anticoagulant regimens or according
to delivery mode. The present study was conducted according to The
Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA) statement. Studies reporting bleeding prevalence in pregnant
women with mechanical heart valves receiving anticoagulant therapy were
identified through PubMed and Embase on December 08, 2021. Data on
bleeding complications, delivery mode, and anticoagulation therapy were
extracted. A total of 37 studies were included, reporting 423 bleeding
complications in 2,508 pregnancies. A meta-analysis calculated a pooled
prevalence of 0.13 (95% confidence interval [CI]: 0.09-0.18) bleeding
episodes per pregnancy across anticoagulant regimens. The combination of
unfractionated heparin (UFH) and vitamin K antagonist (VKA) and single VKA
therapy showed the lowest risk of bleeding (8 and 12%). Unexpectedly, the
highest risk of bleeding was found in women receiving a combination of
low-molecular-weight-heparin (LMWH) and VKA (33%) or mono-therapy with
LMWH (22%). However, this could be dose related. No difference in bleeding
was found between caesarean section versus vaginal delivery (p=0.08). In
conclusion, bleeding episodes are common during pregnancy in women with
mechanical heart valves receiving anticoagulant therapy. A combination of
UFH and VKA or VKA monotherapy showed the lowest risk of
bleeding. Copyright Thieme. All rights reserved.

<28>
Accession Number
639158763
Title
Impella versus extracorporeal membranous oxygenation (ECMO) for
cardiogenic shock: a systematic review and meta-analysis.
Source
Current problems in cardiology. (pp 101427), 2022. Date of Publication:
26 Sep 2022.
Author
Ahmad S.; Ahsan M.J.; Ikram S.; Lateef N.; Khan B.A.; Tabassum S.; Naeem
A.; Qavi A.H.; Ardhanari S.; Goldsweig A.M.
Institution
(Ahmad) Department of Internal Medicine, East Carolina University,
Greenville, NC, United States
(Ahsan) Division of Cardiovascular Medicine, Iowa Heart Center, Des
Moines, IA, United States
(Ikram) Department of Internal Medicine, SEGi University, Petaling Jaya,
Malaysia
(Lateef, Goldsweig) Division of Cardiovascular Medicine, University of
Nebraska Medical Center, Omaha, NE, United States
(Khan) Department of Internal Medicine, Jewish Hospital - Mercy Health,
Cincinnati, OH, United States
(Tabassum, Naeem) Department of Internal Medicine, King Edward Medical
University, PK, Lahore, Pakistan
(Qavi, Ardhanari) Division of Cardiovascular Medicine, East Carolina
University, Greenville, NC, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The use of mechanical circulatory support (MCS) in cardiogenic
shock (CS) is increasing. We conducted a systematic review and
meta-analysis to compare outcomes with the Impella device vs. ECMO in
patients with CS. METHOD(S): We searched the Medline, EMBASE,
Cochrane, and Clinicaltrials.gov databases for observational studies
comparing Impella to ECMO in patients with CS. Risk ratios (RRs) for
categorical variables and standardized mean differences (SMDs) for
continuous variables were calculated with 95% confidence intervals (CIs)
using a random-effects model. RESULT(S): Twelve retrospective studies
and one prospective study (Impella n=6652, ECMO n=1232) were identified.
Impella use was associated with lower incidence of in-hospital mortality
(RR 0.88 [95% CI 0.80-0.94], p=0.0004), stroke (RR 0.30 [0.21-0.42],
p<0.00001), access-site bleeding (RR 0.50 [0.37-0.69], p<0.0001), major
bleeding (RR 0.56 [0.39-0.80], p=0.002), and limb ischemia (RR 0.42
[0.27-0.65], p=0.0001). Baseline lactate levels were significantly lower
in the Impella group (SMD -0.52 [-0.73- -0.31], p<0.00001). There was no
significant difference in mortality at 6-12 months, MCS duration, need for
MCS escalation, bridge-to-LVAD or heart transplant, and renal replacement
therapy use between Impella and ECMO groups. CONCLUSION(S): In
patients with CS, Impella device use was associated with lower in-hospital
mortality, stroke, and device-related complications than ECMO. However,
patients in the ECMO group had higher baseline lactate
levels. Copyright © 2022. Published by Elsevier Inc.

<29>
Accession Number
2019147269
Title
Neuroprotective effect of remote ischemic preconditioning in patients
undergoing cardiac surgery: A randomized controlled trial.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 952033. Date of Publication: 06 Sep 2022.
Author
Zhu S.; Zheng Z.; Lv W.; Ouyang P.; Han J.; Zhang J.; Dong H.; Lei C.
Institution
(Zhu, Zheng, Lv, Ouyang, Dong, Lei) Department of Anesthesiology and
Perioperative Medicine, Xijing Hospital, Air Force Medical University,
Xi'an, China
(Han) Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China
(Zhang) Department of Anesthesiology and Perioperative Medicine, Henan
Provincial People's Hospital, People's Hospital of Zhengzhou University,
Zhengzhou, China
Publisher
Frontiers Media S.A.
Abstract
Background: The neuroprotective effect of remote ischemic preconditioning
(RIPC) in patients undergoing elective cardiopulmonary bypass
(CPB)-assisted coronary artery bypass graft (CABG) or valvular cardiac
surgery remains unclear. Method(s): A randomized, double-blind,
placebo-controlled superior clinical trial was conducted in patients
undergoing elective on-pump coronary artery bypass surgery or valve
surgery. Before anesthesia induction, patients were randomly assigned to
RIPC (three 5-min cycles of inflation and deflation of blood pressure cuff
on the upper limb) or the control group. The primary endpoint was the
changes in S-100 calcium-binding protein beta (S100-beta) levels at 6 h
postoperatively. Secondary endpoints included changes in Neuron-specific
enolase (NSE), Mini-mental State Examination (MMSE), and Montreal
Cognitive Assessment (MoCA) levels. Result(s): A total of 120
patients [mean age, 48.7 years; 36 women (34.3%)] were randomized at three
cardiac surgery centers in China. One hundred and five patients were
included in the modified intent-to-treat analysis (52 in the RIPC group
and 53 in the control group). The primary result demonstrated that at 6 h
after surgery, S100-beta levels were lower in the RIPC group than in the
control group (50.75; 95% confidence interval, 67.08 to 64.40 pg/ml vs.
70.48; 95% CI, 56.84 to 84.10 pg/ml, P = 0.036). Compared to the control
group, the concentrations of S100-beta at 24 h and 72 h and the
concentration of NSE at 6 h, 24 h, and 72 h postoperatively were
significantly lower in the RIPC group. However, neither the MMSE nor the
MoCA revealed significant between-group differences in postoperative
cognitive performance at 7 days, 3 months, and 6 months after surgery.
 Conclusion(s): In patients undergoing CPB-assisted cardiac surgery,
RIPC attenuated brain damage as indicated with the decreased release of
brain damage biomarker S100-beta and NSE. Clinical trial registration:
[ClinicalTrials.gov], identifier [NCT01231789]. Copyright © 2022
Zhu, Zheng, Lv, Ouyang, Han, Zhang, Dong and Lei.

<30>
Accession Number
2018052514
Title
Differentiating Associations of Glycemic Traits With Atherosclerotic and
Thrombotic Outcomes: Mendelian Randomization Investigation.
Source
Diabetes. 71(10) (pp 2222-2232), 2022. Date of Publication: October 2022.
Author
Yuan S.; Mason A.M.; Burgess S.; Larsson S.C.
Institution
(Yuan, Larsson) Unit of Cardiovascular and Nutritional Epidemiology,
Institute of Environmental Medicine, Karolinska Institutet, Stockholm,
Sweden
(Mason) British Heart Foundation Cardiovascular Epidemiology Unit,
Department of Public Health and Primary Care, University of Cambridge,
Cambridge, United Kingdom
(Burgess) MRC Biostatistics Unit, University of Cambridge, Cambridge,
United Kingdom
(Burgess) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
(Larsson) Unit of Medical Epidemiology, Department of Surgical Sciences,
Uppsala University, Uppsala, Sweden
Publisher
American Diabetes Association Inc.
Abstract
We conducted a Mendelian randomization analysis to differentiate
associations of four glycemic indicators with a broad range of
atherosclerotic and thrombotic diseases. Independent genetic variants
associated with fasting glucose (FG), 2 h glucose after an oral glucose
challenge (2hGlu), fasting insulin (FI), and glycated hemoglobin
(HbA<inf>1c</inf>) at the genome-wide significance threshold were used as
instrumental variables. Summary-level data for 12 atherosclerotic and 4
thrombotic outcomes were obtained from large genetic consortia and the
FinnGen and UK Biobank studies. Higher levels of genetically predicted
glycemic traits were consistently associated with increased risk of
coronary atherosclerosis-related diseases and symptoms. Genetically
predicted glycemic traits except HbA<inf>1c</inf> showed positive
associations with peripheral artery disease risk. Genetically predicted FI
levels were positively associated with risk of ischemic stroke and chronic
kidney disease. Genetically predicted FG and 2hGlu were positively
associated with risk of large artery stroke. Genetically predicted 2hGlu
levels showed positive associations with risk of small vessel stroke.
Higher levels of genetically predicted glycemic traits were not associated
with increased risk of thrombotic outcomes. Most associations for
genetically predicted levels of 2hGlu and FI remained after adjustment for
other glycemic traits. Increase in glycemic status appears to increase
risks of coronary and peripheral artery atherosclerosis but not
thrombosis. Copyright © 2022 by the American Diabetes
Association.

<31>
Accession Number
2018024153
Title
Effect of Continuous Infusion of Intravenous Nefopam on Postoperative
Opioid Consumption After Video-assisted Thoracic Surgery: A Double-blind
Randomized Controlled Trial.
Source
Pain Physician. 25(6) (pp 491-500), 2022. Date of Publication:
September/October 2022.
Author
Yoon S.; Lee H.B.; Na K.J.; Park S.; Bahk J.; Lee H.-J.
Institution
(Yoon, Lee, Bahk, Lee) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Yoon, Bahk, Lee) Department of Anesthesiology and Pain Medicine, Seoul
National University College of Medicine, Seoul, South Korea
(Na, Park) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
(Na, Park) Department of Thoracic and Cardiovascular Surgery, Seoul
National University College of Medicine, Seoul, South Korea
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Although nefopam has been reported to have opioid-sparing and
analgesic effects in postsurgical patients, its effectiveness in
video-assisted thoracoscopic surgery (VATS) is unknown. Objective(s):
This study aimed to investigate the opioid-sparing and analgesic effects
of perioperative nefopam infusion for lung resection. Study Design:
Double-blinded randomized controlled trial. Setting(s): Operating
room, postoperative recovery room, and ward at a single tertiary
university hospital. Method(s): Ninety patients scheduled for
elective VATS for lung resection were randomized to either the nefopam
(group N) or control group (group C). Group N received 20 mg nefopam over
30 minutes immediately after the induction of anesthesia. Nefopam was
administered continuously for 24 hours postoperative, using a dual-channel
elastomeric infusion pump combined with fentanyl-based intravenous
patient-controlled analgesia. Group C received the same volume of normal
saline as nefopam solution administered in the same manner. The primary
outcome measure was fentanyl consumption for the first postoperative 24
hours. The secondary outcome measures were the cumulative fentanyl
consumption during the first postoperative 48 hours, pain intensity at
rest and during coughing evaluated using an 11-point numeric rating scale,
quality of recovery at postoperative time points 24 hours and 48 hours,
and the occurrence of analgesic-related side effects during the first
postoperative 24 hours and postoperative 24 to 48 hour period. Variables
related to chronic postsurgical pain (CPSP) were also investigated by
telephone interviews with patients at 3 months postoperative. This
prospective randomized trial was approved by the appropriate institutional
review board and was registered in the ClinicalTrials.gov registry.
 Result(s): A total of 83 patients were enrolled. Group N showed
significantly lower fentanyl consumption during the first postoperative 24
hours and 48 hours (24 hours: median difference:-270 microg [95%CI,-400
to-150 microg], P < 0.001); 48 hours: median difference:-365 microg [95%
CI:-610 to-140 microg], P < 0.001). Group N also showed a significantly
lower pain score during coughing at 24 hours postoperative (median
difference,-1 [corrected 95% CI:-2.5 to 0], adjusted P = 0.040). However,
there were no significant between-group differences in the postoperative
quality of recovery, occurrence of analgesic-related side effects, length
of hospital stay, and occurrence of CPSP. Limitation(s): Despite the
significant opioid-sparing effect of perioperative nefopam infusion, it
would have been difficult to observe significant improvements in other
postoperative outcomes owing to the modest sample size.
 Conclusion(s): Perioperative nefopam infusion using a dual-channel
elastomeric infusion pump has a significant opioid-sparing effect in
patients undergoing VATS for lung resection. Therefore, it could be a
feasible option for multimodal analgesia in these patients. Copyright
© 2022, American Society of Interventional Pain Physicians. All
rights reserved.

<32>
Accession Number
2017985291
Title
Perioperative Management of Calciphylaxis: Literature Review and Treatment
Recommendations.
Source
Orthopedic Reviews. 14(3) (no pagination), 2022. Date of Publication:
2022.
Author
Strand N.; Maloney J.; Wu S.; Kraus M.; Schneider R.; Gomez D.; Char S.
Institution
(Strand, Maloney, Kraus) Anesthesiology, Mayo Clinic, AZ, United States
(Wu, Gomez) Mayo Clinic Alix School of Medicine, United States
(Char) Anesthesiology, Rutgers, United States
Publisher
Open Medical Publishing
Abstract
Calciphylaxis is a serious and rare medical condition that leads to
substantial clinical manifestations including pain, creating perioperative
and treatment challenges. No standard treatment protocol exists nor are
comprehensive guidelines available for perioperative management of
patients with calciphylaxis. In this review, we evaluate existing
literature (January 2000 to May 2021) with the aim to offer guidance for
treating patients with this challenging disease through the perioperative
period. Although no therapies are currently considered standard for
treating calciphylaxis, multiple interventions are available for improving
symptoms. Preoperative and intraoperative management involves monitoring
and optimizing patient comorbid conditions and any possible electrolyte
imbalances. Postoperative management can be challenging when potential
calciphylaxis triggers are indicated, such as warfarin and
corticosteroids. In addition, poor wound healing and difficult pain
control are common. Therefore, a multifactorial approach to controlling
postoperative pain is recommended that includes the use of nerve blocks,
renal-sparing opioids, benzodiazepines, and/or ketamine. We present
preoperative, intraoperative, and postoperative recommendations for
treating calciphylaxis with levels of evidence when
appropriate. Copyright © 2022, Open Medical Publishing. All
rights reserved.

<33>
[Use Link to view the full text]
Accession Number
2020368902
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. 135(4) (pp 757-768), 2022. Date of Publication:
01 Oct 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.;
Kramer R.; Subramaniam K.; Nascimben L.; Fontes M.; Scavo V.; Sniecinski
R.; Lombard F.; Welsby I.; Milliken J.; Hazelrigg S.; Tibayan F.;
Rodriguez-Blanco Y.; Moainie S.; Moulton M.; Iribarne A.; Firstenberg M.;
Answini G.; Garrett E.; Beaver T.; Reda H.; Szeto W.
Institution
(Moront) Department of Cardiothoracic Sugery, Promedical Toledo Hospital,
Toledo, OH, United States
(Woodward, Chen, Henriquez, Barcelo, Mondou) Bioscience Research Group,
Grifols, Barcelona, Spain
(Essandoh) Department of Anesthesiology, Wexner Medical Center, The 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, United States
(Shore-Lesserson) Department of Anesthesiology, North Shore University
Hospital, New York, 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
Lippincott Williams and Wilkins
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 Lippincott
Williams and Wilkins. All rights reserved.

<34>
Accession Number
2020322151
Title
Propofol or Midazolam for Sedation and Early Extubation Following Coronary
Artery Bypass Graft Surgery.
Source
Pakistan Journal of Medical and Health Sciences. 16(8) (pp 237-239), 2022.
Date of Publication: August 2022.
Author
Rai S.A.; Khan M.I.; Malak A.M.; Asghar M.T.
Institution
(Rai) FCPS Anesthesiology, Department of Anaesthesia and ICU, Chaudary
Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
(Khan, Asghar) Department of Anaesthesia and ICU, Chaudary Pervaiz Elahi
Institute of Cardiology, Multan, Pakistan
(Malak) FCPS Anesthesiology, Department of Anaesthesia and ICU, Military
Hospital, Rawalpindi, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Objective: To evaluate the efficacy of midazolam and propofol for
postoperative sedation and early extubation following cardiac surgery.
 Method(s): This randomized control trial was conducted at the Cardiac
Surgery Department of the Choudhary Pervaiz Elahi Institute of Cardiology
from February 2019 to February 2020. A total of 60 American Society of
Anesthesiologists (ASA) III patients planned to undergo coronary artery
bypass graft surgery were included. After shifting into intensive care
unit (ICU), patients were divided in two groups by lottery method and
study drugs propofol and midazolam were started. Both infusions were
terminated after four hours and patients were assessed for postoperative
sedation and extubation. Hemodynamic parameters, arterial blood gases and
respiratory functions were assessed and recorded. Result(s): The mean
time to awakening, time to extubation in midazolam group was 94.11+/-4.36
minutes, 94.47+/-6.11 minutes respectively and in propofol group it was
96.58+/-4.31 minutes, 91.91+/-3.94 minutes respectively. Difference was
statistically significant. Conclusion(s): Results of our study reveal
that there was no difference in both drugs regarding sedation and
extubation time, both drugs are safe, effective and useful in patients of
coronary artery bypass graft surgery. Copyright © 2022 Lahore
Medical And Dental College. All rights reserved.

<35>
Accession Number
2019682889
Title
Outcomes of dexmedetomidine versus propofol sedation in critically ill
adults requiring mechanical ventilation: a systematic review and
meta-analysis of randomised controlled trials.
Source
British Journal of Anaesthesia. 129(4) (pp 515-526), 2022. Date of
Publication: October 2022.
Author
Heybati K.; Zhou F.; Ali S.; Deng J.; Mohananey D.; Villablanca P.;
Ramakrishna H.
Institution
(Heybati) Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester,
Rochester, MN, United States
(Zhou, Ali, Deng) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Ali) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Deng) Temerty Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Mohananey) Department of Cardiology, Medical College of Wisconsin,
Milwaukee, WI, United States
(Villablanca) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Ramakrishna) Department of Anesthesiology and Perioperative Medicine,
Mayo Clinic - Rochester, Rochester, MN, United States
Publisher
Elsevier Ltd
Abstract
Background: Guidelines have recommended the use of dexmedetomidine or
propofol for sedation after cardiac surgery, and propofol monotherapy for
other patients. Further outcome data are required for these drugs.
 Method(s): This systematic review and meta-analysis was prospectively
registered on PROSPERO. The primary outcome was ICU length of stay.
Secondary outcomes included duration of mechanical ventilation, ICU
delirium, all-cause mortality, and haemodynamic effects. Intensive care
patients were analysed separately as cardiac surgical, medical/noncardiac
surgical, those with sepsis, and patients in neurocritical care. Subgroup
analyses based on age and dosage were conducted. Result(s): Forty-one
trials (N=3948) were included. Dexmedetomidine did not significantly
affect ICU length of stay across any ICU patient subtype when compared
with propofol, but it reduced the duration of mechanical ventilation (mean
difference -0.67 h; 95% confidence interval: -1.31 to -0.03 h; P=0.041;
low certainty) and the risk of ICU delirium (risk ratio 0.49; 95%
confidence interval: 0.29-0.87; P=0.019; high certainty) across cardiac
surgical patients. Dexmedetomidine was also associated with a greater risk
of bradycardia across a variety of ICU patients. Subgroup analyses
revealed that age might affect the incidence of haemodynamic side-effects
and mortality among cardiac surgical and medical/other surgical patients.
 Conclusion(s): Dexmedetomidine did not significantly impact ICU
length of stay compared with propofol, but it significantly reduced the
duration of mechanical ventilation and the risk of delirium in cardiac
surgical patients. It also significantly increased the risk of bradycardia
across ICU patient subsets. Copyright © 2022 British Journal of
Anaesthesia

<36>
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. 80(5) (pp 416-422), 2022. Date of Publication:
November 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

<37>
Accession Number
2015881362
Title
Characterization of Near-Infrared Imaging and Indocyanine-Green Use
Amongst General Surgeons: A Survey of 263 General Surgeons.
Source
Surgical Innovation. 29(4) (pp 494-502), 2022. Date of Publication: August
2022.
Author
Verhoeff K.; Mocanu V.; Fang B.; Dang J.; Sun W.; Switzer N.J.; Birch
D.W.; Karmali S.
Institution
(Verhoeff, Mocanu, Fang, Dang, Sun, Switzer) Department of Surgery,
University of Alberta, Edmonton, AB, Canada
(Birch, Karmali) Centre for Advancement of Surgical Education and
Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
Publisher
SAGE Publications Inc.
Abstract
Background: Near-infrared fluorescence imaging (NIRFI) is an increasingly
utilized imaging modality, however its use amongst general surgeons and
its barriers to adoption have not yet been characterized. Method(s):
This survey was sent to Canadian Association of General Surgeons and the
Society of American Gastrointestinal and Endoscopic Surgeons members.
Survey development occurred through consensus of NIRFI experienced
surgeons. Result(s): Survey completion rate for those opening the
email was 16.0% (n = 263). Most respondents had used NIRFI (n = 161,
61.2%). Training, higher volumes, and bariatric, thoracic, or foregut
subspecialty were associated with use (P <.001). Common reasons for NIRFI
included anastomotic assessment (n = 117, 72.7%), cholangiography (n =
106, 65.8%), macroscopic angiography (n = 66, 41.0%), and bowel viability
assessment (n = 101, 62.7%). Technical knowledge, training and poor
evidence were cited as common barriers to NIRFI adoption.
 Conclusion(s): NIRFI use is common with high case volume, bariatric,
foregut, and thoracic surgery practices associated with adoption. Barriers
to use appear to be lack of awareness, low confidence in current evidence,
and inadequate training. High quality randomized studies evaluating NIRFI
are needed to improve confidence in current evidence; if deemed
beneficial, training will be imperative for NIRFI adoption. Copyright
© The Author(s) 2022.

<38>
Accession Number
2020471539
Title
RIB FRACTURE AS A RARE AND UNDER-REPORTED ETIOLOGY OF PLEURAL SPACE
INFECTION: CASE REPORT AND REVIEW OF LITERATURE.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A459), 2022. Date of Publication: October 2022.
Author
KAPLAN I.A.N.; ALBERMANI T.; JAIN A.; R VELASQUEZ R.; R ROBLES M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Challenging Disorders of the Pleura SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm
INTRODUCTION: There are at least 248,000 emergency department encounters
and 46,000 inpatient admissions per year with a diagnosis of rib fracture
(1). The majority heal without complications however, there is a 4%
mortality associated with this injury primarily coming from infection (2).
Most clinicians are aware of the risk of pneumonia with rib injury when
respiratory excursion is limited due to pain. In this case report we
discuss a less commonly appreciated infectious complication, empyema. CASE
PRESENTATION: 55 year old male past medical history of alcoholic liver
cirrhosis, hepatitis B and C status post treatment, and IV drug abuse
presented to our institution with right-sided chest pain. He reported
getting into a fight in the street and receiving a blow with a block of
concrete in the right side of his chest about two weeks ago. On admission
chest x ray he was noted to have a right sided infiltrate and pleural
effusion (figure 1). CT chest was obtained which showed a displaced
fracture in the right 6th rib. There was also a fluid collection with
scattered pockets of air concerning for abscess (figure 2). He was started
on broad spectrum antibiotics and a chest tube was placed for pleural
effusion. The fluid was exudative and cultures grew MSSA. TPA and Dornase
was used to break up loculations within the fluid. Lytic therapy was
stopped as patient had significant bleeding from the chest tube and CT
scan was repeated. We reviewed the imaging with radiology and thoracic
surgery which showed an increase in the size of the abscess and a gas
pattern traveling up the minor fissure. Additionally, there were visible
bits of bone fragment entering the pleural space (figure 3). The patient
was taken to the OR for thoracotomy, decortication and drainage of the
abscess cavity. The patient was recovered on the medical floors and
discharged to rehab on 6 weeks of IV cefazolin. DISCUSSION: In this case
report we present a rare infectious complication of rib injury; empyema.
Our patient's infection was likely due to a displaced rib fracture with
translation of bone fragments into the pleural space. His initial chest x
ray did not show any acute rib fractures. Screening chest x rays miss
about 50% of rib fractures. Even on CT chest about 10% of rib fractures
are missed (1). When evaluating the causes of an abscess in the lung or a
possible pleural space infection, clinicians should be aware of rib
fracture as an inciting, or worsening factor for morbidity.
 CONCLUSION(S): Pleural space infections are an uncommon but important
complication of rib fracture. Patients with rib fracture, especially those
who are immunocompromised, need close monitoring to prevent infectious
complications and morbidity related to this injury. Surgical evaluation
and operative exploration of the pleural space may be the best option for
definitive management of this condition. Reference #1: Martin TJ, Eltorai
AS, Dunn R, Varone A, Joyce MF, Kheirbek T, Adams C Jr, Daniels AH,
Eltorai AEM. Clinical management of rib fractures and methods for
prevention of pulmonary complications: A review. Injury. 2019
Jun;50(6):1159-1165. doi: 10.1016/j.injury.2019.04.020. Epub 2019 Apr 22.
PMID: 31047683. Reference #2: Brasel, Karen J. MD, MPH; Guse, Clare E. MS;
Layde, Peter MD, MS; Weigelt, John A. MD Rib fractures: Relationship with
pneumonia and mortality, Critical Care Medicine: June 2006 - Volume 34 -
Issue 6 - p 1642-1646 doi: 10.1097/01.CCM.0000217926.40975.4. DISCLOSURES:
No relevant relationships by Tarik Albermani No relevant relationships by
Anant Jain No relevant relationships by Ian Kaplan No relevant
relationships by Miguel Robles No relevant relationships by Ricardo
Velasquez Copyright © 2022 American College of Chest Physicians

<39>
Accession Number
2020471469
Title
AN UNLIKELY CARDIAC MASS: INCIDENTAL METASTATIC FINDING.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1344-A1345), 2022. Date of Publication: October
2022.
Author
MAKAR M.; HENDRY R.; J DICHIARA G.; SHAIKH A.; A STEWART P.A.U.L.;
AKBARULLAH S.Y.E.D.; HRUSKA J.; B SCHNEIDER X.; DEL MUNDO L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Mediastinum Case Report Posters SESSION TYPE: Case Report
Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION:
Dysphagia, the objective impairment or difficulty of swallowing, is an age
related disease that affects approximately 40% of Americans older than 60
years old. [1] The two most common causes of dysphagia are mechanical
obstructive and motility disorders.[2] One cause of mechanical obstructive
dysphagia is esophageal cancer. Esophageal cancer is an aggressive cancer
with a 5 year relative survival rate ranging between 4% and 40%. About 84%
are males over the age of 67 years old with a 65% occurrence in the lower
third of the esophagus. The incidence of esophageal adenocarcinoma (EA)
has gradually increased over the decades. [4] Prognosis in esophageal
cancer is dependent on invasion and spread to regional or distant
structures. [3] Here, we report a case of dysphagia that ultimately leads
to EA with metastasis to the heart. CASE PRESENTATION: In September 2021,
a 72 year old non-smoker Caucasian male with a past medical history
significant for atrial fibrillation on Eliquis, hypertension,
gastroesophageal reflux disease, and coronary artery disease presented to
the gastroenterologist due to six weeks of dysphagia and unintentional
weight loss. Upper endoscopy revealed distal esophageal mass with biopsy
consistent with malignant esophageal adenocarcinoma. A staging CT
angiography chest was then performed which showed a 4.1 centimeter lesion
in the right atrium consistent with a mass or thrombus [Image 1]. A trans
esophageal echocardiogram showed a right atrial mass measuring 41 x 26 mm
from the right atrial free wall and adherent to the septum [Image 2]. A
staging EGD showed T3N1 nearly fully obstructive gastroesophageal
adenocarcinoma. The right atrial tumor was resected and sent to pathology
which confirmed metastatic adenocarcinoma. DISCUSSION: The most common
clinical manifestation of thoracic esophageal tumors is progressive
dysphasia with weight loss. The most common sites of distant metastasis of
EA are the liver, lungs, bones and adrenal glands [5]. The incidence of
cardiac metastasis (CM) in the literature ranges from 2.3 to 18.3% [6].
Esophageal tumors are typically found on esophagogastroduodenoscopy and if
CM are present, rarely produce clinical cardiac symptoms [7]. However,
symptoms may include congestive heart failure, valvular heart disease, and
electrocardiographic changes. Additionally, most CM are detected
post-mortem [8-9]. In one study, out of 20,998 open heart surgeries
performed during a 23 year period, only 5 patients had cardiac
manifestation of extra-cardiac tumors [10]. CONCLUSION(S): The
prevalence of malignant diseases continues to increase around the world.
The rarity of intra-cardiac metastatic disease, specifically esophageal
adenocarcinoma is evident in the literature. Although there are no
official screening guidelines for cardiac metastasis, we suggest screening
oncologic patients presenting with cardiopulmonary syndromes. Reference
#1: 1. Sura, Livia. Dysphagia in the Elderly: Management and Nutritional
Considerations. https://www.dovepress.com/getfile.php?fileid=2476. 2. Azer
SA, Kshirsagar RK. Dysphagia. [Updated 2021 Jun 15]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK559174/ 3. Shaheen
O, Ghibour A, Alsaid B. Esophageal Cancer Metastases to Unexpected Sites:
A Systematic Review. Gastroenterol Res Pract. 2017;2017:1657310.
doi:10.1155/2017/1657310 4. Wu SG, Zhang WW, He ZY, Sun JY, Chen YX, Guo
L. Sites of metastasis and overall survival in esophageal cancer: a
population-based study. Cancer Manag Res. 2017 Dec 6;9:781-788. doi:
10.2147/CMAR.S150350. PMID: 29255373; PMCID: PMC5723120. Reference #2: 5.
Meltzer CC, Luketich JD, Friedman D, et al. Whole-body FDG positron
emission tomographic imaging for staging esophageal cancer comparison with
computed tomography. Clin Nucl Med 2000; 25:882. 6. Reynen K, Kockeritz U,
Strasser RH. Metastases to the heart. Ann Oncol. 2004;15:375-381. [PubMed]
[Google Scholar] 7. Secondary cardiac tumor originating from laryngeal
carcinoma: case report and review of the literature. Renders F,
Vanderhyden M, Andries E. Acta Cardiol. 2005;60:57-60. [PubMed] [Google
Scholar] Reference #3: 8. Cardiac metastases. Bussani R, De-Giorgio F,
Abbate A, Silvestri F. J Clin Pathol. 2007;60:27-34. [PMC free article]
[PubMed] [Google Scholar] 9. A 30-year analysis of cardiac neoplasms at
autopsy. Butany J, Leong SW, Carmichael K, Komeda M.
https://www.ncbi.nlm.nih.gov/pubmed/16003450. Can J Cardiol.
2005;21:675-680. [PubMed] [Google Scholar] 10. Burazor, I., Aviel-Ronen,
S., Imazio, M. et al. Metastatic cardiac tumors: from clinical
presentation through diagnosis to treatment. BMC Cancer 18, 202 (2018).
https://doi.org/10.1186/s12885-018-4070-x DISCLOSURES: No relevant
relationships by Syed Akbarullah No relevant relationships by LLOYD Del
Mundo No relevant relationships by Gerard DiChiara No relevant
relationships by Robert Hendry No relevant relationships by Jerome Hruska
No relevant relationships by Monica Makar No relevant relationships by
Xenia Schneider No relevant relationships by Anaam Shaikh No relevant
relationships by Paul Stewart Copyright © 2022 American College
of Chest Physicians

<40>
Accession Number
2020471155
Title
COVID-19 CARDIAC TAMPONADE WITH CARDIOGENIC SHOCK IN A PREVIOUSLY
VACCINATED YOUNG ADULT: A CASE REPORT.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A751), 2022. Date of Publication: October 2022.
Author
KANDAH O.M.A.R.; W GOLDEN T.; S BUMBALO T.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Complications in Patients with COVID-19
SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm -
1:45 pm INTRODUCTION: Previous case reports have shown a number of cardiac
complications associated with, and attributed to COVID-19 infection
including acute myocardial injury and infarction, dysrhythmias, acute
heart failure, pericarditis, and venous thromboembolic events, among
others. Up until this point, these cases have all been documented in
unvaccinated individuals 1. CASE PRESENTATION: Here we report a unique
case of a 40-year-old previously vaccinated woman who presented with
generalized weakness, chest pain, dyspnea, and vomiting. She was found to
be septic and positive for COVID-19. Transthoracic echocardiogram showed a
small pericardial effusion on admission and the patient was diagnosed with
acute myopericarditis secondary to COVID-19. Within the first 24 hours
following admission, the patient's condition rapidly deteriorated and she
developed worsening pericardial effusion, with subsequent cardiac
tamponade, and cardiogenic shock. Following attempted pericardiocentesis
and surgical drainage, cardiac function did not improve and she expired
soon after. DISCUSSION: Despite most of the clinical attention being
focused on the effects of SARS-CoV-2 on the respiratory system and the
pneumonia it causes, there have been more reported complications involving
other organ systems, particularly the heart and kidneys. Studies have
shown three main categories of cardiac involvement and complications
related to COVID-19: myocardial injury, acute heart failure, and
arrhythmia. Focusing on myocardial injuries, there have been some reports
attempting to elucidate the frequency of myo- and pericarditis as
complications of COVID-19. Yet still to this date, little is known about
pericarditis as a COVID-19 complication. Of the case reports published
thus far regarding COVID-19 pericarditis, the majority of them do not
exhibit cardiac tamponade. In one systematic review published in
September, 2021, a total of 33 studies including 32 case reports and one
case series were included and pericardial effusion and cardiac tamponade
were reported in 76% and 35% of the cases, respectively 2. To our
knowledge, our case is the first of its kind, illustrating cardiac
tamponade in a fully vaccinated individual. Although, there have been no
clear mechanisms explaining the pathogenesis of cardiac involvement in
patients suffering from COVID-19, multiple possibilities have been
hypothesized. Similar to other cardiotoxic viruses, an inflammatory
response is likely triggered resulting in pericarditis and pericardial
effusion 3. When left unabated, cardiac tamponade can occur.
 CONCLUSION(S): Our case documents a reminder of the critical nature
of SARS-CoV-2, even in vaccinated patients. To our knowledge, this is the
first reported case of cardiac tamponade in a previously vaccinated
individual. This case highlights the importance of quick diagnosis and
treatment in patients suffering from potential lethal complications of
COVID-19. Reference #1: Long B, Brady WJ, Koyfman A, Gottlieb M.
Cardiovascular complications in COVID-19. Am J Emerg Med.
2020;38(7):1504-1507 Reference #2: Diaz-Arocutipa C, Saucedo-Chinchay J,
Imazio M. Pericarditis in patients with COVID-19: a systematic review. J
Cardiovasc Med (Hagerstown). 2021 Sep 1;22(9):693-700 Reference #3:
Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient
With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819-24
DISCLOSURES: no disclosure on file for Thomas Bumbalo; no disclosure on
file for Thaddeus Golden; No relevant relationships by Omar
Kandah Copyright © 2022 American College of Chest Physicians

