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<1>
Accession Number
614094607
Title
Transcatheter Mitral Valve Replacement for Patients With Symptomatic
Mitral Regurgitation: A Global Feasibility Trial.
Source
Journal of the American College of Cardiology. 69(4) (pp 381-391), 2017.
Date of Publication: 31 Jan 2017.
Author
Muller D.W.M.; Farivar R.S.; Jansz P.; Bae R.; Walters D.; Clarke A.;
Grayburn P.A.; Stoler R.C.; Dahle G.; Rein K.A.; Shaw M.; Scalia G.M.;
Guerrero M.; Pearson P.; Kapadia S.; Gillinov M.; Pichard A.; Corso P.;
Popma J.; Chuang M.; Blanke P.; Leipsic J.; Sorajja P.; Conellan M.; Spina
R.; Pedersen W.; Sun B.; Scalia G.; Grayburn P.; Stoler R.; Hebeler R.;
Fiane A.; Feldman T.; Salinger M.; Smart S.; Mick S.; Krishnaswamy A.;
Carroll J.; George I.; Missov E.; Kiser A.
Institution
(Muller, Jansz, Shaw) Departments of Cardiology and Cardiothoracic
Surgery, St. Vincent's Hospital, Sydney, Australia
(Farivar, Bae, Sorajja) Center for Valve and Structural Heart Disease and
Cardiothoracic Surgery Service, Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, Minnesota, United States
(Walters, Clarke, Scalia) Departments of Cardiology and Cardiothoracic
Surgery, Prince Charles Hospital, Brisbane, Australia
(Grayburn, Stoler) Divisions of Cardiology and Cardiothoracic Surgery,
Baylor University Medical Center, Dallas, Texas, United States
(Dahle, Rein) Departments of Cardiology and Cardiothoracic Surgery, Oslo
University Hospital, Oslo, Norway
(Guerrero, Pearson) Divisions of Cardiology and Cardiothoracic Surgery,
Evanston Hospital, Evanston, Illinois, United States
(Kapadia, Gillinov) Departments of Cardiovascular Medicine and
Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,
United States
(Pichard, Corso) Division of Cardiology and Department of Cardiothoracic
Surgery, Medstar Washington Hospital Center, Washington DC, United States
(Popma, Chuang) Beth Israel Deaconness Medical Center, Boston,
Massachusetts, United States
(Blanke, Leipsic) St. Paul's Hospital, Vancouver, British Columbia, Canada
Publisher
Elsevier Inc.
Abstract
Background Symptomatic mitral regurgitation (MR) is associated with high
morbidity and mortality that can be ameliorated by surgical valve repair
or replacement. Despite this, many patients with MR do not undergo
surgery. Transcatheter mitral valve replacement (TMVR) may be an option
for selected patients with severe MR. Objectives This study aimed to
examine the effectiveness and safety of TMVR in a cohort of patients with
native valve MR who were at high risk for cardiac surgery. Methods
Patients underwent transcatheter, transapical delivery of a self-expanding
mitral valve prosthesis and were examined in a prospective registry for
short-term and 30-day outcomes. Results Thirty patients (age 75.6 +/- 9.2
years; 25 men) with grade 3 or 4 MR underwent TMVR. The MR etiology was
secondary (n = 23), primary (n = 3), or mixed pathology (n = 4). The
Society of Thoracic Surgeons Predicted Risk of Mortality was 7.3 +/- 5.7%.
Successful device implantation was achieved in 28 patients (93.3%). There
were no acute deaths, strokes, or myocardial infarctions. One patient died
13 days after TMVR from hospital-acquired pneumonia. Prosthetic leaflet
thrombosis was detected in 1 patient at follow-up and resolved after
increased oral anticoagulation with warfarin. At 30 days, transthoracic
echocardiography showed mild (1+) central MR in 1 patient, and no residual
MR in the remaining 26 patients with valves in situ. The left ventricular
end-diastolic volume index decreased (90.1 +/- 28.2 ml/m² at
baseline vs. 72.1 +/- 19.3 ml/m² at follow-up; p = 0.0012), as
did the left ventricular end-systolic volume index (48.4 +/- 19.7
ml/m² vs. 43.1 +/- 16.2 ml/m²; p = 0.18).
Seventy-five percent of the patients reported mild or no symptoms at
follow-up (New York Heart Association functional class I or II).
Successful device implantation free of cardiovascular mortality, stroke,
and device malfunction at 30 days was 86.6%. Conclusions TMVR is an
effective and safe therapy for selected patients with symptomatic native
MR. Further evaluation of TMVR using prostheses specifically designed for
the mitral valve is warranted. This intervention may help address an unmet
need in patients at high risk for surgery. (Early Feasibility Study of the
Tendyne Mitral Valve System [Global Feasibility Study];
NCT02321514)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<2>
Accession Number
2021649405
Title
A randomised controlled trial of dexmedetomidine for delirium in adults
undergoing heart valve surgery.
Source
Anaesthesia. 78(5) (pp 571-576), 2023. Date of Publication: May 2023.
Author
Wang H.-B.; Jia Y.; Zhang C.-B.; Zhang L.; Li Y.-N.; Ding J.; Wu X.; Zhang
Z.; Wang J.-H.; Wang Y.; Yan F.-X.; Yuan S.; Sessler D.I.
Institution
(Wang, Jia, Li, Ding, Wu, Zhang, Wang, Yan, Yuan) Department of
Anaesthesiology, Fuwai Hospital, National Centre for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Zhang) Department of Anaesthesiology, Fuwai Hospital, Chinese Academy of
Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital,
Shenzhen), Shenzhen, China
(Zhang) Department of Anaesthesiology, Chongqing Hospital of Traditional
Chinese Medicine, Chongqing, China
(Wang) Department of Medical Research & Biometrics Centre, Fuwai Hospital,
National Centre for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
Publisher
John Wiley and Sons Inc
Abstract
Dexmedetomidine might reduce delirium after cardiac surgery. We allocated
326 participants to an infusion of dexmedetomidine at a rate of 0.6 mug
kg^-1 for 10 min and then at 0.4
mug.kg^-1.h^-1 until the end of surgery; 326 control
participants received comparable volumes of saline. We detected delirium
in 98/652 (15%) participants during the first seven postoperative days:
47/326 after dexmedetomidine vs. 51/326 after placebo, p = 0.62, adjusted
relative risk (95%CI) 0.86 (0.56-1.33), p = 0.51. Postoperative renal
impairment (Kidney Disease Improving Global Outcomes stages 1, 2 and 3)
was detected in 46, 9 and 2 participants after dexmedetomidine and 25, 7
and 4 control participants, p = 0.040. Intra-operative dexmedetomidine
infusion did not reduce the incidence of delirium after cardiac valve
surgery but might impair renal function.<br/>Copyright &#xa9; 2023
Association of Anaesthetists.

<3>
Accession Number
2021630645
Title
Effectiveness of an intervention to reduce sedentary behaviour as a
personalised secondary prevention strategy for patients with coronary
artery disease: main outcomes of the SIT LESS randomised clinical trial.
Source
International Journal of Behavioral Nutrition and Physical Activity. 20(1)
(no pagination), 2023. Article Number: 17. Date of Publication: December
2023.
Author
van Bakel B.M.A.; Kroesen S.H.; Bakker E.A.; van Miltenburg R.V.; Gunal
A.; Scheepmaker A.; Aengevaeren W.R.M.; Willems F.F.; Wondergem R.;
Pisters M.F.; de Bruin M.; Hopman M.T.E.; Thijssen D.H.J.; Eijsvogels
T.M.H.
Institution
(van Bakel, Kroesen, Bakker, van Miltenburg, Hopman, Thijssen, Eijsvogels)
Department of Physiology, Radboud Institute for Health Sciences, Radboud
University Medical Center, P.O. Box 9101, Nijmegen 6500 HB, Netherlands
(Gunal, Scheepmaker) Department of Cardiology, Bernhoven Hospital, Uden,
Netherlands
(Aengevaeren, Willems) Department of Cardiology, Rijnstate Hospital,
Arnhem, Netherlands
(Wondergem, Pisters) Department of Rehabilitation, Physical Therapy
Science and Sport, University Medical Center Utrecht Brain Center, Utrecht
University, Utrecht, Netherlands
(Wondergem, Pisters) Research Group Empowering Healthy Behaviour,
Department of Health Innovations and Technology, Fontys University of
Applied Sciences, Eindhoven, Netherlands
(Wondergem, Pisters) Center for Physical Therapy Research and Innovation
in Primary Care, Julius Health Care Centers, Utrecht, Netherlands
(de Bruin) Department of IQ Healthcare, Radboud Institute for Health
Sciences, Radboud University Medical Center, Nijmegen, Netherlands
(Thijssen) Research Institute for Sports and Exercise Sciences, Liverpool
John Moores University, Liverpool, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: A high sedentary time is associated with increased mortality
risk. Previous studies indicate that replacement of sedentary time with
light- and moderate-to-vigorous physical activity attenuates the risk for
adverse outcomes and improves cardiovascular risk factors. Patients with
cardiovascular disease are more sedentary compared to the general
population, while daily time spent sedentary remains high following
contemporary cardiac rehabilitation programmes. This clinical trial
investigated the effectiveness of a sedentary behaviour intervention as a
personalised secondary prevention strategy (SIT LESS) on changes in
sedentary time among patients with coronary artery disease participating
in cardiac rehabilitation. <br/>Method(s): Patients were randomised to
usual care (n = 104) or SIT LESS (n = 108). Both groups received a
comprehensive 12-week centre-based cardiac rehabilitation programme with
face-to-face consultations and supervised exercise sessions, whereas SIT
LESS participants additionally received a 12-week, nurse-delivered, hybrid
behaviour change intervention in combination with a pocket-worn activity
tracker connected to a smartphone application to continuously monitor
sedentary time. Primary outcome was the change in device-based sedentary
time between pre- to post-rehabilitation. Changes in sedentary time
characteristics (prevalence of prolonged sedentary bouts and proportion of
patients with sedentary time >= 9.5 h/day); time spent in light-intensity
and moderate-to-vigorous physical activity; step count; quality of life;
competencies for self-management; and cardiovascular risk score were
assessed as secondary outcomes. <br/>Result(s): Patients (77% male) were
63 +/- 10 years and primarily diagnosed with myocardial infarction (78%).
Sedentary time decreased in SIT LESS (- 1.6 [- 2.1 to - 1.1] hours/day)
and controls (- 1.2 [-1.7 to - 0.8]), but between group differences did
not reach statistical significance (-0.4 [-1.0 to 0.3]) hours/day). The
post-rehabilitation proportion of patients with a sedentary time above the
upper limit of normal (>= 9.5 h/day) was significantly lower in SIT LESS
versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4
(0.2-0.8)). No differences were observed in the other predefined secondary
outcomes. <br/>Conclusion(s): Among patients with coronary artery disease
participating in cardiac rehabilitation, SIT LESS did not induce
significantly greater reductions in sedentary time compared to controls,
but delivery was feasible and a reduced odds of a sedentary time >= 9.5
h/day was observed. Trial registration: Netherlands Trial Register:
NL9263. Graphical Abstract: Outcomes of the SIT LESS trial: changes in
device-based sedentary time from pre-to post-cardiac rehabilitation
(control group) and cardiac rehabilitation + SIT LESS (intervention
group). SIT LESS reduced the odds of patients having a sedentary time >9.5
hours/day (upper limit of normal), although the absolute decrease in
sedentary time did not significantly differ from controls. SIT LESS
appears to be feasible, acceptable and potentially beneficial, but a
larger cluster randomised trial is warranted to provide a more accurate
estimate of its effects on sedentary time and clinical outcomes. CR:
cardiac rehabilitation. [Figure not available: see
fulltext.]<br/>Copyright &#xa9; 2023, The Author(s).

<4>
Accession Number
2021931845
Title
Full-endoscopic discectomy for thoracic disc herniations: a single-arm
meta-analysis of safety and efficacy outcomes.
Source
European Spine Journal. 32(4) (pp 1254-1264), 2023. Date of Publication:
April 2023.
Author
Silva J.D.S.; Carelli L.E.; de Oliveira J.A.A.; de Araujo R.M.L.
Institution
(Silva) Division of Medicine, Department of Neurosurgery, Hospital of
Federal University of Piaui - UFPI, Piaui, Teresina, Brazil
(Carelli) Division of Traumatology and Orthopedics, Department of
Medicine, National Institute of Traumatology and Orthopedics - INTO, Rio
de Janeiro, Brazil
(de Oliveira) Division of Traumatology and Orthopedics, Department of
Medicine, Federal University of Ceara - UFC, Ceara, Fortaleza, Brazil
(de Araujo) Division of Neurosurgery, Department of Medicine, University
of Sao Paulo - USP, Sao Paulo, Brazil
(Silva) Division of Neurosurgery, University Hospital, Federal University
of Piaui, University Camp Petronio Portela Minister w/n. Ininga, Piaui,
Teresina 64049-550, Brazil
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: Surgical intervention is the treatment of choice in patients
with thoracic disc herniation with refractory symptoms and progressive
myelopathy. Due to high occurrence of complications from open surgery,
minimally invasive approaches are desirable. Nowadays, endoscopic
techniques have become increasingly popular and full-endoscopic surgery
can be performed in the thoracic spine with low complication rates.
<br/>Method(s): Cochrane Central, PubMed, and Embase databases were
systematically searched for studies that evaluated patients who underwent
full-endoscopic spine thoracic surgery. The outcomes of interest were
dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and
dysesthesia. In the absence of comparative studies, a single-arm
meta-analysis was performed. <br/>Result(s): We included 13 studies with a
total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17
to 82 years, with 56.5% male. The procedure was performed under local
anesthesia with sedation in 222 patients (77.9%). A transforaminal
approach was used in 88.1% of the cases. There were no cases of infection
or death reported. The data showed a pooled incidence of outcomes as
follows, with their respective 95% confidence intervals (CI)-dural tear
(1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc
herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%);
epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI
0.1-3.4%). <br/>Conclusion(s): Full-endoscopic discectomy has a low
incidence of adverse outcomes in patients with thoracic disc herniations.
Controlled studies, ideally randomized, are warranted to establish the
comparative efficacy and safety of the endoscopic approach relative to
open surgery.<br/>Copyright &#xa9; 2023, The Author(s), under exclusive
licence to Springer-Verlag GmbH Germany, part of Springer Nature.

<5>
Accession Number
2022273108
Title
Decisional Needs and Patient Treatment Preferences for Heart Failure
Medications: A Scoping Review.
Source
CJC Open. 5(2) (pp 136-147), 2023. Date of Publication: February 2023.
Author
MacDonald B.J.; Barry A.R.; Turgeon R.D.
Institution
(MacDonald, Barry, Turgeon) Faculty of Pharmaceutical Sciences, University
of British Columbia, Vancouver, BC, Canada
Publisher
Elsevier Inc.
Abstract
Background: Pharmacologic management of heart failure with reduced
ejection fraction (HFrEF) involves several medications. Decision aids
informed by patient decisional needs and treatment preferences could
assist in making HFrEF medication choices; however, these are largely
unknown. <br/>Method(s): We searched MEDLINE, Embase, and the Cumulative
Index to Nursing and Allied Health Literature (CINAHL), without language
restriction, for qualitative, quantitative, and mixed-method studies that
included patients with HFrEF or clinicians providing HFrEF care, and
reported data on decisional needs or treatment preferences applicable to
HFrEF medications. We classified decisional needs using a modified version
of the Ottawa Decision Support Framework (ODSF). <br/>Result(s): From 3996
records, we included 16 reports describing 13 studies (n = 854). No study
explicitly assessed ODSF decisional needs; however, 11 studies reported
ODSF-classifiable data. Patients commonly reported having inadequate
knowledge or information, and difficult decisional roles. No study
systematically assessed treatment preferences, but 6 studies reported on
attribute preferences. Reducing mortality and improving symptoms
frequently were ranked as being important, whereas cost importance
rankings varied, and adverse events generally were ranked as being less
important. <br/>Conclusion(s): This scoping review identified key
decisional needs regarding HFrEF medications, notably inadequate knowledge
or information, and difficult decisional roles, which can readily be
addressed by decision aids. Future studies should systematically explore
the full scope of ODSF-based decisional needs in patients with HFrEF,
along with relative preferences among treatment attributes to further
inform development of individualized decision aids.<br/>Copyright &#xa9;
2022 The Authors

<6>
Accession Number
2023317577
Title
EFFECT OF ALLOPURINOL VERSUS SALINE HYDRATION IN PREVENTING CONTRAST
INDUCED NEPHROPATHY.
Source
NeuroQuantology. 21(5) (pp 809-821), 2023. Date of Publication: 2023.
Author
Sultan K.; Naeemullah; Shah M.A.U.; Abbasi M.S.R.; Erum H.; Mushtaq A.;
Jadoon S.K.; Tasneem S.; Jadoon A.; Ijaz R.
Institution
(Sultan) Rawal Institute of Health Sciences, Islamabad, Pakistan
(Naeemullah) Pakistan institute of medical sciences Islamabad, Post
graduate resident nephrology PIMS, Islamabad, Pakistan
(Shah) Muhammad Afnan Ullah Shah, PGR nephrology, PIMS, Islamabad,
Pakistan
(Abbasi) Department of Nephrology, Pakistan Institute of Medical Sciences,
Islamabad, Pakistan
(Erum) SR PAF Hospital Unit 2, Islamabad, Pakistan
(Mushtaq) Pakistan institute of Medical Sciences (PIMS), Islamabad,
Pakistan
(Jadoon) Dr. Sarosh Khan Jadoon, Resident Surgeon SKBZ/CMH, Pakistan
(Tasneem) Public Health Professional, MSPH Health Services Academy,
Pakistan
(Jadoon) Ziauddin university hospital, Pakistan
(Ijaz) Surgery AJKMC HOD General Surgery SKBZ /CMH, Pakistan
Publisher
Anka Publishers
Abstract
Contrast.induced.nephropathy
(CIN).is.a.generally.reversible.form.of.acute.kidney.injury.that.occurs.so
on.after.the.administration.of.radio-contrast.media. Several therapies are
being used for prevention of CIN. We aimed to gather the data about
protective role of single oral dose of Allupurinol along with hydration
with normal saline as compared to normal saline only in our settings.
<br/>Objective(s): To evaluate the effect
of.Allopurinol.in.preventing.contrast.induced.nephropathy.in.patients.unde
rgoing.Coronary.intervention. Subjects and Methods: In this randomized
controlled trial, a total of seventy six (n=76) adult (age 18-75 years)
patients of either gender who were planned to undergo coronary
intervention were selected for this study over a period of six months at
Department of Nephrology/Cardiology, Pakistan Institute of Medical
Sciences (PIMS), SZABMU, Islamabad. All the enrolled patients had eGFR <60
ml/min. Participants were divided in two groups randomly by using random
number tables. Patients in group A received a single dose of 300 mg
Allopurinol orally 12 hour before contrast based procedure and intravenous
normal saline hydration at the rate of 0.5 ml/kg/h in continuous infusion
12 hour before and 12 hour after contrast based procedure. Group B
received normal saline hydration alone in dose equal to group A. Blood
samples were drawn 12 hours before procedure. Samples were analyzed for
serum creatinine levels. Blood sample were drawn after 48 hours and 5 days
of procedure for serum creatinine analysis. CIN was assessed in all
patients which
was.defined.as.an.absolute.increase.in.serum.creatinine.level.of>.0.5.mg/d
l.or.a.relative.increase.of.>.25%.from.baseline.at.48.hours.after.contrast
.exposure and compared in both treatment groups. <br/>Result(s): Gender
distribution was similar in both groups with M:F of 1.71 in group A and
1.53 in group B (P = 0.813). Mean age was 57.6 years +/- 7.4 SD in group A
while it was 58.4 years +/- 6.5 SD in group B (P = 0.612). There were
63.2% (n=24/38) patients in group A who were between <=60years of age and
36.8% (n=14/38) had age >60 years. The figures for group B were 65.8%
(n=25/38) and 34.2% (n=13/38) respectively (P = 0.811). Mean BMI was 32.1
Kg/m² +/- 4.6 SD in group A while it was 31.2 Kg/m²
+/- 4.2 in group B (P = 0.368). There were 7.9% (n=3/38) patients in group
A who had BMI <25 Kg/m² and 92.1% (n=35/38) had BMI >=25
Kg/m². The figures for group B were 10.5% (n=4/38) and 89.5%
(n=34/38) respectively (P=0.692). Mean serum uric acid levels at baseline
in group A was 5.6 mg/dL +/- 1.4 SD and it was 5.5 +/- 1.3 SD in group B
(P = 0.721). There were 76.3% (n=29/38) patients in group A who had
baseline serum uric acid levels within normal limits and 23.7% (n=9/38)
had raised levels. The figures for group B were 81.6% (n=31/38) and 18.4%
(n=7/38) respectively (P = 0574). There were 34.2% (n=13/38) patients in
group A 39.5% (n=15/38) patients in group B who were hypertensive
(P=0.634, table 6). In both the groups there were 34.2% (n=13/38) patients
who were diabetic (P=1.0). Mean serum creatinine levels at baseline in
group A was 1.31 mg/dL +/- 0.07 SD and it was 1.28 +/- 0.09 SD in group B
(P = 0.612). Mean eGFR at baseline in group A was 53.7 ml/min +/- 4.7 SD
and it was 54.8 ml/min/1.73m² +/- 3.8 SD in group B (P =
0.277). Mean maximal allowable contrast dose (MACD) was in group A was
323.3ml +/- 51.7 SD and it was 313.4ml +/- 60.9 SD in group B (P = 0.445).
Mean contrast volume was 146.8ml +/- 10.7 SD in group A and it was 148.4ml
+/- 9.8 SD in group B (P = 0.503). The mean CV/MACD ratio was similar in
both groups (0.46 vs 0.49, P = 0.175, table 7). Contrast induced
nephropathy (CIN) was observed in 5.3% (n=2/38) patients in group A while
it was observed in 21.1% (n=8/38) patients in group B as per pour
operational definitions (p=0.042). CIN in both the groups were stratified
with respect to age, gender, BMI and baseline comorbids. In patients with
baseline uric acid within normal limits, CIN was observed in 3.4% (n=1/29)
patients in group A while it was observed in 9.7% (n=3/31) patients in
group B (P=0.334, table 10). In patients with raised uric acid levels at
baseline, CIN was observed in 11.1% (n=1/9) patients in group A while it
was observed in 71.4% (n=5/7) patients in group B (P=0.013). Efficacy of
single dose of Allopurinol dose along with hydration with normal saline
was significantly better in patients with raised serum uric acid levels at
baseline when compared with normal saline only (P=0.013). No other
significant difference noted across all groups (P>0.05 in all cases)
<br/>Conclusion(s): CIN developed in significantly lesser number of
patients who received a single dose of 30 mg of Allopurinol 12 hours
before administration of contrast along with Saline hydration as compared
to patients receiving hydration alone.<br/>Copyright &#xa9; 2023, Anka
Publishers. All rights reserved.

<7>
Accession Number
2023824018
Title
Comparison of the hemodynamic effects of opioid-based versus
lidocaine-based induction of anesthesia with propofol in older adults: a
randomized controlled trial.
Source
Anaesthesia Critical Care and Pain Medicine. 42(4) (no pagination), 2023.
Article Number: 101225. Date of Publication: August 2023.
Author
Amin S.M.; Hasanin A.; ElSayed O.S.; Mostafa M.; Khaled D.; Arafa A.S.;
Hassan A.
Institution
(Amin, Hasanin, ElSayed, Mostafa, Khaled, Arafa, Hassan) Department of
Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
Publisher
Elsevier Masson s.r.l.
Abstract
Background: The present study aims to compare the hemodynamic profile of
lidocaine and fentanyl during propofol induction of general anesthesia.
<br/>Method(s): This randomized controlled trial included patients aged
above 60 years undergoing elective non-cardiac surgery. The included
patients received either 1 mg/kg lidocaine (n = 50) or 1 mcg/kg fentanyl
(n = 50) based on total body weight with propofol induction of anesthesia.
Patient's hemodynamics were recorded every minute for the first 5 min then
every 2 min until 15 min after induction of anesthesia. Hypotension (mean
arterial pressure [MAP] <65 mmHg or >30% reduction from baseline) was
treated by intravenous 4 mcg bolus of norepinephrine. Outcomes included
norepinephrine requirements (primary), the incidence of postinduction
hypotension, MAP, heart rate, intubation condition, and postoperative
delirium via the cognitive assessment method. <br/>Result(s): Forty-seven
patients in the lidocaine group and 46 patients in the fentanyl group were
analyzed. None in the lidocaine group experienced hypotension, while 28/46
(61%) of patients in the fentanyl group developed at least one episode of
hypotension requiring a median (25th and 75th quartiles) norepinephrine
dose of 4 (0,5) mcg, p-value <0.001 for both outcomes. The average MAP was
lower in the fentanyl group than in the lidocaine group at all time points
after anesthesia induction. The average heart rate was comparable between
the two groups nearly at all time points after anesthesia induction. The
overall intubation condition was comparable between the two groups. None
of the included patients developed postoperative delirium.
<br/>Conclusion(s): Lidocaine-based regimen for induction of anesthesia
reduced the risk of postinduction hypotension in older patients compared
to the fentanyl-based regimen.<br/>Copyright &#xa9; 2023 Societe francaise
d'anesthesie et de reanimation (Sfar)

<8>
Accession Number
2023771164
Title
Perioperative individualized hemodynamic optimization according to
baseline mean arterial pressure in cardiac surgery patients: Rationale and
design of the OPTIPAM randomized trial.
Source
American Heart Journal. 261 (pp 10-20), 2023. Date of Publication: July
2023.
Author
Descamps R.; Amour J.; Besnier E.; Bougle A.; Charbonneau H.; Charvin M.;
Cholley B.; Desebbe O.; Fellahi J.-L.; Frasca D.; Labaste F.; Lena D.;
Mahjoub Y.; Mertes P.-M.; Molliex S.; Moury P.-H.; Moussa M.D.; Oilleau
J.-F.; Ouattara A.; Provenchere S.; Rozec B.; Parienti J.-J.; Fischer
M.-O.
Institution
(Descamps) Department of Anesthesiology and Critical Care Medicine, Caen
University Hospital, Caen, France
(Amour) Institute of Perfusion, Critical Care Medicine and Anesthesiology
in Cardiac Surgery (IPRA), Hopital Prive Jacques Cartier, Massy, France
(Besnier) Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Department of
Anesthesiology and Critical Care, Rouen, France
(Bougle) Sorbonne Universite, GRC 29, Assistance Publique - Hopitaux de
Paris, DMU DREAM, Departement d'Anesthesie et Reanimation, Institut de
Cardiologie, Hopital La Pitie-Salpetriere, Paris, France
(Charbonneau) Department of Anesthesiology and Intensive Care Unit,
Clinique Pasteur, France
(Charvin) CHU Clermont-Ferrand, Medecine Peri-Operatoire (MC, FL, PJ,
A-LC, EF), Universite Clermont-Auvergne (EF), France
(Cholley) AP-HP, Hopital Europeen Georges Pompidou, Paris, France
(Desebbe) Department of Anesthesiology and Intensive Care, Ramsay Sante
Sauvegarde Clinic, Lyon, France
(Fellahi) Service d'anesthesie-Reanimation, Hopital Louis Pradel, Bron
Cedex, Boulevard Pinel, France
(Frasca) Department of Anaesthesia and Intensive Care, University Hospital
of Poitiers, France
(Labaste) Anesthesiology and Intensive Care Department, University
Hospital of Toulouse, Toulouse, France
(Lena) Institut Arnault Tzanck, Cardiologie Medico-chirurgicale, Saint
Laurent du Var, France
(Mahjoub) Anesthesia and Critical Care Medicine Department, Amiens
University Medical Center, Amiens, France
(Mertes) Service d'Anesthesie-Reanimation, Nouvel Hopital Civil, Hopitaux
Universitaires de Strasbourg, Strasbourg, France
(Molliex) Department of Anaesthesiology and Critical Care Medicine,
Hopital Nord, Saint Etienne, France
(Moury) Pole Anesthesie-Reanimation, CHU Grenoble Alpes, Grenoble, France
(Moussa) CHU Lille, Pole d'Anesthesie-Reanimation, Lille, France
(Oilleau) Department of Anaesthesia and Critical Care, Brest University
Hospital, Brest, France
(Ouattara) CHU Bordeaux, Department of Anaesthesia and Critical Care,
Magellan Medical Surgical Centre, Bordeaux, France
(Provenchere) Anesthesiology and surgical critical care department, DMU
PARABOL, AP-HP, Bichat Hospital, Paris, France
(Rozec) Service d'Anesthesie-Reanimation, Hopital Laennec, Centre
Hospitalier Universitaire, Nantes, France
(Parienti) Department of Biostatistics and Clinical Research, Caen
University Hospital, Caen, France
(Fischer) Clinique Saint Augustin, Institut Aquitain du Coeur, Bordeaux
Cedex, France
Publisher
Elsevier Inc.
Abstract
Background: Postoperative morbidity and mortality after cardiac surgery
with cardiopulmonary bypass (CPB) remain high despite recent advances in
both anesthesia and perioperative management. Among modifiable risk
factors for postoperative complications, optimal arterial pressure during
and after surgery has been under debate for years. Recent data suggest
that optimizing arterial pressure to the baseline of the patient may
improve outcomes. We hypothesize that optimizing the mean arterial
pressure (MAP) to the baseline MAP of the patient during cardiac surgery
with CPB and during the first 24 hours postoperatively may improve
outcomes. Study design: The OPTIPAM trial (NCT05403697) will be a
multicenter, randomized, open-label controlled trial testing the
superiority of optimized MAP management as compared with a MAP of 65 mm Hg
or more during both the intraoperative and postoperative periods in 1,100
patients scheduled for cardiac surgery with CPB. The primary composite end
point is the occurrence of acute kidney injury, neurological complications
including stroke or postoperative delirium, and death. The secondary end
points are hospital and intensive care unit lengths of stay, Day 7 and Day
90 mortality, postoperative cognitive dysfunction on Day 7 and Day 90, and
quality of life at Day 7 and Day 90. Two interim analyses will assess the
safety of the intervention. <br/>Conclusion(s): The OPTIPAM trial will
assess the effectiveness of an individualized target of mean arterial
pressure in cardiac surgery with CPB in reducing postoperative morbidity.
Clinical trial registration: NCT05403697<br/>Copyright &#xa9; 2023
Elsevier Inc.

<9>
Accession Number
2013831529
Title
The impact of del Nido cardioplegia solution on blood morphology
parameters.
Source
Perfusion (United Kingdom). 38(2) (pp 277-284), 2023. Date of Publication:
March 2023.
Author
Sanetra K.; Domaradzki W.; Cisowski M.; Shrestha R.; Bialek K.; Bochenek
A.; Jankowska-Sanetra J.; Pawel Buszman P.; Gerber W.
Institution
(Sanetra, Pawel Buszman) Faculty of Medicine and Health Sciences, Andrzej
Frycz Modrzewski Krakow University, Krakow, Poland
(Sanetra, Domaradzki, Shrestha, Bialek, Bochenek, Gerber) Department of
Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland
(Cisowski) Department of Cardiac Surgery, University Hospital, Institute
of Medical Sciences, University of Opole, Opole, Poland
(Bochenek) Faculty of Medicine, University of Technology, Katowice, Poland
(Bochenek, Pawel Buszman) Center for Cardiovascular Research and
Development, American Heart of Poland, Katowice, Poland
(Jankowska-Sanetra, Pawel Buszman) Department of Cardiology, American
Heart of Poland, Bielsko-Biala, Poland
Publisher
SAGE Publications Ltd
Abstract
Background: Crystalloid cardioplegic solutions are believed to reduce
hemoglobin significantly and increase the transfusion rate. However,
recent reports indicate that the del Nido cardioplegia may preserve blood
morphology parameters. <br/>Method(s): In "The del Nido versus cold blood
cardioplegia in aortic valve Replacement" trial patients undergoing aortic
valve replacement were randomized into the del Nido (DN) or cold blood
cardioplegia (CB) group. For the subanalysis, patients who underwent blood
transfusions were excluded from the study. Red blood cell (RBC) count,
hemoglobin, white blood cell (WBC) count and platelet (PLT) count were
measured before the surgery, 24-, 48-, and 96 hours postoperatively.
Furthermore, percental variation in first-last measure was compared in
groups. In addition, indexed normalized ratio (INR) and activated partial
thromboplastin time (aPTT) were compared preoperatively and 24 hours after
the surgery. <br/>Result(s): Eighteen (24%) patients from the del Nido
group and 22 (29.3%) patients from the CB group received blood product
transfusions (p = 0.560) and were excluded from further analysis. As such,
57 patients remained in DN group and 53 patients remained in CB group. No
difference was found in RBC, hemoglobin, WBC, and platelet count in time
intervals. Percental variation in first-last measure revealed higher fall
in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No
difference was shown in preoperative and 24-hour postoperative INR and
aPTT. <br/>Conclusion(s): The del Nido cardioplegia does not decrease
blood morphology parameters when compared to cold blood cardioplegia and
may be used alternatively regardless of bleeding and coagulopathy
risk.<br/>Copyright &#xa9; The Author(s) 2021.

<10>
Accession Number
2020375196
Title
Clinical efficacy and safety comparison of Watchman device versus
ACP/Amulet device for percutaneous left atrial appendage closure in
patients with nonvalvular atrial fibrillation: A study-level meta-analysis
of clinical trials.
Source
Clinical Cardiology. 46(2) (pp 117-125), 2023. Date of Publication:
February 2023.
Author
Bing S.; Chen R.R.
Institution
(Bing, Chen) Department of Cardiology, Tang du Hospital, Air Force Medical
University, Shaanxi, Xi'an, China
Publisher
John Wiley and Sons Inc
Abstract
Left atrial appendage occlusion is not inferior to oral anticoagulants in
the prevention of stroke in several randomized controlled trials. However,
the clinical efficacy and safety comparison of the Watchman and amplatzer
cardiac plug (ACP)/Amulet devices for percutaneous left atrial appendage
closure (LAAC) in patients with non-valvular atrial fibrillation was
controversial. A database search was conducted using PubMed, EMBASE,
Cochrane Library, and Clinicaltrials.gov for trials that compared Watchman
device vs ACP/Amulet device. The effective outcomes were stroke and
systemic embolism. Safety outcomes were all-cause death, cardiovascular
death, and major bleeding. Device-related complications included
device-related thrombus (DRT), peri-device leaks (PDL > 5 mm). A total of
19 articles involving 6224 patients were included in the present study.
The Watchman and ACP/Amulet groups comprised 3267 and 2957 patients,
respectively. No statistically significant differences were detected in
the stroke (odd ratio [OR]:1.24, 95% confidence interval [CI]: 0.92-1.67,
p =.17, I² = 0), systemic embolism (OR:1.10, 95% CI: 0.51-2.35,
p =.81, I² = 0%), all-cause death (OR:0.97, 95% CI: 0.80-1.18,
p =.77, I² = 1%), cardiogenic death (OR:0.99, 95% CI:
0.77-1.29, p =.96, I² = 0%), major bleeding (OR:1.18, 95% CI:
0.98-1.43, p =.08, I² = 25%). DRT (OR:1.48, 95% CI: 1.06-2.06,
p =.02, I² = 0%) and PDL > 5 mm (OR:2.57, 95% CI: 1.63-4.04, p
<.0001, I² = 0%) were significantly lower in ACP/Amulet group
compared to Watchman group. The effective and safety outcomes were
comparable between two groups. ACP/Amulet group had significantly lower
rates of DRT and PDL > 5 mm than Watchman group.<br/>Copyright &#xa9; 2022
The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.

<11>
Accession Number
2018987071
Title
Prognosis of PCI in AMI setting in the elderly population: Outcomes from
the multicenter prospective e-ULTIMASTER registry.
Source
Clinical Cardiology. 45(12) (pp 1211-1219), 2022. Date of Publication:
December 2022.
Author
Saada M.; Kobo O.; Polad J.; Halabi M.; IJsselmuiden A.J.J.; Puentes A.;
Monsegu J.; Austin D.; Baisebenov R.K.; Spano F.; Roguin A.
Institution
(Saada, Kobo, Roguin) Department of Cardiology, Hillel Yaffe Medical
Center, Technion-Faculty of Medicine, Hadera, Israel
(Polad) Department of Cardiology, Jeroen Bosch Ziekenhuis, 's
Hertogenbosch, Netherlands
(Halabi) Department of Cardiology, Ziv Hospital, Safed, Israel
(IJsselmuiden) Cardiology Department, Amphia Hospital Breda, Breda,
Netherlands
(Puentes) Department of Cardiology, San Juan de Dios Hospital, Santiago,
Chile
(Monsegu) Department of Cardiology, Groupe Hospitalier Mutualiste,
Institut Cardiovasculaire, Grenoble, France
(Austin) Department of Cardiology, The James Cook University Hospital,
Middlesbrough, United Kingdom
(Baisebenov) Department of Cardiology, Regional Cardiology Center,
Pavlodar, Kazakhstan
(Spano) Department of Cardiology, Meander Medical Center, Amersfoort,
Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Background: Elderly patients with ST-elevation myocardial infarction
(STEMI) who undergo percutaneous coronary intervention (PCI) are usually
excluded from major trials. Hyopthesis: This study sought to assess 1-year
clinical outcomes following PCI with a drug-eluting stent in patients
older than 80 years old with STEMI. <br/>Method(s): The large all-comer,
multicontinental e-ULTIMASTER registry included 7507 patients with STEMI
who underwent PCI using the Ultimaster stent. The primary clinical
endpoint was 1-year target lesion failure, a composite of cardiac death
(CD), target vessel-related myocardial infarction (TV-MI), or clinically
driven target lesion revascularization (CD-TLR). <br/>Result(s): There
were 457 (6.1%) patients in the elderly group (>=80 years old) that were
compared to 7050 (93.9%) patients <80 years. The elderly patients included
more female patients and had significantly more comorbidities and had more
complex coronary anatomy. The primary endpoint occurred in 7.2% of the
elderly, compared to 3.1% of the younger group (p <.001). All-cause
mortality was significantly higher among the elderly group compared to the
younger group (10.1% vs. 2.3%, p <.0001), as well as CD (6.1% vs. 1.6%, p
<.0001), but not TV-MI (1.1% vs. 0.7%, p =.34) or CD-TLR (1.1% vs. 1.4%, p
=.63). <br/>Conclusion(s): Elderly patients with STEMI presentation had a
higher incidence of the composite endpoint than younger patients.
All-cause and CD were higher for elderly patients compared to patients
younger than 80 years old. However, there was no difference in the
incidence of TV-MI or target lesion revascularizations. These findings
suggest that PCI for STEMI in elderly patients is relatively
safe.<br/>Copyright &#xa9; 2022 The Authors. Clinical Cardiology published
by Wiley Periodicals LLC.

<12>
Accession Number
2022850173
Title
Immunosuppressive therapy in virus-negative inflammatory cardiomyopathy:
20-year follow-up of the TIMIC trial.
Source
European Heart Journal. 43(36) (pp 3463-3473), 2022. Date of Publication:
21 Sep 2022.
Author
Chimenti C.; Russo M.A.; Frustaci A.
Institution
(Chimenti, Frustaci) Department of Clinical Internal, Anesthesiology and
Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
(Chimenti, Frustaci) Molecular and Cellular Cardiology Lab, IRCCS 'L.
Spallanzani', Rome, Italy
(Russo) MEBIC Consortium, San Raffaele 21 University, Rome, Italy
Publisher
Oxford University Press
Abstract
Aims: Long-Term results of the Tailored IMmunosuppression in
virus-negative Inflammatory Cardiomyopathy (TIMIC) trial protocol have
been evaluated. <br/>Methods and Results: Eighty-five patients with
endomyocardial biopsy-proven virus-negative chronic inflammatory
cardiomyopathy were enrolled in the randomized, double-blind,
placebo-controlled TIMIC trial and received prednisone and azathioprine (n
= 43) vs. placebo (n = 42) for 6 months. Immunosuppressive treatment
promoted an improvement in cardiac function in 88% of the cases compared
with none of the patients in the placebo group, which were switched to a
6-month immunosuppressive therapy at the end of the 6-month study period.
Long-Term (up to 20 years) clinical outcomes of the whole cohort of 85
patients originally enrolled in the TIMIC trial (Group A) were compared
with those of a 1:2 propensity score-matched control cohort of patients
untreated with the TIMIC protocol (Group B) and followed for a comparable
period of time. The primary outcome was a composite of cardiovascular
death and heart transplantation. At long-Term follow-up, the risk of
cardiovascular death [hazard ratio (HR) 6.77; 95% confidence interval (CI)
2.36-19.45] and heart transplantation (HR 7.92; 95% CI 1.80-34.88) was
significantly higher in Group B patients. Group A showed a persistent
improvement in the left ventricular ejection fraction compared with Group
B (HR 7.24; 95% CI 3.05-17.18). A higher number of Group B patients
underwent implantable cardioverter defibrillator implantation. The
incidence of recurrent myocarditis was similar between groups, and
patients with evidence of a recurrent cardiac inflammatory process
promptly responded to a TIMIC protocol application. <br/>Conclusion(s):
Virus-negative inflammatory cardiomyopathy benefits from immunosuppressive
therapy even after long-Term follow-up. Recurrence appears to respond to a
new TIMIC protocol application.<br/>Copyright &#xa9; 2022 The Author(s).
Published by Oxford University Press on behalf of European Society of
Cardiology.

<13>
Accession Number
2022850096
Title
Impact of baseline renal dysfunction on cardiac outcomes and end-stage
renal disease in heart failure patients with mitral regurgitation: The
COAPT trial.
Source
European Heart Journal. 43(17) (pp 1639-1648), 2022. Date of Publication:
01 May 2022.
Author
Beohar N.; Ailawadi G.; Kotinkaduwa L.N.; Redfors B.; Simonato M.; Zhang
Z.; Morgan L.G.; Escolar E.; Kar S.; Lim D.S.; Mishell J.M.; Whisenant
B.K.; Abraham W.T.; Lindenfeld J.; Mack M.J.; Stone G.W.
Institution
(Beohar) Columbia University Medical Center, Columbia University Division
of Cardiology at Mount Sinai Medical Center, Miami Beach, FL 33140, United
States
(Ailawadi) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
(Kotinkaduwa, Redfors, Simonato, Zhang, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Redfors) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Morgan) Division of Cardiology, Medical University of South Carolina,
Columbia, SC, United States
(Escolar) Columbia University Medical Center, Columbia University Division
of Cardiology at Mount Sinai Medical Center, Miami Beach, FL 33140, United
States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, San Francisco, CA,
United States
(Whisenant) Intermountain Heart Center, Salt Lake City, UT, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Oxford University Press
Abstract
Aims: Baseline renal dysfunction (RD) adversely impacts outcomes among
patients with heart failure (HF) and severe secondary mitral regurgitation
(MR). Heart failure and MR, in turn, accelerate progression to end-stage
renal disease (ESRD), worsening prognosis. We sought to determine the
impact of RD in HF patients with severe MR and the impact of transcatheter
mitral valve repair (TMVr) on new-onset ESRD and the need for renal
replacement therapy (RRT). <br/>Methods and Results: The COAPT trial
randomized 614 patients with HF and severe MR to MitraClip plus
guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were
stratified into three RD subgroups based on baseline estimated glomerular
filtration rate (eGFR, mL/min/1.73 m2): none (>=60), moderate (30-60), and
severe (<30). End-stage renal disease was defined as eGFR <15 mL/min/1.73
m2 or RRT. The 2-year rates of all-cause death or HF hospitalization
(HFH), new-onset ESRD, and RRT according to RD and treatment were
assessed. Baseline RD was present in 77.0% of patients, including 23.8%
severe RD, 6.0% ESRD, and 5.2% RRT. Worse RD was associated with greater
2-year risk of death or HFH (none 45.3%; moderate 53.9%; severe 69.2%; P <
0.0001). MitraClip vs. GDMT alone improved outcomes regardless of RD (P
interaction = 0.62) and reduced new-onset ESRD [2.9 vs. 8.1%, hazard ratio
(HR) 0.34, 95% confidence interval (CI) 0.15-0.76, P = 0.008] and the need
for new RRT (2.5 vs. 7.4%, HR 0.33, 95% CI 0.14-0.78, P = 0.011).
<br/>Conclusion(s): Baseline RD was common in the HF patients with severe
MR enrolled in COAPT and strongly predicted 2-year death and HFH.
MitraClip treatment reduced new-onset ESRD and the need for RRT,
contributing to the improved prognosis after TMVr.<br/>Copyright &#xa9;
2022 The Author(s). Published by Oxford University Press on behalf of
European Society of Cardiology. All rights reserved.

<14>
Accession Number
2022720383
Title
A Prospective Randomized Comparative Study of Anaesthetic and Analgesic
Advantages of Dexmedetomidine Versus Saline Infusion for Spine Surgery in
Prone Position Under General Anaesthesia.
Source
International Journal of Pharmaceutical and Clinical Research. 14(12) (pp
815-820), 2022. Date of Publication: 2022.
Author
Helawar S.; Nadkarni M.; Sudha Shree P.; Prakash K.S.
Institution
(Helawar, Sudha Shree, Prakash) Department of Anaesthesia, Kanachur
Institute of Medical Sciences, Karnataka, Mangalore, India
(Nadkarni) Department of Anaesthesia, Seth Gordhandas Sunderdas Medical
College and the King Edward Memorial Hospital, Maharashtra, Mumbai, India
Publisher
Dr Yashwant Research Labs Pvt Ltd
Abstract
Background: In this study, we wanted to evaluate the anaesthetic and
analgesic advantages of dexmedetomidine with that of saline infusion for
spine surgery in prone position under general anaesthesia. <br/>Method(s):
This was a hospital based randomized prospective comparative study
conducted among 60 patients who presented with thoracic spine surgeries of
duration 3-4 hours under general anaesthesia, in the Department of General
Anaesthesia in Seth G S Medical College, KEM Hospital, Mumbai from 2013 to
2014 after obtaining clearance from Institutional Ethics Committee and
written informed consent from the study participants. <br/>Result(s): The
sex distribution in both the groups was analysed using Pearson chi square
test and the difference was not statistically significant. The mean
isoflurane requirement in group D was 0.89+/-0.14 whereas that in group C
was 1.04+/-0.11. The difference in mean was statistically significant with
p value < 0.001. This shows that dexmedetomidine infusion in group D
decreases the isoflurane requirement. Inj. vecuronium in group D patient
was 12+/- 1.64 mg and that in group C patients was 13.66+/-1.21mg. There
was statistically significant difference in the requirement of Inj.
vecuronium between two groups. Less requirement of Inj. vecuronium in
group D patients indicated that dexmedetomidine infusion decreases the
requirement of Inj. vecuronium. The mean requirement of injection fentanyl
in group D patients was 140.33+/-17.90^gm where in as that in group C
patients was 117.50+/-29.07^gm. There was statistically significant
difference in fentanyl requirement between both the groups with p value <
0.001. Decrease in the requirement of Inj. fentanyl in group D patients
was because of analgesic action of dexmedetomidine infusion. No difference
was seen with regard to requirement of Inj. atropine between two groups.
Inj. Ephedrine requirement was compared between group D and group C using
Chi square test. There was no significant difference in the requirement of
Inj. Ephedrine. <br/>Conclusion(s): Dexmedetomidine attenuates the
pressure response to laryngoscopy, incision and extubation.
Dexmedetomidine's hypotensive effect reduces the bleeding at surgical
site. We can conclude that dexmedetomidine infusion is good anaesthetic
adjuvant in spine surgery under general anaesthesia in view of its
hemodynamic stability, anaesthetic and analgesic sparing
effect.<br/>Copyright &#xa9; 2022, Dr Yashwant Research Labs Pvt Ltd. All
rights reserved.

<15>
Accession Number
641035977
Title
Cardiac Anesthesia Intraoperative Interpretation Accuracy of
Transesophageal Echocardiograms: A Review of the Current Literature and
Meta-Analysis.
Source
Vascular health and risk management. 19 (pp 223-230), 2023. Date of
Publication: 2023.
Author
Kawana E.; Vachirakorntong B.; Zhitny V.P.; Wajda M.C.; Alexander L.;
Young J.P.; Tun K.M.; Al-Taweel O.; Ahsan C.; Varsanyi G.; Singh A.
Institution
(Kawana, Alexander, Al-Taweel, Ahsan, Singh) Kirk Kerkorian School of
Medicine, University of Nevada, Las Vegas, NV, United States
(Vachirakorntong) Touro University Nevada College of Osteopathic Medicine,
Henderson, NV, United States
(Zhitny, Wajda) Department of Anesthesiology, Perioperative Care and Pain
Medicine, New York University, New York City, NY, United States
(Zhitny, Tun, Singh) Department of Internal Medicine, Kirk Kerkorian
School of Medicine, Las Vegas, NV, United States
(Alexander, Al-Taweel, Ahsan) Department of Cardiology, University Medical
Center of Southern Nevada, Las Vegas, NV, United States
(Young) Department of Biology, University of Utah, Salt Lake City, UT,
United States
(Varsanyi) Department of Anesthesiology and Perioperative Medicine,
OptumCare, Las Vegas, NV, United States
Publisher
NLM (Medline)
Abstract
Background: In the United States, echocardiography is an essential
component of the care of many cardiac patients. Recently, increased
attention has been given to the accuracy of interpretation of
cardiac-based procedures in different specialties, amongst them the field
of cardiac anesthesiology and primary echocardiographers for
transesophageal echocardiogram (TEE). The purpose of this study was to
assess the TEE skills of cardiac anesthesiologists in comparison to
primary echocardiographers, either radiologists or cardiologists. In this
systematic review, we evaluated available current literature to identify
if cardiac anesthesiologists interpret TEE procedures at an identical
level to that of primary echocardiographers. <br/>Method(s): A PRISMA
systematic review was utilized from PubMed from the years 1952-2022. A
broad keyword search of "Cardiology Anesthesiology Echocardiogram" and
"Echocardiography Anesthesiology" to identify the literature was used.
From reviewing 1798 articles, there were a total of 9 studies included in
our systematic review, 3 of which yielded quantitative data and 6 of which
yielded qualitative data. The mean accuracy from each of these three
qualitative studies was calculated and used to represent the overall
accuracy of cardiac anesthesiologists. <br/>Result(s): Through identified
studies, a total of 8197 TEEs were interpreted by cardiac
anesthesiologists with a concordance rate of 84% to the interpretations of
primary echocardiographers. Cardiac anesthesiologists had a concordance
rate of 83% when compared to radiologists. On the other hand, cardiac
anesthesiologists and cardiologists had a concordance rate of 87% in one
study and 79% in another study. <br/>Conclusion(s): Based on these
studies, cardiac anesthesiologists are shown to interpret TEEs similarly
to that of primary echocardiographers. At this time, there is no gold
standard to evaluate the accuracy of TEE readings. One way to address this
is to individually assess the TEE interpretation of anesthesiologists and
primary echocardiographers with a double-blind study.<br/>Copyright &#xa9;
2023 Kawana et al.

<16>
Accession Number
641035657
Title
Predictive value of urinary cell cycle arrest biomarkers for all
cause-acute kidney injury: a meta-analysis.
Source
Scientific reports. 13(1) (pp 6037), 2023. Date of Publication: 13 Apr
2023.
Author
Huang F.; Zeng Y.; Lv L.; Chen Y.; Yan Y.; Luo L.; Pan R.; Jiang J.; Wei
X.
Institution
(Huang, Zeng, Lv, Yan, Luo, Pan, Jiang, Wei) Department of Nephrology,
First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
330006, China
(Huang, Chen, Pan, Jiang) Nanchang University, Nanchang 330006, China
(Lv) Shangrao Guangxin District People's Hospital, Shangrao, Jiangxi,
China
Publisher
NLM (Medline)
Abstract
The cell cycle arrest markers tissue inhibitor metalloproteinases-2
(TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have
been identified as potential biomarkers of acute kidney injury (AKI) in
critically ill adults in intensive care units and cardiac
surgery-associated AKI (CSA-AKI). However, the clinical impact on
all-cause AKI remains unclear. Here, we report a meta-analysis performed
to evaluate the predictive value of this biomarker for all-cause AKI. The
PubMed, Cochrane, and EMBASE databases were systematically searched up to
April 1, 2022. We used the Quality Assessment Tool for Diagnosis Accuracy
Studies (QUADAS-2) to assess the quality. We extracted useful information
from these studies and calculated the sensitivity, specificity, and area
under the receiver operating characteristic curve (AUROC). Twenty studies
with 3625 patients were included in the meta-analysis. The estimated
sensitivity of urinary [TIMP-2]x[IGFBP7] in the diagnosis of all-cause AKI
was 0.79 (95% CI 0.72, 0.84), and the specificity was 0.70 (95% CI 0.62,
0.76). The value of urine [TIMP-2]x[IGFBP7] in the early diagnosis of AKI
was assessed using a random effects model. The pooled positive likelihood
ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio
(DOR) were 2.6 (95% CI 2.1, 3.3), 0.31 (95% CI 0.23, 0.40), and 8 (95% CI
6, 13), respectively. The AUROC was 0.81 (95% CI 0.78-0.84). No
significant publication bias was observed in eligible studies. Subgroup
analysis indicated that the diagnostic value was related to the severity
of AKI, time measurement, and clinical setting. This study shows that
urinary [TIMP-2]x[IGFBP7] is a reliable effective predictive test for all
cause-AKI. However, whether and how urinary [TIMP-2]x[IGFBP7] can be used
in clinical diagnosis still requires further research and clinical
trials.<br/>Copyright &#xa9; 2023. The Author(s).

<17>
Accession Number
640393234
Title
Effect of menthol lozenges after extubation on thirst, nausea,
physiological parameters, and comfort in cardiovascular surgery patients:
A randomized controlled trial.
Source
Intensive & critical care nursing. 76 (pp 103415), 2023. Date of
Publication: 01 Jun 2023.
Author
Can S.; Gezginci E.; Yapici N.
Institution
(Can) Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and
Research Hospital, Istanbul, Turkey
(Gezginci) Hamidiye Faculty of Nursing, University of Health Sciences
Turkey, Istanbul, Turkey
(Yapici) Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Health
Application and Research Center, University of Health Sciences Turkey,
Istanbul, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To determine the effect of post-extubation oral menthol
lozenges on thirst, nausea, physiological parameters, and comfort level in
patients undergoing cardiovascular surgery. RESEARCH METHODOLOGY/DESIGN:
The study was a single-centre, randomized controlled trial. SETTING: This
study included 119 patients undergoing coronary artery bypass graft
surgery in a training and research hospital. Patients in the intervention
group (n = 59) received menthol lozenges at 30, 60, and 90 min after
extubation. Patients in the control group (n = 60) received standard care
and treatment. MAIN OUTCOME MEASURES: The primary outcome of the study was
the change in post-extubation thirst assessed by Visual Analogue Scale
after using menthol lozenges compared to baseline. Secondary outcomes were
changes in post-extubation physiological parameters and nausea severity
assessed by Visual Analogue Scale compared to baseline, and comfort level
assessed with Shortened General Comfort Questionnaire. <br/>RESULT(S):
Between-group comparisons showed that the intervention group had
significantly lower thirst scores at all time points and nausea at the
first assessment (p < 0.05) and significantly higher comfort scores (p <
0.05) than the control group. There were no significant differences
between the groups in physiological parameters at baseline or any of the
postoperative assessments (p > 0.05). <br/>CONCLUSION(S): In patients
undergoing coronary artery bypass graft surgery, the use of menthol
lozenges effectively increased comfort level by reducing post-extubation
thirst and nausea, but had no effect on physiological parameters.
IMPLICATIONS FOR CLINICAL PRACTICE: Nurses should be vigilant for
complaints such as thirst, nausea, and discomfort in patients after
extubation. Nurses' administration of menthol lozenges to patients may
help reduce post-extubation thirst, nausea, and discomfort.<br/>Copyright
&#xa9; 2023 Elsevier Ltd. All rights reserved.

<18>
Accession Number
2023895610
Title
Platelet Function is Preserved After Moderate Cardiopulmonary Bypass Times
But Transiently Impaired After Protamine.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Tornudd M.; Ramstrom S.; Kvitting J.-P.E.; Alfredsson J.; Nyberg L.;
Bjorkman E.; Berg S.
Institution
(Tornudd, Nyberg, Bjorkman, Berg) Department of Cardiothoracic and
Vascular Surgery and Department of Health, Medicine and Caring Sciences,
Linkoping University, Linkoping, Sweden
(Ramstrom, Nyberg, Bjorkman) Department of Clinical Chemistry and
Department of Biomedical and Clinical Sciences, Linkoping University,
Linkoping, Sweden
(Ramstrom) Cardiovascular Research Centre, School of Medical Sciences,
Faculty of Medicine and Health, Orebro University, Orebro, Sweden
(Kvitting) Department of Cardiothoracic Surgery, Oslo University Hospital,
Oslo, Rikshospitalet, Norway
(Kvitting) Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
(Alfredsson) Department of Cardiology and Department of Health, Medicine
and Caring Sciences, Linkoping University, Linkoping, Sweden
Publisher
W.B. Saunders
Abstract
Objectives: Previous studies have described impaired platelet function
after cardiopulmonary bypass (CPB). Whether this is still valid in
contemporary cardiac surgery is unclear. This study aimed to quantify
changes in function and number of platelets during CPB in a present-day
cardiac surgery cohort. <br/>Design(s): Prospective, controlled clinical
study. <br/>Setting(s): A single-center university hospital.
<br/>Participant(s): Thirty-nine patients scheduled for coronary artery
bypass graft surgery with CPB. <br/>Intervention(s): Platelet function and
numbers were measured at 6 timepoints in 39 patients during and after
coronary artery bypass graft surgery; at baseline before anesthesia, at
the end of CPB, after protamine administration, at intensive care unit
(ICU) arrival, 3 hours after ICU arrival, and on the morning after
surgery. <br/>Measurements and Main Results: Platelet function was
assessed with impedance aggregometry and flow cytometry. Platelet numbers
are expressed as actual concentration and as numbers corrected for
dilution using hemoglobin as a reference marker. There was no consistent
impairment of platelet function during CPB with either impedance
aggregometry or flow cytometry. After protamine administration, a decrease
in platelet function was seen with impedance aggregometry and for some
markers of activation with flow cytometry. Platelet function was restored
3 hours after arrival in the ICU. During CPB (85.0 +/- 21 min), the number
of circulating platelets corrected for dilution increased from 1.73 +/-
0.42 x 10⁹/g to 1.91 +/- 0.51 x 10⁹/g (p < 0.001).
<br/>Conclusion(s): During cardiac surgery with moderate CPB times,
platelet function was not impaired, and no consumption of circulating
platelets could be detected. Administration of protamine transiently
affected platelet function.<br/>Copyright &#xa9; 2023 The Authors

<19>
Accession Number
2023957416
Title
3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement
in Low-Risk Patients With Aortic Stenosis.
Source
Journal of the American College of Cardiology. 81(17) (pp 1663-1674),
2023. Date of Publication: 02 May 2023.
Author
Forrest J.K.; Deeb G.M.; Yakubov S.J.; Gada H.; Mumtaz M.A.; Ramlawi B.;
Bajwa T.; Teirstein P.S.; DeFrain M.; Muppala M.; Rutkin B.J.; Chawla A.;
Jenson B.; Chetcuti S.J.; Stoler R.C.; Poulin M.-F.; Khabbaz K.; Levack
M.; Goel K.; Tchetche D.; Lam K.Y.; Tonino P.A.L.; Ito S.; Oh J.K.; Huang
J.; Popma J.J.; Kleiman N.; Reardon M.J.; Sorajja P.; Byrne T.; Kirshner
M.; Crouch J.; Coselli J.; Silva G.; Hebeler R.; Stoler R.; Islam A.;
Rousou A.; Bladergroen M.; Fail P.; Netherland D.; Tonino W.A.L.; Sudre
A.; Berthoumieu P.; Khalili H.; Hughes G.C.; Harrison J.K.; De A.; Tsau
P.; van Mieghem N.M.; Larbalestier R.; Yong G.; Agarwal S.; Martin W.;
Park S.; Reardon M.; Mohammadi S.; Rodes-Cabau J.; Sparling J.; Elkins
C.C.; Ganzel B.; Matthews R.V.; Starnes V.A.; Ando K.; Chevalier B.; Farge
A.; Combs W.; Bagur R.; Chu M.; Fontana G.; Dev V.; Leya F.; Tuchek J.M.;
Inglessis I.; Jassar A.; Piazza N.; Lacappelle K.; Steinberg D.; Katz M.;
Wang J.; Kozina J.; Slachman F.; Merritt R.; Jensen B.; Alvarez J.; Gooley
R.; Smith J.; Ibrahim R.; Cartier R.; Rovin J.; Fujita T.; Rutkin B.;
Yakubov S.; Song H.; Zahr F.; Miyagawa S.; Rajagopal V.; Kauten J.; Mumtaz
M.; Bhindi R.; Brady P.; Batra S.; Davis T.; Iskander A.; Heimansohn D.;
Hermiller J.; Takamisawa I.; Haldis T.; Yamazaki S.; Teirstein P.; Tada
N.; Saito S.; Merhi W.; Leung S.; Muller D.; Heijmen R.; Petrossian G.;
Robinson N.; Knight P.; Ling F.; Radhakrishnan S.; Fremes S.; Lehr E.;
Gafoor S.; Noel T.; Walton A.; Resar J.; Adams D.; Sharma S.; Lilly S.;
Tadros P.; Zorn G.; Dauerman H.; Ittleman F.; Horlick E.; Feindel C.; Welt
F.; Sharma V.; Markowitz A.; Carroll J.; Fullerton D.; Griffith B.; Gupta
A.; de Marchena E.; Salerno T.; Chetcuti S.; Sultan I.; Pasupati S.; Kon
N.; Zhao D.; Forrest J.
Institution
(Forrest) Yale University School of Medicine, New Haven, CT, United States
(Deeb, Chetcuti) University of Michigan Health Systems University
Hospital, Ann Arbor, MI, United States
(Yakubov) OhioHealth Riverside Methodist Hospital, Columbus, OH, United
States
(Gada, Mumtaz) University of Pittsburgh Medical Center, Harrisburg, PA,
United States
(Ramlawi) Lankenau Heart Institute, Philadelphia, PA, United States
(Bajwa) Aurora St Luke's Medical Center, Milwaukee, WI, United States
(Teirstein) Scripps Clinic, La Jolla, CA, United States
(DeFrain, Muppala) HealthPark Medical Center, Fort Myers, FL, United
States
(Rutkin) North Shore University Hospital, Manhasset, NY, United States
(Chawla, Jenson) Mercy Medical Center, Iowa Heart, Des Moines, IA, United
States
(Stoler) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Poulin, Khabbaz) Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Levack, Goel) Vanderbilt University Medical Center, Nashville, TN, United
States
(Tchetche) Clinique Pasteur, Toulouse, France
(Lam, Tonino) Catharina Ziekenhuis, Eindhoven, Netherlands
(Ito, Oh) Echocardiography Core Laboratory, Mayo Clinic, Rochester, MN,
United States
(Huang, Popma) Medtronic, Mounds View, MN, United States
(Kleiman, Reardon) Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Randomized data comparing outcomes of transcatheter aortic
valve replacement (TAVR) with surgery in low-surgical risk patients at
time points beyond 2 years is limited. This presents an unknown for
physicians striving to educate patients as part of a shared
decision-making process. <br/>Objective(s): The authors evaluated 3-year
clinical and echocardiographic outcomes from the Evolut Low Risk trial.
<br/>Method(s): Low-risk patients were randomized to TAVR with a
self-expanding, supra-annular valve or surgery. The primary endpoint of
all-cause mortality or disabling stroke and several secondary endpoints
were assessed at 3 years. <br/>Result(s): There were 1,414 attempted
implantations (730 TAVR; 684 surgery). Patients had a mean age of 74 years
and 35% were women. At 3 years, the primary endpoint occurred in 7.4% of
TAVR patients and 10.4% of surgery patients (HR: 0.70; 95% CI: 0.49-1.00;
P = 0.051). The difference between treatment arms for all-cause mortality
or disabling stroke remained broadly consistent over time: -1.8% at year
1; -2.0% at year 2; and -2.9% at year 3. The incidence of mild
paravalvular regurgitation (20.3% TAVR vs 2.5% surgery) and pacemaker
placement (23.2% TAVR vs 9.1% surgery; P < 0.001) were lower in the
surgery group. Rates of moderate or greater paravalvular regurgitation for
both groups were <1% and not significantly different. Patients who
underwent TAVR had significantly improved valve hemodynamics (mean
gradient 9.1 mm Hg TAVR vs 12.1 mm Hg surgery; P < 0.001) at 3 years.
<br/>Conclusion(s): Within the Evolut Low Risk study, TAVR at 3 years
showed durable benefits compared with surgery with respect to all-cause
mortality or disabling stroke. (Medtronic Evolut Transcatheter Aortic
Valve Replacement in Low Risk Patients; NCT02701283)<br/>Copyright &#xa9;
2023 The Authors

<20>
Accession Number
2022580308
Title
Coronary Syndromes and High-Altitude Exposure-A Comprehensive Review.
Source
Diagnostics. 13(7) (no pagination), 2023. Article Number: 1317. Date of
Publication: April 2023.
Author
Macovei L.; Macovei C.M.; Macovei D.C.
Institution
(Macovei) Acute Cardiac Care Unit, Cardiology Clinic, Institute of
Cardiovascular Diseases "Prof. Dr. George I.M. Georgescu", "Grigore T
Popa" University of Medicine and Pharmacy, Iasi 700503, Romania
(Macovei) Pneumology Clinic, Pneumology Hospital, Dr. I Cihac No. 30
Street, Iasi 700115, Romania
(Macovei) Faculty of Economics and Business Administration, "Alexandru I
Cuza" University, Iasi 700115, Romania
Publisher
MDPI
Abstract
The aim of this review is to identify a preventive strategy in order to
minimize the risk of adverse events in patients with coronary syndromes
and acute exposure to high-altitude. For this purpose we searched the
electronic database of PubMed, EMBASE, and Web of Science for studies
published in the last 30 years in this field. The conclusions of this
review are: patients with stable coronary artery disease on optimal
treatment and in a good physical condition can tolerate traveling to high
altitude up to 3500 m; on the other hand, patients with unstable angina or
recent myocardial infarction no older than 6 months should take less
interest in hiking or any activity involving high altitude. Air-traveling
is contraindicated for patients with myocardial infarction within previous
2 weeks, angioplasty or intracoronary stent placement within previous 2
weeks, and unstable angina or coronary artery bypass grafting within
previous 3 weeks. The main trigger for sudden cardiac death is the lack of
gradual acclimatization to high-altitude and to the exercise activity, and
the most important risk factor is prior myocardial
infarction.<br/>Copyright &#xa9; 2023 by the authors.

