EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2024090561
Title
Impact of coronary stenting on top of medical therapy and of inclusion of
periprocedural infarctions on hard composite endpoints in patients with
chronic coronary syndromes: a meta-analysis of randomized controlled
trials.
Source
Minerva Cardiology and Angiology. 71(2) (pp 221-229), 2023. Date of
Publication: April 2023.
Author
Galli M.; Vescovo G.M.; Andreotti F.; d'Amario D.; Leone A.M.; Benenati
S.; Vergallo R.; Niccoli G.; Trani C.; Porto I.
Institution
(Galli, Andreotti, d'Amario, Leone, Vergallo, Niccoli, Trani) Department
of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University
Polyclinic Foundation, Rome, Italy
(Galli, Andreotti, Leone, Niccoli, Trani) Sacred Heart Catholic
University, Rome, Italy
(Vescovo) Division of Cardiology, Department of Cardiac, Thoracic and
Vascular Sciences, University of Padua, Padua, Italy
(Benenati, Porto) Irccs San Martino University Hospital, Italian
Cardiovascular Network, University of Genoa, Genoa, Italy
(Porto) Department of Internal Medicine and Medical Specialties (DIMI),
University of Genoa, Genoa, Italy
Publisher
Edizioni Minerva Medica
Abstract
iNTrodUCTioN: Composite endpoints are pivotal when assessing rare outcomes
over relatively short followups. Most randomized controlled trials (rCTs)
comparing percutaneous coronary intervention (PCi) with stent implantation
to optimal medical therapy (oMT) in chronic coronary syndromes (CCS)
patients included both hard and soft outcomes in their primary endpoint,
with periprocedural myocardial infarctions (Mis) systematically allocated
to the PCi arm. We meta-analyzed the above rCTs for composite hard
endpoints, with and without periprocedural Mis. eVideNCe aCQUiSiTioN: This
study is registered in ProSPero Crd42020166754 and follows the Preferred
reporting items for Systematic reviews and Meta-analyses and Cochrane
Collaboration reporting. Patients had inducible ischemia, no left main
disease nor severe left ventricular dysfunction. eVideNCe SyNTHeSiS: Six
rCTs involving 10,751 patients followed for a mean of 4.4 years were
included. PCi+oMT versus oMT alone was associated with no difference in
the two co-primary composite endpoints of all-cause death/Mi/stroke and
cardiovascular death/Mi including all-Mis (irr 0.99; 95% Ci 0.90-1.08 and
irr 0.95; 95% Ci 0.83-1.08 respectively). after inclusion of spontaneous
rather than all-Mis (i.e., excluding periprocedural Mis), the odds showed
benefit of PCI+OMT for both co-primary endpoints (IRR 0.88; 95% CI
0.80-0.97, P<0.01 and IRR 0.81; 95% CI 0.69-0.95, P=0.01 respectively)
with numbers needed to treat of 42 in both cases. CoNClUSioNS: among CCS
patients with inducible myocardial ischemia without severely reduced
ejection fraction or left main disease, adding PCi to oMT reduces hard
composite outcomes only after exclusion of periprocedural Mis. Continued
efforts to define periprocedural MIs reproducibly, to assess their
prognostic relevance and to prevent them are warranted.<br/>Copyright
&#xa9; 2021 Edizioni Minerva Medica.

<2>
Accession Number
2023832552
Title
Effects of crystalloid and colloid priming strategies for cardiopulmonary
bypass on colloid oncotic pressure and haemostasis: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 35(3) (no pagination),
2022. Article Number: ivac127. Date of Publication: 01 Sep 2022.
Author
Beukers A.M.; De Ruijter J.A.C.; Loer S.A.; Vonk A.; Bulte C.S.E.
Institution
(Beukers, De Ruijter, Loer, Bulte) Amsterdam UMC Location, Vrije
Universiteit Amsterdam, Department of Anaesthesiology, Amsterdam,
Netherlands
(Vonk) Amsterdam UMC Location, University of Amsterdam, Department of
Cardiothoracic Surgery, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
OBJECTIVES: Colloid oncotic pressure (COP) is an important factor in
cardiac surgery, owing to its role in haemodilution. The effect of
cardiopulmonary bypass prime fluids on the COP is unknown. In this study,
the effect of crystalloid and colloid prime fluids, with or without
retrograde autologous priming (RAP), on the COP during elective cardiac
surgery was evaluated. <br/>METHOD(S): Randomized controlled trials and
prospective clinical trials comparing crystalloid and colloid priming
fluids or with RAP were selected. The primary outcome was the COP;
secondary outcomes were fluid balance, fluid requirements, weight gain,
blood loss, platelet count and transfusion requirements. <br/>RESULT(S):
From 1582 records, 29 eligible studies were identified. COPs were
comparable between gelofusine and hydroxyethyl starch (HES) during bypass
[mean difference (MD): 0.69; 95% confidence interval (CI): -2.05, 3.43; P
= 0.621], after bypass (MD: -0.11; 95% CI: -2.54, 2.32; P = 0.930) and
postoperative (MD: -0.61; 95% CI: -1.60, 0.38; P = 0.228). Fluid balance
was lower with HES than with crystalloids. RAP reduced transfusion
requirements compared with crystalloids. Blood loss was comparable between
groups. <br/>CONCLUSION(S): COPs did not differ between crystalloids and
colloids. As a result of increased transcapillary fluid movement, fluid
balance was lower with HES than with crystalloids. Haematocrit and
transfusion requirements were comparable between groups. However, the
latter was lower when RAP was applied to crystalloid priming compared with
crystalloids alone. Finally, no differences in blood loss were observed
between the groups.<br/>Copyright &#xa9; 2022 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<3>
Accession Number
2023026258
Title
Anesthetic Management of Patients With Kartagener Syndrome: A Systematic
Review of 99 Cases.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(6) (pp 1021-1025),
2023. Date of Publication: June 2023.
Author
Cheng L.; Dong Y.; Liu S.
Institution
(Cheng, Dong, Liu) Department of Anesthesiology, Shengjing Hospital of
China Medical University, Shenyang, China
Publisher
W.B. Saunders
Abstract
KARTAGENER SYNDROME (KS) is characterized by the triad of chronic
sinusitis, bronchiectasis, and situs inversus. The mirrored anatomy and
respiratory infections in patients with KS patients pose great challenges
for anesthetic management. The aim of this review is to summarize
published cases with the hope of helping anesthesiologists perform
anesthesia in patients with KS more safely. A comprehensive literature
search for all cases of anesthetic management of KS patients was performed
in Pubmed, EMBASE, CNKI, and Wanfang Database. The extracted data included
age, sex, type of surgery, preoperative treatment, type of anesthesia,
anesthetic agents, airway management, central venous catheterization,
transesophageal echocardiogram, reversal of neuromuscular blockade,
adverse events during the surgery, and postoperative complications. The
study authors included 82 single-case reports, 3 case series, and 1 case
cohort, with a total number of 99 patients. The most common surgical
procedures were thoracic surgery (51.5%), which was followed by ear, nose,
and throat surgery (16.5%), and general surgery (14.5%). The preoperative
treatment of the patients was reported in only 20 patients, and included
antibiotics, bronchodilators, steroids, chest physiotherapy, and postural
drainage. General anesthesia was performed for 85.4% of the surgeries, and
regional anesthesia was performed in 14.6% of the cases. For nonthoracic
surgery, an endotracheal tube was the most commonly used airway device.
For thoracic surgery, a double-lumen tube was the most commonly used
airway device. The intraoperative process was uneventful in most patients,
and most patients recovered smoothly in the postoperative
course.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<4>
Accession Number
2022780207
Title
Standard-Intensity Versus Low-Intensity Anticoagulation with Warfarin in
Asian Patients with Atrial Fibrillation: A Multi-Center, Randomized
Controlled Trial.
Source
Clinical and Applied Thrombosis/Hemostasis. 29 (no pagination), 2023. Date
of Publication: January-December 2023.
Author
Cho J.G.; Lee K.H.; Kim Y.R.; Kim S.; Gwak J.; Cho E.; Sin Y.; Shin S.Y.;
Park H.W.; Ko J.S.; Kim N.H.; Park Y.M.; Lee J.M.; Yoon N.S.; Kim S.S.;
Kim J.H.; Kim D.M.
Institution
(Cho, Lee, Kim, Kim, Gwak, Cho, Sin, Park, Yoon) Department of
Cardiovascular Medicine, Chonnam National University Hospital, Gwangju,
South Korea
(Cho, Lee, Kim, Park, Yoon) Department of Internal Medicine, Chonnam
National University Medical School, Gwangju, South Korea
(Shin) Department of Cardiovascular Medicine, Chung-Ang University College
of Medicine, Seoul, South Korea
(Ko, Kim) Department of Cardiovascular Medicine, Wonkwang University
Hospital, Gwangju, South Korea
(Park) Department of Cardiovascular Medicine, Gachon University Gil
Medical Center, Incheon, South Korea
(Lee) Department of Cardiovascular Medicine, Kyung Hee University Medical
College, Seoul, South Korea
(Kim) Department of Cardiovascular Medicine, Chosun University Hospital,
Gwangju, South Korea
(Kim) Department of Cardiovascular Medicine, Chungnam National University
Hospital, Daejeon, South Korea
(Kim) Department of Cardiovascular Medicine, Dankook University Hospital,
Cheonan, South Korea
Publisher
SAGE Publications Inc.
Abstract
Anticoagulation with warfarin in Asian patients with atrial fibrillation
(AF) often has been decreased as an international normalized ratio (INR)
of prothrombin time 1.6-2.6 due to fear of bleeding, although universal
criteria recommend an INR of 2.0-3.0. In this randomized, open-label
trial, low-intensity anticoagulation (INR 1.6-2.6) was compared with
standard-intensity anticoagulation (INR 2.0-3.0) with warfarin. A total
616 patients with AF and at least 1 risk factor for stroke were randomized
to low-intensity anticoagulation (n = 308) and standard-intensity
anticoagulation (n = 308) groups. The intention-to-treat analysis was
performed to determine differences. The baseline characteristics of the
two groups were comparable. New-onset stroke occurred in 2 patients (0.44%
per year) in the low-intensity group and 5 patients (1.05% per year) in
the standard-intensity group (HR 0.42, 95% CI 0.08-2.15). Major bleeding
occurred in 4 patients (0.89% per year) in the low-intensity group and 5
patients (1.06% per year) in the standard-intensity group (HR 0.84, 95% CI
0.22-3.11). The rate of the net clinical outcome (composite of stroke,
systemic embolism, major bleeding, and death) was 1.33% per year in the
low-intensity group compared with 2.12% per year in the standard-intensity
group (HR 0.63, 95% CI 0.23-1.72). In Asian patients with AF, clinical
outcomes were not different between low-intensity and standard-intensity
anticoagulation with warfarin.<br/>Copyright &#xa9; The Author(s) 2023.

<5>
Accession Number
2022707063
Title
Transcatheter versus surgical closure of ventricular septal defect: a
comparative study.
Source
Cardiothoracic Surgeon. 31(1) (no pagination), 2023. Article Number: 8.
Date of Publication: December 2023.
Author
Singab H.; Elshahat M.K.; Taha A.S.; Ali Y.A.; El-Emam A.M.; Gamal M.A.
Institution
(Singab, Taha, Gamal) Department of Cardiothoracic Surgery, Academic
Institute of Cardiac Surgery, Ain-Shams University, Cairo, Egypt
(Elshahat) Department of Cardiac Surgery, National Heart Institute, Giza,
Egypt
(Ali) Department of Cardiology, Ain-Shams University, Cairo, Egypt
(El-Emam) Department of Cardiology, National Heart Institute, Giza, Egypt
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: In many countries, surgical closure of ventricular septal
defects remains the recommended approach of ventricular septal defect
closure. The aim of this study is to compare the safety, efficacy, and
clinical effects of surgical versus transcatheter closure of a ventricular
septal defect. <br/>Method(s): We conducted a comparative randomized study
on patients undergoing ventricular septal defect closure. Patients were
allocated to undergo either surgical (group I) or catheter (group II)
ventricular septal defect closure. <br/>Result(s): Seventy-two patients
were included. Operation success was achieved in 100% of the surgical
group versus 33 of 36 patients of the percutaneous group (91.6%) (p value
0.076). There was no significant difference regarding the residual
ventricular septal defect. The postoperative echo in group I revealed
severe tricuspid regurgitation in one patient (2.7%), and one patient
needed a permanent pacemaker. On the other hand, in group II, during the
procedure, one patient had severe tricuspid regurge (2.7%). There was a
significant difference in the postoperative data favoring group II over
group I regarding ventilation duration, intensive care unit stay, total
hospital stay, and blood transfusion (P value < 0.001 each).
<br/>Conclusion(s): Both transcatheter device closure and surgical repair
are effective treatments. In contrast, the psychological profile of the
transcatheter device was superior to the surgical repair, especially in
terms of avoiding sternotomy scar, blood loss and transfusion, and
hospital stay. On the other hand, transcatheter intervention is limited
only to the anatomically suitable ventricular septal defects, in addition,
surgical backup is a must in case of complicated transcatheter closure,
which gives the upper hand to surgery to be the recommended approach for
most of the ventricular septal defects. Clinical registration number:
NCT05306483 registered 04/05/2022 (retrospectively registered) at
ClinicalTrials.gov PRS. Graphical Abstract: [Figure not available: see
fulltext.]<br/>Copyright &#xa9; 2023, The Author(s).

<6>
Accession Number
2022706885
Title
Iron metabolism-related indicators as predictors of the incidence of acute
kidney injury after cardiac surgery: a meta-analysis.
Source
Renal Failure. 45(1) (no pagination), 2023. Article Number: 2201362. Date
of Publication: 2023.
Author
Zhao L.; Yang X.; Zhang S.; Zhou X.
Institution
(Zhao) The Fifth Clinical Medical College of Shanxi Medical University,
Shanxi, Taiyuan, China
(Yang) Department of Microbiology and Immunology, School of Basic
Medicine, Shanxi Medical University, Shanxi, Taiyuan, China
(Zhang) Fourth People's Hospital of Taiyuan, Shanxi, Taiyuan, China
(Zhou) Department of Nephrology, Shanxi Provincial People's Hospital, The
Fifth Clinical Medical College of Shanxi Medical University, Shanxi,
Taiyuan, China
Publisher
Taylor and Francis Ltd.
Abstract
Background: Some studies have found that ferroptosis plays an important
role in the incidence of acute kidney injury (AKI) after cardiac surgery.
However, whether iron metabolism-related indicators can be used as
predictors of the incidence of AKI after cardiac surgery remains unclear.
<br/>Objective(s): We aimed to systematically evaluate whether iron
metabolism-related indicators can be used as predictors of the incidence
of AKI after cardiac surgery via meta-analysis. <br/>Search Method(s): The
PubMed, Embase, Web of Science, and Cochrane Library databases were
searched from January 1971 to February 2023 to identify prospective
observational and retrospective observational studies examining iron
metabolism-related indicators and the incidence of AKI after cardiac
surgery among adults. Data Extraction and Synthesis: The following data
were extracted by two independent authors (ZLM and YXY): date of
publication, first author, country, age, sex, number of included patients,
iron metabolism-related indicators, outcomes of patients, patient types,
study types, sample, and specimen sampling time. The level of agreement
between authors was determined using Cohen's kappa value. The
Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies.
Statistical heterogeneity across the studies was measured by the
I² statistic. The standardized mean difference (SMD) and 95%
confidence interval (CI) were used as effect size measures. Meta-analysis
was performed using Stata 15. <br/>Result(s): After applying the inclusion
and exclusion criteria, 9 articles on iron metabolism-related indicators
and the incidence of AKI after cardiac surgery were included in this
study. Meta-analysis revealed that after cardiac surgery, baseline serum
ferritin (mug/L) (I² = 43%, fixed effects model, SMD = -0.3,
95% CI:-0.54 to -0.07, p = 0.010), preoperative and 6-hour postoperative
fractional excretion (FE) of hepcidin (%) (I² = 0.0%, fixed
effects model, SMD = -0.41, 95% CI: -0.79 to -0.02, p = 0.038;
I² = 27.0%, fixed effects model, SMD = -0.49, 95% CI: -0.88 to
-0.11, p = 0.012), 24-hour postoperative urinary hepcidin (mug/L)
(I² = 0.0%, fixed effects model, SMD = -0.60, 95% CI: -0.82 to
-0.37, p < 0.001) and urine hepcidin/urine creatinine ratio (mug/mmoL)
(I² = 0.0%, fixed effects model, SMD = -0.65, 95% CI: -0.86 to
-0.43, p < 0.001) were significantly lower in patients who developed to
AKI than in those who did not. <br/>Conclusion(s): After cardiac surgery,
patients with lower baseline serum ferritin levels (mug/L), lower
preoperative and 6-hour postoperative FE of hepcidin (%), lower 24-hour
postoperative hepcidin/urine creatinine ratios (mug/mmol) and lower
24-hour postoperative urinary hepcidin levels (mug/L) are more likely to
develop AKI. Therefore, these parameters have the potential to be
predictors for AKI after cardiac surgery in the future. In addition, there
is a need for relevant clinical research of larger scale and with multiple
centers to further test these parameters and prove our conclusion. Trial
Registration: PROSPERO identifier: CRD42022369380.<br/>Copyright &#xa9;
2023 The Author(s). Published by Informa UK Limited, trading as Taylor &
Francis Group.

<7>
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.

<8>
Accession Number
2022462730
Title
Post-Operative Outcomes of Pre-Thoracic Surgery Respiratory Muscle
Training vs Aerobic Exercise Training: A Systematic Review and Network
Meta-analysis.
Source
Archives of Physical Medicine and Rehabilitation. 104(5) (pp 790-798),
2023. Date of Publication: May 2023.
Author
Kunadharaju R.; Saradna A.; Ray A.; Yu H.; Ji W.; Zafron M.; Mador M.J.
Institution
(Kunadharaju, Saradna, Mador) University at Buffalo, Jacobs School of
Medicine and Biomedical Sciences, Department of Pulmonary, Critical Care,
and Sleep Medicine, Buffalo, NY, United States
(Ray) Roswell Park Comprehensive Cancer Center, Department of Cancer
Prevention & Control, Buffalo, NY, United States
(Yu) Roswell Park Comprehensive Cancer Center, Department of Biostatistics
and Bioinformatics, Buffalo, NY, United States
(Ji) Virginia Polytechnic Institute and State University, Center for
Biostatistics and Health Data Science, Blacksburg, VA, United States
(Zafron) University at Buffalo, Jacobs School of Medicine and Biomedical
Sciences, Reference and Education Services, Buffalo, NY, United States
(Mador) VA WNY Healthcare System, Buffalo, NY, United States
Publisher
W.B. Saunders
Abstract
Objective: To compare the postoperative outcomes of preoperative
respiratory muscle training (RMT) with a device to preoperative aerobic
exercise training (AET) in patients undergoing thoracic surgeries (cardiac
and lung). <br/>Data Sources: PubMed, EMBASE, Cochrane, and Web of Science
were comprehensively searched upon inception to 9/2020. Study Selection:
All randomized control studies, including preoperative RMT and
preoperative AET compared with a non-training control group, were
included. <br/>Data Extraction: The meta-analysis was performed for
outcomes including postoperative pulmonary complications (PPC), pneumonia,
postoperative respiratory failure (PRF), hospital length of stay (HLOS),
and mortality. We performed a network meta-analysis based on Bayesian
random-effects regression models. <br/>Data Synthesis: A total of 25
studies, 2070 patients were included in this meta-analysis. Pooled data
for the patients who performed RMT with a device showed a reduction in
PPCs, pneumonia, PRF with odds ratio (OR) of 0.35 (P value .006), 0.38 (P
value .002), and 0.22 (P value .008), respectively. Pooled data for the
patients who performed AET showed reduction in PPC, pneumonia with a OR of
0.33 (P value <.00001) and OR of 0.54 (P value .01), respectively. HLOS
was decreased by 1.69 days (P value <.00001) by performing RMT and 1.79
days (P value .0008) by performing AET compared with the usual group. No
significant difference in all-cause mortality compared with usual care in
both RMT and AET intervention groups. No significant difference in the
incidence of PRF compared with usual group in RMT + AET and AET alone
intervention groups (OR 0.32; P=.21; OR 0.94; P=.87). Based on rank
probability plots analysis, on network meta-analysis, RMT and AET ranked
similarly on the primary outcome of PPC and secondary outcomes of
pneumonia, PRF and HLOS. <br/>Conclusion(s): In thoracic surgeries,
preoperative RMT is comparable with preoperative AET to prevent PPC,
pneumonia, and PRF and reduce HLOS. It can be considered in patients in
resource-limited settings.<br/>Copyright &#xa9; 2022 American Congress of
Rehabilitation Medicine

<9>
Accession Number
2024109757
Title
Effect of preoperative inspiratory muscle training on postoperative
outcomes in patients undergoing cardiac surgery: A systematic review and
meta-analysis.
Source
World Journal of Clinical Cases. 11(13) (pp 2981-2991), 2023. Date of
Publication: 06 May 2023.
Author
Wang J.; Wang Y.-Q.; Shi J.; Yu P.-M.; Guo Y.-Q.
Institution
(Wang, Wang, Shi, Guo) Department of Cardiovascular Surgery, Sichuan
University West China Hospital, Sichuan Province, Chengdu 610041, China
(Yu) Rehabilitation Medicine Center, West China Hospital, Sichuan
University, Sichuan Province, Chengdu 610041, China
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND Cardiovascular disease is the most prevalent disease worldwide
and places a great burden on the health and economic welfare of patients.
Cardiac surgery is an important way to treat cardiovascular disease, but
it can prolong mechanical ventilation time, intensive care unit (ICU)
stay, and postoperative hospitalization for patients. Previous studies
have demonstrated that preoperative inspiratory muscle training could
decrease the incidence of postoperative pulmonary complications. AIM To
explore the effect of preoperative inspiratory muscle training on
mechanical ventilation time, length of ICU stay, and duration of
postoperative hospitalization after cardiac surgery. METHODS A literature
search of PubMed, Web of Science, Cochrane Library, EMBASE, China National
Knowledge Infrastructure, WanFang, and the China Science and Technology
journal VIP database was performed on April 13, 2022. The data was
independently extracted by two authors. The inclusion criteria were: (1)
Randomized controlled trial; (2) Accessible as a full paper; (3) Patients
who received cardiac surgery; (4) Preoperative inspiratory muscle training
was implemented in these patients; (5) The study reported at least one of
the following: Mechanical ventilation time, length of ICU stay, and/or
duration of postoperative hospitalization; and (6) In English language.
RESULTS We analyzed six randomized controlled trials with a total of 925
participants. The pooled mean difference of mechanical ventilation time
was -0.45 h [95% confidence interval (CI): -1.59-0.69], which was not
statistically significant between the intervention group and the control
group. The pooled mean difference of length of ICU stay was 0.44 h (95%CI:
-0.58-1.45). The pooled mean difference of postoperative hospitalization
was -1.77 d in the intervention group vs the control group [95%CI:
-2.41-(-1.12)]. CONCLUSION Preoperative inspiratory muscle training may
decrease the duration of postoperative hospitalization for patients
undergoing cardiac surgery. More high-quality studies are needed to
confirm our conclusion<br/>Copyright &#xa9; The Author(s) 2023. Published
by Baishideng Publishing Group Inc. All rights reserved.

<10>
[Use Link to view the full text]
Accession Number
2024014152
Title
Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients.
Source
New England Journal of Medicine. 388(15) (pp 1353-1364), 2023. Date of
Publication: 2023.
Author
Nissen S.E.; Lincoff A.M.; Brennan D.; Ray K.K.; Mason D.; Kastelein
J.J.P.; Thompson P.D.; Libby P.; Cho L.; Plutzky J.; Bays H.E.; Moriarty
P.M.; Menon V.; Grobbee D.E.; Louie M.J.; Chen C.-F.; Li N.; Bloedon L.;
Robinson P.; Horner M.; Sasiela W.J.; McCluskey J.; Davey D.;
Fajardo-Campos P.; Petrovic P.; Fedacko J.; Zmuda W.; Lukyanov Y.;
Nicholls S.J.
Institution
(Nissen, Lincoff, Brennan, Cho, Menon, McCluskey, Davey) Cleveland Clinic,
Cleveland, United States
(Ray, Mason) Imperial College London, London, United Kingdom
(Kastelein) University of Amsterdam Academic Medical Center, Amsterdam,
Netherlands
(Grobbee) University Medical Center Utrecht, Utrecht, Netherlands
(Thompson) Hartford Hospital, Hartford, CT, United States
(Libby, Plutzky) Brigham and Women s Hospital, Harvard Medical School,
Boston, United States
(Bays) Louisville Metabolic and Atherosclerosis Research Center,
Louisville, KY, United States
(Moriarty) University of Kansas Medical Center, Kansas City, United States
(Louie, Chen, Li, Bloedon, Robinson, Horner, Sasiela) Esperion
Therapeutics, Ann Arbor, MI, United States
(Fajardo-Campos) Centro de Investigacion Cardiovascular y Metabolica,
Tijuana, Mexico
(Petrovic) General Hospital Sveti Luka, Smederevo, Serbia
(Fedacko) Center of Clinical and Preclinical Research Medipark, Pavol
Jozef Safarik University, Kosice, Slovakia
(Zmuda) Medicome, Oswiecim, Poland
(Lukyanov) Pavlov First St. Petersburg State Medical University, St.
Petersburg, Russian Federation
(Nicholls) Victorian Heart Institute, Monash University, Melbourne, VIC,
Australia
Publisher
Massachussetts Medical Society
Abstract
Background Bempedoic acid, an ATP citrate lyase inhibitor, reduces
low-density lipoprotein (LDL) cholesterol levels and is associated with a
low incidence of muscle-related adverse events; its effects on
cardiovascular outcomes remain uncertain. Methods We conducted a
double-blind, randomized, placebo-controlled trial involving patients who
were unable or unwilling to take statins owing to unacceptable adverse
effects ("statin-intolerant"patients) and had, or were at high risk for,
cardiovascular disease. The patients were assigned to receive oral
bempedoic acid, 180 mg daily, or placebo. The primary end point was a
four-component composite of major adverse cardiovascular events, defined
as death from cardiovascular causes, nonfatal myocardial infarction,
nonfatal stroke, or coronary revascularization. Results A total of 13,970
patients underwent randomization; 6992 were assigned to the bempedoic acid
group and 6978 to the placebo group. The median duration of follow-up was
40.6 months. The mean LDL cholesterol level at baseline was 139.0 mg per
deciliter in both groups, and after 6 months, the reduction in the level
was greater with bempedoic acid than with placebo by 29.2 mg per
deciliter; the observed difference in the percent reductions was 21.1
percentage points in favor of bempedoic acid. The incidence of a primary
end-point event was significantly lower with bempedoic acid than with
placebo (819 patients [11.7%] vs. 927 [13.3%]; hazard ratio, 0.87; 95%
confidence interval [CI], 0.79 to 0.96; P=0.004), as were the incidences
of a composite of death from cardiovascular causes, nonfatal stroke, or
nonfatal myocardial infarction (575 [8.2%] vs. 663 [9.5%]; hazard ratio,
0.85; 95% CI, 0.76 to 0.96; P=0.006); fatal or nonfatal myocardial
infarction (261 [3.7%] vs. 334 [4.8%]; hazard ratio, 0.77; 95% CI, 0.66 to
0.91; P=0.002); and coronary revascularization (435 [6.2%] vs. 529 [7.6%];
hazard ratio, 0.81; 95% CI, 0.72 to 0.92; P=0.001). Bempedoic acid had no
significant effects on fatal or nonfatal stroke, death from cardiovascular
causes, and death from any cause. The incidences of gout and
cholelithiasis were higher with bempedoic acid than with placebo (3.1% vs.
2.1% and 2.2% vs. 1.2%, respectively), as were the incidences of small
increases in serum creatinine, uric acid, and hepatic-enzyme levels.
Conclusions Among statin-intolerant patients, treatment with bempedoic
acid was associated with a lower risk of major adverse cardiovascular
events (death from cardiovascular causes, nonfatal myocardial infarction,
nonfatal stroke, or coronary revascularization). (Funded by Esperion
Therapeutics; CLEAR Outcomes ClinicalTrials.gov number, NCT02993406.)
<br/>Copyright &#xa9; 2023 Massachusetts Medical Society.

<11>
Accession Number
2022737588
Title
Rheumatism as a cause of cardiac hemangioma: a rare case report and review
of literature with special focus on etiology.
Source
BMC Cardiovascular Disorders. 23(1) (no pagination), 2023. Article Number:
203. Date of Publication: December 2023.
Author
Xie T.; Masroor M.; Chen X.; Liu F.; Zhang J.; Yang D.; Liu C.; Xiang M.
Institution
(Xie, Xiang) Department of Cardiac Surgery, Hainan General Hospital,
Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311,
China
(Masroor) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan
430022, China
(Masroor) Department of Cardiothoracic and Vascular Surgery, Amiri Medical
Complex, Kabul, Afshar, Afghanistan
(Chen) International College of Nursing, Hainan Vocational University of
Science and Technology, Haikou 570311, China
(Liu) Department of Pathology, Hainan General Hospital, Hainan Affiliated
Hospital of Hainan Medical University, Haikou 570311, China
(Zhang, Yang) Department of Ultrasound Medicine, Hainan General Hospital,
Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311,
China
(Liu) Department of Ultrasound Medicine, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan 430022,
China
Publisher
BioMed Central Ltd
Abstract
Background: Cardiac hemangioma is a very rare benign tumor of the heart
which accounts for 1-2% of all primary cardiac tumors. Multiple cardiac
hemangiomas are even rarer with only three cases published in the
literature. Pathologically it can be divided into cavernous hemangioma,
capillary hemangioma, arteriovenous hemangioma, mixed-type hemangioma, and
so on. At present, the etiology of cardiac hemangioma is not completely
clear. In this study, we present multiple cardiac hemangiomas located in
the right atrium and discuss the new unreported possible cause
(rheumatism) of cardiac hemangioma. This is the fourth case of multiple
cardiac hemangiomas in the medical literature and the first time to
present rheumatism as the cause of cardiac hemangioma. Case presentation:
A 53-year-old man presented to the clinic with intermittent chest
tightness and shortness of breath for 2 years. On echocardiography,
multiple soft tissue masses in the right atrium were found. The patient
had rheumatic heart disease with severe mitral stenosis and moderate
tricuspid regurgitation. Two masses with a diameter of about 20 mm and 15
mm were seen in the right atrium. One mass was located on the inferior
margin of the fossa ovalis and the other was adjacent to the inferior vena
cava. Both masses were successfully removed surgically. The mitral valve
replacement and tricuspid valve plasty were performed at the same time.
The postoperative histopathology results confirmed the diagnosis of
cavernous hemangioma. <br/>Conclusion(s): The occurrence of multiple
hemangiomas in the heart is possible, especially in the presence of
rheumatism. Rheumatism is one of the possible etiologies of cardiac
hemangioma. Cardiologists and cardiac surgeons should be aware of its
occurrence and should consider cardiac hemangioma as a differential
diagnosis especially in rheumatic heart disease patients when they present
with soft tissue cardiac masses for accurate management.<br/>Copyright
&#xa9; 2023, The Author(s).

<12>
Accession Number
2024175428
Title
Bilateral internal thoracic artery coronary grafting: risks and benefits
in elderly patients.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 8(8) (pp
861-870), 2022. Date of Publication: 01 Dec 2022.
Author
Zhou Z.; Fu G.; Huang S.; Chen S.; Liang M.; Wu Z.
Institution
(Zhou, Fu, Huang, Chen, Liang, Wu) Department of Cardiac Surgery, First
Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road,
Guangzhou 510080, China
(Zhou, Fu, Huang, Chen, Liang, Wu) NHC Key Laboratory of Assisted
Circulation, Sun Yat-sen University, Guangzhou 510080, China
Publisher
Oxford University Press
Abstract
Aims Whether bilateral internal thoracic artery (BITA) grafting benefits
elderly patients in coronary artery bypass grafting (CABG) remains unclear
since they tend to have a limited life expectancy and severe
comorbidities. We aim to evaluate the outcomes of BITA vs. single internal
thoracic artery (SITA) grafting in elderly patients. Methods and results A
meta-analysis was performed by database searching until May 2021. Studies
comparing BITA and SITA grafting among elderly patients were included. One
randomized controlled trial, nine propensity score matching, and six
unmatched studies were identified, with a total of 18 146 patients (7422
received BITA grafting and 10 724 received SITA grafting). Compared with
SITA grafting, BITA grafting had a higher risk of deep sternal wound
infection (DSWI) [odds ratio: 1.67; 95% confidence interval (CI):
1.22-2.28], and this risk could not be significantly reduced by the
skeletonization technique. Meanwhile, BITA grafting was associated with a
higher long-term survival [hazard ratio: 0.83; 95% CI: 0.77-0.90], except
for the octogenarian subgroup. Reconstructed Kaplan-Meier survival curves
revealed 4-year, 8-year, and 12-year overall survival rates of 85.5%,
66.7%, and 45.3%, respectively, in the BITA group and 79.3%, 58.6%, and
34.9%, respectively, in the SITA group. No significant difference was
observed in early mortality, perioperative myocardial infarction,
perioperative cerebral vascular accidents, or re-exploration for bleeding.
Conclusion Compared with SITA grafting, BITA grafting could provide a
long-term survival benefit for elderly patients, although this benefit
remained uncertain in octogenarians. Meanwhile, elderly patients who
received BITA were associated with a higher risk of DSWI and such a risk
could not be eliminated by the skeletonization technique.<br/>Copyright
&#xa9; The Author(s) 2021. Published by Oxford University Press on behalf
of the European Society of Cardiology. All rights reserved.

<13>
Accession Number
2024175414
Title
Fast vs. ultraslow thrombolytic infusion regimens in patients with
obstructive mechanical prosthetic valve thrombosis: a pilot randomized
clinical trial.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 8(7) (pp
668-676), 2022. Date of Publication: 01 Nov 2022.
Author
Sadeghipour P.; Saedi S.; Saneei L.; Rafiee F.; Yoosefi S.; Parsaee M.;
Siami R.; Saberi M.; Pouraliakbar H.; Ghadrdoost B.; Bakhshandeh H.;
Peighambari M.M.; Farrashi M.; Mohebbi B.; Naderi N.; Amin A.; Maleki M.;
Khajali Z.; De Caterina R.
Institution
(Sadeghipour, Mohebbi, Maleki) Cardiovascular Intervention Research
Center, Rajaie Cardiovascular, Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sadeghipour, Ghadrdoost, Bakhshandeh) Clinical Trial Center, Rajaie
Cardiovascular, Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Saedi, Saneei, Rafiee, Yoosefi, Siami, Saberi, Pouraliakbar, Ghadrdoost,
Bakhshandeh, Peighambari, Naderi, Amin, Khajali) Rajaie Cardiovascular,
Medical and Research Center, Iran University of Medical Sciences, Vali-Asr
Ave, Niyayesh Blvd, Tehran 1996911101, Iran, Islamic Republic of
(Parsaee, Farrashi) Echocardiography Research Center, Rajaie
Cardiovascular, Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(De Caterina) University Cardiology Division, Pisa University Hospital,
University of Pisa, Via Paradisa 2, Pisa 56124, Italy
(De Caterina) Fondazione Villa Serena per la Ricerca, Citta Sant'Angelo,
Pescara, Italy
Publisher
Oxford University Press
Abstract
Aims Thrombolysis is an alternative to surgery for mechanical prosthetic
valve thrombosis (MPVT). Randomized clinical trials have yet to test the
safety and efficacy of a proposed ultraslow thrombolytic infusion regimen.
Methods and This single-centre, open-label, pilot randomized clinical
trial randomized adult patients with acute obstructive MPVT to results an
ultraslow thrombolytic regimen [25 mg of recombinant tissue-type
plasminogen activator (rtPA) infused in 25 h] and a fast thrombolytic
regimen (50 mg of rtPA infused in 6 h). If thrombolysis failed, a repeated
dose of 25 mg of rtPA for 6 h was administered in both groups up to a
cumulative dose of 150 mg or the occurrence of a complication. The primary
outcome was a complete MPVT resolution (>75% fall in the obstructive
gradient by transthoracic echocardiography, <10degree limitation in
opening and closing valve motion angles by fluoroscopy, and symptom
improvement). The key safety outcome was a Bleeding Academic Research
Consortium type III or V major bleeding. Overall, 120 patients, including
63 (52.5%) women, at a mean age of 36.3 +/- 15.3 years, were randomized.
Complete thrombolysis success was achieved in 51 patients (85.0%) in the
ultraslow-regimen group and 47 patients (78.3%) in the fast-regimen group
[odds ratio 1.58; 95% confidence interval (CI) 0.25-1.63; P = 0.34]. One
case of transient ischaemic attack and three cases of intracranial
haemorrhage (absolute risk difference -6.6%; 95%CI -12% -0.3%; P = 0.07)
were observed only in the fast-regimen group. Conclusion The ultraslow
thrombolytic regimen conferred a high thrombosis resolution rate without
major complications. Such findings should be replicated in more adequately
powered trials.<br/>Copyright &#xa9; The Author(s) 2021. Published by
Oxford University Press on behalf of the European Society of Cardiology.
All rights reserved.

<14>
[Use Link to view the full text]
Accession Number
2024037316
Title
Urinary Neutrophil Gelatinase-Associated Lipocalin/Hepcidin-25 Ratio for
Early Identification of Patients at Risk for Renal Replacement Therapy
after Cardiac Surgery: A Substudy of the BICARBONATE Trial.
Source
Anesthesia and Analgesia. 133(6) (pp 1510-1519), 2021. Date of
Publication: 01 Dec 2021.
Author
Elitok S.; Kuppe H.; Devarajan P.; Bellomo R.; Isermann B.; Westphal S.;
Kube J.; Albert C.; Ernst M.; Kropf S.; Haase-Fielitz A.; Haase M.
Institution
(Elitok, Ernst) Department of Nephrology and Endocrinology, Ernst von
Bergmann Hospital Potsdam, Potsdam, Germany
(Kuppe) Institute of Cardiac Thoracic Vascular Anesthesia and Intensive
Care Medicine, German Heart Center Berlin and Charite-University Medicine
Berlin, Berlin, Germany
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital, Cincinnati, OH, United States
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, Austin Health, Heidelberg, VIC,
Australia
(Isermann) Department of Integrated Critical Care, Center for Integrated
Critical Care, The University of Melbourne, Melbourne, VIC, Australia
(Isermann) Department of Laboratory Medicine, Institute of Laboratory
Medicine, Clinical Chemistry, Molecular Diagnostic, Leipzig University
Hospital, Leipzig, Germany
(Westphal) Department of Laboratory Medicine, Institute of Laboratory
Medicine, Tertiary Hospital Dessau, Rolau, Dessau, Germany
(Kube, Haase) Department of Anesthesiology and Intensive Care, Helios
Klinikum Leisnig, Leisnig, Germany
(Albert) Diaverum Renal Care Center, Potsdam, Germany
(Kube) Medical Faculty, University Clinic for Cardiology and Angiology
(Albert) Medical Faculty
(Kropf) Medical Faculty, Institute for Biometrics and Medical Informatics,
Otto Von-Guericke-University Magdeburg, Magdeburg, Germany
(Haase-Fielitz) Brandenburg Medical School Theodor Fontane, Neuruppin,
Germany
(Haase-Fielitz) Faculty of Health Sciences Brandenburg, Potsdam, Germany
(Haase-Fielitz) Institute of Integrated Health Care Systems Research and
Social Medicine, Otto Von-Guericke-University Magdeburg, Magdeburg,
Germany
(Haase-Fielitz) Department of Cardiology, Brandenburg Heart Center,
Immanuel Hospital, Bernau, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Acute kidney injury requiring renal replacement therapy
(AKI-RRT) is strongly associated with mortality after cardiac surgery;
however, options for early identification of patients at high risk for
AKI-RRT are extremely limited. Early after cardiac surgery, the predictive
ability for AKI-RRT even of one of the most extensively evaluated novel
urinary biomarkers, neutrophil gelatinase-Associated lipocalin (NGAL),
appears to be only moderate. We aimed to determine whether the
NGAL/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of
hepcidin-25) early after surgery may compare favorably to NGAL for
identification of high-risk patients after cardiac surgery.
<br/>METHOD(S): This is a prospective substudy of the BICARBONATE trial, a
multicenter parallel-randomized controlled trial comparing perioperative
bicarbonate infusion for AKI prevention to usual patient care. At a
tertiary referral center, 198 patients at increased kidney risk undergoing
cardiac surgery with cardiopulmonary bypass were included into the present
study. The primary outcome measure was defined as AKI-RRT. Secondary
outcomes were in-hospital mortality and long-Term mortality. We compared
area under the curve of the receiver operating characteristic (AUC-ROC) of
urinary NGAL with that of the urinary NGAL/hepcidin-25 ratio within 60
minutes after end of surgery. We compared adjusted AUC and performed
cross-validated reclassification statistics of the (logarithmic) urinary
NGAL/hepcidin-25 ratio adjusted to Cleveland risk score/EuroScore,
cross-clamp time, age, volume of packed red blood cells, and (logarithmic)
urinary NGAL concentration. The association of the NGAL/hepcidin-25 ratio
with long-Term patient survival was assessed using Cox proportional hazard
regression analysis adjusting for EuroScore, aortic cross-clamp time,
packed red blood cells and urinary NGAL. <br/>RESULT(S): Patients with
AKI-RRT (n = 13) had 13.7-Times higher NGAL and 3.3-Times lower
hepcidin-25 concentrations resulting in 46.9-Times higher NGAL/hepcidin-25
ratio early after surgery compared to patients without AKI-RRT. The
NGAL/hepcidin-25 ratio had higher AUC-ROC compared with NGAL for risk of
AKI-RRT and in-hospital mortality (unadjusted AUC-ROC difference 0.087,
95% confidence interval [CI], 0.036-0.138, P <.001; 0.082, 95% CI,
0.018-0.146, P =.012). For AKI-RRT, the NGAL/hepcidin-25 ratio increased
adjusted category-free net reclassification improvement (cfNRI; 0.952, 95%
CI, 0.437-1.468; P <.001) and integrated discrimination improvement (IDI;
0.040, 95% CI, 0.008-0.073; P =.016) but not AUC difference. For
in-hospital mortality, the ratio improved AUC of the reference model (AUC
difference 0.056, 95% CI, 0.003-0.108; P =.037) and cfNRI but not IDI. The
urinary NGAL/hepcidin-25 ratio remained significantly associated with
long-Term mortality after adjusting for the model covariates.
<br/>CONCLUSION(S): The urinary NGAL/hepcidin-25 ratio appears to early
identify high-risk patients and outperform NGAL after cardiac surgery.
Confirmation of our findings in other cardiac surgery centers is now
needed.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins. All
rights reserved.

<15>
Accession Number
641153288
Title
The Remote Exercise SWEDEHEART study - Rationale and design of a
multicenter registry-based cluster randomized crossover clinical trial
(RRCT).
Source
American heart journal. (no pagination), 2023. Date of Publication: 25
Apr 2023.
Author
Back M.; Leosdottir M.; Ekstrom M.; Hambraeus K.; Ravn-Fischer A.; Oberg
B.; Ostlund O.; James S.
Institution
(Back) Department of Occupational Therapy and Physiotherapy, Sahlgrenska
University Hospital, Gothenburg, Sweden; Department of Molecular and
Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University
of Gothenburg, Gothenburg, Sweden; Department of Medical and Health
Sciences, Division of Physiotherapy, Linkoping University, Linkoping,
Sweden
(Leosdottir) Department of Cardiology, Skane University Hospital, Malmo,
Sweden; Department of Clinical Sciences Malmo, Lund University, Malmo,
Sweden
(Ekstrom) Division of Cardiovascular Medicine, Department of Clinical
Sciences, Danderyd Hospital, Stockholm, Sweden
(Hambraeus) Department of Cardiology, Falu Hospital, Falun, Sweden
(Ravn-Fischer) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Oberg) Department of Medical and Health Sciences, Division of
Physiotherapy, Linkoping University, Linkoping, Sweden
(Ostlund) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(James) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden; Department of Medical Sciences, Uppsala University, Uppsala,
Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: Despite proven benefits of exercise-based cardiac
rehabilitation (EBCR), few patients with myocardial infarction (MI)
participate in and complete these programs. STUDY DESIGN AND OBJECTIVES:
The Remote Exercise SWEDEHEART study is a large multicenter registry-based
cluster randomized crossover clinical trial with a planned enrollment of
1500 patients with a recent MI. Patients at intervention centers will be
offered supervised EBCR, either delivered remotely, center-based or as a
combination of both modes, as self-preferred choice. At control centers,
patients will be offered supervised center-based EBCR, only. The duration
of each time period (intervention/control) for each center will be 15
months and then cross-over occurs. The primary aim is to evaluate if
remotely delivered EBCR, offered as an alternative to center-based EBCR,
can increase participation in EBCR sessions. The proportion completers in
each group will be presented in a supportive responder analysis. The key
secondary aim is to is to investigate if remote EBCR is as least as
effective as center-based EBCR, in terms of physical fitness and
patient-reported outcome measures. Follow-up of major adverse
cardiovascular events (cardiovascular- and all-cause mortality, recurrent
hospitalization for acute coronary syndrome, heart failure
hospitalization, stroke, and coronary revascularization) will be performed
at 1 and 3 years. Safety monitoring of serious adverse events will be
registered, and a cost-effectiveness analysis will be conducted to
estimate the cost per quality-adjusted life-year (QALY) associated with
the intervention compared with control. <br/>CONCLUSION(S): The cluster
randomized crossover clinical trial Remote Exercise SWEDEHEART study is
evaluating if participation in EBCR sessions can be increased, which may
contribute to health benefits both on a group level and for individual
patients including a more equal access to health care. TRIAL REGISTRATION:
The study is registered at ClinicalTrials.gov (Identifier:
NCT04260958).<br/>Copyright &#xa9; 2023. Published by Elsevier Inc.

