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<1>
Accession Number
2019919646
Title
Benefits and risks of antihypertensive medication in adults with different
systolic blood pressure: A meta-analysis from the perspective of the
number needed to treat.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 986502. Date of Publication: 19 Oct 2022.
Author
Mao Y.; Ge S.; Qi S.; Tian Q.-B.
Institution
(Mao, Ge, Qi, Tian) Hebei Key Laboratory of Environment and Human Health,
Department of Epidemiology and Statistics, School of Public Health, Hebei
Medical University, Shijiazhuang, China
Publisher
Frontiers Media S.A.
Abstract
Background: The blood pressure (BP) threshold for initial pharmacological
treatment remains controversial. The number needed to treat (NNT) is a
significant indicator. This study aimed to explore the benefits and risks
of antihypertensive medications in participants with different systolic
BPs (SBPs), and cardiovascular disease status from the perspective of the
NNT. <br/>Method(s): We conducted a meta-analysis of 52 randomized
placebo-controlled trials. The data were extracted from published articles
and pooled to calculate NNTs. The participants were divided into five
groups, based on the mean SBP at entry (120-129.9, 130-139.9, 140-159.9,
160-179.9, and >=180 mmHg). Furthermore, we stratified patients into those
with and without cardiovascular disease. The primary outcomes were the
major adverse cardiovascular events (MACEs), and adverse events (AEs)
leading to discontinuation. <br/>Result(s): Antihypertensive medications
were not associated with MACEs, however, it increased AEs, when the SBP
was <140 mmHg. For participants with cardiovascular disease or at a high
risk of heart failure and stroke, antihypertensive treatment reduced MACEs
when SBP was >=130 mmHg. Despite this, only 2-4 subjects had reduced MACEs
per 100 patients receiving antihypertensive medications for 3.50 years.
The number of individuals who needed to treat to avoid MACEs declined with
an increased cardiovascular risk. <br/>Conclusion(s): Pharmacological
treatment could be activated when SBP reaches 140 mmHg. For people with
cardiovascular disease or at a higher risk of stroke and heart failure,
130 mmHg may be a better therapeutic threshold. It could be more
cost-effective to prioritize antihypertensive medications for people with
a high risk of developing cardiovascular disease.<br/>Copyright &#xa9;
2022 Mao, Ge, Qi and Tian.

<2>
Accession Number
2021752558
Title
Effect of a standardised heart team protocol versus a guideline-based
protocol on revascularisation decision stability in stable complex
coronary artery disease: Rationale and design of a randomised trial of
cardiology specialists using historic cases.
Source
BMJ Open. 12(12) (no pagination), 2022. Article Number: e064761. Date of
Publication: 01 Dec 2022.
Author
Ma H.; Lin S.; Li X.; Wang Y.; Xu B.; Zheng Z.
Institution
(Ma, Lin, Li, Zheng) National Clinical Research Center of Cardiovascular
Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Lin, Zheng) Department of Cardiovascular Surgery, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Li) Central China Sub-center, The National Center for Cardiovascular
Diseases, Zhengzhou, China
(Wang) Medical Research and Biometrics Center, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
(Xu) Catheterization Laboratories, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Zheng) National Health Commission Key Laboratory of Cardiovascular
Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch
of National Center for Cardiovascular Diseases, Zhengzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction A multidisciplinary heart team approach has been recommended
by revascularisation guidelines, but how to organise and implement the
heart team in a standardised way has not been validated. Inter-team and
intra-team decision instability existed in the guideline-based heart team
protocol, and our standardised heart team protocol based on a mixed method
study may improve decision stability. The objective of this study is to
evaluate the effect of the standardised heart team protocol versus the
guideline-based protocol on decision-making stability in stable complex
coronary artery disease (CAD). Methods and analysis Eighty-four eligible
interventional cardiologists, cardiac surgeons or non-interventional
cardiologists from 26 hospitals in China have been enrolled. They will be
randomised to a standardised heart team protocol group or a
guideline-based protocol group to make revascularisation decisions for 480
historic cases (from a prospective registry) with stable complex CAD. In
the standardised group, we will establish 12 heart teams based on an
evidence-based protocol, including specialist selection, specialist
training, team composition, team training and a standardised meeting
process. In the guideline-based group, we will organise 12 heart teams
according to the guideline principles, including team composition and
standardised meeting process. The primary outcome is the overall percent
agreement in revascularisation decisions between heart teams within a
group. To demonstrate the clinical implication of decision-making
stability, we will further explore the association between decision
stability and 1-year clinical outcomes. Ethics and dissemination The study
was approved by the Institutional Review Board (IRB) of Fuwai Hospital
(No. 2019-1303). All participants have provided informed consent and all
patients included as historic cases provided written informed consent at
the time of entry to the prospective registry. The results of this trial
will be disseminated through manuscript publication and
national/international conferences, and reported in the trial registry
entry. Trial registration number NCT05039567.<br/>Copyright &#xa9;

<3>
Accession Number
2019418739
Title
Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation With
Cardiogenic Shock Secondary to Mechanical Complication.
Source
Cardiovascular Revascularization Medicine. 45 (pp 44-50), 2022. Date of
Publication: December 2022.
Author
So C.-Y.; Kang G.; Lee J.C.; Frisoli T.M.; O'Neill B.; Wang D.D.; Eng
M.H.; O'Neill W.; Villablanca P.A.
Institution
(So, Kang, Lee, Frisoli, O'Neill, Wang, Eng, O'Neill, Villablanca) Center
for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, United
States
(So) Divison of Cardiology, Department of Medicine and Therapeutics,
Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR,
Hong Kong
Publisher
Elsevier Inc.
Abstract
Introduction: Acute MR due to mechanical mitral valve (MV) complications
frequently results in cardiogenic shock and requires emergency surgical
intervention. There was limited evidence for alternative treatment like
MitraClip for patients at prohibitive surgical risk. We aimed to study the
technical features and outcomes of emergency transcatheter edge-to-edge
repair (TEER) using the MitraClip system for patients with cardiogenic
shock (CS) secondary to acute mitral regurgitation (MR) and mechanical MV
complication. <br/>Material(s) and Method(s): We performed institutional
review and systemic literature review to identify all TEER for CS patients
due to acute mitral regurgitation and mechanical MV complication. Clinical
endpoints included device success rate assessed at the end of procedure,
ability to wean off MCS, all-cause and cardiovascular mortality at 30-day.
<br/>Result(s): Eight patients were identified from institutional review.
Detail anatomical analysis found that patients with mechanical MV
complications related to myocardial infarction had a lower transseptal
height achieved during MitraClip (3.6 +/- 0.1 cm vs 4.3 +/- 0.3 cm, p =
0.03) than those not related. Pooled analysis for cases from institutional
review (n = 8) and systemic literature review (n = 16) was performed. The
device success rate was 68.8 %. Seventy-five percent (n = 18) cases
required mechanical circulatory support (MCS), and 94.4 % were able to
wean off MCS. At 30-day, the cardiovascular mortality was 4.5 % and the
all-cause mortality was 9.1 %. <br/>Conclusion(s): In CS patients due to
acute MR and mechanical MV complications, TEER with/without MCS was
feasible with a reasonable device success rate.<br/>Copyright &#xa9; 2022
Elsevier Inc.

<4>
Accession Number
2018812407
Title
Factors and outcomes associated with improved left ventricular systolic
function in patients with cardiomyopathy.
Source
Cardiology Journal. 29(6) (pp 978-984), 2022. Date of Publication: 2022.
Author
Eiger D.S.; Inoue L.Y.T.; Li Q.; Bardy G.; Lee K.; Poole J.; Mark D.;
Samad Z.; Friedman D.; Fishbein D.; Sanders G.; Al-Khatib S.M.
Institution
(Eiger, Lee, Mark, Samad, Friedman, Sanders, Al-Khatib) Department of
Medicine, Duke University, Durham, NC, United States
(Inoue, Li) Department of Biostatistics, University of Washington,
Seattle, WA, United States
(Bardy) The Seattle Institute for Cardiac Research, Seattle, WA, United
States
(Lee) Department of Biostatistics and Bioinformatics, Duke University,
Durham, NC, United States
(Poole, Fishbein) Department of Medicine, University of Washington,
Seattle, WA, United States
(Mark, Sanders, Al-Khatib) Duke Clinical Research Institute, Duke
University, Durham, NC, United States
Publisher
Via Medica
Abstract
Background: Many patients in the Sudden Cardiac Death in Heart Failure
Trial (SCD-HeFT) had a significant improvement (> 10%) in the left
ventricular ejection fraction (LVEF) during the course of the study, but
the factors and outcomes associated with such improvement are uncertain.
<br/>Method(s): We examined factors and rates of mortality, cause-specific
mortality, and implantable cardioverter-defibrillator (ICD) shocks
associated with improvement in LVEF by analyzing patients in the SCD-HeFT
who were randomized to placebo or an ICD and who had an LVEF checked
during follow-up. <br/>Result(s): During a median follow-up of 3.99 years,
of 837 patients who had at least two follow-up LVEF measurements, 276
(33%) patients had > 10% improvement in LVEF and 561 (67%) patients had no
significant change in LVEF. Factors significantly associated with LVEF
improvement included female sex, white race, history of hypertension, a
QRS duration < 120 ms, and beta-blocker use. Improvement in LVEF was
associated with a significant improvement in survival. There was no
significant association between improvement in LVEF and cause-specific
death, but there was a significant association between improvement in LVEF
and reduced risk of receiving appropriate ICD shocks. <br/>Conclusion(s):
About a third of patients in this analysis, who were randomized to placebo
or an ICD in SCD-HeFT, had a significant improvement in LVEF during
follow-up; improvement in LVEF was associated with improved survival but
not with cause-specific death, and with decreased likelihood of receiving
appropriate ICD shocks.<br/>Copyright &#xa9; 2022 Via Medica.

<5>
Accession Number
2020371176
Title
The role of stress echocardiography in transcatheter aortic valve
implantation and transcatheter edge-to-edge repair era: A systematic
review.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 964669. Date of Publication: 16 Nov 2022.
Author
Pavasini R.; Fabbri G.; Bianchi N.; Deserio M.A.; Sanguettoli F.;
Zanarelli L.; Tonet E.; Passarini G.; Serenelli M.; Campo G.
Institution
(Pavasini, Fabbri, Bianchi, Deserio, Sanguettoli, Zanarelli, Tonet,
Passarini, Serenelli, Campo) Cardiology Unit, Azienda
Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
Publisher
Frontiers Media S.A.
Abstract
Objectives: In the last decade, percutaneous treatment of valve disease
has changed the approach toward the treatment of aortic stenosis (AS) and
mitral regurgitation (MR). The clinical usefulness of stress
echocardiography (SE) in the candidates for transcatheter aortic valve
implantation (TAVI) and transcatheter edge-to-edge repair (TEER) of MR
remains to be established. Therefore, the key aim of this review is to
assess the main applications of SE in patients undergoing TAVI or TEER.
<br/>Method(s): We searched for relevant studies to be included in the
systematic review on PubMed (Medline), Cochrane library, Google Scholar,
and Biomed Central databases. The literature search was conducted in
February 2022. The inclusion criteria of the studies were: observational
and clinical trials or meta-analysis involving patients with AS or MR
evaluated with SE (excluding those in which SE was used only for screening
of pseudo-severe stenosis) and treated with percutaneous procedures.
<br/>Result(s): Thirteen studies published between 2013 and 2021 were
included in the review: five regarding candidates for TEER and eight for
TAVI. In TEER candidates, seeing an increase in MR grade, and stroke
volume of >40% during SE performed before treatment was, respectively,
related to clinical benefits (p = 0.008) and an increased quality of life.
Moreover, overall, 25% of patients with moderate secondary MR at rest
before TEER had the worsening of MR during SE. At the same time, in SE
performed after TEER, an increase in mean transvalvular diastolic gradient
and in systolic pulmonary pressure is expected, but without sign and
symptoms of heart failure. Regarding TAVI, several studies showed that
contractile reserve (CR) is not predictive of post-TAVI ejection fraction
recovery and mortality in low-flow low-gradient AS either at 30 days or at
long-term. <br/>Conclusion(s): This systematic review shows in TEER
candidates, SE has proved useful in the optimization of patient selection
and treatment response, while its role in TAVI candidates is less defined.
Therefore, larger trials are needed to test and confirm the utility of SE
in candidates for percutaneous procedures of valve diseases.<br/>Copyright
&#xa9; 2022 Pavasini, Fabbri, Bianchi, Deserio, Sanguettoli, Zanarelli,
Tonet, Passarini, Serenelli and Campo.

<6>
Accession Number
2018303424
Title
Key Components, Current Practice and Clinical Outcomes of ERAS Programs in
Patients Undergoing Orthopedic Surgery: A Systematic Review.
Source
Journal of Clinical Medicine. 11(14) (no pagination), 2022. Article
Number: 4222. Date of Publication: July 2022.
Author
Salamanna F.; Contartese D.; Brogini S.; Visani A.; Martikos K.; Griffoni
C.; Ricci A.; Gasbarrini A.; Fini M.
Institution
(Salamanna, Contartese, Brogini, Visani, Fini) Complex Structure Surgical
Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna
40136, Italy
(Martikos, Griffoni, Gasbarrini) Spine Surgery Unit, IRCCS Istituto
Ortopedico Rizzoli, Bologna 40136, Italy
(Ricci) Anesthesia-Resuscitation and Intensive Care, IRCCS Istituto
Ortopedico Rizzoli, Bologna 40136, Italy
Publisher
MDPI
Abstract
Enhanced recovery after surgery (ERAS) protocols have led to improvements
in outcomes in several surgical fields, through multimodal optimization of
patient pathways, reductions in complications, improved patient
experiences and reductions in the length of stay. However, their use has
not been uniformly recognized in all orthopedic fields, and there is still
no consensus on the best implementation process. Here, we evaluated pre-,
peri-, and post-operative key elements and clinical evidence of ERAS
protocols, measurements, and associated outcomes in patients undergoing
different orthopedic surgical procedures. A systematic literature search
on PubMed, Scopus, and Web of Science Core Collection databases was
conducted to identify clinical studies, from 2012 to 2022. Out of the 1154
studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on
elbow surgery and 143 on hip and/or knee surgery) were considered eligible
for this review. Results showed that ERAS protocols improve the recovery
from orthopedic surgery, decreasing the length of hospital stays (LOS) and
the readmission rates. Comparative studies between ERAS and non-ERAS
protocols also showed improvement in patient pain scores, satisfaction,
and range of motion. Although ERAS protocols in orthopedic surgery are
safe and effective, future studies focusing on specific ERAS elements, in
particular for elbow, thorax and spine, are mandatory to optimize the
protocols.<br/>Copyright &#xa9; 2022 by the authors.

<7>
Accession Number
2021409769
Title
Methodological quality of studies assessing validity and reliability of
the European Heart Failure Self-care Behaviour Scale: a systematic review
using the COSMIN methodology.
Source
European Journal of Cardiovascular Nursing. 20(5) (pp 501-512), 2021. Date
of Publication: 01 Jun 2021.
Author
Koberich S.; Kato N.P.; Kugler C.; Stromberg A.; Jaarsma T.
Institution
(Koberich) Medical Center - University of Freiburg, Nursing Direction,
Breisacher Str., Freiburg 79085, Germany
(Kato, Stromberg, Jaarsma) Division of Nursing Sciences and Reproductive
Health, Department of Health, Medicine and Caring Sciences, Linkoping
University, Linkoping SE-581 83, Sweden
(Kugler) Institute of Nursing Science, Faculty of Medicine,
Albert-Ludwigs-University of Freiburg, Breisacher Str. 153, Freiburg
79110, Germany
(Stromberg) Department of Cardiology, Linkoping University, Linkoping
SE-581 83, Sweden
Publisher
Oxford University Press
Abstract
Aims: The European Heart Failure Self-care Behaviour Scale (EHFScBS) is
frequently used to assess self-care behaviours in patients with heart
failure. This scale has been translated into several languages. The
COnsensus-based Standards for the selection of health status Measurement
INstrument (COSMIN) Risk of Bias checklist for a systematic review has
recently been published. The aim of the study was to assess the
methodological quality of studies reporting on psychometric evaluations of
the EHFScBS using the COSMIN methodology. <br/>Methods and Results: To
identify relevant studies, a systematic literature search was performed
using PubMed and CINAHL databases in December 2019 and the search was
updated in June 2020. The COSMIN Risk of Bias checklist was used to assess
the methodological quality. In total, 21 relevant studies were rated. The
overall methodological quality of content validity was rated as inadequate
in 17 studies and a main reason of the inadequate rating was a lack of
patient involvement. Structural validity was adequately addressed in 12
studies, internal consistency in seven, and eight of 11 studies reporting
on construct validity and had good methodological quality.
<br/>Conclusion(s): Although the use of the EHFScBS has grown rapidly and
the validity and reliability are reported to be good, the methodological
quality of studies reporting on psychometric properties of the scale is
not optimal. Further studies are necessary to strengthen the evidence on
validity and reliability of the EHFScBS.<br/>Copyright &#xa9; 2021 The
Author(s). Published by Oxford University Press on behalf of the European
Society of Cardiology.

<8>
Accession Number
2021409763
Title
Effect of nurse-initiated forced-air warming blanket on the reduction of
hypothermia complications following coronary artery bypass grafting: a
randomized clinical trial.
Source
European Journal of Cardiovascular Nursing. 20(5) (pp 445-453), 2021. Date
of Publication: 01 Jun 2021.
Author
Bezerra A.S.D.M.; Santos V.B.; Lopes C.T.; De Barros A.L.B.L.
Institution
(Bezerra, Santos, Lopes, De Barros) Escola Paulista de Enfermagem,
Universidade Federal de Sao Paulo (EPE-UNIFESP), Departamento de
Enfermagem Clinica e Cirurgica and Programa de Pos Graduacao em
Enfermagem, 754 Napoleao de Barros St, Vila Clementino, Sao Paulo-SP
04024-002, Brazil
(Bezerra) Instituto Dante Pazzanese de Cardiologia (IDPC), Divisao de
Enfermagem, 500 Dr Dante Pazzanese Av, Ibirapuera, Sao Paulo-SP 04012-909,
Brazil
Publisher
Oxford University Press
Abstract
Aims: To evaluate the effect of postoperative forced-air warming (FAW) on
the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial
infarction (AMI), and blood product transfusion in hypothermic patients
following on-pump CABG and compare temperatures associated with the use of
FAW and warming with a sheet and wool blanket. <br/>Methods and Results: A
randomized clinical trial conducted with 200 patients undergoing isolated
on-pump CABG from January to November 2018. Patients were randomly
assigned into an Intervention Group (IG, FAW, n = 100) and Control Group
(CG, sheet and blanket, n = 100). The tympanic temperature of all patients
was measured over a 24-h period. ExB was the primary outcome, while
arrhythmia, AMI, and blood product transfusion were secondary outcomes.
The effect of the interventions on the outcomes was investigated through
using bivariate logistic regression, with a level of significance of 5%.
The IG was 79% less likely to experience bleeding than the CG [odds ratio
(OR) = 0.21, confidence interval (CI) 95% 0.12-0.39, P < 0.001]; the
occurrence of AMI in the IG was 94% lower than that experienced by the CG
(OR = 0.06, CI 95% 0.01-0.48, P < 0.001); and the IG was also 77% less
likely to experience arrhythmia than the CG (OR = 0.23, CI 95% 0.12-0.47,
P < 0.001); no difference was found between groups in terms of blood
product transfusion (P < 0.279). <br/>Conclusion(s): These findings show
that FAW can be used following CABG until patients reach normothermia to
avoid undesirable clinical outcomes. Trial registration: REBeC
RBR-5t582g.<br/>Copyright &#xa9; 2020 Published on behalf of the European
Society of Cardiology. All rights reserved.

<9>
Accession Number
2020127723
Title
Efficacy and safety of degludec U100 versus glargine U300 for the early
postoperative management of patients with type 2 diabetes mellitus
undergoing coronary artery bypass graft surgery: A non-inferiority
randomized trial.
Source
Diabetic Medicine. 40(1) (no pagination), 2023. Article Number: e15002.
Date of Publication: January 2023.
Author
Kuchay M.S.; Mathew A.; Mishra M.; Surendran P.; Kaur P.; Wasir J.S.; Gill
H.K.; Jain R.; Gagneja S.; Kohli C.; Kumari P.; Singh M.K.; Mishra S.K.
Institution
(Kuchay, Mathew, Mishra, Kaur, Wasir, Gill, Jain, Gagneja, Kohli, Kumari,
Mishra) Division of Endocrinology and Diabetes, Medanta-The Medicity
Hospital, Gurugram, India
(Surendran, Singh) Department of Clinical Research and Studies,
Medanta-The Medicity Hospital, Gurugram, India
Publisher
John Wiley and Sons Inc
Abstract
Aims: To compare the efficacy and safety of degludec U100 versus glargine
U300 for the early postoperative management of patients with type 2
diabetes mellitus (T2D) undergoing coronary artery bypass graft (CABG)
surgery. <br/>Method(s): A total of 239 patients were randomly assigned
(1:1) to receive a basal-bolus regimen in the early postoperative period
using degludec U100 (n = 122) or glargine U300 (n = 117) as basal and
glulisine before meals. The primary outcome was mean differences between
groups in their daily BG concentrations. The major safety outcome was the
occurrence of hypoglycemia. <br/>Result(s): There were no differences in
mean daily BG concentrations (157 vs. 162 mg/dl), mean percentage of
readings within target BG of 70-180 mg/dl (74% vs. 73%), daily basal
insulin dose (19 vs. 21 units/day), length of stay (median [IQR]: 9 vs. 9
days), or hospital complications (21.3% vs. 21.4%) between treatment
groups. There were no differences in the proportion of patients with BG
<70 mg/dl (15.6% vs. 23.1%) or <54 mg/dl (1.6% vs. 4.3%) between
degludec-100 and glargine-300 groups. <br/>Conclusion(s): Treatment with
degludec U100 is as effective and safe as glargine U300 for the early
postoperative hospital management of patients with T2D undergoing
CABG.<br/>Copyright &#xa9; 2022 Diabetes UK.

<10>
Accession Number
2021730088
Title
The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus
Document: Management of infants and neonates with tetralogy of Fallot.
Source
Journal of Thoracic and Cardiovascular Surgery. 165(1) (pp 221-250), 2023.
Date of Publication: January 2023.
Author
Miller J.R.; Stephens E.H.; Goldstone A.B.; Glatz A.C.; Kane L.; Van
Arsdell G.S.; Stellin G.; Barron D.J.; d'Udekem Y.; Benson L.;
Quintessenza J.; Ohye R.G.; Talwar S.; Fremes S.E.; Emani S.M.; Eghtesady
P.
Institution
(Miller, Eghtesady) Section of Pediatric Cardiothoracic Surgery,
Department of Surgery, Washington University School of Medicine in St
Louis/St Louis Children's Hospital, St Louis, Mo, United States
(Stephens) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
Minn, United States
(Goldstone) Section of Congenital and Pediatric Cardiac Surgery, Division
of Cardiothoracic Surgery, Columbia University, New York, NY, United
States
(Glatz) Division of Pediatrics, Department of Pediatric Cardiology,
Washington University School of Medicine in St Louis/St Louis Children's
Hospital, St Louis, Mo, United States
(Kane) Transmedics, Inc, Andover, Mass, United States
(Van Arsdell) Division of Cardiothoracic Surgery, Department of Surgery,
UCLA Mattel Children's Hospital, Los Angeles, Calif, United States
(Stellin) Pediatric and Congenital Cardiac Surgery Unit, Department of
Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Barron) Division of Cardiovascular Surgery, The Hospital for Sick
Children, Toronto, ON, Canada
(d'Udekem) Division of Cardiac Surgery, Children's National Heart
Institute, Children's National Hospital, Washington, DC, United States
(Benson) Division of Pediatric Cardiology, The Hospital for Sick Children,
Toronto, ON, Canada
(Quintessenza) Department of Cardiovascular Surgery, Johns Hopkins All
Children's Heart Institute, St Petersburg, Fla, United States
(Ohye) Section of Pediatric Cardiovascular Surgery, Department of Cardiac
Surgery, University of Michigan Medical School, Ann Arbor, Mich, United
States
(Talwar) Department of Cariothoracic and Vascular Surgery, All India
Institute of Medical Sciences, New Delhi, India
(Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
(Emani) Department of Cardiovascular Surgery, Boston Children's Hospital,
Boston, Mass, United States
Publisher
Elsevier Inc.
Abstract
Objective: Despite decades of experience, aspects of the management of
tetralogy of Fallot with pulmonary stenosis (TOF) remain controversial.
Practitioners must consider newer, evolving treatment strategies with
limited data to guide decision making. Therefore, the TOF Clinical
Practice Standards Committee was commissioned by the American Association
for Thoracic Surgery to provide a framework on this topic, focused on
timing and types of interventions, management of high-risk patients,
technical considerations during interventions, and best practices for
assessment of outcomes of the interventions. In addition, the group was
tasked with identifying pertinent research questions for future
investigations. It is recognized that variability in institutional
experience could influence the application of this framework to clinical
practice. <br/>Method(s): The TOF Clinical Practice Standards Committee is
a multinational, multidisciplinary group of cardiologists and surgeons
with expertise in TOF. With the assistance of a medical librarian, a
citation search in PubMed, Embase, Scopus, and Web of Science was
performed using key words related to TOF and its management; the search
was restricted to the English language and the year 2000 or later.
Articles pertaining to pulmonary atresia, absent pulmonary valve,
atrioventricular septal defects, and adult patients with TOF were
excluded, as well as nonprimary sources such as review articles. This
yielded nearly 20,000 results, of which 163 were included. Greater
consideration was given to more recent studies, larger studies, and those
using comparison groups with randomization or propensity score matching.
Expert consensus statements with class of recommendation and level of
evidence were developed using a modified Delphi method, requiring 80% of
the member votes with 75% agreement on each statement. <br/>Result(s): In
asymptomatic infants, complete surgical correction between age 3 and 6
months is reasonable to reduce the length of stay, rate of adverse events,
and need for a transannular patch. In the majority of symptomatic
neonates, both palliation and primary complete surgical correction are
useful treatment options. It is reasonable to consider those with low
birth weight or prematurity, small or discontinuous pulmonary arteries,
chromosomal anomalies, other congenital anomalies, or other comorbidities
such as intracranial hemorrhage, sepsis, or other end-organ compromise as
high-risk patients. In these high-risk patients, palliation may be
preferred; and, in patients with amenable anatomy, catheter-based
procedures may prove favorable over surgical palliation.
<br/>Conclusion(s): Ongoing research will provide further insight into the
role of catheter-based interventions. For complete surgical correction,
both transatrial and transventricular approaches are effective; however,
the smallest possible ventriculotomy should be utilized. When possible,
the pulmonary valve should be spared; and if unsalvageable, reconstruction
can be considered. At the conclusion of the operation, adequate relief of
the right ventricular outflow obstruction should be confirmed, and
identification of a significant fixed anatomical obstruction should prompt
further intervention. Given our current knowledge and the gaps identified,
we propose several key questions to be answered by future research and
potentially by a TOF registry: When to palliate or proceed with complete
surgical correction, as well as the ideal type of palliation; the optimal
surgical approach for complete repair for the best long-term preservation
of right ventricular function; and the utility, efficacy, and durability
of various pulmonary valve preservation and reconstruction
techniques.<br/>Copyright &#xa9; 2022 The American Association for
Thoracic Surgery

<11>
Accession Number
639802093
Title
Joint 2022 European Society of Thoracic Surgeons and The American
Association for Thoracic Surgery guidelines for the prevention of
cancer-associated venous thromboembolism in thoracic surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 63(1) (no pagination),
2022. Date of Publication: 02 Dec 2022.
Author
Shargall Y.; Wiercioch W.; Brunelli A.; Murthy S.; Hofstetter W.; Lin J.;
Li H.; Linkins L.-A.; Crowther M.; Davis R.; Rocco G.; Morgano G.P.;
Schunemann F.; Muti-Schunemann G.; Douketis J.; Schunemann H.J.; Litle
V.R.
Institution
(Shargall) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Wiercioch, Morgano, Muti-Schunemann, Schunemann) Department of Health
Research Methods, Evidence, and Impact, McMaster University, Hamilton,
Ontario, Canada
(Brunelli) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
(Murthy) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Hofstetter) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Houston, TX, United States
(Lin) Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI,
United States
(Li) Department of Thoracic Surgery, Capital Medical University, Beijing,
China
(Linkins, Crowther, Douketis, Schunemann) Department of Medicine, McMaster
University, Hamilton, Ontario, Canada
(Davis) Patient Representative, Burlington, ON, Canada
(Rocco) Memorial Sloan Kettering Cancer Center, New York, NY
(Schunemann) Medizinische Fakultat, Albert-Ludwigs-Universitat Freiburg,
Freiburg, Germany
(Litle) Department of Surgery, Boston University School of Medicine,
Boston, MA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Venous thromboembolism (VTE), which includes deep vein
thrombosis and pulmonary embolism, is a potentially fatal but preventable
postoperative complication. Thoracic oncology patients undergoing surgical
resection, often after multimodality induction therapy, represent among
the highest risk groups for postoperative VTE. Currently there are no VTE
prophylaxis guidelines specific to these thoracic surgery patients.
Evidenced-based recommendations will help clinicians manage and mitigate
risk of VTE in the postoperative period and inform best practice.
<br/>OBJECTIVE(S): These joint evidence-based guidelines from The American
Association for Thoracic Surgery and the European Society of Thoracic
Surgeons aim to inform clinicians and patients in decisions about
prophylaxis to prevent VTE in patients undergoing surgical resection for
lung or esophageal cancer. <br/>METHOD(S): The American Association for
Thoracic Surgery and the European Society of Thoracic Surgeons formed a
multidisciplinary guideline panel that included broad membership to
minimize potential bias when formulating recommendations. The McMaster
University GRADE Centre supported the guideline development process,
including updating or performing systematic evidence reviews. The panel
prioritized clinical questions and outcomes according to their importance
for clinicians and patients. The Grading of Recommendations Assessment,
Development and Evaluation (GRADE) approach was used, including GRADE
Evidence-to-Decision frameworks, which were subject to public comment.
<br/>RESULT(S): The panel agreed on 24 recommendations focused on
pharmacological and mechanical methods for prophylaxis in patients
undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy,
as well as extended resections for lung cancer. <br/>CONCLUSION(S): The
certainty of the supporting evidence for the majority of recommendations
was judged as low or very low, largely due to a lack of direct evidence
for thoracic surgery. The panel made conditional recommendations for use
of parenteral anticoagulation for VTE prevention, in combination with
mechanical methods, over no prophylaxis for cancer patients undergoing
anatomic lung resection or esophagectomy. Other key recommendations
include: conditional recommendations for using parenteral anticoagulants
over direct oral anticoagulants, with use of direct oral anticoagulants
suggested only in the context of clinical trials; conditional
recommendation for using extended prophylaxis for 28 to 35 days over
in-hospital prophylaxis only for patients at moderate or high risk of
thrombosis; and conditional recommendations for VTE screening in patients
undergoing pneumonectomy and esophagectomy. Future research priorities
include the role of preoperative thromboprophylaxis and the role of risk
stratification to guide use of extended prophylaxis. (J Thorac Cardiovasc
Surg 2022;:1-31).<br/>Copyright &#xa9; 2022 The American Association for
Thoracic Surgery, European Association for Cardio-Thoracic Surgery
Published by Elsevier Inc and Oxford University Press. All rights
reserved.

<12>
Accession Number
2020627036
Title
Association between intraoperative oliguria and postoperative acute kidney
injury in non-cardiac surgical patients: a systematic review and
meta-analysis.
Source
Journal of Anesthesia. (no pagination), 2022. Date of Publication: 2022.
Author
Milder D.A.; Liang S.S.; Ong S.G.K.; Kam P.C.A.
Institution
(Milder, Liang) Department of Anaesthesia, Westmead Hospital, Westmead,
Australia
(Ong) Department of Anaesthesiology, Sengkang General Hospital, Singapore,
Singapore
(Ong) Department of Surgical Intensive Care, Singapore General Hospital,
Singapore, Singapore
(Kam) Discipline of Anaesthesia, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW 2006, Australia
Publisher
Springer
Abstract
Purpose: This systematic review and meta-analysis aimed to evaluate the
association between intraoperative oliguria and the risk of postoperative
acute kidney injury (AKI) in patients undergoing non-cardiac surgery.
<br/>Method(s): The MEDLINE and EMBASE databases were searched up to
August 2022 for studies in adult patients undergoing non-cardiac surgery,
where the association between intraoperative urine output and the risk of
postoperative AKI was assessed. Both randomised and non-randomised studies
were eligible for inclusion. Study selection and risk of bias assessment
were independently performed by two investigators. The risk of bias was
evaluated using the Newcastle-Ottawa scale. We performed meta-analysis of
the reported multivariate adjusted odds ratios for the association between
intraoperative oliguria (defined as urine output < 0.5 mL/kg/hr) and the
risk of postoperative AKI using the inverse-variance method with random
effects models. We conducted sensitivity analyses using varying
definitions of oliguria as well as by pooling unadjusted odds ratios to
establish the robustness of the primary meta-analysis. We also conducted
subgroup analyses according to surgery type and definition of AKI to
explore potential sources of clinical or methodological heterogeneity.
<br/>Result(s): Eleven studies (total 49,252 patients from 11
observational studies including a post hoc analysis of a randomised
controlled trial) met the selection criteria. Seven of these studies
contributed data from a total 17,148 patients to the primary
meta-analysis. Intraoperative oliguria was associated with a significantly
elevated risk of postoperative AKI (pooled adjusted odds ratio [OR] 1.74;
95% confidence interval [CI] 1.36-2.23, p < 0.0001, 8 studies).
Sensitivity analyses supported the robustness of the primary
meta-analysis. There was no evidence of any significant subgroup
differences according to surgery type or definition of AKI.
<br/>Conclusion(s): This study demonstrated a significant association
between intraoperative oliguria and the risk of postoperative AKI,
regardless of the definitions of oliguria or AKI used. Further prospective
and multi-centre studies using standardised definitions of intraoperative
oliguria are required to define the thresholds of oliguria and establish
strategies to minimise the risk of AKI.<br/>Copyright &#xa9; 2022, The
Author(s) under exclusive licence to Japanese Society of
Anesthesiologists.

<13>
Accession Number
2020594490
Title
Early and Late Postoperative Tachyarrhythmias in Children and Young Adults
Undergoing Congenital Heart Disease Surgery.
Source
Pediatric Cardiology. (no pagination), 2022. Date of Publication: 2022.
Author
Joye R.; Beghetti M.; Wacker J.; Malaspinas I.; Bouhabib M.; Polito A.;
Bordessoule A.; Shah D.
Institution
(Joye, Beghetti, Wacker, Malaspinas, Bouhabib) Pediatric Cardiology Unit,
Department of Woman, Child, and Adolescent Medicine, Geneva University
Hospital, Geneva, Switzerland
(Polito, Bordessoule) Pediatric Intensive Care Unit, Department of Woman,
Child, and Adolescent Medicine, Geneva University Hospital, Geneva,
Switzerland
(Shah) Electrophysiology Unit, Cardiology Division, Geneva University
Hospital, Geneva, Switzerland
Publisher
Springer
Abstract
The population of patients with congenital heart disease is constantly
growing with an increasing number of individuals reaching adulthood. A
significant proportion of these children and young adults will suffer from
tachyarrhythmias due to the abnormal anatomy, the hemodynamic burden, or
as a sequela of surgical treatment. Depending on the underlying mechanism,
arrhythmias may arise in the early postoperative period (hours to days
after surgery) or in the late postoperative period (usually years after
surgery). A good understanding of the electrophysiological characteristics
and pathophysiological mechanisms is therefore crucial to guide the
therapeutic approach. Here, we synthesize the current state of knowledge
on epidemiological features, risk factors, pathophysiological insights,
electrophysiological features, and therapy regarding tachyarrhythmias in
children and young adults undergoing reparative surgery for congenital
heart disease. The evolution and latest data on treatment options,
including pharmacological therapy, ablation procedures, device therapy
decision, and thromboprophylaxis, are summarized. Finally, throughout this
comprehensive review, knowledge gaps and areas for future research are
also identified.<br/>Copyright &#xa9; 2022, The Author(s).

<14>
Accession Number
639806273
Title
Impact of video-assisted thoracoscopic lobectomy versus open lobectomy for
lung cancer on recovery assessed using self-reported physical function:
VIOLET RCT.
Source
Health technology assessment (Winchester, England). 26(48) (pp 1-162),
2022. Date of Publication: 01 Dec 2022.
Author
Lim E.; Harris R.A.; McKeon H.E.; Batchelor T.J.; Dunning J.; Shackcloth
M.; Anikin V.; Naidu B.; Belcher E.; Loubani M.; Zamvar V.; Dabner L.;
Brush T.; Stokes E.A.; Wordsworth S.; Paramasivan S.; Realpe A.; Elliott
D.; Blazeby J.; Rogers C.A.
Institution
(Lim, Anikin) Academic Division of Thoracic Surgery, Royal Brompton and
Harefield Hospitals, London, United Kingdom
(Harris, McKeon, Dabner, Brush, Rogers) Clinical Trials and Evaluation
Unit, Bristol Trials Centre, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Batchelor) Thoracic Surgery, University Hospitals Bristol and Weston NHS
Foundation Trust, Bristol Royal Infirmary, Bristol, United Kingdom
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United
Kingdom
(Shackcloth) Department of Thoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Naidu) Department of Thoracic Surgery, Institute of Inflammation and
Ageing, University of Birmingham, Birmingham, United Kingdom
(Belcher) Cardiothoracic Surgery, John Radcliffe Hospital, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Loubani) Department of Cardiothoracic Surgery, Castle Hill Hospital,
Cottingham, United Kingdom
(Zamvar) Department of Cardiothoracic Surgery, Edinburgh Royal Infirmary,
Edinburgh, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Oxford, United Kingdom
(Stokes, Wordsworth) National Institute for Health and Care Research
Oxford Biomedical Research Centre, Oxford, United Kingdom
(Paramasivan, Realpe) Population Health Sciences, Bristol Medical School,
University of Bristol, Bristol, United Kingdom
(Elliott, Blazeby) National Institute for Health and Care Research Bristol
and Weston Biomedical Research Centre, Surgical Innovation Theme, Centre
for Surgical Research, Bristol Medical School, University of Bristol,
Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Lung cancer is the leading cause of cancer death. Surgery
remains the main method of managing early-stage disease. Minimal-access
video-assisted thoracoscopic surgery results in less tissue trauma than
open surgery; however, it is not known if it improves patient outcomes.
<br/>OBJECTIVE(S): To compare the clinical effectiveness and
cost-effectiveness of video-assisted thoracoscopic surgery lobectomy with
open surgery for the treatment of lung cancer. DESIGN, SETTING AND
PARTICIPANTS: A multicentre, superiority, parallel-group, randomised
controlled trial with blinding of participants (until hospital discharge)
and outcome assessors conducted in nine NHS hospitals. Adults referred for
lung resection for known or suspected lung cancer, with disease suitable
for both surgeries, were eligible. Participants were followed up for 1
year. INTERVENTIONS: Participants were randomised 1:1 to video-assisted
thoracoscopic surgery lobectomy or open surgery. Video-assisted
thoracoscopic surgery used one to four keyhole incisions without rib
spreading. Open surgery used a single incision with rib spreading, with or
without rib resection. MAIN OUTCOME MEASURES: The primary outcome was
self-reported physical function (using the European Organisation for
Research and Treatment of Cancer Quality of Life Questionnaire Core 30) at
5 weeks. Secondary outcomes included upstaging to pathologic node stage 2
disease, time from surgery to hospital discharge, pain in the first 2
days, prolonged pain requiring analgesia at >5 weeks, adverse health
events, uptake of adjuvant treatment, overall and disease-free survival,
quality of life (Quality of Life Questionnaire Core 30, Quality of Life
Questionnaire Lung Cancer 13 and EQ-5D) at 2 and 5 weeks and 3, 6 and 12
months, and cost-effectiveness. <br/>RESULT(S): A total of 503 patients
were randomised between July 2015 and February 2019 (video-assisted
thoracoscopic surgery, n=247; open surgery, n=256). One participant
withdrew before surgery. The mean age of patients was 69 years; 249
(49.5%) patients were men and 242 (48.1%) did not have a confirmed
diagnosis. Lobectomy was performed in 453 of 502 (90.2%) participants and
complete resection was achieved in 429 of 439 (97.7%) participants.
Quality of Life Questionnaire Core 30 physical function was better in the
video-assisted thoracoscopic surgery group than in the open-surgery group
at 5 weeks (video-assisted thoracoscopic surgery, n=247; open surgery,
n=255; mean difference 4.65, 95% confidence interval 1.69 to 7.61;
p=0.0089). Upstaging from clinical node stage 0 to pathologic node stage 1
and from clinical node stage 0 or 1 to pathologic node stage 2 was similar
(p>=0.50). Pain scores were similar on day 1, but lower in the
video-assisted thoracoscopic surgery group on day 2 (mean difference
-0.54, 95% confidence interval -0.99 to -0.09; p=0.018). Analgesic
consumption was 10% lower (95% CI -20% to 1%) and the median hospital stay
was less (4 vs. 5 days, hazard ratio 1.34, 95% confidence interval 1.09,
1.65; p=0.006) in the video-assisted thoracoscopic surgery group than in
the open-surgery group. Prolonged pain was also less (relative risk 0.82,
95% confidence interval 0.72 to 0.94; p=0.003). Time to uptake of adjuvant
treatment, overall survival and progression-free survival were similar
(p>=0.28). Fewer participants in the video-assisted thoracoscopic surgery
group than in the open-surgery group experienced complications before and
after discharge from hospital (relative risk 0.74, 95% confidence interval
0.66 to 0.84; p<0.001 and relative risk 0.81, 95% confidence interval 0.66
to 1.00; p=0.053, respectively). Quality of life to 1 year was better
across several domains in the video-assisted thoracoscopic surgery group
than in the open-surgery group. The probability that video-assisted
thoracoscopic surgery is cost-effective at a willingness-to-pay threshold
of 20,000 per quality-adjusted life-year is 1. LIMITATIONS: Ethnic
minorities were under-represented compared with the UK population (<5%),
but the cohort reflected the lung cancer population. <br/>CONCLUSION(S):
Video-assisted thoracoscopic surgery lobectomy was associated with less
pain, fewer complications and better quality of life without any
compromise to oncologic outcome. Use of video-assisted thoracoscopic
surgery is highly likely to be cost-effective for the NHS. FUTURE WORK:
Evaluation of the efficacy of video-assisted thoracoscopic surgery with
robotic assistance, which is being offered in many hospitals. TRIAL
REGISTRATION: This trial is registered as ISRCTN13472721. FUNDING: This
project was funded by the National Institute for Health and Care Research
( NIHR ) Health Technology Assessment programme and will be published in
full in Health Technology Assessment; Vol. 26, No. 48. See the NIHR
Journals Library website for further project information.

