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<1>
Accession Number
2024974284
Title
Cardiac Surgery in Jehovah's Witnesses Patients and Association With
Peri-Operative Outcomes: A Systematic Review and Meta-Analysis.
Source
Current Problems in Cardiology. 48(9) (no pagination), 2023. Article
Number: 101789. Date of Publication: September 2023.
Author
Vitolo M.; Mei D.A.; Cimato P.; Bonini N.; Imberti J.F.; Cataldo P.;
Menozzi M.; Filippini T.; Vinceti M.; Boriani G.
Institution
(Vitolo, Mei, Bonini, Imberti, Cataldo, Menozzi, Boriani) Cardiology
Division, Department of Biomedical, Metabolic and Neural Sciences,
University of Modena and Reggio Emilia, Policlinico di Modena, Modena,
Italy
(Vitolo, Bonini, Imberti) Clinical and Experimental Medicine PhD Program,
University of Modena and Reggio Emilia, Modena, Italy
(Cimato) Department of Cardiac Surgery, Villa Torri Hospital, GVM Care &
Research, Bologna, Italy
(Filippini, Vinceti) Environmental, Genetic and Nutritional Epidemiology
Research Center, Department of Biomedical, Metabolic and Neural Sciences,
University of Modena and Reggio Emilia Modena Italy
(Filippini) School of Public Health, University of California Berkeley,
Berkeley, CA, United States
(Vinceti) Department of Epidemiology, Boston University School of Public
Health, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Strategies for blood conservation, coupled with a careful
preoperative assessment, may be applied to Jehovah's Witnesses (JW)
patients who are candidates for cardiac surgery interventions. There is a
need to assess clinical outcomes and safety of bloodless surgery in JW
patients undergoing cardiac surgery. <br/>Method(s): We performed a
systematic review and meta-analysis of studies comparing JW patients with
controls undergoing cardiac surgery. The primary endpoint was short-term
mortality (in-hospital or 30-day mortality). Peri-procedural myocardial
infarction, re-exploration for bleeding, pre-and postoperative Hb levels
and cardiopulmonary bypass (CPB) time were also analyzed. <br/>Result(s):
A total of 10 studies including 2,302 patients were included. The pooled
analysis showed no substantial differences in terms of short-term
mortality among the two groups (OR 1.13, 95% CI 0.74-1.73,
I²=0%). There were no differences in peri-operative outcomes
among JW patients and controls (OR 0.97, 95% CI 0.39-2.41,
I²=18% for myocardial infarction; OR 0.80, 95% CI 0.51-1.25,
I²=0% for re-exploration for bleeding). JW patients had a
higher level of preoperative Hb (Standardized Mean Difference [SMD] 0.32,
95% CI 0.06-0.57) and a trend toward a higher level of postoperative Hb
(SMD 0.44, 95% CI -0.01-0.90). A slightly lower CPB time emerged in JWs
compared with controls (SMD -0.11, 95% CI -0.30-0.07). <br/>Conclusion(s):
JW patients undergoing cardiac surgery, with avoidance of blood
transfusions, did not have substantially different peri-operative outcomes
compared with controls, with specific reference to mortality, myocardial
infarction, and re-exploration for bleeding. Our results support the
safety and feasibility of bloodless cardiac surgery, applying patient
blood management strategies.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<2>
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Accession Number
2024777718
Title
Transcatheter Repair for Patients with Tricuspid Regurgitation.
Source
New England Journal of Medicine. 388(20) (pp 1833-1842), 2023. Date of
Publication: 2023.
Author
Sorajja P.; Whisenant B.; Hamid N.; Naik H.; Makkar R.; Tadros P.; Price
M.J.; Singh G.; Fam N.; Kar S.; Schwartz J.G.; Mehta S.; Bae R.; Sekaran
N.; Warner T.; Makar M.; Zorn G.; Spinner E.M.; Trusty P.M.; Benza R.;
Jorde U.; McCarthy P.; Thourani V.; Tang G.H.L.; Hahn R.T.; Adams D.H.
Institution
(Sorajja, Hamid, Bae) Allina Health Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, United States
(Whisenant, Sekaran) Intermountain Medical Center, Murray, UT, United
States
(Naik, Warner) St. Josephs Hospital and Integrated Medical Services,
Phoenix, AZ, United States
(Makkar, Makar) Cedars Sinai Medical Center, Los Angeles, CA, United
States
(Price) Scripps Clinic Green Hospital, La Jolla, CA, United States
(Singh) UC Davis Medical Center, Sacramento, CA, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Spinner, Trusty) Abbott Structural Heart, Santa Clara, CA, United States
(Tadros, Zorn) Kansas University Medical Center, Kansas City, United
States
(Fam) St. Michaels Hospital, Toronto, Canada
(Mehta) McMaster University, Hamilton, ON, Canada
(Schwartz) Carolinas Medical Center, Charlotte, NC, United States
(Jorde) Ohio State University, Columbus, United States
(Tang, Adams) Montefiore Medical Center, Bronx, United States
(Hahn) Mount Sinai Health System and New York, Presbyterian Columbia
University Medical Center, New York, NY, United States
(McCarthy) Northwestern University, Chicago, United States
(Thourani) Marcus Valve Center, Piedmont Heart Institute, Atlanta, United
States
Publisher
Massachussetts Medical Society
Abstract
Abstract Background Severe tricuspid regurgitation is a debilitating
condition that is associated with substantial morbidity and often with
poor quality of life. Decreasing tricuspid regurgitation may reduce
symptoms and improve clinical outcomes in patients with this disease.
Methods We conducted a prospective randomized trial of percutaneous
tricuspid transcatheter edge-to-edge repair (TEER) for severe tricuspid
regurgitation. Patients with symptomatic severe tricuspid regurgitation
were enrolled at 65 centers in the United States, Canada, and Europe and
were randomly assigned in a 1:1 ratio to receive either TEER or medical
therapy (control). The primary end point was a hierarchical composite that
included death from any cause or tricuspid-valve surgery; hospitalization
for heart failure; and an improvement in quality of life as measured with
the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement
defined as an increase of at least 15 points in the KCCQ score (range, 0
to 100, with higher scores indicating better quality of life) at the
1-year follow-up. The severity of tricuspid regurgitation and safety were
also assessed. Results A total of 350 patients were enrolled; 175 were
assigned to each group. The mean age of the patients was 78 years, and
54.9% were women. The results for the primary end point favored the TEER
group (win ratio, 1.48; 95% confidence interval, 1.06 to 2.13; P=0.02).
The incidence of death or tricuspid-valve surgery and the rate of
hospitalization for heart failure did not appear to differ between the
groups. The KCCQ quality-of-life score changed by a mean (+/-SD) of
12.3+/-1.8 points in the TEER group, as compared with 0.6+/-1.8 points in
the control group (P<0.001). At 30 days, 87.0% of the patients in the TEER
group and 4.8% of those in the control group had tricuspid regurgitation
of no greater than moderate severity (P<0.001). TEER was found to be safe;
98.3% of the patients who underwent the procedure were free from major
adverse events at 30 days. Conclusions Tricuspid TEER was safe for
patients with severe tricuspid regurgitation, reduced the severity of
tricuspid regurgitation, and was associated with an improvement in quality
of life. (Funded by Abbott; TRILUMINATE Pivotal ClinicalTrials.gov number,
NCT03904147.)<br/>Copyright &#xa9; 2023 Massachusetts Medical Society.

<3>
Accession Number
2023895610
Title
Platelet Function is Preserved After Moderate Cardiopulmonary Bypass Times
But Transiently Impaired After Protamine.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(7) (pp 1110-1120),
2023. Date of Publication: July 2023.
Author
Tornudd M.; Ramstrom S.; Kvitting J.-P.E.; Alfredsson J.; Nyberg L.;
Bjorkman E.; Berg S.
Institution
(Tornudd, Nyberg, Bjorkman, Berg) Department of Cardiothoracic and
Vascular Surgery and Department of Health, Medicine and Caring Sciences,
Linkoping University, Linkoping, Sweden
(Ramstrom, Nyberg, Bjorkman) Department of Clinical Chemistry and
Department of Biomedical and Clinical Sciences, Linkoping University,
Linkoping, Sweden
(Ramstrom) Cardiovascular Research Centre, School of Medical Sciences,
Faculty of Medicine and Health, Orebro University, Orebro, Sweden
(Kvitting) Department of Cardiothoracic Surgery, Oslo University Hospital,
Oslo, Rikshospitalet, Norway
(Kvitting) Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
(Alfredsson) Department of Cardiology and Department of Health, Medicine
and Caring Sciences, Linkoping University, Linkoping, Sweden
Publisher
W.B. Saunders
Abstract
Objectives: Previous studies have described impaired platelet function
after cardiopulmonary bypass (CPB). Whether this is still valid in
contemporary cardiac surgery is unclear. This study aimed to quantify
changes in function and number of platelets during CPB in a present-day
cardiac surgery cohort. <br/>Design(s): Prospective, controlled clinical
study. <br/>Setting(s): A single-center university hospital.
<br/>Participant(s): Thirty-nine patients scheduled for coronary artery
bypass graft surgery with CPB. <br/>Intervention(s): Platelet function and
numbers were measured at 6 timepoints in 39 patients during and after
coronary artery bypass graft surgery; at baseline before anesthesia, at
the end of CPB, after protamine administration, at intensive care unit
(ICU) arrival, 3 hours after ICU arrival, and on the morning after
surgery. <br/>Measurements and Main Results: Platelet function was
assessed with impedance aggregometry and flow cytometry. Platelet numbers
are expressed as actual concentration and as numbers corrected for
dilution using hemoglobin as a reference marker. There was no consistent
impairment of platelet function during CPB with either impedance
aggregometry or flow cytometry. After protamine administration, a decrease
in platelet function was seen with impedance aggregometry and for some
markers of activation with flow cytometry. Platelet function was restored
3 hours after arrival in the ICU. During CPB (85.0 +/- 21 min), the number
of circulating platelets corrected for dilution increased from 1.73 +/-
0.42 x 10⁹/g to 1.91 +/- 0.51 x 10⁹/g (p < 0.001).
<br/>Conclusion(s): During cardiac surgery with moderate CPB times,
platelet function was not impaired, and no consumption of circulating
platelets could be detected. Administration of protamine transiently
affected platelet function.<br/>Copyright &#xa9; 2023 The Authors

<4>
Accession Number
2023870256
Title
Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A
systematic review and meta-analysis.
Source
Emergency Medicine Journal. 40(6) (pp 407-417), 2023. Date of Publication:
01 Jun 2023.
Author
Matthies A.; Trauer M.; Chopra K.; Jarman R.D.
Institution
(Matthies, Chopra) Emergency Department, Homerton University Hospital NHS
Foundation Trust, London, United Kingdom
(Matthies, Trauer, Chopra) School of Health and Life Sciences, Teesside
University, Middlesbrough, United Kingdom
(Trauer) Emergency Department, Guy's and Saint Thomas' NHS Foundation
Trust, London, United Kingdom
(Jarman) Accident and Emergency Department, Royal Victoria Infirmary,
Newcastle upon Tyne, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background Point-of-care (POC) lung ultrasound (LUS) is widely used in the
emergency setting and there is an established evidence base across a range
of respiratory diseases, including previous viral epidemics. The necessity
for rapid testing combined with the limitations of other diagnostic tests
has led to the proposal of various potential roles for LUS during the
COVID-19 pandemic. This systematic review and meta-analysis focused
specifically on the diagnostic accuracy of LUS in adult patients
presenting with suspected COVID-19 infection. Methods Traditional and
grey-literature searches were performed on 1 June 2021. Two authors
independently carried out the searches, selected studies and completed the
Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2).
Meta-analysis was carried out using established open-source packages in R.
We report overall sensitivity, specificity, positive and negative
predictive values, and the hierarchical summary receiver operating
characteristic curve for LUS. Heterogeneity was determined using the I 2
statistic. Results Twenty studies were included, published between October
2020 and April 2021, providing data from a total of 4314 patients. The
prevalence and admission rates were generally high across all studies.
Overall, LUS was found to be 87.2% sensitive (95% CI 83.6 to 90.2) and
69.5% specific (95% CI 62.2 to 72.5) and demonstrated overall positive and
negative likelihood ratios of 3.0 (95% CI 2.3 to 4.1) and 0.16 (95% CI
0.12 to 0.22), respectively. Separate analyses for each reference standard
revealed similar sensitivities and specificities for LUS. Heterogeneity
was found to be high across the studies. Overall, the quality of studies
was low with a high risk of selection bias due to convenience sampling.
There were also applicability concerns because all studies were undertaken
during a period of high prevalence. Conclusion During a period of high
prevalence, LUS had a sensitivity of 87% for the diagnosis of COVID-19
infection. However, more research is required to confirm these results in
more generalisable populations, including those less likely to be admitted
to hospital. PROSPERO registration number CRD42021250464.<br/>Copyright
&#xa9; 2023 BMJ Publishing Group. All rights reserved.

<5>
Accession Number
2023397967
Title
Postoperative Analgesic Effects of Serratus Anterior Plane Block for
Thoracic and Breast Surgery: A Meta-analysis of Randomized Controlled
Trials.
Source
Pain Physician. 26(2) (pp E51-E62), 2023. Date of Publication: March/April
2023.
Author
Meng J.; Zhao H.-Y.; Zhuo X.-J.; Shen Q.-H.
Institution
(Meng, Zhao, Zhuo) Department of Anesthesiology, Sir Run Run Shaw Hospital
Affiliated to Zhejiang University, China
(Shen) Department of Anesthesiology, The Affiliated Hospital of Jiaxing
Universit, China
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Postoperative pain is a concern after thoracic and breast
surgeries. Recent studies have demonstrated that ultrasound-guided
serratus anterior plane block (SAPB) could provide postoperative
analgesia. <br/>Objective(s): The objective of this systematic review and
meta-analysis was to examine the effects of SAPB on postoperative
analgesia in thoracic and breast surgery. <br/>Study Design: A systematic
review and meta-analysis of randomized control trials (RCTs).
<br/>Method(s): We systematically queried the PubMed, Embase, Web of
Science, and Cochrane Library online databases from their establishment
through Mar 31, 2022. Eligible RCTs were selected for the purpose of
conducting the meta-analysis. The risk of bias of the included trials was
assessed by Cochrane Review Manager. The level of certainty was examined
utilizing the GRADE (Grade of Recommendations Assessment, Development, and
Evaluation) scale to determine whether the evidence was of high quality or
not. <br/>Result(s): During the process of the meta-analysis, a total of
27 pieces of literature was included in the present research. SAPB
significantly reduced the intraoperative opioid consumption (mean
difference [MD] =-9.52 mg of morphine equivalent, 95% CI,-15.50 to-3.54; P
< 0.01, I² = 98%) and postoperative pain opioid consumption (MD
=-23.12 mg of morphine equivalent, 95% CI,-30.59 to-15.65; P < 0.01,
I² = 100%. Also, patients in the SAPB group had lower pain
scores during the first postoperative 24 hours. Furthermore, SAPB
attenuated the occurrence of postsurgical nausea and vomiting, as well as
chronic postsurgical pain. <br/>Limitation(s): Double-blinding was not
performed in some trials, also some assessors were not blinded; the
included sample sizes of eligible trials which reported the incidence of
chronic postsurgical pain were relatively small; the comparisons between
SAPB and other types of blocks were not performed in our meta-analysis.
<br/>Conclusion(s): Our findings suggest that SAPB not only relieves acute
pain after thoracic and breast surgery, but also reduces the incidence of
chronic postsurgical pain.<br/>Copyright &#xa9; 2023, American Society of
Interventional Pain Physicians. All rights reserved.

<6>
Accession Number
2023632247
Title
Genetic Factors Influencing Warfarin Dose in Han Chinese Population: A
Systematic Review and Meta-Analysis of Cohort Studies.
Source
Clinical Pharmacokinetics. 62(6) (pp 819-833), 2023. Date of Publication:
June 2023.
Author
Zhao Z.; Zhao F.; Wang X.; Liu D.; Liu J.; Zhang Y.; Hu X.; Zhao M.; Tian
C.; Dong S.; Jin P.
Institution
(Zhao, Zhao, Zhang, Hu, Zhao, Jin) Department of Pharmacy, Beijing
Hospital; National Center of Gerontology; Institute of Geriatric Medicine,
Chinese Academy of Medical Sciences; Beijing Key Laboratory of Assessment
of Clinical Drugs Risk and Individual Application (Beijing Hospital), No.
1 Dahua Road, Dongdan, Dongcheng District, Beijing 100730, China
(Wang, Liu, Liu) Department of Cardiology, Beijing Hospital, National
Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of
Medical Sciences, Beijing 100730, China
(Tian) Department of Pharmacy, Beijing Children's Hospital, Capital
Medicine University, National Center for Children's Health, Beijing
100045, China
(Dong) Department of Pharmacy, Peking University Third Hospital, Beijing
100191, China
Publisher
Adis
Abstract
Objective: To investigate the association of single nucleotide
polymorphisms (SNPs) of various genes known to influence mean daily
warfarin dose (MDWD) in the Han Chinese population. <br/>Method(s): The
study is a systematic review and meta-analysis. Selected studies retrieved
by searching Pubmed, Embase (Ovid), Medline, CNKI, Wanfang data, and
SinoMed (from their inception to 31 August 2022) for the cohort studies
assessing genetic variations that may possibly influence MDWD in Chinese
patients were included. <br/>Result(s): A total of 46 studies including a
total of 10,102 Han Chinese adult patients were finally included in the
meta-analysis. The impact of 20 single nucleotide polymorphisms (SNPs) in
8 genes on MDWD was analyzed. The significant impact of some of these SNPs
on MDWD requirements was demonstrated. Patients with CYP4F2 rs2108622 TT,
EPHX1 rs2260863 GC, or NQO1 rs1800566 TT genotype required more than 10%
higher MDWD. Furthermore, patients with ABCB1 rs2032582 GT or GG, or CALU
rs2290228 TT genotype required more than 10% lower MDWD. Subgroup analysis
showed that patients with EPHX1 rs2260863 GC genotype required 7% lower
MDWD after heart valve replacement (HVR). <br/>Conclusion(s): This is the
first systematic review and meta-analysis assessing the association
between single nucleotide polymorphisms (SNPs) of various genes known to
influence MDWD besides CYP2C9 and VKORC1 in the Han Chinese population.
CYP4F2 (rs2108622), GGCX (rs12714145), EPHX1 (rs2292566 and rs2260863),
ABCB1 (rs2032582), NQO1 (rs1800566), and CALU (rs2290228) SNPs might be
moderate factors affecting MDWD requirements. Registered information:
PROSPERO International Prospective Register of Systematic Reviews
(CRD42022355130).<br/>Copyright &#xa9; 2023, The Author(s), under
exclusive licence to Springer Nature Switzerland AG.

<7>
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Accession Number
2015200199
Title
Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk With or
Without Oral Anticoagulant Therapy After Coronary Stenting: An Open-Label,
Randomized, Controlled Trial.
Source
Circulation. 144(15) (pp 1196-1211), 2021. Date of Publication: 12 Oct
2021.
Author
Smits P.C.; Frigoli E.; Tijssen J.; Juni P.; Vranckx P.; Ozaki Y.; Morice
M.-C.; Chevalier B.; Onuma Y.; Windecker S.; Tonino P.A.L.; Roffi M.;
Lesiak M.; Mahfoud F.; Bartunek J.; Hildick-Smith D.; Colombo A.;
Stankovic G.; Iniguez A.; Schultz C.; Kornowski R.; Ong P.J.L.; Alasnag
M.; Rodriguez A.E.; Moschovitis A.; Laanmets P.; Heg D.; Valgimigli M.
Institution
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Frigoli, Heg) Clinical Trial Unit, University of Bern, Switzerland
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
Netherlands
(Tijssen) Ecri, Rotterdam, Netherlands
(Juni) University of Toronto, Applied Health Research Centre, Li Ka Shing
Knowledge Institute, St Michael's Hospital, Canada
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Belgium
(Ozaki) Department of Cardiology, School of Medicine, Fujita Health
University, Toyoake, Japan
(Morice) Cardiovascular European Research Center, Massy, France
(Chevalier) Ramsay Generale de Sante, Interventional Cardiology
Department, Institut Cardiovasculaire Paris Sud, Massy, France
(Onuma) National University of Ireland, Galway, Ireland
(Windecker) Department of Cardiology, Bern University Hospital,
Switzerland
(Tonino) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Roffi) Division of Cardiology, Geneva University Hospitals, Switzerland
(Lesiak) First Department of Cardiology, University of Medical Sciences,
Poznan, Poland
(Mahfoud) Department of Cardiology, Angiology, Intensive Care Medicine,
Saarland University, Homburg, Germany
(Bartunek) Cardiovascular Center, Olv Hospital, Aalst, Belgium
(Hildick-Smith) Brighton and Sussex University Hospitals, Nhs Trust,
United Kingdom
(Colombo) Unit of Cardiovascular Interventions, Irccs San Raffaele
Scientific Institute, Milan, Italy
(Stankovic) Department of Cardiology, Clinical Center of Serbia, Faculty
of Medicine, University of Belgrade, Serbia
(Iniguez) Hospital Alvaro Cunqueiro, Vigo, Spain
(Schultz) Department of Cardiology, University of Western Australia, Royal
Perth Hospital Campus, Australia
(Kornowski) Rabin Medical Center, Sackler School of Medicine, Tel Aviv
University, Israel
(Ong) Tan Tock Seng Hospital, Singapore
(Alasnag) Department of Cardiology, King Fahad Armed Forces Hospital,
Jeddah, Saudi Arabia
(Rodriguez) Cardiac Unit Otamendi Hospital, Buenos Aires School of
Medicine, Cardiovascular Research Center, Argentina
(Moschovitis) HerzZentrum, Hirslanden, Zurich, Switzerland
(Laanmets) North-Estonia Medical Centre Foundation, Tallinn, Estonia
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Universita della Svizzera Italiana, Lugano, Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimal duration of antiplatelet therapy (APT) in patients
at high bleeding risk with or without oral anticoagulation (OAC) after
coronary stenting remains unclear. <br/>Method(s): In the
investigator-initiated, randomize, open-label MASTER DAPT trial
(Management of High Bleeding Risk Patients Post Bioresorbable Polymer
Coated Stent Implantation With an Abbreviated Versus Standard DAPT
Regimen), 4579 patients at high bleeding risk were randomized after
1-month dual APT to abbreviated or nonabbreviated APT strategies.
Randomization was stratified by concomitant OAC indication. In this
subgroup analysis, we report outcomes of populations with or without an
OAC indication. In the population with an OAC indication, patients changed
immediately to single APT for 5 months (abbreviated regimen) or continued
>=2 months of dual APT and single APT thereafter (nonabbreviated regimen).
Patients without an OAC indication changed to single APT for 11 months
(abbreviated regimen) or continued >=5 months of dual APT and single APT
thereafter (nonabbreviated regimen). Coprimary outcomes at 335 days after
randomization were net adverse clinical outcomes (composite of all-cause
death, myocardial infarction, stroke, and Bleeding Academic Research
Consortium 3 or 5 bleeding events); major adverse cardiac and cerebral
events (all-cause death, myocardial infarction, and stroke); and type 2,
3, or 5 Bleeding Academic Research Consortium bleeding. <br/>Result(s):
Net adverse clinical outcomes or major adverse cardiac and cerebral events
did not differ with abbreviated versus nonabbreviated APT regimens in
patients with OAC indication (n=1666; hazard ratio [HR], 0.83 [95% CI,
0.60-1.15]; and HR, 0.88 [95% CI, 0.60-1.30], respectively) or without OAC
indication (n=2913; HR, 1.01 [95% CI, 0.77-1.33]; or HR, 1.06 [95% CI,
0.79-1.44]; Pinteraction=0.35 and 0.45, respectively). Bleeding Academic
Research Consortium 2, 3, or 5 bleeding did not significantly differ in
patients with OAC indication (HR, 0.83 [95% CI, 0.62-1.12]) but was lower
with abbreviated APT in patients without OAC indication (HR, 0.55 [95% CI,
0.41-0.74]; Pinteraction=0.057). The difference in bleeding in patients
without OAC indication was driven mainly by a reduction in Bleeding
Academic Research Consortium 2 bleedings (HR, 0.48 [95% CI, 0.33-0.69];
Pinteraction=0.021). <br/>Conclusion(s): Rates of net adverse clinical
outcomes and major adverse cardiac and cerebral events did not differ with
abbreviated APT in patients with high bleeding risk with or without an OAC
indication and resulted in lower bleeding rates in patients without an OAC
indication. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT03023020. <br/>Copyright &#xa9; 2021 The Authors.

<8>
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Accession Number
633265261
Title
General Versus Local Anesthesia With Conscious Sedation in Transcatheter
Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial.
Source
Circulation. 142(15) (pp 1437-1447), 2020. Date of Publication: 13 Oct
2020.
Author
Thiele H.; Kurz T.; Feistritzer H.-J.; Stachel G.; Hartung P.; Lurz P.;
Eitel I.; Marquetand C.; Nef H.; Doerr O.; Vigelius-Rauch U.; Lauten A.;
Landmesser U.; Treskatsch S.; Abdel-Wahab M.; Sandri M.; Holzhey D.;
Borger M.; Ender J.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.; Fach
A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Ruckert Y.; Funkat
A.-K.; Desch S.; Berggreen A.E.; Heringlake M.; De Waha-Thiele S.
Institution
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri,
Holzhey, Borger, Ender, Desch) Heart Center Leipzig at University,
Leipzig, Germany
(Thiele, Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri,
Holzhey, Borger, Ruckert, Funkat, Desch) Leipzig Heart Institute, Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, Berggreen, Heringlake, De
Waha-Thiele) University Clinic Schleswig-Holstein, University Heart Center
Lubeck, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Frey, Konig,
Desch, De Waha-Thiele) German Center for Cardiovascular Research (DZHK),
Germany
(Nef, Doerr, Vigelius-Rauch) Universitatsklinikum Marburg/Giesen, Giesen,
Germany
(Lauten, Landmesser, Treskatsch) Universitatsklinikum Charite, Campus
Benjamin Franklin, Berlin, Germany
(Ince, Oner) Universitatsklinikum Rostock, Germany
(Hambrecht, Fach, Augenstein) Klinikum Links der Weser, Bremen, Germany
(Frey) University Clinic Schleswig-Holstein, Kiel, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
University of Lubeck, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In clinical practice, local anesthesia with conscious sedation
(CS) is performed in roughly 50% of patients undergoing transcatheter
aortic valve replacement. However, no randomized data assessing the safety
and efficacy of CS versus general anesthesia (GA) are available.
<br/>Method(s): The SOLVE-TAVI (Comparison of Second-Generation
Self-Expandable Versus Balloon-Expandable Valves and General Versus Local
Anesthesia in Transcatheter Aortic Valve Implantation) trial is a
multicenter, open-label, 2x2 factorial, randomized trial of 447 patients
with aortic stenosis undergoing transfemoral transcatheter aortic valve
replacement comparing CS versus GA. The primary efficacy end point was
powered for equivalence (equivalence margin 10% with significance level
0.05) and consisted of the composite of all-cause mortality, stroke,
myocardial infarction, infection requiring antibiotic treatment, and acute
kidney injury at 30 days. <br/>Result(s): The primary composite end point
occurred in 27.2% of CS and 26.4% of GA patients (rate difference, 0.8
[90% CI, -6.2 to 7.8]; P<inf>equivalence</inf>=0.015). Event rates for the
individual components were as follows: all-cause mortality, 3.2% versus
2.3% (rate difference, 1.0 [90% CI, -2.9 to 4.8];
P<inf>equivalence</inf><0.001); stroke, 2.4% versus 2.8% (rate difference,
-0.4 [90% CI, -3.8 to 3.8]; P<inf>equivalence</inf><0.001); myocardial
infarction, 0.5% versus 0.0% (rate difference, 0.5 [90% CI, -3.0 to 3.9];
P<inf>equivalence</inf><0.001), infection requiring antibiotics 21.1%
versus 22.0% (rate difference, -0.9 [90% CI, -7.5 to 5.7];
P<inf>equivalence</inf>=0.011); acute kidney injury, 9.0% versus 9.2%
(rate difference, -0.2 [90% CI, -5.2 to 4.8];
P<inf>equivalence</inf>=0.0005). There was a lower need for inotropes or
vasopressors with CS (62.8%) versus GA (97.3%; rate difference, -34.4 [90%
CI, -41.0 to -27.8]). <br/>Conclusion(s): Among patients with aortic
stenosis undergoing transfemoral transcatheter aortic valve replacement,
use of CS compared with GA resulted in similar outcomes for the primary
efficacy end point. These findings suggest that CS can be safely applied
for transcatheter aortic valve replacement. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT02737150.<br/>Copyright &#xa9; 2020 Lippincott Williams and Wilkins.
All rights reserved.

<9>
Accession Number
641536993
Title
A systematic review on the effect of bone wax application in cardiac
surgery.
Source
British Journal of Surgery. Conference: Annual Scientific Meeting of the
Surgical Research Society. Nottingham United Kingdom. 110(Supplement 3)
(pp iii44), 2023. Date of Publication: May 2023.
Author
Shah A.; Kuma N.S.; Raja S.; Bhudia S.
Institution
(Shah) University College London Medical School, London, United Kingdom
(Shah, Kuma) National Medical Research Association (NMRA), United Kingdom
(Raja, Bhudia) Royal Brompton and Harefield NHS Foundation Trust, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Introduction: Limited and conflicting evidence exists on whether bone wax
usage in cardiac surgery increases risk of infection. A systematic review
was conducted to examine the cardiac surgery postoperative outcomes
following bone wax application. <br/>Method(s): Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered
to in this review. The EMBASE, MEDLINE and Scopus databases were searched
for studies evaluating perioperative bone wax usage, excluding non-English
papers. All relevant synonyms of Cardiac Surgery, Bone Wax, Infection, and
Healing were used for paper identification. Wound infection, sternal
dehiscence, postoperative sternal bleeding, postoperative chest drainage
and mortality were outcomes of interest. <br/>Result(s): From the 66
articles identified, 5 were included following full-text screening. No
statistically significant difference in infection risk between the bone
wax (BW) and comparator groups existed. However, the evidence suggests
bone wax significantly increases sternal dehiscence risk. Studies
reporting postoperative bleeding showed a significantly greater mean
volume in the BW group. All studies reporting postoperative chest drainage
(n=3) showed a greater mean volume in the BW group, of which two were
significant. Of the three papers reporting mortality, two showed increased
risk in the BW group. <br/>Conclusion(s): Current evidence indicates no
significant association between bone wax and wound infection. Bone wax is
associated with increased risk of sternal dehiscence, postoperative
sternal bleeding, postoperative chest drainage and mortality. Greater
emphasis should be placed on bone wax alternatives in clinical practice.
Limited data necessitates larger studies, and for clearer guidelines to be
established around them.

<10>
[Use Link to view the full text]
Accession Number
2024923309
Title
Methodological Standards for the Design, Implementation, and Analysis of
Randomized Trials in Cardiac Surgery: A Scientific Statement from the
American Heart Association.
Source
Circulation. 145(4) (pp E129-E142), 2022. Date of Publication: 25 Jan
2022.
Author
Gaudino M.; Chikwe J.; Bagiella E.; Bhatt D.L.; Doenst T.; Fremes S.E.;
Lawton J.; Masterson Creber R.M.; Sade R.M.; Zwischenberger B.A.
Publisher
Lippincott Williams and Wilkins
Abstract
Cardiac surgery presents specific methodological challenges in the design,
implementation, and analysis of randomized controlled trials. The purposes
of this scientific statement are to review key standards in cardiac
surgery randomized trial design and implementation, and to provide
recommendations for conducting and interpreting cardiac surgery trials.
Recommendations include a careful evaluation of the suitability of the
research question for a clinical trial, assessment of clinical equipoise,
feasibility of enrolling a representative patient cohort, impact of
practice variations on the safety and efficacy of the study intervention,
likelihood and impact of crossover, and duration of follow-up. Trial
interventions and study end points should be predefined, and appropriate
strategies must be used to ensure adequate deliverability of the trial
interventions. Every effort must be made to ensure a high completeness of
follow-up; trial design and analytic techniques must be tailored to the
specific research question and trial setting.<br/>Copyright &#xa9; 2022
Lippincott Williams and Wilkins. All rights reserved.

