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<1>
Accession Number
2021411439
Title
Clinical utility of demoralization: A systematic review of the literature.
Source
Clinical Psychology Review. 99 (no pagination), 2023. Article Number:
102227. Date of Publication: February 2023.
Author
Agnieszka W.; Fiammetta C.
Institution
(Agnieszka) Department of Geriatrics, Faculty of Health Sciences,
Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun,
Jurija Gagarina 11, Torun 87-100, Poland
(Fiammetta) Department of Health Sciences, University of Florence, via di
San salvi n. 12, Florence, Italy
(Fiammetta) Department of Psychiatry and Neuropsychology, Maastricht
University, PO Box 616 6200, MD, Maastricht, Netherlands
Publisher
Elsevier Inc.
Abstract
Demoralization is a complex clinical phenomenon which has raised a growing
interest in clinical and research realms. The present systematic review of
the literature aimed at (1) updating on demoralization prevalence in
different populations, (2) identifying the instruments more largely used
to assess demoralization, and (3) verifying whether new tools of
assessment have been proposed. PubMed and Web of Science were searched
from inception to April 2022. Search terms were:
demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA
guidelines were followed. GRADE rating system was used. A total of 188
papers were included. Demoralization appeared to be a distinctive
psychological state common in medical, psychiatric, and non-clinical
settings, thus not limited to life-threatening diseases. Diagnostic
Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS)
are the most commonly used tools to assess it. DCPR allow to diagnose
demoralization as a manifestation of dealing with chronic stress. DS
captures dimensionally a psychological distress related to end of life.
Demoralization is associated with clinical features encompassing
allostatic overload, quality of life, wellbeing/euthymia. Implications on
health outcomes and treatment are discussed. Demoralization warrants
careful consideration in clinical contexts through valid assessment
procedures. DCPR are recommended to diagnose it, DS can be helpful to
capture clinical details. Copyright © 2022 Elsevier Ltd

<2>
Accession Number
2021644759
Title
Extended, virtual and augmented reality in thoracic surgery: A systematic
review.
Source
Interactive Cardiovascular and Thoracic Surgery. 34(2) (pp 201-211), 2022.
Date of Publication: 01 Feb 2022.
Author
Arjomandi Rad A.; Vardanyan R.; Thavarajasingam S.G.; Zubarevich A.; Van
Den Eynde J.; Sa M.P.B.O.; Zhigalov K.; Sardiari Nia P.; Ruhparwar A.;
Weymann A.
Institution
(Arjomandi Rad, Vardanyan, Thavarajasingam) Department of Medicine,
Faculty of Medicine, Imperial College London, London, United Kingdom
(Zubarevich, Zhigalov, Ruhparwar, Weymann) Department of Thoracic and
Cardiovascular Surgery, West German Heart and Vascular Center Essen,
University Hospital of Essen, University Duisburg-Essen, Essen, Germany
(Van Den Eynde) Department of Cardiovascular Diseases, University
Hospitals Leuven, Leuven, Belgium
(Sa) Department of Cardiovascular Surgery, Pronto Socorro Cardiologico de
Pernambuco (PROCAPE), University of Pernambuco, Recife, Brazil
(Sardiari Nia) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Extended reality (XR), encompassing both virtual reality (VR)
and augmented reality, allows the user to interact with a
computer-generated environment based on reality. In essence, the immersive
nature of VR and augmented reality technology has been warmly welcomed in
all aspects of medicine, gradually becoming increasingly feasible to
incorporate into everyday practice. In recent years, XR has become
increasingly adopted in thoracic surgery, although the extent of its
applications is unclear. Here, we aim to review the current applications
of XR in thoracic surgery. METHOD(S): A systematic database search
was conducted of original articles that explored the use of VR and/or
augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane
database and Google Scholar, from inception to December 2020.
 RESULT(S): Our search yielded 1494 citations, of which 21 studies
published from 2007 to 2019 were included in this review. Three main areas
were identified: (i) the application of XR in thoracic surgery training;
(ii) preoperative planning of thoracic procedures; and (iii)
intraoperative assistance. Overall, XR could produce progression along the
learning curve, enabling trainees to reach acceptable standards before
performing in the operating theatre. Preoperatively, through the
generation of 3D-renderings of the thoracic cavity and lung anatomy, VR
increases procedural accuracy and surgical confidence through
familiarization of the patient's anatomy. XR-Assisted surgery may have
therapeutic use particularly for complex cases, where conventional methods
would yield inadequate outcomes due to inferior accuracy.
 CONCLUSION(S): XR represents a salient step towards improving
thoracic surgical training, as well as enhancing preoperative planning and
intraoperative guidance. Copyright © 2021 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<3>
Accession Number
639238907
Title
Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac
Procedures: The UNIVERSAL Randomized Clinical Trial.
Source
JAMA Cardiology. 7(11) (pp 1110-1118), 2022. Date of Publication: 09 Nov
2022.
Author
Jolly S.S.; Alrashidi S.; D'Entremont M.-A.; Alansari O.; Brochu B.;
Heenan L.; Skuriat E.; Tyrwhitt J.; Raco M.; Tsang M.; Valettas N.;
Velianou J.L.; Sheth T.; Sibbald M.; Mehta S.R.; Pinilla-Echeverri N.;
Schwalm J.D.; Natarajan M.K.; Kelly A.; Akl E.; Tawadros S.; Camargo M.;
Faidi W.; Bauer J.; Moxham R.; Nkurunziza J.; Dutra G.; Winter J.
Institution
(Jolly, D'Entremont, Heenan, Skuriat, Tyrwhitt, Sheth, Mehta,
Pinilla-Echeverri, Schwalm, Natarajan) Population Health Research
Institute, Hamilton, ON, Canada
(Jolly, Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth,
Sibbald, Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Nkurunziza,
Dutra) McMaster University, Hamilton, ON, Canada
(Jolly, Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth,
Sibbald, Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Tawadros,
Camargo, Faidi, Bauer, Moxham, Nkurunziza, Dutra) Hamilton Health
Sciences, Hamilton, ON, Canada
(Jolly, Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth,
Sibbald, Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Nkurunziza)
Niagara Health, ON, Canada
(D'Entremont) Centre Hospitalier Universitaire de Sherbrooke (CHUS),
Sherbrooke, QC, Canada
(Brochu) CK Hui Heart Centre, Royal Alexandra Hospital Edmonton, Edmonton,
AB, Canada
(Akl) McGill University Faculty of Medicine and Health Sciences, Montreal,
QC, Canada
(Winter) Departamento de Enfermedades Cardiovasculares, Clinica Alemana de
Santiago, Universidad Del Desarrollo, Chile
Publisher
American Medical Association
Abstract
Importance: A significant limitation of femoral artery access for cardiac
interventions is the increased risk of vascular complications and bleeding
compared with radial access. Strategies to make femoral access safer are
needed. Objective(s): To determine whether routinely using
ultrasonography guidance for femoral arterial access for coronary
angiography/intervention reduces bleeding or vascular complications.
 Design, Setting, and Participant(s): The Routine Ultrasound Guidance
for Vascular Access for Cardiac Procedures (UNIVERSAL) randomized clinical
trial is a multicenter, prospective, open-label trial of
ultrasonography-guided femoral access vs no ultrasonography for coronary
angiography or intervention with planned femoral access. Patients were
randomized from June 26, 2018, to April 26, 2022. Patients with
ST-elevation myocardial infarction were not eligible.
 Intervention(s): Ultrasonography guidance vs no ultrasonography
guidance for femoral arterial access on a background of fluoroscopic
landmarking. Main Outcomes and Measures: The primary composite
outcome is the composite of major bleeding based on the Bleeding Academic
Research Consortium 2, 3, or 5 criteria or major vascular complications
within 30 days. Result(s): A total of 621 patients were randomized at
2 centers in Canada (mean [SD] age, 71 [10.24] years; 158 [25.4%] female).
The primary outcome occurred in 40 of 311 patients (12.9%) in the
ultrasonography group vs 50 of 310 patients (16.1%) without
ultrasonography (odds ratio, 0.77 [95% CI, 0.49-1.20]; P =.25). The rates
of Bleeding Academic Research Consortium 2, 3, or 5 bleeding were 10.0%
(31 of 311) vs 10.7% (33 of 310) (odds ratio, 0.93 [95% CI, 0.55-1.56]; P
=.78). The rates of major vascular complications were 6.4% (20 of 311) vs
9.4% (29 of 310) (odds ratio, 0.67 [95% CI, 0.37-1.20]; P =.18).
Ultrasonography improved first-pass success (277 of 311 [86.6%] vs 222 of
310 [70.0%]; odds ratio, 2.76 [95% CI, 1.85-4.12]; P <.001) and reduced
the number of arterial puncture attempts (mean [SD], 1.2 [0.5] vs 1.4
[0.8]; mean difference, -0.26 [95% CI, -0.37 to -0.16]; P <.001) and
venipuncture (10 of 311 [3.1%] vs 37 of 310 [11.7%]; odds ratio, 0.24 [95%
CI, 0.12-0.50]; P <.001) with similar times to access (mean [SD], 114
[185] vs 129 [206] seconds; mean difference, -15.1 [95% CI, -45.9 to
15.8]; P =.34). All prerandomization prespecified subgroups were
consistent with the overall finding. Conclusions and Relevance: In
this randomized clinical trial, use of ultrasonography for femoral access
did not reduce bleeding or vascular complications. However,
ultrasonography did reduce the risk of venipuncture and number of
attempts. Larger trials may be required to demonstrate additional
potential benefits of ultrasonography-guided access. Trial Registration:
ClinicalTrials.gov Identifier: NCT03537118. Copyright © 2022
American Medical Association. All rights reserved.

<4>
Accession Number
2021287930
Title
Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction.
Source
New England Journal of Medicine. 387(15) (pp 1351-1360), 2022. Date of
Publication: 13 Oct 2022.
Author
Perera D.; Clayton T.; O'Kane P.D.; Greenwood J.P.; Weerackody R.; Ryan
M.; Morgan H.P.; Dodd M.; Evans R.; Canter R.; Arnold S.; Dixon L.J.;
Edwards R.J.; De Silva K.; Spratt J.C.; Conway D.; Cotton J.; McEntegart
M.; Chiribiri A.; Saramago P.; Gershlick A.; Shah A.M.; Clark A.L.; Petrie
M.C.
Institution
(Perera, Ryan, Morgan, Chiribiri, Shah) The National Institute for Health
and Care Research, Biomedical Research Centre, The British Heart
Foundation Centre of Research Excellence, School of Cardiovascular and
Metabolic Medicine and Sciences, King's College London, London, United
Kingdom
(Perera, Arnold, De Silva) Guy's and St. Thomas' NHS Foundation Trust,
London, United Kingdom
(Clayton, Dodd, Evans, Canter) The London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Weerackody) Barts Health NHS Trust, London, United Kingdom
(Spratt) St. George's University Hospitals NHS Foundation Trust, London,
United Kingdom
(Shah) King's College Hospital NHS Foundation Trust, London, United
Kingdom
(O'Kane) University Hospitals Dorset NHS Foundation Trust, Bournemouth,
United Kingdom
(Greenwood) Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
(Dixon) Belfast Health and Social Care NHS Trust, Belfast, United Kingdom
(Edwards) Newcastle Hospitals NHS Foundation Trust, Newcastle, United
Kingdom
(De Silva) University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Conway) Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
(Cotton) Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
(McEntegart, Petrie) The Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Saramago) The University of York, York, United Kingdom
(Gershlick) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Clark) Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Whether revascularization by percutaneous coronary intervention
(PCI) can improve event-free survival and left ventricular function in
patients with severe ischemic left ventricular systolic dysfunction, as
compared with optimal medical therapy (i.e., individually adjusted
pharmacologic and device therapy for heart failure) alone, is unknown.
METHODS We randomly assigned patients with a left ventricular ejection
fraction of 35% or less, extensive coronary artery disease amenable to
PCI, and demonstrable myocardial viability to a strategy of either PCI
plus optimal medical therapy (PCI group) or optimal medical therapy alone
(optimal-medical-therapy group). The primary composite outcome was death
from any cause or hospitalization for heart failure. Major secondary
outcomes were left ventricular ejection fraction at 6 and 12 months and
quality-of-life scores. RESULTS A total of 700 patients underwent
randomization - 347 were assigned to the PCI group and 353 to the
optimal-medical-therapy group. Over a median of 41 months, a
primary-outcome event occurred in 129 patients (37.2%) in the PCI group
and in 134 patients (38.0%) in the optimal-medical-therapy group (hazard
ratio, 0.99; 95% confidence interval [CI], 0.78 to 1.27; P = 0.96). The
left ventricular ejection fraction was similar in the two groups at 6
months (mean difference, -1.6 percentage points; 95% CI, -3.7 to 0.5) and
at 12 months (mean difference, 0.9 percentage points; 95% CI, -1.7 to
3.4). Quality-of-life scores at 6 and 12 months appeared to favor the PCI
group, but the difference had diminished at 24 months. CONCLUSIONS Among
patients with severe ischemic left ventricular systolic dysfunction who
received optimal medical therapy, revascularization by PCI did not result
in a lower incidence of death from any cause or hospitalization for heart
failure. Copyright © 2022 Massachusetts Medical Society.

<5>
Accession Number
2021208226
Title
Association between cuffed tracheal tube use and reduced
ventilator-associated pneumonia and conditions after elective cardiac
surgery in infants and young children.
Source
Minerva Anestesiologica. 88(11) (pp 890-900), 2022. Date of Publication:
November 2022.
Author
Nacoti M.; Carobbio A.; Finazzi S.; Pellicioli I.; Consonni F.; Ferrari
F.; Favarato M.; Fazzi F.; Bonanomi E.
Institution
(Nacoti, Pellicioli, Consonni, Ferrari, Favarato, Fazzi, Bonanomi)
Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care,
Papa Giovanni XXIII Hospital, Bergamo, Italy
(Carobbio) FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo,
Italy
(Finazzi) Department of Clinical Epidemiology, Mario Negri IRCCS
Pharmacological Research Institute, Ranica, Bergamo, Italy
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is a serious
complication in children after cardiac surgery that may result from
micro-aspiration. However, the current recommendation to use cuffed
tracheal tubes (TTs) versus uncuffed TTs in children is still uncertain.
Our main aim was to evaluate the incidence of VAP, ventilator-associated
tracheobronchitis (VAT) and ventilator-associated conditions (VAC) in
children up to five years old who underwent elective cardiac surgery.
 METHOD(S): Single-center, prospective before-and-after study at a
tertiary pediatric intensive care unit (PICU) in Italy. 242 patients (121
in each group) through the following periods: phase I (from Jan 2017 to
20th Feb 2018), during which children were intubated with
uncuffed TTs; phase II (from 21th Feb 2018 to Feb 2019), during
which children were intubated with cuffed TTs. RESULT(S): Data were
collected using an electronic dedicated database. Median age was five
months. The use of cuffed tubes reduced the risk of VAC and VAP
respectively 15.8 times (95% CI 3.4-73.1, P=0.0008) and 14.8 times (95% CI
3.1-71.5, P=0.002). No major related airway complications were observed in
the cuffed TTs group. Average treatment effect, calculated after
propensity score matching, confirmed the significant effect of cuffed TTs
on VAC and VAP. CONCLUSION(S): Our study suggests a marked reduction
of VAP and VAC associated with use of a cuffed versus uncuffed TT in
infants and children <=5 years of age after elective cardiac surgery. A
randomized clinical trial is needed to confirm these results and define
the impact of use of a cuffed versus uncuffed TT across other relevant ICU
outcomes and non-cardiac PICU patients. Copyright © 2022 EDIZIONI
MINERVA MEDICA.

<6>
Accession Number
2018642556
Title
Bicuspid Aortic Valve Stenosis: From Pathophysiological Mechanism, Imaging
Diagnosis, to Clinical Treatment Methods.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2022. Article
Number: 798949. Date of Publication: 2022.
Author
Perrin N.; Ibrahim R.; Durrleman N.; Basmadjian A.; Leroux L.; Demers P.;
Modine T.; Ali W.B.
Institution
(Perrin, Ibrahim, Durrleman, Basmadjian, Demers, Ali) Structural Heart
Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
(Perrin) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(Leroux, Modine) Service Medico-Chirurgical, Valvulopathies-Chirurgie
Cardiaque-Cardiologie Interventionelle Structurelle, Hopital Cardiologique
de Haut Leveque, CHU Bordeaux, Bordeaux, France
Publisher
Frontiers Media S.A.
Abstract
Bicuspid aortic valve (BAV) is the most frequent congenital anomaly and
has a natural evolution toward aortic regurgitation or stenosis due to the
asymmetrical valve function associated with an evolutive ascending
aortopathy. Several BAV classifications exist describing the presence and
number of raphe, amount and location of calcium, and the symmetry of the
functional cusps. The impact of BAV morphology on transcatheter aortic
valve implantation (TAVI) outcomes still remains little investigated.
Pivotal randomized trials comparing TAVI with surgery have excluded BAV
until yet. However, data from registries and observational studies
including highly selected patients have shown promising results of TAVI in
BAV. With this review, we aimed at describing anatomical and
pathophysiological characteristics of BAV, discussing the main aspects to
assess diagnostic imaging modalities, and giving an overview of TAVI
outcomes and technical considerations specific to BAV
morphology. Copyright © 2022 Perrin, Ibrahim, Durrleman,
Basmadjian, Leroux, Demers, Modine and Ben Ali. This is an open-access
article distributed under the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or reproduction in other forums is
permitted, provided the original author(s) and the copyright owner(s) are
credited and that the original publication in this journal is cited, in
accordance with accepted academic practice. No use, distribution or
reproduction is permitted which does not comply with these terms.

<7>
Accession Number
2021644722
Title
In patients undergoing coronary artery bypass grafting, is endoscopic
harvesting superior to open radial artery harvesting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(3) (pp 447-451), 2021.
Date of Publication: 01 Mar 2021.
Author
Lei J.J.H.; Ravendren A.; Snosi M.; Harky A.
Institution
(Lei, Ravendren) School of Medicine, Imperial College London, London,
United Kingdom
(Snosi, Harky) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Health and Life
Science, University of Liverpool, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, Liverpool Heart and
Chest Hospital, University of Liverpool, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'In patients undergoing
coronary artery bypass grafting, is endoscopic radial artery harvesting
(ERAH) superior to open radial artery harvesting in terms of postoperative
complications, mortality, graft quality and patency rates?'. Altogether
130 papers were found using the reported search, of which 5 represented
the best evidence to answer the clinical question. Two studies were
meta-analyses and 3 were randomized trials. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. In terms of graft
quality, 2 randomized studies showed preserved endothelial integrity and
vasoreactivity with ERAH, whereas 1 randomized study found superior
endothelial function with open radial artery harvesting. Importantly, 3
studies showed graft patency was not compromised with ERAH. One
meta-analysis reported no differences in graft patency between groups at 1
year [odds ratio (OR) 1.24] and up to 3-5-years follow-up (OR 1.81), as
well as similar perioperative myocardial infarction rates (OR 0.80). Two
meta-analyses found similar mortality in the perioperative period (OR
0.62-0.78) and up to 5 years (OR 0.64-0.67); ERAH reduced the incidence of
perioperative wound complications (P-values 0.001-0.03); however, harvest
times were increased with ERAH (P < 0.0005). We conclude that ERAH is
non-inferior to open radial artery harvesting in terms of mortality, graft
quality and patency rates, but superior in terms of reducing perioperative
wound complications, with good cosmetic effect. However, these benefits
come at the cost of increased harvesting time. Copyright © 2020
The Author(s).

<8>
Accession Number
2021644698
Title
Comparison of early postoperative cytokine changes in patients undergoing
intubated and non-intubated thoracic surgery: a randomized controlled
trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(3) (pp 343-350), 2021.
Date of Publication: 01 Mar 2021.
Author
Jeon J.; Sung S.; Moon Y.; Koo J.; Hyun K.; Han K.; Hwang W.
Institution
(Jeon) Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Sung) Department of Thoracic and Cardiovascular Surgery, Ewha Womans
University Seoul Hospital, Seoul, South Korea
(Moon) Department of Thoracic and Cardiovascular Surgery, Eunpyeong St.
Mary's Hospital, College of Medicine, The Catholic University of Korea,
Seoul, South Korea
(Koo, Hwang) Department of Anesthesia and Pain Medicine, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Hyun) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Han) Department of Statistics and Actuarial Science, Soongsil University,
Seoul, South Korea
Publisher
Oxford University Press
Abstract
OBJECTIVES: The inflammatory response after surgery is associated with
patient prognosis. Patients who undergo thoracic surgery exhibit a
profound systemic inflammatory response due to the surgical procedures
used and application of one-lung ventilation. The aim of this study was to
compare perioperative inflammatory changes in patients after intubated and
non-intubated thoracic surgery for primary lung cancer resection.
 METHOD(S): This prospective randomized controlled study included
forty patients who underwent surgical resection for stage I non-small-cell
lung cancer. Blood samples for cytokine analysis were collected just
before induction, at 1 and 24 h after surgery. Levels of the
pro-inflammatory cytokine and anti-inflammatory cytokines were measured
using quantitative sandwich enzyme immunoassay kits. RESULT(S): The
basal values of cytokines were comparable between 2 groups. Within each
group, the postoperative levels of interleukin (IL)-1, IL-6 and tumour
necrosis factor-alpha increased, while those of IL-4 and IL-10 did not
change significantly. The levels of IL-6 and tumour necrosis factor-alpha
were significantly lower in group NI at 1 and 24 h postoperatively. Other
cytokines did not differ in both groups during postoperative period. The
IL-6/IL-10 ratio at 1 h after surgery was lower in non-intubated patients
than in intubated patients, but there was no difference at 24 h after
surgery CONCLUSION(S): Non-intubated thoracic surgery may attenuate
the early inflammatory cytokine changes following major resection for
primary lung cancer compared with intubated conventional surgery. Clinical
trial registration: ClinicalTrials.gov registry number
NCT04007354. Copyright © 2020 The Author(s).

<9>
Accession Number
2021678295
Title
Study protocol and baseline characteristics of Randomized trial for
Evaluation in Secondary Prevention Efficacy of Combination Therapy-Statin
and Eicosapentaenoic Acid: RESPECT-EPA, the combination of a randomized
control trial and an observational biomarker study.
Source
American Heart Journal. 257 (pp 1-8), 2023. Date of Publication: March
2023.
Author
Nishizaki Y.; Miyauchi K.; Iwata H.; Inoue T.; Hirayama A.; Kimura K.;
Ozaki Y.; Murohara T.; Ueshima K.; Kuwabara Y.; Tanaka-Mizuno S.;
Yanagisawa N.; Sato T.; Daida H.
Institution
(Nishizaki, Miyauchi, Iwata, Daida) Department of Cardiovascular Biology
and Medicine, Juntendo University Graduate School of Medicine, Tokyo,
Bunkyo, Japan
(Inoue) Japan Red Cross Society, Nasu Red Cross Hospital, Tochigi,
Otawara, Japan
(Inoue) Dokkyo Medical University, Tochigi, Mibu, Japan
(Hirayama) Department of Cardiology, Osaka Police Hospital, Osaka,
Sumiyoshi, Japan
(Kimura) Department of Cardiology, Yokohama City University Medical
Center, Kanagawa, Yokohama, Japan
(Ozaki) Department of Cardiology, Fujita Health University, Aichi,
Toyoake, Japan
(Murohara) Department of Cardiology, Nagoya University Graduate School of
Medicine, Aichi, Nagoya, Japan
(Ueshima) Medical Examination Center, Uji-Takeda Hospital, Kyoto, Uji,
Japan
(Kuwabara) Cancer Control Center, Osaka International Cancer Institute,
Osaka, Otemae, Japan
(Tanaka-Mizuno) Department of Digital Health and Epidemiology, Graduate
School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
(Yanagisawa) Medical Technology Innovation Center, Juntendo University,
Tokyo, Bunkyo, Japan
(Sato) Department of Biostatistics, Kyoto University School of Public
Health, Kyoto, Kyoto, Japan
(Daida) Faculty of Health Science, Juntendo University, Tokyo, Bunkyo,
Japan
Publisher
Elsevier Inc.
Abstract
Background: Omega-3 polyunsaturated fatty acids (PUFAs) have been a hot
topic since the Japan EPA Lipid Intervention Study (JELIS), the first
landmark study using a highly purified eicosapentaenoic acid (EPA),
indicated that EPA could decrease the incidence of cardiovascular events.
Over 20 years have passed since the JELIS was conducted, and the standard
treatment for dyslipidemia has altered significantly since then. The JELIS
subjects did not undertake the current risk management especially current
standard statins and did not exclusively target secondary prevention
patients. In addition, the subjects included are relatively high EPA
population. Furthermore, the clinical implication of the plasma
EPA/arachidonic acid (AA) ratio as a biomarker has not yet been validated.
Therefore, the Randomized trial for Evaluation in Secondary Prevention
Efficacy of Combination Therapy - Statin and EPA (RESPECT-EPA) was planned
and is currently underway in Japan. Method(s): The RESPECT-EPA
comprises two parts: the open-label randomized controlled trial (RCT) and
biomarker study (prospective cohort study design). The RCT included
patients with a low EPA/AA ratio. These patients were then randomized to
highly purified EPA (1800 mg/day) or control groups. The primary endpoint
was cardiovascular death, non-fatal myocardial infarction, non-fatal
ischemic stroke, unstable angina pectoris, and clinically indicated
coronary revascularization. The biomarker study assesses the EPA/AA
ratio's usefulness as a biomarker for cardiovascular events prediction.
 Result(s): In the RCT, a total of 2,460 patients were enrolled in 95
sites in Japan. Patients' baseline characteristics were similar between
intervention and control groups in the RCT. The baseline median EPA/AA
ratio was 0.243 and 0.235, respectively. A total of 1,314 patients were
participated in the observational part, and the baseline median EPA/AA
ratio was 0.577. Conclusion(s): After this study is completed, we
will have further evidence on whether a highly purified EPA is effective
in reducing cardiovascular events for secondary prevention or not, as well
as whether if EPA/AA ratio is a predictor for future cardiovascular
events. This study was registered in the University Hospital Medical
Information Network Clinical Trials Registry
(UMIN000012069). Copyright © 2022 The Authors

<10>
Accession Number
2021603663
Title
The incidence and mortality rate of catheter-related neonatal pericardial
effusion: A meta-analysis.
Source
Medicine (United States). 101(47) (pp E32050), 2022. Date of Publication:
25 Nov 2022.
Author
Wang J.; Wang Q.; Liu Y.; Lin Z.; Janjua M.U.; Peng J.; Du J.
Institution
(Wang) The First Clinical Medical Institute, Hainan Medical University,
Hainan, China
(Wang, Liu, Lin, Du) Department of Neonatology, Hainan Modern Women and
Children's Hospital, Haikou, Hainan, China
(Janjua) International Education Institute, Changsha Medical University,
Changsha, Hunan, China
(Peng) Medical Administration Department, Hainan Modern Women and
Children's Hospital, Haikou, Hainan, China
Publisher
Lippincott Williams and Wilkins
Abstract
Backgroud: Neonatal pericardial effusion (PCE) is one of the most severe
complications of central catheters in neonates with its rapid progression
and high mortality. We aim to estimate the overall incidence and mortality
of catheter-related neonatal PCE, more importantly, to identify possible
predictors for clinical reference. Method(s): We searched MEDLINE,
Embase, Cochrane Library, Web of Science, china national knowledge
infrastructure, Wanfang Data, and Sinomed databases for subject words
"central catheter,""neonate,""pericardial effusion"and their random words
till June 8, 2020. This meta-analysis is based on the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. Possible
predictors of occurrences and deaths were extracted and assessed
cooperatively. The pooled incidence rate of catheter-related neonatal PCE
was calculated using a random effects model. Result(s): Twenty-one
cohort studies and 99 cases were eligible. Pooled incidence is 3.8[2.2,
6.7]. Polyurethane catheters generate significantly more neonatal PCE than
silicone counterparts (P<.01). 27% of the patients die. The mortality of
patients with bradycardia is higher than others (P<.05). Catheters with a
guidewire result in more deaths than umbilical venous catheter (UVC) and
peripherally inserted central catheters (PICC) (P<.05). Without
pericardiocentesis, mortality increases (P<.01). The difference of deaths
between reposition and removing the catheter is insignificant (P>.05).
 Conclusion(s): Central catheters in Seldinger Technique (with a
guidewire) put neonates at greater risk of PCE and consequent death.
Silicone catheters excel at avoiding deadly catheter-related PCE, which
could be a better choice in neonatal intensive care units (NICU). When
catheter-related PCE occurs, timely diagnosis and pericardiocentesis save
lives. Copyright © 2022 the Author(s). Published by Wolters
Kluwer Health, Inc.

<11>
Accession Number
639752125
Title
Risk of bleeding after percutaneous coronary intervention and its impact
on further adverse events in clinical trial participants with comorbid
peripheral arterial disease.
Source
International journal of cardiology. (no pagination), 2022. Date of
Publication: 07 Dec 2022.
Author
Pinxterhuis T.H.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; Schotborgh C.E.;
Anthonio R.L.; Roguin A.; Danse P.W.; Benit E.; Aminian A.; Stoel M.G.;
Linssen G.C.M.; Geelkerken R.H.; von Birgelen C.
Institution
(Pinxterhuis, Ploumen) Department of Cardiology, Thoraxcentrum Twente,
Medisch Spectrum Twente, Enschede, the Netherlands; Health Technology and
Services Research, Faculty BMS, Technical Medical Centre, University of
Twente, Enschede, the Netherlands
(Zocca, Stoel) Department of Cardiology, Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, Netherlands
(Doggen) Health Technology and Services Research, Faculty BMS, Technical
Medical Centre, University of Twente, Enschede, Netherlands
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Anthonio) Department of Cardiology, Treant Zorggroep, Scheper Hospital,
Emmen, Netherlands
(Roguin) Department of Cardiology, Hillel Yaffe Medical Center, Hadera and
B. Rappaport-Faculty of Medicine, Institute of Technology, Haifa, Israel
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Benit) Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo, and
Hengelo, the Netherlands
(Geelkerken) Department of Vascular Surgery, Medisch Spectrum Twente,
Enschede, the Netherlands; Multi-modality Medical Imaging (M3I) group,
Faculty of Science and Technology, Technical Medical Centre, University of
Twente, Enschede, the Netherlands
(von Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, the Netherlands; Health Technology and Services
Research, Faculty BMS, Technical Medical Centre, University of Twente,
Enschede, the Netherlands. Electronic address: c.vonbirgelen@mst.nl
Publisher
NLM (Medline)
Abstract
BACKGROUND: Both patients with obstructive coronary artery disease (CAD)
and patients with peripheral arterial disease (PADs) have an increased
bleeding risk. Information is scarce on bleeding in CAD patients, treated
with percutaneous coronary intervention (PCI), who have comorbid PADs. We
assessed whether PCI patients with PADs have a higher bleeding risk than
PCI patients without PADs. Furthermore, in PCI patients with PADs we
evaluated the extent by which bleeding increased the risk of further
adverse events. METHOD(S): Three-year pooled patient-level data of
two randomized PCI trials (BIO-RESORT, BIONYX) with drug-eluting stents
were analyzed to assess mortality and the composite endpoint major adverse
cardiac events (MACE: all-cause mortality, any myocardial infarction,
emergent coronary artery bypass surgery, or target lesion
revascularization). RESULT(S): Among 5989 all-comer patients,
followed for 3years, bleeding occurred in 7.7% (34/440) with comorbid PADs
and 5.0% (279/5549) without PADs (HR: 1.59, 95%CI:1.11-2.23, p=0.010). Of
all PADs patients, those with a bleeding had significantly higher rates of
all-cause mortality (HR: 4.70, 95%CI:2.37-9.33, p<0.001) and MACE (HR:
2.39, 95%CI:1.23-4.31, p=0.003). Furthermore, PADs patients with a
bleeding were older (74.4+/-6.9 vs. 67.4+/-9.5, p<0.001). After correction
for age and other potential confounders, bleeding remained independently
associated with all-cause mortality (adj.HR: 2.97, 95%CI:1.37-6.43,
p=0.006) while the relation of bleeding with MACE became borderline
non-significant (adj.HR: 1.85, 95%CI:0.97-3.55, p=0.06).
 CONCLUSION(S): PCI patients with PADs had a higher bleeding risk than
PCI patients without PADs. In PADs patients, bleeding was associated with
all-cause mortality, even after adjustment for potential
confounders. Copyright © 2022. Published by Elsevier B.V.

<12>
Accession Number
639751589
Title
Adenosine as adjunctive therapy in acute coronary syndrome: a
meta-analysis of randomized controlled trials.
Source
European heart journal. Cardiovascular pharmacotherapy. (no pagination),
2022. Date of Publication: 10 Dec 2022.
Author
Laborante R.; Bianchini E.; Restivo A.; Ciliberti G.; Galli M.; Vergallo
R.; Rodolico D.; Zito A.; Princi G.; Leone A.M.; Aurigemma C.; Romagnoli
E.; Montone R.A.; Burzotta F.; Trani C.; Crea F.; D'Amario D.
Institution
(Laborante, Bianchini, Restivo, Ciliberti, Galli, Rodolico, Zito, Princi,
Burzotta, Trani, Crea) Department of Cardiovascular and Pulmonary
Sciences, Catholic University of the Sacred Heart, Rome, Italy
(Galli) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
(Vergallo, Leone, Aurigemma, Romagnoli, Montone, Burzotta, Trani, Crea)
Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico
Universitario Agostino Gemelli IRCCS, Rome, Italy
(D'Amario) Department of Translational Medicine, Universita del Piemonte
Orientale, Novara, Italy
Publisher
NLM (Medline)
Abstract
AIM: Adenosine has been tested in several randomized controlled trials
(RCTs) to minimize the incidence of coronary microvascular obstruction
(CMVO). The aim of the present study was to pool all the RCTs comparing
intracoronary or intravenous adenosine versus placebo in patients with
acute coronary syndrome (ACS) undergoing myocardial revascularization.
METHODS AND RESULTS: PubMed and Scopus electronic databases were scanned
for eligible studies up to June 5th 2022. A total of 26 RCTs with 5843
patients were included. Efficacy endpoints were major adverse cardiac
events (MACE), all-cause-death, non-fatal myocardial infarction and heart
failure. Atrioventricular blocks and ventricular fibrillation/sustained
ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial
blush grade, Thrombolysis In Myocardial Infarction (TIMI) flow grade, left
ventricular ejection fraction (LVEF), infarct size, and ST-segment
resolution were also assessed. Adenosine administration was not associated
with any clinical benefit in terms of MACE, all-cause death, non-fatal
myocardial infarction, and heart failure. However, adenosine was
associated with an increased rate of advanced atrioventricular blocks and
of VF/SVT in studies with total mean ischemic time > 3 hours, compared to
placebo. Remarkably, among patients undergoing percutaneous coronary
intervention, adenosine was associated with reduced myocardial blush grade
0-1 and TIMI flow grade 0-2, compared to placebo. Furthermore, adenosine
did not show favourable effects on LVEF and infarct size.
 CONCLUSION(S): Adenosine infusion, as adjunctive therapy in ACS, was
associated with an increased risk of advanced atrioventricular blocks and
increased rates of adenosine-triggered ventricular arrhythmias in patients
with long ischemic time, without providing any clinical benefit compared
to placebo. Copyright © The Author(s) 2022. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<13>
[Use Link to view the full text]
Accession Number
2020871887
Title
A Multicenter, Phase 2, Randomized, Placebo-Controlled, Double-Blind,
Parallel-Group, Dose-Finding Trial of the Oral Factor XIa Inhibitor
Asundexian to Prevent Adverse Cardiovascular Outcomes After Acute
Myocardial Infarction.
Source
Circulation. 146(16) (pp 1196-1206), 2022. Date of Publication: 18 Oct
2022.
Author
Rao S.V.; Kirsch B.; Bhatt D.L.; Coppolecchia R.; Eikelboom J.; James
S.K.; Jones W.S.; Keller L.; Hermanides R.S.; Campo G.; Ferreiro J.L.;
Mundl H.; Alexander J.H.; Hengstenberg C.; Steinwender C.; Alber H.;
Steringer-Mascherbauer R.; Schober A.; Auer J.; Roithinger F.X.; Von
Lewinski D.; Moertl D.; Huber K.; Coussement P.; Hoffer E.; Beauloye C.;
Janssens L.; Vranckx P.; De Raedt H.; Vanassche T.; Vrolix M.; Rokyta R.;
Parenica J.; Pelouch R.; Motovska Z.; Alan D.; Kettner J.; Polasek R.;
Cermak O.; Sedlon P.; Hanis J.; Novak M.; Belohlavek J.; Horacek T.;
Leggewie S.; Wenzel P.; Vom Dahl J.; Sievers B.; Pulz J.; Schellong S.;
Clemmensen P.; Muller-Hennessen M.; Rassaf T.; Falukozi J.; Ruzsa Z.;
Tomcsanyi J.; Csanadi Z.; Herczeg B.; Koszegi Z.; Vorobcsuk A.; Kiss R.;
Baranyai C.; Dezsi C.; Merkely B.; Lupkovics G.; Rossini R.; Scherillo M.;
Sergio Saba P.; Calogero Campo G.; Calo L.; Nassiacos D.; Quadri G.;
Sciahbasi A.; Silvio Marenzi G.C.; Reimers B.; Perna G.P.; Sacca S.;
Fattore L.; Brunelli C.; Picchi A.; Kuramochi T.; Kondo K.; Aoyama T.;
Kudoh T.; Yamamoto T.; Takaya T.; Mukai Y.; Fukui K.; Morioka N.; Ando K.;
Yamamuro A.; Morita Y.; Koga Y.; Watanabe T.; Sakamoto T.; Shibasaki T.;
Maebuchi D.; Takahashi A.; Yonetsu T.; Kakuta T.; Nishina H.; Oemrawsingh
R.; Dorman R.; Oude Ophius T.; Prins P.; Al Windy N.Y.Y.; Zoet-Nugteren
S.K.; Hermanides R.; Van Eck M.; Scherptong R.; Cornel J.H.; Damman P.;
Bech G.; Torquay R.; Kietselaer B.; Grzelakowski P.; Krzysztof D.; Budaj
A.; Miekus P.; Przybylski A.; Zarebinski M.; Balsam P.; Szachniewicz J.;
Gierlotka M.; Tycinska A.; Iniguez Romo A.; Fernandez Ortiz A.; Carrasquer
Cucarella A.; Sanmartin Fernandez M.; Sionis A.; Bueno Zamora H.; Ferreiro
Gutierrez J.L.; Almenar L.; Ferreira Gonzalez I.; Pascual Figal D.A.;
Almendro Delia M.; Jimenez Fernandez M.; Skeppholm M.; Zedigh C.; Angeras
O.; Lauermann J.; Erlinge D.; Gustafsson R.; Mooe T.; Utreras A.; James
S.; Grimfjard P.; Pedrazzini G.; Mach F.; Fournier S.; Haegeli L.; Beer
J.H.; Leibundgut G.; Kobza R.; Kaiser C.; Kunadian V.; Al-Lamee R.; Gorog
D.; Khan S.; Trevelyan J.; Toor I.; Smith J.; Purushottam B.; Treasure C.;
Arena F.; Vedere A.; Henderson D.; Gilani S.; Jones A.; Carrillo-Jimenez
R.; Gillespie E.; Marhefka G.; Wang D.; Olson C.; Bloom S.; Iftikhar F.;
Brabham D.; McGinty J.; Thompson C.; Talano J.; Ginete W.; Williams M.;
Masud A.; Ariani M.; Bitar F.; Wang T.; Samuelson B.
Institution
(Rao) New York University Langone Health System, New York, NY, United
States
(Jones, Alexander) Duke Clinical Research Institute, Duke University
School of Medicine, Durham, NC, United States
(Kirsch, Keller, Mundl) Bayer Ag, Wuppertal, Germany
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Budaj) Centre of Postgraduate Medical Education, Grochowski Hospital,
Warsaw, Poland
(Coppolecchia) Bayer Us Llc, Whippany, NJ, United States
(Eikelboom) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(James) Department of Medical Sciences, Uppsala Clinical Research Center,
Uppsala University, Sweden
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Hermanides) Isala Hospital, Zwolle, Netherlands
(Campo) Cardiovascular Institute, Azienda Ospedaliero-Universitaria di
Ferrara, Cona, Italy
(Ferreiro) Department of Cardiology, Bellvitge University Hospital,
BIOHEART: Cardiovascular Diseases Group-IDIBELL, CIBERCV, l'Hospitalet de
Llobregat, Barcelona, Spain
(Shibasaki) Saitama Sekishinkai Hospital, Saitama, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Oral activated factor XI (FXIa) inhibitors may modulate
coagulation to prevent thromboembolic events without substantially
increasing bleeding. We explored the pharmacodynamics, safety, and
efficacy of the oral FXIa inhibitor asundexian for secondary prevention
after acute myocardial infarction (MI). Method(s): We randomized 1601
patients with recent acute MI to oral asundexian 10, 20, or 50 mg or
placebo once daily for 6 to 12 months in a double-blind,
placebo-controlled, phase 2, dose-ranging trial. Patients were randomized
within 5 days of their qualifying MI and received dual antiplatelet
therapy with aspirin plus a P2Y12 inhibitor. The effect of asundexian on
FXIa inhibition was assessed at 4 weeks. The prespecified main safety
outcome was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding
comparing all pooled asundexian doses with placebo. The prespecified
efficacy outcome was a composite of cardiovascular death, MI, stroke, or
stent thrombosis comparing pooled asundexian 20 and 50 mg doses with
placebo. Result(s): The median age was 68 years, 23% of participants
were women, 51% had ST-segment-elevation MI, 80% were treated with aspirin
plus ticagrelor or prasugrel, and 99% underwent percutaneous coronary
intervention before randomization. Asundexian caused dose-related
inhibition of FXIa activity, with 50 mg resulting in >90% inhibition. Over
a median follow-up of 368 days, the main safety outcome occurred in 30
(7.6%), 32 (8.1%), 42 (10.5%), and 36 (9.0%) patients receiving asundexian
10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian versus
placebo: hazard ratio, 0.98 [90% CI, 0.71-1.35]). The efficacy outcome
occurred in 27 (6.8%), 24 (6.0%), 22 (5.5%), and 22 (5.5%) patients
assigned asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively
(pooled asundexian 20 and 50 mg versus placebo: hazard ratio, 1.05 [90%
CI, 0.69-1.61]). Conclusion(s): In patients with recent acute MI, 3
doses of asundexian, when added to aspirin plus a P2Y12 inhibitor,
resulted in dose-dependent, near-complete inhibition of FXIa activity
without a significant increase in bleeding and a low rate of ischemic
events. These data support the investigation of asundexian at a dose of 50
mg daily in an adequately powered clinical trial of patients who
experienced acute MI. Copyright © 2022 American Heart
Association, Inc.

