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<1>
Accession Number
2014470926
Title
The Chinese consensus for surgical treatment of traumatic rib fractures
2021 (C-STTRF 2021).
Source
Chinese Journal of Traumatology - English Edition. 24(6) (pp 311-319),
2021. Date of Publication: November 2021.
Author
Kong L.-W.; Huang G.-B.; Yi Y.-F.; Du D.-Y.; Bai X.-J.; Cheng L.-M.; Cui
S.-S.; Du G.-L.; Deng J.; Dai J.-G.; Dang X.-B.; Fu X.-B.; Fu Y.; Ge B.;
Gao J.-M.; Hou L.-J.; Hu P.-Y.; Hou Z.-Y.; Jiang B.-G.; Jiang J.-X.; Jia
Y.-F.; Jing J.-H.; Li C.-M.; Lv D.-C.; Liu G.-D.; Liang G.-Y.; Lian H.-K.;
Li K.-N.; Li L.; Liu L.-M.; Lin Y.-D.; Li Z.-F.; Liu Z.-M.; Shao B.; Shen
Y.; Tao N.; Tang P.-F.; Tan Q.-Y.; Hu P.; Wang C.; Wu C.; Wang D.-L.; Wang
G.; Wang H.-D.; Wu J.-L.; Wu Q.-C.; Wang R.-W.; Wang T.-B.; Wu X.; Wang
Z.-G.; Xu F.; Xiao R.-J.; Xiao Y.-B.; Yu A.-Y.; Yu B.; Yang J.; Yang
X.-F.; Zhu D.-B.; Zeng J.; Zhou J.-H.; Zhang L.-Y.; Zhao X.-J.; Zhong
Y.-F.
Institution
(Kong, Du) Department of Cardiothoracic Surgery, Chongqing Emergency
Medical Center, Chongqing University Central Hospital, Chongqing 400014,
China
(Huang, Du) Department of Trauma Surgery, Chongqing Emergency Medical
Center, Chongqing University Central Hospital, Chongqing 400014, China
(Yi) Department of Cardiothoracic Surgery, Xiamen University Affiliated
Southeast Hospital, Zhangzhou, Fujian Province 363000, China
(Bai, Li) Tongji Hospital, Tongji Medical College, Huazhong University of
Science and Technology
(Cheng) Tongji Hospital, Tongji University School of Medicine
(Cui) China-Japan Union Hospital of Jilin University
(Kong, Huang, Du, Gao, Hu, Zhao) Chongqing Emergency Medical Center,
Chongqing University Central Hospital
(Du, Dang) Shanxi Province People's Hospital
(Deng) Affiliated Hospital of Guizhou Medical University
(Dai) Xinqiao Hospital, Army Military Medical University
(Fu, Tang) General Hospital of People's Liberation Army
(Fu) The Second Hospital, University of South China
(Ge) The Fourth People's Hospital of Guiyang
(Hou) Changzheng Hospital, Second Military Medical University
(Hu) Tiantai People's Hospital of Zhejiang Province
(Hou) The Third Hospital of Hebei Medical University
(Jiang) Peking University People's Hospital, National Center for Trauma
Medicine
(Jiang, Liu, Tan, Wang, Wang, Zhou) Army Medical Center of People's
Liberation Army
(Jia, Wang) The Second Affiliated Hospital of Inner Mongolia Medical
University
(Jing) The Second Hospital of Anhui Medical University
(Li) Jilin Central Hospital
(Lv) First Affiliated Hospital of Dalian Medical University
(Liu) Editorial Department of Chinese Journal of Trauma
(Liang) Guizhou Medical University
(Lian) Zhengzhou Central Hospital Affiliated to Zhengzhou University
(Li) Affiliated Hospital of Chengdu University
(Li) Editorial Department of Chinese Journal of Traumatology(English
Edition)
(Lin) West China Hospital of Sichuan University
(Liu) Shanghai Oriental Hospital of Tongji University
(Shao) The First People's Hospital of Kunming
(Shen, Yang) The First Affiliated Hospital, School of Medicine, Zhejiang
University
(Tao) Suining Central Hospital, Sichuan Province
(Wang) The First Affiliated Hospital of Hainan Medical University
(Wu) Children's Hospital of Chongqing Medical University
(Wang, Yu) Affiliated Hospital of Zunyi Medical University
(Wang, Wu, Yu) Southern Hospital of Southern Medical University
(Wang) Southwest Hospital of Army Medical University
(Wu) Union Shenzhen Hospital, Huazhong University of Science and
Technology
(Wu) The First Affiliated Hospital of Chongqing Medical University
(Xu) The First Affiliated Hospital of Soochow University
(Xiao) People's Hospital of Xingyi City, Guizhou Province
(Xiao) Xinqiao Hospital of Army Medical University
(Yang) Chongqing Emergency Medical Center, Central Hospital of Chongqing
University
(Yi) Xiamen University Affiliated Southeast Hospital
(Zhu) The Affiliated Hospital of Nantong University
(Zeng) Sichuan Provincial People's Hospital
(Zhang) Daping Hospital, Army Military Medical University
(Zhong) Chongqing University Three Gorges Hospital)
Publisher
Elsevier B.V.
Abstract
Rib fracture is the most common injury in chest trauma. Most of patients
with rib fractures were treated conservatively, but up to 50% of patients,
especially those with combined injury such as flail chest, presented
chronic pain or chest wall deformities, and more than 30% had long-term
disabilities, unable to retain a full-time job. In the past two decades,
surgery for rib fractures has achieving good outcomes. However, in clinic,
there are still some problems including inconsistency in surgical
indications and quality control in medical services. Before the year of
2018, there were 3 guidelines on the management of regional traumatic rib
fractures were published at home and abroad, focusing on the guidance of
the overall treatment decisions and plans; another clinical guideline
about the surgical treatment of rib fractures lacks recent related
progress in surgical treatment of rib fractures. The Chinese Society of
Traumatology, Chinese Medical Association, and the Chinese College of
Trauma Surgeons, Chinese Medical Doctor Association organized experts from
cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics
and other disciplines to participate together, following the principle of
evidence-based medicine and in line with the scientific nature and
practicality, formulated the Chinese consensus for surgical treatment of
traumatic rib fractures (STTRF 2021). This expert consensus put forward
some clear, applicable, and graded recommendations from seven aspects:
preoperative imaging evaluation, surgical indications, timing of surgery,
surgical methods, rib fracture sites for surgical fixation, internal
fixation method and material selection, treatment of combined injuries in
rib fractures, in order to provide guidance and reference for surgical
treatment of traumatic rib fractures. Copyright © 2021 Chinese
Medical Association

<2>
Accession Number
2025893676
Title
The Emerging Significance of Amyloid Deposits in the Ligamentum Flavum of
Spinal Stenosis Patients: A Review.
Source
World Neurosurgery. 177 (pp 88-97), 2023. Date of Publication: September
2023.
Author
Wang A.Y.; Patel J.; Kanter M.; Olmos M.; Maurer M.S.; McPhail E.D.; Patel
A.R.; Arkun K.; Kryzanski J.; Riesenburger R.I.
Institution
(Wang, Patel, Kanter, Olmos, Arkun, Kryzanski, Riesenburger) Department of
Neurosurgery, Tufts Medical Center, Boston, MA, United States
(Patel) CardioVascular Center, Tufts Medical Center, Boston, MA, United
States
(Arkun) Department of Pathology and Laboratory Medicine, Tufts Medical
Center, Boston, MA, United States
(Maurer) Department of Cardiology, Columbia University Irving Medical
Center, New York, NY, United States
(McPhail) Department of Laboratory Medicine and Pathology, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier Inc.
Abstract
Spinal stenosis is one of the most common neurosurgical diseases and a
leading cause of pain and disability. Wild-type transthyretin amyloid
(ATTRwt) has been found in the ligamentum flavum (LF) of a significant
subset of patients with spinal stenosis who undergo decompression surgery.
Histologic and biochemical analyses of LF specimens from spinal stenosis
patients, normally discarded as waste, have the potential to help
elucidate the underlying pathophysiology of spinal stenosis and possibly
allow for medical treatment of stenosis and screening for other systemic
diseases. In the present review, we discuss the utility of analyzing LF
specimens after spinal stenosis surgery for ATTRwt deposits. Screening for
ATTRwt amyloidosis cardiomyopathy through LF specimens has led to the
early diagnosis and treatment of cardiac amyloidosis in several patients,
with more expected to benefit from this process. Emerging evidence in the
literature also point to ATTRwt as a contributor to a previously
unrecognized subtype of spinal stenosis in patients who might, in the
future, benefit from medical therapy. In the present report, we review the
current literature regarding the early detection of ATTRwt cardiomyopathy
via LF screening and the possible contribution of ATTRwt deposits in the
LF to spinal stenosis development. Copyright © 2023 Elsevier Inc.

<3>
Accession Number
2025885861
Title
Alirocumab effect on preventing periprocedural ischaemic events in
coronary heart disease patients undergoing coronary stenting (APPEASE
trial): Study protocol of a multicentre, open-label, randomised controlled
trial.
Source
BMJ Open. 13(7) (no pagination), 2023. Article Number: e072541. Date of
Publication: 11 Jul 2023.
Author
Huang Z.; Zhuang X.; Zhang S.; Huang Y.; Yuan L.; Lin A.; Tang L.; Xiong
Z.; Christopher O.; Chen Y.; Wu B.; Ling Y.; Li S.; Jie Q.; Xiong L.; Qian
X.; Liao X.; Liu J.
Institution
(Huang, Tang, Chen, Wu, Ling, Li, Qian, Liu) Department of Cardiovascular
Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong,
Guangzhou, China
(Huang, Zhuang, Zhang, Huang, Xiong, Christopher, Liao) Cardiology
Department, First Affiliated Hospital of Sun Yat-sen University,
Guangdong, Guangzhou, China
(Huang, Zhuang, Zhang, Huang, Xiong, Christopher, Liao) NHC Key Laboratory
of Assisted Circulation, Sun Yat-Sen University, Guangdong, Guangzhou,
China
(Yuan) Department of Science and Research, Third Affiliated Hospital of
Sun Yat-Sen University, Guangdong, Guangzhou, China
(Lin, Jie) Department of Cardiology, Cardiovascular Institute of Panyu
District, Guangzhou Panyu Central Hospital, Guangdong, Guangzhou, China
(Xiong) Department of Cardiology, Second Affiliated Hospital of Guangzhou
Medical University, Guangdong, Guangzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction Percutaneous coronary intervention (PCI)-related myocardial
infarction (type 4a MI) and major periprocedural myocardial injury have
been demonstrated leading to poor prognosis of patients with coronary
heart disease (CHD) undergoing elective PCI and still remain high
occurrence even after the therapy of dual antiplatelet agents and statins.
Proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab has
been shown to be effectively in reducing the risk of acute MI (AMI).
However, the effect of alirocumab on preventing PCI-related MI or major
periprocedural myocardial injury in patients with CHD undergoing elective
PCI remains uncertain. Methods and analysis Alirocumab effect on
Preventing Periprocedural ischaemic Events in coronary heart diseAse
patients undergoing coronary StEnting trial is a multicentre, open-label,
randomised controlled trial aiming to determine whether alirocumab could
reduce the incidence of type 4a MI or major periprocedural myocardial
injury in patients with CHD undergoing elective PCI. In total, 422 non-AMI
CHD patients planned to undergo elective PCI will be randomly assigned to
receive standard pharmacotherapy of CHD (control group) or additional use
of subcutaneous alirocumab 75 mg 1 day before procedure (alirocumab
group). The primary outcome is type 4a MI or major periprocedural
myocardial injury defined as high-sensitivity cardiac troponin elevating
above 5x99 th percentile upper reference limit in 48 hours after PCI.
Patients will continue receiving standard pharmacotherapy or additional
biweekly subcutaneous alirocumab 75 mg for 3 months according to the
initial randomisation group. We will follow up for 3 months and record all
the major adverse cardiovascular events (MACEs). Incidence of PCI-related
MI or major periprocedural myocardial injury, and MACE in 3 months after
PCI will be compared between control group and alirocumab group. Ethics
and dissemination Ethics approval has been obtained from the Medical
Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen
University with approval number: (2022)02-140-01. The results of this
study will be reported through peer-reviewed journals and conference
presentations. Trial registration number ChiCTR2200063191. Copyright
© 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.

<4>
Accession Number
2025694884
Title
A comparison of treating physician versus independent core lab assessments
of post-aneurysm treatment imaging outcomes: an analysis of prospectively
collected data from a randomized trial.
Source
Journal of Neurosurgery. 139(1) (pp 85-93), 2023. Date of Publication:
July 2023.
Author
Patra D.P.; Syal A.; Rahme R.J.; Abi-Aad K.R.; Singh R.; Turcotte E.L.;
Jones B.A.; Meyer J.; Hudson M.; Chong B.W.; Dabus G.; James R.F.; Krishna
C.; Bendok B.R.
Institution
(Patra, Turcotte, Meyer, Hudson, Krishna, Bendok) Department of
Neurological Surgery, Mayo Clinic, Phoenix, United States
(Patra, Turcotte, Meyer, Hudson, Krishna, Bendok) Precision
Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, United States
(Patra, Turcotte, Jones, Meyer, Hudson, Krishna, Bendok) Neurosurgery
Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ, United States
(Syal) New York Medical College, Valhalla, NY, United States
(Rahme) Department of Neurosurgery, Global Neuroscience Institute,
Philadelphia, PA, United States
(Abi-Aad) SUNY Upstate Medical University, Syracuse, NY, United States
(Singh) Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States
(Jones) Division of Neurosurgery, Southern Illinois University School of
Medicine, Springfield, IL, United States
(Dabus) Department of Neuroradiology, Miami Neuroscience Institute,
Baptist Health South Florida, Miami, FL, United States
(James) Department of Neurosurgery, IU Health Physicians Neurosurgery,
Indianapolis, IN, United States
(Bendok) Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic,
Phoenix, United States
(Chong, Bendok) Department of Radiology, Mayo Clinic, Phoenix, AZ, United
States
Publisher
American Association of Neurological Surgeons
Abstract
OBJECTIVE Aneurysm occlusion has been used as surrogate marker of aneurysm
treatment efficacy. Aneurysm occlusion scales are used to evaluate the
outcome of endovascular aneurysm treatment and to monitor recurrence.
These scales, however, require subjective interpretation of imaging data,
which can reduce the utility and reliability of these scales and the
validity of clinical studies regarding aneurysm occlusion rates. Use of a
core lab with independent blinded reviewers has been implemented to
enhance the validity of occlusion rate assessments in clinical trials. The
degree of agreement between core labs and treating physicians has not been
well studied with prospectively collected data. METHODS In this study, the
authors analyzed data from the Hydrogel Endovascular Aneurysm Treatment
(HEAT) trial to assess the interrater agreement between the treating
physician and the blinded core lab. The HEAT trial included 600 patients
across 46 sites with intracranial aneurysms treated with coiling. The
treating site and the core lab independently reviewed immediate
postoperative and follow-up imaging (3-12 and 18-24 months, respectively)
using the Raymond-Roy occlusion classification (RROC) scale, Meyer scale,
and recanalization survey. A post hoc analysis was performed to calculate
interrater reliability using Cohen's kappa. Further analysis was performed
to assess whether degree of agreement varied on the basis of various
factors, including scale used, timing of imaging, size of the aneurysm,
imaging modality, location of the aneurysm, dome-to-neck ratio, and
rupture status. RESULTS Minimal interrater agreement was noted between the
core lab reviewers and the treating physicians for assessing aneurysm
occlusion using the RROC grading scale (k = 0.39, 95% CI 0.38-0.40) and
Meyer scale (k = 0.23, 95% CI 0.14-0.38). The degree of agreement between
groups was slightly better but still weak for assessing recanalization (k
= 0.45, 95% CI 0.38-0.52). Factors that significantly improved degree of
agreement were scales with fewer variables, greater time to follow-up,
imaging modality (digital subtraction angiography), and wide-neck
aneurysms. CONCLUSIONS Assessment of aneurysm treatment outcome with
commonly used aneurysm occlusion scales suffers from risk of poor
interrater agreement. This supports the use of independent core labs for
validation of outcome data to Copyright ©AANS 2023.

<5>
Accession Number
2025404759
Title
Virtual reality-assisted distraction during transcatheter aortic valve
implantation under local anaesthesia: A randomised study.
Source
International Journal of Cardiology. 387 (no pagination), 2023. Article
Number: 131130. Date of Publication: 15 Sep 2023.
Author
Lind A.; Ahsan M.; Totzeck M.; Al-Rashid F.; Haddad A.; Dubler S.; Brenner
T.; Skarabis A.; El Gabry M.; Rassaf T.; Janosi R.A.
Institution
(Lind, Ahsan, Totzeck, Al-Rashid, Rassaf, Janosi) Department of Cardiology
and Vascular Medicine, West-German Heart and Vascular Center Essen,
University Hospital Essen, University Duisburg-Essen, Essen, Germany
(El Gabry) Department of Heart Surgery, West-German Heart and Vascular
Center Essen, University Hospital Essen, University Duisburg-Essen, Essen,
Germany
(Haddad, Dubler, Brenner, Skarabis) Department of Anaesthesiology and
Intensive Care Medicine, University Hospital Essen, University
Duisburg-Essen, Essen, Germany
Publisher
Elsevier Ireland Ltd
Abstract
Background: A minimal approach, using local anaesthesia alone, has been
advocated to promote faster transcatheter aortic valve replacement (TAVR)
procedures in intermediate-risk patients. Pre- and periprocedural anxiety
and pain remain a concern. Virtual reality (VR) is a form of
non-pharmacological distraction that can potentially modulate pain and
anxiety. This randomised study explored whether VR reduces pain and
anxiety during TAVR without sedation and compared the effects of VR with
those of standard care. Methods and Results: Between June 2022 and
March 2023, 207 patients underwent transfemoral TAVR (TF-TAVR). Of these,
117 (56.5%) patients were willing to participate in the study and met the
educational background and mental status criteria for assessment.
Fifty-nine patients underwent TF-TAVR with VR glasses (VR group).
Fifty-eight patients underwent standard TF-TAVR without VR (control group;
CG). Post-interventional anxiety scores (STAI-S) (31.5 +/- 13.4 vs. 38.5
+/- 19.2, p = 0.02) and the perceived duration of the procedure (60.1 +/-
32.3 vs. 73.0 +/- 32.4, p = 0.04) were lower in the VR than in the CG.
Procedure time, pain, and anxiety scores (visual analogue scale) were
similar between the groups. The complication rate was low and not
associated with VR. Post-interventional delirium occurred in nine
patients, and was similar between the groups (VR: 4 [6.8%] vs. CG: 5
[8.6%], p = 0.71). No periprocedural strokes were observed.
 Conclusion(s): VR for TAVR is feasible and safe and expands the
non-drug spectrum of therapy for anxiety and pain in patients undergoing
TAVR with a minimalistic approach. Copyright © 2023 Elsevier B.V.

<6>
Accession Number
2024563486
Title
Ross procedure versus pulmonary homograft versus mechanical valve versus
bioprosthetic valve versus Ozaki procedure for surgical aortic valve
replacement: a frequentist network meta-analysis.
Source
Egyptian Heart Journal. 75(1) (no pagination), 2023. Article Number: 64.
Date of Publication: December 2023.
Author
Mathew D.M.; Fusco P.J.; Varghese K.S.; Abdel-Nasser O.; Awad A.K.;
Giannaris P.; Mathew S.M.; Ahmed A.
Institution
(Awad, Abdel-Nasser) Faculty of Medicine, Ain Shams University, Cairo,
Egypt
(Mathew, Fusco, Varghese, Giannaris, Mathew, Ahmed) City University of New
York School of Medicine, 1589 Amsterdam Avenue, New York, NY 10031, United
States
(Awad) Faculty of Medicine, El-Galala University, Suez, Egypt
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: There has been a resurgence in interest regarding the Ross
procedure due to recent publications detailing positive long-term
outcomes. Conversely, surgical aortic valve replacement (SAVR) with a
pulmonary homograft (PH), mechanical (MV), bioprosthetic (BV), or the
Ozaki procedure each has its own technical advantages and disadvantages.
Therefore, we performed a network meta-analysis (NMA) comparing other
alternatives to Ross procedure. Method(s): Medical databases were
comprehensively searched for studies comparing the Ross procedure with AVR
using a PH, MV, BV, or the Ozaki procedure. Outcomes were pooled as risk
ratios (RR) with their 95% confidence intervals (95% CI). Result(s):
A total of 7816 patients were pooled for our NMA from 24 studies. Compared
to Ross procedure, both BV and MV were associated with significantly
higher rates of 30-day mortality of RR (2.37, 95% CI 1.20-4.67) and (1.88
95% CI 1.04-3.40), respectively, with no significant difference regarding
PH or Ozaki. However, only MV was associated with a higher risk of 30-day
stroke (RR 8.42, 95% CI 1.57-45.23) with no significant difference in the
other alternatives, as well as 30-day MI which showed no significant
differences between any of the aortic conduits compared to the Ross
procedure. Regarding 30-day major bleeding, MV was associated with a
higher when compared to the Ross procedure RR (4.58, 95% CI 1.94-10.85),
PH was associated with a lower risk of major bleeding with RR (0.35, 95%
CI 0.17-0.71), and BV showed no significant difference. With a mean
follow-up duration of 8.5 years compared to the Ross procedure, BV, PH,
and MV were associated with a higher risk of long-term mortality with RR
(1.89, 95% CI 1.38-2.58), (1.38, 95% CI 1.0-1.87), and (1.94, 95% CI
1.52-2.47), respectively, with the Ozaki procedure showed no significant
difference. Regarding long-term stroke-with a mean of 6.3-year follow-up
duration-there were no significant differences between any of the aortic
conduits compared to the Ross procedure. Nevertheless, long-term need for
reintervention-with a mean follow-up duration of 17.5 years-was
significant of higher risk with both BV and PH with RR (3.28, 95% CI
1.21-8.84) and (2.42, 95% CI 1.05-5.58), respectively, compared to Ross
procedure with MV and Ozaki having no significant difference.
 Conclusion(s): The Ross procedure is a viable treatment option for
patients undergoing SAVR, showing promising outcomes at short- and
long-term follow-ups. Copyright © 2023, The Author(s).

<7>
Accession Number
2023803588
Title
Global trends in perioperative stroke research from 2003 to 2022: a web of
science-based bibliometric and visual analysis.
Source
Frontiers in Neurology. 14 (no pagination), 2023. Article Number: 1185326.
Date of Publication: 2023.
Author
Ji S.; Shi Y.; Fan X.; Jiang T.; Yang X.; Tao T.; Ye B.
Institution
(Ji, Shi, Fan, Jiang, Yang, Tao, Ye) Department of Anesthesiology, Air
Force Medical Center, Beijing, China
(Ji, Shi, Tao, Ye) Graduate School of China Medical University, Shenyang,
China
Publisher
Frontiers Media SA
Abstract
Background: Perioperative stroke is a potentially devastating complication
in surgical patients, which has attracted global attention. This
retrospective bibliometric and visual analysis evaluates the status and
global trends in perioperative stroke research. Method(s): Papers
published between 2003 and 2022 were retrieved from the Web of Science
core collection. Extracted data were summarized and analyzed using
Microsoft Excel and further bibliometric and co-occurrence analyses were
conducted using VOSviewer and CiteSpace software. Result(s):
Publications on perioperative stroke have increased over the years. The
USA topped the list of countries with the highest number of publications
and citations, while Canada had the highest mean citation frequency. The
Journal of Vascular Surgery and Annals of Thoracic Surgery had the highest
number of publications and citation frequency for perioperative stroke.
Regarding authors, Malas, Mahmoud B. contributed the most publications to
the field, and Harvard University had the highest number of publications
(409 papers). Based on an overlay visualization map, timeline view, and
the strongest strength burst of keywords, "antiplatelet therapy,"
"antithrombotic therapy," "carotid revascularization," "bleeding
complications," "postoperative cognitive dysfunction," "intraoperative
hypotension," "thrombectomy," "cerebral revascularization," "valve
surgery," "tranexamic acid," and "frozen elephant trunk" were trending
topics in perioperative stroke research. Conclusion(s): Publications
regarding perioperative stroke have experienced rapid growth in the past
20 years and are likely to continuously increase. Research on
perioperative antiplatelet and antithrombotic, cardiovascular surgery,
postoperative cognitive dysfunction, thrombectomy, tranexamic acid, and
frozen elephant trunk has attracted increasing attention, and these topics
are emerging hotspots of present research and possible candidates for
future research. Copyright © 2023 Ji, Shi, Fan, Jiang, Yang, Tao
and Ye.

<8>
Accession Number
2023336939
Title
Identifying leukocyte phenotypes by scRNA-seq to predict cardiovascular
risk.
Source
Nature Reviews Cardiology. 20(7) (pp 439-440), 2023. Date of Publication:
July 2023.
Author
Gollmer J.; Zirlik A.
Institution
(Gollmer, Zirlik) University Heart Center Graz, Department of Cardiology,
Medical University Graz, Graz, Austria
Publisher
Nature Research

<9>
Accession Number
2022782040
Title
The win ratio method in heart failure trials: lessons learnt from EMPULSE.
Source
European Journal of Heart Failure. 25(5) (pp 632-641), 2023. Date of
Publication: May 2023.
Author
Pocock S.J.; Ferreira J.P.; Collier T.J.; Angermann C.E.; Biegus J.;
Collins S.P.; Kosiborod M.; Nassif M.E.; Ponikowski P.; Psotka M.A.;
Teerlink J.R.; Tromp J.; Gregson J.; Blatchford J.P.; Zeller C.; Voors
A.A.
Institution
(Pocock, Collier, Gregson) Medical Statistics Department, London School of
Hygiene & Tropical Medicine, London, United Kingdom
(Ferreira) Heart Failure Clinic, Internal Medicine Department, Centro
Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
(Ferreira) Inserm, Centre d'Investigations Cliniques-Plurithematique
14-33, Universite de Lorraine, and Inserm U1116, CHRU, Nancy, France
(Angermann) Comprehensive Heart Failure Centre, University and University
Hospital of Wurzburg, and Department of Medicine I, University Hospital of
Wurzburg, Wurzburg, Germany
(Biegus, Ponikowski) Institute of Heart Diseases, Medical University,
Wroclaw, Poland
(Collins) Department of Emergency Medicine, Vanderbilt University Medical
Center and Geriatric Research and Education Clinical Care, Tennessee
Valley Healthcare Facility VA Medical Center, Nashville, TN, United States
(Kosiborod, Nassif) Saint Luke's Mid America Heart Institute, Kansas City,
MO, United States
(Kosiborod, Nassif) School of Medicine, University of Missouri-Kansas
City, Kansas City, MO, United States
(Kosiborod) George Institute for Global Health, Sydney, NSW, Australia
(Kosiborod) University of New South Wales, Sydney, NSW, Australia
(Psotka) Inova Heart and Vascular Institute, Falls Church, VA, United
States
(Teerlink) Section of Cardiology, San Francisco Veterans Affairs Medical
Center and School of Medicine, University of California San Francisco, San
Francisco, CA, United States
(Tromp) Saw Swee Hock School of Public Health, National University of
Singapore, and the National University Health System, Singapore, Singapore
(Blatchford) Elderbrook Solutions GmbH on behalf of Boehringer Ingelheim
Pharma GmbH & Co. KG, Biberach, Germany
(Zeller) Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
(Voors) Department of Cardiology, University Medical Center Groningen,
Groningen, Netherlands
Publisher
John Wiley and Sons Ltd
Abstract
Aims: The EMPULSE trial evaluated the clinical benefit of empagliflozin
versus placebo using the stratified win ratio approach in 530 patients
with acute heart failure (HF) after initial stabilization. We aim to
elucidate how this method works and what it means, thereby giving guidance
for use of the win ratio in future trials. Methods and Results: The
primary trial outcome is a hierarchical composite of death, number of HF
events, time to first HF event, or a >=5-point difference in Kansas City
Cardiomyopathy Questionnaire (KCCQ) total symptom score change at 90 days.
In an overall (unstratified) analysis we show how comparison of all 265 x
265 patients pairs contribute to 'wins' for empagliflozin and placebo at
all four levels of the hierarchy, leading to an unstratified win ratio of
1.38 (95% confidence interval [CI] 1.11-1.71; p = 0.0036). How such a win
ratio should (and should not) be interpreted is then described. The more
complex primary analysis using a stratified win ratio is then presented in
detail leading to a very similar overall result. Win ratios for de novo
acute HF and decompensated chronic HF patients were 1.29 and 1.39,
respectively, their weighted combination yielding an overall stratified
win ratio of 1.36 (95% CI 1.09-1.68) (p = 0.0054). Alternative ways of
including HF events and KCCQ scores in the clinical hierarchy are
presented, leading to recommendations for their use in future trials.
Specifically, inclusion of both number of HF events and time-to-first HF
event appears an unnecessary complication. Also, the use of a 5-point
margin for KCCQ score paired comparisons is not statistically necessary.
 Conclusion(s): The EMPULSE trial findings illustrate how deaths,
clinical events and patient-reported outcomes can be integrated into a win
ratio analysis strategy that yields clinically meaningful findings of
patient benefit. This has implications for future trial designs that
recognize the clinical priorities of patient evaluation and the need for
efficient progress towards approval of new treatments. Copyright
© 2023 The Authors. European Journal of Heart Failure published by
John Wiley & Sons Ltd on behalf of European Society of Cardiology.

<10>
Accession Number
2021706611
Title
Late gadolinium enhancement and the risk of ventricular arrhythmias and
sudden death in NYHA class I patients with non-ischaemic cardiomyopathy.
Source
European Journal of Heart Failure. 25(5) (pp 740-750), 2023. Date of
Publication: May 2023.
Author
Di Marco A.; Brown P.; Mateus G.; Faga V.; Nucifora G.; Claver E.; Viedma
J.; Galvan F.; Bradley J.; Dallaglio P.D.; de Frutos F.; Miller C.A.;
Comin-Colet J.; Anguera I.; Schmitt M.
Institution
(Di Marco, Mateus, Faga, Claver, Viedma, Galvan, Dallaglio, de Frutos,
Comin-Colet, Anguera) Department of Cardiology, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Di Marco, Faga, Claver, Dallaglio, de Frutos, Comin-Colet, Anguera)
Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and
Systemic Diseases and Cellular Aging Program, Institut d'Investigacio
Biomedica de Bellvitge-IDIBELL, Barcelona, Spain
(Di Marco, Miller, Schmitt) Division of Cardiovascular Sciences, School of
Medical Sciences, Faculty of Biology, Medicine and Health, University of
Manchester, Manchester Academic Health Science Centre, Manchester, United
Kingdom
(Brown, Nucifora, Bradley, Schmitt) Department of Cardiology, North West
Heart Centre, Manchester University NHS Foundation Trust, Manchester,
United Kingdom
(Miller) Manchester University NHS Foundation Trust, Manchester Academic
Health Science Centre, Manchester, United Kingdom
(Miller) Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix
Biology & Regenerative Medicine, School of Biology, Faculty of Biology,
Medicine and Health, University of Manchester, Manchester Academic Health
Science Centre, Manchester, United Kingdom
(Comin-Colet) Department of Clinical Sciences, School of Medicine,
University of Barcelona, Barcelona, Spain
Publisher
John Wiley and Sons Ltd
Abstract
Aim: To compare the risk of ventricular arrhythmias (VA) and sudden death
(SD) between New York Heart Association (NYHA) class I and NYHA class
II-III patients with non-ischaemic cardiomyopathy (NICM). Methods and
Results: Observational retrospective cohort study including patients with
NICM who underwent cardiac magnetic resonance at two hospitals. The
primary endpoint included appropriate implantable cardioverter
defibrillator (ICD) therapies, sustained ventricular tachycardia,
resuscitated cardiac arrest and SD. The secondary endpoint included heart
failure (HF) hospitalizations, heart transplant, left ventricular assist
device implant or HF death. Overall, 698 patients were included, 33% in
NYHA class I. During a median follow-up of 31 months, the primary endpoint
occurred in 57 patients (8%), with no differences between NYHA class I and
NYHA class II-III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement
(LGE) was the only independent predictor of the primary outcome both in
NYHA class I and NYHA class II-III patients. LGE+ NYHA class I patients
had a similar cumulative incidence of the primary endpoint as compared to
LGE+ NYHA class II-III (p = 0.92) and a significantly higher risk as
compared to LGE- NYHA class II-III cases (p < 0.001). The risk of the
secondary endpoint was significantly higher in patients in NYHA class
II-III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001).
 Conclusion(s): Patients with NICM in NYHA class I are not necessarily
at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high
risk. NYHA class I patients with high-risk factors, such as LGE, could
benefit from primary prevention ICD at least as much as those in NYHA
class II-III with the same risk factors. Copyright © 2023
European Society of Cardiology.

<11>
Accession Number
641898061
Title
Exercise-based cardiac rehabilitation programmers for patients after
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
Medicine. 102(30) (pp e34478), 2023. Date of Publication: 28 Jul 2023.
Author
Li Z.; Song W.; Yang N.; Ding Y.
Institution
(Li, Song, Yang) Department of Rehabilitation Medicine, Beijing Daxing
District People's Hospital, Beijing, China
(Ding) Department of Respiratory and Critical Care Medicine, Beijing
Daxing District People's Hospital, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Currently, transcatheter aortic valve implantation (TAVI) is
presently a recognized treatment modality for patients with severe aortic
stenosis who are often old, disabled, frail, and have low exercise
capacity (ExCap). It is further expected from this therapy to improve
quality of life by improving of the cardio function performance. The aim
of this study is to evaluate the effect of exercise-based cardiac
rehabilitation (CR) on patients after TAVI. METHOD(S): PubMed,
Embase, Cochrane Library, and Web of Science were searched from inception
to December 10, 2022 for relevant studies that evaluated the effect of CR
on patients after TAVI. The primary outcome was the improvement of
6-minute walked distance and Barthel index score after CR. The secondary
outcomes included other parameters such as SF-12 scale, HADS score, Morse
Fall Scale, Frailty-Index, ExCap, and FIM score. All statistical analyses
were performed using the standard statistical procedures provided in
Review Manager 5.2. RESULT(S): A total of 12 observational studies
were identified, with 2365 participants. Pooled data indicated that CR
programmers significantly improved the 6-minute walked distance (SMD 0.65;
95% confidence intervals [CI] 0.51-0.79) and Barthel index score (SMD
0.83; 95% CI 0.61-1.06). In addition, compared with admission, patients
experienced significant improvement in SF-12 scale at CR discharge, with a
pooled mean differences (MD) of 2.74 (95% CI 0.86-4.61) in physical
component score and 2.76 (95% CI 0.59-4.93) in mental component score.
Similar results were also observed in ExCap (MD 8.10 W; 95% CI 1.57
W-14.63 W) and FIM score (MD 11.0; 95% CI 6.22-15.78). CONCLUSION(S):
Our analysis indicated that exercise-based CR programmers had significant
effect on patients after TAVI in improving exercise tolerance and
functional independence. Copyright © 2023 the Author(s).
Published by Wolters Kluwer Health, Inc.

<12>
Accession Number
641894446
Title
Vascular complications of ProGlide versus Prostar in transcatheter aortic
valve replacement (TAVR) procedures: meta-analysis.
Source
BJS open. 7(4) (no pagination), 2023. Date of Publication: 10 Jul 2023.
Author
Xiang Y.; Chen C.; Zhao J.; Ma Y.; Huang B.; Wu Z.
Institution
(Xiang, Zhao, Ma, Huang, Wu) Division of Vascular Surgery, Department of
General Surgery, West China Hospital, Sichuan University, Chengdu, China
(Chen) Division of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this study was to compare the vascular
complications of ProGlide and Prostar in percutaneous transfemoral
transcatheter aortic valve replacement. METHOD(S): Electronic
databases were searched in July 2022 for studies that compared the
vascular complications of ProGlide and Prostar for percutaneous closure in
transcatheter aortic valve replacement. The primary outcome was major
vascular complications and the secondary outcomes were minor vascular
complications, types of access-site vascular complications, device
failure, and additional intervention. Estimates of relative effects were
pooled to generate ORs and their 95 per cent c.i. using a random-effects
model. The risk of bias in non-randomized comparative studies was assessed
using the Risk Of Bias In Non-randomized Studies - of Interventions
('ROBINS-I') tool. RESULT(S): Nine studies were identified and a
total of 7529 patients were included. Among them, 4144 patients received
ProGlide and 3385 received Prostar. The pooled data showed that the risk
of major vascular complications was significantly lower with ProGlide
versus Prostar (OR 0.50, 95 per cent c.i. 0.32 to 0.78). Regarding the
types of vascular complications, vascular trauma was the most common
complication and the risk was similar between groups (OR 1.02, 95 per cent
c.i. 0.55 to 1.91). ProGlide had a lower risk of bleeding complications
(OR 0.46, 95 per cent c.i. 0.22 to 0.94), but a higher risk of ischaemia
complications (OR 1.90, 95 per cent c.i. 1.10 to 3.27). The risk of device
failure was lower in the ProGlide group (OR 0.45, 95 per cent c.i. 0.21 to
0.95). Both groups had a similar risk of having additional interventions
for vascular complications (OR 1.02, 95 per cent c.i. 0.75 to 1.39). The
use of ProGlide was associated with a lower risk of additional surgical
treatments (OR 0.52, 95 per cent c.i. 0.34 to 0.80), but a higher risk of
endovascular treatments (OR 2.69, 95 per cent c.i. 1.29 to 5.63).
 CONCLUSION(S): In percutaneous transfemoral transcatheter aortic
valve replacement procedures, ProGlide has superior safety and efficacy
when compared with Prostar; it is associated with fewer major vascular
complications and device failures. The vascular complications of ProGlide
are more likely to be dealt with using endovascular treatments than
surgical treatments. Copyright © The Author(s) 2023. Published by
Oxford University Press on behalf of BJS Society Ltd.

<13>
Accession Number
640884424
Title
Video-assisted thoracic surgery versus thoracotomy for treatment of
patients with pulmonary sequestration: A systematic review and
meta-analysis.
Source
Asian journal of surgery. 46(8) (pp 3387-3388), 2023. Date of Publication:
01 Aug 2023.
Author
Xie Y.; Yan D.; Shen J.
Institution
(Xie, Yan) Department of Cardiothoracic Surgery, Taizhou People's
Hospital, Jiangsu Province 225300, China
(Shen) Department of Cardiothoracic Surgery, Taizhou People's Hospital,
Jiangsu Province 225300, China
Publisher
NLM (Medline)

<14>
Accession Number
640239666
Title
Pain Control after Reduction Mammaplasty with Combination Bupivacaine and
Dexamethasone Regional Block: A Randomized Controlled Trial.
Source
Plastic and reconstructive surgery. 152(2) (pp 217e-226e), 2023. Date of
Publication: 01 Aug 2023.
Author
Taylor G.A.; Panichella J.C.; Neusner A.; Lo A.; Vazquez D.; Zhao H.;
Trehan G.; Livelsberger J.; Gassman A.A.
Institution
(Taylor) From the Department of Surgery, Temple University Hospital
(Panichella, Vazquez, Zhao) Lewis Katz School of Medicine at Temple
University
(Neusner) Division of Plastic and Reconstructive Surgery, Department of
Surgery, Lahey Hospital & Medical Center
(Lo) Division of Plastic Surgery, Department of Surgery, Penn State Milton
S. Hershey Medical Center
(Trehan, Livelsberger) Department of Anesthesiology
(Gassman) PRMA Plastic Surgery
Publisher
NLM (Medline)
Abstract
BACKGROUND: There are many approaches to pain control in reduction
mammaplasty. Preoperative bupivacaine regional blocks control pain
relatively inexpensively ($0.07/mL), but last only 8 hours. A liposomal
bupivacaine formulation lasts 72 hours but can be costly ($17.21/mL).
Orthopedic and thoracic operations have demonstrated that dexamethasone
($0.44/mL) plus bupivacaine can prolong analgesia. The authors conducted a
double-blind, randomized, controlled trial to determine whether
dexamethasone plus bupivacaine regional block improves postoperative pain
control, reduces inpatient narcotic use, and improves patient
satisfaction. METHOD(S): Female patients were randomized into control
and experimental groups. Both groups received preoperative modified block
of the pectoral nerves: bupivacaine plus saline (control group) or
bupivacaine plus dexamethasone (experimental group). Postoperative pain
regimens were standardized. Vital signs, pain scores, narcotic
consumption, and antiemetic use were recorded throughout the
hospitalization. Quality-of-life surveys were distributed at the first
postoperative visit. RESULT(S): Fifty-one patients completed the
study: 25 control and 26 experimental group patients. The experimental
group averaged lower pain scores, although there was no statistically
significant difference overall or at each 4-hour interval. Postoperative
narcotic use was significantly lower in the experimental group (mean, 23.2
oral morphine equivalents versus 36.6 oral morphine equivalents per
patient; P = 0.026). There were no differences in 4-hour interval vital
signs, antiemetic use, or length of stay. Survey results showed enhanced
quality of life in the experimental group, but this was not statistically
significant. CONCLUSION(S): The addition of dexamethasone to
bupivacaine in the preoperative modified block of the pectoral nerves
block before bilateral reduction mammaplasty resulted in significantly
less narcotic consumption in the hospital. This can be a cost-effective
adjunct for postoperative pain control. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, II. Copyright © 2023 by the American
Society of Plastic Surgeons.

<15>
Accession Number
2026115769
Title
Bridge to Transplant and Transplant Outcomes in Cardiac Amyloidosis: A
Systematic Review.
Source
Heart Lung and Circulation. Conference: 71st Annual Scientific Meeting of
the Cardiac Society of Australia and New Zealand. Adelaide Australia.
32(Supplement 3) (pp S271), 2023. Date of Publication: July 2023.
Author
Raftopulos N.; Gorrie N.; Bart N.
Institution
(Raftopulos, Gorrie, Bart) St Vincent's Hospital, Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: Amyloid cardiomyopathy (ACM) is a progressive disease caused
by abnormal protein deposits in cardiac tissue. Causes include
immunoglobulin light chains (AL) and transthyretin (ATTR). Orthotopic
heart transplantation (OHT) remains definitive treatment for end-stage
heart failure patients. Mechanical circulatory support (MCS) may be
considered as bridge to transplant but is typically limited by right
ventricular dysfunction and anatomical suitability. This study aimed to
evaluate outcomes of OHT and MCS in ACM. Method(s): Databases OVID,
PubMed and Cochrane Review were searched following PRISMA guidelines,
assessing 50 studies examining 868 ACM patients (90 MCS, 778 OHT).
 Result(s): There were 868 OHT patients (511 [59%] male, 195 [22%]
female, 162 unspecified [19%], mean age 55 years, 191 AL and 108 ATTR
reported cases). The largest registry documented one- and five-year
survival rates of 89 and 78 for ACM, compared to non-ACM restrictive
cardiomyopathy, 86 and 76. Infection and renal failure were common adverse
events. 90 ACM patients underwent MCS (62% ATTR, 38% AL, 68 male, 13
female, 9 unspecified, mean age 59 years) including 57 left ventricular
assist devices (VAD), 8 Bi-VAD and 25 total artificial hearts. Bleeding
and device-related infection were common adverse events. ACM with MCS had
higher rates of biventricular support and poorer survival compared to
non-ACM. Conclusion(s): Current advancements demonstrate comparable
ACM transplant outcomes compared to non-ACM. MCS remains limited; <10% had
MCS prior to OHT compared to the general OHT population (>40%). Outcomes
in ACM are poorer with MCS; hence ACM patients should be referred early
for OHT. Copyright © 2023

<16>
Accession Number
2026115520
Title
Risk Factors Associated With Cardiac Implantable Electronic Device (CIED)
Infections: An Australian Linked Data Study.
Source
Heart Lung and Circulation. Conference: 71st Annual Scientific Meeting of
the Cardiac Society of Australia and New Zealand. Adelaide Australia.
32(Supplement 3) (pp S213), 2023. Date of Publication: July 2023.
Author
Hill M.; Shawon S.; Sotade O.; Strachan L.; Challis G.; King K.; Jorm L.
Institution
(Hill, Strachan, Challis, King) Medtronic, Sydney, NSW, Australia
(Shawon, Sotade, Jorm) 2Centre for Big Data Research in Health,
UNSW, Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background: Cardiac implantable electronic device (CIED) infection is a
serious complication associated with significant morbidity and mortality
[1]. The European Heart Rhythm Association (EHRA) guidelines include risk
factors for CIED infections, which were derived from a meta-analysis of
pooled data including >200,000 patients in 60 international studies [1].
There is limited evidence on the risk factors for CIED infection in the
Australian setting. This study aimed to examine the predictors of CIED
infection. Method(s): This was a retrospective cohort study using
secondary linked hospital data for patients who underwent CIED procedures
from January 2016 to June 2020 in private hospitals and to June 2021 in
public hospitals in New South Wales, Australia. Multivariable Cox
regression, adjusted for age, sex, and comorbidities, was used to identify
predictors of CIED infection. Result(s): Of the 37,675 patients
undergoing CIED procedures, hospitalisations for infections occurred in
500 patients (1.3%). The following factors were significantly associated
with CIED infection: previous CIED infection (HR 14.43), younger age (HR
1.66), device type (HR 1.47 for cardiac resynchronisation therapy CRT-P;
HR 1.69 for CRT-D), previous CIED procedure (HR 1.90 for revision; HR 1.54
for replacement; HR 1.69 for one procedure; HR 3.06 for two or more
procedures), concomitant cardiac surgery (HR 1.59), atrial fibrillation
(HR 1.24), congestive heart failure (HR 1.36), chronic kidney disease (HR
1.57), chronic obstructive pulmonary disease (HR 1.25), cardiomyopathy (HR
1.57), and obesity (HR 1.26). Conclusion(s): Patient-relevant
factors, specific comorbidities, previous CIED procedures, and especially
previous CIED infection are risk factors for a CIED infection in
Australia. Copyright © 2023

<17>
Accession Number
2024775186
Title
Comparison of outcomes of self-expanding versus balloon-expandable valves
for transcatheter aortic valve replacement: a meta-analysis of randomized
and propensity-matched studies.
Source
BMC Cardiovascular Disorders. 23(1) (no pagination), 2023. Article Number:
382. Date of Publication: December 2023.
Author
Wang B.; Mei Z.; Ge X.; Li Y.; Zhou Q.; Meng X.; An G.
Institution
(Wang, Mei, Ge, Li, Zhou, Meng, An) National Key Laboratory for Innovation
and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular
Remodeling and Function Research, Chinese Ministry of Education, Chinese
National Health Commission and Chinese Academy of Medical Sciences, Qilu
Hospital of Shandong University, Jinan, China
Publisher
BioMed Central Ltd
Abstract
Background: The postoperative outcomes of transcatheter aortic valve
replacement (TAVR) with the new generation of self-expanding valves (SEV)
and balloon-expandable valves (BEV) remain uncertain. Method(s): We
conducted a meta-analysis based on randomized controlled trials (RCTs) and
propensity score-matched (PSM) studies to evaluate the performance of the
new generation TAVR devices, with a focus on Edwards SAPIEN 3/Ultra BEV,
Medtronic Evolut R/PRO SEV, and Boston ACURATE neo SEV. Our primary
endpoints were mortality and complications at both 30 days and one year
post-operation. Result(s): A total of 4 RCTs and 14 PSM studies were
included. Our findings showed no significant difference between SEV and
BEV regarding 30-day and 1-year mortality rates. ACURATE SEV required less
permanent pacemaker implantation (PPI) at 30-day as compared to SAPIEN
BEV, while Evolut SEV required a higher rate of PPI than SAPIEN BEV. The
incidence of stroke, major or life-threatening bleeding (MLTB), major
vascular complications (MVC), coronary artery obstruction (CAO) and acute
kidney injury (AKI) did not differ significantly between the two groups.
SEV had a larger effective orifice area (EOA) and lower mean transvalvular
gradients (MPG) compared to BEV. However, there was an increased risk of
paravalvular leakage (PVL) associated with SEV. Conclusion(s): In
terms of 30-day mortality, stroke, bleeding, MVC, AKI, CAO, and one-year
mortality, there was comparability between the two valve types following
TAVR. SEV was associated with better hemodynamic outcomes, except for a
higher incidence of PVL. Compared to SAPIEN BEV, ACURATE SEV had a lower
risk of PPI at 30 days, while Evolut SEV was associated with a higher risk
of PPI. These findings underscore the importance of personalized valve
selection. Copyright © 2023, The Author(s).

<18>
Accession Number
641916409
Title
Surgical outcomes of double-orifice mitral valve repair in patients with
atrioventricular canal defects: a systematic review and meta-analysis.
Source
Cardiology in the young. (pp 1-11), 2023. Date of Publication: 31 Jul
2023.
Author
Ghosh S.; Halder V.; Mittal A.; Mishra A.; Haranal M.; Aggarwal P.; Singh
H.; Barwad P.; Naganur S.; Thingnam S.K.S.
Institution
(Ghosh, Naganur) Department of Cardiology, PGIMER, Chandigarh, India
(Halder, Haranal, Barwad, Thingnam) AhmedabadIndia
(Mittal, Mishra, Aggarwal, Singh) Department of CTVS, PGIMER, Chandigarh,
India
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Double-orifice mitral valve or left atrioventricular valve
is a rare congenital cardiac anomaly that may be associated with an
atrioventricular septal defect. The surgical management of double-orifice
mitral valve/double-orifice left atrioventricular valve with
atrioventricular septal defect is highly challenging with acceptable
clinical outcomes. This meta-analysis is aimed to evaluate the surgical
outcomes of double-orifice mitral valve/double-orifice left
atrioventricular valve repair in patients with atrioventricular septal
defect. METHODS AND RESULTS: A total of eight studies were retrieved from
the literature by searching through PubMed, Google Scholar, Embase, and
Cochrane databases. Using Bayesian hierarchical models, we estimated the
pooled proportion of incidence of double-orifice mitral
valve/double-orifice left atrioventricular valve with atrioventricular
septal defect as 4.88% in patients who underwent surgical repair (7
studies; 3295 patients; 95% credible interval [CI] 4.2-5.7%). As compared
to pre-operative regurgitation, the pooled proportions of post-operative
regurgitation were significantly low in patients with moderate status: 5.1
versus 26.39% and severe status: 5.7 versus 29.38% [8 studies; 171
patients]. Moreover, the heterogeneity test revealed consistency in the
data (p < 0.05). Lastly, the pooled estimated proportions of early and
late mortality following surgical interventions were low, that is, 5 and
7.4%, respectively. CONCLUSION(S): The surgical management of
moderate to severe regurgitation showed corrective benefits
post-operatively and was associated with low incidence of early mortality
and re-operation.

<19>
Accession Number
2025866366
Title
Impact of obstructive sleep apnea in cardiovascular risk in the pediatric
population: A systematic review.
Source
Sleep Medicine Reviews. 71 (no pagination), 2023. Article Number: 101818.
Date of Publication: October 2023.
Author
Castillo-Garcia M.; Solano-Perez E.; Coso C.; Romero-Peralta S.;
Garcia-Borreguero D.; Izquierdo J.L.; Mediano O.
Institution
(Castillo-Garcia, Solano-Perez, Coso, Romero-Peralta, Izquierdo, Mediano)
Pneumology Department, Hospital Universitario de Guadalajara, Sleep Unit,
Guadalajara, Spain
(Castillo-Garcia, Romero-Peralta) Predoctoral Student in Universidad de
Alcala, Madrid, Spain
(Castillo-Garcia, Romero-Peralta, Garcia-Borreguero) Sleep Research
Institute, Madrid, Spain
(Solano-Perez, Coso, Mediano) Centro de Investigacion Biomedica en Red de
Enfermedades Respiratorias (CIBERES), Madrid, Spain
(Izquierdo, Mediano) Medicine Department, Universidad de Alcala, Madrid,
Spain
Publisher
W.B. Saunders Ltd
Abstract
While the association of obstructive sleep apnea (OSA) with an increased
cardiovascular risk (CVR) in the adult population is well known, there is
insufficient evidence to affirm something similar in the pediatric
population. On the other hand, adenotonsillectomy has been shown to be an
effective treatment. Our objective was to evaluate the association of
sleep respiratory disorders in children with increased CVR and the impact
of adenotonsillectomy in the literature. To this aim, a literature search
was conducted, between 2002 to the present. After carrying out a
systematic review, the following results were provided: thoracic
echocardiography after surgery found improvements in terms of cardiac
function and structure; blood pressure (BP) measurement, verified a
tendency to higher BP values in the OSA pediatric population, which
improved after surgery; different biomarkers of CVR, were increased in OSA
patients and improved after treatment and finally; some studies found
endothelial dysfunction in pediatric OSA, a measurement of vascular system
function, was reversible with adenotonsillectomy. Increases in BP
parameters, biological markers related to CVR and alterations in cardiac
function structure, have been reported in pediatric patients with OSA. At
least, some of these parameters would be reversible after
adenotonsillectomy, reflecting a possible reduction in CVR. Copyright
© 2023 Elsevier Ltd

<20>
Accession Number
2025735226
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
left main coronary artery disease: A randomized controlled trial.
Source
Journal of the Pakistan Medical Association. 73(4) (pp S22-S25), 2023.
Date of Publication: April 2023.
Author
Mady K.M.; Ettish A.A.A.; Elfeky W.M.; Abdelaal M.M.
Institution
(Mady, Ettish, Elfeky, Abdelaal) Department of Cardiothoracic Surgery,
Kafrelsheikh University, Egypt
Publisher
Pakistan Medical Association
Abstract
Objective: To compare the outcome of off-pump and on-pump coronary artery
bypass graft surgery in patients with left main coronary artery disease.
 Method(s): The randomised, controlled, prospective, multicentric
study was conducted in 2020 during the period from January 2020 to
December 2020 at Kafrelsheikh University Hospital, International Cardiac
Centre and Alexandria New Medical Centre, Egypt, and comprised patients
with left main coronary artery disease who underwent coronary artery
bypass graft surgery. The patients were randomised to on-pump surgery
group I (Control Group) and off-pump surgery group II(Interventional
Group). All patients were assessed pre-operatively for the presence of
comorbid conditions and post-operatively for myocardial infarction, acute
kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data
was analysed using SPSS 20. Result(s): Of the 60 patients, 44(73.3%)
were men and 16(26.6%) were women. The overall mean age was 66.4+/-9.2
years. There were 30(50%) patients in each of the two groups. There were
2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II.
There was 1(3.3%) case of acute kidney injury in group I and none in group
II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in
group II. There was 1(3.3%) case of sternal dehiscence in group I and none
in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in
group II. There was no significant difference with respect to outcome
between the groups (p>0.05). Conclusion(s): Off-pump coronary artery
bypass graft surgery was found to be efficient and non-inferior to on-pump
procedure in patients with left main coronary artery
disease. Copyright © 2023 Pakistan Medical Association. All
rights reserved.

<21>
Accession Number
2025643336
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
chronic obstructive pulmonary disease.
Source
Journal of the Pakistan Medical Association. 73(4) (pp S34-S38), 2023.
Date of Publication: 2023.
Author
Mady K.M.; Ettish A.A.A.; Elfeky W.M.; Abdelaal M.M.
Institution
(Mady, Ettish, Elfeky, Abdelaal) Department of Cardiothoracic Surgery,
Kafrelsheikh University, Egypt
Publisher
Pakistan Medical Association
Abstract
Objective: To compare the outcome of coronary artery bypass grafting with
and without cardiopulmonary bypass in patients of chronic obstructive
pulmonary disease. Method(s): The prospective randomised multicentre
study was conducted in 2020 at Kafrelsheikh University Hospital,
International Cardiac Centre and Alexandria New Medical Centre, Egypt.
Patients regardless of age and gender who had ischaemic heart disease and
chronic obstructive pulmonary disease were enrolled, and randomised into
on-pump procedure group 1 and off-pump procedure group II. All patients
were assessed preoperatively for pulmonary function tests and
postoperatively for duration of mechanical ventilation, respiratory
failure, pneumonia, atrial fibrillation, acute respiratory distress
syndrome, pleural effusion, lung atelectasis, sternal dehiscence,
intensive care unit stay and overall hospital stay. Data was analysed
using SPSS ver 25 Armonk, NY: IBM Corp.; Released 2017. Result(s): Of
the 60 patients, 30(50%) were in each of the two groups. Overall, there
were 20(33.3%) women and 40(66.6%) men with mean age 56.5+/-6.05 years.
The mean duration of mechanical ventilation in group I was 12.07+/-5.18
minutes compared to 6.97+/-2.25 minutes in group II (p<0.001). The mean
duration of stay in intensive care unit in group I was 4.17+/-1.64 days
compared to 3.03+/-1.03 days in group II (p<0.001). The mean hospital stay
was 7.40+/-1.90 days in group I and 5.93+/-1.17 days in group II
(p<0.001). There was no significant difference between the groups
regarding the frequency of respiratory failure, pneumonia, atrial
fibrillation, acute respiratory distress syndrome, pleural effusion, lung
atelectasis and sternal dehiscence (p=1.000) Conclusion(s): Off-pump
coronary artery bypass grafting was found to be efficient and had a faster
postoperative course than on-pump procedure in patients with chronic
obstructive pulmonary disease. Copyright © 2023 Pakistan Medical
Association. All rights reserved.

<22>
Accession Number
2025395994
Title
Effects of Elective Coronary Revascularization vs Medical Therapy Alone on
Noncardiac Mortality: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 16(10) (pp 1144-1156), 2023. Date of
Publication: 22 May 2023.
Author
Navarese E.P.; Lansky A.J.; Farkouh M.E.; Grzelakowska K.; Bonaca M.P.;
Gorog D.A.; Raggi P.; Kelm M.; Yeo B.; Uminska J.; Curzen N.; Kubica J.;
Wijns W.; Kereiakes D.J.
Institution
(Navarese, Grzelakowska, Yeo, Uminska, Kubica) Interventional Cardiology
and Cardiovascular Medicine Research, Department of Cardiology and
Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
(Navarese, Raggi) Faculty of Medicine, University of Alberta, Edmonton,
AB, Canada
(Navarese, Grzelakowska, Yeo, Uminska, Kubica) SIRIO MEDICINE Research
Network, Bydgoszcz, Poland
(Lansky) Yale School of Medicine, New Haven, CT, United States
(Farkouh) Peter Munk Cardiac Centre, University of Toronto, Toronto, ON,
Canada
(Farkouh) Cedars Sinai Health System, Los Angeles, Canada
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
Aurora, CO, United States
(Gorog) Faculty of Medicine, National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Gorog) Cardiology Department, East and North Hertfordshire NHS Trust,
Stevenage, United Kingdom
(Kelm) Heinrich Heine University Medical Center Dusseldorf, Dusseldorf,
Germany
(Kelm) Division of Cardiology, Pulmonology, and Vascular Medicine,
Cardiovascular Research Institute Dusseldorf, Dusseldorf, Germany
(Curzen) University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Curzen) University of Southampton, Southampton, United Kingdom
(Wijns) Lambe Institute for Translational Medicine and CURAM, National
University of Ireland Galway and Saolta University Healthcare Group,
Galway, Ireland
(Kereiakes) Christ Hospital and Lindner Research Center, Cincinnati, OH,
United States
Publisher
Elsevier Inc.
Abstract
Background: Uncertainty exists whether coronary revascularization plus
medical therapy (MT) is associated with an increase in noncardiac
mortality in chronic coronary syndrome (CCS) when compared with MT alone,
particularly following recent data from the ISCHEMIA-EXTEND (International
Study of Comparative Health Effectiveness with Medical and Invasive
Approaches) trial. Objective(s): This study conducted a large-scale
meta-analysis of trials comparing elective coronary revascularization plus
MT vs MT alone in patients with CCS to determine whether revascularization
has a differential impact on noncardiac mortality at the longest
follow-up. Method(s): We searched for randomized trials comparing
revascularization plus MT vs MT alone in patients with CCS. Treatment
effects were measured by rate ratios (RRs) with 95% CIs, using
random-effects models. Noncardiac mortality was the prespecified endpoint.
The study is registered with PROSPERO (CRD42022380664). Result(s):
Eighteen trials were included involving 16,908 patients randomized to
either revascularization plus MT (n = 8,665) or to MT alone (n = 8,243).
No significant differences were detected in noncardiac mortality between
the assigned treatment groups (RR: 1.09; 95% CI: 0.94-1.26; P = 0.26),
with absent heterogeneity (I2 = 0%). Results were consistent
without the ISCHEMIA trial (RR: 1.00; 95% CI: 0.84-1.18; P = 0.97). By
meta-regression, follow-up duration did not affect noncardiac death rates
with revascularization plus MT vs MT alone (P = 0.52). Trial sequential
analysis confirmed the reliability of meta-analysis, with the cumulative
Z-curve of trial evidence within the nonsignificance area and reaching
futility boundaries. Bayesian meta-analysis findings were consistent with
the standard approach (RR: 1.08; 95% credible interval: 0.90-1.31).
 Conclusion(s): In patients with CCS, noncardiac mortality in late
follow-up was similar for revascularization plus MT compared with MT
alone. Copyright © 2023 American College of Cardiology Foundation

<23>
Accession Number
2025376633
Title
A Systematic Review and Meta-Analysis of Prevalence, Characteristics, and
Impact of Mitral Annular Calcification on Outcomes After Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 201 (pp 123-130), 2023. Date of
Publication: 15 Aug 2023.
Author
Moin A.; Lak H.M.; Zafar M.; Tariq R.; Shaikh F.H.; Mussa M.; Bansal A.;
Shekhar S.; Harb S.; Unai S.; Kapadia S.R.
Institution
(Moin, Zafar, Tariq, Mussa) Department of Internal Medicine, Dow Medical
College, Civil Hospital, Karachi, Pakistan
(Lak) Section of Clinical Cardiology, Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Sydell and Arnold Miller Family
Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Shaikh) Department of Cardiology, Dow Medical College, Civil Hospital,
Karachi, Pakistan
(Bansal, Shekhar, Harb, Kapadia) Aortic Valve Center, Robert and Suzanne
Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller
Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland,
Ohio, United States
(Unai) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
Publisher
Elsevier Inc.
Abstract
There is a paucity of data on the prognostic impact of mitral annular
calcification (MAC) in patients who underwent transcatheter aortic valve
implantation (TAVI) with conflicting results being reported by the studies
that are published. Therefore, we performed a meta-analysis to assess the
short-term and long-term outcomes of MAC in patients after TAVI. Of 25,407
studies identified after the initial database search, 4 observational
studies comprising 2,620 patients (2,030 patients in the nonsevere MAC arm
and 590 patients in the severe MAC arm) were included in the final
analysis. Compared with patients with nonsevere MAC, the severe MAC group
was associated with significantly higher incidences of overall bleeding
(0.75 [0.57 to 0.98], p = 0.03, I2 = 0%) at 30 days. However,
no significant difference was observed between the 2 groups for the rest
of the 30-day outcomes: all-cause mortality (0.79 [0.42 to 1.48], p =
0.46, I2 = 9%), myocardial infarction (1.62 [0.37 to 7.04], p =
0.52, I2 = 0%), cerebrovascular accident or stroke (1.22 [0.53
to 2.83], p = 0.64, I2 = 0%), acute kidney injury (1.48 [0.64
to 3.42], p = 0.35, I2 = 0%), and pacemaker implantation (0.70
[0.39 to 1.25], p = 0.23, I2 = 68%). Similarly, follow-up
outcomes also showed no significant difference between the 2 groups:
all-cause mortality (0.69 [0.46 to 1.03], p = 0.07, I2 = 44%),
cardiovascular mortality (0.52 [0.24 to 1.13], p = 0.10, I2 =
70%) and stroke (0.83 [0.41 to 1.69], p = 0.61, I2 = 22%). The
sensitivity analysis, however, demonstrated significant results for
all-cause mortality (0.57 [0.39 to 0.84], p = 0.005, I2 = 7%)
by removing the study by Okuno et al5 and cardiovascular
mortality (0.41 [0.21 to 0.82], p = 0.01, I2 = 66%) by removing
the study by Lak et al.7 In conclusion, our meta-analysis
corroborates the notion that isolated MAC is not an independent predictor
of long-term mortality after TAVI and determines severe MAC to be a
predictor of mortality at follow-up because of the higher incidence of
mitral valve dysfunction associated with it. Copyright © 2023

<24>
Accession Number
2025144498
Title
Effect of vitamin D on postoperative atrial fibrillation in patients who
underwent coronary artery bypass grafting: A systematic review and
meta-analysis.
Source
Journal of Cardiology. 82(3) (pp 220-224), 2023. Date of Publication:
September 2023.
Author
Hameed I.; Malik S.; Nusrat K.; Siddiqui O.M.; Khan M.O.; Mahmood S.;
Memon A.; Usman M.S.; Siddiqi T.J.
Institution
(Hameed, Malik, Nusrat, Siddiqui, Khan, Mahmood, Memon) Dow University of
Health Sciences, Karachi, Pakistan
(Usman, Siddiqi) University of Mississippi Medical Center, Jackson, MS,
United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Vitamin D insufficiency/deficiency has been identified as a
risk factor for postoperative atrial fibrillation (POAF) after coronary
artery bypass grafting (CABG). This is associated with significantly
increased morbidity and mortality leading to not only prolonged hospital
and intensive care unit (ICU) stay, but increased risk of stroke, heart
failure, dementia, and long-term atrial fibrillation. This analysis aims
to evaluate the efficacy of vitamin D supplementation in preventing POAF
in patients undergoing CABG. Method(s): We searched PubMed, Cochrane
Central Register of Controlled Trials and SCOPUS from inception to June
2022 for randomized controlled trials (RCTs). The outcome of interest was
the incidence of POAF. Secondarily, we analyzed the length of ICU stay,
length of hospital stay, cardiac arrest, cardiac tamponade, and blood
transfusion. Results were pooled using a random-effect model. Three RCTs
consisting of 448 patients were included. Result(s): Our results
suggest that vitamin D significantly reduced the incidence of POAF (RR:
0.60; 95 % CI: 0.40, 0.90; p = 0.01; I2 = 8 %). It was also
observed that vitamin D significantly reduced the duration of ICU stay
(WMD: -1.639; 95 % CI: -1.857, -1.420; p < 0.00001). Furthermore, the
length of hospital stay (WMD: -0.85; 95 % CI: -2.14, 0.43; p = 0.19;
I2 = 87 %) was also reduced, however, the result was not
significant. Conclusion(s): Our pooled analysis suggests that vitamin
D prevents POAF. Future large-scale randomized trials are needed to
confirm our results. Copyright © 2023 Elsevier Ltd

<25>
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. 37(9) (pp 1744-1750),
2023. Date of Publication: September 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.
 Design(s): Meta-analysis of randomized controlled trials.
 Setting(s): Postoperative care. Intervention(s): Perioperative
regional anesthesia. Patient(s): Adults undergoing thoracic surgery.
 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. 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. Copyright
© 2023 Elsevier Inc.