<16>
Accession Number
2024058573
Title
A norepinephrine weaning strategy using dynamic arterial elastance is
associated with reduction of acute kidney injury in patients with
vasoplegia after cardiac surgery: A post-hoc analysis of the randomized
SNEAD study.
Source
Journal of Clinical Anesthesia. 88 (no pagination), 2023. Article Number:
111124. Date of Publication: September 2023.
Author
Guinot P.-G.; Huette P.; Bouhemad B.; Abou-Arab O.; Nguyen M.
Institution
(Guinot, Bouhemad, Nguyen) Department of Anaesthesiology and Critical Care
Medicine, Dijon University Medical Centre, Dijon 21000, France
(Guinot, Bouhemad, Nguyen) University of Burgundy and Franche-Comte, LNC
UMR1231, Dijon F-21000, France
(Huette, Abou-Arab) Department of Anaesthesiology and Critical Care
Medicine, Amiens University Medical Centre, Amiens 80000, France
Publisher
Elsevier Inc.
Abstract
Study objective: To evaluate the impact of a dynamic arterial elastance
guided norepinephrine weaning strategy on the occurrence of acute kidney
injury (AKI) in patients with vasoplegia after cardiac surgery.
<br/>Design(s): A post-hoc analysis of a monocentric randomized controlled
trial. <br/>Setting(s): A tertiary care hospital in France.
<br/>Participant(s): Vasoplegic cardiac surgical patients treated with
norepinephrine. <br/>Intervention(s): Patients were randomized to an
algorithm-based norepinephrine weaning intervention (dynamic arterial
elastance) group or a control group. Measurements: The primary endpoint
was the number of patients with AKI defined according to Kidney Disease
Improving Global Outcomes (KDIGO) criteria. The secondary endpoint were
major adverse cardiac post-operative events (new onset of atrial
fibrillation or flutter, low cardiac output syndrome, and in-hospital
death). End points were evaluated during the first seven post-operative
days. <br/>Result(s): 118 patients were analyzed. In the overall study
population, the mean age was 70 (62-76) years, 65% were male and the
median EuroSCORE was 7 (5-10). Overall, 46 (39%) patients developed AKI
(30 KDIGO 1, 8 KDIGO 2, 8 KDIGO 3), and 6 patients required renal
replacement therapy. The incidence of AKI was significantly lower in the
intervention group than in the control group (16 patients (27%) vs 30
patients (51%), p = 0.12). Higher dose and longer duration of
norepinephrine were associated with AKI severity. <br/>Conclusion(s):
Decreasing norepinephrine exposure by using a dynamic arterial elastance
guided norepinephrine weaning strategy was associated with a reduced
incidence of acute kidney injury in patients with vasoplegia after cardiac
surgery. Further prospective multicentric studies are needed to confirm
these results.<br/>Copyright &#xa9; 2023 The Author(s)

<17>
Accession Number
2023946163
Title
Clinical Outcomes of PASCAL Compared With the MitraClip for Symptomatic
Mitral Regurgitation: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 16(8) (pp 1005-1007), 2023. Date of
Publication: 24 Apr 2023.
Author
Bansal A.; Faisaluddin M.; Agarwal S.; Badwan O.; Harb S.C.; Krishnaswamy
A.; Gillinov M.; Kapadia S.R.
Publisher
Elsevier Inc.

<18>
Accession Number
629599809
Title
Protocol for the electroencephalography guidance of anesthesia to
alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic,
randomized clinical trial.
Source
F1000Research. 8 (no pagination), 2023. Article Number: 1165. Date of
Publication: 2023.
Author
Deschamps A.; Saha T.; El-Gabalawy R.; Jacobsohn E.; Overbeek C.; Palermo
J.; Robichaud S.; Dumont A.A.; Djaiani G.; Carroll J.; Kavosh M.S.;
Tanzola R.; Schmitt E.M.; Inouye S.K.; Oberhaus J.; Mickle A.; Ben
Abdallah A.; Avidan M.S.
Institution
(Deschamps) Department of Anesthesiology and Pain Medicine, Montreal Heart
Institute and Universite de Montreal, Montreal, QC H1T 1C8, Canada
(Saha, Tanzola) Department of Anesthesiology and Perioperative Medicine,
Queen's University, Kingston, Kingston, ON, Canada
(El-Gabalawy) Department of Clinical Health Psychology, Anesthesiology,
Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB,
Canada
(Jacobsohn) Departments of Anesthesia and Internal Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Overbeek, Palermo) Department of Anesthesiology and Pain Medicine,
University of Montreal, Montreal, QC, Canada
(Robichaud) Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
(Dumont) Montreal Health Innovation Coordinating Center, Montreal Heart
Institute, Montreal, QC, Canada
(Djaiani, Carroll) Department of Anesthesia, University of Toronto,
Toronto, ON, Canada
(Kavosh) Department of Anesthesiology, Perioperative and Pain Medicine,
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Schmitt, Inouye) Department of Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Oberhaus, Mickle, Ben Abdallah, Avidan) Department of Anesthesiology,
Washington University School of Medicine, St-Louis, MO, United States
Publisher
F1000 Research Ltd
Abstract
Background: There is some evidence that electroencephalography guidance of
general anesthesia can decrease postoperative delirium after non-cardiac
surgery. There is limited evidence in this regard for cardiac surgery. A
suppressed electroencephalogram pattern, occurring with deep anesthesia,
is associated with increased incidence of postoperative delirium (POD) and
death. However, it is not yet clear whether this electroencephalographic
pattern reflects an underlying vulnerability associated with increased
incidence of delirium and mortality, or whether it is a modifiable risk
factor for these adverse outcomes. <br/>Method(s): The Electroe
ncephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes
(ENGAGES-Canada) is an ongoing pragmatic 1200 patient trial at four
Canadian sites. The study compares the effect of two anesthetic management
approaches on the incidence of POD after cardiac surgery. One approach is
based on current standard anesthetic practice and the other on
electroencephalography guidance to reduce POD. In the guided arm,
clinicians are encouraged to decrease anesthetic administration, primarily
if there is electroencephalogram suppression and secondarily if the EEG
index is lower than the manufacturers recommended value (bispectral index
(BIS) or WAVcns below 40 or Patient State Index below 25). The aim in the
guided group is to administer the minimum concentration of anesthetic
considered safe for individual patients. The primary outcome of the study
is the incidence of POD, detected using the confusion assessment method or
the confusion assessment method for the intensive care unit; coupled with
structured delirium chart review. Secondary outcomes include unexpected
intraoperative movement, awareness, length of intensive care unit and
hospital stay, delirium severity and duration, quality of life, falls, and
predictors and outcomes of perioperative distress and dissociation.
<br/>Discussion(s): The ENGAGES-Canada trial will help to clarify whether
or not using the electroencephalogram to guide anesthetic administration
during cardiac surgery decreases the incidence, severity, and duration of
POD. Registration: ClinicalTrials.gov
(https://clinicaltrials.gov/ct2/show/NCT02692300 NCT02692300)
26/02/2016<br/>Copyright: &#xa9; 2023 Deschamps A et al.

<19>
Accession Number
2023943105
Title
Study protocol of a phase 2, randomised, placebo-controlled, double-blind,
adaptive, parallel group clinical study to evaluate the efficacy and
safety of recombinant alpha-1-microglobulin in subjects at high risk for
acute kidney injury following open-chest cardiac surgery (AKITA trial).
Source
BMJ Open. 13(4) (no pagination), 2023. Article Number: e068363. Date of
Publication: 06 Apr 2023.
Author
Mazer C.D.; Siadati-Fini N.; Boehm J.; Wirth F.; Myjavec A.; Brown C.D.;
Koyner J.L.; Boening A.; Engelman D.T.; Larsson T.E.; Renfurm R.; De
Varennes B.; Noiseux N.; Thielmann M.; Lamy A.; Laflamme M.; Von Groote
T.; Ronco C.; Zarbock A.
Institution
(Mazer) Department of Anesthesia, St. Michael's Hospital, Toronto, ON,
Canada
(Mazer) Department of Anesthesiology and Pain Medicine, Physiology and
Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
(Siadati-Fini) Anaesthesia Department, St. Michael's Hospital, Toronto,
ON, Canada
(Boehm, Wirth) Department of Cardiovascular Surgery, Technische
Universitat Munchen, Munchen, Germany
(Boehm, Wirth) Insure (Institute for Translational Cardiac Surgery),
Department of Cardiovascular Surgery, German Heart Centre Munich, Munchen,
Germany
(Myjavec) Department of Cardiac Surgery, University of Hradec Kralove,
Hradec Kralove, Czechia
(Brown) Department of Cardiac Surgery, New Brunswick Heart Centre, Saint
John, NB, Canada
(Koyner) Department of Medicine, Section of Nephrology, University of
Chicago, Pritzker School of Medicine, Chicago, IL, United States
(Boening) Department of Cardiovascular Surgery, Justus-Liebig-University,
Giessen, Germany
(Engelman) Heart and Vascular Program, Baystate Medical Center,
Springfield, MA, United States
(Larsson) Guard Therapeutics, Stockholm, Sweden
(Renfurm) Global Drug Development Unit Cardio-Renal-Metabolism, Novartis
Pharma AG, Basel, Switzerland
(De Varennes) Division of Cardiac Surgery, McGill University, Faculty of
Medicine, Montreal, QC, Canada
(Noiseux) Division of Cardiac Surgery, Universite de Montreal, Montreal,
QC, Canada
(Thielmann, Lamy) Department for Thoracic and Cardiovascular Surgery,
West-German Heart and Vascular Center Essen, University Duisburg-Essen,
Essen, Germany
(Lamy) Population Health Research Institute, Hamilton Health Sciences,
Hamilton, ON, Canada
(Laflamme) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, University of Quebec, Quebec, QC, Canada
(Von Groote, Zarbock) Department of Anesthesiology, Intensive Care
Medicine, University Hospital Munster, Munster, Germany
(Ronco) International Renal Research Institute of Vicenza, San Bortolo
Hospital of Vicenza, Vicenza, Italy
Publisher
BMJ Publishing Group
Abstract
Introduction Acute kidney injury (AKI) is a common complication after
cardiac surgery (CS) and is associated with adverse short-term and
long-term outcomes. Alpha-1-microglobulin (A1M) is a circulating
glycoprotein with antioxidant, heme binding and mitochondrial-protective
mechanisms. RMC-035 is a modified, more soluble, variant of A1M and has
been proposed as a novel targeted therapeutic protein to prevent
CS-associated AKI (CS-AKI). RMC-035 was considered safe and generally well
tolerated when evaluated in four clinical phase 1 studies. Methods and
analysis This is a phase 2, randomised, double-blind, adaptive design,
parallel group clinical study that evaluates RMC-035 compared with placebo
in approximately 268 cardiac surgical patients at high risk for CS-AKI.
RMC-035 is administered as an intravenous infusion. In total, five doses
will be given. Dosing is based on presurgery estimated glomerular
filtration rate (eGFR), and will be either 1.3 or 0.65 mg/kg. The primary
study objective is to evaluate whether RMC-035 reduces the incidence of
postoperative AKI, and key secondary objectives are to evaluate whether
RMC-035 improves postoperative renal function compared with placebo. A
blinded interim analysis with potential sample size reassessment is
planned once 134 randomised subjects have completed dosing. An independent
data monitoring committee will evaluate safety and efficacy data at
prespecified intervals throughout the trial. The study is a global
multicentre study at approximately 30 sites. Ethics and dissemination The
trial was approved by the joint ethics committee of the physician chamber
Westfalen-Lippe and the University of Munster (code '2021-778 f-A') and
subsequently approved by the responsible ethics committees/relevant
institutional review boards for the participating sites. The study is
conducted in accordance with Good Clinical Practice, the Declaration of
Helsinki and other applicable regulations. Results of this study will be
published in a peer-reviewed scientific journal. Trial registration number
NCT05126303.<br/>Copyright &#xa9; Authors 2023

<20>
Accession Number
2023698208
Title
Minimally Invasive Direct Coronary Artery Bypass Versus Percutaneous
Coronary Intervention for Isolated Left Anterior Descending Artery
Stenosis: An Updated Meta-Analysis.
Source
Heart Surgery Forum. 26(1) (pp E114-E125), 2023. Date of Publication:
2023.
Author
Zhang S.; Chen S.; Yang K.; Li Y.; Yun Y.; Zhang X.; Qi X.; Zhou X.; Zhang
H.; Zou C.; Ma X.
Institution
(Zhang, Chen, Li, Zhang, Zou, Ma) Department of Cardiovascular Surgery,
Shandong Provincial Hospital, Shandong University, Jinan, China
(Yang) Shandong First Medical University, Jinan, China
(Yun) Department of Radiology, Qilu Hospital of Shandong University,
Jinan, China
(Zhang, Zhang, Zou, Ma) Department of Cardiovascular Surgery, Shandong
Provincial Hospital, Shandong First Medical University, Jinan, China
(Qi) Key Laboratory for Experimental Teratology, The Ministry of
Education, Department of Medical Genetics, School of Basic Medical
Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
(Zhou) Department of Endocrinology, Shandong Provincial Hospital, Shandong
First Medical University, Jinan, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: The optimal revascularization strategy for isolated left
anterior descending (LAD) coronary artery lesion between minimally
invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary
intervention (PCI) remains controversial. This updated meta-analysis aims
to compare the long- and short-term outcomes of MIDCAB versus PCI for
patients with isolated LAD coronary artery lesions. <br/>Method(s): The
Pubmed, Web of Science, and Cochrane databases were searched for
retrieving potential publications from 2002 to 2022. The primary outcome
was long-term survival. Secondary outcomes were long-term target vessel
revascularization (TVR), long-term major adverse cardiovascular events
(MACEs), and short-term outcomes, including postoperative mortality,
myocardial infarction (MI), TVR, and MACEs of any cause in-hospital or 30
days after the revascularization. <br/>Result(s): Six randomized
controlled trials (RCTs) and eight observational studies were included in
this updated meta-analysis. In total, 1757 patients underwent MIDCAB and
15245 patients underwent PCI. No statistically significant difference was
found between the two groups in the rates of long-term survival. MIDCAB
had a lower long-term MACE rate compared with PCI. Besides, PCI resulted
in an augmented risk of TVR. Postoperative mortality, MI, TVR, and MACEs
were similar between the two groups. <br/>Conclusion(s): The updated
meta-analysis presents the evidence that MIDCAB has a reduced risk of
long-term TVR and MACEs, with no benefit in terms of long-term mortality
and short-term results, in comparison with PCI. Large multicenter RCTs,
including patients treated with newer techniques, are warranted in the
future.<br/>Copyright &#xa9; 2023 Forum Multimedia Publishing, LLC.

<21>
Accession Number
2023484821
Title
THE EFFECTS OF LOW FLOW AND NORMAL FLOW DESFLURANE ANESTHESIA ON LIVER AND
RENAL FUNCTIONS AND SERUM CYSTATIN C LEVELS IN GERIATRIC PATIENTS: A
PROSPECTIVE RANDOMIZED CONTROLLED STUDY.
Source
Turk Geriatri Dergisi. 26(1) (pp 068-078), 2023. Date of Publication:
2023.
Author
Guler Kol A.; Gunes H.Y.
Institution
(Guler Kol, Gunes) Van Yuzuncu Yil University, Faculty of Medicine,
Department of Anesthesiology and Reanimation, Van, Turkey
Publisher
Turkish Geriatrics Society
Abstract
Introduction: Aging is a physiological process and the elderly population
is increasing. In parallel to the increasing of the elderly population,
the number of geriatric patients who required an invasive procedure or
surgical intervention under anesthesia are also increasing. The geriatric
patients who are frailty and have a loss of functional reserve in all
organ systems are more sensitive to anesthetic agents. The purpose of this
research was to investigate whether low flow desflurane anesthesia also
affects hepatic and kidney functions, in elderly patients. <br/>Method(s):
After approval from the local ethics committee, the patients were divided
into two groups; as the low flow desflurane anesthesia group and the
normal flow desflurane anesthesia group using the closed-envelope method.
Calibration and leakage tests of the anesthesia device (Primus, Drager)
were performed before anesthesia. Heamodynamics parametres, peripheral
oxygen saturation, and bispectral index monitoring were performed to all
patients in operating room. The blood samples were collected before
anesthesia induction, after surgery, and at the postoperative 24th hour.
The serum alanine aminotransferase and aspartate aminotransferase levels
were measured to assess the liver damage. The serum creatinine, blood urea
nitrogen, and cystatin C levels were measured to assess the kidney
function. <br/>Result(s): The serum alanine aminotransferase, aspartate
aminotransferase, blood urea nitrogen, creatinine and cystatin C levels
and hemodynamic parameters, peripheral oxygen saturation and bispectral
index values were similar in both groups. <br/>Conclusion(s): It was
concluded that low-flow desflurane anesthesia does not adversely affect
liver and kidney functions in geriatric patients and is as safe as
normal-flow desflurane anesthesia.<br/>Copyright &#xa9; 2023, Turkish
Geriatrics Society. All rights reserved.

<22>
Accession Number
2023144100
Title
Pectus Excavatum in Cardiac Surgery Patients.
Source
Annals of Thoracic Surgery. 115(5) (pp 1312-1321), 2023. Date of
Publication: May 2023.
Author
Stephens E.H.; Dearani J.A.; Jaroszewski D.E.
Institution
(Stephens, Dearani) Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, Minnesota, United States
(Jaroszewski) Division of Thoracic Surgery, Department of Cardiovascular
and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona, United States
Publisher
Elsevier Inc.
Abstract
Background: Pectus excavatum frequently accompanies congenital heart
disease and connective tissue diseases requiring cardiac surgery.
Sometimes the indication is cardiac repair, with the pectus being
incidentally noticed; other times, the pectus subsequently develops or
becomes more significant after cardiac surgery. This review arms cardiac
and congenital surgeons with background about the physiologic impact of
pectus, indications for repair and repair strategies, and outcomes for
cardiac surgery patients requiring pectus repair. <br/>Method(s): A
comprehensive literature review was performed using keywords related to
pectus excavatum, pectus repair, and cardiac/congenital heart surgery
within the PubMed database. <br/>Result(s): The risks of complications
related to pectus repair, including in the setting of cardiac surgery or
after cardiac surgery, are low in experienced hands, and patients
demonstrate cardiopulmonary benefits and symptom relief. Concomitant
pectus and cardiac surgery should be considered if it is performed in
conjunction with those experienced in pectus repair, particularly given
the increased cardiopulmonary impact of pectus after bypass. In the
setting of potential bleeding or hemodynamic instability, delayed sternal
closure is recommended. For those with anticipated pectus repair after
cardiac surgery, the pericardium should be reconstructed for cardiac
protection. For those undergoing pectus repair after cardiac surgery
without a membrane placed, a "hybrid" approach is safe and effective.
<br/>Conclusion(s): Patients undergoing cardiac surgery noted to have
pectus should be considered for possible concomitant or staged pectus
repair. For those who will undergo a staged procedure, a barrier membrane
should be placed before chest closure.<br/>Copyright &#xa9; 2023 The
Society of Thoracic Surgeons

<23>
Accession Number
2023110168
Title
Recombinant Alpha-1-Microglobulin (RMC-035) to Prevent Acute Kidney Injury
in Cardiac Surgery Patients: Phase 1b Evaluation of Safety and
Pharmacokinetics.
Source
Kidney International Reports. 8(5) (pp 980-988), 2023. Date of
Publication: May 2023.
Author
Weiss R.; Meersch M.; Wempe C.; von Groote T.; Agervald T.; Zarbock A.
Institution
(Weiss, Meersch, Wempe, von Groote, Zarbock) Department of Anesthesiology,
Intensive Care and Pain Medicine, University Hospital Munster, Munster,
Germany
(Agervald) Guard Therapeutics International AB, Stockholm, Sweden
(Agervald) Renal Division, Department of Clinical Science, Intervention
and Technology, Karolinska Institutet, Stockholm, Sweden
Publisher
Elsevier Inc.
Abstract
Introduction: Acute kidney injury (AKI) is a common complication in
cardiac surgery patients and prevention is needed to improve clinical
outcomes. Alpha-1-microglobulin (A1M) is a physiological antioxidant with
strong tissue-protective and cell-protective properties that has
demonstrated renoprotective effects. RMC-035, a recombinant variant of
endogenous human A1M, is being developed for the prevention of AKI in
cardiac surgery patients. <br/>Method(s): In this phase 1b, randomized,
double-blind, and parallel group clinical study, 12 cardiac surgery
patients undergoing elective, open-chest, on-pump coronary artery bypass
graft and/or valve surgery with additional predisposing AKI risk factors
were enrolled to receive in total 5 intravenous doses of either RMC-035 or
placebo. The primary objective was to evaluate the safety and tolerability
of RMC-035. The secondary objective was to evaluate its pharmacokinetic
properties. <br/>Result(s): RMC-035 was well tolerated. The nature and
frequency of adverse events (AEs) were consistent with the expected
background rates in the underlying patient population with no AEs reported
as related to study drug. No clinically relevant changes were observed for
vital signs or laboratory parameters except for renal biomarkers. Several
established AKI urine biomarkers were reduced at 4 hours after first dose
administration in the treatment group, indicating a reduced perioperative
tubular cell injury following RMC-035 treatment. <br/>Conclusion(s):
Multiple intravenous doses of RMC-035 were well tolerated in patients
undergoing cardiac surgery. Observed RMC-035 plasma exposures were safe
and in the range of expected pharmacological activity. Furthermore, urine
biomarkers suggest reduced perioperative kidney cell injury, warranting
further investigation of RMC-035 as a potential renoprotective
treatment.<br/>Copyright &#xa9; 2023 International Society of Nephrology

<24>
Accession Number
2022741814
Title
Antithrombotic regimens for the prevention of major adverse cardiac events
in chronic coronary syndrome: A systematic review and network
meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1040936. Date of Publication: 2023.
Author
Marques G.L.; Albuquerque A.M.; Romaniello G.; Bozzi F.P.L.; da Cunha
G.P.; Andraus G.S.; Hastreiter G.; Maniesi B.; Baena C.; Guedes M.
Institution
(Marques, Baena, Guedes) Postgraduate Program in Health Sciences, School
of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
(Marques, Romaniello, da Cunha, Hastreiter) Department of Internal
Medicine, Universidade Federal do Parana, Curitiba, Brazil
(Albuquerque) School of Medicine, Universidade Federal do Rio de Janeiro,
Rio Janeiro, Brazil
(Bozzi, Baena) Department of Cardiology, Hospital Universitario Cajuru,
Curitiba, Brazil
(Bozzi) Department of Cardiology, Hospital Marcelino Champagnat, Curitiba,
Brazil
(Andraus, Maniesi) School of Medicine, Pontificia Universidade Catolica do
Parana, Curitiba, Brazil
Publisher
Frontiers Media S.A.
Abstract
Backgroud: Antithrombotic therapy is the cornerstone of chronic coronary
syndrome (CCS) management. However, the best treatment option that
optimally balances bleeding risk and efficacy remains undefined. Our
objective was to evaluate the effectiveness and safety of antithrombotic
options and identify the optimal treatment option for patients with CCS.
<br/>Method(s): We used the MEDLINE, CENTRAL and Embase databases to
search for randomized controlled trials with follow-up periods longer than
12 months that compared aspirin (ASA) monotherapy with other
antithrombotic therapies in patients with CCS. The Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines were used.
Extracted data [hazard ratios (HR)] were pooled using Bayesian
fixed-effect models, allowing the estimation of credible intervals (CrI)
and posterior probabilities of benefit, harm, and practical equivalence.
Confidence in the results was assessed with the Confidence In Network
Meta-Analysis (CINeMA) tool. The primary efficacy and safety outcomes were
major adverse cardiovascular events (MACE) and primary bleeding,
respectively. Secondary outcomes were acute myocardial infarction,
ischemic stroke, all-cause, and cardiovascular-specific mortality.
<br/>Result(s): Five trials with a total of 80,605 patients were included.
Mean patient age ranged from 61 to 69 years, while 20.3% to 31.4% were
women. The reference treatment was ASA monotherapy. ASA + prasugrel 10 mg
and clopidogrel 75 mg monotherapy presented the greatest benefit for MACE
[HR 0.52 (95% CrI, 0.39-0.71); and 0.68 (95% CrI, 0.54-0.88)]. There was a
probability of 98.8% that ASA + ticagrelor was practically equivalent to
ASA monotherapy. Regarding the primary bleeding outcome, clopidogrel 75 mg
monotherapy performed best [HR 0.64 (0.42, 0.99)]. There was a probability
of 97.4% that ASA + Prasugrel 10 mg increases bleeding (HR > 1.0).
Secondary outcome results followed a similar treatment ranking pattern as
in primary outcomes. Overall, CINeMA confidence ratings were judged as
either low or very low. <br/>Conclusion(s): These results revealed that
clopidogrel monotherapy might provide the best risk-benefit balance in
treating CCS. However, low CINeMA confidence ratings may preclude more
forceful conclusions. Our analysis suggests that current guidelines
recommending ASA as first-line therapy for CCS management need to be
revised to include additional pharmacological options.<br/>Copyright 2023
Marques, Albuquerque, Romaniello, Bozzi, da Cunha, Andraus, Hastreiter,
Maniesi, Baena and Guedes.

<25>
Accession Number
2022631906
Title
Propofol and survival: an updated meta-analysis of randomized clinical
trials.
Source
Critical Care. 27(1) (no pagination), 2023. Article Number: 139. Date of
Publication: December 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
BioMed Central Ltd
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. Graphical Abstract: [Figure not available: see
fulltext.]<br/>Copyright &#xa9; 2023, The Author(s).

<26>
Accession Number
2022345620
Title
Effectiveness of dual antiplatelet de-escalation therapy on the prognosis
of patients with ST segment elevation myocardial infarction undergoing
percutaneous coronary intervention.
Source
BMC Cardiovascular Disorders. 23(1) (no pagination), 2023. Article Number:
168. Date of Publication: December 2023.
Author
Zhao Z.; Wang J.; Lei M.; Li Y.; Yang Y.; An L.; Sun X.; Li C.; Xue Z.
Institution
(Zhao, Wang, Lei, Li, Yang, An, Sun, Li, Xue) Department of Cardiology,
Langfang Core Laboratory of Precision Treatment of CAD, Langfang People's
Hospital, Hebei Medical University, Langfang, No. 37, Xinhua Road,
Langfang 065000, China
Publisher
BioMed Central Ltd
Abstract
Aim: To investigate the effectiveness of de-escalation of ticagrelor (from
ticagrelor 90 mg to clopidogrel 75 mg or ticagrelor 60 mg) on the
prognosis of patients with ST segment elevation myocardial infarction
(STEMI) undergoing percutaneous coronary intervention (PCI) after 3 months
of oral dual antiplatelet therapy (DAPT). <br/>Method(s): From March 2017
to August 2021, 1056 patients with STEMI in a single centre, through
retrospective investigation and analysis, were divided into intensive
(ticagrelor 90 mg), standard (clopidogrel 75 mg after PCI) and
de-escalation groups (clopidogrel 75 mg or ticagrelor 60 mg after 3 months
of treatment with 90 mg ticagrelor) based on the type and dose of
P2Y<inf>12</inf> inhibitor 3 months after PCI, and the patients had a >=
12-month history of oral DAPT. The primary end point was major adverse
cardiovascular and cerebrovascular events (MACCEs) during the 12-month
follow-up period, including composite end points of cardiac death,
myocardial infarction, ischaemia-driven revascularization and stroke. The
major safety endpoint was bleeding events. <br/>Result(s): The results
showed that during the follow-up period, there was no statistically
significant difference in the incidence of MACCEs between the intensive
and de-escalation groups (P > 0.05). The incidence of MACCEs in the
standard treatment group was higher than that in the intensive treatment
group (P = 0.014), but the incidence of bleeding events in the
de-escalation group was significantly lower than that in the standard
group (9.3% vs. 18.4%, chi2=7.191, P = 0.027). The Cox regression analysis
showed that increases in haemoglobin (HGB) (HR = 0.986) and estimated
glomerular filtration rate (eGFR) (HR = 0.983) could reduce the incidence
of MACCEs, while old myocardial infarction (OMI) (P = 0.023) and
hypertension (P = 0.013) were independent predictors of MACCEs.
<br/>Conclusion(s): For STEMI patients undergoing PCI, the de-escalation
scheme of ticagrelor to clopidogrel 75 mg or ticagrelor 60 mg at 3 months
after PCI was related to the reduction of bleeding events, especially
minor bleeding events, without an increase in ischaemic
events.<br/>Copyright &#xa9; 2023, The Author(s).

<27>
Accession Number
2022892300
Title
Extended reality for procedural planning and guidance in structural heart
disease - a review of the state-of-the-art.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2023.
Date of Publication: 2023.
Author
Stephenson N.; Pushparajah K.; Wheeler G.; Deng S.; Schnabel J.A.; Simpson
J.M.
Institution
(Stephenson, Pushparajah, Wheeler, Deng, Schnabel, Simpson) School of
Biomedical Engineering and Imaging Sciences, King's College London,
London, United Kingdom
(Stephenson, Pushparajah, Simpson) Department of Congenital Heart Disease,
Evelina Children's Hospital, London, United Kingdom
(Schnabel) Technical University of Munich, Munich, Germany
(Schnabel) Institute of Machine Learning in Biomedical Imaging, Helmholtz
Center Munich, Munich, Germany
(Stephenson) St Thomas' Hospital, 3rd Floor, Lambeth Wing, London SE1 7EH,
United Kingdom
Publisher
Springer Science and Business Media B.V.
Abstract
Extended reality (XR), which encompasses virtual, augmented and mixed
reality, is an emerging medical imaging display platform which enables
intuitive and immersive interaction in a three-dimensional space. This
technology holds the potential to enhance understanding of complex spatial
relationships when planning and guiding cardiac procedures in congenital
and structural heart disease moving beyond conventional 2D and 3D image
displays. A systematic review of the literature demonstrates a rapid
increase in publications describing adoption of this technology. At least
33 XR systems have been described, with many demonstrating proof of
concept, but with no specific mention of regulatory approval including
some prospective studies. Validation remains limited, and true clinical
benefit difficult to measure. This review describes and critically
appraises the range of XR technologies and its applications for procedural
planning and guidance in structural heart disease while discussing the
challenges that need to be overcome in future studies to achieve safe and
effective clinical adoption.<br/>Copyright &#xa9; 2023, The Author(s).

<28>
Accession Number
2022867908
Title
Evaluation of levosimendan as treatment option in a large case-series of
preterm infants with cardiac dysfunction and pulmonary hypertension.
Source
European Journal of Pediatrics. (no pagination), 2023. Date of
Publication: 2023.
Author
Schroeder L.; Holcher S.; Leyens J.; Geipel A.; Strizek B.; Dresbach T.;
Mueller A.; Kipfmueller F.
Institution
(Schroeder, Holcher, Leyens, Dresbach, Mueller, Kipfmueller) Department of
Neonatology and Pediatric Intensive Care Medicine, University Children's
Hospital Bonn, Venusberg-Campus 1, Bonn D-53127, Germany
(Geipel, Strizek) Department of Obstetrics and Prenatal Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Levosimendan as a calcium-sensitizer is a promising innovative
therapeutical option for the treatment of severe cardiac dysfunction (CD)
and pulmonary hypertension (PH) in preterm infants, but no data are
available analyzing levosimendan in cohorts of preterm infants. The
design/setting of the evaluation is in a large case-series of preterm
infants with CD and PH. Data of all preterm infants (gestational age (GA)
< 37 weeks) with levosimendan treatment and CD and/or PH in the
echocardiographic assessment between 01/2018 and 06/2021 were screened for
analysis. The primary clinical endpoint was defined as echocardiographic
response to levosimendan. Preterm infants (105) were finally enrolled for
further analysis. The preterm infants (48%) were classified as extremely
low GA newborns (ELGANs, < 28 weeks of GA) and 73% as very low birth
weight infants (< 1500 g, VLBW). The primary endpoint was reached in 71%,
without difference regarding GA or BW. The incidence of moderate or severe
PH decreased from baseline to follow-up (24 h) in about 30%, with a
significant decrease in the responder group (p < 0.001). The incidence of
left ventricular dysfunction and bi-ventricular dysfunction decreased
significantly from baseline to follow-up (24 h) in the responder-group (p
= 0.007, and p < 0.001, respectively). The arterial lactate level
decreased significantly from baseline (4.7 mmol/l) to 12 h (3.6 mmol/l, p
< 0.05), and 24 h (3.1 mmol/l, p < 0.01). <br/>Conclusion(s): Levosimendan
treatment is associated with an improvement of both CD and PH in preterm
infants, with a stabilization of the mean arterial pressure during the
treatment and a significant decrease of arterial lactate levels. Future
prospective trials are highly warranted.What is Known:* Levosimendan as a
calcium-sensitizer and inodilator is known to improve the low cardiac
output syndrome (LCOS), and improves ventricular dysfunction, and PH, both
in pediatric as well as in adult populations. Data related to critically
ill neonates without major cardiac surgery and preterm infants are not
available.What is New:* This study evaluated the effect of levosimendan on
hemodynamics, clinical scores, echocardiographic severity parameters, and
arterial lactate levels in a case-series of 105 preterm infants for the
first time. Levosimendan treatment in preterm infants is associated with a
rapid improvement of CD and PH, an increase of the mean arterial pressure,
and a significant decrease in arterial lactate levels, as surrogate marker
for a LCOS.* How this study might affect research, practice, or policy. As
no data are available regarding the use of levosimendan in this
population, our results hopefully animate the research community to
conduct future prospective trails analyzing levosimendan in randomized
controlled trials (RCT) and observational control studies. Additionally,
our results potentially motivate clinicians to introduce levosimendan as
second second-line therapy in cases of severe CD and PH in preterm infants
without improvement using standard treatment strategies.<br/>Copyright
&#xa9; 2023, The Author(s).

<29>
Accession Number
640377479
Title
Anterolateral territory coronary artery bypass grafting strategies: a
non-inferiority randomized clinical trial: the AMI-PONT 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
Stevens L.-M.; Chartrand-Lefebvre C.; Mansour S.; Beland V.; Soulez G.;
Forcillo J.; Basile F.; Prieto I.; Noiseux N.
Institution
(Stevens, Forcillo, Basile, Prieto, Noiseux) Division of Cardiac Surgery,
Department of Surgery, Centre Hospitalier de l'Universite de Montreal,
Montreal, QC, Canada
(Stevens, Chartrand-Lefebvre, Mansour, Beland, Soulez, Forcillo, Noiseux)
CHUM Research Centre (CRCHUM), Montreal, QC, Canada
(Chartrand-Lefebvre, Soulez) Department of Radiology, Centre Hospitalier
de l'Universite de Montreal, Montreal, QC, Canada
(Mansour) Division of Cardiology, Department of Medicine, Centre
Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The main objective was to assess whether a composite coronary
artery bypass grafting strategy including a saphenous vein graft bridge to
distribute left internal mammary artery outflow provides non-inferior
patency rates compared to conventional grafting surgery with separated
left internal mammary artery to left anterior descending coronary graft
and aorto-coronary saphenous vein grafts to other anterolateral targets.
<br/>METHOD(S): All patients underwent isolated grafting surgery with
cardiopulmonary bypass and received >=2 grafts/patients on the
anterolateral territory. The graft patency (i.e. non-occluded) was
assessed using multislice spiral computed tomography at 1 year.
<br/>RESULT(S): From 2012 to 2021, 208 patients were randomized to a
bridge (n=105) or conventional grafting strategy (n=103). Patient
characteristics were comparable between groups. The anterolateral graft
patency was non-inferior in the composite bridge compared to conventional
grafting strategy at 1 year [risk difference 0.7% (90% confidence interval
-4.8 to 6.2%)]. The graft patency to the left anterior descending coronary
was no different between groups (P=0.175). Intraoperatively, the bridge
group required shorter vein length for anterolateral targets (P < 0.001)
and exhibited greater Doppler flow in the mammary artery pedicle
(P=0.004). The composite outcome of death, myocardial infarction or target
vessel reintervention at 30days was no different (P=0.164).
<br/>CONCLUSION(S): Anterolateral graft patency of the composite bridge
grafting strategy is non-inferior to the conventional grafting strategy at
1 year. This novel grafting strategy is safe, efficient, associated with
several advantages including better mammary artery flow and shorter vein
requirement, and could be a valuable alternative to conventional grafting
strategies. Ten-year clinical follow-up is underway. TRIAL REGISTRATION:
ClinicalTrials.gov: NCT01585285.<br/>Copyright &#xa9; The Author(s) 2023.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<30>
Accession Number
2022921651
Title
Cardiac Fibrosis and Innervation State in Uncorrected and Corrected
Transposition of the Great Arteries: A Postmortem Histological Analysis
and Systematic Review.
Source
Journal of Cardiovascular Development and Disease. 10(4) (no pagination),
2023. Article Number: 180. Date of Publication: April 2023.
Author
Engele L.J.; van der Palen R.L.F.; Egorova A.D.; Bartelings M.M.; Wisse
L.J.; Glashan C.A.; Kies P.; Vliegen H.W.; Hazekamp M.G.; Mulder B.J.M.;
Ruiter M.C.D.; Bouma B.J.; Jongbloed M.R.M.
Institution
(Engele, Mulder, Bouma) Center for Congenital Heart Disease
Amsterdam-Leiden (CAHAL), Department of Clinical and Experimental
Cardiology, Amsterdam Cardiovascular Sciences, Heart Centre, Amsterdam
UMC, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
(Engele) Netherlands Heart Institute, Utrecht 3511 EP, Netherlands
(van der Palen) Center for Congenital Heart Disease Amsterdam-Leiden
(CAHAL), Department of Pediatric Cardiology, Leiden University Medical
Center, Leiden 2333 ZA, Netherlands
(Egorova, Glashan, Kies, Vliegen, Jongbloed) Center for Congenital Heart
Disease Amsterdam-Leiden (CAHAL), Department of Cardiology, Leiden
University Medical Center, Leiden 2333 ZA, Netherlands
(Bartelings, Wisse, Ruiter, Jongbloed) Center for Congenital Heart Disease
Amsterdam-Leiden (CAHAL), Department of Anatomy and Embryology, Leiden
University Medical Center, Leiden 2333 ZA, Netherlands
(Hazekamp) Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL),
Department of Cardiothoracic Surgery, Leiden University Medical Center,
Leiden 2333 ZA, Netherlands
Publisher
MDPI
Abstract
In the transposition of the great arteries (TGA), alterations in
hemodynamics and oxygen saturation could result in fibrotic remodeling,
but histological studies are scarce. We aimed to investigate fibrosis and
innervation state in the full spectrum of TGA and correlate findings to
clinical literature. Twenty-two human postmortem TGA hearts, including TGA
without surgical correction (n = 8), after Mustard/Senning (n = 6), and
arterial switch operation (ASO, n = 8), were studied. In newborn
uncorrected TGA specimens (1 day-1.5 months), significantly more
interstitial fibrosis (8.6% +/- 3.0) was observed compared to control
hearts (5.4% +/- 0.8, p = 0.016). After the Mustard/Senning procedure, the
amount of interstitial fibrosis was significantly higher (19.8% +/- 5.1, p
= 0.002), remarkably more in the subpulmonary left ventricle (LV) than in
the systemic right ventricle (RV). In TGA-ASO, an increased amount of
fibrosis was found in one adult specimen. The amount of innervation was
diminished from 3 days after ASO (0.034% +/- 0.017) compared to
uncorrected TGA (0.082% +/- 0.026, p = 0.036). In conclusion, in these
selected postmortem TGA specimens, diffuse interstitial fibrosis was
already present in newborn hearts, suggesting that altered oxygen
saturations may already impact myocardial structure in the fetal phase.
TGA-Mustard/Senning specimens showed diffuse myocardial fibrosis in the
systemic RV and, remarkably, in the LV. Post-ASO, decreased uptake of
nerve staining was observed, implicating (partial) myocardial denervation
after ASO.<br/>Copyright &#xa9; 2023 by the authors.

<31>
Accession Number
2024178266
Title
Preoperative risk assessment tools for morbidity after cardiac surgery: A
systematic review.
Source
European Journal of Cardiovascular Nursing. 21(7) (pp 655-664), 2022. Date
of Publication: 01 Sep 2022.
Author
Sanders J.; Makariou N.; Tocock A.; Magboo R.; Thomas A.; Aitken L.M.
Institution
(Sanders) St Bartholomew's Hospital, Barts Health NHS Trust, West
Smithfield, London EC1A 7DN, United Kingdom
(Sanders, Magboo, Thomas) William Harvey Research Institute, Queen Mary
University of London, Charterhouse Square, London, United Kingdom
(Makariou) Barts and the London Medical School, Queen Mary University of
London, Charterhouse Square, London, United Kingdom
(Tocock) Knowledge and Library Services, St Bartholomew's Hospital, Barts
Health NHS Trust, West Smithfield, London, United Kingdom
(Magboo, Thomas) Critical Care, St Bartholomew's Hospital, Barts Health
NHS Trust, West Smithfield, London, United Kingdom
(Aitken) School of Health Sciences, City, University of London,
Northampton Square, London, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Postoperative morbidity places considerable burden on health
and resources. Thus, strategies to identify, predict, and reduce
postoperative morbidity are needed. <br/>Aim(s): To identify and explore
existing preoperative risk assessment tools for morbidity after cardiac
surgery. <br/>Method(s): Electronic databases (including MEDLINE, CINAHL,
and Embase) were searched to December 2020 for preoperative risk
assessment models for morbidity after adult cardiac surgery. Models
exploring one isolated postoperative morbidity and those in patients
having heart transplantation or congenital surgery were excluded. Data
extraction and quality assessments were undertaken by two authors.
<br/>Result(s): From 2251 identified papers, 22 models were found. The
majority (54.5%) were developed in the USA or Canada, defined morbidity
outcome within the in-hospital period (90.9%), and focused on major
morbidity. Considerable variation in morbidity definition was identified,
with morbidity incidence between 4.3% and 52%. The majority (45.5%)
defined morbidity and mortality separately but combined them to develop
one model, while seven studies (33.3%) constructed a morbidity-specific
model. Models contained between 5 and 50 variables. Commonly included
variables were age, emergency surgery, left ventricular dysfunction, and
reoperation/previous cardiac surgery, although definition differences
across studies were observed. All models demonstrated at least reasonable
discriminatory power [area under the receiver operating curve
(0.61-0.82)]. <br/>Conclusion(s): Despite the methodological heterogeneity
across models, all demonstrated at least reasonable discriminatory power
and could be implemented depending on local preferences. Future strategies
to identify, predict, and reduce morbidity after cardiac surgery should
consider the ageing population and those with minor and/or multiple
complex morbidities. <br/>Copyright &#xa9; 2022 The Author(s).

<32>
[Use Link to view the full text]
Accession Number
2024100350
Title
Pharmacological Agents That Prevent Postoperative Cognitive Dysfunction in
Patients with General Anesthesia: A Network Meta-analysis.
Source
American Journal of Therapeutics. 28(4) (pp E420-E433), 2021. Date of
Publication: 01 Jul 2021.
Author
Li M.; Yang Y.; Ma Y.; Wang Q.
Institution
(Li) Institute of Urology, Chinese Medicine Hospital of Linyi, Linyi City,
China
(Yang) Department of Anesthesiology, Women and Children's Health Care
Hospital of Linyi, Linyi City, China
(Ma) The Evidence Based Medicine Center, Lanzhou University, Lanzhou City,
China
(Wang) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Postoperative cognitive dysfunction (POCD) is associated with
prolonged hospital stays, increased mortality, and negative socioeconomic
consequences. Dexmedetomidine, ketamine, dexamethasone, and lidocaine have
previously been reported to be effective for preventing POCD.Study
question:In this network meta-analysis, we apply direct and indirect
comparisons to rank these pharmacological agents in terms of their effect
on POCD, through which we seek to provide evidence for future clinical
medication.Data sources:A comprehensive literature search of PubMed,
EMBASE, the Cochrane Library, and Web of Science was conducted to identify
randomized controlled trials that examined the effects of dexmedetomidine,
ketamine, dexamethasone, or lidocaine on POCD induced by general
anesthesia.Study design:For eligible studies, 2 reviewers independently
extracted data and assessed the respective risk of bias. Bayesian network
meta-analysis was conducted using R-3.4.1 software. A total of 30 articles
were included in this meta-analysis. <br/>Result(s):Direct comparison
showed that dexmedetomidine [odds ratio (OR) = 0.42, 95% confidence
interval (CI): 0.32-0.55] may decrease the incidence of POCD for
noncardiac surgery; dexmedetomidine (OR = 0.08, 95% CI: 0.01-0.63) and
ketamine (OR = 0.09, 95% CI: 0.02-0.32) were found to decrease POCD for
cardiac surgery. The R-software ranking result for prevention of POCD was
dexmedetomidine, lidocaine, ketamine, placebo, and dexamethasone,
respectively, in noncardiac surgery, and dexmedetomidine, ketamine,
lidocaine, placebo, and dexamethasone in cardiac surgery.
<br/>Conclusion(s):Dexmedetomidine exhibited obvious superiority to other
agents for noncardiac surgery; dexmedetomidine and ketamine exhibited a
significantly better performance than other agents for cardiac surgery.
Dexamethasone did not show better efficacy than the placebo. However, more
rigorously designed studies comprising larger sample sizes are needed to
confirm our findings.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<33>
Accession Number
2024200779
Title
Platelet and Monocyte Activation After Transcatheter Aortic Valve
Replacement (POTENT-TAVR): A Mechanistic Randomized Trial of Ticagrelor
Versus Clopidogrel.
Source
Structural Heart. (no pagination), 2023. Article Number: 100182. Date of
Publication: 2023.
Author
Zidar D.A.; Al-Kindi S.; Longenecker C.T.; Parikh S.A.; Gillombardo C.B.;
Funderburg N.T.; Juchnowski S.; Huntington L.; Jenkins T.; Nmai C.; Osnard
M.; Shishebhor M.; Filby S.; Tatsuoka C.; Lederman M.M.; Blackstone E.;
Attizzani G.; Simon D.I.
Institution
(Zidar, Al-Kindi, Longenecker, Gillombardo, Juchnowski, Huntington,
Jenkins, Osnard, Shishebhor, Filby, Tatsuoka, Lederman, Attizzani, Simon)
Department of Medicine, Case Western Reserve University, Cleveland, OH,
United States
(Zidar, Juchnowski, Huntington) Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, OH, United States
(Zidar, Al-Kindi, Longenecker, Gillombardo, Juchnowski, Huntington,
Jenkins, Shishebhor, Filby, Attizzani, Simon) Harrington Heart & Vascular
Institute, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Parikh) Division of Cardiology, Center for Interventional Vascular
Therapy, Columbia University Irving Medical Center, New York, NY, United
States
(Funderburg) Division of Medical Laboratory Science, School of Health and
Rehabilitations Sciences, Ohio State University, Columbus, OH, United
States
(Nmai) New York University Grossman School of Medicine, New York, NY,
United States
(Blackstone) Department of Population Health and Quantitative Health
Sciences, Cleveland Clinic Foundation, Cleveland, OH, United States
Publisher
Cardiovascular Research Foundation
Abstract
Background: Inflammation and thrombosis are often linked mechanistically
and are associated with adverse events after transcatheter aortic valve
replacement (TAVR). High residual platelet reactivity (HRPR) is especially
common when clopidogrel is used in this setting, but its relevance to
immune activation is unknown. We sought to determine whether residual
activity at the purinergic receptor P2Y12 (P2Y12) promotes prothrombotic
immune activation in the setting of TAVR. <br/>Method(s): This was a
randomized trial of 60 patients (enrolled July 2015 through December 2018)
assigned to clopidogrel (300mg load, 75mg daily) or ticagrelor (180mg
load, 90 mg twice daily) before and for 30 days following TAVR. Co-primary
endpoints were P2Y12-dependent platelet activity (Platelet Reactivity
Units; VerifyNow) and the proportion of inflammatory (cluster of
differentiation [CD] 14+/CD16+) monocytes 1 day after TAVR.
<br/>Result(s): Compared to clopidogrel, those randomized to ticagrelor
had greater platelet inhibition (median Platelet Reactivity Unit
[interquartile range]: (234 [170.0-282.3] vs. 128.5 [86.5-156.5], p <
0.001), but similar inflammatory monocyte proportions (22.2% [18.0%-30.2%]
vs. 25.1% [22.1%-31.0%], p = 0.201) 1 day after TAVR. Circulating
monocyte-platelet aggregates, soluble CD14 levels, interleukin 6 and 8
levels, and D-dimers were also similar across treatment groups. HRPR was
observed in 63% of the clopidogrel arm and was associated with higher
inflammatory monocyte proportions. Major bleeding events, pacemaker
placement, and mortality did not differ by treatment assignment.
<br/>Conclusion(s): Residual P2Y12 activity after TAVR is common in those
treated with clopidogrel but ticagrelor does not significantly alter
biomarkers of prothrombotic immune activation. HRPR appears to be an
indicator (not a cause) of innate immune activation in this
setting.<br/>Copyright &#xa9; 2023

<34>
Accession Number
2024200753
Title
General Anesthesia Versus Local Anesthesia in Patients Undergoing
Transcatheter Aortic Valve Replacement: An Updated Meta-Analysis and
Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Ahmed A.; Mathew D.M.; Mathew S.M.; Varghese K.S.; Khaja S.; Vega E.;
Pandey R.; Thomas J.J.; Mathew C.S.; Ahmed S.; George J.; Awad A.K.; Fusco
P.J.
Institution
(Ahmed, Mathew, Mathew, Varghese, Khaja, Vega, Pandey, Thomas, Mathew,
Ahmed, Fusco) City University of New York School of Medicine, New York, NY
(Awad, Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(George) University of Toledo College of Medicine and Life Sciences,
Toledo, OH
Publisher
W.B. Saunders
Abstract
Objectives: For patients with aortic stenosis, transcatheter aortic valve
replacement (TAVR) offers a less invasive treatment modality than
conventional surgical valve replacement. Although the surgery is performed
traditionally under general anesthesia (GA), recent studies have described
success with TAVR using local anesthesia (LA) and/or conscious sedation.
The study authors performed a pairwise meta-analysis to compare the
clinical outcomes of TAVR based on operative anesthesia management.
<br/>Design(s): A random effects pairwise meta-analysis via the
Mantel-Haenszel method. <br/>Setting(s): Not applicable, as this is a
meta-analysis. <br/>Participant(s): No individual patient data were used.
<br/>Intervention(s): Not applicable, as this is a meta-analysis.
<br/>Measurements and Main Results: The authors comprehensively searched
the PubMed, Embase, and Cochrane databases to identify studies comparing
TAVR performed using LA or GA. Outcomes were pooled as risk ratios (RR) or
standard mean differences (SMD) and their 95% CIs. The authors' pooled
analysis included 14,388 patients from 40 studies (7,754 LA; 6,634 GA).
Compared to GA TAVR, LA TAVR was associated with significantly lower rates
of 30-day mortality (RR 0.69; p < 0.01) and stroke (RR 0.78; p = 0.02).
Additionally, LA TAVR patients had lower rates of 30-day major and/or
life-threatening bleeding (RR 0.64; p = 0.01), 30-day major vascular
complications (RR 0.76; p = 0.02), and long-term mortality (RR 0.75; p =
0.009). No significant difference was seen between the 2 groups for a
30-day paravalvular leak (RR 0.88, p = 0.12). <br/>Conclusion(s):
Transcatheter aortic valve replacement performed using LA is associated
with lower rates of adverse clinical outcomes, including 30-day mortality
and stroke. No difference was seen between the 2 groups for a 30-day
paravalvular leak. These results support the use of minimally invasive
forms of TAVR without GA.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<35>
Accession Number
641147907
Title
Analysis of perioperative corticosteroid therapy in children undergoing
cardiac surgery: A systematic review and meta-analysis.
Source
Clinical cardiology. (no pagination), 2023. Date of Publication: 26 Apr
2023.
Author
Chen D.; Du Y.
Institution
(Chen) Gastrointestinal Surgery, Chunzhou County Hospital of Huai'an City,
Huai'an, China
(Du) Pediatric Surgery, Huai'an Maternal and Child Health Care Hospital,
China
Publisher
NLM (Medline)
Abstract
The advantages and disadvantages of using corticosteroids in children
undergoing cardiac surgery is still contentious. To examine how
perioperative corticosteroids affect postoperative mortality and clinical
outcomes in pediatric cardiac surgery with cardiopulmonary bypass (CPB).
We used MEDLINE, EMBASE, and the Cochrane Database to conduct a
comprehensive search up through January 2023. Children aged 0-18
undergoing cardiac surgery were included in the meta-analysis of
randomized controlled studies comparing perioperative corticosteroids with
other therapeutic therapies, placebo, or no treatment. All-cause hospital
mortality was the primary endpoint of the study. Hospitalization duration
was a secondary result. The Cochrane Risk of Bias Assessment Tool was used
to evaluate the research quality. Ten trials and 7798 pediatric
participants were included in our analysis. Children taking
corticosteroids had no significant difference in all-cause in-hospital
mortality using a random-effect model with relative risk (RR)=0.38, 95%
confidence interval (CI)=0.16-0.91, I2 =79%, p=.03 for methylprednisolone
and RR=0.29, 95% CI=0.09-0.97, I2 =80%, p=.04. For the secondary outcome,
there was a significant difference between the corticosteroid and placebo
groups, with pooled standard mean difference (SMD)=-0.86, 95% CI=-1.57 to
-0.15, I2 =85%, p=.02 for methylprednisolone and SMD=-0.97, 95% CI -1.90
to -0.04, I2 =83%, p=.04 for dexamethasone. Perioperative corticosteroids
may not improve mortality, but they reduce hospital stay compared to
placebo. Further evidence from randomized controlled studies with larger
samples is required for approaching at a valid conclusion.<br/>Copyright
&#xa9; 2023 The Authors. Clinical Cardiology published by Wiley
Periodicals, LLC.