<15>
Accession Number
639806010
Title
Efficacy and Safety of NOACs Compared With VKAs for Patients With Atrial
Fibrillation After Transcatheter Aortic Valve Implantation: A System
Review and Meta-Analysis.
Source
Clinical and applied thrombosis/hemostasis : official journal of the
International Academy of Clinical and Applied Thrombosis/Hemostasis. 28
(pp 10760296221145168), 2022. Date of Publication: 01 Jan 2022.
Author
Ge J.; Han W.; Ma C.; Maduray K.; Chen T.; Zhong J.
Institution
(Ge, Han, Ma, Maduray, Chen, Zhong) Key Laboratory of Cardiovascular
Remodeling and Function Research, Chinese Ministry of Education, Chinese
National Health Commission and Chinese Academy of Medical Sciences, State
and Shandong Province Joint Key Laboratory of Translational Cardiovascular
Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of
Medicine, Shandong University, Jinan, China
(Zhong) Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College
of Medicine, Shandong University, Qingdao, China
Publisher
NLM (Medline)
Abstract
Novel oral anticoagulants (NOACs) are preferentially recommended in
patients with nonvalvular atrial fibrillation (AF) for stroke prevention
over vitamin K antagonists (VKAs). However, the evidence regarding the
efficacy and safety of NOACs versus VKAs after transcatheter aortic valve
implantation (TAVI) in patients with AF is very rare. Pubmed, Embase, Web
of science, and Cochrane Databases were searched for eligible studies
published before May 19, 2022. A total of 11 studies were included in this
meta-analysis involving 27107 patients. Regarding primary outcomes, there
were no differences between NOACs and VKAs in all-cause mortality (RR:
0.84, 95% CI: (0.69, 1.02)) and stroke (RR: 1.00, 95% CI: (0.85, 1.19)).
With respect to secondary outcomes, NOACs were associated with reduced
incidence of bleeding (RR: 0.77, 95% CI: (0.71, 0.83)) and intracranial
bleeding (RR: 0.57, 95% CI: (0.39, 0.83)), whereas no significant
differences were found in major or life-threatening bleeding (RR: 0.98,
95% CI: (0.82, 1.17)) and myocardial infarction (RR: 1.37, 95% CI: (0.83,
2.26)). Our meta-analysis revealed the safety and efficacy of NOACs may be
superior to VKAs in AF patients undergoing TAVI.

<16>
Accession Number
639805118
Title
Efficacy of perioperative intravenous lidocaine infusion on postoperative
pulmonary complications in patients undergoing video-assisted
thoracoscopic lung resection surgery: protocol for a randomised controlled
trial.
Source
BMJ open. 12(12) (pp e066828), 2022. Date of Publication: 12 Dec 2022.
Author
Wang F.; He Y.; Zhou M.; Luo Q.; Zeng Z.; Liu L.; Zeng S.; Lei Q.
Institution
(Wang, He, Zhou, Luo, Zeng, Lei) Department of Anesthesiology, Sichuan
Academy of Medical Sciences and Sichuan People's Hospital, University of
Electronic Science and Technology of China, Chengdu, Sichuan, China
(Liu) Department of Anesthesiology, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan, China
(Zeng) Department of Anesthesiology, Sichuan Academy of Medical Sciences
and Sichuan People's Hospital, University of Electronic Science and
Technology of China, Chengdu, Sichuan, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Postoperative pulmonary complications (PPCs) are the most
common complications following thoracoscopic surgery, resulting in
increased hospital costs and perioperative mortality. Studies have shown
that intravenous lidocaine infusion can exert its anti-inflammatory
properties by reducing the release of proinflammatory cytokines. This
study is designed to investigate whether intraoperative intravenous
lidocaine infusion can reduce the incidence of PPCs in adult patients
undergoing video-assisted thoracoscopic lung resection surgery. METHODS
AND ANALYSIS: This single-centre, double-blinded study will enrol 366
patients scheduled for video-assisted thoracoscopic lung resection
surgery. Patients will be randomly assigned to the lidocaine or placebo
infusion group in a 1: 1 ratio. The lidocaine group will receive lidocaine
intravenously during the intraoperative period, while the placebo group
will be administered normal saline at an equal volume, infusion rate and
timing. The primary outcome is the incidence of PPCs within 7 days
following surgery. The secondary outcomes are quality of postoperative
recovery 40 scores; length of hospital stay (determined by the number of
days from admission to discharge); incidence of moderate to severe pain
within 24 and 48 hours at rest and when coughing; incidence of additional
rescue analgesics use and incidence of adverse events. ETHICS AND
DISSEMINATION: The study was reviewed and approved by the Ethics Committee
of Sichuan Provincial People's Hospital (approval no. 20222241). Written
informed consent will be obtained from all patients before randomisation.
The results of this trial will be disseminated in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER: ChiCTR2200061979.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

<17>
Accession Number
639804564
Title
Effect of Acupressure on Dental Anxiety in Children: a Pilot Study for a
Randomized Clinical Trial.
Source
Journal of acupuncture and meridian studies. 15(5) (pp 307-313), 2022.
Date of Publication: 31 Oct 2022.
Author
Soares M.E.C.; Araujo A.S.; Pinto I.C.L.; Barbosa L.S.A.; Borsatto M.C.;
Galo R.
Institution
(Soares, Araujo, Pinto, Barbosa) Department of Dentistry, School of
Biological and Health Sciences, Universidade Federal dos Vales do
Jequitinhonha e Mucuri, Diamantina, Brazil
(Borsatto) Clinical Pediatric Dentistry Department, Ribeirao Preto School
of Dentistry, Universidade de Sao Paulo, Ribeirao Preto, Brazil
(Galo) Department of Dental Materials and Prosthesis, Ribeirao Preto
School of Dentistry, Universidade de Sao Paulo, Ribeirao Preto, Brazil
Publisher
NLM (Medline)
Abstract
Background: Anxiety is an important problem in children in dental clinics.
Acupressure may be a useful tool to assist in dental procedures in anxious
children. <br/>Objective(s): This pilot study was performed to examine the
effects of acupressure on dental anxiety in children undergoing
restorative procedures. <br/>Method(s): Fourteen children aged 7-10 years
and with at least one primary molar with caries on the dentine were
included in the study. The participants also needed to score at least one
point on the modified Venham Picture Test (VPTm) for the determination of
anxiety. The children were randomly allocated to two groups: group A -
non-documented points for the reduction of anxiety and induction of
relaxation; group B - documented points (EX-HN3, Shen Men of auricular
acupuncture). The anxiety scale was administered on three occasions: prior
to the application of acupressure; immediately after sitting in the dental
chair to undergo restorative treatment; and after removal of acupressure
at the end of the restorative procedure. Heart rate (HR) was measured when
each child sat in the dental chair, after the removal of carious tissue,
and after the removal of acupressure. <br/>Result(s): After the procedure,
HR (as an indicator of anxiety) was statistically significantly lower in
group B than group A (p = 0.02). However, there was no significant
difference between the groups regarding anxiety before and during the
restorative procedure (VPTm and HR: p > 0.05). <br/>Conclusion(s): The
children who received acupressure on documented points for the reduction
of anxiety had a significantly lower HR after the restorative procedure.
No significant between-group difference was found regarding anxiety
measured using a psychometric evaluation (VPTm).

<18>
Accession Number
2021831893
Title
The Effect of Mechanical Ventilation Mode on Blood Loss in Endoscopic
Sinus Surgery, A Randomized Clinical Study.
Source
Journal of Pharmaceutical Negative Results. 13 (pp 221-226), 2022. Date of
Publication: 2022.
Author
Masoud Farzadfar S.A.; Hajijafari M.; Karbasi Z.
Institution
(Masoud Farzadfar) Faculty of Medicine, Kashan University of Medical
Sciences, Kashan, Iran, Islamic Republic of
(Hajijafari) Trauma Research Center, Kashan University of Medical
Sciences, Kashan, Iran, Islamic Republic of
(Karbasi) Department of ENT, School of Medicine, Kashan University of
Medical Science, Kashan, Iran, Islamic Republic of
Publisher
ResearchTrentz Academy Publishing Education Services
Abstract
Background: One of the important problem during endoscopic sinus surgery
is bleeding. Bleeding causes disruption of the surgical field and damages
the base of the skull and the eye cavity and consequently increases the
duration of surgery vasopressor drugs may cause instability of
hemodynamic, specially, in hypertension patients or patients with ischemic
heart. Hypotension induction with various drugs causes to use a greater
amount of anesthetic drugs and its side effects. Therefore, it is
necessary to find a treatment for this complication. We decided to do a
study on two modes of ventilation to reduce bleeding and increasing
surgery satisfaction. <br/>Method(s): This investigation was performed on
134 patients. They were candidates of endoscopic sinus surgery 67 in
volume mechanical ventilation group and 67 in pressure mechanical
ventilation group. Patients were divided randomly in two groups and were
recorded vital signs, complications, and bleeding. We used ANOVA and
Chi-square tests to compare the data. <br/>Result(s): The findings
indicated that there is not significant difference between VCV and PCV in
duration of surgery, intraoperative bleeding, heart rate, mean arterial
blood pressure and surgeon satisfaction (P>0.05). <br/>Conclusion(s):
Various methods of ventilation did not show significant difference in
bleeding and due to inconsistencies in the results of the current study
and some studies and due to the limitations of the studies, further
studies with higher numbers of specimens are recommended.<br/>Copyright
&#xa9; 2022 Wolters Kluwer Medknow Publications. All rights reserved.

<19>
Accession Number
2021803308
Title
Providing Epidemiological Data in Lumbar Spine Imaging Reports Did Not
Affect Subsequent Utilization of Spine Procedures: Secondary Outcomes from
a Stepped-Wedge Randomized Controlled Trial.
Source
Pain Medicine (United States). 22(6) (pp 1272-1280), 2021. Date of
Publication: 01 Jun 2021.
Author
Suri P.; Meier E.N.; Gold L.S.; Marcum Z.A.; Johnston S.K.; James K.T.;
Bresnahan B.W.; O'reilly M.; Turner J.A.; Kallmes D.F.; Sherman K.J.; Deyo
R.A.; Luetmer P.H.; Avins A.L.; Griffith B.; Heagerty P.J.; Rundell S.D.;
Jarvik J.G.; Friedly J.L.
Institution
(Suri, Meier, Gold, Johnston, James, O'reilly, Turner, Heagerty, Rundell,
Jarvik, Friedly) Clinical Learning, Evidence, and Research Center,
University of Washington, Seattle, WA, United States
(Suri, Turner, Rundell, Friedly) Department of Rehabilitation Medicine,
University of Washington, Seattle, WA, United States
(Suri) Seattle Epidemiologic Research and Information Center, VA Puget
Sound Health Care System, Seattle, WA, United States
(Suri) Rehabilitation Care Services, VA Puget Sound Health Care System,
Seattle, WA, United States
(Meier, Heagerty) Department of Biostatistics, University of Washington,
Seattle, WA, United States
(Gold, Johnston, James, Bresnahan, O'reilly, Jarvik) Department of
Radiology, School of Medicine, University of Washington, Seattle, WA,
United States
(Marcum) Department of Pharmacy, School of Pharmacy, University of
Washington, Seattle, WA, United States
(Turner) Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle, WA, United States
(Kallmes, Luetmer) Department of Radiology, Mayo Clinic, Rochester, MN,
United States
(Sherman) Kaiser Permanente Washington, Seattle, WA, United States
(Deyo) Departments of Family Medicine and Internal Medicine, Oregon Health
& Science University, Portland, OR, United States
(Avins) Division of Research (ALA), Kaiser Permanente Northern California,
Oakland, CA, United States
(Griffith) Department of Radiology, Henry Ford Hospital, Detroit, MI,
United States
(Jarvik) Department of Neurological Surgery, University of Washington,
Seattle, WA, United States
Publisher
Oxford University Press
Abstract
Objective: To evaluate the effect of inserting epidemiological information
into lumbar spine imaging reports on subsequent nonsurgical and surgical
procedures involving the thoracolumbosacral spine and sacroiliac joints.
<br/>Design(s): Analysis of secondary outcomes from the Lumbar Imaging
with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized
trial. <br/>Setting(s): Primary care clinics within four integrated health
care systems in the United States. Subjects: 238,886 patients >=18 years
of age who received lumbar diagnostic imaging between 2013 and 2016.
<br/>Method(s): Clinics were randomized to receive text containing age-
and modality-specific epidemiological benchmarks indicating the prevalence
of common spine imaging findings in people without low back pain, inserted
into lumbar spine imaging reports (the "LIRE intervention"). The study
outcomes were receiving 1) any nonsurgical lumbosacral or sacroiliac spine
procedure (lumbosacral epidural steroid injection, facet joint injection,
or facet joint radiofrequency ablation; or sacroiliac joint injection) or
2) any surgical procedure involving the lumbar, sacral, or thoracic spine
(decompression surgery or spinal fusion or other spine surgery).
<br/>Result(s): The LIRE intervention was not significantly associated
with subsequent utilization of nonsurgical lumbosacral or sacroiliac spine
procedures (odds ratio [OR] = 1.01, 95% confidence interval [CI]
0.93-1.09; P = 0.79) or any surgical procedure (OR = 0.99, 95 CI
0.91-1.07; P = 0.74) involving the lumbar, sacral, or thoracic spine. The
intervention was also not significantly associated with any individual
spine procedure. <br/>Conclusion(s): Inserting epidemiological text into
spine imaging reports had no effect on nonsurgical or surgical procedure
utilization among patients receiving lumbar diagnostic imaging.
<br/>Copyright &#xa9; 2021 The Author(s).

<20>
Accession Number
639804270
Title
Meta-Analysis Comparing Valve-in-Valve Transcatheter Mitral Valve
Replacement Versus Redo Surgical Mitral Valve Replacement in Degenerated
Bioprosthetic Mitral Valve.
Source
The American journal of cardiology. 189 (pp 98-107), 2022. Date of
Publication: 13 Dec 2022.
Author
Ismayl M.; Abbasi M.A.; Mostafa M.R.; Aboeata A.; Vora A.N.; Ben-Dor I.;
Anavekar N.S.; Goldsweig A.M.
Institution
(Ismayl) Department of Internal Medicine, Creighton University School of
Medicine, Omaha, NE, United States
(Abbasi, Anavekar) Division of Cardiovascular Medicine, Department of
Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Mostafa) Department of Internal Medicine, Rochester Regional/Unity
Hospital, Rochester, NY, United States
(Aboeata) Division of Cardiovascular Medicine, Department of Internal
Medicine, Creighton University School of Medicine, Omaha, NE, United
States
(Vora) UPMC Heart and Vascular Institute, Harrisburg, PA, United States
(Ben-Dor) Division of Interventional Cardiology, Medstar Washington
Hospital Center, Washington District of Columbia
(Goldsweig) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Nebraska Medical Center, Omaha, NE, United States
Publisher
NLM (Medline)
Abstract
Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) and redo
surgical mitral valve replacement (redo-SMVR) are 2 treatment strategies
for patients with bioprosthetic mitral valve dysfunction. We conducted a
systematic review and meta-analysis to compare the outcomes of ViV-TMVR
versus redo-SMVR. We searched PubMed, EMBASE, Cochrane, and Google Scholar
for studies comparing outcomes of ViV-TMVR versus redo-SMVR in degenerated
bioprosthetic mitral valves. We used a random-effects model to calculate
odd ratios (ORs) with 95% confidence intervals (CIs). Outcomes included
in-hospital, 30-day, 1-year, and 2-year mortality, stroke, bleeding, acute
kidney injury, arrhythmias, permanent pacemaker insertion, and hospital
length of stay (LOS). A total of 6 observational studies with 707 subjects
were included. The median follow-up was 2.7 years. Despite their older age
and greater co-morbidity burden, patients who underwent ViV-TMVR had a
similar in-hospital mortality (OR 0.52, 95% CI 0.22 to 1.23, p = 0.14),
30-day mortality (OR 0.65, 95% CI 0.36 to 1.17, p = 0.15), 1-year
mortality (OR 0.97, 95% CI 0.63 to 1.49, p = 0.89), and 2-year mortality
(OR 1.17, 95% CI 0.65 to 2.13, p = 0.60) compared with redo-SMVR. ViV-TMVR
was associated with significantly lower periprocedural complications,
including stroke, bleeding, acute kidney injury, arrhythmias, and
permanent pacemaker insertion, and shorter hospital LOS than redo-SMVR. In
conclusion, ViV-TMVR was associated with better outcomes than redo-SMVR in
patients with degenerated bioprosthetic mitral valves, including lower
complication rates and shorter hospital LOS, with no significant
difference in mortality rates. Large-scale randomized trials are needed to
mitigate biases and confirm our findings.<br/>Copyright &#xa9; 2022
Elsevier Inc. All rights reserved.

<21>
Accession Number
639801250
Title
The effects of milking and suction drain management methods in paediatric
patients after cardiac surgery.
Source
International journal of nursing practice. (pp e13122), 2022. Date of
Publication: 14 Dec 2022.
Author
Gokgoz G.; Karabacak U.; Kan Onturk Z.
Institution
(Gokgoz) Istanbul Training and Research Hospital, TR. Ministry of Health,
Istanbul, Turkey
(Karabacak, Kan Onturk) Faculty of Health Sciences, Department of Nursing,
Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
AIM: The aim of this study is to determine the effects of milking and
suction methods on maintaining drain patency following cardiac surgery in
paediatric patients. <br/>METHOD(S): This was a randomized controlled
trial. The patients were assigned to three groups (suction method, milking
method, and control group) between July 2018 and December 2019.
<br/>RESULT(S): The most frequent medical diagnoses were tetralogy of
Fallot (34.4%, n =31) and ventricular septal defect (14.4%, n =13). Heart
rate may increase unless a method was chosen to maintain drain patency (F:
4.450, p =0.003); suction (F: 0.528 p =0.781) and milking (F: 2.281 p
=0.070) methods did not significantly increase the heart rate. The use of
a manipulation method for maintaining drain patency maintained stability
of the blood pressure values and did not affect haemodynamic stability,
oxygen saturation, and body temperature. There was no statistically
significant difference within and among the groups (p >0.05) in relation
to the volume of bleeding between admission until the sixth hour, although
there was greater bleeding with the milking method (2.67+/-15.30ml) and
less bleeding (-5.00+/-23.30) with the suction method. <br/>CONCLUSION(S):
The milking and suction methods used to maintain drain patency can be
employed and will assist with maintaining the stability of the patient
within the first critical 6h. Further studies need to be conducted in
order to clarify that the recommendations can be generalized to all
children with congenital heart disease.<br/>Copyright &#xa9; 2022 John
Wiley & Sons Australia, Ltd.

<22>
Accession Number
639801096
Title
Ultrasound-guided serratus anterior plane block versus paravertebral block
on postoperation analgesia and safety following the video-assisted
thoracic surgery: A prospective, randomized, double-blinded
non-inferiority clinical trial.
Source
Asian journal of surgery. (no pagination), 2022. Date of Publication: 12
Dec 2022.
Author
Wang Y.; Shi M.; Huang S.; He X.; Gu X.; Ma Z.
Institution
(Wang, Shi, He, Gu, Ma) Nanjing Drum Tower Hospital Clinical College of
Nanjing Medical University, China
(Huang) Nanjing Drum Tower Hospital Clinical College of Nanjing Medical
University, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Both the anesthetic efficacy of ultrasound-guided serrate
anterior plane block (SAPB) and the ultrasound-guided paravertebral block
(PVB) in alleviating postoperative pain have been well concerned. This
study primarily aims to evaluate whether the ultrasound-guided SAPB and
ultrasound-guided PVB can provide comparable analgesia for video-assisted
thoracic surgery. Secondarily, the safety and clinical satisfaction of the
two blocks are evaluated. <br/>METHOD(S): It was a prospective,
randomized, double-blinded non-inferiority clinical trial involving 99
patients with lung nodules receiving video-assisted thoracic surgery with
ultrasound-guided SAPB or PVB on T4 and T7 vertebra using 0.375%
ropivacaine at 3 mg/kg. The Visual Analogue Scale (VAS) scores at rest and
cough at 24 h/48 h postoperatively and the incidence and severity of
chronic pain at 3 and 6 months postoperatively were the primary outcome.
Secondary outcomes included the complications and block application time
of two kinds of blocks, and consumption of sufentanil as an analgesic
rescue. <br/>RESULT(S): A total of 92 eligible patients were recruited,
including 46 in the SAPB group and 46 in the PVB group. No significant
differences in VAS scores at rest and cough at first 48 h, 3 months, and 6
months postoperatively between the SAPB group and PVB group were detected
(all P > 0.05). The SAPB group had fewer complications and higher patient
satisfaction(P<0.05). <br/>CONCLUSION(S): The ultrasound-guided SAPB was
not inferior to PVB in alleviating postoperative pain following the VATS
with fewer complications and higher patient satisfaction.<br/>Copyright
&#xa9; 2022 Asian Surgical Association and Taiwan Robotic Surgery
Association. Published by Elsevier B.V. All rights reserved.

<23>
Accession Number
639801053
Title
Conventional Prostheses versus Sutureless Perceval for Aortic Valve
Replacement: A Meta-Analysis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2022. Date of Publication: 15 Dec 2022.
Author
Colarossi G.; Migliorini F.; Becker M.; Arias J.P.; Autschbach R.; Moza
A.; Aljalloud A.
Institution
(Colarossi, Arias, Autschbach, Moza, Aljalloud) Department of Thoracic and
Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
(Colarossi, Becker, Aljalloud) Department of Cardiology, Germany
(Migliorini) Department of Orthopaedic, Trauma, Reconstructive Surgery,
RWTH University Hospital Aachen, Aachen, Germany
Publisher
NLM (Medline)
Abstract
PURPOSE: Perceval sutureless valves have gained popularity. Whether this
implant performs superior to the traditional sutured prosthesis remains
unclear. This meta- analysis compared the Perceval implants versus the
sutured conventional valves for aortic valve replacement (AVR).
<br/>METHOD(S): This meta-analysis was conducted according to the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. The following databases were accessed: PubMed, Google Scholar,
Web of Science, Scopus, and EMBASE. All clinical investigations comparing
Perceval versus the conventional prostheses for AVR were considered.
<br/>RESULT(S): The Perceval group demonstrated higher rate of pacemaker
implantation (P <0.00001). Aortic cross-clamp (ACC) time (P <0.00001) and
cardiopulmonary bypass (CPB) time (P <0.00001) were shorter in the
Perceval group. Similarity was found in mean and peak pressure gradient (P
= 0.8 and P = 0.2, respectively), mean aortic valve area (P = 0.3), length
of intensive care unit (P = 0.4) and hospital stay (P = 0.2), rate of
revision (P = 0.11), hemorrhages (P = 0.05), paravalvular leak (P = 0.3),
cerebrovascular complication (P = 0.7), and early mortality (P = 0.06).
<br/>CONCLUSION(S): Given the shorter ACC time and CPB time, Perceval AVR
can be an alternative in high-risk patients. The higher rate of pacemaker
implantation following Perceval may limit its routine implantation.

<24>
Accession Number
639800965
Title
The Analgesic Effects of the Addition of Intravenous Ibuprofen to a
Multimodal Analgesia Regimen for Pain Management After Pediatric Cardiac
Surgery: A Randomized Controlled Study.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2022.
Date of Publication: 22 Nov 2022.
Author
Abdelbaser I.; Abo-Zeid M.; Hayes S.; Taman H.I.
Institution
(Abdelbaser) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Mansoura University, Mansoura, Egypt
(Abo-Zeid, Hayes, Taman) Department of Anesthesia and Surgical Intensive
Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Intravenous ibuprofen is used to control fever and pain. This
study aimed to assess the analgesic effects of the addition of intravenous
ibuprofen to a multimodal analgesia regimen for pain management after
pediatric cardiac surgery. DESIGN: A randomized, controlled,
double-blinded, superiority study. SETTING: University hospital.
PARTICIPANTS: Seventy-eight pediatric patients who underwent open cardiac
surgery using midline sternotomy incision were screened for eligibility;
10 patients were excluded, leaving 68 patients (34 patients in the
ibuprofen group and 34 patients in the control group) for final data
analysis. INTERVENTIONS: Patients were randomly allocated to either the
ibuprofen group, in which the patient received intravenous ibuprofen
infusion of 10 mg/kg/6 hours for 24 hours, or the control group, in which
the patient received a placebo 0.9% saline. MEASUREMENTS AND MAIN RESULTS:
The primary endpoint was the 24-hour postoperative fentanyl consumption,
and the secondary endpoints were postoperative modified objective pain
score and the incidence of ibuprofen-related side effects (eg, vomiting,
epigastric pain, bleeding, and renal dysfunction). The mean total fentanyl
consumption (mug/kg) during the first postoperative 24 hours after
extubation was significantly lower (p<0.001) in the ibuprofen group (3.5
+/- 1.3) than the control group (5.1 +/- 1.4). The median postoperative
modified objective pain score was significantly lower (p < 0.05) in the
ibuprofen group than the control group at 0 hours, 2 hours, 12 hours, 16
hours, 20 hours, and 24 hours postoperatively. Ibuprofen did not cause
significant increases in the incidences of bleeding, epigastric pain, and
vomiting. Postoperative renal dysfunction was not reported in any patient.
<br/>CONCLUSION(S): The addition of intravenous ibuprofen to a multimodal
analgesia regimen for pain management after pediatric cardiac surgery
improved postoperative analgesia in terms of reduction of opioid
consumption and pain scores.<br/>Copyright &#xa9; 2022 Elsevier Inc. All
rights reserved.

<25>
Accession Number
2020655150
Title
Comprehensive collection of COVID-19 related prosthetic valve failure: a
systematic review.
Source
Journal of Thrombosis and Thrombolysis. (no pagination), 2022. Date of
Publication: 2022.
Author
Trieu T.K.; Birkeland K.; Kimchi A.; Kedan I.
Institution
(Trieu) College of Medicine, California Northstate University, Elk Grove,
CA, United States
(Birkeland) Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Kimchi, Kedan) Smidt Heart Institute, Cedars-Sinai Hospital, 8501
Wilshire Blvd Suite 200, Beverly Hills, Los Angeles, CA, United States
Publisher
Springer
Abstract
Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of
venous thromboembolism (VTE) and COVID-19 infection has been well
established. Increased inflammatory response in the setting of COVID-19
infection is associated with VTE and hypercoagulability. Venous and
arterial thrombotic events in COVID-19 infection have been well
documented; however, few cases have been reported involving cardiac valve
prostheses. In this review, we present a total of eight cases involving
COVID-19-related prosthetic valve thrombosis (PVT), as identified in a
systematic review. These eight cases describe valve position (mitral
versus aortic) and prosthesis type (bioprosthetic versus mechanical), and
all cases demonstrate incidents of PVT associated with simultaneous or
recent COVID-19 infection. None of these eight cases display obvious
non-adherence to anticoagulation; five of the cases occurred greater than
three years after the most recent valve replacement. Our review offers
insights into PVT in COVID-19 infected patients including an indication
for increased monitoring in the peri-infectious period. We explore valve
thrombosis as a mechanism for prosthetic valve failure. We describe
potential differences in antithrombotic strategies that may offer added
antithrombotic protection during COVID-19 infection. With the growing
population of valve replacement patients and recurring COVID-19 infection
surges, it is imperative to explore relationships between COVID-19 and
PVT.<br/>Copyright &#xa9; 2022, The Author(s).

<26>
Accession Number
2020443606
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 (United Kingdom). (no pagination), 2022. Date of Publication:
2022.
Author
Gholampour Dehaki M.; Gorjipour F.; Mahdavi M.; Kachoueian N.; Heidarynia
S.
Institution
(Gholampour Dehaki, Gorjipour, Mahdavi, Heidarynia) Iran University of
Medical Sciences, Rajaie Cardiovascular Medical and Research Center,
Tehran, Iran, Islamic Republic of
(Gorjipour, Heidarynia) Iranian Scientific Society of Extracorporeal
Technology, Iran University of Medical Sciences, Rajaie Cardiovascular
Medical and Research Center, Tehran, Iran, Islamic Republic of
(Gorjipour) Physiology Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Gorjipour) Qashqaei Biotechnology Laboratories, Tehran, Iran, Islamic
Republic of
(Kachoueian) Imam Hossein Educational Hospital, Shahid Beheshti University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
SAGE Publications Ltd
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; The Author(s) 2022.

<27>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2022 European Society for Clinical
Nutrition and Metabolism

<28>
Accession Number
2018671776
Title
Differences Among Clinical Trials and Registries on Surgical and
Percutaneous Coronary Interventions.
Source
Annals of Thoracic Surgery. 115(1) (pp 79-86), 2023. Date of Publication:
January 2023.
Author
Chadow D.; Audisio K.; Perezgrovas-Olaria R.; Cancelli G.; Robinson N.B.;
Rahouma M.; Soletti G.; Angiolillo D.J.; Metkus T.S.; Gaudino M.F.L.
Institution
(Chadow, Audisio, Perezgrovas-Olaria, Cancelli, Robinson, Rahouma,
Soletti, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, New York, United States
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, Florida, United States
(Metkus) Division of Cardiology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, Maryland, United States
(Metkus) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University School of Medicine, Baltimore, Maryland, United States
Publisher
Elsevier Inc.
Abstract
Background: A need exists for systematic evaluation of the differences in
baseline characteristics and early outcomes between patients enrolled in
randomized controlled trials (RCTs) and clinical practice for coronary
artery bypass grafting (CABG) and percutaneous coronary intervention
(PCI). <br/>Method(s): Systematic searches were conducted to identify RCTs
comparing CABG vs PCI and CABG or PCI registries. Sixteen predefined
baseline characteristics and 30-day mortality were extracted from the
included studies. Pooled proportion and mean with 95% CI were calculated
for binary and continuous outcomes, respectively, by using the random
effects model. <br/>Result(s): Fourteen RCTs and 10 registries including
more than 2 million patients were included. Registry patients who
underwent CABG had a higher prevalence of hypertension, smoking, reduced
left ventricular ejection fraction, and prior myocardial infarction, but a
lower prevalence of single-vessel disease when compared with CABG-treated
patients included in RCTs. Regarding PCI, hypertension, hyperlipidemia,
left main coronary artery disease, triple-vessel coronary disease, and
NYHA functional class <IV were significantly more prevalent among patients
in RCTs, whereas age, reduced left ventricular ejection fraction, and
smoking were more represented among PCI registry patients. Thirty-day
mortality was higher in registries for both PCI-treated and CABG-treated
patients. <br/>Conclusion(s): There were significant differences in
baseline characteristics and 30-day mortality between patients enrolled in
RCTs comparing CABG vs PCI and CABG and PCI registries. However, results
were mixed, and the discrepancy was less than seen in other
fields.<br/>Copyright &#xa9; 2023 The Society of Thoracic Surgeons

<29>
[Use Link to view the full text]
Accession Number
2021699094
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
Lippincott Williams and Wilkins
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. Methods 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). Results 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 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.<br/>Copyright &#xa9; 2023 Lippincott Williams and
Wilkins. All rights reserved.

<30>
Accession Number
2020305514
Title
Procedural complications associated with percutaneous mitral balloon
valvotomy: A systematic review.
Source
Expert Review of Cardiovascular Therapy. 20(12) (pp 929-932), 2022. Date
of Publication: 2022.
Author
Rashid H.; Haq Z.U.; Alam S.; Nazir M.; Nadir M.; Fakhar T.; Zaidi S.M.J.;
Mustafa B.; Malik J.
Institution
(Rashid) Department of Critical Care, Wythenshawe Hospital, Manchester,
United Kingdom
(Haq) Medical Student, Lahore Medical and Dental College, Lahore, Pakistan
(Alam) Department of Cardiology, Mardan Medical Complex, Mardan, Pakistan
(Nazir) Medical Student, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Nadir) Department of Cardiology, Rawalpindi Institute of Cardiology,
Rawalpindi, Pakistan
(Fakhar) Shifa College of Medicine, Islamabad, Pakistan
(Zaidi) Department of Medicine, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Mustafa) Department of Cardiology, Akbar Niazi Teaching Hospital,
Islamabad, Pakistan
(Malik) Department of Electrophysiology, Armed Forces Institute of
Cardiology, Rawalpindi, Pakistan
Publisher
Taylor and Francis Ltd.
Abstract
Background: As Percutaneous mitral balloon valvotomy (PMBV) remains the
keystone in treating mitral stenosis, we conducted this review to
elucidate the cumulative frequency and predictors of complications
following PMBV and their occurrence in various patient populations. Areas
covered: We searched digital databases for relevant studies covering
complications of PMBV and retrieved articles using the Medical Subject
Heading (MeSH) keywords. Expert opinion: A total of 37 articles (8 RCTs, 7
nonrandomized clinical trials, 22 observational studies) were selected for
qualitative analysis. A total of 11,803 patients undergoing PMBV among 37
studies were included, with a mean success rate of 84.54%. The most common
complication was mitral regurgitation (8.2%) followed by an atrial septal
defect (2.4%). Other relevant complications like stroke, pericardial
tamponade, rupture of mitral leaflets, and conduction abnormalities were
present in <1% of the patients.<br/>Copyright &#xa9; 2022 Informa UK
Limited, trading as Taylor & Francis Group.

<31>
Accession Number
2021752533
Title
Sarcopenia as a predictor of outcome after transcatheter aortic valve
implantation: Protocol for systematic review and meta-analysis.
Source
BMJ Open. 12(11) (no pagination), 2022. Article Number: e067461. Date of
Publication: 30 Nov 2022.
Author
Luo K.; Yang L.; Li Y.
Institution
(Luo, Yang, Li) Department of Anesthesiology, Sichuan University, Chengdu,
China
(Yang, Li) Department of Anesthesiology, Chinese Academy of Medical
Sciences, Cheng du, China
Publisher
BMJ Publishing Group
Abstract
Introduction Sarcopenia represents a central biological substratum of
frailty, which increases the incidence of adverse events and mortality
after surgery for oesophageal cancer, gastrectomy and pancreatic surgery.
Recently, sarcopenia has been suggested as a predictor of outcomes in
patients undergoing transcatheter aortic valve implantation (TAVI).
However, since relevant data were variable, we aimed to perform a
systematic review and meta-analysis of the current literature to evaluate
sarcopenia as a predictor of post-TAVI outcomes. Methods and analysis Two
investigators will conduct independent searches in PubMed, EMBASE, Web of
Science, MEDLINE and the Cochrane Library, from database inception to
October 2022. The search will not be limited by language or region.
Eligible studies will include reports investigating post-TAVI outcomes in
patients with sarcopenia, who are aged >18 years and diagnosed using a CT
scan. The primary outcome is short-term mortality (30-day mortality),
while the secondary outcomes include long-term mortality (>30 days),
length of intensive care unit (ICU) stay, need for ICU admission (the
number of patients in the sarcopenia or non-sarcopenia group requiring ICU
admission), length of hospital stay and overall complications. Included
studies will be assessed for risk of bias according to the Quality in
Prognosis Studies critical assessment tool and certainty of evidence using
the Grading of Recommendations, Assessment, Development and Evaluation.
The analysis will be done with Review Manager (V.5.4) software. If testing
reveals little or no statistical heterogeneity, a fixed-effect model will
be used for data synthesis; otherwise, a random-effect model may be
employed. On encountering substantial heterogeneity, subgroup analysis and
leave-one-out jackknife sensitivity analysis will be used to verify the
robustness of the results. The obtained results will be presented as
forest plots while Cochran's Q test and I 2 test will be used to calculate
the heterogeneity (>50% indicating strong heterogeneity). Ethics and
dissemination No ethical approval is needed for this study since we will
be using data from previously published studies. The results will be
disseminated in a peer-reviewed journal. PROSPERO registration number
CRD42022349525.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<32>
Accession Number
2018283879
Title
Incidental findings on routine preoperative noncontrast chest computed
tomography and chest radiography prior to cardiac surgery in the
multicenter randomized controlled CRICKET study.
Source
European Radiology. 33(1) (pp 294-301), 2023. Date of Publication: January
2023.
Author
Knol W.G.; den Harder A.M.; de Heer L.M.; Benke K.; Maurovich-Horvat P.;
Leiner T.; Merkely B.; Krestin G.P.; Bogers A.J.J.C.; Budde R.P.J.
Institution
(Knol, Bogers) Department of Cardiothoracic Surgery, Erasmus MC,
Rotterdam, Netherlands
(Knol, Krestin, Budde) Department of Radiology & Nuclear Medicine, Erasmus
MC, PO BOX 2040, ND-547, CA, Rotterdam 3000, Netherlands
(den Harder, Leiner) Department of Radiology, University Medical Center
Utrecht and Utrecht University, Utrecht, Netherlands
(de Heer) Department of Cardiothoracic Surgery, University Medical Center
Utrecht and Utrecht University, Utrecht, Netherlands
(Benke) Department of Cardiovascular Surgery, Heart and Vascular Center,
Semmelweis University, Budapest, Hungary
(Maurovich-Horvat, Merkely) Department of Cardiology, Heart and Vascular
Center, Semmelweis University, Budapest, Hungary
(Maurovich-Horvat) Department of Radiology, Medical Imaging Center,
Semmelweis University, Budapest, Hungary
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To describe the prevalence and consequences of incidental
findings when implementing routine noncontrast CT prior to cardiac
surgery. <br/>Method(s): In the multicenter randomized controlled CRICKET
study, 862 adult patients scheduled for cardiac surgery were randomized
1:1 to undergo standard of care (SoC), which included a chest-radiograph,
or an additional preoperative noncontrast chest CT-scan (SoC+CT). In this
subanalysis, all incidental findings detected on the chest radiograph and
CT-scan were analyzed. The influence of smoking status on incidental
findings was also evaluated, adjusting for sex, age, and group allocation.
<br/>Result(s): Incidental findings were observed in 11.4% (n = 49) of
patients in the SoC+CT group and in 3.7% (n = 16) of patients in the
SoC-group (p < 0.001). The largest difference was observed in findings
requiring follow-up (SoC+CT 7.7% (n = 33) vs SoC 2.3% (n = 10), p <
0.001). Clinically relevant findings changing the surgical approach or
requiring specific treatment were observed in 10 patients (1.2%, SoC+CT:
1.6% SoC: 0.7%), including lung cancer in 0.5% of patients (n = 4) and
aortic dilatation requiring replacement in 0.2% of patients (n = 2).
Incidental findings were more frequent in patients who stopped smoking (OR
1.91, 1.03-3.63) or who actively smoked (OR 3.91, 1.85-8.23).
<br/>Conclusion(s): Routine CT-screening increases the rate of incidental
findings, mainly by identifying more pulmonary findings requiring
follow-up. Incidental findings are more prevalent in patients with a
history of smoking, and preoperative CT might increase the yield of
identifying lung cancer in these patients. Incidental findings, but not
specifically the use of routine CT, are associated with delay of surgery.
Key Points: * Clinically relevant incidental findings are identified more
often after a routine preoperative CT-scan, when compared to a standard of
care workup, with some findings changing patient management. * Patients
with a history of smoking have a higher rate of incidental findings and a
lung cancer rate comparable to that of lung cancer screening trials. * We
observed no clear delay in the time to surgery when adding routine CT
screening.<br/>Copyright &#xa9; 2022, The Author(s).

<33>
Accession Number
2020594672
Title
Effect of bilateral ultrasound-guided erector spinae plane block on
postoperative pain after open lumbar spinal surgery: a double-blind,
randomized controlled trial.
Source
European Spine Journal. (no pagination), 2022. Date of Publication: 2022.
Author
Wittayapairoj A.; Wittayapairoj K.; Vechvitvarakul M.
Institution
(Wittayapairoj, Vechvitvarakul) Department of Anesthesiology, Faculty of
Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
(Wittayapairoj) Department of Orthopedics, Faculty of Medicine, Khon Kaen
University, 123 Mittraparp Highway, Muang District, Khon Kaen 40002,
Thailand
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: The peripheral nerve blocks (PNB) are an important part of the
multimodal analgesia for reducing postoperative pain, opioids consumption
and its side effects. A new PNB, Erector spinae plane block (ESPB), has
been revealed postoperative analgesic effect in various surgical
procedures such as breast, thoracic and abdominal surgery, with the
limitation of the studies for spine surgery. We aimed to evaluate the
analgesic effect of ultrasound-guided bilateral erector spinae plane block
(ESPB) after open lumbar spinal surgery. <br/>Method(s): A double-blind,
randomized controlled trial was conducted. Sixty-two patients undergoing
posterior lumbar spinal surgery were randomly allocated into two groups.
The ESPB group (n = 31) received ultrasound (US)-guided bilateral ESPB
using 20 ml of 0.375% bupivacaine with adrenaline 5 mcg/ml per side. The
control group (n = 31) received no intervention. The same postoperative
analgesia regimen was applied by oral acetaminophen 10-15 mg/kg every 6 h,
naproxen 250 mg twice daily, and intravenous (IV) morphine via
patient-controlled analgesia (PCA) device. The postoperative morphine
consumption, numerical pain score (NRS) and the side effects were
recorded. <br/>Result(s): The bilateral ESPB group reduced the 24
h-morphine consumption by 42.9% (P < 0.001), decreased overall pain score
at rest by 1.4 points (P = 0.02), and decreased overall pain score on
movement by 2.2 points (P < 0.001). No severe complications related to the
block technique or morphine used occurred. <br/>Conclusion(s): The
US-guided bilateral ESPB demonstrated the effectiveness for postoperative
analgesia management after open lumbar spinal surgery regarding reduced
opioid consumption and pain score without any serious
complications.<br/>Copyright &#xa9; 2022, The Author(s), under exclusive
licence to Springer-Verlag GmbH Germany, part of Springer Nature.