<26>
Accession Number
2024818471
Title
Albumin Infusion and Blood Loss After Cardiac Surgery.
Source
Annals of Thoracic Surgery. 116(2) (pp 392-399), 2023. Date of
Publication: August 2023.
Author
Talvasto A.; Ilmakunnas M.; Raivio P.; Vlasov H.; Hiippala S.; Suojaranta
R.; Wilkman E.; Petaja L.; Helve O.; Juvonen T.; Pesonen E.
Institution
(Talvasto, Ilmakunnas, Vlasov, Hiippala, Suojaranta, Wilkman, Petaja,
Pesonen) Department of Anesthesiology and Intensive Care Medicine,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Raivio, Juvonen) Department of Cardiac Surgery, Heart and Lung Center,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Helve) Pediatric Research Center, Children's Hospital, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Helve) Department of Health Security, Finnish Institute for Health and
Welfare, Helsinki, Finland
Publisher
Elsevier Inc.
Abstract
Background: In the recent ALBICS (ALBumin In Cardiac Surgery) trial, 4%
albumin used for cardiopulmonary bypass priming and volume replacement
increased perioperative bleeding compared with Ringer acetate. In the
present exploratory study, albumin-related bleeding was further
characterized. Method(s): Ringer acetate and 4% albumin were compared
in a randomized, double-blinded fashion in 1386 on-pump adult cardiac
surgery patients. The study end points for bleeding were the Universal
Definition of Perioperative Bleeding (UDPB) class and its components.
 Result(s): The UDPB bleeding grades were higher in the albumin group
than the Ringer group: "insignificant" (albumin vs Ringer: 47.5% vs
62.9%), "mild" (12.7% vs 8.9%), "moderate" (28.7% vs 24.4%), "severe"
(10.2% vs 3.2%), and "massive" (0.9% vs. 0.6%; P < .001). Patients in the
albumin group received red blood cells (45.2% vs 31.5%; odds ratio [OR],
1.80; 95% CI, 1.44-2.24; P < .001), platelets (33.3% vs 21.8%; OR, 1.79;
95% CI, 1.41-2.28; P < .001), and fibrinogen (5.6% vs 2.6%; OR, 2.24; 95%
CI, 1.27-3.95; P < .05), and underwent resternotomy (5.3% vs 1.9%; OR,
2.95; 95% CI, 1.55-5.60, P < .001) more often than patients in the Ringer
group. The strongest predictors of bleeding were albumin group allocation
(OR, 2.18; 95% CI, 1.74-2.74) and complex (OR, 2.61; 95% CI, 2.02-3.37)
and urgent surgery (OR, 1.63; 95% CI, 1.26-2.13). In interaction analysis,
the effect of albumin on the risk of bleeding was stronger in patients on
preoperative acetylsalicylic acid. Conclusion(s): Perioperative
administration of albumin, compared with Ringer's acetate, resulted in
increased blood loss and higher UDBP class. The magnitude of this effect
was similar to the complexity and urgency of the surgery. Copyright
© 2023 The Society of Thoracic Surgeons

<27>
Accession Number
2024817389
Title
A systematic review of biological changes in surgeons' acute stress levels
during surgery.
Source
Surgery in Practice and Science. 13 (no pagination), 2023. Article Number:
100174. Date of Publication: June 2023.
Author
Budden A.; Song S.; Henry A.; Wakefield C.E.; Abbott J.
Institution
(Budden, Song, Abbott) Gynaecological Research and Clinical Evaluation
(GRACE) Group, Royal Hospital for Women, Sydney, Australia
(Budden, Song, Henry, Wakefield, Abbott) School of Clinical Medicine,
UNSW, Sydney, Australia
(Henry) Department of Women's and Children's Health, St George Hospital,
Sydney, Australia
(Wakefield) Kids Cancer Centre, Sydney Children's Hospital, Sydney,
Australia
Publisher
Elsevier Ltd
Abstract
Background: While a degree of stress facilitates learning and task
performance, excessive stress in surgeons may lead to poor patient
outcomes, with maladaptive stress as a risk factor for surgeon burnout or
self-harm through mechanisms including substance abuse, and suicide. We
aim to systematically review publications investigating how measures of
surgeons' acute biological stress change during surgery. Method(s):
Medline, Embase, Cochrane library, and The United States, Australian, and
European clinical trials registries were searched using the terms stress;
surgeon; cortisol; skin conductance; and heart rate. Studies had to report
at least one measure of biological stress related to surgery or simulated
surgical exercise and have been published between January 1996 to June
2022. Result(s): Twenty-eight studies with a total of 433
participants met inclusion criteria with cortisol, heart rate, heart rate
variability, and electrodermal activity being reported. Salivary cortisol
was measured in four studies with conflicting directional changes
reported. Mean heart rate increased in nine studies (by 6-22
beats/minute), however the impact of the physical work of surgery was not
reported. Heart rate variability, as measured by low-frequency to
high-frequency ratio, was significantly increased in three of six studies.
One study measured electrodermal activity reporting significant increase
in skin conductance in a simulation setting. Conclusion(s): While
some biological measures appear able to detect changes in acute stress in
surgeons (particularly heart rate), appropriate measures of stress during
non-stressful and stressful surgery are yet to be fully identified.
Importantly, there are no current pathways for identifying surgeons at
risk of burnout or self-harm and this is a critical unmet research
need. Copyright © 2023

<28>
Accession Number
2024605420
Title
UpStreAm doxycycline in ST-eLeVation myocArdial infarction: targetinG
infarct hEaling and ModulatIon (SALVAGE-MI trial).
Source
European Heart Journal: Acute Cardiovascular Care. 12(3) (pp 143-152),
2023. Date of Publication: 01 Mar 2023.
Author
Noaman S.; Neil C.; O'Brien J.; Frenneaux M.; Hare J.; Wang B.; Tai T.Y.;
Theuerle J.; Shaw J.; Stub D.; Bloom J.; Walton A.; Duffy S.J.; Peter
K.-H.; Cox N.; Kaye D.M.; Taylor A.; Chan W.
Institution
(Noaman, Neil, Stub, Cox, Chan) Department of Cardiology, Western Health,
176 Furlong Rd, St Albans, VIC, Australia
(Noaman, O'Brien, Hare, Theuerle, Shaw, Stub, Bloom, Walton, Duffy, Peter,
Kaye, Taylor, Chan) Department of Cardiology, Alfred Health, 55 Commercial
Road, Melbourne, VIC 3004, Australia
(Noaman, Neil, Chan) Department of Medicine, University of Melbourne,
Building 104, Alan Gilbert Building University of Melbourne, 161 Barry St,
Carlton, VIC, Australia
(Noaman, Wang, Tai, Peter, Kaye, Chan) Department of Heart Failure
Research, Baker IDI Heart and Diabetes Institute, 75 Commercial Rd,
Melbourne, VIC, Australia
(Frenneaux) Department of Cardiology, Hamad Medical Corporation, Doha
7GPR+3M9, Qatar
(Duffy) Department of Public Health and Preventive Medicine, Centre of
Cardiovascular Research and Education in Therapeutics (CCRET), Monash
University, 29 Ancora Imparo Way, Clayton, VIC, Australia
Publisher
Oxford University Press
Abstract
Aims Experimental studies demonstrate protective effects of doxycycline on
myocardial ischaemia-reperfusion injury. The trial investigated whether
doxycycline administered prior to reperfusion in patients presenting with
ST-elevation myocardial infarction (STEMI) reduces infarct size (IS) and
ameliorates adverse left ventricular (LV) remodelling. Methods and results
In this randomized, double-blind, placebo-controlled trial, patients
presenting with STEMI undergoing primary percutaneous coronary
intervention (PPCI) were randomized to either intravenous doxycycline or
placebo prior to reperfusion followed by 7 days of oral doxycycline or
placebo. The primary outcome was final IS adjusted for area-at-risk
(fIS/AAR) measured on two cardiac magnetic resonance scans ~6 months
apart. Of 103 participants, 50 were randomized to doxycycline and 53 to
placebo and were matched for age (59 +/- 12 vs. 60 +/- 10 years), male sex
(92% vs. 79%), diabetes mellitus (26% vs. 11%) and left anterior
descending artery occlusion (50% vs. 49%), all P > 0.05. Patients treated
with doxycycline had a trend for larger fIS/AAR [0.79 (0.5-0.9) vs. 0.61
(0.47-0.76), P = 0.06], larger fIS at 6 months [18.8% (12-26) vs. 13.6%
(11-21), P = 0.08], but similar acute IS [21.7% (17-34) vs. 19.4% (14-27),
P = 0.19] and AAR [26% (20-36) vs. 24.7% (16-31), P = 0.22] compared with
placebo. Doxycycline did not ameliorate adverse LV remodelling
[%DELTAend-diastolic volume index, 1.1% (-3.8-8.4) vs. -1.34% (-6.1-5.8),
P = 0.42] and was independently associated with larger fIS (regression
coefficient = 0.175, P = 0.03). Conclusion Doxycycline prior to PPCI
neither reduced IS acutely or at six months nor attenuated adverse LV
remodelling. These data raise safety concerns regarding doxycycline use in
STEMI for infarct modulation and healing. Copyright © The
Author(s) 2022. Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
2024544073
Title
Transcatheter Aortic Valve Replacement and Impact of Subclinical Leaflet
Thrombosis in Low-Risk Patients: LRT Trial 4-Year Outcomes.
Source
Circulation: Cardiovascular Interventions. 16(5) (pp E012655), 2023. Date
of Publication: 01 May 2023.
Author
Waksman R.; Bhogal S.; Gordon P.; Ehsan A.; Wilson S.R.; Levitt R.; Parikh
P.; Bilfinger T.; Hanna N.; Buchbinder M.; Asch F.M.; Kim F.Y.; Weissman
G.; Ben-Dor I.; Shults C.C.; Ali S.; Sutton J.A.; Shea C.; Zhang C.;
Garcia-Garcia H.M.; Satler L.F.; Rogers T.
Institution
(Waksman, Bhogal, Ben-Dor, Ali, Sutton, Shea, Zhang, Garcia-Garcia,
Satler, Rogers) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Gordon) Division of Cardiology, Miriam Hospital, Providence, RI, United
States
(Ehsan) Division of Cardiothoracic Surgery, Lifespan Cardiovascular
Institute, Providence, RI, United States
(Wilson) Department of Cardiology, North Shore University Hospital,
Manhasset, NY, United States
(Levitt) Department of Cardiology, HCA Virginia Health System, Richmond,
United States
(Parikh) Department of Medicine, Stony Brook Hospital, NY, United States
(Bilfinger) Department of Surgery, Stony Brook Hospital, NY, United States
(Hanna) John Heart Institute Cardiovascular Consultants, St. John Health
System, Tulsa, OK, United States
(Buchbinder) Foundation for Cardiovascular Medicine, Stanford University,
CA, United States
(Asch) MedStar Health Research Institute, MedStar Washington Hospital
Center, DC, United States
(Kim) Department of Interventional Cardiology, Valley Health, Ridgewood,
NJ, United States
(Weissman) Department of Cardiology, MedStar Washington Hospital Center,
DC, United States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital
Center, DC, United States
(Rogers) Cardiovascular Branch, Division of Intramural Research, National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda,
MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The LRT trial (Low-Risk Transcatheter Aortic Valve Replacement
[TAVR]) demonstrated the safety and feasibility of TAVR in low-risk
patients, with excellent 1- and 2-year outcomes. The objective of the
current study is to provide the overall clinical outcomes and the impact
of 30-day hypoattenuated leaflet thickening (HALT) on structural valve
deterioration at 4 years. Method(s): The prospective, multicenter LRT
trial was the first Food and Drug Administration-approved investigational
device exemption study to evaluate feasibility and safety of TAVR in
low-risk patients with symptomatic severe tricuspid aortic stenosis.
Clinical outcomes and valve hemodynamics were documented annually through
4 years. Result(s): A total of 200 patients were enrolled, and
follow-up was available on 177 patients at 4 years. The rates of all-cause
mortality and cardiovascular death were 11.9% and 3.3%, respectively. The
stroke rate rose from 0.5% at 30 days to 7.5% at 4 years, and permanent
pacemaker implantation rose from 6.5% at 30 days to 11.7% at 4 years.
Endocarditis was detected in 2.5% of the cohort, with no new cases
reported between 2 and 4 years. Transcatheter heart valve hemodynamics
remained excellent post-procedure and were maintained (mean gradient
12.56+/-5.54 mm Hg and aortic valve area 1.69+/-0.52 cm2) at 4
years. At 30 days, HALT was observed in 14% of subjects who received a
balloon-expandable transcatheter heart valve. There was no difference in
valve hemodynamics between patients with and without HALT (mean gradient
14.94+/-5.01 mm Hg versus 12.3+/-5.57 mm Hg; P=0.23) at 4 years. The
overall rate of structural valve deterioration was 5.8%, and there was no
impact of HALT on valve hemodynamics, endocarditis, or stroke at 4 years.
 Conclusion(s): TAVR in low-risk patients with symptomatic severe
tricuspid aortic stenosis was found to be safe and durable at 4 years.
Structural valve deterioration rates were low irrespective of the type of
valve, and the presence of HALT at 30 days did not affect structural valve
deterioration, transcatheter valve hemodynamics, and stroke rate at 4
years. Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT02628899. Copyright © 2023 Lippincott Williams and
Wilkins. All rights reserved.

<30>
Accession Number
2024543520
Title
Risk of parenterally transmitted hepatitis following exposure to invasive
procedures in Italy: SEIEVA surveillance 2000-2021.
Source
Journal of Hepatology. 79(1) (pp 61-68), 2023. Date of Publication: July
2023.
Author
Caminada S.; Mele A.; Ferrigno L.; Alfonsi V.; Crateri S.; Iantosca G.;
Sabato M.; Tosti M.E.
Institution
(Caminada, Mele, Sabato) Sapienza University of Rome, Department of Public
Health and Infectious Diseases, Rome, Italy
(Mele) Prevention Department - Health Local Unit Lecce, Italy
(Ferrigno, Crateri, Iantosca, Tosti) Istituto Superiore di Sanita,
National Centre for Global Health, Rome, Italy
(Alfonsi) Sant'Andrea Hospital, University La Sapienza, Rome, Italy
Publisher
Elsevier B.V.
Abstract
Background & Aims: Surgical interventions and invasive
diagnostic/therapeutic procedures are known routes of transmission of
viral hepatitis. Using data from the Italian surveillance system for acute
viral hepatitis (SEIEVA), the aim of this study was to investigate the
association between specific types of invasive procedures and the risk of
acute HBV and HCV infections. Method(s): Data from SEIEVA (period
2000-2021) were used. The association between acute HBV and HCV infection
and potential risk factors, i.e. surgical interventions and
diagnostic/therapeutic procedures (given according to the ICD-9-CM
classification), was investigated in comparison to age-matched hepatitis A
cases, used as controls, by conditional multiple logistic regression
analysis. Result(s): A total of 8,176 cases with acute HBV, 2,179
with acute HCV, and the respective age-matched controls with acute HAV
infection were selected for the main analysis. Most of the procedures
evaluated were associated with the risk of acquiring HBV or HCV. The
strongest associations for HBV infection were: gynaecological surgery
(odds ratio [OR] 5.19; 95% CI 1.12-24.05), otorhinolaryngological surgery
(OR 3.78; 95% CI 1.76-8.09), and cardiac/thoracic surgery (OR 3.52; 95% CI
1.34-9.23); while for HCV infection, they were: neurosurgery (OR 11.88;
95% CI 2.40-58.85), otorhinolaryngological surgery (OR 11.54; 95% CI
2.55-52.24), and vascular surgery (OR 9.52; 95% CI 3.25-27.87). Hepatitis
C was also strongly associated with ophthalmological surgery (OR 8.32; 95%
CI 2.24-30.92). Biopsy and/or endoscopic procedures were significantly
associated with both HCV (OR 3.84; 95% CI 2.47-5.95) and, to a lesser
extent, HBV infection (OR 1.48; 95% CI 1.16-1.90). Conclusion(s):
Despite the progress made in recent years, invasive procedures still
represent a significant risk factor for acquiring parenterally transmitted
hepatitis viruses, thus explaining the still numerous and unexpected cases
diagnosed among the elderly population in Italy. Our results underline the
importance of observing universal precautions to control the iatrogenic
transmission of hepatitis viruses. Impact and implications: Cases of
parenterally transmitted acute viral hepatitis in the elderly population,
that are difficult to explain based on the most widely recognised risk
factors, continue to be diagnosed in Italy. Based on the Italian SEIEVA
surveillance of acute viral hepatitis data, this study highlights an
increased risk of acquiring hepatitis B and C following exposure to
invasive procedures, which might explain the observed cases in elderly
individuals. Furthermore, this finding emphasises the need to observe
universal precautions strictly, in healthcare settings, including in the
case of minor surgical procedures. Copyright © 2023 The Authors

<31>
Accession Number
2024418892
Title
Surgical Treatment of Atrioesophageal Fistula: A Systematic Review.
Source
Annals of Thoracic Surgery. 116(2) (pp 421-428), 2023. Date of
Publication: August 2023.
Author
Amirkhosravi F.; Azimuddin A.; Nguyen D.T.; Chihara R.; Chan E.Y.; Graviss
E.A.; Reul R.M.; Kim M.P.
Institution
(Amirkhosravi, Chihara, Chan, Kim) Division of Thoracic Surgery,
Department of Surgery, Houston Methodist Hospital, Houston, Texas, United
States
(Azimuddin) Texas A&M University College of Medicine, Bryan, Texas, United
States
(Nguyen, Graviss) Department of Pathology and Genomic Medicine, Houston
Methodist Hospital, Houston, Texas, United States
(Chihara, Chan, Graviss, Kim) Department of Surgery and Cardiothoracic
Surgery, Weill Cornell Medical College, Houston Methodist Hospital,
Houston, Texas, United States
(Reul) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas,
United States
Publisher
Elsevier Inc.
Abstract
Background: Atrioesophageal fistula is a rare and morbid complication of
ablation therapy for atrial fibrillation. Surgery provides increased
survival; however, which surgical approach provides the best outcome is
unclear. Method(s): We performed a retrospective analysis of cases in
the literature and at our institution. We characterized patients by
presenting symptoms, diagnostic method, surgical therapy with different
approaches, and survival. Result(s): In total, 219 patients were
found, with 216 patients identified from 122 papers in the literature and
3 patients from our institutional database (2000-2022). The most common
presenting symptoms included fever/chill (71.8%) and neurologic deficiency
(62.9%). The overall survival for this cohort was 47%. Patients who had an
operation had significantly improved survival compared with those who did
not have an operation (71.9.3% vs 11%, P < .001). Patients who survived
after surgical intervention typically underwent right thoracotomy (45.1%),
patch repair of the left atrium (61.1%), and primary repair of the
esophagus (68.3%) on cardiopulmonary bypass (84.8%) with a flap between
the 2 organs (84.6%). Patients who had cardiopulmonary bypass had
increased survival (39 of 45 [86.7%]) compared with those who did not have
cardiopulmonary bypass (7 of 17 [41.2%], P < .001). Conclusion(s):
Patients with atrioesophageal fistula should undergo surgical
intervention. A patch repair of the left atrium and primary repair of the
esophagus with a flap between the organs during cardiopulmonary bypass is
the most common successful repair. Cardiopulmonary bypass may allow better
debridement and repair of the left atrium, which may provide a survival
advantage in the treatment of this rare disease. Copyright © 2023
The Society of Thoracic Surgeons

<32>
Accession Number
2024384628
Title
Association of Preoperative Prognostic Nutritional Index with Risk of
Postoperative Acute Kidney Injury: A Meta-Analysis of Observational
Studies.
Source
Nutrients. 15(13) (no pagination), 2023. Article Number: 2929. Date of
Publication: July 2023.
Author
Liu C.-C.; Liu P.-H.; Chen H.-T.; Lee C.-W.; Cheng W.-J.; Chen J.-Y.; Hung
K.-C.
Institution
(Liu) Department of Anesthesiology, E-Da Hospital, I-Shou University,
Kaohsiung City 82445, Taiwan (Republic of China)
(Liu) Department of Nursing, College of Medicine, I-Shou University,
Kaohsiung City 82445, Taiwan (Republic of China)
(Liu) School of Medicine, I-Shou University, Kaohsiung City 82445, Taiwan
(Republic of China)
(Liu) Department of Anesthesiology, E-Da Dachang Hospital, I-Shou
University, Kaohsiung City 82445, Taiwan (Republic of China)
(Chen) Department of Chinese Medicine, Chi Mei Medical Center, Tainan City
71004, Taiwan (Republic of China)
(Chen) Division of Nephrology, Department of Internal Medicine, Chi Mei
Medical Center, Tainan City 71004, Taiwan (Republic of China)
(Chen) Department of Health and Nutrition, Chia Nan University of Pharmacy
and Science, Tainan City 71710, Taiwan (Republic of China)
(Lee) Department of Neurology, Chi Mei Medical Center, Tainan City 71004,
Taiwan (Republic of China)
(Cheng) Department of Anesthesiology, Chi Mei Medical Center, Liouying,
Tainan City 73657, Taiwan (Republic of China)
(Chen, Hung) Department of Anesthesiology, Chi Mei Medical Center, Tainan
City 71004, Taiwan (Republic of China)
(Chen, Hung) School of Medicine, College of Medicine, National Sun Yat-Sen
University, Kaohsiung City 80424, Taiwan (Republic of China)
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
This meta-analysis aimed to assess the clinical association of the
preoperative prognostic nutritional index (pre-PNI) with the risk of
postoperative acute kidney injury. Four databases (e.g., Medline) were
searched from inception to December 2022 to investigate the association
between pre-PNI (i.e., low vs. high) and PO-PNI as well as the correlation
between pre-PNI and other postoperative prognostic indices. Overall, 13
observational studies, including 9185 patients, were eligible for
analysis. A low PNI was related to increased risks of PO-AKI [odd ratio
(OR) = 1.65, p = 0.001, 3811 patients], postoperative infection (OR = 2.1,
p < 0.00001, 2291 patients), and mortality (OR = 1.93, p < 0.0001, 2159
patients). Albeit statistically nonsignificant, a trend was noted, linking
a low PNI to higher risks of postoperative bleeding (OR = 2.5, p = 0.12,
1157 patients) and stroke (OR = 1.62, p = 0.07, 2036 patients). Pooled
results revealed a prolonged intensive care unit (ICU) stay in patients
with low PNIs compared to those with high PNIs (MD: 0.98 days, p = 0.02,
2209 patients) without a difference in hospital stay between the two
groups (MD: 1.58 days, p = 0.35, 2249 patients). This meta-analysis
demonstrated an inverse correlation between PNI and the risks of PO-AKI,
postoperative infection, and mortality, as well as the length of ICU stay,
which warrants further investigations for verification. Copyright
© 2023 by the authors.

<33>
Accession Number
2024317233
Title
Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial
Fibrillation: A Randomized Controlled Trial.
Source
JACC: Clinical Electrophysiology. Part 2. 9(7) (pp 1013-1023), 2023. Date
of Publication: July 2023.
Author
van der Heijden C.A.J.; Weberndorfer V.; Vroomen M.; Luermans J.G.;
Chaldoupi S.-M.; Bidar E.; Vernooy K.; Maessen J.G.; Pison L.; van Kuijk
S.M.J.; La Meir M.; Crijns H.J.G.M.; Maesen B.
Institution
(van der Heijden, Bidar, Maessen, La Meir, Maesen) Department of
Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht,
Netherlands
(Weberndorfer, Vroomen, Luermans, Chaldoupi, Vernooy, Crijns) Department
of Cardiology, Maastricht University Medical Center, Maastricht,
Netherlands
(Weberndorfer, Luermans, Chaldoupi, Bidar, Vernooy, Maessen, Crijns,
Maesen) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
(Vroomen) Department of Cardiac Surgery, Robert Bosch Hospital, Stuttgart,
Germany
(Pison) Department of Cardiology, Hospital Oost Limburg, Genk, Belgium
(van Kuijk) Department of Clinical Epidemiology and Medical Technology
Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
(La Meir) Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
Publisher
Elsevier Inc.
Abstract
Background: Although catheter ablation (CA) is successful for the
treatment of paroxysmal atrial fibrillation (AF), results are less
satisfactory in persistent AF. Hybrid ablation (HA) results in better
outcomes in patients with persistent atrial fibrillation (persAF), as it
combines a thoracoscopic epicardial and transvenous endocardial approach
in a single procedure. Objective(s): The purpose of this study was to
compare the effectiveness and safety of HA with CA in a prospective,
superiority, unblinded, randomized controlled trial. Method(s):
Forty-one ablation-naive patients with (long-standing)-persAF were
randomized to HA (n = 19) or CA (n = 22) and received pulmonary vein
isolation, posterior left atrial wall isolation and, if needed, a
cavotricuspid isthmus ablation. The primary efficacy endpoint was freedom
from any atrial tachyarrhythmia >5 minutes off antiarrhythmic drugs after
12 months. The primary and secondary safety endpoints included major and
minor complications and the total number of serious adverse events.
 Result(s): After 12 months, the freedom of atrial tachyarrhythmias
off antiarrhythmic drugs was higher in the HA group compared with the CA
group (89% vs 41%, P = 0.002). There was 1 pericarditis requiring
pericardiocentesis and 1 femoral arteriovenous-fistula in the HA group. In
the CA arm, 1 bleeding from the femoral artery occurred. There were no
deaths, strokes, need for pacemaker implantation, or conversions to
sternotomy, and the number of (serious) adverse events was comparable
between groups (21% vs 14%, P = 0.685). Conclusion(s): Hybrid AF
ablation is an efficacious and safe procedure and results in better
outcomes than catheter ablation for the treatment of patients with
persistent AF. (Hybrid Versus Catheter Ablation in Persistent AF
[HARTCAP-AF]; NCT02441738) Copyright © 2023 The Authors

<34>
Accession Number
2024223923
Title
Definitions of massive transfusion in adults with critical bleeding: a
systematic review.
Source
Critical Care. 27(1) (no pagination), 2023. Article Number: 265. Date of
Publication: December 2023.
Author
Lin V.S.; Sun E.; Yau S.; Abeyakoon C.; Seamer G.; Bhopal S.; Tucker H.;
Doree C.; Brunskill S.J.; McQuilten Z.K.; Stanworth S.J.; Wood E.M.; Green
L.
Institution
(Lin, McQuilten, Wood) Transfusion Research Unit, School of Public Health
and Preventive Medicine, Monash University, Melbourne, Australia
(Sun) Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Parkville, Australia
(Yau, Seamer, Bhopal) Faculty of Medicine, Nursing, and Health Sciences,
Monash University, Clayton, Australia
(Abeyakoon, McQuilten, Wood) Department of Clinical Haematology, Monash
Health, Clayton, Australia
(Tucker, Green) Blizard Institute, Queen Mary University of London,
London, United Kingdom
(Doree, Brunskill, Stanworth) Systematic Review Initiative, NHS Blood and
Transplant, Oxford, United Kingdom
(Stanworth) Radcliffe Department of Medicine, University of Oxford,
Oxford, United Kingdom
(Stanworth) National Institute for Health Research Biomedical Research
Centre Haematology Theme, Oxford, United Kingdom
(Stanworth) Department of Haematology, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Green) NHS Blood and Transplant, London, United Kingdom
(Green) Barts Health NHS Trust, London, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Definitions for massive transfusion (MT) vary widely between
studies, contributing to challenges in interpretation of research findings
and practice evaluation. In this first systematic review, we aimed to
identify all MT definitions used in randomised controlled trials (RCTs) to
date to inform the development of consensus definitions for MT.
 Method(s): We systematically searched the following databases for
RCTs from inception until 11 August 2022: MEDLINE, Embase, Cochrane
Central Register of Controlled Trials (CENTRAL), PubMed, Cumulative Index
to Nursing and Allied Health Literature, and Transfusion Evidence Library.
Ongoing trials were sought from CENTRAL, ClinicalTrials.gov, and World
Health Organisation International Clinical Trials Registry Platform. To be
eligible for inclusion, studies had to fulfil all the following three
criteria: (1) be an RCT; (2) include an adult patient population with
major bleeding who had received, or were anticipated to receive, an MT in
any clinical setting; and (3) specify a definition for MT as an inclusion
criterion or outcome measure. Result(s): Of the 8,458 distinct
references identified, 30 trials were included for analysis (19 published,
11 ongoing). Trauma was the most common clinical setting in published
trials, while for ongoing trials, it was obstetrics. A total of 15
different definitions of MT were identified across published and ongoing
trials, varying greatly in cut-offs for volume transfused and time period.
Almost all definitions specified the number of red blood cells (RBCs)
within a set time period, with none including plasma, platelets or other
haemostatic agents that are part of contemporary transfusion
resuscitation. For completed trials, the most commonly used definition was
transfusion of >= 10 RBC units in 24 h (9/19, all in trauma), while for
ongoing trials it was 3-5 RBC units (n = 7), with the timing for
transfusion being poorly defined, or in some trials not provided at all (n
= 5). Conclusion(s): Transfusion of >= 10 RBC units within 24 h was
the most commonly used definition in published RCTs, while lower RBC
volumes are being used in ongoing RCTs. Any consensus definitions should
reflect the need to incorporate different blood components/products for MT
and agree on whether a 'one-size-fits-all' approach should be used across
different clinical settings. Copyright © 2023, The Author(s).

<35>
Accession Number
2024200779
Title
Platelet and Monocyte Activation After Transcatheter Aortic Valve
Replacement (POTENT-TAVR): A Mechanistic Randomized Trial of Ticagrelor
Versus Clopidogrel.
Source
Structural Heart. 7(4) (no pagination), 2023. Article Number: 100182. Date
of Publication: July 2023.
Author
Zidar D.A.; Al-Kindi S.; Longenecker C.T.; Parikh S.A.; Gillombardo C.B.;
Funderburg N.T.; Juchnowski S.; Huntington L.; Jenkins T.; Nmai C.; Osnard
M.; Shishebhor M.; Filby S.; Tatsuoka C.; Lederman M.M.; Blackstone E.;
Attizzani G.; Simon D.I.
Institution
(Zidar, Al-Kindi, Longenecker, Gillombardo, Juchnowski, Huntington,
Jenkins, Osnard, Shishebhor, Filby, Tatsuoka, Lederman, Attizzani, Simon)
Department of Medicine, Case Western Reserve University, Cleveland, OH,
United States
(Zidar, Juchnowski, Huntington) Louis Stokes Cleveland Veterans Affairs
Medical Center, Cleveland, OH, United States
(Zidar, Al-Kindi, Longenecker, Gillombardo, Juchnowski, Huntington,
Jenkins, Shishebhor, Filby, Attizzani, Simon) Harrington Heart & Vascular
Institute, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Parikh) Division of Cardiology, Center for Interventional Vascular
Therapy, Columbia University Irving Medical Center, New York, NY, United
States
(Funderburg) Division of Medical Laboratory Science, School of Health and
Rehabilitations Sciences, Ohio State University, Columbus, OH, United
States
(Nmai) New York University Grossman School of Medicine, New York, NY,
United States
(Blackstone) Department of Population Health and Quantitative Health
Sciences, Cleveland Clinic Foundation, Cleveland, OH, United States
Publisher
Cardiovascular Research Foundation
Abstract
Background: Inflammation and thrombosis are often linked mechanistically
and are associated with adverse events after transcatheter aortic valve
replacement (TAVR). High residual platelet reactivity (HRPR) is especially
common when clopidogrel is used in this setting, but its relevance to
immune activation is unknown. We sought to determine whether residual
activity at the purinergic receptor P2Y12 (P2Y12) promotes prothrombotic
immune activation in the setting of TAVR. Method(s): This was a
randomized trial of 60 patients (enrolled July 2015 through December 2018)
assigned to clopidogrel (300mg load, 75mg daily) or ticagrelor (180mg
load, 90 mg twice daily) before and for 30 days following TAVR. Co-primary
endpoints were P2Y12-dependent platelet activity (Platelet Reactivity
Units; VerifyNow) and the proportion of inflammatory (cluster of
differentiation [CD] 14+/CD16+) monocytes 1 day after TAVR.
 Result(s): Compared to clopidogrel, those randomized to ticagrelor
had greater platelet inhibition (median Platelet Reactivity Unit
[interquartile range]: (234 [170.0-282.3] vs. 128.5 [86.5-156.5], p <
0.001), but similar inflammatory monocyte proportions (22.2% [18.0%-30.2%]
vs. 25.1% [22.1%-31.0%], p = 0.201) 1 day after TAVR. Circulating
monocyte-platelet aggregates, soluble CD14 levels, interleukin 6 and 8
levels, and D-dimers were also similar across treatment groups. HRPR was
observed in 63% of the clopidogrel arm and was associated with higher
inflammatory monocyte proportions. Major bleeding events, pacemaker
placement, and mortality did not differ by treatment assignment.
 Conclusion(s): Residual P2Y12 activity after TAVR is common in those
treated with clopidogrel but ticagrelor does not significantly alter
biomarkers of prothrombotic immune activation. HRPR appears to be an
indicator (not a cause) of innate immune activation in this
setting. Copyright © 2023

<36>
Accession Number
2024162281
Title
The Effects of Peroxisome Proliferator-Activated Receptor-Delta Modulator
ASP1128 in Patients at Risk for Acute Kidney Injury Following Cardiac
Surgery.
Source
Kidney International Reports. 8(7) (pp 1407-1416), 2023. Date of
Publication: July 2023.
Author
van Till J.W.O.; Nojima H.; Kameoka C.; Hayashi C.; Sakatani T.; Washburn
T.B.; Molitoris B.A.; Shaw A.D.; Engelman D.T.; Kellum J.A.
Institution
(van Till) Mitobridge Inc., Cambridge, MA, United States
(Nojima, Hayashi) Astellas Pharma Global Development Inc., Northbrook, IL,
United States
(Kameoka, Sakatani) Astellas Pharma Inc, Development, Tokyo, Japan
(Washburn) Department of Thoracic Surgery, Heart Center, Huntsville, AL,
United States
(Molitoris) Division of Nephrology, Indiana University School of Medicine,
Indianapolis, IN, United States
(Shaw) Department of Intensive Care and Resuscitation, Cleveland Clinic,
Cleveland, OH, United States
(Engelman) Heart and Vascular Program, Baystate Health and University of
Massachusetts Medical School-Baystate, Springfield, MA, United States
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
Publisher
Elsevier Inc.
Abstract
Introduction: Peroxisome proliferator-activated receptor delta (PPARdelta)
plays a central role in modulating mitochondrial function in
ischemia-reperfusion injury. The novel PPARdelta modulator, ASP1128, was
evaluated. Method(s): A randomized, double-blind, placebo-controlled,
biomarker assignment-driven, multicenter study was performed in adult
patients at risk for acute kidney injury (AKI) following cardiac surgery,
examining efficacy and safety of a 3-day, once-daily intravenous dose of
100 mg ASP1128 versus placebo (1:1). AKI risk was based on clinical
characteristics and postoperative urinary biomarker (TIMP2)*(IGFBP7). The
primary end point was the proportion of patients with AKI based on serum
creatinine within 72 hours postsurgery (AKI-SCr72h). Secondary endpoints
included the composite end point of major adverse kidney events (MAKE:
death, renal replacement therapy, and/or >=25% reduction of estimated
glomerular filtration rate [eGFR]) at days 30 and 90). Result(s): A
total of 150 patients were randomized and received study medication (81
placebo, 69 ASP1128). Rates of AKI-SCr72h were 21.0% and 24.6% in the
placebo and ASP1128 arms, respectively (P = 0.595). Rates of
moderate/severe AKI (stage 2/3 AKI-SCr and/or stage 3 AKI-urinary output
criteria) within 72 hours postsurgery were 19.8% and 23.2%, respectively
(P = 0.609). MAKE occurred within 30 days in 11.1% and 13.0% in the
placebo and ASP1128 arms (P = 0.717), respectively; and within 90 days in
9.9% and 15.9% in the placebo and ASP1128 arms (P = 0.266), respectively.
No safety issues were identified with ASP1128 treatment, but rates of
postoperative atrial fibrillation were lower (11.6%) than in the placebo
group (29.6%). Conclusion(s): ASP1128 was safe and well-tolerated in
patients at risk for AKI following cardiac surgery, but it did not show
efficacy in renal endpoints. Copyright © 2023 International
Society of Nephrology

<37>
Accession Number
2023964458
Title
Randomized, Double-Blind, Active Comparator Pharmacodynamic Study of
Platelet Inhibition with Crushed and Integral Formulations of Clopidogrel
and Ticagrelor in Acute Coronary Syndrome.
Source
American Journal of Cardiovascular Drugs. 23(4) (pp 455-466), 2023. Date
of Publication: July 2023.
Author
Perla H.T.; Thomson V.S.; Attumalil T.V.; Geevar T.; Alex A.G.; Dave R.G.;
Nair S.C.; Gowri S.M.; Mony P.K.; George P.; Joseph G.
Institution
(Perla, Thomson, Attumalil, Alex, George, Joseph) Department of
Cardiology, Christian Medical College and Hospital, Vellore, India
(Geevar, Dave, Nair) Department of Immunohematology and Transfusion
Medicine, Christian Medical College and Hospital, Vellore, India
(Gowri) Department of Biostatistics, Christian Medical College and
Hospital, Vellore, India
(Mony) Department of Epidemiology and Population Health, St John's
National Academy of Health Sciences, Bangalore, India
(Thomson) Salalah Heart Center, Salalah, Oman
Publisher
Adis
Abstract
Background: Crushed formulations of specific antiplatelet agents produce
earlier and stronger platelet inhibition. We studied the platelet
inhibitory effect of crushed clopidogrel in patients with acute coronary
syndrome (ACS) and its relative efficacy compared with integral
clopidogrel, crushed and integral ticagrelor. Objective(s): We aimed
to compare the platelet inhibitory effect of crushed and integral
formulations of clopidogrel and ticagrelor in patients with acute coronary
syndrome (ACS). Method(s): Overall, 142 patients with suspected ACS
were randomly assigned to receive crushed or integral formulations of
clopidogrel or ticagrelor. Platelet inhibition at baseline and 1 and 8 h
was assessed using the VerifyNow assay. High on-treatment platelet
reactivity (HTPR) >= 235 P2Y<inf>12</inf> reaction units (PRUs) 1 h after
the medication loading dose was also determined. Result(s): The PRU
and percentage inhibition median (interquartile range) at 1 h for the
different formulations were as follows: crushed clopidogrel: 196.50
(155.50, 246.50), 9.36 (- 1.79, 25.10); integral clopidogrel: 189.50
(159.00, 214.00), 2.32 (- 2.67, 19.89); crushed ticagrelor: 59.00 (10.00,
96.00), 75.53 (49.12, 95.18); and integral ticagrelor: 126.50 (50.00,
168.00), 40.56 (25.59, 78.69). There was no significant difference in PRU
or percentage platelet inhibition between the crushed and integral
formulations of clopidogrel (p = 0.990, p = 0.479); both formulations of
ticagrelor were superior to the clopidogrel formulations (p < 0.05). On
paired comparison, crushed ticagrelor showed robust early inhibition of
platelets compared with the integral formulation (p = 0.03). Crushed
clopidogrel exhibited the maximal HTPR of 34.3%, but was < 3% for both
formulations of ticagrelor. Conclusion(s): The platelet inhibitory
effect of crushed clopidogrel is not superior to integral preparation in
patients with ACS. Crushed ticagrelor produced maximal platelet inhibition
acutely. HTPR rates in ACS are similar and very low with both formulations
of ticagrelor, and maximal with crushed clopidogrel. Clinical Trials
Registry of India identifier number CTRI/2020/06/025647. Graphical
Abstract: [Figure not available: see fulltext.] Copyright © 2023,
The Author(s), under exclusive licence to Springer Nature Switzerland AG.

<38>
Accession Number
2023751246
Title
An Updated Meta-Analysis on Cerebral Embolic Protection in Patients
Undergoing Transcatheter Aortic Valve Intervention Stratified by Baseline
Surgical Risk and Device Type.
Source
Structural Heart. 7(4) (no pagination), 2023. Article Number: 100178. Date
of Publication: July 2023.
Author
Khan S.U.; Zahid S.; Alkhouli M.A.; Akbar U.A.; Zaid S.; Arshad H.B.;
Little S.H.; Reardon M.J.; Kleiman N.S.; Goel S.S.
Institution
(Khan, Zaid, Arshad, Little, Kleiman, Goel) Department of Cardiology,
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United
States
(Zahid) Sands-Constellation Heart Institute, Rochester General Hospital,
Rochester, NY, United States
(Alkhouli) Division of Interventional Cardiology, Mayo Clinic, Rochester,
MN, United States
(Akbar) Department of Medicine, North Shore University Hospital, New York,
NY, United States
(Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart & Vascular Center, Houston, TX, United States
Publisher
Cardiovascular Research Foundation
Abstract
Background: Transcatheter aortic valve intervention (TAVI) can lead to the
embolization of debris. Capturing the debris by cerebral embolic
protection (CEP) devices may reduce the risk of stroke. New evidence has
allowed us to examine the effects of CEP in patients undergoing TAVI. We
aimed to assess the effects of CEP overall and stratified by the device
used (SENTINEL or TriGuard) and the surgical risk of the patients.
 Method(s): We selected randomized controlled trials using electronic
databases through September 17, 2022. We estimated random-effects risk
ratios (RR) with (95% confidence interval) and calculated absolute risk
differences at 30 days across baseline surgical risks derived from the
TAVI trials for any stroke (disabling and nondisabling) and all-cause
mortality. Result(s): Among 6 trials (n = 3921), CEP vs. control did
not reduce any stroke [RR: 0.95 (0.50-1.81)], disabling [RR: 0.75
(0.18-3.16)] or nondisabling [RR: 0.99 (0.65-1.49)] strokes, or all-cause
mortality [RR: 1.23 (0.55-2.77)]. However, when analyzed by device,
SENTINEL reduced disabling stroke [RR: 0.46 (0.22-0.95)], translating into
6 fewer per 1000 in high-risk, 3 fewer per 1000 in intermediate-risk, and
1 fewer per 1000 in low surgical-risk patients. CEP vs. control did not
reduce the risk of any bleeding [RR: 1.03 (0.44-2.40)], major vascular
complications [RR: 1.41 (0.57-3.48)], or acute kidney injury [RR: 1.36
(0.57-3.28)]. Conclusion(s): This updated meta-analysis showed that
SENTINEL CEP might reduce disabling stroke in patients undergoing TAVI.
Patients with high and intermediate surgical risks were most likely to
derive benefits. Copyright © 2023 The Authors

<39>
Accession Number
2023648244
Title
Clinical characteristics and outcome of Mycobacterium chimaera infections
after cardiac surgery: systematic review and meta-analysis of 180
heater-cooler unit-associated cases.
Source
Clinical Microbiology and Infection. 29(8) (pp 1008-1014), 2023. Date of
Publication: August 2023.
Author
Wetzstein N.; Kohl T.A.; Diricks M.; Mas-Peiro S.; Holubec T.; Kessel J.;
Graf C.; Koch B.; Herrmann E.; Vehreschild M.J.G.T.; Hogardt M.; Niemann
S.; Stephan C.; Wichelhaus T.A.
Institution
(Wetzstein, Kessel, Vehreschild, Stephan) Department of Internal Medicine,
Infectious Diseases, University Hospital Frankfurt, Goethe University,
Frankfurt am Main, Germany
(Kohl, Diricks, Niemann) The German Centre for Infection Research (DZIF),
partner site Hamburg-Lubeck-Borstel-Riems, Germany
(Kohl, Diricks, Niemann) Research Centre Borstel, Molecular and
Experimental Mycobacteriology, Borstel, Germany
(Mas-Peiro) Department of Internal Medicine, University Hospital
Frankfurt, Goethe University, Cardiology, Frankfurt am Main, Germany
(Holubec) Department of Cardiovascular Surgery, University Hospital
Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
(Graf) Department of Internal Medicine, University Hospital Frankfurt,
Goethe University, Gastroenterology and Hepatology, Frankfurt am Main,
Germany
(Koch) Department of Internal Medicine, University Hospital Frankfurt,
Goethe University, Nephrology, Frankfurt am Main, Germany
(Herrmann) Institute of Biostatistics and Mathematical Modelling, Goethe
University, Frankfurt am Main, Germany
(Hogardt, Wichelhaus) Institute of Medical Microbiology and Infection
Control, University Hospital Frankfurt, Goethe University, Frankfurt am
Main, Germany
Publisher
Elsevier B.V.
Abstract
Objectives: Since 2013, heater-cooler unit (HCU) associated Mycobacterium
chimaera infections linked to a global outbreak have been described. These
infections were characterised by high morbidity and mortality due to
delayed diagnosis, as well as challenges in antimycobacterial and surgical
therapy. This study aimed to investigate the clinical characteristics and
outcome of published cases of HCU-associated M. chimaera infections.
 Method(s): We searched PubMed and the Web of Science until 15 June
2022 for case reports, case series, and cohort studies, without language
restriction, on patients with M. chimaera infection and a prior history of
cardiac surgery. In this systematic review of case reports, no risk of
bias assessment could be performed. Clinical, microbiological, and
radiological features were recorded. Logistic regression and time-to-event
analyses were performed to identify the potential factors associated with
better survival. Result(s): One hundred eighty patients from 54
publications were included. Most patients underwent surgical aortic valve
(67.0%; 118/176 of patients with available data) or combined aortic valve
and root replacement (15.3%; 27/176). The median period between the time
point of surgery and the first symptoms was 17 months (interquartile range
13-26 months). The overall case fatality rate was 45.5% (80/176), with a
median survival of 24 months after the initiation of antimycobacterial
therapy or diagnosis. A reoperation (including the removal or exchange of
foreign material) was associated with better survival in multivariate
logistic regression (OR 0.32 for lethal events; 95% CI 0.12-0.79; p 0.015)
and in time-to-event analysis (p 0.0094). Discussion(s): This
systematic review and meta-analysis confirm the high overall mortality of
HCU -associated disseminated M. chimaera infections after cardiac surgery.
A reoperation seems to be associated with better survival. Physicians have
to stay aware of this infection, as patients might still be present today
due to the long latency period. Copyright © 2023 European Society
of Clinical Microbiology and Infectious Diseases

<40>
Accession Number
2023616107
Title
Postoperative pulmonary complications in older patients undergoing
elective surgery with a supraglottic airway device or tracheal intubation.
Source
Anaesthesia. 78(8) (pp 953-962), 2023. Date of Publication: August 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, 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. Copyright © 2023 Association of Anaesthetists.

<41>
Accession Number
2023313674
Title
Percutaneous treatment of left circumflex coronary artery injury related
to mitral valve surgery: Case series and systematic review of the
literature.
Source
Catheterization and Cardiovascular Interventions. 102(1) (pp 121-137),
2023. Date of Publication: 01 Jul 2023.
Author
Benedetti A.; Castaldi G.; Poletti E.; Moroni A.; Scott B.; Convens C.;
Verheye S.; Vermeersch P.; Agostoni P.; Zivelonghi C.
Institution
(Benedetti, Castaldi, Poletti, Moroni, Scott, Convens, Verheye,
Vermeersch, Agostoni, Zivelonghi) HartCentrum, Ziekenhuis Netwerk
Antwerpen (ZNA) Middelheim, Antwerp, Belgium
Publisher
John Wiley and Sons Inc
Abstract
Left circumflex coronary artery (LCx) injury related to mitral valve
surgery is a rare complication. The best treatment option is not defined,
and percutaneous coronary intervention (PCI) may represent an effective
treatment to avoid prolonged myocardial ischemia. To evaluate feasibility
and efficacy of PCI treatment, all records of LCx injury related to mitral
valve surgery and treated with PCI were included after a systematic PubMed
searching. Moreover, we retrospectively analyzed our single-center PCI
database and patients fulfilling the inclusion criteria were included.
Patients undergoing transcatheter mitral valve intervention, non-mitral
valve surgery, conservatively or surgically treated after LCx injury were
excluded. Data about patient characteristics, procedural details, PCI
success, and in-hospital mortality were collected. Fifty-six patients were
included, 58.9% were male (n = 33) and the median age was 60.5 years (IQR
= 21.75). The majority had left dominant or codominant coronary system
(62.2%, n = 28 and 15.6%, n = 7, respectively). Clinical manifestations
ranged from hemodynamic stability (21.1%, n = 8) to hemodynamic
instability (42.1%, n = 16) and cardiac arrest (18.4%, n = 7). On ECG,
23.5% of patients (n = 12) presented ST-segment depression, 58.8% (n = 30)
ST-segment elevation, 7.8% (n = 4) atrioventricular block, and 29.4% (n =
15) ventricular arrhythmias. Left ventricle dysfunction was present in
52.3% (n = 22) of patients and wall motion abnormalities in 71.4% (n =
30). PCI success rate was 82.1% (n = 46) and in-hospital mortality 4.5% (n
= 2). LCx injury related to mitral surgery is a rare complication
characterized by an increased risk of mortality. PCI seems a feasible
treatment option, still burdened by suboptimal results, probably related
to the technical challenges posed by the surgical failure. Copyright
© 2023 Wiley Periodicals LLC.

<42>
Accession Number
2023174570
Title
Mild aortic insufficiency following transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 102(1) (pp 166-175),
2023. Date of Publication: 01 Jul 2023.
Author
Hameed I.; Ahmed A.; Kumar A.; Li E.; Candelario K.; Khan S.; Kannan A.;
Latif N.; Amabile A.; Geirsson A.; Williams M.L.
Institution
(Hameed, Ahmed, Li, Candelario, Khan, Kannan, Latif, Amabile, Geirsson,
Williams) Section of Cardiac Surgery, Department of Surgery, Yale School
of Medicine, New Haven, CT, United States
(Kumar) Department of Internal Medicine, Cleveland Clinic Akron General,
Akron, OH, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Post-procedural aortic insufficiency (AI) continues to be
prevalent following transcatheter aortic valve replacement (TAVR). While
several studies have assessed the outcomes of moderate-severe AI following
TAVR, the incidence, predictors, and outcomes of mild AI remain unclear.
 Method(s): A systematic literature review was performed to identify
studies reporting on mild AI following TAVR. The primary outcome was
pooled incidence of post-TAVR mild AI. Secondary outcomes included pooled
incidence of mild AI at 30 days and long term. The pooled incidence of
midterm mortality in patients with post-TAVR mild AI was also evaluated.
The random effect generalized linear mixed-effects model with
logit-transformed proportions and Hartung-Knapp adjustment was used to
calculate pooled incidence rates. Meta-regression was performed to
identify predictors of mild AI. Result(s): The pooled analysis
included 19,241 patients undergoing TAVR across 50 studies. The mean age
of patients ranged from 73 to 85 years, and female patients ranged from
20.0% to 83.3%. The overall pooled incidence of post-TAVR mild AI was
56.1% (95% confidence interval [CI] 0.31-0.64). The pooled incidence of
mild AI at 30 days was 33.7% (95% CI 0.12-0.37). At mean follow-up of 1.15
years, the pooled incidence of mild AI was 37.0% (95% CI 0.16-0.45). The
overall pooled incidence of Midterm mortality (mean follow-up 1.22 years)
in patients with mild AI was 14.8% (95% CI 0.10-0.25). At meta-regression,
none of the explored variables correlated with a difference in mild AI
incidence. Conclusion(s): In published studies to date, 50% of
patients undergoing TAVR develop mild AI postoperatively. In 37% of
patients, this persists in long term. Though the incidence of AI is likely
improving with newer generation TAVR valves, the prevalence and outcomes
of mild AI should be closely monitored as TAVR volume and indications
expand to younger patients with long life expectancy. The long-term
outcomes of mild AI remain unclear. Further dedicated studies on post-TAVR
mild AI are needed. Copyright © 2023 Wiley Periodicals LLC.

<43>
Accession Number
2023133051
Title
Comparison of milrinone with dobutamine in patients undergoing cardiac
surgery: a systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. 70(7) (pp 1272-1274), 2023. Date of
Publication: July 2023.
Author
Alkadri J.; Hu R.; Jeffers M.S.; Ross J.; McIsaac D.I.; McDonald B.
Institution
(Alkadri, McIsaac, McDonald) Department of Anesthesiology and Pain
Medicine, University of Ottawa, Ottawa, ON, Canada
(Hu) Department of Surgery, Division of General Surgery, University of
Ottawa, Ottawa, ON, Canada
(Jeffers) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
(Jeffers) Clinical Epidemiology Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Ross) Department of Surgery, Division of Urology, University of Ottawa,
Ottawa, ON, Canada
(McDonald) Division of Cardiac Anesthesiology, University of Ottawa Heart
Institute, Ottawa, ON, Canada
Publisher
Springer

<44>
Accession Number
2023132741
Title
Transcatheter edge-to-edge mitral valve repair for post-myocardial
infarction papillary muscle rupture and acute heart failure: A systematic
review.
Source
Catheterization and Cardiovascular Interventions. 102(1) (pp 138-144),
2023. Date of Publication: 01 Jul 2023.
Author
Cali F.; Pagnesi M.; Pezzola E.; Montisci A.; Metra M.; Adamo M.
Institution
(Cali, Pagnesi, Pezzola, Metra, Adamo) Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, Division of
Cardiology, ASST Spedali Civili di Brescia, University of Brescia,
Brescia, Italy
(Montisci) Division of Cardiothoracic Intensive Care, ASST Spedali Civili
di Brescia, Brescia, Italy
Publisher
John Wiley and Sons Inc
Abstract
Papillary muscle rupture (PMR) is a rare complication of acute myocardial
infarction (AMI) associated with high mortality and morbidity. Surgery is
the gold-standard treatment for these patients, but it is burdened by a
high perioperative risk due to hemodynamic instability. Mitral
transcatheter edge-to-edge repair (M-TEER) was reported to be safe and
effective in unstable patients with significant mitral regurgitation.
However, data in patients with post-AMI PMR are limited to a few case
reports. In this review, we summarized all data available regarding
percutaneous treatment of post-AMI PMR. These results show that M-TEER is
safe and effective in this setting with low in-hospital mortality and
complications and high rate of significant mitral regurgitation
reduction. Copyright © 2023 Wiley Periodicals LLC.

<45>
Accession Number
2022867908
Title
Evaluation of levosimendan as treatment option in a large case-series of
preterm infants with cardiac dysfunction and pulmonary hypertension.
Source
European Journal of Pediatrics. 182(7) (pp 3165-3174), 2023. Date of
Publication: July 2023.
Author
Schroeder L.; Holcher S.; Leyens J.; Geipel A.; Strizek B.; Dresbach T.;
Mueller A.; Kipfmueller F.
Institution
(Schroeder, Holcher, Leyens, Dresbach, Mueller, Kipfmueller) Department of
Neonatology and Pediatric Intensive Care Medicine, University Children's
Hospital Bonn, Venusberg-Campus 1, Bonn D-53127, Germany
(Geipel, Strizek) Department of Obstetrics and Prenatal Medicine,
University Hospital Bonn, Bonn, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Levosimendan as a calcium-sensitizer is a promising innovative
therapeutical option for the treatment of severe cardiac dysfunction (CD)
and pulmonary hypertension (PH) in preterm infants, but no data are
available analyzing levosimendan in cohorts of preterm infants. The
design/setting of the evaluation is in a large case-series of preterm
infants with CD and PH. Data of all preterm infants (gestational age (GA)
< 37 weeks) with levosimendan treatment and CD and/or PH in the
echocardiographic assessment between 01/2018 and 06/2021 were screened for
analysis. The primary clinical endpoint was defined as echocardiographic
response to levosimendan. Preterm infants (105) were finally enrolled for
further analysis. The preterm infants (48%) were classified as extremely
low GA newborns (ELGANs, < 28 weeks of GA) and 73% as very low birth
weight infants (< 1500 g, VLBW). The primary endpoint was reached in 71%,
without difference regarding GA or BW. The incidence of moderate or severe
PH decreased from baseline to follow-up (24 h) in about 30%, with a
significant decrease in the responder group (p < 0.001). The incidence of
left ventricular dysfunction and bi-ventricular dysfunction decreased
significantly from baseline to follow-up (24 h) in the responder-group (p
= 0.007, and p < 0.001, respectively). The arterial lactate level
decreased significantly from baseline (4.7 mmol/l) to 12 h (3.6 mmol/l, p
< 0.05), and 24 h (3.1 mmol/l, p < 0.01). Conclusion(s): Levosimendan
treatment is associated with an improvement of both CD and PH in preterm
infants, with a stabilization of the mean arterial pressure during the
treatment and a significant decrease of arterial lactate levels. Future
prospective trials are highly warranted.What is Known:* Levosimendan as a
calcium-sensitizer and inodilator is known to improve the low cardiac
output syndrome (LCOS), and improves ventricular dysfunction, and PH, both
in pediatric as well as in adult populations. Data related to critically
ill neonates without major cardiac surgery and preterm infants are not
available.What is New:* This study evaluated the effect of levosimendan on
hemodynamics, clinical scores, echocardiographic severity parameters, and
arterial lactate levels in a case-series of 105 preterm infants for the
first time. Levosimendan treatment in preterm infants is associated with a
rapid improvement of CD and PH, an increase of the mean arterial pressure,
and a significant decrease in arterial lactate levels, as surrogate marker
for a LCOS.* How this study might affect research, practice, or policy. As
no data are available regarding the use of levosimendan in this
population, our results hopefully animate the research community to
conduct future prospective trails analyzing levosimendan in randomized
controlled trials (RCT) and observational control studies. Additionally,
our results potentially motivate clinicians to introduce levosimendan as
second second-line therapy in cases of severe CD and PH in preterm infants
without improvement using standard treatment strategies. Copyright
© 2023, The Author(s).

<46>
Accession Number
2022803754
Title
Prognostic factors for chronic post-surgical pain after lung and pleural
surgery: a systematic review with meta-analysis, meta-regression and trial
sequential analysis.
Source
Anaesthesia. 78(8) (pp 1005-1019), 2023. Date of Publication: August 2023.
Author
Clephas P.R.D.; Hoeks S.E.; Singh P.M.; Guay C.S.; Trivella M.; Klimek M.;
Heesen M.
Institution
(Clephas) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Hoeks, Klimek) Department of Anaesthesia, Erasmus University Medical
Center, Rotterdam, Netherlands
(Singh) Department of Anaesthesia, Washington University School of
Medicine in St. Louis, St Louis, MO, United States
(Guay) Department of Anaesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Guay) Picower Institute for Learning and Memory, Massachusetts Institute
of Technology, Cambridge, MA, United States
(Trivella) Centre for Statistics in Medicine, University of Oxford,
Oxford, United Kingdom
(Heesen) Department of Anaesthesia, Kantonsspital Baden AG, Baden,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Chronic post-surgical pain is known to be a common complication of
thoracic surgery and has been associated with a lower quality of life,
increased healthcare utilisation, substantial direct and indirect costs,
and increased long-term use of opioids. This systematic review with
meta-analysis aimed to identify and summarise the evidence of all
prognostic factors for chronic post-surgical pain after lung and pleural
surgery. Electronic databases were searched for retrospective and
prospective observational studies as well as randomised controlled trials
that included patients undergoing lung or pleural surgery and reported on
prognostic factors for chronic post-surgical pain. We included 56 studies
resulting in 45 identified prognostic factors, of which 16 were pooled
with a meta-analysis. Prognostic factors that increased chronic
post-surgical pain risk were as follows: higher postoperative pain
intensity (day 1, 0-10 score), mean difference (95%CI) 1.29 (0.62-1.95), p
< 0.001; pre-operative pain, odds ratio (95%CI) 2.86 (1.94-4.21), p <
0.001; and longer surgery duration (in minutes), mean difference (95%CI)
12.07 (4.99-19.16), p < 0.001. Prognostic factors that decreased chronic
post-surgical pain risk were as follows: intercostal nerve block, odds
ratio (95%CI) 0.76 (0.61-0.95) p = 0.018 and video-assisted thoracic
surgery, 0.54 (0.43-0.66) p < 0.001. Trial sequential analysis was used to
adjust for type 1 and type 2 errors of statistical analysis and confirmed
adequate power for these prognostic factors. In contrast to other studies,
we found that age had no significant effect on chronic post-surgical pain
and there was not enough evidence to conclude on sex. Meta-regression did
not reveal significant effects of any of the study covariates on the
prognostic factors with a significant effect on chronic post-surgical
pain. Expressed as grading of recommendations, assessment, development and
evaluations criteria, the certainty of evidence was high for pre-operative
pain and video-assisted thoracic surgery, moderate for intercostal nerve
block and surgery duration and low for postoperative pain intensity. We
thus identified actionable factors which can be addressed to attempt to
reduce the risk of chronic post-surgical pain after lung
surgery. Copyright © 2023 The Authors. Anaesthesia published by
John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

<47>
Accession Number
2022489959
Title
Effect of Perioperative Oral Vitamin C Supplementation on In-Hospital
Postoperative Medication Costs for Cardiac Surgery Patients: A
Prospective, Single-Centre, Randomised Clinical Trial.
Source
PharmacoEconomics - Open. 7(4) (pp 655-663), 2023. Date of Publication:
July 2023.
Author
Heerman J.; Boydens C.; Allaert S.; Cathenis K.; Deryckere K.;
Vanoverschelde H.
Institution
(Heerman, Boydens, Allaert, Vanoverschelde) Department of Anaesthesia and
Intensive Care, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30,
Ghent 9000, Belgium
(Cathenis) Department of Cardiac Surgery, AZ Maria Middelares Hospital,
Buitenring Sint-Denijs 30, Ghent 9000, Belgium
(Deryckere) Department of Pharmaceutics, AZ Maria Middelares Hospital,
Buitenring Sint-Denijs 30, Ghent 9000, Belgium
Publisher
Adis
Abstract
Background: Due to its antioxidant properties, vitamin C might be a
promising and effective strategy for preventing postoperative atrial
fibrillation (POAF) after cardiac surgery. This study was aimed at
evaluating whether vitamin C supplementation is effective in reducing the
cost of in-hospital postoperative medication used for patients undergoing
coronary artery bypass (CABG) or valve surgery (+/-CABG).
 Objective(s): The primary goal of this study was to evaluate the
impact of perioperative vitamin C supplementation in patients undergoing
cardiac surgery on in-hospital postoperative medication costs, while
secondary endpoints were the effects on length of stay (LOS) in both the
intensive care unit (ICU) and the hospital, and the incidence of POAF.
 Material(s) and Method(s): From November 2018 to January 2021, 253
patients planned for CABG or valve surgery (+/-CABG) in AZ Maria
Middelares, Ghent, Belgium, and who met the inclusion criteria (>=18 years
of age, all having cardiac sinus rhythm, and who provided written informed
consent) were randomised into a placebo group or vitamin C group. The
medication was administered orally (1 g twice daily), starting from 5 days
preoperatively until 10 days postoperatively. The medication used, LOS in
the hospital/ICU, and development of clinically relevant POAF in the ICU
were registered. Result(s): Mean medication costs were 264.6 +/- 98.1
for patients in the vitamin C group and 294.9 +/- 267.3 for patients in
the placebo group. When stratifying according to the type of surgery (CABG
or valve surgery [+/-CABG]), these costs did not significantly differ.
There was no significant difference in LOS or the incidence of clinically
relevant POAF. Conclusion(s): Our data did not identify any
short-term financial impact on postoperative medication costs after oral
perioperative vitamin C supplementation (1 g twice daily) for patients
undergoing a CABG procedure or valve surgery (+/-CABG). No effect was
found on the LOS or the incidence of clinically relevant POAF. Potential
effects in the longer term, after intravenous administration of vitamin C
or in other types of (cardiac) surgery, are still to be investigated.
Clinical Trials registration number: NCT03592680. Copyright ©
2023, The Author(s).