<36>
Accession Number
641147386
Title
Prophylactic Administration with Methylene Blue Improves Hemodynamic
Stabilization During Obstructive Jaundice-Related Diseases' Operation: a
Blinded Randomized Controlled Trial.
Source
Journal of gastrointestinal surgery : official journal of the Society for
Surgery of the Alimentary Tract. (no pagination), 2023. Date of
Publication: 26 Apr 2023.
Author
Huang J.; Gao X.; Wang M.; Yang Z.; Xiang L.; Li Y.; Yi B.; Gu J.; Wen J.;
Lu K.; Zhao H.; Ma D.; Chen L.; Ning J.
Institution
(Huang, Gao, Wang, Yang, Li, Yi, Gu, Wen, Lu, Ning) Department of
Anesthesiology, Southwest Hospital, Third Military Medical University, 30
Gaotanyan Road, Chongqing 400038, China
(Xiang, Zhao) Department of Nephrology, Southwest Hospital, Third Military
Medical University, 30 Gaotanyan Road, Chongqing 400038, China
(Ma) Division of Anaesthetics, Pain Medicine and Intensive Care,
Department of Surgery and Cancer, Faculty of Medicine, Imperial College
London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW109NH,
United Kingdom
(Chen) Breast Disease Center, Southwest Hospital, Third Military Medical
University, Chongqing 400038, China
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Patients with obstruction jaundice are at a high risk of
hypotension and need high volume of fluids and a high dose of
catecholamine to maintain organ perfusion during operation procedure. All
these likely contribute to high perioperative morbidity and mortality. The
aim of the study is to evaluate the effects of methylene blue on the
hemodynamics in patients undergoing surgeries associated with obstructive
jaundice. DESIGN: A prospective, randomized, and controlled clinical
study. SETTING: The enrolled patients randomly received 2 mg/kg of
methylene blue in saline or saline (50 ml) before anesthesia induction.
The primary outcome was the frequency and dose of noradrenaline
administration to maintain mean arterial blood pressure over 65 mmHg
or>80% of baseline, and systemic vascular resistance (SVR) over 800
dyne/s/cm5 during operation. The secondary outcomes were liver and kidney
functions, and ICU stay. PATIENTS: Seventy patients were enrolled in the
study and randomly assigned to receive either methylene blue or control
(n=35/group). <br/>RESULT(S): Fewer patients received noradrenaline in the
methylene blue group when compared with the control group (13/35 vs 23/35,
P=0.017), and the noradrenaline dose administrated during operation was
reduced in the methylene blue group when compared with the control group
(0.32+/-0.57 mg vs 1.787+/-3.51 mg, P=0.018). The blood level of
creatinine, glutamic oxalacetic transaminase, and glutamic-pyruvic
transaminase after the operation was reduced in the methylene blue group
when compared with the control group. <br/>CONCLUSION(S): Prophylactic
administration of methylene blue before operation associated with
obstructive jaundice improves hemodynamic stability and short-term
prognosis. QUESTION: Methylene blue use prevented refractory hypotension
during cardiac surgery, sepsis, or anaphylactic shock. It is still unknown
that methylene blue on the vascular hypo-tone associated with obstructive
jaundice. FINDINGS: Prophylactic administration with methylene blue
improved peri-operative hemodynamic stability, and hepatic and kidney
function on the patients with obstructive jaundice. MEANINGS: Methylene
blue is a promising and recommended drug for the patients undergoing the
surgeries of relief obstructive jaundice during peri-operation
management.<br/>Copyright &#xa9; 2023. The Author(s).

<37>
Accession Number
2023943103
Title
Effect of the VivaSight double-lumen tube on the incidence of hypoxaemia
during one-lung ventilation in patients undergoing thoracoscopic surgery:
A study protocol for a prospective randomised controlled trial.
Source
BMJ Open. 13(4) (no pagination), 2023. Article Number: e068071. Date of
Publication: 05 Apr 2023.
Author
Long S.; Li Y.; Guo J.; Hu R.
Institution
(Long, Li, Guo, Hu) Department of Anaesthesiology, Sun Yat-sen University
First Affiliated Hospital, Guangdong, Guangzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction A double-lumen tube (DLT) is a traditional one-lung
ventilation tool that needs to be positioned under the guidance of a
fibreoptic bronchoscope or auscultation. The placement is complex, and
poor positioning often causes hypoxaemia. In recent years, VivaSight
double-lumen tubes (v-DLTs) have been widely used in thoracic surgery.
Because the tubes can be continuously observed during intubation and the
operation, malposition can be corrected at any time. However, the effect
of v-DLT on perioperative hypoxaemia has been rarely reported. The aim of
this study was to observe the incidence of hypoxaemia during one-lung
ventilation with v-DLT and to compare the perioperative complications
between v-DLT and conventional double-lumen tube (c-DLT). Methods and
analysis One hundred patients planning to undergo thoracoscopic surgery
will be randomised into the c-DLT group and the v-DLT group. During
one-lung ventilation, both groups of patients will receive low tidal
volume for volume control ventilation. When the blood oxygen saturation
falls below 95%, the DLT will be repositioned and the oxygen concentration
will be increased to improve the respiratory parameters (5 cm H 2 O
Positive end-expiratory pressure (PEEP) on the ventilation side and 5 cm H
2 O CPAP (continuous airway positive pressure) on the operation side), and
double lung ventilation measures will be taken in sequence to prevent a
further decline in blood oxygen saturation. The primary outcomes are the
incidence and duration of hypoxaemia and the number of intraoperative
hypoxaemia treatments, and the secondary outcomes will be postoperative
complications and total hospitalisation expenses. Ethics and dissemination
The study protocol was approved by the Clinical Research Ethics Committee
of The First Affiliated Hospital, Sun Yat-sen University (2020-418) and
registered at the Chinese Clinical Trial Registry
(http://www.chictr.org.cn). The results of the study will be analysed and
reported. Trial registration number ChiCTR2100046484.<br/>Copyright &#xa9;
Authors 2023

<38>
Accession Number
2023915511
Title
Effect of angiotensin-converting enzyme inhibitors or angiotensin receptor
blockers on cardiovascular outcomes in dialysis patients: a systematic
review and meta-analysis.
Source
Nephrology Dialysis Transplantation. 38(1) (pp 203-211), 2023. Date of
Publication: 01 Jan 2023.
Author
Georgianos P.I.; Tziatzios G.; Roumeliotis S.; Vaios V.; Sgouropoulou V.;
Tsalikakis D.G.; Liakopoulos V.; Agarwal R.
Institution
(Georgianos, Roumeliotis, Vaios, Sgouropoulou, Liakopoulos) Section of
Nephrology and Hypertension, 1st Department of Medicine, Ahepa Hospital,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Tziatzios) 2nd Department of Gastroenterology, Iatriko Athinon, Athens,
Greece
(Tsalikakis) Department of Electrical and Computer Engineering, University
of Western Macedonia, Kozani, Greece
(Agarwal) Division of Nephrology, Department of Medicine, Indiana
University School of Medicine, Richard L. Roudebush Veterans
Administration Medical Center, Indianapolis, IN, United States
Publisher
Oxford University Press
Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs) and/or
angiotensin receptor blockers (ARBs) are recommended by guidelines as
first-line antihypertensive therapies in the general population or in
patients with earlier stages of kidney disease. However, the
cardioprotective benefit of these agents among patients on dialysis
remains uncertain. <br/>Method(s): We searched the MEDLINE, PubMed and
Cochrane databases from inception through February 2022 to identify
randomized controlled trials (RCTs) comparing the efficacy of ACEIs/ARBs
relative to placebo or no add-on treatment in patients receiving dialysis.
RCTs were eligible if they assessed fatal or non-fatal cardiovascular
events as a primary efficacy endpoint. <br/>Result(s): We identified five
RCTs involving 1582 dialysis patients. Compared with placebo or no add-on
treatment, the use of ACEIs/ARBs was not associated with a significantly
lower risk of cardiovascular events {risk ratio [RR] 0.79 [95% confidence
interval (CI) 0.57-1.11]}. Furthermore, there was no benefit in
cardiovascular mortality [RR 0.82 (95% CI 0.59-1.14)] and all-cause
mortality [RR 0.86 (95% CI 0.64-1.15)]. These results were consistent when
the included RCTs were stratified by subgroups, including hypertension,
ethnicity, sample size, duration of follow-up and quality.
<br/>Conclusion(s): The present meta-analysis showed that among patients
on dialysis, the use of ACEIs/ARBs is not associated with a significantly
lower risk of cardiovascular events and all-cause mortality as compared
with placebo or no add-on treatment.<br/>Copyright &#xa9; 2022 The
Author(s). Published by Oxford University Press on behalf of the ERA.

<39>
Accession Number
2023698184
Title
Predictive Efficacy of the Index of Microcirculatory Resistance for Acute
Allograft Rejection and Cardiac Events After Heart Transplantation: A
Systematic Review and Meta-Analysis.
Source
Heart Surgery Forum. 25(5) (pp E784-E792), 2022. Date of Publication:
2022.
Author
Lu Z.; Song G.; Bai X.
Institution
(Lu, Song, Bai) Department of Cardiovascular Surgery, Qilu Hospital of
Shandong University, Jinan, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: In patients treated by heart transplantation, the index of
microcirculatory resistance (IMR) has been found to have predictive
potential for subsequent acute allograft rejection (AAR) and long-time
cardiac events. When consulting related literature, the studies mostly
were single-center with small sample sizes. The question of whether IMR
can be utilized as a predictive biomarker is becoming increasingly
contentious. To confirm the predictive efficacy of IMR, researchers did a
systematic review and meta-analysis. <br/>Method(s): From inception to
April 2022, PubMed, EMBASE, Cochrane Library, Web of Science, Ovid,
ProQuest, and Scopus systematically were searched. The results were
presented as pooled ratio rate (RR) with 95% confidence intervals (CI).
Assessment of the quality, heterogeneity analyses, and publication bias
analysis also were performed. <br/>Result(s): A total of 616 patients were
studied in five trials. There were significant differences in subsequent
AAR (RR = 4.08; 95% CI: 2.69~6.17; P = 0.000) or long-time cardiac events
(RR=2.14; 95% CI: 1.44~3.19; P = 0.000) between IMR-high and IMR-low
patients in the forest plots. Patients treated with heart transplantation
in the high IMR group had better predictive efficacy than the low IMR
group. <br/>Conclusion(s): High IMR could predict the events of subsequent
AAR and cardiac events after heart transplantation. This will help reduce
the occurrence of adverse events and personalize treatment for
patients.<br/>Copyright &#xa9; 2022 Forum Multimedia Publishing, LLC.

<40>
Accession Number
2022850486
Title
Exercise-based cardiac rehabilitation for coronary heart disease: a
meta-analysis.
Source
European Heart Journal. 44(6) (pp 452-469), 2023. Date of Publication: 07
Feb 2023.
Author
Dibben G.O.; Faulkner J.; Oldridge N.; Rees K.; Thompson D.R.; Zwisler
A.-D.; Taylor R.S.
Institution
(Dibben, Taylor) MRC/CSO Social and Public Health Sciences Unit, Institute
of Health and Well Being, University of Glasgow, Glasgow, United Kingdom
(Faulkner) School of Sport, Health and Community, Faculty Health and
Wellbeing, University of Winchester, Winchester, United Kingdom
(Oldridge) College of Health Sciences, University of Wisconsin-Milwaukee,
Milwaukee, WI, United States
(Rees) Division of Health Sciences, Warwick Medical School, University of
Warwick, Coventry, United Kingdom
(Thompson) School of Nursing and Midwifery, Queen's University Belfast,
Belfast, United Kingdom
(Zwisler) REHPA, The Danish Knowledge Centre for Rehabilitation and
Palliative Care, Odense University Hospital, Nyborg, Denmark
(Zwisler) Department of Clinical Research, University of Southern Denmark,
Odense, Denmark
(Zwisler) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Taylor) Robertson Centre for Biostatistics, Institute of Health and Well
Being, University of Glasgow, Glasgow, United Kingdom
Publisher
Oxford University Press
Abstract
Aims Coronary heart disease is the most common reason for referral to
exercise-based cardiac rehabilitation (CR) globally. However, the
generalizability of previous meta-analyses of randomized controlled trials
(RCTs) is questioned. Therefore, a contemporary updated meta-analysis was
undertaken. Methods Database and trial registry searches were conducted to
September 2020, seeking RCTs of exercise-based interventions with and
results >=6-month follow-up, compared with no-exercise control for adults
with myocardial infarction, angina pectoris, or following coronary artery
bypass graft, or percutaneous coronary intervention. The outcomes of
mortality, recurrent clinical events, and health-related quality of life
(HRQoL) were pooled using random-effects meta-analysis, and
cost-effectiveness data were narratively synthesized. Meta-regression was
used to examine effect modification. Study quality was assessed using the
Cochrane risk of bias tool. A total of 85 RCTs involving 23 430
participants with a median 12-month follow-up were included. Overall,
exercise-based CR was associated with significant risk reductions in
cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval
(CI): 0.64-0.86, number needed to treat (NNT): 37], hospitalizations (RR:
0.77, 95% CI: 0.67-0.89, NNT: 37), and myocardial infarction (RR: 0.82,
95% CI: 0.70-0.96, NNT: 100). There was some evidence of significantly
improved HRQoL with CR participation, and CR is cost-effective. There was
no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89-1.04),
coronary artery bypass graft (RR: 0.96, 95% CI: 0.80-1.15), or
percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69-1.02). No
significant difference in effects was found across different patient
groups, CR delivery models, doses, follow-up, or risk of bias. Conclusion
This review confirms that participation in exercise-based CR by patients
with coronary heart disease receiving contemporary medical management
reduces cardiovascular mortality, recurrent cardiac events, and
hospitalizations and provides additional evidence supporting the
improvement in HRQoL and the cost-effectiveness of CR.<br/>Copyright
&#xa9; The Author(s) 2022. Published by Oxford University Press on behalf
of the European Society of Cardiology.

<41>
Accession Number
2022850448
Title
Growth differentiation factor 15 and cardiovascular risk: individual
patient meta-analysis.
Source
European Heart Journal. 44(4) (pp 293-300), 2023. Date of Publication: 21
Jan 2023.
Author
Kato E.T.; Morrow D.A.; Guo J.; Berg D.D.; Blazing M.A.; Bohula E.A.;
Bonaca M.P.; Cannon C.P.; de Lemos J.A.; Giugliano R.P.; Jarolim P.; Kempf
T.; Newby L.K.; O'Donoghue M.L.; Pfeffer M.A.; Rifai N.; Wiviott S.D.;
Wollert K.C.; Braunwald E.; Sabatine M.S.
Institution
(Kato) Department of Cardiovascular Medicine, Department of Clinical
Laboratory, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku,
Kyoto 606-8507, Japan
(Morrow, Guo, Berg, Bohula, Giugliano, O'Donoghue, Wiviott, Braunwald,
Sabatine) TIMI Study Group, 60 Fenwood Road, 7th floor, Boston, MA 02115,
United States
(Morrow, Guo, Berg, Bohula, Cannon, Giugliano, O'Donoghue, Pfeffer,
Wiviott, Braunwald, Sabatine) Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA
02115, United States
(Blazing, Newby) Duke Clinical Research Institute, Duke University, 300 W.
Morris Street, Durham, NC 27701, United States
(Bonaca) Cardiovascular Division, Department of Medicine, University of
Colorado School of Medicine, 13001 East 17th PIace, Aurora, CO 80045,
United States
(de Lemos) Division of Cardiology, University of Texas Southwestern
Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9003, United
States
(Jarolim) Department of Pathology, Brigham and Women's Hospital, 75
Francis Street, Boston, MA 02115, United States
(Kempf, Wollert) Division of Molecular and Translational Cardiology,
Department of Cardiology and Angiology, Hannover Medical School,
Carl-Neuberg-Str, 1, Hannover D-30625, Germany
(Rifai) Department of Pathology, Boston Children's Hospital, 300 Longwood
Avenue, Boston, MA 02115, United States
Publisher
Oxford University Press
Abstract
Aims Levels of growth differentiation factor 15 (GDF-15), a cytokine
secreted in response to cellular stress and inflammation, have been
associated with multiple types of cardiovascular (CV) events. However, its
comparative prognostic performance across different presentations of
atherosclerotic cardiovascular disease (ASCVD) remains unknown. Methods An
individual patient meta-analysis was performed using data pooled from
eight trials including 53 486 patients. Baseline and results GDF-15
concentration was analyzed as a continuous variable and using established
cutpoints (<1200 ng/L, 1200-1800 ng/L, > 1800 ng/L) to evaluate its
prognostic performance for CV death/hospitalization for heart failure
(HHF), major adverse cardiovascular events (MACE), and their components
using Cox models adjusted for clinical variables and established CV
biomarkers. Analyses were further stratified on ASCVD status: acute
coronary syndrome (ACS), stabilized after recent ACS, and stable ASCVD.
Overall, higher GDF-15 concentration was significantly and independently
associated with an increased rate of CV death/HHF and MACE (P < 0.001 for
each). However, while GDF-15 showed a robust and consistent independent
association with CV death and HHF across all presentations of ASCVD, its
prognostic association with future myocardial infarction (MI) and stroke
only remained significant in patients stabilized after recent ACS or with
stable ASCVD [hazard ratio (HR): 1.24, 95% confidence interval (CI):
1.17-1.31 and HR: 1.16, 95% CI: 1.05-1.28 for MI and stroke, respectively]
and not in ACS (HR: 0.98, 95% CI: 0.90-1.06 and HR: 0.87, 95% CI:
0.39-1.92, respectively). Conclusion Growth differentiation factor 15
consistently adds prognostic information for CV death and HHF across the
spectrum of ASCVD. GDF-15 also adds prognostic information for MI and
stroke beyond clinical risk factors and cardiac biomarkers but not in the
setting of ACS.<br/>Copyright &#xa9; The Author(s) 2022. Published by
Oxford University Press on behalf of European Society of Cardiology.

<42>
Accession Number
2022850391
Title
Impact of empagliflozin on decongestion in acute heart failure: the
EMPULSE trial.
Source
European Heart Journal. 44(1) (pp 41-50), 2023. Date of Publication: 01
Jan 2023.
Author
Biegus J.; Voors A.A.; Collins S.P.; Kosiborod M.N.; Teerlink J.R.;
Angermann C.E.; Tromp J.; Ferreira J.P.; Nassif M.E.; Psotka M.A.;
Brueckmann M.; Salsali A.; Blatchford J.P.; Ponikowski P.
Institution
(Biegus, Ponikowski) Institute of Heart Diseases, Wroclaw Medical
University, ul. Borowska 213, Wroclaw 50-556, Poland
(Voors) Department of Cardiology, University of Groningen, University
Medical Center Groningen, Hanzeplein 1, P.O Box 30001, Groningen HPC AB
31, Netherlands
(Collins) Department of Emergency Medicine, Vanderbilt University Medical
Center, Nashville, TN, United States
(Collins) Geriatric Research and Education Clinical Care, Tennessee Valley
Healthcare Facility VA Medical Center, Nashville, TN, United States
(Kosiborod) Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City, MO, United States
(Kosiborod) The George Institute for Global Health, the University of New
South Wales, Sydney, NSW, Australia
(Teerlink) Section of Cardiology, San Francisco Veterans Affairs Medical
Center, School of Medicine, University of California San Francisco, 4150
Clement Street, San Francisco, CA 94121, United States
(Angermann) Comprehensive Heart Failure Center Wurzburg, University and
University Hospital Wurzburg, Department of Medicine 1, University
Hospital Wurzburg, Am Schwarzenberg 15, Haus, Wurzburg A15 97078, Germany
(Tromp) Saw Swee Hock School of Public Health, National University of
Singapore, the National University Health System, Singapore
(Tromp) 12 Science Drive 2, #10-01 117549, Singapore
(Ferreira) Universite de Lorraine, Inserm, Centre d'Investigations
Cliniques Plurithematique 1433, Inserm U1116, CHRU, F-CRIN INI-CRCT
(Cardiovascular and Renal Clinical Trialists), Nancy, France
(Ferreira) UnIC@RISE, Department of Surgery and Physiology, Cardiovascular
Research and Development Center, University of Porto, Porto, Portugal
(Nassif) Saint Luke's Mid America Heart Institute, the University of
Missouri, Kansas City, MO, United States
(Psotka) Inova Heart and Vascular Institute, Falls Church, 3300 Gallows
Road, Falls Church, VA 22042, United States
(Brueckmann) Boehringer Ingelheim International GmbH, Binger Strase 173,
Ingelheim am Rhein 55216, Germany
(Brueckmann) First Department of Medicine, Faculty of Medicine Mannheim,
University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
(Salsali) Novo Nordisk pharmaceutical company, Vandtarnsvej 110, Soborg,
Copenhagen 2860, Denmark
(Salsali) Faculty of Medicine, Rutgers University, New Brunswick, 125
Paterson street, New Brunswick, NJ 08901, United States
(Blatchford) Elderbrook Solutions GmbH, Sky Tower, Borsigstr. 4,
Bietigheim-Bissingen D-74321, Germany
Publisher
Oxford University Press
Abstract
Aims Effective and safe decongestion remains a major goal for optimal
management of patients with acute heart failure (AHF). The effects of the
sodium-glucose cotransporter 2 inhibitor empagliflozin on
decongestion-related endpoints in the EMPULSE trial (NCT0415775) were
evaluated. Methods A total of 530 patients hospitalized for AHF were
randomized 1:1 to either empagliflozin 10 mg once daily or placebo for 90
and results days. The outcomes investigated were: weight loss (WL), WL
adjusted for mean daily loop diuretic dose (WL-adjusted), area under the
curve of change from baseline in N-terminal pro-B-type natriuretic peptide
levels, hemoconcentration, and clinical congestion score after 15, 30, and
90 days of treatment. Compared with placebo, patients treated with
empagliflozin demonstrated significantly greater reductions in all studied
markers of decongestion at all time-points, adjusted mean differences (95%
confidence interval) at Days 15, 30, and 90 were: for WL -1.97 (-2.86,
-1.08), -1.74 (-2.73, -0.74); -1.53 (-2.75, -0.31) kg; for WL-adjusted:
-2.31 (-3.77, -0.85), -2.79 (-5.03, -0.54), -3.18 (-6.08, -0.28) kg/40 mg
furosemide i.v. or equivalent; respectively (all P < 0.05). Greater WL at
Day 15 (i.e. above the median WL in the entire population) was associated
with significantly higher probability for clinical benefit at Day 90
(hierarchical composite of all-cause death, heart failure events, and a
5-point or greater difference in Kansas City Cardiomyopathy Questionnaire
total symptom score change from baseline to 90 days) with the win ratio of
1.75 (95% confidence interval 1.37, 2.23; P < 0.0001). Conclusion
Initiation of empagliflozin in patients hospitalized for AHF resulted in
an early, effective and sustained decongestion which was associated with
clinical benefit at Day 90.<br/>Copyright &#xa9; The Author(s) 2022.
Published by Oxford University Press on behalf of European Society of
Cardiology.

<43>
Accession Number
2022648479
Title
Clinical efficacy and safety of Cox-maze IV procedure for atrial
fibrillation in patients with aortic valve calcification.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1092068. Date of Publication: 2023.
Author
Guo R.; Fan C.; Sun Z.; Zhang H.; Sun Y.; Song L.; Jiang Z.; Liu L.
Institution
(Guo, Fan, Sun, Zhang, Sun, Song, Jiang, Liu) Department of Cardiovascular
Surgery, The Second Xiangya Hospital, Central South University, Changsha,
China
Publisher
Frontiers Media S.A.
Abstract
Objective: Atrial fibrillation is associated with a high incidence of
heart valve disease. There are few prospective clinical research comparing
aortic valve replacement with and without surgical ablation for safety and
effectiveness. The purpose of this study was to compare the results of
aortic valve replacement with and without the Cox-maze IV procedure in
patients with calcific aortic valvular disease and atrial fibrillation.
<br/>Method(s): We analyzed one hundred and eight patients with calcific
aortic valve disease and atrial fibrillation who underwent aortic valve
replacement. Patients were divided into concomitant Cox maze surgery
(Cox-maze group) and no concomitant Cox-maze operation (no Cox-maze
group). After surgery, freedom from atrial fibrillation recurrence and
all-cause mortality were evaluated. <br/>Result(s): Freedom from all-cause
mortality after aortic valve replacement at 1 year was 100% in the
Cox-maze group and 89%, respectively, in the no Cox-maze group. No
Cox-maze group had a lower rate of freedom from atrial fibrillation
recurrence and arrhythmia control than those in the Cox-maze group (P =
0.003 and P = 0.012, respectively). Pre-operatively higher systolic blood
pressure (hazard ratio, 1.096; 95% CI, 1.004-1.196; P = 0.04) and
post-operatively increased right atrium diameters (hazard ratio, 1.755;
95% CI, 1.182-2.604; P = 0.005) were associated with atrial fibrillation
recurrence. <br/>Conclusion(s): The Cox-maze IV surgery combined with
aortic valve replacement increased mid-term survival and decreased
mid-term atrial fibrillation recurrence in patients with calcific aortic
valve disease and atrial fibrillation. Pre-operatively higher systolic
blood pressure and post-operatively increased right atrium diameters are
associated with the prediction of recurrence of atrial
fibrillation.<br/>Copyright 2023 Guo, Fan, Sun, Zhang, Sun, Song, Jiang
and Liu.

<44>
Accession Number
2022325539
Title
Clinical outcomes of MANTA vs suture-based vascular closure devices after
transcatheter aortic valve replacement: An updated meta-analysis.
Source
Indian Heart Journal. 75(1) (pp 59-67), 2023. Date of Publication: 01 Jan
2023.
Author
Doshi R.; Vasudev R.; Guragai N.; Patel K.N.; Kumar A.; Majmundar M.;
Doshi P.; Patel P.; Shah K.; Santana M.; Roman S.; Vallabhajosyula S.;
Virk H.; Bikkina M.; Shamoon F.
Institution
(Doshi, Vasudev, Guragai, Patel, Shah, Santana, Roman, Virk, Bikkina,
Shamoon) Department of Cardiology, St Joseph University Medical Center,
Paterson, NJ, United States
(Patel) Department of Internal Medicine, Saint Peter's University
Hospital, New Brunswick, NJ, United States
(Kumar) Department of Internal Medicine Cleveland Clinic Akron General,
Akron, OH, United States
(Majmundar) Department of Cardiology, University of Kansas Medical Center,
Kansas City, KS, United States
(Doshi) Department of Medicine, MS Ramaiah Medical College, Bengaluru,
India
(Vallabhajosyula) Section of Cardiovascular Medicine, Department of
Medicine, Wake Forest University School of Medicine, Winston-Salem, NC,
United States
Publisher
Elsevier B.V.
Abstract
Objective: A recently published randomized control trial showed different
results with suture-based vascular closure device (VCD) than plug-based
VCD in patients undergoing transfemoral transcatheter aortic valve
replacement (TAVR). The learning curve for MANTA device is steep, while
the learning curve for suture based VCD is shallow as the devices are
quite different. In this meta-analysis, we have compared suture-based
(ProGlide and Prostar XL) vs plug-based VCDs (MANTA). <br/>Method(s): We
performed a meta-analysis of all published studies (using PubMed/Medline
and Cochrane databases) reporting the clinical outcome of plug-based vs
suture-based VCDs in transfemoral TAVR patients. <br/>Result(s): We
included nine studies with a total of 2865 patients (plug-based n = 1631,
suture-based n = 1234). There was no significant difference in primary
outcome of all bleeding when using plug-based as opposed to suture-based
VCDs (RR 1.14 [0.62-2.06] I² = 72%). There was no significant
difference in the incidence of secondary outcomes between two groups
including major life threatening bleeding (RR 1.16 [0.38-3.58]
I² = 65%), major vascular complications (RR 0.84 [0.35-2.00]
I² = 55%), minor vascular complications (RR 1.05 [0.56-1.95]
I² = 42%), pseudo aneurysm (RR 1.84 [0.11-29.98] I²
= 44%), stenosis-dissection (RR 0.98 [0.66-1.47] I² = 0%), VCD
failure (RR 1.71 [0.96-3.04] I² = 0%), and blood transfusion
(RR 1.01 [0.38-2.71], I² = 61%). <br/>Conclusion(s): Large bore
arteriotomy closure with plug-based VCD was not superior to suture-based
VCDs in this transfemoral TAVR population. There was very frequent use of
secondary VCDs in suture-based VCD group which is not practical when using
MANTA. Additional high-powered studies are required to determine the
safety and efficacy of MANTA device.<br/>Copyright &#xa9; 2023
Cardiological Society of India

<45>
Accession Number
2020666854
Title
Risk of major adverse cardiovascular events with tofacitinib versus tumour
necrosis factor inhibitors in patients with rheumatoid arthritis with or
without a history of atherosclerotic cardiovascular disease: A post hoc
analysis from ORAL Surveillance.
Source
Annals of the Rheumatic Diseases. 82(1) (pp 119-129), 2022. Date of
Publication: 22 Sep 2022.
Author
Charles-Schoeman C.; Buch M.H.; Dougados M.; Bhatt D.L.; Giles J.T.;
Ytterberg S.R.; Koch G.G.; Vranic I.; Wu J.; Wang C.; Kwok K.; Menon S.;
Rivas J.L.; Yndestad A.; Connell C.A.; Szekanecz Z.
Institution
(Charles-Schoeman) Division of Rheumatology, Department of Medicine,
University of California, Los Angeles, Los Angeles, CA, United States
(Buch) Centre for Musculoskeletal Research, Division of Musculoskeletal
and Dermatological Sciences, Faculty of Biology, Medicine and Health,
University of Manchester, Manchester, United Kingdom
(Buch) NIHR Manchester Biomedical Research Centre, Manchester University
Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre,
Manchester, United Kingdom
(Dougados) Universite de Paris, Department of Rheumatology, Hopital
Cochin; Assistance Publique-Hopitaux de Paris, Paris, France
(Dougados) INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES
Sorbonne Paris-Cite, Paris, France
(Bhatt) Division of Cardiovascular Medicine, Brigham and Women's Hospital
and Harvard Medical School, Boston, MA, United States
(Giles) Division of Rheumatology, Columbia University Vagelos, College of
Physicians and Surgeons, New York, NY, United States
(Ytterberg) Division of Rheumatology, Mayo Clinic, Rochester, MN, United
States
(Koch) Department of Biostatistics, University of North Carolina at Chapel
Hill, Chapel Hill, NC, United States
(Vranic) Pfizer Ltd, Tadworth, United Kingdom
(Wu, Wang, Menon, Connell) Pfizer Inc, Groton, CT, United States
(Kwok) Pfizer Inc, New York, NY, United States
(Rivas) Pfizer SLU, Madrid, Spain
(Yndestad) Pfizer Inc, Oslo, Norway
(Szekanecz) Division of Rheumatology, Faculty of Medicine, University of
Debrecen, Debrecen, Hungary
Publisher
BMJ Publishing Group
Abstract
Objectives Evaluate risk of major adverse cardiovascular events (MACE)
with tofacitinib versus tumour necrosis factor inhibitors (TNFi) in
patients with rheumatoid arthritis (RA) with or without a history of
atherosclerotic cardiovascular disease (ASCVD) in ORAL Surveillance.
Methods Patients with RA aged >=50 years with >=1 additional CV risk
factor received tofacitinib 5 mg or 10 mg two times per day or TNFi.
Hazard rations (HRs) were evaluated for the overall population and by
history of ASCVD (exploratory analysis). Results Risk of MACE, myocardial
infarction and sudden cardiac death were increased with tofacitinib versus
TNFi in ORAL Surveillance. In patients with history of ASCVD (14.7%;
640/4362), MACE incidence was higher with tofacitinib 5 mg two times per
day (8.3%; 17/204) and 10 mg two times per day (7.7%; 17/222) versus TNFi
(4.2%; 9/214). HR (combined tofacitinib doses vs TNFi) was 1.98 (95%
confidence interval (CI) 0.95 to 4.14; interaction p values: 0.196 (for
HR)/0.059 (for incidence rate difference)). In patients without history of
ASCVD, MACE HRs for tofacitinib 5 mg two times per day (2.4%; 30/1251) and
10 mg two times per day (2.8%; 34/1234) versus TNFi (2.3%; 28/1237) were,
respectively, 1.03 (0.62 to 1.73) and 1.25 (0.76 to 2.07). Conclusions
This post hoc analysis observed higher MACE risk with tofacitinib versus
TNFi in patients with RA and history of ASCVD. Among patients without
history of ASCVD, all with prevalent CV risk factors, MACE risk did not
appear different with tofacitinib 5 mg two times per day versus TNFi. Due
to the exploratory nature of this analysis and low statistical power, we
cannot exclude differential MACE risk for tofacitinib 5 mg two times per
day versus TNFi among patients without history of ASCVD, but any absolute
risk excess is likely low. Trial registration number
NCT02092467.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2023.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<46>
Accession Number
2013908270
Title
Levosimendan administration is not associated with increased risk of
bleeding and blood transfusion requirement in patients undergoing off-pump
coronary artery bypass grafting: a retrospective study from single center.
Source
Perfusion (United Kingdom). 38(2) (pp 270-276), 2023. Date of Publication:
March 2023.
Author
Wang L.-H.; Wang X.-H.; Tan J.-C.; He L.-X.; Fu R.-Q.; Lin Y.; Yao Y.-T.
Institution
(Wang, Fu) Department of Anesthesiology, Chuiyangliu Hospital of Tsinghua
University, Beijing, China
(Wang, Tan, He, Lin, Yao) Department of Anesthesiology, Fuwai Hospital,
National Center for Cardiovascular Diseases, Peking Union Medical College
and Chinese Academy of Medical Sciences, Beijing, China
(Wang) Department of Nutrition and Food, Tangshan City Center for Disease
Control and Prevention, Tangshan, China
(Tan) Department of Anesthesiology, Shunde Hospital of Southern Medical
University, Foshan, China
(Lin) Department of Cardiovascular Surgery, Fujian Medical University
Union Hospital, Fuzhou, China
Publisher
SAGE Publications Ltd
Abstract
Background: Levosimendan (LEVO) is a positive inotropic drug which could
increase myocardial contractility and reduce the mortality rate in cardiac
surgical patients. However, Whether LEVO is associated with postoperative
bleeding and blood transfusion in cardiac surgical patients is
controversial. Therefore, the current study was designed to investigate
the impact of LEVO administration on bleeding and blood transfusion
requirement in off-pump coronary artery bypass grafting (OPCAB) patients.
<br/>Method(s): In a retrospective analysis, a total of 292 patients, aged
40-87 years, undergoing elective OPCAB between January 2019 and July 2019,
were divided into LEVO group (n = 151) and Control group (n = 141).
Patients in LEVO group continuously received LEVO at a rate of 0.1-0.2 mug
kg^-1 min^-1 after anesthesia induction until 24 hours
after OPCAB or patients in Control group received no LEVO. The primary
outcome was postoperative chest drainage volume. The secondary outcomes
were reoperation for postoperative bleeding, transfusion requirement of
red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrate
(PC), etc. Comparisons of two groups were performed with the Student's
t-test or Wilcoxon-Mann-Whitney test. <br/>Result(s): There was no
significant difference with respect to chest drainage volume ((956.29 +/-
555.45) ml vs (1003.19 +/- 572.25) ml, p = 0.478) and the incidence of
reoperation for postoperative bleeding (1.32% vs 1.42%, p = 0.945) between
LEVO group and Control group. The transfusion incidence and volume of
allogeneic RBCs, FFP, and PC were comparable between two groups.
<br/>Conclusion(s): LEVO administration was neither associated with more
postoperative blood loss nor increased allogeneic blood transfusion
requirement in OPCAB patients.<br/>Copyright &#xa9; The Author(s) 2021.

<47>
Accession Number
2022353412
Title
Effects of glucagon-like peptide-1 receptor agonists on major coronary
events in patients with type 2 diabetes.
Source
Diabetes, Obesity and Metabolism. 25(S1) (pp 53-63), 2023. Date of
Publication: April 2023.
Author
Guo X.; Sang C.; Tang R.; Jiang C.; Li S.; Liu N.; Long D.; Du X.; Dong
J.; Ma C.
Institution
(Guo, Sang, Tang, Jiang, Li, Liu, Long, Du, Dong, Ma) Department of
Cardiology, Beijing Anzhen Hospital, Capital Medical University, National
Clinical Research Center for Cardiovascular Diseases, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Aims: To perform a meta-analysis to assess the effects of glucagon-like
peptide-1 receptor agonists (GLP-1RAs) on major coronary events, including
myocardial infarction (MI), unstable angina and coronary
revascularization, in patients with type 2 diabetes mellitus (T2DM).
<br/>Material(s) and Method(s): We systematically searched the PubMed,
CENTRAL, EMBASE and clinicaltrial.gov databases to seek eligible studies
with a cardiovascular endpoint comparing GLP-1RAs with a placebo in T2DM
patients. Odds ratio (ORs) and 95% confidence intervals (CIs) were
calculated for the outcomes. <br/>Result(s): Nine studies, with a total of
64 236 patients, were included. GLP-1RA treatment reduced fatal and
nonfatal MI by 8% (OR 0.92, 95% CI 0.86-0.99; P = 0.02, I² =
39%). The reduction reached 15% in human-based GLP-1RA-treated patients.
Similarly, once-weekly GLP-1RA treatment reduced the risk of MI by 13%. In
contrast, GLP-1RA treatment did not reduce the risk of hospitalization for
unstable angina (OR 1.11, 95% CI 0.97-1.28; P = 0.13, I² =
21%). GLP-1RAs exhibited a tendency to lower the risk of coronary
revascularization (OR 0.95, 95% CI 0.89-1.02; P = 0.15, I² =
22%), but without statistical significance. Human-based GLP-1RAs decreased
the risk by 11%. <br/>Conclusion(s): In high-risk patients with T2DM,
GLP-1RAs were associated with a decrease in MI, especially the human-based
and once-weekly GLP-1RAs. No benefit was seen for hospitalization for
unstable angina or coronary revascularization. Further research is
urgently needed to ascertain improvements in coronary
events.<br/>Copyright &#xa9; 2023 John Wiley & Sons Ltd.

<48>
Accession Number
2021719571
Title
Performance and usability of pre-operative prediction models for 30-day
peri-operative mortality risk: a systematic review.
Source
Anaesthesia. 78(5) (pp 607-619), 2023. Date of Publication: May 2023.
Author
Vernooij J.E.M.; Koning N.J.; Geurts J.W.; Holewijn S.; Preckel B.;
Kalkman C.J.; Vernooij L.M.
Institution
(Vernooij, Koning, Geurts) Department of Anaesthesia, Rijnstate Hospital,
Netherlands
(Holewijn) Department of Vascular Surgery, Rijnstate Hospital, Netherlands
(Preckel) Department of Anaesthesia, Amsterdam UMC, Amsterdam, Netherlands
(Kalkman) University Medical Centre, Utrecht, Netherlands
(Vernooij) Department of Anaesthesia, University Medical Centre Utrecht,
Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Estimating pre-operative mortality risk may inform clinical
decision-making for peri-operative care. However, pre-operative mortality
risk prediction models are rarely implemented in routine clinical
practice. High predictive accuracy and clinical usability are essential
for acceptance and clinical implementation. In this systematic review, we
identified and appraised prediction models for 30-day postoperative
mortality in non-cardiac surgical cohorts. PubMed and Embase were searched
up to December 2022 for studies investigating pre-operative prediction
models for 30-day mortality. We assessed predictive performance in terms
of discrimination and calibration. Risk of bias was evaluated using a tool
to assess the risk of bias and applicability of prediction model studies.
To further inform potential adoption, we also assessed clinical usability
for selected models. In all, 15 studies evaluating 10 prediction models
were included. Discrimination ranged from a c-statistic of 0.82
(MySurgeryRisk) to 0.96 (extreme gradient boosting machine learning
model). Calibration was reported in only six studies. Model performance
was highest for the surgical outcome risk tool (SORT) and its external
validations. Clinical usability was highest for the surgical risk
pre-operative assessment system. The SORT and risk quantification index
also scored high on clinical usability. We found unclear or high risk of
bias in the development of all models. The SORT showed the best
combination of predictive performance and clinical usability and has been
externally validated in several heterogeneous cohorts. To improve clinical
uptake, full integration of reliable models with sufficient face validity
within the electronic health record is imperative.<br/>Copyright &#xa9;
2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf
of Association of Anaesthetists.