<34>
Accession Number
639791865
Title
A Large-Scale Genome-Wide Association Study of Angiographically Determined
Burden of Coronary Atherosclerosis in a Genetically Diverse Population.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Hilliard A.; Zanetti D.; Lynch J.; Damrauer S.M.; Ho Y.-L.; Plomondon
M.E.; Waldo S.; Chang K.-M.; Tsao P.S.; Clarke S.L.; Assimes T.L.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Few large-scale genome wide association studies (GWAS) of
angiographically derived burden of coronary atherosclerosis have been
reported to date. The yield of this approach relative to case-control GWAS
of coronary artery disease (CAD) remains unclear. <br/>Method(s): We used
the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program,
a national quality and safety organization for invasive cardiac
procedures, to conduct the largest ever GWAS of burden of coronary
atherosclerosis involving participants of the Million Veteran Program
(MVP). Obstructive disease of a native major vessel was defined as the
presence of at least one obstruction >50% of the luminal diameter, or a
prior revascularization procedure, involving the main artery and/or its
major branches. Non-obstructive disease was defined as one or more vessels
having one or more obstructions of >20% but none more than 50%. We
classified an individual's extent of disease as normal, non-obstructive,
one vessel, two vessel, or three vessel / left main CAD. GWAS was
performed stratified by racial/ethnic group using linear regression in
REGENIE, with age, sex, and genetic principal components as covariates.
Stratified results were then combined through meta-analysis using GWAMA.
<br/>Result(s): The extent of disease was quantified in 49,213
non-Hispanic White, 11,326 non-Hispanic Black, and 4,058 Hispanic MVP
participants, a majority of which were subjects with clinical CAD.
Forty-three loci reached genome wide significance including 27 among
Whites, four among Blacks at SORT1, LPL, COL4A2, and LDLR, two among
Hispanics at CDKN2B-AS1 and NRG4, and an additional 13 through
meta-analysis of all three strata. Two loci, HHEX and NRG4, have not been
previously established as susceptibility loci CAD. <br/>Conclusion(s):
Large-scale GWAS of burden of coronary atherosclerosis complements
discovery efforts of case-control GWAS of CAD. Despite substantially
smaller sample sizes, this quantitative approach recapitulated many
established loci for CAD, uncovered novel loci, and identified several
known susceptibility loci in admixed Black and Hispanic populations. The
latter required a remarkably larger sample size to achieve through GWAS of
clinically defined events alone.

<35>
Accession Number
639791732
Title
Rationale and Design of Randomized Controlled Trial Evaluating an Atrial
Appendage Micrograft Transplantation in Conjunction With Coronary Artery
Bypass Surgery.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Sikorski V.T.; Nummi A.; Mulari S.; Kankuri E.M.; Vento A.E.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In addition to the revascularization therapies for ischemic
heart disease (IHD), such as coronary artery bypass grafting (CABG),
tissue-engineered cell therapies can help further improve myocardial
repair. First clinical results on autologous right atrial
appendage-derived micrograft (AAM) transplantation have demonstrated
excellent safety and feasibility profiles and suggested a therapeutic
effect on myocardial viability. This randomized clinical trial aims to
extend the evaluation of efficacy of AAMs transplantation when combined
with CABG surgery. Methods and objectives: This double-blinded randomized
controlled AAMS2 trial will assess the benefits, safety, and feasibility
of the perioperatively assembled and epicardially transplanted AAMs-patch
in conjunction with CABG. The trial recruits a total of 50 patients, half
of which are randomized to receive the AAMs-patch (CABG+AAMs) and the
other half to undergo a standard CABG. Prior to surgery, cardiac structure
and function are assessed with late gadolinium enhancement cardiac
magnetic resonance imaging (LGE-CMRI), electrocardiogram, and
transthoracic echocardiography (TTE). LGE-CMRI, electrocardiogram, and TTE
are repeated at 6-month follow-up for structural and functional
comparisons to baseline. The primary endpoints focus on the efficacy of
the AAMs patch as evaluated by LGE-CMRI and TTE as well as changes in
health-related quality of life assessments, 6-minute walk test or
N-terminal-pro-BNP levels. The secondary endpoints centre on feasibility
and safety. For molecular and especially RNA-level analysis of the
response to therapy in blood, RNA-stabilized whole blood and plasma
samples are collected. <br/>Conclusion(s): The AAMS2 trial is expected to
provide further feasibility and safety data as well as insights for
efficacy of epicardial AAMs-patch transplantation when administered during
CABG surgery. (Figure Presented).

<36>
Accession Number
639791639
Title
Association Between Perioperative Hyponatremia and Survival After Left
Ventricular Assist Device Implantation: A Systematic Review and
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Del Rio-Pertuz G.; Benjanuwattra J.; Leelaviwat N.; Abdelnabi M.;
Mekraksakit P.; Argueta-Sosa E.E.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Hyponatremia, defined as a serum sodium (Na) level <135 mEq/L,
is a common electrolyte disorder in patients with congestive heart failure
and cardiac surgical patients, and its presence is associated with
increased morbidity and mortality. Few published reports have described if
there is an association between perioperative hyponatremia and left
ventricular assist device (LVAD) outcomes. The consolidation of these
studies could provide information on patient selection for LVAD
implantation if hyponatremia is a concern.Hypothesis: The presence of
perioperative hyponatremia is associated with mortality after LVAD
implantation. <br/>Method(s): We systematically searched PubMed, Embase,
and Scopus for abstracts and full-text papers from inception to May 2022.
Studies were included if they evaluated the association between
perioperative hyponatremia (Serum Na <135 mEq/L) and survival after LVAD
implantation. Data were integrated using the random-effects, generic
inverse variance method of DerSimonian and Laird. The study was registered
in the Prospero CRD42022334062. <br/>Result(s): After removing duplicated
and applying the inclusion criteria, a total of 4 studies published from
2018 to 2022 were included. Two studies including 527 patients evaluated
the association between hyponatremia before LVAD implantation and
mortality, no significant association was found (Odds Ratio (OR): 1.30
Confidence interval (CI) 95%: 0.74-2.31 p:0.26, Figure 1). On the other
hand, two studies including 313 patients, evaluated the presence of
hyponatremia after LVAD implantation, and no significant association to
mortality was found (OR:1.46, CI 95%: 0.49-4.37 p:0.02, Figure 2).
<br/>Conclusion(s): Hyponatremia before or after LVAD implantation is not
significantly associated to mortality. These results may suggest that
optimization of hyponatremia may not be critical in the perioperative
period. (Figure Presented).

<37>
Accession Number
639791602
Title
The Association Between Albumin and Outcomes in Heart Failure and
Secondary Mitral Regurgitation: Insights From the COAPT Trial.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Feng K.Y.; Ambrosy A.P.; Li D.; Kong J.; Zaroff J.; Mishell J.; Ku I.A.;
Scotti A.; Coisne A.; Redfors B.; Mack M.; Abraham W.T.; Lindenfeld J.;
Stone G.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Low serum albumin level is associated with increased morbidity
and mortality in numerous chronic diseases, but the relationship between
albumin and outcomes in heart failure (HF) and secondary mitral
regurgitation (SMR) has not been previously described. <br/>Method(s): The
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)
trial was a multicenter, randomized, controlled, parallel-group,
open-label study that evaluated the efficacy and safety of transcatheter
edge-to-edge repair (TEER) with the MitraClip + guideline-directed medical
therapy (GDMT) versus GDMT alone in patients with symptomatic HF and
moderate-to-severe or severe SMR. Baseline serum albumin level was
obtained at enrollment. <br/>Result(s): Among 614 patients enrolled in
COAPT, 559 (91.0%) had a baseline albumin level (median 4.0 g/dL
[interquartile range: 3.7-4.2 g/dL]). Patients with albumin <4.0 g/dL
compared with >=4.0 g/dL were older (mean 73.7 years vs. 70.6), more
likely to have ischemic cardiomyopathy (65.0% vs. 555.2%) and a
hospitalization within the prior year (72.9% vs. 62.9%). After
multivariable adjustment, patients with albumin <4.0 g/dL compared to
>=4.0 g/dL had higher 2-year rates of all-cause mortality (41.7% vs.
28.8%; HR 1.46, 95% CI 1.06-2.02; p=0.022; Figure Panel A), but no
significant differences in the composite of all-cause mortality or
hospitalization for HF (HHF), HHF alone, or all-cause hospitalizations
(all p>0.05; Figure Panel B). There were no significant interactions
between albumin and the relative efficacy of TEER + GDMT versus GDMT alone
with respect to clinical outcomes (all p-interactions >0.05; Figure Panel
B). <br/>Conclusion(s): In patients with HF and severe SMR enrolled in the
COAPT trial, low serum albumin levels were common and were an independent
predictor of mortality. MitraClip treatment provided a similar benefit
regardless of baseline albumin level. (Figure Presented).

<38>
Accession Number
639791238
Title
CVSA Early Career Investigator Award Finalist: Restrictive or Liberal
Transfusion for Acute Coronary Syndromes -Insights From the TRICS-III
Randomized Controlled Trial, Systematic Review, and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Mistry N.; Hare G.; Shehata N.; Papa F.; Kramer R.S.; Saha T.; Verma S.;
Mazer D.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The optimal transfusion strategy for patients with ACS is
unclear. Current data are inconclusive and there is a paucity of long term
data; therefore, we performed a subgroup analysis of patients with AMI in
the Transfusion Thresholds in Cardiac Surgery (TRICS-III) randomized
controlled trial (RCT) to add evidence addressing this important clinical
question, and interpret the results in the context of a systematic review
and meta-analysis. <br/>Method(s): The TRICS-III trial randomized patients
undergoing cardiac surgery on cardiopulmonary bypass with a
moderate-to-high risk of death to restrictive transfusion (transfuse at
hemoglobin <7.5g/dL) or a liberal strategy (operating room and ICU:
transfuse at hemoglobin <9.5g/dL; ward: <8.5g/dL). AMI patients were those
undergoing coronary artery bypass graft surgery with a recent MI and >=1
of the following enrichment criteria: unstable angina, critical
preoperative state, preoperative intra aortic balloon pump, and/or
emergency surgery. The primary outcome for this analysis was MACE
(all-cause death, MI, and revascularization) at 6 months. The MEDLINE and
EMBASE databases were searched through April 2022 to identify RCTs
evaluating restrictive versus liberal transfusion in patients with ACS.
The primary outcome was MACE at the longest available timepoint.
<br/>Result(s): In the TRICS AMI population (N=194), a restrictive
transfusion strategy did not increase the risk of MACE (OR: 1.36; 95% CI:
0.57-3.27). Three additional RCTs met eligibility criteria for the
systematic review yielding a total of 1015 patients. The transfusion
strategies were similar across all studies. After synthesizing the data,
restrictive transfusion was associated with a trend toward an increased
absolute risk of MACE (4%; 95% CI, -1 to 9%) and MI (3%; 95% CI, 0 to 6%)
at the longest available timepoint (Figure). <br/>Conclusion(s): In the
setting of ACS, liberal transfusion strategies may reduce the risk of long
term adverse cardiovascular events.

<39>
Accession Number
639791229
Title
Higher Anatomical Syntax Score is Associated With Lower Survival After
CABG in the REGROUP Trial.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Zenati M.A.; Habertheuer A.; Stock E.; Arshanskiy M.; Hattler B.; Dematt
E.; Bhatt D.; Biswas K.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The SYNergy between Percutaneous Coronary Intervention with
TAXus and Cardiac Surgery (SYNTAX) score quantifies complexity of coronary
artery disease (CAD) using angiographic data to objectively guide mode of
revascularization. Recent studies evaluating complexity of CAD by the
anatomical SYNTAX score (SS1) and impact on clinical outcomes following
CABG have been inconclusive. Hypothesis: We sought to investigate the
prognostic value of SS1 in predicting survival and incidence of major
adverse cardiac events (MACE) following CABG in the REGROUP trial
(ClinicalTrials.gov number NCT01850082.) Methods: This was a pre-planned
sub-analysis of the REGROUP trial which randomized patients undergoing
isolated CABG to endoscopic versus open vein harvest at 16 U. S. Veterans
Affairs Medical Centers between 2014-2017; The median follow-up was 4.7
years (interquartile range 3.84-5.45). SS1 was extracted for all patients
and stratified by terciles. Time-to-event survival analysis was performed
for MACE defined as death from any cause, nonfatal myocardial infarction,
or repeat revascularization over the study follow-up. <br/>Result(s): The
mean SS1 for this cohort (N=1,145) was 28.5+/-11.5 (median 27). Mean age
was 66.4+/-6.90 years, 50.2% were diabetics and 99.5% were males
reflecting the Veterans population. According to SS1 terciles, low (<23),
intermediate (23-32) and high (>32) SS1 groups comprised 383, 393 and 369
patients, respectively. Over study follow-up, SS1 terciles were associated
with allcause death (log-rank, p=0.012), which occurred in 8.6%, 14.2% and
15.2% of patients respectively(p=0.013). However, SS1 was not associated
with higher rates of the composite MACE which occurred in 20.4%, 22.6% and
25.5% of patients (p=0.247). <br/>Conclusion(s): Over the REGROUP study
follow-up, complexity of CAD evaluated by the SS1 is significantly
associated with all-cause death, but not MACE.

<40>
Accession Number
639791221
Title
Characterization of Hypertrophic Cardiomyopathy Caused by Mutations in
Four and a Half Lim Domains 1 Gene.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Marco C.; Losi M.-A.; Borrelli F.; Calore C.; Canciello G.; Manganelli F.;
Tozza S.; Bello L.; Chen S.N.; He L.; Marinas M.B.; Celeghin R.; Marra
M.P.; Todde G.; Frisso G.; Taylor M.; Pilichou K.; Lombardi R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Mutations in Four and Half Lim domain 1 (FHL1), an
X-chromosome gene, have been described in rare cases of Hypertrophic
Cardiomyopathy (HCM), mainly associated with myopathy. The current
knowledge of the outcome of HCM caused by FHL1 mutations relies only on
isolated case series. <br/>Objective(s): We aim to establish the
prevalence of FHL1 mutations in a large population with overt HCM and
clinically characterize HCM patients carrying FHL1 pathogenic and likely
pathogenic genetic variants. <br/>Method(s): From a total population of
794 HCM patients from 3 Referral Centers for hereditary cardiomyopathies,
349 HCM probands, who tested negative for sarcomeric mutations, were
genetically screened by using Next Generation Panels including FHL1.
Moreover, all patients underwent personal and family history collection,
physical examination, 12-lead electrocardiogram and echocardiography;
while Cardiac Magnetic Resonance (CMR) was performed in a subgroup.
Clinical and genetic data of FHL1 mutation carriers from our cohort were
pooled with those of 52 FHL1 positive HCM cases from literature.
<br/>Result(s): We identified 2 FHL1 pathogenic and 2 likely pathogenic
variants (1 missense: c.764G>C; 2 duplications: c.762dup and c.599dupT;
and 1 deletion: c.210delG) in 6 HCM probands (0.8% of all HCM and 1.7 % of
non sarcomeric HCM). As shown in Fig.1 A, pooled analysis suggested that
clinical phenotype of FHL1-HCM was characterized by early-onset, severe
diastolic dysfunction independently from the degree of hypertrophy and
fibrosis at CMR (Fig 1 B), high sudden death risk, increased incidence of
atrial fibrillation and evolution toward heart failure requiring heart
transplantation, and variable skeletal muscle involvement.
<br/>Conclusion(s): HCM patients carrying FHL1 mutations present with a
worse prognosis as compared with the classic sarcomeric-HCM. A better
characterization of these patients is needed for a personalized preventive
and therapeutic approach. (Figure Presented).

<41>
Accession Number
639791177
Title
Post TAVR Outcomes Among Patient With Amyloidosis and Aortic Stenosis: A
Meta Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Jaiswal V.; Ang S.P.; Kalra K.; Khan N.; Joshi A.; Jaiswal A.; Vadiyala
M.R.; Patel N.; Chia J.E.; Raut A.; Aziz T.; Manohar H.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Aortic stenosis (AS) is one of the most prevalent valvular
heart diseases globally. As many as 16% of AS patients have underlying
cardiac amyloidosis (CA). To date, there is a paucity of data on outcomes
among AS with concomitant CA patients post-TAVR. Hypothesis: This study
aimed to evaluate the clinical outcomes post TAVR among patients with CA.
<br/>Method(s): We performed a systematic literature search of databases
for relevant articles from inception until June 01, 2022. Unadjusted odds
ratios (OR) were pooled using a random-effect model, and a p-value of
<0.05 was considered statistically significant. <br/>Result(s): 5 studies
with 1,488 patients were involved in the final analysis. The mean age of
patients among CA+AS and AS alone was (85 vs 80) years. The number of
males affected with dual pathology was higher compared to AS alone (71% vs
59%). 29% of patients were having a right bundle branch block in the CA+AS
group, while 12% were among AS alone. Mean IV Septal Thickness (1.53 vs
1.33), mean relative wall thickness (0.60 vs 0.40) and mean LA dimensions
(5.19 vs 4.8) were higher among the CA+AS group compared with AS alone. At
the mean follow up of 12 months the odds of in-hospital mortality (OR,
2.09(95% CI: 0.77-5.63), P = 0.15), stroke (OR, 0.46(95%CI: 0.06-3.60), P
= 0.46), and vascular complication (OR, 0.19(95% CI: 0.01-3.40), P = 0.26)
were comparable between both group. In contrast, the incidence of acute
kidney injury (OR, 3.09(95% CI: 2.02-4.71), P<0.001), and major bleeding
(OR, 1.74(95% CI: 1.02-2.98), P = 0.04) were significantly higher among
CA+AS group compared to AS group following TAVR. <br/>Conclusion(s): TAVR
appeared to be a safe procedure among patients diagnosed with amyloidosis
in aortic stenosis with a similar mortality rate between both groups of
patients. Further studies should aim at determining the optimal valve
replacement strategy in AS patients with concomitant CA.

<42>
Accession Number
639791128
Title
Transcatheter versus Surgical Aortic Valve Replacement Outcomes Among
Solid Organ Transplant Patients: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Jaiswal V.; Kalra K.; Ishak A.; Attia A.; Sharma P.; Jaiswal A.; Grubb
K.J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The safety and clinical outcomes of transcatheter aortic
valve replacement (TAVR) versus surgical aortic valve replacement (SAVR)
among solid organ transplant patients are not well documented.
<br/>Objective(s): This study aimed to evaluate the clinical outcomes of
TAVR and SAVR among patients with a history of solid organ
transplantation. <br/>Method(s): We performed a systematic literature
search of databases for relevant articles from inception until April 20,
2022. <br/>Result(s): A total of 342 studies were identified, resulting in
7 studies with a total of 6,128 patients included in the final analysis.
The odds of in-hospital mortality (OR 0.29, 95% CI 0.16-0.52, p < 0.0001),
blood transfusion (OR 0.30, 95% CI 0.22-0.40 p < 0.00001), postoperative
bleeding (OR 0.40, 95% CI 0.33-0.48 p < 0.00001), acute kidney injury (OR
0.50, 95% CI 0.38-0.67 p < 0.00001), and sepsis or infection (OR 0.37, 95%
CI 0.25-0.56, p < 0.00001) were significantly lower in patients undergoing
TAVR compared to SAVR. Permanent pacemaker implantation was significantly
higher in patients who underwent SAVR (OR 2.96, 95% CI 1.98-4.44, p =
<0.00001) than those who had TAVR. The odds of 30-day mortality, one-year
mortality and acute myocardial infarction were similar between the two
groups respectively. Length of hospital stay was significantly lower in
patients undergoing TAVR (MD -4.12 mmHg, 95% CI -5.06-3.18, p = <0.00001)
compared to those who underwent SAVR. <br/>Conclusion(s): TAVR is
confirmed to be advantageous in short term with improved in-hospital
survival and lower rates of major complications.

<43>
Accession Number
639791121
Title
Early Surgery versus Conservative Management Among Patients With
Asymptomatic Aortic Stenosis: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Jaiswal V.; Kalra K.; Attia A.; Khan N.; Joshi A.; Baburaj A.; Butey S.;
Patel N.; Jaiswal A.; Naz S.; Ishak A.; Peng Ang S.; Chia J.E.; Pasam C.;
Mudwari R.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: With the increasing prevalence of asymptomatic severe AS and
its progression to the symptomatic stage the early surgical aortic valve
repair is emerging as a popular option but with limited evidence of its
efficacy and safety. <br/>Objective(s): We aimed to conduct a
meta-analysis to evaluate the efficacy and safety to early surgical aortic
valve repair as compared to conservative management. <br/>Method(s): A
systematic literature search was performed in PubMed, Scopus, Embase and
Cochrane databases for studies comparing the early surgery versus
conservative management among asymptomatic aortic stenosis patients. The
primary outcome was all-cause mortality. Secondary endpoints were
cardiovascular mortality (CVM), sudden cardiac death (SCD),
hospitalisation due to heart failure, the composite of mortality and
MACCE, Clinical thromboembolic events, major bleeding, myocardial
infarction (MI), and stroke. <br/>Result(s): A total of 5 articles (3
observational studies and 2 randomized controlled trials) were included.
We found that there were significantly lower odds of all-cause mortality
[OR, 0.33; (95%CI:0.25-0.42); p<0.000001], cardiovascular mortality [OR,
0.34 (95%CI:0.25-0.47); p<0.00001] and composite of mortality and MACE
(OR:0.32(95%CI:0.24,0.42;p<0.00001), sudden cardiac death (OR:0.32; CI:
0.16-0.64; p=0.001) and hospitalization due to heart failure (OR:0.27, CI:
0.16-0.44; p<0.00001) with early surgical aortic valve repair compared to
conservative management. There was no significant difference between the
incidence of major bleeding, clinical thromboembolic events, stroke and
myocardial infarction between the conservative care groups and early
surgery. We also found a reduced risk of <br/>Conclusion(s): Among
asymptomatic patients with AS, SAVR shows better outcomes in reducing
mortality and other complications compared with the conservative
management approach.

<44>
Accession Number
639790960
Title
Myocardial Metabolic Dysregulation and Right Ventricular Outcomes After
Surgery for Advanced Heart Failure.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Ghadimi K.; Giamberardino S.; Nguyen M.; Parikh J.; Schroder J.;
Lorenzana-Saldivar E.; Thompson W.; Rajagopal S.; Bryner B.; Milano C.A.;
Shah S.H.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Inhaled pulmonary vasodilators (iPVD) help prevent right
heart failure (RHF) by lowering PVR after surgery. However, variable
change in PVR is seen in response to iPVD. As metabolism is central to
cardiomyocyte function, we evaluated the role of right ventricular (RV)
myocardial metabolism in iPVD response heterogeneity. Hypothesis: We
previously identified plasma metabolic biomarkers as potential reporters
of response heterogeneity and posited here that these key metabolites
change in parallel with changes in RV phenotypes. <br/>Method(s): We
evaluated 63 LVAD or heart transplant recipients with precapillary
pulmonary hypertension before surgery from a recent randomized trial
(INSPIRE-FLO, NCT03081052). All participants received iPVD after
heart-lung bypass through postoperative day 1 (pod 1). Targeted profiling
of > 500 metabolites (MxP Quant 500, Biocrates) was performed in baseline
and pod 1 plasma, and in RV free-wall full-thickness biopsies from LVAD
recipients. Principal components analysis (PCA) was used for metabolite
dimensionality reduction. Generalized linear models were used to assess
the association of percent change (%DELTA) in metabolite factors with (1)
%DELTA PVR (baseline to pod1); (2) responder, PVR < 3 Wood U vs.
non-responder, PVR >= 3 Wood U, on pod 1); (3) RHF after surgery.
<br/>Result(s): PCA identified 21 factors with 204 metabolites clustering
in biologically consistent pathways. Of these, %DELTA in factor 8 (glycine
and eight glycerophospholipids, GPs) were positively correlated with
%DELTA PVR (P < 0.05). There was a trend for association in %DELTA in
factors 1 and 12 (ceramides, other GPs, amino acids: glutamate, aspartate,
alanine, glutamine) and %DELTA PVR (both P < 0.10, negatively correlated).
There was a trend for association in %DELTA in factor 7 (long chain
acylcarnitines) and subsequent RHF (P = 0.08, positively correlated). No
metabolites were associated with responder status. Plasma levels of select
metabolites in factors 1 and 12 were positively correlated with RV
myocardial levels (P < 0.05), suggesting a myocardial source.
<br/>Conclusion(s): Leveraging a unique clinical trial cohort, we
identified substrates of amino acid and fatty acid mitochondrial
s-oxidation metabolism in RV myocardium that may serve as biomarkers of
metabolism in RHF.

<45>
Accession Number
639790814
Title
Edoxaban For Pediatric Patients With Cardiac Diseases: A Randomized, Open
Label, Multicenter Study.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Portman M.A.; Jacobs J.P.; Newburger J.W.; Berger F.; Grosso M.A.; Duggal
A.C.; Goldenberg N.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Standard of care (SOC) anticoagulation for thromboembolism
(TE) prevention in patients <18 years old with cardiac disease includes
low molecular weight heparins or vitamin K antagonists. Limited data exist
comparing direct oral anticoagulants as edoxaban with conventional
anticoagulants in this population. Hypothesis: Edoxaban is at least as
safe as the current standard-of-care (low molecular weight heparins and/or
vitamin K antagonists) with regard to the incidence of major and
clinically relevant nonmajor bleeding in pediatric patients with cardiac
diseases at risk of thromboembolism. <br/>Method(s): We performed a phase
3, multinational, prospective, randomized, open-label, blindedendpoint
trial in patients <18 years old with cardiac disease (ENNOBLE-ATE,
NCT00687882). Children were randomized 2:1 to age-and weight-based oral
edoxaban once-daily versus SOC for 3 months (main study). Randomization
was stratified by concomitant use of aspirin and by underlying disease
groups, as follow: history of Fontan procedure; Kawasaki disease; heart
failure; other. Both groups continued in an extension with edoxaban
through 1 year. The primary endpoint was adjudicated International Society
on Thrombosis and Haemostasis defined clinically-relevant bleeding (CRB).
The main secondary endpoint was a composite of symptomatic TE and
asymptomatic intracardiac thrombosis. <br/>Result(s): We randomized 168
children from May 2018 to September 2021. The CRB event rates were similar
between groups during the main period. One subject per group experienced a
nonmajor CRB. Treatment-emergent adverse events occurred in 46.8% (51/109)
with edoxaban and 41.4% (24/58) with SOC. One SOC subject experienced 2 TE
events (DVT with PE). In 152 subjects continuing in the extension, one CRB
event (0.7%; trauma related) and 4 TEs occurred (2.8%; 2 strokes and 2
coronary artery thromboses and/or myocardial infarctions).
<br/>Conclusion(s): Bleeding and TE occurred rarely for both groups and
during the extension,suggesting that edoxaban is safe and effective for TE
prevention in this population. Once daily edoxaban may provide advantage
for children considering difficulties with enoxaparin injections and food
and drug interactions with warfarin.

<46>
Accession Number
639790703
Title
Autoimmune Limbic Encephalitis Mimicking Inferior Myocardial Infarction on
ECG.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Zeitjian A.; Noor B.; Chand R.
Publisher
Lippincott Williams and Wilkins
Abstract
Case Presentation: A 64 year-old man was brought to the emergency
department (ED) after being found down, awake, but unresponsive by family.
In the ED, he denied chest pain and shortness of breath. His past medical
history included coronary artery disease status-post coronary artery
bypass grafting, heart failure with reduced ejection fraction, and
paroxysmal atrial fibrillation. On physical exam, he was hemodynamically
stable, oriented to self and place with no other significant neurological
findings. The field and ED electrocardiograms (ECGs) (Figure 1) were
consistent with an acute inferior ST elevation myocardial infarction
(STEMI). The patient underwent emergent coronary angiography via left
heart catheterization which showed no acute lesions requiring
intervention. Initial pertinent lab work included a peak troponin-I of
0.095 ng/mL and serum sodium of 126 mmol/L. Collateral information
revealed that the patient has progressive memory loss and intermittent
episodes of hand tremors with non-purposeful eye movements. He also had a
witnessed faciobrachial dystonic seizure, which is pathognomonic for
Leucine-rich, Glioma Inactivated-1 (LGI1) autoimmune encephalitis. Serum
and CSF analyses were positive for LGI-1 IgG antibodies, confirming the
diagnosis. The patient was treated with high-dose steroids, IVIG, and
valproic acid with improvement in seizure activity and cognitive status,
and discharged on prednisone and levetiracetam. <br/>Discussion(s): Per
review of the current literature, central nervous system pathology may
induce sympathetic overactivity causing transient myocardial injury,
referred to as neurogenic stunned myocardium. This can manifest as left
ventricular dysfunction, myocardial injury, and/or ECG changes consistent
with myocardial infarction. This case presentation highlights an example
of a seizure leading to neurogenic stunned myocardium with an ECG showing
an acute inferior STEMI.

<47>
Accession Number
639790613
Title
Post Transcatheter Aortic Valve Replacement (TAVR) Mortality Outcomes in
Patients With and Without Severe LV Dysfunction (LVEF<35%): A Pooled
Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Shrivastava S.; Pandya K.K.; Saqib N.; Sethi N.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is indicated in
patients with severely reduced left ventricular ejection fraction (LVEF)
and can restore left ventricular (LV) function. However, mortality
outcomes in this unique subset of patients has been studied only in
limited cohorts. <br/>Method(s): Extensive search on PubMed and Google
Scholar yielded 1069 reports meeting inclusion criteria. These studies
were independently evaluated by 2 physicians. Nine studies comparing
allcause mortality in patients undergoing TAVR with and without severely
reduced LVEF (<35%) were included with a total of 31,952 patients. A
study-level analysis was done using Review manager 5.3. As a guide, an I2
>30% was considered an indicator of statistical heterogeneity among the
studies. A Mantel-Haenszel Random effects model was used to calculate the
Odds Ratio for homogeneous endpoints. A p value <0.05 was considered
significant. <br/>Result(s): 30-day and 1-year all-cause mortality was
significantly higher among patients with severely reduced LVEF yielding
Odds Ratios of 1.80[CI 1.33-2.87; p=0.01; I = 77%] (A) and 1.81 [1.65-1.99
p<0.001; I = 26%] (B). respectively. <br/>Conclusion(s): There is a
staggering 80% increased risk of short- and long-term mortality in
patients with severely reduced LV function following TAVR. These findings
are concerning despite lack of randomized data. Interdisciplinary
management with advanced heart failure teams should be undertaken
pre-emptively in these patients for close monitoring and early
intervention.

<48>
Accession Number
639790611
Title
A Meta Analysis for Clinical Outcomes of Transcatheter Aortic Valve
Replacement in Patients With Bicuspid versus Tricuspid Aortic Valves Using
Balloon Expandable versus Self Expanding Valves.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Wang E.; Radwan Y.; Salam M.F.; Al-Asad K.S.; Halboni A.; Al-abcha A.;
Saleh Y.; George A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Over the past decade, several next generation transcatheter
aortic valve replacement (TAVR) devices have been developed with the aim
of improving patients' outcomes. Bicuspid aortic valves (BAVs) are an
emerging issue in TAVR practice. The goal of this study was to compare
clinical outcomes of TAVR using balloon-expandable (BE) versus
self-expanding (SE) transcatheter heart valves in patients with BAV vs
tricuspid aortic valve (TAV). <br/>Method(s): We searched PubMed, Cochrane
and Embase databases systematically for relevant studies from inception to
March 2022. The primary focus was 1-year all-cause mortality. Additional
outcomes included short term (30-days) all-cause mortality, cardiovascular
mortality, stroke, major/life threatening bleeding, permanent pacemaker
(PPM) implantation and major vascular complications. <br/>Result(s): There
were 28 studies with a total 346,033 patients who underwent TAVR, 17,835
of which had BAV stenosis. In the BE group, there was a statistically
lower risk of mortality of TAVR in the BAV when compared to the TAV (OR
0.69 [95% CI 0.49-0.97]; p=0.03). In terms of short-term outcomes of BE
group, the risks of all-cause mortality, stroke, PPM implantation, major
bleeding, and major vascular complications were all similar between the
two arms. In the SE group, there were not statistically significant in the
clinical outcomes between patients in BAV and TAV. <br/>Conclusion(s): The
use of balloon-expandable valves in TAVR was associated with a lower risk
of 1- year mortality in patients with BAV compared to patients with TAV.
These data support the need for a randomized trial to compare the
balloon-expandable valves in BAV patients.

<49>
Accession Number
639790554
Title
Antiplatelet Therapy Reduces Mortality When Compared to Direct Oral
Anticoagulants in Post-Transcatheter Aortic Valve Replacement Patients
Without Any Indication for Anticoagulation.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Moreira M.J.B.; Do Amaral Peixoto N.A.; Udoma Udofa O.C.; De Lucena Silva
Araujo S.; Tinajero S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter Aortic Valve Replacement (TAVR) is a widely
used minimally invasive treatment for severe aortic stenosis. Though the
procedure is safe and effective, patients are still at risk for ischemic
and hemorrhagic events after this intervention. The post-procedure
antithrombotic management in these patients continues to be a source of
debate, particularly in patients who do not have a preexisting or
concurrent comorbidity which requires long-term anticoagulation therapy.
<br/>Method(s): We performed a systematic review and meta-analysis to
compare Direct Oral Anticoagulants (DOACs) versus antiplatelet therapy
after TAVR in patients without previous indication for chronic oral
anticoagulation. PubMed, EMBASE, and Cochrane databases were searched for
randomized controlled trials (RCTs). Risk ratio (RR) with P value < 0.05
were considered statistically significant. The primary endpoints of
interest were death, obstructive valve thrombosis and major bleeding. No
time for follow-up was limited. <br/>Result(s): Three studies involving
2922 patients undergoing TAVR were included. Of the participants, 1459
received antiplatelets and 1463 received DOACs. Antiplatelets were
associated with significantly lower all-cause mortality (RR 1.68
[1.22-2.30], 95%IC; p=0.001). Major bleeding did not differ significantly
between groups, but DOACs had a higher risk of bleeding when compared to
antiplatelet drugs (RR 1.44 [0.90-2.32]; 95%IC, p=0.13). The antiplatelet
group had a significantly higher risk of valve thrombosis than the DOACs
group (RR 0.27 [0.14-0.51]; 95%IC; p<0.0001). <br/>Conclusion(s): This
meta-analysis suggests that the use of antiplatelet, in comparison to the
DOACs, after the TAVR procedure, reduces all-cause mortality, without
significantly increasing the risk of bleeding. However, DOACs have been
shown to reduce valve thrombosis. This is the best current evidence
available. More RCTs, however, are needed to consolidate these findings.

<50>
Accession Number
639790440
Title
Updated Meta-Analysis on Safety and Efficacy of Cerebral Embolic
Protection Devices Among Patients Undergoing Transcatheter Aortic Valve
Replacement.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Shrestha D.B.; Shtembari J.; Lamichhane S.; Baniya A.; Shahi M.; Sutton
N.R.; Villablanca P.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cerebral embolic protection devices (CEP) have been
introduced to capture embolic debris and reduce the risk of stroke during
Transcatheter Aortic Valve Replacement (TAVR). Available evidence
regarding the safety and efficacy of CEP is inconclusive. Therefore, we
aimed to determine the safety and efficacy of CEP use during TAVR.
<br/>Method(s): Major electronic databases were searched for the relevant
articles with appropriate search terms. All relevant data from 17 studies
were extracted into a standardized form. Statistical analyses were
performed using Revman 5.4. Odds Ratio (OR) or mean differences (MD) were
used to estimate the desired outcome with a 95% confidence interval (CI).
<br/>Result(s): A total of 17 studies involving 204,875 patients (15,880
in the CEP arm and 188,995 in the non-CEP arm) were included. No
significant difference in 30-day stroke was observed with the use of CEP
between the two groups (OR 0.75, 95% CI 0.55 to 1.03). The use of CEP was
associated with a lower odds of 30-day mortality by 39% (OR 0.61, 95% CI
0.53 to 0.70). Based on diffusion weighted-magnetic resonance imaging
(DW-MRI), there were no differences in the occurrence of new lesions, the
total volume of lesions, and the number of new lesions. In addition, the
use of CEP in patients undergoing TAVR was associated with a reduction in
major or life-threatening bleeding events (OR 0.89, 95% CI 0.81 to 0.98).
No differences were observed in the outcomes of acute kidney injury and
major vascular complications between both arms. <br/>Conclusion(s): No
significant difference in 30-day stroke was observed with the use of CEP
in TAVR patients. The use of CEP was associated with significantly lower
odds of 30-day mortality and lower rates of major or life-threatening
bleeding compared with no CEP in patients undergoing TAVR. Further studies
are needed to confirm current findings.

<51>
Accession Number
639790420
Title
Diabetes Mellitus and Acute Heart Failure With Reduced Ejection Fraction:
A National Database Study.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Khalil M.; Gomez-Pineiro E.; Mir T.; Uddin M.; Khalil A.; Tahir H.; Uddin
N.; Tasniya R.; Qureshi W.; Sheikh M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Literature regarding outcomes of acute heart failure with
reduced ejection fraction (HFrEF) in patients with diabetes mellitus (DM)
is still evolving. <br/>Objective(s): To study the all-cause mortality and
clinical outcomes of acute HFrEF in diabetic patients. <br/>Method(s):
Data from the National Emergency Department Sample (NEDS), which
constitutes 20% of the sample of hospital-owned emergency departments (ED)
in the United States (US), was analyzed for hospital encounters related to
acute HF and DM using International Classification of Diseases-10 (ICD-10)
codes. <br/>Result(s): Out of the total 1,479,716 acute HF encounters
(mean age 69.7+/-14.9 years,47.3%females) recorded for the years
2016-2018, 803,308 (54.3%) were acute HFrEFrelated, with 317,517 (39.5%)
HFrEF with DM. The HFrEF with DM group had higher multi-organ
complications including NSTEMI (14.6% vs 12.9%; p-value <0.001), acute
kidney injury (AKI) (29.3% vs 26.2%; p-value <0.001), AKI requiring
hemodialysis (10.5% vs 6.7%; p-value <0.001) when compared to HFrEF group
only. However, the all-cause mortality for HFrEF only was higher as
compared to HFrEF with DM (5% vs 4.8%; p <0.001). Moreover, HFrEF with DM
group had higher coronary interventions including PCI (7.6% vs 7.1%;
p-value <0.001), and CABG (1.9% vs 1.4%; pvalue <0.001).
<br/>Conclusion(s): Surprisingly, HFrEF complicated by DM did not show
significant worsening in mortality rates compared to patients with acute
HFrEF. Ischemic cardiac work-up showed mortality benefits. The possibility
of selection bias for ischemic cardiac procedures suggest more randomized
trials to evaluate the hypothesis generated.

<52>
Accession Number
639790242
Title
Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients
With Bicuspid versus Tricuspid Aortic Valve Stenosis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Radwan Y.; Wang E.; Salam M.F.; Al-Asad K.S.; Halboni A.; Al-abcha A.;
Saleh Y.; Abela G.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has proven to
be safe and efficacious in patients with tricuspid aortic valve (TAV)
stenosis. However, due to its anatomic complexity, bicuspid aortic valve
(BAV) stenosis has been excluded from previous trials, and data remain
limited regarding TAVR in this group of patients. <br/>Method(s): We
searched the databases systematically for relevant studies from inception
to March 2022. The primary focus was all-cause mortality at 1-year.
Additional outcomes included 30-day mortality, 30-day stroke, and 30-day
major vascular complications. <br/>Result(s): We included 28 studies with
a total of 346,033 patients who underwent TAVR, of which 17,835 patients
had BAV stenosis. The risks of 1-year mortality and 30-day major vascular
complications were similar between the 2 groups. However, patients with
BAV who underwent TAVR had a higher risk of 30-days mortality (BAV 2.3% vs
TAV 2.2%, p=0.02) and 30-day stroke (BAV 2.2% vs TAV 1.8%, p=0.01). A
subgroup analysis of 23,623 matched patients of whom 49.5% had BAV
stenosis was performed. The risk of 1-year mortality was lower in patients
with BAV compared to TAV (BAV 5.8% vs TAV 6.8%, p=0.009). Risks of 30-day
mortality, and 30-day major vascular complication were similar between the
two groups. However, the risk of 30-day stroke was higher in the BAV group
(BAV 2.2% vs TAV 1.7%, p=0.02). <br/>Conclusion(s): In our meta-analysis,
among patients who underwent TAVR for aortic stenosis, there was no
significant difference between BAV vs TAV in outcomes, except for higher
risk of 30-days mortality and stroke. Among matched groups, patients with
BAV stenosis undergoing TAVR had comparable outcomes to patients with TAV
stenosis except for higher risk of stroke and lower risk of 1-year
mortality in BAV group.More studies, specifically randomized trials, are
still warranted to further assess efficacy, safety and reassure the
long-term outcomes in this group of patients.