<48>
Accession Number
2022395333
Title
Dynamic Prediction of Patient Outcomes in the Intensive Care Unit: A
Scoping Review of the State-of-the-Art.
Source
Journal of Intensive Care Medicine. 38(7) (pp 575-591), 2023. Date of
Publication: July 2023.
Author
Lapp L.; Roper M.; Kavanagh K.; Bouamrane M.-M.; Schraag S.
Institution
(Lapp, Roper, Kavanagh) University of Strathclyde, Glasgow, United Kingdom
(Bouamrane) Usher Institute, College of Medicine and Veterinary Medicine,
University of Edinburgh, Glasgow, United Kingdom
(Schraag) Golden Jubilee National Hospital, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Introduction: Intensive care units (ICUs) are high-pressure, complex,
technology-intensive medical environments where patient physiological data
are generated continuously. Due to the complexity of interpreting multiple
signals at speed, there are substantial opportunities and significant
potential benefits in providing ICU staff with additional decision support
and predictive modeling tools that can support and aid decision-making in
real-time. This scoping review aims to synthesize the state-of-the-art
dynamic prediction models of patient outcomes developed for use in the
ICU. We define "dynamic" models as those where predictions are regularly
computed and updated over time in response to updated physiological
signals. Method(s): Studies describing the development of predictive
models for use in the ICU were searched, using PubMed. The studies were
screened as per Preferred Reporting Items for Systematic Reviews and
Meta-Analysis (PRISMA) guidelines, and the data regarding predicted
outcomes, methods used to develop the predictive models, preprocessing the
data and dealing with missing values, and performance measures were
extracted and analyzed. Result(s): A total of n = 36 studies were
included for synthesis in our review. The included studies focused on the
prediction of various outcomes, including mortality (n = 17),
sepsis-related complications (n = 12), cardiovascular complications (n =
5), and other complications (respiratory, renal complications, and
bleeding, n = 5). The most common classification methods include logistic
regression, random forest, support vector machine, and neural networks.
 Conclusion(s): The included studies demonstrated that there is a
strong interest in developing dynamic prediction models for various ICU
patient outcomes. Most models reported focus on mortality. As such, the
development of further models focusing on a range of other serious and
well-defined complications-such as acute kidney injury-would be
beneficial. Furthermore, studies should improve the reporting of key
aspects of model development challenges. Copyright © The
Author(s) 2023.

<49>
Accession Number
2022334563
Title
Is robotic assistance an added value in minimally invasive mitral valve
surgery? A meta-analysis from propensity score-matched series.
Source
Asian Cardiovascular and Thoracic Annals. 31(4) (pp 369-377), 2023. Date
of Publication: May 2023.
Author
Jegaden O.; Al Shamry A.; Ashafy S.; Mahdi A.; Eker A.
Institution
(Jegaden, Mahdi) Department of Cardiac Surgery, Mediclinic Middle East,
MBRU, AbuDhabi, United Arab Emirates
(Al Shamry) Department of Cardiac Surgery and ICU, Saudi German Hospital,
Dubai, United Arab Emirates
(Ashafy) Department of Cardiac Surgery, Zayed Military Hospital, AbuDhabi,
United Arab Emirates
(Eker) Department of Cardiac Surgery, Centre Cardio-Thoracic, Monaco,
Monaco
Publisher
SAGE Publications Inc.
Abstract
Objectives: There is still ongoing debate about the benefits of robotic
assistance (R-MVS) in comparison with video assistance (V-MVS) in
minimally invasive mitral valve surgery. This study aims to update the
current evidence. Method(s): Three propensity score-matched studies
published from 2011 to 2021 were included with a total of 1193 patients
operated on from 2005 (R-MVS: 536, V-MVS: 657). Data regarding early
mortality, postoperative event, and time-related outcomes were extracted
and submitted to a meta-analysis using weighted random-effects modeling.
 Result(s): The incidence of early mortality, stroke, renal failure,
conversion, atrial fibrillation, and prolonged ventilation were similar,
all in the absence of heterogeneity. Reoperation for bleeding (odds ratio
[OR]: 0.36, 95% confidence interval [CI] 0.16-0.81, p = 0.01) and the need
for blood transfusion (OR: 0.30, 95% CI, 0.20-0.56, p = 0.001) were
significantly lower in V-MVS group. Regarding time-related outcomes, there
was evidence for important heterogeneity of treatment effect among the
studies. Operative times were longer in R-MVS: differences in means were
20.7 min for cross-clamp time (95% CI, 9.07-32.3, p = 0.001), 20.7 min for
cardiopulmonary bypass time (95% CI, 2.5-38.9, p = 0.03) and 40.2 min for
total operative time (95% CI, 24.5-55.8, p < 0.001). Intensive care unit
stay and hospital stay were reported in one study, and longer after R-MVS
compared to V-MVS; the differences in means were 0.17 days (p = 0.005) and
0.6 days (p = 0.017), respectively. Total cost of both procedures was
reported in an additional dedicated propensity score-matched series
including 448 patients; it was 21% higher for R-MVS than for V-MVS.
 Conclusion(s): This meta-analysis showed excellent outcomes of both
video and robotic techniques with low incidence of morbidity and
mortality. However, there is no evidence for an added value of robotic
assistance in comparison with video assistance; the drawbacks of mini
access are reported higher regardless the induced over cost. Copyright
© The Author(s) 2023.

<50>
Accession Number
2022125434
Title
Effect of perioperative benzodiazepine use on intraoperative awareness and
postoperative delirium: a systematic review and meta-analysis of
randomised controlled trials and observational studies.
Source
British Journal of Anaesthesia. 131(2) (pp 302-313), 2023. Date of
Publication: August 2023.
Author
Wang E.; Belley-Cote E.P.; Young J.; He H.; Saud H.; D'Aragon F.; Um K.;
Alhazzani W.; Piticaru J.; Hedden M.; Whitlock R.; Mazer C.D.; Kashani
H.H.; Zhang S.Y.; Lucas A.; Timmerman N.; Nishi C.; Jain D.; Kugler A.;
Beaver C.; Kloppenburg S.; Schulman S.; Borges F.K.; Kavosh M.; Wada C.;
Lin S.; Sibilio S.; Lauw M.; Benz A.; Szczeklik W.; Mokhtari A.; Jacobsohn
E.; Spence J.
Institution
(Wang, He, Saud, Lin) Michael G. DeGroote School of Medicine, McMaster
University, Hamilton, ON, Canada
(Belley-Cote) Departments of Medicine (Cardiology and Critical Care),
McMaster University, Hamilton, ON, Canada
(Belley-Cote, Whitlock, Borges, Spence) Perioperative Research Division,
Population Health Research Institute, Hamilton, ON, Canada
(Young) Health Sciences Library, McMaster University, Hamilton, ON, Canada
(D'Aragon) Department d'anesthesiologie, Universite de Sherbrooke, Quebec,
QU, Canada
(Um, Piticaru) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Alhazzani) Departments of Critical Care, Medicine (Gastroenterology), and
Health Research Methods, Evaluation, and Impact, McMaster University,
Hamilton, ON, Canada
(Hedden) Faculty of Arts and Science, Queen's University, Kingston, ON,
Canada
(Whitlock) Departments of Surgery (Cardiac Surgery) and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
(Mazer) Department of Anesthesia and Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Kashani) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Zhang) Faculty of Medicine, McGill University, Montreal, QU, Canada
(Lucas) Department of Health Research Methods, Evaluation, and Impa, ct;
McMaster University, Hamilton, ON, Canada
(Timmerman, Nishi, Kugler) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Jain) Department of Anesthesiology, Trillium Health Partners, Toronto,
ON, Canada
(Beaver) Sheridan College, Oakville, ON, Canada
(Kloppenburg) Organon, Montreal, QU, Canada
(Schulman) Department of Medicine (Hematology), McMaster University,
Hamilton, ON, Canada
(Schulman) Thrombosis and Atherosclerosis Research Institute, Population
Health Research Institute, Hamilton, ON, Canada
(Schulman) Department of Obstetrics and Gynecology, I.M. Sechenov First
Moscow State Medical University, Moscow, Russian Federation
(Borges) Departments of Medicine and Health Research Methods, Evaluation,
and Impact, McMaster University, Hamilton, ON, Canada
(Kavosh) Department of Medicine, Coney Island Hospital, Brooklyn, NY,
United States
(Wada) Faculty of Arts, Waseda University, Tokyo, Japan
(Sibilio) Division of Cardiac Surgery, Instituto Clinico Sant'Ambrogio,
Milan, Italy
(Sibilio) Division of Cardiac Surgery, Centre Hospitaliere Universitaire
de Lille, Lille, France
(Lauw, Benz) Population Health Research Institute, Hamilton, ON, Canada
(Szczeklik) Center for Intensive Care and Perioperative Medicine,
Jagiellonian University Medical College, Krakow, Poland
(Mokhtari) Department of Medicine (Cardiology), McMaster University,
Hamilton, ON, Canada
(Jacobsohn) Departments of Anesthesia and Perioperative Medicine and
Medicine (Critical Care), University of Manitoba, Winnipeg, MB, Canada
(Spence) Departments of Anesthesia and Critical Care and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
Publisher
Elsevier Ltd
Abstract
Background: Benzodiazepine use is associated with delirium, and guidelines
recommend avoiding them in older and critically ill patients. Their
perioperative use remains common because of perceived benefits.
 Method(s): We searched CENTRAL, MEDLINE, CINAHL, PsycInfo, and Web of
Science from inception to June 2021. Pairs of reviewers identified
randomised controlled trials and prospective observational studies
comparing perioperative use of benzodiazepines with other agents or
placebo in patients undergoing surgery. Two reviewers independently
abstracted data, which we combined using a random-effects model. Our
primary outcomes were delirium, intraoperative awareness, and mortality.
 Result(s): We included 34 randomised controlled trials (n=4354) and
nine observational studies (n=3309). Observational studies were considered
separately. Perioperative benzodiazepines did not increase the risk of
delirium (n=1352; risk ratio [RR] 1.43; 95% confidence interval [CI]:
0.9-2.27; I2=72%; P=0.13; very low-quality evidence). Use of
benzodiazepines instead of dexmedetomidine did, however, increase the risk
of delirium (five studies; n=429; RR 1.83; 95% CI: 1.24-2.72;
I2=13%; P=0.002). Perioperative benzodiazepine use decreased
the risk of intraoperative awareness (n=2245; RR 0.26; 95% CI: 0.12-0.58;
I2=35%; P=0.001; very low-quality evidence). When considering
non-events, perioperative benzodiazepine use increased the probability of
not having intraoperative awareness (RR 1.07; 95% CI: 1.01-1.13;
I2=98%; P=0.03; very low-quality evidence). Mortality was
reported by one randomised controlled trial (n=800; RR 0.90; 95% CI:
0.20-3.1; P=0.80; very low quality). Conclusion(s): In this
systematic review and meta-analysis, perioperative benzodiazepine use did
not increase postoperative delirium and decreased intraoperative
awareness. Previously observed relationships of benzodiazepine use with
delirium could be explained by comparisons with dexmedetomidine.
Systematic review protocol: PROSPERO CRD42019128144 Copyright ©
2022 British Journal of Anaesthesia

<51>
Accession Number
2021973543
Title
Deconstructing the Dogma: Systematic Literature Review and Meta-analysis
of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve
Endocarditis.
Source
Open Forum Infectious Diseases. 9(11) (no pagination), 2022. Article
Number: ofac583. Date of Publication: 01 Nov 2022.
Author
Ryder J.H.; Tong S.Y.C.; Gallagher J.C.; Mcdonald E.G.; Thevarajan I.; Lee
T.C.; Cortes-Penfield N.W.
Institution
(Ryder, Cortes-Penfield) Department of Internal Medicine, Division of
Infectious Diseases, University of Nebraska Medical Center, Omaha, NE,
United States
(Tong, Thevarajan) Victorian Infectious Diseases Service, Royal Melbourne
Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne,
Australia
(Tong, Thevarajan) Department of Infectious Diseases, University of
Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne,
Australia
(Gallagher) Department of Pharmacy Practice, Temple University,
Philadelphia, PA, United States
(Mcdonald, Lee) Clinical Practice Assessment Unit, Department of Medicine,
McGill University, Montreal, QC, Canada
Publisher
Oxford University Press
Abstract
Background: Based primarily on in vitro and animal models, with little
data directly addressing patient outcomes, current guidelines recommend
treating staphylococcal prosthetic valve endocarditis (PVE) with
antibiotic combinations including gentamicin and rifampin. Here, we
synthesize the clinical data on adjunctive rifampin and gentamicin in
staphylococcal PVE. Method(s): We conducted a systematic review and
meta-analysis of PubMed- and Cochrane-indexed studies reporting outcomes
of staphylococcal PVE treated with adjunctive rifampin, gentamicin, both
agents, or neither (ie, glycopeptide or beta-lactam monotherapy). We
recorded outcomes including mortality, relapsed infection, length of stay,
nephrotoxicity, hepatotoxicity, and important drug-drug interactions
(DDIs). Result(s): Four relevant studies were identified. Two studies
(n = 117) suggested that adding gentamicin to rifampin-containing regimens
did not reduce clinical failure (odds ratio [OR], 0.98 [95% confidence
interval {CI},. 39-2.46]), and 2 studies (n = 201) suggested that adding
rifampin to gentamicin-containing regimens did not reduce clinical failure
(OR, 1.29 [95% CI,. 71-2.33]). Neither gentamicin nor rifampin was
associated with reduced infection relapse; 1 study found that rifampin
treatment was associated with longer hospitalizations (mean, 31.3 vs 42.3
days; P <. 001). Comparative safety outcomes were rarely reported, but 1
study found rifampin to be associated with hepatoxicity, nephrotoxicity,
and DDIs, leading to treatment discontinuation in 31% of patients.
 Conclusion(s): The existing clinical data do not suggest a benefit of
either adjunctive gentamicin or rifampin in staphylococcal PVE. Given that
other studies also suggest these agents add nephrotoxicity, hepatoxicity,
and risk of DDIs without benefit in staphylococcal endovascular
infections, we suggest that recommendations for gentamicin and rifampin in
PVE be downgraded and primarily be used within the context of clinical
trials. Copyright © 2022 The Author(s). Published by Oxford
University Press on behalf of Infectious Diseases Society of America.

<52>
Accession Number
2021329915
Title
Multivessel vs. culprit-vessel only percutaneous coronary interventions in
acute myocardial infarction and cardiogenic shock: a systematic review and
meta-analysis of prospective randomized and retrospective studies.
Source
European Heart Journal: Acute Cardiovascular Care. 11(7) (pp 558-569),
2022. Date of Publication: 01 Jul 2022.
Author
Gill G.S.; Sanchez J.S.; Thandra A.; Kanmanthareddy A.; Alla V.M.;
Garcia-Garcia H.M.
Institution
(Gill, Thandra, Kanmanthareddy, Alla) Division of Cardiovascular Disease,
Creighton University School of Medicine, Omaha, NE, United States
(Sanchez) Hospital Universitari i Politecnic La Fe, Valencia, Spain
(Sanchez) Centro de Investigacion Biomedica en Red (CIBERCV), Madrid,
Spain
(Garcia-Garcia) Department of Medicine, Georgetown University, Washington,
DC, United States
(Garcia-Garcia) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
Publisher
Oxford University Press
Abstract
Aims: Studies comparing outcomes of multivessel (MV) vs. culprit-vessel
(CV) only percutaneous coronary intervention (PCI) during index cardiac
catheterization in patients presenting with acute myocardial infarction
(MI) and cardiogenic shock (CS) have reported conflicting results. In this
systematic review we aim to investigate outcomes with MV vs. CV-only
revascularization strategies in patients with acute MI and CS.
 Methods and Results: PubMed, Google Scholar, CINAHL and Cochrane
databases were queried for studies comparing MV vs. CV PCI in patients
with acute MI and CS. Data were extracted and pooled by means of random
effects model. Primary outcome was early all-cause mortality (up to 30
days), while the secondary outcomes included late all-cause mortality
(mean, 11.4 months), stroke, new renal replacement therapy, reinfarction,
repeat revascularization, and bleeding. Pooled odds ratio (OR), 95%
confidence intervals (CIs), and number needed to harm (NNH) were
calculated. A total of 16 studies enrolling 75 431 patients were included.
The MV PCI was associated with higher risk of early mortality [OR 1.17,
95% CI (1.00-1.35); P = 0.04; NNH = 62], stroke [1.15 (1.03-1.29); P =
0.01; NNH = 351], and new renal replacement therapy [1.33 (1.06-1.67); P =
0.01; NNH = 61]; and with lower risk of repeat revascularization [0.61
(0.41-0.89); P = 0.01] when compared with CV PCI. No significant
difference was observed in late-term mortality [1.02 (0.84-1.25); P =
0.84], risk of reinfarction [1.13 (0.94-1.35); P = 0.18], or bleeding
[1.21 (0.94-1.55); P = 0.13] between groups. Conclusion(s): Among
patients with acute MI and CS, MV PCI during index cardiac catheterization
was associated with higher risk of early mortality, stroke, and renal
replacement therapy. Copyright © 2022 The Author(s).

<53>
Accession Number
2021329908
Title
Presentation cardiac troponin and early computed tomography coronary
angiography in patients with suspected acute coronary syndrome: a
pre-specified secondary analysis of the RAPID-CTCA trial.
Source
European Heart Journal: Acute Cardiovascular Care. 11(7) (pp 570-579),
2022. Date of Publication: 01 Jul 2022.
Author
Wang K.-L.; Roobottom C.; Smith J.E.; Goodacre S.; Oatey K.; O'Brien R.;
Storey R.F.; Curzen N.; Keating L.; Kardos A.; Felmeden D.; Thokala P.;
Mills N.L.; Newby D.E.; Gray A.J.
Institution
(Wang, Mills, Newby) Centre for Cardiovascular Science, University of
Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh
EH16 4SB, United Kingdom
(Wang) School of Medicine, National Yang Ming Chiao Tung University,
Taipei, Taiwan (Republic of China)
(Wang) General Clinical Research Center, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
(Roobottom) Department of Radiology, University Hospitals Plymouth NHS
Trust, Plymouth, United Kingdom
(Smith) Emergency Department, University Hospitals Plymouth NHS Trust,
Plymouth, United Kingdom
(Goodacre, Thokala) School of Health and Related Research, University of
Sheffield, Sheffield, United Kingdom
(Oatey) Edinburgh Clinical Trials Unit, University of Edinburgh,
Edinburgh, United Kingdom
(O'Brien, Gray) Department of Emergency Medicine, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton, Southampton,
United Kingdom
(Curzen) Department of Cardiology, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
(Keating) Department of Emergency Medicine, Royal Berkshire NHS Foundation
Trust, Reading, United Kingdom
(Kardos) Translational Cardiovascular Research Group, Milton Keynes
University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom
(Kardos) Faculty of Medicine and Health Science, University of Buckingham,
Buckingham, United Kingdom
(Felmeden) Department of Cardiology, Torbay and South Devon NHS Foundation
Trust, Torquay, United Kingdom
(Mills, Gray) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims: To evaluate the potential associations between presentation cardiac
troponin and the clinical impact of early computed tomography coronary
angiography (CTCA) in intermediate-risk patients with suspected acute
coronary syndrome. Methods and Results: In a large multicentre
randomized controlled trial of patients with intermediate-risk chest pain
due to suspected acute coronary syndrome, early CTCA had no effect on the
primary outcome - death or subsequent Type 1 or 4b myocardial infarction -
but reduced the rate of invasive coronary angiography. In this
pre-specified secondary analysis, cardiovascular testing and clinical
outcomes were compared between those with or without cardiac troponin
elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated
cardiac troponin concentration and 744 (43%) had a normal concentration.
Patients with cardiac troponin elevation had a higher Global Registry of
Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely
to have obstructive coronary artery disease (59 vs. 33%; P < 0.001),
non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001)
testing, coronary revascularization (47 vs. 15%; P < 0.001), and the
primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no
evidence that presentation cardiac troponin was associated with the
relative effects of early CTCA on rates of non-invasive (Pinteraction =
0.33) and invasive (Pinteraction = 0.99) testing, coronary
revascularization (Pinteraction = 0.57), or the primary outcome
(Pinteraction = 0.41). Conclusion(s): Presentation cardiac troponin
had no demonstrable associations between the effects of early CTCA on
reductions in non-invasive and invasive testing, or the lack of effect on
coronary revascularization or the primary outcome in intermediate-risk
patients with suspected acute coronary syndrome. Copyright © 2022
The Author(s).

<54>
Accession Number
2021281992
Title
Effect of chest ultrasound compared with pericardial window for the
diagnosis of occult penetrating cardiac wounds in hemodynamically stable
subjects with penetrating thoracic trauma: A meta-analysis.
Source
International Wound Journal. 20(6) (pp 2483-2491), 2023. Date of
Publication: August 2023.
Author
Yan T.; Xie W.; Xu M.
Institution
(Yan, Xu) Department of Liver Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Yan, Xie) Department of Emergency, People's Hospital of Deyang, Deyang,
China
Publisher
John Wiley and Sons Inc
Abstract
We conducted a meta-analysis to assess the diagnostic performance of chest
ultrasound compared with a pericardial window for the detection of occult
penetrating cardiac wounds in patients with penetrating thoracic trauma
who were hemodynamically stable. A systematic literature search up to
December 2022 was performed and 567 related studies were evaluated. The
chosen studies comprised 629 penetrating thoracic trauma subjects who
participated in the selected studies' baseline. Odds ratio (OR) with 95%
confidence intervals (CIs) were calculated to assess the effect of
different chest ultrasounds on wound infection after penetrating thoracic
trauma by the dichotomous methods with a random or fixed effect model. The
chest ultrasound resulted in significantly lower occult penetrating
cardiac wounds detection (OR, 0.02; 95% CI, 0.01-0.08, P < 0.001), higher
false positive (OR, 33.85; 95% CI, 9.21-124.39, P < 0.001), and higher
false negative (OR, 27.31; 95% CI, 7.62-97.86, P < 0.001) compared with
the pericardial window in penetrating thoracic trauma. The chest
ultrasound resulted in significantly lower occult penetrating cardiac
wound detection, higher false positives, and higher false negatives
compared with the pericardial window in penetrating thoracic trauma.
Although care should be taken when dealing with the results because all of
the studies had less than 200 subjects as a sample size. Copyright
© 2023 The Authors. International Wound Journal published by
Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<55>
Accession Number
2021080771
Title
A meta-analysis examined the effect of topical vancomycin application in
decreasing sternal wound infections post cardiac surgery.
Source
International Wound Journal. 20(6) (pp 2068-2074), 2023. Date of
Publication: August 2023.
Author
Zhang Y.; Zhang P.; Li H.; Chi H.; Zheng N.; Pan X.; Tang C.
Institution
(Zhang, Zhang, Li, Chi, Zheng, Pan, Tang) Department of Cardiovascular
Surgery, Sixth Medical Center, General Hospital of the Chinese People's
Liberation Army, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
To assess the impact of topical vancomycin (TV) application in decreasing
sternal wound infections (SWIs) post cardiac surgery (CS), we lead a
meta-analysis. Twenty-three thousand seven hundred and forty five
participants had CS at the outset of the investigations, according to a
thorough evaluation of the literature done up to November 2022; 8730 of
them used TV, while 15 015 were controls. To assess the effectiveness of
TV application in lowering SWIs following CS, odds ratios (OR) with 95%
confidence intervals (CIs) were computed with dichotomous technique with a
fixed- or random-effect model. The TV had significantly lower SWIs post CS
(OR, 0.34; 95% CI, 0.20-0.57; P <.001), and deep SWIs post CS (OR, 0.26;
95% CI, 0.11-0.65; P =.004) compared with control as shown in Figures 2
and 3. Yet, there was no significant difference found amongst TV and
control in superficial SWIs post CS (OR, 0.30; 95% CI, 0.07-1.30; P
=.011). The TV had significantly lower SWIs, and deep SWIs post CS, and no
significant difference was found in superficial SWIs post CS compared with
control. The low number of included studies in this meta-analysis for
superficial SWIs calls for precaution when analysing the
outcomes. Copyright © 2023 The Authors. International Wound
Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons
Ltd.

<56>
Accession Number
2020363365
Title
Prevalence and factors associated with pressure injury in patients
undergoing open heart surgery: A systematic review and meta-analysis.
Source
International Wound Journal. 20(6) (pp 2321-2333), 2023. Date of
Publication: August 2023.
Author
Taghiloo H.; Ebadi A.; Saeid Y.; Jalali Farahni A.; Davoudian A.
Institution
(Taghiloo) Department of Operating Room and Anesthesiology, School of
Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan,
Iran, Islamic Republic of
(Ebadi) Behavioral Sciences Research Centre, Life Style Institute, School
of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Saeid) Trauma Research Center and Faculty of Nursing, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Jalali Farahni) Atherosclerosis Research Center, Baqiyatallah University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Davoudian) Deputy of Research and Technology, Zanjan University of
Medical Sciences, Zanjan, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc
Abstract
Pressure injuries (PIs) are one of the major and costliest medical
problems with severe implications for patients. Cardiovascular surgery
patients are at the higher risk of developing surgery-related PIs. So this
study was conducted with the aim of investigating the prevalence and
factors associated with PIs in patients undergoing open heart surgery. We
identified articles through electronic databases such as Web of Science,
Scopus, PubMed, ProQuest; and Persian Databases: SID, Magiran and Irandoc
without restriction on language or publication period (from inception
through June 2022). Finally, 17 studies that fulfilled eligibility
criteria were included in final systematic review and meta-analysis. Data
analyses were conducted using STATA version 14. The pooled prevalence of
PI in patients undergoing open heart surgery was 24.06% (95% CI:
17.85-30.27). High heterogeneity was observed across the included studies
(I2 = 96.0, P < 0.000). The prevalence by gender was reported
as 25.19% (95% CI: 13.45-36.93) in men and 33.36% (95 CI%: 19.99-46.74) in
women. The result showed there was statistically significant association
between PI and Female sex (Pooled Est: 1.551, 95% CI: 1.199-2.006, z =
3.345, P = 0.001), diabetes (Pooled Est: 1.985, 95% CI: 1.383-2.849, z =
3.719, P = 0.000), advanced age (SMD: 0.33 years; 95% CI: 0.09-0.57),
Duration of surgery (SMD: 0.47; 95% CI: 0.19-0.75) and preoperative serum
albumin level (SMD: 0.56; 95% CI: 0.14-0.98). The relatively high PIs
incidence among patients undergoing open heart surgery suggests that
typical PI prevention methods are insufficient for this population.
Targeted prevention measures must be developed and
implemented. Copyright © 2022 The Authors. International Wound
Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons
Ltd.

<57>
Accession Number
2020309335
Title
Staged Revascularization for Chronic Total Occlusion in the Non-IRA in
Patients with ST-segment Elevation Myocardial Infarction Undergoing
Primary Percutaneous Coronary Intervention: An Updated Systematic Review
and Meta-analysis.
Source
Cardiovascular Innovations and Applications. 6(4) (pp 209-218), 2022. Date
of Publication: 2022.
Author
Geng Y.; Wang Y.; Liu L.; Miao G.; Zhang O.; Xue Y.; Zhang P.
Institution
(Geng, Wang, Liu, Miao, Zhang, Xue, Zhang) Department of Cardiology,
Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua
University, Beijing, China
Publisher
Compuscript Ltd
Abstract
Objectives: Meta-analysis was performed to evaluate the effect of staged
revascularization with concomitant chronic total occlusion (CTO) in the
non-infarct-associated artery (non-IRA) in patients with ST-segment
elevation myocardial infarction (STEMI) treated with primary percutaneous
coronary intervention (p-PCI). Method(s): Various electronic
databases were searched for studies published from inception to June,
2021. The primary endpoint was all-cause death, and the secondary endpoint
was a composite of major adverse cardiac events (MACEs). Odds ratios (ORs)
were pooled with 95% confidence intervals (CIs) for dichotomous data.
 Result(s): Seven studies involving 1540 participants were included in
the final analysis. Pooled analyses revealed that patients with successful
staged revascularization for CTO in non-IRA with STEMI treated with p-PCI
had overall lower all-cause death compared with the occluded CTO group
(OR, 0.46; 95% CI, 0.23-0.95), cardiac death (OR, 0.43; 95% CI,
0.20-0.91), MACEs (OR, 0.47; 95% CI, 0.32-0.69) and heart failure (OR,
0.57; 95% CI, 0.37-0.89) compared with the occluded CTO group. No
significant differences were observed between groups regarding myocardial
infarction and repeated revascularization. Conclusion(s): Successful
revascularization of CTO in the non-IRA was associated with better
outcomes in patients with STEMI treated with p-PCI. Copyright ©
2022 Cardiovascular Innovations and Applications. Creative Commons
Attribution-NonCommercial 4.0 International License

<58>
Accession Number
2019390809
Title
The Application of the Nurse-Led Sedation and Analgesia Management in ICU
after Heart Surgeries.
Source
Evidence-based Complementary and Alternative Medicine. 2022 (no
pagination), 2022. Article Number: 7706172. Date of Publication: 2022.
Author
Lu R.; Song H.; Wang L.; Xiong H.; Chen Z.; Liu X.; Wang S.; Xie C.; Jia
P.
Institution
(Lu, Wang, Xiong, Chen) Department of SICU, Sichuan Academy of Medical
Sciences and Sichuan Provincial People's Hospital, School of Medicine,
University of Electronic Science and Technology of China, Sichuan,
Chengdu, China
(Lu, Wang, Chen, Xie, Jia) Chinese Academy of Sciences Sichuan
Translational Medicine Research Hospital, Sichuan, Chengdu, China
(Song) Department of Nursing, Sichuan Provincial People's Hospital and
QiongLai Hospital, Sch. of Med., Univ. of Electronic Science and
Technology of China, Chengdu, Sichuan Uestc.edu.cn, China
(Xiong) Department of Neurosurgery, Sichuan Academy of Medical Sciences
and Sichuan Provincial People's Hospital, School of Medicine, University
of Electronic Science and Technology of China, Sichuan, Chengdu, China
(Liu) Department of ICU, Deyang People's Hospital, Sichuan, Deyang, China
(Wang) School of Nursing, North Sichuan Medical College, Sichuan,
Nanchong, China
(Xie) Department of Nursing, Sichuan Academy of Medical Sciences and
Sichuan Provincial People's Hospital, School of Medicine, University of
Electronic Science and Technology of China, Sichuan, Chengdu, China
(Jia) Department of NICU, Sichuan Academy of Medical Sciences and Sichuan
Provincial People's Hospital, School of Medicine, University of Electronic
Science and Technology of China, Sichuan uestc.edu.cn, Chengdu, China
Publisher
Hindawi Limited
Abstract
Aim. Traditional sedation management consists of doctors adjusting the
dosage of sedative drugs or adding other drugs in combination according to
the evaluation of nurses; the nurses then execute the orders. The nurses'
passive execution in the process is not the ideal model for continuous
evaluation and observation of sedation. This study aims to investigate the
application and effects of nurse-provided procedural sedation and
analgesia for patients in intensive care unit. Methods. The experimental
group consisted of 354 heart surgery patients who received procedural
sedation and analgesia from nurses from November 2020 to August 2021. The
control group consisted of 301 patients who had had heart surgery and
received the traditional sedation management program from January to
October 2020. The differences in levels of the sedative effect, delirium,
and unplanned extubation of patients between these two groups were
compared. Results. There were no significant differences in baseline
characteristics between the two groups (P>0.05). It was found that both
insufficient sedation and excessive sedation decreased in the experimental
group when compared to the control group, while the appropriate proportion
of sedation increased (72.41% versus 37.98%); the difference was
statistically significant (P<0.05). The incidence of delirium was lower
for patients in the experimental group than for patients in the control
group (37.01% versus 66.45%); the difference was statistically significant
(P<0.05). The incidence of unplanned extubation caused by patient factors
was lower for the experimental group than for the control group, but the
difference was not statistically significant (P>0.05). Conclusion. The
programmed sedation scheme led by nurses can improve the sedation effect
and reduce the incidence of delirium. Implications for Practice. The
management team gives the sedative goal and establishes the standard
flowchart. The sedation management led by the nurse according to the goal
and flowchart is better than the traditional sedation
management. Copyright © 2022 Rong Lu et al.

<59>
Accession Number
2016535173
Title
Long-term 5-year outcome of the randomized IMPRESS in severe shock trial:
Percutaneous mechanical circulatory support vs. intra-aortic balloon pump
in cardiogenic shock after acute myocardial infarction.
Source
European Heart Journal: Acute Cardiovascular Care. 10(9) (pp 1009-1015),
2021. Date of Publication: 01 Dec 2021.
Author
Karami M.; Eriksen E.; Ouweneel D.M.; Claessen B.E.; Vis M.M.; Baan J.;
Beijk M.; Packer E.J.S.; Sjauw K.D.; Engstrom A.; Vlaar A.; Lagrand W.K.;
Henriques J.P.S.
Institution
(Karami, Ouweneel, Claessen, Vis, Baan, Beijk, Engstrom, Henriques)
Department of Interventional Cardiology, Heart Center, Amsterdam
Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam,
Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Eriksen, Packer) Department of Heart Disease, Haukeland University
Hospital, Jonas Lies vei 65, Bergen 5021, Norway
(Claessen) Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar,
Netherlands
(Sjauw) Department of Cardiology, Medical Center Leeuwarden, Henri
Dunantweg 2, Leeuwarden 8934 AD, Netherlands
(Engstrom) Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
(Vlaar, Lagrand) Department of Intensive Care, Amsterdam UMC, University
of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
Publisher
Oxford University Press
Abstract
Aims: To assess differences in long-term outcome and functional status of
patients with cardiogenic shock (CS) treated by percutaneous mechanical
circulatory support (pMCS) and intra-aortic balloon pump (IABP).
 Methods and Results: Long-term follow-up of the multicentre,
randomized IMPRESS in Severe Shock trial (NTR3450) was performed 5-year
after initial randomization. Between 2012 and 2015, a total of 48 patients
with severe CS from acute myocardial infarction (AMI) with ST-segment
elevation undergoing immediate revascularization were randomized to pMCS
by Impella CP (n = 24) or IABP (n = 24). For the 5-year assessment,
all-cause mortality, functional status, and occurrence of major adverse
cardiac and cerebrovascular event (MACCE) were assessed. MACCE consisted
of death, myocardial re-infarction, repeat percutaneous coronary
intervention, coronary artery bypass grafting, and stroke. Five-year
mortality was 50% (n = 12/24) in pMCS patients and 63% (n = 15/24) in IABP
patients (relative risk 0.87, 95% confidence interval 0.47-1.59, P =
0.65). MACCE occurred in 12/24 (50%) of the pMCS patients vs. 19/24 (79%)
of the IABP patients (P = 0.07). All survivors except for one were in New
York Heart Association Class I/II [pMCS n = 10 (91%) and IABP n = 7
(100%), P = 1.00] and none of the patients had residual angina. There were
no differences in left ventricular ejection fraction between the groups
(pMCS 52 +/- 11% vs. IABP 48 +/- 10%, P = 0.53). Conclusion(s): In
this explorative randomized trial of patients with severe CS after AMI,
there was no difference in long-term 5-year mortality between pMCS and
IABP-treated patients, supporting previously published short-term data and
in accordance with other long-term CS trials. Copyright © 2021
The Author(s) 2021.

<60>
Accession Number
2016535167
Title
Acute kidney injury in patients with acute coronary syndrome undergoing
invasive management treated with bivalirudin vs. unfractionated heparin:
Insights from the MATRIX trial.
Source
European Heart Journal: Acute Cardiovascular Care. 10(10) (pp 1170-1179),
2021. Date of Publication: 01 Dec 2021.
Author
Landi A.; Branca M.; Ando G.; Russo F.; Frigoli E.; Gargiulo G.; Briguori
C.; Vranckx P.; Leonardi S.; Gragnano F.; Calabro P.; Campo G.; Ambrosio
G.; Santucci A.; Varbella F.; Zaro T.; Heg D.; Windecker S.; Juni P.;
Pedrazzini G.; Valgimigli M.
Institution
(Landi, Pedrazzini, Valgimigli) Division of Cardiology, Cardiocentro
Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48,
Lugano CH-6900, Switzerland
(Branca, Frigoli, Heg) CTU Bern, University of Bern, Bern, Switzerland
(Ando) Department of Clinical and Experimental Medicine, Azienda
Ospedaliera Universitaria Policlinico Gaetano Martino, University of
Messina, Messina, Italy
(Russo) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Gargiulo) Department of Advanced Biomedical Science, University of Naples
Federico II, Naples, Italy
(Briguori) Interventional Cardiology Unit, Mediterranea Cardiocentro,
Naples, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, University of Hasselt,
Hasselt, Belgium
(Leonardi) Coronary Care Unit, Department of Molecular Medicine,
University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Gragnano, Calabro) Division of Cardiology, Sant'Anna e San Sebastiano
Hospital, Caserta, Italy
(Gragnano, Calabro) Department of Translational Medicine, University of
Campania Luigi Vanvitelli, Caserta, Italy
(Campo) Cardiology Unit, Cardiovascular Institute, Azienda
Ospedaliero-Universitaria di Ferrara, Cona, Italy
(Ambrosio, Santucci) Department of Cardiology, Azienda
Ospedaliero-Universitaria S. Maria della Misericordia, Perugia, Italy
(Varbella) Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3,
Turin, Italy
(Varbella) Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi
Gonzaga Orbassano, Turin, Italy
(Zaro) Cardiology Division, A.O. Ospedale Civile di Vimercate (MB),
Vimercate, Italy
(Windecker, Valgimigli) Department of Cardiology, University of Bern,
Bern, Switzerland
(Juni) Department of Medicine, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, ON, Canada
Publisher
Oxford University Press
Abstract
Aims: Acute kidney injury (AKI) is a critical complication among patients
with acute coronary syndrome (ACS) undergoing invasive management. The
value of adjunctive antithrombotic strategies, such as bivalirudin or
unfractionated heparin (UFH) on the risk of AKI is unclear. Methods
and Results: Among 7213 patients enrolled in the MATRIX-Antithrombin and
Treatment Duration study, 128 subjects were excluded due to incomplete
information on serum creatinine (sCr) or end-stage renal disease on
dialysis treatment. The primary endpoint was AKI defined as an absolute
(>0.5 mg/dL) or a relative (>25%) increase in sCr. AKI occurred in 601
patients (16.9%) treated with bivalirudin and 616 patients (17.4%) treated
with UFH [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.85-1.09;
P = 0.58]. A >25% sCr increase was observed in 597 patients (16.8%) with
bivalirudin and 616 patients (17.4%) with UFH (OR: 0.96; 95% CI:
0.85-1.08; P = 0.50), whereas a >0.5 mg/dL absolute sCr increase occurred
in 176 patients (5.0%) with bivalirudin vs. 189 patients (5.4%) with UFH
(OR: 0.92; 95% CI: 0.75-1.14; P = 0.46). By implementing the Kidney
Disease Improving Global Outcomes (KDIGO) criteria, the risk of AKI was
not significantly different between bivalirudin and UFH groups (OR: 0.88;
95% CI: 0.72-1.07; P = 0.21). Subgroup analyses of the primary endpoint
suggested a benefit with bivalirudin in patients randomized to femoral
access. Conclusion(s): Among ACS patients undergoing invasive
management, the risk of AKI was not significantly lower with bivalirudin
compared with UFH. Copyright © 2021.

<61>
Accession Number
2015524229
Title
Assessment of the ESC quality indicators in patients with acute myocardial
infarction: A systematic review.
Source
European Heart Journal: Acute Cardiovascular Care. 10(8) (pp 878-889),
2021. Date of Publication: 01 Oct 2021.
Author
Rossello X.; Masso-Van Roessel A.; Perello-Bordoy A.; Mas-Llado C.;
Ramis-Barcelo M.F.; Vives-Borras M.; Pons J.; Peral V.
Institution
(Rossello, Masso-Van Roessel, Perello-Bordoy, Mas-Llado, Ramis-Barcelo,
Vives-Borras, Pons, Peral) Cardiology Department, Health Research
Institute of the Balearic Islands (IdISBa), Hospital Universitari Son
Espases, Palma, Spain
(Rossello) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Rossello) Facultat de Medicina, Universitat de les Illes Balears (UIB),
Illes Balears, Palma, Spain
Publisher
Oxford University Press
Abstract
Aims: To help improving quality of care in patients with acute myocardial
infarction (AMI), the European Society of Cardiology (ESC) set 20 quality
indicators (QIs). There is a need to compile and summarize QI
availability, feasibility, and global compliance in real-world registries.
 Methods and Results: A systematic review of PubMed and Web of Science
was conducted including all original articles reporting the use of the ESC
QIs in AMI patients. Methods and reporting follow the guidelines of the
PRISMA Statement and the protocol was registered in PROSPERO
(CRD42020190541). Among the 220 screened citations, 9 studies met the
inclusion criteria after full-text review. Among these 9 studies, there
were 11 different cohorts. Patients were recruited from three different
continents (31 countries). The number of QIs assessed ranged from 6 to 20,
with 5 studies (56%) reporting data for at least 75% of the 20 QIs. There
were room for improvement in terms of data availability (i.e. domain 6
measuring patient's satisfaction), feasibility (i.e. difficulties to find
all data for composite QIs in domain 7), and attainment (i.e. high levels
of compliance with the percentage of reperfused ST-segment elevation
myocardial infarction patients, but low levels for a timely reperfusion).
 Conclusion(s): Our systematic review has shown that it is possible to
measure most QIs in existing registries, and that there is room for
improvement in terms of data availability, feasibility, and levels of
attainment to QIs. Our findings may influence the design of future
registries to capture this information and help in QIs definition
updates. Copyright © 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<62>
Accession Number
2015524156
Title
Cardiac troponin and infective endocarditis prognosis: A systematic review
and meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 10(3) (pp 356-366),
2021. Date of Publication: 01 Mar 2021.
Author
Postigo A.; Vernooij R.W.M.; Fernandez-Aviles F.; Martinez-Selles M.
Institution
(Postigo, Fernandez-Aviles, Martinez-Selles) Department of Cardiology,
Hospital General Universitario Gregorio Maranon, Madrid, Spain
(Postigo, Fernandez-Aviles, Martinez-Selles) Instituto de Investigacion
Sanitaria Gregorio Maranon, Madrid, Spain
(Postigo, Fernandez-Aviles, Martinez-Selles) Facultad de Medicina,
Universidad Complutense, Madrid, Spain
(Postigo, Fernandez-Aviles, Martinez-Selles) CIBERCV, Madrid, Spain
(Vernooij) Department of Nephrology and Hypertension, University Medical
Center Utrecht, Utrecht, Netherlands
(Vernooij) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(Martinez-Selles) Facultad de Ciencias Biomedicas, Universidad Europea,
Madrid, Spain
Publisher
Oxford University Press
Abstract
Aims: Infective endocarditis (IE) is associated with high mortality and
morbidity. Cardiac troponin (Tn) elevation seems to be common in patients
with IE and could be associated with a poor prognosis. The aim of this
study was to synthesize the prognostic value of Tn in patients with IE.
 Methods and Results: We searched in MEDLINE, EMBASE, and the Cochrane
library, including the Cochrane Central Register of Controlled Trials
(CENTRAL) until February 2020. Observational studies reporting on the
association between Tn and in-hospital and 1-year mortality, and IE
complications were considered eligible. As each centre uses different
conventional or ultra-sensitive Tn, with different normality threshold, we
considered them as normal or elevated according to the criteria specified
in each article. Articles were systematically selected, assessed for bias,
and, when possible, meta-analysed using a random effect model. After
retrieving 542 articles, 18 were included for qualitative synthesis and 9
for quantitative meta-analysis. Compared with patients with normal Tn
levels, patients with Tn elevation presented higher in-hospital mortality
[odds ratio (OR) 5.96, 95% confidence interval (CI) 3.46-10.26; P <
0.0001], 1-year mortality (OR 2.67, 95% CI 1.42-5.02; P = 0.002), and
surgery rates (OR 2.34, 95% CI 1.42-3.85; P = 0.0008). They also suffered
more frequent complications: Central nervous system events (OR 8.85, 95%
CI 3.23-24.26; P < 0.0001) and cardiac abscesses (OR 4.96, 95% CI
1.94-12.70; P = 0.0008). Conclusion(s): Tn elevation is associated
with a poor prognosis in patients with IE. Troponin determination seems to
provide additional help in the prognostic assessment of these
patients. Copyright © 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<63>
Accession Number
2015524126
Title
The value of urinary sodium assessment in acute heart failure.
Source
European Heart Journal: Acute Cardiovascular Care. 10(2) (pp 216-223),
2021. Date of Publication: 01 Feb 2021.
Author
Tersalvi G.; Dauw J.; Gasperetti A.; Winterton D.; Cioffi G.M.; Scopigni
F.; Pedrazzini G.; Mullens W.
Institution
(Tersalvi, Cioffi, Scopigni, Pedrazzini) Department of Cardiology,
Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano 6900, Switzerland
(Tersalvi, Dauw, Mullens) Department of Cardiology, Ziekenhuis
Oost-Limburg, Genk, Belgium
(Dauw) Doctoral School for Medicine and Life Sciences, Hasselt University,
Diepenbeek, Belgium
(Gasperetti) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Winterton) Department of Anesthesia and Intensive Care Medicine, ASST
Monza, Monza, Italy
(Cioffi) Department of Cardiology, Kantonsspital Luzern, Lucerne,
Switzerland
(Pedrazzini) Department of Biomedical Sciences, University of Italian
Switzerland, Lugano, Switzerland
(Mullens) Biomedical Research Institute, Faculty of Medicine and Life
Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
Publisher
Oxford University Press
Abstract
Acute heart failure (AHF) is a frequent medical condition that needs
immediate evaluation and appropriate treatment. Patients with signs and
symptoms of volume overload mostly require intravenous loop diuretics in
the first hours of hospitalization. Some patients may develop diuretic
resistance, resulting in insufficient and delayed decongestion, with
increased mortality and morbidity. Urinary sodium measurement at baseline
and/or during treatment has been proposed as a useful parameter to tailor
diuretic therapy in these patients. This systematic review discusses the
current sum of evidence regarding urinary sodium assessment to evaluate
diuretic efficacy in AHF. We searched Medline, Embase, and Cochrane
Clinical Trials Register for published studies that tested urinary sodium
assessment in patients with AHF. Copyright © 2020 Published on
behalf of the European Society of Cardiology. All rights reserved.

<64>
Accession Number
2015363045
Title
A randomised controlled feasibility trial of a clinical protocol to manage
hypotension during major non-cardiac surgery.
Source
Anaesthesia. 77(7) (pp 795-807), 2022. Date of Publication: 01 July 2022.
Author
Wijeysundera D.N.; Duncan D.; Moreno Garijo J.; Jerath A.; Meineri M.;
Parotto M.; Wasowicz M.; McCluskey S.A.
Institution
(Wijeysundera) Department of Anesthesia, St. Michael's Hospital, Toronto,
ON, Canada
(Wijeysundera, Duncan, Moreno Garijo, Jerath, Meineri, Parotto, Wasowicz,
McCluskey) Department of Anesthesiology and Pain Medicine, University of
Toronto, ON, Canada
(Meineri) Department of Anaesthesia and Intensive Care, Heart Centre
Leipzig, Germany
Publisher
John Wiley and Sons Inc
Abstract
Intra-operative hypotension is a risk factor for postoperative morbidity
and mortality. Minimally invasive monitors that derive other haemodynamic
parameters, such as stroke volume, may better inform the management of
hypotension. As a prelude to a multicentre randomised controlled trial, we
conducted a single-centre feasibility trial of a protocol to treat
hypotension as informed by minimally invasive haemodynamic monitoring
during non-cardiac surgery. We recruited adults aged >=40 years with
cardiovascular risk factors who underwent non-cardiac surgery requiring
invasive arterial pressure monitoring. Participants were randomly
allocated to usual care, or a clinical protocol informed by an arterial
waveform contour analysis monitor. Participants, outcome assessors,
clinicians outside operating theatres and analysts were blinded to
treatment allocation. Feasibility was evaluated based on: consent rate;
recruitment rate; structured feedback from anaesthesia providers; and
between-group differences in blood pressure, processes-of-care and
outcomes. The consent rate among eligible patients was 33%, with 30
participants randomly allocated to the protocol and 30 to usual care.
Anaesthesia providers rated the protocol to be feasible and acceptable.
The protocol was associated with reduced fluid balance and hypotension
exposure in the peri-operative setting. Postoperative complications
included: acute myocardial injury in 18 (30%); acute kidney injury in 17
(28%); and surgical site infection in 7 (12%). The severity of
complications was rated as moderate or severe in 25 (42%) participants. In
summary, this single-centre study confirmed the feasibility of a
multicentre trial to assess the efficacy and safety of a physiologically
guided treatment protocol for intra-operative hypotension based on
minimally invasive haemodynamic monitors. Copyright © 2022
Association of Anaesthetists.

<65>
Accession Number
2014191088
Title
Oral preanesthetic medication in children comparison between midazolam
alone and in combination with ketamine: a systematic review and
meta-analysis.
Source
Brazilian Journal of Anesthesiology (English Edition). 73(4) (pp 477-490),
2023. Date of Publication: 01 Jul 2023.
Author
Oliveira Filho G.L.R.D.; Castilhos C.M.; Kriegl J.P.; Bianchi G.N.
Institution
(Oliveira Filho, Castilhos, Kriegl, Bianchi) Universidade Federal de Santa
Catarina, Departamento de Cirurgia, SC, Florian.polis, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Background: Up to 60% of pediatric surgical patients develop high levels
of preoperative anxiety. This study compared the effects of oral
combinations of midazolam and ketamine with oral midazolam alone for
pediatric preanesthetic medication. Method(s): The study protocol was
registered in PROSPERO as CRD42020172920. A systematic literature search
was conducted using Medline, Cochrane, EMBASE, CENTRAL, and Web of Science
for randomized controlled trials comparing oral combinations of midazolam
and ketamine with midazolam alone as preanesthetic medication in elective
surgical pediatric patients. Meta-analyses included the following
outcomes: anxiety and sedation levels, child...s behavior during
separation from parents, face mask acceptance, and venipuncture. The
quality of evidence was assessed using GRADE criteria. Result(s):
Twenty studies were included. The following effects (RR (95% CI)) were
observed for combinations of ketamine and midazolam relative midazolam
alone: anxiolysis (1.2 (0.94...1.52); p.s=.s0.15; I2.s=.s80%;
GRADE.s=.svery low); satisfactory sedation (1.2 ( 1.10...1.31);
p.s<.s0.001; I2.s=.s71%; GRADE.s=.svery low); behavior during parental
separation (1.2 (1.06...1.36); p.s=.s0.003; I2.s=.s88%; GRADE.s=.svery
low); facial mask acceptance (1.13 (1.04...1.24); p.s=.s0.007; I2.s=.s49%;
GRADE.s=.svery low); behavior during venipuncture (1.32 (1.11...1.57);
p.s=.s0.002; I2.s=.s66%; GRADE.s=.svery low). Conclusion(s): While
similar probabilities of obtaining anxiolysis were found, adequate
sedation, calm behavior during child...s separation from parents, low
levels of fear during face mask adaptation, and cooperative behavior
during peripheral venous cannulation were more likely with
midazolam-ketamine combinations. Copyright © 2021 Sociedade
Brasileira de Anestesiologia

<66>
Accession Number
2013587649
Title
Predictive performance of thyromental height for difficult laryngoscopies
in adults: a systematic review and meta-analysis.
Source
Brazilian Journal of Anesthesiology (English Edition). 73(4) (pp 491-499),
2023. Date of Publication: 01 Jul 2023.
Author
Carvalho C.I.C.I.D.; Santos Neto J.M.; Orange F.V.A.D.
Institution
(Carvalho, Orange) Instituto de Medicina Integral Prof. Fernando Figueira
(IMIP), Department of Post-graduation, PE, Recife, Brazil
(Santos Neto) Universidade Federal de Pernambuco (UFPE), Hospital das
Cl.inicas, Department of Anesthesia, PE, Recife, Brazil
Publisher
Elsevier Editora Ltda
Abstract
Background: Thyromental height (TMH) was first reported as a great single
test for prediction of difficult laryngoscopies, although further studies
have shown variable estimates of its accuracy. We thus performed this
meta-analysis to summarize the predictive values of TMH mainly for
prediction of difficult laryngoscopies. Method(s): A search in
PubMed, EMBASE, LILACS, and Scielo was conducted in June 2020. We included
prospective cohorts fully reported with patients. 16 years old, providing
data on predictive values of TMH for prediction of either difficult
laryngoscopies or difficult intubations. Diagnostic properties and
association between TMH and Cormack and Lehanes...s classification by
direct laryngoscopy were evaluated. A random-effects meta-analysis using
hierarchical models was performed. Result(s): Eight studies
evaluating 2844 patients were included. All included studies had high risk
of bias and low concern regarding applicability. There was significant
heterogeneity among the studies. The pooled diagnostic odds ratio (DOR)
and positive (LR+) and negative (LR-) likelihood ratios were as follows:
DOR, 57.94 (95% CI: 18.19...184.55); LR+, 11.32 (95% CI: 4.28...29.92);
and LR-, 0.23 (95% CI: 0.15...0.35). Summary sensitivity and specificity
for studies with common threshold were 82.6 (95% CI: 74...88.8%) and 93.5
(95% CI: 79...98.2%), respectively. The estimated AUC was 81.1%.
 Conclusion(s): TMH arises as a good predictor of difficult
laryngoscopies in adult patients from diverse populations presenting
better predictive values than most previously reported bedside tests.
However, the high risk of bias throughout the studies may have skewed the
results of the individual research as well as the summary points of the
present meta-analysis. Copyright © 2021 Sociedade Brasileira de
Anestesiologia

<67>
Accession Number
2007038288
Title
Outcomes in non-ST-segment elevation myocardial infarction patients
according to heart failure at admission: Insights from a large trial with
systematic early invasive strategy.
Source
European Heart Journal: Acute Cardiovascular Care. 10(7) (pp 736-745),
2021. Date of Publication: 01 Sep 2021.
Author
Popovic B.; Sorbets E.; Abtan J.; Cohen M.; Pollack C.V.; Bode C.; Wiviott
S.D.; Sabatine M.S.; Mehta S.R.; Ruzyllo W.; Rao S.V.; French W.J.; Kerkar
P.; Kiss R.G.; Estrada J.L.N.; Elbez Y.; Ducrocq G.; Steg P.G.
Institution
(Popovic) Universite de Lorraine, CHRU de Nancy, Departement de
Cardiologie, Nancy, France
(Sorbets) Universite de Paris, Puis APHP, Hotel Dieu, Centre de Diagnostic
et de Therapeutique; French Alliance for Cardiovascular Trials (FACT),
INSERM LVTS-U1148, France
(Abtan, Elbez, Ducrocq, Steg) APHP, Department of Cardiology, Hopital
Bichat, France
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Mount
Sinai School of Medicine, Newark, NJ, United States
(Pollack) Department of Emergency Medicine, Thomas Jefferson University
Hospital, Philadelphia, United States
(Pollack) Sidney Kimmel Medical College, United States
(Bode) Medizinische Universitatsklinik, Freiburg, Germany
(Wiviott, Sabatine) Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Mehta) McMaster University and the Population Health Research Institute,
Hamilton Health Sciences, Hamilton, ON, Canada
(Ruzyllo) Institute of Cardiology, Warsaw, Poland
(Rao) The Duke Clinical Research Institute, Durham, NC, United States
(French) David Geffen School of Medicine at UCLA, Torrance, CA, United
States
(Kerkar) Seth GS Medical College, India
(Kerkar) KEM Hospital Parel, India
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Estrada) Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital London, United
Kingdom
(Abtan, Ducrocq, Steg) French Alliance for Cardiovascular Trials (FACT),
INSERM LVTS-U1148, DHU FIRE, University of Paris, France
Publisher
Oxford University Press
Abstract
Background: Previous studies published before the era of systematic early
invasive strategy have reported a higher mortality in non-ST-segment
elevation myocardial infarction patients with heart failure. The aim of
our study was to compare the clinical characteristics, outcomes and causes
of death of patients according to their heart failure status at admission
in a large non-ST-segment elevation myocardial infarction population with
planned early invasive management. Method(s): We performed a post-hoc
analysis of the Treatment of Acute Coronary Syndrome with Otamixaban
randomised trial which included non-ST-segment elevation myocardial
infarction patients with systematic coronary angiography within 72 h.
Patients were categorised according to presence or absence of heart
failure (Killip grade >=2) at admission. Result(s): A total of 13,172
patients were enrolled, of whom 944 (7.2%) had heart failure. At day 30,
death occurred in 213 patients (1.6%) and cardiovascular death was the
dominant cause of death in both groups ((with vs without heart failure)
78.8% vs 78.4%, p = 0.94). At six months, death occurred in 90/944 (9.5%)
patients with heart failure and 258/12228 patients without heart failure
(2.1%) (p < 0.001). After adjustment on Global Registry of Acute Coronary
Events risk score, heart failure was an independent predictor of all-cause
mortality at day 30 (odds ratio: 1.58; 95% confidence interval, 1.06-2.36,
p = 0.02) and at day 180 (odds ratio: 1.77; 95% confidence interval,
1.3-2.42, p < 0.001) as well as of ischaemic complications (cardiovascular
death, myocardial infarction, stent thrombosis or stroke at day 30 (odds
ratio: 1.28; 95% confidence interval, 1.01-1.62, p = 0.04).
 Conclusion(s): Non-ST-segment elevation myocardial infarction
patients with heart failure at admission still have worse outcomes than
those without heart failure, even with systematic early invasive strategy.
Further efforts are needed to improve the prognosis of these high risk
patients. Copyright © 2020 Published on behalf of the European
Society of Cardiology. All rights reserved.

<68>
Accession Number
2006909314
Title
Revascularisation in older adult patients with non-ST-segment elevation
acute coronary syndrome: effect and impact on 6-month mortality.
Source
European Heart Journal: Acute Cardiovascular Care. 9(4) (pp 358-366),
2020. Date of Publication: 01 Jun 2020.
Author
Bardaji A.; Barrabes J.A.; Ribera A.; Bueno H.; Fernandez-Ortiz A.;
Marrugat J.; Oristrell G.; Ferreira-Gonzalez I.
Institution
(Bardaji) Servicio de Cardiologia, Hospital Universitari de Tarragona Joan
XXIII, Tarragona, Spain
(Barrabes, Ribera, Oristrell, Ferreira-Gonzalez) Servicio de Cardiologia,
Hospital Universitari Vall d'Hebron, Barcelona, Spain
(Bueno) Servicio de Cardiologia, Hospital Universitario, 12 de Octubre,
Madrid, Spain
(Fernandez-Ortiz) Servicio de Cardiologia, Hospital Clinico San Carlos,
Madrid, Spain
(Marrugat) Grupo de Epidemiologia y Genetica Cardiovascular, Instituto
Hospital del Mar de Investigaciones Medicas, Barcelona, Spain
Publisher
SAGE Publications Inc.
Abstract
Although revascularisation in non-ST-segment elevation acute coronary
syndrome (NSTEACS) is associated with better outcomes, its impact in older
adult patients is unclear. This is a retrospective analyses of three
national NSTEACS registries conducted during the past decade in Spain.
Patients aged 75 years and older were included: DESCARTES (DES; year 2002;
n=534), MASCARA (MAS; 2005; n=1736) and DIOCLES (DIO; 2012; n=593). The
adjusted association between revascularisation and total (inhospital and
6-month) mortality was estimated by two-stage meta-analysis (pooled effect
across the three registries with inverse-variability weights) and
one-stage meta-analysis (multilevel model with random effects across
studies). The impact of revascularisation was assessed comparing the
observed and the expected mortality based on a logistic regression model
in the pooled database. Although revascularisation was associated with a
lower risk of mortality in meta-analyses (two-stage: odds ratio 0.44, 95%
confidence interval 0.29-0.67; one-stage: odds ratio 0.54, 95% confidence
interval 0.36-0.81) and the revascularisation rate increased steadily from
2002 (DES 14.2%) to 2012 (DIO 43.7%), its impact was not patent across
registries, probably because this increase was concentrated in low and
medium-risk GRACE strata (tertile 1, 2 and 3: MAS 59%, 20% and 6%; DIO
64%, 39% and 19%, respectively). In conclusion, a consistent increase of
revascularisation in NSTEACS in older adults was not followed by a
decrease in mortality at 6 months, probably because the impact of this
strategy is limited to the higher risk population, the stratum with the
lowest revascularisation rate in real life. Copyright © The
European Society of Cardiology 2019.

<69>
Accession Number
2004236202
Title
Outcome after surgical repair of tetralogy of Fallot: A systematic review
and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 159(1) (pp 220-236.e8),
2020. Date of Publication: January 2020.
Author
Romeo J.L.R.; Etnel J.R.G.; Takkenberg J.J.M.; Roos-Hesselink J.W.;
Helbing W.A.; van de Woestijne P.; Bogers A.J.J.C.; Mokhles M.M.
Institution
(Romeo, Etnel, Takkenberg, van de Woestijne, Bogers, Mokhles) Department
of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Helbing) Division of Pediatric Cardiology, Department of Pediatrics,
Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam,
Netherlands
(Helbing) Division of Pediatric Cardiology, Department of Pediatrics,
Radboud University Medical Center, Amalia Children's Hospital, Nijmegen,
Netherlands
Publisher
Mosby Inc.
Abstract
Introduction: Tetralogy of Fallot (TOF) is the most common cyanotic
congenital heart disease. Intracardiac correction was pioneered by Walton
Lillehei in 1955 and has since then gone through major developments. The
aim of this study was to provide a systematic literature review of
published results on the long-term outcome of complete surgical correction
of TOF. Method(s): MEDLINE, PubMed, Embase, Web of Science, Cochrane,
and Google Scholar were systematically searched for literature published
between January 2000 and July 2018. Pooled estimates with a random effects
model after log-transformation were calculated for mortality and
reintervention. Potential heterogeneity was assessed by subgroup analyses
and meta-regression. Result(s): A total of 143 papers of 137 distinct
cohorts comprising 21,427 patients and total follow-up duration of 147,430
patient-years were included. Overall mean age at correction was 3.7 +/-
5.6 years, but excluding papers exclusively focusing on correction in
adults yielded a mean age of 0.5 +/- 2.5 years at correction. Previous
palliative shunts (107 studies), a transventricular approach (81 studies),
and a transannular patch (124 studies) were used in 16% (range 0%-78%),
39% (range 0%-100%), and 49% (range 0%-100%) of the patients.
respectively. In case a transannular patch was used, monocusp
reconstruction was applied in 15% (range 0%-100%) (49 studies). The most
common genetic abnormality was Down syndrome, with a pooled estimated
prevalence of 4.6% (range 0%-12.3%). The pooled estimates of early and
late mortality were 2.84% (95% confidence interval [CI], 2.34-3.45) and
0.42%/year (95% CI, 0.33-0.54), respectively. The pooled estimate of late
cardiac mortality was 0.26%/year (95% CI, 0.21-0.34). Valve-related
mortality and non-valve-related mortality had pooled estimates of
0.20%/year (95% CI, 0.15-0.26) and 0.17%/year (95% CI, 0.12-0.22),
respectively. The pooled estimate of reintervention was 2.26%/year (95%
CI, 1.86-2.75). Conclusion(s): TOF can be surgically corrected at a
young age with low perioperative and long-term mortality. Life-long
intensive follow-up and substantial reintervention rates characterize the
clinical course. Copyright © 2019 The American Association for
Thoracic Surgery

<70>
Accession Number
2003522934
Title
Efficacy and safety of vorapaxar for secondary prevention in low body
weight in patients with atherosclerosis: Analyses from the TRA
2degreeP-TIMI 50 Trial.
Source
European Heart Journal: Acute Cardiovascular Care. 10(2) (pp 190-199),
2021. Date of Publication: 01 Feb 2021.
Author
Xu H.; Bonaca M.P.; Goodrich E.; Scirica B.M.; Morrow D.A.
Institution
(Xu, Bonaca, Goodrich, Scirica, Morrow) TIMI Study Group, Brigham and
Women's Hospital, 350 Longwood Avenue, 1st office floor, Boston, MA 02115,
United States
Publisher
Oxford University Press
Abstract
Background: Vorapaxar inhibits the thrombin-mediated activation of
platelets, reduces thrombotic events in patients with myocardial
infarction or peripheral arterial disease while increasing bleeding. In
the TRA 2degreeP-TIMI 50 trial, we observed a nominally significant
interaction between low body weight and the reduced efficacy of vorapaxar.
 Method(s): We investigated the relationship between body weight and
the efficacy and safety of vorapaxar within a multinational, randomized,
double-blind, placebo-controlled trial of vorapaxar in patients with
atherosclerosis. This analysis was performed among 20,138 patients with a
clinical indication for vorapaxar. Result(s): Compared with patients
weighing 60 kg or more, patients weighing less than 60 kg were older, more
frequently women, Asian and had renal insufficiency (each P<0.001). The
efficacy of vorapaxar with respect to cardiovascular death, myocardial
infarction and stroke showed a significant interaction with patients'
weight (Pinteraction<0.03). However among patients younger than 65 years,
vorapaxar reduced the primary endpoint regardless of weight (weight >=60
kg: 6.4% vs. 8.1%, hazard ratio (HR) 0.75, 95% confidence interval (CI)
0.65-0.86; weight <60 kg: 5.4% vs. 7.2%, HR 0.75, 95% CI 0.37-1.49,
Pinteraction=0.98). Among patients aged 65 years and older, the efficacy
of vorapaxar diminished in patients weighing less than 60 kg (high weight:
10.4% vs. 12.6%, HR 0.81, 95% CI 0.69-0.95; low weight: 16.1% vs. 9.0%, HR
1.62, 95% CI 0.95-2.76, Pinteraction=0.01). The relative increase in
bleeding with vorapaxar was not modified by weight (all
Pinteraction>0.05). Conclusion(s): Vorapaxar reduced vascular events
and improved net clinical outcome regardless of body weight in younger
patients. Elderly patients with low weight may not be good candidates for
aggressive secondary prevention with vorapaxar added to standard
therapy. Copyright © 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<71>
Accession Number
2003400464
Title
Prognostic implications of microcirculatory perfusion versus
macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy.
Source
European Heart Journal: Acute Cardiovascular Care. 9(2) (pp 108-119),
2020. Date of Publication: 01 Mar 2020.
Author
Wijntjens G.W.M.; Fengler K.; Fuernau G.; Jung C.; den Uil C.; Akin S.;
van de Hoef T.P.; Serpytis R.; Diletti R.; Henriques J.P.S.; Serpytis P.;
Thiele H.; Piek J.J.
Institution
(Wijntjens, van de Hoef, Henriques, Piek) Heart Center, Amsterdam
Universitair Medische Centra, Netherlands
(Fengler, Thiele) Department of Internal Medicine/Cardiology, University
Hospital, Germany
(Fuernau) Medical Clinic II (Cardiology/Angiology/Intensive Care
Medicine), University of Luebeck, Germany
(Jung) Medical Faculty, University Hospital Dusseldorf, Germany
(den Uil) Department of Intensive Care Medicine, Erasmus University
Medical Center, Netherlands
(den Uil, Akin, Diletti) Department of Cardiology, Erasmus University
Medical Center, Netherlands
(Akin) Department of Intensive Care, Haga Teaching Hospital, The Hague,
Netherlands
(Serpytis, Serpytis) Clinic of Cardiac and Vascular Diseases, Vilnius
University, Lithuania
Publisher
SAGE Publications Inc.
Abstract
Background: After early revascularisation, restoration of macrocirculatory
perfusion parameters is the primary objective in the management of
cardiogenic shock complicated acute myocardial infarction. Nevertheless,
vital organ perfusion may be compromised at the systemic microcirculatory
level, even in patients with preserved macrohaemodynamics. Microvascular
perfusion was shown to have independent prognostic value for early
mortality. The present study aims to compare the prognostic value of
microcirculatory versus macrocirculatory perfusion parameters.
 Method(s): This substudy of the culprit lesion-only percutaneous
coronary intervention versus multivessel percutaneous coronary
intervention in cardiogenic shock (CULPRIT-SHOCK) trial examined the
sublingual capillary network using videomicroscopy post-percutaneous
coronary intervention to determine the proportion of perfused capillaries
(<20 microm) and perfused capillary density. Thirty-day follow-up was
performed to obtain the occurrence of a combined clinical endpoint of
all-cause death and renal replacement therapy. Result(s):
Videomicroscopy measurements were performed in 66 patients. There was a
significant adjusted association between microcirculatory perfusion
parameters and the combined clinical endpoint (proportion of perfused
capillaries: P=0.020; perfused capillary density: P=0.035), whereas there
was no significant adjusted association between macrocirculatory perfusion
parameters and the combined clinical endpoint (systolic blood pressure:
P=0.205). Normotensive patients with compromised microcirculatory
perfusion parameters had a higher risk of the combined clinical endpoint
than normotensive patients with preserved microcirculatory perfusion
parameters (proportion of perfused capillaries: Breslow P=0.014; perfused
capillary density: Breslow P=0.076). Conclusion(s): There is a
significant and independent association between microcirculatory perfusion
parameters perfused capillary density and proportion of perfused
capillaries and the combined clinical endpoint of all-cause death and
renal replacement therapy at 30 days follow-up. In patients with loss of
haemodynamic coherence between microcirculatory and macrocirculatory
perfusion parameters, microcirculatory perfusion parameters confer
dominant prognostic value. Copyright © The European Society of
Cardiology 2019.