<41>
Accession Number
2020471152
Title
LONG-TERM ORAL SUPPRESSIVE ANTIBIOTIC THERAPY FOR PROSTHETIC VALVE
ENDOCARDITIS WITH PERIVALVULAR EXTENSION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A313-A314), 2022. Date of Publication: October 2022.
Author
NIEVES H.A.; J ACEVEDO-VALLES J.O.S.E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Chest Infection Case Report Posters SESSION
TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm
INTRODUCTION: Prosthetic valve endocarditis (PVE) compromises around 20%
of all infective endocarditis (IE) cases. More than 30% of these patients
complicate with perivalvular extension requiring surgery. Recommendations
for cardiac surgery are based on observational studies and provide limited
data. When statically adjusted no improvement on hospital and one year
survival is evidenced, except on cases with the strongest indications for
surgery. In non-surgical candidates' standard treatment for 2-6 weeks of
IV antibiotic treatment is suitable for non-complicated IE however in
presence of perivalvular extension antibiotic duration has not been well
studied. CASE PRESENTATION: 91-year-old male with a past medical history
of coronary artery disease, chronic kidney disease stage 2, diabetes
mellitus type 2, hypertension, and aortic valve stenosis status post
transcatheter aortic valve replacement with a metallic valve who presented
with general weakness. Denied chills, fever, or recent dental
instrumentation. He was afebrile with stable vital signs. Physical
examination was remarkable for poor oral hygiene, painful red-purple lumps
on distal toes on lower extremities and a systolic ejection murmur with a
loud S2 metallic click on left lower sternal border auscultation.
Laboratories showed leukocytosis with elevated sedimentation rate and
C-reactive protein. Electrocardiogram revealed a new first-degree
atrioventricular block. Blood cultures were positive for Streptococcus
sanguinis. Transesophagic echocardiogram demonstrated PVE complicated with
perivalvular abscess with fistulous tract between aortic valve annulus and
aorta. Due to comorbidities, poor functionality and underweight status, he
was not deemed a surgical candidate. After goals of care discussion, he
refused further invasive management and opted for antibiotic treatment. He
was managed with intravenous Ceftriaxone 2gm daily for 6 weeks and oral
Amoxicillin 875mg/Clauvanate 125mg twice daily indefinitely. After
discharge he was followed by an interdisciplinary team. DISCUSSION:
Randomized studies are needed to improve recommendations regarding the
surgical management of patients with IE and PVE subset. Indications for
cardiac surgery in PVE are not absolute reason why each case must be
evaluated individually and a detailed risk versus benefits assessment must
be done before considering early surgical intervention versus long term
oral suppressive antibiotic therapy. Patients with a more severe
presentation of infection may benefit from surgical intervention, but not
all will be able to undergo procedure reason why alternate medical therapy
is needed. CONCLUSION(S): For this patient unfit for cardiothoracic
surgery long term oral suppressive antibiotic therapy resulted to be an
alternative treatment modality. Nevertheless, close outpatient follow-up
and compliance was required due to the risk of progression of infection.
Reference #1: Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM,
Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF,
Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA; American
Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki
Disease of the Council on Cardiovascular Disease in the Young, Council on
Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and
Stroke Council. Infective Endocarditis in Adults: Diagnosis, Antimicrobial
Therapy, and Management of Complications: A Scientific Statement for
Healthcare Professionals From the American Heart Association. Circulation.
2015 Oct 13;132(15):1435-86. doi: 10.1161/CIR.0000000000000296. Epub 2015
Sep 15. Erratum in: Circulation. 2015 Oct 27;132(17):e215. Erratum in:
Circulation. 2016 Aug 23;134(8):e113. Erratum in: Circulation. 2018 Jul
31;138(5):e78-e79. PMID: 26373316. Reference #2: Mihos CG, Capoulade R,
Yucel E, Picard MH, Santana O. Surgical Versus Medical Therapy for
Prosthetic Valve Endocarditis: A Meta-Analysis of 32 Studies. Ann Thorac
Surg. 2017 Mar;103(3):991-1004. doi: 10.1016/j.athoracsur.2016.09.083.
Epub 2017 Feb 4. PMID: 28168964. Reference #3: Bolger AF. Challenges in
treating prosthetic valve endocarditis. JAMA Intern Med. 2013 Sep
9;173(16):1504-5. doi: 10.1001/jamainternmed.2013.7020. PMID: 23857327.
DISCLOSURES: No relevant relationships by Jose Acevedo-Valles No relevant
relationships by Hector Nieves Copyright © 2022 American College
of Chest Physicians

<42>
Accession Number
2020471131
Title
FETAL MASS PUZZLE: AN UNEXPECTED DIAGNOSIS.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2028-A2029), 2022. Date of Publication: October
2022.
Author
STATHOS J.; VASQUEZ D.; FIREIZEN Y.; M SHAHRIARY C.; SOLIMAN A.; P SETTY
S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Strange Cardiovascular Disorders and Presentations SESSION
TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am
INTRODUCTION: Prenatal found masses can represent a diagnosis challenge.
Our case describes a newborn patient who presented with a large mass
initially suspected to be a congenital pulmonary airway malformation
(CPAM) on fetal echocardiogram. Cardiothoracic surgery resected the mass
and eventual pathology evaluation revealed that it was in fact an immature
teratoma. Cardiac teratomas are the rarest intracardiac tumors of
childhood which account for less than 2% of overall cardiac tumors in
pediatric patients and are often detected antenatally. They are generally
benign, but they tend to grow rapidly, thus causing serious mechanical
consequences. Although rare, cardiac teratomas should be a consideration
when encountering cystic, congenital masses near the mediastinum. CASE
PRESENTATION: A newborn patient presented to our neonatal ICU with a large
mass suspected to be a congenital pulmonary airway malformation (CPAM) on
fetal echocardiogram. After delivery, the infant had an echocardiogram
which revealed a pericardial effusion (drained in the cardiac catheter lab
with a pericardial tube placed) and a cystic echogenic mass on the upper
right cardiac border. Initial cytology was unrevealing. A chest CT with
contrast revealed a complex cystic anterior mediastinal mass (unlikely to
be a CPAM) that was compressing the posterior cardiac structures.
Cardiothoracic surgery was consulted and recommended expeditious resection
of the mass. During the operation, it was noted that the mass was
originating in the pericardium and attached to the right atrium and
ascending aorta(Img.1). Pathology evaluation revealed that it was in fact
an immature teratoma(Img 2). DISCUSSION: Primary cardiac tumors are
extremely rare, with most fetal and newborn cardiac tumors being found to
be histologically benign. Cardiac teratomas account for less than 2% of
cardiac tumors in pediatric patients and are generally detected
antenatally. Most occur in the pericardial cavity. These tumors are
generally benign, but grow rapidly over the first few weeks, and thus
induce serious mechanical consequences for the afflicted patient.
Resection of the teratoma after birth is curative of any etiology that may
arise from its growth and mass displacement. CONCLUSION(S):
Congenital cardiac teratomas, although a rare pathology, must be
considered in patients with thoracic masses. Histologically, the teratomas
are benign tumors and are often cystic, multicystic, or solid-multicystic
derived from all three germ layers (endoderm, ectoderm, and mesoderm)(Img
3). A computed topography should be used in order to further elucidate
pathology as its superior to chest x-ray and US. The recommended
therapeutic management is complete surgical excision particularly when
symptoms of impending tamponade appear. As such, careful consideration
must be used when evaluating postnatally a thoracic mass. Reference #1:
Ahmed A. Nassr, Sherif A. Shazly, Shaine A. Morris, Nancy Ayres, Jimmy
Espinoza, Hadi Erfani, Olutoyin A. Olutoye, Sara K. Sexson, Oluyinka O.
Olutoye, Charles D. Fraser, Michael A. Belfort, Alireza A. Shamshirsaz,
Prenatal management of fetal intrapericardial teratoma: a systematic
review, Prenatal Diagnosis, 10.1002/pd.5113, 37, 9, (849-863), (2017)
Reference #2: E. Araujo Junior, G. Tonni, M. Chung, R. Ruano, W. P.
Martins, Perinatal outcomes and intrauterine complications following fetal
intervention for congenital heart disease: systematic review and
meta-analysis of observational studies, Ultrasound in Obstetrics &
Gynecology, 10.1002/uog.15867, 48, 4, (426-433), (2016). Reference #3:
Shi-Min Yuan, Fetal Intrapericardial Teratomas: An Update, Zeitschrift fur
Geburtshilfe und Neonatologie, 10.1055/a-1114-6572, 224, 04, (187-193),
(2020) DISCLOSURES: No relevant relationships by Yaron Fireizen No
relevant relationships by Shaun Setty no disclosure on file for Cyrus
Shahriary; No relevant relationships by Antoine Soliman No relevant
relationships by Joseph Stathos No relevant relationships by Dibanni
Vasquez Copyright © 2022 American College of Chest Physicians

<43>
Accession Number
2020471122
Title
TALCOMA IN LUNG CANCER SCREENING: A RARE BENIGN CAUSE OF PET SCAN AVIDITY.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1400), 2022. Date of Publication: October 2022.
Author
SMITH C.; E COVEY A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Invasion of the Pleura SESSION TYPE: Case Reports PRESENTED
ON: 10/18/2022 11:15 am - 12:15 pm INTRODUCTION: Pleurodesis is a
procedure in which local inflammation is intentionally induced to create
adherence between the visceral and parietal pleural surfaces for the
resolution of pneumothorax or recurrent pleural effusion. This can be
achieved either mechanically with abrasion or chemically with solutions
such as talc, bleomycin, tetracyclines, dextrose, and autologous blood
patch. Among those, talc slurry is one of the most common due to its
success rates. Talcoma is an exceedingly rare pleural-based mass of
aggregated talc sequestered by localized inflammatory response. Though
benign in etiology, the diagnosis can be challenging as the inflammation
induced by talc pleurodesis has been known to cause avid
Fluorodeoxyglucose Positron Emission Tomography (PET) up to 20 years
post-procedurally. CASE PRESENTATION: A 61-year-old male with a history of
chronic obstructive pulmonary disease with bullous emphysema complicated
by three spontaneous pneumothoraces and right-sided talc pleurodesis
eighteen years prior underwent regular lung cancer screening by low-dose
computerized tomography (LDCT) scan due to high risk for malignancy. His
social history was significant for remote cocaine use and 45 pack-year
smoking history. LDCT demonstrated an irregular nodule 2x1.2cm in the
right major fissure which appeared new since previous examination (fig 1).
The lesion was described as LungRADS 4, and the patient underwent
subsequent PET to further characterize the lesion (fig 2). PET
re-demonstrated the right major fissure nodule which was hypermetabolic
and identified multiple additional hypermetabolic pleural-based nodules as
well as a 9mm station 8 lymph node for which endobronchial ultrasound was
negative. Due to the documented changes in imaging with high-risk history
but concern for talcoma, a CT-guided core needle biopsy of the pleural
nodule was performed. Pathology demonstrated polarizable foreign material
with reactive foreign body giant cells consistent with talcoma (fig 3).
DISCUSSION: With the recent expansion of lung cancer screening candidates
under the USPSTF recommendations, there will be an increased prevalence of
unusual and rare pathology. These patients will be both asymptomatic and
high risk for lung cancer. This diagnosis can be particularly challenging
due to its avidity by PET caused by the inherent immunogenicity of talc.
It is essential to elicit a thorough history of all patients with abnormal
results of LDCT including prior pulmonary and cardiothoracic procedures.
 CONCLUSION(S): Talcoma is a benign lesion which is a very rare
sequalae of talc pleurodesis. A high index of suspicion is necessary to
make this diagnosis, as it closely resembles its neoplastic counterparts
including avidity by PET. The new lung cancer screening guidelines will
likely increase the incidence of rare lesions, so it is imperative to
gather adequate history and physical exam data to guide clinical
management. Reference #1: 1. Zablockis R, Danila E, Gruslys V,
Cincileviciute G. Systemic Inflammatory Response to Different Sclerosing
Agents as a Predictor of Pleurodesis Outcome. In Vivo.
2021;35(4):2391-2398. doi:10.21873/invivo.12516 Reference #2: 2.
Karampinis, I, Galata, C, Arani, A, Grilli, M, Hetjens, S, Shackcloth, M,
et al. Autologous blood pleurodesis for the treatment of postoperative air
leaks. A systematic review and meta-analysis. Thoracic Cancer. 2021; 12:
2648- 2654. https://doi.org/10.1111/1759-7714.14138 Reference #3: 3.
Vandemoortele T, Laroumagne S, Roca E, et al. Positive FDG-PET/CT of the
pleura twenty years after talc pleurodesis: three cases of benign talcoma.
Respiration. 2014;87(3):243-248. doi:10.1159/000356752 DISCLOSURES: No
relevant relationships by Andrea Covey No relevant relationships by Andrea
Covey No relevant relationships by Clarissa Smith Copyright ©
2022 American College of Chest Physicians

<44>
Accession Number
2020471032
Title
MUCUS OR MELANOMA? A CASE REPORT.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1792), 2022. Date of Publication: October 2022.
Author
LACAVERA M.; W BOLDT J.O.H.N.; M GRAHAM R.; SPENCE D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Cancer Imaging Case Report Posters 2 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm
INTRODUCTION: Primary tracheal carcinomas are rare, the majority are
malignant, and most often consist of squamous cell and adenoid cystic
carcinoma. A standardized treatment for tracheal tumors has not been
established. We present a patient with tracheal melanoma to raise
awareness and to consider treatment modalities. CASE PRESENTATION: A
79-year-old male with active myeloma and past medical history of prostate
cancer and fully-resected melanoma presented for an abnormality seen on CT
imaging. In August 2021, CT imaging revealed a nodularity at the anterior
lateral trachea measuring 9mm suspected to be inspissated mucus. Due to
the onset of hemoptysis six months later, a CT scan was repeated. The
patient's tracheal lesion was still present and had progressed in size to
17mm. Due to suspicion for malignancy, bronchoscopy and argon plasma
coagulation was performed. Pathology revealed cells positive for SOX10,
Melan A, and TRK protein consistent with malignant melanoma. DISCUSSION:
There are few documented cases of primary tracheal melanoma; theories of
primary tracheal melanoma consist of transformation of epithelial cells or
neuroendocrine cells into melanocytes or migration of melanocytes during
embryogenesis. The incidence of secondary tracheal tumors is unknown and
arise from tumor invasion of nearby structures or lymph node or
hematologic metastasis. Pulmonary, renal, GI, melanoma, and breast tumors
metastasize to endobronchial tissue. Due to rarity of isolated tracheal
tumors, a standard treatment has not been identified; current treatment
modalities include surgical resection, argon plasma coagulation, and
chemoradiation. For melanoma, immune checkpoint inhibitors can be utilized
including the combination of a BRAF inhibitor and MEK inhibitor in the
setting of an activating BRAF mutation. CONCLUSION(S): Overall,
tracheal tumors are primarily malignant, symptoms are often vague, and
diagnosis can be difficult, which is why careful comparison of radiologic
evidence is crucial for patient outcomes. Mainstays of treatments thus
far, include resection, argon plasma coagulation, and chemoradiation.
Reference #1: Urdaneta AI, James BY, Wilson LD. Population based cancer
registry analysis of primary tracheal carcinoma. American journal of
clinical oncology. 2011 Feb 1;34(1):32-7. Reference #2: Madariaga ML,
Gaissert HA. Overview of malignant tracheal tumors. Annals of
cardiothoracic surgery. 2018 Mar;7(2):244. Reference #3: Madariaga ML,
Gaissert HA. Secondary tracheal tumors: a systematic review. Annals of
Cardiothoracic Surgery. 2018 Mar;7(2):183. DISCLOSURES: No relevant
relationships by John Boldt No relevant relationships by Robert Graham No
relevant relationships by Margeaux LaCavera No relevant relationships by
David Spence Copyright © 2022 American College of Chest
Physicians

<45>
Accession Number
2020470996
Title
THORACIC ENDOMETRIOSIS PRESENTING AS RECURRENT SPONTANEOUS PNEUMOTHORAX.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1843), 2022. Date of Publication: October 2022.
Author
RODMAN K.; J CATION L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Challenging Disorders of the Pleura SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm
INTRODUCTION: Endometriosis is defined as the presence of ectopic
endometrial tissue outside of the uterine cavity and musculature. Thoracic
endometriosis is exceedingly rare and often presents as spontaneous
catamenial pneumothorax, catamenial hemothorax or hemoptysis. Thoracic
endometriosis requires biopsy proven tissues for diagnosis. We present an
interesting case of rare biopsy proven thoracic endometriosis presenting
as recurrent catamenial pneumothorax. CASE PRESENTATION: A 29 year old
female with a past medical history of endometriosis and small bowel
obstruction with partial colectomy presented to the emergency room
complaining of nausea, vomiting, and abdominal pain. The patient endorsed
associated R sided chest pain that began two days prior to her abdominal
symptoms without dyspnea, cough, or hypoxemia. Abdominal x-ray
demonstrated a partially visualized right pneumothorax which was
subsequently confirmed with a chest x-ray. Upon further questioning, the
patient revealed this was her third pneumothorax in the last five years,
all of which coincided with her menstrual cycle. The first occurrence was
a right sided pneumothorax found while the patient was admitted to the
hospital for a small bowel obstruction secondary to abdominal
endometriosis. Four years later, the patient presented to an emergency
room with abdominal pain and shortness of breath where she was found to
have a right-sided tension pneumothorax. Given all three of her
pneumothoraces were associated with the patient's menses, the diagnosis of
catamenial pneumothorax was suspected. Thoracic surgery was consulted and
the patient underwent a right video-assisted thoracoscopic surgery with
betadine pleurodesis. During the procedure, a hyperemic area of the
pleural lining was noted and biopsied. Pleural biopsy showed benign
endometrial tissue with reactive mesothelial lining, consistent with
pleural endometriosis. Follow up imaging revealed resolution of
pneumothorax. Gynecology was consulted and hormonal suppression therapy
was initiated. Patient has had no known recurrence of pneumothorax since
discharge from the hospital. DISCUSSION: Thoracic endometriosis presenting
as catamenial pneumothorax should be suspected in all young females with a
history of recurrent pneumothoraces. It is important to note that
recurrent catamenial pneumothorax can often occur years apart, making the
diagnosis more difficult. Good history taking is crucial in identifying
suspected cases and any female patient presenting with pneumothorax of
unclear etiology should be asked about their menstrual history.
 CONCLUSION(S): It is important for physicians to be able to recognize
the various presentations of thoracic endometriosis as establishing a
diagnosis can lead to treatment and therefore prevention of future
recurrence. Reference #1: Andres MP, Arcoverde FVL, Souza CCC, Fernandes
LFC, Abrao MS, Kho RM. Extrapelvic Endometriosis: A Systematic Review. J
Minim Invasive Gynecol. 2020;27(2):373-389. doi:10.1016/j.jmig.2019.10.004
Reference #2: Alifano M, Jablonski C, Kadiri H, et al. Catamenial and
noncatamenial, endometriosis-related or nonendometriosis-related
pneumothorax referred for surgery. Am J Respir Crit Care Med.
2007;176(10):1048-1053. doi:10.1164/rccm.200704-587OC Reference #3: Romer
T. Long-term treatment of endometriosis with dienogest: retrospective
analysis of efficacy and safety in clinical practice [published correction
appears in Arch Gynecol Obstet. 2019 Jan;299(1):293]. Arch Gynecol Obstet.
2018;298(4):747-753. doi:10.1007/s00404-018-4864-8 DISCLOSURES: No
relevant relationships by Lannie Cation No relevant relationships by Kelly
Rodman Copyright © 2022 American College of Chest Physicians

<46>
Accession Number
2020470852
Title
A RARE CASE OF ENTEROCOCCUS FAECALIS BIOPROSTHETIC AORTIC VALVE ABSCESS.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A591-A592), 2022. Date of Publication: October 2022.
Author
ALAM J.M.; AHMED H.; SRINIVASAN A.; C WILSON B.; BEAR M.; TAHIR A.; MONK
M.; TORRES J.; SARVA S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Chest Infection Case Report Posters SESSION
TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm
INTRODUCTION: Enterococcal aortic valve abscess is a rare condition
associated with poor outcomes. Incidence of perivalvular abscess in
infective endocarditis is 30%. Staphylococcus aureus and Escherichia coli
are the most common culprits. There are cases of Enterococcus species
causing infective endocarditis but few cases are reported on
bio-prosthetic aortic valve abscess. We report a unique case of
Enterococcus faecalis associated bio-prosthetic aortic valve abscess. CASE
PRESENTATION: 68-year-old male with history of Hypertension, Diabetes
Mellitus type 2, Coronary Artery Disease status-post Coronary Artery
Bypass Graft, Congestive Heart Failure with reduced Ejection Fraction of
20% and a bio-prosthetic aortic valve via Transcatheter Aortic Valve
Replacement (TAVR) presents with acute onset low back pain after a
mechanical fall. He was admitted one month ago for fever, dyspnea,
hypotension and found to have Enterococcus faecalis bacteremia. A
Transthoracic Echocardiogram (TTE) at the time did not show any evidence
of endocarditis. He was discharged with IV Ampicillin for two weeks. On
arrival this admission, he was hypotensive and tachycardic. CT and MRI of
the lumbar spine showed chronic degenerative changes. Blood cultures were
positive for Enterococcus faecalis and he was started on IV ceftriaxone
and ampicillin. A repeat TTE did not show evidence of endocarditis.
Transesophageal echocardiogram (TEE) showed echolucency around the
bio-prosthetic aortic valve suggestive of perivalvular abscess. He was
escalated to IV Gentamicin, Ceftriaxone and ampicillin. Cardiothoracic
surgery recommended transfer to a higher level of care for aortic valve
replacement. DISCUSSION: Prevalence of infective endocarditis in
enterococcus bacteremia is 30% and echocardiography is imperative in all
patients. If the original TTE is negative for vegetations, a TEE should be
pursued to rule out infective endocarditis. Our case is one of the first
to describe Enterococcus faecalis related bio-prosthetic aortic valve
abscess which if not identified and treated in time can result poor
outcomes. Mainstay treatment is IV antibiotics but definite management is
to replace the prosthetic valve requiring a team of highly specialized
surgeons and cardiologists. CONCLUSION(S): Our patient was a unique
case in that they returned to the hospital after being discharged one
month ago for Enterococcus faecalis bacteremia during which the TTE did
not show any evidence of endocarditis. A repeat TTE on readmission was
also negative for any vegetations but a TEE did show a definite aortic
valve abscess. The Nova score is used to obviate the necessity for TEE but
should be used cautiously in patients with bio-prosthetic valve. Thus, a
TEE should always be pursued in cases where the TTE fails to show any
evidence of endocarditis in a patient with previously inserted
bio-prosthetic valve along with bacteremia. Reference #1: San Roman, Jose
A., and Javier Lopez. "Prosthetic Valve Endocarditis." ESC CardioMed,
2018, pp. 1720-1723., https://doi.org/10.1093/med/9780198784906.003.0392.
Reference #2: Olmos, Carmen, et al. "Short-Course Antibiotic Regimen
Compared to Conventional Antibiotic Treatment for Gram-Positive Cocci
Infective Endocarditis: Randomized Clinical Trial (Satie)." BMC Infectious
Diseases, vol. 20, no. 1, 2020,
https://doi.org/10.1186/s12879-020-05132-1. Reference #3: Piper C, Korfer
R, Horstkotte D. Prosthetic valve endocarditis. Heart. 2001
May;85(5):590-3 DISCLOSURES: no disclosure on file for Haris Ahmed; No
relevant relationships by Junaid Alam No relevant relationships by Matthew
Bear No relevant relationships by Muhammad Monk No relevant relationships
by sivatej sarva No relevant relationships by Aswin Srinivasan No relevant
relationships by Arooj Tahir No relevant relationships by Jordan Torres No
relevant relationships by BRANDEN WILSON Copyright © 2022
American College of Chest Physicians

<47>
Accession Number
2020470821
Title
SEALANT GLUE TO MANAGE BLEEDING POSTNAVIGATION BRONCHOSCOPY-GUIDED LUNG
BIOPSY.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2081), 2022. Date of Publication: October 2022.
Author
BASS B.M.; ZIATABAR S.; HENSON T.; N HARRIS K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Great Procedural Cases: Fire, Ice, Struts, Valves, and Glue
SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm
INTRODUCTION: Hemoptysis is a common problem faced by Interventional
Pulmonologists. In cases of bleeding peripheral lung lesions, a combined
diagnostic and therapeutic approach is needed. Here we present a unique
case of utilizing CoSeal via navigational bronchoscopy to manage a
bleeding lesion in the distal airway after transbronchial biopsies. CASE
PRESENTATION: A 74 year-old male with a history of atrial fibrillation on
Eliquis, chronic obstructive pulmonary disease (COPD), lung adenocarcinoma
status post lobectomy and radiation, with multiple hospital admissions for
pneumonia, was referred for recurrent hemoptysis. He was scheduled for
bronchoscopy but became acutely hypoxic, found to have spontaneous
pneumothorax (PTX) on the right. Pigtail catheter was emergently placed
and he was intubated. Bedside bronchoscopy showed bright red blood with no
obvious source of bleeding. Repeat bronchoscopies localized bleeding to
the right upper lobe (RUL) where a mass had been seen on CT. Patient
underwent navigational bronchoscopy with biopsy of the mass. Following
biopsy, there was continued bleeding. The navigational bronchoscope was
retracted 2 centimeters from the center of the lesion. We injected 2
milliliters of CoSeal using the Duplocath 180 via the Edge Firm Tip 180
Catheter and allowed time for coagulation. The bronchoscope was then
retracted back to the right mainstem bronchus and the fibrin clot was seen
in the posterior segment of the RUL. On continued bronchoscopies over the
following days, there continued to be fibrin clot and no further evidence
of bleeding. DISCUSSION: CoSeal is a polyethylene glycol hydrogel drip
composed of two solutions which cross-link to create a sealant. Its
primary use is for vascular surgeries to form a direct mechanical barrier
to blood flow. However, it has been utilized in many different formats
including prevention of adhesions after left ventricular assist device
implantation and preventing prolonged air leaks after lung resection. In
our institution, we frequently use CoSeal to achieve hemostasis in
patients with hemoptysis. In this patient, his lung function was
compromised by COPD, resolving PTX and pneumonia. Therefore, we aimed to
directly target the source of bleeding to avoid derecruitment of several
segmental airways to avoid hypoxia. By using CoSeal via navigational
bronchoscopy, we were able to directly target the lesion to obtain
hemostasis while only compromising the RUL posterior segment for gas
exchange. CONCLUSION(S): Bleeding in the airways can be difficult to
control and hard to manage. Directed utilization of CoSeal via
navigational bronchoscopy is one way to maximize hemostasis while
minimizing the amount of airway compromise from devices like a balloon or
endobronchial blocker. In our patient, this technique showed promising
findings for coagulation. However, further experience using this method
will need to be performed to support this conclusion. Reference #1: Kunio,
Nicholas. "Topical Hemostatic Agents." Consultative Hemostasis and
Thrombosis (Third Edition), 2013,
https://www.sciencedirect.com/science/article/pii/B9781455722969000294.
Accessed 25 March 2022. Reference #2: Cannata, Aldo. "Use of CoSeal in a
Patient With a Left Ventricular Assist Device." The Annals of Thoracic
Surgery, 2009,
https://www.annalsthoracicsurgery.org/article/S0003-4975(08)02261-3/fullte
xt. Accessed 25 March 2022. Reference #3: Lequaglie, Cosimo. "Use of a
sealant to prevent prolonged air leaks after lung resection: a prospective
randomized study." NCBI, 8 October 2012,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508954/. Accessed 25 March
2022. DISCLOSURES: No relevant relationships by Brittany Bass No relevant
relationships by Kassem Harris No relevant relationships by Theresa Henson
No relevant relationships by Sally Ziatabar Copyright © 2022
American College of Chest Physicians

<48>
Accession Number
2020470812
Title
WORK HARD OR SMART? A CASE OF EFFORT-RELATED SUBCLAVIAN THROMBOSIS.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2437), 2022. Date of Publication: October 2022.
Author
KAZMI S.H.; NAHAR R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Thrombosis Jamboree: Rare and Unique Cases SESSION TYPE:
Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm
INTRODUCTION: Paget Schroetter Syndrome is a primary spontaneous venous
thrombosis of axillary-subclavian system that generally presents in the
dominant arm of young individuals. It is a rare condition with an
incidence of 1 to 2 per 100,000 individuals.1 Thrombosis is secondary to
venous thoracic outlet compression through either anatomic predisposition
or due to repetitive musculoskeletal motion. CASE PRESENTATION:
44-year-old female presented with 3 days of right upper extremity pain,
swelling and limitation in ROM. She endorsed increased activity involving
abducting arm while performing her tasks as a cook during the holiday
season. She denied any respiratory symptoms, recent trauma,
instrumentation, or immobilization of her right arm. She was up to date
with cancer screening, had no prior thrombotic episodes and denied use of
oral contraceptives. She was tachycardic with exam findings of a swollen,
warm, tender right arm without skin changes. Doppler US showed occlusive
acute thrombosis of right axillary and subclavian veins with non-occlusive
extension into right innominate vein. CT PE revealed bilateral segmental
pulmonary emboli without evidence of right heart strain. Her
hypercoagulable lab work-up was unremarkable. Thrombolysis and follow up
surgery were discussed with patient, however, she opted for conservative
therapy with anticoagulation. A follow up CT venogram to assess for
thoracic outlet obstruction was found to be negative. She was discharged
with thoracic surgery follow up for elective first rib removal.
DISCUSSION: In PSS vigorous physical activity can cause microtrauma to the
blood vessels and subsequent thrombus formation. Prompt diagnosis and
definitive treatment are necessary to prevent both acute and
post-thrombotic neurovascular complications. Clinically apparent pulmonary
embolism can concomitantly occur in 5-8% of patients with upper extremity
DVT2. Immediate management of proximal upper extremity DVT involves
systemic anticoagulation for 3-6 months. In patients with limb-threatening
acute thrombosis, catheter-directed thrombolysis may be beneficial3.
However, there is a lack of high-quality trials on the management of PSS
without formed guidelines. Definitive surgical intervention is aimed at
decompressing the thoracic outlet with first rib resection, but the timing
of decompression is debatable without a prospective randomized comparison.
In absence of definitive measures, these individuals are at high risk for
post-thrombotic complications as well as recurrent thrombosis of proximal
vasculature of the arm. If inadequately treated, Paget Schroetter syndrome
could contribute to significant morbidity and disability as it affects the
dominant arm of the high-functioning population. CONCLUSION(S): Paget
Schroetter syndrome is thrombosis of proximal vessels of the arm in a
young population for which further research is required to establish a
standard of care treatment algorithm. Reference #1: Lindbald B, Tengborn
L, Bergqvist D. Deep vein thrombosis of the axillary-subclavian veins:
epidemiologic data, effects of different types of treatment and late
sequelae. Eur J Vasc Surg 1988;2:161-5 Reference #2: Munoz FJ, Mismetti P,
Poggio R, et al. Clinical outcome of patients with upper-extremity deep
vein thrombosis: results from the RIETE Registry. Chest 2008;133:143-8
Reference #3: Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug
K, Geersing GJ, Huisman MV, Kearon C, King CS, Knighton AJ, Lake E, Murin
S, Vintch JRE, Wells PS, Moores LK. Antithrombotic Therapy for VTE
Disease: Second Update of the CHEST Guideline and Expert Panel Report.
Chest. 2021 Dec;160(6):e545-e608 DISCLOSURES: No relevant relationships by
Syed Hammad Kazmi No relevant relationships by Richa Nahar Copyright
© 2022 American College of Chest Physicians

<49>
Accession Number
2020470805
Title
A FISTULOUS ISSUE: GASTROPLEURAL FISTULA AS A COMPLICATION OF GASTRECTOMY.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1410-A1411), 2022. Date of Publication: October
2022.
Author
PERSAUD P.N.; S CHHABRIA M.; R NATHANI A.; MANEK G.; C MEHTA A.T.U.L.;
NAVARRETE S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Once in a Lifetime Pleural Cases SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION:
Gastropleural fistula is a rare complication of bariatric surgery and
gastrectomy. Patients present with unresolving left lower lobe (LLL)
pneumonia and complex left pleural space infections, necessitating
multiple readmissions and many courses of antibiotics until the diagnosis
is made. It is often a missed diagnosis and requires a high degree of
clinical suspicion. Here, we present two cases of gastropleural fistulae.
CASE PRESENTATION: Case 1: 60-year-old male admitted for ruptured
abdominal aortic aneurysm, requiring repair. His stay was complicated by
GI bleed necessitating embolization, and large paraesophageal hernia with
fundal necrosis needing hernia repair, sleeve gastrectomy, and gastropexy.
His stay was further complicated by empyema status post chest tube
placement. Eventually discharged to LTACH. He presented a month later for
sepsis and purulent drainage from his prior chest tube site. CT showed
findings of recurrent empyema and air in the pleural space concerning for
fistula. Upper GI series was done showing leakage at the greater curvature
of the stomach to the left pleural space, consistent with a gastropleural
fistula (Fig. 1A). An EGD-guided stent was placed to cover the defect,
with resolution of the fistula (Fig 1B). Case 2: 64-year-old female with
history of gastric bypass many years ago presented with months of
unresolving LLL pneumonia despite several trials of antibiotics. She
presented with septic shock and respiratory failure requiring intubation.
Endotracheal tube had dark material coming out and bedside ultrasound
showed air bubbles entering the stomach on inspiration. Bronchoscopy
showed dark brown secretions in the LLL. CT was done showing gas from the
lung base communicating with the gastric remnant consistent with a
gastropleural fistula (Fig. 2). Thoracic surgery was consulted and
performed thoracotomy, fistula takedown, and partial gastrectomy of the
remnant. After surgery, her pneumonia resolved without recurrence.
DISCUSSION: Based on review of literature, patients with gastropleural
fistulae present weeks to months after their surgical procedure with a
variety of complaints including fever, cough, shortness of breath, chest
pain, hemoptysis [1,2]. Imaging commonly demonstrates unresolving LLL
pneumonia and pleural effusion. As demonstrated by our cases, index of
suspicion must be high to diagnose this condition and may often take
months to arrive at the right diagnosis. Imaging modalities commonly used
to make the diagnosis are upper GI x-ray series with oral contrast and CT
scans of the chest, abdomen, and pelvis. Some authors have suggested
simple bedside tests such as demonstration of bile salts in the pleural
fluid [3]. CONCLUSION(S): While the management is surgical, we as
pulmonologists need to be aware of this rare but life-threatening
complication of gastrectomy to make a timely diagnosis and guide
management. Reference #1: 1) Garcia-Quintero, P., Hernandez-Murcia, C.,
Romero, R., Derosimo, J., & Gonzalez, A. (2015). Gastropleural fistula
after bariatric surgery: a report of two cases. Journal of robotic
surgery, 9(2), 163-166. Reference #2: 2) Alghanim, F., Alkhaibary, A.,
Alzakari, A., & AlRumaih, A. (2018). Gastropleural fistula as a rare
complication of gastric sleeve surgery: a case report and comprehensive
literature review. Case reports in surgery, 2018. Reference #3: 3)
Rotstein, O. D., Pruett, T. L., & Simmons, R. L. (1985). Gastropleural
fistula: report of three cases and review of the literature. The American
journal of surgery, 150(3), 392-396. DISCLOSURES: No relevant
relationships by Mamta Chhabria No relevant relationships by Gaurav Manek
No relevant relationships by Atul Mehta No relevant relationships by
Avantika Nathani No relevant relationships by Salvador Navarrete No
relevant relationships by Purnadeo Persaud Copyright © 2022
American College of Chest Physicians

<50>
Accession Number
2020470784
Title
CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION
MYOCARDIAL INFARCTION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A266-A267), 2022. Date of Publication: October 2022.
Author
ROBERTSON C.; TATINENI L.; TALHA QASMI S.Y.E.D.; SARVA S.; BABU KESAVAN
R.; DANIEL M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Infections In and Around the Heart Case Posters SESSION
TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm
INTRODUCTION: An increasingly reported presentation of infective
endocarditis (IE) is myocardial infarction (MI), and in some cases, may be
the earliest sign of IE. This is believed to occur due to obstruction by
vegetations, septic emboli, or compression of coronary arteries. Less
common is to find a nonobstructive MI associated with endocarditis as is
detailed here. CASE PRESENTATION: 68-year-old male with past history of
coronary artery disease (CAD), hypertension, diabetes mellitus, atrial
flutter on Eliquis, aortic stenosis s/p TAVR in past year, ascending aorta
dilation, no history of drug use, and recent hospitalization 3 months
prior for MSSA bacteremia, presented with worsening dyspnea and
generalized weakness for 1 week, bilateral shoulder pain, burning
epigastric pain, and diaphoresis. Admitted to ICU for cardiogenic shock,
acute hypoxic respiratory failure, and NSTEMI. EKG with ST depressions in
V3-V4 and troponin elevation up to 150 ng/mL in 8 hours. Left heart
catheterization found nonobstructive CAD, severely elevated filling
pressures, and severely elevated aortic gradients. Transthoracic
echocardiogram (TTE) showed dilated left atrium, mildly reduced systolic
function with global akinesis, moderate mitral regurgitation, and severe
stenosis of bioprosthetic aortic valve. TTE from recent admission was
normal. Given recent MSSA bacteremia, despite negative blood cultures at
present, transesophageal echocardiogram (TEE), to rule out endocarditis
causing valve dysfunction and/or microemboli, revealed severe
bioprosthetic leaflet thickening and vegetation obstructing outflow during
systole and extending into left ventricular outflow tract (LVOT) during
diastole. Open aortic valve replacement and ascending aortic aneurysm
repair were performed. Operative report detailed heavy pannus ingrowth of
the valve with near complete obstruction of LVOT. Hemodynamic instability
necessitated delayed primary closure. TEE at time of closure showed normal
biatrial and biventricular size, normal systolic function and wall motion,
and bioprosthetic aortic valve with normal function. DISCUSSION: This case
emphasizes the increased risk of IE in those with prosthetic valves. One
of the main predictors of prosthetic valve endocarditis (PVE) is staph
aureus bacteremia; of note, culture positivity with other organisms was
not significantly associated with increased embolic events. 1-6% of
patients develop PVE after valve replacement. In one study, early S.
aureus PVE accounted for 19.2% of cases and late complications were less
likely the more time after surgery. CONCLUSION(S): Given that our
patient was treated for MSSA bacteremia 3 months prior, and in association
with the above statistics, it brings to light that one might should
consider regular evaluation of cardiac valves in those with recent history
of staph aureus bacteremia or recent implantation of prosthetic valves.
Reference #1: Zhao J, Yang J, Chen W, et al. Acute myocardial infarction
as the first sign of infective endocarditis: a case report. J Int Med Res.
2020;48(12):300060520980598. doi:10.1177/0300060520980598 Reference #2:
Liu YH, Lee WH, Chu CY, et al. Infective endocarditis complicated with
nonobstructive ST elevation myocardial infarction related to septic
embolism with intracranial hemorrhage: A case report. Medicine
(Baltimore). 2018;97(48):e13089. doi:10.1097/MD.0000000000013089 Reference
#3: Yang A, Tan C, Daneman N, et al. Clinical and echocardiographic
predictors of embolism in infective endocarditis: systematic review and
meta-analysis. Clin Microbial Infect 2019; 25: 178-187. Published 2018 Aug
23. doi:10.1016/j.cmi.2018.08.010 DISCLOSURES: No relevant relationships
by Michael Daniel No relevant relationships by Ramesh Babu Kesavan No
relevant relationships by Syed Talha Qasmi No relevant relationships by
Cassie Robertson No relevant relationships by sivatej sarva No relevant
relationships by Lakshmi Tatineni Copyright © 2022 American
College of Chest Physicians