<53>
Accession Number
639789987
Title
Vascular Complications and Outcomes Following Transcatheter Aortic Valve
Replacement in Patients on Chronic Steroids Therapy. A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Peng Ang S.; Chia T.H.; Jaiswal V.; Song D.; Ee Chia J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Chronic steroids therapy was reportedly linked to increased
vascular complications (VC) following invasive vascular procedures.
However, its association with VC after transcatheter aortic valve
replacement (TAVR) remained uncertain, with conflicting results being
reported. We aimed to compare the rate of vascular complications and
outcomes between patients with and without chronic steroid use after TAVR.
<br/>Method(s): We conducted a comprehensive literature search in PubMed,
Embase and Cochrane databases for relevant studies. Endpoints were
described according to Valve Academic Research Consortium-2 definitions
and were assessed within 30 days of TAVR. Effect sizes were pooled using
the DerSimonian and Laird random-effects model as risk ratio (RR) with 95%
confidence intervals (CI). <br/>Result(s): 5 studies with 6136 patients
undergoing TAVR (328 steroids, 5808 non-steroids) were included in the
analysis. Patients on chronic steroids were younger (mean age 80.2 vs 82.3
years) and were more likely to be female (56% vs 54%). Patients on chronic
steroids had a higher risk of major vascular complications (RR 2.32, 95%
CI 1.73-3.11, p<0.001), major bleeding (RR 1.61, 95% CI 1.27-2.05,
p<0.001) and aortic annulus rupture (RR 4.66, 95% CI 1.67-13.01, p<0.001).
There was no significant difference in terms of minor vascular
complications (RR 1.43, 95% CI 1.00-2.04, p=0.05), in-hospital mortality
(RR 1.86, 95% CI 0.74-4.70, p=0.19) and 30-day mortality (RR 1.14, 95% CI
0.53-2.46, p=0.74) between both groups. <br/>Conclusion(s): Chronic
steroid therapy is associated with increased rate of major VCs, major
bleeding and aortic annulus rupture following TAVR. Further randomized
controlled trials were encouraged to confirm these findings.

<54>
Accession Number
639789984
Title
Prevalence and Outcomes of Prosthetic Valve Endocarditis Post-Tavr: A
Proportion Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Susan Varghese J.; Vadiyala M.R.; Ang S.P.; Chia J.E.; Reddy A.; Ishak A.;
Yaqoob S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Prosthetic valve endocarditis (PVE) may occur after
trans-catheter aortic valve replacement (TAVR), resulting in
bio-prosthetic valve dysfunction. We aim to assess the clinical
characteristics and long-term outcomes post TAVR. <br/>Method(s): We
performed a systematic literature search in PubMed, Scopus, and Embase for
relevant articles from inception until June 01, 2022. Primary outcome was
all-cause mortality. Secondary outcomes include acute kidney injury,
stroke, systemic embolisation, heart failure and valve re-intervention.
All endpoints were pooled using a random-effect model. <br/>Result(s): A
total of 33 studies were included, comprising 346,094 patients who
underwent TAVR. Amongst the various co-morbidities, most common were
diabetes (11%), chronic kidney disease (8%) and chronic obstructive
pulmonary disease (COPD) (8%).The pooled incidence of PVE was 1% [95% CI
(1%-2%)]. The most common approach was trans-femoral (n=15) (88% [95% CI
(79%-95%)]) followed by trans-apical (n=9) (14% [95% CI(10%-18%)]). The
most common organisms isolated were staphylococcus species (n=24) (34%
[95% CI (30%-38%)]), followed by streptococcal species (n=23) in 23% and
enterococcus species (n=22) in 24%. The leading complications reported
were acute kidney injury (AKI) (30% [95% CI (19%-44%)]) (n=7),
cerebrovascular accident (10% [95% CI (7%-14%)]) (n=13), embolisation (17%
[95% CI (10%-26%)]) (n=11) and patients requiring a surgical valve
replacement (12% [95% CI (8%-18%)] ) (n=14). The all-cause mortality was
49% [95% CI (41%-56%)], while the in-hospital mortality was 4% [95% CI
(2%-9%)]. <br/>Conclusion(s): Incidence of IE post TAVR is low (1%), but
is associated with a higher rate of mortality (49%) and morbidity. As a
result, aggressive management is needed to reduce post-TAVR complications.

<55>
Accession Number
639789981
Title
Higher In-Hospital Mortality After TAVR and PCI on Same Hospitalization: A
Systematic Review and MetaAnalysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
De Miranda Gauza M.; Calomeni P.A.-K.B.; Felix N.; Machado M.; Melo P.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Aortic stenosis (AS) patients admitted for elective
transcatheter aortic valve replacement (TAVR) frequently present
significant coronary artery disease (CAD). Despite the increasing number
of TAVR procedures, it remains unclear if the strategy of performing
percutaneous coronary intervention (PCI) and TAVR during the same
hospitalization differs from isolated TAVR. <br/>Method(s): We performed a
systematic review and meta-analysis of observational studies in patients
with AS and significant CAD (lesions >=50%). The aim of the study was to
compare TAVR and PCI on same hospitalization (with no regard for whether
in the same procedure) to TAVR and deferred PCI. In-hospital mortality,
acute kidney injury and major bleeding were our outcomes of interest.
<br/>Result(s): We included 4 studies with 2917 patients, 665 treated with
TAVR+PCI and 2252 treated with TAVR alone. TAVR+PCI was associated with
higher in-hospital mortality (OR 1.66; 95% CI 1.21 - 2.27; p=0.002; Fig.
1). However, there was no difference in acute kidney injury (OR 0.59; 95%
CI 0.26 - 1.32; p=0.20; Fig. 2A). Furthermore, TAVR+PCI seemed to lower
the rate of major bleeding (OR 0.65; 95% CI 0.46 - 0.93; p=0.02 Fig. 2B).
<br/>Conclusion(s): In this meta-analysis of retrospective studies, TAVR
and PCI on same hospital admission was associated with higher in-hospital
mortality when compared to isolated TAVR.

<56>
Accession Number
639789837
Title
Stroke Risk and Oral Anticoagulation Use With Extended Cardiac Monitoring
for Atrial Fibrillation versus Usual Care: A Systematic Review With
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Cheung C.; MacDonald B.; Turgeon R.; Field T.; Hill M.D.; Sposato L.; Ha
A.; Verma A.; Verma S.; Svendsen J.H.; Larsen J.M.; Diederichsen S.; Tat
K.K.; Andrade J.G.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Prolonged cardiac monitoring is frequently used to detect
atrial fibrillation (AF) in high-risk populations, with the goal of
preventing thromboembolic events. We sought to determine the impact of
prolonged cardiac monitoring on the incidence of stroke and systemic
embolism (SSE) or transient ischemic attack (TIA) METHODS: We performed a
systematic review and meta-analysis of randomized trials evaluating
prolonged monitoring versus usual care (PROSPERO #CRD42021277611). Studies
were identified through CENTRAL, MEDLINE, and Embase. We included studies
with >=100 participants and >=30 days follow-up. The primary outcome was a
composite of SSE/TIA, as reported in the original trials. Secondary
outcomes included AF detection, oral anticoagulation (OAC) initiation, and
major bleeding. Sensitivity analysis examining the impact of monitoring
device, and indication for monitoring were performed. Meta-analyses were
performed with R using a random-effects model. <br/>RESULT(S): From 1411
records, we included 9 RCTs (n = 10,205). Mean age was 70 years, 40% were
female, and mean CHADS2 score was 4.0. Studies used implantable cardiac
monitors (n = 4), external cardiac monitors (n = 3), or handheld ECG
devices (n = 2). Study populations included post-stroke (n = 5), high risk
for AF or stroke (n = 2), and post-cardiac surgery (n = 1). Mean followup
was 16 months (range 3-65). Extended monitoring did not significantly
reduce the primary outcome (Figure, random effects risk ratio [RR] 0.87,
95% confidence interval [CI] 0.72-1.06, I2 = 0%) or its individual
components. Extended monitoring increased AF detection (RR 4.56, 95% CI
3.01-6.92, I2 = 65%) and OAC usage (RR 2.25, 95% CI 2.01-2.53, I2 = 0%),
but did not impact major bleeding (RR 1.23, 95% CI 0.84-1.82, I2 = 0%).
<br/>CONCLUSION(S): Prolonged monitoring was associated with increased AF
detection and OAC use, without significantly reducing the occurrence of
thromboembolic events.

<57>
Accession Number
639789737
Title
Sex-Based Differences in Outcomes After Mitral Valve Repair for Severe
Secondary Mitral Regurgitation.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Nappi F.; Di magli A.; Nenna A.; Umberto B.; Chello M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Sex-based differences in outcomes after mitral valve repair
for severe secondary ischemic mitral regurgitation (SIMR) is poorly
understood. We examined differences in outcomes between men and women
after mitral valve repair for severe SIMR. <br/>Method(s): 96 patients
with SIMR were randomized to undergo either papillary muscle approximation
(PMA) with restrictive mitral annuloplasty (RMA) or RMA alone to evaluate
efficacy and safety. The primary endpoint was death and major adverse
cardiac or cerebrovascular events (MACCE) at 5 years. <br/>Result(s): 38
of the 96 enrolled (39.5%) were women. Five-year survival was 68% in women
and 78% men (HR 1.48; 95% CI 0.67-3.24). Men and women had similar
mortality rates in the PMA (HR 2.64; 95% CI 0.77-9.04) and RMA group (HR
0.93; 95%CI 0.31-2.78). Freedom from MACCE at 5 years was lower among
women than men (6% vs 23%; HR 1.89; 95%CI 1.20-2.98). The hazard for MACCE
was higher in women in the PMA group alone (HR 3.00; 95% CI 1.50-6.02).
Freedom from treatment failure was similar between sexes (55% in women and
69% in men; HR 1.58; 95% CI 0.81-3.06). Similar functional status (26.3%
vs 24.1%) and rehospitalization rates (23.7% vs 24.1%) were noted at 5
years. There were no significant differences in the percentage of change
over 5 years in LVESD and LVEDD between the sexes. <br/>Conclusion(s):
Women with SIMR who underwent mitral valve repair displayed no significant
differences in the degree of five-year survival. MACCEs however, recurred
more frequently in women. (Figure Presented).

<58>
Accession Number
639789686
Title
Randomized Comparison of a Radiofrequency Wire versus a Radiofrequency
Needle System for Transseptal Puncture.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Dewland T.A.; Gerstenfeld E.; Moss J.; Lee A.C.; Vedantham V.; Lee R.J.;
Tseng Z.; Hsia H.H.; Lee B.K.; Wall G.; Chang K.; Yang M.; Marcus G.M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transseptal puncture is a necessary component of many
electrophysiology and structural heart procedures. A new technology
utilizes a specialized introducer wire to cross the septum with
radiofrequency (RF) energy, eliminating the need for a transseptal needle
and wire/needle exchanges. The RF wire technique, however, has not been
evaluated in a randomized trial. <br/>Method(s): The Wire Instrumentation
with Radiofrequency Energy to Impact Transseptal puncture (WIRE IT,
NCT04645342) study was an investigator-initiated and designed trial that
enrolled individuals >=18 years of age undergoing double transseptal
puncture for atrial fibrillation or left atrial flutter ablation.
Participants were randomized to a transseptal approach with either a RF
needle (NRG Transseptal Needle, Baylis Medical) or RF wire (Versacross RF
Wire, Baylis Medical). The primary outcome was time to achieve first
transseptal puncture. Timing was started at insertion of the guidewire
into the short femoral vein sheath and was stopped once the transseptal
sheath was positioned in the left atrium and the dilator and guidewire
were removed. Secondary outcomes included second and combined transseptal
puncture time, fluoroscopy time, number of equipment exchanges, and
complications. <br/>Result(s): A total of 75 participants were enrolled
between November 30, 2020 and February 2, 2022 (36 RF needle, 39 RF wire).
No crossovers occurred. Randomization to the RF wire resulted in a
statistically significant reduction in first transseptal time compared to
the RF needle (Figure). Second and combined transseptal times and number
of equipment exchanges were also reduced with the RF wire. One participant
in the RF needle group experienced transient AV block due to mechanical
trauma. There were no complications in the RF wire group.
<br/>Conclusion(s): The RF wire technique resulted in faster time to
transseptal puncture and fewer equipment exchanges compared to an RF
needle with no difference in complications.

<59>
Accession Number
639789664
Title
Outcomes Following Aortic Valve Replacement Among Kidney Transplant
Recipients. A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Ang S.P.; Chia J.E.; Jaiswal V.; Mudwari R.; Song D.; Chia T.H.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: While kidney transplant recipients (KTR) are high risk
candidates for valve replacements, the safety of transcatheter aortic
valve replacement (TAVR) is limited among this population as they are
excluded from major trials. We aimed to compare the outcomes between TAVR
and surgical aortic valve replacement (SAVR) among KTR by a systematic
review and metaanalysis. <br/>Method(s): We comprehensively searched
PubMed, Embase, and Cochrane Library from its inception until April 20,
2022 for relevant studies. Outcomes were pooled using the DerSimonian and
Laird random-effects model and reported as odd ratios (OR) or standardized
mean difference (SMD) and 95% confidence intervals (CI). <br/>Result(s): 6
studies involving 5,452 patients (1,956 TAVR, 3,496 SAVR) were included in
the analysis. TAVR patients were older (69.4 years vs 62.8 years), were
less likely to be male (66.7% vs 67.9%) and had a higher prevalence of
most comorbidities including coronary artery diseases (78% vs 58%), heart
failure (71% vs 42%) and diabetes mellitus (52% vs 45%). Compared with
SAVR, KTR undergoing TAVR had significantly lower risk of in-hospital
all-cause mortality (OR 0.51, 95% CI: 0.39 to 0.67, p<0.001), acute kidney
injury (RR 0.49, 95% CI: 0.34 to 0.71, p<0.001), blood transfusion (OR
0.29, 95% CI: 0.19 to 0.55, p<0.001) and a shorter length of hospital stay
(SMD -0.67, 95% CI: -1.10 to -0.24, p=0.002). In contrast, there was a
higher need for permanent pacemaker implantation among the TAVR cohort
compared to SAVR cohort (OR 3.44, 95% CI: 2.67- 4.43, p<0.001).
<br/>Conclusion(s): TAVR appeared to be a safe alternative compared to
SAVR in KTR, with a lower rate of short-term mortality, AKI and length of
hospitalization but a higher rate of permanent pacemaker implantation.
Further studies are encouraged to study the long-term outcomes among these
patients.

<60>
Accession Number
639789599
Title
A Systematic Review on Cardiac Papillary Fibroelastoma Presenting With
Cerebrovascular Events.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Neupane G.; Sharma R.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Cardiac papillary fibroelastomas (CPF) are rare, benign
endocardial tumors with embolic complications like cerebrovascular events.
The objective of this systematic review is to identify the clinical
profile, diagnostic approach, tumor characteristics, and treatment
modalities of patients with CPF presenting with stroke or TIA.
<br/>Method(s): We performed a systematic review using PUBMED and EMBASE
databases involving all the published case reports and case series of CPF
with TIA or stroke as presentation until April 2022. Viewpoints,
editorials, and review articles were excluded. <br/>Result(s): A total of
161 cases were identified from 133 case reports and 11 case series. The
mean age was 54.8 +/- 15.6 years with 53.4% females. The proportion of
patients with TIA and stroke was 32.3% and 67.8% respectively.
Neuroimaging demonstrated the involvement of multiple sites (36.6%) and
middle cerebral artery territory (35.6%) as major sites of stroke. The
primary imaging tool for the diagnosis of CPF was echocardiogram. The size
of the tumor varied from 2 to 47 mm³ (mean 11.8 +/- 7.1).
Left-sided valves were the most common location of the tumor (73.2%).
Mitral valve was the most common valve involved (38.9%) with the anterior
leaflet being the more common site (61.3%). The aortic valve was involved
in 32.5% with non-coronary cusp being the more common site (37.5%). About
10.6% of cases were missed by TTE (mean size of valvular tumors missed by
TTE was 5.6 +/- 1.9 mm). Most of the tumors (91.4%) showed independent
mobility. Surgical excision was performed in 89.5% cases with
histopathological confirmation. Medical management prior to surgery
included antiplatelets (87.9%) and anticoagulation (12.1%). Simple
excision, excision with valve repair and excision with valve replacement
were done in 66.7%, 16.7% and 16.7% respectively. Most patients (97.8%)
had uneventful post-operative course. <br/>Conclusion(s): CPFs are
potential differential diagnosis for cryptogenic stroke. TEE serves as a
better diagnostic modality for cardiac workup of cryptogenic stroke if the
initial TTE is negative. While the consensus for CPF management remains
controversial, the results of our study support surgical management as the
primary approach for left-sided tumors presenting as stroke/TIA.

<61>
Accession Number
639789442
Title
Spontaneous Hemopericardium After Rivaroxaban.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Nawal S.; Ismail H.; Lewis J.F.
Publisher
Lippincott Williams and Wilkins
Abstract
Direct oral anticoagulants (DOACs) such as rivaroxaban have become the
drugs of choice when treating a variety of conditions requiring
anticoagulation. We describe a case of a patient found to have
hemopericardium with tamponade physiology on a routine echo ordered for
evaluation of tachycardia. A 49-year-old man with systemic hypertension
was found to have a right lower lobe pulmonary embolus (PE) during a
hospitalization for diabetic ketoacidosis complicated by pneumoperitoneum
s/p small bowel resection. Rivaroxaban 15 mg twice daily was initiated for
treatment of PE. On day 2 rivaroxaban, patient became tachycardic. Chest
CT showed a small to moderate pericardial effusion with pericardial
enhancement. On day 7, a echo showed trivial pericardial effusion without
hemodynamic compromise. Tachycardia persisted after hospital discharge,
but patient was otherwise asymptomatic. Patient transitioned to
rivaroxaban 20 daily after 3 weeks. Outpatient echo done 2 months after
discharge showed a large pericardial effusion with tamponade physiology.
Patient was instructed to go to hospital for admission. Labs were
significant for Hgb 7.8, and elevated PT 52.50, INR 4.5 and PTT 33.80.
Rivaroxaban was held, and patient was given 2 units FFP, Vitamin K 10 mg
oral, Kcentra 4208 units and 2 units pRBCs. Patient underwent a
pericardiocentesis with removal of 600 cc of sanguineous fluid. Fluid
analysis was consistent with hemorrhagic effusion. Repeat echo showed a
small residual, anterior pericardial effusion with constrictive
physiology. Patient was discharged on reduced dose of rivaroxaban 10 daily
and Vitamin K 5 mg daily until outpatient follow up. Our case of
hemopericardium occurring in a middleaged man without confounding issues
is unusual. Although hemopericardium with DOACs have been reported, the
majority of cases have occurred in patients with pre-disposing risk
factors. A systemic review of 26 cases by Asad, et al. described risks
associated with cardiac tamponade with DOACs. The incidence of
hemopericardium and tamponade appeared highest in elderly men with renal
and coagulation abnormalities. Our case highlights the importance of
vigilance in patients on DOACs who present with subtle symptoms suggestive
of hemodynamic compromise or instability.

<62>
Accession Number
639789307
Title
Improved Recovery Times and Postoperative Outcomes After Cardiac Surgery
Done Under Thoracic Epidural Anaesthesia: A Systematic Review,
Meta-Analysis, With Trial Sequential Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Chiew J.K.; Low C.J.; Zeng K.; Goh Z.J.; Ling R.R.; Chen Y.; Ti L.K.;
Ramanathan K.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Research on fast-track recovery protocols postulate epidural
anaesthesia (TEA) in cardiac surgery contribute to improved postoperative
outcomes. However, concerns about TEA's safety and current equivocal
evidence, hinder its widespread usage. We conducted a systematic review
and meta-analysis to assess the effects of TEA in cardiac surgery.
<br/>Method(s): We searched four databases for randomised controlled
trials (RCTs) assessing the use of TEA against only GA in adults
undergoing cardiac surgery, up till 4 June 2022. We conducted random
effects meta-analyses (DerSimonian and Laird), evaluated risk of bias
using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence
via the GRADE approach. Primary outcomes were ICU and Hospital length of
stay, with other outcomes including postoperative complications. Trial
sequential analysis (TSA) was conducted on all outcomes to elicit
statistical and clinical benefit. <br/>Result(s): Our meta-analysis
included 39 RCTs (1941 TEA patients, 2047 GA patients). TEA significantly
reduced ICU LOS (Figure 1: -6.8 hours, 95%-CI: -10.8 to -2.8, p=0.0009),
hospital LOS (-0.7 days, 95%-CI: -1.2 to -0.2, p=0.0051), and extubation
time (-2.8 hours, 95%-CI: -3.8 to -1.8, p=0.0001). However, there was no
significant reduction in mortality. TSA found that the cumulative Z-curve
passed the TSA-adjusted boundary for ICU LOS (see below), hospital LOS,
and ET, suggesting a clinical benefit. TEA also significantly reduced
transfusion requirements, pain scores, delirium, arrhythmia, and pooled
pulmonary complications, without additional complications such as epidural
hematomas. <br/>Conclusion(s): TEA reduces ICU and hospital lengths of
stay, and postoperative complications in patients undergoing cardiac
surgery with minimal reported complications. These findings favour the use
of TEA in cardiac surgery, and warrants consideration for use in cardiac
surgeries worldwide.

<63>
Accession Number
639789221
Title
Evaluation of Stable Angina by Coronary Computed Tomographic Angiography
versus Standard of Care: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Palicherla A.; Ismayl M.; Thandra A.; Shaikh K.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There has been growing evidence comparing Coronary Computed
Tomography Angiography (CCTA) versus the standard of care(SOC) in patients
with suspected stable coronary artery disease (CAD). We aimed to perform a
systematic review and meta-analysis to compare CCTA versus SOC in patients
with stable CAD. <br/>Method(s): We searched multiple databases for
randomized controlled trials (RCTs) comparing CCTA with SOC with various
functional testing approaches for the evaluation of stable CAD. We used a
random-effects model to calculate risk ratios (RRs) with 95% confidence
intervals (CIs). Outcomes included all-cause mortality, myocardial
infarction (MI), hospitalization for unstable angina (UA), invasive
angiography, revascularization, percutaneous coronary intervention (PCI),
and coronary artery bypass grafting (CABG). <br/>Result(s): We identified
6 RCTs with a total of 19,881 patients with stable CAD, of which 9,995
underwent CCTA and 9,886 underwent UC. There were no significant
differences between CCTA and SOC in terms of all-cause mortality (RR:
0.91; 95% CI: 0.70-1.19; p=0.64), MI (RR: 0.78; 95% CI: 0.58-1.05;
p=0.70), hospitalizations for UA (RR: 1.20; 95% CI: 0.95-1.51;p=0.64),
invasive angiography (RR: 0.11; 95% CI: 0.32-1.61; p<0.00001),
revascularization (RR:1.25; 95% CI: 0.83- 1.89; p<0.00001), PCI (RR: 1.20;
95% CI: 0.78-1.85; p<0.00001), and CABG rates (RR: 0.89; 95% CI:
0.530-1.49; p=0.0003). <br/>Conclusion(s): In patients with stable CAD,
CCTA is associated with similar outcomes compared to the usual standard of
care. Given its non-invasive nature and capability to evaluate
atherosclerotic plaque burden, CCTA may be preferred as an initial
strategy for the evaluation of patients with stable CAD.

<64>
Accession Number
639789159
Title
Advanced Cardiovascular Imaging for the Diagnosis of Mycobacterium
Chimaera Prosthetic Valve Infective Endocarditis After Open-Heart Surgery:
A Systematic Review.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Sanchez-Nadales A.; Diaz Sierra A.V.; Xu B.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Mycobacterium chimaera is an emerging pathogen, recognized
to cause prosthetic valve infective endocarditis (PVIE) and disseminated
infection following open-chest cardiac surgery with certain contaminated
heater-cooler systems. Diagnosis is challenging and requires a very high
index of suspicion. Data regarding the optimal cardiac imaging evaluation
of this condition is limited. <br/>Method(s): Scopus, PubMed, EMBASE, Ovid
and Cochrane were searched for published articles through October 2021,
using keywords "Mycobacterium chimaera", "Prosthetic valve" and
"Endocarditis". 169 articles were found and reviewed for study
eligibility. Articles were included if they consisted of Mycobacterium
chimaera causing IE, with imaging modalities used to establish diagnosis
Results: Thirty-three articles were included, yielding twenty-two cases of
Mycobacterium chimaera PVIE. The disease manifested on average thirty
months after surgery, with an average patient age of 59 years (90% male).
Imaging modalities to establish the diagnosis of prosthetic valve
infective endocarditis included: transthoracic echocardiogram in 5 cases,
transesophageal echocardiogram (TEE) in nine cases, 18F-FDG-PET/CT in
seven cases. A combination of imaging modalities with TEE and
18F-FDG-PET/CT was reported once; TTE, TEE and 18F-FDG-PET/CT was also
noted in one case. Lastly there was one instance each of combined use of
TTE, TEE, and one of the following: CTA, Cardiac MRI, or standard CT. Nine
cases did not specify the imaging modality used to achieve diagnosis. Ten
patients died. <br/>Conclusion(s): PVIE due to Mycobacterium chimaera
infection is a rare and challenging diagnosis, which requires a high index
of suspicion. Accurate diagnosis should be aided by multimodality cardiac
imaging, with 18F-FDG-PET/CT being a powerful adjunct imaging modality.

<65>
Accession Number
639788962
Title
Elevated C-Reactive Protein Level Amplifies the Association of
Lipoprotein(a) With Cardiovascular Risk and Risk Reduction With Alirocumab
After Acute Coronary Syndrome.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Schwartz G.G.; Szarek M.; Bhatt D.; Bittner V.A.; Diaz R.; Garon G.;
Goodman S.G.; Harrington R.A.; Jukema J.W.W.; Manvelian G.; Pordy R.;
White H.D.; Zeiher A.M.; Steg P.G.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the ODYSSEY OUTCOMES trial (NCT01663402) the PCSK9
inhibitor alirocumab [ALI] reduced the risk of cardiovascular events [CVE]
after acute coronary syndrome [ACS] in patients [pts] with elevated
atherogenic lipoproteins despite optimized statin treatment, an effect
modified by baseline levels of lipoprotein [Lp](a). Levels of the
inflammatory biomarker highsensitivity C-reactive protein [hsCRP] are
associated with risk after ACS. In this post hoc analysis, we determined
whether Lp(a)-associated risk of CVE after ACS and reduction in that risk
with ALI are modified by concurrent hsCRP levels. <br/>Method(s): 18,924
pts were randomized to ALI or placebo [PBO] 1-12 months after ACS and
followed for median 2.8 years. Baseline Lp(a) and hsCRP were available in
18,290 pts. CVE [CV death, non-fatal MI, stroke, unstable angina or heart
failure hospitalization, ischemia-driven coronary revascularization,
peripheral artery events, and venous thromboembolism] were evaluated by
baseline quartile of Lp(a) and by hsCRP dichotomized at 0.2 mg/dL.
<br/>Result(s): Median (Q1-Q3) baseline Lp(a) was 21.3 (6.7-59.6) mg/dL.
In 10,323 pts with baseline hsCRP<;0.2 mg/dL (Fig top) risk of CVE in the
PBO group increased modestly in Lp(a) Q4 (P =0.0592). Overall treatment
hazard ratio [HR] was 0.91 without significant trend across Lp(a)
quartiles. In 7967 pts with baseline hsCRP>=0.2 mg/dL (Fig bottom) risk of
CVE in the PBO group was elevated and increased across Lp(a) quartiles (P
<;0.0001). Overall treatment HR was 0.82 and decreased across Lp(a)
quartiles (P =0.0003). <br/>Conclusion(s): Elevated hsCRP amplifies the
relationship of Lp(a) with risk of CVE after ACS and the reduction in that
risk with alirocumab. <br/>Funding(s): Sanofi, Regeneron Pharmaceuticals
(Figure Presented).

<66>
Accession Number
639788958
Title
Clinical Outcomes of Transcatheter Aortic Valve Replacement With Without
Percutaneous Coronary Intervention - An Updated Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Review S.; Yassen M.; Moustafa A.
Publisher
Lippincott Williams and Wilkins
Abstract
Hypothesis: Transcatheter aortic valve replacement (TAVR) serves as a
less-invasive treatment option for high-risk patients with severe aortic
stenosis. Given the coexistence of obstructive coronary artery disease in
patients with high-grade aortic stenosis (estimated to be 40-75%), there
is inconsistent clinical data regarding potential mortality benefits of
paired percutaneous coronary intervention (PCI) with TAVR procedures.
<br/>Method(s): We performed a literature search using PubMed, Embase, and
Cochrane Library from inception through April 2022 to assess the mortality
impact of preceding/concomitant PCI in patients undergoing transcatheter
aortic valve replacement. The primary outcomes were 30-day all-cause
mortality, 30-day cardiovascular mortality, and 6 months-1 year all-cause
mortality. Secondary outcomes included 30-day myocardial infarction,
stroke, major bleeding/vascular complications, and acute kidney injury.
<br/>Result(s): 11 studies (10 retrospective cohort studies, 1 randomized
control trial) involving 2791 patients were included in the meta-analysis.
Compared to patients undergoing TAVR alone, the TAVR+PCI group showed no
significant difference in 30-day all-cause mortality (RR 0.90, CI 0.66,
1.22, p =0.49), 30-day cardiovascular mortality (RR 0.71 CI 0.44, 1.14, p
=0.16), or 6 months-1 year all-cause mortality (RR 0.94, CI 0.75, 1.18, p
=0.57). Regarding secondary outcomes, 30-day myocardial infarction was
higher in the TAVR+PCI group compared to the TAVR group (RR 3.09, CI 1.26,
7.57, p =0.01), while no significant differences were found in rates of
30-day stroke (RR 1.14, CI 0.56, 2.33, p =0.72), major bleeding/vascular
complications (RR 1.11, CI 0.79, 1.56, p =0.55), and acute kidney injury
(RR 1.07, CI 0.75, 1.54, p =0.71). <br/>Conclusion(s):
Concomitant/preceding percutaneous coronary intervention does not confer
any additional mortality benefit, and may increase the risk of 30-day
myocardial infarction, in patients with high-grade aortic stenosis
undergoing transcatheter aortic valve replacement. Further trials with
large sample sizes are needed to confirm our findings.

<67>
Accession Number
639788812
Title
The Cardioprotective and Anti-Inflammatory Effect of Inhaled Nitric Oxide
During Fontan Surgery: A Prospective Randomized Study.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Kolcz J.; Karnas E.; Surma E.K.Z.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Open heart surgery that requires cardiopulmonary by-pass
(CPB) evokes tremendous stress and inflammatory responses, affecting
postoperative organ function, morbidity, and mortality. Although part of
this reaction triggers protective and anti-inflammatory phenomena, it is
harmful, particularly in patients with single ventricle congenital heart
defects during Fontan surgery. Unfortunately, there is no perfect
anti-inflammatory and stress defence strategy despite decades of research.
Hypothesis: This study aimed to investigate the influence of nitric oxide
(NO) inhaled directly into the oxygenator during CPB on a proteome profile
of inflammatory cytokines, metabolic response markers, heart and lung
protection indicators, and the early clinical outcomes. <br/>Method(s):
The study involved 115 patients randomized to the Fontan-NO group,
receiving NO inhalation (n=48) and the Fontan group, not receiving NO
(n=49). Eighteen patients were excluded from the study. The clinical data
were prospectively analyzed. Proteome profiler essays were used for
repeated measurements of investigated analytes. <br/>Result(s): Fontan-NO
patients had significantly lower levels of lactate (p=0.04) and glucose
(p=0.02), lower pulmonary artery pressure (p=0.03) and catecholamine index
(p=0.042), shorter ventilatory support time (p=0.03) and ICU stay
(p=0.04). Plasma factors analysis has shown a significantly higher
concentration of interleukin-10, tissue inhibitor of metalloproteinase,
prolactin, and angiopoietin and a lower concentration of interleukin-6,
interleukin-8, interleukin-1beta, granulocytemacrophage colony-stimulating
factor, pentraxin, matrix metalloproteinase-8, troponin-I, CK-MB, and
insulin in Fontan-NO group. Multiple regression analysis revealed the
influence of Il-6 and Il-8 on respiratory support time and ICU stay and
the relationship between catecholamine index, duration of effusions, and
indicators of myocardial damage. <br/>Conclusion(s): NO inhaled into the
oxygenator during CPB can alleviate the inflammatory response, improve
myocardial and lung protection, and reduce metabolic stress in patients
with a single ventricle undergoing Fontan surgery. The observed effects
can influence short-term clinical outcomes.

<68>
Accession Number
639788803
Title
Gender Disparities After Transcatheter Aortic Valve Replacement With Newer
Generation Transcatheter Heart Valves: A Systematic Review and
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Trongtorsak A.; Thangjui S.; Adhikari P.; Shrestha B.; Kewcharoen J.;
Navaravong L.; Kanjanauthai S.; Attanasio S.; Saudye H.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Evidence demonstrated gender disparities after transcatheter
aortic valve replacement (TAVR) with early generation transcatheter heart
valves (THV)s. However, it is unclear whether gender-related differences
persist with the newer generation THVs. We conducted this meta-analysis
and systematic review to assess gender disparities after TAVR with newer
generation THVs Methods: We searched MEDLINE, and Embase databases from
inception to May 2022 to identify studies that reported gender-specific
outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut
R, and Evolut Pro). Outcomes of interests included 30-day mortality,
1-year mortality and vascular complications. Data were pooled using
random-effects models to calculate pooled odds ratio (OR) and 95%
conference interval (CI). <br/>Result(s): Four studies with a total of
47,933 patients (21,073 in females and 26,860 in males) were included.
Ninety-six percent received TAVR via transfemoral approach. Females had
higher 30-day mortality (OR = 1.53, 95%CI 1.31-1.79, p-value (p) < 0.001)
and vascular complications (OR=1.43, 95%CI 1.23-1.65, p< 0.001). However,
1-year mortality was similar between 2 groups (OR=0.83, 95%CI 0.67-1.04,
p=0.33). <br/>Conclusion(s): Higher 30-day mortality after TAVR in females
may be attributed from higher vascular complications. Further research is
needed to explore potential causes of increased mortality. While vascular
complications may be an etiology, other patient characteristics or
procedure-related issues should be evaluated. (Figure Presented).

<69>
Accession Number
639788722
Title
Valve-in-Valve Transcatheter Mitral Valve Replacement versus Redo Surgical
Mitral Valve Replacement for Degenerated Bioprosthetic Valves: A
Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Ismayl M.; Abbasi M.; Zaalouk M.; Aboeata A.S.; Anavekar N.S.; Goldsweig
A.M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Valve-in-valve transcatheter mitral valve replacement
(ViV-TMVR) and redo surgical mitral valve replacement (redo-SMVR) are two
treatment strategies for patients with bioprosthetic mitral valve
dysfunction. We conducted a systematic review and meta-analysis to compare
the outcomes of ViV-TMVR versus redo-SMVR. <br/>Method(s): We searched
PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing
outcomes of ViV-TMVR versus redo-SMVR in degenerated bioprosthetic mitral
valves. We used a random effects model to calculate risk ratios (RRs) with
95% confidence intervals (CIs). Outcomes included in-hospital, 30-day,
1-year, and 2-year mortality, stroke, bleeding and vascular complications,
acute kidney injury (AKI), arrhythmias, and hospital length of stay (LOS).
<br/>Result(s): Six observational studies with a total of 1,339 subjects
were included. Median follow-up was 2 years. Compared to redo-SMVR,
ViV-TMVR was associated with significantly lower inhospital (RR 0.42; 95%
CI 0.25-0.70; p=0.001) and 30-day mortality (RR 0.49; 95% CI 0.24-0.98;
p=0.04) but similar 1-year (RR 0.97; 95% CI 0.64-1.47; p=0.89) and 2-year
mortality (RR 1.14; 95% CI 0.71-1.81; p=0.59). Stroke, bleeding, AKI, and
arrhythmias were less frequent and hospital LOS was shorter with ViV-TMVR,
however vascular complications were similar between both strategies.
<br/>Conclusion(s): In patients with degenerated bioprosthetic mitral
valves, ViV-TMVR is associated with better outcomes compared to redo-SMVR
including lower in-hospital and 30-day mortality, lower complication
rates, and shorter hospital LOS. Given these findings and the ongoing
advances in transcatheter therapeutics, ViV-TMVR may be preferred over
redo-SMVR, particularly in individuals at intermediate-to-high surgical
risk.

<70>
Accession Number
639788694
Title
Incidence of In-Hospital Cardiac Arrest and Associated In-Hospital
Mortality in Pediatric Critically Ill Patients With Cardiac Disease
Significantly Decreased Over Time: Results From a Systematic Review and
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Sperotto F.; Daverio M.; Gregor D.; Dorste A.; Allan C.K.; Amigoni A.;
Thiagarajan R.R.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Studies evaluating trends in the incidence and mortality for
in-hospital cardiac arrest (IHCA) in children with cardiac disease
admitted to the intensive care unit (ICU) are rare. Additionally, there is
limited information on factors associated with IHCA and mortality.
Hypothesis: We hypothesized that the incidence of IHCA and the mortality
rate in cardiac children admitted to the ICU has significantly decreased
over time. <br/>Method(s): We conducted a systematic review of PubMed, Web
of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects
meta-analysis was used to compute pooledproportions and pooled-ORs.
Meta-regression adjusted for type of study (registry vs cohort) and
diagnostic category (surgical vs general cardiac) was used to evaluate
trends in incidence and mortality. <br/>Result(s): Of the 2,574 studies
identified, 25 were included in the systematic review (126,087 patients),
18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children
experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers
with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital
mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital
mortality decreased significantly in the last 20 y (p<0.001, Figure 1, and
p=0.020, respectively), while the proportion of patients achieving ROSC
did not change (p=0.572). Neonatal age, prematurity, comorbidities,
univentricular physiology, arrhythmias, pre-arrest mechanical ventilation,
ECMO, and higher surgical complexity increased IHCA and mortality odds.
<br/>Conclusion(s): A significant proportion (5%) of cardiac children in
the ICU experience IHCA. Decreasing trends in IHCA and in-hospital
mortality suggests that education on preventive measures and post-arrest
care have been effective. However, unchanged proportion of patients not
achieving ROSC illustrates the crucial need for developing resuscitation
strategies specific to children with cardiac disease.

<71>
Accession Number
639788619
Title
A Systematic Review and Meta-Analysis of Comparative Studies of
Postoperative Atrial Fibrillation in Obstructive Sleep Apnea Patients
Undergoing Coronary Artery Bypass Grafting.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Mondal A.; Katukuri N.; Pingili A.; Sanku K.; Tajdin B.; Zahdeh T.;
Cherukuri A.S.; Jalili H.; Bahadoran P.; Srikanth S.; Desai R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Post-CABG Atrial Fibrillation (PCAF) is linked to higher
mortality, morbidity, and healthcare costs. Obstructive Sleep Apnea (OSA)
has been studied as a risk factor for PCAF in a few studies. In this
study, we sought to review and analyze the association between OSA and
PCAF. <br/>Method(s): We systematically searched PubMed, Scopus, and
EMBASE for studies on OSA as predictors of PCAF using relevant keywords
through June 2022. Random effects models were used to estimate pooled
rates of PCAF with subgroup analysis. I² statistics were used
to report inter-study heterogeneity. Leave-one-out meta-analysis was
performed to evaluate the effect of each study on the overall estimate.
<br/>Result(s): A total of 15 (N= 534387) studies were included between
2008-2021 in our Systematic review/Meta-analysis (Median follow-up
duration: 29 days; mean age: 59-72 years; Males: 68.4%). 8 US-based
studies, with the rest from Europe and South Asia, were included. A total
of 34654 PCAF events were recorded. Pooled analysis of unadjusted (OR
1.23, 95%CI 1.07-1.42, p<0.01) and adjusted (1.24, 95%CI 1.10- 1.40,
p<0.01) odds of PCAF was higher in OSA vs non-OSA cohorts. Subgroup
analysis indicated greater risks of PCAF in prospective studies (OR 1.83,
95% CI 1.24- 2.71 p 0.01) but not in retrospective studies. Rates of PCAF
were higher in studies reported from other countries compared to the US
(1.24 vs 1.18, p<0.001) and with longer follow-up (>3 years) compared to
those with shorter follow-up (1 month) duration. <br/>Conclusion(s): In
this meta-analysis, OSA predicted a nearly 25% higher risk of developing
PCAF. Prospective studies assessing the long-term impact of OSA on
cardiovascular risk after CABG are warranted to curtail worse outcomes.

<72>
Accession Number
639788530
Title
A Systematic Review and Meta-analysis of Factors Associated With Long-Term
Mortality in Adults After Coronary Artery Bypass Graft Surgery.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Talukder S.; Dimagli A.; Benedetto U.; Gray A.; Gerry S.; Lees B.; Krzych
L.; Gaudino M.F.; Taggart D.; Flather M.D.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: With an ageing and increasingly multi-morbid population, the
use of coronary artery bypass grafting (CABG) is expected to increase. As
short-term CABG mortality rates have decreased, estimating long-term
outcomes for patients with specific risk factors has become more relevant.
Previous single observational studies have identified risk factors for
adverse long-term outcomes, such as older age and diabetes.
<br/>Purpose(s): Understanding the pre-operative characteristics that
affect late mortality post-CABG can lead to effective risk stratification
and enhancement of secondary prevention programmes, thereby aiming to
improve long-term prognosis after the procedure. <br/>Method(s): MEDLINE,
Embase, Google Scholar, and Cochrane electronic databases were searched to
identify all relevant articles evaluating associations between
pre-operative risk factors and longterm mortality (>=5 years ) post-CABG.
Studies with <500 patients were excluded. <br/>Result(s): From 1193
potentially eligible articles, 43 studies met the inclusion criteria. A
total of 360,481 patients, with an average follow-up of 10 years, were
included, representing an approximate cumulative total of 3,604,810
person-years. After pooling adjusted hazard ratios, 6 major risk factors
were found to be independently associated with long-term mortality after
CABG: age, ischaemia (peripheral vascular disease, prior cerebrovascular
accident, left main stem coronary disease), diabetes mellitus, atrial
fibrillation, renal impairment (chronic kidney disease and
dialysis-dependent chronic kidney disease), and impaired left ventricular
function (reduced LV ejection fraction or prior heart failure) (see Table
1). <br/>Conclusion(s): We have identified six groups of risk factors for
long-term mortality post-CABG. Further work is needed to assess whether
the influence of these risk factors varies over time and if targeted
interventions for high-risk groups lead to improved long-term mortality.