<72>
Accession Number
628375879
Title
Radial versus femoral access in patients with acute coronary syndrome
undergoing invasive management: A prespecified subgroup analysis from
VALIDATE-SWEDEHEART.
Source
European Heart Journal: Acute Cardiovascular Care. 8(6) (pp 510-519),
2019. Date of Publication: 01 Sep 2019.
Author
Volz S.; Angeras O.; Koul S.; Haraldsson I.; Sarno G.; Venetsanos D.;
Grimfard P.; Ulvenstam A.; Hofmann R.; Hamid M.; Henareh L.; Wagner H.;
Jensen J.; Danielewicz M.; Ostlund O.; Eriksson P.; Schersten F.; Linder
R.; Ramunddal T.; Petursson P.; Frobert O.; James S.; Erlinge D.; Omerovic
E.
Institution
(Volz, Angeras, Haraldsson, Petursson, Omerovic) Department of Cardiology,
Sahlgrenska University Hospital, Sweden
(Koul, Schersten, Erlinge) Department of Cardiology, Lund University,
Sweden
(Sarno, Ostlund, James) Department of Medical Sciences and Uppsala
Clinical Research Center, Uppsala University, Sweden
(Venetsanos, Henareh) Department of Cardiology, Karolinska University
Hospital, Sweden
(Grimfard) Department of Internal Medicine, Vastmanlands Sjukhus, Sweden
(Ulvenstam) Department of Cardiology, Ostersund Hospital, Sweden
(Hofmann, Jensen) Department of Clinical Science and Education, Karolinska
Institutet, Sweden
(Hamid) Department of Cardiology, Malarsjukhuset, Sweden
(Wagner) Department of Cardiology, Helsingborg Lasarett, Sweden
(Jensen) Unit of Cardiology, Capio S:t Gorans Sjukhus, Sweden
(Danielewicz) Department of Cardiology, Karlstad Hospital, Sweden
(Eriksson) Department of Cardiology, Umea University, Sweden
(Linder) Department of Cardiology, Danderyd Hospital, Sweden
(Ramunddal) Department of Cardiology, Arhus University Hospital, Sweden
(Frobert) Department of Cardiology, Orebro University, Sweden
Publisher
SAGE Publications Inc.
Abstract
Aims: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment
Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy
in the Swedish Web System for Enhancement and Development of
Evidence-based Care in Heart Disease Evaluated according to Recommended
Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not
superior to unfractionated heparin in patients with acute coronary
syndrome undergoing invasive management. We assessed whether the access
site had an impact on the primary endpoint of death, myocardial infarction
or major bleeding at 180 days and whether it interacted with
bivalirudin/unfractionated heparin. Methods and Results: A total of
6006 patients with acute coronary syndrome planned for percutaneous
coronary intervention were randomised to either bivalirudin or
unfractionated heparin. Arterial access was left to the operator
discretion. Overall, 90.5% of patients underwent transradial access and
9.5% transfemoral access. Baseline risk was higher in transfemoral access.
The unadjusted hazard ratio for the primary outcome was lower with
transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67,
p<0.001) and remained lower after multivariable adjustment (hazard ratio
0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was
associated with lower risk of death (hazard ratio 0.41, 95% confidence
interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95%
confidence interval 0.44-0.75, p<0.001). There was no interaction between
treatment with bivalirudin and access site for the primary endpoint
(p=0.976) or major bleeding (p=0.801). Conclusion(s): Transradial
access was associated with lower risk of death, myocardial infarction or
major bleeding at 180 days. Bivalirudin was not associated with less
bleeding, irrespective of access site. Copyright © The European
Society of Cardiology 2019.

<73>
Accession Number
628375022
Title
Role of coronary angiography in patients with a non-diagnostic
electrocardiogram following out of hospital cardiac arrest: Rationale and
design of the multicentre randomized controlled COUPE trial.
Source
European Heart Journal: Acute Cardiovascular Care. 9(4_suppl) (pp
S131-S137), 2020. Date of Publication: November 2020.
Author
Viana-Tejedor A.; Ariza-Sole A.; Martinez-Selles M.; Mena M.J.; Vila M.;
Garcia C.; Garcia Acuna J.M.; Baneras J.; Garcia Rubira J.C.; Perez P.J.;
Querol C.T.; Pastor G.; Andrea R.; Osorio P.L.; Alonso N.; Martinez C.;
Perez Rodriguez M.; Noriega F.J.; Ferrera C.; Salinas P.; Gil I.N.; Ortiz
A.F.; Macaya C.
Institution
(Viana-Tejedor, Noriega, Ferrera, Salinas, Gil, Ortiz, Macaya) Cardiology
Department, Hospital Clinico San Carlos, Instituto de Investigacion
Sanitaria Hospital Clinico San Carlos (IdISSC), Madrid, Spain
(Ariza-Sole) Cardiology Department, Hospital Universitari de Bellvitge,
Barcelona, Spain
(Martinez-Selles) Cardiology Department, Hospital General Universitario
Gregorio Maranon, CIBERCV, Universidad Complutense, Universidad Europea,
Madrid, Spain
(Mena) Cardiology Department, Hospital Universitario Ramon y Cajal,
Madrid, Spain
(Vila) Cardiology Department, Fundacio Institut de Recerca de l'Hospital
de la Santa Creu i Sant Pau, Barcelona, Spain
(Garcia) Cardiology Department, Hospital Universitari Germans Trias i
Pujol, CIBERCV, Barcelona, Spain
(Garcia Acuna) Cardiology Department, Hospital Universitario de Santiago
de Compostela, CIBERCV, Spain
(Baneras) Cardiology Department, Hospital Universitario Vall d'Hebron,
CIBERCV, Barcelona, Spain
(Garcia Rubira) Cardiology Department, Hospital Virgen de la Macarena,
Seville, Spain
(Perez) Cardiology Department, Hospital Universitario de Canarias,
Tenerife, Spain
(Querol) Cardiology Department, Hospital Universitari Arnau de Vilanova,
Lleida - IRBLL, Lleida, Spain
(Pastor) Cardiology Department, Hospital Clinico Universitario de
Valladolid, CIBERCV, Valladolid, Spain
(Andrea) Instituto Cardiovascular, Hospital Clinic, IDIBAPS, Universidad
de Barcelona, Institut de Investigacions Mediques Pi i Sunyer, Spain
(Osorio) Cardiology Department, Institut d Investigacion Biomedica Dr,
Josep Trueta de Girona, CIBERCV, Girona, Spain
(Alonso) Cardiology Department, Hospital Universitario de Leon, Spain
(Martinez) Intensive Care Medicine Department, Hospital Universitario
Principe de Asturias, Madrid, Spain
(Perez Rodriguez) Cardiology Department. Hospital, Universitari de
Tarragona Joan XXIII. Tarragona, Spain
Publisher
SAGE Publications Inc.
Abstract
Background: Coronary artery disease (CAD) is a major cause of
out-of-hospital cardiac arrest (OHCA). The role of emergency coronary
angiography (CAG) and percutaneous coronary intervention (PCI) following
cardiac arrest in patients without ST-segment elevation myocardial
infarction (STEMI) remains unclear. Aim(s): We aim to assess whether
emergency CAG and PCI, when indicated, will improve survival with good
neurological outcome in post-OHCA patients without STEMI who remain
comatose. Method(s): COUPE is a prospective, multicentre and
randomized controlled clinical trial. A total of 166 survivors of OHCA
without STEMI will be included. Potentially non-cardiac aetiology of the
cardiac arrest will be ruled out prior to randomization. Randomization
will be 1:1 for emergency (within 2 h) or deferred (performed before
discharge) CAG. Both groups will receive routine care in the intensive
cardiac care unit, including therapeutic hypothermia. The primary efficacy
endpoint is a composite of in-hospital survival free of severe dependence,
which will be evaluated using the Cerebral Performance Category Scale. The
safety endpoint will be a composite of major adverse cardiac events
including death, reinfarction, bleeding and ventricular arrhythmias.
 Conclusion(s): This study will assess the efficacy of an emergency
CAG versus a deferred one in OHCA patients without STEMI in terms of
survival and neurological impairment. Copyright © The European
Society of Cardiology 2019.

<74>
Accession Number
626417445
Title
Practical considerations for cangrelor use in patients with acute coronary
syndromes.
Source
European Heart Journal: Acute Cardiovascular Care. 8(1) (pp 39-44), 2019.
Date of Publication: 01 Feb 2019.
Author
Leonardi S.; Bhatt D.L.
Institution
(Leonardi) Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, United States
Publisher
SAGE Publications Inc.
Abstract
Cangrelor, the first and currently only available intravenous
P2Y<inf>12</inf> receptor antagonist, has been approved and is now being
used in patients with coronary artery disease requiring percutaneous
coronary intervention. The rationale for cangrelor use is most robust in
patients requiring an immediate, profound, and predictable level of
P2Y<inf>12</inf> inhibition - especially in patients with acute coronary
syndromes. Herein we summarize the drug development program and reflect on
practical considerations for clinicians on cangrelor use in the acute
setting surrounding percutaneous coronary intervention, including
selection of patients, concomitant administration of glycoprotein IIb/IIIa
inhibitors and transition strategies from intravenous to oral
P2Y<inf>12</inf> receptor antagonists. Copyright © The European
Society of Cardiology 2017.

<75>
Accession Number
625678931
Title
Targeting elevated left ventricular end-diastolic pressure following
primary percutaneous coronary intervention for ST-segment elevation
myocardial infarction - a phase one safety and feasibility study.
Source
European Heart Journal: Acute Cardiovascular Care. 9(7) (pp 758-763),
2020. Date of Publication: October 2020.
Author
Khan A.A.; Davies A.J.; Whitehead N.J.; McGee M.; Al-Omary M.S.; Baker D.;
Bhagwandeen R.; Renner I.; Majeed T.; Hatton R.; Collins N.J.; Attia J.;
Boyle A.J.
Institution
(Khan, Davies, Whitehead, McGee, Al-Omary, Baker, Bhagwandeen, Hatton,
Collins, Attia, Boyle) John Hunter Hospital, Newcastle, Australia
(Khan, Al-Omary, Renner, Majeed, Collins, Attia, Boyle) The University of
Newcastle, Australia
(Khan, Majeed, Collins, Attia, Boyle) Hunter Medical Research Institute,
Newcastle, Australia
Publisher
SAGE Publications Inc.
Abstract
Introduction: Elevated left ventricular end diastolic pressure (LVEDP) is
an independent predictor of mortality and heart failure in patients with
ST-segment elevation myocardial infarction (STEMI). Whether lowering
elevated LVEDP improves outcomes remains unknown. Method(s): This
non-randomized, single blinded study with prospective enrolment and
sequential group allocation recruited patients undergoing primary
percutaneous coronary intervention for STEMI with LVEDP 20 mmHg measured
immediately after primary percutaneous coronary intervention. The
intervention arm (n=10) received furosemide 40 mg intravenous bolus plus
escalating doses of glyceryl trinitrate (100 microg per min to a maximum
of 1000 microg) during simultaneous measurement of LVEDP. The control
group (n=10) received corresponding normal saline boluses with
simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy
endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate
needed to reduce LVEDP by 20%. Safety endpoint was symptomatic
hypotension (systolic blood pressure < 90 mmHg). Result(s): From 1
April 2017 to 23 August 2017 we enrolled 20 patients (age: 64+/-9 years,
males: 60%, n=12, anterior STEMI: 65%, n=13). The mean LVEDP for the whole
cohort (n=20) was 29+/-4 mmHg (intervention group: 28+/-3 mmHg vs. control
group: 31+/-5 mmHg; p=0.1). The LVEDP dropped from 28+/-3 to 16+/-2 mmHg
in the glyceryl trinitrate + furosemide group (p <0.01) but remained
unchanged in the control group. The median dose of glyceryl trinitrate
required to produce 20% reduction in LVEDP in the intervention group was
200 microg (range: 100-800). One patient experienced asymptomatic decline
in systolic blood pressure to below 90 mmHg. There was no correlation
between LVEDP and left ventricular ejection fraction. Conclusion(s):
The administration of glyceryl trinitrate plus furosemide in patients with
elevated LVEDP following primary percutaneous coronary intervention for
STEMI safely reduces LVEDP. Copyright © The European Society of
Cardiology 2018.

<76>
Accession Number
625678747
Title
Sex-related response to bivalirudin and unfractionated heparin in patients
with acute myocardial infarction undergoing percutaneous coronary
intervention: A subgroup analysis of the VALIDATE-SWEDEHEART trial.
Source
European Heart Journal: Acute Cardiovascular Care. 8(6) (pp 502-509),
2019. Date of Publication: 01 Sep 2019.
Author
Venetsanos D.; Sederholm Lawesson S.; Frobert O.; Omerovic E.; Henareh L.;
Robertsson L.; Linder R.; Gotberg M.; James S.; Alfredsson J.; Erlinge D.;
Swahn E.
Institution
(Venetsanos, Sederholm Lawesson, Alfredsson, Swahn) Department of
Cardiology and Department of Medical and Health Sciences, Linkoping
University, Linkoping, Sweden
(Frobert) Department of Cardiology, Orebro University, Sweden
(Omerovic) Department of Cardiology, Sahlgrenska University Hospital,
Sweden
(Henareh) Department of Medicine, Karolinska Institute, Sweden
(Robertsson) Department of Cardiology, Sodra Alvsborgs Sjukhus, Sweden
(Linder) Department of Cardiology, Danderyd Hospital, Sweden
(Gotberg, Erlinge) Department of Cardiology, Skane University Hospital,
Sweden
(James) Department of Medical Sciences, Uppsala University, Sweden
Publisher
SAGE Publications Inc.
Abstract
Aims: Our aim was to study the impact of sex on anticoagulant treatment
outcomes during percutaneous coronary intervention in acute myocardial
infarction patients. Method(s): This study was a prespecified
analysis of the Bivalirudin versus Heparin in ST-Segment and Non
ST-Segment Elevation Myocardial Infarction in Patients on Modern
Antiplatelet Therapy in the Swedish Web System for Enhancement and
Development of Evidence-based Care in Heart Disease Evaluated according to
Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART) trial, in which
patients with myocardial infarction were randomised to bivalirudin or
unfractionated heparin during percutaneous coronary intervention. The
primary outcome was the composite of death, myocardial infarction or major
bleeding at 180 days. Result(s): There was a lower risk of the
primary outcome in women assigned to bivalirudin than to unfractionated
heparin (13.6% vs 17.1%, hazard ratio 0.78, 95% confidence interval
(0.60-1.00)) with no significant difference in men (11.8% vs 11.2%, hazard
ratio 1.06 (0.89-1.26), p for interaction 0.05). The observed difference
was primarily due to lower risk of major bleeding (Bleeding Academic
Research Consortium definition 2, 3 or 5) associated with bivalirudin in
women (8.9% vs 11.8%, hazard ratio 0.74 (0.54-1.01)) but not in men (8.5%
vs 7.3%, hazard ratio 1.16 (0.94-1.43) in men, p for interaction 0.02).
Conversely, no significant difference in the risk of Bleeding Academic
Research Consortium 3 or 5 bleeding, associated with bivalirudin, was
found in women 4.5% vs 5.4% (hazard ratio 0.84 (0.54-1.31)) or men 2.9% vs
2.1% (hazard ratio 1.36 (0.93-1.99)). Bleeding Academic Research
Consortium 2 bleeding occurred significantly less often in women assigned
to bivalirudin than to unfractionated heparin. The risk of death or
myocardial infarction did not significantly differ between randomised
treatments in men or women. Conclusion(s): In women, bivalirudin was
associated with a lower risk of adverse outcomes, compared to
unfractionated heparin, primarily due to a significant reduction in
Bleeding Academic Research Consortium 2 bleeds. Copyright © The
European Society of Cardiology 2018.

<77>
Accession Number
624508370
Title
Medical treatment or revascularisation as the best approach for
spontaneous coronary artery dissection: A systematic review and
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 7(7) (pp 614-623),
2018. Date of Publication: 01 Oct 2018.
Author
Martins J.L.; Afreixo V.; Santos L.; Costa M.; Santos J.; Goncalves L.
Institution
(Martins, Santos, Santos) Department of Cardiology, Baixo Vouga Hospital
Centre, Portugal
(Afreixo) CIDMA/IBIMED/Department of Mathematics, University of Aveiro,
Portugal
(Costa, Goncalves) Department of Cardiology, Coimbra Hospital and
Universitary Centre - General Unit, Portugal
Publisher
SAGE Publications Inc.
Abstract
Introduction: Patients presenting with spontaneous coronary artery
dissection (SCAD) may receive either conservative medical management or a
revascularisation strategy. There is still a lack of consensus with
respect to the best treatment approach for SCAD. Objective(s): We
sought to determine whether outcomes differ between the first-line
treatment approaches (conservative versus revascularisation) in patients
with SCAD. Method(s): We searched Medline, EMBASE and the Cochrane
Library for studies published from January 1990 to November 2016 that
compared first-line treatments for patients with SCAD. We conducted a
pooled risk ratio meta-analysis for four main outcomes: mortality,
myocardial infarction (MI), SCAD recurrence and target vessel
revascularisation (TVR). Result(s): We identified 11 non-randomised
studies that included a total of 631 patients. A pooled meta-analysis
showed no significant difference between conservative management and
revascularisation approaches in mortality (risk difference [RD] = 0.01;
95% confidence interval [CI] = -0.01 to 0.04; I2 = 0%; p = 1),
MI (RD = -0.01; 95% CI = -0.04 to 0.03; I2 = 0%; p = 0.5) or
SCAD recurrence (RD = -0.01; 95% CI = -0.06 to 0.05; I2 = 0%; p
= 0.74). Revascularisation as an initial first-line approach was
associated with an estimated additional risk of TVR of 6.3% (RD = 0.06;
95% CI = 0.01-0.11; I2 = 0%; p = 0.96). Conclusion(s): The
results demonstrate an increased risk of TVR when revascularisation was
used as the initial first-line treatment approach. The treatment decision
must be individualised and be based on both clinical and angiographic
factors, but conservative therapy should prevail in most
cases. Copyright © The European Society of Cardiology 2017.

<78>
Accession Number
622706299
Title
Systolic mitral annulus velocity is a sensitive index for changes in left
ventricular systolic function during inotropic therapy in patients with
acute heart failure.
Source
European Heart Journal: Acute Cardiovascular Care. 7(4) (pp 321-329),
2018. Date of Publication: 01 Jun 2018.
Author
Husebye T.; Eritsland J.; Bjornerheim R.; Andersen G.O.
Institution
(Husebye, Eritsland, Bjornerheim, Andersen) Department of Cardiology, Oslo
University Hospital Ulleval, Norway
(Husebye, Eritsland, Bjornerheim, Andersen) Centre for Heart Failure
Research, University of Oslo, Norway
(Husebye) Faculty of Medicine, University of Oslo, Norway
(Andersen) Centre for Clinical Heart Research, Oslo University Hospital
Ulleval, Norway
Publisher
SAGE Publications Inc.
Abstract
Background: Echocardiography is recommended for assessment of left
ventricular systolic function in patients with acute heart failure but few
randomised trials have validated techniques like tissue Doppler (TDI) and
speckle tracking (STE) in patients with acute heart failure following
ST-elevation myocardial infarction. Method(s): This was a substudy
from the LEAF (LEvosimendan in Acute heart Failure following myocardial
infarction) trial (NCT00324766), which randomised 61 patients developing
acute heart failure, including cardiogenic shock, within 48 hours after
ST-elevation myocardial infarction, double-blind to a 25-hour infusion of
levosimendan or placebo. TDI-derived systolic mitral annulus velocity
(S'), STE-derived global longitudinal strain (S<inf>l</inf>) and strain
rate (SR<inf>l</inf>) were measured at baseline, day 1, day 5 and after 42
days. Result(s): Datasets rejected for analyses were 2% (TDI) and 17%
(STE). S' increased by 23% in the levosimendan group versus 8% in the
placebo group from baseline to day 1 (p= 0.011) and by 30% vs. 3% from
baseline to day 5 (p <0.0005). Significant, but less pronounced,
improvements in global S<inf>l</inf> (p = 0.025 and p = 0.032) and in
global SR<inf>l</inf> (p = 0.046 and p = 0.001) in favour of levosimendan
were also present. Conclusion(s): S' by TDI and STE-derived
S<inf>l</inf> and SR<inf>l</inf> were sensitive indices for changes in
left ventricular systolic function related to treatment with levosimendan.
However, S' by TDI was more feasible and sensitive and might be preferred
for assessment of changes in left ventricular systolic function in
critically ill patients with acute heart failure receiving inotropic
therapy. Copyright © 2017, The European Society of Cardiology
2017.

<79>
Accession Number
621769611
Title
CHA<inf>2</inf>DS<inf>2</inf>-VASc risk factors as predictors of stroke
after acute coronary syndrome: A systematic review and meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 7(3) (pp 264-274),
2018. Date of Publication: 01 Apr 2018.
Author
Guerra F.; Scappini L.; Maolo A.; Campo G.; Pavasini R.; Shkoza M.;
Capucci A.
Institution
(Guerra, Scappini, Maolo, Shkoza, Capucci) Cardiology and Arrhythmology
Clinic, Marche Polytechnic University, University Hospital 'Ospedali
Riuniti', Italy
(Campo, Pavasini) Cardiology Department, Universita degli Studi di
Ferrara, Ospedale Sant'Anna, Italy
Publisher
SAGE Publications Inc.
Abstract
Background: Stroke is a rare but serious complication of acute coronary
syndrome. At present, no specific score exists to identify patients at
higher risk. The aim of the present study is to test whether each clinical
variable included in the CHA<inf>2</inf>DS<inf>2</inf>-VASc score retains
its predictive value in patients with recent acute coronary syndrome,
irrespective of atrial fibrillation. Method(s): The meta-analysis was
conducted according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational
Studies in Epidemiology (MOOSE) guidelines. All clinical trials and
observational studies presenting data on the association between
stroke/transient ischemic attack incidence and at least one
CHA<inf>2</inf>DS<inf>2</inf>-VASc item in patients with a recent acute
coronary syndrome were considered in the analysis. Atrial fibrillation
diagnosis was also considered. Result(s): The whole cohort included
558,193 patients of which 7108 (1.3%) had an acute stroke and/or transient
ischemic attack during follow-up (median nine months;
1st-3rd quartile 1-12 months). Age and previous
stroke had the highest odds ratios (odds ratio 2.60; 95% confidence
interval 2.21-3.06 and odds ratio 2.74; 95% confidence interval 2.19-3.42
respectively), in accordance with the two-point value given in the
CHA<inf>2</inf>DS<inf>2</inf>-VASc score. All other factors were
positively associated with stroke, although with lower odds ratios. Atrial
fibrillation, while present in only 11.2% of the population, confirmed its
association with an increased risk of stroke and/or transient ischemic
attack (odds ratio 2.04; 95% confidence interval 1.71-2.44).
 Conclusion(s): All risk factors included in the
CHA<inf>2</inf>DS<inf>2</inf>-VASc score are associated with stroke/
transient ischemic attack in patients with recent acute coronary syndrome,
and retain similar odds ratios to what already seen in atrial
fibrillation. The utility of CHA<inf>2</inf>DS<inf>2</inf>-VASc score for
risk stratification of stroke in patients with acute coronary syndrome
remains to be determined. Copyright © 2016, © The European
Society of Cardiology 2016.

<80>
Accession Number
619605925
Title
Emergency transcatheter aortic valve implantation in patients with severe
aortic regurgitation and a left ventricle assist device: A case report and
systematic review.
Source
European Heart Journal: Acute Cardiovascular Care. 6(8) (pp 719-727),
2017. Date of Publication: 01 Dec 2017.
Author
van der Werf H.W.; Schurer R.A.J.; Vonck T.E.; Poelman J.E.; Klungel A.A.;
Cernak V.; van den Heuvel A.F.M.; van der Harst P.
Institution
(van der Werf, Schurer, Vonck, Poelman, Klungel, van den Heuvel, van der
Harst) Department of Cardiology, University of Groningen, University
Medical Centre Groningen, Netherlands
(Cernak) Department of Anaesthesiology, University of Groningen,
University Medical Centre Groningen, Netherlands
Publisher
SAGE Publications Inc.
Abstract
Background: Cardiogenic shock due to severe aortic regurgitation in
patients with left ventricle assist devices is a life threatening
condition. Here, we consider transcatheter aortic valve implantation as a
treatment option. Methods and Results: A patient with a left
ventricle assist device was presented to us with cardiogenic shock due to
severe aortic regurgitation. We successfully implanted a transcatheter
aortic valve in emergency setting. The patient recovered and underwent
cardiac transplantation three months afterwards. We performed a systematic
literature review and identified 10 cases of patients with a left
ventricle assist device undergoing transcatheter aortic valve
implantation. In these cases, there was no procedural related mortality
reported. In four (40%) patients, transcatheter aortic valve implantation
resulted in significant paravalvular aortic regurgitation. In two of these
cases it was due to migration of the valve towards the left ventricle.
 Conclusion(s): Our case report and review of literature suggests that
transcatheter aortic valve implantation is a feasible and lifesaving
treatment option for left ventricle assist device patients presenting with
severe aortic regurgitation. Copyright © 2016, © The
European Society of Cardiology 2016.

<81>
Accession Number
619605794
Title
Impact of preoperative use of P2Y12 receptor inhibitors on clinical
outcomes in cardiac and non-cardiac surgery: A systematic review and
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 6(8) (pp 753-770),
2017. Date of Publication: 01 Dec 2017.
Author
Siller-Matula J.M.; Petre A.; Delle-Karth G.; Huber K.; Ay C.;
Lordkipanidze M.; De Caterina R.; Kolh P.; Mahla E.; Gersh B.J.
Institution
(Siller-Matula, Petre, Delle-Karth) Department of Cardiology, Medical
University of Vienna, Austria
(Huber) 3rd Medical Department of Cardiology and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Ay) Division of Haematology and Haemostaseology, Department of Medicine
I, Medical University of Vienna, Austria
(Lordkipanidze) Faculty of Pharmacy, University of Montreal; Research
Center, Montreal Heart Institute, Canada
(De Caterina) Institute of Cardiology, 'G d'Annunzio' University -
Chieti-Pescara, Chieti, Italy
(Kolh) Department of Cardiothoracic Surgery, University Hospital of Liege,
Belgium
(Mahla) Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Graz, Austria
(Gersh) Division of Cardiovascular Diseases, Department of Internal
Medicine, Mayo Clinic, College of Medicine Rochester, United States
Publisher
SAGE Publications Inc.
Abstract
Objective: To review systematically the evidence and perform a
meta-analysis of benefits and risks associated with use of
P2Y<inf>12</inf> receptor inhibitors in coronary artery bypass graft-,
non-cardiac- and device surgery. Data selection and analysis: We performed
a meta-analysis of published studies. Patients with preoperative use of
clopidogrel, ticagrelor or prasugrel (late discontinuation: <5 days before
surgery or no discontinuation) were compared with patients without
preoperative use of the respective drug (early discontinuation: 5 days
before surgery or no users of P2Y<inf>12</inf> receptor inhibitors).
Outcomes evaluated were re-operation for major bleeding, death, myocardial
infarction, combined major adverse cardiac events (MACEs) and major
haematoma. Using a random effect model, relative risks (RRs) and 95%
confidence intervals (CI) were calculated for each outcome.
 Result(s): Fifty-four studies met the selection criteria and included
50,048 patients. Preoperative use of clopidogrel on top of aspirin in
patients undergoing coronary artery bypass graft was associated with a
2.5-fold increased risk of re-operation for bleeding (95% CI: 1.92-3.25;
p<0.001) and a 1.47-fold increased risk of death (95% CI: 1.25-1.72;
p<0.001), but did not diminish the risk for myocardial infarction (RR:
0.96; 95% CI: 0.75-1.25; p=0.18) or MACE (RR: 1.16; 95% CI: 0.90--1.50;
p=0.30). In patients undergoing non-cardiac surgery, preoperative use of
clopidogrel increased the RR of re-operation for major bleeding by
2.05-fold (95% CI: 1.13-3.73; p=0.002) but did not reduce the RR for MACE
or death. Clopidogrel use during cardiac device implantation raised the RR
for procedure-related haematoma by 3.0-fold (95% CI: 1.30--6.94; p=0.001).
Whereas preoperative ticagrelor use did not increase the risk for
mortality (RR: 1.03; 95% CI: 0.49-2.14), preoperative prasugrel use tended
to increase the risk for death (RR: 5.06; 95% CI: 0.54-47.65).
 Conclusion(s): Preoperative exposure to clopidogrel on top of aspirin
did not reduce the risk of MACE but was associated with increased risk of
bleeding and mortality. Copyright © 2015, © The European
Society of Cardiology 2015.

<82>
Accession Number
618870648
Title
Editor's Choice- Impact of immediate multivessel percutaneous coronary
intervention versus culprit lesion intervention on 1-year outcome in
patients with acute myocardial infarction complicated by cardiogenic
shock: Results of the randomised IABP-SHOCK II trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6(7) (pp 601-609),
2017. Date of Publication: 01 Oct 2017.
Author
Zeymer U.; Werdan K.; Schuler G.; Zahn R.; Neumann F.-J.; Furnau G.; de
Waha S.; Schneider S.; Thiele H.
Institution
(Zeymer, Zahn) Klinikum Ludwigshafen, Medizinische Klinik B, Germany
(Zeymer, Schneider) Institut fur Herzinfarktforschung Ludwigshafen,
Germany
(Werdan) Universitatsklinikum Halle, Klinik fur Kardiologie, Germany
(Schuler, Furnau, Thiele) Universitat Leipzig, Herzzentrum, Kardiologie,
Germany
(Neumann) Herzzentrum Bad Krozingen, Germany
(de Waha) Herzzentrum Bad Segeberg, Germany
(Thiele) Medical Clinic II, Universitares Herzzentrum Lubeck University
Hospital Schleswig-Holstein, Germany
Publisher
SAGE Publications Inc.
Abstract
Background: Current guidelines recommend immediate multivessel
percutaneous coronary intervention (PCI) in patients with cardiogenic
shock, despite the lack of randomised trials. We sought to investigate the
use and impact on outcome of multivessel PCI in comparison to culprit
lesion only PCI in a retrospective analysis in patients with cardiogenic
shock complicating acute myocardial infarction. Methods and Results:
In the randomised IABP-SHOCK II trial, investigating the effect of
intra-aortic balloon pump on outcome, 451 (75%) of the total of 600
patients had multivessel coronary artery disease and underwent PCI.
Immediate multivessel PCI was performed in 167 (37%) patients. TIMI 3
patency after PCI in all treated vessels was observed in 83.2% versus
79.0% of patients after multivessel versus culprit lesion PCI,
respectively. The 30-day (44.9% vs. 42.3%) and 12-month (54.8% vs. 52.7%)
mortality rates did not significantly differ between the two groups. In
the multivariate analysis multivessel PCI was not associated with an
improved mortality after 12 months (odds ratio 0.92, 95% confidence
intervals 0.69-1.21). Conclusion(s): In this retrospective analysis
of the largest randomised study in cardiogenic shock immediate multivessel
PCI was used in approximately one third of patients with cardiogenic
shock. There was no benefit with immediate multivessel PCI in comparison
to culprit lesion only PCI. Therefore a randomised trial is needed to
determine the definitive role of multivessel PCI in cardiogenic shock.
Clinical Trial Registration: ClinicalTrials.gov,
NCT00491036. Copyright © 2016, © The European Society of
Cardiology 2016.

<83>
Accession Number
618467553
Title
Outcomes after planned invasive or conservative treatment strategy in
patients with non-ST-elevation acute coronary syndrome and a normal value
of high sensitivity troponin at randomisation: A Platelet Inhibition and
Patient Outcomes (PLATO) trial biomarker substudy.
Source
European Heart Journal: Acute Cardiovascular Care. 6(6) (pp 500-510),
2017. Date of Publication: 01 Sep 2017.
Author
Giannitsis E.; Wallentin L.; James S.K.; Bertilsson M.; Siegbahn A.;
Storey R.F.; Husted S.; Cannon C.P.; Armstrong P.W.; Steg P.G.; Katus H.A.
Institution
(Giannitsis, Katus) Medizinische Klinik, Universitatsklinikum Heidelberg,
Germany
(Wallentin, James, Siegbahn) Department of Medical Sciences, Uppsala
University, Sweden
(Wallentin, James, Bertilsson, Siegbahn) Uppsala Clinical Research Center,
Uppsala University, Sweden
(Storey) Department of Cardiovascular Science, University of Sheffield,
United Kingdom
(Husted) Medical Department, Hospital Unit West, Herning/Holstebro,
Denmark
(Cannon) Cardiovascular Division, Brigham and Women's Hospital, United
States
(Cannon) Harvard Clinical Research Institute, United States
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Canada
(Steg) INSERM-Unite 1148, France
(Steg) Hopital Bichat, France
(Steg) Universite Paris-Diderot, Sorbonne-Paris Cite, France
(Steg) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Steg) Institute of Cardiovascular Medicine and Science, Royal Brompton
Hospital, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Aims: Current guidelines for patients with non-ST-elevation acute coronary
syndrome (NSTE-ACS) recommend early invasive treatment in
intermediate-to-high risk patients based on medical history,
electrocardiogram (ECG) and elevated troponin. Patients with normal levels
of cardiac troponin measured with a high-sensitivity method (cTnT-hs)
might not benefit from early invasive procedures. Methods and
Results: In this Prospective Randomized Platelet Inhibition and Patient
Outcomes (PLATO) blood-core substudy, 1232 patients presented with
NSTE-ACS had a high sensitivity cardiac troponin T (cTnT-hs) level
<99th percentile (<14 ng/l) at randomisation. The outcomes in
relation to a planned invasive (n=473) vs planned conservative treatment
(n=759), were evaluated by adjusted Cox proportional hazard analyses. In
patients with a normal cTnT-hs at randomisation, regardless of randomised
treatment, a planned invasive vs conservative treatment was associated
with a 2.3-fold higher risk (7.3% vs 3.4%, p=0.0028) for cardiovascular
(CV) death or myocardial infarction (MI), driven by higher rates of
procedure-related MI (3.4% vs 0.1%), while there were no differences in
rates of CV death (1.3% vs 1.3%, p=0.72) or spontaneous MI (3.0% vs 2.1%,
p=0.28). There were significantly more major bleeds (hazard ratio (HR)
2.98, p<0.0001), mainly due to coronary artery bypass graft (CABG)-related
(HR 4.05, p<0.0001) and non-CABG procedural-related major bleeding events
(HR 5.31, p=0.0175), however there were no differences in
non-procedure-related major bleeding (1.5% vs 1.9%, p=0.45). Findings were
consistent for patients with a normal cTnI-hs at randomisation.
 Conclusion(s): In patients with NSTE-ACS and normal cTnT-hs, a
planned early invasive treatment strategy was associated with increased
rates of procedure-related MI and bleeding but no differences in long-term
spontaneous MI, non-procedure-related bleeding or mortality. Copyright
© 2016, © The European Society of Cardiology 2016.

<84>
Accession Number
618043763
Title
ST-segment resolution with bivalirudin versus heparin and routine
glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment
elevation myocardial infarction patients transported for primary
percutaneous coronary intervention: The EUROMAX ST-segment resolution
substudy.
Source
European Heart Journal: Acute Cardiovascular Care. 6(5) (pp 404-411),
2017. Date of Publication: 01 Aug 2017.
Author
van't Hof A.; Giannini F.; ten Berg J.; Tolsma R.; Clemmensen P.;
Bernstein D.; Coste P.; Goldstein P.; Zeymer U.; Hamm C.; Deliargyris E.;
Steg P.G.
Institution
(van't Hof, Giannini) Isala Hospital, Netherlands
(ten Berg) St Antonius Hospital, Netherlands
(Tolsma) EMS RAV IJsselland, Netherlands
(Clemmensen) The Heart Centre, Copenhagen University Hospital, Denmark
(Bernstein, Deliargyris) The Medicines Company, United States
(Coste) Centre Hospitalier Universitaire Bordeaux, Universite de Bordeaux,
France
(Goldstein) Centre Hospitalier Regional Universitaire de Lille, France
(Zeymer) Klinikum Ludwigshafen, Germany
(Hamm) Kerckhoff Heart and Thoraxcenter, Germany
(Steg) Universite Paris-Diderot, France
Publisher
SAGE Publications Inc.
Abstract
Background: Myocardial reperfusion after primary percutaneous coronary
intervention (PCI) can be assessed by the extent of post-procedural
ST-segment resolution. The European Ambulance Acute Coronary Syndrome
Angiography (EUROMAX) trial compared pre-hospital bivalirudin and
pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors
(GPIs) in primary PCI. This nested substudy was performed in centres
routinely using pre-hospital GPI in order to compare the impact of
randomized treatments on ST-resolution after primary PCI. Method(s):
Residual cumulative ST-segment deviation on the single one hour
post-procedure electrocardiogram (ECG) was assessed by an independent core
laboratory and was the primary endpoint. It was calculated that 762
evaluable patients were needed to show non-inferiority (85% power, alpha
2.5%) between randomized treatments. Result(s): A total of 871
participated with electrocardiographic data available in 824 patients
(95%). Residual ST-segment deviation one hour after PCI was 3.8+/-4.9 mm
versus 3.9+/-5.2 mm for bivalirudin and heparin+GPI, respectively
(p=0.0019 for non-inferiority). Overall, there were no differences between
randomized treatments in any measures of ST-segment resolution either
before or after the index procedure. Conclusion(s): Pre-hospital
treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI
with regard to residual ST-segment deviation or ST-segment resolution,
reflecting comparable myocardial reperfusion with the two
strategies. Copyright © The European Society of Cardiology 2015.

<85>
Accession Number
614922993
Title
Vorapaxar in patients with coronary artery bypass grafting: Findings from
the TRA 2degreeP-TIMI 50 trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6(2) (pp 164-172),
2017. Date of Publication: 01 Mar 2017.
Author
Kosova E.C.; Bonaca M.P.; Dellborg M.; He P.; Morais J.; Oude Ophuis T.;
Scirica B.M.; Tendera M.; Theroux P.; Braunwald E.; Morrow D.A.
Institution
(Kosova) Department of Medicine, Brigham and Women's Hospital, Boston,
United States
(Bonaca, He, Scirica, Braunwald, Morrow) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, United States
(Dellborg) Sahlgrenska Academy, University of Gothenburg and Sahlgrenska
University Hospital, Gothenburg, Sweden
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Oude Ophuis) Canisius-Willhelmina Hospital, Nijmegen, Netherlands
(Tendera) Third Division of Cardiology, Medical University of Silesia,
Katowice, Poland
(Theroux) Montreal Heart Institute, University of Montreal, Canada
Publisher
SAGE Publications Inc.
Abstract
Background: Vorapaxar is a first-in-class protease-activated receptor-1
antagonist indicated for the reduction of cardiovascular death, myocardial
infarction, and stroke in stable patients with prior atherothrombosis, who
have not had a prior stroke or transient ischemic attack. The aims of this
study were to investigate: 1) the role of vorapaxar in patients with
severe coronary artery disease treated previously with coronary artery
bypass grafting (CABG); and 2) safety in patients undergoing CABG while
receiving vorapaxar. Method(s): TRA 2degreeP-TIMI 50 was a
randomized, double-blinded, placebo-controlled trial of vorapaxar in
26,449 stable patients with prior atherothrombosis followed for a median
of 30 months. We 1) investigated the efficacy of vorapaxar among patients
with a history of CABG prior to randomization (n=2942); and 2) assessed
the safety among 367 patients who underwent a new CABG during the trial.
 Result(s): Patients with a prior CABG were at higher risk for
cardiovascular death, myocardial infarction, or stroke at three years
compared with patients without a prior CABG (13.7% vs. 7.8%, p<0.001).
Among patients with a prior CABG, vorapaxar significantly reduced the risk
of cardiovascular death, myocardial infarction, or stroke (11.9% vs.
15.6%, hazard ratio 0.71, 95% confidence interval 0.58-0.88, p=0.001;
number-needed-to-treat = 27). In patients undergoing CABG while receiving
vorapaxar, the rate of Thrombolysis in Myocardial Infarction CABG major
bleeding was 6.3% vs. 4.1% with placebo (hazard ratio 1.53, 95% confidence
interval 0.58-4.01, p=0.39). Conclusion(s): In patients with a prior
CABG, vorapaxar significantly reduced the risk of recurrent major
cardiovascular events. In patients undergoing CABG while receiving
vorapaxar, bleeding risk appeared similar to that seen in the overall
trial population. Copyright © 2016, © The European Society
of Cardiology 2016.

<86>
Accession Number
614410223
Title
Thrombus aspiration in non-ST-elevation myocardial infarction - 12-month
clinical outcome of the randomised TATORT-NSTEMI trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6(1) (pp 10-17), 2017.
Date of Publication: 01 Feb 2017.
Author
Meyer-Saraei R.; de Waha S.; Eitel I.; Desch S.; Scheller B.; Bohm M.;
Lauer B.; Gawaz M.; Geisler T.; Gunkel O.; Bruch L.; Klein N.; Pfeiffer
D.; Schuler G.; Zeymer U.; Thiele H.
Institution
(Meyer-Saraei, de Waha, Eitel, Desch, Thiele) Department of Cardiology,
Angiology and Intensive Care Medicine, University Heart Centre Luebeck,
University Hospital Schleswig-Holstein, Luebeck, Germany
(Meyer-Saraei, de Waha, Eitel, Desch, Thiele) German Centre for
Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck,
Luebeck, Germany
(Scheller, Bohm) Department of Internal Medicine III, University of
Saarland, Homburg, Germany
(Lauer) Department of Cardiology, Zentralklinik Bad Berka, Germany
(Gawaz, Geisler) Department of Cardiology/Cardiovascular Medicine,
University of Tuebingen, Germany
(Gunkel) Department of Internal Medicine II, Klinikum Frankfurt/Oder,
Germany
(Bruch) Department of Internal Medicine, Unfallkrankenhaus Berlin, Germany
(Klein, Pfeiffer) Department of Internal Medicine I, University of
Leipzig, Germany
(Schuler) Department of Internal Medicine/Cardiology, University of
Leipzig Heart Centre, Germany
(Zeymer) Institut fur Herzinfarktforschung, Klinikum der Stadt
Ludwigshafen, Germany
Publisher
SAGE Publications Inc.
Abstract
Background: In the randomised TATORT-NSTEMI trial routine thrombus
aspiration in comparison with standard percutaneous coronary intervention
(PCI) did not reduce the primary endpoint of microvascular obstruction
assessed by cardiac magnetic resonance imaging in patients with
non-ST-elevation myocardial infarction (NSTEMI). So far, no data on
long-term outcome of head-to-head comparisons between both treatment
strategies in NSTEMI patients have been reported. Method(s): The
prospective, controlled, multicentre, randomised, open-label TATORT-NSTEMI
trial assigned patients with NSTEMI and thrombus-containing lesions to
aspiration thrombectomy plus PCI (n=221) or standard PCI only (n=219). The
primary endpoint of the current analysis was the occurrence of major
adverse cardiac events defined as the composite of death, myocardial
reinfarction, target vessel revascularisation, and new congestive heart
failure at 12-month follow-up. In addition, functional outcome and quality
of life were assessed. Result(s): At one year, major adverse cardiac
events occurred in 19 patients in the thrombectomy arm and 29 patients in
the standard PCI group (8.7% vs. 13.4%, relative risk 0.63, 95% confidence
interval 0.35-1.12, p=0.11). The individual components of the combined
endpoint such as death (p=0.20), myocardial reinfarction (p=0.73), target
vessel revascularisation (p=0.42), and congestive heart failure (p=0.18)
were similar in both groups. Functional outcome and quality of life did
not differ significantly between both groups (Canadian Cardiovascular
Society class: p=0.68, New York Heart Association class: p=0.70 and
EuroQol5D score: p=0.96). Post-hoc analyses revealed consistent results
with regard to the occurrence of major adverse cardiac events across a
wide range of subgroups (all p>0.05). Conclusion(s): In this first
randomised trial on thrombectomy in NSTEMI patients, routine thrombus
aspiration before PCI did not improve clinical outcome at 12-month
follow-up. Copyright © 2015, © The European Society of
Cardiology 2015.

<87>
Accession Number
613238456
Title
Tpeak-to-Tend/QT is an independent predictor of early ventricular
arrhythmias and arrhythmic death in anterior ST elevation myocardial
infarction patients.
Source
European Heart Journal: Acute Cardiovascular Care. 5(6) (pp 473-480),
2016. Date of Publication: 2016.
Author
Mugnai G.; Benfari G.; Fede A.; Rossi A.; Chierchia G.-B.; Vassanelli F.;
Menegatti G.; Ribichini F.L.
Institution
(Mugnai, Benfari, Fede, Rossi, Vassanelli, Menegatti, Ribichini)
Department of Cardiology, University Hospital of Verona, Italy
(Chierchia) Heart Rhythm Management Centre, UZ Brussel-VUB, Belgium
Publisher
SAGE Publications Inc.
Abstract
Background: The aim of our study was to analyse the markers of transmural
dispersion of ventricular repolarization, especially Tpeak-to-Tend and
Tpeak-to-Tend /QT ratio, in patients with anterior ST elevation myocardial
infarction on admission and to evaluate their association with in-hospital
life-threatening arrhythmias and mortality. Methods and Results: A
total of 223 consecutive patients with anterior wall ST elevation
myocardial infarction admitted to our Division of Cardiology between
January 2010 and December 2012 were prospectively evaluated. A standard
electrocardiogram was obtained on admission and then analysed. The primary
end point was constituted by in-hospital ventricular arrhythmias and
arrhythmic death. At univariate analysis heart rate (odds ratio = 1.03;
95% confidence intervals 1.006-1.05; p=0.001), maximal ST elevation (odds
ratio =1.25; 95% confidence intervals 1.10-1.43; p=0.0001), QTc Bazett
(odds ratio = 1.01; 95% confidence intervals 1.006-1.02; p=0.002), QT
dispersion (odds ratio = 1.02; 95% confidence intervals 1.002-1.04;
p=0.02) and both Tpeak-to-Tend and Tpeak-to-Tend/QT (odds ratio = 1.02;
95% confidence intervals 1.01-1.03; p<0.0001 and OR = 1.07; 95% confidence
intervals 1.03-1.11; p<0.0001 respectively) were significantly associated
with ventricular arrhythmias and arrhythmic mortality. Of note,
Tpeak-to-Tend /QT remained a predictor of early ventricular arrhythmias
and arrhythmic death (odds ratio = 1.04; 95% confidence intervals 1.003 -
1.10; p=0.03) independently from heart rate and maximal ST elevation.
Receiver operating characteristic curve analysis showed that Tpeak-to-Tend
/QT values <0.31 had a predictive negative value of 92% for the prediction
of the composite outcome. Conclusion(s): Tpeak-to-Tend /QT was an
independent predictor of early ventricular arrhythmias and arrhythmic
mortality in patients with anterior ST elevation myocardial infarction.
Especially, Tpeak-to-Tend /QT <0.31 may identify a subgroup of ST
elevation myocardial infarction patients with low risk of early
arrhythmias and arrhythmic death. Copyright © The European
Society of Cardiology 2015.

<88>
Accession Number
612826331
Title
Pretreatment with aspirin in acute coronary syndromes: Lessons from the
ACUITY and HORIZONS-AMI trials.
Source
European Heart Journal: Acute Cardiovascular Care. 5(5) (pp 449-454),
2016. Date of Publication: 2016.
Author
Brener S.J.; Mehran R.; Lansky A.J.; Ayele G.M.; Stone G.W.
Institution
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, United States
(Brener, Mehran, Ayele, Stone) Department of Medicine, Cardiovascular
Research Foundation, United States
(Mehran) Mount Sinai Medical Center, United States
(Lansky) Yale University Medical Center, United States
(Stone) Columbia University Medical Center, United States
Publisher
SAGE Publications Inc.
Abstract
Background: Aspirin is promptly administered to patients presenting with
acute coronary syndromes. It is not known whether aspirin pretreatment in
acute coronary syndrome patients is beneficial, particularly because some,
but not all, prior studies identified aspirin pretreatment as an
independent risk factor for adverse ischemic events. Objective(s): To
study the effect of aspirin pretreatment in patients with acute coronary
syndromes enrolled in two large randomized clinical trials.
 Method(s): Patients enrolled in the ACUITY and HORIZONS-AMI trials
were analyzed according to aspirin pretreatment within 5-7 days before
acute coronary syndromes. We evaluated the incidence of death, myocardial
infarction, target vessel revascularization, stent thrombosis and bleeding
at 30 days and 1 year. Multivariable regression analysis was performed for
all-cause and cardiac death. Result(s): Among 17,387 patients, 10,587
(60.9%) were pretreated with aspirin. Pretreated patients were
significantly older and more likely to have diabetes mellitus,
hypertension and prior revascularization, and receive only medical therapy
without revascularization. Aspirin pretreatment was associated with
reduced 48-hour cardiac death (adjusted hazard ratio 0.50, 95% confidence
interval 0.26-0.97; P=0.04) and 30-day death (adjusted hazard ratio 0.68,
95% confidence interval 0.49-0.94; P=0.04). Myocardial infarction was more
frequent in the aspirin pretreatment group at 30 days (P<0.0001), while
stent thrombosis was less frequent (P=0.01). A strong interaction was
present such that aspirin pretreatment was associated with reduced 30-day
death in patients with non-ST-segment elevation acute coronary syndrome
(NSTEACS), but not in those with ST-segment elevation myocardial
infarction (P=0.001). Conclusion(s): Among patients with acute
coronary syndromes in these two large prospective studies, aspirin
pretreatment identified a higher risk cohort and was an independent
predictor of reduced mortality at 30 days, especially in patients with
NSTEACS. Copyright © The European Society of Cardiology 2016.

<89>
Accession Number
611313674
Title
Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in
patients with non-ST elevation acute coronary syndromes. Lessons learnt
from the ACCOAST-trial.
Source
European Heart Journal: Acute Cardiovascular Care. 5(3) (pp 282-288),
2016. Date of Publication: 2016.
Author
Zeymer U.; Montalescot G.; Ardissino D.; Bolognese L.; Clemmensen P.;
Collet J.-P.; Lopez-Sendon J.; Widimsky P.
Institution
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung,
Germany
(Montalescot, Collet) Centre Hospitalier Universitaire Pitie-Salpetriere,
France
(Ardissino) Azienda Ospedaliero-Universitaria, Italy
(Bolognese) Azienda Ospedaliero, Italy
(Clemmensen) Department of Medicine, Division of Cardiology, Nykoebing F
Hospital, Denmark
(Lopez-Sendon) University Hospital La Paz, Spain
(Widimsky) Cardiology Department at the Third Faculty of Medicine, Charles
University and University Hospital, Kralovske Vinohrady, Czechia
Publisher
SAGE Publications Inc.
Abstract
The optimal time-point of the initiation of P2Y12 antagonist therapy in
patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is
still a matter of debate. European guidelines recommend P2Y12 as soon as
possible after first medical contact. However, the only trial which
compared the two strategies did not demonstrate any benefit of
pretreatment with prasugrel before angiography compared to starting
therapy after angiography and just prior to percutaneous coronary
intervention (PCI). This paper summarizes the results of pharmacodynamic
and previous studies, and gives recommendations for the initiation of
P2Y12 antagonist therapy in NSTE-ACS in different clinical
situations. Copyright © The European Society of Cardiology 2015.

<90>
Accession Number
611313671
Title
Frailty is associated with worse outcomes in non-ST-segment elevation
acute coronary syndromes: Insights from the TaRgeted platelet Inhibition
to cLarify the Optimal strateGy to medicallY manage Acute Coronary
Syndromes (TRILOGY ACS) trial.
Source
European Heart Journal: Acute Cardiovascular Care. 5(3) (pp 231-242),
2016. Date of Publication: 2016.
Author
White H.D.; Westerhout C.M.; Alexander K.P.; Roe M.T.; Winters K.J.; Cyr
D.D.; Fox K.A.A.; Prabhakaran D.; Hochman J.S.; Armstrong P.W.; Ohman E.M.
Institution
(White) Green Lane Cardiovascular Service, Auckland City Hospital and
University of Auckland, Auckland, New Zealand
(Westerhout, Armstrong) Canadian VIGOUR Centre, University of Alberta,
Canada
(Alexander, Roe, Cyr, Ohman) Duke Clinical Research Institute, United
States
(Alexander, Roe, Ohman) Division of Cardiology, Department of Medicine,
Duke University School of Medicine, United States
(Winters) Eli Lilly and Company, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh, United
Kingdom
(Prabhakaran) Centre for Chronic Disease Control, Public Health Foundation
of India, India
(Hochman) Division of Cardiology, Department of Medicine, Langone Medical
Center, New York University, United States
(Armstrong) Division of Cardiology, Department of Medicine, University of
Alberta, Canada
Publisher
SAGE Publications Inc.
Abstract
Aims: Little is known regarding consequences of frailty in patients with
acute coronary syndrome (ACS). We assessed the associations of frailty and
outcomes in ACS patients who were participating in a clinical trial.
 Methods and Results: The TaRgeted platelet Inhibition to cLarify the
Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY
ACS) trial randomized 9326 patients planned for medical management to
prasugrel or clopidogrel. The primary endpoint was a composite of
cardiovascular death, myocardial infarction (MI), or stroke over a period
of 30 months. A frailty score based upon the Fried score was self-reported
at baseline in patients aged >=65 years. Five frailty questions were
recorded for 4996/5102 (97.9%) patients: 72.3% were classified as
not-frail (0 items), 23.0% as pre-frail (1-2 items), and 4.7% as frail
(>=3 items). Increasing frailty score was associated with older age,
diabetes, and higher Global Registry of Acute Coronary Events (GRACE)
scores. Frailty was associated with a higher unadjusted incidence of the
primary endpoint (pre-frail vs not-frail: 29.2% vs 23.1%; hazard ratio
[HR]: 1.39; 95% confidence interval [CI]: 1.19-1.61; p<0.001; frail vs
not-frail: 39.7% vs 23.1%; HR: 1.76; 95% CI: 1.36-2.28; p<0.001), and
all-cause mortality (pre-frail vs not-frail: 21.7% vs 15.0%; HR: 1.45; 95%
CI: 1.22-1.73; p<0.001; frail vs not-frail: 30.2% vs 15.0%; HR: 1.98; 95%
CI: 1.47-2.68; p<0.001). After adjustment for baseline characteristics and
GRACE covariates, frailty remained independently associated with the
primary endpoint: pre-frail vs not-frail, HR: 1.33; 95% CI: 1.15-1.54;
p<0.001; frail vs not-frail, HR: 1.52; 95% CI: 1.18-1.98; p=0.002. There
was no association of frailty with bleeding. Conclusion(s): Frailty
is associated with the composite of cardiovascular death, MI, or stroke.
Frailty assessment contributes to risk prediction and adds to the GRACE
score. Copyright © The European Society of Cardiology 2015.

<91>
Accession Number
368817086
Title
Dexmedetomidine as anesthetic adjunct for fast tracking and pain control
in off-pump coronary artery bypass.
Source
Saudi Journal of Anaesthesia. 7(1) (pp 6-8), 2013. Date of Publication:
January-March 2013.
Author
Abdel-Meguid M.E.
Institution
(Abdel-Meguid) Department of Anesthesia, Faculty of Medicine, Ain Shams
University, Egypt
(Abdel-Meguid) King Fahad Specialist Hospital, Saudi Arabia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Objective: This study was designed to determine the efficacy of
dexmedetomidine (a highly selective alpha-2 agonist) in achieving fast
tracking and improved postoperative pain control in off-pump coronary
artery bypass (OPCAB) patients. Method(s): Thirty patients scheduled
for elective OPCAB were prospectively randomized into two groups: Group I
(15 patients) started dexmedetomidine at 0.5 ug/kg/hour after the
induction of anesthesia; this was reduced to 0.3 ug/kg/hour on admission
in the cardiac intensive care unit and continued for 12 hours post
extubation. Group II (15 patients) received a similar volume and infusion
rate of normal saline. Visual analog scale (VAS) of 10-100 was explained
thoroughly to the patients during the preoperative visit. Postoperative
pain was managed with morphine. The total dose of morphine was recorded.
Extubation time and VAS was recorded every two hours for 12 hours post
extubation. Result(s): Extubation time in group I was 72+/-8 minutes
and 186+/-22 minutes in group II. Mean total use of narcotics in group II
was 23.5+/-20.7 mg compared to 11.4+/-6.3 mg in group I. VAS median
figures were lower at all data points in group I than in group II.
 Conclusion(s): Dexmedetomidine showed an effective and safe profile
as an anesthetic adjunct in OPCAB, achieving fast tracking of patients and
higher quality of pain control with a lower consumption of narcotics.

<92>
Accession Number
2025874363
Title
Tracheal Bronchus in Children.
Source
Journal of the College of Physicians and Surgeons Pakistan. 33(6) (pp
916-922), 2023. Date of Publication: 2023.
Author
Yuan S.-M.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Fujian Province, Putian,
China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Tracheal bronchus is an uncommon congenital anomaly. It is often of
important significance during endotracheal intubation. In paediatrics with
tracheal bronchus, stenosis of trachea and (or) bronchus and the
management strategies remain to be further clarified. A comprehensive
retrieval of literature since 2000 revealed 43 articles with 334
paediatric patients with tracheal bronchus. The delayed diagnosis rate is
4.1%. Paediatric patients with tracheal bronchus most often present with
recurrent pneumonia and atelectasis. In less than one-third of the
patients, there was an intrinsic or extrinsic stenosis of the trachea,
which warrant a conservative or a surgical treatment. A surgical treatment
was performed in 15.3% of the patients, in most of which the operations
were for relieving the tracheal stenosis. The surgical outcomes were
satisfactory. Paediatric patients with tracheal bronchus with tracheal
stenosis and recurrent pneumonia and persistent atelectasis warrant active
treatments, and surgical treatments are preferred. No treatment is needed
in those with no tracheal stenosis or those with no or mild
symptoms. Copyright © 2023 College of Physicians and Surgeons
Pakistan. All rights reserved.