<49>
Accession Number
640577255
Title
A commentary on 'A comparison of regional anesthesia techniques in
patients undergoing video-assisted thoracic surgery: A network
meta-analysis'.
Source
International journal of surgery (London, England). 109(3) (pp 498-499),
2023. Date of Publication: 01 Mar 2023.
Author
Zhao Y.; Cheng C.; Jiao X.; Guo L.
Institution
(Zhao, Guo) Department of Anesthesiology
(Cheng, Jiao) Intensive Care Unit, Shanxi Province Cancer Hospital, Shanxi
Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical
Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi
Province, Taiyuan, China
Publisher
NLM (Medline)

<50>
[Use Link to view the full text]
Accession Number
634773849
Title
Exposure-Response Relationship of Tranexamic Acid in Cardiac Surgery: A
Model-based Meta-analysis.
Source
Anesthesiology. 134(2) (pp 165-178), 2021. Date of Publication: 01 Feb
2021.
Author
Zufferey P.J.; Lanoiselee J.; Graouch B.; Vieille B.; Delavenne X.; Ollier
E.
Institution
(Zufferey, Lanoiselee, Delavenne, Ollier) Institut National de la Sante et
de la Recherche Medicale (INSERM), U1059, Vascular Dysfunction and
Hemostasis, Saint-Etienne, France
(Zufferey, Lanoiselee, Graouch, Vieille) Department of Anesthesia and
Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne,
France
(Zufferey, Delavenne, Ollier) Clinical Pharmacology Department, University
Hospital of Saint-Etienne, Saint-Etienne, France
(Delavenne, Ollier) University of Lyon, Saint-Etienne, France
Publisher
Lippincott Williams and Wilkins
Abstract
Background: It is unclear whether high-dose regimens of tranexamic acid in
cardiac surgery (total dose, 80 to 100 mg/kg) confer a clinical advantage
over low-dose regimens (total dose, approximately 20 mg/kg), particularly
as tranexamic acid-associated seizure may be dose-related. The authors'
aim was to characterize the exposure-response relationship of this drug.
<br/>Method(s): Databases were searched for randomized controlled trials
of intravenous tranexamic acid in adult patients undergoing
cardiopulmonary bypass surgery. Observational studies were added for
seizure assessment. Tranexamic acid concentrations were predicted in each
arm of each study using a population pharmacokinetic model. The
exposure-response relationship was evaluated by performing a model-based
meta-analysis using nonlinear mixed-effect models. <br/>Result(s):
Sixty-four randomized controlled trials and 18 observational studies
(49,817 patients) were included. Seventy-three different regimens of
tranexamic acid were identified, with the total dose administered ranging
from 5.5 mg/kg to 20 g. The maximum effect of tranexamic acid for
postoperative blood loss reduction was 40% (95% credible interval, 34 to
47%), and the EC<inf>50</inf>was 5.6 mg/l (95% credible interval, 0.7 to
11 mg/l). Exposure values with low-dose regimens approached the 80%
effective concentration, whereas with high-dose regimens, they exceeded
the 90% effective concentration. The predicted cumulative blood loss up to
48 h postsurgery differed by 58 ml between the two regimens, and the
absolute difference in erythrocyte transfusion rate was 2%. Compared to no
tranexamic acid, low-dose and high-dose regimens increased the risk of
seizure by 1.2-fold and 2-fold, respectively. However, the absolute risk
increase was only clinically meaningful in the context of prolonged
open-chamber surgery. <br/>Conclusion(s): In cardiopulmonary bypass
surgery, low-dose tranexamic acid seems to be an appropriate regimen for
reducing bleeding outcomes. This meta-analysis has to be interpreted with
caution because the results are observational and dependent on the lack of
bias of the predicted tranexamic acid exposures and the quality of the
included studies.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<51>
Accession Number
641133126
Title
APOL1 Variants and Cardiovascular Disease: Results from the African
American Study of Kidney Disease and Hypertension (AASK).
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2016. Chicago, IL United States. 27 (pp 814A), 2016. Date of Publication:
November 2016.
Author
Chen T.K.; Appel L.J.; Tin A.; Choi M.J.; Estrella M.M.
Institution
(Chen, Appel, Tin, Choi, Estrella) Johns Hopkins Univ, United States
Publisher
Wolters Kluwer Health
Abstract
Background: Studies on the association between APOL1 risk variants and
cardiovascular disease (CVD) have been conflicting thus far. We aimed to
determine whether APOL1 high-risk variants are associated with increased
risk for adverse CVD outcomes in the context of established
hypertension-attributed chronic kidney disease (CKD). <br/>Method(s):
Using data from the trial and cohort phases of AASK (mean follow-up 7.7
years), we constructed Cox proportional hazards models to estimate the
relative hazard of experiencing a composite CVD outcome (cardiac
revascularization procedure, nonfatal myocardial infarction, heart failure
exacerbation, stroke, or cardiovascular death) among African Americans
with the APOL1 high-risk (2 alleles) vs. low-risk (0-1 allele) genotypes.
We adjusted for age, gender, ancestry, smoking, body mass index, total
cholesterol, randomized treatment groups, and baseline and longitudinal
estimated glomerular filtration rate (eGFR), systolic blood pressure, and
proteinuria. Censoring occurred at ESRD, death, lost to follow-up, or
administrative censoring. <br/>Result(s): Among the 1094 AASK trial
participants, 693 had APOL1 genotyping available (23% high-risk genotype)
and were included in our study. At baseline, the APOL1 high-risk group had
a lower mean eGFR (44.7 vs. 50.1 ml/min/1.73 m²) and more
proteinuria (median 0.19 vs. 0.06) compared to the low risk group. In both
unadjusted (HR: 1.23; 95% CI: 0.83 to 1.81; p=0.31) and fully adjusted
(HR: 1.14; 95% CI: 0.76 to 1.72; p=0.53) models, individuals with the
APOL1 high-risk genotype had similar risk for the composite CVD outcome as
those with the low-risk genotype. Use of additive or dominant genetic
models yielded similar findings. <br/>Conclusion(s): Among African
Americans with hypertension-attributed CKD, APOL1 high-risk variants are
not associated with an increased risk for cardiovascular disease. (Figure
Presented).

<52>
Accession Number
641132953
Title
Early Mortality and Late Outcomes for Coronary Revascularisation in
Chronic Kidney Disease - A Systematic Review and Meta-Analysis.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2016. Chicago, IL United States. 27 (pp 818A), 2016. Date of Publication:
November 2016.
Author
Ramphul R.; Banerjee D.
Institution
(Ramphul, Banerjee) Renal and Transplantation Unit, St. George's Univ
Hospitals NHS Foundation Trust, London, United Kingdom
Publisher
Wolters Kluwer Health
Abstract
Background: Despite the high prevalence of coronary artery disease in
patients with chronic kidney disease (CKD), the optimal method of coronary
revascularisation remains unclear. We conducted a systematic review and
meta-analysis of the available literature comparing early mortality and
long-term outcomes of percutaneous coronary intervention (PCI) and
coronary artery bypass graft (CABG) in patients with CKD. <br/>Method(s):
We reviewed contemporary studies, conducted after the year 2000 as PCI
therapy have improved, comparing PCI to CABG in CKD patients, using Review
Manager 5.1 for statistical analysis and PRISMA guidelines for reporting.
Clinical endpoints compared were early (in-hospital or 30-day) and late (>
than 1 year) mortality; repeat revascularisation, occurrence of major
adverse cardiovascular events (MACE) and myocardial infarction (MI) after
revascularisation. <br/>Result(s): 4 studies investigated early mortality.
The pooled analysis showed similar early deaths for PCI and CABG (4% v 6%,
p=0.44, Figure 1a). In 6 studies reporting late mortality, CABG was
associated with less deaths compared to PCI (26% v 30%, p<0.001, Figure
1b). Repeat revascularisation was reported in 3 studies with CABG less
likely to lead to further revascularisation compared to PCI (2% v 14%,
p=0.01, Figure 1c). The occurrence of MACE was reported in 3 studies. CABG
was associated with significantly less events compared to PCI (18% v 28%,
p=0.01, Figure 1d) and although MI alone occurred less often with CABG
than PCI this was not statistically significant (4% v 10%, p=0.41). There
existed a selection bias with PCI preferred to CABG in single vessel
disease and CABG for multivessel or left main disease. <br/>Conclusion(s):
The results favour CABG for late mortality, repeat revascularisation and
MACE whilst PCI is marginally beneficial for early mortality. (Figure
Presented).

<53>
Accession Number
641131104
Title
Early Mortality and Late Outcomes for Coronary Revascularisation in End
Stage Renal Disease - A Systematic Review and Meta-Analysis.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2016. Chicago, IL United States. 27 (pp 584A), 2016. Date of Publication:
November 2016.
Author
Ramphul R.; Banerjee D.
Institution
(Ramphul, Banerjee) Renal and Transplantation Unit, St. George's Univ
Hospitals NHS Foundation Trust, London, United Kingdom
Publisher
Wolters Kluwer Health
Abstract
Background: Despite the high prevalence of coronary artery disease in
patients with end-stage renal disease (ESRD), the optimal method of
coronary revascularisation remains unclear. We conducted a systematic
review and meta-analysis of the available literature comparing outcomes
after percutaneous coronary intervention (PCI) and coronary artery bypass
graft (CABG) in ESRD patients. <br/>Method(s): We reviewed contemporary
studies, conducted after the year 2000 as PCI therapy have improved,
comparing PCI to CABG in ESRD patients, using Review Manager 5.1 for
statistical analysis and PRISMA guidelines for reporting. Clinical
endpoints compared were early (in-hospital or 30-day) and late (> than 1
year) mortality; repeat revascularisation, occurrence of major adverse
cardiovascular events (MACE) and myocardial infarction (MI) after
revascularisation. <br/>Result(s): In 12 studies investigating early
mortality, the analysis demonstrated less early deaths for PCI compared to
CABG (4% v 8%, p<0.001, Figure 1a). Late mortality was reported in 10
studies with late deaths similar for CABG and PCI (44% v 50%, p=0.32).
Repeat revascularisation was reported in 9 studies. CABG was less likely
to require revascularisation compared to PCI (12% v 41%, p<0.001, Figure
1b). The occurrence of MACE was reported in 3 studies. CABG was associated
with less events compared to PCI (16% v 57%, p<0.001, Figure 1c).
Similarly, MI alone occurred less often with CABG than PCI (5% v 11%,
p=0.003, Figure 1d). There existed a selection bias with PCI preferred to
CABG in single vessel disease and CABG for multivessel or left main
disease. <br/>Conclusion(s): The results demonstrate better early
mortality in patients with ESRD undergoing PCI, however the results
favoured CABG for repeat revascularisation, MACE and MI. CABG was only
marginally beneficial for late mortality.

<54>
Accession Number
641130807
Title
Nesiritide Modulates Inflammatory Response during Cardiac Surgery.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2016. Chicago, IL United States. 27 (pp 566A), 2016. Date of Publication:
November 2016.
Author
Beaver T.M.; Cobb J.A.; Koratala A.; Ejaz A.A.
Institution
(Beaver, Cobb) Div of Thoracic and Cardiovascular Surgery, Univ of
Florida, United States
(Koratala, Ejaz) Div of Nephrology, Hypertension and Renal
Transplantation, Univ of Florida, United States
Publisher
Wolters Kluwer Health
Abstract
Background: The study was performed to investigate the effects of NES on
inflammatory response during cardiac surgery. <br/>Method(s): N=29 cardiac
surgery patients were randomized to an infusion of NES versus placebo
(Ctrl). The effect of NES on inflammatory response was investigated by
measuring a panel of candidate biomarkers and clinical parameters at
predetermined time points. <br/>Result(s): There were no significant
differences between the groups with regards to the early biomarkers of
AKI: urine NGAL (NES 230.3+71.5ng/mL vs. Ctrl 554.4+263.3ng/ mL, p=0.253)
and urine IL-18 (NES 29.9+4.8pg/mL vs. 254.5+118.3pg/mL, p=0.090). A
concerted biomarker kinetic pattern of time-differentiated peak
concentrations was observed. IL-10, IP-10, IL-6, IL-10, IP-10, MIP-1a,
INF-a, INF-g, IL-1a, IL-3 and IL-7 reached peak concentration at 0hr
following end of CPB; TNF-a, EGF, GM-CSF, IL-12p40, IL-17, MIP-1b and
MCP-1 at 1hr; IL-18, VEGF, IL-13 and IL-1ra at 2hrs, TNF-b, G-CSF, IL-1b,
IL-2, IL-4, IL-5 and IL-15 at 2hrs; and ET-1 and IL-18 at 6hrs. A
generalized trend towards lower levels of biomarker concentration in the
NES group compared to the Ctrl group could be observed. At 0hr, the NES
group exhibited significant reduction of peak concentrations of IL-6
(p=0.009), IL-10 (p=0.009), IL-1a (p= 0.020), IP-10 (p= 0.001) and IFN-a
(p=0.032) compared to the Ctrl group. Significant reduction in peak
concentrations of TNF-a (p=0.007) and MIP-b (p=0.027) at 1hr and ET-1
(p=0.020) at 6hrs were observed in the NES group compared to the Ctrl
group. <br/>Conclusion(s): Our study demonstrated a concerted inflammatory
response in cardiac surgery that was modulated by nesiritide. Furthermore
nesiritide attenuated ET-1 response thus suggesting that previously
observed favorable renal effect may be linked to attenuated renal
vasoconstriction. (Figure Presented).

<55>
Accession Number
2023541589
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, 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
Dove Medical Press Ltd
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 echocardio-graphers. 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. T.

<56>
Accession Number
2023541735
Title
Posttransplant Diabetes Mellitus (PTDM) Following Solid Organ
Transplantation-Systematic Analysis of Prevalence and Total Mortality and
Meta-Analysis of Randomized Interventional Studies Aimed at Lowering Blood
Glucose.
Source
Current Diabetes Reviews. 19(7) (no pagination), 2023. Article Number:
e071122210692. Date of Publication: 2023.
Author
Almdal K.; Hornum M.; Almdal T.
Institution
(Almdal, Almdal) Department of Endocrinology PE, Rigshospitalet,
Copenhagen, Denmark
(Hornum) Department of Nephrology P, Rigshospitalet, Copenhagen, Denmark
(Hornum) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
(Almdal) Department of Microbiology and Immunology, University of
Copenhagen, Copenhagen, Denmark
Publisher
Bentham Science Publishers
Abstract
Objective: A systematic review of the prevalence and prognosis of
posttransplant diabetes mellitus (PTDM) following the transplantation of
heart, lung, liver and kidney and a meta-analysis of randomised studies of
glucose-lowering treatment is reported. <br/>Method(s): We searched for
publications on solid organ transplants and PTDM in relation to the risk
and total mortality of PTDM and randomized controlled trials aiming at
reducing glucose levels. <br/>Result(s): PTDM prevalence one year after
transplantation was reported to be 9-40%. Ten years after transplantation,
60-85% of people without PTDM and 30-76% of people with PTDM were alive.
Following kidney transplantation, we identified six randomized controlled
trials on the treatment of PTDM. Intervention ranged from 3 to 12 months.
Four studies used intervention with oral glucose-lowering drugs, one used
dietician appointments and exercise, and one used insulin treatment. Among
the intermediate results reported, a reduction in HbA1c of 2.7 mmol/mol,
and an increase in the odds ratio of serious adverse events of 3.0 was
significant. <br/>Conclusion(s): In conclusion, information on the
prevalence and effect on survival of PTDM is het-erogeneous, and the
randomized studies on the effect of treatment available are short and lack
information on clinically important endpoints, such as mortality or
morbidity.<br/>Copyright &#xa9; 2023 Bentham Science Publishers.

<57>
Accession Number
641128982
Title
Evaluating the value of progressive muscle relaxation therapy for patients
with lumbar disc herniation after surgery based on a
difference-in-differences model.
Source
Biotechnology & genetic engineering reviews. (pp 1-12), 2023. Date of
Publication: 26 Apr 2023.
Author
Chen X.; Chen G.; Zhao Y.; Chen Q.; Huang J.; Hu G.
Institution
(Chen, Zhao, Chen, Huang, Hu) Ward of Nursing Department of the First
Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
(Chen) Department of Orthopedics, First Affiliated Hospital of Wenzhou
Medical University, Zhejiang, China
Publisher
NLM (Medline)
Abstract
We evaluate the value of progressive muscle relaxation (PMR) for patients
with lumbar disc herniation after surgery based on a
difference-in-differences model. A total of 128 patients with lumbar disc
herniation who underwent surgery were randomly assigned to undergo either
conventional intervention (conventional intervention group, n=64) or
conventional intervention combined with PMR (PMR group, n=64).
Perioperative anxiety level, stress level and lumbar function were
compared between the two groups and compared pain between the two groups
before and 1week and 1 and 3months after surgery. After 3months, no one
was lost to follow-up. At 1 day before surgery and 3days after surgery,
Self-rating Anxiety Scale score in the PMR group was significantly lower
than that in the conventional intervention group (P<0.05). At 30 min
before surgery, heart rate and systolic blood pressure in the PMR group
were significantly lower than those in the conventional intervention group
(P<0.05). After intervention, the scores of subjective symptoms, clinical
signs and restrictions on activities of daily living were significantly
higher in the PMR group than those in the conventional intervention group
(all P<0.05). Visual Analogue Scale score in the PMR group was
significantly lower than that in the conventional intervention group (all
P<0.05). The amplitude of change in VAS score in the PMR group was greater
than that in the conventional intervention group (P<0.05). PMR can relieve
perioperative anxiety and stress in patients with lumbar disc herniation,
reduce postoperative pain and improve lumbar function.

<58>
Accession Number
2015978516
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass grafting in left main coronary artery disease: an
individual patient data meta-analysis.
Source
The Lancet. 398(10318) (pp 2247-2257), 2021. Date of Publication: 18 Dec
2021.
Author
Sabatine M.S.; Bergmark B.A.; Murphy S.A.; O'Gara P.T.; Smith P.K.;
Serruys P.W.; Kappetein A.P.; Park S.-J.; Park D.-W.; Christiansen E.H.;
Holm N.R.; Nielsen P.H.; Stone G.W.; Sabik J.F.; Braunwald E.
Institution
(Sabatine, Bergmark, Murphy, Braunwald) Thrombolysis in Myocardial
Infarction Study Group, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, United States
(Sabatine, Bergmark, Murphy, O'Gara, Braunwald) Division of Cardiovascular
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Smith) Department of Surgery (Cardiothoracic), Duke University School of
Medicine, Duke Clinical Research Institute, Durham, NC, United States
(Serruys) Department of Cardiology, National University of Ireland Galway,
Galway, Ireland
(Serruys) National Heart and Lung Institute, Imperial College London,
London, UK, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Park, Park) Department of Cardiology, Asan Medical Center, Seoul, South
Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Nielsen) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Stone) The Zena and Michael A Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Background: The optimal revascularisation strategy for patients with left
main coronary artery disease is uncertain. We therefore aimed to evaluate
long-term outcomes for patients treated with percutaneous coronary
intervention (PCI) with drug-eluting stents versus coronary artery bypass
grafting (CABG). <br/>Method(s): In this individual patient data
meta-analysis, we searched MEDLINE, Embase, and the Cochrane database
using the search terms "left main", "percutaneous coronary intervention"
or "stent", and "coronary artery bypass graft*" to identify randomised
controlled trials (RCTs) published in English between database inception
and Aug 31, 2021, comparing PCI with drug-eluting stents with CABG in
patients with left main coronary artery disease that had at least 5 years
of patient follow-up for all-cause mortality. Two authors (MSS and BAB)
identified studies meeting the criteria. The primary endpoint was 5-year
all-cause mortality. Secondary endpoints were cardiovascular death,
spontaneous myocardial infarction, procedural myocardial infarction,
stroke, and repeat revascularisation. We used a one-stage approach; event
rates were calculated by use of the Kaplan-Meier method and treatment
group comparisons were made by use of a Cox frailty model, with trial as a
random effect. In Bayesian analyses, the probabilities of absolute risk
differences in the primary endpoint between PCI and CABG being more than
0.0%, and at least 1.0%, 2.5%, or 5.0%, were calculated. <br/>Finding(s):
Our literature search yielded 1599 results, of which four RCTs-SYNTAX,
PRECOMBAT, NOBLE, and EXCEL-meeting our inclusion criteria were included
in our meta-analysis. 4394 patients, with a median SYNTAX score of 25.0
(IQR 18.0-31.0), were randomly assigned to PCI (n=2197) or CABG (n=2197).
The Kaplan-Meier estimate of 5-year all-cause death was 11.2% (95% CI
9.9-12.6) with PCI and 10.2% (9.0-11.6) with CABG (hazard ratio 1.10, 95%
CI 0.91-1.32; p=0.33), resulting in a non-statistically significant
absolute risk difference of 0.9% (95% CI -0.9 to 2.8). In Bayesian
analyses, there was an 85.7% probability that death at 5 years was greater
with PCI than with CABG; this difference was more likely than not less
than 1.0% (<0.2% per year). The numerical difference in mortality was
comprised more of non-cardiovascular than cardiovascular death.
Spontaneous myocardial infarction (6.2%, 95% CI 5.2-7.3 vs 2.6%, 2.0-3.4;
hazard ratio [HR] 2.35, 95% CI 1.71-3.23; p<0.0001) and repeat
revascularisation (18.3%, 16.7-20.0 vs 10.7%, 9.4-12.1; HR 1.78,
1.51-2.10; p<0.0001) were more common with PCI than with CABG. Differences
in procedural myocardial infarction between strategies depended on the
definition used. Overall, there was no difference in the risk of stroke
between PCI (2.7%, 2.0-3.5) and CABG (3.1%, 2.4-3.9; HR 0.84, 0.59-1.21;
p=0.36), but the risk was lower with PCI in the first year after
randomisation (HR 0.37, 0.19-0.69). <br/>Interpretation(s): Among patients
with left main coronary artery disease and, largely, low or intermediate
coronary anatomical complexity, there was no statistically significant
difference in 5-year all-cause death between PCI and CABG, although a
Bayesian approach suggested a difference probably exists (more likely than
not <0.2% per year) favouring CABG. There were trade-offs in terms of the
risk of myocardial infarction, stroke, and revascularisation. A heart team
approach to communicate expected outcome differences might be useful to
assist patients in reaching a treatment decision. <br/>Funding(s): No
external funding.<br/>Copyright &#xa9; 2021 Elsevier Ltd

<59>
Accession Number
2023994225
Title
Preprocedural muscle strength and physical performance and the association
with functional decline or mortality in frail older patients after
transcatheter aortic valve implementation: a systematic review and
meta-analysis.
Source
Age and Ageing. 51(9) (no pagination), 2022. Article Number: afac211. Date
of Publication: 01 Sep 2022.
Author
Van Erck D.; Dolman C.D.; Limpens J.; Scholte Op Reimer W.J.M.; Henriques
J.P.; Delewi R.; Schoufour J.D.
Institution
(Van Erck, Scholte Op Reimer, Henriques, Delewi) Department of Cardiology,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Dolman) Department of Cardiothoracic Surgery, Amsterdam UMC, University
of Amsterdam, Amsterdam, Netherlands
(Limpens) Medical Library, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Scholte Op Reimer) Research Group Chronic Diseases, HU University of
Applied Sciences, Utrecht, Netherlands
(Schoufour) Faculty of Health, Center of Expertise Urban Vitality,
Amsterdam University of Applied Science, Amsterdam, Netherlands
(Schoufour) Faculty of Sports and Nutrition, Center of Expertise Urban
Vitality, Amsterdam University of Applied Science, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background: A significant number of older patients planned for
transcatheter aortic valve implantation (TAVI) experience a decline in
physical functioning and death, despite a successful procedure.
<br/>Objective(s): To systematically review the literature on the
association of preprocedural muscle strength and physical performance with
functional decline or long-term mortality after TAVI. <br/>Method(s): We
followed the PRISMA guidelines and pre-registered this review at PROSPERO
(CRD42020208032). A systematic search was conducted in MEDLINE and EMBASE
from inception to 10 December 2021. Studies reporting on the association
of preprocedural muscle strength or physical performance with functional
decline or long-term (>6 months) mortality after the TAVI procedure were
included. For outcomes reported by three or more studies, a meta-analysis
was performed. <br/>Result(s): In total, two studies reporting on
functional decline and 29 studies reporting on mortality were included.
The association with functional decline was inconclusive. For mortality,
meta-analysis showed that low handgrip strength (hazard ratio (HR) 1.80
[95% confidence interval (CI): 1.22-2.63]), lower distance on the 6-minute
walk test (HR 1.15 [95% CI: 1.09-1.21] per 50 m decrease), low performance
on the timed up and go test (>20 s) (HR 2.77 [95% CI: 1.79-4.30]) and slow
gait speed (<0.83 m/s) (HR 2.24 [95% CI: 1.32-3.81]) were associated with
higher long-term mortality. <br/>Conclusion(s): Low muscle strength and
physical performance are associated with higher mortality after TAVI,
while the association with functional decline stays inconclusive. Future
research should focus on interventions to increase muscle strength and
physical performance in older cardiac patients.<br/>Copyright &#xa9; 2022
The Author(s). Published by Oxford University Press on behalf of the
British Geriatrics Society. All rights reserved.

<60>
Accession Number
2023974505
Title
Complication Rate of Percutaneous Dilatational Tracheostomy in Critically
Ill Adults with Obesity: A Systematic Review and Meta-analysis.
Source
JAMA Otolaryngology - Head and Neck Surgery. 149(4) (pp 334-343), 2023.
Date of Publication: 13 Apr 2023.
Author
Roy C.F.; Silver J.A.; Turkdogan S.; Siafa L.; Correa J.A.; Kost K.
Institution
(Roy, Silver, Turkdogan, Kost) Department of Otolaryngology-Head and Neck
Surgery, McGill University, Health Centre, Montreal, QC, Canada
(Siafa) Faculty of Medicine, McGill University, Montreal, QC, Canada
(Correa) Department of Mathematics and Statistics, McGill University,
Montreal, QC, Canada
Publisher
American Medical Association
Abstract
Importance: Obesity has traditionally been described as a relative
contraindication to percutaneous dilatational tracheostomy (PDT).
Increased familiarity with the technique and use of bronchoscopy or
real-time ultrasonography to enhance visualization have led many
practitioners to expand the indication for PDT to patients historically
deemed to have high risk of perioperative complications.
<br/>Objective(s): To assess the reported complication rate of PDT in
critically ill adults with obesity and compare it with that of open
surgical tracheostomies (OSTs) in this patient population and with that of
PDT in their counterparts without obesity. <br/>Data Sources: In this
systematic review and meta-analysis, Ovid MEDLINE, Embase, and the
Cochrane Central Register of Controlled Trials were searched from January
1, 2000, to March 1, 2022. Key terms related to percutaneous tracheostomy
and obesity were included. Study Selection: Original investigations of
critically ill adult patients (age >=18 years) with obesity who underwent
PDT that reported at least 1 complication of interest were included. Case
reports or series with fewer than 5 patients were excluded, as were
studies in a language other than English or French. Data Extraction and
Synthesis: Preferred Reporting Items for Systematic Reviews and
Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in
Epidemiology (MOOSE) were used, with independent extraction by multiple
observers. Frequencies were reported for all dichotomous variables.
Relative risks for complications were calculated using both fixed-effects
and random-effects models in the meta-analysis. <br/>Main Outcomes and
Measures: Main outcomes included mortality directly associated with the
procedure, conversion to OST, and complications associated with the
procedure (subclassified into life-threatening or non-life-threatening
adverse events). <br/>Result(s): Eighteen studies were included in the
systematic review, comprising 1355 patients with obesity who underwent
PDT. The PDT-related complication rate was 16.6% among patients with
obesity overall (791 patients, 17 studies), most of which were
non-life-threatening. Only 0.6% of cases (8 of 1314 patients, 17 studies)
were aborted or converted to an OST. A meta-analysis of 12 studies (N =
4212; 1078 with obesity and 3134 without obesity) showed that patients
with obesity had a higher rate of complications associated with PDT
compared with their counterparts without obesity (risk ratio, 1.78; 95%
CI, 1.38-2.28). A single study compared PDT with OST directly for
critically ill adults with obesity; thus, the intended meta-analysis could
not be performed in this subgroup. <br/>Conclusions and Relevance: The
findings suggest that the rate of complications of PDT is low in
critically ill individuals with obesity, although the risk of
complications may be higher than in individuals without
obesity..<br/>Copyright &#xa9; 2023 American Medical Association. All
rights reserved.

<61>
Accession Number
2023798274
Title
Meta-analysis assessing the sensitivity and specificity of
¹⁸F-FDG PET/CT for the diagnosis of prosthetic valve
endocarditis (PVE) using individual patient data (IPD).
Source
American Heart Journal. 261 (pp 21-34), 2023. Date of Publication: July
2023.
Author
O'Gorman P.; Nair L.; Kisiel N.; Hughes I.; Huang K.; Hsu C.C.-T.; Fagman
E.; Heying R.; Pizzi M.N.; Roque A.; Singh K.
Institution
(O'Gorman, Huang, Hsu) Medical Imaging Department, Gold Coast University
Hospital (Queensland Health), Southport, Australia
(Nair) Department of Cardiothoracic Surgery, The Prince Charles Hospital
(Queensland Health), Brisbane, Australia
(Kisiel) Department of Nuclear Medicine, Royal Brisbane and Women's
Hospital (Queensland Health), Brisbane, Australia
(Hughes) Office for Research Governance and Development (Biostatistics),
Gold Coast University Hospital (Queensland Health), Southport, Australia
(Hughes) School of Medicine, The University of Queensland, Brisbane,
Australia
(Fagman) Department of Radiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Fagman) Department of Radiology, Institute of Clinical Sciences,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Heying) Pediatric Cardiology, University Hospitals Leuven, Belgium
(Pizzi) Department of Cardiology, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
(Pizzi, Roque) Universitat Autonoma de Barcelona, Barcelona, Spain
(Pizzi, Roque) Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
(Roque) Institut de Diagnostic per la Imatge (IDI), Barcelona, Spain
(Roque) Department of Radiology, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
(Singh) Cardiology Department, Gold Coast University Hospital (Queensland
Health), Southport, Australia
Publisher
Elsevier Inc.
Abstract
Importance: The use of ¹⁸F-FDG PET/CT in diagnostic algorithms
for PVE has increased since publication of studies and guidelines
advocating its use. The assessment of test accuracy has been limited by
small study sizes. We undertook a systematic review using individual
patient data (IPD) meta-analysis techniques. <br/>Objective(s): To
estimate the summary sensitivity and specificity of ¹⁸F-FDG
PET/CT in diagnosing PVE. We also assessed the effect of patient factors
on test accuracy as defined by changes in the odds ratios associated with
each factor. The effect of the PET/CT study on the final diagnosis was
also assessed when compared to the preliminary Duke classification to
determine in which patient group ¹⁸F-FDG PET/CT had the
greatest utility. Study Selection: Studies were included if PET/CT was
performed for suspicion of PVE and IPD of both the PET/CT result and final
diagnosis defined by a gold-standard assessment was available. There were
3 possible final diagnoses ("definite PVE," "possible PVE," and "rejected
PVE"). <br/>Result(s): Seventeen studies were included with IPD available
for 537 patients (from 538 scans). The summary sensitivity and specificity
were 85% (95% CI 74.2%-91.8%) and 86.5% (95% CI 75.8%-92.9%) respectively
when patients with final diagnosis of "possible PVE" were classified as
positive for PVE. When this group was classified as negative for PVE,
sensitivity was 87.4% (95% CI 80.4%-92.1%) and specificity was 84.9% (95%
CI 71.5%-92.6%). Patients with a known pathogen (especially coagulase
negative staphylococcal species), elevated CRP, a biological or aortic
valve infection appeared more likely to have an accurate PET/CT diagnosis.
Those with a mechanical valve, prior antibiotic treatment or a
transcatheter aortic valve replacement valve were less likely to have an
accurate test. Time since valve implantation and the presence of surgical
adhesive did not appear to affect test accuracy. Of the patients with a
preliminary Duke classification of "possible PVE," 84% received a more
conclusive final diagnosis of "definite" or "rejected" PVE after the
PET/CT study. <br/>Conclusions and Relevance: ¹⁸F-FDG PET/CT
has high sensitivity and specificity in diagnosing PVE and the diagnostic
utility is greatest in patients with a preliminary Duke classification of
"possible PVE." Some patient factors appear to affect test accuracy,
though these results should be interpreted with caution given low patient
numbers for subgroup analyses.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<62>
Accession Number
2022850115
Title
Cardiopulmonary exercise testing and efficacy of percutaneous coronary
intervention: A substudy of the ORBITA trial.
Source
European Heart Journal. 43(33) (pp 3132-3145), 2022. Date of Publication:
01 Sep 2022.
Author
Ganesananthan S.; Rajkumar C.A.; Foley M.; Thompson D.; Nowbar A.N.;
Seligman H.; Petraco R.; Sen S.; Nijjer S.; Thom S.A.; Wensel R.; Davies
J.; Francis D.; Shun-Shin M.; Howard J.; Al-Lamee R.
Institution
(Ganesananthan, Rajkumar, Foley, Nowbar, Seligman, Petraco, Sen, Nijjer,
Thom, Wensel, Francis, Shun-Shin, Howard, Al-Lamee) National Heart and
Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane
Road W12 0HS, London, United Kingdom
(Ganesananthan, Rajkumar, Foley, Seligman, Petraco, Sen, Nijjer, Francis,
Shun-Shin, Howard, Al-Lamee) Imperial College Healthcare NHS Trust,
London, United Kingdom
(Thompson) University College London, London, United Kingdom
(Wensel) DRK-Kliniken-Berlin and Charite Berlin, Germany
(Davies) Essex Cardiothoracic Centre, Basildon, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: Oxygen-pulse morphology and gas exchange analysis measured during
cardiopulmonary exercise testing (CPET) has been associated with
myocardial ischaemia. The aim of this analysis was to examine the
relationship between CPET parameters, myocardial ischaemia and anginal
symptoms in patients with chronic coronary syndrome and to determine the
ability of these parameters to predict the placebo-controlled response to
percutaneous coronary intervention (PCI). <br/>Methods and Results:
Patients with severe single-vessel coronary artery disease (CAD) were
randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent
pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE)
and symptom assessment. These assessments were repeated at the end of a
6-week blinded follow-up period. A total of 195 patients with CPET data
were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse
plateau was observed during CPET had higher (more ischaemic) DSE score
[+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068]
and lower fractional flow reserve (-0.07; 95% CI:-0.12 to-0.02, P = 0.011)
compared with those without. At lower (more abnormal) oxygen-pulse slopes,
there was a larger improvement of the placebo-controlled effect of PCI on
DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and
oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina
physical-limitation score [oxygen-pulse plateau presence (Pinteraction =
0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen
uptake efficacy slope was significantly associated with higher symptom
burden but did not relate to severity of ischaemia or predict response to
PCI. <br/>Conclusion(s): Although selected CPET parameters relate to
severity of angina symptoms and quality of life, only an oxygen-pulse
plateau detects the severity of myocardial ischaemia and predicts the
placebo-controlled efficacy of PCI in patients with single-vessel
CAD.<br/>Copyright &#xa9; 2022 The Author(s). Published by Oxford
University Press on behalf of European Society of Cardiology.

<63>
Accession Number
2022612107
Title
Body mass index affecting ticagrelor monotherapy vs. ticagrelor with
aspirin in patients with acute coronary syndrome: A pre-specified
sub-analysis of the TICO randomized trial.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1128834. Date of Publication: 2023.
Author
Kim B.G.; Hong S.-J.; Kim B.-K.; Lee Y.-J.; Lee S.-J.; Ahn C.-M.; Shin
D.-H.; Kim J.-S.; Ko Y.-G.; Choi D.; Hong M.-K.; Jang Y.
Institution
(Kim) Division of Cardiology, Department of Internal Medicine, Sanggye
Paik Hospital, Inje University College of Medicine, Seoul, South Korea
(Hong, Kim, Lee, Lee, Ahn, Shin, Kim, Ko, Choi, Hong) Division of
Cardiology, Department of Internal Medicine, Severance Cardiovascular
Hospital, Yonsei University College of Medicine, Seoul, South Korea
(Jang) Division of Cardiology, Department of Internal Medicine, CHA
Bundang Medical Center, CHA University, Seongnam, South Korea
Publisher
Frontiers Media S.A.
Abstract
Background: Although ticagrelor monotherapy after 3-month dual
antiplatelet therapy (DAPT) results in a significantly greater net
clinical benefit over that with ticagrelor-based 12-month DAPT in patients
with acute coronary syndrome (ACS), it remains uncertain whether this
effect is dependent on body mass index (BMI). We aimed to evaluate the
BMI-dependent effect of these treatment strategies on clinical outcomes.
<br/>Method(s): This was a pre-specified subgroup analysis from the TICO
trial (Ticagrelor Monotherapy After 3 Months in Patients Treated With New
Generation Sirolimus-eluting Stent for Acute Coronary Syndrome),
evaluating the interaction between BMI and treatment strategies for the
primary outcome [composite of major bleeding and adverse cardiac and
cerebrovascular events (MACCE): death, myocardial infarction, stent
thrombosis, stroke, or target-vessel revascularization]. The secondary
outcomes were major bleeding and MACCE. <br/>Result(s): Based on a
pre-specified BMI threshold of 25 kg/m², 3,056 patients were
stratified. Patients with BMI <25 kg/m² had a higher risk of
primary and secondary outcomes than those with BMI >=25 kg/m².
Regardless of the BMI subgroup, the effects of ticagrelor monotherapy
after 3-month DAPT on the primary outcome (p<inf>int</inf>= 0.61), major
bleeding (p<inf>int</inf>= 0.76), and MACCE (p<inf>int</inf>= 0.80) were
consistent without significant interaction compared with ticagrelor-based
12-month DAPT. The treatment effects according to the BMI quartiles and
age, sex, and diabetic status were also consistent without significant
interaction. <br/>Conclusion(s): The BMI-dependent impact of ticagrelor
monotherapy after 3-month DAPT compared with 12-month DAPT on clinical
outcomes was not heterogeneous in patients with ACS. Clinical Trial
Registration: [www.ClinicalTrials.gov], identifier
[NCT02494895].<br/>Copyright 2023 Kim, Hong, Kim, Lee, Lee, Ahn, Shin,
Kim, Ko, Choi, Hong and Jang.

<64>
Accession Number
2021922053
Title
Nighttime dexmedetomidine for delirium prevention in non-mechanically
ventilated patients after cardiac surgery (MINDDS): A single-centre,
parallel-arm, randomised, placebo-controlled superiority trial.
Source
eClinicalMedicine. 56 (no pagination), 2023. Article Number: 101796. Date
of Publication: February 2023.
Author
Qu J.Z.; Mueller A.; McKay T.B.; Westover M.B.; Shelton K.T.; Shaefi S.;
D'Alessandro D.A.; Berra L.; Brown E.N.; Houle T.T.; Akeju O.
Institution
(Qu, Mueller, McKay, Shelton, Berra, Brown, Houle, Akeju) Department of
Anesthesia, Critical Care and Pain Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Westover) Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
(Shaefi) Department of Anesthesia, Critical Care and Pain Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,
United States
(D'Alessandro) Division of Cardiac Surgery, Department of Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Berra) Respiratory Care Services, Massachusetts General Hospital, Boston,
MA, United States
(Brown) Institute for Medical Engineering and Sciences, Massachusetts
Institute of Technology, Cambridge, MA, United States
Publisher
Elsevier Ltd
Abstract
Background: The delirium-sparing effect of nighttime dexmedetomidine has
not been studied after surgery. We hypothesised that a nighttime dose of
dexmedetomidine would reduce the incidence of postoperative delirium as
compared to placebo. <br/>Method(s): This single-centre, parallel-arm,
randomised, placebo-controlled superiority trial evaluated whether a short
nighttime dose of intravenous dexmedetomidine (1 mug/kg over 40 min) would
reduce the incidence of postoperative delirium in patients 60 years of age
or older undergoing elective cardiac surgery with cardiopulmonary bypass.
Patients were randomised to receive dexmedetomidine or placebo in a 1:1
ratio. The primary outcome was delirium on postoperative day one.
Secondary outcomes included delirium within three days of surgery, 30-,
90-, and 180-day abbreviated Montreal Cognitive Assessment scores, Patient
Reported Outcome Measures Information System quality of life scores, and
all-cause mortality. The study was registered as NCT02856594 on
ClinicalTrials.gov on August 5, 2016, before the enrolment of any
participants. <br/>Finding(s): Of 469 patients that underwent
randomisation to placebo (n = 235) or dexmedetomidine (n = 234), 75 met a
prespecified drop criterion before the study intervention. Thus, 394
participants (188 dexmedetomidine; 206 placebo) were analysed in the
modified intention-to-treat cohort (median age 69 [IQR 64, 74] years;
73.1% male [n = 288]; 26.9% female [n = 106]). Postoperative delirium
status on day one was missing for 30 (7.6%) patients. Among those in whom
it could be assessed, the primary outcome occurred in 5 of 175 patients
(2.9%) in the dexmedetomidine group and 16 of 189 patients (8.5%) in the
placebo group (OR 0.32, 95% CI: 0.10-0.83; P = 0.029). A non-significant
but higher proportion of participants experienced delirium within three
days postoperatively in the placebo group (25/177; 14.1%) compared to the
dexmedetomidine group (14/160; 8.8%; OR 0.58; 95% CI, 0.28-1.15). No
significant differences between groups were observed in secondary outcomes
or safety. <br/>Interpretation(s): Our findings suggested that in elderly
cardiac surgery patients with a low baseline risk of postoperative
delirium and extubated within 12 h of ICU admission, a short nighttime
dose of dexmedetomidine decreased the incidence of delirium on
postoperative day one. Although non-statistically significant, our
findings also suggested a clinical meaningful difference in the three-day
incidence of postoperative delirium. <br/>Funding(s):National Institute on
Aging (R01AG053582).<br/>Copyright &#xa9; 2022 The Author(s)

<65>
Accession Number
2021560348
Title
Meta-Analysis on Early Versus Delayed Coronary Angiography for Patients
With Out-of-Hospital Cardiac Arrest Without ST-Elevation Myocardial
Infarction.
Source
American Journal of Cardiology. 188 (pp 41-43), 2023. Date of Publication:
01 Feb 2023.
Author
Hamed M.; Neupane G.; Abdelsalam M.; Elkhawas I.; Morsy M.; Khalili H.;
Elgendy I.Y.; Elbadawi A.
Institution
(Hamed, Neupane) Department of Internal Medicine, Florida Atlantic
University, Boca Raton, FL, United States
(Abdelsalam) Division of Cardiology, Charleston Area Medical Center,
Charleston, West Virginia
(Elkhawas) Department of Internal Medicine, Steward Carney Hospital,
Dorchester, Massachusetts, United States
(Morsy) Division of Cardiology, University of Virginia, Charlottesville,
VA, United States
(Khalili) Division of Cardiology, Florida Atlantic University, Boca Raton,
FL, United States
(Elgendy) Division of Cardiology, University of Kentucky, Lexington,
Kentucky
(Elbadawi) Division of Cardiology, University of Texas Southwestern
Medical Center, Dallas, Texas, United States
Publisher
Elsevier Inc.

<66>
Accession Number
2020848191
Title
Direct oral anticoagulant versus antiplatelet therapy following
transcatheter aortic valve replacement in patients without prior or
concurrent indication for anticoagulation: A meta-analysis of randomized
studies.
Source
Catheterization and Cardiovascular Interventions. 101(2) (pp 449-457),
2023. Date of Publication: 01 Feb 2023.
Author
Barbosa Moreira M.J.; Peixoto N.A.D.A.; Udoma-Udofa O.C.; de Lucena Silva
Araujo S.; Enriquez S.K.T.
Institution
(Barbosa Moreira) Department of Medicine, Federal University of Rio Grande
do Norte, Natal, Brazil
(Peixoto) Department of Medicine, University of Buenos Aires, Buenos
Aires, Argentina
(Udoma-Udofa) Department of Medicine, Federal University of Juiz de Fora,
Juiz de Fora, Brazil
(de Lucena Silva Araujo) Department of Medicine, Federal University of
Pelotas, Pelotas, Brazil
(Enriquez) Hospital de Especialidades Santa Margarita, Portoviejo, Ecuador
Publisher
John Wiley and Sons Inc
Abstract
Introduction: The antithrombotic management following transcatheter aortic
valve replacement (TAVR) in patients who do not have a concurrent
indication for long-term anticoagulation therapy is an ongoing source of
debate. <br/>Method(s): We performed a systematic review and meta-analysis
to compare direct oral anticoagulants (DOACs) versus antiplatelet therapy
after TAVR in patients without a concomitant indication for chronic oral
anticoagulation. PubMed, Embase, and Cochrane databases were searched.
Only randomized controlled trials were included. Risk ratios (RR) with p <
0.05 were considered statistically significant. <br/>Result(s): Three
studies were included, with 2922 patients who underwent TAVR, of whom 1463
(50.1%) received DOACs. Patients who received DOACs therapy had
significantly higher all-cause mortality (RR: 1.68; 95% confidence
intervals [CI]: 1.22-2.30; p = 0.001) and non-cardiovascular mortality
(RR: 2.33; 95% CI: 1.13-4.80; p = 0.02). The incidence of major bleeding
was not significantly different between the groups (5.3% vs. 3.8%; RR:
1.44; 95% CI: 0.90-2.32; p = 0.13). There was no difference between DOACs
and antiplatelet therapy in terms of: ischemic stroke (RR: 1.28; 95% CI:
0.76-2.15; p = 0.35) and cardiovascular mortality (RR: 1.36; 95% CI:
0.92-2.03; p = 0.13). Lastly, the DOACs group had a significantly lower
risk of valve thrombosis than the antiplatelet group (0.8% vs. 3.2%; RR:
0.27; 95% CI: 0.14-0.51; p < 0.0001). <br/>Conclusion(s): In this
meta-analysis of randomized studies comparing DOACs to antiplatelet
therapy after TAVR in patients without a concomitant indication for
anticoagulation, DOACs were associated with a lower incidence of valve
thrombosis and a higher rate of all-cause mortality, driven by an increase
in noncardiac causes of death.<br/>Copyright &#xa9; 2022 Wiley Periodicals
LLC.

<67>
Accession Number
2020719371
Title
Design and logistical considerations for the randomized adaptive
non-inferiority storage-duration-ranging CHIlled Platelet Study.
Source
Clinical Trials. 20(1) (pp 36-46), 2023. Date of Publication: February
2023.
Author
Zantek N.D.; Steiner M.E.; VanBuren J.M.; Lewis R.J.; Berry N.S.; Viele
K.; Krachey E.; Dean J.M.; Nelson S.; Spinella P.C.
Institution
(Zantek) Department of Laboratory Medicine and Pathology, University of
Minnesota, Minneapolis, MN, United States
(Steiner) Department of Pediatrics, University of Minnesota, Minneapolis,
MN, United States
(VanBuren, Dean) Department of Pediatrics, University of Utah, Salt Lake
City, UT, United States
(Lewis) Harbor-UCLA Medical Center, Torrance, CA, United States
(Lewis) David Geffen School of Medicine at UCLA, Los Angeles, CA, United
States
(Lewis, Berry, Viele, Krachey) Berry Consultants, Austin, TX, United
States
(Nelson) Fine Point Pharma LLC, Durham, NC, United States
(Spinella) Department of Surgery and Critical Care Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Platelet transfusion is a potentially life-saving therapy for
actively bleeding patients, ranging from those undergoing planned surgical
procedures to those suffering unexpected traumatic injuries. Platelets are
currently stored at room temperature (20degreeC-24degreeC) with a maximum
storage duration of 7 days after donation. The CHIlled Platelet Study
trial will compare the efficacy and safety of standard room
temperature-stored platelets with platelets that are cold-stored
(1degreeC-6degreeC), that is, chilled, with a maximum of storage up to 21
days in adult and pediatric patients undergoing complex cardiac surgical
procedures. Methods/Results: CHIlled Platelet Study will use a Bayesian
adaptive design to identify the range of cold storage durations for
platelets that are non-inferior to standard room temperature-stored
platelets. If cold-stored platelets are non-inferior at durations greater
than 7 days, a gated superiority analysis will identify durations for
which cold-stored platelets may be superior to standard platelets. We
present example simulations of the CHIlled Platelet Study design and
discuss unique challenges in trial implementation. The CHIlled Platelet
Study trial has been funded and will be implemented in approximately 20
clinical centers. Early randomization to enable procurement of cold-stored
platelets with different storage durations will be required, as well as a
platelet tracking system to eliminate platelet wastage and maximize trial
efficiency and economy. <br/>Discussion(s): The CHIlled Platelet Study
trial will determine whether cold-stored platelets are non-inferior to
platelets stored at room temperature, and if so, will determine the
maximum duration (up to 21 days) of storage that maintains
non-inferiority. Trial registration: ClinicalTrials.gov,
NCT04834414<br/>Copyright &#xa9; The Author(s) 2022.