<73>
Accession Number
639788387
Title
Lipoprotein(a) is a Residual Cardiovascular Risk Factor in Statin Treated
Stroke Survivors - Insights From the SPARCL Trial.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Chemello K.; Gallo A.; Lambert G.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Elevated lipoprotein (a) [Lp(a)] plasma levels are causally
associated with CAD. The association between Lp(a) and stroke is however
less clear. The SPARCL trial has demonstrated the superiority of 80mg
atorvastatin to placebo for the prevention of stroke in patients with
recent stroke or TIA. The aim of the current study was to investigate if
Lp(a) is predictive of recurrent cerebrovascular and incident coronary
events in these patients. <br/>Method(s): Lp(a) concentration and
apolipoprotein(a) [apo(a)] isoform size, a strong determinant of Lp(a)
plasma levels, were measured by LC-HRMS in samples collected at baseline
from 2814 SPARCL participants (1418 randomized to atorvastatin & 1396 to
placebo). Within each treatment arm, we compared patients in the highest
quartile (>84.0nmol/L) with those in the lowest quartiles of Lp(a)
concentrations and patients in the lowest quartile (<25.9 KIV domains)
with those in the highest quartiles of apo(a) size distributions. The
relationship between these parameters and subsequent events was
established with a Cox proportional hazard model adjusted for age, sex,
type of entry event, time since entry event, BMI, smoking, hypertension,
non HDLC and DM. <br/>Result(s): In patients randomized to atorvastatin,
elevated Lp(a) concentrations and shorter apo(a) isoforms were
independently associated with an increased risk of coronary events [HR
(95% CI) of 1.607 (1.007-2.563) p=0.047 & 2.052 (1.303-3.232) p=0.002,
respectively]. These associations were primarily driven by a significantly
higher incidence of coronary revascularisation procedures, stable angina
requiring hospitalization, and MI. No such association was found in
patients randomized to placebo [0.925 (0.606-1.412) & 1.105
(0.735-1.659)]. We did not observe any significant association between
elevated Lp(a) concentrations or short apo(a) isoforms and the risk of
recurrent cerebrovascular events in patients randomized to atorvastatin
[0.794 (0.586-1.076) & 1.114 (0.760- 1.352)] or placebo [0.914
(0.688-1.214) & 0.940 (0.709-1.248)]. <br/>Conclusion(s): Lp(a)
contributes to the residual CAD risk of statin-treated stroke/TIA
survivors, paving the way for the use of novel therapies targeting Lp(a)
in patients with a history of stroke and elevated Lp(a).

<74>
Accession Number
639788366
Title
Long Term, Synergistic Benefit of Transmyocardial Laser Revascularization
and Platelet Rich Plasma - Significant Improvement of Global Longitudinal
Strain in Coronary Artery Bypass Graft Patients.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Khalpey Z.; Aslam U.; Deckwa J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Transmyocardial revascularization (TMR) is a procedure
designed to treat patients with end-stage coronary artery disease (CAD).
TMR creates myocardial micropores which undergo endothelialization and
redistribute ischemic stress, thereby improving regional wall motion.
Autologous platelet rich plasma (PRP) growth factors contribute to
endothelialization and neovascularization. In this study, we evaluate the
effectiveness of TMR combined with PRP to improve cardiac function in
patients undergoing CABG using echocardiograms. <br/>Method(s): A
single-center, single surgeon retrospective analysis of CABG patients was
performed (2019-2021). Patients in the TMR group had ten channels (7
Watts/channel) created in the inferolateral wall of the left ventricle
(LV) and those in the PRP group had autologous PRP extract injected(1ml,
without calcium) in the same area. In patients treated with both TMR and
PRP, ten channels were made in the inferolateral LV with PRP extract
injected in the peri-TMR zone, 5mm adjacent to the channels.
Post-operative ejection fraction (EF) and global longitudinal strain (GLS)
were measured using speckle tracking up to one year. <br/>Result(s):
Fifty-two patients (71% men, mean age 66y +/-9.04y) were enrolled in the
study and randomized to four experimental groups: CABG only (n=16);
CABG/TMR (n=17); CABG/PRP (n=10); and CABG/TMR/PRP (n=9). At one-year
follow-up, patients treated with both TMR and PRP had a significant
improvement in average GLS (-15.96, p= 0.02) compared to TMR alone
(-13.78, p= 0.26) and PRP alone (-15.79, p= 0.08). Patients treated with
TMR and PRP also had a significant rise in post-operative EF (57.78%, SD
+/- 6.18) compared to TMR alone (55.0%, SD +/- 6.85) and PRP alone (49.5%,
SD +/- 11.65). <br/>Conclusion(s): TMR with PRP extract treatment at the
time of CABG confers a significant one year improvement in cardiac
function as measured by LVEF and GLS. These outcome metrics highlight
cardiac remodeling and can mitigate the incidence of heart failure
readmissions. With further prospective trials and longer follow-up
periods, concomitant adjunctive TMR with PRP extract therapy at time of
CABG may have durable and significant cardiac scar remodeling benefits
leading to heart recovery in CABG patients.

<75>
Accession Number
639788156
Title
Valve-in-Valve Transcatheter Mitral Valve Replacement versus Redo Surgical
Mitral Valve ReplacementSytemetaic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Zahid S.; Inayat A.; Hamayel A.; Salman F.; Jain D.; Humayun O.; Warraich
S.; Goel S.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Data on comparative outcomes between valve in valve
transcatheter mitral valve replacement (ViV-TMVR) versus redo-surgical
mitral valve replacement (SMVR) for degenerated bioprosthetic valves
remain limited. Hypothesis: ViV TMVR is associated with lower in-hospital
mortality and complication rates compared with redo SMVR. <br/>Method(s):
The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with
various combinations of medical subject headings (MeSH) to identify
relevant articles. Eight studies evaluating comparative outcomes (ViV TMVR
vs Redo SMVR) for patients with degenerated bioprosthetic valves were
included in the analysis. <br/>Result(s): A total of 5,161 patients with
degenerated prosthetic mitral valves underwent ViV TMVR (n = 1163) and
redo SMVR (n = 3998) were included in the study. The mean age of patients
was 76 versus 66 years for ViV TMVR versus the redo SMVR group,
respectively (p<;0.01). In terms of comorbidities, female gender (55% vs
53.4%), serum creatinine (1.52 vs 1.3), dialysis (6.4% vs 6.6% ), LVEF
(55.56+/-9.5 vs 57.35+/-8.7), diabetes (20.2% vs 19.5%), hypertension
(73.5% vs 63.4%), atrial fibrillation (64.5% vs 69% ), and mitral
regurgitation (82.4% vs 80.5%) were similar between the ViV TMVR and redo
SMVR groups respectively. Using a pooled analysis, in-hospital mortality,
and major bleeding were significantly lower for patients undergoing ViV
TMVR compared with redo SMVR. No significant difference was observed in
the incidence of stroke. The length of stay was significantly lower in the
ViV TMVR group compared with the redo SMVR group. <br/>Conclusion(s): ViV
TMVR is associated with lower in-hospital mortality, complications, and
length of hospital stay compared with redo SMVR for degenerated
bioprosthetic valves. (Figure Presented).

<76>
Accession Number
639788146
Title
Role of Early Aortic Valve Replacement versus Conventional Management in
Asymptomatic Patients With Severe Aortic Stenosis: A Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Kaur A.; Dhaliwal A.; Sohal S.; Balboul Y.; Tamis-Holland J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Aortic-valve replacement (AVR) is an effective therapy for
patients with severe symptomatic aortic stenosis (AS) but the appropriate
timing of intervention for asymptomatic patients with severe AS remains
controversial. Increased mortality associated with the onset of symptoms
challenges the conventional "watchful waiting" strategy followed for this
subset of patients. An early intervention may be warranted, however the
data supporting this hypothesis is small. Our aim was to perform
meta-analysis looking at outcomes of early surgical AVR (SAVR) in
asymptomatic severe AS patients with preserved LVEF. <br/>Method(s):
Electronic databases were searched for studies comparing early SAVR and
conventional treatment in patients with asymptomatic severe AS and normal
LV function. The primary outcome of interest was all cause mortality.
Secondary outcome was heart failure hospitalization. Random-effects model
was used to estimate the pooled risk ratio (RR), and 95% confidence
interval (CI) using Revman 5.4.1. Subgroup analysis stratified by study
design was performed. Heterogeneity was assessed by Higgins I²
statistic. <br/>Result(s): We found total of 8 studies (2 RCTs; 6
observational) from which 2669 patients with asymptomatic severe AS were
identified. 1354 underwent SAVR and 1315 were managed conservatively. The
mean age was 68 years with mean follow up duration of 4.8+/-2 years. There
was statistically significant reduction in all-cause mortality (RR: 0.37;
CI: 0.27-0.50; p<;0.05; I2 = 68%) and heart failure hospitalization (RR:
0.24; CI: 0.16-0.36; p<;0.05; I2 = 0%) among patients who underwent AVR
compared with conservative treatment with subgroup analysis by study
design showing similar trends. <br/>Conclusion(s): Our meta-analysis shows
that compared with conventional treatment strategy, early SAVR in
asymptomatic patients with severe AS is associated with improved long-term
outcomes notably reduced all cause mortality and heart failure
hospitalizations. (Figure Presented).

<77>
Accession Number
639788073
Title
Intervention With Cerebral Embolic Protection in Transcatheter Aortic
Valve Implantation (INTERCEPTavi): Does Carbon-Dioxide Flushing Reduce
Vascular Brain Injury?.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Khawaja S.; Hanna L.; Singh A.; Crockett S.; Malik I.; Sen S.; Ruparelia
N.; Hadjiloizou N.; Farag M.; Khamis R.Y.; Gibbs R.; Mikhail G.W.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) is associated
with 2-3% clinical stroke rate and much higher incidence of silent
cerebral infarction. This study investigated the neuroprotective benefits
of minimising air emboli in TAVI. It aimed to demonstrate a reduction in
vascular brain injury by flushing TAVI valves with CO and saline compared
to saline only as per standard practise. <br/>Method(s): Patients
undergoing transfemoral TAVI for aortic stenosis were enrolled. Patients
were randomised to CO and saline (TAVI-CO ) versus saline only (TAVI-S)
flushing of TAVI valves during preparation. Patients underwent MRI brain
following TAVI to identify new cerebral infarcts and any reduction in
vascular brain injury by reducing air emboli. <br/>Result(s): Twenty-Two
patients were enrolled in the study with a mean age of 79+/-10 years.
Fifteen (68%) were males. Nine patients (41%) had history of hypertension,
5 (23%) had previous cerebrovascular disease and 5 (23%) had diabetes. Two
(9%) patients did not have their TAVI valve implanted and hence were
excluded. No patients had any procedural related complications. Three
(14%) patients required permanent pacemaker insertion post procedure and
could not have their MRI. Fifteen patients (68%) had MRI brain post-TAVI,
7 patients in the TAVI-CO group and 8 patients in the TAVI-S group.
TAVI-CO group had a total of 41 new cerebral lesions compared to 66
lesions in TAVI-S group. TAVI-CO had on average 6.80 new lesions/patient
compared to 8.25 lesions/patients in TAVI-S (p=0.34) Cerebral infarcts
were also analysed according to valve type. In self-expanding valves
(n=7), TAVI-CO<inf>2</inf> had 8 lesions/patient compared to 10
lesions/patient in TAVI- S (p=0.46). In balloon-expanding valves (n=8),
TAVI-CO<inf>2</inf> had 4.25 lesions/patient compared to 6.25
lesions/patient in TAVI-S (p=0.25). <br/>Conclusion(s): There is a trend
in the reduction in the number of new cerebral lesions in the
TAVI-CO<inf>2</inf> arm compared to the TAVI-S patients. This is the first
study that identifies the importance of air emboli in TAVI and the
associated potential vascular brain injury. As brain injury remains a
significant concern during TAVI, a larger randomised trial is required to
further investigate the neuroprotective benefit of flushing TAVI valves
with CO<inf>2</inf>.

<78>
Accession Number
639788008
Title
Hypothermia as an Adjunctive Therapy to Percutaneous Intervention in
St-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis
of Randomized Control Trials.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Mhanna M.; Ranabothu M.; Beran A.; Al-Abdouh A.; Jabri A.; Sajdeya O.;
Barbarawi M.; Al-Aaraj A.; Eltahawy E.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In the setting of acute ST-elevation myocardial infarction
(STEMI), several randomized control trials (RCTs) suggested a potential
benefit with the use of Therapeutic hypothermia (TH). However, results
from previous studies are contradictory. <br/>Method(s): We performed a
comprehensive literature search for studies that evaluated the efficacy
and safety of adjunctive TH compared to the standard percutaneous coronary
intervention (PCI) in awake patients with STEMI. The primary outcome was
the infarct size (IS) and microvascular obstruction (MVO) assessed by
cardiac imaging at the end of follow-up. The secondary outcomes were major
adverse cardiovascular events (MACE), procedure-related complications, and
door to balloon time. Relative risk (RR) or the mean difference (MD) and
corresponding 95% confidence intervals (CIs) were calculated using the
random-effects model. <br/>Result(s): A total of 10 RCTs, including 706
patients (mean age: 58+/-9.6 years, 364 patients managed with adjunctive
TH vs. 342 with standard PCI), were included. As compared to standard PCI,
TH was not associated with a statistically significant improvement in the
IS (MD: -0.87 %, 95%CI: -2.97, 1.23; P = 0.42) or in the MVO (MD: 0.11 %,
95%CI: -0.06, 0.27; P = 0.21). MACE and its individual components were
comparable between the two groups. However, the TH approach was associated
with an increased risk of infection and prolonged door to balloon time.
Furthermore, there was a trend in the TH group toward an increased
incidence of stent thrombosis and paroxysmal atrial fibrillation.
<br/>Conclusion(s): According to our meta-analysis of published RCTs, the
benefit of TH in STEMI patients is modest, with a marginal safety profile
and potential for care delays. Larger-scale RCTs are needed to further
clarify our results. (Figure Presented).

<79>
Accession Number
639787971
Title
The Ross Procedure versus Mechanical versus Bioprosthetic Aortic Valve
Replacement: A Network Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Yokoyama Y.; Kuno T.; Toyoda N.; Fujisaki T.; Takagi H.; Itagaki S.;
Ibrahim M.; Ouzounian M.; El-Hamamsy I.; Fukuhara S.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The Ross operation appears to restore normal survival in young
and middle-aged adults with aortic valve disease. However, there is
limited data comparing it to conventional aortic valve replacement
options. <br/>Objective(s): To compare outcomes of the Ross procedure,
mechanical and bioprosthetic aortic valve replacement (M-AVR, B-AVR).
<br/>Method(s): MEDLINE and EMBASE were searched through March 2022 to
identifyrandomized controlled trials (RCTs) and propensity-score matched
studies (PSMs) that investigated outcomes of patients >=16-year-old
undergoing the Ross procedure, M-AVR or B-AVR. <br/>Result(s): The
systematic literature search identified 2 RCTs and 8 PSMs involving a
total of 4,812 patients (Ross: n=1,991; M-AVR: n=2,019; B-AVR: n=802).
All-cause mortality was significantly lower in the Ross procedure group
compared with M-AVR (hazard rate (HR) [95% confidence interval (CI)]=0.58
[0.35-0.97], P=0.035) and BAVR (HR [95% CI]=0.32 [0.18-0.59], P <;0.001)
groups. The reintervention rate was lower in the Ross and M-AVR groups
compared with B-AVR (HR [95% CI] =0.31 [0.15-0.65], P=0.002, HR [95% 272
CI] =0.15 [0.05-0.41], P<; 0.001, respectively), while it was higher after
the Ross procedure compared with M-AVR group (HR [95% CI] =2.12
[1.04-4.33], P=0.039). However, post-Ross reinterventions included both
autograft and right ventricular outflow tract. Major bleeding rate was
lower after the Ross procedure compared with M-AVR. Long-term stroke rate
was lower following the Ross procedure compared with M-AVR and B-AVR. The
rate of endocarditis was also lower after the Ross procedure compared with
B-AVR. <br/>Conclusion(s): Improved long-term outcomes of the Ross
procedure are demonstrated compared with conventional M-AVR and B-AVR
options. These results highlight a need to enhance the recognition of the
Ross procedure and revisit current guidelines regarding the optimal valve
substitute for young and middle-aged patients. (Figure Presented).

<80>
Accession Number
639787939
Title
Tavr Outcomes in Overweight and Obese Patients: Systematic Review and
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Gupta R.; Behnoush A.H.; Khalaji A.; Mahmoudi E.; Maitz T.; Goel A.; Malik
A.H.; Bandyopadhyay D.; Aronow W.S.; Vyas A.; Patel N.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In recent years, the "obesity paradox" has been shown in
studies demonstrating better outcomes in overweight and obese patients
undergoing percutaneous or surgical cardiovascular procedures. This study
compares the effect of body-mass index (BMI) on outcomes in patients
undergoing transcatheter aortic valve replacement (TAVR). <br/>Method(s):
A comprehensive systematic search was conducted in PubMed, Web of Science,
and Cochrane library for relevant studies. Studies were included if they
had categories for BMI (normalweight, overweight, and obese) and reported
the outcomes of TAVR in each group. Random-effects using STATA was
performed for the meta-analysis. <br/>Result(s): 34 studies with 96,093
patients were included in our study. Overweight and obese patients had a
significantly lower rate of 1-year all-cause mortality, long-term
all-cause mortality and moderate to severe aortic regurgitation compared
to normal-weight patients (Figure 1). Incidence of 30-day myocardial
infarction was lower in overweight patients, and 1-year stroke incidence
was significantly lower in obese patients compared with normal cases. In
contrast, permanent pacemaker implantation was more observed in overweight
and obese patients. There was no significant difference in outcomes in
underweight patients compared to normal-weight ones except for a higher
rate of major vascular complications in underweight cases.
<br/>Conclusion(s): Our analysis showed improved outcomes in terms of
all-cause mortality and aortic regurgitation in overweight and obese
patients undergoing TAVR compared to normal-weight patients.

<81>
Accession Number
639787803
Title
Coronary Artery Bypass Grafting Demonstrates Lower Mortality Rates
Compared to Percutaneous Coronary Intervention for Multivessel Coronary
Artery Disease: An Updated Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Elfaituri M.K.; Khaled A.; Benghatnsh A.T.S.; Msherghi A.; Elfaituri A.;
Omran E.; Faraj H.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Treating individuals with stable multivessel coronary artery
disease (CAD) and retained ventricular function is still debatable.
Percutaneous coronary intervention (PCI) and coronary bypass grafting
(CABG) are all options for treatment, and they are all employed in tandem
with rigorous secondary prevention. One technique's significant long-term
mortality benefit over the other is still debatable for multivessel
disease management. Hypothesis: To compare the long-term mortality and
complications of coronary artery bypass graft (CABG) versus Percutaneous
Coronary Intervention (PCI) among patients with multivessel disease.
<br/>Method(s): Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus,
and grey literature were searched in March 2022. We only included
randomized clinical trials (RCTs) that reported the outcome differences
between CABG and PCI. The primary outcome was long-term all-cause
mortality. The secondary outcomes were re-intervention rate and major
adverse cardiac events (MACE). The statistical analysis was performed
using Comprehensive Meta-analysis software version 3. <br/>Result(s): A
total of 6 Randomized Control Trails (RCTs) studies were included in the
analysis comprising 7,126 patients (3558 PCI and 3568 CABG). The median
follow up period was 6.33 years. Long-term mortality from any cause (after
2 years follow up or more) was significantly higher in PCI group compared
to CABG group (HR: 1.44; 95% CI, 1.25-1.67; P <; 0.01; I²=
18.78%). This trend was consistent among diabetic patients (HR: 1.39; 95%
CI, 1.14-1.69; P <; 0.01; I²= 23.73%). CABG procedure was
associated with lower rate of additional or repeat intervention (RR: 0.25;
95% CI, 0.17-0.37; P <; 0.01; I²= 74.4%).
Cardiovascular-specific mortality and MACE were lower among CABG group
compared to PCI (RR: 0.77; 95% CI, 0.58-0.95; P <; 0.01; I²=
0%), (RR: 0.77; 95% CI, 0.64-0.93; P <; 0.01; I²= 0%),
respectively. <br/>Conclusion(s): The study shows that CABG provides lower
long-term mortality rates, including diabetic patients, a lower rate of
repeat intervention, and lower major adverse cardiac events. Therefore,
CABG is an effective and safe approach for patients with multivessel
diseases compared to PCI, especially in the long term.

<82>
Accession Number
639787779
Title
Safety and Efficacy of Transcatheter Aortic Valve Replacement With
Continuation vs Interruption of PeriProcedural Anticoagulation: A
Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Agarwal S.; Bansal A.; Akhtar K.; Khan J.; Anwaar M.F.; Maheshwari S.;
Garg N.; Baber U.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Approximately 33% of patients undergoing transcatheter
aortic valve replacement (TAVR) have an indication for long-term
anticoagulation. In clinical routine, anticoagulation is often
discontinued 2 to 4 days before TAVR. The purpose of this meta-analysis
was to compare the safety and efficacy of TAVR in patients with
per-procedural continuation vs interruption of anticoagulation.
<br/>Method(s): An electronic search was performed using PubMed and Ovid
Medline from inception to May 2022. The primary outcome of interest was
life-threatening or major bleeding. The secondary outcomes were all-cause
mortality, stroke, vascular complications, need for blood transfusion, and
closure device failure. <br/>Result(s): Three observational studies were
included in our final analysis which consisted of 2,286 patients, with
anticoagulation being continued in 1,069 patients and interrupted in 1,217
patients. Although, there was no significant difference in our primary
outcome of life-threatening or major bleeding between both groups, there
was a trend toward decreased risk of bleeding in patients who were
continued on anticoagulation (RR: 0.81; CI: 0.65 to 1.0; I² :
0%, p=0.05). There was a significantly lower risk of stroke (RR: 0.55; CI:
0.35 to 0.88; I² : 0%, p=0.01) and need for blood transfusion
(RR: 0.72; CI: 0.59 to 0.87; I : 0%, p<;0.01) in patients who were
continued on anticoagulation as compared to those in whom anticoagulation
was interrupted. There was no significant difference in the all-cause
mortality (RR: 0.76; CI: 0.49 to 1.19; I² : 10%, p=0.24), major
vascular complications (RR: 0.86; CI: 0.68 to 1.09; I² : 0%,
p=0.22), or closure device failure (RR: 0.90; CI: 0.51 to 1.59;
I² : 0%, p=0.72) between both the cohorts. <br/>Conclusion(s):
In a patient undergoing TAVR who requires long-term anticoagulation,
continuing anticoagulation is superior to interrupting anticoagulation in
reducing the risk of stroke without any increase in life-threatening or
major bleeding. (Figure Presented).

<83>
Accession Number
639787760
Title
Transcatheter versus Surgical Aortic Valve Replacement With Concurrent
Coronary Revascularization: A Systematic Review and Meta-Analysis.
Source
Circulation. Conference: American Heart Association's 2022 Scientific
Sessions and the American Heart Association's 2022 Resuscitation Science
Symposium. Chicago, IL United States. 146(Supplement 1) (no pagination),
2022. Date of Publication: November 2022.
Author
Sakurai Y.; Yokoyama Y.; Fukuhara S.; Takagi H.; Kuno T.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: This meta-analysis aimed to evaluate outcomes of transcatheter
aortic valve replacement (TAVR) with percutaneous coronary intervention
(PCI) versus surgical aortic valve replacement (SAVR) with coronary artery
bypass grafting (CABG). <br/>Method(s): MEDLINE and EMBASE were searched
through November 2021 to identify studies comparing TAVR+PCI and SAVR+CABG
for severe aortic stenosis with concurrent coronary artery disease.
Outcomes of interest were long-term all-cause mortality, repeat coronary
intervention, rehospitalization, myocardial infarction, and stroke during
follow-up, and 30-day periprocedural outcomes. <br/>Result(s): Two
randomized controlled trials and six observational studies including a
total of 104,220 patients (TAVR+PCI, n = 5,004; SAVR+CABG, n = 99,226)
were included. Median follow-up periods ranged from one to three years.
TAVR+PCI was associated with higher all-cause mortality and coronary
reintervention during follow-up period (Hazard Ratio [HR], 1.35; 95%
confidence interval [CI], 1.11-1.65; p = 0.003, HR, 4.14; 95% CI,
1.74-9.86; p = 0.001, respectively), 30-day permanent pacemaker
implantation rate (Odds Ratio [OR], 3.79; 95% CI, 1.61-8.95; p = 0.002),
and periprocedural vascular complications (OR 6.97; 95% CI, 1.85-26.30; p
= 0.004). In contrast, TAVR+PCI was associated with a lower rate of 30-day
acute kidney injury (OR, 0.32; 95% CI, 0.20- 0.50; p = 0.0001).
Rehospitalization, myocardial infarction, stroke during follow-up, and
other periprocedural outcomes including 30-day mortality were similar in
both groups. <br/>Conclusion(s): In patients with severe aortic stenosis
and coronary artery disease, TAVR+PCI was associated with higher all-cause
mortality at follow-up compared with SAVR+CABG. Heart team approach to
assess TAVR candidacy remains imperative. (Figure Presented).

<84>
Accession Number
2021803165
Title
Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review.
Source
Pain Medicine (United States). 22(12) (pp 2827-2834), 2021. Date of
Publication: 01 Dec 2021.
Author
Lobova V.A.; Roll J.M.; Roll M.L.C.
Institution
(Lobova, Roll) Elson S. Floyd College of Medicine, Washington State
University, Spokane, WA, United States
(Roll) Department of Community and Behavioral Health, Program of
Excellence in the Addictions, Washington State University, Spokane, WA,
United States
(Roll) Macalester College, Saint Paul, MN, United States
Publisher
Oxford University Press
Abstract
Objective: To investigate the effects of intraoperative methadone in
comparison with those of standard-of-care intraoperative opioids, such as
fentanyl and morphine, on pain scores, opioid consumption, and adverse
effects in adults undergoing cardiothoracic surgery. <br/>Method(s): The
literature was reviewed in PubMed, Embase, Cochrane Library, and Google
Scholar, followed by a manual search of the reference lists of the
identified articles. Search terms included a combination of
"intraoperative methadone,""methadone,"and "cardiac surgery."Our review
includes four studies published between 2011 and 2020. Quality assessment
of the studies was performed. <br/>Result(s): The initial search
identified 715 articles, from which 461 duplicates were removed and 236
were eliminated on the basis of inclusion and exclusion criteria. Eighteen
articles underwent full-text review. Four studies evaluating a total of
435 patients with various cardiothoracic procedures were included in this
review. We found that intraoperative methadone decreased acute
postoperative pain and reduced postoperative opioid consumption in the
first 24 postoperative hours in patients who received 0.1-0.3 mg/kg
intraoperative methadone in comparison with morphine and fentanyl. No
difference was found in adverse effects between the groups. Quality
assessment of the studies showed a low risk of bias in three of the
randomized controlled trials and a high risk of bias in the retrospective
review because of the baseline confounding bias in the study design.
<br/>Conclusion(s): Intraoperative methadone use reduces acute
postoperative pain and lowers opioid consumption in comparison with
morphine and fentanyl. Initial results suggest that methadone may be an
equivalent opioid to be administered during cardiothoracic procedures to
reduce acute postsurgical pain, though further research is warranted.
<br/>Copyright &#xa9; 2021 The Author(s). Published by Oxford University
Press on behalf of the American Academy of Pain Medicine. All rights
reserved.

<85>
Accession Number
639794278
Title
Structural Valve Deterioration After Self-Expanding Transcatheter or
Surgical Aortic Valve Implantation in Patients at Intermediate or High
Risk.
Source
JAMA cardiology. (no pagination), 2022. Date of Publication: 14 Dec 2022.
Author
O'Hair D.; Yakubov S.J.; Grubb K.J.; Oh J.K.; Ito S.; Deeb G.M.; Van
Mieghem N.M.; Adams D.H.; Bajwa T.; Kleiman N.S.; Chetcuti S.; Sondergaard
L.; Gada H.; Mumtaz M.; Heiser J.; Merhi W.M.; Petrossian G.; Robinson N.;
Tang G.H.L.; Rovin J.D.; Little S.H.; Jain R.; Verdoliva S.; Hanson T.; Li
S.; Popma J.J.; Reardon M.J.
Institution
(O'Hair) Cardiovascular Service Line, Boulder Community Health, Boulder,
CO, United States
(Yakubov) Department of Interventional Cardiology, Ohio Health Riverside
Methodist Hospital, Columbus, United States
(Grubb) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, Georgia
(Oh, Ito) Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN,
United States
(Deeb, Chetcuti) Department of Interventional Cardiology, University of
Michigan Hospitals, Ann Arbor, United States
(Deeb, Chetcuti) Department of Cardiac Surgery, University of Michigan
Hospitals, Ann Arbor, United States
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Adams, Tang) Department of Cardiovascular Surgery, Mount Sinai Health
System, NY, United States
(Bajwa) Department of Cardiothoracic Surgery, Aurora St. Luke's Medical
Center, Milwaukee, WI, United States
(Kleiman, Little, Reardon) Department of Cardiology, Houston Methodist
DeBakey Heart and Vascular Center, Houston, TX, United States
(Kleiman, Little, Reardon) Department of Cardiothoracic Surgery, Houston
Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
(Sondergaard) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Gada, Mumtaz) Department of Interventional Cardiology, University of
Pittsburgh Medical Center Pinnacle Health, Harrisburg, PA, United States
(Gada, Mumtaz) Department of Cardiothoracic Surgery, University of
Pittsburgh Medical Center Pinnacle Health, Harrisburg, PA, 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
(Petrossian, Robinson) Department of Cardiothoracic and Vascular Surgery,
Saint Francis Hospital, Roslyn, NY, United States
(Rovin) Center for Advanced Valve and Structural Heart Care, Morton Plant
Hospital, Clearwater, FL, Puerto Rico
(Jain) Aurora Cardiovascular Services, Aurora-St. Luke's Medical Center,
Milwaukee, WI, United States
(Verdoliva, Hanson, Li, Popma) Structural Heart and Aortic, Medtronic,
Minneapolis, MN, United States
Publisher
NLM (Medline)
Abstract
Importance: The frequency and clinical importance of structural valve
deterioration (SVD) in patients undergoing self-expanding transcatheter
aortic valve implantation (TAVI) or surgery is poorly understood.
<br/>Objective(s): To evaluate the 5-year incidence, clinical outcomes,
and predictors of hemodynamic SVD in patients undergoing self-expanding
TAVI or surgery. <br/>Design, Setting, and Participant(s): This post hoc
analysis pooled data from the CoreValve US High Risk Pivotal (n=615) and
SURTAVI (n=1484) randomized clinical trials (RCTs); it was supplemented by
the CoreValve Extreme Risk Pivotal trial (n=485) and CoreValve Continued
Access Study (n=2178). Patients with severe aortic valve stenosis deemed
to be at intermediate or increased risk of 30-day surgical mortality were
included. Data were collected from December 2010 to June 2016, and data
were analyzed from December 2021 to October 2022. <br/>Intervention(s):
Patients were randomized to self-expanding TAVI or surgery in the RCTs or
underwent self-expanding TAVI for clinical indications in the
nonrandomized studies. <br/>Main Outcomes and Measures: The primary end
point was the incidence of SVD through 5 years (from the RCTs). Factors
associated with SVD and its association with clinical outcomes were
evaluated for the pooled RCT and non-RCT population. SVD was defined as
(1) an increase in mean gradient of 10 mm Hg or greater from discharge or
at 30 days to last echocardiography with a final mean gradient of 20 mm Hg
or greater or (2) new-onset moderate or severe intraprosthetic aortic
regurgitation or an increase of 1 grade or more. <br/>Result(s): Of 4762
included patients, 2605 (54.7%) were male, and the mean (SD) age was 82.1
(7.4) years. A total of 2099 RCT patients, including 1128 who received
TAVI and 971 who received surgery, and 2663 non-RCT patients who received
TAVI were included. The cumulative incidence of SVD treating death as a
competing risk was lower in patients undergoing TAVI than surgery (TAVI,
2.20%; surgery, 4.38%; hazard ratio [HR], 0.46; 95% CI, 0.27-0.78;
P=.004). This lower risk was most pronounced in patients with smaller
annuli (23 mm diameter or smaller; TAVI, 1.32%; surgery, 5.84%; HR, 0.21;
95% CI, 0.06-0.73; P=.02). SVD was associated with increased 5-year
all-cause mortality (HR, 2.03; 95% CI, 1.46-2.82; P<.001), cardiovascular
mortality (HR, 1.86; 95% CI, 1.20-2.90; P=.006), and valve disease or
worsening heart failure hospitalizations (HR, 2.17; 95% CI, 1.23-3.84;
P=.008). Predictors of SVD were developed from multivariate analysis.
<br/>Conclusions and Relevance: This study found a lower rate of SVD in
patients undergoing self-expanding TAVI vs surgery at 5 years. Doppler
echocardiography was a valuable tool to detect SVD, which was associated
with worse clinical outcomes. Trial Registration: ClinicalTrials.gov
Identifiers: NCT01240902, NCT01586910, and NCT01531374.

<86>
Accession Number
639793683
Title
Chlorthalidone vs. Hydrochlorothiazide for Hypertension-Cardiovascular
Events.
Source
The New England journal of medicine. (no pagination), 2022. Date of
Publication: 14 Dec 2022.
Author
Ishani A.; Cushman W.C.; Leatherman S.M.; Lew R.A.; Woods P.; Glassman
P.A.; Taylor A.A.; Hau C.; Klint A.; Huang G.D.; Brophy M.T.; Fiore L.D.;
Ferguson R.E.
Institution
(Ishani, Cushman, Leatherman, Lew, Woods, Glassman, Taylor, Hau, Klint,
Huang, Brophy, Fiore, Ferguson) From Minneapolis Veterans Affairs (VA)
Health Care System, and the Department of Medicine, University of
Minnesota - both in Minneapolis (A.I.); Medical Service, Memphis VA
Medical Center, and the Department of Preventive Medicine, University of
Tennessee Health Science Center - both in Memphis (W.C.C.); the
Cooperative Studies Program Coordinating Center, VA Boston Healthcare
System (S.M.L., R.A.L., P.W., C.H., A.K., M.T.B., L.D.F., R.E.F.), the
Department of Biostatistics, Boston University School of Public Health
(S.M.L., R.A.L.), and the Department of Medicine, Boston University School
of Medicine (M.T.B., R.E.F.) - all in Boston; Pharmacy Benefits Management
Services (P.A.G.) and the Office of Research and Development (G.D.H.),
Department of Veterans Affairs, Washington, DC; VA Greater Los Angeles
Healthcare System, and the David Geffen School of Medicine, University of
California, Los Angeles - both in Los Angeles (P.A.G.); and Michael E.
DeBakey VA Medical Center, and the Department of Medicine, Baylor College
of Medicine - both in Houston (A.A.T.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Whether chlorthalidone is superior to hydrochlorothiazide for
preventing major adverse cardiovascular events in patients with
hypertension is unclear. <br/>METHOD(S): In a pragmatic trial, we randomly
assigned adults 65 years of age or older who were patients in the
Department of Veterans Affairs health system and had been receiving
hydrochlorothiazide at a daily dose of 25 or 50 mg to continue therapy
with hydrochlorothiazide or to switch to chlorthalidone at a daily dose of
12.5 or 25 mg. The primary outcome was a composite of nonfatal myocardial
infarction, stroke, heart failure resulting in hospitalization, urgent
coronary revascularization for unstable angina, and non-cancer-related
death. Safety was also assessed. <br/>RESULT(S): A total of 13,523
patients underwent randomization. The mean age was 72 years. At baseline,
hydrochlorothiazide at a dose of 25 mg per day had been prescribed in
12,781 patients (94.5%). The mean baseline systolic blood pressure in each
group was 139 mm Hg. At a median follow-up of 2.4 years, there was little
difference in the occurrence of primary-outcome events between the
chlorthalidone group (702 patients [10.4%]) and the hydrochlorothiazide
group (675 patients [10.0%]) (hazard ratio, 1.04; 95% confidence interval,
0.94 to 1.16; P=0.45). There were no between-group differences in the
occurrence of any of the components of the primary outcome. The incidence
of hypokalemia was higher in the chlorthalidone group than in the
hydrochlorothiazide group (6.0% vs. 4.4%, P<0.001). <br/>CONCLUSION(S): In
this large pragmatic trial of thiazide diuretics at doses commonly used in
clinical practice, patients who received chlorthalidone did not have a
lower occurrence of major cardiovascular outcome events or
non-cancer-related deaths than patients who received hydrochlorothiazide.
(Funded by the Veterans Affairs Cooperative Studies Program;
ClinicalTrials.gov number, NCT02185417.).<br/>Copyright &#xa9; 2022
Massachusetts Medical Society.

<87>
Accession Number
639793622
Title
Extracorporeal Membrane Oxygenation for Graft Dysfunction Early after
Heart Transplantation: A Systematic Review and Meta-analysis.
Source
Journal of cardiac failure. (no pagination), 2022. Date of Publication:
10 Dec 2022.
Author
Aleksova N.; Buchan T.A.; Foroutan F.; Zhu A.; Conte S.; Macdonald P.;
Noly P.-E.; Carrier M.; Marasco S.F.; Takeda K.; Pozzi M.; Baudry G.; Atik
F.A.; Lehmann S.; Jawad K.; Hickey G.W.; Defontaine A.; Baron O.; Loforte
A.; Cavalli G.G.; Absi D.O.; Kawabori M.; Mastroianni M.A.; Simonenko M.;
Sponga S.; Moayedi Y.; Orchanian-Cheff A.; Ross H.J.; Rao V.; Guyatt G.;
Billia F.; Alba A.C.
Institution
(Aleksova, Buchan, Foroutan, Moayedi, Ross, Rao, Billia, Alba) Peter Munk
Cardiac Centre, Toronto General Hospital, Toronto, Canada
(Zhu) Faculty of Medicine, University of Toronto, Toronto, Canada
(Conte, Macdonald) Heart Transplant Unit, St Vincent's Hospital, Sydney,
NSW, Australia
(Noly, Carrier) Department of Cardiac Surgery, Montreal Heart Institute,
University of Montreal, Montreal, Canada
(Marasco) Department of Cardiothoracic Surgery, Alfred Hospital,
Melbourne, Australia
(Takeda) Department of Surgery, Division of Cardiac, Thoracic & Vascular
Surgery, Columbia University, NY, United States
(Pozzi, Baudry) Service de Chirurgie Cardiaque et Cardiologie, Hospices
Civils de Lyon, Hopital Louis Pradel, Lyon, France
(Atik) Instituto de Cardiologia e Transplantes do Distrito Federal (ICDF),
Brasilia, Brazil
(Lehmann, Jawad) Clinic of Cardiac Surgery, Heart Center, University of
Leipzig, Leipzig, Germany
(Hickey) UPMC Heart and Vascular Institute, University of Pittsburgh,
Pittsburgh, United States
(Defontaine, Baron) Centre Hospitalier Universitaire de Nantes, Nantes,
France
(Loforte, Cavalli) Division of Cardiac Surgery, S. Orsola University
Hospital, Bologna, Italy
(Absi) Cardiovascular and Intrathoracic Transplant Department, Favaloro
Foundation University Hospital, Buenos Aires, Argentina
(Kawabori, Mastroianni) Department of Cardiovascular Surgery, Tufts
Medical Center, Boston, MA, United States
(Simonenko) Almazov National Medical Research Centre, St. Petersburg,
Russian Federation
(Sponga) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, Canada
(Guyatt) Department of Health Research Methods, McMaster University,
Hamilton, Canada
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)
is a prevailing option for the management of severe early graft
dysfunction (EGD). This systematic review and individual patient data
(IPD) meta-analysis aims to evaluate: 1) mortality, 2) rates of major
complications, 3) prognostic factors and 4) the effect of different
VA-ECMO strategies on outcomes in adult heart transplant (HT) recipients
supported with VA-ECMO. METHODS AND RESULTS: We conducted a systematic
search and included studies of adults (>=18y) who received VA-ECMO during
their index hospitalization after HT and reported on mortality at any
timepoint. We pooled data using random-effects models. To identify
prognostic factors, we analysed IPD using mixed effects logistic
regression. We assessed the certainty in the evidence using the GRADE
framework. We included 49 observational studies of 1477 patients who
received VA-ECMO post-HT, of which 15 studies provided IPD for 448
patients. There were no differences in mortality estimates between IPD and
non-IPD studies. The short-term (30-day/in-hospital) mortality estimate
was 33% (moderate certainty, 95%CI: 28-39%) and 1-year mortality estimate
50% (moderate certainty, 95%CI: 43-57%). Recipient age (OR 1.02, 95% CI:
1.01-1.04) and prior sternotomy (OR 1.57, 95%CI 0.99-2.49) are associated
with increased short-term mortality. There is low certainty evidence that
early intraoperative cannulation and peripheral cannulation reduce the
risk of short-term death. <br/>CONCLUSION(S): One third of patients who
receive VA-ECMO for EGD do not survive 30 days or to hospital discharge,
and half do not survive to 1-year after HT. Improving outcomes will
require ongoing research focused on optimizing VA-ECMO strategies and care
in the first year after HT.<br/>Copyright &#xa9; 2022. Published by
Elsevier Inc.

