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<1>
Accession Number
2027537872
Title
Flow-controlled versus pressure-controlled ventilation in cardiac surgery
with cardiopulmonary bypass - A single-center, prospective, randomized,
controlled trial.
Source
Journal of Clinical Anesthesia. 91 (no pagination), 2023. Article Number:
111279. Date of Publication: December 2023.
Author
Spraider P.; Abram J.; Martini J.; Putzer G.; Glodny B.; Hell T.; Barnes
T.; Enk D.
Institution
(Spraider, Abram, Martini, Putzer) Department of Anaesthesiology and
Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35,
Innsbruck 6020, Austria
(Glodny) Department of Radiology, Medical University of Innsbruck,
Anichstrasse 35, Innsbruck 6020, Austria
(Hell) Department of Mathematics, Faculty of Mathematics, Computer Science
and Physics, University of Innsbruck, Technikerstrasse 15, Innsbruck 6020,
Austria
(Barnes) University of Greenwich, Old Royal Naval College, Park Row,
London SE109LS, United Kingdom
(Enk) Faculty of Medicine, University of Munster, Albert-Schweitzer-Campus
1, Munster 48149, Germany
Publisher
Elsevier Inc.
Abstract
Study objective: Multifactorial comparison of flow-controlled ventilation
(FCV) to standard of pressure-controlled ventilation (PCV) in terms of
oxygenation in cardiac surgery patients after chest closure.
 Design(s): Prospective, non-blinded, randomized, controlled trial.
 Setting(s): Operating theatre at an university hospital, Austria.
 Patient(s): Patients scheduled for elective, open, on-pump, cardiac
surgery. Intervention(s): Participants were randomized to either
individualized FCV (compliance guided end-expiratory and peak pressure
setting) or control of PCV (compliance guided end-expiratory pressure
setting and tidal volume of 6-8 ml/kg) for the duration of surgery.
Measurements: The primary outcome measure was oxygenation
(PaO<inf>2</inf>/FiO<inf>2</inf>) 15 min after intraoperative chest
closure. Secondary endpoints included CO<inf>2</inf>-removal assessed as
required minute volume to achieve normocapnia and lung tissue aeration
assessed by Hounsfield unit distribution in postoperative computed
tomography scans. Main Result(s): Between April 2020 and April 2021
56 patients were enrolled and 50 included in the primary analysis (mean
age 70 years, 38 (76%) men). Oxygenation, assessed by
PaO<inf>2</inf>/FiO<inf>2</inf>, was significantly higher in the FCV group
(n = 24) compared to the control group (PCV, n = 26) (356 vs. 309, median
difference (MD) 46 (95% CI 3 to 90) mmHg; p = 0.038). Additionally, the
minute volume required to obtain normocapnia was significantly lower in
the FCV group (4.0 vs. 6.1, MD -2.0 (95% CI -2.5 to -1.5) l/min; p <
0.001) and correlated with a significantly lower exposure to mechanical
power (5.1 vs. 9.8, MD -5.1 (95% CI -6.2 to -4.0) J/min; p < 0.001).
Evaluation of lung tissue aeration revealed a significantly reduced amount
of non-aerated lung tissue in FCV compared to PCV (5 vs. 7, MD -3 (95% CI
-4 to -1) %; p < 0.001). Conclusion(s): In patients undergoing
on-pump, cardiac surgery individualized FCV significantly improved
oxygenation and lung tissue aeration compared to PCV. In addition, carbon
dioxide removal was accomplished at a lower minute volume leading to
reduced applied mechanical power. Copyright © 2023 The Authors

<2>
Accession Number
2027356724
Title
Scoping review of percutaneous mechanical aspiration for valvular and
cardiac implantable electronic device infective endocarditis.
Source
Clinical Microbiology and Infection. (no pagination), 2023. Date of
Publication: 2023.
Author
Mourad A.; Hillenbrand M.; Skalla L.A.; Holland T.L.; Zwischenberger B.A.;
Williams A.R.; Turner N.A.
Institution
(Mourad, Hillenbrand, Holland, Turner) Department of Medicine, Division of
Infectious Diseases, Duke University Medical Center, Durham, NC, United
States
(Skalla) Duke University Medical Center Library & Archives, Duke
University School of Medicine, Durham, NC, United States
(Zwischenberger, Williams) Department of Surgery, Division of
Cardiovascular and Thoracic Surgery, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier B.V.
Abstract
Background: Percutaneous mechanical aspiration (PMA) of intravascular
vegetations is a novel strategy for management of patients with infective
endocarditis (IE) who are at high risk of poor outcomes with conventional
cardiac surgery. However, clear indications for its use as well as patient
outcomes are largely unknown. Objective(s): To conduct a scoping
review of the literature to summarize patient characteristics and outcomes
of those undergoing PMA for management of IE. Method(s): Two
independent reviewers screened abstracts and full text for inclusion and
independently extracted data. Data sources: MEDLINE, Embase, and Web of
Science. Study eligibility criteria: Studies published until February 21,
2023, describing the use of PMA for management of patients with cardiac
implantable electronic device (CIED) or valvular IE were included.
Assessment of risk of bias: As this was a scoping review, risk of bias
assessment was not performed. Methods of data synthesis: Descriptive data
was reported. Result(s): We identified 2252 titles, of which 1442
abstracts were screened, and 125 full text articles were reviewed for
inclusion. Fifty-one studies, describing a total of 294 patients who
underwent PMA for IE were included in our review. Over 50% (152/294) of
patients underwent PMA to debulk cardiac implantable electronic device
lead vegetations prior to extraction (152/294), and 38.8% (114/294) of
patients had a history of drug use. Patient outcomes were inconsistently
reported, but few had procedural complications, and all-cause in-hospital
mortality was 6.5% (19/294). Conclusion(s): While PMA is a promising
advance in the care of patients with IE, higher quality data regarding
patient outcomes are needed to better inform the use of this
procedure. Copyright © 2023 European Society of Clinical
Microbiology and Infectious Diseases

<3>
Accession Number
2017454595
Title
A Comparison on Effects of High Dose Rosuvastatin versus High Dose
Atorvastatin on Lipid Profile and CRP Level in Patients Undergoing
Percutaneous Coronary Intervention: A Randomized Study.
Source
Pharmaceutical Sciences. 27(4) (pp 568-574), 2021. Date of Publication:
December 2021.
Author
Darban M.; Yusefabadi E.; Khani M.M.; Sohrabi B.; Bagheri B.
Institution
(Darban) Department of Internal Medicine, Kowsar Hospital, Semnan
University of Medical Sciences, Semnan, Iran, Islamic Republic of
(Yusefabadi) Student Research Committee, Kowsar Hospital, Semnan
University of Medical Sciences, Semnan, Iran, Islamic Republic of
(Khani) Social Determinates of Health Research Center, Semnan University
of Medical Sciences, Semnan, Iran, Islamic Republic of
(Khani) Department of Epidemiology and Biostatistics, Semnan University of
Medical Sciences, Semnan, Iran, Islamic Republic of
(Sohrabi) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Bagheri) Cancer Research Center, Semnan University of Medical Sciences,
Semnan, Iran, Islamic Republic of
(Bagheri) Center for Molecular Cardiology, University of Zurich,
Schlieren, Switzerland
Publisher
Tabriz University of Medical Sciences
Abstract
Background: Statins are the most common drugs used for reducing
low-density lipids (LDL). In addition to their lipid-lowering effects,
they have well-documented anti-inflammatory actions. The goal of this
study was to compare the effects of high dose atorvastatin and
rosuvastatin on lipid profiles and high sensitivity C Reactive Protein
(hs-CRP) in patients undergoing percutaneous coronary intervention (PCI).
 Method(s): The study was done between October 2017 and September 2018
in Semnan Kowsar Hospital. In this randomized trial, 69 patients with
atherosclerotic coronary artery disease were randomly assigned 1:1 to
receive atorvastatin (80 mg daily) or rosuvastatin (40 mg daily) for 4
months. Levels of hs-CRP and lipid profiles including cholesterol,
triglyceride, low-density lipids (LDL), and high-density lipids (HDL) were
measured and compared before and after the treatments. Lipid profiles were
measured at baseline, 2 months, and 4 months of the treatment.
 Result(s): Sixty patients completed the study. The mean age was 61.1
+/- 6.6 years with an excess of males. After 4 months, both drugs could
significantly reduce LDL levels, however, the between-group differences
were not statistically significant. Rosuvastatin significantly increased
HDL levels (p < 0.05). In addition, triglyceride levels had a significant
reduction in both groups, yet the differences were not significant. Both
drugs caused significant reductions in hs-CRP levels (p < 0.05). Moreover,
the effects of treatments were seen in drug naive patients as well as
patients who were on statins prior to the trial. Conclusion(s): The
results indicate that high dose therapies with atorvastatin and
rosuvastatin have similar effects on lipid profiles and hs-CRP levels in
patients undergoing PCI. Copyright © 2021 The Author(s).

<4>
Accession Number
2027270633
Title
Comparison of Antiplatelet Monotherapies After Percutaneous Coronary
Intervention According to Clinical, Ischemic, and Bleeding Risks.
Source
Journal of the American College of Cardiology. 82(16) (pp 1565-1578),
2023. Date of Publication: 17 Oct 2023.
Author
Yang S.; Kang J.; Park K.W.; Hur S.-H.; Lee N.H.; Hwang D.; Yang H.-M.;
Ahn H.-S.; Cha K.S.; Jo S.-H.; Ryu J.K.; Suh I.-W.; Choi H.-H.; Woo S.-I.;
Han J.-K.; Shin E.-S.; Koo B.-K.; Kim H.-S.
Institution
(Yang, Kang, Park, Hwang, Yang, Han, Koo, Kim) Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, South
Korea
(Hur) Keimyung University Dongsan Hospital, Daegu, South Korea
(Lee) Kangnam Sacred Heart Hospital, Hallym University, Seoul, South Korea
(Ahn) Uijeongbu St Mary's Hospital, Uijeongbu, South Korea
(Cha) Pusan National University Hospital, Busan, South Korea
(Jo) Hallym University Sacred Heart Hospital, Anyang, South Korea
(Ryu) Daegu Catholic University Medical Center, Daegu, South Korea
(Suh) Anyang SAM Medical Center, Anyang, South Korea
(Choi) Chuncheon Sacred Heart Hospital, Hallym University College of
Medicine, Chuncheon, South Korea
(Woo) Inha University Hospital, Inha University, Incheon, South Korea
(Shin) Ulsan University Hospital, Ulsan, South Korea
Publisher
Elsevier Inc.
Abstract
Background: Clopidogrel was superior to aspirin monotherapy in secondary
prevention after percutaneous coronary intervention (PCI).
 Objective(s): The purpose of this study was to evaluate the benefits
of clopidogrel across high-risk subgroups Methods: This was a post hoc
analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of
coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that
randomly assigned patients who were event free for 6 to 18 months post-PCI
on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy.
Two clinical risk scores were used for risk stratification: the DAPT score
and the Thrombolysis In Myocardial Infarction Risk Score for Secondary
Prevention (TRS 2degreeP) (the sum of age >=75 years, diabetes,
hypertension, current smoking, peripheral artery disease, stroke, coronary
artery bypass grafting, heart failure, and renal dysfunction). The primary
composite endpoint was a composite of all-cause death, nonfatal myocardial
infarction, stroke, readmission because of acute coronary syndrome, and
major bleeding (Bleeding Academic Research Consortium type >=3) at 2 years
after randomization. Result(s): Among 5,403 patients, clopidogrel
monotherapy showed a lower rate of the primary composite endpoint than
aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of
clopidogrel over aspirin was consistent regardless of TRS 2degreeP (high
TRS 2degreeP [>=3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS
2degreeP [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction =
0.454) and regardless of DAPT score (high DAPT score [>=2] group: HR: 0.68
[95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI:
0.59-0.96]) (P for interaction = 0.662). The association was similar for
the individual outcomes. Conclusion(s): The beneficial effect of
clopidogrel over aspirin monotherapy was consistent regardless of clinical
risk or relative ischemic and bleeding risks compared with aspirin
monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary
Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM];
NCT02044250) Copyright © 2023 American College of Cardiology
Foundation

<5>
Accession Number
2027131707
Title
Myocardial Protection by Desflurane: From Basic Mechanisms to Clinical
Applications.
Source
Journal of Cardiovascular Pharmacology. 82(3) (pp 169-179), 2023. Date of
Publication: 25 Sep 2023.
Author
Qin H.; Zhou J.
Institution
(Qin, Zhou) Department of Anesthesiology, Shengjing Hospital, China
Medical University, Shenyang, China
Publisher
Lippincott Williams and Wilkins
Abstract
Coronary heart disease is an affliction that is common and has an adverse
effect on patients' quality of life and survival while also raising the
risk of intraoperative anesthesia. Mitochondria are the organelles most
closely associated with the pathogenesis, development, and prognosis of
coronary heart disease. Ion abnormalities, an acidic environment, the
production of reactive oxygen species, and other changes during abnormal
myocardial metabolism cause the opening of mitochondrial permeability
transition pores, which disrupts electron transport, impairs mitochondrial
function, and even causes cell death. Differences in reliability and
cost-effectiveness between desflurane and other volatile anesthetics are
minor, but desflurane has shown better myocardial protective benefits in
the surgical management of patients with coronary artery disease. The
results of myocardial protection by desflurane are briefly summarized in
this review, and biological functions of the mitochondrial permeability
transition pore, mitochondrial electron transport chain, reactive oxygen
species, adenosine triphosphate-dependent potassium channels, G
protein-coupled receptors, and protein kinase C are discussed in relation
to the protective mechanism of desflurane. This article also discusses the
effects of desflurane on patient hemodynamics, myocardial function, and
postoperative parameters during coronary artery bypass grafting. Although
there are limited and insufficient clinical investigations, they do
highlight the possible advantages of desflurane and offer additional
suggestions for patients. Copyright © 2023 Wolters Kluwer Health,
Inc. All rights reserved.

<6>
Accession Number
2026912932
Title
An Evidence-Based Approach to Anticoagulation Therapy Comparing Direct
Oral Anticoagulants and Vitamin K Antagonists in Patients With Atrial
Fibrillation and Bioprosthetic Valves: A Systematic Review, Meta-Analysis,
and Network Meta-Analysis.
Source
American Journal of Cardiology. 206 (pp 132-150), 2023. Date of
Publication: 01 Nov 2023.
Author
Suppah M.; Kamal A.; Saadoun R.; Baradeiya A.M.A.; Abraham B.; Alsidawi
S.; Sorajja D.; Fortuin F.D.; Arsanjani R.
Institution
(Suppah, Abraham, Alsidawi, Sorajja, Fortuin, Arsanjani) Department of
Cardiology, Mayo Clinic Arizona, Phoenix, Arizona, United States
(Kamal, Saadoun) Department of Cardiology, University of Pittsburgh
Medical Center, Hillman Cancer Center, Pittsburgh, PA, United States
(Baradeiya) Internal Medicine Department, Baylor College of Medicine,
Houston, Texas, United States
Publisher
Elsevier Inc.
Abstract
Direct oral anticoagulants (DOACs) are a newer class of anticoagulants
that inhibit factor Xa or factor IIa and include drugs such as
rivaroxaban, apixaban, edoxaban, betrixaban, and dabigatran. Although
vitamin K antagonists (VKAs) have been traditionally used to prevent
thromboembolic events, DOACs have gained popularity because of their
faster onset and offset of action and reduced need for monitoring. This
study aimed to provide more data for anticoagulants in patients with
atrial fibrillation with bioprosthetic heart valves by incorporating all
available trials to date. A search was performed across 5 electronic
databases to identify relevant studies. We analyzed the data using a
pooled risk ratio for categorical outcomes and used the I2 test
to determine heterogeneity. The quality of randomized controlled trials
was assessed using the Cochrane risk of bias assessment tool, and the
National Institutes of Health tool was used for observational studies. Our
study included a frequentist network meta-analysis (MA) of the aggregate
data to obtain the network estimates for the outcomes of interest. We
retrieved 28 studies with a total of 74,660 patients with bioprosthetic
heart valves. Our MA significantly showed that DOACs decrease the risk of
all-cause bleeding (risk ratio [RR] 0.80, 95% confidence interval [CI]
0.75 to 0.85, p >0.00001), stroke and systemic embolization (RR 0.89, 95%
CI 0.80 to 0.99, p = 0.03), and intracranial bleeding outcomes (RR 0.62,
95% CI 0.45 to 0.86, p = 0.004) compared with VKA. In contrast, there was
no significant difference between the compared groups in major bleeding
(RR = 0.92, 95% CI 0.84 to 1.02, p = 0.10) and all-cause mortality
outcomes (RR = 0.96, 95% CI 0.85 to 1.07, p = 0.43), respectively. In
addition, the network MA results did not favor any of the studied
interventions over each other (p <0.05) regarding all-cause bleeding,
mortality, stroke and systemic embolization, and major bleeding outcomes.
In conclusion, our study found that DOACs are more effective in reducing
the risk of bleeding, stroke, systemic embolism, and intracranial bleeding
than VKAs. However, no significant difference was observed in the
incidence of gastrointestinal bleeding, major bleeding, thromboembolic
events, and all-cause mortality. In addition, our network MA did not
identify any specific DOAC treatment as more favorable than
others. Copyright © 2023 Elsevier Inc.

<7>
Accession Number
2026432966
Title
Pleural effusion secondary to endometriosis: A systematic review.
Source
American Journal of the Medical Sciences. 366(4) (pp 296-304), 2023. Date
of Publication: October 2023.
Author
Porcel J.M.; Sancho-Marquina P.; Monteagudo P.; Bielsa S.
Institution
(Porcel, Sancho-Marquina, Monteagudo, Bielsa) Pleural Medicine Unit,
Department of Internal Medicine, Arnau de Vilanova University Hospital
Hospital, IRBLleida, Universitat de Lleida, Lleida, Spain
Publisher
Elsevier B.V.
Abstract
Background: Endometriosis-associated pleural effusion is a rare occurrence
with poorly defined clinical characteristics. Method(s): A systematic
review was performed to examine all articles on endometriosis-associated
pleural effusion extracted from 4 databases (PubMed, Embase, Web of
Science and Scopus) from inception until November 2022. Result(s): A
total of 142 articles (isolated cases and small retrospective series)
involving 176 patients (median age 33 years) with endometriosis-associated
pleural effusion were included. The most frequent symptoms were dyspnea
(67%), chest pain (55%) and abdominal pain (40%). Pleural effusion was
predominantly unilateral (89%), right-sided (88.5%) and massive (56%).
Ascites was evident in 42% of the cases. Pleural fluid had a bloody
appearance in 99% of cases and always met the exudate criteria. Pleural
fluid cytology identified only 9% of the patients, with pleural biopsy
being the most common diagnostic procedure (74%). Most patients were
treated with hormones (76%), thoracic surgery (60%) and abdominal surgery
(27%). Effusion recurrence was observed in 26% of cases after a median
follow-up of 1 year. Conclusion(s): The presence of right-sided
hemorrhagic pleural effusion in a young woman warrants an assessment for
the possibility of endometriosis. Despite conventional treatment, effusion
recurs in approximately a quarter of patients. Copyright © 2023
Southern Society for Clinical Investigation

<8>
Accession Number
2026016259
Title
Transcatheter aortic valve implantation results are not superimposable to
surgery in patients with aortic stenosis at low surgical risk.
Source
Cardiology Journal. 30(4) (pp 595-605), 2023. Date of Publication: 31 Aug
2023.
Author
Acconcia M.C.; Perrone M.A.; Sergi D.; Luozzo M.D.; Marchei M.; De Vico
P.; Scavalli A.S.; Pannarale G.; Chiocchi M.; Gaudio C.; Romeo F.; Caretta
Q.; Barilla F.
Institution
(Acconcia, Scavalli, Pannarale, Gaudio, Barilla) Department of
Cardiovascular Disease, University of Rome La Sapienza, Rome, Italy
(Perrone, Sergi, Luozzo, Marchei, De Vico, Romeo) Department of
Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
(Chiocchi) Department of Diagnostic Imaging, Molecular Imaging,
Interventional Radiology and Radiotherapy, University of Rome Tor Vergata,
Rome, Italy
(Caretta) Department of Experimental and Clinical Medicine, University of
Florence, Italy
Publisher
Via Medica
Abstract
Background: The aim of this meta-analysis was to compare the impact of
transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve
replacement (SAVR) in patients with severe aortic valve stenosis (AS) at
low surgical risk. Method(s): All randomized controlled trials (RCTs)
and observational studies (Obs) published from January 2014 until March
31st, 2020 were retrieved through the PubMed computerized
database and at the site https://www.clinicaltrials.com. The relative risk
(RR) with the 95% confidence interval (CI) was used to evaluate the effect
of the intervention under comparison. The primary endpoints were all-cause
30-day mortality and 1-year mortality. The 30-day safety endpoints were:
stroke, acute kidney injury stage 2 or 3, major bleeding, moderate/severe
paravalvular leak, need for new permanent pacemaker (PM) implantation.
 Result(s): After detailed review 9 studies, related to 4 RCTs and 5
Obs, were selected. The overall analysis of RCTs plus Obs showed a
significantly lower 30-day mortality for TAVI (RR = 0.55; 95% CI
0.45-0.68, p < 0.00001; I2 = 0%). However, an increased risk of
new PM implantation (RR = 2.87; 95% CI 2.01-3.67, p < 0.00001,
I2 = 0%) and of paravalvular leak (RR = 7.28; 95% CI
3.83-13.81, p < 0.00001, I2 = 0%) was observed in TAVI compared
to SAVR. On the contrary, a lower incidence of major bleeding (RR = 0.38;
95% CI 0.27-0.54, p < 0.00001, I2 = 0%) and of acute kidney
injury was observed (RR = 0.33; 95% CI 0.19-0.56, p < 0.0001,
I2 = 0%) in TAVI. Conclusion(s): TAVI and SVAR in the
treatment of AS in the patients at low surgical risk are not
super-imposable. In particular, if 30-day and 1-year mortality, major
bleeding and acute kidney injury were significantly lower for TAVI, the
need of new PM implantation and paravalvular leak were significantly lower
in SAVR. Consequently, we suggest the need of more trials to evaluate the
effectiveness of TAVI as routine therapeutic procedure in the treatment of
patients with low surgical risk AS. Copyright © 2023 Via Medica.

<9>
Accession Number
2025974401
Title
Intraoperative Insulin Infusion Regimen versus Insulin Bolus Regimen for
Glucose Management during CABG Surgery: A Randomized Clinical Trial.
Source
Jordan Journal of Pharmaceutical Sciences. 16(3) (pp 487-498), 2023. Date
of Publication: 23 Sep 2023.
Author
Alqassieh R.; Odeh M.; Jirjees F.
Institution
(Alqassieh) Faculty of Medicine, Hashemite University, Jordan
(Odeh) Pharmacy Management and Pharmaceutical Care Innovation Centre,
Hashemite University, Jordan
(Odeh) Department of Clinical pharmacy and Pharmacy Practice, Faculty of
Pharmaceutical Sciences, Hashemite University, Jordan
(Jirjees) College of Pharmacy, University of Sharjah, United Arab Emirates
Publisher
University of Jordan,Deanship of Scientific Research
Abstract
Background and Aim: The stress induced by surgery disrupts the delicate
balance between hepatic glucose production and glucose utilization in the
body. Despite the significance of intraoperative glycaemic control for
diabetic patients, limited attention has been given to this aspect. Two
methods for administering insulin to manage glucose levels during surgery
exist. This study aimed to compare intraoperative glucose levels in
diabetic patients undergoing Coronary Artery Bypass Graft (CABG) surgery
using either insulin infusion or the bolus method. Method(s): This
was a Randomized Clinical Trial (RCT). Seventy diabetic patients aged 40
or older scheduled for CABG surgery were enrolled in the trial. They were
randomly assigned, using block randomization, to receive intraoperative
insulin via either infusion or the bolus method. The primary outcome
measure was intraoperative glucose levels. Subsequent insulin unit
requirements and intraoperative potassium levels were secondary outcomes.
Data was monitored throughout the CABG procedure and recorded at six
different checkpoints. Result(s): Male patients constituted the
majority in both groups, with no significant differences in the
preoperative characteristics of patients, including HbA1c levels and
comorbidities. The infusion regimen demonstrated a statistically
significant reduction in glucose levels (-19.12 mg/dL, 95% CI:-27.68
to-10.55, P<0.001, Cohen's d=1.06) compared to the bolus regimen. The
total insulin units administered in the infusion group were 480 units, as
opposed to 600 units in the bolus group (P=0.001, Cohen's d=0.85).
Importantly, no cases of hypoglycemia or hyperkalemia were reported among
the patients. Conclusion(s): Intraoperative glucose control using
insulin was effective for CABG patients with diabetes. However, the
infusion regimen exhibited statistically superior results compared to the
bolus regimen. Clinical Trials Registry and Registration Number: The trial
received approval from the Ethics Committee on 2/1/2019/2020 and was
registered on Clinicaltrials.gov under ID: NCT04824586. Copyright
© 2023 DSR Publishers/The University of Jordan. All Rights Reserved.