<21>
Accession Number
2022580270
Title
Combined CT Coronary Artery Assessment and TAVI Planning.
Source
Diagnostics. 13(7) (no pagination), 2023. Article Number: 1327. Date of
Publication: April 2023.
Author
Renker M.; Schoepf U.J.; Kim W.K.
Institution
(Renker, Kim) Department of Cardiology, Campus Kerckhoff of the Justus
Liebig University Giessen, Bad Nauheim 61231, Germany
(Renker, Kim) Department of Cardiac Surgery, Campus Kerckhoff of the
Justus Liebig University Giessen, Bad Nauheim 61231, Germany
(Renker, Kim) German Centre for Cardiovascular Research (DZHK), Partner
Site Rhine-Main, Bad Nauheim 61231, Germany
(Schoepf) Heart & Vascular Center, Medical University of South Carolina,
Charleston, SC 29425, United States
(Kim) Department of Cardiology, Justus Liebig University Giessen, Giessen
35392, Germany
Publisher
MDPI
Abstract
Computed tomography angiography (CTA) of the aorta and the iliofemoral
arteries is crucial for preprocedural planning of transcatheter aortic
valve implantation (TAVI) in patients with severe aortic stenosis (AS),
because it provides details on a variety of aspects required for heart
team decision-making. In addition to providing relevant diagnostic
information on the degree of aortic valve calcification, CTA allows for a
customized choice of the transcatheter heart valve system and the TAVI
access route. Furthermore, current guidelines recommend the exclusion of
relevant coronary artery disease (CAD) prior to TAVI. The feasibility of
coronary artery assessment with CTA in patients scheduled for TAVI has
been established previously, and accumulating data support its value. In
addition, fractional flow reserve determined from CTA (CT-FFR) and machine
learning-based CT-FFR were recently shown to improve its diagnostic yield
for this purpose. However, the utilization of CTA for coronary artery
evaluation remains limited in this specific population of patients due to
the relatively high risk of CAD coexistence with severe AS. Therefore, the
current diagnostic work-up prior to TAVI routinely includes invasive
catheter coronary angiography at most centers. In this article, the
authors address technological prerequisites and CT protocol
considerations, discuss pitfalls, review the current literature regarding
combined CTA coronary artery assessment and preprocedural TAVI evaluation,
and provide an overview of unanswered questions and future research goals
within the field.<br/>Copyright &#xa9; 2023 by the authors.

<22>
Accession Number
2022429395
Title
Impact of low-density lipoprotein cholesterol and lipoprotein(a) on
mid-term clinical outcomes following coronary artery bypass grafting: A
secondary analysis of the DACAB trial.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1103681. Date of Publication: 2023.
Author
Yu Q.; Xue Q.; Liu H.; Hu J.; Wang R.; Song Y.; Zhou Y.; Zhang W.; Zhu Y.;
Zhao Q.
Institution
(Yu, Zhou, Zhu, Zhao) Department of Cardiovascular Surgery, Ruijin
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China
(Xue) Department of Cardiovascular Surgery, The First Affiliated Hospital
of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China
(Liu) Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Hu) Department of Cardiac Surgery, Heart Center of Henan Provincial
People's Hospital, Central China Fuwai Hospital of Zhengzhou University,
Zhengzhou, China
(Wang) Department of Cardiovascular Surgery, Nanjing First Hospital,
Nanjing Medical University, Nanjing, China
(Song) Department of Cardiovascular Surgery, Jiangsu Province Hospital,
Nanjing, China
(Zhang) Department of Biostatistics, School of Public Health, Fudan
University, Shanghai, China
Publisher
Frontiers Media S.A.
Abstract
Purpose: The objective was to evaluate the influence of low-density
lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical
outcomes in patients undergoing coronary artery bypass grafting (CABG).
<br/>Method(s): This is a secondary analysis of a 5-year follow-up of the
DACAB trial (NCT02201771), in which 500 patients who underwent primary
isolated CABG were randomized to three-antiplatelet therapy for 1 year
after surgery. Of them, 459 patients were recruited in this secondary
analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated
measurement of LDL-C levels during the follow-up were recorded. Cut-off
values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were
stratified into LDL-C <1.8, 1.8-<2.6, and >=2.6 mmol/L subgroups. Cut-off
value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a)
<30 and >=30 mg/dL subgroups. The primary outcome was 4-point major
adverse cardiovascular events (MACE-4), a composite of all-cause death,
myocardial infarction, stroke, and repeated revascularization. Median
follow-up time was 5.2 (interquartile range, 4.2-6.1) years.
<br/>Result(s): During the follow-up, 129 (28.1%) patients achieved the
attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8-<2.6
mmol/L, and 144 (31.4%) remained LDL-C >=2.6 mmol/L. Compared with the
postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was
significantly higher in the LDL-C 1.8-<2.6 mmol/L group [adjusted hazard
ratio (aHR) = 1.92, 95% CI, 1.12-3.29; P = 0.019] and LDL-C >=2.6 mmol/L
group (aHR = 3.90, 95% CI, 2.29-6.64; P < 0.001). Baseline Lp(a) >=30
mg/dL was identified in 131 (28.5%) patients and was associated with an
increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06-2.18; P = 0.022).
<br/>Conclusion(s): For CABG patients, exposure to increased levels of
postoperative LDL-C or baseline Lp(a) was associated with worse mid-term
clinical outcomes. Our findings suggested the necessity of achieving LDL-C
target and potential benefit of adding Lp(a) targeted lipid-lowering
therapy in CABG population.<br/>Copyright 2023 Yu, Xue, Liu, Hu, Wang,
Song, Zhou, Zhang, Zhu and Zhao.

<23>
Accession Number
2023805485
Title
Angiographic quantification of aortic regurgitation following myval
octacor implantation; independent core lab adjudication.
Source
International Journal of Cardiology. (no pagination), 2023. Date of
Publication: 2023.
Author
Elkoumy A.; Jose J.; Gunasekaran S.; Kumar A.; Srinivas B.C.; Manjunath
C.N.; Ravindranath K.S.; Parekh M.; Chandra P.; Kapoor R.; Abdelshafy M.;
Seth A.; Agrawal P.; Mathur A.; Rao R.S.; Elzomor H.; Sadanada K.S.;
Arsang-Jang S.; Mehrotra S.; Raghuraman B.; Khanolkar U.; Premchand R.K.;
Chopra M.; Krishna P.; Mehta H.; Gupta R.; Kumar V.; Senguttuvan N.B.;
Baumbach A.; Serruys P.W.; Soliman O.
Institution
(Elkoumy, Abdelshafy, Elzomor, Arsang-Jang, Serruys, Soliman) Discipline
of Cardiology, Saolta Group, Galway University Hospital, Health Service
Executive and CORRIB Core Lab, University of Galway, Galway H91 V4AY,
Ireland
(Elkoumy) Islamic Center of Cardiology, Al-Azhar University, Nasr City,
Cairo 11651, Egypt
(Jose) Department of Cardiology, Christian Medical College & Hospital,
Vellore 632004, India
(Gunasekaran) Department of Cardiology, Apollo Main Hospital, Greams Road,
Chennai 600006, India
(Kumar) Department of Cardiology, Meitra Hospital, Kerala, Calicut 673005,
India
(Srinivas, Manjunath, Ravindranath) Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Jayanagar, Bengaluru 560041, India
(Parekh) Sir H. N. Reliance Foundation Hospital and Research Centre,
Girgaon, Maharashtra, Mumbai 400004, India
(Chandra, Kapoor) Medanta, The Medicity Hospitals, Haryana 122001, India
(Seth, Agrawal, Mathur) Fortis Escorts Heart Institute, New Delhi 110025,
India
(Rao) Rajasthan Hospital Limited, Rajasthan, Jaipur 302018, India
(Sadanada) Sri Jayadeva Institute of Cardiovascular Sciences and Research,
Karnataka, Mysuru 570016, India
(Kumar) Madras Medical Mission Hospital, Tamil Nadu, Chennai 600037, India
(Arsang-Jang, Serruys, Soliman) CURAM, SFI Research Centre for Medical
Devices, Galway H91 W2TY, Ireland
(Mehrotra, Raghuraman, Khanolkar) Narayana Institute of Cardiac Sciences,
Karnataka, Bengaluru 560099, India
(Premchand) Krishna Institute of Medical Sciences (KIMS), Telangana,
Hyderabad 500014, India
(Chopra) Narayana Hospital (NH), Gujarat, Ahmedabad 380023, India
(Krishna) P S Govindaswami (PSG), Coimbatore 641004, India
(Mehta) S. L. Raheja Hospital - Fortis, Maharashtra, Mumbai 400016, India
(Gupta) Apollo Hospital, Maharashtra, Navi Mumbai 400614, India
(Kumar) Max Hospital, Saket, Delhi, New Delhi 110017, India
(Senguttuvan) Sri Ramachandra Hospital (SRMC), Tamil Nadu, Chennai 600116,
India
(Baumbach) William Harvey Research Institute, Queen Mary University of
London and Barts Heart Centre, London EC1M 6BQ, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: The balloon expandable Myval transcatheter heart valve (THV)
showed encouraging results regarding residual aortic regurgitation (AR)
from multiple observational studies. The newly designed Myval Octacor has
been introduced recently, aiming for a reduction in AR and improved
performance. <br/>Objective(s): The focus of this study is to report the
incidence of AR using the validated quantitative Videodensitometry
angiography technology (qLVOT-AR%) in the first in human use of the Myval
Octacor THV system. Methodology: We report on the first in human use of
the Myval Octacor THV system in 125 patients in 18 Indian centres.
Independent retrospective analysis of the final aortograms following
implantation of the Myval Octacor was performed using the CAAS-A-Valve
software. AR is reported as a regurgitation fraction. The previously
validated cutoff values have been used to identify >=moderate AR (RF%
>17%), mild (6% < RF% <=17%), and none or trace AR (RF% <= 6%).
<br/>Result(s): Final aortogram was analysable for 103 patients (84.4%)
among the 122 available aortograms. 64 (62%) patients, had tricuspid
aortic valve (TAV), 38 (37%) with bicuspid AV (BAV), and one with
unicuspid AV. The median absolute RF% was 2% [1, 6], moderate or more AR
incidence was 1.9%, mild AR in 20.4%, and none or trace AR in 77.7%. The
two cases with RF% >17% were in the BAV group. <br/>Conclusion(s): The
initial results of Myval Octacor using quantitative angiography-derived
regurgitation fraction demonstrated a favourable outcome regarding
residual AR, possibly due to improved device design. Results must be
confirmed in a larger randomised study, including other imaging
modalities.<br/>Copyright &#xa9; 2023 The Author(s)

<24>
Accession Number
2022466783
Title
Impact of coronary artery disease on clinical outcomes after TAVR:
Insights from the BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2023.
Date of Publication: 2023.
Author
Feldman D.; Cao D.; Sartori S.; Zhang Z.; Hengstenberg C.; Tron C.;
Anthopoulos P.; Widder J.D.; Meneveau N.; Stella P.R.; Ferrari M.; Jeger
R.; Violini R.; Dumonteil N.; Chen S.; Yan R.; Nicolas J.; Razuk V.;
Spirito A.; Vogel B.; Mehran R.; Dangas G.
Institution
(Feldman, Cao, Sartori, Zhang, Chen, Yan, Nicolas, Razuk, Spirito, Vogel,
Mehran, Dangas) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Feldman, Razuk) Department of Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Cao) Department of Biomedical Sciences, Humanitas University, Milan,
Italy
(Hengstenberg) Department of Internal Medicine II, Division of Cardiology,
Medical University of Vienna, Vienna, Austria
(Tron) Division of Cardiology, Rouen University Hospital, Rouen, France
(Anthopoulos) European Medical, Arena Pharmaceuticals Inc, Zurich,
Switzerland
(Widder) Department of Medicine, Cardiology and Angiology, Municipial
Hospital Karlsruhe, Karlsruhe, Germany
(Meneveau) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Ferrari) Division of Interventional Cardiology, Helios Dr. Horst Schmidt
Kliniken Wiesbaden, Wiesbaden, Germany
(Jeger) Department of Cardiology, Triemli Hospital, Zurich, Switzerland
(Jeger) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
(Violini) Department of Interventional Cardiology, Azienda Ospedaliera
S.Camillo Forlanini, Rome, Italy
(Dumonteil) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
Publisher
John Wiley and Sons Inc
Abstract
Objective: To determine the prognostic impact of coronary artery disease
(CAD) in patients randomized to bivalirudin or unfractionated heparin
(UFH) during transcatheter aortic valve replacement (TAVR).
<br/>Background(s): CAD is a common comorbidity among patients undergoing
TAVR and studies provide conflicting data on its prognostic impact.
<br/>Method(s): The Bivalirudin on Aortic Valve Intervention Outcomes-3
(BRAVO-3) randomized trial compared the use of bivalirudin versus UFH in
802 high-surgical risk patients undergoing transfemoral TAVR for severe
symptomatic aortic stenosis. Patients were stratified according to the
presence or absence of history of CAD as well as periprocedural
anticoagulation. The coprimary endpoints were net adverse cardiac events
(NACE; a composite of all-cause mortality, myocardial infarction, stroke,
or major bleeding) and major Bleeding Academic Research Consortium (BARC)
bleeding >=3b at 30 days postprocedure. <br/>Result(s): Among 801
patients, 437 (54.6%) had history of CAD of whom 223 (51.0%) received
bivalirudin. There were no significant differences in NACE (adjusted odds
ratio [OR]: 1.04; 95% confidence interval [CI]: 0.69-1.58) or BARC >= 3b
bleeding (adjusted OR: 0.84; 95% CI: 0.51-1.39) in patients with vs
without CAD at 30 days. Among CAD patients, periprocedural use of
bivalirudin was associated with similar NACE (OR: 0.80; 95% CI: 0.47-1.35)
and BARC >= 3b bleeding (OR: 0.64; 95% CI: 0.33-1.25) compared with UFH,
irrespective of history of CAD (p-interaction = 0.959 for NACE;
p-interaction = 0.479 for major bleeding). <br/>Conclusion(s): CAD was not
associated with a higher short-term risk of NACE or major bleeding after
TAVR. Periprocedural anticoagulation with bivalirudin did not show any
advantage over UFH in patients with and without CAD.<br/>Copyright &#xa9;
2023 Wiley Periodicals LLC.

<25>
Accession Number
2023966288
Title
Safety and performance parameters of the Myval transcatheter aortic valve
bioprosthesis: The SAPPHIRE prospective registry.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2023. Date of
Publication: 2023.
Author
Testa L.; Criscione E.; Popolo Rubbio A.; Squillace M.; Ielasi A.; Tespili
M.; Brambilla N.; Bedogni F.
Institution
(Testa, Criscione, Popolo Rubbio, Squillace, Tespili, Brambilla, Bedogni)
Dept of Cardiology, IRCCS Pol. S. Donato, San Donato Milanese, Milan,
Italy
(Ielasi) Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio,
Milan, Italy
Publisher
Elsevier Inc.
Abstract
Background: TAVR is an established treatment for patients with severe
symptomatic aortic stenosis. Different THV platforms are nowadays
available, each of them with its inherent limitations and others are under
development aiming at overcoming such limitations. We thus sought to
investigate the performance and 1-year clinical outcome of a new
generation, balloon expandable, THV: the MyvalTM (Meril Life Sciences Pvt.
Ltd., Vapi, Gujarat, India). <br/>Method(s): This registry included the
first 100 consecutive patients (mean age 80.7 +/- 7.7; STS 4.3 +/- 3.3 %),
who underwent transcatheter aortic valve implantation for severe stenosis
of the native aortic valve from May 2020 to December 2020, in two Italian
Centers. Clinical and procedural outcomes were defined according to VARC-3
criteria. <br/>Result(s): Transfemoral Myval THV was successfully
implanted in all patients, with no intra-hospital mortality (technical
success 100 %): vascular access complications were all "minor" (16 %), and
managed by compression/balloon inflation; no cases of annular rupture or
coronary obstruction occurred; 5 % of patients required an in-hospital
pacemaker implantation (PM). Device success was 99 %. Overall and
cardiovascular mortality were 6 % (CI 5 %-7 %) and 4 % (CI 2 %-5 %) at 1-
year, while 12 % (CI 9 %-14 %) and 7 % (6-9 %) at 2 years. A total of 9 %
of the patients required a PM within 12 months, and no further PM
implantation occurred afterwards. No cerebrovascular events, renal failure
and myocardial infarction occurred between discharge and 2-year follow-up.
No events of structural valve deterioration but a sustained improvement of
echocardiographic parameters were observed. <br/>Conclusion(s): The Myval
THV has a promising safety/efficacy profile at 2 year follow up. This
performance should be further evaluated in the context of randomized
trials to better elucidate its potential.<br/>Copyright &#xa9; 2023

<26>
Accession Number
2023949983
Title
Perioperative Management of Vitamin K Antagonists and Direct Oral
Anticoagulants: A Systematic Review and Meta-analysis.
Source
Chest. (no pagination), 2023. Date of Publication: 2023.
Author
Shah S.; Nayfeh T.; Hasan B.; Urtecho M.; Firwana M.; Saadi S.; Abd-Rabu
R.; Nanaa A.; Flynn D.N.; Rajjoub N.S.; Hazem W.; Seisa M.O.; Hassett
L.C.; Spyropoulos A.C.; Douketis J.D.; Murad M.H.
Institution
(Shah, Nayfeh, Hasan, Urtecho, Firwana, Saadi, Abd-Rabu, Nanaa, Rajjoub,
Hazem, Seisa, Murad) Evidence-Based Practice Center, Mayo Clinic,
Rochester, MN
(Shah, Nayfeh, Hasan, Urtecho, Firwana, Saadi, Abd-Rabu, Nanaa, Rajjoub,
Hazem, Seisa, Murad) Robert D. and Patricia E. Kern Center for the Science
of Health Care Delivery, Mayo Clinic, Rochester, MN
(Hassett) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN
(Flynn) School of Medicine, University of North Carolina at Chapel Hill,
Chapel Hill, NC, United States
(Spyropoulos) Institute of Health Systems Science-Feinstein Institutes for
Medical Research and The Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Department of Medicine, Anticoagulation and Clinical
Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York,
NY, United States
(Douketis) Department of Medicine, McMaster University, Hamilton, ON,
Canada
Publisher
Elsevier Inc.
Abstract
Background: The management of patients who are receiving chronic oral
anticoagulation therapy and require an elective surgery or an invasive
procedure is a common clinical scenario. Research Question: What is the
best available evidence to support the development of American College of
Chest Physicians guidelines on the perioperative management of patients
who are receiving long-term vitamin K agonist (VKA) or direct oral
anticoagulant (DOAC) and require elective surgery or procedures? Study
Design and Methods: A literature search including multiple databases from
database inception through July 16, 2020, was performed. Meta-analyses
were conducted when appropriate. <br/>Result(s): In patients receiving VKA
(warfarin) undergoing elective noncardiac surgery, shorter (< 3 days) VKA
interruption is associated with an increased risk of major bleeding. In
patients who required VKA interruption, heparin bridging (mostly with
low-molecular-weight heparin [LMWH]) was associated with a statistically
significant increased risk of major bleed, representing a very low
certainty of evidence (COE). Compared with DOAC interruption 1 to 4 days
before surgery, continuing DOACs may be associated with higher risk of
bleeding demonstrated in some, but not all studies. In patients who needed
DOAC interruption, bridging with LMWH may be associated with a
statistically significant increased risk of bleeding, representing a low
COE. <br/>Interpretation(s): The certainty in the evidence supporting the
perioperative management of anticoagulants remains limited. No
high-quality evidence exists to support the practice of heparin bridging
during the interruption of VKA or DOAC therapy for an elective surgery or
procedure, or for the practice of interrupting VKA therapy for minor
procedures, including cardiac device implantation, or continuation of a
DOAC vs short-term interruption of a DOAC in the perioperative
period.<br/>Copyright &#xa9; 2022 American College of Chest Physicians

<27>
[Use Link to view the full text]
Accession Number
2021804148
Title
Humoral and Cellular Response of Transplant Recipients to a Third Dose of
mRNA SARS-CoV-2 Vaccine: A Systematic Review and Meta-analysis.
Source
Transplantation. 107(1) (pp 204-215), 2023. Date of Publication: 01 Jan
2023.
Author
Bailey A.J.M.; Maganti H.B.; Cheng W.; Shorr R.; Arianne Buchan C.; Allan
D.S.
Institution
(Bailey, Arianne Buchan, Allan) Faculty of Medicine, University of Ottawa,
Ottawa, ON, Canada
(Bailey, Maganti, Allan) Canadian Blood Services, Stem Cells and Centre
for Innovation, Ottawa, ON, Canada
(Maganti, Allan) Clinical Epidemiology and Regenerative Medicine, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Cheng) Department of Biostatistics, Yale School of Public Health, New
Haven, CT, United States
(Shorr) Library and Information Services, The Ottawa Hospital, Ottawa, ON,
Canada
(Arianne Buchan) Division of Infectious Diseases, Department of Medicine,
The Ottawa Hospital, Ottawa, ON, Canada
(Allan) Blood and Marrow Transplant Program, Division of Hematology,
Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background. High rates of nonresponse to 2 doses of mRNA severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine have been reported
in transplant recipients. Several studies have investigated the efficacy
of a third dose in this population. However, efficacy remains unclear, as
response rates vary across studies. Therefore, we conducted a systematic
review and meta-analysis to determine the efficacy of a third dose of any
mRNA SARS-CoV-2 vaccine in transplant recipients. Methods. Preferred
Reporting Items for Systematic Review and Meta-Analysis reporting
guidelines (PROSPERO:CRD42021281498) were followed. Medline, Embase, and
CENTRAL were searched from inception to December 2, 2021, without
restrictions. All full-text studies reporting on the efficacy of a third
dose of any mRNA SARS-CoV-2 vaccine in pediatric and adult transplant
recipients were included. The National Institutes of Health quality
assessment tool for case series and the Cochrane risk of bias tool
determined study quality. Meta-analysis was performed via the
DerSimonian-Laird random-effect model. Results. Of 84 records, 12 studies
totaling 1257 patients met inclusion criteria. One study was a randomized
controlled trial, whereas all other studies were observational. Across 7
studies (801 patients), humoral response after 3 doses was observed in
66.1% (95% confidence interval, 62.8%-69.4%; I²= 0%) of
transplant recipients. Triple immunosuppression, mycophenolate,
antiproliferatives, and belatacept use were associated with reduced odds
of humoral response in studies reporting multivariate analyses. Transplant
recipients receiving a third dose displayed higher levels of neutralizing
antibodies to SARS-CoV-2 variants (Alpha, Beta, and Delta) compared with
placebo. Conclusions. A third dose SARS-CoV-2 mRNA vaccine should be
strongly considered in transplant recipients. Limitations included lack of
controlled studies and clinically relevant thresholds to determine
response to vaccination.<br/>Copyright &#xa9; 2023 Lippincott Williams and
Wilkins. All rights reserved.

<28>
Accession Number
2021799115
Title
Performance of CardioCel in Cardiac Surgery: A Systematic Review.
Source
World Journal for Pediatric and Congenital Heart Surgery. 14(2) (pp
211-219), 2023. Date of Publication: March 2023.
Author
Patukale A.A.; Suna J.; Anand A.; Betts K.S.; Karl T.R.; Venugopal P.;
Marathe S.P.; Alphonso N.
Institution
(Patukale, Suna, Anand, Karl, Venugopal, Marathe, Alphonso) Queensland
Paediatric Cardiac Service (QPCS), Queensland Children's Hospital,
Brisbane, Australia
(Patukale, Suna, Anand, Karl, Venugopal, Marathe, Alphonso) School of
Clinical Medicine, Children's Health Queensland Clinical Unit, University
of Queensland, Brisbane, Australia
(Patukale, Suna, Anand, Karl, Venugopal, Marathe, Alphonso) Centre for
Child Health Research, University of Queensland, Brisbane, Australia
(Betts) School of Population Health, Curtin University, Perth, Australia
Publisher
SAGE Publications Inc.
Abstract
A systematic review was performed for evaluation of the performance of
CardioCel in cardiac surgery. The review included all studies
published from January 2013 to December 2020. We conclude that CardioCel
is a strong, flexible tissue substitute with good handling characteristics
and a low incidence of thrombosis, aneurysm formation, infection, or
structural degeneration. It can be used for a variety of intracardiac and
extracardiac repairs of congenital heart defects in all age groups with
good durability at mid-term follow-up. However, the use of CardioCel in
certain positions requires caution. Information on the long-term
performance of CardioCel is lacking.<br/>Copyright &#xa9; The Author(s)
2023.

<29>
Accession Number
2021621329
Title
Transcutaneous electrical acupoint stimulation for the prevention of
postoperative delirium in elderly surgical patients: A systematic review
and meta-analysis.
Source
Frontiers in Aging Neuroscience. 15 (no pagination), 2023. Article Number:
1046754. Date of Publication: 31 Jan 2023.
Author
Huang K.-Y.; Liang S.; Chen L.; Xu Y.-Y.; Grellet A.
Institution
(Huang, Liang, Chen, Xu) Department of Acupuncture, Ningbo Hospital of
Traditional Chinese Medicine, Affiliated Hospital of Zhejiang Chinese
Medical University, Ningbo, China
(Grellet) The First Clinical Medical College, Nanjing University of
Chinese Medicine, Nanjing, China
Publisher
Frontiers Media S.A.
Abstract
Objective: This systematic review and meta-analysis aimed to evaluate the
preventive effect of transcutaneous electrical acupoint stimulation on
postoperative delirium in elderly surgical patients. <br/>Method(s):
PubMed, CENTRAL, China National Knowledge Infrastructure, and WanFang
databases were searched for randomized controlled trials regarding the
effect of transcutaneous electrical acupoint stimulation on preventing
postoperative delirium in elderly patients undergoing any type of surgery.
The primary outcome was the incidence of postoperative delirium. The
secondary outcome was the duration of postoperative delirium. All analyses
were conducted using RevMan 5.3 and Stata 13.0 software. <br/>Result(s):
Twelve trials with 991 participants were included, and most of them were
at high/unclear risk of bias. Meta-analysis showed transcutaneous
electrical acupoint stimulation could reduce the incidence of
postoperative delirium (RR = 0.40, 95%CI = 0.29 to 0.55, p < 0.00001) and
shorten the duration of postoperative delirium (MD = -0.97 days, 95%CI =
-1.72 to -0.22, p = 0.01). Subgroup analyses demonstrated that
transcutaneous electrical acupoint stimulation reduced the incidence of
postoperative delirium in elderly patients undergoing orthopedic surgery
and thoracic surgery, but not digestive surgery; transcutaneous electrical
acupoint stimulation with dilatational wave and with continuous wave were
both beneficial; and transcutaneous electrical acupoint stimulation was
favored when compared to blank and sham control. <br/>Conclusion(s):
Transcutaneous electrical acupoint stimulation could reduce the incidence
of postoperative delirium and shorten the duration of postoperative
delirium in elderly surgical patients. The findings should be interpreted
with caution due to weak evidence. High-quality, large sample, and
multi-center trials are needed to further confirm the preliminary
findings. Systematic review registration:
https://inplasy.com/inplasy-2022-7-0096/, identifier:
INPLASY202270096.<br/>Copyright &#xa9; 2023 Huang, Liang, Chen, Xu and
Grellet.

<30>
Accession Number
2021731093
Title
Delayed Ventricular Septal Rupture Repair on Patient Outcomes After
Myocardial Infarction: A Systematic Review.
Source
Current Problems in Cardiology. 48(3) (no pagination), 2023. Article
Number: 101521. Date of Publication: March 2023.
Author
Rashid H.; Kumar K.; Ullah A.; Kamin M.; Shafique H.M.; Elahi A.; Najam
A.; Zaidi S.M.J.; Asad M.; Mahmoodi A.; Malik J.
Institution
(Rashid) Department of Medicine, North Manchester General Hospital,
Manchester, United Kingdom
(Kumar) Department of Medicine, Dr. Ruth K.M. Pfau Civil Hospital,
Karachi, Pakistan
(Ullah) Department of Cardiology, Khyber Medical University Institute of
Medical Sciences, Kohat, Pakistan
(Kamin) Department of Endocrinology, Bolan Medical University and Health
Sciences, Quetta, Pakistan
(Shafique) Department of Interventional Cardiology, Armed Forces Institute
of Cardiology, Rawalpindi, Pakistan
(Elahi, Najam) Department of Medicine, Shifa International Hospital,
Islamabad, Pakistan
(Zaidi, Malik) Cardiovascular Analytics Group, Hong Kong, Hong Kong
(Asad) Department of Cardiology, Benazir Bhutto Hospital, Rawalpindi,
Pakistan
(Mahmoodi) Department of Medicine, Ibn e Seena Hospital, Kabul,
Afghanistan
Publisher
Elsevier Inc.
Abstract
Even though the prevalence of VSR after MI is only 1%-3%, the mortality
associated with the condition is more than 80%. Very few studies in the
literature have described in detail the treatment options for delayed VSR
repair. This systematic review was conducted to evaluate the outcomes of
delayed ventricular septal rupture (VSR) repair following acute myocardial
infarction (AMI). Digital databases were searched systematically to
identify studies reporting the outcomes of delayed VSR repair. Detailed
study and patient-level baseline characteristics including the type of
study, sample size, follow-up, number of delayed repairs, time to repair,
outcomes (in terms of major adverse cardiovascular events), and predictors
of outcome were abstracted. A total of 12 studies, recruiting 8,579
patients were included in the final analysis. Male gender, young age (<60
years), and delayed VSR repair were reported as predictors of survival
along with left ventricular assist devices (LVADs) and extracorporeal
membrane oxygenation (ECMO), and the use of inotropes before surgery.
Postoperative renal failure, higher New York Heart Association (NYHA)
score, early repair, and history of heart failure (HF) were demonstrated
as predictors of mortality. This study demonstrated that delayed VSR
repair can reduce mortality in patients who develop VSR after AMI.
Furthermore, the use of LVADs can prolong the time of surgery, and the use
of inotropes can predict survival benefits in this patient
cohort.<br/>Copyright &#xa9; 2022 Elsevier Inc.

<31>
Accession Number
2023847701
Title
Long-Term Outcomes Comparison Between Surgical and Percutaneous Coronary
Revascularization in Patients With Multivessel Coronary Disease or Left
Main Disease: A Systematic Review and Study Level Meta-Analysis of
Randomized Trials.
Source
Current Problems in Cardiology. 48(7) (no pagination), 2023. Article
Number: 101699. Date of Publication: July 2023.
Author
Formica F.; Gallingani A.; Tuttolomondo D.; Hernandez-Vaquero D.; Singh
G.; Pattuzzi C.; Maestri F.; Niccoli G.; Ceccato E.; Lorusso R.; Nicolini
F.
Institution
(Formica, Pattuzzi, Niccoli, Nicolini) Department of Medicine and Surgery,
University of Parma, Parma, Italy
(Gallingani, Pattuzzi, Maestri, Nicolini) Cardio-Thoracic-Vascular
Department, Cardiac Surgery Unit, University Hospital of Parma, Parma,
Italy
(Tuttolomondo, Niccoli) Cardio-Thoracic-Vascular Department, Cardiology
Unit, University Hospital of Parma, Parma, Italy
(Hernandez-Vaquero) Cardiac Surgery Department, Hospital Universitario
Central de Asturias, Oviedo, Spain
(Singh) Department of Critical Care Medicine and Division of Cardiac
Surgery, Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Ceccato) Division of Medical and Law Library, Medical Library, University
of Parma, Parma, Italy
(Lorusso) Department of Cardio-Thoracic Surgery, Cardiovascular Research
Institute Maastricht (CARIM), Maastricht, Netherlands
Publisher
Elsevier Inc.
Abstract
Recent randomized trials comparing coronary artery bypass graft (CABG)
with percutaneous coronary intervention (PCI) utilizing drug-eluting
stents in patients with left main disease (LMD) and/or multivessel disease
(MVD), reported conflicting results. We performed a study level
meta-analysis comparing the 2 interventions for the treatment of LMD or
MVD. Using electronic databases, we retrieved 6 trials, between January,
2010 and December, 2022. Five-years Kaplan-Meier curves of endpoints where
reconstructed. Comparisons were made by cox-linear regression frailty
model and by landmark analysis. A random-effect method was applied. A
total of 8269 patients were included and randomly assigned to CABG (n =
4135) or PCI (n = 4134). During 5-years follow-up, PCI showed a higher
incidence of all-cause mortality (hazard ratio [HR] 1.28; 95% confidence
interval [CI], 1.11-1.47; P < 0.0001]), myocardial infarction (HR 1.84;
95% CI, 1.54-2.19; P < 0.0001) and repeat coronary revascularization (HR
1.96; 95% CI, 1.72-2.24; P < 0.0001). There was no long-term difference
between the 2 interventions for cardiovascular death (P = 0.14) and stroke
(P = 0.20), although the incidence of stroke was higher with CABG within
30-days from intervention (P < 0.0001). PCI was associated with an
increased risk for composite endpoints (P < 0.0001) and major cerebral and
cardiovascular events. (P < 0.0001). In conclusion, at 5-year follow-up,
in patients with LMD and/or MVD there was a significant higher incidence
of all-cause mortality, myocardial infarction and repeat revascularization
with PCI compared to CABG. The incidence of stroke was higher with CABG
during the postprocedural period, but no difference was found during
5-years follow-up. Longer follow-up is mandatory to better define outcome
difference between the 2 interventions.<br/>Copyright &#xa9; 2023 Elsevier
Inc.

<32>
Accession Number
2023792074
Title
Impact of evidence-based bundles on ventilator-associated pneumonia
prevention: A systematic review.
Source
Journal of Infection in Developing Countries. 17(2) (pp 194-201), 2023.
Date of Publication: February 2023.
Author
Da Rocha Gaspar M.D.; Antunes Rinaldi E.C.; Mello R.G.; Dos Santos F.A.;
Nadal J.M.; Andreane Cabral L.P.; Farago P.V.
Institution
(Da Rocha Gaspar, Antunes Rinaldi, Andreane Cabral) Department of Nursing
and Public Health, State University of Ponta Grossa, Parana, Ponta Grossa,
Brazil
(Da Rocha Gaspar, Nadal, Farago) Postgraduate Program in Pharmaceutical
Sciences, Department of Pharmaceutical Sciences, State University of Ponta
Grossa, Parana, Ponta Grossa, Brazil
(Mello) Little Prince Colleges, Parana, Curitiba, Brazil
(Dos Santos) Department of Dentistry, State University of Ponta Grossa,
Parana, Ponta Grossa, Brazil
Publisher
Journal of Infection in Developing Countries
Abstract
Introduction: This review aimed at investigating the impact of bundle
components on the prevention of ventilator-associated pneumonia (VAP) in
adults and the elderly. Methodology: The databases consulted were PubMed,
EBSCO, and Scielo. The terms Bundle and Pneumonia were searched in
combination. The original articles were selected in Spanish and English;
published between January 2008 and December 2017. After eliminating the
duplicate papers, an analysis of the titles and the abstracts was
performed in order to select the assessed articles. A total of 18 articles
were included in this review that were evaluated according to the
following criteria: research reference, country of data collection, type
of study, characteristics of the studied patients, analysis and
intervention performed, bundle items investigated and their results, and
research outcome. <br/>Result(s): Four bundle items were presented in all
the investigated papers. 61% of those works were considered from seven to
eight bundle items. Daily evaluation of sedation interruption and daily
assessment for verifying extubation condition, head-of-bed elevation at 30
degrees, cuff pressure monitoring, coagulation prophylaxis, and oral
hygiene were the most reported bundle items. One study described the
increased mortality of patients under mechanical ventilation when omitted
the bundle items of oral hygiene and stress ulcer prophylaxis. Head-of-bed
elevation at 30 degrees was the item reported in 100% of the studied
papers. <br/>Conclusion(s): Existing research demonstrated that VAP
reduction occurred when bundle items were performed for adults and the
elderly. Four works showed the relevance of team education as a central
approach to the event reduction related to the ventilator.<br/>Copyright
&#xa9; 2023 Da Rocha Gaspar et al. This is an open-access article
distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.

<33>
Accession Number
2023724453
Title
Postoperative pericardial effusion, pericardiotomy, and atrial
fibrillation: An explanatory analysis of the PALACS trial.
Source
American Heart Journal. 260 (pp 113-123), 2023. Date of Publication: June
2023.
Author
Rong L.Q.; Di Franco A.; Rahouma M.; Dimagli A.; Chan J.; Lopes A.J.; Kim
J.; Sanna T.; Devereux R.B.; Delgado V.; Weinsaft J.W.; Crea F.; Alexander
J.H.; Gillinov M.; DiMaio J.M.; Pryor K.O.; Girardi L.; Gaudino M.
Institution
(Rong, Chan, Lopes, Pryor) Department of Anesthesiology, Weill Cornell
Medicine, New York, NY, United States
(Di Franco, Rahouma, Dimagli, Girardi, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United
States
(Kim, Devereux, Weinsaft) Department of Cardiology/Medicine, Weill Cornell
Medicine, New York, NY, United States
(Sanna, Crea) Department of Cardiovascular Medicine, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
(Sanna, Crea) Department of Cardiovascular and Pulmonary Sciences,
Catholic University of the Sacred Heart, Rome, Italy
(Delgado) Department of Cardiology, Heart and Lung Center, Leiden
University Medical Center, Leiden, Netherlands
(Delgado) Department of Cardiology, Heart Institute, Hospital University
Germans Trias i Pujol, Badalona, Spain
(Alexander) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(DiMaio) Department of Cardiothoracic Surgery, Baylor Scott & White The
Heart Hospital, Plano, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: In the Posterior left pericardiotomy for the prevention of
atrial fibrillation after cardiac surgery (PALACS) trial, posterior
pericardiotomy was associated with a significant reduction in
postoperative atrial fibrillation (POAF) after cardiac surgery. We aimed
to investigate the mechanisms underlying this effect. <br/>Method(s): We
included PALACS patients with available echocardiographic data (n =
387/420, 92%). We tested the hypotheses that the reduction in POAF with
the intervention was associated with 1) a reduction in postoperative
pericardial effusion and/or 2) an effect on left atrial size and function.
Spline and multivariable logistic regression analyses were used.
<br/>Result(s): Most patients (n = 307, 79%) had postoperative pericardial
effusions (anterior 68%, postero-lateral 51.9%). The incidence of
postero-lateral effusion was significantly lower in patients undergoing
pericardiotomy (37% vs 67%; P < .001). The median size of anterior
effusion was comparable between patients with and without POAF (5.0 [IQR
3.0-7.0] vs 5.0 [IQR 3.0-7.5] mm; P = .42), but there was a nonsignificant
trend towards larger postero-lateral effusion in the POAF group (5.0 [IQR
3.0-9.0] vs 4.0 [IQR 3.0-6.4] mm; P = .06). There was a non-linear
association between postero-lateral effusion and POAF at a cut-off at 10
mm (OR 2.70; 95% CI 1.13, 6.47; P = .03) that was confirmed in
multivariable analysis (OR 3.5, 95% CI 1.17, 10.58; P = 0.02). Left atrial
dimension and function did not change significantly after posterior
pericardiotomy. <br/>Conclusion(s): Reduction in postero-lateral
pericardial effusion is a plausible mechanism for the effect of posterior
pericardiotomy in reducing POAF. Measures to reduce postoperative
pericardial effusion are a promising approach to prevent
POAF.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<34>
Accession Number
2022389139
Title
Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for
postoperative delirium? A double blinded randomised controlled trial.
Source
Scandinavian Cardiovascular Journal. 57(1) (no pagination), 2023. Article
Number: 2186326. Date of Publication: 2023.
Author
Claesson Lingehall H.; Gustafson Y.; Svenmarker S.; Appelblad M.;
Davidsson F.; Holmner F.; Wahba A.; Olofsson B.
Institution
(Claesson Lingehall, Svenmarker, Appelblad, Davidsson, Holmner, Wahba)
Department of Public Health and Clinical Medicine, Heart Centre, Umea
University, Umea, Sweden
(Claesson Lingehall, Olofsson) Department of Nursing, Umea University,
Umea, Sweden
(Gustafson) Department of Community Medicine and Rehabilitation, Geriatric
Medicine, Umea University, Umea, Sweden
(Wahba) Norwegian University of Circulation and Medical Imagining,
Trondheim, Norway
Publisher
Taylor and Francis Ltd.
Abstract
Objective: Postoperative delirium (POD) is common after cardiac surgery.
We have previously identified plasma sodium concentration and the volume
of infused fluids during surgery as possible risk factors. Both are linked
to the selection and composition of the pump prime used for
cardiopulmonary bypass (CPB). Present study aims to examine whether
hyperosmolality increases the risk for POD. <br/>Design(s): Patients >=65
years (n = 195) scheduled for cardiac surgery were prospectively enrolled
into this double blinded randomised clinical trial. Study group received a
pump prime containing mannitol and ringer-acetate (966 mOsmol) (n = 98)
vs. ringer-acetate (388 mOsmol) (n = 97) in the control group.
Postoperative delirium was defined according to DSM-5 criteria based on a
test-battery pre- and postoperatively (days 1-3). Plasma osmolality was
measured on five occasions and coordinated with the POD assessments. The
primary outcome was the POD incidence related to hyperosmolality as the
secondary outcome. <br/>Result(s): The incidence of POD was 36% in the
study group and 34% in the control group, without intergroup difference
(p=.59). The plasma osmolality was significantly higher in the study
group, both on days 1 and 3 and after CPB (p<.001). Post hoc analysis
indicated that high osmolality levels increased the risk for delirium on
day 1 by 9% (odds ratio (OR) 1.09, 95% CI 1.03-1.15) and by 10% on day 3
(OR 1.10, 95% CI 1.04-1.16). <br/>Conclusion(s): Use of a prime solution
with high osmolality did not increase the incidence of POD. However, the
influence of hyperosmolality as a risk factor for POD warrants further
investigation.<br/>Copyright &#xa9; 2023 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<35>
Accession Number
2022850267
Title
Empagliflozin in acute myocardial infarction: the EMMY trial.
Source
European Heart Journal. 43(41) (pp 4421-4432), 2022. Date of Publication:
01 Nov 2022.
Author
Von Lewinski D.; Kolesnik E.; Tripolt N.J.; Pferschy P.N.; Benedikt M.;
Wallner M.; Alber H.; Berger R.; Lichtenauer M.; Saely C.H.; Moertl D.;
Auersperg P.; Reiter C.; Rieder T.; Siller-Matula J.M.; Gager G.M.; Hasun
M.; Weidinger F.; Pieber T.R.; Zechner P.M.; Herrmann M.; Zirlik A.;
Holman R.R.; Oulhaj A.; Sourij H.
Institution
(Von Lewinski, Kolesnik, Benedikt, Wallner, Zirlik) Department of Internal
Medicine, Division of Cardiology, Medical University of Graz,
Auenbruggerplatz 15, Graz 8036, Austria
(Tripolt, Pferschy, Pieber, Sourij) Department of Internal Medicine,
Division of Endocrinology and Diabetology, Medical University of Graz,
Auenbruggerplatz 15, Graz 8036, Austria
(Tripolt, Pferschy, Sourij) Interdisciplinary Metabolic Medicine Trials
Unit, Medical University of Graz, Graz, Austria
(Alber) Department of Cardiology, Public Hospital Klagenfurt am
Woerthersee, Klagenfurt am Woerthersee, Austria
(Berger) Department of Internal Medicine, Brothers of Saint John of God
Eisenstadt, Eisenstadt, Austria
(Lichtenauer) Department of Internal Medicine II, Division of Cardiology
and Internal Intensive Care Medicine, Paracelsus Medical Private
University Salzburg, Salzburg, Austria
(Saely) Vorarlberg Institute for Vascular Investigation and Treatment
(VIVIT), Feldkirch, Austria
(Moertl, Auersperg) Karl Landsteiner University of Health Sciences, Krems
3050, Austria
(Moertl, Auersperg) Department of Internal Medicine 3, University Hospital
St. Poelten, St. Poelten 3100, Austria
(Reiter) Department of Cardiology and Intensive Care Medicine, Kepler
University Hospital Linz, Linz, Austria
(Rieder) Department of Medicine, Kardinal Schwarzenberg Hospital
Schwarzach, Schwarzach, Austria
(Siller-Matula, Gager) Department of Cardiology, Medical University of
Vienna, Vienna, Austria
(Hasun, Weidinger) 2nd Medical Department with Cardiology and Intensive
Care Medicine, Hospital Landstrasse, Vienna, Austria
(Zechner) Department of Cardiology and Intensive Care Medicine, Hospital
Graz South West, West Location, Graz, Austria
(Herrmann) Clinical Institute of Medical and Chemical Laboratory
Diagnostics, Medical University of Graz, Graz, Austria
(Holman) Radcliffe Department of Medicine, University of Oxford, Oxford,
United Kingdom
(Oulhaj) Department of Epidemiology and Population Health, College of
Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab
Emirates
(Oulhaj) Research and Data Intelligence Support Center, Khalifa
University, Abu Dhabi, United Arab Emirates
Publisher
Oxford University Press
Abstract
Aims: Sodium-glucose co-transporter 2 inhibition reduces the risk of
hospitalization for heart failure and for death in patients with
symptomatic heart failure. However, trials investigating the effects of
this drug class in patients following acute myocardial infarction are
lacking. <br/>Methods and Results: In this academic, multicentre,
double-blind trial, patients (n = 476) with acute myocardial infarction
accompanied by a large creatine kinase elevation (>800 IU/L) were randomly
assigned to empagliflozin 10 mg or matching placebo once daily within 72 h
of percutaneous coronary intervention. The primary outcome was the
N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) change
over 26 weeks. Secondary outcomes included changes in echocardiographic
parameters. Baseline median (interquartile range) NT-proBNP was 1294
(757-2246) pg/mL. NT-proBNP reduction was significantly greater in the
empagliflozin group, compared with placebo, being 15% lower [95%
confidence interval (CI) -4.4% to -23.6%] after adjusting for baseline
NT-proBNP, sex, and diabetes status (P = 0.026). Absolute left-ventricular
ejection fraction improvement was significantly greater (1.5%, 95% CI
0.2-2.9%, P = 0.029), mean E/e' reduction was 6.8% (95% CI 1.3-11.3%, P =
0.015) greater, and left-ventricular end-systolic and end-diastolic
volumes were lower by 7.5 mL (95% CI 3.4-11.5 mL, P = 0.0003) and 9.7 mL
(95% CI 3.7-15.7 mL, P = 0.0015), respectively, in the empagliflozin
group, compared with placebo. Seven patients were hospitalized for heart
failure (three in the empagliflozin group). Other predefined serious
adverse events were rare and did not differ significantly between groups.
<br/>Conclusion(s): In patients with a recent myocardial infarction,
empagliflozin was associated with a significantly greater NT-proBNP
reduction over 26 weeks, accompanied by a significant improvement in
echocardiographic functional and structural parameters.<br/>Copyright
&#xa9; 2022 The Author(s). Published by Oxford University Press on behalf
of European Society of Cardiology.

<36>
Accession Number
2022850165
Title
Riociguat in pulmonary hypertension and heart failure with preserved
ejection fraction: The haemoDYNAMIC trial.
Source
European Heart Journal. 43(36) (pp 3402-3413), 2022. Date of Publication:
21 Sep 2022.
Author
Dachs T.M.; Duca F.; Rettl R.; Binder-Rodriguez C.; Dalos D.; Ligios L.C.;
Kammerlander A.; Grunig E.; Pretsch I.; Steringer-Mascherbauer R.;
Ablasser K.; Wargenau M.; Mascherbauer J.; Lang I.M.; Hengstenberg C.;
Badr-Eslam R.; Kastner J.; Bonderman D.
Institution
(Dachs, Duca, Rettl, Binder-Rodriguez, Dalos, Ligios, Kammerlander,
Mascherbauer, Lang, Hengstenberg, Badr-Eslam, Kastner, Bonderman) Division
of Cardiology, Department of Internal Medicine II, Medical University of
Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
(Grunig) Centre for Pulmonary Hypertension Thoraxklinik at Heidelberg
University Hospital, Translational Lung Research Centre Heidelberg (TLRC),
German Centre for Lung Research (DZL), Heidelberg 69126, Germany
(Pretsch) Division of Cardiology and Intensive Care, Department of
Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner
Hauptstrase 48, Salzburg 5020, Austria
(Steringer-Mascherbauer) Division of Cardiology Angiology and Intensive
Care, Department of Internal Medicine II, Public Hospital Elisabethinen
Linz, Fadingerstrase 1, Linz 4020, Austria
(Ablasser) Division of Cardiology, Medical University of Graz,
Auenbruggerplatz 15, Graz 8036, Austria
(Wargenau) M.A.R.C.O. GmbH and Co. KG, Institute for Clinical Research and
Statistics, Schirmerstrase 71, Duesseldorf 40211, Germany
(Mascherbauer) Division of Cardiology, Department of Internal Medicine
III, University Hospital of St. Poelten, Dunant-Platz 1, St. Poelten 3100,
Austria
(Bonderman) Division of Cardiology, Department of Internal Medicine v,
Favoriten Clinic, Kundratstrase 3, Vienna 1100, Austria
Publisher
Oxford University Press
Abstract
Aims: The presence of pulmonary hypertension (PH) severely aggravates the
clinical course of heart failure with preserved ejection fraction (HFpEF).
To date, neither established heart failure therapies nor pulmonary
vasodilators proved beneficial. This study investigated the efficacy of
chronic treatment with the oral soluble guanylate cyclase stimulator
riociguat in patients with PH-HFpEF. <br/>Methods and Results: The phase
IIb, randomized, double-blind, placebo-controlled, parallel-group,
multicentre DYNAMIC trial assessed riociguat in PH-HFpEF. Patients were
recruited at five hospitals across Austria and Germany. Key eligibility
criteria were mean pulmonary artery pressure >=25mmHg, pulmonary arterial
wedge pressure >15mmHg, and left ventricular ejection fraction >=50%.
Patients were randomized to oral treatment with riociguat or placebo
(1:1). Patients started at 0.5mg three times daily (TID) and were
up-Titrated to 1.5mg TID. The primary efficacy endpoint was change from
baseline to week 26 in cardiac output (CO) at rest, measured by right
heart catheterization. Primary efficacy analyses were performed on the
full analysis set. Fifty-eight patients received riociguat and 56 patients
placebo. After 26 weeks, CO increased by 0.37 +/- 1.263L/min in the
riociguat group and decreased by-0.11 +/- 0.921L/min in the placebo group
(least-squares mean difference: 0.54L/min, 95% confidence interval 0.112,
0.971; P = 0.0142). Five patients dropped out due to riociguat-related
adverse events but no riociguat-related serious adverse event or death
occurred. <br/>Conclusion(s): The vasodilator riociguat improved
haemodynamics in PH-HFpEF. Riociguat was safe in most patients but led to
more dropouts as compared to placebo and did not change clinical symptoms
within the study period.<br/>Copyright &#xa9; 2022 The Author(s).
Published by Oxford University Press on behalf of European Society of
Cardiology.

<37>
Accession Number
2023770695
Title
Effect of combined use of cerebral oximetry and electroencephalogram
monitoring on the incidence of perioperative neurocognitive disorders in
adult cardiac and non-cardiac surgery: A systematic review of randomized
and non-randomized trials.
Source
Acta Anaesthesiologica Belgica. 73(4) (pp 221-234), 2022. Date of
Publication: December 2022.
Author
Souberbielle Q.; Sariyar A.J.; Momeni M.
Institution
(Souberbielle, Sariyar, Momeni) Department of Anesthesiology, Cliniques
Universitaires Saint-Luc, Universite Catholique de Louvain (UCLouvain),
Institut de Recherche Experimentale et Clinique (IREC), Belgium
Publisher
BeSARPP
Abstract
Background: There is insufficient evidence to recommend using either
intraoperative cerebral oximetry or (processed) electroencephalogram (EEG)
alone for preventing perioperative neurocognitive disorders (PNDs).
<br/>Objective(s): : To evaluate the effectiveness of combined use of
cerebral oximetry and electroencephalogramguided anesthesia on the
incidence of PNDs in adult patients undergoing cardiac and non-cardiac
interventions. <br/>Method(s): A PICOS - based systematic review of
English articles using Pubmed and Embase (from inception to August 2022)
was performed. There were no exclusion criteria regarding the type of the
study. Abstract proceedings and new study protocols or ongoing studies
were not included. Review articles were analyzed in search of eligible
references. All possible terms that were illustrative of PNDs were used.
<br/>Result(s): Among the 63 full manuscripts that were analyzed in
detail, 15 met the inclusion criteria. We found 2 retrospective, 8
prospective observational and 5 randomized controlled trials of which 1
did not evaluate the use of neuromonitoring in the randomization process.
The definition and the methods used to diagnose PNDs were very
heterogeneous. Only 8 studies used an algorithm to avoid/treat cerebral
oxygen desaturation and/or to treat EEG abnormalities. Overall, there was
a tendency towards less PNDs in studies where such an algorithm was used.
<br/>Conclusion(s): Our results suggest that integrating information
obtained from cerebral oximetry and an EEG monitor may reduce the
incidence of PNDs whenever an adapted algorithm is used to improve brain
function.<br/>Copyright &#xa9; 2022 ARSMB-KVBMG. All rights reserved.

<38>
Accession Number
2022819156
Title
Predictors of gastrointestinal bleeding in patients following left
ventricular assist device implantation: a systematic review and
meta-analysis.
Source
Future Cardiology. 18(12) (pp 957-967), 2022. Date of Publication: 2022.
Author
Gangwani M.K.; Aziz M.; Nawras A.; Priyanka F.; Ahmed Z.; Khan R.S.; Qamar
M.A.; Haroon F.; Aziz A.; Smith W.L.; Ravi S.J.K.; Parikh V.; Alyousif Z.;
Mahmood A.; Tariq R.; Rai D.; Aronow W.S.
Institution
(Gangwani, Ahmed, Alyousif, Mahmood) Department of Medicine, University of
Toledo Medical Center, Toledo, OH 43614, United States
(Aziz, Nawras) Department of Gastroenetrology, University of Toledo
Medical Center, Toledo, OH 43614, United States
(Priyanka) Department of Medicine, Chandka Medical College, Larkana,
Pakistan
(Khan) Department of Gastroenetrology, Baylor College of Medicine,
Houston, TX 77030, United States
(Qamar) Division of Surgery, Ziauddin Medical College, Karachi, Pakistan
(Haroon) Department of Internal Medicine, Mercy Hospital, St. Louis, MO
63141, United States
(Aziz) Department of Medicine, Aga Khan University, United States
(Smith) Department of Toledo Libraries, University of Toledo, Toledo, OH
43614, United States
(Ravi) Department of Gastroenterology, Guthrie Robert Packer Hospital,
Sayre, PA 18840, United States
(Parikh, Rai) Department of Cardiology, Sands Constellation Heart
Institute, Rochester Regional Health, Rochester, NY 14621, United States
(Aronow) Department of Cardiology, Westchester Medical Center, Valhalla,
NY 10595, United States
(Tariq) Department of Gastroenterology, Mayo Clinic, Rochester, MN 55902,
United States
Publisher
Newlands Press Ltd
Abstract
Aim: Our study aims to provide a more holistic understanding of the
available data and predictive risk factors for gastrointestinal bleed
(GIB). <br/>Material(s) and Method(s): We searched MEDLINE, Embase,
Cochrane Central Register of Controlled Trials and Web of Science Core
Collection and calculated relative risk and meta-regression was utilized
to evaluate for risk factors in order to assess the effect of covariates.
<br/>Result(s): Our meta-analysis reported a pooled prevalence rate of GIB
of 24.4%. Meta-regression analysis did not yield a statistically
significant association between GIB and risk factors, including age,
gender, hypertension, chronic kidney disease and diabetes.
<br/>Conclusion(s): Studies investigating larger sample sizes are required
for conclusive findings.<br/>Copyright &#xa9; 2022 Future Medicine Ltd.

<39>
Accession Number
2022819151
Title
Surgical valvotomy versus balloon dilatation for children with severe
aortic valve stenosis: a systematic review.
Source
Future Cardiology. 18(11) (pp 901-913), 2022. Date of Publication: 2022.
Author
Elhedai H.; Mohamed S.S.S.; Idriss H.; Bhattacharya P.; Mohamedahmed
A.Y.Y.
Institution
(Elhedai) Department of Cardiology, Birmingham Women's & Children's Nhs
Foundation Trust, Birmingham, United Kingdom
(Mohamed) Anaesthesia & Intensive Care Department, Sudan Medical
Specialization Board, Khartoum, Sudan
(Idriss) Department of Paediatrics, Homerton University Hospitals Nhs
Trust, London, United Kingdom
(Bhattacharya, Mohamedahmed) Department of General Surgery, Sandwell &
West Birmingham Hospitals Nhs Trust, Birmingham, United Kingdom
Publisher
Newlands Press Ltd
Abstract
Aim: To evaluate outcomes of interventions for severe aortic valve
stenosis (AS), whether it is done by surgical aortic valvotomy (SAV) or
balloon aortic dilatation (BAD). <br/>Result(s): Eleven studies with total
number of 1733 patients; 743 patients had SAV, while 990 patients received
BAD. There was no significant difference in early mortality (odds ratio
[OR]: 0.96, p = 0.86), late mortality (OR: 1.28, p = 0.25), total
mortality (OR: 1.10, p = 0.56), and freedom from aortic valve replacement
(OR: 1.00, p = 1.00). Reduction of aortic systolic gradient was
significantly higher in the SAV group (OR: 2.24, p = 0.00001), and
postprocedural AR rate was lower in SAV group (OR: 0.21, p = 0.00001).
<br/>Conclusion(s): SAV is associated with better reduction of aortic
systolic gradient and lesser post procedural AR which reduce when compared
with BAD.<br/>Copyright &#xa9; 2022 Future Medicine Ltd.

<40>
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.