<51>
Accession Number
2020470623
Title
ACHROMOBACTER XYLOSOXIDANS: A RARE ORGANISM CAUSING A RARE CASE OF
TRICUSPID VALVE ENDOCARDITIS.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A221), 2022. Date of Publication: October 2022.
Author
KRAMER M.; TZARNAS S.; JANGA C.; NAEEM I.; WALTERS L.; D CHECCHIO
L.U.C.Y.; CHAN V.; T ESTEPA A.; R QAMAR Z.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: The Cardiac Intensivist 1 SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION:
Achromobacter xylosoxidans (A. xylosoxidans) endocarditis is rare, with
only 23 cases reported to date and only one case of tricuspid valvular
involvement. We present a 43-year-old female with tricuspid valve
endocarditis in the setting of A. xylosoxidans bacteremia. CASE
PRESENTATION: 43-year-old female with past medical history of lymphedema
and pulmonary embolism on Eliquis had an initial hospitalization to the
medical intensive care unit in August of 2021 for septic shock with blood
cultures positive for A.xylosoxidans on day one. Her lower extremity
wounds were the suspected source of infection. Four subsequent sets of
blood cultures over the next ten days remained negative. She received a
total of two weeks of piperacillin-tazobactam and was discharged. Patient
was re-admitted two months later with altered mental status and chest
pain. Again, blood cultures grew A. xylosoxidans and antibiotics were
broadened from piperacillin-tazobactam to meropenem for CNS penetration.
Computed tomography (CT) lower extremity showed diffuse soft tissue
inflammation. CT head was negative for acute intracranial pathology.
Septic pulmonary emboli were seen on CT chest/abdomen/pelvis.
Echocardiogram showed a 13mm x 9.6mm echodensity on the anterior leaflet
of the tricuspid valve (image 1). Unfortunately, she was intubated for
airway protection, received increasing doses of vasopressor medications,
and due to persistent acidemia was started on continuous renal replacement
therapy. The source of bacteremia is still unclear given there were no
procedures performed including central line placement. She was deemed
unstable to undergo surgical intervention for endocarditis and succumbed
to her disease. Autopsy revealed a 1.0 cm tricuspid valve vegetation,
microscopic findings of the lungs indicated acute pneumonia (right and
left lower lobes), septic emboli, and diffuse alveolar damage. Lower
extremities bilaterally revealed gaping wounds and granulation tissue
formation on microscopic evaluation. DISCUSSION: A. xylosoxidans is an
aerobic motile, gram-negative rod and seldom causes endocarditis.
A.xylosoxidans is a rare bacteria that is usually associated with central
line infections. Unlike the only other case of tricuspid valve
endocarditis, this patient has no obvious risk factors including
prosthetic valve or central line for A. xylosoxidans bacteremia.
 CONCLUSION(S): The rarity of this organism limits successful
treatment modalities and more research is needed to improve management in
future cases. Reference #1: Rodrigues CG, Rays J, Kanegae MY. Native-valve
endocarditis caused by Achromobacter xylosoxidans: a case report and
review of literature. Autops Case Rep. 2017;7(3):50-55. Published 2017 Sep
30. doi:10.4322/acr.2017.029 DISCLOSURES: No relevant relationships by
Vincent Chan No relevant relationships by Lucy Checchio No relevant
relationships by Adrian Estepa No relevant relationships by Chaitra Janga
No relevant relationships by Mackenzie Kramer No relevant relationships by
Ifrah Naeem No relevant relationships by Zahra Qamar No relevant
relationships by Stephanie Tzarnas No relevant relationships by Laura
Walters Copyright © 2022 American College of Chest Physicians

<52>
Accession Number
2020470608
Title
EKOSONIC ENDOVASCULAR SYSTEM CATHETER FOR SUCCESSFUL TREATMENT OF RIGHT
ATRIAL THROMBUS AND PULMONARY EMBOLISM: A CASE REPORT.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A798-A799), 2022. Date of Publication: October 2022.
Author
NETZEL A.; IQBAL F.; S HANSRA R.; R GRIER L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Critical Care Cases SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION:
Pulmonary embolism (PE) and right heart thrombus carries a high mortality.
Treatment modalities with reviewed patient outcomes include
anticoagulation, systemic thrombolysis, and surgical intervention.
However, multiple meta-analyses published over the last 30 years report
varying mortality rates for these modalities, limiting the creation of
guidelines for optimal treatment [1-5]. In this case report, we present a
patient with a PE and right atrial thrombus who was successfully treated
with a lesser studied modality, EkoSonic Endovascular System (EKOS)
catheter-directed thrombolysis. CASE PRESENTATION: A 50 year old African
American female with a past medical history pertinent for May Thurner
Syndrome and a prior deep vein thrombosis (DVT) in pregnancy presented
with dyspnea on exertion, tachycardia, and decreased oxygen saturation. CT
imaging revealed bilateral submassive pulmonary embolisms with an
associated large right atrial thrombus (30.6 x 31.5mm), and extensive left
lower extremity DVT. She was hemodynamically stable on presentation.
Following multidisciplinary discussion, the best treatment approach was
determined to be catheter-directed thrombolysis with bilateral EkoSonic
Endovascular System (EKOS) catheters placed into the left and right
pulmonary arteries. Within 30 hours, repeat echocardiogram revealed
complete resolution of the atrial thrombus. The patient's hypoxia
completely resolved, the EKOS catheters were removed, and an inferior vena
cava (IVC) filter was placed. The patient was discharged home on hospital
day 5 with apixaban for continued anticoagulation. DISCUSSION: A widely
accepted guideline for the management of pulmonary embolism in the
presence of a right heart thrombus does not exist. Previously published
retrospective meta-analyses agree that (1) any treatment has improved
survival outcomes over no treatment and that (2) systemic thrombolysis or
surgical embolectomy is preferred over anticoagulation alone [1-4]. To
date, no prospective studies have been done to compare the different
treatment modalities, making a multidisciplinary approach vital for
patient care. Additionally, the use of catheter directed thrombolysis,
specifically for PE with right heart thrombus, has not been extensively
studied or reported [3]. EKOS catheters, however, are well studied for the
treatment of PE alone, and have demonstrated reduced bleeding risk and
improved quality of life scores as compared to systemic thrombolytic
therapy [6]. CONCLUSION(S): While more research directly comparing
the different treatment modalities is needed, this case demonstrates the
safety of catheter directed thrombolysis. A multidisciplinary discussion
between critical care, cardiothoracic surgery, and vascular surgery to
evaluate a specific facility's available expertise and treatment
modalities will be critical to ensuring successful treatment of the
patient. Reference #1: 1. Rose PS, Punjabi NM, Pearse DB. Treatment of
right heart thromboemboli. Chest 2002; 121: 806-14. 2. Torbicki A, Galie
N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ; ICOPER Study Group.
Right heart thrombi in pulmonary embolism: Results from the International
Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003; 41:
2245-51. Reference #2: 3. Athappan G, Prasanna S, Chacko P, Gandhi S.
Comparative efficacy of different modalities for treatment of right heart
thrombi in transit: A pooled analysis. Vascular Medicine 2015; 20(2):
131-138. 4. The European Cooperative Study on the clinical significance of
right heart thrombi. European Working Group on Echocardiography. Eur Heart
J 1989; 10: 1046-1059. Reference #3: 5. Kinney EL, Wright RJ. Efficacy of
treatment of patients with echocardiographically detected right-sided
heart thrombi: A meta-analysis. Am Heart J 1989; 118: 569-573. 6. Tapson
VF, Sterling K, Jones N, et al. A Randomized Trial of the Optimum Duration
of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk
Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018;
11(14): 1401-1410. DISCLOSURES: No relevant relationships by Laurie Grier
No relevant relationships by Rajkamal Hansra No relevant relationships by
Fatima Iqbal No relevant relationships by Audrey Netzel Copyright
© 2022 American College of Chest Physicians

<53>
Accession Number
2020470569
Title
CARDIAC SARCOIDOSIS: WHEN THE RIGHT VENTRICLE ISN'T RIGHT.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A177-A178), 2022. Date of Publication: October 2022.
Author
NATHANI A.R.; L RIBEIRO NETO M.; C CREMER P.A.U.L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Unusual Presentations of Sarcoidosis SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm
INTRODUCTION: Sarcoidosis is a multisystem inflammatory disorder that
affects the heart in almost a third of the cases (1). The left ventricle
(LV) is the most commonly affected site. We present a case of right
ventricular (RV) cardiac sarcoidosis presenting as ventricular
arrhythmias. CASE PRESENTATION: A 55 year old male presented to the
emergency department with sudden onset chest discomfort and
lightheadedness while at rest. He was hemodynamically stable and exam
showed no murmur, but electrocardiogram demonstrated a new wide complex
ventricular tachycardia (VT). Electrolytes were corrected and he was
initially treated with IV amiodarone which converted him back to normal
sinus rhythm. Echocardiogram showed an ejection fraction of 55%, with
normal size and function of the heart. Computed Tomography Angiography
showed normal coronary arteries and prominent mediastinal and right hilar
lymph nodes. Cardiac Magnetic Resonance Imaging revealed enhancement of
the RV mid to apical anterior and lateral wall segments with no LV
involvement. Electrophysiological studies did not have any inducible VT,
however on isoproterenol washout there were two episodes of polymorphic
VT. He was discharged with a Lifevest and Zio patch. Genetic testing for
cardiac arrhythmias and cardiomyopathy was done but did not identify any
pathogenic variants. At this time, differential diagnosis included
Arrhythmogenic right ventricular cardiomyopathy (ARVC), sarcoidosis, and
myocarditis. Fluorodeoxyglucose (FDG)-positron emission tomography (PET)
scan showed uptake limited to entire RV free wall with avid FDG uptake
seen in multiple mediastinal lymph nodes. Endobronchial ultrasound and
transbronchial needle aspiration was positive for benign lymphoid
granuloma (negative for acid fast bacilli and fungi). Treatment with
Methotrexate and Prednisone was initiated. Implantable
cardioverter-defibrillator placement was recommended, however the patient
chose to hold off on the procedure. A PET scan after 3 months revealed
resolution of inflammation in the RV as well as lymph nodes. Zio patch
interrogation had almost complete resolution of premature ventricular
contractions (PVCs) and VTs. Steroids were eventually tapered off and
patient was maintained on methotrexate and regular PET scans. DISCUSSION:
Cardiac sarcoidosis frequently presents with a combination of LV
subepicardial, LV multifocal, septal, and RV free wall involvement (2).
Isolated RV involvement is rare, but when present, such as this case, can
often present with fatal arrhythmias. The most common differential
diagnosis is ARVC as they have similar ECHO and PET scan findings (3).
Without other systemic features of sarcoidosis, granulomas seen in an
endomyocardial biopsy helps differentiate between the two and allows for
early steroids for sarcoidosis. CONCLUSION(S): RV sarcoid, though
rare, can present with potentially fatal arrhythmias and early treatment
can be life saving. Reference #1: Youssef G, Beanlands RS, Birnie DH, Nery
PB. Cardiac sarcoidosis: applications of imaging in diagnosis and
directing treatment. Heart. 2011 Dec;97(24):2078-87. doi:
10.1136/hrt.2011.226076. PMID: 22116891. Reference #2: Okasha O,
Kazmirczak F, Chen KA, Farzaneh-Far A, Shenoy C. Myocardial Involvement in
Patients With Histologically Diagnosed Cardiac Sarcoidosis: A Systematic
Review and Meta-Analysis of Gross Pathological Images From Autopsy or
Cardiac Transplantation Cases. J Am Heart Assoc. 2019 May
21;8(10):e011253. doi: 10.1161/JAHA.118.011253. PMID: 31070111; PMCID:
PMC6585321. Reference #3: Philips B, Madhavan S, James CA, te Riele AS,
Murray B, Tichnell C, Bhonsale A, Nazarian S, Judge DP, Calkins H, Tandri
H, Cheng A. Arrhythmogenic right ventricular dysplasia/cardiomyopathy and
cardiac sarcoidosis: distinguishing features when the diagnosis is
unclear. Circ Arrhythm Electrophysiol. 2014 Apr;7(2):230-6. doi:
10.1161/CIRCEP.113.000932. Epub 2014 Mar 1. PMID: 24585727 DISCLOSURES: No
relevant relationships by Paul Cremer No relevant relationships by
Avantika Nathani No relevant relationships by Manuel Ribeiro
Neto Copyright © 2022 American College of Chest Physicians

<54>
Accession Number
2020470523
Title
PULMONARY CAPILLARY HEMANGIOMATOSIS: A CONUNDRUM FOR EXPERTS.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2304), 2022. Date of Publication: October 2022.
Author
AZEEM Q.; DUDIKI N.; AZIM D.U.A.; KUMAR S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Unusual Pulmonary Hypertension Cases SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm
INTRODUCTION: Pulmonary capillary hemangiomatosis (PCH), a rare cause of
pulmonary hypertension (PH), hypoxemia, and markedly impaired diffusion
capacity of the lungs, is seldom identified antemortem. We report a case
of early biopsy-proven PCH in a patient with rapidly progressive
hypoxemia. CASE PRESENTATION: A 60-year-old female with a prior diagnosis
of COPD presented for evaluation of rapidly progressive hypoxemia and
exertional dyspnea. Of note, she had smoked for two years but endorses
secondhand smoke exposure. Pulmonary function tests (PFTs) showed a normal
FEV1/FVC ratio with severely decreased total lung capacity and diffusion
capacity. PFTs impelled to revisit the initial diagnosis of COPD while
raising the possibility of restrictive lung disease. High-resolution
computed tomography (HRCT) of the chest revealed significant bilateral
ground-glass opacities, interlobular septal thickening, crazy paving
pattern, and small bilateral effusions. Autoimmune panel for interstitial
lung disease was negative. BNP was mildly elevated; her echocardiogram,
however, showed no findings of systolic or diastolic heart failure. Given
her HRCT findings, the patient was referred to cardiothoracic surgery for
video-assisted thoracoscopic lung biopsy. A tissue exam showed septal
thickening due to interstitial capillary proliferation but without
inflammation or fibrosis. Immunostaining of CD34 and ERG along with
reticulin stain highlighted interstitial capillary proliferation.
Histologic findings led to the diagnosis of PCH. The patient was then
referred for a lung transplant. DISCUSSION: PCH is a rare disease that
poses a significant diagnostic challenge owing to its rarity, rapid
progression, and incompletely understood histopathological findings.
Histopathologic findings constitute obliteration of small pulmonary veins
by fibrous intimal thickening and patchy capillary proliferation. It
presents with nonspecific symptoms of progressive dyspnea, cough with or
without hemoptysis, chest pain, and fatigue. CT chest often shows diffuse
centrilobular ground-glass opacities with interlobular septal thickening,
also seen in many other pulmonary diseases. In rare instances where PCH is
diagnosed antemortem, it is generally accompanied by PH. Diagnosis of PCH
is crucial as conventional therapies for PH, such as vasodilators, are
contraindicated and may exacerbate the disease leading to death. Lung
biopsy is the only reliable means of diagnosis given the nonspecific
nature of clinical and radiographic features. The overall prognosis of PCH
remains poor, with lung transplant as the only means of definitive cure.
 CONCLUSION(S): High clinical suspicion of PCH is vital when
evaluating a patient with accelerated hypoxemia and characteristic
radiological features. Lung transplant is the sole means of definitive
treatment, further emphasizing early diagnosis and prompt evaluation.
Reference #1: Chaisson NF, Dodson MW, Elliott CG. Pulmonary Capillary
Hemangiomatosis and Pulmonary Veno-occlusive Disease. Clin Chest Med.
2016;37:523-534. doi:10.1016/j.ccm.2016.04.014 Reference #2: Abdelnabi M,
Almaghraby A, Abdelgawad H, Elkafrawy F, Ziada K. Pulmonary capillary
hemangiomatosis: a case series and review of literature. Am J Cardiovasc
Dis. 2021;11:239-245. Reference #3: Wang WJ, Hong C, Han Q, et al.
Pulmonary Capillary Hemangiomatosis without Pulmonary Hypertension: An
Early Stage of Disease?. Chin Med J (Engl). 2018;131:245-246.
doi:10.4103/0366-6999.222326 DISCLOSURES: No relevant relationships by
Qiraat Azeem No relevant relationships by Dua Azim No relevant
relationships by Natasha Dudiki No relevant relationships by Sohail
Kumar Copyright © 2022 American College of Chest Physicians

<55>
Accession Number
2020470340
Title
IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM:
A CASE REPORT.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1373), 2022. Date of Publication: October 2022.
Author
MAIN O.; PATEL H.; ISLAM J.; K GRONER L.; WONG I.V.A.N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Problems in the Pleura Case Posters 1 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION:
Esophageal-pleural fistula (EPF) is a rare condition, which can occur in
the setting of radiation, esophageal tumors, or as a procedural
complication. We present a unique case of EPF in a patient who developed
an intramural esophageal hematoma after transesophageal echocardiogram
(TEE) CASE PRESENTATION: An 81-year-old woman presented with two days of
dysphagia, and vomitus after a TEE for mitral valvuloplasty. After
hospitalization, an esophagram, CT chest, and EGD all suggested intramural
hematoma of the distal esophagus. Initial management was conservative to
allow self-absorption of the hematoma; however, hospital stay was
complicated by respiratory failure requiring mechanical ventilation. Chest
x-ray demonstrated a large right hydropneumothorax necessitating chest
tube placement. Fluid analysis revealed an exudate with amylase 127, and
LDH 1,700 units/L. Gram stain showed yeast and blood culture positive for
lactobacillus species. On hospital day 25, chest tube output appeared
thick and purulent, concerning for enteral feeding leaking into the
pleural space. Dilute methylene blue infusion into the orogastric tube
(OGT) revealed a possibility of a fistula which was later confirmed by EGD
showing esophago-pleural fistula (EPF) in mid-distal esophagus (Figure 1).
An esophageal stent was placed, chest tube output decreased, and she was
eventually extubated. Her hospital course however, was further complicated
by sepsis and multiorgan failure, she expired on hospital day 44.
DISCUSSION: EPF is a rare complication of endoscopic intervention,
malignancy, radiation therapy, and chronic infection [1]. Diagnosis is
typically made with contrast induced esophagography demonstrating
extravasation of contrast into the pleural space or via EGD. In cases of
associated pleural effusion, fluid analysis can play a key role in the
diagnosis of EPF. Fluid is usually exudative, with pleural fluid amylase
levels greater than the upper limit of serum amylase or a ratio greater
than 1. Pleural fluid gram stain and culture can reveal the presence of
gastrointestinal flora such as yeast, lactobacillus, or gram-negative
rods. In patients unable to tolerate oral contrast due to high aspiration
risk, infusion of methylene blue in OGT can be used for diagnosis. Passage
of dye into the thoracostomy tube can confirm a connection between the
esophagus and pleural space. Management of an EPF typically depends on the
size, location, and severity of perforation. Treatment options include
self-expanding esophageal stenting or surgical reconstruction. The
mortality rate from esophageal perforation ranges from 10-50%, with
delayed diagnosis resulting in severe sepsis, mediastinitis, and death
[2]. CONCLUSION(S): Esophageal perforation is a rare complication of
TEE. Our aim was to highlight the importance of maintaining a high index
of clinical suspicion for EPF as a cause of pleural effusion post
esophageal manipulation. Reference #1: Sainathan S, Andaz S. A systematic
review of transesophageal echocardiography-induced esophageal perforation.
Echocardiography. 2013;30(8):977-983. doi:10.1111/echo.12290 Reference #2:
Randhawa MS, Rai MP, Dhar G, Bandi A. Large oesophageal haematoma as a
result of transoesophageal echocardiogram (TEE). BMJ Case Rep.
2017;2017:bcr2017223278. Published 2017 Nov 8. doi:10.1136/bcr-2017-223278
DISCLOSURES: No relevant relationships by Lauren Groner No relevant
relationships by Jahrul Islam No relevant relationships by Olivia Main No
relevant relationships by Harsh Patel No relevant relationships by Ivan
Wong Copyright © 2022 American College of Chest Physicians

<56>
Accession Number
2020470288
Title
POSTERIOR TRACHEAL MEMBRANE LACERATION AFTER SELF-EXTUBATION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A766-A767), 2022. Date of Publication: October 2022.
Author
BIRNBAUM B.; MOORE J.; GARCIA B.; KATTIH Z.E.I.N.; C MACHNICKI S.; A MINA
B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Treating the Heart in the ICU Case Report Posters SESSION
TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm
INTRODUCTION: Orotracheal intubation is performed across a wide variety of
clinical settings. Injuries sustained during intubation are more frequent
in emergent, high-risk intubations. Rates of injury are inversely
correlated with the provider's technical skill. High risk and emergent
intubations should be performed by the most experienced member of the
treatment team. CASE PRESENTATION: A 56-year-old woman with history of
chronic obstructive pulmonary disease was found to be comatose and
cyanotic in her bathtub by emergency medical services. She was urgently
intubated with improvement in color. The patient regained consciousness
during transport, subsequently self-extubated and was transferred to the
emergency department. She reported recreational use of fentanyl prior to
this episode. On presentation, her oxygen saturation was normal while
breathing ambient air. She then suddenly developed hemoptysis,
approximately 20 milliliters total, accompanied by progressively
increasing oxygen requirements of up to 6 liters per minute by nasal
cannula. Chest radiography revealed emphysema of the neck and
pneumomediastinum. Computed tomography of the chest demonstrated
laceration to the posterior tracheal membrane measuring 4 centimeters in
length by 0.5 centimeters in depth, accompanied by prevertebral emphysema
extending from the level of C1 to T2. Thoracic surgery was consulted, and
the patient was taken emergently for awake inspection bronchoscopy. She
underwent primary repair of the defect with an uncomplicated
post-operative course and was discharged to an inpatient rehabilitation
program. DISCUSSION: Injury during orotracheal intubation can occur at any
point from the lip to trachea. Dental injury is the most frequently
reported complication followed by direct soft tissue injury of the lip,
buccal mucosa, tongue, vocal cords, larynx, and oropharynx. Tracheal
rupture associated with intubation is an extremely rare occurrence with a
reported incidence of 0.005%. The most common cause of injury to the pars
membranosa is believed to be from the rapid movement of the endotracheal
tube with an over-inflated cuff. Tracheal rupture tends to have a female
predilection in the setting of weaker membranes and smaller tracheas,
which increases risk of injury from over-distended cuffs. Large defects
with extensive emphysema typically require primary repair. However, there
are case reports of conservative management of small defects with good
outcomes. It is difficult to confirm the cause of our patient's tracheal
rupture, but her abrupt self-extubation is the most likely etiology,
making this presentation exceptionally unusual. CONCLUSION(S):
Providers performing orotracheal intubation should be familiar with both
common and uncommon complications of intubation. Incidence of tracheal
rupture from intubation is very low. Providers should be aware of the
signs of perforation to allow for prompt diagnosis and treatment.
Reference #1: Lim H, Kim JH, Kim D, et al. Tracheal rupture after
endotracheal intubation - A report of three cases -. Korean J Anesthesiol.
2012;62(3):277-280. doi:10.4097/kjae.2012.62.3.277 Reference #2: Minambres
E, Buron J, Ballesteros MA, Llorca J, Munoz P, Gonzalez-Castro A. Tracheal
rupture after endotracheal intubation: a literature systematic review. Eur
J Cardiothorac Surg. 2009 Jun;35(6):1056-62. doi:
10.1016/j.ejcts.2009.01.053. Epub 2009 Apr 14. PMID: 19369087. Reference
#3: Conti M, Pougeoise M, Wurtz A, Porte H, Fourrier F, Ramon P, Marquette
CH. Management of postintubation tracheobronchial ruptures. Chest. 2006
Aug;130(2):412-8. doi: 10.1378/chest.130.2.412. PMID: 16899839.
DISCLOSURES: No relevant relationships by Brian Birnbaum No relevant
relationships by Brenda Garcia No relevant relationships by Zein Kattih No
relevant relationships by Stephen Machnicki No relevant relationships by
Bushra Mina No relevant relationships by Jonathan Moore Copyright
© 2022 American College of Chest Physicians

<57>
Accession Number
2020470271
Title
SYNCHRONOUS MULTIPLE PRIMARY TUMORS OF THE SAME LOBE.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1746-A1747), 2022. Date of Publication: October
2022.
Author
DAVIDSON S.E.A.N.; KAUR K.; G FOREMAN M.; M OPREA-ILIES G.; L FLENAUGH
E.R.I.C.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Cancer Case Report Posters 1 SESSION TYPE: Case Report
Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Lung
cancer is the leading cause of cancer related mortality with non small
cell lung cancer (NSCLC) accounting for more than half of lung cancer
cases. We have also begun to identify patients with multiple, synchronous
primary tumors with developing technologies. CASE PRESENTATION: 58y/o
patient with history of tobacco smoke and crack cocaine use who was found
with significant weight loss. Underwent CT Chest w/o contrast 01/22/19
which showed stellate noncalcified pulmonary nodule with pleural tails
worrisome for adenocarcinoma in the RUL. Also found with subpleural
nodular opacity within the same lobe. Atypical infectious etiologies were
also ruled out. PET/CT scan showed FDG avidity. Patient underwent VATS
with RUL wedge resection and lobectomy with Cardiothoracic Surgery. Tissue
samples were sent for histologic analysis. The 2.1x2.0x1.0cm nodule showed
acinar pattern-lung adenocarcinoma with lymphovascular invasion. The
2.2x1.0x0.9cm nodule showed adenocarcinoma with both acinar and lepidic
pattern, also with lymphovascular invasion. Initially, she was staged as
pT3N1M0, Stage IIIA. But then tissue samples were sent for molecular
analysis by next-generation sequencing (NSG). This then downgraded her
staging as pT1cN1M0, Stage IIB. She was then referred to Heme/Onc and was
started on chemotherapy. DISCUSSION: Adenocarcinomas are the most
common-type of NSCLC currently studied. Our review used histiologic
analysis as well as with molecular analysis from wedge biopsy. In one
cohort study, comprehensive histologic analysis was found to be superior
to the Martini-Melamed clinical criteria to differentiate between
metastasis and multiple primary tumors [1]. The histologic patterns were
acinar and lepidic, both of which belong to the invasive, non-mucinous
subtype of adenocarcinoma. NSG was also used in this case to assist with
differentiation between synchronous multiple primary lung cancers and
metastasis. This form of molecular analysis allows for simultaneous and
parallel sequencing of multiple genes/gene markers [3]. What is unique in
our case, however, is that there were two separate foci of primary tumors
that are both the same laterality and lobe. In one randomized,
double-blinded trial in 2013 looking at chemoprevention against secondary
primary tumors, an identified risk factor that increased the risk of
second primary tumors by 30% was tobacco smoking [2]. CONCLUSION(S):
Our case used NSG in addition to histologic analysis to identify two
separate, synchronous primary lung tumors as opposed to metastasis. NSG is
instrumental to better characterize the tumor to correctly determine the
stage; in our case her staging was downgraded from IIIA to IIB which has
better prognostic value for patients. Adenocarcinoma can present very
atypically as in our case. Reference #1: Girard, N., Deshpande, C., Lau,
C., Finley, D., Rusch, V., Pao, W., & Travis, W. D. (2009). Comprehensive
histologic assessment helps to differentiate multiple lung primary
nonsmall cell carcinomas from metastases. The American journal of surgical
pathology, 33(12), 1752-1764. https://doi.org/10.1097/PAS.0b013e3181b8cf03
Reference #2: Karp, D., Lee, S., Keller, S., Wright, G., Aisner, S....
Khuri, F. (2013). Randomized, double-blind, placebo-controlled, phase III
chemoprevention trial of selenium supplementation in patients with
resected stage I non-small-cell lung cancer: ECOG 5597. Journal of
Clinical Oncology, 31(33):4179. Reference #3: Luthra, R., Chen, H.,
Roy-Chowdhuri, S., Singh, R. (2015). Next-Generation Sequencing in
Clinical Molecular Diagnostics of Cancer: Advantages and Challenges.
Cancers. 7(4): 2023-2036. DISCLOSURES: No relevant relationships by Sean
Davidson No relevant relationships by Eric Flenaugh No relevant
relationships by Marilyn Foreman No relevant relationships by KOMAL KAUR
No relevant relationships by Gabriela Oprea-Ilies Copyright ©
2022 American College of Chest Physicians

<58>
Accession Number
2020470233
Title
PULMONARY ARTERY PSEUDOANEURYSM (PAP) AND MASSIVE HEMOPTYSIS AS A
COMPLICATION OF MUCORMYCOSIS AND COVID-19 PNEUMONIA.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1009), 2022. Date of Publication: October 2022.
Author
SUNG C.C.; PATEL K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: PAP is a
rare entity that can occur secondary to infection, malignancy, or trauma.
Mucormycosis in the setting of Covid-19 pneumonia has been increasingly
recognized but PAP has only recently been reported in this setting. CASE
PRESENTATION: A 44 year-old man with type 2 diabetes, non-ischemic
cardiomyopathy, hypothyroidism, and ulcerative colitis presented with
dyspnea and cough in July 2021. He was diagnosed with Covid-19 pneumonia
and initially treated with molnupiravir. Eight days later he presented to
the emergency room with worsening dyspnea, hypoxemia and diabetic
ketoacidosis. He required 3L of oxygen and was intubated for airway
protection. CT chest revealed mild bilateral patchy opacities and
dexamethasone was started. Unfortunately, persistent fevers and worsening
respiratory status ensued and repeat chest CT on hospital day (HD) 8
showed a new large left upper lobe (LUL) cavitary lesion. Cultures
ultimately grew Rhizopus microsporus and he was started on amphotericin
then isavuconazole after acute kidney injury developed. Dexamethasone was
discontinued and interval imaging after ten days showed dramatic growth of
the cavitary lesion (9 x 6 x 3 cm) with new extension through the chest
wall, infiltrating the intercostal spaces and pectoralis muscle. Due to
ventilator dependency a tracheostomy was performed on HD 24. Despite
anti-fungal therapy the cavitary lesion persisted, with evidence of
osseous destruction of the third and fourth ribs, as well as new fluid
collections within the cavity and hilar extension. On HD 46 he was
transferred to our institution for Thoracic Surgery and Interventional
Radiology (IR) evaluations. Percutaneous drain placement followed by
pneumonectomy vs. staged cavernostomy was considered; however, on HD 50,
the patient suddenly developed massive hemoptysis. CTA of the chest showed
a 1.6 x 1.5 cm PAP with active hemorrhage from the LUL anterior segmental
artery with dispersion into the cavity. Urgent coil and glue embolization
was successfully performed by IR. Ultimately, thoracic surgical
intervention was deemed too high risk and thus he was medically managed
with a regimen of isavuconazole, amphotericin, and terbinafine. Hemoptysis
did not recur and he was eventually discharged from the hospital and
liberated from both mechanical ventilation and tracheostomy. Chest CT 6
months from the initial diagnosis has shown stable to mildly decreased
size of the cavitary lesion. DISCUSSION: This is the first case to our
knowledge of PAP as a complication of Covid-19 and Mucor superinfection in
the United States. Five cases of this combination have been recently
reported in other countries. Risk factors for Mucor infection after Covid
appear to be uncontrolled diabetes, DKA, and steroid administration.
 CONCLUSION(S): A high index of suspicion should be maintained in
patients with these risk factors, as PAP can present as massive hemoptysis
and is often fatal. Reference #1: Hoenigl M, Seidel D, Carvalho A, et al.
The emergence of COVID-19 associated mucormycosis: a review of cases from
18 countries [ 2022 Jan 25]. Lancet Microbe.
2022;10.1016/S2666-5247(21)00237-8. doi:10.1016/S2666-5247(21)00237-8
Reference #2: Pruthi H, Muthu V, Bhujade H, et al. Pulmonary Artery
Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series
and Systematic Review of the Literature. Mycopathologia.
2022;187(1):31-37. doi:10.1007/s11046-021-00610-9 Reference #3: Coffey MJ,
Fantone J 3rd, Stirling MC, Lynch JP 3rd. Pseudoaneurysm of pulmonary
artery in mucormycosis. Radiographic characteristics and management. Am
Rev Respir Dis. 1992;145(6):1487-1490. doi:10.1164/ajrccm/145.6.1487
DISCLOSURES: No relevant relationships by Kevin Patel No relevant
relationships by Clifford Sung Copyright © 2022 American College
of Chest Physicians

<59>
Accession Number
2020470230
Title
BLEEDING RISK AFTER CORONARY ARTERY BYPASS GRAFTING: DOES THE DUAL
ANTIPLATELET THERAPY REGIMEN MATTER?.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A249), 2022. Date of Publication: October 2022.
Author
BOLAJI O.; D UNAMBA U.; A SOJI-AYOADE D.; AKINWALE M.; SHITTU M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Treatment Debates in Critical Care SESSION TYPE: Rapid Fire
Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Studies
have shown the significance of dual antiplatelet therapy to prevent graft
failure after coronary artery bypass grafting (CABG). However, P2Y12
inhibitors like prasugrel and ticagrelor have increased the risk of
bleeding. We compared the risk of bleeding in three different dual
antiplatelet regimens, Aspirin and Clopidogrel(CA), Aspirin and
Ticagrelor(TA), Aspirin and Pradugrel, which are the most common regimen
used after coronary artery bypass grafting, in this meta-analysis.
 METHOD(S): We conducted a systematic literature search according to
the PRISMA guidelines on five(5) major databases (PubMed, EMBASE, Web of
Science, Cochrane, and ProQuest) from 1970 to December 20th, 2021, and
Google Scholar. Studies that reported incidence of bleeding in addition to
clinical benefit were included. Pooled odds ratios were calculated using
the Cochran-Mantel-Haenszel Method. RESULT(S): Six studies, including
four randomized control trials and two cohort studies producing 7530
individuals, were included in the meta-analysis. Four thousand two hundred
ninety-three(4293) received either TA or PA, while 3237 received CA. There
is no significant difference in the risk of major bleeding in patients
receiving TA/PA to CA (OR= 2.37; CI=0.8-1.82; p=0.17) and minor bleeding
(OR=3.05; CI= 0.5-4.21; p=0.58). There is no significant difference
between the AT/AP group compared to AC with regard to major cardiac and
cerebrovascular events(MACCE) ( OR= 1.5; CI= 0.3-21.5; p=0.88). AT/AP have
a higher net clinical benefit compared to AC(OR=0.73; CI= 0.42-0.65;
P=0.0003). CONCLUSION(S): The use of AT/AP does increase the risk of
bleeding compared to AC, but there is a noticeable increase in clinical
benefit of using AT/AP over AC after CABG without an increase in MACCE.
CLINICAL IMPLICATIONS: This study further confirms the net clinical
benefit of using AT or PA after CABG with no increased risk of bleeding
compared to AC. DISCLOSURES: No relevant relationships by Mariam Akinwale
No relevant relationships by Olayiwola Bolaji No relevant relationships by
Muhammed Shittu No relevant relationships by Demilade Soji-Ayoade No
relevant relationships by Uchenna Unamba Copyright © 2022
American College of Chest Physicians