<88>
Accession Number
2019352773
Title
Factors associated with hospitalisations of patients with chronic heart
failure approaching the end of life: A systematic review.
Source
Palliative Medicine. 36(10) (pp 1452-1468), 2022. Date of Publication:
December 2022.
Author
Zehnder A.R.; Pedrosa Carrasco A.J.; Etkind S.N.
Institution
(Zehnder, Etkind) Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King's College London, London, United Kingdom
(Zehnder) Rautipraxis, Zurich, Switzerland
(Pedrosa Carrasco) Research Group Medical Ethics, Philipps-University
Marburg, Marburg, Germany
(Etkind) Department of Public Health and Primary Care, University of
Cambridge, Cambridge, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background: Heart failure has high mortality and is linked to substantial
burden for patients, carers and health care systems. Patients with chronic
heart failure frequently experience recurrent hospitalisations peaking at
the end of life, but most prefer to avoid hospital. The drivers of
hospitalisations are not well understood. <br/>Aim(s): We aimed to
synthesise the evidence on factors associated with all-cause and heart
failure hospitalisations of patients with advanced chronic heart failure.
<br/>Design(s): Systematic review of studies quantitatively evaluating
factors associated with all-cause or heart failure hospitalisations in
adult patients with advanced chronic heart failure. Data sources: Five
electronic databases were searched from inception to September 2020.
Additionally, searches for grey literature, citation searching and
hand-searching were performed. We assessed the quality of individual
studies using the QualSyst tool. Strength of evidence was determined
weighing number, quality and consistency of studies. Findings are reported
narratively as pooling was not deemed feasible. <br/>Result(s): In 54
articles, 68 individual, illness-level, service-level and environmental
factors were identified. We found high/moderate strength evidence for
specialist palliative or hospice care being associated with reduced risk
of all-cause and heart failure hospitalisations, respectively. Based on
high strength evidence, we further identified black/non-white ethnicity as
a risk factor for all-cause hospitalisations. <br/>Conclusion(s): Efforts
to integrate hospice and specialist palliative services into care may
reduce avoidable hospitalisations in advanced heart failure. Inequalities
in end-of-life care in terms of race/ethnicity should be addressed.
Further research should investigate the causality of the relationships
identified here.<br/>Copyright &#xa9; The Author(s) 2022.

<89>
Accession Number
2021329915
Title
Multivessel vs. culprit-vessel only percutaneous coronary interventions in
acute myocardial infarction and cardiogenic shock: a systematic review and
meta-analysis of prospective randomized and retrospective studies.
Source
European Heart Journal: Acute Cardiovascular Care. 11(7) (pp 558-569),
2022. Date of Publication: 01 Jul 2022.
Author
Gill G.S.; Sanchez J.S.; Thandra A.; Kanmanthareddy A.; Alla V.M.;
Garcia-Garcia H.M.
Institution
(Gill, Thandra, Kanmanthareddy, Alla) Division of Cardiovascular Disease,
Creighton University School of Medicine, Omaha, NE, United States
(Sanchez) Hospital Universitari i Politecnic La Fe, Valencia, Spain
(Sanchez) Centro de Investigacion Biomedica en Red (CIBERCV), Madrid,
Spain
(Garcia-Garcia) Department of Medicine, Georgetown University, Washington,
DC, United States
(Garcia-Garcia) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
Publisher
Oxford University Press
Abstract
Aims: Studies comparing outcomes of multivessel (MV) vs. culprit-vessel
(CV) only percutaneous coronary intervention (PCI) during index cardiac
catheterization in patients presenting with acute myocardial infarction
(MI) and cardiogenic shock (CS) have reported conflicting results. In this
systematic review we aim to investigate outcomes with MV vs. CV-only
revascularization strategies in patients with acute MI and CS.
<br/>Methods and Results: PubMed, Google Scholar, CINAHL and Cochrane
databases were queried for studies comparing MV vs. CV PCI in patients
with acute MI and CS. Data were extracted and pooled by means of random
effects model. Primary outcome was early all-cause mortality (up to 30
days), while the secondary outcomes included late all-cause mortality
(mean, 11.4 months), stroke, new renal replacement therapy, reinfarction,
repeat revascularization, and bleeding. Pooled odds ratio (OR), 95%
confidence intervals (CIs), and number needed to harm (NNH) were
calculated. A total of 16 studies enrolling 75 431 patients were included.
The MV PCI was associated with higher risk of early mortality [OR 1.17,
95% CI (1.00-1.35); P = 0.04; NNH = 62], stroke [1.15 (1.03-1.29); P =
0.01; NNH = 351], and new renal replacement therapy [1.33 (1.06-1.67); P =
0.01; NNH = 61]; and with lower risk of repeat revascularization [0.61
(0.41-0.89); P = 0.01] when compared with CV PCI. No significant
difference was observed in late-term mortality [1.02 (0.84-1.25); P =
0.84], risk of reinfarction [1.13 (0.94-1.35); P = 0.18], or bleeding
[1.21 (0.94-1.55); P = 0.13] between groups. <br/>Conclusion(s): Among
patients with acute MI and CS, MV PCI during index cardiac catheterization
was associated with higher risk of early mortality, stroke, and renal
replacement therapy.<br/>Copyright &#xa9; 2022 The Author(s).

<90>
Accession Number
2021329908
Title
Presentation cardiac troponin and early computed tomography coronary
angiography in patients with suspected acute coronary syndrome: a
pre-specified secondary analysis of the RAPID-CTCA trial.
Source
European Heart Journal: Acute Cardiovascular Care. 11(7) (pp 570-579),
2022. Date of Publication: 01 Jul 2022.
Author
Wang K.-L.; Roobottom C.; Smith J.E.; Goodacre S.; Oatey K.; O'Brien R.;
Storey R.F.; Curzen N.; Keating L.; Kardos A.; Felmeden D.; Thokala P.;
Mills N.L.; Newby D.E.; Gray A.J.
Institution
(Wang, Mills, Newby) Centre for Cardiovascular Science, University of
Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh
EH16 4SB, United Kingdom
(Wang) School of Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan (Republic of China)
(Wang) General Clinical Research Center, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
(Roobottom) Department of Radiology, University Hospitals Plymouth NHS
Trust, Plymouth, United Kingdom
(Smith) Emergency Department, University Hospitals Plymouth NHS Trust,
Plymouth, United Kingdom
(Goodacre, Thokala) School of Health and Related Research, University of
Sheffield, Sheffield, United Kingdom
(Oatey) Edinburgh Clinical Trials Unit, University of Edinburgh,
Edinburgh, United Kingdom
(O'Brien, Gray) Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, Southampton,
United Kingdom
(Curzen) Department of Cardiology, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
(Keating) Department of Emergency Medicine, Royal Berkshire NHS Foundation
Trust, Reading, United Kingdom
(Kardos) Translational Cardiovascular Research Group, Milton Keynes
University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom
(Kardos) Faculty of Medicine and Health Science, University of Buckingham,
Buckingham, United Kingdom
(Felmeden) Department of Cardiology, Torbay and South Devon NHS Foundation
Trust, Torquay, United Kingdom
(Mills, Gray) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims: To evaluate the potential associations between presentation cardiac
troponin and the clinical impact of early computed tomography coronary
angiography (CTCA) in intermediate-risk patients with suspected acute
coronary syndrome. <br/>Methods and Results: In a large multicentre
randomized controlled trial of patients with intermediate-risk chest pain
due to suspected acute coronary syndrome, early CTCA had no effect on the
primary outcome - death or subsequent Type 1 or 4b myocardial infarction -
but reduced the rate of invasive coronary angiography. In this
pre-specified secondary analysis, cardiovascular testing and clinical
outcomes were compared between those with or without cardiac troponin
elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated
cardiac troponin concentration and 744 (43%) had a normal concentration.
Patients with cardiac troponin elevation had a higher Global Registry of
Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely
to have obstructive coronary artery disease (59 vs. 33%; P < 0.001),
non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001)
testing, coronary revascularization (47 vs. 15%; P < 0.001), and the
primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no
evidence that presentation cardiac troponin was associated with the
relative effects of early CTCA on rates of non-invasive (Pinteraction =
0.33) and invasive (Pinteraction = 0.99) testing, coronary
revascularization (Pinteraction = 0.57), or the primary outcome
(Pinteraction = 0.41). <br/>Conclusion(s): Presentation cardiac troponin
had no demonstrable associations between the effects of early CTCA on
reductions in non-invasive and invasive testing, or the lack of effect on
coronary revascularization or the primary outcome in intermediate-risk
patients with suspected acute coronary syndrome.<br/>Copyright &#xa9; 2022
The Author(s).

<91>
[Use Link to view the full text]
Accession Number
2021323025
Title
Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary
Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized
Controlled BEST Trial.
Source
Circulation. 146(21) (pp 1581-1590), 2022. Date of Publication: 22 Nov
2022.
Author
Ahn J.-M.; Kang D.-Y.; Yun S.-C.; Hur S.H.; Park H.-J.; Tresukosol D.;
Kang W.C.; Kwon H.M.; Rha S.-W.; Lim D.-S.; Jeong M.-H.; Lee B.-K.; Huang
H.; Lim Y.H.; Bae J.H.; Kim B.O.; Ong T.K.; Ahn S.G.; Chung C.-H.; Park
D.-W.; Park S.-J.
Institution
(Ahn, Kang, Yun, Chung, Park, Park) Heart Institute, Division of
Biostatistics, Center for Medical Research and Information, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Park) Catholic University of Korea, Seoul St. Mary's Hospital, South
Korea
(Tresukosol) Siriraj Hospital, Bangkok, Thailand
(Kang) Gachon University Gil Hospital, Incheon, South Korea
(Kwon) Gangnam Severance Hospital, Seoul, South Korea
(Rha, Lim) Korea University Guro Hospital, Seoul, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Huang) Sir Run Run Shaw Hospital, Zhejiang, Hangzhou, China
(Lim) Hanyang University Hospital, Seoul, South Korea
(Bae) Konyang University Hospital, Daejeon, South Korea
(Huang, Lim, Kim) Inje University Sanggye Paik Hospital, Seoul, South
Korea
(Ong) Sarawak General Hospital, Sarawak, Kuching, Malaysia
(Ahn) Yonsei University Wonju Severance Christian Hospital, Wonju, South
Korea
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Long-term comparative outcomes after percutaneous coronary
intervention (PCI) with everolimus-eluting stents and coronary artery
bypass grafting (CABG) are limited in patients with multivessel coronary
artery disease. <br/>METHOD(S): This prospective, multicenter, randomized
controlled trial was conducted in 27 international heart centers and was
designed to randomly assign 1776 patients with angiographic multivessel
coronary artery disease to receive PCI with everolimus-eluting stents or
CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the
CABG group) between July 2008 and September 2013, the study was terminated
early because of slow enrollment. The primary end point was the composite
of death from any cause, myocardial infarction, or target vessel
revascularization. <br/>RESULT(S): During a median follow-up of 11.8 years
(interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary
end point occurred in 151 patients (34.5%) in the PCI group and 134
patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI,
0.88-1.56]; P=0.26). No significant differences were seen in the
occurrence of a safety composite of death, myocardial infarction, or
stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53];
P=0.70), as well as the occurrence of death from any cause (20.5% and
19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous
myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27];
P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95%
CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG.
<br/>CONCLUSION(S): In patients with multivessel coronary artery disease,
there were no significant differences between PCI and CABG in the
incidence of major adverse cardiac events, the safety composite end point,
and all-cause mortality during the extended follow-up. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique identifiers: NCT05125367 and
NCT00997828.<br/>Copyright &#xa9; 2022 American Heart Association, Inc.

<92>
Accession Number
2021316220
Title
A 12-week cardiac telerehabilitation programme does not prevent relapse of
physical activity levels: long-term results of the FIT@Home trial.
Source
European Journal of Preventive Cardiology. 29(7) (pp E255-E257), 2022.
Date of Publication: 01 May 2022.
Author
Brouwers R.W.M.; Kemps H.M.C.; Herkert C.; Peek N.; Kraal J.J.
Institution
(Brouwers, Kemps, Herkert) Department of Cardiology, Maxima Medical
Center, De Run 4600, Postbus 7777, Veldhoven 5500 MB, Netherlands
(Brouwers, Kemps, Herkert) Vitality Center, Maxima Medical Center, De Run
4600, Postbus 7777, Veldhoven 5500 MB, Netherlands
(Kemps) Department of Industrial Design, Eindhoven University of
Technology, Atlas 3 South, PO Box 513, Eindhoven 5600 MB, Netherlands
(Peek) Centre for Health Informatics, Division of Informatics, Imaging and
Data Sciences, University of Manchester, Oxford Road, Manchester M13 9P,
United Kingdom
(Kraal) Department of Human-Centered Design, Faculty of Industrial Design
Engineering, Delft University of Technology, Landbergstraat 15, Delft 2628
CE, Netherlands
Publisher
Oxford University Press

<93>
Accession Number
2021316205
Title
Impact of activity trackers on secondary prevention in patients with
coronary artery disease: A systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 29(7) (pp 1047-1056), 2022.
Date of Publication: 01 May 2022.
Author
Kaihara T.; Intan-Goey V.; Scherrenberg M.; Falter M.; Frederix I.;
Dendale P.
Institution
(Kaihara, Intan-Goey, Scherrenberg, Falter, Frederix, Dendale) Heart
Centre Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt 3500, Belgium
(Kaihara, Scherrenberg, Falter, Frederix, Dendale) Faculty of Medicine and
Life Sciences, UHasselt, Agoralaan gebouw D, Diepenbeek 3590, Belgium
(Kaihara) Division of Cardiology, Department of Internal Medicine, St.
Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki
216-8511, Japan
(Scherrenberg) Faculty of Medicine, University of Antwerp, Campus Drie
Eiken, Building S Universiteitsplein 1, ,(Antwerp), Wilrijk 2610, Belgium
(Falter) Faculty of Medicine, Department of Cardiology, KULeuven,
Herestraat 49, Leuven 3000, Belgium
Publisher
Oxford University Press
Abstract
Aims: Coronary artery disease (CAD) is related to high rates of morbidity
and mortality among cardiovascular diseases (CVDs). Activity trackers have
been used in cardiac rehabilitation (CR) in the last years. However, their
effectiveness to influence outcomes after CAD is debated. This review
summarizes the latest data of impact of activity trackers on CVD risk and
outcomes: peak oxygen consumption (VO2), major adverse cardiovascular
events (MACE), quality of life (QoL), and low-density
lipoprotein-cholesterol (LDL-C). <br/>Methods and Results: Articles from
1986 to 2020 in English were searched by electronic databases (PubMed,
Cochrane Library, and Embase). Inclusion criteria were: randomized
controlled trials of CAD secondary prevention using an activity tracker
which include at least peak VO2, MACE, QoL, or LDL-C as outcomes.
Meta-analysis was performed. After removing duplicates, 604 articles were
included and the screening identified a total of 11 articles. Compared to
control groups, intervention groups with activity trackers significantly
increased peak VO2 [mean difference 1.54; 95% confidence interval (CI)
(0.50-2.57); P = 0.004] and decreased MACE [risk ratio 0.51; 95% CI
(0.31-0.86); P = 0.01]. Heterogeneity was low (I2 = 0%) for MACE and high
(I2 = 51%) for peak VO2. Intervention with an activity tracker also has
positive impact on QoL. There was no between-group difference in LDL-C.
<br/>Conclusion(s): CR using activity trackers has a positive and
multi-faceted effect on peak VO2, MACE, and QoL in patients with
CAD.<br/>Copyright &#xa9; 2021 Published on behalf of the European Society
of Cardiology. All rights reserved.

<94>
Accession Number
2021316203
Title
Effectiveness of home-based cardiac telerehabilitation as an alternative
to Phase 2 cardiac rehabilitation of coronary heart disease: A systematic
review and meta-analysis.
Source
European Journal of Preventive Cardiology. 29(7) (pp 1017-1043), 2022.
Date of Publication: 01 May 2022.
Author
Ramachandran H.J.; Jiang Y.; Tam W.W.S.; Yeo T.J.; Wang W.
Institution
(Ramachandran, Jiang, Tam, Wang) Alice Lee Centre for Nursing Studies,
Yong Loo Lin School of Medicine, National University of Singapore, 10
Medical Drive, Singapore 117597, Singapore
(Yeo) Cardiac Rehabilitation, Department of Cardiology, National
University Heart Centre, Singapore, Singapore
Publisher
Oxford University Press
Abstract
Aims: The onset of the COVID-19 pandemic saw the suspension of
centre-based cardiac rehabilitation (CBCR) and has underscored the need
for home-based cardiac telerehabilitation (HBCTR) as a feasible
alternative rehabilitation delivery model. Yet, the effectiveness of HBCTR
as an alternative to Phase 2 CBCR is unknown. We aimed to conduct a
meta-analysis to quantitatively appraise the effectiveness of HBCTR.
<br/>Methods and Results: PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and
PsycINFO were searched from inception to January 2021. We included
randomized controlled trials (RCTs) comparing HBCTR to Phase 2 CBCR or
usual care in patients with coronary heart disease (CHD). Out of 1588
studies, 14 RCTs involving 2869 CHD patients were included in this review.
When compared with usual care, participation in HBCTR showed significant
improvement in functional capacity {6-min walking test distance [mean
difference (MD) 25.58 m, 95% confidence interval (CI) 14.74-36.42]}; daily
step count (MD 1.05 K, 95% CI 0.36-1.75) and exercise habits [odds ratio
(OR) 2.28, 95% CI 1.30-4.00)]; depression scores (standardized MD-0.16,
95% CI-0.32 to 0.01) and quality of life [Short-Form mental component
summary (MD 2.63, 95% CI 0.06-5.20) and physical component summary (MD
1.99, 95% CI 0.83-3.16)]. Effects on medication adherence were synthesized
narratively. HBCTR and CBCR were comparably effective. <br/>Conclusion(s):
In patients with CHD, HBCTR was associated with an increase in functional
capacity, physical activity (PA) behaviour, and depression when compared
with UC. When HBCTR was compared to CBCR, an equivalent effect on
functional capacity, PA behaviour, QoL, medication adherence, smoking
behaviour, physiological risk factors, depression, and cardiac-related
hospitalization was observed.<br/>Copyright &#xa9; 2021 Published on
behalf of the European Society of Cardiology. All rights reserved.

<95>
Accession Number
2021315945
Title
The effects of showering in 48-72 h after coronary artery bypass graft
surgery through median sternotomy on wound infection, pain, comfort, and
satisfaction: randomized controlled trial.
Source
European Journal of Cardiovascular Nursing. 21(1) (pp 56-66), 2022. Date
of Publication: 01 Jan 2022.
Author
Gok F.; Demir Korkmaz F.; Emrecan B.
Institution
(Gok) Department of Surgical Diseases Nursing, Faculty of Health Sciences,
Pamukkale University, Kinikli Yerleskesi, Denizli 20020, Turkey
(Demir Korkmaz) Department of Surgical Diseases Nursing, Faculty of
Nursing, Ege University, Izmir 35100, Turkey
(Emrecan) Department of Cardiac Surgery, Faculty of Medicine, Pamukkale
University, Denizli 20020, Turkey
Publisher
Oxford University Press
Abstract
Aims Time of showering after surgery is still a controversial issue for
surgical patients and health professionals. We evaluated the effects of
showering in 48-72 h after median sternotomy on sternal wound infections,
pain due to sternotomy, patient comfort, and satisfaction levels.Methods
and results The study was a randomized controlled clinical trial.
Fifty-one patients were randomly allocated (1:1) to the shower (n= 26) or
non-shower group (n= 25). The patients in the shower group (intervention
group) showered in the first 48-72 h after surgery and the patients in the
non-shower group (control group) were not allowed to shower until their
chest tube sutures were removed. They were instructed to shower on the
next day after removal of the chest tube sutures. The rate of sternal
wound infections was significantly lower in the shower group (n= 2, 7.7%)
than in the nonshower group patients (n= 8, 32.0%; P= 0.038). A logistic
regression analysis showed that early post-operative showering was
protective and significantly reduced the risk of sternal wound infections
independently of other variables [odds ratio (OR): 0.177; 95% confidence
interval (CI): 0.033-0.940; P= 0.042]. The pain severity score was
significantly lower in the shower group patients. Also, comfort and
satisfaction scores were significantly higher in this group (P< 0.05).
Conclusion Early showering after sternotomy was found to be protective
against sternal wound infections and had a positive effect on pain,
comfort, and satisfaction. Trial registration Clinical Trials.gov
registration number NCT04250961
(https://clinicaltrials.gov/ct2/show/NCT04250961).<br/>Copyright &#xa9;
2022 SAGE Publications Inc.. All rights reserved.

<96>
Accession Number
2021315941
Title
Nurse co-ordinated health and lifestyle modification for reducing multiple
cardio-metabolic risk factors in regional adults: outcomes from the MODERN
randomized controlled trial.
Source
European Journal of Cardiovascular Nursing. 21(1) (pp 26-35), 2022. Date
of Publication: 01 Jan 2022.
Author
Carrington M.J.; Zimmet P.Z.
Institution
(Carrington) Pre-Clinical Disease and Prevention Unit, Baker Heart and
Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
(Zimmet) Department of Diabetes, Faculty of Medicine, Nursing and Health
Sciences, Monash University, 99 Commercial Road, Melbourne, VIC 3004,
Australia
Publisher
Oxford University Press
Abstract
Background : Nurse-led health and lifestyle modification programmes can
prevent cardio-metabolic diseases and be advantageous where health
disparities exist. Aims : To assess the effectiveness of a nurse-driven
health and lifestyle modification programme in improving cardio-metabolic
risk parameters for higher-risk regional residing adults. Methods : We
conducted an open, parallel-group randomized controlled trial in two
sites. Participants were aged 40-70 years with no prior cardiovascular
disease who had any three or more of; central obesity, elevated
triglycerides, reduced high-density lipoprotein cholesterol, elevated
blood pressure (BP) and dysglycaemia. Intervention participants received
individual face-to-face and telephone coaching for improving
cardio-metabolic risk. Control group participants received standard care
and general information about risk factor management. The primary endpoint
was the percentage of participants who achieved the target risk factor
thresholds or clinically significant minimum changes for any three or more
cardio-metabolic risk factors during 24 months of follow-up. Results :
Participant average age was 57.6 (SD 7.6) years, 61% were female and 71%
were employed. The primary endpoint was achieved by 76% intervention (97
of 127) and 71% usual care (92 of 129) participants [adjusted risk ratio
(RR): 1.08; 95% CI 0.94, 1.24; P = 0.298]. Improved BP in the intervention
group was more likely than in the control group (84% vs. 65%) (adj. RR:
1.28; 95% CI 1.11, 1.48; P = 0.001) but no other cardio-metabolic
component. Conclusion : Nurse intervention to modify cardio-metabolic risk
parameters had no enhanced effectiveness compared with usual care.
However, participation was associated with improvements in
cardio-metabolic abnormalities, with particular emphasis on BP. Trial
Registration: Registered with the Australian New Zealand Clinical Trial
Registry (ACTRN12616000229471).<br/>Copyright &#xa9; 2021 Published on
behalf of the European Society of Cardiology. All rights reserved.

<97>
Accession Number
2021637338
Title
Effect of Vitamin D Supplementation on Postoperative Outcomes in Cardiac
Surgery Patients: A Systematic Review.
Source
Journal of Cardiac Critical Care. 6(3) (pp 195-200), 2022. Date of
Publication: July 2022.
Author
Das S.; Bej P.
Institution
(Das) Department of Cardiac Anaesthesia and Critical Care, AIIMS, New
Delhi, India
(Bej) Department of Community Medicine, Rama Medical College and Research
Centre, Uttar Pradesh, Hapur Pin- 245304, India
Publisher
Thieme Medical and Scientific Publishers Pvt Ltd
Abstract
Background Vitamin D deficiency is a very common occurrence in cardiac
patients. It has been proved that cardiac surgery and cardiopulmonary
bypass accelerate the deficiency further. The postoperative outcomes of
patients deteriorate in the presence of vitamin D deficiency.
Perioperative supplementation of vitamin D is the only solution to the
problem. Hence, the present systematic review was conducted to derive the
efficacy and safety of vitamin D supplementation on postoperative outcomes
in cardiac surgery patients. Method Publications over duration of last 10
years was searched from different database and web sites. The data from
full-text research articles were analyzed for the effect on different
postoperative outcomes and side effects. Result Eight randomized control
trials were retrieved on the effect of perioperative vitamin D
supplementation in cardiac surgery patients and their postoperative
outcomes. Six articles (75%) were found to be in favor of improvement in
postoperative outcome. Two articles (25%) did not find any difference of
outcome between the control and treatment group. All the studies observed
the restoration of vitamin D to normal and no adverse effects from
supplementation. Conclusion Perioperative vitamin D supplementation
improves the postoperative outcomes after cardiac surgery. It is effective
and safe to supplement vitamin D in cardiac surgery
patients.<br/>Copyright &#xa9; 2022 Thieme India. All rights reserved.

<98>
Accession Number
2021308254
Title
Temporal Trends of Infective Endocarditis in North America From 2000 to
2017-A Systematic Review.
Source
Open Forum Infectious Diseases. 8(11) (no pagination), 2021. Article
Number: ofab479. Date of Publication: 01 Nov 2021.
Author
Talha K.M.; Dayer M.J.; Thornhill M.H.; Tariq W.; Arshad V.; Tleyjeh I.M.;
Bailey K.R.; Palraj R.; Anavekar N.S.; Sohail M.R.; DeSimone D.C.; Baddour
L.M.
Institution
(Talha, Tariq, Arshad, Tleyjeh, Palraj, DeSimone, Baddour) Division of
Infectious Diseases, Department of Medicine, Mayo Clinic, School of
Medicine and Science, Rochester, MN, United States
(Dayer) Department of Cardiology, Somerset Foundation Trust, Taunton,
United Kingdom
(Thornhill) Academic Unit of Oral & Maxillofacial Medicine Surgery &
Pathology, University of Sheffield, School of Clinical Dentistry,
Sheffield, United Kingdom
(Tleyjeh) Division of Epidemiology, Mayo Clinic, School of Medicine and
Science, Rochester, MN, United States
(Tleyjeh) Infectious Diseases Section, Department of Medical Specialties,
King Fahad Medical City, Riyadh, Saudi Arabia
(Tleyjeh) College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
(Bailey) Department of Biomedical Statistics and Informatics, Mayo Clinic,
School of Medicine and Science, Rochester, MN, United States
(Anavekar, DeSimone, Baddour) Department of Cardiovascular Disease, Mayo
Clinic, School of Medicine and Science, Rochester, MN, United States
(Sohail) Section of Infectious Diseases, Baylor College of Medicine,
Houston, TX, United States
Publisher
Oxford University Press
Abstract
Background. The objective of this paper was to examine temporal changes of
infective endocarditis (IE) incidence and epidemiology in North America.
Methods. A systematic review was conducted at Mayo Clinic, Rochester. Ovid
EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science were
searched for studies published between January 1, 2000, and May 31, 2020.
Four referees independently reviewed all studies, and those that reported
a population-based incidence of IE in patients aged 18 years and older in
North America were included. Results. Of 8588 articles screened, 14 were
included. Overall, IE incidence remained largely unchanged throughout the
study period, except for 2 studies that demonstrated a rise in incidence
after 2014. Five studies reported temporal trends of injection drug use
(IDU) prevalence among IE patients with a notable increase in prevalence
observed. Staphylococcus aureus was the most common pathogen in 7 of 9
studies that included microbiologic findings. In-patient mortality ranged
from 3.7% to 14.4%, while the percentage of patients who underwent surgery
ranged from 6.4% to 16.0%. Conclusions. The overall incidence of IE has
remained stable among the 14 population-based investigations in North
America identified in our systematic review. Standardization of study
design for future population-based investigations has been highlighted for
use in subsequent systematic reviews of IE.<br/>Copyright &#xa9; The
Author(s) 2021.

<99>
Accession Number
2020896091
Title
The Anti-Inflammatory and Antioxidant Effects of Propofol and Sevoflurane
in Children With Cyanotic Congenital Heart Disease.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(1) (pp 65-72), 2023.
Date of Publication: January 2023.
Author
Karacaer F.; Biricik E.; Ilginel M.; Tunay D.L.; Dogus Y.; Ozturk O.G.;
Guzel Y.; Benli O.; Gunes Y.
Institution
(Karacaer, Biricik, Ilginel, Tunay, Gunes) Balcali Hospital, Cukurova
University, Anesthesiology and Reanimation Department, Adana, Turkey
(Dogus, Ozturk) Balcali Hospital, Cukurova University, Biochemistry
Department, Adana, Turkey
(Guzel) Balcali Hospital, Cukurova University, Cardiovascular Surgery
Department, Adana, Turkey
(Benli) Ministry of Health University, Adana City Training and Research
Hospital, Cardiovascular Surgery Department, Adana, Turkey
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to compare the anti-inflammatory and
antioxidant effects of propofol and sevoflurane in children with cyanotic
congenital heart disease (CCHD) undergoing cardiac surgery with
cardiopulmonary bypass. <br/>Design(s): Prospective, randomized,
double-blind study. <br/>Setting(s): Single center, university hospital.
<br/>Participant(s): Children ages 1-10 years with CCHD undergoing
elective cardiac surgery with cardiopulmonary bypass.
<br/>Intervention(s): Children were randomized to receive general
anesthesia with either sevoflurane (group S) or propofol (group P).
Systemic inflammatory response syndrome (SIRS) occurrence was assessed at
the end of the surgery and at the sixth, 12th, and 24th postoperative
hours. Blood samples were obtained at 4 times: after anesthesia induction
(T0), after release of the aortic cross-clamp (T1), at the end of the
surgery (T2), and at the postoperative 24th hour (T3). The serum levels of
interleukin 6 and tumor necrosis factor alpha, and the total antioxidant
status (TAS) and total oxidant status, were analyzed. <br/>Result(s): SIRS
was more common in group S than in group P at all times (p = 0.020, p =
0.036, p = 0.004, p = 0.008). There were no significant differences
between the groups in the mean tumor necrosis factor alpha and interleukin
6 levels at any time. The TAS level at T2 was higher in group P than group
S (p = 0.036). The serum TAS level increased at T2 compared with T0 in
group P, but it decreased in group S (p = 0.041). <br/>Conclusion(s): The
results showed that propofol provided a greater antioxidant effect and
reduced SIRS postoperatively more than sevoflurane in children with CCHD
undergoing cardiac surgery.<br/>Copyright &#xa9; 2022 Elsevier Inc.

<100>
Accession Number
2021788606
Title
Effect of Positive End-Expiratory Pressure (PEEP) Titration in Elderly
Patients Undergoing Lobectomy.
Source
Medical Science Monitor. 28 (no pagination), 2022. Article Number:
e938225. Date of Publication: 2022.
Author
Yao W.; Yang B.; Wang W.; Han Q.; Liu F.; Shan S.; Wang C.; Zheng M.
Institution
(Yao, Han, Shan, Wang, Zheng) Center for Anesthesiology, Department of
Anesthesia, Cangzhou Central Hospital, Hebei, Cangzhou, China
(Yang) Center for Thoracic Surgery, Cangzhou Central Hospital, Hebei,
Cangzhou, China
(Wang) Medical Laboratory Department, Cangzhou Central Hospital, Hebei,
Cangzhou, China
(Liu) Medical Imaging Department, Cangzhou Central Hospital, Hebei,
Cangzhou, China
Publisher
International Scientific Information, Inc.
Abstract
Background: Currently, one-lung ventilation in thoracoscopic lobectomy
adopts mostly a protective ventilation mode, which includes low tidal
volume (a tidal volume of 6 mL/kg predicted body weight), positive
end-expiratory pressure (PEEP), and intermittent lung inflation. However,
there is no clear conclusion regarding the value of PEEP in elderly
patients undergoing lobectomy. Material/Methods: Fifty patients who
underwent video-assisted thoracoscopic unilateral lobectomy, aged 65 to 78
years, with a body mass index of 18 to 29 kg/m² and ASA grades
I to III, were randomly divided into 2 groups (n=25 each): optimal
oxygenation titration group (group O) and optimal compliance titration
group (group C). Mean arterial pressure (MAP), heart rate (HR), and
central venous pressure (CVP) were recorded in both groups at different
time points. The radial artery blood samples were collected at 3 time
points for blood gas analysis, and the void volume/tidal volume ratio was
calculated. The peak airway pressure and PEEP values were recorded at 4
min after the completion of one-lung ventilation titration (T2), and the
driving pressure was calculated. <br/>Result(s): The best PEEP value of
titration in the best compliance group was lower than that of the best
oxygenation method, the peak was lower, and the dynamic lung compliance
was higher; however, this had no effect on MAP and HR. The CVP was lower
than optimal oxygenation at T2. <br/>Conclusion(s): Dynamic lung
compliance-guided PEEP titration improved lung function in elderly
patients undergoing lobectomy.<br/>Copyright &#xa9; Med Sci Monit, 2022.

<101>
Accession Number
2019925621
Title
Coronary angiography of the ex-situ beating donor heart in a portable
organ care system.
Source
Catheterization and Cardiovascular Interventions. 100(7) (pp 1252-1260),
2022. Date of Publication: 01 Dec 2022.
Author
Meredith T.; Scheuer S.; Hoffman M.; Joshi Y.; Kathir K.; Gunalingam B.;
Roy D.; Wilson S.; Jansz P.; Macdonald P.; Muller D.
Institution
(Meredith, Hoffman, Kathir, Gunalingam, Roy, Wilson, Muller) Department of
Interventional Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
(Meredith, Scheuer, Joshi, Jansz, Macdonald) Victor Chang Cardiac Research
Institute, Darlinghurst, NSW, Australia
(Meredith, Scheuer, Joshi, Jansz, Macdonald, Muller) Faculty of Medicine
and Health, University of New South Wales, Sydney, NSW, Australia
(Scheuer, Joshi, Jansz, Macdonald) Department of Heart and Lung
Transplantation, St Vincent's Hospital, Sydney, NSW, Australia
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To determine safety and feasibility of ex-situ coronary
angiography. <br/>Background(s): To cater for the perpetually growing
demand for heart donors, interest in donation following circulatory death
(DCD) has been rekindled. Further pursuit of donor pool expansion has led
to eligibility extension to "marginal" donors who are at higher risk of
coronary artery disease (CAD). Excluding CAD in potentially eligible DCD
donors, for whom ante-mortem angiography is commonly not permitted, is
therefore challenging. Ex-situ coronary angiography serves as an ethical
and feasible diagnostic tool to assess for preclusive CAD. <br/>Method(s):
We undertook a systematic review of the published literature and
institutional retrospective review of case experience with ex-situ
coronary angiography of donor hearts, supported by a portable organ care
system. <br/>Result(s): Combined literature and institutional case review
yielded nine total cases of ex-situ coronary angiography of donor human
hearts plus one experimental porcine model. Of the eight cases of ex-situ
coronary angiography performed at our institute, all were conducted
without complication or injury to the allograft. Two thirds of reported
human cases have proceeded to successful transplantation.
<br/>Conclusion(s): Diagnostic coronary angiography of the ex-situ beating
donor heart is safe, feasible, and demonstrates novel clinical utility in
mitigating subsequent transplantation of unsuitable allografts. In the
setting of suspected coronary atherosclerosis of the donor heart, which
may preclude favorable transplantation outcomes, ex-situ coronary
angiography should be considered at eligible transplant
centers.<br/>Copyright &#xa9; 2022 The Authors. Catheterization and
Cardiovascular Interventions published by Wiley Periodicals LLC.

<102>
Accession Number
2019975078
Title
Hybrid coronary revascularization (HCR) versus coronary artery bypass
grafting (CABG) in multivessel coronary artery disease (MVCAD): A
meta-analysis of 14 studies comprising 4226 patients.
Source
Catheterization and Cardiovascular Interventions. 100(7) (pp 1182-1194),
2022. Date of Publication: 01 Dec 2022.
Author
Nagraj S.; Tzoumas A.; Kakargias F.; Giannopoulos S.; Ntoumaziou A.;
Kokkinidis D.G.; Alvarez Villela M.; Latib A.
Institution
(Nagraj) Jacobi Medical Center/Albert Einstein College of Medicine, The
Bronx, NY, United States
(Tzoumas) University of Cincinnati Medical Center, Cincinnati, OH, United
States
(Kakargias) Department of Medicine, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Giannopoulos) Division of Cardiology, Rocky Mountain Regional VA Medical
Center, Aurora, CO, United States
(Ntoumaziou) General Hospital of Filiates, Filiates, Greece
(Kokkinidis) Section of Cardiovascular Medicine, Yale University School of
Medicine, Yale New Haven Hospital, New Haven, CT, United States
(Alvarez Villela) Division of Cardiology, Jacobi Medical Center/Albert
Einstein College of Medicine, The Bronx, NY, United States
(Latib) Department of Cardiology, Montefiore Medical Center/Albert
Einstein College of Medicine, New York City, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To compare the outcomes of hybrid coronary revascularization
(HCR) with traditional coronary artery bypass grafting (CABG) in
multivessel coronary artery disease (MVCAD). <br/>Background(s): HCR has
emerged as an alternative to CABG in patients with MVCAD. Through
minimally invasive surgical techniques, HCR carries the potential for
faster recovery postoperatively, fewer complications, and lower
utilization of resources. <br/>Method(s): Systematic search of electronic
databases was conducted up to December 2021 and studies comparing HCR with
CABG in the treatment of MVCAD were included in this meta-analysis.
Primary outcomes of interest were incidence of 5-year mortality and major
adverse cardiac and cerebral event (MACCE). <br/>Result(s): Fourteen
studies (12 observational studies and 2 randomized controlled trials)
comprising 4226 patients were included. The rates of 5-year mortality
(odds ratios [OR]: 1.55; 95% confidence interval [CI]: 0.92-2.62;
I² = 83.0%) and long-term MACCE (OR: 0.97; 95% CI: 0.47-2.01;
I² = 74.7%) were comparable between HCR and CABG groups. HCR
was associated with a significantly lower likelihood of perioperative
blood transfusion (OR: 0.36; 95% CI: 0.25-0.51; I² = 55.9%),
shorter mean hospital stay (weighted mean difference: -2.04; 95% CI: -2.60
to -1.47; I² = 54%), and risk of postoperative acute kidney
injury (OR: 0.45; 95% CI: 0.23-0.88; p = 0.02). CABG demonstrated a lower
likelihood of requiring long-term repeat revascularization (OR: 1.51; 95%
CI: 1.03-2.20; I² = 18%) over a follow-up duration of 29.14 +/-
21.75 months. <br/>Conclusion(s): This meta-analysis suggests that HCR is
feasible and safe for the treatment of MVCAD. However, benefits of HCR
should be carefully weighed against the increased long-term risk of
repeat-revascularization when selecting patients, and further studies
evaluating differences in long-term mortality between HCR and CABG are
required.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC.