<10>
Accession Number
2025928225
Title
Regression of Coronary Fatty Plaque and Risk of Cardiac Events According
to Blood Pressure Status: Data From a Randomized Trial of Eicosapentaenoic
Acid and Docosahexaenoic Acid in Patients With Coronary Artery Disease.
Source
Journal of the American Heart Association. 12(18) (no pagination), 2023.
Article Number: e030071. Date of Publication: 19 Sep 2023.
Author
Welty F.K.; Hariri E.; Asbeutah A.A.; Daher R.; Amangurbanova M.; Chedid
G.; Elajami T.K.; Alfaddagh A.; Malik A.
Institution
(Welty, Asbeutah, Amangurbanova, Elajami, Alfaddagh, Malik) Division of
Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Hariri) Cleveland Clinic Foundation, Cleveland, OH, United States
(Daher, Chedid) Gilbert and Rose-Marie Chagoury School of Medicine,
Lebanese American University, Byblos, Lebanon
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Residual risk of cardiovascular events and plaque progression
remains despite reduction in low-density lipopro-tein cholesterol. Factors
contributing to residual risk remain unclear. The authors examined the
role of eicosapentaenoic acid and docosahexaenoic acid in coronary plaque
regression and its predictors. METHODS AND RESULTS: A total of 240
patients with stable coronary artery disease were randomized to
eicosapentaenoic acid plus docosahexaenoic acid (3.36 g/d) or none for 30
months. Patients were stratified by regression or progression of coronary
fatty plaque measured by coronary computed tomographic angiography.
Cardiac events were ascertained. The mean+/-SD age was 63.0+/-7.7 years,
mean low-density lipoprotein cholesterol level was <2.07 mmol/L, and
median triglyceride level was <1.38 mmol/L. Regressors had a 14.9%
reduction in triglycerides that correlated with fatty plaque regression
(r=0.135; P=0.036). Compared with regressors, progressors had higher
cardiac events (5% vs 22.3%, respectively; P<0.001) and a 2.89-fold
increased risk of cardiac events (95% CI, 1.1- 8.0; P=0.034). Baseline
non- high-density lipoprotein cholesterol level <2.59 mmol/L (100 mg/dL)
and systolic blood pressure <125 mm Hg were significant independent
predictors of fatty plaque regression. Normotensive patients taking
eicosapentaenoic acid plus docosahexaenoic acid had regression of
noncalcified coronary plaque that correlated with triglyceride reduction
(r=0.35; P=0.034) and a significant decrease in neutrophil/lympho-cyte
ratio. In contrast, hypertensive patients had no change in noncalcified
coronary plaque or neutrophil/lymphocyte ratio. CONCLUSION(S):
Triglyceride reduction, systolic blood pressure <125 mm Hg, and non-
high-density lipoprotein cholesterol <2.59 mmol/L were associated with
coronary plaque regression and reduced cardiac events. Normotensive
patients had greater benefit than hypertensive patients potentially due to
lower levels of inflammation. Future studies should examine the role of
inflammation in plaque regression. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT01624727. Copyright © 2023 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<11>
Accession Number
2027243395
Title
causalCmprsk: An R package for nonparametric and Cox-based estimation of
average treatment effects in competing risks data.
Source
Computer Methods and Programs in Biomedicine. 242 (no pagination), 2023.
Article Number: 107819. Date of Publication: December 2023.
Author
Vakulenko-Lagun B.; Magdamo C.; Charpignon M.-L.; Zheng B.; Albers M.W.;
Das S.
Institution
(Vakulenko-Lagun) Department of Statistics, University of Haifa, Haifa,
Israel
(Magdamo, Albers) Laboratory of Systems Pharmacology, Harvard Medical
School, Boston, MA, United States
(Charpignon) Institute for Data, Systems, and Society, Massachusetts
Institute of Technology, Cambridge, MA, United States
(Zheng) Department of Non-communicable Disease Epidemiology, London School
of Hygiene & Tropical Medicine, London, United Kingdom
(Albers, Das) Department of Neurology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background and Objective: Competing risks data arise in both observational
and experimental clinical studies with time-to-event outcomes, when each
patient might follow one of the multiple mutually exclusive competing
paths. Ignoring competing risks in the analysis can result in biased
conclusions. In addition, possible confounding bias of the
treatment-outcome relationship has to be addressed, when estimating
treatment effects from observational data. In order to provide tools for
estimation of average treatment effects on time-to-event outcomes in the
presence of competing risks, we developed the R package causalCmprsk. We
illustrate the package functionality in the estimation of effects of a
right heart catheterization procedure on discharge and in-hospital death
from observational data. Method(s): The causalCmprsk package
implements an inverse probability weighting estimation approach, aiming to
emulate baseline randomization and alleviate possible treatment selection
bias. The package allows for different types of weights, representing
different target populations. causalCmprsk builds on existing methods from
survival analysis and adapts them to the causal analysis in non-parametric
and semi-parametric frameworks. Result(s): The causalCmprsk package
has two main functions: fit.cox assumes a semiparametric structural Cox
proportional hazards model for the counterfactual cause-specific hazards,
while fit.nonpar does not impose any structural assumptions. In both
frameworks, causalCmprsk implements estimators of (i) absolute risks for
each treatment arm, e.g., cumulative hazards or cumulative incidence
functions, and (ii) relative treatment effects, e.g., hazard ratios, or
restricted mean time differences. The latter treatment effect measure
translates the treatment effect from probability into more intuitive time
domain and allows the user to quantify, for example, by how many days or
months the treatment accelerates the recovery or postpones illness or
death. Conclusion(s): The causalCmprsk package provides a convenient
and useful tool for causal analysis of competing risks data. It allows the
user to distinguish between different causes of the end of follow-up and
provides several time-varying measures of treatment effects. The package
is accompanied by a vignette that contains more details, examples and
code, making the package accessible even for non-expert
users. Copyright © 2023 Elsevier B.V.

<12>
Accession Number
2025730373
Title
Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic
Valve Replacement: A Prognostic Systematic Review and Meta-Analysis.
Source
Journal of Clinical Medicine. 12(18) (no pagination), 2023. Article
Number: 6025. Date of Publication: September 2023.
Author
Jimenez-Xarrie E.; Asmarats L.; Roque-Figuls M.; Millan X.; Li C.H.P.;
Fernandez-Peregrina E.; Sanchez-Cena J.; Masso van Roessel A.; Maestre
Hittinger M.L.; Paniagua P.; Arzamendi D.
Institution
(Jimenez-Xarrie, Asmarats, Millan, Li, Fernandez-Peregrina, Sanchez-Cena,
Masso van Roessel, Arzamendi) Cardiology Department, Hospital de la Santa
Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), Barcelona
08025, Spain
(Roque-Figuls) Biomedical Research Institute Sant Pau (IIB Sant Pau),
Barcelona 08025, Spain
(Maestre Hittinger, Paniagua) Anesthesiology Department, Hospital de la
Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau),
Barcelona 08025, Spain
(Arzamendi) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Madrid 28029, Spain
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Transcatheter aortic valve replacement (TAVR) is currently the treatment
of choice for patients aged >=75 years with severe aortic stenosis.
Preoperative anemia is present in a large proportion of patients and may
increase the risk of post-procedural complications. The purpose of this
prognostic systematic review was to analyze the impact of baseline anemia
on short- and mid-term outcomes following TAVR. A computerized search was
performed on PubMed and Web of Science databases for studies published
between January 2013 and December 2022. Primary outcomes were 30-day need
for transfusion, acute renal failure, 30-day and mid-term mortality, and
readmission during the first year post-TAVR. Data were analyzed via random
effects model using inverse variance method with 95% confidence intervals.
Eleven observational studies met our eligibility criteria and included a
total of 12,588 patients. The prevalence of baseline anemia ranged between
39% and 72%, with no relevant sex differences. Patients with preprocedural
anemia received more blood transfusions [OR: 2.95 (2.13-4.09)]), and
exhibited increased rates of acute kidney injury [OR:1.74 (1.45-2.10)],
short-term mortality [OR: 1.47 (1.07-2.01], and mid-term [OR: 1.89
(1.58-2.25)] mortality following TAVR compared with those without anemia.
Baseline anemia determined an increased risk for blood transfusion, acute
kidney injury, and short/mid-term mortality among TAVR
recipients. Copyright © 2023 by the authors.

<13>
Accession Number
2027242862
Title
Paediatric aortic valve replacement: a meta-analysis and microsimulation
study.
Source
European Heart Journal. 44(34) (pp 3231-3246), 2023. Date of Publication:
07 Sep 2023.
Author
Notenboom M.L.; Schuermans A.; Etnel J.R.G.; Veen K.M.; Van De Woestijne
P.C.; Rega F.R.; Helbing W.A.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Notenboom, Etnel, Veen, Van De Woestijne, Bogers, Takkenberg) Department
of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC,
Doctor Molewaterplein 40, , Zuid-Holland, Rotterdam 3015 GD, Netherlands
(Schuermans, Rega) Department of Cardiac Surgery, University Hospitals
Leuven, UZ Leuven Gasthuisberg, Herestraat 49, , Flanders, Leuven 3000,
Belgium
(Schuermans) Cardiovascular Research Center, Massachusetts General
Hospital, 149 13th Street, 4th floor, Boston, MA 02129, United States
(Schuermans) Program in Medical and Population Genetics, Cardiovascular
Disease Initiative, Broad Institute of Harvard and MIT, Merkin Building,
415 Main St., Cambridge, MA 02142, United States
(Helbing) Department of Paediatrics, Division of Paediatric Cardiology,
Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, , Zuid-Holland,
Rotterdam 3015 CN, Netherlands
Publisher
Oxford University Press
Abstract
Aims: To support decision-making in children undergoing aortic valve
replacement (AVR), by providing a comprehensive overview of published
outcomes after paediatric AVR, and microsimulation-based age-specific
estimates of outcome with different valve substitutes. Methods and
Results: A systematic review of published literature reporting clinical
outcome after paediatric AVR (mean age <18 years) published between
1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome
after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR
(hAVR), and/or bioprosthetic AVR were considered for inclusion. Early
risks (<30d), late event rates (>30d) and time-to-event data were pooled
and entered into a microsimulation model. Sixty-eight studies, of which
one prospective and 67 retrospective cohort studies, were included,
encompassing a total of 5259 patients (37 435 patient-years; median
follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross
procedure, mAVR, and hAVR was 9.2 +/- 5.6, 13.0 +/- 3.4, and 8.4 +/- 5.4
years, respectively. Pooled early mortality for the Ross procedure, mAVR,
and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6%
(6.6%-17.0%), respectively, and late mortality rate was 0.5%/year
(0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year
(0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy
in the first 20 years was 18.9 years (18.6-19.1 years) after Ross
(relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after
mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk
of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross
and 17.8% (95% CI: 17.0%-19.4%) after mAVR. Conclusion(s): Results of
paediatric AVR are currently suboptimal with substantial mortality
especially in the very young with considerable reintervention hazards for
all valve substitutes, but the Ross procedure provides a survival benefit
over mAVR. Pros and cons of substitutes should be carefully weighed during
paediatric valve selection. Copyright © 2023 The Author(s).
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<14>
Accession Number
2027159265
Title
Clinical efficacy and safety outcomes of bempedoic acid: An updated
systematic review and meta-analysis after CLEAR Outcomes trial.
Source
Health Sciences Review. 9 (no pagination), 2023. Article Number: 100116.
Date of Publication: December 2023.
Author
Bhandari A.; Oli P.R.; Shrestha D.B.; Dawadi S.; Pathak B.D.; Bhandari M.;
Sedhai Y.R.; Basnet B.; Regmi L.; Singh A.; Patel N.K.
Institution
(Bhandari) Department of Internal Medicine, Saint Johns' Hospital, HSHS
Medical Group, Springfield, IL, United States
(Oli, Regmi) Department of Internal Medicine, Province Hospital, Surkhet,
Birendranagar, Nepal
(Shrestha) Department of Internal Medicine, Mount Sinai Hospital, Chicago,
IL, United States
(Dawadi) Department of Internal Medicine, Nepalese Army Institute of
Health Sciences, Kathmandu, Nepal
(Pathak) Department of Internal Medicine, Jibjibe Primary Health Care
Center, Rasuwa, Nepal
(Bhandari) Department of Internal Medicine, Division of Cardiology, Cape
Fear Valley Medical Center, 1638 Owen Drive, Fayetteville, NC, United
States
(Sedhai) Department of Internal Medicine, Division of Pulmonary Disease
and Critical Care, University of Kentucky College of Medicine-Bowling
Green Campus, Bowling Green, KY, United States
(Basnet) Department of Internal Medicine, Frye Regional Medical Center,
Hickory, NC, United States
(Singh) Department of Internal Medicine, Division of Cardiology, Tower
Health Program, 420 S. Fifth Avenue, West Reading, PA, United States
(Patel) Department of Internal Medicine, Division of Cardiology, Virginia
Commonwealth University, School of Medicine, Richmond, VA, United States
Publisher
Elsevier Ltd
Abstract
Purpose: Statins are the cornerstone therapy for primary or secondary
prevention of atherosclerotic cardiovascular disease (ASCVD). However, a
significant portion of patients are intolerant to statin or show
inadequate lipid-lowering. Bempedoic acid (BA) has been shown to decrease
low-density lipoprotein cholesterol (LDL-C) in clinical trials. However,
the evidence on the effect of BA on clinical cardiovascular outcomes was
limited until the CLEAR Outcomes trial. Thus, to fully appraise the
available data, we performed this meta-analysis. Method(s): PubMed,
Pubmed Central, Embase, and Scopus databases were searched for relevant
articles published before May 1, 2023. Pertinent data from the included
studies were extracted and analyzed using RevMan v5.4. Result(s): Out
of 2209 studies evaluated, five randomized control trials with 17,384
patients with established ASCVD or at high risk of ASCVD were included for
analysis. The BA therapy reduced major adverse cardiovascular events (OR
0.85, CI 0.77-0.93; <0.0001), non-fatal myocardial infarction (OR 0.75, 95
% CI 0.64-0.88; p <0.0001), hospitalization for unstable angina (OR 0.69,
CI 0.53-0.89; p = 0.005) and coronary revascularization (OR 0.80, CI
0.61-0.91; <0.0001) significantly without decreasing the risk of all-cause
death (OR 1.19, CI 0.73-1.94; p = 0.49), cardiovascular death (OR 1.04, CI
0.87-1.25; p = 0.68) and non-fatal stroke (OR 0.84, CI 0.66-1.06; p =
0.15). Conclusion(s): Based on our analysis the bempedoic acid
addition to therapy reduced cardiovascular events in selective patients
who are either intolerant to statins or do not achieve recommended LDL-C
levels despite being on a maximum dose of statins and/or
ezetimibe. Copyright © 2023 The Author(s)

<15>
Accession Number
2027344637
Title
Nutritional markers accompanying acquired chylothorax in infants: a
systematic review.
Source
Nutrition Reviews. 81(10) (pp 1321-1328), 2023. Date of Publication: 01
Oct 2023.
Author
Marzotto K.N.; Choudhary T.; Wright L.A.; Howell M.P.; Kimball T.R.;
Pigula F.A.; Piggott K.D.
Institution
(Marzotto, Choudhary) Tulane University School of Medicine, New Orleans,
LA, United States
(Wright) Matas Library, Tulane University School of Medicine, New Orleans,
LA, United States
(Howell) Department of Pediatrics, Tulane University School of Medicine,
New Orleans, LA, United States
(Kimball, Piggott) Department of Pediatrics, Louisiana State University
Health, New Orleans, LA, United States
(Pigula) Department of Surgery, Louisiana State University Health, New
Orleans, LA, United States
Publisher
Oxford University Press
Abstract
Context: Chylothorax is a well-established acquired complication of
thoracic surgery in infants. Current data suggest acquired chylothorax may
affect infant growth and nutrition because of a loss of essential
nutrients via chylous effusion. Objective(s): The 3 objectives for
this study were: (1) identify nutritional markers affected by the
development of acquired chylothorax in infants; (2) highlight the
variability in methods used to assess nutritional status and growth in
this patient population; and (3) highlight nutritional deficits that can
serve as treatment targets during postoperative feeding protocols.
 Data Sources: A systematic literature search was conducted between
May 31, 2021, and June 21, 2022, using the PubMed, Embase, CINAHL, and Web
of Science databases. Search terms included, but were not limited to,
"chylothorax,""infants,"and "nutrition."Data Extraction: Inclusion
criteria required studies that measured quantitative markers of nutrition
in >=10 participants aged <1 year with acquired chylothorax. A total of
575 studies were screened and all but 4 were eliminated. Nutritional
markers were categorized into 4 different groups: total serum protein
level, triglyceride levels, growth velocity, and weight for length. Data
Analysis: The variation in methods, time points, interventional groups,
and nutritional markers did not facilitate a meta-analysis. Risk of bias
was assessed using the Cochrane Risk of Bias in Nonrandomized Studies
assessment tool. Conclusion(s): This review highlights the need for
reliable quantitative markers of nutrition that will enable providers to
assess the nutritional needs of infants with chylothorax. Future studies
must focus on measuring markers of nutrition at regular intervals in
larger study populations. Copyright © 2023 The Author(s).

<16>
Accession Number
642397961
Title
Computed Tomography Cardiac Angiography Before Invasive Coronary
Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA
Trial.
Source
Circulation. (no pagination), 2023. Date of Publication: 29 Sep 2023.
Author
Jones D.A.; Beirne A.-M.; Kelham M.; Rathod K.S.; Andiapen M.; Wynne L.;
Godec T.; Forooghi N.; Ramaseshan R.; Moon J.C.; Davies C.; Bourantas
C.V.; Baumbach A.; Manisty C.; Wragg A.; Ahluwalia A.; Pugliese F.; Mathur
A.
Institution
(Jones, Beirne, Kelham, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan,
Baumbach, Ahluwalia, Mathur) Centre for Cardiovascular Medicine and
Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B.,
A.A., A.M.)
(Jones, Godec, Baumbach, Ahluwalia) Barts Cardiovascular Clinical Trials
Unit, Queen Mary University of London, A.B
(Jones, Beirne, Kelham, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan,
Moon, Davies, Bourantas, Baumbach, Manisty, Wragg, Ahluwalia, Pugliese,
Mathur) Faculty of Medicine & Dentistry, and NIHR Barts Biomedical
Research Centre, Barts Heart Centre and William Harvey Research Institute,
Queen Mary University of London, UK. (D.A.J., A.-M.B., M.K., K.S.R., M.A.,
L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P.,
A.M.)
(Jones, Beirne, Kelham, Rathod, Andiapen, Wynne, Forooghi, Ramaseshan,
Bourantas, Baumbach, Wragg, Mathur) Barts Interventional Group, Barts
Heart Centre, Barts Health NHS Trust, London, UK. (D.A.J., A.-M.B., M.K.,
K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.)
(Moon, Davies, Manisty, Pugliese) Department of Cardiac Imaging, Barts
Heart Centre, Barts Health NHS Trust, C.D., C.M., London, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with previous coronary artery bypass grafting often
require invasive coronary angiography (ICA). However, for these patients,
the procedure is technically more challenging and has a higher risk of
complications. Observational studies suggest that computed tomography
cardiac angiography (CTCA) may facilitate ICA in this group, but this has
not been tested in a randomized controlled trial. METHOD(S): This
study was a single-center, open-label randomized controlled trial
assessing the benefit of adjunctive CTCA in patients with previous
coronary artery bypass grafting referred for ICA. Patients were randomized
1:1 to undergo CTCA before ICA or ICA alone. The co-primary end points
were procedural duration of the ICA (defined as the interval between local
anesthesia administration for obtaining vascular access and removal of the
last catheter), patient satisfaction after ICA using a validated
questionnaire, and the incidence of contrast-induced nephropathy. Linear
regression was used for procedural duration and patient satisfaction
score; contrast-induced nephropathy was analyzed using logistic
regression. We applied the Bonferroni correction, with P<0.017 considered
significant and 98.33% CIs presented. Secondary end points included
incidence of procedural complications and 1-year major adverse cardiac
events. RESULT(S): Over 3 years, 688 patients were randomized with a
median follow-up of 1.0 years. The mean age was 69.8+/-10.4 years, 108
(15.7%) were women, 402 (58.4%) were White, and there was a high burden of
comorbidity (85.3% hypertension and 53.8% diabetes). The median time from
coronary artery bypass grafting to angiography was 12.0 years, and there
were a median of 3 (interquartile range, 2 to 3) grafts per participant.
Procedure duration of the ICA was significantly shorter in the CTCA+ICA
group (CTCA+ICA, 18.6+/-9.5 minutes versus ICA alone, 39.5+/-16.9 minutes
[98.33% CI, -23.5 to -18.4]; P<0.001), alongside improved mean ICA
satisfaction scores (1=very good to 5=very poor; -1.1 difference [98.33%
CI, -1.2 to -0.9]; P<0.001), and reduced incidence of contrast-induced
nephropathy (3.4% versus 27.9%; odds ratio, 0.09 [98.33% CI, 0.04-0.2];
P<0.001). Procedural complications (2.3% versus 10.8%; odds ratio, 0.2
[95% CI, 0.1-0.4]; P<0.001) and 1-year major adverse cardiac events (16.0%
versus 29.4%; hazard ratio, 0.4 [95% CI, 0.3-0.6]; P<0.001) were also
lower in the CTCA+ICA group. CONCLUSION(S): For patients with
previous coronary artery bypass grafting, CTCA before ICA leads to
reductions in procedure time and contrast-induced nephropathy, with
improved patient satisfaction. CTCA before ICA should be considered in
this group of patients. REGISTRATION: URL: https://www. CLINICALTRIALS:
gov; Unique identifier: NCT03736018.

<17>
Accession Number
642397015
Title
Index hospital cost of adverse events following thoracic surgery: a
systematic review of economic literature.
Source
BMJ open. 13(9) (pp e069382), 2023. Date of Publication: 28 Sep 2023.
Author
Jones D.; Kumar S.; Anstee C.; Gingrich M.; Simone A.; Ahmadzai Z.;
Thavorn K.; Seely A.
Institution
(Jones) Department of Surgery, University of Ottawa, Ottawa, ON, Canada
(Jones, Kumar, Anstee, Gingrich, Simone) Methods Centre, Ottawa Hospital
Research Institute, Ottawa, ON, Canada
(Ahmadzai) Department of Surgery, Ottawa, ON, Canada
(Thavorn) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Seely) Department of Epidemiology, Ottawa Hospital Research Institute,
Ottawa, ON, Canada
(Seely) Department of Surgery, Ottawa Hospital, Ottawa, ON, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Adverse events (AEs) following thoracic surgery place
considerable strain on healthcare systems. A rigorous evaluation of the
economic impact of thoracic surgical AEs remains lacking and is required
to understand the value of money of formal quality improvement
initiatives. Our objective was to conduct a systematic review of all
available literature focused on specific cost of postoperative AEs
following thoracic surgery. DESIGN: Systematic review of the economic
literature was performed, following recommendations from the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA
SOURCES: An economic search filter developed by the Canadian Agency for
Drugs and Technologies in Health was applied, and MEDLINE, Embase and The
Cochrane Library were searched from inception to January 2022. ELIGIBILITY
CRITERIA: We included English articles involving adult patients who
underwent a thoracic surgical procedure with estimated costs of
postoperative complications. Eligible study designs included comparative
observational studies, randomised control trials, decision analytic or
cost-prediction models, cost analyses, cost or burden of illness studies,
economic evaluation studies and systematic reviews and/or meta-analyses of
cost analyses and cost of illness studies. DATA EXTRACTION AND SYNTHESIS:
Two reviewers independently screened titles and abstracts in the first
stage and full-text articles of included studies in the second stage.
Disagreements during abstract and full-text screening stages were resolved
via discussion until a consensus was reached. Studies were appraised for
methodological quality using the Critical Appraisal Skills Program
checklist. RESULT(S): 3349 studies were identified: 20 met inclusion
criteria. Most were conducted in the USA (12/20), evaluating AE impact on
hospital expenditures (18/20). 68 procedure-specific AE mean costs were
characterised (USD$). The most commonly described were anastomotic leak
(mean:range) (USD$49 278:$6 176-$133 002) and pneumonia ($12 258:$2608-$34
591) following esophagectomy, and prolonged air leak ($2556:$571-$3573),
respiratory failure ($19 062:$11 841-$37 812), empyema ($30 189:$23
784-$36 595), pneumonia ($15 362:$2542-$28 183), recurrent laryngeal nerve
injury ($16 420:$4224-$28 616) and arrhythmia ($6835:$5833-$8659)
following lobectomy. CONCLUSION(S): Hospital costs associated with
AEs following thoracic surgery are substantial and varied. Quantifying
costs of AEs enable future economic evaluation studies, which could help
prioritising value-directed quality improvement to optimally improve
outcomes and reduce costs. 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.

<18>
Accession Number
642401886
Title
Differences in Postoperative Atrial Fibrillation Incidence and Outcomes
After Cardiac Surgery According to Assessment Method and Definition: A
Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. (pp e030907), 2023. Date of
Publication: 30 Sep 2023.
Author
Perezgrovas-Olaria R.; Alzghari T.; Rahouma M.; Dimagli A.; Harik L.;
Soletti G.J.; An K.R.; Caldonazo T.; Kirov H.; Cancelli G.; Audisio K.;
Yaghmour M.; Polk H.; Toor R.; Sathi S.; Demetres M.; Girardi L.N.;
Biondi-Zoccai G.; Gaudino M.
Institution
(Perezgrovas-Olaria, Alzghari, Rahouma, Dimagli, Harik, Soletti, An,
Cancelli, Audisio, Yaghmour, Polk, Toor, Sathi, Girardi, Gaudino)
Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
USA
(An) Division of Cardiac Surgery, Department of Surgery University of
Toronto ON Canada, Canada
(Caldonazo, Kirov) Department of Cardiothoracic Surgery Friedrich Schiller
University Jena Jena Germany, Germany
(Demetres) Weill Cornell Medicine New York NY USA, Samuel J. Wood Library
and C.V. Starr Biomedical Information Centre
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies Sapienza University of Rome Latina Italy, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro Naples Italy
Publisher
NLM (Medline)
Abstract
Background Postoperative atrial fibrillation (POAF) is the most frequent
complication of cardiac surgery. Despite clinical and economic
implications, ample variability in POAF assessment method and definition
exist across studies. We performed a study-level meta-analysis to evaluate
the influence of POAF assessment method and definition on its incidence
and association with clinical outcomes. Methods and Results A systematic
literature search was conducted to identify studies comparing the outcomes
of patients with and without POAF after cardiac surgery that also reported
POAF assessment method. The primary outcome was POAF incidence. The
secondary outcomes were in-hospital mortality, stroke, intensive care unit
length of stay, and postoperative length of stay. Fifty-nine studies
totaling 197774 patients were included. POAF cumulative incidence was 26%
(range: 7.3%-53.1%). There were no differences in POAF incidence among
assessment methods (27%, [range: 7.3%-53.1%] for continuous telemetry, 27%
[range: 7.9%-50%] for telemetry plus daily ECG, and 19% [range:
7.8%-42.4%] for daily ECG only; P>0.05 for all comparisons). No
differences in in-hospital mortality, stroke, intensive care unit length
of stay, and postoperative length of stay were found between assessment
methods. No differences in POAF incidence or any other outcomes were found
between POAF definitions. Continuous telemetry and telemetry plus daily
ECG were associated with higher POAF incidence compared with daily ECG in
studies including only patients undergoing isolated coronary artery bypass
grafting. Conclusions POAF incidence after cardiac surgery remains high,
and detection rates are variable among studies. POAF incidence and its
association with adverse outcomes are not influenced by the assessment
method and definition used, except in patients undergoing isolated
coronary artery bypass grafting.