<60>
Accession Number
2020470056
Title
UNUSUAL CASE OF BILATERAL VENOUS THORACIC OUTLET SYNDROME.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A81), 2022. Date of Publication: October 2022.
Author
KHALYFA A.; D GORECKI M.; D GABBERT D.; OHRI H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Rare Cases in Cardiothoracic Surgery SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm
INTRODUCTION: Thoracic outlet syndrome is an uncommon etiology of upper
extremity deep vein thrombosis. The underlying mechanism involves
compression of the subclavian vein leading to venous stasis. Primary upper
extremity deep vein thrombosis (UEDVT) is also common in younger patients
due to the repetitive nature of vein compression and muscle hypertrophy.
It is therefore paramount to recognize UEDVTs and appropriately intervene
to promote best functional outcome. We present a unique case of bilateral
UEDVT in the setting of bilateral venous thoracic outlet syndrome. CASE
PRESENTATION: Patient is a 29-year-old female with no significant past
medical history who presented with right upper extremity swelling. Patient
was diagnosed with right UEDVT involving the right subclavian, right
axillary, and right brachial veins. The patient had no personal or family
history of blood clots, had not undergone recent surgeries, was not on
OCPs, and did not engage in strenuous, repetitive activity involving upper
extremities. Her hypercoagulable workup was negative. CT Chest with
contrast revealed no overt evidence of thoracic compression of the
subclavian vein however subsequent venogram showed subclavian stenosis.
The patient received catheter guided thrombolysis. Given concern for
thoracic outlet syndrome, the patient underwent first rib and subclavian
muscle resection to prevent recurrence. Upon the 3 month follow up,
bilateral upper extremity ultrasound was obtained and showed no evidence
of thrombus in the right upper extremity but did show totally obstructing
chronic left UEDVT. Furthermore, positional changes on duplex ultrasound
were concerning for proximal stenosis in the left subclavian vein with
concern for thoracic outlet syndrome on the left side. The patient was
underwent left rib resection with follow up visits showing no further
evidence of UEDVT bilaterally. DISCUSSION: Venous thoracic outlet syndrome
(VTOS), also called Paget-Schroetter syndrome constitutes only 4% of all
thoracic outlet syndromes. Athletes, including baseball players, weight
lifters, as well as workers with repetitive overhead motion, such as
mechanics, are particularly at risk. Recurrent deep vein thrombosis
involving the bilateral upper extremities in the setting of VTOS is an
extremely rare occurrence as most recurrent upper extremity DVTs have been
documented on the ipsilateral side. Our case is unique as our patient not
only had contralateral bilateral upper extremity DVTs, but also had
evidence of bilateral venous thoracic outlet syndrome. CONCLUSION(S):
In patients with unilateral upper extremity DVTs with no predisposing
conditions besides possible thoracic outlet compression, it may be prudent
to image the contralateral upper extremity to rule out contralateral DVT.
Further studies are necessary to elucidate the incidence of contralateral
DVT in patients who present with DVT due to thoracic outlet compression.
Reference #1: Munoz FJ, Mismetti P, Poggio R, et al. Clinical outcome of
patients with upper-extremity deep vein thrombosis: results from the RIETE
Registry. Chest 2008. 133:143-8. Reference #2: Peek J, Voss CG, Unlu C et
al, Outcome of surgical treatment for thoracic outlet syndrome: systemic
review and metanalysis. Annals of Vascular Surgery. 2017. 303-326.
Reference #3: Joffe HV, Goldhaber SZ, Upper extremity deep vein
thrombosis. Circulation. 2002. 1874-1880. DISCLOSURES: No relevant
relationships by David Gabbert No relevant relationships by Mateusz
Gorecki No relevant relationships by Ahamed Khalyfa No relevant
relationships by Himanshu Ohri Copyright © 2022 American College
of Chest Physicians

<61>
Accession Number
2020469932
Title
IATROGENIC MASSIVE SUBCUTANEOUS EMPHYSEMA AFTER CHEST TUBE PLACEMENT: A
CHALLENGING RARE COMPLICATION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2053-A2054), 2022. Date of Publication: October
2022.
Author
HOROUB A.L.I.; SHOLI T.; ALDIABAT M.; AL-KHATEEB M.; M QATANANI A.; AL
JABIRI Y.; YUSUF M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Uncommon Procedures and Procedure Complications Case
Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15
pm - 01:15 pm INTRODUCTION: Subcutaneous Emphysema can happen as a
concomitant manifestation in patients with traumatic pneumothorax but
usually not spontaneous pneumothorax. Most of the time it's self-limited
but sometimes further intervention is required. CASE PRESENTATION: 58
years old female with past medical history of COPD on 2 L home oxygen,
Bullous Emphysema, Obesity class 3 (BMI 60 kg/m2), OSA, Hypertension, and
Diabetes Mellites. She presented with shortness of breath for 1 day,
associated with dry cough and decreased exercise tolerance. Physical exam
was remarkable for bilateral wheezing and decrease air entry in the right
side of the lung. Chest X-ray (CXR) showed small, less than 2 cm
spontaneous secondary pneumothorax with emphysematous changes (Image 1a).
Chest Tube placement was deferred as the pneumothorax was small and the
risk of rupturing other boluses was high. The patient was admitted to the
medicine floor and treated for COPD Exacerbation with serial CXR
follow-up. On the second day of admission, the patient's dyspnea got worse
and a repeat CXR showed worsening of the pneumothorax. The patient was
transferred to Medical ICU and Surgery was consulted for chest tube
placement. The patient initially refused the procedure and chest CT scan
as recommended. Later, the scan was done and showed diffuse emphysematous
bullous disease and compressive pneumothorax (Image 1b). Eventually, Chest
Tube was placed without immediate complication.Twelve hours after the
procedure, the patient complained of sore throat and chest tightness. Her
voice became muffled, and her face looked puffy (Image 2). Repeat CXR
showed massive subcutaneous emphysema (Image 3a). Thoracic Surgery
followed up and an Air leak was noted. The Surgical Team decided to remove
the tube and place a new one. Over days the patient clinically improved
but Subcutaneous Emphysema slowly resolved (Image 3b). Chest Tube was
removed on day 16 of admission. The patient was eventually discharged home
with appropriate follow-up. DISCUSSION: It's challenging to approach
pneumothorax in patients with underlying complicated anatomy as our
patient has a diffuse bullous emphysematous disease with poor body
habitus. To our knowledge, this is the first case to be reported as
massive subcutaneous emphysema after chest tube insertion for spontaneous
secondary pneumothorax. The treatment is usually self-limited but
sometimes chest tube insertion or adjustment is required. Prophylaxis for
secondary pneumothorax like open thoracotomy, Video-assisted Thoracic
Surgery (VATS) or chemical pleurodesis should be discussed with the
patient. CONCLUSION(S): Subcutaneous Emphysema can happen after chest
tube placement but it's rare. It is usually self-limited and resolves
slowly. Further intervention is required if it's massive and specially
with non-resolving pneumothorax. Reference #1: Maunder RJ, Pierson DJ,
Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology,
diagnosis, and management. Arch Intern Med. 1984 Jul;144(7):1447-53. PMID:
6375617. Reference #2: Hallifax RJ, Yousuf A, Jones HE, Corcoran JP,
Psallidas I, Rahman NM. Effectiveness of chemical pleurodesis in
spontaneous pneumothorax recurrence prevention: a systematic review.
Thorax. 2017 Dec;72(12):1121-1131. doi: 10.1136/thoraxjnl-2015-207967.
Epub 2016 Nov 1. PMID: 27803156; PMCID: PMC5738542. DISCLOSURES: No
relevant relationships by yazan Al Jabiri No relevant relationships by
Mohannad Al-Khateeb No relevant relationships by Mohammad Aldiabat No
relevant relationships by Ali Horoub No relevant relationships by Ahmad
Qatanani No relevant relationships by Tasnim Sholi No relevant
relationships by Mubarak yusuf Copyright © 2022 American College
of Chest Physicians

<62>
Accession Number
2020469853
Title
PRIMARY SJOGREN SYNDROME AND PULMONARY INVOLVEMENT: UTILITY OF SALIVARY
GLAND BIOPSY IN DIAGNOSIS.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2209), 2022. Date of Publication: October 2022.
Author
RANAT R.I.K.I.; D TRANDAFIRESCU T.H.E.O.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Autoimmune Diseases Gone Wild: Rare Cases of Pulmonary
Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON:
10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Sjogren syndrome (SS) is an
autoimmune condition that affects excretory glands in the mouth, eyes, and
nose. Patients have primary Sjogren syndrome (pSS) when presenting with
sicca symptoms (dry eyes/mouth). Diagnostic salivary gland biopsy shows
lymphoid infiltration. Extraglandular involvement of pSS has been
documented. However, pSS can be difficult to diagnose as serologies can be
negative. This case report will present a patient with interstitial lung
disease (ILD) complicated by sicca symptoms and discuss the utility of
minimal salivary gland biopsy (mSGB) in diagnosing pSS. CASE PRESENTATION:
A 35-year-old female presented to the emergency room for left-sided
pleuritic chest pain and dry cough. CT thorax showed moderate lower lobe
interstitial and airspace opacities (Fig 1). Oral antibiotics were started
for community-acquired pneumonia. Follow up high-resolution CT chest
showed persistent bibasilar opacities. QuantiFERON, HIV, hepatitis B/C,
anti-cyclic citrullinated peptide, anti-ribonucleoprotein,
anti-centromere, anti-Ro/La, anti-Smith, anti-DNA antibodies, and
anti-SCL70 were negative. A video-assisted thoracic surgery was performed
for lung biopsy. The biopsy showed diffuse ILD, fibrosis, chronic
nonspecific inflammation interstitial pneumonia (NSIP), and lymphoid
hyperplasia. Mycophenolate mofetil with steroid taper was started,
resulting in improvement of bibasilar opacities (Fig 2). Four years later
the patient presented with worsening shortness of breath and sicca
symptoms. Repeat CT chest without contrast showed bilateral ground glass
opacities (Fig 3). Repeat connective tissue disease workup was negative.
Right lower lip mSGB was performed showing oral component of SS (Focus
score > 1). Plaquenil and Cevimeline were started with improvement in
symptoms. DISCUSSION: SS is an autoimmune disease resulting in the
destruction of excretory glands. pSS, a form of SS, is diagnosed when
sicca symptoms are present. pSS can have extraglandular involvement,
including respiratory symptoms. Bronchiolitis, interstitial lung disease
(ILD), and sarcoidosis are various forms of pulmonary pSS. ILD primarily
presents as NSIP with lymphocytic infiltrates. Lacrimal/salivary gland
biopsies show mononuclear infiltrates in pSS. Serologies can aid in the
diagnosis of pSS; however, many patients lack such markers. In patients
with nonspecific symptoms, there may be utility in mSGB. A systematic
review of 5 retrospective studies showed distinct histopathology of pSS.
Using mSGB could allow early detection of pSS, guiding management and
improving patient prognosis. CONCLUSION(S): Nonspecific symptoms and
negative serological markers can make diagnosing pSS difficult. Patients
with idiopathic lymphocytic ILD, mSGB should be considered for pSS
diagnosis. Utilizing a minor procedure like mSGB could lead to early
diagnosis with improvement in patient outcomes. Reference #1: Enomoto,
Yasunori et al. "Prognostic factors in interstitial lung disease
associated with primary Sjogren's syndrome: a retrospective analysis of 33
pathologically-proven cases." PloS one vol. 8,9 e73774. 9 Sep. 2013.
Reference #2: Depascale, Roberto et al. "Diagnosis and management of lung
involvement in systemic lupus erythematosus and Sjogren's syndrome: a
literature review." Therapeutic advances in musculoskeletal disease vol.
13 1759720X211040696. 30 Sep. 2021. Reference #3: Berardicurti, Onorina et
al. "Association Between Minor Salivary Gland Biopsy During Sjogren's
Syndrome and Serologic Biomarkers: A Systematic Review and Meta-Analysis."
Frontiers in immunology vol. 12 686457. 11 Jun. 2021. DISCLOSURES: No
relevant relationships by Riki ranat No relevant relationships by Theo
Trandafirescu Copyright © 2022 American College of Chest
Physicians

<63>
Accession Number
2020469767
Title
AN UNCOMMON CAUSE OF CHEST PAIN: CEMENT EMBOLISM.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A2306), 2022. Date of Publication: October 2022.
Author
CHANDAK T.R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Global Case Reports in Critical Care SESSION TYPE: Global
Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION:
Transvertebral cement leakages into tissues and paravertebral veins are
common after percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) but
pulmonary cement embolism(PCE) is rare with an incidence of 3.5 to 23%.
CASE PRESENTATION: A 45-year-old female with metastatic breast cancer to
bone, ER+ PR +Her-2/neu negative presented with right sided chest pain.
She was treated with palbociclib, Letrozole, Lupron, denosumab and
cacecitabine. Patient underwent T11 kyphoplasty at outside hospital one
month prior. Immediately post procedure she had transient mild right
posterior pleuritic chest pain that recurred and progressively became
worse in the ensuing weeks. At age 16 she had history of recurrent
spontaneous pneumothoraces requiring pleurodesis. Her exam was benign. T =
36.8C, HR 76, BP 152/91, RR 20, O2 sat 100% on room air. CXR revealed no
acute process or rib fracture but there was intrabody cement in the T11
vertebra from prior vertebroplasty with extension of the cement into
prevertebral veins. Small amount of embolized cement noted in a pulmonary
artery branch at the right lung base. CTA chest a day later was
corroborative without large central emboli. Kyphoplasty changes involving
T11 vertebral body were noted with extension of the cement into
prevertebral veins. No DVT was noted. After 24 hour observation and pain
management, she was discharged with NSAIDS, tramadol and did well on
outpatient follow up in 1 month. DISCUSSION: Krueger first described in
2009 that 239 clinical complications following PVP and PKP were reported
to the FDA. 14 of 239 (5.8 %) cases were cement embolisms, 6 were
asymptomatic noted on routine postoperative X-rays. 8 were symptomatic but
without mortality. But Wang (2012) in a review of five observational
studies consisting of 51 cases, reported 5 lethal cases, ranging from
chest pain, mild to severe dyspnea, cyanosis and ARDS. Barakat(2018)
described emergent heart surgery performed in 2/9 patients: interventional
therapy in 1, and 6 treated by anticoagulation. Guo(2021) published long
term outcomes in 12 Chinese females with PCE amongst 1460 procedures with
no perioperative mortality. Majority were asymptomatic, except for 2 who
experienced transient symptoms. All were sub segmental and peripheral
emboli that did not change on imaging over the 5-13 years explained by the
bio-inert nature of polymethylmethacrylate (PMMA). Routine cxr is proposed
postprocedure to screen for PCE. Biplanar fluoroscope and Multidetector CT
may be used CONCLUSION(S): PCE is a serious yet little known
complication of PVP and PKP that are increasingly common in elderly
patients with osteoporosis and malignancy. Fortunately majority of them
are peripheral, asymptomatic and only need surveillance. For symptomatic,
central pulmonary cement embolism long term anticoagulation therapy has
been recommended. Endovascular retrieval and open surgery may be required
at times. Reference #1: Krueger A, Bliemel C, Zettl R, Ruchholtz S.
Management of pulmonary cement embolism after percutaneous vertebroplasty
and kyphoplasty: a systematic review of the literature. Eur Spine J.
2009;18(9):1257-1265. doi:10.1007/s00586-009-1073-y Reference #2: Wang, L.
J., Yang, H. L., Shi, Y. X., Jiang, W. M., & Chen, L. (2012, Aug).
Pulmonary cement embolism associated with percutaneous vertebroplasty or
kyphoplasty: a systematic review. Orthop Surg, 4(3), 182-189.
https://doi.org/10.1111/j.1757-7861.2012.00193.x Reference #3: Guo, H.,
Li, J., Ma, Y., Guo, D., Liang, D., Zhang, S., & Tang, Y. (2021, Nov).
Long-Term Outcomes of Peripheral Pulmonary Cement Embolism in Patients
with Polymethylmethacrylate Augmentation: A Case Series with a Minimum
Follow-Up of Five Years. World Neurosurg, 155, e315-e322. DISCLOSURES: No
relevant relationships by Twinkle Chandak Copyright © 2022
American College of Chest Physicians

<64>
Accession Number
2020469652
Title
BIOPROSTHETIC AORTIC VALVE FAILURE IN END-STAGE RENAL DISEASE AND
REINTERVENTION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A142-A143), 2022. Date of Publication: October 2022.
Author
KEDARISETTI S.; RAJMOHAN D.; SHEN Y.; KHANNA A.; M MARGULIS M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Anatomical Cardiovascular Disease Case Posters SESSION
TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has been
increasingly used as the procedure of choice for severe aortic stenosis
(1). We describe a patient with bioprosthetic valve stenosis requiring
replacement, 3 years after TAVR. CASE PRESENTATION: Our patient is a 67
year old man with medical history significant for ESRD receiving
hemodialysis, aortic stenosis s/p TAVR (with Medtronic Evolut Pro valve)
who presented to the hospital with a chief complaint of shortness of
breath at rest. Other chronic medical problems included hyperlipidemia,
hypertension, latent tuberculosis and peptic ulcer disease. His shortness
of breath had worsened in recent times with reduced exercise tolerance. He
visited the ER multiple times and was also admitted in another facility
with similar complaints in the prior month. At presentation, he was
afebrile, tachypneic, hypoxic requiring oxygen support and had a BP of
110/70. On examination, jugular venous distension, a systolic murmur and
diffuse bilateral crackles in lung fields were appreciated. Labs revealed
normal lactic acid, aleukocytosis, elevated pro BNP of >70,000 and
troponin T of 0.173. Chest radiograph was significant for bilateral
pulmonary edema and bilateral pleural effusions. Thoracentesis showed
transudative effusion. He was symptomatic at rest which was consistent
with NYHA class IV and volume status was initially managed with earlier
hemodialysis treatment. A 12-lead EKG showed sinus rhythm with 1st degree
AV block and a new LBBB. ACS was ruled out. Cardiology evaluated the
patient for possible aortic stenosis. A 2D Echo was remarkable for
borderline concentric left ventricular hypertrophy, dilated left atrium,
EF of 40-45% and aortic stenosis. Transesophageal echo demonstrated aortic
valve dysfunction with a peak velocity of 4.7 m/s, valve area (EOA) of
0.86 cm square, DVI of 0.27 and a mean valve gradient of 18.9 mmHg. He was
diagnosed with severe bioprosthetic aortic valve stenosis and transferred
to another facility for reintervention. DISCUSSION: Failure of
bioprosthetic aortic valve is one of the clinical outcomes causing
increased mortality and morbidity. Mechanisms involved include thrombosis,
valve degeneration and restenosis (2). Patients with TAVR may present with
symptoms of heart failure, therefore a high degree of clinical suspicion
is required to diagnose in a timely manner. Our patient had multiple
hospital visits and impending cardiogenic shock complicated further by end
stage renal disease and hemodialysis hypotension. In such cases,
management can become very challenging. Patients with ESRD on hemodialysis
have been found to have TAVR failure and poor long term outcomes in
several studies (3). CONCLUSION(S): Our case report highlights the
importance of considering and evaluating for TAVR failure particularly in
ESRD patients who are symptomatic as it may lead to clinical
decompensation necessitating reintervention. Reference #1: Mack MJ, Leon
MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson
WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J,
Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL,
Williams M, Akin J, Davidson MJ, Svensson LG; PARTNER 1 trial
investigators. 5-year outcomes of transcatheter aortic valve replacement
or surgical aortic valve replacement for high surgical risk patients with
aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015
Jun 20;385(9986):2477-84. doi: 10.1016/S0140-6736(15)60308-7. Epub 2015
Mar 15. PMID: 25788234. Reference #2: Mazine A, Verma S, Yanagawa B. Early
failure of aortic bioprostheses: what are the mechanisms? Curr Opin
Cardiol. 2019 Mar;34(2):173-177. doi: 10.1097/HCO.0000000000000602. PMID:
30575649. Reference #3: Ogami T, Kurlansky P, Takayama H, Ning Y, Ali ZA,
Nazif TM, Vahl TP, Khalique O, Patel A, Hamid N, Ng VG, Hahn RT, Avgerinos
DV, Leon MB, Kodali SK, George I. Long-Term Outcomes of Transcatheter
Aortic Valve Replacement in Patients With End-Stage Renal Disease. J Am
Heart Assoc. 2021 Aug 17;10(16):e019930. doi: 10.1161/JAHA.120.019930.
Epub 2021 Aug 13. PMID: 34387093; PMCID: PMC8475055. DISCLOSURES: No
relevant relationships by Sreekari Kedarisetti No relevant relationships
by Ashok Khanna No relevant relationships by Marina Margulis No relevant
relationships by divya rajmohan No relevant relationships by Yaoyun
Shen Copyright © 2022 American College of Chest Physicians

<65>
Accession Number
2020469572
Title
METASTATIC MELANOMA TO THE LUNG CURED WITH LOBECTOMY: A CASE REPORT.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A85-A86), 2022. Date of Publication: October 2022.
Author
ASSAAD M.A.R.C.; E ELSAYEGH D.A.N.Y.; ABI MELHEM R.; EL GHARIB K.; KASSEM
A.L.I.; RABAH H.; ITANI A.; DAHABRA L.O.A.I.; ABOU YASSINE A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Surgery Case Report Posters SESSION TYPE:
Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm
INTRODUCTION: Cutaneous Melanoma is the malignant version of the
melanocytes. It can have both hematogenous and lymphatogenous spread,
sites of metastasis include liver, brain and bone. Lung is the most
visceral site affected by melanoma metastasis. We herein present a case of
a female patient with history of cutaneous melanoma that relapsed 14 years
later as a solitary pulmonary nodule. CASE PRESENTATION: 79-year-old
Caucasian female, with a history of chronic obstructive pulmonary disease
and right forearm melanoma resected at age of 57 presents for follow up.
Patient, back when she was diagnosed with BRAF V600 mutated-positive
cutaneous melanoma, underwent wide local excision. Regular follow-ups, of
her stage II melanoma did not prove any local or distant recurrences. In
July 2014, while undergoing pre-operative work up for bladder polyp
removal, patient was found to have a solitary pulmonary nodule that
warranted further work up. For a better assessment of the lesion, full
body positron emission tomography was obtained; it confirmed a
pathological fludeoxyglucose uptake within a 2 x 2 x 1.7 cm left lower
lobe pulmonary nodule (Figure 1 and 2). The maximum standardized uptake
value recorded was 41. PET scan failed to show any other suspicious
lesions. Thorough cutaneous exam did not reveal any skin pathology.
Computed tomography (CT) guided needle biopsy was performed, revealing an
aggressive melanotic tumor. The patient underwent wedge resection of the
left lower lobe. The tumor was tested positive for the same BRAF mutation
the previously resected melanoma harbored. Since resection, routine
work-up was negative for recurrence, and CT scans of the chest did not
demonstrate interval changes from previous studies. DISCUSSION: Melanoma
is most commonly cutaneous, and early detection is crucial in preventing
disease spread. Primary melanoma of the lung has been rarely described and
results supposedly from the embryogenic migration of neural crest cells to
the lungs; however, these lesions could have been easily mistaken for
primary especially that cutaneous lesions are not always identified.
Pulmonary metastasis from melanoma mostly occur peripherally and present
as solid nodules. The peripheral location in the lung renders the wedge
resection a possible and successful therapeutic option. Melanoma
therapeutic approach has changed drastically with targeted therapy.
Immunotherapy, as proven, has increased the 10-year survival rate in Stage
IV melanoma to 20%. In a randomized clinically trial on melanoma patients
with brain metastasis, immunotherapy was shown to be an alternative
option. CONCLUSION(S): Melanoma is one of the most virulent cancers
that has a wide clinical presentation and portrays a high mortality rate.
Recently emerged therapy has changed disease course and was successful in
an advanced stage of the illness. Reference #1: Prieto-Granada C, Howe N,
McCardle T. Melanoma Pathology. Melanoma. 2016;1012:10-30. Reference #2:
Stadelmann SA, Bluthgen C, Milanese G, Nguyen-Kim TDL, Maul JT, Dummer R,
et al. Lung nodules in melanoma patients: Morphologic criteria to
differentiate non-metastatic and metastatic lesions. Diagnostics.
2021;11(5). Reference #3: Tsaknis G, Naeem M, Singh A, Vijayakumar S.
Malignant melanoma without primary, presenting as solitary pulmonary
nodule: a case report. J Med Case Rep [Internet]. 2021;15(1):1-4.
Available from: https://doi.org/10.1186/s13256-021-02933-z DISCLOSURES: No
relevant relationships by Racha Abi Melhem No relevant relationships by
Ahmad Abou Yassine No relevant relationships by Marc Assaad No relevant
relationships by Loai Dahabra No relevant relationships by Khalil El
Gharib no disclosure on file for Dany Elsayegh; No relevant relationships
by Ahmad Itani No relevant relationships by Ali Kassem No relevant
relationships by Hussein Rabah Copyright © 2022 American College
of Chest Physicians

<66>
Accession Number
2020469562
Title
FOOD FOR THOUGHT: A RARE CASE OF ATRIAL ESOPHAGEAL FISTULA FOLLOWING AN
ATRIAL ABLATION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A99), 2022. Date of Publication: October 2022.
Author
PATEL S.; FARHAT R.Y.A.N.; E BOWKER W.; A SULIMAN S.; FUHER C.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Rare Cases in Cardiothoracic Surgery SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm
INTRODUCTION: Atrialesophageal fistula (AEF) is an extremely rare and
often fatal complication of atrial ablation procedures and is caused by
massive thermal injury to the esophagus and surrounding structures. It
occurs in 0.1 - 0.25% of patients and can lead to esophageal perforation
with significant mortality if left untreated. We present a rare and
challenging case of AEF following radiofrequency ablation (RFA). CASE
PRESENTATION: A 67-year-old female with history hypertension,
hyperlipidemia and atrial fibrillation status post RFA one month prior,
who presented with altered mental status. Four days prior to her
presentation she experienced fevers, somnolence, nausea, and was found
unresponsive at home after an episode of emesis. Initial CT head revealed
acute bilateral frontal and parietal infarcts, and serological evaluation
was notable for leukocytosis and lactic acidosis. She was treated
empirically for meningitis however subsequent blood cultures were positive
for Streptococcus mitis and Streptococcus salivarius pointing to the
possibility of septic emboli secondary to infective endocarditis. A
transesophageal echocardiogram was performed one week later, which
revealed an echogenic structure in the left atrium. Given her recent RFA,
the possibility of AEF was discussed and an urgent high-resolution CT
thorax with contrast was performed the same day. It demonstrated free air
in the left atrium and AEF arising from the right lower pulmonary vein not
previously visualized on admission CT thorax. She underwent emergent
surgical exploration with a primary repair of the esophageal atrial
fistula and intercostal muscle flap that evening. She eventually recovered
and was discharged to a rehab facility. DISCUSSION: Atrial-esophageal
fistula is an extremely rare complication which can occur up to 6 weeks
post-cardiac ablation, and often presents with nonspecific neurological,
cardiac, and gastrointestinal symptoms. Development of a fistula allows
bacteria and air from the esophagus into the atria which may lead to
septic emboli and death secondary to cerebral air embolisms, massive
gastrointestinal bleeding, and septic shock. Blood cultures usually grow
oropharyngeal flora as seen with our case. Given the rare incidence of
this complication it is vital to maintain a high clinical suspicion and
obtain a thorough procedural history in patients presenting with a new
fever, leukocytosis, or neurologic symptoms within 2-6 weeks of a cardiac
ablation. Early identification leads to swift surgical interventions and
improved outcomes. CONCLUSION(S): Our case demonstrates the
importance of early identification of AEF. Despite this being an uncommon
complication of cardiac ablation, it is associated with an exceptionally
high morbidity and mortality indicating the need for a high clinical
suspicion and thorough history to allow swift and early treatment.
Reference #1: Scanavacca M, Hachul D, Sosa E. Atrioesophageal fistula: a
dangerous complication of catheter ablation for atrial fibrillation.Nat
Clin Pract Cardiovasc Med. 2007; 4:578-579. doi: 10.1038/ncpcardio1010.
Reference #2: Chavez P, Messerli FH, Casso Dominguez A, Aziz EF,
Sichrovsky T, Garcia D, Barrett CD, Danik S. Atrioesophageal fistula
following ablation procedures for atrial fibrillation: systematic review
of case reports.Open Heart. 2015; 2:e000257. doi:
10.1136/openhrt-2015-000257 Reference #3: Gilcrease GW, Stein JB. A
delayed case of fatal atrioesophageal fistula following radiofrequency
ablation for atrial fibrillation.J Cardiovasc Electrophysiol. 2010;
21:708-711. doi: 10.1111/j.1540-8167.2009.01688.x. DISCLOSURES: No
relevant relationships by Weston Bowker No relevant relationships by Ryan
Farhat No relevant relationships by Cordel Fuher No relevant relationships
by Sumit Patel No relevant relationships by Sally Suliman Copyright
© 2022 American College of Chest Physicians

<67>
Accession Number
2020469521
Title
TRICUSPID VALVE INFECTIVE ENDOCARDITIS REQUIRING VALVE REPLACEMENT THREE
TIMES IN AN IV DRUG USER.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A90-A91), 2022. Date of Publication: October 2022.
Author
BHOPALWALA H.; MISHRA V.; M KHARAWALA A.; DEWASWALA N.; TORRES P.; R
TIWARI N.; SHYAM GANTI S.; BHOPALWALA A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Surgery Case Report Posters SESSION TYPE:
Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm
INTRODUCTION: Tricuspid valve infective endocarditis (TVIE) is most
commonly associated with intravenous drug use (IVDU), which on failing
medical management, is treated via various surgical modalities (1,2).
Tricuspid valve replacement (TVR) is the preferred treatment of choice in
patients presenting with recurrent TVIE of prosthetic valves (3). CASE
PRESENTATION: A 46-year-old man with a long history of infective
endocarditis (IE) secondary to intravenous drug use (IVDU), who had
undergone TV replacement twice before, presented with IE of the prosthetic
valve for the third time, despite reported abstinence from IVDU. Fungemia,
which is challenging to clear, in addition to bacteremia, was hypothesized
to be one of the reasons for this complication. He was treated with
intravenous antibiotics, following which he was switched to oral
suppressive therapy. However, despite adequate medical management with
Vancomycin and Micafungin for a period of over one year, a transesophageal
echocardiogram (TEE) showed the presence of highly mobile vegetation
measuring 2.1 cm x 1.5 cm on the TV prosthesis. He was then operated on
for the third time for TV replacement within a span of 16 months from his
first episode of IE. His condition remained stable after being discharged
from his third TV replacement surgery, following which he was set up for
cardiac rehabilitation with cardiology and infectious disease specialists.
DISCUSSION: The 2015 European Society of Cardiology (ESC) guidelines
recommend surgery if the IE is caused by micro-organisms that are
difficult to eradicate (e.g., fungi), if bacteremia persists beyond seven
days despite adequate antimicrobial therapy, in persistent TV vegetations
larger than 20 mm after recurrent pulmonary emboli, and patients with
right-sided heart failure due to severe tricuspid regurgitation, with poor
response to diuretic therapy. According to the American College of
Cardiology (ACC) 2015 update for IE in adults, early valve surgery is
recommended in - prosthetic valves for persistent bacteremia lasting
greater than 5-7 days after appropriate antimicrobial therapy and
prosthetic valve IE caused by fungi or highly resistant organisms.
Surgical management is associated with a higher rate of reoperation in IE
in IVDU (20%) than non-users (5%) and an increased mortality risk.
 CONCLUSION(S): To our knowledge, there has not been any case that
required the TV to be replaced for the third consecutive time due to the
recurrence of IE. We have highlighted that multiple replacements of the TV
for TVIE can be safely undertaken without complications, provided there
are strong indications for the same. Reference #1: Hussain ST, Witten J,
Shrestha NK, et al. Tricuspid valve endocarditis. Ann Cardiothorac Surg.
2017;6(3):255-261. doi:10.21037/acs.2017.03.09 Reference #2: Luc JGY, Choi
JH, Kodia K, et al. Valvectomy versus replacement for the surgical
treatment of infective tricuspid valve endocarditis: a systematic review
and meta-analysis. Ann Cardiothorac Surg. 2019;8(6):610-620.
doi:10.21037/acs.2019.11.06 Reference #3: Kadri AN, Wilner B, Hernandez
AV, et al. Geographic Trends, Patient Characteristics, and Outcomes of
Infective Endocarditis Associated With Drug Abuse in the United States
From 2002 to 2016. J Am Heart Assoc. 2019 Oct;8(19):e012969. doi:
10.1161/JAHA.119.012969 DISCLOSURES: No relevant relationships by Huzefa
Bhopalwala No relevant relationships by Adnan Bhopalwala No relevant
relationships by Nakeya Dewaswala No relevant relationships by Subramanya
shyam ganti No relevant relationships by Amrin Kharawala No relevant
relationships by Vinayak Mishra No relevant relationships by Nishant
Tiwari no disclosure on file for Pedro Torres; Copyright © 2022
American College of Chest Physicians

<68>
Accession Number
2020469474
Title
A SUBTLE PRESENTATION OF INFECTIVE ENDOCARDITIS WITH COXIELLA BURNETII AND
CUTIBACTERIUM COINFECTION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A472), 2022. Date of Publication: October 2022.
Author
WU B.; XIAN LEE S.H.U.; GUILFOOSE J.O.H.N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disseminated Bacterial Infections SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION:
Infective endocarditis (IE) is a serious condition that can lead patients
to rapidly deteriorate. Though commonly associated with staphylococci,
enterococci, and streptococci, many less well-known pathogens have been
documented. Our case illustrates IE with co-infection of Coxiella burnetii
and Cutibacterium. CASE PRESENTATION: A 60-year-old male farmer with
history significant for remote Q fever, aneurysms in the right common
iliac artery, the ascending aorta and the sinus of Valsalva, coronary
artery disease, complete heart block with permanent pacemaker (PPM), and
bicuspid aortic valve with severe aortic stenosis status post
bioprosthetic aortic valve replacement (AVR), 2 years ago, is admitted for
enlarging aneurysm of the sinus of Valsalva and bioprosthetic aortic valve
instability seen on serial surveillance imaging studies. Vitals and
physical examination were unremarkable except for bilateral diminished
bibasilar lung sounds. White blood cell count (WBC), 13 K/uL, and absolute
polymorphonuclear neutrophils (PMN), 9.74 K/uL, were elevated. Platelet,
83 K/uL, was low. He underwent repeat sternotomy with AVR for prosthetic
valve dysfunction, lysis of mediastinal adhesions and drainage of
bilateral pleural effusions. Pathology report suggested bioprosthetic
valve endocarditis and anaerobic intra-operative cultures grew
Cutibacterium acnes. Blood cultures were negative. Given prior Q fever and
reported unintentional weight loss with occasional night sweats, Q fever
antibody titers were obtained with phase I and II IgG titers elevated
(1:4096). A 6-week course of ceftriaxone was initiated with plans for
long-term oral doxycycline. Several months later, results of polymerase
chain reaction (PCR) of the tissue from the infected valve returned
positive for Coxiella burnetii confirming active Coxiella burnetii
endocarditis, and hydroxychloroquine was added. DISCUSSION: Our case
details a patient with IE due to Cutibacterium acnes and Coxiella burnetii
co-infection. Patients can present with low-grade fevers, unintentional
weight loss, and night sweats. Typically, a non-pathogenic, commensal
organism of skin flora, Cutibacterium biofilm formation can lead to IE and
infected cardiac devices, presenting as device malfunction or dehiscence.
Cutibacterium IE is usually treated surgically with source control and 4-6
weeks of beta-lactams with or without synergistic aminoglycosides. Even
with treatment, patients with valvular heart disease can relapse as
Coxiella burnetii is an obligate intracellular pathogen. Chronic Q fever
is treated with doxycycline and hydroxychloroquine for at least 18 months.
 CONCLUSION(S): Clinicians should consider chronic Q fever in patients
with structural heart disease from rural, farming communities. Both
chronic Q fever and Cutibacterium acnes can present inconspicuously,
leading to missed diagnosis and consequences of recurrent surgical
intervention and mortality. Reference #1: Anantha-Narayanan M, Reddy YNV,
Sundaram V, et al Endocarditis risk with bioprosthetic and mechanical
valves: systematic review and meta-analysis. Heart 2020;106:1413-1419.
Reference #2: Fenollar F, Fournier PE, Carrieri MP, Habib G, Messana T,
Raoult D. Risks factors and prevention of Q fever endocarditis. Clin
Infect Dis. 2001 Aug 1;33(3):312-6. doi: 10.1086/321889. Epub 2001 Jun 25.
PMID: 11438895. Reference #3: Silvia Limonta, Emmanuelle Cambau,
Marie-Line Erpelding, Caroline Piau-Couapel, Francois Goehringer, Patrick
Plesiat, Matthieu Revest, Veronique Vernet-Garnier, Vincent Le Moing,
Bruno Hoen, Xavier Duval, Pierre Tattevin, for the EI 2008 de l'AEPEI
working group, Infective Endocarditis Related to Unusual Microorganisms: A
Prospective Population-Based Study, Open Forum Infectious Diseases, Volume
7, Issue 5, May 2020, ofaa127, https://doi.org/10.1093/ofid/ofaa127
DISCLOSURES: No relevant relationships by John Guilfoose No relevant
relationships by Shu Xian Lee No relevant relationships by Benita
Wu Copyright © 2022 American College of Chest Physicians