<93>
Accession Number
2025110500
Title
Role of wearable devices in cardiac telerehabilitation: A scoping review.
Source
PLoS ONE. 18(5 MAY) (no pagination), 2023. Article Number: e0285801. Date
of Publication: May 2023.
Author
Jones A.K.; Yan C.L.; Rivera Rodriquez B.P.; Kaur S.; Andrade-Bucknor S.
Institution
(Jones) University of Miami Miller School of Medicine, Miami, FL, United
States
(Yan, Rivera Rodriquez, Kaur) Department of Medicine, University of Miami,
Jackson Memorial Hospital, Miami, FL, United States
(Andrade-Bucknor) Department of Medicine, Division of Cardiovascular
Disease, University of Miami, Jackson Memorial Hospital, Miami, FL, United
States
Publisher
Public Library of Science
Abstract
Background Cardiac rehabilitation (CR) is an evidence-based comprehensive
program that includes exercise training, health education, physical
activity promotion, and extensive counseling for the management of
cardiovascular risk factors. Wearable devices monitor certain
physiological functions, providing biometric data such as heart rate,
movement, sleep, ECG analysis, blood pressure, energy expenditure, and
numerous other parameters. Recent evidence supports wearable devices as a
likely relevant component in cardiovascular risk assessment and disease
prevention. The purpose of this scoping review is to better understand the
role of wearable devices in home-based CR (HBCR) and to characterize the
evidence regarding the incorporation of wearable devices in HBCR programs
and cardiovascular outcomes. Methods & findings We created a search
strategy for multiple databases, including PubMed, Embase (Elsevier),
CINAHL (Ebsco), Cochrane CENTRAL (Wiley), and Scopus (Elsevier). Studies
were included if the patients were eligible for CR per Medicare guidelines
and >18 years of age and if some type of wearable device was utilized
during HBCR. Our search yielded 57 studies meeting all criteria. The
studies were classified into 4 groups: patients with coronary heart
disease (CHD) without heart failure (HF); patients with HF; patients with
heart valve repair or replacement; and patients with exposure to
center-based CR. In three groups, there was an upward trend toward
improvement in quality of life (QOL) and peak VO2, less sedentary time,
and an increase in daily step count in the intervention groups compared to
control groups. Conclusions HBCR using wearable devices can be a
comparable alternative or adjunct to center-based CR for patients with CHD
and HF. More studies are needed to draw conclusions about the
comparability of HBCR to center-based CR in patients with heart valve
repair or replacement. Copyright: © 2023 Jones et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<94>
Accession Number
2025102876
Title
Left Bundle Branch Block: Characterization, Definitions, and Recent
Insights into Conduction System Physiology.
Source
Cardiology Clinics. 41(3) (pp 379-391), 2023. Date of Publication: August
2023.
Author
Pujol-Lopez M.; Tolosana J.M.; Upadhyay G.A.; Mont L.; Tung R.
Institution
(Pujol-Lopez, Tolosana, Mont) Arrhythmia Section, Cardiology Department,
Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, Universitat
de Barcelona, C/ Villarroel 170, Catalonia, Barcelona 08036, Spain
(Pujol-Lopez, Tolosana, Mont) Institut d'Investigacions Biomediques August
Pi i Sunyer, Catalonia, Barcelona, Spain
(Tolosana, Mont) Centro de Investigacion Biomedica en Red Enfermedades
Cardiovasculares, Madrid, Spain
(Upadhyay, Tung) Center for Arrhythmia Care, Pritzker School of Medicine,
University of Chicago, The University of Chicago Medicine, Heart and
Vascular Center, 5841 South Maryland Avenue, Chicago, IL 60637, United
States
Publisher
W.B. Saunders

<95>
Accession Number
2024613589
Title
Mechanical insufflation-exsufflation to promote extubation success in
critically ill adults on intensive care: protocol for a randomised
controlled feasibility trial.
Source
Pilot and Feasibility Studies. 9(1) (no pagination), 2023. Article Number:
129. Date of Publication: December 2023.
Author
Swingwood E.; Voss S.; Tume L.N.; Bewley J.; Turner N.; Ntoumenopoulos G.;
Rose L.; Cramp F.
Institution
(Swingwood, Voss, Cramp) Faculty of Health and Applied Sciences,
University of the West of England, Bristol, United Kingdom
(Swingwood) Adult Therapy Services, University Hospitals Bristol and
Weston NHS Foundation Trust, Bristol, United Kingdom
(Tume) Faculty of Health, Social Care & Medicine, Edge Hill University,
Ormskirk, United Kingdom
(Bewley) Department of Intensive Care, University Hospitals Bristol and
Weston NHS Foundation Trust, Bristol, United Kingdom
(Turner) Bristol Trials Centre, Bristol Medical School, University of
Bristol, Bristol, United Kingdom
(Ntoumenopoulos) Department of Physiotherapy, St Vincent's Hospital,
Sydney, Australia
(Rose) Florence Nightingale Faculty of Nursing, Midwifery and Palliative
Care, King's College London, London, United Kingdom
(Rose) Department of Critical Care and Lane Fox Respiratory Unit, Guy's
and Thomas' Foundation NHS Hospital Trust, London, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Extubation failure, defined as reintubation within 48 h, is
associated with increased intensive care unit (ICU) length of stay and
higher mortality risk. One cause of extubation failure is secretion
retention, resulting from an inability to cough effectively. Mechanical
insufflation-exsufflation (MI-E) simulates a cough aiding secretion
clearance. However, MI-E is not routinely used in the ICU for invasively
ventilated patients. This study aims to determine feasibility and
acceptability of a randomised controlled trial (RCT) examining MI-E use to
promote extubation success in intubated, ventilated adults.
 Method(s): It is a single-centre, feasibility RCT with
semi-structured interviews, economic scoping, and exploratory physiology
study. The feasibility RCT (n = 50) will compare standard care to a MI-E
protocol including a minimum of two MI-E sessions via the endotracheal
tube prior to extubation. Post-extubation, MI-E will be delivered via
facemask or mouthpiece up to two times/day for 48 h. MI-E settings will be
individualised. All patients will receive standard care (no MI-E) in
relation to mechanical ventilation, weaning, rehabilitation, physiotherapy
techniques such as positioning, manual airway clearance techniques,
manual/ventilator hyperinflation, endotracheal suctioning, and
nebulisation. Clinical data collection will occur before, on completion,
and 5-min post-physiotherapy sessions (intervention/control arms).
Resource use will be calculated for each 24-h period. Analyses will be
descriptive and address feasibility outcomes including participant
recruitment and attrition, proportion of MI-E treatment sessions
completed, dataset completeness, and frequency of adverse events and
acceptability. Semi-structured online interviews informed by the
Theoretical Framework of Acceptability (TFA) with patients, clinicians,
and family members will explore the acceptability of the MI-E intervention
and study processes. Interview data will be analysed using reflexive
thematic analysis based on TFA domains through first-level coding. The
embedded physiology study will use electrical impedance tomography and
lung ultrasound to explore lung recruitment and de-recruitment during MI-E
in a subset of 5-10 patients. Discussion(s): This study will examine
feasibility and acceptability of a RCT protocol of MI-E to promote
extubation success. Study findings will inform design modification and
conduct of a future adequately powered trial. Furthermore, the study will
contribute and advance the understanding of MI-E use in critically ill
intubated adults. Trial registration: ISRCTN 24603037; IRAS
303674 Copyright © 2023, The Author(s).

<96>
Accession Number
2024349388
Title
Trends in ICU mortality and underlying risk over three decades among
mechanically ventilated patients. A group level analysis of cohorts from
infection prevention studies.
Source
Annals of Intensive Care. 13(1) (no pagination), 2023. Article Number: 62.
Date of Publication: December 2023.
Author
Hurley J.C.
Institution
(Hurley) Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Hurley) Division of Internal Medicine, Grampians Health, Ballarat, VIC,
Australia
(Hurley) Internal Medicine Service, Ballarat Health Services, PO Box 577,
Ballarat 3353, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Has either the underlying risk or the mortality incidence
among ICU patients receiving mechanical ventilation (MV) in the literature
changed in recent decades? Interpreting ICU mortality trends requires an
adjusted analysis accounting for changes in underlying patient risk.
 Method(s): Control and intervention groups from 147 randomized
concurrent control trials (RCCT) of various VAP prevention interventions,
as listed primarily within 13 Cochrane reviews and 63 observational
studies listed primarily within four systematic reviews. Eligible studies
were those including ICU patients with > 50% of patients receiving > 24 h
of MV with mortality data available. ICU mortality (censored day 21 or
before) or late (after day 21) mortality together with group-mean age, and
group-mean APACHE II scores were extracted from all groups. These
incidences were summarized in five meta-regression models versus
publication year being variously adjusted for age, APACHE II scores, type
of study intervention and other group level parameters. Result(s):
Among 210 studies published between 1985 and 2021, 169 being found in
systematic reviews, the increase per decade in mean mortality incidence,
group-mean APACHE II scores, and group-mean age, were < 1 percentage point
(p = 0.43), 1.83 (95% CI; 0.51-3.15) points, and 3.9 (95% CI; 1.1-6.7)
years, respectively. Only in the model with risk adjustment for both
group-mean age and group-mean APACHE II score was a significant decline in
mortality apparent. In all models, the mortality incidence among
concurrent control groups of decontamination studies was paradoxically
five percentage points higher than benchmark and showed greater
dispersion. Conclusion(s): Mortality incidence has changed little
over 35 years among ICU infection prevention studies whilst the patient
age and underlying disease severity, measured as APACHE II, have both
increased. The paradoxically high mortality among concurrent control
groups within studies of decontamination methods of infection prevention
remains unaccounted for. Copyright © 2023, The Author(s).

<97>
Accession Number
2023293965
Title
Whipple's disease-associated infective endocarditis: a systematic review.
Source
Infectious Diseases. 55(7) (pp 447-457), 2023. Date of Publication: 2023.
Author
Ioannou P.; Kourtidis M.; Mytilinis D.-O.; Psyllaki A.; Baliou S.;
Kofteridis D.
Institution
(Ioannou, Kofteridis) School of Medicine, University of Crete, Heraklion,
Greece
(Ioannou, Kourtidis, Mytilinis, Psyllaki, Baliou, Kofteridis) Department
of Internal Medicine & Infectious Diseases, University Hospital of
Heraklion, Heraklion, Greece
Publisher
Taylor and Francis Ltd.
Abstract
Whipple's disease is an uncommon chronic systemic disease caused by
Tropheryma whippelii. The most characteristic findings of late Whipple's
disease include diarrhoea, abdominal pain, weight loss, and arthralgias,
however, other clinical findings can occur, including lymphadenopathy,
fever, neurologic manifestations, myocarditis and endocarditis. The aim of
the present study was to systematically review all cases of Whipple's
disease-associated infective endocarditis (IE) in the literature. A
systematic review of PubMed, Scopus, and Cochrane Library (all published
studies up to 28 May 2022) for studies providing data on epidemiology,
clinical characteristics as well as data on treatment and outcomes of
Whipple's disease-associated IE was performed. A total of 72 studies,
containing data for 127 patients, were included. A prosthetic valve was
present in 8% of patients. The aortic valve was the most commonly involved
intracardiac site followed by the mitral valve. Heart failure, embolic
phenomena, and fever were the most common clinical presentations, however,
fever occurred in less than 30% of patients. Sepsis was rarely noted. The
diagnosis was most commonly performed through pathology through positive
PCR or histology in cardiac valves in 88.2% of patients. Trimethoprim with
sulfamethoxazole were the most commonly used antimicrobials followed by
cephalosporins and tetracyclines. Surgery was performed in 84.3% of
patients. Mortality was 9.4%. A multivariate logistic regression analysis
model identified presentation with sepsis or development of a paravalvular
abscess to be independently associated with increased mortality, while
treatment with the combination of trimethoprim with sulfamethoxazole was
independently associated with reduced mortality. Copyright © 2023
Society for Scandinavian Journal of Infectious Diseases.

<98>
Accession Number
2022474270
Title
Effect of BMI on patients undergoing transcatheter aortic valve
implantation: A systematic review and meta-analysis.
Source
Progress in Cardiovascular Diseases. 78 (pp 58-66), 2023. Date of
Publication: 01 May 2023.
Author
Gupta R.; Mahmoudi E.; Behnoush A.H.; Khalaji A.; Malik A.H.; Sood A.;
Bandyopadhyay D.; Zaid S.; Goel A.; Sreenivasan J.; Patel C.; Vyas A.V.;
Lavie C.J.; Patel N.C.
Institution
(Gupta, Patel, Vyas, Patel) Department of Cardiology, Lehigh Valley Health
Network, Allentown, PA, United States
(Mahmoudi, Behnoush, Khalaji) Universal Scientific Education and Research
Network, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Malik, Bandyopadhyay) Department of Cardiology, Westchester Medical
Center and New York Medical College, Valhalla, NY, United States
(Sood) Department of Internal Medicine, The Wright Center for Graduate
Medical Education, Scranton, PA, United States
(Zaid, Goel) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Institute, Houston, TX, United States
(Sreenivasan) Department of Cardiovascular Medicine, Yale University
School of Medicine, New Haven, CT, United States
(Lavie) John Ochsner Heart and Vascular Institute, Ochsner Clinical
School, The University of Queensland School of Medicine, New Orleans, LA,
United States
Publisher
W.B. Saunders
Abstract
Background: The relationship of body mass index (BMI) and an "obesity
paradox" with cardiovascular risk prediction is controversial. This
systematic review and meta-analysis aims to compare the associations of
different BMI ranges on transcatheter aortic valve implantation (TAVI)
outcomes. Method(s): International databases, including PubMed, the
Web of Science, and the Cochrane Library, were systematically searched for
observational and randomized controlled trial studies investigating TAVI
outcomes in any of the four BMI categories: underweight, normal weight,
overweight, and obese with one of the predefined outcomes. Primary
outcomes were in-hospital, 30-day, and long-term all-cause mortality.
Random-effects meta-analysis was performed to calculate the odds ratio
(OR) or standardized mean differences (SMD) with 95% confidence interval
(CI) for each paired comparison between two of the BMI categories.
 Result(s): A total of 38 studies were included in our analysis,
investigating 99,829 patients undergoing TAVI. There was a trend toward
higher comorbidities such as hypertension, diabetes, and dyslipidemia in
overweight patients and individuals with obesity. Compared with
normal-weight, patients with obesity had a lower rate of 30-day mortality
(OR 0.42, 95% CI 0.25-0.72, p < 0.01), paravalvular aortic regurgitation
(OR 0.63, 95% CI 0.44-0.91, p = 0.01), 1-year mortality (OR 0.48, 95% CI
0.24-0.96, p = 0.04), and long-term mortality (OR 0.69, 95% CI 0.51-0.94,
p = 0.02). However, acute kidney injury (OR 1.16, 95% CI 1.04-1.30, p =
0.01) and permanent pacemaker implantation (OR 1.25, 95% CI 1.05-1.50, p =
0.01) odds were higher in patients with obesity. Noteworthy, major
vascular complications were significantly higher in underweight patients
in comparison with normal weight cases (OR 1.62, 95% CI 1.07-2.46, p =
0.02). In terms of left ventricular ejection fraction (LVEF), patients
with obesity had higher post-operative LVEF compared to normal-weight
individuals (SMD 0.12, 95% CI 0.02-0.22, p = 0.02). Conclusion(s):
Our results suggest the presence of the "obesity paradox" in TAVI outcomes
with higher BMI ranges being associated with lower short- and long-term
mortality. BMI can be utilized for risk prediction of patients undergoing
TAVI. Copyright © 2023 Elsevier Inc.

<99>
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. 37(4) (pp 596-603), 2023. Date of Publication:
August 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. 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. 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. 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. Copyright © 2023, The Author(s) under exclusive licence
to Japanese Society of Anesthesiologists.

<100>
Accession Number
2023492087
Title
Use of cardiopulmonary bypass is associated with chronic postsurgical pain
among patients undergoing coronary artery bypass graft surgery: follow-up
of a randomized, clinical trial.
Source
Journal of Anesthesia. 37(4) (pp 555-561), 2023. Date of Publication:
August 2023.
Author
Minami K.; Tadokoro N.; Fukushima S.; Fujita T.; Ohnishi Y.
Institution
(Minami) Department of Critical Care Medicine, National Cerebral and
Cardiovascular Center, 6-1 Kishibeshinmachi, Osaka, Suita 564-8565, Japan
(Tadokoro, Fukushima, Fujita) Department of Cardiac Surgery, National
Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Osaka, Suita
564-8565, Japan
(Ohnishi) Department of Anesthesiology, National Cerebral and
Cardiovascular Center, 6-1 Kishibeshinmachi, Osaka, Suita 564-8565, Japan
Publisher
Springer
Abstract
Background: Chronic postsurgical pain (CPSP) worsens patients' mortality,
morbidity, and quality of life. Cardiopulmonary bypass is mandatory for
cardiac surgery, but it induces intense inflammation. The presence of
inflammation is a crucial part of pain sensitization. An extreme
inflammatory response due to cardiopulmonary bypass might cause a high
prevalence of CPSP after cardiac surgery. We hypothesized that the
prevalence and severity of CPSP are higher in patients after on-pump
coronary artery bypass graft (CABG) surgery than in those after off-pump
CABG surgery. Method(s): This prospective, observational study was
performed on a cohort from a randomized trial (on-pump CABG: 81 patients,
off-pump CABG: 86 patients). A questionnaire about the severity of
surgical wound pain that evaluated pain with the numerical rating scale
(NRS) was filled out by the patients. NRS responses for current pain, peak
pain in the last 4 weeks, and average pain in the last 4 weeks were
evaluated. The main outcomes were the severity of CPSP as evaluated using
the NRS and the prevalence of CPSP. CPSP was defined as pain with an NRS
score > 0. Differences in severity between groups were analyzed using
multivariate ordinal logistic regression models adjusted for age and sex,
and differences in prevalence between groups were analyzed using
multivariate logistic regression models adjusted for age and sex.
 Result(s): The questionnaire return rate was 77.0%. During a median
follow-up of 17 years, 26 patients complained of CPSP (on-pump CABG: 20
patients, off-pump CABG: 6 patients). Ordinal logistic regression showed
that the NRS response for current pain (odds ratio [OR] 2.34; 95% CI
1.12-4.92; P = 0.024) and the NRS response for peak pain in the last 4
weeks (OR 2.71; 95% CI 1.35-5.42; P = 0.005) were significantly higher in
patients who underwent on-pump CABG surgery than in those who underwent
off-pump CABG. Logistic regression showed that on-pump CABG surgery was an
independent predictor of CPSP (OR 2.59; 95% CI 1.06-6.31; P = 0.036).
 Conclusion(s): The prevalence and severity of CPSP are higher in
patients with on-pump CABG surgery than in those with off-pump CABG
surgery. Copyright © 2023, The Author(s) under exclusive licence
to Japanese Society of Anesthesiologists.

<101>
Accession Number
2019701904
Title
Anatomical variation in the branching pattern of the aortic arch: a
literature review.
Source
Irish Journal of Medical Science. 192(4) (pp 1807-1817), 2023. Date of
Publication: August 2023.
Author
Murray A.; Meguid E.A.
Institution
(Murray) Queen's University Belfast, University Road, Belfast BT7 1NN,
United Kingdom
(Meguid) School of Medicine, Dentistry and Biomedical Sciences, Whitla
Medical Building, Queen's University Belfast, 1st Floor, 97 Lisburn Road,
Belfast BT9 7AE, United Kingdom
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Many anatomical variations of the branching pattern of the
aortic arch have been documented in the literature. These find their
origin in alterations to the embryological development of the arch and
have significant implications for surgical and radiological interventions.
 Method(s): Embase and Medline database searches were carried out in
June 2021 and identified 1197 articles, of which 24 were considered
eligible. Result(s): Twenty-eight variations were found. The
prevalence of the six main variations found is as follows: normal
configuration (61.2-92.59%); bovine arch type 1 (4.95-31.2%); bovine arch
type 2 (0.04-24%); origin of left vertebral artery (0.17-15.3%); aberrant
right subclavian artery (0.08-3.33%); thyroid ima artery (0.08-2%).
Concomitant variations present in conjunction with these variations are
also documented, as were other variations which could not be classified
into these six groups. Conclusion(s): Anatomical variations in the
branching pattern of the aortic arch are present in over one-third of
individuals in some populations. These are important pre- and
intra-operatively during thoracic, neck and thyroid surgery. A greater
effort should be employed to construct an official classification to
facilitate greater understanding among clinicians. Copyright ©
2022, The Author(s).

<102>
[Use Link to view the full text]
Accession Number
641903318
Title
Early mortality associated with combination Impella 5.5 and extracorporeal
membrane oxygenation support as bridge to cardiac replacement therapy.
Source
ASAIO Journal. Conference: 68th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2023. San Francisco, CA United
States. 69(Supplement 2) (pp 136), 2023. Date of Publication: June 2023.
Author
Girish A.; Brown M.A.; Cevasco M.; Wald J.W.; Olia S.; Molina M.; Senker
R.; Bermudez C.
Institution
(Girish) Georgetown University, School of Medicine, Washington, DC, United
States
(Brown, Cevasco, Olia, Bermudez) Division of Cardiovascular Surgery,
University of Pennsylvania, Philadelphia, PA, United States
(Wald, Molina, Senker) Division of Cardiology, University of Pennsylvania,
Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: End stage heart failure is treated with durable left
ventricular assist device (LVAD) or orthotopic heart transplant (OHT).
Patients with severe ventricular dysfunction and/or cardiogenic shock may
require temporary mechanical circulatory support (tMCS) while awaiting
cardiac replacement therapy. Extracorporeal membrane oxygenation (ECMO)
and the Impella 5.5 (Abiomed; Danvers, MA) are well-studied bridging
therapies. However, investigations of concomitant ECMO and Impella 5.5
(ECpella 5.5) therapy are lacking. The aim of this study is to compare
mortality at 30-days and at most recent follow-up across four groups with
different tMCS bridging strategies. Method(s): This is a
retrospective study evaluating all patients who were bridged to durable
LVAD or OHT between December 31, 2018 to January 31, 2023 at our
institution. Patients were separated into the following groups: Group 1
(solo ECMO), Group 2 (solo Impella 5.5), Group 3 (ECMO followed by Impella
5.5), and Group 4 (Impella 5.5 followed by ECMO). Patient demographics and
early (30-day) mortality were collected from chart review (table 1). Group
comparisons for continuous variables were performed with analysis of
variance (ANOVA), and chi-square test of independence and Fisher's exact
tests were used for outcome data comparisons between groups.
 Result(s): This study included 61 patients bridged to LVAD or OHT
with ECMO and/or Impella 5.5. Mean (std) age was 49.4 (14.3) years and
mean (std) time on tMCS was 10.5 (8.4) days. 49% of our cohort required
solo ECMO (Group 1, n = 30), 25% required solo Impella 5.5 (Group 2, n =
15), 11% required Impella 5.5 following ECMO (Group 3, n = 7), and 15%
required escalation to ECMO from Impella 5.5 (Group 4, n = 9). Mortality
at 30-days for Group 1 was 16.7%. No patients died in the 30-day
postoperative period in Groups 2-4. Mortality at most-recent follow-up was
33.3%, 6.7%, 28.6%, and 0% for Groups 1-4, respectively. ANOVA revealed
significant between-group differences for days on tMCS (p < 0.01).
Chi-square test of independence revealed no significant difference in
overall mortality across treatment groups (p = 0.07). Further partitioning
with pairwise Fisher's exact tests between treatment groups revealed no
significant differences in mortality at most recent follow-up.
 Conclusion(s): Limited data exists comparing mortality between
different combinations of tMCS as bridge to cardiac replacement therapy,
and even less is known about mortality associated with order of therapy
initiation. This data demonstrates comparable mortality between solo ECMO,
solo Impella 5.5, ECMO followed by Impella 5.5, and Impella 5.5 escalated
to ECMO therapies. Large, randomized controlled trials are required to
fully evaluate the impact of order of tMCS in bridging to cardiac
replacement therapy. (Table Presented).

<103>
[Use Link to view the full text]
Accession Number
641903214
Title
Outcomes Of Percutaneous Transcatheter Interventions For Aortic
Insufficiency In Patients With Continuous-Flow Left Ventricular Assist
Devices: A Systematic Review.
Source
ASAIO Journal. Conference: 68th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2023. San Francisco, CA United
States. 69(Supplement 2) (pp 130), 2023. Date of Publication: June 2023.
Author
Ahmad D.; Pancio G.; Bheemreddy P.; Jain A.; Vishnevsky A.; Ruggiero N.J.;
Rajapreyar I.; Rajagopal K.; Entwistle J.W.; Massey H.T.;
Tchantchaleishvili V.
Institution
(Ahmad, Pancio, Bheemreddy, Jain, Rajagopal, Entwistle, Massey,
Tchantchaleishvili) Department of Surgery, Division of Cardiac surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Vishnevsky, Ruggiero, Rajapreyar) Department of Medicine, Division of
Cardiology, Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: De novo progressive aortic insufficiency (AI) in
continuousflow left ventricular assist devices (CF-LVADs) leads to
impaired device performance and poor outcomes. Given the paucity of
experience with transcatheter interventions for such AI, we sought to pool
the existing evidence on patients treated with transcatheter interventions
for de-novo AI following CF-LVAD use. Method(s): Electronic search
identified adult patients with CF-LVADs who underwent percutaneous
transcatheter interventions for AI, including transcatheter aortic valve
replacement (TAVR) or an occlusion device (OD) placement. Case-level data
for 59 patients from 41 published reports and three unpublished cases were
extracted and analyzed. Result(s): The median patient age was 61
years [Interquartile range (IQR) 52, 69] and 27% (16/59) were female.
Non-ischemic cardiomyopathy was diagnosed in 45% (27/59) of patients.
Following transcatheter intervention, median pre-intervention AI grade of
4 [4-4] improved to a median grade of 1 [0, 1] (p=<0.01). Both baseline
and post-intervention AI grades were comparable between TAVR and OD.
Valve-in-valve procedures were undertaken in 13.6 % (8/59) of patients due
to paravalvular leak and valve dislodgement. With a median follow-up of
5.6 months [2.8, 8.5], the overall mortality was 32.2% (19/59) and was
significantly less in the TAVR group [TAVR: 20.6% (7/34) vs. OD: 48%
(12/25), p=0.04]. Kaplan-Meier survival analysis achieved no statistical
significance in survival between the groups (Figure). Conclusion(s):
Both TAVR and OD showed similar efficacy in reducing AI. Potentially
greater overall mortality with OD warrants additional studies before their
widespread utilization in this patient population. (Figure Presented).

<104>
[Use Link to view the full text]
Accession Number
641903067
Title
Outcomes of outflow graft stenting in HeartMate 3 left ventricular assist
devices: A systematic review.
Source
ASAIO Journal. Conference: 68th Annual Conference of the American Society
for Artificial Internal Organs, ASAIO 2023. San Francisco, CA United
States. 69(Supplement 2) (pp 47), 2023. Date of Publication: June 2023.
Author
Patil S.; Ahmad D.; Shah K.; Vishnevsky A.; Ruggiero N.J.; Rajapreyar I.;
Rame J.E.; Alvarez R.; Rajagopal K.; Entwistle J.W.; Massey H.T.;
Tchantchaleishvili V.
Institution
(Patil, Ahmad, Rajagopal, Entwistle, Massey, Tchantchaleishvili) Division
of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United
States
(Shah) Lawrenceville School, Lawrenceville, NJ, United States
(Vishnevsky, Ruggiero, Rajapreyar, Rame, Alvarez) Division of Cardiology,
Thomas Jefferson University, Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Outflow graft stenosis in continuous-flow left ventricular
assist devices (CF-LVAD) is multifactorial. We sought to pool the existing
evidence on indications, utilization patterns, and outcomes of
transcatheter interventions for outflow graft stenosis in the HeartMate 3
(HM 3) LVAD. Method(s): An electronic search was performed to
identify all studies in the English literature reporting on HM 3 LVAD
outflow graft stenting. Sixteen published reports and one unpublished case
comprising a total of 28 patients were included. Patient-level data were
extracted for analysis. Result(s): Median patient age was 68.5 years
[Interquartile range: 58, 71] and 25.9% (7/27) were female. Dyspnea [60.7%
(17/28)] was the most common presenting symptom. Low flow alarms were
present in 60% (15/25) of patients, of which 20% (3/15) did not report
other symptoms. LVAD findings included external compression [35.7 %
(10/28)], graft twist [21.4% (6/28)], graft twist and external compression
[14.3% (4.28)], intravascular thrombus [10.7% (3/28)], graft twist and
intravascular thrombus [3.6% (1/28)], and pseudoaneurysm of outflow graft
[3.6% (1/28)]. Median time from LVAD implantation to stenting was 2.1
years [1.4, 3] with 35.7% (10/28) receiving two stents and 14.3% (4/28)
receiving >2 stents. Immediate flow normalization after stenting was
observed in 85.7% (24/28). Recurrent stenosis was observed in 8% (2/25).
Other complications included neurological events [8% (2/25)], recurrent
low flow alarms [8% (2/25)], and severe right ventricular failure [8%
(2/25)]. Heart transplantation was performed in 8% (2/25) after stenting.
The 30-day mortality was 12% (3/25). Overall mortality was also 12% (3/25)
at a median follow-up of 3.9 months [1, 17]. Conclusion(s): Outflow
graft stenting in HM 3 LVAD appears to be a reasonable treatment option
for outflow graft stenosis with low overall rate of complications and
mortality. Further refinement of indications and approach may improve
outcomes.

<105>
Accession Number
2025917676
Title
Early safety and feasibility of a first-in-class biomimetic transcatheter
aortic valve - DurAVR.
Source
EuroIntervention. 19(4) (pp E352-E361), 2023. Date of Publication: July
2023.
Author
Kodali S.K.; Sorajja P.; Meduri C.U.; Feldt K.; Cavalcante J.L.; Garg P.;
Hamid N.; Poon K.K.; Settergren M.; Burns M.R.; Ruck A.; Sathananthan J.;
Zajarias A.; Shaburishvili T.; Zirakashvili T.; Zhividze M.; Katchakhidze
G.; Bapat V.
Institution
(Kodali) Columbia University Irving Medical Center, New York, NY, United
States
(Sorajja, Cavalcante, Hamid, Burns, Bapat) Minneapolis Heart Institute,
Abbott Northwestern Hospital, Minneapolis, MN, United States
(Meduri, Feldt, Settergren, Ruck) Department of Cardiology, Karolinska
University Hospital, Stockholm, Sweden
(Feldt, Settergren, Ruck) Department of Medicine, Solna, Karolinska
Institutet, Stockholm, Sweden
(Garg) Norwich Medical School, University of East Anglia, Norwich, United
Kingdom
(Garg) Norfolk and Norwich University Hospitals NHS Foundation Trust,
Norwich, United Kingdom
(Poon) St. Andrew's War Memorial Hospital, Brisbane, QLD, Australia
(Sathananthan) St. Paul's Hospital, Vancouver, BC, Canada
(Zajarias) Washington University School of Medicine, St. Louis, MO, United
States
(Shaburishvili, Zirakashvili, Zhividze) Cardiovascular Clinic, Tbilisi
Heart and Vascular Clinic, Tbilisi, Georgia
(Katchakhidze) Aversi Clinic, Tbilisi, Georgia
Publisher
Europa Group
Abstract
Background: TAVI is a widely accepted treatment for patients with severe
aortic stenosis (AS). Despite the adoption of diverse therapies,
opportunities remain to develop technologies tailored to provide optimal
acute and potential long-term benefits, particularly around haemodynamics,
flow and durability. Aim(s): We aimed to evaluate the safety and
feasibility of the DurAVR transcatheter heart valve (THV), a
first-in-class biomimetic valve, in the treatment of patients with
symptomatic severe AS. Method(s): This was a first-in-human (FIH),
prospective, non-randomised, single-arm, single-centre study. Patients
with severe, symptomatic AS of any surgical risk and who were eligible for
the DurAVR THV prosthesis were recruited; they were assessed at baseline,
30 days, 6 months, and 1 year post-procedure for implant success,
haemodynamic performance, and safety. Result(s): Thirteen patients
(73.9+/-6.4 years old, 77% female) were enrolled. The DurAVR THV was
successfully implanted in 100% of cases with no device-related
complications. One access site complication, one permanent pacemaker
implantation, and one case of moderate aortic regurgitation occurred.
Otherwise, no deaths, stroke, bleeding, reinterventions, or myocardial
infarction were reported during any of the follow-up visits. Despite a
mean annulus size of 22.95+/-1.09 mm, favourable haemodynamic results were
observed at 30 days (effective orifice area [EOA] 2.00+/-0.17
cm2, and mean pressure gradient [MPG] 9.02+/-2.68 mmHg) and
were sustained at 1 year (EOA 1.96+/-0.11 cm2, MPG 8.82+/-1.38
mmHg), resulting in zero patients with any degree of prosthesis-patient
mismatch. Additionally, new valve performance measures derived from
cardiovascular magnetic resonance displayed restoration of laminar flow,
consistent with a predisease state, in conjunction with a mean coaptation
length of 8.3+/-1.7 mm. Conclusion(s): Preliminary results from the
FIH study with DurAVR THV demonstrate a good safety profile with promising
haemodynamic performance sustained at 1 year and restoration of
near-normal flow dynamics. Further clinical investigation is warranted to
evaluate how DurAVR THV may play a role in addressing the challenge of
lifetime management in AS patients. Copyright © Europa Digital &;
Publishing 2023. All rights reserved.

<106>
Accession Number
641913122
Title
Percutaneous mitral annuloplasty with the Carillon device: outcomes in
proportionate and disproportionate functional mitral regurgitation.
Source
American heart journal. (no pagination), 2023. Date of Publication: 27
Jul 2023.
Author
Kalmucki P.; Lipiecki J.; Witte K.K.; Goldberg S.L.; Baszko A.; Siminiak
T.
Institution
(Kalmucki) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
(Lipiecki) Clermont Ferrand, France
(Witte) RWTH, Universitatsklinikum, Aachen, Germany
(Goldberg) Tyler Heart Institute at Community Hospital of the Monterey
Peninsula, Monterey, CA, United States; Cardiac Dimensions, Kirkland, WA,
United States. Electronic address: stevgold@cardiacdimensions.com
(Baszko) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
(Siminiak) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
Publisher
NLM (Medline)
Abstract
BACKGROUND: It has been suggested that the disparity of outcomes between
the studies of transcutaneous edge-to-edge repair (TEER) for functional
mitral regurgitation (FMR) in heart failure with reduced ejection fraction
(HFrEF) could be due to systematic differences in the populations studied.
One proposal is that there are two broad groups: those with proportional
FMR who respond less favourably, and those in whom the FMR is greater than
expected (disproportionate) FMR where edge-to-edge TEER seems to be more
effective. Whether this grouping is relevant for other percutaneous
interventions for FMR is unknown. OBJECTIVE(S): We sought to compare
clinical and echocardiographic outcomes of patients with HFrEF and
proportionate and disproportionate FMR treated with indirect annuloplasty
using the Carillon device. METHOD(S): This is a pooled analysis from
three trials of patients with FMR. Key patient eligibility in these trials
specified persistent grade 2+ to 4+ FMR with >5.5 cm left ventricular (LV)
end-diastolic diameter (LVEDD) and reduced ejection fraction. Patients
with an effective regurgitant orifice area/LV end-diastolic volume
(EROA/LVEDV) ratio under 0.15 were assigned to the proportionate FMR group
(n=74;65%) and those with a ratio above 0.15 were classed as having
disproportionate FMR (n=39;35%). RESULT(S): At 12 months following
treatment, both groups showed improvements in all MR variables including
regurgitation volume, EROA and vena contracta. Moreover, in patients with
proportionate MR there were clinically relevant and statistically
significant improvements in LV volumes and diameters. There was no
independent relationship between the degree of proportionality as a
continuous variable and the remodeling response to Carillon therapy
(change in LVEDV r=0.17; change in LVESV r=0.14). CONCLUSION(S):
Percutaneous mitral annuloplasty with the Carillon device reduces MR in
patients with both proportionate and disproportionate FMR, and also
results in LV reverse remodeling in those with proportionate FMR. The
effect on remodeling remains to be verified in a large scale
trial. Copyright © 2023. Published by Elsevier Inc.

<107>
Accession Number
641913021
Title
Comparison of the Outcomes of Oral Versus Nasal Endotracheal Intubation in
Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled
Study.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2023.
Date of Publication: 08 Jul 2023.
Author
Abdelbaser I.; Abourezk A.R.; Magdy M.; Elnegerey N.; Sabry R.; Tharwat
M.; Sayedalahl M.
Institution
(Abdelbaser, Abourezk, Magdy, Elnegerey, Sayedalahl) Department of
Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura
University, Mansoura, Egypt
(Sabry, Tharwat) Department of Cardiothoracic Surgery, Faculty of
Medicine, Mansoura University, Mansoura, Egypt
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The choice of oral or nasal endotracheal intubation in children
undergoing cardiac surgery is affected by several factors. This study
compared the outcomes of oral versus nasal intubation in neonates and
infants who underwent open cardiac surgery. DESIGN: A randomized,
controlled, open-labeled study. SETTING: At a university hospital.
PARTICIPANTS: A total of 220 infants and neonates who underwent cardiac
surgery. INTERVENTIONS: Patients were allocated randomly to oral or nasal
intubation. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was
postoperative fentanyl consumption (microg/kg/h) by intubated patients.
Secondary outcome measures were the increase in heart rate (HR) from
baseline during intubation, the time consumed for intubation, accidental
intraoperative extubation, the occurrence of epistaxis, time to
extubation, the onset of full oral feeding, intensive care unit (ICU) and
hospital lengths of stay, and the incidence of postoperative complications
(the need for reintubation, stridor, pneumonia, wound infection). The mean
(SD) postoperative fentanyl consumption of intubated patients (the primary
outcome) was significantly lower (p < 0.001) in the nasal intubation group
(0.53 +/- 0.48) microg/kg/h compared with the oral intubation group (0.82
+/- 0.20) microg/kg/h. The median (IQR) time needed for the intubation
(31.5, 27-35 v 16, 14.8-18 seconds) was significantly (p < 0.001) longer,
and the mean (SD) increase in HR (beats/min) from baseline during
intubation (18 +/- 5 v 26 +/- 7) was significantly (p < 0.001) lower in
the nasal intubation group compared to the oral intubation group. The
incidence of inadvertent intraoperative extubation was significantly (p =
0.029) higher in the oral (n = 6, 6.1%) than in the nasal (n = 0, 0%)
intubation group. The median (IQR) time to extubation (14, 12.6-17.2 v
20.5, 16.4-25.4 hours) and the ICU length of stay (27, 26-28 v 30, 28-34
hours) were significantly (p < 0.05) shorter in the nasal group compared
to the oral group. The median (IQR) time to onset of full oral feeding was
significantly (p = 0.031) shorter in the nasal intubation group (3, 1-6
days) compared to the oral intubation group (4, 2-7 days). There were no
significant differences between the oral and nasal groups in the duration
of hospital stay and the indices for reintubation, postintubation stridor,
pneumonia, and surgical wound infection. CONCLUSION(S): The nasal
route for intubation is associated with less postoperative fentanyl
consumption, earlier extubation, lower incidence of accidental extubation,
and earlier full oral feeding than oral intubation. The nasal route is not
associated with an increased risk of postoperative pneumonia or surgical
wound infection. Copyright © 2023 Elsevier Inc. All rights
reserved.

<108>
Accession Number
641912225
Title
Association between postoperative delirium and adverse outcomes in older
surgical patients: A systematic review and meta-analysis.
Source
Journal of clinical anesthesia. 90 (pp 111221), 2023. Date of Publication:
27 Jul 2023.
Author
Yan E.; Veitch M.; Saripella A.; Alhamdah Y.; Butris N.; Tang-Wai D.F.;
Tartaglia M.C.; Nagappa M.; Englesakis M.; He D.; Chung F.
Institution
(Yan, Alhamdah, Butris, Chung) Department of Anesthesia and Pain
Management, Toronto Western Hospital, University Health Network,
University of Toronto, Toronto, ON, Canada; Institute of Medical Science,
Temerty Faculty of Medicine, University of Toronto, ON, Canada
(Veitch, Saripella) Department of Anesthesia and Pain Management,
University of Toronto, Toronto Western Hospital ,University Health
Network, Toronto, ON, Canada
(Tang-Wai) Division of Neurology, Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Tartaglia) Institute of Medical Science, Temerty Faculty of Medicine,
University of Toronto, ON, Canada; Division of Neurology, Department of
Medicine, University of Toronto, Toronto, ON, Canada
(Nagappa) Department of Anesthesia & Perioperative Medicine, Schulich
School of Medicine and Dentistry, Western University, London, ON, Canada
(Englesakis) Library & Information Services, University Health Network,
Toronto, ON, Canada
(He) Department of Anesthesiology and Pain Medicine, University of
Toronto, Mount Sinai Hospital, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
STUDY OBJECTIVE: To assess the incidence of postoperative delirium and its
outcomes in older non-cardiac surgical patients. DESIGN: A systematic
review and meta-analysis with multiple databases searched from inception
to February 22, 2022. SETTING: Postoperative assessments. PATIENTS:
Non-cardiac and non-neurological surgical patients aged >=60 years with
and without postoperative delirium. Included studies must report >=1
postoperative outcome. Studies with a small sample size (N < 100 subjects)
were excluded. MEASUREMENTS: Outcomes comprised the pooled incidence of
postoperative delirium and its postoperative outcomes, including
mortality, complications, unplanned intensive care unit admissions, length
of stay, and non-home discharge. For dichotomous and continuous outcomes,
OR and difference in means were computed, respectively, with a 95% CI.
MAIN RESULTS: Fifty-four studies (20,988 patients, 31 elective studies, 23
emergency studies) were included. The pooled incidence of postoperative
delirium was 19% (95% CI: 16%, 23%) after elective surgery and 32% (95%
CI: 25%, 39%) after emergency surgery. In elective surgery, postoperative
delirium was associated with increased mortality at 1-month (OR: 6.60; 95%
CI: 1.58, 27.66), 6-month (OR: 5.69; 95% CI: 2.33, 13.88), and 1-year (OR:
2.87; 95% CI: 1.63, 5.06). The odds of postoperative complications,
unplanned intensive care unit admissions, prolonged length of hospital
stay, and non-home discharge were also higher in delirium cases. In
emergency surgery, patients with postoperative delirium had greater odds
of mortality at 1-month (OR: 3.56; 95% CI: 1.77, 7.15), 6-month (OR: 2.60;
95% CI: 1.88, 3.61), and 1-year (OR: 2.30; 95% CI: 1.77, 3.00).
 CONCLUSION(S): Postoperative delirium was associated with higher odds
of mortality, postoperative complications, unplanned intensive care unit
admissions, length of hospital stay, and non-home discharge. Prevention
and perioperative management of delirium may optimize surgical
outcomes. Copyright © 2023 Elsevier Inc. All rights reserved.

<109>
Accession Number
2025886908
Title
Application of topical pharyngeal anesthesia to reduce adverse reactions
during painless gastroscopy: A prospective randomized study.
Source
Technology and Health Care. 31(4) (pp 1245-1251), 2023. Date of
Publication: 2023.
Author
Sun H.; Lin X.; Liu Y.; Hu S.; Yu Y.; Song C.
Institution
(Lin, Sun, Lin, Liu, Hu, Yu, Song) Department of Gastroenterology, The
Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University,
Wenzhou People's Hospital, Zhejiang, Wenzhou, China
Publisher
IOS Press BV
Abstract
Background: Studies have reported that certain adverse reactions can occur
during painless gastroscopy examination. Knowing how to decrease the risks
and incidence of adverse reactions is of great importance.
 Objective(s): To investigate whether topical pharyngeal anesthesia
combined with intravenous anesthesia is superior to intravenous anesthesia
alone in patients undergoing painless gastroscopy and to determine whether
this combined approach had any additional benefits. Method(s): Three
hundred patients undergoing painless gastroscopy were randomly assigned to
either the control group or the experimental group. In the control group,
patients were anesthetized with propofol, while patients in the
experimental group received propofol combined with 2% lidocaine spray for
topical pharyngeal anesthesia. Hemodynamic parameters before and after the
procedure, including the heart rate (HR), mean arterial pressure (MAP),
and pulse oxygen saturation (SPO2) were recorded. Any adverse reactions
experienced by the patient, including choking and respiratory depression,
and the total dosage of propofol required during each procedure were also
documented. Result(s): Compared with pre-anesthetic data, the HR,
MAP, and SPO2 were reduced after the completion of the painless
gastroscopy procedure in both groups. However, the HR, MAP, and SPO2
measurements taken after the gastroscopy were significantly lower in the
control group than those of the experimental group (P< 0.05); thus, the
hemodynamic parameters of the experimental group were more stable.
Compared with the control group, there was significant reduction in the
total amount of propofol administered in the experimental group (P< 0.05).
The incidence of adverse reactions, including choking and respiratory
depression, was significantly lower in the experimental group (P< 0.05).
 Conclusion(s): The results demonstrated that the application of
topical pharyngeal anesthesia in painless gastroscopy can significantly
reduce the incidence of adverse reactions. Thus, the combination of
topical pharyngeal and intravenous anesthesia is worthy of clinical
application and promotion. Copyright © 2023 - IOS Press. All
rights reserved.

<110>
Accession Number
2025644074
Title
Cardiopulmonary Bypass and Continuous Low Tidal Volume.
Source
Medical Forum Monthly. 34(5) (pp 7-10), 2023. Date of Publication: May
2023.
Author
Asad H.; Mehmood H.; Hussain S.; Hussain R.; Arshed M.; Ali I.
Institution
(Asad, Mehmood) Department of Anaesthesiology, Dow University Hospital,
Ojha Campus, Karachi, Pakistan
(Hussain) Department of Anaesthesiology, Murshid Hospital & Health Care
Centre, Karachi, Pakistan
(Hussain) Department of Anaesthesiology, NICVD Hospital, Karachi, Pakistan
(Arshed) Department of Anaesthesiology, Liaquat National Hospital,
Karachi, Pakistan
(Ali) Department of Anaesthesiology, Social Security Hospital, Landhi,
Karachi, Pakistan
Publisher
Medical Forum Monthly
Abstract
Objective: is to compare the effects of low tidal volume ventilation
versus no-ventilation in terms of reducing pulmonary dysfunction during
cardiopulmonary bypass (CPB) in patients undergoing conventional coronary
artery bypass graft (CABG) surgery. Study Design: Randomized
controlled trial study Place and Duration of Study: This study was
conducted at the Dow University of Health Sciences from June 2021 to June
2022. Material(s) and Method(s): A total of 62 patients who were
planned to for cardiac pulmonary bypass graft surgery were enrolled and
randomized in two groups. Group A ventilation group was managed with low
tidal volume ventilation 3 ml/kg, 12 breaths/min respiratory rate and 5
cmHg PEEP. In group B non-ventilation group ventilation was arrested.
 Result(s): The mean PaO2/FiO2 Ratio after intubation of Group A and
Group B was 340.91+/-23.89 and 348.79+/-24.65, respectively. (p=0.207).
The mean PaO2/FiO2 Ratio after 1 hour of CPB and PaO2/FiO2 Ratio after
hours of CPB of Group A was greater than Group B, (p<0.001). Whereas, the
A-a oxygen (O2) gradient after 1 hour of cardiopulmonary bypass CPB (kPa)
and A-a oxygen (O2) gradient after 4 hour of cardiopulmonary bypass CPB
(kPa) of Group A was less than Group B, (p<0.001). The mean ventilation
time of Group A and Group B was 5.61+/-0.86 hours and 7.77+/-0.98 hours,
respectively. (p<0.001). While, ICU stay and hospital stay of both the
groups was almost same, (P>0.050). Conclusion(s): In cardiac surgery
patients especially cardiopulmonary bypass low tidal volume ventilation is
associated with reduce risk of complications and better oxygenation during
cardiopulmonary bypass. Copyright © 2023 Medical Forum Monthly.
All rights reserved.

<111>
Accession Number
2025277353
Title
Effect of Canagliflozin on Heart Failure Hospitalization in Diabetes
According to Baseline Heart Failure Risk.
Source
JACC: Heart Failure. 11(7) (pp 825-835), 2023. Date of Publication: July
2023.
Author
Khan M.S.; Segar M.W.; Usman M.S.; Patel K.V.; Van Spall H.G.C.; DeVore
A.D.; Vaduganathan M.; Lam C.S.P.; Zannad F.; Verma S.; Butler J.; Tang
W.H.W.; Pandey A.
Institution
(Khan, DeVore) Division of Cardiology, Duke University School of Medicine,
Durham, NC, United States
(Segar) Department of Cardiology, Texas Heart Institute, Houston, TX,
United States
(Usman, Butler) Department of Medicine, University of Mississippi Medical
Center, Jackson, MS, United States
(Patel) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
(Van Spall) Department of Medicine, Population Health Research Institute,
Research Institute of St. Joseph's, McMaster University, Hamilton, ON,
Canada
(DeVore) Duke Clinical Research Institute, Durham, NC, United States
(Vaduganathan) Brigham and Women's Hospital Heart and Vascular Center,
Department of Medicine, Harvard Medical School, Boston, MA, United States
(Lam) National Heart Centre Singapore, Duke-National University of
Singapore, Singapore
(Zannad) Universite de Lorraine, CIC Insert, CHRU, Nancy, France
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, ON, Canada
(Butler) Baylor Scott and White Research Institute, Dallas, TX, United
States
(Tang) Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Pandey) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: In the CANVAS (Canagliflozin Cardiovascular Assessment Study)
program, canagliflozin reduced the risk of heart failure (HF)
hospitalization among individuals with type 2 diabetes mellitus (T2DM).
 Objective(s): The purpose of this study was to evaluate heterogeneity
in absolute and relative treatment effects of canagliflozin on HF
hospitalization according to baseline HF risk as assessed by
diabetes-specific HF risk scores (WATCH-DM [Weight (body mass index), Age,
hyperTension, Creatinine, HDL-C, Diabetes control (fasting plasma glucose)
and QRS Duration, MI and CABG] and TRS-HF<inf>DM</inf> [TIMI Risk Score
for HF in Diabetes]). Method(s): Participants in the CANVAS trial
were categorized into low, medium, and high risk for HF using the WATCH-DM
score (for participants without prevalent HF) and the TRS-HF<inf>DM</inf>
score (for all participants). The outcome of interest was time to first HF
hospitalization. The treatment effect of canagliflozin vs placebo for HF
hospitalization was compared across risk strata. Result(s): Among
10,137 participants with available HF data, 1,446 (14.3%) had HF at
baseline. Among participants without baseline HF, WATCH-DM risk category
did not modify the treatment effect of canagliflozin (vs placebo) on HF
hospitalization (P interaction = 0.56). However, the absolute and relative
risk reduction with canagliflozin was numerically greater in the high-risk
group (cumulative incidence, canagliflozin vs placebo: 8.1% vs 12.7%; HR:
0.62 [95% CI: 0.37-0.93]; P = 0.03; number needed to treat: 22) than in
the low- and intermediate-risk groups. When overall study participants
were categorized according to the TRS-HF<inf>DM</inf> score, a
statistically significant difference in the treatment effect of
canagliflozin across risk strata was observed (P interaction = 0.04).
Canagliflozin significantly reduced the risk of HF hospitalization by 39%
in the high-risk group (HR: 0.61 [95% CI: 0.48-0.78]; P < 0.001; number
needed to treat: 20) but not in the intermediate- or low-risk groups.
 Conclusion(s): Among participants with T2DM, the WATCH-DM and
TRS-HF<inf>DM</inf> can reliably identify those at high risk for HF
hospitalization and most likely to benefit from
canagliflozin. Copyright © 2023 American College of Cardiology
Foundation

<112>
Accession Number
2025191571
Title
Acyl ghrelin improves cardiac function in heart failure and increases
fractional shortening in cardiomyocytes without calcium mobilization.
Source
European Heart Journal. 44(22) (pp 2009-2025), 2023. Date of Publication:
07 Jun 2023.
Author
Lund L.H.; Hage C.; Pironti G.; Thorvaldsen T.; Ljung-Faxn U.;
Zabarovskaja S.; Shahgaldi K.; Webb D.-L.; Hellstrom P.M.; Andersson D.C.;
Stahlberg M.
Institution
(Lund, Hage, Pironti, Thorvaldsen, Ljung-Faxn, Zabarovskaja, Andersson,
Stahlberg) Department of Medicine, Unit of Cardiology, Karolinska
Institutet D1:04, Stockholm 171 76, Sweden
(Lund, Hage, Thorvaldsen, Andersson, Stahlberg) Heart and Vascular Theme,
Karolinska University Hospital, Norrbacka, S1:02, Stockholm 171 76, Sweden
(Pironti, Andersson) Department of Physiology and Pharmacology, Karolinska
Institutet, Biomedicum, Solnavagen 9 ,Solna 171 65, Sweden
(Ljung-Faxn) Perioperative Medicine and Intensive Care, Karolinska
University Hospital, Stockholm 171 76, Sweden
(Shahgaldi) Department of Clinical Physiology, Sunderby Hospital, Lulea
971 80, Sweden
(Webb, Hellstrom) Department of Medical Sciences, Gastroenterology and
Hepatology, Uppsala University, Uppsala 751 05, Sweden
Publisher
Oxford University Press
Abstract
Background and Aims: Ghrelin is an endogenous appetite-stimulating peptide
hormone with potential cardiovascular benefits. Effects of acylated
(activated) ghrelin were assessed in patients with heart failure and
reduced ejection fraction (HFrEF) and in ex vivo mouse cardiomyocytes.
 Methods and Results: In a randomized placebo-controlled double-blind
trial, 31 patients with chronic HFrEF were randomized to synthetic human
acyl ghrelin (0.1 mug/kg/min) or placebo intravenously over 120 min. The
primary outcome was change in cardiac output (CO). Isolated mouse
cardiomyocytes were treated with acyl ghrelin and fractional shortening
and calcium transients were assessed. Acyl ghrelin but not placebo
increased cardiac output (acyl ghrelin: 4.08 +/- 1.15 to 5.23 +/- 1.98
L/min; placebo: 4.26 +/- 1.23 to 4.11 +/- 1.99 L/min, P < 0.001). Acyl
ghrelin caused a significant increase in stroke volume and nominal
increases in left ventricular ejection fraction and segmental longitudinal
strain and tricuspid annular plane systolic excursion. There were no
effects on blood pressure, arrhythmias, or ischaemia. Heart rate decreased
nominally (acyl ghrelin: 71 +/- 11 to 67 +/- 11 b.p.m.; placebo 69 +/- 8
to 68 +/- 10 b.p.m.). In cardiomyocytes, acyl ghrelin increased fractional
shortening, did not affect cellular Ca2+ transients, and reduced troponin
I phosphorylation. The increase in fractional shortening and reduction in
troponin I phosphorylation was blocked by the acyl ghrelin antagonist
D-Lys 3. Conclusion(s): In patients with HFrEF, acyl ghrelin
increased cardiac output without causing hypotension, tachycardia,
arrhythmia, or ischaemia. In isolated cardiomyocytes, acyl ghrelin
increased contractility independently of preload and afterload and without
Ca2+ mobilization, which may explain the lack of clinical side effects.
Ghrelin treatment should be explored in additional randomized trials.
Clinical Trial Registration: ClinicalTrials.gov Identifier:
NCT05277415 Copyright © 2023 The Author(s). Published by Oxford
University Press on behalf of the European Society of Cardiology.

<113>
Accession Number
2024912492
Title
SERCA2a Agonist Effects on Cardiac Performance During Exercise in Heart
Failure With Preserved Ejection Fraction.
Source
JACC: Heart Failure. 11(7) (pp 760-771), 2023. Date of Publication: July
2023.
Author
Sarma S.; MacNamara J.P.; Hieda M.; Howden E.J.; Lawley J.S.; Livingston
S.; Samels M.; Levine B.D.
Institution
(Sarma, MacNamara, Livingston, Samels, Levine) Institute for Exercise and
Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas,
TX, United States
(Sarma, MacNamara, Levine) Department of Internal Medicine, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Hieda) Department of Medicine and Biosystemic Science, School of
Medicine, Kyushu University, Fukuoka, Japan
(Hieda) Department of Hematology, Oncology, and Cardiovascular Medicine,
School of Medicine, Kyushu University, Fukuoka, Japan
(Howden) Baker Heart and Diabetes Institute, Melbourne, Australia
(Lawley) Department Sport Science, University of Innsbruck, Innsbruck,
Austria
Publisher
Elsevier Inc.
Abstract
Background: Impaired ventricular relaxation influences left ventricular
pressures during exercise in heart failure with preserved ejection
fraction (HFpEF). Sarco/endoplasmic reticulum calcium-adenosine
triphosphatase (SERCA2a) facilitates myocardial relaxation by increasing
calcium reuptake and is impaired in HFpEF. Objective(s): This study
sought to investigate the effects of istaroxime, a SERCA2 agonist, on
lusitropic and hemodynamic function during exercise in patients with HFpEF
and control subjects. Method(s): Eleven control subjects (7 male, 4
female) and 15 patients with HFpEF (8 male, 7 female) performed upright
cycle exercise with right-sided heart catheterization. Participants
received istaroxime (0.5 mug/kg/min) or saline placebo (single-blind,
crossover design). Cardiac output, pulmonary capillary wedge pressure
(PCWP), and diastolic function were measured at rest and during submaximal
exercise. In an exploratory analysis (Hedge's g), 7 patients with HFpEF
received higher-dose istaroxime (1.0 mug/kg/min). End-systolic elastance
(Ees) was calculated by dividing systolic blood pressure (SBP) x 0.9 by
end-systolic volume (ESV) (on 3-dimensional echocardiography).
 Result(s): Patients with HFpEF had higher PCWP (25 +/- 10 mm Hg vs 12
+/- 5 mm Hg; P < 0.001) and lower tissue Doppler velocities during
exercise. Istaroxime (0.5 mug/kg/min) had no effect on resting or exercise
measures in patients with HFpEF or control subjects. Control subjects had
a larger increase in Ees (DELTA 1.55 +/- 0.99 mm Hg/mL vs DELTA 0.86 +/-
1.31 mm Hg/mL; P = 0.03), driven by lower ESV. Comparing placebo and
istaroxime 1.0 mug/kg/min during exercise, PCWP during the 1.0 mug/kg/min
istaroxime dose was slightly lower (DELTA 2.2 mm Hg; Hedge's g = 0.30).
There were no effects on diastolic function, but there were increases in
SBP and s', suggesting a mild inotropic effect. Conclusion(s):
Low-dose istaroxime had no effect on cardiac filling pressure or
parameters of relaxation in patients with HFpEF during exercise. Higher
doses of istaroxime may have been more effective in reducing exercise PCWP
in patients with HFpEF. (Hemodynamic Response to Exercise in HFpEF
Patients After Upregulation of SERCA2a; NCT02772068) Copyright ©
2023 American College of Cardiology Foundation

<114>
Accession Number
2024912483
Title
Guideline-Directed Medical Therapy Tolerability in Patients With Heart
Failure and Mitral Regurgitation: The COAPT Trial.
Source
JACC: Heart Failure. 11(7) (pp 791-805), 2023. Date of Publication: July
2023.
Author
Cox Z.L.; Zalawadiya S.K.; Simonato M.; Redfors B.; Zhou Z.; Kotinkaduwa
L.; Zile M.R.; Udelson J.E.; Lim D.S.; Grayburn P.A.; Mack M.J.; Abraham
W.T.; Stone G.W.; Lindenfeld J.
Institution
(Cox) Lipscomb University College of Pharmacy, Nashville, TN, United
States
(Cox, Zalawadiya, Lindenfeld) Department of Cardiology, Vanderbilt
University Medical Center, Nashville, TN, United States
(Simonato, Redfors, Zhou, Kotinkaduwa) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Redfors) NewYork-Presbyterian Hospital/Columbia University Medical
Center, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Wallenberg Laboratory, Institute of Medicine, University of
Gothenburg, Gothenburg, Sweden
(Zile) Medical University of South Carolina, RJH Department of Veterans
Affairs Medical Center, Charleston, SC, United States
(Udelson) Division of Cardiology, Tufts University School of Medicine,
Boston, MA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Grayburn) Baylor Heart and Vascular Institute, Dallas, TX, United States
(Mack) Department of Cardiovascular Surgery, Baylor Scott and White
Health, Plano, TX, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: In the COAPT (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients With Functional
Mitral Regurgitation) trial, a central committee of heart failure (HF)
specialists optimized guideline-directed medical therapies (GDMT) and
documented medication and goal dose intolerances before patient
enrollment. Objective(s): The authors sought to assess the rates,
reasons, and predictors of GDMT intolerance in the COAPT trial.
 Method(s): Baseline use, dose, and intolerances of
angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor
blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs),
beta-blockers, and mineralocorticoid receptor antagonists (MRAs) were
analyzed in patients with left ventricular ejection fraction (LVEF) <=40%,
in whom maximally tolerated doses of these agents as assessed by an
independent HF specialist were required before enrollment. Result(s):
A total of 464 patients had LVEF <=40% and complete medication
information. At baseline, 38.8%, 39.4%, and 19.8% of patients tolerated 3,
2, and 1 GDMT classes, respectively (any dose); only 1.9% could not
tolerate any GDMT. Beta-blockers were the most frequently tolerated GDMT
(93.1%), followed by ACEIs/ARBs/ARNIs (68.5%), and then MRAs (55.0%).
Intolerances differed by GDMT class, but hypotension and kidney
dysfunction were most common. Goal doses were uncommonly achieved for
beta-blockers (32.3%) and ACEIs/ARBs/ARNIs (10.2%) due to intolerances
limiting titration. Only 2.2% of patients tolerated goal doses of all 3
GDMT classes. Conclusion(s): In a contemporary trial population with
HF, severe mitral regurgitation, and systematic HF specialist-directed
GDMT optimization, most patients had medical intolerances prohibiting 1 or
more GDMT classes and achieving goal doses. The specific intolerances
noted and methods used for GDMT optimization provide important lessons for
the implementation of GDMT optimization in future clinical trials.
(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT
Trial] [COAPT]; NCT01626079) Copyright © 2023 American College of
Cardiology Foundation

<115>
Accession Number
2024436115
Title
The impact of semi-upright position on severity of sleep disordered
breathing in patients with obstructive sleep apnea: a two-arm,
prospective, randomized controlled trial.
Source
BMC Anesthesiology. 23(1) (no pagination), 2023. Article Number: 236. Date
of Publication: December 2023.
Author
Lukachan G.A.; Yadollahi A.; Auckley D.; Gavrilovic B.; Matelski J.; Chung
F.; Singh M.
Institution
(Lukachan) Department of Anesthesia, Believers Church Medical College
Hospital, Kerala, Thiruvalla, India
(Yadollahi, Gavrilovic) KITE - Toronto Rehabilitation Institute,
University Health Network, University of Toronto, Toronto, ON, Canada
(Auckley) Division of Pulmonary, Critical Care and Sleep Medicine,
MetroHealth Medical Center, Case Western Reserve University, Cleveland,
OH, United States
(Matelski) Biostatistics Research Unit, University Health Network,
Toronto, ON, Canada
(Chung, Singh) Department of Anesthesia, Toronto Western Hospital,
University Health Network, University of Toronto, 399 Bathurst Street, McL
2-405, Toronto, ON M5T 2S8, Canada
Publisher
BioMed Central Ltd
Abstract
Background: The severity of sleep-disordered breathing is known to worsen
postoperatively and is associated with increased cardio-pulmonary
complications and increased resource implications. In the general
population, the semi-upright position has been used in the management of
OSA. We hypothesized that the use of a semi-upright position versus a
non-elevated position will reduce postoperative worsening of OSA in
patients undergoing non-cardiac surgeries. Method(s): This study was
conducted as a prospective randomized controlled trial of perioperative
patients, undergoing elective non-cardiac inpatient surgeries. Patients
underwent a preoperative sleep study using a portable polysomnography
device. Patients with OSA (apnea hypopnea index (AHI) > 5 events/hr),
underwent a sleep study on postoperative night 2 (N2) after being
randomized into an intervention group (Group I): semi-upright position (30
to 45 degrees incline), or a control group (Group C) (zero degrees from
horizontal). The primary outcome was postoperative AHI on N2. The
secondary outcomes were obstructive apnea index (OAI), central apnea index
(CAI), hypopnea index (HI), obstructive apnea hypopnea index (OAHI) and
oxygenation parameters. Result(s): Thirty-five patients were
included. Twenty-one patients were assigned to the Group 1 (females-14
(67%); mean age 65 +/- 12) while there were fourteen patients in the Group
C (females-5 (36%); mean age 63 +/- 10). The semi-upright position
resulted in a significant reduction in OAI in the intervention arm (Group
C vs Group I postop AHI: 16.6 +/- 19.0 vs 8.6 +/- 11.2 events/hr; overall
p = 0.01), but there were no significant differences in the overall AHI or
other parameters between the two groups. Subgroup analysis of patients
with "supine related OSA" revealed a decreasing trend in postoperative AHI
with semi-upright position, but the sample size was too small to evaluate
statistical significance. Conclusion(s): In patients with newly
diagnosed OSA, the semi-upright position resulted in improvement in
obstructive apneas, but not the overall AHI. Trial registration: This
trial was retrospectively registered in clinicaltrials.gov NCT02152202 on
02/06/2014. Copyright © 2023, The Author(s).

<116>
Accession Number
2024436113
Title
Analgesic effectiveness of serratus anterior plane block in patients
undergoing video-assisted thoracoscopic surgery: a systematic review and
updated meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 23(1) (no pagination), 2023. Article Number: 235. Date
of Publication: December 2023.
Author
Li J.; Wang X.; Wang Y.; Zhang W.
Institution
(Li, Wang, Wang, Zhang) Department of Anesthesiology, Yuncheng Central
Hospital, Shanxi Medical University, Shanxi Province, Yuncheng 044000,
China
Publisher
BioMed Central Ltd
Abstract
Background: Serratus anterior plane block (SAPB) is a promising regional
technique for analgesia in thoracic surgery. Till now, several randomized
controlled trials (RCTs) have explored the effectiveness of SAPB for
postoperative pain control in patients undergoing video-assisted
thoracoscopic surgery (VATS), but the sample sizes were small and
conclusions remained in controversy. Therefore, we conducted the present
systematic review and meta-analysis. Method(s): RCTs evaluating the
analgesic performance of SAPB, comparing to control methods (no block,
placebo or local infiltration anesthesia), in patients undergoing VATS
were searched in PubMed, EMBASE, Web of Science and Cochrane Library from
inception to December 31, 2022. Mean difference (MD) and corresponding 95%
confidence interval (95%CI) were calculated for postoperative pain scores
at various time points, postoperative opioid consumption and length of
hospital stay. Pooled relative risk (RR) with 95%CI were calculated for
the risk of postoperative nausea and vomiting (PONV) and dizziness. A
random-effect model was applied. Result(s): A total of 12 RCTs (837
participants) were finally included. Compared to control group, SAPB had
significant reductions of postoperative pain scores at 2 h (MD = -1.58,
95%CI: -1.86 to -1.31, P < 0.001), 6 h (MD = -2.06, 95%CI: -2.74 to -1.38,
P < 0.001), 12 h (MD = -1.72, 95%CI: -2.30 to -1.14, P < 0.001) and 24 h
(MD = -1.03, 95%CI: -1.55 to -0.52, P < 0.001), respectively. Moreover,
SAPB conferred a fewer postoperative opioid consumption (MD = -7.3 mg of
intravenous morphine equivalent, 95%CI: -10.16 to -4.44, P < 0.001) and
lower incidence of PONV (RR = 0.56, 95%CI: 0.41 to 0.77, P < 0.001). There
was no difference between both groups regarding length of hospital stay
and risk of dizziness. Conclusion(s): SAPB shows an excellent
performance in postoperative pain management in patients undergoing VATS
by reducing pains scores, postoperative opioid consumption and incidence
of PONV. However, due to huge heterogeneity, more well-designed,
large-scale RCTs are needed to verify these findings in the
future. Copyright © 2023, The Author(s).