<41>
Accession Number
640357998
Title
Warm versus cold blood cardioplegia in paediatric congenital heart
surgery: a randomized trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 63(4) (no pagination),
2023. Date of Publication: 03 Apr 2023.
Author
Stoica S.; Smartt H.J.M.; Heys R.; Sheehan K.; Walker-Smith T.; Parry A.;
Beringer R.; Ttofi I.; Evans R.; Dabner L.; Ghorbel M.T.; Lansdowne W.;
Reeves B.C.; Angelini G.D.; Rogers C.A.; Caputo M.
Institution
(Stoica, Sheehan, Parry, Beringer, Ttofi, Lansdowne, Caputo) Bristol Royal
Hospital for Children, University Hospitals Bristol and Weston NHS
Foundation Trust, Bristol, United Kingdom
(Smartt, Heys, Walker-Smith, Evans, Dabner, Reeves, Rogers) Bristol Trials
Centre, Bristol Medical School, University of Bristol, Bristol, United
Kingdom
(Smartt, Heys, Sheehan, Walker-Smith, Evans, Dabner, Reeves, Angelini,
Rogers) National Institute for Health Research Bristol Biomedical Research
Centre, University Hospitals Bristol and Weston NHS Foundation Trust and
University of Bristol, Bristol, United Kingdom
(Ghorbel, Angelini, Caputo) Bristol Heart Institute, University of
Bristol, Bristol, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Intermittent cold blood cardioplegia is commonly used in
children, whereas intermittent warm blood cardioplegia is widely used in
adults. We aimed to compare clinical and biochemical outcomes with these 2
methods. <br/>METHOD(S): A single-centre, randomized controlled trial was
conducted to compare the effectiveness of warm (>=34degreeC) versus cold
(4-6degreeC) antegrade cardioplegia in children. The primary outcome was
cardiac troponin T over the 1st 48 postoperative hours. Intensive care
teams were blinded to group allocation. Outcomes were compared by
intention-to-treat using linear mixed-effects, logistic or Cox regression.
<br/>RESULT(S): 97 participants with median age of 1.2years were
randomized (49 to warm, 48 to cold cardioplegia); 59 participants (61%)
had a risk-adjusted congenital heart surgery score of 3 or above. There
were no deaths and 92 participants were followed to 3-months. Troponin
release was similar in both groups [geometric mean ratio 1.07; 95%
confidence interval (CI) 0.79-1.44; P=0.66], as were other cardiac
function measures (echocardiography, arterial and venous blood gases,
vasoactive-inotrope score, arrhythmias). Intensive care stay was on
average 14.6h longer in the warm group (hazard ratio 0.52; 95% CI
0.34-0.79; P=0.003), with a trend towards longer overall hospital stays
(hazard ratio 0.66; 95% CI 0.43-1.02; P=0.060) compared with the cold
group. This could be related to more unplanned reoperations on bypass in
the warm group compared to cold group (3 vs 1). <br/>CONCLUSION(S): Warm
blood cardioplegia is a safe and reproducible technique but does not
provide superior myocardial protection in paediatric heart
surgery.<br/>Copyright &#xa9; The Author(s) 2023. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<42>
Accession Number
641028283
Title
Propofol and survival: an updated meta-analysis of randomized clinical
trials.
Source
Critical care (London, England). 27(1) (pp 139), 2023. Date of
Publication: 12 Apr 2023.
Author
Kotani Y.; Pruna A.; Turi S.; Borghi G.; Lee T.C.; Zangrillo A.; Landoni
G.; Pasin L.
Institution
(Kotani, Pruna, Turi, Borghi, Zangrillo, Landoni) Department of Anesthesia
and Intensive Care, San Raffaele Hospital, IRCCS San Raffaele Scientific
Institute, Via Olgettina, Milan 60-20132, Italy
(Kotani, Zangrillo, Landoni) School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Lee) Division of Infectious Diseases, Department of Medicine, McGill
University, Montreal, QC, Canada
(Pasin) Anesthesia and Intensive Care Unit, Padua University Hospital,
Padua, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Propofol is one of the most widely used hypnotic agents in the
world. Nonetheless, propofol might have detrimental effects on clinically
relevant outcomes, possibly due to inhibition of other interventions'
organ protective properties. We performed a systematic review and
meta-analysis of randomized controlled trials to evaluate if propofol
reduced survival compared to any other hypnotic agent in any clinical
setting. <br/>METHOD(S): We searched eligible studies in PubMed, Google
Scholar, and the Cochrane Register of Clinical Trials. The following
inclusion criteria were used: random treatment allocation and comparison
between propofol and any comparator in any clinical setting. The primary
outcome was mortality at the longest follow-up available. We conducted a
fixed-effects meta-analysis for the risk ratio (RR). Using this RR and 95%
confidence interval, we estimated the probability of any harm (RR>1)
through Bayesian statistics. We registered this systematic review and
meta-analysis in PROSPERO International Prospective Register of Systematic
Reviews (CRD42022323143). <br/>RESULT(S): We identified 252 randomized
trials comprising 30,757 patients. Mortality was higher in the propofol
group than in the comparator group (760/14,754 [5.2%] vs. 682/16,003
[4.3%]; RR=1.10; 95% confidence interval, 1.01-1.20; p=0.03; I2=0%; number
needed to harm=235), corresponding to a 98.4% probability of any increase
in mortality. A statistically significant mortality increase in the
propofol group was confirmed in subgroups of cardiac surgery, adult
patients, volatile agent as comparator, large studies, and studies with
low mortality in the comparator arm. <br/>CONCLUSION(S): Propofol may
reduce survival in perioperative and critically ill patients. This needs
careful assessment of the risk versus benefit of propofol compared to
other agents while planning for large, pragmatic multicentric randomized
controlled trials to provide a definitive answer.<br/>Copyright &#xa9;
2023. The Author(s).

<43>
Accession Number
641027878
Title
Early and mid-term outcomes of off-pump versus on-pump coronary artery
bypass surgery in patients with triple-vessel coronary artery disease: a
randomized controlled trial.
Source
Journal of cardiothoracic surgery. 18(1) (pp 140), 2023. Date of
Publication: 13 Apr 2023.
Author
Forouzannia S.M.; Forouzannia S.K.; Yarahmadi P.; Alirezaei M.; Shafiee
A.; Anari N.Y.; Masoudkabir F.; Dehghani Z.; Pashang M.
Institution
(Forouzannia, Yarahmadi, Alirezaei) Tehran Heart Center, Cardiovascular
Diseases Research Institute, Tehran University of Medical Sciences, North
Kargar St, Tehran, Iran, Islamic Republic of
(Forouzannia) Tehran Heart Center, Cardiovascular Diseases Research
Institute, Tehran University of Medical Sciences, North Kargar St, Tehran,
Iran, Islamic Republic of
(Shafiee, Masoudkabir, Dehghani, Pashang) Cardiac Primary Prevention
Research Center, Cardiovascular Diseases Research Institute, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Anari) Faculty of Medicine, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND AND AIM OF THE STUDY: Several studies have compared early and
late outcomes of on-pump coronary artery bypass grafting (CABG) and
off-pump CABG. However, there is still an ongoing debate on this matter,
especially in patients with triple-vessel coronary artery disease (3VD).
<br/>METHOD(S): We randomly assigned 274 consecutive patients with 3VD to
two equal groups to undergo on-pump CABG or off-pump CABG. The primary
outcome was major adverse cardiac and cerebrovascular events (MACCE),
including all-cause mortality, acute coronary syndrome, stroke or
transient ischemic attack, and the need for repeat revascularization. The
secondary outcomes were postoperative infection, ventilation time, ICU
admission duration, hospital stay length, and renal failure after surgery.
<br/>RESULT(S): The median follow-up duration was 31.2 months (range
24.6-35.2 months). The mean age of patients was 61.4+/-9.3 years (range:
38-86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE
occurrences in on-pump and off-pump groups, respectively (P value=0.23).
MACCE components including all-cause death, non-fatal MI, CVA, and
revascularization did not significantly differ between on-pump and
off-pump groups. We observed no difference in the occurrence of MACCE
between off-pump and on-pump groups in multivariable regression analysis
(HR=0.57; 95% CI 0.24-1.32; P value=0.192). There were no statistical
differences in postoperative outcomes between the off-pump and on-pump
CABG groups. <br/>CONCLUSION(S): Off-pump CABG is an equal option to
on-pump CABG for 3VD patients with similar rates of MACCE and
postoperative complications incidence when surgery is performed in the
same setting by an expert surgeon in both methods.
(IRCT20190120042428N1).<br/>Copyright &#xa9; 2023. The Author(s).

<44>
Accession Number
2023871814
Title
Serratus anterior and pectoralis plane blocks for robotically assisted
mitral valve repair: a randomised clinical trial.
Source
British Journal of Anaesthesia. (no pagination), 2023. Date of
Publication: 2023.
Author
Alfirevic A.; Marciniak D.; Duncan A.E.; Kelava M.; Yalcin E.K.;
Hamadnalla H.; Pu X.; Sessler D.I.; Bauer A.; Hargrave J.; Bustamante S.;
Gillinov M.; Wierup P.; Burns D.J.P.; Lam L.; Turan A.
Institution
(Alfirevic, Marciniak, Duncan, Kelava, Bauer, Hargrave, Bustamante)
Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland,
OH, United States
(Duncan, Yalcin, Pu, Sessler, Turan) Department of Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
(Yalcin, Turan) Department of General Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Hamadnalla) Department of Anesthesiology, Pain Management and
Perioperative Medicine, Henry Ford Health System, Detroit, MI, United
States
(Pu) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Gillinov, Burns) Department of Thoracic and Cardiovascular Surgery and
Cleveland Clinic, Cleveland, OH, United States
(Wierup) Department of Cardiothoracic Surgery, Lund University, Lund,
Sweden
(Lam) Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH,
United States
Publisher
Elsevier Ltd
Abstract
Background: Minimally invasive cardiac surgery provokes substantial pain
and therefore analgesic consumption. The effect of fascial plane blocks on
analgesic efficacy and overall patient satisfaction remains unclear. We
therefore tested the primary hypothesis that fascial plane blocks improve
overall benefit analgesia score (OBAS) during the initial 3 days after
robotically assisted mitral valve repair. Secondarily, we tested the
hypotheses that blocks reduce opioid consumption and improve respiratory
mechanics. <br/>Method(s): Adults scheduled for robotically assisted
mitral valve repairs were randomised to combined pectoralis II and
serratus anterior plane blocks or to routine analgesia. The blocks were
ultrasound-guided and used a mixture of plain and liposomal bupivacaine.
OBAS was measured daily on postoperative Days 1-3 and were analysed with
linear mixed effects modelling. Opioid consumption was assessed with a
simple linear regression model and respiratory mechanics with a linear
mixed model. <br/>Result(s): As planned, we enrolled 194 patients, with 98
assigned to blocks and 96 to routine analgesic management. There was
neither time-by-treatment interaction (P=0.67) nor treatment effect on
total OBAS over postoperative Days 1-3 with a median difference of 0.08
(95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated
ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no
evidence of a treatment effect on cumulative opioid consumption or
respiratory mechanics. Average pain scores on each postoperative day were
similarly low in both groups. <br/>Conclusion(s): Serratus anterior and
pectoralis plane blocks did not improve postoperative analgesia,
cumulative opioid consumption, or respiratory mechanics during the initial
3 days after robotically assisted mitral valve repair. Clinical trial
registration: NCT03743194.<br/>Copyright &#xa9; 2023 British Journal of
Anaesthesia

<45>
Accession Number
2021281738
Title
Neuromarkers which can predict neurodevelopmental impairment among
children with congenital heart defects after cardiac surgery: A systematic
literature review.
Source
Developmental Neurorehabilitation. 26(3) (pp 206-215), 2023. Date of
Publication: 2023.
Author
Chiperi L.E.; Tecar C.; Toganel R.
Institution
(Chiperi) Department of Pediatric Cardiology, Emergency Institute for
Cardiovascular Diseases and Heart Transplant, Targu Mures, Romania
(Chiperi) Doctoral School of I.O.S.U.D, George Emil Palade University of
Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
(Tecar) Department of Neurosciences, Iuliu Hatieganu University of
Medicine and Pharmacy, Cluj-Napoca, Romania
(Toganel) Department of Pediatrics, George Emil Palade University of
Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
Publisher
Taylor and Francis Ltd.
Abstract
The aim of this systematic literature review was to assess the data
regarding neuromarkers used to evaluate the impact of cardiovascular
surgery on neurodevelopmental pattern of children with congenital heart
defects. A systematic search was performed on PubMed and Google Scholar
databases. Out of 713 publications screened, 10 studies (471 patients) met
the inclusion criteria. The included studies were coded on several
variables: number and heterogeneity of patients (age, congenital heart
defects), exclusion of patients with conditions that predispose to
neurological impairment, neuroimaging workup pre- and post-surgery,
neurodevelopmental assessment, interventions (part of a different study),
and follow-up period. Results were reported according to PRISMA
guidelines. Findings include: neuron-specific enolase and brain-derived
neurotrophic factor are not reliable neuromarkers, for protein S100B
different results were reported, for activin A there is lack of evidence,
and glial fibrillary acidic protein could represent a reliable neuromarker
for acute brain-injury. Directions for future research are
discussed.<br/>Copyright &#xa9; 2023 Taylor & Francis Group, LLC.

<46>
Accession Number
2015199578
Title
Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia
and custodiol cardioplegia in minimally invasive cardiac surgery.
Source
Perfusion (United Kingdom). 38(3) (pp 464-472), 2023. Date of Publication:
April 2023.
Author
Chan J.; Oo S.; Butt S.; Benedetto U.; Caputo M.; Angelini G.D.; Vohra
H.A.
Institution
(Chan, Oo, Benedetto, Angelini, Vohra) Department of Cardiac Surgery,
Bristol Heart Institute, Bristol, United Kingdom
(Butt) Department of Perfusion Sciences, St George's Hospital, London,
United Kingdom
(Caputo) Department of Cardiac Surgery, Bristol Royal Hospital for
Children, Bristol, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Introduction: Minimally invasive cardiac surgery has been evolving, with
the intention of reducing surgical trauma, improve cosmesis and patient
satisfaction. Single dose, crystalloid cardioplegia such as Del Nido
cardioplegia and Custoidol solution have been increasingly used to reduce
the interruption from repeating cardioplegia dosing to minimise the
cardiopulmonary bypass and cross clamp time. However, the best
cardioplegia for myocardial protection in adult minimally invasive cardiac
surgery remains controversial. We aimed to conduct a meta-analysis to
analyse the current evidence in the literature. <br/>Method(s): A
systematic review and meta-analysis was performed following the updated
2020 PRISMA guideline. Articles published in the five major electronic
databases up 1st of April 2021 were identified and reviewed. The primary
outcome was in-hospital or 30-day mortality. Traditional pairwise and
Bayesian network meta-analyses were conducted. <br/>Result(s): Nine
articles were included in this study. The use of Del Nido cardioplegia was
associated with a lower volume of cardioplegia used (Del Nido vs Blood,
1105.62 mL+/-123.47 vs 2569.46 mL+/-1515.52, p<0.001), cardiopulmonary
bypass (Del Nido vs Custoidol vs Blood: 91.67+/-14.78 vs 138.05 +/- 21.30
vs 119.38+/-26.91 minutes, p<0.001) and cross-clamp time (Del Nido vs
Custoidol vs Blood: 74.99+/-18.55 vs 82.01 +/- 17.28 vs 93.66+/-8.88
minutes, p < 0.001). No differences were observed in the incidence of
in-hospital/30-day mortality rate, new onset of atrial fibrillation and
stroke. Ranking analysis showed the Custoidol solution has the highest
probability to be the first ranked cardioplegia. <br/>Conclusion(s): No
differences were found between blood and crystalloid cardioplegia in adult
minimally invasive cardiac surgery in several clinical outcomes. The
cardioplegia of choice in minimally invasive cardiac surgery remains the
surgeons' decision and preference.<br/>Copyright &#xa9; The Author(s)
2022.

<47>
Accession Number
2022183172
Title
The prognostic impacts of frailty on clinical and patient-reported
outcomes in patients undergoing coronary artery or valvular
surgeries/procedures: A systematic review and meta-analysis.
Source
Ageing Research Reviews. 85 (no pagination), 2023. Article Number: 101850.
Date of Publication: March 2023.
Author
Wong C.W.Y.; Yu D.S.F.; Li P.W.C.; Chan B.S.
Institution
(Wong, Chan) School of Nursing, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Room 543, 5/Academic Building, 3 Sassoon Road,
Pokfulam, Hong Kong
(Yu) School of Nursing, Li Ka Shing Faculty of Medicine, The University of
Hong Kong, Room 521, 5/Academic Building, 3 Sassoon Road, Pokfulam, Hong
Kong
(Li) School of Nursing, Li Ka Shing Faculty of Medicine, The University of
Hong Kong, Room 523, 5/F Academic Building, 3 Sassoon Road, Pokfulam, Hong
Kong
Publisher
Elsevier Ireland Ltd
Abstract
Background: Frailty is emerging as an important prognostic indicator for
patients undergoing cardiac surgeries/procedures. We sought to evaluate
the prognostic and differential impacts of frailty on patients undergoing
coronary artery or valvular surgical procedures of different levels of
invasiveness, and to explore the differential predictability of various
frailty measurement models. <br/>Method(s): Eight databases were searched
for prospective cohort studies that have adopted validated measure(s) of
frailty and reported clinical, healthcare service utilization, or
patient-reported outcomes in patients undergoing coronary artery or
valvular surgeries/procedures. <br/>Result(s): Sixty-two articles were
included (N = 16,679). Frailty significantly predicted mortality
(short-term [<= 30 days]: odds ratio [OR]: 2.33, 95% confidence interval
[CI]: 1.28-4.26; midterm [6 months to 1 year]: OR: 3.93, 95%CI: 2.65-5.83;
long-term [>1 year]: HR: 2.23, 95%CI: 1.60-3.11), postoperative
complications (ORs: 2.54-3.57), discharge to care facilities (OR: 5.52,
95%CI: 3.84-7.94), hospital readmission (OR: 2.00, 95%CI: 1.15-3.50), and
reduced health-related quality of life (HRQoL; standardized mean
difference: -0.74, 95%CI: -1.30 to -0.18). Subgroup analyses showed that
frailty exerted a greater impact on short-term mortality in patients
undergoing open-heart surgeries than those receiving transcatheter
procedures. Multidimensional and physical-aspect-focused frailty
measurements performed equally in predicting mortality, but
multidimensional measurements were more predictive of hospital readmission
than physical-aspect-focused measurements. <br/>Conclusion(s): Frailty was
predictive of postoperative mortality, complications, increased healthcare
service utilization, and reduced HRQoL. The impact of frailty on
short-term mortality was more prominent in patients undergoing open-heart
surgeries than those receiving transcatheter procedures. Multidimensional
measures of frailty enhanced prognostic risk estimation, especially for
hospital readmission.<br/>Copyright &#xa9; 2023 Elsevier B.V.

<48>
Accession Number
2021302851
Title
Rationale and design of the iCORONARY trial: improving the
cost-effectiveness of coronary artery disease diagnosis.
Source
Netherlands Heart Journal. 31(4) (pp 150-156), 2023. Date of Publication:
April 2023.
Author
Peper J.; Becker L.M.; Bruning T.A.; Budde R.P.J.; van Dockum W.G.;
Frederix G.W.J.; Habets J.; Henriques J.P.S.; Houthuizen P.; Mohamed
Hoesein F.A.A.; Planken R.N.; Voskuil M.; Bots M.L.; Leiner T.; Swaans
M.J.
Institution
(Peper, Becker, Swaans) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Peper, Becker, Mohamed Hoesein, Leiner) Department of Radiology,
University Medical Centre Utrecht, Utrecht, Netherlands
(Bruning, van Dockum) Department of Cardiology, Maasstad Hospital,
Rotterdam, Netherlands
(Budde) Department of Radiology, Erasmus Medical Centre, Rotterdam,
Netherlands
(Frederix) Department of Public Health, Healthcare Innovation and
Evaluation and Medical Humanities, University Medical Centre Utrecht,
Utrecht, Netherlands
(Habets) Department of Radiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Henriques) Department of Cardiology, Amsterdam University Medical Centre,
Amsterdam, Netherlands
(Houthuizen) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Planken) Department of Radiology, Amsterdam University Medical Centre,
Amsterdam, Netherlands
(Voskuil) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Bots) Julius Centre for Health Sciences and Primary Care, University
Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
(Leiner) Department of Radiology, Mayo Clinic Hospital, Rochester, United
States
Publisher
Bohn Stafleu van Loghum
Abstract
Background: In patients with stable coronary artery disease (CAD),
revascularisation decisions are based mainly on the visual grading of the
severity of coronary stenosis on invasive coronary angiography (ICA).
However, invasive fractional flow reserve (FFR) is the current standard to
determine the haemodynamic significance of coronary stenosis. Non-invasive
and less-invasive imaging techniques such as computed-tomography-derived
FFR (FFR-CT) and angiography-derived FFR (QFR) combine both anatomical and
functional information in complex algorithms to calculate FFR. Trial
design: The iCORONARY trial is a prospective, multicentre, non-inferiority
randomised controlled trial (RCT) with a blinded endpoint evaluation. It
investigates the costs, effects and outcomes of different diagnostic
strategies to evaluate the presence of CAD and the need for
revascularisation in patients with stable angina pectoris who undergo
coronary computed tomography angiography. Those with a Coronary Artery
Disease-Reporting and Data System (CAD-RADS) score between 0-2 and 5 will
be included in a prospective registry, whereas patients with CAD-RADS 3 or
4A will be enrolled in the RCT. The RCT consists of three randomised
groups: (1) FFR-CT-guided strategy, (2) QFR-guided strategy or (3)
standard of care including ICA and invasive pressure measurements for all
intermediate stenoses. The primary endpoint will be the occurrence of
major adverse cardiac events (death, myocardial infarction and repeat
revascularisation) at 1 year. Clinicaltrials.gov-identifier: NCT04939207.
<br/>Conclusion(s): The iCORONARY trial will assess whether a strategy of
FFR-CT or QFR is non-inferior to invasive angiography to guide the need
for revascularisation in patients with stable CAD. Non-inferiority to the
standard of care implies that these techniques are attractive,
less-invasive alternatives to current diagnostic pathways.<br/>Copyright
&#xa9; 2023, The Author(s).

<49>
Accession Number
2023166551
Title
Effect on Vitamin D supplements and Fatty Acids in management of
cardiovascular diseases.
Source
Journal of Population Therapeutics and Clinical Pharmacology. 30(3) (pp
e417-e425), 2023. Date of Publication: 2023.
Author
Laylani L.A.-A.-S.S.; Jassim A.F.; Ali A.H.; Mustafa M.A.
Institution
(Laylani) Community Health Department, Kirkuk Technical Institute,
Northern Technical University, Iraq
(Jassim) Ministry of Education, Directorate general of education in
Saladin, Department of Samarra, Iraq
(Ali) Department of Pharmacy Techniques, Northern Institute
University-Al-Dour Institute Technical, Iraq
Publisher
Codon Publications
Abstract
Introduction: n-3 polyunsaturated fatty acids (PUFA) and vitamin D
exclusively and have been the focus of numerous research regarding their
possible significance in lowering cardiovascular risk. Numerous
physiological processes, including signal transduction, ion channel
kinetics, and protein and membrane trafficking are modulated in part by
lipid microdomains. The inclusion of n-3 PUFA modifies the physical
characteristics of cellular and organelle membrane structures and affects
the positioning, functioning, and signaling of membrane-associated
proteins. Aims and Objectives: To analyze the effect of vitamin D
supplements and fatty acids on the management of cardiovascular diseases.
<br/>Method(s): This is a prospective study which was conducted on 80
patients for whom cardiovascular abnormalities were considered and their
parameters were determined before administration of n3 fatty acids and
Vitamin D3. After 6 months course of drugs containing n3 fatty acids and
Vitamin D3, the cardiovascular abnormalities including mortality were
assessed for end outcome. The statistical analysis was conducted to
determine the significance of the improvement. <br/>Result(s): The study
found that end assessment showed that ischemic stroke (p=0.032) and
cardiovascular mortality (p=0.023) were significantly found to be less in
the n-3 FAs group and vitamin-D group compared to the control group.
<br/>Conclusion(s): The study concluded that administration of n-3 FAs
group and vitamin-D at a mentioned dosage for 6 months may lead to a
statistically significant reduction in cardiovascular mortality and
ischemic stroke as compared to healthy controls.<br/>Copyright &#xa9;
2022.

<50>
Accession Number
2023770858
Title
Congenital mitral valve defects in pediatric population: a narrative
review of surgical repair.
Source
Pediatric Medicine. 6 (no pagination), 2023. Article Number: 6. Date of
Publication: 28 Feb 2023.
Author
Chen W.; Li M.; Sheng W.; Jia B.; Huang G.
Institution
(Chen, Li, Sheng, Jia, Huang) Heart Center, Children's Hospital of Fudan
University, Shanghai, China
(Chen, Li, Sheng, Jia, Huang) Shanghai Key Laboratory of Birth Defects,
Shanghai, China
Publisher
AME Publishing Company
Abstract
Background and Objective: Congenital mitral valve malformations (CMVM) are
rare and heterogeneous. The functional classification includes mitral
regurgitation, stenosis, and combined lesions. Surgical strategies of CMVM
remain challenging in the pediatric population due to various
malformations, growth potential, the requirement of long-term
anticoagulation, and the necessity of avoiding or delaying valve
replacement. Surgical techniques for CMVM must be individually tailored
for patients to achieve a proper valve function rather than "normal"
anatomy. Compared with mitral repair, mitral valve replacement (MVR) is a
less common procedure in children due to high mortality and morbidity
rates. Options for cardiac valve replacement in children are limited to
prostheses sizes that do not accommodate somatic growth, especially for
neonates and infants. The need for lifelong anticoagulation may lead to
adverse long-term pregnancy outcomes for female patients, limiting the
application of MVR. This review aims to provide a comprehensive analysis
of the current surgical techniques and developments for treating mitral
valve (MV) regurgitation and stenosis and the outcome of various surgical
strategies. <br/>Method(s): We conducted a literature search using online
database PubMed, Web of Science, and Embase for English literatures up to
Sep, 2021. We also consulted standard textbooks. Both original research
and systematic reviews and meta-analysis were included. Key Content and
Findings: This review mainly introduced current surgical strategies of
CMVM regarding to different anatomical defects of mitral valve and
short-term and long-term outcomes of different surgical strategies.
According to the literature, using autologous pericardium, percutaneous
edge-to-edge MV repair using the MitraClip and artificial chordae
implantation showed satisfied effectiveness among patients with MV
regurgitation. Surgical repair for MV stenosis also showed satisfying
survival rate and freedom from reoperation rate. MVR are challenging for
infants especially neonates, the chimney technique and ROSS II strategies
were proved to be effective for severe cases. <br/>Conclusion(s): MV
repair is accomplishable in the majority of cases for both congenital MV
regurgitation and stenosis. With the development of modification and
implantation strategies, both short- and long-term outcomes of MVR in
children are encouraging.<br/>Copyright &#xa9; Pediatric Medicine. All
rights reserved.

<51>
Accession Number
641013428
Title
Perceval valve intermediate outcomes: a systematic review and
meta-analysis at 5-year follow-up.
Source
Journal of cardiothoracic surgery. 18(1) (pp 129), 2023. Date of
Publication: 11 Apr 2023.
Author
Jolliffe J.; Moten S.; Tripathy A.; Skillington P.; Tatoulis J.; Muneretto
C.; Di Bacco L.; Galvao H.B.F.; Goldblatt J.
Institution
(Jolliffe, Moten, Tripathy, Skillington, Tatoulis, Goldblatt)
Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street
Parkville, Melbourne, VIC, Australia
(Muneretto, Di Bacco) School of Cardiac Surgery, University of Brescia,
Brescia, Italy
(Galvao) Centre for Cardiovascular Biology and Disease Research, Latrobe
University, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: New technologies for the treatment of Aortic Stenosis are
evolving to minimize risk and treat an increasingly comorbid population.
The Sutureless Perceval Valve is one such alternative. Whilst short-term
data is promising, limited mid-term outcomes exist, until now. This is the
first systematic review and meta-analysis to evaluate mid-term outcomes in
the Perceval Valve in isolation. <br/>METHOD(S): A systematic literature
review of 5 databases was performed. Articles included evaluated
echocardiographic and mortality outcomes beyond 5 years in patients who
had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the
articles. Weighted estimates were performed for all post-operative and
mid-term data. Aggregated Kaplan Meier curves were reconstructed from
digitised images to evaluate long-term survival. <br/>RESULT(S): Seven
observational studies were identified, with a total number of 3196
patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2,
3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively.
Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%),
structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%)
and valve explant (2.3%) were acceptable at up to mid-term follow up.
Haemodynamics were also acceptable at up mid-term with mean-valve gradient
(range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective
orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass
(78 min) and Aortic cross clamp times (52 min) were also favourable.
<br/>CONCLUSION(S): To our knowledge, this represents the first
meta-analysis to date evaluating mid-term outcomes in the Perceval Valve
in isolation and demonstrates good 5-year mortality, haemodynamic and
morbidity outcomes. KEY QUESTION: What are the mid-term outcomes at up to
5 years follow up in Perceval Valve Aortic Valve Replacement? KEY
FINDINGS: Perceval Valve AVR achieves 80% freedom from mortality at 5
years with low valve gradients and minimal morbidity. KEY OUTCOMES:
Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality,
durability and haemodynamic outcomes.<br/>Copyright &#xa9; 2023. Crown.

<52>
Accession Number
641000085
Title
Comparison of intranasal midazolam-fentanyl with dexmedetomidine-fentanyl
as pre-medication in the paediatric age group.
Source
The Indian journal of medical research. 157(1) (pp 51-56), 2023. Date of
Publication: 01 Jan 2023.
Author
Kaur T.; Kumar P.; Kundra T.S.; Kaur I.
Institution
(Kaur, Kumar, Kundra) Department of Anaesthesiology & ICU, Government
Medical College, Patiala, Punjab, India
(Kaur) Department of Anaesthesia, Jeevan Hospital, Patiala, Punjab, India
Publisher
NLM (Medline)
Abstract
Background & objectives: Intranasal midazolam-fentanyl is commonly used as
pre-medication in paediatric patients, but there is a risk of respiratory
depression with this combination. Dexmedetomidine is a drug that preserves
respiratory function. The objective of this study was to compare the
efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in
paediatric patients undergoing elective surgeries. <br/>Method(s): Hundred
children in the age group of 3-8 yr of American Society of
Anaesthesiologists physical status grade 1 were randomized into two
groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2
mug/kg) and group B received intranasal dexmedetomidine (1
mug/kg)-fentanyl (2 mug/kg) 20 min before induction of general
anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental
separation and response to intravenous cannulation were seen after 20 min.
Children were monitored for 2 h for post-operative analgesia by Oucher's
Facial Pain Scale. <br/>Result(s): Sedation scores were satisfactory in
both groups, although children in group A were more sedated than in group
B. Parental separation and response to intravenous cannulation were
comparable in both the groups. The two groups were also haemodynamically
comparable intraoperatively. Post-operative heart rate was also comparable
at all-time intervals in both the groups except for heart rate at 100 and
120 min which were more in group A. Group A experienced more
post-operative pain as assessed by Oucher's Facial Pain Scale as compared
to group B. Children receiving intranasal dexmedetomidine-fentanyl had
better post-operative analgesia as compared to those who received
intranasal midazolam-fentanyl. Interpretation & conclusions: Both
intranasal midazolam with fentanyl and intranasal dexmedetomidine with
fentanyl provided satisfactory sedation. Both groups were comparable in
separation reaction and response to intravenous cannulation with better
post-operative analgesia in children receiving intranasal
dexmedetomidine-fentanyl.

<53>
Accession Number
2023047610
Title
TEMPORAL TRENDS OF UTILIZATION AND READMISSION RATES WITH INTRAVASCULAR
ULTRASOUND USE FOR CHRONIC TOTAL OCCLUSION: NATIONWIDE ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orange
County Convention Center, Orlando United States. 81(8 Supplement) (pp
935), 2023. Date of Publication: 07 Mar 2023.
Author
Alzu'Bi H.; Abumoawad A.; Rmilah A.A.; Elkheshen A.; Qarajeh R.; Escolar
E.
Institution
(Alzu'Bi, Abumoawad, Rmilah, Elkheshen, Qarajeh, Escolar) Mount Sinai
Medical Center, Miami Beach, FL, United States
(Alzu'Bi, Abumoawad, Rmilah, Elkheshen, Qarajeh, Escolar) Boston
University, Boston, MA
Publisher
Elsevier Inc.
Abstract
Background Chronic total occlusion (CTO) is common and the intervention
remains a challenge despite the evolution in technology and techniques.
There is a paucity of data regarding the real-world utilization and
outcomes of intravascular ultrasound (IVUS) guided for elective
percutaneous coronary interventions (PCIs) for patient with CTO. Methods
We queried the Nationwide Readmissions Database (NRD) between 2016 and
2019 using ICD-10 codes for patients who presented with CTO. A total of
392,068 CTO patients were identified in the NRD. We excluded 143,559
patients who were diagnosed with acute myocardial infarction including
STEMI, NSTEMI and unstable angina. We excluded 59,108 patients who were
discharged in October, November, and December due to lack of 3 months
follow-up. We also excluded 41 patients due to missing information about
in-hospital mortality. We eventually included in our analysis 189,360
patients who we grouped into two categories based on the use of IVUS or
not. Because of the significant differences in baseline patient
characteristics, a propensity score-matched model was used. Results Among
189,360 hospitalizations with CTO 5,118 (2.7%) underwent IVUS-guided PCI.
IVUS use increased from 2.2% in 2016 to 3.5% in 2019, (p-trend < 0.01). In
the matched cohorts, in-hospital mortality and overall readmission rates
within 90-day were similar in both cohorts (1.07% vs. 1.41%, p=0.446) and
(22.5% vs. 23.8%, p=0.461) respectively. Patients who underwent
IVUS-guided PCI were less likely to have coronary artery bypass graft
(CABG) surgery (3.1% vs. 8.0%, p=0.002) and more likely to another PCI
(19.1% vs. 9.5%, p=0.002) within 90-day readmissions. Conclusion The
utilization of IVUS in elective CTO-PCI are slowly increasing over the
years. The overall in-hospital mortality and readmission rates were
similar. Patients with CTO who underwent IVUS-guided PCI were twice as
likely to have another PCI and two times less likely to have CABG within 3
months after discharge. Randomized clinical trials are warranted to
evaluate the long-term benefits of IVUS use in elective CTO-PCI
procedure.<br/>Copyright &#xa9; 2023 American College of Cardiology
Foundation

<54>
Accession Number
2023047102
Title
SYSTEMATIC REVIEW AND META-ANALYSIS OF TIME-TO-EVENT LONG-TERM OUTCOMES
FOLLOWINGTHE ROSS PROCEDURE.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orange
County Convention Center, Orlando United States. 81(8 Supplement) (pp
1939), 2023. Date of Publication: 07 Mar 2023.
Author
Shimamura J.; Fukuhara S.; Yokoyama Y.; Takagi H.; Kuno T.
Institution
(Shimamura, Fukuhara, Yokoyama, Takagi, Kuno) Emory University School of
Medicine, Atlanta, GA, United States
Publisher
Elsevier Inc.
Abstract
Background The optimal aortic valve substitute for non-elderly adults
remains controversial. Recently, considerable data on the Ross procedure
have accumulated worldwide. This study aimed to analyze long-term outcomes
following the Ross procedure using meta-analysis of time-to-event
outcomes. Methods A literature search was performed with MEDLINE, EMBASE,
Cochrane Library, Web of Science, and Google Scholar through June 2022;
studies reporting clinical outcomes of the Ross procedure with follow-up
of more than 20 years were included. The outcomes of interest were
perioperative mortality and/or freedom from reintervention of autograft
and/or right ventricular outflow tract (RVOT). Results Six studies,
including 4,910 patients (3,601 males), were identified. Survival rate at
5, 10, 15, and 20 years was 99.9+/-0.1%, 97.6+/-0.5%, 94.3+/-0.9%, and
87.4+/-1.9%, respectively. Freedom from autograft reintervention at 5, 10,
15, and 20 years was 97.7+/-0.5%, 95.3+/-0.7%, 91.4+/-1.2%, 84.8+/-2.5%.
Freedom from RVOT reintervention was 99.0+/-0.3%, 99.0+/-0.3%,
97.5+/-0.7%, 93.3+/-1.8%. Freedom from any valve reintervention (either
autograft or RVOT) at 5, 10, 15, and 20 years was 95.8+/-0.6, 92.6+/-0.9,
88.5+/-1.2, 80.8+/-2.5%. Conclusion This meta-analysis demonstrated that
approximately 20% of patients with the Ross procedure received any valve
reintervention at 20 years. Additionally, the Ross procedure was confirmed
to provide excellent survival for up to 20 years despite the need for
reintervention in some patients. [Formula presented]<br/>Copyright &#xa9;
2023 American College of Cardiology Foundation

<55>
Accession Number
2023045576
Title
THE ROCKWOOD CLINICAL FRAILTY SCALE PREDICTS MORTALITY FOLLOWING AORTIC
VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orange
County Convention Center, Orlando United States. 81(8 Supplement) (pp
920), 2023. Date of Publication: 07 Mar 2023.
Author
Prendiville T.; Leahy A.; Ahmad F.; Gabr A.; Afilalo J.; Mamas M.A.;
Casserly I.P.; O'Connor M.; Galvin R.
Institution
(Prendiville, Leahy, Ahmad, Gabr, Afilalo, Mamas, Casserly, O'Connor,
Galvin) University Hospital Limerick, Limerick, Ireland
Publisher
Elsevier Inc.
Abstract
Background Assessment of frailty prior to aortic valve intervention is
recommended in the 2020 American Heart Association/American College of
Cardiology valvular heart disease guidelines. However, there is a lack of
consensus on how it is best measured. The Clinical Frailty Scale (CFS) is
a well-validated measure of frailty that is relatively quick to calculate,
but evidence is needed on whether it can predict adverse outcomes
post-aortic valve intervention. As such, we sought to examine whether this
scale predicts mortality following aortic valve replacement (AVR), looking
at both transcatheter (TAVR) and surgical (SAVR) interventions. Methods We
systematically searched 9 electronic databases from 2005 to 2021 for
studies reporting on clinical outcomes post-TAVR/SAVR, where patients had
undergone frailty assessment with the CFS prior to their procedure. Our
primary endpoint was 12-month mortality, though a number of secondary
clinical endpoints were also assessed. From the included studies, we
extracted 12-month mortality data corresponding to a CFS score of 5-9
(i.e. frail) versus 1-4 (i.e. non-frail). Meta-analysis using a random
effects model was performed to calculate pooled relative risk ratios for
TAVR and SAVR separately. Results Of 2612 records screened, 9 studies were
included in the review (5 TAVR, 3 SAVR, 1 which included both
interventions). Amongst 4923 TAVR patients, meta-analysis showed 12-month
mortality rates of 19.1% for the frail cohort versus 9.8% for the
non-frail cohort (RR 2.53 [1.63-3.95], p<0.001, I²=83%). For
the smaller cohort of SAVR patients (n=454), there was a 12-month
mortality rate of 20.3% versus 3.9% for the frail and non-frail cohorts
respectively (RR 5.08 [2.31-11.15], p<0.001, I²=5%). Conclusion
Frailty, as determined by the CFS, was associated with an increased
mortality risk in the 12 months following either TAVR or SAVR. These data
would support its use in the pre-operative assessment of elderly patients
undergoing aortic valve interventions.<br/>Copyright &#xa9; 2023 American
College of Cardiology Foundation

<56>
Accession Number
2022742621
Title
Abstract No. 68 Comparison of Safety and Efficacy of Mechanical
Thrombectomy and Ultrasound Accelerated Thrombolysis for Management of
Pulmonary Embolism: A Systematic Review.
Source
Journal of Vascular and Interventional Radiology. Conference: SIR 2022
Annual Scientific Meeting Program. Boston United States. 34(3 Supplement)
(pp S32-S33), 2023. Date of Publication: March 2023.
Author
Choksi E.; Zhao X.; Shukla P.; Kumar A.
Institution
(Choksi) Rowan University School of Osteopathic Medicine
(Zhao, Shukla, Kumar) Rutgers New Jersey Medical School
Publisher
Elsevier Inc.
Abstract
Purpose: To compare and evaluate the safety and efficacy of mechanical
thrombectomy (MT) and ultrasound-accelerated thrombolysis (USAT) in
pulmonary embolism (PE) management by performing a systematic review of
the literature. <br/>Material(s) and Method(s): The PubMed database was
searched to identify all pertinent articles on utilization of either
Inari's FlowTriever and Penumbra's Indigo mechanical thrombectomy devices
(Group A) or the Ekos Endovascular system (Group B). A combination of the
following search terms was used: "pulmonary embolism," "mechanical
thrombectomy," "Penumbra," "Indigo," "FlowTriever," "Inari,"
"ultrasound-assisted thrombolysis," "Ekos," and "EkoSonic." Outcomes
variables analyzed include pre- and post-procedure RV/LV ratio, pre- and
post-procedure pulmonary artery pressure, pre-and post-procedure heart
rate, pre-and post-procedure oxygen saturation, hospital length of stay,
technical success, specific complications, and mortality rate. Statistical
analyses of results were conducted using t-test, chi square analysis and
adjusted relative risk. <br/>Result(s): Initial literature search yielded
303 studies, of which 34 studies were included. 16 studies pertained to
Group A and 18 studies pertained to Group B. There were 786 patients in
Group A and 773 patients in Group B. Group A had a higher average age of
patients compared with Group B (61.32 +/- 13.35 vs. 59.01 +/- 15.34 years,
t = 3.17, P < 0.0016). Group B had a higher technical success rate than
group A (89.1% vs. 99.3%, chi² = 60.22, P < 0.0001). Group B
had a larger change in mean pulmonary artery pressure (5.31 +/- 4.49 vs.
15.93 +/- 4.60, t = 39.79, P < 0.0001). Group B had a larger change in
heart rate than Group A (18.72 +/- 8.28 vs. 27.1 +/- 5.23, t = 9.83, P <
0.0001). Group B had a larger change in oxygen saturation compared with
Group A (4.87 +/- 3.55 vs. 13.79 +/- 3.41, t = 12.22, P < 0.0001). Group A
had a lower complication rate compared with Group B (2.57% vs. 6.0%,
adjusted RR (95% CI): 0.43 (0.26-0.72). There was no statistical
difference in change in RV/LV ratio, length of hospital stay or mortality
rate between the two groups. <br/>Conclusion(s): Ultrasound accelerated
thrombolysis and percutaneous mechanical thrombectomy are effective
therapies for pulmonary embolism with comparable clinical
outcomes.<br/>Copyright &#xa9; 2022

<57>
Accession Number
2021588627
Title
IMPACT OF EARLY POSTOPERATIVE IMMUNONUTRITION ON RENAL IMPAIRMENT IN
LOW-RISK CARDIAC SURGERY PATIENTS.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 37th
EACTAIC Annual Congress. Naples Italy. 36(Supplement 1) (pp S11-S12),
2022. Date of Publication: December 2022.
Author
Svetikiene M.; Trybe D.; Isajevas V.; Vezeliene J.; Ringaitiene D.;
Serpytis M.; Sipylaite J.
Institution
(Svetikiene, Trybe, Isajevas, Vezeliene, Ringaitiene, Serpytis, Sipylaite)
Department of Anaesthesiology and Intensive Care, Institute of Clinical
Medicine, Faculty of Medicine, Vilnius, Lithuania
Publisher
W.B. Saunders
Abstract
Rationale: Cardiac surgeries with the use of cardiopulmonary bypass (CPB)
lead to significant changes in homeostasis and a more or less pronounced
immune response (1). Renal impairment is the most common clinically
important complication in adult cardiac surgery patients, and is
associated with increased mortality and morbidity (2). The aim of the
study was to research the efficacy of early postoperative enteral
immunonutrition on renal impairment after cardiac surgery. <br/>Method(s):
A low operative risk adult patients, who underwent elective cardiac
surgery, were included to the study. The patients were randomized into
immunonutrition (IN) and control (C) groups. The IN group was supplemented
with glutamine and antioxidants for five postoperative days. Creatinine
levels were monitored in patients throughout the hospital stay - the worst
parameters were recorded, analyzed and compared between the groups.
Moreover renal impairment was assessed according to the RIFLE criteria.
Student t-test and Mann-Whitney U test was used to compare differences
between the groups. A logistic regression model was developed to assess
the relationship between immunonutrition and the risk of kidney injury.
<br/>Result(s): Fifty-five patients were enrolled in the study, the mean
age was 69.7+/-6.3 years, 28(50.9%) males, the median operative risk was
1.75%. Twenty-seven (49.1%) were in the IN group. A statistically
significant decrease in postoperative creatinine clearance (worsening of
renal function) was detected in the C group, accordingly 77,07 +/- 23,90
vs 63,43 +/- 23,31 (ml/min), p = 0,037. Based on RIFLE classification, our
subjects were at risk of renal impairment in 11 cases (2 cases in the IN
group and 9 cases in the C group, p = 0.023) and 5 patients had renal
impairment (2 cases in the immunomodulatory group, 3 cases in the control
group, p = 0.673). A logistic regression model was developed to assess the
relationship between immunonutrition and the risk of kidney injury. The
patients without glutamine and antioxidants supplementation had a
4.312-fold increased risk of kidney injury (p = 0,02). <br/>Conclusion(s):
Early postoperative immunonutrition has a positive effect on reducing risk
of renal impairment in low-risk cardiac surgical patients.<br/>Copyright
&#xa9; 2022

<58>
Accession Number
2021588622
Title
ERECTOR SPINAE PLANE BLOCK FOR MINIMALLY INVASIVE MITRAL VALVE SURGERY HAS
NO IMPACT ON POSTOPERATIVE OUTCOMES: A DOUBLE-BLIND, PROSPECTIVE
RANDOMIZED PLACEBO-CONTROLLED TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 37th
EACTAIC Annual Congress. Naples Italy. 36(Supplement 1) (pp S46-S47),
2022. Date of Publication: December 2022.
Author
Hoogma D.F.; Van Den Eynde R.; Al Tmimi L.; Tournoy J.; Verbrugghe P.;
Fieuws S.; Coppens S.; Rex S.
Institution
(Hoogma, Van Den Eynde, Al Tmimi, Coppens, Rex) University Hospitals of
Leuven, Department of Anesthesiology, Leuven, Belgium
(Verbrugghe) University Hospitals of Leuven, Department of Cardiac
Surgery, Leuven, Belgium
(Fieuws) University of Leuven, Biomedical Sciences Group, Leuven
Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven,
Belgium
(Tournoy) Geriatric Medicine, University Hospitals Leuven, Department of
Public Health and Primary Care, Leuven, Belgium
Publisher
W.B. Saunders
Abstract
Objective: Compared to traditional sternotomy, minimally invasive mitral
valve surgery (MIMVS) using video-assisted thoracoscopy has been shown to
result in an increased incidence of moderate to severe acute postoperative
pain.1 The Erector Spinae Plane (ESP) block, a novel fascial plane block,
may be an useful and safe option for postoperative analgesia in MIMVS.2 As
randomized trials in this field are sparse, we hypothesized that an
intermittent ESP block with ropivacaine 0.5% (intervention group) compared
to normal saline 0.9% (control group) is effective in reducing
postoperative pain after MIVMS.3 Design & Methods: PPThis single center,
double-blind, prospective, randomized, placebo-controlled trial was
approved by the local Ethics Committee (S62638 June 4th 2019, EudraCT
2019-001125-27). The trial was supported by the EACTA Research Grant 2020.
Primary endpoint was postoperative 24h morphine consumption. Based on
pilot data and to have an 80% power to show a 25% reduction in 24h
morphine consumption in the intervention-group compared to the
control-group, 64 patients had to be randomized (1:1 ratio). A pre-planned
sample size recalculation was performed after inclusion of 32 patients.
Multiple secondary endpoints were evaluated up to 30-days postoperatively
including postoperative pain scores, midaxillary sensory block, rescue
treatments for pain and hospital length of stay.3 Results: Sample size
recalculation revealed the need to recruit 4 additional patients in each
group. 72 patients were randomized between July 2nd 2019 and November 4th
2021. Regarding our primary outcome, 2 patients in the intervention-group
could not be assessed due to reintubation and ischemic cerebral event. In
the control-group, we observed 2 epileptic seizures requiring unblinding
of the randomization to start appropriate treatment. There were no
differences in baseline or procedural characteristics. The median (IQR)
24h morphine consumption was not different between the intervention- and
control-group: 41mg [30;55] vs 37mg [29;50], p=0.70, respectively (Table
1). Mean numerical rating scale values for pain showed no significant
differences between groups (Figure 1). The number of morphine boli
requested each hour by the patient, sensory block, rescue treatments for
pain and hospital length of stay were comparable (Figure 2 & Table 1).
<br/>Conclusion(s): In the current placebo-controlled trial following
MIMVS, we were unable to demonstrate any benefit from the addition of an
intermittent ESP-block to a standard multimodal analgesia
regimen.<br/>Copyright &#xa9; 2022

<59>
Accession Number
2021588609
Title
INVESTIGATING THE EFFECT OF INSPIRED OXYGEN FRACTION ON RIGHT VENTRICULAR
3D STRAIN DURING GENERAL ANAESTHESIA IN PATIENTS WITH STABLE CORONARY
ARTERY DISEASE.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 37th
EACTAIC Annual Congress. Naples Italy. 36(Supplement 1) (pp S8-S9), 2022.
Date of Publication: December 2022.
Author
Baumann R.; Fisher K.; Friess J.; Madhkour R.; Erdoes G.; Terbeck S.;
Eberle B.; Schoenhoff F.S.; Guensch D.P.
Institution
(Schoenhoff) Department of Cardiovascular Surgery, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Baumann, Fisher, Friess, Erdoes, Terbeck, Eberle, Guensch) Department of
Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
(Madhkour) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
Publisher
W.B. Saunders
Abstract
Introduction: Patients with coronary artery disease (CAD) undergoing
general anesthesia are at risk of perioperative complications. Hyperoxia
is a known coronary vasoconstrictor. However, it is also a pulmonary
vasodilator, reducing right ventricular afterload. Thus, there may be
competing effects of hyperoxia on right ventricular function. In this
study we investigated the effects of hyperoxia and normoxia on right
ventricular (RV) function assessed by 3D transesophageal echocardiography
(TEE) during general anesthesia in CAD patients before elective coronary
artery bypass graft surgery. <br/>Method(s): In this randomized clinical
trial study participants (n=106) were prospectively recruited using a
crossover design. In anesthetized patients the fraction of inspired oxygen
(FiO2) was titrated to a normoxic state (FiO2=0.3) and a hyperoxic state
(FiO2=0.8). At both states TEE images were acquired to assess RV ejection
fraction (RVEF) and global longitudinal free-wall strain (RVGLS).
<br/>Result(s): There was no difference between normoxia and hyperoxia in
RVEF (46+/-6% vs. 45+/-8, p=0.504) nor in RVGLS (-22.4+/-4.8 vs.
-21.9+/-4.3, p=0.352). However, RV function improved and worsened in some
patients. ROC analysis (Figure A) shows that RVGLS at normoxia can better
predict, which patients will worsen with excess oxygen. With a cut-off of
-20% for RVGLS (Sensitivity: 87%, Specificity: 49%), it was demonstrated
that hyperoxia was beneficial for patients with a poor strain at normoxia
(>-20%) but detrimental for those with normal strain at normoxia (<-20%,
Figure B), while RVEF with a cut-off of 40% (Sens: 88%, Spec: 33%) was
unable to predict this response (Figure C.). <br/>Conclusion(s): In CAD
patients undergoing general anaesthesia, hyperoxia has heterogenous
effects on the RV and the potential detrimental effects of hyperoxia were
best predicted by RVGLS. Intraoperative strain analysis might be a tool to
target oxygen levels based on individual needs.<br/>Copyright &#xa9; 2022

<60>
Accession Number
2021571562
Title
Unique Occupational Health Risks in Cardiac Catheterization Laboratory
Workers.
Source
Journal of Medical Imaging and Radiation Sciences. Conference: RTi3 2022.
Toronto Canada. 53(4 Supplement 1) (pp S8), 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

<61>
Accession Number
2021559265
Title
A REVIEW OF EUROPEAN GUIDELINES FOR PATIENT BLOOD MANAGEMENT WITH A
PARTICULAR EMPHASIS ON ANTIFIBRINOLYTIC DRUG ADMINISTRATION FOR CARDIAC
SURGERY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 37th
EACTAIC Annual Congress. Naples Italy. 36(Supplement 1) (pp S48-S49),
2022. Date of Publication: December 2022.
Author
Klein A.; Agarwal S.; Cholley B.; Fassl J.; Griffin M.; Kaakinen T.;
Paulus P.; Rex S.; Siegemund M.; van Saet A.
Institution
(Klein) Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge,
United Kingdom
(Agarwal) Manchester University NHS Foundation Trust, Manchester, United
Kingdom
(Cholley) AP-HP Hopital Europeen Georges Pompidou, Paris, France
(Fassl) Herzzentrum Dresden GmbH Universitatklinik an der Technischen
Universitat Dresden, Dresden, Germany
(Griffin) Mater University Hospital and Mater Private Hospital, Dublin,
Ireland
(Kaakinen) Research Group of Surgery, Anesthesiology and Intensive Care,
MRC of Oulu University, Oulu, University Hospital, Oulu, Finland
(Paulus) Kepler University Hospital GmbH, Linz, Austria
(Rex) Department of Anesthesiology, University Hospitals Leuven, Belgium
(Siegemund) Invensive Care Unit Department of Clinical Research,
University Basel, Switzerland
(van Saet) Department of Anesthesiology, Erasmus Medical Center,
Rotterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Introduction: Patient blood management (PBM) is a proactive approach
towards improving the quality and appropriateness of care. PBM has been
recommended by the World Health Organization (WHO) since 2011. The aim is
to manage anaemia and bleeding in surgical patients with the objective to
minimise the need for transfusion. AntiVbrinolytics play a major role in
cardiac surgery, where the risk of perioperative bleeding is high and
affects most patients. AntiVbrinolytics effectively reduce bleeding,
transfusions, re-operations, and associated morbidity and mortality. They
represent an essential part of the pharmacological arsenal of PBM. The
authors compared the current available European guidelines in PBM and
analysed the place of different antiVbrinolytics in cardiac surgery,
according to these guidelines. <br/>Method(s): A literature search on
European PBM guidelines was performed in December 2020 and repeated in
January 2021 using PubMed, Cochrane Database and Google Scholar databases.
<br/>Result(s): Thirteen documents were identiVed, from 6 countries
(France, Germany, Italy, The Netherlands, Romania, UK), provided by
European Commission or European and/or national learned societies. Of
these 13 articles, 10 mentioned cardiac surgery, with 1 fully dedicated to
it, and 8 were actual PBM guidelines. <br/>Discussion(s): Despite the
trend towards high-level PBM practices, and the implementation of PBM
programs actively supported by the European Commission, national or
international PBM guidelines for European countries appear to be both few
and heterogeneous in form and content. At the European level, guidelines
on bleeding management were published in 2017 by the ESAIC and those
dedicated to cardiac surgery were published in 2018 jointly by the EACTS
and the EACTA. All the current available guidelines follow and agree on
the deVnition of PBM as deVned by the WHO, supported by three pillars:
optimizing blood volume, minimising blood loss and optimizing the
patient's tolerance to anaemia. Most of them were divided according to the
three main surgical phases: preoperative, perioperative and
post-operative. Anaemia management appears as a cornerstone of PBM in all
guidelines, followed by limiting blood loss during surgical procedures to
reduce transfusions and limit the risk of reoperation for bleeding. In
this context, the European and national PBM guidelines all recommend the
prophylactic use of antiVbrinolytics to avoid or reduce perioperative
bleeding. However, they differ in the type of antiVbrinolytic recommended,
when it should be given and how (bolus or infusion or both), including the
dose and timing. Indeed, when mentioned, the dosing to be used generally
differs from one guideline to another. Most guidelines recommend only the
use of tranexamic acid. Aprotinin is rarely mentioned, partly because of
its recent reintroduction in Europe (Table 1). The implementation of PBM
practices in Europe is still challenging, as there is a real need for more
homogenous guidance in PBM and in the use of antiVbrinolytics, especially
in cardiac surgery. New clinical data to promote the use of
antiVbrinolytics could be of interest to improve, accelerate and deploy
PBM implementation at a large scale.<br/>Copyright &#xa9; 2022

<62>
Accession Number
2021559259
Title
SERRATUS ANTERIOR PLANE BLOCK FOR TOTALLY ENDOSCOPIC AORTIC VALVE
REPLACEMENT SURGERY: A RANDOMIZED CONTROLLED TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: 37th
EACTAIC Annual Congress. Naples Italy. 36(Supplement 1) (pp S10), 2022.
Date of Publication: December 2022.
Author
Van Hilst E.; Vandenbrande J.; Callebaut I.; Stessel B.; Yilmaz A.; Jalil
H.; Vrancken D.; De Donder L.
Institution
(Van Hilst) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Vandenbrande, Callebaut, Stessel, Jalil, Vrancken, De Donder) Department
of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
(Yilmaz) Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt,
Belgium
Publisher
W.B. Saunders
Abstract
Objective: Totally endoscopic aortic valve replacement (AVR) has several
benefits compared to the classic approach via sternotomy. However, pain
after this thoracoscopic intervention is still a problem. The current pain
treatment after AVR consists of opioids. Unfortunately, opioids have
various side effects, such as nausea, constipation and respiratory
depression. These side effects prevent a fast recovery after surgery.
Therefore, it is essential to keep postoperative opioid consumption to a
minimum. This study aims to investigate the efficacy of the serratus
anterior plane (SAP) block in reducing acute postoperative pain after
totally endoscopic AVR surgery. During a SAP block, local anaesthetics are
injected in the plane beneath the anterior serratus muscle and in the
plane between latissimus dorsi and serratus anterior in an ultrasound
guided manner. This induces analgesia in dermatomes T2 to T9, which
includes the place where surgical incision is realized. In this study,
postoperative pain was compared between a treatment with the postoperative
SAP block and a treatment without the SAP block. Design and method: This
double-blinded, mono-center, prospective, randomized controlled
superiority trial took place in the Jessa Hospital in Hasselt, Belgium.
Patients undergoing totally endoscopic AVR were included and randomly
allocated to the experimental group, receiving the standard of care plus
SAP block, or the control group, receiving normal standard of care. The
primary outcome was total opioid (piritramide) consumption during the
first 24h after surgery. Secondary outcome measures were physical and
mental health measured by the SF-36 questionnaire on postoperative day 2
and length of stay in the ICU and hospital. <br/>Result(s): Between
December 3, 2020 and May 11, 2022, 67 patients were included, of which 62
were analysed. The need for opioid consumption was lower in the
experimental group compared to the control group (12 mg [8-26] vs. 19 mg
[13.5-30.5], p=0.06). Physical (p=0.70) and mental health (p=0.93) on
postoperative day 2 and length of stay in the ICU (p=0.79) and hospital
(p=0.84) were similar in both groups. <br/>Conclusion(s): These
preliminary data show a tendency towards reduced opioid consumption when
postoperative single-shot serratus anterior plane block is added to
routine postoperative care management after thoracoscopic
AVR.<br/>Copyright &#xa9; 2022

<63>
Accession Number
2022332749
Title
Effect of Remote Ischaemic Preconditioning on Perioperative Endothelial
Dysfunction in Non-Cardiac Surgery: A Randomised Clinical Trial.
Source
Cells. 12(6) (no pagination), 2023. Article Number: 911. Date of
Publication: March 2023.
Author
Wahlstrom K.L.; Hansen H.F.; Kvist M.; Burcharth J.; Lykkesfeldt J.;
Gogenur I.; Ekeloef S.
Institution
(Wahlstrom, Hansen, Kvist, Burcharth, Gogenur, Ekeloef) Center for
Surgical Science, Department of Surgery, Zealand University Hospital,
Lykkebaekvej 1, Koge 4600, Denmark
(Lykkesfeldt) Section of Experimental Animal Models, Department of
Veterinary and Animal Sciences, Faculty of Health and Medical Sciences,
University of Copenhagen, Ridebanevej 9, Frederiksberg C 1871, Denmark
(Gogenur) Department of Clinical Medicine, University of Copenhagen,
Blegdamsvej 3B, Copenhagen N 2200, Denmark
Publisher
MDPI
Abstract
Endothelial dysfunction result from inflammation and excessive production
of reactive oxygen species as part of the surgical stress response. Remote
ischemic preconditioning (RIPC) potentially exerts anti-oxidative and
anti-inflammatory properties, which might stabilise the endothelial
function after non-cardiac surgery. This was a single centre randomised
clinical trial including 60 patients undergoing sub-acute laparoscopic
cholecystectomy due to acute cholecystitis. Patients were randomised to
RIPC or control. The RIPC procedure consisted of four cycles of five
minutes of ischaemia and reperfusion of one upper extremity. Endothelial
function was assessed as the reactive hyperaemia index (RHI) and
circulating biomarkers of nitric oxide (NO) bioavailability (L-arginine,
asymmetric dimethylarginine (ADMA), L-arginine/ADMA ratio, tetra- and
dihydrobiopterin (BH<inf>4</inf> and BH<inf>2</inf>), and total plasma
biopterin) preoperative, 2-4 h after surgery and 24 h after surgery. RHI
did not differ between the groups (p = 0.07). Neither did levels of
circulating biomarkers of NO bioavailability change in response to RIPC.
L-arginine and L-arginine/ADMA ratio was suppressed preoperatively and
increased 24 h after surgery (p < 0.001). The
BH<inf>4</inf>/BH<inf>2</inf>-ratio had a high preoperative level,
decreased 2-4 h after surgery and remained low 24 h after surgery (p =
0.01). RIPC did not influence endothelial function or markers of NO
bioavailability until 24 h after sub-acute laparoscopic cholecystectomy.
In response to surgery, markers of NO bioavailability increased, and
oxidative stress decreased. These findings support that a minimally
invasive removal of the inflamed gallbladder countereffects reduced
markers of NO bioavailability and increased oxidative stress caused by
acute cholecystitis.<br/>Copyright &#xa9; 2023 by the authors.

<64>
Accession Number
2023832242
Title
The use of objective assessments in the evaluation of technical skills in
cardiothoracic surgery: a systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 35(3) (no pagination),
2022. Article Number: ivac194. Date of Publication: 01 Sep 2022.
Author
Hussein N.; Van Den Eynde J.; Callahan C.; Guariento A.;
Gollmann-Tepekoylu C.; Elbatarny M.; Loubani M.
Institution
(Hussein, Loubani) Hull-York-Medical-School, University of York, York,
United Kingdom
(Hussein, Loubani) Department of Cardiothoracic Surgery, Castle Hill
Hospital, Cottingham, United Kingdom
(Van Den Eynde) Department of Cardiovascular Sciences, Ku Leuven, Leuven,
Belgium
(Callahan) Department of Surgery, Washington University School of
Medicine, St. Louis, MO, United States
(Guariento) Pediatric and Congenital Cardiac Surgery Unit, Department of
Cardiac, Thoracic, Vascular Sciences and Public Health, University of
Padua, Padua, Italy
(Gollmann-Tepekoylu) Department of Cardiac Surgery, Medical University of
Innsbruck, Innsbruck, Austria
(Elbatarny) Department of Cardiac Surgery, University of Toronto, Toronto,
ON, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: With reductions in training time and intraoperative exposure,
there is a need for objective assessments to measure trainee progression.
This systematic review focuses on the evaluation of trainee technical
skill performance using objective assessments in cardiothoracic surgery
and its incorporation into training curricula. <br/>METHOD(S): Databases
(EBSCOHOST, Scopus and Web of Science) and reference lists of relevant
articles for studies that incorporated objective assessment of technical
skills of trainees/residents in cardiothoracic surgery were included. Data
extraction included task performed; assessment setting and tool used;
number/level of assessors; study outcome and whether the assessments were
incorporated into training curricula. The methodological rigour of the
studies was scored using the Medical Education Research Study Quality
Instrument (MERSQI). <br/>RESULT(S): Fifty-four studies were included for
quantitative synthesis. Six were randomized-controlled trials. Cardiac
surgery was the most common speciality utilizing objective assessment
methods with coronary anastomosis the most frequently tested task.
Likert-based assessment tools were most commonly used (61%). Eighty-five
per cent of studies were simulation-based with the rest being
intraoperative. Expert surgeons were primarily used for objective
assessments (78%) with 46% using blinding. Thirty (56%) studies explored
objective changes in technical performance with 97% demonstrating
improvement. The other studies were primarily validating assessment tools.
Thirty-nine per cent of studies had established these assessment tools
into training curricula. The mean +/- standard deviation MERSQI score for
all studies was 13.6 +/- 1.5 demonstrating high validity.
<br/>CONCLUSION(S): Despite validated technical skill assessment tools
being available and demonstrating trainee improvement, their regular
adoption into training curricula is lacking. There is a need to
incorporate these assessments to increase the efficiency and transparency
of training programmes for cardiothoracic surgeons. <br/>Copyright &#xa9;
2022 The Author(s). Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery.