<69>
Accession Number
2020469398
Title
DIAPHRAGMATIC PARALYSIS FOLLOWING SECOND DOSE OF THE BNT162B2 MRNA
COVID-19 VACCINE.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A1597), 2022. Date of Publication: October 2022.
Author
PRUDENTI J.A.; M MANN J.A.C.K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Using Imaging for Diagnosis Case Posters SESSION TYPE: Case
Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION:
The vaccines against SARS-CoV-2 or COVID-19 have been shown to be safe and
effective at preventing severe disease and death. In a phase 3 trial the
BNT162b2 mRNA COVID-19 vaccine showed a 52% and 95% efficacy after the
first and second doses, respectively (1). Side effects following
vaccination are common but are typically mild and self limited (2). The
most common side effects are headache, fever, fatigue, arthralgias and
pain at the injection site (2). More severe and devastating side effects
have been reported including cerebral venous thrombosis and myocarditis
(3) (4). Here we report a case of unilateral diaphragmatic paralysis
following the second dose of the BNT162b2 mRNA COVID-19 vaccine. CASE
PRESENTATION: The patient was a 56 year old female with a past medical
history of reactive airways disease and hypertension who was seen in the
pulmonology clinic shortly after receiving her second dose of the BNT162b2
mRNA COVID-19 vaccine. After her second dose she developed burning
shoulder pain, erythema and swelling that extended to the neck and axilla.
She went to an urgent care and was advised to treat with ice and NSAIDs,
she had a chest radiograph performed which was reported to be negative.
Her symptoms persisted and she was sent to the emergency room, chest x-ray
showed interval development of an elevated left hemidiaphragm. A CT Chest
with inspiratory and expiratory films was performed and the left diaphragm
was noted to be in the same location during inspiration and expiration
consistent with diaphragmatic paralysis. PFT showed a reduction in her
FVC, TLC and DLCO compared to 13 years prior. DISCUSSION: Diaphragmatic
paralysis is a well described clinical entity that is most often
associated with cardiothoracic surgery where hypothermia and local ice
slush application are thought to induce phrenic nerve injury (5). It has
also been described as a complication of viral infections, including a
recent report of unilateral diaphragm paralysis in a patient with acute
COVID-19 infection (6). In a case series of 246 patients with amyotrophic
neuralgia which can include diaphragm paralysis, 5 patients received a
vaccine in the week before developing symptoms (8) Additionally, Crespo
Burrilio et al recently described a case of amyotrophic neuralgia and
unilateral diaphragm paralysis following administration of the Vaxzevri
(AstraZeneca) COVID-19 vaccine (7). This case highlights a potential side
effect of the BNT162b2 mRNA COVID-19 vaccine that has not been previously
reported CONCLUSION(S): Reference #1: Polack FP, Thomas SJ, Kitchin
N. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Engl J
Med. 2020;383:2603-2615. Reference #2: Menni, C., Klaser, K., May, A.,
Polidori, L., Capdevila, J., Louca, P., Sudre, C. H., Nguyen, L. H., Drew,
D. A., Merino, J., Hu, C., Selvachandran, S., Antonelli, M., Murray, B.,
Canas, L. S., Molteni, E., Graham, M. S., Modat, M., Joshi, A. D.,
Mangino, M., ... Spector, T. D. (2021). Vaccine side-effects and
SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study
app in the UK: a prospective observational study. The Lancet. Infectious
diseases, 21(7), 939-949. https://doi.org/10.1016/S1473-3099(21)00224-3
Reference #3: Jaiswal V, Nepal G, Dijamco P, et al. Cerebral Venous Sinus
Thrombosis Following COVID-19 Vaccination: A Systematic Review. J Prim
Care Community Health. 2022;13:21501319221074450.
doi:10.1177/21501319221074450 DISCLOSURES: No relevant relationships by
Jack Mann No relevant relationships by John Prudenti Copyright ©
2022 American College of Chest Physicians

<70>
Accession Number
2020467293
Title
AORTOCORONARY SAPHENOUS VEIN GRAFT ANEURYSM: A SILENT COMPLICATION.
Source
Chest. Conference: CHEST 2022 Annual Meeting. Nashville United States.
162(4 Supplement) (pp A96), 2022. Date of Publication: October 2022.
Author
MEYER L.M.; P PRABHAKAR A.; G MUTHAPPAN P.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Interventions 1 SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION:
Aorto-coronary saphenous vein graft aneurysm (SVGA), defined as a focal
dilatation of the graft lumen >= 1.5 times that of the normal vessel, is a
rare complication of coronary artery bypass grafting (CABG). SVGA has an
incident rate of 0.07 % [1]. CASE PRESENTATION: A 57-year-old man with
history of multivessel coronary artery disease (status post CABG with
LIMA-LAD, SVG-RCA, SVG-Diagonal 12.5 years prior), multiple percutaneous
transluminal coronary angioplasty (PTCA), status post drug-eluting
stenting to LCx, RCA and SVG-RCA graft as well as bare-metal stenting to
LCx and RCA, hypertension, severe alcohol use and liver cirrhosis was
hospitalized for new onset alcoholic cirrhosis with ascites and dyspnea.
CT Chest revealed an incidental extracardiac mass along the right heart
border. Follow-up MRI Chest and CTA Chest confirmed a 4 cm aneurysm of
SVG-RCA bypass graft with partial thrombosis. Coronary angiography with
intravascular ultrasound revealed a native vessel measuring 2.5 mm and SVG
measuring 3.5 mm. The patient was judged to be a high-risk candidate for
surgery and was treated percutaneously with a 4 x 26 mm Papyrus covered
stent in the mid to proximal section of the SVG-RCA graft vessel,
maintaining distal perfusion and sealing the aneurysm. The patient
tolerated the procedure well without any complications and remained
asymptomatic on follow-up evaluation. DISCUSSION: SVGA is a rare
complication of CABG that is usually asymptomatic and incidentally
detected though associated with significant morbidity and mortality. The
mechanism underlying formation of SVGA is poorly understood, although late
aneurysm formations (> 5 years after CABG) are thought to occur due to SVG
atherosclerotic degeneration, changes in smooth muscle cell orientation in
the vicinity of valves and graft endothelial dysfunction [2]. SVGAs have
been most commonly associated with grafts to RCA, followed by the LAD,
obtuse marginal and LCx arteries [3]. SVGAs continue to grow at variable
rate, and the risk of complication increases with size. The management of
SVGA is dependent on size. Aneurysms with diameter less than 1 cm and
adequate blood flow are medically treated with serial monitoring and
anticoagulation therapy, whereas in cases of aneurysms measuring >= 2 cm
or rapidly expanding, prompt intervention is indicated. Traditionally,
SVGAs were surgically resected. More recently percutaneous techniques
including covered stents, vascular plugs, and arterial coiling have proven
to be viable treatment options. CONCLUSION(S): This case illustrates
percutaneous management of SVGAs. Such cases demand a multimodality
diagnostic approach for accurate evaluation, including true size and
complications of the SVGA as well as understanding of management
strategies to reduce complications such as aneurysm rupture, mass effect,
thromboembolism and myocardial infarction. Reference #1: Dieter RS, Patel
AK, Yandow D, et al. Conservative vs. invasive treatment of aortocoronary
saphenous vein graft aneurysms: Treatment algorithm based upon a large
series. Cardiovasc Surg. 2003;11(6):507-513.
doi:10.1016/S0967-2109(03)00108-X Reference #2: Benchimol A, Harris CL,
Desser KB, Fleming H. Aneurysms of an aorto-coronary artery saphenous vein
bypass graft-a case report. Vasc Surg. 1975;9(4):261-264.
doi:10.1177/153857447500900410 Reference #3: Ramirez FD, Hibbert B, Simard
T, et al. Natural history and management of aortocoronary saphenous vein
graft aneurysms: a systematic review of published cases. Circulation.
2012;126(18):2248-2256. doi:10.1161/CIRCULATIONAHA.112.101592 DISCLOSURES:
No relevant relationships by Luke Meyer No relevant relationships by
Palaniappan Muthappan No relevant relationships by Akruti
Prabhakar Copyright © 2022 American College of Chest Physicians

<71>
Accession Number
2020440574
Title
Primary left ventricular unloading with delayed reperfusion in patients
with anterior ST-elevation myocardial infarction: Rationale and design of
the STEMI-DTU randomized pivotal trial.
Source
American Heart Journal. 254 (pp 122-132), 2022. Date of Publication:
December 2022.
Author
Kapur N.K.; Kim R.J.; Moses J.W.; Stone G.W.; Udelson J.E.; Ben-Yehuda O.;
Redfors B.; Issever M.O.; Josephy N.; Polak S.J.; O'Neill W.W.
Institution
(Kapur, Udelson) Tufts Medical Center, Boston, MA
(Kim) Duke University Medical Center, Durham, NC
(Moses) Columbia University Irving Medical Center/NewYork-Presbyterian
Hospital, NY
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, NY
(Moses, Ben-Yehuda, Redfors, Issever) Cardiovascular Research Foundation,
NY
(Josephy, Polak) >Abiomed, Inc, Danvers, Massachusetts, United States
(Josephy) Massachusetts Institute of Technology, Cambridge, MA
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: Despite successful primary percutaneous coronary intervention
(PCI) in ST-elevation myocardial infarction (STEMI), myocardial salvage is
often suboptimal, resulting in large infarct size and increased rates of
heart failure and mortality. Unloading of the left ventricle (LV) before
primary PCI may reduce infarct size and improve prognosis. Study design
and objectives: STEMI-DTU (NCT03947619) is a prospective, randomized,
multicenter trial designed to compare mechanical LV unloading with the
Impella CP device for 30 minutes prior to primary PCI to primary PCI alone
without LV unloading. The trial aims to enroll approximately 668 subjects,
with a potential sample size adaptation, with anterior STEMI with a
primary end point of infarct size as a percent of LV mass evaluated by
cardiac magnetic resonance at 3-5 days after PCI. The key secondary
efficacy end point is a hierarchical composite of the 1-year rates of
cardiovascular mortality, cardiogenic shock >=24 hours after PCI, use of a
surgical left ventricular assist device or heart transplant, heart
failure, intra-cardiac defibrillator or chronic resynchronization therapy
placement, and infarct size at 3 to 5 days post-PCI. The key secondary
safety end point is Impella CP-related major bleeding or major vascular
complications within 30 days. Clinical follow-up is planned for 5 years.
 Conclusion(s): STEMI-DTU is a large-scale, prospective, randomized
trial evaluating whether mechanical unloading of the LV by the Impella CP
prior to primary PCI reduces infarct size and improves prognosis in
patients with STEMI compared to primary PCI alone without LV
unloading. Copyright © 2022

<72>
Accession Number
2020466194
Title
Right Heart Catheterization Timing and Outcomes of Cardiogenic Shock:
Analysis from the National Readmission Database.
Source
Current Problems in Cardiology. 47(12) (no pagination), 2022. Article
Number: 101388. Date of Publication: December 2022.
Author
Elzanaty A.M.; Maraey A.; Khalil M.; Elsharnoby H.; Nazir S.; Moukarbel
G.V.
Institution
(Elzanaty, Nazir, Moukarbel) Division of Cardiovascular Medicine,
University of Toledo, Toledo, OH
(Maraey) Department of Hospital Medicine, University of North Dakota,
Bismarck, ND
(Khalil) Department of Internal Medicine, Lincoln Medical Center, New
York, NY
(Elsharnoby) Department of Cardiovascular Medicine, Tanta University,
Tanta, Egypt
Publisher
Elsevier Inc.
Abstract
Recent studies showed significant mortality benefit with right heart
catheterization (RHC) use in cardiogenic (CS). The optimal timing of RHC
in those patients is unknown owing to the lack of available data. The
Nationwide Readmission Database 2016-2018 was queried for hospitalizations
with CS. We excluded patients presented with cardiac arrest or with a
history of ventricular assist devices or heart transplantation. Complex
samples multivariable logistic, cox, and linear regression models were
used to determine the association between RHC timing in the index
admission (<2 days [early RHC] vs >= 2 days [late RHC]) and in-hospital
outcomes (mortality, acute kidney injury [AKI], mechanical circulatory
device use [MCD], index length of stay [LOS], hospital charges), and
all-cause 30-day readmissions. A total of 46,963 hospitalizations [18,632
in the early group and 28,332 in the late group] were included in this
analysis. RHC was more likely to happen in large teaching hospitals.
Although there was no difference in mortality (adjusted odds ratio [aOR]:
1.05; Confidence interval [CI] 0.97-1.14; P= 0.233). Patients in the early
RHC group had a lower incidence of AKI (aOR: 0.69; CI: 0.64-0.74; P <
0.01), higher rate of MCS use (aOR:1.67; CI:1.54-1.81; P < 0.001), shorter
LOS (abeta: -6.2; CI -6.62 to -5.77; P <.001), lower hospital charges, and
lower readmission rates (adjusted hazards ratio [aHR]: 0.91; CI: 0.84-
0.98; P = 0.01) compared to the late RHC group. Early RHC was associated
with decreased incidence of AKI, decreased LOS, total charges, and
readmission rates with no difference in survival. Subgroup analysis of
patients who did not receive MCS during the index admission showed similar
outcomes albeit with increased mortality. Further randomized controlled
trials are needed to validate these results. Copyright © 2022
Elsevier Inc.

<73>
Accession Number
2019662706
Title
Left ventricular assist device implantation via lateral thoracotomy: A
systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 41(10) (pp 1440-1458), 2022.
Date of Publication: October 2022.
Author
Ribeiro R.V.P.; Lee J.; Elbatarny M.; Friedrich J.O.; Singh S.; Yau T.;
Yanagawa B.
Institution
(Ribeiro, Lee, Elbatarny, Yanagawa) Division of Cardiovascular Surgery,
St. Michael's Hospital, Toronto, ON, Canada
(Friedrich) Critical Care and Medicine Departments and Li Ka Shing
Knowledge Institute, St. Michael's Hospital, and Department of Medicine
and Interdepartmental Division of Critical Care, University of Toronto,
Toronto, ON, Canada
(Singh) Division of Cardiac Surgery, Trillium Health Partners, Toronto,
ON, Canada
(Yau) Division of Cardiac Surgery, Toronto General Hospital, Toronto, ON,
Canada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Left ventricular assist device (LVAD) implantation via lateral
thoracotomy can offer similar effectiveness to conventional approaches
with less perioperative adverse events. We performed a systematic review
and meta-analysis to determine the potential benefits of lateral
thoracotomy (LT) for LVAD implantation compared to median sternotomy.
 METHOD(S): We searched MEDLINE and Embase databases for studies
comparing continuous-flow LVAD implantation using LT with conventional
sternotomy. Main outcomes were perioperative mortality and complications.
 Result(s): Twenty-five observational studies enrolling 3072 patients
were included with a median follow-up of 10 months. Perioperative
mortality (30 day or in-hospital) was 7% (LT) and 14% (sternotomy);
however, mortality differences were no longer statistically significant in
matched/adjusted studies (RR:0.86; 95%CI:0.52-1.44; p = 0.58). LT was
associated with decreased need for blood product transfusions (mean
difference[MD]: -4.7; 95%CI: -7.2 to -2.3 units; p < 0.001), reoperation
for bleeding (RR:0.34; 95%CI:0.22-0.54; p < 0.001), postoperative RVAD
implantation (RR:0.53; 95%CI:0.36-0.77; p < 0.001), days requiring
inotropes (MD: -1.1; 95%CI: -2.1 to -0.03 inotrope days; p = 0.04), ICU
(MD: -3.3; 95%CI: -6.0 to -0.7 ICU days; p = 0.01), and hospital length of
stay (MD: -5.1; 95%CI: -10.1 to -0.1 hospital days; p = 0.04) in
matched/adjusted studies. Overall mortality during follow-up was
significantly lower for LT in unmatched/unadjusted studies but not
statistically significantly lower in matched/adjusted studies (Hazard
Ratio:0.82; 95%CI:0.59-1.14; p = 0.24). CONCLUSION(S): LVAD
implantation via LT was associated with significantly decreased need for
blood products, reoperation for bleeding, and postoperative RVAD
implantation. Furthermore, days on inotropic support were also lower,
likely contributing to the shorter length of stay. These findings support
greater use of a LT approach for carefully selected
patients. Copyright © 2022 International Society for Heart and
Lung Transplantation

<74>
Accession Number
2019352800
Title
Comparison of Post-operative Outcomes Between Direct Axillary Artery
Cannulation and Side-Graft Axillary Artery Cannulation in Cardiac Surgery:
A Systematic Review and Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 925709. Date of Publication: 10 Jun 2022.
Author
Xie Y.; Liu Y.; Yang P.; Lu C.; Hu J.
Institution
(Xie, Liu, Yang, Lu, Hu) Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, Chengdu, China
(Hu) Department of Cardiovascular Surgery, West China Guang'an Hospital,
Sichuan University, Guang'an, China
Publisher
Frontiers Media S.A.
Abstract
Background: There is a growing perception of using axillary artery
cannulation to improve operative outcomes in cardiopulmonary bypass
surgery. Two techniques, direct cannulation or side-graft cannulation, can
be used for axillary artery cannulation, but which technique is better is
controversial. Method(s): A meta-analysis of comparative studies
reporting operative outcomes using direct cannulation vs. side-graft
cannulation was performed. We searched the PubMed, EMbase, Web of Science,
and Cochrane Library. Outcomes of interest were neurological dysfunction,
cannulation-related complications and early mortality. The fixed effects
model was used. Result(s): A total of 1,543 patients were included in
the final analysis. Direct cannulation was used in 846 patients, and
side-graft cannulation was used in 697 patients. Meta-analysis showed a
higher occurrence of neurological Complication in direct cannulation group
[odds ratio, 1.45, 95% CI (1.00, 2.10), chi2 = 4.40, P = 0.05]
and a significantly higher incidence of cannulation-related complications
in the direct cannulation group [odds ratio, 3.12, 95% CI (1.87, 5.18),
chi2 = 2.54, P < 0.0001]. The incidence of early mortality did
not have a difference [odds ratio, 0.95, 95% CI (0.64, 1.41),
chi2 = 6.35, P = 0.79]. Conclusion(s): This study suggests
that side-graft axillary artery cannulation is a better strategy as it
reduces the incidence of neurological dysfunction and cannulation-related
complications. Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/, identifier:
CRD42022325456. Copyright © 2022 Xie, Liu, Yang, Lu and Hu.

<75>
Accession Number
2019352787
Title
Alcohol Septal Ablation or Septal Myectomy? An Updated Systematic Review
and Meta-Analysis of Septal Reduction Therapy for Hypertrophic Obstructive
Cardiomyopathy.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 900469. Date of Publication: 25 May 2022.
Author
Zheng X.; Yang B.; Hui H.; Lu B.; Feng Y.
Institution
(Zheng, Yang, Lu) Department of Geriatrics, Affiliated Hospital of
Guangdong Medical University, Zhanjiang, China
(Hui) Department of Cardiology, Affiliated Hospital of Guangdong Medical
University, Zhanjiang, China
(Feng) Department of Nuclear Medicine, Affiliated Hospital of Guangdong
Medical University, Zhanjiang, China
Publisher
Frontiers Media S.A.
Abstract
Objective: To evaluate the safety and effectiveness of alcohol septal
ablation (ASA) and septal myectomy (SM) for the treatment of hypertrophic
obstructive cardiomyopathy. Method(s): We searched the PubMed,
MEDLINE, EMBASE, and CBM databases for observational research articles
related to ASA and SM published from the establishment of the databases to
November 2021. All ultimate selected articles were highly related to our
target. The Newcastle-Ottawa Scale was used to evaluate the literature
quality. A fixed or random effect model was performed in the meta-analysis
depending on the heterogeneity of the included studies. The
Mantel-Haenszelt test with relative risk ratio (RR) and 95% confidence
interval (CI) was used to measure the effect indicator of binary data,
while the inverse variance method with weighted mean difference (WMD) and
95% CI was used to measure the effect indicator of continuous data.
 Result(s): A totally of 3,647 cases (1,555 cases treated with ASA and
2,092 cases treated with SM) were included. The results of the systematic
review indicated no statistically significant difference in postoperative
all-cause mortality (RR = 0.82; 95% CI: 0.65-1.04; P = 0.10) between
patients treated with ASA and SM, but both the reduction in the
postoperative left ventricular outflow tract pressure gradient (WMD = 9.35
mmHg, 95% CI: 5.38-13.31, P < 0.00001) and the post-operative improvement
on cardiac function, assessed by the grade of New York Heart Association
(NYHA), compared to pre-operative measurements (WMD = 0.13; 95% CI:
0.00-0.26; P < 0.04) in the ASA group were slightly inferior to those in
the SM group. In addition, both the risk of pacemaker implantation (RR =
2.83, 95% CI: 2.06-3.88; P < 0.00001) and the risk of reoperation (RR =
11.23, 95% CI: 6.21-20.31; P < 0.00001) are recorded at a higher level
after ASA procedure. Conclusion(s): Both ASA and SM have a high
degree of safety, but the reduction in the postoperative left ventricular
outflow tract pressure gradient and the improvement on cardiac function
are slightly inferior to SM. In addition, both the risk of pacemaker
implantation and the risk of reoperation are recorded at a higher level
after ASA procedure. The operative plan should be chosen through
multidisciplinary discussions in combination with the wishes of the
patients and the actual clinical situation. Copyright © 2022
Zheng, Yang, Hui, Lu and Feng.

<76>
Accession Number
2019398873
Title
Role of advanced imaging techniques in cardiac surgery: Aortic dissection.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Paneitz D.C.; Hedgire S.; Jassar A.S.
Institution
(Paneitz, Jassar) Division of Cardiac Surgery, Harvard Medical School,
Massachusetts General Hospital, Boston, MA, United States
(Hedgire) Department of Radiology, Division of Cardiovascular Imaging,
Harvard Medical School, Massachusetts General Hospital, Boston, MA, United
States
Publisher
John Wiley and Sons Inc
Abstract
Background: Collaboration among cardiac surgeons and radiologists is
essential to fully leverage advanced imaging technologies and improve the
care of cardiac surgery patients. In this review, a cardiac surgeon and
cardiovascular radiologist discuss imaging pearls and considerations in
aortic dissection cases. Method(s): The surgeon and the radiologist
discuss imaging considerations in two aortic dissection cases.
 Result(s): It is essential to obtain and review all phases of a CTA
when diagnosing acute aortic pathology. Optimizing scan parameters and
careful multiplanar image review is necessary for adept interpretation.
Current CT technology allows ECG gating to eliminate motion artifact and
allow for dynamic assessment of the aortic pathology. Concurrent
evaluation of thoracic aorta and coronary arteries is feasible. A
systematic review of the scan using landmarks is critical for appropriate
diagnosis and reporting. As TEVAR is increasingly used for arch repair,
collaboration with radiologists is essential for preoperative planning in
redo cases. Conclusion(s): Collaboration among cardiac surgeons and
radiologists is mutually beneficial for surgeons, radiologists, and their
patients. Copyright © 2022 Wiley Periodicals LLC.

<77>
Accession Number
2020270091
Title
Mitral Valve Repair for Anterior/Bi-leaflet Versus Posterior Leaflet
Degenerative Mitral Valve Disease: A Systematic Review and Meta-analysis.
Source
Current Problems in Cardiology. 47(12) (no pagination), 2022. Article
Number: 101355. Date of Publication: December 2022.
Author
Iqbal K.; Haque I.U.; Shaikh V.F.; Rathore S.S.; Yasmin F.; Iqbal A.;
Shariff M.; Kumar A.; Stulak J.M.
Institution
(Iqbal, Haque, Shaikh, Yasmin, Iqbal) Department of Internal Medicine, Dow
Medical College, Dow University of Health Sciences, Karachi, Pakistan
(Rathore) Department of Internal Medicine, Dr. Sampurnanand Medical
College, Rajasthan, Jodhpur, India
(Shariff, Stulak) Department of General Surgery, Mayo Clinic, Rochester,
MN
(Kumar) Department of Internal Medicine, Cleveland Clinic Akron General,
Akron, OH
(Kumar) Section of Cardiovascular Research, Heart, Vascular and Thoracic
Department, Cleveland Clinic Akron General, Akron, OH
(Stulak) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
Publisher
Elsevier Inc.
Abstract
Mitral valve repair (MVr) secondary to degenerative anterior/bi-leaflet
mitral valve disease is more challenging than posterior leaflet repair.
However, conclusive evidence is needed to make decisions based on the
outcomes rather than technical difficulties. This meta-analysis compares
anterior/bi-leaflet MVr with isolated posterior leaflet repair in patients
with mitral regurgitation (MR) due to degenerative mitral valve disease.
The outcomes of interest were long-term (>= 5 years) survival and freedom
from re-operation and moderate-to-severe MR. Meta-analysis of 10 studies
showed that there was no significant difference in long-term survival
(risk ratio, RR: 1.00; 95% confidence interval, 95% CI 0.96-1.04), freedom
from moderate-to-severe MR (RR: 0.95; 95% CI 0.87-1.03), and freedom from
re-operation (RR: 0.96; 95% CI 0.90-1.02) between anterior/bi-leaflet MVr
and posterior leaflet repair. As outcomes of anterior/bilateral repair
were comparable with those of isolated posterior leaflet repair, our
findings do not support the inclination towards replacement over repair
for MR caused by anterior/bilateral degenerative mitral
disease. Copyright © 2022 Elsevier Inc.

<78>
Accession Number
2019312658
Title
Postoperative analgesia efficacy of erector spinae plane block in patients
submitted to cardiac surgery: randomized clinical trial.
Source
Brazilian Journal of Anesthesiology (English Edition). 72(5) (pp 678-679),
2022. Date of Publication: 01 Sep 2022.
Author
Silva L.M.; Brandao A.J.F.M.; Godoy J.T.; Leao W.M.; Freitas J.F.D.;
Fernandes M.L.
Institution
(Silva, Godoy) CET Santa Casa de Belo Horizonte, MG, Belo Horizonte,
Brazil
(Brandao, Leao, Freitas, Fernandes) Santa Casa de Misericordia de Belo
Horizonte, Servico de Anestesiologia, MG, Belo Horizonte, Brazil
(Leao, Fernandes) Hospital das Clinicas da Universidade Federal de Minas
Gerais (UFMG), MG, Belo Horizonte, Brazil
Publisher
Elsevier Editora Ltda

<79>
Accession Number
2018165219
Title
A meta-analysis of the associations of elements of the fear-avoidance
model of chronic pain with negative affect, depression, anxiety,
pain-related disability and pain intensity.
Source
European Journal of Pain (United Kingdom). 26(8) (pp 1611-1635), 2022.
Date of Publication: September 2022.
Author
Rogers A.H.; Farris S.G.
Institution
(Rogers) Department of Psychology, University of Houston, Houston, TX,
United States
(Farris) Department of Psychology, Rutgers, The State University of New
Jersey, Piscataway, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background and objective: Biopsychosocial conceptualizations of clinical
pain conditions recognize the multi-faceted nature of pain experience and
its intersection with mental health. A primary cognitive-behavioural
framework is the Fear-Avoidance Model, which posits that pain
catastrophizing and fear of pain (including avoidance, cognitions and
physiological reactivity) are key antecedents to, and drivers of, pain
intensity and disability, in addition to pain-related psychological
distress. This study aimed to provide a comprehensive analysis of the
magnitude of the cross-sectional association between the primary
components of the Fear-Avoidance Model (pain catastrophizing, fear of
pain, pain vigilance) with negative affect, anxiety, depression, pain
intensity and disabilities in studies of clinical pain. Databases and data
treatment: A search of MEDLINE and PubMed databases resulted in 335
studies that were evaluated in this meta-analytic review, which
represented 65,340 participants. Result(s): Results from the random
effect models indicated a positive, medium- to large-sized association
between fear of pain, pain catastrophizing, and pain vigilance measures
and outcomes (pain-related negative affect, anxiety, depression and
pain-related disability) and medium-sized associations with pain
intensity. Fear of pain measurement type was a significant moderator of
effects across all outcomes. Conclusion(s): These findings provide
empirical support, aligned with the components of the fear-avoidance (FA)
model, for the relevance of both pain catastrophizing and fear of pain to
the pain experience and its intersection with mental health. Implications
for the conceptualization of the pain catastrophizing and fear of pain
construct and its measurement are discussed. Significance: This
meta-analysis reveals that, among individuals with various pain
conditions, pain catastrophizing, fear of pain, and pain vigilance have
medium to large associations with pain- related negative affect, anxiety,
and depression, pain intensity and disability. Differences in the strength
of the associations depend on the type of self-report tool used to assess
fear of pain. Copyright © 2022 The Authors. European Journal of
Pain published by John Wiley & Sons Ltd on behalf of European Pain
Federation - EFIC .

<80>
Accession Number
2020365441
Title
The role of optimism in manifesting recovery outcomes after coronary
artery bypass graft surgery: A systematic review.
Source
Journal of Psychosomatic Research. 162 (no pagination), 2022. Article
Number: 111044. Date of Publication: November 2022.
Author
Arsyi D.H.; Permana P.B.D.; Karim R.I.; Abdurachman
Institution
(Arsyi, Permana, Karim) Faculty of Medicine, Universitas Airlangga,
Mayjend. Prof. Dr. Moestopo Street no. 47, Surabaya, East Java 60132,
Indonesia
(Abdurachman) Department of Anatomy, Histology, and Pharmacology, Faculty
of Medicine, Universitas Airlangga, Mayjend. Prof. Dr. Moestopo Street no.
47, Surabaya, East Java 60132, Indonesia
Publisher
Elsevier Inc.
Abstract
Objective: Coronary artery bypass graft (CABG) is a major surgery
conducted in coronary heart disease management. Postoperative recovery is
a crucial process for patients undergoing CABG. This systematic review
evaluates current evidence regarding the association between trait
optimism and recovery outcomes in patients following coronary artery
bypass graft surgery. Method(s): This review followed the Preferred
Reporting Items of Systematic Review and Meta-Analysis (PRISMA) 2020
Guideline. The inclusion criteria focused on observational study that
examined study participants aged >=18 years old undergoing elective CABG
and measurement of trait optimism with validated methods (i.e. LOT, LOT-R)
and at least one recovery outcome. Studies in non-English languages and
duplicates were excluded. A systematic literature search was carried out
on PubMed, Scopus, and Web of Science electronic databases. Search results
were screened based on the eligibility criteria. The Newcastle-Ottawa
Scale was used to assess the quality of each included study.
 Result(s): The search yielded a total of 1853 articles, in which 7
articles fulfilled the eligibility criteria and were subsequently included
in the analysis. Measurement of trait optimism was conducted on 1276
patients who underwent a non-emergency/elective CABG. Optimism was
significantly associated with several categories of recovery, including
reduced rehospitalization rate, complications, pain, and physical symptoms
along with improved quality of life, rate of return to normal life, and
psychological status. Conclusion(s): Our review showed that trait
optimism was associated with recovery outcomes following CABG surgery.
However, the heterogeneity of recovery outcomes may hamper the clinical
benefit of trait optimism in CABG. (PROSPERO
CRD42022301882). Copyright © 2022 Elsevier Inc.

<81>
Accession Number
639076918
Title
Prognostic Implications of Fractional Flow Reserve after Coronary
Stenting: A Systematic Review and Meta-analysis.
Source
JAMA Network Open. 5(9) (pp E2232842), 2022. Date of Publication: 22 Sep
2022.
Author
Hwang D.; Koo B.-K.; Zhang J.; Park J.; Yang S.; Kim M.; Yun J.P.; Lee
J.M.; Nam C.-W.; Shin E.-S.; Doh J.-H.; Chen S.-L.; Kakuta T.; Toth G.G.;
Piroth Z.; Johnson N.P.; Pijls N.H.J.; Hakeem A.; Uretsky B.F.; Hokama Y.;
Tanaka N.; Lim H.-S.; Ito T.; Matsuo A.; Azzalini L.; Leesar M.A.; Neleman
T.; Van Mieghem N.M.; Diletti R.; Daemen J.; Collison D.; Collet C.; De
Bruyne B.
Institution
(Hwang, Koo, Park, Yang, Kim, Yun) Department of Internal Medicine and
Cardiovascular Center, Seoul National University Hospital, Seoul, South
Korea
(Zhang) Department of Cardiology, The Second Affiliated Hospital, School
of Medicine, Zhejiang University, Hangzhou, China
(Lee) Division of Cardiology, Department of Internal Medicine, Heart
Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, South Korea
(Nam) Department of Medicine, Keimyung University, Dongsan Medical Center,
Daegu, South Korea
(Shin) Division of Cardiology, Ulsan Hospital, Ulsan, South Korea
(Doh) Department of Medicine, Inje University, Ilsan Paik Hospital,
Goyang, South Korea
(Chen) Division of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
(Kakuta) Division of Cardiovascular Medicine, Tsuchiura Kyodo General
Hospital, Ibaraki, Japan
(Toth) University Heart Centre Graz, Medical University Graz, Austria
(Piroth) Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
(Johnson) Weatherhead PET Center for Preventing and Reversing
Atherosclerosis, Division of Cardiology, Department of Medicine,
University of Texas Medical School, Memorial Hermann Hospital, Houston,
United States
(Pijls) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Hakeem) Division of Cardiovascular Diseases and Hypertension, Robert Wood
Johnson Medical School, Rutgers University, New Brunswick, NJ, United
States
(Hakeem) National Institute of Cardiovascular Diseases, Karachi, Pakistan
(Uretsky) Central Arkansas VA Health System, Little Rock, AR, United
States
(Uretsky) University of Arkansas for Medical Sciences, Little Rock, United
States
(Hokama, Tanaka) Department of Cardiology, Tokyo Medical University,
Hachioji Medical Center, Tokyo, Japan
(Lim) Department of Cardiology, Ajou University School of Medicine, Suwon,
South Korea
(Ito) Department of Cardiology, Nagoya City University Graduate School of
Medical Sciences, Nagoya, Japan
(Matsuo) Department of Cardiology, Kyoto Second Red Cross Hospital, Kyoto,
Japan
(Azzalini) Division of Cardiology, Department of Medicine, University of
Washington, Seattle, United States
(Leesar) Division of Cardiovascular Diseases, University of Alabama,
Birmingham, United States
(Neleman, Van Mieghem, Diletti, Daemen) Department of Interventional
Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Collison) West of Scotland Regional Heart and Lung Centre, Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Collet, De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium
(De Bruyne) Department of Cardiology, University of Lausanne, Switzerland
Publisher
American Medical Association
Abstract
Importance: Fractional flow reserve (FFR) after percutaneous coronary
intervention (PCI) is generally considered to reflect residual disease.
Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES)
implantation remains unclear. Objective(s): To evaluate the clinical
relevance of post-PCI FFR measurement after DES implantation. Data
Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled
Trials were searched for relevant published articles from inception to
June 18, 2022. Study Selection: Published articles that reported post-PCI
FFR after DES implantation and its association with clinical outcomes were
included. Data Extraction and Synthesis: Patient-level data were collected
from the corresponding authors of 17 cohorts using a standardized
spreadsheet. Meta-estimates for primary and secondary outcomes were
analyzed per patient and using mixed-effects Cox proportional hazard
regression with registry identifiers included as a random effect. All
processes followed the Preferred Reporting Items for Systematic Review and
Meta-analysis of Individual Participant Data. Main Outcomes and
Measures: The primary outcome was target vessel failure (TVF) at 2 years,
a composite of cardiac death, target vessel myocardial infarction (TVMI),
and target vessel revascularization (TVR). The secondary outcome was a
composite of cardiac death or TVMI at 2 years. Result(s): Of 2268
articles identified, 29 studies met selection criteria. Of these, 28
articles from 17 cohorts provided data, including a total of 5277 patients
with 5869 vessels who underwent FFR measurement after DES implantation.
Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men.
Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had
a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340
patients (7.2%), with cardiac death or TVMI occurring in 111 patients
(2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of
TVF (adjusted hazard ratio [HR] per 0.01 FFR decrease, 1.04; 95% CI,
1.02-1.05; P <.001). The risk of cardiac death or MI also increased
inversely with post-PCI FFR (adjusted HR, 1.03; 95% CI, 1.00-1.07, P
=.049). These associations were consistent regardless of age, sex, the
presence of hypertension or diabetes, and clinical diagnosis.
 Conclusions and Relevance: Reduced FFR after DES implantation was
common and associated with the risks of TVF and of cardiac death or TVMI.
These results indicate the prognostic value of post-PCI physiologic
assessment after DES implantation.. Copyright © 2022 American
Medical Association. All rights reserved.