<11>
Accession Number
2024917369
Title
Cardiac rehabilitation in coronary artery bypass grafting patients: Effect
of eight weeks of moderate-intensity continuous training versus
high-intensity interval training.
Source
Clinical Hemorheology and Microcirculation. 83(3) (pp 305-314), 2023. Date
of Publication: 2023.
Author
Shafiee N.; Kordi N.; Gadruni K.; Salehfard Z.; Jung F.; Heidari N.
Institution
(Shafiee) Department of Sport Physiology, Faculty of Sport Sciences, The
University of Mazandaran, Babolsar, Iran, Islamic Republic of
(Kordi) Department of Exercise Physiology, Faculty of Sport Sciences, Razi
University, Kermanshah, Iran, Islamic Republic of
(Gadruni) Faculty of Physical Education, University of Tabriz, Tabriz,
Iran, Islamic Republic of
(Salehfard) Department of Sport Physiology, School of Physical Education
and Sport Sciences, Alzahra University, Tehran, Iran, Islamic Republic of
(Jung) Faculty of Health Sciences Brandenburg, Brandenburg University of
Technology Cottbus-Senftenberg, Senftenberg, Germany
(Heidari) Faculty of Sport Science, Shahid Rajaei Teacher Training
University, Tehran, Iran, Islamic Republic of
Publisher
IOS Press BV
Abstract
BACKGROUND: Physical training in patients with heart failure can affect
hemodynamic, cardiac and angiogenesis parameters. <br/>OBJECTIVE(S): The
aim of the present study was to investigate the effects of traditional
moderate-intensity rehabilitation training and interval training on some
angiogenesis factors in coronary artery bypass graft (CABG) patients.
<br/>METHOD(S): Thirty CABG patients (mean age+/-SD, 55+/-3 years) were
randomly assigned to one of three groups: high-intensity interval training
(HIIT) or moderate-intensity continuous training (MICT) or the control
group. After the initial assessments, eligible patients in the
experimental groups (HIIT and MICT) performed exercise training for 8
weeks, while the control group did not. Angiogenesis and angiostatic
indices, including pro-adrenomedullin (pro-ADM), basic fibroblast growth
factor (bFGF), and endostatin, were then measured. <br/>RESULT(S): The
results showed no significant difference between pro-ADM in the HIIT and
MICT groups (P = 0.99), but a significant difference was found between
MICT and the control group and between HIIT and the control group (P =
0.001). There is also no significant difference between the bFGF levels in
the HIIT and MICT training groups (P = 1.00), but the changes in this
factor between the training groups and the control group were significant
(P = 0.001). There was a significant difference between the levels of
endostatin in all three groups. <br/>CONCLUSION(S): Two methods of cardiac
rehabilitation (HIIT and MICT) may be useful for the recovery of patients
with coronary artery bypass grafting. This improvement manifested itself
in changes in angiogenesis and angiostatic indices in this study. However,
more extensive studies are needed to investigate the effects of these two
types of rehabilitation programs on other indicators of angiogenesis and
angiostatic. <br/>Copyright &#xa9; 2023 - IOS Press. All rights reserved.

<12>
Accession Number
2025057997
Title
The effect of driving pressure-guided versus conventional mechanical
ventilation strategy on pulmonary complications following on-pump cardiac
surgery: A randomized clinical trial.
Source
Journal of Clinical Anesthesia. 89 (no pagination), 2023. Article Number:
111150. Date of Publication: October 2023.
Author
Li X.-F.; Jiang R.-J.; Mao W.-J.; Xin J.; Yu H.
Institution
(Li, Yu, Xin, Yu) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu 610041, China
(Jiang) Department of Anesthesiology, Chengdu Second People's Hospital,
Chengdu 610041, China
(Mao) Department of Anesthesiology, Jianyang People's Hospital, Jianyang
641400, China
Publisher
Elsevier Inc.
Abstract
Study objective: Postoperative pulmonary complications occur frequently
and are associated with worse postoperative outcomes in cardiac surgical
patients. The advantage of driving pressure-guided ventilation strategy in
decreasing pulmonary complications remains to be definitively established.
We aimed to investigate the effect of intraoperative driving
pressure-guided ventilation strategy compared with conventional
lung-protective ventilation on pulmonary complications following on-pump
cardiac surgery. <br/>Design(s): Prospective, two-arm, randomized
controlled trial. <br/>Setting(s): The West China university hospital in
Sichuan, China. <br/>Patient(s): Adult patients who were scheduled for
elective on-pump cardiac surgery were enrolled in the study.
<br/>Intervention(s): Patients undergoing on-pump cardiac surgery were
randomized to receive driving pressure-guided ventilation strategy based
on positive end-expiratory pressure (PEEP) titration or conventional
lung-protective ventilation strategy with fixed 5 cmH<inf>2</inf>O of
PEEP. Measurements: The primary outcome of pulmonary complications
(including acute respiratory distress syndrome, atelectasis, pneumonia,
pleural effusion, and pneumothorax) within the first 7 postoperative days
were prospectively identified. Secondary outcomes included pulmonary
complication severity, ICU length of stay, and in-hospital and 30-day
mortality. <br/>Main Result(s): Between August 2020 and July 2021, we
enrolled 694 eligible patients who were included in the final analysis.
Postoperative pulmonary complications occurred in 140 (40.3%) patients in
the driving pressure group and 142 (40.9%) in the conventional group
(relative risk, 0.99; 95% confidence interval, 0.82-1.18; P = 0.877).
Intention-to-treat analysis showed no significant difference between study
groups regarding the incidence of primary outcome. The driving pressure
group had less atelectasis than the conventional group (11.5% vs 17.0%;
relative risk, 0.68; 95% confidence interval, 0.47-0.98; P = 0.039).
Secondary outcomes did not differ between groups. <br/>Conclusion(s):
Among patients who underwent on-pump cardiac surgery, the use of driving
pressure-guided ventilation strategy did not reduce the risk of
postoperative pulmonary complications when compared with conventional
lung-protective ventilation strategy.<br/>Copyright &#xa9; 2023

<13>
Accession Number
2025050957
Title
Predicting 5-Year Clinical Outcomes After Transcatheter or Surgical Aortic
Valve Replacement (a Risk Score from the SURTAVI Trial).
Source
American Journal of Cardiology. 200 (pp 78-86), 2023. Date of Publication:
01 Aug 2023.
Author
van Bergeijk K.H.; Wykrzykowska J.J.; van Mieghem N.M.; Windecker S.;
Sondergaard L.; Gada H.; Li S.; Hanson T.; Deeb G.M.; Voors A.A.; Reardon
M.J.
Institution
(van Bergeijk, Wykrzykowska, Voors) University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
(van Mieghem) Erasmus University Medical Center Rotterdam, Rotterdam,
Netherlands
(Windecker) University of Bern, Bern, Switzerland
(Sondergaard) The Heart Center Copenhagen, Copenhagen, Denmark
(Gada) University of Pittsburgh Medical Center Pinnacle Health,
Pittsburgh, Pennsylvania, United States
(Li, Hanson) Statistical Services, Medtronic, Minneapolis, MN, United
States
(Deeb) University of Michigan, Ann Arbor, MI, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
Texas
Publisher
Elsevier Inc.
Abstract
Risk prediction scores for long-term outcomes after transcatheter aortic
valve implantation (TAVI) or surgical aortic valve replacement (SAVR) are
lacking. This study aimed to develop preprocedural risk scores for 5-year
clinical outcomes after TAVI or SAVR. This analysis included 1,660
patients at an intermediate surgical risk with severe aortic stenosis
randomly assigned to TAVI (n = 864) or SAVR (n = 796) from the SURTAVI
(Surgical Replacement and Transcatheter Aortic Valve Implantation) trial.
The primary end point was a composite of all-cause mortality or disabling
stroke at 5 years. The secondary end point was a composite of
cardiovascular mortality or hospitalizations for valve disease or
worsening heart failure at 5 years. Preprocedural multivariable predictors
of clinical outcomes were used to calculate a simple risk score for both
procedures. At 5 years, the primary end point occurred in 31.3% of the
patients with TAVI and 30.8% of the patients with SAVR. Preprocedural
predictors differed between TAVI and SAVR. Baseline anticoagulant use was
a common predictor for events in both procedures, whereas male sex and a
left ventricular ejection fraction <60% were significant predictors for
events in patients with TAVI and SAVR, respectively. A total of 4 simple
scoring systems were created based on these multivariable predictors. The
C-statistics of all models were modest but performed better than the
contemporary risk scores. In conclusion, preprocedural predictors of
events differ between TAVI and SAVR, necessitating separate risk models.
Despite the modest predictive value of the SURTAVI risk scores, they
appeared superior to other contemporary scores. Further research is needed
to strengthen and validate our risk scores, possibly by including
biomarker and echocardiographic parameters.<br/>Copyright &#xa9; 2023 The
Author(s)

<14>
[Use Link to view the full text]
Accession Number
2024923256
Title
Icosapent Ethyl Reduces Ischemic Events in Patients with a History of
Previous Coronary Artery Bypass Grafting: REDUCE-IT CABG.
Source
Circulation. 144(23) (pp 1845-1855), 2021. Date of Publication: 07 Dec
2021.
Author
Verma S.; Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.;
Dhingra N.K.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz
C.; Gibson C.M.; Pinto D.; Giugliano R.P.; Budoff M.J.; Mason R.P.; Tardif
J.-C.; Ballantyne C.M.
Institution
(Verma, Tardif) Montreal Heart Institute, Universite de Montreal, Quebec,
Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine, Center
for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
(Gibson, Pinto) Baim Clinical Research Institute, Boston, MA, United
States
(Budoff) David Geffen School of Medicine, Lundquist Institute, Torrance,
CA, United States
(Mason) Elucida Research, Beverly, MA, United States
(Dhingra) Division of Cardiac Surgery, St Michael's Hospital, University
of Toronto, ON, Canada
(Bhatt, Giugliano) Brigham and Women's Hospital, Heart and Vascular
Center, Harvard Medical School, Boston, MA, United States
(Steg) Universite de Paris, Assistance Publique-Hopitaux de Paris, Hopital
Bichat, French Alliance for Cardiovascular Trials, Institut National de la
Sante et de la Recherche Medicale, U-1148, Paris, France
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, United States
(Brinton) Utah Lipid Center, Salt Lake City, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Ketchum, Juliano, Jiao, Doyle, Granowitz) Amarin Pharma Inc, Bridgewater,
NJ, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Despite advances in surgery and pharmacotherapy, there remains
significant residual ischemic risk after coronary artery bypass grafting
surgery. <br/>Method(s): In REDUCE-IT (Reduction of Cardiovascular Events
With Icosapent Ethyl-Intervention Trial), a multicenter,
placebo-controlled, double-blind trial, statin-treated patients with
controlled low-density lipoprotein cholesterol and mild to moderate
hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or
placebo. They experienced a 25% reduction in risk of a primary efficacy
end point (composite of cardiovascular death, myocardial infarction,
stroke, coronary revascularization, or hospitalization for unstable
angina) and a 26% reduction in risk of a key secondary efficacy end point
(composite of cardiovascular death, myocardial infarction, or stroke) when
compared with placebo. The current analysis reports on the subgroup of
patients from the trial with a history of coronary artery bypass grafting.
<br/>Result(s): Of the 8179 patients randomized in REDUCE-IT, a total of
1837 (22.5%) had a history of coronary artery bypass grafting, with 897
patients randomized to icosapent ethyl and 940 to placebo. Baseline
characteristics were similar between treatment groups. Randomization to
icosapent ethyl was associated with a significant reduction in the primary
end point (hazard ratio [HR], 0.76 [95% CI, 0.63-0.92]; P=0.004), in the
key secondary end point (HR, 0.69 [95% CI, 0.56-0.87]; P=0.001), and in
total (first plus subsequent or recurrent) ischemic events (rate ratio,
0.64 [95% CI, 0.50-0.81]; P=0.0002) compared with placebo. This yielded an
absolute risk reduction of 6.2% (95% CI, 2.3%-10.2%) in first events, with
a number needed to treat of 16 (95% CI, 10-44) during a median follow-up
time of 4.8 years. Safety findings were similar to the overall study:
beyond an increased rate of atrial fibrillation/flutter requiring
hospitalization for at least 24 hours (5.0% vs 3.1%; P=0.03) and a
nonsignificant increase in bleeding, occurrences of adverse events were
comparable between groups. <br/>Conclusion(s): In REDUCE-IT patients with
a history of coronary artery bypass grafting, treatment with icosapent
ethyl was associated with significant reductions in first and recurrent
ischemic events. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT01492361.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<15>
Accession Number
2023677357
Title
Influence of preoperative frailty on quality of life after cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of the American Geriatrics Society. (no pagination), 2023. Date
of Publication: 2023.
Author
Fehlmann C.A.; Bezzina K.; Mazzola R.; Visintini S.M.; Guo M.H.; Rubens
F.D.; Wells G.A.; McGuinty C.; Huang A.; Khoury L.; Boczar K.E.
Institution
(Fehlmann, Rubens, Wells, Boczar) School of Epidemiology and Public
Health, University of Ottawa, Ottawa, ON, Canada
(Fehlmann) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Fehlmann) Division of Emergency Medicine, Geneva University Hospitals,
Geneva, Switzerland
(Bezzina) Care of the Elderly Program, Elisabeth Bruyere Hospital, Ottawa,
ON, Canada
(Mazzola, McGuinty, Boczar) University of Ottawa Heart Institute, Ottawa,
ON, Canada
(Visintini) Berkman Library, University of Ottawa Heart Institute, Ottawa,
ON, Canada
(Guo, Rubens) Department of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Wells) Research Methods Centre, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Huang, Khoury) Division of Geriatric Medicine, The Ottawa Hospital,
Ottawa, ON, Canada
(Boczar) Division of Cardiology, Department of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Frailty has emerged as an important prognostic marker of
increased mortality after cardiac surgery, but its association with
quality of life (QoL) and patient-centered outcomes is not fully
understood. We sought to evaluate the association between frailty and such
outcomes in older patients undergoing cardiac surgery. <br/>Method(s):
This systematic review included studies evaluating the effect of
preoperative frailty on QoL outcomes after cardiac surgery amongst
patients 65 years and older. The primary outcome was patient's perceived
change in QoL following cardiac surgery. Secondary outcomes included
residing in a long-term care facility for 1 year, readmission in the year
following the intervention, and discharge destination. Screening,
inclusion, data extraction, and quality assessment were performed
independently by two reviewers. Meta-analyses based on the random-effects
model were conducted. The evidential quality of findings was assessed with
the GRADE profiler. <br/>Result(s): After the identification of 3105
studies, 10 observational studies were included (1580 patients) in the
analysis. Two studies reported on the change in QoL following cardiac
surgery, which was higher for patients with frailty than for patients
without. Preoperative frailty was associated with both hospital
readmission (pooled odds ratio [OR] 1.48 [0.80-2.74], low GRADE level) as
well as non-home discharge (pooled OR 3.02 [1.57-5.82], moderate GRADE
level). <br/>Conclusion(s): While evidence in this field is limited by
heterogeneity of frailty assessment and non-randomized data, we
demonstrated that baseline frailty may possibly be associated with
improved QoL, but with increased readmission as well as discharge to a
non-home destination following cardiac surgery. These patient-centered
outcomes are important factors when considering interventional options for
older patients. Study Registration: OSF registries
(https://osf.io/vm2p8).<br/>Copyright &#xa9; 2023 The Authors. Journal of
the American Geriatrics Society published by Wiley Periodicals LLC on
behalf of The American Geriatrics Society.

<16>
Accession Number
641537562
Title
Clinical outcomes of different revascularization approaches for patients
with multi-vessel coronary artery disease: A network meta-analysis.
Source
Perfusion. (pp 2676591231182585), 2023. Date of Publication: 09 Jun 2023.
Author
Hasan S.U.; Pervez A.; Naseeb M.W.; Rajput B.S.; Faheem A.; Hameed I.; Sa
M.P.; Zubair M.M.
Institution
(Hasan, Pervez) Aga Khan University Hospital, Karachi, Pakistan
(Naseeb, Rajput, Faheem) Dow University of Health Sciences, Karachi,
Pakistan
(Hameed) Department of Cardiothoracic Surgery, Yale School of Medicine,
New Haven, CT, United States
(Sa) Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood,
PA, United States
(Zubair) Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: As surgical techniques continue to evolve, the optimal
approach for revascularizing multi-vessel coronary artery disease (CAD)
remains a matter of ongoing debate. Accordingly, our objective was to
compare and contrast various surgical techniques utilized in the
management of multi-vessel CAD. <br/>METHOD(S): A systematic literature
review was performed using PubMed, Embase, and Cochrane central register
of controlled trials from inception to May 2022. Random-effects network
meta-analysis was performed for the primary outcome; target vessel
revascularization (TVR), and secondary outcomes; mortality, major adverse
cardiac and cerebrovascular events, postoperative myocardial infarction,
new-onset atrial fibrillation, stroke, new-onset dialysis, in patients
undergoing percutaneous coronary intervention (PCI) with a stent, off-pump
coronary bypass graft, on-pump coronary artery bypass graft (ONCABG),
hybrid coronary revascularization, minimally-invasive coronary artery
bypass, or robot-assisted coronary artery bypass (RCAB) surgeries.
<br/>RESULT(S): A total of 8841 patients were included from 23 studies.
The analysis showed that ONCABG had the highest freedom from TVR, with a
mean (SD) absolute risk of 0.027 (0.029); although ONCABG was found to be
superior to all other methods, it was only significantly better than
first-generation stent PCI. While RCAB did not demonstrate significant
superiority over other treatments, it showed a greater probability of
preventing postoperative complications. Notably, no significant
heterogeneity was calculated for any of the reported outcomes.
<br/>CONCLUSION(S): ONCABG shows a better rank probability compared to all
other techniques for preventing TVR, while RCAB offers greater freedom
from most postoperative complications. However, given the absence of
randomized controlled trials, these results should be interpreted with
caution.

<17>
Accession Number
2023649341
Title
Natural history of moderate aortic stenosis and predictors for mortality:
Systematic review and meta-analysis.
Source
Journal of Cardiology. 82(1) (pp 1-7), 2023. Date of Publication: July
2023.
Author
Yokoyama Y.; Fukuhara S.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
PA, United States
(Fukuhara) Department of Cardiothoracic Surgery, University of Michigan,
Ann Arbor, MI, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, NY, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Although the current guidelines advocate imaging surveillance for moderate
aortic stenosis (AS), recent studies suggest a worse prognosis associated
with moderate AS than previously reported. Considering the recent paradigm
shift in AS management, the risk/benefit profile of aortic valve
replacement (AVR) for moderate AS needs to be re-evaluated. Herein, we
conducted meta-analyses of natural history and risk predictors in patients
with moderate AS. PubMed and EMBASE were searched through May 2022 to
identify studies that investigated the natural history of patients with
moderate AS. Meta-analyses with random effects model were conducted. Our
analysis included 20 observational studies which enrolled a total of
11,114 patients with moderate AS. The rate of all-cause death was 11.0 [95
% confidence interval (CI), 7.6-14.4] per 100 patients per year. Surgical
or transcatheter AVR occurred at a rate of 8.5 (95 % CI, 6.2-10.8;
I², 98.9 %) per 100 patients per year. Occurrence of AVR during
follow-up [hazard ratio (HR) (95 % CI) = 0.56 (0.42-0.75), p < 0.001] and
early AVR for moderate AS [HR (95 % CI) = 0.47 (0.25-0.90), p = 0.02] were
associated with significantly lower all-cause mortality, while left
ventricular ejection fraction <50 % [HR (95 % CI) = 1.84 (1.33-2.57), p =
0.0003] and symptomatic status [HR (95 % CI) = 1.52 (1.32-1.75), p <
0.0001] were associated with increased all-cause mortality. Sex difference
was not related to all-cause mortality. Our meta-analysis suggested that
moderate AS was associated with high mortality, especially in low left
ventricular systolic function or symptomatic patients. In addition,
significant portion of the patients underwent AVR during
follow-up.<br/>Copyright &#xa9; 2023 Elsevier Ltd

<18>
Accession Number
2022851299
Title
Percutaneous MitraClip Device or Surgical Mitral Valve Repair in Patients
With Primary Mitral Regurgitation Who Are Candidates for Surgery: Design
and Rationale of the REPAIR MR Trial.
Source
Journal of the American Heart Association. 12(4) (no pagination), 2023.
Article Number: e027504. Date of Publication: 21 Feb 2023.
Author
McCarthy P.M.; Whisenant B.; Asgar A.W.; Ailawadi G.; Hermiller J.;
Williams M.; Morse A.; Rinaldi M.; Grayburn P.; Thomas J.D.; Martin R.;
Asch F.M.; Shu Y.; Sundareswaran K.; Moat N.; Kar S.
Institution
(McCarthy, Thomas) Northwestern Medicine, Chicago, IL, United States
(Whisenant) Intermountain Healthcare, Murray, UT, United States
(Asgar) Montreal Heart Institute, Montreal, QC, Canada
(Ailawadi) University of Michigan Hospital, Ann Arbor, MI, United States
(Hermiller) St. Vincent's Hospital, Indianapolis, IN, United States
(Williams) New York University Medical Center, New York, NY, United States
(Morse) St. Thomas Hospital, Nashville, TN, United States
(Rinaldi) Sanger Heart and Vascular Institute, Charlotte, NC, United
States
(Grayburn) Baylor Scott and White Hospital, Plano, TX, United States
(Martin) Emory University, Atlanta, GA, United States
(Asch) Medstar Health Research Institute, Washington, DC, United States
(Shu, Sundareswaran, Moat) Abbott, Santa Clara, CA, United States
(Kar) Los Robles Medical Center, Thousand Oaks, CA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The current standard of care for the treatment of patients
with primary mitral regurgitation (MR) is surgical mitral valve repair.
Transcatheter edge-to-edge repair with the MitraClip device provides a
less invasive treatment option for patients with both primary and
secondary MR. Worldwide, >150 000 patients have been treated with the
MitraClip device. However, in the United States, MitraClip is approved for
use only in primary patients with MR who are at high or prohibitive risk
for mitral valve surgery. The REPAIR MR (Percutaneous MitraClip Device or
Surgical Mitral Valve Repair in Patients With Primary Mitral Regurgitation
Who Are Candidates for Surgery) trial is designed to compare early and
late outcomes associated with tran-scatheter edge-to-edge repair with the
MitraClip and surgical repair of primary MR in older or moderate surgical
risk patients. METHODS AND RESULTS: The REPAIR MR trial is a prospective,
randomized, parallel-controlled, open-label multicenter, noninfe-riority
trial for the treatment of severe primary MR (verified by an independent
echocardiographic core laboratory). Patients with severe MR and
indications for surgery because of symptoms (New York Heart Association
class II- IV), or without symptoms with left ventricular ejection fraction
<=60%, pulmonary artery systolic pressure >50 mm Hg, or left ventricular
end-systolic diameter >=40 mm are eligible for the trial provided they
meet the moderate surgical risk criteria as follows: (1) >=75 years of
age, or (2) if <75 years of age, then the subject has a Society of
Thoracic Surgeons Predicted Risk Of Mortality score of >=2% for mitral
repair (or Society of Thoracic Surgeons replacement score of >=4%), or the
presence of a comorbidity that may introduce a surgery-specific risk. The
local surgeon must determine that the mitral valve can be surgically
repaired. Additionally, an independent eligibility committee will confirm
that the MR can be reduced to mild or less with both the MitraClip and
surgical mitral valve repair with a high degree of certainty. A total of
500 eligible subjects will be randomized in a 1:1 ratio to receive the
MitraClip device or to undergo surgical mitral valve repair (control
group). There are 2 co- primary end points for the trial, both of which
will be evaluated at 2 years. Each subject will be followed for 10 years
after enrollment. The study has received approval from both the Food and
Drug Administration and the Centers for Medicare and Medicaid Services,
and enrolled its first subject in July 2020. <br/>CONCLUSION(S): The
REPAIR MR trial will determine the safety and effectiveness of
transcatheter edge-to-edge repair with the MitraClip in patients with
primary MR who are at moderate surgical risk and are candidates for
surgical MV repair. The trial will generate contemporary comparative
clinical evidence for the MitraClip device and surgical MV repair.
REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04198870;
NCT04198870.<br/>Copyright &#xa9; 2023 The Authors.

<19>
Accession Number
2022788823
Title
The Effect and Possible Mechanism of Cardiac Rehabilitation in Partial
Revascularization Performed on Multiple Coronary Artery Lesions.
Source
Clinical Interventions in Aging. 18 (pp 235-248), 2023. Date of
Publication: 2023.
Author
Gao Y.; Yue L.; Hao W.; Miao Z.; Wang F.; Wang S.; Luan B.
Institution
(Gao, Hao, Miao, Luan) Department of Cardiology, The People's Hospital of
Liaoning Province, Liaoning Province, Shenyang, China
(Yue) Department of Ultrasound, The Fourth Affiliated Hospital of China
Medical University, Liaoning Province, Shenyang, China
(Wang, Wang) Department of Cardiology, The First Affiliated Hospital of
Liaoning University of Traditional Chinese Medicine, Liaoning Province,
Shenyang, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: To observe the effect of cardiac rehabilitation (CR) in patients
with partial revascularization performed on multiple coronary artery
lesions and explore its possible mechanism. <br/>Patients and Methods: A
total of 400 patients with multiple coronary artery lesions were enrolled
and randomly divided into a complete revascularization group and a CR
group, with 200 cases in each group. Target lesion revascularization was
performed radically in the complete revascularization group, while it was
partially completed in the CR group, and postoperative CR was performed.
All the patients were put under conventional treatment. Left ventricular
end diastolic dimension (LVEDD), left ventricular ejection fraction
(LVEF), 6-minute walking distance (6-MWD), quality-of-life scores, safety
and levels of serum nitric oxide (NO), nitric oxide synthase (NOS),
superoxide dismutase (SOD), and vascular endothelial growth factor (VEGF)
were evaluated and compared between two groups before and after training.
<br/>Result(s): There was no significant difference in LVEDD, LVEF, 6-MWD,
quality-of-life scores, levels of serum NO, NOS, SOD, and VEGF between two
groups before training (p>0.05). 1 year later, compared with the complete
revascularization group, the occurrence of major adverse events in the CR
group declined (p>0.05); the measurements of LVEDD decreased and LVEF
increased (p>0.05), 6-MWD increased significantly (p<0.05),
quality-of-life scores were higher (p<0.05), the levels of serum NO, NOS,
and SOD increased noticeably, and the levels of serum VEGF decreased
significantly in the CR group (p<0.05). There were significant differences
within the same group, before and after training (p<0.05).
<br/>Conclusion(s): Cardiac rehabilitation training, not increase in the
incidence of adverse events, is effective and safe after partial
revascularization in patients with multiple coronary artery lesions, which
has notable clinical advantages in promoting patients' exercise endurance
and quality-of-life by improving the nitric oxide synthase system and
antioxidant system and reducing the level of VEGF.<br/>Copyright &#xa9;
2023 Gao et al. This work is published and licensed by Dove Medical Press
Limited.

<20>
Accession Number
2022678443
Title
The Effect of Female Sex on Short-Term Outcomes of Patients Undergoing
Off-Pump Versus On-Pump Coronary Artery Bypass Grafting.
Source
Brazilian Journal of Cardiovascular Surgery. 38(1) (pp 110-123), 2023.
Date of Publication: 2023.
Author
Fan J.; Luo S.-L.; Pan Y.-C.; Wu T.-Y.; Chen Y.; Li W.-J.
Institution
(Fan, Luo, Pan, Wu, Chen, Li) Department of Cardiology, Guangzhou First
People's Hospital, School of Medicine, South China University of
Technology, Guangzhou, China
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: According to the American Heart Association guideline for
coronary artery bypass grafting (CABG), female patients undergoing on-pump
CABG (ONCAB) are at higher risk of short-term adverse outcomes than male
patients. However, whether off-pump CABG (OPCAB) can improve the
short-term outcome of female patients compared to ONCAB remains unclear.
<br/>Method(s): We conducted a meta-analysis to study the effect of the
female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115
patients were enrolled in 12 studies, including 20,245 females who
underwent ONCAB and 10,910 females who underwent OPCAB. <br/>Result(s):
The in-hospital mortality in female patients who underwent OPCAB was
significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%;
odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without
(OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The
incidence of postoperative stroke in female patients who underwent OPCAB
was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI
0.48-0.73) before cardiovascular risk factor adjustment but was not
significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no
significant difference in the incidence of postoperative myocardial
infarction between women who underwent OPCAB and those in the ONCAB group
(1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43). <br/>Conclusion(s): In
contrast to the American Heart Association CABG guideline, female patients
who had OPCAB don't have unfavorable outcomes compared with the ONCAB
group.<br/>Copyright &#xa9; 2023, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<21>
Accession Number
2022097707
Title
Effects of preoperative nutritional status on disability-free survival
after cardiac and thoracic aortic surgery: a prospective observational
study.
Source
Journal of Anesthesia. 37(3) (pp 401-407), 2023. Date of Publication: June
2023.
Author
Kawanishi H.; Ida M.; Naito Y.; Kawaguchi M.
Institution
(Kawanishi, Ida, Naito, Kawaguchi) Department of Anesthesiology, Nara
Medical University, 840 Shijo-Cho, Nara, Kashihara 634-8522, Japan
Publisher
Springer
Abstract
Purpose: Preoperative malnutrition is associated with postoperative
complications, prolonged intensive care unit stay, and mortality, leading
to functional disability after non-cardiac surgery. However, its effects
on cardiac and thoracic aortic surgery outcomes remain unknown. We
examined the effects of preoperative malnutrition on disability-free
survival after surgery and assessed the perioperative 12-item World Health
Organization Disability Assessment Schedule 2.0 (WHODAS2.0) score based on
the preoperative nutritional status. <br/>Method(s): We included
individuals aged >= 55 years who underwent elective cardiac and/or
thoracic aortic surgery between April 1, 2016 and December 28, 2018 in a
tertiary center. The nutritional status was assessed preoperatively using
the Mini Nutritional Assessment Short Form, with scores < 12 points
indicating a poor nutritional status. The JapanSCORE2 was calculated for
surgical risk prediction. Our primary outcome was disability-free survival
1 year after surgery (WHODAS2.0 score: < 16%). The odds ratio of poor
nutritional status for disability-free survival was calculated using
multiple logistic regression analysis after adjusting for age,
JapanSCORE2, and duration of surgery. <br/>Result(s): One hundred patients
were followed up for 1 year. Preoperatively, 41 of them had a poor
nutritional status. The disability-free survival rates 1 year
postoperatively were 46.3% (19/41) and 64.4% (38/59) in patients with and
without poor preoperative nutritional status, respectively. The adjusted
odds ratio of poor nutritional status for disability-free survival at 1
year after surgery was 0.42 (95% confidence interval, 0.17-0.99).
<br/>Conclusion(s): Patients with a poor preoperative nutritional status
had less likely to show disability-free survival 1 year after cardiac and
thoracic aortic surgery.<br/>Copyright &#xa9; 2023, The Author(s) under
exclusive licence to Japanese Society of Anesthesiologists.

<22>
Accession Number
2021874437
Title
3D liver model-based surgical education improves preoperative
decision-making and patient satisfaction-a randomized pilot trial.
Source
Surgical Endoscopy. 37(6) (pp 4545-4554), 2023. Date of Publication: June
2023.
Author
Giehl-Brown E.; Dennler S.; Garcia S.A.; Seppelt D.; Oehme F.; Schweipert
J.; Weitz J.; Riediger C.
Institution
(Giehl-Brown, Dennler, Garcia, Oehme, Schweipert, Weitz, Riediger)
Department of Visceral, Thoracic and Vascular Surgery, University Hospital
Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany
(Giehl-Brown, Dennler, Garcia, Oehme, Schweipert, Weitz, Riediger)
National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
(Giehl-Brown, Dennler, Garcia, Oehme, Schweipert, Weitz, Riediger) German
Cancer Research Center (DKFZ), Heidelberg, Germany
(Giehl-Brown, Dennler, Garcia, Oehme, Schweipert, Weitz, Riediger) Faculty
of Medicine, University Hospital Carl Gustav Carus, Technische Universitat
Dresden, Dresden, Germany
(Giehl-Brown, Dennler, Garcia, Oehme, Schweipert, Weitz, Riediger)
Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
(Seppelt) Department of Radiology, University Hospital Carl Gustav Carus
Dresden, Technische Universitat Dresden, Dresden, Germany
Publisher
Springer
Abstract
Objective: Hepatobiliary surgery bares obstacles to informed consent for
the patients due to its complexity and related risk of postoperative
complications. 3D visualization of the liver has been proven to facilitate
comprehension of the spatial relationship between anatomical structures
and to assist in clinical decision-making. Our objective is to utilize
individual 3D-printed liver models to enhance patient satisfaction with
surgical education in hepatobiliary surgery. Design, setting: We conducted
a prospective, randomized pilot study comparing 3D liver model-enhanced
(3D-LiMo) surgical education against regular patient education during
preoperative consultation at the department of Visceral, Thoracic and
Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
<br/>Participant(s): Of 97 screened patients, undergoing hepatobiliary
surgery, 40 patients were enrolled from July 2020 to January 2022.
<br/>Result(s): The study population (n = 40) was predominantly of male
gender (62.5%) with a median age of 65.2 years and a high prevalence of
preexisting diseases. Underlying disease, warranting hepatobiliary
surgery, was malignancy in the majority of cases (97.5%). Patients in the
3D-LiMo group were more likely to feel very thoroughly educated and
exhibited a higher level of satisfaction following surgical education than
the control group (80 vs. 55%, n.s.; 90 vs. 65%, n.s.; respectively).
Applying 3D models was also associated with enhanced understanding of the
underlying disease with regard to amount (100% vs. 70%, p = 0.020) and
location of liver masses (95 vs. 65%, p = 0.044). 3D-LiMo patients also
demonstrated enhanced understanding of the surgical procedure (80 vs. 55%,
n.s.), leading to better awareness for the occurrence of postoperative
complications (88.9, vs. 68.4%, p = 0.052). Adverse event profiles were
similar. <br/>Conclusion(s): In conclusion, individual 3D-printed liver
models increase patient satisfaction with surgical education and
facilitate patients' understanding of the surgical procedure as well as
awareness of postoperative complications. Therefore, the study protocol is
feasible to apply to an adequately powered, multicenter, randomized
clinical trial with minor modifications.<br/>Copyright &#xa9; 2023, The
Author(s).