<14>
Accession Number
2021604159
Title
Impact of Antibiotic Stewardship Rounds in the Intensive Care Setting: A
Prospective Cluster-Randomized Crossover Study.
Source
Clinical Infectious Diseases. 74(11) (pp 1986-1992), 2022. Date of
Publication: 01 Jun 2022.
Author
Seidelman J.L.; Turner N.A.; Wrenn R.H.; Sarubbi C.; Anderson D.J.; Sexton
D.J.; Moehring R.W.
Institution
(Seidelman) Duke Center for Antimicrobial Stewardship and Infection
Prevention, Durham, NC, United States
(Sarubbi) Unc Rex Healthcare, Raleigh, NC, United States
(Sexton) Division of Infectious Diseases, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Moehring) Duke Center for Antimicrobial Stewardship and Infection
Prevention, Durham, NC, United States
Publisher
Oxford University Press
Abstract
Background: Few groups have formally studied the effect of dedicated
antibiotic stewardship rounds (ASRs) on antibiotic use (AU) in intensive
care units (ICUs). Method(s): We implemented weekly ASRs using a
2-arm, cluster-randomized, crossover study in 5 ICUs at Duke University
Hospital from November 2017 to June 2018. We excluded patients without an
active antibiotic order, or if they had a marker of high complexity
including an existing infectious disease consult, transplantation,
ventricular assist device, or extracorporeal membrane oxygenation. AU
during and following ICU stay for patients with ASRs was compared to the
controls. We recorded the number of reviews, recommendations delivered,
and responses. We evaluated change in ICU-specific AU during and after the
study. Result(s): Our analysis included 4683 patients: 2330
intervention and 2353 controls. Teams performed 761 reviews during ASRs,
which excluded 1569 patients: 60% of patients off antibiotics, and 8%
complex patients. Exclusions affected 88% of cardiothoracic ICU (CTICU)
patients. The AU rate ratio (RR) was 0.97 (95% confidence interval [CI],.
91-1.04). When CTICU was removed, the RR was 0.93 (95% CI,. 89-.98). AU in
the poststudy period decreased by 16% (95% CI, 11%-24%) compared to AU in
the baseline period. Change in AU was differential among units: largest in
the neurology ICU (-28%) and smallest in the CTICU (-2%).
 Conclusion(s): Weekly multidisciplinary ASRs was a high-resource
intervention associated with a small AU reduction. The noticeable ICU AU
decline over time is possibly due to indirect effects of ASRs. Effects
differed among specialty ICUs, emphasizing the importance of customizing
ASRs to match unit-specific population, workflow, and
culture. Copyright © 2021 The Author(s). Published by Oxford
University Press for the Infectious Diseases Society of America. All
rights reserved.

<15>
Accession Number
2021597928
Title
Comparison Between Sedative And Analgesic Effects Of Dexmedetomidine
Versus Fentanyl For Pediatric Patients Following Cardiac Surgery In
Intensive Care Unit.
Source
Journal of Pharmaceutical Negative Results. 13 (pp 1058-1064), 2022. Date
of Publication: 2022.
Author
Attia W.A.; Aziz O.M.A.; Reheem A.M.A.; Sayed O.M.E.-E.; Mahmoud M.M.
Institution
(Attia, Aziz, Mahmoud) Pediatric Cardiology Department, Faculty of
Medicine, Cairo University, Egypt
(Reheem) Anesthesia Department, Faculty of Medicine, Cairo University,
Egypt
(Attia, Aziz, Sayed) Pediatric Cardiology Department, Al-NAS Hospital,
Egypt
Publisher
ResearchTrentz Academy Publishing Education Services
Abstract
The ICU staff should make careful pharmacological choices for sedation
following cardiac surgery. The purpose of this research was to assess the
effectiveness and safety of dexmedetomidine versus fentanyl for
postoperative sedation, hemodynamic and ventilatory parameters in
pediatric patients admitted to the ICU following cardiovascular surgery. A
total of 60 pediatric patients admitted to the ICU following heart
surgery, ranging in age from one day to fifteen years, and requiring
mechanical ventilation upon admission, were included in the prospective
and comparative research. They were randomly assigned to one of two
groups: Group D (n = 30) received dexmedetomidine, whereas Group F (n =
30) received fentanyl. In terms of age, weight, height, gender, and type
of surgery, there was no statistically significant difference between the
two groups. There were no significant variations in ventilatory measures
such as respiratory rate, oxygen saturation, or arterial blood gases in
either group when compared to baseline or to each other. There were no
significant variations in sedation (COMFORT-B) or pain (FLACC) scores
between the two groups. There was no statistically significant difference
in the use of rescue sedatives between the two groups. There was a
statistically significant difference in intubation length between the two
groups. In comparison to fentanyl, dexmedetomidine is a safe and similarly
effective medication for the sedation of mechanically ventilated pediatric
patients admitted to the ICU following cardiac surgery, with good
hemodynamic stability and earlier extubation. Copyright © 2022
Wolters Kluwer Medknow Publications. All rights reserved.

<16>
[Use Link to view the full text]
Accession Number
2021126455
Title
Effects on Mortality and Major Bleeding of Radial Versus Femoral Artery
Access for Coronary Angiography or Percutaneous Coronary Intervention:
Meta-Analysis of Individual Patient Data From 7 Multicenter Randomized
Clinical Trials.
Source
Circulation. 146(18) (pp 1329-1343), 2022. Date of Publication: 01 Nov
2022.
Author
Gargiulo G.; Giacoppo D.; Jolly S.S.; Cairns J.; Le May M.; Bernat I.;
Romagnoli E.; Rao S.V.; Van Leeuwen M.A.H.; Mehta S.R.; Bertrand O.F.;
Wells G.A.; Meijers T.A.; Siontis G.C.M.; Esposito G.; Windecker S.; Juni
P.; Valgimigli M.
Institution
(Gargiulo, Esposito) Department of Advanced Biomedical Sciences,
University Federico Ii of Naples, Italy
(Giacoppo) Cardiology Department, Alto Vicentino Hospital, Santorso, Italy
(Giacoppo) Cardiovascular Research Institute, Mater Private Hospital,
Royal College of Surgeons in Ireland, Dublin, Ireland
(Giacoppo) ISAResearch Center, Deutsches Herzzentrum Munchen, Technisches
Universitat Munchen, Germany
(Jolly, Mehta) Population Health Research Institute, McMaster University
and Hamilton Health Sciences, Canada
(Cairns) University of British Columbia, Vancouver, Canada
(Le May, Wells) Department of Medicine, University of Ottawa Heart
Institute, Canada
(Bernat) University Hospital, Faculty of Medicine Pilsen, Charles
University, Czechia
(Romagnoli) Fondazione Policlinico Universitario Agostino Gemelli, Irccs,
Rome, Italy
(Rao) The Duke Clinical Research Institute, Durham, NC, United States
(Van Leeuwen, Meijers) Department of Cardiology, Isala Heart Center,
Zwolle, Netherlands
(Bertrand) Quebec Heart and Lung Institute, Quebec City, Canada
(Siontis, Windecker, Valgimigli) Department of Cardiology, University
Hospital of Bern, Switzerland
(Juni) Applied Health Research Center, Li Ka Shing Knowledge Institute, St
Michael's Hospital, Department of Medicine, University of Toronto, Canada
(Juni) Division of Cardiology, Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale (EOC), Lugano, Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In some randomized clinical trials, transradial access (TRA)
compared with transfemoral access (TFA) was associated with lower
mortality in patients with coronary artery disease undergoing invasive
management. We analyzed the effects of TRA versus TFA across multicenter
randomized clinical trials and whether these associations are modified by
patient or procedural characteristics. Method(s): We performed an
individual patient data meta-analysis of multicenter randomized clinical
trials comparing TRA with TFA among patients undergoing coronary
angiography with or without percutaneous coronary intervention. The
primary outcome was all-cause mortality and the co-primary outcome was
major bleeding at 30 days. The primary analysis was conducted by 1-stage
mixed-effects models on the basis of the intention-to-treat cohort. The
effect of access site on mortality and major bleeding was assessed further
by multivariable analysis. The relationship among access site, bleeding,
and mortality was investigated by natural effect model mediation analysis
with multivariable adjustment. Result(s): A total of 21 600 patients
(10 775 TRA, 10 825 TFA) from 7 randomized clinical trials were included.
The median age was 63.9 years, 31.9% were women, 95% presented with acute
coronary syndrome, and 75.2% underwent percutaneous coronary intervention.
All-cause mortality (1.6% versus 2.1%; hazard ratio, 0.77 [95% CI,
0.63-0.95]; P=0.012) and major bleeding (1.5% versus 2.7%; odds ratio,
0.55 [95% CI, 0.45-0.67]; P<0.001) were lower with TRA. Subgroup analyses
for mortality showed consistent results, except for baseline hemoglobin
level (Pinteraction=0.003), indicating that the benefit of TRA was
substantial in patients with moderate or severe anemia, whereas it was not
significant in patients with milder or no baseline anemia. After
adjustment, TRA remained associated with 24% and 51% relative risk
reduction of all-cause mortality and major bleeding, respectively. A
mediation analysis showed that the benefit of TRA on mortality was only
partially driven by major bleeding prevention and ancillary mechanisms are
required to fully explain the causal association. Conclusion(s): TRA
is associated with lower all-cause mortality and major bleeding at 30 days
compared with TFA. The effect on mortality was driven by patients with
anemia. The reduction in major bleeding only partially explains the
mortality benefit. Registration: URL: https://www.crd.york.ac.uk/prospero;
Unique identifier: CRD42018109664. Copyright © 2021 American
Heart Association, Inc.

<17>
Accession Number
2016939828
Title
2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve
Replacement in Low-Risk Patients.
Source
Journal of the American College of Cardiology. 79(9) (pp 882-896), 2022.
Date of Publication: 08 Mar 2022.
Author
Forrest J.K.; Deeb G.M.; Yakubov S.J.; Rovin J.D.; Mumtaz M.; Gada H.;
O'Hair D.; Bajwa T.; Sorajja P.; Heiser J.C.; Merhi W.; Mangi A.; Spriggs
D.J.; Kleiman N.S.; Chetcuti S.J.; Teirstein P.S.; Zorn G.L.; Tadros P.;
Tchetche D.; Resar J.R.; Walton A.; Gleason T.G.; Ramlawi B.; Iskander A.;
Caputo R.; Oh J.K.; Huang J.; Reardon M.J.
Institution
(Forrest, Mangi) Department of Internal Medicine (Cardiology), Yale
University School of Medicine, New Haven, CT, United States
(Forrest, Mangi) Department of Surgery (Cardiac Surgery), Yale University
School of Medicine, New Haven, CT, United States
(Deeb, Chetcuti) Department of Interventional Cardiology, University of
Michigan Hospitals, Ann Arbor, MI, United States
(Deeb, Chetcuti) Department of Cardiovascular Surgery, University of
Michigan Hospitals, Ann Arbor, MI, United States
(Yakubov) Department of Interventional Cardiology, Riverside
Methodist-OhioHealth, Columbus, OH, United States
(Rovin, Spriggs) Department of Cardiac Surgery, Morton Plant Hospital,
Clearwater, FL, United States
(Mumtaz, Gada) Department of Interventional Cardiology, University of
Pittsburgh Medical Center Pinnacle, Wormleyburg, PA, United States
(Mumtaz, Gada) Department of Cardiovascular and Thoracic Surgery,
University of Pittsburgh Medical Center Pinnacle, Wormleyburg, PA, United
States
(O'Hair, Bajwa) Department of Interventional Cardiology, Aurora St. Luke's
Medical Center, Milwaukee, WI, United States
(O'Hair, Bajwa) Department of Cardiovascular Surgery, Aurora St. Luke's
Medical Center, Milwaukee, WI, United States
(Sorajja) Department of Interventional Cardiology, Minneapolis Heart
Institute-Abbott Northwestern Hospital, Minneapolis, MN, United States
(Heiser, Merhi) Department of Interventional Cardiology, Spectrum Health,
Grand Rapids, MI, United States
(Heiser, Merhi) Department of Cardiothoracic Surgery, Spectrum Health,
Grand Rapids, MI, United States
(Kleiman, Reardon) Department of Interventional Cardiology, Houston
Methodist-DeBakey Heart and Vascular Center, Houston, TX, United States
(Kleiman, Reardon) Department of Cardiothoracic Surgery, Houston
Methodist-DeBakey Heart and Vascular Center, Houston, TX, United States
(Teirstein) Department of Interventional Cardiology, Scripps Clinic, La
Jolla, CA, United States
(Zorn, Tadros) Department of Interventional Cardiology, University of
Kansas, Kansas City, KS, United States
(Zorn, Tadros) Department of Cardiac Surgery, University of Kansas, Kansas
City, KS, United States
(Tchetche) Department of Interventional Cardiology, Clinique Pasteur,
Toulouse, France
(Resar) Department of Interventional Cardiology, Johns Hopkins Hospital,
Baltimore, MD, United States
(Walton) Department of Interventional Cardiology, Alfred Hospital,
Melbourne, VIC, Australia
(Gleason) Department of Cardiac Surgery, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Ramlawi) Department of Cardiovascular Surgery, Valley Health System,
Winchester, Virginia, United States
(Iskander, Caputo) Department of Interventional Cardiology, Saint Joseph's
Hospital Health Center, Syracuse, NY, United States
(Iskander, Caputo) Department of Cardiovascular Surgery, Saint Joseph's
Hospital Health Center, Syracuse, NY, United States
(Oh) Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester, MN,
United States
(Huang) Department of Statistics, Medtronic, Minneapolis, MN, United
States
Publisher
Elsevier Inc.
Abstract
Background: The Evolut Low Risk Trial (Medtronic Evolut Transcatheter
Aortic Valve Replacement in Low Risk Patients) showed that transcatheter
aortic valve replacement (TAVR) with a supra-annular, self-expanding valve
was noninferior to surgery for the primary endpoint of all-cause mortality
or disabling stroke at 2 years. This finding was based on a Bayesian
analysis performed after 850 patients had reached 1 year of follow-up.
 Objective(s): The goal of this study was to report the full 2-year
clinical and echocardiographic outcomes for patients enrolled in the
Evolut Low Risk Trial. Method(s): A total of 1,414 low-surgical risk
patients with severe aortic stenosis were randomized to receive TAVR or
surgical AVR. An independent clinical events committee adjudicated adverse
events, and a central echocardiographic core laboratory assessed
hemodynamic endpoints. Result(s): An attempted implant was performed
in 730 TAVR and 684 surgical patients from March 2016 to May 2019. The
Kaplan-Meier rates for the complete 2-year primary endpoint of death or
disabling stroke were 4.3% in the TAVR group and 6.3% in the surgery group
(P = 0.084). These rates were comparable to the interim Bayesian rates of
5.3% with TAVR and 6.7% with surgery (difference: -1.4%; 95% Bayesian
credible interval: -4.9% to 2.1%). All-cause mortality rates were 3.5% vs
4.4% (P = 0.366), and disabling stroke rates were 1.5% vs 2.7% (P =
0.119), respectively. Between years 1 and 2, there was no convergence of
the primary outcome curves. Conclusion(s): The complete 2-year
follow-up from the Evolut Low Risk Trial found that TAVR is noninferior to
surgery for the primary endpoint of all-cause mortality or disabling
stroke, with event rates that were slightly better than those predicted by
using the Bayesian analysis. (Medtronic Evolut Transcatheter Aortic Valve
Replacement in Low Risk Patients [Evolut Low Risk Trial];
NCT02701283) Copyright © 2022

<18>
Accession Number
2018633896
Title
Comparison of effectiveness and safety of epsilon-aminocaproic acid and
tranexamic acid in adult patients undergoing cardiac surgery.
Source
JMS - Journal of Medical Society. 36(2) (pp 52-59), 2022. Date of
Publication: May-August 2022.
Author
Singh L.C.; Singh S.; Okyere I.; Annamalai A.; Singh A.
Institution
(Singh) Department of Anaesthesia, RIMS, Manipur, Imphal, India
(Singh) Departments of Anaesthesiology and Intensive Care Kwame Nkrumah
University of Science and Technology, Ghana
(Okyere) Departments of Surgery, Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana
(Singh) Department of Community Health, School of Public Health, Kwame
Nkrumah University of Science and Technology, Kumasi, Ghana
(Singh, Annamalai) Department of Cardiac Anaesthesia, SAMSRI, Uttar
Pradesh, Lucknow, India
Publisher
Regional Institute of Medical Sciences
Abstract
Objective: The objective of the study is to evaluate the effectiveness and
safety of epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) in
reducing bleeding, re-exploration, and blood transfusion in patients who
underwent a cardiac surgical procedure for mitral valve replacement on
cardiopulmonary bypass. Method(s): A single-center, prospective,
randomized, and double-blind clinical comparison study was conducted after
obtaining institutional ethical approval; sixty patients of either gender
between 18 and 60 years of age were randomly divided into two batches:
EACA batch (n = 30) given 100 mg/kg EACA as a bolus during induction of
anesthesia and then infused at 20 mg/kg/h during surgery and 6 h after
surgery and TXA batch (n = 30) given TXA 20 mg/kg/h as a bolus during
induction of anesthesia and then infused at 2 mg/kg/h during surgery and 6
h after surgery. The patient parameters, blood loss, transfusion
requirements in the first 24 h, and other complications were recorded.
 Result(s): Blood loss per hour through the chest tube drain was
significantly lower for the first 6 postoperative hours in the TXA than in
the EACA (P < 0.05). The total postoperative blood loss was 416 +/- 47.74
ml and 489 +/- 42.12 ml in 24 h (P = 0.0001), and the blood transfusion
requirement was 0.45 +/- 0.62 units and 0.86 +/- 0.87 units (P = 0.0481)
in the TXA and EACA, respectively. The re-exploration rate was 3.34% and
13.34% in TXA and EACA (P = 0.0629). Five percent of the patients reported
seizures in the study (P > 0.05). The findings of this study suggested
that prophylactic therapy with EACA or TXA was effective and safer in
reducing perioperative blood loss in cardiac surgical procedures with
mitral valve replacement. Furthermore, TXA was significantly more
effective than EACA. Copyright © 2022 Journal of Medical Society
 Published by Wolters Kluwer-Medknow.

<19>
Accession Number
2018496226
Title
Role of Aromatherapy as a Natural Complementary and Alternative Therapy in
Cardiovascular Disease: A Comprehensive Systematic Review.
Source
Evidence-based Complementary and Alternative Medicine. 2022 (no
pagination), 2022. Article Number: 4543078. Date of Publication: 2022.
Author
Almohammed H.I.; A Alanazi N.; Maghrabi E.F.; A Alotaibi M.
Institution
(Almohammed) Department Of Basic Science, Faculty Of Medicine, Almaarefa
University, Riyadh 11597, Saudi Arabia
(A Alanazi, Maghrabi) Faculty Of Medicine, University Science Malaysia
(USM), Kelantan, Kubang Kerian 16150, Malaysia
(A Alotaibi) College Of Medicine, Imam Mohammad Ibn Saud Islamic
University, Riyadh, Saudi Arabia
Publisher
Hindawi Limited
Abstract
Background. The purpose of this study was a comprehensive review of
studies on the effect of aromatherapy with plant essential oils on the
improvement of some conditions, for example, anxiety, stress, sleep
quality, fatigue, and pain in people with cardiovascular disease.
Materials and Methods. We carried out this systematic review based on the
instructions of Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA). Ethical agreement was not necessary as main data
have not been collected. During March 2022, we searched the main English
databases, for example, Google Scholar, Web of Sciences, EMBASE, EBSCO,
ScienceDirect, Scopus, and PubMed/MEDLINE, with limitation to human
clinical trials. For this study, no time limit was applied for the
publication of articles. Results. Out of 1380 papers, 52 papers up to
March 2022 were eligible for review in this systematic review. Based on
the obtained results, the most widely used medicinal plants for
aromatherapy in patients with cardiovascular diseases were Lavandula
angustifolia (lavender, 55.7%), Rosa damascena (Damask rose, 11.5%), and
Mentha piperita (peppermint, 5.8%), respectively. Most studies have been
performed on the effect of aromatherapy on coronary angiography (21
papers, 40.4%), followed by artery bypass graft surgery (14 studies,
26.9%), and cardiac patients (5 studies, 9.6%). Most studies on the effect
of aromatherapy in cardiovascular diseases were performed on anxiety (31
papers, 59.6%), sleep quality (8 studies, 15.4%), and hemodynamic
parameters (6 studies, 11.5%), respectively. Conclusion. This study
systematically reviewed the effects of aromatherapy in patients with
cardiovascular diseases. The review of studies showed that lavender,
Damask rose, and peppermint are the most frequents plants used for
aromatherapy, whereas they significantly improved some illnesses and
conditions, especially anxiety and sleep quality. Therefore, it can be
concluded that cardiologist can used aromatherapy as a natural
complementary and alternative therapy particularly with lavender, Damask
rose, and peppermint to improve quality of life and some conditions such
as anxiety and sleep quality. Copyright © 2022 Hamdan I
AlMohammed et al.

<20>
Accession Number
2021049209
Title
Validation of the Emory Risk Score in the Transcatheter Aortic Valve
Implantation Population: A Canadian Perspective.
Source
CJC Open. 4(12) (pp 1060-1068), 2022. Date of Publication: December 2022.
Author
Hyde E.K.; Throndson K.; Arcinas L.A.; Shah A.H.; Hiebert B.; Yamashita
M.H.; Lee Samson D.; Maric A.; Love R.; Poettcker D.; Arora R.C.; Seifer
C.M.; Kass M.
Institution
(Hyde, Throndson, Shah, Hiebert, Yamashita, Maric, Poettcker, Arora,
Seifer, Kass) Cardiac Sciences, St. Boniface Hospital, Winnipeg, MB,
Canada
(Arcinas, Shah, Seifer, Kass) Department of Internal Medicine, Section of
Cardiology, Rady Faculty of Health Sciences, University of Manitoba,
Winnipeg, MB, Canada
(Yamashita, Arora) Department of Surgery, Section of Cardiac Surgery, Rady
Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
(Lee Samson, Love) Health Sciences Centre, Winnipeg, MB, Canada
Publisher
Elsevier Inc.
Abstract
Background: Permanent pacemaker (PPM) implantation may be indicated
post-transcatheter aortic valve implantation (TAVI). The Emory Risk Score
(ERS) is a validated predictive risk score of the need for a PPM post-TAVI
using a balloon-expandable valve. Our objectives were to determine the
validity of the ERS in our local TAVI population with both
balloon-expandable and self-expanding valves and to identify additional
electrocardiographic (ECG) parameters predictive of the need for a PPM
post-TAVI. Method(s): Retrospective chart and electronic database
reviews were performed to collect demographic and procedural information.
Two expert readers reviewed all ECGs. Independent factors associated with
PPM implantation were examined with multivariable logistic regression via
a stepwise selection process with calculation of the area under the
receiver operating characteristic curve to assess model discrimination.
 Result(s): The overall PPM implantation rate was 11.7%; rates were 9%
for the Sapien 3 valves, 10% for the Evolut Pro valves, and 17% for the
Evolut R valves. The ERS was found to not be predictive of need for PPM
post-TAVI for the entire cohort. Right bundle branch block was the only
ERS parameter independently associated with new PPM implant (8.5% vs 25%,
odds ratio = 3.59, P = 0.01). No additional ECG parameters met the
criteria for statistical significance. Conclusion(s): The poor
predictive value of the ERS in determining the need for a PPM post-TAVI in
our patient population suggests that further refinement of a formula (or
risk-calculator) is warranted. Identification of a precise risk-calculator
is likely to facilitate patient mobilization and reduce inpatient
healthcare resource utilization. Copyright © 2022 The Authors

<21>
Accession Number
2021177317
Title
Design and Rationale of Routine UltrasouNd GuIdance for Vascular AccEss
foR Cardiac Procedures: A Randomized TriaL (UNIVERSAL).
Source
CJC Open. 4(12) (pp 1074-1080), 2022. Date of Publication: December 2022.
Author
Alrashidi S.; d'Entremont M.-A.; Alansari O.; Winter J.; Brochu B.; Heenan
L.; Skuriat E.; Tyrwhitt J.; Raco M.; Tsang M.B.; Valettas N.; Velianou
J.; Sheth T.; Sibbald M.; Mehta S.R.; Pinilla-Echeverri N.; Schwalm J.D.;
Natarajan M.K.; Kelly A.; Akl E.; Tawadros S.; Camargo M.; Faidi W.; Dutra
G.; Jolly S.S.
Institution
(Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth, Sibbald,
Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Dutra, Jolly)
McMaster University, Hamilton, ON, Canada
(Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth, Sibbald,
Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Tawadros, Camargo,
Faidi, Dutra, Jolly) Hamilton Health Sciences, Hamilton, ON, Canada
(Alrashidi, Alansari, Raco, Tsang, Valettas, Velianou, Sheth, Sibbald,
Mehta, Pinilla-Echeverri, Schwalm, Natarajan, Kelly, Jolly) Niagara
Health, St. Catharines, ON, Canada
(d'Entremont, Heenan, Skuriat, Tyrwhitt, Sheth, Mehta, Pinilla-Echeverri,
Schwalm, Natarajan, Jolly) Population Health Research Institute, Hamilton,
ON, Canada
(d'Entremont) Centre Hospitalier Universitaire de Sherbrooke (CHUS),
Sherbrooke, QC, Canada
(Winter) Clinica Alemana de Santiago, Santiago, Chile
(Brochu) CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, AB,
Canada
(Akl) McGill University Health Centre, Montreal, QC, Canada
Publisher
Elsevier Inc.
Abstract
Background: A significant limitation of femoral artery access for cardiac
interventions is the increased risk of vascular complications and bleeding
compared to radial access. Ultrasound (US)-guided femoral access may
reduce major vascular complications and bleeding. We aim to determine
whether routinely using US guidance for femoral arterial access for
coronary angiography or intervention will reduce Bleeding Academic
Research Consortium (BARC) 2, 3, or 5 bleeding or major vascular
complications. Method(s): The Ultrasound Guidance for Vascular Access
for Cardiac Procedures: A Randomized Trial (UNIVERSAL) is a multicentre,
prospective, open-label, randomized trial with blinded outcomes
assessment. Patients undergoing coronary angiography with or without
intervention via a femoral approach with fluoroscopic guidance will be
randomized 1:1 to US-guided femoral access, compared to no US. The primary
outcome is the composite of major bleeding based on the BARC 2, 3, or 5
criteria or major vascular complications within 30 days. The trial is
designed to have 80% power and a 2-sided alpha level of 5% to detect a 50%
relative risk reduction for the primary outcome based on a control event
rate of 14%. Result(s): We completed enrollment on April 29, 2022,
with 621 randomized patients. The patients had a mean age of 71 years
(25.4% female), with a high rate of comorbidities, as follows: 45% had a
prior percutaneous coronary intervention; 57% had previous coronary artery
bypass surgery; and 18% had peripheral vascular disease.
 Conclusion(s): The UNIVERSAL trial will be one of the largest
randomized trials of US-guided femoral access and has the potential to
change guidelines and increase US uptake for coronary procedures
worldwide. Copyright © 2022 The Authors

<22>
Accession Number
2021416815
Title
Neuromuscular electrical stimulation after cardiovascular surgery
mitigates muscle weakness in older individuals with diabetes.
Source
Annals of Physical and Rehabilitation Medicine. 66(2) (no pagination),
2023. Article Number: 101659. Date of Publication: March 2023.
Author
Takino K.; Kameshima M.; Asai C.; Kawamura I.; Tomita S.; Sato H.;
Hirakawa A.; Yamada S.
Institution
(Takino) Department of Cardiac Rehabilitation, Gifu Heart Center, 4-14-4,
Yabuta-minami, Gifu, Japan
(Takino) Program in Physical and Occupational Therapy, Nagoya University
Graduate School of Medicine, Japan
(Kameshima) Department of Cardiac Rehabilitation, Nagoya Heart Center,
1-1-11, Sunadabashi, higasi-ku, Nagoya, Japan
(Asai) Department of Cardiac Rehabilitation, Toyohashi Heart Center, 1-21,
Gobudori, Toyohasi, Oyamacho, Japan
(Kawamura) Department of Cardiology, Gifu Heart Center, 4-14-4,
Yabuta-minami, Gifu, Japan
(Tomita) Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4,
Yabuta-minami, Gifu, Japan
(Sato, Hirakawa) Division of Biostatistics and Data Science, Clinical
Research Center, Tokyo Medical and Dental University Hospital of Medicine,
1-5-45 Yushima, Tokyo, Bunkyo-ku, Japan
(Yamada) Department of Integrated Health Sciences, Nagoya University
Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya,
Japan
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Cardiovascular surgery leads to postsurgical muscle weakness,
probably because of muscle proteolysis and peripheral nerve dysfunction,
which are augmented by aging and diabetes mellitus. Objective(s): We
examined the effect of neuromuscular electrical stimulation (NMES) on
postsurgical muscle weakness in older individuals with diabetes mellitus.
 Method(s): We conducted a multicentre, randomized, controlled trial,
and screened consecutive patients with diabetes who underwent
cardiovascular surgery for eligibility (age >= 65 years). Those included
were randomly assigned to the NMES or the sham group. The primary outcome
was the percent change in isometric knee extension strength (%DELTAIKES)
from preoperative to postoperative day 7. Secondary outcomes were the
percent change in usual (%DELTAUWS), maximum walking speed (%DELTAMWS),
and grip strength (%DELTAGS). A statistician who was blinded to group
allocation used intention-to-treat analysis (student t test).
 Result(s): Of 1151 participants screened for eligibility, 180 (NMES,
n = 90; sham, n = 90) were included in the primary analysis. %DELTAIKES
was significantly lower in the NMES than sham group (NMES: mean -2%, 95%
confidence interval [CI] -6 to 1; sham: -13%, 95% CI -17 to -9, p <
0.001). Among the secondary outcomes, %DELTAMWS was significantly lower
and %DELTAUWS and %DELTAGS were lower, although not significantly, in the
NMES than sham group. Conclusion(s): A short course of NMES (< 1
week) mitigated postsurgical muscle weakness and functional decline in
older persons with diabetes mellitus. NMES could be recommended as a part
of postsurgical rehabilitation in older people with diabetes mellitus,
especially those with a low functional reserve. Copyright © 2022

<23>
Accession Number
2021723454
Title
Application of indocyanine green fluorescence for ureter imaging: review.
Source
Vestnik Transplantologii i Iskusstvennykh Organov. 24(1) (pp 26-30), 2022.
Date of Publication: 2022.
Author
Smagulov A.D.; Rysmakhanov M.S.; Koishybayev Zh.M.; Sultangereyev Y.B.;
Mussin N.M.
Institution
(Smagulov, Rysmakhanov, Koishybayev, Mussin) West Kazakhstan Medical
University, Aktobe, Kazakhstan
(Rysmakhanov, Sultangereyev) Department of Surgery and Transplantation,
Aktobe Medical Center, Aktobe, Kazakhstan
Publisher
Russian Transplant Society
Abstract
Introduction. Indocyanine green has been used in medicine for more than 70
years in cardio-thoracic surgery, hepatobiliary and colorectal surgery,
urology, gynecology, transplantology, etc. This review based on literature
dates describing the use of ICG for intraoperative imaging and evaluation
of the ureteral perfusion. Method. The research searched in the electronic
database PubMed, Scopus, Elsevier, Springer, and Web of Science between
January 2000 and December 2020, using the following search terms: ICG
imaging, ureteral vessels. Additional literature data identified from
separately published sources. Results. There are 21 articles were obtained
in the specified database: 9 - with intravenous ICG, 12 - with
intraureteral administration. The use of intravenous ICG followed by next
clinical situation: ureteral imaging is described for ureteral strictures,
for isolation and preservation of the ureteral branch of the uterine
artery during radical hysterectomy, for robotic radical cystectomy with
ureteroenterostomy, for laparoscopic removal of ureteral endometriosis,
for evaluation of ureteral perfusion during kidney transplantation, and
for identification and prevention of ureteral damage during pelvic surgery
in patients with colorectal tumors and gynecological pathologies.
Conclusions. Both intravenous and intraureteral ICG imaging are safe, easy
to perform, and easily reproducible. It allows objectively identifying the
degree of perfusion of the ureteral wall, clearly determining the
boundaries of the stricture. It is effectively helps in the prevention of
ureteral wall damage in extraurinal surgical interventions. Copyright
© 2022 Russian Transplant Society. All rights reserved.

<24>
Accession Number
2021686500
Title
Randomized Comparison of Transcatheter Edge-to-Edge Repair for
Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients.
Source
JACC: Cardiovascular Interventions. 15(24) (pp 2523-2536), 2022. Date of
Publication: 26 Dec 2022.
Author
Lim D.S.; Smith R.L.; Gillam L.D.; Zahr F.; Chadderdon S.; Makkar R.; von
Bardeleben R.S.; Kipperman R.M.; Rassi A.N.; Szerlip M.; Goldman S.;
Inglessis-Azuaje I.; Yadav P.; Lurz P.; Davidson C.J.; Mumtaz M.; Gada H.;
Kar S.; Kodali S.K.; Laham R.; Hiesinger W.; Fam N.P.; Kessler M.; O'Neill
W.W.; Whisenant B.; Kliger C.; Kapadia S.; Rudolph V.; Choo J.; Hermiller
J.; Morse M.A.; Schofer N.; Gafoor S.; Latib A.; Koulogiannis K.; Marcoff
L.; Hausleiter J.
Institution
(Lim) University of Virginia Health System Hospital, Charlottesville, VA,
United States
(Smith, Szerlip) Baylor Scott and White: The Heart Hospital Plano, Plano,
TX, United States
(Gillam, Kipperman, Koulogiannis, Marcoff) Atlantic Health System
Morristown Medical Center, Morristown, NJ, United States
(Zahr, Chadderdon) Oregon Health & Science University, Portland, OR,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(von Bardeleben) University Medical Centre Mainz, Mainz, Germany
(Rassi) Kaiser Permanente San Francisco Medical Center, San Francisco, CA,
United States
(Goldman) Lankenau Medical Center, Wynnewood, PA, United States
(Inglessis-Azuaje) Massachusetts General Hospital, Boston, MA, United
States
(Yadav) Piedmont Heart Institute, Atlanta, GA, United States
(Lurz) University of Leipzig, Leipzig, Germany
(Davidson) Northwestern University, Chicago, IL, United States
(Mumtaz, Gada) UPMC Pinnacle, Harrisburg, PA, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kodali) Columbia University Medical Center, New York, NY, United States
(Laham) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Hiesinger) Stanford University Medical Center, Palo Alto, CA, United
States
(Fam) St. Michael's Hospital, Toronto, ON, Canada
(Kesler) University of Ulm, Ulm, Germany
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Kliger) Northwell-Lenox Hill, New York, NY, United States
(Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
(Rudolph) Ruhr-Universitat Bochum, Bad Oeynhausen, Bochum, Germany
(Choo) The Christ Hospital, Cincinnati, OH, United States
(Hermiller) St. Vincent Heart Center of Indiana, Indianapolis, IN, United
States
(Morse) Ascension Saint Thomas Hospital, Nashville, TN, United States
(Schofer) University Heart and Vascular Center Hamburg, Hamburg, Germany
(Gafoor) Swedish Medical Center, Seattle, WA, United States
(Latib) Montefiore Medical Center, Bronx, NY, United States
(Hausleiter) Klinikum der Universitat Munchen, Munich, Germany
Publisher
Elsevier Inc.
Abstract
Background: Severe symptomatic degenerative mitral regurgitation (DMR) has
a poor prognosis in the absence of treatment, and new transcatheter
options are emerging. Objective(s): The CLASP IID (Edwards PASCAL
Transcatheter Valve Repair System Pivotal Clinical Trial) randomized trial
(NCT03706833) is the first to evaluate the safety and effectiveness of the
PASCAL system compared with the MitraClip system in patients with
significant symptomatic DMR. This report presents the primary safety and
effectiveness endpoints for the trial. Method(s): Patients with 3+ or
4+ DMR at prohibitive surgical risk were assessed by a central screening
committee and randomized 2:1 (PASCAL:MitraClip). Study oversight also
included an echocardiography core laboratory and a clinical events
committee. The primary safety endpoint was the composite major adverse
event rate at 30 days. The primary effectiveness endpoint was the
proportion of patients with mitral regurgitation (MR) <=2+ at 6 months.
 Result(s): A prespecified interim analysis in 180 patients
demonstrated noninferiority of the PASCAL system vs the MitraClip system
for the primary safety and effectiveness endpoints of major adverse event
rate (3.4% vs 4.8%) and MR <=2+ (96.5% vs 96.8%), respectively. Functional
and quality-of-life outcomes significantly improved in both groups (P <
0.05). The proportion of patients with MR <=1+ was durable in the PASCAL
group from discharge to 6 months (PASCAL, 87.2% and 83.7% [P = 0.317 vs
discharge]; MitraClip, 88.5% and 71.2% [P = 0.003 vs discharge]).
 Conclusion(s): The CLASP IID trial demonstrated safety and
effectiveness of the PASCAL system and met noninferiority endpoints,
expanding transcatheter treatment options for prohibitive surgical risk
patients with significant symptomatic DMR. Copyright © 2022
American College of Cardiology Foundation

<25>
Accession Number
2020549281
Title
Safety and efficacy of direct cardiac shockwave therapy in patients with
ischemic cardiomyopathy undergoing coronary artery bypass grafting (the
CAST-HF trial): study protocol for a randomized controlled trial-an
update.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 988. Date of
Publication: December 2022.
Author
Nagele F.; Polzl L.; Graber M.; Hirsch J.; Mayr A.; Pamminger M.; Troger
F.; Theurl M.; Schreinlechner M.; Sappler N.; Dorfmuller C.; Mitrovic M.;
Ulmer H.; Grimm M.; Gollmann-Tepekoylu C.; Holfeld J.
Institution
(Nagele, Polzl, Graber, Hirsch, Grimm, Gollmann-Tepekoylu, Holfeld)
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck,
Austria
(Mayr, Pamminger, Troger) Department of Radiology, Medical University of
Innsbruck, Innsbruck, Austria
(Theurl, Schreinlechner, Sappler) Department of Internal Medicine III,
Medical University of Innsbruck, Innsbruck, Austria
(Dorfmuller, Mitrovic) Heart Regeneration Technologies, Innsbruck, Austria
(Ulmer) Department of Medical Statistics, Informatics and Health
Economics, Innsbruck, Austria
Publisher
BioMed Central Ltd
Abstract
Background: Coronary artery disease (CAD) remains a severe socio-economic
burden in the Western world. Coronary obstruction and subsequent
myocardial ischemia result in the progressive replacement of contractile
myocardium with dysfunctional, fibrotic scar tissue. Post-infarctional
remodelling is causal for the concomitant decline of left-ventricular
function and the fatal syndrome of heart failure. Available neurohumoral
treatment strategies aim at the improvement of symptoms. Despite extensive
research, therapeutic options for myocardial regeneration, including
(stem)-cell therapy, gene therapy, cellular reprogramming or tissue
engineering, remain purely experimental. Thus, there is an urgent clinical
need for novel treatment options for inducing myocardial regeneration and
improving left-ventricular function in ischemic cardiomyopathy. Shockwave
therapy (SWT) is a well-established regenerative tool that is effective
for the treatment of chronic tendonitis, long-bone non-union and
wound-healing disorders. In preclinical trials, SWT regenerated ischemic
myocardium via the induction of angiogenesis and the reduction of fibrotic
scar tissue, resulting in improved left-ventricular function.
 Method(s): In this prospective, randomized controlled, single-blind,
monocentric study, 80 patients with reduced left-ventricular ejection
fraction (LVEF<= 40%) are subjected to coronary-artery bypass-graft
surgery (CABG) surgery and randomized in a 1:1 ratio to receive additional
cardiac SWT (intervention group; 40 patients) or CABG surgery with sham
treatment (control group; 40 patients). This study aims to evaluate (1)
the safety and (2) the efficacy of cardiac SWT as adjunctive treatment
during CABG surgery for the regeneration of ischemic myocardium. The
primary endpoints of the study represent (1) major cardiac events and (2)
changes in left-ventricular function 12 months after treatment. Secondary
endpoints include 6-min walk test distance, improvement of symptoms and
assessment of quality of life. Discussion(s): This study aims to
investigate the safety and efficacy of cardiac SWT during CABG surgery for
myocardial regeneration. The induction of angiogenesis, decrease of
fibrotic scar tissue formation and, thus, improvement of left-ventricular
function could lead to improved quality of life and prognosis for patients
with ischemic heart failure. Thus, it could become the first clinically
available treatment strategy for the regeneration of ischemic myocardium
alleviating the socio-economic burden of heart failure. Trial
registration: ClinicalTrials.gov NCT03859466. Registered on 1 March
2019. Copyright © 2022, The Author(s).