<103>
Accession Number
2021571485
Title
Unique Occupational Health Risks in Cardiac Catheterization Laboratory
Workers.
Source
Journal of Medical Imaging and Radiation Sciences. Conference: The 22nd
International Society of Radiographers and Radiological Technologists
(ISRRT) World Congress Conference Proceedings. Bangkog Thailand. 53(4
Supplement 1) (pp S7), 2022. Date of Publication: December 2022.
Author
Steelman C.
Institution
(Steelman) Weber State University, School of Radiologic Sciences, Ogden,
UT, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Since the emergence of the cath lab in the 1980s, the use of
percutaneous intervention has grown exponentially to address conditions
that previously required surgery, including sophisticated coronary
reperfusion, valve replacement, and structural repair. These procedures
are only possible through the increasing use of ionizing radiation. And
though technological advancements have reduced radiation dose,
increasingly complex procedures lead to increases in patient and staff
exposure as well as a greater potential for injury. The purpose of this
review is to examine the prevalence of health problems among personnel
staff working in interventional cardiology/cardiac electrophysiology and
the inadequacy of personal radiation protective equipment in this
environment. <br/>Method(s): A systematic literature review was used to
identify, select, and critically appraise research to determine the
efficacy of personal protection equipment currently worn in the cardiac
catheterization lab. The literature reviewed was collected from the
following databases: Academic Search Premier, Cumulative Index to Nursing
and Allied Health Literature (CINAHL), PubMed, Science Direct, and
Medline. The search was limited to full-text and scholarly (peer-reviewed)
journals published between 2012 and 2022 in the English language. The
methodological quality of the included studies was assessed using the
Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA). <br/>Result(s): Several themes emerged from this literature
review: occupational health risks in cardiac catheterization laboratory
workers are not limited to occupational exposure to radiation, orthopedic
strain is a recognized risk factor in personnel staff performing
fluoroscopically guided cardiovascular procedures, orientation of the
operators to the radiation source appears to be critical and may
significantly reduce the effectiveness of personal radiation protective
equipment, and commercially available personal radiation protective
equipment does not meet the needs of those working in the cardiac
catheterization lab. <br/>Conclusion(s): There is a need to broaden the
scope of education and training of medical imaging professionals on the
occupational health risks and the appropriate use of radiation protection
devices and equipment in the catheterization laboratory.<br/>Copyright
&#xa9; 2022

<104>
Accession Number
2021657249
Title
BAlloon expandable vs. SElf expanding transcatheter vaLve for degenerated
bioprosthesIs: design and rationale of the BASELINE trial.
Source
American Heart Journal. 256 (pp 139-147), 2023. Date of Publication:
February 2023.
Author
Nuis R.-J.; van Belle E.; Teles R.; Blackman D.; Veulemans V.; Santos
I.A.; Pilgrim T.; Tarantini G.; Saia F.; Iakovou I.; Mascherbauer J.;
Vincent F.; Geleijnse M.; Sathananthan J.; Wood D.; Makkar R.; Van Mieghem
N.M.
Institution
(Nuis, Geleijnse, Van Mieghem) Department of Cardiology, Erasmus
University Medical Center, Rotterdam, Netherlands
(van Belle, Vincent) Department of Cardiology, Institut Coeur Poumon,
Lille, France
(Teles) Hospital de Santa Cruz, CHLO; Nova Medical School, Lisbon,
Portugal
(Blackman) Department of Cardiology, Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
(Veulemans) Division of Cardiology, Heinrich Heine University Medical
Center Dusseldorf, Dusseldorf, Germany
(Santos) Departamento de Cardiologia, Hospital Clinico Universitario,
Valladolid, Spain
(Pilgrim) Department of Cardiology, Bern University Hospital, University
of Bern, Bern, Switzerland
(Tarantini) Department of Cardiac, Thoracic, Vascular Science and Public
Health, University of Padova, Padua, Italy
(Saia) U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda
Ospedaliero-Universitaria di Bologna, Bologna, Italy
(Iakovou) Department of Cardiology, Onassis Cardiac Surgery Center,
Athens, Greece
(Mascherbauer) Department of Cardiology, University Hospital St. Polten,
Sankt Polten, Austria
(Sathananthan, Wood) Centre for Cardiovascular and Heart Valve Innovation,
St. Paul's and Vancouver General Hospital, Vancouver, Canada
(Makkar) Department of Cardiology, Cedars-Sinai Medical Center, Los
Angeles, Canada
Publisher
Elsevier Inc.
Abstract
Background: Surgical aortic valve bioprostheses may degenerate over time
and require redo intervention. Transcatheter aortic valve replacement
(TAVR) is a less invasive alternative to redo surgery. The BAlloon
Expandable vs. SElf Expanding Transcatheter VaLve for Degenerated
BioprosthesIs (BASELINE) trial was designed to compare the performance of
the balloon-expandable SAPIEN-3 Ultra and the self-expanding EVOLUT PRO+
valve systems in symptomatic patients with a failing surgical
bioprosthesis. <br/>Method(s): The BASELINE trial is an
investigator-initiated, non-funded, prospective, randomized, open-label,
superiority trial enrolling a total of 440 patients in up to 50 sites in
12 countries in Europe and North-America. The primary endpoint is device
success at 30-days defined by the Valve Academic Research Consortium-3
Criteria as the composite of technical success, freedom from mortality,
freedom for surgery or intervention related to the device or to a major
vascular or access-related or cardiac structural complication with an
intended performance of the valve (mean gradient <20 mmHg and less than
moderate aortic regurgitation). The co-primary endpoint at 1 year is
defined as the composite of all-cause death, disabling stroke,
rehospitalization for heart failure or valve related problems. Independent
Core Laboratories will conduct uniform analyses of echocardiography (pre-,
post-, 1-year post-procedure), multi-sliced computed tomography (pre-, and
if available post-procedure) and cine-fluoroscopy studies.
<br/>Conclusion(s): The BASELINE trial is a head-to-head comparative trial
investigating the 2 most used contemporary transcatheter heart valves for
the treatment of a failing surgical aortic bioprosthesis.
(ClinicalTrials.gov number NCT04843072).<br/>Copyright &#xa9; 2022 The
Author(s)

<105>
Accession Number
2021754919
Title
Hepatitis B in Heart Transplant Donors and Recipients: A Systematic Review
and Meta-Analysis.
Source
Journal of Surgical Research. 283 (pp 1078-1090), 2023. Date of
Publication: March 2023.
Author
Yost C.C.; Jimenez D.C.; Weber M.P.; Maynes E.J.; Belden K.A.;
Tchantchaleishvili V.; Massey H.T.; Sass D.A.; Rame J.E.; Zurlo J.J.;
Aburjania N.
Institution
(Yost, Jimenez, Weber, Maynes, Tchantchaleishvili, Massey) Division of
Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
(Belden, Zurlo, Aburjania) Division of Infectious Diseases, Thomas
Jefferson University, Philadelphia, Pennsylvania
(Sass) Division of Gastroenterology and Hepatology, Thomas Jefferson
University, Philadelphia, Pennsylvania
(Rame) Division of Cardiology, Thomas Jefferson University, Philadelphia,
Pennsylvania
Publisher
Academic Press Inc.
Abstract
Introduction: Expanding the heart donor pool to include patients with
hepatitis B virus (HBV) could help ameliorate the organ shortage in heart
transplantation. We performed a systematic review and meta-analysis to
evaluate the management and recipient outcomes of D+/R- and D-/R+ heart
transplants. <br/>Method(s): An electronic search was performed to
identify all relevant studies published on heart transplants involving
HBV+ donors and/or HBV+ recipients. A comparison was performed between two
groups where heart transplants were performed a) D+/R- (n = 98) versus b)
D-/R+ (n = 65). <br/>Result(s): Overall, 13 studies were selected,
comprising 163 patients. Mean patient age was 55 y (95% CI: 39, 78) and
79% (69, 86) were male. Active post-transplant HBV infection requiring
antiviral treatment occurred in 11% (1, 69) of D+/R- recipients and 33%
(9, 71) of D-/R+ recipients. Post-transplant antiviral therapy was given
to 80% (6, 100) of D+/R- recipients compared to 72% (42, 90) of D-/R+
recipients (P = 0.84). Hepatitis-related mortality was observed in no
D+/R- recipients and 7% (2, 27) of D-/R+ recipients. Survival 1-y
post-transplant was comparable between both groups at 83% (83, 92) and 81%
(61, 92) for D+/R- and D-/R+ transplants, respectively.
<br/>Conclusion(s): Our review found that HBV D+/R- heart transplantation
was associated with fewer active hepatitis infections and lower
hepatitis-related mortality than D-/R+ transplantation, with comparable
survival at 1 y. Additional studies utilizing HBV nucleic acid testing
(NAT) to compare outcomes with HBsAg+ and anti-HBc+ donors are crucial to
reach more definitive conclusions about the risk of donor-derived
infections in this context.<br/>Copyright &#xa9; 2022 Elsevier Inc.

<106>
Accession Number
2018839310
Title
Incidence, Current Guidelines and Management of Gastrointestinal Bleeding
after Transcatheter Aortic Valve Replacement: A Systematic Review.
Source
Current Cardiology Reviews. 19(1) (pp 65-77), 2023. Article Number:
e230622206351. Date of Publication: 01 Jan 2023.
Author
Adalja D.; Zala H.; Victor V.; Sheth A.; Willyard C.; Suzu-Ki E.; Patel
H.P.; Majmundar M.; Vallabhajosyula S.; Doshi R.
Institution
(Adalja) Department of Internal Medicine, St Joseph's University Medical
Center, Paterson, NJ, United States
(Zala) Department of Clinical Research, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Victor) Department of Internal Medicine, Canton Medical Education
Foundation, Canton, OH, United States
(Sheth) Department of Internal Medicine, Louisiana State University Health
Sciences Center, Shreveport, LA, United States
(Willyard) Department of Internal Medicine, University of Nevada Reno
School of Medicine, Reno, NV, United States
(Suzu-Ki) Department of Pediatrics, UCSF-Fresno, Fresno, CA, United States
(Patel) Department of Internal Medi-cine, Louis A Weiss Memorial Hospital,
Chicago, IL, United States
(Majmundar) Department of Cardiology, Maimonides Medical Center, Brooklyn,
NY, United States
(Vallabhajosyula) Section of Cardiovascular Medicine, Wake Forest
University School of Medicine, Winston-Salem, NC, United States
(Doshi) Department of Cardiology, St Joseph's University Medical Center,
Paterson, NJ, United States
Publisher
Bentham Science Publishers
Abstract
Background: There is a significant increase in morbidity and mortality in
patients complicated by major bleeding following transcatheter aortic
valve replacement (TAVR). It has become more challenging to manage such
complications when the patient needs to be on anticoagulation or
antiplatelet agent post-procedure to prevent thrombotic/embolic
complications. <br/>Method(s): We systematically reviewed all available
randomized controlled trials and observational studies to identify
incidence rates of gastrointestinal bleeding post-procedure. After
performing a systematic search, a total of 8731 patients from 15 studies
(5 RCTs and 10 non-RCTs) were included in this review. <br/>Result(s): The
average rate of gastrointestinal bleeding during follow-up was 3.0% in
randomized controlled trials and 1.9% among observational studies.
<br/>Conclusion(s): Gastrointestinal bleeding has been noted to be higher
in the RCTs as compared to observational studies. This review expands
knowledge of current guidelines and possible management of patients
undergoing TAVR.<br/>Copyright &#xa9; 2023 Bentham Science Publishers.

<107>
Accession Number
2020626845
Title
Effect of alirocumab and evolocumab on all-cause mortality and major
cardiovascular events: A meta-analysis focusing on the number needed to
treat.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 1016802. Date of Publication: 02 Dec 2022.
Author
Wang H.-F.; Mao Y.-C.; Xu X.-Y.; Zhao S.-Y.; Han D.-D.; Ge S.-Y.; Song K.;
Geng C.; Tian Q.-B.
Institution
(Wang, Mao, Zhao, Han, Ge, Song, Geng, Tian) Department of Epidemiology
and Statistics, School of Public Health, Hebei Medical University,
Shijiazhuang, China
(Wang, Mao, Zhao, Han, Ge, Song, Geng, Tian) Hebei Province Key Laboratory
of Environment and Human Health, Shijiazhuang, China
(Xu) Postdoctoral Research Station in Basic Medicine, Hebei Medical
University, Shijiazhuang, China
(Xu) School of Nursing, Hebei Medical University, Shijiazhuang, China
Publisher
Frontiers Media S.A.
Abstract
Aims: The efficacy of anti-proprotein convertase subtilisin/Kexin type 9
(PCSK9) monoclonal antibodies in patients with atherosclerotic
cardiovascular disease (ASCVD) remains unclear. Therefore, this study aims
to assess the effect of PCSK9 inhibitors (alirocumab and evolocumab) on
ASCVD patients considering the number needed to treat (NNT).
<br/>Method(s): We reviewed randomized controlled trials (RCTs) which
compared the effects of alirocumab or evolocumab and placebo or standards
of care. All articles were published in English up to May 2022. Using
random effect models, we estimated risk ratios (RRs), NNT, and 95%
confidence intervals (CI). <br/>Result(s): We incorporated 12 RCTs with 53
486 patients total, of which 27 674 received PCSK9 inhibitors and 25 812
received placebos. The mean follow-up duration was 1.56 years. The effect
of PCSK9 inhibitors on major adverse cardiovascular events (MACE) was
statistically significant, and the corresponding mean NNT was 36.
Alirocumab reduced the risk of MACE, stroke, and coronary
revascularization; the corresponding mean NNT were 37, 319, and 107,
respectively. Evolocumab positively affected MACE, myocardial infarction,
stroke, and coronary revascularization; the corresponding mean NNT were
32, 78, 267, and 65, respectively. The effects of alirocumab or evolocumab
on all-cause mortality and cardiovascular mortality were not statistically
significant. <br/>Conclusion(s): This study suggests that preventing one
patient from MACE needed to treat 36 patients with ASCVD with PCSK9
inhibitors for 1.56 years. Both alirocumab and evolocumab reduced MACE,
stroke, and coronary revascularization. Evolocumab had a positive effect
on myocardial infarction, but no effects were noted for alirocumab. In
addition, alirocumab may not be as effective as evolocumab. NNT visualizes
the magnitude of efficacy to assist in clinical decisions. Systematic
review registration:
[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=344908],
identifier [CRD42022344908].<br/>Copyright &#xa9; 2022 Wang, Mao, Xu,
Zhao, Han, Ge, Song, Geng and Tian.

<108>
Accession Number
2020622085
Title
Colchicine for prevention of post-operative atrial fibrillation:
Meta-analysis of randomized controlled trials.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 1032116. Date of Publication: 01 Dec 2022.
Author
Ge P.; Fu Y.; Su Q.; Jin M.; Guo L.; Miao C.; Zhu S.; Zhuang J.; Zhang Z.;
Hong J.
Institution
(Ge, Guo, Hong) Shanghai General Hospital of Nanjing Medical University,
Shanghai, China
(Ge) Department of Cardiology, The Affiliated Huaian No.1 People's
Hospital of Nanjing Medical University, Jiangsu, Huaian, China
(Fu, Su, Jin, Zhu, Hong) Department of Emergency and Critical Care,
Shanghai General Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
(Miao, Zhuang) Department of Internal and Emergency Medicine, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine,
Shanghai, China
(Zhang) Department of Cardiology, Shanghai General Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
Publisher
Frontiers Media S.A.
Abstract
Objective: This study intended to assess the efficacy of colchicine for
prevention of post-operative atrial fibrillation (AF). <br/>Background(s):
Post-operative AF is a common complication of surgery operations.
Inflammation plays a crucial role in the pathogenesis of post-operative
AF. Colchicine, a potent anti-inflammatory drug, may have a role in
mitigating the incidence of post-operative AF. <br/>Method(s): We searched
Cochrane Library, Web of Science, PubMed, China National Knowledge
Infrastructure (CNKI), Database of Chinese sci-tech periodicals (COVIP),
and Wanfang Database for randomized controlled trials (RCTs) comparing
colchicine versus placebo, or usual care for prevention of post-operative
AF. The main outcome was the occurrence of AF post operation, which
includes cardiac surgery, lung surgery, or pulmonary vein isolation. The
estimated risk ratio (RR) for the occurrence of post-operative AF was
evaluated using a random-effects model. The safety end point was the
development of any side effects. <br/>Result(s): A total of 12 RCTs with
2274 patients were eventually included in this meta-analysis, where 1141
patients received colchicine and 1133 patients received placebo or usual
care. Perioperative colchicine treatment was related to a decreased
incidence of post-operative AF (RR: 0.65; 95% confidence interval [CI]:
0.56 to 0.75, p<0.001). Although the incidence of gastrointestinal side
effects was increased with colchicine therapy when compared to placebo (RR
= 2.49, 95% CI 1.85 to 3.34, p < 0.001), the incidence of major adverse
events was not increased (RR = 0.86, 95% CI 0.46 to 1.60, p = 0.64).
<br/>Conclusion(s): In conclusion, the results of our meta-analysis
suggest that colchicine treatment could lower the incidence of
post-operative AF. Further studies are needed to determine the optimal
colchicine treatment regime to minimize the incidence of adverse
events.<br/>Copyright &#xa9; 2022 Ge, Fu, Su, Jin, Guo, Miao, Zhu, Zhuang,
Zhang and Hong.

<109>
Accession Number
2020581029
Title
The effects of mineralocorticoid receptor antagonists on cardiovascular
outcomes in patients with end-stage renal disease and heart failure.
Source
European Journal of Heart Failure. (no pagination), 2022. Date of
Publication: 2022.
Author
Lin D.S.-H.; Lin F.-J.; Lin Y.-S.; Lee J.-K.; Lin Y.-H.
Institution
(Lin, Lee, Lin) Division of Cardiology, Department of Internal Medicine,
National Taiwan University Hospital, Taipei, Taiwan (Republic of China)
(Lin) Division of Cardiology, Department of Internal Medicine, National
Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan (Republic of
China)
(Lin) School of Pharmacy, College of Medicine, National Taiwan University,
Taipei, Taiwan (Republic of China)
(Lin) Department of Pharmacy, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
(Lin) Graduate Institute of Clinical Pharmacy, College of Medicine,
National Taiwan University, Taipei, Taiwan (Republic of China)
(Lin) Division of Cardiology, Department of Internal Medicine, Chang Gung
Memorial Hospital, Chiayi, Taiwan (Republic of China)
(Lin) College of Medicine, Graduate Institute of Clinical Medical
Sciences, Chang Gung University, Taoyuan City, Taiwan (Republic of China)
(Lee) Department of Internal Medicine, National Taiwan University College
of Medicine, Taipei, Taiwan (Republic of China)
(Lee, Lin) Department of Laboratory Medicine, National Taiwan University
College of Medicine, Taipei, Taiwan (Republic of China)
(Lee, Lin) Cardiovascular Center, National Taiwan University Hospital,
Taipei, Taiwan (Republic of China)
(Lee) Telehealth Center, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Mineralocorticoid receptor antagonists (MRAs) have been shown to
provide survival benefits in patients with heart failure; however, MRA use
in patients with chronic kidney disease has been limited by safety
concerns. The effects of MRAs on outcomes in patients with end-stage renal
disease (ESRD) and heart failure remain unknown. The aim of this study was
to evaluate the effects of MRAs on cardiovascular outcomes in patients
with heart failure under maintenance dialysis in a real-world setting.
<br/>Methods and Results: A retrospective cohort study was conducted by
collecting data from the Taiwan National Health Insurance Research
Database (NHIRD). Patients diagnosed with heart failure and ESRD and who
started maintenance dialysis between 1 January 2001 and 31 December 2013
were identified. Patients were grouped according to MRA prescription. The
outcomes of interest included cardiovascular (CV) death, hospitalization
for heart failure (HHF), all-cause mortality, acute myocardial infarction
(AMI), ischaemic stroke, any coronary revascularization procedures, and
new-onset hyperkalaemia. Propensity score matching was performed at a 1:3
ratio between MRA users and non-users to minimize selection bias. A total
of 50 872 patients who satisfied our inclusion and exclusion criteria were
identified. After 1:3 matching, 2176 patients were included in the MRA
group, and 6528 patients were included in the non-MRA group. The risk of
CV death was significantly lower among patients who received MRAs than
those who did not (hazard ratio [HR] 0.88, 95% confidence interval [CI]
0.80-0.95), as was the risk of all-cause mortality (HR 0.88, 95% CI
0.83-0.94). Reductions in the risks of CV death and all-cause mortality
were more prominent among patients undergoing haemodialysis and those with
coronary artery disease. <br/>Conclusion(s): In patients undergoing
regular dialysis who are diagnosed with heart failure, the use of MRAs is
associated with lower risks of all-cause mortality and CV death. The
benefits of MRA treatment in heart failure may persist in patients with
ESRD. Further investigations through randomized controlled trials are
needed to assess the efficacy and safety of MRAs in this high-risk
population.<br/>Copyright &#xa9; 2022 European Society of Cardiology.

<110>
Accession Number
2020479974
Title
Justification of empiric methodology to determine dexmedetomidine dose for
the TREX study.
Source
Paediatric Anaesthesia. (no pagination), 2022. Date of Publication: 2022.
Author
Disma N.; Goffredo B.M.; Cairoli S.; Cirillo G.; Morse J.; Anderson B.J.;
Bonfiglio R.; Cordani R.; Garrone M.; Patrone E.; Iengo A.; Bocca P.; Izzo
F.; Diotto V.; Lenares E.; Robino C.; Neri S.; Colantonio L.; Calderini
E.; Picardo S.; Tucci I.; Di Persio A.; Montagnini L.; Blesi L.; Pistone
B.; Kuppers B.; De Lorenzo B.; Caramelli F.; Pasini L.
Institution
(Disma, Cirillo) Unit for Research and Innovation, Department of
Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
(Goffredo, Cairoli) Division of Metabolic Disease and Drug Biology, IRCCS
Ospedale Bambino Gesu, Rome, Italy
(Morse, Anderson) Department Anesthesiology, Faculty Medicine and Health
Science, University of Auckland, Auckland, New Zealand
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Dexmedetomidine is the sedative agent administered in
combination with remifentanil and low dose of sevoflurane in the
interventional arm of the ongoing TREX trial (Trial Remifentanil
DExmedetomidine). The TREX pilot study (published in Paediatr Anaesth
2019;29:59-67) established infusion rates higher than those initially
proposed. This could be attributed to an inappropriate target
concentration for sedation or incorrect initial pharmacokinetic parameter
estimates. <br/>Method(s): The TREX study is a Phase III, randomized,
active controlled, parallel group, blinded evaluator, multicenter,
superiority trial comparing neurological outcome after standard
sevoflurane anesthesia with dexmedetomidine/remifentanil, and low dose
sevoflurane anesthesia in children aged less than 2 years undergoing
anesthesia of 2 h or longer. In this report, dexmedetomidine
pharmacokinetics were analyzed in the interventional arm of the Italian
population. <br/>Result(s): There were 162 blood samples from 32 infants
(22 male and 10 female). The median (IQR) age was 12 (5.2-15.5) months,
weight 9.9 (7.3-10.8) kg. Duration of anesthesia ranged from 2 to 6 h.
None of the children were born premature (median postnatal age 39 weeks,
IQR 38-40 weeks). A 3-compartment PK model that incorporated allometric
scaling and a maturation function demonstrated plasma concentration
observations from the current Italian arm of the TREX study were
consistent with those predicted by a "universal" model using pooled data
obtained from neonates to adults. <br/>Conclusion(s): This current PK
analysis from the Italian arm of the TREX study confirms that plasma
concentration of dexmedetomidine is predictable using known covariates
such as age and size. The initial target concentration (0.6
mug.L^-1) used to sedate children cared for in the intensive
care after cardiac surgery was inadequate for infants in the current TREX
study. A target concentration 1 mcg.L^-1, corresponding to a
loading dose of 1 mcg.kg^-1 followed by an infusion of 1
mcg.kg^-1.h^-1, provided adequate
sedation.<br/>Copyright &#xa9; 2022 The Authors. Pediatric Anesthesia
published by John Wiley & Sons Ltd.

<111>
Accession Number
639784127
Title
Surgical management of spontaneous intracranial hypotension syndrome: a
literature review.
Source
Neurologia i neurochirurgia polska. (no pagination), 2022. Date of
Publication: 13 Dec 2022.
Author
Sobczyk P.; Bojarski P.; Sobstyl M.
Institution
(Sobczyk) Department of Neurosurgery, Institute of Psychiatry and
Neurology, Warsaw, Poland
(Bojarski, Sobstyl) Department of Neurosurgery, Institute of Psychiatry
and Neurology, Warsaw, Poland
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Spontaneous intracranial hypotension (SIH) is a highly
disabling but often misdiagnosed disorder. The optimal management options
for patients with SIH remain uncertain. The aim of this study was to
review studies reporting the management of SIH with a special emphasis on
the surgical treatment of SIH including clinical trials, case series and
case reports related to the issue of various neurosurgical procedures
performed for SIH treatment. <br/>OBJECTIVE(S): The clinical outcomes of
patients diagnosed with SIH treated with either only surgery or with
surgery as the primary method of treatment were analysed. MATERIAL AND
METHODS: The PubMed, Scopus and Google Scholar databases were searched
according to the established criteria. <br/>RESULT(S): The literature
search revealed seven clinical trials, five case series and eight case
reports regarding surgical treatment of patients diagnosed with SIH.
Manuscripts reporting at least five individuals treated surgically for SIH
were considered as case series. In most published articles, surgery
provided clinical benefit, resulting in a success rate of 82.6-100% for
complete relief of SIH symptoms. <br/>CONCLUSION(S): Our literature review
has revealed that SIH can be diagnosed reliably by MRI and cisternography.
The identification of the location of SIH is mandatory for its successful
surgical treatment. The clinical outcome is related to the location of SIH
in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the
thoracic region. Surgical treatment is very effective and the obtained
treatment results are complete and permanent. of the location of SIH is
mandatory for its successful surgical treatment. The clinical outcome is
related to the location of SIH in the spinal canal. Most often,
cerebrospinal fluid leakage occurs in the thoracic region. Surgical
treatment is very effective and the obtained treatment results are
complete and permanent.

<112>
Accession Number
639782098
Title
Plasma Renin Activity Increases With Cardiopulmonary Bypass and is
Associated With Vasoplegia After Cardiac Surgery.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2022.
Date of Publication: 22 Nov 2022.
Author
Montgomery M.L.; Gross C.R.; Lin H.-M.; Ouyang Y.; Levin M.A.; Corkill
H.E.; El-Eshmawi A.; Adams D.H.; Weiner M.M.
Institution
(Montgomery, Gross, Levin, Corkill, Weiner) Department of Anesthesiology,
Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai,
New York, NY
(Lin, Ouyang) Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY
(El-Eshmawi, Adams) Department of Cardiovascular Surgery, Icahn School of
Medicine at Mount Sinai, New York, NY
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To describe the trend in plasma renin activity over time in
patients undergoing cardiac surgery on cardiopulmonary bypass, and to
investigate if increased plasma renin activity is associated with
postcardiopulmonary bypass vasoplegia. DESIGN: A prospective cohort study.
SETTING: Patients were enrolled from June 2020 to May 2021 at a tertiary
cardiac surgical institution. PATIENTS: A cohort of 100 adult patients
undergoing cardiac surgery on cardiopulmonary bypass.None. MEASUREMENTS
AND MAIN RESULTS: Plasma renin activity was measured at 5 time points:
baseline, postoperatively, and at midnight on postoperative days 1, 2, and
3. Plasma renin activity and delta plasma renin activity were correlated
with the incidence of vasoplegia and clinical outcomes. The median plasma
renin activity increased approximately 3 times from baseline immediately
after cardiac surgery, remained elevated on postoperative days 0, 1, and
2, and began to downtrend on postoperative day 3. Plasma renin activity
was approximately 3 times higher at all measured time points in patients
who developed vasoplegia versus those who did not. <br/>CONCLUSION(S): In
patients undergoing cardiac surgery on cardiopulmonary bypass, plasma
renin activity increased postoperatively and remained elevated through
postoperative day 2. Additionally, patients with vasoplegic syndrome after
cardiac surgery on cardiopulmonary bypass had more robust elevations in
plasma renin activity than nonvasoplegic patients. These findings support
the need for randomized controlled trials to determine if patients
undergoing cardiac surgery with high plasma renin activity may benefit
from targeted treatment with therapies such as synthetic angiotensin
II.<br/>Copyright &#xa9; 2022 Elsevier Inc. All rights reserved.

<113>
Accession Number
2018723597
Title
Deep Sternal Wound Infection and Mortality in Cardiac Surgery: A
Meta-analysis.
Source
Annals of Thoracic Surgery. 115(1) (pp 272-280), 2023. Date of
Publication: January 2023.
Author
Perezgrovas-Olaria R.; Audisio K.; Cancelli G.; Rahouma M.; Ibrahim M.;
Soletti G.J.; Chadow D.; Demetres M.; Girardi L.N.; Gaudino M.
Institution
(Perezgrovas-Olaria, Audisio, Cancelli, Rahouma, Soletti, Chadow, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, New York, United States
(Ibrahim) Department of General Surgery, Maimonides Medical Center,
Brooklyn, New York, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Centre, Weill Cornell Medicine, New York, New York, United States
Publisher
Elsevier Inc.
Abstract
Background: Deep sternal wound infection (DSWI) is a rare but severe
complication after cardiac surgical procedures and has been associated
with increased early morbidity and mortality. Studies reporting long-term
outcomes in patients with DSWI have shown contradictory results. We
performed a study-level meta-analysis evaluating the impact of DSWI on
short- and long-term clinical outcomes. <br/>Method(s): A systematic
literature search was conducted to identify studies comparing short- and
long-term outcomes of patients submitted to cardiac surgical procedures
who developed DSWI and patients who did not. The primary outcome was
overall mortality. Secondary outcomes were in-hospital mortality,
follow-up mortality, major adverse cardiovascular events, myocardial
infarction, and repeat revascularization. Postoperative outcomes were also
investigated. <br/>Result(s): Twenty-four studies totaling 407 829
patients were included. Overall, 6437 (1.6%) patients developed DSWI. Mean
follow-up was 3.5 years. DSWI was associated with higher overall mortality
(incidence rate ratio [IRR], 1.99; 95% CI, 1.66-2.38; P < .001),
in-hospital mortality (odds ratio, 3.30; 95% CI, 1.88-5.81; P < .001),
follow-up mortality (IRR, 2.02; 95% CI, 1.39-2.94; P = .001), and major
adverse cardiovascular events (IRR, 2.04; 95% CI, 1.60-2.59; P < .001). No
differences in myocardial infarction and repeat revascularization were
found, but limited studies reported those outcomes. DSWI was associated
with longer postoperative hospitalization, stroke, myocardial infarction,
and respiratory and renal failure. Sensitivity analyses on isolated
coronary artery bypass grafting studies and by adjustment method were
consistent with the main analysis. <br/>Conclusion(s): Compared with
patients who did not develop DSWI, patients with DSWI after cardiac
surgical procedures had increased risk of death as well as short- and
long-term adverse clinical outcomes.<br/>Copyright &#xa9; 2023 The Society
of Thoracic Surgeons

<114>
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. <br/>Objective(s): We
examined the effect of neuromuscular electrical stimulation (NMES) on
postsurgical muscle weakness in older individuals with diabetes mellitus.
<br/>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).
<br/>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. <br/>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.<br/>Copyright &#xa9; 2022

<115>
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. <br/>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.
<br/>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. <br/>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).<br/>Copyright &#xa9; 2022 The Authors

<116>
[Use Link to view the full text]
Accession Number
2021677786
Title
The Regional Cerebral Oxygen Saturation Effect of Inotropes/Vasopressors
Administered to Treat Intraoperative Hypotension: A Bayesian Network
Meta-analysis.
Source
Journal of Neurosurgical Anesthesiology. 35(1) (pp 31-40), 2023. Date of
Publication: 01 Jan 2023.
Author
Bombardieri A.M.; Singh N.P.; Yaeger L.; Athiraman U.; Tsui B.C.H.; Singh
P.M.
Institution
(Bombardieri, Tsui) Department of Anesthesiology, Perioperative and Pain
Medicine, Stanford University School of Medicine, Stanford, CA, United
States
(Singh) Department of Anesthesiology, MMIMSR, MM (DU), Haryana, India
(Yaeger) Bernard Becker Medical Library, United States
(Athiraman, Singh) Department of Anesthesiology, Perioperative and Pain
Medicine, Washington University in St. Louis School of Medicine, St.
Louis, MO, United States
Publisher
Lippincott Williams and Wilkins
Abstract
One of the main concerns of intraoperative hypotension is adequacy of
cerebral perfusion, as cerebral blood flow decreases passively when mean
arterial pressure falls below the lower limit of cerebral autoregulation.
Treatment of intraoperative hypotension includes administration of drugs,
such as inotropes and vasopressors, which have different pharmacological
effects on cerebral hemodynamics; there is no consensus on the preferred
drug to use. We performed a network meta-analysis (NMA) to pool and
analyze data comparing the effect on cerebral oxygen saturation
(ScO<inf>2</inf>) measured by cerebral oximetry of various
inotropes/vasopressors used to treat intraoperative hypotension. We
searched randomized control trials in Embase, Ovid Medline, Scopus,
Cochrane Central Register of Controlled Trials, and Web of Science. We
included studies that enrolled adult patients undergoing surgery under
general/spinal anesthesia that compared at least 2 inotropes/vasopressors
to treat hypotension. We reviewed 51 full-text manuscripts and included 9
randomized controlled trials in our study. The primary outcome was change
in ScO<inf>2</inf>. Our results showed the likelihood that dopamine,
ephedrine, and norepinephrine had the lowest probability of decreasing
ScO<inf>2</inf>. The suggested rank order to maintain ScO<inf>2</inf>,
from higher to lower, was dopamine <ephedrine <norepinephrine
<phenylephrine. Drugs in the lower rank order, like phenylephrine, produce
higher reductions in ScO<inf>2</inf>. Compared with dopamine, the mean
difference (95% credible interval) of ScO<inf>2</inf>reduction was:
ephedrine -3.19 (-15.74, 8.82), norepinephrine -4.44 (-18.23, 9.63) and
phenylephrine -6.93 (-18.31, 4.47). The results of our NMA suggest that
dopamine and ephedrine are more likely to preserve ScO<inf>2</inf>,
followed by norepinephrine. Compared with the other
inotropes/vasopressors, phenylephrine decreased ScO<inf>2</inf>. Because
of the inherent imprecision of direct/indirect comparisons, the rank
orders are possibilities, not absolute ranks. Therefore the results of
this NMA should be interpreted with caution.<br/>Copyright &#xa9; 2023
Lippincott Williams and Wilkins. All rights reserved.

<117>
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.<br/>Copyright
&#xa9; The Author(s) 2022.

<118>
Accession Number
2016346468
Title
Plumping up a Cushion of Human Biowaste in Regenerative Medicine: Novel
Insights into a State-of-the-Art Reserve Arsenal.
Source
Stem Cell Reviews and Reports. 18(8) (pp 2709-2739), 2022. Date of
Publication: December 2022.
Author
Najafi-Ghalehlou N.; Feizkhah A.; Mobayen M.; Pourmohammadi-Bejarpasi Z.;
Shekarchi S.; Roushandeh A.M.; Roudkenar M.H.
Institution
(Najafi-Ghalehlou) Department of Medical Laboratory Sciences, Faculty of
Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Feizkhah, Mobayen, Pourmohammadi-Bejarpasi, Roushandeh, Roudkenar) Burn
and Regenerative Medicine Research Center, School of Medicine, Velayat
Hospital, Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Shekarchi) Anatomical Sciences Department, School of Medicine, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Roudkenar) Cardiovascular Diseases Research Center, Department of
Cardiology, School of Medicine, Heshmat Hospital, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
Springer
Abstract
Major breakthroughs and disruptive methods in disease treatment today owe
their thanks to our inch by inch developing conception of the infinitive
aspects of medicine since the very beginning, among which, the role of the
regenerative medicine can on no account be denied, a branch of medicine
dedicated to either repairing or replacing the injured or diseased cells,
organs, and tissues. A novel means to accomplish such a quest is what is
being called "medical biowaste", a large assortment of biological samples
produced during a surgery session or as a result of physiological
conditions and biological activities. The current paper accentuating
several of a number of promising sources of biowaste together with their
plausible applications in routine clinical practices and the confronting
challenges aims at inspiring research on the existing gap between clinical
and basic science to further extend our knowledge and understanding
concerning the potential applications of medical biowaste. Graphical
abstract: [Figure not available: see fulltext.]<br/>Copyright &#xa9; 2022,
The Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature.

<119>
Accession Number
2018675594
Title
The Effect of Pre-emptive Oral Melatonin versus Placebo on Post-operative
Analgesia in Infants after Thoracotomy for Closed Cardiac Surgeries: A
Randomized Controlled Study.
Source
Open Access Macedonian Journal of Medical Sciences. Part B. 10 (pp
2195-2201), 2022. Date of Publication: 01 Jan 2022.
Author
Saleh A.; Hassan P.
Institution
(Saleh, Hassan) Department of Anesthesia, Surgical Intensive Care and Pain
Management, Cairo University, Cairo, Egypt
Publisher
Scientific Foundation SPIROSKI
Abstract
BACKGROUND: Thoracotomy pain is one of the severest types of pain that
should be managed properly, especially in children. Opioids are the most
widely prescribed analgesics for post-operative pain, but they can have a
number of undesirable side effects. Melatonin could be employed as an
adjuvant analgesic therapy during procedural discomfort as it had no known
major side effects. STUDY DESIGN: This was a double-blinded, controlled
randomized study. <br/>METHOD(S): Fifty patients divided randomly into two
equal groups. One hour before surgery, children in M group (n = 25) were
given 0.5 mg/kg orally of melatonin 3 mg tablets) and patients in Group P
(n = 25) received a placebo (5 ml of water by syringe 5 ml) orally.
Post-operative pethidine consumption over the 1^st 24 h (mg) was
recorded, the intraoperative fentanyl consumption (HR and ABP) at
baseline, 1 min after induction, at skin incision, and every 30 min till
the end of the surgery were recorded. Neonatal Infant Pain Score (NIPS) at
4 h, 6 h, 8 h, 12 h, 18 h, and 24 h postoperatively was recorded. Other
reported data include demographic data, extubation time, days of ICU stay,
and complications. <br/>RESULT(S): Total post-operative pethidine
consumption (mg) over 24 h was significantly lower in M group than P group
(3.48 +/- 2.23 vs. 7.68 +/- 4.52 p = 0.01). Intraoperative fentanyl
consumption (ug) was significantly lower in M group than P group (10.28
+/- 4.98 vs. 17.08 +/- 7.39 p < 0.001). As regards NIPS, it was
statistically lower in M group than P group in all times except at 8 h and
24 h with significant difference. <br/>CONCLUSION(S): Oral melatonin is an
effective and safe pre-emptive drug as it reduces the total post-operative
pethidine consumption over the first 24 h and decreased post-operative
pain scores without any unpleasant effects in pediatrics undergoing closed
heart surgery.<br/>Copyright &#xa9; 2022 Amany Saleh, Passaint Hassan.

<120>
Accession Number
2017527127
Title
Immobile Leaflets at Time of Bioprosthetic Valve Implantation: A Novel
Risk Factor for Early Bioprosthetic Failure: A Novel Risk Factor for Early
Bioprosthetic Failure.
Source
Heart Lung and Circulation. 31(8) (pp 1166-1175), 2022. Date of
Publication: August 2022.
Author
Naser J.A.; Crestanello J.A.; Nkomo V.T.; Luis S.A.; Thaden J.J.; Geske
J.B.; Anderson J.H.; Sinak L.J.; Michelena H.I.; Pislaru S.V.; Padang R.
Institution
(Naser) Department of Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Naser, Nkomo, Luis, Thaden, Geske, Anderson, Sinak, Michelena, Pislaru,
Padang) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN,
United States
(Crestanello) Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier Ltd
Abstract
Objectives: The clinical implications of finding immobile leaflet(s) at
the time of bioprosthetic valve implantation but with acceptable
prosthetic haemodynamics are uncertain. We sought to determine the
characteristics of such patients and their impact on outcome.
<br/>Method(s): Patients with immobile leaflet at the time of surgical
bioprosthetic valve implantation were identified retrospectively by a
systematic search of an institutional echocardiography database
(2010-2020). Intraoperative echocardiograms were reviewed de-novo to
confirm immobile leaflet(s) at the time of implantation. Cases were
matched 1:2 to controls with normal bioprosthetic leaflets motion for age,
sex, prosthesis position, prosthesis model, size, year of implantation,
and pre-implantation left ventricular ejection fraction. Proportional
hazards method was used to analyse the composite endpoint of stroke, valve
thrombosis or re-intervention. <br/>Result(s): Immobile leaflet at the
time of bioprosthetic valve implantation were found in 26 patients (median
age 71 ys 39% males) following tricuspid (n=13), mitral (n=11) and aortic
(n=2) valve replacements; 96% received porcine prostheses; prosthesis size
was 27 mm or larger in 92%. Immobile leaflet were recorded on
intraoperative reports in 16 (62%) cases. It resulted in elevated gradient
or mild-moderate prosthetic regurgitation in three (12%), but none led to
immediate corrective action intraoperatively. At median follow-up of 21
(4-50) months, presence of immobile leaflet was associated with composite
clinical endpoint of stroke, valve thrombosis or re-intervention (hazard
ratio 6.8, 95% CI 1.8-25.2, p<0.01) compared to controls.
<br/>Conclusion(s): Immobile leaflet immediately post-bioprosthetic valve
implantation is frequently under-recognised intraoperatively and appears
to be associated with early bioprosthetic dysfunction and worse clinical
outcome.<br/>Copyright &#xa9; 2022 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<121>
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. <br/>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. <br/>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.
<br/>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.<br/>Copyright &#xa9; 2020 The Author(s).

<122>
Accession Number
2021269763
Title
Development and internal validation of a prediction model for acute kidney
injury following cardiac valve replacement surgery.
Source
International Journal of Cardiology. 370 (pp 345-350), 2023. Date of
Publication: 01 Jan 2023.
Author
Pan L.; Deng Y.; Dai S.; Feng X.; Feng L.; Yang Z.; Liao Y.; Zheng B.
Institution
(Pan, Deng, Dai, Feng, Yang, Liao) Department of Nephrology, The First
Affiliated Hospital of Guangxi Medical University, China
(Feng, Zheng) Department of Cardiac surgery, The First Affiliated Hospital
of Guangxi Medical University, China
Publisher
Elsevier Ireland Ltd
Abstract
Background: Acute kidney injury (AKI) is a common complication after
cardiac surgery. This study aims to develop and validate a risk model for
predicting AKI after cardiac valve replacement surgery. <br/>Method(s):
Data from patients undergoing surgical valve replacement between January
2015 and December 2018 in our hospital were retrospectively analyzed. The
subjects were randomly divided into a derivation cohort and a validation
cohort at a ratio of 7:3. The primary outcome was defined as AKI within 7
days after surgery. Logistic regression analysis was conducted to select
risk predictors for developing the prediction model. Receiver operator
characteristic curve (ROC), calibration plot and clinical decision curve
analysis (DCA) will be used to evaluate the discrimination, precision and
clinical benefit of the prediction model. <br/>Result(s): A total of 1159
patients were involved in this study. The prevalence of AKI following
surgery was 37.0% (429/1159). Logistic regression analysis showed that
age, hemoglobin, fibrinogen, serum uric acid, cystatin C, bicarbonate, and
cardiopulmonary bypass time were independent risk factors associated with
AKI after surgical valve replacement (all P < 0.05). The areas under the
ROC curves (AUCs) in the derivation cohort and the validation cohort were
0.777 (95% CI 0.744-0.810) and 0.760 (95% CI 0.706-0.813), respectively.
The calibration plots indicated excellent consistency between the
prediction probability and actual probability. DCA demonstrated great
clinical benefit of the prediction model. <br/>Conclusion(s): We developed
a prediction model for predicting AKI after cardiac valve replacement
surgery that was internally validated to have good discrimination,
calibration, and clinical practicability.<br/>Copyright &#xa9; 2022
Elsevier B.V.

<123>
Accession Number
2020398858
Title
Meta-analysis of short- and long-term clinical outcomes of the
self-expanding Evolut R/pro valve versus the balloon-expandable Sapien 3
valve for transcatheter aortic valve implantation.
Source
International Journal of Cardiology. 371 (pp 100-108), 2023. Date of
Publication: 15 Jan 2023.
Author
Lerman T.T.; Levi A.; Kornowski R.
Institution
(Lerman) Department of Internal Medicine F-Recanati, Beilinson Hospital,
Rabin Medical Center, Petah Tikva, Israel
(Lerman, Levi, Kornowski) Department of Cardiology, Rabin Medical Center,
Petah Tikva, Israel
(Lerman, Levi, Kornowski) The Faculty of Medicine, Tel Aviv University,
Tel Aviv, Israel
Publisher
Elsevier Ireland Ltd
Abstract
Background: The Evolut R/Pro and the Sapien 3 are the most commonly valve
systems used today for transcatheter aortic valve implantation (TAVI).
However, there is a still uncertainty regarding the efficacy and safety
comparison of these two valves. <br/>Method(s): We conducted a systematic
review and meta-analysis of randomized controlled trials (RCTs) and
observational studies comparing the Evolut R/Pro versus the Sapien 3. The
primary outcome was all-cause mortality (short and long-term). The
secondary outcomes were stroke, bleeding, permanent pacemaker implantation
(PPI), acute kidney injury (AKI), major vascular complication, device
success, moderate- severe aortic regurgitation (AR), and pressure
gradients. <br/>Result(s): Twenty-one publications totaling 35,248
patients were included in the analysis. Evolut R/Pro was associated with
higher risk of short-term all-cause mortality (OR = 1.31;95% CI 1.15-1.49,
p < 0.001) and a trend of higher long-term mortality (OR = 1.07;95% CI
1.00-1.16, p = 0.06). The Evolut R/Pro was associated with higher risk of
PPI and AR and lower risk for bleeding, major vascular complication, and
pressure gradients. There was no significant difference between the groups
regarding the risk of stroke, AKI and device success. <br/>Conclusion(s):
The Evolut R/Pro valve system compared to the Sapien 3 is associated with
higher risk of short-term mortality, significant AR and PPI while
providing the advantage of lower risk of bleeding, major vascular
complication, and lower residual transvalvular gradients.<br/>Copyright
&#xa9; 2022 Elsevier B.V.