<23>
Accession Number
2021632876
Title
Comparison of the LigaSureTM bipolar vessel sealer to monopolar
electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a
prospective randomized controlled trial.
Source
Surgical Endoscopy. 37(6) (pp 4449-4457), 2023. Date of Publication: June
2023.
Author
Gabryel P.; Kasprzyk M.; Roszak M.; Campisi A.; Smolinski S.; Zielinski
P.; Piwkowski C.
Institution
(Gabryel, Kasprzyk, Smolinski, Zielinski, Piwkowski) Department of
Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego
62 Street, Poznan 60-569, Poland
(Roszak) Department of Computer Science and Statistics, Poznan University
of Medical Sciences, Poznan, Poland
(Campisi) Department of Thoracic Surgery, University and Hospital
Trust-Ospedale Borgo Trento, Verona, Italy
Publisher
Springer
Abstract
Background: High-energy devices allow better vessel sealing compared with
monopolar electrocautery and could improve the outcomes of surgical
operations. The objective of the study was to compare tissue dissection by
the LigaSureTM device with that by monopolar electrocoagulation for
thoracoscopic lobectomy and lymphadenectomy. <br/>Method(s): This
pragmatic, parallel group, prospective randomized controlled trial was
funded by the Medtronic External Research Program (ISR-2016-10,756) and
registered at www.clinicaltrials.gov (NCT03125798). The study included
patients aged 18 years or older, who had undergone thoracoscopic lobectomy
with lymphadenectomy at the Department of Thoracic Surgery of Poznan
University of Medical Sciences between May 3, 2018, and November 4, 2021.
Using simple randomization, the patients were assigned to undergo tissue
dissection with either the LigaSure device (study group) or monopolar
electrocautery (control group). Participants and care givers, except
operating surgeons, were blinded to group assignment. The primary outcome
was postoperative chest drainage volume. Secondary outcomes were change of
the esophageal temperature during subcarinal lymphadenectomy and
C-reactive protein level 72 h after surgery. <br/>Result(s): Study
outcomes were analyzed in 107 patients in each group. We found no
differences between the study and control groups in terms of chest
drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in
esophageal temperature (- 0.1 degreeC vs. - 0.1 degreeC, respectively; p =
0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p
= 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95%
CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to
12.2) in the control group (p < 0.001). <br/>Conclusion(s): The use of the
LigaSure device did not allow to decrease the chest drainage volume, local
thermal spread, and systemic inflammatory response. The number of lymph
nodes removed was higher in patients operated with the LigaSure device,
which indicated better quality of lymphadenectomy.<br/>Copyright &#xa9;
2023, The Author(s).

<24>
Accession Number
2021232036
Title
Conscious sedation/monitored anesthesia care versus general anesthesia in
patients undergoing transcatheter aortic valve replacement: A
meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2023. Article
Number: 1099959. Date of Publication: 10 Jan 2023.
Author
Hung K.-C.; Chen J.-Y.; Hsing C.-H.; Chu C.-C.; Lin Y.-T.; Pang Y.-L.;
Teng I.-C.; Chen I.-W.; Sun C.-K.
Institution
(Hung) School of Medicine, College of Medicine, National Sun Yat-sen
University, Kaohsiung City, Taiwan (Republic of China)
(Hung, Chen, Hsing, Chu, Lin, Pang, Teng) Department of Anesthesiology,
Chi Mei Medical Center, Tainan City, Taiwan (Republic of China)
(Hsing) Department of Medical Research, Chi Mei Medical Center, Tainan
City, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, Chi Mei Medical Center, Liouying,
Tainan City, Taiwan (Republic of China)
(Sun) Department of Emergency Medicine, E-Da Hospital, Kaohsiung City,
Taiwan (Republic of China)
(Sun) College of Medicine, I-Shou University, Kaohsiung City, Taiwan
(Republic of China)
Publisher
Frontiers Media S.A.
Abstract
Background: To compare the merits and safety between conscious
sedation/monitored anesthesia (CS/MAC) and general anesthesia (GA) for
patients receiving transcatheter aortic valve replacement (TAVR).
Measurements: Databases including EMBASE, MEDLINE, and the Cochrane
Library databases were searched from inception to October 2022 to identify
studies investigating the impact of CS/MAC on peri-procedural and
prognostic outcomes compared to those with GA. The primary outcome was the
association of CS/MAC with the risk of 30-day mortality, while secondary
outcomes included the risks of adverse peri-procedural (e.g.,
vasopressor/inotropic support) and post-procedural (e.g., stroke)
outcomes. Subgroup analysis was performed based on study design [i.e.,
cohort vs. matched cohort/randomized controlled trials (RCTs)]. <br/>Main
Result(s): Twenty-four studies (observational studies, n = 22; RCTs, n =
2) involving 141,965 patients were analyzed. Pooled results revealed lower
risks of 30-day mortality [odd ratios (OR) = 0.66, p < 0.00001, 139,731
patients, certainty of evidence (COE): low], one-year mortality (OR =
0.72, p = 0.001, 4,827 patients, COE: very low), major bleeding (OR =
0.61, p = 0.01, 6,888 patients, COE: very low), acute kidney injury (OR =
0.71, p = 0.01, 7,155 patients, COE: very low), vasopressor/inotropic
support (OR = 0.25, p < 0.00001, 133,438 patients, COE: very low), shorter
procedure time (MD = -12.27 minutes, p = 0.0006, 17,694 patients, COE:
very low), intensive care unit stay (mean difference(MD) = -7.53 h p =
0.04, 7,589 patients, COE: very low), and hospital stay [MD = -0.84 days,
p < 0.00001, 19,019 patients, COE: very low) in patients receiving CS/MAC
compared to those undergoing GA without significant differences in
procedure success rate, risks of cardiac-vascular complications (e.g.,
myocardial infarction) and stroke. The pooled conversion rate was 3.1%.
Results from matched cohort/RCTs suggested an association of CS/MAC use
with a shorter procedural time and hospital stay, and a lower risk of
vasopressor/inotropic support. <br/>Conclusion(s): Compared with GA, our
results demonstrated that the use of CS/MAC may be feasible and safe in
patients receiving TAVR. However, more evidence is needed to support our
findings because of our inclusion of mostly retrospective studies.
Systematic review registration: https://www.crd.york.ac.uk/prospero/,
identifier CRD42022367417.<br/>Copyright &#xa9; 2023 Hung, Chen, Hsing,
Chu, Lin, Pang, Teng, Chen and Sun.

<25>
Accession Number
2018754055
Title
The clinical outcomes of reni-angiotensin system inhibitors for patients
after transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 963731. Date of Publication: 11 Aug 2022.
Author
Wang S.; Lin X.; Guan Y.; Huang J.
Institution
(Wang) Department of Translation Medicine Center, Affiliated Hangzhou
First People's Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wang, Huang) Department of Cardiology, Affiliated Hangzhou First People's
Hospital, Zhejiang University School of Medicine, Hangzhou, China
(Lin, Guan) The Fourth School of Clinical Medicine, Zhejiang Chinese
Medical University, Hangzhou, China
Publisher
Frontiers Media S.A.
Abstract
Aims: The objective of our systematic reviews and meta-analysis is to
evaluate the clinical outcomes of RAS inhibitors for patients after TAVR.
<br/>Methods and Results: We performed a comprehensive search for Embase,
Pubmed, and Cochrane databases from inception to May 1, 2022. The analysis
of all outcomes was performed using the random-effects model. In total, 7
articles with a total of 32,585 patients (RAS inhibitor, N = 14,871;
Controls, N = 17,714) were included in our study. There was a
significantly lower rates of all-cause mortality (RR = 0.76, 95%Cl = 0.68
to 0.86, P < 0.01), cardiovascular death (RR = 0.66, 95%Cl = 0.59-0.74, P
< 0.01) and HF readmission (RR = 0.87, 95%Cl = 0.80-0.94, P < 0.01) in
patients with RAS inhibitors compared with controls. Patients with RAS
inhibitors also had lower rates of all-cause mortality (RR = 0.82, 95%Cl =
0.76-0.89, P < 0.01) and cardiovascular death (RR = 0.73, 95%Cl,
0.62-0.85, P < 0.01) after propensity matching. <br/>Conclusion(s): In
conclusion, our systematic reviews and meta-analysis demonstrated that RAS
inhibitors could improve the clinical outcomes for patients after TAVR.
Further large and high-quality trials should be conducted to support the
use of RAS inhibitors for patients after TAVR.<br/>Copyright &#xa9; 2022
Wang, Lin, Guan and Huang.

<26>
Accession Number
2017087870
Title
A Randomized Controlled Trial Evaluating Outcome Impact of Cilostazol in
Patients with Coronary Artery Disease or at a High Risk of Cardiovascular
Disease.
Source
Journal of Personalized Medicine. 12(6) (no pagination), 2022. Article
Number: 938. Date of Publication: June 2022.
Author
Lin J.-L.; Tseng W.-K.; Lee P.-T.; Lee C.-H.; Tseng S.-Y.; Chen P.-W.;
Chang H.-Y.; Chao T.-H.
Institution
(Lin, Lee, Lee, Tseng, Chen, Chang, Chao) Department of Internal Medicine,
National Cheng Kung University Hospital, College of Medicine, National
Cheng Kung University, Tainan 704302, Taiwan (Republic of China)
(Lin) Department of Internal Medicine, National Cheng Kung University
Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung
University, Yunlin 640003, Taiwan (Republic of China)
(Tseng) Department of Internal Medicine, E-Da Hospital, Kaohsiung 824005,
Taiwan (Republic of China)
(Chao) Health Management Center, National Cheng Kung University Hospital,
College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
(Republic of China)
Publisher
MDPI
Abstract
Previous studies found that cilostazol has a favorable effect on glucose
and lipid homeosta-sis, endothelial function, atherosclerosis, and
vasculo-angiogenesis. However, it is poorly understood whether these
effects can translate into better clinical outcomes. This study
investigated the outcome effect of cilostazol in patients with coronary
artery disease (CAD) or at a high risk of cardiovascular (CV) disease. We
conducted a randomized, double-blind, placebo-controlled trial involving
266 patients who received cilostazol, 200 mg/day (n = 134) or placebo (n =
132). Pre-specified clinical endpoints including composite major adverse
cardiovascular events (MACE) (CV death, non-fatal myocardial infarct,
non-fatal stroke, hospitalization for heart failure, or unplanned coronary
revascu-larization), the composite major coronary event (MCE) and major
adverse CV and cerebrovascular event (MACCE), were prospectively assessed.
The mean duration of follow-up was 2.9 years. Relative to placebo,
cilostazol treatment had a borderline effect on risk reduction of MACE
(hazard ratio [HR], 0.67; 95% confidence interval (CI), 0.34-1.33),
whereas the beneficial effect in favor of cilostazol was significant in
patients with diabetes mellitus or a history of percutaneous coronary
intervention (p for interaction, 0.02 and 0.06, respectively). Use of
cilostazol, significantly reduced the risk of MCE (HR, 0.38; 95% CI,
0.17-0.86) and MACCE (HR, 0.47; 95% CI, 0.23-0.96). A significantly lower
risk of angina pectoris (HR, 0.38; 95% CI, 0.17-0.86) was also observed in
the cilostazol group. After multi-variable adjustment, cilostazol
treatment independently predicted a lower risk of MCE. In conclusion,
these results suggest cilostazol may have beneficial effects in patients
with CAD or at a high risk of CV disease.<br/>Copyright &#xa9; 2022 by the
authors. Licensee MDPI, Basel, Switzerland.

<27>
Accession Number
2025028711
Title
Meta-analysis of phase-specific survival after transcatheter versus
surgical aortic valve replacement from randomized control trials.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2023.
Date of Publication: 2023.
Author
Yokoyama Y.; Shimoda T.; Sloan B.; Takagi H.; Fukuhara S.; Kuno T.
Institution
(Yokoyama, Sloan) Department of Surgery, St Luke's University Health
Network, Bethlehem, Pa, United States
(Shimoda) Department of Cardiovascular Surgery, University of Tsukuba
Hospital, Ibaraki, Japan
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, Mich, United States
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: Transcatheter aortic valve replacement (TAVR) is an established
alternative to surgical aortic valve replacement (SAVR) for severe
symptomatic aortic stenosis, although phase-specific survival and cause of
death are implicated following these procedures. Herein, we conducted a
phase-specific meta-analysis to compare outcomes after TAVR versus SAVR.
<br/>Method(s): A systematic search of databases was performed from
inception through December 2022 to identify randomized controlled trials
that compared outcomes of TAVR and SAVR. For each trial, the hazard ratio
(HR) with 95% confidence interval (CI) of outcomes of interest was
extracted for the following each specific phase: the very short-term (0-1
years after the procedure), short-term (1-2 years), and mid-term (2-5
years). Phase-specific HRs were separately pooled using the random-effects
model. <br/>Result(s): Our analysis included 8 randomized controlled
trials, which enrolled a total of 8885 patients with a mean age of 79
years. The survival after TAVR compared with SAVR was greater in the very
short-term periods (HR, 0.85; 95% CI, 0.74-0.98; P = .02) but similar in
the short-term periods. In contrast, lower survival was observed in the
TAVR group compared with the SAVR group in the mid-term periods (HR, 1.15;
95% CI, 1.03-1.29; P = .02). Similar temporal trends favoring SAVR in the
mid-term were present for cardiovascular mortality and rehospitalization
rates. In contrast, the rates of aortic valve reinterventions and
permanent pacemaker implantations were initially greater in the TAVR
group, although SAVR's superiority eventually disappeared in the mid-term.
<br/>Conclusion(s): Our analysis demonstrated phase-specific outcomes
following TAVR and SAVR.<br/>Copyright &#xa9; 2023 The American
Association for Thoracic Surgery

<28>
Accession Number
2024504866
Title
Transcatheter Aortic Valve Implantation in Cardiac Amyloidosis and Aortic
Stenosis.
Source
American Journal of Cardiology. 198 (pp 101-107), 2023. Date of
Publication: 01 Jul 2023.
Author
Riley J.M.; Junarta J.; Ullah W.; Siddiqui M.U.; Anzelmi A.; Ruge M.;
Vishnevsky A.; Alvarez R.J.; Ruggiero N.J.; Rajapreyar I.N.; Brailovsky Y.
Institution
(Riley, Junarta, Anzelmi, Ruge) Department of Medicine, Thomas Jefferson
University Hospitals, Philadelphia, Pennsylvania, United States
(Ullah, Siddiqui, Vishnevsky, Alvarez, Ruggiero, Rajapreyar, Brailovsky)
Department of Jefferson Heart Institute, Thomas Jefferson University
Hospitals, Philadelphia, Pennsylvania, United States
Publisher
Elsevier Inc.
Abstract
Aortic stenosis (AS) and cardiac amyloidosis (CA) occur concomitantly in a
significant number of patients and portend a higher risk of all-cause
mortality. Previous studies have investigated outcomes in patients with
concomitant CA/AS who underwent transcatheter aortic valve implantation
(TAVI) versus medical therapy alone, but no evidence-based consensus
regarding the ideal management of these patients has been established.
Medline, Scopus, and Cochrane Central Register of Controlled Trials were
systematically searched to identify relevant studies. Methodologic bias
was assessed using the modified Newcastle-Ottawa scale for observational
studies. A total of 4 observational studies comprising 83 patients were
included. Of these, 45 patients (54%) underwent TAVI, whereas 38 (46%)
were managed conservatively. Of the 3 studies that included baseline
characteristics by treatment group, 30% were women. The risk of all-cause
mortality was found to be significantly lower in patients who underwent
TAVI than those treated with conservative medical therapy alone (odds
ratio 0.24, 95% confidence interval 0.08 to 0.73). In conclusion, this
meta-analysis suggests a lower risk of all-cause mortality in patients
with CA with AS who underwent TAVI than those managed with medical therapy
alone.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<29>
Accession Number
641528087
Title
WARFARIN VERSUS NOVEL ANTICOAGULANTS IN PATIENTS WITH ARTIFICIAL HEART
VALVES.
Source
Journal of Hospital Medicine. Conference: Society of Hospital Medicine
Converge, SHM 2023. Austin, TX United States. 18(Supplement 1) (pp
S152-S153), 2023. Date of Publication: March 2023.
Author
Sharma U.; Deo S.; Srivastava Y.; Almader-Douglas D.
Institution
(Sharma, Almader-Douglas) Mayo Clinic Arizona, United States
(Deo) Case western, United States
(Srivastava) Brown, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Although novel oral anticoagulants (NOAC) have been proven as
effective alternatives to warfarin in patients with atrial fibrillation,
the effectiveness of NOACs in patients with artificial (bioprosthetic and
mechanical) heart valves is not known. This systematic review and
meta-analysis evaluates multiple clinical outcomes between warfarin and
NOACs in patients with artificial heart valves. <br/>Method(s): PubMed,
CINHAL, and Clinicaltrials.gov were searched through May 2022 using
keywords and search strategy developed with a librarian, for studies
comparing clinical outcomes of adults (>18 years) with artificial heart
valves that received warfarin vs. NOACs. Data was pooled with Der Simonian
and Laird's random effects model. <br/>Result(s): randomized control
trials (RCTs) and four were retrospective cohort studies. Mechanical and
bioprosthetic valves were represented in 14.7% and 85.3% of patients
respectively. There was no statistically significant difference between
NOACs and warfarin for all bleeding, all-cause mortality, TIA, systemic
embolism, and all-stroke outcomes. Overall Warfarin led to 22% more major
bleeding (OR = 1.22, 95% CI = [1.05, 1.41], p = 0.01) and more ischemic
stroke (OR = 1.72, 95% CI = [1.1, 2.68], p = 0.02) compared to NOACs. Also
amongst patients with bioprosthetic heart valves, Warfarin led to 33% more
major bleeding compared to NOACs (OR = 1.33, 95% CI = [1.06, 1.66]).
However, NOACs led to 65% more major bleeding compared to warfarin among
those with mechanical heart valves (OR = 0.35, 95% CI = [0.18, 0.67]).
<br/>Conclusion(s): Compared with warfarin, NOACs reduced the risk of
ischemic stroke and major bleeding in patients with artificial heart
valves. There were no statistically significant differences between the
two for the outcomes of all bleeding, all-cause mortality, systemic
embolism, TIA, and all-strokes. NOACs reduced the risk of ischemic stroke
and major bleeding in patients with bioprosthetic heart valves, but not in
patients with mechanical heart valves compared to Warfarin.

<30>
Accession Number
2025069755
Title
A rare cause of dysphagia and simultaneous hoarseness of voice in the
octogenarian: a Killian-Jamieson diverticulum, management, and review of
literature.
Source
Annals of Medicine and Surgery. 85(3) (pp 583-588), 2023. Date of
Publication: 01 Mar 2023.
Author
Chaudhry I.U.H.; Al Ghamdi A.M.; Al Qahtani Y.; Algazal T.; Razzaq B.; Al
Abdulhai M.A.; Al Fraih O.M.
Institution
(Chaudhry, Al Ghamdi, Al Qahtani, Algazal, Razzaq, Al Abdulhai, Al Fraih)
Division of Thoracic Surgery, Dammam Medical Complex, Dammam, Saudi Arabia
Publisher
Wolters Kluwer Health
Abstract
Killian-Jameson diverticulum: An 82-year-old male presented with
progressive dysphagia and simultaneous hoarseness of voice for the past 6
months. He had mitral valve repair and a permanent pacemaker for a heart
block 5 years ago. A computed tomographic scan of the neck demonstrated a
cervical esophageal diverticulum. Oral Gastrogrifin contrast study
confirmed esophageal diverticulum in Killian-Jamieson space. Open surgical
diverticulectomy was performed safely. Patient's dysphagia resolved
immediately, and he regained his normal voice after 6 weeks. Introduction:
Killian-Jamieson's esophageal diverticulum is a rare form of pulsion
diverticulum which originate through a muscular gap in the anterolateral
wall of the esophagus, inferior to the cricopharyngeus muscle and superior
to the circular and longitudinal muscle of the esophagus. Killian-Jamieson
defined this area where the recurrent laryngeal nerve enters the pharynx,
called Killian-Jamieson triangle. Ekberg and Nylander, in 1983, described
an esophageal diverticulum in Killian-Jamieson space. The most common
clinical manifestations in such patients are dysphagia, cough, epigastric
pain, recurrent respiratory tract infections, and rarely hoarseness of
voice. In symptomatic patients, surgical or endoscopic resection of the
diverticulum is mandatory. We report this case in line with SCARE
(Surgical CAse REport) criteria. Case Report: An 82-year-old male
presented to our outpatient clinic with a history of progressive dysphagia
for solid food and hoarseness of voice for the last 6 months. He denied
gastroesophageal reflux, cough, and shortness of breath. On examination of
the neck, there was swelling on the left side but no tenderness or
lymphadenopathy. Basic blood investigations, including complete blood
count, liver, and renal panels, were normal. An echocardiogram showed mild
impairment of left ventricle function and normally functioning mitral
valve. Chest X-ray showed a pacemaker in position. Computed tomography
scan of the neck showed esophageal diverticulum. Gastrogrifin contrast
study showed esophageal Killian-Jamieson diverticulum (KJD).
<br/>Discussion(s): The acquired esophageal diverticulum is categorized
into three types based on its anatomical location. Zenker's and
Killian-Jamieson (pulsion diverticulum) in the proximal part, traction
diverticulum in the middle part, due to pulling from fibrous adhesions
following the lymph node infection and epiphanic pulsion type in the
distal esophagus. Although the KJD and Zenker's diverticulum (ZD) arise
close to each other in the pharyngoesophageal area, they are anatomically
distinct. Although ZD and KJD have the same demographic features, they are
more commonly found in older men (60-80 years) and women, respectively.
The incidence of ZD is 0.01-0.11%, and KJD is 0.025% of the population.
Rubesin et al. reported radiographic findings in 16 KJD cases. They found
the majority of them were on the left side (72%), followed by 20% on the
right side and 8% bilateral. <br/>Conclusion(s): In conclusion, we report
a rare case of dysphagia and simultaneous hoarseness of voice in an
octogenarian due to KJD, who was treated with open diverticulectomy, and
dysphagia resolved; he regained his voice back after 6 weeks. In our
opinion, endoscopic surgery in such a patient with KJD can put recurrent
laryngeal at risk of injury since an endoscopic approach operator cannot
visualize and dissect away the recurrent laryngeal nerve, particularly
when KJD already compresses it.<br/>Copyright &#xa9; 2023 The Author(s).
Published by Wolters Kluwer Health, Inc.

<31>
Accession Number
2023727262
Title
Interventional Cardio-Oncology: Unique Challenges and Considerations in a
High-Risk Population.
Source
Current Treatment Options in Oncology. (no pagination), 2023. Date of
Publication: 2023.
Author
Leiva O.; Alam U.; Bohart I.; Yang E.H.
Institution
(Leiva) Division of Cardiology, Department of Medicine, New York
University Grossman School of Medicine, New York, NY, United States
(Alam, Bohart) Department of Medicine, New York University Grossman School
of Medicine, New York, NY, United States
(Yang) Division of Cardiology, Department of Medicine, UCLA
Cardio-Oncology Program, University of California at Los Angeles, 100
Medical Plaza, Suite 630, Los Angeles, CA 90095, United States
Publisher
Springer
Abstract
Patients with cancer are at risk of developing cardiovascular disease
(CVD) including atherosclerotic heart disease (AHD), valvular heart
disease (VHD), and atrial fibrillation (AF). Advances in percutaneous
catheter-based treatments, including percutaneous coronary intervention
(PCI) for AHD, percutaneous valve replacement or repair for VHD, and
ablation and left atrial appendage occlusion devices (LAAODs) for AF, have
provided patients with CVD significant benefit in the recent decades.
However, trials and registries investigating outcomes of these procedures
often exclude patients with cancer. As a result, patients with cancer are
less likely to undergo these therapies despite their benefits. Despite the
inclusion of cancer patients in randomized clinical trial data, studies
suggest that cancer patients derive similar benefits of percutaneous
therapies for CVD compared with patients without cancer. Therefore,
percutaneous interventions for CVD should not be withheld in patients with
cancer, as they may still benefit from these procedures.<br/>Copyright
&#xa9; 2023, The Author(s).

<32>
Accession Number
2023616107
Title
Postoperative pulmonary complications in older patients undergoing
elective surgery with a supraglottic airway device or tracheal intubation.
Source
Anaesthesia. (no pagination), 2023. Date of Publication: 2023.
Author
Yang L.Q.; Zhu L.; Shi X.; Miao C.H.; Yuan H.B.; Liu Z.Q.; Gu W.D.; Liu
F.; Hu X.X.; Shi D.P.; Duan H.W.; Wang C.Y.; Weng H.; Huang Z.L.; Li L.Z.;
He Z.Z.; Li J.; Hu Y.P.; Lin L.; Pan S.T.; Xu S.H.; Tang D.; Sessler D.I.;
Liu J.; Irwin M.G.; Yu W.F.
Institution
(Yang, Zhu, Shi, Pan, Xu, Tang, Yu) Renji Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Yang, Zhu, Yu) Key Laboratory of Anesthesiology (Shanghai Jiao Tong
University), Ministry of Education, Shanghai, China
(Miao) Fudan University Shanghai Cancer Center, Shanghai, China
(Yuan) Shanghai Changzheng Hospital, Shanghai, China
(Liu) Shanghai First Maternity and Infant Hospital, Tongji University
School of Medicine, Shanghai, China
(Gu) Huadong Hospital, Fudan University, Shanghai, China
(Liu, Liu) West China Hospital, Sichuan University, Chengdu, China
(Hu) Guanghua Hospital Affiliated to Shanghai University of Traditional
Chinese Medicine, Shanghai, China
(Shi) Jiading District Central Hospital Affiliated Shanghai University of
Medicine and Health Sciences, Shanghai, China
(Duan) Shanghai Pudong Hospital Fudan University Pudong Medical Center,
Shanghai, China
(Wang) Huangpu Branch of Ninth People's Hospital Affiliated to Medical
College of Shanghai Jiao Tong University, Shanghai, China
(Weng) Shanghai Fengxian District Central Hospital, Shanghai, China
(Huang) Ren Ji Hospital (West) affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China
(Li) Shanghai Pudong New Area People's Hospital, Shanghai, China
(He) Ren Ji Hospital (South) affiliated to Shanghai Jiao Tong University
School of Medicine, Shanghai, China
(Li) First Affiliated Hospital of Wenzhou Medical University, Wenzhou,
China
(Hu) The Second Hospital of Wuxi affiliated to Nanjing Medical University,
Wuxi, China
(Lin) The First Affiliated Hospital of Xiamen University, Xiamen, China
(Sessler) Cleveland Clinic, Cleveland, OH, United States
(Irwin) Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong
Kong
Publisher
John Wiley and Sons Inc
Abstract
The two most commonly used airway management techniques during general
anaesthesia are supraglottic airway devices and tracheal tubes. In older
patients undergoing elective non-cardiothoracic surgery under general
anaesthesia with positive pressure ventilation, we hypothesised that a
composite measure of in-hospital postoperative pulmonary complications
would be less frequent when a supraglottic airway device was used compared
with a tracheal tube. We studied patients aged >= 70 years in 17 clinical
centres. Patients were allocated randomly to airway management with a
supraglottic airway device or a tracheal tube. Between August 2016 and
April 2020, 2900 patients were studied, of whom 2751 were included in the
primary analysis (1387 with supraglottic airway device and 1364 with a
tracheal tube). Pre-operatively, 2431 (88.4%) patients were estimated to
have a postoperative pulmonary complication risk index of 1-2.
Postoperative pulmonary complications, mostly coughing, occurred in 270 of
1387 patients (19.5%) allocated to a supraglottic airway device and 342 of
1364 patients (25.1%) assigned to a tracheal tube (absolute difference
-5.6% (95%CI -8.7 to -2.5), risk ratio 0.78 (95%CI 0.67-0.89); p < 0.001).
Among otherwise healthy older patients undergoing elective surgery under
general anaesthesia with intra-operative positive pressure ventilation of
their lungs, there were fewer postoperative pulmonary complications when
the airway was managed with a supraglottic airway device compared with a
tracheal tube.<br/>Copyright &#xa9; 2023 Association of Anaesthetists.

<33>
Accession Number
641531461
Title
Chronological comparison of TAVI and SAVR stratified to surgical risk: a
systematic review, meta-analysis, and meta-regression.
Source
Acta cardiologica. (pp 1-12), 2023. Date of Publication: 09 Jun 2023.
Author
Park D.Y.; An S.; Kassab K.; Jolly N.; Attanasio S.; Sawaqed R.; Malhotra
S.; Doukky R.; Vij A.
Institution
(Park) Department of Medicine, John H. Stroger Jr Hospital of Cook County,
Chicago, IL, United States
(An) Department of Biomedical Science, Seoul National University Graduate
School, Seoul, South Korea
(Kassab) Division of Cardiology, Ascension Borgess Hospital/Michigan State
University, Kalamazoo, MI, United States
(Jolly, Attanasio) Division of Cardiology, Rush University Medical Center,
Chicago, IL, United States
(Sawaqed) Division of Cardiothoracic Surgery, Cook County Health, Chicago,
IL, United States
(Sawaqed) Division of Cardiothoracic Surgery, Rush Medical College,
Chicago, IL, United States
(Malhotra, Doukky, Vij) Division of Cardiology, Cook County Health,
Chicago, IL, United States
(Malhotra, Doukky, Vij) Division of Cardiology, Rush Medical College,
Chicago, IL, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been
established as a reasonable alternative to surgical aortic valve
replacement (SAVR) in patients with severe aortic stenosis. However,
long-term outcomes including valve durability and the need for
reintervention are unanswered, especially in younger patients who tend to
be low surgical risk. We performed a meta-analysis comparing clinical
outcomes after TAVI and SAVR over 5years stratified to low, intermediate,
and high surgical risks. <br/>METHOD(S): We identified propensity
score-matched observational studies and randomised controlled trials
comparing TAVI and SAVR. Primary outcomes, including all-cause mortality,
moderate or severe aortic regurgitation, moderate or severe paravalvular
regurgitation, pacemaker placement, and stroke, were extracted.
Meta-analyses of outcomes after TAVI compared to SAVR were conducted for
different periods of follow-up. Meta-regression was also performed to
analyse the correlation of outcomes over time. <br/>RESULT(S): A total of
36 studies consisting of 7 RCTs and 29 propensity score-matched studies
were selected. TAVI was associated with higher all-cause mortality at
4-5years in patients with low or intermediate surgical risk.
Meta-regression time demonstrated an increasing trend in the risk of
all-cause mortality after TAVI compared with SAVR. TAVI was generally
associated with a higher risk of moderate or severe aortic regurgitation,
moderate or severe paravalvular regurgitation, and pacemaker placement.
<br/>CONCLUSION(S): TAVI demonstrated an increasing trend of all-cause
mortality compared with SAVR when evaluated over a long-term follow-up.
More long-term data from recent studies using newer-generation valves and
state-of-the-art techniques are needed to accurately assign risks.