<117>
Accession Number
2024436013
Title
Effects of penehyclidine hydrochloride combined with dexmedetomidine on
pulmonary function in patients undergoing heart valve surgery: a
double-blind, randomized trial.
Source
BMC Anesthesiology. 23(1) (no pagination), 2023. Article Number: 237. Date
of Publication: December 2023.
Author
He F.; Lu Y.; Mao Q.; Zhou L.; Chen Y.; Xie Y.
Institution
(He, Lu, Mao, Zhou, Chen, Xie) Department of Anesthesiology, The First
Affiliated Hospital of Guangxi Medical University, Nanning, China
(Xie) Guangxi Key Laboratory of Enhanced Recovery After Surgery for
Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical
University, Nanning, China
Publisher
BioMed Central Ltd
Abstract
Aim: To investigate the effects of penehyclidine hydrochloride combined
with dexmedetomidine on pulmonary function in patients undergoing heart
valve surgery with cardiopulmonary bypass (CPB). Method(s): A total
of 180 patients undergoing elective heart valve surgery with CPB were
randomly divided into four groups: 45 in group P (intravenous
penehyclidine hydrochloride 0.02 mg/kg 10 min before anesthesia induction
and at the beginning of CPB, total 0.04 mg/kg); 43 in group D
(dexmedetomidine 0.5 mug/kg/h after induction of anesthesia until the end
of anesthesia); 44 in group PD (penehyclidine hydrochloride 0.04 mg/kg
combined with dexmedetomidine 0.5 mug/kg/h intravenously during
anesthesia); and 43 in group C (same amount of normal saline 10 min before
and after anesthesia induction, to the end of anesthesia, and at the
beginning of CPB). The main outcomes were the incidence and severity of
postoperative pulmonary complications (PPCs). The secondary outcomes were:
(1) extubation time, length of stay in intensive care, and postoperative
hospital stay, and adverse events; and (2) pulmonary function evaluation
indices (oxygenation index and respiratory index) and plasma inflammatory
factor concentrations (tumor necrosis factor-alpha, interleukin-6,
C-reactive protein and procalcitonin) during the perioperative period.
 Result(s): The incidence of PPCs in groups P, D and PD after CPB was
lower than that in group C (P < 0.05), and the incidence in group PD was
significantly lower than that in groups P and D (P < 0.05). The scores for
PPCs in groups P, D and PD were lower than those in group C (P < 0.05).
 Conclusion(s): Combined use of penehyclidine hydrochloride and
dexmedetomidine during anesthesia reduced the occurrence of postoperative
pulmonary dysfunction, and improved the prognosis of patients undergoing
heart valve surgery with CPB. Trial registration: The trial was registered
in the Chinese Clinical Trial Registry on 3/11/2020 (Registration No.:
ChiCTR2000039610). Copyright © 2023, The Author(s).

<118>
Accession Number
2024277601
Title
Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac
Surgery: A Prospective, Randomized Controlled, Single-Center Clinical
Study.
Source
Drug Design, Development and Therapy. 17 (pp 1665-1677), 2023. Date of
Publication: 2023.
Author
Jin L.; Liang Y.; Yu Y.; Miao P.; Huang Y.; Xu L.; Wang H.; Wang C.; Huang
J.; Guo K.
Institution
(Jin, Yu, Miao, Huang, Xu, Wang, Guo) Department of Anesthesia, Zhongshan
Hospital, Fudan University, Shanghai, China
(Liang) Department of Anesthesiology, University of Texas Health Center at
Houston, Houston, TX, United States
(Wang) Department of Cardiac Surgery, Zhongshan Hospital, Fudan
University, Shanghai, China
(Huang) Department of Anesthesiology & Perioperative Medicine University
of Louisville, Louisville, KY, United States
Publisher
Dove Medical Press Ltd
Abstract
Objective: To investigate the feasibility of multimodal regimen by
paracetamol, gabapentin, ketamine, lidocaine, dexmedetomidine and
sufentanil among cardiac surgery patients, and compare the analgesia
efficacy with conventional sufentanil-based regimen. Design(s): A
single-center, prospective, randomized, controlled clinical trial.
 Setting(s): One participating center, the cardiovascular center of
the major integrated teaching hospital. Participant(s): A total of
115 patients were assessed for eligibility: 108 patients were randomized,
7 cases were excluded. Intervention(s): The control group (group T)
received conventional anesthesia management. Interventions in the
multimodal group (group M) were as follows in addition to the standard of
care: gabapentin and acetaminophen 1 hour before surgery; ketamine for
induction and to maintain anesthesia with lidocaine and dexmedetomide.
Ketamine, lidocaine, and dexmedetomidine were added to routine sedatives
postoperatively in group M. Measurements and Main Results: The
incidence of moderate-to-severe pain on coughing made no significant
difference (68.5% vs 64.8%, P=0.683). Group M had significantly less
sufentanil use (135.72microg vs 94.85microg, P=0.000) and lower rescue
analgesia rate (31.5% vs 57.4%, P=0.007). There was no significant
difference in the incidence of chronic pain, PONV, dizziness, inflammation
index, mechanical ventilation time, length of stay, and complications
between the two groups. Conclusion(s): Our multimodal regimen in
cardiac surgery is feasible, but was not superior to traditional
sufentanil-based regimen in the aspects of analgesia effects; however, it
did reduce perioperative opioid consumption along with rescue analgesia
rate. Moreover, it showed the same length of stay and the incidences of
postoperative complications. Copyright © 2023 Jin et al. This
work is published and licensed by Dove Medical Press Limited.

<119>
Accession Number
2025143269
Title
Effectiveness and quality of life in lung cancer, pre-, post- and
perioperative rehabilitation - A review.
Source
Physiology International. 110(2) (pp 89-107), 2023. Date of Publication:
June 2023.
Author
Abidi Y.; Fekete M.; Farkas A.; Horvath A.; Varga J.T.
Institution
(Abidi, Varga) Department of Pulmonology, Semmelweis University, Budapest
H-1083, Hungary
(Fekete) Department of Public Health, Faculty of Medicine, Semmelweis
University, Budapest, Hungary
(Farkas) Centre for Energy Research, Budapest H-1121, Hungary
(Horvath) Chiesi Hungary Kft., Budapest H-1138, Hungary
(Varga) Department of Pulmonary Rehabilitation, National Koranyi Institute
of Pulmonology, Budapest H-1122, Hungary
Publisher
Akademiai Kiado ZRt.
Abstract
Functional conditions like lung function and exercise capacity are
important limiting factors of chest surgery in lung cancer with
co-morbidities (chronic obstructive pulmonary disease (COPD) and other
chronic respiratory diseases). Pulmonary rehabilitation has a favourable
effect on the cardiovascular system, metabolism, respiratory and
peripheral muscles and lung mechanics. Our aim was to assess the role of
pre-, post- and peri-operative pulmonary rehabilitation in lung cancer in
this review. We sought to size up the importance of pulmonary
rehabilitation in patients undergoing surgery with or without
(neo)adjuvant treatment, radiotherapy, chemotherapy, chemoradiotherapy,
major physiological impairments and complications. Searches were performed
in PubMed and ClinicalTrials.gov databases using the terms "exercise",
"rehabilitation", "small cell lung cancer", "non-small cell lung cancer",
"exercise capacity", "chest surgery"and "quality of life"from inception to
February 7th, 2022. Pulmonary rehabilitation has been recognized as an
effective intervention to reduce lung cancer related symptoms and improve
the pulmonary function, lung mechanics, chest kinematics, respiratory- and
peripheral muscle function, physical activity and quality of life (QoL) of
the patients. In conclusion, this review shows positive, highly
encouraging and effective results of pulmonary rehabilitation in terms of
the patients' lung function, functional mobility and quality of life. The
tools for complex pulmonary rehabilitation have evolved considerably over
the past two decades, thus this research has been conducted on a variety
of studies about this subject and serves as a synthesis of the systematic
and meta-analytic reviews. Copyright © 2023 The Author(s).

<120>
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. 37(9) (pp 1726-1733),
2023. Date of Publication: September 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.
 Design(s): A single-center, randomized, double-blinded, controlled,
superiority study. Setting(s): At a University Children's Hospital.
 Participant(s): Fifty-two patients aged 2 to 10 years who underwent
open-heart surgery. Intervention(s): Patients were randomized to
receive either bilateral MTP block or no block (control).
 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).
 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. Copyright © 2023 Elsevier Inc.

<121>
Accession Number
2024683463
Title
A meta-analysis evaluating efficacy and safety of colchicine for
prevention of major cardiovascular events in patients with coronary artery
disease.
Source
Clinical Research in Cardiology. (no pagination), 2023. Date of
Publication: 2023.
Author
Chen T.; Liu G.; Yu B.
Institution
(Chen, Yu) Department of Cardiology, The First Affiliated Hospital of
China Medical University, Nanjing North Street No. 155, Heping District,
Shenyang 110001, China
(Liu) Department of Oncology, West China Hospital, Sichuan University,
Sichuan, Chengdu, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Inflammatory plays a key role in the development of coronary
artery disease (CAD). Colchicine as an anti-inflammatory treatment for CAD
has attracted much attention, its efficacy and safety are controversial
and deserved further exploration. Methods and Results: To evaluate
the efficacy and safety of colchicine for patients with CAD, relevant
randomized controlled trials (RCTs) were identified by searching several
databases including PubMed, Web of Science, and EMBASE from January 1992
to May 2022. Fourteen eligible trials of colchicine therapy include
populations with chronic coronary syndrome (CCS) (N = 2), acute coronary
syndrome (ACS) (N = 5), and percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) (N = 7), and involve a total of
13,235 patients which include 6654 subjects in colchicine group and 6581
subjects in the respective control arms. The outcome was reported as odds
ratio (OR) and 95% confidence interval (CI), as the relative measure of
association. Overall, the incidences of major adverse cardiovascular
events (MACEs) (OR 0.65; 95% CI 0.54-0.77, p < 0.01), new ACS (OR 0.68;
95% CI 0.57-0.81, p < 0.01), coronary revascularization (OR 0.65; 95% CI
0.53-0.78, p < 0.01), and stroke (OR 0.51; 95% CI 0.32-0.82, p < 0.01),
were lower in the colchicine group than in the placebo arm. We did not
find a significant reduction in the incidence of atrial fibrillation (OR
0.84; 95% CI 0.68-1.04, p = 0.11), all-cause mortality (OR 1.06; 95% CI
0.83-1.35, p = 0.83), cardiovascular mortality (OR 0.77; 95% CI 0.52-1.15,
p = 0.21). However, we found that colchicine did increase
non-cardiovascular mortality (OR 1.44; 95% CI 1.04-2.01, p = 0.03).
Although the incidence of gastrointestinal events in the colchicine
treatment group was higher than that in the placebo arms (OR 2.08; 95% CI
1.39-3.12, p < 0.01), the symptoms disappeared rapidly after drug
withdrawal and could be tolerated by most patients. Colchicine did not
increase the incidence of infections (OR 1.42; 95% CI 0.82-2.46, p =
0.22), pneumonia (OR 1.55; 95% CI 0.58-4.18, p = 0.39), cancers (OR 0.98;
95% CI 0.79-1.22, p = 0.88), bleeding (OR 1.14; 95% CI 0.41-3.14, p =
0.80). Conclusion(s): Colchicine is an effective, relatively safe
drug that could be considered for the treatment of CAD. However, we need
to pay attention to the increasing occurrence of non-cardiovascular
mortality and infection especially pneumonia possibly caused by
colchicine. Graphical abstract: Efficacy and safety of colchicine for
patients with CAD. CAD coronary artery disease; RCTs randomized controlled
trials; OR odds ratio; MACEs major adverse cardiovascular events; ACS
acute coronary syndrome; NNT number needed to treat; NNH number needed to
harm [Figure not available: see fulltext.]. Copyright © 2023, The
Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

<122>
Accession Number
2022485235
Title
Day surgery unit robotics thoracic surgery: feasibility and management.
Source
Journal of Cancer Research and Clinical Oncology. 149(10) (pp 7831-7836),
2023. Date of Publication: August 2023.
Author
Li X.; Liu Y.; Zhou Y.; Gao Y.; Duan C.; Zhang C.
Institution
(Li, Liu, Zhou, Gao, Duan, Zhang) Department of Thoracic Surgery,
XiangyaHospital, Central South University, Hunan, Changsha 410008, China
(Li, Liu, Zhou, Gao, Duan, Zhang) Hunan Engineering Research Center for
Pulmonary Nodules Precise Diagnosis & Treatment, Hunan, Changsha 410008,
China
(Li, Liu, Zhou, Gao, Duan, Zhang) National Clinical Research Center for
Geriatric Disorders, Hunan, Changsha 410008, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Day surgery has been widely carried out in medical developed
countries such as Europe and the United States with high efficiency,
safety and economy. The development of thoracic day surgery started late,
and currently only a few top three hospitals carry thoracic day surgery.
In recent years, with the continuous in-depth application of the concept
of accelerated rehabilitation surgery (ERAS) in the field of surgery,
thoracic surgery ERAS has also entered clinical practice with remarkable
results. At present, the application of day surgery in the field of
thoracic surgery is still in its infancy, and the application of
robot-assisted thoracic surgery in thoracic surgery has brought new
opportunities for the popularization of day surgery in thoracic surgery.
 Method(s): We retrospectively reviewed 86 patients underwent thoracic
day surgery under the application of robot-assisted surgery system and
through systematic randomization method choose 86 patients underwent
conventional thoracic surgery under the application of robot-assisted
surgery system at our Institute between 2020 and 2022. We analyzed the
clinical and pathological features between the two groups. Result(s):
The clinical feature of location of the nodules, the size of nodules, pN,
histology and postoperative complications were homogenous between the two
groups. The average age was significantly higher in the conventional mode
group, the ratio of male patients and the patients with history of smoking
were significantly lower in day-surgery mode group. The major surgical
method in conventional mode group was lobectomy resection (48.8%). While
the segmental resection was the major surgical in day surgery mode group.
The hospital stay and the time of drain was significant longer in
conventional mode group. And the total medical cost in conventional was
more than day-surgery mode group. While the histology and postoperative
complications were homogenous between the two groups. Conclusion(s):
Before this, day surgery and robotics assistant surgery in thoracic
surgery had been proved feasibility and safety. However, there was no
report of day surgery unit robotics assistant thoracic surgery. Our
clinical practice demonstrated that the method of day surgery unit
robotics thoracic surgery is feasibility and safety enough. Copyright
© 2023, The Author(s), under exclusive licence to Springer-Verlag
GmbH Germany, part of Springer Nature.

<123>
Accession Number
2026035692
Title
Outcomes and complications of nonagenarians undergoing cardiac surgery: A
scoping review protocol.
Source
BMJ Open. 13(7) (no pagination), 2023. Article Number: e072293. Date of
Publication: 18 Jul 2023.
Author
Ludski J.; Carp B.; Makar T.; Yii M.; Lee D.-K.; Weinberg L.
Institution
(Ludski, Carp, Makar, Weinberg) Department of Anesthesia, Austin Health,
Heidelberg, VIC, Australia
(Yii) Department of Cardiac Surgery, Epworth Eastern Hospital, Box Hill,
VIC, Australia
(Lee) Department of Anesthesiology and Pain Medicine, Dongguk University
Ilsan Hospital, Goyang, South Korea
(Weinberg) Department of Critical Care, University of Melbourne,
Parkville, VIC, Australia
Publisher
BMJ Publishing Group
Abstract
Introduction Continually rising life expectancy and a shift towards an
ageing population are resulting in an increasing population of
nonagenarians. By 2030, the global population of nonagenarians is expected
to exceed 30 million. The incidence of symptomatic cardiac disease is
reported to occur in 25% of those aged over 75 years. Therefore, the
number of nonagenarians undergoing cardiac surgery is also expected to
increase. A linear relationship between advanced age and surgical risk has
previously been demonstrated; however, it is not yet known whether this
knowledge extends to the perioperative course and mortality of
nonagenarians undergoing cardiac surgery. This scoping review aims to
review the literature, assess whether a deficiency exists in the published
literature and potentially identify knowledge gaps to guide future efforts
to improve the understanding of nonagenarians undergoing cardiac surgery.
Methods and analysis Following the relevant aspects of the Preferred
Reporting Items for Systematic Review and Meta-Analysis Extension for
Scoping Review guidelines, electronic databases of MEDLINE, EMBASE and the
Cochrane Library will be systematically searched, with additional
reference tracking of eligible studies. Studies reporting the outcomes of
nonagenarians undergoing open cardiac surgery or minimally invasive
cardiac surgery requiring cardiopulmonary bypass will be included.
Screening and data extraction will be performed by two reviewers
independently. The data will be analysed and summarised descriptively with
a narrative approach. Qualitative data that capture quality-of-life
outcomes will be subjected to thematic analysis where feasible.
Additionally, reporting results will highlight similarities and
differences in nonagenarian selection for surgery. Ethics and
dissemination Ethics approval was not required. The findings will be
disseminated through professional networks, conference presentations and
publications in scientific journals. Copyright © 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.

<124>
Accession Number
2026035669
Title
Effect of prehabilitation-related DIET ary protein intake on Q uality o f
R ecovery after elective cardiac surgery (DIETQoR) study: Protocol of a
randomised controlled trial.
Source
BMJ Open. 13(7) (no pagination), 2023. Article Number: e069528. Date of
Publication: 20 Jul 2023.
Author
Cheung H.H.T.; Yau D.K.W.; Chiu L.C.S.; Wong M.K.H.; Yeung S.S.Y.;
Underwood M.J.; Wong R.H.L.; Joynt G.M.; Lee A.
Institution
(Cheung, Yau, Chiu, Wong, Joynt, Lee) Anaesthesia and Intensive Care, The
Chinese University of Hong Kong, Hong Kong, Hong Kong
(Yeung) Medicine and Therapeutics, The Chinese University of Hong Kong,
Hong Kong, Hong Kong
(Underwood) Cardiovascular Services, Auckland City Hospital, Auckland, New
Zealand
(Wong) Division of Cardiothoracic Surgery, The Chinese University of Hong
Kong, Hong Kong, Hong Kong
Publisher
BMJ Publishing Group
Abstract
Introduction Protein malnutrition is associated with higher risks of
postoperative complications, mortality, prolonged postoperative stays in
hospital, slower physical and mental recovery after surgery and lower
subsequent health-related quality of life. To reduce the risk of
postoperative morbidity and mortality, nutritional prehabilitation
programmes have been developed recently to build up patient's nutritional
reserve to withstand the stress of surgery. The intervention involves
nutritional screening and counselling, and increasing dietary protein
intake in protein-malnourished patients in the several weeks before
surgery. However, there are few well-conducted preoperative studies to
examine the effect of increasing dietary protein intake on the quality of
recovery of malnourished patients after elective cardiac surgery. Method
and analysis This randomised controlled trial of malnourished patients
undergoing major elective cardiac surgery will compare the quality of
postoperative recovery in patients with or without nutritional
prehabilitation. One hundred and thirty-two patients will be randomised to
receive nutritional prehabilitation (target-adjusted whey protein powder
supplementation and an individualised 1 hour session/week counselling by a
dietician 1 month before operation date) or standard care (no nutritional
prehabilitation). Primary outcomes will be the quality of recovery after
surgery (15-item Quality of Recovery) on the third postoperative day.
Secondary outcomes will include days (alive and) at home within 30 days,
changes in the WHO Disability Assessment Schedule 2.0, changes in
health-related quality of life (EQ-5D) and Cardiac Postoperative Morbidity
Survey. An outcomes assessor will be blinded to the treatment allocation.
Appropriate univariate analyses, generalised estimating equations and
multiple regressions will be performed for intention-to-treat and
per-protocol analyses. Ethics and dissemination The Joint CUHK-NTEC
Clinical Research Ethics Committee approved the study protocol (CREC Ref.
No.: 2021.703 T). The findings will be presented at scientific meetings,
peer-reviewed journals and to study participants. Trial registration
number ChiCTR2200057463. Copyright © 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.

<125>
Accession Number
2025917561
Title
Stepwise provisional versus systematic culotte for stenting of true
coronary bifurcation lesions: five-year follow-up of the multicentre
randomised EBC TWO Trial.
Source
EuroIntervention. 19(4) (pp E297-E304), 2023. Date of Publication: July
2023.
Author
Arunothayaraj S.; Behan M.W.; Lefevre T.; Lassen J.F.; Chieffo A.;
Stankovic G.; Burzotta F.; Pan M.; Ferenc M.; Hovasse T.; Spence M.S.;
Brunel P.; Cotton J.M.; Cockburn J.; Carrie D.; Baumbach A.; Maeng M.;
Louvard Y.; Hildick-Smith D.
Institution
(Arunothayaraj, Cockburn, Hildick-Smith) Sussex Cardiac Centre, University
Hospitals Sussex NHS Trust, Brighton, United Kingdom
(Behan) Edinburgh Heart Centre, Edinburgh, United Kingdom
(Lefevre, Hovasse, Louvard) Institut Cardiovasculaire Paris Sud, Hopital
Prive Jacques Cartier, Ramsay Sante, Massy, France
(Lassen) Department of Cardiology B, Odense University Hospital, Odense,
Denmark
(Lassen) University of Southern Denmark, Odense, Denmark
(Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Stankovic) Department of Cardiology, University Clinical Centre of
Serbia, Belgrade, Serbia
(Stankovic) Faculty of Medicine, University of Belgrade, Belgrade, Serbia
(Burzotta) Fondazione Policlinico A. Gemelli IRCCS, Universita Cattolica
del Sacro Cuore, Rome, Italy
(Pan) Department of Cardiology, Reina Sofia Hospital, University of
Cordoba, (IMIBIC), Cordoba, Spain
(Ferenc) University Heart Center Freiburg - Bad Krozingen, Bad Krozingen,
Germany
(Spence) Department of Cardiology, Royal Victoria Hospital, Belfast,
United Kingdom
(Brunel) Hopital Prive Dijon Bourgogne, Clinique Valmy, Dijon, France
(Cotton) Royal Wolverhampton University Hospital NHS Trust, Wolverhampton,
United Kingdom
(Carrie) Department of Cardiology, Toulouse University, Rangueil Hospital,
Toulouse, France
(Baumbach) Centre for Cardiovascular Medicine and Devices, William Harvey
Research Institute, Queen Mary University of London, Barts Heart Centre,
London, United Kingdom
(Maeng) Department of Cardiology, Aarhus University Hospital, Aarhus
University, Aarhus, Denmark
Publisher
Europa Group
Abstract
Background: The multicentre European Bifurcation Club Trial (EBC TWO)
showed no significant differences in 12-month clinical outcomes between
patients randomised to a provisional stenting strategy or systematic
culotte stenting in non-left main true bifurcations. Aim(s): This
study aimed to investigate the 5-year clinical results of the EBC TWO
Trial. Method(s): A total of 200 patients undergoing stent
implantation for non-left main bifurcation lesions were recruited into EBC
TWO. Inclusion criteria required a side branch diameter >=2.5 mm and side
branch lesion length >5 mm. Five-year follow-up was completed for 197
patients. The primary endpoint was the composite of all-cause mortality,
myocardial infarction, or target vessel revascularisation. Result(s):
The mean side branch stent diameter was 2.7+/-0.3 mm and mean side branch
lesion length was 10.3+/-7.2 mm. At 5-year follow-up, the primary endpoint
occurred in 18.4% of provisional and 23.7% of systematic culotte patients
(hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.41-1.38). No
significant differences were identified individually for all-cause
mortality (7.8% vs 7.2%, HR 1.11, 95% CI: 0.40-3.05), myocardial
infarction (8.7% vs 13.4%, HR 0.64, 95% CI: 0.27-1.50) or target vessel
revascularisation (6.8% vs 9.3%, HR 1.12, 95% CI: 0.37-3.34). Stent
thrombosis rates were also similar (1.9% vs 3.1%, HR 0.63, 95% CI:
0.11-3.75). There was no significant interaction between the extent of
side branch disease and the primary outcome (p=0.34). Conclusion(s):
In large non-left main true bifurcation lesions, the use of a systematic
culotte strategy showed no benefit over provisional stenting for the
composite outcome of all-cause mortality, myocardial infarction, or target
vessel revascularisation at 5 years. The stepwise provisional approach may
be considered preferable for the majority of true coronary bifurcation
lesions. Copyright © Europa Digital & Publishing 2023. All rights
reserved.

<126>
Accession Number
2025007809
Title
Autologous platelet-rich plasma fibrin-glue reduces bleeding after
coronary artery bypass grafting, a randomized clinical study.
Source
Hippokratia. 26(4) (pp 143-146), 2022. Date of Publication: 2022.
Author
Abbasi T.M.; Emadi E.; Hamidi A.D.
Institution
(Abbasi) Department of Cardiac Surgery, Imam Reza Hospital, University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Emadi) Vascular and Endovascular Surgery Research Center, University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Hamidi) Surgical Oncology Research Center Mashhad, University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Lithografia Antoniadis I - Psarras Th G.P.
Abstract
Background: Excessive bleeding is common and can be life-threatening in
patients undergoing coronary artery bypass grafting (CABG) surgery.
Existing conventional methods for preventing bleeding are ineffective or
impractical; thus, additional strategies are required. This study used the
autologous platelet-rich plasma fibrin-glue (PRP-FG) as a topical
hemostatic and tissue regenerative agent to evaluate its preventive effect
in postoperative bleeding in off-pump CABG surgery anastomosis.
 Method(s): Patients undergoing elective off-pump CABG were randomly
allocated into control (16 males and ten fe-males) and case (19 males and
seven females) groups. In the control group, hemostasis was accomplished
exclusively using electrocautery and overcharging. In contrast, in the
case group, PRP-FG was applied in the place of distal and proximal
coronary graft anastomosis and sternotomy at the end of the operation and
after surgical homeostasis. Patients were closely monitored for 48 hours
in the intensive care unit (ICU), and the drainage volume was estimated
based on blood accumulation in the chest tube bottle. Mean hemoglobin,
platelet count, international normalized ratio (INR), time of surgery,
bleeding volume in the operating room, and bleeding (drainage) volume in
ICU after 48 hours were docu-mented for both case and control groups.
 Result(s): There were no meaningful differences between the two
groups regarding sex, age, mean hemoglobin, platelet count, INR, time of
surgery, and bleeding volume in the operating room. A significant decrease
in the postoperative bleeding volume was observed in ICU after 48 hours
for the case group compared to the control group. Conclusion(s):
Topical application of autologous PRP-FG significantly reduces
postoperative bleeding volume after CABG surgery without adding extra
risks to the patient. Copyright © 2022, Lithografia Antoniadis I
- Psarras Th G.P. All rights reserved.

<127>
[Use Link to view the full text]
Accession Number
2026037287
Title
Percutaneous Coronary Intervention Compared with Coronary Artery Bypass
Graft Surgery for Patients with 3-vessel Disease: A Preferred Reporting
Items for Systematic Reviews and Meta-Analyses-compliant Systematic Review
and Meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 76(5) (pp 527-532), 2020. Date of
Publication: 25 Nov 2020.
Author
Zhao H.; Zhang D.
Institution
(Zhao) The Affiliated Hospital of Shandong University of Traditional
Chinese Medicine, Shandong, China
(Zhang) Department of Cardiology, Nanjing First Hospital, Nanjing Medical
University, Nanjing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives:Previous investigations showed inconsistent results for
comparison in clinical outcomes between patients with 3-vessel disease
(3VD) treated with percutaneous coronary intervention (PCI) and coronary
artery bypass graft (CABG) surgery. A systematic review and meta-analysis
is essential to compare the clinical outcomes of PCI with CABG surgery for
patients with 3VD. Method(s):We systematically searched on PubMed and
Web of Science for articles which compared PCI with CABG for patients with
3VD and published from January 1989 to January 2020. We computed the
hazard ratios (HRs) and 95% confidence intervals (CIs) for individual
clinical outcomes. Result(s):This study indicated that the PCI group
was associated with a 1.51-fold higher risk of all-cause mortality
compared with the CABG group in patients with 3VD (HR 1.51, 95% CI
1.38-1.65). In addition, the PCI group showed a 3.08-fold and 2.94-fold
higher risk compared with the CABG group in risks of myocardial infarction
(MI) and target-vessel revascularization (TVR), respectively (MI: HR 3.08,
95% CI 2.61-3.63; TVR: HR 2.94, 95% CI 1.94-4.46). Conclusion(s):In
conclusion, in patients with 3VD, PCI was consistently associated with
higher rates of all-cause mortality, MI, and TVR, compared with
CABG. Copyright © Lippincott Williams & Wilkins.

<128>
Accession Number
2026080568
Title
Does dexmedetomidine reduce the risk of acute kidney injury after cardiac
surgery? A meta-analysis of randomized controlled trials.
Source
Brazilian Journal of Anesthesiology (English Edition). (no pagination),
2023. Date of Publication: 2023.
Author
Zhao C.; Liu S.; Zhang H.; Gao M.
Institution
(Zhao, Zhang, Gao) Capital Medical University, Beijing Shijitan Hospital,
Department of Intensive Care Unit, Beijing, China
(Liu) Capital Medical University, Beijing Chest Hospital, Beijing
Tuberculosis and Thoracic Tumor Research Institute, Department of
Pharmacy, Beijing, China
Publisher
Elsevier Editora Ltda
Abstract
Background: Acute Kidney Injury (AKI) is a common complication after
cardiac surgery and has been associated with poor outcomes.
Dexmedetomidine (DEX) has been shown to confer direct renoprotection based
on some animal and clinical studies, but data from other trials came to
the opposite conclusion following cardiac surgery. This meta-analysis was
conducted to evaluate the effects of perioperative DEX administration on
the occurrence of AKI and the outcomes after cardiac surgery.
 Method(s): We searched databases including EMBASE, PubMed, and
Cochrane CENTRAL for Randomized Controlled Trials (RCTs) focused on DEX
for AKI in adult patients after cardiac surgery. The primary outcome was
incidence of AKI. Secondary outcomes were Mechanical Ventilation (MV)
duration, Intensive Care Unit (ICU) Length Of Stay (LOS), hospital LOS and
mortality. Result(s): Fifteen trials enrolling 2907 study patients
were collected in the meta-analyses. Compared with controls, DEX reduced
the incidence of postoperative AKI (Odds Ratio [OR = 0.66]; 95% Confidence
Interval [95% CI 0.48-0.91]; p = 0.01), and there was no significant
difference between groups in postoperative mortality (OR = 0.63; 95% CI
0.32-1.26; p = 0.19), MV duration (Weighted Mean Difference [WMD = -0.44];
95% CI -1.50-0.63; p = 0.42), ICU LOS (WMD = -1.19; 95% CI -2.89-0.51; p =
0.17), and hospital LOS (WMD = -0.31; 95% CI -0.76-0.15; p = 0.19).
 Conclusion(s): Perioperative DEX reduced the incidence of
postoperative AKI in adult patients undergoing cardiac surgery. No
significant decrease existed in mortality, MV duration, ICU LOS and
hospital LOS owing to DEX administration. Copyright © 2023

<129>
Accession Number
641897516
Title
Confounding Adjustment in Observational Studies on Cardiothoracic
Interventions: A Systematic Review of Methodological Practice.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2023.
Date of Publication: 28 Jul 2023.
Author
Velders B.J.J.; Boltje J.W.T.; Vriesendorp M.D.; Klautz R.J.M.; Le Cessie
S.; Groenwold R.H.H.
Institution
(Velders, Vriesendorp, Klautz) Department of Cardiothoracic Surgery,
Leiden University Medical Center, Leiden, Netherlands
(Velders, Le Cessie, Groenwold) Department of Clinical Epidemiology,
Leiden University Medical Center, Leiden, Netherlands
(Boltje) Department of Cardiothoracic Surgery, Amsterdam University
Medical Center, Amsterdam, Netherlands
(Le Cessie, Groenwold) Department of Biomedical Data Science, Leiden
University Medical Center, Leiden, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: It is unknown which confounding adjustment methods are
currently used in the field of cardiothoracic surgery and whether these
are appropriately applied. The aim of this study was to systematically
evaluate the quality of conduct and reporting of confounding adjustment
methods in observational studies on cardiothoracic interventions.
 METHOD(S): A systematic review was performed which included all
observational studies that compared different interventions and were
published between January 1 and July 1, 2022, in three European and
American cardiothoracic surgery journals. Detailed information on
confounding adjustment methods was extracted and subsequently described.
 RESULT(S): Ninety-two articles were included in the analysis. Outcome
regression (N=49, 53%) and propensity score matching (N=44, 48%) were most
popular (sometimes used in combination), while 11 (12%) studies applied no
method at all. The way of selecting confounders was not reported in 42
(46%) of the studies, solely based on previous literature or clinical
knowledge in 14 (16%), and (partly) data-driven in 25 (27%). For the
studies that applied propensity score matching, the matched cohorts
comprised on average 46% of the entire study population (range 9% - 82%).
 CONCLUSION(S): Current reporting of confounding adjustment methods is
insufficient in a large part of observational studies on cardiothoracic
interventions, which makes quality judgement difficult. Appropriate
application of confounding adjustment methods is crucial for causal
inference on optimal treatment strategies for clinical practice. Reporting
on these methods is an important aspect of this, which can be
improved. Copyright © The Author(s) 2023. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<130>
Accession Number
641896866
Title
Pain management after cardiac surgery via median sternotomy: A systematic
review and procedure-specific postoperative pain management (PROSPECT)
recommendation.
Source
European journal of anaesthesiology. (no pagination), 2023. Date of
Publication: 20 Jul 2023.
Author
Maessen T.; Korir N.; Van de Velde M.; Kennes J.; Pogatzki-Zahn E.; Joshi
G.P.
Institution
(Maesen) From the Department of Anaesthesiology, Intensive Care, and Pain
Medicine, University Hospital Munster, Munster, Germany (TM, EP-Z), the
Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven
and University Hospital Leuven, Leuven, Belgium (NK, MVdeV, JK), the
Department of Anesthesiology and Pain Management, University of Texas
Southwestern Medical Centre, Dallas, Texas, USA (GPJ)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pain after cardiac surgery via median sternotomy can be
difficult to treat, and if inadequately managed can lead to respiratory
complications, prolonged hospital stays and chronic pain.
 OBJECTIVE(S): To evaluate available literature and develop
recommendations for optimal pain management after cardiac surgery via
median sternotomy. DESIGN: A systematic review using PROcedure-SPECific
Pain Management (PROSPECT) methodology. ELIGIBILITY CRITERIA: Randomised
controlled trials and systematic reviews published in the English language
until November 2020 assessing postoperative pain after cardiac surgery via
median sternotomy using analgesic, anaesthetic or surgical interventions.
DATA SOURCES: PubMed, Embase and Cochrane Databases. RESULT(S): Of
319 eligible studies, 209 randomised controlled trials and three
systematic reviews were included in the final analysis. Pre-operative,
intra-operative and postoperative interventions that reduced postoperative
pain included paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs),
intravenous magnesium, intravenous dexmedetomidine and parasternal
block/infiltration. CONCLUSION(S): The analgesic regimen for cardiac
surgery via sternotomy should include paracetamol and NSAIDs, unless
contraindicated, administered intra-operatively and continued
postoperatively. Intra-operative magnesium and dexmedetomidine infusions
may be considered as adjuncts particularly when basic analgesics are not
administered. It is not clear if combining dexmedetomidine and magnesium
would provide superior pain relief compared with either drug alone.
Parasternal block/surgical site infiltration is also recommended. However,
no basic analgesics were used in the studies assessing these
interventions. Opioids should be reserved for rescue analgesia. Other
interventions, including cyclo-oxygenase-2 specific inhibitors, are not
recommended because there was insufficient, inconsistent or no evidence to
support their use and/or due to safety concerns. Copyright © 2023
European Society of Anaesthesiology and Intensive Care. Unauthorized
reproduction of this article is prohibited.

<131>
Accession Number
641895206
Title
Efficacy of perioperative prophylactic administration of corticosteroids
in pediatric cardiac surgeries using cardiopulmonary bypass: A systematic
review with meta-analysis.
Source
Anaesthesia, critical care & pain medicine. (pp 101281), 2023. Date of
Publication: 25 Jul 2023.
Author
Takeshita J.; Nakajima Y.; Tachibana K.; Takeuchi M.; Shime N.
Institution
(Takeshita) Department of Anesthesiology, Osaka Prefectural Hospital
Organization, Osaka Women's and Children's Hospital, 840 Murodo-cho,
Izumi, Osaka 594-1101, Japan
(Nakajima) Department of Anesthesiology and Intensive Care, Kinki
University Faculty of Medicine, 3-4-1 Kowakae, Higashiosaka, Osaka
577-8502, Japan; Outcomes Research Consortium, 9500 Euclid Avenue, P77,
Cleveland, OH 44195, USA
(Tachibana) Department of Anesthesiology, Osaka Prefectural Hospital
Organization, Osaka Women's and Children's Hospital, 840 Murodo-cho,
Izumi, Osaka 594-1101, Japan
(Takeuchi) Department of Critical Care Medicine, National Cerebral and
Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan
(Shime) Department of Emergency and Critical Care Medicine, Graduate
School of Biomedical & Health Sciences, Hiroshima University, 1-3-2
Kagamiyama ,Higashihiroshima, Hiroshima 739-8511, Japan
Publisher
NLM (Medline)
Abstract
An updated systematic review with meta-analysis comparing perioperative
prophylactic administration of corticosteroids with placebo in pediatric
cardiac surgeries using cardiopulmonary bypass was conducted. The Cochrane
Central Register of Controlled Trials and MEDLINE (via PubMed) were
searched for relevant randomized controlled trials published between
January 1, 2000, and February 14, 2023. The primary outcome was
postoperative in-hospital mortality. Secondary outcomes were duration of
mechanical ventilation, length of intensive care unit and hospital stay,
postoperative low cardiac output syndrome, and adverse events. A total of
11 studies were included in the meta-analysis. Corticosteroid
administration did not decrease postoperative in-hospital mortality
compared with placebo (relative risk, 0.69; 95% confidence interval, 0.40
to 1.17). Subgroup analyses according to the type of corticosteroids and
neonates revealed that corticosteroids did not decrease postoperative
in-hospital mortality. In the trial sequential analysis, the last point in
the z-curve was within the futility borders. Although the duration of
mechanical ventilation (mean difference, -5.54hours; 95% confidence
interval (CI), -9.75 to -1.34) and incidence of low cardiac output
syndrome (relative risk, 0.75; 95% CI, 0.59 to 0.96) decreased with
corticosteroid administration, it did not affect the length of intensive
care unit (mean difference, -0.28 days; 95% CI, -0.74 to 0.17) and
hospital stay (mean difference, -0.59 days; 95% CI, -1.31 to 0.14). In
conclusion, perioperative prophylactic corticosteroid administration in
pediatric cardiac surgeries using cardiopulmonary bypass did not decrease
postoperative in-hospital mortality compared with placebo. According to
the trial sequential analysis results, additional randomized controlled
trials assessing mortality are not required. PROSPERO REGISTRY NUMBER: CRD
42023391789. Copyright © 2023. Published by Elsevier Masson SAS.

<132>
Accession Number
2026005041
Title
Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe
obesity: A randomized controlled trial.
Source
Metabolism: Clinical and Experimental. 147 (no pagination), 2023. Article
Number: 155655. Date of Publication: October 2023.
Author
Koschker A.-C.; Warrings B.; Morbach C.; Seyfried F.; Jung P.; Dischinger
U.; Edelmann F.; Herrmann M.J.; Stier C.; Frantz S.; Malzahn U.; Stork S.;
Fassnacht M.
Institution
(Koschker, Dischinger, Stier, Fassnacht) Dept. Internal Medicine I,
Division of Endocrinology and Diabetology, University Hospital, University
of Wurzburg, Wurzburg, Germany
(Koschker, Warrings, Morbach, Herrmann, Frantz, Stork, Fassnacht) Dept.
Clinical Research & Epidemiology, Comprehensive Heart Failure Center,
University Hospital, University of Wurzburg, Wurzburg, Germany
(Warrings, Herrmann) Dept. Psychiatry, Psychosomatics, and Psychotherapy,
Center for Mental Health, University Hospital, University of Wurzburg,
Wurzburg, Germany
(Morbach, Frantz, Stork) Dept. of Internal Medicine I, Division of
Cardiology, University Hospital, University of Wurzburg, Wurzburg, Germany
(Seyfried, Stier) Dept. General, Visceral, Transplant, Vascular, and
Pediatric Surgery, University Hospital, University of Wurzburg, Wurzburg,
Germany
(Jung) Dept. Internal Medicine I, Division of Pneumology, University
Hospital, University of Wurzburg, Wurzburg, Germany
(Edelmann) Dept. Internal Medicine and Cardiology, Campus Virchow
Klinikum, Charite University Medicine Berlin, Berlin, Germany
(Edelmann) German Centre for Cardiovascular research (DZHK), Partner Site
Berlin, Germany
(Malzahn) Center for Clinical Trials, University Hospital Wurzburg,
Wurzburg, Germany
Publisher
W.B. Saunders
Abstract
Objective: Randomized evidence comparing the cardiovascular effects of
surgical and conservative weight management is lacking. Patients &
methods: In this single-center, open-label randomized trial, obese
patients with indication for Roux-en-Y gastric bypass (RYGB) and able to
perform treadmill cardiopulmonary exercise testing (CPET) were included.
After a 6-12 month run-in phase of multimodal anti-obesity treatment,
patients were randomized to RYGB or psychotherapy-enhanced lifestyle
intervention (PELI) and co-primary endpoints were assessed 12 months
later. Thereafter, PELI patients could opt for surgery and patients were
reassessed 24 months after randomization. Co-primary endpoints were mean
change (95 % confidence intervals) in peak VO<inf>2</inf> (ml/min/kg body
weight) in CPET and the physical functioning scale (PFS) of the Short Form
health survey (SF-36). Result(s): Of 93 patients entering the study,
60 were randomized. Among these (median age 38 years; 88 % women; mean BMI
48.2 kg/m2), 46 (RYGB: 22 and PELI: 24) were evaluated after 12
months. Total weight loss was 34.3 % after RYGB vs. 1.2 % with PELI, while
peak VO<inf>2</inf> increased by +4.3 ml/min/kg (2.7, 5.9) vs +1.1
ml/min/kg (-0.2, 2.3); p < 0.0001. Respective improvement in PFS score was
+40 (30, 49) vs +10 (1, 15); p < 0.0001. 6-minute walking distance also
favored the RYGB group: +44 m (17, 72) vs +6 m (-14, 26); p < 0.0001. Left
ventricular mass decreased after RYGB, but not with PELI: -32 g (-46, -17)
vs 0 g (-13,13); p < 0.0001. In the non-randomized follow-up, 34 patients
were assessed. Favorable changes were sustained in the RYGB group and were
repeated in the 15 evaluated patients that opted for surgery after PELI.
 Conclusion(s): Among adults with severe obesity, RYGB in comparison
to PELI resulted in improved cardiopulmonary capacity and quality of life.
The observed effect sizes suggest that these changes are clinically
relevant. Copyright © 2023 The Authors

<133>
Accession Number
2025885855
Title
Impact of wearable device-based interventions with feedback for increasing
daily walking activity and physical capacities in cardiovascular patients:
A systematic review and meta-analysis of randomised controlled trials.
Source
BMJ Open. 13(7) (no pagination), 2023. Article Number: e069966. Date of
Publication: 11 Jul 2023.
Author
Heizmann A.-N.; Chapelle C.; Laporte S.; Roche F.; Hupin D.; Le Hello C.
Institution
(Heizmann, Chapelle, Laporte, Roche, Hupin, Le Hello) INSERM
U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne,
Saint-Etienne, France
(Chapelle, Laporte) Clinical Research Unit, Innovation, Pharmacology,
Saint-Etienne University Hospital, Saint-Etienne, France
(Laporte, Roche, Hupin, Le Hello) Campus Health and Innovation, Jean
Monnet University, Saint-Etienne, France
(Roche, Hupin) Department of Physiology, Saint-Etienne University
Hospital, Saint-Etienne, France
(Le Hello) Department of Vascular and Therapeutic Medicine, Saint-Etienne
University Hospital, Saint-Etienne, France
Publisher
BMJ Publishing Group
Abstract
Objective To systematically review randomised controlled trials (RCTs)
using a wearable physical activity monitoring device as an intervention to
increase daily walking activity and improve physical capacities in
patients with cardiovascular disease (CVD). Design Systematic review and
meta-analysis of RCTs. Data sources PubMed, Embase and Web of Science from
inception to June 2022. Eligibility criteria Randomised controlled studies
including patients with CVD over 18 years of age at the end of a cardiac
rehabilitation programme comparing an intervention group using a wearable
physical activity monitoring device with feedback with usual care or with
a control group receiving no feedback on their physical activity and
reporting a change in the daily number of steps and/or a change in the
distance covered in the 6-minute walk test (6-MWT) or a change in peak
oxygen uptake (VO2 peak) as endpoints. Results Sixteen RCTs were included.
The intervention of wearing a physical activity monitoring device with
feedback significantly improved daily number of steps compared with
controls (standardised mean difference (SMD) 0.85; 95% CI (0.42; 1.27);
p<0.01). The effect was greater when the duration of the intervention was
less than 3 months (SMD 1.0; 95% CI (0.18; 1.82); p<0.01) than when the
duration of the intervention was 3 months or longer (SMD 0.71; 95% CI
(0.27; 1.16); p<0.01), but no significant interaction was found between
subgroups (p=0.55). 6-MWT distance and VO2 peak showed only small effects
(SMD 0.34; 95% CI (-0.11; 0.80); p=0.02 and SMD 0.54; 95% CI (0.03; 1.03);
p=0.07, respectively). Conclusion The use of wearable physical activity
monitoring devices appears to help patients with CVD to increase their
daily walking activity and thus their physical activity, particularly in
the short term. PROSPERO registration number CRD42022300423. Copyright
© 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.

<134>
Accession Number
2025878274
Title
Serratus anterior plane block versus thoracic epidural block in patients
undergoing thoracotomy: a randomized double-blind trial.
Source
Anaesthesia, Pain and Intensive Care. 27(3) (pp 389-395), 2023. Date of
Publication: June 2023.
Author
Gamal R.M.; Bossily S.S.; Ali A.R.; Samy S.F.; Seif N.E.; Ahmed H.I.
Institution
(Gamal, Bossily, Samy) National Cancer Institute, Cairo University, Cairo,
Egypt
(Ali, Seif, Ahmed) Cairo University, Cairo, Egypt
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Background & Objective: Standard pain management technique after thoracic
surgery is thoracic epidural analgesia, parentral analgesics and nerve
blocks. Thoracic epidural analgesia (TEA) has many known complications,
including respiratory depression and urinary retention. Serratus anterior
plane block (SAPB) is a simple procedure, which provides postoperative
pain relief by blocking the lateral cutaneous branches of T2-T9 spinal
neurons. We compared the analgesic efficacy of both of these techniques in
thoracotomy patients in this randomized trial. Methodology: The study
involved 74 cancer patients scheduled for thoracotomy. The patients were
randomly divided into two groups. The patients in Group SAPB underwent
ultrasound-guided serratus anterior plan block (SAPB) with catheter
insertion. The second group (Group TEA) underwent TEA with preoperative
indwelling catheter insertion. In both groups blocks were activated before
induction of routine general anesthesia (GA) by a bupivacaine bolus dose,
then continued as bupivacaine infusion in ICU for postoperative analgesia.
Hemodynamic monitoring was started. Intraoperative fentanyl consumption,
postoperative morphine consumption, and time to first request for
analgesic were noted including MAP in the two groups. Result(s): Both
groups were statistically comparable regarding intraoperative fentanyl
consumption, postoperative morphine consumption, and time to first request
for analgesia in the two groups. Hypotensive episodes were significantly
more frequent (P < 0.001) in the TEA group (n = 17; 45.9%) compared to the
Group SAPB (n = 2; 5.4%). Ramsey sedation scores (RSS) were comparable in
the two groups immediately postoperatively and after 2 h. After 4 h after
recovery all patients in both groups had an RSS of 2. Conclusion(s):
Ultrasound-guided serratus anterior plane block is associated with reduced
intraoperative and postoperative fentanyl consumption, but the Ramsey
sedation scores were equivalent in the two groups after recovery and upto
4h. Copyright © 2023 Faculty of Anaesthesia, Pain and Intensive
Care, AFMS. All rights reserved.

<135>
Accession Number
2025863627
Title
Final 3-Year Outcomes of a Randomized Trial Comparing a Self-Expanding to
a Balloon-Expandable Transcatheter Aortic Valve.
Source
Circulation: Cardiovascular Interventions. 16(7) (pp E012873), 2023. Date
of Publication: 01 Jul 2023.
Author
Lanz J.; Mollmann H.; Kim W.-K.; Burgdorf C.; Linke A.; Redwood S.; Hilker
M.; Joner M.; Thiele H.; Conzelmann L.; Conradi L.; Kerber S.; Thilo C.;
Toggweiler S.; Prendergast B.; Husser O.; Stortecky S.; Deckarm S.; Kunzi
A.; Heg D.; Walther T.; Windecker S.; Pilgrim T.
Institution
(Lanz, Stortecky, Windecker, Pilgrim) Department of Cardiology,
Inselspital, Bern University Hospital, Switzerland
(Mollmann) Department of Internal Medicine I, St-Johannes-Hospital,
Dortmund, Germany
(Kim) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Burgdorf) Heart and Vascular Center, Bad Bevensen, Germany
(Linke) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Technische Universitat Dresden, Germany
(Redwood, Prendergast) Department of Cardiology, St Thomas' Hospital,
London, United Kingdom
(Hilker) Department of Cardiothoracic Surgery, University Medical Center,
Regensburg, Germany
(Joner) German Heart Centre, Technical University of Munich, Germany
(Thiele) Heart Center Leipzig, University of Leipzig, Germany
(Conzelmann) Department of Cardiac Surgery, Helios Klinik, Karlsruhe,
Germany
(Conradi) Department of Cardiovascular Surgery, University Heart and
Vascular Center, Hamburg, Germany
(Kerber) Department of Cardiology, Cardio-vascular Center Bad Neustadt,
Germany
(Thilo) Department of Internal Medicine I, RoMed Klinikum Rosenheim,
Germany
(Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Lucerne,
Switzerland
(Husser) Department of Cardiology and Intensive Care Medicine, Augustinum
Klinik Munich, Germany
(Deckarm, Kunzi, Heg) Clinical Trials Unit Bern, University of Bern,
Switzerland
(Walther) Department of Cardiac and Vascular Surgery, University Hospital
Frankfurt, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: In the SCOPE I trial (Safety and Efficacy of the Symetis
ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis),
transcatheter aortic valve implantation with the self-expanding ACURATE
neo (NEO) did not meet noninferiority compared with the balloon-expandable
SAPIEN 3 (S3) device regarding a composite end point at 30 days due to
higher rates of prosthetic valve regurgitation and acute kidney injury.
Data on long-term durability of NEO are scarce. Here, we report whether
early differences between NEO and S3 translate into differences in
clinical outcomes or bioprosthetic valve failure 3 years after
transcatheter aortic valve implantation. METHOD(S): Patients with
severe aortic stenosis were randomized to transfemoral transcatheter
aortic valve implantation with NEO or S3 at 20 European centers. Clinical
outcomes at 3 years are compared using Cox proportional or Fine-Gray
subdistribution hazard models by intention-to-treat. Bioprosthetic valve
failure is reported for the valve-implant cohort. RESULT(S): Among
739 patients, 84 of 372 patients (24.3%) had died in the NEO and 85 of 367
(25%) in the S3 group at 3 years. Comparing NEO with S3, the 3-year rates
of all-cause death (hazard ratio, 0.98 [95% CI, 0.73-1.33]), stroke
(subhazard ratio, 1.04 [95% CI, 0.56-1.92]), and hospitalization for
congestive heart failure (subhazard ratio, 0.74 [95% CI, 0.51-1.07]) were
similar between the groups. Aortic valve reinterventions were required in
4 NEO and 3 S3 patients (subhazard ratio, 1.32 [95% CI, 0.30-5.85]). New
York Heart Association functional class <=II was observed in 84% (NEO) and
85% (S3), respectively. Mean gradients remained lower after NEO at 3 years
(8 versus 12 mm Hg; P<0.001). CONCLUSION(S): Early differences
between NEO and S3 did not translate into significant differences in
clinical outcomes or bioprosthetic valve failure throughout 3 years.
REGISTRATION: URL: https://clinicaltrials.gov, Unique identifier:
NCT03011346. Copyright © 2023 Lippincott Williams and Wilkins.
All rights reserved.

<136>
Accession Number
2025823450
Title
Multimodal prehabilitation for major surgery in elderly patients to lower
complications: protocol of a randomised, prospective, multicentre,
multidisciplinary trial (PREHABIL Trial).
Source
BMJ Open. 13(1) (no pagination), 2023. Article Number: e070253. Date of
Publication: 03 Jan 2023.
Author
Beilstein C.M.; Krutkyte G.; Vetsch T.; Eser P.; Wilhelm M.; Stanga Z.;
Bally L.; Verra M.; Huber M.; Wuethrich P.Y.; Engel D.
Institution
(Beilstein, Krutkyte, Vetsch, Huber, Wuethrich, Engel) Department of
Anaesthesiology and Pain Medicine, Inselspital University Hospital,
University of Bern, Bern, Switzerland
(Krutkyte, Stanga) Division of Diabetes, Endocrinology, Nutritional
Medicine and Metabolism, Inselspital University Hospital Bern, University
of Bern, Bern, Switzerland
(Vetsch, Eser, Wilhelm) Medical Division Rehabilitation & Sports Medicine,
Inselspital University Hospital, University of Bern, Bern, Switzerland
(Bally) Department of Diabetes, Endocrinology, Clinical Nutrition and
Metabolism, Inselspital University Hospital, Bern, Switzerland
(Verra) Institute of Physiotherapy, Inselspital University Hospital,
University of Bern, Bern, Switzerland
Publisher
BMJ Publishing Group
Abstract
Introduction The global volume of surgery is growing and the population
ageing, and economic pressure is rising. Major surgery is associated with
relevant morbidity and mortality. Postoperative reduction in physiological
and functional capacity is especially marked in the elderly, multimorbid
patient with low fitness level, sarcopenia and malnutrition. Interventions
aiming to optimise the patient prior to surgery (prehabilitation) may
reduce postoperative complications and consequently reduce health costs.
Methods and analysis This is a multicentre, multidisciplinary,
prospective, 2-arm parallel-group, randomised, controlled trial with
blinded outcome assessment. Primary outcome is the Comprehensive
Complications Index at 30 days. Within 3 years, we aim to include 2x233
patients with a proven fitness deficit undergoing major surgery to be
randomised using a computer-generated random numbers and a minimisation
technique. The study intervention consists of a structured, multimodal,
multidisciplinary prehabilitation programme over 2-4 weeks addressing
deficits in physical fitness and nutrition, diabetes control, correction
of anaemia and smoking cessation versus standard of care. Ethics and
dissemination The PREHABIL trial has been approved by the responsible
ethics committee (Kantonale Ethikkomission Bern, project ID 2020-01690).
All participants provide written informed consent prior to participation.
Participant recruitment began in February 2022 (10 and 8 patients analysed
at time of submission), with anticipated completion in 2025. Publication
of the results in peer-reviewed scientific journals are expected in late
2025. Trial registration number NCT04461301. Copyright ©
Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY.
Published by BMJ.

<137>
Accession Number
2025698490
Title
Multicentre, randomised, double-blind, parallel controlled trial to
investigate timing of platelet inhibition after coronary artery bypass
grafting: TOP-CABG trial study.
Source
BMJ Open. 13(6) (no pagination), 2023. Article Number: e070823. Date of
Publication: 29 Jun 2023.
Author
Yuan X.; Chu Q.; Chen K.; Wang Y.; Zhang L.; Zheng Y.; Hu S.
Institution
(Yuan, Chu, Chen, Hu) State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing, China
(Yuan, Chu, Chen, Hu) Department of Cardiac Surgery, Fuwai Hospital,
Chinese Academy of Medical Science, Peking Union Medical College, Beijing,
China
(Wang, Zhang) National Clinical Research Centre of Cardiovascular
Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Centre for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Zheng) Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical
Science, Peking Union Medical College, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Dual antiplatelet therapy (DAPT), referred to as the
combination of aspirin and P2Y 12 receptor antagonist (clopidogrel or
ticagrelor), potentially improves patency of saphenous vein grafts (SVG)
after coronary artery bypass grafting (CABG), while it is further proposed
that DAPT potentially increases bleeding risk. Compared with DAPT,
de-escalated DAPT (De-DAPT) is an effective antiplatelet strategy for
acute coronary syndrome treatment, which significantly reduces the risk of
bleeding without increasing the incidence of major adverse cardiovascular
events. However, insufficient evidence is available to determine the
timing of DAPT after CABG. Methods and analysisEthics and dissemination
The Ethics Committee in Fuwai hospital approved this study (2022-1774).
Fifteen centres agreed to participate the TOP-CABG trial, and the study
has been approved in these 15 centres by whose ethics committee. The
results of the trial will be submitted for publication in a peer-reviewed
journal. Trial registration number NCT05380063. Copyright ©
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.

<138>
Accession Number
2025683570
Title
The clinical and angiographic impact of intravascular ultrasound guided
stenting of unprotected left main and proximal left anterior descending
coronary artery. A prospective randomized controlled study in Egypt.
Source
Cor et Vasa. 65(3) (pp 468-476), 2023. Date of Publication: 2023.
Author
Hanboly N.H.; Kamel Baghdady Y.M.; Mostafa M.M.; Fahmy Hashad A.A.; Sadek
Y.A.
Institution
(Hanboly, Kamel Baghdady, Mostafa, Fahmy Hashad) Cardiovascular
Department, Faculty of Medicine, Cairo University, Cairo, Egypt
(Sadek) Cardiovascular Department, Faculty of Medicine, Helwan University,
Egypt
Publisher
Czech Society of Cardiology Z.S
Abstract
Background: Coronary angiography has some limitations in the proper
assessment of coronary artery lesions. Intravascular ultrasound (IVUS)
before percutaneous coronary intervention (PCI) can identify significant
stenosis, select the appropriate stent and detect complications. The study
aimed to evaluate the impact of intravascular ultrasound on clinical and
angiographic outcomes after revascularization by stenting for patients
with unprotected left main (ULM) or proximal left anterior descending
(LAD) coronary artery disease (CAD). Material(s) and Method(s): A
prospective randomized controlled study that was carried on sixty patients
presented with stable angina or non-ST elevation acute coronary syndrome.
Coronary angiography that was carried out at cardiac catheterization
laboratory at the National Heart Institute in Egypt revealed significant
left main or proximal LAD coronary artery disease. Patients were scheduled
for revascularization by PCI. Percutaneous coronary intervention guided by
coronary IVUS was done in thirty patients (Group A). Whereas, Group B
included 30 patients in which PCI was not guided by IVUS. The patients
were followed for six months to detect any primary or secondary endpoints.
 Result(s): IVUS guidance was associated with a significant higher
post-stent minimal lumen diameter as found by quantitative coronary
angiography (QCA) (p = 0.001), stent diameter (p = 0.001), and adjunct
post-dilatation (p = 0.02). By comparing both study groups it was found
that IVUS guidance was associated with significant lower rates of stent
thrombosis in target lesions, non-fatal myocardial infarction related to
target lesions, target lesion revascularization and all cause major
adverse cardiac events (MACE) within 6 months of follow-up (p-value 0.038,
for all). Conclusion(s): IVUS guided PCI during ULM and proximal LAD
coronary artery stenting improves clinical outcome with significant lower
rates of MACE at 6 months which is due to significant lower risk of target
lesion revascularization and stent thrombosis. We recommended routine use
of IVUS during revascularization by stenting in cases of ULM or proximal
LAD CAD. Copyright © 2023 Czech Society of Cardiology Z.S. All
rights reserved.

<139>
Accession Number
2025468102
Title
Identifying a list of healthcare 'never events' to effect system change: a
systematic review and narrative synthesis.
Source
BMJ Open Quality. 12(2) (no pagination), 2023. Article Number: e002264.
Date of Publication: 26 Jun 2023.
Author
Bowman C.L.; De Gorter R.; Zaslow J.; Fortier J.H.; Garber G.
Institution
(Bowman, De Gorter, Zaslow, Fortier, Garber) Safe Medical Care Research,
Canadian Medical Protective Association, Ottawa, ON, Canada
(Garber) Department of Medicine, School of Epidemiology and Public Health,
University of Ottawa, Ottawa, ON, Canada
(Garber) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Garber) Department of Medicine, University of Toronto, Toronto, ON,
Canada
Publisher
BMJ Publishing Group
Abstract
Background Never events (NEs) are patient safety incidents that are
preventable and so serious they should never happen. To reduce NEs,
several frameworks have been introduced over the past two decades;
however, NEs and their harms continue to occur. These frameworks have
varying events, terminology and preventability, which hinders
collaboration. This systematic review aims to identify the most serious
and preventable events for targeted improvement efforts by answering the
following questions: Which patient safety events are most frequently
classified as never events? Which ones are most commonly described as
entirely preventable? Methods For this narrative synthesis systematic
review we searched Medline, Embase, PsycINFO, Cochrane Central and CINAHL
for articles published from 1 January 2001 to 27 October 2021. We included
papers of any study design or article type (excluding press
releases/announcements) that listed NEs or an existing NE framework.
Results Our analyses included 367 reports identifying 125 unique NEs.
Those most frequently reported were surgery on the wrong body part, wrong
surgical procedure, unintentionally retained foreign objects and surgery
on the wrong patient. Researchers classified 19.4% of NEs as 'wholly
preventable'. Those most included in this category were surgery on the
wrong body part or patient, wrong surgical procedure, improper
administration of a potassium-containing solution and wrong-route
administration of medication (excluding chemotherapy). Conclusions To
improve collaboration and facilitate learning from errors, we need a
single list that focuses on the most preventable and serious NEs. Our
review shows that surgery on the wrong body part or patient, or the wrong
surgical procedure best meet these criteria. Copyright ©
Author(s) (or their employer(s)) 2023.

<140>
Accession Number
2025086520
Title
The efficacy of PCSK9 inhibitors on major cardiovascular events and lipid
profile in patients with diabetes: a systematic review and meta-analysis
of randomized controlled trials.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 9(4) (pp
318-327), 2023. Date of Publication: 01 Jun 2023.
Author
Imbalzano E.; Ilardi F.; Orlando L.; Pintaudi B.; Savarese G.; Rosano G.
Institution
(Imbalzano, Orlando) Department of Clinical and Experimental Medicine,
University of Messina, Via Consolare Valeria, Ndegree1, Messina 98125,
Italy
(Ilardi) Department of Advanced Biomedical Sciences, Federico II
University Hospital, Via S. Pansini, 5, NA, Napoli 80131, Italy
(Pintaudi) Diabetes Unit, Niguarda Ca Granda Hospital, Milan, Italy
(Savarese) Department of Medicine, Division of Cardiology, Heart and
Vascular Theme, Karolinska Institute, Stockholm, Sweden
(Rosano) Department of Cardiology, IRCCS San Raffaele Roma, Rome, Italy
Publisher
Oxford University Press
Abstract
Objective To evaluate the specific effects of PCSK9 inhibitors (i.e.
alirocumab and evolocumab) on major cardiovascular events (MACE) and lipid
profile in patients with diabetes. Methods and results We conducted a
systematic review of literature according to the PRISMA statement. A total
of eight randomized control trials (RCTs) enrolling 20 651 patients with
diabetes were included. The mean follow-up was 51 weeks. We included RCTs
that had compared the subtilisin-kexin type 9 inhibitors (PCSK9i)
alirocumab and evolocumab with placebo in subjects with
hypercholesterolaemia and diabetes mellitus. MACE occurred in 8.7% of
patients with diabetes randomized to PCSK9i vs. 11.0% of those randomized
to placebo. Thus, the use of alirocumab or evolocumab reduced MACE by 18%
[odds ratio (OR): 0.82; 95% confidence interval (CI): 0.74-0.90]. Compared
with control group, the use of PCSK9 inhibitors was associated with a
significant percentage change from baseline in low-density lipoprotein
cholesterol [mean difference (MD) -58.48%; 95% CI: -63.73 to -53.22%, P <
0.0001], high-density lipoprotein cholesterol (HDL-C) (MD 5.21%; 95% CI:
3.26-7.17%), triglycerides (MD -14.59%; 95% CI: -19.42 to -9.76%),
non-HDL-C (MD -48.84%; 95% CI: -54.54 to -43.14%), and total cholesterol
(MD -33.76%; 95% CI: -38.71 to -28.8%). Moreover, a significant reduction
of lipoprotein(a) (MD -32.90%; 95% CI: -38.55 to -27.24%) and
apolipoprotein B (MD -46.83%; 95% CI: -52.71 to -40.94%) were observed in
PCSK9i group compared with placebo. Conclusion PCSK9i appear to be
effective in reducing the risk of MACE and in improving lipid profiles of
subjects with diabetes and dyslipidaemia. Copyright © The
Author(s) 2023. Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved.