<26>
Accession Number
2020483462
Title
Does Intraoperative Fibrinogen Affect Blood Loss or Transfusion Practice
After Aortic Arch Surgery: A Prematurely Ended Randomized Trial.
Source
Clinical and Applied Thrombosis/Hemostasis. 28 (no pagination), 2022. Date
of Publication: January-December 2022.
Author
Vlot E.A.; Hackeng C.M.; Aper S.J.A.; Sonker U.; Heijmen R.H.; van Dongen
E.P.A.; Noordzij P.G.
Institution
(Vlot, van Dongen, Noordzij) Department of Anesthesia, Intensive Care and
Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
(Hackeng, Aper) Department of Clinical Chemistry, St. Antonius Hospital,
Nieuwegein, Netherlands
(Sonker, Heijmen) Department of Cardiac Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
Publisher
SAGE Publications Inc.
Abstract
Cardiovascular surgery is often complicated by significant bleeding due to
perioperative coagulopathy. The effectiveness of treatment with fibrinogen
concentrate to reduce the perioperative blood transfusion rate after
thoracic aortic replacement surgery in prior studies has shown conflicting
results. Therefore, we conducted a double-blind randomized controlled
trial to investigate if a single dose of intraoperative fibrinogen
administration reduced blood loss and allogeneic transfusion rate after
elective surgery for thoracic arch aneurysm with deep hypothermic
circulatory arrest. Twenty patients were randomized to fibrinogen
concentrate (N = 10) or placebo (N = 10). The recruitment of study
patients was prematurely ended due to a low inclusion rate. Perioperative
transfusion, 5-minute bleeding mass after study medication and
postoperative blood loss were not different between the groups with
fibrinogen concentrate or placebo. Due to small volumes of postoperative
blood loss and premature study termination, a beneficial effect of
fibrinogen concentrate on the number of blood transfusions could not be
established. However, treatment with fibrinogen efficiently restored
fibrinogen levels and clot strength to preoperative values with a more
effective preserved postoperative thrombin generation capacity. This
result might serve as a pilot for further multicenter studies to assess
the prospective significance of automated and standardized thrombin
generation as a routine assay for monitoring perioperative coagulopathy
and its impact on short- and long-term operative results. Copyright
© The Author(s) 2022.

<27>
Accession Number
2021605197
Title
Non-vitamin K antagonist oral anticoagulants in patients with valvular
heart disease.
Source
European Heart Journal, Supplement. 24 (pp A19-A31), 2022. Date of
Publication: 01 Feb 2022.
Author
Fanaroff A.C.; Vora A.N.; Lopes R.D.
Institution
(Fanaroff) Division of Cardiovascular Medicine, Department of Medicine,
Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center,
Leonard Davis Institute for Health Economics, University of Pennsylvania,
3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
(Vora) UPMC Heart and Vascular Institute, Harrisburg, PA, United States
(Vora, Lopes) Division of Cardiovascular Medicine, Department of Medicine,
Duke University, 2400 Pratt St, Durham, NC 27710, United States
(Lopes) Duke Clinical Research Institute, Duke University, PO Box 17969,
Durham, NC 27715, United States
Publisher
Oxford University Press
Abstract
The non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran,
rivaroxaban, apixaban, and edoxaban have transformed the management of
atrial fibrillation (AF), but are only approved by regulatory authorities
for stroke prophylaxis in patients with so-called "non-valvular AF."This
terminology has spawned confusion about which patients with valvular heart
disease benefit from NOACs and which should be treated with vitamin K
antagonists (VKAs) instead. Patients with valvular heart disease other
than mechanical prosthetic valves or severe mitral stenosis (including
those with bioprosthetic valves) were included in pivotal trials
demonstrating the benefit of NOACs over VKAs, and consensus guidelines
recommend NOACs over VKAs in these patients. Subsequent devoted randomized
controlled trials in patients with AF and bioprosthetic valves, including
transcatheter valves, have confirmed the safety of NOACs in this
population. In patients with rheumatic mitral stenosis, observational
studies indicate that NOACs may be safe and effective, but randomized
controlled trials are ongoing. By contrast, a randomized controlled trial
showed that dabigatran is harmful in patients with mechanical prosthetic
mitral valves; however, these data may not extrapolate to patients with
mechanical valve prostheses in other locations or to other NOACs, and
randomized controlled trials are ongoing. In this review, we discuss these
data in greater depth, and make recommendations for the use of NOACs in
patients with valvular heart disease. Copyright © The Author(s)
2022.

<28>
Accession Number
2021605191
Title
Clinical impact of myocardial fibrosis in severe aortic stenosis.
Source
European Heart Journal, Supplement. 23(Se) (pp E147-E150), 2021. Date of
Publication: 01 Oct 2021.
Author
Castrichini M.; Vitrella G.; De Luca A.; Altinier A.; Korcova R.; Pagura
L.; Radesich C.; Sinagra G.
Institution
(Castrichini, Vitrella, De Luca, Altinier, Korcova, Pagura, Radesich,
Sinagra) Division of Cardiology, Cardiovascular Department, Azienda
Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
Publisher
Oxford University Press
Abstract
The pressure overload due to the progressive narrowing of the valve area
determines the development of the left ventricular hypertrophy which
characterizes aortic stenosis (AS). The onset of myocardial fibrosis marks
the inexorable decline of an initially compensatory response towards heart
failure. However, myocardial fibrosis does not yet represent a key element
in the prognostic and therapeutic framework of AS. In this context,
cardiac magnetic resonance imaging plays a major role by highlighting both
the focal irreversible fibrotic replacement, using the late gadolinium
enhancement (LGE) technique, and the earlier diffuse reversible
interstitial fibrosis, using the T1 mapping techniques. For this reason,
the presence of myocardial fibrosis would be useful to identify a subgroup
of patients at greater risk of events among the subjects with severe AS.
Actually, more and more evidences seem to identify the presence of LGE as
a powerful prognostic factor to be used to optimize the timing of
prosthetic valve replacement. Randomized clinical trials, such as the
EVoLVeD trial currently underway, will be needed to better define the
importance of myocardial fibrosis assessment in the management of patients
with AS. Copyright © The Author(s) 2021.

<29>
Accession Number
2021605161
Title
The ISCHEMIA trial: Optimal medical therapy against PTCA in the stable
patient: The endless story.
Source
European Heart Journal, Supplement. 23 (pp E55-E58), 2021. Date of
Publication: 01 Oct 2021.
Author
Santucci A.; Cavallini C.
Institution
(Santucci, Cavallini) Azienda Ospedaliera S.Maria della Misericordia,
Piazzale Menghini 1, Perugia 06129, Italy
Publisher
Oxford University Press
Abstract
In patients with acute coronary syndrome, an aggressive approach with
coronary angiography and revascularization leads to important benefits
compared to medical therapy alone. On the contrary, the prognostic impact
of coronary revascularization in patients suffering from stable coronary
artery disease has long been the subject of debate. The pivotal study in
this area is COURAGE, published in 2007, in which coronary
revascularization showed no benefit about the combined endpoint of death
from all causes and acute myocardial infarction (AMI), compared to medical
therapy. The ISCHEMIA study, published in 2020, compared selective
coronary angiography and revascularization vs. a non-invasive approach. By
protocol, the patients were initially evaluated with coronary computed
axial tomography angiography: in case of coronary stenosis 50%, they were
then randomized to the two strategies. While in the invasive arm patients
were revascularized, in the non-invasive arm revascularization was used
only in case of patient destabilization. As in COURAGE, the results of
ISCHEMIA did not demonstrate superiority of revascularization over medical
therapy alone for a combined endpoint of cardiovascular death, AMI, or
hospitalization for unstable angina, heart failure, or cardiac arrest.
Based on recent evidence from ISCHEMIA, it is therefore confirmed that
coronary revascularization in stable patients does not seem to improve the
prognosis compared to medical therapy alone. Copyright © 2021
Oxford University Press. All rights reserved.

<30>
Accession Number
2018422994
Title
Impact of Lower Versus Higher LDL Cholesterol Targets on Cardiovascular
Events After Ischemic Stroke in Patients With Diabetes.
Source
Diabetes. 70(8) (pp 1807-1815), 2021. Date of Publication: August 2021.
Author
Amarenco P.; Kim J.S.; Labreuche J.; Charles H.; Giroud M.; Lee B.-C.;
Lavallee P.C.; Mahagne M.-H.; Meseguer E.; Nighoghossian N.; Steg P.G.;
Vicaut E.; Bruckert E.
Institution
(Amarenco, Charles, Lavallee, Meseguer) INSERM LVTS-U1148, DHU FIRE,
Department of Neurology and Stroke Center, Bichat Hospital, Assistance
Publique-Hopitaux de Paris (APHP), University of Paris, Paris, France
(Kim) Asan Medical Center, Seoul, South Korea
(Labreuche) EA 2694, Sante Publique Epidemiologie et Qualite des Soins,
CHU Lille, Universite Lille, Lille, France
(Giroud) EA 7460, Dijon Stroke Registry, Department of Neurology,
University Hospital of Dijon, University of Burgundy, University of
Burgundy Franche-Comte, Dijon, France
(Lee) Department of Neurology, Hallym University Sacred Heart Hospital,
Anyang, South Korea
(Mahagne) Stroke Unit, Pasteur Hospital, Nice, France
(Nighoghossian) Department of Neurology and Stroke Center, Hospices Civils
de Lyon, Lyon University, Lyon, France
(Steg) INSERM LVTS-U1148, Bichat Hospital, Assistance Publique-Hopitaux de
Paris (APHP), University of Paris, Paris, France
(Vicaut) Department of Biostatistics, Fernand Widal Hospital, APHP,
Universite Paris-Diderot, Sorbonne-Paris Cite, Paris, France
(Bruckert) Department of Endocrinology, Pitie-Salpetriere Hospital,
Assistance Publique-Hopitaux de Paris (APHP), Sorbonne University, Paris,
France
Publisher
American Diabetes Association Inc.
Abstract
After an ischemic stroke with evidence of atherosclerosis, lipid-lowering
treatment with a target LDL cholesterol of 70 mg/dL compared with 100 +/-
10 mg/dL reduced the risk of subsequent cardiovascular events. In this
analysis, we explored the effectW in the subgroup of patients with
diabetes compared with the subgroup without, as well as in those with
newly diagnosed diabetes. Patients with ischemic stroke in the previous 3
months or transient ischemic attack within the previous 15 days and
evidence of cerebrovascular or coronary artery atherosclerosis were
randomly assigned at a 1:1 ratio to a target LDL cholesterol of 70 mg/dL
or 100 +/- 10 mg/dL using statin or ezetimibe. The primary outcome was the
composite of ischemic stroke, myocardial infarction, new symptoms
requiring urgent coronary or carotid revascularization, and death
resulting from vascular disease. We performed a prespecified analysis to
evaluate the effect in patients with diabetes. Of 2,860 patients enrolled,
643 had diabetes at baseline, with a mean age of 66.2 years and baseline
LDL cholesterol of 127 mg/dL, and were followed for a median of 3 years.
The primary composite end point occurred in 27 (8.2%) of 328 patients in
the lower-target group and in 44 (14.0%) of 315 patients in the
higher-target group (adjusted hazard ratio [HR] 0.56; 95% CI 0.34-0.89; P
5 0.016). In patients without diabetes, the HR was 0.87 (95% CI 0.66-1.14;
P 5 0.31; interaction P 5 0.15). In those with diabetes, there were three
intracranial hemorrhages in both randomization groups (0.9% vs. 1.0%,
respectively). Newly diagnosed diabetes occurred in 98 (9.2%) of 1,070 and
in 80 (7.4%) of 1,085 patients in the lower-and higher-target groups,
respectively (HR 1.27; 95% CI 0.94-1.71; P 5 0.11), and baseline higher
HbA<inf>1c</inf> was the unique multivariable predictor. In conclusion,
after an ischemic stroke with evidence of atherosclerosis, targeting an
LDL cholesterol of 70 mg/dL compared with 100 +/- 10 mg/dL consistently
reduced the risk of subsequent stroke and othermajor vascular events in
patients with and without diabetes, but the higher risk in those with
diabetes yielded a higher absolute risk reduction, with number needed to
treat of 17. Copyright © 2021 by the American Diabetes
Association.

<31>
Accession Number
639742996
Title
Cardiac rehabilitation after TAVI - a systematic review and meta-analysis.
Source
Current problems in cardiology. (pp 101531), 2022. Date of Publication:
06 Dec 2022.
Author
Oz A.; Tsoumas I.; Lampropoulos K.; Xanthos T.; Karpettas N.; Papadopoulos
D.
Institution
(Oz, Tsoumas, Lampropoulos, Xanthos, Karpettas, Papadopoulos) European
University Cyprus, School of medicine, Cyprus
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Despite the increasing popularity of TAVI in patients with
high surgical risk, there is no current guideline for the management of
patients following the intervention. PURPOSE: This systematic review and
meta-analysis aims to summarize and analyse all clinical data and evidence
regarding the effectiveness and outcomes of CR following TAVI.
METHODOLOGY: The first meta-analysis measured the walked distance in the
Six-Minute Walk Test (6MWT) and the second meta-analysis included studies
that showed the Barthel Index (BI) before and after CR. RESULT(S):
The mean distance walked prior to CR was 235.88 +/- 69.36 m increased to
292.12 +/- 54.92 m after rehabilitation, signifying a moderate clinically
relevant effect size (0.593 (0.42, 0.76); P=0.00). The mean BI score
before CR was 76.6 +/- 11.5 which increased to 89.8 +/- 5.5 after the
programme and similarly demonstrated a significant standardized mean
improvement (0.75 (0.57, 0.93); P= 0.00). CONCLUSION(S):
Exercise-based CR in patients with aortic stenosis treated with TAVI
demonstrated a significant improvement in exercise tolerance and
functional independence shown by the 6MWT and BI. Copyright ©
2022. Published by Elsevier Inc.

<32>
Accession Number
639742744
Title
Intimal hyperplasia, saphenous vein graft disease, and clinical outcomes:
Insights from the CTSN VEST randomized trial.
Source
The Journal of thoracic and cardiovascular surgery. (no pagination),
2022. Date of Publication: 30 Oct 2022.
Author
Goldstein D.J.; Chang H.L.; Mack M.J.; Voisine P.; Gammie J.S.; Marks
M.E.; Iribarne A.; Vengrenyuk Y.; Raymond S.; Taylor B.S.; Dagenais F.;
Ailawadi G.; Chu M.W.A.; DiMaio J.M.; Narula J.; Moquete E.G.; O'Sullivan
K.; Williams J.B.; Crestanello J.A.; Scavo V.; Puskas J.D.; Acker M.A.;
Gillinov M.; Gelijns A.C.; O'Gara P.T.; Moskowitz A.J.; Alexander J.H.;
Bagiella E.
Institution
(Goldstein) Department of Cardiovascular and Thoracic Surgery, Montefiore
Medical Center, Bronx, NY, United States
(Chang, Marks, Raymond, Moquete, O'Sullivan, Gelijns, Moskowitz, Bagiella)
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY
(Mack, DiMaio) Cardiothoracic Surgery, Baylor Scott & White Health, Plano,
United States
(Voisine, Dagenais) Department of Surgery, Institut de Cardiologie et
Pneumologie de Quebec, Quebec City, Quebec, Canada
(Gammie) Johns Hopkins Heart and Vascular Institute, Johns Hopkins Health
System, Baltimore, Md, Liberia
(Iribarne) Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center,
NH, Lebanon
(Vengrenyuk) Division of Cardiology, Mount Sinai Hospital and Icahn School
of Medicine at Mount Sinai, New York, NY
(Taylor) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, Md, Liberia
(Ailawadi) Department of Cardiac Surgery, University of Michigan, Mich,
Ann Arbor, United States
(Chu) Division of Cardiac Surgery, Western University, London Health
Sciences Centre, London, ON, Canada
(Narula) Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New
York, NY
(Williams) Cardiovascular Surgery, WakeMed Health and Hospitals, Raleigh,
NC, United States
(Crestanello) Department of Cardiovascular Surgery, Mayo Clinic, Minn,
Rochester, United Kingdom
(Scavo) Cardiovascular and Thoracic Surgery, Lutheran Medical Group, Ind,
Fort Wayne, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Morningside,
New York, NY
(Acker) Division of Cardiovascular Surgery, University of Pennsylvania,
Hospital of the University of Pennsylvania, Philadelphia, Pa, United
States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Mass,
Boston, United States
(Alexander) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Diffuse intimal hyperplasia and graft irregularity adversely
affect the long-term patency of saphenous vein grafts (SVGs) and clinical
outcomes of patients undergoing coronary artery bypass grafting (CABG).
The VEST trial evaluated the efficacy of external graft support in
limiting the development of intimal hyperplasia (IH) at 1 year
postsurgery. In the present secondary analysis, we explored the
associations between graft disease and IH and clinical events. We also
examined risk factors for early graft occlusion. METHOD(S): VEST is a
within-patient randomized, multicenter trial that enrolled 224 patients
with multivessel coronary disease undergoing CABG surgery, of whom 203
were evaluated by 1 year postsurgery. Intimal hyperplasia, lumen
uniformity, graft stenosis, and graft perfusion were measured by
intravascular ultrasound and angiography. Major cardiac and
cerebrovascular events (MACCE; including death, myocardial infarction,
stroke, and revascularization) were recorded over a median follow-up of 3
years. RESULT(S): Worse lumen uniformity, greater stenosis, and worse
graft perfusion were associated with higher IH values and an increased
incidence of clinical events. Consistent with previous findings, we
identified endoscopic vein harvesting, female sex, and transit time flow
measurement of pulsatility index and flow as risk factors for SVG
occlusion during the first year postsurgery. CONCLUSION(S): In this
secondary analysis of the VEST trial, we observed an association between
intimal hyperplasia area and clinical measures of SVG disease at 1 year
postsurgery. More severe SVG disease and larger areas of IH were
associated with a higher incidence of 3-year MACCE. Ongoing follow-up to 5
years will further elucidate the impact of SVG disease on long-term
clinical outcomes of CABG. Copyright © 2022 The American
Association for Thoracic Surgery. Published by Elsevier Inc. All rights
reserved.

<33>
Accession Number
2020568897
Title
The Early Effects of Bariatric Surgery on Cardiac Structure and Function:
a Systematic Review and Meta-Analysis.
Source
Obesity Surgery. (no pagination), 2022. Date of Publication: 2022.
Author
Huang S.; Lan Y.; Zhang C.; Zhang J.; Zhou Z.
Institution
(Huang, Lan, Zhang, Zhang, Zhou) National Clinical Research Center for
Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of
Diabetes Immunology, Ministry of Education, and Department of Metabolism
and Endocrinology, The Second Xiangya Hospital of Central South
University, Hunan, Changsha 410011, China
(Huang, Lan) Department of Ultrasound Diagnosis, The Second Xiangya
Hospital of Central South University, Hunan, Changsha 410011, China
Publisher
Springer
Abstract
Background: This meta-analysis was performed to investigate how cardiac
structures and functions change in the very early stage after bariatric
surgery. Material(s) and Method(s): We thoroughly searched the
PubMed, Embase, Cochrane Library, and Web of Science databases for
articles including patients who underwent bariatric surgery and examined
the changes of their cardiac indices. Results were pooled by using Review
Manager 5.1 and Stata 12.0. Weighted mean differences (WMDs) with 95%
confidence intervals (CIs) were obtained. The I-squared (I2)
test was used to determine the heterogeneity between studies. To identify
publication bias, funnel plots and Egger's test were utilized. The
leave-one-out method was used to conduct sensitivity analysis.
 Result(s): In this meta-analysis, 24 research including 942 patients
were considered. According to our findings, most cardiac indices changed
3-6 months following bariatric surgery. An improvement in cardiac geometry
was reflected by a reduction in left ventricular mass (LVM) (WMD = -
22.06, 95% CI = (- 27.97, - 16.16)). The left ventricular diastolic
function improved, as reflected by the decrease in the E/e' ratio (WMD = -
0.90, 95% CI = (- 1.83, - 0.16)). Left ventricular ejection fraction
(LVEF) did not show an obvious change (WMD = 0.94, 95% CI = (- 0.19,
2.07)), while a more sensitive indicator of left ventricular systolic
function, left ventricular longitudinal strain (LV LS), increased (WMD = -
2.43, 95% CI = (- 3.96, - 0.89)). Conclusion(s): This meta-analysis
includes the newest and most comprehensive cardiac indices to prove that
cardiac structures and functions are improved early after bariatric
surgery, which has not been reported by any other studies. Copyright
© 2022, The Author(s), under exclusive licence to Springer
Science+Business Media, LLC, part of Springer Nature.

<34>
Accession Number
2021293690
Title
Computed Tomography vs Invasive Coronary Angiography in Patients With
Suspected Coronary Artery Disease: A Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 15(12) (pp 2147-2149), 2022. Date of
Publication: December 2022.
Author
Kheiri B.; Simpson T.F.; Osman M.; German D.M.; Fuss C.S.; Ferencik M.
Publisher
Elsevier Inc.

<35>
Accession Number
2017710600
Title
Leaflet Resection vs Preservation for Degenerative Mitral Regurgitation:
Functional Outcomes and Mitral Stenosis at 12 Months in a Randomized
Trial.
Source
Canadian Journal of Cardiology. 38(6) (pp 808-814), 2022. Date of
Publication: June 2022.
Author
Hibino M.; Pandey A.; Chan V.; Mazer C.D.; Dhingra N.K.; Bonneau C.; Verma
R.; Quan A.; Teoh H.; Cheema A.; Yanagawa B.; Leong-Poi H.; Connelly K.A.;
Bisleri G.; Verma S.
Institution
(Hibino, Dhingra, Quan, Teoh, Yanagawa, Bisleri, Verma) Division of
Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital,
Toronto, ON, Canada
(Hibino, Yanagawa, Bisleri, Verma) Department of Surgery, University of
Toronto, ON, Canada
(Pandey) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Chan) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Chan) School of Epidemiology, Public Health and Preventive Medicine,
University of Ottawa, Ottawa, Ontario, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of St
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, ON, Canada
(Mazer, Connelly) Department of Physiology, University of Toronto,
Toronto, ON, Canada
(Bonneau) Division of Cardiac Surgery, McGill University, Montreal, QC,
Canada
(Verma) Royal College of Surgeons in Ireland, Dublin, Ireland
(Teoh) Division of Endocrinology and Metabolism, Li Ka Shing Knowledge
Institute of St Michael's Hospital, Toronto, ON, Canada
(Cheema) Division of Cardiology, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Leong-Poi, Connelly) Division of Cardiology, Li Ka Shing Knowledge
Institute of St Michael's Hospital, Toronto, ON, Canada
(Leong-Poi, Connelly) Department of Medicine, University of Toronto, ON,
Canada
(Verma) Department of Pharmacology and Toxicology, University of Toronto,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Mitral valve repair is the gold standard treatment for
degenerative mitral regurgitation (MR). The Canadian Mitral Research
Alliance (CAMRA) CardioLink-2 trial showed no significant association
between repair strategy, that is, leaflet resection vs preservation, and
risk of functional mitral stenosis. In this subanalysis, we compared
outcomes and functional tests at 12 months. Method(s): CAMRA
CardioLink-2 was a multicentre randomized controlled trial that allocated
patients with degenerative MR and posterior leaflet prolapse to leaflet
resection (n = 54) or preservation (n = 50). Stress echocardiography and
functional status assessments, including the 6-minute walk test, were
compared 12 months after repair. Result(s): Baseline demographics,
stress echocardiographic findings, and mitral annuloplasty prosthesis size
(33.0 +/- 3.0 vs 33.6 +/- 3.4 mm; P = 0.4) were similar between the two
groups. There were no readmissions for heart failure or deaths during the
follow-up period. At 12 months, a larger percentage of patients were in
NYHA functional class >= 2 in the resection group compared with the
preservation group (P = 0.01). Exercise capacity, rate-pressure product,
6-minute walk distance, and mean mitral valve gradients were not
significantly different between the groups at 12 months. A more prominent
increase in mean mitral gradient with smaller annuloplasty sizes was
observed in the resection group at both rest (P = 0.03) and peak exercise
(P = 0.005) in the linear regression model. Conclusion(s): At 12
months, there were no significant differences in mitral valve gradient,
exercise capacity, and 6-minute walk test between repair strategies.
Leaflet preservation may offer a larger mitral valve orifice with improved
gradients in patients requiring smaller annuloplasty sizes. Copyright
© 2022 Canadian Cardiovascular Society

<36>
Accession Number
2018075780
Title
Transcatheter aortic valve replacement in aortic stenosis and cardiac
amyloidosis: a systematic review and meta-analysis.
Source
ESC Heart Failure. 9(5) (pp 3188-3197), 2022. Date of Publication: October
2022.
Author
Cannata F.; Chiarito M.; Pinto G.; Villaschi A.; Sanz-Sanchez J.; Fazzari
F.; Regazzoli D.; Mangieri A.; Bragato R.M.; Colombo A.; Reimers B.;
Condorelli G.; Stefanini G.G.
Institution
(Cannata, Chiarito, Pinto, Villaschi, Condorelli, Stefanini) Department of
Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4,
Pieve Emanuele-Milan, Italy
(Cannata, Chiarito, Pinto, Villaschi, Fazzari, Regazzoli, Mangieri,
Bragato, Colombo, Reimers, Condorelli, Stefanini) IRCCS Humanitas Research
Hospital, Rozzano-Milan, Italy
(Sanz-Sanchez) Hospital Universitario y Politecnico La Fe, Valencia, Spain
(Sanz-Sanchez) Centro de Investigacion Biomedica en Red (CIBERCV), Madrid,
Spain
Publisher
John Wiley and Sons Inc
Abstract
Aims: Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical
diseases of the elderly. Up to 16% of older adults with severe AS referred
to transcatheter aortic valve replacement (TAVR) have a concomitant
diagnosis of CA. CA-AS population suffers from reduced functional capacity
and worse prognosis than AS patients. As the prognostic impact of TAVR in
patients with CA-AS has been historically questioned and in light of
recently published evidence, we aim to provide a comprehensive synthesis
of the efficacy and safety of TAVR in CA-AS patients. Methods and
Results: We performed a systematic review and meta-analysis of studies:
(i) evaluating mortality with TAVR as compared with medical therapy in
CA-AS patients and (ii) reporting complications and clinical outcomes of
TAVR in CA-AS patients as compared with patients with AS alone. A total of
seven observational studies were identified: four reported mortality with
TAVR, and four reported complications and clinical outcomes after TAVR of
patients with CA-AS compared with AS alone patients. In patients with
CA-AS, the risk of mortality was lower with TAVR (n = 44) as compared with
medical therapy (n = 36) [odds ratio (OR) 0.23, 95% confidence interval
(CI) 0.07-0.73, I2 = 0%, P = 0.001, number needed to treat =
3]. The safety profile of TAVR seems to be similar in patients with CA-AS
(n = 75) as compared with those with AS alone (n = 536), with comparable
risks of stroke, vascular complications, life-threatening bleeding, acute
kidney injury, and 30 day mortality, although CA-AS was associated with a
trend towards an increased risk of permanent pacemaker implantation (OR
1.76, 95% CI 0.91-4.09, I2 = 0%, P = 0.085). CA is associated
with a numerically higher rate of long-term mortality and
rehospitalizations following TAVR in patients with CA-AS as compared with
those with AS alone. Conclusion(s): TAVR is an effective and safe
procedure in CA-AS patients, with a substantial survival benefit as
compared with medical therapy, and a safety profile comparable with
patients with AS alone except for a trend towards higher risk of permanent
pacemaker implantation. Copyright © 2022 The Authors. ESC Heart
Failure published by John Wiley & Sons Ltd on behalf of European Society
of Cardiology.

<37>
Accession Number
2020878218
Title
The role of duloxetine in reducing opioid consumption after thoracotomy: a
prospective, randomized, double-blinded, placebo-controlled pilot trial.
Source
Minerva Anestesiologica. 88(10) (pp 780-788), 2022. Date of Publication:
October 2022.
Author
Abdelghafar E.M.; Othman A.H.; Elrawas M.M.; Kilany A.M.; Shaker E.H.
Institution
(Abdelghafar, Elrawas, Shaker) Department of Anesthesia and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
(Othman) Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer
Institute, Assiut University, Assiut, Egypt
(Kilany) Department of Research on Children with Special Needs, National
Research Center, Cairo, Egypt
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Exploration of the thoracic cavity through a thoracotomy
incision for thoracic malignancies is accompanied by severe, excruciating
acute postoperative pain. The objective of this study is to evaluate the
efficacy of perioperative duloxetine when given as part of a multimodal
analgesia in reducing the dose of opioids needed to treat acute
postoperative pain after thoracotomy. METHOD(S): Sixty patients
scheduled for thoracotomy were randomly assigned to one of two treatment
groups. The duloxetine group (D) received duloxetine 60 mg orally two
hours before the surgical procedure and 24 hours after surgery, and the
placebo group (P) received oral equivalent placebo capsules during the
same time schedule. The primary outcome was the postoperative consumption
of narcotics. Secondary outcome measures were assessment of postoperative
pain scores (VAS) during rest, walking and coughing, hemodynamic variables
and development of any side effects. RESULT(S): Total dose of
morphine needed to treat postoperative pain in first 48 hours,
intraoperative isoflurane concentrations, intra- and postoperative
epidural infusion rates all were significantly lower in group D (P<0.001).
Postoperative pain at rest (VAS-R) was significantly less frequent in
group D compared to group P at all-time intervals so as during walking
(VAS-W) (P<0.001). While during cough (VAS-C), it was comparable at all
time point except at 12 hours which was significantly low in group D
(P<0.001). The intra-, postoperative mean blood pressure and development
of side effects were comparable between the two groups.
 CONCLUSION(S): Oral duloxetine used perioperatively during thoracic
surgery may play an important role as multimodal analgesia for acute
postoperative pain without any added side effects. Copyright ©
2022 EDIZIONI MINERVA MEDICA.

<38>
Accession Number
2021623615
Title
SODIUM BICARBONATE INFUSION: TO PREVENT CARDIAC SURGERY-ASSOCIATED ACUTE
KIDNEY INJURY.
Source
International Journal of Academic Medicine and Pharmacy. 4(5) (pp 27-30),
2022. Date of Publication: 2022.
Author
Namdev H.
Institution
(Namdev) Department of Cardiothoracic and Vascular Surgery,
Superspeciality Hospital, MGMMC, Madhya Pradesh, Indore, India
Publisher
Necati Ozpinar
Abstract
Background: Acute kidney injury (AKI) is a frequent and severe
postoperative complication in patients undergoing cardiac surgery with an
incidence varying from 36.3 to 52.0%. With increasing interest, this topic
has been specifically referred to as cardiac surgery-associated acute
kidney injury (CSA-AKI). CSA-AKI could contribute to increased in-hospital
mortality, 5-year mortality, 30-day readmission, requirement for renal
replacement therapy (RRT), ICU length of stay, and total postoperative
cost. Material(s) and Method(s): Study was done in the period of
February 2019 to February 2020 at Super speciality hospital GMC Nagpur.
This study was a double-blind, randomized controlled trial designed to
assess if the administration of sodium bicarbonate as a continuous
infusion commenced prior to cardiopulmonary bypass would result in less
postoperative acute renal dysfunction in patients undergoing cardiac
surgery. This prospective study enrolled 70 consecutive patients who
underwent on pump cardiac surgery. A Microsoft Excel-based (Microsoft
Corp., Redmond, WA) random-number generator was used to create the
randomization list. Allocation concealment to patients, anesthesiologists,
cardiac surgeons, intensive care specialists, bedside nurses, and
investigators was ensured. Treatment allocation was only revealed after
the study had been completed, the database locked, and statistical
analysis completed. Result(s): No statistical difference between the
groups was detected in terms of age (41.84 +/- 13.762 vs 46.77 +/- 13.249)
days, P=0.331; age range, 16 year -80 years), weight (49.17 +/- 10.413vs
56.17 +/- 17.666 kg, P =0.183, and duration of CPB (93.2857 +/- 33.79913
vs 105.8429 +/- 41.68955 minutes, P=0.270) and in cross clamp time
(67.1143 +/- 27.20110 vs 75.9143 +/- 37.93539 minutes, P=0.079) which is
shown in Table.1, 3. Conclusion(s): Perioperative alkalization of
blood and urine using an infusion of sodium bicarbonate did not result in
a decrease in the incidence of acute kidney injury in patients undergoing
cardiac surgery. Copyright © 2022 University of Agriculture. All
rights reserved.

<39>
Accession Number
2021623614
Title
HYPOMAGNESAEMIA AND ROLE OF MAGNESIUM SUPPLEMENTATION DURING
CARDIOPULMONARY BYPASS IN PEDIATRICS CARDIAC SURGERY.
Source
International Journal of Academic Medicine and Pharmacy. 4(5) (pp 23-26),
2022. Date of Publication: 2022.
Author
Namdev H.; Goel A.; Piyushgupta
Institution
(Namdev, Goel, Piyushgupta) Department of Cardiothoracic and Vascular
Surgery, Superspeciality Hospital, MGMMC, Madhya Pradesh, Indore, India
Publisher
Necati Ozpinar
Abstract
Background: A significant source of morbidity and mortality following
cardiac surgery for congenital heart disease is postoperative arrhythmias.
Patients with congenital cardiac disease are particularly susceptible to
rhythm abnormalities in the early postoperative period. Little is known
about the prevalence, danger signs, treatment, and prevention of early
postoperative arrhythmias in juvenile cardiac surgery. An incidence of
between 15% and 17.7% was observed in a recent report by Roos-Hesselink
and Karamermer. Material(s) and Method(s): This prospective study was
conducted at Super speciality hospital GMC Nagpur, All patients with
tetralogy of Fallot undergoing intra-cardiac repair in the Department of
Cardiothoracic and Vascular Surgery between February 2019 to February 2020
were enrolled in this study. A total of 90 patients were included in this
study.The patients receiving any antiarrhythmic medication either prior to
surgery or intraoperative were excluded from the study.The patients were
randomly assigned to one of the following groups: Group 1 (Mg0), receiving
normal saline (placebo), group 2 (Mg25), receiving 25mg/kg of MgSO4, and
group 3 (Mg50), and receiving 50mg/kg of MgSO4. Maximum total dose of
MgSO4 did not exceed 2g. All subjects received a single bolus of either
placebo or drug into the CPB circuit at the initiation of the rewarming
period. MgSO4 (500mg/mL; 4mEq/mL). The composition of the bypass circuit
and perfusion protocols were according to established institutional
practices. Patients receiving antiarrhythmics preoperatively or
intraoperatively were excluded from the study. Result(s):
Hypomagnesaemia was present in 28% of patients. None of the patients who
were administered magnesium developed hypomagnesaemia. The incidence of
JET was found to be increased (53.3%) in the placebo group as compared to
13.3% and 6.7% in the groups receiving 25 and 50mg/kg of magnesium
(p<.001). 22 patients having JET 14 (64%) had hypomagnesaemia and rest of
the 8(36%) occurred in patients with normal magnesium levels (p<.001). The
mean mechanical ventilation time and the mean length of ICU stay were both
prolonged those with hypomagnesaemia. The mean mechanical ventilation time
and length of ICU stay were both prolonged in the patients with JET.
 Conclusion(s): Hypomagnesemia is one of the factors responsible for
JET and in turn with prolonged ICU stay and prolonged mechanical
ventilation time. Our study suggests that supplementation of MgSO4 during
CPB reduces the incidence of hypomagnesaemia and reduces the overall
incidence of JET. Copyright © 2022 University of Agriculture. All
rights reserved.