<19>
Accession Number
642401365
Title
Individualized heparin monitoring and management reduces protamine
requirements in cardiac surgery on minimal invasive extracorporeal
circulation; A prospective randomized study.
Source
Perfusion. (pp 2676591231204284), 2023. Date of Publication: 30 Sep 2023.
Author
Gkiouliava A.; Argiriadou H.; Antonitsis P.; Goulas A.; Papapostolou E.;
Sarridou D.; Karapanagiotidis G.T.; Anastasiadis K.
Institution
(Gkiouliava, Argiriadou, Papapostolou, Sarridou) Department of
Anesthesiology and Intensive Care, AHEPA University Hospital, Aristotle
University of Thessaloniki School of Medicine, Thessaloniki, Greece
(Antonitsis, Karapanagiotidis, Anastasiadis) Cardiothoracic Department,
AHEPA University Hospital, Aristotle University of Thessaloniki School of
Medicine, Thessaloniki, Greece
(Goulas) First Laboratory of Pharmacology, Aristotle University of
Thessaloniki School of Medicine, Thessaloniki, Greece
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Individualized heparin and protamine management is
increasingly used as a strategy to reduce coagulation activation and
bleeding complications. While it is associated with increased heparin
requirements during Cardiopulmonary Bypass (CPB), the impact on protamine
administration remains controversial. We aim to investigate the effect of
heparin level-guided monitoring on protamine dosing during cardiac surgery
where low-anticoagulation protocols are implemented. METHOD(S): This
is a prospective, randomized, controlled trial. A total of 132 patients
undergoing elective full-spectrum cardiac surgery with Minimal Invasive
Extracorporeal Circulation (MiECC) were recruited. All patients were
managed by the same anaesthetic, surgical and perfusion team. Patients
were randomly allocated in two groups; the individualized
heparin-protamine titration (IHPT) group and the conventional
heparinization and reversal group by using ACT (cACT) with a 0.75:1,
protamine: heparin ratio. Titration was accomplished with the Hepcon HMS
Plus (Medtronic, Minneapolis, MN) system. The primary outcome of the study
was the total protamine dose used. Secondary outcomes comprised of the
total heparin dose, the percentage of patients achieving target ACT, 24-h
transfusion requirements, postoperative bleeding, duration of mechanical
ventilation, major morbidity and length of hospital stay. Patients in each
group were divided in two subgroups according to the target ACT; those
operated for coronary artery bypass grafting (CABG) using a target ACT
>300 s and the rest (non-CABG) patients operated with a target ACT >400 s,
respectively. RESULT(S): Protamine requirements were significantly
reduced when IHPT was implemented; CABG (118 +/- 24 mg vs 163 +/- 61 mg; p
< 0.001) and non-CABG cases (151 +/- 46 mg vs 197 +/- 45 mg; p < 0.001).
Moreover, heparin requirements were significantly higher in the non-CABG
subgroup managed with IHPT (34,539 +/- 7658 IU vs 29,893 +/- 9037 IU; p =
0.02). In overall, no significant differences were detected with respect
to postoperative bleeding, transfusion of RBC or other blood products.
 CONCLUSION(S): Individualized heparin monitoring and management
reduces protamine requirements in cardiac surgery with MiECC implementing
reduced anticoagulation strategy. TRIAL REGISTRATION: clinicaltrials.gov;
NCT04215588.

<20>
Accession Number
638001941
Title
Clinical Outcomes of Different Warfarin Self-Care Strategies: A Systematic
Review and Network Meta-Analysis.
Source
Thrombosis and Haemostasis. 122(4) (pp 492-505), 2022. Date of
Publication: January 20, 2022.
Author
Dhippayom T.; Boonpattharatthiti K.; Thammathuros T.; Dilokthornsakul P.;
Sakunrag I.; Devine B.
Institution
(Dhippayom, Boonpattharatthiti, Thammathuros, Sakunrag) Department of
Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan
University, Phitsanulok, Thailand
(Boonpattharatthiti) Division of Clinical Pharmacy, Faculty of
Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand
(Dilokthornsakul) Department of Pharmacy Practice, Center of
Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences,
Naresuan University, Phitsanulok, Thailand
(Devine) The Comparative Health Outcomes, Policy, and Economics Institute,
School of Pharmacy, University of Washington, Seattle, WA, United States
Publisher
Georg Thieme Verlag
Abstract
Aim To compare the effects of different strategies for warfarin self-care.
Methods PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses,
and OpenGrey were searched from inception to August 2021. Randomized
controlled trials (RCTs) of warfarin self-care, either patient
self-testing (PST) or patient self-management (PSM), were included.
Self-care approaches were classified based on the TIP framework (theme,
intensity, provider): (1) PST >=1/week via e-Health (PST/High/e-Health);
(2) PST >=1/week by health care practitioner (PST/High/HCP); (3) PST
<1/week via e-Health (PST/Low/e-Health); (4) PSM >=1/week by e-Health
(PSM/High/e-Health); (5) PSM >=1/week by patient (PSM/High/Pt); (6) PSM
<1/week by patient (PSM/Low/Pt); and (7) PSM with flexible frequency by
patient (PSM/Flex/Pt). Mean differences (MDs) and risk ratios (RRs) with
95% confidence interval (CI) were estimated using frequentist network
meta-analyses with a random-effects model. The certainty of evidence was
evaluated using CINeMA (Confidence in Network Meta-Analysis). Results
Sixteen RCTs involving 5,895 participants were included. When compared
with usual care, time in therapeutic range was higher in PSM/High/Pt and
PST/High/e-Health with MD [95% CI] of 7.67% [0.26-15.08] and 5.65%
[0.04-11.26], respectively. The certainty of evidence was rated as
moderate for these findings. The risk of thromboembolic events was lower
in the PSM/Flex/Pt group when compared with PST/High/e-Health (RR: 0.39
[0.20-0.77]) and usual care (RR: 0.38 [0.17-0.88]) with low and very low
level of evidence, respectively. There was no significant difference in
the proportion of international normalized ratio (INR) values in range,
major bleeding, and all-cause mortality among different self-care
features. Conclusion Patient self-care (either PST or PSM) by measuring
INR values at least once weekly is more effective in controlling the INR
level. Copyright © 2022 Georg Thieme Verlag. All rights reserved.

<21>
Accession Number
636912019
Title
Efficacy and Safety of Aspirin for Primary Cardiovascular Risk Prevention
in Younger and Older Age: An Updated Systematic Review and Meta-analysis
of 173,810 Subjects from 21 Randomized Studies.
Source
Thrombosis and Haemostasis. 122(3) (pp 445-455), 2022. Date of
Publication: December 31, 2021.
Author
Calderone D.; Greco A.; Ingala S.; Agnello F.; Franchina G.; Scalia L.;
Buccheri S.; Capodanno D.
Institution
(Calderone, Greco, Ingala, Agnello, Franchina, Scalia, Capodanno) Division
of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico -
San Marco, University of Catania, Catania, Italy
(Buccheri) Department of Medical Sciences, Uppsala University, Uppsala,
Sweden
(Buccheri) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
Publisher
Georg Thieme Verlag
Abstract
Aims The efficacy and safety of aspirin for primary cardiovascular disease
(CVD) prevention is controversial. The aim of this study was to
investigate the efficacy and safety of aspirin in subjects with no overt
CVD, with a focus on age as a treatment modifier. Methods and Results
Randomized trials comparing aspirin use versus no aspirin use or placebo
were included. The primary efficacy outcome was all-cause death. The
primary safety outcome was major bleeding. Secondary ischemic and bleeding
outcomes were explored. Subgroup analyses were conducted to investigate
the consistency of the effect sizes in studies including younger and older
individuals, using a cut-off of 65 years. A total of 21 randomized trials
including 173,810 individuals at a mean follow-up of 5.3 years were
included. Compared with control, aspirin did not reduce significantly the
risk of all-cause death (risk ratio: 0.96; 95% confidence interval:
0.92-1.00, p = 0.057). Major adverse cardiovascular events were
significantly reduced by 11%, paralleled by significant reductions in
myocardial infarction and transient ischemic attack. Major bleeding,
intracranial hemorrhage, and gastrointestinal bleeding were significantly
increased by aspirin. There was a significant age interaction for death (p
for interaction = 0.007), with aspirin showing a statistically significant
7% relative benefit on all-cause death in studies including younger
patients. Conclusion The use of aspirin in subjects with no overt CVD was
associated with a neutral effect on all-cause death and a modest lower
risk of major cardiovascular events at the price of an increased risk in
major bleeding. The benefit of aspirin might be more pronounced in younger
individuals. Copyright © 2022 Georg Thieme Verlag. All rights
reserved.

<22>
Accession Number
635319371
Title
Safety and Efficacy of Different Antithrombotic Strategies after
Transcatheter Aortic Valve Implantation: A Network Meta-Analysis.
Source
Thrombosis and Haemostasis. 122(2) (pp 216-225), 2022. Article Number:
210095. Date of Publication: June 15, 2021.
Author
Navarese E.P.; Grisafi L.; Spinoni E.G.; Mennuni M.G.; Rognoni A.;
Ratajczak J.; Podhajski P.; Koni E.; Kubica J.; Patti G.
Institution
(Navarese, Kubica) Department of Cardiology and Internal Medicine,
Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Grisafi, Spinoni, Patti) Department of Translational Medicine, University
of Eastern Piedmont, Via Solaroli 17, Novara, Italy
(Grisafi, Spinoni, Mennuni, Rognoni, Patti) Department of Thoracic, Heart
and Vascular Diseases, Maggiore della Carita Hospital, Novara, Italy
(Ratajczak) Department of Health Promotion, Nicolaus Copernicus
University, Bydgoszcz, Poland
(Ratajczak, Podhajski) Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Koni) Department of Interventional Cardiology, Santa Corona Hospital,
Pietra Ligure, Italy
Publisher
Georg Thieme Verlag
Abstract
Background The optimal pharmacological therapy after transcatheter aortic
valve implantation (TAVI) remains uncertain. We compared efficacy and
safety of various antiplatelet and anticoagulant approaches after TAVI by
a network meta-analysis. Methods A total of 14 studies (both observational
and randomized) were considered, with 24,119 patients included. Primary
safety endpoint was the incidence of any bleeding complications during
follow-up. Secondary safety endpoint was major bleeding. Efficacy
endpoints were stroke, myocardial infarction, and cardiovascular
mortality. A frequentist network meta-analysis was conducted with a
random-effects model. The following strategies were compared: dual
antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), oral
anticoagulation (OAC), and OAC + SAPT. The mean follow-up was 15 months.
Results In comparison to DAPT, SAPT was associated with a 44% risk
reduction of any bleeding (odds ratio [OR]: 0.56 [95% confidence interval,
CI: 0.39-0.80]). SAPT was ranked as the safest strategy for the prevention
of any bleeding (p -score: 0.704), followed by OAC alone (p -score: 0.476)
and DAPT (p -score: 0.437). Consistent results were observed for major
bleeding. The incidence of cardiovascular death and secondary ischemic
endpoints did not differ among the tested antithrombotic approaches. In
patients with indication for long-term anticoagulation, OAC alone showed
similar rates of stroke (OR: 0.92 [95% CI: 0.41-2.05], p = 0.83) and
reduced occurrence of any bleeding (OR: 0.49 [95% CI: 0.37-0.66], p <
0.01) versus OAC + SAPT. Conclusion The present network meta-analysis
supports after TAVI the use of SAPT in patients without indication for OAC
and OAC alone in those needing long-term anticoagulation. Copyright
© 2022 American Institute of Physics Inc.. All rights reserved.

<23>
Accession Number
2027128507
Title
Myocardial recovery in children supported with a durable ventricular
assist device - a systematic review.
Source
European Journal of Cardio-thoracic Surgery. 64(2) (no pagination), 2023.
Article Number: ezad263. Date of Publication: 01 Aug 2023.
Author
Rohde S.; De By T.M.M.H.; Bogers A.J.J.C.; Schweiger M.
Institution
(Rohde, Bogers) Department of Cardio-thoracic surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(De By) EUROMACS, EACTS House, Windsor, United Kingdom
(Schweiger) Children's Hospital Zurich, Pediatric Heart Centre, Department
for Congenital Heart Surgery, Zurich, Switzerland
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: A small percentage of paediatric patients supported with a
ventricular assist device (VAD) can have their device explanted following
myocardial recovery. The goal of this systematic review is to summarize
the current literature on the clinical course in these children after
weaning. METHOD(S): A systematic literature search was performed on
27 May 2022 using Embase, Medline ALL, Web of Science Core Collection,
Cochrane Central Register of Controlled Trials and Google Scholar to
include all literature on paediatric patients supported by a durable VAD
during the last decade. Overlapping study cohorts and registry-based
studies were filtered out. RESULT(S): Thirty-seven articles were
included. Eighteen of them reported on the incidence of recovery in cohort
studies, with an overall incidence rate of 8.7% (81/928). Twenty-two of
the included articles reported on clinical outcomes after VAD explantation
(83 patients). The aetiologies varied widely and were not limited to
diseases with a natural transient course like myocarditis. Most of the
patients in the included studies (70; 84.3%) were supported by a Berlin
Heart EXCOR, and in 66.3% (55/83), only the left ventricle had to be
supported. The longest follow-up period was 19.1 years, and multiple
studies reported on long-term myocardial recovery. Fewer than half of the
reported deaths had a cardiac cause. CONCLUSION(S): Myocardial
recovery during VAD support is dependent on various contributing
components. The interactions among patient-, device-, time- and
hospital-related factors are complex and not yet fully understood.
Long-term recovery after VAD support is achievable, even after a long
duration of VAD support, and even in patients with aetiologies different
from myocarditis or post-cardiotomy heart failure. More research is needed
on this favourable outcome after VAD support. Copyright © 2023
The Author(s). Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<24>
Accession Number
2026887830
Title
Clinical outcomes of patients undergoing percutaneous coronary
intervention treated with colchicine.
Source
REC: Interventional Cardiology. 5(2) (pp 110-117), 2023. Date of
Publication: April 2023.
Author
Soria Jimenez C.E.; Sanchez J.S.; Levine M.B.; Hayat F.; Chang J.;
Garcia-Garcia H.M.
Institution
(Soria Jimenez) Department of Cardiology, MedStar Washington/Georgetown
University Hospital Center, Washington, DC, United States
(Sanchez) Department of Cardiology, Hospital Universitario y Politecnico
La Fe, Valencia, Spain
(Sanchez) Centro de Investigacion Biomedica en Red Enfermedades
Cardiovaculares (CIBERCV), Spain
(Hayat) Department of Medicine, MedStar Washington Hospital Center,
Washington, DC, United States
(Chang) Department of Medicine, NYU Langone Health, New York, United
States
(Levine, Garcia-Garcia) Section of Interventional Cardiology, MedStar
Washington Hospital Center, Washington, DC, United States
Publisher
Sociedad Espanola de Cardiologia
Abstract
Introduction and objectives: The role of inflammation in the pathogenesis
of coronary artery disease, and that resulting from percutaneous coronary
intervention (PCI) is increasingly recognized, yet the effect of
colchicine in attenuating peri-PCI inflammation remains unknown. This
meta-analysis investigated the efficacy of colchicine in patients
undergoing PCI for secondary prevention of coronary artery disease.
 Method(s): The Web of Science, PubMed, Ovid MEDLINE, Embase, Cochrane
Central Register of Controlled Trials and ClinicalTrials. gov databases
were searched. Data on studies assessing the efficacy profile of
colchicine in patients undergoing PCI were pooled using a random-effects
model. Result(s): In 13 studies of 7414 patients, no differences were
observed between patients treated with colchicine compared to those
without for all-cause mortality (OR, 1.1; 95%CI, 0.72-1.56; I2
= 0%), cardiovascular mortality (OR, 0.98; 95%CI, 0.42-2.28; I2
= 14.2%), myocardial infarction (OR, 0.84; 95%CI, 0.65-1.08; I2
= 1.4%) or coronary revascularization (OR, 0.64; 95%CI, 0.28-1.42;
I2 = 49.3%). However, patients treated with colchicine had a
lower risk of stroke (OR, 0.33; 95%CI, 0.15-0.72; I2 = 0%).
 Conclusion(s): Adding colchicine to standard medical therapy in
patients undergoing PCI did not decrease all-cause mortality,
cardiovascular mortality or urgent revascularization. However, it showed a
trend towards a lower risk of myocardial infarction and a significantly
lower risk of stroke. Copyright © 2023 International Journal of
Mathematical, Engineering and Management Sciences. All rights reserved.

<25>
Accession Number
2026638987
Title
Clinical outcomes of Mechanical circulatory support with Impella versus
intra-aortic balloon pump in cardiogenic shock complicating acute
myocardial infarction.
Source
Journal of Cardiovascular Disease Research. 13(5) (pp 1131-1147), 2022.
Date of Publication: 2022.
Author
El Azim Habba E.S.; Kamal A.M.; El Din Hadad El Shafey W.
Institution
(El Azim Habba, Kamal, El Din Hadad El Shafey) Cardiology Department,
Menofia University, Egypt
Publisher
EManuscript Technologies
Abstract
Objective The goal of this research was to compare the role of intra
aortic balloon pump (IABP) vs. percutanous mechanical circulatory support
(PMCS)Impella CP on the progression of cardiogenic shock following acute
myocardial infarction. Background Acute myocardial infarction (AMI) is
exacerbated with cardiogenic shock (CS) and had a high death rate despite
advances in management. The use of short-term (PMCS) devices improves
hemodynamics. Patients The study was prospective, conducted on (60
patient) admitted to coronary care unit (CCU), in chest diseases hospital
in Kuwait with CS following AMI from January 2020 till January 2021.
Methods 60 cases with massive CS following AMI were randomly assigned to
Impella-cp (n 30) or IABP (n 30) in a randomized, prospective, open-label
trial (n 30). Massive CS was diagnosed as having a systolic blood pressure
< 90 mm Hg or requiring inotropic or vasoactive therapy, as well as
hypoperfusion. The1ry outcome was one month mortality. Results The 1ry
outcome was death at one month, which was similar in cases treated with
IABP and pMCS (43 percent and 46 percent, respectively). The 2ry end
objective was the rate of device-related problems, which was minimal in
this study group despite being greater than that demonstrated for
non-emergent pLVAD-application. Transfusion-related hemorrhagic
complications appeared in 13.3 percent of Impella patients vs. 3.3 percent
of IABP patients (however surgical management of hemorrhagic complications
was necessary in one person in the Impella group). Because of the larger
sheath utilized in the Impella group, femoral artery thrombus was 26.7
percent compared to 3.3 percent in the IABP group. Cerebrovascular stroke
was 30% in Impella versus 10% in IABP (reinfarction and revascularization
were 6.6 percent in Impella vs. 10.9 percent in the IABP group, 2 cases
needed CABG). Failure of the kidney was 43.3% in Impella vs. 33.3% at IABP
group. Conclusion PCMS in the form of Impella is not related with
increased short-term survival in cases with massive CS following AMI, but
it is related to more thrombosis and bleeding risks when compared to IABP
group. To elucidate any Impella advantages in future researches, better
case selection, use of smaller sheaths, early implantation and should be
avoided in futile patient. Copyright © 2022 EManuscript
Technologies. All rights reserved.

<26>
Accession Number
2025456457
Title
Effect of perioperative goal-directed fluid therapy on postoperative
complications after thoracic surgery with one-lung ventilation: a
systematic review and meta-analysis.
Source
World Journal of Surgical Oncology. 21(1) (no pagination), 2023. Article
Number: 297. Date of Publication: December 2023.
Author
Li X.; Zhang Q.; Zhu Y.; Yang Y.; Xu W.; Zhao Y.; Liu Y.; Xue W.; Fang Y.;
Huang J.
Institution
(Li, Zhang, Zhu, Yang, Xu, Zhao, Liu, Xue, Fang, Huang) Department of
Anesthesiology, The First Affiliated Hospital of Kunming Medical
University, KunMing, China
Publisher
BioMed Central Ltd
Abstract
Background: An understanding of the impact of goal-directed fluid therapy
(GDFT) on the outcomes of patients undergoing one-lung ventilation (OLV)
for thoracic surgery remains incomplete and controversial. This
meta-analysis aimed to assess the effect of GDFT compared to other fluid
therapy strategies on the incidence of postoperative complications in
patients with OLV. Method(s): The Embase, Cochrane Library, Web of
Science, and MEDLINE via PubMed databases were searched from their
inception to November 30, 2022. Forest plots were constructed to present
the results of the meta-analysis. The quality of the included studies was
evaluated using the Cochrane Collaboration tool and Risk Of Bias In
Non-Randomized Study of Interventions (ROBINS-I). The primary outcome was
the incidence of postoperative complications. Secondary outcomes were the
length of hospital stay, PaO<inf>2</inf>/FiO<inf>2</inf> ratio, total
fluid infusion, inflammatory factors (TNF-alpha, IL-6), and postoperative
bowel function recovery time. Result(s): A total of 1318 patients
from 11 studies were included in this review. The GDFT group had a lower
incidence of postoperative complications [odds ratio (OR), 0.47; 95%
confidence interval (95% CI), 0.29-0.75; P = 0.002; I 2, 67%],
postoperative pulmonary complications (OR 0.48, 95% CI 0.27-0.83; P =
0.009), and postoperative anastomotic leakage (OR 0.51, 95% CI 0.27-0.97;
P = 0.04). The GDFT strategy reduces total fluid infusion.
 Conclusion(s): GDFT is associated with lower postoperative
complications and better survival outcomes after thoracic surgery for
OLV. Copyright © 2023, BioMed Central Ltd., part of Springer
Nature.

<27>
Accession Number
2024560770
Title
Outcomes in Primary Repair of Truncus Arteriosus with Significant Truncal
Valve Insufficiency: A Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 44(8) (pp 1649-1657), 2023. Date of Publication:
December 2023.
Author
Mitta A.; Vogel A.D.; Korte J.E.; Brennan E.; Bradley S.M.; Kavarana M.N.;
Konrad Rajab T.; Kwon J.H.
Institution
(Mitta, Vogel, Bradley, Kavarana, Konrad Rajab, Kwon) Division of
Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty
Street, Charleston, SC 29425, United States
(Korte) Department of Public Health Sciences, Medical University of South
Carolina, Charleston, SC, United States
(Brennan) Department of Research & Education Services, Medical University
of South Carolina, Charleston, SC, United States
Publisher
Springer
Abstract
Data regarding the effect of significant TVI on outcomes after truncus
arteriosus (TA) repair are limited. The aim of this meta-analysis was to
summarize outcomes among patients aged <= 24 months undergoing TA repair
with at least moderate TVI. A systematic literature search was conducted
in PubMed, Scopus, and CINAHL Complete from database inception through
June 1, 2022. Studies reporting outcomes of TA repair in patients with
moderate or greater TVI were included. Studies reporting outcomes only for
patients aged > 24 months were excluded. The primary outcome was overall
mortality, and secondary outcomes included early mortality and truncal
valve reoperation. Random-effects models were used to estimate pooled
effects. Assessment for bias was performed using funnel plots and Egger's
tests. Twenty-two single-center observational studies were included for
analysis, representing 1,172 patients. Of these, 232 (19.8%) had moderate
or greater TVI. Meta-analysis demonstrated a pooled overall mortality of
28.0% after TA repair among patients with significant TVI with a relative
risk of 1.70 (95% CI [1.27-2.28], p < 0.001) compared to patients without
TVI. Significant TVI was also significantly associated with an increased
risk for early mortality (RR 2.04; 95% CI [1.36-3.06], p < 0.001) and
truncal valve reoperation (RR 3.90; 95% CI [1.40-10.90], p = 0.010).
Moderate or greater TVI before TA repair is associated with an increased
risk for mortality and truncal valve reoperation. Management of TVI in
patients remains a challenging clinical problem. Further investigation is
needed to assess the risk of concomitant truncal valve surgery with TA
repair in this population. Copyright © 2023, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<28>
Accession Number
2024498135
Title
Coronary Artery Bypass Grafting in Dialysis-Dependent Patients - Key
Peri-Operative Considerations.
Source
Cardiovascular Revascularization Medicine. 54 (pp 73-80), 2023. Date of
Publication: September 2023.
Author
Shell D.
Institution
(Shell) Department of Cardiothoracic Surgery, St Vincent's Hospital -
Melbourne, St Vincent's Health Australia, Melbourne, Australia
Publisher
Elsevier Inc.
Abstract
Cardiovascular disease represents the leading cause of mortality in
dialysis-dependent (DD) patients, with the great majority of these
patients afflicted by severe coronary artery disease. As rates of
end-stage renal disease increase worldwide, DD patients represent a
growing proportion of the coronary artery bypass grafting (CABG) cohort.
Yet, these patients are complex, with crucial changes in their
haemodynamic and physiologic profiles that complicate revascularisation
surgery. First, this comprehensive literature review explores the outcomes
and prognostic factors for DD patients undergoing CABG. We then summarise
the intricacies relating to important peri-operative decisions such as use
of cardio-pulmonary bypass and choice of conduit. Copyright ©
2023 Elsevier Inc.

<29>
Accession Number
2024071345
Title
Infective endocarditis involving MitraClip© devices: a
systematic literature review.
Source
Infection. 51(5) (pp 1241-1248), 2023. Date of Publication: October 2023.
Author
Bertolino L.; Ramadan M.S.; Zampino R.; Durante-Mangoni E.
Institution
(Bertolino, Zampino) Department of Advanced Medical & Surgical Sciences,
University of Campania 'L. Vanvitelli', Naples, Italy
(Ramadan, Zampino, Durante-Mangoni) Unit of Infectious and Transplant
Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore
Ruggieri, Naples 80131, Italy
(Ramadan, Durante-Mangoni) Department of Precision Medicine, University of
Campania 'L. Vanvitelli', Naples, Italy
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Progress of interventional cardiology has boosted the use of
newer cardiac devices. These devices are perceived to be less prone to
infections compared to traditional surgical prostheses, but little data
are currently available. In this systematic review (SR), we summarize
current literature regarding the clinical characteristics, management, and
outcomes of patients with MitraClip-related infective endocarditis (IE).
 Method(s): We conducted a SR of PubMed, Google Scholar, Embase, and
Scopus between January 2003 and March 2022. MitraClip-related IE was
defined according to 2015 ESC criteria whereas MitraClip involvement as
vegetation on the device or on the mitral valve. Risk of bias was assessed
through standardized checklist and potential bias of underestimation
cannot be excluded. Data regarding clinical presentation,
echocardiography, management, and outcome were collected. Result(s):
Twenty-six cases of MitraClip-related IE were retrieved. The median age of
patients was 76 [61-83] years with a median EuroScore of 41%. Fever was
present in 65.8% of patients followed by signs and symptoms of heart
failure (42.3%). IE occurred early in 20 (76.9%) cases with a median time
between MitraClip implantation and IE symptom onset of 5 [2-16] months.
Staphylococcus aureus was the major causative microorganism (46%).
Surgical mitral valve replacement was needed in 50% of patients. A
conservative medical approach was considered in the remainder. The overall
in-hospital mortality rate was 50% (surgical group: 38.4%; medical group:
58.3%; p = 0.433). Conclusion(s): Our results suggest that
MitraClip-related IE affects elderly, comorbid patients, is mostly due to
Staphylococcus aureus, and has a poor prognosis irrespective of the
therapeutic approach. Clinicians must be aware of the features of this new
entity among cardiovascular infections. Copyright © 2023, The
Author(s).