<34>
Accession Number
641528698
Title
The Impact of Resource Allocation During the COVID-19 Pandemic on Cardiac
Surgical Practice and Patient Outcomes: A Systematic Review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2023.
Date of Publication: 08 Jun 2023.
Author
El-Andari R.; Fialka N.M.; Nagendran J.
Institution
(El-Andari, Nagendran) Division of Cardiac Surgery, Department of Surgery,
University of Alberta, Edmonton, AB, Canada
(Fialka) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The COVID-19 pandemic has shaken the world and placed enormous
strain on healthcare systems globally. In this systematic review, we
investigate the effect of resource allocation on cardiac surgery programs
and the impact on patients awaiting elective cardiac surgery.
<br/>METHOD(S): PubMed and Embase were systematically searched for
articles published from January 1st 2019-August 30th 2022. This systematic
review included studies investigating the impact of the COVID-19 pandemic
on resource allocation and the subsequent influence on cardiac surgery
outcomes. 1,676 abstracts and titles were reviewed and 20 studies were
included in this review. <br/>RESULT(S): During the COVID-19 pandemic,
resources were allocated away from elective cardiac surgery to help
support the pandemic response. This resulted in increased wait times for
elective patients, increased rates of urgent or emergent surgical
intervention, and increased rates of mortality or complications for
patients awaiting or undergoing cardiac surgery during the pandemic.
<br/>CONCLUSION(S): While the finite resources available during the
pandemic were often insufficient to meet the needs of all patients as well
as the influx of new COVID-19 patients, resource allocation away from
elective cardiac surgery resulted in prolonged wait times, more frequent
urgent or emergent surgeries, and negative impacts on patient outcomes.
Understanding the impacts of delayed access to care with regards to
urgency of care, increased morbidity and mortality, and increased
utilization of resources per indexed case needs to be considered to
navigate through pandemics to minimize the lingering effects that continue
to negatively impact patient outcomes.<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.

<35>
Accession Number
641528631
Title
Comparison of endovenous laser ablation and cyanoacrylate embolization in
the non-invasive treatment of superficial venous insufficiency in terms of
patient satisfaction.
Source
Phlebology. (pp 2683555231182020), 2023. Date of Publication: 08 Jun
2023.
Author
Er Z.C.; Ikbali Afsar F.; Atilgan K.; Onuk B.E.
Institution
(Er) Cardiovascular Surgery, Bozok Universitesi Tip Fakultesi, Turkey
(Ikbali Afsar) Cardiovascular Surgery, 29 Mayis Devlet Hastanesi, Ankara,
Turkey
(Atilgan, Onuk) Cardiovascular Surgery, TOBB ETU Hospital, Ankara, Turkey
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Ablation with n-butyl cyanoacrylate is a clinically newer
technique than endovenous laser ablation and other interventional
techniques in the treatment of chronic venous insufficiency (CVI). The aim
of this study was to compare the endovenous laser ablation (EVLA) and
n-butyl cyanoacrylate (NBCA) interventional techniques in terms of
benefit, effectiveness, and patient satisfaction. MATERIALS AND METHODS:
The study was conducted at Yozgat City Hospital and Bozok University
Research Hospital Cardiovascular Surgery clinics between November 2016 and
February 2021. A total of 260 symptomatic patients with 130 randomized
cases in each intervention group were included. NBCA patients constituted
Group 1 and EVLA patients Group 2. The saphenous vein was evaluated by
color Doppler ultrasonography (CDUS) of the lower extremity. Patients with
saphenous veins over 5.5 mm in diameter and a saphenous-femoral reflux
time of 2 s or longer were included in the study. The patients were asked
about their satisfaction and symptoms in the first postoperative week
during an outpatient clinic follow-up with CDUS investigation at the first
and sixth months. <br/>RESULT(S): Although vena saphenous magna (VSM)
closure results were similar with the two methods, satisfaction rates were
found to be higher with the NBCA procedure. <br/>CONCLUSION(S): Comparison
of the new methods used in the treatment of CVI revealed similar VSM
closure rates in the two methods, but the satisfaction rate was higher
with the NBCA technique in this study.

<36>
Accession Number
641528348
Title
Development and validation of an international preoperative risk
assessment model for postoperative delirium.
Source
Age and ageing. 52(6) (no pagination), 2023. Date of Publication: 01 Jun
2023.
Author
Dodsworth B.T.; Reeve K.; Falco L.; Hueting T.; Sadeghirad B.; Mbuagbaw
L.; Goettel N.; Schmutz Gelsomino N.
Institution
(Dodsworth, Schmutz Gelsomino) Zurich8005, Switzerland
(Reeve) Institute of Data Analysis and Process Design, Zurich University
of Applied Sciences, Winterthur 8400, Switzerland
(Falco) Zuhlke Engineering AG, Schlieren 8952, Switzerland
(Hueting) Haaksbergen 7481 GJNetherlands
(Sadeghirad, Mbuagbaw) Department of Health Research Methods, Evidence,
McMaster University, and Impact, Canada
(Sadeghirad, Mbuagbaw) Department of Anesthesia, McMaster University,
Canada
(Mbuagbaw) Department of Pediatrics, McMaster University, Hamilton ON L8S
4L8, Canada
(Mbuagbaw) Biostatistics Unit, Father Sean O'Sullivan Research Centre, St
Joseph's Healthcare, Hamilton ON L8S 4L8, Canada
(Mbuagbaw) Centre for Development of Best Practices in Health (CDBPH),
Yaounde Central Hospital, Yaounde 12117, Cameroon
(Mbuagbaw) Division of Epidemiology and Biostatistics, Department of
Global Health, Stellenbosch University, Cape Town 7600, South Africa
(Goettel) Department of Anesthesiology, University of Florida College of
Medicine, Gainesville FL 32610, United States
(Goettel) Department of Clinical Research, University of Basel, Basel
4031, Switzerland
(Schmutz Gelsomino) Department of Anaesthesia, University Hospital Basel,
Spitalstrasse 21, Basel 4031, Switzerland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium (POD) is a frequent complication in
older adults, characterised by disturbances in attention, awareness and
cognition, and associated with prolonged hospitalisation, poor functional
recovery, cognitive decline, long-term dementia and increased mortality.
Early identification of patients at risk of POD can considerably aid
prevention. <br/>METHOD(S): We have developed a preoperative POD risk
prediction algorithm using data from eight studies identified during a
systematic review and providing individual-level data. Ten-fold
cross-validation was used for predictor selection and internal validation
of the final penalised logistic regression model. The external validation
used data from university hospitals in Switzerland and Germany.
<br/>RESULT(S): Development included 2,250 surgical (excluding cardiac and
intracranial) patients 60 years of age or older, 444 of whom developed
POD. The final model included age, body mass index, American Society of
Anaesthesiologists (ASA) score, history of delirium, cognitive impairment,
medications, optional C-reactive protein (CRP), surgical risk and whether
the operation is a laparotomy/thoracotomy. At internal validation, the
algorithm had an AUC of 0.80 (95% CI: 0.77-0.82) with CRP and 0.79 (95%
CI: 0.77-0.82) without CRP. The external validation consisted of 359
patients, 87 of whom developed POD. The external validation yielded an AUC
of 0.74 (95% CI: 0.68-0.80). <br/>CONCLUSION(S): The algorithm is named
PIPRA (Pre-Interventional Preventive Risk Assessment), has European
conformity (ce) certification, is available at http://pipra.ch/ and is
accepted for clinical use. It can be used to optimise patient care and
prioritise interventions for vulnerable patients and presents an effective
way to implement POD prevention strategies in clinical
practice.<br/>Copyright &#xa9; The Author(s) 2023. Published by Oxford
University Press on behalf of the British Geriatrics Society. All rights
reserved. For permissions, please email: journals.permissions@oup.com.

<37>
Accession Number
2024869013
Title
Effect of Shorter Cross Clamp Time vs. longer Cross Clamp time on cardiac
enzyme levels in patients of CAD undergoing CABG.
Source
Pakistan Journal of Medical and Health Sciences. 17(4) (pp 159-162), 2023.
Date of Publication: April 2023.
Author
Mahmood S.R.; Arif A.; Jabeen S.; Hafeez H.; Ihsan A.R.; Yunus A.
Institution
(Mahmood, Hafeez) Punjab Institute Of Cardiology Lahore, Pakistan
(Arif, Jabeen, Ihsan, Yunus) Shalamar Hospital, Lahore, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Aim: To compare mean cardiac enzyme levels in of shorter cross clamp time
V/S longer cross Clamp time in patients undergoing CABG in local
population. <br/>Study Design: Randomized Controlled Trial Place and
duration: This study was performed from 2^nd April 2020 to
2^nd October 2020 in the Department of Cardiac Surgery Punjab
Institute of Cardiology, Lahore. Methodology: After informed consent, all
patients undergoing CABG were enrolled and divided into two groups. A
predesigned performa was used to enter preop, intra op and post op
variables and cardiac enzyme levels were compared between shorter (<60
minutes) and longer (>60 minutes) aortic cross clamp time groups.
<br/>Result(s): Study had enrolled 300 patients and 150(50%) patients were
designated group A (shorter cross clamp time and 150 (50%) patients were
designated in group B (longer cross clamp time). Out of these 300, 246
patients (82%) were males and 54 (18%) were females. Extremes of age were
70 years and 37 years and mean age was 56.77+/-8.03 years. Group A
(shorter cross clamp time) patients had mean age of 56.64 +/-7.53 and
group B (longer cross clamp time) patients had 56.89+/-8.52 .Mean EF (%)
was 52.17+/-8.98 with 23% being minimum and 70% being maximum. In group A
patients, 93 patients (62%) were hypertensive, 82(55%) were smokers and 67
(45%) patients were diabetic, while group B had 110 (73%) hypertensive,
84(56%) smokers and 73(49%) diabetic patients. Mean CPB time in group A
was recorded to be 93.72+/-29.97 and mean CPB time in group B was
121.04+/-31.83. The P-value was 0.001, significant enough to represent
difference in CPG time in both groups Practical Implication: Additionally,
no notable difference was found in need of inotropic supports between two
groups. Longer cross clamp time is also associated with longer CPB time
which in turn correlates with higher morbidity and mortality.
<br/>Conclusion(s): It is concluded that prolonged cross clamp time is an
independent predictor of morbidity despite cardio protection by modern
strategies<br/>Copyright &#xa9; 2023 Lahore Medical And Dental College.
All rights reserved.

<38>
Accession Number
2024869012
Title
Correlation of Post-Operative Outcomes in patients undergoing CABG
Receiving Antegradecardioplegia alone Versus Combined Antegrade Plus
Retrograde Cardioplegia: A Prospective Review.
Source
Pakistan Journal of Medical and Health Sciences. 17(4) (pp 156-158), 2023.
Date of Publication: April 2023.
Author
Jabeen S.; Arif A.; Bukhari S.R.; Umair M.; Akbar S.; Yunus A.
Institution
(Jabeen, Bukhari) Registrar Cardiovascular Surgery Department, Shalamar
Hospital, Lahore, Pakistan
(Arif) Senior Registrar Cardiovascular surgery department, Shalamar
Hospital, Lahore, Pakistan
(Umair, Akbar) Registrar Cardiac Surgery department, Punjab Institute of
Cardiology, Lahore, Pakistan
(Yunus) Cardiovascular Surgery Department, Shalamar Hospital, Lahore,
Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Aim: To compare the mean ejection fraction and cardiac enzymes level in
patients with Ischemic heart disease undergoing elective coronary artery
bypass graft surgery (CABG) having antegrade blood cardioplegia versus
antegrade plus retrograde Cardioplegia. Study design: Randomized
Controlled Trial Place and duration: This study was performed from 7th
February, 2020 to 7th August, 2020 at the Cardiac Surgery Department, PIC,
Jail Road, Lahore. Methodology: After receiving informed consent, all
patients undergoing CABG were enrolled in this study. In order to compare
the mean ejection fraction and cardiac enzyme levels between patients who
had antegrade blood cardioplegia and those who had antegrade plus
retrograde cardioplegia, preoperative, intraoperative, and postoperative
characteristics were recorded into the predesigned proforma.
<br/>Result(s): The total number of patients 72 was enrolled in this study
who were divided into two groups. There were 36(50%) patients of who have
given Cardioplegia through antegrade route while CABG and 36(50%) patients
who have given Cardioplegia through antegrade plus retrograde route while
CABG in this study. According to Table 1, the mean age of the patients in
Group A was 51.86+/-9.35 years, whereas the mean ages of the participants
in Group B 52.92+/-7.70 years. There were 26(72%) male and 10(28%) females
in Group A and 30(83%) male and 6(17%) females in Group B. The mean BMI in
Group A was 25.65+/-5.18 and 25.02+/-3.97 in Group B. There were 35(97%)
hypertensive and 1(3%) non hypertensive patients in Group A and B
respectively. Similarly, there were 33(92%) diabetic and 3(8%) non
diabetic patients in Group A and 28 (78%) diabetic and 8(22%) non diabetic
patients were in Group B. There were 26(72%) smokers and 10(28%) non-
smokers in Group A and 24 (67%) smokers and 12(33%) non-smokers in this
Group B. Practical Implication: The comparison of CKMB(IU/L) levels in
Antegrade route group and antegrade plus retrograde group baseline and
after 48 hours shows insignificant p-values of 0.17 and 0.12 respectively
which shows that there is no significant difference in CKMB levels
regarding these two routes chosen for giving Cardioplegia to patients
undergoing coronary artery bypass grafting. <br/>Conclusion(s): Although
both required additional surgical manoeuvres, however, the antegrade and
antegrade plus retrograde cardioplegia approaches were equally effective
and safe. Prior research demonstrated that multiple infusions offer
superior protection to either antegrade or retrograde cardioplegia
alone.<br/>Copyright &#xa9; 2023 Lahore Medical And Dental College. All
rights reserved.

<39>
Accession Number
2023640390
Title
Quantity and location of aortic valve calcification predicts paravalvular
leakage after transcatheter aortic valve replacement: a systematic review
and meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1170979. Date of Publication: 2023.
Author
Shi J.; Li W.; Zhang T.; Han C.; Wang Z.; Pei X.; Li X.; Zhao Z.; Wang P.;
Han J.; Chen S.
Institution
(Shi) Shandong Provincial Hospital, Shandong University, Jinan, China
(Shi, Li, Han, Li) Department of Second Clinical Medical School, Cheeloo
College of Medicine, Shandong University, Jinan, China
(Li, Han, Pei, Han) Department of Basic Medical School, Cheeloo College of
Medicine, Shandong University, Jinan, China
(Zhang) Department of Vascular Surgery, Jiyang District People's Hospital,
Jinan, China
(Wang) Department of Cardiovascular Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, China
(Zhao, Wang) Department of Public Health School, Cheeloo College of
Medicine, Shandong University, Jinan, China
(Chen) Department of Interventional Diagnosis and Treatment, Shandong
Provincial Hospital Affiliated to Shandong First Medical University,
Jinan, China
Publisher
Frontiers Media S.A.
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is the
first-line treatment for patients with moderate-to-high surgical risk of
severe aortic stenosis. Paravalvular leakage (PVL) is a serious
complication of TAVR, and aortic valve calcification contributes to the
occurrence of PVL. This study aimed to investigate the effect of location
and quantity of calcification in the aortic valve complex (AVC) and left
ventricular outflow tract (LVOT) on PVL after TAVR. <br/>Method(s): We
performed a systematic review and meta-analysis to evaluate the effect of
quantity and location of aortic valve calcification on PVL after TAVR
using observational studies from PubMed and EMBASE databases from
inception to February 16, 2022. <br/>Result(s): Twenty-four observational
studies with 6,846 patients were included in the analysis. A high quantity
of calcium was observed in 29.6% of the patients; they showed a higher
risk of significant PVL. There was heterogeneity between studies (I2 =
15%). In the subgroup analysis, PVL after TAVR was associated with the
quantity of aortic valve calcification, especially those located in the
LVOT, valve leaflets, and the device landing zone. A high quantity of
calcium was associated with PVL, regardless of expandable types or MDCT
thresholds used. However, for valves with sealing skirt, the amount of
calcium has no significant effect on the incidence of PVL.
<br/>Conclusion(s): Our study elucidated the effect of aortic valve
calcification on PVL and showed that the quantity and location of aortic
valve calcification can help predict PVL. Furthermore, our results provide
a reference for the selection of MDCT thresholds before TAVR. We also
showed that balloon-expandable valves may not be effective in patients
with high calcification, and valves with sealing skirts instead of those
without sealing skirts should be applied more to prevent PVL from
happening. Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354630,
identifier: CRD42022354630.<br/>Copyright 2023 Shi, Li, Zhang, Han, Wang,
Pei, Li, Zhao, Wang, Han and Chen.

<40>
Accession Number
2023640378
Title
A comparable efficacy and safety between intracardiac echocardiography and
transesophageal echocardiography for percutaneous left atrial appendage
occlusion.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1194771. Date of Publication: 2023.
Author
Zhang Z.-Y.; Li F.; Zhang J.; Zhang L.; Liu H.-H.; Zhao N.; Yang F.; Kong
Q.; Zhou Y.-T.; Qian L.-L.; Wang R.-X.
Institution
(Zhang, Li, Zhang, Zhang, Liu, Zhao, Yang, Kong, Zhou, Qian, Wang)
Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing
Medical University, Wuxi, China
Publisher
Frontiers Media S.A.
Abstract
Background: Accumulated clinical studies utilized intracardiac
echocardiography (ICE) to guide percutaneous left atrial appendage
occlusion (LAAO). However, its procedural success and safety compared to
traditional transesophageal echocardiography (TEE) remained elusive.
Therefore, we performed a meta-analysis to compare efficacy and safety of
ICE and TEE for LAAO. <br/>Method(s): We screened studies from four online
databases (including the Cochrane Library, Embase, PubMed, and Web of
Science) from their inception to 1 December 2022. We used a random or
fixed-effect model to synthesize the clinical outcomes and conducted a
subgroup analysis to identify the potential confounding factors.
<br/>Result(s): A total of twenty eligible studies with 3,610 atrial
fibrillation (AF) patients (1,564 patients for ICE and 2,046 patients for
TEE) were enrolled. Compared with TEE group, there was no significant
difference in procedural success rate [risk ratio (RR) = 1.01; P = 0.171],
total procedural time [weighted mean difference (WMD) = -5.58; P = 0.292],
contrast volume (WMD = -2.61; P = 0.595), fluoroscopic time (WMD = -0.34;
P = 0.705; I² = 82.80%), procedural complications (RR = 0.82; P
= 0.261), and long-term adverse events (RR = 0.86; P = 0.329) in the ICE
group. Subgroup analysis revealed that ICE group might be associated with
the reduction of contrast use and fluoroscopic time in the hypertension
proportion <90 subgroup, with lower total procedure time, contrast volume,
and the fluoroscopic time in device type subgroup with multi-seal
mechanism, and with the lower contrast use in paroxysmal AF (PAF)
proportion <=50 subgroup. Whereas, ICE group might increase the total
procedure time in PAF proportion >50 subgroup and contrast use in
multi-center subgroup, respectively. <br/>Conclusion(s): Our study
suggests that ICE may have comparable efficacy and safety compared to TEE
for LAAO.<br/>Copyright 2023 Zhang, Li, Zhang, Zhang, Liu, Zhao, Yang,
Kong, Zhou, Qian and Wang.

<41>
Accession Number
2023500445
Title
Efficacy of CytoSorb: a systematic review and meta-analysis.
Source
Critical Care. 27(1) (no pagination), 2023. Article Number: 215. Date of
Publication: December 2023.
Author
Becker S.; Lang H.; Vollmer Barbosa C.; Tian Z.; Melk A.; Schmidt B.M.W.
Institution
(Becker, Lang, Vollmer Barbosa, Tian, Schmidt) Department of Nephrology
and Hypertension, Hannover Medical School, Carl-Neuberg-Strase 1, Hannover
30625, Germany
(Melk) Department of Pediatric Kidney, Liver and Metabolic Diseases,
Hannover Medical School, Hannover, Germany
Publisher
BioMed Central Ltd
Abstract
Introduction: Cytokine adsorption using the CytoSorb adsorber has been
proposed in various clinical settings including sepsis, ARDS,
hyperinflammatory syndromes, cardiac surgery or recovery after cardiac
arrest. The aim of this analysis is to provide evidence for the efficacy
of the CytoSorb adsorber with regard to mortality in various settings.
<br/>Method(s): We searched PubMed, Cochrane Library database and the
database provided by CytosorbentsTM (01.1.2010-29.5.2022). We considered
randomized controlled trials and observational studies with control
groups. The longest reported mortality was defined as the primary
endpoint. We computed risk ratios and 95%-confidence intervals and used
DerSimonian and Lairds random effects model. We analysed all studies
combined and divided them into the subgroups: sepsis, cardiopulmonary
bypass surgery (CPB), other severe illness, SARS-CoV-2 infection and
recovery from cardiac arrest. The meta-analysis was registered in advance
(PROSPERO: CRD42022290334). <br/>Result(s): Of an initial 1295
publications, 34 studies were found eligible, including 1297 patients
treated with CytoSorb and 1314 controls. Cytosorb intervention did not
lower mortality (RR [95%-CI]: all studies 1.07 [0.88; 1.31], sepsis 0.98
[0.74; 1.31], CPB surgery 0.91 [0.64; 1.29], severe illness 0.95 [0.59;
1.55], SARS-CoV-2 1.58 [0.50; 4.94]). In patients with cardiac arrest, we
found a significant survival advantage of the untreated controls (1.22
[1.02; 1.46]). We did not find significant differences in ICU length of
stay, lactate levels, or IL-6 levels after treatment. Of the eligible 34
studies only 12 were randomized controlled trials. All observational
studies showed moderate to serious risk of bias. <br/>Interpretation(s):
To date, there is no evidence for a positive effect of the CytoSorb
adsorber on mortality across a variety of diagnoses that justifies its
widespread use in intensive care medicine.<br/>Copyright &#xa9; 2023, The
Author(s).

<42>
Accession Number
2023209426
Title
Revascularization Options for Left Main Disease: What Clinicians Need to
Know.
Source
Current Atherosclerosis Reports. 25(6) (pp 267-273), 2023. Date of
Publication: June 2023.
Author
Khalid U.; Kayani W.; Alam M.; Denktas A.E.
Institution
(Khalid, Denktas) Section of Cardiology, Medical Care Line, Michael E.
DeBakey VA Medical Center, Houston, TX, United States
(Khalid, Kayani, Alam, Denktas) Section of Cardiology, Department of
Medicine, Baylor College of Medicine, Houston, TX, United States
Publisher
Springer
Abstract
Purpose of Review: Left main disease represents the highest-risk lesion
subset of coronary artery disease and is associated with adverse
cardiovascular events. Accordingly, we aim to understand how the
significance of left main disease is assessed by different modalities,
followed by a review of management options in current era. Recent
Findings: Invasive coronary angiogram remains the gold standard for
assessment of left main disease, but intracoronary imaging or
physiological testing is indicated for angiographically equivocal disease.
Revascularization by either coronary artery bypass surgery or percutaneous
coronary intervention is strongly recommended, which have been compared by
six randomized trials, as well as recent meta-analyses. <br/>Summary:
Surgical revascularization remains the preferred mode of
revascularization, especially in patients with high lesion complexity and
left ventricular dysfunction. Randomized studies are needed to understand
if current-generation stents with the use of intracoronary imaging and
improved medical therapy could match outcomes with surgical
revascularization.<br/>Copyright &#xa9; 2023, This is a U.S. Government
work and not under copyright protection in the US; foreign copyright
protection may apply.

<43>
Accession Number
2023113427
Title
Patch Materials for Pulmonary Artery Arterioplasty and Right Ventricular
Outflow Tract Augmentation: A Review.
Source
Pediatric Cardiology. 44(5) (pp 973-995), 2023. Date of Publication: June
2023.
Author
Schwartzman W.E.; Jimenez M.; Yates A.R.; Armstrong A.K.; Salavitabar A.;
Hor K.K.; Hoerstrup S.; Emmert M.Y.; Shinoka T.; Carrillo S.A.; Breuer
C.K.; Kelly J.M.
Institution
(Schwartzman) The Ohio State University College of Medicine, Columbus, OH,
United States
(Yates, Armstrong, Salavitabar, Hor, Shinoka, Carrillo, Kelly) The Heart
Center, Nationwide Children's Hospital, Columbus, OH, United States
(Yates, Armstrong, Salavitabar, Hor, Kelly) Department of Pediatrics, The
Ohio State University College of Medicine, Columbus, OH, United States
(Jimenez, Shinoka, Breuer, Kelly) Center for Regenerative Medicine,
Abigail Wexner Research Institute at Nationwide Children's Hospital,
Columbus, OH, United States
(Shinoka, Carrillo, Breuer) Department of Surgery, The Ohio State
University Wexner Medical Center, Columbus, OH, United States
(Shinoka, Carrillo, Breuer) Department of Cardiothoracic Surgery,
Nationwide Children's Hospital, Columbus, OH, United States
(Hoerstrup, Emmert) Institute for Regenerative Medicine, University of
Zurich, Zurich, Switzerland
(Emmert) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Emmert) Department of Cardiovascular Surgery, Charite Universitatsmedizin
Berlin, Berlin, Germany
Publisher
Springer
Abstract
Patch augmentation of the right ventricular outflow tract (RVOT) and
pulmonary artery (PA) arterioplasty are relatively common procedures in
the surgical treatment of patients with congenital heart disease. To date,
several patch materials have been applied with no agreed upon clinical
standard. Each patch type has unique performance characteristics, cost,
and availability. There are limited data describing the various advantages
and disadvantages of different patch materials. We performed a review of
studies describing the clinical performance of various RVOT and PA patch
materials and found a limited but growing body of literature. Short-term
clinical performance has been reported for a multitude of patch types, but
comparisons are limited by inconsistent study design and scarce histologic
data. Standard clinical criteria for assessment of patch efficacy and
criteria for intervention need to be applied across patch types. The field
is progressing with improvements in outcomes due to newer patch
technologies focused on reducing antigenicity and promoting neotissue
formation which may have the ability to grow, remodel, and
repair.<br/>Copyright &#xa9; 2023, The Author(s).

<44>
Accession Number
2022098215
Title
The impact of time-of-day reperfusion on remote ischemic conditioning in
ST-elevation myocardial infarction: a RIC-STEMI substudy.
Source
Heart and Vessels. 38(7) (pp 909-918), 2023. Date of Publication: July
2023.
Author
Pires C.M.; Lamas D.; Gaspar A.; Lourenco A.P.; Antunes N.; Marques J.;
Leite-Moreira A.F.
Institution
(Pires, Gaspar, Antunes, Marques) Department of Cardiology, Braga
Hospital, Braga, Portugal
(Lamas) Minho University, Braga, Portugal
(Gaspar, Lourenco, Leite-Moreira) Department of Surgery and Physiology,
UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
Publisher
Springer
Abstract
Daytime variation affects the tolerance of cardiomyocytes to
ischemia-reperfusion injury (IRI). This study aims to evaluate the impact
of time-of-day reperfusion on clinical outcomes of remote ischemic
conditioning (RIC) as an adjuvant to primary percutaneous coronary
intervention(PPCI) in ST-elevation myocardial infarction(STEMI) patients.
A post-hoc analysis of a prospective, single-center parallel 1:1
randomized trial (RIC-STEMI) was performed. This analysis included 448
STEMI patients previously randomized to either PPCI alone (PPCI group) (n
= 217) or RIC as an adjuvant to PPCI (RIC + PPCI group) (n = 231).
Moreover, the sample was divided according to the time of PPCI:
night-morning (22 h-11h59min) (n = 216) or afternoon (12 h-21h59min) (n =
232) groups. The primary follow-up endpoint was a composite of cardiac
death and hospitalization due to heart failure. There were no significant
differences in the clinical characteristics and the follow-up outcomes
between groups. The afternoon period (HR = 0.474; 95% CI 0.230-0.977; p =
0.043) and RIC (HR = 0.423; 95% CI 0.195-0.917; p = 0.029) were
independent predictors of the primary follow-up endpoint. An univariate
analysis showed a lower frequency of primary follow-up endpoint, just in
the afternoon period (10.3%vs0.9%; p = 0.002), in the RIC + PPCI group. A
multivariate analysis revealed that RIC was an independent predictor of
the primary follow-up endpoint in the afternoon group (HR = 0.098; 95% CI
0.012-0.785; p = 0.029), but not in the night-morning group. In addition,
the afternoon period was not an independent predictor of the primary
follow-up endpoint when the multivariate analysis was performed in the
PPCI group. In conclusion, this study showed an important cardioprotective
effect of RIC, namely in the afternoon period, suggesting that the
afternoon period enhances the cardioprotection induced by
RIC.<br/>Copyright &#xa9; 2023, The Author(s).

<45>
Accession Number
2020056639
Title
Bayesian Meta-analysis of Direct Oral Anticoagulation Versus Vitamin K
Antagonists With or Without Concomitant Antiplatelet After Transcatheter
Aortic Valve Implantation in Patients With Anticoagulation Indication.
Source
Angiology. 74(6) (pp 509-518), 2023. Date of Publication: July 2023.
Author
Lee G.S.J.; Tay H.S.E.; Teo V.X.Y.; Goh R.S.J.; Chong B.; Chan S.P.; Tay
E.; Lim Y.; Yip J.; Chew N.W.S.; Kuntjoro I.
Institution
(Lee, Tay, Teo, Goh, Chong, Chan, Lim, Yip, Kuntjoro) Yong Loo Lin School
of Medicine, National University of Singapore, Singapore
(Chan, Tay, Lim, Yip, Chew, Kuntjoro) Department of Cardiology, National
University Health System, National University Heart Centre, Singapore
Publisher
SAGE Publications Inc.
Abstract
Patients undergoing transcatheter aortic valve implantation (TAVI)
commonly have co-morbidities requiring anticoagulation. However, the
optimal post-procedural anticoagulation regimen is not well-established.
This meta-analysis investigates safety and efficacy outcomes of direct
oral anticoagulants (DOACs) and Vitamin K Antagonist (VKA), with or
without concomitant antiplatelet therapy. We searched EMBASE and MEDLINE
for appropriate studies. Subgroup analyses were performed for
anticoagulant monotherapy and combined therapy with antiplatelet agents.
Eleven studies (6359 patients) were included. Overall, there were no
differences between DOACs and VKA for all-cause mortality (Odds Ratio
[OR]:.69; Credible Interval [CrI]:.40-1.06), cardiovascular-related
mortality (OR:.76; Crl:.13-3.47), bleeding (OR:.95; CrI:.75-1.17), stroke
(OR: 1.04; CrI:.65-1.63), myocardial infarction (OR: 1.51; CrI:.55-3.84),
and valve thrombosis (OR:.29; CrI:.01-3.54). For DOACs vs VKA monotherapy
subgroup, there were no differences in outcomes. For the combined therapy
subgroup, there was decreased odds of all-cause mortality in the DOACs
group compared with the VKA group (OR:.13; CrI:.02-.65), but no
differences for bleeding and stroke. DOACs and VKA have similar safety and
efficacy profiles for post-TAVI patients with anticoagulation indication.
However, if concomitant antiplatelet therapy is required, DOACs were more
favorable than VKA for all-cause mortality.<br/>Copyright &#xa9; The
Author(s) 2022.

<46>
Accession Number
2024917752
Title
Artificial intelligence, big data and heart transplantation: Actualities.
Source
International Journal of Medical Informatics. 176 (no pagination), 2023.
Article Number: 105110. Date of Publication: August 2023.
Author
Palmieri V.; Montisci A.; Vietri M.T.; Colombo P.C.; Sala S.; Maiello C.;
Coscioni E.; Donatelli F.; Napoli C.
Institution
(Palmieri, Maiello) Azienda Ospedaliera dei Colli Monaldi-Cotugno-CTO,
Department of Cardiac Surgery and Transplantation, Naples, Italy
(Montisci) Division of Cardiothoracic Intensive Care, Cardiothoracic
Department, ASST Spedali Civili, Brescia, Italy
(Vietri) Department of Precision Medicine, "Luigi Vanvitelli" University
of Campania School of Medicine, Naples, Italy
(Colombo) Milstein Division of Cardiology, Department of Medicine,
Columbia University Vagelos College of Physicians and Surgeons, New York,
NY, United States
(Sala) Chair of Anesthesia and Intensive Care, University of Brescia,
Brescia, Italy
(Coscioni) Department of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi
d'Aragona, Salerno, Italy
(Donatelli) Department of Cardiac Surgery, Istituto Clinico Sant'Ambrogio,
Milan, Italy
(Donatelli) Chair of Cardiac Surgery, University of Milan, Milan, Italy
(Napoli) Department of Advanced Medical and Surgical Sciences (DAMSS),
"Luigi Vanvitelli" University of Campania School of Medicine, Naples,
Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: As diagnostic and prognostic models developed by traditional
statistics perform poorly in real-world, artificial intelligence (AI) and
Big Data (BD) may improve the supply chain of heart transplantation (HTx),
allocation opportunities, correct treatments, and finally optimize HTx
outcome. We explored available studies, and discussed opportunities and
limits of medical application of AI to the field of HTx. <br/>Method(s): A
systematic overview of studies published up to December 31st, 2022, in
English on peer-revied journals, have been identified through
PUBMED-MEDLINE-WEB of Science, referring to HTx, AI, BD. Studies were
grouped in 4 domains based on main studies' objectives and results:
etiology, diagnosis, prognosis, treatment. A systematic attempt was made
to evaluate studies by the Prediction model Risk Of Bias ASsessment Tool
(PROBAST) and the Transparent Reporting of a multivariable prediction
model for Individual Prognosis Or Diagnosis (TRIPOD). <br/>Result(s):
Among the 27 publications selected, none used AI applied to BD. Of the
selected studies, 4 fell in the domain of etiology, 6 in the domain of
diagnosis, 3 in the domain of treatment, and 17 in that of prognosis, as
AI was most frequently used for algorithmic prediction and discrimination
of survival, but in retrospective cohorts and registries. AI-based
algorithms appeared superior to probabilistic functions to predict
patterns, but external validation was rarely employed. Indeed, based on
PROBAST, selected studies showed, to some extent, significant risk of bias
(especially in the domain of predictors and analysis). In addition, as
example of applicability in the real-world, a free-use prediction
algorithm developed through AI failed to predict 1-year mortality post-HTx
in cases from our center. <br/>Conclusion(s): While AI-based prognostic
and diagnostic functions performed better than those developed by
traditional statistics, risk of bias, lack of external validation, and
relatively poor applicability, may affect AI-based tools. More unbiased
research with high quality BD meant for AI, transparency and external
validations, are needed to have medical AI as a systematic aid to clinical
decision making in HTx.<br/>Copyright &#xa9; 2023 The Authors

<47>
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. 39(7) (pp 1405-1419),
2023. Date of Publication: July 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).