<82>
Accession Number
2020435410
Title
Neutrophil gelatinase-associated lipocalin (NGAL) in kidney injury - A
systematic review.
Source
Clinica Chimica Acta. 536 (pp 135-141), 2022. Date of Publication: 01 Nov
2022.
Author
Marakala V.
Institution
(Marakala) Department of Basic Medical Sciences, College of Medicine,
University of Bisha, Bisha 61922, Saudi Arabia
Publisher
Elsevier B.V.
Abstract
Background: Neutrophil Gelatinase Associated Lipocalin (NGAL) is a
secretory protein of neutrophils that can be found both in plasma and
urine. Previous works have demonstrated a valuable marker for the early
detection of acute kidney injury. In this systematic review, we aimed to
assess whether NGAL could be helpful in the diagnosis and prognosis of
systemic diseases with kidney involvement. Method(s): MEDLINE,
PubMed, and EMBASE databases were searched for NGAL, described as a human
biomarker for diseases (total: 1690). Specifically, included studies
describing the use of NGAL for determining kidney injury outcomes and
other conditions associated with kidney dysfunction, including
cardiovascular diseases, cardiac surgery, and critically ill systemic
disorders. Result(s): A total of 24 validated studies were included
in the systemic review after applying the exclusion criteria. In all these
studies, NGAL appeared to have a predictive value irrespective of age,
from newborn to 78 years. The results indicate that NGAL levels can
accurately predict the outcome and severity of acute kidney injury occur
in several disease processes, including contrast-induced AKI during
cardiac surgery, kidney transplant rejection, chronic heart failure, and
systemic inflammation in critically ill patients, even though the
significance of NGAL is highly variable across studies. Very high plasma
NGAL levels were observed in the patients before the acute rejection of
the kidney, indicating the prognostic potential of the NGAL. Specifically,
the assays conducted before 72 hrs provided a significant predictive
value. Conclusion(s): Urinary and serum NGAL appears to be an
independent predictor of not only kidney complications but also
cardiovascular and liver-related diseases. The kidney is also involved in
pathogenesis. Copyright © 2022 Elsevier B.V.

<83>
Accession Number
2020227229
Title
Using machine learning to aid treatment decision and risk assessment for
severe three-vessel coronary artery disease.
Source
Journal of Geriatric Cardiology. 19(5) (pp 367-376), 2022. Date of
Publication: 2022.
Author
Liu J.; Feng X.-X.; Duan Y.-F.; Liu J.-H.; Zhang C.; Jiang L.; Xu L.-J.;
Tian J.; Zhao X.-Y.; Zhang Y.; Sun K.; Xu B.; Zhao W.; Hui R.-T.; Gao
R.-L.; Wang J.-Z.; Yuan J.-Q.; Huang X.; Song L.
Institution
(Liu, Liu, Hui, Wang, Song) State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
(Feng) Endocrinology and Cardiovascular Disease Centre, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Feng, Huang) Department of Endocrinology, Fuwai Hospital, Chinese Academy
of Medical Sciences, Shenzhen, China
(Duan) Nanjing TooBoo Technology Co. Ltd, Nanjing, China
(Zhang, Jiang, Tian, Zhao, Zhang, Xu, Gao, Yuan) Department of Cardiology,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing, China
(Xu, Song) Cardiomyopathy Ward, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Sun) Medical Research Center, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
(Zhao) Information Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Yuan, Song) National Clinical Research Center for Cardiovascular
Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
(Huang) Solar activity Prediction Center, National Astronomical
Observatories, Chinese Academy of Sciences, Beijing, China
Publisher
Science Press
Abstract
BACKGROUND Three-vessel disease (TVD) with a SYNergy between PCI with
TAXus and cardiac surgery (SYNTAX) score of >= 23 is one of the most
severe types of coronary artery disease. We aimed to take advantage of
machine learning to help in decision- making and prognostic evaluation in
such patients. METHODS We analyzed 3786 patients who had TVD with a SYNTAX
score of >= 23, had no history of previous revascularization, and
underwent either coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) after enrollment. The patients were randomly
assigned to a training group and testing group. The C4.5 decision tree
algorithm was applied in the training group, and all-cause death after a
median follow-up of 6.6 years was regarded as the class label. RESULTS The
decision tree algorithm selected age and left ventricular end-diastolic
diameter (LVEDD) as splitting features and divided the patients into three
subgroups: subgroup 1 (age of <= 67 years and LVEDD of <= 53 mm), subgroup
2 (age of <= 67 years and LVEDD of > 53 mm), and subgroup 3 (age of > 67
years). PCI conferred a patient survival benefit over CABG in subgroup 2.
There was no significant difference in the risk of all-cause death between
PCI and CABG in subgroup 1 and subgroup 3 in both the training data and
testing data. Among the total study population, the multivariable analysis
revealed significant differences in the risk of all-cause death among
patients in three subgroups. CONCLUSIONS The combination of age and LVEDD
identified by machine learning can contribute to decision-making and risk
assessment of death in patients with severe TVD. The present results
suggest that PCI is a better choice for young patients with severe TVD
characterized by left ventricular dilation. Copyright © 2022 JGC.

<84>
Accession Number
639149884
Title
A nomogram to predict nosocomial infection in patients on venoarterial
extracorporeal membrane oxygenation after cardiac surgery.
Source
Perfusion. (pp 2676591221130484), 2022. Date of Publication: 29 Sep 2022.
Author
Li X.; Wang L.; Li C.; Wang X.; Hao X.; Du Z.; Xie H.; Yang F.; Wang H.;
Hou X.
Institution
(Li, Wang, Li, Wang, Hao, Du, Xie, Yang, Wang, Hou) Center for Cardiac
Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel
Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing,
China
(Li) Department of intensive care unit, Aviation General Hospital of China
Medical University, Beijing, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: After cardiac surgery, patients on venoarterial
extracorporeal membrane oxygenation (VA-ECMO) have a higher risk of
nosocomial infection in the intensive care unit (ICU). We aimed to
establish an intuitive nomogram to predict the probability of nosocomial
infection in patients on VA-ECMO after cardiac surgery. METHOD(S): We
included patients on VA-ECMO after cardiac surgery between January 2011
and December 2020 at a single center. We developed a nomogram based on
independent predictors identified using univariate and multivariate
logistic regression analyses. We selected the optimal model and assessed
its performance through internal validation and decision-curve analyses.
 RESULT(S): Overall, 503 patients were included; 363 and 140 patients
were randomly divided into development and validation sets, respectively.
Independent predictors derived from the development set to predict
nosocomial infection included older age, white blood cell (WBC) count
abnormality, ECMO environment in the ICU, and mechanical ventilation (MV)
duration, which were entered into the model to create the nomogram. The
model showed good discrimination, with areas under the curve (95%
confidence interval) of 0.743 (0.692-0.794) in the development set and
0.732 (0.643-0.820) in the validation set. The optimal cutoff probability
of the model was 0.457 in the development set (sensitivity, 0.683;
specificity, 0.719). The model showed qualified calibration in both the
development and validation sets (Hosmer-Lemeshow test, p > .05). The
threshold probabilities ranged from 0.20 to 0.70. CONCLUSION(S): For
adult patients receiving VA-ECMO treatment after cardiac surgery, a
nomogram-monitoring tool could be used in clinical practice to identify
patients with high-risk nosocomial infections and provide an early
warning.

<85>
Accession Number
2010511778
Title
A Literature Review of Cannabis and Myocardial Infarction-What Clinicians
May Not Be Aware Of.
Source
CJC Open. 3(1) (pp 12-21), 2021. Date of Publication: January 2021.
Author
Chetty K.; Lavoie A.; Deghani P.
Institution
(Chetty) University of Calgary, Calgary, AB, Canada
(Lavoie, Deghani) Department of Cardiology, University of Saskatchewan,
Saskatoon, SK, Canada
Publisher
Elsevier Inc.
Abstract
Increasing legalization and expanding medicinal use have led to a
significant rise in global cannabis consumption. With this development, we
have seen a growing number of case reports describing adverse
cardiovascular events, specifically, cannabis-induced myocardial
infarction (MI). However, there are considerable knowledge gaps on this
topic among health care providers. This review aims to provide an
up-to-date review of the current literature, as well as practical
recommendations for clinicians. We also focus on proposed mechanisms
implicating cannabis as a risk factor for MI. We performed a comprehensive
literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing
and Allied Health Literature (CINAHL), and Turning Research into Practice
(TRIP) PRO databases for articles published between 2000 and 2018. A total
of 92 articles were included. We found a significant number of reports
describing cannabis-induced MI. This was especially prevalent among young
healthy patients, presenting shortly after use. The most commonly proposed
mechanisms included increased autonomic stimulation, altered platelet
function, vasospasm, and direct toxic effects of smoke constituents.
However, it is likely that the true pathogenesis is multifactorial. We
should increase our pretest probability for MI in young patients
presenting with chest pain. We also recommend against cannabis use in
patients with known coronary artery disease, especially if they have
stable angina. Finally, if patients are adamant about using cannabis,
health care providers should recommend against smoking cannabis, avoidance
of concomitant tobacco use, and use of the lowest
delta-9-tetrahydrocannabinol dose possible. Data quality is limited to
that of observational studies and case report data. Therefore, more
clinical trials are needed to determine a definitive cause-and-effect
relationship. Copyright © 2020

<86>
Accession Number
2007978431
Title
Estimates of Geriatric Delirium Frequency in Noncardiac Surgeries and Its
Evaluation Across the Years: A Systematic Review and Meta-analysis.
Source
Journal of the American Medical Directors Association. 22(3) (pp
613-620.e9), 2021. Date of Publication: March 2021.
Author
Silva A.R.; Regueira P.; Albuquerque E.; Baldeiras I.; Cardoso A.L.;
Santana I.; Cerejeira J.
Institution
(Silva, Baldeiras, Cardoso, Santana, Cerejeira) Centre for Neuroscience
and Cell Biology, University of Coimbra, Coimbra, Portugal
(Silva, Regueira, Baldeiras, Cardoso, Cerejeira) Coimbra Institute for
Clinical and Biomedical Research (iCBR), Coimbra, Portugal
(Regueira, Albuquerque, Cerejeira) Department of Psychiatry, Centro
Hospitalar Universitario de Coimbra, Coimbra, Portugal
(Regueira, Baldeiras, Santana, Cerejeira) Faculty of Medicine, Coimbra
University, Coimbra, Portugal
(Santana) Department of Neurology, Centro Hospitalar Universitario de
Coimbra, Coimbra, Portugal
Publisher
Elsevier Inc.
Abstract
Objectives: Delirium is an acute neuropsychiatric syndrome associated with
poor outcomes. Older adults undergoing surgery have a higher risk of
manifesting perioperative delirium, particularly those having associated
comorbidities. It remains unclear whether delirium frequency varies across
surgical settings and if it has remained stable across the years. We
conducted a systematic review to (1) determine the overall frequency of
delirium in older people undergoing noncardiac surgery; (2) explore
factors explaining the variability of the estimates; and (3) determine the
changing of the estimates over the past 2 decades. Design(s):
Systematic review and meta-analysis. Literature search was performed in
MEDLINE, PubMed, ISI Web of Science, EBSCO, ISRCTN registry,
ScienceDirect, and Embase in January 2020 for studies published from 1995
to 2020. Setting(s): Noncardiac surgical settings.
 Participant(s): Forty-nine studies were included with a total of
26,865 patients screened for delirium. Method(s): We included
observational and controlled trials reporting incidence, prevalence, or
proportion of delirium in adults aged >=60 years undergoing any noncardiac
surgery requiring hospitalization. Data extracted included sample size,
reported delirium frequencies, surgery type, anesthesia type, delirium
diagnosis method, length of hospitalization, and year of assessment.
(PROSPERO registration no.: CRD42020160045). Result(s): We found an
overall pooled frequency of preoperative delirium of 17.9% and
postoperative delirium (POD) of 23.8%. The POD estimates increased between
1995 and 2020 at an average rate of 3% per year. Pooled estimates of POD
were significantly higher in studies not excluding patients with lower
cognitive performance before surgery (28% vs 16%) and when general
anesthesia was used in comparison to local, spinal, or epidural anesthesia
(28% vs 20%). Conclusions and Implications: Type of anesthesia and
preoperative cognitive status were significant moderators of delirium
frequency. POD in noncardiac surgery has been increasing across the years,
suggesting that more resources should be allocated to delirium prevention
and management. Copyright © 2020 AMDA - The Society for
Post-Acute and Long-Term Care Medicine. Elsevier Inc. This is an open
access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

<87>
Accession Number
2016008520
Title
Multicenter randomized study evaluating the outcome of ganglionated plexi
ablation in maze procedure.
Source
General Thoracic and Cardiovascular Surgery. 70(10) (pp 908-915), 2022.
Date of Publication: October 2022.
Author
Sakamoto S.-I.; Ishii Y.; Otsuka T.; Mitsuno M.; Shimokawa T.; Isomura T.;
Yaku H.; Komiya T.; Matsumiya G.; Nitta T.
Institution
(Sakamoto, Ishii, Nitta) Department of Cardiovascular Surgery, Nippon
Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
(Otsuka) Department of Hygiene and Public Health, Nippon Medical School,
Tokyo, Japan
(Mitsuno) Department of Cardiovascular Surgery, Hyogo College of Medicine,
Hyogo, Japan
(Shimokawa) Department of Cardiovascular Surgery, Teikyo University,
Tokyo, Japan
(Isomura) Department of Cardiovascular Surgery, IMS Tokyo Katsushika
General Hospital, Tokyo, Japan
(Yaku) Department of Cardiovascular Surgery, Kyoto Prefectural University
of Medicine, Kyoto, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Okayama, Japan
(Matsumiya) Department of Cardiovascular Surgery, Chiba University
Graduate School of Medicine, Chiba, Japan
Publisher
Springer
Abstract
Objective: The benefit of adding ganglionated plexi ablation to the maze
procedure remains controversial. This study aims to compare the outcomes
of the maze procedure with and without ganglionated plexi ablation.
 Method(s): This multicenter randomized study included 74 patients
with atrial fibrillation associated with structural heart disease.
Patients were randomly allocated to the ganglionated plexi ablation group
(maze with ganglionated plexi ablation) or the maze group (maze without
ganglionated plexi ablation). The lesion sets in the maze procedure were
unified in all patients. High-frequency stimulation was applied to clearly
identify and perform ganglionated plexi ablation. Patients were followed
up for at least 6 months. The primary endpoint was a recurrence of atrial
fibrillation. Result(s): The intention-to-treat analysis included 69
patients (34 in the ganglionated plexi ablation group and 35 in the maze
group). No surgical mortality was observed in either group. After a mean
follow-up period of 16.3 +/- 7.9 months, 86.8% of patients in the
ganglionated plexi ablation group and 91.4% of those in the maze group did
not experience atrial fibrillation recurrence. Kaplan-Meier atrial
fibrillation-free curves showed no significant difference between the two
groups (P =.685). Cox proportional hazards regression analysis indicated
that left atrial dimension was the only risk factor for atrial
fibrillation recurrence (hazard ratio: 1.106, 95% confidence interval
1.017-1.024, P =.019). Conclusion(s): The addition of ganglionated
plexi ablation to the maze procedure does not improve early outcome when
treating atrial fibrillation associated with structural heart
disease. Copyright © 2022, The Author(s), under exclusive licence
to The Japanese Association for Thoracic Surgery.

<88>
Accession Number
2015259452
Title
A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage
During Carotid Recanalization: Direct Comparisons of Post-operative
Complications.
Source
Frontiers in Pharmacology. 13 (no pagination), 2022. Article Number:
796329. Date of Publication: 25 Feb 2022.
Author
Pan Y.; Zhao Z.; Yang T.; Jiao Q.; Wei W.; Ji J.; Xin W.
Institution
(Pan) Department of Neurology, Weifang Medical University, Weifang, China
(Zhao, Yang) Department of Neurosurgery, Heji Hospital Affiliated Changzhi
Medical College, Changzhi, China
(Jiao) Second Department of Internal Medicine, Gucheng Country Hospital,
Shijiazhuang, China
(Wei) Department of Neurology, Mianyang Central Hospital, Mianyang, China
(Ji) Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng,
China
(Xin) Department of Neurosurgery, Tianjin Medical University General
Hospital, Tianjin, China
Publisher
Frontiers Media S.A.
Abstract
Background: Protamine can decrease the risk of hemorrhage during carotid
recanalization. However, it may cause severe side effects. There is no
consensus on the safety and efficacy of protamine during surgery. Thus, we
conduct a comprehensive review and meta-analysis to compare the
differences between the protamine and the no-protamine group.
 Method(s): We systematically obtained literature from Medline, Google
Scholar, Cochrane Library, and PubMed electronic databases. All four
databases were scanned from 1937 when protamine was first adopted as a
heparin antagonist until February 2021. The reference lists of identified
studies were manually checked to determine other eligible studies that
qualify. The articles were included in this meta-analysis as long as they
met the criteria of PICOS; conference or commentary articles, letters,
case report or series, and animal observation were excluded from this
study. The Newcastle-Ottawa Quality Assessment Scale and Cochrane
Collaboration's tool are used to assess the risk of bias of each included
observational study and RCT, respectively. Stata version 12.0 statistical
software (StataCorp LP, College Station, Texas) was adopted as statistical
software. When I2 < 50%, we consider that the data have no
obvious heterogeneity, and we conduct a meta-analysis using the
fixed-effect model. Otherwise, the random-effect model was performed.
 Result(s): A total of 11 studies, consisting of 94,618 participants,
are included in this study. Our analysis found that the rate of wound
hematoma had a significant difference among protamine and no-protamine
patients (OR = 0.268, 95% CI = 0.093 to 0.774, p = 0.015). Furthermore,
the incidence of hematoma requiring re-operation (0.7%) was significantly
lower than that of patients without protamine (1.8%). However, there was
no significant difference in the incidence of stroke, wound hematoma with
hypertension, transient ischemic attacks (TIA), myocardial infarction
(MI), and death. Conclusion(s): Among included participants
undergoing recanalization, the use of protamine is effective in reducing
hematoma without increasing the risk of having other complications.
Besides, more evidence-based performance is needed to supplement this
opinion due to inherent limitations. Copyright © 2022 Pan, Zhao,
Yang, Jiao, Wei, Ji and Xin.

<89>
Accession Number
2017198517
Title
Sex-Specific Difference in Outcomes after Transcatheter Mitral Valve
Repair with MitraClip Implantation: A Systematic Review and Meta-Analysis.
Source
Journal of Interventional Cardiology. 2022 (no pagination), 2022. Article
Number: 5488654. Date of Publication: 2022.
Author
Sun F.; Liu H.; Zhang Q.; Zhou J.; Zhan H.; Lu F.
Institution
(Sun, Zhou, Zhan, Lu) Department of Cardiovascular Surgery, Hospital of
Zhengzhou University, Zhengzhou, China
(Liu) Department of Emergency, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou Zzu.edu.cn, China
(Zhang) Department of Endovascular Surgery, Hospital of Zhengzhou
University, Zhengzhou, China
Publisher
Hindawi Limited
Abstract
Background. Implantation of the MitraClip is a safe and effective therapy
for mitral valve repair in patients ineligible for surgery or at high risk
of adverse surgical outcomes. However, only limited information is
available concerning sex differences in transcatheter mitral valve repair.
We therefore sought to conduct a comprehensive meta-analysis of studies
that investigated differences between men and women in outcomes following
MitraClip implantation. Methods. The PubMed and Embase databases were
searched until November 2019 for studies reporting outcomes after
MitraClip implantation in women versus men. Outcomes included all-cause
mortality and major complications at 30 days and one year of follow-up.
Results. Six studies (n = 1,109 women; n = 1,743 men) were analyzed. At 30
days, women had a similar risk of postoperative complications, such as
stroke, major bleeding, and pericardium effusion, without differences in
all-cause mortality, procedure success, or MitraClip usage. At one year,
the all-cause mortality, the reduction of mitral regurgitation, and the
risk of rehospitalization for heart failure were also comparable between
male and female patients. Conclusion. Gender disparity was not found in
complications or prognosis of patients undergoing MitraClip implantation.
This study suggests that gender should not be considered as a critical
factor in the selection of patients as candidates for MitraClip
implantation of concern during follow-up. Copyright © 2022
Fuqiang Sun et al.

<90>
Accession Number
2020309335
Title
Staged Revascularization for Chronic Total Occlusion in the Non-IRA in
Patients with ST-segment Elevation Myocardial Infarction Undergoing
Primary Percutaneous Coronary Intervention: An Updated Systematic Review
and Meta-analysis.
Source
Cardiovascular Innovations and Applications. 6(4) (pp 209-218), 2022. Date
of Publication: 2022.
Author
Geng Y.; Wang Y.; Liu L.; Miao G.; Zhang O.; Xue Y.; Zhang P.
Institution
(Geng, Wang, Liu, Miao, Zhang, Xue, Zhang) Department of Cardiology,
Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua
University, Beijing, China
Publisher
Compuscript Ltd
Abstract
Objectives: Meta-analysis was performed to evaluate the effect of staged
revascularization with concomitant chronic total occlusion (CTO) in the
non-infarct-associated artery (non-IRA) in patients with ST-segment
elevation myocardial infarction (STEMI) treated with primary percutaneous
coronary intervention (p-PCI). Method(s): Various electronic
databases were searched for studies published from inception to June,
2021. The primary endpoint was all-cause death, and the secondary endpoint
was a composite of major adverse cardiac events (MACEs). Odds ratios (ORs)
were pooled with 95% confidence intervals (CIs) for dichotomous data.
 Result(s): Seven studies involving 1540 participants were included in
the final analysis. Pooled analyses revealed that patients with successful
staged revascularization for CTO in non-IRA with STEMI treated with p-PCI
had overall lower all-cause death compared with the occluded CTO group
(OR, 0.46; 95% CI, 0.23-0.95), cardiac death (OR, 0.43; 95% CI,
0.20-0.91), MACEs (OR, 0.47; 95% CI, 0.32-0.69) and heart failure (OR,
0.57; 95% CI, 0.37-0.89) compared with the occluded CTO group. No
significant differences were observed between groups regarding myocardial
infarction and repeated revascularization. Conclusion(s): Successful
revascularization of CTO in the non-IRA was associated with better
outcomes in patients with STEMI treated with p-PCI. Copyright ©
2022 Cardiovascular Innovations and Applications. Creative Commons
Attribution-NonCommercial 4.0 International License

<91>
Accession Number
2020229406
Title
Percutaneous closure of left ventricular pseudoaneurysm.
Source
Postepy w Kardiologii Interwencyjnej. 18(2) (pp 101-110), 2022. Date of
Publication: 2022.
Author
Yuan S.-M.
Institution
(Yuan) The First Hospital of Putian, Teaching Hospital, Fujian Medical
University, Putian, China
Publisher
Termedia Publishing House Ltd.
Abstract
The aim of the present study is to describe the indications, treatment
effects, and patient outcomes of percutaneous management of left
ventricular pseudoaneurysm (LVPA). The study materials were based on
comprehensive literature retrieval since 2004. The mechanisms of LVPA
formation can be divided into surgical, percutaneous, and medial disease
related. Of the surgical mechanisms, coronary artery bypass grafting
prevailed. The formation time was the longest in medical disease-related
LVPAs up to 44.4 months. The percutaneous procedures succeeded on the
first try in 79 (84.9%) patients, whereas failures were encountered during
the percutaneous manoeuvres in 14 (15.1%) patients. Percutaneous closure
of LVPA was especially indicated for patients carrying a high surgical
risk. The iatrogenic traumas, such as left ventricular venting, should be
avoided to prevent this complication. The preliminary cut-off valves of
oversize 3.3 mm and oversize ratio 1.6 should be followed for reference
for device choice. Copyright © 2022 Termedia Publishing House
Ltd.. All rights reserved.

<92>
Accession Number
2020226458
Title
The impact of multivisceral liver resection on short- and long-term
outcomes of patients with colorectal liver metastasis: A systematic review
and meta-analysis.
Source
Clinics. 77 (no pagination), 2022. Article Number: 100099. Date of
Publication: 01 Jan 2022.
Author
Silveira Junior S.; Tustumi F.; Magalhaes D.D.P.; Jeismann V.B.; Fonseca
G.M.; Kruger J.A.P.; Coelho F.F.; Herman P.
Institution
(Silveira Junior, Tustumi, Magalhaes, Jeismann, Fonseca, Coelho, Herman)
Divisao de Cirurgia do Aparelho Digestivo, Departamento de
Gastroenterologia, Hospital das Clinicas, Faculdade de Medicina,
Universidade de Sao Paulo (HCFMUSP), SP, Sao Paulo, Brazil
(Kruger) Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das
Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), SP,
Sao Paulo, Brazil
Publisher
Universidade de Sao Paulo. Museu de Zoologia
Abstract
The impact of Multivisceral Liver Resection (MLR) on the outcome of
patients with Colorectal Liver Metastasis (CRLM) is unclear. The present
systematic review aimed to compare patients with CRLM who underwent MLR
versus standard hepatectomy regarding short- and long-term outcomes. MLR
is a feasible procedure but has a higher risk of major complications. MLR
did not negatively affect long-term survival, suggesting that an extended
resection is an option for potentially curative treatment for selected
patients with CRLM. Copyright © 2022 HCFMUSP

<93>
Accession Number
2019844792
Title
Meta-Analysis Comparing Venoarterial Extracorporeal Membrane Oxygenation
With or Without Impella in Patients With Cardiogenic Shock.
Source
American Journal of Cardiology. 181 (pp 94-101), 2022. Date of
Publication: 15 Oct 2022.
Author
Bhatia K.; Jain V.; Hendrickson M.J.; Aggarwal D.; Aguilar-Gallardo J.S.;
Lopez P.D.; Narasimhan B.; Wu L.; Arora S.; Joshi A.; Tomey M.I.; Mahmood
K.; Qamar A.; Birati E.Y.; Fox A.
Institution
(Bhatia, Aguilar-Gallardo, Lopez, Wu, Joshi) Mount Sinai Heart, Mount
Sinai Morningside Hospital, New York, New York
(Jain) Division of Internal Medicine, Cleveland Clinic Foundation,
Cleveland, Ohio
(Hendrickson) Department of Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
(Aggarwal) Department of Internal Medicine, Beaumont Hospital, Royal Oak,
MI, United States
(Narasimhan) Department of Cardiology, Debakey Cardiovascular Center,
Houston Methodist, Texas
(Arora) Division of Cardiology, University of North Carolina School of
Medicine, Chapel Hill, NC, United States
(Tomey, Mahmood, Fox) Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, New York
(Qamar) Section of Interventional Cardiology, NorthShore Cardiovascular
Institute, University of Chicago, Chicago, Illinois
(Birati) Poriya Medical Center, Bar-Ilan University, Israel
Publisher
Elsevier Inc.
Abstract
Cardiogenic shock is associated with high short-term mortality.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly
used as a mechanical circulatory support strategy for patients with
refractory cardiogenic shock. A drawback of this hemodynamic support
strategy is increased left ventricular (LV) afterload, which is mitigated
by concomitant use of Impella (extracorporeal membrane oxygenation with
Impella [ECPELLA]). However, data regarding the benefits of this approach
are limited. We conducted a systematic search of Medline, EMBASE, and
Cochrane databases to identify studies including patients with cardiogenic
shock reporting clinical outcomes with Impella plus VA-ECMO compared with
VA-ECMO alone. Primary outcome was short-term all-cause mortality
(in-hospital or 30-day mortality). Secondary outcomes included major
bleeding, hemolysis, continuous renal replacement therapy, weaning from
mechanical circulatory support, limb ischemia, and transition to
destination therapy with LV assist device (LVAD) or cardiac transplant. Of
2,790 citations, 7 observational studies were included. Of 1,054 patients
with cardiogenic shock, 391 were supported with ECPELLA (37%). Compared
with patients on only VA-ECMO support, patients with ECPELLA had a lower
risk of short-term mortality (risk ratio [RR] 0.89 [0.80 to 0.99],
I2 = 0%, p = 0.04) and were significantly more likely to
receive a heart transplant/LVAD (RR 2.03 [1.44 to 2.87], I2 =
0%, p <0.01). However, patients with ECPELLA had a higher risk of
hemolysis (RR 2.03 [1.60 to 2.57], I2 = 0%, p <0.001), renal
failure requiring continuous renal replacement therapy (RR 1.46 [1.23 to
174], I2 = 11%, p <0.0001), and limb ischemia (RR 1.67 [1.15 to
2.43], I2 = 0%, p = 0.01). In conclusion, among patients with
cardiogenic shock requiring VA-ECMO support, concurrent LV unloading with
Impella had a lower likelihood of short-term mortality and a higher
likelihood of progression to durable LVAD or heart transplant. However,
patients supported with ECPELLA had higher rates of hemolysis, limb
ischemia, and renal failure requiring continuous renal replacement
therapy. Future prospective randomized are needed to define the optimal
treatment strategy in this high-risk cohort. Copyright © 2022
Elsevier Inc.

<94>
Accession Number
2018874133
Title
Effect of Clemastine Fumarate on Perioperative Hemodynamic Instability
Mediated by Anaphylaxis During Cardiopulmonary Bypass Surgery.
Source
Medical Science Monitor. 28 (no pagination), 2022. Article Number:
e936367. Date of Publication: 02 Jul 2022.
Author
Tian L.; Liu Y.; Fei Y.; Lv H.; Yan F.; Li L.; Shi J.
Institution
(Tian, Liu, Lv, Yan, Li, Shi) Department of Anesthesiology, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Fei) Department of Anesthesiology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
Publisher
International Scientific Information, Inc.
Abstract
Background: Perioperative hemodynamic instability mediated by anaphylaxis
is a life-threatening complication in patients undergoing cardiac surgery
with cardiopulmonary bypass (CPB). This study aimed to evaluate the effect
of clemastine fumarate in this specific patient population.
Material/Methods: We enrolled 100 participants who met the inclusion
criteria and randomly allocated them to the treatment group and the
placebo group. Participants in the treatment group and the placebo group
were treated separately with an injection of clemastine fumarate and
saline, respectively. Plasma histamine concentration and blood pressure
were quantified at 5 timepoints during the perioperative period, and
differences between the 2 groups were assessed by repeated-measures ANOVA.
The postoperative complications and in-hospital mortality also were
evaluated. All participants were followed up for 7 days after cardiac
surgery. Result(s): Plasma histamine concentrations increased in both
groups but were statistically significantly lower in the treatment group
during the perioperative period (P=0.007). Diastolic blood pressure
(P=0.014) and mean arterial pressure (P=0.024) in the treatment group were
significantly higher than in the placebo group during the perioperative
period. The coefficients of variation for systolic (13.9+/-4.2% vs
17.2+/-4.4%, P<0.01) and diastolic (12.9+/-4.9% vs 15.3+/-5.2%, P=0.02)
blood pressure were significantly lower in the treatment group compared
with the placebo group. Conclusion(s): Pretreatment with clemastine
fumarate restrains the increase in histamine concentration and provides
safer hemodynamics in patients undergoing cardiac surgery with
CPB. Copyright © 2022 International Scientific Information, Inc..
All rights reserved.

<95>
Accession Number
2007103936
Title
Feasibility of Perioperative eHealth Interventions for Older Surgical
Patients: A Systematic Review.
Source
Journal of the American Medical Directors Association. 21(12) (pp
1844-1851.e2), 2020. Date of Publication: December 2020.
Author
Jonker L.T.; Haveman M.E.; de Bock G.H.; van Leeuwen B.L.; Lahr M.M.H.
Institution
(Jonker, Haveman, van Leeuwen) Department of Surgery, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(Jonker, de Bock, Lahr) Department of Epidemiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
Publisher
Elsevier Inc.
Abstract
Objectives: EHealth interventions are increasingly being applied in
perioperative care but have not been adequately studied for older surgical
patients who could potentially benefit from them. Therefore, we evaluated
the feasibility of perioperative eHealth interventions for this
population. Design(s): A systematic review of prospective
observational and interventional studies was conducted. Three electronic
databases (PubMed, EMBASE, CINAHL) were searched between January 1999 and
July 2019. Study quality was assessed by Methodological Index for
Non-Randomized Studies (MINORS) with and without control group. Setting
and Participants: Studies of surgical patients with an average age >=65
years undergoing any perioperative eHealth intervention with active
patient participation (with the exception of telerehabilitation following
orthopedic surgery) were included. Measures: The main outcome measure was
feasibility, defined as a patient's perceptions of usability,
satisfaction, and/or acceptability of the intervention. Other outcomes
included compliance and study completion rate. Result(s): Screening
of 1569 titles and abstracts yielded 7 single-center prospective studies
with 223 patients (range n = 9-69 per study, average age 66-74 years)
undergoing oncological, cardiovascular, or orthopedic surgery. The median
MINORS scores were 13.5 of 16 for 6 studies without control group, and 14
of 24 for 1 study with a control group. Telemonitoring interventions were
rated as "easy to use" by 89% to 95% of participants in 3 studies.
Patients in 3 studies were satisfied with the eHealth intervention and
would recommend it to others. Acceptability (derived from consent rate)
ranged from 71% to 89%, compliance from 53% to 86%, and completion of
study follow-up from 54% to 95%. Conclusions and Implications: Results of
7 studies involving perioperative eHealth interventions suggest their
feasibility and encourage further development of technologies for older
surgical patients. Future feasibility studies require clear definitions of
appropriate feasibility outcome measures and a comprehensive description
of patient characteristics such as functional performance, level of
education, and socioeconomic status. Copyright © 2020 AMDA - The
Society for Post-Acute and Long-Term Care Medicine. Elsevier Inc. This is
an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).