<65>
Accession Number
2023893715
Title
Randomized feasibility trial of prophylactic radiofrequency ablation to
prevent atrial fibrillation after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2023.
Date of Publication: 2023.
Author
Willekes C.L.; Fanning J.S.; Heiser J.C.; Wai Sang S.L.; Timek T.A.;
Parker J.; Ragagni M.K.
Institution
(Willekes, Fanning, Heiser, Wai Sang, Timek) Department of Cardiothoracic
Surgery, Corewell Health Hospital, Grand Rapids, Mich, United States
(Willekes, Fanning, Heiser, Wai Sang, Timek) College of Human Medicine,
Michigan State University, Grand Rapids, Mich, United States
(Parker) Office of Research and Education, Corewell Health Hospital, Grand
Rapids, Mich, United States
(Ragagni) Department of Cardiovascular Research, Corewell Health Hospital,
Grand Rapids, Mich, United States
Publisher
Elsevier Inc.
Abstract
Objective: To evaluate the feasibility of prophylactic radiofrequency
isolation of the pulmonary veins, with left atrial appendage amputation,
to reduce the incidence of postoperative atrial fibrillation after cardiac
surgery in patients aged 70 years and older. <br/>Method(s): The Federal
Food and Drug Administration granted an investigational device exemption
to utilize a bipolar radiofrequency clamp for prophylactic pulmonary vein
isolation in a limited feasibility trial. Sixty-two patients without prior
dysrhythmias were prospectively randomized to undergo either their index
cardiac surgical procedure or bilateral pulmonary vein isolation and left
atrial appendage amputation during their cardiac operation. The primary
outcome was occurrence of in-hospital postoperative atrial fibrillation.
Subjects were on 24-hour telemetry until discharge. Dysrhythmias, any
episode of atrial fibrillation >30 seconds, were confirmed by
electrophysiologists blinded to the study. <br/>Result(s): Sixty patients,
mean age 75 years and mean Congestive heart failure, Hypertension, Age
(>65 = 1, >75 = 2 points), Diabetes, previous Stroke/Transient ischemic
attack (2 points), Vascular disease, Gender (female) score of 4, were
analyzed. Thirty-one patients randomized to control and 29 to the
treatment group. The majority of patients in each group underwent isolated
coronary artery bypass grafting. No perioperative complications related to
the treatment procedure, need for permanent pacemaker, or mortality
occurred. The in-hospital incidence of postoperative atrial fibrillation
was 55% (17 out of 31) in the control group and 7% (2 out of 29) in the
treatment group (P < .001) The control group had a significantly higher
requirement for antiarrhythmic medications at discharge: 45% (14 out of
31) versus 7% (2 out of 29) in the treatment group (P < .001).
<br/>Conclusion(s): Prophylactic radiofrequency isolation of the pulmonary
veins with left atrial appendage amputation during the primary cardiac
surgical operation reduced the incidence of postoperative atrial
fibrillation in patients aged 70 years and older with no history of atrial
arrhythmias.<br/>Copyright &#xa9; 2023 The American Association for
Thoracic Surgery

<66>
Accession Number
2022489959
Title
Effect of Perioperative Oral Vitamin C Supplementation on In-Hospital
Postoperative Medication Costs for Cardiac Surgery Patients: A
Prospective, Single-Centre, Randomised Clinical Trial.
Source
PharmacoEconomics - Open. (no pagination), 2023. Date of Publication:
2023.
Author
Heerman J.; Boydens C.; Allaert S.; Cathenis K.; Deryckere K.;
Vanoverschelde H.
Institution
(Heerman, Boydens, Allaert, Vanoverschelde) Department of Anaesthesia and
Intensive Care, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30,
Ghent 9000, Belgium
(Cathenis) Department of Cardiac Surgery, AZ Maria Middelares Hospital,
Buitenring Sint-Denijs 30, Ghent 9000, Belgium
(Deryckere) Department of Pharmaceutics, AZ Maria Middelares Hospital,
Buitenring Sint-Denijs 30, Ghent 9000, Belgium
Publisher
Adis
Abstract
Background: Due to its antioxidant properties, vitamin C might be a
promising and effective strategy for preventing postoperative atrial
fibrillation (POAF) after cardiac surgery. This study was aimed at
evaluating whether vitamin C supplementation is effective in reducing the
cost of in-hospital postoperative medication used for patients undergoing
coronary artery bypass (CABG) or valve surgery (+/-CABG).
<br/>Objective(s): The primary goal of this study was to evaluate the
impact of perioperative vitamin C supplementation in patients undergoing
cardiac surgery on in-hospital postoperative medication costs, while
secondary endpoints were the effects on length of stay (LOS) in both the
intensive care unit (ICU) and the hospital, and the incidence of POAF.
<br/>Material(s) and Method(s): From November 2018 to January 2021, 253
patients planned for CABG or valve surgery (+/-CABG) in AZ Maria
Middelares, Ghent, Belgium, and who met the inclusion criteria (>=18 years
of age, all having cardiac sinus rhythm, and who provided written informed
consent) were randomised into a placebo group or vitamin C group. The
medication was administered orally (1 g twice daily), starting from 5 days
preoperatively until 10 days postoperatively. The medication used, LOS in
the hospital/ICU, and development of clinically relevant POAF in the ICU
were registered. <br/>Result(s): Mean medication costs were 264.6 +/- 98.1
for patients in the vitamin C group and 294.9 +/- 267.3 for patients in
the placebo group. When stratifying according to the type of surgery (CABG
or valve surgery [+/-CABG]), these costs did not significantly differ.
There was no significant difference in LOS or the incidence of clinically
relevant POAF. <br/>Conclusion(s): Our data did not identify any
short-term financial impact on postoperative medication costs after oral
perioperative vitamin C supplementation (1 g twice daily) for patients
undergoing a CABG procedure or valve surgery (+/-CABG). No effect was
found on the LOS or the incidence of clinically relevant POAF. Potential
effects in the longer term, after intravenous administration of vitamin C
or in other types of (cardiac) surgery, are still to be investigated.
Clinical Trials registration number: NCT03592680.<br/>Copyright &#xa9;
2023, The Author(s).

<67>
Accession Number
2022485235
Title
Day surgery unit robotics thoracic surgery: feasibility and management.
Source
Journal of Cancer Research and Clinical Oncology. (no pagination), 2023.
Date of Publication: 2023.
Author
Li X.; Liu Y.; Zhou Y.; Gao Y.; Duan C.; Zhang C.
Institution
(Li, Liu, Zhou, Gao, Duan, Zhang) Department of Thoracic Surgery,
XiangyaHospital, Central South University, Hunan, Changsha 410008, China
(Li, Liu, Zhou, Gao, Duan, Zhang) Hunan Engineering Research Center for
Pulmonary Nodules Precise Diagnosis & Treatment, Hunan, Changsha 410008,
China
(Li, Liu, Zhou, Gao, Duan, Zhang) National Clinical Research Center for
Geriatric Disorders, Hunan, Changsha 410008, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Day surgery has been widely carried out in medical developed
countries such as Europe and the United States with high efficiency,
safety and economy. The development of thoracic day surgery started late,
and currently only a few top three hospitals carry thoracic day surgery.
In recent years, with the continuous in-depth application of the concept
of accelerated rehabilitation surgery (ERAS) in the field of surgery,
thoracic surgery ERAS has also entered clinical practice with remarkable
results. At present, the application of day surgery in the field of
thoracic surgery is still in its infancy, and the application of
robot-assisted thoracic surgery in thoracic surgery has brought new
opportunities for the popularization of day surgery in thoracic surgery.
<br/>Method(s): We retrospectively reviewed 86 patients underwent thoracic
day surgery under the application of robot-assisted surgery system and
through systematic randomization method choose 86 patients underwent
conventional thoracic surgery under the application of robot-assisted
surgery system at our Institute between 2020 and 2022. We analyzed the
clinical and pathological features between the two groups. <br/>Result(s):
The clinical feature of location of the nodules, the size of nodules, pN,
histology and postoperative complications were homogenous between the two
groups. The average age was significantly higher in the conventional mode
group, the ratio of male patients and the patients with history of smoking
were significantly lower in day-surgery mode group. The major surgical
method in conventional mode group was lobectomy resection (48.8%). While
the segmental resection was the major surgical in day surgery mode group.
The hospital stay and the time of drain was significant longer in
conventional mode group. And the total medical cost in conventional was
more than day-surgery mode group. While the histology and postoperative
complications were homogenous between the two groups. <br/>Conclusion(s):
Before this, day surgery and robotics assistant surgery in thoracic
surgery had been proved feasibility and safety. However, there was no
report of day surgery unit robotics assistant thoracic surgery. Our
clinical practice demonstrated that the method of day surgery unit
robotics thoracic surgery is feasibility and safety enough.<br/>Copyright
&#xa9; 2023, The Author(s), under exclusive licence to Springer-Verlag
GmbH Germany, part of Springer Nature.

<68>
Accession Number
641031337
Title
Recurrent Atherosclerotic Cardiovascular Disease Events Potentially
Prevented with Guideline-Recommended Cholesterol-Lowering Therapy
following Myocardial Infarction.
Source
Cardiovascular drugs and therapy. (no pagination), 2023. Date of
Publication: 13 Apr 2023.
Author
Sakhuja S.; Bittner V.A.; Brown T.M.; Farkouh M.E.; Levitan E.B.; Safford
M.M.; Woodward M.; Chen L.; Sun R.; Dhalwani N.; Jones J.; Kalich B.;
Exter J.; Muntner P.; Rosenson R.S.; Colantonio L.D.
Institution
(Sakhuja, Levitan, Chen, Muntner, Colantonio) Department of Epidemiology,
University of Alabama at Birmingham, Birmingham, AL, United States
(Bittner, Brown) Department of Medicine, Division of Cardiovascular
Disease, University of Alabama at Birmingham, Birmingham, AL, United
States
(Farkouh) Peter Munk Cardiac Centre, University of Toronto and Heart and
Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada
(Safford) Department of Medicine, Weill Cornell Medicine, New York, NY,
USA
(Woodward) George Institute for Global Health, University of New South
Wales, Sydney, Australia
(Woodward) George Institute for Global Health, School of Public Health,
Imperial College, London, United Kingdom
(Sun) Department of Healthcare Policy and Organization and Policy,
University of Alabama at Birmingham, Birmingham, AL, United States
(Dhalwani, Jones) Center for Observational Research, Amgen Inc., Thousand
Oaks, CA, United States
(Kalich, Exter) Amgen Inc., Thousand Oaks, CA, United States
(Rosenson) Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New
York, NY, USA
Publisher
NLM (Medline)
Abstract
PURPOSE: Many adults with atherosclerotic cardiovascular disease (ASCVD)
who are recommended to take a statin, ezetimibe and/or a proprotein
convertase subtilisin/kexin type 9 inhibitor (PCSK9i) by the 2018 American
Heart Association/American College of Cardiology cholesterol guideline do
not receive these medications. We estimated the percentage of recurrent
ASCVD events potentially prevented with guideline-recommended
cholesterol-lowering therapy following a myocardial infarction (MI)
hospitalization. <br/>METHOD(S): We conducted simulations using data from
US adults with government health insurance through Medicare or commercial
health insurance in the MarketScan database. We used data from patients
with an MI hospitalization in 2018-2019 to estimate the percentage
receiving guideline-recommended therapy. We used data from patients with
an MI hospitalization in 2013-2016 to estimate the 3-year cumulative
incidence of recurrent ASCVD events (i.e., MI, coronary revascularization
or ischemic stroke). The low-density lipoprotein cholesterol (LDL-C)
reduction with guideline-recommended therapy was derived from trials of
statins, ezetimibe and PCSK9i, and the associated ASCVD risk reduction was
estimated from a meta-analysis by the Cholesterol-Lowering Treatment
Trialists Collaboration. <br/>RESULT(S): Among 279,395 patients with an MI
hospitalization in 2018-2019 (mean age 75 years, mean LDL-C 92 mg/dL),
27.3% were receiving guideline-recommended cholesterol-lowering therapy.
With current cholesterol-lowering therapy use, 25.3% (95%CI: 25.2%-25.4%)
of patients had an ASCVD event over 3 years. If all patients were to
receive guideline-recommended therapy, 19.8% (95%CI: 19.5%-19.9%) were
estimated to have an ASCVD event over 3 years, representing a 21.6%
(95%CI: 20.5%-23.6%) relative risk reduction. <br/>CONCLUSION(S):
Implementation of guideline-recommended cholesterol-lowering therapy could
prevent a substantial percentage of recurrent ASCVD events.<br/>Copyright
&#xa9; 2023. The Author(s), under exclusive licence to Springer
Science+Business Media, LLC, part of Springer Nature.

<69>
Accession Number
641030757
Title
Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management
After Adult Cardiac Surgery: Protocol for a Systematic Review.
Source
The Journal of cardiovascular nursing. (no pagination), 2023. Date of
Publication: 11 Apr 2023.
Author
Wynne R.; Fredericks S.; Hyde E.K.; Matthews S.; Bowden T.;
O'Keefe-McCarthy S.; Martorella G.; Magboo R.; Gjeilo K.H.; Jedwab R.M.;
Keeping-Burke L.; Murfin J.; Bruneau J.; Lie I.; Sanders J.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Many patients report moderate to severe pain in the acute
postoperative period. Enhanced recovery protocols recommend multimodal
analgesics, but the optimal combination of these is unknown. PURPOSE: The
aim of this study was to synthesize the best available evidence about
effectiveness of multimodal analgesics on pain after adult cardiac
surgery. <br/>METHOD(S): A systematic review to determine the effect of
multimodal postoperative analgesics is proposed (International Prospective
Register of Systematic Reviews Registration CRD42022355834). Multiple
databases including the Cochrane Library, Cochrane Central Register of
Controlled Trials, Cumulative Index to Nursing and Allied Health
Literature, American Psychological Association, the Education Resources
Information Centre, the Excerpta Medica database, the Medical Literature
Analysis and Retrieval System Online, Scopus, Web of Science, and clinical
trials databases will be searched. Screening in Covidence and quality
assessment will be conducted by 2 authors. A grading of recommendations,
assessment, development, and evaluation summary of findings will be
presented if meta-analysis is possible.<br/>Copyright &#xa9; 2023 Wolters
Kluwer Health, Inc. All rights reserved.

<70>
Accession Number
641029760
Title
Implementation of the Kidney Disease Improving Global Outcomes guidelines
for the prevention of acute kidney injury after cardiac surgery: An
international cohort survey.
Source
European journal of anaesthesiology. (no pagination), 2023. Date of
Publication: 13 Apr 2023.
Author
Massoth C.; Kullmar M.; Moncho A.P.; Suarez S.G.; Grigoryev E.; Ivkin A.;
von Dossow V.; Ott S.; Rau N.; Meersch M.; Zarbock A.
Institution
(Massoth) From the Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Munster, Germany (CM, La Fe University and
Polytechnic Hospital Valencia (APM), Department of Anaesthesiology,
University Hospital Vall d Hebron Barcelona, Scientific Research Institute
for Complex Issues of Cardiovascular Diseases, Institute of
Anaesthesiology and Pain Therapy, Heart and Diabetes Center Bad
Oeynhausen, Ruhr- University (VvD), German Heart Center Berlin (SO,
Department of Cardiac Anaesthesiology and Intensive Care Medicine, Germany
(SO) and Department of Intensive Care Medicine, University Hospital Vall
d'Hebron Barcelona, Charite-Universitatsmedizin Berlin, Kemerovo, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND: Increasing evidence from randomised controlled trials supports
the implementation of a six-measure care bundle proposed by the Kidney
Disease Improving Global Outcomes (KDIGO) guidelines in patients at high
risk for acute kidney injury (AKI) to reduce its incidence after cardiac
surgery. <br/>OBJECTIVE(S): To assess compliance with the KDIGO bundle in
clinical practice. DESIGN: Prospective observational multinational study.
SETTING: Six international tertiary care centres, from February 2021 to
November 2021. PATIENTS: Five hundred and thirty-seven consecutive
patients undergoing cardiac surgery during a 1-month observational period.
INTERVENTIONS: All patients were assessed for the postoperative
implementation of the following measures: avoidance of nephrotoxic
medication and radiocontrast agents whenever possible, strict glycaemic
control, close monitoring of renal function, optimisation of haemodynamic
and volume status and functional monitoring of haemodynamic status. MAIN
OUTCOME MEASURES: The primary endpoint was the proportion of patients
receiving fully compliant care. Secondary outcomes were occurrence of AKI
and major adverse kidney event rate at day 30. <br/>RESULT(S): The full
care bundle was applied to 0.4% of patients. There was avoidance of
nephrotoxic drugs in 15.6%, radiocontrast agents in 95.3% and
hyperglycaemia in 39.6%. Close monitoring of urine output and serum
creatinine was achieved in 6.3%, 57.4% underwent optimisation of volume
and haemodynamic status, and 43.9% received functional haemodynamic
monitoring. 27.2% developed AKI within 72 h after surgery. The average
number of implemented measures was 2.6 +/- 1.0 and did not differ between
AKI or non-AKI patients (P = 0.854). <br/>CONCLUSION(S): Adherence with
the KDIGO bundle was very low in cardiac surgery patients. Initiatives to
improve guideline compliance might provide a strategy to mitigate the
burden of AKI. TRIAL REGISTRATION: www.drks.de DRKS00024204.<br/>Copyright
&#xa9; 2023 European Society of Anaesthesiology and Intensive Care.
Unauthorized reproduction of this article is prohibited.

<71>
Accession Number
641029667
Title
Individualized red-cell transfusion strategy for non-cardiac surgery in
adults: a randomized controlled trial.
Source
Chinese medical journal. (no pagination), 2023. Date of Publication: 14
Apr 2023.
Author
Liao R.; Liu J.; Zhang W.; Zheng H.; Zhu Z.; Sun H.; Yu Z.; Jia H.; Sun
Y.; Qin L.; Yu W.; Luo Z.; Chen Y.; Zhang K.; Ma L.; Yang H.; Wu H.; Liu
L.; Yuan F.; Xu H.; Zhang J.; Zhang L.; Liu D.; Huang H.
Institution
(Liao, Liu, Luo, Xu) Department of Anesthesiology, Research Unit for
Perioperative Stress Assessment and Clinical Decision, Chinese Academy of
Medical Sciences (2018RU012), West China Hospital of Sichuan University,
Chengdu, Sichuan 610041, China
(Zhang, Zhang) Department of Anesthesiology, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, Henan 450052, China
(Zheng, Zhang) Department of Anesthesiology, First Affiliated Hospital of
Xinjiang Medical University, Urumqi, Xinjiang 830054, China
(Zhu, Liu) Department of Anesthesiology, Affiliated Hospital of Zunyi
Medical College, Zunyi, Guizhou 563003, China
(Sun) Department of Anesthesiology, Beijing Friendship Hospital of Capital
Medical University, Beijing 100069, China
(Yu) Department of Bioinformatics and Biostatistics, School of Life
Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240,
China
(Jia) Department of Anesthesiology, Fourth Hospital of Hebei Medical
University, Hebei 050019, China
(Sun) Department of Anesthesiology, Xijing Hospital of the Fourth Military
Medical University, Xi'an, Shaanxi 710032, China
(Qin) Department of Transfusion, West China Hospital of Sichuan
University, Chengdu, Sichuan 610041, China
(Yu) Department of Anesthesiology, Tianjin First Center Hospital, Tianjin
300192, China
(Chen) Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou,
Fujian 350001, China
(Zhang) Department of Anesthesiology, Sichuan Cancer Hospital & Institute,
Chengdu, Sichuan 610041, China
(Ma) Department of Anesthesiology, Peking Union Medical College Hospital,
Beijing 100032, China
(Yang) Department of Anesthesiology, Tongji Hospital of Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, Hubei
430030, China
(Wu) Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital of
Sichuan University, Chengdu, Sichuan 610041, China
(Liu) Department of Orthopedic Surgery, West China Hospital of Sichuan
University, Chengdu, Sichuan 610041, China
(Yuan) Department of Anesthesiology, General Hospital Affiliated to
Tianjin Medical University, Tianjin 300052, China
(Huang) Department of Anesthesiology and Translational Neuroscience
Center, West China Second University Hospital of Sichuan University,
Chengdu, Sichuan 610041, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Red-cell transfusion is critical for surgery during the
peri-operative period; however, the transfusion threshold remains
controversial mainly owing to the diversity among patients. The patient's
medical status should be evaluated before making a transfusion decision.
Herein, we developed an individualized transfusion strategy using the
West-China-Liu's Score based on the physiology of oxygen
delivery/consumption balance and designed an open-label, multicenter,
randomized clinical trial to verify whether it reduced red cell
requirement as compared with that associated with restrictive and liberal
strategies safely and effectively, providing valid evidence for
peri-operative transfusion. <br/>METHOD(S): Patients aged >14 years
undergoing elective non-cardiac surgery with estimated blood loss > 1000
mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly
assigned to an individualized strategy, a restrictive strategy following
China's guideline or a liberal strategy with a transfusion threshold of
hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the
proportion of patients who received red blood cells (superiority test) and
a composite of in-hospital complications and all-cause mortality by day 30
(non-inferiority test). <br/>RESULT(S): We enrolled 1182 patients: 379,
419, and 384 received individualized, restrictive, and liberal strategies,
respectively. Approximately 30.6% (116/379) of patients in the
individualized strategy received a red-cell transfusion, less than 62.5%
(262/419) in the restrictive strategy (absolute risk difference, 31.92%;
97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI:
2.70-5.30%; P<0.001), and 89.8% (345/384) in the liberal strategy
(absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio,
20.06; 97.5% CI: 12.74-31.57; P<0.001). No statistical differences were
found in the composite of in-hospital complications and mortality by day
30 among the three strategies. <br/>CONCLUSION(S): The individualized
red-cell transfusion strategy using the West-China-Liu's Score reduced
red-cell transfusion without increasing in-hospital complications and
mortality by day 30 when compared with restrictive and liberal strategies
in elective non-cardiac surgeries. TRIAL REGISTRATION: ClinicalTrials.gov,
NCT01597232.<br/>Copyright &#xa9; 2023 The Chinese Medical Association,
produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

<72>
Accession Number
2022554337
Title
Bleeding Events After Transcatheter Aortic Valve Replacement: JACC
State-of-the-Art Review.
Source
Journal of the American College of Cardiology. 81(7) (pp 684-702), 2023.
Date of Publication: 21 Feb 2023.
Author
Avvedimento M.; Nuche J.; Farjat-Pasos J.I.; Rodes-Cabau J.
Institution
(Avvedimento, Nuche, Farjat-Pasos, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, QC, Canada
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve replacement (TAVR) has gained over time a major
reduction in procedural complications. Despite this, clinically relevant
bleeding still occurs in a non-negligible proportion of patients and
adversely affects prognosis. Patients with severe aortic stenosis are at
heightened risk for spontaneous bleeding due to advanced age and a high
comorbidity burden. Also, procedural factors and antithrombotic management
contribute to define individual bleeding susceptibility. Bleeding
prevention represents an emerging area for improving patient care. Because
of the tight hemorrhagic/ischemic balance, a tailored approach based on
individual bleeding-risk profile, such as a less invasive antithrombotic
regimen or appropriate diagnostic preprocedural evaluation, should be
pursued to avoid bleeding events. This review aims to provide an in-depth
overview of bleeding events in the TAVR field, including definitions,
timing and the extent of risk, and clinical impact, as well as updates on
antithrombotic management and its potential influence on bleeding
complications.<br/>Copyright &#xa9; 2023 American College of Cardiology
Foundation

<73>
[Use Link to view the full text]
Accession Number
2023789387
Title
Meta-analysis of the effect of colchicine on C-reactive protein in
patients with acute and chronic coronary syndromes.
Source
Coronary Artery Disease. 34(3) (pp 210-215), 2023. Date of Publication: 01
May 2023.
Author
Alam M.; Kontopantelis E.; Mamas M.A.; Savinova O.V.; Jhaveri A.; Siddiqui
E.; Jhamnani S.
Institution
(Alam, Savinova) Department of Biomedical Sciences, New York Institute of
Technology College of Osteopathic Medicine, Old Westbury, NY, United
States
(Kontopantelis) Division of Informatics, Imaging & Data Sciences Faculty
of Biology, Medicine and Health School of Health Sciences University of
Manchester, Manchester, United Kingdom
(Mamas) Keele Cardiac Research Group, Keele University, Stoke-on-Trent,
United Kingdom
(Jhaveri, Siddiqui) NYU Grossman School of Medicine, New York, United
States
(Jhamnani) CommonSpirit Health, Phoenix, AZ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective The anti-inflammatory drug colchicine has recently shown
benefits in the prevention of major adverse cardiovascular events (MACE)
in patients with the acute coronary syndrome (ACS) and chronic coronary
syndromes (CCS). This meta-analysis focuses on understanding Colchicine's
effects on the high-sensitivity C-reactive protein (hs-CRP) to provide
mechanistic insight to explain its clinical event reduction. Methods A
computerized search of MEDLINE was conducted to retrieve journal articles
with studies performed on humans from 1 January 2005 to 1 January 2022,
using keywords: 'Colchicine AND Coronary', 'Colchicine AND CRP', and
'Colchicine AND Coronary Artery Disease'. Studies were included if they
measured hs-CRP changes from baseline, and colchicine or placebo were
given to patients with ACS or CCS. Results Thirteen studies with a
biomarker subgroup population of 1636 patients were included in the hs-CRP
meta-analysis. Of those 13 studies, 8 studies with a total population of
6016 reported clinical events defined as myocardial infarction (MI),
stroke, cardiovascular death, periprocedural MI, repeat angina after PCI
and repeat revascularization. Multivariate analysis revealed a weak
negative correlation of -0.1056 (P = 0.805) between change in CRP and
clinical events. Overall, colchicine treatment resulted in a greater
reduction in hs-CRP levels compared with placebo (Mean Difference: -1.59;
95% Confidence Interval, -2.40 to -0.79, P = 0.0001) and clinical events
(Odds Ratio: 0.78; 95% Confidence Interval 0.64 to 0.95, P = 0.01)
Conclusion Colchicine therapy is associated with a reduction in hs-CRP and
clinical events in patients with ACS and CCS. This finding supports
colchicine's anti-inflammatory efficacy via CRP reduction to explain its
clinical benefit.<br/>Copyright &#xa9; 2023 Lippincott Williams and
Wilkins. All rights reserved.

<74>
Accession Number
2023741734
Title
Sodium glucose co-transporter 2 inhibition with empagliflozin on
metabolic, cardiac and renal outcomes in recent cardiac transplant
recipients (EMPA-HTx): Protocol for a randomised controlled trial.
Source
BMJ Open. 13(3) (no pagination), 2023. Article Number: e069641. Date of
Publication: 29 Mar 2023.
Author
Raven L.M.; Muir C.A.; Kessler Iglesias C.; Bart N.K.; Muthiah K.; Kotlyar
E.; Macdonald P.; Hayward C.S.; Jabbour A.; Greenfield J.R.
Institution
(Raven, Muir, Greenfield) Department of Diabetes and Endocrinology, St
Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
(Raven, Greenfield) Clinical Diabetes, Appetite and Metabolism Laboratory,
Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
(Raven, Muir, Kessler Iglesias, Bart, Muthiah, Kotlyar, Macdonald,
Hayward, Jabbour, Greenfield) School of Clinical Medicine, St Vincent's
Campus, Faculty of Medicine and Health, University of New South Wales,
Sydney, NSW, Australia
(Kessler Iglesias, Bart, Muthiah, Kotlyar, Macdonald, Hayward, Jabbour)
Department of Heart and Lung Transplantation, St Vincent's Hospital
Sydney, Darlinghurst, NSW, Australia
(Kessler Iglesias, Bart, Muthiah, Kotlyar, Macdonald, Hayward, Jabbour)
Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiac transplantation (CTx) is a life-saving operation that
can improve the quality and length of a recipient's life.
Immunosuppression medication, required to prevent rejection, can result in
adverse metabolic and renal effects. Clinically significant complications
include metabolic effects such as diabetes and weight gain, renal
impairment, and cardiac disease such as allograft vasculopathy and
myocardial fibrosis. Sodium glucose co-transporter 2 (SGLT2) inhibitors
are a class of oral medication that increase urinary excretion of glucose.
In patients with type 2 diabetes, SGLT2 inhibitors improve cardiovascular,
metabolic and renal outcomes. Similar benefits have been shown in patients
with heart failure and reduced ejection fraction irrespective of diabetes
status. In patients with post-transplant diabetes mellitus, SGLT2
inhibitors improve metabolic parameters; however, their benefit and safety
have not been evaluated in randomised prospective studies. This study will
potentially provide a novel therapy to improve or prevent complications
(diabetes, kidney failure and heart fibrosis) that occur with
immunosuppressive medications. Methods The EMPA-HTx study is a randomised,
placebo-controlled trial of the SGLT2 inhibitor empagliflozin 10 mg daily
versus placebo in recent CTx recipients. One hundred participants will be
randomised 1:1 and commence the study medication within 6-8 weeks of
transplantation with treatment and follow-up until 12 months after
transplantation. Demographic information, anthropomorphic measurements,
pathology tests and cardiac magnetic resonance (CMR) scan will be recorded
at baseline and follow-up. Patients will be reviewed monthly during the
study until 12 months post-CTx and data will be collected for each patient
at each study visit. The overall aim of the study is to assess the safety
and efficacy of empagliflozin in CTx recipients. The primary outcome is
glycaemic improvement measured as change in glycated haemoglobin and/or
fructosamine. Key secondary outcomes are cardiac interstitial fibrosis
measured by CMR and renal function measured by estimated glomerular
filtration rate. Ethics and dissemination This study has been approved by
St Vincent's Hospital Human Research Ethics Committee (2021/ETH12184). The
findings will be presented at national and international scientific
meetings and published in peer-reviewed journals. Trial registration
number ACTRN12622000978763.<br/>Copyright &#xa9; 2023 BMJ Publishing
Group. All rights reserved.

<75>
Accession Number
2021354240
Title
Thoracic paravertebral versus interpleural catheter for post-thoracotomy
pain control in minimally invasive cardiac surgery.
Source
Asian Cardiovascular and Thoracic Annals. 31(3) (pp 202-209), 2023. Date
of Publication: March 2023.
Author
Pujara J.; Singh G.; Prajapati M.; Ninama S.; Rajesh V.S.P.; Trivedi V.;
Pandya H.
Institution
(Pujara, Singh, Prajapati, Ninama, Rajesh, Trivedi) Department of Cardiac
Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre,
Affiliated to B. J. Medical College Ahmedabad, Gujarat, Ahmedabad, India
(Pandya) Department of Research, U. N. Mehta Institute of Cardiology and
Research Centre, Affiliated to B. J. Medical College Ahmedabad, Gujarat,
Ahmedabad, India
Publisher
SAGE Publications Inc.
Abstract
Objective: The aim of this study was to compare efficacy and safety of
paravertebral block (PVB) and interpleural analgesia (IPA) after minimally
invasive cardiac surgery through thoracotomy in terms of quality of
analgesia, post-operative mechanical ventilation time, intensive care unit
(ICU) and hospital length of stay (LOS) and complications. <br/>Design(s):
A randomized, prospective study. <br/>Participant(s): A total of 50 adult
patients (18-50 years old) undergoing minimally invasive cardiac surgery
via thoracotomy. <br/>Intervention(s): Patients were randomized for group
A: paravertebral epidural catheter (n = 25), group B: interpleural
catheter (n = 25). All patients were given Inj. Bupivacaine 0.125%, 8 ml
and Inj. Tramadol 100 mg as an adjuvant, total volume 10 ml.
<br/>Result(s): After obtaining institutional review board approval, data
collected and analysed - visual analogue score (VAS) at rest and on
coughing, haemodynamic and respiratory parameters, time to extubation,
supplementary analgesia requirement, LOS and complications. VAS was
recorded at 0, 2, 3, 4, 8, 12 and 24 h post-extubation, while blood gases
at-after shifting, 4, 8, 12 and 24 h. There were no significant
differences in haemodynamic or respiratory parameters, VAS at rest and on
coughing, ventilation duration, ICU and hospital LOS between two groups.
The requirement of rescue analgesia was in one patient of mini coronary
artery bypass in group B, while one patient in group A required
reintubation due to respiratory acidosis and got successfully extubated on
next day morning. <br/>Conclusion(s): PVB and IPA both are safe and
effective techniques for minimally invasive cardiac surgery with
thoracotomy. It allows optimal pain control and safe ICU fast-track
post-operative course.<br/>Copyright &#xa9; The Author(s) 2023.

<76>
Accession Number
2021339478
Title
Effects of Ultrasound-Guided Transversus Thoracic Muscle Plane Block on
Postoperative Pain and Side Effects: A Systematic Review and Meta-Analysis
of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(5) (pp 788-800),
2023. Date of Publication: May 2023.
Author
Liu G.; Gao M.; Wang B.; Lin Y.; Guan Y.; Chen G.; Zhang P.; Hu Y.; Cai
Q.; Qin W.
Institution
(Liu, Lin, Guan) Guangxi Medical University, Guangxi, Nanning, China
(Gao) Department of Anesthesiology, Taihe Hospital, Hubei University of
Medicine, Hubei, Shiyan, China
(Chen, Zhang, Hu, Cai) Department of Orthopedics, Xiangyang Central
Hospital, Affiliated Hospital of Hubei University of Arts and Science,
Hubei, China
(Hu, Wang, Qin) Department of Ultrasound, Xiangyang Central Hospital,
Affiliated Hospital of Hubei University of Arts and Science, Hubei,
Xiangyang, China
Publisher
W.B. Saunders
Abstract
The effects of the transversus thoracic muscle plane (TTP) block on
postoperative pain have become increasingly controversial. This
meta-analysis compared the effects of the TTP block versus no block on
postoperative analgesia and side effects to determine whether this new
technique is a reliable alternative for pain management. PubMed, Cochrane
Library, Embase, Web of Science, ClinicalTrials.gov, China National
Knowledge Infrastructure, Chongqing VIP information, and Wanfang Data were
searched for clinical studies investigating the analgesic effect of the
TTP block compared to controls. The primary outcomes included the
postoperative pain scores at rest and during movement, morphine
consumption in 24 hours, and the rate of postoperative nausea and vomiting
(PONV). Eleven randomized controlled trials (RCTs), including 682
patients, were reviewed. The meta-analysis showed that the TTP block
significantly could reduce the pain scores at 0 (at rest: mean difference
[MD], -2.28; 95% CI: -2.67 to -1.90) (during movement: MD: -2.09, 95% CI:
-2.62 to -1.56) and 12 hours (at rest: -1.42, 95% CI: -2.03 to -0.82)
(during movement: MD: -2.13, 95% CI: -2.80 to -1.46) after surgery,
24-hour postoperative analgesic consumption (MD: -23.18, 95% CI: -33.71 to
-12.66), and the incidence of PONV (odds ratio, 0.36, 95% CI: 0.15-0.88).
Furthermore, the trial sequence analysis confirmed the result of less
24-hour postoperative analgesic consumption in the TTP block group. As a
novel technique, the TTP block exhibited a superior postoperative
analgesic effect during the early postoperative period. Nevertheless,
additional well-designed RCTs are needed.<br/>Copyright &#xa9; 2022

<77>
Accession Number
2020950006
Title
Externally mounted versus internally mounted leaflet aortic bovine
pericardial bioprosthesis: meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. 71(4) (pp 207-215), 2023.
Date of Publication: April 2023.
Author
Yokoyama Y.; Sakurai Y.; Kuno T.; Takagi H.; Fukuhara S.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Sakurai) Department of Surgery, Marshall University Joan Edwards School
of Medicine, Huntington, WV, United States
(Kuno) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, 111 East 210th St, Bronx, NY 10467-2401, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
Publisher
Springer
Abstract
Background: Recent studies reported higher-than-expected rates of early
structural valve degeneration (SVD) and/or reoperation of externally
mounted leaflet aortic bioprosthesis compared with others. This
meta-analysis aims to compare the outcomes of bioprostheses with
externally versus internally mounted leaflet design in patients who
underwent surgical aortic valve replacement (SAVR). <br/>Method(s):
MEDLINE and EMBASE were searched through November 2021 to identify
comparative studies investigating outcomes following SAVR with either
externally or internally mounted leaflet aortic bioprosthesis. Outcomes of
interest were reoperation for SVD or any cause and all-cause mortality.
<br/>Result(s): Our analysis included 15 observational studies that
enrolled a total of 23,539 patients who underwent SAVR using externally
mounted (n = 9338; 39.7%) or internally mounted leaflet (n = 14,201;
60.3%) bioprostheses. Externally mounted valves consisted of the Trifecta
(Abbott, St Paul, MN) (n = 6146) and the Mitroflow (LivaNova, London, UK)
(n = 3192), and all internally mounted valves were the Perimount (Edwards
Lifesciences, Irvine, CA). Externally mounted valves compared with the
Perimount were associated with higher reoperation rates for SVD [hazard
ratio (HR) 3.55, 95% confidence interval (CI) 2.67-4.72; P < 0.001] and
any cause (HR 9.36, 95% CI 3.70-23.67; P < 0.001). Furthermore, externally
mounted valves demonstrated higher all-cause mortalities (HR 1.33, 95% CI
1.13-1.56; P < 0.001). <br/>Conclusion(s): The present study summarizing
updated evidence revealed higher reoperation rates and all-cause
mortalities in patients with externally mounted leaflet aortic
bioprostheses compared with those with internally mounted design. Choosing
the right SAVR valve type is critical part of lifetime management of
aortic valve disease.<br/>Copyright &#xa9; 2023, The Author(s), under
exclusive licence to The Japanese Association for Thoracic Surgery.

<78>
[Use Link to view the full text]
Accession Number
2021804133
Title
Mammalian Target of Rapamycin Inhibitors and Kidney Function after
Thoracic Transplantation: A Systematic Review and Recommendations for
Management of Lung Transplant Recipients.
Source
Transplantation. 107(1) (pp 53-73), 2023. Date of Publication: 01 Jan
2023.
Author
Schmucki K.; Hofmann P.; Fehr T.; Inci I.; Kohler M.; Schuurmans M.M.
Institution
(Schmucki, Hofmann, Kohler, Schuurmans) Division of Pulmonology,
University Hospital Zurich, Zurich, Switzerland
(Schmucki, Hofmann, Fehr) Department of Internal Medicine, Cantonal
Hospital Graubunden, Chur, Switzerland
(Fehr, Inci, Kohler, Schuurmans) Faculty of Medicine, University of
Zurich, Zurich, Switzerland
(Inci) Department of Thoracic Surgery, Zurich University Hospital, Zurich,
Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Background. Chronic kidney disease (CKD) after lung transplantation is
common and limits the survival of transplant recipients. The calcineurin
inhibitors (CNI), cyclosporine A, and tacrolimus being the cornerstone of
immunosuppression are key mediators of nephrotoxicity. The mammalian
target of rapamycin (mTOR) inhibitors, sirolimus and everolimus, are
increasingly used in combination with reduced CNI dosage after lung
transplantation. Methods. This systematic review examined the efficacy and
safety of mTOR inhibitors after lung transplantation and explored their
effect on kidney function. Results. mTOR inhibitors are often introduced
to preserve kidney function. Several clinical trials have demonstrated
improved kidney function and efficacy of mTOR inhibitors. The potential
for kidney function improvement and preservation increases with early
initiation of mTOR inhibitors and low target levels for both mTOR
inhibitors and CNI. No defined stage of CKD for mTOR inhibitor initiation
exists, nor does severe CKD preclude the improvement of kidney function
under mTOR inhibitors. Baseline proteinuria may negatively predict the
preservation and improvement of kidney function. Discontinuation rates of
mTOR inhibitors due to adverse effects increase with higher target levels.
Conclusions. More evidence is needed to define the optimal
immunosuppressive regimen incorporating mTOR inhibitors after lung
transplantation. Not only the indication criteria for the introduction of
mTOR inhibitors are needed, but also the best timing, target levels, and
possibly discontinuation criteria must be defined more clearly. Current
evidence supports the notion of nephroprotective potential under certain
conditions.<br/>Copyright &#xa9; 2023 Lippincott Williams and Wilkins. All
rights reserved.

<79>
Accession Number
2023553199
Title
Long-term effects of lowering postprandial glucose level on cardiovascular
outcomes in early-stage diabetic patients with coronary artery disease:
10-year post-trial follow-up analysis of the DIANA study.
Source
Journal of Diabetes and its Complications. 37(5) (no pagination), 2023.
Article Number: 108469. Date of Publication: May 2023.
Author
Kataoka Y.; Yasuda S.; Asaumi Y.; Honda S.; Noguchi T.; Miyamoto Y.; Sase
K.; Iwahashi N.; Kawamura T.; Kosuge M.; Kimura K.; Takamisawa I.; Iwanaga
Y.; Miyazaki S.
Institution
(Kataoka, Asaumi, Honda, Noguchi) Department of Cardiovascular Medicine,
National Cerebral & Cardiovascular Centre, Osaka, Suita, Japan
(Yasuda) Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine, Sendai, Japan
(Miyamoto) Open Innovation Center, National Cerebral and Cardiovascular
Center, Suita, Japan
(Sase) Department of Clinical Pharmacology, Juntendo University School of
Medicine, Tokyo, Japan
(Iwahashi, Kosuge) Division of Cardiology, Yokohama City University
Medical Center, Yokohama, Japan
(Kawamura) Department of Cardiovascular Medicine, Kindai University,
Faculty of Medicine, Osakasayama, Japan
(Kimura) Yokosuka City Hospital, Yokosuka, Japan
(Takamisawa) Department of Cardiology, Sakakibara Heart Institute, Tokyo,
Fuchu, Japan
(Iwanaga) Center for Cerebral and Cardiovascular Disease Information,
National Cerebral & Cardiovascular Center, Osaka, Japan
(Miyazaki) Saiseikai Tondabayashi Hospital, Osaka, Japan
Publisher
Elsevier Inc.
Abstract
Aims: To elucidate the long-term cardiovascular benefit of lowering
postprandial hyperglycemia (PPG) in early-stage T2DM patients.
<br/>Method(s): This 10-year post-trial follow-up study included 243
patients from the DIANA (DIAbetes and diffuse coronary Narrowing) study, a
multi-center randomized controlled trial which compared the efficacy of
one-year life-style and pharmacological (voglibose/nateglinide)
intervention lowering PPG on coronary atherosclerosis in 302 early-stage
T2DM subjects [impaired glucose tolerance (IGT) or newly-diagnosed T2DM]
(UMIN-CTRID#0000107). MACE (all-cause death, non-fatal MI or unplanned
coronary revascularization) were compared in (1) three assigned therapies
(life-style intervention/vogliose/nateglinide) and (2) patients with and
without improvement of PPG (reversion from IGT to NGT or from DM to
IGT/NGT on 75 g oral glucose tolerance test). <br/>Result(s): During the
10-year post-trial observational period, voglibose (HR = 1.07, 95%CI:
0.69-1.66, p = 0.74) or nateglinide (HR = 0.99, 95%CI: 0.64-1.55, p =
0.99) did not reduce MACE. Similarly, achieving the improvement of PPG was
not associated with a reduction of MACE (HR = 0.78, 95%CI: 0.51-1.18, p =
0.25). However, in IGT subjects (n = 143), this glycemic management
significantly reduced the occurrence of MACE (HR = 0.44, 95%CI: 0.23-0.86,
p = 0.01), especially unplanned coronary revascularization (HR = 0.46,
95%CI: 0.22-0.94, p = 0.03). <br/>Conclusion(s): The early improvement of
PPG significantly reduced MACE and unplanned coronary revascularization in
IGT subjects during the post-trial 10-year period.<br/>Copyright &#xa9;
2023 The Authors

<80>
Accession Number
2022448866
Title
Intravascular Imaging During Percutaneous Coronary Intervention: JACC
State-of-the-Art Review.
Source
Journal of the American College of Cardiology. 81(6) (pp 590-605), 2023.
Date of Publication: 14 Feb 2023.
Author
Truesdell A.G.; Alasnag M.A.; Kaul P.; Rab S.T.; Riley R.F.; Young M.N.;
Batchelor W.B.; Maehara A.; Welt F.G.; Kirtane A.J.
Institution
(Truesdell) Virginia Heart, Falls Church, VA, United States
(Truesdell, Batchelor) Inova Heart and Vascular Institute, Falls Church,
VA, United States
(Alasnag) Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi
Arabia
(Kaul) Piedmont Heart Institute, Atlanta, GA, United States
(Rab) Emory University, Atlanta, GA, United States
(Riley) Overlake Medical Center and Clinics, Bellevue, WA, United States
(Young) Division of Cardiovascular Medicine, Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
(Maehara, Kirtane) Cardiovascular Research Foundation, New York, NY,
United States
(Welt) Cardiovascular Division, University of Utah Health, Salt Lake City,
UT, United States
(Kirtane) Columbia University Irving Medical Center/New York-Presbyterian
Hospital, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Coronary angiography has historically served as the gold standard for
diagnosis of coronary artery disease and guidance of percutaneous coronary
intervention (PCI). Adjunctive use of contemporary intravascular imaging
(IVI) technologies has emerged as a complement to conventional
angiography-to further characterize plaque morphology and optimize the
performance of PCI. IVI has utility for preintervention lesion and vessel
assessment, periprocedural guidance of lesion preparation and stent
deployment, and postintervention assessment of optimal endpoints and
exclusion of complications. The role of IVI in reducing major adverse
cardiac events in complex lesion subsets is emerging, and further studies
evaluating broader use are underway or in development. This paper provides
an overview of currently available IVI technologies, reviews data
supporting their utilization for PCI guidance and optimization across a
variety of lesion subsets, proposes best practices, and advocates for
broader use of these technologies as a part of contemporary
practice.<br/>Copyright &#xa9; 2023

<81>
Accession Number
2022270135
Title
The Potential of Proton Therapy for Locally Advanced Breast Cancer:
Clinical and Technical Considerations.
Source
Current Oncology. 30(3) (pp 2869-2878), 2023. Date of Publication: March
2023.
Author
Lalani N.; Alqarni S.; Jimenez R.B.
Institution
(Lalani, Alqarni) Department of Radiation Oncology, The Irving Greenberg
Family Cancer Centre, Ottawa, ON K2H 8P4, Canada
(Jimenez) Department of Radiation Oncology, The Massachusetts General
Hospital, Boston, MA 02114, United States
Publisher
MDPI
Abstract
Proton therapy is a promising therapeutic modality with unique physical
properties that allow for abrupt dose fall-off distal to the target of
interest, thereby sparing nearby organs at risk. A number of studies have
identified the utility of proton radiation in mitigating treatment related
sequelae for patients with locally advanced breast cancers. Thus, in the
following review, we highlight clinical and technical considerations for
proton radiotherapy delivery in patients with locally advanced breast
cancer.<br/>Copyright &#xa9; 2023 by the authors.

<82>
Accession Number
2022267168
Title
Impact of Insulin-Treated Compared to Non-Insulin-Treated Diabetes
Mellitus on Outcome of Percutaneous Coronary Intervention with Drug-Coated
Balloons versus Drug-Eluting Stents in De Novo Coronary Artery Disease:
The Randomized BASKET-SMALL 2 Trial.
Source
Journal of Cardiovascular Development and Disease. 10(3) (no pagination),
2023. Article Number: 119. Date of Publication: March 2023.
Author
Seeger J.; Wohrle J.; Scheller B.; Farah A.; Ohlow M.-A.; Mangner N.;
Mobius-Winkler S.; Weilenmann D.; Stachel G.; Leibundgut G.; Rickenbacher
P.; Cattaneo M.; Gilgen N.; Kaiser C.; Jeger R.
Institution
(Seeger, Wohrle) Department of Cardiology and Intensive Care, Medical
Campus Lake Constance, Friedrichshafen 88048, Germany
(Scheller) Clinical and Experimental Interventional Cardiology, University
of Saarland, Homburg 66421, Germany
(Farah) Klinikum Westfalen, Dortmund, Knappschaftskrankenhaus 44143,
Germany
(Ohlow) SRH Wald-Klinikum Gera, Gera 07548, Germany
(Mangner) Department of Internal Medicine and Cardiology, Technische
Universitat Dresden, Dresden 01062, Germany
(Mobius-Winkler) Department of Cardiology, University Hospital Jena, Jena
07747, Germany
(Weilenmann) Cantonal Hospital St Gallen, St. Gallen 9007, Switzerland
(Stachel) Heart Center Leipzig, University Hospital, Leipzig 04289,
Germany
(Leibundgut) Cantonal Hospital Baselland, Liestal 4410, Switzerland
(Rickenbacher, Cattaneo, Gilgen, Kaiser) University Hospital Basel,
University of Basel, Basel 4001, Switzerland
(Jeger) Department of Cardiology, Cardiovascular Research Institute Basel
(CRIB), University Hospital Basel, Basel 4031, Switzerland
(Jeger) Department of Cardiology, Triemli Hospital Zurich, Zurich 8063,
Switzerland
Publisher
MDPI
Abstract
Background: We evaluated the outcome of PCI of de novo stenosis with
drug-coated balloons (DCB) versus drug-eluting stents (DES) in patients
with insulin-treated diabetes mellitus (ITDM) versus non-insulin-treated
diabetes mellitus (NITDM). <br/>Method(s): Patients were randomized in the
BASKET-SMALL 2 trial to DCB or DES and followed over 3 years for MACE
(cardiac death, non-fatal myocardial infarction [MI], and target vessel
revascularization [TVR]). Outcome in the diabetic subgroup (n = 252) was
analyzed with respect to ITDM or NITDM. <br/>Result(s): In NITDM patients
(n = 157), rates of MACE (16.7% vs. 21.9%, hazard ratio [HR] 0.68, 95%
confidence interval [CI] 0.29-1.58, p = 0.37), death, non-fatal MI, and
TVR (8.4% vs. 14.5%, HR 0.30, 95% CI 0.09-1.03, p = 0.057) were similar
between DCB and DES. In ITDM patients (n = 95), rates of MACE (DCB 23.4%
vs. DES 22.7%, HR 1.12, 95% CI 0.46-2.74, p = 0.81), death, non-fatal MI,
and TVR (10.1% vs. 15.7%, HR 0.64, 95% CI 0.18-2.27, p = 0.49) were
similar between DCB and DES. TVR was significantly lower with DCB versus
DES in all diabetic patients (HR 0.41, 95% CI 0.18-0.95, p = 0.038).
<br/>Conclusion(s): DCB compared to DES for treatment of de novo coronary
lesions in diabetic patients was associated with similar rates of MACE and
numerically lower need for TVR both for ITDM and NITDM
patients.<br/>Copyright &#xa9; 2023 by the authors.

<83>
Accession Number
640101578
Title
Cardiac rehabilitation in coronary artery bypass grafting patients: Effect
of eight weeks of moderate-intensity continuous training versus
high-intensity interval training.
Source
Clinical hemorheology and microcirculation. 83(3) (pp 305-314), 2023. Date
of Publication: 2023.
Author
Shafiee N.; Kordi N.; Gadruni K.; SalehFard Z.; Jung F.; Heidari N.
Institution
(Shafiee) Department of Sport Physiology, Faculty of Sport Sciences,
University of Mazandaran, Babolsar, Iran, Islamic Republic of
(Kordi) Department of Exercise Physiology, Faculty of Sport Sciences, Razi
University, Kermanshah, Iran, Islamic Republic of
(Gadruni) Faculty of Physical Education, University of Tabriz, Tabriz,
Iran; Kurdistan Education Office, Ministry of Education, Kurdistan, Iran;
Uro-Oncology Research Center, Tehran University of Medical Sciences,
Tehran, Iran
(SalehFard) Department of Sport Physiology, School of Physical Education
and Sport Sciences, Alzahra University, Tehran, Iran, Islamic Republic of
(Jung) Faculty of Health Sciences Brandenburg, Brandenburg University of
Technology Cottbus-Senftenberg, Senftenberg, Germany
(Heidari) Faculty of Sport Science, Shahid Rajaei Teacher Training
University, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Physical training in patients with heart failure can affect
hemodynamic, cardiac and angiogenesis parameters. <br/>OBJECTIVE(S): The
aim of the present study was to investigate the effects of traditional
moderate-intensity rehabilitation training and interval training on some
angiogenesis factors in coronary artery bypass graft (CABG) patients.
<br/>METHOD(S): Thirty CABG patients (mean age+/-SD, 55+/-3 years) were
randomly assigned to one of three groups: high-intensity interval training
(HIIT) or moderate-intensity continuous training (MICT) or the control
group. After the initial assessments, eligible patients in the
experimental groups (HIIT and MICT) performed exercise training for 8
weeks, while the control group did not. Angiogenesis and angiostatic
indices, including pro-adrenomedullin (pro-ADM), basic fibroblast growth
factor (bFGF), and endostatin, were then measured. <br/>RESULT(S): The
results showed no significant difference between pro-ADM in the HIIT and
MICT groups (P = 0.99), but a significant difference was found between
MICT and the control group and between HIIT and the control group (P =
0.001). There is also no significant difference between the bFGF levels in
the HIIT and MICT training groups (P = 1.00), but the changes in this
factor between the training groups and the control group were significant
(P = 0.001). There was a significant difference between the levels of
endostatin in all three groups. <br/>CONCLUSION(S): Two methods of cardiac
rehabilitation (HIIT and MICT) may be useful for the recovery of patients
with coronary artery bypass grafting. This improvement manifested itself
in changes in angiogenesis and angiostatic indices in this study. However,
more extensive studies are needed to investigate the effects of these two
types of rehabilitation programs on other indicators of angiogenesis and
angiostatic.

<84>
Accession Number
2022878437
Title
Use of machine learning in pediatric surgical clinical prediction tools: A
systematic review.
Source
Journal of Pediatric Surgery. 58(5) (pp 908-916), 2023. Date of
Publication: May 2023.
Author
Bianco A.; Al-Azzawi Z.A.M.; Guadagno E.; Osmanlliu E.; Gravel J.; Poenaru
D.
Institution
(Bianco, Al-Azzawi, Poenaru) Faculty of Medicine and Health Sciences,
McGill University, Montreal, QC, Canada
(Guadagno, Poenaru) Harvey E. Beardmore Division of Pediatric Surgery, The
Montreal Children's Hospital, McGill University Health Centre, Montreal,
QC, Canada
(Osmanlliu) Department of Pediatrics, McGill University Health Centre,
Montreal, QC, Canada
(Gravel) Department of Pediatric Emergency Medicine, Sainte-Justine
Hospital, Universite de Montreal, Montreal, QC, Canada
Publisher
W.B. Saunders
Abstract
Purpose: Clinical prediction tools (CPTs) are decision-making instruments
utilizing patient data to predict specific clinical outcomes,
risk-stratify patients, or suggest personalized diagnostic or therapeutic
options. Recent advancements in artificial intelligence have resulted in a
proliferation of CPTs created using machine learning (ML)-yet the clinical
applicability of ML-based CPTs and their validation in clinical settings
remain unclear. This systematic review aims to compare the validity and
clinical efficacy of ML-based to traditional CPTs in pediatric surgery.
<br/>Method(s): Nine databases were searched from 2000 until July 9, 2021
to retrieve articles reporting on CPTs and ML for pediatric surgical
conditions. PRISMA standards were followed, and screening was performed by
two independent reviewers in Rayyan, with a third reviewer resolving
conflicts. Risk of bias was assessed using the PROBAST. <br/>Result(s):
Out of 8300 studies, 48 met the inclusion criteria. The most represented
surgical specialties were pediatric general (14), neurosurgery (13) and
cardiac surgery (12). Prognostic (26) CPTs were the most represented type
of surgical pediatric CPTs followed by diagnostic (10), interventional
(9), and risk stratifying (2). One study included a CPT for diagnostic,
interventional and prognostic purposes. 81% of studies compared their CPT
to ML-based CPTs, statistical CPTs, or the unaided clinician, but lacked
external validation and/or evidence of clinical implementation.
<br/>Conclusion(s): While most studies claim significant potential
improvements by incorporating ML-based CPTs in pediatric surgical
decision-making, both external validation and clinical application remains
limited. Further studies must focus on validating existing instruments or
developing validated tools, and incorporating them in the clinical
workflow. <br/>Type of Study: Systematic Review Level of Evidence: Level
III<br/>Copyright &#xa9; 2023 The Author(s)

<85>
Accession Number
2023871505
Title
TCTAP A-060 Intravascular Ultrasonography Guided Percuatneous Coronary
Intervention with Everolimus-Eluting Stents or Bypass Surgery for
Multivessel Coronary Artery Disease: Post-hoc Analysis of BEST Trial.
Source
Journal of the American College of Cardiology. Conference: 28th
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). Grand Walkerkill, Seoul South Korea. 81(16 Supplement)
(pp S40-S41), 2023. Date of Publication: 25 Apr 2023.
Author
Lee J.; Kim H.; Choi Y.; Kang D.-Y.; Ahn J.-M.; Park D.-W.; Park S.-J.
Institution
(Lee, Kim, Choi, Kang, Ahn, Park, Park) Asan Medical Center, South Korea
Publisher
Elsevier Inc.
Abstract
Background: The Long-term outcome of Intravascular ultrasonography (IVUS)
guided percutaneous coronary intervention (PCI) with everolimus-eluting
stent and coronary-artery bypass grafting (CABG) are limited in patients
with multivessel coronary artery disease Methods: We analyzed patient data
from BEST trial, randomly assigned 880 patients with angiographic
multivessel coronary artery disease to receive PCI with everolimus-eluting
stent or CABG between July 2008 and September 2013. Post-hoc analysis
divided patient data into IVUS guidance PCI or angiographic-guided PCI or
received CABG. 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 to 12.5 years, the maximum of 13.7 years), the primary end
point occurred in 58 patients (44.3%) in the PCI without IVUS group and 75
patients (22.8%) in the PCI with IVUS group and 95 patients (24.0%) in the
CABG group (adjusted hazard ratio for PCI with IVUS as compared with the
CABG group [aHR] 0.93; 95%confidence interval [CI], 0.74 to 1.13; P=0.93).
IVUS-guided PCI group was similar risk of composited of death, myocardial
infarction, or stroke than CABG group (17.6%and 22.0%, aHR 0.84; 95% CI
0.60 to 1.18, P=0.32). However, any repeat revascularization (19.1% and
10.6%. aHR 1.92; 95% CI 1.28 to 2.88, P = 0.002) were more frequent in
IVUS-guided PCI than CABG group. [Formula presented] [Formula presented]
<br/>Conclusion(s): Inpatients with multivessel coronary artery disease,
there were no significant differences between IVUS-guided PCI and CABG in
the rates of major adverse cardiac events compared with angiography-guided
PCI with higher rate of major adverse cardiac events. during an
extended-follow-up of up to 14 years<br/>Copyright &#xa9; 2023

<86>
Accession Number
2023871413
Title
TCTAP A-039 On-Pump and Off-Pump Coronary Artery Bypass Grafting on
10-Year Mortality Versus Percutaneous Coronary Intervention.
Source
Journal of the American College of Cardiology. Conference: 28th
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). Grand Walkerkill, Seoul South Korea. 81(16 Supplement)
(pp S24-S25), 2023. Date of Publication: 25 Apr 2023.
Author
Serruys P.W.; Kageyama S.; Ninomiya K.; O'Leary N.; Masuda S.; Kotoku N.;
Colombo A.; Van Geuns R.; Mack M.J.; Garg S.; Onuma Y.
Institution
(Serruys, Kageyama, Ninomiya, O'Leary, Masuda, Kotoku, Onuma) University
of Galway, Ireland
(Colombo) EMO GVM Centro Cuore Columbus, Italy
(Van Geuns) Erasmus MC, Netherlands
(Mack) Baylor University Medical Center, United States
(Garg) Royal Blackburn Hospital, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: The very long-term mortality of off-pump and on-pump coronary
artery bypass grafting (CABG) versus percutaneous coronary intervention
(PCI) in a randomized complex coronary artery disease (CAD)population is
unknown. This study aims to investigate the impact of on-pump and off-pump
CABG versus PCI on 10-year all-cause mortality. <br/>Method(s): The
SYNTAXES trial randomized 1800 patients with three-vessel and/or left main
CAD to PCI or CABG and assessed their survival at10 years. In this
sub-study, the hazard of mortality over 10 years was compared according to
the technique of revascularization: on-pump CABG (n=725), off-pump CABG
(n=128), and PCI (n=903). <br/>Result(s): There was substantial inter-site
variation in the use of off-pump CABG despite baseline characteristics
being largely homogeneous amongst the three groups. The crude rate of
mortality was significantly lower following on-pump CABG versus PCI (25.6%
vs 28.4%, Hazard Ratio [HR] 0.79, 95%Confidence Interval [CI] 0.65-0.96),
whilst it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR
0.98, 95%CI 0.69-1.40). After adjusting for the nine variables included in
the SYNTAX score II 2020, 10-year mortality remained significantly lower
with on-pump CABG than PCI (HR 0.75 against PCI,p=0.009). [Formula
presented] <br/>Conclusion(s): In the SYNTAXES trial, 10-year mortality
adjusted for major confounders was significantly lower following on-pump
CABG compared to PCI, whilst off-pump CABG offered no prognostic survival
benefit over PCI. Site heterogeneity in the technique used in bypass
surgery has had measurable effects on treatment performance. Given its
impact on outcomes, it should be-stratified in future
studies.<br/>Copyright &#xa9; 2023

<87>
Accession Number
641008011
Title
Risk predictors and outcomes of infective endocarditis among adult
patients with congenital heart disease.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1843), 2022. Date of Publication: September 2022.
Author
Fedchenko M.; Giang K.W.; Snygg-Martin U.; Dellborg M.; Mandalenakis Z.
Institution
(Fedchenko, Giang, Dellborg, Mandalenakis) Institute of Medicine -
Sahlgrenska Academy, University of Gothenburg, Department of Molecular and
Clinical Medicine/Cardiology, Gothenburg, Sweden
(Snygg-Martin) Institute of Biomedicine, Sahlgrenska Academy, Department
of Infectious Diseases, Gothenburg, Sweden
Publisher
European Respiratory Society
Abstract
Background: Infective endocarditis (IE) is a serious disease associated
with increased morbidity and mortality. Patients with adult congenital
heart disease (ACHD) have been reported to be at a particularly increased
risk of infective endocarditis (IE). <br/>Purpose(s): To investigate the
risk predictors of IE, and the long-term risk of IE among ACHD patients
aged 18-65 years, compared with matched controls without ACHD, in a
nationwide setting. <br/>Method(s): All patients with ACHD in Sweden born
in years 1952-1999 and who survived until 18 years of age were followed in
the National Patient Register and Cause of Death Register until year 2017.
For each case of ACHD, approximately ten controls without ACHD were
randomly selected from the Total Population Register and matched by birth
year and sex. The study population was followed from 18 years of age and
until a first time diagnosis of IE, death or end of study. Both
comorbidities and occurrence of ACHD related surgery were collected from
1970 and onwards. Cox proportional hazard models were used to predict the
risk of IE. <br/>Result(s): Altogether, 36,189 ACHD patients and 403,962
controls without ACHD were included. A total of 706 (1.95%) ACHD patients
and 147 (0.04%) controls developed IE during a median follow-up of 15.5
(interquartile range (IQR) 6.9-28.5) years (ACHD) and 15.5 (IQR 7.5-28.5)
years (controls). ACHD patients were somewhat younger at age of IE
diagnosis compared with controls, median age 33.9 (IQR 25.4-44.1) years in
ACHD vs 39.8 (IQR 30.6-52.0) years in controls. The overall risk of IE was
markedly higher among ACHD patients compared with controls, with a hazard
ratio (HR) of 54.8 (95% confidence interval (CI), 45.9-65.5). More than
one third of the ACHD patients with IE (n=272, 38.5%) had undergone any
kind of previous congenital heart surgery whereof 122 (44.9%) had
undergone valve replacement (mechanical/biological) prior to IE. In ACHD
patients, the most important risk predictors for IE were ACHD related
cardiac surgery and valve replacement surgery, HR 117 (95% CI 93.0-148)
and HR 74.8 (95% CI 56.4-99.2), respectively. Diabetes mellitus, previous
ischemic stroke and presence of an intracardiac electronic device also
predicted the risk of IE, however, they were less important predictors
(diabetes: HR 1.69, 95% CI 1.01-2.82, ischemic stroke: HR 1.75, 95% CI
1.21-2.52, electronic device: HR 1.59, 95% CI 1.05-2.39).
<br/>Conclusion(s): The risk of developing IE was found to be almost 55
times higher in patients with ACHD aged 18-65 years compared with matched
controls. Previous ACHD related surgery and valve replacement were the
most significant risk predictors. These results underscore the need of
continuous clinical follow-up as well as the need of further research to
prevent this serious complication of ACHD.