<30>
Accession Number
2026110300
Title
Comparison of Crystalloid Preloading and Coloading for Prevention of
Spinal-induced Hypotension in Cesarean Delivery: A Randomized Controlled
Trial at a Tertiary Facility in Ghana.
Source
Open Access Macedonian Journal of Medical Sciences. 11(B) (pp 627-633),
2023. Date of Publication: 2023.
Author
Quarshie A.; Anno A.; Djagbletey R.; Sarpong P.; Sottie D.; Phillips B.J.;
Lassey P.D.; Aryee G.; Essuman R.; Darkwa E.O.
Institution
(Quarshie, Anno, Sarpong, Sottie) Department of Anesthesia, Korle-Bu
Teaching Hospital, Accra, Ghana
(Djagbletey, Phillips, Lassey, Aryee, Essuman, Darkwa) Department of
Anaesthesia, University of Ghana Medical School, Accra, Ghana
Publisher
Scientific Foundation SPIROSKI
Abstract
BACKGROUND: Spinal anesthesia is the recommended technique for cesarean
section. It is easy to perform and provides a reliable, safe, effective,
and fast sensory and motor block of high quality. Hypotension, which can
be deleterious to both mother and baby, is however a common side effect.
Preloading has not been shown to consistently prevent spinal-induced
hypotension. AIM: The aim of this study was to compare coloading with
preloading using crystalloids for preventing spinal anesthesia-induced
hypotension in parturients undergoing scheduled cesarean delivery.
MATERIALS AND METHODS: A single-blinded, randomized, and controlled study
was conducted on 88 patients at term scheduled for elective cesarean
delivery under spinal anesthesia at the Korle-Bu Teaching Hospital.
Parturients were randomly assigned to receive a preload of 12.5 mL/kg of
Ringer's Lactate (Group P) before the spinal anesthetic or a coload of
12.5 mL/kg of Ringers Lactate (Group C) at the time of the spinal
procedure. Blood pressure, heart rate, incidence and timing of nausea and
vomiting, and amount and frequency of vasopressor used were recorded for
the first 10 minutes post-spinal anesthesia. Neonatal Apgar scores were
determined at 1 and 5 minutes after birth. RESULT(S): The two groups
were comparable with respect to age, weight, height, gestational age, ASA
classification, baseline hemodynamic measurements, time to onset of
hypotension, and time to delivery of baby post-spinal anesthesia.
Post-spinal anesthesia changes in the heart rate, systolic blood pressure
and mean arterial blood pressure were also comparable between the two
groups. None of the patients in both groups experienced nausea or vomiting
without hypotension. Although the cumulative dose of ephedrine to treat
hypotension in the preload group was higher compared to the coload group,
the difference was not statistically significant (16.3 vs. 12.4; p-value =
0.110). CONCLUSION(S): Preloading and coloading with 12.5 mL/kg of
Ringer's Lactate are comparable but neither is effective alone for
preventing spinal-induced hypotension in the obstetric population. A
vasopressor regimen is required to improve efficacy of the fluid load for
preventing spinal-induced hypotension. Copyright © 2023 Amanda
Quarshie, Audrey Anno, Robert Djagbletey, Pokua Sarpong, Daniel Sottie,.

<31>
Accession Number
2026068005
Title
Outcomes of Chylothorax Nonoperative Management After Cardiothoracic
Surgery: A Systematic Review and Meta-Analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 38(6) (no pagination), 2023.
Article Number: 20220326. Date of Publication: 2023.
Author
Dos Santos L.L.; Dos Santos C.L.; Hu N.K.T.; Datrino L.N.; Tavares G.;
Tristao L.S.; Orlandini M.F.; Serafim M.C.A.; Tustumi F.
Institution
(Dos Santos, Tustumi) Departament of Gastroenterology, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Dos Santos, Hu, Datrino, Tavares, Tristao, Orlandini, Serafim)
Departament of Evidence-Based Medicine, Faculdade de Medicina, Centro
Universitario Lusiada, Sao Paulo, Santos, Brazil
(Orlandini) Departament of Evidence-Based Medicine, Oya Care, Sao Paulo,
Sao Paulo, Brazil
(Tustumi) Departament of Health Sciences, Faculdade de Medicina, Hospital
Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Chylothorax after thoracic surgery is a severe complication
with high morbidity and mortality rate of 0.10 (95% confidence interval
[CI] 0.06 - 0.02). There is no agreement on whether nonoperative treatment
or early reoperation should be the initial intervention. This systematic
review and meta-analysis aimed to evaluate the outcomes of the
conservative approach to treat chyle leakage after cardiothoracic
surgeries. Method(s): A systematic review was conducted in PubMed,
Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saude)
databases; a manual search of references was also done. The inclusion
criteria were patients who underwent cardiothoracic surgery, patients who
received any nonoperative treatment (e.g., total parenteral nutrition,
low-fat diet, medium chain triglycerides), and studies that evaluated
chylothorax resolution, length of hospital stay, postoperative
complications, infection, morbidity, and mortality. Result(s):
Twenty-two articles were selected. Pulmonary complications, infections,
and arrhythmia were the most common complications after surgical
procedures. The incidence of chylothorax in cardiothoracic surgery was
1.8% (95% CI 1.7 - 2%). The mean time of maintenance of the chest tube was
16.08 days (95% CI 12.54 - 19.63), and the length of hospital stay was
23.74 days (95% CI 16.08 - 31.42) in patients with chylothorax receiving
nonoperative treatment. Among patients that received conservative
treatment, the morbidity event was 0.40 (95% CI 0.23 - 0.59), and
reoperation rate was 0.37 (95% CI 0.27 - 0.49). Mortality rate was 0.10
(95% CI 0.06 - 0.02). Conclusion(s): Nonoperative treatment for
chylothorax after cardiothoracic procedures has significant hospital stay,
morbidity, mortality, and reoperation rates. Copyright © 2023,
Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.

<32>
Accession Number
2025730305
Title
Human Albumin Infusion in Critically Ill and Perioperative Patients:
Narrative Rapid Review of Meta-Analyses from the Last Five Years.
Source
Journal of Clinical Medicine. 12(18) (no pagination), 2023. Article
Number: 5919. Date of Publication: September 2023.
Author
Wiedermann C.J.
Institution
(Wiedermann) Institute of General Practice and Public Health,
Claudiana-College of Health Professions, Bolzano 39100, Italy
(Wiedermann) Department of Public Health, Medical Decision Making and HTA,
University of Health Sciences, Medical Informatics and Technology-Tyrol,
Hall 6060, Austria
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Human albumin, a vital plasma protein with diverse molecular
properties, has garnered interest for its therapeutic potential in various
diseases, including critical illnesses. However, the efficacy of albumin
infusion in critical care and its associated complications remains
controversial. To address this, a review of recent meta-analyses was
conducted to summarize the evidence pertaining to albumin use in critical
illness. Method(s): Adhering to the rapid review approach, designed
to provide a concise synthesis of existing evidence within a short
timeframe, relevant meta-analyses published in the last five years were
identified and analyzed. PubMed, Embase, and Cochrane databases of
systematic reviews were searched using pre-defined search terms. Eligible
studies included meta-analyses examining the association between albumin
infusion and outcomes in critically ill and perioperative patients.
 Result(s): Twelve meta-analyses were included in the review, covering
diverse critical illnesses and perioperative scenarios such as sepsis,
cardiothoracic surgery, and acute brain injury. The analyses revealed
varying levels of evidence for the effects of albumin use on different
outcomes, ranging from no significant associations to suggestive and
convincing. Conclusion(s): Albumin infusion stabilizes hemodynamic
resuscitation endpoints, improves diuretic resistance, and has the
potential to prevent hypotensive episodes during mechanical ventilation in
hypoalbuminemic patients and improve the survival of patients with septic
shock. However, caution is warranted due to the methodological limitations
of the included studies. Further high-quality research is needed to
validate these findings and inform clinical decision-making regarding
albumin use in critical care. Copyright © 2023 by the author.

<33>
Accession Number
642385898
Title
Association of general anesthesia exposure with risk of postoperative
delirium in patients receiving transcatheter aortic valve replacement: a
meta-analysis and systematic review.
Source
Scientific reports. 13(1) (pp 16241), 2023. Date of Publication: 27 Sep
2023.
Author
Ko C.-C.; Hung K.-C.; Chang Y.-P.; Liu C.-C.; Cheng W.-J.; Wu J.-Y.; Li
Y.-Y.; Lin T.-C.; Sun C.-K.
Institution
(Ko) Department of Medical Imaging, Chi Mei Medical Center, Tainan City,
Taiwan (Republic of China)
(Ko) Department of Health and Nutrition, Chia Nan University of Pharmacy
and Science, Tainan City, Taiwan (Republic of China)
(Hung, Cheng) Department of Anesthesiology, Chi Mei Medical Center, Tainan
City, Taiwan (Republic of China)
(Hung) School of Medicine, College of Medicine, National Sun Yat-Sen
University, Kaohsiung City, Taiwan (Republic of China)
(Chang) Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital,
Kaohsiung Medical University, Kaohsiung City, Taiwan (Republic of China)
(Chang) Department of Neurology, Kaohsiung Medical University Hospital,
Kaohsiung Medical University, Kaohsiung City, Taiwan (Republic of China)
(Liu) Department of Anesthesiology, E-Da Hospital, I-Shou University,
Kaohsiung City, Taiwan (Republic of China)
(Wu) Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
(Republic of China)
(Li) Department of Anesthesiology, Chi Mei Medical Center, Tainan City,
Taiwan (Republic of China)
(Lin) Department of Anesthesiology, Tri-Service General Hospital, National
Defense Medical Center, Taipei City, Taiwan (Republic of China)
(Sun) Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou
University, No. 305, Dachang 1St Road ,Kaohsiung City, Taiwan (Republic of
China)
(Sun) School of Medicine for International Students, College of Medicine,
I-Shou University, Kaohsiung City, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
The aim of this meta-analysis was to assess the association of general
anesthesia (GA) exposure with the risk of POD in this patient population.
Databases including Medline, EMBASE, Cochrane library, and Google Scholar
were searched from inception to December 2022. Analysis of 17 studies
published between 2015 and 2021 involving 10,678 individuals revealed an
association of GA exposure with an elevated risk of POD [odd ratio
(OR)=1.846, 95% CI 1.329 to 2.563, p=0.0003, I2=68.4%, 10,678 patients].
Subgroup analysis of the diagnostic methods also demonstrated a positive
correlation between GA exposure and POD risk when validated methods were
used for POD diagnosis (OR=2.199, 95% CI 1.46 to 3.31, p=0.0002).
Meta-regression analyses showed no significant impact of age, male
proportion, and sample size on the correlation between GA and the risk of
POD. The reported overall incidence of POD from the included studies
regardless of the type of anesthesia was between 0.8 and 27%. Our
meta-analysis showed a pooled incidence of 10.3% (95% CI 7% to 15%). This
meta-analysis suggested an association of general anesthesia with an
elevated risk of postoperative delirium, implying the necessity of
implementing appropriate prophylactic strategies against this complication
when general anesthesia was used in this clinical setting. Copyright
© 2023. Springer Nature Limited.

<34>
Accession Number
2026677782
Title
Expert Systematic Review on the Choice of Conduits for Coronary Artery
Bypass Grafting: Endorsed by the European Association for Cardio-Thoracic
Surgery (EACTS) and The Society of Thoracic Surgeons (STS).
Source
Annals of Thoracic Surgery. 116(4) (pp 659-674), 2023. Date of
Publication: October 2023.
Author
Gaudino M.; Bakaeen F.G.; Sandner S.; Aldea G.S.; Arai H.; Chikwe J.;
Firestone S.; Fremes S.E.; Gomes W.J.; Bong-Kim K.; Kisson K.; Kurlansky
P.; Lawton J.; Navia D.; Puskas J.D.; Ruel M.; Sabik J.F.; Schwann T.A.;
Taggart D.P.; Tatoulis J.; Wyler von Ballmoos M.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York-Presbyterian Hospital, New York, New York, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Sandner) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Aldea) Division of Cardiothoracic Surgery, University of Washington
School of Medicine, Seattle, WA, United States
(Arai) Department of Cardiovascular Surgery, Graduate School of Medical
and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo,
Japan
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, California, United States
(Firestone, Kisson) The Society of Thoracic Surgeons, Chicago, Illinois,
United States
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Gomes) Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo
Hospital, Escola Paulista de Medicina, Universidade Federal de Sao Paulo
(Unifesp), SP, Sao Paulo, Brazil
(Bong-Kim) Cardiovascular Center, Myong-ji Hospital, Gyeong-gi-do, South
Korea
(Kurlansky) Division of Cardiac Surgery, Department of Surgery, Columbia
University, New York, New York, United States
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, Baltimore, Maryland, United States
(Navia) Department of Cardiac Surgery, ICBA Instituto Cardiovascular,
Buenos Aires, Argentina
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
New York, New York, United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, Ohio, United States
(Schwann) Division of Cardiac Surgery, Baystate Health, Springfield,
Massachusetts, United States
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Tatoulis) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
University of Melbourne, Melbourne, Australia
(Wyler von Ballmoos) Division of Cardiothoracic Surgery, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Texas, United States
Publisher
Elsevier Inc.

<35>
Accession Number
2026366812
Title
Clinical Practice Guideline of Spanish Society of Pneumology and Thoracic
Surgery (SEPAR) on Pharmacological Treatment of Tobacco Dependence 2023.
Source
Archivos de Bronconeumologia. 59(10) (pp 651-661), 2023. Date of
Publication: October 2023.
Author
Rabade-Castedo C.; de Granda-Orive J.I.; Riesco-Miranda J.A.; De
Higes-Martinez E.; Ramos-Pinedo A.; Cabrera-Cesar E.; Signes-Costa Minana
J.; Garcia Rueda M.; Pastor-Espla E.; Jimenez-Ruiz C.A.
Institution
(Rabade-Castedo) Servicio de Neumologia, Complejo Hospitalario
Universitario de Santiago de Compostela, Santiago de Compostela, La
Coruna, Spain
(de Granda-Orive) Servicio de Neumologia, Hospital Universitario 12 de
octubre Madrid, Spain
(de Granda-Orive) Universidad Complutense, Madrid, Spain
(Riesco-Miranda) Servicio de Neumologia, Hospital Universitario de
Caceres, Caceres, Spain
(Riesco-Miranda) Centro de Investigacion en Red de enfermedades
respiratorias (CIBERES), Madrid, Spain
(Riesco-Miranda) Instituto Universitario de Investigacion Biosanitaria de
Extremadura (INUBE), Spain
(De Higes-Martinez, Ramos-Pinedo) Unidad de Neumologia, Hospital
Universitario Fundacion Alcorcon, Spain
(De Higes-Martinez, Ramos-Pinedo) Universidad Rey Juan Carlos, Madrid,
Spain
(Cabrera-Cesar) Servicio de Neumologia, Hospital Universitario Virgen de
la Victoria, Malaga, Spain
(Signes-Costa Minana) Servicio de Neumologia, Hospital Clinico
Universitario de Valencia, Spain
(Signes-Costa Minana) Instituto de Investigacion Sanitaria de Valencia
(INCLIVA), Valencia, Spain
(Garcia Rueda) Servicio de Neumologia, Hospital Carlos Haya de Malaga,
Malaga, Spain
(Pastor-Espla) Servicio de Neumologia, Hospital Universitario San Juan de
Alicante, Alicante, Spain
(Jimenez-Ruiz) Unidad Especializada en Tabaquismo de la Comunidad de
Madrid, Hospital Clinico San Carlos, Madrid, Spain
Publisher
Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR)
Abstract
Introduction: There are multiple systematic reviews and meta-analyses on
the efficacy and safety of pharmacological treatments against nicotine
dependence. However, there are few guidelines to answer frequent questions
asked by a clinician treating a smoker. Therefore, the aim of this paper
is to facilitate the treatment of tobacco addiction. Material(s) and
Method(s): 12 PICO questions are formulated from a GLOBAL PICO question:
"Efficacy and safety of pharmacological treatment of tobacco dependence".
A systematic review was carried out to answer each of the questions and
recommendations were made. The GRADE (Grading of Recommendations,
Assessment, Development and Evaluation) system was used to grade the
certainty of the estimated effects and the strength of the
recommendations. Result(s): Varenicline, nicotine replacement therapy
(NRT), bupropion and cytisine are more effective than placebo. Varenicline
and combined nicotine therapy are superior to the other therapies. In
smokers with high dependence, a combination of drugs is recommended, being
more effective those associations containing varenicline. Other
optimization strategies with lower efficacy consist of increasing the
doses, the duration, or retreat with varenicline. In specific populations
varenicline or NRT is recommended. In hospitalized, the treatment of
choice is NRT. In pregnancy it is indicated to prioritize behavioral
treatment. The financing of smoking cessation treatments increases the
number of smokers who quit smoking. There is no scientific evidence of the
efficacy of pharmacological treatment of smoking cessation in adolescents.
 Conclusion(s): The answers to the 12 questions allow us to extract
recommendations and algorithms for the pharmacological treatment of
tobacco dependence. Copyright © 2023 The Author(s)

<36>
Accession Number
2025928524
Title
Implementation and Importance of Cardiac Rehabilitation for Cardiac
Patients in Saudi Arabia: A Systematic Review.
Source
Current Vascular Pharmacology. 21(4) (pp 224-233), 2023. Date of
Publication: 2023.
Author
Ahmed R.H.; Bugis B.A.
Institution
(Ahmed) Department of Public Health, College of Health Sciences, Saudi
Electronic University, Riyadh, Saudi Arabia
(Ahmed) Clinical Care Delivery Administration, King Fahad Medical City,
Second Health Cluster, Riyadh, Saudi Arabia
(Bugis) Department of Public Health, College of Health Sciences, Saudi
Electronic University, Dammam, Saudi Arabia
Publisher
Bentham Science Publishers
Abstract
Objective: Cardiac rehabilitation (CR) has progressed over the years from
a basic monitoring procedure for a safe return to physical activity to a
multidisciplinary strategy that emphasizes patient education, specifically
for designed exercise training, risk factor management, and the general
health of cardiac patients. Method(s): Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) reporting was used for this
systematic review. The studies included were retrieved via an electronic
search of Google Scholar and PubMed using the following terms: cardiac
rehabilitation (CR), cardiac diseases, coronary artery bypass graft, heart
failure, cardiac rehabilitation guidelines, rehabilitation, recovery of
function, cardiac rehabilitation importance, cardiac rehabilitation
outcomes, physical therapy modalities, secondary prevention, physical
medicine, and cardiac rehabilitation phases. Result(s): Publications
(n=24) that included worldwide standards demonstrating the implementation
of CR programs in a variety of scenarios were reviewed. These publications
are based on well-defined guidelines that represent best practices from
several cardiology societies, which use varying valid programs by
comparing those guidelines with CR/secondary prevention programs.
 Conclusion(s): Several indications have been used in the development
of the CR program, with the goal of regaining autonomy and increasing
physical, psychological, and social activities. With the Saudi Vision 2030
initiatives for health national transformation programs, there are targets
set to ensure the reduction and prevention of noncommunicable diseases and
to reduce cardiovascular disease risks by initiating an accredited CR
program and guidelines for Saudi Arabia. Copyright © 2023 Bentham
Science Publishers.

<37>
Accession Number
2025825419
Title
Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A
Randomized Controlled Study.
Source
Acta Cardiologica Sinica. 39(5) (pp 720-732), 2023. Date of Publication:
September 2023.
Author
Akkus O.; Huzmeli I.; Seker T.; Bekler O.; Sen F.; Kaypakli O.; Ozer A.Y.;
Yalcin F.
Institution
(Akkus, Bekler, Sen, Kaypakli, Yalcin) Department of Cardiology, Tayfur
Ata Sokmen Faculty of Medicine, Hatay, Turkey
(Huzmeli) Department of Physiotherapy and Rehabilitation, Faculty of
Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
(Seker) Department of Cardiology, Adana Health Practice and Research
Center, University of Health Sciences, Adana, Turkey
(Ozer) Department of Physiotherapy and Rehabilitation, Faculty of Health
Sciences, Marmara University, Istanbul, Turkey
Publisher
Republic of China Society of Cardiology
Abstract
Background: Chronic coronary syndrome (CCS) is one of the most
life-restricting coronary artery diseases, and symptom relief is the main
goal in CCS patients who suffer from angina. Objective(s): To assess
the potential benefits of device-guided breathing in CCS patients with
angina in this randomized, controlled, single-blinded study.
 Method(s): Fifty-one patients with CCS received device-guided
breathing for 7 days/8 weeks. Exercise capacity [exercise stress test],
cardiac function [transthoracic echocardiography], and angina severity
[Canadian Cardiovascular Society Classification] were evaluated initially
and after the training. Device-guided breathing was performed at the
lowest resistance of the device (POWERbreathe Classic LR) for the control
group (n = 17). The low load training group (LLTG; n = 18) and high load
training group (HLTG; n = 16) were trained at 30% and 50% of maximal
inspiratory pressure. Baseline characteristics were compared using one-way
ANOVA and Kruskal-Wallis test. Categorical data were compared using the
chi-square test. ANCOVA was performed to compare changes between three
groups. A p value < 0.05 was considered statistically significant.
 Result(s): Metabolic equivalent values were significantly improved in
both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score
significantly improved and shifted to low-risk both in the HLTG (p <
0.001) and LLTG (p < 0.001) groups. Angina severity significantly
alleviated after the training in both HLTG and LLTG groups (p < 0.001, p =
0.002). Conclusion(s): An 8-week long program of short-term
respiratory muscle training provided positive gains in exercise capacity
and angina severity in CCS patients with angina. The effects of long-term
training programs on CCS patients should be investigated clinically
because of the possibility of helping to decrease the need for invasive
treatments. Copyright © 2023, Republic of China Society of
Cardiology. All rights reserved.

<38>
Accession Number
2024465334
Title
Rhythm vs. Rate Control in Patients with Postoperative Atrial Fibrillation
after Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Clinical Medicine. 12(13) (no pagination), 2023. Article
Number: 4534. Date of Publication: July 2023.
Author
Ahmed M.; Belley-Cote E.P.; Qiu Y.; Belesiotis P.; Tao B.; Wolf A.; Kaur
H.; Ibrahim A.; Wong J.A.; Wang M.K.; Healey J.S.; Conen D.; Devereaux
P.J.; Whitlock R.P.; Mcintyre W.F.
Institution
(Ahmed, Belley-Cote, Belesiotis, Kaur, Wong, Wang, Healey, Conen,
Devereaux, Whitlock, Mcintyre) Faculty of Health Sciences, McMaster
University, Hamilton, ON L8L 2X2, Canada
(Qiu) Ottawa Heart Institute, University of Ottawa, Ottawa, ON K1Y 4W7,
Canada
(Tao) Department of Medicine, University of British Columbia, Vancouver,
BC V6T 1Z1, Canada
(Wolf, Ibrahim) Department of Medicine, Western University, Hamilton, ON
N6A 5C1, Canada
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
complication after cardiac surgery; it is associated with morbidity and
mortality. We undertook this review to compare the effects of rhythm vs.
rate control in this population. Method(s): We searched MEDLINE,
Embase and CENTRAL to March 2023. We included randomized trials and
observational studies comparing rhythm to rate control in cardiac surgery
patients with POAF. We used a random-effects model to meta-analyze data
and rated the quality of evidence using GRADE. Result(s): From 8,110
citations, we identified 8 randomized trials (990 patients). Drug regimens
used for rhythm control included amiodarone in four trials, other class
III anti-arrhythmics in one trial, class I anti-arrhythmics in four trials
and either a class I or III anti-arrhythmic in one trial. Rhythm control
compared to rate control did not result in a significant difference in
length of stay (mean difference -0.8 days; 95% CI -3.0 to +1.4,
I2 = 97%), AF recurrence within 1 week (130 events; risk ratio
[RR] 1.1; 95%CI 0.6-1.9, I2 = 54%), AF recurrence up to 1 month
(37 events; RR 0.9; 95%CI 0.5-1.8, I2 = 0%), AF recurrence up
to 3 months (10 events; RR 1.0; 95%CI 0.3-3.4, I2 = 0%) or
mortality (25 events; RR 1.6; 95%CI 0.7-3.5, I2 = 0%). Effect
measures from seven observational studies (1428 patients) did not differ
appreciably from those in randomized trials. Conclusion(s): Although
atrial fibrillation is common after cardiac surgery, limited low-quality
data guide its management. Limited available evidence suggests no clear
advantage to either rhythm or rate control. A large-scale randomized trial
is needed to inform this important clinical question. Copyright ©
2023 by the authors.

<39>
Accession Number
2027201146
Title
Atrial Fibrillation and Bioprosthetic Valves: An Evidence-Based Approach
to Anticoagulation Therapy With Direct Oral Anticoagulants and Vitamin K
Antagonists: A Systematic Review, Meta-Analysis, and Network
Meta-Analysis.
Source
American Journal of Cardiology. (no pagination), 2023. Date of
Publication: 2023.
Author
Orban M.
Institution
(Orban) Nemocnicna a.s., Cardiology Clinic, Slovakia, Malacky, Slovakia
Publisher
Elsevier Inc.