<96>
Accession Number
2020113425
Title
TCT-54 Bifurcation Left Main Coronary Stenting With or Without
Intracoronary Imaging: Outcomes From the European Bifurcation Club Left
Main Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty-Fourth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Boston
United States. 80(12 Supplement) (pp B22), 2022. Date of Publication: 20
Sep 2022.
Author
Maznyczka A.; Arunothayaraj S.; Egred M.; Banning A.; Brunel P.; Ferenc
M.; Hovasse T.; Wlodarczak A.; Pan M.; Schmitz T.; Silvestri M.; Erglis
A.; Kretov E.; Lassen J.; Chieffo A.; Lefevre T.; Burzotta F.; Cockburn
J.; Darremont O.; Stankovic G.; Morice M.-C.; Louvard Y.; Hildick-Smith D.
Institution
(Maznyczka) Portsmouth University Hospitals, Portsmouth, United Kingdom
(Arunothayaraj) Royal Sussex County Hospital, Brighton, United Kingdom
(Egred) Freeman Hospital, Newcastle, United Kingdom
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Brunel) Hopital Prive Dijon Bourgogne, Dijon, France
(Ferenc) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Hovasse, Lefevre) Institut Cardiovasculaire Paris Sud, Ramsay Sante,
Massy, France
(Wlodarczak) Copper Health Center, Lubin, Poland
(Pan) Reina Sofia Hospital. Cordoba, Spain
(Schmitz) Contilia Heart Center, Essen, Germany
(Silvestri) GCS Axium-Rambot, Marseille, France
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
(Kretov) Sibirskiy Fmicrodmicrordegreel Biomedical Research Center
Novosibirsk, Novosibirsk, Russian Federation
(Lassen) Odense University Hospital, Odense, Denmark
(Chieffo) San Raffaele Scientific Institute, Milano, Italy
(Burzotta) UOC di Interventistica Cardiologica e Diagnostica Invasiva,
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita
Cattolica del Sacro Cuore, Rome, Italy
(Cockburn, Hildick-Smith) Sussex Cardiac Centre, University Hospitals
Sussex, Brighton, United Kingdom
(Darremont) Clinique St Augustin, Bordeaux, Bordeaux, France
(Stankovic) Department of Cardiology, University Clinical Center of
Serbia, Belgrade, Serbia
(Morice) Cardiovascular European Research Center, Paris, France
(Louvard) Institut Hospitalier Jacques Cartier, Guerande, France
Publisher
Elsevier Inc.
Abstract
Background: The impact of intracoronary imaging on outcomes of provisional
vs dual bifurcation left main (LM) stenting is unknown. We investigated
the impact of intracoronary imaging in the EBC MAIN (European Bifurcation
Club Left Main Coronary Stent Study) trial. Method(s): 467 patients
were randomized to dual-stenting or a stepwise provisional approach. 455
patients were included in this analysis. Use of intravascular ultrasound
(IVUS) or optical coherence tomography (OCT) was at the operator's
discretion. The primary outcome was all-cause death, myocardial infarction
(MI) or target vessel revascularization (TVR) at 1 year. Result(s):
Mean age was 71 +/- 10 years (77% male). The procedural indication was
stable angina in 63% and acute coronary syndrome in 37%. Intracoronary
imaging was used in 179 patients (IVUS n = 151 and OCT n = 28). Overall,
the primary outcome did not differ with intracoronary imaging vs
angiographic guidance alone (17% vs 16%; OR 1.09 [95% CI 0.66-1.82]; P =
0.738), nor for patients who had re-intervention based on imaging findings
vs none (14% vs 16%; OR 0.86 [95% CI 0.35-2.12]; P = 0.745). With
angiographic guidance only, primary outcome events were more frequent with
dual vs provisional stenting (21% vs 10%; OR 2.24 [95% CI 1.13-4.45]; P =
0.022). With intracoronary imaging, there were numerically fewer primary
outcome events with dual vs provisional stenting (13% vs 21%; OR 0.54 [95%
CI 0.24-1.22]; P = 0.137). There was a significant interaction between
intracoronary imaging use and LM bifurcation stenting strategy, with
respect to the primary outcome (P = 0.009). There were no significant
interactions with intracoronary imaging use, the primary outcome, and
stent length in the main vessel, or extent of coronary calcification.
 Conclusion(s): In EBC MAIN, overall, the primary outcome did not
differ between patients who did or did not have intracoronary imaging.
However, in patients with angiography guidance alone, the primary outcome
was more common with a dual-stent, than provisional-stent strategy.
Nonrandomized use of intravascular imaging was associated with numerically
fewer primary outcome events with dual-stenting than a provisional
approach. Categories: CORONARY: Complex and Higher Risk Procedures for
Indicated Patients (CHIP) Copyright © 2022

<97>
Accession Number
2020113401
Title
TCT-164 Targeted Therapy With a Localized Abluminal Groove Low-Dose
Sirolimus-Eluting Biodegradable-Polymer Coronary Stent: Subgroup Analysis
of 5-Year Outcomes of the TARGET All Comers Randomized Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty-Fourth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Boston
United States. 80(12 Supplement) (pp B66), 2022. Date of Publication: 20
Sep 2022.
Author
Kelbaek H.; Lansky A.; Xu B.; Baumbach A.; van Royen N.; Knaapen P.;
Johnson T.; Smits P.; Vlachojannis G.; Arkenbout K.; Holmvang L.; Janssens
L.; Ochala A.; Wijns W.
Institution
(Kelbaek) Roskilde Hospital, Roskilde, Denmark
(Lansky) Yale School of Medicine, CT, New Haven, United States
(Xu) Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing,
China
(Baumbach) Department of Cardiology, Barts Heart Centre, Barts Health NHS
Trust, London, United Kingdom
(van Royen) Radboud University Medical Center, Nijmegen, Netherlands
(Knaapen) Amsterdam University Medical Center - Academic Medical Center,
Amsterdam, Netherlands
(Johnson) Cheltenham General Hospital, Auckland, New Zealand
(Smits) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Vlachojannis) University Medical Center Utrecht, Utrecht, Netherlands
(Arkenbout) Department of Cardiology, Tergooi Hospital, Blaricum,
Netherlands
(Holmvang) Rigshospitalet, Copenhagen, Denmark
(Janssens) Imelda Hospital Bonheiden, Bonheiden, Belgium
(Ochala) University Hospital, Katowice, Poland
(Wijns) Lambe Institute for Translational Medicine and CURAM, National
University of Ireland Galway, Galway, Ireland
Publisher
Elsevier Inc.
Abstract
Background: Targeted therapy with the biodegradable-polymer
sirolimus-eluting Firehawk stent was noninferior to the durable-polymer
everolimus-eluting XIENCE stent on the basis of target lesion failure
(TLF) at 12 months. Whether the results are sustained at 5 years in
high-risk subgroups is unknown. Method(s): TARGET All Comers is a
prospective, multicenter, open-label, noninferiority trial of 1,653
patients referred for coronary stenting, randomized 1:1 to Firehawk or
XIENCE at 21 centers in 10 European Union countries. The primary endpoint
was TLF at 12 months (a composite of cardiac death, target vessel
myocardial infarction, or ischemia-driven target lesion
revascularization). Secondary endpoints included components of TLF and a
patient-oriented composite endpoint (POCE; death, any myocardial
infarction, or any revascularization). We report 5-year prespecified
patient and lesion subgroup results. [Formula presented] Results: From
December 2015 to October 2016, 1,653 patients were randomized to Firehawk
(n = 823) or XIENCE (n = 830); 94% completed 5-year follow-up. Patient,
lesion, and procedural characteristics were well matched. At 5 years, TLF
was 17.1% for Firehawk and 16.3% for XIENCE (P = 0.68). Cardiac death
(4.0% vs 4.2%; P = 0.85), target vessel myocardial infarction (10.6% vs
10.3%; P = 0.85), ischemia-driven target lesion revascularization (6.0% vs
6.5%; P = 0.74), and definite or probable ST (2.8% vs 3.0%; P = 0.81) did
not differ for Firehawk vs XIENCE, respectively. The POCE rate was 34.0%
for Firehawk and 32.7% for XIENCE (P = 0.58). Figures 1 and 2 depict
subgroup analyses for TLF and the POCE at 5 years. Conclusion(s):
Firehawk demonstrated noninferior TLF at 12 months with sustained outcomes
at 5 years vs XIENCE. In this all-comers population, one-third experienced
the POCE at 5 years. The subgroups results are consistent between
treatment arms. Categories: CORONARY: Stents: Drug-Eluting Copyright
© 2022

<98>
Accession Number
2019321025
Title
Microarray meta-analysis reveals IL6 and p38beta/MAPK11 as potential
targets of hsa-miR-124 in endothelial progenitor cells: Implications for
stent re-endothelization in diabetic patients.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 964721. Date of Publication: 13 Sep 2022.
Author
Arencibia A.; Salazar L.A.
Institution
(Arencibia, Salazar) Department of Basic Sciences, Faculty of Medicine,
Center of Molecular Biology and Pharmacogenetics, Universidad de La
Frontera, Temuco, Chile
Publisher
Frontiers Media S.A.
Abstract
Circulating endothelial progenitor cells (EPCs) play an important role in
the repair processes of damaged vessels, favoring re-endothelization of
stented vessels to minimize restenosis. EPCs number and function is
diminished in patients with type 2 diabetes, a known risk factor for
restenosis. Considering the impact of EPCs in vascular injury repair, we
conducted a meta-analysis of microarray to assess the transcriptomic
profile and determine target genes during the differentiation process of
EPCs into mature ECs. Five microarray datasets, including 13 EPC and 12 EC
samples were analyzed, using the online tool ExpressAnalyst.
Differentially expressed genes (DEGs) analysis was done by Limma method,
with an log<inf>2</inf>FC > 1 and FDR < 0.05. Combined p-value
by Fisher exact method was computed for the intersection of datasets.
There were 3,267 DEGs, 1,539 up-regulated and 1,728 down-regulated in
EPCs, with 407 common DEGs in at least four datasets. Kyoto Encyclopedia
of Genes and Genomes (KEGG) analysis showed enrichment for terms related
to "AGE-RAGE signaling pathway in diabetic complications." Intersection of
common DEGs, KEGG pathways genes and genes in protein-protein interaction
network (PPI) identified four key genes, two up-regulated (IL1B and
STAT5A) and two down-regulated (IL6 and MAPK11). MicroRNA enrichment
analysis of common DEGs depicted five hub microRNA targeting 175 DEGs,
including STAT5A, IL6 and MAPK11, with hsa-miR-124 as common regulator.
This group of genes and microRNAs could serve as biomarkers of EPCs
differentiation during coronary stenting as well as potential therapeutic
targets to improve stent re-endothelization, especially in diabetic
patients. Copyright © 2022 Arencibia and Salazar.

<99>
Accession Number
2019287817
Title
Comparative effects of different types of cardioplegia in cardiac surgery:
A network meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 996744. Date of Publication: 13 Sep 2022.
Author
Tan J.; Bi S.; Li J.; Gu J.; Wang Y.; Xiong J.; Yu X.; Du L.
Institution
(Tan, Wang, Xiong, Yu, Du) Department of Anesthesiology, West China
Hospital, Sichuan University, Chengdu, China
(Bi) Department of Burn and Plastic Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Li) West China School of Medicine, Sichuan University, Chengdu, China
(Gu) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Frontiers Media S.A.
Abstract
Objective: To compare the outcomes of four types of cardioplegia during
cardiac surgery: del Nido (DN), blood cardioplegia (BC),
histidine-tryptophan-ketoglutarate (HTK) and St. Thomas. Method(s):
Randomized controlled trials (RCTs) and observational cohort studies from
2005 to 2021 were identified in PubMed, Embase, and Cochrane databases.
Data were extracted for the primary endpoint of perioperative mortality as
well as the following secondary endpoints: atrial fibrillation, renal
failure, stroke, use of an intra-aortic balloon pump, re-exploration,
intensive care unit stay and hospital stay. A network meta-analysis
comparing all four types of cardioplegia was performed, as well as direct
meta-analysis comparing pairs of cardioplegia types. Result(s): Data
were extracted from 18 RCTs and 49 observational cohort studies involving
18,191 adult patients (55 studies) and 1,634 children (12 studies). Among
adult patients, risk of mortality was significantly higher for HTK (1.89,
95% CI 1.10, 3.52) and BC (RR 1.73, 95% CI 1.22, 2.79) than for DN. Risk
of atrial fibrillation was significantly higher for BC (RR 1.41, 95% CI
1.09, 1.86) and DN (RR 1.51, 95% CI 1.15, 2.03) than for HTK. Among
pediatric patients, no significant differences in endpoints were observed
among the four types of cardioplegia. Conclusion(s): This network
meta-analysis suggests that among adult patients undergoing cardiac
surgery, DN may be associated with lower perioperative mortality than HTK
or BC, while risk of atrial fibrillation may be lower with HTK than with
BC or DN. Copyright © 2022 Tan, Bi, Li, Gu, Wang, Xiong, Yu and
Du.

<100>
Accession Number
2018098847
Title
Anticoagulation in Atrial Fibrillation Associated with Mitral Stenosis.
Source
Cardiovascular and Hematological Agents in Medicinal Chemistry. 20(3) (pp
172-174), 2022. Date of Publication: November 2022.
Author
da Silva R.M.F.L.
Institution
(da Silva) Department of Internal Medicine, Faculty of Medicine, Federal
University of Minas Gerais, Belo Horizonte, Brazil
Publisher
Bentham Science Publishers
Abstract
Rheumatic valve disease is present in 0.4 % of the word population, mainly
in low-income countries. Rheumatic mitral stenosis affects more women and
between 40 to 75 % of patients may have atrial fibrillation (AF), more
frequently in upper-middle income countries. This rhythm disturbance is
due to increased atrial pressure, chronic inflammation, fibrosis, and left
atrial enlargement. There is also an increase in the prevalence of AF with
age in patients with mitral stenosis. The risk of stroke is 4 % per year.
Success rates for cardioversion, Cox-Maze procedure, and catheter ablation
are low. Therefore, anticoagulation with vitamin K antagonist is mandatory
for Evaluated Heart valves, Rheumatic or Artificial (EHRA) classification
type 1. However, this anticoagulation is used by less than 80 % of those
eligible and less than 30 % have the international normalized ratio in the
therapeutic range. The safety and efficacy of using rivaroxaban, a direct
factor Xa inhibitor anticoagulant, were demonstrated in the RIVER trial
with a sample of 1005 patients with AF and bioprosthetic mitral valve. The
indication for valve replacement, that is, if severe mitral stenosis or
severe mitral regurgitation, was not specified. A randomized, open-label
study (DAVID-MS) is underway to compare the effectiveness and safety of
dabigatran and warfa-rin therapy for stroke prevention in patients with AF
and moderate or severe mitral stenosis. Thus, the applicability of the use
of direct anticoagulants in patients with AF and mitral stenosis and also
in those undergoing mitral bioprostheses surgery will be the subject of
further studies. The findings may explain if specific atrial changes of
mitral stenosis even after the valve replacement will influence
thromboembolic events with direct anticoagulants. Copyright ©
2022 Bentham Science Publishers.

<101>
Accession Number
622801072
Title
Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke
with patent foramen ovale: Systematic review of randomized trials,
sequential meta-analysis, and new insights from the CLOSE study.
Source
Journal of the American Heart Association. 7(12) (no pagination), 2018.
Article Number: e008356. Date of Publication: 01 Jun 2018.
Author
Guerin P.; Chatellier G.; Mas J.-L.; Turc G.; Domigo V.; Guiraud V.; Touze
E.; Calvet D.; Varenne O.; Menacer S.; Sroussi M.; Nana A.; Cabanes L.;
Guillon B.; Schunck A.; Herisson F.; De Gaalon S.; Sevin M.; Langlard
J.-M.; Piriou N.; Jaafar P.; Massardier E.; d'Here B.; Stepowski D.; Bauer
F.; Hosseini H.; Teiger E.; Duval A.-M.; Lim P.; Mechtouff L.;
Nighoghossian N.; Derex L.; Cho T.; Rossi R.; Rioufol G.; Derumeaux G.;
Thibaut H.; Barthelet M.; Thivolet S.; Arquizan C.; Mourand I.; Sportouch
C.; Cade S.; Cransac F.; Giroud M.; Bejot Y.; Eicher J.-C.; L'Huillier I.;
Vuillier F.; Moulin T.; Meneveau N.; Chopard R.; Descotes-Genon V.;
Detante O.; Garambois K.; Bertrand B.; Saunier C.; Mazighi M.; Juliard
E.J.-M.; Brochet E.; Guidoux C.; Meseguer D.; Cabrejo L.; Lavallee P.;
Amarenco P.; Messika-Zeitoun; Lepage L.; Bugnicourt J.-M.; Canaple S.;
Lamy C.; Godefroy O.; Leborgne L.; Guillaumont M.-P.; Trojette F.;
Malaquin D.; Vaduva C.; Couvreur G.; Golfier V.; Plurien F.; Taldir G.;
Lucas C.; Cordonnier C.; Henon H.; Dumont F.; Dequatre-Ponchelle N.; Leys
D.; Godart F.; Richardson M.; Polge A.-S.; Montaigne D.; Coisne A.; Sibon
I.; Rouanet F.; Renou P.; Thambo J.-B.; Reant P.; Laffite S.; Roudaut R.;
Garnier P.; Comtet C.; Delsart D.; Ferrier A.; Bourgois N.; Clavelou P.;
Rouhart F.; Timsit S.; Le Cadet E.; Tirel A.; Mocquard Y.; Jobic Y.; Le
Ven F.; Pouliquen M.-C.; Milandre L.; Robinet-Borgomano E.; Laksiri N.;
Rey C.; Fraisse A.; Habib G.; Chalvignac V.; Thuny F.; Sablot D.; Runavot
G.; Piot C.; Targosz F.; Chopat P.; Sultan P.; Lacour C.; Richard S.;
Ducrocq X.; Marcon F.; Selton-Suty M.C.; Huttin O.; Bruandet M.; Zuber M.;
Tamazyan R.; Antakly Y.; Garcon P.; Serfaty J.; Favrole P.; Dubois-Rande
J.-L.; Hammoudi N.; Pinel J.-F.; Schleich J.-M.; Donal E.; Lelong B.;
Chabanne C.; Viader F.; Apoil M.; Cogez J.; Labombarda F.; Saloux E.;
Reiner P.; Buffon F.; Baudet M.; Logeart D.; Lefebvre C.; Bataille M.;
Godard F.; Biausque F.; Lefetz Y.; Clement-Dupont M.; Weimar C.; Zegarac
V.; Schmitz T.; Plicht B.; Eissmann M.; Mahabadi A.; Obadia M.; Aubry P.;
Iglesias Benyounes N.; Macian F.; Lusson J.-R.; Darodes N.; Tanguy B.;
Mohty D.; Vuillemet F.; Onea R.; Greciano S.; Roth O.; Neau J.-P.; Quillet
L.; Christiaens L.; Saudeau D.; Patat F.; Singer O.; Fichtlscherer S.;
Pico F.; Juliard J.-M.; Charbonnel C.
Institution
(Turc, Calvet, Mas) Department of Neurology, Hopital Sainte-Anne, Paris,
France
(Turc, Calvet, Sroussi, Chatellier, Mas) Universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Turc, Calvet, Mas) INSERM U894, Paris, France
(Turc, Calvet, Mas) DHU Neurovasc, Paris, France
(Guerin) Department of Cardiology, INSERM UMR 915, Institut du Thorax,
Nantes, France
(Guerin) Institut du Thorax, Centre Hospitalier Universitaire de Nantes,
Nantes, France
(Sroussi) Department of Cardiology, Cochin Hospital, India
(Chatellier) Epidemiology and Clinical Research Unit, Georges Pompidou
European Hospital, France
(Chatellier) APHP, Paris, France
(Chatellier) INSERM CIC 1418, Paris, France
(Mas, Turc, Domigo, Guiraud, Touze, Calvet, Lamy, Teiger, Juliard,
Dubois-Rande, Aubry, Varenne, Menacer, Sroussi, Nana, Cabanes) Hopital
Sainte-Anne, Paris, France
(Guerin, Guillon, Schunck, Herisson, De Gaalon, Sevin, Langlard, Piriou,
Jaafar) Hopital Laennec, Nantes, France
(Massardier, Juliard, Aubry, d'Here, Stepowski, Bauer) CHU Rouen, France
(Hosseini, Dubois-Rande, Teiger, Duval, Lim) Hopital Henri Mondor,
Creteil, France
(Mechtouff, Nighoghossian, Derex, Cho, Rossi, Rioufol, Derumeaux, Thibaut,
Barthelet, Thivolet) CHU Pierre Wertheimer, Lyon, France
(Arquizan, Mourand, Piot, Sportouch, Cade, Cransac) Hopital Gui de
Chauliac, Montpellier, France
(Giroud, Bejot, Eicher, Eicher, L'Huillier) CHU Dijon, France
(Vuillier, Moulin, Meneveau, Chopard, Descotes-Genon) CHU Jean Minjoz,
Besancon, France
(Detante, Garambois, Bertrand, Saunier) CHU Grenoble-Alpes, France
(Mazighi, Guidoux, Juliard, Aubry, Brochet, Guidoux, Meseguer, Cabrejo,
Lavallee, Amarenco, Messika-Zeitoun, Lepage) Hopital Bichat, Paris, France
(Bugnicourt, Canaple, Lamy, Godefroy, Rey, Leborgne, Guillaumont,
Trojette, Malaquin) CHU Nord, Amiens, France
(Vaduva, Couvreur, Golfier, Schleich, Plurien, Taldir) Hopital Yves Le
Foll, St-Brieuc, France
(Lucas, Cordonnier, Henon, Dumont, Dequatre-Ponchelle, Leys, Godart, Rey,
Richardson, Polge, Montaigne, Coisne) CHU Salengro, Lille, France
(Sibon, Rouanet, Renou, Thambo, Reant, Laffite, Roudaut) CHU Bordeaux,
France
(Garnier, Lusson, Comtet, Delsart) Hopital Nord, St-Etienne, France
(Ferrier, Bourgois, Clavelou, Lusson, Lusson) CHU Montpied,
Clermont-Ferrand, France
(Guerin, Rouhart, Timsit, Le Cadet, Tirel, Mocquard, Jobic, Le Ven,
Pouliquen) CHU La Cavale Blanche, Brest, France
(Milandre, Robinet-Borgomano, Laksiri, Rey, Fraisse, Habib, Chalvignac,
Thuny) CHU La Timone, Marseille, France
(Sablot, Runavot, Piot, Targosz, Chopat, Sultan) CH Perpignan, France
(Lacour, Richard, Ducrocq, Marcon, Selton-Suty, Huttin) CHU Nancy, France
(Bruandet, Zuber, Tamazyan, Juliard, Aubry, Antakly, Garcon, Serfaty)
Hopital Saint-Joseph, Paris, France
(Favrole, Dubois-Rande, Hammoudi) Hopital Tenon, Paris, France
(Pinel, Schleich, Donal, Lelong, Chabanne) Hopital Pontchaillou, Rennes,
France
(Viader, Apoil, Cogez, Juliard, Labombarda, Saloux) CHU Caen, France
(Reiner, Buffon, Juliard, Baudet, Logeart) Hopital Lariboisiere, Paris,
France
(Lefebvre, Bataille, Godard, Biausque, Lefetz, Clement-Dupont) CH Lens,
France
(Weimar, Zegarac, Schmitz, Plicht, Eissmann, Mahabadi) Essen University
Hospital, Essen, Germany
(Obadia, Juliard, Aubry, Iglesias Benyounes) Fondation Hopital Rothschild,
Paris, France
(Macian, Lusson, Darodes, Tanguy, Mohty) CHU Limoges, France
(Vuillemet, Onea, Greciano, Roth) Hopitaux Civils de Colmar, France
(Neau, Quillet, Christiaens) CHU Poitiers et CHRU Tours, France
(Saudeau, Patat) CHU Bretonneau, Tours, France
(Singer, Fichtlscherer) Goethe University Hospital, Frankfurt, Germany
(Pico, Juliard, Charbonnel) CH Mignot, Versailles, France
Publisher
American Heart Association Inc.
Abstract
Background--We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) comparing patent foramen ovale (PFO)
closure, anticoagulation, and antiplatelet therapy to prevent stroke
recurrence in patients with PFO-associated cryptogenic stroke. Methods and
Results--We searched Medline, Cochrane Library, and EMBASE through March
2018. The primary outcome was stroke recurrence. Pooled incidences, hazard
ratios, and risk ratios (RRs) were calculated in random-effects
meta-analyses. PFO closure was associated with a lower risk of recurrent
stroke compared with antithrombotic therapy (antiplatelet therapy or
anticoagulation: 3560 patients from 6 RCTs; RR=0.36, 95% CI: 0.17-0.79;
I2=59%). The effect of PFO closure on stroke recurrence was
larger in patients with atrial septal aneurysm or large shunt (RR=0.27,
95% CI, 0.11-0.70; I2=42%) compared with patients without these
anatomical features (RR=0.80, 95% CI, 0.43-1.47; I2=12%). Major
complications occurred in 2.40% (95% CI, 1.03-4.25; I2=77%) of
procedures. New-onset atrial fibrillation was more frequent in patients
randomized to PFO closure versus antithrombotic therapy (RR=4.33, 95% CI,
2.37-7.89; I2=14%). One RCT compared PFO closure versus
anticoagulation (353 patients; hazard ratio=0.14, 95% CI, 0.00-1.45) and 2
RCTs compared PFO closure versus antiplatelet therapy (1137 patients;
hazard ratio=0.18, 95% CI, 0.05-0.63; I2=12%). Three RCTs
compared anticoagulation versus antiplatelet therapy, with none showing a
significant difference. Conclusions--PFO closure is superior to
antithrombotic therapy to prevent stroke recurrence after cryptogenic
stroke. The annual absolute risk reduction of stroke was low, but it has
to be tempered by a substantial time at risk (at least 5 years) in young
and middle-aged patients. PFO closure was associated with an increased
risk of atrial fibrillation. Copyright © 2018 The Authors.

<102>
Accession Number
2020352702
Title
Influences of Antithrombotic Elastic Socks Combined with Air Pressure in
Reducing Lower Extremity Deep Venous Thrombosis for Patients Undergoing
Cardiothoracic Surgery.
Source
Computational and Mathematical Methods in Medicine. 2022 (no pagination),
2022. Article Number: 1338214. Date of Publication: 2022.
Author
Fu W.; Zhang Q.; Sun X.; Gu Y.
Institution
(Fu, Sun) Department of Thoracic Surgery, Affiliated Hospital of Nantong
University, Jiangsu, Nantong 226001, China
(Zhang) Department of Cardiovascular Surgery, Affiliated Hospital of
Nantong University, Jiangsu, Nantong 226001, China
(Gu) Department of Surgery, Affiliated Hospital of Nantong University,
Jiangsu, Nantong 226001, China
Publisher
Hindawi Limited
Abstract
This study was designed to investigate the application and therapeutic
effect of antithrombotic elastic socks combined with air pressure in the
prevention of lower extremity deep venous thrombosis in patients
undergoing cardiothoracic surgery. Sixty patients in cardiothoracic
surgery of our hospital from January 2019 to December 2020 were randomly
divided into a study group and control group. The control group was
treated with routine treatment intervention. Based on routine treatment
intervention, the study group was treated with antithrombotic elastic
socks combined with pneumatic treatment intervention. The activated
partial thromboplastin time (APTT), thrombin time (TT), femoral venous
blood flow velocity of both lower limbs, and the incidence of lower
extremity deep venous thrombosis (LEDVT), postoperative lower extremity
swelling, inflammatory factors, and satisfaction were measured. After
intervention, APTT (31.74+/-1.15 s) and TT (14.58+/-0.24 s) in the study
group were higher than those in the control group APTT (25.13+/-1.14 s)
and TT (12.14+/-0.23 s) (P<0.05). The left lower limb femoral vein blood
flow velocity and the right lower limb femoral vein blood flow velocity in
the study group were better than those in the control group (P<0.05). The
incidence of postoperative lower limb swelling and deep vein in the study
group was lower than that in the control group (P<0.05). Serum tumor
necrosis factor alpha and interleukin-6 concentrations in the study group
were lower than those in the control group (P<0.05). The satisfaction rate
of patients in the study group (93.33%) was significantly higher than that
in the control group (70.00%) (P<0.05). In conclusion, after
cardiothoracic surgery, antithrombotic elastic socks combined with air
pressure can significantly reduce the incidence of LEDVT by improving
patients' coagulation function, reducing inflammatory reaction. It is
worthy of popularization and application in relevant surgery.
 Copyright © 2022 Weihong Fu et al.

<103>
Accession Number
2013234790
Title
Investigating the Effect of Tranexamic Acid on the Treatment of Subdural
Hematoma: A Systematic Review Study.
Source
Archives of Neuroscience. 9(3) (no pagination), 2022. Article Number:
e127011. Date of Publication: Jul 2022.
Author
Hatefi M.; Komlakh K.
Institution
(Hatefi) Clinical Research Development, Imam Khomeini Hospital, Ilam
University of Medical Sciences, Ilam, Iran, Islamic Republic of
(Komlakh) Department of Neurosurgery, School of Medicine, Imam Hossein
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Brieflands
Abstract
Context: Tranexamic acid (TXA) belongs to the family of lysine-derived
antifibrinolytics. TXA requires a simple molecular break-down in the liver
to be metabolized and has a high renal excretion. Objective(s): This
study aimed to determine the effect of TXA on subdural hematoma (SDH)
treatment using the SR method. Method(s): Following a systematic
review design, this study aimed to evaluate the effect of TXA on SDH
treatment using studies published from 2000 to 2020. The search was
performed by two researchers who were dominant in various types of SR
studies and specialized discussion of neurosurgery. A checklist that
contained the following items was used to collect the data: surname, year
of study, year of publication, population, sample size, age, intervention,
and outcomes. Data were also classified and reported using Word software.
 Result(s): Initially, 178 articles were identified, out of which 118
were removed due to the relevance of the title and method, 44 due to
duplication, six due to following the SR method, and three due to having a
case report design. Seven studies were found as eligible, as follows: the
study by Wakabayashi et al. with a sample of 199 patients, Kageyama et
al.'s study with 21 patients, Wan et al.'s study with 90 patients, Kutty
et al.' study with 27 patients, Tanweer et al.'s study with 14 patients,
Yamada et al.'s study with 193 patients, and Lodewijkx et al.'s study with
7 patients. All articles showed that TXA could reduce SH.
 Conclusion(s): Regarding the positive effect of TXA on reducing SDH,
administration of this medicine is recommended in the treatment of
patients with CSDH. Copyright © 2022, Author(s).

<104>
Accession Number
638831806
Title
Effect of a Decision Aid on Agreement between Patient Preferences and
Repair Type for Abdominal Aortic Aneurysm: A Randomized Clinical Trial.
Source
JAMA Surgery. 157(9) (pp E222935), 2022. Date of Publication: September
2022.
Author
Eid M.A.; Barry M.J.; Tang G.L.; Henke P.K.; Johanning J.M.; Tzeng E.;
Scali S.T.; Stone D.H.; Suckow B.D.; Lee E.S.; Arya S.; Brooke B.S.;
Nelson P.R.; Spangler E.L.; Murebee L.; Dosluoglu H.H.; Raffetto J.D.;
Kougais P.; Brewster L.P.; Alabi O.; Dardik A.; Halpern V.J.; O'Connell
J.B.; Ihnat D.M.; Zhou W.; Sirovich B.E.; Metha K.; Moore K.O.; Voorhees
A.; Goodney P.P.
Institution
(Eid, Stone, Suckow, Sirovich, Metha, Moore, Voorhees, Goodney) Department
of Surgery and VA Outcomes Group, White River Junction VA Medical Center,
White River Junction, VT, United States
(Eid, Stone, Suckow, Sirovich, Metha, Goodney) Geisel School of Medicine
at Dartmouth, Hanover, NH, United States
(Barry) Massachusetts General Hospital, Center for Shared Decision Making,
Boston, United States
(Tang) Seattle VA Medical Center, Seattle, WA, United States
(Henke) Ann Arbor VA Medical Center, Ann Arbor, MI, United States
(Johanning) Omaha VA Medical Center, Omaha, NE, United States
(Tzeng) Pittsburgh VA Medical Center, Pittsburgh, PA, United States
(Scali) Gainesville VA Medical Center, Gainesville, FL, United States
(Lee) Sacramento VA Medical Center, Mather, CA, United States
(Arya) Palo Alto VA Medical Center, Palo Alto, CA, United States
(Brooke) Salt Lake City VA, Salt Lake City, UT, United States
(Nelson) Muskogee VA Medical Center, Muskogee, OK, United States
(Spangler) Birmingham VA, Birmingham, AL, United States
(Murebee) Durham VA Medical Center, Durham, NC, United States
(Dosluoglu) Buffalo VA Medical Center, Buffalo, NY, United States
(Raffetto) West Roxbury VA, Boston, MA, United States
(Kougais) Houston VA Medical Center, Houston, TX, United States
(Brewster, Alabi) Atlanta VA Medical Center, Atlanta, GA, United States
(Dardik) West Haven VA Medical Center, West Haven, CT, United States
(Halpern) Phoenix VA Medical Center, Phoenix, AZ, United States
(O'Connell) Los Angeles VA Medical Center, Los Angeles, CA, United States
(Ihnat) Minneapolis VA Medical Center, Minneapolis, MN, United States
(Zhou) Tucson VA Medical Center, Tucson, AZ, United States
Publisher
American Medical Association
Abstract
Importance: Patients with abdominal aortic aneurysm (AAA) can choose open
repair or endovascular repair (EVAR). While EVAR is less invasive, it
requires lifelong surveillance and more frequent aneurysm-related
reinterventions than open repair. A decision aid may help patients receive
their preferred type of AAA repair. Objective(s): To determine the
effect of a decision aid on agreement between patient preference for AAA
repair type and the repair type they receive. Design, Setting, and
Participant(s): In this cluster randomized trial, 235 patients were
randomized at 22 VA vascular surgery clinics. All patients had AAAs
greater than 5.0 cm in diameter and were candidates for both open repair
and EVAR. Data were collected from August 2017 to December 2020, and data
were analyzed from December 2020 to June 2021. Intervention(s):
Presurgical consultation using a decision aid vs usual care. Main
Outcomes and Measures: The primary outcome was the proportion of patients
who had agreement between their preference and their repair type, measured
using chi2analyses, kappa statistics, and adjusted odds ratios.
 Result(s): Of 235 included patients, 234 (99.6%) were male, and the
mean (SD) age was 73 (5.9) years. A total of 126 patients were enrolled in
the decision aid group, and 109 were enrolled in the control group. Within
2 years after enrollment, 192 (81.7%) underwent repair. Patients were
similar between the decision aid and control groups by age, sex, aneurysm
size, iliac artery involvement, and Charlson Comorbidity Index score.
Patients preferred EVAR over open repair in both groups (96 of 122 [79%]
in the decision aid group; 81 of 106 [76%] in the control group; P =.60).
Patients in the decision aid group were more likely to receive their
preferred repair type than patients in the control group (95% agreement
[93 of 98] vs 86% agreement [81 of 94]; P =.03), and kappa statistics were
higher in the decision aid group (kappa = 0.78; 95% CI, 0.60-0.95)
compared with the control group (kappa = 0.53; 95% CI, 0.32-0.74).
Adjusted models confirmed this association (odds ratio of agreement in the
decision aid group relative to control group, 2.93; 95% CI, 1.10-7.70).
 Conclusions and Relevance: Patients exposed to a decision aid were
more likely to receive their preferred AAA repair type, suggesting that
decision aids can help better align patient preferences and treatments in
major cardiovascular procedures. Trial Registration: ClinicalTrials.gov
Identifier: NCT03115346. Copyright © 2022 American Medical
Association. All rights reserved.

<105>
Accession Number
638461760
Title
Prothrombin Complex Concentrate vs Plasma for Post-Cardiopulmonary Bypass
Coagulopathy and Bleeding: A Randomized Clinical Trial.
Source
JAMA Surgery. 157(9) (pp 757-764), 2022. Date of Publication: September
2022.
Author
Smith M.M.; Schroeder D.R.; Nelson J.A.; Mauermann W.J.; Welsby I.J.;
Pochettino A.; Montonye B.L.; Assawakawintip C.; Nuttall G.A.
Institution
(Smith, Nelson, Mauermann, Nuttall) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, College of Medicine and Science,
Rochester, MN, United States
(Schroeder) Department of Biomedical Statistics and Informatics, Mayo
Clinic, College of Medicine and Science, Rochester, MN, United States
(Welsby) Department of Anesthesiology, Duke University, Medical Center,
Durham, NC, United States
(Pochettino) Division of Cardiovascular Surgery, Department of Surgery,
Mayo Clinic, College of Medicine and Science, Rochester, MN, United States
(Montonye) Anesthesia Clinical Research Unit, Mayo Clinic College of
Medicine and Science, Rochester, MN, United States
(Assawakawintip) Department of Anesthesiology, Wetchakarunrasm Hospital,
Bangkok, Thailand
Publisher
American Medical Association
Abstract
Importance: Post-cardiopulmonary bypass (CPB) coagulopathy and bleeding
are among the most common reasons for blood product transfusion in
surgical practices. Current retrospective data suggest lower transfusion
rates and blood loss in patients receiving prothrombin complex concentrate
(PCC) compared with plasma after cardiac surgery. Objective(s): To
analyze perioperative bleeding and transfusion outcomes in patients
undergoing cardiac surgery who develop microvascular bleeding and receive
treatment with either PCC or plasma. Design, Setting, and
Participant(s): A single-institution, prospective, randomized clinical
trial performed at a high-volume cardiac surgical center. Patients were
aged 18 years or older and undergoing cardiac surgery with CPB. Patients
undergoing complex cardiac surgical procedures (eg, aortic replacement
surgery, multiple procedures, or repeated sternotomy) were preferentially
targeted for enrollment. During the study period, 756 patients were
approached for enrollment, and 553 patients were randomized. Of the 553
randomized patients, 100 patients met criteria for study intervention.
 Intervention(s): Patients with excessive microvascular bleeding, a
prothombin time (PT) greater than 16.6 seconds, and an international
normalized ratio (INR) greater than 1.6 were randomized to receive
treatment with either PCC or plasma. The PCC dose was 15 IU/kg or closest
standardized dose; the plasma dose was a suggested volume of 10 to 15
mL/kg rounded to the nearest unit. Main Outcomes and Measures: The
primary outcome was postoperative bleeding (chest tube output) from the
initial postsurgical intensive care unit admission through midnight on
postoperative day 1. Secondary outcomes were PT/INR, rates of
intraoperative red blood cell (RBC) transfusion after treatment, avoidance
of allogeneic transfusion from the intraoperative period to the end of
postoperative day 1, postoperative bleeding, and adverse events.
 Result(s): One hundred patients (mean [SD] age, 66.8 [13.7] years; 61
[61.0%] male; and 1 [1.0%] Black, 1 [1.0%] Hispanic, and 98 [98.0%] White)
received the study intervention (49 plasma and 51 PCC). There was no
significant difference in chest tube output between the plasma and PCC
groups (median [IQR], 1022 [799-1575] mL vs 937 [708-1443] mL). After
treatment, patients in the PCC arm had a greater improvement in PT (effect
estimate, -1.37 seconds [95% CI, -1.91 to -0.84]; P <.001) and INR (effect
estimate, -0.12 [95% CI, -0.16 to -0.07]; P <.001). Fewer patients in the
PCC group required intraoperative RBC transfusion after treatment (7 of 51
patients [13.7%] vs 15 of 49 patients [30.6%]; P =.04); total
intraoperative transfusion rates were not significantly different between
groups. Seven (13.7%) of 51 patients receiving PCCs avoided allogeneic
transfusion from the intraoperative period to the end of postoperative day
1 vs none of those receiving plasma. There were no significant differences
in postoperative bleeding, transfusions, or adverse events.
 Conclusions and Relevance: The results of this study suggest a
similar overall safety and efficacy profile for PCCs compared with plasma
in this clinical context, with fewer posttreatment intraoperative RBC
transfusions, improved PT/INR correction, and higher likelihood of
allogeneic transfusion avoidance in patients receiving PCCs. Trial
Registration: ClinicalTrials.gov Identifier: NCT02557672. Copyright
© 2022 American Medical Association. All rights reserved.