<48>
Accession Number
2025049210
Title
CO131 Off Pump Coronary Artery Bypass (OPCAB) Versus on Pump Coronary
Artery Bypass Grafting (CABG) with Cardiopulmonary Bypass; An Umbrella
Review.
Source
Value in Health. Conference: ISPOR 2023: Impacting Innovation, Value, and
Healthcare Decision Making. Boston United States. 26(6 Supplement) (pp
S39), 2023. Date of Publication: June 2023.
Author
Gopalan G.; Moinudeen S.; Rm K.; Kachroo D.K.; Sharma J.; Varalakshmi G.
Institution
(Gopalan) Kalam Institute of Health Technology, AMTZ- A JBI Affiliated
Group, AP, Visakhapatnam, India
(Moinudeen) Kalam Institute of Health Technology, AMTZ- A JBI Affiliated
Group, Visakhapatnam, India
(Rm) Kalam Institute of Health Technology, AMTZ- A JBI Affiliated group,
Visakhapatnam, India
(Kachroo) Kalam Institute of Health Technology, Visakhapatnam, India
(Sharma) Andhra Pradesh MedTech Zone, Andhra Pradesh, India
(Varalakshmi) Andhra Pradesh Medical Technology Zone (AMTZ), AP,
Vishakhapatnam, India
Publisher
Elsevier Ltd
Abstract
Objectives: To assess the clinical effectiveness of OPCAB versus On- pump
CABG surgery with Cardiopulmonary Bypass (CPB) in patients with coronary
artery disease in terms of short- term mortality and other complications
such as cerebrovascular accidents/ complications, renal complications/
injury, atrial fibrillation and myocardial infarction. <br/>Method(s):
Electronic databases were searched for published studies and systematic
reviews and meta- analyses comparing OPCAB to CABG with Cardiopulmonary
Bypass to assess the clinical effectiveness in terms of mortality and
other complications were included. 22 reviews that met the eligibility
criteria were then assessed for methodological quality using the AMSTAR- 2
tool and a narrative summary was given. <br/>Result(s): Two reviews were
evaluated to be critically low, one review reported low quality, sixteen
reviews reported moderate methodological quality and three reviews
reported high quality. From the summary of findings tables, it was
observed that there was a reduction in short term mortality rate, renal
complications, cerebrovascular events, and rate of atrial fibrillation
among patients who underwent OPCAB surgical technique as compared to on
pump surgical technique. Though it was inconclusive of whether there was
any significant difference between both groups for the rate of myocardial
infarction. <br/>Conclusion(s): The clinical effectiveness as reported by
the included reviews indicate that OPCAB is associated with lower rates of
short- term mortality, renal complications, cerebrovascular events and
atrial fibrillation as compared to on pump CABG. As for myocardial
infarction, patients who underwent OPCAB are as likely to have myocardial
infarction as those who underwent on pump CABG. Even though CPB costs an
additional expense and the adverse events being high among patients, one
cannot avoid employing CPB assistance when it is necessary, particularly
when the patient's vital signs fall below the required range, or when the
patient's lab results indicate a severe illness, or for other
reasons.<br/>Copyright &#xa9; 2023

<49>
Accession Number
2025048282
Title
PCR54 A Systematic Review and Quality Assessment of Cardiovascular
Disease-Specific Patient Reported Outcome Measures (PROMS): Part II
Psychometric Properties.
Source
Value in Health. Conference: ISPOR 2023: Impacting Innovation, Value, and
Healthcare Decision Making. Boston United States. 26(6 Supplement) (pp
S321), 2023. Date of Publication: June 2023.
Author
Li X.
Institution
(Li) McMaster University, Hamilton, ON, Canada
Publisher
Elsevier Ltd
Abstract
Objectives: Health-related Quality of Life (HRQoL) instruments for
cardiovascular diseases (CVDs) have been commonly used to measure
important patient-reported outcomes in clinical trials and practices. This
study aimed at systematically identifying and evaluating the psychometric
properties of CVD-specific HRQoL instruments. <br/>Method(s): CINAHL,
Embase, and PubMed were systematically searched from inception to January
20, 2022. Studies that reported psychometric properties, including
reliability, validity and responsiveness, for CVD-specific instruments
were included. Two reviewers independently assessed the methodological
quality using the Consensus-based Standards for the Selection of Health
Measurement Instruments (COSMIN) methods on evaluating measurement
properties and quality of evidence. <br/>Result(s): 142 studies reporting
psychometric properties of 40 instruments were identified. 5 (12.5%)
instruments demonstrated optimal measurement properties with "sufficient"
or "inconsistent" ratings across all 8 properties. Only 2 (5.0%)
instruments were supported by moderate or high quality of evidence
consistently across remaining properties. In addition, we found 5 (12.5%)
instruments can be optimally used in heart failure, 4 (10.0%) in coronary
artery disease (CAD), 1 (2.5%) in atrial fibrillation and 2 (5.0%) in
cardiac surgeries. <br/>Conclusion(s): Of 40 intrsuments validated in
CVDs, only a small minority had psychometric properties rated as
sufficient by COSMIN. Given the use of HRQoL instruments to guide clinical
studies of drugs and devices in CVDs, there is a need for better adherence
to quality standards in instruments validation.<br/>Copyright &#xa9; 2023

<50>
Accession Number
2023671558
Title
Subclinical postoperative atrial fibrillation: a randomized trial.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1153275. Date of Publication: 2023.
Author
Sabbag A.; Berkovich A.; Raanani E.; Volvovitch D.; McIntyre W.F.; Kassif
Y.; Kogan A.; Glikson M.; Beinart R.
Institution
(Sabbag, Berkovich, Beinart) Davidai Arrhythmia Center, Sheba Medical
Center, Ramat Gan, Israel
(Sabbag, Berkovich, Raanani, Volvovitch, Kassif, Kogan, Beinart) Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
(Raanani, Volvovitch, Kassif, Kogan) Department of Cardiac Surgery, Sheba
Medical Center, Ramat Gan, Israel
(McIntyre) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Glikson) Jesselson Integrated Heart Center, Shaare Zedek Medical Center,
Jerusalem, Israel
Publisher
Frontiers Media S.A.
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
complication of cardiac surgery, requiring interventions and prolonging
hospital stay. POAF is associated with increased mortality and a higher
rate of systemic thrombo-embolism. The rates of recurrent AF, optimal
follow-up and management remain unclear. We aimed to evaluate the
incidence of recurrent atrial fibrillation (AF) events, during long term
follow-up in patients with POAF following cardiac surgery. <br/>Method(s):
Patients with POAF and a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of >=2
were randomized in a 2:1 ratio to either implantation of a loop recorder
(ILR) or ECG monitoring using periodic Holters. Participants were followed
prospectively for 2 years. The primary end point was the occurrence of AF
longer than 5 min. <br/>Result(s): The final cohort comprised of 22
patients, of whom 14 received an ILR. Over a median follow up of 25.7 (IQR
of 24.7-44.4) months, 8 patients developed AF, representing a cumulative
annualized risk of AF recurrence of 35.7%. There was no difference between
ILR (6 participants, 40%) and ECG/Holter (2 participants, 25% p = 0.917).
All 8 patients with AF recurrence were treated with oral anticoagulation.
There were no cases of mortality, stroke or major bleeding. Two patients
underwent ILR explantation due to pain at the implantation site.
<br/>Conclusion(s): The rate of recurrent AF in patients with POAF after
cardiac surgery and a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of >=2 is
approximately 1 in 3 when followed systematically. Further research is
need to assess the role of ILRs in this population.<br/>Copyright 2023
Sabbag, Berkovich, Raanani, Volvovitch, McIntyre, Kassif, Kogan, Glikson
and Beinart.

<51>
Accession Number
2025071443
Title
Impact of Regional Anesthesia on Subjective Quality of Recovery in
Patients Undergoing Thoracic Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Xu M.; Zhang G.; Tang Y.; Wang R.; Yang J.
Institution
(Xu, Zhang, Tang, Wang, Yang) Department of Anesthesiology, West China
Hospital of Sichuan University, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Regional anesthesia can be effective for managing pain after
thoracic surgery. This study evaluated whether it can also improve
patient-reported quality of recovery (QoR) after such surgery.
<br/>Design(s): Meta-analysis of randomized controlled trials.
<br/>Setting(s): Postoperative care. <br/>Intervention(s): Perioperative
regional anesthesia. <br/>Patient(s): Adults undergoing thoracic surgery.
<br/>Measurements and Main Results: The primary outcome was total QoR
scores 24 hours after surgery. Secondary outcomes were postoperative
opioid consumption, pain scores, pulmonary function, respiratory
complications, and other adverse effects. Eight studies were identified,
of which 6 involving 532 patients receiving video-assisted thoracic
surgery were included in the quantitative analysis of QoR. Regional
anesthesia significantly improved QoR-40 score (mean difference 9.48; 95%
CI 3.53-15.44; I² = 89%; 4 trials involving 296 patients) and
QoR-15 score (mean difference 6.7; 95% CI 2.58-10.82; I² = 0%;
2 trials involving 236 patients). Regional anesthesia also significantly
reduced postoperative opioid consumption and the incidence of nausea and
vomiting. Insufficient data were available to meta-analyze the effects of
regional anesthesia on postoperative pulmonary function or respiratory
complications. <br/>Conclusion(s): The available evidence suggests that
regional anesthesia can enhance QoR after video-assisted thoracic surgery.
Future studies should confirm and extend these findings.<br/>Copyright
&#xa9; 2023 Elsevier Inc.

<52>
Accession Number
2025028681
Title
Bilateral Ultrasound-Guided Mid-Point Transverse Process to Pleura Block
for Perioperative Analgesia in Pediatric Cardiac Surgery: A Randomized
Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Abdelbaser I.; Abourezk A.R.; Badran A.; Abdelfattah M.
Institution
(Abdelbaser, Abourezk, Badran, Abdelfattah) Department of Anesthesia and
Surgical Intensive Care, Faculty of Medicine, Mansoura University,
Mansoura, Egypt
Publisher
W.B. Saunders
Abstract
Objective: Mid-point transverse process to pleura (MTP) block is a new
regional analgesia technique. This study aimed to assess the perioperative
analgesic effects of MTP block in children undergoing open-heart surgery.
<br/>Design(s): A single-center, randomized, double-blinded, controlled,
superiority study. <br/>Setting(s): At a University Children's Hospital.
<br/>Participant(s): Fifty-two patients aged 2 to 10 years who underwent
open-heart surgery. <br/>Intervention(s): Patients were randomized to
receive either bilateral MTP block or no block (control).
<br/>Measurements and Main Results: The primary outcome was fentanyl
consumption in the first postoperative 24 hours. The secondary outcomes
were intraoperative fentanyl consumption, modified objective pain score
(MOPS) measured at 1, 4, 8, 16, and 24 hours after extubation, and the
duration of stay in the intensive care unit (ICU). The mean (SD)
postoperative fentanyl consumption (microg/kg) in the first 24 hours was
significantly reduced in the MTP block group (4.4 +/- 1.2) compared to the
control group (6.0 +/- 1.4, p < 0.001). The mean (SD) intraoperative
fentanyl requirement (microg/ kg) was significantly reduced in the MTP
block group (9.1 +/- 1.9) compared to the control group (13.0 +/- 2.1, p <
0.001). The MOPS was significantly reduced in the MTP block group compared
to the control group at 1, 4, 8, and 16 hours after extubation but was
comparable in both groups at 24 hours. The mean (SD) duration of ICU stay
(hours) was significantly reduced in the MTP block group (25.0 +/- 2.9)
compared to the control group (30.7 +/- 4.2, p < 0.001).
<br/>Conclusion(s): Single-shot bilateral ultrasound-guided MTP block in
children undergoing cardiac surgery reduced the mean fentanyl consumption
in the first postoperative 24 hours, intraoperative fentanyl requirements,
pain score at rest, time to extubation, and duration of ICU
stay.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<53>
Accession Number
2023562545
Title
Co-Occurrence of Sensorineural Hearing Loss and Congenital Heart Disease:
Etiologies and Management.
Source
Laryngoscope. (no pagination), 2023. Date of Publication: 2023.
Author
Yang T.; Fan X.; Fan Y.; Song W.; Liu X.; Wang J.; Chen X.
Institution
(Yang, Fan, Fan, Song, Wang, Chen) Department of Otolaryngology, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
(Liu) Department of Cardiac Surgery, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives/Hypothesis: The co-occurrence of sensorineural hearing loss
(SNHL) and congenital heart disease (CHD) is a rare condition with complex
etiologies. The purpose of this study is to assess the etiologies,
clinical features, and outcomes of cochlear implant (CI) in this patient
population. <br/>Study Design: Case series and literature review.
<br/>Method(s): Clinical data of children who were diagnosed with SNHL and
CHD and received CIs at a tertiary hospital from 2016 to 2021 were
retrospectively analyzed. A literature review was performed to identify
patients with SNHL and CHD. <br/>Finding(s): Of the 382 children who
underwent cochlear implantation at our center, eight (2.1%) were diagnosed
with SNHL and CHD. A literature review identified 1525 patients from 254
studies; the database therefore consisted of 1533 patients. The most
common genetic etiologies of co-occurring SNHL and CHD were CHARGE
syndrome (36.3%), Turner syndrome (8.4%), 22q11.2 deletion (3.0%), Noonan
syndrome (2.9%), and Down syndrome (2.5%), whereas the most common
non-genetic etiologies were congenital rubella syndrome (22.9%) and SNHL
after early cardiac surgery (5.5%). Most of the patients presented with
congenital, bilateral, severe-profound SNHL requiring early
rehabilitation. Of the 126 children who received CIs at a median age of
2.5 years, half showed delayed speech development at last follow-up.
<br/>Conclusion(s): Co-occurring SNHL and CHD is a rare condition with
complex etiologies. Timely hearing intervention with long-term follow-up
and proper timing of heart surgery is essential for these children.
<br/>Level of Evidence: 4, case series Laryngoscope, 2023.<br/>Copyright
&#xa9; 2023 The Authors. The Laryngoscope published by Wiley Periodicals
LLC on behalf of The American Laryngological, Rhinological and Otological
Society, Inc.

<54>
Accession Number
641520741
Title
The Effect of Combination Prayer Therapy and Education on Pre-operative
Coronary Artery Bypass Graft Anxiety.
Source
Journal of holistic nursing : official journal of the American Holistic
Nurses' Association. (pp 8980101231176906), 2023. Date of Publication: 07
Jun 2023.
Author
Awaludin S.; Nurachmah E.; Novitasari D.
Institution
(Awaludin) School of Nursing, Faculty of Health Sciences, Jenderal
Soedirman University, Purwokerto, Indonesia
(Nurachmah) Faculty of Nursing, University of Indonesia, Jakarta,
Indonesia
(Novitasari) Faculty of Health, Harapan Bangsa University, Purwokerto,
Indonesia
Publisher
NLM (Medline)
Abstract
Background: Anxiety is a problem that most often occurs in the
pre-operative coronary artery bypass graft surgery stage. The combination
of prayer therapy with education is expected to be able to overcome
anxiety. The combination of prayer and education therapy have been
researched as a potential holistic intervention for reducing anxiety in
coronary artery bypass graft surgery. <br/>Purpose(s): This study compares
the effect of combination therapy with the golden standard of therapy in
hospitals. <br/>Method(s): A true-experimental design was used. Fifty
participants were randomly assigned to two groups. Data were collected
using a State-Trait Anxiety Inventory questionnaire from Spielberger.
<br/>Finding(s): Most respondents were elderly, male, high school
graduates in the treatment group, and bachelor graduates in the control
group. Prayer therapy and education have an effect of 63.8% on reducing
anxiety. An increase of 1 constant in the provision of prayer therapy and
education can reduce anxiety by 0.772. <br/>Conclusion(s): The combination
of prayer therapy and education becomes the holistic nursing modality that
can reduce anxiety in pre-operative coronary artery bypass graft patients.

<55>
[Use Link to view the full text]
Accession Number
2024900322
Title
Clinical Burden and Unmet Need in Recurrent Pericarditis: A Systematic
Literature Review.
Source
Cardiology in Review. 30(2) (pp 59-69), 2022. Date of Publication: 01 Mar
2022.
Author
Klein A.; Cremer P.; Kontzias A.; Furqan M.; Forsythe A.; Crotty C.;
Lim-Watson M.; Magestro M.
Institution
(Klein, Cremer, Furqan) The Department of Cardiovascular Medicine, Center
for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular
and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Kontzias) Department of Medicine, Division of Rheumatology, Allergy and
Immunology, Center of Autoinflammatory Diseases, State University of New
York Stonybrook, New York, NY, United States
(Forsythe, Crotty) Purple Squirrel Economics, New York, NY, United States
(Lim-Watson, Magestro) Value and Access, Kiniksa Pharmaceuticals Corp.,
Lexington, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Inflammation of the pericardium (pericarditis) is characterized by
excruciating chest pain. This systematic literature review summarizes
clinical, humanistic, and economic burdens in acute, especially recurrent,
pericarditis, with a secondary aim of understanding United States
treatment patterns and outcomes. Short-term clinical burden is well
characterized, but long-term data are limited. Some studies report
healthcare resource utilization and economic impact; none measure
health-related quality-of-life. Pericarditis is associated with infrequent
but potentially life-threatening complications, including cardiac
tamponade (weighted average: 12.7% across 10 studies), constrictive
pericarditis (1.84%; 9 studies), and pericardial effusion (54.7%; 16
studies). There are no approved pericarditis treatments; treatment
guidelines, when available, are inconsistent on treatment course or
duration. Most recommend first-line use of conventional treatments, for
example, nonsteroidal antiinflammatory drugs with or without colchicine;
however, 15-30% of patients experience recurrence. Second-line therapy may
involve conventional therapies plus long-term utilization of
corticosteroids, despite safety issues and the difficulty of tapering or
discontinuation. Other exploratory therapies (eg, azathioprine,
immunoglobulin, methotrexate, anakinra) present steroid-sparing options,
but none are supported by robust clinical evidence, and some present
tolerability challenges that may impact adherence. Pericardiectomy is
occasionally pursued in treatment-refractory patients, although data are
limited. This lack of an evidence-based treatment pathway for patients
with recurrent disease is reflected in readmission rates, for example,
12.2% at 30 days in 1 US study. Patients with continued recurrence and
inadequate treatment response need approved, safe, accessible treatments
to resolve pericarditis symptoms and reduce recurrence risk without
excessive treatment burden.<br/>Copyright &#xa9; 2022 The Author(s).
Published by Wolters Kluwer Health, Inc.

<56>
[Use Link to view the full text]
Accession Number
2024900314
Title
Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese
Patients A Systematic Review and Meta-Analysis.
Source
Cardiology in Review. 30(1) (pp 1-7), 2022. Date of Publication: 01 Jan
2022.
Author
Lee Y.; Anvari S.; Soon M.S.; Tian C.; Wong J.A.; Hong D.; Anvari M.;
Doumouras A.G.
Institution
(Lee, Soon, Tian, Hong, Anvari, Doumouras) The Division of General
Surgery, McMaster University, Hamilton, ON, Canada
(Anvari) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Wong) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Class 2 obesity or greater [body mass index (BMI) >35 kg/m²] is
a relative contraindication for heart transplant due to its associated
perioperative risks and mortality. Whether bariatric surgery can act as a
potential bridging procedure to heart transplantation is unknown. The aim
of this systematic review and meta-analysis is to investigate the role of
bariatric surgery on improving transplant candidacy in patients with
end-stage heart failure (ESHF). MEDLINE, EMBASE, CENTRAL, and PubMed
databases were searched up to September 2019 for studies that performed
bariatric surgery on patients with severe obesity and ESHF. Outcomes of
interest included incidence of patients listed for heart transplantation
after bariatric surgery, proportion of patients that successfully received
transplant, the change in BMI after bariatric surgery, and 30-day
complications. Pooled estimates were calculated using a random-effects
meta-analysis of proportions. Eleven studies with 98 patients were
included. Mean preoperative BMI was 44.9 (2.1) kg/m² and BMI
after surgery was 33.2 (2.3) kg/m² with an absolute BMI
reduction of 26.1%. After bariatric surgery, 71% [95% confidence interval
(CI), 55-86%] of patients with ESHF were listed for transplantation. The
mean time from bariatric surgery to receiving a heart transplant was 14.9
(4.0) months. Of the listed patients, 57% (95% CI, 39-74%) successfully
received heart transplant. The rate of 30-day mortality after bariatric
surgery was 0%, and the 30-day major and minor complications after
bariatric surgery was 28% (95% CI, 10-49%). Bariatric surgery can
facilitate sustained weight loss in obese patients with ESHF, improving
heart transplant candidacy and the incidence of
transplantation.<br/>Copyright &#xa9; 2020 Wolters Kluwer Health, Inc. All
rights reserved.

<57>
[Use Link to view the full text]
Accession Number
2024877005
Title
Endothelin-1, Outcomes in Patients With Heart Failure and Reduced Ejection
Fraction, and Effects of Dapagliflozin: Findings From DAPA-HF.
Source
Circulation. 147(22) (pp 1670-1683), 2023. Date of Publication: 30 May
2023.
Author
Yeoh S.E.; Docherty K.F.; Campbell R.T.; Jhund P.S.; Hammarstedt A.;
Heerspink H.J.L.; Jarolim P.; Kober L.; Kosiborod M.N.; Martinez F.A.;
Ponikowski P.; Solomon S.D.; Sjostrand M.; Bengtsson O.; Greasley P.J.;
Sattar N.; Welsh P.; Sabatine M.S.; Morrow D.A.; McMurray J.J.V.
Institution
(Yeoh, Docherty, Campbell, Jhund, Sattar, Welsh, Sabatine, McMurray)
British Heart Foundation Cardiovascular Research Centre, University of
Glasgow, United Kingdom
(Hammarstedt, Sjostrand, Bengtsson, Greasley) BioPharmaceuticals Research
and Development, AstraZeneca, Gothenburg, Sweden
(Heerspink) Department of Clinical Pharmacy and Pharmacology, University
of Groningen, University Medical Center Groningen, Netherlands
(Heerspink) George Institute for Global Health, University of New South
Wales, Sydney, Australia
(Jarolim) Department of Pathology, Brigham and Women's Hospital, Boston,
MA, United States
(Morrow) Thrombolysis in Myocardial Infarction Study Group, Brigham and
Women's Hospital, Boston, MA, United States
(Solomon) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Kober) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Denmark
(Kosiborod) Saint Luke's Mid America Heart Institute, University of
Missouri, Kansas City, United States
(Martinez) Universidad Nacional de Cordoba, Argentina
(Ponikowski) Center for Heart Diseases, University Hospital, Wroclaw
Medical University, Poland
Publisher
Lippincott Williams and Wilkins
Abstract
Background: ET-1 (endothelin-1) is implicated in the pathophysiology of
heart failure and renal disease. Its prognostic importance and
relationship with kidney function in patients with heart failure with
reduced ejection fraction receiving contemporary treatment are uncertain.
We investigated these and the efficacy of dapagliflozin according to ET-1
level in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse
Outcomes in Heart Failure). <br/>Method(s): We investigated the incidence
of the primary outcome (cardiovascular death or worsening heart failure),
change in kidney function, and the effect of dapagliflozin according to
baseline ET-1 concentration, adjusting in Cox models for other recognized
prognostic variables in heart failure including NT-proBNP (N-terminal
pro-B-type natriuretic peptide). We also examined the effect of
dapagliflozin on ET-1 level. <br/>Result(s): Overall, 3048 participants
had baseline ET-1 measurements: tertile 1 (T1; <=3.28 pg/mL; n=1016); T2
(>3.28-4.41 pg/mL; n=1022); and T3 (>4.41 pg/mL; n=1010). Patients with
higher ET-1 were more likely male, more likely obese, and had lower left
ventricular ejection fraction, lower estimated glomerular filtration rate,
worse functional status, and higher NT-proBNP and hs-TnT (high-sensitivity
troponin-T). In the adjusted Cox models, higher baseline ET-1 was
independently associated with worse outcomes and steeper decline in kidney
function (adjusted hazard ratio for primary outcome of 1.95 [95% CI,
1.53-2.50] for T3 and 1.36 [95% CI, 1.06-1.75] for T2; both versus T1;
estimated glomerular filtration rate slope: T3, -3.19 [95% CI, -3.66 to
-2.72] mL/min per 1.73 m²per y, T2, -2.08 [95% CI, -2.52 to
-1.63] and T1 -2.35 [95% CI, -2.79 to -1.91]; P=0.002). The benefit of
dapagliflozin was consistent regardless of baseline ET-1, and the
placebo-corrected decrease in ET-1 with dapagliflozin was 0.13 pg/mL (95%
CI, 0.25-0.01; P=0.029). <br/>Conclusion(s): Higher baseline ET-1
concentration was independently associated with worse clinical outcomes
and more rapid decline in kidney function. The benefit of dapagliflozin
was consistent across the range of ET-1 concentrations measured, and
treatment with dapagliflozin led to a small decrease in serum ET-1
concentration. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT03036124.<br/>Copyright &#xa9; 2023 Lippincott Williams and
Wilkins. All rights reserved.

<58>
[Use Link to view the full text]
Accession Number
2024877003
Title
Association Between Hemoglobin Levels and Efficacy of Intravenous Ferric
Carboxymaltose in Patients With Acute Heart Failure and Iron Deficiency:
An AFFIRM-AHF Subgroup Analysis.
Source
Circulation. 147(22) (pp 1640-1653), 2023. Date of Publication: 30 May
2023.
Author
Filippatos G.; Ponikowski P.; Farmakis D.; Anker S.D.; Butler J.; Fabien
V.; Kirwan B.-A.; MacDougall I.C.; Metra M.; Rosano G.; Ruschitzka F.; Van
Der Meer P.; Wachter S.; Jankowska E.A.
Institution
(Filippatos, Farmakis) National and Kapodistrian University of Athens
Medical School, Athens University Hospital Attikon, Athens, Greece
(Ponikowski, Jankowska) Institute of Heart Diseases, Wroclaw Medical
University; and Institute of Heart Diseases, University Hospital, Wroclaw,
Poland
(Anker) Department of Cardiology and Berlin Institute of Health Center for
Regenerative Therapies, German Centre for Cardiovascular Research Partner
Site Berlin, Charite Universitatsmedizin Berlin, Germany
(Butler) University of Mississippi Medical Center, Jackson, United States
(Fabien, Wachter) Vifor Pharma Ltd, Glattbrugg, Switzerland
(Kirwan) Department of Clinical Research, Socar Research Sa, Nyon,
Switzerland
(Kirwan) London School of Hygiene and Tropical Medicine, University
College London, United Kingdom
(MacDougall) Department of Renal Medicine, King's College Hospital,
London, United Kingdom
(Metra) Department of Cardiology, University and Civil Hospital, Brescia,
Italy
(Rosano) Centre for Clinical and Basic Research, Department of Medical
Sciences, Irccs San Raffaele Pisana, Rome, Italy
(Ruschitzka) Department of Cardiology, University Heart Center, University
Hospital Zurich and University of Zurich, Switzerland
(Van Der Meer) Department of Cardiology, University Medical Center,
Groningen, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Iron deficiency, with or without anemia, is an adverse
prognostic factor in heart failure (HF). In AFFIRM-AHF (a randomized,
double-blind placebo-controlled trial comparing the effect of intravenous
ferric carboxymaltose on hospitalizations and mortality in iron-deficient
subjects admitted for acute heart failure), intravenous ferric
carboxymaltose (FCM), although having no significant effect on the primary
end point, reduced the risk of HF hospitalization (hHF) and improved
quality of life versus placebo in iron-deficient patients stabilized after
an acute HF (AHF) episode. These prespecified AFFIRM-AHF subanalyses
explored the association between hemoglobin levels and FCM treatment
effects. <br/>Method(s): AFFIRM-AHF was a multicenter, double-blind,
randomized, placebo-controlled trial of FCM in hospitalized AHF patients
with iron deficiency. Patients were stratified by baseline hemoglobin
level (<12 versus >=12 g/dL). In each subgroup, the primary composite
(total hHF and cardiovascular death) and secondary (total hHF; total
cardiovascular hospitalizations and cardiovascular death; time to
cardiovascular death, and time to first/days lost due to hHF or
cardiovascular death) outcomes were assessed with FCM versus placebo at
week 52. Sensitivity analyses using the World Health Organization anemia
definition (hemoglobin level <12 g/dL [women] or <13 g/dL [men]) were
performed, among others. <br/>Result(s): Of 1108 AFFIRM-AHF patients, 1107
were included in these subanalyses: 464 (FCM group, 228; placebo group,
236) had a hemoglobin level <12 g/dL, and 643 (FCM, 329; placebo, 314) had
a hemoglobin level >=12 g/dL. Patients with a hemoglobin level <12 g/dL
were older (mean, 73.7 versus 69.1 years), with more frequent previous HF
(75.0% versus 68.7%), serum ferritin <100 mug/L (75.4% versus 68.1%), and
transferrin saturation <20% (87.9% versus 81.4%). For the primary outcome,
annualized event rates per 100 patient-years with FCM versus placebo were
71.1 and 73.6 (rate ratio, 0.97 [95% CI, 0.66-1.41]), respectively, and
48.5 versus 72.9 (RR, 0.67 [95% CI, 0.48-0.93]) in the hemoglobin levels
<12 and >=12 g/dL subgroups, respectively. No significant interactions
between hemoglobin subgroup and treatment effect were observed for primary
(P<inf>interaction</inf>=0.15) or secondary outcomes. Changes from
baseline in hemoglobin, serum ferritin and transferrin saturation were
significantly greater with FCM versus placebo in both subgroups between
weeks 6 and 52. Findings were similar using the World Health Organization
definition for anemia. <br/>Conclusion(s): The effects of intravenous FCM
on outcomes in iron-deficient patients stabilized after an AHF episode,
including improvements in iron parameters over time, did not differ
between patients with hemoglobin levels <12 and >=12 g/dL. Registration:
URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02937454.<br/>Copyright &#xa9; 2023 Lippincott Williams and Wilkins.
All rights reserved.