<40>
Accession Number
2025629625
Title
Evidence of Bariatric Surgery Benefits Cardiac Function in Non-HFpEF
Patients with Obesity: a Meta-Analysis.
Source
Obesity Surgery. (no pagination), 2023. Date of Publication: 2023.
Author
Lu S.-J.; Zhang T.-T.; Zhang X.-W.; Wang L.; Zhao Y.-W.; Wang R.; Miao
X.-Q.; Zhao G.-H.
Institution
(Lu, Zhang, Zhang, Zhao, Wang, Miao, Zhao) Department of Gastroenterology
Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian
Medical University, No. 826 Southwest Road Shahekou District, Dalian
116033, China
(Lu, Zhao, Wang) Dalian Medical University, No. 9 West Section Lvshun
South Road, Dalian 116044, China
(Wang) Department of Cardiology, The Dalian Municipal Central Hospital
Affiliated of Dalian Medical University, No. 826 Southwest Road Shahekou
District, Dalian 116033, China
Publisher
Springer
Abstract
Background/Objective: Nowadays, increasing clinical evidence on metabolic
and weight-loss effects of bariatric surgery on improving cardiac
structure in obese patients, but its application in improving the cardiac
function of HF (heart failure) patients remains controversial. The
objective of this meta-analysis was to assess the effects of BS on cardiac
function by quantifying the changes of LVEF (left ventricular ejection
fraction) and NYHA (New York Heart Association classification) after
operations in non-HFpEF (heart failure and preserved ejection fraction)
patients. Method(s): Articles were searched using PubMed and Embase
from inception to December 9, 2022, and the Minors scale was used for
quality assessments. The included patients should be non-HFpEF and
clinically severely obese, and their pre-operative and post-operative
values of LVEF or NYHA should be reported. Result(s): Nine studies
involving 146 patients were eventually included with a final result
showing that the cardiac functional parameters were improved in non-HFpEF
patients. After a weighted mean follow-up time of 15.8 months, the mean
NYHA decreased by 0.59 (I 2 = 0; 95% CI 0.27 ~ 0.92; p =
0.003), and the mean LVEF increased by 7.49% (I 2 = 0; 95% CI -
9.99 ~ - 4.99; p < 0.00001). Conclusion(s): Bariatric surgery offers
beneficial cardiac effects on non-HFpEF patients with obesity but failed
to show a significant improvement in the pooled analysis for the changes
of cardiac parameters. The improving degree may be related to the baseline
BMI, the extent of BMI loss, and the baseline age. Future studies should
focus on finding out the influencing factors of effectivenesses and
defining the suitable crowd. Graphical Abstract: [Figure not available:
see fulltext.]. Copyright © 2023, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<41>
Accession Number
2023928974
Title
Extrapleural infusion of levobupivacaine versus
levobupivacaine-sufentanil-adrenaline after video-assisted thoracoscopic
surgery (VATS): A randomised controlled trial.
Source
Acta Anaesthesiologica Scandinavica. 67(9) (pp 1256-1265), 2023. Date of
Publication: October 2023.
Author
Larsson M.; Sartipy U.; Franco-Cereceda A.; Spigset O.; Loevenich M.;
Owall A.; Jakobsson J.
Institution
(Larsson, Sartipy, Franco-Cereceda, Owall) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Larsson, Owall) Function Perioperative Medicine and Intensive Care,
Section for Cardiothoracic Anaesthesia and Intensive Care, Karolinska
University Hospital, Stockholm, Sweden
(Sartipy, Franco-Cereceda) Department of Cardiothoracic Surgery,
Karolinska University Hospital, Stockholm, Sweden
(Spigset, Loevenich) Department of Clinical Pharmacology, St. Olav
University Hospital, Trondheim, Norway
(Spigset) Department of Clinical and Molecular Medicine, Norwegian
University of Science and Technology, Trondheim, Norway
(Jakobsson) Institution for Clinical Sciences, Karolinska Institutet at
Danderyd Hospital, Stockholm, Sweden
(Jakobsson) Department of Anaesthesia and Intensive Care, Danderyd
Hospital, Stockholm, Sweden
Publisher
John Wiley and Sons Inc
Abstract
Background: Peripheral blocks are increasingly used for analgesia after
video-assisted thoracic surgery (VATS). We hypothesised that addition of
sufentanil and adrenaline to levobupivacaine would improve the analgesic
effect of a continuous extrapleural block. Method(s): We randomised
60 patients undergoing VATS to a 5-mL h-1 extrapleural infusion
of levobupivacaine at 2.7 mg mL-1 (LB group) or levobupivacaine
at 1.25 mg mL-1, sufentanil at 0.5 mug mL-1, and
adrenaline at 2 mug mL-1 (LBSA group). The primary outcome was
the cumulative morphine dose administered as patient-controlled analgesia
(PCA-morphine) at 48 and 72 h. The secondary outcomes were pain according
to numerical rating scale (NRS) at rest and after two deep breaths twice
daily, peak expiratory flow (PEF) daily, quality of recovery (QoR)-15
score at 1 day and 3 weeks postoperatively, serum levobupivacaine
concentrations at 1 h after the start and at the end of the intervention,
and adverse events. Result(s): At 48 h, the median cumulative
PCA-morphine dose for the LB group was 6 mg (IQR, 2-10 mg) and for the
LBSA group 7 mg (IQR, 3-13.5 mg; p =.378). At 72 h, morphine doses were 10
mg (IQR, 3-22 mg) and 12.5 mg (IQR, 4-21 mg; p =.738), respectively.
Median NRS score at rest and after two deep breaths was 3 or lower at all
time points for both treatment groups. PEF did not differ between groups.
Three weeks postoperatively, only the LB group returned to baseline QoR-15
score. The LB group had higher, but well below toxic, levobupivacaine
concentrations at 48 and 72 h. The incidence of nausea, dizziness,
pruritus and headache was equally low overall. Conclusion(s): For a
continuous extrapleural block, and compared to plain levobupivacaine at
13.5 mg h-1, levobupivacaine at 6.25 mg h-1 with
addition of sufentanil and adrenaline did not decrease postoperative
morphine consumption. The levobupivacaine serum concentrations after 48
and 72 h of infusion were well below toxic levels, therefore our findings
support the use of the maximally recommended dose of levobupivacaine for a
2- to 3-day continuous extrapleural block. Copyright © 2023 The
Authors. Acta Anaesthesiologica Scandinavica published by John Wiley &
Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

<42>
Accession Number
642357779
Title
Comparing the Effectiveness and Safety of MedAn with the Nishikawa Blade
and UE Videolaryngoscopes for Left-Sided Double-Lumen Endobronchial Tube
Intubation: A Randomized Controlled Trial.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 29 (pp e940916), 2023. Date of Publication: 26 Sep
2023.
Author
Zhang Y.; Zhang W.; Wang S.; Yin H.; Xu Y.; Fang Z.; Bao H.; Zhang C.;
Wang X.; Liu W.
Institution
(Zhang, Zhang, Wang, Yin, Xu, Fang, Bao, Zhang, Wang) Department of
Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital,
Nanjing Medical University, Nanjing, Jiangsu, China
(Liu) Department of Pharmacology, School of Basic Medical Sciences,
Nanjing Medical University, Nanjing, Jiangsu, China
Publisher
NLM (Medline)
Abstract
BACKGROUND The purpose of this study was to compare the effectiveness and
safety of the MedAn videolaryngoscope with the Nishikawa blade (MedAn) vs
the UE videolaryngoscope (UE) for intubation with a left-sided
double-lumen endobronchial tube (LDLT) in patients with normal airways.
MATERIAL AND METHODS We randomly categorized 106 patients scheduled to
undergo elective thoracic surgery with LDLT for one-lung ventilation into
2 groups: the UE group (Group UE) and the MedAn group (Group MedAn), using
the MedAn or UE for LDLT intubation. The primary outcome was time to
successful intubation. The Cormack-Lehane classification of laryngeal view
was the key secondary outcome. Other secondary outcomes included
first-attempt and overall intubation success rates, laryngoscopy time,
LDLT placement time, operators' subjective evaluation of
videolaryngoscopes, hemodynamic changes during videolaryngoscopic
intubation, and adverse outcomes. RESULTS The time to successful
intubation and LDLT placement time of Group MedAn were 42.0 (32.35, 47.0)
s and 23.0 (18.0, 26.0) s, and it was shorter than in Group UE (median, 42
s vs 49 s, 23 s vs 30 s, P<0.001). Group MedAn had a better laryngeal view
(P=0.03) and less subglottic/tracheal mucosal injury (P<0.001) than Group
UE. Moreover, the operators' subjective grading of ease of laryngoscopy,
quality of view, and ease of LDLT placement were higher in Group MedAn
than in Group UE (P<0.05). CONCLUSIONS Compared with the UE, the MedAn
could reduce the intubation time and provide a better laryngeal view and
sufficient intubation space for safer LDLT intubation in patients with
normal airways.

<43>
Accession Number
2027304207
Title
Predicting Death or Disability after Surgery in the Older Adult.
Source
Anesthesiology. 139(4) (pp 420-431), 2023. Date of Publication: 01 Oct
2023.
Author
Shulman M.A.; Wallace S.; Gilbert A.; Reilly J.R.; Kasza J.; Myles P.S.
Institution
(Shulman, Wallace, Reilly, Myles) Department of Anaesthesiology and
Perioperative Medicine, Alfred Hospital, Monash University, Melbourne,
Australia
(Gilbert) Data Governance and Security, Alfred Hospital, Melbourne,
Australia
(Kasza) School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Older patients are vulnerable to developing new or worsening
disability after surgery. Despite this, patient or surgical
characteristics predisposing to postoperative disability are poorly
defined. The aim of the study was to develop and validate a model,
subsequently transformed to point-score form, to predict 6-month death or
disability in older patients after surgery. Method(s): The authors
built a prospective, single-center registry to develop and validate the
prediction model. The registry included patients 70 yr of age or older
undergoing elective and nonelective, cardiac and noncardiac surgery
between May 25, 2017, and February 11, 2021, and combined clinical data
from the electronic medical record, hospital administrative data
(International Classification of Diseases, Tenth Revision, Australian
Modification codes) and World Health Organization (Geneva, Switzerland)
Disability Assessment Schedule data collected directly from the patients.
Death or disability was defined as being dead or having a World Health
Organization Disability Assessment Schedule score 16% or greater. Included
patients were randomly divided into model development (70%) and internal
validation (30%) cohorts. Once constructed, the logistic regression and
point-score models were assessed using the internal validation cohort and
an external validation cohort comprising data from a separate randomized
trial. Result(s): Of 2,176 patients who completed the World Health
Organization Disability Assessment Schedule immediately before surgery,
927 (43%) patients were disabled, and 413 (19%) had significant
disability. By 6 months after surgery, 1,640 patients (75%) had data
available for the primary outcome analysis. Of these patients, 195 (12%)
patients had died, and 691 (42%) were dead or disabled. The developed
point-score model included the preoperative World Health Organization
Disability Assessment Schedule score, patient age, dementia, and chronic
kidney disease. The point score model retained good discrimination in the
internal (area under the curve, 0.74; 95% CI, 0.69 to 0.79) and external
(area under the curve, 0.77; 95% CI, 0.74 to 0.80) validation data sets.
 Conclusion(s): The authors developed and validated a point score
model to predict death or disability in older patients after
surgery. Copyright © 2023 Lippincott Williams and Wilkins. All
rights reserved.

<44>
Accession Number
2027273356
Title
Effects of PCSK9 inhibitors on coronary microcirculation, inflammation and
cardiac function in patients with CHD after PCI: a protocol for systematic
review and meta-analysis.
Source
BMJ Open. 13(9) (no pagination), 2023. Article Number: 074067. Date of
Publication: 18 Sep 2023.
Author
Ye X.; Wang S.; Liu X.; Wu Q.; Lv Y.; Lv Q.; Li J.; Li L.; Yang Y.
Institution
(Ye, Wu, Lv, Li, Li) Guang'anmen Hospital, China Academy of Chinese
Medical Sciences, Beijing, China
(Wang) Department of Cardiology, China Academy of Traditional Chinese
Medicine Guang'anmen Hospital, Beijing, China
(Liu) Capital Medical University, Beijing, China
(Lv) Shanghai Qianhe Technology Co LTD, Shanghai, China
(Yang) Beijing University of Chinese Medicine, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Coronary heart disease (CHD) is one of the common
cardiovascular diseases that seriously jeopardise human health, and
endothelial inflammation and dyslipidaemia are the initiating links
leading to its occurrence. Percutaneous coronary intervention (PCI) is one
of the most effective surgical treatments for CHD with narrowed or blocked
blood vessels, which can quickly unblock the blocked vessels and restore
coronary blood supply. However, most patients may experience coronary
microcirculation disorders (CMDs) and decreased cardiac function after PCI
treatment, which directly affects the efficacy of PCI and the prognosis of
patients. Preprotein converting enzyme subtilisin/Kexin 9 (PCSK9)
inhibitors are novel pleiotropy lipid-lowering drug with dual
anti-inflammation and lipid-lowering effects, and represent a new clinical
pathway for rapid correction of dyslipidaemia. Therefore, we designed this
protocol to systematically evaluate the effects of PCSK9 inhibitors on
coronary microcirculation and cardiac function in patients with CHD after
PCI, and to provide high-quality evidence-based evidence for the clinical
application of PCSK9 inhibitors. Methods and analysis This protocol is
reported strictly in accordance with the 2020 Preferred Reporting Items
for Systematic Reviews and Meta-analyses Protocols Guidelines. We will
search PubMed, EMBASE, Web of Science and three Chinese databases (CNKI,
Wanfang and VIP database) according to preset search strategies, without
language and publication data restrictions. We will work with manual
retrieval to screen references that have been included in the literature.
Google Scholar will be used to search for grey literature. The final
included literature must meet the established inclusion criteria. Titles,
abstracts and full text will be extracted independently by two reviewers,
and disagreements will be resolved through discussion or the involvement
of a third reviewer. Extracted data will be analysed using Review Manager
V.5.3. The Cochrane Risk of Bias Tool will be used to evaluate the risk of
bias. Publication bias will be assessed by funnel plots. Heterogeneity
will be assessed by I 2 test and subgroup analyses will be used to further
investigate potential sources of heterogeneity. The quality of the
literature will be assessed by GRADE score. This protocol will start in
January 2026 and end in December 2030. Ethics and dissemination This study
is a systematic review of published literature data and no special ethical
approval was required. PROSPERO registration number CRD42022346189.
 Copyright © Author(s) (or their employer(s)) 2023. Re-use
permitted under CC BY. Published by BMJ.

<45>
Accession Number
2027273339
Title
Frequency of postoperative cognitive dysfunction after non-cardiac surgery
and its impact on functional outcomes: protocol for a systematic review.
Source
BMJ Open. 13(9) (no pagination), 2023. Article Number: 071732. Date of
Publication: 18 Sep 2023.
Author
Roldan Y.; Khattak S.; Samari S.; Chan O.; Pancucci M.; Sritharan P.;
Jamil Y.; Marcucci M.
Institution
(Roldan) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Khattak, Samari, Sritharan) Michael G DeGroote School of Medicine,
McMaster University, Hamilton, ON, Canada
(Chan, Pancucci) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Jamil) Department of Internal Medicine, Yale University, New Haven, CT,
United States
(Marcucci) Departments of Health Research Methods, Evidence, and Impact,
and Medicine, Division of Perioperative Care and Department of Medicine,
Division of General Internal Medicine, McMaster University, Hamilton, ON,
Canada
(Marcucci) Perioperative Medicine and Surgical Research Unit, Population
Health Research Institute, Hamilton, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Older surgical candidates are at increased risk of a
phenomenon known as postoperative cognitive dysfunction (POCD). Several
studies have looked at the incidence of POCD at different time points
following surgery, using different study methods. Fewer have assessed
whether changes in cognition after surgery are attributable to surgery and
how they impact patient function and quality of life. The aim of this
systematic review is to summarise and appraise studies addressing any of
the following research questions (RQs): (RQ1) what is the frequency of
POCD after non-cardiac surgery?; (RQ2) is non-cardiac surgery associated
with an increased risk of cognitive decline?; (RQ3) is POCD after
non-cardiac surgery associated with patient-important outcomes? Methods
and analysis This protocol adhered to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses Protocols guidelines. Three
electronic databases (MEDLINE, PsycINFO and EMBASE) will be systematically
searched from their inception date. Identified studies will be screened by
two reviewers for eligibility using Covidence, and data will be extracted
into a standardised electronic form. We will evaluate methodological
quality of included studies using the Quality In Prognosis Studies and its
adaptation to the overall prognosis question, and the CLARITY risk of bias
for cohort and case-control studies. For RQ1, we will estimate an average
POCD frequency at different time points by performing a meta-analysis of
included studies when appropriate. For RQ2 and RQ3, we will extract and
meta-analyse the effect measures for the association of surgery with
cognitive decline when compared with the non-surgical comparator, and
association of cognitive changes with functional changes, quality of life
and other patient-important outcomes based on available evidence. We will
narratively summarise and discuss the different methods implemented in the
existing studies to answer the three RQs, and when meta-analysis is deemed
infeasible, we will qualitatively report the results of the included
studies. Ethics and dissemination This project involves the collection and
analysis of data from previously published studies and therefore does not
require ethics approval. We plan to present the findings of this research
project at peer-reviewed conferences and publish the results in
peer-reviewed journals. PROSPERO registration number CRD42022370674.
 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.

<46>
Accession Number
2025644607
Title
Comment on "Effect of high-energy and/or high-protein feeding in children
with congenital heart disease after cardiac surgery: a systematic review
and meta-analysis".
Source
European Journal of Pediatrics. (no pagination), 2023. Date of
Publication: 2023.
Author
Xiang G.
Institution
(Xiang) Department of Neonatology, The Central Hospital of Enshi Tujia and
Miao Autonomous Prefecture, Hubei, Enshi 445000, China
Publisher
Springer Science and Business Media Deutschland GmbH

<47>
Accession Number
2027238412
Title
"HU" ARE YOU CALLING FAT?.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A4054-A4055), 2023. Date of Publication: October
2023.
Author
PATEL N.; KEMPPAINEN C.; QADEER A.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Imaging Case Report Posters 4 SESSION TYPE: Case Report
Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION:
Although common to find incidental pulmonary nodules on radiologic
imaging, it can be challenging to determine the etiology. Size can
distinguish between a pulmonary nodule and a pulmonary mass, as nodules
are defined to be any opacity less than 30 mm in diameter, whereas any
opacity larger is considered a pulmonary mass(1). Other characteristics
such as pattern of calcification can help determine possibility of
malignancy, and Hounsfield units (HU) can determine density of underlying
tissue, suggesting its composition(2). A lipoma on computed tomography
(CT) chest imaging will appear as a hypodense mass, helping to further
differentiate between other lung lesions(3). Therefore, it is important to
understand the differences between various lung lesions and apply them to
the patient at hand. CASE PRESENTATION: 64-year-old female, former smoker
with significant family history of lung cancer initially presented to
pulmonary clinic for evaluation of dyspnea on exertion after a negative
cardiac workup. Initial chest radiography revealed a left sided mass-like
opacity measuring 7.7x8.2x7.8 cm abutting both the hilum and lateral
pleura (Fig 1). CT chest with intravenous contrast demonstrated a
well-circumscribed lesion within the left upper lobe measuring
11.0x7.5x7.5 cm with HU ranging from -120 to -90, consistent with adipose
tissue (Fig 2). Based on these features, the lung mass can be
radiographically diagnosed as an intrathoracic lipoma, without the need
for a biopsy. Given the size of the lipoma, it is difficult to determine
if it originates from chest wall or pericardium. Currently, patient is
being evaluated for surgical resection of lung mass. DISCUSSION: Lipomas
are common benign neoplasms composed of adipose tissue, typically
presenting as soft nodules anywhere in the body where adipocytes are
present, including the thoracic cavity. Lipomatous lesions typically are
well circumscribed, homogenous, with HU ranging from -135 to -83(4). In
the case above, there was a broad differential diagnosis for the large
mass-like lesion after the initial X-ray, including malignancy, benign
mass, or organizing pneumonia. After further evaluation with CT Chest,
however, it was clear this was most likely a benign lesion with its
homogenous appearance and HU consistent with adipose tissue. Liposarcomas,
on the other hand, have a heterogenous appearance with HU typically
ranging from -83 and +38 HU(5). Distinguishing benign features
radiographically is paramount to avoid unnecessary biopsies and establish
a diagnosis. Guidelines are not clear on further management, however due
to concern for continued growth, mass compression of surrounding
structures and potential for liposarcoma, surgical resection is often
advised(6). CONCLUSION(S): Intrathoracic lipomas can be determined to
be benign based on radiographic characteristics and HU, but still may need
to undergo surgical resection, especially if symptomatic. REFERENCE #1: 1.
Harders, Stefan Walbom, et al. "Characterization of Pulmonary Lesions in
Patients with Suspected Lung Cancer: Computed Tomography versus
[18F] Fluorodeoxyglucose-Positron Emission Tomography/Computed
Tomography." Cancer Imaging : the Official Publication of the
International Cancer Imaging Society, U.S. National Library of Medicine,
16 Oct. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3478790/. 2.
Khan, Ali Nawaz, et al. "Solitary Pulmonary Nodule: A Diagnostic Algorithm
in the Light of Current Imaging Technique." Avicenna Journal of Medicine,
U.S. National Library of Medicine, Oct. 2011,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507065/#ref11. 3. Bulyashki,
Daniel, et al. "Pulmonary Lipoma in an Atypical Location of the Pulmonary
Fissure, Extirpated by Uniportal Vats - Case Report and Review of
Literature." European Medical Journal, European Medical Journal, 16 Mar.
2021,
https://www.emjreviews.com/respiratory/article/pulmonary-lipoma-in-an-atyp
ical-location-of-the-pulmonary-fissure-extirpated-by-uniportal-vats-case-r
eport-and-review-of-literature/. 4. Chikui, Toru, et al. "Imaging Findings
of Lipomas in the Orofacial Region with CT, US, and Mri." Kyushu
University, Elsevier USA, 1 Jan. 1997,
https://kyushu-u.pure.elsevier.com/en/publications/imaging-findings-of-lip
omas-in-the-orofacial-region-with-ct-us-an. 5. Lindahl S, Markhede G,
Berlin O. Computed Tomography of Lipomatous and Myxoid Tumors. Acta
Radiologica Diagnosis. 1985;26(6):709-713.
doi:10.1177/0284185185026006136. Aldahmashi, Mohammed, et al. "The Largest
Reported Intrathoracic Lipoma: A Case Report and Current Perspectives
Review - Journal of Cardiothoracic Surgery." BioMed Central, BioMed
Central, 11 Dec. 2019,
https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-01
9-1030-8#:~:text=Once%20the%20Intrathoracic%20lipomas%20are,after%20surgic
al%20resection%20%5B1%5D. DISCLOSURES: No relevant relationships by
Camilla Kemppainen No relevant relationships by Nikita Patel No relevant
relationships by Asem Qadeer Copyright © 2023 American College of
Chest Physicians

<48>
Accession Number
2027236855
Title
SPONTANEOUS HEMOPERICARDIUM IN THE SETTING OF END-STAGE RENAL DISEASE AND
CONCURRENT APIXABAN USE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A2458-A2459), 2023. Date of Publication: October
2023.
Author
ARIATTI A.; ADEMI B.; CHOA J.; KHAN Y.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters 5 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION:
In the evaluation of hemodynamically unstable patients presenting in
shock, cardiac tamponade is frequently considered as a possible etiology.
For patients with underlying malignancy, autoimmune disease, recent
invasive cardiac procedures or end-stage renal disease (ESRD), suspicion
of pericardial effusion quickly rises. However, this diagnosis can often
be initially overlooked in the absence of those risk factors. Here we
present a case of spontaneous hemopericardium in the setting of direct
oral anticoagulant (DOAC) use, ESRD, and chronic, ongoing infection. CASE
PRESENTATION: A 56-year old woman with a history of ESRD on hemodialysis
and diabetes complicated by bilateral lower extremity amputation and
chronic osteomyelitis was admitted to the ICU for initially suspected
septic shock. Her admission vitals were a blood pressure of 89/74mmHg,
heart rate of 120, respiration rate of 24 and temperature of 99.2degree
Fahrenheit. The physical exam was significant for altered mental status,
labored breathing, a wound on the right lower extremity stump, tachycardia
and distant heart sounds. Labwork demonstrated an anion gap of 31, lactic
acid of 14 mmol/L, INR of 5 and WBC of 17.0 10^3/uL. The patient's
presentation was at first attributed to an underlying infection given her
chronic osteomyelitis and an open wound at the right below knee amputation
site. Shen then underwent emergent dialysis the same day of admission with
the goal of 2 liters of volume removal. This session was ended early as
the patient became further hypotensive necessitating vasopressor support
and intubated for concern of airway protection, worsening encephalopathy
and increased work of breathing. Transthoracic echocardiogram (TTE) and
electrocardiogram (ECG) demonstrated tamponade physiology with electrical
alternans, respectively. The patient was taken for a pericardiocentesis
with 1 liter of bloody fluid removed. She made quick hemodynamic and
clinical improvement, extubated within 48 hours, taken off vasopressor
support and able to be stepped down to the medical floor. DISCUSSION:
Limited data exist in evaluating the safety of DOACs for those with
underlying ESRD. While these patients often take the medication at a
reduced dose, there are a growing number of case reports demonstrating
increased rates of bleeding and even hemopericardium. Prescribers should
take caution and enable shared decision making when initiating DOACs in
high-risk patients. Equally important, physicians cannot exclude tamponade
in the absence of typical risk factors. While TTE, ECG, physical exam
findings and abnormal vitals remain the mainstay of diagnosis, DOAC use in
ESRD patients should raise the pre-test probability of pericardial
effusion. Elevated INR greater than 5 can also be an early clue for
increased risk of bleeding into pericardial space and a transthoracic
echocardiogram should be considered in all patients with hemodynamic
instability. In the prevention of the development of adverse bleeding
events, further research could be conducted on intermittent laboratory
monitoring in identified high-risk patients. CONCLUSION(S): The use
of DOACs in patients with ESRD can increase the risk of spontaneous
bleeding, even when the dose is adjusted. When these patients have a
clinical presentation suggestive of cardiac tamponade without other risks
for pericardial effusions, spontaneous hemopericardium should be
considered. REFERENCE #1: Shah A, van den Brink A, de Mol B. Raised
international normalized ratio: an early warning for a late cardiac
tamponade? Ann Thorac Surg. 2006 Sep;82(3):1090-1. doi:
10.1016/j.athoracsur.2006.01.035. PMID: 16928545. REFERENCE #2: Zain Ul
Abideen Asad, Sardar Hassan Ijaz, Amna Mohyud Din Chaudhary, Safi U. Khan,
Aneesh Pakala, Hemorrhagic Cardiac Tamponade Associated with Apixaban: A
Case Report and Systematic Review of Literature, Cardiovascular
Revascularization Medicine, Volume 20, Issue 11, Supplement, 2019, Pages
15-20, ISSN 1553-8389, https://doi.org/10.1016/j.carrev.2019.04.002.
DISCLOSURES: No relevant relationships by Besim Ademi No relevant
relationships by Allison Ariatti No relevant relationships by Jacqueline
Choa No relevant relationships by Yasin Khan Copyright © 2023
American College of Chest Physicians

<49>
Accession Number
2027236766
Title
DIAGNOSIS AND TREATMENT OF A RARE POSTERIORLY LOCULATED PERICARDIAL
EFFUSION SECONDARY TO FOCAL PERICARDITIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A520-A521), 2023. Date of Publication: October 2023.
Author
PONIR C.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 16 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm
INTRODUCTION: Pericardial effusions are initially seen in up to 60% of
patients on either chest x-ray (CXR) or transthoracic echocardiogram (TTE)
but commonly do not require intervention. Cancer patients who undergo
allogenic stem cell bone marrow transplants (alloSCT) have been seen to
have pericardial effusions, but rarely large enough to cause intervention.
The pathophysiology of post-alloSCT pericardial effusions is poorly
understood, but the effusions themselves can lead to scarring and
fibrosis. In this case, we will address an unusual presentation of a
loculated pericardial effusion secondary to focal pericarditis
masquerading as a cardiac malignancy versus thrombus. We will discuss
diagnosis strategies via multimodal imaging and also delve into the
limited treatment options for patients with posterior fluid collections.
CASE PRESENTATION: The patient is a 74-year-old male with a history of
acute myeloid leukemia post-allographic stem cell transplant (alloSCT) who
presented due to two weeks of palpitations and pleuritic chest pain. EKG
showed sinus tachycardia to 120 beats per minute with stable vitals. Labs,
troponins, and CXR were unremarkable. Chest CT Angiogram ruled out
pulmonary emboli but showed an enlarging posterior left pericardial
4.7x9.2cm mass with mass effect on the left atrium concerning for
malignancy versus thrombus. A heparin drip was started. Transthoracic echo
showed large echo-lucent, likely fluid-filled, posterior mass. Cardiac
magnetic resonance imaging was ordered verifying a fluid filled mass most
concerning for a rare posteriorly loculated pericardial effusion most
consistent with focal pericarditis. High dose ibuprofen and colchicine
resolved the patient's symptoms. Due to the mass effect on the left
atrium, the patient converted into atrial flutter with rapid rates for
which the electrophysiology team recommended starting a diltiazem drip
with oral metoprolol tartrate and oral diltiazem for adequate
atrioventricular (AV) nodal blockade. This was quickly followed by
tamponade physiology with bradycardia, likely a confounding finding in the
setting of his AV nodal blockade. Interventional Radiology deemed
pericardiocentesis or percutaneous window and pericardial drain placement
of the posterior effusion unsafe. Cardiothoracic surgery was then
consulted for sternotomy and subxiphoid window, but the patient declined.
Given his worsening hypotension, arrhythmia, and no alternative solution
for pericardial fluid removal, the patient opted to transition to comfort
care. DISCUSSION: Cancer patients who undergo allogenic stem cell bone
marrow transplants have been seen to have pericardial effusion which can
lead to scarring and fibrosis. This patient did have small pericardial
effusions in the past. Multimodal imaging was necessary to ascertain the
mass's consistency and guide appropriate treatment. CONCLUSION(S):
His arrhythmia, subsequent cardiogenic shock from tamponade, and
discussion of intervention required the input of multiple teams. Though
the patient opted to pursue comfort care in lieu of surgical intervention,
his case redemonstrates the importance of multimodal imaging and
multidisciplinary collaboration between the primary team and all
consultants on board to deliver the best care in the most complicated and
rare situations. REFERENCE #1: Imazio, M., Gaita, F., & LeWinter, M.
(2015). Evaluation and Treatment of Pericarditis: A Systematic Review.
JAMA, 314(14), 1498-1506.
https://doi-org.wake.idm.oclc.org/10.1001/jama.2015.12763 REFERENCE #2:
Imazio, M., Mayosi, B. M., Brucato, A., Markel, G., Trinchero, R.,
Spodick, D. H., & Adler, Y. (2010). Triage and management of pericardial
effusion. Journal of cardiovascular medicine (Hagerstown, Md.), 11(12),
928-935. https://doi-org.wake.idm.oclc.org/10.2459/JCM.0b013e32833e5788
REFERENCE #3: Norkin, M., Ratanatharathorn, V., Ayash, L., Abidi, M. H.,
Al-Kadhimi, Z., Lum, L. G., & Uberti, J. P. (2011). Large pericardial
effusion as a complication in adults undergoing SCT. Bone marrow
transplantation, 46(10), 1353-1356.
https://doi-org.wake.idm.oclc.org/10.1038/bmt.2010.297 DISCLOSURES: No
relevant relationships by Cynthia Ponir Copyright © 2023 American
College of Chest Physicians