<88>
Accession Number
641007957
Title
Cost-effectiveness of statin therapy in categories of patients in the UK.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2841), 2022. Date of Publication: September 2022.
Author
Mihaylova B.; Wu R.; Williams C.; Zhou J.; Schlackow I.; Emberson J.;
Reith C.; Keech A.; Robson J.; Wilkinson K.; Armitage J.; Collins R.; Gray
A.; Simes J.; Baigent C.
Institution
(Mihaylova, Williams, Zhou, Emberson, Reith, Armitage, Collins, Gray,
Baigent) University of Oxford, Nuffield Department of Population Health,
Oxford, United Kingdom
(Wu, Robson) Queen Mary University of London, Wolfson Institute of
Population Health, London, United Kingdom
(Schlackow) University of Oxford, Oxford, United Kingdom
(Keech, Simes) University of Sydney, NHMRC Clinical Trials Centre, Sydney,
Australia
(Wilkinson) Public Representative, Oxford, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: Cardiovascular disease (CVD) mortality has declined steadily
over the last few decades across Europe and North America.
<br/>Purpose(s): To provide contemporary estimates of long-term
effectiveness and cost-effectiveness of statin therapy in different
categories of patients in UK. <br/>Method(s): The CTT-UKB micro-simulation
model, developed using the Cholesterol Treatment Trialists' Collaboration
data (CTT: 118,000 participants; 5 years follow-up), and calibrated in the
UK Biobank cohort (UKB: 502,000 participants; 9 years follow-up). The
model integrates parametric risk equations for incident myocardial
infarction, stroke, coronary revascularization, diabetes, cancer and
vascular and nonvascular death, and projects annually these endpoints and
survival using patient characteristics at entry. UKB data and linked
primary and hospital care data informed healthcare costs in the model
(2020 UK); 2021 UK NHS Drug Tariff informed statin costs (atorvastatin
40mg at 1.22 and 80mg at 1.68 per 28 tablets); and Health Survey for
England data informed health-related quality of life in the model.
Previous CTT meta-analysis, atorvastatin doseresponse randomized trials,
and further meta-analyses of statin trials and cohort studies informed
effects of 40mg/80mg atorvastatin therapy daily on rates of incident
myocardial infarction, stroke, coronary revascularization, vascular death,
diabetes, myopathy and rhabdomyolysis. The model was used to project gains
in quality-adjusted life years (QALYs) and additional cost per QALY with
lifetime use of atorvastatin 40mg or 80mg daily in categories of UKB
participants by sex, age at statin initiation (40-49; 50-59 and 60-70
years), and 10-year CVD risk (QRISK3 risk (%): <5; 5-10, 10-15, 15-20,
>=20). Further scenarios explored effects of 5-year delay of statin
initiation in people under 45 years of age or stopping statin therapy at
80 years of age. <br/>Result(s): Across men and women in categories by age
and CVD risk, lifetime use of atorvastatin 40mg daily was associated with
increases in survival by 0.44-1.69 years (0.28-1.02 QALYs), and
atorvastatin 80mg daily with increases in survival of 0.45-1.87 years
(0.32-1.13 QALYs; Figure 1) with gains larger among participants at higher
CVD risk. Both atorvastatin 40mg and 80mg doses were in the range of
cost-effective treatments with incremental cost per QALY gained with
atorvastatin 40mg daily versus no statin therapy below 7200/QALY and with
atorvastatin 80mg vs 40mg daily below 16000/QALY (Figure 2) across all
patient categories studied. Compared to lifetime statin therapy, stopping
therapy at 80 years of age substantially reduced benefits and was not
cost-effective in any patient category studied. Similarly, compared to
immediate initiation, 5-year delay of statin therapy in 40-45 years old
patients was not a cost-effective. <br/>Conclusion(s): In the UK, statin
therapy remains highly cost-effective across men and women 40-70 years
old, including those at 10-year CVD risk <5%.

<89>
Accession Number
641006954
Title
Comparing direct oral anticoagulants versus vitamin K antagonist in
patients with atrial fibrillation after transcatheter aortic valve
replacement: An updated meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1631), 2022. Date of Publication: September 2022.
Author
Dhaliwal A.; Kaur A.; Konje S.; Bhatia K.; Sohal S.; Rawal H.; Turagam M.;
Gwon Y.; Mamas M.; Dominguez A.; Bhatt D.; Velagapudi P.
Institution
(Dhaliwal) New York Hand Surgery, New York, United States
(Kaur, Konje, Bhatia, Dominguez) Mount Sinai St Luke's and Mount Sinai
West Hospital, New York, United States
(Sohal) Newark Beth Israel Medical Center, Newark, United States
(Rawal) Insight Hospital and Medical Center, Chicago, United States
(Turagam) Mount Sinai Hospital, New York, United States
(Gwon, Velagapudi) University of Nebraska Medical Center, Omaha, United
States
(Mamas) Keele University, Keele, United Kingdom
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
European Respiratory Society
Abstract
Background: Oral anticoagulation therapy is indicated for patients
undergoing transcatheter aortic valve replacement (TAVR) with concomitant
or new onset atrial fibrillation (AF). However the data on optimal
anticoagulation regimen in this population remains unclear.
<br/>Purpose(s): To compare efficacy and safety outcomes of direct oral
anticoagulants (DOACs) versus Vitamin K antagonists (VKA) in patients with
AF post TAVR. <br/>Method(s): We searched electronic databases (PubMed,
Embase, Scopus, Cochrane) from inception to February28th, 2022 using MeSH
terms and keywords for DOACs, AF or TAVR. Primary outcome of interest was
allcause stroke or systemic embolic event. Secondary safety outcomes were
major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95%
confidence interval (CI) were calculated using a random-effects model.
Interstudy heterogeneity was assessed using the Higgins I 2 value. All
statistical analysis were performed using RevMan 5.4.1 software.
<br/>Result(s): We identified five eligible studies (1RCT, 4
observational) including 3694 patients (DOAC n=1581, VKA n=2113). The mean
age was 81.4+/-0.9 years. The mean follow-up was 12.4+/-14.3 months. Type
of DOACs included apixaban (n=394, 24.9%), rivaroxaban (n=354, 22.4%),
dabigatran (n=119, 7.5%) and edoxaban (n=714, 45.2%).There was no
significant difference in primary outcome of stroke or systemic embolic
event (RR: 0.93; CI: 0.65-1.33; p>0.05; I²=5%), or in secondary
outcomes of major bleeding (RR: 1.02; CI: 0.78-1.34; p>0.05;
I²=44%) and all-cause mortality (RR: 0.87; CI: 0.59-1.27;
p>0.05; I²=56%) between DOACs and VKA groups.
<br/>Conclusion(s): This meta-analysis shows anticoagulation therapy with
DOACs has similar safety and efficacy outcomes compared to VKA in patients
with AF undergoing TAVR. (Figure Presented).

<90>
Accession Number
641006919
Title
Proprotein convertase subtilisin/kexin type 9 (PCSK9), platelet activation
and interaction with the vascular endothelium: The impact of PCSK9
inhibition with evolocumab in acute coronary syndrome.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1281), 2022. Date of Publication: September 2022.
Author
Ziogos E.; Chelko S.P.; Walsh E.; Engel M.; Gerstenblith G.; Halushka
M.K.; Leucker T.M.
Institution
(Ziogos, Gerstenblith, Leucker) Johns Hopkins University, School of
Medicine, Department of Medicine, Baltimore, United States
(Chelko, Engel) Florida State University, College of Medicine, Department
of Biomedical Sciences, Tallahassee, United States
(Walsh, Halushka) Johns Hopkins University, School of Medicine, Department
of Pathology, Baltimore, United States
Publisher
European Respiratory Society
Abstract
Background/Introduction: Platelet activation and endothelial dysfunction
may contribute to adverse outcomes in patients with acute myocardial
infarction. Pre-clinical studies indicate PCSK9 enhances platelet
activation. <br/>Purpose(s): Our goals were (1) to examine the role of
PCSK9 as a potential mediator of platelet activation in patients with
acute coronary syndrome (ACS) and (2) to perform immunohistochemical
studies of left internal mammary artery (LIMA) specimens to examine
interactions among PCSK9, platelets, and endothelial cells in specimens
obtained during coronary bypass surgery. <br/>Method(s): Participants from
the Evolocumab in Acute Coronary Syndrome trials (EVACS; NCT03515304,
NCT04082442), with a NSTEMI and a troponin-I of >5 ng/ml or a STEMI were
randomized to placebo or to 420 mg SC of evolocumab, a monoclonal
anti-PCSK9 antibody, within 24 hours of hospitalization. We performed
serial ex vivo analysis of PF4, a marker of platelet activation, in serum
samples obtained at baseline (prior to study drug administration) and at
day 30. PF4 values were normalized to total platelet count. All of the
participants were on guideline-directed therapies for ACS. Additionally,
LIMA samples from patients undergoing coronary bypass surgery were
immunostained with PCSK9, the endothelial cell transmembrane glycoprotein
CD31 (platelet endothelial cell adhesion molecule- 1) and the platelet
surface marker CD61 (integrin beta-3). Outcome data were summarized using
medians and interquartile ranges. <br/>Result(s): Forty-six participants
were randomized in a 1:1 fashion to placebo or to evolocumab. Mean (+/-SD)
age of the cohort was 60+/-13 years, 48% were women and 22% were African
American. Baseline PF4 levels (expressed as ng/1k platelets) were similar
between the two groups (placebo: 9.3 [4-12] vs evolocumab 8.0 [4-12],
p=0.8). In the placebo group, there was a significant increase in PF4 at
30 days to 13.1 [11-14], p<0.01 (baseline vs 30 days). In contrast, there
was no significant change from baseline in the evolocumab group at 30 days
(10.7 [6-13]), which was significantly lower than the placebo group
(p=0.04). Furthermore, immunostaining of LIMA specimens obtained from
patients during coronary artery bypass surgery revealed colocalization of
PCSK9, CD31, and CD61 on the vascular endothelial cell surface (see
Figure). <br/>Conclusion(s): PCSK9 inhibition with evolocumab decreases
platelet activation in ACS patients on dual anti-platelet therapy. PCSK9
is associated with platelets and endothelial cells at the vascular
endothelium. PCSK9 is a potential mediator of the interaction between
platelets and vascular endothelial cells in patients with coronary artery
disease. (Figure Presented).

<91>
Accession Number
641006905
Title
To compare efficacy and safety of direct oral anticoagulants in patients
with concurrent atrial fibrillation and bioprosthetic heart valve repair
or replacement: A systematic review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1630), 2022. Date of Publication: September 2022.
Author
Kaur A.; Dhaliwal A.; Khandait H.; Konje S.; Bhatia K.; Sohal S.; Turagam
M.; Gwon Y.; Mamas M.; Dominguez A.; Bhatt D.; Velagapudi P.
Institution
(Kaur, Konje, Bhatia, Dominguez) Icahn School of Medicine at Mount Sinai
Morningside West, New York City, United States
(Dhaliwal) New York Hand Surgery, New York, United States
(Khandait) Trinitas Regional Medical Center, Elizabeth, NJ, United States
(Sohal) Newark Beth Israel Medical Center, Newark, United States
(Turagam) Mount Sinai Hospital, New York, United States
(Gwon, Velagapudi) University of Nebraska Medical Center, Omaha, United
States
(Mamas) Keele University, Keele, United Kingdom
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
European Respiratory Society
Abstract
Background: Use of direct oral anticoagulants (DOACs) is contraindicated
in patients with mechanical valves. However data on their use in patients
with atrial fibrillation (AF) and bioprosthetic valves (BV) is still
limited. <br/>Purpose(s): To assess the safety and efficacy of DOACs
versus Vitamin K antagonist (VKA) in patients with AF after BV repair or
replacement. <br/>Method(s): We performed a comprehensive review of
electronic databases (PubMed, Embase, Scopus, Cochrane) using MeSH terms
and keywords for DOACs, AF and BVs from inception through December 2021.
Randomized clinical trials (RCT) or observational studies that reported
clinical outcomes comparing DOACs versus VKA in patients with AF and BVs
were eligible for inclusion. Ten articles were reviewed for full text.
Primary outcome was a composite of all cause stroke or systemic embolic
event. Secondary outcomes included major bleeding and all-cause mortality.
Subgroup analysis stratified by study design was performed. Pooled risk
ratio (RR) and 95% confidence interval (CI) were calculated using Mantel-
Haenszel method with DerSimonian-Laird estimator for tau2 for random
effects model. Interstudy heterogeneity was assessed using the Higgins I 2
value. All statistical analysis was performed using RevMan 5.4.1 software.
<br/>Result(s): Ten studies (5 RCTs, 5 observational studies) with a total
of 5,333 patients (DOACs n=2434; VKA n=2899) were included. Aortic, mitral
and mixed BV repair or replacement were 74.2%, 25.6% and 0.02%
respectively. The mean age was 72.6+/-11.9 years. The mean follow-up was
15.7+/-12.9 months. Type of DOACs included apixaban (n=553, 22.7%),
rivaroxaban (n=893, 36.7%), dabigatran (n=151, 6.2%) and edoxaban (n=837,
34.4%). There was no significant difference in primary outcome of stroke
or systemic embolic event (RR: 0.79; CI: 0.56-1.11; p>0.05;
I²=12%) or secondary outcomes of major bleeding (RR: 0.84; CI:
0.64- 1.11; p>0.05; I²=45%), and all-cause mortality (RR: 0.84;
CI: 0.64-1.11; p>0.05; I²=29%) between DOACs compared with VKA.
<br/>Conclusion(s): In patients with AF and BV, DOACs are non-inferior to
VKA for risk of stroke or systemic embolism, major bleeding, and all-cause
mortality. Thus, DOACs can serve as a viable alternative to VKAs which
have a narrow therapeutic index, multiple drug interactions, and require
frequent monitoring. (Figure Presented).

<92>
Accession Number
641006900
Title
Activation of mitochondrial telomerase reverses relative lymphopenia post
myocardial infarction: Results from the randomised, double-blinded TACTIC
phase IIa pilot trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1225), 2022. Date of Publication: September 2022.
Author
Spyridopoulos I.; Bawamia B.; Spray L.; Wangsaputra V.; Stellos K.;
Bennaceur K.; Kharatikoopaei E.; Ogundimu E.; Gale C.P.; Keavney B.; Maier
R.; Hancock H.; Richardson G.; Austin D.
Institution
(Spyridopoulos, Bawamia, Spray, Wangsaputra, Bennaceur, Maier, Hancock,
Richardson) Newcastle University, Newcastle-Upon-Tyne, United Kingdom
(Stellos) European Center for Angioscience, Mannheim, Germany
(Kharatikoopaei, Ogundimu) Durham University, Durham, United Kingdom
(Gale) Leeds Teaching Hospitals, Leeds, United Kingdom
(Keavney) University of Manchester, Manchester, United Kingdom
(Austin) James Cook University Hospital, Middlesbrough, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: Immune ageing is a phenomenon which includes lymphopenia,
expansion of pro-inflammatory T-lymphocyte subsets and telomere
shortening. While lymphopenia predicts mortality after myocardial
infarction (MI), MI itself leads to both an increase in terminally
differentiated memory CD8+ T-lymphocytes (CD8+ TEMRAs) and a decrease in
telomere length. Activation of telomerase has been shown to ameliorate
lymphopenia, and improve heart function after MI in mouse models. TA-65 is
an oral telomerase activator, which may ameliorate immune ageing and
improve outcome after MI. <br/>Method(s): This double-blinded, randomized
placebo-controlled pilot study evaluated the use of TA-65 in 90 MI
patients over 65 years, the average onset age for immune ageing. Patients
were randomised to either TA-65 (16 mg daily, n=45) or placebo (n=45) for
12 months. The majority of patients underwent percutaneous coronary
intervention (87%) or coronary artery bypass surgery (2%) as treatment for
their index MI. The pre-defined primary endpoint was the proportion of
CD8+ TEMRA T-lymphocytes at 12 months, a marker of immune ageing. A linear
mixed effects model was used for the analysis. <br/>Result(s): The
proportion of CD8+ TEMRAs after 12 months did not differ between the 2
treatment groups, although only increased significantly in the placebo
group (+2.2%, 95% CI: 0.14-4.24). TA-65 was well tolerated, with total
adverse events lower in the treatment group (TA-65 vs. placebo group:
N=130 vs. n=185). We observed at 12 months a 62% reduction in mean
high-sensitivity CRP (hsCRP: TA-65 vs. placebo group: 1.1+/-0.9 vs.
2.9+/-6.4 mg/L) and a 15%-increase in mean peripheral blood lymphocytes in
TA-65 after 12 months. In the whole sample, among those who were treated
with TA-65 compared to Placebo, after 12 months peripheral blood
lymphocytes increased (+285 cells /mul, 95% CI: 117-452). The latter was
due to significant increases in the TA-65 group from baseline to 12 months
across all major lymphocyte populations: CD3+ (+15%), CD4+ (+14%),CD8+
T-lymphocytes (+19%), B-lymphocytes (+17%) and natural killer cells
(+12%), while no changes occurred in major lymphocyte populations in the
placebo group over the course of the study. <br/>Conclusion(s): In this
randomised clinical trial, we found that while CD8+ TEMRAs were not
significantly altered after 12 months, the telomerase activator TA-65
significantly increased all major lymphocyte subsets and substantially
reduced hsCRP at 12 months in patients with MI. These findings suggest
TA-65 holds great promise in potentially reducing inflammation while
improving an age-related decline in major lymphocyte populations, thereby
enhancing immunity. A larger, multicentre, powered phase IIb efficacy
trial to examine the potential effect of TA-65 in prognosis and heart
function after MI is therefore warranted.

<93>
Accession Number
641006860
Title
Early aortic valve replacement improves exercise capacity in truly
asymptomatic patients with severe aortic stenosis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1629), 2022. Date of Publication: September 2022.
Author
Banovic M.; Boskovic N.; Bojanic M.; Nedeljkovic I.; Jovanovic M.; Penicka
M.; Bartunek J.
Institution
(Banovic, Boskovic, Bojanic, Nedeljkovic, Jovanovic) Clinical center of
Serbia, Belgrade, Serbia
(Penicka, Bartunek) Olv Hospital Aalst, Aalst, Belgium
Publisher
European Respiratory Society
Abstract
Background: Exercise capacity is a strong predictor of morbidity and
mortality overall. In severe aortic stenosis (AS) ustained pressure
overload during watchful waiting is associated with LV structural and
functional deterioration and impaired clinical outcome both pre- and post
aortic valve replacement (AVR). The effect of early surgical aortic valve
replacement (SAVR) in asymptomatic patients with severe AS and normal left
ventricular function on exercise capacity in unknown. <br/>Aim(s):We
investigated whether the early surgical AVR in truly asymptomatic patients
with severe aortic stenosis and normal LVEF improves the exercise
capacity. <br/>Method(s): This is a sub-analysis or the AVATAR trial
(NCT02436655), which is international prospective randomized controlled
trial that evaluated the safety and efficacy of early SAVR in the
treatment of asymptomatic patients with severe AS, according to common
criteria (valve area <=1 cm² with aortic jet velocity >4 m/s or
a mean transaortic gradient >=40 mm Hg), and with normal left ventricular
function. Patients underwent cardiopulmonary exercise testing (supine
bicycle, ramp protocol, 15 W/min) at the baseline and 12 months following
the randomization. Patients who had positive exercise testing at baseline
visit were excluded. We compared the value of workload (in WATs), VO2 max,
VO2 AT, VE/VCO2 and PETCO2 slope at the inclusion and at 12 months.
<br/>Result(s): Total of 157 patients (mean age, 67 years; 57% men) were
randomly allocated to early surgery (n=78) or conservative treatment
(n=79). Mean LVEF and Vmax in early surgery and conservative treatment
group were 70% and 4.5m/s and 69% and 4.5m/s, respectively. After 12
months in patients with conservative treatment there was a slight decrease
in the values of workload, VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope, but
without statistical significance. However operated patients showed a
significant increase in workload (115.4+/-38.4 watts at 12 months vs
104.8+/-42.2 at inclusion, p=0.038) and VO2 max (19.7+/-6.8 at 12 months
vs 16.2+/-5.4 at the inclusion, p=0.048), while there was slight increase
in the values of VO2 AT, VEVCO2 and PETCO2 but without statistical
significance. <br/>Conclusion(s): Early SAVR improve the functional
capacity in asymptomatic patients with severe aortic stenosis and normal
left ventricular ejection fraction.

<94>
Accession Number
641006831
Title
Factors associated with outcome five years after infectious endocarditis -
the POET trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1675), 2022. Date of Publication: September 2022.
Author
Pries-Heje M.
Institution
(Pries-Heje) Rigshospitalet - Copenhagen University Hospital, Copenhagen,
Denmark
Publisher
European Respiratory Society
Abstract
Introduction: In stabilized patients with left-sided infectious
endocarditis (IE) a shift to oral antibiotic treatment was non-inferior
compared to conventional intravenous antibiotic treatment as assessed six
months after randomization (1). After 5 years the primary outcome was
superior in the orally treated group (2). Factors associated with primary
outcome in the POET trial have not previously been reported.
<br/>Purpose(s): To identify factors associated with the occurrence of the
primary outcome in the POET trial (Partial Oral Antibiotic Endocarditis
Treatment) after 5-years of follow-up. <br/>Method(s): The POET trial was
a Danish national randomized clinical trial with inclusion from 2011-2017.
Patients were randomized 1:1 to shift to partial oral versus continued
intravenous antibiotic treatment after fulfilling stabilization criteria.
Patients were followed from randomization until July 2020. The primary
outcome was a composite outcome including the occurrence of 1) all-cause
mortality, 2) non-intended heart valve surgery, 3) embolization or 4)
relapse of positive blood culture with the primary IE causing bacteria.
Associations between baseline characteristics and IEspecific factors and
the occurrence of the primary outcome were examined using univariate
cox-regression analysis and a multivariate model was constructed using
backwards elimination at p>0.05. The proportional hazard assumption was
assessed with Schoenfeld residuals. <br/>Result(s): A total of 400
patients with left-sided endocarditis were randomized. After a median
follow-up of 5.4 years (IQR 4.0-6.9), one or more of the components of the
primary outcome had occurred in 156 patients (Table 1) (mean age 71.5
years (SD 10.0), 119 males (76.3%)). Patients who reached a primary
outcome were older, more comorbid, more often had an existing prosthetic
valve at time of IE admission, had IE localized to the aortic valve, had
vegetations >9 mm or valvular incompetence at time of admission. In
multivariable regression analysis older age (HR 1.03; 95% CI 1.02-1.05,
p<0.001), diabetes (HR 1.56; 95% CI 1.06-2.30, p=0.025), renal failure (HR
2.13; 95% CI 1.40-3.24, p<0.001), and prosthetic aortic valve (HR 1.52;
95% CI 1.08-2.14, p=0.016) were associated with a risk of reaching a
primary outcome, while heart valve surgery during primary admission for
endocarditis (HR 0.41; 95% CI 0.27-0.62, p<0.001) and shift to oral
antibiotic treatment (HR 0.69; 95% CI 0.50-0.95, p=0.022) were associated
with a lower risk (Table 2). <br/>Conclusion(s): In the POET-trial older
age, diabetes, renal failure and prosthetic aortic valve at baseline were
independently associated with a higher risk of reaching a primary outcome,
while heart valve surgery and shift to oral antibiotic treatment were
associated with a lower risk. These findings may inform future guidelines
for treatment of endocarditis. (Table Presented).

<95>
Accession Number
641006822
Title
Early intervention versus conservative management of asymptomatic severe
aortic stenosis: A systematic review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1628), 2022. Date of Publication: September 2022.
Author
Costa G.; Cardoso J.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic
Surgery, Vila Nova de Gaia, Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
(Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Aortic stenosis (AS) is the most common valvular disease in
developed countries. However, the specific timing of intervention for
asymptomatic patients with severe AS remains controversial.
<br/>Purpose(s): To compare the outcomes of early aortic valve replacement
(AVR) versus watchful waiting (WW) in asymptomatic patients with AS.
<br/>Method(s): We systematically searched PubMed, Embase and Cochrane
databases, in December 2021, for both interventional or observational
studies comparing early AVR with WW in the treatment of asymptomatic
severe AS. Random-effects meta-analysis was performed. <br/>Result(s):
Thirteen studies were included in which two were randomised clinical
trials. A total of 4,679 patients were included, providing a 1,268 pooled
death events (327 in early AVR and 941 in WW). Our meta-analysis showed a
significantly lower all-cause mortality for the early-AVR compared with WW
group, although with a moderate amount of heterogeneity between studies in
the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence
interval [CI] 0.34, 0.50, P<0.01; I²=60%). An early surgery
strategy displayed a significantly lower cardiovascular mortality (pooled
OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure
hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01,
I²=7%). However, both groups had similar rates of stroke
(pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I²=0%) and
myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14,
I²=0%). <br/>Conclusion(s): Our pooled data suggest that an
early-AVR strategy is preferable for asymptomatic patients with severe AS.
(Figure Presented).

<96>
Accession Number
641006727
Title
Specific characteristics of STEMI in COVID-19 patients and their practical
implications: A systematic review.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1424), 2022. Date of Publication: September 2022.
Author
Gitto M.; Novelli L.; Cozzi O.; Reimers B.; Condorelli G.; Stefanini G.G.
Institution
(Gitto, Novelli, Cozzi, Reimers, Condorelli, Stefanini) Humanitas Research
Hospital, Milan, Italy
Publisher
European Respiratory Society
Abstract
Introduction: STEMI is one of the cardiac emergencies whose management has
been mostly challenged by the COVID-19 pandemic. Patients presenting with
the "lethal combo" of STEMI and concomitant SARS-CoV- 2 infection have
faced dramatic issues related to need for self-isolation, systemic
inflammation with multi-organ disease, and difficulties to obtain timely
diagnosis and treatment. <br/>Method(s):We performed a systematic search
of three electronic databases from February 1st 2020 to January 31st 2022.
We included all studies reporting crude rates of in-hospital outcomes of
STEMI patients with concomitant COVID-19. <br/>Result(s): A total of 9
observational studies were identified, mainly conducted during the first
wave of the pandemic. STEMI patients with COVID -19 were more likely
Afro-American and displayed higher rates of hypertension and diabetes with
lower smoking prevalence. Associated comorbidities, including coronary
artery disease, prior stroke and chronic kidney disease were also more
common in those with SARS-CoV-2 infection. At coronary angiography, a
higher thrombus burden in COVID-19 positive STEMI patients was
highlighted, with up to 10-fold higher rates of stent thrombosis and
greater need for glycoprotein IIb/IIa inhibitors and aspiration
thrombectomy; this was not always associated with prolonged times from
symptom onset to hospital admission and door-to-balloon. COVID-19 positive
STEMI patients were less likely to receive coronary angiography and
primary PCI, and more likely to be treated with fibrinolytics only. At the
same time, patients with Covid-19 were more prone to present MINOCA.
In-hospital mortality ranged from 15% to 40%, with consistent variability
across different studies and subjects who tested positive for SARS-CoV- 2
did also present higher rates of cardiogenic shock, cardiac arrest,
prolonged ICU stay, mechanical ventilation, major bleeding, and stroke.
<br/>Conclusion(s): The coexistence of STEMI and COVID-19 was associated
with increased in-hospital mortality and poor short-term prognosis. This
was not entirely attributable to logistic issues determining delayed
coronary revascularization, since patients' specific clinical and
angiographic characteristics, including higher burden of cardiovascular
risk factors and greater coronary thrombogenicity might have substantially
contributed to this trend. (Figure Presented).

<97>
Accession Number
641006604
Title
High-sensitive Troponin T is not associated with the progression of
asymptomatic mild to moderate aortic stenosis: A post hoc substudy of the
SEAS trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2291), 2022. Date of Publication: September 2022.
Author
Hadziselimovic E.; Greve A.M.; Sajadieh A.; Olsen M.H.; Kesaniemi Y.A.;
Nienaber C.A.; Ray S.G.; Rossebo A.B.; Willenheimer R.; Wachtell K.;
Nielsen O.W.
Institution
(Hadziselimovic, Sajadieh, Nielsen) Bispebjerg University Hospital,
Department of Cardiology, Copenhagen, Denmark
(Greve) Rigshospitalet - Copenhagen University Hospital, Department of
Clinical Biochemistry 3011, Copenhagen, Denmark
(Olsen) Holbaek Hospital, Department of Cardiology, Holbaek, Denmark
(Kesaniemi) Oulu University Hospital, Medical Research Center Oulu,
Research Unit of Internal Medicine, Oulu, Finland
(Nienaber) Imperial College London, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Ray) Manchester University Hospitals, Manchester, United Kingdom
(Rossebo) Oslo University Hospital Ulleval, Department of Cardiology,
Oslo, Norway
(Willenheimer) Lund University, Heart Health Group, Malmo, Sweden
(Wachtell) Weill Cornell Medicine, Division of Cardiology, New York,
United States
Publisher
European Respiratory Society
Abstract
Background: Aortic stenosis (AS) and coronary artery disease (CAD) share
pathophysiological pathways, as reflected by frequent concomitant
revascularization in patients undergoing aortic valve replacement (AVR).
High-sensitive Troponin T (hsTnT) is a proven biomarker of cardiomyocyte
overload and injury, and predicts postoperative mortality after AVR.
However, it is unknown if hsTnT can predict AVR, mortality or ischemic
coronary events (ICE) in asymptomatic AS patients. <br/>Purpose(s): To
investigate the hypothesis that increased hsTnT is associated with more
severe AS and a higher risk of adverse outcomes in asymptomatic AS
patients without overt CAD. <br/>Method(s): HsTnT concentrations were
examined at baseline and after 1- year follow-up in 1739 asymptomatic AS
patients enrolled in the randomized, double-blind Simvastatin and
Ezetimibe in Aortic Stenosis (SEAS) study. The main inclusion criteria
were: Left ventricular (LV) ejection fraction >55%, transaortic maximal
velocity between 2.5-4.0 m/s, and no history of CAD. The primary exposure
variable was increased hsTnT (>14 pg/mL according to the assay
manufacturer, Roche). This study's primary endpoint was a composite of
competing risk outcomes: All-cause mortality as the first event, AVR
without revascularization, and ICE (defined as myocardial infarction
before AVR, PCI before or combined with AVR, or any CABG). Multivariable
regression examined associations between hsTnT and clinical variables. Cox
proportional hazards regression models were adjusted for age, sex,
creatinine, LV mass index, mean aortic pressure gradient (Pmean) and
stratified by center and lipid-lowering treatment. We analyzed outcomes
during 5-year follow-up from baseline. <br/>Result(s): At baseline, 453
(26.0%) patients had increased hsTnT and 302 (17.4%) had moderate-severe
AS with a mean (SD) aortic valve area of 0.8 (0.2) cm² and
Pmean of 33.2 (8.8) mmHg. The median annual hsTnT change from baseline to
year 1 was 0.8 pg/mL (IQR, -0.4 to 2.3), regardless of AS severity
(P=0.08). In adjusted models, log(hsTnT at baseline) was associated with
age, sex, creatinine, and LV mass index (all P<0.05), but not with AS
severity (P=0.36). The incidence rate ratio for ICE (Figure 1) in patients
with increased vs normal baseline hsTnT concentrations was 2.32 (95% CI,
1.72-3.11, P<0.001). In adjusted Cox regression, increased hsTnT was
associated with an increased 5-year ICE risk (HR 1.64; 95% CI, 1.18-2.29,
P=0.003), but neither with AVR without revascularization nor death (Figure
1). <br/>Conclusion(s): In these asymptomatic AS patients without overt
CAD, hsTnT is often normal and remains stable during 1 year of follow-up
regardless of AS severity. Increased hsTnT is associated with CAD-related
events, but neither to AS severity nor AVR without concomitant
revascularization. This analysis does not support routine hsTnT
measurement in asymptomatic AS to predict AVR related to AS progression,
although hsTnT could improve the risk assessment for ICE. (Figure
Presented).

<98>
Accession Number
641006592
Title
Long-term impact of persistent vegetations at 6 month followup after
treatment of infective endocarditis: A substudy of the Partial Oral vs
Intravenous Antibiotic Treatment of Endocarditis (POET) tria.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1670), 2022. Date of Publication: September 2022.
Author
Hjulmand J.; Pries-Heje M.; Try Lenz I.; Carter-Storch R.; Gill S.; Bruun
N.E.; Povlsen J.A.; Christiansen U.; Helweg-Larsen J.; Fosboel E.; Toender
N.; Moser C.; Iversen K.; Ihlemann N.; Bundgaard H.
Institution
(Hjulmand, Pries-Heje, Try Lenz, Helweg-Larsen, Fosboel, Moser, Bundgaard)
Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
(Carter-Storch, Gill, Ihlemann) Odense University Hospital, Odense,
Denmark
(Bruun) Roskilde University Hospital, Roskilde, Denmark
(Povlsen) Aarhus University Hospital, Aarhus, Denmark
(Christiansen) Aalborg University Hospital, Aalborg, Denmark
(Toender) Nordsjaellands Hospital, Hilleroed, Denmark
(Iversen) Herlev Hospital, Herlev, Denmark
Publisher
European Respiratory Society
Abstract
Background: Our knowledge of changes in vegetation size throughout the
course of infective endocarditis (IE) and the impact of persistent
vegetations on mortality or embolization after completed antibiotic
treatment is sparse. No study has previously investigated the prevalence
or clinical impact of persistent vegetations on transthoracic
echocardiography (TTE) at 6-months follow-up after ended IE treatment.
<br/>Purpose(s): To investigate the association between persistent
vegetations at the 6-months TTE after treatment for IE and long-term
prognosis as assessed in the POET trial. <br/>Method(s): The POET trial
was a nationwide, multicenter RCT, randomizing 400 patients to either
partial oral or intravenous (IV) antibiotic treatment of left-sided IE,
after initial stabilization of infection using conventional IV therapy. A
persistent vegetation was defined as a vegetation seen on 6-months
follow-up TTE (4-7 months) after ended antibiotic treatment for IE. In the
POET trial, primary outcome was defined as 1) all-cause mortality, 2)
unplanned cardiac surgery, 3) embolic events or 4) relapse of bacteremia,
in the 5-year follow-up period. Patients without TTE due to death or lack
of available TTE were excluded. <br/>Result(s): Out of 400 patients, 20
were excluded due to death during 6- months follow-up, and 201 were
excluded due to unavailable TTE, leaving 179 TTEs for analysis. At
6-months follow-up, a persistent vegetation was seen in 30 patients
(16.7%, 21 males (70%), mean age 69.6 years (SD 7.7)) (Table 1). Seventeen
patients (56.7%) had a persistent vegetation on the aortic valve and 13
patients (43.3%) on the mitral valve. More patients without a persistent
vegetation had undergone initial surgical treatment of IE than those with
a vegetation (57.7 vs 23.3%, p=0.001). In all surgically treated patients
with persistent vegetation at 6-months follow-up, the vegetation was found
on another valve than the operated valve. The composite primary outcome
from 6-months follow-up and until 5-year follow-up occurred in 8 patients
(26.7%) with a persistent vegetation, compared to 38 patients (25.5%)
(p=1.00) without. (Table 2) In patients randomized for peroral treatment,
no significant difference in prevalence of persistent vegetation was found
(15 patients (50%) with persistent vegetations vs. 74 patients (49.7%)
without, p=1.00). <br/>Conclusion(s): The occurrence of persistent
vegetations at 6 months followup was 16.7%. There was no association
between persistent vegetations at 6-months follow-up and the occurrence of
the primary outcome after 5 years follow-up, suggesting that the risk
associated with residual vegetations after end of antibiotic treatment is
negligible after 6-months. (Table Presented).

<99>
Accession Number
641006591
Title
Revascularization strategies versus optimal medical therapy in chronic
coronary syndrome: A systematic review and network meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2143), 2022. Date of Publication: September 2022.
Author
Galli M.; Benenati S.; Zito A.; Capodanno D.; Biondi-Zoccai G.; Ortega-Paz
L.; D'Amario D.; Porto I.; Burzotta F.; Trani C.; De Caterina R.; Escaned
J.; Gaudino M.; Angiolillo D.J.; Crea F.
Institution
(Galli, Burzotta, Trani, Crea) Catholic University of the Sacred Heart,
Rome, Italy
(Benenati, Porto) Ospedale Policlinico San Martino IRCCS, Genoa, Italy
(Zito, D'Amario) IRCCS Foundation Agostino Gemelli University Hospital,
Rome, Italy
(Capodanno) AOU Policlinico - Vittorio Emanuele, Catania, Italy
(Biondi-Zoccai) Sapienza University of Rome, Rome, Italy
(Ortega-Paz, Angiolillo) University of Florida, College of Medicine,
Jacksonville, United States
(De Caterina) University of Pisa, Pisa, Italy
(Escaned) Hospital Clinico San Carlos, Madrid, Spain
(Gaudino) Weill Cornell Medicine, New York, United States
Publisher
European Respiratory Society
Abstract
Background: Whether revascularization reduces ischemic events and improves
prognosis in patients with chronic coronary artery syndrome (CCS) without
left main (LM) disease or reduced left ventricle ejection fraction (LVEF)
remains a topic of debate. Nevertheless, the impact of revascularization
on outcomes in patients with CCS may be influenced by the
revascularization strategy adopted. <br/>Purpose(s): We aimed at
evaluating the comparative effects of different revascularization
strategies in patients with CCS. <br/>Method(s): A total of 18 randomized
controlled trials including angiographyguided percutaneous coronary
intervention (PCI), physiology-guided PCI and coronary artery bypass graft
(CABG), were included. Effect estimates included direct comparisons for
all treatments and direct and indirect evidence were in agreement for all
included outcomes, fulfilling the consistency assumption. Incidence rate
ratios (IRR) and associated 95% confidence intervals (CIs) were used to
adjust outcomes according to follow-up durations. Medical therapy was used
as reference strategy. <br/>Result(s): Compared with medical therapy, at a
mean follow-up of 5.1 years, all revascularization strategies were
associated with a reduction of the primary endpoint, as defined in each
trial, the extent of which was modest with angiography-guided PCI (IRR
0.86, 95% CI 0.75-0.99) and greater with physiology-guided PCI (IRR 0.60,
95% CI 0.47-0.77) and CABG (IRR 0.58, 95% CI 0.48-0.70). Moreover,
angiography-guided PCI was associated with increased primary endpoint
compared to physiology-guided PCI (IRR 1.43, 95% CI 1.14-1.79) and CABG
(IRR 1.49, 95% CI 1.27-1.74). CABG was the only strategy associated with
reduced myocardial infarction (IRR 0.68, 95% CI 0.52-0.90), cardiovascular
death (IRR 0.76, 95% CI 0.64-0.89), and all-cause death (IRR 0.87, 95% CI
0.77-0.99), but increased stroke (IRR 1.69, 95% CI 1.04-2.76). Results
were consistent at secondary analysis exploring the impact on outcomes of
baseline characteristics, such as 3-vessel disease, diabetes mellitus,
year of publication or stents used. <br/>Conclusion(s): In CCS patients
without LM disease or reduced LVEF, physiology-guided PCI and CABG were
associated with better outcomes than angiography-guided PCI. Compared with
medical therapy, CABG was the only revascularization strategy associated
with a reduction of myocardial infarction and death rates, at the cost of
higher risk of stroke.(Figure Presented).

<100>
Accession Number
641006589
Title
Clinical outcome up to 2 years after percutaneous coronary intervention in
all-comers with concomitant symptomatic peripheral arterial disease: A
pooled analysis in 9,204 randomized trial participants.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2044), 2022. Date of Publication: September 2022.
Author
Pinxterhuis T.H.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; Schotborgh C.E.;
Anthonio R.L.; Roguin A.; Danse P.W.; Benit E.; Aminian A.; Stoel M.G.;
Linssen G.C.M.; Geelkerken R.H.; Von Birgelen C.
Institution
(Pinxterhuis, Ploumen, Zocca, Stoel, Geelkerken, Von Birgelen) Thorax
Centre in Medisch Spectrum Twente (MST), Enschede, Netherlands
(Doggen) University of Twente, Enschede, Netherlands
(Schotborgh) Haga Hospital, Den Haag, Netherlands
(Anthonio) Treant Zorggroep Scheper Hospital, Emmen, Netherlands
(Roguin) Hillel Yaffe Medical Center, Hadera, Israel
(Danse) Rijnstate Hospital, Arnhem, Netherlands
(Benit) Jessa Hospital, Hasselt, Belgium
(Aminian) CHU Charleroi, Charleroi, Belgium
(Linssen) Twente Hospital Group, Almelo, Netherlands
Publisher
European Respiratory Society
Abstract
Background: An increasing number of patients with coronary artery disease,
who undergo percutaneous coronary intervention, also have symptomatic
peripheral arterial disease. These patients have a worse long-term
prognosis, but it is unclear whether the inferior outcome can be seen as
early as during the first 2 years from coronary stenting. <br/>Purpose(s):
The aim of this study in all-comers was to evaluate the impact of
symptomatic peripheral arterial disease on 1- and 2-year clinical outcome
after coronary stenting. <br/>Method(s): Patient-level data from four
large-scale randomised coronary drug-eluting stent trials in all-comers
(TWENTE (clinicaltrials. gov: NCT01066650), DUTCH PEERS (NCT01331707),
BIO-RESORT (NCT01674803), and BIONYX (NCT02508714)) were pooled to
evaluate the impact of symptomatic peripheral arterial disease on clinical
outcome after coronary stenting. Peripheral arterial disease was defined
as a history (by anamnesis or medical record) of an obstructive arterial
lesion, resulting from atherosclerosis in peripheral locations including
the lower and upper extremities, carotid or vertebral arteries, and
mesenteric or renal arteries. Main clinical endpoint was target vessel
failure, a composite of cardiac death, target vessel related myocardial
infarction, or clinically indicated target vessel revascularisation.
<br/>Result(s): Of all 9,204 trial participants, 695 (7.6%) had
symptomatic peripheral arterial disease. These patients were older and had
a higher cardiovascular risk profile, including a higher prevalence of
diabetes, renal failure, hypertension, hypercholesterolemia, and prior
stroke. At 1-year followup, patients with peripheral arterial disease
showed significantly higher event rates of some endpoints. At 2-year
follow-up, patients with peripheral arterial disease showed significantly
higher rates of various clinical endpoints, including mortality (7.1% vs.
3.0%, p<0.001), myocardial infarction (4.8% vs. 3.4%, p0.04), repeated
revascularisation (6.7% vs 4.5%, p<0.04), and major adverse cardiac events
(14.6% vs. 8.3%, p<0.001, Figure 1). After multivariate adjustment for
confounders, symptomatic peripheral arterial disease was found to be
independently associated with the 2-year risks of target vessel and lesion
failure, major adverse cardiac events, and all-cause death (p<0.02, for
all, Table 1). <br/>Conclusion(s): Obstructive coronary artery disease
with concomitant symptomatic peripheral arterial disease resulted in
higher cardiovascular risk profiles and higher rates of all-cause
mortality and various composite clinical endpoints during the first two
years of follow-up after coronary stenting. Knowledge of these findings
allows to identify patients with an increased short- and medium-term
adverse event risk after percutaneous coronary intervention, which is
useful for both Heart Team and informed consent discussions. (Figure
Presented).

<101>
Accession Number
641006583
Title
The music therapy effectiveness in hypertensive patients with acute
myocardial infarction after previous coronary artery bypass surgery;
18-year experience of the MUSIC study.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2197), 2022. Date of Publication: September 2022.
Author
Mitrovic P.; Paladin A.; Radovanovic M.; Radovanovic N.; Rajic D.; Matic
G.; Jozic T.; Dizdarevic I.; Jankovic J.; Radovanovic M.N.
Institution
(Mitrovic, Radovanovic, Radovanovic) Clinical center of Serbia and School
of Medicine, University of Belgrade, Department of Emergency Cardiology,
Belgrade, Serbia
(Paladin) Serbian National Broadcasting Agency, Belgrade, Serbia
(Rajic, Matic, Jozic, Dizdarevic, Jankovic, Radovanovic) Clinical center
of Serbia, Department of Emergency Cardiology, Cardiology Clinic,
Belgrade, Serbia
Publisher
European Respiratory Society
Abstract
Patients who have clinical evidence of hypertension (HT) after coronary
artery bypass surgery (CABS) have a poor prognosis in expression of acute
myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can
produce an increase in sympathetic nervous system activity leading to an
increase in cardiac workload. The purpose of this study was to evaluate
the effectiveness of music therapy on prognosis of patients with HT and
AMI, after CABS. <br/>Method(s): 314 patients (males 78.4%, mean age
59.8+/-1.2 yrs) with AMI after previous CABS have been selected from the
patients consecutively submitted from January 2003 to January 2019. HT was
registered in 166 (53.0%) pts with AMI after previous CABS. All patients
with HT were randomized and divided in 2 groups: Study group of 83
patients treated with music therapy and Control group of 83 patients with
no music therapy. Each patient in study group underwent two sessions of
medical therapy (12 minutes) in a day. Both groups were similar in
baselines, post-AMI characteristics and post-AMI medical therapy. The
plasma cytokine and catecholamine were measured in both groups.
<br/>Result(s): In the Study group, heart rate was significantly decreased
by music therapy (p=0.0196). In the Control group, there were no
significant changes in heart rate. Among cytokines (p=0.0160), plasma
interleukin- 6 (IL-6) (p=0.0179) in the Study group was significantly
lower than those in the Control group, as well as plasma adrenaline
(p=0.0162) and noradrenalin (p=0.0218) levels. <br/>Conclusion(s): This
study provides support for the use of musical therapy in patients with HT
and AMI after previous CABS. The positive effects of music therapy, in
these patients, are probably because of enhanced of parasympathetic
activities and reduction of plasma cytokine and catecholamine levels.

<102>
Accession Number
641006534
Title
Performance assessment of unfractionated heparin protocol in pediatric
patients supported on extracorporeal membrane oxygenation.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2696), 2022. Date of Publication: September 2022.
Author
Shorog E.; Aljazairi A.; Aljasser R.; Owaidah T.; Al-Mehizia R.; Adalaty
H.; Alhashim S.
Institution
(Shorog) King Faisal Specialist Hospital and Research Centre, King Khalid
University, Riyadh, Abha, Saudi Arabia
(Aljazairi, Aljasser, Owaidah, Al-Mehizia, Adalaty, Alhashim) King Faisal
Specialist Hospital and Research Centre, Pharmaceutical Care Division,
Riyadh, Saudi Arabia
Publisher
European Respiratory Society
Abstract
Background: Using extracorporeal membrane oxygenation in critical care
setting is evolving. Unfractionated heparin is the most commonly used
anticoagulant and a well-designed protocol is needed. However, there is no
consensus from any organization regarding standard protocol. We developed
UFH protocol taking into consideration best available evidence and
anecdotal ECMO data. This study aims to assess ability of current protocol
to achieve anti-Xa assay therapeutic target. <br/>Method(s): Prospective
cohort, single-arm study conducted in Pediatric Cardiac Surgery Intensive
Care Unit. Twenty patients were required. Anti- Xa assay therapeutic range
is 0.1-0.3 U/mL for bleeding and 0.3-0.7 U/mL for non-bleeding patients.
The protocol was developed after comprehensive literature review and
continuous strict review process by a multidisciplinary ECMO team. It
identifies initial UFH infusion dosing and subsequent adjustment,
frequency of monitoring Anti-Xa assay, and other laboratory parameters. To
ensure protocol adherence, teaching sessions were provided. Finally, we
explored survival to discharge rate. The study was approved by the Office
of Research Affairs with verbal consent. <br/>Result(s): Twenty patients
were included, half of them were female. Mean age of 35 months +/- SD 52.5
and mean weight of 5.7 kg +/- SD 3.8-14.1. Mean estimated glomerular
filtration rate using schwartz equation was 80 mL/min/1.73 m2 +/- SD 34.7.
Main indications of ECMO use were failure to wean after surgery (45%).
Median ECMO duration was 6 days+ (IQR: 4.5-7.5). Baseline Anti-Xa assay
before cannulation was 0.1 IU/mL. Another important baseline laboratory
value was antithrombin III, the mean was 21.1 +/- SD 14.3. Selection of
bleeding protocol is based on a set of criteria in the bleeding section
(Appendix 1). Pre-canulation heparin bolus of 50-100 units/kg was given if
ACT is <300 seconds for 11 patients (55%). Holding unfractionated heparin
was required in 8 patients (40). Median time UFH was on-hold 13.5 hours
(IQR: 10.5-27.5). Achieving Anti-Xa assay therapeutic target thorough out
study period was reported in 70% of patients. Median time to achieve
target was 41 hours (IQR: 0-91.5) and maintained for 8 hours (IQR: 0-22).
Hemorrhagic complications were reported in 8 patients (40%) while
thrombotic complications in 5 patients (25%). Both peripheral cannulation
site bleeding and gastrointestinal bleeding occurred in 5%. Surgical
exploration was needed in 6 patients (30%). Median time to first
replacement was 80.5 hours (IQR: 19.5- 228.5). Median hospital length of
stay was 37 + IQR: 43-22 with survival rate at discharge of 75%.
<br/>Conclusion(s): Implemented UFH protocol in pediatric ECMO failed to
achieve target in early hours after cannulation. However, the majority of
those critically ill patients achieved Anti-Xa assay target and maintained
it after the third day until day ten. Thromboembolic, hemorrhagic
complications, and survival rates were consistent with the reported data.

<103>
Accession Number
641006518
Title
Ten years survival benefit of CABG or PCI based on individual prediction.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2043), 2022. Date of Publication: September 2022.
Author
Serruys P.W.; Gao C.; Ninomiya K.; Hara H.; Garg S.; Onuma Y.; Kappetein
A.P.; Mohr F.W.; Mack M.
Institution
(Serruys, Gao, Ninomiya, Hara, Onuma) National University of Ireland,
Galway, Ireland
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Kappetein) Erasmus University Medical Centre, Rotterdam, Netherlands
(Mohr) Heart Center of Leipzig, Leipzig, Germany
(Mack) Baylor Scott and White The Heart Hospital, Plano, United States
Publisher
European Respiratory Society
Abstract
Background: To compare the observed and individual predicted mortalities
according to the SYNTAX score II 2020 (SSII-2020) in the all-comers SYNTAX
population, and retrospectively assess the appropriateness of
revascularization with percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG) in patients with three vessel
disease (3VD) and/or left main disease (LMCAD). <br/>Method(s): Internal
and external validation of the SSII-2020 to predict 10- year all-cause
death was performed in the respective randomized and registry SYNTAX
populations. Differences in individual predicted mortalities following
CABG or PCI were ranked and displayed with the observed mortalities. The
proportions of screened patients deriving a survival benefit from CABG or
PCI were determined retrospectively. <br/>Result(s): A total of 2602
participants (as-treated population) were included in the randomized and
registry cohorts. In the randomized cohort, all-cause mortality at 10
years, as an average treatment effect, was 23.8% (199/865) with CABG and
28.6% (249/901) with PCI, with a differential survival benefit of 4.6%
(95% CI: 0.58% to 8.7%, log-rank p value=0.023). In the CABG and PCI
registries, mortalities were 27.8% (167/644) and 55.4% (99/192),
respectively. Calibration and discrimination of the SSII-2020 was helpful
in CABG and PCI patients in the randomized and registry cohorts. In the
PCI registry, the SSII-2020 underestimated mortality since specific
comorbidities that entail high mortality are not included in the formula
(C-index: 0.72, intercept: 0.38, slope: 0.66), whilst in the CABG
registry, it predicted mortality with a helpful calibration and
discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The
proportions of patients with a predicted survival benefit following CABG
and PCI were respectively 78.3% (1383/1766) and 21.7% (383/1766) in the
randomized cohort, and 82.4% (2143/2602) and 17.7% (459/2602) in the whole
SYNTAX trial population. <br/>Conclusion(s): In the randomized and
registry cohort of this all-comers population with 3VD and/or LMCAD, there
was reasonable agreement between the individual predicted and observed
mortalities after CABG or PCI, such that the predicted 10-year survival
benefit might be helpful in determining the appropriateness of each
modality of revascularization. (Figure Presented).

<104>
Accession Number
641006383
Title
Total arterial revascularization is associated with long-term survival
benefit in coronary artery bypass grafting: Systematic review with
meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2139), 2022. Date of Publication: September 2022.
Author
Ren J.; Royse A.; Tian D.; Royse C.; Boggett S.; Bellomo R.; Gaudino M.;
Fremes S.
Institution
(Ren, Royse, Royse, Boggett, Bellomo) University of Melbourne, Melbourne,
Australia
(Tian) University of Sydney, Sydney, Australia
(Gaudino) Weill Cornell Medicine,We, New York, United States
(Fremes) Sunnybrook Health Sciences Centre, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Importance: Total arterial revascularization (TAR), the complete avoidance
of saphenous vein grafting (SVG) in coronary artery bypass grafting
(CABG), is advocated based on the superior conduit durability and
resistance against atherosclerosis. However, the low adoption rate of TAR
indicates a high level of controversy. <br/>Objective(s): To compare
long-term survival between TAR and conventional CABG involving SVG. Data
sources: A comprehensive literature search was conducted through digital
databases including MEDLINE, Embase, and Cochrane Central Register of
Controlled Trials from the inception to May 2021. Study selection: The
inclusion criteria were randomized clinical trials, or propensity-score
balanced or multivariable-adjusted observational studies with a sample
size of at least 100 patients in each arm, isolated CABG, comparing TAR
(SVG=0) vs. non-TAR (SVG>=1), and inclusion of all-cause mortality. Data
extraction and synthesis: Two reviewers performed independent extraction
following Preferred Reporting Items for Systematic Reviews and
Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) and 95%
confidence intervals (CI) were estimated with random-effect and
fixedeffect models using generic inverse variance weighting. Individual
patient time-to-event data were reconstructed to create an overall
Kaplan-Meier survival function for matched studies. Sensitivity analyses
were performed according to the risk of bias, matching status, and source
of HR. <br/>Main Outcomes and Measures: The primary endpoint was all-cause
mortality. <br/>Result(s): A total of 23 studies (100,314 patients), all
with a retrospective observational design, were identified. The weighted
mean follow-up time was 8.8 years post-operatively. Total arterial
revascularization was associated with greater freedom from all-cause
mortality than non-TAR (HR, 0.77, 95% CI, 0.71 to 0.84, p<0.001). There
was evidence of low heterogeneity (I²=45%) across studies. Low
publication bias was observed. Leave-oneout influence analysis and
sensitivity analyses produced consistent results. Cochrane Collaboration
signaling domains showed no critical risk of bias. Conclusions and
relevance: This meta-analysis found superior late survival associated with
total arterial revascularization. Further randomized clinical trials are
needed.

<105>
Accession Number
641006372
Title
The impact of statin on post-operative atrial fibrillation after discharge
from cardiac surgery: Secondary analysis of the SEARCH-AF CardioLink-1
randomized trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2342), 2022. Date of Publication: September 2022.
Author
Hibibo M.; Verma S.; Pandey A.; Quan A.; Verma A.; Bisleri G.; Ha A.;
Mazer C.D.
Institution
(Hibibo, Verma, Pandey, Quan, Bisleri, Mazer) St. Michael's Hospital,
Cardiac surgery, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Ha) UHN-University of Toronto, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Background: There is conflicting evidence regarding the use of statins to
reduce the risk of post-operative atrial fibrillation (POAF) in patients
undergoing cardiac surgery. <br/>Purpose(s):We sought to determine the
effects of statin use on the burden of new-onset post-discharge POAF in
the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial
Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial.
<br/>Method(s): In the SEARCH-AF trial, 336 patients with risk factors for
stroke (CHA2DS2-VASc score >=2) and no history of preoperative AF were
randomized to usual care or continuous cardiac rhythm monitoring for 30
days after discharge from cardiac surgery with a wearable, patched-based
device. The primary endpoint was the occurrence of cumulative atrial
fibrillation/ flutter (AF/AFL) lasting for >=6 minutes detected by
continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram
within 30 days of randomization. Using time-to-event analysis and Cox
regression, we evaluated the association between the risk of
post-operative AF in relation to statin use and dosing intensity (low,
moderate, high) at the time of discharge. We excluded patients who
experienced post-operative AF during hospitalization in this analysis.
<br/>Result(s): In the overall cohort (n=336), 260 (77.4%) patients were
treated with statins at the time of hospital discharge. There were 18
(5.4%) patients who experienced post-operative AF during hospitalization.
Patients prescribed with statins were more likely to be male (p=0.018),
had lower CHA2DS2-VASc scores (p=0.011), and were more likely to undergo
isolated coronary artery bypass grafting (CABG) (p=0.083). Baseline
characteristics were otherwise similar between the 2 groups. Patients
treated with statins at discharge had a 2-fold lower rate of
post-operative AF than those who were not treated with statins in the
overall cohort (17.6% vs. 8.2%, Log-Rank p=0.017) and among those who were
randomized to continuous cardiac rhythm monitoring (31.6% vs. 16.0%,
Log-Rank p=0.027) (Figure). After adjusting for surgery type (CABG vs.
valve surgery) and the CHA2DS2-VASc score, statin use at discharge was
associated with a lower risk of post-operative AF within 30 days after
surgery (hazard ratio 0.48, 95% CI 0.24-0.97). Furthermore, increasing
intensity of statin therapy was associated with lower risk of POAF
(ptrend=0.0012) (Figure 1) <br/>Conclusion(s): Among cardiac surgery
patients with risk factors for stroke and no history of pre-operative AF,
the use of statins was associated with a reduction in post-operative AF
risk within 30 days of discharge. The routine use of high-intensity statin
to prevent post-operative AF after cardiac surgery deserves further study.

<106>
Accession Number
641006359
Title
Comparison of the safety and efficacy of antithrombotic regimens following
TAVR in patients without having an indication for chronic oral
anticoagulation.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2090), 2022. Date of Publication: September 2022.
Author
Guedeney P.; Roule V.; Mesnier J.; Chapelle C.; Portal J.J.; Laporte S.;
Ollier E.; Zeitouni M.; Kerneis M.; Barthelemy O.; Sorrentino S.; Silvain
J.; Vicaut E.; Montalescot G.; Collet J.P.
Institution
(Guedeney, Zeitouni, Kerneis, Barthelemy, Silvain, Montalescot, Collet)
Hospital Pitie-Salpetriere, Paris, France
(Roule) University Hospital of Caen, Department of Cardiology, Caen,
France
(Mesnier) Bichat Hospital, University Paris-Diderot, INSERM-UMR1148,FACT
French Alliance for Cardiovascular T, Paris, France
(Chapelle, Laporte, Ollier) University Hospital of Saint-Etienne, Unite de
Recherche Clinique Innovation et Pharmacologie, Saint-Etienne, France
(Portal, Vicaut) Lariboisiere APHP Site of Saint Louis University
Hospital, Unite de Recherche Clinique, Paris, France
(Sorrentino) Magna Graecia University of Catanzaro, Cardiology, Catanzaro,
Italy
Publisher
European Respiratory Society
Abstract
Aims: To compare the safety and efficacy of antithrombotic regimens
following transcatheter aortic valve replacement (TAVR) in patients
without having an indication for chronic oral anticoagulation <br/>Methods
and Results: We conducted a Prospero-registered systematic review and
network meta-analysis of randomized controlled trials evaluating post-TAVR
antithrombotic regimens up to March 2021. We estimated the relative risk
and 95% confidence intervals using a fixed effect model in a frequentist
pairwise and network metanalytic approach. We included 6 studies
comprising of 3,777 patients with a mean weighted follow-up of 13.3
months. Single antiplatelet therapy (SAPT) was associated with a
significant reduction of life-threatening, disabling, or major bleeding
compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95%
confidence interval [CI]: 0.28-0.69), apixaban (RR: 0.47, 95% CI
0.26-0.84) and lowdose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI:
0.16-0.57). Risk of all-cause death was significantly reduced with DAPT
compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI:
0.41-0.88) and a consistent reduction was observed with SAPT and DAPT
compared to apixaban (RR: 0.60, 95% CI: 0.31-1.16 and RR: 0.58, 95% CI:
0.32-1.04, respectively). There were no differences between the various
regimens with respect to myocardial infarction and stroke. Apixaban
significantly reduced the risk of pulmonary embolism, valve thrombosis and
grade 3 or 4 reduced leaflet motion. <br/>Conclusion(s): Following TAVR in
patients without an indication for chronic oral anticoagulant, SAPT was
associated with the lowest risk of bleeding compared to DAPT and direct
oral anticoagulant-based regimens without significant ischemic offset.
(Figure Presented).