<141>
Accession Number
2025064626
Title
Post-procedural structural heart CT imaging: TAVR, TMVR, and other
interventions.
Source
Clinical Imaging. 101 (pp 86-95), 2023. Date of Publication: September
2023.
Author
Haramati A.; Latib A.; Lazarus M.S.
Institution
(Haramati) Department of Radiology, New York-Presbyterian/Weill Cornell
Medicine, 525 East 68th Street, New York, NY 10065, United
States
(Latib) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, 111 East 210th Street, Bronx, NY 10467,
United States
(Lazarus) Department of Radiology, Montefiore Medical Center, Albert
Einstein College of Medicine, 111 East 210th Street, Bronx, NY
10467, United States
Publisher
Elsevier Inc.
Abstract
Transcatheter valve replacement has experienced substantial growth in the
past decade and this technique can now be used for any of the four heart
valves. Transcatheter aortic valve replacement (TAVR) has overtaken
surgical aortic valve replacement. Transcatheter mitral valve replacement
(TMVR) is often performed in pre-existing valves or after prior valve
repair, although numerous devices are undergoing trials for replacement of
native valves. Transcatheter tricuspid valve replacement (TTVR) is
similarly under active development. Lastly, transcatheter pulmonic valve
replacement (TPVR) is most often used for revision treatment of congenital
heart disease. Given the growth of these techniques, radiologists are
increasingly called upon to interpret post-procedural imaging for these
patients, particularly with CT. These cases will often arise unexpectedly
and require detailed knowledge of potential post-procedural appearances.
We review both normal and abnormal post-procedural findings on CT. Certain
complications-device migration or embolization, paravalvular leak, or
leaflet thrombosis-can occur after replacement of any valve. Other
complications are specific to each type of valve, including coronary
artery occlusion after TAVR, coronary artery compression after TPVR, or
left ventricular outflow tract obstruction after TMVR. Finally, we review
access-related complications, which are of particular concern due to the
requirement of large-bore catheters for these procedures. Copyright
© 2023 Elsevier Inc.

<142>
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. Copyright © 2023 The
Author(s)

<143>
Accession Number
2024989446
Title
Cognitive-behavioural therapy reduces psychological distress in younger
patients with cardiac disease: a randomized trial.
Source
European Heart Journal. 44(11) (pp 986-996), 2023. Date of Publication: 14
Mar 2023.
Author
Holdgaard A.; Eckhardt-Hansen C.; Lassen C.F.; Kjesbu I.E.; Dall C.H.;
Michaelsen K.L.; Sibilitz K.L.; Prescott E.; Rasmusen H.K.
Institution
(Holdgaard, Kjesbu, Dall, Michaelsen, Prescott, Rasmusen) Department of
Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23,
Copenhagen 2400, Denmark
(Eckhardt-Hansen, Lassen) Department of Social Medicine, Bispebjerg
Frederiksberg Hospitals, University of Copenhagen, Denmark
(Sibilitz) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Aims To test whether usual outpatient cardiac rehabilitation (CR)
supplemented by a cognitive-behavioural therapy (CBT) intervention may
reduce anxiety and depression compared with usual CR. Methods In this
multicentre randomized controlled trial, 147 cardiac patients (67% men,
mean age 54 years, 92% with coronary artery and results disease) with
psychological distress defined as a hospital anxiety and depression scale
(HADS) anxiety or depression score >=8 were randomized to five sessions of
group CBT plus usual CR (intervention, n = 74) or CR alone (control, n =
73). Patients with severe distress or a psychiatric diagnosis were
excluded. The intervention was delivered by cardiac nurses with CBT
training and supervised by a psychologist. A reference, non-randomized
group (background, n = 41) of consecutive patients without psychological
distress receiving usual CR was included to explore the effect of time on
HADS score. The primary outcome, total HADS score after 3 months, improved
more in the intervention than in the control group [the mean total HADS
score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation
7.8), P < 0.001]. Significant between-group differences were maintained
after 6 months. Compared with the control group, the intervention group
also had greater adherence to CR (P = 0.003), more improvement in the
heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a
significant reduction in cardiac readmissions at 12 months (P < 0.01). The
background group had no significant change in HADS score over time.
Conclusion Brief CBT provided by cardiac nurses in relation to CR reduced
anxiety and depression scores, improved HeartQoL and adherence to CR, and
reduced cardiovascular readmissions. The programme is simple and may be
implemented by CR nurses. Copyright © The Author(s) 2023.
Published by Oxford University Press on behalf of the European Society of
Cardiology. All rights reserved.

<144>
Accession Number
2024989441
Title
Moderate-intensity statin with ezetimibe vs. high-intensity statin in
patients with diabetes and atherosclerotic cardiovascular disease in the
RACING trial.
Source
European Heart Journal. 44(11) (pp 972-983), 2023. Date of Publication: 14
Mar 2023.
Author
Lee Y.-J.; Cho J.Y.; You S.C.; Lee Y.-H.; Yun K.H.; Cho Y.-H.; Shin W.-Y.;
Im S.W.; Kang W.C.; Park Y.; Lee S.Y.; Lee S.-J.; Hong S.-J.; Ahn C.-M.;
Kim B.-K.; Ko Y.-G.; Choi D.; Hong M.-K.; Jang Y.; Kim J.-S.
Institution
(Lee, Lee, Lee, Hong, Ahn, Kim, Ko, Choi, Hong, Kim) Division of
Cardiology, Severance Hospital, Yonsei University College of Medicine,
Yonsei-ro 50-1, Seoul 03722, South Korea
(Cho, Yun) Department of Cardiovascular Medicine, Wonkwang University
Hospital, Muwang-ro 895, Iksan 54538, South Korea
(You) Department of Biomedical Systems Informatics, Yonsei University
College of Medicine, Yonsei-ro 50-1, Seoul 03722, South Korea
(Cho) Department of Cardiology, Hanyang University College of Medicine,
Hwasu-ro 14 beon-gil 55, Goyang 10475, South Korea
(Shin) Department of Cardiology, Soonchunhyang University Cheonan
Hospital, Suncheonhyang 6-gil 31, Cheonan 31151, South Korea
(Im, Jang) Department of Cardiology, CHA University College of Medicine,
Yatap-ro 59, Seongnam 13496, South Korea
(Kang) Department of Cardiology, Gachon University College of Medicine,
Namdong-daero 774 beon-gil 21, Incheon 21565, South Korea
(Park) Department of Cardiology, Gyeongsang National University Changwon
Hospital, Samjeongja-ro 11, Changwon 51472, South Korea
(Lee) Department of Cardiology, Inje University Ilsan Paik Hospital,
Juhwa-ro 170, Ilsan 10380, South Korea
Publisher
Oxford University Press
Abstract
Aims This study evaluated the effect of moderate-intensity statin with
ezetimibe combination therapy vs. high-intensity statin monotherapy among
patients with diabetes mellitus (DM) and atherosclerotic cardiovascular
disease (ASCVD). Methods and results This was a pre-specified, stratified
subgroup analysis of the DM cohort in the RACING trial. The primary
outcome was a 3-year composite of cardiovascular death, major
cardiovascular events, or non-fatal stroke. Among total patients, 1398
(37.0%) had DM at baseline. The incidence of the primary outcome was 10.0%
and 11.3% among patients with DM randomized to ezetimibe combination
therapy vs. high-intensity statin monotherapy (hazard ratio: 0.89; 95%
confidence interval: 0.64-1.22; P = 0.460). Intolerance-related
discontinuation or dose reduction of the study drug was observed in 5.2%
and 8.7% of patients in each group, respectively (P = 0.014). LDL
cholesterol levels <70 mg/dL at 1, 2, and 3 years were observed in 81.0%,
83.1%, and 79.9% of patients in the ezetimibe combination therapy group,
and 64.1%, 70.2%, and 66.8% of patients in the high-intensity statin
monotherapy group (all P < 0.001). In the total population, no significant
interactions were found between DM status and therapy regarding primary
outcome, intolerance-related discontinuation or dose reduction, and the
proportion of patients with LDL cholesterol levels <70 mg/dL. Conclusion
Ezetimibe combination therapy effects observed in the RACING trial
population are preserved among patients with DM. This study supports
moderate-intensity statin with ezetimibe combination therapy as a suitable
alternative to high-intensity statins if the latter cannot be tolerated,
or further reduction in LDL cholesterol is required among patients with DM
and ASCVD. Copyright © The Author(s) 2022. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved.

<145>
Accession Number
2024989440
Title
Dual antiplatelet therapy duration after percutaneous coronary
intervention in high bleeding risk: a meta-analysis of randomized trials.
Source
European Heart Journal. 44(11) (pp 954-968), 2023. Date of Publication: 14
Mar 2023.
Author
Costa F.; Montalto C.; Branca M.; Hong S.-J.; Watanabe H.; Franzone A.;
Vranckx P.; Hahn J.-Y.; Gwon H.-C.; Feres F.; Jang Y.; De Luca G.; Kedhi
E.; Cao D.; Steg P.G.; Bhatt D.L.; Stone G.W.; Micari A.; Windecker S.;
Kimura T.; Hong M.-K.; Mehran R.; Valgimigli M.
Institution
(Costa, Micari) Department of Biomedical and Dental Sciences and
Morphological and Functional Imaging, University of Messina, A.O.U.
Policlinic 'G. Martino', Messina 98100, Italy
(Montalto) De Gasperis Cardio Center, Interventional Cardiology Unit,
Niguarda Hospital, Milan, Italy
(Branca) CTU Bern, University of Bern, Bern, Switzerland
(Hong, Hong) Severance Cardiovascular Hospital, Yonsei University Health
System, Seoul, South Korea
(Watanabe, Kimura) Department of Cardiology, Hirakata Kohsai Hospital,
Hirakata, Japan
(Franzone) Department of Advanced Biomedical Sciences, Federico II
University Hospital, Naples 80131, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences,
University of Hasselt, Hasselt, Belgium
(Hahn, Gwon) Heart Vascular Stroke Institute, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Feres) Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Jang) Department of Cardiology, CHA Bundang Medical Center, Seongnam,
South Korea
(De Luca) Clinical and Experimental Cardiology Unit, AOU Sassari, Italy
(Kedhi) Clinique Hopitaliere Erasme, Universite Libre de Bruxelles,
Brussels, Belgium
(Cao) Cardio Center, Humanitas Research Hospital IRCCS, Milan, Italy
(Steg) Universite Paris-Cite, FACT, INSERM_U1148 and AP-HP, Hopital
Bichat, Paris, France
(Bhatt) Brigham and Women's Hospital Heart, Vascular Center, Harvard
Medical School, Boston, MA, United States
(Stone, Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Mount
Sinai Hospital, New York, NY, United States
(Windecker) Department of Cardiology, Inselspital, Bern University
Hospital, Bern, Switzerland
(Valgimigli) Cardiocentro Ticino Institute, Universita della Svizzera
Italiana (USI), Lugano, Switzerland
Publisher
Oxford University Press
Abstract
Aims The optimal duration of dual antiplatelet therapy (DAPT) after
percutaneous coronary intervention (PCI) in patients at high bleeding risk
(HBR) is still debated. The current study, using the totality of existing
evidence, evaluated the impact of an abbreviated DAPT regimen in HBR
patients. Methods and results A systematic review and meta-analysis was
performed to search randomized clinical trials comparing abbreviated [i.e.
very-short (1 month) or short (3 months)] with standard (>=6 months) DAPT
in HBR patients without indication for oral anticoagulation. A total of 11
trials, including 9006 HBR patients, were included. Abbreviated DAPT
reduced major or clinically relevant non-major bleeding [risk ratio (RR):
0.76, 95% confidence interval (CI): 0.61-0.94; I2 = 28%], major
bleeding (RR: 0.80, 95% CI: 0.64-0.99, I2 = 0%), and
cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I2 = 0%)
compared with standard DAPT. No difference in all-cause mortality, major
adverse cardiovascular events, myocardial infarction, or stent thrombosis
was observed. Results were consistent, irrespective of HBR definition and
clinical presentation. Conclusion In HBR patients undergoing PCI, a 1- or
3-month abbreviated DAPT regimen was associated with lower bleeding and
cardiovascular mortality, without increasing ischaemic events, compared
with a >=6-month DAPT regimen. Copyright © The Author(s) 2022.
Published by Oxford University Press on behalf of the European Society of
Cardiology. All rights reserved.

<146>
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. Copyright © 2023 Elsevier Inc.

<147>
Accession Number
2024383473
Title
Incidence of delirium after non-cardiac surgery in the Chinese elderly
population: a systematic review and meta-analysis.
Source
Frontiers in Aging Neuroscience. 15 (no pagination), 2023. Article Number:
1188967. Date of Publication: 2023.
Author
Gong X.-Y.; Hou D.-J.; Yang J.; He J.-L.; Cai M.-J.; Wang W.; Lu X.-Y.;
Gao J.
Institution
(Gong, Yang, He, Cai, Wang, Lu, Gao) School of Nursing, Chengdu University
of Traditional Chinese Medicine, Sichuan, Chengdu, China
(Hou) School of Medicine and Life Sciences, Chengdu University of
Traditional Chinese Medicine, Sichuan, Chengdu, China
Publisher
Frontiers Media SA
Abstract
Background: POD places a heavy burden on the healthcare system as the
number of elderly people undergoing surgery is increasing annually because
of the aging population. As a large country with a severely aging
population, China's elderly population has reached 267 million. There has
been no summary analysis of the pooled incidence of POD in the elderly
Chinese population. Method(s): Systematic search databases included
PubMed, Web of Science, EMBASE, Cochrane Library Databases, China
Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database
(CBM), WanFang Database, and Chinese Science and Technology Periodicals
(VIP). The retrieval time ranged from the database's establishment to
February 8, 2023. The pooled incidence of delirium after non-cardiac
surgery was calculated using a random effects model. Meta-regression,
subgroup, and sensitivity analyses were used to explore the source of
heterogeneity. Result(s): A total of 52 studies met the inclusion
criteria, involving 18,410 participants. The pooled incidence of delirium
after non-cardiac surgery in the elderly Chinese population was 18.6% (95%
CI: 16.4-20.8%). The meta-regression results revealed anesthesia method
and year of publication as a source of heterogeneity. In the subgroup
analysis, the gender subgroup revealed a POD incidence of 19.6% (95% CI:
16.9-22.3%) in males and 18.3% (95% CI: 15.7-20.9%) in females. The year
of publication subgroup analysis revealed a POD incidence of 20.3% (95%
CI: 17.4-23.3%) after 2018 and 14.6 (95% CI: 11.6-17.6%) in 2018 and
before. In the subgroup of surgical types, the incidence of hip fracture
surgery POD was 20.7% (95% CI: 17.6-24.3%), the incidence of non-cardiac
surgery POD was 18.4% (95% CI: 11.8-25.1%), the incidence of orthopedic
surgery POD was 16.6% (95% CI: 11.8-21.5%), the incidence of abdominal
neoplasms surgery POD was 14.3% (95% CI: 7.6-21.1%); the incidence of
abdominal surgery POD was 13.9% (95% CI: 6.4-21.4%). The anesthesia
methods subgroup revealed a POD incidence of 21.5% (95% CI: 17.9-25.1%)
for general anesthesia, 15.0% (95% CI: 10.6-19.3%) for intraspinal
anesthesia, and 8.3% (95% CI: 10.6-19.3%) for regional anesthesia. The
measurement tool subgroup revealed a POD incidence of 19.3% (95% CI:
16.7-21.9%) with CAM and 16.8% (95% CI: 12.6-21.0%) with DSM. The sample
size subgroup revealed a POD incidence of 19.4% (95% CI: 16.8-22.1%) for
patients <= 500 and 15.3% (95% CI: 11.0-19.7%) for patients > 500. The
sensitivity analysis suggested that the pooled incidence of postoperative
delirium in this study was stable. Conclusion(s): Our systematic
review of the incidence of delirium after non-cardiac surgery in elderly
Chinese patients revealed a high incidence of postoperative delirium.
Except for cardiac surgery, the incidence of postoperative delirium was
higher for hip fracture surgery than for other types of surgery. However,
this finding must be further explored in future large-sample studies.
Systematic review registration: https://www.crd.york.ac.uk/prospero/,
identifier: PROSPERO CRD42023397883. Copyright © 2023 Gong, Hou,
Yang, He, Cai, Wang, Lu and Gao.

<148>
Accession Number
2023560021
Title
Erratum to: Propofol and survival: an updated meta-analysis of randomized
clinical trials (Critical Care, (2023), 27, 1, (139),
10.1186/s13054-023-04431-8).
Source
Critical Care. 27(1) (no pagination), 2023. Article Number: 208. Date of
Publication: December 2023.
Author
Hansel J.
Institution
(Hansel) University of Manchester, Manchester, United Kingdom
Publisher
BioMed Central Ltd

<149>
Accession Number
2022651685
Title
Computed tomography-derived membranous septum length as predictor of
conduction abnormalities and permanent pacemaker implantation after TAVI:
A meta-analysis of observational studies.
Source
Catheterization and Cardiovascular Interventions. 101(7) (pp 1203-1213),
2023. Date of Publication: 01 Jun 2023.
Author
Michel Pompeu S.a.; Van den Eynde J.; Jacquemyn X.; Erten O.; Rodriguez
R.; Goldman S.; Coady P.M.; Gnall E.; Gray W.A.; Jarrett H.; Abramson
S.V.; Clavel M.-A.; Pibarot P.; Ramlawi B.
Institution
(Michel Pompeu, Rodriguez, Goldman, Ramlawi) Department of Cardiothoracic
Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line
Health, Wynnewood, PA, United States
(Michel Pompeu, Erten, Ramlawi) Department of Cardiothoracic Surgery
Research, Lankenau Institute for Medical Research, Wynnewood, PA, United
States
(Van den Eynde, Jacquemyn) Department of Cardiovascular Sciences, KU
Leuven, Leuven, Belgium
(Coady, Gnall, Gray) Department of Interventional Cardiology, Lankenau
Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, PA,
United States
(Jarrett, Abramson) Department of Cardiovascular Imaging, Lankenau Medical
Center, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, United
States
(Clavel, Pibarot) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
(Clavel, Pibarot) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, QC, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Permanent pacemaker implantation (PPI) after transcatheter
aortic valve implantation (TAVI) is associated with higher risk of
mortality and rehospitalization for heart failure. Efforts to prevent
conduction abnormalities (CA) requiring PPI after TAVI should be made. The
membranous septum (MS) length and its interaction with implantation depth
(ID-DELTAMSID) could provide useful information about the risk of CA/PPI
following TAVI. Objective(s): To identify MS length and DELTAMSID as
predictors of CA/PPI following TAVI. Method(s): Study-level
meta-analysis of studies published by September 30, 2022. Result(s):
Eighteen studies met our eligibility including 5740 patients. Shorter MS
length was associated with a significantly higher risk of CA/PPI (per 1 mm
decrease: odds ratio [OR] 1.60, 95% confidence interval [CI] 1.28-1.99, p
< 0.001). Similarly, lower DELTAMSID was associated with a significantly
higher risk of CA/PPI (per 1 mm decrease: OR 1.75, 95% CI 1.32-2.31, p <
0.001). Meta-regression analyses revealed a statistically significant
modulation of the effect of shorter MS length and lower DELTAMSID on the
outcome (CA/PPI) by balloon postdilatation (positive regression
coefficients with p < 0.001); with increasing use of balloon
postdilatation, the effect of shorter MS length and lower DELTAMSID on the
outcome increased. MS length and DELTAMSID demonstrated excellent
discriminative abilities, with diagnostic ORs equaling 9.49 (95% CI
4.73-19.06), and 7.19 (95% CI 3.31-15.60), respectively.
 Conclusion(s): Considering that short MS length and low DELTAMSID are
associated with higher risk of CA and PPI, we should include measurement
of MS length in the pre-TAVI planning with MDCT and try to establish
optimal ID values before the procedure to avoid CA/PPI. Copyright
© 2023 Wiley Periodicals LLC.

<150>
Accession Number
2021667369
Title
Effectiveness of a structured pharmacist-delivered intervention for
patients post-acute coronary syndromes on all-cause hospitalizations and
cardiac-related hospital readmissions: a prospective quasi-experimental
study.
Source
International Journal of Clinical Pharmacy. 45(3) (pp 630-640), 2023. Date
of Publication: June 2023.
Author
El Hajj M.S.; Kaddoura R.; Abu Yousef S.E.A.; Orabi B.; Awaisu A.; AlYafei
S.; Shami R.; Mahfoud Z.R.
Institution
(El Hajj, Awaisu) Department of Clinical Pharmacy and Practice, College of
Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
(Kaddoura, Abu Yousef, Orabi, AlYafei) Heart Hospital, Hamad Medical
Corporation, Doha 3050, Qatar
(Shami) College of Health Sciences, QU Health, Qatar University, Doha
2713, Qatar
(Shami) World Innovation Summit for Health (WISH), Qatar Foundation, Doha
5825, Qatar
(Mahfoud) Weill Cornell Medicine-Qatar, P.O. Box 24144, Doha, Qatar
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Acute coronary syndrome (ACS) is a leading cause of mortality
and morbidity in Qatar and globally. Aim(s): The primary objective of
the study was to evaluate the effectiveness of a structured clinical
pharmacist-delivered intervention on all-cause hospitalizations and
cardiac-related readmissions in patients with ACS. Method(s): A
prospective quasi-experimental study was conducted at Heart Hospital in
Qatar. Discharged ACS patients were allocated to one of three study arms:
(1) an intervention group (received a structured clinical
pharmacist-delivered medication reconciliation and counselling at
discharge, and two follow-up sessions at 4 weeks and 8 weeks
post-discharge), (2) a usual care group (received the general usual care
at discharge by clinical pharmacists) or, (3) a control group (discharged
during weekends or after clinical pharmacists' working hours). Follow-up
sessions for the intervention group were designed to re-educate and
counsel patients about their medications, remind them about the importance
of medication adherence, and answer any questions they may have. At the
hospital, patients were allocated into one of the three groups based on
intrinsic and natural allocation procedures. Recruitment of patients took
place between March 2016 and December 2017. Data were analyzed based on
intention-to-treat principles. Result(s): Three hundred seventy-three
patients were enrolled in the study (intervention = 111, usual care = 120,
control = 142). Unadjusted results showed that the odds of 6-month
all-cause hospitalizations were significantly higher among the usual care
(OR 2.034; 95% CI: 1.103-3.748, p = 0.023) and the control arms (OR 2.704;
95% CI: 1.456-5.022, p = 0.002) when compared to the intervention arm.
Similarly, patients in the usual care arm (OR 2.304; 95% CI: 1.122-4.730,
p = 0.023) and the control arm (OR 3.678; 95% CI: 1.802-7.506, p <= 0.001)
had greater likelihood of cardiac-related readmissions at 6 months. After
adjustment, these reductions were only significant for cardiac-related
readmissions between control and intervention groups (OR 2.428; 95% CI:
1.116-5.282, p = 0.025). Conclusion(s): This study demonstrated the
impact of a structured intervention by clinical pharmacists on
cardiac-related readmissions at 6 months post-discharge in patients
post-ACS. The impact of the intervention on all-cause hospitalization was
not significant after adjustment for potential confounders. Large
cost-effective studies are required to determine the sustained impact of
structured clinical pharmacist-provided interventions in ACS setting.
Trial registration: Clinical Trials: NCT02648243 Registration date:
January 7, 2016. Copyright © 2023, The Author(s).

<151>
Accession Number
2020664012
Title
Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and
Meta-Analysis.
Source
Seminars in Thrombosis and Hemostasis. 49(5) (pp 542-552), 2023. Date of
Publication: 12 Jun 2023.
Author
Jakobsen C.; Larsen J.B.; Fuglsang J.; Hvas A.-M.
Institution
(Jakobsen, Larsen) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Aarhus C, Denmark
(Larsen, Fuglsang) Department of Clinical Medicine, Aarhus University,
Aarhus C, Denmark
(Fuglsang) Department of Obstetrics and Gynecology, Aarhus University
Hospital, Aarhus C, Denmark
(Hvas) Faculty of Health, Aarhus University, Aarhus C, Denmark
Publisher
Thieme Medical Publishers, Inc.
Abstract
Anticoagulant therapy is essential in pregnant women with mechanical heart
valves to prevent valve thrombosis. The risk of bleeding complications in
these patients has not gained much attention. This systematic review and
meta-analysis investigate the prevalence of bleeding peri-partum and
post-partum in women with mechanical heart valves and also investigate
whether bleeding risk differed across anticoagulant regimens or according
to delivery mode. The present study was conducted according to The
Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA) statement. Studies reporting bleeding prevalence in pregnant
women with mechanical heart valves receiving anticoagulant therapy were
identified through PubMed and Embase on December 08, 2021. Data on
bleeding complications, delivery mode, and anticoagulation therapy were
extracted. A total of 37 studies were included, reporting 423 bleeding
complications in 2,508 pregnancies. A meta-analysis calculated a pooled
prevalence of 0.13 (95% confidence interval [CI]: 0.09-0.18) bleeding
episodes per pregnancy across anticoagulant regimens. The combination of
unfractionated heparin (UFH) and vitamin K antagonist (VKA) and single VKA
therapy showed the lowest risk of bleeding (8 and 12%). Unexpectedly, the
highest risk of bleeding was found in women receiving a combination of
low-molecular-weight-heparin (LMWH) and VKA (33%) or mono-therapy with
LMWH (22%). However, this could be dose related. No difference in bleeding
was found between caesarean section versus vaginal delivery (p = 0.08). In
conclusion, bleeding episodes are common during pregnancy in women with
mechanical heart valves receiving anticoagulant therapy. A combination of
UFH and VKA or VKA monotherapy showed the lowest risk of
bleeding. Copyright © 2022. Thieme. All rights reserved.

<152>
Accession Number
2025288974
Title
Practice Changing Updates in Perioperative Medicine Literature 2022. A
Systematic Review.
Source
American Journal of Medicine. 136(8) (pp 753-762.e1), 2023. Date of
Publication: August 2023.
Author
Khambaty M.; Devalapalli A.P.; Silbert R.E.; Kashiwagi D.T.; Regan D.W.;
Sundsted K.K.; Mauck K.F.
Institution
(Khambaty, Devalapalli, Kashiwagi, Regan, Sundsted) Division of Hospital
Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN,
United States
(Silbert, Mauck) Division of General Internal Medicine, Department of
Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN,
United States
(Kashiwagi) Department of Internal Medicine, Sheikh Shakhbout Medical City
in partnership with Mayo Clinic, Abu Dhabi, United Arab Emirates
Publisher
Elsevier Inc.
Abstract
Perioperative medicine is a rapidly growing multidisciplinary field with
significant advances published each year. In this review, we highlight
important perioperative publications in 2022. A multi-database literature
search from January to December of 2022 was undertaken. Original research
articles, systematic reviews, meta-analyses, and guidelines were included.
Abstracts, case reports, letters, protocols, pediatric and obstetric
articles, and cardiac surgery literature were excluded. Two authors
reviewed each reference using the Distiller SR systematic review software
(Evidence Partners Inc., Ottawa, Ont, Canada). A modified Delphi technique
was used to identify 8 practice-changing articles. We identified another
10 articles for tabular summaries. We highlight why these articles have
the potential to change clinical perioperative practice and areas where
more information is needed. Copyright © 2023 Elsevier Inc.

<153>
Accession Number
2024699923
Title
Association Between Postoperative Delirium and Long-Term Subjective
Cognitive Decline in Older Patients Undergoing Cardiac Surgery: A
Secondary Analysis of the Minimizing Intensive Care Unit Neurological
Dysfunction with Dexmedetomidine-Induced Sleep Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(9) (pp 1700-1706),
2023. Date of Publication: September 2023.
Author
Namirembe G.E.; Baker S.; Albanese M.; Mueller A.; Qu J.Z.; Mekonnen J.;
Wiredu K.; Westover M.B.; Houle T.T.; Akeju O.
Institution
(Namirembe, Baker, Albanese, Mueller, Qu, Mekonnen, Wiredu, Houle, Akeju)
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Westover) Department of Neurology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
Objectives: This study aimed to evaluate whether a measure of subjective
cognitive decline (SCD), the Patient-Reported Outcomes Measurement
Information System (PROMIS) Applied Cognition-Abilities questionnaire, was
associated with postoperative delirium. It was hypothesized that delirium
during the surgical hospitalization would be associated with a decrease in
subjective cognition up to 6 months after cardiac surgery. Design(s):
This was a secondary analysis of data from the Minimizing Intensive Care
Unit Neurological Dysfunction with Dexmedetomidine-induced Sleep
randomized, placebo-controlled, parallel-arm superiority trial.
 Setting(s): Data from patients recruited between March 2017 and
February 2022 at a tertiary medical center in Boston, Massachusetts were
analyzed in February 2023. Participant(s): Data from 337 patients
aged 60 years or older who underwent cardiac surgery with cardiopulmonary
bypass were included. Intervention(s): Patients were assessed
preoperatively and postoperatively at 30, 90, and 180 days using the
subjective PROMIS Applied Cognition-Abilities and telephonic Montreal
Cognitive Assessment. Measurement and Main Results: Postoperative delirium
occurred within 3 days in 39 participants (11.6%). After adjusting for
baseline function, participants who developed postoperative delirium
self-reported worse cognitive function (mean difference [MD] -2.64 [95% CI
-5.25, -0.04]; p = 0.047) up to 180 days after surgery, as compared with
nondelirious patients. This finding was consistent with those obtained
from objective t-MoCA assessments (MD -0.77 [95% CI -1.49, -0.04]; p =
0.04). Conclusion(s): In this cohort of older patients undergoing
cardiac surgery, in-hospital delirium was associated with SCD up to 180
days after surgery. This finding suggested that measures of SCD may enable
population-level insights into the burden of cognitive decline associated
with postoperative delirium. Copyright © 2023 Elsevier Inc.

<154>
Accession Number
2024498397
Title
The First Dedicated Comprehensive Heart Failure Program in the United
States: The Division of Circulatory Physiology at Columbia Presbyterian
(1992-2004).
Source
Journal of Cardiac Failure. 29(7) (pp 1078-1090), 2023. Date of
Publication: July 2023.
Author
PACKER M.
Institution
(PACKER) From the Baylor Heart and Vascular Institute, Baylor University
Medical Center, Dallas, Texas, and Imperial College, London, United
Kingdom
Publisher
Elsevier B.V.
Abstract
The first dedicated multidisciplinary heart failure program in the United
States was founded as the Division of Circulatory Physiology at the
Columbia University College of Physicians & Surgeons in 1992. The Division
was administratively and financially independent of the Division of
Cardiology and grew to 24 faculty members at its peak. Its administrative
innovations included (1) a comprehensive full-integrated service line,
with 2 differentiated clinical teams, one devoted to drug therapy and the
other to heart transplantation and ventricular assist devices; (2) a nurse
specialist/physician assistant-led clinical service; and (3) a financial
structure independent of (and not supported by) other cardiovascular
medical or surgical services. The division had 3 overarching missions: (1)
to promote a unique career development path for each faculty member to be
linked to recognition in a specific area of heart failure expertise; (2)
to change the trajectory and enhance the richness of intellectual
discourse in the discipline of heart failure, so as to foster an
understanding of fundamental mechanisms and to develop new therapeutics;
and (3) to provide optimal medical care to patients and to promote the
ability of other physicians to provide optimal care. The major research
achievements of the division included (1) the development of beta-blockers
for heart failure, from initial hemodynamic assessments to
proof-of-concept studies to large-scale international trials; (2) the
development and definitive assessment of flosequinan, amlodipine, and
endothelin antagonists; (3) initial clinical trials and concerns with
nesiritide; (4) large-scale trials evaluating dosing of angiotensin
converting-enzyme inhibitors and the efficacy and safety of neprilysin
inhibition; (5) identification of key mechanisms in heart failure,
including neurohormonal activation, microcirculatory endothelial
dysfunction, deficiencies in peripheral vasodilator pathways, noncardiac
factors in driving dyspnea, and the first identification of subphenotypes
of heart failure and a preserved ejection fraction; (6) the development of
a volumetric approach to the assessment of myocardial shortening; (7)
conceptualization and early studies of cardiac contractility modulation as
a treatment for heart failure; (8) novel approaches to the identification
of cardiac allograft rejection and new therapeutics to prevent allograft
vasculopathy; and (9) demonstration of the effect of left ventricular
assist devices to induce reverse remodeling, and the first randomized
trial showing a survival benefit with ventricular assist devices. Above
all, the division served as an exceptional incubator for a generation of
leaders in the field of heart failure. Copyright © 2023 The
Author(s)

<155>
Accession Number
2016427814
Title
A systematic review of the evidence supporting post-operative
antithrombotic use following cardiopulmonary bypass in children with CHD.
Source
Cardiology in the Young. 32(1) (pp 10-20), 2022. Date of Publication: 01
Jan 2022.
Author
Thompson E.J.; Foote H.P.; Li J.S.; Rotta A.T.; Goldenberg N.A.; Hornik
C.P.
Institution
(Thompson, Foote, Li, Rotta, Hornik) Department of Pediatrics, Duke
University School of Medicine, Durham, NC, United States
(Li, Hornik) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
(Goldenberg) Department of Pediatrics and Medicine, Division of
Hematology, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Goldenberg) Institute for Clinical and Translational Research, Cancer and
Blood Disorders Institute, Heart Institute, Johns Hopkins All Children's
Hospital, St. Petersburg, FL, United States
Publisher
Cambridge University Press
Abstract
Objectives: To determine the optimal antithrombotic agent choice, timing
of initiation, dosing and duration of therapy for paediatric patients
undergoing cardiac surgery with cardiopulmonary bypass. Method(s): We
used PubMed and EMBASE to systematically review the existing literature of
clinical trials involving antithrombotics following cardiac surgery from
2000 to 2020 in children 0-18 years. Studies were assessed by two
reviewers to ensure they met eligibility criteria. Result(s): We
identified 10 studies in 1929 children across three medications classes:
vitamin K antagonists, cyclooxygenase inhibitors and indirect thrombin
inhibitors. Four studies were retrospective, five were prospective
observational cohorts (one of which used historical controls) and one was
a prospective, randomised, placebo-controlled, double-blind trial. All
included were single-centre studies. Eight studies used surrogate
biomarkers and two used clinical endpoints as the primary endpoint. There
was substantive variability in response to antithrombotics in the
immediate post-operative period. Studies of warfarin and aspirin showed
that laboratory monitoring levels were frequently out of therapeutic range
(variably defined), and findings were mixed on the association of these
derangements with bleeding or thrombotic events. Heparin was found to be
safe at low doses, but breakthrough thromboembolic events were common.
 Conclusion(s): There are few paediatric prospective randomised
clinical trials evaluating antithrombotic therapeutics post-cardiac
surgery; most studies have been observational and seldom employed clinical
endpoints. Standardised, validated endpoints and pragmatic trial designs
may allow investigators to determine the optimal drug, timing of
initiation, dosing and duration to improve outcomes by limiting
post-operative morbidity and mortality related to bleeding or thrombotic
events. Copyright © The Author(s), 2022. Published by Cambridge
University Press.

<156>
Accession Number
2014931813
Title
Evaluation of a tummy time intervention to improve motor skills in infants
after cardiac surgery.
Source
Cardiology in the Young. 32(8) (pp 1210-1215), 2022. Date of Publication:
27 Aug 2022.
Author
Uzark K.; Smith C.; Yu S.; Lowery R.; Tapley C.; Romano J.C.; Butcher J.
Institution
(Uzark, Romano) Department of Cardiac Surgery, University of Michigan Mott
Children's Hospital, Ann Arbor, MI, United States
(Uzark, Smith, Yu, Lowery, Tapley, Romano, Butcher) Department of
Pediatrics, University of Michigan Mott Children's Hospital, Ann Arbor,
MI, United States
Publisher
Cambridge University Press
Abstract
Background: Infants who require open heart surgery are at increased risk
for developmental delays including gross motor impairments which may have
implications for later adaptive skills and cognitive performance. We
sought to evaluate the feasibility and efficacy of a tummy time
intervention to improve motor skill development in infants after cardiac
surgery. Method(s): Infants <4 months of age who underwent cardiac
surgery were randomly assigned to tummy time with or without outpatient
reinforcement or standard of care prior to hospital discharge. The Alberta
Infant Motor Scale (AIMS) was administered to each infant prior to and 3
months after discharge. Groups were compared, and the association between
parent-reported tummy time at home and change in motor scores at follow-up
was examined. Result(s): Parents of infants (n = 64) who had cardiac
surgery at a median age of 5 days were randomly assigned to tummy time
instruction (n = 20), tummy time + outpatient reinforcement (n = 21) or
standard of care (n = 23). Forty-nine (77%) returned for follow-up. At
follow-up, reported daily tummy time was not significantly different
between groups (p = 0.17). Fifteen infants had <15 minutes of tummy time
daily. Infants who received >15 minutes of tummy time daily had a
significantly greater improvement in motor scores than infants with <15
minutes of tummy time daily (p = 0.01). Conclusion(s): In infants
following cardiac surgery, <15 minutes of tummy time daily is associated
with increased motor skill impairment. Further research is needed to
elucidate the best strategies to optimise parental compliance with tummy
time recommendations. Copyright © The Author(s), 2021. Published
by Cambridge University Press.

<157>
Accession Number
2025075355
Title
A Systematic Literature Review and Meta-Analysis of Randomized Controlled
Trials Comparing Robotic Assisted Cancer Surgery with the Laparoscopic or
Open Approach.
Source
Value in Health. Conference: ISPOR 2023: Impacting Innovation, Value, and
Healthcare Decision Making. Boston United States. 26(6 Supplement) (pp
S305), 2023. Date of Publication: June 2023.
Author
Hebert A.; Yankovsky A.; Patel N.; Kreaden U.
Institution
(Hebert) Intuitive Surgical, San Marcos, CA, United States
(Yankovsky, Patel) Intuitive Surgical, Palo Alto, CA, United States
(Kreaden) Intuitive Surgical, Sunnyvale, CA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: Randomized controlled trials (RCT) are the "Gold standard" for
assessing medical devices; however, there is a paucity of RCTs and typical
hospital programs offer multispecialty robotic surgery. Therefore, we
compared a set of common clinical outcomes for robotic, laparoscopic, and
open surgery across multiple specialties. Method(s): A systematic
literature review (using PRISMA) and meta-analysis (using RevMan 5.4) was
performed. Randomized controlled trials involving robotic surgery
performed with da Vinci Surgical systems published in PubMed, Embase, and
Scopus from January 1, 2010 to August 4, 2022 were included. Exclusion
criteria were language not English, pediatric population, benign
procedures, no outcomes of interest, or redundant data. Primary outcomes
were operative time, conversions, transfusions, length of hospital stay,
postoperative complications, reoperations, readmission, and mortality
within 30-days (Prospero #CRD42022374854). Result(s): The search
identified 44 RCTs across urology, gynecology, colorectal, thoracic,
general surgery, and head & neck specialties for cancer indications.
Compared to open surgery, robotic-assisted surgery resulted in fewer
transfusions (OR 0.41 [0.29, 0.57], p<0.00001) and postoperative
complications (OR 0.60 [0.44, 0.80], p=0.0006), and a shorter hospital
stay (WMD -1.00 [-1.65, -0.35], p=0.003). Compared to laparoscopic
surgery, robotic-assisted surgery resulted in fewer conversions (RD
-0.0123 [-0.0245, -0.0001, p=0.049) and a shorter hospital stay (WMD -0.57
[-0.92, -0.21], p=0.002). There were no differences in transfusions or
postoperative complications. Operative time was significant in favor of
laparoscopic (WMD 27.76 [15.92, 39.60], p<0.00001) and open (WMD 56.94
[36.48, 77.39], p<0.00001) surgery. There was no difference in
readmission, reoperation, or mortality for either comparison.
 Conclusion(s): Our meta-analysis of available RCTs using the da Vinci
surgical systems for cancer procedures has shown similar or superior
surgical outcomes for robotic assisted surgery compared to open or
laparoscopic surgery across 6 specialties. These findings can help policy
makers and healthcare providers evaluate robotic-assisted surgery from a
multispecialty perspective. Copyright © 2023

<158>
[Use Link to view the full text]
Accession Number
641881325
Title
REMNANT CHOLESTEROL AND INTENSIVE BLOOD PRESSURE CONTROL IN OLDER PATIENTS
WITH HYPERTENSION: A POST HOC ANALYSIS OF THE STEP RANDOMIZED TRIAL.
Source
Journal of Hypertension. Conference: 32nd Scientific Meeting of the
European Society of Hypertension, ESH 2023. Milan Italy. 41(Supplement 3)
(pp e11), 2023. Date of Publication: June 2023.
Author
Yang R.; Cai J.
Institution
(Yang, Cai) Hypertension Center, Fuwai Hospital, Peking Union Medical
College and Chinese Academy of Medical Sciences, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Emerging evidence shows the close relationship between remnant
cholesterol (RC) and hypertension. However, it is unknown whether RC is
associated with the effect of intensive systolic blood pressure (SBP)
lowering on cardiovascular outcomes. We aimed to determine the influence
of baseline RC on the effect of intensive SBP lowering in hypertensive
patients. Design and method: We performed a post-hoc analysis of the
Strategy of Blood Pressure Intervention in the Elderly Hypertensive
Patients (STEP) trial. Participants were randomly allocated to intensive
SBP treatment (110 to <130 mmHg) or standard SBP treatment (130 to <150
mmHg). RC was calculated as total cholesterol minus high-density
lipoprotein cholesterol minus low-density lipoprotein cholesterol. The
median RC concentration was used to categorize participants into low and
high RC groups. The primary outcome was a composite of stroke, acute
coronary syndrome, acute decompensated heart failure, coronary
revascularization, atrial fibrillation, or death from cardiovascular
causes. Result(s): Of the 8,511 participants in the STEP trial, 8,276
participants had available baseline RC concentrations (low RC group: n =
4,200; high RC group: n = 4,076). After a median follow-up of 3.33 years,
a reduction in the primary outcome was observed in participants allocated
to receive intensive SBP lowering in both groups; however, the reduction
was only significant in the high RC group (high RC group: adjusted hazard
ratio [aHR] 0.62; 95% confidence interval [CI] 0.45-0.84; low RC group:
0.91 [0.67-1.24]; P for interaction = 0.09). Intensive SBP treatment
decreased all-cause mortality in the high RC group (aHR 0.48; 95% CI 0.28
- 0.81) but increased it in the low RC group (aHR 2.51; 95% CI 1.47 -
4.28; P for interaction <0.001). Among the adverse events, only
hypotension was slightly increased in the high RC group (adjusted relative
risk 1.48; 95% CI 1.02 - 2.16). Conclusion(s): Patients with high RC
experienced greater cardiovascular benefits with intensive SBP lowering.

<159>
[Use Link to view the full text]
Accession Number
641881308
Title
THE INFLUENCE OF BASELINE DIASTOLIC BLOOD PRESSURE ON THE EFFECTS OF
INTENSIVE BLOOD PRESSURE LOWERING: RESULTS FROM THE STEP RANDOMIZED TRIAL.
Source
Journal of Hypertension. Conference: 32nd Scientific Meeting of the
European Society of Hypertension, ESH 2023. Milan Italy. 41(Supplement 3)
(pp e11), 2023. Date of Publication: June 2023.
Author
Yang R.; Cai J.
Institution
(Yang, Cai) Hypertension Center, Fuwai Hospital, Peking Union Medical
College and Chinese Academy of Medical Sciences, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The Strategy of Blood Pressure Intervention in the Elderly
Hypertensive Patients (STEP) trial reported cardiovascular benefits of
intensive systolic blood pressure (SBP) lowering. However, the influence
of baseline diastolic blood pressure (DBP) on the effects of intensive SBP
lowering on cardiovascular outcomes has not been fully elucidated. Design
and method: In this post hoc analysis of the STEP trial, participants were
randomly assigned to receive intensive (110 to <130 mmHg) or standard SBP
treatment (130 to <150 mmHg) and categorized by baseline DBP into
subgroups: <70, 70 - 79, and > = 80 mmHg. The primary outcome was a
composite of stroke, acute coronary syndrome, acute decompensated heart
failure, coronary revascularization, atrial fibrillation, or death from
cardiovascular causes. A competing risk proportional hazards regression
model was used in the analysis. We compared results across subgroups
stratified by baseline DBP levels by including a multiplicative
interaction term between SBP treatment arms and subgroups (treatment
arm*subgroup). Result(s): Of the 8,511 participants, 960, 2,474, and
5,077 had baseline DBP divided in intervals of <70, 70 - 79, and > = 80
mmHg, respectively. A reduction in the primary outcome was observed among
those randomized to intensive SBP lowering in each DBP subgroup but was
significant only in the subset of participants with baseline DBP > = 80
mmHg (<70 mmHg: adjusted hazard ratio, 0.81 [95% confidence interval, 0.43
- 1.51]; 70 - 79 mmHg: 0.80 [0.55 - 1.15]; > = 80 mmHg: 0.73 [0.54 -
0.97]). There were no significant interactions between SBP treatment and
baseline DBP subgroups for the primary and secondary outcomes (all P for
interaction >0.05). The sensitivity analyses showed consistent results
with the main analysis. Conclusion(s): Baseline DBP levels did not
modify the beneficial effects of intensive SBP lowering on cardiovascular
outcomes.

<160>
Accession Number
641880924
Title
BILATERAL ARM PAIN AS AN UNUSUAL PRESENTATION FOR ACUTE CORONARY SYNDROME.
Source
Journal of General Internal Medicine. Conference: Annual Meeting of the
Society of General Internal Medicine, SGIM 2023. Aurora, CO United States.
38(Supplement 2) (pp S626), 2023. Date of Publication: July 2023.
Author
Soghoyan K.Z.; Doyle J.E.; Thirumeni R.; Ficalora R.; Curtis D.; Quade R.
Institution
(Soghoyan, Doyle, Thirumeni, Ficalora, Curtis, Quade) Internal Medicine,
Indiana University, School of Medicine, Indianapolis, IN, United States
Publisher
Springer New York LLC
Abstract
CASE: A 74-year-old female with a notable history of coronary artery
disease status post percutaneous coronary intervention of the left
anterior descending (LAD) coronary artery in 2010. She had a normal
dobutamine stress test in July 2021 and a normal treadmill stress test in
September 2021. The patient presented to our cardiology clinic due to
chest discomfort with particularly bothersome bilateral upper extremity
pain. The cardiologist was concerned with her atypical presentation and
asked that she report to the Emergency Department. Initial ECG was without
ST-segment elevation or T-wave changes. Serial high-sensitivity troponins
resulted 0, 0, 0.01, 0.01 (reference range 0.0 to 0.04
nanogram/milliliter). With her current presentation, two normal stress
tests within the past six months, and ongoing symptoms, the cardiology
team recommended the patient undergo left heart catheterization.
Remarkably, the study revealed proximal-LAD 80% stenosis, mid-LAD 95%
stenosis, first diagonal 95% stenosis, and first obtuse marginal 70%
stenosis. Cardiothoracic surgery was consulted, and she successfully
underwent triple-vessel coronary artery bypass grafting (CABG). Her
postoperative course was uneventful, and she was discharged home when
medically stable. The patient returned to our Emergency Department within
five days following a 3-hour history of bilateral upper extremity pain.
She reported that this pain is like what she experienced before her CABG.
Repeat left heart catheterization revealed a patent saphenous vein graft
to first obtuse marginal and the left internal mammary artery to LAD in
sequence with the diagonal is widely patent; however, there was a near 90%
occlusion of the marginal branch distal to the insertion site of the
graft. By approaching the native vessel, she successfully received a stent
to the obtuse marginal with TIMI grade III flow afterward. Following the
stent placement, her symptoms resolved. IMPACT/DISCUSSION: With her
unusual presentation and subsequent remarkable findings on cardiac
catheterization, this case highlights the evolving methodology of ACS
diagnostics. Females and those with comorbidities such as diabetes
mellitus often present with atypical anginal equivalents. Clinical gestalt
is not enough to rule in ACS. Unusual cases such as this warrant thorough
investigation. Literature review with PubMed using MeSH terms "bilateral
arm pain" and "acute coronary syndrome" did not yield any report of
bilateral arm pain as a presenting symptom of NSTEMI. On review of gender
and ethnicity-based symptomatology related to ACS, no clear indicator was
identified that correlates white women's presentation with NSTEMI.
 CONCLUSION(S): Women can present with atypical symptoms in acute
coronary syndrome (ACS). However, with the adoption of highsensitivity
troponins, the diagnostic incidence of ACS has climbed in all
demographics. Though extensive diagnostic algorithms have been developed
for ACS, unusual cases still provide a challenge.

<161>
Accession Number
641880156
Title
INTEGRATED OUTPATIENT TREATMENT OF OPIOID USE DISORDER AND
INJECTION-RELATED INFECTIONS: PROGRESS AND PRELIMINARY OUTCOMES IN THE
BUPRENORPHINE PLUS OUTPATIENT PARENTERAL ANTIBIOTIC THERAPY (B-OPAT)
STUDY.
Source
Journal of General Internal Medicine. Conference: Annual Meeting of the
Society of General Internal Medicine, SGIM 2023. Aurora, CO United States.
38(Supplement 2) (pp S315), 2023. Date of Publication: July 2023.
Author
Fanucchi L.; VanMeter C.M.; Grubbs J.A.; Walsh S.L.; Thornton A.C.;
Lofwall M.
Institution
(Fanucchi, Grubbs, Thornton) Division of Infectious Diseases, University
of Kentucky College of Medicine, Lexington, KY, United States
(Fanucchi, VanMeter, Walsh, Lofwall) Center on Drug and Alcohol Research,
University of Kentucky College of Medicine, Lexington, KY, United States
(Walsh, Lofwall) Department of Behavioral Science, University of Kentucky,
College of Medicine, Lexington, KY, United States
Publisher
Springer New York LLC
Abstract
BACKGROUND: Hospitalizations for severe, injection-related infections
(SIRI) are increasing with the opioid epidemic. Outpatient parenteral
antibiotic therapy (OPAT) is often not offered to persons with opioid use
disorder (OUD) and SIRI, though increasing evidence suggests it may be
feasible and safe. This study evaluates the efficacy and
cost-effectiveness of an integrated care model combining buprenorphine for
OUD with OPAT for SIRI (B-OPAT) compared to treatment as usual (TAU) on
key OUD, infectious disease, and economic outcomes. We present the current
trial status and preliminary outcomes. METHOD(S): B-OPAT is a
randomized, 2-arm superiority trial recruiting a goal of 90 adults
hospitalized with OUD and SIRI needing 2 or more weeks IV antibiotic
therapy. Randomization is 1:1 to either discharge once medically stable to
an integrated outpatient care model combining Buprenorphine and OPAT
(B-OPAT) or to TAU. Stratification variables include the clinical SIRI
subgroup, stimulant use disorder, and sex. The clinical SIRI
stratification has 3 subgroups: 1) low risk endocarditis (IE) (tricuspid
valve [TV] managed without surgery), 2) high risk IE (TV managed
surgically, aortic valve, mitral valve, prosthetic valve), and 3) non-IE
(e.g. osteomyelitis). The study intervention period is 12-weeks after
hospital discharge followed by a 3-month safety follow-up window.
 RESULT(S): From Mar 2021-Oct 2022, 200 persons were screened, 165
excluded (top barriers: distance/transportation 35, complex
medical/psychiatric comorbidities 32, housing instability 18,
patientdirected discharge 20), and 37 randomized (B-OPAT: 18, TAU: 19). To
date, baseline characteristics appear similar (Table). Average hospital
length of stay in B-OPAT is 23.4 days, and 31.9 days in TAU. B-OPAT
subjects completed 19 days of OPAT versus 3.7 days in TAU. In the 12-weeks
post-discharge, B-OPAT had 7 serious adverse events (SAE) in 6 subjects: 1
overdose death, 5 hospitalizations (2 orthopedic surgery, 1 bacteremia, 1
COVID, 1 gastrointestinal bleeding), 1 non-fatal overdose. TAU had 11 SAEs
in 5 subjects: 3 deaths (1 overdose, 1 SIRI complication, 1 myocardial
infarction), 6 hospitalizations (2 pain related to SIRI, 1 bacteremia, 1
antibiotic intolerance, 1 valve replacement, 1 hemorrhagic stroke), and 2
nonfatal overdoses. CONCLUSION(S): At ~40% target enrollment,
emerging data suggest subjects receiving the outpatient care model
combining OUD treatment with OPAT may have fewer SAEs than those in TAU
and reduced length of stay. Continued study recruitment will help answer
whether B-OPAT is clinically-and cost-effective relative to current
practice and should be disseminated more broadly.

<162>
Accession Number
641879739
Title
PROCEDURAL/SURGICAL RHYTHM CONTROL FOR PATIENTS WITH ATRIAL FIBRILLATION:
A META-ANALYSIS.
Source
Journal of General Internal Medicine. Conference: Annual Meeting of the
Society of General Internal Medicine, SGIM 2023. Aurora, CO United States.
38(Supplement 2) (pp S127), 2023. Date of Publication: July 2023.
Author
Montane B.; Zhang S.; Wolfe J.D.; Cooper D.H.; Doering M.; Gage B.F.
Institution
(Montane, Zhang, Wolfe, Cooper, Doering) Washington University in St
Louis, St Louis, MO, United States
(Gage) Medicine, Washington University, St Louis School of Medicine, St
Louis, MO, United States
Publisher
Springer New York LLC
Abstract
BACKGROUND: Atrial fibrillation quadruples the risk of ischemic strokes.
Whether rhythm control via catheter ablation or surgical rhythm reduces
this risk is unknown. Our objective was to understand long term ischemic
stroke risk for different treatments of atrial fibrillation.
 METHOD(S): We combined prior trials to quantify the reduction on
ischemic stroke from rhythm control via catheter ablation or surgery (e.g.
the Maze procedure). We included trials that met the following inclusion
criteria: >1 month of follow up, adult patients with atrial fibrillation,
English language, and randomization to either catheter ablation or
surgical rhythm control vs. conservative therapy. The primary outcome was
the relative risk of ischemic stroke after a 30-day blanking period (when
no strokes were included). We combined trials using the Cochran-Mantel-
Haenszel method to quantify the relative risk (RR) of stroke. We used the
Haldane correction for trials that observed 0 strokes in either arm.
 RESULT(S): The 22 trials of catheter ablation randomized a total of
5,659 patients and had a RR (95% CI) of 0.64 (0.43-0.95). The 20 trials of
surgical rhythm control randomized a total of 2,083 patients and had a
relative risk (95% CI) of 0.64 (0.41-0.998). Together, the 42 trials had a
RR (95% CI) for ischemic stroke of 0.64 (0.48-0.87). CONCLUSION(S):
After the 30-day blanking period, catheter ablation or surgical rhythm
control reduced the risk of ischemic stroke in trial participants with
atrial fibrillation. We hypothesize that over a longer period, maintenance
of sinus rhythm associated with procedural/surgical rhythm therapy reduces
the risk of ischemic stroke for patients suffering from atrial
fibrillation.

<163>
Accession Number
2026066325
Title
Impact of Additional Administration of von Willebrand Factor Concentrates
to Thrombocyte Transfusion in Perioperative Bleeding in Cardiac Surgery.
Source
Transfusion Medicine and Hemotherapy. (no pagination), 2023. Date of
Publication: 2023.
Author
Ledergerber K.; Hollinger A.; Zimmermann S.; Todorov A.; Trutmann M.;
Gallachi L.; Gschwandtner L.A.; Ryser L.A.; Gebhard C.E.; Bolliger D.;
Buser A.; Tsakiris D.A.; Siegemund M.
Institution
(Ledergerber, Hollinger, Zimmermann, Trutmann, Gallachi, Gschwandtner,
Ryser, Gebhard, Siegemund) Intensive Care Unit, University Hospital Basel,
Basel, Switzerland
(Hollinger, Gebhard, Bolliger, Buser, Tsakiris, Siegemund) Medical
Faculty, University of Basel, Basel, Switzerland
(Todorov) Cardiovascular Gender Medicine, University Hospital Zurich,
Zurich, Switzerland
(Bolliger, Buser) Department of Anesthesiology, University Hospital Basel,
Basel, Switzerland
(Tsakiris) Department of Transfusion Medicine and Hematology, Basel
University Hospital, Basel, Switzerland
(Siegemund) Department of Clinical Research, University of Basel, Basel,
Switzerland
(Buser) Regional Blood Transfusion Service of the Swiss Red Cross, Basel,
Switzerland
Publisher
S. Karger AG
Abstract
Background: Von Willebrand factor (vWF) is an important part of blood
coagulation since it binds platelets to each other and to endothelial
cells. In traumatic and surgical haemorrhage, both blood cells and
plasmatic factors are consumed, leading to consumption coagulopathy and
fluid resuscitation. This often results in large amounts of crystalloids
and blood products being infused. Additional administration of vWF complex
and platelets might mitigate this problem. We hypothesize that
administration of vWF concentrate additionally to platelet concentrates
reduces blood loss and the amount of blood products (platelets, red blood
cells [RBC], fresh frozen plasma [FFP]) administered. Method(s): We
conducted a monocentric 6-year retrospective data analysis of cardiac
surgery patients. Included were all patients receiving platelet
concentrates within 48 h postoperatively. Patients who additionally
received vWF concentrates were allocated to the intervention group and all
others to the control group. Groups were compared in mixed regression
models correcting for known confounders, based on nearest neighbour
propensity score matching. Primary endpoints were loss of blood (day one
and two) and amount of needed blood products on day one and two
(platelets, RBC, FFP). Secondary endpoints were intensive care unit (ICU)
and in-hospital length of stay, ICU and in-hospital mortality, and
absolute difference of platelet counts before and after treatment.
 Result(s): Of 497 patients analysed, 168 (34%) received vWF
concentrates. 121 patients in both groups were considered for nearest
neighbour matching. Patients receiving additional vWF were more likely to
receive more blood products (RBC, FFP, platelets) in the first 24 h after
surgery and had around 200 mL more blood loss at the same time.
 Conclusion(s): In this retrospective analysis, no benefit in
additional administration of vWF to platelet concentrates on perioperative
blood loss, transfusion requirement (platelets, RBC, FFP), length of stay,
and mortality could be found. These findings should be verified in a
prospective randomized controlled clinical trial (<ext-link
ext-link-type="uri"xlink:href="http://www.clinicaltrials.gov"xmlns:xlink="
http://www.w3.org/1999/xlink">www.clinicaltrials.gov</ext-link> identifier
NCT04555785). Copyright © 2023 The Author(s). Published by S.
Karger AG, Basel. This article is licensed under the Creative Commons
Attribution 4.0 International License (CC BY). Usage, derivative works and
distribution are permitted provided that proper credit is given to the
author and the original publisher.

<164>
Accession Number
2024779536
Title
Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing
Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-blind
Randomized Comparative Trial.
Source
Journal of Tehran University Heart Center. 18(2) (pp 115-121), 2023. Date
of Publication: 2023.
Author
Samadifar Z.; Aslanabadi N.; Arbat B.K.; Separham A.; Javanshir E.
Institution
(Samadifar, Aslanabadi, Arbat, Separham, Javanshir) Cardiovascular
Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Publisher
Tehran Heart Center
Abstract
Background: Atrial fibrillation (AF) is a supraventricular tachyarrhythmia
characterized by disorganized atrial activity and subsequent mechanical
atrial failure. Postoperative AF is a frequent complication of coronary
artery bypass grafting (CABG). Although there is evidence of decreased AF
after CABG with statin usage, information is scarce regarding a direct
comparison between atorvastatin and rosuvastatin. The present study was
conducted to compare the efficacy of rosuvastatin and atorvastatin in
preventing post-CABG AF. Method(s): The present double-blind
randomized comparative clinical trial selected CABG candidates with stable
ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg
per day) or rosuvastatin (20 mg per day) was prescribed 1 week before
surgery, and the outcomes were compared. Result(s): Two-hundred
patients, 100 cases in each group, completed the study. Twenty-five
patients in each group were female, and the mean age was 59.30+/-8.42
years in the rosuvastatin group and 60.13+/-9.40 years in the atorvastatin
group (P=0.513). The frequency of AF was 31% in the atorvastatin group and
27% in the rosuvastatin group (P=0.534). No significant differences
existed between the groups concerning the length of hospital and ICU stay
(P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and
P=0.648). A subgroup analysis of only patients with stable ischemic heart
disease could not detect a significant difference between the study groups
in any of the investigated outcomes. Our logistic regression analysis
showed an association only between age and the incidence of AF after CABG
(OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Conclusion(s): Rosuvastatin
and atorvastatin are similar concerning the prevention of post-CABG AF,
but there is a need for future well-designed multicenter studies on this
topic. Copyright © 2023 Tehran University of Medical Sciences.

<165>
Accession Number
2024441429
Title
Bleeding risk in patients prescribed dual antiplatelet therapy and triple
therapy after coronary interventions: the ADAPTT retrospective
population-based cohort studies.
Source
Health Technology Assessment. 27(8) (pp 1-257), 2023. Date of Publication:
May 2023.
Author
Harris J.; Pouwels K.B.; Johnson T.; Sterne J.; Pithara C.; Mahadevan K.;
Reeves B.; Benedetto U.; Loke Y.; Lasserson D.; Doble B.; Hopewell-Kelly
N.; Redwood S.; Wordsworth S.; Mumford A.; Rogers C.; Pufulete M.
Institution
(Harris, Reeves, Rogers, Pufulete) Bristol Trials Centre, University of
Bristol, Bristol, United Kingdom
(Pouwels, Doble, Wordsworth) Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, United
Kingdom
(Johnson, Mahadevan) Department of Cardiology, Bristol Heart Institute,
Bristol, United Kingdom
(Sterne) National Institute for Health Research Biomedical Research
Centre, Department of Population Health Sciences, University of Bristol,
Bristol, United Kingdom
(Pithara, Redwood) National Institute for Health Research Applied Research
Collaboration West (NIHR ARC West), Bristol, United Kingdom
(Benedetto, Mumford) Bristol Medical School, University of Bristol,
Bristol, United Kingdom
(Loke) Norwich Medical School, University of East Anglia, Norwich, United
Kingdom
(Lasserson) Institute of Applied Health Research, University of
Birmingham, Birmingham, United Kingdom
(Hopewell-Kelly) University of the West of England, Bristol, United
Kingdom
Publisher
NIHR Journals Library
Abstract
Background: Bleeding among populations undergoing percutaneous coronary
intervention or coronary artery bypass grafting and among conservatively
managed patients with acute coronary syndrome exposed to different dual
antiplatelet therapy and triple therapy (i.e. dual antiplatelet therapy
plus an anticoagulant) has not been previously quantified.
 Objective(s): The objectives were to estimate hazard ratios for
bleeding for different antiplatelet and triple therapy regimens, estimate
resources and the associated costs of treating bleeding events, and to
extend existing economic models of the cost-effectiveness of dual
antiplatelet therapy. Design(s): The study was designed as three
retrospective population-based cohort studies emulating target randomised
controlled trials. Setting(s): The study was set in primary and
secondary care in England from 2010 to 2017. Participant(s):
Participants were patients aged >= 18 years undergoing coronary artery
bypass grafting or emergency percutaneous coronary intervention (for acute
coronary syndrome), or conservatively managed patients with acute coronary
syndrome. Data sources: Data were sourced from linked Clinical Practice
Research Datalink and Hospital Episode Statistics. Intervention(s):
Coronary artery bypass grafting and conservatively managed acute coronary
syndrome: aspirin (reference) compared with aspirin and clopidogrel.
Percutaneous coronary intervention: aspirin and clopidogrel (reference)
compared with aspirin and prasugrel (ST elevation myocardial infarction
only) or aspirin and ticagrelor. Main Outcome Measure(s): Primary
outcome: any bleeding events up to 12 months after the index event.
 Secondary Outcomes: major or minor bleeding, all-cause and
cardiovascular mortality, mortality from bleeding, myocardial infarction,
stroke, additional coronary intervention and major adverse cardiovascular
events. Result(s): The incidence of any bleeding was 5% among
coronary artery bypass graft patients, 10% among conservatively managed
acute coronary syndrome patients and 9% among emergency percutaneous
coronary intervention patients, compared with 18% among patients
prescribed triple therapy. Among coronary artery bypass grafting and
conservatively managed acute coronary syndrome patients, dual antiplatelet
therapy, compared with aspirin, increased the hazards of any bleeding
(coronary artery bypass grafting: hazard ratio 1.43, 95% confidence
interval 1.21 to 1.69; conservatively-managed acute coronary syndrome:
hazard ratio 1.72, 95% confidence interval 1.15 to 2.57) and major adverse
cardiovascular events (coronary artery bypass grafting: hazard ratio 2.06,
95% confidence interval 1.23 to 3.46; conservatively-managed acute
coronary syndrome: hazard ratio 1.57, 95% confidence interval 1.38 to
1.78). Among emergency percutaneous coronary intervention patients, dual
antiplatelet therapy with ticagrelor, compared with dual antiplatelet
therapy with clopidogrel, increased the hazard of any bleeding (hazard
ratio 1.47, 95% confidence interval 1.19 to 1.82), but did not reduce the
incidence of major adverse cardiovascular events (hazard ratio 1.06, 95%
confidence interval 0.89 to 1.27). Among ST elevation myocardial
infarction percutaneous coronary intervention patients, dual antiplatelet
therapy with prasugrel, compared with dual antiplatelet therapy with
clopidogrel, increased the hazard of any bleeding (hazard ratio 1.48, 95%
confidence interval 1.02 to 2.12), but did not reduce the incidence of
major adverse cardiovascular events (hazard ratio 1.10, 95% confidence
interval 0.80 to 1.51). Health-care costs in the first year did not differ
between dual antiplatelet therapy with clopidogrel and aspirin monotherapy
among either coronary artery bypass grafting patients (mean difference 94,
95% confidence interval -155 to 763) or conservatively managed acute
coronary syndrome patients (mean difference 610, 95% confidence interval
-626 to 1516), but among emergency percutaneous coronary intervention
patients were higher for those receiving dual antiplatelet therapy with
ticagrelor than for those receiving dual antiplatelet therapy with
clopidogrel, although for only patients on concurrent proton pump
inhibitors (mean difference 1145, 95% confidence interval 269 to 2195).
 Conclusion(s): This study suggests that more potent dual antiplatelet
therapy may increase the risk of bleeding without reducing the incidence
of major adverse cardiovascular events. These results should be carefully
considered by clinicians and decision-makers alongside randomised
controlled trial evidence when making recommendations about dual
antiplatelet therapy. Limitation(s): The estimates for bleeding and
major adverse cardiovascular events may be biased from unmeasured
confounding and the exclusion of an eligible subgroup of patients who
could not be assigned an intervention. Because of these limitations, a
formal cost-effectiveness analysis could not be conducted. Future work:
Future work should explore the feasibility of using other UK data sets of
routinely collected data, less susceptible to bias, to estimate the
benefit and harm of antiplatelet interventions. Trial registration: This
trial is registered as ISRCTN76607611. Funding(s): This project was
funded by the National Institute for Health and Care Research (NIHR)
Health Technology Assessment programme and will be published in full in
Health Technology Assessment; Vol. 27, No. 8. See the NIHR Journals
Library website for further project information. Copyright © 2023
Harris et al.