<40>
Accession Number
2021604237
Title
Clinical utility of non-contact charge density 'SuperMap' algorithm for
the mapping and ablation of organized atrial arrhythmias.
Source
Europace. 24(5) (pp 747-754), 2022. Date of Publication: 01 May 2022.
Author
Pope M.T.B.; Leo M.; Briosa E Gala A.; Betts T.R.
Institution
(Pope, Leo, Briosa E Gala, Betts) Department of Cardiology, Oxford
University Hospitals Nhs Foundation Trust, Oxford, United Kingdom
(Pope, Briosa E Gala) Department for Human Development and Health,
University of Southampton, Southampton, United Kingdom
(Betts) Division of Cardiovascular Medicine, University of Oxford
Biomedical Research Centre, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: SuperMap is a novel non-contact algorithm for the mapping of
organized atrial arrhythmias. We prospectively evaluated SuperMap during
mapping and ablation of atrial tachycardias (ATs) and paced rhythms and
compared to conventional high-density contact mapping. Methods and
Results: Consecutive patients undergoing SuperMap guided ablation of
pre-existing ATs or AT developed during atrial fibrillation ablation
procedures were included together with maps obtained during pacing to
assess block in linear lesions. The time taken to obtain diagnostic maps
was measured together with the number of electrogram (EGM) points and
accuracy compared to the arrhythmia diagnosis confirmed using a
combination of map findings, entrainment, and response to ablation. In a
subgroup of patients, concurrent contact mapping was performed with
contact and SuperMap analysed by separate operators blinded to the other
technique. The time taken to generate a diagnostic map, EGM number, and
map accuracy was compared. Thirty-one patients (62 maps) were included
with contact mapping performed in 19 [39 maps (33 for AT)]. SuperMap
acquisition time was 314 s [interquartile range (IQR) 239-436]. The median
number of EGM points used per map was 5399 (IQR 3279-8677). SuperMap was
faster than contact mapping [394 +/- 219 s vs. 611 +/- 331 s; difference
217 s, 95% confidence interval (CI) 116-318, P < 0.0005]. The number of
EGM points used per map was higher for SuperMap (7351 +/- 5054 vs. 3620
+/- 3211; difference 3731, 95% CI 2073-5388, P < 0.0005). SuperMap and
contact mapping were accurate in 92% and 85% of maps, respectively, P =
0.4805. Conclusion(s): SuperMap non-contact charge density mapping is
a rapid and reliable approach to guide the ablation of complex atrial
arrhythmias. Copyright © 2021 The Author(s). Published by Oxford
University Press on behalf of the European Society of Cardiology.

<41>
Accession Number
2014741083
Title
Morbidity and mortality in patients managed with high compared with low
blood pressure targets during on-pump cardiac surgery: a systematic review
and meta-analysis of randomized controlled trials.
Source
Canadian Journal of Anesthesia. 69(3) (pp 374-386), 2022. Date of
Publication: March 2022.
Author
McEwen C.C.; Amir T.; Qiu Y.; Young J.; Kennedy K.; Grocott H.P.; Kashani
H.; Mazer D.; Brudney S.; Kavosh M.; Jacobsohn E.; Vedel A.; Wang E.;
Whitlock R.P.; Belley-Cote E.P.; Spence J.
Institution
(McEwen) Department of Surgery (Cardiac Surgery), McMaster University,
Hamilton, ON, Canada
(Amir, Qiu, Wang) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Young) Health Sciences Library, McMaster University, Hamilton, ON, Canada
(Kennedy) Department of Health Research Methods, Evaluation, and Impact,
McMaster University, Hamilton, ON, Canada
(Grocott, Kashani, Kavosh) Department of Anesthesia and Perioperative
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Brudney, Jacobsohn) Departments of Medicine (Critical Care) and
Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg,
MB, Canada
(Vedel) Department of Cardiothoracic Anesthesiology, Copenhagen University
Hospital, Copenhagen, Denmark
(Whitlock) Departments of Surgery (Cardiac Surgery) and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
(Whitlock, Belley-Cote, Spence) Perioperative Research Division,
Population Health Research Institute, Hamilton, ON, Canada
(Belley-Cote) Departments of Medicine (Cardiology and Critical Care) and
Health Research Methods, Evaluation, and Impact, McMaster University,
Hamilton, ON, Canada
(Spence) Departments of Anesthesia and Critical Care and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
Publisher
Springer
Abstract
Purpose: Many believe that blood pressure management during cardiac
surgery is associated with postoperative outcomes. We conducted a
systematic review and meta-analysis of randomized controlled trials (RCTs)
to determine the impact of high compared with low intraoperative blood
pressure targets on postoperative morbidity and mortality in adults
undergoing cardiac surgery on cardiopulmonary bypass (CPB). Our primary
objective was to inform the design of a future large RCT. Source: We
searched MEDLINE, EMBASE, Web of Science, CINAHL, and CENTRAL for RCTs
comparing high with low intraoperative blood pressure targets in adult
patients undergoing any cardiac surgical procedure on CPB. We screened
reference lists, grey literature, and conference proceedings. Principal
findings: We included eight RCTs (N =1,116 participants); all examined the
effect of blood pressure management only during the CPB. Trial definitions
of high compared with low blood pressure varied and, in some, there was a
discrepancy between the target and achieved mean arterial pressure. We
observed no difference in delirium, cognitive decline, stroke, acute
kidney injury, or mortality between high and low blood pressure targets
(very-low to low quality evidence). Higher blood pressure targets may have
increased the risk of requiring a blood transfusion (three trials; n = 456
participants; relative risk, 1.4; 95% confidence interval, 1.1 to 1.9; P =
0.01; moderate quality evidence) but this finding was based on a small
number of trials. Conclusion(s): Individual trial definitions of high
and low blood pressure targets varied, limiting inferences. The effect of
high (compared with low) blood pressure targets on other morbidity and
mortality after cardiac surgery remains unclear because of limitations
with the body of existing evidence. Research to determine the optimal
management of blood pressure during cardiac surgery is required. Study
registration: PROSPERO (CRD42020177376); registered: 5 July
2020. Copyright © 2022, Canadian Anesthesiologists' Society.

<42>
Accession Number
639192480
Title
Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries:
A Randomized Clinical Trial.
Source
JAMA Surgery. 157(11) (pp 983-990), 2022. Date of Publication: 09 Nov
2022.
Author
Dehghan N.; Nauth A.; Schemitsch E.; Vicente M.; Jenkinson R.; Kreder H.;
McKee M.
Institution
(Dehghan) The CORE Institute, Phoenix, AZ, United States
(Dehghan, McKee) University of Arizona College of Medicine Phoenix,
Phoenix, United States
(Nauth, Vicente) St Michael's Hospital, University of Toronto, Toronto,
ON, Canada
(Schemitsch) London Health Sciences Centre, London, ON, Canada
(Jenkinson, Kreder) Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, ON, Canada
(McKee) Banner University Medical Center, Phoenix, AZ, United States
Publisher
American Medical Association
Abstract
Importance: Unstable chest wall injuries have high rates of mortality and
morbidity. In the last decade, multiple studies have reported improved
outcomes with operative compared with nonoperative treatment. However, to
date, an adequately powered, randomized clinical trial to support
operative treatment has been lacking. Objective(s): To compare
outcomes of surgical treatment of acute unstable chest wall injuries with
nonsurgical management. Design, Setting, and Participant(s): This was
a multicenter, prospective, randomized clinical trial conducted from
October 10, 2011, to October 2, 2019, across 15 sites in Canada and the
US. Inclusion criteria were patients between the ages of 16 to 85 years
with displaced rib fractures with a flail chest or non-flail chest
injuries with severe chest wall deformity. Exclusion criteria included
patients with significant other injuries that would otherwise require
prolonged mechanical ventilation, those medically unfit for surgery, or
those who were randomly assigned to study groups after 72 hours of injury.
Data were analyzed from March 20, 2019, to March 5, 2021.
 Intervention(s): Patients were randomized 1:1 to receive operative
treatment with plate and screws or nonoperative treatment. Main
Outcomes and Measures: The primary outcome was ventilator-free days (VFDs)
in the first 28 days after injury. Secondary outcomes included mortality,
length of hospital stay, intensive care unit stay, and rates of
complications (pneumonia, ventilator-associated pneumonia, sepsis,
tracheostomy). Result(s): A total of 207 patients were included in
the analysis (operative group: 108 patients [52.2%]; mean [SD] age, 52.9
[13.5] years; 81 male [75%]; nonoperative group: 99 patients [47.8%]; mean
[SD] age, 53.2 [14.3] years; 75 male [76%]). Mean (SD) VFDs were 22.7
(7.5) days for the operative group and 20.6 (9.7) days for the
nonoperative group (mean difference, 2.1 days; 95% CI, -0.3 to 4.5 days; P
=.09). Mortality was significantly higher in the nonoperative group (6
[6%]) than in the operative group (0%; P =.01). Rates of complications and
length of stay were similar between groups. Subgroup analysis of patients
who were mechanically ventilated at the time of randomization demonstrated
a mean difference of 2.8 (95% CI, 0.1-5.5) VFDs in favor of operative
treatment. Conclusions and Relevance: The findings of this randomized
clinical trial suggest that operative treatment of patients with unstable
chest wall injuries has modest benefit compared with nonoperative
treatment. However, the potential advantage was primarily noted in the
subgroup of patients who were ventilated at the time of randomization. No
benefit to operative treatment was found in patients who were not
ventilated. Trial Registration: ClinicalTrials.gov Identifier:
NCT01367951. Copyright © 2022 American Medical Association. All
rights reserved.

<43>
Accession Number
2019330708
Title
Oral anticoagulation following bioprosthetic SAVR in patients with atrial
fibrillation: What's the current status of NOACs?.
Source
Interactive Cardiovascular and Thoracic Surgery. 35(1) (no pagination),
2022. Article Number: ivac112. Date of Publication: 01 Jul 2022.
Author
Milojevic M.; Nikolic A.; Micovic S.; Jeppsson A.
Institution
(Milojevic, Micovic) Department of Cardiac Surgery and Cardiovascular
Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
(Nikolic) Department of Cardiac Surgery, Acibadem-Sistina Hospital,
Skopje, North Macedonia
(Jeppsson) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, Gothenburg University, Gothenburg, Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
Publisher
Oxford University Press

<44>
Accession Number
2019265745
Title
Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: A
Systematic Review.
Source
International Journal of Molecular Sciences. 23(18) (no pagination), 2022.
Article Number: 10948. Date of Publication: September 2022.
Author
Cozma A.; Sporis N.D.; Lazar A.L.; Buruiana A.; Ganea A.M.; Malinescu
T.V.; Berechet B.M.; Fodor A.; Sitar-Taut A.V.; Vlad V.C.; Negrean V.;
Orasan O.H.
Institution
(Cozma, Ganea, Malinescu, Berechet, Sitar-Taut, Vlad, Negrean, Orasan)
Department of Internal Medicine, Iuliu Hatieganu University of Medicine
and Pharmacy, Cluj-Napoca 400012, Romania
(Sporis, Buruiana) Department of Medical Oncology, Prof. Dr. I. Chiricuta
Oncology Institute, Cluj-Napoca 400015, Romania
(Lazar) Department of Dermatology, Iuliu Hatieganu University of Medicine
and Pharmacy, Cluj-Napoca 400012, Romania
(Fodor) Clinical Centre of Diabetes, Nutrition and Metabolic Disease,
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400012,
Romania
Publisher
MDPI
Abstract
Immune checkpoint inhibitors (ICIs) are an important advancement in the
field of cancer treatment, significantly improving the survival of
patients with a series of advanced malignancies, like melanoma, non-small
cell lung cancer (NSCLC), hepatocellular carcinoma (HCC), renal cell
carcinoma (RCC), and Hodgkin lymphoma. ICIs act upon T lymphocytes and
antigen-presenting cells, targeting programmed cell death protein 1 (PD1),
programmed cell death protein ligand 1 (PD-L1), and cytotoxic T-lymphocyte
antigen 4 (CTLA-4), breaking the immune tolerance of the T cells against
malignant cells and enhancing the body's own immune response. A variety of
cardiac-adverse effects are associated with ICI-based treatment, including
pericarditis, arrhythmias, cardiomyopathy, and acute coronary syndrome,
with myocarditis being the most studied due to its often-unexpected onset
and severity. Overall, Myocarditis is rare but presents an immune-related
adverse event (irAE) that has a high fatality rate. Considering the rising
number of oncological patients treated with ICIs and the severity of their
potential adverse effects, a good understanding and continuous
investigation of cardiac irAEs is of the utmost importance. This
systematic review aimed to revise recent publications (between 2016-2022)
on ICI-induced cardiac toxicities and highlight the therapeutical approach
and evolution in the selected cases. Copyright © 2022 by the
authors.

<45>
Accession Number
2019158207
Title
Long-term follow-up of acute and chronic rejection in heart transplant
recipients from hepatitis C viremic (NAT+) donors.
Source
American Journal of Transplantation. 22(12) (pp 2951-2960), 2022. Date of
Publication: December 2022.
Author
Stachel M.W.; Alimi M.; Narula N.; Flattery E.E.; Xia Y.; Ramachandran A.;
Saraon T.; Smith D.; Reyentovich A.; Goldberg R.; Kadosh B.S.; Razzouk L.;
Katz S.; Moazami N.; Gidea C.G.
Institution
(Stachel, Flattery, Ramachandran, Saraon, Reyentovich, Goldberg, Kadosh,
Razzouk, Katz, Gidea) Leon H. Charney Division of Cardiology, Department
of Medicine, NYU Langone Health, New York, NY, United States
(Alimi, Smith, Moazami) Department of Cardiothoracic Surgery, NYU Langone
Health, New York, NY, United States
(Narula) Department of Pathology, NYU Langone Health, New York, NY, United
States
(Xia) Division of Biostatistics Research, Department of Population Health,
NYU Langone Health, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
The long-term safety of heart transplants from hepatitis C viremic (NAT+)
donors remains uncertain. We conducted a prospective study of all patients
who underwent heart transplantation at our center from January 2018
through August 2020. Routine testing was performed to assess for
donor-derived cell-free DNA, acute cellular rejection (ACR),
antibody-mediated rejection (AMR), and cardiac allograft vasculopathy
(CAV). Allograft dysfunction and mortality were also monitored.
Seventy-five NAT- recipients and 32 NAT+ recipients were enrolled in the
study. All NAT+ recipients developed viremia detected by PCR, were treated
with glecaprevir/pibrentasvir at the time of viremia detection, and
cleared the virus by 59 days post-transplant. Patients who underwent NAT
testing starting on post-operative day 7 (NAT+ Group 1) had significantly
higher viral loads and were viremic for a longer period compared with
patients tested on post-operative day 1 (NAT+ Group 2). Through 3.5 years
of follow-up, there were no statistically significant differences in
timing, severity, or frequency of ACR in NAT+ recipients compared with the
NAT- cohort, nor were there differences in noninvasive measures of graft
injury, incidence or severity of CAV, graft dysfunction, or mortality.
There were five episodes of AMR, all in the NAT- group. There were no
statistically significant differences between Group 1 and Group 2 NAT+
cohorts. Overall, these findings underscore the safety of heart
transplantation from NAT+ donors. Copyright © 2022 The American
Society of Transplantation and the American Society of Transplant
Surgeons.

<46>
Accession Number
2021399307
Title
Management of chyle leaks following esophageal resection: A systematic
review.
Source
Diseases of the Esophagus. 34(11) (no pagination), 2021. Article Number:
doab012. Date of Publication: 01 Nov 2021.
Author
Power R.; Smyth P.; Donlon N.E.; Nugent T.; Donohoe C.L.; Reynolds J.V.
Institution
(Power, Smyth, Donlon, Nugent, Donohoe, Reynolds) National Oesophageal and
Gastric Centre, St James's Hospital, Dublin, Ireland
(Reynolds) Department of Surgery, Trinity Translational Medicine
Institute, St. James's Hospital, Trinity College Dublin, Dublin 08,
Ireland
Publisher
Oxford University Press
Abstract
Background: Chyle leakage is an uncommon but potentially life-threatening
complication following esophageal resections. The optimal management
strategy is not clear, with a limited evidence base. Method(s):
Searches were conducted up to 31 December 2020 on MEDLINE, Embase, and Web
of Science for randomized trials or retrospective studies that evaluated
the management of chyle leakage following esophageal resection. Two
authors independently screened studies, extracted data, and assessed for
bias. The protocol was prospectively registered on PROSPERO (CRD:
42021224895) and reported in accordance with preferred reporting items for
systematic reviews and meta-analyses guidelines. Result(s): A total
of 530 citations were reviewed. Twenty-five studies, totaling 1016
patients met the inclusion criteria, including two low-quality clinical
trials and 23 retrospective case series. Heterogeneity of study design and
outcomes prevented meta-analysis. The overall incidence of chyle
leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks
conservatively, 17 by surgical ligation of the thoracic duct, 5 by
pleurodesis, and 6 described percutaneous lymphangiography with thoracic
duct embolization or disruption. Conclusion(s): The evidence base for
optimal management of chyle leakage postesophagectomy is lacking, which
may be related to its low incidence. There is a paucity of high-quality
prospective studies directly comparing treatment modalities, but there is
some low-certainty evidence that percutaneous approaches have reduced
morbidity but lower efficacy compared with surgery. Further high-quality,
prospective studies that compare interventions at different levels of
severity are needed to determine the optimal approach to
treatment. Copyright © 2021 The Author(s). Published by Oxford
University Press on behalf of International Society for Diseases of the
Esophagus.

<47>
Accession Number
639434335
Title
Impact of prior coronary artery bypass grafting on periprocedural and
short-term outcomes of patients undergoing transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
Coronary artery disease. 34(1) (pp 42-51), 2023. Date of Publication: 01
Jan 2023.
Author
Machanahalli Balakrishna A.; Ismayl M.; Palicherla A.; Aboeata A.;
Goldsweig A.M.; Zhao D.X.; Vallabhajosyula S.
Institution
(Machanahalli Balakrishna, Ismayl, Palicherla) Department of Internal
Medicine, Creighton University School of Medicine, Omaha, NE, United
States
(Aboeata) Division of Cardiovascular Medicine, Department of Medicine,
Creighton University School of Medicine, Omaha, NE, United States
(Goldsweig) Department of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
(Zhao, Vallabhajosyula) Section of Cardiovascular Medicine, Department of
Medicine, Wake Forest University School of Medicine, Winston-Salem, NC,
United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The effect of prior coronary artery bypass graft (CABG) on the
outcomes of transcatheter aortic valve replacement (TAVR) remains
incompletely characterized. In this meta-analysis, we investigated the
impact of prior CABG on TAVR outcomes. METHOD(S): A systematic search
was conducted in PubMed, Google Scholar, and Cochrane databases from
inception to 24 July 2022, using the search terms 'TAVR', 'CABG',
'peri-procedural complications', and 'mortality'. The major outcomes were
peri-procedural complications, intraprocedural mortality, 30-day
mortality, and 30-day cardiac mortality. We used random-effects models to
aggregate data and to calculate pooled incidence and risk ratios with 95%
confidence intervals (CIs). RESULT(S): Among 116 results from the
systematic search, a total of 8 studies (5952 patients) were included.
Compared to patients without previous CABG, patients with prior CABG
undergoing TAVR were younger, predominantly male sex, had more
comorbidities, higher rates of peri-procedural myocardial infarction (MI)
[relative risk (RR) 1.93; 95% CI, 1.09-3.43; P =0.03], but lower rates of
stroke (RR 0.71; 95% CI, 0.51-0.99; P =0.04), major vascular complications
(RR 0.70; 95% CI, 0.51-0.95; P =0.02), and major bleeding (RR 0.70; 95%
CI, 0.56-0.88; P =0.002). There were no significant differences between
the two cohorts in rates of pacemaker implantation, cardiac tamponade,
acute kidney injury, intra-procedural mortality, 30-day mortality, and
30-day cardiac mortality. CONCLUSION(S): Among patients undergoing
TAVR, a history of prior CABG was not associated with an increased risk of
periprocedural complications (except for acute MI) or short-term mortality
compared to those without CABG. Copyright © 2022 Wolters Kluwer
Health, Inc. All rights reserved.

<48>
Accession Number
2020551543
Title
Effect of high-energy and/or high-protein feeding in children with
congenital heart disease after cardiac surgery: a systematic review and
meta-analysis.
Source
European Journal of Pediatrics. (no pagination), 2022. Date of
Publication: 2022.
Author
Ni P.; Wang X.L.; Xu Z.M.; Luo W.
Institution
(Ni, Xu) Department of Thoracic and Cardiovascular Surgery, Shanghai
Children's Medical Center, School of Medicine, Shanghai Jiao Tong
University, Shanghai, China
(Wang) Department of Cardiology, Shanghai Children's Medical Center,
School of Medicine, Shanghai Jiao Tong University, Shanghai, China
(Luo) Nursing Department, Shanghai Children's Medical Center, School of
Medicine, Shanghai Jiao Tong University, 1678 Dong-fang Road, Shanghai
200127, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
High-energy or high-protein feeding offers a promising approach to
improving malnutrition in children after congenital heart surgery.
However, the effect of high-energy or high-protein feeding in this
population has not yet been systematically reviewed. Therefore, we aimed
to assess the safety and effectiveness of high-energy or high-protein
feeding in children after congenital heart surgery. Five electronic
databases (PubMed, Embase, CENTRAL, CINAHL, and Scopus) were searched from
inception to April 23, 2022. After screening the literature according to
inclusion and exclusion criteria, a risk of bias assessment was performed
using version 2 of the Cochrane risk-of-bias tool for randomized trials,
and the certainty of the evidence was assessed using the Grading of
Recommendations, Assessment, Development and Evaluations system. Finally,
the random effects model was used to perform a meta-analysis of all data.
A total of 609 subjects from 9 studies were included for qualitative
analysis, and meta-analyses were performed on data from 8 of these
studies. The results showed that high-energy and/or high-protein feeding
did not increase feeding intolerance (RR = 1.09, 95% CI: 0.80, 1.48) or
fluid intake (MD = - 12.50 ml/kg/d, 95% CI: - 36.10, 11.10); however, the
intervention was beneficial in increasing weight (MD = 0.5 kg, 95% CI:
0.23, 0.77) and reducing the duration of mechanical ventilation (MD = -
17.45 h, 95% CI: - 27.30, - 7.60), intensive care unit (ICU) stay (MD = -
1.45 days, 95% CI: - 2.36, - 0.54) and hospital stay (MD = - 2.82 days,
95% CI: - 5.22, - 0.43). However, high-energy and/or protein feeding did
not reduce the infection rate (RR = 0.68, 95% CI: 0.25, 1.87) or mortality
(RR = 1.50, 95% CI: 0.47, 4.82). Conclusion(s): The certainty of the
evidence was graded as moderate to high, which suggests that high-energy
and/or high-protein feeding may be safe in children after congenital heart
surgery. Furthermore, this intervention improves nutrition and reduces the
duration of mechanical ventilation, length of ICU stay, and length of
hospital stay. However, the overall conclusion of this meta-analysis will
need to be confirmed in a cohort of patients with different cardiac
physiologies.What is Known:* Malnutrition is highly prevalent in children
with congenital heart disease (CHD) and can negatively affect the
prognosis of these children.* High-energy and/or high-protein feeding can
improve nutrition status and facilitate recovery; however, evidence on its
safety and efficacy is lacking. What is New:* Pooled data suggest that
high-energy and/or high-protein feeding does not increase fluid intake or
feeding intolerance in children with CHD.* High-energy and/or high-protein
feeding may reduce the duration of mechanical ventilation, length of
intensive care unit stay, and length of hospital stay. Copyright
© 2022, The Author(s), under exclusive licence to Springer-Verlag
GmbH Germany, part of Springer Nature.

<49>
Accession Number
2015389102
Title
Intercostal lung herniation; a rare complication after mini-transthoracic
approach (TTA) for thoracic disc herniation. Two case reports and review
of literature.
Source
European Spine Journal. 31(12) (pp 3708-3712), 2022. Date of Publication:
December 2022.
Author
De Vries S.E.N.; Arts M.P.; Van Huijstee P.J.
Institution
(Arts) Department of Neurosurgery, Haaglanden Medical Center, The Hague,
Netherlands
(De Vries, Van Huijstee) Department of General Surgery, Haga Medical
Center, The Hague, Netherlands
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Lung herniation is a rare condition, most often due to
thoracic injury, but has also been described as a complication following
cardiothoracic surgery. Here, we report two cases of post-surgical lung
herniation following a neurosurgical mini-transthoracic (mini-TTA) for
treatment of thoracic herniated discs. With this report we aim to make
surgeons aware of this rare complication, review existing literature on
surgical repairs and describe our novel correction technique using video
assisted thoracic surgery (VATS) and a combination of mesh covering the
muscle defect internally and nitinol rib plates for rib approximation on
the outside of the thoracic cavity. Case description: Patient A was an
85-year-old man who presented with a subcutaneous swelling at the site of
surgery following a left sided mini-TTA. Computed tomography (CT) revealed
pulmonary tissue herniation. He underwent VATS guided reconstruction.
Using two Ventralex meshes covering the defect on the inside and a
NiTi-rib H-plate for rib approximation. Patient B was a 73-year-old woman
who developed pulmonary complaints with a soft mass at the surgery site
after a left sided mini-TTA. She also underwent VATS guided
reconstruction. A large Sempramesh composite mesh and two NiTi-Rib
H-plates were used. Recovery was uncomplicated and follow-up revealed no
recurrence in both cases. Conclusion(s): These cases should make
surgeons aware of the possibility of post-surgical development of lung
herniation and describe successful correction using a combination of mesh
material and NiTi-Rib H-plates through a VATS technique. Copyright
© 2022, The Author(s).

<50>
Accession Number
2020479961
Title
Efficacy and safety of remimazolam for non-obese patients during
anesthetic induction in cardiac surgery: study protocol for a multicenter
randomized trial.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 984. Date of
Publication: December 2022.
Author
Liu H.-M.; Li P.; Yu H.; Liu B.; Liang P.
Institution
(Yu, Liu, Yu, Liu, Liang) Department of Anesthesiology, West China
Hospital, Sichuan University, No.37 Guoxue Alley, Sichuan, Chengdu 610041,
China
(Li) Department of Anesthesiology, Wu'an First People's Hospital, Wu'an
056300, China
(Liang) Day Surgery Center, West China Hospital, Sichuan University, No.37
Guoxue Alley, Sichuan, Chengdu 610041, China
Publisher
BioMed Central Ltd
Abstract
Background: Valvular heart disease remains common in both developed and
developing countries, and it requires timely surgical treatment when
necessary. However, the stability of hemodynamics during anesthesia
induction in patients undergoing valve replacement surgery is difficult to
maintain due to their impaired cardiac function. Remimazolam, a novel and
ultrashort-acting intravenous sedative-hypnotic, may be beneficial to
stable hemodynamics, but the evidence is limited. Therefore, this study
aims to evaluate the effect of remimazolam induction on hemodynamics
compared with midazolam and etomidate in patients undergoing valve
replacement surgery. Method(s): This is a prospective, multicenter
randomized controlled trial (RCT). Three hundred and sixty-three non-obese
adult patients aged 45 to 80 years old undergoing valve surgery with
cardiopulmonary bypass will be randomly allocated to receive remimazolam
tosilate, midazolam, or etomidate during anesthetic induction. The primary
outcome is the incidence of hypotension within 20 min after the
administration of investigated drugs. The hypotension is defined as
systolic blood pressure (SBP) < 90 mmHg or a 30% reduction in SBP from
baseline or the application of vasoactive drugs. Secondary outcomes
include incidence of successful sedation, time to successful sedation,
incidence of delirium and postoperative low cardiac output syndrome within
7 days after surgery, hospital mortality, mechanical ventilation time, ICU
length of stay, and hospital length of stay. Discussion(s): To our
knowledge, this is the first prospective RCT to investigate the efficacy
and safety of remimazolam induction in adult cardiac surgery compared with
midazolam and etomidate. This study will provide important information on
the application of remimazolam in cardiac surgery in the future. Trial
registration: Chinese Clinical Trial Registry chictr.org.cn
ChiCTR2100050122. Registered on August 16, 2021. Copyright ©
2022, The Author(s).

<51>
[Use Link to view the full text]
Accession Number
2021677804
Title
Memory Problems in Children with Congenital Heart Disease: A Narrative
Review.
Source
Journal of Neurosurgical Anesthesiology. 35(1) (pp 136-141), 2023. Date of
Publication: 01 Jan 2023.
Author
Jackson W.M.; Monteleone M.; Kim A.; Ko R.
Institution
(Jackson, Kim, Ko) Columbia University Irving Medical Center, New York,
NY, United States
(Monteleone) Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Care for congenital heart diseases (CHD) has improved
significantly over the past several decades, and children with CHD are now
surviving into adulthood. Cognitive and behavioral problems affect
children with CHD more than healthy peers. A review of performance on
neuropsychological memory tasks has not been reported. We aimed to
summarize the published literature on memory problems in people with CHD.
 Method(s): We searched Pubmed, Medline, and PsycINFO from January 1,
1986 to March 22, 2022 to reflect modern care for people with CHD. Our
inclusion criteria were randomized controlled trials or observational
studies that included children with CHD older than age 3 years, which
reported the results of at least 1 neuropsychological test of memory in
the CHD group. Our exclusion criteria were studies that included heart
transplant recipients and studies that included children who required
extracorporeal membrane oxygenation. Result(s): Thirty-one studies
that met our inclusion criteria and avoided exclusion criteria were
included in this review. Several studies reported deficits in the
subdomains of short-term and long-term memory and visual and verbal
memory, though we found substantial heterogeneity across studies. The most
likely subdomain to be affected in children with CHD appears to be
short-term visual memory. Conclusion(s): There is likely an increased
risk of memory problems for children and adults with CHD. We were unable
to quantify the risk of memory problems due to the heterogeneity of
published studies. Future research should make efforts to account for
confounding variables and standardize outcome measures. Copyright
© 2023 Lippincott Williams and Wilkins. All rights reserved.

<52>
Accession Number
2021617671
Title
Effect of balanced opioid-free anaesthesia on postoperative nausea and
vomiting after video-assisted thoracoscopic lung resection: protocol for a
randomised controlled trial.
Source
BMJ Open. 12(11) (no pagination), 2022. Article Number: e066202. Date of
Publication: 22 Nov 2022.
Author
Long Y.-Q.; Wang D.; Chen S.; Xu Y.; Feng C.-D.; Ji F.-H.; Cheng H.; Peng
K.
Institution
(Long, Wang, Xu, Feng, Ji, Cheng, Peng) Anesthesiology, First Hospital,
Soochow University, Suzhou, Jiangsu, China
(Long, Wang, Feng, Ji, Cheng, Peng) Institute of Anaesthesiology, Soochow
University, Suzhou, Jiangsu, China
(Chen) Thoracic Surgery, First Hospital, Soochow University, Suzhou,
Jiangsu, China
(Xu) Anesthesiology, Suzhou Xiangcheng People's Hospital, Suzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction Opioid-free anaesthesia (OFA) may reduce opioid-related side
effects such as postoperative nausea and vomiting (PONV) and hyperalgesia.
This study aims to investigate the effects of balanced OFA on PONV and
pain outcomes in patients undergoing video-assisted thoracoscopic surgery
(VATS). Methods and analysis This randomised controlled trial will be
conducted at the First Affiliated Hospital of Soochow University in
Suzhou, China. A total of 120 adults scheduled for VATS lung resection
will be randomly assigned with a 1:1 ratio to either an OFA group or a
control group, stratified by sex (n=60 in each group). Patients will
receive balanced anaesthesia with esketamine, dexmedetomidine and
sevoflurane (the OFA group), or sufentanil and sevoflurane (the control
group). All patients will receive PONV prophylaxis with intraoperative
dexamethasone and ondansetron. Multimodal analgesia consists of
intraoperative flurbiprofen axetil, ropivacaine infiltration at the end of
surgery and postoperative patient-controlled sufentanil. The primary
outcome is the incidence of PONV within 48 hours after surgery. Secondary
outcomes are nausea, vomiting, need for antiemetic therapy, pain scores at
rest and while coughing, postoperative sufentanil consumption, need for
rescue analgesia, length of post-anaesthesia care unit stay, length of
postoperative hospital stay, and 30-day and 90-day post-surgical pain and
mortality. Safety outcomes are hypotension, bradycardia, hypertension,
tachycardia, interventions for haemodynamic events, level of sedation,
headache, dizziness, nightmare and hallucination. All analyses will be
performed in the modified intention-to-treat population. Ethics and
dissemination Ethics approval was obtained from the Ethics Committee of
the First Affiliated Hospital of Soochow University (2022-042). All
patients will provide written informed consent. The results of this study
will be published in a peer-reviewed journal. Trial registration number
Chinese Clinical Trial Registry (ChiCTR2200059710). Copyright ©
Author(s) (or their employer(s)) 2022.

<53>
Accession Number
2021617668
Title
Protocol for a randomised controlled trial: Reducing reintubation among
high-risk cardiac surgery patients with high-flow nasal cannula (I-CAN).
Source
BMJ Open. 12(11) (no pagination), 2022. Article Number: e066007. Date of
Publication: 25 Nov 2022.
Author
Freundlich R.E.; Wanderer J.P.; French B.; Moore R.P.; Hernandez A.; Shah
A.S.; Byrne D.W.; Pandharipande P.P.
Institution
(Freundlich, Wanderer, Hernandez, Pandharipande) Department of
Anesthesiology, Vanderbilt University, Medical Center, Nashville, TN,
United States
(Freundlich) Department of Biomedical Informatics, Vanderbilt University,
Medical Center, Nashville, TN, United States
(French, Moore, Byrne) Department of Biostatistics, Vanderbilt University,
Medical Center, Nashville, TN, United States
(Shah) Department of Cardiac Surgery, Vanderbilt University, Medical
Center, Nashville, TN, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Heated, humidified, high-flow nasal cannula oxygen therapy
has been used as a therapy for hypoxic respiratory failure in numerous
clinical settings. To date, limited data exist to guide appropriate use
following cardiac surgery, particularly among patients at risk for
experiencing reintubation. We hypothesised that postextubation treatment
with high-flow nasal cannula would decrease the all-cause reintubation
rate within the 48 hours following initial extubation, compared with usual
care. Methods and analysis Adult patients undergoing cardiac surgery (open
surgery on the heart or thoracic aorta) will be automatically enrolled,
randomised and allocated to one of two treatment arms in a pragmatic
randomised controlled trial at the time of initial extubation. The two
treatment arms are administration of heated, humidified, high-flow nasal
cannula oxygen postextubation and usual care (treatment at the discretion
of the treating provider). The primary outcome will be all-cause
reintubation within 48 hours of initial extubation. Secondary outcomes
include all-cause 30-day mortality, hospital length of stay, intensive
care unit length of stay and ventilator-free days. Interaction analyses
will be conducted to assess the differential impact of the intervention
within strata of predicted risk of reintubation, calculated according to
our previously published and validated prognostic model. Ethics and
dissemination Vanderbilt University Medical Center IRB approval, 15 March
2021 with waiver of written informed consent. Plan for publication of
study protocol prior to study completion, as well as publication of
results. Trial registration number clinicaltrials.gov, NCT04782817
submitted 25 February 2021. Date of protocol 29 August 2022. Version 2.0.
 Copyright © Author(s) (or their employer(s)) 2022.

<54>
Accession Number
639730191
Title
The effects of lavandula aromatherapy on pain relief after coronary artery
bypass graft surgery: A randomized clinical trial.
Source
Applied nursing research : ANR. 68 (pp 151638), 2022. Date of Publication:
01 Dec 2022.
Author
Ebrahimi S.; Paryad E.; Ghanbari Khanghah A.; Pasdaran A.; Kazemnezhad
Leili E.; Sadeghi Meibodi A.M.
Institution
(Ebrahimi) Master of Science in Nursing (MSN), School of Nursing and
Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Paryad) GI Cancer Screening and Prevention Research Center (GCSPRC),
Department of Nursing, School of Nursing and Midwifery, Guilan University
of Medical Sciences, Rasht, Iran, Islamic Republic of
(Ghanbari Khanghah) Social Determinants of Health Research Center (SDHRC),
Department of Nursing, Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
(Pasdaran) Medicinal Plants Processing Research Center, Department of
Pharmacognosy, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Kazemnezhad Leili) Social Determinants of Health Research Center (SDHRC),
Biostatistics, Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Sadeghi Meibodi) Department of Cardiovascular, School of Medicine, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIMS: Coronary artery bypass graft surgery (CABG) is a
primary treatment in coronary artery disease (CAD). Patients experience
pain after CABG. Pain may increase postoperative complications and
decrease quality of life (QoL). This study aims to determine the lavandula
aromatherapy effect on patients' pain after CABG. METHOD(S): 98
patients undergoing CABG were randomly assigned to intervention and
placebo groups. The intervention group inhaled 5-drops of 20 % lavandula
essential oil (LEO) and the placebo group was exposed to 5-drop of
distilled water. LEO or distilled water were dropped into a sterile gauze
converted to the form of a necklace. The subjects wore necklace for three
consecutive days and intervention was performed each 24 h. The pain
intensity, systolic blood pressure (SBP), and diastolic blood pressure
(DBP) were measured before each intervention and 30 min after it. Also,
the mean analgesic intake was recorded. SPSS version 16 was used to
analyze the data. RESULT(S): The mean pain score measured in the
intervention group showed a more decrease than that obtained in the
placebo group after the first and second interventions. Additionally, the
mean pain score in the intervention group demonstrated a significant
decrease than the placebo group after the second intervention (P=0.008).
Moreover, mean SBP after the second intervention (P=0.046) and mean DBP
after the first intervention (P=0.029) revealed a significant difference
between two groups. Moreover, the intervention group received less
analgesic than the placebo group. CONCLUSION(S): Lavandula
aromatherapy can reduce pain and received analgesic dose after
CABG. Copyright © 2022. Published by Elsevier Inc.

<55>
Accession Number
2020118991
Title
Insulin signaling in the central nervous system, a possible
pathophysiological mechanism of anesthesia-induced delayed neurocognitive
recovery/postoperative neurocognitive disorder: a narrative review.
Source
Expert Review of Neurotherapeutics. 22(10) (pp 839-847), 2022. Date of
Publication: 2022.
Author
Qeva E.; Sollazzo C.; Bilotta F.
Institution
(Qeva, Sollazzo, Bilotta) Department of Anesthesia and Intensive Care
Medicine, SapienzaRomeRome, Italy
(Qeva) Department of Anesthesia, Intensive Care and Emergency, University
of Turin, Turin 10126, Italy
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Impairment in neurocognitive functions ranges between
delayed neurocognitive recovery (DNR) and postoperative neurocognitive
disorders (pNCD). Incidence varies from 11% after noncardiac surgery to
60% after cardiac surgery. Areas covered: Insulin receptors (IRs)
signaling pathway in the central nervous system (CNS) could be a possible
pathophysiological mechanism of anesthesia-induced DNR/pNCD and
perioperative intranasal insulin administration could be a preventive
approach. This hypothesis is supported by the following evidence: effects
of IRs-CNS signaling pathway on neuromodulation; higher incidence of
DNR/pNCD in patients with insulin resistance; neurotoxicity of IRs
signaling pathways after anesthetic exposure; improvement of
neurocognitive impairment after insulin exposure. This narrative review
was conducted after a literature search of PubMed, EMBASE and SCOPUS
online medical data performed in May 2022. Expert opinion: Perioperative
intranasal insulin is shown to be protective and future studies should
address: the role of insulin as a neuromodulator; its integration into
neuroprotection approaches; patient populations that might benefit from
this approach; a well-defined protocol of intranasal insulin
administration in a perioperative background and other disciplines; and
possible collateral effects. Copyright © 2022 Informa UK Limited,
trading as Taylor & Francis Group.