<68>
Accession Number
2020627036
Title
Association between intraoperative oliguria and postoperative acute kidney
injury in non-cardiac surgical patients: a systematic review and
meta-analysis.
Source
Journal of Anesthesia. 37(2) (pp 219-233), 2023. Date of Publication:
April 2023.
Author
Milder D.A.; Liang S.S.; Ong S.G.K.; Kam P.C.A.
Institution
(Milder, Liang) Department of Anaesthesia, Westmead Hospital, Westmead,
Australia
(Ong) Department of Anaesthesiology, Sengkang General Hospital, Singapore,
Singapore
(Ong) Department of Surgical Intensive Care, Singapore General Hospital,
Singapore, Singapore
(Kam) Discipline of Anaesthesia, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW 2006, Australia
Publisher
Springer
Abstract
Purpose: This systematic review and meta-analysis aimed to evaluate the
association between intraoperative oliguria and the risk of postoperative
acute kidney injury (AKI) in patients undergoing non-cardiac surgery.
<br/>Method(s): The MEDLINE and EMBASE databases were searched up to
August 2022 for studies in adult patients undergoing non-cardiac surgery,
where the association between intraoperative urine output and the risk of
postoperative AKI was assessed. Both randomised and non-randomised studies
were eligible for inclusion. Study selection and risk of bias assessment
were independently performed by two investigators. The risk of bias was
evaluated using the Newcastle-Ottawa scale. We performed meta-analysis of
the reported multivariate adjusted odds ratios for the association between
intraoperative oliguria (defined as urine output < 0.5 mL/kg/hr) and the
risk of postoperative AKI using the inverse-variance method with random
effects models. We conducted sensitivity analyses using varying
definitions of oliguria as well as by pooling unadjusted odds ratios to
establish the robustness of the primary meta-analysis. We also conducted
subgroup analyses according to surgery type and definition of AKI to
explore potential sources of clinical or methodological heterogeneity.
<br/>Result(s): Eleven studies (total 49,252 patients from 11
observational studies including a post hoc analysis of a randomised
controlled trial) met the selection criteria. Seven of these studies
contributed data from a total 17,148 patients to the primary
meta-analysis. Intraoperative oliguria was associated with a significantly
elevated risk of postoperative AKI (pooled adjusted odds ratio [OR] 1.74;
95% confidence interval [CI] 1.36-2.23, p < 0.0001, 8 studies).
Sensitivity analyses supported the robustness of the primary
meta-analysis. There was no evidence of any significant subgroup
differences according to surgery type or definition of AKI.
<br/>Conclusion(s): This study demonstrated a significant association
between intraoperative oliguria and the risk of postoperative AKI,
regardless of the definitions of oliguria or AKI used. Further prospective
and multi-centre studies using standardised definitions of intraoperative
oliguria are required to define the thresholds of oliguria and establish
strategies to minimise the risk of AKI.<br/>Copyright &#xa9; 2022, The
Author(s) under exclusive licence to Japanese Society of
Anesthesiologists.

<69>
Accession Number
2020483978
Title
Short-term dual antiplatelet therapy for 1-3 months after percutaneous
coronary intervention using drug eluting stents: A systematic review and
meta-analysis of randomized clinical trials.
Source
Catheterization and Cardiovascular Interventions. 101(2) (pp 299-307),
2023. Date of Publication: 01 Feb 2023.
Author
Rout A.; Sharma A.; Ikram S.; Garg A.
Institution
(Rout, Ikram) Division of Cardiology, University of Louisville, KY, United
States
(Sharma) Division of Cardiology, Rutgers New Jersey Medical School, NJ,
United States
(Garg) Division of Cardiology, Ellis Hospital, New York, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The optimal dual antiplatelet therapy (DAPT) duration and
regimen in patients undergoing percutaneous coronary intervention (PCI)
using current generation drug eluting stents (DES) is still unclear.
<br/>Aim(s): To compare the safety and efficacy of short-term DAPT
(S-DAPT) with longer duration DAPT (l-DAPT) after contemporary PCI.
<br/>Method(s): We searched for studies comparing S-DAPT (<=3 months)
followed by single antiplatelet therapy (SAPT) with aspirin or a
P2Y<inf>12</inf> inhibitor against L-DAPT (6-12 months) after PCI with
current generation DES. Primary end-points of interest were major bleeding
and stent thrombosis (ST) at 1 year. Random-effects meta-analyses were
performed to calculate odds ratios with 95% CIs. <br/>Result(s): Eleven
RCTs (n = 48,946) were included in the primary analysis. Major bleeding
was significantly lower with S-DAPT (n = 24,424) (odd ratio [OR 0.65; 95%
confidence interval, CI 0.52-0.80]) compared with L-DAPT (n = 24,486).
There were no differences in ST between the two groups [OR 1.26; 95% CI
0.97-1.63]. There were no significant differences in risks of all-cause
death, cardiovascular death or myocardial infarction between S-DAPT and
L-DAPT groups. In a subgroup analysis, there was borderline significantly
higher ST with 1 month S-DAPT [1.39; 1.0-1.92], but not with 3 months
S-DAPT [1.07; 0.70-1.64], when compared to L-DAPT. Finally, there were no
significant treatment interactions observed when trials using SAPT with
aspirin were compared with those using P2Y<inf>12</inf> inhibitor
monotherapy. <br/>Conclusion(s): Among patients undergoing current
generation DES implantation, S-DAPT for 1-3 months reduces major bleeding
without an increase in ischemic events compared with L-DAPT. Three months
S-DAPT might provide a better risk-benefit profile based on current
analysis. Further study is needed to define the SAPT of choice after 1-3
months DAPT.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC.

<70>
Accession Number
2019842399
Title
How does the modality of delivering force feedback influence the
performance and learning of surgical suturing skills? We don't know, but
we better find out! A review.
Source
Surgical Endoscopy. 37(4) (pp 2439-2452), 2023. Date of Publication: April
2023.
Author
Oppici L.; Grutters K.; Bechtolsheim F.; Speidel S.
Institution
(Oppici, Grutters) Psychology of Learning and Instruction, Department of
Psychology, School of Science, Technische Universitat Dresden, Zellescher
Weg 17, Dresden 01069, Germany
(Oppici, Bechtolsheim, Speidel) Centre for Tactile Internet with
Human-in-the-Loop (CeTI), Technische Universitat Dresden, Dresden, Germany
(Oppici) Norwegian School of Sport Sciences, Oslo, Norway
(Bechtolsheim) Department of Visceral, Thoracic- and Vascular Surgery,
University Hospital Carl Gustav Carus, Technische Universitat Dresden,
Dresden, Germany
(Speidel) Division of Translational Surgical Oncology, National Center for
Tumor Diseases Dresden, Dresden, Germany
Publisher
Springer
Abstract
Background: Force feedback is a critical element for performing and
learning surgical suturing skill. Force feedback is impoverished or not
present at all in non-open surgery (i.e., in simulation, laparoscopic, and
robotic-assisted surgery), but it can be augmented using different
modalities. This rapid, systematic review examines how the modality of
delivering force feedback influences the performance and learning of
surgical suturing skills. <br/>Method(s): An electronic search was
performed on PubMed/MEDLINE, Web of Science, and Embase databases to
identify relevant articles. The results were synthesized using vote
counting based on direction of effect. <br/>Result(s): A total of nine
studies of medium-to-low quality were included. The synthesis of results
suggests that the visual modality could be more beneficial than the
tactile and auditory modalities in improving force control and that
auditory and tactile modalities could be more beneficial than the visual
modality in improving suturing performance. Results are mixed and unclear
with regards to how modality affects the reduction of force magnitude and
unclear when unimodal was compared to multimodal feedback. The studies
have a general low level of evidence. <br/>Conclusion(s): The low number
of studies with low methodological quality and low level of evidence (most
were proof of concept) prevents us from drawing any meaningful conclusion
and as such it is currently unknown whether and how force feedback
modality influences surgical suturing skill. Speculatively, the visual
modality may be more beneficial for improving the control of exerted
force, while auditory and tactile modalities may be more effective in
improving the overall suturing performance. We consider the issue of
feedback modality to be highly relevant in this field, and we encourage
future research to conduct further investigation integrating principles
from learning psychology and neuroscience: identify feedback goal,
context, and skill level and then design and compare feedback modalities
accordingly.<br/>Copyright &#xa9; 2022, The Author(s).

<71>
Accession Number
2023949983
Title
Perioperative Management of Vitamin K Antagonists and Direct Oral
Anticoagulants: A Systematic Review and Meta-analysis.
Source
Chest. 163(5) (pp 1245-1257), 2023. Date of Publication: May 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, United States
(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, United States
(Hassett) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(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, and 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

<72>
Accession Number
2023287895
Title
Effects of Dexmedetomidine on Brain and Inflammatory Outcomes In Pediatric
Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(6) (pp 1013-1020),
2023. Date of Publication: June 2023.
Author
Hashiya M.; Okubo Y.; Kato T.
Institution
(Hashiya) Department of Anesthesiology, National Center for Child Health
and Development, Tokyo, Japan
(Okubo, Kato) Department of Social Medicine, National Center for Child
Health and Development, Tokyo, Japan
Publisher
W.B. Saunders
Abstract
Objective: Dexmedetomidine use decreases adverse neurocognitive outcomes
in adults undergoing cardiovascular surgery, but its effect has been
unclear in children with congenital heart disease. <br/>Method(s): The
authors conducted a systematic review using the PubMed, Embase, and
Cochrane Library databases for randomized controlled trials (RCTs) that
compared intravenous dexmedetomidine with normal saline during pediatric
cardiac surgery under anesthesia. Published randomized controlled trials
that evaluated children aged <18 years who underwent congenital heart
surgery were included. Nonrandomized trials, observational studies, case
series and case reports, editorials, reviews, and conference papers were
excluded. The quality of the included studies was assessed using the
Cochrane revised tool for assessing risk-of-bias in randomized trials.
Meta-analysis was performed to estimate the effects of intravenous
dexmedetomidine on brain markers (neuron-specific enolase [NSE], S-100beta
protein) and inflammatory markers (interleukin-6, tumor necrosis factor
[TNF]-alpha, nuclear factor kappa-B [NF-kappaB]) during and after cardiac
surgery, using random-effect models for standardized mean difference
(SMD). <br/>Result(s): Seven RCTs involving 579 children were eligible for
the following meta-analyses. Most children underwent cardiac surgery for
atrial or ventricular septum defects. Pooled analyses (5 treatment groups
in 3 RCTs with 260 children) showed that dexmedetomidine use was
associated with reduced serum levels of NSE (pooled SMD, -0.54; 95% CI,
-0.96 to -0.12) and S-100beta (pooled SMD, -0.85; 95% CI, -1.67 to -0.04)
within 24 hours after the surgery. Also, dexmedetomidine use was
associated with reduced levels of interleukin-6 (pooled SMD, -1.55; 95%
CI, -2.82 to -0.27; 4 treatment groups in 2 RCTs with 190 children). In
contrast, the authors observed similar levels of TNF-alpha (pooled SMD,
-0.07; 95% CI, -0.33 to 0.19; 4 treatment groups in 2 RCTs with 190
children) and NF-kappaB (pooled SMD, -0.27; 95% CI, -0.62 to 0.09; 2
treatment groups in 1 RCT with 90 children) between the dexmedetomidine
and control groups. <br/>Conclusion(s): The authors' findings support the
effect of dexmedetomidine on reductions in brain markers among children
who undergo cardiac surgery. Further studies would be needed to elucidate
its clinically meaningful effects using cognitive functions in the long
term, and its effects among children who undergo more complex cardiac
surgeries.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<73>
Accession Number
2023108228
Title
Methylprednisolone for Cardiac Surgery in Infants: Findings From a
Large-scale, Randomized, Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(6) (pp 860-862),
2023. Date of Publication: June 2023.
Author
Townsley M.M.
Institution
(Townsley) Division of Congenital Cardiac Anesthesiology, University of
Alabama at Birmingham School of Medicine, Birmingham, AL, United States
(Townsley) Bruno Pediatric Heart Center, Children's of Alabama,
Birmingham, AL, United States
Publisher
W.B. Saunders

<74>
Accession Number
2022803754
Title
Prognostic factors for chronic post-surgical pain after lung and pleural
surgery: a systematic review with meta-analysis, meta-regression and trial
sequential analysis.
Source
Anaesthesia. (no pagination), 2023. Date of Publication: 2023.
Author
Clephas P.R.D.; Hoeks S.E.; Singh P.M.; Guay C.S.; Trivella M.; Klimek M.;
Heesen M.
Institution
(Clephas) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Hoeks, Klimek) Department of Anaesthesia, Erasmus University Medical
Center, Rotterdam, Netherlands
(Singh) Department of Anaesthesia, Washington University School of
Medicine in St. Louis, St Louis, MO, United States
(Guay) Department of Anaesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Guay) Picower Institute for Learning and Memory, Massachusetts Institute
of Technology, Cambridge, MA, United States
(Trivella) Centre for Statistics in Medicine, University of Oxford,
Oxford, United Kingdom
(Heesen) Department of Anaesthesia, Kantonsspital Baden AG, Baden,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Chronic post-surgical pain is known to be a common complication of
thoracic surgery and has been associated with a lower quality of life,
increased healthcare utilisation, substantial direct and indirect costs,
and increased long-term use of opioids. This systematic review with
meta-analysis aimed to identify and summarise the evidence of all
prognostic factors for chronic post-surgical pain after lung and pleural
surgery. Electronic databases were searched for retrospective and
prospective observational studies as well as randomised controlled trials
that included patients undergoing lung or pleural surgery and reported on
prognostic factors for chronic post-surgical pain. We included 56 studies
resulting in 45 identified prognostic factors, of which 16 were pooled
with a meta-analysis. Prognostic factors that increased chronic
post-surgical pain risk were as follows: higher postoperative pain
intensity (day 1, 0-10 score), mean difference (95%CI) 1.29 (0.62-1.95), p
< 0.001; pre-operative pain, odds ratio (95%CI) 2.86 (1.94-4.21), p <
0.001; and longer surgery duration (in minutes), mean difference (95%CI)
12.07 (4.99-19.16), p < 0.001. Prognostic factors that decreased chronic
post-surgical pain risk were as follows: intercostal nerve block, odds
ratio (95%CI) 0.76 (0.61-0.95) p = 0.018 and video-assisted thoracic
surgery, 0.54 (0.43-0.66) p < 0.001. Trial sequential analysis was used to
adjust for type 1 and type 2 errors of statistical analysis and confirmed
adequate power for these prognostic factors. In contrast to other studies,
we found that age had no significant effect on chronic post-surgical pain
and there was not enough evidence to conclude on sex. Meta-regression did
not reveal significant effects of any of the study covariates on the
prognostic factors with a significant effect on chronic post-surgical
pain. Expressed as grading of recommendations, assessment, development and
evaluations criteria, the certainty of evidence was high for pre-operative
pain and video-assisted thoracic surgery, moderate for intercostal nerve
block and surgery duration and low for postoperative pain intensity. We
thus identified actionable factors which can be addressed to attempt to
reduce the risk of chronic post-surgical pain after lung
surgery.<br/>Copyright &#xa9; 2023 The Authors. Anaesthesia published by
John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

<75>
Accession Number
640141101
Title
Routine cerebral embolic protection in transcatheter aortic valve
implantation: rationale and design of the randomised British Heart
Foundation PROTECT-TAVI trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
18(17) (pp 1428-1435), 2023. Date of Publication: 24 Apr 2023.
Author
Kharbanda R.K.; Perkins A.D.; Kennedy J.; Banning A.P.; Baumbach A.;
Blackman D.J.; Dodd M.; Evans R.; Hildick-Smith D.; Jamal Z.; Ludman P.;
Palmer S.; Stables R.; Clayton T.
Institution
(Kharbanda, Banning) NIHR Oxford Biomedical Research Centre, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Kharbanda, Dodd, Evans, Jamal, Clayton) Department of Cardiovascular
Medicine, University of Oxford, Oxford, United Kingdom
(Perkins) Clinical Trials Unit and Department of Medical Statistics,
London School of Hygiene and Tropical Medicine, London, United Kingdom
(Kennedy) Acute Vascular Imaging Centre, Radcliffe Department of Medicine,
University of Oxford, Oxford, United Kingdom
(Baumbach) Centre for Cardiovascular Medicine and Devices, William Harvey
Research Institute, Queen Mary University of London, UK and Barts Heart
Centre, London, United Kingdom
(Blackman) Department of Cardiology, Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
(Hildick-Smith) Cardiac Surgery, Cardiac Center, Royal Sussex County
Hospital, UK and Sussex University Hospitals Trust, Brighton, United
Kingdom
(Ludman) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Palmer) Centre for Health Economics, University of York, York, United
Kingdom
(Stables) Liverpool Centre for Cardiovascular Science, University of
Liverpool, UK and Liverpool Heart & Chest Hospital, Liverpool, United
Kingdom
Publisher
NLM (Medline)
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment
for aortic stenosis. Cerebral embolic protection (CEP) devices may impact
periprocedural stroke by capturing debris destined for the brain. However,
there is a lack of high-quality randomised trial evidence supporting the
use of CEP during TAVI. The British Heart Foundation (BHF) PROTECT-TAVI
trial will address whether the routine use of CEP reduces the incidence of
stroke in patients undergoing TAVI. BHF PROTECT-TAVI is a prospective,
open-label, outcome-adjudicated, multicentre randomised controlled trial.
The trial is open to all adult patients scheduled for TAVI at
participating specialist cardiac centres across the United Kingdom who are
able to receive the CEP device. The trial will recruit 7,730 participants.
Participants will be randomised in a 1:1 ratio to undergo TAVI with CEP or
TAVI without CEP (standard of care). The primary outcome is the incidence
of stroke at 72 hours post-TAVI. Key secondary outcomes include the
incidence of stroke and all-cause mortality up to 12 months post-TAVI,
disability and cognitive outcomes, stroke severity, access site
complications and a health economics analysis. The sample size of 7,730
participants has 80% power to detect a 33% relative risk reduction from a
3% incidence of the primary outcome in the controls. Trial recruitment
commenced in October 2020. As of October 2022, 3,068 patients have been
enrolled. BHF PROTECT-TAVI is designed to provide definitive evidence on
the clinical efficacy and cost-effectiveness of using routine CEP with the
SENTINEL device to reduce stroke in TAVI.

<76>
[Use Link to view the full text]
Accession Number
633409371
Title
A Pilot Trial of Platelets Stored Cold versus at Room Temperature for
Complex Cardiothoracic Surgery.
Source
Anesthesiology. 133(6) (pp 1173-1183), 2020. Date of Publication: 01 Dec
2020.
Author
Strandenes G.; Sivertsen J.; Bjerkvig C.K.; Fosse T.K.; Cap A.P.; Del
Junco D.J.; Kristoffersen E.K.; Haaverstad R.; Kvalheim V.; Braathen H.;
Lunde T.H.F.; Hervig T.; Hufthammer K.O.; Spinella P.C.; Apelseth T.O.
Institution
(Strandenes, Sivertsen, Kristoffersen, Braathen, Lunde, Hervig, Apelseth)
Departments of Immunology and Transfusion Medicine, Haukeland University
Hospital, Bergen, Norway
(Bjerkvig, Fosse) Anesthesia and Intensive Care, Haukeland University
Hospital, Bergen, Norway
(Haaverstad, Kvalheim) Heart Disease, Haukeland University Hospital,
Bergen, Norway
(Apelseth) Clinical Biochemistry and Pharmacology, Haukeland University
Hospital, Bergen, Norway
(Hufthammer) The Centre for Clinical Research, Haukeland University
Hospital, Bergen, Norway
(Strandenes) The Department of War Surgery and Emergency Medicine,
Norwegian Armed Forces Medical Services, Oslo, Norway
(Bjerkvig, Fosse, Kristoffersen, Haaverstad, Kvalheim, Hervig) The
Institute of Clinical Science, University of Bergen, Bergen, Norway
(Bjerkvig, Fosse) The Norwegian Naval Special Operations Command, Bergen,
Norway
(Cap) The U.S. Army Institute of Surgical Research, Department of Defense,
Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston,
San Antonio, TX, United States
(Del Junco) The Joint Trauma System, Department of Defense, Center of
Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, San
Antonio, TX, United States
(Spinella) The Division of Pediatric Critical Care, Department of
Pediatrics, Washington University In. St Louis, St. Louis, MO, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: This pilot trial focused on feasibility and safety to provide
preliminary data to evaluate the hemostatic potential of cold-stored
platelets (2degree to 6degreeC) compared with standard room
temperature-stored platelets (20degree to 24degreeC) in adult patients
undergoing complex cardiothoracic surgery. This study aimed to assess
feasibility and to provide information for future pivotal trials.
<br/>Method(s): A single center two-stage exploratory pilot study was
performed on adult patients undergoing elective or semiurgent complex
cardiothoracic surgery. In stage I, a two-armed randomized trial,
platelets stored up to 7 days in the cold were compared with those stored
at room temperature. In the subsequent single-arm stage II, cold storage
time was extended to 8 to 14 days. The primary outcome was clinical effect
measured by chest drain output. Secondary outcomes were platelet function
measured by multiple electrode impedance aggregometry, total blood usage,
immediate and long-term (28 days) adverse events, length of stay in
intensive care, and mortality. <br/>Result(s): In stage I, the median
chest drain output was 720 ml (quartiles 485 to 1,170, n = 25) in patients
transfused with room temperature-stored platelets and 645 ml (quartiles
460 to 800, n = 25) in patients transfused with cold-stored platelets. No
significant difference was observed. The difference in medians between the
room temperature- and cold-stored up to 7 days arm was 75 ml (95% CI,
-220, 425). In stage II, the median chest drain output was 690 ml (500 to
1,880, n = 15). The difference in medians between the room temperature arm
and the nonconcurrent cold-stored 8 to 14 days arm was 30 ml (95% CI,
-1,040, 355). Platelet aggregation in vitro increased after transfusion in
both the room temperature- and cold-stored platelet study arms. Total
blood usage, number of adverse events, length of stay in intensive care,
and mortality were comparable among patients receiving cold-stored and
room temperature-stored platelets. <br/>Conclusion(s): This pilot trial
supports the feasibility of platelets stored cold for up to 14 days and
provides critical guidance for future pivotal trials in high-risk
cardiothoracic bleeding patients.<br/>Copyright &#xa9; 2020 Lippincott
Williams and Wilkins. All rights reserved.

<77>
Accession Number
641087440
Title
LEX-211: a phase 3, active-control, randomised study of four-factor
prothrombin complex concentrate versus frozen plasma in bleeding adult
cardiac surgery patients.
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Solomon C.; Karkouti K.; Callum J.; Tanaka K.; Grewal D.; Knaub S.; Levy
J.
Institution
(Solomon) Octapharma AG, Clinical R and D Haematology, Lachen, Switzerland
(Karkouti) University of Toronto, Toronto, Canada
(Callum) Queen's University, Kingston, ON, Canada
(Tanaka) University of Oklahoma, Oklahoma, United States
(Grewal) University Health Network, Toronto, Canada
(Knaub) Octapharma AG, Lachen, Switzerland
(Levy) Duke University, Durham, NC, United States
Publisher
BioMed Central Ltd
Abstract
Introduction: The LEX-211 (FARES-2) study will determine if fourfactor
prothrombin complex concentrate (4F-PCC, Octaplex, Octapharma) is
clinically non-inferior to frozen plasma (FP) in terms of haemostatic
effectiveness in cardiac surgery patients requiring coagulation factor
replacement. Cardiac surgery is often complicated by coagulopathic
bleeding, leading to transfusion and poor outcomes. <br/>Method(s):
LEX-211 will include patients >= 18 years old undergoing cardiac surgery
with cardiopulmonary bypass (CPB) who require coagulation factor
replacement due to bleeding and known/suspected coagulation factor
deficiency. Exclusion criteria are heart transplant, insertion/removal of
ventricular assist devices, high probability of death within 24 h, severe
right heart failure, heparin contraindications, thromboembolic event
within 3 months and IgA deficiency. Patients will be randomised to PCC or
FP, with weight-based doses shown in Fig. 1. The primary endpoint is the
haemostatic response to PCC vs. FP, rated 'effective' if no further
haemostatic intervention (haemostatic agents or surgical re-opening for
bleeding) is required 60 min-24 h after the first dose. Secondary
endpoints include global haemostatic response (60 min-24 h), bleeding (24
h), blood product/coagulation factor use (24 h, 7 days), surgical
re-exploration (24 h) and coagulation parameters (~ 1 h post-treatment).
Safety endpoints include treatment- emergent adverse events (e.g.,
thromboembolic events), ICU stay and mortality (30 days). An unblinded
interim analysis (100 evaluable patients per group) will test the sample
size assumptions and reestimate if necessary. <br/>Result(s): LEX-211 has
started with the first sites initiated in Q4 2022. Completion is expected
Q4 2024. <br/>Conclusion(s): The results of this study will inform
clinical practice for bleeding cardiac surgery patients requiring
coagulation factor replacement, potentially reducing blood product usage
and improving outcomes.

<78>
Accession Number
641087402
Title
Efficacy & safety of 3 factors prothrombin complex concentrate (3FPCC) in
infants BW < 5 kg & neonates underwent congenital cardiac surgery with
refractory bleeding after CPB: an exploratory retrospective propensity
score matched study.
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Kongsayreepong S.; Raykateeraro N.; Subtaweesin T.
Institution
(Kongsayreepong, Raykateeraro) Siriraj hospital, Mahidol University,
Department of Anesthesiology and Critical Care, Bangkok, Thailand
(Subtaweesin) Siriraj Hospital, Mahidol University, Division of
Cardiothoracic Surgery, Department of Surgery, Bangkok, Thailand
Publisher
BioMed Central Ltd
Abstract
Introduction: Refractory bleeding after CPB was associated with poor
outcome.PCC was off-label used for refractory bleeding in adult cardiac
surgery. Urgent information is needed infants & neonates undergoing
congenital cardiac surgery. The aim of this study was to determine the
efficacy & safety of PCC in infants (BW < 5 kg) & neonates underwent
congenital cardiac surgery with CPB who had refractory bleeding after CPB
despite prophylaxis TXA, complete reversal of protamine & conventional
coagulation factors. <br/>Method(s): A retrospective study of infants (BW
< 5 kg) & neonates underwent congenital cardiac surgery with CPB between
Jan 2015- Mar 2022 (n = 142). Pts with hx of thrombosis, stroke, seizure,
AKI, bleeding disorder were excluded. 3 FPCC (Profinine) was given in
refractory bleeding after CPB. Demographic data, RACHS score, type &
duration of surgery, CPB data, amount of TXA & PCC, postoperative
bleeding, allogeneic transfusion, re-exploration, ECMO support, incidence
of thrombosis, stroke, MI, stroke, CKD, ventilators days, ICU & hospital
LOS, in hospital mortality were recorded. <br/>Result(s): As baseline
characteristic of pts in the TXA plus PCC gr.were significantly different
from the only TXA gr. A propensity score matching was applied to reduce
the impact of different baseline characteristic between pts received only
TXA (n = 39) & TXA plus PCC (n = 17). The result found that TXA plus PCC
gr. had significantly less PO bleeding at 12 h [8.3 (0, 18.4) vs 16.7
(4.2, 37.7) ml/ kg, p = 0.019] & bleeding all [21.3 (11.6, 30.9) vs 46.2
(26.7, 71.2) ml/ kg, p = 0.001]. Pts in the TXA plus PCC had a tendency to
have less significant bleed at 6 h & PO allogeneic transfusion. No
significantly different in ventilator day, ICU & hospital LOD. No pt in
the TXA plus PCC gr needed ECMO or mortality. <br/>Conclusion(s): 3 FPCC
had shown the efficacy in significantly decrease postoperative bleeding &
a tendency to decrease postoperative allogeneic transfusion without
incidence of thrombosis. Large randomized control trial is needed.

<79>
Accession Number
641087584
Title
Comparative evaluation of different respiratory rehabilitation methods in
the early postoperative period of cardiac surgery patients.
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Fomina D.V.; Eremenko A.A.; Zyulyaeva T.P.; Grekova M.S.; Alferova A.P.;
Grin O.O.; Dmitrieva S.S.
Institution
(Fomina, Eremenko, Zyulyaeva, Grekova, Alferova, Grin, Dmitrieva)
Petrovsky National Research Centre of Surgery, Intensive Care Unit,
Moscow, Russian Federation
Publisher
BioMed Central Ltd
Abstract
Introduction: The frequency of postoperative respiratory failure due to
ineffective coughing and evacuation of bronchial mucus is 17%-22%. The
objective was to evaluate the effectiveness of different cough stimulation
methods in the early postoperative period of cardiac surgery patients.
<br/>Method(s): In randomized prospective comparative study
(Clinical-Trials.gov-NCT05159401) four methods were evaluated. There were
20 patients in each group. 1st group-oscillatory PEP-therapy (Acapella DH
Green, Portex), group 2-external chest oscillatory massage combined with
intermittent pressure mask ventilation Comfort Cough Plus, Seoil Pacific
Corporation, (CC), group 3-vibroacoustic lung massage, BARK VibroLUNG,
(VL). The 4th control group included patients with manual chest massage
(MCM). Procedures were performed 10-12 h after tracheal extubation 3 times
a day for 3 days. Before the procedure and 20 min after it, the
effectiveness of sputum discharge, gas exchange and maximum inspiratory
lung capacity (MILC) were evaluated. <br/>Result(s): The largest number of
patients with productive cough was fixed in groups 1, 2 and 4 after fourth
session, in group VL during 4-6 session. The increase in SpO2 on room air
after 3 days of treatment with PEP-therapy and MCM was 4%, in others-5%
(Table 1). The maximum increase in MILC was registered in the patients
with PEP-therapy, the minimum-in the MCM group. Mean MILC exceeded more
than 2000 ml in group 1 by session 7, in group 2 by session 4, in group 3
by session 9, in group 4 by session 8. No significant effect on
PaCO<inf>2</inf> was noted. <br/>Conclusion(s): The effects of the applied
methods of mechanical stimulation of cough were directed to improve the
passage of mucus and oxygenating lung function. After 3 days of treatment
the most significant increase of MILC was registered in PEP-therapy and CC
group. No undesirable effects of the procedures were noted.

<80>
Accession Number
641087520
Title
Benefits of fully closed loop ventilation modes in patients with body mass
index > 35 kg/m2.
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Komnov R.; Eremenko A.; Alferova A.; Riabova D.; Titov P.; Urbanov A.;
Fominukh M.; Gerasimenko S.
Institution
(Komnov, Eremenko, Alferova, Riabova, Titov, Urbanov, Fominukh,
Gerasimenko) Petrovsky Russian Research Center of Surgery, Post Cardiac
Surgery Intensive Care unit, Moscow, Russian Federation
Publisher
BioMed Central Ltd
Abstract
Introduction: In recent years, there is an active automation of processes
in medicine and robotic (Intellectual) ventilation modes are being
actively introduced into the daily practice of intensive care units. These
modes allow for automated respiratory support, minimizing clinician
involvement. <br/>Method(s): In this randomized trial 32 adult patients
with BMI > 35 were included. Half of them were ventilated with
INTELLiVENTASV mode and 16 with conventional ventilation modes after
uncomplicated cardiac surgery. Hamilton G5 ventilators were used and 8
physicians were involved into the study. Care of both groups was
standardized, except modes of postoperative ventilation. We compared: -
The physician's workload, through accounting number of manual ventilator
settings and time they spent near the ventilator in every group; - Safety
of respiratory support by considering driving pressure and mechanical
power during mechanical ventilation, positive end expiratory pressure,
FiO<inf>2</inf> and tidal volume level during all phases of respiratory
support; - Duration of tracheal intubation in the ICU. <br/>Result(s): In
the Intellivent group the number of manual ventilator settings and
physician's time spent near the ventilator before tracheal extubation were
significant lower: 1 (0-2) versus 6 +/- 2, and 64 +/- 17 s versus 36 +/-
90 s respectively (p < 0.0001 in both cases). Intellivent-ASV mode was
more protective compared to conventional mode through significant
reduction in the driving pressure, mechanical power, tidal volume,
FiO<inf>2</inf> and PEEP levels, but without difference between
PaO<inf>2</inf>/ FiO<inf>2</inf> ratio (Table 1). There were no
significant differences in the duration of respiratory support in the ICU:
276 +/- 103 min (Intellivent group) versus 300 (225-175) min (control) (p
= 0.2427). <br/>Conclusion(s): Intellivent-ASV mode in patients with BMI >
35 after uncomplicated cardiac surgery allows to personalize respiratory
support, provides more protective mechanical ventilation and reduces the
physician's workload.

<81>
Accession Number
641088098
Title
Analgesic potential of a serratus anterior plane block, placed on ICU
arrival, after totally endoscopic aortic valve replacement (TEAVR).
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Dubois J.; Callebaut I.; Vranken D.; Gruyters I.; Jalil H.; Van Tornout
M.; Brands M.; Herbots J.; Stessel B.; Vandenbrande J.
Institution
(Dubois) Jessa, Critical Care, Hasselt, Belgium
(Callebaut, Vranken, Gruyters, Jalil, Van Tornout, Brands, Herbots,
Stessel, Vandenbrande) Jessa, Anesthesiology and Intensive Care, Hasselt,
Belgium
Publisher
BioMed Central Ltd
Abstract
Introduction: Regional anesthesia is of growing importance in
postoperative pain control. We examined whether a Serratus Anterior Plane
Block (SAPB), placed on arrival at the Intensive Care Unit (ICU), in
addition to standard-of-care after TEAVR could improve the quality of
postoperative pain management. <br/>Method(s): We performed the first
double-blinded randomized controlled trial on 75 patients undergoing
TEAVR. Patients allocated to the intervention arm received a SAPB on ICU
arrival when the patient was sedated. SAPB was placed by a block team,
leaving the attending anesthesiologist, surgical team and critical care
team blinded. Ultrasound- guided SAPB was performed on the right
hemithorax at T2-T5 level: 30 ml of bupivacaine 0.25% was injected under
the serratus anterior (SA) muscle and 10 ml bupivacaine 0.25% was
administered between the latissimus dorsi and SA muscle. Control patients
were approached by the block team for the same time span, though no SAPB
was performed. Further analgesic treatment included acetaminophen and
ketorolac unless contra-indications, as well as piritramide
patient-controlled analgesia (PCA). Sedation was provided by means of
dexmedetomidine. <br/>Result(s): Thirty-seven patients were allocated to
the control versus 38 to the SAPB group. Patients receiving SAPB suffered
significantly less pain at 4, 8 and 24 h postoperatively (p values: 0.05,
0.03 and 0.04 respectively) (Fig. 1). Also 24 h-cumulative piritramide PCA
consumption was significantly lower in the SABP group (median 12 mg, IQR
8-26 mg) versus control group (median 20 mg, IQR 15-31 mg) (p < 0.01). No
differences in intraoperative use of sufentanil (p = 0.20) and ketamine (p
= 0.59) neither postoperative use of NSAIDS (p = 0.18) and dexmedetomidine
(p = 0.39) were observed. Time to extubation neither ICU length of stay
was influenced by SAPB. <br/>Conclusion(s): SAPB added to standard-of-care
after TEAVR improved postoperative pain control, by significantly
decreasing opioid consumption and pain scores in the first 24 h after
surgery.

<82>
Accession Number
641088054
Title
Multimodal versus opioid analgesia in cardiac surgery (MONDAY).
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Belkaid N.B.; Bogaert S.B.; Moerman A.M.; Bouchez S.B.; Peperstraete H.P.
Institution
(Belkaid, Peperstraete) Ghent University Hospital, Department of Intensive
Care Medicine, Ghent, Belgium
(Bogaert) AZ Groeninge, Department of Anesthesiology and Intensive Care,
Kortrijk, Belgium
(Moerman) Ghent University Hospital, Department of Anesthesiology, Ghent,
Belgium
(Bouchez) OLV Ziekenhuis, Department of Anesthesiology, Aalst, Belgium
Publisher
BioMed Central Ltd
Abstract
Introduction: Cardiac surgery performed by sternotomy is associated with
moderate to severe acute postoperative pain. Our goal is to compare
standard opioid based regimen to a multimodal pain management to determine
which therapy provides the most comfort, the fastest extubation time, the
least pain and the least delirium. <br/>Method(s): In this prospective
randomized double-blinded trial we evaluated two groups of 50 patients,
divided in an opioid group and a multimodal group. In the multimodal group
pregabaline 75 mg, dexmedetomidine, ketamine and lidocaine was given
versus liberal fentanyl and remifentanil in the opioid group.
Postoperative pain was scored every 8 h by the NRS-scale/CPOT score in the
awake/sedated patient. Delirium postoperatively is measured by the
ICDSC-score. Time to extubation, LOS in ICU, LOS in hospital and rescue
pain medication are compared between both groups. <br/>Result(s):
Ninety-six patients were successfully enrolled. There were no differences
in baseline characteristics between both groups. The multimodal pain
scheme was administered in 46 patients, while 50 patients received the
opioid based scheme. After linear mixed model analysis no significant
differences were seen in CPOT-score (p = 0.305), NRSscore (p = 0.182)
(Fig. 1), consumption in rescue pain medication and ICDSC-score (p =
0.267). In the opioid group, mean LOS in ICU was 34 h in the opioid group
versus 51 h in the multimodal group, (p = 0.032). Time to extubation or
LOS in hospital showed no significant difference between both groups.
<br/>Conclusion(s): This trial shows a significant difference in LOS in
ICU in favor of the opioid group. No significant difference could be found
in pain, delirium, intubation time or LOS in hospital between multimodal
analgesia versus an opioid-based analgetic protocol in cardiac surgery by
sternotomy. This is not in line with previous studies but is probably
because this trial is underpowered. It shows that there is a place for
multimodal analgesia in cardiac surgery and it can be a good alternative
for opioid based protocols.

<83>
Accession Number
641087983
Title
The effect of glutamine on kidney damage in cardiac surgery patients at
high risk for AKI: a double-blind randomized controlled trial.
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Weiss R.; Von Groote T.; Meersch M.; Schafers M.; Kellum J.A.; Zarbock A.
Institution
(Weiss) University Hospital Munster, Department for Anesthesiology,
Intensive Care and Pain Medicine, Munster, Germany
(Von Groote, Meersch, Zarbock) University Hospital Munster, Munster,
Germany
(Schafers) University Hospital Munster, Department of Nuclear Medicine,
Munster, Germany
(Kellum) University of Pittsburgh, Center for Critical Care Nephrology,
Department of Critical Care Medicine, Pittsburgh, United States
Publisher
BioMed Central Ltd
Abstract
Introduction: Acute kidney injury (AKI) after cardiac surgery is
associated with increased morbidity and mortality. However, no specific
treatment options are available. As an amino acid, glutamine serves
multiple purposes in the human body, including reactive oxygen species
scavenging and elimination. This trial assesses the effect of glutamine on
renal damage biomarkers in cardiac surgery patients at risk for AKI.
<br/>Method(s): 64 high risk patients were identified by high
postoperative urinary [TIMP2] * [IGFBP7] levels and received either body
weight adapted glutamine or saline-control for 12 h intravenously. The
primary outcome was the change in urinary [TIMP2] * [IGFBP7] levels after
12 h of administration. Secondary outcomes included the change in KIM-1
and NGAL, overall AKI rates, free days of mechanical ventilation and
vasoactive medication, renal replacement therapy, mortality, length of
ICU/hospital stay, and major adverse kidney events at day 90.
<br/>Result(s): Patients received coronary artery bypass graft surgery
(32/64), valve surgery (18/64), a combination of both (6/64), or other
procedures (8/64). Mean age was 68 [SD +/- 10] years, 10 of 64 were women.
Mean on-pump time was 68.4 [SD +/- 10.5] minutes. After glutamine
administration, urinary [TIMP-2] * [IGFBP7] were significantly lower in
the glutamine compared to the control group (primary endpoint,
intervention: median 0.18 (Q1, Q3; 0.09, 0.29), controls: median 0.44 (Q1,
Q3; 0.14, 0.79), p = 0.01) (Table 1). KIM-1 and NGAL were also
significantly lower in the glutamine group. The overall AKI rate within 72
h was not different among groups: intervention 11/31 (35.5%) vs. control
8/32 (25.0%); p = 0.419; RR, 0.86% (95% CI 0.62%, 1.20%). There were no
significant differences regarding further secondary endpoints.
<br/>Conclusion(s): Glutamine significantly decreased markers of kidney
damage in cardiac surgery patients at high risk for AKI. Future trials
need to investigate whether the administration of glutamine might be able
to reduce the occurrence of AKI after cardiac surgery.

<84>
Accession Number
641087879
Title
Systematic review of risk factors and outcomes associated with the
development of persistent acute kidney injury in non-renal solid organ
transplant recipients.
Source
Critical Care. Conference: 42nd International Symposium on Intensive Care
and Emergency Medicine. Brussels Belgium. 27(Supplement 1) (no
pagination), 2023. Date of Publication: March 2023.
Author
Saraiva I.E.; Hamahata N.; Sakhuja A.; Chen X.; Minturn J.S.; Sanchez
P.G.; Chan E.; Kaczorowski D.J.; Al-Khafaji A.; Gomez H.
Institution
(Saraiva, Hamahata) University of Pittsburgh Medical Center, Department of
Critical Care Medicine, Pittsburgh, United States
(Sakhuja) West Virginia University, Division of Critical Care, Morgantown,
United States
(Chen, Minturn, Al-Khafaji, Gomez) University of Pittsburgh, Department of
Critical Care Medicine, Pittsburgh, United States
(Sanchez, Chan, Kaczorowski) University of Pittsburgh, Department of
Cardiothoracic Surgery, Pittsburgh, United States
Publisher
BioMed Central Ltd
Abstract
Introduction: Persistent acute kidney injury (pAKI), defined as AKI that
persists beyond 72 h of the initial insult, carries worse prognosis than
AKI that resolves within this timeframe in critically ill patients.
However, the association of persistent AKI and outcome is not well
characterized in solid organ transplant patients. The aims of this study
are (1) to determine the occurrence of pAKI and the association between
pAKI and clinical outcomes and (2) to identify the risk factors for
developing persistent AKI among heart, lung or liver transplant
recipients. <br/>Method(s): We performed a systematic review of the
literature including PubMed, EMBASE, Web of Science, and Cochrane Library.
We included human prospective and retrospective cohort and randomized
clinical studies that involved recipients of heart, lung, and/or liver
transplant during the index hospitalization, and reported on the rates of
occurrence of pAKI, and outcomes including graft failure and mortality.
<br/>Result(s): We identified 8789 records, of which 3228 were selected
for abstract review. Ten studies were selected for full text review and
included in final analysis. One study reported 152 episodes of pAKI
(54.5%) in 279 patients receiving 301 liver grafts. pAKI was associated
with graft loss in 25% compared to 8.7% in patients without pAKI. Three
studies reported occurrence of pAKI of 32.4-49.2% in 821 lung transplant
recipients. Risk factors reported were body mass index, nephrotoxic
agents, and hypotension. pAKI was associated with all-cause mortality with
a HR varying substantially between 1.77 and 14.69. No studies
investigating pAKI in heart transplant patients were found.
<br/>Conclusion(s): Persistent AKI is a common complication in non-renal
solid organ transplant recipients and is associated with worse clinical
outcomes. Utilization of standard nomenclature and attention to timing of
renal dysfunction are essential aspects to better understand the problem
and development of mitigation strategies.

<85>
Accession Number
2024108355
Title
Abstract #1403811: Rapidly Progressive Aortic Stenosis After Teriparatide
Initiation: A Rare Case.
Source
Endocrine Practice. Conference: AACE Annual Meeting 2023. Seattle United
States. 29(5 Supplement) (pp S51-S52), 2023. Date of Publication: May
2023.
Author
Ambalavanan J.; Hubbard C.; Khan L.
Institution
(Ambalavanan, Hubbard, Khan) Cleveland Clinic, OH, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Recombinant Parathyroid Hormone (rPTH) or Teriparatide is
frequently used to manage severe osteoporosis due to its anabolic mode of
action particularly in patients who are at a high risk of vertebral and
non-vertebral fractures. Aortic valve stenosis is a common valve condition
seen in the older population. There are multiple etiologies for aortic
stenosis, but drug induced aortic stenosis is rare. Moreover, its natural
history includes gradual progression towards severity. We present an
interesting case of rapidly progressive aortic stenosis after teriparatide
initiation. Case Description: An 84-year-old female with history of
hypertension, hyperlipidemia, atrial fibrillation presented to the
endocrine clinic for management of osteoporosis. She was diagnosed with
osteoporosis in 2000 at age 62. Initial etiology was assumed to be
post-menopausal and was treated with oral bisphosphonates. As she had
compression fractures of her spine while on treatment, secondary causes of
osteoporosis were explored, and she was found to have primary
hyperparathyroidism. Her labs were significant for PTH-84 pg/ml, Ca-10.8
mg/dl. She underwent parathyroidectomy in 2016 with normalization of PTH
and calcium. After her surgery, she was treated with denosumab infusions
every 6 months. She did well till June 2021. Her bone mineral density
scores were stable throughout this period. At this point, she suffered
bilateral atypical femoral fractures and was thought to be due to chronic
anti-resorptive therapy. We stopped denosumab and transitioned her to
teriparatide daily injections. She did well for 1 year but then presented
to us for management in Aug 2022 prior to valve replacement for severe
aortic stenosis. Her labs were significant for normal calcium, 25-hydroxy
vitamin D and phosphorus levels. On reviewing her echocardiograms prior to
and after initiation of teriparatide we found a rapid progression of her
aortic stenosis from moderate to severe, based on mean gradients and peak
velocities, over a span of 7 months. <br/>Discussion(s): Natural
progression of aortic stenosis from mild to severe happens over several
years (mean duration-5 years), not just a few months. One possible
explanation for this rapid progression seen in our patient is due to the
presence of osteoblast like cells (arising from vascular endothelial cell
precursor cells) in the aortic valve which appear to be stimulated by PTH
and hence valve calcification/stenosis. On a thorough review of literature
there were no clinical studies that have reported aortic stenosis
progression from teriparatide use. To our knowledge, there was a single
case report that reported the same phenomenon in Israel. As a result, we
wanted to educate the community about the possible association between
teriparatide use and worsening aortic stenosis in certain cases.
Performing serial echocardiograms in high-risk patients and involving
cardiology for early diagnosis and management is essential.<br/>Copyright
&#xa9; 2023

<86>
Accession Number
641086600
Title
Plasma Proteomics and Incident Coronary Heart Disease: The Cardiovascular
Health Study.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Lifestyle and Cardiometabolic Health 2022 Scientific Sessions.
Chicago, IL United States. 145(Supplement 1) (no pagination), 2022. Date
of Publication: March 2022.
Author
Huber M.; Bis J.; Brody J.; Sitlani C.; Austin T.; Katz D.; Psaty B.;
Floyd J.S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Coronary heart disease (CHD) is the leading cause of death
in most of the developed world. The systematic profiling of plasma
proteins levels in a well-characterized cohort may uncover new therapeutic
targets for CHD prevention. <br/>Method(s): Plasma levels of 1,298
proteins were measured with SomaScan aptamers in 3,185 participants of the
Cardiovascular Health Study. After excluding participants with prevalent
myocardial infarction (MI), we evaluated longitudinal associations of
protein levels with the primary outcome of incident CHD (acute MI or death
from CHD) and with a secondary outcome of angina, coronary
revascularization, acute MI, or death from CHD. Primary analyses adjusted
for demographic variables, smoking, diabetes, hypertension, body mass
index, blood pressure, and LDL cholesterol. A p-value < 7.6 x 10-5
(corrected for the number of principal components explaining 95% of
protein variance) was considered statistically significant. Among
significant proteins, we queried the largest available genomic studies to
identify potential protein quantitative trait loci, and we interrogated
published GWAS to assess potential causal relationships using Mendelian
randomization. <br/>Result(s): Among 2,868 participants, the mean age at
baseline was 74 years, 62% (1,784) were female, and 16% (456)
self-identified as Black. After a median follow-up time of 15 years (IQR
10-21) years, 576 (20%) participants had an incident CHD event. Ten
proteins were associated with incident CHD, and an additional 27 proteins
were associated with the secondary outcome. Adjustment for aspirin and
statin use, kidney function, or known cardiac biomarkers (NT-proBNP,
high-sensitive cardiac troponin T, C-reactive protein) had little impact
on associations, and censoring at a shorter duration of follow-up
increased the magnitude of protein-outcome associations.
<br/>Conclusion(s): Thirty-seven proteins were associated with incident
CHD in a cohort of community-dwelling older adults. Two-sample Mendelian
randomization analyses are in progress, and proteomic analyses for an
additional ~3,700 proteins are planned.