<50>
Accession Number
2027236725
Title
AN UNCOMMON COMPLICATION OF AN AUTOMATED CHEST COMPRESSION DEVICE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A5437), 2023. Date of Publication: October 2023.
Author
SCHUTTE B.; FREDERICKSON J.A.; SAHASRANAMAN V.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Report Posters 7 SESSION TYPE: Case Report
Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: The
incidence of iatrogenic tracheal rupture with endotracheal intubation is
reported to be approximately 0.005%. Mortality in these patients is
estimated to be up to 22%. Literature is scarce on whether automated chest
compression devices increase this risk. Here we present a case of
iatrogenic tracheal rupture during emergent intubation. CASE PRESENTATION:
Our patient was a 67-year-old woman who presented with nausea and emesis.
Physical exam revealed acute encephalopathy and bradycardia. Workup was
consistent with severe diabetic ketoacidosis, including an arterial pH of
6.85. She subsequently developed agonal respiration followed by cardiac
arrest with ventricular fibrillation. Defibrillation was performed
immediately followed by CPR with a mechanical chest compression device.
Multiple attempts at video laryngoscopic intubation failed due to poor
visualization, confirmed by absence of color change on colorimetry. There
was evidence of bleeding from the trachea, so direct laryngoscopy was
performed, this time successfully. CT scan of the chest revealed
subcutaneous emphysema, pneumomediastinum, and a postero-lateral tracheal
defect measuring 17mm. Interventional pulmonology could not place a
tracheal stent due to increasing size of the defect and extension to the
carina noted on bronchoscopy. Surgical repair was attempted via
thoracotomy approach. Unfortunately, the patient was unable to tolerate
single lung ventilation, and the procedure was aborted. After discussion
with the family, the patient was compassionately extubated. DISCUSSION:
The most significant risk factors for tracheal perforation during
endotracheal intubation include emergent nature, multiple attempts, and
inexperienced practitioners. In our case, the provider was an experienced
emergency physician, so the complicating factor was most likely the
external chest compression device. With manual CPR, intubation is
typically attempted during a brief pause for pulse check. Automated chest
compression devices afford shorter breaks in CPR by avoiding switching of
providers. For this reason, attempts at intubation are commonly performed
while compressions are ongoing. This poses increased risk for
complications, including iatrogenic tracheal perforation.
 CONCLUSION(S): Automated chest compression devices are touted for
their ability to provide consistent, indefatigable chest compressions with
minimal interruptions. However, providers must consider that these devices
present inherent risk for complications during emergent intubation.
REFERENCE #1: Alshoubi A, Khan A, DeJesus V, Hauck E. A Case Report of
Iatrogenic Bronchial Rupture following Endobronchial Blocker Placement.
Case Rep Crit Care. 2022;2022:2494542. Published 2022 May 23.
doi:10.1155/2022/2494542 REFERENCE #2: Eduardo Minambres, Javier Buron,
Maria Angeles Ballesteros, Javier Llorca, Pedro Munoz, Alejandro
Gonzalez-Castro, Tracheal rupture after endotracheal intubation: a
literature systematic review, European Journal of Cardio-Thoracic Surgery,
Volume 35, Issue 6, June 2009, Pages 1056-1062,
https://doi.org/10.1016/j.ejcts.2009.01.053 REFERENCE #3: Grewal HS,
Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of
Tracheobronchial Injuries: A Contemporary Review. Chest.
2019;155(3):595-604. doi:10.1016/j.chest.2018.07.018 DISCLOSURES: No
relevant relationships by Joseph Frederickson No relevant relationships by
Venketraman Sahasranaman No relevant relationships by Bryce
Schutte Copyright © 2023 American College of Chest Physicians

<51>
Accession Number
2027236241
Title
SPONTANEOUS SPLENIC RUPTURE PRESENTING AS TTP: ONE HEMATOLOGIC EMERGENCY
MASKED AS ANOTHER.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A2583-A2584), 2023. Date of Publication: October
2023.
Author
MATEEN R.U.B.A.; DESAI R.; ADDANKI T.; ADNAN SULTAN S.; KHALID S.A.R.A.;
ANSARI A.; KAPA T.; JIBAWI N.; JAIN P.; KHAN R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters 40 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION:
Spontaneous splenic rupture (SSR) is a rare, critical condition with an
incidence of <0.5%. It commonly presents with left upper quadrant (LUQ)
abdominal pain and hemodynamic instability. SSR has multiple causative
factors such as malignancy, infection, vascular disease and
anticoagulation use. We describe an unusual presentation of SSR that, to
the best of our literature search, has not been previously described. CASE
PRESENTATION: A 54-year-old female with chronic anticoagulation use
secondary to mechanical aortic and mitral valve replacement presented with
LUQ abdominal pain for 1 day with no history of trauma or infection. The
patient was afebrile and tachycardic to 120s on arrival but was clinically
stable. Labs demonstrated hemoglobin 9.9, INR 4.3, platelets 298, and
BUN/Cr 12/0.9. CT angio abdomen showed an abnormal mass-like appearance of
the stomach and enlarged spleen from mass infiltration of the stomach.
Overnight, a rapid response team (RRT) was called for worsening abdominal
pain, tachycardia and tachypnea. No abnormalities were found on the
abdominal exam, however there was an acute drop in hemoglobin to 6.8.
Within hours of the initial RRT, the patient became altered, hypotensive,
and was in respiratory distress. ICU transfer was initiated with emergent
intubation and vasopressor support. Labs showed creatinine 1.6, hemoglobin
5.9, platelets 37, INR 7.8, haptoglobin <30 and reticulocyte count 2.2.
Peripheral blood smear showed innumerable schistocytes, too numerous to
have occurred from mechanical valve shearing. A preliminary diagnosis of
TTP was made given altered mentation, thrombocytopenia, hemolysis and
worsening renal function with high risk PLASMIC score, and plasmapheresis
was initiated. The patient continued to decline and developed severe
abdominal distension with increased bladder pressure. General surgery was
consulted. The patient underwent emergent laparotomy for abdominal
compartment syndrome and a large peritoneal hematoma was removed along
with 4L of liquid blood. Due to high bleeding risk, further exploration
was deferred. During the second laparotomy, an enlarged, fractured spleen
was removed. Pathological results were unremarkable. ADAMST13 levels
resulted within normal range. Our patient made a full recovery and was
discharged after 22 days of hospitalization. DISCUSSION: SSR is rare and
the absence of trauma can lead to misdiagnosis and treatment delay.
Although our patient's presentation was concerning for TTP, risk factors
for SSR were not taken into account such as initial concern for gastric
malignancy and chronic anticoagulation use. Any suspicion for TTP is a
hematologic emergency, thus immediate plasmapheresis was started. However,
in conjunction to treatment for suspected TTP, SSR should be high on the
differential with prompt surgical evaluation and workup to avoid
complications. In this patient, prompt diagnosis might have prevented the
development of abdominal compartment syndrome, multiple high-risk
surgeries, and a prolonged hospital stay. CONCLUSION(S): This novel
case presentation and literature review of SSR provides clinician
awareness for early recognition of a rare critical diagnosis that could
lead to improved patient outcomes. Patients who present with signs and
symptoms of a hematologic emergency such as TTP should concomitantly be
worked up for SSR. REFERENCE #1: Gedik E, Girgin S, Aldemir M, Keles C,
Tuncer MC, Aktas A. Non-traumatic splenic rupture: report of seven cases
and review of the literature. World J Gastroenterol.
2008;14(43):6711-6716. doi:10.3748/wjg.14.6711 REFERENCE #2: Akoury T,
Whetstone DR. Splenic Rupture. [Updated 2022 Jul 18]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK525951/ REFERENCE
#3: Ahbala T, Rabbani K, Louzi A, Finech B. Spontaneous splenic rupture:
case report and review of literature. Pan Afr Med J. 2020 Sep 8;37:36.
doi: 10.11604/pamj.2020.37.36.25635. PMID: 33209163; PMCID: PMC7648463.
DISCLOSURES: No relevant relationships by Tejaswini Addanki No relevant
relationships by Saria Adnan Sultan No relevant relationships by Adnan
Ansari No relevant relationships by Rinky Desai No relevant relationships
by Pankaj Jain No relevant relationships by Nidal Jibawi No relevant
relationships by Tejasvini Kapa No relevant relationships by Sara Khalid
No relevant relationships by Roozehra Khan No relevant relationships by
Ruba Mateen Copyright © 2023 American College of Chest Physicians

<52>
Accession Number
2027229580
Title
POP GOES THE PLEURA: RECURRENT PNEUMOTHORACES IN THE SETTING OF CATAMENIAL
DISEASE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A3632), 2023. Date of Publication: October 2023.
Author
THOMAS-NADLER S.; MODI R.I.T.U.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of Pleura Case Report Posters 10 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am
INTRODUCTION: Catamenial Pneumothorax is a rare clinical presentation that
occurs in women as recurrent pneumothorax in women of reproductive age.
Presence of endometrial tissue in the thoracic cavity activates during the
menstrual cycle which can sometimes lead to recurrent spontaneous
pneumothorax despite treatment. These treatments sometimes include video
assisted thoracic surgery (VATS) with or in addition to hormonal therapy.
In this case we discuss a patient who had recurrent spontaneous
pneumothorax secondary to her endometriosis and the different treatment
modalities. CASE PRESENTATION: A 32 year old female with a medical history
of smoking and dysmenorrhea who presented to pulmonary for follow up of
her recurrent pneumothorax. She had her first pneumothorax in 2015 and at
that time she was treated conservatively. Subsequently in 2016 she had
another right pneumothorax and underwent wedge resection of the right
upper lobe, mechanical pleurodesis, partial pleurectomy and diaphragm
repair. During that time it was noted in surgery that she did have some
dark blue and red lesions along her pleural and diaphragm. Biopsy was also
done which just showed emphysematous changes. She was also seen by
obstetrics and gynecology for concern of endometriosis and started on
deprovera but was never officially diagnosed. In 2019 she had another
right sided pneumothorax and had a chest tube placed and was discharged
from the hospital. She was on deprovera during that time. Was followed by
thoracic surgery for her recurrent pneumothorax and cervical esophageal
dysphagia despite before on dept shots. She was following ECU Pulmonary in
2020 for concern of COPD since she continued to have some shortness of
breath and had a long standing smoking history. Patient underwent a right
VATS with talc pleurodesis in 2021 after presenting to pulmonary clinic
with cheat pain and shortness of breath. Chest XR at that time did show
Large R pneumothorax. DISCUSSION: Thoracic endometriosis is the most
common site for extra pelvic endometriosis that presents with chest pain
and shortness of breath. It most commonly affects right side (85-90%)
versus the left side due to the fenestrations on the right side of the
diaphragm. With this case, it is important to emphasize how these patients
should be treat after surgical intervention and that these patient may
need to undergo multiple interventions despite being on hormonal therapy.
Not many studies have been done examining the need for hormonal therapy.
Some case studies reflect some patients that have some response but most
patients are followed clinically. It is also common that patients can
develop pleural thickening and loculations which makes management of
future pneumothoraces even more difficult. CONCLUSION(S): With the
disease affecting young population and having a significant effect on
lifestyle, it is prudent that more research should be done for chest pain
and shortness of breath management. REFERENCE #1: KOROM, S., CANYURT, H.,
MISSBACH, A., SCHNEITER, D., KURRER, M., HALLER, U., KELLER, P., FURRER,
M., & WEDER, W. (2004). Catamenial Pneumothorax Revisited: Clinical
approach and systematic review of the literature. Journal of Thoracic and
Cardiovascular Surgery, 128(4), 502-508.
https://doi.org/10.1016/s0022-5223(04)00772-x REFERENCE #2: Leong, A. C.,
Coonar, A. S., & Lang-Lazdunski, L. (2006). Catamenial Pneumothorax:
Surgical Repair of the Diaphragm and Hormone Treatment. Annals of the
Royal College of Surgeons of England, 88(6), 547-549.
https://doi.org/10.1308/003588406x130732 REFERENCE #3: Carter, E. J., &
Ettensohn, D. B. (1990). Catamenial Pneumothorax. Chest, 98(3), 713-716.
https://doi.org/10.1378/chest.98.3.713 DISCLOSURES: No relevant
relationships by Ritu Modi No relevant relationships by Samantha
Thomas-Nadler Copyright © 2023 American College of Chest
Physicians

<53>
Accession Number
2027229210
Title
RHODOCOCCUS PNEUMONIA WITH LUNG CAVITATION IN THE SETTING OF BONE MARROW
TRANSPLANT.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1446-A1447), 2023. Date of Publication: October
2023.
Author
BOYD T.; WINTERTON B.M.; WILHITE R.E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Report Posters 5 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION:
Rhodococcus hoagie (formerly known as Rhodococcus equis) is a
gram-positive, encapsulated, intracellular bacillus, which rarely effects
immunocompetent humans. Patients with HIV have accounted for up to
two-thirds of infections (1). We present a case of a bone marrow
transplant patient with a Rhodococcus infection reflecting an increasing
prevalence of cases reported in organ transplant patients (2,3). CASE
PRESENTATION: A 65-year-old female with a history of treated latent
tuberculosis (TB), acute myeloid leukemia status post allogenic unrelated
fully matched bone marrow transplant with subsequent development of graft
vs host disease (GVHD) on chronic immunosuppressive therapy presented to
the emergency department for one week of dry cough, left rib pain, and a
35-pound weight loss over the past three months. Social history was
remarkable for owning horses. Her current medications included prednisone,
mycophenolate mofetil, tacrolimus, ruxolitinib, acyclovir, fluconazole,
and trimethoprim-sulfamethoxazole. Physical exam was unremarkable. Lab
workup was significant for procalcitonin 0.24 ng/mL. Computed Tomography
(CT) chest showed a left upper lobe cavitary lesion with central lucency
(Figure 1). A bronchoscopy with bronchoalveolar lavage was conducted and
did not demonstrate any significant findings. Blood cultures grew R.
hoagie. Based on her social and medical history, it was thought that the
cavitary lesion was most likely secondary to R. hoagie infection. She was
initially treated with broad spectrum antibiotics. Once sensitivities
resulted, antibiotics were switched to ertapenem, azithromycin,
moxifloxacin for a planned two-month course. A repeat CT after two months
revealed a decrease in size of the cavity (FIgure 2). Infectious Disease
planned to administer lifelong secondary prophylaxis with a single drug
based on susceptibilities, but her malaise and cough returned.
Cardiothoracic surgery evaluated her for left upper lobe wedge resection,
but she was deemed a poor surgical. She passed away three months after her
initial presentation, during an admission to another hospital where she
was found to again to have R. hoagie infection. DISCUSSION: R. hoagie
infection is classically associated with horse farms where transmission
occurs via inhalation of aerosolized soil and horse feces. Infected
patients most commonly present with pulmonary symptoms with up to 80% of
immunocompromised hosts developing pulmonary cavitations but other organ
involvement have been reported (2).Our case highlights the importance of
correctly and promptly identifying R. hoagie infection as mortality is
high in bone marrow transplant patients (2). The vague clinical
presentation in the context of an immunocompromised patient suggests a
broad differential. As a result, these infections are probably
underreported and misdiagnosed (2), leading to delays in empiric
treatment, and death in some cases (1). However, a thorough work can lead
to the appropriate diagnosis. There is also a lack of knowledge regarding
duration of therapy in the immunocompromised. No prospective study has
compared the use of a single bactericidal antibiotic with two antibiotics
(3). CONCLUSION(S): Our case, its challenges of diagnosis, treatment,
and its ultimate poor outcome illustrates the need for further study to
guide treatment in this underrepresented population. More consideration
could be given to the long-term course, management, and outcomes in future
work. REFERENCE #1: Jiang Y, Li J, Qin W, Gao Y, Liao X, Zeng Y.
Tuberculosis with cavities? Rapid diagnosis of Rhodococcus equi pulmonary
infection with cavities by acid-fast staining: A case report. Front Public
Health. 2022 Sep 16;10:982917. REFERENCE #2: da Silva Campana P, Martinho
LZM, Batista MV, Higashino H, Rizek C, Rossi F, Oliveira FN, Rocha V,
Costa SF. Rhodococcus hoagii bloodstream infection in an allogeneic
hematopoietic stem cell transplantation patient: Case report and review of
literature. REFERENCE #3: Lin WV, Kruse RL, Yang K, Musher DM. Diagnosis
and management of pulmonary infection due to Rhodococcus equi. Clin
Microbiol Infect. 2019 Mar;25(3):310-315. DISCLOSURES: No relevant
relationships by Tyler Boyd No relevant relationships by Rodger Wilhite No
relevant relationships by Blaine Winterton Copyright © 2023
American College of Chest Physicians

<54>
Accession Number
2027229175
Title
LONG-TERM OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION VS CORONARY
ARTERY BYPASS GRAFTING IN PATIENTS WITH DIABETES MELLITUS WITH MULTIVESSEL
DISEASE: A META-ANALYSIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A305), 2023. Date of Publication: October 2023.
Author
SONG D.; SINGH R.; ANTONY R.; JAIN S.; SHAH V.; RASTOGI T.; MOZELL D.;
BATTH S.; KIM A.; BOGART M.; LIEBER J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Posters 3 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm
PURPOSE: Long term cardiovascular outcome comparison of multivessel
coronary disease among patients with diabetes mellitus (DM) undergoing
percutaneous coronary intervention (PCI) or coronary artery bypass graft
(CABG) is limited. To compare the long-term cardiovascular outcome PCI vs
CABG among DM patients with multivessel disease. METHOD(S): Online
databases were explored to identify studies that compared cardiovascular
outcomes between PCI and CABG among patients with DM and multi-vessel
coronary disease. The primary outcome was all-cause mortality. Secondary
outcomes included major adverse cardiovascular and cerebrovascular events
(MACCE), myocardial infarction (MI), rate of revascularization, cardiac
death, and cerebrovascular accident (CVA). RESULT(S): A total of 27
studies with 37,091 (PCI n=19,838 (53%) and CABG n=17,253 (47%)) patients
were included in our analysis. The mean age was 64 +/- 5.9 years for PCI
group and 63.8 +/- 5.3 years for CABG group; and, predominantly male
(71.22% vs 74.29%) for PCI and CABG respectively. The most common
comorbidity was hypertension (64.35% vs 62.88%) in both PCI and CABG
respectively. Compared with CABG, PCI group had a higher odds of overall
all-cause mortality (OR 1.18, 95% CI 1.02-1.37, p=0.03), MACCE (OR 1.52,
95% CI 1.31-1.75, p=0.00), MI (OR 1.85, 95% CI 1.46-2.36, p=0.00), repeat
revascularization (OR 3.08, 95% CI 2.34-4.05, p=0.00) and cardiac death
(OR 1.27, 95% 1.02-1.59, p=0.04), while CVA (0.57, 95% CI 0.37-0.86,
p=0.01) was higher in the CABG compared to PCI. CONCLUSION(S):
Diabetic patients with multivessel coronary artery disease have worse
outcomes undergoing PCI as compared to CABG. However, CVA was
significantly higher with CABG. CLINICAL IMPLICATIONS: CABG remains the
preferred management among eligible patients with DM and multivessel
disease. DISCLOSURES: No relevant relationships by Ronny Antony No
relevant relationships by Simrat Batth No relevant relationships by
Michael Bogart No relevant relationships by Samkit Jain No relevant
relationships by Andrew Kim No disclosure on file for Joseph Lieber No
relevant relationships by Daniel Mozell No relevant relationships by Tanya
Rastogi No relevant relationships by Vaibhav Shah No relevant
relationships by Ranbir Singh No relevant relationships by David
Song Copyright © 2023 American College of Chest Physicians

<55>
Accession Number
2027228897
Title
CORONARY ARTERY AIR EMBOLISM POST CT-GUIDED LUNG BIOPSY: A CASE REPORT AND
TREATMENT APPROACH.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A5448), 2023. Date of Publication: October 2023.
Author
SAN JUAN R.; SUBRAMANIAN R.; JOSHI H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Report Posters 7 SESSION TYPE: Case Report
Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION:
Coronary Artery Air Embolism (CAAE) is a rare, potentially fatal
complication of CT-guided transthoracic lung biopsy, causing cardiac
ischemia, arrhythmias, hypotension and cardiac arrest. Prompt recognition
and management are crucial. This case study presents a patient with
systemic and coronary air embolism following percutaneous lung biopsy,
resulting in Acute Myocardial Infarction and cardiac arrest. CASE
PRESENTATION: A 57-year-old female with Cirrhosis, Hypertension and
Diabetes Mellitus underwent a CT-guided biopsy of a PET-CT-positive left
lower lobe pulmonary nodule. She coughed forcefully at the end of the
procedure, experienced cardiac arrest with pulseless electric activity
(PEA) and was resuscitated after 20 minutes. Pre-arrest chest CT revealed
systemic air embolism affecting the left ventricle, coronary arteries, and
descending aorta (Fig 1) along with a small pulmonary hemorrhage at the
biopsy site. Post arrest, Her left ventricular ejection fraction was 20%,
and troponin levels rose significantly. Treatment included hyperoxia on
the ventilator, vasopressors, inotropes, and the Trendelenburg position. A
follow-up chest CT showed systemic gas resolution. She was extubated on
Day 6, and her left ventricular ejection fraction improved to 55% before
discharge. DISCUSSION: CT-Guided Lung Biopsy is a commonly performed
procedure for evaluating lung nodules. It complications include
pneumothorax (12-45% of cases), pulmonary hemorrhage (6-18%) and systemic
air embolism (0.04-0.07% of cases)1. CAAE introduces gas bubbles into the
bloodstream via three mechanisms2. Risk factors encompass parenchymal
hemorrhage, lower lobe biopsy, and larger biopsy needle use3.Air embolism
in coronary arteries can cause myocardial ischemia, infarction,
dysrhythmias and cardiac arrest. In this patient, PEA Arrest resulted from
air embolism, worsened by pulmonary hemorrhage and hypoxia. Timely
interventions include the Trendelenburg position, mechanical ventilation,
100% oxygen and consideration of hyperbaric oxygen therapy for achieving
near-full recovery. CONCLUSION(S): CAAE is a rare but potentially
fatal complication during CT-Guided Lung Biopsy. Prompt recognition and
management, including hyperoxia with 100% oxygen, potential hyperbaric
oxygen therapy and supportive care can significantly improve morbidity and
mortality. REFERENCE #1: Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ,
Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic
lung biopsy: meta-analysis. Eur Radiol. Jan 2017;27(1):138-148.
doi:10.1007/s00330-016-4357-8 REFERENCE #2: Mansour A, AbdelRaouf S,
Qandeel M, Swaidan M. Acute coronary artery air embolism following
CT-guided lung biopsy. Cardiovasc Intervent Radiol. Jan-Feb
2005;28(1):131-4. doi:10.1007/s00270-004-0118-1 REFERENCE #3: Ishii H,
Hiraki T, Gobara H, et al. Risk factors for systemic air embolism as a
complication of percutaneous CT-guided lung biopsy: multicenter
case-control study. Cardiovasc Intervent Radiol. Oct 2014;37(5):1312-20.
doi:10.1007/s00270-013-0808-7 DISCLOSURES: No relevant relationships by
Hariom Joshi No relevant relationships by Rodolfo San Juan No relevant
relationships by Rakeshkumar Subramanian Copyright © 2023
American College of Chest Physicians

<56>
Accession Number
2027228266
Title
A NOVEL THERAPY FOR TRICUSPID VALVE INFECTIVE ENDOCARDITIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A608), 2023. Date of Publication: October 2023.
Author
SCHUTTE B.; KOTARU T.R.; JAGAN N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease: Hearts and Bugs SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am
INTRODUCTION: Right sided infective endocarditis, seen predominantly in
intravenous drug users, encompasses a minority of cases but poses a
significant clinical challenge. Mortality is higher in patients with
ongoing Staph aureus bacteremia, septic emboli, larger vegetation burden,
and poor surgical candidacy for valvular repair or replacement. Herein we
present a novel approach to a patient with all of these risk factors. CASE
PRESENTATION: A 23 y.o. female with ongoing IV drug use presented with
arthralgias and fatigue. Physical exam revealed purulent drainage from the
right foot along with right hip, left knee, and bilateral wrist
tenderness. CT chest showed multiple cavitary lesions, consistent with
septic emboli. CT abdomen/pelvis exposed a right pelvic sidewall abscess
measuring up to 16cm. Transthoracic echo displayed a 1.6x2.5cm vegetation
on the tricuspid valve. Transesophageal echo revealed a multi-lobed
echodensity on the tricuspid measuring 5.1x1x1.6cm. Her clinical status
unfortunately deteriorated, requiring intubation and mechanical
ventilation. Blood cultures were positive for methicillin sensitive Staph
aureus. Infectious disease, cardiology, cardiothoracic surgery, and
orthopedic surgery were subsequently consulted. Patient was deemed a poor
candidate for valvular surgery given multiple abscesses and persistent
bacteremia despite broad-spectrum antimicrobial coverage and attempted
drainage of the knee effusions and pelvic abscess. Interventional
cardiology was consulted and, after extensive discussion with her family
and obtaining informed consent, recommended vegetation debulking with the
Inari FlowTriever system. Over 9cm of vegetation was successfully removed
from the tricuspid valve. Blood cultures obtained a day after the
procedure were sterile. Fortunately, her condition continued to improve,
and she underwent debridement of the pelvic abscess and bilateral feet.
Ultimately, she was successfully extubated and continues to work on
rehabilitation. DISCUSSION: Prolonged IV antibiotics are the hallmark of
therapy for infective endocarditis. Surgery is indicated in the case of
vegetations larger than 2cm, septic emboli, recurrent bacteremia, or
evidence of ongoing shock. If patients are deemed poor surgical
candidates, options have previously been limited. Catheter-based
interventions emerged in 2014. Their use in vegetation debulking is
off-label and more novel with approximately 300 cases reported in the
literature. A recent meta-analysis showed clinically successful treatment
in 79.1% of patients, defined as reduction in vegetation size >50%,
in-hospital survival, absence of bacteremia recurrence, and no further
requirement of valvular surgery. Our case depicts an example of
catheter-based interventions providing a favorable outcome in a patient
who otherwise would have had high risk of morbidity and mortality.
 CONCLUSION(S): For patients with right sided infective endocarditis
and persistent bacteremia, source control is essential. In patients who
are deemed poor surgical candidates, catheter-based debulking may be a
viable therapeutic option. REFERENCE #1: Chu VH, Cabell CH, Benjamin DK
Jr, et al. Early predictors of in-hospital death in infective
endocarditis. Circulation. 2004;109(14):1745-1749.
doi:10.1161/01.CIR.0000124719.61827.7F REFERENCE #2: Mhanna M, Beran A,
Al-Abdouh A, et al. AngioVac for Vegetation Debulking in Right-sided
Infective Endocarditis: A Systematic Review and Meta-Analysis. Curr Probl
Cardiol. 2022;47(11):101353. doi:10.1016/j.cpcardiol.2022.101353 REFERENCE
#3: Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH.
Mortality from infective endocarditis: clinical predictors of outcome.
Heart. 2002;88(1):53-60. doi:10.1136/heart.88.1.53 DISCLOSURES: No
relevant relationships by Nikhil Jagan No relevant relationships by Tharun
Kotaru No relevant relationships by Bryce Schutte Copyright ©
2023 American College of Chest Physicians