<56>
Accession Number
2018789287
Title
Outcome of Pregnancy in Women With D-Transposition of the Great Arteries:
A Systematic Review.
Source
Journal of the American Heart Association. 11(23) (no pagination), 2022.
Article Number: e026862. Date of Publication: 06 Dec 2022.
Author
Pizula J.; Devera J.; Ng T.M.H.; Yeung S.L.; Thangathurai J.; Herrick N.;
Chatfield A.J.; Mehra A.; Elkayam U.
Institution
(Pizula, Devera, Ng, Thangathurai, Herrick, Mehra, Elkayam) Division of
Cardiovascular Medicine, Department of Medicine, University of Southern
California, Los Angeles, CA, United States
(Elkayam) Department of Obstetrics and Gynecology, University of Southern
California, Los Angeles, CA, United States
(Ng, Yeung, Chatfield) School of Pharmacy, University of Southern
California, Los Angeles, CA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Information on maternal and fetal outcomes of pregnancy in
women with D-transposition of the great arteries is limited. We conducted
a systematic literature review on pregnancies in women with transposition
of the great arteries after atrial and arterial switch operations to
better define maternal and fetal risk. METHODS AND RESULTS: A systematic
review was performed on studies between 2000 and 2021 that identified 676
pregnancies in 444 women with transposition of the great arteries. A total
of 556 pregnancies in women with atrial switch operation were tolerated by
most cases with low mortality (0.6%). Most common maternal complications,
however, were arrhythmias (9%) and heart failure (8%) associated with
serious morbidity in some patients. Worsening functional capacity, right
ventricular function, and tricuspid regurgitation occurred in =20% of the
cases. Rate of fetal and neonatal mortality was 1.4% and 0.8%,
respectively, and rate of prematurity was 32%. A total of 120 pregnancies
in women with arterial switch operation were associated with no maternal
mortality, numerically lower rates of arrhythmias and heart failure (6%
and 5%, respectively), significantly lower rate of prematurity (11%;
P<0.001), and only 1 fetal loss. CONCLUSION(S): Pregnancy is
tolerated by most women with transposition of the great arteries and
atrial switch operation with low mortality but important morbidity. Most
common maternal complications were arrhythmias, heart failure, worsening
of right ventricular function, and tricuspid regurgitation. There was also
a high incidence of prematurity and increased rate of fetal loss and
neonatal mortality. Outcome of pregnancy in women after arterial switch
operations is more favorable, with reduced incidence of maternal
complications and fetal outcomes similar to women without underlying
cardiac disease. Copyright © 2022 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<57>
Accession Number
2018789285
Title
Device-Based Approaches Targeting Cardioprotection in Myocardial
Infarction: The Expanding Armamentarium of Innovative Strategies.
Source
Journal of the American Heart Association. 11(23) (no pagination), 2022.
Article Number: e026474. Date of Publication: 06 Dec 2022.
Author
Romeo F.J.; Mazurek R.; Sakata T.; Mavropoulos S.A.; Ishikawa K.
Institution
(Romeo, Mazurek, Sakata, Mavropoulos, Ishikawa) Cardiovascular Research
Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
Publisher
American Heart Association Inc.
Abstract
Coronary reperfusion therapy has played a pivotal role for reducing
mortality and heart failure after acute myocardial infarction. Although
several adjunctive approaches have been studied for reducing infarct size
further, both ischemia- reperfusion injury and microvascular obstruction
are still major contributors to both early and late clinical events after
acute myocardial infarction. The progress in the field of cardioprotection
has found several promising proof-of-concept preclinical studies. However,
translation from bench to bedside has not been very successful. This
comprehensive review discusses the importance of infarct size as a driver
of clinical outcomes post-acute myocardial infarction and summarizes
recent novel device-based approaches for infarct size reduction.
Device-based interventions including mechanical cardiac unloading,
myocardial cooling, coronary sinus interventions, supersaturated oxygen
therapy, and vagal stimulation are discussed. Many of these approaches can
modify ischemic myocardial biology before reperfusion and offer unique
opportunities to target ischemia- reperfusion injury. Copyright ©
2022 The Authors.

<58>
Accession Number
2021393344
Title
Recommendations for the use of coronary and valve simulators in cardiac
surgical training: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 61(1) (pp 1-10), 2022. Date
of Publication: 01 Jan 2022.
Author
Whittaker G.; Salmasi M.Y.; Aydin A.; Magouliotis D.; Raja S.G.;
Asimakopoulos G.; Moorjani N.; Athanasiou T.
Institution
(Whittaker, Salmasi, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
(Whittaker) Department of Cardiothoracic Surgery, Manchester University
NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, United
Kingdom
(Aydin) MRC Centre for Transplantation, King's College London, London,
United Kingdom
(Magouliotis) Department of Cardiothoracic Surgery, University of
Thessaly, Larissa, Greece
(Raja, Asimakopoulos) Department of Cardiothoracic Surgery, Royal Brompton
& Harefield NHS Foundation Trust, London, United Kingdom
(Moorjani) Department of Cardiothoracic Surgery, Royal Papworth Hospital
NHS Foundation Trust, Cambridge, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The aim of this study was to systematically review the
simulators that are currently available for coronary artery bypass graft
and valve surgery and, in addition, to review the validation evidence
supporting them and to recommend several simulators for training based on
the analysis of results. METHOD(S): A systematic literature search of
the MEDLINE (1946 to May 2021) and EMBASE (1947 to May 2021) databases was
performed to identify simulators for coronary artery and valvular
procedures in cardiothoracic surgery. A selection of keywords and MeSH
terms was used to execute the literature search. After identification of
relevant articles, data were extracted and analysed. RESULT(S):
Thirty-seven simulators were found in 31 articles. Simulators were found
for coronary artery bypass graft (n = 24) and valve surgery (n = 13). The
majority of models were either benchtop (n = 28) or hybrid (n = 8)
modalities. Evidence of validity was demonstrated in 15 (40.5%)
simulators. Twenty-two (59.5%) simulators had no validation evidence, and
1 (2.7%) simulator had 3 or more elements of validity established.
 CONCLUSION(S): Two simulators were recommended for supplemental
training in cardiothoracic surgery. Low-fidelity models can provide a
broad foundation for surgical skills' development whereas high-fidelity
simulators can be used for immersive training scenarios and appraisals.
These should be utilized in early training, at which point the learning
curve of trainees is steepest. Copyright © 2021 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<59>
Accession Number
2020508955
Title
Fractional Flow Reserve versus Angiography-Guided Management of Coronary
Artery Disease: A Meta-Analysis of Contemporary Randomised Controlled
Trials.
Source
Journal of Clinical Medicine. 11(23) (no pagination), 2022. Article
Number: 7092. Date of Publication: December 2022.
Author
Maznyczka A.M.; Matthews C.J.; Blaxill J.M.; Greenwood J.P.; Mozid A.M.;
Rossington J.A.; Veerasamy M.; Wheatcroft S.B.; Curzen N.; Bulluck H.
Institution
(Maznyczka, Matthews, Blaxill, Greenwood, Mozid, Rossington, Veerasamy,
Wheatcroft, Bulluck) Yorkshire Heart Centre, Leeds General Infirmary,
Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, United Kingdom
(Blaxill, Greenwood, Mozid, Rossington, Veerasamy, Wheatcroft, Bulluck)
Leeds Institute of Cardiovascular and Metabolic Medicine, University of
Leeds, Leeds LS1 3EX, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, Southampton SO17
1BJ, United Kingdom
(Curzen) Coronary Research Group, University Hospital Southampton NHS
Trust, Southampton SO17 1BJ, United Kingdom
Publisher
MDPI
Abstract
Background and Aims: Randomised controlled trials (RCTs) comparing
outcomes after fractional flow reserve (FFR)-guided versus
angiography-guided management for obstructive coronary artery disease
(CAD) have produced conflicting results. We investigated the efficacy and
safety of an FFR-guided versus angiography-guided management strategy
among patients with obstructive CAD. Method(s): A systematic
electronic search of the major databases was performed from inception to
September 2022. We included studies of patients presenting with angina or
myocardial infarction (MI), managed with medications, percutaneous
coronary intervention, or bypass graft surgery. A meta-analysis was
performed by pooling the risk ratio (RR) using a random-effects model. The
endpoints of interest were all-cause mortality, MI and unplanned
revascularisation. Result(s): Eight RCTs, with outcome data from 5077
patients, were included. The weighted mean follow up was 22 months. When
FFR-guided management was compared to angiography-guided management, there
was no difference in all-cause mortality [3.5% vs. 3.7%, RR: 0.99 (95%
confidence interval (CI) 0.62-1.60), p = 0.98, heterogeneity
(I2) 43%], MI [5.3% vs. 5.9%, RR: 0.93 (95%CI 0.66-1.32), p =
0.69, I2 42%], or unplanned revascularisation [7.4% vs. 7.9%,
RR: 0.92 (95%CI 0.76-1.11), p = 0.37, I2 0%]. However, the
number patients undergoing planned revascularisation by either stent or
surgery was significantly lower with an FFR-guided strategy [weighted mean
difference: 14 (95% CI 3 to 25)%, p =< 0.001]. Conclusion(s): In
patients with obstructive CAD, an FFR-guided management strategy did not
impact on all-cause mortality, MI and unplanned revascularisation, when
compared to an angiography-guided management strategy, but led to up to a
quarter less patients needing revascularisation. Copyright © 2022
by the authors.

<60>
Accession Number
2020506612
Title
Artificial Intelligence in Pediatric Cardiology: A Scoping Review.
Source
Journal of Clinical Medicine. 11(23) (no pagination), 2022. Article
Number: 7072. Date of Publication: December 2022.
Author
Sethi Y.; Patel N.; Kaka N.; Desai A.; Kaiwan O.; Sheth M.; Sharma R.;
Huang H.; Chopra H.; Khandaker M.U.; Lashin M.M.A.; Hamd Z.Y.; Emran T.B.
Institution
(Sethi, Patel, Kaka, Kaiwan) PearResearch, Dehradun 248001, India
(Sethi) Department of Medicine, Government Doon Medical College, Dehradun
248001, India
(Patel, Kaka) Department of Medicine, GMERS Medical College, Himmatnagar
383001, India
(Desai) Department of Medicine, SMIMER Medical College, Surat 395010,
India
(Kaiwan) Department of Medicine, Northeast Ohio Medical University,
Rootstown, OH 44272, United States
(Sheth) Department of Medicine, GMERS Gandhinagar, Gandhinagar 382012,
India
(Sharma) Department of Medicine, Government Medical College, Nagpur
440003, India
(Huang) Faculty of Medicine and Health Science, Royal College of Surgeons
in Ireland, Dublin D02 YN77, Ireland
(Chopra) Chitkara College of Pharmacy, Chitkara University, Rajpura
140401, India
(Khandaker) Centre for Applied Physics and Radiation Technologies, School
of Engineering and Technology, Sunway University, Bandar Sunway 47500,
Malaysia
(Lashin) Department of Biomedical Engineering, College of Engineering,
Princess Nourah bint Abdulrahman University, P.O. 84428, Riyadh 11671,
Saudi Arabia
(Hamd) Department of Radiological Sciences, College of Health and
Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O.
84428, Riyadh 11671, Saudi Arabia
(Emran) Department of Pharmacy, BGC Trust University Bangladesh,
Chittagong 4381, Bangladesh
(Emran) Department of Pharmacy, Faculty of Allied Health Sciences,
Daffodil International University, Dhaka 1207, Bangladesh
Publisher
MDPI
Abstract
The evolution of AI and data science has aided in mechanizing several
aspects of medical care requiring critical thinking: diagnosis, risk
stratification, and management, thus mitigating the burden of physicians
and reducing the likelihood of human error. AI modalities have expanded
feet to the specialty of pediatric cardiology as well. We conducted a
scoping review searching the Scopus, Embase, and PubMed databases covering
the recent literature between 2002-2022. We found that the use of neural
networks and machine learning has significantly improved the diagnostic
value of cardiac magnetic resonance imaging, echocardiograms, computer
tomography scans, and electrocardiographs, thus augmenting the clinicians'
diagnostic accuracy of pediatric heart diseases. The use of AI-based
prediction algorithms in pediatric cardiac surgeries improves
postoperative outcomes and prognosis to a great extent. Risk
stratification and the prediction of treatment outcomes are feasible using
the key clinical findings of each CHD with appropriate computational
algorithms. Notably, AI can revolutionize prenatal prediction as well as
the diagnosis of CHD using the EMR (electronic medical records) data on
maternal risk factors. The use of AI in the diagnostics, risk
stratification, and management of CHD in the near future is a promising
possibility with current advancements in machine learning and neural
networks. However, the challenges posed by the dearth of appropriate
algorithms and their nascent nature, limited physician training, fear of
over-mechanization, and apprehension of missing the 'human touch' limit
the acceptability. Still, AI proposes to aid the clinician tomorrow with
precision cardiology, paving a way for extremely efficient
human-error-free health care. Copyright © 2022 by the authors.

<61>
Accession Number
2020506462
Title
Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta
Analysis.
Source
Journal of Clinical Medicine. 11(23) (no pagination), 2022. Article
Number: 6955. Date of Publication: December 2022.
Author
D'Amico F.; Barucco G.; Licheri M.; Valsecchi G.; Zaraca L.; Mucchetti M.;
Zangrillo A.; Monaco F.
Institution
(D'Amico, Barucco, Licheri, Valsecchi, Zaraca, Mucchetti, Zangrillo,
Monaco) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan 20132, Italy
(Zangrillo) Faculty of Medicine, Vita-Salute San Raffaele University,
Milan 20132, Italy
Publisher
MDPI
Abstract
Introduction: Recent studies showed that balanced opioid-free anesthesia
is feasible and desirable in several surgical settings. However, in
thoracic surgery, scientific evidence is still lacking. Thus, we conducted
the first systematic review and meta-analysis of opioid-free anesthesia in
this field. Method(s): The primary outcome was the occurrence of any
complication. Secondary outcomes were the length of hospital stay,
recovery room length of stay, postoperative pain at 24 and 48 h, and
morphine equivalent consumption at 48 h. Result(s): Out of 375
potentially relevant articles, 6 studies (1 randomized controlled trial
and 5 observational cohort studies) counting a total of 904 patients were
included. Opioid-free anesthesia compared to opioid-based anesthesia, was
associated with a lower rate of any complication (74 of 175 [42%] vs. 200
of 294 [68%]; RR = 0.76; 95% CI, 0.65-0.89; p < 0.001; I2 =
0%), lower 48 h morphine equivalent consumption (MD -14.5 [-29.17/-0.22];
p = 0.05; I2 = 95%) and lower pain at 48 h (MD -1.95
[-3.6/0.3]; p = 0.02, I = 98%). Conclusion(s): Opioid-free anesthesia
in thoracic surgery is associated with lower postoperative complications,
and less opioid demand with better postoperative analgesia at 48 h
compared to opioid-based anesthesia. Copyright © 2022 by the
authors.

<62>
Accession Number
2021608192
Title
A Clinical Mathematical Model Estimating Postoperative Urine Output in
Children Underwent Cardiopulmonary Bypass for Congenital Heart Surgery.
Source
Journal of Pediatric Intensive Care. (no pagination), 2022. Date of
Publication: 2022.
Author
Baloglu O.; Ryan S.D.; Onder A.M.; Rosen D.; Mullett C.J.; Munther D.S.
Institution
(Baloglu) Department of Pediatric Critical Care Medicine, Cleveland Clinic
Children's, Cleveland Clinic, Cleveland, OH, United States
(Baloglu) Cleveland Clinic Children's Center for Artificial Intelligence
(C4AI), Cleveland Clinic, Cleveland, OH, United States
(Ryan, Munther) Department of Mathematics and Statistics, Cleveland State
University, Cleveland, OH, United States
(Onder) Division of Pediatric Nephrology, Nemours Children's Hospital,
Wilmington, DE, United States
(Rosen) Division of Pediatric Cardiothoracic Anesthesiology, West Virginia
University, School of Medicine, Morgantown, WV, United States
(Mullett) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, West Virginia University, School of Medicine, Morgantown, WV,
United States
Publisher
Georg Thieme Verlag
Abstract
Objectives Our objective was to build a proof of concept of the clinical
mathematical model estimating postoperative urine output (UOP) utilizing
preoperative, intraoperative, and immediate postoperative variables in
children who underwent cardiopulmonary bypass (CPB) for congenital heart
surgery. Methods This was a single-center, retrospective cohort study in a
university-affiliated children's hospital. Patients younger than 21 years
old who underwent CPB for congenital heart surgery and were
postoperatively admitted to West Virginia University Children's Hospital's
pediatric intensive care unit (PICU) between September 1, 2007 and June
31, 2013 were included in the study. Body surface area, CPB duration,
first measured hematocrit, serum pH, central venous pressure, and
vasoactive-inotropic score in the PICU were used to build the mathematical
model. A randomly selected 50% of the dataset was used to calculate model
parameters. A cross-validation was used to assess model performance.
Results A total of 256 patients met the inclusion criteria. The model was
able to achieve mean absolute error of 1.065 mL/kg/h (95% confidence
interval (CI): 1.062-1.067 mL/kg/h), root mean squared error of 1.80
mL/kg/h (95% CI: 1.799-1.804 mL/kg/h), and R 2 of 0.648 (95% CI:
0.646-0.650) in estimating UOP in the first 32 hours of postoperative
period. Conclusions The mathematical model utilizing preoperative,
intraoperative, and immediate postoperative variables may be a potentially
useful clinical tool in estimating UOP in the first 32 hours postoperative
period. Copyright © 2022. Thieme. All rights reserved.

<63>
Accession Number
2020560928
Title
Short-term outcome after transcatheter aortic valve replacement with a
novel balloon-expandable valve.
Source
Netherlands Heart Journal. (no pagination), 2022. Date of Publication:
2022.
Author
Halim J.; den Heijer P.; van den Branden B.; Meuwissen M.; Vos J.;
Scholzel B.; IJsselmuiden A.
Institution
(Halim, den Heijer, van den Branden, Meuwissen, Vos, Scholzel,
IJsselmuiden) Department of Cardiology, Amphia Hospital Breda, Breda,
Netherlands
Publisher
Bohn Stafleu van Loghum
Abstract
Objectives: Transcatheter aortic valve replacement (TAVR) has been
expanding rapidly with numerous transcatheter heart valve (THV) systems
currently available. The Myval balloon-expandable (BE) valve (Meril Life
Sciences Pvt. Ltd., India) is a novel THV system indicated for the
treatment of patients with severe aortic stenosis. The primary objective
of this study is to assess the safety and performance of the Myval BE
valve. Method(s): In this prospective single-centre study, 120
consecutive patients who underwent TAVR with the Myval BE valve were
included. Clinical outcomes were evaluated at 30 days and 6 months using
Valve Academic Research Consortium-2 criteria. All-cause mortality,
stroke, acute kidney injury, major vascular complications, moderate or
severe paravalvular leakage (PVL) and need for a permanent pacemaker
implantation (PPI) were investigated. Result(s): At 6-month
follow-up, all-cause death and cardiac death were seen in 5.8% and 0.8% of
the patients respectively. Periprocedural stroke and need for PPI were
both seen in 3.3% of the patients. Access-site-related vascular and
bleeding complications were absent. Improved valve haemodynamics and no
moderate to severe PVL could be seen at 30 days. An intermediate valve
size was selected in 51% of the patients. Conclusion(s): The Myval BE
valve demonstrates improved valve haemodynamics, absence of moderate to
severe PVL and good safety outcomes at 6-month follow-up with low cardiac
death rate and acceptable rates of permanent pacemaker implantation and
periprocedural stroke. Future randomised controlled trials will further
establish the clinical utility of the Myval BE valve. Copyright ©
2022, The Author(s).

<64>
Accession Number
639738144
Title
A direct wire pacing device for transcatheter heart valve and coronary
interventions: a first-in-human, multicentre study of the Electroducer
Sleeve.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2022. Date of Publication: 08 Dec 2022.
Author
Wintzer-Wehekind J.; Lefevre T.; Benamer H.; Monsegu J.; Tchetche D.;
Garot P.; Honton B.; Dumonteil N.; Abdellaoui M.
Institution
(Wintzer-Wehekind, Monsegu, Abdellaoui) Institut Cardiovasculaire de
Grenoble, Grenoble, France
(Wintzer-Wehekind, Monsegu, Abdellaoui) VilleurbanneFrance
(Lefevre, Benamer, Garot) Institut Cardiovasculaire Paris Sud, Hopital
Prive Jacques Cartier, Massy, France
(Tchetche, Honton, Dumonteil) Groupe Cardiovasculaire Interventionnel,
Clinique Pasteur, Toulouse, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) and complex
percutaneous coronary interventions (PCI) may require cardiac pacing
during device delivery, generally requiring the insertion of a temporary
pacing lead via an additional venous access site. The purpose-built
Electroducer Sleeve device provides direct wire pacing without the need
for a temporary venous pacemaker. AIMS: This study assessed the safety of
temporary cardiac pacing using the novel sleeve device during PCI.
 METHOD(S): This was a multicentre, non-randomised, prospective,
first-in-human, single-arm, pilot study. The primary endpoint was analysis
of a safety outcome, defined as the occurrence of haematomas or bleeding
complications at the device vascular access site. Secondary endpoints
included analyses of effectiveness and qualitative outcomes.
 RESULT(S): Sixty patients (mean age: 77.9+/-9.6 years) from 4 centres
in France were included: 39 (65%) underwent TAVI, and 21 (35%) underwent
PCI. Procedures were performed using the sleeve with access through the
radial (32 patients; 53.3%) or femoral arteries (26; 43.3%), or the
femoral vein (2; 3.3%). Primary endpoint analysis revealed that 2 patients
(3.3%) developed EArly Discharge After Transradial Stenting of CoronarY
Arteries Study (EASY) grade I/Bleeding Academic Research Consortium (BARC)
type I haematomas at the device access site. As a measure of
effectiveness, a haemodynamic effect was observed after each spike
delivery in 54 patients (90%). Analyses of other secondary endpoints
showed that 2 patients (6.3%) presented asymptomatic radial artery
occlusion. No allergies were reported. CONCLUSION(S): This
first-in-human trial using the Electroducer Sleeve indicated that this
novel, purpose-built, temporary pacing device was safe and effective.
Larger prospective studies are required to confirm these findings.

<65>
Accession Number
639735014
Title
Combination Therapy With Nicardipine and Isosorbide Dinitrate to Prevent
Spasm in Transradial Percutaneous Coronary Intervention (from the NISTRA
Multicenter Double-Blind Randomized Controlled Trial).
Source
The American journal of cardiology. 188 (pp 89-94), 2022. Date of
Publication: 05 Dec 2022.
Author
Bouchahda N.; Ben Abdessalem M.A.; Ben Hlima N.; Ben Messaoud M.; Denguir
H.; Boussaada M.M.; Saoudi W.; Jamel A.; Hassine M.; Bouraoui H.; Mahjoub
M.; Mahdhaoui A.; Jeridi G.; Betbout F.; Gamra H.
Institution
(Bouchahda, Ben Messaoud, Boussaada, Hassine, Mahjoub, Betbout, Gamra)
Cardiology A Department, University of Monastir, Research Laboratory LR12
SP 16, Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Ben Abdessalem, Saoudi, Bouraoui, Mahdhaoui, Jeridi) Cardiology
Department, Universite de Sousse, Laboratoire de Recherche: interactions
cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia
(Ben Hlima, Jamel) Cardiology Department, Universite de Sousse, Kairouen
Ibn el Jazzar University Hospital, Tunisia
(Denguir) Cardiology Department, University of Monastir, Gabes University
Hospital, Tunisia
Publisher
NLM (Medline)
Abstract
Verapamil and nitroglycerin are widely used to prevent radial artery spasm
(RAS) during percutaneous cardiovascular procedures. However, these agents
are not typically available in most African countries and consequently,
isosorbide dinitrate is often the only spasmolytic treatment. Our aim was
to compare the efficacy of isosorbide dinitrate alone versus isosorbide
dinitrate used together with nicardipine to prevent RAS during transradial
coronary procedures. This was a randomized controlled double-blind
multicenter trial. Patients (n = 1,523) were randomized to receive either
a sole therapy of isosorbide dinitrate (n = 760) or the combination of
isosorbide dinitrate and nicardipine (n = 763). Our primary end point was
the occurrence of RAS; defined as considerable perceived hindrance of
catheter advancement. Our secondary end points were severe RAS; defined as
(1) severe arm pain, (2) the need for either morphine or midazolam
treatment, and (3) necessity for crossover to the contralateral radial or
femoral artery. RAS incidence was reduced with the combination therapy
versus isosorbide dinitrate alone (15% vs 25%, p <0.001), with a number
needed to treat of 10 patients. There was also a significant reduction in
the incidence of the secondary end points with combination therapy (3.6%
vs 8.2%, p <0.001), with a number needed to treat of 22 patients. This
result was driven by reductions in both femoral crossover (0.5% vs 2.4%, p
= 0.003) and the use of morphine or midazolam injections (1.6% vs 3.5%, p
= 0.02) with combination therapy. In conclusion, we demonstrated the
superiority of the combination therapy of isosorbide dinitrate and
nicardipine over isosorbide dinitrate alone in reducing the incidence of
RAS. Copyright © 2022 Elsevier Inc. All rights reserved.

<66>
Accession Number
639734181
Title
Should moderate ischemic mitral regurgitation be corrected during coronary
artery bypass grafting? a systematic review and meta-analysis.
Source
Perfusion. (pp 2676591221144558), 2022. Date of Publication: 08 Dec 2022.
Author
Wu H.; Zhang W.
Institution
(Wu, Zhang) Department of Cardiothoracic Surgery, Changzhi People's
Hospital, Changzhi, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Ischemic mitral regurgitation (IMR) is associated with
increased risks of mortality and heart failure. However, the optimal
management of moderate IMR remains controversial. We conducted a
meta-analysis to appraise whether moderate IMR should be corrected during
coronary artery bypass grafting (CABG). METHOD(S): We searched
PubMed, Embase, and Cochrane databases from its inception up to 15 October
2022 for studies that assessed CABG alone versus CABG with mitral valve
(MV) surgery in patients with moderate IMR. The primary outcome was
perioperative mortality. RESULT(S): Four randomized controlled trials
and three observational studies with propensity-matched data including
1209 patients assessing CABG alone (n = 598) versus CABG with MV surgery
(n = 611) were included. Compared to CABG alone, the addition of MV
surgery did not significantly increase perioperative mortality (RR, 1.01;
95% CI, 0.52-1.96; p = 0.98) and stroke (RR, 2.14; 95% CI, 0.97-4.72; p =
0.06), whereas a longer cardiopulmonary bypass duration (MD, 54.91; 95%
CI, 42.13-67.68; p < 0.01) and an increased incidence of renal failure
were observed in the combined-procedure group. At follow-up, the addition
of MV surgery was significantly associated with reduced rates of residual
MR (RR, 0.26; 95% CI, 0.13-0.51; p < 0.01) and NYHA class III-IV (RR,
0.54; 95% CI, 0.37-0.78; p < 0.01). However, there was no difference in
either mid-term mortality (RR, 1.05; 95% CI, 0.65-1.70; p = 0.82) or late
mortality (RR, 91; 95% CI, 0.49-1.71; p = 0.78) between the CABG alone
group and the combined-procedure group. CONCLUSION(S): In patients
with moderate IMR, the addition of MV surgery to CABG did not increase
perioperative mortality. Despite the reduced rates of moderate MR and NYHA
class III-IV at follow-up, the addition of MV surgery did not translate in
a reduction in mid-term or late mortality.

<67>
Accession Number
639732553
Title
Safety of apixaban and rivaroxaban compared to warfarin after cardiac
surgery.
Source
Journal of cardiac surgery. (no pagination), 2022. Date of Publication:
07 Dec 2022.
Author
Naik K.D.; Whitson B.A.; McLaughlin E.M.; Matre N.B.; Rozycki A.J.
Institution
(Naik) Department of Pharmacy, Cleveland Clinic Foundation, Columbus, OH,
United States
(Whitson) Department of Surgery, Ohio State University Wexner Medical
Center, Columbus, United States
(McLaughlin) Department of Biostatistics, Ohio State University, Columbus,
OH, United States
(Matre) Department of Quality and Operations, Ohio State University Wexner
Medical Center, Columbus, OH, United States
(Rozycki) Department of Pharmacy, Ohio State University Wexner Medical
Center, Columbus, OH, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Direct oral anticoagulants (DOACs) are frequently prescribed
for the management of atrial fibrillation and venous thrombosis. There is
a lack of published data on the utilization of DOACs in individuals who
have undergone recent cardiac surgery. The purpose of this study was to
evaluate the safety and efficacy of apixaban and rivaroxaban compared to
warfarin in patients postcardiac surgery. METHOD(S): In this
retrospective cohort study, patients were separated into a DOAC cohort or
a warfarin cohort based on the agent they received after cardiac surgery.
Patients could be included if they were >=18 years of age and received or
were discharged on either rivaroxaban, apixaban, or warfarin within 7 days
after cardiac surgery. The primary outcome for the study was the rate of
International Society on Thrombosis and Hemostasis (ISTH) major bleeding
during hospitalization and for 30 days following discharge or until first
follow-up appointment. RESULT(S): There were a total of 194 patients
included in the analysis, 97 in the DOAC cohort and 97 in the warfarin
cohort. Four patients (4.1%) in the DOAC group experienced ISTH major
bleeding, while 2 patients (2.1%) in the warfarin cohort experienced ISTH
major bleeding (p=0.68). No patients in the DOAC cohort experienced a
thrombotic event, whereas 2 patients (2.1%) in the warfarin cohort
experienced a thrombotic complication (p=0.5). CONCLUSION(S):
Apixaban and rivaroxaban demonstrated similar safety when compared to a
matched cohort of warfarin patients. Larger prospective randomized studies
are needed to confirm these findings. Copyright © 2022 The
Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.

<68>
Accession Number
639732273
Title
Association of liver dysfunction with outcomes after cardiac surgery-a
meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2022.
Date of Publication: 08 Dec 2022.
Author
Kirov H.; Caldonazo T.; Audisio K.; Rahouma M.; Robinson N.B.; Cancelli
G.; Soletti G.J.; Demetres M.; Ibrahim M.; Faerber G.; Gaudino M.; Doenst
T.
Institution
(Kirov, Caldonazo, Faerber, Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University Jena, Germany
(Audisio, Rahouma, Robinson, Cancelli, Soletti, Gaudino) Department of
Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical
Center, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, USA
(Ibrahim) Department of General Surgery, Maimonides Medical Center.
Brooklyn, NY, United States
(Ibrahim) Nuffield Department of Surgical Sciences, University of Oxford,
Oxford, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To perform a meta-analysis of studies reporting outcomes in
patients with liver dysfunction addressed by the model of end-stage liver
disease (MELD) and Child-Turcotte-Pugh (CTP) scores undergoing cardiac
surgery. METHOD(S): A systematic literature search was conducted to
identify contemporary studies reporting short- and long-term outcomes in
patients with liver dysfunction compared to patients with no or mild liver
dysfunction undergoing cardiac surgery (stratified in high and low score
group based on the study cutoffs). Primary outcome was perioperative
mortality. Secondary outcomes were perioperative neurological events,
prolonged ventilation, sepsis, bleeding and/or need for transfusion, acute
kidney injury, and long-term mortality. RESULT(S): A total of 33
studies with 48,891 patients were included. Compared with the low score
group, being in the high score group was associated with significantly
higher risk of perioperative mortality (Odds ratio, OR 3.72, 95%
confidence interval, CI 2.75-5.03, P<0.001). High score group was also
associated with a significantly higher rate of perioperative neurological
events (OR 1.49, CI 1.30-1.71, P<0.001), prolonged ventilation (OR 2.45,
CI 1.94-3.09, P<0.001), sepsis (OR 3.88, CI 2.07-7.26, P<0.001), bleeding
and/or need for transfusion (OR 1.95, CI 1.43-2.64, P<0.001), acute kidney
injury (OR 3.84, CI 2.12-6.98, P<0.001), and long-term mortality
(incidence risk ratio, IRR:, 1.29, CI 1.14-1.46, P<0.001).
 CONCLUSION(S): The analysis suggests that liver dysfunction in
patients undergoing cardiac surgery is independently associated with
higher risk of short and long-term mortality and also with an increased
occurrence of various perioperative adverse events. Copyright ©
The Author(s) 2022. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery.

<69>
Accession Number
639732268
Title
Characteristics of Clinical Trial Sites for Novel Transcatheter Mitral and
Tricuspid Valvular Therapies.
Source
JAMA cardiology. (no pagination), 2022. Date of Publication: 07 Dec 2022.
Author
Nathan A.S.; Reddy K.P.; Yang L.; Eberly L.A.; Dayoub E.J.; Khatana
S.A.M.; Julien H.M.; Desai N.D.; Szeto W.Y.; Herrmann H.C.; Kobayashi
T.J.; Fiorilli P.; Batchelor W.B.; Mehran R.; Alkhouli M.A.; Giri J.;
Groeneveld P.W.; Fanaroff A.C.
Institution
(Nathan, Eberly, Dayoub, Khatana, Julien, Herrmann, Kobayashi, Fiorilli,
Giri, Fanaroff) Division of Cardiology, Hospital of the University of
Pennsylvania, Philadelphia, United States
(Nathan, Reddy, Yang, Eberly, Dayoub, Khatana, Julien, Desai, Kobayashi,
Giri, Groeneveld, Fanaroff) Penn Cardiovascular Outcomes, Quality,
Evaluative Research Center, University of Pennsylvania, Philadelphia,
United States
(Nathan, Yang, Eberly, Dayoub, Khatana, Julien, Desai, Kobayashi, Giri,
Groeneveld, Fanaroff) Leonard Davis Institute of Health Economics,
University of Pennsylvania, Philadelphia, United States
(Nathan, Khatana, Julien, Kobayashi, Fiorilli, Giri, Groeneveld) Corporal
Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
(Desai, Szeto) Division of Cardiac Surgery, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, United States
(Batchelor) Inova Heart and Vascular Institute, Fairfax, VA, United States
(Mehran) Icahn School of Medicine at Mount Sinai, NY, United States
(Alkhouli) Mayo Clinic, Rochester, MN, United States
(Groeneveld) Division of General Internal Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, United States
Publisher
NLM (Medline)
Abstract
Importance: Racial and ethnic minority and socioeconomically disadvantaged
patients have been underrepresented in randomized clinical trials. Efforts
have focused on enhancing inclusion of minority groups at sites
participating at clinical trials; however, there may be differences in the
patient populations of the sites that participate in clinical trials.
 Objective(s): To identify any differences in the racial, ethnic, and
socioeconomic composition of patient populations among candidate sites in
the US that did vs did not participate in trials for novel transcatheter
therapies. Design, Setting, and Participant(s): This cross-sectional
analysis used Medicare Provider Claims from 2019 for patients admitted to
hospitals in the US. All clinical trials for transcatheter mitral and
tricuspid valve therapies and the hospitals participating in each of the
trials were identified using ClinicalTrials.gov. Hospitals with active
cardiac surgical programs that did not participate in the trials were also
identified. Data analysis was performed between July 2021 and July 2022.
Exposures: Multivariable linear regression models were used to identify
differences in racial, ethnic, and socioeconomic characteristics among
patients undergoing cardiac surgery or transcatheter aortic valve
replacement at trial vs nontrial hospitals. Main Outcome and Measures: The
main outcome of the study was participation in a clinical trial for novel
transcatheter mitral or tricuspid valve therapies. Result(s): A total
of 1050 hospitals with cardiac surgery programs were identified, of which
121 (11.5%) participated in trials for transcatheter mitral or tricuspid
therapies. Patients treated in trial hospitals had a higher median zip
code-based household income (difference of $5261; 95% CI, $2986-$7537), a
lower Distressed Communities Index score (difference of 5.37; 95% CI,
2.59-8.15), and no significant difference in the proportion of patients
dual eligible for Medicaid (difference of 0.86; 95% CI, -2.38 to 0.66).
After adjusting for each of the socioeconomic indicators separately, there
was less than 1% difference in the proportion of Black and Hispanic
patients cared for at hospitals participating vs not participating in
clinical trials. Conclusions and Relevance: In this cohort study
among candidate hospitals for clinical trials for transcatheter mitral or
tricuspid valve therapies, trial hospitals took care of a more
socioeconomically advantaged population than nontrial hospitals, with a
similar proportion of Black and Hispanic patients. These data suggest that
site selection efforts may improve enrollment of socioeconomically
disadvantaged patients but may not improve the enrollment of Black and
Hispanic patients.

<70>
[Use Link to view the full text]
Accession Number
2021603986
Title
IMPELLA VERSUS EXTRACORPOREAL MEMBRANE OXYGENATION in CARDIOGENIC SHOCK: A
SYSTEMATIC REVIEW and META-ANALYSIS.
Source
Shock. 58(5) (pp 349-357), 2022. Date of Publication: 01 Nov 2022.
Author
Abusnina W.; Ismayl M.; Al-Abdouh A.; Ganesan V.; Mostafa M.R.; Hallak O.;
Peterson E.; Abdou M.; Goldsweig A.M.; Aboeata A.; Dahal K.
Institution
(Abusnina, Ismayl, Ganesan, Aboeata, Dahal) Department of Cardiology,
Creighton University, School of Medicine, Omaha, NE, United States
(Al-Abdouh) Department Pf Medicine, University of Kentucky, Lexington, KY,
United States
(Mostafa) Department of Medicine, Rochester Regional/Unity Hospital,
Rochester, NY, United States
(Hallak) Division of Cardiology, Kettering Medical Center, Dayton, OH,
United States
(Peterson) Creighton University, School of Medicine, Omaha, NE, United
States
(Abdou) Division of Cardiology, Emory University, Atlanta, GA, United
States
(Goldsweig) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiogenic shock (CS) carries high mortality. The roles of
specific mechanical circulatory support (MCS) systems are unclear. We
compared the clinical outcomes of Impella versus extracorporal membrane
oxygenation (ECMO) in patients with CS. Method(s): This is a
systematic review and meta-analysis that was conducted in accordance with
Preferred Reporting Items for Systematic Reviews and Meta Analyses
guidelines. We searched PubMed, Cochrane Central Register, Embase, Web of
Science, Google Scholar, and ClinicalTrials.gov (inception through May 10,
2022) for studies comparing the outcomes of Impella versus ECMO in CS. We
used random-effects models to calculate risk ratios (RRs) with 95%
confidence interval (CIs). End points included in-hospital, 30-day, and
12-month all-cause mortality, successful weaning from MCS, bridge to
transplant, all reported bleeding, stroke, and acute kidney injury.
 Result(s): A total of 10 studies consisting of 1,827 CS patients
treated with MCS were included in the analysis. The risk of in-hospital
all-cause mortality was significantly lower with Impella compared with
ECMO (RR, 0.80; 95% CI, 0.65-1.00; P = 0.05), whereas there was no
statistically significant difference in 30-day (RR, 0.97, 95% CI,
0.82-1.16; P = 0.77) and 12-month mortality (RR, 0.90; 95% CI, 0.74-1.11;
P = 0.32). There were no significant differences between the two groups in
terms of successful weaning (RR, 0.97; 95% CI, 0.81-1.15; P = 0.70) and
bridging to transplant (RR, 0.88; 95% CI, 0.58-1.35; P = 0.56). There was
less risk of bleeding and stroke in the Impella group compared with the
ECMO group. Conclusion(s): In patients with CS, the use of Impella is
associated with lower rates of in-hospital mortality, bleeding, and stroke
than ECMO. Future randomized studies with adequate sample sizes are needed
to confirm these findings. Copyright © Wolters Kluwer Health,
Inc. All rights reserved.

<71>
Accession Number
2021316115
Title
Long-term prognostic value of late gadolinium enhancement and
periprocedural myocardial infarction after uncomplicated
revascularization: MASS-V follow-up.
Source
European Heart Journal Cardiovascular Imaging. 23(2) (pp 255-265), 2022.
Date of Publication: 01 Feb 2022.
Author
Linhares-Filho J.; Hueb W.; Lima E.; Rezende P.; Azevedo D.; Rochitte C.;
Nomura C.; Serrano-Junior C.; Ramires J.; Kalil-Filho R.
Institution
(Linhares-Filho, Hueb, Lima, Rezende, Azevedo, Rochitte, Nomura,
Serrano-Junior, Ramires, Kalil-Filho) Department of Clinical Cardiology,
Heart Institute (InCor) University of Sao Paulo, Av. Dr. Eneas de Carvalho
Aguiar 44, AB, Room 114, Cerqueira Cesar, Sao Paulo 05403-000, Brazil
Publisher
Oxford University Press
Abstract
Aims Cardiac biomarkers elevation is common after revascularization, even
in absence of periprocedural myocardial infarction (PMI) detection by
imaging methods. Thus, late gadolinium enhancement cardiac magnetic
resonance (LGE-CMR) may be useful on PMI diagnosis and prognosis. We
sought to evaluate long-term prognostic value of PMI and new LGE after
revascularization. Methods Two hundred and two patients with multivessel
coronary disease and preserved ventricular function who under- and results
went elective revascularization were included, of whom 136 (67.3%)
underwent coronary artery bypass grafting and 66 (32.7%) percutaneous
coronary intervention. The median follow-up was 5 years (4.8-5.8 years).
Cardiac biomarkers measurement and LGE-CMR were performed before and after
procedures. The Society for Cardiovascular Angiography and Interventions
definition was used to assess PMI. Primary endpoint was composed of death,
infarction, additional revascularization, or cardiac hospitalization.
Primary endpoint was observed in 29 (14.3%) patients, of whom 13 (14.9%)
had PMI and 16 (13.9%) did not (P = 0.93). Thirty-six (17.8%) patients had
new LGE. Twenty (12.0%) events occurred in patients without new LGE and 9
(25.2%) in patients with it (P = 0.045). LGE was also associated to
increased mortality, with 4 (2.4%) and 4 (11.1%) deaths in subjects
without and with it (P = 0.02). LGE was the only independent predictor of
primary endpoint and mortality (P = 0.03 and P = 0.02). Median LGE mass
was estimated at 4.6 g. Patients with new LGE had a greater biomarkers
release (median troponin: 8.9 ng/mL vs. 1.8 ng/mL and median creatine
kinase-MB: 38.0 ng/mL vs. 12.3 ng/mL; P < 0.001 in both comparisons).
Conclusions New LGE was shown to be better prognostic predictor than
biomarker-only PMI definition after uncomplicated revascularization.
Furthermore, new LGE was the only independent predictor of cardiovascular
events and mortality. Clinical trial
http://www.controlled-trials.com/ISRCTN09454308.
registration. Copyright © The Author(s) 2020.