<87>
Accession Number
641087377
Title
Sex-related Differences in Mortality after 15-years Follow Up Post
Coronary Artery Bypass Graft Surgery:a Systematic Review and
Meta-analysis.
Source
Circulation. Conference: American Heart Association's Epidemiology and
Prevention/Lifestyle and Cardiometabolic Health 2022 Scientific Sessions.
Chicago, IL United States. 145(Supplement 1) (no pagination), 2022. Date
of Publication: March 2022.
Author
Alsadaoee M.; Aslam F.; Ijaz H.; Dhar K.; AlSadawi M.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Previous data suggest that short and intermediate term
outcomes post coronary artery bypass graft (CABG) surgery differ between
women and men, but long-term outcomes (>15-years) has been poorly
investigated. This meta-analysis sought to elaborate sex-specific
differences in mortality post CABG after 15 years of follow up.
<br/>Method(s): Systematic search was executed in December, 2020 for
studies reporting sex-specific mortality post CABG after 15 years of
follow up. The search was not restricted to time, publication status or
language. <br/>Result(s): A total of 6 studies and 81,691 patients (15,501
women and 66,189 men) were included. Pooled analysis demonstrated that
after 15 years of follow up post CABG, women did not have a statistically
significant 15-years mortality compared to men [odds ratio (OR) 0.96, 95%
confidence interval (CI) 1.60-1.68, p=0.09]. <br/>Conclusion(s): In out
finding, women did not have a statistically significant 15-years mortality
post CABG compared to men.

<88>
Accession Number
641104242
Title
The Remote Ischemic Preconditioning in Cardiac Surgery Trial (Remote
IMPACT).
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2015. San Diego, CA United States. 26 (pp B3), 2015. Date of Publication:
November 2015.
Author
Walsh M.
Institution
(Walsh) McMaster Univ, Canada
(Walsh) Population Health Research Inst, Canada
Publisher
Wolters Kluwer Health
Abstract
Background: Cardiac surgery is frequently complicated by
ischemia-reperfusion injury which can lead to kidney and myocardial
injury. Preoperative Remote Ischemic Preconditioning (RIPC), cycles of
brief ischemia to a limb alternating with reperfusion, may reduce the
frequency or severity of organ injury after cardiac surgery.
<br/>Method(s): We randomly allocated 258 patients at high risk for death
after cardiac surgery to receive either RIPC or a sham procedure
immediately after induction of anesthesia. RIPC consisted of 3 cycles of
thigh tourniquet inflation to 300 mmHg for 5 minutes followed by 5 minutes
reperfusion. The sham group tourniquets were inflated to 15 mmHg. Patients
and care providers were blinded. The main clinical outcomes were change in
creatinine over the first 4 postoperative days and the peak CK-MB within
24 hours of surgery. Other outcomes were assessed to 30 days after
randomization. Analyses were performed according to the intention-to-treat
principle. <br/>Result(s): We randomized 128 patients to RIPC and 130 to
sham. No patients were lost to follow-up. There was no significant between
group differences in postoperative change in creatinine (p=0.79) or peak
CK-MB (p=0.18) (Figure 1). We found no significant differences in the
frequency of acute kidney injury (34% vs 31%), myocardial injury (24% vs
19%), stroke (4% vs 3%) or mortality (6% vs 5%) at 30 days.
<br/>Conclusion(s): In this trial RIPC did not affect markers of kidney
and myocardial injury. These results fail to provide proof-of-concept that
RIPC may impact clinically important outcomes in the cardiac surgery
setting. (Figure Presented).

<89>
Accession Number
641104091
Title
Effect of Methylprednisolone on Acute Kidney Injury in Patients Undergoing
Cardiac Surgery with Cardiopulmonary Bypass.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2015. San Diego, CA United States. 26 (pp B1), 2015. Date of Publication:
November 2015.
Author
Garg A.X.; Whitlock R.P.
Institution
(Garg) Western Univ, London, Canada
(Whitlock) McMaster Univ, Hamilton, Canada
Publisher
Wolters Kluwer Health
Abstract
Background: Acute kidney injury is a common complication of the 20 million
cardiac surgeries performed worldwide each year. We conducted a substudy
of the Steroids In caRdiac Surgery (SIRS) trial to determine whether
methylprednisolone alters the risk of acute kidney injury in patients
undergoing cardiac surgery with cardiopulmonary bypass [substudy protocol
BMJ Open 2014 Mar 5;4(3): e004842]. <br/>Method(s): This was a randomized
clinical trial of 7,286 high-risk patients undergoing cardiac surgery with
cardiopulmonary bypass from 79 centres in 18 countries between June 2007
and December 2013. Patients were assigned to take intravenous
methylprednisolone (250 mg at anesthetic induction and 250 mg at
initiation of cardiopulmonary bypass) or placebo. Patients, care givers
and outcome-assessors were blinded to allocation. Acute kidney injury was
defined as >=50% or >= 26.5 mmol/L (>= 0.3 mg/dL) increase in the
postoperative serum creatinine concentration from the preoperative
concentration in the 14 days following surgery, or new dialysis in the 30
days following surgery. <br/>Result(s): Methylprednisolone (n=3,647)
versus placebo (n=3,639) did not alter the risk of acute kidney injury
(40.9% versus 39.5%, respectively; relative risk 1.03 [95% CI, 0.96 to
1.11]). Results were consistent with multiple alternate continuous and
categorical definitions of acute kidney injury, and in the subgroup with
baseline chronic kidney disease. <br/>Conclusion(s): Amongst patients
undergoing cardiac surgery with cardiopulmonary bypass, the use of
corticosteroids in the perioperative period did not alter the risk of
acute kidney injury. (Table Presented).

<90>
Accession Number
641104029
Title
High Dose Perioperative Atorvastatin and Acute Kidney Injury Following
Cardiac Surgery.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2015. San Diego, CA United States. 26 (pp B1), 2015. Date of Publication:
November 2015.
Author
Billings F.T.; Wagner C.E.; Hendricks P.; Shi Y.; Petracek M.R.; Brown
N.J.
Institution
(Billings, Wagner, Hendricks, Shi, Petracek, Brown) Vanderbilt Univ,
Nashville, TN, United States
Publisher
Wolters Kluwer Health
Abstract
Background: Hydroxy-methylglutaryl-coenzyme A reductase inhibitors
(statins) affect several mechanisms underlying acute kidney injury (AKI),
a common and dangerous complication after cardiac surgery. We hypothesized
that short-term high-dose perioperative atorvastatin would reduce AKI
following cardiac surgery. <br/>Method(s): We randomized elective cardiac
surgery patients, stratified by chronic kidney disease (CKD), to
atorvastatin or matching-placebo starting the day prior to surgery until
hospital discharge in pre-study statin naive subjects or until the day
after surgery in pre-study statin-using subjects. Our primary endpoint was
AKI by AKIN criteria. <br/>Result(s): The study was stopped on
recommendations of the DSMB after 653 of 820 subjects completed the study
due to futility and an increased incidence of AKI among statinnaive
subjects with CKD randomized to atorvastatin. AKI occurred in 20.8% of
subjects randomized to atorvastatin versus 19.5% randomized to placebo
(P=0.75). Among statinnaive subjects (n=199), however, AKI occurred in
21.6 % randomized to atorvastatin versus 13.4% randomized to placebo
(p=0.14), and 52.9% vs. 15.8%, P=0.03, in patients with CKD (n=36). Serum
creatinine concentrations increased a median of 0.11 (-0.11 - 0.56) versus
0.05 (-0.12 - 0.33) mg/dl in statin-naive patients randomized to
atorvastatin versus placebo (P=0.007), and this effect was magnified among
those with CKD, whereserum creatinine concentrations increased by 0.26
(-0.22 - 0.94) versus -0.06 mg/dl (-0.16 - 0.41), P=0.04.
<br/>Conclusion(s): High-dose perioperative atorvastatin treatment does
not reduce AKI following cardiac surgery and may increase risk in patients
with CKD who are naive to statin treatment. Perioperative continuation or
short-term withdrawal of statin treatment in statin-using patients does
not affect AKI. (Figure Presented).

<91>
Accession Number
641103019
Title
Pilot Trial of Dietary Restriction for Protection from Acute Kidney Injury
in Cardiac Surgery.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2015. San Diego, CA United States. 26 (pp 108A), 2015. Date of
Publication: November 2015.
Author
Grundmann F.; Kubacki T.; Mueller R.-U.; Scherner M.; Faust M.; Becker I.;
Spath M.; Johnsen M.; Benzing T.; Rolf Burst V.
Institution
(Grundmann, Kubacki, Mueller, Scherner, Faust, Becker, Spath, Johnsen,
Benzing, Rolf Burst) Univ of Cologne, Cologne, Germany
Publisher
Wolters Kluwer Health
Abstract
Background: Even small acute changes in kidney function as a result of
acute kidney injury (AKI) can result in short-term and long-term
complications including chronic kidney disease, end-stage renal disease
and death. However, despite an increasing incidence of AKI few preventive
and therapeutic options exist. Short-term reduction of calorie intake has
been shown to provide effective protection from ischemic AKI in mice.
<br/>Method(s): In this single-center randomized controlled trial
(ClinicalTrials.gov Identifier: NCT01534364) 82 patients with at least one
risk factor for postsurgical AKI scheduled for cardiac surgery (CABG,
valve replacement) were randomly assigned in a 1:1 ratio into a diet group
(DG: 60% of calculated energy expenditure for 7 days prior to surgery) or
an ad libitum food intake control group (CG). The intention-to-treat
population encompassed 76 patients. The primary endpoint was defined as
the change in serum creatinine from baseline to 24 hours after surgery,
secondary endpoints included incidence of AKI (KDIGO criteria).
<br/>Result(s): Demographic and surgery associated characteristics were
similar in both groups (DG 80% male vs. CG 77.5% male; age: DG 72y[63-76]
vs. CG 75y[70-77], body weight: DG 84.6kg[72.-91.7] vs. CG 79.1kg[75.0-
72.7], crossclamp time: DG 59min[52- 82] vs. CG 59min[44-82]). Average
calorie intake in the DG was 1323 kcal and a 3 kg[- 4.0 to -2.2] weight
loss was observed (no weight change in the CG). With respect to the
primary outcome measure there was no difference between the groups.
Overall incidence of AKI was similar in both groups with considerably less
patients with stage 1 AKI in the DG (n.s.). Length of stay, need for renal
replacement therapy and mortality did not differ <br/>Conclusion(s):
Dietary restriction is safe and feasible in patients awaiting cardiac
surgery. Despite its beneficial effect in animal studies restriction of
calorie intake did not alter serum creatinine dynamics or AKI incidence
after cardiac surgery.

<92>
Accession Number
641102885
Title
Reducing Post-CABG Acute Kidney Injury by Multipronged Preventive
Interventions.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2015. San Diego, CA United States. 26 (pp 104A), 2015. Date of
Publication: November 2015.
Author
Cheungpasitporn W.; Mao M.A.; Thongprayoon C.; Qian Q.
Institution
(Cheungpasitporn, Mao, Thongprayoon, Qian) Nephrology and Hypertension,
Mayo Clinic, Rochester, MN, United States
Publisher
Wolters Kluwer Health
Abstract
Background: Acute kidney injury (AKI) post cardiac surgery is frequently a
multifactorial event, associated with an increased morbidity and
mortality. As AKI has no specific treatment, prevention is critical. This
study aims to apply multipronged preventive measures to reduce AKI after
coronary artery bypass grafting (CABG). <br/>Method(s): Prospective
randomized interventional study. Non-dialysis and non-kidney transplant
adults (³18 years old) undergoing elective CABG in March
2014-Feburary 2015 were randomized (1:1 ratio) to control and intervention
groups. The intervention group was intervened to minimize potential
nephrotoxic conditions perioperatively (48 hours prior to the operation to
5 days postoperation). Outcome measures included the incidence and
severity of post-CABG AKI using the AKIN criteria, length of hospital
stay, discharge disposition and hospital mortality. Data from a similar
cohort in March 2013-Feburary 2014 were extracted and compared with the
results from the control group to assess the spillover effects.
<br/>Result(s): Post-CABG AKI occurred in 19% (n=33) of the 174 patients
in the intervention group; 30% (n=51) of the 172 in the control group,
p=0.02, consistent with a 36% AKI risk reduction with the interventions
[RR = 0.64 (95% CI: 0.44-0.94)]. Number needed to prevent one AKI was 10.
The AKI severity was mostly mild and similar between the two groups; 98%
and 94% were in stage 1 AKI in the control and intervention groups,
respectively. Compared to non-AKI, AKI patients in both groups had a
longer length of hospital stay and higher risk of being discharged to a
care facility. No hospital mortality was noted in both groups. The AKI
occurrence in the year prior to the study was similar to that in the
control group. <br/>Conclusion(s): Multipronged preventive measures can
significantly reduce post-CABG AKI. The implementation of the preventive
measures is uncomplicated. This approach can potentially be adopted in
most hospital settings. These results should encourage initiatives towards
developing AKI prevention protocols.

<93>
Accession Number
641102553
Title
Search for New Data to Predict Kidney Transplant Outcomes in the Organ
Procurement and Transplantation Network Database.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2015. San Diego, CA United States. 26 (pp 867A), 2015. Date of
Publication: November 2015.
Author
Sheta M.A.; Kasiske B.L.; Alexander C.E.; Kim J.
Institution
(Sheta) Univ of Minnesota, United States
(Kasiske) Hennepin County Medical Center, United States
(Alexander) Univ Health Network, United States
(Kim) Living Legacy Foundation of Maryland, United States
Publisher
Wolters Kluwer Health
Abstract
Background: The Organ Procurement and Transplantation Network (OPTN)
collects data used to monitor transplant program outcomes for quality
assurance and regulatory oversight. It is imperative that the variables in
the OPTN database used by the Scientific Registry of Transplant Recipients
to determine expected outcomes after kidney transplant be reliable,
complete, and up-to-date. <br/>Method(s): We conducted a systematic review
to identify risk factors not included in current OPTN data that predict
graft failure or mortality after kidney transplant. We searched for
studies with:publication date between Jan 1 2000-May 1 2015; at least 1000
subjects in one or more risk prediction models;multivariate analysis used
to select variables predicting patient or graft survival; inclusion in the
multivariate model of at least one risk factor collected before or at the
time of transplant that is not already collected by OPTN;and English
language. For duplicate publications we selected the most recent. For
publications with overlapping but distinct cohorts, we selected the one
with the largest cohort.We arbitrarily limited the search to studies
including 1000 participants in at least one risk-prediction model.Although
a small single-center study may convincingly show that a newly described
risk factor predicts outcomes at that center, there are likely major
barriers to measuring and collecting this risk factor uniformly at every
program in the US. <br/>Result(s): We identified 33 studies that met
inclusion criteria; 6 (18%) were singlecenter, 4 (12%) were multicenter,
and 23 (70%) were registry studies. Promising new variables included:
myocardial infarction, coronary artery revascularization, atrial
fibrillation, congestive heart failure, valvular heart disease, cerebral
vascular accident, carotid artery revascularization, aortic aneurysm
repair, ischemic leg amputation or revascularization, tobacco abuse,
alcohol and illicit drug dependence, ZIP code, and socioeconomic status.
<br/>Conclusion(s): This review provides evidence for the new OPTN Ad Hoc
Data Advisory Committee to update the OPTN database.

<94>
Accession Number
2024088116
Title
Narrative review of single ventricle: where are we after 40 years?.
Source
Translational Pediatrics. 12(2) (pp 221-244), 2023. Date of Publication:
February 2023.
Author
Corno A.F.; Findley T.O.; Salazar J.D.
Institution
(Corno, Salazar) Pediatric and Congenital Cardiac Surgery, Children's
Heart Institute, Department of Pediatrics, Memorial Hermann Children's
Hospital, McGovern Medical School, The University of Texas Health Science
Center in Houston, Houston, TX, United States
(Findley) Division of Neonatal-Perinatal Medicine, Department of
Pediatrics, Memorial Hermann Children's Hospital, McGovern Medical School,
The University of Texas Health Science Center in Houston, Houston, TX,
United States
Publisher
AME Publishing Company
Abstract
Background and Objective: Key medical and surgical advances have been made
in the longitudinal management of patients with "functionally" single
ventricle physiology, with the principles of Fontan circulation applied to
other complex congenital heart defects. The purpose of this article is to
review all of the innovations, starting from fetal life, that led to a
change of strategy for single ventricle. <br/>Method(s): Our literature
review included all full articles published in English language on the
Cochrane, MedLine, and Embase with references to "single ventricle" and
"univentricular hearts", including the initial history of the treatments
for this congenital heart defects as well as the innovations reported
within the last decades. Key Content and Findings: All innovations
introduced have been analyzed, including: (I) fetal diagnosis and
interventions, in particular to prevent or reduce brain damages; (II)
neonatal care; (III) post-natal diagnosis; (IV) interventional cardiology
procedures; (V) surgical procedures, including neonatal palliations,
hybrid procedures, bidirectional Glenn and variations, Fontan completion,
biventricular repair; (VI) perioperative management; (VII) Fontan failure,
with Fontan take-down and conversion, and mechanical circulatory support;
(VIII) transplantation, including heart, heart and lung, heart and liver;
(IX) exercise; (X) pregnancy; (XI) adolescents and adults without Fontan
completion; (XII) future studies, including experimental studies on
animals, computational studies, genetics, stem cells and bioengineering.
<br/>Conclusion(s): These last 40 years have certainly changed the course
of natural history for children born with any form of "functionally"
single ventricle, thanks to the improvement in diagnostic and treatment
techniques, and particularly to the increased knowledge of the morphology
and function of these complex hearts, from fetal to adult life. There is
still much left unexplored and room for improvement, and all efforts
should be concentrated in collaborations among different institutions and
specialties, focused on the same matter.<br/>Copyright &#xa9;
Translational Pediatrics. All rights reserved.

<95>
Accession Number
2024088112
Title
Robotic-assisted surgery in pediatrics: what is evidence-based?-a
literature review.
Source
Translational Pediatrics. 12(2) (pp 271-279), 2023. Date of Publication:
February 2023.
Author
Boscarelli A.; Giglione E.; Caputo M.R.; Guida E.; Iaquinto M.; Scarpa
M.-G.; Olenik D.; Codrich D.; Schleef J.
Institution
(Boscarelli, Guida, Iaquinto, Scarpa, Olenik, Codrich, Schleef) Department
of Pediatric Surgery and Urology, Institute of Maternal and Child
Health-IRCCS "Burlo Garofolo", Trieste, Italy
(Giglione, Caputo) Pediatric Surgery Division, Women's and Children's
Health Department, University of Padua, Padua, Italy
Publisher
AME Publishing Company
Abstract
Background and Objective: The use of robotic-assisted surgery (RAS) has
increased more slowly in pediatrics than in the adult population. Despite
the many advantages of robotic instruments, the da Vinci Surgical System
(Intuitive Surgical, Sunnyvale, CA, USA) still presents some limitations
for use in pediatric surgery. This study aims to examine evidence-based
indications for RAS in the different fields of pediatric surgery according
to the published literature. <br/>Method(s): A database search (MEDLINE,
Scopus, Web of Science) was performed to identify articles covering any
aspect of RAS in the pediatric population. Using Boolean operators AND/OR,
all possible combinations of the following search terms were used: robotic
surgery, pediatrics, neonatal surgery, thoracic surgery, abdominal
surgery, urologic surgery, hepatobiliary surgery, and surgical oncology.
The selection criteria were limited to the English language, pediatric
patients (under 18 years of age), and articles published after 2010. Key
Content and Findings: A total of 239 abstracts were reviewed. Of these, 10
published articles met the purposes of our study with the highest level of
evidence and therefore were analyzed. Notably, most of the articles
included in this review reported evidence-based indications in urological
surgery. <br/>Conclusion(s): According to this study, the exclusive
indications for RAS in the pediatric population are pyeloplasty for
ureteropelvic junction obstruction in older children and ureteral
reimplantation according to the Lich-Gregoire technique in selected cases
for the need to access the pelvis with a narrow anatomical and working
space. All other indications for RAS in pediatric surgery are still under
discussion to date, and cannot be supported by papers with a high level of
evidence. However, RAS is certainly a promising technology. Further
evidence is strongly encouraged in the future.<br/>Copyright &#xa9;
Translational Pediatrics. All rights reserved.

<96>
Accession Number
2024178985
Title
Sex Differences in Outcomes After Transcatheter Aortic Valve Replacement:
A POPular TAVI Subanalysis.
Source
JACC: Cardiovascular Interventions. 16(9) (pp 1095-1102), 2023. Date of
Publication: 08 May 2023.
Author
van Bergeijk K.H.; van Ginkel D.-J.; Brouwer J.; Nijenhuis V.J.; van der
Werf H.W.; van den Heuvel A.F.M.; Voors A.A.; Wykrzykowska J.J.; ten Berg
J.M.
Institution
(van Bergeijk, van der Werf, van den Heuvel, Voors, Wykrzykowska)
Department of Cardiology, University Medical Center Groningen, University
of Groningen, Groningen, Netherlands
(van Ginkel, Brouwer, Nijenhuis, ten Berg) Department of Cardiology, St.
Antonius Hospital, Nieuwegein, Netherlands
(ten Berg) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Stroke and bleeding are complications after transcatheter
aortic valve replacement (TAVR). A higher incidence of bleeding and stroke
has been reported in women, but the role of antithrombotic management pre-
and post-TAVR has not been studied. <br/>Objective(s): The study sought to
compare bleeding and ischemic complications after TAVR between women and
men stratified by antiplatelet and oral anticoagulant (OAC) regimen.
<br/>Method(s): The POPular TAVI (Antiplatelet Therapy for Patients
Undergoing Transcatheter Aortic Valve Implantation) trial was a randomized
clinical trial to test the hypothesis that monotherapy with aspirin or OAC
after TAVR is safer than the addition of clopidogrel. The primary
endpoints of interest of this post hoc subanalysis were: 1) all bleeding;
and 2) a composite of ischemic events consisting of stroke and myocardial
infarction. Secondary endpoints were: 1) nonprocedural bleeding; 2) major
or life-threatening bleeding; 3) minor bleeding; 4) stroke; 5) myocardial
infarction; and 6) all-cause death. <br/>Result(s): A total of 978
patients (466 [47.6%] women) were included in this study. All bleeding and
the composite of myocardial infarction and stroke rates were similar
between sexes (all bleeding: 106 [22.8%] women vs 121 [23.6%] men; P =
0.815; ischemic events: 26 [5.6%] vs 36 [7.0%]; P = 0.429). However, major
or life-threatening bleeding occurred more often in women (58 [12.5%]) vs
men (38 [7.4%]) (P = 0.011), most of which were access site bleedings. The
use of aspirin pre- and post-TAVR increased major or life-threatening
bleeding in women but not in men. <br/>Conclusion(s): After TAVR, overall
bleeding and ischemic outcomes were similar between women and men.
However, women had more major or life-threatening bleedings, especially
those receiving aspirin pre- and post-TAVR.<br/>Copyright &#xa9; 2023
American College of Cardiology Foundation

<97>
Accession Number
2024161176
Title
Erector Spinae Plane Block With Liposomal Bupivacaine: Analgesic Adjunct
in Adult Pectus Surgery.
Source
Journal of Surgical Research. 289 (pp 171-181), 2023. Date of Publication:
September 2023.
Author
Malan S.H.; Jaroszewski D.E.; Craner R.C.; Weis R.A.; Murray A.W.;
Meinhardt J.R.; Girardo M.E.; Abdelrazek A.S.; Borah B.J.; Dholakia R.;
Smith B.B.
Institution
(Malan) Adult Cardiothoracic Anesthesiology Fellow, Baylor Scott & White
Medical Center, Texas A&M Health Science Center College of Medicine,
Temple, Texas, United States
(Jaroszewski) Professor of Surgery, Department of Cardiovascular Surgery,
Mayo Clinic, Phoenix, Arizona, United States
(Craner, Weis, Murray, Smith) Assistant Professor of Anesthesiology,
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic,
Phoenix, Arizona, United States
(Meinhardt) Mayo Clinic Alix School of Medicine, Phoenix, Arizona, United
States
(Girardo) Department of Research Biostatistics, Mayo Clinic, Phoenix,
Arizona, United States
(Abdelrazek) Research Fellow, Cardiovascular Surgery Research, Mayo
Clinic, Rochester, Minnesota, United States
(Borah, Dholakia) Mayo Clinic College of Medicine & Science Robert D. &
Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo
Clinic, Rochester, Minnesota, United States
Publisher
Academic Press Inc.
Abstract
Introduction: Pain management may be challenging in patients undergoing
pectus excavatum (PE) bar removal surgery. To enhance recovery, opioid
sparing strategies with regional anesthesia including ultrasound-guided
erector spinae plane block (ESPB) have been implemented. The purpose of
this study was to evaluate the safety and efficacy of bilateral ESPB with
a liposomal bupivacaine/traditional bupivacaine mixture as part of an
enhanced patient recovery pathway. <br/>Material(s) and Method(s): A
retrospective review of adult patients who underwent PE bar removal from
January 2019 to December 2020 was performed. Perioperative data were
reviewed and recorded. Patients who received ESPB were compared to
historical controls (non-ESPB patients). <br/>Result(s): A total of 202
patients were included (non-ESPB: 124 patients; ESPB: 78 patients). No
adverse events were attributed to ESPB. Non-ESPB patients received more
intraoperative opioids (milligram morphine equivalents; 41.8 +/- 17.0 mg
versus 36.7 +/- 17.1, P = 0.05) and were more likely to present to the
emergency department within 7 d postoperatively (4.8% versus 0%, P = 0.05)
when compared to ESPB patients. No significant difference in total
perioperative milligram morphine equivalents, severe pain in
postanesthesia care unit (PACU), time from PACU arrival to analgesic
administration, PACU length of stay, or postprocedure admission rates
between groups were observed. <br/>Conclusion(s): In patients undergoing
PE bar removal surgery, bilateral ESPB with liposomal bupivacaine was
performed without complications. ESPB with liposomal bupivacaine may be
considered as an analgesic adjunct to enhance recovery in patients
undergoing cardiothoracic procedures but further prospective randomized
clinical trials comparing liposomal bupivacaine to traditional local
anesthetics with and without indwelling nerve catheters are
necessary.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<98>
Accession Number
2024131232
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 and Pain Medicine. 42(4) (no pagination), 2023.
Article Number: 101230. Date of Publication: August 2023.
Author
Elbardan I.M.; Shehab A.S.; Mabrouk I.M.
Institution
(Elbardan, Shehab, Mabrouk) Anaesthesia and Surgical Intensive Care
Department, Faculty of Medicine, Alexandria University, Champollion
Street, Azaritta, Alexandria 21521, Egypt
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Effective analgesia after cardiac surgery contributes to
enhanced recovery. <br/>Aim(s): 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 5.0 h,
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 Societe francaise d'anesthesie et de
reanimation (Sfar)

<99>
Accession Number
2024124060
Title
Hamartoma of mature cardiac myocytes: systematic review.
Source
Cardiovascular Pathology. 65 (no pagination), 2023. Article Number:
107538. Date of Publication: 01 Jul 2023.
Author
Techasatian W.; Gozun M.; Morihara C.; Pham A.; Benavente K.; Nagamine T.;
Nishimura Y.
Institution
(Techasatian, Gozun, Morihara, Pham, Benavente, Nagamine, Nishimura)
Department of Medicine, John A. Burns School of Medicine, University of
Hawai'i, Honolulu, HI, United States
Publisher
Elsevier Inc.
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 2, 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 Inc.

<100>
Accession Number
2024162281
Title
The Effects of Peroxisome Proliferator-Activated Receptor-Delta Modulator
ASP1128 in Patients at Risk for Acute Kidney Injury Following Cardiac
Surgery.
Source
Kidney International Reports. (no pagination), 2023. Date of Publication:
2023.
Author
van Till J.W.O.; Nojima H.; Kameoka C.; Hayashi C.; Sakatani T.; Washburn
T.B.; Molitoris B.A.; Shaw A.D.; Engelman D.T.; Kellum J.A.
Institution
(van Till) Mitobridge Inc., Cambridge, MA, United States
(Nojima, Hayashi) Astellas Pharma Global Development Inc., Northbrook, IL,
United States
(Kameoka, Sakatani) Astellas Pharma Inc, Development, Tokyo, Japan
(Washburn) Department of Thoracic Surgery, Heart Center, Huntsville, AL,
United States
(Molitoris) Division of Nephrology, Indiana University School of Medicine,
Indianapolis, IN, United States
(Shaw) Department of Intensive Care and Resuscitation, Cleveland Clinic,
Cleveland, OH, United States
(Engelman) Heart and Vascular Program, Baystate Health and University of
Massachusetts Medical School-Baystate, Springfield, MA, United States
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
Publisher
Elsevier Inc.
Abstract
Introduction: Peroxisome proliferator-activated receptor delta (PPARdelta)
plays a central role in modulating mitochondrial function in
ischemia-reperfusion injury. The novel PPARdelta modulator, ASP1128, was
evaluated. <br/>Method(s): A randomized, double-blind, placebo-controlled,
biomarker assignment-driven, multicenter study was performed in adult
patients at risk for acute kidney injury (AKI) following cardiac surgery,
examining efficacy and safety of a 3-day, once-daily intravenous dose of
100 mg ASP1128 versus placebo (1:1). AKI risk was based on clinical
characteristics and postoperative urinary biomarker (TIMP2)*(IGFBP7). The
primary end point was the proportion of patients with AKI based on serum
creatinine within 72 hours postsurgery (AKI-SCr72h). Secondary endpoints
included the composite end point of major adverse kidney events (MAKE:
death, renal replacement therapy, and/or >=25% reduction of estimated
glomerular filtration rate [eGFR]) at days 30 and 90). <br/>Result(s): A
total of 150 patients were randomized and received study medication (81
placebo, 69 ASP1128). Rates of AKI-SCr72h were 21.0% and 24.6% in the
placebo and ASP1128 arms, respectively (P = 0.595). Rates of
moderate/severe AKI (stage 2/3 AKI-SCr and/or stage 3 AKI-urinary output
criteria) within 72 hours postsurgery were 19.8% and 23.2%, respectively
(P = 0.609). MAKE occurred within 30 days in 11.1% and 13.0% in the
placebo and ASP1128 arms (P = 0.717), respectively; and within 90 days in
9.9% and 15.9% in the placebo and ASP1128 arms (P = 0.266), respectively.
No safety issues were identified with ASP1128 treatment, but rates of
postoperative atrial fibrillation were lower (11.6%) than in the placebo
group (29.6%). <br/>Conclusion(s): ASP1128 was safe and well-tolerated in
patients at risk for AKI following cardiac surgery, but it did not show
efficacy in renal endpoints.<br/>Copyright &#xa9; 2023 International
Society of Nephrology

<101>
Accession Number
2024108730
Title
Nephrotic syndrome and acute coronary syndrome in children, teenagers and
young adults: Systematic literature review.
Source
Archives of Cardiovascular Diseases. (no pagination), 2023. Date of
Publication: 2023.
Author
Wolf O.; Didier R.; Chague F.; Bichat F.; Rochette L.; Zeller M.; Fauchier
L.; Bonnotte B.; Cottin Y.
Institution
(Wolf, Didier, Chague, Bichat, Zeller, Cottin) Department of Cardiology,
University Teaching Hospital of Dijon Bourgogne, Dijon 21000, France
(Rochette, Zeller) PEC2, EA 7460, University of Burgundy, Dijon 21000,
France
(Fauchier) Department of Cardiology, Francois-Rabelais University,
University Teaching Hospital of Trousseau, Tours 37044, France
(Bonnotte) Department of Internal Medicine, University Teaching Hospital
of Dijon Bourgogne, Dijon 21000, France
Publisher
Elsevier Masson s.r.l.
Abstract
Myocardial infarction is rare in children, teenagers and young adults
(aged < 20 years). The most common aetiologies identified include Kawasaki
disease, familial hypercholesterolaemia, collagen vascular disease-induced
coronary arteritis, substance abuse (cocaine, glue sniffing), trauma,
complications of congenital heart disease surgery, genetic disorders (such
as progeria), coronary artery embolism, occult malignancy and several
other rare conditions. Nephrotic syndrome is a very rare cause of
myocardial infarction, but it is probably underestimated. The purpose of
this review was to determine the current state of knowledge on acute
coronary syndrome related to nephrotic syndrome. We thus performed a
comprehensive structured literature search of the Medline database for
articles published between January 1st, 1969 and December 31st, 2021.
Myocardial infarction in young adults can be broadly divided into two
groups: cases of angiographically normal coronary arteries; and cases of
coronary artery disease of varying aetiology. There are several possible
mechanisms underlying the association between acute coronary syndrome and
nephrotic syndrome: (1) coronary thrombosis related to hypercoagulability
and/or platelet hyperactivity; (2) atherosclerosis related to
hyperlipidaemia; and (3) drug treatment. All of these mechanisms must be
evaluated systematically in the acute phase of disease because they evolve
rapidly with the treatment of nephrotic syndrome. In this review, we
propose a decision algorithm for the management of acute coronary syndrome
in the context of nephrotic syndrome. The final part of the review
presents the short- and medium-term therapeutic strategies available.
Thromboembolism related to nephrotic syndrome is a rare
non-atherosclerotic cause of acute coronary syndrome, and prospective
studies are needed to evaluate a systematic approach with personalized
therapeutic strategies.<br/>Copyright &#xa9; 2023 Elsevier Masson SAS

<102>
Accession Number
2023908064
Title
Evaluation of the effectiveness and safety of a multi-faceted computerized
antimicrobial stewardship intervention in surgical settings: A
single-centre cluster-randomized controlled trial.
Source
International Journal of Antimicrobial Agents. 61(5) (no pagination),
2023. Article Number: 106787. Date of Publication: May 2023.
Author
Yuan X.; Chen K.; Yuan J.; Chu Q.; Gao Y.; Yu F.; Diao X.; Chen X.; Li Y.;
Sun H.; Shu C.; Wang W.; Pan X.; Zhao W.; Hu S.
Institution
(Yuan, Chen, Chu, Li, Sun, Shu, Wang, Pan, Hu) State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Yuan, Chen, Chu, Li, Sun, Shu, Wang, Pan, Hu) Department of Cardiac
Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Yuan, Yu, Diao, Zhao) Information Centre, Fuwai Hospital, Chinese Academy
of Medical Sciences and Peking Union Medical College, Beijing, China
(Hu, Gao) National Clinical Research Centre of Cardiovascular Diseases,
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National
Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Chen) Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
Publisher
Elsevier B.V.
Abstract
Background: Inappropriate antimicrobial use is common among patients
undergoing surgery. It remains unclear whether a multi-faceted
computerized antimicrobial stewardship programme is effective and safe in
reducing inappropriate antimicrobial use in surgical settings.
<br/>Method(s): A multi-faceted computerized antimicrobial stewardship
intervention system was developed, and an open-label, cluster-randomized,
controlled trial was conducted among 18 surgical teams that enrolled 2470
patients for open chest cardiovascular surgery. The surgical teams were
divided at random into intervention and control groups at a ratio of 1:1.
The primary endpoints were days of therapy (DOT)/1000 patient-days,
defined daily dose (DDD)/1000 patient-days and length of therapy
(LOT)/1000 patient-days. <br/>Result(s): Mean DOT, DDD and LOT per 1000
patient-days were significantly lower in the intervention group compared
with the control group (472.2 vs 539.8, 459.5 vs 553.8, and 438.4 vs
488.7; P<0.05), with reductions of 14.2% [95% confidence interval (CI)
11.8-16.7%], 18.7% (95% CI 15.9-21.4%) and 11.9% (95% CI 9.6-14.1%),
respectively. The daily risk of inappropriate antimicrobial use after
discharge from the intensive care unit decreased by 23.9% [95% CI
15.5-31.5% (incidence risk ratio 0.76, 95% CI 0.69-0.85)] in the
intervention group. There was no significant difference in rates of
infection or surgical-related complications between the groups. Median
antimicrobial costs were significantly lower in the intervention group
{873.4 [interquartile range (IQR) 684.5-1255.4] RMB vs 1178.7 (IQR
869.1-1814.5) RMB; P<0.001} (1 RMB approximately equivalent to 0.16 US$ in
2022). <br/>Conclusion(s): The multi-faceted computerized antimicrobial
stewardship interventions reduced inappropriate antimicrobial use safely.
Clinical trial registration: Clinicaltrials.gov:
NCT04328090.<br/>Copyright &#xa9; 2023 The Authors

<103>
Accession Number
2023896074
Title
Venous External Support in Coronary Artery Bypass Surgery: A Systematic
Review and Meta-Analysis.
Source
Current Problems in Cardiology. 48(7) (no pagination), 2023. Article
Number: 101687. Date of Publication: July 2023.
Author
Gemelli M.; Gallo M.; Addonizio M.; Pahwa S.; Van den Eynde J.; Trivedi
J.; Slaughter M.S.; Gerosa G.
Institution
(Gemelli, Addonizio, Gerosa) Cardiac Surgery Unit, Department of Cardiac,
Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
(Gallo, Pahwa, Trivedi, Slaughter) Department of Cardiothoracic Surgery,
University of Louisville, Louisville, KY
(Van den Eynde) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
Publisher
Elsevier Inc.
Abstract
Neointimal hyperplasia and lumen irregularities are major contributors to
vein graft failure and the use of VEST^(R) should prevent this.
In this review, we aim to evaluate the angiographic outcomes of externally
supported vein grafts. Medline, Embase and Cochrane Library were
systematically reviewed for randomized clinical trials published by August
2022. The primary outcome was graft failure. Secondary outcomes included
graft ectasia, intimal hyperplasia area and thickness, and graft
nonuniformity. Odds ratios (OR) for dichotomous variables and mean
difference (MD) for continuous variables with 95% confidence intervals
(CI) were pooled using a fixed-effects model. Three randomized controlled
trials with a total of 437 patients were included with follow-up ranging
from 1 to 2 years. The odds of graft failure were similar in the 2 groups
(OR 1.22; 95%CI 0.88-1.71; I2 = 0%). Intimal hyperplasia area [MD -0.77
mm²; 95%CI -1.10 to -0.45; I² = 0%] and thickness
[MD -0.06 mm; 95% CI -0.08 to -0.04; I²=0%] were significantly
lower in the VEST group. Fitzgibbon Patency Scale of II or III
(representing angiographic conduit nonuniformity; OR 0.67; 95%CI
0.48-0.94; I² = 0%) and graft ectasia (OR 0.53; 95%CI
0.32-0.88; I² = 33%) were also significantly lower in the VEST
group. At short-term follow-up, VEST does not seem to reduce the incidence
of graft failure, although it is associated with attenuation of intimal
hyperplasia and nonuniformity. Longer angiographic follow-up is warranted
to determine whether these positive effects might translate into a
positive effect in graft failure and in long-term clinical
outcomes.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<104>
Accession Number
2024022908
Title
The effect of applying telehealth education to home care of infants after
congenital heart disease surgery.
Source
International Journal for Quality in Health Care. 35(1) (no pagination),
2023. Article Number: mzac102. Date of Publication: 2023.
Author
Zhang Q.-L.; Lin S.-H.; Lin W.-H.; Chen Q.; Cao H.
Institution
(Zhang, Lin, Lin, Chen, Cao) Department of Cardiac Surgery, Fujian
Children's Hospital (Fujian Branch of Shanghai Children's Medical Center),
College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics,
Fujian Medical University, No. 966 of Hengyu Road, Fujian, Fuzhou 350001,
China
Publisher
Oxford University Press
Abstract
Background: The purpose of this study was to investigate the effect of
applying telehealth education to home care of infants after congenital
heart disease (CHD) surgery. <br/>Method(s): A prospective randomized
controlled study was conducted from July 2020 to February 2021 in Fujian
Children's Hospital to compare the home care condition of infants after
CHD surgery between the intervention group and the control group.
<br/>Result(s): At 3 months after discharge, parents' caring ability and
CHD knowledge in the intervention group were significantly better than
those in the control group and were significantly improved compared with
those at discharge time (P < 0.05). The parental care burden in the
intervention group was significantly lower than that in the control group
and was significantly lower than that at discharge time (P < 0.05). During
the follow-up period, the rate of loss of follow-up and complications in
the intervention group were significantly lower than those in the control
group (P < 0.05). <br/>Conclusion(s): Telehealth education via WeChat can
effectively improve the knowledge of disease and home care ability of
parents of infants after CHD surgery and reduce their home care burden,
which can effectively reduce the incidence of complications and lost to
follow-up rate after discharge.<br/>Copyright &#xa9; 2023 The Author(s).

<105>
Accession Number
2023965974
Title
Aortic valve replacement reduces mortality in moderate aortic stenosis: A
systematic review and meta-Analysis.
Source
Journal of Geriatric Cardiology. 20(1) (pp 61-67), 2023. Date of
Publication: January 2023.
Author
Franke K.B.; Bhatia D.; Roberts-Thomson R,l.; Psaltis P.J.
Institution
(Franke, Bhatia, Psaltis) Adelaide Medical School, University of Adelaide,
Adelaide, Australia
(Franke, Psaltis) Vascular Research Centre, Lifelong Health Theme, South
Australian Health and Medical Research Institute, Adelaide, Australia
(Roberts-Thomson, Psaltis) Department of Cardiology, Royal Adelaide
Hospital, Adelaide, Australia
Publisher
Science Press
Abstract
BACKGROUND With the introduction of transcatheter aortic valve replacement
and an evolving understanding of the natural progression and history of
aortic stenosis, the potential for earlier intervention in appropriate
patients is promising; however, the benefit of aortic valve replacement in
moderate aortic stenosis remains unclear. METHODS Pubmed, Embase, and the
Cochrane Library databases were searched up until 30th of December 2021
using keywords including moderate aortic stenosis and aortic valve
replacement. Studies reporting all-cause mortality and outcomes in early
aortic valve replacement (AVR) compared to conservative management in
patients with moderate aortic stenosis were included. Hazard ratios were
generated using random-effects meta-Analysis to determine effect
estimates. RESULTS 3470 publications were screened with title and abstract
review, which left 169 articles for full-Text review. Of these studies, 7
met inclusion criteria and were included, totalling 4,827 patients. All
studies treated AVR as a time-dependent co-variable in cox-regression
multivariate analysis of all-cause mortality. Intervention with surgical
or transcatheter AVR was associated with a 45% decreased risk of all-cause
mortality (HR = 0.55 [0.42-0.68], I2 = 51.5%, P < 0.001). All studies were
representative of the overall cohort with appropriate sample sizes, with
no evidence of publication, detection, or information biases in any of the
studies. CONCLUSIONIn this systematic review and meta-Analysis, we report
a 45% reduction in all-cause mortality in patients with moderate aortic
stenosis who were treated with early aortic valve replacement compared to
a strategy of conservative management. Randomised control trials are
awaited to determine the utility of AVR in moderate aortic
stenosis.<br/>Copyright &#xa9; 2023 Science Press. All rights reserved.

<106>
Accession Number
2024053327
Title
Regional block techniques for pain management after video-assisted
thoracoscopic surgery: a covariate-adjusted Bayesian network
meta-analysis.
Source
Wideochirurgia I Inne Techniki Maloinwazyjne. 18(1) (pp 52-68), 2023. Date
of Publication: 2023.
Author
Jiang T.; Mo X.; Zhan R.; Zhang Y.; Yu Y.
Institution
(Jiang, Mo, Zhang, Yu) Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Hubei Province, Wuhan, China
(Zhan) The First Affiliated Hospital of Anhui Medical University Gaoxin
District, Anhui Province, Hefei, China
Publisher
Termedia Publishing House Ltd.
Abstract
Introduction: Nerve block is widely used for pain management after
video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral block
(TPVB), erector spinae plane block (ESPB), serratus anterior plane block
(SAPB), and intercostal nerve block (ICNB) are alternative treatments.
<br/>Material(s) and Method(s): Network meta-analysis based on Bayesian
analyses was performed to obtain results for direct comparison, indirect
comparison, and network comparison, and to make rankings based on
probabilities. Covariates were adjusted to determine the effect of the
covariates on results of this study. <br/>Result(s): The study identified
61 randomized controlled trials (RCTs) (4468 patients). There were results
of probability ranking for the first ("best" treatment): 24 h morphine
consumption, TPVB > ESPB > ICNB > SAPB. Covariate adjustment allowed the
four treatments to change somewhat in the likelihood of the best choice.
<br/>Conclusion(s): TPVB ranks best in our analysis. ESPB is a viable
alternative. SAPB and ICNB seem to play a limited role in postoperative
pain management.<br/>Copyright &#xa9; 2023 Termedia Publishing House Ltd..
All rights reserved.

<107>
Accession Number
2023496585
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.; Liu J.; Zhang X.; Cheng E.; Zhou Z.
Institution
(Lin, Zhang, Huang, Liu, Zhang, Cheng) Department of Anesthesiology, The
Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, China
(Zhou) Department of Anesthesiology, The Affiliated Taian City Central
Hospital of Qingdao University, Shandong, Taian, China
(Liu) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical
University, Jiangsu, Xuzhou, China
(Liu) Jiangsu Province Key Laboratory of Anesthesia and Analgesia
Application Technology, Xuzhou Medical University, Jiangsu, Xuzhou, China
(Liu) NMPA Key Laboratory for Research and Evaluation of Narcotic and
Psychotropic Drugs, Xuzhou Medical University, Jiangsu, Xuzhou, China
Publisher
Dove Medical Press Ltd
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.