<124>
Accession Number
639773363
Title
EFFECT OF RED BLOOD CELL STORAGE TIME IN PEDIATRIC CARDIAC SURGICAL
PATIENTS: A SUBGROUP ANALYSIS OF THE ABC-PICU RANDOMIZED CONTROLLED TRIAL.
Source
Pediatric Critical Care Medicine. Conference: 11th Congress of the World
Federation of Pediatric Intensive and Critical Care Societies, WFPICCS
2022. Virtual. 23(11 Supplement 1) (no pagination), 2022. Date of
Publication: November 2022.
Author
Martin S.M.; Tucci M.; Spinella P.C.; Ducruet T.; Fergusson D.A.; Freed
D.H.; Lacroix J.; Poirier N.; Sivarajan B.V.; Steiner M.E.; Willems A.;
Garcia Guerra G.
Institution
(Martin, Tucci, Lacroix) Department of Pediatrics, Sainte-Justine
University Hospital, Universite de Montreal, Montreal, QC, Canada
(Spinella) Departments of Surgery and Critical Care Medicine, Pittsburgh
University, Pittsburgh, PA, United States
(Ducruet) Unite de Recherche Clinique Appliquee (URCA), Centre Hospitalier
Universitaire Sainte-Justine, Montreal, QC, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Freed) Department of Surgery, University of Alberta, Edmonton, AB, Canada
(Poirier) Department of Cardiac Surgery, CHU Sainte Justine, University of
Montreal, Montreal, QC, Canada
(Sivarajan, Garcia Guerra) Departemant of Pediatric Cardiac Intensive
Care, Stollery Children's Hospital, University of Alberta, Edmonton, AB,
Canada
(Steiner) Divisions of Hematology/Oncology and Critical Care, Department
of Pediatrics, University of Minnesota, Minneapolis, MN, United States
(Willems) Pediatric Intensive Care Unit, Department of Intensive Care,
Leiden University Hospital, Leiden, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND AND AIM: This study aimed to determine if transfusion of fresh
red blood cells (RBC) units reduced the incidence of new or progressive
multiple organ dysfunction syndrome (NPMODS) compared with the use of
standardissue RBC in pediatric cardiac surgical patients. <br/>METHOD(S):
Preplanned secondary analysis of the Age of Blood in Children in Pediatric
Intensive Care Unit (ABC-PICU) study, an international randomized
controlled trial, performed between 2014 and 2018 in 50 pediatric tertiary
care centers. This study included patients aged 3 days to 16 years
enrolled in the ABC-PICU trial and admitted to PICU/cardiac PICU after
cardiac surgery with cardiopulmonary bypass (CPB). Patients were
randomized to receive either fresh (stored <= 7 days) or standard-issue
RBC. The primary outcome measure was NPMODS, measured at 28 days or at
discharge, or death. Data was analyzed as per intention to treat.
<br/>RESULT(S): One hundred and seventy-eight patients (median age: 0.6
years) were included and analyzed. There were 89 patients randomized to
the fresh RBC group and 89 to the standard-issue RBC group. There were no
statistically significant differences in NPMODS between fresh (43 of 89
[48.3%]) and standard-issue RBC groups (38 of 88 [43.2%]), with a relative
risk of 1.12 (95% CI, 0.81 to 1.54; P = 0.49) and an unadjusted absolute
risk difference of 5.1% (95% CI, -9.5% to 19.8%; P = 0.49).
<br/>CONCLUSION(S): In neonates and children undergoing cardiac surgery
with CPB, the use of fresh RBCs did not significantly reduce the incidence
of NPMODS compared to the standard-issue RBC.

<125>
Accession Number
2021604280
Title
Long-term clinical impact of permanent pacemaker implantation in patients
undergoing transcatheter aortic valve implantation: a systematic review
and meta-analysis.
Source
Europace. 24(7) (pp 1127-1136), 2022. Date of Publication: 01 Jul 2022.
Author
Zito A.; Princi G.; Lombardi M.; D'amario D.; Vergallo R.; Aurigemma C.;
Romagnoli E.; Pelargonio G.; Bruno P.; Trani C.; Burzotta F.; Crea F.
Institution
(Zito, Princi, Lombardi, D'amario, Vergallo, Aurigemma, Romagnoli,
Pelargonio, Bruno, Trani, Burzotta, Crea) Department of Cardiovascular and
Thoracic Sciences, Universita Cattolica del Sacro Cuore, L.go A. Gemelli
1, Rome 00168, Italy
(D'amario, Vergallo, Aurigemma, Romagnoli, Pelargonio, Bruno, Trani,
Burzotta, Crea) Department of Cardiovascular Medicine, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Publisher
Oxford University Press
Abstract
Aims: The aims of this study is to assess by an updated meta-analysis the
clinical outcomes related to permanent pacemaker implantation (PPI) after
transcatheter aortic valve implantation (TAVI) at long-term (>=12 months)
follow-up (LTF). <br/>Methods and Results: A comprehensive literature
research was performed on PubMed and EMBASE. The primary endpoint was
all-cause death. Secondary endpoints were rehospitalization for heart
failure, stroke, and myocardial infarction. A subgroup analysis was
performed according to the Society of Thoracic Surgeon - Predicted Risk of
Mortality (STS-PROM) score. This study is registered with PROSPERO
(CRD42021243301). A total of 51 069 patients undergoing TAVI from 31
observational studies were included. The mean duration of follow-up was 22
months. At LTF, PPI post-TAVI was associated with a higher risk of
all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI)
1.10-1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32,
95% CI 1.13-1.52; P < 0.001). In contrast, the risks of stroke and
myocardial infarction were not affected. Among the 20 studies that
reported procedural risk, the association between PPI and all-cause death
risk at LTF was statistically significant only in studies enrolling
patients with high STS-PROM score (RR 1.25, 95% CI 1.12-1.40), although
there was a similar tendency of the results in those at medium and low
risk. <br/>Conclusion(s): Patients necessitating PPI after TAVI have a
higher long-term risk of all-cause death and rehospitalization for heart
failure as compared to those who do not receive PPI.<br/>Copyright &#xa9;
2022 The Author(s).

<126>
Accession Number
2020575085
Title
Feasibility to estimate mean systemic filling pressure with inspiratory
holds at the bedside.
Source
Frontiers in Physiology. 13 (no pagination), 2022. Article Number:
1041730. Date of Publication: 29 Nov 2022.
Author
Wijnberge M.; Jansen J.R.C.; Pinsky M.R.; Klanderman R.B.; Terwindt L.E.;
Bosboom J.J.; Lemmers N.; Vlaar A.P.; Veelo D.P.; Geerts B.F.
Institution
(Wijnberge, Klanderman, Terwindt, Bosboom, Lemmers, Veelo) Amsterdam UMC
Location Academic Medical Center, Department of Anesthesiology, Amsterdam,
Netherlands
(Wijnberge, Klanderman, Bosboom, Vlaar) Amsterdam UMC Location Academic
Medical Center, Department of Intensive Care Medicine, Amsterdam,
Netherlands
(Jansen) Leiden University Medical Center, Department of Intensive Care
Medicine, Leiden, Netherlands
(Pinsky) Department of Critical Care Medicine, University of Pittsburgh,
Pittsburgh, PA, United States
(Geerts) Healthplus.ai, Amsterdam, Netherlands
Publisher
Frontiers Media S.A.
Abstract
Background: A decade ago, it became possible to derive mean systemic
filling pressure (MSFP) at the bedside using the inspiratory hold
maneuver. MSFP has the potential to help guide hemodynamic care, but the
estimation is not yet implemented in common clinical practice. In this
study, we assessed the ability of MSFP, vascular compliance (Csys), and
stressed volume (Vs) to track fluid boluses. Second, we assessed the
feasibility of implementation of MSFP in the intensive care unit (ICU).
Exploratory, a potential difference in MSFP response between colloids and
crystalloids was assessed. <br/>Method(s): This was a prospective cohort
study in adult patients admitted to the ICU after cardiac surgery. The
MSFP was determined using 3-4 inspiratory holds with incremental pressures
(maximum 35 cm H<inf>2</inf>O) to construct a venous return curve. Two
fluid boluses were administered: 100 and 500 ml, enabling to calculate Vs
and Csys. Patients were randomized to crystalloid or colloid fluid
administration. Trained ICU consultants acted as study supervisors, and
protocol deviations were recorded. <br/>Result(s): A total of 20 patients
completed the trial. MSFP was able to track the 500 ml bolus (p < 0.001).
In 16 patients (80%), Vs and Csys could be determined. Vs had a median of
2029 ml (IQR 1605-3164), and Csys had a median of 73 ml mmHg^-1
(IQR 56-133). A difference in response between crystalloids and colloids
was present for the 100 ml fluid bolus (p = 0.019) and in a post hoc
analysis, also for the 500 ml bolus (p = 0.010). <br/>Conclusion(s): MSFP
can be measured at the bedside and provides insights into the hemodynamic
status of a patient that are currently missing. The clinical feasibility
of Vs and Csys was judged ambiguously based on the lack of required
hemodynamic stability. Future studies should address the clinical
obstacles found in this study, and less-invasive alternatives to determine
MSFP should be further explored. Clinical Trial Registration:
ClinicalTrials.gov Identifier NCT03139929.<br/>Copyright &#xa9; 2022
Wijnberge, Jansen, Pinsky, Klanderman, Terwindt, Bosboom, Lemmers, Vlaar,
Veelo and Geerts.

<127>
Accession Number
2021703568
Title
Intimal hyperplasia, saphenous vein graft disease, and clinical outcomes:
Insights from the CTSN VEST randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2022.
Date of Publication: 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, United States
(Mack, DiMaio) Cardiothoracic Surgery, Baylor Scott & White Health, Plano,
Tex, 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, United States
(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, United States
(Taylor) Division of Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, Md, United States
(Ailawadi) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, Mich, 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, United States
(Williams) Cardiovascular Surgery, WakeMed Health and Hospitals, Raleigh,
NC
(Crestanello) Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, Minn, United States
(Scavo) Cardiovascular and Thoracic Surgery, Lutheran Medical Group, Fort
Wayne, Ind, United States
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Morningside,
New York, NY, United States
(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, Ohio, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
Mass, United States
(Alexander) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC
Publisher
Elsevier Inc.
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2022 The American
Association for Thoracic Surgery

<128>
Accession Number
2020475414
Title
Safety of apixaban and rivaroxaban compared to warfarin after cardiac
surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
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, The Ohio State University Wexner Medical
Center, Columbus, United States
(McLaughlin) Department of Biostatistics, The Ohio State University,
Columbus, OH, United States
(Matre) Department of Quality and Operations, The Ohio State University
Wexner Medical Center, Columbus, OH, United States
(Rozycki) Department of Pharmacy, The Ohio State University Wexner Medical
Center, Columbus, OH, United States
Publisher
John Wiley and Sons Inc
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2022 The
Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.

<129>
Accession Number
2020312785
Title
Intravenous acetaminophen for postoperative pain control after open
abdominal and thoracic surgery in pediatric patients: a systematic review
and meta-analysis.
Source
Pediatric Surgery International. 39(1) (no pagination), 2023. Article
Number: 7. Date of Publication: December 2023.
Author
Archer V.; Cloutier Z.; Park L.; Briatico D.; Walton J.M.
Institution
(Archer, Cloutier, Park) Division of General Surgery, Department of
Surgery, McMaster University, Hamilton, ON, Canada
(Briatico, Walton) Division of Pediatric General Surgery, Department of
Surgery, McMaster University, Hamilton, ON, Canada
(Briatico, Walton) McMaster Pediatric Surgery Research Collaborative,
Hamilton, ON, Canada
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Pediatric opioid exposure increases short- and long-term adverse events
(AE). The addition of intravenous acetaminophen (IVA) to pediatric pain
regimes to may reduce opioids but is not well studied postoperatively. Our
objective was to quantify the impact of IVA on postoperative pain, opioid
use, and AEs in pediatric patients after major abdominal and thoracic
surgery. Medline, Embase, CINAHL, Web of Science, and Cochrane Library
were searched systematically for randomized controlled trials (RCTs)
comparing IVA to other modalities. Five RCTs enrolling 443 patients with
an average age of 2.12 years (+/- 2.81) were included. Trials comparing
IVA with opioids to opioids alone were meta-analyzed. Low to very
low-quality evidence demonstrated equivalent pain scores between the
groups (-0.23, 95% CI -0.88 to 0.40, p 0.47) and a reduction in opioid
consumption (-1.95 morphine equivalents/kg/48 h, 95% CI -3.95 to 0.05, p
0.06) and minor AEs (relative risk 0.39, 95% CI 0.11 to 1.43, p 0.15). We
conclude that the addition of IVA to opioid-based regimes in pediatric
patients may reduce opioid use and minor AEs without increasing
postoperative pain. Given the certainty of evidence, further research
featuring patient-important outcomes and prolonged follow-up is necessary
to confirm these findings.<br/>Copyright &#xa9; 2022, The Author(s), under
exclusive licence to Springer-Verlag GmbH Germany, part of Springer
Nature.

<130>
Accession Number
2019385934
Title
Defining the Phenotypes for Heart Failure With Preserved Ejection
Fraction.
Source
Current Heart Failure Reports. 19(6) (pp 445-457), 2022. Date of
Publication: December 2022.
Author
Rucker D.; Joseph J.
Institution
(Rucker) Department of Medicine, Boston Medical Center, Boston, MA, United
States
(Joseph) Massachusetts Veterans Epidemiology Research & Information
Center, Veterans Affairs Boston Healthcare System, Cardiology Section
(111), 1400 VFW Parkway, West Roxbury, Boston, MA 02132, United States
(Joseph) Department of Medicine, Brigham & Women's Hospital, Boston, MA,
United States
Publisher
Springer
Abstract
Purpose of Review: Heart failure with preserved ejection fraction (HFpEF)
imposes a significant burden on society and healthcare. The lack in
efficacious therapies is likely due to the significant heterogeneity of
HFpEF. In this review, we define various phenotypes based on underlying
comorbidities or etiologies, discuss phenotypes arrived at by novel
methods, and explore therapeutic targets. Recent Findings: A few studies
have used machine learning methods to uncover sub-phenotypes within HFpEF
in an unbiased manner based on clinical features, echocardiographic
findings, and biomarker levels. <br/>Summary: We synthesized the
literature and propose three broad phenotypes: (1) young, with few
comorbidities, usually obese and with low natriuretic peptide levels, (2)
obese with substantive cardiometabolic burden and comorbidities and
impaired ventricular relaxation, (3) old, multimorbid, with high rates of
atrial fibrillation, renal and coronary artery disease, chronic
obstructive pulmonary disease, and left ventricular hypertrophy. We also
propose potential therapeutic strategies for these
phenotypes.<br/>Copyright &#xa9; 2022, This is a U.S. Government work and
not under copyright protection in the US; foreign copyright protection may
apply.

<131>
Accession Number
2021644753
Title
In patients with thoracic aortic graft infection, is graft explantation
and replacement superior to in situ graft preservation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 34(2) (pp 291-296), 2022.
Date of Publication: 01 Feb 2022.
Author
Poon S.S.; George J.; Kumar P.; Field M.
Institution
(Poon, George, Kumar) Department of Cardiac Surgery, Morriston Hospital,
Swansea, United Kingdom
(Field) Department of Cardiac Surgery, Liverpool Heart and Chest Hospital,
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 whether graft explantation
and replacement are superior to graft preservation in patients with
thoracic aortic graft infections. Altogether, more than 487 papers were
found using the reported search; of these, 7 comparative studies
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 were tabulated.
Although thoracic aortic graft infection is uncommon following cardiac
surgery, it still carries a significant risk of in-hospital mortality and
poor long-term survival. Current findings in the literature are limited to
retrospective cohort studies with relatively small sample sizes; also,
there is a lack of randomized controlled trials on this topic. There was
significant heterogeneity in patient groups and variation in surgical
techniques across centres. In this context, a graft-sparing approach may
be a safe therapy with comparable early mortality and late survival
outcomes in carefully selected patients. The selection may include the
absence of graft pseudoaneurysm, anastomotic leak and fistula; the
presence of indolent infection in patients with poor clinical conditions;
and significant frailty and comorbidities where the risks of surgical
explantation exceed the benefits. The rate of reinfection is low following
both graft replacement and the graft-sparing approach. Moreover, the use
of a tissue flap improves the surgical outcomes.<br/>Copyright &#xa9; 2021
The Author(s).

<132>
Accession Number
2015030975
Title
Comparison of erector spinae plane and paravertebral nerve blocks for
postoperative analgesia in children after the Nuss procedure: study
protocol for a randomized controlled non-inferiority clinical trial.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 139. Date of
Publication: December 2022.
Author
Xu M.; Zhang G.; Gong J.; Yang J.
Institution
(Xu, Zhang, Yang) Department of Anesthesiology and National Clinical
Research Center for Geriatrics, West China Hospital of Sichuan University,
Sichuan Province, Chengdu, China
(Gong) Department of Biomedical Engineering, Northwestern University,
Evanston, IL, United States
Publisher
BioMed Central Ltd
Abstract
Background: Thoracic paravertebral block (TPVB) is a widely advocated
regional technique for alleviating postoperative pain in children
undergoing elective pectus excavatum repair. However, this technique is
associated with some undesirable adverse events. Recently, the erector
spinae plane block (ESPB) has been introduced as a practical alternative
to the TPVB in thoracic surgery. This interfascial regional anesthesia
technique interrupts pain sensation by injecting local anesthetics between
the muscular layers of the thoracic wall. Several case series described it
as an effective pain management technique following pectus excavatum
repair. Therefore, this trial is designed to test the hypothesis that ESPB
is non-inferior to TPVB in postoperative pain control after pectus
excavatum repair. <br/>Method(s): This is a prospective randomized
double-blind non-inferiority trial. A total of 40 patients aged 4 to 18
years undergoing Nuss surgery will be randomly assigned to receive pain
treatment with either ESPB or TPVB. All patients will receive additional
systemic multimodal analgesia with an intravenous patient-controlled
analgesia pump and acetaminophen. The primary outcome is the pain
intensity at rest, 24 h postoperatively. Secondary outcomes include
accumulated morphine-equivalent consumption, postoperative pain scores,
emergence agitation incidence, time of the first mobilization, time to
first rescue analgesia, complications related to pain treatment, and
morphine-related adverse events. <br/>Discussion(s): This will the first
randomized controlled trial to compare ESPB with TPVB for analgesia after
pectus excavatum repair. This trial aims to provide important clinical
evidence to elaborate on the analgesic mechanism of ESPB in children.
Trial registration: ClinicalTrials.govNCT05034601. This trial was
prospectively registered.<br/>Copyright &#xa9; 2022, The Author(s).

<133>
Accession Number
2014694211
Title
Recent progress in the pig-to-nonhuman primate kidney transplantation
model: Report of a symposium.
Source
Xenotransplantation. 29(1) (no pagination), 2022. Article Number: e12728.
Date of Publication: January/February 2022.
Author
Cooper D.K.C.
Institution
(Cooper) Department of Surgery, Center for Transplantation Sciences,
Massachusetts General Hospital, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Three excellent presentations at an industry-sponsored symposium at the
(virtual) congress of the combined IXA/CTRMS (September 23-25, 2021) were
directed to the value and limitations of the pig-to-nonhuman primate (NHP)
kidney transplantation model. Daniel Firl and James Markmann provided a
meta-analysis comparing the results of kidney allotransplantation and
xenotransplantation in NHPs during the past 25 years. Remarkably, the
authors had identified 73 published reports that included 910 individual
experiments. Although recipient survival after allotransplantation was
longer, the superiority over the survival of xenografts was less than
anticipated. Given the excellent short- and medium-term results of
clinical kidney allotransplantation today, these data provide hope that
the results of clinical pig kidney xenotransplantation may prove
significantly better than in NHPs. The authors identified several factors
that were shown to statistically influence the success or failure of
xenotransplantation. Jean Kwun provided valuable information relating to
the longstanding question of whether the survival of a pig organ would be
jeopardized if transplanted into an allosensitized recipient. He
demonstrated that pig kidney transplantation in an HLA-sensitized patient
may be at a disadvantage, although multiple genetic engineering of the
organ-source pig significantly delayed rejection. In the initial clinical
trials, therefore, it would seem wise to exclude any patient with evidence
of anti-HLA antibodies. Andrew Adams reported longer survival (>1 year) of
Rhesus monkeys with life-supporting pig kidney grafts than has been
achieved previously. Although not consistently achieved, these excellent
results were obtained with an anti-CD154mAb-based regimen after
CD4⁺T cell and partial CD20⁺B cell depletion.
Factors that might have contributed to this success, including the
phenotype of the pig, the species of the recipient, the recipient's
anti-pig antibody level, and the immunosuppressive regimen, were
discussed. Importantly, pig kidney function appeared to be normal in
long-term surviving monkeys. Each study contributed to our goal of
introducing xenotransplantation into the clinic.<br/>Copyright &#xa9; 2022
John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

<134>
Accession Number
2018755125
Title
Changes in Maximum Tongue Pressure and Postoperative Dysphagia in
Mechanically Ventilated Patients after Cardiovascular Surgery.
Source
Indian Journal of Critical Care Medicine. 26(12) (pp 1253-1258), 2022.
Date of Publication: December 2022.
Author
Yamada T.; Ochiai R.; Kotake Y.
Institution
(Yamada) Department of Anesthesiology, Toho University Graduate School of
Medicine, Ota-ku Omorinishi, Tokyo, Japan
(Ochiai) Toho University, Japan
(Kotake) Department of Anesthesiology, Ohashi Medical Center, Toho
University, Ohashi, Tokyo, Japan
Publisher
Jaypee Brothers Medical Publishers (P) Ltd
Abstract
Background: There is no objective quantitative parameter for dysphagia,
and the relationship between changes in maximum tongue pressure values and
dysphagia is unknown. This study aimed to determine whether there is a
difference in the change in maximal tongue pressure after extubating
patients who were ventilated after cardiovascular surgery, with or without
dysphagia. <br/>Material(s) and Method(s): Adult patients who underwent
mechanical ventilation via endotracheal intubation following
cardiovascular surgery were included. Tongue pressure was measured before
cardiovascular surgery and at 6 hours; 3 and 7 days after extubation.
Dysphagia was confirmed by the functional oral intake scale (FOIS) on day
7 after extubation; an FOIS level above or equal to 6 was considered
"dysphagia-negative." Results: Of 68 patients, 15 (22.1%) were in the
dysphagia-positive group, which significantly showed a history of diabetes
mellitus, prolonged mechanical ventilation, and postextubation
hospitalization. Additionally, the postoperative C-reactive protein level
was significantly higher in the dysphagia-positive group than in the
dysphagia-negative group. Maximum tongue pressure was significantly lower
in the dysphagia-positive group at 3 and 7 days postextubation. Using a
cutoff value of 27.6 kPa in a receiver operating characteristic curve
(ROC) for maximum tongue pressure at 3 days after extubation, the area
under the curve (AUC) was 0.82, sensitivity was 84.9%, and specificity was
84.2%. <br/>Conclusion(s): Tongue pressure at 3 days after extubation is
significantly lower in patients with dysphagia after cardiovascular
surgery than in patients without dysphagia. If the maximum tongue pressure
value is below 27.6 kPa on the third day following extubation, oral intake
should be performed with caution.<br/>Copyright &#xa9; The Author(s). 2022
Open Access.

<135>
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.<br/>Copyright &#xa9; 2021 The
Author(s).

<136>
Accession Number
2011934093
Title
Atrial fibrillation after cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 165(1) (pp 94-103.e24),
2023. Date of Publication: January 2023.
Author
Caldonazo T.; Kirov H.; Rahouma M.; Robinson N.B.; Demetres M.; Gaudino
M.; Doenst T.; Dobrev D.; Borger M.A.; Kiehntopf M.; Skoloff K.
Institution
(Caldonazo, Kirov, Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University Jena, Jena, Germany
(Rahouma, Robinson, Gaudino) Department of Cardiothoracic Surgery at New
York Presbyterian, Weill Cornell Medical Center, New York, NY, United
States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medical Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: New-onset postoperative atrial fibrillation (POAF) after
cardiac surgery is common, with rates up to 60%. POAF has been associated
with early and late stroke, but its association with other cardiovascular
outcomes is less known. The objective was to perform a meta-analysis of
the studies reporting the association of POAF with perioperative and
long-term outcomes in patients with cardiac surgery. <br/>Method(s): We
performed a systematic review and a meta-analysis of studies that
presented outcomes for cardiac surgery on the basis of the presence or
absence of POAF. MEDLINE, EMBASE, and the Cochrane Library were assessed;
57 studies (246,340 patients) were selected. Perioperative mortality was
the primary outcome. Inverse variance method and random model were
performed. Leave-one-out analysis, subgroup analyses, and metaregression
were conducted. <br/>Result(s): POAF was associated with perioperative
mortality (odds ratio [OR], 1.92; 95% confidence interval [CI],
1.58-2.33), perioperative stroke (OR, 2.17; 95% CI, 1.90-2.49),
perioperative myocardial infarction (OR, 1.28; 95% CI, 1.06-1.54),
perioperative acute renal failure (OR, 2.74; 95% CI, 2.42-3.11), hospital
(standardized mean difference, 0.80; 95% CI, 0.53-1.07) and intensive care
unit stay (standardized mean difference, 0.55; 95% CI, 0.24-0.86),
long-term mortality (incidence rate ratio [IRR], 1.54; 95% CI, 1.40-1.69),
long-term stroke (IRR, 1.33; 95% CI, 1.21-1.46), and longstanding
persistent atrial fibrillation (IRR, 4.73; 95% CI, 3.36-6.66).
<br/>Conclusion(s): The results suggest that POAF after cardiac surgery is
associated with an increased occurrence of most short- and long-term
cardiovascular adverse events. However, the causality of this association
remains to be established.<br/>Copyright &#xa9; 2021 The American
Association for Thoracic Surgery

<137>
Accession Number
2018851020
Title
Resternotomy Coronary Artery Bypass 1999-2018: Insights From The Society
of Thoracic Surgeons Adult Cardiac Surgery Database.
Source
Annals of Thoracic Surgery. 115(1) (pp 62-71), 2023. Date of Publication:
January 2023.
Author
Rappoport N.; Aviel G.; Shahian D.M.; Korach A.; Carmi S.; Keaney J.F.;
Shapira O.M.
Institution
(Rappoport) Department of Software and Information Systems Engineering,
Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer
Sheva, Israel
(Aviel, Korach, Shapira) Department of Cardiothoracic Surgery, Hadassah
Hebrew University Medical Center, Jerusalem, Israel
(Shahian) Division of Cardiac Surgery, Department of Surgery and The
Center of Quality & Safety, Massachusetts General Hospital and Harvard
Medical School, Boston, Massachusetts, United States
(Carmi) Braun School of Public Health and Community Medicine, The Faculty
of Medicine, The Hebrew University, Jerusalem, Israel
(Keaney) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, Massachusetts, United States
Publisher
Elsevier Inc.
Abstract
Background: We sought to quantify the risk trend of resternotomy coronary
artery bypass grafting (CABG) over the past 2 decades. <br/>Method(s): We
compared the outcomes of 194 804 consecutive resternotomy CABG patients
and 1 445 894 randomly selected first-time CABG patients (50% of total)
reported to The Society of Thoracic Surgeons Adult Cardiac Surgery
Database between 1999 and 2018. Primary outcomes were in-hospital
mortality and overall morbidity. Using multiple logistic regression for
each outcome for each year, we computed the annual trends of risk-adjusted
odds ratios for the primary outcomes in the entire cohort and in 194 776
propensity-matched pairs. <br/>Result(s): The annual resternotomy CABG
case volume from participating centers declined by 68%, from a median of
25 (range, 14-44) to a median of 8 (range, 4-15). Compared with first-time
CABG, resternotomy CABG patients were consistently older, with higher
proportions of comorbidities. After propensity matching, primary outcomes
of resternotomy and first-time CABG were similar (mortality: 3.5% vs 2.3%,
standardized difference [SDiff], 7.5%; morbidity: 40.7% vs 40.3%, SDiff,
0.9%). Mortality of resternotomy CABG performed after prior CABG was
higher than that after prior non-CABG (4.3% vs 2.4%; SDiff, 10.8).
Morbidity was similar between these subgroups (41.0% vs 39.1%; SDiff,
2.9). The adjusted odds ratio for mortality after resternotomy CABG
declined from 1.93 (95% CI, 1.73-2.16) to 1.22 (95% CI, 0.92-1.62), and
that of morbidity declined from 1.13 (95% CI, 1.08-1.18) to 0.91 (95% CI,
0.87-0.95), P < .001 for both. <br/>Conclusion(s): The risk of
resternotomy CABG has decreased substantially over time. Resternotomy CABG
performed after a prior CABG is higher risk compared with that performed
after a non-CABG operation.<br/>Copyright &#xa9; 2023 The Society of
Thoracic Surgeons

<138>
Accession Number
2018452039
Title
Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery
for Left Main Disease Trial.
Source
Annals of Thoracic Surgery. 115(1) (pp 72-78), 2023. Date of Publication:
January 2023.
Author
Jarrett C.M.; Pelletier M.; Abu-Omar Y.; Baeza C.; Elgudin Y.; Markowitz
A.; Vega P.R.; Dressler O.; Kappetein A.P.; Serruys P.W.; Stone G.W.;
Sabik J.F.
Institution
(Jarrett, Pelletier, Abu-Omar, Baeza, Elgudin, Markowitz, Vega, Sabik)
Department of Surgery, University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States
(Dressler, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, New York, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Stone) NewYork-Presbyterian Hospital, Columbia University Medical Center,
New York, New York, United States
Publisher
Elsevier Inc.
Abstract
Background: We investigated outcomes of coronary artery bypass grafting
(CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH)
within the Evaluation of XIENCE Versus CABG (EXCEL) trial. <br/>Method(s):
All patients in EXCEL randomized to CABG were included in this study. For
this analysis, the primary end points were ischemia-driven
revascularization (IDR) and graft stenosis or occlusion at 5 years.
Additional end points were as follows: a composite of death from any
cause, stroke, or myocardial infarction; bleeding; blood product
transfusion; major arrhythmia; and infection requiring antibiotics. Event
rates were based on Kaplan-Meier estimates in time-to-first-event
analyses. <br/>Result(s): Of the 957 patients randomized to CABG, 686
(71.7%) received at least 1 venous graft with 257 (37.5%) patients in the
EVH group and 429 (62.5%) patients in the OVH group. At 5 years, IDR was
higher (11.5% vs 6.7%; P = .047) in the EVH group. At 5 years, rates of
graft stenosis or occlusion (9.7% vs 5.4%; P = .054) and the primary end
point (17.4% vs 20.9%; P = .27) were similar. In-hospital bleeding (11.3%
vs 13.8%; P = .35), in-hospital blood product transfusion (12.8% vs 13.1%;
P = .94), and infection requiring antibiotics within 1 month (13.6% vs
16.8%; P = .27) were similar between EVH and OVH patients. Major
arrhythmia in the hospital (19.8% vs 13.5%; P = .03) and within 1 month
(21.8% vs 15.4%; P = .03) was higher in EVH patients. <br/>Conclusion(s):
IDR at 5 years was higher in the EVH group. EVH and OVH patients had
similar rates of graft stenosis or occlusion and the composite of death,
stroke, or myocardial infarction at 5 years.<br/>Copyright &#xa9; 2023 The
Society of Thoracic Surgeons

<139>
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. <br/>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. <br/>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. <br/>CONCLUSION(S): Lavandula
aromatherapy can reduce pain and received analgesic dose after
CABG.<br/>Copyright &#xa9; 2022. Published by Elsevier Inc.

<140>
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. <br/>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.
<br/>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)). <br/>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.<br/>Copyright
&#xa9; 2022, The Author(s), under exclusive licence to Springer
Science+Business Media, LLC, part of Springer Nature.

<141>
Accession Number
2021665351
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
American Journal of Cardiology. 188 (pp 89-94), 2023. Date of Publication:
01 Feb 2023.
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, Rue du 1er juin, 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, Kairouen Ibn el Jazzar
University Hospital, Universite de Sousse, Tunisia
(Denguir) Cardiology Department, Gabes University Hospital, University of
Monastir, Tunisia
Publisher
Elsevier Inc.
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.<br/>Copyright &#xa9; 2022 Elsevier Inc.

<142>
Accession Number
2021195535
Title
Cerebral Embolic Protection in Transcatheter Aortic Valve Replacement: A
Meta-Analysis of Randomized Clinical Trials.
Source
American Journal of Cardiology. 187 (pp 179-180), 2023. Date of
Publication: 15 Jan 2023.
Author
Al-Abcha A.; Saleh Y.; Abbasi M.; El-Am E.; Alkhouli M.
Institution
(Al-Abcha, Abbasi, El-Am, Alkhouli) Department of Cardiovascular Medicine,
Mayo Clinic, Rochester, Minnesota, United States
(Saleh) Department of Cardiovascular Medicine, Houston Methodist DeBakey
Heart and Vascular Center, Houston, Texas, United States
Publisher
Elsevier Inc.

<143>
Accession Number
2021747789
Title
The cisterna chyli: a systematic review of definition, prevalence, and
anatomy.
Source
American Journal of Physiology - Heart and Circulatory Physiology. 323(5)
(pp H1010-H1018), 2022. Date of Publication: November 2022.
Author
Moazzam S.; O'Hagan L.A.; Clarke A.R.; Itkin M.; Phillips A.R.J.; Windsor
J.A.; Mirjalili S.A.
Institution
(Moazzam, O'Hagan) School of Medicine, The University of Auckland,
Auckland, New Zealand
(Clarke) Auckland Bioengineering Institute, The University of Auckland,
Auckland, New Zealand
(Itkin) Department of Radiology, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, United States
(Phillips) Applied Surgery and Metabolism Laboratory, School of Biological
Sciences, The University of Auckland, Auckland, New Zealand
(Windsor) Surgical and Translational Research Centre, Faculty of Medical
and Health Sciences, The University of Auckland, Auckland, New Zealand
(Mirjalili) Department of Anatomy and Medical Imaging, The University of
Auckland, Auckland, New Zealand
Publisher
American Physiological Society
Abstract
The cisterna chyli is a lymphatic structure found at the caudal end of the
thoracic duct that receives lymph draining from the abdominal and pelvic
viscera and lower limbs. In addition to being an important landmark in
retroperitoneal surgery, it is the key gateway for interventional
radiology procedures targeting the thoracic duct. A detailed understanding
of its anatomy is required to facilitate more accurate intervention, but
an exhaustive summary is lacking. A systematic review was conducted, and
49 published human studies met the inclusion criteria. Studies included
both healthy volunteers and patients and were not restricted by language
or date. The detectability of the cisterna chyli is highly variable,
ranging from 1.7 to 98%, depending on the study method and criteria used.
Its anatomy is variable in terms of location (vertebral level of T10 to
L3), size (ranging 2-32 mm in maximum diameter and 13-80 mm in maximum
length), morphology, and tributaries. The size of the cisterna chyli
increases in some disease states, though its utility as a marker of
disease is uncertain. The anatomy of the cisterna chyli is highly
variable, and it appears to increase in size in some disease states. The
lack of well-defined criteria for the structure and the wide variation in
reported detection rates prevent accurate estimation of its natural
prevalence in humans. <br/>Copyright &#xa9; 2022 the American
Physiological Society.

<144>
Accession Number
2021704282
Title
Supplemental Regional Block Anesthesia Reduces Opioid Utilization
Following Free Flap Reconstruction of the Oral Cavity: A Prospective,
Randomized Clinical Trial.
Source
Journal of Oral and Maxillofacial Surgery. (no pagination), 2022. Date of
Publication: 2022.
Author
Le J.M.; Gigliotti J.; Sayre K.S.; Morlandt A.B.; Ying Y.P.
Institution
(Le) Resident, Department of Oral and Maxillofacial Surgery, University of
Alabama at Birmingham, Birmingham, AL
(Gigliotti) Assistant Professor, Faculty of Dental Medicine and Oral
Health Sciences, McGill University, Montreal, QC, Canada
(Sayre) Assistant Professor, Department of Oral and Maxillofacial Surgery,
Boston University School of Dental Medicine, Boston, MA, United States
(Morlandt) Professor, Section of Oral Oncology, Department of Oral and
Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
(Ying) Associate Professor, Section of Oral Oncology, Department of Oral
and Maxillofacial Surgery, University of Alabama at Birmingham,
Birmingham, AL
Publisher
W.B. Saunders
Abstract
Purpose: Regional anesthesia has been shown to effectively manage acute
pain and reduce opioid utilization in the early postoperative period
following colorectal, orthopedic, and thoracic surgeries. The same effect,
however, has not been demonstrated in major head and neck surgery. The
purpose of this study is to determine whether supplemental regional
anesthesia reduces opioid utilization following microvascular free flap
reconstruction of the oral cavity. <br/>Method(s): A prospective,
randomized clinical trial was conducted for patients undergoing oral
cavity reconstruction using microvascular free tissue transfer between
January 2020 and March 2022. The predictor variable was a regional
anesthetic nerve block, delivered preoperatively, at the flap donor site.
The primary and secondary outcomes were opioid utilization, measured in
oral morphine equivalent (OME), from postoperative day 1 to 5, and
hospital length of stay (LOS), respectively. Covariates included age, sex,
tobacco and alcohol history, prior radiation therapy, pathology, oral
site, flap type, tracheostomy, and neck dissection. Student's t test,
chi² test, and linear regression models were computed using
correlations with 95% confidence intervals (CIs). For all statistical
tests, P values of <.05 were regarded as statistically significant.
<br/>Result(s): Ninety-eight participants completed the study. The mean
age was 56 years with 55% male. Forty-eight patients received a
presurgical regional anesthesia block, and 50 patients served as control
subjects. Bivariate analysis demonstrated an even distribution of all
study variables. Total OME utilization was significantly less in the
treatment group compared to the control group, (166.32 vs 118.43 OME; 95%
CI, 1.32 to 94.45; P = .04). The LOS was comparable (6.60 vs 6.48 days;
95% CI, -0.53 to 0.77; P = .71). Tobacco use had a positive effect (B =
0.28; 95% CI, 21.63 to 115.31; P = .005) while the block had a negative
effect with total OME, (B = -0.19; 95% CI, -90.39 to -0.59; P = .047). The
extent of the neck dissection (B = 0.207; 95% CI, 0.026 to 1.403; P =
.042) was a positive predictor for LOS. Overall, there were no adverse
events associated with the regional block throughout the study period.
<br/>Conclusion(s): Supplemental regional anesthesia is safe and
associated with reduced opioid utilization in patients undergoing
vascularized free flap reconstruction of composite oral cavity defects and
does not prolong the length of hospitalization.<br/>Copyright &#xa9; 2022

<145>
Accession Number
2021589753
Title
Selection of the best of 2022 in heart failure.
Source
REC: CardioClinics. (no pagination), 2022. Date of Publication: 2022.
Author
Recio-Mayoral A.; Santiago-Vacas E.; Dobarro-Perez D.; de Juan-Baguda J.;
Gonzalez-Costello J.
Institution
(Recio-Mayoral) Unidad de Insuficiencia Cardiaca Especializada e
Hipertension Pulmonar, Servicio de Cardiologia, Hospital Universitario
Virgen Macarena, Sevilla, Spain
(Santiago-Vacas) Unidad de Insuficiencia Cardiaca, Servicio de
Cardiologia, Hospital Germans Trias i Pujol, Barcelona, Badalona, Spain
(Dobarro-Perez) Unidad de Insuficiencia Cardiaca, Servicio de Cardiologia,
Hospital Alvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo,
Pontevedra, Vigo, Spain
(de Juan-Baguda) Unidad de Insuficiencia Cardiaca, Servicio de
Cardiologia, Hospital Universitario 12 de Octubre, Instituto de
Investigacion Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
(de Juan-Baguda) Centro de Investigacion en Red de Enfermedades
Cardiovasculares (CIBERCV), Spain
(de Juan-Baguda) Facultad de Medicina, Universidad Europea, Madrid, Spain
(Gonzalez-Costello) Unidad de Insuficiencia Cardiaca Avanzada y Trasplante
Cardiaco, Servicio de Cardiologia, Hospital Universitari de Bellvitge,
Barcelona, L'Hospitalet de Llobregat, Spain
(Gonzalez-Costello) Grupo de Enfermedades Cardiovasculares BIOHEART,
Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Universitat de
Barcelona, Barcelona, L'Hospitalet de Llobregat, Spain
Publisher
Elsevier Espana S.L.U
Abstract
Multiple studies of maximum interest have been published in the field of
heart failure during the last year. We have carried out a systematic
review of the most relevant publications (from 05-09-2021 to 05-09-2022),
selecting the most outstanding publications, ordering them by thematic
blocks. References to the American guidelines on heart failure and the
joint guidelines of the European societies of cardiology and respiration
in pulmonary hypertension, both published in this period, are
included.<br/>Copyright &#xa9; 2022 Sociedad Espanola de Cardiologia