<72>
Accession Number
2021072956
Title
Reasons for staying in hospital after video-assisted thoracoscopic surgery
lobectomy.
Source
BJS Open. 6(3) (no pagination), 2022. Article Number: zrac050. Date of
Publication: 01 Jun 2022.
Author
Huang L.; Kehlet H.; Petersen R.H.
Institution
(Huang, Petersen) Department of Cardiothoracic Surgery, Copenhagen
University Hospital, Rigshospitalet, Copenhagen, Denmark
(Kehlet) Section of Surgical Pathophysiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Background: Despite implementation of enhanced recovery after surgery
(ERAS) in lung surgery, potential barriers for improvements should be
identified. The aim of this single-centre, prospective ERAS cohort study
was to explore reasons for delayed patient discharge after video-assisted
thoracoscopic surgery (VATS) lobectomy with a median length of hospital
stay (LOS) of 2 days. Method(s): Consecutive patients referred for
VATS lobectomy were consulted twice daily by an investigator for the
primary reasons for continued hospitalization. The secondary outcomes were
risk factors for delayed recovery using univariate and multivariate
regression analyses. Result(s): A total of 147 patients were included
(69 with LOS more than 2 days and 78 with LOS of 2 days or less) from
April 2020 to December 2020. Air leak (27.7 per cent), pneumonia (20.2 per
cent), pain (15.3 per cent), urinary/renal factors (11.0 per cent), atrial
fibrillation (7.0 per cent), respiratory failure (4.5 per cent), cognitive
factors/delirium (4.3 per cent), gastrointestinal factors (3.8 per cent),
oxygen dependency (2.7 per cent), social factors (2.0 per cent), and
pleural effusion (1.4 per cent) were important factors for discharge more
than 2 days after surgery. The 30-day readmission rate after discharge was
21 per cent for LOS of 2 days or less and 22 per cent for LOS more than 2
days (P = 0.856). On a multivariate regression model, age (per 5-year
increase, odds ratio (OR) 1.29, 95 per cent c.i. 1.01 to 1.66, P = 0.043)
and forced expiratory volume in 1 s (FEV1) per cent (per 5 per cent
increase, OR 0.89, 95 per cent c.i. 0.81 to 0.98, P = 0.021) were
significantly related to discharge after more than 2 days.
 Conclusion(s): Despite a short median LOS of 2 days, air leak,
pneumonia, and pain remain the most important challenges for further
improvement of the ERAS programme. Age and FEV1 per cent were
statistically significant risk factors for LOS longer than 2
days. Copyright © 2022 The Author(s).

<73>
Accession Number
2021026057
Title
Evaluation of cardiovascular risk biomarkers after moderate consumption of
red wine and cachaca in a randomized crossover trial: The Wine and Cachaca
Study (WICAS).
Source
Clinical Nutrition ESPEN. 52 (pp 113-118), 2022. Date of Publication:
December 2022.
Author
Henrique de Moraes Cellia P.; Lima E.G.; Agrizzi de Angeli L.R.; Martins
E.B.; Rached F.H.; Pitta F.G.; Cassaro Strunz C.M.; Serrano Jr. C.V.
Institution
(Henrique de Moraes Cellia, Lima, Martins, Rached, Pitta, Cassaro Strunz,
Serrano Jr.) Heart Institute (InCor), Sao Paulo University (USP), Sao
Paulo, Brazil
(Agrizzi de Angeli) Orthopedics and Traumatotology Institute, Sao Paulo
University (USP), Sao Paulo, Brazil
Publisher
Elsevier Ltd
Abstract
Introduction: Moderate daily consumption of alcohol (MDCA) is associated
with cardiovascular risk (CVR) reduction in observational studies. Some
researches have suggested that this benefit may be associated not only
with red wine consumption but also with other beverages. However, there
are no clinical trials evaluating the possible CVR benefit of Brazilian
spirit (cachaca) in humans. Method(s): This is a prospective,
randomized, crossover study including healthy individuals initially
assigned to a MDCA of cachaca or red wine for a period of 4 weeks. After a
one-week abstinence period, the type of drink was changed for another 4
weeks of intervention. The MDCA for both beverages was determined as a
dose equivalent to 28 g of ethanol per day for men and 14 g for women. CVR
biomarkers analyses were performed before and after each intervention to
assess the serologic status of C-reactive protein, lipid profile, platelet
aggregation and glycemic profile. This study is registered on the ISRCTN
platform under number 15978506. Result(s): Of the 42 subjects
initially randomized, 2 refused to continue in the study. The median age
was 44.3 +/- 10.3 years and 19 were male (47.5%). Adherence to the
protocol was considered ideal with 100% regular use in both interventions
and only 3 individuals in each intervention group reported alcohol abuse.
There was no significant variation in anthropometric measurements during
the study, except for weight gain (0.7 kg) in the red wine group (p =
0.005). The median of the delta of platelet aggregation for MDCA of
cachaca was 1.2% (-1.1 to 5.3) and the median of the delta to the MDCA of
wine was -1.6% (-4.5 to 2) (p = 0.02). The other biomarkers didn't show
any statistically significant variation. Conclusion(s): Moderate
consumption of wine and cachaca was related to variation in laboratory
biomarkers of CVR related to atherosclerosis. There was significant weight
gain during the period of wine consumption and there was observed a
difference between platelet aggregation values after both
interventions. Copyright © 2022 European Society for Clinical
Nutrition and Metabolism

<74>
Accession Number
2020740664
Title
Impact of procedural success on clinical outcome after MitraClip: Results
from the MITRA-FR trial.
Source
Archives of Cardiovascular Diseases. 115(11) (pp 545-551), 2022. Date of
Publication: November 2022.
Author
Messika-Zeitoun D.; Attias D.; Piriou N.; Iung B.; Armoiry X.; Trochu
J.-N.; Donal E.; Habib G.; Cormier B.; Guerin P.; Lefevre T.;
Maucort-Boulch D.; Boutitie F.; Vahanian A.; Riche B.; Obadia J.-F.
Institution
(Messika-Zeitoun) Department of Cardiology, University of Ottawa Heart
Institute, Ottawa ON K1Y 4W7, Canada
(Attias) Centre Cardiologique du Nord, Saint-Denis 93200, France
(Piriou, Trochu) Inserm, CNRS, Institut du thorax, CHU de Nantes,
Universite de Nantes, Nantes 44007, France
(Iung, Vahanian) Inserm 1148, Universite de Paris, Paris 75877, France
(Iung) Hopital Bichat, AP-HP, Paris 75018, France
(Armoiry) Pharmacy Department, Hopital Edouard-Herriot, Lyon 69003, France
(Armoiry) Laboratoire MATEIS, Universite Claude-Bernard, Villeurbanne
69100, France
(Trochu) Hopital Guillaume- et Rene-Laennec, Saint-Herblain 44093, France
(Donal) CHU de Rennes, Hopital Pontchaillou, Rennes 35000, France
(Donal) Inserm, LTSI UMR 1099, Universite de Rennes 1, Rennes 35043,
France
(Habib) Cardiology Department, Hopital de la Timone, AP-HM, Marseille
13005, France
(Habib) IRD, APHM, MEPHI, IHU-Mediterranee Infection, Aix-Marseille
Universite, Marseille 13005, France
(Cormier, Lefevre) Institut Cardiovasculaire Paris Sud, Hopital Prive
Jacques-Cartier, Massy 91300, France
(Guerin) Inserm UMR 1229, Interventional Cardiology Unit, Institut du
Thorax, CHU de Nantes, Universite de Nantes, Nantes 44007, France
(Maucort-Boulch, Boutitie, Riche) Universite Lyon 1, Villeurbanne 69100,
France
(Maucort-Boulch, Boutitie, Riche) Equipe Biostatistique-Sante, Pole Sante
Publique, Laboratoire de Biometrie et Biologie Evolutive, CNRS, UMR 5558,
Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon,
Villeurbanne 69622, France
(Obadia) Chirurgie Cardiovasculaire et Transplantation Cardiaque, Hopital
Cardiovasculaire Louis Pradel, Universite Claude-Bernard, Hospices Civils
de Lyon, Bron 69677, France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Differences in procedural success rates have been proposed to
explain the divergent results between the MITRA-FR trial (Percutaneous
Repair with the MitraClip Device for Severe Functional/Secondary Mitral
Regurgitation) and the COAPT trial (Cardiovascular Outcomes Assessment of
the MitraClip Percutaneous Therapy for Heart Failure Patients with
Functional Mitral Regurgitation). Aim(s): To examine whether MITRA-FR
patients who had successful clip implantation achieved a better outcome
than the control group. Method(s): Based on the per protocol
population of MITRA-FR, we compared the outcome in 71 patients in whom
optimal clip implantation was achieved (group 1: mitral regurgitation
grade <= 1 + at discharge) with that in 23 patients with non-optimal clip
implantation (group 2: mitral regurgitation grade >= 2 + at discharge) and
that in 137 patients in the control group (group 3). The primary endpoint
was all-cause death or unplanned hospitalization for heart failure at 24
months. Result(s): Event-free survival was not different across the
groups (42 +/- 6% in group 1, 30 +/- 10% in group 2 and 31 +/- 4% in group
3; log-rank P = 0.32). In multivariable analyses, after adjustment for
age, sex, rhythm, aetiology, left ventricular ejection fraction and mitral
regurgitation severity, group was not associated with variations in
outcome: using Group 3 as reference, hazard ratio 0.86, 95% confidence
interval 0.58-1.27 (P = 0.43) in group 1; and hazard ratio 0.98 95%
confidence interval 0.54-1.76 (P = 0.94) in group 2. Conclusion(s):
The clinical outcome of patients in whom optimal procedural result was
achieved at discharge was not different compared with the control group.
Our results do not support the hypothesis that the differences in rates of
residual mitral regurgitation at discharge between MITRA-FR and COAPT
explain the divergent results between the two trials. Copyright ©
2022 Elsevier Masson SAS

<75>
Accession Number
2021287907
Title
Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement.
Source
New England Journal of Medicine. 387(14) (pp 1253-1263), 2022. Date of
Publication: 06 Oct 2022.
Author
Kapadia S.R.; Makkar R.; Leon M.; Abdel-Wahab M.; Waggoner T.; Massberg
S.; Rottbauer W.; Horr S.; Sondergaard L.; Karha J.; Gooley R.; Satler L.;
Stoler R.C.; Messe S.R.; Baron S.J.; Seeger J.; Kodali S.; Krishnaswamy
A.; Thourani V.H.; Harrington K.; Pocock S.; Modolo R.; Allocco D.J.;
Meredith I.T.; Linke A.
Institution
(Kapadia) The Department of Cardiovascular Medicine, Cleveland, United
States
(Krishnaswamy) Cleveland Clinic Foundation, Cleveland, United States
(Makkar) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
United States
(Leon) Columbia Interventional Cardiovascular Care, New York, United
States
(Kodali) Columbia University Medical Center, New York, United States
(Abdel-Wahab) Leipzig Heart Center, University of Leipzig, Leipzig,
Germany
(Massberg) Medizinische Klinik und Poliklinik I, Klinikum der Universitat
Munchen, German Center for Cardiovascular Research (DZHK), Munich Heart
Alliance, Munich, Germany
(Rottbauer) Universitaetsklinikum Ulm, Ulm, Germany
(Seeger) Medical Campus Lake Constance, Friedrichshafen, Germany
(Linke) The Clinic for Internal Medicine and Cardiology, Technische
Universitat Dresden, Herzzentrum, Dresden, Germany
(Waggoner) Pima Heart and Vascular, Tucson Medical Center Healthcare,
Tucson, AZ, United States
(Horr) Centennial Medical Center, Nashville, United States
(Sondergaard) Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Karha) Heart Hospital of Austin, Austin, TX, United States
(Stoler) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Harrington) Baylor Scott and White the Heart Hospital-Plano, Plano, TX,
United States
(Gooley) Monash Medical Centre, Clayton, VIC, Australia
(Satler) Washington Hospital Center, Washington, DC, United States
(Messe) The Department of Neurology, University of Pennsylvania,
Philadelphia, United States
(Baron) Lahey Hospital and Medical Center, Burlington, MA, United States
(Modolo, Allocco, Meredith) Boston Scientific, Marlborough, MA, United
States
(Thourani) Piedmont Heart Institute, Atlanta, United States
(Pocock) The London School of Hygiene and Tropical Medicine, London,
United Kingdom
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) for the treatment
of aortic stenosis can lead to embolization of debris. Capture of debris
by devices that provide cerebral embolic protection (CEP) may reduce the
risk of stroke. METHODS We randomly assigned patients with aortic stenosis
in a 1:1 ratio to undergo transfemoral TAVR with CEP (CEP group) or
without CEP (control group). The primary end point was stroke within 72
hours after TAVR or before discharge (whichever came first) in the
intention-to-treat population. Disabling stroke, death, transient ischemic
attack, delirium, major or minor vascular complications at the CEP access
site, and acute kidney injury were also assessed. A neurology professional
examined all the patients at baseline and after TAVR. RESULTS A total of
3000 patients across North America, Europe, and Australia underwent
randomization; 1501 were assigned to the CEP group and 1499 to the control
group. A CEP device was successfully deployed in 1406 of the 1489 patients
(94.4%) in whom an attempt was made. The incidence of stroke within 72
hours after TAVR or before discharge did not differ significantly between
the CEP group and the control group (2.3% vs. 2.9%; difference, -0.6
percentage points; 95% confidence interval, -1.7 to 0.5; P = 0.30).
Disabling stroke occurred in 0.5% of the patients in the CEP group and in
1.3% of those in the control group. There were no substantial differences
between the CEP group and the control group in the percentage of patients
who died (0.5% vs. 0.3%); had a stroke, a transient ischemic attack, or
delirium (3.1% vs. 3.7%); or had acute kidney injury (0.5% vs. 0.5%). One
patient (0.1%) had a vascular complication at the CEP access site.
CONCLUSIONS Among patients with aortic stenosis undergoing transfemoral
TAVR, the use of CEP did not have a significant effect on the incidence of
periprocedural stroke, but on the basis of the 95% confidence interval
around this outcome, the results may not rule out a benefit of CEP during
TAVR. Copyright © 2022 Massachusetts Medical Society.

<76>
Accession Number
639655259
Title
High versus low blood pressure targets for cardiac surgery while on
cardiopulmonary bypass.
Source
Cochrane Database of Systematic Reviews. 2022(11) (no pagination), 2022.
Article Number: CD013494. Date of Publication: 30 Nov 2022.
Author
Kotani Y.; Kataoka Y.; Izawa J.; Fujioka S.; Yoshida T.; Kumasawa J.;
Kwong J.S.W.
Institution
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Kataoka) Department of Internal Medicine, Kyoto Min-iren Asukai Hospital,
Kyoto, Japan
(Kataoka) Scientific Research Works Peer Support Group (SRWS-PSG), Osaka,
Japan
(Kataoka) Section of Clinical Epidemiology, Department of Community
Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
(Kataoka) Department of Healthcare Epidemiology, Kyoto University Graduate
School of Medicine/School of Public Health, Kyoto, Japan
(Izawa) Division of Critical Care Medicine, Department of Internal
Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan
(Izawa) Department of Preventive Services, Kyoto University Graduate
School of Public Health, Kyoto, Japan
(Fujioka) Department of Anesthesiology, Jikei University School of
Medicine, Tokyo, Japan
(Yoshida) Intensive Care Unit, Jikei University Kashiwa Hospital,
Department of Emergency Medicine, Jikei University School of Medicine,
Tokyo, Japan
(Yoshida) Department of Health Data Science, Graduate School of Data
Science, Yokohama City University, Yokohama, Japan
(Kumasawa) Department of Critical Care Medicine, Sakai City Medical
Center, Sakai City, Japan
(Kumasawa) Human Health Sciences, Kyoto University Graduate School of
Medicine, Kyoto, Japan
(Kwong) Global Health Nursing, Graduate School of Nursing Science, St
Luke's International University, Tokyo, Japan
Publisher
John Wiley and Sons Ltd
Abstract
Background: Cardiac surgery is performed worldwide. Most types of cardiac
surgery are performed using cardiopulmonary bypass (CPB). Cardiac surgery
performed with CPB is associated with morbidities. CPB needs an
extracorporeal circulation that replaces the heart and lungs, and performs
circulation, ventilation, and oxygenation of the blood. The lower limit of
mean blood pressure to maintain blood flow to vital organs increases in
people with chronic hypertension. Because people undergoing cardiac
surgery commonly have chronic hypertension, we hypothesised that
maintaining a relatively high blood pressure improves desirable outcomes
among the people undergoing cardiac surgery with CPB. Objective(s):
To evaluate the benefits and harms of higher versus lower blood pressure
targets during cardiac surgery with CPB. Search Method(s): We used
standard, extensive Cochrane search methods. The latest search of
databases was November 2021 and trials registries in January 2020.
 Selection Criteria: We included randomised controlled trials (RCTs)
comparing a higher blood pressure target (mean arterial pressure 65 mmHg
or greater) with a lower blood pressure target (mean arterial pressure
less than 65 mmHg) in adults undergoing cardiac surgery with CPB.
 Data Collection and Analysis: We used standard Cochrane methods.
Primary outcomes were 1. acute kidney injury, 2. cognitive deterioration,
and 3. all-cause mortality. Secondary outcomes were 4. quality of life, 5.
acute ischaemic stroke, 6. haemorrhagic stroke, 7. length of hospital
stay, 8. renal replacement therapy, 9. delirium, 10. perioperative
transfusion of blood products, and 11. perioperative myocardial
infarction. We used GRADE to assess certainty of evidence. Main
Result(s): We included three RCTs with 737 people compared a higher blood
pressure target with a lower blood pressure target during cardiac surgery
with CPB. A high blood pressure target may result in little to no
difference in acute kidney injury (risk ratio (RR) 1.30, 95% confidence
interval (CI) 0.81 to 2.08; I2 = 72%; 2 studies, 487 participants;
low-certainty evidence), cognitive deterioration (RR 0.82, 95% CI 0.45 to
1.50; I2 = 0%; 2 studies, 389 participants; low-certainty evidence), and
all-cause mortality (RR 1.33, 95% CI 0.30 to 5.90; I2 = 49%; 3 studies,
737 participants; low-certainty evidence). No study reported haemorrhagic
stroke. Although a high blood pressure target may increase the length of
hospital stay slightly, we found no differences between a higher and a
lower blood pressure target for the other secondary outcomes. We also
identified one ongoing RCT which is comparing a higher versus a lower
blood pressure target among the people who undergo cardiac surgery with
CPB. Authors' conclusions: A high blood pressure target may result in
little to no difference in patient outcomes including acute kidney injury
and mortality. Given the wide CIs, further studies are needed to confirm
the efficacy of a higher blood pressure target among those who undergo
cardiac surgery with CPB. Copyright © 2022 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<77>
Accession Number
2017828588
Title
Outcome of dogs treated with chemotherapy for mesothelioma: A
retrospective clinical study on 40 cases and a literature review.
Source
Veterinary and Comparative Oncology. 20(4) (pp 825-835), 2022. Date of
Publication: December 2022.
Author
Lajoinie M.; Chavalle T.; Floch F.; Sayag D.; Lanore D.; Ponce F.; Chamel
G.
Institution
(Lajoinie, Chavalle, Ponce, Chamel) Service de cancerologie, VetAgro Sup,
Universite de Lyon, UR ICE, Marcy-l'Etoile, France
(Floch) Oncovet, Villeneuve-d'Ascq, France
(Sayag) ONCOnseil-Unite d'expertise en oncologie veterinaire, Toulouse,
France
(Lanore) Pole Sante Chanturgue, Clermont-Ferrand, France
(Lanore) Alliance, Bordeaux, France
(Chamel) Armonia, Villefontaine, France
Publisher
John Wiley and Sons Inc
Abstract
Mesothelioma is an uncommon cancer in dogs for which there is no
established standard of care. Chemotherapy is often suggested despite no
definitive proof of efficacy. The aim of this study was to evaluate the
impact of chemotherapy on survival of dogs with mesothelioma. A
retrospective multicentric study was carried out. To be included, dogs
needed to present an evocative clinical evolution and a morphological
diagnosis of mesothelioma. Exclusion of other cause of effusion and
complete clinical follow-up were also required. Fourty dogs were included,
27 received chemotherapy (group 1) and 13 did not (group 2). Groups were
heterogeneous regarding the proportion of animals undergoing surgery as
part of their treatment (16 in group 1, 2 in group 2; p =.016) and
homogeneous otherwise. Univariate analysis showed that dogs from group 1
survived significantly longer than dogs from group 2 (MST: 366 vs. 74
days; p <.001). Complete resolution of effusion after the first
chemotherapy administration positively correlated with survival in group 1
(MST: 415 vs. 160 days; p <.01). All other variable tested had no
significant impact on survival in univariate analysis, but dogs undergoing
surgery and dogs having serous membranes' modification at medical imaging
tended to survive longer. Multivariate analysis confirmed that
chemotherapy was the sole variable independently associated with survival
in our study (odds ratio 5.57-6.12; p <.01). Copyright © 2022 The
Authors. Veterinary and Comparative Oncology published by John Wiley &
Sons Ltd.

<78>
Accession Number
2014799221
Title
The Efficacy of Corticosteroids, NSAIDs, and Colchicine in the Treatment
of Pediatric Postoperative Pericardial Effusion.
Source
Pediatric Cardiology. 43(2) (pp 279-289), 2022. Date of Publication:
February 2022.
Author
Somani N.; Breur H.
Institution
(Somani, Breur) Department of Pediatric Cardiology, University Medical
Center Utrecht, Lundlaan 6, Utrecht 3584 EA, Netherlands
Publisher
Springer
Abstract
The objective of this study is to investigate and compare the efficacy of
corticosteroids, NSAIDs, and colchicine in treating postoperative
pericardial effusion (PPE) following cardiac surgery in the pediatric
setting, on the basis of available literature. To investigate and compare
the efficacy of corticosteroids, NSAIDs, and colchicine in treating
postoperative pericardial effusion (PPE) following cardiac surgery in the
pediatric setting, on the basis of available literature. A systematic
review was conducted by carrying out a database search in PubMed on April
20th, 2021. An English language filter was added, but no time restrictions
were applied. Lack of pediatric literature prompted a broadening of the
search to include adult literature. One pediatric and four adult studies
were included, but the pediatric evidence was not found to be of
satisfactory quality, and the findings of adult literature could not be
readily generalized to the pediatric setting. No well-founded conclusions
could be drawn regarding the efficacy of corticosteroids, NSAIDs, or
colchicine in treating PPE, as a striking lack of evidence for their
efficacy in the pediatric setting were revealed. A knowledge gap was found
in the literature, indicating a need for good-quality randomized
controlled trials to bridge this gap. Copyright © 2022, The
Author(s).

<79>
Accession Number
2020079627
Title
Evidence for pharmacological interventions to reduce cardiovascular risk
for patients with chronic kidney disease: a study protocol of an evidence
map.
Source
Systematic Reviews. 11(1) (no pagination), 2022. Article Number: 238. Date
of Publication: December 2022.
Author
Colombijn J.M.T.; Idema D.L.; van der Braak K.; Spijker R.; Meijvis
S.C.A.; Bots M.L.; Hooft L.; Verhaar M.C.; Vernooij R.W.M.
Institution
(Colombijn, Meijvis, Verhaar, Vernooij) Department of Nephrology &
Hypertension, University Medical Centre Utrecht, Heidelberglaan 100,
Utrecht 3584 CX, Netherlands
(Colombijn, Spijker, Bots, Vernooij) Julius Centre for Health Sciences and
Primary Care, University Medical Centre Utrecht, Utrecht University,
Utrecht, Netherlands
(Idema, van der Braak, Spijker, Hooft) Cochrane Netherlands, Julius Center
for Health Sciences and Primary Care, University Medical Center Utrecht,
Utrecht University, Utrecht, Netherlands
(Spijker) Medical Library, Amsterdam UMC, University of Amsterdam,
Amsterdam Public Health, Amsterdam, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Patients with chronic kidney disease (CKD) require a
personalised strategy for cardiovascular risk management (CVRM) to reduce
their high risk of cardiovascular morbidity and mortality. Despite their
high risk, patients with CKD appear to be underrepresented in randomised
controlled trials (RCTs) for pharmacological CVRM interventions to reduce
cardiovascular risk (pharmacological CVRM interventions). As a result, it
remains unclear whether the efficacy of these interventions found in
patients without CKD is similarly applicable to patients with CKD. This
evidence map aims to provide an overview of the availability of the
evidence from pharmacological CVRM trials for patients with CKD by
assessing how often patients with reduced kidney function are specifically
excluded or included from RCTs on pharmacological CVRM interventions and
whether studies report efficacy estimates of interventions specifically
for kidney patients. Method(s): We will perform a systematic
literature search in ClinicalTrials.gov to identify relevant planned,
ongoing, and completed RCTs on a broad range of CVRM medications after
which we will retrieve the published protocols and papers via
ClinicalTrials.gov itself, Embase, MEDLINE, or Google Scholar. We will
include RCTs that investigate the efficacy of platelet inhibitors,
anticoagulants, antihypertensives, glucose-lowering medication, and
lipid-lowering medication on all-cause mortality, cardiovascular
mortality, cardiovascular morbidity, and end-stage kidney disease in
patients with a cardiovascular history or a major risk factor for
cardiovascular disease. Two reviewers will independently screen trial
records and their corresponding full-text publications to determine
eligibility and extract data. Outcomes of interest are the exclusion of
patients with reduced kidney function from RCTs and whether the study
population was restricted to kidney patients or subgroup analyses were
performed on kidney function. Results will be visualised in an evidence
map. Discussion(s): The availability of evidence on the efficacy and
safety of pharmacological CVRM interventions in patients with CKD might be
limited. Hence, we will identify knowledge gaps for future research. At
the same time, the availability of evidence, or lack thereof, might
warrant caution from healthcare decision-makers in making strong
recommendations based on the extrapolation of results from studies to
patients who were explicitly excluded from participation. Systematic
review registration: PROSPERO CRD42022296746. Copyright © 2022,
The Author(s).

<80>
Accession Number
2019429773
Title
A Randomized Pilot Study Assessing if SEDLine Monitoring During Induction
of Surgical Patients is Associated With Reduced Dosage of Administered
Induction Agents.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 26(4) (pp 260-265),
2022. Date of Publication: December 2022.
Author
Krause M.; Nguyen A.; O'Brien O.; Khoche S.; Schmidt U.
Institution
(Krause, O'Brien, Khoche, Schmidt) Department of Anesthesiology,
University of California San Diego, San Diego, CA, United States
(Nguyen) Division of Critical Care Medicine, Providence Santa Rosa
Memorial Hospital, Santa Rosa, CA, United States
Publisher
SAGE Publications Inc.
Abstract
Background. Intubations, especially in emergent settings, carry a high
risk of hemodynamic instability with potentially catastrophic outcomes.
Weight-based dosing of induction drugs can be inappropriately high for
elective or emergent intubations and lead to hemodynamic instability. We
hypothesized that monitoring the patient state index of SEDLine monitors
(Masimo, Irvine, CA) would decrease the dose of induction drugs in the
operating room during elective intubations. Methods. In this randomized
study, SEDLine monitoring was provided to the intervention group but not
to the control group during the induction of anesthesia in the operating
room. Anesthesia providers in the intervention group were advised to
titrate induction drugs to a Patient State Index of <50 before proceeding
with intubation. The primary outcome was the induction dose of propofol
and etomidate per kilogram normalized to propofol dose equivalents.
Secondary outcomes included supplemental doses of ketamine, midazolam,
fentanyl, phenylephrine, and ephedrine per kg, time from induction to
intubation, administration of additional propofol or vasopressors after
induction, mean arterial pressure >= or <65 mmHg, and lowest mean arterial
pressure post-induction. Results. We found no significant difference in
propofol equivalents between groups (P =.41). Using a SEDLine decreased
the odds that a patient would require vasopressors during induction (odds
ratio of.39 [95% confidence interval,.15-.98]). Conclusion. SEDLine
monitoring during induction did not decrease dosing of the induction drugs
etomidate and propofol but decreased the odds of receiving vasopressors.
Further studies are warranted to assess the utility of processed
electroencephalography in emergent intubations outside of the operating
room. Copyright © The Author(s) 2022.

<81>
Accession Number
2018715569
Title
Effect of high-flow nasal therapy on patient-centred outcomes in patients
at high risk of postoperative pulmonary complications after cardiac
surgery: a statistical analysis plan for NOTACS, a multicentre adaptive
randomised controlled trial.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 699. Date of
Publication: December 2022.
Author
Dawson S.N.; Chiu Y.-D.; Klein A.A.; Earwaker M.; Villar S.S.
Institution
(Dawson, Chiu, Villar) MRC Biostatistics Unit, School of Clinical
Medicine, University of Cambridge, Cambridge, United Kingdom
(Dawson, Earwaker) Papworth Trials Unit Collaboration, Royal Papworth
Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Klein) Department of Anaesthesia and Intensive Care, Royal Papworth
Hospital, Cambridge, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: The NOTACS trial will assess the efficacy, safety and
cost-effectiveness of high-flow nasal therapy (HFNT) compared to standard
oxygen therapy (SOT) on the outcomes of patients after cardiac surgery.
Methods/design: NOTACS is an adaptive, international, multicentre,
parallel-group, randomised controlled trial, with a pre-planned interim
sample size re-estimation (SSR). A minimum of 850 patients will be
randomised 1:1 to receive either HFNT or SOT. The primary outcome is days
alive and at home in the first 90 days after the planned surgery (DAH90),
with a number of secondary analyses and cost-effectiveness analyses also
planned. The interim SSR will take place after a minimum of 300 patients
have been followed up for 90 days and will allow for the sample size to
increase up to a maximum of 1152 patients. Result(s): This manuscript
provides detailed descriptions of the design of the NOTACS trial, and the
analyses to be undertaken at the interim and final analyses. The main
purpose of the interim analysis is to assess safety and to perform a
sample size re-estimation. The main purpose of the final analysis is to
examine the safety, efficacy and cost-effectiveness of HFNT compared to
SOT on the outcomes of patients after cardiac surgery. Discussion(s):
This manuscript outlines the key features of the NOTACS statistical
analysis plan and was submitted to the journal before the interim analysis
in order to preserve scientific integrity under an adaptive design
framework. The NOTACS SAP closely follows published guidelines for the
content of SAPs in clinical trials. Trial registration: ISRCTN14092678.
Registered on 13 May 2020. Copyright © 2022, The Author(s).

<82>
[Use Link to view the full text]
Accession Number
635498339
Title
Delirium in Older Patients after Combined Epidural-General Anesthesia or
General Anesthesia for Major Surgery: A Randomized Trial.
Source
Anesthesiology. 135(2) (pp 218-232), 2021. Date of Publication: 01 Aug
2021.
Author
Li Y.-W.; Li H.-J.; Zhao B.-J.; Guo X.-Y.; Feng Y.; Zuo M.-Z.; Yu Y.-P.;
Kong H.; Zhao Y.; Huang D.; Deng C.-M.; Hu X.-Y.; Liu P.-F.; Li Y.; An
H.-Y.; Zhang H.-Y.; Wang M.-R.; Wu Y.-F.; Wang D.-X.; Sessler D.I.; Zeng
Y.; Mu D.-L.; Liu Y.-F.; Zhou W.-J.; Shan G.-J.; Ma Q.; Zheng X.-Y.; Fu
C.; Zhang Y.; Liang X.-Q.; Liu C.; He S.-T.; Cheng T.; Huang S.-M.; Du
Y.-T.; Xu S.-C.; Wang R.; Xiao L.; Zhang J.; Yang W.-Z.; Liu W.-P.; Han
W.-Y.; Yu Y.; Hua Z.; Zhang J.-J.
Institution
(Li, Li, Kong, Zhao, Huang, Deng, Wang, Zeng, Mu, Liu, Zhou, Shan, Ma,
Zheng, Fu, Zhang, Liang, Liu, He, Cheng, Huang, Du, Xu) Department of
Anesthesiology and Critical Care Medicine, Peking University First
Hospital, Beijing, China
(Li, Yu, Wang, Wu) The Peking University Clinical Research Institute,
Peking University Health Science Center, Beijing, China
(Zhao, Hu, Liu) The Department of Anesthesiology, Beijing Shijitan
Hospital, Capital Medical University, Beijing, China
(Guo, Li) The Department of Anesthesiology, Peking University Third
Hospital, Beijing, China
(Feng, An) The Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Zuo, Zhang) The Department of Anesthesiology, Beijing Hospital, National
Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of
Medical Sciences, Beijing, China
(Sessler) The O Utcomes R Esearch C Onsortium, Cleveland, OH, United
States
(Sessler) The Department of O Utcomes R Esearch, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
(Wang, Xiao, Zhang, Yang) Department of Anesthesiology, Beijing Shijitan
Hospital, Capital Medical University, Beijing, China
(Liu, Han) Department of Anesthesiology, Peking University Third Hospital,
Beijing, China
(Yu, Hua) Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Zhang) Department of Anesthesiology, Beijing Hospital, National Centre of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Delirium is a common and serious postoperative complication,
especially in the elderly. Epidural anesthesia may reduce delirium by
improving analgesia, reducing opioid consumption, and blunting stress
response to surgery. This trial therefore tested the hypothesis that
combined epidural-general anesthesia reduces the incidence of
postoperative delirium in elderly patients recovering from major
noncardiac surgery. Method(s): Patients aged 60 to 90 yr scheduled
for major noncardiac thoracic or abdominal surgeries expected to last 2 h
or more were enrolled. Participants were randomized 1:1 to either combined
epidural-general anesthesia with postoperative epidural analgesia or
general anesthesia with postoperative intravenous analgesia. The primary
outcome was the incidence of delirium, which was assessed with the
Confusion Assessment Method for the Intensive Care Unit twice daily during
the initial 7 postoperative days. Result(s): Between November 2011
and May 2015, 1,802 patients were randomized to combined epidural-general
anesthesia (n = 901) or general anesthesia alone (n = 901). Among these,
1,720 patients (mean age, 70 yr; 35% women) completed the study and were
included in the intention-to-treat analysis. Delirium was significantly
less common in the combined epidural-general anesthesia group (15 [1.8%]
of 857 patients) than in the general anesthesia group (43 [5.0%] of 863
patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number
needed to treat 31). Intraoperative hypotension (systolic blood pressure
less than 80 mmHg) was more common in patients assigned to epidural
anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to
1.65; P < 0.001), and more epidural patients were given vasopressors (495
[58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P <
0.001). Conclusion(s): Older patients randomized to combined
epidural-general anesthesia for major thoracic and abdominal surgeries had
one third as much delirium but 50% more hypotension. Clinicians should
consider combining epidural and general anesthesia in patients at risk of
postoperative delirium, and avoiding the combination in patients at risk
of hypotension. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<83>
Accession Number
2021072918
Title
Topical antibiotic prophylaxis for surgical wound infections in clean and
clean-contaminated surgery: a systematic review and meta-analysis.
Source
BJS Open. 5(6) (no pagination), 2021. Article Number: zrab125. Date of
Publication: 01 Nov 2021.
Author
Chen P.-J.; Hua Y.-M.; Toh H.S.; Lee M.-C.
Institution
(Chen) Department of Emergency Medicine, Chi Mei Medical Center, Tainan,
Taiwan (Republic of China)
(Hua, Lee) Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
(Republic of China)
(Toh) Department of Intensive Care Medicine, Chi Mei Medical Center,
Tainan, Taiwan (Republic of China)
(Toh) Institute of Clinical Medicine, College of Medicine, National Cheng
Kung University, Tainan, Taiwan (Republic of China)
(Toh) Department of Health and Nutrition, Chia Nan University of Pharmacy
& Science, Tainan, Taiwan (Republic of China)
(Lee) Department of Public Health, College of Medicine, National Cheng
Kung University, Tainan, Taiwan (Republic of China)
Publisher
Oxford University Press
Abstract
Background: Topical antibiotics are widely prescribed as prophylaxis for
surgical site infection (SSI). Despite giving high drug concentrations at
local wound sites, their efficacy remains controversial. This study is a
systematic review and meta-analysis designed to compare the efficacy and
safety of topical antibiotics with non-antibiotic agents in preventing
SSI. Method(s): Randomized controlled trials (RCTs) comparing topical
antibiotics in patients with clean and clean-contaminated postsurgical
wounds were included. Relevant trials published before 30 September 2020,
were searched in the PubMed, Embase, and Cochrane databases, without
language restrictions. The primary outcome was the incidence of SSIs,
presented as the event rate. The secondary outcome was the incidence of
contact dermatitis (safety outcome). Data were synthesized using the
random-effects model, with the results expressed as risk ratio (RR) with
95 per cent confidence intervals (c.i.). Result(s): Thirteen RCTs
were included. The incidence of SSIs and contact dermatitis showed no
significant difference between topical antibiotics and non-antibiotic
agents (RR 0.89, 95 per cent c.i. 0.59 to 1.32 (P = 0.56, I2 = 48 per
cent); and RR 2.79, 95 per cent c.i. 0.51 to 15.19 (P = 0.24, I2 = 0 per
cent), respectively). In the subgroup analyses, a reduction in SSIs was
also not observed in dermatological (RR 0.77, 95 per cent c.i. 0.39 to
1.55; P = 0.46, I2 = 65 per cent), ocular (RR 0.08, 95 per cent c.i. 0.00
to 1.52; P = 0.09), spinal (RR 1.34, 95 per cent c.i. 0.65 to 2.77; P =
0.43, I2 = 0 per cent), orthopaedic (RR 0.69, 95 per cent c.i. 0.37 to
1.29; P = 0.25, I2 = 0 per cent), or cardiothoracic surgeries (RR 1.60, 95
per cent c.i. 0.79 to 3.25; P = 0.19). Conclusion(s): Given the
current evidence, the routine application of topical antibiotics to
surgical wounds did not reduce the incidence of SSI. Further trials are
needed to assess their effectiveness in high-risk surgeries or in selected
patient groups. Copyright © 2022 The Author(s).