<107>
Accession Number
641006322
Title
Outcomes following acute myocardial injury and type 2 myocardial
infarction in patients with and without coronary artery disease.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1149), 2022. Date of Publication: September 2022.
Author
Taggart C.; Gard A.; Bularga A.; Wereski R.; Kimenai D.; Chapman A.R.;
Lindahl B.; Mills N.L.; Eggers K.
Institution
(Taggart, Bularga, Wereski, Kimenai, Chapman, Mills) University of
Edinburgh, Edinburgh, United Kingdom
(Gard, Lindahl, Eggers) Uppsala University, Uppsala, Sweden
Publisher
European Respiratory Society
Abstract
Background: Acute myocardial injury and type 2 myocardial infarction
typically occur in the setting of a concurrent illness. Differentiating
acute myocardial injury from type 2 myocardial infarction is challenging
as it relies on the assessment of myocardial ischaemia. Indeed, some have
questioned whether this distinction is important, as patients with both
conditions are at increased risk of future cardiovascular events. Whether
this risk is similar and the role of identifying those with coronary
artery disease is uncertain. <br/>Purpose(s): To determine whether future
risk of cardiovascular events and death differs in patients with type 2
myocardial infarction and acute myocardial injury according to the
presence or absence of prior coronary artery disease. <br/>Method(s): We
conducted a secondary analysis of a multi-centre randomised controlled
trial of 48,282 consecutive patients with suspected acute coronary
syndrome. Patients with an adjudicated index diagnosis of acute myocardial
injury and type 2 myocardial infarction were stratified according to
whether they were known previously to have coronary artery disease defined
as prior coronary revascularisation, myocardial infarction, or angina.
Cardiovascular death or myocardial infarction adjusted for the competing
risk of non-cardiovascular death and all-cause death at one year was
compared. <br/>Result(s): In 9,115 patients with elevated cardiac troponin
concentrations, 1,676 (18%) and 1,121 (12%) had acute myocardial injury
and type 2 myocardial infarction, respectively. Patients with either
condition known to have coronary artery disease were older (mean [standard
deviation] age 78 [11] versus 73 [16] years) and more likely to be female
(55% versus 45%) than those with no prior history. Coronary artery disease
was previously identified in 40% (454/1,121) and 30% (509/1,167) of those
with type 2 myocardial infarction and acute myocardial injury,
respectively. Cardiovascular death or myocardial infarction at one year
was more common in patients known to have coronary artery disease than
those without for both acute myocardial injury (23% [115/509]) versus 14%
[158/1,167]; P<0.001) and type 2 myocardial infarction (20% [91/454]
versus 10% [69/667]; logrank P<0.001) (Figure 1). Similarly all-cause
death at one year was higher in patients with known coronary artery
disease for both acute myocardial injury (31% [357/1,167] versus 18%
[123/667]; P<0.001) and type 2 myocardial infarction (40% [115/509] versus
30% [135/454]; P<0.001) (Figure 2). <br/>Conclusion(s): Coronary artery
disease is recognised in around one third of patients with acute
myocardial injury and type 2 myocardial infarction and is associated with
higher rates of cardiovascular events and all-cause death. Risk doubled in
those with coronary artery disease and was similar whether the index
diagnosis was myocardial injury or infarction, suggesting that coronary
investigation and secondary prevention may have a role in both conditions.

<108>
Accession Number
641006300
Title
Long-term toxicity of radiosurgery for ablation of ventricular
tachycardia.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
701), 2022. Date of Publication: September 2022.
Author
Cvek J.; Peichel P.; Knybel L.; Jiravsky O.; Sramko M.; Hecko J.; Neuwirth
R.; Plasek J.; Kautzner J.
Institution
(Cvek) University Hospital Ostrava, Oncology, Ostrava, Czechia
(Peichel, Sramko, Kautzner) Institute for Clinical and Experimental
Medicine (IKEM), Prague, Czechia
(Knybel, Plasek) University Hospital Ostrava, Ostrava, Czechia
(Jiravsky, Hecko, Neuwirth) Hospital Podlesi, Cardiology, Trinec, Czechia
Publisher
European Respiratory Society
Abstract
Introduction: There is a rising interest in using radiosurgery to modify
arrhythmogenic substrate in patients with recurrent VT. However, data on
the safety are still inadequate. <br/>Purpose(s): This is update of
toxicity evaluation based on the compilation from our case series, NIRA-VT
and STAR-VT. <br/>Method(s): Between 2014 and March 2021, 36 patients (33
male, 3 females; mean age 66+/-10 years) with structural heart disease
(ischemic cardiopathy, dilated cardiopathy or fibroma associated scar)
from two electrophysiology centers in the Czech Republic (Trinec, Prague)
underwent radiosurgery for recurrent VT. Radiosurgery was performed after
at least one failed catheter ablation for VT. The critical part of the VT
substrate was identified by electroanatomic mapping using a combination of
voltage mapping, pace mapping, and activation mapping; and it was marked
on a contrast-enhanced computer tomography study as a CTV. In NIRA-VT
trial, CTV included scar based on PET/CT evaluation. Radiosurgery system
with real-time motion tracking using the tip of the electrode of an
indwelling defibrillator as a fiducial marker was used. A total radiation
dose of 25 Gy was delivered to the ablation target in a single session
during free breathing. Radiation-induced toxicity was evaluated according
to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
Only patients with follow up longer than 6 months were included in long
term radiation related side effects evaluation. <br/>Result(s): The mean
CTV and PTV were 26+/-11 ml and 41+/-22 ml respectively. No patient
exhibited acute (up to 3 months) elevation of troponin, pericardial
effusion, or a decrease in left ventricular ejection fraction from
baseline. Four patients developed acute mild nausea, which waned after
antiemetic drugs. Long-term radiation related side effects were evaluated
in 19 patients. Two patients (11%) presented radiological signs of lung
fibrosis in small area in close distance from PTV. There was no
significant decrease in left ventricular ejection fraction during follow
up. Six patients (33%) gradually developed significant progression of
known mitral regurgitation after SBRT, two (11%) of them had to undergo
mitral valve replacement (grade 4 toxicity). Two cases of esophagitis
(12%) were seen with one radiation toxicity related death (grade 5
toxicity) due to the unresectable esophagi-pericardial fistula (6%).
<br/>Conclusion(s): Our data indicate the feasibility of radiosurgery,
majority of patients presented no/mild radiation related toxicity and
decrease of VT burden. However, we have seen three cases of grade 4,5
toxicity. To further investigate long-term safety and efficacy of
radiosuergery for VT, enrolling into a randomized prospective study is in
progress.

<109>
Accession Number
641006284
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
with stenting for multivessel coronary artery disease without left main
coronary disease:reconstructed individual patient data.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1416), 2022. Date of Publication: September 2022.
Author
Chew N.W.S.; Ng C.H.; Xiao J.L.; Chan K.H.; Loh P.H.; Low A.; Lee C.H.;
Tan H.C.; Chan M.Y.
Institution
(Chew, Chan, Loh, Low, Lee, Tan, Chan) National University Heart Centre,
Singapore, Singapore
(Ng, Xiao) National University of Singapore, Singapore, Singapore
Publisher
European Respiratory Society
Abstract
Background and aims: Data are emerging on 10-year mortality comparing
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) with stenting for multivessel disease (MVD) without
left main (LM) involvement. We conducted an updated two-stage metaanalysis
using reconstructed individual patient data to compare long-term mortality
between CABG and PCI for patients with MVD without significant LM coronary
disease. <br/>Method(s): Medline and Embase databases were searched for
articles comparing CABG with PCI for MVD. A two-stage meta-analysis was
conducted using reconstructed patient level survival data for all-cause
mortality with subgroups by SYNTAX score. The shared-frailty and
stratified Cox models were fitted to compare survival endpoints.
<br/>Result(s): We screened 1496 studies and included six randomized
controlled trials with 7181 patients. PCI was associated with greater
10-year all-cause mortality risk (HR: 1.282, CI: 1.118-1.469, p<0.001)
compared with CABG. In patients with low SYNTAX score, 10-year all-cause
mortality after PCI was comparable to CABG (HR: 1.102, 0.822-1.479,
p=0.516). However, in patients with moderate to high SYNTAX score, 10-year
allcause mortality was significantly higher after PCI compared with CABG
(HR: 1.444, 1.122-1.858, p<0.001; HR: 1.856, 1.380-2.497, p<0.001
respectively). <br/>Conclusion(s): This updated reconstructed individual
patient-data metaanalysis revealed a sustained lower cumulative all-cause
mortality of CABG over PCI for multivessel disease without LM involvement.
(Figure Presented).

<110>
Accession Number
641006227
Title
Reconstructed meta-analysis of percutaneous coronary intervention versus
coronary artery bypass grafting for left main disease.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1415), 2022. Date of Publication: September 2022.
Author
Chew N.W.S.; Ng C.H.; Kong G.; Tan D.; Lim W.H.; Kofidis T.; Yip J.; Loh
P.H.; Chan K.H.; Low A.; Lee C.H.; Yeo T.C.; Tan H.C.; Chan M.Y.
Institution
(Chew, Kofidis, Yip, Loh, Chan, Low, Lee, Yeo, Tan, Chan) National
University Heart Centre, Singapore, Singapore
(Ng, Kong, Tan, Lim) National University of Singapore, Singapore,
Singapore
Publisher
European Respiratory Society
Abstract
Background: Randomized controlled trials (RCTs) comparing percutaneous
coronary intervention (PCI) with drug-eluting stents and coronary artery
bypass grafting (CABG) for patients with left main coronary artery disease
(LMCAD) have reported conflicting results. <br/>Objective(s): We performed
a systematic review from inception to 23 May 2021 and one-stage
reconstructed individual-patient data meta-analysis (IPDMA) that included
10-year mortality outcomes. <br/>Method(s): The primary outcome was
10-year all-cause mortality. Secondary outcomes included myocardial
infarction (MI), stroke and unplanned revascularization at 5 years. We did
IPDMA using published Kaplan-Meier curves to provide individual data
points in coordinates and numbers at risk were used to increase the
calibration accuracy of the reconstructed data. Shared frailty model or,
when proportionality assumptions were not met, a restricted mean survival
time model were fitted to compare outcomes between treatment groups.
<br/>Result(s): Of 583 articles retrieved, 5 RCTs were included. A total
of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297)
or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and
CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925- 1.292;
p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI:
0.992-1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998- 1.013,
p=0.133) at 5 years. Unplanned revascularization was more frequent
following PCI compared with CABG (HR 1.807, 95% CI: 1.524- 2.144, p<0.001)
at 5 years. <br/>Conclusion(s): This meta-analysis using reconstructed
participant-level time-to-event data showed no statistically significant
difference in cumulative 10-year all-cause mortality between PCI versus
CABG in the treatment of LMCAD. (Figure Presented).

<111>
Accession Number
641006165
Title
Dual versus single antiplatelet therapy after transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2087), 2022. Date of Publication: September 2022.
Author
Eikelboom R.; Qiu Y.; Kim K.; Whitlock R.; Belley-Cote E.
Institution
(Eikelboom, Qiu, Kim) McMaster University, Hamilton, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
Canada
Publisher
European Respiratory Society
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is the
intervention of choice for patients with severe symptomatic aortic
stenosis who have high or intermediate surgical risk. TAVR valves are at
risk of thrombosis and serious sequelae including stroke, peripheral
embolism, and valve dysfunction requiring intervention. The optimal method
of antithrombotic therapy to reduce risk of thrombosis with an acceptable
increase in risk of bleeding is uncertain. <br/>Objective(s): This
systematic review and meta-analysis assesses the effects of dual
antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) on
mortality, thrombosis and bleeding in patients undergoing TAVR.
<br/>Method(s): We systematically searched EMBASE, MEDLINE and CENTRAL
from January 1, 2002 until February 9, 2021 for randomized trials
comparing DAPT to SAPT after TAVR. Two reviewers independently screened
titles and abstracts, and then the full text of potentially relevant
articles in duplicate. Data abstraction and risk of bias was also
performed in duplicate. Risk ratios and 95% confidence intervals were
pooled using the Mantel-Haenzel method and random effects modelling. We
assessed the certainty of the evidence for each outcome using the Grading
of Recommendations, Assessments, Development and Evaluation (GRADE)
approach. <br/>Result(s): We included 4 randomized controlled trials of
1086 patients. Risk of bias was low or somewhat concerning for all
studies. We found no difference in mortality (risk ratio (RR) 1.02, 95%
confidence interval (CI), 0.63 to 1.63) or stroke (RR 1.03, 95% CI
0.57-1.84), but a significant increase in major bleeding (RR 2.04, 95% CI,
1.31-3.19), with DAPT compared to SAPT. There were too few events to
conduct meta-analysis for clinical valve thrombosis, subclinical valve
thrombosis, transvalvular gradients on echocardiography, or aortic valve
reintervention. The certainty of the evidence was low or very low due to
risk of bias, inconsistency, and imprecision. <br/>Conclusion(s): There is
very low certainty evidence that DAPT has little to no effect compared to
SAPT on mortality and stroke. There is low certainty evidence that DAPT
likely causes more major bleeding than SAPT.

<112>
Accession Number
641006147
Title
Midodrine in treatment of post coronary revascularization vasoplagia;
pilot, open label, assessor blinded randomized clinical trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1098), 2022. Date of Publication: September 2022.
Author
Sheikhy A.; Ziaoddini M.; Navid H.; Ahmadi-Tafti H.; Hosseini K.
Institution
(Sheikhy, Ziaoddini, Navid, Ahmadi-Tafti, Hosseini) Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
European Respiratory Society
Abstract
Purpose: Post cardiac surgery hypotension and inotrope dependence are
among major causes of prolonged intensive care unit (ICU) stay. Besides
routine managements, catecholamine inotrope-vasopressors are the
traditional treatment. However, there is an increasing interest to
catecholaminesparing agents, such as Midodrine, oral alfa1 agonist, in
patients with vasoplegia. Up to now there are no randomized study with
midodrine on post cardiac surgery patients. <br/>Material(s) and
Method(s): In this pilot, open label, assessor blind, randomized clinical
trial from June 2020 to December 2021, 65 patients with refractory (more
than 24 hours inotropes) hypotension after coronary revascularization were
included. Patients were randomly assigned to receive Midodrine add-on
therapy (10 mg stat and 5 mg po every 12 hours) or placebo addon routine
treatment. The primary outcome was liberation time from IV
inotrope-support. Secondary outcomes were ICU admission time and total
vasopressor dosage after randomization. <br/>Result(s): 32 patients
enrolled in Midodrine group, with a mean age of 60.72, and 33 patients
received placebo with mean age of 63.27. Median liberation time from
inotrope was 27 hours in Midodrine group and 49 hours in placebo group
(p=0.022). ICU admission time for Midodrine and placebo groups were 115
and 121 hours, respectively (p=0.990). Total vasopressor dosage after
randomization were similar in two studied groups, 4352 mug in Midodrine
group and 5637 mug in placebo group (p=0.405). No adverse event was
observed in Midodrine group. <br/>Conclusion(s): Midodrine add-on inotrope
therapy was a safe medication with appropriate compliance in ICU admitted
patients after cardiac surgery, which seems to decrease the inotrope
dependent time.

<113>
Accession Number
641006070
Title
Clinical impact of peri-device leaks following percutaneous left atrial
appendage occlusion: A systematic review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2135), 2022. Date of Publication: September 2022.
Author
Samaras A.; Papazoglou A.; Balomenakis C.; Bekiaridou A.; Moysidis D.;
Patsiou V.; Orfanidis A.; Feidakis A.; Giannakoulas G.; Tzikas A.
Institution
(Samaras, Papazoglou, Balomenakis, Bekiaridou, Moysidis, Patsiou,
Orfanidis, Feidakis, Giannakoulas, Tzikas) Ahepa University Hospital,
Cardiology Department, Thessaloniki, Greece
Publisher
European Respiratory Society
Abstract
Background: Peri-device leaks (PDL) are quite common after left-atrial
appendage occlusion (LAAO) given the complex anatomy of LAA and
surrounding structures. However, there is uncertainty regarding the
prognostic implications of PDL. <br/>Material(s) and Method(s): Literature
search was conducted in MEDLINE (PubMed), EMBASE, Scopus by ELSEVIER and
Cochrane Central Register of Controlled Trials (CENTRAL) databases until
12 October 2021. A random-effects meta-analysis was performed to assess
the effect of PDL presence on thromboembolism, all-cause mortality and
major bleeding occurrence. Sensitivity analyses accounted for: I. the
combined AF ablation performance, ii. the anticoagulation strategy
followed after LAAO, iii. mean PDL size, and iv. mean female percentage.
<br/>Result(s): Of 699 articles initially retrieved, 46 were deemed
eligible for this analysis (9,184 AF patients undergoing LAAO out of whom
1,446 had PDL). PDL presence was significantly associated with elevated
odds of thromboembolism (FIgure 1) [pooled odds ratio (pOR) 3.05, 95%
confidence interval (CI) 1.94-4.81; I²=37%]; yet PDL was not
significantly linked with mortality (pOR=0.86, 95% CI: 0.25-2.95;
I²=69%) and major bleeding rates (0.95, 95% CI: 0.27-3.35;
I²=72%). AF-ablation did not significantly interact with the
prognostic impact of PDL when performed in conjunction with LAAO (p for
subgroup= 0.17). Antiplatelet discharge medication affected the prognostic
value of PDL (p for subgroup <0.01 and =0.04, respectively). The
prognostic significance of mean PDL size [periprocedural or at 1-3 months
or D(mean size)/D(time of follow-up)] on the risk of thromboembolism did
not yield any significant association (p values >0.05). Meta-regression
analysis of the mean female percentage demonstrated a non-significant
trend towards a positive linear correlation between female percentage and
risk of thromboembolism (p=0.10) (FIgure 2). <br/>Conclusion(s): This is
the first meta-analysis on the prognostic impact of PDL after LAAO. The
findings highlighted a significant association between PDL and
thromboembolic events, warranting careful post-LAAO device surveillance.
(Figure Presented).

<114>
Accession Number
641006048
Title
Prognostic value of left ventricular global longitudinal strain in
patients with severe aortic stenosis for transcatheter aortic valve
implantation-related morbidity and mortality: A meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2085), 2022. Date of Publication: September 2022.
Author
Stens N.A.; Van Iersel O.; Rooijakkers M.J.P.; Van Wely M.H.; Nijveldt R.;
Bakker E.A.; Van Royen N.; Thijssen D.H.J.
Institution
(Stens, Van Iersel, Rooijakkers, Van Wely, Nijveldt, Bakker, Van Royen,
Thijssen) Radboud University Medical Centre, Nijmegen, Netherlands
Publisher
European Respiratory Society
Abstract
Aims: Current methods, including left ventricular ejection fraction
(LVEF), demonstrate limited prognostic value for post-Transcatheter Aortic
Valve Implantation (TAVI) outcomes. Studies elaborating on LV global
longitudinal strain (GLS) showed promising results, but are often
underpowered. <br/>Purpose(s): This meta-analysis aims to evaluate the
prognostic value of preprocedural global longitudinal strain (GLS) for
post-TAVI mortality and morbidity. <br/>Method(s): A systematic search was
conducted in PubMed, Embase and Web of Science from 2001 to 2021. All
studies that comprised patients with severe aortic stenosis who underwent
TAVI and investigated the association between preprocedural
speckle-tracking-derived GLS and clinical outcomes, were included. An
inversely-weighted random effects metaanalysis was adopted to investigate
the association between preprocedural GLS vs primary (i.e. all-cause
mortality) and secondary (i.e. major cardiovascular events [MACE])
post-TAVI outcomes. <br/>Result(s): Of the 1,057 identified records, 12
were eligible, all of which had a low-to-moderate risk of bias
(Newcastle-Ottawa scale). On average, the 2,068 unique patients
demonstrated preserved ejection fraction but impaired longitudinal
function (mean LVEF 52.2+/-4.4%, GLS -13.5+/-1.6%). Patients with a lower
GLS had a higher all-cause mortality (pooled hazard ratio (HR) 1.99 [95%
confidence interval (CI): 1.59, 2.50]) and MACE (1.26 [95% CI: 1.08,
1.46]) risk compared to patients with higher GLS. In addition, each 1%
decrease of GLS was associated with an increased postprocedural mortality
(HR 1.06 [95% CI: 1.03, 1.08]) and MACE risk (pooled HR 1.08 [95% CI:
1.01, 1.15]). <br/>Conclusion(s): Preprocedural GLS was significantly
associated with post- TAVI mortality and morbidity. This suggests a
potential clinically important role of pre-TAVI evaluation of GLS for risk
stratification of patients with severe aortic stenosis. (Figure
Presented).

<115>
Accession Number
641005855
Title
Impact of left ventricular ejection fraction on 10-year mortality after
percutaneous coronary intervention or coronary artery bypass grafting.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2033), 2022. Date of Publication: September 2022.
Author
Masuda S.; Ninomiya K.; Kageyama S.; Kotoku N.; Mack M.J.; Kappetein A.P.;
Morice M.C.; Onuma Y.; Serruys P.W.
Institution
(Masuda, Ninomiya, Kageyama, Kotoku, Onuma, Serruys) National University
of Ireland, Galway, Ireland
(Mack) Baylor University Medical Center, Dallas, United States
(Kappetein) Erasmus University Rotterdam, Rotterdam, Netherlands
(Morice) Jacques Cartier Private Hospital, Massy, France
Publisher
European Respiratory Society
Abstract
Backgrounds: The impact on vital prognosis at very long-term of
percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) in patients with reduced ejection fraction (EF) remains to
be elucidated. <br/>Objective(s): To investigate the impact of left
ventricular ejection fraction (LVEF) on 10-year mortality after PCI and
CABG in the SYNTAX trial. <br/>Method(s): In the SYNTAXES study, 1,800
randomized patients were categorized into three groups according to the
current guidelines; (1) reduced EF (rEF; LVEF <=40%), (2) mildly reduced
EF (mrEF; LVEF 41-49%), (3) preserved EF (pEF; LVEF >=50%). The primary
endpoint was 10-year allcause mortality. Event rate up to 10 years was
estimated according to the Kaplan-Meier method, and the log-rank test was
performed to examine the differences among LVEF subgroups. The SYNTAX
score 2020 (SS-2020) was compared between the patients with reduced (LVEF
<50%) and preserved EF (LVEF >=50%) in order to better refine their
respective personalized vital prognosis and assess in cross-validation the
value of the risk score. <br/>Result(s): The population was stratified as
rEF (n=168), mrEF (n=179), and pEF (n=1453). Ten-year all-cause mortality
were 44.0% vs. 31.8% vs. 22.6% (P<0.001), in patients with rEF, mrEF and
pEF, respectively. The significant interaction was not identified between
LVEF classification and treatment (P interaction = 0.183). In patients
with rEF, there was a tendency toward higher mortality in PCI group than
CABG (52.9% vs 39.6%, P=0.054), and no significant differences in patients
with mrEF (36.0% vs. 28.6%, P=0.273) and pEF (23.9% vs. 22.2%, P=0.275).
According to the SS-2020, PCI was a relatively safe modality of
revascularization in 37.8% of the patients with reduced EF (LVEF <50%). In
the population with preserved EF (LVEF >=50%), the proportion of patients
eligible to PCI with predicted equipoise in mortality with CABG was 57.5%.
<br/>Conclusion(s): LVEF could an important factor for determining the
revascularization treatment in patients presenting with complex coronary
artery disease. Calculation of individualized 10-year prognosis using the
SS-2020 may be a viable option in decision-making. (Figure Presented).

<116>
Accession Number
641005794
Title
Association of late gadolinium enhancement in cardiac magnetic resonance
with heart failure outcomes in patients with non-ischemic cardiomyopathy.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
286), 2022. Date of Publication: September 2022.
Author
Tao M.; Al-Sadawi M.; Aslam F.; Mann N.; Goldschmidt M.; Tam E.
Institution
(Tao, Al-Sadawi, Aslam, Mann, Goldschmidt, Tam) Stony Brook University
Hospital, Stony Brook, United States
Publisher
European Respiratory Society
Abstract
Background: Late-gadolinium enhancement (LGE) in cardiac magnetic
resonance (CMR) has been found to be associated with increased mortality
in patients with non-ischemic cardiomyopathy (NICM). The correlation
between LGE and heart failure (HF) hospitalization, referral for heart
transplant, and ejection fraction (EF) improvement have not been well
established. <br/>Purpose(s): This meta-analysis assessed the relationship
between LGE in CMR with HF hospitalization, referral for heart transplant
and EF improvement in patients with NICM. <br/>Method(s): We searched the
databases for studies reporting the association between LGE in CMR for
NICM and HF outcomes including Ovid MEDLINE, EMBASE, Web of Science, and
Google Scholar for all studies. The search was not restricted to time or
publication status. The minimal follow up duration is one year.
<br/>Result(s): A total of 216 studies resulted from the literature
search. A total of 25 studies and 3,039 patients (1,265 with LGE vs 1,774
without LGE) were included; mean follow up is around 33 months (ranging
between 13 to 71 months). Our analysis demonstrated that LGE in NICM was
associated with increased risk of HF hospitalization (odds ratio 3.38, 95%
confidence interval 2.27-5.04; P<0.01), referral for transplant (odds
ratio 5.08, 95% confidence interval 2.49-10.35; P<0.01), and lower chance
for EF improvement (odds ratio 0.16, 95% confidence interval 0.03-0.85; P
0.03). Heterogeneity is moderate: chi2=49.5, df=21 (P=0.001),
I²=57%. (Figures 1 and 2) <br/>Conclusion(s): Our results
suggest that LGE is associated with increased risk of HF hospitalization
and referral for heart transplant and lower chance for EF improvement in
long-term follow up.

<117>
Accession Number
641005729
Title
The influence of rivaroxaban compared to vitamin K antagonist treatment
upon development of cardiovascular calcification the IRIVASC-trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
185), 2022. Date of Publication: September 2022.
Author
Stoehr R.; Marx N.; Schuh A.; Brandenburg V.
Institution
(Stoehr, Marx) RWTH University Hospital Aachen, Internal Medicine I,
Cardiology, Pulmonology and Vascular Medicine, Aachen, Germany
(Schuh) St Katharinen KH, Innere I, Frechen, Germany
(Brandenburg) Rhein-Maas Clinic, Wurselen, Germany
Publisher
European Respiratory Society
Abstract
Vitamin K antagonists (VKA) such as warfarin or phenprocoumon are the
mainstay of therapy for patients with several specific indications for
longterm oral anticoagulant therapy (OAT). Due to interferences with
Matrix-Gla protein, an important vitamin K-dependent local calcification
inhibitor in cardiovascular structures, VKAs are theoretically linked to
the development of increased cardiovascular calcification (CVC). The
IRIVASC trial was a multi-center, prospective, controlled, open,
randomized, interventional clinical trial and included 192 patients with
atrial fibrillation or pulmonary embolism and an indication for oral
anticoagulation >12 months. In short, patients with an indication for OAT
were randomized to receive either Rivaroxaban (n=96) or VKA (n=96) and
followed up over 12 months. MultiSlice CT (MSCT) was performed at baseline
and after 12-month follow up. The primary endpoint of the study was the
progression of coronary artery and aortic valve (AV) calcification, as
determined by MSCT (volume score). Baseline demographic and laboratory
values were comparable between the VKA and the Rivaroxaban groups (median
age 72 vs 68, 73.6 vs 69.9 male). The main indication for anticoagulation
was AF (95.4% vs 96.6%) After 12-month follow-up complete data sets were
available for 164 patients (86%) for coronary calcification and 67
patients for valvular calcification (per protocol analysis). Overall, we
found no differences in the primary endpoints. Development of coronary
artery calcification was similar within the 2 groups as evidenced by
similar developments of the coronary agatston score (804.8+/-1062.3 vs
946.7+/-1024.4, p=0.38), the coronary volume score (571.9+/-855.6 ml vs
791.7+/-820.1 ml, p=0.359) and the coronary mass score (143.2+/-195.9 mg
vs. 172.2+/-190.8 mg, p=0.335) after 12 month. Similarly, there was no
difference in the development of aortic valve calcification (AV) (AV
Agatston score 441.6+/-711.9 vs. 352.6+/-751.2, p=0.621. AV volume score
388.2+/-589.0 ml vs 354.3+/-654.3, ml p=0.824 and AV Mass Score
75.7+/-135.1 mg vs 60.2+/-122.9, p=0.626 mg) (Table 1). To our knowledge
this is the first multicenter prospective, randomized trial to ever
investigate the effects of VKA vs rivaroxaban treatment regarding the
development of coronary and valvular calcification. Our findings are
clinically relevant as VKA will remain the mainstay of treatment for
several conditions including mechanical valve replacement or
antiphospholipid syndrome and hence include patients at cardiovascular
risk. Our data point towards a comparable risk of overt CVC progression as
detectable by CT-scans in patients irrespective of VKA or NOAK treatment.

<118>
Accession Number
641005706
Title
Systolic blood pressure time in range and long-term clinical outcomes in
patients with ischaemic cardiomyopathy.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
838), 2022. Date of Publication: September 2022.
Author
Zhou Z.; Fu G.; Jian B.; Liang M.; Chen G.; Wu Z.
Institution
(Zhou, Fu, Jian, Liang, Chen, Wu) First Affiliated Hospital of Sun Yat-sen
University, Department of Cardiac Surgery, Guangzhou, China
Publisher
European Respiratory Society
Abstract
Background: The relationship between systolic blood pressure (SBP) control
and long-term clinical outcomes in patients with ischaemic cardiomyopathy
remains unclear. It has been previously reported that either too high or
too low SBP may lead to a poorer prognosis. But current SBP control
metrics may not take into account the possible effects of fluctuating SBP
overtime on patients. <br/>Purpose(s): This study aimed to estimate the
association between time in range (TIR) of SBP and long-term clinical
outcomes in patients with ischaemic cardiomyopathy. <br/>Method(s): This
study was a post-hoc analysis of The Surgical Treatment of Ischaemic Heart
Failure (STICH) trial, a randomized controlled trial with two hypotheses
that enrolled participants with coronary artery disease and left
ventricular ejection fraction <=35%. The SBP target range of the TIR was
defined as 110 to 130 mmHg and the SBP TIR was calculated by linear
interpolation method. Patients were equally divided into four groups by
quartiles of TIR. Multivariable-adjusted Cox proportional hazards
regression models were constructed to compare the effects of different
levels of TIR on a 10-year prognosis. The primary outcome was all-cause
mortality. Subgroup analyses were performed according to whether patients
were assigned to coronary artery bypass grafting (CABG) or medical therapy
(MED), and in populations with different baseline SBP. <br/>Result(s): A
total of 1194 eligible patients were included according to the purpose of
our study. Compared with patients in the quartile 4 group (TIR
77.87-100%), the fully adjusted hazard ratios (aHRs) and 95% confidence
intervals (CIs) of all-cause mortality were 1.32 (0.98-1.78) for quartile
3 group (TIR 54.81-77.63%), 1.40 (1.03-1.90) for quartile 2 group (TIR
32.59-54.67%), and 1.53 (1.14-2.04) for quartile 1 group (TIR 0-32.56%) (P
for trend = 0.005). When evaluated TIR as a continuous variable, per 1-SD
decrement (29.28%) in TIR significantly increased the incidence of
all-cause mortality [1.15 (1.04-1.26)]. Similarly, the decrement in TIR
significantly elevated the risk of cardiovascular (CV) mortality and the
risk of all-cause mortality plus CV rehospitalization. Consistent results
were also observed in subgroup analyses of either CABG or MED, or
different baseline SBP, indicating the robustness of our findings.
<br/>Conclusion(s): This study suggested that in patients with ischaemic
cardiomyopathy, a higher SBP TIR was significantly associated with a
decreased risk of all-cause mortality, CV mortality and the composite of
allcause mortality plus CV rehospitalization, regardless of whether the
patient received CABG or MED, and the level of baseline SBP. Our findings
support that TIR might be a substitutable metric of SBP control for
long-term clinical outcomes in patients with ischaemic cardiomyopathy.

<119>
Accession Number
641005652
Title
Severe early-onset cardiomyopathy and poor prognosis observed in 73
patients with pathogenic KLHL24 variants.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
887), 2022. Date of Publication: September 2022.
Author
Vermeer M.; Arevalo Gomez K.F.; Hoes M.F.; Tromp J.; Verdonschot J.A.J.;
Henkens M.T.H.M.; Sillje H.H.W.; Bolling M.C.; Van Der Meer P.
Institution
(Vermeer, Arevalo Gomez, Sillje, Van Der Meer) University Medical Center
Groningen, Department of Cardiology, Groningen, Netherlands
(Hoes, Henkens) Maastricht University Medical Centre (MUMC), Cardiology,
Maastricht, Netherlands
(Tromp) Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
(Verdonschot) Maastricht University Medical Centre (MUMC), Clinical
Genetics, Maastricht, Netherlands
(Bolling) University Medical Center Groningen, Department of Dermatology,
Groningen, Netherlands
Publisher
European Respiratory Society
Abstract
Background/Introduction: Pathogenic variants in KLHL24 might cause skin
fragility or cardiomyopathy. KLHL24 controls desmin turnover and patients
with heterozygous gain-of-function variants (HET-GOF; i.e. overactivity),
typically born with epidermolysis bullosa simplex (EBS), can develop
dilated cardiomyopathy (DCM), whereas patients with homozygous
lossof-function variants (HOM-LOF) can develop hypertrophic cardiomyopathy
(HCM). <br/>Purpose(s): This study aims to characterize the cardiac
phenotype and prognosis of patients with pathogenic KLHL24 variants.
<br/>Method(s): Observational studies on KLHL24 found in PUBMED were
included in this analysis. Patients were stratified according to their
genotype and the study outcomes were cardiomyopathy diagnosis and
cardiovascular (CV) events. CV events were defined as sudden cardiac death
(SCD), death from heart failure (HF) or heart transplantation (HTx).
Kaplan-Meier (KM) curves were constructed to visualize the age at
diagnosis and CV event free-survival. For the HET-GOF group, this analysis
was stratified by sex and log-rank testing was used to test for
significant differences in the distribution. To achieve between group
balance, the sex-stratified KM curves were weighted for age and cohort.
<br/>Result(s): In total, 73 patients from 14 studies were included in
this analysis and Figure 1A shows their geographic distribution. In
general, patients have a median age [IQR] of 18 [7-33]), 53% were men, 38%
were diagnosed with cardiomyopathy, and 84% were patients with HETGOF
variants. Patients with HOM-LOF variants have a median age of 27 [26-31]
and 55% is male (Figure 1B). HOM-LOF variants c.917G>A [p.(Arg306His)] and
c.1048G>T [p.(Glu350*)] segregated in 2 Middle Eastern families, reporting
11 patients born from seemingly unaffected consanguineous heterozygous
parents. All HOM-LOF patients were diagnosed with HCM before the age of 32
(27, [26-31]; Figure 1C), resulting in 4 CV events (SCD n=3; HTx n=1;
Figure 1D). Patients with HET-GOF variants have a median age of 14 [6-33]
and 53% were men (Figure 1B). HETGOF variants c.1A>G, c.1A>T, c.2T>C,
c.3G>T, c.3G>A and c.22A>T [p.(Val2-Met29)] segregated with disease in 34
families, reporting 62 patients in 14 countries. All patients with HET-GOF
had EBS at birth and 27% was diagnosed with DCM. The probability of
diagnosis during lifetime was significantly different (p<0.001, weighted
p<0.001) between men (25 [16- 34], n=9) and women (45 [31-47], n=8; Figure
1E). In total, 7 CV events (SCD n=1; HF n=4; HTx n=2) were reported for
patients with HET-GOF variants. Figure 1F shows the general differences in
CV events between sexes (p=0.026, weighted p=0.073). The median age of CV
events for men was 20 (n=4) and 54 for women (n=3). <br/>Conclusion(s):
Patients with HOM-LOF variants were diagnosed at an early age with a
severe form of HCM. Men with HET-GOF variants were diagnosed with DCM
earlier than women. Men also have a higher probability for CV events at a
younger age than women.

<120>
Accession Number
641005651
Title
Geographic disparity in 10-year mortality after coronary artery
revascularization in the SYNTAXES trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2030), 2022. Date of Publication: September 2022.
Author
Kageyama S.; Serruys P.W.; Masuda S.; Ninomiya K.; Kotoku N.; Onuma Y.
Institution
(Kageyama, Serruys, Masuda, Ninomiya, Kotoku, Onuma) National University
of Ireland Galway, Galway, Ireland
Publisher
European Respiratory Society
Abstract
Aims: To investigate geographic disparity in long-term mortality following
revascularization in patients with complex coronary artery disease (CAD).
<br/>Methods and Results: The SYNTAXES trial randomized 1800 patients with
three-vessel and/or left main CAD to percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) and assessed their
survival at 10-years. Patients were stratified according to the region of
recruitment: North America (N-A, n=245), Eastern Europe (E-E: Poland,
Hungary, Czech, n=189), Northern Europe (N-E: United Kingdom, Sweden,
Norway, Latvia, Finland, and Denmark, n=425), Southern Europe (S-E: Spain,
Portugal, and Italy, n=263), andWestern Europe (W-E: Netherlands, Germany,
France, Belgium, and Austria, n=678), which also served as the reference
group. Compared to W-E, patients were younger in E-E (62 vs 65 years,
p<0.001), and less frequently male in N-A (65.3% vs 79.6%, p<0.001).
Diabetes (16.0% vs 25.4%, p<0.001) and peripheral vascular disease (6.8%
vs 10.9%, p=0.025) were less frequent in N-E than W-E. Ejection fraction
was highest in W-E (62% vs 56%, p<0.001). Compared to W-E, the mean
anatomic SYNTAX score was higher in S-E (29 vs 31, p=0.008) and lower in
N-A (26, p<0.001). Crude ten-year mortality was similar in N-A (31.6%),
and W-E (30.7%), and significantly lower in E-E (22.5%, p=0.041), N-E
(21.9%, p=0.003) and S-E (22.0%, p=0.014) as presented in left-middle
lower of the graphical abstract.We adjusted the survival curves by
following factors based on previous report; age, sex, medically treated
diabetes, current smokers, peripheral vascular disease, chronic
obstructive pulmonary disease, chronic kidney disease, left ventricular
ejection fraction, disease type, and anatomical SYNTAX score [1]. When the
differences in baseline characteristics were adjusted, mortality was still
significantly lower in NE (HR 0.85, 95% CI [0.74-0.97], p=0.019) and
trended lower in S-E (HR 0.72 95% CI [0.52-0.99] p=0.043) compared to W-E
(right middle-lower of the graphical abstract). However, no significant
interaction (P interaction = 0.728) between region and modality of
revascularization was seen. Discussion and conclusions: The main findings
of this study are: 1. Rates of crude 10-year mortality were significantly
lower in E-E, N-E, and S-E compared to W-E and N-A. 2. The differences in
10-year mortality remained significantly lower with N-E and S-E even after
adjustment for confounding factors. 3. However, when comparing PCI to CABG
in the five geographic regions, there were no statistically significant
interactions between the geographic disparity in pre- and peri-procedural
characteristics and all-cause mortality. In the era of globalization,
knowledge and understanding of geographic disparity are of paramount
importance for the correct interpretation of global studies. (Figure
Presented).

<121>
Accession Number
641005591
Title
Quantitative angiographic assessment of aortic regurgitation post 11
different types of TAVI devices a multicentre pooled analysis of 2665
valves.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2078), 2022. Date of Publication: September 2022.
Author
Abdelshafy M.; Soliman O.; Kim W.; Ruck A.; Elkoumy A.; Elzomor H.; Wang
R.; Tao L.; Garg S.; Mylotte D.; Onuma Y.; Serruys P.
Institution
(Abdelshafy, Soliman, Elkoumy, Elzomor, Mylotte, Onuma, Serruys) National
University of Ireland, Galway, Ireland
(Kim) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Ruck) Karolinska Institute, Stockholm, Sweden
(Wang, Tao) Xijing Hospital of the Fourth Military Medical University,
Xi'an, China
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: Regurgitation following TAVR impacts all-cause mortality. So
far, no quantitative comparison of regurgitation by the same core lab has
been performed among the various commercially available transcatheter
heart valves (THV) We aimed to compare quantitative angiographic aortic
regurgitation (AR) of 11 different types of THVs. <br/>Method(s): This is
a multicentre retrospective corelab pooled analysis of aortograms from
2704 consecutive patients treated with 11 different THV devices. Analysis
was done by quantitative videodensitometric aortography (LVOT-AR), which
is an objective, accurate, and reproducible tool for assessment of AR
following TAVR. This method relies on time density changes in contrast
medium after injection in the ascending aorta and its regurgitation (and
subsequent density increase) in the LVOT. The ratio between the areas
under the two-time density curves of these regions quantifies the AR in
absolute percentage. The valves evaluated include ACURATE neo2 (n=120),
Lotus (n=546), Myval (n=108), VitaFlow (n=105), Evolut PRO (n=95), SAPIEN
3 (n=397), Evolut R (n=295), SAPIEN XT (n=239), ACURATE neo (n=120),
Venus-A (n=113) and CoreValve (n=532). Stratification of continuous
variable regurgitation into categorical variables was performed according
to the following pre-determined threshold criteria: 1) none/trace
regurgitation (LVOT-AR<6%); 2) mild (6%<= LVOT-AR <=17%); and 3) moderate
or severe (LVOT-AR >17%). <br/>Result(s): The addition of anti PVR sealing
features to the new generations ACURATE neo2 THV proved to be effective in
reduction the incidence of significant PVR In comparison with the first
generation ACURATE neo. Myval, VitaFlow and Venus-A THVs are showing
promising results. Although the incidence of moderate/severe AR has
regressed over time with new generations of THVs, the incidence of mild AR
is still prominent with all THVs still exhibiting mild AR with an
incidence ranging between 30% and 50% with the exception of the Lotus
valve that had an 19% incidence of mild AR <br/>Conclusion(s): ACURATE
neo2 had the lowest severe/moderate percentage of AR showing significant
improvements in comparison to ACURATE neo. Myval, VitaFlow and Venus-A are
promising options in the THV armamentarium. These results should be
confirmed in prospective randomized, head-to-head comparisons between
THVs. (Figure Presented).

<122>
Accession Number
641005405
Title
Left atrial appendage occlusion versus standard of care in patients with
atrial fibrillation and a prior thrombo-embolic event despite oral
anticoagulant therapy: A propensity score matched comparison.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
632), 2022. Date of Publication: September 2022.
Author
Maarse M.; Seiffge D.; Fierro N.; Tondo C.; Pracon R.; De Backer O.;
Nielsen-Kudsk J.; Estevez-Loureiro R.; Benito-Gonzalez T.; Nombela-Franco
L.; Arzamendi D.; Alla V.; Swaans M.; Werring D.; Boersma L.
Institution
(Maarse, Swaans, Boersma) St Antonius Hospital, Nieuwegein, Netherlands
(Seiffge) Bern University Hospital, Inselspital, Neurology, Bern,
Switzerland
(Fierro) San Raffaele Hospital, Cardiology, Milan, Italy
(Tondo) Centro cardiologico Monzino, Cardiology, Milan, Italy
(Pracon) National Institute of Cardiology, Cardiology, Warsaw, Poland
(De Backer) Rigshospitalet - Copenhagen University Hospital, Cardiology,
Copenhagen, Denmark
(Nielsen-Kudsk) Aarhus University Hospital, Cardiology, Aarhus, Denmark
(Estevez-Loureiro) University Hospital Complex of Vigo, Cardiology, Vigo,
Spain
(Benito-Gonzalez) Leon Hospital (University Assistance Complex of Leon),
Cardiology, Leon, Spain
(Nombela-Franco) Hospital Clinico San Carlos, Cardiology, Madrid, Spain
(Arzamendi) Centro Medico Teknon, Cardiology, Barcelona, Spain
(Alla) Creighton University Medical Centre, Cardiology, Omaha, United
States
(Werring) University College London, Neurology, London, United Kingdom
Publisher
European Respiratory Society
Abstract
Introduction: Patients with atrial fibrillation (AF) that suffer from
ischemic stroke despite oral anticoagulant (OAC) therapy have a very high
risk of recurrent stroke and better prevention strategies are needed. Left
atrial appendage occlusion (LAAO) is a promising secondary prevention
strategy that may provide mechanical protection in patients that suffer
from thrombo-embolic events under OAC. However, evidence showing
effectiveness of LAAO in this population is scarce and the current
international guidelines only consider LAAO in patients with a
contra-indication for OAC. <br/>Purpose(s): To compare percutaneous LAAO
to standard-of-care including continuing/switching anticoagulation therapy
for secondary stroke prevention in patients with AF and a prior
thrombo-embolic event and/or LAA thrombus under OAC therapy.
<br/>Method(s): The STR-OAC LAAO cohort is an international collaboration
combining a selection of patients from multiple LAAO registries (22
participating centers). Patients that underwent percutaneous LAAO because
of a thrombo-embolic event and/or LAA thrombus on OAC were included.
Propensity score matching (optimal matching method, 1:1 ratio) with a
previously published multi-center dataset of patients continuing/switching
anticoagulation treatment after a thrombo-embolic event was performed to
adjust for imbalances in age, sex, hypertension, diabetes mellitus and
CHA2DS2-VASc score. The primary outcome was ischemic stroke. Time-to-event
analysis was performed with Kaplan-Meier curves and Coxproportional-
hazard regression analyses. <br/>Result(s): A total of 404 patients
underwent LAAO between 2010-2021 and were included in the STR-OAC LAAO
cohort. Mean age was 72+/-9 years; 44% was female and mean CHA2DS2-VASc
and HAS-BLED score were 4.8+/-1.7 and 2.5+/-1.4, respectively. Most
patients received a Watchman or Amplatzer device (53% and 43%). Oral
anticoagulation was discontinued after LAAO at discharge or after
confirmation of adequate LAA closure at 1-3 months follow-up in 44% or
20%, respectively. The remaining 35% of patients continued OAC after LAAO
as an adjunctive strategy. All LAAO patients were propensity-score matched
and included in the primary outcome analysis. Baseline characteristics
were well balanced after matching (Table 1). During follow up including
1406 patient-years (LAAO 1007; control 399) a total of 61 patients
experienced an ischemic stroke: 2.2% per patient-year in LAAO group versus
9.8% per patient-year in the control group. LAAO was associated with a
significantly lower risk of ischemic stroke (HR 0.33, 95% CI [0.19-0.59],
p<0.001) compared to standard-of-care (Figure 1). <br/>Conclusion(s): In
this propensity-score matched study, LAAO was associated with a lower risk
of ischemic stroke compared to standard-of-care in patients with a
thrombo-embolic event and/or LAA thrombus despite OAC treatment.
Randomized controlled trial data may further confirm the effectiveness of
LAAO in this very high-risk population.

<123>
Accession Number
641005297
Title
Perioperative rosuvastatin therapy increases creatine kinase and the risk
of acute kidney injury in patients undergoing cardiac surgery.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2675), 2022. Date of Publication: September 2022.
Author
Wijesurendra R.; Sardell R.; Hill M.; Jayaram R.; Samuel N.; Staplin N.;
Emberson J.; Collins R.; Zheng Z.; Haynes R.; Casadei B.
Institution
(Wijesurendra, Sardell, Hill, Samuel, Staplin, Emberson, Collins, Haynes)
University of Oxford, Nuffield Department of Population Health, Oxford,
United Kingdom
(Jayaram, Casadei) University of Oxford, Division of Cardiovascular
Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
(Zheng) Fuwai Hospital, Beijing, China
Publisher
European Respiratory Society
Abstract
Introduction: In patients undergoing cardiac surgery, perioperative statin
therapy does not prevent atrial fibrillation or myocardial injury, but
results in increased creatinine levels after surgery. Here we investigated
the incidence of acute kidney injury (AKI) in 1922 patients scheduled for
elective cardiac surgery who were randomized to perioperative rosuvastatin
(20 mg once daily) or placebo in the Statin Therapy In Cardiac Surgery
(STICS) trial. <br/>Method(s): AKI post-surgery was defined according to
international guidelines using plasma creatinine. Biomarkers related to
kidney function, muscle injury and inflammation were investigated,
including cystatin C, total creatine kinase (CK), troponin I, growth
differentiation factor 15 (GDF-15), interleukin-6 (IL-6), procalcitonin,
and placental growth factor (PGF). <br/>Result(s): At 48 hours
post-surgery, AKI was significantly more common in patients allocated to
rosuvastatin compared to placebo when defined by creatinine (24.7% vs
19.3%; OR 1.37 [95% CI 1.10-1.70]; p=0.005; Figure 1A) or by cystatin C
(9.2% vs 5.1%; OR 1.86 [95% CI 1.29-2.67]; p<0.001; Figure 1B). Elevations
in CK to >10x and >40x baseline level were also more frequent in
rosuvastatin-allocated patients compared to placebo (30.9% vs 26.5%,
p=0.02, and 2.1% vs 0.7%, p=0.02, respectively; Figure 1C). Post-operative
concentrations of troponin I, GDF-15, IL-6, procalcitonin, and PGF were
similar between the groups (Table 1). <br/>Conclusion(s): Perioperative
rosuvastatin initiation increased the absolute risk of AKI after cardiac
surgery by 4-5%. Rosuvastatin also led to greater elevations in
post-operative creatine kinase, but did not affect other biomarkers of
tissue injury, inflammation, and myocardial injury. Further research is
needed to delineate the underlying mechanism of AKI with perioperative
rosuvastatin. (Table Presented).

<124>
Accession Number
641005285
Title
Ventricular arrhythmias and sudden cardiac death caused by mitral valve
prolapse: Should we operate and when.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1647), 2022. Date of Publication: September 2022.
Author
Cameron J.; Sutherland N.; Han H.C.; Raman J.; Lim H.
Institution
(Cameron, Han) Austin Hospital, Cardiology, Melbourne, Australia
(Sutherland) Northern Health, Cardiology, Melbourne, Australia
(Raman, Lim) University of Melbourne, Medicine, Melbourne, Australia
Publisher
European Respiratory Society
Abstract
Background: Several autopsy and observational studies have investigated
the link between mitral valve prolapse (MVP) and sudden cardiac death
(SCD) due to the well accepted yet rare occurrence of complex ventricular
arrhythmia (VA) in this cohort. Few studies however have investigated
whether arrhythmia burden and more importantly SCD are reduced following
surgical correction of MVP. <br/>Purpose(s): To investigate the impact of
mitral valve surgery (MVS) (replacement or repair) on VA and SCD in
patients with MVP. <br/>Method(s): A systematic review of the current
literature was conducted using an electronic search of the PubMed database
in October 2021. Studies were included if subjects had undergone mitral
valve (MV) repair or replacement with documented rates of arrythmias/SCD
pre- and postintervention. Small patient numbers in individual reports
precluded formal meta-analysis and results were reported on a per study
basis. <br/>Result(s): 19 identified studies (10 cohort studies, nine case
studies) comprised 1322 patients with a pooled mean age of 63.4 years and
38.9% were female. 748 of the 1322 patients underwent MVS: 263 MV repair,
18 MV replacement (one with leaflet and papillary muscle excision), two MV
repair with Maze procedure, 177 percutaneous transcatheter MV repair, 45
annuloplasty with or without valve repair, and in 243 cases the surgical
method was not specified. Of the 10 included cohort studies, seven of the
eight which investigated rates of VA post MVS concluded there was a
significant reduction, while one reported the predisposition to arrythmia
persisted after relieving the abnormal mechanical effects of non-ischaemic
MR (75% due to MVP). One study reported a reduction in SCD post MVS. Each
of the nine included case studies showed a reduction in VA post MVS. One
study showed mitral annular disjunction (MAD) was independently associated
with a higher risk of arrhythmic events, this link persisting with time
dependent MVS although reduced compared to medical management.
<br/>Conclusion(s): The underlying mechanisms for VA and SCD associated
with MVP are not completely understood, and guidelines for the surgical
correction of MVP based on arrhythmic and SCD risk are lacking. This
systematic review illustrates a possible reduction in VA following MVS.
Further identification of patients at risk of SCD, and potential use of
risk stratification algorithms, would allow for consideration of earlier
management and appropriate use of implantable cardioverter-defibrillators
(ICD) placement / MVS with an expected survival benefit.

<125>
Accession Number
641005270
Title
Recurrent atherosclerotic cardiovascular disease events preventable with
guideline recommended lipid-lowering treatment following myocardial
infarction.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2374), 2022. Date of Publication: September 2022.
Author
Sakhuja S.; Bittner V.A.; Brown T.M.; Farkouh M.E.; Levitan E.B.; Rosenson
R.; Safford M.M.; Muntner P.; Chen L.; Sun R.; Noshad S.; Dhalwani N.;
Woodward M.; Colantonio L.D.
Institution
(Sakhuja, Levitan, Muntner, Chen, Sun, Colantonio) University of Alabama
Birmingham, School of Public Health, Birmingham, United States
(Bittner, Brown) University of Alabama Birmingham, Department of Medicine,
Division of Cardiovascular Disease, Birmingham, United States
(Farkouh) University of Toronto, Toronto, Canada
(Rosenson) Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New
York, United States
(Safford) Weill Cornell Medicine, New York, United States
(Noshad, Dhalwani) Amgen Inc., Thousand Oaks, United States
(Woodward) Imperial College London, George Institute for Global Health,
London, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: The 2018 American Heart Association/American College of
Cardiology (AHA/ACC) cholesterol guideline provides recommendations for
lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein
convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent
atherosclerotic cardiovascular disease (ASCVD) events in adults with
established ASCVD. Many adults with ASCVD who are recommended to take
statins, ezetimibe and/or PCSK9i do not receive these medications.
<br/>Purpose(s): To estimate the number of recurrent ASCVD events
potentially prevented by population-wide use of guideline recommended LLT
following a myocardial infarction (MI). <br/>Method(s): We simulated the
population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline
recommended LLT over 3 and 5 years among US adults with government health
insurance through Medicare or commercial health insurance following
hospital discharge for MI. We used data from patients with an MI
hospitalization in 2018-2019 to estimate the percentage receiving
guideline recommended LLT defined by having the medications available to
take in the 30 days after their discharge date. We used data from patients
with an MI hospitalization in 2013-2016 to estimate the 3 and 5-year
cumulative incidence of recurrent ASCVD events (i.e., MI, coronary
revascularization or ischemic stroke). The reduction in ASCVD events
associated with guideline recommended LLT was estimated from a
meta-analysis by the Cholesterol-Lowering Treatment Trialists
Collaboration. We conducted a sensitivity analysis estimating the number
and percentage of ASCVD events prevented if LLT recommendations from the
2019 European Society of Cardiology/European Atherosclerosis Society
(ESC/EAS) cholesterol guideline were followed. We repeated all analyses
with recurrent coronary heart disease (i.e., MI or coronary
revascularization) and ischemic stroke events as separate outcomes.
<br/>Result(s): Among 279,395 adults with an MI hospitalization in
2018-2019 (mean age 75 years, 54% men, mean low-density lipoprotein
cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With
current lipid-lowering medication use, we estimated that 70,698 (95% CI:
70,311- 71,077) and 89,255 (95% CI: 88,841-89,730) ASCVD events would
occur in 3 and 5 years, respectively, after MI hospital discharge (Table,
top panel). If all patients were to receive 2018 AHA/ACC guideline
recommended LLT, the number of ASCVD events was estimated to be reduced by
21.6%, representing 15,264 (95% CI: 14,451-16,679) events prevented over 3
years and 19,271 (95% CI: 18,245-21,055) events prevented over 5 years. A
higher number of recurrent ASCVD events were estimated to be averted
following the LLT recommendations of the 2019 ESC/EAS cholesterol
guideline (Table, bottom panel). <br/>Conclusion(s): Population-wide
implementation of guideline recommended LLT in adults with an MI
hospitalization could prevent a substantial number of recurrent ASCVD
events.

<126>
Accession Number
641005206
Title
Revascularization of significant coronary artery disease in patients
undergoing transcatheter aortic valve implantation: A systematic review
and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1597), 2022. Date of Publication: September 2022.
Author
Aarts H.; Van Hemert N.D.; Meijs T.A.; Van Nieuwkerk A.C.; Voskuil M.;
Delewi R.
Institution
(Aarts, Van Hemert, Meijs, Voskuil) University Medical Center Utrecht,
Cardiology, Utrecht, Netherlands
(Van Nieuwkerk, Delewi) Amsterdam University Medical Center, Cardiology,
Amsterdam, Netherlands
Publisher
European Respiratory Society
Abstract
Background: The prevalence of coronary artery disease (CAD) in patients
with severe aortic valve stenosis undergoing transcatheter aortic valve
implantation (TAVI) is high. However, the importance of a percutaneous
coronary intervention (PCI) prior to TAVI has been matter of debate.
Importantly, patients undergoing TAVI are characterized by high age often
accompanied by highly calcified coronary arteries, increasing the risk of
severe periprocedural complications. Moreover, patients with a severe
aortic valve stenosis are limited in their ability to compensate for these
lifethreatening complications. Together with the necessity of dual
antiplatelet therapy after PCI, this may explain a possible negative
effect of PCI in this patient population. However, there is still
insufficient evidence regarding the importance of PCI in patients
undergoing TAVI. <br/>Purpose(s): The aim of this systematic review and
meta-analysis was to assess the need for PCI in patients with significant
CAD undergoing TAVI. <br/>Method(s): A systematic search was conducted to
identify studies comparing optimal medical treatment only versus PCI in
patients with significant CAD undergoing TAVI. Endpoints were all-cause
mortality, cardiac death, stroke, myocardial infarction, and major
bleeding which were assessed at 30 days, one year, and beyond one year
following TAVI. <br/>Result(s): A total of 14 studies was included in this
meta-analysis, including 3838 patients of which 1806 patients (47.1%)
underwent PCI before TAVI. All-cause mortality was not significantly
different between optimal medical treatment only and PCI at 30 days (OR:
1.27; 95% CI, 0.91-1.77; p=0.17; I²=0%), at one year (OR: 0.91;
95% CI, 0.64-1.29; p=0.59; I²=45%), and beyond one year (OR
0.68; 95% CI, 0.42-1.08; p=0.10; I²=49%). Cardiac death and
myocardial infarction was similar across the groups at 30 days (OR cardiac
death: 1.94; 95% CI, 0.36-10.56; p=0.45; I²=28%; OR myocardial
infarction: 0.50; 95% CI, 0.13-1.91; p=0.31; I²=0%), and at one
year (OR cardiac death: 0.77; 95% CI, 0.19-3.13; p=0.72;
I²=84%; OR myocardial infarction: 0.74; 95% CI, 0.21-2.66;
p=0.64; I²=18%). Stroke did not significantly differ between
PCI and optimal medical treatment groups at 30 days (OR: 0.77; 95% CI,
0.31-1.92; p=0.57; I²=0%). However, patients that underwent
TAVI without preceding PCI had significantly lower risk of major bleeding
at 30 days (OR: 0.66; 95% CI, 0.46-0.94; p=0.022; I²=0%).
<br/>Conclusion(s): This systematic review and meta-analysis showed no
significant differences in clinical outcomes between patients with and
without PCI prior to TAVI at both short- and long-term follow-up, apart
from a higher risk of major bleeding within 30 days in patients undergoing
PCI before TAVI.

<127>
Accession Number
641005204
Title
Clinical factors affecting survival in patients with D-transposition of
the great arteries after atrial switch repair: A meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
680), 2022. Date of Publication: September 2022.
Author
Nartowicz S.; Jakielska E.; Cieplucha A.; Ratajczak P.; Grajek S.N.;
Lesiak M.; Trojnarska O.
Institution
(Nartowicz, Jakielska) Poznan University of Medical Sciences, Poznan,
Poland
(Cieplucha, Grajek, Lesiak, Trojnarska) Poznan University of Medical
Sciences, Department of Cardiology, Poznan, Poland
(Ratajczak) Poznan University of Medical Sciences, Department of
Pharmacoeconomics and Social Pharmacy, Poznan, Poland
Publisher
European Respiratory Society
Abstract
Background: Atrial switch repair (AtrSR) was the initial method of
operation in patients with D-transposition of the great arteries (D-TGA)
constituting the right ventricle as a systemic one. Currently, it has been
replaced with arterial switch operation (ASO), but the cohort of adults
after AtrSR is still large and requires strict cardiological management of
late complications. For this reason, we aimed to evaluate potential
long-term mortality risk factors in patients with D-TGA after AtrSR
(either Mustard or Senning procedure) Method: We searched MEDLINE database
for suitable trials. We included 22 retrospective and prospective cohort
studies of patients with D-TGA with at least 5 years mean/median follow-up
time after Mustard or Senning procedure, with an end-point of non-sudden
cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30
days after surgery. <br/>Result(s): A total of 2912 patients were
enrolled, of which 351 met the combined endpoint of n-SCD/SCD. The
long-term mortality risk factors were: NYHA>II/heart failure
hospitalization (OR=7.25; p=0.0001), tricuspid valve regurgitation
(OR=4.64; p=0.0005), Mustard procedure (OR=2.15; p=0.0008), complex D-TGA
(OR=2.41; p=0.005), right ventricle dysfunction (OR=1.94; p=0.05).
Supraventricular arrhythmia (SVT; OR=2.07; p=0.09) and pacemaker
implantation (OR=2.37; p=0.29) did not affect long-term survival in this
group of patients. In an additional analysis, SVT showed a statistically
significant impact on SCD (OR=2.74; p=0.005) but not on n-SCD (OR=1.5;
p=0.57). <br/>Conclusion(s): This meta-analysis identified that at least
moderate tricuspid valve regurgitation, NYHA class > II/heart failure
hospitalization, right ventricle dysfunction, complex D-TGA and Mustard
procedure as risk factors of long-term mortality in patients after AtrSR.

<128>
Accession Number
641005126
Title
Infective endocarditis of mitral valve, valve replacement or repair - a
meta-analysis of 10,965 patients.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2122), 2022. Date of Publication: September 2022.
Author
Fathy M.H.; Elnagar M.A.; Elbadawi M.A.; Awad A.K.
Institution
(Fathy, Elnagar, Elbadawi, Awad) Ain Shams University Hospital, Cairo,
Egypt
Publisher
European Respiratory Society
Abstract
Background: Being characterized by high mortality and recurrence rates,
native mitral valve infective endocarditis (IE) constitutes a burden on
both patients and surgeons from its poor prognosis and debatable
interventions. Mitral valve repair (MVRr) and mitral valve replacement
(MVRp) are two main surgical methods. Nevertheless, which of them carries
an outweigh benefit over the other is still controversial. Thus, in our
meta-analysis we aimed to further investigate the efficacy of each
technique on both short term and long-term outcomes. <br/>Method(s): Our
search strategy was applied on several databases including the PubMed,
Scopus, Web of science, and Cochrane literature databases to compare MVP
and MVR, with data extracted for baseline characteristics, mortality,
survival, recurrent endocarditis, and valve reoperation. Risk and hazard
ratio (RR and HR) and 95% confidence interval (CI) were pooled and
analyzed using RevMan 5.0. <br/>Result(s): A total of 22 relevant
publications with a total population of 10,965 patients, with 3,557
patients having undergone MVRr and 7,408 patients having undergone MVRp,
respectively, were analyzed. Patients who underwent MVP may benefit from a
lower risk of early mortality (RR 0.44; 95% CI, 0.38-0.51; p<0.00001;
I²=0%), a higher long-term survival rate (HR 0.56; 95% CI,
0.36-0.76; p<0.001; I²=0%), and a lower risk of recurrence (RR
0.66; 95% CI, 0.40-0.93; p=0.05; I²=0%). Although the risk of
reoperation was observed lower for MVRr, it was not statistically
significant (RR, 0.86; 95% CI, 0.36-1.36; p=0.76; I²=37%).
<br/>Conclusion(s): Our results suggests that MVRr showed superiority in
the terms of in hospital mortality and long-term survival. Furthermore, it
has lower risk of recurrence and valve reoperation. Therefore, MVRr is an
appropriate as a primary treatment choice and should be considered
whenever possible in most IE patients. <br/>Conclusion(s): Our results
suggests that MVRr showed superiority in the terms of in hospital
mortality and long-term survival. Furthermore, it has lower risk of
recurrence and valve reoperation. Therefore, MVRr is an appropriate as a
primary treatment choice and should be considered whenever possible in
most IE patients. (Figure Presented).