<57>
Accession Number
2027228211
Title
LOST IN TRANSIT: A COMPLICATED IVC FILTER RETRIEVAL PRECIPITATING CARDIAC
ARREST.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A5396-A5397), 2023. Date of Publication: October
2023.
Author
BUERSCHEN E.; PRABHAKAR A.P.; ZINGAS N.; BERGLUND A.J.; NARDY V.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Common Procedures, Unintended Consequences SESSION TYPE:
Rapid Fire Case Reports PRESENTED ON: 10/11/2023 09:40 am - 10:25 am
INTRODUCTION: In the United States, approximately 65,000 inferior vena
cava filters are placed every year; offering an alternative option to curb
the risk of thromboembolism in patients with contraindications to systemic
anticoagulation. IVC filters are designed to be retrieved percutaneously,
but statistics show that most filters placed will not be removed in the
person's lifetime. In fact, a systematic review showed the average
retrieval rate of IVC filters was only 34%. When retrieval is performed,
however, success rates are near-perfect, at 98.2%. Complications of filter
removal are exceedingly rare, with an incidence of 1.7%. Of those
complications, only a handful of cases have resulted in cardiopulmonary
arrest. CASE PRESENTATION: We report a case of a 59-year-old male patient
who experienced cardiac arrest as a grave complication of IVC filter
removal. The patient had experienced a thromboembolism while hospitalized
with COVID in July 2021, and due to a gastrointestinal bleed limiting
potential treatment with anticoagulation, he subsequently had IVC filter
placement. In April 2022, the patient became a candidate for
anticoagulation, and elected to undergo IVC filter removal. During the
retrieval procedure, interventional radiologists were unable to completely
remove the filter, and left it lodged in the right internal jugular vein.
He was sent to a tertiary center in Dayton, Ohio, where a radiologist and
vascular surgeon deemed him appropriate for surgery the following morning.
However, he developed hemodynamic complications overnight and experienced
a PEA cardiac arrest secondary to pericardial effusion requiring a
pericardiocentesis. ROSC was eventually achieved, and he was rushed to the
operating room. Surgeons performed a primary sternotomy which identified
perforation of the ascending aorta on the right, lateral position,
adjacent to the SVC; damage caused by the lodged IVC filter. The
perforation was repaired by a cardiothoracic surgeon, and the patient's
condition stabilized. He underwent subsequent surgery for complete removal
of the IVC filter three days later. He was discharged home after a 15-day
hospital stay, with intact neurologic function. DISCUSSION: Pulmonary
embolism is a dangerous condition, with mortality rates of untreated
patients reported as high as 30%. The percutaneous, retrievable IVC filter
provides protection against the development of pulmonary embolism; and
retrieval, while often routine, can occasionally prove to be difficult and
lead to varying degrees of complication. It is important to closely
monitor patients with retrieval failure, and focus on prompt removal of
the filter to prevent the infliction of further damage.
 CONCLUSION(S): IVC filters are essential in pulmonary embolism
prevention in patients who are not candidates for anticoagulation. While
the vast majority of retrievals are successful, cases such as this
highlight the grave complications of retrieval failure, and provide an
inviting arena for the innovation of novel ways to retrieve filters that
are unable to be removed using traditional techniques. REFERENCE #1:
Quencer, Keith B., et al. "Procedural Complications of Inferior Vena Cava
Filter Retrieval, an Illustrated Review." CVIR Endovascular, vol. 3, no.
1, 2020, https://doi.org/10.1186/s42155-020-00113-6. REFERENCE #2: Tao,
Mary Jiayi, et al. "Temporary Inferior Vena Cava Filter Indications,
Retrieval Rates, and Follow-up Management at a Multicenter Tertiary Care
Institution." Journal of Vascular Surgery, vol. 64, no. 2, 27 Apr. 2020,
pp. 430-437., https://doi.org/10.1016/j.jvs.2016.02.034. REFERENCE #3:
Al-Hakim, Ramsey, et al. "Inferior Vena Cava Filter Retrieval:
Effectiveness and Complications of Routine and Advanced Techniques."
Journal of Vascular and Interventional Radiology, vol. 25, no. 6, June
2014, pp. 933-939., https://doi.org/10.1016/j.jvir.2014.01.019.
DISCLOSURES: No relevant relationships by Andrew Berglund No relevant
relationships by Emily Buerschen No relevant relationships by Vince Nardy
No relevant relationships by Akruti Prabhakar No relevant relationships by
Nicholas Zingas Copyright © 2023 American College of Chest
Physicians

<58>
Accession Number
2027228081
Title
CONGENITAL COMPLETE ABSENCE OF THE PERICARDIUM.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A184), 2023. Date of Publication: October 2023.
Author
BISHOP M.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: CT surgery: Something Is Not Where It Should Be SESSION
TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am
INTRODUCTION: Congenital absence of the pericardium is a rare finding in
which the fibroserous covering of the heart fails to form. This rare
malformation is very difficult to diagnose and usually presents as an
asymptomatic finding. There are multiple different types of pericardial
defects, and the majority are found incidentally when undergoing a
separate surgical procedure or at an autopsy. As imaging has improved,
cardiac echo, CT, or MRI has been able to help diagnose pericardial
defects. Complete absence of the pericardium is the rarest of the
pericardial malformations with a prevalence of 0.002-0.0004 %. CASE
PRESENTATION: A 54-year-old male with a history of metastatic colon cancer
diagnosed in 2014 had a solitary pulmonary nodule that had increased in
size from 5mm to 10 mm on CT chest in 2023. The patient underwent
sigmoidectomy with post-op FOLFOX chemotherapy. He was found to have
metastatic disease in his liver in 2016 and underwent liver resection with
10 more cycles of chemotherapy. A preoperative workup revealed no prior
cardiac history or current cardiac symptoms. Physical exam, EKG, and labs
were all within normal limits. The patient underwent video-assisted
thoracoscopic surgical wedge resection of the nodule in the left lower
lobe with the finding of complete absence of the pericardium. The heart
did not have any signs of anatomic abnormalities or dysfunction other than
no pericardial covering. DISCUSSION: Congenital absence of the pericardium
has a multifactorial pathogenesis. There is often a defect in the fusion
of the pleuropericardial membrane in the midline allows connection of the
pericardial and pleural cavities. There is also a component of premature
atrophy of the left common cardinal vein during the 5th-6th week of
embryogenesis which leads to deficiencies in the pericardium. The most
common defect is the absence of the left pericardium comprising 70 percent
of all cases with male dominance while right-sided absence is around 19
percent of the cases. Complete absence is the rarest with only 9 percent
of total cases. Partial defects are more dangerous, as the partial defect
can allow the heart to become trapped and cause valvular regurgitation,
myocardial ischemia with infarction, and even sudden cardiac death.
Complete absence of the pericardium has a great prognosis while partial
has the chance of becoming strangulated. If a partial defect is diagnosed,
a pericardiectomy or a pericardioplasty may need to be performed.
 CONCLUSION(S): If complete absence of the pericardium in an
asymptomatic patient is found, no intervention is needed. Cardiac
echocardiography, CT, and MRI provide valuable information that can
diagnose the presence of a partial or complete pericardial defect that
will allow you to visualize a defect prior to operative intervention.
Surgical intervention is only needed when symptoms arise or when a partial
defect is noted that has a high risk for herniation or strangulation.
Congenital absence of the pericardium is often asymptomatic and difficult
to diagnose on physical examination. It is highly important to diagnose,
characterize the defect, and treat the finding due to the risk of possible
complications and sudden death in those with partial defects. REFERENCE
#1: Abbas AE, Appleton CP, Liu PT, Sweeney JP. Congenital absence of the
pericardium: case presentation and review of literature. Int J Cardiol.
2005;98:21-25 DISCLOSURES: No relevant relationships by Michael
Bishop Copyright © 2023 American College of Chest Physicians

<59>
Accession Number
2027228080
Title
INFECTED FOREGUT DUPLICATION CYST: A RARE CAUSE OF RESPIRATORY DISTRESS IN
AN ADULT.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A3533-A3534), 2023. Date of Publication: October
2023.
Author
RAHMAN AKKAWI A.; IMRAN S.A.N.A.; TUCK N.; BEAVERS C.; GRIZZELL B.;
RAPHAEL I.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Unexpected Airway Abnormalities SESSION TYPE: Rapid Fire
Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am INTRODUCTION:
Foregut duplication cysts are rare congenital malformations that may
present with various symptoms based on location. This malformation can be
found in multiple body parts, including the thorax, oral cavity,
oropharynx, hypopharynx, trachea, esophagus, and stomach. Although rare,
they can occur in young patients and adults. While many cases of foregut
duplication cysts are asymptomatic, respiratory symptoms are the most
common when symptoms occur. We, herein, present a case of an infected
foregut duplication cyst presenting with shortness of breath and
difficulty swallowing. CASE PRESENTATION: A 63-year-old woman with a
history of hypertension and hyperlipidemia presented with difficulty
swallowing and shortness of breath of three hours duration. She felt she
had eaten food she could not pass, causing shortness of breath and
prompting her to seek medical attention. Before this episode, she reported
having difficulty with more significant food portions over the past few
months. Additionally, she stated that whenever she lies on her back, she
experiences whistling breath sounds. She denies hemoptysis, fevers,
chills, night sweats, or weight loss.A chest CT scan revealed an 8 cm
posterior mediastinal cystic mass, possibly infected and causing
compression of the trachea and esophagus. An MRI of the chest also showed
a thick-walled mediastinal cyst, confirming the diagnosis. A barium
swallow study was also performed, revealing no evidence of esophageal
stricture or contrast extravasation. The patient was started on antifungal
and broad-spectrum antibiotics, and she underwent a video-assisted
thoracic surgery with mediastinal cyst resection. The postoperative period
was unremarkable, and the patient was discharged in stable condition.
DISCUSSION: During the early stages of embryonic development,
gastrointestinal malformations can occur due to abnormal canalization,
resulting in alimentary tract duplications. Most of these duplications
tend to develop in a retrocardiac position within the right posterior
mediastinum, as seen in our patient. It can present with various symptoms
depending on the location and size of the cyst. In this case, the
infection of the foregut duplication cyst increased its size, which caused
compression of adjacent structures, including the trachea and esophagus.
This, in turn, resulted in narrowed airways and difficulty swallowing.
Other respiratory symptoms that may occur include cough, wheezing, and
recurrent respiratory infections. Imaging studies, such as a chest CT scan
and MRI, are essential for diagnosing foregut duplication cysts. Surgical
resection is the treatment of choice, and in this case, the patient
underwent surgical resection of the cyst, which was found to be infected.
 CONCLUSION(S): Foregut duplication cysts are rare congenital
malformations that may present with respiratory symptoms and can be
located in various body parts. It is important to note that their
diagnosis can be challenging as they often present with non-specific
symptoms. Imaging studies are essential for diagnosing these cysts.
Surgical resection is the treatment of choice for symptomatic cases.
REFERENCE #1: Liu R, Adler DG. Duplication cysts: Diagnosis, management,
and the role of endoscopic ultrasound. Endosc Ultrasound. 2014
Jul;3(3):152-60. REFERENCE #2: Gonzalez-Urquijo M, Hinojosa-Gonzalez DE,
Padilla-Armendariz DP, Saldana-Rodriguez JA, Leyva-Alvizo A, Rodarte-Shade
M, Rojas-Mendez J. Esophageal Duplication Cysts in 97 Adult Patients: A
Systematic Review. World J Surg. 2022 Jan;46(1):154-162. REFERENCE #3:
Wildi SM, Hoda RS, Fickling W, Schmulewitz N, Varadarajulu S, Roberts SS,
Ferguson B, Hoffman BJ, Hawes RH, Wallace MB. Diagnosis of benign cysts of
the mediastinum: the role and risks of EUS and FNA. Gastrointest Endosc.
2003 Sep;58(3):362-8 DISCLOSURES: No relevant relationships by Abdul
Rahman Akkawi No relevant relationships by Craig Beavers No disclosure on
file for Brett Grizzell No relevant relationships by Sana Imran No
relevant relationships by Ibrahim Raphael No relevant relationships by
Nicholas Tuck Copyright © 2023 American College of Chest
Physicians

<60>
Accession Number
2027228074
Title
COMPARISON OF OUTCOMES OF PERICARDIOCENTESIS VERSUS PERICARDIOTOMY FOR
PERICARDIAL EFFUSIONS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A283), 2023. Date of Publication: October 2023.
Author
ASLLANAJ B.; BENGE E.; URZUA A.; OH D.; PEPITO D.O.N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Posters 1 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm
PURPOSE: Pericardial effusions can be drained by pericardiocentesis or by
surgical pericardiotomy, with limited evidence of superiority in regards
to management. As the most optimal procedure remains controversial, we
aimed to compare clinical outcomes in patients with pericardial effusions
who undergo surgical pericardiotomy or pericardiocentesis. Observed
differences in outcomes included post-procedural 3-month recurrence rates,
hemodynamic instability with regards to cardiac tamponade and development
of cardiogenic shock, and effects on in-hospital mortality.
 METHOD(S): We retrospectively assessed 4, 536 patients who underwent
a procedure for treatment of a pericardial effusion. The study population
was divided into two groups and patients treated with ultrasound guided
pericardiocentesis were compared with patients who underwent surgical
pericardiotomy. Inclusion criteria aimed at including adult patients (age
range 18-70) with diagnosed pericardial effusion who are treated with
pericardiocentesis or surgical pericardiotomy. Key exclusion criteria
included age greater than 70. RESULT(S): Effusion recurrence rate was
significantly higher in patients treated with pericardiocentesis than with
pericardiotomy. The rate of complications, including hemodynamic
instability, was similar in both groups. No difference in post-procedural
in-hospital mortality was present. CONCLUSION(S): In our study,
surgical pericardiotomy had higher success rate in preventing recurrence
of pericardial effusion compared to pericardiocentesis. Both
pericardiocentesis and pericardiotomy are safe and effective treatment
strategies for therapeutic or diagnostic drainage of a pericardial
effusion. CLINICAL IMPLICATIONS: Our results may help to guide physicians
in the management of patients requiring drainage of a pericardial
effusion. Larger controlled trials comparing outcomes between
pericardiocentesis and pericardial window are needed to confirm the
superiority of pericardiotomy over pericardiocentesis. DISCLOSURES: No
relevant relationships by Blerina Asllanaj No relevant relationships by
Elizabeth Benge No relevant relationships by Derek Oh No relevant
relationships by Don Pepito No relevant relationships by Alexander
Urzua Copyright © 2023 American College of Chest Physicians

<61>
Accession Number
2027227843
Title
MULTIDISCIPLINARY APPROACH IN MANAGING INVASIVE RHINOPULMONARY
MUCORMYCOSIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1207-A1208), 2023. Date of Publication: October
2023.
Author
DAVIES A.; SULAIMAN Z.I.; ISLAM S.U.; CHAO A.; HOY S.L.; VAZQUEZ J.O.S.E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Beyond the Lungs: Cases of Disseminated Disease SESSION
TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm
INTRODUCTION: Mucormycosis is a rare, life-threatening infection that
targets the immunocompromised population. We present a case in which a
middle-aged female, with a history of refractory acute myelocytic leukemia
(AML) and recent allogeneic hematopoietic stem cell transplant (HSCT),
successfully overcame this aggressive and opportunistic disease due to a
multidisciplinary approach involving hematology/oncology, interventional
pulmonology (IP), otolaryngology, cardiothoracic surgery, and infectious
disease (ID). CASE PRESENTATION: A 53-year-old female with a history of
AML, treated with chemotherapy, had an allogeneic HSCT from a matched
unrelated donor. While admitted, she developed pancytopenia and signs of
acute sinusitis with right periorbital cellulitis. Computed tomography
(CT) of the sinus showed inflammation in the right maxillary and ethmoid
sinuses. Given concerns for invasive fungal sinusitis (IFS), ID was
consulted for evaluation and management. Bedside nasal endoscopy,
performed by otolaryngology, revealed mucosal edema with thick secretions,
but no evidence of necrosis. Maxillofacial magnetic resonance imaging
indicated increased thickening involving bilateral ethmoid, maxillary, and
sphenoid sinuses without bony invasion or concern for IFS. She was
eventually discharged home, however two weeks later, an outpatient nasal
endoscopy showed necrosis and crusting of nasal cavity bilaterally,
consistent with IFS. She was re-admitted for functional endoscopic sinus
surgery and debridement. A CT chest showed development of a left upper
lobe (LUL) consolidative cavitary mass, concerning for invasive fungal
disease (IFD). Liposomal amphotericin B (LAmB) with isavuconazole dual
therapy was started by ID, while IP was consulted for tissue diagnosis. A
robotic bronchoscopy with transbronchial biopsy of the LUL mass was
performed by IP, confirming IFD. Thoracic surgery performed a
video-assisted thoracoscopic surgery with extended LUL wedge resection of
LUL mass. Intraoperative pathology confirmed mucormycosis. ID recommended
continuing dual anti-mold therapy and decreasing her immunosuppression
therapy. Upon discharge, her LAmB was switched to micafungin, while
continuing isavuconazole for the treatment of mucormycosis. She was seen
in the ID clinic after completing a 6-week course of combination
micafungin and isavuconazole therapy, and now remains on isavuconazole
indefinitely. DISCUSSION: Even within the HSCT population, mucormycosis is
rare, occurring in 0.1-2% of patients (1). Mucormycosis is known for its
high mortality; 36-40% in individuals with rhino-orbito-cerebral
involvement and 58% for those who develop pulmonary manifestations (2, 3).
Ideal management is surgical, to obtain source control and debulk the
infected tissue, with simultaneous, early medical therapy (4, 5). LAmB in
combination with triazoles or echinocandins, leads to no mortality benefit
compared to monotherapy, despite showing clear synergism and mortality
benefits in murine models (6, 7). However, the synergism in dual therapy
does allow for lower doses of therapeutic LAmB to be tolerated, thus
avoiding further treatment toxicities (7). In the outpatient setting, LAmB
requires infusion and frequent electrolyte oversight, therefore
de-escalation to micafungin with isavuconazole as dual therapy is
preferred, when source control is adequately achieved (8).
 CONCLUSION(S): Mucormycosis can be controlled with a
multi-disciplinary team approach to reduce morbidity and mortality.
Combination LAmB and isavuconazole in the inpatient setting or micafungin
and isavuconazole in the outpatient setting, is indicated for the greatest
synergistic effects, after successful source control. REFERENCE #1:
Mucormycosis in organ and stem cell transplant recipients. Lanternier F,
Sun HY, Ribaud P, Singh N, Kontoyiannis DP, Lortholary O. Clin Infect Dis.
2012;54(11):1629. Epub 2012 Mar 19. REFERENCE #2: Ashraf DC, Idowu OO,
Hirabayashi KE, et al. Outcomes of a Modified Treatment Ladder Algorithm
Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital
Sinusitis. Am J Ophthalmol. 2022;237:299-309.
doi:10.1016/j.ajo.2021.05.025 REFERENCE #3: Muthu V, Agarwal R, Dhooria S,
et al. Has the mortality from pulmonary mucormycosis changed over time? A
systematic review and meta-analysis. Clin Microbiol Infect.
2021;27(4):538-549. doi:10.1016/j.cmi.2020.12.035 DISCLOSURES: No relevant
relationships by Andrew Chao No relevant relationships by Adrian Davies No
relevant relationships by Stanley Hoy Consultant relationship with COOK
Medical Please note: June 2022 Added 03/30/2023 by Shaheen Islam,
source=Web Response, value=Consulting fee No relevant relationships by
Zoheb Sulaiman No relevant relationships by Jose Vazquez Copyright
© 2023 American College of Chest Physicians

<62>
Accession Number
2027227800
Title
PULMONARY EMBOLISM AFTER CABG AND WARFARIN RE-INITIATION.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A237-A238), 2023. Date of Publication: October 2023.
Author
ALJASSANI K.; MIRZA T.; ALI R.; SEYEDROUDBARI S.A.R.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothroacic Surgery Case Report Posters 1 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm
INTRODUCTION: Postoperative heparin bridging therapy reduces the risk of
thromboembolic events and must be balanced with the risk of bleeding
complications1. For patients with a history of venous thromboembolism
(VTE) on DOAC, current guidelines recommend against bridging if the VTE
was more than 3 months ago2. However, bridging therapy is often overused
among low-risk patients and underused among high-risk patients3, which
suggests the need for clearer recommendations. CASE PRESENTATION: Our case
involves a 67-year-old male with a past medical history of DM type 2,
hypertension, coronary artery disease, history of DVT and pulmonary
embolism on warfarin, and obesity. He underwent off-pump robotic-assisted
CABG of the LIMA to LAD artery. The operation and postoperative period
were uneventful. He was started on aspirin and warfarin on postoperative
day one. On postoperative day five, he was discharged to home on aspirin
and warfarin with a therapeutic INR of 2-3. Throughout the following week,
he was followed up with the INR clinic, and INR was at therapeutic level.
One week later, the patient presented to the ED for sudden onset
right-sided chest pain and shortness of breath. CTPE showed right-sided
middle and lower lobe pulmonary embolism with some degree of right heart
strain. Venous doppler showed acute nonocclusive right common femoral to
popliteal vein thrombosis. Echocardiography showed moderate right heart
strain with RVSP/PASP < 30. The patient was treated conservatively with
heparin infusion, warfarin, and oxygen therapy that was gradually weaned
until his discharge five days later. Hematology recommended increasing the
goal of INR to 2.5-3.5. DISCUSSION: A few studies have described pulmonary
embolism after coronary artery bypass surgery mostly as an indirect
association. One prospective study of 24 patients specifically looked at
the association and incidence of pulmonary embolism after off-pump CABG.
They performed a CTPE approximately a week after surgery and they were
able to find pulmonary embolism in 6/24 (25%) of the patients, a
strikingly high number.3 Several retrospective studies have shown the
incidence rate to be 1.5%4, however, a systematic review and analysis of
retrospective and prospective studies calculated a cumulative incidence of
0.8%.5 It has been suggested that this variation of numbers may be
secondary to differences in anticoagulation practices. The use of
post-operative bridging has led to a significant decrease in the
incidence. Shammas et al. performed an analysis to calculate the incidence
of fatal pulmonary embolism after CABG which was found to be 0.49% in
studies from 1975 to 1996 whereas it was decreased to 0.16% in a
subsequent analysis from 2004 to 2009. 5 CONCLUSION(S): More studies
are required to update the guideline regarding postoperative heparin
bridging therapy to reduce the risk of thromboembolic events that must be
balanced with the risk of bleeding complications especially for patients
with a history of venous thromboembolism (VTE), bridging therapy is often
overused among low-risk patients and underused among high-risk patients,
which suggests the need for clearer recommendations. REFERENCE #1:
https://www.cochrane.org/CD003747/PVD_heparin-prevent-deep-vein-thrombosis
-or-pulmonary-embolism-acutely-ill-medical-patients-excluding REFERENCE
#2:
https://www.uptodate.com/contents/perioperative-management-of-patients-rec
eiving-anticoagulants?search=heparin%20bridge&source=search_result&selecte
dTitle=1~150&usage_type=default&display_rank=1#H31 REFERENCE #3:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415673/4. Morris WT, Lamb
AM: Clinical trials are usually beneficial to patients and hospitals. N Z
Med J 1989;102:472-474. 5. Pulmonary Embolism Following Coronary Artery
Bypass Grafting - Protopapas - 2011 - Journal of Cardiac Surgery - Wiley
Online Library 6. Shammas, NW: Pulmonary embolus after coronary artery
bypass surgery: A review of the literature. Clin Cardiol 2000;23:637-644.
DISCLOSURES: No relevant relationships by Rimsha Ali No relevant
relationships by Khaldoon Aljassani No relevant relationships by Taaha
Mirza No relevant relationships by Sara Seyedroudbari Copyright ©
2023 American College of Chest Physicians