<108>
Accession Number
2022921703
Title
Early and Mid-Term Outcomes of Transcatheter Aortic Valve Implantation
versus Surgical Aortic Valve Replacement: Updated Systematic Review and
Meta-Analysis.
Source
Journal of Cardiovascular Development and Disease. 10(4) (no pagination),
2023. Article Number: 157. Date of Publication: April 2023.
Author
Lerman T.T.; Levi A.; Talmor-Barkan Y.; Kornowski R.
Institution
(Lerman) Department of Internal Medicine F-Recanati, Beilinson Hospital,
Rabin Medical Center, Petah Tikva 4941492, Israel
(Lerman, Levi, Talmor-Barkan, Kornowski) Department of Cardiology, Rabin
Medical Center, Petah Tikva 4941492, Israel
(Lerman, Levi, Talmor-Barkan, Kornowski) The Faculty of Medicine, Tel Aviv
University, Tel Aviv 6997801, Israel
Publisher
MDPI
Abstract
(1) Background: The use of transcatheter aortic valve implantation (TAVI)
for the treatment of severe symptomatic aortic stenosis is expanding
significantly. We aimed to perform a meta-analysis comparing the safety
and efficacy of TAVI versus surgical aortic valve replacement (SAVR)
during the early and mid-term follow-up period. (2) Methods: We conducted
a meta-analysis of randomized controlled trials (RCTs) comparing 1- to
2-year outcomes between TAVI and SAVR. The study protocol was
preregistered in PROSPERO and the results were reported according to
PRISMA guidelines. (3) Results: The pooled analysis included data from
eight RCTs totaling 8780 patients. TAVI was associated with a lower risk
of all-cause mortality or disabling stroke (OR 0.87, 95%CI 0.77-0.99),
significant bleeding (OR 0.38, 95%CI 0.25-0.59), acute kidney injury (AKI;
OR 0.53, 95%CI 0.40-0.69) and atrial fibrillation (OR 0.28, 95%CI
0.19-0.43). SAVR was associated with a lower risk of major vascular
complication (MVC; OR 1.99, 95%CI 1.29-3.07) as well as permanent
pacemaker implantation (PPI; OR 2.28, 95%CI 1.45-3.57). (3)
<br/>Conclusion(s): TAVI compared with SAVR during early and mid-term
follow-up was associated with a lower risk of all-cause mortality or
disabling stroke, significant bleeding, AKI and atrial fibrillation;
however, it was associated with a higher risk of MVC and
PPI.<br/>Copyright &#xa9; 2023 by the authors.

<109>
Accession Number
2022921655
Title
Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and
Bleeding Risk: A Narrative Review.
Source
Journal of Cardiovascular Development and Disease. 10(4) (no pagination),
2023. Article Number: 135. Date of Publication: April 2023.
Author
Tsigkas G.; Vakka A.; Apostolos A.; Bousoula E.; Vythoulkas-Biotis N.;
Koufou E.-E.; Vasilagkos G.; Tsiafoutis I.; Hamilos M.; Aminian A.;
Davlouros P.
Institution
(Tsigkas, Vakka, Apostolos, Vythoulkas-Biotis, Koufou, Vasilagkos,
Davlouros) Department of Cardiology, University Hospital of Patras, Patras
265 04, Greece
(Apostolos) First Department of Cardiology, Hippocration General Hospital,
National and Kapodistrian University of Athens, Athens 157 72, Greece
(Bousoula) Department of Cardiology, Tzaneio General Hospital, Piraeus 185
36, Greece
(Tsiafoutis) First Department of Cardiology, Red Cross Hospital, Athens
115 26, Greece
(Hamilos) Department of Cardiology, Heraklion University Hospital, Crete,
Heraklion 715 00, Greece
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi 6042, Belgium
Publisher
MDPI
Abstract
Cardiovascular (CV) events in patients with cancer can be caused by
concomitant CV risk factors, cancer itself, and anticancer therapy. Since
malignancy can dysregulate the hemostatic system, predisposing cancer
patients to both thrombosis and hemorrhage, the administration of dual
antiplatelet therapy (DAPT) to patients with cancer who suffer from acute
coronary syndrome (ACS) or undergo percutaneous coronary intervention
(PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS,
other structural interventions, such as TAVR, PFO-ASD closure, and LAA
occlusion, and non-cardiac diseases, such as PAD and CVAs, may require
DAPT. The aim of the present review is to review the current literature on
the optimal antiplatelet therapy and duration of DAPT for oncologic
patients, in order to reduce both the ischemic and bleeding risk in this
high-risk population.<br/>Copyright &#xa9; 2023 by the authors.

<110>
[Use Link to view the full text]
Accession Number
2024037271
Title
Neurocognitive, Quality of Life, and Behavioral Outcomes for Patients with
Covert Stroke after Cardiac Surgery: Exploratory Analysis of Data from a
Prospectively Randomized Trial.
Source
Anesthesia and Analgesia. 133(5) (pp 1187-1196), 2021. Date of
Publication: 01 Nov 2021.
Author
Lewis C.; Levine A.; Balmert L.C.; Chen L.; Sherwani S.S.; Nemeth A.J.;
Grafman J.; Gottesman R.; Brown C.H.; Hogue C.W.
Institution
(Lewis, Levine, Sherwani, Hogue) Department of Anesthesiology, United
States
(Balmert, Chen) Division of Biostatistics, Department of Preventive
Medicine, United States
(Nemeth) Department of Radiology, United States
(Grafman) Shirley Ryan Abilitylab, Department of Rehabilitation and
Physical Medicine, Northwestern University, Feinberg School of Medicine,
Chicago, IL, United States
(Gottesman) Department of Neurology, United States
(Brown) Department of Anesthesiology & Critical Care, The Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Asymptomatic brain ischemic injury detected with
diffusion-weighted magnetic resonance imaging (DWI) is reported in more
than one-half of patients after cardiac surgery. There are conflicting
findings on whether DWI-detected covert stroke is associated with
neurocognitive dysfunction after surgery, and it is unclear whether such
ischemic injury affects quality of life or behavioral outcomes. The
purpose of this study was to perform exploratory analysis on whether
covert stroke after cardiac surgery is associated with delayed
neurocognitive recovery 1 month after surgery, impaired quality of life,
anxiety, or depression. <br/>METHOD(S): Analysis of data collected in a
prospectively randomized study in patients undergoing cardiac surgery
testing whether basing mean arterial pressure (MAP) targets during
cardiopulmonary bypass to be above the lower limit of cerebral
autoregulation versus usual practices reduces the frequency of adverse
neurological outcomes. A neuropsychological testing battery was
administered before surgery and then 1 month later. Patients underwent
brain magnetic resonance imaging (MRI) between postoperative days 3 and 5.
The primary outcome was DWI-detected ischemic lesion; the primary end
point was change from baseline in domain-specific neurocognitive Z scores
1 month after surgery. Secondary outcomes included a composite indicator
of delayed neurocognitive recovery, quality of life measures, state and
trait anxiety, and Beck Depression Inventory scores. <br/>RESULT(S): Of
the 164 patients with postoperative MRI data, clinical stroke occurred in
10 patients. Of the remaining 154 patients, 85 (55.2%) had a covert
stroke. There were no statistically significant differences for patients
with or without covert stroke in the change from baseline in Z scores in
any of the cognitive domains tested adjusted for sex, baseline cognitive
score, and randomization treatment arm. The frequency of delayed
neurocognitive recovery (no covert stroke, 15.1%; covert stroke, 17.6%; P
=.392), self-reported quality of life measurements, anxiety rating, or
depression scores were not different between those with or without DWI
ischemic injury. <br/>CONCLUSION(S): More than one-half of patients
undergoing cardiac surgery demonstrated covert stroke. In this exploratory
analysis, covert stroke was not found to be significantly associated with
neurocognitive dysfunction 1 month after surgery; evidence of impaired
quality of life, anxiety, or depression, albeit a type II error, cannot be
excluded.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins. All
rights reserved.

<111>
[Use Link to view the full text]
Accession Number
2024037228
Title
Association between Cerebral Desaturation and Postoperative Delirium in
Thoracotomy with One-Lung Ventilation: A Prospective Cohort Study.
Source
Anesthesia and Analgesia. 133(1) (pp 176-186), 2021. Date of Publication:
01 Jul 2021.
Author
Cui F.; Zhao W.; Mu D.-L.; Zhao X.; Li X.-Y.; Wang D.-X.; Jia H.-Q.; Dai
F.; Meng L.
Institution
(Cui, Mu, Wang) Department of Anesthesiology and Critical Care, Peking
University First Hospital, Beijing, China
(Zhao, Jia) Department of Anesthesiology, The Fourth Hospital of Hebei
Medical University, Shijiazhuang, China
(Zhao) Department of Anesthesiology, Second Xiangya Hospital, Central
South University, Changsha, China
(Zhao, Meng) Department of Anesthesiology, Yale University, School of
Medicine, New Haven, CT, United States
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Dai) Department of Biostatistics, Yale University, School of Public
Health, New Haven, CT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The association between cerebral desaturation and
postoperative delirium in thoracotomy with one-lung ventilation (OLV) has
not been specifically studied. <br/>METHOD(S): A prospective observational
study performed in thoracic surgical patients. Cerebral tissue oxygen
saturation (Scto<inf>2</inf>) was monitored on the left and right
foreheads using a near-infrared spectroscopy oximeter. Baseline
Scto<inf>2</inf>was measured with patients awake and breathing room air.
The minimum Scto<inf>2</inf>was the lowest measurement at any time during
surgery. Cerebral desaturation and hypersaturation were an episode of
Scto<inf>2</inf>below and above a given threshold for >=15 seconds during
surgery, respectively. The thresholds based on relative changes by
referring to the baseline measurement were <80%, <85%, <90%, <95%, and
<100% baseline for desaturation and >105%, >110%, >115%, and >120%
baseline for hypersaturation. The thresholds based on absolute values were
<50%, <55%, <60%, <65%, and <70% for desaturation and >75%, >80%, >85%,
and >90% for hypersaturation. The given area under the threshold
(AUT)/area above the threshold (AAT) was analyzed. Delirium was assessed
until postoperative day 5. The primary analysis was the association
between the minimum Scto<inf>2</inf>and delirium using multivariable
logistic regression controlled for confounders (age, OLV time, use of
midazolam, occurrence of hypotension, and severity of pain). The secondary
analysis was the association between cerebral desaturation/hypersaturation
and delirium, and between the AUT/AAT and delirium using multivariable
logistic regression controlled for the same confounders. Multiple testing
was corrected using the Holm-Bonferroni method. We additionally monitored
somatic tissue oxygen saturation on the forearm and upper thigh.
<br/>RESULT(S): Delirium occurred in 35 (20%) of 175 patients (65 +/- 6
years old). The minimum left or right Scto<inf>2</inf>was not associated
with delirium. Cerebral desaturation defined by <90% baseline for left
Scto<inf>2</inf>(odds ratio [OR], 5.82; 95% confidence interval [CI],
2.12-19.2; corrected P =.008) and <85% baseline for right
Scto<inf>2</inf>(OR, 4.27; 95% CI, 1.77-11.0; corrected P =.01) was
associated with an increased risk of delirium. Cerebral desaturation
defined by other thresholds, cerebral hypersaturation, the AUT/AAT, and
somatic desaturation and hypersaturation were all not associated with
delirium. <br/>CONCLUSION(S): Cerebral desaturation defined by <90%
baseline for left Scto<inf>2</inf>and <85% baseline for right
Scto<inf>2</inf>, but not the minimum Scto<inf>2</inf>, may be associated
with an increased risk of postthoracotomy delirium. The validity of these
thresholds needs to be tested by randomized controlled
trials.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins. All
rights reserved.

<112>
Accession Number
2022779829
Title
Transcatheter Aortic Valve Replacement for Aortic Valve Infective
Endocarditis: A Systematic Review and Call for Action.
Source
Cardiology and Therapy. (no pagination), 2023. Date of Publication: 2023.
Author
Brankovic M.; Hashemi A.; Ansari J.; Sharma A.
Institution
(Brankovic, Hashemi) Department of Medicine, Rutgers New Jersey Medical
School, Newark, NJ, United States
(Brankovic) Transatlantic Cardiovascular Study Group, Bloomfield, NJ,
United States
(Ansari) Department of Cardiology, Newark Beth Israel Medical Center,
Newark, NJ, United States
(Sharma) Division of Cardiology, Department of Medicine, New Jersey
Medical School, Newark, NJ, United States
Publisher
Adis
Abstract
We aimed to systematically analyze the literature on the use of
transcatheter aortic valve replacement (TAVR) to treat active aortic valve
infective endocarditis (AV-IE). Surgery is declined in one-third of
patients with IE who meet indications because of prohibitive surgical
risk. TAVR might be an alternative for selected patients with AV-IE as a
bridge-to-surgery or stand-alone therapy. PubMed/MEDLINE, Embase, and
Cochrane databases were searched (2002-2022) for studies on TAVR use in
active AV-IE. Of 450 identified reports, six met inclusion criteria (all
men, mean age 71 +/- 12 years, median Society of Thoracic Surgeons (STS)
score 27, EuroSCORE 56). All patients were prohibitive surgical risk
candidates. Five out of six patients had severe, and one patient had
moderate aortic regurgitation on presentation. Five out of six patients
had prosthetic valve endocarditis after surgical valve replacement 13
years before (median), and one patient had TAVR a year before
hospitalization. All patients had cardiogenic shock as the indication for
TAVR. Four patients received balloon-expanding, and two patients received
self-expanding TAVR after a median of 19 (IQR 9-25) days from diagnosis of
IE. No death or myocardial infarction occurred, but one patient had a
stroke within the first 30 days. The median event-free time was 9 (IQR
6-14) months including no death, reinfection, relapse IE, or valve-related
rehospitalization. Our review suggests that TAVR can be considered as an
adjuvant therapy to medical treatment for selected patients in whom
surgery is indicated for treatment of acute heart failure due to aortic
valve destruction and incompetence caused by infective endocarditis, but
who have a prohibitive surgical risk. Nonetheless, a well-designed
prospective registry is urgently needed to investigate the outcomes of
TAVR for this off-label indication. No evidence exists for using the TAVR
to treat infection-related surgical indications such as uncontrolled
infection or control of septic embolization.<br/>Copyright &#xa9; 2023,
The Author(s).

<113>
Accession Number
2022708433
Title
Pragmatic evaluation of events and benefits of lipid lowering in older
adults (PREVENTABLE): Trial design and rationale.
Source
Journal of the American Geriatrics Society. (no pagination), 2023. Date
of Publication: 2023.
Author
Joseph J.; Pajewski N.M.; Dolor R.J.; Sellers M.A.; Perdue L.H.; Peeples
S.R.; Henrie A.M.; Woolard N.; Jones W.S.; Benziger C.P.; Orkaby A.R.;
Mixon A.S.; VanWormer J.J.; Shapiro M.D.; Kistler C.E.; Polonsky T.S.;
Chatterjee R.; Chamberlain A.M.; Forman D.E.; Knowlton K.U.; Gill T.M.;
Newby L.K.; Hammill B.G.; Cicek M.S.; Williams N.A.; Decker J.E.; Ou J.;
Choudhary G.; Gazmuri R.J.; Schmader K.E.; Roumie C.L.; Vaughan C.P.;
Effron M.B.; Cooper-DeHoff R.M.; Supiano M.A.; Shah R.C.; Whittle J.C.;
Hernandez A.F.; Ambrosius W.T.; Williamson J.D.; Alexander K.P.; Romashkan
S.; Fine L.; Weiner M.; Cooper-DeHoff R.; Jones S.; Callahan K.; Espinoza
S.; Rubinstein J.; Snyder H.; Carrillo M.; Rothman R.; Shenkman B.; Carton
T.; Nauman B.; McTique K.; Jefferson M.; Wing J.; Bloodworth S.; Owens A.;
Bordelon L.; Heimberg M.; Massey J.; Gonzalez M.; Brashears B.; Kaczkowski
K.; King M.; Hoisington K.; Lovato J.; Almonte J.; White J.; Gaziano M.;
Lovato L.; Poddar K.; Taylor Z.; Hunt D.; Hervey J.; Kelsey M.; Leverty
R.; Batch B.; Richmond A.; Hufstedler M.; Chang A.; Hetzel J.; Laffey M.;
Pahor M.; Houston D.; Kitzman D.; Rapp S.; Sachs B.; Lang S.; Nulph R.;
Rives E.; Zieman S.; Newman A.; Kapitanovsky K.; Reboussin D.; Cicek M.;
Halverson K.; Gaussoin S.; Dohner C.; Monds P.; Alred C.; Bowman J.; Bunke
J.; Deckard N.; Lowe T.; Thiel R.; VanDoren K.; Whiteside H.; Reuben D.;
Peduzzi P.; Solomon S.; Florez H.; Breitner J.; Greenland P.; Travison T.;
Waitman R.; Bancks M.; Burnet K.; Telzak A.; Vanterpool Y.E.; Oberembt S.;
Davies I.; Shade L.; Strout K.; Kitzman H.; Patel M.; Rao G.; Ufholz K.;
Rao S.; Cardoso E.; Allen J.; Kulshreshtha A.; Brown W.; Cripps S.; Ford
D.; Gauvey-Kern M.; Meilander A.; Kohnhorst D.; Rosas S.; Druckrey J.;
Loepfe T.; Kaseno J.; Berendt M.; Akatue R.; Houtschilt S.; Linder J.;
Brown T.; Bazzano L.; Williams S.; Brill S.; Jindra M.; Yurko E.; Tapan
M.; Kirkwood L.; Azhar G.; Pangle A.; Carlson M.; Lu J.; Wells B.; Gordon
H.; Ashley N.; Ernst M.; Grdinovac K.; Lower E.; Hart J.; Carrasquillo O.;
Linares V.; Hall M.; Boyer L.; Hahn-Cover K.; Grieshaber V.; Fisher A.;
Kirke S.; Ake J.; Klawson E.; Lee J.; Johnson K.; Musi N.; Brown K.; Rubin
C.; Thompson G.; Bah H.; Wharton J.; Wall M.; Zamora E.; Betancourt J.;
Binder E.; Young A.; Goyal P.; Park F.; Almonte A.; Carlsson C.; Zylstra
H.; Munoz A.; Tinker A.; Soe K.; Clarke J.-A.; Vu K.; Hy C.; Lee C.; Zeng
A.; Hallock A.; Reuben-Hallock K.; Malm B.; Spreyer K.; Yaksic E.; Lee P.;
Runge C.; Kundu S.; Chau K.; Rodriguez-Cintron W.; Fuentes-Medina S.;
White S.M.; Liu M.; Romero I.; Tavabi A.; Penny W.; St. John M.; Eleazer
P.; Thongsa S.; Krishnasamy S.; Ricks J.; Walsh J.; Espique L.; Fernandes
J.; Willis T.; Ricci A.; Peek B.; Michael J.; Lockhart M.; Hall D.; Withee
C.; Markland A.; Davis D.; Todela T.; Sullivan D.; Sawyer L.; Lorscheter
J.; Gupta A.; Castle T.; Reynolds J.; Kramer H.; Kirchner K.; Spencer
A.K.; Godschalk M.; Taylor C.; Atlas S.; Guerrero R.B.; Kansal M.; Tenorio
J.; Singh V.; Kiran S.; Albert M.; Knipping V.; Childress R.; Beaverson
B.; Tamariz L.; Denizard J.; Peruvemba S.; Venetucci J.; Shivaswamy V.;
Ramalingam R.
Institution
(Joseph) VA Providence Healthcare System, Providence, RI, United States
(Pajewski, Perdue, Woolard, Shapiro, Ambrosius, Williamson) Wake Forest
University School of Medicine, Winston-Salem, NC, United States
(Dolor, Sellers, Jones, Chatterjee, Newby, Hammill, Hernandez, Alexander)
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, United States
(Peeples) VA Boston Healthcare System, Boston, MA, United States
(Henrie) Cooperative Studies Program Clinical Research Pharmacy
Coordinating Center, Office of Research and Development, Department of
Veterans Affairs, Albuquerque, NM, United States
(Benziger) Essentia Health, Duluth, MN, United States
(Orkaby) New England Geriatric Research, Education, and Clinical Center
(GRECC), VA Boston Healthcare System, and Division of Aging, Brigham &
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Mixon, Roumie) Vanderbilt University Medical Center and Geriatric
Research Education and Clinical Center (GRECC), VA Tennessee Valley
Healthcare System, Nashville, TN, United States
(VanWormer) Marshfield Clinical Research Institute, Marshfield, WI, United
States
(Kistler) Department of Family Medicine, School of Medicine, University of
North Carolina at Chapel Hill, NC, United States
(Polonsky) University of Chicago Medicine, Chicago, IL, United States
(Chamberlain, Cicek) Mayo Clinic, Rochester, MN, United States
(Forman) Department of Medicine, Sections of Geriatrics and Cardiology,
University of Pittsburgh, Pittsburgh GRECC, VA Pittsburgh Healthcare
System, Pittsburgh, PA, United States
(Knowlton) Intermountain Healthcare, Salt Lake City, UT, United States
(Gill) Yale School of Medicine, New Haven, CT, United States
(Williams) TN CEAL, Nashville, TN, United States
(Decker) Section of Primary Care Medicine, Medical College of Wisconsin,
Milwaukee, WI, United States
(Ou) Cardiology Division, John Cochran VA Medical Center and Cardiology
Division, Washington University School of Medicine, St. Louis, MO, United
States
(Rubinstein) Division of Cardiology, Cincinnati VAMC and Division of
Cardiovascular Diseases, Department of Internal Medicine, College of
Medicine, University of Cincinnati, Cincinnati, OH, United States
(Choudhary) Providence VA Medical Center, and Lifespan Cardiovascular
Institute, Alpert Medical School of Brown University, Providence, RI,
United States
(Gazmuri) Captain James A. Lovell Federal Health Care Center, Rosalind
Franklin University of Medicine and Science, Chicago, IL, United States
(Schmader) Duke University and GRECC, Durham VA Medical Center, Durham,
NC, United States
(Vaughan) Birmingham/Atlanta Geriatric Research Education and Clinical
Center (GRECC), Department of Veterans Affairs, and Division of Geriatrics
& Gerontology, Department of Medicine, Emory University, Atlanta, GA,
United States
(Effron) John Ochsner Heart and Vascular Institute, The University of
Queensland Ochsner Clinical School, New Orleans, LA, United States
(Cooper-DeHoff) University of Florida, College of Pharmacy and College of
Medicine, Gainesville, FL, United States
(Supiano) The University of Utah, Salt Lake, UT, United States
(Shah) Family & Preventive Medicine and the Rush Alzheimer's Disease
Center, Rush University, Chicago, IL, United States
(Whittle) Clement J Zablocki VA Medical Center, Milwaukee, WI, United
States
Publisher
John Wiley and Sons Inc
Abstract
Whether initiation of statins could increase survival free of dementia and
disability in adults aged >=75 years is unknown. PREVENTABLE, a
double-blind, placebo-controlled randomized pragmatic clinical trial, will
compare high-intensity statin therapy (atorvastatin 40 mg) with placebo in
20,000 community-dwelling adults aged >=75 years without cardiovascular
disease, disability, or dementia at baseline. Exclusion criteria include
statin use in the prior year or for >5 years and inability to take a
statin. Potential participants are identified using computable phenotypes
derived from the electronic health record and local referrals from the
community. Participants will undergo baseline cognitive testing, with
physical testing and a blinded lipid panel if feasible. Cognitive testing
and disability screening will be conducted annually. Multiple data sources
will be queried for cardiovascular events, dementia, and disability;
survival is site-reported and supplemented by a National Death Index
search. The primary outcome is survival free of new dementia or persisting
disability. Co-secondary outcomes are a composite of cardiovascular death,
hospitalization for unstable angina or myocardial infarction, heart
failure, stroke, or coronary revascularization; and a composite of mild
cognitive impairment or dementia. Ancillary studies will offer mechanistic
insights into the effects of statins on key outcomes. Biorepository
samples are obtained and stored for future study. These results will
inform the benefit of statins for increasing survival free of dementia and
disability among older adults. This is a pioneering pragmatic study
testing important questions with low participant burden to align with the
needs of the growing population of older adults.<br/>Copyright &#xa9; 2023
The American Geriatrics Society. This article has been contributed to by
U.S. Government employees and their work is in the public domain in the
USA.

<114>
Accession Number
2022675907
Title
Machine learning to predict myocardial injury and death after non-cardiac
surgery.
Source
Anaesthesia. (no pagination), 2023. Date of Publication: 2023.
Author
Nolde J.M.; Schlaich M.P.; Sessler D.I.; Mian A.; Corcoran T.B.; Chow
C.K.; Chan M.T.V.; Borges F.K.; McGillion M.H.; Myles P.S.; Mills N.L.;
Devereaux P.J.; Hillis G.S.
Institution
(Nolde, Schlaich) Dobney Hypertension Centre, Royal Perth Hospital
Research Foundation, Perth, Australia
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Mian) School of Computer Science and Software Engineering, University of
Western Australia, Perth, Australia
(Corcoran) Department of Anaesthesia and Pain Medicine, Royal Perth
Hospital and Medical School, University of Western Australia and
Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital
and Monash University, Melbourne, Australia
(Chow) Westmead Applied Research Centre, Faculty of Medicine and Health,
University of Sydney, and Department of Cardiology, Westmead Hospital,
Sydney, Australia
(Chan) Department of Anaesthesia and Intensive Care, The Chinese
University of Hong Kong, Hong Kong
(Borges, McGillion, Devereaux) McMaster University, Faculty of Health
Sciences and Population Health Research Institute, Hamilton, ON, Canada
(Myles) Department of Anaesthesiology and Peri-operative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
(Mills) British Heart Foundation Centre for Cardiovascular Science,
University of Edinburgh and Usher Institute, Edinburgh, United Kingdom
(Hillis) Medical School, University of Western Australia and Department of
Cardiology, Royal Perth Hospital, Perth, Australia
Publisher
John Wiley and Sons Inc
Abstract
Myocardial injury due to ischaemia within 30 days of non-cardiac surgery
is prognostically relevant. We aimed to determine the discrimination,
calibration, accuracy, sensitivity and specificity of single-layer and
multiple-layer neural networks for myocardial injury and death within 30
postoperative days. We analysed data from 24,589 participants in the
Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation study.
Validation was performed on a randomly selected subset of the study
population. Discrimination for myocardial injury by single-layer vs.
multiple-layer models generated areas (95%CI) under the receiver operating
characteristic curve of: 0.70 (0.69-0.72) vs. 0.71 (0.70-0.73) with
variables available before surgical referral, p < 0.001; 0.73 (0.72-0.75)
vs. 0.75 (0.74-0.76) with additional variables available on admission, but
before surgery, p < 0.001; and 0.76 (0.75-0.77) vs. 0.77 (0.76-0.78) with
the addition of subsequent variables, p < 0.001. Discrimination for death
by single-layer vs. multiple-layer models generated areas (95%CI) under
the receiver operating characteristic curve of: 0.71 (0.66-0.76) vs. 0.74
(0.71-0.77) with variables available before surgical referral, p = 0.04;
0.78 (0.73-0.82) vs. 0.83 (0.79-0.86) with additional variables available
on admission but before surgery, p = 0.01; and 0.87 (0.83-0.89) vs. 0.87
(0.85-0.90) with the addition of subsequent variables, p = 0.52. The
accuracy of the multiple-layer model for myocardial injury and death with
all variables was 70% and 89%, respectively.<br/>Copyright &#xa9; 2023 The
Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of
Association of Anaesthetists.

<115>
Accession Number
641124175
Title
Perioperative Arrhythmias.
Source
Deutsches Arzteblatt international. (Forthcoming) (no pagination), 2023.
Date of Publication: 21 Aug 2023.
Author
Pecha S.; Kirchhof P.; Reissmann B.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Perioperative arrhythmias are common depending on the type of
the operation and can increase morbidity and mortality. <br/>METHOD(S):
This review is based on pertinent publications retrieved by a selective
search in PubMed, as well as the relevant European guidelines.
<br/>RESULT(S): Arrhythmias are seen in more than 90% of cardiac
operations; they are usually transient and often asymptomatic. The risk
factors for arrhythmia include ion channel diseases, old age, structural
heart disease, cardiac surgery, noncardiac surgery with major fluid
shifts, and pulmonary resection. The full spectrum of supraventricular and
ventricular arrhythmias can arise perioperatively. Correct ECG
interpretation, consideration of the arrhythmia in the overall clinical
context, and an understanding of its causes, pathophysiology, and options
for effective treatment are critically important. According to a
meta-analysis, beta-blockers lower the risk of perioperative atrial
fibrillation (OR = 0.56; 95% confidence interval: [0.35; 0.91]). If
anticoagulant treatment is not interrupted for surgery, there is less
bleeding with direct oral anticoagulants than with vitamin K antagonists
(relative risk: 0.62 [0.47; 0.82]). Moreover, clinical follow-up is
important, especially for patients with new-onset atrial fibrillation or
heart failure. <br/>CONCLUSION(S): The identification of high-risk
patients and the provision of individualized perioperative monitoring are
essential aspects of patient safety. Outpatient cardiological follow-up
can improve outcomes.

<116>
Accession Number
641123294
Title
Patient-, Clinician-, and Institution-level Variation in Inotrope Use for
Cardiac Surgery: A Multicenter Observational Analysis.
Source
Anesthesiology. (no pagination), 2023. Date of Publication: 24 Apr 2023.
Author
Mathis M.R.; Janda A.M.; Kheterpal S.; Schonberger R.B.; Pagani F.D.;
Engoren M.C.; Mentz G.B.; Shook D.C.; Muehlschlegel J.D.
Institution
(Mathis, Janda, Kheterpal, Engoren, Mentz) Department of Anesthesiology,
University of Michigan Medical School, Ann Arbor, MI, United States
(Mathis) Department of Computational Bioinformatics, University of
Michigan Medical School, Ann Arbor, MI, United States
(Schonberger) Department of Anesthesiology, Yale School of Medicine, New
Haven, CT, United States
(Pagani) Department of Cardiac Surgery, University of Michigan Medical
School, Ann Arbor MI 48109, United States
(Shook, Muehlschlegel) Department of Anesthesiology, Pain Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Conflicting evidence exists regarding the risks and benefits
of inotropic therapies during cardiac surgery, and the extent of variation
in clinical practice remains understudied. Therefore, the authors sought
to quantify patient-, anesthesiologist-, and hospital-related
contributions to variation in inotrope use. <br/>METHOD(S): In this
observational study, non-emergent adult cardiac surgeries using
cardiopulmonary bypass were reviewed across a multicenter cohort of
academic and community hospitals from 2014 to 2019. Patients who were
moribund, receiving mechanical circulatory support, or receiving
preoperative/home inotropes were excluded. The primary outcome was an
inotrope infusion (epinephrine, dobutamine, milrinone, dopamine)
administered for greater than 60 consecutive minutes intraoperatively or
ongoing upon transport from the operating room. Institution-, clinician-,
and patient-level variance components were studied. <br/>RESULT(S): Among
51,085 cases across 611 attending anesthesiologists and 29 hospitals,
27,033 (52.9%) cases received at least one intraoperative inotrope,
including 21,796 (42.7%) epinephrine, 6,360 (12.4%) milrinone, 2,000
(3.9%) dobutamine, and 602 (1.2%) dopamine (non-mutually exclusive).
Variation in inotrope use was 22.6% attributable to the institution, 6.8%
to the primary attending anesthesiologist, and 70.6% to the patient. The
adjusted median odds ratio for the same patient receiving inotropes was
1.73 between two randomly selected clinicians and 3.55 between two
randomly selected institutions. Factors most strongly associated with
increased likelihood of inotrope use were institutional medical school
affiliation (adjusted odds ratio 6.2, 95% CI 1.39-27.8), heart failure
(2.60, 2.46-2.76), pulmonary circulation disorder (1.72, 1.58-1.87), loop
diuretic home medication (1.55, 1.42-1.69), Black race (1.49, 1.32-1.68),
and digoxin home medication (1.48, 1.18-1.86). <br/>CONCLUSION(S):
Variation in inotrope use during cardiac surgery is attributable to the
institution and clinician in addition to the patient. Variation across
institutions and clinicians suggests a need for future quantitative and
qualitative research to understand variation in inotrope use impacting
outcomes and develop evidence-based, patient-centered inotrope
therapies.<br/>Copyright &#xa9; 2023, the American Society of
Anesthesiologists. All Rights Reserved.

<117>
Accession Number
641122790
Title
Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in
Noncardiac Surgery : An International Randomized Controlled Trial.
Source
Annals of internal medicine. (no pagination), 2023. Date of Publication:
25 Apr 2023.
Author
Marcucci M.; Painter T.W.; Conen D.; Lomivorotov V.; Sessler D.I.; Chan
M.T.V.; Borges F.K.; Leslie K.; Duceppe E.; Martinez-Zapata M.J.; Wang
C.Y.; Xavier D.; Ofori S.N.; Wang M.K.; Efremov S.; Landoni G.;
Kleinlugtenbelt Y.V.; Szczeklik W.; Schmartz D.; Garg A.X.; Short T.G.;
Wittmann M.; Meyhoff C.S.; Amir M.; Torres D.; Patel A.; Ruetzler K.;
Parlow J.L.; Tandon V.; Fleischmann E.; Polanczyk C.A.; Lamy A.; Jayaram
R.; Astrakov S.V.; Wu W.K.K.; Cheong C.C.; Ayad S.; Kirov M.; de Nadal M.;
Likhvantsev V.V.; Paniagua P.; Aguado H.J.; Maheshwari K.; Whitlock R.P.;
McGillion M.H.; Vincent J.; Copland I.; Balasubramanian K.; Biccard B.M.;
Srinathan S.; Ismoilov S.; Pettit S.; Stillo D.; Kurz A.; Belley-Cote
E.P.; Spence J.; McIntyre W.F.; Bangdiwala S.I.; Guyatt G.; Yusuf S.;
Devereaux P.J.
Institution
(Marcucci, Conen, Borges, Ofori, Wang, Lamy, Whitlock, McGillion, Vincent,
Copland, Balasubramanian, Pettit, Stillo, Belley-Cote, Spence, McIntyre,
Bangdiwala, Yusuf, Devereaux) Population Health Research Institute,
Hamilton, Ontario, Canada (M.M., D.C., F.K.B., S.N.O., M.K.W., A.L.,
R.P.W., M.H.M., J.V., I.C., K.B., S.P., D.S., E.P.B., J.S., W.F.M.,
S.I.B., S.Y., P.J.D.)
(Painter) Acute Care Medicine, University of Adelaide, Adelaide, SA,
Australia
(Lomivorotov, Ismoilov) Department of Anesthesiology and Intensive Care,
E. Meshalkin National Medical Research Centre, Novosibirsk, Russian
Federation
(Sessler, Ruetzler, Ayad, Maheshwari, Kurz) Anesthesiology Institute,
Department of Outcomes Research, Cleveland Clinic, K.M., Cleveland, S.A,
United States
(Chan, Wu) Chinese University of Hong Kong, Hong Kong Special
Administrative Region, China (M.T.V.C., China
(Leslie) Department of Critical Care Medicine, Melbourne Medical School,
University of Melbourne, Melbourne, VIC, United Kingdom
(Duceppe) Department of Medicine, Centre Hospitalier de l'Universite de
Montreal, Montreal, QC, Canada
(Martinez-Zapata) Iberoamerican Cochrane Centre, Public Health and
Clinical Epidemiology Service, IIB Sant Pau, CIBERESP, Barcelona,
Philippines
(Wang, Cheong) Department of Anesthesiology, Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia
(Xavier) St. John's Medical College, Bangalore
(Efremov) Saint Petersburg State University Hospital, Saint Petersburg,
United States
(Landoni) Department of Anesthesiology and Intensive Care, IRCCS San
Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan,
United States
(Kleinlugtenbelt) Department of Orthopedic and Trauma Surgery, Deventer
Ziekenhuis, Deventer, Netherlands
(Szczeklik) Centre for Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Poland (W.S.), Krakow, Poland
(Schmartz) CHU Brugmann, Universite Libre de Bruxelles, Brussels, Belgium
(Garg) Department of Medicine, Western University, London, ON, Canada
(Short) Department of Anaesthesia, Auckland City Hospital, Auckland, New
Zealand
(Wittmann) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Germany (M.W.), Bonn, Germany
(Meyhoff) Department of Anesthesia and Intensive Care, Copenhagen
University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
(Amir) Department of Surgery, Shifa International Hospital and Shifa
Tameer-e-Millat University, Islamabad, Pakistan
(Torres) Departamento de Epidemiologia y Estudios en Salud, Universidad de
Los Andes, Santiago, Dominican Republic
(Patel, Tandon) Department of Medicine, McMaster University, Hamilton,
Ontario, Canada (A.P., V.T.)
(Parlow) Department of Anesthesiology and Perioperative Medicine, Queen's
University, and Kingston Health Sciences Centre, Kingston, Ontario, Canada
(J.L.P.)
(Fleischmann) Department of Anesthesia, Intensive Care Medicine and Pain
Medicine, Medical University of Vienna, Vienna, Austria
(Polanczyk) UFRGS, Hospital de Clinicas de Porto Alegre, National
Institute for Health Technology Assessment, IATS; Hospital Moinhos de
Vento, Porto Alegre, Brazil (C.A.P.)
(Jayaram) Department of Anaesthetics, Clinical Neurosciences, University
of Oxford, Oxford University Hospitals NHS Trust, United Kingdom (R.J.),
Oxford, United Kingdom
(Astrakov) Department of Anesthesiology, Novosibirsk State University,
Novosibirsk, Russian Federation
(Kirov) Department of Anesthesiology and Intensive Care Medicine, Northern
State Medical University, Russian Federation
(de Nadal) Department of Anesthesiology and Intensive Care, Hospital Vall
d'Hebron, Universitat Autonoma de Barcelona, Spain (M. de N.), Barcelona,
Philippines
(Likhvantsev) V. Negovsky Reanimatology Research Institute, Moscow,
Russian Federation
(Paniagua) Anesthesiology Department, Santa Creu i Sant Pau University
Hospital, Barcelona, Philippines
(Aguado) Trauma & Orthopaedic Surgery Department, Hospital Clinico
Universitario de Valladolid, Valladolid, Mexico
(Biccard) Department of Anesthesia and Perioperative Medicine, Groote
Schuur Hospital, University of Cape Town, South Africa (B.M.B.), Cape
Town, South Africa
(Srinathan) Section of Thoracic Surgery, Department of Surgery, University
of Manitoba, Winnipeg, MB, Canada
(Guyatt) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada (G.G.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Among patients having noncardiac surgery, perioperative
hemodynamic abnormalities are associated with vascular complications.
Uncertainty remains about what intraoperative blood pressure to target and
how to manage long-term antihypertensive medications perioperatively.
<br/>OBJECTIVE(S): To compare the effects of a hypotension-avoidance and a
hypertension-avoidance strategy on major vascular complications after
noncardiac surgery. DESIGN: Partial factorial randomized trial of 2
perioperative blood pressure management strategies (reported here) and
tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723).
SETTING: 110 hospitals in 22 countries. PATIENTS: 7490 patients having
noncardiac surgery who were at risk for vascular complications and were
receiving 1 or more long-term antihypertensive medications. INTERVENTION:
In the hypotension-avoidance strategy group, the intraoperative mean
arterial pressure target was 80mm Hg or greater; before and for 2days
after surgery, renin-angiotensin-aldosterone system inhibitors were
withheld and the other long-term antihypertensive medications were
administered only for systolic blood pressures 130mm Hg or greater,
following an algorithm. In the hypertension-avoidance strategy group, the
intraoperative mean arterial pressure target was 60mm Hg or greater; all
antihypertensive medications were continued before and after surgery.
MEASUREMENTS: The primary outcome was a composite of vascular death and
nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac
arrest at 30days. Outcome adjudicators were masked to treatment
assignment. <br/>RESULT(S): The primary outcome occurred in 520 of 3742
patients (13.9%) in the hypotension-avoidance group and in 524 of 3748
patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99
[95% CI, 0.88 to 1.12]; P =0.92). Results were consistent for patients who
used 1 or more than 1 antihypertensive medication in the long term.
LIMITATION: Adherence to the assigned strategies was suboptimal; however,
results were consistent across different adherence levels.
<br/>CONCLUSION(S): In patients having noncardiac surgery, our
hypotension-avoidance and hypertension-avoidance strategies resulted in a
similar incidence of major vascular complications. PRIMARY FUNDING SOURCE:
Canadian Institutes of Health Research, National Health and Medical
Research Council (Australia), and Research Grant Council of Hong Kong.

<118>
Accession Number
641093396
Title
Statin loading before coronary artery bypass grafting: a randomized trial.
Source
European heart journal. (no pagination), 2023. Date of Publication: 22
Apr 2023.
Author
Liakopoulos O.J.; Kuhn E.W.; Hellmich M.; Schlomicher M.; Strauch J.;
Reents W.; Diegeler A.; Thielmann M.; Wendt D.; Borgermann J.; Gummert
J.F.; Stoppe C.; Goetzenich A.; Martens S.; Reichenspurner H.; Wippermann
J.; Reuter H.; Choi Y.-H.; Wahlers T.
Institution
(Liakopoulos, Kuhn, Choi, Wahlers) Department of Cardiothoracic Surgery,
University Hospital Cologne, Kerpener Str. 62, Cologne 50937, Germany
(Liakopoulos, Choi) Department of Cardiac Surgery, Kerckhoff-Clinic,
Justus-Liebig-University of Giessen, Campus KerckhoffBenekestr. 2-8, Bad
Nauheim 61231, Germany
(Hellmich) Institute of Medical Statistics and Computational Biology,
University Hospital Cologne, Cologne, Germany
(Schlomicher, Strauch) Department of Cardiothoracic Surgery,
Ruhr-University Hospital Bergmannsheil, Bochum, Germany
(Reents, Diegeler) Department of Cardiac Surgery, Bad Neustadt a. d.
Saale, Germany
(Thielmann, Wendt) Department of Thoracic and Cardiovascular Surgery, West
German Heart and Vascular Center Essen, University Hospital Essen, Essen,
Germany
(Borgermann, Gummert) Clinic for Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum,
Bad Oeynhausen, Germany
(Stoppe, Goetzenich) Department of Thoracic and Cardiovascular Surgery,
University Hospital Aachen, Aachen, Germany
(Martens) Department of Cardiac and Thoracic Surgery, University Hospital
Munster, Munster, Germany
(Reichenspurner) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Hamburg, Germany
(Wippermann) Department of Cardiothoracic Surgery, Otto-von Guericke
University, Magdeburg, Germany
(Reuter) Department of Cardiology, University Hospital Cologne, Cologne,
Germany
Publisher
NLM (Medline)
Abstract
AIMS: Evidence suggests that a high-dose statin loading before a
percutaneous coronary revascularization improves outcomes in patients
receiving long-term statins. This study aimed to analyse the effects of
such an additional statin therapy before surgical revascularization.
METHODS AND RESULTS: This investigator-initiated, randomized,
double-blind, and placebo-controlled trial was conducted from November
2012 to April 2019 at 14 centres in Germany. Adult patients (n = 2635)
with a long-term statin treatment (>=30 days) who were scheduled for
isolated coronary artery bypass grafting (CABG) were randomly assigned to
receive a statin-loading therapy or placebo at 12 and 2 h prior to surgery
using a web-based system. The primary outcome of major adverse cardiac and
cerebrovascular events (MACCE) was a composite consisting of all-cause
mortality, myocardial infarction (MI), and a cerebrovascular event
occuring within 30 days after surgery. Key secondary endpoints included a
composite of cardiac death and MI, myocardial injury, and death within 12
months. Non-statistically relevant differences were found in the modified
intention-to-treat analysis (2406 patients; 1203 per group) between the
statin (13.9%) and placebo groups (14.9%) for the primary outcome [odds
ratio (OR) 0.93, 95% confidence interval (CI) 0.74-1.18; P = 0.562] or any
of its individual components. Secondary endpoints including cardiac death
and MI (12.1% vs. 13.5%; OR 0.88, 95% CI 0.69-1.12; P = 0.300), the area
under the troponin T-release curve (median 0.398 vs. 0.394 ng/ml, P =
0.333), and death at 12 months (3.1% vs. 2.9%; P = 0.825) were comparable
between treatment arms. <br/>CONCLUSION(S): Additional statin loading
before CABG failed to reduce the rate of MACCE occuring within 30 days of
surgery.<br/>Copyright &#xa9; The Author(s) 2023. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<119>
Accession Number
641091655
Title
Percutaneous Closure of Post-Infarct Left Ventricular Pseudoaneurysm; A
Review of Literature.
Source
Current problems in cardiology. (pp 101743), 2023. Date of Publication:
19 Apr 2023.
Author
Naguib M.; Elsayed M.; Khouzam R.N.; Iskander A.
Institution
(Naguib) Bachelor of Medicine and Bachelor of Surgery and Bachelor of
Obstetrics, Roayl college of Surgeons in Ireland & North Lincolnshire and
Goole NHS Trust Junior doctor
(Elsayed) Bachelor of Medicine and Bachelor of Surgery and Bachelor of
Obstetrics, Roayl college of Surgeons in Ireland & Southport at Osmskirk
district hospital NHS Junior doctor, Ireland
(Khouzam) Consultant Interventional Cardiologist, Methodist Health Care
(Iskander) Doctor of Medicine, Consultant Interventional Cardiologist, St.
Joseph's Hospital Cardiology Associates, St. Joseph's Health Hospital
Publisher
NLM (Medline)
Abstract
Left ventricular pseudoaneurysm is a well-known complication of myocardial
infarction and open-heart surgery and has recently been described as
succeeding transapical transcatheter aortic valve replacement (TAVR).
While surgical intervention is the conventional therapeutic approach,
transcatheter closure can be considered in patients at high risk for
surgical procedures. In this article, we present a post-myocardial
infarction pseudoaneurysm for which closure was done via retrograde left
ventricular (LV) access using an Amplatzer Septal Occluder, and provide a
review of recent literature focusing on indications and outcomes of the
different percutaneous techniques and devices.<br/>Copyright &#xa9; 2023.
Published by Elsevier Inc.