<129>
Accession Number
641005108
Title
Prognostic value of left and right ventricular strain in heart failure
with reduced and preserved ejection fraction: A meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
75), 2022. Date of Publication: September 2022.
Author
Pastore M.C.; Fusini L.; Mandoli G.E.; Carrucola C.; Vigna M.; Muratori
M.; Pepi M.; Cavigli L.; D'Ascenzi F.; Focardi M.; Valente S.; Mondillo
S.; Pontone G.; Patti G.; Cameli M.
Institution
(Pastore, Mandoli, Carrucola, Vigna, Cavigli, D'Ascenzi, Focardi, Valente,
Mondillo, Pontone) University of Siena, Siena, Italy
(Fusini, Muratori, Pepi) IRCCS Monzino Cardiology Center, Milan, Italy
(Patti, Cameli) University of Eastern Piedmont, Novara, Italy
Publisher
European Respiratory Society
Abstract
Background: The association of speckle tracking echocardiography measures
of left ventricular (LV) and right ventricular (RV) strain with clinical
outcome in heart failure with reduced and preserved ejection fraction
(HFrEF and HFpEF) has been extensively investigated. In fact, while the
contribute of LV ejection fraction (LVEF) for prognosis is controversial,
myocardial strain has proven to be a strong and independent prognostic
predictor in many HF studies. <br/>Purpose(s): The aim of this
meta-analysis was to assess the prognostic value of LV global longitudinal
strain (GLS) and free wall RV longitudinal strain (fwRVLS) by
2-dimensional speckle tracking echocardiography in patients with HFrEF, HF
with mildly-reduced ejection fraction (HFmrEF) and HFpEF. <br/>Method(s):
A systematic literature search of medical databases including Pubmed,
Scopus, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of
Controlled Trials, Scopus was performed using PRISMA principles. All
relevant studies in English language reporting the predictive value of LV
GLS and/or fwRVLS for mortality and/or cardiovascular events in HFrEF,
HFmrEF and HFpEF, with follow up >6 months, were identified. Case
reports/series and abstract congresses were excluded (Fig. 1). All-cause
mortality and a composite endpoint of cardiovascular death,
rehospitalization for HF, cardiac transplantation, ventricular assist
device implantation were analyzed. Hazard ratios (HR) were extracted from
univariate and multivariate random-effects models reporting on the
association of LV GLS and fwRVLS and outcome and described as pooled
estimates with 95% confidence intervals (CI). <br/>Result(s): Fifty
studies (n=18276 patients) satisfied the inclusion criteria (35 studies in
chronic HF, 15 studies in acute HF). Most studies (n=36) included patients
with HFrEF, while 14 studies included patients with HFmrEF (n=3) and with
HFpEF (n=11); thus HFmrEF and HFpEF were grouped together for the
analysis. Overall, 48 studies included LV GLS (median value = -9% [from
-17% to -11%], 17 studies included fwRVLS (median value = -18% [from -24%
to -14%]). Over a median follow up of 32 [from 7 to 67] months follow up,
5618 (31%) had a cardiovascular event or died. LV GLS and fwRVLS were
independently associated with all-cause mortality and the composite
outcome, regardless of LVEF (Fig. 2), both in HFrEF (HR 1.26; 95% CI
[1.15; 1.37]; p<0.01 for LV GLS and HR 1.06; 95% CI [1.03; 1.09]; p<0.01
for fwRVLS) and in HFpEF (HR 1.07; 95% CI [1.03; 1.12]; p<0.01 for LV GLS
and HR 1.08; 95% CI [0.96; 1.21]; p<0.01 for fwRVLS). <br/>Conclusion(s):
These meta-analysis data demonstrate that LV and RV strain are associated
with mortality and cardiovascular events in patients with HF, HFmrEF and
HFpEF and may provide important additive prognostic information. These
findings emphasize the potential usefulness of LV GLS and fwRVLS in
clinical practice to improve the risk stratification and management of
patients with HF regardless of LVEF.

<130>
Accession Number
641005080
Title
Transcatheter mitral-valve repair for functional mitral regurgitation data
from the real-life in comparison with landmark randomized trials.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2121), 2022. Date of Publication: September 2022.
Author
Kaddoura R.; Al-Badriyeh D.B.; Abushanab D.A.; Al-Hijji M.A.
Institution
(Kaddoura, Abushanab, Al-Hijji) Hamad Medical Corporation Heart Hospital,
Doha, Qatar
(Al-Badriyeh) Qatar University, Doha, Qatar
Publisher
European Respiratory Society
Abstract
Background: Publication of COAPT and MITRA-FR trials on the use of
transcatheter mitral-valve repair (TMVR) for functional mitral
regurgitation (MR) in 2018, has raised many questions due to their
divergent results despite having similar objectives. <br/>Purpose(s): To
investigate the characteristics and outcomes of patients from real-life
data who underwent TMVR for functional MR, in comparison with the two
landmark trials. <br/>Method(s): A meta-analysis was performed according
to Cochrane Handbook for Systematic Reviews and the Preferred Reporting
Items for Systematic Reviews and Meta-analyses statement. A comprehensive
systematic literature search was conducted to identify observational
studies that enrolled patients with functional MR, published in 2020 and
2021. No further restrictions were implemented. Independent reviewers
performed study selection, data extraction, risk-of-bias and
quality-of-evidence assessments. Variables of interest were related to
patient demographics, medications, echocardiogram parameters, and
outcomes. Patient variables from observational studies were compared with
those reported in randomized trials, using a random-effects model for each
variable. Mean difference (MD) and odds ratio (OR), with 95% confidence
intervals (95% CI), were used to compare continuous and categorical data,
respectively. Variables that were not reported in both COAPT and MITRA-FR
trials were not presented. R software was used for non-comparative pooling
of variables, and RevMan software was used for comparative meta-analysis.
<br/>Result(s): Thirty-two studies, enrolling 9497 patients, were
included. Patients were found to be older in real-life than in landmark
trials ([MD -2.73; 95% CI: -4.06, -1.40] for COAPT; [MD -4.33; 95% CI:
-5.94, -2.72] for MITRA-FR), while more males were recruited in MITRA-FR
trial (OR 1.71; 95% CI: 1.15-2.52). Moreover, patients in MITRA-FR trial
were less likely to have atrial fibrillation or renal insufficiency.
Patients from real-life were more likely to be more symptomatic (i.e., New
York Heart Association (NYHA) class III/IV) and less likely to have
implanted cardiac devices than those in randomized trials. MITRA-FR trial
patients had better compliance with guideline-directed therapies for heart
failure with reduced ejection fraction. Ejection fraction ranged from
31.3% to 33.9% between three study arms. More patients in randomized
trials presented with moderate-tosevere MR (grade 3+), whereas severe MR
(grade 4+) was more common among patients from real-life. Procedure
success, defined as MR grade <=2+, was more frequent in randomized trials,
with better symptoms' relief in COAPT trial (NYHA class I/II). There was
no difference in number of devices implanted between real-life and
landmark trials data. [Tables 1 and 2] <br/>Conclusion(s): Real-life data
on TMVR in functional MR, as presented by low-quality and heterogenous
observational studies, showed substantial differences from the results of
the main randomized trials. (Table Presented).

<131>
Accession Number
641005060
Title
CAD in kidney transplant recipients: A real-world assessment
pre-ISCHEMIA-CKD.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2619), 2022. Date of Publication: September 2022.
Author
Rocha B.; Amador R.; Maltes S.; Cunha G.; Mateus C.; Aguiar C.; Weigert
A.; Mendes M.
Institution
(Rocha, Amador, Maltes, Cunha, Mateus, Aguiar, Weigert, Mendes) Hospital
de Santa Cruz, Lisbon, Portugal
Publisher
European Respiratory Society
Abstract
Background: The ISCHEMIA-CKD trial has shown that an initial invasive
strategy, as compared to conservative treatment, did not reduce the risk
of death and non-fatal myocardial infarction, nor did it improve
quality-oflife in patients with advanced chronic kidney disease (CKD) and
coronary artery disease (CAD) with moderate-to-severe ischemia. Similar
findings were reported in patients with CKD enlisted for kidney
transplantation (KT). We aimed to evaluate screening and treatment CAD
strategies in patients who ultimately underwent KT at our center.
<br/>Method(s): This is a single-center study of consecutive patients who
received a KT from 2015 to 2020. Obstructive CAD was defined whenever one
of the following criteria was met: Lesion with a stenosis >70% (or >50%,
if left main disease) or CAD requiring revascularization, as per the Heart
Team discussion. CAD evaluation refers to non-invasive or invasive
coronary angiography and/or stress testing, irrespective of clinical
scenario. <br/>Result(s): A total of 324 patients underwent KT [mean age
55+/-12 years; 65.1% male; CKD most often due to hypertensive or diabetic
nephropathy and polycystic kidney disease - 41.8%; median time from renal
replacement therapy (RRT) to KT - 60 (40-88) months]. A flow-chart
summarizing CAD diagnosis over time is depicted in Figure 1. Overall, 119
(36.7%) patients had CAD evaluation prior to KT, of whom 21 underwent
myocardial revascularization - 8, 12 and 1 patients with acute coronary
syndrome (ACS), chronic coronary syndrome (CCS) and silent ischaemia,
respectively. At a median time of 46 (25-66) months after KT, 36 (11.1%)
more patients had CAD evaluation, of whom 8 underwent percutaneous
myocardial revascularization - 6 and 2 for ACS and CCS, respectively.
Those with obstructive CAD were older (64 vs 54 years-old; p<0.001), with
a higher burden of cardiovascular (CV) risk factors (p<0.001) and more
likely to have had a CV death (9.5 vs. 1.0%; p=0.025) or CV
hospitalization (38.1 vs. 13.4%; p=0.007). CAD status (revascularized vs.
non-revascularized) was not associated with improved major outcomes at
follow-up. We found no strong predictors of CAD requiring
revascularization post-KT, including time from RRT to KT. There were no
patients with refractory angina, left main disease or reduced left
ventricular ejection fraction (<40%) in need of myocardial
revascularization over follow-up. <br/>Conclusion(s): Obstructive CAD was
uncommon in our cohort of patients who received a KT, most of whom with
asymptomatic or mildly (monthly angina) symptomatic CCS or non-fatal ACS.
These findings, together with the most recent evidence, may argue against
routine CAD screening in all patients being enlisted for KT.
Notwithstanding, randomized evidence is eagerly awaited to further guide
treatment decisions in the post-ISCHEMIACKD era. (Table Presented).

<132>
Accession Number
641005029
Title
Early aortic valve replacement in asymptomatic severe aortic stenosis with
preserved ejection fraction.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1593), 2022. Date of Publication: September 2022.
Author
Costa G.; Cardoso J.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic
Surgery, Vila Nova de Gaia, Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
(Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Aortic stenosis (AS) is the most common valvular disease in
developed countries. Specific timing of intervention for asymptomatic
patients with severe aortic stenosis and preserved ejection fraction
remains controversial. <br/>Purpose(s): To compare the outcomes of early
aortic valve replacement (AVR) versus watchful waiting (WW) in
asymptomatic AS patients with preserved ejection. <br/>Method(s): We
systematically searched PubMed, Embase and Cochrane databases, in November
2021, for both interventional or observational studies comparing early-AVR
with WW in the treatment of asymptomatic severeAS with preserved ejection
fraction criteria. Random-effects metaanalysis was performed.
<br/>Result(s): Eight studies were included in which two were randomized
clinical trials. A total of 2672 patients were included, providing a 642
pooled death events (327 in early-AVR and 941 in watchful waiting). In our
metaanalysis, early-AVR revealed a significant lower all-cause mortality
(pooled OR, 0.39; 95% CI [0.30, 0.51], P<0.01; I²=47%).
Additionally, the early- AVR group presented a lower rate of
cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01;
I²=64%). Both strategies had similar rate of stroke (pooled OR,
1.30; 95% CI [0.39, 4.27], P=0.67; I²=0%) and myocardial
infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28;
I²=0%). Heart Failure hospitalizations presented a lower trend
early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36;
I²=36%). <br/>Conclusion(s): Our pooled data suggests that
early-AVR strategy is preferable for asymptomatic severe AS patients with
preserved ejection fraction. (Figure Presented).

<133>
Accession Number
641004983
Title
Concomitant tricuspid repair in mitral regurgitation surgery: A systematic
review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1592), 2022. Date of Publication: September 2022.
Author
Costa G.; Cardoso J.; Donato H.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro Hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic
Surgery, Vila Nova de Gaia, Portugal
(Donato, Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra,
Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Tricuspid Regurgitation (TR) is common in patients with severe
mitral disease. However, the evidence is insufficient to inform a decision
about whether to perform prophylactic tricuspid-valve repair during
mitral-valve surgery in patients who have moderate TR or less-thanmoderate
regurgitation. <br/>Purpose(s): To compare the outcomes of concomitant
tricuspid repair in mitral valve surgery versus no concomitant tricuspid
repair in less-thansevere TR patients. <br/>Method(s): We systematically
searched PubMed, Embase and Cochrane databases, in December 2021, for
interventional studies comparing concomitant tricuspid repair in mitral
valve surgery versus no tricuspid intervention. Random-effects
meta-analysis was performed. <br/>Result(s): Four randomised trials were
included, providing a total of 651 patients (323 in prophylactic tricuspid
intervention group and 328 patients in conservative group). Our
meta-analysis showed a similar all-cause mortality for concomitant
prophylactic tricuspid repair compared with no tricuspid intervention
(pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I²=0%).
Additionally, there is a similar New York Heart Association (NYHA) III-IV
classes in both groups, despite a lower trend in the tricuspid
intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08;
I²=0%) (Figure 3). However, there was a significant lower
progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01;
I²=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11,
0.46], P<0.01; I²=27%). <br/>Conclusion(s): Our pooled analysis
suggests that a tricuspid-valve repair at the time of mitral-valve surgery
in patients with moderate or less-thanmoderate TR does not impact
perioperative or postoperative all-cause mortality, despite reducing TR
severity and progression of TR following intervention. (Figure Presented).

<134>
Accession Number
641004960
Title
Efficacy of controlvit as a complementary strategy in reducing
hospitalizations in patients with heart failure. Randomized clinical
trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2820), 2022. Date of Publication: September 2022.
Author
Achury D.M.; Garcia A.G.; Marino A.M.; Bohorquez W.B.; Gonzalez R.G.
Institution
(Achury, Gonzalez) Javeriana University, Bogota, Colombia
(Garcia, Marino, Bohorquez) San Ignacio Hospital, Bogota, Colombia
Publisher
European Respiratory Society
Abstract
Introduction: In patients with heart failure, the main cause of hospital
admissions is due to episodes of decompensation, which are associated with
an increase in the costs and resources needed for care; they have a
negative impact on the quality of life and prognosis of the disease.
Therefore, it is necessary to design, evaluate and implement alternatives
to achieve efficient follow-up and monitoring, improving adherence to
treatment and helping identify decompensation episodes that facilitate
their early treatment, so new hospital admissions can be avoided. For this
reason, the use of information and communication technologies (apps) is
emerging as an excellent strategy for the possibility of improving
coverage, real-time monitoring and timeliness of care. ControlVitR is an
electronic application that allows permanent, real-time monitoring of
biomedical measurements for early detection of complications.
<br/>Objective(s): To determine the efficacy of ControlVitR as a
complementary strategy in reducing hospital admissions in patients in a
heart failure program. Methodology: A randomized, placebo-controlled,
open-label clinical trial was conducted, (n=140), included patients with
heart failure under controlled clinical follow-up in a structured heart
failure program, into NYHA FC II-IV, capable of handling smartphones and
with permanent internet connectivity. All patients were provided with
educational elements, a scale and a blood pressure monitor to enter
clinical data and a symptom questionnaire necessary for follow-up. The
patients were randomized to 2 groups: Intervention: Use of ControlVitR vs.
placebo, with a 6-month follow-up. The primary outcome was the difference
in readmissions for heart failure between the 2 groups. Patients on the
waiting list for heart transplantation or use of ventricular assist
devices were excluded. All participants signed informed consent and the
protocol was approved by the institutional ethics committee.
<br/>Result(s): A total of 140 patients were included in the study
(intervention = 71, placebo = 69), with an average age of 66 years, 71%
were men, the main etiology of heart failure was ischemic (60%), the main
comorbidities were arterial hypertension (44%), dyslipidemia (42%),
hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus
(27%). During follow-up, there were 6 deaths (3 in each group) and 17
readmissions (3 in the intervention group and 14 in the control group).
After adjustment for comorbidities, HR 0.72 CI95 (0.52; 0.92), p=0.0325
was found. <br/>Conclusion(s): In patients with heart failure, ControlVitR
is a useful and complementary tool for follow-up, which reduces hospital
admissions due to episodes of decompensation.

<135>
Accession Number
641004959
Title
Prognostic utility of left ventricular global longitudinal strain in
patients with systemic amyloidosis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
270), 2022. Date of Publication: September 2022.
Author
Bhatia K.; Aggarwal D.; Ochoa-Jimenez R.; Lopez P.; Konje S.; Argulian E.
Institution
(Bhatia, Ochoa-Jimenez, Lopez, Konje, Argulian) Mount Sinai Heart, Mount
Sinai Morningside, New York, United States
(Aggarwal) Beaumont Health System, Internal Medicine, Troy, United States
Publisher
European Respiratory Society
Abstract
Background: Myocardial deposition of amyloid proteins results in
restrictive cardiomyopathy. Left ventricular global longitudinal strain
(GLS) has emerged as a sensitive measure for detecting subclinical cardiac
dysfunction over traditional echocardiographic parameters. However,
multiple studies have provided differing conclusions regarding prognostic
utility of impaired GLS in patients with systemic amyloidosis.
<br/>Purpose(s): We conducted a systematic review and meta-analysis to
evaluate whether impaired GLS was associated with increased mortality or
major adverse cardiovascular events (MACE) in patients with systemic
amyloidosis. <br/>Method(s): We performed a literature search of Embase,
Medline and Web of Science databases to identify studies that reported the
association of GLS with clinical outcomes in patients with systemic
amyloidosis (light chain or TTR amyloidosis). Outcomes of interest
included all-cause mortality and MACE, defined as a composite of death or
heart transplant or heart failure hospitalization. Unadjusted and adjusted
hazard ratio (uHR and aHR respectively) were pooled using a random effects
model. Heterogeneity among the studies was assessed using the Higgins I2
value. <br/>Result(s): Out of 2139 initial citations, 28 observational
studies with a total of 2713 patients were included in the analysis. The
mean age ranged between 58-78 years and 62% of the patients were male.
Most patients had cardiac amyloidosis (83%) and light-chain amyloidosis
accounted for 69% of cases. Mean follow-up ranged between 1 and 5 years.
GLS was significantly higher (less negative) (mean difference (MD) -3.69
[-5.94, -1.44], I²=87, p<0.01) in non-survivors compared with
survivors. Similarly, patients who experienced MACE had a significantly
higher mean GLS (MD -3.22, [-5.21, -1.22,], I²=82, p<0.01]. The
risk of both mortality and MACE increased significantly for every -1%
increase in GLS. In unadjusted models, a GLS above the defined threshold
value was associated with a significantly higher risk of mortality (uHR:
1.66 [1.22, 5.21], I²=85.2, p<0.01) and MACE (uHR: 2.24 [1.28,
3.92], I²=39, p<0.01). In multivariable models an increase in
GLS by -1% was an independent predictor of mortality (aHR: 1.09
[1.01,1.16], I²=53, p=0.02) and MACE (aHR: 1.24 [1.14,1.36],
I²=0, p<0.01). <br/>Conclusion(s): In patient with amyloidosis,
the baseline left ventricular GLS may help identify patients with a higher
risk of mortality and MACE.

<136>
Accession Number
641004906
Title
Meta-analysis comparing outcomes in patients undergoing transcatheter
aortic valve implantation with versus without percutaneous coronary
intervention.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1590), 2022. Date of Publication: September 2022.
Author
Costa G.; Marinho V.; Costa M.; Goncalves L.; Teixeira R.
Institution
(Costa, Teixeira) Centro hospitalar de Coimbra, Coimbra, Portugal
(Marinho, Costa, Goncalves) Centro Hospitalar Universitario de Coimbra,
Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Patients having transcatheter aortic valve implantation (TAVI)
routinely undergo coronary angiography before the procedure to define the
coronary anatomy and to evaluate the extend of coronary artery disease
(CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant
with TAVI confers any additional clinical benefit in patients with CAD
remains unclear. <br/>Purpose(s): To compare the outcomes of PCI prior to
TAVI in patients with significant coronary artery disease and severe
aortic stenosis. <br/>Method(s): We systematically searched PubMed, Embase
and Cochrane databases, in November 2021, for both retrospective and
prospective studies comparing TAVI with PCI versus TAVI alone.
Random-effects metaanalysis was performed. <br/>Result(s): Eleven studies
were included in which one was a randomized clinical trial. A total of
2530 patients were included, providing a 145 pooled death events (64 in
TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes,
our pooled analysis revealed a similar all-cause mortality (pooled OR,
1.24; 95% CI [0.80, 1.93], P=0.34; I²=27% - Figure),
cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45;
I²=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13],
P=0.86; I²=0%). However, our analysis revealed a higher rate of
myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P<0.01;
I²=0%) and major bleeding events (pooled OR, 1.40; 95% CI
[1.02, 1.93], P=0.04; I²=0%) in the TAVI with PCI group. A
1-year clinical outcomes analysis revealed a trend for lower allcause
mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91],
P=0.06; I²=0%), similar cardiovascular death rate (pooled OR,
1.15; 95% CI [0.70, 1.89], P=0.59; I²=6%) and major bleeding
events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I²=0%).
<br/>Conclusion(s): Our pooled data suggests that PCI with TAVI in
patients with severe aortic stenosis and concomitant CAD grants no
additional clinical advantage. (Figure Presented).

<137>
Accession Number
641004738
Title
Lipoprotein(a) and the effect of alirocumab on coronary and non-coronary
revascularization following acute coronary syndrome.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
1386), 2022. Date of Publication: September 2022.
Author
Steg P.; Szarek M.; Valgimigli M.; Islam S.; Zeiher A.M.; Bhatt D.L.;
Bittner V.A.; Diaz R.; Goodman S.G.; Harrington R.A.; Jukema J.W.; Pordy
R.; Scemama M.; White H.D.; Schwartz G.G.
Institution
(Steg) Hospital Bichat-Claude Bernard, Paris, France
(Szarek) State University of New York, Downstate Medical Center, New York,
United States
(Valgimigli) Cardiocentro Ticino Institute, Lugano, Switzerland
(Islam) NYU Long Island School of Medicine, Division of Health Services
Research, Mineola, United States
(Zeiher) Goethe University Hospital, Frankfurt, Germany
(Bhatt) Brigham and Women's Hospital, Boston, United States
(Bittner) University of Alabama Birmingham, Birmingham, United States
(Diaz) Estudios Cardiologicos Latinoamerica (ECLA), Rosario, Argentina
(Goodman) St. Michael's Hospital, Toronto, Canada
(Harrington) School of Medicine, Stanford, United States
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Pordy) Regeneron Pharmaceuticals,Inc., Tarrytown, United States
(Scemama) Sanofi, Paris, France
(White) Auckland City Hospital, Auckland, New Zealand
(Schwartz) University of Colorado, Aurora, United States
Publisher
European Respiratory Society
Abstract
Background: Many patients require arterial revascularization after an
index ACS. Lipoprotein(a) is thought to play a pathogenic role in
atherothrombosis. In the ODYSSEY OUTCOMES trial, the PCSK9 inhibitor
alirocumab reduced major adverse cardiovascular events after ACS, with
greater reduction among those with higher lipoprotein(a).
<br/>Objective(s): We determined whether the risk of first coronary or any
(coronary, peripheral artery or carotid) revascularization after ACS was
modified by the level of lipoprotein(a) and treatment with alirocumab or
placebo. <br/>Method(s): The ODYSSEY OUTCOMES trial (NCT01663402) compared
alirocumab with placebo in 18,924 patients with ACS and elevated
atherogenic lipoproteins despite optimized statin treatment. Treatment
effects were summarized by competing-risks proportional hazard models.
<br/>Result(s): A total of 1559 (8.2%) patients had coronary, 204 (1.1%)
peripheral artery, and 40 (0.2%) carotid revascularization after
randomization. Alirocumab reduced first coronary revascularization (9.6%
vs. 11.3% at 4 years; hazard ratio [HR] 0.88, 95% confidence interval [CI]
0.80-0.97; p=0.01) and any first revascularization (10.8% vs. 13.0%; HR
0.85, 95% CI 0.78-0.94; p=0.001). Baseline lipoprotein(a) quartile was
directly associated with risk of coronary or any revascularization in the
placebo arm (ptrend <0.0001) and inversely related to treatment HRs
(ptrend <0.001). The greatest benefits of alirocumab on coronary or any
revascularization were observed in patients with baseline lipoprotein(a)
in the top quartile (>=59.6 mg/dL) (figures). <br/>Conclusion(s):
Alirocumab reduced revascularization after ACS. The risk of
revascularization and reduction in that risk with alirocumab were greatest
in patients with elevated lipoprotein(a) at baseline. (Figure Presented).

<138>
Accession Number
641004655
Title
Predictors of mitral valve hemodynamics after mitral valve repair for
degenerative mitral regurgitation: A subanalysis of the CAMRA randomized
trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2115), 2022. Date of Publication: September 2022.
Author
Rumman R.; Verma S.; Chan V.; Mazer D.; Quan A.; De Varennes B.E.; Chu
M.W.A.; Latter D.; Teoh H.; Yanagawa B.; Leong-Poi H.; Connelly K.
Institution
(Rumman) St. Michael's Hospital, Department of Medicine, Toronto, Canada
(Verma, Latter, Yanagawa) St. Michael's Hospital, Cardiac Surgery,
Toronto, Canada
(Chan) Ottawa Heart Institute, Cardiac Surgery, Ottawa, Canada
(Mazer) St. Michael's Hospital, Anesthesia, Toronto, Canada
(Quan, Teoh) St. Michael's Hospital, Toronto, Canada
(De Varennes) McGill University Health Centre, Cardiac Surgery, Montreal,
Canada
(Chu) London Health Sciences Centre, Cardiac Surgery, London, Canada
(Leong-Poi, Connelly) St. Michael's Hospital, Cardiology, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Introduction: Intra-operative predictors of mid-to-late mitral valve
dysfunction after surgical repair of mitral regurgitation (MR) caused by
prolapse remain poorly characterized. This study aims to evaluate the
effect of annuloplasty prosthesis size on post-operative MV hemodynamics
at rest and during exercise, and to identify perioperative predictors of
MV dysfunction. <br/>Method(s): 104 patients were randomly assigned to
resection and preservation for surgical treatment of posterior leaflet
prolapse in the Canadian Mitral Research Alliance CardioLink-2 study.
Echocardiograms were performed at baseline and 1 year postoperatively.
Intraoperative TEE was performed to assess immediate MV gradients.
Exercise TTE was performed 1 year after repair. Linear regression analysis
was used to identify associations between MV indices (rest and peak
exercise gradients) at 12 months, and perioperative echocardiographic and
clinical factors. <br/>Result(s): Mean age of participants was 65+/-10
years, and 83% were male. Larger annuloplasty size was associated with
lower transmitral gradients at rest and during peak exercise. In
multivariable analysis, annuloplasty size >=34mm was associated with lower
mean and peak rest and exercise gradients at 12 months, after adjustment
for repair type, age, sex, and BSA (p<0.001). Higher pre-operative
pulmonary artery pressures were associated with reduced functional
capacity post-operatively. Intra-operative TEE gradients predict resting
and exercise MV hemodynamics at 1 year. <br/>Conclusion(s): Annuloplasty
size >=34mm is associated with improved MV hemodynamics at rest and during
peak exercise 1 year post MV repair. MV repair prior to onset of pulmonary
hypertension confers favourable post operative functional capacity.
Finally, intra-operative TEE can be used to identify patients at risk of
mitral valve dysfunction within 1 year of repair. (Figure Presented).

<139>
Accession Number
641004626
Title
Coronary perforation incidence and temporal trends (COPIT): Systematic
review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2064), 2022. Date of Publication: September 2022.
Author
Mikhail P.; Howden N.; Monjur M.; Said C.; Jeyaprakash P.; Bland A.;
Collison D.; McCartney P.; Adamson C.; Morrow A.; Carrick D.; McEntegart
M.; Ford T.
Institution
(Mikhail, Howden, Said, Bland, Ford) Gosford Hospital, Gosford, Australia
(Monjur) St George Hospital, Sydney, Australia
(Jeyaprakash) Nepean Hospital, Sydney, Australia
(Collison) Golden Jubilee National Hospital, Glasgow, United Kingdom
(McCartney, Adamson, Morrow) University of Glasgow, Glasgow, United
Kingdom
(Carrick) Hairmyres Hospital, East Kilbride, United Kingdom
(McEntegart) Columbia University, New York, United States
Publisher
European Respiratory Society
Abstract
Background: Despite advancements in Percutaneous Coronary Intervention
(PCI) technology and techniques, iatrogenic coronary artery perforation
(CAP) remains a dreaded potential complication within the cardiac
catheterisation laboratory. Data detailing the incidence of coronary
perforation during PCI has previously been obtained from relatively small
datasets. A swell of large data published in recent times provides
invaluable information regarding PCI related CAP. <br/>Purpose(s): COPIT
is a systematic review and meta-analysis targeted at detailing the
incidence, outcomes, etiology and treatment modalities of PCI related CAP
including evaluation of temporal trends since the inception of PCI to
contemporary practice. Additionally, COPIT provides hypothesis generating
data regarding predictors of CAP during PCI. <br/>Method(s): A prospective
systematic review and meta-analysis using MEDLINE and EMBASE via the OVID
interface (PROSPERO ID: CRD42020207881) was performed according to the
PRISMA guidelines. Identified relevant studies were used in a
pre-specified sensitivity analysis to detail incidence, outcomes,
etiology, treatment modalities and risk factors of PCI complicated by CAP.
Studies limited to PCI in high risk populations only such as CTO-PCI or
rotational atherectomy only were excluded. <br/>Result(s): 67 studies met
eligibility criteria detailing 5,568,191 PCIs over a 38-year period
(1982-2020). The pooled incidence of CAP was 0.39% (95% CI: 0.34-0.45%)
with no change in incidence over that time. Approximately 1 in 5
perforations led to cardiac tamponade (21.1%). Ellis 3 perforations are
increasing in frequency and account for 43% of all perforations. Mortality
due to perforation occurs in 7.5% of all CAP (95% CI 6.7% - 8.4%) but has
declined over the studied period. Meta-regression suggested that female
gender, hypertension, chronic kidney disease and previous coronary bypass
grafting were all associated with higher incidence of CAP. Coronary
perforation was most frequently caused by distal wire exit (37%) followed
by balloon dilation catheters (28%). Covered stents were used to treat 25%
of perforations, with emergency cardiac surgery needed in 17%.
<br/>Conclusion(s): Coronary perforations occurs in approximately 1 in 250
allcomer PCI procedures. A tendency towards increase in coronary
perforations is likely reflective of contemporary trends towards high
pressure post-dilatation with 1:1 vessel sizing as well as an ageing
population with increasingly complex, calcific coronary disease. However,
reduction in CAP related mortality suggests earlier recognition and
effective treatment with transcatheter techniques. (Figure Presented).

<140>
Accession Number
641004532
Title
Outcomes comparison between robotic and conventional mitral valve surgery:
A systematic review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2164), 2022. Date of Publication: September 2022.
Author
Pratita J.; Ardaya R.; Pritazahra A.; Rahman F.H.F.
Institution
(Pratita) Fakultas Kedokteran Universitas Indonesia (FKUI), Division of
Cardiothoracic and Vascular Surgery, Department of Surgery, Central
Jakarta, Indonesia
(Ardaya) University College London, School of Surgical and Interventional
Sciences, London, United Kingdom
(Pritazahra) University College London, Institute of Cardiovascular
Science, London, United Kingdom
(Rahman) MMC Hospital, South Jakarta, Indonesia
Publisher
European Respiratory Society
Abstract
Background: Robotic-assisted cardiac surgery has emerged as a popular
minimal invasive cardiac surgery approach, as it provides several
advantages compared to conventional and other minimally invasive
approaches. Mitral valve surgeries, including repair and replacement, are
currently the most common cardiac surgeries performed with a robotic
approach. However, there are concerns that surgeon's learning curve and
prolonged operation time associated with this approach could compromise
the surgical outcomes, hence the low acceptance of the technique in the
clinical setting. In addition, despite various studies comparing robotic
and conventional mitral surgery, it remains unclear whether the former
would give comparable, if not better, outcomes. <br/>Purpose(s): This
study aims to compare the outcomes of robotic and conventional sternotomy
mitral valve surgeries. <br/>Method(s): A comprehensive literature search
was performed through Pubmed, CENTRAL, and ScienceDirect for studies
comparing robotic and sternotomy approach for mitral valve repair and
replacement. Studies were screened with our eligibility criteria, and
their quality was examined using the Newcastle-Ottawa scale. The primary
outcome analysed in this study was the perioperative mortality.
<br/>Result(s): Twelve studies involving 4300 patients (2223 experienced
robotic surgery) were included. Pooled analysis showed that patients who
underwent robotic surgery had a significant decrease in perioperative
mortality compared to those who underwent sternotomy surgery (RR 0.33, 95%
CI 0.18, 0.60, p=0.0003, I²=0%). Moreover, ICU length of stay
was also shorter in the robotic group (MD -13.67, 95% CI -20.04, -7.29,
p<0.0001, I²=93%). Re-operation risk due to bleeding was not
significantly different between both groups (RR 1.13, 95% CI 0.79, 1.62,
p=0.51, I²=0%). Egger's test result showed no evidence of
small-study effects (p=0.83), and the funnel plot appeared symmetrical,
meaning there was no publication bias. <br/>Conclusion(s): Results from
our meta-analysis refute the current concerns limiting the acceptance of
robotic approach in mitral valve surgeries, showing significantly lower
perioperative mortality and ICU length of stay, as well as a comparable
re-operation risk due to bleeding with the conventional approach. (Figure
Presented).

<141>
Accession Number
641004512
Title
Valvular surgery is associated with an increased risk of post-operative
atrial fibrillation: Secondary analysis of the SEARCH-AF CardioLink-1
randomized trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2163), 2022. Date of Publication: September 2022.
Author
Hibino M.; Verma S.; Pandey A.; Quan A.; Verma A.; Bisleri G.; Mazer C.D.;
Ha A.
Institution
(Hibino, Verma, Pandey, Quan, Bisleri, Mazer) St. Michael's Hospital,
Cardiac Surgery, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Background: Patients undergoing valve surgery have a higher risk of
developing post-operative atrial fibrillation (POAF) relative to those
undergoing isolated coronary artery bypass grafting (CABG). Whether this
risk extends beyond hospital discharge is unknown. <br/>Purpose(s): We
examined the association between surgery type (isolated CABG vs. valve
repair/replacement) on the incidence of post-operative atrial fibrillation
(POAF) by conducting a secondary analysis of the Post- Surgical Enhanced
Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF)
CardioLink-1 randomized trial. <br/>Method(s): In the SEARCH-AF trial, 336
patients with risk factors for stroke (CHA2DS2-VASc score >=2) and no
history of preoperative AF were randomized to usual care or continuous
cardiac rhythm monitoring for 30 days after discharge from cardiac surgery
with a wearable, patched-based device. The primary outcome was occurrence
of cumulative atrial fibrillation/ flutter (AF/AFL) lasting for >=6
minutes detected by continuous monitoring or AF/AFL documented by a
12-lead ECG within 30 days of randomization. We compared the risk of POAF
between patients who underwent CABG vs. valve repair/replacement. Patients
who experienced postoperative AF during hospitalization were excluded from
this analysis. <br/>Result(s): The overall cohort consisted of 255, 39,
and 42 patients who underwent isolated CABG, isolated valve
replacement/repair, and CABG + valve repair/replacement, respectively.
Baseline characteristics were similar among the groups except for younger
age (p=0.0014), higher prevalence of preoperative myocardial infarction
(p=0.002) and lower ejection fraction (p=0.025) in the isolated CABG
group. Eighteen patients experienced post-operative AF during
hospitalization. Patients who underwent CABG + valve surgery or isolated
valve surgery were more likely to experience post-operative AF compared
with those who underwent isolated CABG (Log-Rank ptrend=0.0096). Among
patients who were randomized to continuous cardiac rhythm monitoring, the
probability of post-operative AF among patients who underwent isolated
CABG, valve surgery, and CABG + valve surgery was 15.8%, 29.4%, and 35.0%,
respectively (Log- Rank ptrend=0.017). After multivariable adjustment, the
risk of developing post-operative AF within 30 days after discharge
remained higher among patients who underwent valve surgery compared with
those who underwent isolated CABG (hazard ratio (HR) 2.22, 95% CI
1.01-4.87. Patients who underwent CABG + repair/replacement had the
highest risk of experiencing post-operative AF when compared to patients
who underwent isolated CABG (HR 2.78, 95% CI 1.12-6.86).
<br/>Conclusion(s): Patients undergoing valve repair or bioprosthetic
valve replacement have a substantial risk of post-operative AF within 30
days after discharge from surgery. An aggressive cardiac rhythm monitoring
strategy during this vulnerable period should be considered for this
high-risk patient population. (Figure Presented).

<142>
Accession Number
641004442
Title
Impact of diabetes and glucose-lowering therapy on post-operative atrial
fibrillation after cardiac surgery: Secondary analysis of the SEARCH-AF
CardioLink-1 randomized clinical trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
508), 2022. Date of Publication: September 2022.
Author
Pandey A.; Hibino M.; Ha A.; Quan A.; Verma A.; Bisleri A.; Mazer C.D.;
Verma S.
Institution
(Pandey, Hibino, Quan, Bisleri, Mazer, Verma) St. Michael's Hospital,
Cardiac surgery, Toronto, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
Publisher
European Respiratory Society
Abstract
Background: Diabetes mellitus is an important risk factor for atrial
fibrillation (AF) and is associated with an increased risk of
complications for patients with AF. The impact of diabetes on
post-operative AF after cardiac surgery is not well-defined.
<br/>Purpose(s): We sought to characterize the effect of diabetes,
insulin, and oral hypoglycemic agents on the incidence of post-operative
atrial fibrillation (POAF) after cardiac surgery. Accordingly, we
conducted a secondary analysis of the Post-Surgical Enhanced Monitoring
for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1
randomized trial. <br/>Method(s): In the SEARCH-AF trial, 336 patients
with risk factors for stroke (CHA2DS2-VASc score >=2) and no history of
preoperative AF were randomized to usual care or continuous cardiac rhythm
monitoring for 30 days after discharge from cardiac surgery with a
wearable, patched-based device. The primary outcome was occurrence of
cumulative atrial fibrillation/ flutter (AF/AFL) lasting for >=6 minutes
detected by continuous monitoring or AF/AFL documented by a 12-lead
electrocardiogram within 30 days of randomization. We assessed the
association between diabetes and occurrence of post-operative AF. In
addition, we examined the association between POAF and glucose-lowering
therapy among patients with diabetes. <br/>Result(s): Among the 176 (52%)
patients with diabetes in the study cohort, 80 (45%) patients were treated
with at least 1 oral hypoglycemic agent and 44 (25%) patients were treated
with insulin. The incidence of POAF occurring within 30 days after
discharge from surgery was similar between patients with or without
diabetes (cumulative incidence: 10.8% vs. 10.0%, log-rank p=0.77). Among
patients with diabetes, the incidence of POAF was highest in those who
were not treated with glucose-lowering therapy (17.3%) when compared with
those treated with oral hypoglycemic agents (10.0%) or insulin (4.5%)
(log-rank ptrend=0.045 among the 3 groups). In an exploratory analysis, we
observed a trend suggesting a lower incidence of POAF among cardiac
surgical patients who were treated with SGLT-2 inhibitors (log-rank
ptrend=0.084). <br/>Conclusion(s): The incidence of POAF occurring after
discharge from cardiac surgery is equally high among patients with or
without diabetes. Our results suggest a potential association between
specific glucose-lowering therapies and risk of POAF after cardiac
surgery, meriting further investigations.

<143>
Accession Number
641004403
Title
Determinants of myocardial injury following transcatheter aortic valve
implantation: A pre-specified substudy from the POPular TAVI trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2106), 2022. Date of Publication: September 2022.
Author
Van Ginkel D.J.; Brouwer J.; Nijenhuis V.J.; Delewi R.; Swaans M.J.;
Timmers L.; Rensing B.J.W.M.; Baan J.; Ten Berg J.M.
Institution
(Van Ginkel, Brouwer, Nijenhuis, Swaans, Timmers, Rensing, Ten Berg) St
Antonius Hospital, Cardiology, Nieuwegein, Netherlands
(Delewi, Baan) Amsterdam UMC - Location Academic Medical Center,
Cardiology, Amsterdam, Netherlands
Publisher
European Respiratory Society
Abstract
Background: Myocardial injury is frequently observed in patients
undergoing transcatheter aortic valve implantation (TAVI) and has been
linked to worse prognosis [1,2]. Yet, knowledge concerning the underlying
mechanisms and preventive strategies is scarce. <br/>Purpose(s): To
identify clinical determinants and the effect of periprocedural
antithrombotic strategies on markers of myocardial injury after TAVI.
<br/>Method(s): The POPular TAVI trial was a prospective, open label,
multicentre randomized controlled trial, investigating the addition of
clopidogrel to aspirin (cohort A) or oral anticoagulation (OAC) (cohort B)
in patients undergoing TAVI [3] Patients randomised to clopidogrel
received a 300mg loading dose before TAVI, followed by a 75mg maintenance
dose once daily. In patients using OAC, this was continued during TAVI
with an international normalized ratio aimed at 2.0. All OAC patients used
a vitamin-K antagonist. Blood samples were taken at baseline, 6, 24, 48,
and 72 hours following TAVI to determine myocardial injury using Creatine
Kinase-MB (CK-MB) and high-sensitive cardiac troponin T (hs-cTnT)
according to the VARC-2 criteria. Also, baseline and procedural variables
were collected in detail. A linear mixed effects model was used for
pair-wise analysis of the changes in enzyme levels at different time
points between groups. Regression analysis was performed using the
logistic regression model. Statistical analyses were performed using R
(version 3.4.1). <br/>Result(s): In total, 131 patients undergoing
transfemoral TAVI were included at two study sites, of whom 63 (48%)
received clopidogrel and 68 (52%) did not. Almost half of the patients
(45%) were on OAC. The rise in CK-MB (mean peak 23.4+/-13.3 U/l) and
hs-cTnT (mean peak of 0.23+/-0.33 ug/) was maximal at 6 and 24 hours,
respectively. The CK-MB and hs-cTnT levels did not differ between the
clopidogrel and no clopidogrel group at any time point (figure 1).
Myocardial injury occurred in 18 (30.1%) patients receiving OAC versus 39
(54.2%) patients not receiving OAC (p=0.007). The course of hs-cTnT
reached higher levels in patients with chronic kidney disease (p<0.001)
and in patients with a preserved left ventricular ejection fraction (LVEF)
(p=0.008). Also, the use of a controlled mechanical expanding prosthesis
was associated with a higher rise of hs-cTnT (p=0.007). (Figure 2) In
multivariable analysis, predictors of a maximal increase in hs-cTnT were a
preserved LVEF (OR 1.15, 95% CI 1.02-1.30) and chronic kidney disease (OR
1.13, 95% CI 1.01-1.28). Other procedural factors, like balloon dilation
and rapid ventricular pacing, were not associated with myocardial injury.
<br/>Conclusion(s): The addition of clopidogrel to aspirin or OAC during
TAVI was not associated with a reduction in myocardial injury. Instead,
OAC therapy, as compared to aspirin, was associated with a reduction in
rise and fall of hs-cTnT. Also, patients with a preserved LVEF or chronic
kidney disease observed higher levels of hs-cTnT. (Figure Presented).

<144>
Accession Number
641004326
Title
The effect of cryothermic and radiofrequency Cox maze IV ablation on
atrial size and function assessed by 3D echocardiography, a randomized
trial. To freeze or to burn.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
102), 2022. Date of Publication: September 2022.
Author
Boano G.; Farkas V.; Astrom Aneq M.
Institution
(Boano, Farkas, Astrom Aneq) Department of Medical and Health Sciences
Linkoping University, Linkoping, Sweden
Publisher
European Respiratory Society
Abstract
Background: The Cox maze procedures have been shown to be safe methods for
restoring sinus rhythm (SR) in patient with atrial fibrillation and often
performed concomitant to mitral valve (MV) surgery. Cryothermy (Cryo) and
Radiofrequency (RF) are available techniques to achieve atrial linear
scars. The differences between the effect of these energy sources on late
left atrial (LA) reverse remodeling are not fully described.
<br/>Purpose(s): This study aims to compare the impact of Cryo and RF
procedures on left atrial (LA) size and function one year after Cox-maze
IV concomitant to MV surgery using 3-dimensional echocardiography (3DE).
<br/>Method(s): Seventy-two patients with MV disease and atrial
fibrillation were randomized to either Cryo (35) or RF (37) ablation.
Another 33 patients were enrolled according to the protocol without
concomitant ablation (No-Maze group). All patients had an echocardiogram
before and one year after surgery. <br/>Result(s): The 42 ablated patients
who recovered sinus rhythm (SR) one year after surgery had comparable left
and right systolic ventricular function and a mean reduction of LA size by
23% (LA volume index decreased from 66+/-24 to 54+/-13ml/m²,
p=0.004). The 3DE extracted reservoir and booster function showed higher
values after RF ablation compared to Cryo (37+/-10% vs 26+/-6%; p<0.001
resp. 18+/-9 vs 7+/-4%, p<0.001), while passive conduit function was
comparable (24+/-11 vs 20+/-8%; p=0.17). Patients with restored SR without
ablation had more preserved systolic atrial function but similar LA size
reduction as those who underwent maze surgery. <br/>Conclusion(s): SR
restoration after MV surgery and maze results in LA size reduction
irrespective of the energy source used. By 3DE we could show that,
compared to RF maze, the extension of ablation area produced by Cryo
implies a major LA structural remodeling affecting LA systolic function.
The reverse size remodeling seems to be the least, the longer AF history.

<145>
Accession Number
641004294
Title
Outcomes of heart transplantation in adults and pediatrics congenital
heart disease: A systematic review and meta-analysis.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2153), 2022. Date of Publication: September 2022.
Author
Mendel B.M.; Holiyono H.I.H.; Angellia P.A.; Prakoso R.P.; Siagian S.N.S.
Institution
(Mendel, Prakoso, Siagian) National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Holiyono, Angellia) University of Indonesia Hospital, Depok, Indonesia
Publisher
European Respiratory Society
Abstract
Background: Heart transplantation (HTx) has progressed from an
experimental therapy option to a well-established therapeutic option for
congenital heart disease (CHD) patients in end-stage heart failure, thus
we can expect a large number of people with CHD to be evaluated for HTx in
the next decades. <br/>Objective(s): To create a systematic review and
meta-analysis regarding short-term and long-term outcomes of HTx in
end-stage adults and pediatrics CHD patients. <br/>Method(s): Four online
databases were screened from the date of inception to January 2022, where
the acquired studies were assessed using the PRISMA statement. The
inclusion criteria were cohort studies that evaluated outcomes of heart
transplantation in end-stage congenital heart disease patients. The
mortality of adults and pediatrics population were analyzed using
random-effect model, showed as summary statistics of overall risk ratio
(RR) with 95% confidence interval (CI). Quality appraisal was conducted
using the STROBE statement. <br/>Result(s): Ten studies met the inclusion
criteria and were eligible to be analyzed. The pediatric population had
stronger 1-year mortality risk [Std. Mean difference 0.62, 95% CI, 0.12 to
3.07; P<0.00001] and 5-year mortality risk [Std. Mean difference 0.82, 95%
CI, 0.37 to 1.84; P<0.00001], while adult population were found to have
higher overall post-transplantation mortality risk [Std. mean difference
1.17, 95% CI 0.66 to 2.08; P<0.00001]. <br/>Conclusion(s): Adults CHD
patients experienced higher mortality rate following heart
transplantation, with improved long-term survival in comparison to
pediatrics CHD recipients. However, further study should be conducted with
standardized subjects as there is moderate quality of evidence and higher
heterogeneity during our meta-analysis. (Figure Presented).

<146>
Accession Number
641004259
Title
Meta-analysis on the comparison of direct oral anticoagulants versus
vitamin K antagonists after transcatheter aortic valve implantation in
patients with pre-existing atrial fibrillation.
Source
European Respiratory Journal. Conference: European Respiratory Society
International Congress, ERS 2022. Barcelona Spain. 60(Supplement 66) (pp
2100), 2022. Date of Publication: September 2022.
Author
Mateo Q.; Tiongco R.; Bernardo J.
Institution
(Mateo, Tiongco, Bernardo) Saint Lukes Medical Center Global City, Taguig,
Philippines
Publisher
European Respiratory Society
Abstract
Background: Transcatheter aortic valve replacement is a treatment option
for symptomatic patients with severe aortic stenosis who are candidates
for a bioprosthesis across the entire spectrum of risk. TAVR carries a
risk for thrombotic and bleeding events, underscoring the importance of
defining the optimal adjuvant antithrombotic regimen. Antithrombotic
consideration is complicated by the fact that many patients undergoing
TAVR are generally elderly with multiple comorbidities, including
conditions that may require long-term oral anticoagulation such as atrial
fibrillation. The optimal antithrombotic regimen for patients with AF
undergoing TAVR is currently unknown. The objective of this meta-analysis
is to add knowledge to existing data involving the use of direct oral
anticoagulant in patients with pre-existing atrial fibrillation undergoing
TAVI and to explore the safety and efficacy of DOACs compared with VKA in
this population Methods: A systematic search for randomized controlled
trials which compare direct oral anticoagulant and vitamin K antagonist
was done using PubMed, Cochrane, MEDLINE and Clinicaltrials.gov. Studies
which were done in the last five years (January 2016-October 2021) and
those that involved human subjects were included in the study. Search
terms include "Direct Oral Anticoagulant", "Vitamin K Antagonist", "TAVR",
"atrial fibrillation", "DOAC" AND "TAVI" OR "VKA" AND "TAVI" AND "atrial
fibrillation" AND "randomized controlled trial". <br/>Result(s): Five
retrospective observational studies and two RCTs (3,998) were included in
this meta-analysis comparing direct oral anticoagulant vs vitamin K
antagonist in patients with known atrial fibrillation post TAVI.
Dabigatran, Rivaroxaban, Apixaban, and Edoxaban were used in these
different studies. Among patients with concomitant indication of oral
anticoagulant like atrial fibrillation, there is no significant difference
between direct oral anticoagulant and vitamin K antagonist in terms of
outcomes on allcause mortality, major and/or life threatening bleeding and
stroke as shown in these values, (OR 1.05, 95% CI: 0.89-1.25, P=0.57,
I²=39%), (OR=1.04, 95% CI: 0.85-1.27, P=0.70,
I²=45%) and (OR=1.10, 95% CI: 0.80-1.51, p=0.56,
I²=0%), respectively. When only the two RCTs are compared,
still there is no significant difference on the outcomes mentioned above
between direct oral anticoagulant and vitamin K antagonist based on these
values (OR=1.07, 95% CI: 0.85-1.36, P=0.57, I²=0%), (OR=1.15,
95% CI: 0.59-2.24, P=0.68, I²=66%) and (OR=0.99, 95% CI:
0.65-1.49, p=0.95, I²=39%), respectively. <br/>Conclusion(s):
Use of direct oral anticoagulant was non inferior with vitamin K
antagonist in terms of outcomes on all-cause mortality, major and/or life
threatening bleeding and stroke. Direct oral anticoagulant is easier to
use with its known safety profile, hence, it is a plausible alternative to
warfarin in this population in patients with known atrial fibrillation
post TAVR.

<147>
Accession Number
2023924680
Title
Acute abdomen secondary to perforated jejunal gastrointestinal stromal
tumor and imatinib-related isolated pericardial effusion in a 50-year-old
female patient: A case report and review of literature.
Source
International Journal of Surgery Case Reports. 106 (no pagination), 2023.
Article Number: 108197. Date of Publication: May 2023.
Author
Aldosari S.; Ayman A.; Almaiman L.; Alzaid T.; Alhossaini R.; Amin T.
Institution
(Aldosari, Alhossaini) Department of Surgery, King Faisal Specialist
Hospital & Research Center, Riyadh, Saudi Arabia
(Aldosari, Almaiman) College of Medicine, Alfaisal University, Riyadh,
Saudi Arabia
(Ayman, Amin) Department of Surgical Oncology, King Faisal Specialist
Hospital & Research Center, Riyadh, Saudi Arabia
(Ayman) Department of General Surgery, Faculty of Medicine, Alexandria
University, Alexandria, Egypt
(Alzaid) Department of Pathology, King Faisal Specialist Hospital &
Research Center, Riyadh, Saudi Arabia
Publisher
Elsevier Ltd
Abstract
Introduction: Gastrointestinal stromal tumors (GIST) are the most common
mesenchymal tumors of the gastrointestinal tract; occurring most often in
the stomach and to a lesser extent in the jejunum. The majority of the
tumors express activating mutations in either c-KIT or PDGFRA tyrosine
kinases, which respond to tyrosine kinase inhibitors (TKI). Jejunal GIST
is considered to be extremely rare and challenging to diagnose due to its
non-specific presentation. As a result, patients usually present at an
advance stage of the disease, making the prognosis poor and difficult to
manage. Case presentation: In the present study, we report a 50-year-old
female who was diagnosed with metastatic jejunal GIST. She was commenced
on Imatinib (TKI) and shortly after she presented to the emergency
department with an acute abdomen. A CT scan of the abdomen revealed
ischemic changes in the jejunal loops and pneumoperitoneum. The patient
required emergency laparotomy due to perforated GIST, and creation of
pericardial window due to hemodynamic instability possibly secondary
TKI-related isolated pericardial effusion. <br/>Conclusion(s): Jejunal
GIST is rare and usually presents as emergency due to obstruction,
hemorrhage or rarely perforation. Although, systemic therapy with TKI is
the principal treatment for advance disease, Jejunal GIST should be
removed surgically. It is surgically challenging due to the anatomical
complexity of the tumor. Surgeons treating such patients must be cautious
for TKI side effects.<br/>Copyright &#xa9; 2023 The Authors

<148>
Accession Number
2023789483
Title
Treat-to-Target or High-Intensity Statin in Patients with Coronary Artery
Disease: A Randomized Clinical Trial.
Source
JAMA. 329(13) (pp 1078-1087), 2023. Date of Publication: 04 Apr 2023.
Author
Hong S.-J.; Lee Y.-J.; Lee S.-J.; Hong B.-K.; Kang W.C.; Lee J.-Y.; Lee
J.-B.; Yang T.-H.; Yoon J.; Ahn C.-M.; Kim J.-S.; Kim B.-K.; Ko Y.-G.;
Choi D.; Jang Y.; Hong M.-K.
Institution
(Hong, Lee, Lee, Ahn, Kim, Kim, Ko, Choi, Hong) Severance Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Hong) Gangnam Severance Hospital, Seoul, South Korea
(Kang) Gachon University College of Medicine, Incheon, South Korea
(Lee) Kangbuk Samsung Hospital, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Lee) Daegu Catholic University Medical Center, Daegu, South Korea
(Yang) Inje University Busan Paik Hospital, Busan, South Korea
(Yoon) Wonju Severance Christian Hospital, Wonju, South Korea
(Jang) CHA University College of Medicine, Seongnam, South Korea
Publisher
American Medical Association
Abstract
Importance: In patients with coronary artery disease, some guidelines
recommend initial statin treatment with high-intensity statins to achieve
at least a 50% reduction in low-density lipoprotein cholesterol (LDL-C).
An alternative approach is to begin with moderate-intensity statins and
titrate to a specific LDL-C goal. These alternatives have not been
compared head-to-head in a clinical trial involving patients with known
coronary artery disease. <br/>Objective(s): To assess whether a
treat-to-target strategy is noninferior to a strategy of high-intensity
statins for long-term clinical outcomes in patients with coronary artery
disease. <br/>Design, Setting, and Participant(s): A randomized,
multicenter, noninferiority trial in patients with a coronary disease
diagnosis treated at 12 centers in South Korea (enrollment: September 9,
2016, through November 27, 2019; final follow-up: October 26, 2022).
<br/>Intervention(s): Patients were randomly assigned to receive either
the LDL-C target strategy, with an LDL-C level between 50 and 70 mg/dL as
the target, or high-intensity statin treatment, which consisted of
rosuvastatin, 20 mg, or atorvastatin, 40 mg. <br/>Main Outcomes and
Measures: Primary end point was a 3-year composite of death, myocardial
infarction, stroke, or coronary revascularization with a noninferiority
margin of 3.0 percentage points. <br/>Result(s): Among 4400 patients, 4341
patients (98.7%) completed the trial (mean [SD] age, 65.1 [9.9] years;
1228 females [27.9%]). In the treat-to-target group (n = 2200), which had
6449 person-years of follow-up, moderate-intensity and high-intensity
dosing were used in 43% and 54%, respectively. The mean (SD) LDL-C level
for 3 years was 69.1 (17.8) mg/dL in the treat-to-target group and 68.4
(20.1) mg/dL in the high-intensity statin group (n = 2200) (P =.21,
compared with the treat-to-target group). The primary end point occurred
in 177 patients (8.1%) in the treat-to-target group and 190 patients
(8.7%) in the high-intensity statin group (absolute difference, -0.6
percentage points [upper boundary of the 1-sided 97.5% CI, 1.1 percentage
points]; P <.001 for noninferiority). <br/>Conclusions and Relevance:
Among patients with coronary artery disease, a treat-to-target LDL-C
strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity
statin therapy for the 3-year composite of death, myocardial infarction,
stroke, or coronary revascularization. These findings provide additional
evidence supporting the suitability of a treat-to-target strategy that may
allow a tailored approach with consideration for individual variability in
drug response to statin therapy. Trial Registration: ClinicalTrials.gov
Identifier: NCT02579499.<br/>Copyright &#xa9; 2023 American Medical
Association. All rights reserved.

<149>
Accession Number
2022466131
Title
Anticoagulation therapy and clinical outcomes following transcatheter
mitral valve repair for patients with mitral regurgitation: A
meta-analysis.
Source
Clinical Cardiology. (no pagination), 2023. Date of Publication: 2023.
Author
Zhang J.; Yang Y.; Jia L.; Su J.; Xiao A.; Lin X.
Institution
(Zhang, Yang, Jia, Su, Xiao, Lin) Cardiology Department, The First
Affiliated Hospital of Anhui Medical University, Anhui, Hefei, China
(Zhang, Yang, Jia, Su, Xiao) Graduate School, Anhui Medical University,
Anhui, China
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter mitral valve repair (TMVR) using MitraClip (MC) is now an
established technique in the interventional treatment of mitral
regurgitation. Common complications after MC procedure are bleeding and
ischemic events. However, 2017 ESC/EACTS and 2020 ACC/AHA did not give a
clear antithrombotic protocol, the policy has been based on clinical
experience. Here, we performed a meta-analysis comparing outcomes with and
without the addition of anticoagulants after TMVR. We searched the
Cochrane Library, EMBASE, PubMed, and Web of Science from inception to
October 6, 2022 to identify studies with or without the use of
anticoagulants after TMVR. From each study, we extracted the number of
people with bleeding, stroke, combined endpoints, and all-cause death.
Five observational cohort studies were included, enrolling a total of 1892
patients undergoing TMVR who were assigned to either the anticoagulation
group (n = 1209) or the no-anticoagulation group (n = 683). Pooled
analysis showed a significantly lower stroke rate in the anticoagulated
group (at least 4 weeks duration) compared with the non-anticoagulated
group (RR [95% CI] = 0.14 [0.0-0.77], p = 0.02), and similar rates of
bleeding, combined endpoints, and all-cause death in both groups (RR [95%
CI] = 0.76 [0.48-1.22], p = 0.26), (RR [95% CI] = 0.52 [0.10-2.63], p =
0.43), and (RR [95% CI] = 0.89 [0.58-1.35], p = 0.58). We observed a
reduced risk of stroke without elevated risk of bleeding, combined
endpoints, or all-cause death in patients using anticoagulants (at least 4
weeks duration) after TMVR compared to no anticoagulants.<br/>Copyright
&#xa9; 2023 The Authors. Clinical Cardiology published by Wiley
Periodicals, LLC.

<150>
Accession Number
2022334563
Title
Is robotic assistance an added value in minimally invasive mitral valve
surgery? A meta-analysis from propensity score-matched series.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2023. Date of
Publication: 2023.
Author
Jegaden O.; Al Shamry A.; Ashafy S.; Mahdi A.; Eker A.
Institution
(Jegaden, Mahdi) Department of Cardiac Surgery, Mediclinic Middle East,
MBRU, AbuDhabi, United Arab Emirates
(Al Shamry) Department of Cardiac Surgery and ICU, Saudi German Hospital,
Dubai, United Arab Emirates
(Ashafy) Department of Cardiac Surgery, Zayed Military Hospital, AbuDhabi,
United Arab Emirates
(Eker) Department of Cardiac Surgery, Centre Cardio-Thoracic, Monaco,
Monaco
Publisher
SAGE Publications Inc.
Abstract
Objectives: There is still ongoing debate about the benefits of robotic
assistance (R-MVS) in comparison with video assistance (V-MVS) in
minimally invasive mitral valve surgery. This study aims to update the
current evidence. <br/>Method(s): Three propensity score-matched studies
published from 2011 to 2021 were included with a total of 1193 patients
operated on from 2005 (R-MVS: 536, V-MVS: 657). Data regarding early
mortality, postoperative event, and time-related outcomes were extracted
and submitted to a meta-analysis using weighted random-effects modeling.
<br/>Result(s): The incidence of early mortality, stroke, renal failure,
conversion, atrial fibrillation, and prolonged ventilation were similar,
all in the absence of heterogeneity. Reoperation for bleeding (odds ratio
[OR]: 0.36, 95% confidence interval [CI] 0.16-0.81, p = 0.01) and the need
for blood transfusion (OR: 0.30, 95% CI, 0.20-0.56, p = 0.001) were
significantly lower in V-MVS group. Regarding time-related outcomes, there
was evidence for important heterogeneity of treatment effect among the
studies. Operative times were longer in R-MVS: differences in means were
20.7 min for cross-clamp time (95% CI, 9.07-32.3, p = 0.001), 20.7 min for
cardiopulmonary bypass time (95% CI, 2.5-38.9, p = 0.03) and 40.2 min for
total operative time (95% CI, 24.5-55.8, p < 0.001). Intensive care unit
stay and hospital stay were reported in one study, and longer after R-MVS
compared to V-MVS; the differences in means were 0.17 days (p = 0.005) and
0.6 days (p = 0.017), respectively. Total cost of both procedures was
reported in an additional dedicated propensity score-matched series
including 448 patients; it was 21% higher for R-MVS than for V-MVS.
<br/>Conclusion(s): This meta-analysis showed excellent outcomes of both
video and robotic techniques with low incidence of morbidity and
mortality. However, there is no evidence for an added value of robotic
assistance in comparison with video assistance; the drawbacks of mini
access are reported higher regardless the induced over cost.<br/>Copyright
&#xa9; The Author(s) 2023.