<166>
Accession Number
2024918387
Title
Incidence, Predictors, and Outcomes Associated With Worsening Renal
Function in Patients With Heart Failure and Secondary Mitral
Regurgitation: The COAPT Trial.
Source
Journal of the American Heart Association. 12(14) (no pagination), 2023.
Article Number: e029504. Date of Publication: 2023.
Author
Kong J.; Zaroff J.G.; Ambrosy A.P.; Fitzpatrick J.K.; Ku I.A.; Mishell
J.M.; Kotinkaduwa L.N.; Redfors B.; Beohar N.; Ailawadi G.; Lindenfeld J.;
Abraham W.T.; Mack M.J.; Kar S.; Lim D.S.; Whisenant B.K.; Stone G.W.
Institution
(Kong, Zaroff, Ambrosy, Fitzpatrick, Ku, Mishell) Kaiser Permanente
Department of Cardiology, San Francisco, CA, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
(Kotinkaduwa, Redfors) Clinical Trials Center Cardiovascular Research
Foundation, New York City, NY, United States
(Redfors) NewYork-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Beohar) Mount Sinai Medical Center Columbia University Division of
Cardiology, Miami Beach, FL, United States
(Ailawadi) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
(Lindenfeld) Vanderbilt University Division of Cardiology, Nashville, TN,
United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Mack) Baylor Scott and White Healthcare, Dallas, TX, United States
(Kar) Cardiovascular Institute, Los Robles Health System, Thousand Oaks,
CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Whisenant) Intermountain Medical Center, Murray, UT, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The incidence and implications of worsening renal function
(WRF) after mitral valve transcatheter edge-to-edge repair (TEER) in
patients with heart failure (HF) are unknown. Therefore, the aim of this
study was to determine the propor-tion of patients with HF and secondary
mitral regurgitation who develop persistent WRF within 30 days following
TEER, and whether this development portends a worse prognosis. METHODS AND
RESULTS: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip
Percutaneous Therapy for Heart Failure Patients With Functional Mitral
Regurgitation) trial, 614 patients with HF and severe secondary mitral
regurgitation were randomized to TEER with the MitraClip plus
guideline-directed medical therapy (GDMT) versus GDMT alone. WRF was
defined as serum creatinine increase >=1.5x or >=0.3 mg/dL from baseline
persisting to day 30 or requiring renal replacement therapy. All-cause
death and HF hospitalization rates between 30 days and 2 years were
compared in patients with and without WRF. WRF at 30 days was present in
11.3% of patients (9.7% in the TEER plus GDMT group and 13.1% in the GDMT
alone group; P=0.23). WRF was associated with all-cause death (hazard
ratio [HR], 1.98 [95% CI, 1.3-3.03]; P=0.001) but not HF hospitalization
(HR, 1.47 [ 95% CI, 0.97-2.24]; P=0.07) between 30 days and 2 years.
Compared with GDMT alone, TEER reduced both death and HF hospitalization
consistently in patients with and without WRF (P<inf>interaction</inf>
=0.53 and 0.57, respectively). CONCLUSION(S): Among patients with HF
and severe secondary mitral regurgitation, the incidence of WRF at 30 days
was not increased after TEER compared with GDMT alone. WRF was associated
with greater 2-year mortality but did not attenuate the treatment benefits
of TEER in reducing death and HF hospitalization compared with GDMT
alone. Copyright © 2023 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<167>
Accession Number
2025992616
Title
Application of "Internet+" cognitive-behavioral intervention in caregivers
of children with congenital heart disease undergoing elective surgery
during the COVID-19 pandemic.
Source
American Journal of Translational Research. 15(4) (pp 2894-2902), 2023.
Date of Publication: 2023.
Author
Jin L.; Chen P.; Fang X.; Li C.; Yang G.; Liu A.
Institution
(Jin, Chen, Liu) School of Nursing, Anhui Medical University, Anhui, Hefei
230061, China
(Li, Yang) Cardiovascular Department, Anhui Provincial Children's
Hospital, Anhui, Hefei 230051, China
(Fang) Anhui Provincial Chest Hospital, Provincial Joint Defense
Institute), Anhui, Hefei 230000, China
Publisher
E-Century Publishing Corporation
Abstract
Objective: To explore the effects of cognitive and behavioral
interventions for caregivers of children undergoing interventional surgery
for congenital heart disease (CHD) during COVID-19. Method(s): A
prospective study was conducted on 140 children with CHD who were
hospitalized in the Department of Cardiology in a children's hospital from
March 2020 to March 2022. The children were randomly divided into an
intervention group and a control group, with 70 cases in each group. In
the control group, caregivers gave routine care, and in the intervention
group, "Internet+" cognitive and behavioral interventions were given. The
psychological status of caregivers before and after intervention, day care
ability on the operation day, readiness for hospital discharge of the
caregivers, sleep quality, and postoperative complications of the
children, the medication compliance, review compliance and satisfaction
were compared between the two groups. Result(s): During the COVID-19
pandemic, the anxiety and depression scores of caregivers in the
intervention group were significantly lower than those in the control
group (P<0.05), and the caregiving ability and readiness for hospital
discharge of the caregivers in the intervention group were better than
those in the control group (P<0.05). The sleep quality of children in the
intervention group was significantly better than that in the control group
during the first week after operation (P<0.05). Postoperative
complications were significantly fewer in the intervention group than in
the control group (chi2=24.433, P<0.001). The medication
compliance, review compliance, and satisfaction were higher in the
intervention group than in the control group (P<0.05). Conclusion(s):
During the pandemic period of COVID-19, "Internet+" cognitive and
behavioral intervention has a good effect and should be promoted in
clinical practice. Copyright © 2023 E-Century Publishing
Corporation. All rights reserved.

<168>
Accession Number
2025976062
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. 63(6) (no pagination), 2023.
Article Number: ezad230. Date of Publication: 01 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
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The coronavirus disease 2019 (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. METHOD(S): PubMed and Embase were systematically
searched for articles published from 1 January 2019 to 30 August 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. A total of 1676 abstracts and titles were
reviewed and 20 studies were included in this review. 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. 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. Copyright © 2023
European Association for Cardio-Thoracic Surgery. All rights reserved.

<169>
Accession Number
2025917675
Title
P2Y<inf>12</inf> inhibitor monotherapy versus dual antiplatelet therapy in
patients with acute coronary syndromes undergoing coronary stenting:
rationale and design of the NEOMINDSET Trial.
Source
EuroIntervention. 19(4) (pp E323-E329), 2023. Date of Publication: July
2023.
Author
Guimaraes P.O.; Franken M.; Tavares C.A.M.; Silveira F.S.; Antunes M.O.;
Bergo R.R.; Joaquim R.M.; Hirai J.C.S.; Andrade P.B.; Pitta F.G.; Mariani
J.; Nascimento B.R.; de Paula J.E.T.; Silveira M.S.; Costa T.A.O.;
Dall'Orto F.T.C.; Serpa R.G.; Sampaio F.B.A.; Ohe L.N.; Mangione F.M.;
Furtado R.H.M.; Sarmento-Leite R.; Monfardini F.; Assis S.R.L.; Nicolau
J.C.; Sposito A.C.; Lopes R.D.; Onuma Y.; Valgimigli M.; Angiolillo D.J.;
Serruys P.W.; Berwanger O.; Bacal F.; Lemos P.A.
Institution
(Guimaraes, Franken, Tavares, Hirai, Pitta, Mariani, Monfardini, Assis,
Berwanger, Bacal, Lemos) Hospital Israelita Albert Einstein, Sao Paulo,
Brazil
(Tavares, Pitta, Furtado, Nicolau, Bacal, Lemos) Instituto do Coracao
(InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Sao Paulo,
Brazil
(Tavares, Pitta, Furtado, Nicolau, Bacal, Lemos) Universidade de Sao
Paulo, Sao Paulo, Brazil
(Silveira, Silveira) Research Center, Clinica do Coracao, Aracaju, Brazil
(Antunes, Costa) Hospital Universitario Sao Francisco de Assis na
Providencia de Deus, Braganca Paulista, Brazil
(Bergo, Dall'Orto) Hospital Santa Lucia, Pocos de Caldas, Brazil
(Joaquim) Instituto de Cardiologia de Santa Catarina, Sao Jose, Brazil
(Andrade) Irmandade da Santa Casa de Misericordia de Marilia, Marilia,
Brazil
(Nascimento) Hospital Universitario Ciencias Medicas, Belo Horizonte,
Brazil
(de Paula) Instituto Cardiovascular de Linhares, Linhares, Brazil
(Serpa) Hospital Santa Casa de Misericordia de Vitoria, Vitoria, Brazil
(Sampaio) Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
(Ohe) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Mangione) Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
(Sarmento-Leite) Instituto de Cardiologia do Rio Grande do Sul, Fundacao
Universitaria de Cardiologia, Porto Alegre, Brazil
(Sposito) Department of Internal Medicine, School of Medical Sciences,
State University of Campinas, Campinas, Brazil
(Lopes) Duke Clinical Research Institute, Duke University, Durham, NC,
United States
(Onuma, Serruys) Department of Cardiology, University of Galway, Galway,
Ireland
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Lugano, Switzerland
(Valgimigli) Universita della Svizzera Italiana, Lugano, Switzerland
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
Publisher
Europa Group
Abstract
Dual antiplatelet therapy (DAPT) is currently the standard of care after
percutaneous coronary intervention (PCI). Recent studies suggest that
reducing DAPT to 1-3 months followed by an aspirin-free single
antiplatelet therapy (SAPT) strategy with a potent P2Y<inf>12</inf>
inhibitor is safe and associated with less bleeding. However, to date, no
randomised trial has tested the impact of initiating SAPT immediately
after PCI, particularly in patients with acute coronary syndromes (ACS).
NEOMINDSET is a multicentre, randomised, open-label trial with a blinded
outcome assessment designed to compare SAPT versus DAPT in 3,400 ACS
patients undergoing PCI with the latest-generation drug-eluting stents
(DES). After successful PCI and up to 4 days following hospital admission,
patients are randomised to receive SAPT with a potent P2Y<inf>12</inf>
inhibitor (ticagrelor or prasugrel) or DAPT (aspirin plus a potent
P2Y<inf>12</inf> inhibitor) for 12 months. Aspirin is discontinued
immediately after randomisation in the SAPT group. The choice between
ticagrelor and prasugrel is at the investigator's discretion. The primary
hypothesis is that SAPT will be non-inferior to DAPT with respect to the
composite endpoint of all-cause mortality, stroke, myocardial infarction
or urgent target vessel revascularisation, but superior to DAPT on rates
of bleeding defined by Bleeding Academic Research Consortium 2, 3 or 5
criteria. NEOMINDSET is the first study that is specifically designed to
test SAPT versus DAPT immediately following PCI with DES in ACS patients.
This trial will provide important insights on the efficacy and safety of
withdrawing aspirin in the early phase of ACS. Copyright © Europa
Digital & Publishing 2023. All rights reserved.

<170>
Accession Number
2025917674
Title
Posterior pericardiotomy for the prevention of atrial fibrillation after
cardiac surgery: a systematic review and meta-analysis of 25 randomised
controlled trials.
Source
EuroIntervention. 19(4) (pp 305-317), 2023. Date of Publication: July
2023.
Author
Abdelaziz A.; Hafez A.H.; Elaraby A.; Roshdy M.R.; Abdelaziz M.; Eltobgy
M.A.; Elsayed H.; El-Samahy M.; Elbehbeh N.A.; Philip K.G.; Abdelaty A.M.;
Rizk M.A.; Al-Tawil M.; AboElfarh H.E.; Ramadan A.; Ghaith H.S.; Wahsh
E.A.; Abdelazeem B.; Fayed B.
Institution
(Abdelaziz, Hafez, Elaraby, Roshdy, Abdelaziz, Eltobgy, Elsayed,
El-Samahy, Elbehbeh, Philip, Abdelaty, Rizk, Al-Tawil, AboElfarh, Ramadan,
Ghaith, Wahsh, Abdelazeem) Medical Research Group of Egypt (MRGE), Cairo,
Egypt
(Abdelaziz, Hafez, Elaraby, Abdelaziz, Ghaith) Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
(Roshdy, Philip) Faculty of Medicine, Sohag University, Sohag, Egypt
(Eltobgy) Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
(Elsayed, El-Samahy, Elbehbeh, Abdelaty, Rizk) Faculty of Medicine,
Zagazig University, Zagazig, Egypt
(Al-Tawil) Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
(AboElfarh) Mansoura Manchester Programme for Medical Education, Faculty
of Medicine, Mansoura University, Mansoura, Egypt
(Ramadan) Faculty of Medicine, South Valley University, Qena Governorate,
Egypt
(Wahsh) Department of Clinical Pharmacy, Faculty of Pharmacy, October 6
University, Giza, Egypt
(Abdelazeem) McLaren Flint Hospital, Flint, MI, United States
(Abdelazeem) Michigan State University, East Lansing, MI, United States
(Fayed) Cardiothoracic Surgery Department, Faculty of Medicine, Port Said
University, Port Said, Egypt
Publisher
Europa Group
Abstract
Background: Atrial fibrillation (AF) associated with postoperative
pericardial effusion is the most commonly reported adverse event after
cardiac surgery. Aim(s): We aimed to determine the role of posterior
pericardiotomy in preventing postoperative AF (POAF). Method(s): We
searched PubMed, Scopus, Web of Science, Ovid, and EBSCO from inception
until 30 June 2022. We included randomised clinical trials (RCTs) that
compared posterior pericardiotomy (PP) versus control (no PP) in patients
undergoing cardiac surgery. The primary endpoint was the incidence of POAF
after cardiac surgery. The secondary endpoints were supraventricular
arrhythmias, early/late pericardial effusion, pericardial tamponade,
pleural effusion, length of hospital/intensive care unit stay,
intra-aortic balloon pump use, revision surgery for bleeding, and
mortality. Result(s): Twenty-five RCTs comprising 4,467 patients were
included in this systematic review and meta-analysis. The overall
incidence rate of POAF was 11.7% in the PP group compared with 23.67% in
the no PP or control group, with a significant decrease in the risk of
POAF following PP (odds ratio [OR] 0.49, 95% confidence interval [CI]:
0.38-0.61). Compared with the control group, the risk of supraventricular
tachycardia (OR 0.66, 95% CI: 0.43-0.89), early pericardial effusion (OR
0.32, 95% CI: 0.22-0.46), late pericardial effusion (OR 0.15, 95% CI:
0.09-0.25), and pericardiac tamponade (OR 0.18, 95% CI: 0.10-0.33) were
lower in the PP group. Conclusion(s): PP is an effective intervention
for reducing the risk of POAF after cardiac surgery. Also, PP is
economically efficient in terms of decreasing the length of hospital
stay. Copyright © Europa Digital & Publishing 2023. All rights
reserved.

<171>
[Use Link to view the full text]
Accession Number
2025890135
Title
Early intervention or watchful waiting for asymptomatic severe aortic
valve stenosis: A systematic review and meta-analysis.
Source
Journal of Cardiovascular Medicine. 21(11) (pp 897-904), 2020. Date of
Publication: 01 Nov 2020.
Author
Ullah W.; Gowda S.N.; Khan M.S.; Sattar Y.; Al-Khadra Y.; Rashid M.;
Mohamed M.O.; Alkhouli M.; Kapadia S.; Bagur R.; Mamas M.A.; Fischman
D.L.; Alraies M.C.
Institution
(Ullah) Abington Jefferson Health, Abington, United States
(Gowda) University of South Dakota, Sioux Falls, United States
(Khan) Mercy Saint Vincent Medical Center, Michigan, United States
(Sattar) Icahn school of medicine, Mount Sinai Elmhurst Hospital, New
York, United States
(Al-Khadra, Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United
States
(Rashid, Mohamed, Mamas) Keele Cardiovascular Research Group, Centre for
Prognosis Research, Institute of Primary Care and Health Sciences, Keele
University, Academic Department of Cardiology, Royal Stoke Hospital,
United Kingdom
(Alkhouli) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, Rochester, MN, United States
(Bagur) London Health Sciences Centre, London, ON, Canada
(Fischman) Department of Cardiology, Thomas Jefferson Hospital,
Philadelphia, PA, United States
(Alraies) Detroit Medical Center, DMC Heart Hospital, Detroit, MI, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
BackgroundThe management of patients with severe but asymptomatic aortic
stenosis is challenging. Evidence on early aortic valve replacement (AVR)
versus symptom-driven intervention in these patients is
unknown.MethodsElectronic databases were searched, articles comparing
early-AVR with conservative management for severe aortic stenosis were
identified. Pooled adjusted odds ratio (OR) was computed using a
random-effect model to determine all-cause and cardiovascular
mortality.ResultsA total of eight studies consisting of 2201 patients were
identified. Early-AVR was associated with lower all-cause mortality [OR
0.24, 95% confidence interval (CI) 0.13-0.45, P <= 0.00001] and
cardiovascular mortality (OR 0.21, 95% CI 0.06-0.70, P = 0.01) compared
with conservative management. The number needed to treat to prevent 1
all-cause and cardiovascular mortality was 4 and 9, respectively. The odds
of all-cause mortality in a selected patient population undergoing
surgical AVR (SAVR) (OR 0.16, 95% CI 0.09-0.29, P <= 0.00001) and SAVR or
transcatheter AVR (TAVR) (OR 0.53, 95% CI 0.35-0.81, P = 0.003) were
significantly lower compared with patients who are managed conservatively.
A subgroup sensitivity analysis based on severe aortic stenosis (OR 0.24,
95% CI 0.11-0.52, P = 0.0004) versus very severe aortic stenosis (OR 0.20,
95% CI 0.08-0.51, P = 0.0008) also mirrored the findings of overall
results.ConclusionPatients with asymptomatic aortic valve stenosis have
lower odds of all-cause and cardiovascular mortality when managed with
early-AVR compared with conservative management. However, because of
significant heterogeneity in the classification of asymptomatic patients,
large scale studies are required. Copyright © 2020 Lippincott
Williams and Wilkins. All rights reserved.

<172>
Accession Number
641885032
Title
Nociception level index-guided antinociception versus routine care during
remifentanil-propofol anaesthesia for moderate-to-high risk cardiovascular
surgery: A randomized trial.
Source
European journal of anaesthesiology. (no pagination), 2023. Date of
Publication: 27 Jul 2023.
Author
Coeckelenbergh S.; Sessler D.I.; Doria S.; Patricio D.; Jaubert L.;
Huybrechts I.; Stefanidis C.; Kapessidou P.; Tuna T.; Engelman E.; Barvais
L.; Perrin L.
Institution
(Coeckelenbergh) From the Department of Anaesthesia and Resuscitation,
Erasme University Hospital, Universite Libre de Bruxelles, Brussels,
Belgium (SC, SD, DP, LJ, IH, TT, EE, LB, LP), Department of
Anaesthesiology and Intensive Care, Paul Brousse Hospital - Hepatobiliary
Centre, Assistance Publique - Hopitaux de Paris, Universite Paris-Saclay,
Villejuif, France (SC), Outcomes Research Consortium, Cleveland, OH,
United States (SC, DIS), Department of Outcomes Research, Anesthesiology
Institute, Cleveland Clinic, Cleveland, Ohio, United States (DIS),
Department of Cardiac Surgery, Erasme University Hospital, Universite
Libre de Bruxelles, Brussels, Belgium (CS), Department of Anaesthesiology,
Saint Pierre University Hospital, Universite Libre de Bruxelles, Brussels,
Belgium (PK), EW Data Analysis, Brussels, Belgium (EE)
Publisher
NLM (Medline)

<173>
Accession Number
641884589
Title
Comparing the effect of the Model of Therapeutic Engagement in cardiac
rehabilitation on the sense of coherence and adherence to treatment: a
randomized clinical trial.
Source
Disability and rehabilitation. (pp 1-10), 2023. Date of Publication: 27
Jul 2023.
Author
Pakrad F.; Jahandideh S.; Oshvandi K.; Majidi L.; Khazaei S.; Pakrad B.
Institution
(Pakrad) Chronic Diseases (Home Care) Research Center, Hamadan University
of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Pakrad, Oshvandi) Department of Nursing, Faculty of Nursing and
Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Jahandideh) School of Nursing and Midwifery, Deakin University, Geelong,
VIC, Australia
(Majidi) Department of Physical Medicine and Rehabilitation, Faculty of
Medicine, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Khazaei) Research Centre for Health Sciences, Hamadan University of
Medical Sciences, Hamadan, Iran, Islamic Republic of
(Pakrad) Department of exercise physiology, Farhangian University,
Hamadan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
PURPOSE: The study aimed to compare the effectiveness of a traditional
cardiac rehabilitation (CR) program with an enhanced program incorporating
the model of therapeutic engagement (MTE) and extended remote support for
patients undergoing coronary artery bypass graft (CABG) patients.
MATERIALS AND METHODS: In a randomized controlled trial, 88 CABG patients
were assigned to experimental and control groups. The experimental group
received integrated MTE cardiac rehabilitation, and assessments were
conducted at three time points: pre-CR, one month later, and three months
post-CR. The study measured medication adherence (MARS-5) and sense of
coherence (SoC-13) scales. RESULT(S): The study found no significant
differences in demographic factors between the experimental and control
groups. However, significant differences were observed in MARS and
individuals' SoC scores over time in the experimental group, with notable
improvements (p<0.001). The control group showed significant changes only
up to one month. Group effects were evident, with consistent increases in
the experimental group's outcomes at each assessment point.
 CONCLUSION(S): Integrating the MTE into CR programs offers benefits
in terms of medication adherence and individuals' sense of coherence,
which warrants further investigation and clinical implementation.

<174>
Accession Number
641883394
Title
Tacrolimus and Cyclosporin Pharmacotherapy, Detection Methods, Cytochrome
P450 Enzymes after Heart Transplantation.
Source
Cardiovascular & hematological agents in medicinal chemistry. (no
pagination), 2023. Date of Publication: 26 Jul 2023.
Author
Tolou-Ghamari Z.
Institution
(Tolou-Ghamari) Alzahra Hospital Research Centers, Nosocomial Research
Center, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Advances in organ transplantation were made after the
discovery of the pure form of cyclosporine by Dr Jean Borel in the 1970s.
In fact, in clinical practice achieving a delicate balance in circulating
immunosuppressive necessitate focus on the difficult task of
post-transplant therapeutic drug monitoring. OBJECTIVE(S): The
purpose of this study was to determine the pharmacologic properties of
cyclosporine-tacrolimus, detection methods, and the effects on the
activity of cytochrome P450 enzymes when prescribing the most efficient
treatments in forms of polypharmacy for the recipients of heart
transplantation. METHOD(S): Scientific literature on the interactions
of tacrolimus and cyclosporine with human cytochrome P450 enzymes was
searched using PUBMED.Gov (https://pubmed.ncbi.nlm.nih.gov/), Web of
Science, and Scopus. RESULT(S): Prescription immunosuppressive drugs
based on polypharmacy accompanied by induction agents could result in
hidden neurotoxicity and nephrotoxicity. A literature search shows that
cyclosporine prescription with antihypertensives drugs needs close
monitoring. Co-administration of tacrolimus and diltiazem or verapamil
needs a decrease in the tacrolimus dose by 20-50%. Vigilant attention to
the lowest possible statin dose is needed when coadministered with
fluvastatin or pravastatin. Polypharmacy based on ticlopidine,
clopidogrel, and cyclosporine or tacrolimus needs monitoring of
immunosuppressive drug levels for several months. A prescription with
clotrimazole or fluconazole needs close monitoring, and itraconazole or
ketoconazole needs to reduce the initial dose by 50%. Combination with
nefazodone needs to be avoided, and alternative drugs such as sertraline
or citalopram could be prescribed in addition to further monitoring
consideration. In prescription with phenytoin, the bound and free
phenytoin levels need close monitoring. CONCLUSION(S): Polypharmacy
based on tacrolimus or cyclosporine needs vigilant therapeutic drug
monitoring due to the cytochrome P450 enzymes associated with biochemical
variables in metabolic pathways. Further attention to polypharmacy should
be given to circulate drugs that could hide pharmacokinetics interactions
associated with infections, malignancies, chronic kidney disease, and
rejection after organ transplantation. Copyright© Bentham Science
Publishers; For any queries, please email at epub@benthamscience.net.

<175>
Accession Number
641883073
Title
Associations of inflammatory biomarkers with the risk of morbidity and
mortality after cardiac surgery: a systematic review and meta-analysis.
Source
The Canadian journal of cardiology. (no pagination), 2023. Date of
Publication: 24 Jul 2023.
Author
Heo R.H.; Wang M.K.; Meyre P.B.; Birchenough L.; Park L.; Vuong K.;
Devereaux P.J.; Blum S.; Lindahl B.; Stone G.; Conen D.
Institution
(Heo) University of Toronto, Department of Medicine, Toronto, Canada;
Population Health Research Institute, McMaster University, Hamilton,
Canada
(Wang, Devereaux, Conen) Population Health Research Institute, McMaster
University, Hamilton, Canada; Department of Medicine, McMaster University,
Hamilton, Canada; Department of Health Research Methods, Evidence &
Impact, McMaster University, Hamilton, Canada
(Meyre) Division of Cardiology and Cardiovascular Research Institute
Basel, University Hospital Basel, Basel, Switzerland
(Birchenough, Park) Faculty of Health Sciences, McMaster University,
Hamilton, Canada
(Vuong) Faculty of Health Sciences, Western University, London, Canada
(Blum) Population Health Research Institute, McMaster University,
Hamilton, Canada; Division of Cardiology and Cardiovascular Research
Institute Basel, University Hospital Basel, Basel, Switzerland
(Lindahl) Department of Medical Sciences, Uppsala University and Uppsala
Clinical Research Center, Uppsala, Sweden
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, USA; Cardiovascular Research
Foundation, New York, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although inflammatory biomarkers have been associated with
cardiovascular events in nonsurgical settings, these associations have not
been systematically addressed in patients undergoing cardiac surgery. This
review aimed to evaluate the relationships of inflammatory markers with
mortality and adverse cardiovascular events in patients undergoing cardiac
surgery. METHOD(S): MEDLINE, EMBASE, and CENTRAL databases were
systematically searched for studies reporting pre- or postoperative levels
of inflammatory biomarkers in patients undergoing cardiac surgery.
Outcomes of interest were postoperative mortality, nonfatal myocardial
infarction, stroke, congestive heart failure, or major adverse
cardiovascular events (MACE). Studies reporting multivariable adjusted
risk estimates were included. Risk estimates were pooled using
random-effects models and reported as summary odds ratios (ORs).
 RESULT(S): Among 14465 citations identified, 29 studies including
29401 participants met the eligibility criteria. The average follow-up
time after surgery was 31 months. Preoperative C-reactive protein (CRP)
levels were associated with an increased risk of all-cause mortality (OR
1.88, 95% CI 1.60-2.20, I2=19%, 11 studies) and MACE (OR 1.73, 95% CI
1.34-2.24, I2=0%, 3 studies). CRP levels measured on postoperative day 6
(OR 7.4, 95% CI 2.90-18.88, 1 study) and day 10 (OR 11.8, 95% CI
3.50-39.78, 1 study) were associated with a higher risk of all-cause
mortality. Less but overall similar information was available for other
inflammatory biomarkers. CONCLUSION(S): In this large meta-analysis,
inflammatory biomarkers measured before or after cardiac surgery were
associated with mortality and adverse cardiovascular outcomes in patients
undergoing cardiac surgery. Copyright © 2023. Published by
Elsevier Inc.

<176>
Accession Number
2025825831
Title
Statin loading before coronary artery bypass grafting: a randomized trial.
Source
European Heart Journal. 44(25) (pp 2322-2331), 2023. Date of Publication:
01 Jul 2023.
Author
Liakopoulos O.J.; Kuhn E.W.; Hellmich M.; Schlomicher M.; Strauch J.;
Reents W.; Diegeler A.; Thielmann M.; Wendt D.; Borgermann J.; Gummert
J.F.; Stoppe C.; Goetzenich A.; Martens S.; Reichenspurner H.; Wippermann
J.; Reuter H.; Choi Y.-H.; Wahlers T.
Institution
(Liakopoulos, Kuhn, Choi, Wahlers) Department of Cardiothoracic Surgery,
University Hospital Cologne, Kerpener Str. 62, Cologne 50937, Germany
(Liakopoulos, Choi) Department of Cardiac Surgery, Kerckhoff-Clinic,
Justus-Liebig-University of Giessen, Campus Kerckhoff, Benekestr. 2-8, Bad
Nauheim 61231, Germany
(Hellmich) Institute of Medical Statistics and Computational Biology,
University Hospital Cologne, Cologne, Germany
(Schlomicher, Strauch) Department of Cardiothoracic Surgery,
Ruhr-University Hospital Bergmannsheil, Bochum, Germany
(Reents, Diegeler) Department of Cardiac Surgery, Bad Neustadt a. d.
Saale, Germany
(Thielmann, Wendt) Department of Thoracic and Cardiovascular Surgery, West
German Heart and Vascular Center Essen, University Hospital Essen, Essen,
Germany
(Borgermann, Gummert) Clinic for Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum,
Bad Oeynhausen, Germany
(Stoppe, Goetzenich) Department of Thoracic and Cardiovascular Surgery,
University Hospital Aachen, Aachen, Germany
(Martens) Department of Cardiac and Thoracic Surgery, University Hospital
Munster, Munster, Germany
(Reichenspurner) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Hamburg, Germany
(Wippermann) Department of Cardiothoracic Surgery, Otto-von Guericke
University, Magdeburg, Germany
(Reuter) Department of Cardiology, University Hospital Cologne, Cologne,
Germany
Publisher
Oxford University Press
Abstract
Aims: Evidence suggests that a high-dose statin loading before a
percutaneous coronary revascularization improves outcomes in patients
receiving long-term statins. This study aimed to analyse the effects of
such an additional statin therapy before surgical revascularization.
 Methods and Results: This investigator-initiated, randomized,
double-blind, and placebo-controlled trial was conducted from November
2012 to April 2019 at 14 centres in Germany. Adult patients (n = 2635)
with a long-term statin treatment (>=30 days) who were scheduled for
isolated coronary artery bypass grafting (CABG) were randomly assigned to
receive a statin-loading therapy or placebo at 12 and 2 h prior to surgery
using a web-based system. The primary outcome of major adverse cardiac and
cerebrovascular events (MACCE) was a composite consisting of all-cause
mortality, myocardial infarction (MI), and a cerebrovascular event
occuring within 30 days after surgery. Key secondary endpoints included a
composite of cardiac death and MI, myocardial injury, and death within 12
months. Non-statistically relevant differences were found in the modified
intention-to-treat analysis (2406 patients; 1203 per group) between the
statin (13.9%) and placebo groups (14.9%) for the primary outcome [odds
ratio (OR) 0.93, 95% confidence interval (CI) 0.74-1.18; P = 0.562] or any
of its individual components. Secondary endpoints including cardiac death
and MI (12.1% vs. 13.5%; OR 0.88, 95% CI 0.69-1.12; P = 0.300), the area
under the troponin T-release curve (median 0.398 vs. 0.394 ng/ml, P =
0.333), and death at 12 months (3.1% vs. 2.9%; P = 0.825) were comparable
between treatment arms. Conclusion(s): Additional statin loading
before CABG failed to reduce the rate of MACCE occuring within 30 days of
surgery. Copyright © 2023 The Author(s). Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved.

<177>
Accession Number
2025763688
Title
Actionable Factors Fostering Health Value Generation and Scalability of
Prehabilitation: A Prospective Cohort Study.
Source
Annals of Surgery. 278(2) (pp E217-E225), 2023. Date of Publication: 01
Aug 2023.
Author
Risco R.; Gonzalez-Colom R.; Montane-Muntane M.; Cano I.; Vela E.; Sebio
R.; Dana F.; Faner J.; Coca M.; Laxe S.; Roca J.; Martinez-Palli G.
Institution
(Risco, Montane-Muntane, Dana, Coca, Martinez-Palli) Anesthesiology
Department, Hospital Clinic de Barcelona, Barcelona, Spain
(Gonzalez-Colom, Cano, Sebio, Dana, Roca, Martinez-Palli) August Pi i
Sunyer Biomedical Research Institute (IDIBAPS) University of Barcelona,
Barcelona, Spain
(Gonzalez-Colom, Cano, Roca, Martinez-Palli) Biomedical Research
Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
(Vela) Information Systems Department, Catalan Health Service, Barcelona,
Spain
(Vela) Digitalization for the Sustainability of the Healthcare System
(DS3), Catalan Health Service, Barcelona, Spain
(Laxe) Physical Medicine and Rehabilitation Department, Hospital Clinic de
Barcelona, Barcelona, Spain
(Faner) Economics Department, Metabolic and Digestive Diseases Institute,
Hospital Clinic de Barcelona, Barcelona, Spain
(Roca) Respiratory Department (ICR), Hospital Clinic de Barcelona,
Barcelona, Spain
Publisher
Wolters Kluwer Health
Abstract
Importance: Prehabilitation has potential for improving surgical outcomes
as shown in previous randomized controlled trials. However, a marked
efficacy-effectiveness gap is limiting its scalability. Comprehensive
analyses of deployment of the intervention in real-life scenarios are
required. Objective(s): To assess health outcomes and cost of
prehabilitation. Design(s): Prospective cohort study with a control
group built using propensity score-matching techniques. Setting(s):
Prehabilitation Unit in a tertiary-care university hospital.
 Participant(s): Candidates for major digestive, cardiac, thoracic,
gynecologic, or urologic surgeries. Intervention(s): Prehabilitation
program, including supervised exercise training, promotion of physical
activity, nutritional optimization, and psychological support. Main
Outcomes and Measures: The comprehensive complication index, hospital and
intensive care unit length of stay, and hospital costs per patient until
30 days after surgery. Patients were classified by the degree of program
completion and level of surgical aggression for sensitivity analysis.
 Result(s): The analysis of the entire study group did not show
differences in study outcomes between prehabilitation and control groups
(n=328 each). The per-protocol analysis, including only patients
completing the program (n=112, 34%), showed a reduction in mean hospital
stay [9.9 (7.2) vs 12.8 (12.4) days; P=0.035]. Completers undergoing
highly aggressive surgeries (n=60) additionally showed reduction in mean
intensive care unit stay [2.3 (2.7) vs 3.8 (4.2) days; P=0.021] and
generated mean cost savings per patient of 3092 (32% cost reduction)
(P=0.007). Five priority areas for action to enhance service efficiencies
were identified. Conclusions and Relevance: The study indicates a low
rate of completion of the intervention and identifies priority areas for
re-design of service delivery to enhance the effectiveness of
prehabilitation. Copyright © 2023 Lippincott Williams and
Wilkins. All rights reserved.

<178>
Accession Number
2022914359
Title
Predictors of mitral valve haemodynamics after mitral valve repair for
degenerative mitral regurgitation.
Source
Heart. 109(11) (pp 866-873), 2023. Date of Publication: 01 Jun 2023.
Author
Rumman R.K.; Verma S.; Chan V.; Mazer D.; Quan A.; Hibino M.; De Varennes
B.; Chu M.W.A.; Latter D.; Teoh H.; Yanagawa B.; Leong-Poi H.; Connelly
K.A.
Institution
(Rumman, Leong-Poi, Connelly) Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Rumman, Leong-Poi, Connelly) Division of Cardiology, Li Ka Shing
Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
(Verma, Quan, Latter, Teoh, Yanagawa) Division of Cardiac Surgery, Li Ka
Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
(Verma, Latter, Yanagawa) Department of Surgery, University of Toronto,
Toronto, ON, Canada
(Verma, Yanagawa) Department of Pharmacology and Toxicology, University of
Toronto, Toronto, ON, Canada
(Chan) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Chan) School of Epidemiology, Public Health and Preventive Medicine,
University of Ottawa, Ottawa, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Hibino) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, GA, United States
(De Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University Health Center, Montreal, QC, Canada
(Chu) Division of Cardiac Surgery, London Health Sciences Centre, Western
University, London, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Objective Intraoperative predictors of functional mitral valve (MV)
stenosis after surgical repair of mitral regurgitation (MR) caused by
prolapse remain poorly characterised. This study evaluated the effect of
annuloplasty size on postoperative MV haemodynamics during exercise and
evaluated predictors of MV hemodynamics. Methods 104 patients were
randomly assigned to leaflet resection or preservation for surgical repair
of MR in the Canadian Mitral Research Alliance CardioLink-2 study. In this
post hoc analysis, we compared MV haemodynamics between the two surgical
groups and examined the relationship between annuloplasty size and MV
haemodynamics 1 year after repair in the combined groups. Echocardiograms
were performed at baseline and intraoperatively. Exercise transthoracic
echocardiography was performed 1 year postoperatively. Multivariable
linear regression analysis was used to identify predictors of exercise MV
gradients at follow-up. Results Mean age of participants was 65+/-10
years, and 83% were male. Median annuloplasty size was 34 (IQR 32-36).
Dividing by the median, 48 (46%) had annuloplasty size of <34 mm and 56
(54%) had >=34 mm. Mean and peak exercise gradients at 1 year were 11+/-5
mm Hg and 22+/-9 mm Hg in <34, and 6+/-3 mm Hg and 14+/-5 mm Hg in >=34
(p<0.001). Rate of residual MR was similar in both groups. In
multivariable analyses, annuloplasty size of >=34 mm was associated with
lower mean and peak exercise gradients at 12 months, after adjustment for
repair type, age, sex, heart rate and body surface area (beta -4.1, 95% CI
-6 to -3, p<0.001, and beta -7 95% CI -10 to -4, p<0.001, respectively).
Intraoperative mean and peak MV gradients by transesophageal
echocardiography independently predicted mean and peak resting and
exercise gradients at follow-up (p<0.001). Similar results were obtained
in both leaflet resection and preservation. Conclusion Annuloplasty size
of >=34 mm is associated with a 4 and 7 mm Hg reduction in mean and peak
exercise MV gradients, respectively, 1 year post MV repair regardless of
the repair strategy used. Intraoperative TEE MV gradients predict exercise
MV gradients 1 year post repair. Trial registration number
NCT02552771. Copyright © 2023 BMJ Publishing Group. All rights
reserved.

<179>
Accession Number
2025963378
Title
Transcatheter Aortic Valve Replacement in Bicuspid Versus Tricuspid Aortic
Valve Stenosis: Meta-Analysis and Systemic Review.
Source
American Journal of Cardiology. 203 (pp 105-112), 2023. Date of
Publication: 15 Sep 2023.
Author
Saeed Al-Asad K.; Martinez Salazar A.; Radwan Y.; Wang E.; Salam M.F.;
Sabanci R.; Saeed M.; Halboni A.; Al-Abcha A.; Abela G.
Institution
(Saeed Al-Asad, Martinez Salazar, Radwan, Wang, Salam, Sabanci, Saeed)
Department of Internal Medicine, Michigan State University, East Lansing,
MI, United States
(Halboni) Department of Internal Medicine, Wayne State University,
Detroit, MI, United States
(Al-Abcha) Department of Cardiology, Mayo Clinic, Rochester, Minnesota,
United States
(Abela) Department of Cardiology, Michigan State University, East Lansing,
MI, United States
Publisher
Elsevier Inc.
Abstract
Because of its anatomic and procedural complexities, bicuspid aortic valve
(BAV) has been excluded from previous trials investigating transcatheter
aortic valve replacement (TAVR). We aimed to compare the clinical outcomes
of TAVR in BAV and tricuspid aortic valve patients. We searched the
databases systematically from inception until March 2023 for studies that
reported the outcomes of TAVR in BAV and tricuspid aortic valve patients.
The primary focus was all-cause mortality at 1 year. Additional outcomes
included outcomes at 30-day follow-up. Secondary and subgroup analyses
were performed on propensity-matched patients, patients at low surgical
risk, and based on the type of transcatheter valve type. We included 30
studies with a total of 193,274 patients who underwent TAVR, of which
14,353 patients had BAV stenosis. The rate of 1-year mortality was lower
in the BAV group compared with the tricuspid group with the results
reaching statistical significance (odds ratio [OR] 0.86, 95% confidence
interval [CI] 0.75 to 0.98, p = 0.02). The rate of 30-day stroke, however,
was higher in patients with BAV who underwent TAVR (OR 1.24, 95% CI 1.08
to 1.43, p <0.05). Other 30-day clinical outcomes were similar between the
2 groups. Similar outcomes were observed in secondary analysis of matched
populations with less mortality and higher rate of stroke in patients with
BAV (OR 0.84, 95% CI 0.72 to 0.96, p = 0.01, and OR 1.38, 95% CI 1.09 to
1.75, p <0.05, respectively). Comparing the outcomes for self-expandable
and balloon-expandable valves resulted in similar results. Subgroup
analysis of low-surgical-risk patients similarly showed lower 1-year
mortality in patients with BAV (OR 0.67, 95% CI 0.50 to 0.91, p = 0.01),
without difference in 30-day stroke between the 2 groups (OR 1.24, 95% CI
0.83 to 1.88, p = 0.30). In conclusion, this report indicates that TAVR is
safe and feasible in patients with BAV, including patients at low surgical
risk. The higher rate of 30-day stroke, however, warrants caution when
pursuing TAVR in this population. More studies, specifically randomized
trials, are still warranted to further assess the safety and the long-term
outcomes in this group. Copyright © 2023 Elsevier Inc.

<180>
Accession Number
2024700620
Title
Use of Preoperative Natriuretic Peptide in Predicting Mortality After
Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(9) (pp 1785-1792),
2023. Date of Publication: September 2023.
Author
Comanici M.; Nadarajah D.; Katumalla E.; Cyclewala S.; Raja S.G.
Institution
(Comanici, Nadarajah, Katumalla, Cyclewala, Raja) Department of Cardiac
Surgery, Harefield Hospital, London, United Kingdom
Publisher
W.B. Saunders
Abstract
The objective of this systematic review was to evaluate the current
evidence on the utility of preoperative B-type natriuretic peptide (BNP)
and N-terminal-pro B-type natriuretic peptide (NT-proBNP) in predicting
short-term and long-term mortality after coronary artery bypass grafting
(CABG). OVID MEDLINE, EMBASE, SCOPUS, and PUBMED were searched from 1946
to August 2022 using the following terms: "coronary artery bypass
grafting" and "BNP" and "outcomes." Eligible studies included
observational studies reporting the association between preoperative BNP
and NT-proBNP levels and short- and long-term mortality after CABG.
Articles were selected systematically, assessed for bias, and, when
possible, meta-analyzed using a random effect model. After retrieving 53
articles, 11 were included for qualitative synthesis and 4 for
quantitative meta-analysis. Studies included in this review showed that
elevated preoperative natriuretic peptide levels, despite variable
cut-offs, have been consistently shown to be associated with short- and
long-term mortality after CABG. The median BNP cut-off value was 145.5
pg/mL (25th-75th percentile 95-324.25 pg/mL), and the mean NT-proBNP value
was 765 +/- 372 pg/mL. Compared to patients with normal natriuretic
peptide levels, patients with elevated BNP and NT-proBNP presented higher
mortality rates after CABG (odds ratio 3.96, 95% confidence interval
2.41-6.52; p < 0.00001). Preoperative BNP level is a powerful predictor of
mortality in patients undergoing CABG. The measurement of BNP can add
significant value to these patients' risk stratification and therapeutic
decision-making. Copyright © 2023 Elsevier Inc.

<181>
Accession Number
2024622463
Title
Transcatheter edge-to-edge repair for mitral regurgitation using PASCAL or
MitraClip.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2023.
Date of Publication: 2023.
Author
Elbadawi A.; Dang A.T.; Hamed M.; Ali A.; Saad M.; Jneid H.; Chhatriwalla
A.K.; Goel S.; Bhatt A.; Mani P.; Bavry A.; Kumbhani D.J.
Institution
(Elbadawi, Bhatt, Mani, Bavry, Kumbhani) Division of Cardiology,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Dang) Department of Internal Medicine, University of Texas Medical
Branch, Galveston, TX, United States
(Hamed) Department of Internal Medicine, Florida Atlantic University, Boca
Raton, FL, United States
(Ali) Division of Internal Medicine, Department of Cardiology, The
University of Texas MD Anderson Cancer Center, Houston, TX, United States
(Saad) Department of Medicine' Division of Cardiology, Alpert Medical
School of Brown University, Lifespan Cardiovascular Institute, Providence,
RI, United States
(Jneid) Division of Cardiology, University of Texas Medical Branch,
Galveston, TX, United States
(Chhatriwalla) Division of Cardiology, Saint Luke's Mid America Heart
Institute and University of Missouri-Kansas City, Kansas City, MO, United
States
(Goel) Division of Cardiology, Houston Methodist, Houston, TX, United
States
Publisher
John Wiley and Sons Inc
Abstract
Background: There is a paucity of data regarding the comparative efficacy
and safety of Mitral valve transcatheter edge-to-edge repair (MTEER) using
the PASCAL or MitraClip systems for patients with mitral regurgitation
(MR). Method(s): An electronic search was conducted for MEDLINE,
COCHRANE, and EMBASE, through February 2023, for studies comparing the
clinical outcomes of MTEER using PASCAL versus MitraClip systems among
patients with severe MR. The primary study outcome was residual MR <= 2 at
discharge. Data were pooled using a random-effects model. Result(s):
The final analysis included six studies with a total of 1581 patients,
with a weighted follow-up period of 3.5 months. Two studies only included
patients with degenerative MR, while the remaining studies included both
degenerative and functional MR. There was no significant difference in
procedure duration between MTEER with the PASCAL or MitraClip systems.
There was no difference in residual MR <= 2 at discharge (94.7% vs. 91.9%;
odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.92-2.27) or
residual MR <= 2 at the mid-term follow-up (94.6% vs. 91.0%, p = 0.05)
among the PASCAL versus MitraClip systems. There was no difference between
both groups in residual MR <= 1 at discharge (73.1% vs. 63.8%, p = 0.12),
while there was greater incidence of residual MR <= 1 at midterm follow-up
with the PASCAL system (71.3% vs. 56.2%, p < 0.001). There was no
difference between the PASCAL and MitraClip MTEER systems in technical
success (97.0% vs. 97.9%, p = 0.15), procedural success (89.1% vs. 87.1%,
p = 0.78), single leaflet detachment (1.8% vs. 1.4%, p = 0.55), or
all-cause mortality (3.6% vs. 4.6%, p = 0.71). Conclusion(s): In this
meta-analysis, we demonstrated comparable efficacy and safety between the
PASCAL and MitraClip MTEER systems at short- and mid-term assessments.
Randomized trials are warranted to evaluate the comparative long-term
outcomes between both MTEER systems. Copyright © 2023 Wiley
Periodicals LLC.

<182>
Accession Number
2018448898
Title
Preoperative hypoalbuminemia in patients undergoing cardiac surgery: a
meta-analysis.
Source
Surgery Today. 53(8) (pp 861-872), 2023. Date of Publication: August 2023.
Author
Xu R.; Hao M.; Zhou W.; Liu M.; Wei Y.; Xu J.; Zhang W.
Institution
(Xu, Hao, Zhou, Liu, Wei, Xu, Zhang) Department of Cardio-Thoracic
Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde
Road, Nanchang 330006, China
(Xu, Hao, Zhou, Liu) Jiangxi Medical College, Nanchang University,
Nanchang 330006, China
Publisher
Springer
Abstract
The preoperative serum albumin level has been shown to be associated with
adverse postoperative complications, meaning that hypoalbuminemia may also
be a risk factor. We performed a meta-analysis to evaluate the association
of serum albumin levels with survival and complication rates after cardiac
surgery. Relevant articles were identified through seven databases. Twenty
studies with 22553 patients (hypoalbuminemia group, n = 9903; normal
group, n = 12650) who underwent cardiac surgery met the inclusion criteria
after screening. The primary outcomes were that hypoalbuminemia was
significantly correlated with serious long-term all-cause mortality
(hazard ratio [HR]: 1.95 [1.54-2.48]; P < 0.00001) and increased mortality
(risk ratio [RR] = 1.91 [1.61-2.27], P < 0.00001). Hypoalbuminemic
patients with cardiopathy were more likely to suffer postoperative
complications (bleeding, infections, renal injury, and others) than those
whose serum albumin levels were normal. Furthermore, hypoalbuminemia
increased the time in the intensive-care unit (ICU) (mean difference [MD]
= 1.18 [0.49-1.87], P = 0.0008), length of hospital stay (LOS) (MD = 3.34,
95% CI: 1.88-4.80, P < 0.00001), and cardiopulmonary bypass time (CPB) (MD
= 12.40 [1.13-23.66], P = 0.03). Hypoalbuminemia in patients undergoing
cardiac surgery appears to have a poor all-cause mortality or increased
risk of complications. Adjusted perioperative serum albumin levels and
treatment strategies for this high-risk population have the potential to
improve the survival. Copyright © 2022, The Author(s) under
exclusive licence to Springer Nature Singapore Pte Ltd.

<183>
[Use Link to view the full text]
Accession Number
641547913
Title
Tricuspid valve repair concomitant with mitral valve surgery: a systematic
review and meta-analysis.
Source
International journal of surgery (London, England). 109(7) (pp 2082-2095),
2023. Date of Publication: 01 Jul 2023.
Author
Yi K.; Xu J.; Zhang X.; Wang W.; Liu C.; Li X.; You T.
Institution
(Yi, You) Department of Cardiovascular Surgery, Gansu Provincial Hospital
(Yi, Xu, Zhang, Wang, You) Gansu International Scientific and
Technological Cooperation Base of Diagnosis and Treatment of Congenital
Heart Disease, Gansu Province, Lanzhou, China
(Wang) Department of Cardiac Surgery, First Hospital of China Medical
University, Shenyang, Liaoning, China
(Xu) Evidence-Based Medicine Center, School of Basic Medical Sciences,
Lanzhou University
(Zhang, Wang) First School of Clinical Medicine of Gansu University of
Chinese Medicine, China
(Liu, Li) First Clinical Medical College of Lanzhou University, Lanzhou,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Uncertainties persist about whether to aggressively and
effectively treat tricuspid regurgitation (TR) during mitral valve (MV)
surgery. REVIEW METHODS: Systematic literature searches were performed in
five databases to collect all relevant studies published before May 2022
on whether the tricuspid valve was treated during MV surgery. Separate
meta-analyses were performed on data from unmatched studies and randomized
controlled trials (RCT)/adjusted studies. MAIN RESULTS: A total of 44
publications were included, of which eight were RCT studies and the rest
were retrospective studies. There was no difference in 30-day mortality
[odds ratio (OR): 1.00, 95% CI: 0.71-1.42, OR: 0.66, 95% CI: 0.30-1.41)]
or overall survival [hazard ratio (HR): 1.01, 95% CI: 0.85-1.19, HR: 0.77,
95% CI: 0.52-1.14] in unmatched studies and RCT/adjusted studies. Late
mortality (OR: 0.37, 95% CI: 0.21-0.64) and cardiac-related mortality (OR:
0.36, 95% CI: 0.21-0.62) were lower in the tricuspid valve repair (TVR)
group in the RCT/adjusted studies. In the unmatched studies, overall
cardiac mortality (OR: 0.48, 95% CI: 0.26-0.88) was lower in the TVR
group. In the late TR progression analysis, the late TR progression was
lower among patients in the concomitantly intervened tricuspid group, and
patients in the untreated tricuspid group were prone to TR progression in
both studies (HR: 0.30, 95% CI: 0.22-0.41, HR: 0.37, 95% CI: 0.23-0.58).
 CONCLUSION(S): TVR concomitant with MV surgery is most effective in
patients with significant TR and dilated tricuspid annulus, especially
those with a significantly reduced risk of distant TR
progression. Copyright © 2023 The Author(s). Published by Wolters
Kluwer Health, Inc.

<184>
Accession Number
641875119
Title
THE EFFECT OF OCTREOTIDE IN ACUTE NON-VARICEAL UPPER GASTROINTESTINAL
BLEEDING IN CHILDREN.
Source
Journal of Pediatric Gastroenterology and Nutrition. Conference: 55th
Annual Meeting of the European Society for Paediatric Gastroenterology
Hepatology and Nutrition, ESPGHAN 2023. Vienna Austria. 76(Supplement 1)
(pp 158-159), 2023. Date of Publication: June 2023.
Author
Vimalesvaran S.; Gaynor E.
Institution
(Vimalesvaran, Gaynor) Department of Paediatric Gastroenterology, Great
Ormond Street Hospital, London, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives and Study: Nonvariceal upper gastrointestinal bleeding (NVUGIB)
is a common complication in critically unwell patients, with limited
treatment options. It is associated with significant morbidity and
mortality. Whilst octreotide is effective in variceal UGIB, little is
known about the use in NVUGIB. The aim of this study was evaluate the
efficacy and safety of octreotide in NVUGIB in children. Method(s): A
retrospective cohort study of children with NVUGIB, treated with
octreotide from April 2019 to October 2022. Exclusion criteria included
varices and history of cirrhosis. Primary outcomes included clinical
resolution of NVUGIB, reduction of bleed and stabilisation of haemoglobin
(Hb). Secondary outcomes included reduction in need for transfusion,
endoscopy, imaging and mortality within 30-days. Result(s): 27
patients were included (Table 1). Median age was 4.6 years (range 1.7-10.0
years). Main presentations were acute Hb drop (74.1%), melaena (55.6%) and
frank haematemesis (29.6%). 17 patients (63.0%) were admitted to PICU;
main comorbidities being post-bone marrow transplantation (BMT) and
post-cardiac surgery on anticoagulation. A standardised protocol using
intravenous octreotide infusion was used. Mean duration of administration
was 7.6 days (2.0-12.0 days). All patients were refractory to high dose
proton pump inhibitors, requiring escalation of treatment. The majority of
patients achieved stabilisation of Hb (85.2%), with clinical resolution in
21 patients (77.8%). Only nine patients (33.3%) underwent endoscopy, of
which four (44.4%) occurred within 24-hours of NVUGIB; most common finding
being erosive gastritis/ oesophagitis. Three patients (11.1%) had side
effects with episodes of hyperglycaemia. Mortality occurred in eight
patients (29.6%); five secondary to complications of BMT.
 Conclusion(s): There are significant costs and side effects
associated with octreotide and the role remains uncertain. However, we
showed that in high-risk patients with NVUGIB, refractory to other
treatment, the use of octreotide as an adjunct was safe and offered
clinical benefit. Larger randomised controlled studies are needed to
validate these results.

<185>
Accession Number
2025931000
Title
Patient-reported outcome measures in congenital heart surgery: A
systematic review.
Source
Cardiology in the Young. 33(3) (pp 337-341), 2023. Date of Publication: 18
Mar 2023.
Author
Francis J.; Prothasis S.; George J.; Stoica S.
Institution
(Francis) Department of Medical Science, The University of Edinburgh, 47
Little France Crescent, Edinburgh EH164TJ, United Kingdom
(Prothasis) Department of Medical Science, The University of Aberdeen,
Polwarth Building, Aberdeen AB25 2ZD, United Kingdom
(George) Department of Cardiac Surgery, Great Ormond Street Hospital,
London WC1N 3JH, United Kingdom
(Stoica) Department of Cardiac Surgery, Bristol Children's Hospital,
Bristol BS2 8BJ, United Kingdom
Publisher
Cambridge University Press
Abstract
Background: Patient-reported outcome measures are commonly used to
evaluate the effectiveness of treatments. CHD remains the most common
congenital malformation. There has been a gradual shift in evaluating the
outcome of surgery for CHD from mortality to morbidity and now to
self-reported outcomes. Aim(s): We aimed to review studies assessing
patient-reported outcome measures as a useful marker of outcome for
patients, both children and adults, who underwent surgery for CHD.
 Method(s): A systematic database search was conducted of original
articles that explored the application of patient-reported outcome
measures in the CHD surgical setting in PubMed and SCOPUS from inception
to February 2022. Result(s): Our search yielded 1511 papers, of which
six studies were included in this review after screening abstract and
full-text, with a total sample size of 5734 patients. The main areas of
discussion were the utility of patient-reported outcome measures,
determinants of patient-reported outcome measures, and the need for a
congenital cardiac surgery-specific patient-reported outcome measure for
paediatric patients and their parents/guardians and adult patients.
 Conclusion(s): This systematic review reports the use of
patient-reported outcome measures to be a useful indicator to gain insight
into the patients' perspective to provide holistic and patient-centred
management. However, further studies are required to assess the utility of
patient-reported outcome measures in a congenital cardiac surgical
setting. Copyright © The Author(s), 2023. Published by Cambridge
University Press.

<186>
[Use Link to view the full text]
Accession Number
2025997795
Title
Impact of Comorbidities and Antiplatelet Regimen on Platelet Reactivity
Levels in Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
Journal of Cardiovascular Pharmacology. 78(3) (pp 463-473), 2021. Date of
Publication: 06 Sep 2021.
Author
Trejo-Velasco B.; Tello-Montoliu A.; Cruz-Gonzalez I.; Moreno R.;
Baz-Alonso J.A.; Salvadores P.J.; Romaguera R.; Molina-Navarro E.;
Paredes-Galan E.; Fernandez-Barbeira S.; Ortiz-Saez A.; Bastos-Fernandez
G.; De Miguel-Castro A.; Figueiras-Guzman A.; Iniguez-Romo A.;
Jimenez-Diaz V.A.
Institution
(Trejo-Velasco, Cruz-Gonzalez) Cardiology Department, Hospital
Universitario de Salamanca, Instituto de Investigacion Biomedica de
Salamanca (IBSAL), Salamanca, Spain
(Tello-Montoliu) Cardiology Department, Hospital Universitario Virgen de
la Arrixaca, IMIB-Arrixaca, Murcia, Spain
(Tello-Montoliu, Cruz-Gonzalez, Moreno, Iniguez-Romo, Jimenez-Diaz) Centro
de Investigacion en Red de Enfermedades Cardiovasculares, Network Research
Center for Cardiovascular Diseases, CIBER-CV, Madrid, Spain
(Moreno) Interventional Cardiology, Instituto de Investigacion Del
Hospital la Paz (IDIPAZ), University Hospital la Paz, Madrid, Spain
(Baz-Alonso, Paredes-Galan, Fernandez-Barbeira, Ortiz-Saez,
Bastos-Fernandez, De Miguel-Castro, Iniguez-Romo, Jimenez-Diaz) Cardiology
Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo,
Spain
(Salvadores, Jimenez-Diaz) Cardiovascular Research Unit, Cardiology
Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo,
Spain
(Salvadores, Jimenez-Diaz) Cardiovascular Research Group, Galicia sur
Health Research Institute, IIS Galicia, SERGAS-UVIGO, Vigo, Spain
(Romaguera) Cardiology Department, Hospital Universitario de Bellvitge,
Barcelona, Spain
(Molina-Navarro) Cardiology Department, Hospital Universitario Virgen de
Las Nieves, Granada, Spain
(Figueiras-Guzman) Departamento de Medicina Preventiva y Salud Publica,
Facultad de Medicina, Universidad de Santiago de Compostela, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
The aim of our study is to assess the impact of anemia, chronic kidney
disease, and diabetes mellitus on platelet reactivity (PR) in patients
with severe aortic stenosis, both at baseline and after transcatheter
aortic valve implantation (TAVI). This study is a prespecified subanalysis
of the REAC-TAVI prospective, multicenter trial that included patients
pretreated with aspirin + clopidogrel before TAVI. PR was measured at
baseline and at 5 different time points after TAVI with the VerifyNow
assay (Accriva Diagnostics, San Diego, CA), over a 3-month follow-up
period. Patients with high PR (HPR) at baseline, before TAVI (n = 48) were
randomized to aspirin + clopidogrel or aspirin + ticagrelor for 3 months,
whereas those with normal PR (NPR) (n = 20) were continued on aspirin +
clopidogrel. A "raiser response" in PR was defined as an increase in PR
units >20% of baseline after TAVI. Patients with HPR before TAVI presented
concomitant anemia and chronic kidney disease more frequently than their
counterparts with NPR. Anemia and higher body mass index were
independently associated with HPR to clopidogrel at baseline. Moreover,
anemic patients with baseline HPR who were continued on clopidogrel
presented higher PR after TAVI than patients with HPR switched to
ticagrelor. All patients with baseline NPR presented a "raiser response"
after TAVI, which was nonexistent among patients with HPR managed with
ticagrelor. In summary, anemia seems as a relevant factor associated with
baseline HPR and higher PR after TAVI in patients with baseline HPR
randomized to clopidogrel, whereas ticagrelor proved more effective than
clopidogrel at attaining sustained reductions in PR during follow-up,
regardless of baseline comorbidities. Copyright © 2021 Lippincott
Williams and Wilkins. All rights reserved.

<187>
Accession Number
2025966555
Title
Renin-angiotensin-aldosterone system dynamics after targeted blood
pressure control using angiotensin II or norepinephrine in cardiac
surgery: mechanistic randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2023. Date of
Publication: 2023.
Author
Coulson T.G.; Miles L.F.; Zarbock A.; Burrell L.M.; Patel S.K.; von Groote
T.; Pilcher D.; Weinberg L.; Landoni G.; Bellomo R.
Institution
(Coulson) Department of Anaesthesiology and Perioperative Medicine, Alfred
Health and Monash University, Melbourne, VIC, Australia
(Coulson, Miles, Weinberg, Bellomo) Department of Critical Care,
University of Melbourne, Melbourne, VIC, Australia
(Miles, Weinberg) Department of Anaesthesia and Pain Medicine, Austin
Health, Melbourne, VIC, Australia
(Zarbock, von Groote) Department of Anaesthesiology, Intensive Care and
Pain Medicine, University Hospital Munster, Munster, Germany
(Burrell, Patel) Department of Medicine, Austin Health, University of
Melbourne, Heidelberg, VIC, Australia
(Burrell) Department of Cardiology, Austin Health, Heidelberg, VIC,
Australia
(Burrell) The Institute for Breathing and Sleep, Heidelberg, VIC,
Australia
(Pilcher) Department of Intensive Care, Alfred Hospital, Melbourne, VIC,
Australia
(Pilcher, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University, Melbourne, VIC, Australia
(Landoni) Department of Anaesthesia, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Melbourne, VIC,
Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Melbourne, VIC, Australia
Publisher
Elsevier Ltd
Abstract
Background: The role of the renin-angiotensin-aldosterone axis in
vasoplegia after cardiac surgery remains unclear. We tested the hypothesis
that, compared with norepinephrine, infusion of angiotensin II titrated to
achieve similar mean arterial pressure (MAP) would suppress plasma renin
concentration (PRC) while maintaining aldosterone levels. Method(s):
In a double-blind, randomised controlled trial, subjects received either
an infusion of angiotensin II or norepinephrine to maintain MAP 70-80 mm
Hg from induction of anaesthesia. We compared PRC, aldosterone, dipeptidyl
peptidase-3, and angiotensin-converting enzyme 2 activity between
treatment groups, before surgery, on ICU admission, and 24 h after
surgery. Result(s): In 60 patients (11.7% female; mean age 68 yr [11
yr]), norepinephrine increased median PRC at ICU admission (median
difference [MD] 46 [inter-quartile range, IQR, 3-88] muU ml-1;
P<0.001) but angiotensin II did not (MD -3 [IQR -62 to 35] muU
ml-1; P=0.36). Aldosterone levels increased with both. The
aldosterone:PRC ratio did not change with norepinephrine (MD -0.01 [IQR
-0.14 to 0.03] muU ml-1 per ng dl-1, P=0.76) but
increased with angiotensin II (MD 0.05 [IQR 0.004-0.26] muU
ml-1 per ng dl-1, P<0.001). The upper quartile of
PRC before surgery was associated with higher vasopressor requirements
when norepinephrine was used to maintain MAP, but not angiotensin II.
Dipeptidyl peptidase-3 levels and angiotensin-converting enzyme 2
activities were similar at all time points. Conclusion(s):
Angiotensin II suppressed renin release while maintaining aldosterone
levels compared with norepinephrine. Higher plasma renin concentration
before surgery was associated with greater vasopressor requirement for
norepinephrine, but not angiotensin II. Clinical trial registration:
Australian and New Zealand Clinical Trials Registry-ACTRN12621000195853
23/02/2021. Copyright © 2023 British Journal of Anaesthesia

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