<84>
Accession Number
2021072878
Title
Association of intraoperative hypotension with postoperative morbidity and
mortality: systematic review and meta-analysis.
Source
BJS Open. 5(1) (no pagination), 2021. Article Number: zraa018. Date of
Publication: 01 Jan 2021.
Author
Wijnberge M.; Schenk J.; Bulle E.; Vlaar A.P.; Maheshwari K.; Hollmann
M.W.; Binnekade J.M.; Geerts B.F.; Veelo D.P.
Institution
(Wijnberge, Schenk, Bulle, Hollmann, Geerts, Veelo) Department of
Anaesthesiology, Amsterdam University Medical Centre, Amsterdam,
Netherlands
(Wijnberge, Bulle, Vlaar, Binnekade) Department of Intensive Care,
Amsterdam University Medical Centre, Amsterdam, Netherlands
(Wijnberge, Vlaar, Hollmann) Laboratory of Experimental Intensive Care and
Anaesthesiology, Amsterdam University Medical Centre, Amsterdam,
Netherlands
(Maheshwari) Department of General Anaesthesiology, Outcomes Research,
Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
Oxford University Press
Abstract
Background: Intraoperative hypotension, with varying definitions in
literature, may be associated with postoperative complications. The aim of
this meta-analysis was to assess the association of intraoperative
hypotension with postoperative morbidity and mortality. Method(s):
MEDLINE, Embase and Cochrane databases were searched for studies published
between January 1990 and August 2018. The primary endpoints were
postoperative overall morbidity and mortality. Secondary endpoints were
postoperative cardiac outcomes, acute kidney injury, stroke, delirium,
surgical outcomes and combined outcomes. Subgroup analyses, sensitivity
analyses and a meta-regression were performed to test the robustness of
the results and to explore heterogeneity. Result(s): The search
identified 2931 studies, of which 29 were included in the meta-analysis,
consisting of 130 862 patients. Intraoperative hypotension was associated
with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent
confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84).
In the secondary analyses, intraoperative hypotension was associated with
cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR
2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of
88 per cent. When hypotension severity, outcome severity and study
population variables were added to the meta-regression, heterogeneity was
reduced to 50 per cent. Conclusion(s): Intraoperative hypotension
during non-cardiac surgery is associated with postoperative cardiac and
renal morbidity, and mortality. A universally accepted standard definition
of hypotension would facilitate further research into this
topic. Copyright © 2021 The Author(s).

<85>
Accession Number
2020450056
Title
Parameters associated with successful weaning of veno-arterial
extracorporeal membrane oxygenation: a systematic review.
Source
Critical Care. 26(1) (no pagination), 2022. Article Number: 375. Date of
Publication: December 2022.
Author
Charbonneau F.; Chahinian K.; Bebawi E.; Lavigueur O.; Levesque E.;
Lamarche Y.; Serri K.; Albert M.; Noly P.-E.; Cournoyer A.; Cavayas Y.A.
Institution
(Charbonneau, Chahinian, Bebawi, Lavigueur, Levesque, Lamarche, Serri,
Albert, Cavayas) Division of Critical Care, Department of Medicine,
Hopital du Sacre-Coeur de Montreal, 5400 Boulevard Gouin Ouest, Montreal,
QC H4J 1C5, Canada
(Levesque, Lamarche, Serri, Albert, Noly, Cavayas) Division of Critical
Care, Department of Surgery, Montreal Heart Institute, Montreal, Canada
(Cournoyer) Department of Emergency Medicine, Hopital du Sacre-Coeur de
Montreal, Montreal, Canada
Publisher
BioMed Central Ltd
Abstract
Purpose: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can
be used to restore organ perfusion in patients with cardiogenic shock
until native heart recovery occurs. It may be challenging, however, to
determine when patients can be weaned successfully from ECMO-surviving
without requiring further mechanical support or heart transplant. We aimed
to systematically review the medical literature to determine the
biomarkers, hemodynamic and echocardiographic parameters associated with
successful weaning of VA-ECMO in adults with cardiogenic shock and to
present an evidence-based weaning algorithm incorporating key findings.
 Method(s): We systematically searched PubMed, Embase, ProQuest,
Google Scholars, Web of Science and the Grey literature for pertinent
original research reports. We excluded studies limited to extracorporeal
cardiopulmonary resuscitation (ECPR) as the neurological prognosis may
significantly alter the decision-making process surrounding the device
removal in this patient population. Studies with a mixed population of
VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded
studies limited to patients in which ECMO was only used as a bridge to VAD
or heart transplant, as such patients are, by definition, never
"successfully weaned." We used the Risk of Bias Assessment tool for
Non-Randomized Studies. The study was registered on the International
prospective register of systematic reviews (PROSPERO CRD42020178641).
 Result(s): We screened 14,578 records and included 47 that met our
pre-specified criteria. Signs of lower initial severity of shock and
myocardial injury, early recovery of systemic perfusion, left and right
ventricular recovery, hemodynamic and echocardiographic stability during
flow reduction trial and/or pump-controlled retrograde trial off predicted
successful weaning. The most widely used parameter was the left
ventricular outflow tract velocity time integral, an indicator of stroke
volume. Most studies had a moderate or high risk of bias. Heterogeneity in
methods, timing, and conditions of measurements precluded any
meta-analysis. Conclusion(s): In adult patients on VA-ECMO for
cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic
parameters may be used to track resolution of systemic hypoperfusion and
myocardial recovery in order to identify patients that can be successfully
weaned. Graphical Abstract: [Figure not available: see
fulltext.] Copyright © 2022, The Author(s).

<86>
Accession Number
639503985
Title
High-Sensitivity Cardiac Troponin I and T Kinetics Differ following
Coronary Bypass Surgery: A Systematic Review and Meta-Analysis.
Source
Clinical chemistry. 68(12) (pp 1564-1575), 2022. Date of Publication: 06
Dec 2022.
Author
Denessen E.J.; Heuts S.; Daemen J.H.; van Doorn W.P.; Vroemen W.H.; Sels
J.-W.; Segers P.; Van't Hof A.W.; Maessen J.G.; Bekers O.; Van Der Horst
I.C.; Mingels A.M.
Institution
(Denessen, van Doorn, Vroemen, Bekers, Mingels) Central Diagnostic
Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
(Denessen, van Doorn, Sels, Van't Hof, Maessen, Bekers, Van Der Horst,
Mingels) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
(Heuts, Segers, Maessen) Department of Cardiothoracic Surgery, Maastricht
University Medical Center+, Maastricht, Netherlands
(Daemen) Department of Surgery, Division of General Thoracic Surgery,
Zuyderland Medical Center, Heerlen, Netherlands
(Sels, Van Der Horst) Department of Intensive Care Medicine, Maastricht
University Medical Center+, Maastricht, Netherlands
(Sels, Van't Hof) Department of Cardiology, Maastricht University Medical
Center+, Maastricht, Netherlands
(Van't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac troponin I and T are both used for diagnosing
myocardial infarction (MI) after coronary artery bypass grafting (CABG),
also known as type 5 MI (MI-5). Different MI-5 definitions have been
formulated, using multiples of the 99th percentile upper reference limit
(10x, 35x, or 70x URL), with or without supporting evidence. These
definitions are arbitrarily chosen based on conventional assays and do not
differentiate between troponin I and T. We therefore investigated the
kinetics of high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT)
following CABG. METHOD(S): A systematic search was applied to MEDLINE
and EMBASE databases including the search terms "coronary artery bypass
grafting" AND "high-sensitivity cardiac troponin." Studies reporting
hs-cTnI or hs-cTnT on at least 2 different time points were included.
Troponin concentrations were extracted and normalized to the
assay-specific URL. RESULT(S): For hs-cTnI and hs-cTnT, 17 (n = 1661
patients) and 15 studies (n = 2646 patients) were included, respectively.
Preoperative hs-cTnI was 6.1x URL (95% confidence intervals: 4.9-7.2) and
hs-cTnT 1.2x URL (0.9-1.4). Mean peak was reached 6-8 h postoperatively
(126x URL, 99-153 and 45x URL, 29-61, respectively). Subanalysis of
hs-cTnI illustrated assay-specific peak heights and kinetics, while
subanalysis of surgical strategies revealed 3-fold higher hs-cTnI than
hs-cTnT for on-pump CABG and 5-fold for off-pump CABG. CONCLUSION(S):
Postoperative hs-cTnI and hs-cTnT following CABG surpass most current
diagnostic cutoff values. hs-cTnI was almost 3-fold higher than hs-cTnT,
and appeared to be highly dependent on the assay used and surgical
strategy. There is a need for assay-specific hs-cTnI and hs-cTnT cutoff
values for accurate, timely identification of MI-5. Copyright @
American Association for Clinical Chemistry 2022.

<87>
Accession Number
2018749642
Title
Muscle usage and workload assessment of cardiac ablation procedure with
the use of a novel catheter torque tool in a pediatric simulator.
Source
Journal of Interventional Cardiac Electrophysiology. 65(3) (pp 757-764),
2022. Date of Publication: December 2022.
Author
Mass P.N.; Kumthekar R.N.; Clark B.C.; Opfermann J.D.; Sherwin E.D.;
DiBiase L.; Berul C.I.
Institution
(Mass, Berul) Shiekh Zayed Institute, Children's National Hospital, 111
Michigan Ave NW, Washington, DC 20010, United States
(Mass, Sherwin, Berul) Department of Cardiology, Children's National
Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
(Kumthekar) Division of Cardiology, Nationwide Children's Hospital,
Columbus, OH, United States
(Clark) Division of Cardiology, Children's Hospital at Montefiore, New
York, NY, United States
(Opfermann) Department of Mechanical Engineering, Johns Hopkins
University, Baltimore, MD, United States
(DiBiase) Division of Cardiology, Montefiore Medical Center, New York, NY,
United States
Publisher
Springer
Abstract
Background: Cardiac ablation catheters are small in diameter and pose
ergonomic challenges that can affect catheter stability. Significant
finger dexterity and strength are necessary to maneuver them safely. We
evaluated a novel torque tool to reduce muscle activation when
manipulating catheters and improve perceived workload of ablation tasks.
The objective was to evaluate measurable success, user perception of
workload, and muscle usage when completing a simulated ablation task with
and without the use of a catheter torque tool. Method(s): Cardiology
attendings and fellows were fitted with surface electromyographic (EMG)
sensors on 6 key muscle groups in the left hand and forearm. A standard
ablation catheter was inserted into a pediatric cardiac ablation simulator
and subjects navigated the catheter tip to 6 specific electrophysiologic
targets, including a 1-min simulated radiofrequency ablation lesion. Time
to complete the task, number of attempts required to complete the lesion,
and EMG activity normalized to percentage of maximum voluntary contraction
were collected throughout the task. The task was completed 4 times, twice
with and twice without the torque tool, in semi-randomized order. A NASA
Task Load Index survey was completed by the participant at the conclusion
of each task. Result(s): Time to complete the task and number of
attempts to create a lesion were not altered by the tool. Subjectively,
participants reported a significant decrease in physical demand, effort,
and frustration, and a significant increase in performance. Muscle
activation was decreased in 4 of 6 muscle groups. Conclusion(s): The
catheter torque tool may improve the perceived workload of cardiac
ablation procedures and reduce muscle fatigue caused by manipulating
catheters. This may result in improved catheter stability and increased
procedural safety. Copyright © 2022, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<88>
Accession Number
639221773
Title
Prediction models for postoperative delirium after cardiac surgery:
Systematic review and critical appraisal.
Source
International journal of nursing studies. 136 (pp 104340), 2022. Date of
Publication: 01 Dec 2022.
Author
Cai S.; Li J.; Gao J.; Pan W.; Zhang Y.
Institution
(Cai, Li) Department of Nursing, Zhongshan Hospital, Fudan University,
Shanghai 200032, China; Department of Critical Care Medicine, Zhongshan
Hospital, Fudan University, Shanghai 200032, China; The Centre for
Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of
Excellence, China
(Gao) Center of Clinical Epidemiology and Evidence-based Medicine, Fudan
University, Shanghai 200032, China; Department of Nutrition, Zhongshan
Hospital, Fudan University, Shanghai 200032, China
(Pan, Zhang) Department of Nursing, Zhongshan Hospital, Fudan University,
Shanghai 200032, China; The Centre for Critical Care Zhongshan Hospital: A
Joanna Briggs Institute Center of Excellence, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Many studies have developed or validated prediction models to
estimate the risk of delirium after cardiac surgery, but the quality of
the model development and model applicability remain unknown.
 OBJECTIVE(S): To systematically review and critically evaluate
currently available prediction models for delirium after cardiac surgery.
DATA SOURCES: PubMed, EMBASE, and MEDLINE were systematically searched.
This systematic review was registered in PROSPERO (Registration ID:
CRD42021251226). STUDY SELECTION: Prospective or retrospective cohort
studies were considered eligible if they developed or validated prediction
models or scoring systems for delirium in the ICU. We included studies
involving adults (age >=18years) undergoing cardiac surgery and excluded
studies that did not validate a prediction model. DATA EXTRACTION: Data
extraction was independently performed by two authors using a standardized
data extraction form based on the Critical Appraisal and Data Extraction
for Systematic Reviews of Prediction Modeling Studies checklist. Quality
of the models was assessed with the Prediction Model Risk of Bias
Assessment Tool (PROBAST). DATA SYNTHESIS: Of 5469 screened studies, 13
studies described 10 prediction models. The postoperative delirium
incidence varied from 11.3% to 51.6%. The most frequently used predictors
were age and cognitive impairment. The reported areas under the curve or
C-statistics were between of 0.74 and 0.91 in the derivation set. The
reported AUCs in the external validation set were between 0.54 and 0.90.
All the studies had a high risk of bias, mainly owing to poor reporting of
the outcome domain and analysis domain; 10 studies were of high concern
regarding applicability. CONCLUSION(S): The current models for
predicting postoperative delirium in the ICU after cardiac surgery had a
high risk of bias according to the PROBAST. Future studies should focus on
improving current prediction models or developing new models with rigorous
methodology. Copyright © 2022. Published by Elsevier Ltd.

<89>
Accession Number
2021644706
Title
A systematic review of risk prediction models for perioperative mortality
after thoracic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(3) (pp 333-342), 2021.
Date of Publication: 01 Mar 2021.
Author
Taylor M.; Hashmi S.F.; Martin G.P.; Shackcloth M.; Shah R.; Booton R.;
Grant S.W.
Institution
(Taylor, Hashmi, Shah) Department of Cardiothoracic Surgery, Wythenshawe
Hospital, Manchester University Hospital Foundation Trust, Manchester,
United Kingdom
(Martin) Division of Informatics, Imaging and Data Science, Faculty of
Biology, Medicine and Health, Manchester Academic Heath Science Centre,
University of Manchester, Manchester, United Kingdom
(Shackcloth) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Booton) Department of Respiratory Medicine, Wythenshawe Hospital,
Manchester University Hospital Foundation Trust, Manchester, United
Kingdom
(Grant) Division of Cardiovascular Sciences, University of Manchester,
ERC, Manchester University Hospitals Foundation Trust, Manchester, United
Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Guidelines advocate that patients being considered for
thoracic surgery should undergo a comprehensive preoperative risk
assessment. Multiple risk prediction models to estimate the risk of
mortality after thoracic surgery have been developed, but their quality
and performance has not been reviewed in a systematic way. The objective
was to systematically review these models and critically appraise their
performance. METHOD(S): The Cochrane Library and the MEDLINE database
were searched for articles published between 1990 and 2019. Studies that
developed or validated a model predicting perioperative mortality after
thoracic surgery were included. Data were extracted based on the checklist
for critical appraisal and data extraction for systematic reviews of
prediction modelling studies. RESULT(S): A total of 31 studies
describing 22 different risk prediction models were identified. There were
20 models developed specifically for thoracic surgery with two developed
in other surgical specialties. A total of 57 different predictors were
included across the identified models. Age, sex and pneumonectomy were the
most frequently included predictors in 19, 13 and 11 models, respectively.
Model performance based on either discrimination or calibration was
inadequate for all externally validated models. The most recent data
included in validation studies were from 2018. Risk of bias (assessed
using Prediction model Risk Of Bias ASsessment Tool) was high for all
except two models. CONCLUSION(S): Despite multiple risk prediction
models being developed to predict perioperative mortality after thoracic
surgery, none could be described as appropriate for contemporary thoracic
surgery. Contemporary validation of available models or new model
development is required to ensure that appropriate estimates of operative
risk are available for contemporary thoracic surgical
practice. Copyright © 2020 The Author(s).

<90>
Accession Number
2021411462
Title
Comparison of Transfemoral versus Transsubclavian/Transaxillary access for
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
IJC Heart and Vasculature. 43 (no pagination), 2022. Article Number:
101156. Date of Publication: December 2022.
Author
Abusnina W.; Machanahalli Balakrishna A.; Ismayl M.; Latif A.; Reda
Mostafa M.; Al-abdouh A.; Junaid Ahsan M.; Radaideh Q.; Haddad T.M.;
Goldsweig A.M.; Ben-Dor I.; Mamas M.A.; Dahal K.
Institution
(Abusnina, Machanahalli Balakrishna, Ismayl, Latif, Radaideh, Haddad,
Dahal) Division of Cardiology, Creighton University School of Medicine,
NE, United States
(Reda Mostafa) Rochester Regional Health/Unity Hospital, Rochester, NY,
United States
(Al-abdouh) Department of Medicine, University of Kentucky, Lexington, KY,
United States
(Junaid Ahsan) Division of Cardiovascular Medicine, Iowa Heart Center, Des
Moines, IA, United States
(Goldsweig) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
(Ben-Dor) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Mamas) Keele Cardiovascular Research Group, Keele University, United
Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Femoral access is the gold standard for transcatheter aortic valve
replacement (TAVR). Safe alternative access, that represents about 15 % of
TAVR cases, remains important for patients without adequate transfemoral
access. We aimed to perform a systematic review and meta-analysis of
studies comparing transfemoral (TF) access versus transsubclavian or
transaxillary (TSc/TAx) access in patients undergoing TAVR. We searched
PubMed, Cochrane CENTRAL Register, EMBASE, Web of Science, Google Scholar
and ClinicalTrials.gov (inception through May 24, 2022) for studies
comparing (TF) to (TSc/TAx) access for TAVR. A total of 21 studies with
75,995 unique patients who underwent TAVR (73,203 transfemoral and 2,792
TSc/TAx) were included in the analysis. There was no difference in the
risk of in-hospital and 30-day all-cause mortality between the two groups
(RR 0.64, 95 % CI 0.36-1.13, P = 0.12) and (RR 0.95, 95 % CI 0.64-1.41, P
= 0.81), while 1-year mortality was significantly lower in the TF TAVR
group (RR 0.79, 95 % CI 0.67-0.93, P = 0.005). No significant differences
in major bleeding (RR 0.82, 95 % CI 0.65-1.03, P = 0.09), major vascular
complications (RR 1.14, 95 % CI 0.75-1.72, P = 0.53), and stroke (RR 0.66,
95 % CI 0.42-1.02, P = 0.06) were observed. In patients undergoing TAVR,
TF access is associated with significantly lower 1-year mortality compared
to TSc/TAx access without differences in major bleeding, major vascular
complications and stroke. While TF is the preferred approach for TAVR,
TSc/TAx is a safe alternative approach. Future studies should confirm
these findings, preferably in a randomized setting. Copyright ©
2022 The Authors

<91>
[Use Link to view the full text]
Accession Number
2021677661
Title
The Effects of Angiotensin Receptor-Neprilysin Inhibition on Major
Coronary Events in Patients with Acute Myocardial Infarction: Insights
from the PARADISE-MI Trial.
Source
Circulation. 146(23) (pp 1749-1757), 2022. Date of Publication: 06 Dec
2022.
Author
Mehran R.; Steg P.G.; Pfeffer M.A.; Jering K.; Claggett B.; Lewis E.F.;
Granger C.; Kober L.; Maggioni A.; Mann D.L.; McMurray J.J.V.; Rouleau
J.-L.; Solomon S.D.; Ducrocq G.; Berwanger O.; De Pasquale C.G.;
Landmesser U.; Petrie M.; Leng D.S.K.; Van Der Meer P.; Lefkowitz M.; Zhou
Y.; Braunwald E.
Institution
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, United States
(Steg) Universite Paris-Cite, AP-HP (Assistance Publique-Hopitaux de
Paris), FACT (French Alliance for Cardiovascular Trials), INSERM U-1148,
France
(Pfeffer, Jering, Claggett, Solomon, Braunwald) Cardiovascular Division,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Lewis) Division of Cardiovascular Medicine, Stanford University, School
of Medicine, Stanford University, Palo Alto, CA, United States
(Granger) Duke University Medical Center, Durham, NC, United States
(Kober) Department of Clinical Medicine, University of Copenhagen, Denmark
(Maggioni) ANMCO Research Center, Heart Care Foundation, Florence, Italy
(Mann) Washington University Medical Center, St Louis, MO, United States
(McMurray, Petrie) British Heart Foundation Cardiovascular Research
Centre, University of Glasgow, United Kingdom
(Rouleau) Montreal Heart Institute, University of Montreal, QC, Canada
(Ducrocq) Departement de Cardiologie, Hopital Bichat Assistance Publique
Hopitaux de Paris, France
(Berwanger) Academic Research Organization (ARO), Hospital Israelita
Albert Einstein, Sao Paulo-SP, Brazil
(De Pasquale) Department of Cardiovascular Medicine, Flinders Medical
Centre, Adelaide, Australia
(Landmesser) Department of Cardiology, Charite-Universitatsmedizin Berlin,
Germany
(Leng) National Heart Centre Singapore, Singapore
(Van Der Meer) Department of Cardiology, University Medical Center
Groningen, University of Groningen, Netherlands
(Lefkowitz, Zhou) Novartis Pharmaceutical Corporation, East Hanover, NJ,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In patients who survive an acute myocardial infarction (AMI),
angiotensin-converting enzyme inhibitors decrease the risk of subsequent
major cardiovascular events. Whether angiotensin-receptor blockade and
neprilysin inhibition with sacubitril/valsartan reduce major coronary
events more effectively than angiotensin-converting enzyme inhibitors in
high-risk patients with recent AMI remains unknown. We aimed to compare
the effects of sacubitril/valsartan on coronary outcomes in patients with
AMI. Method(s): We conducted a prespecified analysis of the
PARADISE-MI trial (Prospective ARNI vs ACE Inhibitors Trial to Determine
Superiority in Reducing Heart Failure Events After MI), which compared
sacubitril/valsartan (97/103 mg twice daily) with ramipril (5 mg twice
daily) for reducing heart failure events after myocardial infarction in
5661 patients with AMI complicated by left ventricular systolic
dysfunction, pulmonary congestion, or both. In the present analysis, the
prespecified composite coronary outcome was the first occurrence of death
from coronary heart disease, nonfatal myocardial infarction,
hospitalization for angina, or postrandomization coronary
revascularization. Result(s): Patients were randomly assigned at a
median of 4.4 [3.0-5.8] days after index AMI (ST-segment-elevation
myocardial infarction 76%, non-ST-segment-elevation myocardial infarction
24%), by which time 89% of patients had undergone coronary reperfusion.
Compared with ramipril, sacubitril/valsartan decreased the risk of
coronary outcomes (hazard ratio, 0.86 [95% CI, 0.74-0.99], P=0.04) over a
median follow-up of 22 months. Rates of the components of the composite
outcomes were lower in patients on sacubitril/valsartan but were not
individually significantly different. Conclusion(s): In survivors of
an AMI with left ventricular systolic dysfunction and pulmonary
congestion, sacubitril/valsartan - compared with ramipril - reduced the
risk of a prespecified major coronary composite outcome. Dedicated studies
are necessary to confirm this finding and elucidate its mechanism.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02924727. Copyright © 2022 Lippincott Williams and Wilkins.
All rights reserved.

<92>
Accession Number
2021647104
Title
Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve
Replacement in Low-risk Patients: A Meta-Analysis Based on a 2-Year
Follow-Up.
Source
Anatolian Journal of Cardiology. 26(11) (pp 802-809), 2022. Date of
Publication: November 2022.
Author
Chen C.-G.; Xi B.-B.; Deng Q.-F.; Zhang X.-Y.; Lin W.-C.; Chen L.-W.; Qiu
Z.-H.
Institution
(Chen, Xi, Deng, Zhang, Lin, Chen, Qiu) Department of Cardiovascular
Surgery, Union Hospital, Fujian Medical University, Fujian, China
(Chen, Xi, Deng, Zhang, Lin, Chen, Qiu) Key Laboratory of Cardio-Thoracic
Surgery, Fujian Medical University, Fujian Province University, Fujian,
China
Publisher
Turkish Society of Cardiology
Abstract
Background: Previous studies have shown that transcatheter aortic valve
implantation is the best alternative therapy to surgical aortic valve
replacement in high-risk surgical patients with aortic stenosis. However,
it is not clear whether transcatheter aortic valve implantation can be
utilized in low-risk surgical patients with aortic stenosis. This study
aimed to evaluate the safety and efficacy of transcatheter aortic valve
implantation in low-risk patients. Method(s): From the outset of our
initiative until April 2022, PubMed, EMBASE, and the Cochrane database
were thoroughly searched, yielding the selection of 3 randomized
controlled trials including 2644 patients with aortic stenosis, to assess
outcome measures at distinct follow-up time. Result(s): The mean
Society of Thoracic Surgeons Predicted Risk of Mortality score of patients
was 2.2. At the 30-day and 1-year follow-up, transcatheter aortic valve
implantation was associated with a lower incidence of all-cause mortality,
cardiovascular mortality, acute kidney injury (stage 2 or 3),
life-threatening or significant bleeding, and new atrial fibrillation but
an increased risk of permanent pacemaker implantation. At the 2-year
follow-up, transcatheter aortic valve implantation only had an advantage
in new atrial fibrillation (relative risk, 0.27; 95% CI, 0.14-0.51; P <
.0001), with no significant difference in all-cause mortality or
cardiovascular mortality. Conclusion(s): For low-risk surgical
patients with aortic stenosis, compared to surgical aortic valve
replacement, transcatheter aortic valve implantation was associated with
lower all-cause mortality at 30-day follow-up and lower cardiovascular
mortality at 1-year follow-up. Except for the advantages in new atrial
fibrillation, transcatheter aortic valve implantation had no significant
impact on mortality at 2-year follow-up. Copyright © 2022 Turkish
Society of Cardiology. All rights reserved.

<93>
Accession Number
2021644807
Title
Revascularization strategies in patients with multivessel coronary artery
disease: A Bayesian network meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 34(6) (pp 947-957), 2022.
Date of Publication: 01 Jun 2022.
Author
Van Den Eynde J.; Bomhals K.; NoCrossed D SignCopyright D.; Jacquemyn X.;
McCutcheon K.; Bennett J.; Puskas J.D.; Oosterlinck W.
Institution
(Van Den Eynde) Helen B. Taussig Heart Center, Johns Hopkins Hospital and
School of Medicine, Baltimore, MD, United States
(Van Den Eynde, Bomhals, NoCrossed D Sign©, Jacquemyn, McCutcheon,
Bennett, Oosterlinck) Department of Cardiovascular Diseases, University
Hospitals Leuven, Leuven, Belgium
(Van Den Eynde, Bomhals, NoCrossed D Sign©, Jacquemyn, McCutcheon,
Bennett, Oosterlinck) Department of Cardiovascular Sciences, KU Leuven,
Leuven, Belgium
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Morningside
Hospital, New York, NY, United States
Publisher
Oxford University Press
Abstract
Treatment modalities for multivessel disease have rapidly evolved, yet the
preferred strategy remains controversial. This meta-analysis compared
outcomes after on-pump (ONCAB), off-pump coronary artery bypass grafting
(OPCAB), percutaneous coronary intervention (PCI) or hybrid coronary
revascularization. A comprehensive search for observational studies and
randomized controlled trials published by August 2020 was performed. A
Bayesian network meta-analysis was conducted for early (<30 days) and late
(>12 months) outcomes. A total of 119 studies were included (n = 700 458
patients). The main analysis was confined to 31 randomized controlled
trials (n = 24 932 patients). PCI was associated with lower early
mortality [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.31-0.79]
and stroke (OR 0.22, 95% CI 0.06-0.60) rates compared with ONCAB, whereas
a reduced risk of early myocardial infarction was observed with OPCAB
compared with ONCAB (OR 0.53, 95% CI 0.32-0.83). Late target vessel
revascularization and major adverse cardiac and cerebrovascular events
were both increased with PCI compared with ONCAB, OPCAB and hybrid
coronary revascularization (by 127-203% and 59-64%, respectively), and
late major adverse cardiac events were increased in PCI compared with
ONCAB and OPCAB (by 64% and 59%). However, PCI was associated with a
significantly lower risk of late stroke compared with ONCAB (OR 0.70, 95%
CI 0.52-0.89). Sensitivity analyses (i) including observational studies
and (ii) limiting to studies with recent cohorts confirmed the findings of
the main analysis. Surgical approaches for revascularization remain
superior to PCI in patients with multivessel disease. Hybrid coronary
revascularization might be viable for some patients, although more
evidence from randomized controlled trials is warranted. Copyright
© 2021 The Author(s). Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery.

<94>
Accession Number
2021644799
Title
Transcatheter aortic valve replacement in obese patients: Procedural
vascular complications with the trans-femoral and trans-carotid access
routes.
Source
Interactive Cardiovascular and Thoracic Surgery. 34(6) (pp 982-989), 2022.
Date of Publication: 01 Jun 2022.
Author
Alperi A.; McInerney A.; Modine T.; Chamandi C.; Tafur-Soto J.D.; Barbanti
M.; Lopez D.; Campelo-Parada F.; Cheema A.N.; Toggweiler S.; Saia F.;
Amat-Santos I.; Oteo J.F.; Serra V.; Dabrowski M.; Abi-Akar R.; Echavarria
N.G.; Valvo R.; Lopez-Pais J.; Matta A.; Arif M.; Moccetti F.; Compagnone
M.; Mohammadi S.; Nombela-Franco L.; Rodes-Cabau J.
Institution
(Alperi, Mohammadi, Rodes-Cabau) Quebec Heart & Lung Institute, Laval
University, Quebec City, Canada
(McInerney, Nombela-Franco) Cardiovascular Institute, Hospital Clinico San
Carlos, Madrid, Spain
(Modine) Centre Hospitalier Universitaire de Lille, Lille, France
(Chamandi, Abi-Akar) Hospital Europeen Georges-Pompidou, Paris, France
(Tafur-Soto, Echavarria) Ochsner Clinical School, Ochsner Medical Center,
New Orleans, LA, United States
(Barbanti, Valvo) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Lopez, Lopez-Pais) CIVERCV, Instituto de Investigacion de Santiago
(IDIS), Hospital Clinico Universitario de Santiago de Compostela, Santiago
de Compostela, Spain
(Campelo-Parada, Matta) Cardiology Department, Rangueil University
Hospital, Toulouse, France
(Cheema, Arif) Division of Cardiology, St Michaels Hospital, Toronto,
Canada
(Toggweiler, Moccetti) Heart Center Luzerne, Luzerner Kantonsspital,
Lucerne, Switzerland
(Saia, Compagnone) Cardiology Unit, Cardio-Thoracic-Vascular Departmentl
University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna,
Italy
(Amat-Santos) CIBERCV, Instituto de Ciencias Del Corazon (ICICOR),
Hospital Clinico Universitario de Valladolid, Valladolid, Spain
(Oteo) Department of Cardiology, Hospital Universitario Puerta de Hierro,
Majadahonda, Spain
(Serra) Hospital General Universitari Vall d'Hebron, Barcelona, Spain
(Dabrowski) Department of Interventional Cardiology and Angiology,
National Institute of Cardiology, Warsaw, Poland
(Rodes-Cabau) Hospital Clinic Barcelona, Barcelona, Spain
Publisher
Oxford University Press
Abstract
OBJECTIVES: Obesity may increase the risk of vascular complications in
transfemoral (TF) transcatheter aortic valve replacement (TAVR)
procedures. The transcarotid (TC) approach has recently emerged as an
alternative access in TAVR. We sought to compare vascular complications
and early clinical outcomes in obese patients undergoing TAVR either by TF
or TC vascular access. METHOD(S): Multicentre registry including
obese patients undergoing TF- or TC-TAVR in 15 tertiary centres. All
patients received newer-generation transcatheter heart valves. For
patients exhibiting unfavourable ileo-femoral anatomic characteristics,
the TC approach was favoured in 3 centres with experience with it. A
propensity score analysis was performed for overcoming unbalanced baseline
covariates. The primary end point was the occurrence of in-hospital
vascular complications (Valve Academic Research Consortium-2 criteria).
 RESULT(S): A total of 539 patients were included, 454 (84.2%) and 85
(15.8%) had a TF and TC access, respectively. In the propensity-adjusted
cohort (TF: 442 patients; TC: 85 patients), both baseline and procedural
valve-related characteristics were well-balanced between groups. A
significant decrease in vascular complications was observed in the TC
group (3.5% vs 12% in the TF group, odds ratio: 0.26, 95% CI: 0.07-0.95, P
= 0.037). There were no statistically significant differences between
groups regarding in-hospital mortality (TC: 2.8%, TF: 1.5%), stroke (TC:
1.2%, TF: 0.4%) and life-threatening/major bleeding events (TC: 2.8%, TF:
3.8%). CONCLUSION(S): In patients with obesity undergoing TAVR with
newer-generation devices, the TC access was associated with a lower rate
of vascular complications. Larger randomized studies are warranted to
further assess the better approach for TAVR in obese patients.
 Copyright © 2021 The Author(s). Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.

<95>
Accession Number
2021644733
Title
Congenital diaphragmatic hernia repair in patients requiring
extracorporeal membrane oxygenation: are outcomes better with repair on
ECMO or after decannulation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(4) (pp 632-637), 2021.
Date of Publication: 01 Apr 2021.
Author
Low Z.K.; Tan A.S.M.; Nakao M.; Yap K.H.
Institution
(Low, Tan, Nakao, Yap) Department of Cardio-thoracic Surgery, KK Women's
and Children's Hospital, Singapore, Singapore
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether congenital
diaphragmatic hernia repair outcomes are better before or after
decannulation in infants requiring extracorporeal membrane oxygenation
(ECMO). A total of 884 papers were found using the reported search, of
which 9 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
We conclude that infants with congenital diaphragmatic hernia requiring
ECMO should undergo a trial of weaning and aim for post-decannulation
repair, as this has been associated with improved survival, shorter ECMO
duration and fewer bleeding complications. However, if weaning of ECMO is
unsuccessful, the patient should ideally undergo early on-ECMO repair
(within 72 h of cannulation), which has been associated with improved
survival, less bleeding, shorter ECMO duration and fewer circuit changes
compared to late on-ECMO repair. Anticoagulation protocols including
perioperative administration of aminocaproic acid or tranexamic acid, as
well as close perioperative monitoring of coagulation parameters have been
associated with reduced bleeding risk with on-ECMO repairs. Copyright
© 2020 The Author(s).

<96>
Accession Number
2021644731
Title
Major cardiovascular events at 5 years in surgical versus percutaneous
revascularization for left main stem disease: an updated meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(4) (pp 530-536), 2021.
Date of Publication: 01 Apr 2021.
Author
Urso S.; Sadaba R.; Nogales E.; Gonzalez J.M.; Tena M.A.; Paredes F.;
Gonzalez-Barbeito M.; Portela F.
Institution
(Urso, Tena, Paredes, Gonzalez-Barbeito, Portela) Cardiac Surgery
Department, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria,
Spain
(Sadaba) Cardiac Surgery Department, Complejo Hospitalario de Navarra,
Pamplona, Spain
(Nogales) Cardiology Department, Hospital Universitario Insular, Las
Palmas de Gran Canaria, Spain
(Gonzalez) Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de
Gran Canaria, Spain
Publisher
Oxford University Press
Abstract
The aim of the present study was to analyse the incidence of major adverse
cardiovascular events in patients undergoing either coronary artery bypass
grafting (CABG) or percutaneous coronary intervention with drug-eluting
stents for left main stem disease. Five manuscripts publishing 5-year
results of 4 trials (SYNTAX, PRECOMBAT, NOBLE and EXCEL) were included.
Overall meta-analysis with inclusion of the 5-year results from the EXCEL
trial using the protocol definition for myocardial infarction showed that
CABG is associated with a significant reduction in the risk of major
adverse cardiovascular events (MACE) (risk ratio = 0.74; 95% confidence
interval = 0.68-0.80). When the universal definition was used to define
myocardial infarction in the EXCEL trial, the analysis demonstrated a
larger benefit of coronary surgery in terms of reduction in the risk of
MACE (risk ratio = 0.70; 95% confidence interval = 0.63-0.76).
Non-significant differences were detected in terms of risk of overall
mortality, cardiac mortality or stroke. In conclusion, this meta-analysis
shows that CABG significantly reduces the risk of MACE in patients with
left main stem disease. The inclusion of the 5-year results of the EXCEL
trial using third universal definition amplifies the benefit of CABG over
percutaneous coronary intervention. Copyright © 2021 The
Author(s).

<97>
Accession Number
2021644723
Title
Does routine topical antimicrobial administration prevent sternal wound
infection after cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(3) (pp 452-456), 2021.
Date of Publication: 01 Mar 2021.
Author
Magro P.L.; Sousa Uva M.
Institution
(Magro, Sousa Uva) Department of Cardio-thoracic Surgery, Hospital de
Santa Cruz, Carnaxide, Portugal
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does routine topical
antimicrobial administration prevent sternal wound infection (SWI) after
cardiac surgery? Altogether >238 papers were found using the reported
search, of which 11 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. Several different antimicrobial agents, dosages and
application protocols were found in the literature. Regarding topical
vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76%
risk reduction in any SWI. Collagen-gentamicin sponge application was
associated with a 38% risk reduction in SWI in another meta-analysis by
Kowalewski et al., which included 4 randomized control trials and >23 000
patients. Lower evidence observational studies found benefit in the use of
different regimes, including: combination of vancomycin paste and
subcutaneous gentamycin; combined cefazoline and gentamicin spray;
isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We
conclude that, in light of the body of evidence available, topical
antibiotic application prevents SWI, including both superficial and deep
SWI. The strongest evidence, derived from 2 meta-analyses, is related to
the use of gentamicin-collagen sponges and topical vancomycin.
Heterogeneity throughout studies regarding antibiotic agents, dosages,
application protocols and SWI definition makes providing general
recommendations challenging. Copyright © 2020 The Author(s).

<98>
Accession Number
2021644710
Title
Depression as a predictor of postoperative delirium after cardiac surgery:
a systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(3) (pp 371-379), 2021.
Date of Publication: 01 Mar 2021.
Author
Falk A.; Kahlin J.; Nymark C.; Hultgren R.; Stenman M.
Institution
(Falk, Hultgren, Stenman) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Falk, Kahlin, Stenman) Perioperative Medicine and Intensive Care
Function, Karolinska University Hospital, Stockholm, Sweden
(Kahlin) Department of Physiology and Pharmacology, Karolinska Institutet,
Stockholm, Sweden
(Nymark) Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Stockholm, Sweden
(Nymark, Hultgren) Heart and Vascular Theme, Karolinska University
Hospital, Stockholm, Sweden
Publisher
Oxford University Press
Abstract
OBJECTIVES: Depression is common in patients with cardiac disease. The
importance of preoperative depression for development of postoperative
delirium (POD) following cardiac surgery is not well known. The aim is to
provide a summary estimate of depression as a predictor of POD following
cardiac surgery. METHOD(S): Systematic search of MEDLINE, EMBASE,
Cochrane Library, Web of Science Core Collection and Psycinfo (Ovid) was
performed from inception to October 2019, including cohort studies
reporting odds ratios (ORs) and 95% confidence intervals (CIs) for POD
following cardiac surgery in patients with preoperative depression
compared to patients without depression. ORs and 95% CIs for POD were
calculated using random-effects meta-analyses. Subgroup and sensitivity
analyses were performed. RESULT(S): Seven studies were included with
a combined study population of 2066 patients. The pooled prevalence of POD
in the combined study population was 26% and preoperative depression was
present in ~9% of the total study population. All studies showed a
positive association between preoperative depression and POD; and in 5
studies, the association was statistically significant. Patients with
depression had a pooled OR of 2.31 (95% CI 1.37-3.90) for POD.
 CONCLUSION(S): This systematic review and meta-analysis confirm the
findings that the previous association between preoperative depression and
increased risk for developing POD reported for other patient groups is
found also in cardiac surgery. Depression screening prior to cardiac
surgery may be effective in identifying patients at higher risk for POD.
 Copyright © 2020 The Author(s).