<151>
Accession Number
641012559
Title
Aspirin vs Clopidogrel for Long-term Maintenance After Coronary Stenting
in Patients With Diabetes: A Post Hoc Analysis of the HOST-EXAM Trial.
Source
JAMA cardiology. (no pagination), 2023. Date of Publication: 12 Apr 2023.
Author
Rhee T.-M.; Bae J.-W.; Park K.W.; Rha S.-W.; Kang J.; Lee H.; Yang H.-M.;
Kwak S.-H.; Chae I.-H.; Shin W.-Y.; Kim D.-K.; Oh J.H.; Jeong M.H.; Kim
Y.H.; Lee N.H.; Hur S.-H.; Yoon J.; Han J.-K.; Shin E.-S.; Koo B.-K.; Kim
H.-S.
Institution
(Rhee, Park, Kang, Yang, Kwak, Han, Koo, Kim) Seoul National University
Hospital and Seoul National University College of Medicine, Seoul, South
Korea
(Bae) Chungbuk National University College of Medicine, Cheongju, South
Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Lee) Seoul National University Healthcare System Gangnam Center, Seoul
National University College of Medicine, Seoul, South Korea
(Chae) Seoul National University Bundang Hospital, Seongnam, South Korea
(Shin) Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
(Kim) Busan Paik Hospital, Inje University, Busan, South Korea
(Oh) Samsung Changwon Hospital, Sungkyunkwan University, Changwon, South
Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Kim) Kangwon National University, School of Medicine, Chuncheon, South
Korea
(Lee) Kangnam Sacred Heart Hospital, Hallym University, Seoul, South Korea
(Hur) Keimyung University Dongsan Hospital, Daegu, South Korea
(Yoon) Yonsei University Wonju Severance Christian Hospital, Wonju, South
Korea
(Shin) Ulsan University Hospital, Ulsan, South Korea
Publisher
NLM (Medline)
Abstract
Importance: Selecting the optimal antiplatelet agent in patients who have
received percutaneous coronary intervention is especially important in
those with diabetes due to the heightened risk of ischemic events in this
population. Studies on the efficacy and safety of clopidogrel vs aspirin
for long-term maintenance after percutaneous coronary intervention in
patients with diabetes are lacking. <br/>Objective(s): To investigate
cardiovascular outcomes with clopidogrel vs aspirin in patients with and
without diabetes. <br/>Design, Setting, and Participant(s): This was a
post hoc analysis of the HOST-EXAM randomized clinical trial, an
investigator-initiated, prospective, randomized, open-label, multicenter
trial performed at 37 centers in Korea. Patients who received dual
antiplatelet therapy without clinical events for 6 to 18 months after
percutaneous coronary intervention with drug-eluting stents were enrolled
from March 2014 to May 2018 with follow-up at 6, 12, 18, and 24 months.
All 5438 patients in the original trial were included in this analysis,
which was conducted from June to October 2021. Interventions and
Exposures: Enrolled patients were randomized 1:1 to clopidogrel or aspirin
monotherapy. Subgroup analyses were performed by the presence of diabetes.
<br/>Main Outcomes and Measures: The main outcome was primary composite
end point of all-cause death, nonfatal myocardial infarction, stroke,
readmission due to acute coronary syndrome, and major bleeding (Bleeding
Academic Research Consortium type 3 or 5) at 24-month follow-up.
<br/>Result(s): Of 5438 patients (mean [SD] age, 63.5 [10.7] years; 1384
[25.5%] female), 1860 (34.2%) had diabetes (925 in the clopidogrel arm and
935 in the aspirin arm), and 5338 (98.2%) completed follow-up. The rate of
the primary composite end point was significantly lower in the clopidogrel
group compared to the aspirin group in patients with diabetes (6.3% vs
9.2%; hazard ratio [HR], 0.69; 95% CI, 0.49-0.96; P=.03; absolute risk
difference [ARD], 2.7%; number needed to treat [NNT], 37) and without
diabetes (5.3% vs 7.0%; HR, 0.76; 95% CI, 0.58-1.00; P=.046; ARD, 1.6%,
NNT, 63; P for interaction=.65). The presence of diabetes was not
associated with a difference in benefit observed with clopidogrel
monotherapy over aspirin for the thrombotic composite end point (HR, 0.68;
95% CI, 0.45-1.04 for patients with diabetes vs HR, 0.68; 95% CI,
0.49-0.93 for those without; P for interaction=.99) and any bleeding with
Bleeding Academic Research Consortium 2, 3, or 5 (HR, 0.65; 95% CI,
0.39-1.09 for patients with diabetes vs HR, 0.74; 95% CI, 0.48-1.13 for
those without; P for interaction=.71). Conclusion and Relevance: In this
study, clopidogrel monotherapy was associated with a lower rate of the
primary composite end point compared to aspirin monotherapy as long-term
maintenance therapy after dual antiplatelet therapy for coronary stenting
in both patients with and without diabetes. Clopidogrel might thus be
considered rather than aspirin in patients who have undergone coronary
stenting and successfully completed dual antiplatelet therapy, regardless
of diabetes status. Trial Registration: ClinicalTrials.gov Identifier:
NCT02044250.

<152>
Accession Number
2022085724
Title
Quantitative flow ratio vs. angiography-only guided PCI in STEMI patients:
one-year cardiovascular outcomes.
Source
BMC Cardiovascular Disorders. 23(1) (no pagination), 2023. Article Number:
136. Date of Publication: December 2023.
Author
Barauskas M.; Ziubryte G.; Jodka N.; Unikas R.
Institution
(Barauskas, Ziubryte, Jodka, Unikas) Department of Cardiology, Hospital of
Lithuanian University of Health Sciences, Kaunas, Lithuania
(Ziubryte) Institute of Cardiology, Lithuanian University of Health
Sciences, Kaunas, Lithuania
Publisher
BioMed Central Ltd
Abstract
Background: Coronary physiology-guided PCIs are recommended worldwide.
However, invasive coronary physiology methods prolong the procedure,
create additional risks for the patients, and prolong the fluoroscopy time
for an interventional cardiologist. Otherwise, there is a noninvasive
coronary physiology evaluation method, QFR, that can be safely used even
in STEMI patients. <br/>Method(s): A total of 198 patients admitted with
STEMI and at least one intermediate (35-75%) diameter stenosis other than
the culprit artery between July 2020 and June 2021 were prospectively
included in this single-center study. All patients were randomized into
one of two groups (1 - QFR-guided PCI; 2 - visual-estimation-only guided
PCI). A 12-month follow-up with echocardiography, exercise stress test,
and quality of life evaluation was performed in all included patients. For
the QOF evaluation, the Seattle Angina Score Questionnaire was chosen.
Statistical analysis was performed using the Kolmogorov-Smirnov test,
Student's t-test, Mann-Whitney U test, Pearson's chi-squared test and
Kaplan-Meier estimator. <br/>Result(s): Ninety-eight (49.5%) patients were
randomized to the first group, and 100 (50.5%) patients were included in
the second group. Statistically, significantly more patients had a medical
history of dyslipidemia (98 vs. 91, p = 0.002) and slightly better left
ventricular ejection fraction (42.21 +/- 7.88 vs. 39.45 +/- 9.62, p =
0.045) in the QFR group. Six fewer patients required non-culprit artery
revascularization within the 12-month FU in the QFR group (1.02% vs. 6%, p
= 0.047). Survival analysis proved that patients in the Angio group had a
more than 6-fold greater risk for death within a 12-month period after MI
(OR 6.23, 95% CI 2.20-17.87, p = 0.006), with the highest mortality risk
within the first two months after initial treatment. <br/>Conclusion(s):
Using QFR in non-culprit lesions in patients with ST-elevation myocardial
infarction reduces mortality and revascularization at the 12-month
follow-up and improves the quality of life of the patient. Trial
registration: The study was approved by the Regional Bioethical Committee
and conducted under the principles of the Helsinki Declaration and local
laws and regulations.<br/>Copyright &#xa9; 2023, The Author(s).

<153>
Accession Number
2023147820
Title
The analgesic effect of erector spinae plane block in thoracic surgery: a
systematic review and meta-analysis of randomized controlled trials.
Source
Signa Vitae. 19(2) (pp 161-170), 2023. Date of Publication: March 2023.
Author
Li Y.; Hou Y.-L.; Guan H.-Y.; Luo H.-X.
Institution
(Li, Hou, Guan, Luo) Department of Anesthesiology, Yongchuan affiliated
Hospital of Chongqing Medical University, Yongchuan, Chongqing 402160,
China
Publisher
Pharmamed Mado Ltd
Abstract
The erector spinae plane block (ESPB) is a new analgesic technology that
came out for the first time in 2016. Some studies have shown that it can
provide effective analgesia in thoracic surgery. This systematic review
and meta-analysis is to evaluate the analgesic effect of ESPB in patients
undergoing thoracic surgery. Embase, PubMed, The Cochrane Library, VIP
database, CNKI, Wanfang database, CBM, were systematically searched, from
2010 to December, 2020. Randomised controlled trials (RCTs) were included
to assess the analgesic effect of the ESPB in thoracic surgery. Eighteen
studies with a total of 1303 patients were included. ESPB group reduced
postoperative 48-hour pain scores at rest or movement at different time
points compared with the control group. ESPB group also showed lower
incidence of postoperative nausea and vomiting (PONV) (odds ratio, OR =
0.48, 95% CI = 0.33 0.71, P < 0.05). ESPB group were better at the number
of patient-controlled intravenous analgesia (PCIA) pressing times (mean
difference, MD = -6.83, 95% CI = -8.73 -4.94, P < 0.05). This review has
shown that compared with simple general anesthesia (GA), GA combined with
ESPB significantly decreases postoperative pain, PONV and opioids
requirements following thoracic surgery.<br/>Copyright &#xa9; 2023 The
Author(s).

<154>
Accession Number
2023644562
Title
Exeporfinium chloride (XF-73) nasal gel dosed over 24 hours prior to
surgery significantly reduced Staphylococcus aureus nasal carriage in
cardiac surgery patients: Safety and efficacy results from a randomized
placebo-controlled phase 2 study.
Source
Infection Control and Hospital Epidemiology. 28 (no pagination), 2023.
Date of Publication: 23 Mar 2023.
Author
Mangino J.E.; Firstenberg M.S.; Milewski R.K.C.; Rhys-Williams W.; Lees
J.P.; Dane A.; Love W.G.; Gonzalez Moreno J.
Institution
(Mangino) Division of Infection Diseases, Department of Internal Medicine,
The Ohio State University, Columbus, OH, United States
(Firstenberg) William Novick Global Cardiac Alliance, Aurora, CO, United
States
(Milewski) Department of Surgery, Yale School of Medicine, New Haven, CT,
United States
(Rhys-Williams, Lees, Love, Gonzalez Moreno) Destiny Pharma, Brighton,
United Kingdom
(Dane) Danestat Consulting Ltd, Macclesfield, United Kingdom
Publisher
Cambridge University Press
Abstract
We studied 83 cardiac-surgery patients with nasal S. aureus carriage who
received 4 intranasal administrations of XF-73 nasal gel or placebo <24
hours before surgery. One hour before surgery, patients exhibited a S.
aureus nasal carriage reduction of 2.5 log10 with XF-73 compared to 0.4
log10 CFU/mL for those who received placebo (95% CI, -2.7 to -1.5; P
<.0001).<br/>Copyright &#xa9; Destiny Pharma plc, 2023. Published by
Cambridge University Press on behalf of The Society for Healthcare
Epidemiology of America.

<155>
Accession Number
2021562381
Title
Comparison of Postoperative Recovery between Balanced and Total
Intravenous Anesthesia in Patients Undergoing Off-Pump Coronary Artery
Bypass (OPCAB) Surgery: A Prospective, Single-Blind Randomized Study.
Source
International Journal of Environmental Research and Public Health. 20(3)
(no pagination), 2023. Article Number: 2310. Date of Publication: February
2023.
Author
Kang D.; Kim M.; Bae H.-B.; Moon S.; Kim J.
Institution
(Kang, Kim) Department of Anesthesiology and Pain Medicine, Chonnam
National University, Hwasun Hospital, Chonnam, Hwasun 58128, South Korea
(Bae, Kim) Department of Anesthesiology and Pain Medicine, Medical School,
Chonnam National University, Gwangju 61469, South Korea
(Bae, Moon, Kim) Department of Anesthesiology and Pain Medicine, Chonnam
National University Hospital, Gwangju 61469, South Korea
Publisher
MDPI
Abstract
Recovery after anesthesia has a significant impact on a patient's return
to daily life. This study was performed to compare the postoperative
quality of recovery according to the method of anesthesia administered
among patients undergoing OPCAB using the Korean version of the Quality of
Recovery-40 (QoR-40K) questionnaire. This single-blind, prospective study
(trial number: KCT0004726) was performed using a population of 102
patients undergoing OPCAB under general anesthesia. The patients were
randomly assigned to one of two groups using a computer-generated list: a
total intravenous anesthesia group (Group T) and a balanced anesthesia
group (Group B). The QoR-40K score was measured preoperatively and at 24
and 48 h after extubation. There was no significant difference in the
QoR-40K scores between the groups at 24 and 48 h after extubation. In
addition, there were no significant differences between groups with
respect to any of the five dimensions of QoR-40K at 24 and 48 h after
extubation. Finally, there were no differences in the postoperative opioid
consumption, time to extubation, or length of hospital stay. In this
study, there was no difference in the QoR-40K score at 24 h after
extubation between Groups T and B. Therefore, both methods of anesthesia
are suitable for use when performing OPCAB.<br/>Copyright &#xa9; 2023 by
the authors.

<156>
Accession Number
2022575514
Title
Subclinical Leaflet Thrombosis After Balloon versus Self-Expandable
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 192 (pp 88-97), 2023. Date of Publication:
01 Apr 2023.
Author
Bansal A.; Agarwal S.; Braghieri L.; Jaggi C.; Bakhtadze B.; Prasada S.;
Reed G.W.; Puri R.; Yun J.; Menon V.; Krishnaswamy A.; Kapadia S.R.
Institution
(Bansal, Braghieri, Jaggi, Bakhtadze, Prasada, Reed, Puri, Yun, Menon,
Krishnaswamy, Kapadia) Department of Cardiovascular Medicine, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Agarwal) Department of Internal Medicine, University of Oklahoma,
Oklahoma City, OK, United States
Publisher
Elsevier Inc.
Abstract
Hypoattenuated leaflet thickening (HALT) has been recognized as one of the
complications after transcatheter aortic valve implantation and may
promote structural valve degeneration and increase the risk of
cerebrovascular events. The 2 main types of available transcatheter heart
valves (THVs), the balloon-expandable (BE) and the self-expanding (SE),
are interchangeably used in clinical practice despite substantial design
differences. There is unclear evidence on whether these 2 different THV
models are achieving similar or different rates of subclinical leaflet
thrombosis/HALT. A systematic search of electronic databases was conducted
to identify studies that reported the incidence of HALT between SE THVs
and BE THVs. The Mantel-Haenszel method was used to calculate the 95%
confidence interval and pooled risk ratio with a random-effects model. A
total of 126 records were identified, of which 22 studies comprising
14,401 patients were included in our final analysis. Among 5,951 patients
receiving SE THVs, 194 (3.2%) developed HALT, compared with 8,450 patients
receiving BE THVs, of whom 484 (5.7%) developed HALT. There was a
statistically significant decrease in the risk of developing HALT in
patients receiving SE THVs compared with those receiving BE THVs (risk
ratio 0.75, 95% confidence interval 0.59 to 0.95, I² 32%, p =
0.02). In conclusion, could potentially reduce the risk of
HALT/subclinical leaflet thrombosis.<br/>Copyright &#xa9; 2023 Elsevier
Inc.

<157>
Accession Number
2022267186
Title
Impact of Mitral Regurgitation Recurrence on Mitral Valve Repair for
Secondary Ischemic Mitral Regurgitation.
Source
Journal of Cardiovascular Development and Disease. 10(3) (no pagination),
2023. Article Number: 124. Date of Publication: March 2023.
Author
Salsano A.; Nenna A.; Molinari N.; Avtaar Singh S.S.; Spadaccio C.;
Santini F.; Chello M.; Fiore A.; Nappi F.
Institution
(Salsano, Santini) DISC Department, University of Genoa, Genova 16132,
Italy
(Nenna, Chello) Department of Cardiovascular Surgery, Universita Campus
Bio-Medico di Roma, Rome 00128, Italy
(Molinari) IDESP, INSERM, PreMEdical INRIA, University of Montpellier, CHU
Montpellier, Montpellier 34295, France
(Avtaar Singh) Cardiothoracic Surgery, Royal Infirmary of Edinburgh,
Edinburgh EH16 4SA, United Kingdom
(Spadaccio) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN 55905, United States
(Fiore) Department of Cardiac Surgery, Hopitaux Universitaires Henri
Mondor APHP, Creteil 94000, France
(Fiore) Advanced Surgical Technologies, Sapienza University of Rome, Roma
00128, Italy
(Nappi) Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis,
Paris 93200, France
Publisher
MDPI
Abstract
Objectives. The current guidelines still do not include specific
recommendations on the use of subvalvular repair (SV-r) for treatment of
ischemic mitral regurgitation (IMR). Therefore, the objective of our study
was to evaluate the clinical impact of mitral regurgitation (MR)
recurrence and ventricular remodeling on long-term outcomes after SV-r
combined with restrictive annuloplasty (RA-r). Methods. We performed a
subanalysis of the papillary muscle approximation trial, studying 96
patients with severe IMR and coronary artery disease undergoing
restrictive annuloplasty alongside subvalvular repair (SV-r + RA-r group)
or restrictive annuloplasty alone (RA-r group). We analyzed treatment
failure differences, the influence of residual MR, left ventricular
remodeling, and clinical outcomes. The primary endpoint was treatment
failure (composite of death; reoperation; or recurrence of moderate,
moderate-to-severe, or severe MR) within 5 years of follow-up after the
procedure. Results. A total of 45 patients showed failure of the treatment
within 5 years, of which 16 patients underwent SV-r + RA-r (35.6%) and 29
underwent RA-r (64.4%, p = 0.006). Patients with significant residual MR
presented with a higher rate of all-cause mortality at 5 years compared
with trivial MR (HR 9.09, 95% CI 2.08-33.33, p = 0.003). MR progression
occurred earlier in the RA-r group, as 20 patients in the RA-r group vs. 6
in SV-r + RA-r group had a significant MR 2 years after surgery (p =
0.002). Conclusions. RA-r remains a surgical mitral repair technique with
an increased risk of failure and mortality at 5 years compared with SV-r.
The rates of recurrent MR are higher, and recurrence occurs earlier, with
RA-r alone compared to SV-r. The addition of the subvalvular repair
increases the durability of the repair, thus extending all of the benefits
of preventing MR recurrence.<br/>Copyright &#xa9; 2023 by the authors.

<158>
Accession Number
2022240623
Title
Preventing pressure injury in open-heart surgical patients: A systematic
review.
Source
Health Science Reports. 6(3) (no pagination), 2023. Article Number: e1148.
Date of Publication: March 2023.
Author
Taghiloo H.; Ebadi A.; Saeid Y.; Jalali Farahni A.; Davoudian A.
Institution
(Taghiloo) MSc in Operating Room, School of Nursing, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ebadi) Behavioral Sciences Research Centre, Life Style Institute, School
of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Saeid) Trauma Research Center and Faculty of Nursing, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Jalali Farahni) School of Medicine, Atherosclerosis Research Center,
Baqiyatallah University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Davoudian) Deputy of Research and Technology, Zanjan University of
Medical sciences, Zanjan, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc
Abstract
Background: Cardiac surgical patients are highly prone to developing
surgery-related Pressure injuries (PIs). Prevention of PIs is an important
patient safety priority in healthcare settings and patients care. So the
aim of this study is to detect the effectiveness of prevention strategies
to decrease PIs prevalence and incidence in patients undergoing open heart
surgery. <br/>Method(s): We identified studies through Web of Science,
Scopus, PubMed, Cochrane, and ProQuest databases from inception through
September 2022 with restrictions on the English language. Cochrane RoB 2,
JBI, and NIH checklist were carried out as critical appraisal Tools to
investigate the studies risk of bias. Finally, 10 studies with a total
sample No. 1348, which fulfilled eligibility criteria were included in
final systematic review. <br/>Result(s): Most common interventions
investigated in included studies were addressing impairments skin care
which included the use of multilayer silicone foam, Care bundle and
multiple intervention programs, alternative head inflatable pads,
pressure-reducing foam mattresses, and electric bed frames as the
effective PIs Prevention (PIP) strategies. While repositioning is one of
the important causes mentioned in most PIP protocols, there was not
adequate evidence to recommend any special turning regimens for PIP.
<br/>Conclusion(s): Given current evidence, multilayer silicone foam, Care
bundle and multiple intervention programs, alternative inflatable head
pads, pressure-reducing foam mattresses, and electric bed frames are
effective strategies to prevent pressure ulcers. Further investigations
are needed to specify the cost-effectiveness of mentioned strategies and
RCTs to determine other PIP strategies such as repositioning and
mobilization, nutritional supplementation, creams, and co-interventions
effects.<br/>Copyright &#xa9; 2023 The Authors. Health Science Reports
published by Wiley Periodicals LLC.

<159>
Accession Number
640991993
Title
Effects of Combined Use of Salbutamol/Budesonide in Thoracic Surgery on
Postoperative Myocardial Injury (MINS) - A Prospective Randomized Clinical
Trial.
Source
Drug design, development and therapy. 17 (pp 1025-1036), 2023. Date of
Publication: 2023.
Author
Lin S.; Zhang Y.; Huang X.; Zhang X.; Cheng E.; Zhou Z.; Liu J.
Institution
(Lin, Zhang, Huang, Zhang, Cheng, Liu) Department of Anesthesiology,
Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
(Zhou) Department of Anesthesiology, Affiliated Taian City Central
Hospital of Qingdao University, Shandong, China
(Liu) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical
University, Xuzhou, Jiangsu, China
(Liu) Jiangsu Province Key Laboratory of Anesthesia and Analgesia
Application Technology, Xuzhou Medical University, Xuzhou, Jiangsu, China
(Liu) NMPA Key Laboratory for Research and Evaluation of Narcotic and
Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, China
Publisher
NLM (Medline)
Abstract
Purpose: This study aims to investigate whether the administration of
salbutamol/budesonide reduced the incidence of myocardial injury in
thoracic surgery. <br/>Method(s): The randomized controlled trial included
298 patients over 45 and at high-risk for cardiovascular complications
after lobectomy. Patients in the experimental group were treated with
salbutamol/budesonide after anesthesia induction with fiberoptic
bronchoscope. The primary outcome was the incidence rates of myocardial
injury, assessed before and three days after the operation. The secondary
outcome was respiratory function at each time point during the operation,
including lung compliance and arterial partial pressure of oxygen,
postoperative pulmonary and cardiovascular complications, hospital stay,
pain score, and analgesic dosage. <br/>Result(s): In the control group,
the incidence of myocardial injury was 57/150 (38%), while that in the
experimental group was 33/148 (22%); compared between the two groups, the
difference in the incidence of myocardial injury was statistically
significant. The dynamic compliance and static compliance at half an hour
after the start of surgery in the experimental group were significantly
improved. Before leaving the operating room, the difference in arterial
oxygen partial pressure between the two groups was statistically
significant. <br/>Conclusion(s): Intraoperative administration of
salbutamol/budesonide reduced the incidence of myocardial injury after
thoracic surgery, improved lung function, and reduced the incidence of
postoperative pulmonary complications.<br/>Copyright &#xa9; 2023 Lin et
al.

<160>
Accession Number
640991596
Title
The effects of differing anticoagulant regimes on blood quality after cell
salvage in coronary artery bypass grafting (CABG): a pilot study.
Source
Journal of cardiothoracic surgery. 18(1) (pp 116), 2023. Date of
Publication: 08 Apr 2023.
Author
Boer W.; van Tornout M.; Brusseleers M.; Strauven M.; de Vooght P.; Vander
Laenen M.; Hoste E.; Jorens P.G.
Institution
(Boer) Department of Anesthesiology, Intensive Care Medicine, Emergency
Medicine and Pain Medicine, Ziekenhuis Oost Limburg ZOL, Genk, Belgium
(van Tornout) Department of Anesthesiology and Intensive Care Medicine, AZ
Sint-Jan Brugge-Oostende AV, Brugge, Belgium
(Brusseleers, Strauven, de Vooght, Vander Laenen) Department of
Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain
Medicine, Ziekenhuis Oost Limburg ZOL, Genk, Belgium
(Hoste) Intensive Care Unit, Department of Internal Medicine and
Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
(Hoste) Research Foundation Flanders (FWO), Brussels, Belgium
(Jorens) Department of Critical Care Medicine, Antwerp University
Hospital, University of Antwerp, Edegem, Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cell salvage reduces allogenic blood transfusion requirements
in surgery. We present a pilot study exploring the impact of anticoagulant
choice, citrate or heparin, on the quality of cell salvaged blood in
adults undergoing coronary artery bypass grafting (CABG). MATERIALS AND
METHODS: Elective on pump CABG patients were randomly allocated to citrate
or heparin anticoagulation. We measured red blood cell characteristics and
inflammation in both the blood collection reservoir and the washed red
blood cell concentrate. Postoperatively, the level of biomarkers and the
coagulation profile in the peripheral blood as well as the transfusion
requirements of allogenic blood products were studied. <br/>RESULT(S):
Thirty eight patients were included, 19 in the citrate group and 19 in the
heparin group. Baseline characteristics were similar. In the washed red
blood cell concentrate, Mean Hb (g/dl) and Ht (%) were lower in the
citrate group [Hb: 18.1 g/dL (SD 1.3) vs. 21.1 (1.6), p<0.001; Ht: 59.9%
(54.7-60.9) vs. 63.7% (62.3-64.8); p<0.001]; Mean corpuscular volume (MCV,
mum 3) was higher [99.1fL (9.4) vs. 88 (4.2), p<0.001] and mean
corpuscular hemoglobin concentration (MCHC, g/dl) lower in the citrate
group [31.9 g/dl (29.6-32.4) vs. 33.6 (33.1-34.0) p<0.001]. Thrombocyte
count (1000/mul) was higher in the citrate group [31.0 (26.0-77.0) vs.
13.0 (10.0-39.0); p=0.006]. There were no differences in the requirement
for allogenic blood products' transfusion (intraoperatively and
postoperatively) or in the coagulation parameters after washed red blood
cell concentrate infusion. Higher IL-10 was found in the citrate group in
the blood collection reservoir, higher neutrophil-derived myeloperoxidase
(MPO) in the heparin group after washed red blood cell concentrate
infusion. <br/>CONCLUSION(S): Though red blood cells in washed red blood
cell concentrate were more swollen and diluted in the citrate group with
more residual thrombocytes, published quality guidelines were met in both
groups. Our pilot study suggests that differences in inflammatory markers
in the blood collection reservoir and after infusion of washed red blood
cell concentrate indicate a possible pro-inflammatory effect of heparin
compared to citrate. A larger study is warranted to confirm these results
and their possible clinical consequences. Trial registration
ClinicalTrials.gov : NCT02674906. Registered 5 February
2016.<br/>Copyright &#xa9; 2023. The Author(s).

<161>
Accession Number
640029767
Title
Antithrombotic therapy and cardiovascular outcomes after transcatheter
aortic valve implantation in patients without indications for chronic oral
anticoagulation: a systematic review and network meta-analysis of
randomized controlled trials.
Source
European heart journal. Cardiovascular pharmacotherapy. 9(3) (pp 251-261),
2023. Date of Publication: 10 Apr 2023.
Author
Guedeney P.; Roule V.; Mesnier J.; Chapelle C.; Portal J.-J.; Laporte S.;
Ollier E.; Zeitouni M.; Kerneis M.; Procopi N.; Barthelemy O.; Sorrentino
S.; Mihalovic M.; Silvain J.; Vicaut E.; Montalescot G.; Collet J.-P.
Institution
(Guedeney, Zeitouni, Kerneis, Procopi, Barthelemy, Silvain, Montalescot,
Collet) Sorbonne Universite, ACTION Study Group, Institut de Cardiologie,
Centre Hospitalier Universitaire, Pitie-Salpetriere, 47 Boulevard de
l'Hopital, Paris 75013, France
(Roule) Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de
Caen Normandie, Normandie Univ, Caen, France
(Mesnier) French Alliance for Cardiovascular Trials (FACT), Universite de
Paris, Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris,
France
(Chapelle, Laporte, Ollier) Unite de Recherche Clinique, Innovation et
Pharmacologie, Saint-Etienne, CHU de Saint-Etienne, France
(Portal, Vicaut) Unite de Recherche Clinique, Lariboisiere Hospital
(AP-HP), ACTION Study Group, Paris, France
(Sorrentino) Division of Cardiology, Department of Medical and Surgical
Science, Magna Graecia University, Catanzaro, Italy
(Mihalovic) Cardiocenter, Third Faculty of Medicine, Charles University,
University Hospital Kralovske Vinohrady, Prague, Czechia
Publisher
NLM (Medline)
Abstract
AIMS: As the antithrombotic regimen that may best prevent ischaemic
complications along with the lowest bleeding risk offset following
transcatheter aortic valve implantation (TAVI) remains unclear, we aimed
to compare the safety and efficacy of antithrombotic regimens in patients
without having an indication for chronic oral anticoagulation. METHODS AND
RESULTS: We conducted a PROSPERO-registered (CRD42021247924) systematic
review and network meta-analysis of randomized controlled trials
evaluating post-TAVI antithrombotic regimens up to April 2022. We
estimated the relative risk (RR) and 95% confidence intervals (95% CIs)
using a random-effects model in a frequentist pairwise and network
metanalytic approach. We included seven studies comprising 4006 patients
with a mean weighted follow-up of 12.9 months. Risk of all-cause death was
significantly reduced with dual antiplatelet therapy (DAPT) compared with
low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR
0.60, 95% CI 0.41-0.88), while no significant reduction was observed with
SAPT vs. DAPT (RR 1.02, 95% CI 0.67-1.58) and SAPT and DAPT compared with
apixaban or edoxaban (RR 0.60, 95% CI 0.32-1.14 and RR 0.59, 95% CI
0.34-1.02, respectively). SAPT was associated with a significant reduction
of life-threatening, disabling, or major bleeding compared with DAPT (RR
0.45, 95% CI 0.29-0.70), apixaban or edoxaban alone (RR 0.45, 95% CI
0.25-0.79), and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95% CI
0.16-0.57). There were no differences between the various regimens with
respect to myocardial infarction, stroke, or systemic embolism.
<br/>CONCLUSION(S): Following TAVI in patients without an indication for
chronic oral anticoagulant, SAPT more than halved the risk of bleeding
compared with DAPT and direct oral anticoagulant-based regimens without
significant ischaemic offset.<br/>Copyright &#xa9; The Author(s) 2023.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<162>
Accession Number
2023857743
Title
Elevated Donor Derived Cell-free DNA In Patients Without Clinical
Rejection.
Source
Journal of Cardiac Failure. Conference: The HFSA Annual Scientific Meeting
2023. Cleveland France. 29(4) (pp 569-570), 2023. Date of Publication:
April 2023.
Author
Alam A.; Hajduczok A.; Hall S.
Institution
(Alam, Hall) Baylor Scott & White Health, Dallas, TX
(Hajduczok) Jefferson Health System, Philadelphia, PA
Publisher
Elsevier B.V.
Abstract
Introduction: Little is known about the elevation of donor derived
cell-free DNA (dd-cfDNA) in patients without evidence of rejection
following heart transplantation; however, it is known that elevations can
precede or follow injury mediated by physical trauma, infectious related
injury, the development of DSA, CAV, and others. Hypothesis: dd-cfDNA can
be elevated in patients without evidence of clinical rejection.
<br/>Method(s): We conducted a systematic search in March 2022 including
studies reporting the incidence of non-rejection allograft injury,
including DSA, CAV, and/or graft dysfunction dd-cfDNA results in adult
heart transplant recipients. DSA were defined as any detectable donor
specific antibodies post-transplant, CAV was defined as CAV >= Class I,
and graft dysfunction was defined as LVEF <= 45% or proportional decrease
in LVEF >=25% from first study visit. The GRADE framework informed our
certainty in the evidence. <br/>Result(s): Three studies have evaluated
the incidence of non-rejection allograft injury to date. Notably, the
SHORE registry data has been published in abstract format with preliminary
analyses. Importantly, the DOAR and SHORE registries define an elevation
in dd-cfDNA as >=0.2, while Holzhauser, et al., defined an elevation as
any level above the limit of detection (>=0.12). This may account for the
discrepancy in findings. Overall, it appears that in patients without
evidence of rejection, DSA formation was the leading cause of elevation in
dd-cfDNA, followed by CAV, and graft dysfunction (Table 1).
<br/>Conclusion(s): Our review suggests that dd-cfDNA may be elevated in
patients without evidence of clinical rejection. Further prospective
studies are warranted to delineate additional prognostic value of dd-cfDNA
in these patient populations.<br/>Copyright &#xa9; 2022

<163>
Accession Number
2023855671
Title
Dilated Cardiomyopathy: Unmasking Contributing Etiologies.
Source
Journal of Cardiac Failure. Conference: The HFSA Annual Scientific Meeting
2023. Cleveland France. 29(4) (pp 692-693), 2023. Date of Publication:
April 2023.
Author
Patel H.; Batra S.
Institution
(Patel) George Washington University Hospital, Washington, DC
(Batra) The George Washington Medical Faculty Associates, Washington, DC
Publisher
Elsevier B.V.
Abstract
Background: The role of genetic conditions in the development of
cardiomyopathy is well established; however, recognition and referral for
genetic testing remains underutilized. Systematic review of complex cases
can increase general awareness in this area of practice. Here we describe
the case of a patient with resolved severe stress induced cardiomyopathy
(SIC), who was ultimately found to have heterozygous
transthyretin-mediated amyloidosis (TTRA). Case: A 27-year-old man (family
history positive for a brother status post heart transplant) presented
with ataxia and cough due to legionella pneumonia. TTE showed left
ventricular (LV) diastolic diameter of 6.2cm, LV ejection fraction 20-25%.
He suffered rapid decompensation with mixed cardiogenic/septic shock
requiring peripheral VA ECMO and Impella-CP placement. Course notable for
brief cardiac arrest on hospital day (HD) 2, incidental diagnosis of COVID
19 on HD 14, conversion to VV ECMO on HD 15, and ECMO decannulation on HD
23. Repeat TTE prior to discharge showed normalization of biventricular
function. <br/>Discussion(s): Despite resolution of refractory shock and
normalization of biventricular function prior to discharge, the TTE
finding of mild LV dilation and strong family history prompted outpatient
pursuit of genetic testing which revealed a heterozygous TTRA mutation
(val142ile). Work-up to assess cardiac involvement included: a
99m-technetium pyrophosphate scintigraphy found to be indeterminate, an
aborted endomyocardial biopsy due to inability to smoothly advance a
bioptome (presumably related to ECMO cannulation), and a cardiac MRI
(pending at the time of this submission). If a cardiac phenotype is
discovered, the patient will be started on targeted treatment of cardiac
amyloid. Screening of first-degree family members has been initiated.
<br/>Conclusion(s): Given the current state of under-diagnosis of genetic
cardiomyopathies and its association with significant morbidity and
mortality, it is prudent to consider genetic testing in young patients
based on clinical history. Examples of clinical scenarios to prompt
further testing include: anatomical findings (i.e. cardiac chamber
enlargement, left ventricular hypertrophy), family history of
cardiomyopathy, or clinical markers suggestive of alternative diagnoses
(i.e. neuropathy, renal insufficiency, mediastinal lymphadenopathy). This
thoughtful and algorithmic use of genetic testing may help improve
long-term patient outcomes given improvements in both detection, family
screening, and treatment for disease-specific
cardiomyopathies.<br/>Copyright &#xa9; 2022

<164>
Accession Number
2023855668
Title
Donor Substance Abuse And Heart Transplantation Outcomes.
Source
Journal of Cardiac Failure. Conference: The HFSA Annual Scientific Meeting
2023. Cleveland France. 29(4) (pp 614-615), 2023. Date of Publication:
April 2023.
Author
Sabra M.; Ilonze O.; Rao R.; Saleem K.; Guglin M.
Institution
(Sabra, Saleem) Indiana University, Indianapolis, IN, United States
(Ilonze, Guglin) Indiana University Health, Indianapolis, IN, United
States
(Rao) Indiana University Health, Carmel, IN
Publisher
Elsevier B.V.
Abstract
Introduction: Heart failure (HF) affects about 64.3 million individuals
worldwide and 6.2 million adults in the United States. Heart
transplantation continues to be the gold standard for treatment of
advanced HF. The International Society for Heart and Lung Transplantation
(ISHLT) recognizes drug abuse including legalized substances like alcohol
and tobacco as an absolute contraindication for heart transplantation but
provides vague guidance on some other substances. In this review, we
analyze the literature on the hearts of donors with prior substance use
and focus on outcomes of heart transplantation such as survival,
rejection, and allograft vasculopathy. <br/>Method(s): The authors
independently searched PubMed reviewing articles published till December
31, 2021 and using the following terms: "Alcohol" AND "Donor" AND "Heart
Transplantation". The last two terms remained the same while we also used
them in combination with "Cocaine", "Marijuana", "Tobacco", "Smoking",
"Methamphetamine", "Opioids" and "Nicotine". We also manually searched the
references in all pertinent articles. The search was limited to English
language. Articles describing pediatric patients were excluded. We
selected the studies with the data on the outcomes of cardiac
transplantation, specifically survival, incidence of rejection, and
allograft vasculopathy. <br/>Result(s): The data of the 27 studies meeting
our criteria were included in this review. Regarding cocaine use, 5
studies evaluated heart transplantation outcomes in donors with history of
cocaine use. Interestingly, no study found any increase of mortality,
rejection, or allograft vasculopathy when the donor hearts with current or
prior cocaine use were accepted. Despite early reports suggesting poor
outcomes of heart transplant from donors with alcohol use, more recent
studies show no increased risk of mortality, rejection, or allograft
vasculopathy as shown in the table. Nicotine use among donors in heart
transplantation was associated with worse outcomes in the 4 studies that
were included in the analysis. Among the studies that looked at the effect
of opioid use in donors for heart transplantation, none showed increased
mortality, rejection, or allograft vasculopathy. <br/>Conclusion(s): Our
study provides insight towards the consideration of heart transplant from
donors with history of substance use. The presented evidence demonstrates
the safety of using donor hearts from patients with history of cocaine,
alcohol, and opioid use. Despite the limitations in interpreting the
presented evidence, our paper provides insight that should drive future
research targeted into the evaluation of substance use in heart
transplant.<br/>Copyright &#xa9; 2022

<165>
Accession Number
2023855642
Title
Glp-1 Receptor Agonists Are Associated With Weight Loss Among Lvad
Patients With Diabetes And Obesity.
Source
Journal of Cardiac Failure. Conference: The HFSA Annual Scientific Meeting
2023. Cleveland France. 29(4) (pp 617), 2023. Date of Publication: April
2023.
Author
Mekhaimar M.; Correa A.; Hamo C.; Doshi A.; Young A.; Roldan J.; Moss N.
Institution
(Mekhaimar, Correa, Hamo, Doshi, Young, Roldan, Moss) Mount Sinai Health
System, New York, NY
Publisher
Elsevier B.V.
Abstract
Introduction: Glucagon-like peptide 1 receptor agonists (GLP-1RA) are
agents currently approved in the treatment of type 2 diabetes and obesity.
In patients with heart failure (HF), GLP-1RA are associated with
significant weight loss. The role of GLP-1RA for weight loss in advanced
HF patients with left ventricular assist devices (LVAD) remains unknown.
Hypothesis: : Use of GLP-1RA in LVAD patients with BMI >35 kg/m2 would be
associated with weight loss. <br/>Method(s): We performed a retrospective
observational review of LVAD patients followed in our outpatient clinic
with a BMI >= 35 kg/m², started on a GLP-1RA over an 11 month
period using electronic medical records. Serial weights were collected
during routine clinic visits in addition to concomitant medication use,
diabetes status, hemoglobin A1c (HbA1c) at GLP-1RA initiation and referral
to bariatric surgery. <br/>Result(s): A total of 19 LVAD patients were
initiated on GLP-1RA, 3 discontinued the drug early due to
gastrointestinal side effects, these were not included in the study.
Sixteen of the patients were maintained on GLP-1RA (mean age 53.5 years,
56% female) for the total time period. Mean body mass index (BMI) prior to
drug initiation was 40.2 kg/m². A total of 14 (87.5%) had
diabetes with a mean HbA1c 7.1% prior to initiation of GLP-1RA. After 11
months on GLP-1RA 12 (75%) patients experienced a mean weight loss of 25
lbs. Among those who lost weight, all had diabetes with 33% on insulin
therapy, 33% on metformin, and 33% on sodium glucose co-transporter type 2
inhibitors. Six (50%) of the patients who lost weight were referred for
bariatric surgery and 1 (8.3%) underwent bariatric surgery during the 11
month period. <br/>Conclusion(s): We demonstrate that advanced heart
failure patients with LVADs, obesity (BMI >35kg/m2) and diabetes
experience weight loss following initiation of GLP-1RA. These findings
have important implications as obesity is often a contraindication for
heart transplantation listing. Additional randomized control studies are
needed for further evaluation of the weight and cardiovascular benefits of
GLP-1RA in patients with advanced heart failure.<br/>Copyright &#xa9; 2022

<166>
Accession Number
2023854350
Title
Recurrent Granulomatous Myocarditis After Heart Transplant: A Systematic
Review.
Source
Journal of Cardiac Failure. Conference: The HFSA Annual Scientific Meeting
2023. Cleveland France. 29(4) (pp 627), 2023. Date of Publication: April
2023.
Author
Stein A.P.; Patel D.; Stewart B.; Al-Ani M.; Vilaro J.; Ahmed M.; Aranda
J.; Parker A.
Institution
(Stein, Patel, Stewart, Al-Ani, Vilaro, Ahmed, Aranda, Parker) The
University of Florida Health, Gainesville, FL, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Post-orthotopic recurrence of granulomatous myocarditis
(GM), including both cardiac sarcoidosis (CS) and giant cell myocarditis
(GCM), is a rare entity, with recurrence rates of 5% in CS and 8% in GCM.
We aim to identify all reported cases of recurrence in the literature and
to assess clinical course, treatments, and outcomes to inform future
post-orthotopic heart transplant (OHT) management to minimize recurrence
and its impact. <br/>Method(s): A systematic review, utilizing PRISMA
guidelines, was performed of MEDLINE/PubMed and Embase of all available
literature including case reports, case series, and other studies of
post-transplant recurrent GM, CS, or GCM. Search terms included "giant
cell myocarditis" or "cardiac sarcoidosis" or "granulomatous myocarditis"
or "myocarditis" or "inflammatory cardiomyopathy" and "transplant" and
"recurrence" or "recurrent." Included publications described proven cases
of recurrent CS or GCM post-OHT, and articles were excluded that did not
record a case of post-OHT CS or GCM, if a duplicate case was reported, if
the study was non-English, or full-text was not available. <br/>Result(s):
Post-transplant GM recurrence has been identified in 43 patients in 32
total publications. Reported cases include 30 GCM patients and 13 CS
patients, most frequently published as a case report, 21 (66%). Mean age
at recurrence was 41 years old for GCM and 49 years old for CS, with the
youngest case reported at 11 years old and the eldest 64 years old. Males
were more commonly identified with recurrence, 22 (67%), specifically in
CS, 11 (85%). Time to recurrence ranged from two weeks to nine years
post-transplant, occurring earlier in GCM (mean 1.6 years) compared to CS
(mean 3.0 years). Endomyocardial biopsies (89%) were the most utilized
diagnostic method over cMRI and PET. Treatment regimens involved a variety
of immunosuppressive agents, often utilizing steroids or increasing other
maintenance therapies to successfully achieve remission. Though
accumulative reported mortality among all cases was still 16.3%.
<br/>Conclusion(s): GM recurrence after cardiac transplant most frequently
occurs in middle-aged men as GCM that typically resolves with minor
adjustments to post-transplant immunosuppressive regimens, though with an
associated mortality risk. Future larger studies including data from
multiple centers must be completed to further characterize disease course
and optimal treatment.<br/>Copyright &#xa9; 2022

<167>
Accession Number
2023854300
Title
"MitraBridge: MitraClip To Delay Advanced Heart Failure Therapies In
Patients With Severe Functional Mitral Regurgitation On Chronic Inotropic
Support".
Source
Journal of Cardiac Failure. Conference: The HFSA Annual Scientific Meeting
2023. Cleveland France. 29(4) (pp 664), 2023. Date of Publication: April
2023.
Author
Price T.J.; Chia R.; Sobieraj M.; Pinciotti D.; Varghese V.; Kovach R.;
Joiner J.; Chen C.; Barn K.
Institution
(Price, Chia, Sobieraj, Pinciotti, Varghese, Kovach, Joiner, Chen, Barn)
Deborah Heart and Lung Center, Browns Mills, NJ, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Severe functional mitral regurgitation (MR) is known to
indicate worsening survival in congestive heart failure patients.
Guideline-directed medical therapy (GDMT) has been shown to improve
survival and reduce heart failure admissions in these patients. Recently,
the COAPT trial demonstrated that heart failure patients with advanced
NYHA classification and severe functional MR benefit from transcatheter
mitral valve approximation in addition to GDMT. However, the role of
MitraClip (MC) in advanced heart failure (AHF) patients on chronic
inotropic therapy awaiting advanced therapies is unknown. <br/>Method(s):
This is a retrospective, single-center case series of patients with AHF on
milrinone therapy and severe functional MR who underwent a MC procedure
from 2018 to 2022. A detailed chart review was performed including
assessment of office visits, hospitalizations, worsening heart failure,
and the need for left ventricular assist device (LVAD) or heart
transplantation. Successful outcomes were defined as the ability to wean
off milrinone. Adverse outcomes were defined as the need for ongoing
milrinone requirement or advanced heart failure therapies. Furthermore,
the average time from MC to successful wean and the degree of residual MR
following MC were assessed. <br/>Result(s): 11 patients on chronic
milrinone with severe functional MR underwent MC placement. 8 patients
(73%) were successfully weaned off milrinone and did not require AHF
therapies. 2 patients (18%) could not be weaned and are currently being
supported on milrinone. 1 patient (9%) underwent successful LVAD
implantation. 0 of the 8 patients (0%) weaned off milrinone had severe
residual MR following MC. 1 of the 3 patients (33%) requiring ongoing
milrinone or AHF therapies had severe residual MR following MC. The
demographics between each group are shown in Table 1. The majority of the
patients weaned off milrinone were male with an average age of 72 years
old. 7 of these patients (88%) were on 2 or more GDMT. The average time
from MC to successful wean off of milrinone was 5.8 days. Of the 8
patients that were weaned off milrinone, 63% have not been re-hospitalized
for heart failure since their procedure. <br/>Conclusion(s): Our
observational data indicates that 73% of our cohort was successfully
weaned off milrinone, delaying their AHF therapies. Furthermore, the
presence of severe residual MR following MC may contribute to the
inability to wean off milrinone. Given the relatively low risk of the MC
procedure compared to AHF therapies, this strategy warrants further
investigation to help delay AHF therapies. This may also be a more cost
effective strategy for healthcare payers. Future prospective randomized
control trials are needed to support our findings.<br/>Copyright &#xa9;
2022

<168>
Accession Number
2023845260
Title
273 Assessing the risk of iatrogenic tumor seeding in dermatology.
Source
Journal of Investigative Dermatology. Conference: 1st International
Societies for Investigative Dermatology Meeting. Tokyo Japan. 143(5
Supplement) (pp S47), 2023. Date of Publication: May 2023.
Author
Kipnis P.; Ramanathan D.; Rohr B.; Carroll B.
Institution
(Kipnis, Ramanathan) Case Western Reserve University School of Medicine,
Cleveland, OH, United States
(Rohr, Carroll) Department of Dermatology, University Hospitals Medical
Center, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Intro: Despite being a feared complication of surgical intervention,
iatrogenic tumor seeding is rarely reported in the dermatology literature
and clinically disregarded in dermatologic interventions. This study aimed
to determine the common characteristics of tumors implicated in iatrogenic
seeding across specialties and evaluate whether this risk is
underestimated in dermatology. <br/>Method(s): A systematic review of
tumor seeding was conducted using the PubMed and Web of Science databases.
Only studies with five or more reports of seeding were included. Seeding
was defined as any transplantation of tumor cells or secondary tumor
growth at a site distinct from the primary tumor, with confirmed shared
origins. <br/>Result(s): 7893 papers were screened, and 170 papers were
included. There were 311,004 patients with 8800 reports of seeding. 13.5%
were in thoracic surgery, 53.5% gastroenterology or general surgery, 11.2%
otolaryngology, 20.0% urology or gynecology, and 0.6% each in orthopedic
surgery, dermatology, and neurosurgery. Tumor staging was categorized as
low (stage 1/2) or high (stage 3/4); 60.9% were low-stage and 39.1% of
cases were high-stage. Seeding was most common in carcinomas (77.8%),
followed by adenocarcinomas (21.8%) and sarcomas (0.4%). A subset analysis
of papers discussing the role of tumor cytology in seeding showed that
poorly differentiated, high-grade, and high-stage malignancies have a
greater iatrogenic propensity to seed. <br/>Conclusion(s): Of 8800 reports
of iatrogenic tumor seeding, only 28 occasions of seeding were reported in
the dermatologic literature, in a cohort study describing an increased
risk of extracapsular extension of melanoma following needle biopsy of
metastatic lymph nodes. This report, in combination with
multi-disciplinary data showing increased seeding risk for poorly
differentiated, high-grade, and high-stage malignancies, indicates that
dermatologic surgeons might consider the risk of iatrogenic seeding when
excising tumors with these features.<br/>Copyright &#xa9; 2023

<169>
Accession Number
2022977504
Title
PP.30 Comparing the Most Influential Publications on Robotic-Assisted
Pulmonary Lobectomy and on Robotic-Assisted Pulmonary Segmentectomy.
Source
Journal of Thoracic Oncology. Conference: IASLC 2023 Latin America
Conference on Lung Cancer. Montevideo Uruguay. 18(3 Supplement 2) (pp
S20-S21), 2023. Date of Publication: March 2023.
Author
Ladehoff L.; Labib K.; West W.; Fiedler C.; Toloza E.
Institution
(Toloza) Moffitt Cancer Center, Tampa, United States
(Ladehoff, Labib, West, Fiedler, Toloza) University of South Florida
Health Morsani College of Medicine, Tampa, United States
Publisher
Elsevier Inc.
Abstract
Background: Since 2001, robotic-assisted thoracic surgery has evolved, and
robotic-assisted pulmonary lobectomy (RAPL) and robotic-assisted pulmonary
segmentectomy (RAPS) have become feasible and safe options for surgical
resection of lung cancers. This study aims to identify and examine the
most influential articles on RAPL and RAPS. <br/>Method(s): The Clarivate
Web of Science Core Collection was used to systematically gather data on
publications about RAPL and/or RAPS. Information for each publication was
examined using bibliometric analysis and reported using descriptive
statistics. <br/>Result(s): Our query yielded 468 articles for RAPL and
220 articles for RAPS. Bibliometric analysis revealed that the top 50
most-cited manuscripts on RAPL were published between 2003 and 2021 and
collectively cited 2,476 times (mean=49.5 citations per article; 95%
confidence interval (CI)=37.8-61.2), while the top 50 papers on RAPS were
published between 2012 and 2021 and collectively cited 1,613 times
(mean=32.3 citations per article; 95% CI=25.6-39.0). There were 11
articles in each top-50 list that included both RAPL and RAPS. All 89
articles were published in English, and the United States originated most
(57) of these publications, followed by China (11) and Italy (10). The top
affiliations for these articles were the University of Alabama (17
publications), Memorial Sloan Kettering Cancer Center (7), and Humanitas
Research Hospitals (7). The most popular journals for these articles were
Annals of Thoracic Surgery (15 manuscripts), Journal of Thoracic Disease
(13), and Journal of Thoracic & Cardiovascular Surgery (9).
<br/>Conclusion(s): We demonstrated increasing numbers of publications for
RAPL after 2003 and for RAPS after 2012, with almost 50% of articles
published after 2017. Given the rising popularity of robotic-assisted
thoracic surgery, current lists of the most influential articles in RAPL
and RAPS could provide references to guide better practice and suggest
future thoracic surgical research.<br/>Copyright &#xa9; 2023

<170>
Accession Number
640994812
Title
Postoperative pulmonary complications in adult surgical patients in low-
and middle-income countries: a systematic review and meta-analysis.
Source
Southern African Journal of Anaesthesia and Analgesia. Conference: South
African Society of Anaesthesiologists Congress, SASA 2023. Bloemfontein
South Africa. 29(1) (pp S2-S3), 2023. Date of Publication: 2023.
Author
Earle E.; Turton E.; Rodseth R.
Institution
(Earle, Turton) Department of Anaesthesia, Universitas Academic Hospital,
University of the Free State, South Africa
(Rodseth) Department of Anaesthesia, School of Clinical Medicine,
University of KwaZulu-Natal, South Africa
(Rodseth) Consistency of Care Division, Netcare Ltd, South Africa
Publisher
Medpharm Publications
Abstract
Background: After surgery, patients are at risk of developing
postoperative pulmonary complications (PPCs). Our current understanding of
PPCs is based on data from high-income countries. <br/>Method(s): A
systematic review and meta-analysis to evaluate the incidence of PPCs in
adult surgical patients from low- and middle-income countries (LMICs). The
protocol was registered in the PROSPERO database (CRD42020212932).
<br/>Result(s): The search strategy was conducted on 27 March 2021 and 1
053 records were identified. The abstracts of 607 records were reviewed.
Fifteen studies were included in the final review; of these, five were of
high methodological quality. The overall pooled event rate for the
incidence of PPCs was 22.4% (95% confidence interval [CI], 15.76-30.78%).
In-hospital mortality in patients who developed PPCs was 33.1% (101/305).
Followup for mortality outcome in the included studies varied. PPCs were
identified as a risk factor for in-hospital mortality (odds ratio [OR]
18.2, CI 11.01-30.09). There were insufficient outcome data to determine
the association of PPCs between elective versus emergency surgery, and
cardio-thoracic versus noncardiothoracic surgery. Advanced age was
associated with the development of PPCs (mean difference [MD] 4.7, 95% CI
0.63- 8.70). Male sex was associated with the development of PPCs (OR 1.5,
CI 1.17-2.02). PPCs were associated with increased length of hospital stay
(LOS) (MD 6.5, 95% CI 4.04-8.96). <br/>Conclusion(s): The incidence of
PPCs was 22.4% following surgery in adult patients of LMICs and was
influenced by differences in the definitions of PPCs used in the studies.
PPCs were identified as a risk factor for in-hospital mortality. Data
about the type of surgery, as well as patient characteristics, were poorly
reported. Further research regarding PPCs in LMICs is needed to provide
granular data for future use.

<171>
Accession Number
2023854240
Title
The Role of High-Fidelity Simulation in the Acquisition of Endovascular
Surgical Skills: A Systematic Review.
Source
Annals of Vascular Surgery. (no pagination), 2023. Date of Publication:
2023.
Author
Gomaa A.-R.; Grafton-Clarke C.; Saratzis A.; Davies R.S.M.
Institution
(Gomaa) Human Anatomy Resource Centre (HARC), University of Liverpool,
Liverpool, United Kingdom
(Grafton-Clarke) University of East Anglia, Norwich, United Kingdom
(Saratzis, Davies) Leicester Vascular Institute, University Hospitals of
Leicester NHS Trust, Leicester, United Kingdom
(Saratzis) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: The widespread introduction of minimally invasive endovascular
techniques in cardiovascular surgery has necessitated a transition in the
psychomotor skillset of trainees and surgeons. Simulation has previously
been used in surgical training; however, there is limited high-quality
evidence regarding the role of simulation-based training on the
acquisition of endovascular skills. This systematic review aimed to
systematically appraise the currently available evidence regarding
endovascular high-fidelity simulation interventions, to describe the
overarching strategies used, the learning outcomes addressed, the choice
of assessment methodology, and the impact of education on learner
performance. <br/>Method(s): A comprehensive literature review was
performed in accordance with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement using relevant keywords to
identify studies evaluating simulation in the acquisition of endovascular
surgical skills. References of review articles were screened for
additional studies. <br/>Result(s): A total of 1,081 studies were
identified (474 after removal of duplicates). There was marked
heterogeneity in methodologies and reporting of outcomes. Quantitative
analysis was deemed inappropriate due to the risk of serious confounding
and bias. Instead, a descriptive synthesis was performed, summarizing key
findings and quality components. Eighteen studies were included in the
synthesis (15 observational, 2 case-control and 1 randomized control
studies). Most studies measured procedure time, contrast usage, and
fluoroscopy time. Other metrics were recorded to a lesser extent.
Significant reductions were noted in both procedure and fluoroscopy times
with the introduction of simulation-based endovascular training.
<br/>Conclusion(s): The evidence regarding the use of high-fidelity
simulation in endovascular training is very heterogeneous. The current
literature suggests simulation-based training leads to improvements in
performance, mostly in terms of procedure and fluoroscopy time.
High-quality randomized control trials are needed to establish the
clinical benefits of simulation training, sustainability of improvements,
transferability of skills and its cost-effectiveness.<br/>Copyright &#xa9;
2023 The Author(s)

<172>
Accession Number
640994132
Title
Comparison of transversus thoracis muscle plane block and
pecto-intercostal fascial plane block for enhanced recovery after
pediatric open-heart surgery.
Source
Anaesthesia, critical care & pain medicine. (pp 101230), 2023. Date of
Publication: 07 Apr 2023.
Author
Elbardan I.M.; Ahmed Sayed Shehab A.S.; Mabrouk I.M.
Institution
(Elbardan) Anaesthesia and Surgical Intensive Care Department, Faculty of
Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
(Ahmed Sayed Shehab) Anaesthesia and Surgical Intensive Care Department,
Faculty of Medicine, Alexandria University, Champollion Street,
Alexandria, Egypt
(Mabrouk) Anaesthesia and Surgical Intensive Care Department, Faculty of
Medicine, Alexandria University, Champollion Street, Alexandria, Egypt
Publisher
NLM (Medline)
Abstract
BACKGROUND: Effective analgesia after cardiac surgery contributes to
enhanced recovery. AIM: To compare the perioperative analgesic
effectiveness of Transversus Thoracis Muscle Plane Block (TTPB) and
Pecto-Intercostal-Fascial Plane Block (PIFB) for controlling
post-sternotomy pain in the pediatric population for ultrafast track
cardiac surgery. <br/>METHOD(S): Double-blind randomized study of 60
children, 2-12 years old, undergoing cardiac surgery via median sternotomy
in whom a bilateral ultrasound-guided TTPB or TIBP block was performed
preemptively. <br/>RESULT(S): Epidemiologic data of both groups were
comparable. TTPB group had a lower median Modified Objective Pain Score
(MOPS) all over the time postoperatively. Fentanyl consumption was
significantly lower in TTBP group compared with PIFB group, only 4/30
received supplemental fentanyl during surgery in the TTPB group vs. 11/30
in the PIFB group (p=0.033). The median [interquartile] values of
postoperative fentanyl consumption were significantly lower in the TTBP
compared with PIFB group: 12.0 [10.0-12.0] vs. 15.0 [15.0-16.0] microg/kg
(p<0.001), respectively. First rescue analgesia was later in the TTPB
group compared to the PIFB group with median times of 7.25 and 5.0hours,
respectively (p<0.001). Both groups had a comparable ICU length of stay
(p=0.919), with a median of 3 days. Furthermore, in the PIFB group, the
incidence of non-sternal wound chest pain (53.3%) was significantly higher
than in the TTPB group (3.3%) (p<0.05). <br/>CONCLUSION(S): TTPB and PIFB
are safe regional blocks that could enhance recovery after pediatric
cardiac surgery. In our series, TTPB provided better and longer-lasting
postoperative analgesia with less incidence of non-sternal wound pain than
PIFB.<br/>Copyright &#xa9; 2023 Elsevier Ltd. All rights reserved.

<173>
Accession Number
640992418
Title
Hamartoma of Mature Cardiac Myocytes: Systematic Review.
Source
Cardiovascular pathology : the official journal of the Society for
Cardiovascular Pathology. (pp 107538), 2023. Date of Publication: 07 Apr
2023.
Author
Techasatian W.; Maan G.; Morihara C.; Pham A.; Benavente K.; Nagamine T.;
Nishimura Y.
Institution
(Techasatian, Maan, Morihara, Pham, Benavente, Nagamine, Nishimura)
Department of Medicine, John A. Burns School of Medicine, University of
Hawai'i, Honolulu, HI 96813, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: While primary cardiac tumors are rare, it has been
increasingly recognized due to improvement in screening measures. However,
the hamartoma of mature cardiac myocytes has been underrecognized compared
to other cardiac tumors, such as cardiac myxomas and papillary
fibroelastomas, and is still potentially associated with critical
consequences such as sudden death. This systematic review aims to
summarize the evidence regarding the hamartoma of mature cardiac myocytes
and characterize the presentations and symptoms for clinicians.
<br/>METHOD(S): Following the PRISMA statement, we searched MEDLINE and
EMBASE for all peer-reviewed articles using keywords including "hamartoma
of mature cardiac myocytes" from their inception to January 2nd, 2023.
<br/>RESULT(S): We included 25 articles, including 34 cases, in this
systematic review. Patients with hamartoma of mature cardiac myocytes
commonly presented with nonspecific symptoms such as dyspnea (35.3%),
although a few presented with sudden death and syncope. The left ventricle
was the common site of origin (41.2%), followed by the right atrium and
ventricle. Surgery was commonly pursued for diagnosis and treatment, while
a few required cardiac transplants (8.8%), and 29.4% were diagnosed with
autopsy or expired. <br/>CONCLUSION(S): Hamartoma of mature cardiac
myocytes is a potentially underrecognized primary cardiac tumor associated
with treatable yet potentially critical consequences. Given the challenges
of differentiating it from malignancy such as angiosarcoma, multimodal
imaging needs to be utilized to pursue a diagnosis. Future studies are
warranted to develop a noninvasive diagnosis mode for cardiac
tumor.<br/>Copyright &#xa9; 2023 Elsevier Ltd. All rights reserved.