<120>
Accession Number
641091151
Title
A machine learning approach to predicting 30-day mortality following
paediatric cardiac surgery: findings from the Australia New Zealand
Congenital Outcomes Registry for Surgery (ANZCORS).
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2023.
Date of Publication: 21 Apr 2023.
Author
Betts K.S.; Marathe S.P.; Chai K.; Konstantinov I.; Iyengar A.; Suna J.;
Venugopal P.; Alphonso N.
Institution
(Betts, Marathe, Suna, Venugopal, Alphonso) Queensland Paediatric Cardiac
Research (QPCR), Brisbane, Australia
(Betts, Chai) School of Population Health, Curtin University, Perth,
Australia
(Marathe, Suna, Venugopal, Alphonso) Queensland Paediatric Cardiac Service
(QPCS), Queensland Children's Hospital, Brisbane, Australia
(Marathe, Suna, Venugopal, Alphonso) School of Clinical Medicine,
Children's Health Queensland Clinical Unit, University of Queensland,
Brisbane, Australia
(Konstantinov) Royal Children's Hospital, Melbourne, Australia
(Iyengar) Starship Children's Hospital, Auckland, New Zealand
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We aim to develop the first risk prediction models for 30-day
mortality for benchmarking outcomes specifically for the Australian and
New Zealand patient populations and examine whether machine learning
algorithms outperform traditional statistical approaches. <br/>METHOD(S):
Data from the Australia New Zealand Congenital Outcomes Registry for
Surgery, which contains information on every paediatric cardiac surgical
encounter in Australian and New Zealand for patients aged <18years between
January 2013 to December 2021 was analysed (n=14,343). The outcome was
mortality within the 30-day period following a surgical encounter, with
approximately 30% of the observations randomly selected to be used for
validation of the final model. Three different ML methods were used, all
of which employed 5-fold cross-validation to prevent overfitting, with
model performance judged primarily by the area under the receiver
operating curve (AUC). <br/>RESULT(S): Among the 14,343 30-day periods
there were 188 deaths (1.3%). In the validation data, the gradient boosted
tree obtained the best performance [AUC=0.87, 95% CI=(0.82, 0.92);
calibration=0.97 95% confidence intervals=(0.72, 1.27)], outperforming
penalised logistic regression and artificial neural networks [AUC of 0.82
and 0.81 respectively]. The strongest predictors of mortality in the GBT
were patient weight, STAT score, age, and gender. <br/>CONCLUSION(S): Our
risk prediction model outperformed logistic regression and achieved a
level of discrimination comparable to the PRAiS2 and STS-CHSD mortality
risk models (both which obtained AUC=0.86). Non-linear ML methods can be
used to construct accurate clinical risk prediction tools.<br/>Copyright
&#xa9; The Author(s) 2023. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<121>
Accession Number
2023698191
Title
Short-Term Nutritional Support Improves The Preoperative Nutritional
Status of Infants With Non-Restrictive Ventricular Septal Defect: A
Prospective Controlled Study.
Source
Heart Surgery Forum. 25(5) (pp E745-E749), 2022. Date of Publication:
2022.
Author
Xu L.-P.; Lin S.-H.; Zhang Q.-L.; Zheng Y.-R.; Lin G.-M.
Institution
(Xu) Department of Neonatology, Zhangzhou Affiliated Hospital of Fujian
Medical University, Zhangzhou, China
(Lin) Medical Department, Zhangzhou Affiliated Hospital of Fujian Medical
University, Zhangzhou, China
(Lin, Zhang, Zheng) Department of Cardiac Surgery, Fujian Branch of
Shanghai Children's Medical Center, Fuzhou, China
(Lin, Zhang, Zheng) Fujian Children's Hospital, Fuzhou, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Objective: To investigate the effect of short-term nutritional support on
improving preoperative nutritional status of infants with non-restrictive
ventricular septal defect. <br/>Method(s): A prospective randomized
controlled study was conducted from June 2021 to December 2021 at a
provincial children's hospital in China. The difference of nutritional
status between the intervention group and the control group after
short-term nutritional support was compared. <br/>Result(s): After one
month of nutritional support, the weight, STRONGkids score, albumin,
prealbumin, and hemoglobin in the intervention group significantly were
higher than those in the control group (P < 0.05). The postoperative
intensive care time and discharge time of the two groups significantly
were lower in the intervention group than those in the control group (P <
0.05). <br/>Conclusion(s): The preoperative nutritional support of 1 month
for infants with non-restrictive ventricular septal defect can effectively
improve their preoperative nutritional status and promote postoperative
recovery.<br/>Copyright &#xa9; 2022 Forum Multimedia Publishing, LLC.

<122>
Accession Number
2023665931
Title
Abbreviated or Standard Antiplatelet Therapy in HBR Patients: Final
15-Month Results of the MASTER-DAPT Trial.
Source
JACC: Cardiovascular Interventions. 16(7) (pp 798-812), 2023. Date of
Publication: 10 Apr 2023.
Author
Landi A.; Heg D.; Frigoli E.; Vranckx P.; Windecker S.; Siegrist P.; Cayla
G.; Wlodarczak A.; Cook S.; Gomez-Blazquez I.; Feld Y.; Seung-Jung P.;
Mates M.; Lotan C.; Gunasekaran S.; Nanasato M.; Das R.; Kelbaek H.;
Teiger E.; Escaned J.; Ishibashi Y.; Montalescot G.; Matsuo H.; Debeljacki
D.; Smits P.C.; Valgimigli M.
Institution
(Landi, Frigoli, Valgimigli) Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale (EOC), Universita della Svizzera Italiana, Lugano,
Switzerland
(Heg, Frigoli) CTU Bern, University of Bern, Bern, Switzerland
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Siegrist) HerzZentrum Hirslanden Zurich, Switzerland
(Cayla) Department of Cardiology, Nimes University Hospital, University of
Montpellier, Nimes, France
(Wlodarczak) Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin,
Poland
(Cook) Department of Cardiology, Fribourg Hospital Cantonal,
Villars-Sur-Glane, Fribourg, Switzerland
(Gomez-Blazquez) Department of Cardiology, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Feld) Cardiology Department, Rambam Healthcare Campus, Haifa, Israel
(Seung-Jung) Department of Internal Medicine, Sungkyunkwan University
School of Medicine, Seoul, South Korea
(Mates) Department of Cardiology, Na Homolce Hospital Cardiovascular
Center, Prague, Czechia
(Lotan) Heart Center, Hadassah Medical Center, Faculty of Medicine, Hebrew
University, Jerusalem, Israel
(Gunasekaran) Department of Cardiology, Apollo Main Hospital, Chennai,
India
(Nanasato) Department of Cardiology, Sakakibara Heart Institute, Tokyo,
Japan
(Das) Cardiothoracic Centre, Freeman Hospital, Newcastle, United Kingdom
(Kelbaek) Department of Cardiology, Zealand University Hospital, Roskilde,
Denmark
(Teiger) Department of Cardiology, University Hospital Henri Mondor,
Creteil, France
(Escaned) Department of Cardiology, Hospital Clinico San Carlos IDISSC and
Universidad Complutense de Madrid, Madrid, Spain
(Ishibashi) Department of Internal Medicine, Division of Cardiology, St.
Marianna University School of Medicine, Kawasaki, Japan
(Montalescot) Sorbonne University, ACTION group, Groupe Hospitalier
Pitie-Salpetriere Hospital, Paris, France
(Matsuo) Department of Cardiovascular Medicine, Gifu Heart Center, Gifu,
Japan
(Debeljacki) Department of Cardiology, Institute for Cardiovascular
Disease, Sremaska Kamenica, Serbia
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Valgimigli) Department of Biomedical Sciences, University of Italian
Switzerland, Lugano, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Clinical outcomes and treatment selection after completing the
randomized phase of modern trials, investigating antiplatelet therapy
(APT) after percutaneous coronary intervention (PCI), are unknown.
<br/>Objective(s): The authors sought to investigate cumulative 15-month
and 12-to-15-month outcomes after PCI during routine care in the MASTER
DAPT trial. <br/>Method(s): The MASTER DAPT trial randomized 4,579 high
bleeding risk patients to abbreviated (n = 2,295) or standard (n = 2,284)
APT regimens. Coprimary outcomes were net adverse clinical outcomes (NACE)
(all-cause death, myocardial infarction, stroke, and BARC 3 or 5
bleeding); major adverse cardiac and cerebral events (MACCE) (all-cause
death, myocardial infarction, and stroke); and BARC type 2, 3, or 5
bleeding. <br/>Result(s): At 15 months, prior allocation to a standard APT
regimen was associated with greater use of intensified APT; NACE and MACCE
did not differ between abbreviated vs standard APT (HR: 0.92 [95% CI:
0.76-1.12]; P = 0.399 and HR: 0.94 [95% CI: 0.76-1.17]; P = 0.579;
respectively), as during the routine care period (HR: 0.81 [95% CI:
0.50-1.30]; P = 0.387 and HR: 0.74 [95% CI: 0.43-1.26]; P = 0.268;
respectively). BARC 2, 3, or 5 was lower with abbreviated APT at 15 months
(HR: 0.68 [95% CI: 0.56-0.83]; P = 0.0001) and did not differ during the
routine care period. The treatment effects during routine care were
consistent with those observed within 12 months after PCI.
<br/>Conclusion(s): At 15 months, NACE and MACCE did not differ in the 2
study groups, whereas the risk of major or clinically relevant nonmajor
bleeding remained lower with abbreviated compared with standard APT.
(Management of High Bleeding Risk Patients Post Bioresorbable Polymer
Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT
Regimen [MASTER DAPT]; NCT03023020)<br/>Copyright &#xa9; 2023 American
College of Cardiology Foundation

<123>
Accession Number
2023615028
Title
Management of mitral stenosis: a systematic review of clinical practice
guidelines and recommendations.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 8(6) (pp
602-618), 2022. Date of Publication: 01 Nov 2022.
Author
Galusko V.; Ionescu A.; Edwards A.; Sekar B.; Wong K.; Patel K.; Lloyd G.;
Ricci F.; Khanji M.Y.
Institution
(Galusko) Department of Cardiology, King's College Hospital, London SE5
9RS, United Kingdom
(Ionescu, Sekar) Morriston, UK Cardiac Regional Centre, Swansea Bay Health
Board, Swansea SA6 6NL, United Kingdom
(Edwards, Lloyd, Khanji) Department of Cardiology, Newham University
Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, United
Kingdom
(Wong, Patel, Lloyd, Khanji) Barts Heart Centre, Barts Health NHS Trust,
West Smithfield, London EC1A 7BE, United Kingdom
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences,
Institute of Advanced Biomedical Technologies, G.d'Annunzio University,
Chieti 66100, Italy
(Ricci) Department of Clinical Sciences, Lund University, Jan Waldenstroms
gata 35-205 02, Malmo SE-221 00, Sweden
(Ricci) Department of Cardiology, Casa di Cura Villa Serena, Citta
Sant'Angelo, Pescara 65013, Italy
(Khanji) NIHR Barts Biomedical Research Centre, William Harvey Research
Institute, Queen Mary University of London, London EC1A 7BE, United
Kingdom
Publisher
Oxford University Press
Abstract
A number of guidelines exist with recommendations for diagnosis and
management of mitral stenosis (MS). We systematically reviewed existing
guidelines for diagnosis and management of MS, highlighting their
similarities and differences, in order to guide clinical decision-making.
We searched national and international guidelines in MEDLINE and EMBASE
(5/4/2011-5/9/2021), the Guidelines International Network, Guideline
Library, National Guideline Clearinghouse, National Library for Health
Guidelines Finder, Canadian Medical Association Clinical Practice
Guidelines Infobase, and websites of relevant organizations. Two
independent reviewers screened titles and abstracts, and the full text of
potentially relevant articles where needed. Selected guidelines were
assessed for rigor of development; only guidelines with Appraisal of
Guidelines for Research and Evaluation II instrument score >50% were
included in the final analysis. Four guidelines were retained for
analysis. There was consensus for percutaneous mitral balloon
commissurotomy as first-line treatment of symptomatic severe rheumatic MS
with suitable anatomy. In patients with unfavourable anatomy, surgical
intervention should be considered. Exercise testing is indicated if
discrepancy exists between symptoms and echocardiographic measurements.
There was no clear divide between rheumatic MS and degenerative MS for
their respective diagnoses and management. Pregnancy in severe MS is
discouraged and the stenosis should be treated before conception.
Long-term antibiotic prophylaxis is recommended for patients with
rheumatic MS. Recommendations for the management of patients with mixed
valvular diseases are lacking.<br/>Copyright &#xa9; 2022 The Author(s).

<124>
Accession Number
2023201007
Title
Protocol for a Systematic Review and Individual Participant Data
Meta-Analysis of Randomized Trials of Screening for Atrial Fibrillation to
Prevent Stroke.
Source
Thrombosis and Haemostasis. 123(3) (pp 366-376), 2023. Date of
Publication: 02 Mar 2023.
Author
McIntyre W.
Publisher
Georg Thieme Verlag
Abstract
Introduction Atrial fibrillation (AF) is a common cause of stroke. Timely
diagnosis of AF and treatment with oral anticoagulation (OAC) can prevent
up to two-thirds of AF-related strokes. Ambulatory electrocardiographic
(ECG) monitoring can identify undiagnosed AF in at-risk individuals, but
the impact of population-based ECG screening on stroke is uncertain, as
ongoing and published randomized controlled trials (RCTs) have generally
been underpowered for stroke. Methods and analysis The AF-SCREEN
Collaboration, with support from AFFECT-EU, have begun a systematic review
and individual participant data meta-analysis of RCTs evaluating ECG
screening for AF. The primary outcome is stroke. Secondary outcomes
include AF detection, OAC prescription, hospitalization, mortality, and
bleeding. After developing a common data dictionary, anonymized data will
be collated from individual trials into a central database. We will assess
risk of bias using the Cochrane Collaboration tool, and overall quality of
evidence with the Grading of Recommendations Assessment, Development and
Evaluation approach.We will pool data using random effects models.
Prespecified subgroup and multilevel meta-regression analyses will explore
heterogeneity. We will perform prespecified trial sequential meta-analyses
of published trials to determine when the optimal information size has
been reached, and account for unpublished trials using the SAMURAI
approach. Impact and Dissemination Individual participant data
meta-analysis will generate adequate power to assess the risks and
benefits of AF screening. Meta-regression will permit exploration of the
specific patient, screening methodology, and health system factors that
influence outcomes. Trial registration number PROSPERO
CRD42022310308.<br/>Copyright &#xa9; 2023 Georg Thieme Verlag. All rights
reserved.

<125>
Accession Number
2022632120
Title
High-flow nasal oxygen vs. standard oxygen therapy for patients undergoing
transcatheter aortic valve replacement with conscious sedation: a
randomised controlled trial.
Source
Perioperative Medicine. 12(1) (no pagination), 2023. Article Number: 11.
Date of Publication: December 2023.
Author
Scheuermann S.; Tan A.; Govender P.; Mckie M.; Pack J.; Martinez G.;
Falter F.; George S.; A. Klein A.
Institution
(Scheuermann, Tan, Govender, Pack, Martinez, Falter, George, A. Klein)
Department of Anaesthesia and Intensive Care, Royal Papworth Hospital,
Cambridge, United Kingdom
(Mckie) MRC Biostatistics Unit, University of Cambridge, Cambridge, United
Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Minimally invasive surgery is becoming more common and
transfemoral transcatheter aortic valve replacement is offered to older
patients with multiple comorbidities. Sternotomy is not required but
patients must lie flat and still for up to 2-3 h. This procedure is
increasingly being performed under conscious sedation with supplementary
oxygen, but hypoxia and agitation are commonly observed. <br/>Method(s):
In this randomised controlled trial, we hypothesised that high-flow nasal
oxygen would provide superior oxygenation as compared with our standard
practice, 2 l min^-1 oxygen by dry nasal specs. This was
administered using the Optiflow THRIVE Nasal High Flow delivery system
(Fisher and Paykel, Auckland, New Zealand) at a flow rate of 50 l
min^-1 and FiO<inf>2</inf> 0.3. The primary endpoint was the
change in arterial partial pressure of oxygen (pO<inf>2</inf>) during the
procedure. Secondary outcomes included the incidence of oxygen
desaturation, airway interventions, the number of times the patient
reached for the oxygen delivery device, incidence of cerebral
desaturation, peri-operative oxygen therapy duration, hospital length of
stay and patient satisfaction scores. <br/>Result(s): A total of 72
patients were recruited. There was no difference in change in
pO<inf>2</inf> from baseline using high-flow compared with standard oxygen
therapy: median [IQR] increase from 12.10 (10.05-15.22 [7.2-29.8]) to
13.69 (10.85-18.38 [8.5-32.3]) kPa vs. decrease from 15.45 (12.17-19.33
[9.2-22.8]) to 14.20 (11.80-19.40 [9.7-35.1]) kPa, respectively. The
percentage change in pO2 after 30 min was also not significantly different
between the two groups (p = 0.171). There was a lower incidence of oxygen
desaturation in the high-flow group (p = 0.027). Patients in the high-flow
group assigned a significantly higher comfort score to their treatment (p
<= 0.001). <br/>Conclusion(s): This study has demonstrated that high flow,
compared with standard oxygen therapy, does not improve arterial
oxygenation over the course of the procedure. There are suggestions that
it may improve the secondary outcomes studied. Trial registration:
International Standard Randomised Controlled Trial Number (ISRCTN)
13,804,861. Registered on 15 April 2019.
https://doi.org/10.1186/ISRCTN13804861<br/>Copyright &#xa9; 2023, The
Author(s).

<126>
Accession Number
2022382823
Title
Remote ischemic preconditioning and clinical outcomes after pediatric
cardiac surgery: a systematic review and meta-analysis.
Source
BMC Anesthesiology. 23(1) (no pagination), 2023. Article Number: 105. Date
of Publication: December 2023.
Author
Li J.; Wang X.; Liu W.; Wen S.; Li X.
Institution
(Li, Liu, Li) Departments of Anesthesiology, DongGuan SongShan Lake
Tungwah Hospital, DongGuan, China
(Wang, Wen) Departments of Anesthesiology, The First Affiliated Hospital,
Sun Yat-Sen University, Guangzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: The benefit of remote ischemia preconditioning (RIPreC) in
pediatric cardiac surgery is unclear. The objective of this systematic
review and meta-analysis was to examine the effectiveness of RIPreC in
reducing the duration of mechanical ventilation and intensive care unit
(ICU) length of stay after pediatric cardiac surgery. <br/>Method(s): We
searched PubMed, EMBASE and the Cochrane Library from inception to
December 31, 2022. Randomized controlled trials comparing RIPreC versus
control in children undergoing cardiac surgery were included. The risk of
bias of included studies was assessed using the Risk of Bias 2 (RoB 2)
tool. The outcomes of interest were postoperative duration of mechanical
ventilation and ICU length of stay. We conducted random-effects
meta-analysis to calculate weighted mean difference (WMD) with 95%
confidence interval (CI) for the outcomes of interest. We performed
sensitivity analysis to examine the influence of intraoperative propofol
use. <br/>Result(s): Thirteen trials enrolling 1,352 children were
included. Meta-analyses of all trials showed that RIPreC did not reduce
postoperative duration of mechanical ventilation (WMD -5.35 h, 95% CI
-12.12-1.42) but reduced postoperative ICU length of stay (WMD -11.48 h,
95% CI -20.96- -2.01). When only trials using propofol-free anesthesia
were included, both mechanical ventilation duration (WMD -2.16 h, 95% CI
-3.87- -0.45) and ICU length of stay (WMD -7.41 h, 95% CI -14.77- -0.05)
were reduced by RIPreC. The overall quality of evidence was moderate to
low. <br/>Conclusion(s): The effects of RIPreC on clinical outcomes after
pediatric cardiac surgery were inconsistent, but both postoperative
mechanical ventilation duration and ICU length of stay were reduced in the
subgroup of children not exposed to propofol. These results suggested a
possible interaction effect of propofol. More studies with adequate sample
size and without intraoperative propofol use are needed to define the role
of RIPreC in pediatric cardiac surgery.<br/>Copyright &#xa9; 2023, The
Author(s).

<127>
Accession Number
2022076783
Title
Extracorporeal Membrane Oxygenation for Graft Dysfunction Early After
Heart Transplantation: A Systematic Review and Meta-analysis.
Source
Journal of Cardiac Failure. 29(3) (pp 290-303), 2023. Date of Publication:
March 2023.
Author
Aleksova N.; BUCHAN T.A.; FOROUTAN F.; ZHU A.; CONTE S.E.A.N.; MACDONALD
P.; NOLY P.-E.; CARRIER M.; MARASCO S.F.; TAKEDA K.O.J.I.; POZZI M.;
BAUDRY G.; ATIK F.A.; LEHMANN S.V.E.N.; JAWAD K.; HICKEY G.W.; DEFONTAINE
A.; BARON O.; LOFORTE A.; CAVALLI G.G.; ABSI D.O.; KAWABORI M.;
MASTROIANNI M.A.; SIMONENKO M.; SPONGA S.; MOAYEDI Y.; ORCHANIAN-CHEFF
A.N.I.; ROSS H.J.; RAO V.; GUYATT G.; BILLIA F.; ALBA A.C.
Institution
(Aleksova, BUCHAN, FOROUTAN, MOAYEDI, ROSS, RAO, BILLIA, ALBA) Peter Munk
Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
(ZHU) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(CONTE, MACDONALD) Heart Transplant Unit, St Vincent's Hospital, Sydney,
NSW, Australia
(NOLY, CARRIER) Department of Cardiac Surgery, Montreal Heart Institute,
University of Montreal, Montreal, Canada
(MARASCO) Department of Cardiothoracic Surgery, The Alfred Hospital,
Melbourne, Australia
(TAKEDA) Department of Surgery, Division of Cardiac, Thoracic & Vascular
Surgery, Columbia University, New York, New York, United States
(POZZI, BAUDRY) Service de Chirurgie Cardiaque et Cardiologie, Hospices
Civils de Lyon, Hopital Louis Pradel, Lyon, France
(ATIK) Instituto de Cardiologia e Transplantes do Distrito Federal (ICDF),
Brasilia, Brazil
(LEHMANN, JAWAD) Clinic of Cardiac Surgery, Heart Center, University of
Leipzig, Leipzig, Germany
(HICKEY) UPMC Heart and Vascular Institute, University of Pittsburgh,
Pittsburgh, PA, United States
(DEFONTAINE, BARON) Centre Hospitalier Universitaire de Nantes, Nantes,
France
(LOFORTE, CAVALLI) Division of Cardiac Surgery, S. Orsola University
Hospital, IRCCS Bologna, Bologna, Italy
(ABSI) Cardiovascular and Intrathoracic Transplant Department, Favaloro
Foundation University Hospital, Buenos Aires, Argentina
(KAWABORI, MASTROIANNI) Department of Cardiovascular Surgery, Tufts
Medical Center, Boston, Massachusetts, United States
(SIMONENKO) Almazov National Medical Research Centre, St. Petersburg,
Russian Federation
(SPONGA) Cardiothoracic Department, University Hospital of Udine, Udine,
Italy
(ORCHANIAN-CHEFF) Library and Information Services, University Health
Network, Toronto, ON, Canada
(GUYATT) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
Publisher
Elsevier B.V.
Abstract
Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO)
is a prevailing option for the management of severe early graft
dysfunction. This systematic review and individual patient data (IPD)
meta-analysis aims to evaluate (1) mortality, (2) rates of major
complications, (3) prognostic factors, and (4) the effect of different
VA-ECMO strategies on outcomes in adult heart transplant (HT) recipients
supported with VA-ECMO. <br/>Methods and Results: We conducted a
systematic search and included studies of adults (>=18 years) who received
VA-ECMO during their index hospitalization after HT and reported on
mortality at any timepoint. We pooled data using random effects models. To
identify prognostic factors, we analysed IPD using mixed effects logistic
regression. We assessed the certainty in the evidence using the GRADE
framework. We included 49 observational studies of 1477 patients who
received VA-ECMO after HT, of which 15 studies provided IPD for 448
patients. There were no differences in mortality estimates between IPD and
non-IPD studies. The short-term (30-day/in-hospital) mortality estimate
was 33% (moderate certainty, 95% confidence interval [CI] 28%-39%) and
1-year mortality estimate 50% (moderate certainty, 95% CI 43%-57%).
Recipient age (odds ratio 1.02, 95% CI 1.01-1.04) and prior sternotomy (OR
1.57, 95% CI 0.99-2.49) are associated with increased short-term
mortality. There is low certainty evidence that early intraoperative
cannulation and peripheral cannulation reduce the risk of short-term
death. <br/>Conclusion(s): One-third of patients who receive VA-ECMO for
early graft dysfunction do not survive 30 days or to hospital discharge,
and one-half do not survive to 1 year after HT. Improving outcomes will
require ongoing research focused on optimizing VA-ECMO strategies and care
in the first year after HT.<br/>Copyright &#xa9; 2022 The Author(s)

<128>
Accession Number
2021904072
Title
A Randomized Trial of Clopidogrel vs Ticagrelor After Off-Pump Coronary
Bypass.
Source
Annals of Thoracic Surgery. 115(5) (pp 1127-1134), 2023. Date of
Publication: May 2023.
Author
Kim H.-H.; Yoo K.-J.; Youn Y.-N.
Institution
(Kim, Yoo, Youn) Division of Cardiovascular Surgery, Severance
Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei
University Health System, Seoul, South Korea
Publisher
Elsevier Inc.
Abstract
Background: This study aimed to compare the outcomes of aspirin in
combination with either ticagrelor or clopidogrel after off-pump coronary
artery bypass (OPCAB) in patients with clopidogrel resistance.
<br/>Method(s): Between November 2014 and November 2020, 1739 patients
underwent OPCAB. Aspirin and clopidogrel treatment was initiated the day
after surgery. On postoperative days 7 to 9, clopidogrel resistance was
evaluated using a point-of-care assay. A total of 278 (18.9%) patients had
clopidogrel resistance ( platelet reaction unit >208) and were enrolled in
the study. The study investigators excluded patients with coresistance to
aspirin (n = 74) and divided the remaining patients (mean age, 67.4 +/-
8.5 years) into 2 groups (an aspirin and ticagrelor group [AT group; n =
102] and an aspirin and clopidogrel group [AC group; n = 102]), randomly
assigned using a 1:1 ratio block table. The primary end point was graft
patency and major adverse cardiovascular events (MACEs; defined as the
composite of cardiovascular mortality, myocardial infarction, and repeat
revascularization at 1 year after OPCAB), and the coprimary end point was
the graft patency rate. The data were analyzed using the intent-to-treat
method. <br/>Result(s): The graft occlusion rates in the AT and AC groups
were 3.9% and 5.9%, respectively (P = .52). Neither death from
cardiovascular causes (1.0% vs 2.9%; P = .32) nor myocardial infarction
showed significant differences (1.0% vs 3.9%; P = .18). No significant
difference in the rates of major bleeding were found between the 2 groups
(P = .75). However, the AT group was associated with a lower rate of MACEs
after OPCAB (hazard ratio, 0.77; 95% CI, 0.684-0.891; P = .01).
<br/>Conclusion(s): These results suggest that ticagrelor may be
associated with reducing MACEs in patients with clopidogrel resistance
after OPCAB.<br/>Copyright &#xa9; 2023 The Society of Thoracic Surgeons

<129>
Accession Number
2024054974
Title
Comparative Efficacy of Adjuvant Nonopioid Analgesia in Adult Cardiac
Surgical Patients: A Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Heybati K.; Zhou F.; Lynn M.J.; Deng J.; Ali S.; Hou W.; Heybati S.;
Tzanis K.; Krever M.; Mughal R.; Ramakrishna H.
Institution
(Heybati) Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester,
Rochester, MN, United States
(Zhou, Lynn, Deng, Ali, Hou, Mughal) Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Lynn) Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada
(Deng) Temerty Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Ali) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Hou, Mughal) Schulich School of Medicine & Dentistry, University of
Western Ontario, London, ON, Canada
(Heybati) Faculty of Science, Queen's University, Kingston, ON, Canada
(Tzanis) Faculty of Science, University of Toronto, Toronto, ON, Canada
(Krever) Faculty of Science, Wilfrid Laurier University, Waterloo, ON,
Canada
(Ramakrishna) Department of Anesthesiology and Perioperative Medicine,
Mayo Clinic, Rochester, MN, United States
Publisher
W.B. Saunders
Abstract
Objectives: To compare the relative efficacy of adjuvant nonopioid
analgesic regimens in adult cardiac surgical patients. <br/>Design(s):
This frequentist, random-effects network meta-analysis (NMA) was
prospectively registered on PROSPERO (CRD42021282913) and conducted
according to the Preferred Reporting Items for Systematic Review and
Meta-Analyses for Network Meta-Analyses (PRISMA-NMA). The risk of bias
(RoB) and confidence of evidence were assessed by RoB 2 and Confidence in
Network Meta-Analysis, respectively. Relevant databases were searched from
inception to October 9, 2021. <br/>Setting(s): A total of 124 (N = 26,257)
randomized controlled trials were included, of which 110 were analyzed.
<br/>Participant(s): Trials enrolling adults (>=18 years of age)
undergoing cardiac surgery that compared nonopioid analgesics against
other nonopioid analgesics, placebo, or no additional treatment, as
adjuvants to standard analgesic management, and reported at least 1 of the
outcomes of interest. Measurement and Main Results: Outcomes of interest
included resting postoperative pain scores at 24 hours. Compared with
standard care and/or placebo, pain scores were reduced significantly by 10
different regimens, including acetaminophen (N = 176; mean difference [MD]
-0.66 points, 95% CI -1.16 to -0.15 points; high confidence), magnesium (N
= 323; -0.05 points, 95% CI -0.07 to -0.02 points; high confidence),
gabapentin (N = 96; MD -0.40 points, 95% CI -0.71 to -0.09; moderate
confidence), and clonidine (N = 64; MD v0.38 points, 95% CI -0.73 to v0.04
points; moderate confidence). Indomethacin, diclofenac, magnesium, and
gabapentin significantly reduced 24-hour opioid consumption. Four regimens
significantly decreased the intensive care unit length of stay.
Hydrocortisone, dexmedetomidine, and clonidine significantly decreased the
duration of mechanical ventilation. Magnesium decreased, while
methylprednisolone significantly increased, the risk of myocardial
infarction. <br/>Conclusion(s): Given the increasing emphasis on enhanced
recovery after surgery(ERAS) protocols and the eventual goal of limiting
opiate prescriptions postoperatively, the authors' data suggested far
greater use of nonopioid adjuncts to minimize pain and enhance recovery
following cardiac surgery.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<130>
Accession Number
2023291728
Title
Levosimendan or Milrinone for Ventricular Septal Defect Repair With
Pulmonary Arterial Hypertension.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(6) (pp 972-979),
2023. Date of Publication: June 2023.
Author
Nag P.; Chowdhury S.R.; Behera S.K.; Das M.; Narayan P.
Institution
(Nag, Chowdhury) Department of Cardiac Anesthesia, Rabindranath Tagore
International Institute of Cardiac Sciences, Narayana Health, Kolkata,
India
(Behera, Das, Narayan) Department of Cardiac Surgery, Rabindranath Tagore
International Institute of Cardiac Sciences, Narayana Health, Kolkata,
India
Publisher
W.B. Saunders
Abstract
Objective: Both milrinone and levosimendan have been used in patients
undergoing surgical closure of ventricular septal defects (VSD) with
pulmonary artery hypertension (PAH); however, the evidence base for their
use is limited. In the present study, the authors sought to compare the
role of levosimendan and milrinone in the prevention of low-cardiac-output
syndrome in the early postoperative period. <br/>Design(s): A prospective,
randomized, controlled trial. <br/>Setting(s): At a tertiary-care center.
<br/>Participant(s): Children between 1 month and 12 years presenting with
VSD and PAH between 2018 and 2020. <br/>Intervention(s): A total of 132
patients were randomized into the following 2 groups: Group L
(levosimendan group) and Group M (milrinone group). <br/>Measurements and
Main Results: In addition to conventional hemodynamic parameters, the
authors also included a myocardial performance index assessment to compare
the groups. The levosimendan group had significantly lower mean arterial
pressure while coming off cardiopulmonary bypass, after shifting to
intensive therapy unit, as well as at 3 and 6 hours postoperatively. The
duration of ventilation (29.6 +/- 13.9 hours v 23.2 +/- 13.3 hours; p =
0.012), as well as postoperative intensive care unit stay, were
significantly prolonged in the levosimendan group (5.48 +/- 1.2 v 4.7 +/-
1.3 days, p = 0.003). There were 2 (1.6%) in-hospital deaths in the entire
cohort, 1 in each arm. There was no difference in the myocardial
performance index of the left or right ventricle. <br/>Conclusion(s): In
patients undergoing surgical repair for VSD with PAH, levosimendan does
not confer any additional benefit compared to milrinone. Both milrinone
and levosimendan appear to be safe in this cohort.<br/>Copyright &#xa9;
2023 Elsevier Inc.

<131>
Accession Number
2020655150
Title
Comprehensive collection of COVID-19 related prosthetic valve failure: a
systematic review.
Source
Journal of Thrombosis and Thrombolysis. 55(3) (pp 474-489), 2023. Date of
Publication: April 2023.
Author
Trieu T.K.; Birkeland K.; Kimchi A.; Kedan I.
Institution
(Trieu) College of Medicine, California Northstate University, Elk Grove,
CA, United States
(Birkeland) Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Kimchi, Kedan) Smidt Heart Institute, Cedars-Sinai Hospital, 8501
Wilshire Blvd Suite 200, Beverly Hills, Los Angeles, CA, United States
Publisher
Springer
Abstract
Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of
venous thromboembolism (VTE) and COVID-19 infection has been well
established. Increased inflammatory response in the setting of COVID-19
infection is associated with VTE and hypercoagulability. Venous and
arterial thrombotic events in COVID-19 infection have been well
documented; however, few cases have been reported involving cardiac valve
prostheses. In this review, we present a total of eight cases involving
COVID-19-related prosthetic valve thrombosis (PVT), as identified in a
systematic review. These eight cases describe valve position (mitral
versus aortic) and prosthesis type (bioprosthetic versus mechanical), and
all cases demonstrate incidents of PVT associated with simultaneous or
recent COVID-19 infection. None of these eight cases display obvious
non-adherence to anticoagulation; five of the cases occurred greater than
three years after the most recent valve replacement. Our review offers
insights into PVT in COVID-19 infected patients including an indication
for increased monitoring in the peri-infectious period. We explore valve
thrombosis as a mechanism for prosthetic valve failure. We describe
potential differences in antithrombotic strategies that may offer added
antithrombotic protection during COVID-19 infection. With the growing
population of valve replacement patients and recurring COVID-19 infection
surges, it is imperative to explore relationships between COVID-19 and
PVT.<br/>Copyright &#xa9; 2022, The Author(s).

<132>
Accession Number
2019950825
Title
Early and mid-term outcomes of transcatheter tricuspid valve repair:
systematic review and meta-analysis of observational studies.
Source
Revista Espanola de Cardiologia. 76(5) (pp 322-332), 2023. Date of
Publication: May 2023.
Author
Alperi A.; Avanzas P.; Almendarez M.; Leon V.; Hernandez-Vaquero D.; Silva
I.; Fernandez del Valle D.; Fernandez F.; Diaz R.; Rodes-Cabau J.; Moris
C.; Pascual I.
Institution
(Alperi, Avanzas, Almendarez, Leon, Hernandez-Vaquero, Silva, Fernandez
del Valle, Fernandez, Diaz, Moris, Pascual) Area del Corazon, Hospital
Universitario Central de Asturias, Asturias, Oviedo, Spain
(Alperi, Avanzas, Almendarez, Hernandez-Vaquero, Diaz, Moris, Pascual)
Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA),
Asturias, Oviedo, Spain
(Avanzas, Hernandez-Vaquero, Moris, Pascual) Universidad de Oviedo,
Asturias, Oviedo, Spain
(Rodes-Cabau) Quebec's Heart and Lung Institute, Quebec, Canada
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Severe tricuspid regurgitation (TR) is
associated with poor prognosis when left untreated, and a growing number
of studies on transcatheter tricuspid valve repair (TTVr) have been
published over the last few months. <br/>Method(s): We performed a
comprehensive systematic review of published literature providing clinical
data on TTVr for patients with significant TR. Early and mid-term clinical
and echocardiographic outcomes were evaluated. Risk ratios (RR) or mean
differences (MD) were obtained when comparing pre- and postprocedural
data. A sensitivity analysis was also performed according to the main
approach for repair (edge-to-edge vs annuloplasty). <br/>Result(s): A
total of 19 studies (all observational or single-arm trials) and 991
patients who underwent isolated TTVr were included. Thirty-day mortality
and stroke rates were 2.8% and 0.2%, respectively. Pooled random-effects
resulted in a significant reduction of >= severe TR (RR, 0.33; 95%CI,
0.26-0.42; P <.001), vena contracta width (MD, 5.9 mm; 95%CI, 4-7.9; P
<.001), right ventricular end-diastolic diameter (MD, 3.5 mm; 95%CI,
2.5-4.5; P <.001), and New York Heart Association (NYHA) class III or IV
at last follow-up (RR, 0.32; 95%CI, 0.27-0.37; P <.001). Bleeding
complications and residual >= severe TR were numerically higher in the
annuloplasty-like group compared with edge-to-edge repair (13.3% vs 3.8%
for bleeding and 40.4% vs 27.9% for residual severe TR).
<br/>Conclusion(s): Among 991 patients comprising the early experience for
several TTVr devices, there was a statistically significant reduction in
>= severe TR, NYHA class III-IV, vena contracta width and right
ventricular end-diastolic diameter after TTVr. Thus far, the edge-to-edge
approach seems to be associated with a better safety
profile.<br/>Copyright &#xa9; 2022 Sociedad Espanola de Cardiologia

<133>
Accession Number
636249340
Title
The efficacy and safety of quantitative flow ratio-guided complete
revascularization in patients with ST-segment elevation myocardial
infarction and multivessel disease: A pilot randomized controlled trial.
Source
Cardiology journal. 30(2) (pp 178-187), 2023. Date of Publication: 2023.
Author
Zhang J.; Yao M.; Jia X.; Feng H.; Fu J.; Tang W.; Cong H.
Institution
(Zhang, Cong) Department of Cardiology, Thoracic Clinical College, Tianjin
Medical University, Tianjin, China
(Zhang, Jia, Feng, Tang) Department of Cardiology, Affiliated Hospital of
Hebei University, Baoding, China
(Yao) Department of Endocrinology, Baoding No.1 Central Hospital, Baoding,
China
(Fu) Department of Cardiology, Fengfeng General Hospital, North China
Medical and Health Group, Handan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In patients with ST-segment elevation myocardial infarction
(STEMI) and multivessel disease (MVD), the treatment strategy for
non-infarct-related artery (non-IRA) remains controversial. Quantitative
flow ratio (QFR) is a new angiography-based physiological assessment
index. However, there is little evidence on the practical clinical
application of QFR. <br/>METHOD(S): Two hundred and twenty-nine patients
with STEMI and MVD were recruited for this study. Patients were randomly
assigned to either receive QFR-guided complete revascularization
(QFR-G-CR) of non-IRA or receive no further invasive treatment. The
primary (1degree) endpoint analyzed included death due to all causes,
non-fatal myocardial infarction (MI), and ischemia-induced
revascularization at 12 months post-surgery. Secondary (2degree) endpoints
included cardiovascular death, unstable angina, stent thrombosis, New York
Heart Association (NYHA) class IV heart failure, and stroke at 1 year post
surgery. Massive bleeding and contrast-associated acute kidney injury
(CAKI) were used as safety endpoints. <br/>RESULT(S): Around the 12 month
follow up, the 1o outcome was recorded in 11/115 patients (9.6%) in the
QFR-G-CR population, relative to 23/114 patients (20.1%) in the IRA-only
PCI population (hazard ratio [HR]: 0.45; 95% confidence interval [CI]:
0.22-0.92; p = 0.025). Unstable angina in 6 (5.2%) and 16 (14.0%) patients
(HR: 0.36; 95% CI: 0.14-0.92; p = 0.026), respectively. No marked
alterations were found in the massive bleeding and CAKI categories.
<br/>CONCLUSION(S): In conclusion, STEMI and MVD patients can benefit from
QFR-G-CR of non-IRA lesions in the initial stages of acute MI. This can
help reduce incidences of major adverse cardiovascular events and unstable
angina, relative to IRA treatment only. Chinese Clinical Trial
Registration number: ChiCTR2100044120.

<134>
[Use Link to view the full text]
Accession Number
635152167
Title
Phrenic Nerve Block at the Azygos Vein Level Versus Sham Block for
Ipsilateral Shoulder Pain after Video-Assisted Thoracoscopic Surgery: A
Randomized Controlled Trial.
Source
Anesthesia and Analgesia. 132(6) (pp 1594-1602), 2021. Date of
Publication: 01 Jun 2021.
Author
Kimura Kuroiwa K.; Shiko Y.; Kawasaki Y.; Aoki Y.; Nishizawa M.; Ide S.;
Miura K.; Kobayashi N.; Sehmbi H.
Institution
(Kimura Kuroiwa, Nishizawa, Ide) Department of Anesthesia, Nagano Red
Cross Hospital, Nagano, Japan
(Shiko) Department of Biostatistics, Clinical Research Center, Chiba
University Hospital, Chiba, Japan
(Kimura Kuroiwa, Kawasaki) Department of Biostatistics of Japanese Red
Cross College of Nursing, Tokyo, Japan
(Aoki) Department of Anesthesiology and Intensive Care, Hamamatsu
University School of Medicine, Hamamatsu, Japan
(Miura, Kobayashi) Department of Thoracic Surgery, Nagano Red Cross
Hospital, Nagano, Japan
(Sehmbi) Department of Anesthesia & Perioperative Medicine, London Health
Sciences Centre, Western University, London, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Ipsilateral shoulder pain (ISP) is a common problem after
pulmonary surgery. We hypothesized that phrenic nerve block (PNB) at the
azygos vein level, near the location of the surgical operation, would be
effective for reducing ISP. Our primary aim was to assess the effect of
PNB on postoperative ISP, following video-assisted thoracic surgery
(VATS). <br/>METHOD(S): This prospective, randomized, patient-blinded,
single-institution trial was registered at the University Hospital Medical
Information Network (UMIN000030464). Enrolled patients had been scheduled
for VATS under general anesthesia with epidural analgesia. Patients were
randomly allocated to receive infiltration of the ipsilateral phrenic
nerve at the azygos vein level with either 10 mL of 0.375% ropivacaine
(PNB group) or 0.9% saline (control group) before chest closure.
Postoperative ISP was assessed using a numerical rating scale (NRS, 0-10)
at rest at 2, 4, 8, 16, and 24 hours. The incidence of ISP was defined as
the proportion of patients who reported an NRS score of >=1 at least once
within 24 hours after surgery. In the primary analysis, the proportion of
patients with ISP was compared between PNB and control groups using the
chi²test. NRS values of ISP and postoperative incision pain
within 24 hours were investigated, as was the frequency of postoperative
analgesic use. Incision pain was assessed using an NRS at the time of ISP
assessment. Finally, the incidence of postoperative nausea and vomiting
and shoulder movement disorders were also evaluated. <br/>RESULT(S):
Eighty-five patients were included, and their data were analyzed. These
patients were randomly assigned to either PNB group (n = 42) or control
group (n = 43). There were no clinically relevant differences in
demographic and surgical profiles between the groups. There was no
significant difference in the incidence of ISP (the control group 20/43
[46.5%] versus the PNB group 14/42 [33.3%]; P =.215). The severity of ISP
was lower in the PNB group than in the control group (linear mixed-effects
model, the main effect of treatment [groups]: P <.001). There were no
significant differences between groups in terms of postoperative incision
pain. The frequency of postoperative analgesic use was significantly
higher in the control group (Wilcoxon rank sum test, P <.001).
Postoperative nausea and vomiting did not significantly differ between the
2 groups. There were no changes in the range of shoulder joint movement.
<br/>CONCLUSION(S): Azygos vein level PNB did not significantly affect the
incidence of ISP after VATS.<br/>Copyright &#xa9; 2021 Lippincott Williams
and Wilkins. All rights reserved.

<135>
[Use Link to view the full text]
Accession Number
635086375
Title
Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury after
On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled
Trial.
Source
Anesthesia and Analgesia. 132(6) (pp 1548-1558), 2021. Date of
Publication: 01 Jun 2021.
Author
Hu J.; Rezoagli E.; Zadek F.; Bittner E.A.; Lei C.; Berra L.
Institution
(Hu) Department of Critical Care Medicine, Chinese PLA General Hospital,
Beijing, China
(Hu, Bittner, Berra) Department of Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, Boston, MA, United States
(Rezoagli) School of Medicine and Surgery, University of Milan-Bicocca,
Monza, Italy
(Zadek) Department of Pathophysiology and Transplantation, University of
Milan, Milan, Italy
(Lei) Department of Anesthesiology and Perioperative Medicine, Xijing
Hospital, Fourth Military Medical University, Xi'an, China
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Cardiac surgery with cardiopulmonary bypass (CPB) is
associated with a high risk of postoperative acute kidney injury (AKI).
Due to limitations of current diagnostic strategies, we sought to
determine whether free hemoglobin (fHb) ratio (ie, levels of fHb at the
end of CPB divided by baseline fHb) could predict AKI after on-pump
cardiac surgery. <br/>METHOD(S): This is a secondary analysis of a
randomized controlled trial comparing the effect of nitric oxide
(intervention) versus nitrogen (control) on AKI after cardiac surgery
(NCT01802619). A total of 110 adult patients in the control arm were
included. First, we determined whether fHb ratio was associated with AKI
via multivariable analysis. Second, we verified whether fHb ratio could
predict AKI and incorporation of fHb ratio could improve predictive
performance at an early stage, compared with prediction using urinary
biomarkers alone. We conducted restricted cubic spline in logistic
regression for model development. We determined the predictive
performance, including area under the receiver-operating-characteristics
curve (AUC) and calibration (calibration plot and accuracy, ie, number of
correct predictions divided by total number of predictions). We also used
AUC test, likelihood ratio test, and net reclassification index (NRI) to
compare the predictive performance between competing models (ie, fHb ratio
versus neutrophil gelatinase-associated lipocalin [NGAL],
N-acetyl-beta-d-glucosaminidase [NAG], and kidney injury molecule-1
[KIM-1], respectively, and incorporation of fHb ratio with NGAL, NAG, and
KIM-1 versus urinary biomarkers alone), if applicable. <br/>RESULT(S):
Data stratified by median fHb ratio showed that subjects with an fHb ratio
>2.23 presented higher incidence of AKI (80.0% vs 49.1%; P =.001), more
need of renal replacement therapy (10.9% vs 0%; P =.036), and higher
in-hospital mortality (10.9% vs 0%; P =.036) than subjects with an fHb
ratio <=2.23. fHb ratio was associated with AKI after adjustment for
preestablished factors. fHb ratio outperformed urinary biomarkers with the
highest AUC of 0.704 (95% confidence interval [CI], 0.592-0.804) and
accuracy of 0.714 (95% CI, 0.579-0.804). Incorporation of fHb ratio
achieved better discrimination (AUC test, P =.012), calibration
(likelihood ratio test, P <.001; accuracy, 0.740 [95% CI, 0.617-0.832] vs
0.632 [95% CI, 0.477-0.748]), and significant prediction increment (NRI,
0.638; 95% CI, 0.269-1.008; P <.001) at an early stage, compared with
prediction using urinary biomarkers alone. <br/>CONCLUSION(S): Results
from this exploratory, hypothesis-generating retrospective, observational
study shows that fHb ratio at the end of CPB might be used as a novel,
widely applicable biomarker for AKI. The use of fHb ratio might help for
an early detection of AKI, compared with prediction based only on urinary
biomarkers.<br/>Copyright &#xa9; 2021 Lippincott Williams and Wilkins. All
rights reserved.