<106>
Accession Number
2020295675
Title
Papaverine Infusion Through Aortic Root before Cardiac Self-recovery in
Heart Valve Replacement with TiO2 Nanocrystalline Film Material.
Source
Cellular and Molecular Biology. 68(3) (pp 322-329), 2022. Date of
Publication: 2022.
Author
Tan X.; Li J.; Jin W.; Mei B.; He G.; Wang Y.; Wei S.; Lai Y.
Institution
(Tan, Li, Jin, Mei, He, Wang, Wei, Lai) Department of Cardiothoracic
Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong
637000, China
Publisher
Cellular and Molecular Biology Association
Abstract
This work was to investigate TiO2 nanocrystalline film material in heart
valve replacement (HVR) and the effect of papaverine infusion through the
aortic root before cardiac self-recovery during the HVR. TiO2
nanocrystalline films were prepared by radio frequency (RF) reactive
sputtering. The crystallization characteristics and surface morphology of
TiO2 nanocrystalline films were observed by X-ray diffraction and scanning
electron microscopy, and the anti-platelet adhesion and anti-coagulation
properties of the films were analyzed. 86 patients with heart valve
disease were selected and all underwent HVR. They were randomly divided
into a control group (routine treatment) and an experimental group
(papaverine perfusion through aortic root), with 43 cases in each group.
The rate of cardiac self-recovery and the dosage of dopamine were
observed. The results showed that the TiO2 nanocrystalline film was
composed of a large number of uniform particles, and the average particle
size was about 18.97 +/- 7.28 nm. The rate of cardiac self-recovery in the
experimental group was 97.67%, which was significantly higher than that in
the control group (67.44%) (P< 0.05). The dosage of epinephrine, dopamine,
and duration of cardiopulmonary bypass (CPB) assistance in the observation
group were less than those in the control group (P < 0.05). These results
indicated that TiO2 nanocrystalline film could be used in HVR, and
papaverine infusion through aortic root before HVR and myocardial
protection measures can significantly improve the rate of cardiac
self-recovery and promote postoperative recovery. Copyright ©
2022 by the C.M.B. Association. All rights reserved.

<107>
Accession Number
2018275307
Title
Stress Management in Pre- and Postoperative Care Amongst Practitioners and
Patients in Cardiac Catheterization Laboratory: A Study Protocol.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 830256. Date of Publication: 01 Jul 2022.
Author
Block A.; Bonaventura K.; Grahn P.; Bestgen F.; Wippert P.-M.
Institution
(Block, Grahn, Bestgen, Wippert) Medical Sociology and Psychobiology,
Department of Health and Physical Activity, University of Potsdam,
Potsdam, Germany
(Block, Wippert) Faculty of Health Sciences Brandenburg, Joint Faculty of
the University of Potsdam, the Brandenburg Medical School Theodor Fontane,
Brandenburg University of Technology Cottbus - Senftenberg, Potsdam,
Germany
(Bonaventura) Department of Cardiology and Angiology, Ernst von Bergmann
Hospital, Potsdam, Germany
Publisher
Frontiers Media S.A.
Abstract
Background: As the number of cardiac diseases continuously increases
within the last years in modern society, so does cardiac treatment,
especially cardiac catheterization. The procedure of a cardiac
catheterization is challenging for both patients and practitioners.
Several potential stressors of psychological or physical nature can occur
during the procedure. The objective of the study is to develop and
implement a stress management intervention for both practitioners and
patients that aims to reduce the psychological and physical strain of a
cardiac catheterization. Method(s): The clinical study (DRKS00026624)
includes two randomized controlled intervention trials with parallel
groups, for patients with elective cardiac catheterization and
practitioners at the catheterization lab, in two clinic sites of the
Ernst-von-Bergmann clinic network in Brandenburg, Germany. Both groups
received different interventions for stress management. The intervention
for patients comprises a psychoeducational video with different stress
management technics and additional a standardized medical information
about the cardiac catheterization examination. The control condition
includes the in hospitals practiced medical patient education before the
examination (usual care). Primary and secondary outcomes are measured by
physiological parameters and validated questionnaires, the day before (M1)
and after (M2) the cardiac catheterization and at a postal follow-up 6
months later (M3). It is expected that people with standardized
information and psychoeducation show reduced complications during cardiac
catheterization procedures, better pre- and post-operative wellbeing,
regeneration, mood and lower stress levels over time. The intervention for
practitioners includes a Mindfulness-based stress reduction program (MBSR)
over 8 weeks supervised by an experienced MBSR practitioner directly at
the clinic site and an operative guideline. It is expected that
practitioners with intervention show improved perceived and chronic
stress, occupational health, physical and mental function, higher
effort-reward balance, regeneration and quality of life. Primary and
secondary outcomes are measured by physiological parameters (heart rate
variability, saliva cortisol) and validated questionnaires and will be
assessed before (M1) and after (M2) the MBSR intervention and at a postal
follow-up 6 months later (M3). Physiological biomarkers in practitioners
will be assessed before (M1) and after intervention (M2) on two work days
and a two days off. Intervention effects in both groups (practitioners and
patients) will be evaluated separately using multivariate variance
analysis. Discussion(s): This study evaluates the effectiveness of
two stress management intervention programs for patients and practitioners
within cardiac catheter laboratory. Study will disclose strains during a
cardiac catheterization affecting both patients and practitioners. For
practitioners it may contribute to improved working conditions and
occupational safety, preservation of earning capacity, avoidance of
participation restrictions and loss of performance. In both groups less
anxiety, stress and complications before and during the procedures can be
expected. The study may add knowledge how to eliminate stressful exposures
and to contribute to more (psychological) security, less output losses and
exhaustion during work. The evolved stress management guidelines, training
manuals and the standardized patient education should be transferred into
clinical routines. Copyright © 2022 Block, Bonaventura, Grahn,
Bestgen and Wippert.

<108>
Accession Number
2019734816
Title
Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve
Implantation in the Contemporary Era: A Systematic Review.
Source
CJC Open. 4(9) (pp 792-801), 2022. Date of Publication: September 2022.
Author
Patel R.V.; Ravindran M.; Manoragavan R.; Sriharan A.; Wijeysundera H.C.
Institution
(Patel, Ravindran) Temerty Faculty of Medicine, University of Toronto,
Toronto, ON, Canada
(Patel, Sriharan, Wijeysundera) Institute for Health Policy, Management,
Evaluation, University of Toronto, Toronto, ON, Canada
(Manoragavan, Wijeysundera) Division of Cardiology, Department of
Medicine, Schulich Heart Program, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Wijeysundera) Sunnybrook Research Institute, University of Toronto,
Toronto, ON, Canada
(Wijeysundera) Institute for Clinical Evaluative Sciences, Toronto, ON,
Canada
Publisher
Elsevier Inc.
Abstract
Background: Despite transcatheter aortic valve implantation (TAVI)
becoming a widely accepted therapeutic option for the management of aortic
stenosis, post-procedure readmission rates remain high. Rehospitalization
is associated with negative patient outcomes, as well as increased
healthcare costs, and has therefore been identified as an important target
for quality improvement. Strategies to reduce the post-TAVI readmission
rate are needed but require the identification of patients at high risk
for rehospitalization. Our systematic review aims to identify predictors
of post-procedure readmission in patients eligible for TAVI.
 Method(s): We conducted a comprehensive search of the MEDLINE,
Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)
databases for the time period from 2015 to the present for articles
evaluating risk factors for rehospitalization post-TAVI with a follow-up
period of at least 30 days in adults age >= 70 years with aortic stenosis.
The quality of included studies was evaluated using the Newcastle-Ottawa
Scale. We present the results as a qualitative narrative review.
 Result(s): We identified 49 studies involving 828,528 patients.
Post-TAVI readmission is frequent, and rates vary (14.9% to 54.3% at 1
year). The most-frequent predictors identified for both 30-day and 1-year
post-TAVI readmission are atrial fibrillation, lung disease, renal
disease, diabetes mellitus, in-hospital life-threatening bleeding, and
non-femoral access. Conclusion(s): This systematic review identifies
the most-common predictors for 30-day and 1-year readmission post-TAVI,
including comorbidities and potentially modifiable procedural approaches
and complications. These predictors can be used to identify patients at
high-risk for readmission who are most likely to benefit from increased
support and follow-up post-TAVI. Copyright © 2022 The Authors

<109>
Accession Number
2012315363
Title
In search of optimal cardioplegia for minimally invasive valve surgery.
Source
Perfusion (United Kingdom). 37(7) (pp 668-674), 2022. Date of Publication:
October 2022.
Author
Russell S.; Butt S.; Vohra H.A.
Institution
(Russell, Vohra) Department of Cardiac Surgery/Cardiovascular Sciences,
Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
(Butt) Department of Perfusion Sciences, St George's Hospital, London,
United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Cardioplegic solutions are used in cardiac surgery to achieve controlled
cardiac arrest during operations, making surgery safer. Cardioplegia can
either be blood or crystalloid based, with perceived pros and cons of each
type. Whilst it is known that cardioplegia causes cardiac arrest, there is
debate over which cardioplegic solution provides the highest degree of
myocardial protection during arrest. Myocardial damage is measured
post-operatively by biomarkers such as serum TnT, TnI or CK-MB. It is
known that the outcomes of minimally invasive valve surgery are comparable
to full sternotomy valve operations. Despite there being a wide diversity
in use of different cardioplegic solutions across the world, this
comprehensive literature review found no superiority of one cardioplegic
solution over the other for myocardial protection during minimally
invasive valve procedures. Copyright © The Author(s) 2021.

<110>
Accession Number
2020406882
Title
PO141 / #879 EFFECT OF TRANSCUTANEOUS ELECTRO-STIMULATION IN AMBULATORY
POSTOPERATIVE REHABILITATION TREATMENT IN THORACIC SURGERY: A PROSPECTIVE
RANDOMIZED CLINICAL STUDY: E-POSTER VIEWING.
Source
Neuromodulation. Conference: International Neuromodulation Society 15th
World Congress. Barcelona Spain. 25(7 Supplement) (pp S272-S273), 2022.
Date of Publication: October 2022.
Author
Alamo-Arce D.; Ramirez R.M.; Del Pino Quintana-Montesdeoca M.; Freixinet
J.; Vilchez M.
Institution
(Alamo-Arce) University of Las Palmas de Gran Canaria, Quirugical and
Clinical Science Department, Las Palmas, Spain
(Ramirez, Del Pino Quintana-Montesdeoca, Freixinet, Vilchez) University of
Las Palmas de Gran Canaria, Department Of Medical And Surgical Sciences,
Las Palmas, Spain
Publisher
Elsevier B.V.
Abstract
Introduction: Chest pain is one of the most difficult problems to solve
after thoracic surgery. Its correct control is often quite difficult,
which can cause complications due to an ineffective cough and superficial
respiratory movements. It could provoke secretion retention, lung
atelectasis, and even pneumonia. In addition, insufficient treatment of
postoperative pain also causes a slower recovery of mobility, delaying the
incorporation to daily life activities. Transcutaneous electrical
stimulation (TENS) is a technique that attempts to establish pain control
by applying electrical current through superficial electrodes. It is based
on the control gate theory of Melzack and Wall. Materials / Methods: In
order to assess the efficacy of transcutaneous electrical stimulation
(TENS) in postoperative recovery after thoracic surgery, a prospective and
randomized study has been developed. The patients (n=109) have been
treated after hospital discharge with physical therapy for 3 weeks. Three
groups have been established: experimental (n = 37), control (n = 35) and
placebo (n = 37), experimental and placebo included TENS application
during the physical therapy protocol. Postoperative pain (McGill test) and
spirometry have been studied before and after treatment. Result(s):
The statistical study was analysed by the Student's t test, in case of
compliance with normality, or the non-parametric Wilcoxon test, otherwise.
A decrease in pain and increase in spirometry data were found in the
experimental group. The greatest discrepancy among groups occurred between
the experimental and the control group,16.77 points (p <0.001). Spirometry
has shown an improvement in FVC (27.11%) and FEV1 (28.68%) (P <0.001) of
the experimental group, which was statistically significant with respect
to the other groups. There have been no complications from the technique.
 Discussion(s): With the use of TENS, a significant decrease in pain
during walking and deep breathing has been described, as well as an
increase in exercise capacity when associated with drug treatment. In this
study, we have attempted to make use of these effects, which may be
responsible for the positive results obtained. The fact that TENS is an
easy-to-apply treatment makes its combination with physical therapy, from
a practical point of view, very simple. Conclusion(s): In conclusion,
the use of TENS, as an adjunctive treatment, has led to an improvement in
pain control and spirometry values in postoperative thoracic surgical
patients, without producing side effects with the technique. Therefore,
its utilization may be recommended in the early outpatient rehabilitation
treatment of patients discharged from hospital after thoracic surgery.
Learning Objectives: - With the use of TENS, a significant decrease in
pain during walking and deep breathing has been described, as well as an
increase in exercise capacity when associated with drug treatment. - The
fact that TENS as a neuromodulator is an easy-to-apply treatment makes its
combination with physical therapy, from a practical point of view, very
simple. - The TENS utilization may be recommended in the early outpatient
rehabilitation treatment of patients discharged from hospital after
thoracic surgery. Keywords: neuromodulation, TENS, postsurgical pain,
thoracic surgery Copyright © 2022

<111>
Accession Number
2020406730
Title
/ #828 THE EXPERIENCE OF PERIOPERATIVE SPINAL CORD STIMULATION TO PREVENT
POST-CABG ATRIAL FIBRILLATION: TRACK 4: CARDIOVASCULAR DISORDERS / NEURAL
ENGINEERING.
Source
Neuromodulation. Conference: International Neuromodulation Society 15th
World Congress. Barcelona Spain. 25(7 Supplement) (pp S136-S137), 2022.
Date of Publication: October 2022.
Author
Murtazin V.; Romanov A.; Kiselev R.; Lomivorotov V.; Chernyavskiy A.
Institution
(Murtazin, Kiselev) National Medical Research Center n. a. acad. E. N.
Meshalkin, Neurosurgery, Novosibirsk, Russian Federation
(Romanov) National Medical Research Center n. a. acad. E. N. Meshalkin,
Arythmology, Novosibirsk, Russian Federation
(Lomivorotov) National Medical Research Center n. a. acad. E. N.
Meshalkin, Anaesthesiology, Novosibirsk, Russian Federation
(Chernyavskiy) National Medical Research Center n. a. acad. E. N.
Meshalkin, Cardiosurgery, Novosibirsk, Russian Federation
Publisher
Elsevier B.V.
Abstract
Introduction: Spinal cord stimulation (SCS) is effective in the treatment
of chronic pain and intractable angina pectoris. Recently, animal studies
have demonstrated that SCS can also suppress atrial fibrillation (AF). Our
study aimed to test the safety and efficacy of temporary SCS to prevent
the occurrence of AF in the early postoperative period in patients
undergoing elective coronary artery bypass grafting (CABG). Materials /
Methods: Fifty-two patients with indications for CABG and history of
paroxysmal AF were randomized to 2 groups: CABG plus standard medical
therapy (MED) with beta-blockers (n=26, Control group) and CABG plus MED
plus the percutaneous lead placement for temporary SCS (n=26, SCS group).
In the SCS group under local anaesthesia and with fluoroscopic guidance,
temporary leads were placed at C7-T4 level according to the patient's
sense of paresthesia and connected to a trial stimulator. Temporary SCS
was begun 3 days before elective CABG, deactivated during surgery,
reactivated in the intensive care unit after CABG, and continued for 7
days at which time the leads were removed. Continuous external ECG
monitoring was performed for 30 days after CABG in all patients. These
primary objectives were tested over the 30-day postoperative period: 1)
occurrence of adverse events, including death, stroke or TIA, myocardial
infarction and kidney injury; and 2) occurrence of AF or any atrial
tachyarrhythmia lasting more than 30 seconds. Result(s): Percutaneous
lead placement for temporary SCS was successfully performed in all 26
patients before CABG without any complications. There were no adverse
events related to temporary SCS in any patient throughout follow-up. There
were no significant differences in CKMB and creatinine levels between
groups (p=0.1 and 0.2, respectively) as well as other typical CABG-related
complications (p>0.05). Postoperative AF occurred in 8 (30.7%) of 26
patients in the Control group versus only 1 (3.8%) of 26 patients in the
SCS group (p=0.012, log-rank test). Discussion(s): Though SCS is a
minimally invasive procedure, it could have complications, but in our
study, we avoid them. We use conventional SCS in these patients with
paresthesia feelings in the chest; hence the effect of SCS with other
types of stimulation (burst or high frequency/density) is the other
direction of exploration in this question. Conclusion(s): Temporary
SCS was effective in suppressing postoperative AF after CABG without any
adverse events in this study. Further studies of SCS with larger samples
are indicated to test its clinical value as a perioperative intervention.
Learning Objectives: 1. The new possibility of neuromodulation therapy as
the new assistance in cardiothoracic surgery. 2. Prediction of benefits of
combined therapy for cardiovascular patients. 3. Discussion of the
modality of neuromodulation technologies applying for treating
cardiovascular patients. Keywords: Spinal cord stimulation, Chronic Pain,
atrial fibrillation, CABG Copyright © 2022

<112>
Accession Number
2020113255
Title
TCT-457 Outcomes of Prosthesis-Patient Mismatch After Transcatheter Aortic
Valve Implantation: A Meta-Analysis of Kaplan-Meier-Derived Individual
Patient Data.
Source
Journal of the American College of Cardiology. Conference: Thirty-Fourth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Boston
United States. 80(12 Supplement) (pp B184), 2022. Date of Publication: 20
Sep 2022.
Author
Sa M.P.; Jacquemyn X.; Tasoudis P.; Van den Eynde J.; Erten O.; Dokollari
A.; Sicouri S.; Clavel M.-A.; Pibarot P.; Ramlawi B.
Institution
(Sa, Ramlawi) Lankenau Heart Institute, PA, Philadelphia, United States
(Jacquemyn, Van den Eynde) KU Leuven, Leuven, Belgium
(Tasoudis, Erten, Dokollari, Sicouri) Lankenau Institute for Medical
Research, Wynnewood, PA, United States
(Clavel) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, Quebec, Canada
(Pibarot) Quebec Heart and Lung Institute, Quebec City, QC, Canada
Publisher
Elsevier Inc.
Abstract
Background: It remains controversial whether prosthesis-patient mismatch
(PPM) (in general considered moderate if iEOA is 0.65-0.85
cm2/m2 and severe when <0.65
cm2/m2) impacts the outcomes after transcatheter
aortic valve replacement (TAVR). Method(s): To evaluate the
time-varying effects and association of PPM with the risk of overall
mortality, we performed a study-level meta-analysis of reconstructed
time-to-event data derived from Kaplan-Meier curves of studies published
by December 30, 2021. Result(s): Twenty-three studies met our
eligibility criteria and included a total of 81,969 patients included in
the Kaplan-Meier curves (19,612 with PPM and 62,357 without PPM). Patients
with moderate/severe PPM had a significantly higher risk of mortality
compared with those without PPM (HR: 1.09; 95% CI: 1.04-1.14; P < 0.001).
In the first 30 months after the procedure, mortality rates were
significantly higher in the moderate/severe PPM group (HR: 1.1; 95% CI:
1.05-1.16; P < 0.001). In contrast, the landmark analysis beyond 30 months
yielded a reversal of the HR (0.83; 95% CI: 0.0.68-1.01; P = 0.064) but
without statistical significance. In the sensitivity analysis, while we
observed that severe PPM showed higher risk of mortality compared with no
PPM (HR: 1.25; 95% CI: 1.16-1.36; P < 0.001), we did not observe a
statistically significant difference for mortality between moderate PPM
and no PPM (HR: 1.03; 95% CI: 0.96-1.10; P = 0.398). Conclusion(s):
Severe PPM, but not moderate PPM, was associated with higher risk of
mortality after TAVR. These results provide support to implementation of
preventive strategies to avoid severe PPM after TAVR. Categories:
STRUCTURAL: Valvular Disease: Aortic Copyright © 2022

<113>
Accession Number
2020113248
Title
TCT-196 PCI Versus CABG for Left Main Disease in Patients Presenting With
Versus Without an Acute Coronary Syndrome.
Source
Journal of the American College of Cardiology. Conference: Thirty-Fourth
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Boston
United States. 80(12 Supplement) (pp B79), 2022. Date of Publication: 20
Sep 2022.
Author
Gaba P.; Christiansen E.; Murphy S.; O'Gara P.; Serruys P.; Kappetein A.;
Park S.-J.; Park D.-W.; Stone G.; Sabatine M.; Holm N.; Bergmark B.
Institution
(Gaba, Murphy, O'Gara, Sabatine, Bergmark) Brigham and Women's Hospital,
MA, Boston, United States
(Christiansen, Holm) Aarhus University Hospital, Skejby, Aarhus, Denmark
(Serruys) National University of Ireland Galway, Galway, Ireland
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Park, Park) Asan Medical Center, Seoul, South Korea
(Stone) Mount Sinai Heart Health System, New York, New York, United States
Publisher
Elsevier Inc.
Abstract
Background: The optimal revascularization strategy for patients with left
main coronary artery (LM) disease presenting with acute coronary syndromes
(ACS) is debated. Method(s): Data from 4 trials comparing PCI with
drug-eluting stents versus coronary artery bypass grafting (CABG) in
patients with LM disease (SYNTAX, PRECOMBAT, NOBLE, and EXCEL) were
pooled. Patients were categorized as with or without ACS at the time of
index revascularization. Kaplan-Meier event rates through 5 years and Cox
model HRs were generated. Interactions between randomized treatment effect
and ACS status were tested. Result(s): Among 4,394 patients
randomized to PCI or CABG, 1,960 (45%) had ACS. Patients with ACS were
more likely to have diabetes, prior myocardial infarction (MI), left
ventricular ejection fraction < 50%, and higher SYNTAX scores. Median time
to revascularization was longer for CABG in patients with (4 vs 1 day) and
without (5 vs 1 day) ACS. A significant interaction was present among PCI
vs CABG, ACS presentation, and 5-year mortality (with ACS: 10.6% vs 12.2%;
HR: 0.85 [95% CI: 0.65-1.11]; without ACS: 11.6% vs 8.6%; HR: 1.38 [95%
CI: 1.06-1.78]; P<inf>int</inf> = 0.011; Figure A). Risk for stroke tended
to be lower with PCI in patients with ACS (HR: 0.60; 95% CI: 0.35-1.03)
but not in patients without ACS (HR: 1.13; 95% CI: 0.69-1.86)
(P<inf>int</inf> = 0.09) (Figure B). Procedural MI rates were lower, and
spontaneous MI and repeat revascularization rates were higher with PCI
regardless of ACS presentation. [Formula presented] Conclusion(s):
Among patients undergoing LM revascularization, those with ACS had greater
comorbidities and coronary complexity than those without ACS. Nonetheless,
outcomes with PCI compared favorably with CABG in this high-risk subgroup.
In contrast, among patients without ACS, CABG reduced mortality. These
results are hypothesis generating and should be confirmed in prospective
studies. Categories: CORONARY: Acute Coronary Syndromes Copyright
© 2022

<114>
Accession Number
2020416707
Title
Antithrombotic Strategy After Transcatheter Aortic Valve Replacement: A
Network Meta-Analysis.
Source
Current Problems in Cardiology. 47(12) (no pagination), 2022. Article
Number: 101348. Date of Publication: December 2022.
Author
Mahalwar G.; Kumar A.; Majmundar M.; Adebolu O.; Yendamuri R.; Lao N.;
Barve N.; Kreutz R.P.; Reed G.W.; Puri R.; Dani S.S.; Kalra A.
Institution
(Mahalwar, Kumar, Adebolu, Yendamuri, Lao, Barve) Department of Medicine,
Cleveland Clinic Akron General, Akron, OH, United States
(Majmundar) Department of Cardiovascular Medicine, Maimonides Medical
Center, New York, NY, United States
(Kreutz) Division of Cardiovascular Medicine, Krannert Cardiovascular
Research Center, Indiana University School of Medicine, Indianapolis, IN,
United States
(Reed, Puri) Department of Cardiovascular Medicine, Heart, Vascular,
Thoracic Institute, Cleveland Clinic, Cleveland, OH
(Dani) Department of Cardiovascular Medicine, Lahey Hospital & Medical
Center, Burlington, MA
(Kalra) Division of Cardiology, Department of Medicine, Cardiovascular
Institute, Kalra Hospitals, New Delhi, India
Publisher
Elsevier Inc.
Abstract
The ideal antithrombotic therapy post transcatheter aortic valve
replacement (TAVR) remains uncertain. We performed a network meta-analysis
of RCTs to report the outcomes with various antithrombotic strategies to
determine the optimal therapy. A systematic search of the PubMed/Medline
and Cochrane databases was performed through January 6, 2022. The primary
outcome was stroke and the secondary outcomes were major/life-threatening
bleeding, myocardial infarction, all-cause mortality, and cardiac
mortality. A network meta-analysis was conducted with a random-effects
model. All analysis was carried out using R version 4.0.3. Six RCTs were
included in the final analysis. SAPT when compared with DAPT was
associated with a reduced risk of major or life-threatening bleeding [OR:
0.42; 95% CI: 0.25-0.70]. Other antithrombotic strategies were associated
with similar odds of major and life-threatening bleeding post TAVR
compared with DAPT. There was no difference in the incidence of stroke,
myocardial infarction, all-cause and cardiac mortality between the various
antithrombotic strategies post TAVR. The present analysis reported SAPT as
the preferred antithrombotic regimen post TAVR compared with other
regimens in patients who do not have other indications for
anticoagulation. Additional studies such as ADAPT-TAVR, CLOE and ATLANTIS
trials will further add to our understanding of the adequate
antithrombotic regimen post TAVR in patients with otherwise no indication
for anticoagulation. Copyright © 2022 Elsevier Inc.

<115>
Accession Number
2013254253
Title
Comparison of Nebulized Versus Intravenous Milrinone on Reducing Pulmonary
Arterial Pressure in Patients with Pulmonary Hypertension Candidate for
Open-cardiac Surgery: A Double-Blind Randomized Clinical Trial.
Source
Anesthesiology and Pain Medicine. 12(3) (no pagination), 2022. Article
Number: e122994. Date of Publication: Jun 2022.
Author
Jorairahmadi S.; Javaherforooshzadeh F.; Babazadeh M.; Gholizadeh B.;
Bakhtiari N.
Institution
(Jorairahmadi, Javaherforooshzadeh) Department of Anesthesiology, Faculty
of Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran,
Islamic Republic of
(Babazadeh) Department of Biochemistry, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Babazadeh, Gholizadeh, Bakhtiari) Ahvaz Anesthesiology and Pain Research
Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
Islamic Republic of
(Gholizadeh) Atherosclerosis Research Center, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran, Islamic Republic of
Publisher
Brieflands
Abstract
Background: Regardless of the cause, pulmonary hypertension can increase
patient complications and mortality. This study com-pared the effect of
nebulized versus intravenous (IV) milrinone on reducing pulmonary arterial
pressure in patients with pulmonary hypertension candidates for
open-cardiac surgery. Method(s): This double-blind, randomized
clinical trial was performed on 32 patients undergoing elective on-pump
cardiac surgery during January 2021-January 2022 in the Cardiac Operating
Room of Golestan Hospital, Ahvaz, Iran. Patients were randomly divided
into test groups nebulize milrinone (N = 16) and IV milrinone (N = 16).
The medication was administered after the cross-clamp of the aorta
opening. The outcome variables included hemodynamic data, cardiac output,
cardiac index, stroke volume, mean arterial pressure (MAP), central venous
pressure, mean pulmonary artery pressure (mPAP), systemic vascular
resistance, pulmonary vascular resistance, MAP/mPAP ratio, time until
extubation, duration of hospitalization in the Intensive Care Unit (ICU),
and duration of hospital stay. Result(s): In the nebulized group, MAP
and MAP/mPAP were significantly higher than in the IV milrinone group (P =
0.09 and P < 0.0001, respectively). The time of extubation (P = 0.001),
duration of hospitalization in the ICU (P = 0.009), and duration of
hospital stay (P = 0.026) in the nebulized milrinone group were
significantly shorter than in the IV milrinone group. Conclusion(s):
Nebulized milrinone administration before weaning off cardiopulmonary
bypass (CPB) can be accelerated and facili-tate weaning off CPB. Moreover,
despite maintaining MAP, nebulized milrinone significantly reduces mPAP.
According to the results of this study, nebulized milrinone is recommended
in patients undergoing cardiac surgery with pulmonary
hypertension. Copyright © 2022, Author(s).

<116>
Accession Number
2019212127
Title
Optimal Timing for Cardiac Surgery in Infective Endocarditis with
Neurological Complications: A Narrative Review.
Source
Journal of Clinical Medicine. 11(18) (no pagination), 2022. Article
Number: 5275. Date of Publication: September 2022.
Author
Siquier-Padilla J.; Cuervo G.; Urra X.; Quintana E.; Hernandez-Meneses M.;
Sandoval E.; Lapena P.; Falces C.; Mestres C.A.; Paez-Carpio A.; Moreno
A.; Miro J.M.
Institution
(Siquier-Padilla) Cardiology Department, Health Research Institute of the
Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma de
Mallorca 07120, Spain
(Cuervo, Hernandez-Meneses, Moreno, Miro) Infectious Diseases Department,
Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona 08036, Spain
(Cuervo, Moreno, Miro) Centro de Investigacion Biomedica en Red de
Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III,
Madrid 28029, Spain
(Urra) Functional Unit of Cerebrovascular Diseases, Institute of
Neurosciences, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona
08036, Spain
(Quintana, Sandoval) Cardiovascular Surgery Department, Hospital
Clinic-IDIBAPS, University of Barcelona, Barcelona 08036, Spain
(Lapena) Faculty of Medicine and Health Sciences, University of Barcelona,
Barcelona 08036, Spain
(Falces) Cardiology Department, Hospital Clinic-IDIBAPS, University of
Barcelona, Barcelona 08036, Spain
(Mestres) Cardiothoracic Surgery Department, The University of the Free
State, Bloemfontein 9300, South Africa
(Paez-Carpio) Radiology Department, Diagnostic Imaging Center (CDI),
Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona 08036, Spain
Publisher
MDPI
Abstract
In patients with infective endocarditis and neurological complications,
the optimal timing for cardiac surgery is unclear due to the varied risk
of clinical deterioration when early surgery is performed. The aim of this
review is to summarize the best evidence on the optimal timing for cardiac
surgery in the presence of each type of neurological complication. An
English literature search was carried out from June 2018 through July
2022. The resulting selection, comprising observational studies, clinical
trials, systematic reviews and society guidelines, was organized into four
sections according to the four groups of neurological complications:
ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac
surgery could be performed without delay in cases of ischemic vascular
neurological complication (provided the absence of severe damage, which
can be avoided with the performance of mechanical thrombectomy in cases of
major stroke), as well as infectious or asymptomatic complications. In the
presence of intracranial hemorrhage, a delay of four weeks is recommended
for most cases, although recent studies have suggested that performing
cardiac surgery within four weeks could be a suitable option for selected
cases. The findings of this review are mostly in line with the
recommendations of the current European and American infective
endocarditis guidelines. Copyright © 2022 by the authors.

<117>
Accession Number
639115706
Title
A 20-year experience in cardiac tumors: a single center surgical
experience and a review of literature.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2022. Date of Publication: 01 Sep 2022.
Author
Restivo L.; De Luca A.; Fabris E.; Pagura L.; Pierri A.; Korcova R.;
Franzese I.; Fiocco A.; Rauber E.; Mazzaro E.; Bussani R.; Belgrano M.;
Pappalardo A.; Sinagra G.
Institution
(Restivo, De Luca, Fabris, Pagura, Pierri, Korcova, Sinagra)
Cardiothoracovascular Department, Division of Cardiology, Azienda
Sanitaria Universitaria Giuliano Isontina and University of Trieste
(Franzese, Fiocco, Rauber, Mazzaro, Pappalardo) Cardiothoracovascular
Department, Division of Cardiac Surgery, Azienda Sanitaria Universitaria
Giuliano Isontina, Trieste, Italy
(Fiocco) Department of Surgical, Medical and Molecular Pathology and
Critical Care, Division of Cardiac Surgery, University of Pisa, Pisa,
Italy
(Bussani) Pathology Department, Azienda Sanitaria Universitaria Giuliano
Isontina and University of Trieste
(Belgrano) Department of Radiology, Azienda Sanitaria Universitaria
Integrata and University of Trieste, Trieste, Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Cardiac tumors are rare and heterogeneous entities which
still remain a diagnostic and therapeutic challenge. The treatment for
most cardiac tumors is prompt surgical resection. We sought to provide an
overview of surgical results from a series of consecutive patients treated
at our tertiary care center during almost a 20-year experience. METHODS
AND RESULTS: In this single center study, 55 consecutive patients with
diagnosis of cardiac tumor underwent surgical treatment from January 2002
to April 2021. Of these, 23 (42%) were male and the mean age was 62 +/- 12
years. Fifteen (27%) patients were symptomatic at the time of the
diagnosis, mostly for dyspnea and palpitations. The most frequent benign
cardiac tumor was myxoma (32; 58%), occurring mainly in the left atrium
(31; 97%). Pleomorphic sarcoma was the most frequent primary malignant
cardiac tumor (4; 7%), mainly located in the ventricles (1; 25% in the
left ventricle; 2; 50% in the right ventricle). In all cases of benign
tumors surgery was successful with no relapses. Two (50%) pleomorphic
sarcomas showed subsequent relapses. After a median follow-up of 44
months, 15 (27%) patients died. Although malignant tumors presented a
limited survival, benign tumors showed a very good prognosis.
 CONCLUSION(S): Cardiac tumors require a multidisciplinary approach to
guarantee a prompt diagnosis and appropriate treatment. In our surgical
experience, outcome after surgery of benign tumors was excellent, while
malignant tumors had poor prognosis despite radical surgery. Copyright
© 2022 Italian Federation of Cardiology - I.F.C. All rights reserved.

<118>
Accession Number
639115533
Title
The prognostic value of previous coronary stent implantation in patients
undergoing myocardial revascularization surgery.
Source
Current vascular pharmacology. (no pagination), 2022. Date of
Publication: 26 Sep 2022.
Author
Villaescusa-Catalan J.M.; Rodriguez-Capitan J.; Sanz-Sanchez C.I.;
Sanchez-Espin G.; Guerrero-Orriach J.L.; Moron F.J.P.; Fernandez-Romero
L.; Melero-Tejedor J.M.; Such-Martinez M.; Porras-Martin C.;
Jimenez-Navarro M.
Institution
(Villaescusa-Catalan, Rodriguez-Capitan, Sanchez-Espin, Moron,
Melero-Tejedor, Such-Martinez, Porras-Martin, Jimenez-Navarro) Unidad de
Gestion Clinica de Cardiologia y Cirugia Cardiovascular, Hospital
Universitario Virgen de la Victoria, Universidad de Malaga, Instituto de
Investigacion Biomedica de Malaga (IBIMA). Malaga, Spain
(Villaescusa-Catalan, Rodriguez-Capitan, Sanz-Sanchez, Sanchez-Espin,
Guerrero-Orriach, Moron, Fernandez-Romero, Melero-Tejedor, Such-Martinez,
Porras-Martin, Jimenez-Navarro) Centro de Investigacion Biomedica en Red
de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III.
Madrid, Spain
(Sanz-Sanchez, Fernandez-Romero) Hospital Universitario Virgen de la
Victoria, Universidad de Malaga, Instituto de Investigacion Biomedica de
Malaga (IBIMA). Malaga, Spain
(Guerrero-Orriach) Unidad de Anestesiologia y Reanimacion, Hospital
Universitario Virgen de la Victoria, Universidad de Malaga, Instituto de
Investigacion Biomedica de Malaga (IBIMA). Malaga, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND: Currently, there are studies underway to determine whether
coronary stent implantation with percutaneous transluminal coronary
angioplasty prior to a coronary artery bypass graft (CABG) influences the
prognosis of surgery. The aim of this study was to assess both the need
for future revascularisation or all-cause mortalityas composite endpoint
after CABG surgery among patients with a previous stent implantation.
 METHOD(S): A retrospective, non-randomised study was performed in 721
patients, who underwent CABGin our centre between 2012 and 2017.This
single-centre study compared two groups: 1) the previous stent group,
patients with previous stent implantation (n=144), and, 2) the
non-previous stent group, patients without previous stent implantation
(n=577). RESULT(S): After a median follow-up of 36 months, the
previous stent group presented a decreased combined event-free survival at
1, 3 and 5 years compared with the non-previous stent group (67.4, 43.5
and 23.0%vs 91.0, 80.3 and 63.0%, respectively; p<0.01). There was also
higher mortality in the previous stent groupthan in the non-previous
stentgroup (96.1, 90.5 and 79.4 vs 91.9, 75.9 and 51.0, respectively;
p=0.01). The multivariable analysis of demographics, baseline comorbidity
and surgical data showed previous stent implantation as an
independentpredictorof the composite endpoint (Hazard Ratio=3.00 and 95%
confident interval=2.09-4.32; p<0.01). CONCLUSION(S): Patients with
percutaneous coronary intervention prior to CABG present higher
comorbidities and clinical eventsduring follow-up than those who do not
undergo stenting. Copyright© Bentham Science Publishers; For any
queries, please email at epub@benthamscience.net.

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