<59>
Accession Number
2024804254
Title
Red blood cell distribution width to predict mortality in heart transplant
recipients: a systematic review.
Source
Monaldi Archives for Chest Disease. 93(2) (pp 78-83), 2023. Article
Number: A4. Date of Publication: 2023.
Author
Acuna-Chavez L.M.; Cruzalegui-Bazan C.; Quispe-Vicuna C.; Saldarriaga C.;
Contreras J.; Chavez-Peche J.A.; Alvarez-Vargas M.; Segura-Saldana P.
Institution
(Acuna-Chavez) Sociedad Cientifica de Estudiantes de Medicina de la
Universidad Nacional de Trujillo, Trujillo, Peru
(Acuna-Chavez, Cruzalegui-Bazan, Quispe-Vicuna, Chavez-Peche,
Alvarez-Vargas, Segura-Saldana) Department of Cardiology Research, Torres
de Salud National Research Center, Lima, Peru
(Cruzalegui-Bazan, Quispe-Vicuna) Sociedad Cientifica de San Fernando,
Universidad Nacional Mayor de San Marcos, Lima, Peru
(Saldarriaga) University of Antioquia, Medellin, Colombia
(Saldarriaga) Pontificia Bolivariana University, Medellin, Colombia
(Saldarriaga) CardioVID Clinic, Medellin, Colombia
(Contreras) Director of Ambulatory Heart Failure Network, The Mount Sinai
Health System, New York, United States
(Chavez-Peche) Clinica San Felipe, Lima, Peru
(Alvarez-Vargas) Departamento de Medicina Interna, Hospital Nacional
Guillermo Almenara, Lima, Peru
(Segura-Saldana) Ingenieria Biomedica, Facultad de Ciencias y Filosofia,
Universidad Peruana Cayetano Heredia, Lima, Peru
(Segura-Saldana) Departamento de Cardiologia, Hospital Nacional Edgardo
Rebagliati Martins, Lima, Peru
Publisher
Page Press Publications
Abstract
Red blood cell distribution width (RDW) has been shown to have prognostic
value in a number of different clinical settings, such as cardiovascular
disease, including heart failure. However, its prognostic value in heart
transplant (HT) recipients remains unknown. The aim of this systematic
review is to determine the prognostic value of pre-transplant RDW for
mortality in HT recipients. There is a pre-published protocol of this
review. The terms "Heart transplant", "Red cell distribution width" and
their synonyms were used in the search strategy. PubMed/Medline, Embase,
Scopus, Web of Science and LILACS were searched until May 17th, 2022,
without date or language restrictions. Two authors independently carried
out the selection, first by title and abstract, second by full-text
revision. Discrepancies were discussed and resolved with three other
authors. Quality of individual studies was assessed with Newcastle Ottawa
Scale (NOS) for cohorts. After removing the duplicates, 3885 articles were
identified. Four articles were included in the qualitative synthesis.
Three studies were classified as "good quality": whereas one as "poor
quality" according to NOS scale. All the included articles evaluated
long-term mortality and one study also evaluated short-term mortality. In
this one, a correlation between higher RDW values and short-term mortality
was reported. Meanwhile, in all the studies, a high pre-HT RDW was a
marker of long-term mortality following cardiac transplantation. Our
review shows that an elevated on-admission RDW is associated with
long-term mortality in heart transplantation recipients.<br/>Copyright
&#xa9; 2023 PAGEPress Publications. All rights reserved.

<60>
[Use Link to view the full text]
Accession Number
2024703278
Title
Postoperative Outcomes in Elderly Patients Undergoing Cardiac Surgery with
Preoperative Cognitive Impairment: A Systematic Review and Meta-Analysis.
Source
Anesthesia and Analgesia. 136(6) (pp 1016-1028), 2023. Date of
Publication: 01 Jun 2023.
Author
Au E.; Thangathurai G.; Saripella A.; Yan E.; Englesakis M.; Nagappa M.;
Chung F.
Institution
(Au, Saripella, Yan, Chung) Department of Anesthesia and Pain Management,
Toronto Western Hospital, University Health Network, Toronto, ON, Canada
(Thangathurai) Department of Medicine, McGill University, Montreal, QC,
Canada
(Yan) Department of Medical Science, University of Toronto, Toronto, ON,
Canada
(Englesakis) Department of Library & Information Services, University
Health Network, Toronto, ON, Canada
(Nagappa) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre and St Joseph Health Care, Schulich School of
Medicine and Dentistry, Western University, London, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Older patients with preoperative cognitive impairment are at
risk for increased postoperative complications after noncardiac surgery.
This systematic review and meta-analysis aimed to determine the
association between preoperative cognitive impairment and dementia and
postoperative outcomes in older surgical patients after cardiac surgery.
<br/>METHOD(S): Eight electronic databases were searched from inception to
January 4, 2022. Inclusion criteria were cardiac surgery patients >=60
years of age; preoperative cognitive impairment; >=1 postoperative
complication reported; comparator group with no preoperative cognitive
impairment; and written in English. Using a random-effects model, we
calculated effect sizes as odds ratio (OR) and standardized mean
differences (SMDs). Risk of random error was assessed by applying trial
sequential analysis. <br/>RESULT(S): Sixteen studies (62,179 patients)
were included. Preoperative cognitive impairment was associated with
increased risk of delirium in older patients after cardiac surgery (70.0%
vs 20.5%; OR, 8.35; 95% confidence interval [CI], 4.25-16.38; I2, 0%; P
<.00001). Cognitive impairment was associated with increased hospital
length of stay (LOS; SMD, 0.36; 95% CI, 0.20-0.51; I2, 22%; P <.00001) and
intensive care unit (ICU) LOS (SMD, 0.39; 95% CI, 0.09-0.68; I2, 70%; P
=.01). No significant association was seen for 30-day mortality (1.7% vs
1.1%; OR, 2.58; 95% CI, 0.64-10.44; I2, 55%; P =.18). <br/>CONCLUSION(S):
In older patients undergoing cardiac surgery, cognitive impairment was
associated with an 8-fold increased risk of delirium, a 5% increase in
absolute risk of major postoperative bleeding, and an increase in hospital
and ICU LOS by approximately 0.4 days. Further research on the feasibility
of implementing routine neurocognitive testing is warranted.<br/>Copyright
&#xa9; 2023 International Anesthesia Research Society.

<61>
Accession Number
2024676504
Title
Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in
Noncardiac Surgery An International Randomized Controlled Trial.
Source
Annals of Internal Medicine. 176(5) (pp 605-614), 2023. Date of
Publication: May 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, ON, Canada
(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, Cleveland, OH, United
States
(Chan, Wu) The Chinese University of Hong Kong, Hong Kong
(Leslie) Department of Critical Care Medicine, Melbourne Medical School,
University of Melbourne, Melbourne, VIC, Australia
(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, Spain
(Wang, Cheong) Department of Anesthesiology, Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia
(Xavier) St. John's Medical College, Bangalore, India
(Efremov) Saint Petersburg State University Hospital, Saint Petersburg,
Russian Federation
(Landoni) Department of Anesthesiology and Intensive Care, IRCCS San
Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan,
Italy
(Kleinlugtenbelt) Department of Orthopedic and Trauma Surgery, Deventer
Ziekenhuis, Deventer, Netherlands
(Szczeklik) Centre for Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, 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, Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
(Meyhoff) Department of Anesthesia and Intensive Care, Copenhagen
University Hospital, Bispebjerg, Copenhagen, Frederiksberg, Denmark
(Amir) Department of Surgery, Shifa International Hospital, Shifa
Tameer-e-Millat University, Islamabad, Pakistan
(Torres) Departamento de Epidemiologia y Estudios en Salud, Universidad de
Los Andes, Santiago, Chile
(Patel, Tandon) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Parlow) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston Health Sciences Centre, Kingston, ON, Canada
(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, Brazil
(Polanczyk) Hospital Moinhos de Vento, Porto Alegre, Brazil
(Jayaram) Department of Anaesthetics, Clinical Neurosciences, University
of Oxford, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
(Astrakov) Department of Anesthesiology, Novosibirsk State University,
Novosibirsk, Russian Federation
(Kirov) Department of Anesthesiology, Intensive Care Medicine, Northern
State Medical University, Arkhangelsk, Russian Federation
(de Nadal) Department of Anesthesiology and Intensive Care, Hospital Vall
d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
(Likhvantsev) V. Negovsky Reanimatology Research Institute, Moscow,
Russian Federation
(Paniagua) Anesthesiology Department, Santa Creu i Sant Pau University
Hospital, Barcelona, Spain
(Aguado) Trauma & Orthopaedic Surgery Department, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Biccard) Department of Anesthesia and Perioperative Medicine, Groote
Schuur Hospital, University of Cape Town, 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, ON, Canada
Publisher
American College of Physicians
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. <br/>Design(s): 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. <br/>Patient(s): 7490 patients having
noncardiac surgery who were at risk for vascular complications and were
receiving 1 or more long-term antihypertensive medications.
<br/>Intervention(s): In the hypotension-avoidance strategy group, the
intraoperative mean arterial pressure target was 80 mm Hg or greater;
before and for 2 days after surgery, renin-angiotensin-aldosterone system
inhibitors were withheld and the other long-term antihypertensive
medications were administered only for systolic blood pressures 130 mm Hg
or greater, following an algorithm. In the hypertension-avoidance strategy
group, the intraoperative mean arterial pressure target was 60 mm 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 30 days. 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.
<br/>Limitation(s): 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.<br/>Copyright &#xa9;
2023 American College of Physicians.

<62>
[Use Link to view the full text]
Accession Number
2024544299
Title
Eliminating Medication Copayments for Low-Income Older Adults at High
Cardiovascular Risk: A Randomized Controlled Trial.
Source
Circulation. 147(20) (pp 1505-1514), 2023. Date of Publication: 16 May
2023.
Author
Campbell D.J.T.; Mitchell C.; Hemmelgarn B.R.; Tonelli M.; Faris P.; Zhang
J.; Tsuyuki R.T.; Fletcher J.; Au F.; Klarenbach S.; Exner D.V.; Manns
B.J.
Institution
(Campbell, Tonelli, Faris, Zhang, Fletcher, Exner, Manns) Department of
Community Health Sciences, University of Calgary, Canada
(Campbell, Tonelli, Au, Manns) Department of Medicine, University of
Calgary, Canada
(Campbell, Exner) Department of Cardiac Sciences, University of Calgary,
Canada
(Campbell, Tonelli, Exner, Manns) Libin Cardiovascular Institute,
University of Calgary, Canada
(Campbell, Tonelli, Manns) O'Brien Institute of Public Health, Cumming
School of Medicine, University of Calgary, Canada
(Mitchell) Pharmaceutical Branch, Alberta Health, Government of Alberta,
Edmonton, Canada
(Hemmelgarn, Tsuyuki, Klarenbach) Department of Medicine, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, Canada
(Faris) Data Integration, Management, and Reporting, Analytics, Alberta
Health Services, Edmonton, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: One in eight people with heart disease has poor medication
adherence that, in part, is related to copayment costs. This study tested
whether eliminating copayments for high-value medications among low-income
older adults at high cardiovascular risk would improve clinical outcomes.
<br/>METHOD(S): This randomized 2x2 factorial trial studied 2 distinct
interventions in Alberta, Canada: eliminating copayments for high-value
preventive medications and a self-management education and support program
(reported separately). The findings for the first intervention, which
waived the usual 30% copayment on 15 medication classes commonly used to
reduce cardiovascular events, compared with usual copayment, is reported
here. The primary outcome was the composite of death, myocardial
infarction, stroke, coronary revascularization, and cardiovascular-related
hospitalizations over a 3-year follow-up. Rates of the primary outcome and
its components were compared using negative binomial regression. Secondary
outcomes included quality of life (Euroqol 5-dimension index score),
medication adherence, and overall health care costs. <br/>RESULT(S): A
total of 4761 individuals were randomized and followed for a median of 36
months. There was no evidence of statistical interaction (P=0.99) or of a
synergistic effect between the 2 interventions in the factorial trial with
respect to the primary outcome, which allowed us to evaluate the effect of
each intervention separately. The rate of the primary outcome was not
reduced by copayment elimination, (521 versus 533 events, incidence rate
ratio 0.84 [95% CI, 0.66-1.07], P=0.162). The incidence rate ratio for
nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death
(0.97 [95% CI, 0.67-1.39]), death (0.94 [95% CI, 0.80 to 1.11]), and
cardiovascular-related hospitalizations (0.78 [95% CI, 0.57 to 1.06]) did
not differ between groups. No significant between-group changes in quality
of life over time were observed (mean difference, 0.012 [95% CI, -0.006 to
0.030], P=0.19). The proportion of participants who were adherent to
statins was 0.72 versus 0.69 for the copayment elimination versus usual
copayment groups, respectively (mean difference, 0.03 [95% CI,
0.006-0.06], P=0.016). Overall adjusted health care costs did not differ
($3575 [95% CI, -605 to 7168], P=0.098). <br/>CONCLUSION(S): In low-income
adults at high cardiovascular risk, eliminating copayments (average,
$35/mo) did not improve clinical outcomes or reduce health care costs,
despite a modest improvement in adherence to medications.<br/>Copyright
&#xa9; 2023 The Authors. Circulation is published on behalf of the
American Heart Association, Inc.

<63>
[Use Link to view the full text]
Accession Number
2024544298
Title
Self-Management Support Using Advertising Principles for Older Adults With
Low Income at High Cardiovascular Risk: A Randomized Controlled Trial.
Source
Circulation. 147(20) (pp 1492-1504), 2023. Date of Publication: 16 May
2023.
Author
Campbell D.J.T.; Tonelli M.; Hemmelgarn B.R.; Faris P.; Zhang J.; Au F.;
Tsuyuki R.T.; Mitchell C.; Pannu R.; Campbell T.; Ivers N.; Fletcher J.;
Exner D.V.; Manns B.J.
Institution
(Campbell, Tonelli, Faris, Zhang, Au, Fletcher, Exner, Manns) Department
of Community Health Sciences, University of Calgary, AB, Canada
(Campbell, Tonelli, Hemmelgarn, Manns) Department of Medicine, University
of Calgary, AB, Canada
(Campbell, Exner) Department of Cardiac Sciences, University of Calgary,
AB, Canada
(Campbell) Department of Psychology, University of Calgary, AB, Canada
(Campbell, Tonelli, Exner, Manns) Cumming School of Medicine, O'Brien
Institute for Public Health, University of Calgary, AB, Canada
(Campbell, Tonelli, Exner, Manns) Libin Cardiovascular Institute,
University of Calgary, AB, Canada
(Hemmelgarn, Tsuyuki) Department of Medicine, University of Alberta,
Edmonton, Canada
(Tsuyuki) Department of Pharmacology, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Canada
(Faris) Data Integration, Management, and Reporting, Analytics, Alberta
Health Services, Edmonton, Canada
(Mitchell) Pharmaceutical and Supplementary Benefits Division, Alberta
Health, Government of Alberta, Edmonton, Canada
(Pannu) Emergence Creative, New York, NY, United States
(Ivers) Department of Family and Community Medicine, Temerty School of
Medicine, University of Toronto, Canada
(Ivers) Women's College Research Institute, Toronto, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Self-management education and support (SMES) interventions
have modest effects on intermediate outcomes for those at risk of
cardiovascular disease, but few studies have measured or demonstrated an
effect on clinical end points. Advertising for commercial products is
known to influence behavior, but advertising principles are not typically
incorporated into SMES design. <br/>METHOD(S): This randomized trial
studied the effect of a novel tailored SMES program designed by an
advertising firm among a population of older adults with low income at
high cardiovascular risk in Alberta, Canada. The intervention included
health promotion messaging from a fictitious "peer" and facilitated relay
of clinical information to patients' primary care provider and pharmacist.
The primary outcome was the composite of death, myocardial infarction,
stroke, coronary revascularization, and hospitalizations for
cardiovascular-related ambulatory care-sensitive conditions. Rates of the
primary outcome and its components were compared using negative binomial
regression. Secondary outcomes included quality of life (EQ-5D [EuroQoL
5-dimension] index score), medication adherence, and overall health care
costs. <br/>RESULT(S): We randomized 4761 individuals, with a mean age of
74.4 years, of whom 46.8% were female. There was no evidence of
statistical interaction (P=0.99) or of a synergistic effect between the 2
interventions in the factorial trial with respect to the primary outcome,
which allowed us to evaluate the effect of each intervention separately.
Over a median follow-up time of 36 months, the rate of the primary outcome
was lower in the group that received SMES compared with the control group
(incidence rate ratio, 0.78 [95% CI, 0.61 to 1.00]; P=0.047). No
significant between-group changes in quality of life over time were
observed (mean difference, 0.0001 [95% CI, -0.018 to 0.018]; P=0.99). The
proportion of participants who were adherent to medications was not
different between the 2 groups (P=0.199 for statins and P=0.754 for
angiotensin-converting enzyme inhibitors/angiotensin receptor blockers).
Overall adjusted health care costs did not differ between those receiving
SMES and the control group ($2015 [95% CI, -$1953 to $5985]; P=0.320).
<br/>CONCLUSION(S): For older adults with low income, a tailored SMES
program using advertising principles reduced the rate of clinical outcomes
compared with usual care. The mechanisms of improvement are unclear and
further studies are required.<br/>Copyright &#xa9; 2023 The Authors.
Circulation is published on behalf of the American Heart Association, Inc.

<64>
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. 37(7) (pp 1169-1178),
2023. Date of Publication: July 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
(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
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.

<65>
Accession Number
2023995768
Title
Del Nido Cardioplegia in Adult Cardiac Surgery: Meta-Analysis of
Randomized Clinical Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(7) (pp 1152-1159),
2023. Date of Publication: July 2023.
Author
Fresilli S.; Labanca R.; Monaco F.; Belletti A.; D'Amico F.; Blasio A.;
Kotani Y.; Landoni G.
Institution
(Fresilli, Labanca, Monaco, Belletti, D'Amico, Blasio, Kotani, Landoni)
Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
Publisher
W.B. Saunders
Abstract
Objective: To compare the outcomes of patients receiving del Nido solution
versus any other type of cardioplegia. <br/>Design(s): A systematic review
and meta-analysis of randomized trials. <br/>Setting(s): Cardiac operating
rooms. <br/>Participant(s): Adult patients (>=18 years old) undergoing
cardiac surgery. <br/>Intervention(s): The EMBASE, MEDLINE, and CENTRAL
databases were searched systematically from their inception until August
2022 for randomized controlled trials comparing del Nido versus other
cardioplegias. <br/>Measurements and Main Results: Ten studies were
included, including 1,812 patients (871 in the del Nido group and 941 in
the control group), and published after 2017. There were significant
reductions in postoperative stroke and/or transient ischemic attack rate
in the del Nido group: 9/467 (1.9%) v 25/540 (4.6%); odds ratio (OR),
0.43; 95% CI, 0.20-0.92 (p = 0.007). Del Nido cardioplegia was also
associated with significantly shorter aortic cross-clamp time (mean
difference, -8.99 minutes; 95% CI, -17.24 to -0.73 [p < 0.001]),
significantly reduced need for defibrillation (89/582 [15%] v 252/655
[38%]; OR, 0.33; 95% CI, 0.15-0.72 [p < 0.001]), significantly lower risk
of postoperative acute kidney injury (21/235 [8.9%] v 34/301 [11%]; OR,
0.50; 95% CI, 0.26-0.97 [p = 0.04]), with no effect on mortality (14/607
[2.3%] v 12/681 [1.8%]; p = 0.5). <br/>Conclusion(s): According to the
authors' meta-analysis of recent randomized clinical trials, del Nido is a
safe cardioplegic solution, which might provide better organ protection in
adult cardiac surgery without differences in mortality when compared to
other cardioplegic solutions.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<66>
Accession Number
2023635338
Title
Glycemic variability and the risk of atrial fibrillation: a meta-analysis.
Source
Frontiers in Endocrinology. 14 (no pagination), 2023. Article Number:
1126581. Date of Publication: 2023.
Author
Li W.; Wang Y.; Zhong G.
Institution
(Li, Wang, Zhong) Department of Cardiology, The First Affiliated Hospital
of Guangxi Medical University, Nanning, China
Publisher
Frontiers Media S.A.
Abstract
Background: Glycemic variability (GV) has been associated with vascular
complications in patients with diabetes. However, the relationship between
GV and risk of atrial fibrillation (AF) remains not fully determined. We
therefore conducted a systematic review and meta-analysis to evaluate the
above association. <br/>Method(s): Medline, Embase, Web of Science,
Wanfang, and China National Knowledge Infrastructure were searched for
longitudinal follow-up studies comparing the incidence of AF between
patients with higher versus lower GV. A random-effects model incorporating
the potential heterogeneity was used to pool the results. <br/>Result(s):
Nine cohort studies with 6,877,661 participants were included, and 36,784
(0.53%) participants developed AF during follow-up. Pooled results showed
that a high GV was associated with an increased risk of AF (risk ratio
[RR]: 1.20, 95% confidence interval [CI]: 1.11 to 1.30, p < 0.001,
I² = 20%). Subgroup analyses suggested consistent association
between GV and AF in prospective (RR: 1.29, 95% CI: 1.05 to 1.59, p =
0.01) and retrospective studies (RR: 1.18, 95% CI: 1.08 to 1.29, p =
0.002), in diabetic (RR: 1.24, 95% CI: 1.03 to 1.50, p = 0.03) and
non-diabetic subjects (RR: 1.13, 95% CI: 1.00 to 1.28, p = 0.05), in
studies with short-term (RR: 1.25, 95% CI: 1.11 to 1.40, p < 0.001) and
long-term GV (RR: 1.18, 95% CI: 1.05 to 1.34, p = 0.006), and in studies
with different quality scores (p for subgroup difference all > 0.05).
<br/>Conclusion(s): A high GV may predict an increased risk of AF in adult
population.<br/>Copyright &#xa9; 2023 Li, Wang and Zhong.

<67>
Accession Number
2023616871
Title
Comparison of regional anesthetic techniques for postoperative analgesia
after adult cardiac surgery: bayesian network meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1078756. Date of Publication: 2023.
Author
Zhou K.; Li D.; Song G.
Institution
(Zhou, Li) Department of Cardiac Surgery, Shengjing Hospital of China
Medical University, Shenyang, China
(Song) Department of Ultrasound, Shengjing Hospital of China Medical
University, Shenyang, China
Publisher
Frontiers Media S.A.
Abstract
Background: Patients usually suffer acute pain after cardiac surgery.
Numerous regional anesthetic techniques have been used for those patients
under general anesthesia. The most effective regional anesthetic technique
was still unclear. <br/>Method(s): Five databases were searched, including
PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The
efficiency outcomes were pain scores, cumulative morphine consumption, and
the need for rescue analgesia in this Bayesian analysis. Postoperative
nausea, vomiting and pruritus were safety outcomes. Functional outcomes
included the time to tracheal extubation, ICU stay, hospital stay, and
mortality. <br/>Result(s): This meta-analysis included 65 randomized
controlled trials involving 5,013 patients. Eight regional anesthetic
techniques were involved, including thoracic epidural analgesia (TEA),
erector spinae plane block, and transversus thoracic muscle plane block.
Compared to controls (who have not received regional anesthetic
techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at
rest and cough, decreased the rate of need for rescue analgesia (OR =
0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD =
-181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD
= -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the
pain score 6 h at rest and the risk of pruritus, shortened the duration of
ICU stay compared to controls. Transversus thoracic muscle plane block
reduced the pain scores 6 and 12 h at rest compared to controls. The
cumulative morphine consumption of each technique was similar at 24, 48 h.
Other outcomes were also similar among these regional anesthetic
techniques. <br/>Conclusion(s): TEA seems the most effective regional
postoperative anesthesia for patients after cardiac surgery by reducing
the pain scores and decreasing the rate of need for rescue analgesia.
Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, ID:
CRD42021276645.<br/>Copyright 2023 Zhou, Li and Song.

<68>
Accession Number
2023571269
Title
Exploring the Relationship between Efpeglenatide Dose and Cardiovascular
Outcomes in Type 2 Diabetes: Insights from the AMPLITUDE-O Trial.
Source
Circulation. 147(13) (pp 1004-1013), 2023. Date of Publication: 28 Mar
2023.
Author
Gerstein H.C.; Li Z.; Ramasundarahettige C.; Baek S.; Branch K.R.H.; Del
Prato S.; Lam C.S.P.; Lopes R.D.; Pratley R.; Rosenstock J.; Sattar N.
Institution
(Gerstein, Li, Ramasundarahettige) Population Health Research Institute,
McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
(Gerstein) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Baek) Hanmi Pharmaceutical, Songpa-gu, Seoul, South Korea
(Branch) Division of Cardiology, University of Washington, Seattle, United
States
(Del Prato) Department of Clinical and Experimental Medicine, Section of
Metabolic Diseases and Diabetes, University of Pisa, Italy
(Lam) National Heart Centre Singapore and Duke-National University of
Singapore (C.S.P.L.)., Singapore
(Lopes) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Pratley) AdventHealth Translational Research Institute, Orlando, FL,
United States
(Rosenstock) Velocity Clinical Research at Medical City, Dallas, TX,
United States
(Sattar) School of Cardiovascular and Metabolic Health, University of
Glasgow, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the AMPLITUDE-O (Effect of Efpeglenatide on Cardiovascular
Outcomes) cardiovascular outcomes trial, adding either 4 mg or 6 mg weekly
of the glucagon-like peptide-1 receptor agonist efpeglenatide to usual
care reduced major adverse cardiovascular events (MACE) in people with
type 2 diabetes at high cardiovascular risk. Whether these benefits are
dose related remains uncertain. <br/>Method(s): Participants were randomly
assigned in a 1:1:1 ratio to placebo, 4 mg or 6 mg of efpeglenatide. The
effect of 6 mg versus placebo and of 4 mg versus placebo on MACE (a
nonfatal myocardial infarction, nonfatal stroke, or death from
cardiovascular or unknown causes) and on all the secondary composite
cardiovascular and kidney outcomes was assessed. A dose-response
relationship was assessed using the log-rank test and
chi²statistic for trend. <br/>Result(s): During a median
follow-up of 1.8 years, MACE occurred in 125 (9.2%) participants assigned
to placebo, 84 (6.2%) participants assigned to 6 mg of efpeglenatide
(hazard ratio [HR], 0.65 [95% CI, 0.5-0.86]; P=0.0027), and 105 (7.7%)
assigned to 4 mg of efpeglenatide (HR, 0.82 [95% CI, 0.63-1.06]; P=0.14).
Participants receiving high-dose efpeglenatide also experienced fewer
secondary outcomes, including the composite of MACE, coronary
revascularization, or hospitalization for unstable angina (HR, 0.73 for 6
mg, P=0.011; HR, 0.85 for 4 mg, P=0.17), a kidney composite outcome
comprising sustained new macroalbuminuria, a >=40% decline in estimated
glomerular filtration rate or renal failure (HR, 0.63 for 6 mg, P<0.0001;
HR, 0.73 for 4 mg, P=0.0009), MACE or any death (HR, 0.67 for 6 mg,
P=0.0021; HR, 0.81 for 4 mg, P=0.08), a kidney function outcome comprising
a sustained >=40% decline in estimated glomerular filtration rate, renal
failure, or death (HR, 0.61 for 6 mg, P=0.0072; HR, 0.97 for 4 mg,
P=0.83), and the composite of MACE, any death, heart failure
hospitalization, or the kidney function outcome (HR, 0.63 for 6 mg,
P=0.0002; HR, 0.81 for 4 mg, P=0.067). A clear dose-response was noted for
all primary and secondary outcomes (all P for trend <=0.018).
<br/>Conclusion(s): The graded salutary relationship between efpeglenatide
dose and cardiovascular outcomes suggests that titrating efpeglenatide and
potentially other glucagon-like peptide-1 receptor agonists to high doses
may maximize their cardiovascular and renal benefits.<br/>Copyright &#xa9;
2023 Lippincott Williams and Wilkins. All rights reserved.

<69>
Accession Number
2023501326
Title
Preemptive parasternal intercostal nerve block for patients undergoing
off-pump coronary artery bypass grafting: a double-blind, randomized,
controlled trial.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1188518. Date of Publication: 2023.
Author
Zou M.; Ruan W.; Liu J.; Xu J.
Institution
(Zou, Liu) Center for Rehabilitation Medicine, Department of
Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's
Hospital, Hangzhou Medical College, Hangzhou, China
(Ruan, Xu) Department of Anesthesiology, The Second XiangYa Hospital of
Central South University, Hunan, China
Publisher
Frontiers Media S.A.
Abstract
Background: Parasternal intercostal nerve block has been increasingly used
for postoperative analgesia and has shown that this technique can provide
effective postoperative analgesia. This study aimed to investigate the
effect of preemptive parasternal intercostal nerve block on the opioid and
vasoactive drug dose required for intraoperative hemodynamic stability and
postoperative analgesia in patients undergoing off-pump coronary artery
bypass grafting. <br/>Method(s): In this prospective, randomized
controlled study, 64 participants aged 45-75 years scheduled for off-pump
coronary artery bypass grafting at The Second Xiangya Hospital of Central
South University. Patients were randomized into two groups and
preoperatively administered ropivacaine (group R) and saline (group S), in
the parasternal intercostal spaces with ultrasound-guided bilateral nerve
block. <br/>Result(s): The primary outcome was intraoperative sufentanil
and vasopressor dosage. The secondary outcomes were intraoperative
hemodynamics, postoperative pain scores, and anesthesia recovery,
postoperative use of rescue dezocine, stay in intensive care unit, and
length of hospital stay. The consumption of intraoperative sufentanil and
vasopressor was significantly lower in group R than in group S. The visual
analog score in group R was significantly lower than that in group S up to
12 h postoperatively. The time to anesthesia recovery was significantly
less in group R than in group S. Most patients in group S required rescue
dezocine, whereas most patients in group R did not. The hemodynamic
variables were stable in all patients. <br/>Conclusion(s): A preemptive
parasternal intercostal nerve block effectively reduced the required
intraoperative sufentanil and norepinephrine dose and provided adequate
analgesia for the first 12 h after surgery. Therefore, a preemptive
parasternal intercostal nerve block is a good option for patients
undergoing off-pump coronary artery bypass grafting. Clinical trial
registration: chictr.org.cn, identifier ChiCTR1800017210.<br/>Copyright
2023 Zou, Ruan, Liu and Xu.

<70>
Accession Number
2023481490
Title
Sutureless vs. rapid-deployment valve: a systemic review and meta-analysis
for a direct comparison of intraoperative performance and clinical
outcomes.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1123487. Date of Publication: 2023.
Author
Wang C.; Xie Y.; Zhang H.; Yang P.; Zhang Y.; Lu C.; Liu Y.; Wang H.; Xu
Z.; Hu J.
Institution
(Wang, Xie, Zhang, Yang, Zhang, Lu, Liu, Wang, Xu, Hu) Department of
Cardiovascular Surgery, West China Hospital, Sichuan University, Sichuan,
Chengdu, China
(Zhang, Yang, Hu) Cardiovascular Surgery Research Laboratory, West China
Hospital, Sichuan University, Sichuan, Chengdu, China
(Hu) Department of Cardiovascular Surgery, Guang'an Hospital of West China
Hospital, Sichuan University, Sichuan, Guang'an, China
Publisher
Frontiers Media S.A.
Abstract
Background: Sutureless and rapid-deployment valves are bioprostheses
anchoring within the aortic annulus with few sutures, and they act as a
hybrid of conventional surgical and transcatheter valves under aortic
valve replacement. Considering that the 3F Enable valve is now off-market,
the only two sutureless and rapid-deployment valves available on the world
marketplace are the Perceval and Intuity valves. However, a direct
comparison of the function of these two valves eludes researchers.
<br/>Purpose(s): Against this background, we performed this systematic
review and meta-analysis comparing the intraoperative performance and
early clinical outcomes between the Perceval valve and the Intuity valve
under sutureless and rapid-deployment aortic valve replacement.
<br/>Method(s): We systematically searched electronic databases through
PubMed/MEDLINE, OvidWeb, Web of Science, and Cochrane Central Register of
Controlled Trials (from the establishment of the database to November 17,
2022, without language restriction) for studies comparing the sutureless
valve (the Perceval) and the rapid-deployment valve (the Intuity) under
aortic valve replacement. Our primary outcomes were early mortality and
postoperative transvalvular pressure gradients. The secondary outcomes
were defined to include aortic cross-clamp and cardiopulmonary bypass
time, paravalvular leak (any paravalvular leak, moderate-to-severe
paravalvular leak) after aortic valve replacement, need for pacemaker
implantation, postoperative neurological events (stroke), and intensive
care unit stay. <br/>Result(s): This meta-analysis included ten
non-randomized trials with 3,526 patients enrolled (sutureless group =
1,772 and rapid-deployment group = 1,754). Quality assessments were
performed, with the mean scores of the studies reading 6.90 (SD = 0.99)
out of 9 according to the Newcastle-Ottawa Scale. Compared with
rapid-deployment aortic valve replacement, sutureless aortic valve
replacement was associated with higher mean and peak transvalvular
pressure gradients postoperatively. In contrast, aortic cross-clamp and
cardiopulmonary time were needed less in sutureless aortic valve
replacement vs. rapid-deployment aortic valve replacement. There was no
evidence of significant publication bias observed by the funnel plot and
Egger's test. <br/>Conclusion(s): For postoperative hemodynamics,
sutureless aortic valve replacement was associated with increased mean and
peak transvalvular pressure gradients compared with rapid-deployment
aortic valve replacement. In sharp contrast, sutureless aortic valve
replacement significantly reduced the amount of time needed for fixing the
aortic cross-clamp and the cardiopulmonary bypass procedure. Systematic
Review Registration: https://www.crd.york.ac.uk/prospero/, identifier
CRD42022343884.<br/>Copyright 2023 Wang, Xie, Zhang, Yang, Zhang, Lu, Liu,
Wang, Xu and Hu.