<99>
Accession Number
2021644703
Title
Mitral valve surgery after a failed MitraClip procedure.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(3) (pp 380-385), 2021.
Date of Publication: 01 Mar 2021.
Author
Melillo F.; Baldetti L.; Beneduce A.; Agricola E.; Margonato A.; Godino C.
Institution
(Melillo, Baldetti, Beneduce, Agricola, Margonato, Godino)
Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
(Agricola, Margonato) Vita-Salute San Raffaele University, Milan, Italy
Publisher
Oxford University Press
Abstract
OBJECTIVES: Among patients undergoing transcatheter mitral valve repair
with the MitraClip device, a relevant proportion (2-6%) requires open
mitral valve surgery within 1 year after unsuccessful clip implantation.
The goal of this review is to pool data from different reports to provide
a comprehensive overview of mitral valve surgery outcomes after the
MitraClip procedure and estimate in-hospital and follow-up mortality.
 METHOD(S): All published clinical studies reporting on surgical
intervention for a failed MitraClip procedure were evaluated for inclusion
in this meta-analysis. The primary study outcome was in-hospital
mortality. Secondary outcomes were in-hospital adverse events and
follow-up mortality. Pooled estimate rates and 95% confidence intervals
(CIs) of study outcomes were calculated using a DerSimionian-Laird binary
random-effects model. To assess heterogeneity across studies, we used the
Cochrane Q statistic to compute I2 values. RESULT(S): Overall, 20
reports were included, comprising 172 patients. Mean age was 70.5 years
(95% CI 67.2-73.7 years). The underlying mitral valve disease was
functional mitral regurgitation in 50% and degenerative mitral
regurgitation in 49% of cases. The indication for surgery was persistent
or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas
6% of patients presented with mitral stenosis. At the time of the
operation, 80% of patients presented in New York Heart Association
functional class III-IV. Despite favourable intraoperative results,
in-hospital mortality was 15%. The rate of periprocedural cerebrovascular
accidents was 6%. At a mean follow-up of 12 months, all-cause death was
26.5%. Mitral valve replacement was most commonly required because the
possibility of valve repair was jeopardized, likely due to severe valve
injury after clip implantation. CONCLUSION(S): Surgical intervention
after failed transcatheter mitral valve intervention is burdened by high
in-hospital and 1-year mortality, which reflects reflecting the high-risk
baseline profile of the patients. Mitral valve replacement is usually
required due to leaflet injury. Copyright © 2020 The Author(s).

<100>
Accession Number
2021047801
Title
Sternotomy Wound Infiltration With Liposomal Versus Plain Bupivacaine for
Postoperative Analgesia After Elective Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Subramaniam K.; Sciortino C.M.; Boisen M.L.; La Colla L.; Dickson A.;
Nowakowski E.; Prangley K.; Ruppert K.M.
Institution
(Subramaniam, Boisen, La Colla, Dickson, Nowakowski, Prangley, Ruppert)
Department of Anesthesiology and Perioperative Medicine, University of
Pittsburgh, Pittsburgh, Panama
(Sciortino) Sentara Mid-Atlantic Cardiothoracic Surgeons, Sentara Medical
Group, Norfolk, VA
(Ruppert) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
Publisher
W.B. Saunders
Abstract
Objectives: Poor pain control after cardiac surgery can be associated with
postoperative complications, longer recovery, and development of chronic
pain. The authors hypothesized that adding liposomal bupivacaine (LB) to
plain bupivacaine (PB) will provide better and long-lasting analgesia when
used for wound infiltration in median sternotomy. Study Design:
Prospective, randomized, and double-blinded clinical trial.
 Setting(s): Single institution, tertiary care university hospital.
 Participant(s): Adult patients who underwent elective cardiac surgery
through median sternotomy. Intervention(s): A single surgeon
performed wound infiltration of LB plus PB or PB into the sternotomy
wound, chest, and mediastinal tube sites. Measurements and Main
Results: Patients were followed up for 72 hours for pain scores, opioid
consumption, and adverse events. Sixty patients completed the study for
analysis (LB group [n = 29], PB group [n = 31]). Patient characteristics,
procedural variables, and pain scores measured at specific intervals from
4 hours until 72 hours postoperatively did not reveal any significant
differences between the groups. Mixed-model regression showed that the
trend of mean pain scores at movement in the LB group was significantly (p
= 0.01) lower compared with the PB group. Opioid consumption over 72 hours
was not significantly different between the 2 groups (oral morphine
equivalents; median [interquartile range], 139 [73, 212] mg in LB v 105
[54, 188] mg in PB, p = 0.29). Recovery characteristics and adverse events
were comparable. Conclusion(s): LB added to PB for sternotomy wound
infiltration during elective cardiac surgery did not significantly improve
the quality of postoperative analgesia. Copyright © 2022 Elsevier
Inc.

<101>
Accession Number
2021047305
Title
COMPETENCE Trial: The EVAHEART 2 continuous flow left ventricular assist
device.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2022. Date of
Publication: 2022.
Author
Allen S.R.; Slaughter M.S.; Ahmed M.M.; Bartoli C.R.; Dhingra R.; Egnaczyk
G.F.; Gulati S.K.; Kiernan M.S.; Mahr C.; Meyer D.M.; Motomura T.; Ono M.;
Ravichandran A.; Shafii A.; Smith J.; Soleimani B.; Toyoda Y.; Yarboro
L.T.; Dowling R.D.
Institution
(Allen, Soleimani) Penn State Health, Milton S. Hershey Medical Center,
Hershey, Pennsylvania, United States
(Slaughter) University of Louisville, Louisville, Kentucky
(Ahmed) University of Florida, Gainesville, FL, United States
(Bartoli) Geisinger Medical Center, Danville, Pennsylvania, United States
(Dhingra, Smith) University of Wisconsin Hospitals and Clinics, Madison,
WI, United States
(Egnaczyk, Dowling) The Christ Hospital, Cincinnati, Ohio, United States
(Gulati) Atrium Health Sanger Heart and Vascular Institute, Charlotte,
North Carolina
(Kiernan) Tufts Medical Center, Boston, Massachusetts, United States
(Mahr) University of Washington, Seattle, WA, United States
(Meyer) Baylor Scott and White, Dallas, Texas, United States
(Motomura) Evaheart, Inc, Houston, Texas, United States
(Ono) Methodist Healthcare, San Antonio, Texas, United States
(Ravichandran) Saint Vincent Health, Indianapolis, IN, United States
(Shafii) Baylor College of Medicine St. Luke's Medical Center, Houston,
Texas, United States
(Toyoda) Temple University Medical Center, Philadelphia, Pennsylvania,
United States
(Yarboro) University of Virginia, Charlottesville, VA, United States
Publisher
Elsevier Inc.
Abstract
Background: Continuous flow left ventricular assist devices have improved
outcomes in patients with end-stage heart failure that require mechanical
circulatory support. Current devices have an adverse event profile that
has hindered widespread application. The EVAHEART2 left ventricular assist
device (EVA2) has design features such as large blood gaps, lower pump
speeds and an inflow cannula that does not protrude into the left
ventricle that may mitigate the adverse events currently seen with other
continuous flow devices. Method(s): A prospective, multi-center
randomized non-inferiority study, COMPETENCE Trial, is underway to assess
non-inferiority of the EVA2 to the HeartMate 3 LVAS when used for the
treatment of refractory advanced heart failure. The primary end-point is a
composite of the individual primary outcomes: Survival to cardiac
transplant or device explant for recovery; Free from disabling stroke;
Free from severe Right Heart Failure after implantation of original
device. Randomization is in a 2:1 (EVA2:HM3) ratio. Result(s): The
first patient was enrolled into the COMPETENCE Trial in December of 2020,
and 25 subjects (16 EVA2 and 9 HM3) are currently enrolled. Enrollment of
a safety cohort is projected to be completed by third quarter of 2022 at
which time an interim analysis will be performed. Short-term cohort (92
EVA2 subjects) and long-term cohort is expected to be completed by the end
of 2023 and 2024, respectively. Conclusion(s): Contemporary risk
scores were therapy responsive in FREEDOM-EV and early improvements
predicted subsequent outcomes. This post hoc analysis suggests that risk
scores may be a surrogate for clinical worsening. Copyright ©
2022 International Society for Heart and Lung Transplantation

<102>
Accession Number
2021025924
Title
Excess Reintervention With Mitroflow Prosthesis for Aortic Valve
Replacement: Ten-Year Outcomes of a Randomized Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Cangut B.; Schaff H.V.; Suri R.M.; Greason K.L.; Stulak J.M.; Lahr B.D.;
Michelena H.I.; Daly R.C.; Dearani J.A.; Crestanello J.A.
Institution
(Cangut, Schaff, Greason, Stulak, Daly, Dearani, Crestanello) Department
of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
(Suri) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Lahr) Division of Biomedical Statistics and Informatics, Mayo Clinic
College of Medicine and Science, Rochester, Minnesota
(Michelena) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota
Publisher
Elsevier Inc.
Abstract
Background: Current bioprostheses are considered to have improved
durability and better hemodynamic performance compared with previous
designs, but there are limited comparative data on late outcomes.
 Method(s): From 2009 through 2011, 300 adults with severe aortic
valve stenosis undergoing aortic valve replacement (AVR) were randomly
assigned to receive Edwards Magna, St Jude Epic, or Sorin Mitroflow
bioprostheses (n = 100, n = 101, n = 99, respectively). Overall survival
was analyzed using Kaplan-Meier and Cox proportional hazards methods,
whereas competing risk analysis was used for all time-to-event outcomes.
Serial echocardiographic data were fitted with longitudinal models
stratified by implant valve size. Result(s): During median follow-up
of 9.8 years (interquartile range, 8.7-10.2), 10-year survival was 50% for
the Magna group, 42% for the Epic group, and 41% for the Mitroflow group
(P = .415). Cumulative risk of stroke was 9% at 10 years, and rates were
comparable for the three groups. Indexed aortic valve area and mean
gradients were similar among the three groups receiving 19 mm and 21 mm
valves, but in larger (23 mm or more) prostheses, gradients were lower (P
< .001) and indexed aortic valve areas were higher in the Magna group (P <
.001). The 10-year risk of endocarditis differed by group (P = .033), with
higher incidence in the Mitroflow vs the Magna group (7% vs 0%, P = .019).
Late risk of reinterventions in the Mitroflow group was 22%, compared with
0% in the Magna group (P < .001) and 5% in the Epic group (P = .008).
 Conclusion(s): The Magna valve had the lowest gradients and largest
indexed aortic valve area with larger implant sizes. The Mitroflow
bioprosthesis is associated with an increased rate of reintervention and
possible increased risk of infection compared with Magna and Epic
valves. Copyright © 2022 The Society of Thoracic Surgeons

<103>
Accession Number
2021378284
Title
High-dose ulinastatin reduces postoperative bleeding and provides
platelet-protective effects in patients undergoing heart valve replacement
surgery.
Source
International Journal of Clinical Pharmacology and Therapeutics. 60(11)
(pp 463-468), 2022. Date of Publication: November 2022.
Author
Lyu Y.; Cao M.; Wei C.; Fang H.; Lu X.
Institution
(Lyu, Fang) Department of Anesthesiology, Minhang Hospital, Fudan
University, Shanghai, China
(Cao, Wei, Lu) Department of Anesthesiology, First Affiliated Hospital of
Anhui Medical University, Hefei, China
(Fang) Department of Anesthesiology, Zhongshan Hospital, Fudan University,
Shanghai, China
Publisher
Dustri-Verlag Dr. Karl Feistle
Abstract
Background: The aim of this prospective study was to investigate the
effect of a high dose of ulinastatin on platelets and coagulation in
patients undergoing mitral valve and/or aortic valve replacement with
cardiopulmonary bypass (CPB). Material(s) and Method(s): 273 patients
were enrolled in this open-label study. According to patients'
willingness, 243 patients were assigned to the ulinastatin group and 30 to
the control group. In the ulinastatin group, ulinastatin (300,000 U) was
given after the induction of anesthesia, ulinastatin (400,000 U) was added
to the CPB pump prime, and then ulinastatin (300,000 U) was administered
after weaning from CPB. Complete blood count and coagulation function test
were conducted 1 day before surgery and on the first postoperative day.
Bleeding and other safety events were recorded during hospitalization.
 Result(s): Less postoperative major bleeding occurred in the
ulinastatin group (0.4 vs. 6.7%, p = 0.03). Moreover, 1 day after CPB,
platelet count in the ulinastatin group increased significantly compared
to that in the control group (157.7 +/- 71.0 vs. 132.1 +/- 59.6, p =
0.03). Interestingly and contrary to what was expected, activated partial
thromboplastin time (APTT) and prothrombin time (PT) did not differ
significantly between the two groups. Ulinastatin application did not
cause significant increase in total costs (p = 0.89). Conclusion(s):
In heart valve replacement surgery with CPB, high-dose ulinastatin could
reduce postoperative bleeding and promote platelet recovery with no
significant additional medical cost. Copyright © 2022
Dustri-Verlag Dr. Karl Feistle. All rights reserved.

<104>
Accession Number
2021570254
Title
Influence of Dexmedetomidine on Myocardial Injury in Patients with
Simultaneous Pancreas-Kidney Transplantation.
Source
Evidence-based Complementary and Alternative Medicine. 2022 (no
pagination), 2022. Article Number: 7196449. Date of Publication: 2022.
Author
Dong A.; Zhang Y.; Lu S.; Yu W.
Institution
(Dong, Lu, Yu) Tianjin First Center Hospital, Tianjin 300192, China
(Zhang) First Teaching Hospital, Tianjin University of Traditional Chinese
Medicine, National Clinical Research Center for Chinese Medicine
Acupuncture and Moxibustion, Tianjin 300193, China
Publisher
Hindawi Limited
Abstract
Background. Diabetes is one of the most common chronic diseases in the
world. End-stage renal disease (ESRD) caused by diabetes is the most
serious long-term complication. The main cause of death in patients with
simultaneous pancreas-kidney transplantation (SPKT) is cardiovascular
disease. Although dexmedetomidine (Dex) has unique advantages in heart
protection against ischaemic/reperfusion injury, few clinical studies have
been conducted on its cardioprotective effect in SPKT. This study aimed to
explore the influence of Dex on myocardial injury in patients undergoing
SPKT and to analyze its possible mechanism. Methods. A randomized
controlled trial (RCT) was performed from July 1, 2018 to December 1,
2020. Eighty patients, regardless of gender, scheduled for SPKT were
randomly allocated into a Dex group (D group) receiving Dex at a rate of 1
mug/kg for 10 minutes before anaesthesia induction and then continuous
infusion at 0.5 mug/kg/hour until the end of surgery and control group (C
group) receiving equivalent capacity of saline. Serum cardiac troponin I
(cTnI), creatine kinase isoenzyme (CK-MB), tumour necrosis factor-alpha
(TNF-alpha), and interleukin-6 (IL-6) were recorded at 5 minutes after
anaesthesia induction (baseline,T0), 5 minutes before renal arteriovenous
opening (T1), 30 minutes after renal arteriovenous opening (T2), 30
minutes after pancreatic related arteriovenous opening (T3), immediately
after surgery (T4), 4 hours after surgery (T5), and 24 hours after surgery
(T6). Adverse cardiovascular events were recorded during the perioperative
period. Changes in ECG S-T segments and T waves were monitored at T0-T6.
Myocardial infarction and percutaneous coronary intervention were recorded
with an average follow-up of one year. Results. Compared with T0,
TNF-alpha and IL-6 concentrations significantly increased at T1-T6 in the
C and D groups (P<0.05). IL-6 concentration increased significantly after
renal artery opening and reached the peak after the opening of pancreatic
blood vessels. Compared with the C group, TNF-alpha, and IL-6
concentrations were significantly reduced in group D at T2-T6 (P<0.05).
Compared with T0, cTnI and CK-MB concentrations were significantly
increased at T3-T6 in the C and D groups (P<0.05). cTnI and CK-MB
concentrations increased significantly after the opening of renal artery,
and reached the peak after the opening of pancreatic blood vessels.
Compared with the C group, cTnI and CK-MB concentrations were
significantly reduced in the D group at T3-T6 (P<0.05). There was no
significant difference in patient characteristics amongst groups,
including the proportion of intraoperative vasoactive drug use and adverse
cardiovascular events during the follow-up period. Heart rate, mean blood
pressure, central venous pressure, and cardiac output were not remarkably
different between the two groups at any time point. Conclusions.
Perioperative reperfusion could aggravate myocardial injury in SPKT. Dex
may be considered a way to reduce myocardial injury caused by inflammatory
action by decreasing the release of inflammatory factors. Trial
Registration Number: Chinese Clinical Trial Registry ID:
ChiCTR2200060084. Copyright © 2022 Aili Dong et al.

<105>
Accession Number
2021291418
Title
Vitamin C supplementation attenuates oxidative stress and improves
erythrocyte deformability in cardiac surgery with cardiopulmonary bypass.
Source
Chinese Journal of Physiology. 65(5) (pp 241-249), 2022. Date of
Publication: September 2022.
Author
Tai Y.-H.; Wu H.-L.; Chu Y.-H.; Huang C.-H.; Ho S.-T.; Lin T.-C.; Lu C.-C.
Institution
(Tai) Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical
University, New Taipei City, Taiwan (Republic of China)
(Tai) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Wu, Chu, Lu) Department of Anesthesiology, Taipei Veterans General
Hospital, Taipei, Taiwan (Republic of China)
(Wu, Huang) School of Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan (Republic of China)
(Chu, Lu) Graduate Institute of Life Sciences, National Defense Medical
Center, Taipei, Taiwan (Republic of China)
(Huang) Division of Cardiovascular Surgery, Department of Surgery, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Ho, Lin) Department of Anesthesiology, Tri. Service General Hospital,
National Defense Medical Center, Taipei, Taiwan (Republic of China)
(Ho) Department of Anesthesiology, Kaohsiung Medical University Hospital,
Kaohsiung Medical University, Kaohsiung, Taiwan (Republic of China)
(Lu) Institute of Aerospace Medicine, National Defense Medical Center,
Taipei, Taiwan (Republic of China)
Publisher
Wolters Kluwer Medknow Publications
Abstract
Cardiopulmonary bypass (CPB) depletes endogenous Vitamin C and generates
oxidative stress in cardiac surgery. This study aimed to clarify whether
Vitamin C supplementation reduces oxidant production and improves
erythrocyte deformability in cardiac surgery with CPB. In a randomized and
controlled design, 30 eligible patients undergoing cardiac surgery with
hypothermic CPB were equally assigned to the Vitamin C group and control
group. Subjects of the Vitamin C group and control group received an
intravenous infusion of Vitamin C 20 mg.kg -1 and a placebo during
rewarming period of CPB, respectively. We measured the plasma level of
reactive oxygen species (ROS) and phosphorylation levels of non-muscle
myosin IIA (NMIIA) in erythrocyte membrane, as an index of erythrocyte
deformability, before and after CPB. Vitamin C supplementation attenuated
the surge in plasma ROS after CPB, mean 1.661 +/- standard deviation 0.801
folds in the Vitamin C group and 2.743 +/- 1.802 in the control group. The
tyrosine phosphorylation level of NMIIA after CPB was upregulated in the
Vitamin C group compared to the control group, 2.159 +/- 0.887 folds and
1.384 +/- 0.445 (P = 0.0237). In addition, the phosphorylation of
vasodilator-stimulated phosphoprotein (VASP) and focal adhesion kinase
(FAK) in erythrocytes was concurrently enhanced in the Vitamin C group
after CPB. The phosphorylation level of endothelial nitric oxide synthase
in erythrocytes was significantly increased in the Vitamin C group (1.734
+/- 0.371 folds) compared to control group (1.102 +/- 0.249; P = 0.0061).
Patients receiving Vitamin C had lower intraoperative blood loss and
higher systemic vascular resistance after CPB compared to controls.
Vitamin C supplementation attenuates oxidative stress and improves
erythrocyte deformability via VASP/FAK signaling pathway in erythrocytes
during CPB. Copyright © 2022 Chinese Journal of Physiology.

<106>
Accession Number
2018459614
Title
Aortic Valve Replacement for Aortic stenosis and Concomitant Coronary
Bypass: An Updated Overview.
Source
NeuroQuantology. 20(15) (pp 2431-2440), 2022. Date of Publication: 2022.
Author
Elfakharany K.M.; Abdelsattarkotb M.; Azab M.A.; Fadaly A.S.
Institution
(Elfakharany, Abdelsattarkotb, Azab, Fadaly) Cardiothoracic Surgery
Department, Faculty of Medicine, Zagazig University, Egypt
Publisher
Anka Publishers
Abstract
Aortic stenosis (AS) and coronary atherosclerosis can independently cause
myocardial ischemia and the sequelae of myocardial ischemia, including
angina, myocardial infarction (MI), and death. A review of the results of
combined aortic valve replacement (AVR) and coronary artery bypass
grafting (CABG) in several centersshow more variable mortality than after
isolated AVR. [1].Patients treated for severe AS constitute a
heterogeneous population ranging from young patients with isolated
bicuspid valve disease to elderly patients with degenerative disease
complicated by multiple comorbidities. The most common comorbidity,most
importantly influencing outcomes after AVR, affecting a third of patients
and half of those above age 70, is coronary artery disease (CAD) [2].When
CAD is present in AVR patients, early-and long-term survival rates have
been found to be worse without CABG. On AVR-CABG, however, there is
conflicting evidence. Some reports demonstrated higher rates of early
mortality. [3].Whereas other reports showed no significant difference with
concomitant AVR-CABG. [4].When indicated, a single session, concomitant
CABG with aortic valve surgery is comparatively harmless with satisfactory
early outcomes and complications. CABG, when combined with double valve
replacement, increases the risk of postoperative morbidities and
mortality. [5]. Copyright © 2022, Anka Publishers. All rights
reserved.

<107>
Accession Number
2012315325
Title
Risk factors for new-onset atrial fibrillation during critical illness: A
Delphi study.
Source
Journal of the Intensive Care Society. 23(4) (pp 414-424), 2022. Date of
Publication: November 2022.
Author
Bedford J.P.; Garside T.; Darbyshire J.L.; Betts T.R.; Young J.D.;
Watkinson P.J.
Institution
(Bedford, Garside, Darbyshire, Young, Watkinson) Nuffield Department of
Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
(Betts) Department of Medicine, University of Oxford, Oxford, Radcliffe,
United Kingdom
(Watkinson) NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background: New-onset atrial fibrillation (NOAF) is common during critical
illness and is associated with poor outcomes. Many risk factors for NOAF
during critical illness have been identified, overlapping with risk
factors for atrial fibrillation in patients in community settings. To
develop interventions to prevent NOAF during critical illness, modifiable
risk factors must be identified. These have not been studied in detail and
it is not clear which variables warrant further study. Method(s): We
undertook an international three-round Delphi process using an expert
panel to identify important predictors of NOAF risk during critical
illness. Result(s): Of 22 experts invited, 12 agreed to participate.
Participants were located in Europe, North America and South America and
shared 110 publications on the subject of atrial fibrillation. All 12
completed the three Delphi rounds. Potentially modifiable risk factors
identified include 15 intervention-related variables. Conclusion(s):
We present the results of the first Delphi process to identify important
predictors of NOAF risk during critical illness. These results support
further research into modifiable risk factors including optimal plasma
electrolyte concentrations, rates of change of these electrolytes, fluid
balance, choice of vasoactive medications and the use of preventative
medications in high-risk patients. We also hope our findings will aid the
development of predictive models for NOAF. Copyright © The
Intensive Care Society 2021.

<108>
[Use Link to view the full text]
Accession Number
2021012969
Title
Preventive Effect of Berberine on Postoperative Atrial Fibrillation.
Source
Circulation: Arrhythmia and Electrophysiology. 15(10) (pp 648-654), 2022.
Date of Publication: 01 Oct 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
Lippincott Williams and Wilkins
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. Copyright © 2022 Lippincott Williams and
Wilkins. All rights reserved.

<109>
Accession Number
2015626119
Title
Polycythaemia Vera and Coronary Artery Bypass Graft Surgery: A Systematic
Review of the Literature.
Source
Heart Lung and Circulation. 31(3) (pp 304-312), 2022. Date of Publication:
March 2022.
Author
Janmohamed I.K.; Sondh R.S.; Ahmed H.; Afzal M.B.; Tyson N.; Harky A.
Institution
(Janmohamed) University of Leeds, Faculty of Health and Medicine, UK,
Leeds, United Kingdom
(Sondh) St George's Hospital Medical School, University of London, UK,
London, United Kingdom
(Ahmed, Afzal) Imperial College London, Department of Medicine, UK,
London, United Kingdom
(Tyson) Nottingham University Hospitals, Department of Cardiac Surgery,
UK, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, UK, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: Polycythaemia vera (PV) is a condition that may potentially
put patients undergoing cardiac surgery at an increased risk of bleeding
and thrombosis; however, there is currently a paucity of literature
regarding the management of these patients. We aim to examine the
literature in this systematic review to indicate the interventions that
may be considered to minimise complications. Method(s): We conducted
a literature search using keywords and MeSH terms to identify articles
discussing PV and cardiac surgery. The studies were identified and
qualitatively analysed using the Preferred Reporting Items for Systematic
Reviews and Meta-analysis (PRISMA) protocol. Result(s): In total, 10
case reports representing 11 patients were identified for this systematic
review and were included in qualitative analysis. 63.6% of patients had
preoperative intermittent phlebotomy, and the majority of patients
received postoperative therapy that involved one antiplatelet agent and
one anticoagulant. Generous perioperative fluid management, phlebotomy,
preservation of core body temperature, early extubation, monitoring of
myocardial ischaemia, infarction and vascular events, intense chest
physiotherapy and patient mobilisation are important to consider to reduce
the risk of complications arising from surgery. Conclusion(s): These
considerations should be systematically discussed in a multidisciplinary
team, where the acute surgical need can be balanced appropriately against
the risk of haemorrhage and thrombosis. Copyright © 2021
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<110>
Accession Number
2014928015
Title
Surgical Treatment of Primary Cardiac Tumors in Children Systematic Review
and Meta-analysis.
Source
Pediatric Cardiology. 43(2) (pp 251-266), 2022. Date of Publication:
February 2022.
Author
Svobodov A.A.; Glushko L.A.; Ergashov A.Y.
Institution
(Svobodov, Glushko, Ergashov) Bakoulev Scientific Center for
Cardiovascular Surgery Moskva, Rublevskoe shosse 135, Moscow 121552,
Russian Federation
Publisher
Springer
Abstract
This systematic review sought to investigate the current evidence
regarding surgical management of primary cardiac tumors in children.
Twenty-four studies were deemed eligible, reporting on 713 pediatric
patients. Cumulative 30-day mortality rate was 5.5% and 7.5% after
surgery. It was revealed a statistically lower mortality rate in the group
of patients below 1 year of age, justifying a more aggressive surgical
approach for primary cardiac tumors, except for rhabdomyoma that can
regress spontaneously. Copyright © 2022, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<111>
Accession Number
2019979881
Title
Incidence, recurrence and management of electrical storm in Brugada
syndrome.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 981715. Date of Publication: 25 Oct 2022.
Author
El-Battrawy I.; Roterberg G.; Kowitz J.; Aweimer A.; Lang S.; Mugge A.;
Zhou X.; Akin I.
Institution
(El-Battrawy, Roterberg, Kowitz, Lang, Zhou, Akin) First Department of
Medicine, Faculty of Medicine, University Medical Centre Mannheim,
University of Heidelberg, Heidelberg, Germany
(El-Battrawy, Lang, Zhou, Akin) DZHK (German Center for Cardiovascular
Research), Mannheim, Germany
(El-Battrawy, Aweimer, Mugge) Bergmannsheil Bochum, Medical Clinic II,
Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
Publisher
Frontiers Media S.A.
Abstract
Background: Brugada syndrome (BrS) is associated with ventricular
tachyarrhythmias. However, the presence of electrical strom (ES) and its
management still debated. Objective(s): We present the outcome and
management of 44 BrS patients suffering from ES. Method(s): A
systematic literature review and pooled analysis Through database review
including PubMed, Web of Science, Cochrane Libary and Cinahl studies were
analyzed. Evidence from 7 reports of 808 BrS patients was identified.
 Result(s): The mean age of patients suffering from ES was 34 +/- 9.5
months (94.7% males, 65.8% spontaneous BrS type I). Using
electrophysiological study ventricular tachycardia/ventricular
fibrillation were inducible in 12/23 (52.2%). Recurrence of ES was
documented in 6.1%. Death from ES was 8.2% after a follow-up of 83.5 +/-
53.4. In up to 27 ES resolved without treatment. External shock was
required in 35.6%, internal ICD shock in 13.3%, Overdrive pacing, left
cardiac sympathetic block and atropin in 2.2%. Short-term antiarrhythmic
management was as the following: Isopreterenol or Isopreterenol in
combination with quinidine 35.5%, orciprenaline in 2.2%, quinidine 2.2%,
disopyramide 2.2% or denopamide 2.2%. However, lidocaine, magensium
sulfate, mexiletine and propanolol failed to control ES.
 Conclusion(s): Although ES is rare in BrS, this entity challenges
physicians. Despite its high mortality rate, spontaneous termination is
possible. Short-term management using Isoproterenol and/or quinidine might
be safe. Prospective studies on management of ES are
warranted. Copyright © 2022 El-Battrawy, Roterberg, Kowitz,
Aweimer, Lang, Mugge, Zhou and Akin.

<112>
Accession Number
2019914414
Title
A systematic review and meta-analysis of periprocedural bridging for
patients with mechanical heart valves undergoing non-cardiac
interventions.
Source
Thrombosis Research. 218 (pp 130-137), 2022. Date of Publication: October
2022.
Author
Bontinis V.; Theodosiadis E.; Bontinis A.; Koutsoumpelis A.; Donikidis I.;
Giannakopoulos N.-N.; Ktenidis K.
Institution
(Bontinis, Bontinis, Koutsoumpelis, Ktenidis) Department of Vascular
Surgery, Aristotle University of Thessaloniki, AHEPA University General
Hospital, Thessaloniki, Greece
(Theodosiadis) Department of Anesthesiology and Intensive Care, Aristotle
University of Thessaloniki, AHEPA University General Hospital,
Thessaloniki, Greece
(Donikidis) Department of Orthopedic Surgery, General Hospital of Edessa,
Edessa, Greece
(Giannakopoulos) 3rd Department of General Surgery, Tzaneio General
Hospital, Piraeus, Greece
Publisher
Elsevier Ltd
Abstract
Objective: To evaluate the safety and efficacy of perioperative bridging
in patients with mechanical heart valves undergoing non-cardiac
interventions. Material(s) and Method(s): A systematic research using
Medline, EMBASE, and Google Scholar was implemented corresponding to the
Preferred Reporting Items for Systematic reviews and Meta-analysis
(PRISMA) statement. Data from the eligible studies were obtained and
meta-analyzed. Primary endpoints included major bleeding and
thromboembolism. Secondary endpoints included minor bleeding, overall
mortality, and overall bleeding (major and minor bleeding). We conducted a
comparative analysis between bridging and non-bridging along with a
sensitivity analysis for patients undergoing major and minor operations.
 Result(s): Fifteen studies comprised of 2305 patients (2453 bridging
episodes) were included. Pooled major bleeding and thromboembolism rates
were 3.85 % (95 % CI: 2.12-5.98) (I2 = 69 %, p < 0.01) and 0.39
% (95 % CI: 0.00-1.41) (I2 = 64 %, p < 0.01). Bridging versus
non-bridging major bleeding, thromboembolism, and overall bleeding risk
ratios (RR) were RR 2.05 (95 % CI: 0.98-4.28) (I2 = 10 %, p =
0.34), RR 1.63 (95 % CI: 0.41-6.50) (I2 = 0 %, p = 0.63) and RR
1.79 (95 % CI: 1.17-2.72) (I2 = 55 %, p = 0.09) respectively.
Subgroup analysis displayed major and minor operation thromboembolism and
overall bleeding rates of 3.09 % (95 % CI: 0.78-6.43) (I2 = 0
%, p = 0.89) versus 0.14 % (95 % CI: 0.00-1.40) (I2 = 0 %, p =
0.93), test for subgroup differences (p < 0.01) and 17.37 % (95 % CI:
11.73-23.77) (I2 = 0 %, p = 0.61) versus 28.18 % (95 % CI:
22.80-33.88) (I2 = 0 %, p = 0.47), test for subgroup
differences (p = 0.01) respectively. Conclusion(s): Our analysis
suggests that bridging may potentially put patients at an increased
bleeding risk regarding overall bleeding rates, while failing to provide
statistically significant benefits concerning thromboembolism and overall
mortality compared to non-bridging. Limitations such as the mixed patient
population don't allow for definite conclusions to be drawn warrantying
further research through randomized controlled trials. Copyright
© 2022 Elsevier Ltd

<113>
[Use Link to view the full text]
Accession Number
634794542
Title
Bedside Allogeneic Erythrocyte Washing with a Cell Saver to Remove
Cytokines, Chemokines, and Cell-derived Microvesicles: A Clinical
Feasibility Study.
Source
Anesthesiology. 134(3) (pp 395-404), 2021. Date of Publication: 01 Mar
2021.
Author
Welsby I.J.; Norris P.J.; Mauermann W.J.; Podgoreanu M.V.; Conn C.M.;
Meade L.; Cannon T.; Keating S.M.; Silliman C.C.; Kehler M.; Schulte P.J.;
Kor D.J.
Institution
(Welsby, Podgoreanu, Cannon) Department of Anesthesiology, Duke University
Medical Center, Durham, NC, United States
(Norris, Keating) Vitalant Research Institute, Departments of Laboratory
Medicine and Medicine, University of California, San Francisco, San
Francisco, CA, United States
(Mauermann, Meade, Kor) Department of Anesthesiology and Perioperative
Medicine, United States
(Conn) Transfusion Medicine Services, United States
(Schulte) Division of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Silliman, Kehler) Vitalant Research Institute, Departments of Pediatrics
and Surgery, School of Medicine, University of Colorado, Aurora, CO,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Removal of cytokines, chemokines, and microvesicles from the
supernatant of allogeneic erythrocytes may help mitigate adverse
transfusion reactions. Blood bank-based washing procedures present
logistical difficulties; therefore, we tested the hypothesis that
on-demand bedside washing of allogeneic erythrocyte units is capable of
removing soluble factors and is feasible in a clinical setting.
 Method(s): There were in vitro and prospective, observation cohort
components to this a priori planned substudy evaluating bedside allogeneic
erythrocyte washing, with a cell saver, during cardiac surgery. Laboratory
data were collected from the first 75 washed units given to a subset of
patients nested in the intervention arm of a parent clinical trial. Paired
pre- and postwash samples from the blood unit bags were centrifuged. The
supernatant was aspirated and frozen at -70degreeC, then batch-tested for
cell-derived microvesicles, soluble CD40 ligand, chemokine ligand 5, and
neutral lipids (all previously associated with transfusion reactions) and
cell-free hemoglobin (possibly increased by washing). From the entire
cohort randomized to the intervention arm of the trial, bedside washing
was defined as feasible if at least 75% of prescribed units were washed
per protocol. Result(s): Paired data were available for 74 units.
Washing reduced soluble CD40 ligand (median [interquartile range]; from
143 [1 to 338] ng/ml to zero), chemokine ligand 5 (from 1,314 [715 to
2,551] to 305 [179 to 488] ng/ml), and microvesicle numbers (from 6.90
[4.10 to 20.0] to 0.83 [0.33 to 2.80] x 106), while cell-free
hemoglobin concentration increased from 72.6 (53.6 to 171.6) mg/dl to
210.5 (126.6 to 479.6) mg/dl (P < 0.0001 for each). There was no effect on
neutral lipids. Bedside washing was determined as feasible for 80 of 81
patients (99%); overall, 293 of 314 (93%) units were washed per protocol.
 Conclusion(s): Bedside erythrocyte washing was clinically feasible
and greatly reduced concentrations of soluble factors thought to be
associated with transfusion-related adverse reactions, increasing
concentrations of cell-free hemoglobin while maintaining acceptable (less
than 0.8%) hemolysis. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<114>
Accession Number
2020454564
Title
The Impact of Bariatric Surgery on Cardiac Structure, and Systolic and
Diastolic Function in Patients with Obesity: A Systematic Review and
Meta-analysis.
Source
Obesity Surgery. (no pagination), 2022. Date of Publication: 2022.
Author
Esparham A.; Shoar S.; Kheradmand H.R.; Ahmadyar S.; Dalili A.; Rezapanah
A.; Zandbaf T.; Khorgami Z.
Institution
(Esparham, Kheradmand, Ahmadyar) Student Research Committee, College of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Shoar) Department of Clinical Research, ScientificWriting Corp, Houston,
TX, United States
(Dalili, Rezapanah) Department of Surgery, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Dalili, Rezapanah) Surgical Oncology Research Center, Imam Reza Hospital,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Zandbaf) Department of Surgery, School of Medicine, Islamic Azad
University, Mashhad, Iran, Islamic Republic of
(Khorgami) Department of Surgery, University of Oklahoma College of
Community Medicine, Tulsa, OK, United States
(Khorgami) Harold Hamm Diabetes Center, University of Oklahoma Health
Sciences Center, Oklahoma City, OK, United States
Publisher
Springer
Abstract
The purpose of this study was to provide pooled data from all studies on
the impact of bariatric surgery on cardiac structure, and systolic and
diastolic function evaluated by either echocardiography or cardiac
magnetic resonance. PubMed, Web of Science, Embase, and Scopus databases
were searched. Almost all of cardiac left-side structural indices improved
significantly after bariatric surgery. However, right-side structural
indices did not change significantly. Left ventricular ejection fraction
and most of the diastolic function indices improved significantly after
the bariatric surgery. The subgroup analysis showed that the left
ventricular mass index decreased more in long-term follow-up (>= 12
months). In addition, subgroup analysis of studies based on surgery type
did not reveal any difference in outcomes between gastric bypass and
sleeve gastrectomy groups. Copyright © 2022, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<115>
Accession Number
639705229
Title
The effect of Del Nido versus custodiol cardioplegia on clinical outcomes
and troponin-I changes among pediatrics with tetralogy of fallot
undergoing cardiopulmonary bypass.
Source
Perfusion. (pp 2676591221141791), 2022. Date of Publication: 04 Dec 2022.
Author
Gholampour Dehaki M.; Gorjipour F.; Mahdavi M.; Kachoueian N.; Heidarynia
S.
Institution
(Gholampour Dehaki, Gorjipour, Mahdavi, Heidarynia) Iran University of
Medical Sciences, 158776Rajaie Cardiovascular Medical and Research Center,
Tehran, Iran, Islamic Republic of
(Gorjipour, Heidarynia) Iranian Scientific Society of Extracorporeal
Technology, Iran University of Medical Sciences, 158776Rajaie
Cardiovascular Medical and Research Center, Tehran, Iran, Islamic Republic
of
(Gorjipour) Physiology Research Center, 440827Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Gorjipour) Qashqaei Biotechnology Laboratories, Tehran, Iran, Islamic
Republic of
(Kachoueian) Imam Hossein Educational Hospital, 48486Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Myocardial protection during operations with cardiopulmonary
bypass (CPB) and aortic cross clamping is vital. For this purpose, Del
Nido (DN) and Custodiol cardioplegia (CC) solutions are used for
single-dose cardioplegia in cardiac surgical procedures with CPB. Present
study aimed to compare the effects of DN and CC on peri-operative clinical
outcomes in pediatrics with Tetralogy of Fallot (TF) undergoing
cardiopulmonary bypass. METHOD(S): Present randomized clinical trial
was performed in two trial groups with parallel design. One group received
DN and another group received CC. We assessed circulatory Troponin-I
(cTnI) and coronary sinus lactate level as primary outcomes. Secondary
outcomes were ventilation time, electrolytes levels, pump time,
cross-clamp time and other clinical parameters. RESULT(S): Duration
of CPB and cross-clamp were the same in both groups. There were no
significant differences in hemodynamic parameters, left ventricular
ejection fraction after the surgery and discharge time between the two
trial groups. Ventilation time (8.5 vs. 18; p = 0.001), ICU stay,
Troponin-I in ICU admission and Coronary sinus lactate level (p = 0.001)
were significantly higher among patients of Custodiol group compared to
other trial group. Electrolytes Na, Cl and K levels, during CPB, were
significantly less in Custodiol group. CONCLUSION(S): When used for
inducing cardiac arrest during CPB, DN solution offers better maintenance
of the electrolyte balance during CPB, and is associated with less
circulatory cTnI and coronary sinus lactate level compared with the CC.

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