<71>
Accession Number
2022033029
Title
Accuracy of a noninvasive estimated continuous cardiac output measurement
under different respiratory conditions: a prospective observational study.
Source
Journal of Anesthesia. 37(3) (pp 394-400), 2023. Date of Publication: June
2023.
Author
Takakura M.; Fujii T.; Taniguchi T.; Suzuki S.; Nishiwaki K.
Institution
(Takakura, Fujii, Taniguchi, Suzuki) Department of Anesthesiology, Nagoya
University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
(Takakura, Taniguchi, Nishiwaki) Department of Anesthesiology, Nagoya
University Graduate School of Medicine, Nagoya, Japan
Publisher
Springer
Abstract
Purpose: The estimated continuous cardiac output (esCCO) system was
recently developed as a noninvasive hemodynamic monitoring alternative to
the thermodilution cardiac output (TDCO). However, the accuracy of
continuous cardiac output measurements by the esCCO system compared to
TDCO under different respiratory conditions remains unclear. This
prospective study aimed to assess the clinical accuracy of the esCCO
system by continuously measuring the esCCO and TDCO. <br/>Method(s): Forty
patients who had undergone cardiac surgery with a pulmonary artery
catheter were enrolled. We compared the esCCO with TDCO from mechanical
ventilation to spontaneous respiration through extubation. Patients
undergoing cardiac pacing during esCCO measurement, those receiving
treatment with an intra-aortic balloon pump, and those with measurement
errors or missing data were excluded. In total, 23 patients were included.
Agreement between the esCCO and TDCO measurements was evaluated using
Bland-Altman analysis with a 20 min moving average of the esCCO.
<br/>Result(s): The paired esCCO and TDCO measurements (939 points before
extubation and 1112 points after extubation) were compared. The respective
bias and standard deviation (SD) values were 0.13 L/min and 0.60 L/min
before extubation, and - 0.48 L/min and 0.78 L/min after extubation. There
was a significant difference in bias before and after extubation (P <
0.001); the SD before and after extubation was not significant (P =
0.315). The percentage errors were 25.1% before extubation and 29.6% after
extubation, which is the criterion for acceptance of a new technique.
<br/>Conclusion(s): The accuracy of the esCCO system is clinically
acceptable to that of TDCO under mechanical ventilation and spontaneous
respiration.<br/>Copyright &#xa9; 2023, The Author(s) under exclusive
licence to Japanese Society of Anesthesiologists.

<72>
Accession Number
2024966453
Title
Mapping the characteristics, methodological quality and standards of
reporting of network meta-analyses on antithrombotic therapies: An
overview.
Source
International Journal of Cardiology. 386 (pp 125-133), 2023. Date of
Publication: 01 Sep 2023.
Author
de Sousa P.G.; Mainka F.F.; Tonin F.S.; Pontarolo R.
Institution
(de Sousa) Department of Medical and Pharmaceutical Sciences, Universidade
Estadual do Oeste do Parana, Cascavel, Brazil
(Mainka, Tonin) Pharmaceutical Sciences Postgraduate Programme,
Universidade Federal do Parana, Curitiba, Brazil
(Pontarolo) Department of Pharmacy, Universidade Federal do Parana,
Curitiba, Brazil
(Tonin) Health & Technology Research Centre, Escola Superior de Tecnologia
da Saude (H&TRC-ESTeSL), Instituto Politecnico de Lisboa, Lisbon, Portugal
Publisher
Elsevier Ireland Ltd
Abstract
Background: Although a large number of network meta-analyses (NMAs) in the
field of cardiology are available, little is known about their
methodological quality. We aimed to map the characteristics and critically
appraised the standards of conduct and evidence reporting of NMAs
assessing antithrombotic therapies for the treatment or prophylaxis of
heart diseases and cardiac surgical procedures. <br/>Method(s): We
systematically searched PubMed and Scopus to identify NMAs comparing the
clinical effects of antithrombotic therapies. Overall characteristics of
the NMAs were extracted and their reporting quality and methodological
quality were evaluated using the PRISMA-NMA checklist and AMSTAR-2,
respectively. <br/>Result(s): We found 86 NMAs published between 2007 and
2022. Comparisons among direct-acting oral anticoagulants were available
in 61 (71%) NMAs. Although around 75% of NMAs stated that they followed
international guidelines for conduct and reporting, only one third
provided a protocol/register. Complete search strategies and publication
bias assessment were lacking in around 53% and 59% of studies,
respectively. Most NMAs (n = 77, 90%) provided supplemental material;
however, only 5 (6%) made the complete raw data available. Network
diagrams were depicted in most studies (n = 67, 78%), yet network geometry
was described in only 11 (12.8%) of them. Mean adherence to the PRISMA-NMA
checklist was 65.1 +/- 16.5%. AMSTAR-2 assessment showed 88% of the NMAs
had critically low methodological quality. <br/>Conclusion(s): Although
there is a wide diffusion of NMA-type studies on antithrombotics for heart
diseases, their methodological and reporting quality remains suboptimal.
This may reflect fragile clinical practices due to misleading conclusions
from critically low-quality NMAs.<br/>Copyright &#xa9; 2023 Elsevier B.V.

<73>
Accession Number
2022675907
Title
Machine learning to predict myocardial injury and death after non-cardiac
surgery.
Source
Anaesthesia. 78(7) (pp 853-860), 2023. Date of Publication: July 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.

<74>
[Use Link to view the full text]
Accession Number
632112573
Title
Ten-Year Outcomes after Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting for Left Main Coronary Disease: Extended Follow-Up of the
PRECOMBAT Trial.
Source
Circulation. 141(18) (pp 1437-1446), 2020. Date of Publication: 05 May
2020.
Author
Park D.-W.; Ahn J.-M.; Park H.; Yun S.-C.; Kang D.-Y.; Lee P.H.; Kim
Y.-H.; Lim D.-S.; Rha S.-W.; Park G.-M.; Gwon H.-C.; Kim H.-S.; Chae
I.-H.; Jang Y.; Jeong M.-H.; Tahk S.-J.; Seung K.B.; Park S.-J.
Institution
(Park, Ahn, Park, Kang, Lee, Kim, Park) Department of Cardiology, Asan
Medical Center, Seoul, South Korea
(Yun) Division of Biostatistics, Asan Medical Center, Seoul, South Korea
(Lim) Korea University Anam Hospital, Seoul, South Korea
(Rha) Korea University Kuro Hospital, Seoul, South Korea
(Park) Ulsan University Hospital, South Korea
(Gwon, Kim) Samsung Medical Center, Seoul, South Korea
(Kim) Seoul National University Hospital, South Korea
(Chae) Seoul National University Bundan Hospital, Seongnam, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Tahk) Ajou University Medical Center, Suwon, South Korea
(Seung) Catholic University of Korea, St. Mary's Hospital, Seoul, South
Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Long-term comparative outcomes after percutaneous coronary
intervention (PCI) with drug-eluting stents and coronary-artery bypass
grafting (CABG) for left main coronary artery disease are highly debated.
<br/>Method(s): In the PRECOMBAT trial (Premier of Randomized Comparison
of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in
Patients with Left Main Coronary Artery Disease), patients with
unprotected left main coronary artery disease were randomly assigned to
undergo PCI with sirolimus-eluting stents (n=300) or CABG (n=300) in 13
hospitals in Korea from April 2004 to August 2009. The follow-up was
extended to at least 10 years for all patients (median, 11.3 years). The
primary outcome was the incidence of major adverse cardiac or
cerebrovascular events (composite of death from any cause, myocardial
infarction, stroke, or ischemia-driven target-vessel revascularization).
<br/>Result(s): At 10 years, a primary outcome event occurred in 29.8% of
the PCI group and in 24.7% of the CABG group (hazard ratio [HR] with PCI
vs CABG, 1.25 [95% CI, 0.93-1.69]). The 10-year incidence of the composite
of death, myocardial infarction, or stroke (18.2% vs 17.5%; HR 1.00 [95%
CI, 0.70-1.44]) and all-cause mortality (14.5% vs 13.8%; HR 1.13 [95% CI,
0.75-1.70]) were not significantly different between the PCI and CABG
groups. Ischemia-driven target-vessel revascularization was more frequent
after PCI than after CABG (16.1% vs 8.0%; HR 1.98 [95% CI, 1.21-3.21).
<br/>Conclusion(s): Ten-year follow-up of the PRECOMBAT trial of patients
with left main coronary artery disease randomized to PCI or CABG did not
demonstrate significant difference in the incidence of major adverse
cardiac or cerebrovascular events. Because the study was underpowered, the
results should be considered hypothesis-generating, highlighting the need
for further research. Registration: URL: https://www.clinicaltrials.gov;
Unique identifiers: NCT03871127 and NCT00422968.<br/>Copyright &#xa9; 2020
Lippincott Williams and Wilkins. All rights reserved.

<75>
[Use Link to view the full text]
Accession Number
631566234
Title
High-Sensitivity Cardiac Troponin and the Universal Definition of
Myocardial Infarction.
Source
Circulation. 141(3) (pp 161-171), 2020. Date of Publication: 21 Jan 2020.
Author
Chapman A.R.; Adamson P.D.; Shah A.S.V.; Anand A.; Strachan F.E.; Ferry
A.V.; Ken Lee K.; Berry C.; Findlay I.; Cruikshank A.; Reid A.; Gray A.;
Collinson P.O.; Apple F.; McAllister D.A.; Maguire D.; Fox K.A.A.;
Vallejos C.A.; Keerie C.; Weir C.J.; Newby D.E.; Mills N.L.
Institution
(Chapman, Adamson, Shah, Anand, Strachan, Ferry, Ken Lee, Fox, Newby,
Mills) BHF/University Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh EH16 4SA, United Kingdom
(Keerie, Weir) Edinburgh Clinical Trials Unit, University of Edinburgh,
United Kingdom
(Vallejos) MRC Human Genetics Unit, University of Edinburgh, United
Kingdom
(Ken Lee) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, United Kingdom
(Berry) Christchurch Heart Institute, University of Otago, New Zealand
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
United Kingdom
(Findlay) Department of Cardiology, Royal Alexandra Hospital, Paisley,
United Kingdom
(Cruikshank, Reid) Department of Biochemistry, Queen Elizabeth University
Hospital, Glasgow, United Kingdom
(Gray) Emergency Medicine Research Group Edinburgh, Royal Infirmary of
Edinburgh, United Kingdom
(Collinson) Departments of Clinical Blood Sciences and Cardiology, St
George's University Hospitals NHS Trust and St George's University of
London, United Kingdom
(Apple) Department of Laboratory Medicine and Pathology, Hennepin
Healthcare/Hennepin County Medical Center & University of Minnesota,
Minneapolis, United States
(Maguire) Emergency Medicine Department, Glasgow Royal Infirmary, United
Kingdom
(Vallejos) Alan Turing Institute, London, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The introduction of more sensitive cardiac troponin assays has
led to increased recognition of myocardial injury in acute illnesses other
than acute coronary syndrome. The Universal Definition of Myocardial
Infarction recommends high-sensitivity cardiac troponin testing and
classification of patients with myocardial injury based on pathogenesis,
but the clinical implications of implementing this guideline are not well
understood. <br/>Method(s): In a stepped-wedge cluster randomized,
controlled trial, we implemented a high-sensitivity cardiac troponin assay
and the recommendations of the Universal Definition in 48 282 consecutive
patients with suspected acute coronary syndrome. In a prespecified
secondary analysis, we compared the primary outcome of myocardial
infarction or cardiovascular death and secondary outcome of
noncardiovascular death at 1 year across diagnostic categories.
<br/>Result(s): Implementation increased the diagnosis of type 1
myocardial infarction by 11% (510/4471), type 2 myocardial infarction by
22% (205/916), and acute and chronic myocardial injury by 36% (443/1233)
and 43% (389/898), respectively. Compared with those without myocardial
injury, the rate of the primary outcome was highest in those with type 1
myocardial infarction (cause-specific hazard ratio [HR] 5.64 [95% CI,
5.12-6.22]), but was similar across diagnostic categories, whereas
noncardiovascular deaths were highest in those with acute myocardial
injury (cause specific HR 2.65 [95% CI, 2.33-3.01]). Despite modest
increases in antiplatelet therapy and coronary revascularization after
implementation in patients with type 1 myocardial infarction, the primary
outcome was unchanged (cause specific HR 1.00 [95% CI, 0.82-1.21]).
Increased recognition of type 2 myocardial infarction and myocardial
injury did not lead to changes in investigation, treatment or outcomes.
<br/>Conclusion(s): Implementation of high-sensitivity cardiac troponin
assays and the recommendations of the Universal Definition of Myocardial
Infarction identified patients at high-risk of cardiovascular and
noncardiovascular events but was not associated with consistent increases
in treatment or improved outcomes. Trials of secondary prevention are
urgently required to determine whether this risk is modifiable in patients
without type 1 myocardial infarction. Clinical Trial Registration:
https://www.clinicaltrials.gov. Unique identifier:
NCT01852123.<br/>Copyright &#xa9; 2020 Lippincott Williams and Wilkins.
All rights reserved.

<76>
Accession Number
2024999536
Title
Ultrasonic bone curette in thoracic spinal decompression: a comprehensive
systematic review and meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 27(10) (pp
4450-4461), 2023. Date of Publication: 2023.
Author
Chen F.-Y.; Wei X.-D.; Yang X.-P.; Yu C.-Q.; Huang S.-Q.; Ou J.-X.; Mu
X.-P.; Wei J.-X.
Institution
(Chen, Wei, Yang, Yu, Huang, Ou, Mu, Wei) Department of Spine Surgery, The
People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of
Medical Sciences, Nanning, China
(Chen, Ou) Graduate School, Guangxi Medical University, Nanning, China
Publisher
Verduci Editore s.r.l
Abstract
OBJECTIVE: The aim of this study was to compare the efficacy and safety of
ultrasonic bone curette (UBC) and conventional surgical instruments in
thoracic laminectomy decompression (TLD) for the treatment of thoracic
spinal stenosis (TSS) by meta-analysis. MATERIALS AND METHODS: Two authors
independently searched Medline via PubMed, Embase, Cochrane Library, Web
of Science, Wanfang Database, and China National Knowledge Infrastructure
for the period from the establishment of the database until January 2023
to identify the studies on the safety and efficacy of UBC vs. conventional
instruments for TSS. Data extraction and quality assessment were performed
by two researchers independently. We used RevMan 5.4 software (Review
Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to analyze
the data. <br/>RESULT(S): Eight retrospective studies were included in the
present work. This meta-analysis revealed that no significant differences
in the preoperative JOA scores, the JOA scores at the last follow-up, the
improvement rate of JOA scores, and the incidence of cerebrospinal fluid
leakage/dura injury were detected between the two groups (p>=0.05).
However, there were significant differences in the operative time and
intraoperative blood loss during single-level TLD [operative time:
MD=-1.47, 95% CI (-1.86, -1.09), p<0.001; intraoperative blood loss:
MD=-46.62, 95% CI (-53.83, -39.40), p<0.001], total operative time
[MD=-56.88, 95% CI (-69.66, -44.10), p<0.001], total intraoperative blood
loss [MD=- 143.52, 95% CI (-212.49, -74.54), p<0.001], the incidence of
neurological deterioration/nerve root injury [RR= 0.29, 95% CI (0.09,
0.91), p=0.03] between the groups. <br/>CONCLUSION(S): The application of
UBC in TLD to treat TSS is safe and effective. UBC can significantly
shorten operation time and reduce intraoperative blood loss compared to
traditional surgical instruments. Moreover, it has the advantage of
reducing perioperative nerve injury.<br/>Copyright &#xa9; 2023 Verduci
Editore s.r.l. All rights reserved.

<77>
Accession Number
2023639721
Title
Direct assessment of microcirculation in shock: a randomized-controlled
multicenter study.
Source
Intensive Care Medicine. (no pagination), 2023. Date of Publication:
2023.
Author
Bruno R.R.; Wollborn J.; Fengler K.; Flick M.; Wunder C.; Allgauer S.;
Thiele H.; Schemmelmann M.; Hornemann J.; Moecke H.M.E.; Demirtas F.;
Palici L.; Franz M.; Saugel B.; Kattan E.; De Backer D.; Bakker J.;
Hernandez G.; Kelm M.; Jung C.
Institution
(Bruno, Schemmelmann, Hornemann, Moecke, Demirtas, Palici, Kelm, Jung)
Medical Faculty, Department of Cardiology, Pulmonology and Vascular
Medicine, Heinrich-Heine-University Duesseldorf, Moorenstrase 5,
Duesseldorf 40225, Germany
(Wollborn) Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, United
States
(Fengler, Thiele) Department of Cardiology, Heart Center Leipzig at
University of Leipzig, Leipzig, Germany
(Flick, Saugel) Department of Anesthesiology, Center of Anesthesiology and
Intensive Care Medicine, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
(Wunder) Department of Anesthesiology and Intensive Care Medicine,
Robert-Bosch-Krankenhaus, Stuttgart, Germany
(Allgauer) Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart,
Germany
(Kattan, Hernandez) Departamento de Medicina Intensiva, Facultad de
Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
(De Backer) Department of Intensive Care, CHIREC Hospitals, Universite
Libre de Bruxelles, Brussels, Belgium
(Bakker) NYU Langone Health and Columbia University Irving Medical Center,
New York, United States
(Franz, Bakker) Erasmus MC University Medical Center, Rotterdam,
Netherlands
(Kelm) CARID (Cardiovascular Research Institute Dusseldorf), Dusseldorf,
Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Shock is a life-threatening condition characterized by
substantial alterations in the microcirculation. This study tests the
hypothesis that considering sublingual microcirculatory perfusion
variables in the therapeutic management reduces 30-day mortality in
patients admitted to the intensive care unit (ICU) with shock.
<br/>Method(s): This randomized, prospective clinical multicenter
trial-recruited patients with an arterial lactate value above two mmol/L,
requiring vasopressors despite adequate fluid resuscitation, regardless of
the cause of shock. All patients received sequential sublingual
measurements using a sidestream-dark field (SDF) video microscope at
admission to the intensive care unit (+/- 4 h) and 24 (+/- 4) hours later
that was performed blindly to the treatment team. Patients were randomized
to usual routine or to integrating sublingual microcirculatory perfusion
variables in the therapy plan. The primary endpoint was 30-day mortality,
secondary endpoints were length of stay on the ICU and the hospital, and
6-months mortality. <br/>Result(s): Overall, we included 141 patients with
cardiogenic (n = 77), post cardiac surgery (n = 27), or septic shock (n =
22). 69 patients were randomized to the intervention and 72 to routine
care. No serious adverse events (SAEs) occurred. In the interventional
group, significantly more patients received an adjustment (increase or
decrease) in vasoactive drugs or fluids (66.7% vs. 41.8%, p = 0.009)
within the next hour. Microcirculatory values 24 h after admission and
30-day mortality did not differ [crude: 32 (47.1%) patients versus 25
(34.7%), relative risk (RR) 1.39 (0.91-1.97); Cox-regression: hazard ratio
(HR) 1.54 (95% confidence interval (CI) 0.90-2.66, p = 0.118)].
<br/>Conclusion(s): Integrating sublingual microcirculatory perfusion
variables in the therapy plan resulted in treatment changes that do not
improve survival at all. Graphical Abstract: [Figure not available: see
fulltext.]<br/>Copyright &#xa9; 2023, The Author(s).

<78>
Accession Number
2024817411
Title
Impact of Preprocedural Computed Tomography on Left Atrial Appendage
Closure Success: A Swiss-Apero Trial Subanalysis.
Source
JACC: Cardiovascular Interventions. 16(11) (pp 1332-1343), 2023. Date of
Publication: 12 Jun 2023.
Author
Galea R.; Aminian A.; Meneveau N.; De Marco F.; Heg D.; Anselme F.; Grani
C.; Huber A.T.; Teiger E.; Iriart X.; Franzone A.; Vranckx P.; Fischer U.;
Pedrazzini G.; Bedogni F.; Valgimigli M.; Raber L.
Institution
(Galea, Grani, Valgimigli, Raber) Department of Cardiology, Bern
University Hospital, University of Bern, Bern, Switzerland
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Meneveau) Besancon University Hospital, University of Burgundy
Franche-Comte, Besancon, France
(De Marco, Bedogni) Department of Cardiology, Istituti di Ricovero e Cura
a Carattere Scientifico Policlinico San Donato, San Donato Milanese,
Milan, Italy
(Heg) Department of Clinical Research, Clinical Trials Unit Bern,
University of Bern, Bern, Switzerland
(Anselme) Department of Cardiology, University Hospital of Rouen, Rouen,
France
(Huber) Department of Diagnostic, Interventional and Pediatric Radiology,
Bern University Hospital, University of Bern, Bern, Switzerland
(Teiger) Department of Cardiology, Henri-Mondor Hospital, Public
Assistance Hospitals of Paris, Creteil, France
(Iriart) Department of Pediatric and Adult Congenital Cardiology, Hopital
Cardiologique du Haut- Leveque, Centre Hospitalier Universitaire de
Bordeaux, Bordeaux-Pessac, France
(Franzone) Department of Advanced Biomedical Sciences, University Federico
II University, Naples, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Fischer) Department of Neurology, Bern University Hospital, University of
Bern, Bern, Switzerland
(Fischer) Department of Neurology, University Hospital Basel, University
of Basel, Switzerland
(Pedrazzini, Valgimigli) Cardiocentro Ticino Institute and Universita
della Svizzera Italiana, Lugano, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: The benefit related to the use of preprocedural computed
tomography angiography (CCTA) on top of periprocedural echocardiography to
plan percutaneous left atrial appendage closure (LAAC) procedures is still
unclear. <br/>Objective(s): The authors sought to evaluate the impact of
preprocedural CCTA on LAAC procedural success. <br/>Method(s): In the
investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and
Watchman Device in Patients Undergoing Left Atrial Appendage Closure)
trial, patients undergoing echocardiography-guided LAAC were randomly
assigned to receive the Amulet (Abbott) or Watchman 2.5/FLX (Boston
Scientific) device across 8 European centers. According to the study
protocol ongoing at the time of the procedure, the first operators had
(CCTA unblinded group) or did not have (CCTA blinded group) access to
preprocedural CCTA images. In this post hoc analysis, we compared blinded
vs unblinded procedures in terms of procedural success defined as complete
left atrial appendage occlusion as evaluated at the end of LAAC
(short-term) or at the 45-day follow-up (long-term) without
procedural-related complications. <br/>Result(s): Among 219 LAACs preceded
by CCTA, 92 (42.1%) and 127 (57.9%) were assigned to the CCTA unblinded
and blinded group, respectively. After adjusting for confounders, operator
unblinding to preprocedural CCTA remained associated with a higher rate of
short-term procedural success (93.5% vs 81.1%; P = 0.009; adjusted OR:
2.76; 95% CI: 1.05-7.29; P = 0.040) and long-term procedural success
(83.7% vs 72.4%; P = 0.050; adjusted OR: 2.12; 95% CI: 1.03-4.35; P =
0.041). <br/>Conclusion(s): In a prospective multicenter cohort of
clinically indicated echocardiography-guided LAACs, unblinding of the
first operators to preprocedural CCTA images was independently associated
with a higher rate of both short- and long-term procedural success.
Further studies are needed to better evaluate the impact of preprocedural
CCTA on clinical outcomes.<br/>Copyright &#xa9; 2023 American College of
Cardiology Foundation

<79>
Accession Number
2024678139
Title
Caffeine, Postoperative Delirium and Change in Outcomes after Surgery
(CAPACHINOS)-2: Protocol for a randomised controlled trial.
Source
BMJ Open. 13(5) (no pagination), 2023. Article Number: e073945. Date of
Publication: 15 May 2023.
Author
Vlisides P.E.; Ragheb J.; McKinney A.; Mentz G.; Runstadler N.; Martinez
S.; Jewell E.; Lee U.; Vanini G.; Schmitt E.M.; Inouye S.K.; Mashour G.A.
Institution
(Vlisides, Ragheb, McKinney, Mentz, Runstadler, Martinez, Jewell, Lee,
Vanini, Mashour) Anesthesiology, Michigan Medicine, Ann Arbor, MI, United
States
(Vlisides, Lee, Vanini, Mashour) Center for Consciousness Science,
University of Michigan, Ann Arbor, MI, United States
(Schmitt, Inouye) Hebrew SeniorLife Institute for Aging Research, Harvard
Medical School, Boston, MA, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Delirium is a major public health issue for surgical patients
and their families because it is associated with increased mortality,
cognitive and functional decline, prolonged hospital admission and
increased healthcare expenditures. Based on preliminary data, this trial
tests the hypothesis that intravenous caffeine, given postoperatively,
will reduce the incidence of delirium in older adults after major
non-cardiac surgery. Methods and analysis The CAffeine, Postoperative
Delirium And CHange In Outcomes after Surgery-2 (CAPACHINOS-2) Trial is a
single-centre, placebo-controlled, randomised clinical trial that will be
conducted at Michigan Medicine. The trial will be quadruple-blinded, with
clinicians, researchers, participants and analysts all masked to the
intervention. The goal is to enrol 250 patients with a 1:1:1: allocation
ratio: dextrose 5% in water placebo, caffeine 1.5 mg/kg and caffeine 3
mg/kg as a caffeine citrate infusion. The study drug will be administered
intravenously during surgical closure and on the first two postoperative
mornings. The primary outcome will be delirium, assessed via long-form
Confusion Assessment Method. Secondary outcomes will include delirium
severity, delirium duration, patient-reported outcomes and opioid
consumption patterns. A substudy analysis will also be conducted with
high-density electroencephalography (72-channel system) to identify neural
abnormalities associated with delirium and Mild Cognitive Impairment at
preoperative baseline. Ethics and dissemination This study was approved by
the University of Michigan Medical School Institutional Review Board
(HUM00218290). An independent data and safety monitoring board has also
been empanelled and has approved the clinical trial protocol and related
documents. Trial methodology and results will be disseminated via clinical
and scientific journals along with social and news media. Trial
registration number NCT05574400.<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.

<80>
Accession Number
2022281334
Title
A systematic review and meta-analysis of the clinical impact of stopping
renin-angiotensin system inhibitor in patients with chronic kidney
disease.
Source
Hypertension Research. 46(6) (pp 1525-1535), 2023. Date of Publication:
June 2023.
Author
Nakayama T.; Mitsuno R.; Azegami T.; Sato Y.; Hayashi K.; Itoh H.
Institution
(Nakayama, Mitsuno, Azegami, Hayashi, Itoh) Division of Endocrinology,
Metabolism and Nephrology, Department of Internal Medicine, Keio
University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
160-8582, Japan
(Azegami) Keio University Health Center, 4-1-1 Hiyoshi, Kohoku-ku,
Yokohama-shi, Kanagawa 223-8521, Japan
(Sato) Department of Preventive Medicine and Public Health, Keio
University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
160-8582, Japan
Publisher
Springer Nature
Abstract
Although renin-angiotensin system (RAS) inhibitors reduce the risk of
cardiovascular diseases and end-stage kidney disease (ESKD) in chronic
kidney disease (CKD) patients, they are often discontinued in clinical
practice due to drug-related adverse events. However, limited evidence is
available about the clinical impact of RAS inhibitor discontinuation in
CKD patients. A comprehensive search of publications investigating the
effect of discontinuing RAS inhibitors on clinical outcomes in CKD
patients in PubMed, the Cochrane Library, and Web of Science was conducted
(inception to November 7, 2022), and potentially relevant studies were
searched by hand (through November 30, 2022). Two reviewers independently
extracted data according to the PRISMA and MOOSE guidelines and assessed
the quality of each study with risk-of-bias tools, RoB2 and ROBINS-I. The
pooled hazard ratio (HR) for each outcome was integrated with a
random-effect model. A total of 1 randomized clinical trial and 6
observational studies involving 248,963 patients were included in the
systematic review. The meta-analysis of observational studies showed that
discontinuation of RAS inhibitors was associated with a higher risk of
all-cause mortality (HR, 1.41 [95% CI, 1.23-1.62]; I² = 97%),
ESKD (1.32 [95% CI, 1.10-1.57]; I² = 94%) and MACE (1.20 [95%
CI 1.15-1.25]; I² = 38%), but not with hyperkalemia (0.79 [95%
CI 0.55-1.15]; I² = 90%). Overall risk of bias was
moderate-to-serious, and quality of evidence (GRADE system) was
low-to-very low. The present study suggests that CKD patients would
benefit from continuing RAS inhibitors. [Figure not available: see
fulltext.]<br/>Copyright &#xa9; 2023, The Author(s), under exclusive
licence to The Japanese Society of Hypertension.

<81>
Accession Number
2024277327
Title
Socioeconomic deprivation and prognostic outcomes in acute coronary
syndrome: A meta-analysis using multidimensional socioeconomic status
indices.
Source
International Journal of Cardiology. 383 (pp 140-150), 2023. Date of
Publication: 15 Jul 2023.
Author
Anand V.V.; Zhe E.L.C.; Chin Y.H.; Goh R.S.J.; Lin C.; Kueh M.T.W.; Chong
B.; Kong G.; Tay P.W.L.; Dalakoti M.; Muthiah M.; Dimitriadis G.K.; Wang
J.-W.; Mehta A.; Foo R.; Tse G.; Figtree G.A.; Loh P.H.; Chan M.Y.; Mamas
M.A.; Chew N.W.S.
Institution
(Anand, Zhe, Chin) Lee Kong Chian School of Medicine, Nanyang
Technological University, Singapore
(Chin, Goh, Lin, Chong, Kong, Tay, Dalakoti, Muthiah, Wang, Foo, Loh,
Chan) Yong Loo Lin School of Medicine, National University Singapore,
Singapore
(Kueh) Royal College of Surgeons in Ireland and University College Dublin
Malaysia Campus, Malaysia
(Dalakoti, Foo, Loh, Chan, Chew) Department of Cardiology, National
University Heart Centre, National University Health System, Singapore
(Muthiah) Division of Gastroenterology and Hepatology, Department of
Medicine, National University Hospital, Singapore
(Muthiah) National University Centre for Organ Transplantation, National
University Health System, Singapore
(Dimitriadis) Faculty of Life Sciences and Medicine, School of Life Course
Sciences, King's College London, London, United Kingdom
(Dimitriadis) Department of Endocrinology ASO/EASO COM, King's College
Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
(Wang) Department of Surgery, Cardiovascular Research Institute (CVRI),
National University of Singapore, Singapore
(Wang) Nanomedicine Translational Research Programme, Centre for
NanoMedicine, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Mehta) Division of Cardiology, Department of Internal Medicine, Virginia
Commonwealth University Pauley Heart Centre, Richmond, VA, United States
(Tse) Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular
Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second
Hospital of Tianjin Medical University, Tianjin 300211, China
(Tse) Kent and Medway Medical School, Kent, Canterbury CT2 7NT, United
Kingdom
(Tse) School of Nursing and Health Studies, Hong Kong Metropolitan
University, Hong Kong
(Figtree) Northern Clinical School, Kolling Institute of Medical Research,
University of Sydney, Sydney, NSW, Australia
(Figtree) Department of Cardiology, Royal North Shore Hospital, Sydney,
NSW, Australia
(Mamas) Keele Cardiovascular Research Group, School of Medicine, Keele
University, Stoke-on-Trent, United Kingdom
(Mamas) Institute of Population Health, University of Manchester, United
Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Low socioeconomic status (SES) is an important prognosticator
amongst patients with acute coronary syndrome (ACS). This paper analysed
the effects of SES on ACS outcomes. <br/>Method(s): Medline and Embase
were searched for articles reporting outcomes of ACS patients stratified
by SES using a multidimensional index, comprising at least 2 of the
following components: Income, Education and Employment. A comparative
meta-analysis was conducted using random-effects models to estimate the
risk ratio of all-cause mortality in low SES vs high SES populations,
stratified according to geographical region, study year, follow-up
duration and SES index. <br/>Result(s): A total of 29 studies comprising
of 301,340 individuals were included, of whom 43.7% were classified as low
SES. While patients of both SES groups had similar cardiovascular risk
profiles, ACS patients of low SES had significantly higher risk of
all-cause mortality (adjusted HR:1.19, 95%CI: 1.10-1.1.29, p < 0.001)
compared to patients of high SES, with higher 1-year mortality (RR:1.08,
95%CI:1.03-1.13, p = 0.0057) but not 30-day mortality (RR:1.07,
95%CI:0.98-1.16, p = 0.1003). Despite having similar rates of ST-elevation
myocardial infarction and non-ST-elevation ACS, individuals with low SES
had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91-0.99, p
= 0.0115) and had higher cerebrovascular accident risk (RR:1.25,
95%CI:1.01-1.55, p = 0.0469). Excess mortality risk was independent of
region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p
= 0.0604) but was dependent on the SES index used (p < 0.0001).
<br/>Conclusion(s): Low SES is associated with increased mortality
post-ACS, with suboptimal coronary revascularisation rates compared to
those of high SES. Concerted efforts are needed to address the global
ACS-related socioeconomic inequity. Registration and protocol: The current
study was registered with PROSPERO, ID: CRD42022347987.<br/>Copyright
&#xa9; 2023 Elsevier B.V.

<82>
Accession Number
2023632221
Title
Head cooling wrap could suppress the elevation of core temperature after
cardiac surgery during forced-air warming in a pediatric intensive care
unit: a randomized clinical trial.
Source
Journal of Anesthesia. (no pagination), 2023. Date of Publication: 2023.
Author
Sakai W.; Chaki T.; Nawa Y.; Oyasu T.; Ichisaka Y.; Nawa T.; Asai H.;
Ebuoka N.; Oba J.; Yamakage M.
Institution
(Sakai, Chaki, Nawa, Oyasu, Ichisaka, Nawa, Asai, Ebuoka, Oba) Pediatric
Intensive Care Unit, Hokkaido Medical Center for Child Health and
Rehabilitation, Hokkaido, Sapporo 006-0041, Japan
(Sakai, Chaki, Nawa, Yamakage) Department of Anesthesiology, Sapporo
Medical University School of Medicine, East 17, South 1, Chuo-Ku,
Hokkaido, Sapporo 060-8556, Japan
(Ichisaka, Asai, Ebuoka, Oba) Department of Cardiovascular Surgery,
Hokkaido Medical Center for Child Health and Rehabilitation, Hokkaido,
Sapporo 006-0041, Japan
Publisher
Springer
Abstract
Purpose: The main aim of the current trial was to explore our hypothesis
that cooling head wraps lower the core temperature more effectively than
ice packs on the head during forced-air warming after pediatric cardiac
surgeries. <br/>Method(s): This study was a single-center Randomized
Controlled Trial. Participants were children with a weight <= 10 kg and
hyperthermia during forced-air warming after cardiac surgeries. When the
core temperature reached 37.5 degreeC, ice packs on the head (group C) or
a cooling head wrap (group H) were used as cooling devices to decrease the
core temperature. The primary outcome was the core temperature. The
secondary outcomes were the foot surface temperature and heart rate. We
measured all outcomes every 30 min for 240 min after the patient developed
hyperthermia. We conducted two-way ANOVA as a pre-planned analysis and
also the Bonferroni test as a post hoc analysis. <br/>Result(s): Twenty
patients were randomly assigned to groups C and H. The series of core
temperatures in group H were significantly lower than those in group C (p
< 0.0001), and post hoc analysis showed that there was no significant
difference in core temperatures at T0 between the two groups and
statistically significant differences in all core temperatures at T30-240
between the two groups. There was no difference between the two groups'
surface temperatures and heart rates. <br/>Conclusion(s): Compared to ice
packs on the head, head cooling wraps more effectively suppress core
temperature elevation during forced-air warming after pediatric cardiac
surgery.<br/>Copyright &#xa9; 2023, The Author(s) under exclusive licence
to Japanese Society of Anesthesiologists.

<83>
Accession Number
641477286
Title
Off-pump injectable versus on-pump conventional tissue valves for
pulmonary valve replacement: the injectable valve implantation randomised
trial (INVITE).
Source
BMJ open. 13(6) (pp e065192), 2023. Date of Publication: 01 Jun 2023.
Author
Heys R.; Walker-Smith T.; Evans R.; Caputo M.; Culliford L.; Reeves B.;
Rogers C.; Turner M.; Hamilton M.; Sheehan K.; Viola N.; Stoica S.; Wright
K.; Angelini G.; Parry A.
Institution
(Heys, Walker-Smith, Evans, Culliford, Reeves, Rogers) Bristol Trials
Centre, Bristol Medical School, University of Bristol, Bristol, United
Kingdom
(Caputo, Turner, Hamilton, Stoica, Wright, Angelini, Parry) Bristol Heart
Institute, University of Bristol, Bristol, United Kingdom
(Sheehan) Bristol Royal Hospital for Children, University Hospitals
Bristol and Weston Foundation NHS Trust, Bristol, United Kingdom
(Viola) University Hospital Southampton NHS Foundation Trust, Southampton
General Hospital, Southampton, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To assess the effectiveness of injectable tissue pulmonary
valve compared with standard pulmonary valve in patients requiring
pulmonary valve replacement surgery. DESIGN: A multicentre, single-blind,
parallel two-group randomised controlled trial. Participants were blind to
their allocation. Follow-up continued for 6 months. Randomised allocations
were generated by a computer using block randomisation, stratified by
centre. SETTING: Two National Health Service secondary care centres in the
UK. PARTICIPANTS: People aged 12-80 years requiring pulmonary valve
replacement. INTERVENTIONS: Participants were randomly allocated (1:1
ratio) to injectable pulmonary valve replacement (IPVR) without
cardiopulmonary bypass (CPB) or standard pulmonary valve replacement
(SPVR) with CPB. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary
outcome was chest drainage volume over the first 24 hours after surgery.
Secondary outcomes included in-hospital clinical outcomes; valve and heart
function 6 months postsurgery and health-related quality of life 6 weeks
and 6 months postsurgery. <br/>RESULT(S): Nineteen participants agreed to
take part. Eleven were allocated to IPVR and eight to SPVR. The trial was
stopped before the target sample size of 60 participants was reached due
to challenges in recruitment. The primary analysis includes all randomised
participants; there were no withdrawals. Chest drain volume 24 hours after
surgery was on average 277.6mL lower with IPVR (IPVR mean 340.0mL; SPVR
mean 633.8mL; mean difference, -277.6; 95% CI, -484.0 to -71.2; p=0.005).
There were no statistically significant differences in time to readiness
for extubation (p=0.476), time to fitness for discharge (p=0.577) and time
to first discharge from the intensive care unit (p=0.209). Six
participants with IPVR required CPB. Safety profiles and quality of life
scores were similar. <br/>CONCLUSION(S): IPVR reduced chest drain volume
despite >50% of participants requiring CPB. There was no evidence of any
other benefit of IPVR. TRIAL REGISTRATION NUMBER:
ISRCTN23538073.<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.

<84>
[Use Link to view the full text]
Accession Number
631740702
Title
Venoarterial Extracorporeal Membrane Oxygenation with Concomitant Impella
Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic
Shock.
Source
ASAIO Journal. 66(5) (pp 497-503), 2020. Date of Publication: 01 May 2020.
Author
O'Horo J.C.; Antharam P.; Ananthaneni S.; Vallabhajosyula S.; Stulak J.M.;
Dunlay S.M.; Holmes D.R.; Barsness G.W.
Institution
(Vallabhajosyula, Ananthaneni, Vallabhajosyula, Dunlay, Holmes, Barsness)
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United
States
(Vallabhajosyula, O'Horo, Antharam) Division of Pulmonary and Critical
Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United
States
(O'Horo) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic, Rochester, MN, United States
(Stulak) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Dunlay) Department of Health Science Research, Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
Publisher
Lippincott Williams and Wilkins
Abstract
There are contrasting data on concomitant Impella device in cardiogenic
shock patients treated with venoarterial extracorporeal membrane
oxygenation (VA ECMO) (ECPELLA). This study sought to compare early
mortality in patients with cardiogenic shock treated with ECPELLA in
comparison to VA ECMO alone. We reviewed the published literature from
2000 to 2018 for randomized, cohort, case-control, and case series studies
evaluating adult patients requiring VA ECMO for cardiogenic shock. Five
retrospective observational studies, representing 425 patients, were
included. Venoarterial extracorporeal membrane oxygenation with
concomitant Impella strategy was used in 27% of the patients. Median age
across studies varied between 51 and 63 years with 59-88% patients being
male. Use of ECPELLA was associated with higher weaning from VA ECMO and
bridging to permanent ventricular assist device or cardiac transplant in
three and four studies, respectively. The studies showed moderate
heterogeneity with possible publication bias. The two studies that
accounted for differences in baseline characteristics between treatment
groups reported lower 30 day mortality with ECPELLA versus VA ECMO. The
remaining three studies did not adjust for potential confounding and were
at high risk for selection bias. In conclusion, ECPELLA is being
increasingly used as a strategy in patients with cardiogenic shock.
Additional large, high-quality studies are needed to evaluate clinical
outcomes with ECPELLA.<br/>Copyright &#xa9; 2020 Lippincott Williams and
Wilkins. All rights reserved.

<85>
[Use Link to view the full text]
Accession Number
631571348
Title
Impact of Induction Immunosuppression on Post-Transplant Outcomes of
Patients Bridged with Contemporary Left Ventricular Assist Devices.
Source
ASAIO Journal. 66(3) (pp 261-267), 2020. Date of Publication: 01 Mar 2020.
Author
Truby L.K.; Batra J.; Jennings D.L.; Takeda K.; DeFilippis E.M.; Takayama
H.; Naka Y.; Farr M.A.; Topkara V.K.
Institution
(Truby) Division of Cardiology, Department of Medicine, Duke University
Medical Center, Durham, NC, United States
(Batra, Jennings, DeFilippis, Farr, Topkara) Division of Cardiology,
Department of Medicine, Columbia University College of Physicians and
Surgeons, New York, NY, United States
(Takeda, Takayama, Naka) Division of Cardiothoracic Surgery, Department of
Surgery, Columbia University College of Physicians and Surgeons, New York,
NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
For patients bridged to transplant (BTT) with left ventricular assist
devices (LVAD), data regarding the use of induction immunosuppressive
therapy remain limited. The objectives of the current study were to
describe the current trends and clinical consequences of IT in patients
BTT with LVAD. The United Network of Organ Sharing database was queried to
identify adult, single-organ heart transplant recipients who were BTT with
LVAD between 2008 and 2018. Propensity score matching was then used to
balance clinical covariates between those patient who did and did not
receive IT. The primary outcomes of interest were graft survival,
hospitalization for rejection and infection, and freedom from transplant
coronary artery disease (TCAD). In the overall cohort, 49.1% (n = 3,978)
received IT, with basiliximab being the most commonly used agent followed
by antithymocyte globulin. After propensity score matching, 4,388 patients
(2,194 without induction and 2,194 with induction) were identified.
Between those who did and did not receive IT, there was no significant
difference in graft survival, freedom from hospitalization for rejection,
and freedom from hospitalization for infection. Patients who received IT
experienced increased freedom from TCAD (p = 0.004) with unadjusted hazard
ratio of 0.81 (95% Cardiac Index: 0.70-0.93). For freedom from TCAD,
antithymocyte globulin was associated with better outcomes than
basiliximab (80.2% vs. 73.1% at 5 years, log rank p value = 0.004). In a
sensitivity analysis, there was no significant increase in hospitalization
for infection in those patients with an infected LVAD before transplant.
Use of induction therapy in patients BTT with LVAD appears to be safe and
feasible, without a significant increase in the risk of infection or
rejection, even in those patients with pretransplant device-related
infections. IT, particularly antithymocyte globulin, was associated with
increased time to development of TCAD. Routine use of IT in patients BTT
with LVAD may be considered, and further randomized control trials are
warranted to further support these data.<br/>Copyright &#xa9; 2020
Lippincott Williams and Wilkins. All rights reserved.

<86>
Accession Number
2023534149
Title
Thoracic epidural analgesia prolongs postoperative QT interval on
electrocardiogram in major non-cardiac surgery: a randomized comparison
and a prospective cohort analysis.
Source
Frontiers in Pharmacology. 14 (no pagination), 2023. Article Number:
936242. Date of Publication: 2023.
Author
Hori K.; Tsujikawa S.; Egami M.; Waki S.; Watanabe R.; Hino H.; Matsuura
T.; Mori T.
Institution
(Hori, Tsujikawa, Watanabe, Hino, Matsuura, Mori) Department of
Anesthesiology, Osaka Metropolitan University Graduate School of Medicine,
Osaka, Japan
(Egami) Central Laboratory, Osaka Metropolitan University Graduate School
of Medicine, Osaka, Japan
(Waki) Department of Anesthesiology, Osaka Rosai Hospital, Osaka, Japan
Publisher
Frontiers Media S.A.
Abstract
Introduction: Prolongation of QT interval on electrocardiogram can be
associated with perioperative lethal arrhythmia. Epidural analgesia is a
commonly used modality to relieve surgical pain by blocking sensory
nerves, which also blocks the autonomic nervous system and can affect QT
interval. Since patient monitoring becomes much less frequent after
surgery than intraoperative period, we investigated the effects of
epidural analgesia on postoperative QT interval with a randomized clinical
trial and a prospective cohort study. <br/>Method(s): In a randomized
study, we assigned 60 patients undergoing thoracic epidural analgesia to
an epidural analgesia or no-epidural analgesia group, in which 3 ml/h of
0.25% epidural levobupivacaine (7.5 mg/h) was administered only in the
epidural analgesia group during surgery. The primary outcome was the
postoperative heart rate-corrected QT interval. In a prospective cohort
study, patients were assigned to receive 5 ml/h epidural levobupivacaine
(12.5 mg/h). The plasma concentration of levobupivacaine was measured
using liquid chromatography-mass spectrometry. <br/>Result(s): The median
postoperative corrected QT interval interval with 3 ml/h epidural
levobupivacaine was significantly longer than that without epidural
analgesia. Using multiple regression analysis for the factors known to
affect postoperative corrected QT interval interval, epidural analgesia
was found to be an independent variable for prolongation, and the mean
difference of the corrected QT interval interval with or without epidural
analgesia was 23 ms after adjustment. The median plasma concentration of
levobupivacaine at the end of surgery was 164 ng/ml with 3 ml/h epidural
levobupivacaine, and the correlation coefficient to the postoperative
corrected QT interval interval was 0.14, showing a not significant
correlation. A prospective cohort study showed that 5 ml/h epidural
levobupivacaine significantly prolonged postoperative corrected QT
interval interval compared to preoperative baseline. The median plasma
concentration of levobupivacaine was 166 ng/ml with 5 ml/h, the
correlation coefficient of which showed no significant correlation.
<br/>Conclusion(s): Thoracic epidural analgesia could enhance
postoperative corrected QT interval prolongation after general anesthesia.
The mechanism is possibly caused by blocking neighboring or part of the
cardiac sympathetic nerves, rather than by systemic effects of epidurally
administered levobupivacaine. Clinical trial number: UMIN000013347 for the
randomized study and UMIN000041518 for the prospective cohort study, which
were registered at University hospital Medical Information Network
Center.<br/>Copyright &#xa9; 2023 Hori, Tsujikawa, Egami, Waki, Watanabe,
Hino, Matsuura and Mori.

<87>
[Use Link to view the full text]
Accession Number
2024807370
Title
Long-term and Temporal Outcomes of Transcatheter Versus Surgical
Aortic-valve Replacement in Severe Aortic Stenosis: A Meta-analysis.
Source
Annals of Surgery. 273(3) (pp 459-466), 2021. Date of Publication: 01 Mar
2021.
Author
Zhang X.-L.; Zhang X.-W.; Lan R.-F.; Chen Z.; Wang L.; Xu W.; Xu B.
Institution
(Zhang, Lan, Chen, Wang, Xu, Xu) Department of Cardiology, Affiliated Drum
Tower Hospital, Nanjing University School of Medicine, Nanjing, China
(Zhang) Department of Endocrinology, Affiliated Drum Tower Hospital,
Nanjing University School of Medicine, Nanjing, China
Publisher
Wolters Kluwer Health
Abstract
Objective:To determine the 5-year and temporal performance of TAVR versus
SAVR. <br/>Background(s):TAVR has become a valuable treatment for severe
aortic stenosis but the long-term safety and efficacy remain unclear.
<br/>Method(s):Databases were searched until October 6, 2019 for
randomized trials with >=5 years' follow-up. Primary outcome was all-cause
mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were
pooled with random-effects models. <br/>Result(s):We included 4 trials
with 3,758 patients. TAVR was associated with a significantly higher
5-year all-cause mortality than SAVR (OR, 1.19; 95% CI, 1.03-1.37; P =
0.02). Landmark analysis showed no significant difference within 2 years
(OR, 0.92; 95% CI, 0.79-1.08; P = 0.33) but a statistically higher
mortality in TAVR between 2 and 5 years (OR, 1.32; 95% CI, 1.14-1.52; P =
0.0002), with significant difference between these 2 temporal phases (P
for interaction = 0.001). Similar interaction was found for cardiovascular
mortality and several other outcomes. Rates of all-cause mortality or
disabling stroke, permanent pacemaker implantation, aortic-valve
rehospitalization, and reintervention were higher, but rates of major
bleeding and new-onset fibrillation were lower in TAVR at 5 years. The
incidences of myocardial infarction, stroke, and transient ischemic attack
were not statistically different between TAVR and SAVR.
<br/>Conclusion(s):TAVR was associated with a significantly higher
all-cause mortality at 5 years compared with SAVR. Of note, all-cause
mortality presented a characteristic temporal pattern showing increased
risk between 2 and 5 years but not within 2 years. Longer-term follow-up
data are warranted. <br/>Copyright &#xa9; 2020 Wolters Kluwer Health, Inc.
All rights reserved.

<88>
[Use Link to view the full text]
Accession Number
2024923176
Title
Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft
Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular
CABG): A Randomized, Double-Blind, Placebo-Controlled Trial.
Source
Circulation. 142(19) (pp 1799-1807), 2020. Date of Publication: 10 Nov
2020.
Author
Willemsen L.M.; Janssen P.W.A.; Peper J.; Soliman-Hamad M.A.; Van Straten
A.H.M.; Klein P.; Hackeng C.M.; Sonker U.; Bekker M.W.A.; Von Birgelen C.;
Brouwer M.A.; Van Der Harst P.; Vlot E.A.; Deneer V.H.M.; Chan Pin Yin
D.R.P.P.; Gimbel M.E.; Beukema K.F.; Daeter E.J.; Kelder J.C.; Tijssen
J.G.P.; Rensing B.J.W.M.; Van Es H.W.; Swaans M.J.; Ten Berg J.M.
Institution
(Willemsen, Janssen, Peper, Chan Pin Yin, Gimbel, Beukema, Kelder,
Rensing, Swaans, Ten Berg) Department of Cardiology, St Antonius Hospital,
Nieuwegein, Netherlands
(Klein, Sonker, Daeter) Department of Cardiothoracic Surgery, St Antonius
Hospital, Nieuwegein, Netherlands
(Hackeng) Department of Clinical Chemistry, St Antonius Hospital,
Nieuwegein, Netherlands
(Van Es) Department of Radiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Vlot) Department of Anesthesiology, Intensive Care and Pain Medicine, St
Antonius Hospital, Nieuwegein, Netherlands
(Peper) Department of Radiology, University Medical Center Utrecht,
Netherlands
(Van Der Harst) Department of Cardiology, University Medical Center
Utrecht, Netherlands
(Deneer) Department of Clinical Pharmacy, Division of Laboratories,
Pharmacy, and Biomedical Genetics, University Medical Center Utrecht,
Netherlands
(Soliman-Hamad, Van Straten) Department of Cardiothoracic Surgery,
Catharina Hospital, Eindhoven, Netherlands
(Bekker) Department of Cardiothoracic Surgery, Erasmus Mc, Rotterdam,
Netherlands
(Von Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, Netherlands
(Von Birgelen) Health Technology and Services Research, University of
Twente, Enschede, Netherlands
(Brouwer) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Van Der Harst) Department of Cardiology, University Medical Center
Groningen, Netherlands
(Deneer) Division of Pharmacoepidemiology and Clinical Pharmacology,
Utrecht Institute of Pharmaceutical Sciences, Utrecht University,
Netherlands
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
Netherlands
(Tijssen) Cardialysis B.V. Rotterdam, Netherlands
(Ten Berg) Cardiovascular Research Institute Maastricht, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Approximately 15% of saphenous vein grafts (SVGs) occlude
during the first year after coronary artery bypass graft surgery (CABG)
despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on
Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass
Grafting Surgery) investigated whether ticagrelor added to standard
aspirin improves SVG patency at 1 year after CABG. <br/>METHOD(S): In this
investigator-initiated, randomized, double-blind, placebo-controlled,
multicenter trial, patients with >=1 SVGs were randomly assigned (1:1)
after CABG to ticagrelor or placebo added to standard aspirin (80 or 100
mg). The primary outcome was SVG occlusion at 1 year, assessed with
coronary computed tomography angiography, in all patients who had primary
outcome imaging available. A generalized estimating equation model was
used to perform the primary analysis per SVG. The secondary outcome was
1-year SVG failure, which was a composite of SVG occlusion, SVG
revascularization, myocardial infarction in myocardial territory supplied
by a SVG, or sudden death. <br/>RESULT(S): Among 499 randomized patients,
the mean age was 67.9+/-8.3 years, 87.1% were male, the indication for
CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used
cardiopulmonary bypass. Primary outcome imaging was available in 219
patients in the ticagrelor group and 224 patients in the placebo group.
The SVG occlusion rate in the ticagrelor group was 9.6% (44 of 457 SVGs)
versus 10.1% in the placebo group (50 of 497 SVGs; odds ratio, 0.87 [95%
CI, 0.49-1.55]; P=0.64). SVG failure occurred in 32 patients (12.9%) in
the ticagrelor group versus 32 patients (13.0%) in the placebo group
(hazard ratio, 1.04 [95% CI, 0.63-1.69]). <br/>CONCLUSION(S): In this
randomized, placebo-controlled trial, the addition of ticagrelor to
standard aspirin did not reduce SVG occlusion at 1 year after CABG.
<br/>Copyright &#xa9; 2020 American Heart Association, Inc.

<89>
Accession Number
641493645
Title
Exploring the Documentation of Delirium in Patients After Cardiac Surgery:
A Retrospective Patient Record Study.
Source
Computers, informatics, nursing : CIN. (no pagination), 2023. Date of
Publication: 05 Jun 2023.
Author
Poikajarvi S.; Peltonen L.-M.; Siirala E.; Heimonen J.; Moen H.; Salantera
S.; Junttila K.
Institution
(Poikajarvi) Author Affiliations: Faculty of Medicine, Department of
Nursing Science, University of Turku (Prof Poikajarvi, Dr Peltonen, Prof
Salantera, and Dr Junttila); Department of Perioperative and Intensive
Care, University of Helsinki and Helsinki University Hospital (Prof
Poikajarvi); Research Services, Turku University Hospital (Dr Siirala);
Faculty of Technology, Department of Computing, University of Turku (Dr
Heimonen); Department of Computer Science, School of Science, Aalto
University (Dr Moen); Turku University Hospital (Prof Salantera); Nursing
Research Center, Helsinki University Hospital and University of Helsinki
(Dr Junttila), Finland
Publisher
NLM (Medline)
Abstract
Delirium is a common disorder for patients after cardiac surgery. Its
manifestation and care can be examined through EHRs. The aim of this
retrospective, comparative, and descriptive patient record study was to
describe the documentation of delirium symptoms in the EHRs of patients
who have undergone cardiac surgery and to explore how the documentation
evolved between two periods (2005-2009 and 2015-2020). Randomly selected
care episodes were annotated with a template, including delirium symptoms,
treatment methods, and adverse events. The patients were then manually
classified into two groups: nondelirious (n = 257) and possibly delirious
(n = 172). The data were analyzed quantitatively and descriptively.
According to the data, the documentation of symptoms such as
disorientation, memory problems, motoric behavior, and disorganized
thinking improved between periods. Yet, the key symptoms of delirium,
inattention, and awareness were seldom documented. The professionals did
not systematically document the possibility of delirium. Particularly, the
way nurses recorded structural information did not facilitate an overall
understanding of a patient's condition with respect to delirium.
Information about delirium or proposed care was seldom documented in the
discharge summaries. Advanced machine learning techniques can augment
instruments that facilitate early detection, care planning, and
transferring information to follow-up care.<br/>Copyright &#xa9; 2023 The
Authors. Published by Wolters Kluwer Health, Inc.

<90>
Accession Number
641492095
Title
Discrepancies in Financial Conflicts of Interest in Robotic Cardiothoracic
Surgery Studies.
Source
The Annals of thoracic surgery. (no pagination), 2023. Date of
Publication: 02 Jun 2023.
Author
Karamchandani M.M.; Tian T.; Hall R.; Nickel I.; Aalberg J.; Lassaletta
A.D.; Chatterjee A.; Walters D.M.
Institution
(Karamchandani, Tian, Hall, Nickel) Department of Surgery, Tufts Medical
Center, Boston, MA, United States
(Aalberg) Tufts University School of Medicine, Boston, MA, United States
(Lassaletta, Walters) Division of Thoracic Surgery, Department of Surgery,
Tufts Medical Center, Boston, MA, United States
(Chatterjee) Division of Plastic and Reconstructive Surgery, Department of
Surgery, Tufts Medical Center, Boston, MA, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Amongst academic surgery publications, self-reporting of
conflicts of interest (COI) has often proven to be inaccurate. Here, we
review the accuracy of COI disclosures among studies related to the use of
robotic technology in cardiothoracic surgery and evaluate factors
associated with increased discrepancies. <br/>METHOD(S): A literature
search identified robotic surgery-related studies with at least one
American author published between January 2015 - December 2020 from three
major American cardiothoracic surgery journals (Journal of Thoracic and
Cardiovascular Surgery, Annals of Thoracic Surgery, and Annals of
Cardiothoracic Surgery). Industry payments from Intuitive SurgicalTM
(IntuitiveTM) were collected using the Centers for Medicare & Medicaid
Open Payments database. COI discrepancies were identified by comparing
author declaration statements with payments found for the year of
publication and year prior (24-month period). <br/>RESULT(S): A total of
144 studies (764 authors) were identified. One-hundred-twelve studies
(78%) had at least one author receive payments from IntuitiveTM.
Ninety-eight (68%) studies had at least one author receive an undeclared
payment from IntuitiveTM. Authors who accurately disclosed payments
received significantly higher median payments compared to authors who did
not ($16,511 [IQR: $6,389 - $159,035] vs $1,762 [IQR: $338 - $7,500],
p<0.0001). Last authors were significantly more likely to have a COI
discrepancy compared to middle and first authors (p = 0.018; p = 0.0015).
<br/>CONCLUSION(S): The majority of studies investigating the use of
robotic technology in cardiothoracic surgery did not accurately declare
COI with IntuitiveTM. This study highlights the need for improved accuracy
of reporting industry sponsorship by publishing authors.<br/>Copyright
&#xa9; 2023. Published by Elsevier Inc.

<91>
Accession Number
641491312
Title
Outcomes of coronary revascularization versus optimal medical therapy
alone for ischemic left ventricular dysfunction: A meta-analysis of
randomized controlled trials.
Source
Kardiologia polska. (no pagination), 2023. Date of Publication: 04 Jun
2023.
Author
Bujak K.; Hudzik B.; Pyka L.; Skrzypek M.; Brugaletta S.; Sabate M.;
Tajstra M.; Legutko J.; Wojakowski W.; Gasior M.
Institution
(Bujak, Hudzik, Pyka, Tajstra, Gasior) 3rd Department of Cardiology,
Faculty of Medical Sciences in Zabrze, Medical University of Silesia,
Katowice, Poland
(Bujak, Brugaletta, Sabate) Hospital Clinic, Cardiovascular Clinic
Institute, Institut d'Investigacions Biomediques August Pi i Sunyer
(IDIBAPS), University of Barcelona, Barcelona, Spain
(Skrzypek) Department of Biostatistics, Faculty of Health Sciences in
Bytom, Medical University of Silesia, Katowice, Poland
(Legutko) Clinical Department of Interventional Cardiology, John Paul II
Hospital, Krakow, Poland
(Legutko) Department of Interventional Cardiology, Institute of
Cardiology, Jagiellonian University Medical College, Krakow, Poland
(Wojakowski) Department of Cardiology and Structural Heart Diseases,
Medical University of Silesia, Katowice, Poland
Publisher
NLM (Medline)

<92>
Accession Number
641491261
Title
Serratus anterior and pectoralis plane blocks for robotically assisted
mitral valve repair: a randomised clinical trial. Comment on Br J Anaesth
2023; 130: 786-794.
Source
British journal of anaesthesia. (no pagination), 2023. Date of
Publication: 02 Jun 2023.
Author
Coppens S.; Hoogma D.; Rex S.; Wolmarans M.; Merjavy P.
Institution
(Coppens, Hoogma, Rex) University Hospitals of Leuven, Department of
Anesthesiology, Leuven, Belgium; University of Leuven, Biomedical Sciences
Group, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
(Wolmarans) Norwich Medical School, University of East Anglia, Norwich,
UK; Department of Anaesthesia, Norfolk & Norwich University Hospital,
Norwich, UK
(Merjavy) Department of Anaesthesia, Craigavon Area University Teaching
Hospital, Craigavon, Northern Ireland, UK; Norwich Medical School,
University of East Anglia, Norwich, UK
Publisher
NLM (Medline)

<93>
Accession Number
641491240
Title
Prognostic impact of precipitated cardiac decompensation in symptomatic
heart failure with reduced ejection fraction and severe secondary mitral
regurgitation.
Source
American heart journal. (no pagination), 2023. Date of Publication: 02
Jun 2023.
Author
Mewton N.; Donal E.; Picard F.; Derimay F.; Grinberg D.; Boulch D.M.;
Bochaton T.; Piriou N.; De Lorgeril A.; Samson G.; Rouleau F.; Riche B.;
Trochu J.N.
Institution
(Mewton, Derimay, Bochaton, De Lorgeril, Samson) Heart Failure Department,
Centre d'Investigation Clinique, Inserm 1407, Hopital Cardiologique Louis
Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine ,Universite Claude
Bernard Lyon 1, Bron, France
(Donal) Cardiology Department, Hospital University Rennes, INSERM,
Universite de Rennes-1, Rennes, France
(Picard) Heart Failure Department, Aquitaine Expert Center for Primary
Pulmonary Hypertension, University Hospital Bordeaux
(Grinberg) Cardiac Surgery Department, Hopital Cardiologique Louis Pradel,
Hospices Civils de Lyon, 28 avenue Doyen Lepine ,Universite Claude Bernard
Lyon 1, Bron, France
(Boulch, Riche) Universite de Lyon, F-69000, Lyon, France; Universite Lyon
1, F-69100, Villeurbanne, France; Hospices Civils de Lyon, Pole Sante
Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon,
France; CNRS, UMR 5558, Laboratoire de Biometrie et Biologie Evolutive,
Equipe Biostatistique-Sante, F-69100, Villeurbanne, France
(Piriou, Trochu) Clinique cardiologique et des maladies vasculaires Pole
hospitalo-universitaire institut du thorax et du systeme nerveux CIC
INSERM 1413 - Institut du Thorax- UMR INSERM 1087 Universite de Nantes
(Rouleau) Cardiology department, University Hospital Angers
Publisher
NLM (Medline)
Abstract
BACKGROUND: Our aim was to assess the distribution of primary (with no
trigger) and secondary (with a decompensation trigger) heart failure
events in a severe heart failure population and their association with
two-year all-cause mortality in the Mitra.Fr study. <br/>METHOD(S): We
included 304 patients with symptomatic heart failure, and severe mitral
regurgitation and guideline directed medical therapy randomized to medical
therapy alone or medical therapy with percutaneous mitral valve repair.
According to the follow-up, we defined three categories of events:
follow-up without any heart failure event, at least one decompensation
starting with a primary heart failure decompensation or starting with a
precipitated secondary heart failure event. The primary outcome was
2-years all-cause mortality. <br/>RESULT(S): 179 patients (59 %) had at
least one heart failure decompensation within 24-months of follow-up. 129
heart failure decompensations (72%) were a first primary heart failure and
50 (28%) were a first secondary decompensation. Finally, 30 patients had
both types of decompensations but these were not taken into account for
the comparison of primary and secondary decompensations. Primary
decompensations were 3-times more frequent than secondary decompensations,
but the mean number of heart failure decompensations was similar in the
"Primary heart failure group" compared to the "Secondary heart failure
group": (1.94+/-1.39 versus 1.80+/-1.07 respectively; p=0.480). Compared
to patients without heart failure decompensation, patients with "Only
primary decompensation" or with "Only secondary decompensation" had a
significantly increased risk of death (HR=4.87, 95%CI [2.86, 8.32] and
2.68 95%CI [1.64, 4.37] respectively). All-cause mortality, was not
significantly different between these two type of decompensations
(HR=1.82, 95%CI [0.93, 3.58]; p=0.082), but each additional heart failure
recurrence was associated with a significant increase in mortality risk
(HR=1.27, 95%CI [1.08; 1.50]; p=0.005). <br/>CONCLUSION(S): In heart
failure with reduced ejection fraction and severe secondary mitral
regurgitation patients, primary heart failure decompensations were
three-times more frequent compared to precipitated decompensations with a
non-significant trend in increased risk of all-cause mortality. Our
results fail to support the differentiation between primary and secondary
decompensations as they seem to portend the same outcome
impact.<br/>Copyright &#xa9; 2023. Published by Elsevier Inc.