<63>
Accession Number
2027227764
Title
NEUROMUSCULAR ELECTRICAL STIMULATION IN ADDITION TO PHYSICAL THERAPY
PREVENTS MUSCLE ATROPHY AFTER LUNG TRANSPLANT SURGERY.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A6409-A6410), 2023. Date of Publication: October
2023.
Author
LAWRENCE A.C.; MAHAN L.D.; KAZA V.; RYAN A.; BOLLINENI S.; MOHANKA M.R.;
JOERNS J.O.; WAIT M.A.; PELTZ M.; HUFFMAN L.Y.N.N.; VERCELES A.; VARGHESE
A.N.U.; WELLS C.; IACONO A.L.D.O.; TORRES F.; TERRIN M.L.; MAGDER L.;
TIMOFTE I.L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Transplantation Posters 2 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm
PURPOSE: Poor outcomes in the early post-transplant period are thought to
be caused by physical impairments associated with limb muscle dysfunction
and deconditioning. Neuromuscular electrical stimulation (NMES) has
emerged as a noninvasive means to enhance muscle mass and improve recovery
in critically ill unable to actively participate in physical therapy but
was not studied in the acute post-transplant setting. We developed a
rehabilitation program that combines physical therapy with NMES and
protein supplementation to prevent muscle atrophy and improve functional
outcomes after lung transplant surgery. METHOD(S): The patients were
randomized to either the treatment arm (n=5) or usual care (n=6) 72 hours
after the transplant. Both groups of patients underwent an initial
assessment of muscle strength measured by using a handheld dynamometer and
lower extremity computer tomography (CT) evaluation within 72 hours
post-transplantation. Patients in the treatment arm received additional
physical therapy plus NMES (10 days) and nutrition supplementation during
hospital recovery. Follow-up handheld dynamometer testing and lower
extremity CT were performed 14 days post-transplant. RESULT(S):
Compared to the standard of care group, the treatment group decreased
average ICU length of stay (5.80 vs 8.67 days) and decreased average
hospital length of stay (16.8 vs 19.5 days). The treatment group had less
decrease in muscle strength assessed by change in handgrip measurement. In
addition, there were decreased changes in thigh muscle area in the
intervention group vs the control group.The treatment group had less
decrease in the muscle strength assessed by change in dominant hand
handgrip measurement and thigh muscle area. Mean change between baseline
and 14 day follow up in handgrip measurement were 2.8 in the intervention
group and -0.8 in the control group. In addition, there were decreased
changes in thigh muscle area in the intervention group vs control group.
Although all patientsexperiends decrease in the thigh muscle area, the
mean change in the intervention group (-16.5) was less than in the control
group (-23.3). CONCLUSION(S): Combined physical therapy with
neuromuscular electric stimulation (NMES) appears to be feasible and safe
during the acute post-transplant period and may reduce muscle wasting and
global muscle strength after the surgical procedure. CLINICAL
IMPLICATIONS: The results can provide the foundation for developing a
novel cardio thoracic rehabilitation program with the potential to improve
outcomes of other cardiothoracic surgical procedures including heart
transplants or CABG. DISCLOSURES: No disclosure on file for Srinivas
Bollineni No relevant relationships by Lynn Huffman No disclosure on file
for Aldo Iacono No relevant relationships by John Joerns No relevant
relationships by Vaidehi Kaza No relevant relationships by Adrian Lawrence
No disclosure on file for Larry Magder No relevant relationships by Luke
Mahan No relevant relationships by Manish Mohanka No relevant
relationships by Matthias Peltz No relevant relationships by Alice Ryan No
relevant relationships by Michael Terrin No relevant relationships by
Irina Timofte No relevant relationships by Fernando Torres No relevant
relationships by Anu Varghese No relevant relationships by Avelino
Verceles No relevant relationships by Michael Wait No relevant
relationships by Chris Wells Copyright © 2023 American College of
Chest Physicians

<64>
Accession Number
2027162988
Title
An investigator-sponsored pragmatic randomized controlled trial of
AntiCoagulation vs AcetylSalicylic Acid after Transcatheter Aortic Valve
Implantation: Rationale and design of ACASA-TAVI.
Source
American Heart Journal. 265 (pp 225-232), 2023. Date of Publication:
November 2023.
Author
Dodgson C.S.; Beitnes J.O.; Klove S.F.; Herstad J.; Opdahl A.; Undseth R.;
Eek C.H.; Broch K.; Gullestad L.; Aaberge L.; Lunde K.; Bendz B.; Lie O.H.
Institution
(Dodgson, Beitnes, Klove, Eek, Broch, Gullestad, Aaberge, Lunde, Bendz,
Lie) Department of Cardiology, Oslo University Hospital Rikshospitalet,
Oslo, Norway
(Herstad) Department of Cardiology, Haukeland University Hospital, Bergen,
Norway
(Opdahl) Department of Cardiology, Oslo University Hospital Ulleval, Oslo,
Norway
(Undseth) The Intervention Centre, Oslo University Hospital, Oslo, Norway
(Dodgson, Broch, Gullestad, Bendz) Institute of Clinical Medicine, Faculty
of Medicine, University of Oslo, Oslo, Norway
(Broch, Gullestad) K. G. Jebsen Cardiac Research Centre, University of
Oslo, Oslo, Norway
Publisher
Elsevier Inc.
Abstract
Background: The optimal antithrombotic therapy after transcatheter aortic
valve implantation (TAVI) is unknown. Bioprosthetic valve dysfunction
(BVD) is associated with adverse outcomes and may be prevented by
anticoagulation therapy. A dedicated randomized trial comparing
monotherapy NOAC to single antiplatelet therapy has not been performed
previously. We hypothesize that therapy with any anti-factor Xa NOAC will
reduce BVD compared to antiplatelet therapy, without compromising safety.
 Method(s): ACASA-TAVI is a multicenter, prospective, randomized,
open-label, blinded endpoint, all-comers trial comparing a monotherapy
anti-factor Xa NOAC strategy (intervention arm) with a single antiplatelet
therapy strategy (control arm) after successful TAVI. Three-hundred and
sixty patients without indication for oral anticoagulation will be
randomized in a 1:1 ratio to either apixaban 5 mg twice per day, edoxaban
60 mg daily, or rivaroxaban 20 mg daily for 12 months followed by
acetylsalicylic acid 75 mg daily indefinitely, or to acetylsalicylic acid
75 mg daily indefinitely. The 2 co-primary outcomes are (1) incidence of
Hypo-Attenuated Leaflet Thickening (HALT) on 4-dimensional cardiac CT at
12 months, and (2) a Safety Composite of VARC-3 bleeding events,
thromboembolic events (myocardial infarction and stroke), and death from
any cause, at 12 months. Result(s): The first 100 patients had a mean
age of 74 +/- 3.6 years, 33% were female, the average body-mass index was
27.9 +/- 4.4 kg/m2, and 15% were smokers. A balloon-expanded
valve was used in 82% and a self-expandable valve in 18%.
 Conclusion(s): The trial is planned, initiated, funded, and conducted
without industry involvement. Trial Registration: ClinicalTrials.gov
Identifier NCT05035277. Copyright © 2023 The Author(s)

<65>
Accession Number
2027057217
Title
TPVB and general anesthesia affects postoperative functional recovery in
elderly patients with thoracoscopic pulmonary resections based on ERAS
pathway.
Source
Translational Neuroscience. 14(1) (no pagination), 2023. Article Number:
20220305. Date of Publication: 01 Jan 2023.
Author
An N.; Dong W.; Pang G.; Zhang Y.; Liu C.
Institution
(An, Dong, Pang, Liu) Department of Anesthesia 1, Inner Mongolia People's
Hospital, Inner Mongolia, Hohhot 010020, China
(Zhang) Department of Thyroid Oncology, Inner Mongolia People's Hospital,
Inner Mongolia, Hohhot 010020, China
Publisher
Walter de Gruyter GmbH
Abstract
Objective: Thoracic surgery is easy to cause various perioperative
complications, especially in elderly patients, due to their physical
weakness and physiological function degeneration. Postoperative cognitive
dysfunction is a common complication in elderly patients undergoing
thoracic surgery. This study focuses on exploring the effects of thoracic
paravertebral block (TPVB) combined with general anesthesia on
postoperative functional recovery in elderly patients undergoing
thoracoscopic radical resection for lung cancer based on enhanced recovery
after surgery (ERAS) pathway. Method(s): A total of 104 patients aged
60 years or older undergoing thoracoscopic radical resection of lung
cancer were randomized into the combination group (n = 52) and the control
group (n = 52). Patients in the control group were given general
anesthesia alone, while patients in the combination group were given TPVB
combined with general anesthesia. All patients applied the ERAS model for
the perioperative intervention. Hemodynamic indices (heart rate [HR] and
mean arterial pressure [MAP]) before anesthesia (T0), 5 min after
thoracoscopic trocar placement (T1), at extubation (T2), 30 min after
extubation (T3), and 6 h after the surgery (T4), postoperative analgesia,
preoperative and postoperative serum pain stress factors
(5-hydroxytryptamine [5-HT], prostaglandin E2 [PGE2], cortisol [Cor],
substance P [SP], and norepinephrine [NE]), tumor markers (CYFRA21-1, CEA,
and CA50), inflammatory factors (IL-6, TNF-alpha, and c-reactive protein
(CRP)), lung function indicators (forced vital capacity [FVC] and forced
expiratory volume in the first second [FEV1]), 6 min walking distance
(6MWD), clinical recovery indicators, hospitalization status, and
postoperative complications in patients between both groups were compared.
 Result(s): Compared with the control group, patients in the
combination group had lower HR and MAP at T1-T4 time points, less
intraoperative doses of remifentanil and propofol, less patient-controlled
interscalene analgesia compression number 24 h after the surgery, lower
visual analogue scale scores 24 h after the surgery, shorter
hospitalization time, postoperative off-bed time, postoperative chest tube
removal time, postoperative first feeding time and gastrointestinal
function recovery time, reduced postoperative serum levels of 5-HT, PGE2,
Cor, SP, NE, CYFRA21-1, CEA, CA50, IL-6, TNF-alpha, and CRP, decreased
complications, and higher FVC, FEV1, and 6MWD. Conclusion(s): Based
on the ERAS pathway, TPVB combined with general anesthesia in
thoracoscopic surgery for lung cancer in elderly patients can effectively
reduce the patients' hemodynamic fluctuations, alleviate postoperative
pain, accelerate the recovery process, and reduce
complications. Copyright © 2023 the author(s), published by De
Gruyter.

<66>
Accession Number
2027012973
Title
Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic
Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD.
Source
Diabetes and Metabolism Journal. 47(4) (pp 535-546), 2023. Date of
Publication: 2023.
Author
Heo G.Y.; Koh H.B.; Kim H.W.; Park J.T.; Yoo T.-H.; Kang S.-W.; Kim J.;
Kim S.W.; Kim Y.H.; Sung S.A.; Oh K.-H.; Han S.H.
Institution
(Heo, Koh, Kim, Park, Yoo, Kang, Han) Department of Internal Medicine,
Institute of Kidney Disease Research, Yonsei University, College of
Medicine, Seoul, South Korea
(Kim) Medical Research Collaborating Center, Seoul National University
Hospital, Seoul National University, College of Medicine, Seoul, South
Korea
(Kim) Department of Internal Medicine, Chonnam National University Medical
School, Gwangju, South Korea
(Kim) Department of Internal Medicine, Inje University, Busan Paik
Hospital, Busan, South Korea
(Sung) Department of Internal Medicine, Nowon Eulji Medical Center, Eulji
University, School of Medicine, Seoul, South Korea
(Oh) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
Publisher
Korean Diabetes Association
Abstract
Background: The optimal level of glycosylated hemoglobin (HbA1c) to
prevent adverse clinical outcomes is unknown in patients with chronic
kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Method(s):
We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy
and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic
Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main
predictor was time-varying HbA1c level at each visit. The primary outcome
was a composite of development of major adverse cardiovascular events
(MACEs) or all-cause mortality. Secondary outcomes included the individual
endpoint of MACEs, allcause mortality, and CKD progression. CKD
progression was defined as a >=50% decline in the estimated glomerular
filtration rate from baseline or the onset of end-stage kidney disease.
 Result(s): During a median follow-up of 4.8 years, the primary
outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the
adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95%
confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19)
for HbA1c levels of 7.0%-7.9% and >=8.0%, respectively, compared with
<7.0%. Additional analysis of baseline HbA1c levels yielded a similar
graded association. In secondary outcome analyses, the aHRs for the
corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26
(95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08
(95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD
progression did not differ between the three groups. Conclusion(s):
This study showed that higher HbA1c levels were associated with an
increased risk of MACE and mortality in patients with CKD and
T2DM. Copyright © 2023 Korean Diabetes Association.

<67>
Accession Number
2026632719
Title
Outcomes of Concomitant Coronary Artery Bypass Grafting in Patients With
Infective Endocarditis: A Systematic Review and Meta-Analysis.
Source
American Journal of Cardiology. 205 (pp 354-359), 2023. Date of
Publication: 15 Oct 2023.
Author
Caldonazo T.; Kirov H.; Doenst T.; Tasoudis P.; Moschovas A.; Faerber G.;
Treml R.E.; Sa M.P.; Mukharyamov M.; Diab M.
Institution
(Caldonazo, Kirov, Doenst, Faerber, Mukharyamov, Diab) Departments of
Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
(Tasoudis) Division of Cardiothoracic Surgery, The University of North
Carolina at Chapel Hill, Chapel Hill, NC, United States
(Moschovas) Department of Cardiothoracic Surgery, University Hospital
Wurzburg, Wurzburg, Germany
(Treml) Departments of Anesthesiology and Intensive Care Medicine,
Friedrich-Schiller-University Jena, Jena, Germany
(Sa) Department of Cardiothoracic Surgery, University of Pittsburgh,
Pittsburgh, PA, United States
(Sa) UPMC Heart and Vascular Institute, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Diab) Department of Cardiac Surgery, Herz- und Kreislaufzentrum,
Rotenburg an der Fulda, Germany
Publisher
Elsevier Inc.
Abstract
It is current practice to perform concomitant coronary artery bypass
grafting (CABG) in patients with infective endocarditis who have relevant
coronary artery disease. However, CABG may add complexity to the
operation. We performed a systematic review and a meta-analysis of studies
that presented outcomes from patients who underwent valve surgery because
of infective endocarditis with or without concomitant CABG. Three
databases were assessed. Perioperative mortality was the primary outcome.
Long-term mortality and postoperative stroke were the secondary outcomes.
Inverse variance method and random model were performed. Five studies with
a total of 5,408 patients were included. Mean follow-up was 8.2 years.
Just 1 study addressed exclusively patients with documented coronary
artery disease. Perioperative mortality did not differ between patients
with or without concomitant CABG (odds ratio 1.53, 95% confidence interval
0.52 to 4.48, p = 0.44). Long-term mortality did not differ between
patients who received and those who did not receive concomitant CABG (odds
ratio 1.79, confidence interval 0.88 to 3.65, p = 0.11). Only 1 study from
a multicenter registry reported data on the occurrence of postoperative
stroke, which demonstrated that its incidence after adjustment was 26% in
patients with concomitant CABG versus 21% in patients without concomitant
CABG (p = 0.003). The results suggest that in endocarditis patients,
adding CABG to valve surgery does not affect perioperative or long-term
mortality. Data available on the impact of concomitant CABG on neurologic
outcomes are limited to a retrospective multicenter registry and suggest
that concomitant CABG may be associated with higher postoperative
stroke. Copyright © 2023 The Authors

<68>
Accession Number
2025897287
Title
Drug-Coated Balloons for De Novo Coronary Artery Lesions: A Meta-Analysis
of Randomized Clinical Trials.
Source
Yonsei Medical Journal. 64(10) (pp 593-603), 2023. Date of Publication:
Oct 2023.
Author
Wang D.; Wang X.; Yang T.; Tian H.; Su Y.; Wang Q.
Institution
(Wang, Wang, Yang, Tian, Su, Wang) Department of Cardiology, Zibo Central
Hospital, Shandong, Zibo, China
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Through meta-analysis, we aimed to assess the efficacy and safety
of drug-coated balloons (DCB), compared with drug-eluting stents (DES) or
uncoated devices, in the treatment of de novo coronary lesions.
 Material(s) and Method(s): Only randomized controlled trials were
included. The primary outcomes were late lumen loss (LLL), target lesion
revascularization (TLR), and major adverse cardiac events (MACEs).
Subgroup analyses were conducted based on clinical indications, whether
DCBs were used with a systematic or bailout stent, and types of DESs.
 Result(s): The present meta-analysis demonstrated that DCBs elicit
significantly lower incidences of TLR, MACE, and LLL, compared with
uncoated devices, and similar incidences, compared with DESs, in the
treatment of de novo coronary lesions. Subgroup analysis indicated that
DCBs used with a bailout stent achieved lower incidences of binary
restenosis and myocardial infarction, compared with uncoated devices, and
provided less LLL than DESs. DCBs showed similar rates of TLR and MACE,
with significantly less LLL, than DESs in treating de novo small-vessel
diseases. The clinical efficacy of DCBs was similar to that of
second-generation DES. Conclusion(s): Overall, DCB is favored over
bare metal stent alone in treating de novo coronary lesions. DCBs appear
to be a prom-ising alternative to DESs in the treatment of de novo
coronary lesions. Copyright © Yonsei University College of
Medicine 2023.

<69>
Accession Number
2025646217
Title
Fluid Overload-Associated Large B-Cell Lymphoma: A Case Report and Review
of Literature.
Source
Hematology Reports. 15(3) (pp 411-420), 2023. Date of Publication:
September 2023.
Author
Bahmad H.F.; Gomez A.S.; Deb A.; Safdie F.M.; Sriganeshan V.
Institution
(Bahmad, Deb, Sriganeshan) The Arkadi M. Rywlin M.D. Department of
Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami
Beach, FL 33140, United States
(Gomez, Sriganeshan) Department of Pathology, Herbert Wertheim College of
Medicine, Florida International University, Miami, FL 33199, United States
(Safdie) Department of Surgery, Division of Thoracic and Cardiovascular
Surgery, Mount Sinai Medical Center, Miami Beach, FL 33140, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a new entity
described in the fifth edition of the World Health Organization (WHO)
Classification of Hematolymphoid Tumors (WHO-HAEM5). It refers to
malignant lymphoma present with symptoms of serous effusions in body
cavities (pleural, peritoneal, and/or pericardial) in the absence of an
identifiable tumor mass. We present a case of an 82-year-old man with a
history of atrial fibrillation and atrial flutter, status post-ablation,
essential hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus
(DM) type 2 who was referred to our hospital for shortness of breath due
to recurrent pleural effusion. Right video-assisted thoracoscopy with
right pleural biopsy was performed. Histopathological examination of the
pleural biopsy revealed dense fibrous tissue, chronic inflammation,
lymphoid aggregates, and granulation tissue, with no evidence of lymphoma.
Cytology of the right pleural fluid revealed large lymphoid cells, which
were positive for CD45, CD20, PAX-5, MUM-1, BCL2, BCL6, and MYC protein.
They were negative for CD3, CD10, CD138, and HHV-8 by immunohistochemistry
(IHC). Epstein-Barr virus (EBV) was negative by in situ hybridization
(ISH). Due to the absence of any evidence of lymphoma elsewhere, a
diagnosis of fluid overload-associated large B-cell lymphoma (FO-LBCL) was
made. We provide a synopsis of the main clinicopathological features of
FO-LBCL and the two main differential diagnoses, primary effusion lymphoma
(PEL) and diffuse large B-cell lymphoma (DLBCL). Copyright © 2023
by the authors.

<70>
Accession Number
2025630837
Title
Comparison of middle-term valve durability between transcatheter aortic
valve implantation and surgical aortic valve replacement: an updated
systematic review and meta-analysis of RCTs.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1242608. Date of Publication: 2023.
Author
Lerman T.T.; Levi A.; Jorgensen T.H.; Sondergaard L.; Talmor-Barkan Y.;
Kornowski R.
Institution
(Lerman) Department of Internal Medicine F-Recanati, Rabin Medical Center,
Beilinson Hospital, Petah Tikva, Israel
(Lerman, Levi, Talmor-Barkan, Kornowski) Department of Cardiology, Rabin
Medical Center, Petah Tikva, Israel
(Lerman, Levi, Talmor-Barkan, Kornowski) The Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Jorgensen, Sondergaard) Department of Cardiology, The Heart Center,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Frontiers Media SA
Abstract
Background: This study aims to compare valve durability between
transcatheter aortic valve implantation (TAVI) and surgical aortic valve
replacement (SAVR). Method(s): We conducted a systematic review and
meta-analysis using data from randomized controlled trials (RCTs). The
primary outcome was structural valve deterioration (SVD). Secondary
outcomes were bioprosthetic valve failure, reintervention, effective
orifice area (EOA), mean pressure gradient, and moderate-severe aortic
regurgitation (AR, transvalvular and/or paravalvular). Result(s):
Twenty-five publications from seven RCTs consisting of 7,970 patients were
included in the analysis with follow-up ranges of 2-8 years. No
significant difference was found between the two groups with regard to SVD
[odds ratio (OR) 0.72; 95% CI: 0.25-2.12]. The TAVI group was reported to
exhibit a statistically significant higher risk of reintervention (OR
2.03; 95% CI: 1.34-3.05) and a moderate-severe AR (OR 6.54; 95% CI:
3.92-10.91) compared with the SAVR group. A trend toward lower mean
pressure gradient in the TAVI group [(mean difference (MD) -1.61; 95% CI:
-3.5 to 0.28)] and significant higher EOA (MD 0.20; 95% CI: 0.08-0.31) was
noted. Conclusion(s): The present data indicate that TAVI provides a
comparable risk of SVD with favorable hemodynamic profile compared with
SAVR. However, the higher risk of significant AR and reintervention was
demonstrated. Systematic Review Registration: PROSPERO
(CRD42022363060). Copyright 2023 Lerman, Levi, Jorgensen, Sondergaard,
Talmor-Barkan and Kornowski.

<71>
Accession Number
2025089859
Title
Chronic remote ischemic conditioning treatment in patients with chronic
stable angina (EARLY-MYO-CSA): a randomized, controlled proof-of-concept
trial.
Source
BMC Medicine. 21(1) (no pagination), 2023. Article Number: 324. Date of
Publication: December 2023.
Author
Guo Q.; Zhao Z.; Yang F.; Zhang Z.; Rao X.; Cui J.; Shi Q.; Liu K.; Zhao
K.; Tang H.; Peng L.; Ma C.; Pu J.; Li M.
Institution
(Guo, Zhao, Zhang, Cui, Shi, Liu, Zhao, Tang, Peng, Ma, Li) Department of
Cardiology, Department of Coronary Heart Disease of Central China Fuwai
Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China
Fuwai of Zhengzhou University, Henan Provincial People's Hospital,
People's Hospital of Zhengzhou University, No. 1 Fuwai Road, Henan
Province, Zhengzhou, China
(Yang, Pu) Department of Cardiology, School of Medicine, Ren Ji Hospital,
Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
(Rao, Li) Medicine Department of Xizang, Minzu University, Shanxi,
Xianyang, China
Publisher
BioMed Central Ltd
Abstract
Background: Chronic remote ischemic conditioning (CRIC) has been shown to
improve myocardial ischemia in experimental animal studies; however, its
effectiveness in patients with chronic stable angina (CSA) has not been
investigated. We conducted a proof-of-concept study to investigate the
efficacy and safety of a six-month CRIC treatment in patients with CSA.
 Method(s): The EARLY-MYO-CSA trial was a prospective, randomized,
controlled trial evaluating the CRIC treatment in patients with CSA with
persistent angina pectoris despite receiving >= 3-month
guideline-recommended optimal medical therapy. The CRIC and control groups
received CRIC (at 200 mmHg) or sham CRIC (at 60 mmHg) intervention for 6
months, respectively. The primary endpoint was the 6-month change of
myocardial flow reserve (MFR) on single-photon emission computed
tomography. The secondary endpoints were changes in rest and stress
myocardial blood flow (MBF), angina severity according to the Canadian
Cardiovascular Society (CCS) classification, the Seattle Angina
Questionnaire (SAQ), and a 6-min walk test (6-MWT). Result(s): Among
220 randomized CSA patients, 208 (105 in the CRIC group, and 103 in the
control group) completed the treatment and endpoint assessments. The mean
change in MFR was significantly greater in the CRIC group than in the
control group (0.27 +/- 0.38 vs. - 0.04 +/- 0.25; P < 0.001). MFR
increased from 1.33 +/- 0.48 at baseline to 1.61 +/- 0.53 (P < 0.001) in
the CRIC group; however, a similar increase was not seen in the control
group (1.35 +/- 0.45 at baseline and 1.31 +/- 0.44 at follow-up, P =
0.757). CRIC treatment, when compared with controls, demonstrated
improvements in angina symptoms assessed by CCS classification (60.0% vs.
14.6%, P < 0.001), all SAQ dimensions scores (P < 0.001), and 6-MWT
distances (440 [400-523] vs. 420 [330-475] m, P = 0.016). The incidence of
major adverse cardiovascular events was similar between the groups.
 Conclusion(s): CSA patients benefit from 6-month CRIC treatment with
improvements in MFR, angina symptoms, and exercise performance. This
treatment is well-tolerated and can be recommended for symptom relief in
this clinical population. Trial registration: [chictr.org.cn], identifier
[ChiCTR2000038649]. Copyright © 2023, BioMed Central Ltd., part
of Springer Nature.

<72>
Accession Number
642290566
Title
Cell salvage for minimising perioperative allogeneic blood transfusion in
adults undergoing elective surgery.
Source
Cochrane Database of Systematic Reviews. 2023(9) (no pagination), 2023.
Article Number: CD001888. Date of Publication: 08 Sep 2023.
Author
Lloyd T.D.; Geneen L.J.; Bernhardt K.; McClune W.; Fernquest S.J.; Brown
T.; Doree C.; Brunskill S.J.; Murphy M.F.; Palmer A.J.R.
Institution
(Lloyd, Fernquest, Palmer) Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,
United Kingdom
(Geneen, Doree, Brunskill) Systematic Review Initiative, NHS Blood and
Transplant, Oxford, United Kingdom
(Geneen, Doree, Brunskill) Nuffield Department of Clinical Laboratory
Sciences, University of Oxford, Oxford, United Kingdom
(Bernhardt, McClune) Medical Sciences Division, University of Oxford,
Oxford, United Kingdom
(Brown) School of Health, Leeds Beckett University, Leeds, United Kingdom
(Murphy) NHS Blood and Transplant, Oxford University Hospitals NHS
Foundation Trust and University of Oxford, Oxford, United Kingdom
(Murphy, Palmer) Blood and Transplant Research Unit in Data Driven
Transfusion, NIHR, Oxford, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Concerns regarding the safety and availability of transfused
donor blood have prompted research into a range of techniques to minimise
allogeneic transfusion requirements. Cell salvage (CS) describes the
recovery of blood from the surgical field, either during or after surgery,
for reinfusion back to the patient. Objective(s): To examine the
effectiveness of CS in minimising perioperative allogeneic red blood cell
transfusion and on other clinical outcomes in adults undergoing elective
or non-urgent surgery. Search Method(s): We searched CENTRAL,
MEDLINE, Embase, three other databases and two clinical trials registers
for randomised controlled trials (RCTs) and systematic reviews from 2009
(date of previous search) to 19 January 2023, without restrictions on
language or publication status. Selection Criteria: We included RCTs
assessing the use of CS compared to no CS in adults (participants aged 18
or over, or using the study's definition of adult) undergoing elective
(non-urgent) surgery only. Data Collection and Analysis: We used
standard methodological procedures expected by Cochrane. Main
Result(s): We included 106 RCTs, incorporating data from 14,528
participants, reported in studies conducted in 24 countries. Results were
published between 1978 and 2021. We analysed all data according to a
single comparison: CS versus no CS. We separated analyses by type of
surgery. The certainty of the evidence varied from very low certainty to
high certainty. Reasons for downgrading the certainty included imprecision
(small sample sizes below the optimal information size required to detect
a difference, and wide confidence intervals), inconsistency (high
statistical heterogeneity), and risk of bias (high risk from domains
including sequence generation, blinding, and baseline imbalances).
Aggregate analysis (all surgeries combined: primary outcome only). Very
low-certainty evidence means we are uncertain if there is a reduction in
the risk of allogeneic transfusion with CS (risk ratio (RR) 0.65, 95%
confidence interval (CI) 0.59 to 0.72; 82 RCTs, 12,520 participants).
Cancer: 2 RCTs (79 participants). Very low-certainty evidence means we are
uncertain whether there is a difference for mortality, blood loss,
infection, or deep vein thrombosis (DVT). There were no analysable data
reported for the remaining outcomes. Cardiovascular (vascular): 6 RCTs
(384 participants). Very low- to low-certainty evidence means we are
uncertain whether there is a difference for most outcomes. No data were
reported for major adverse cardiovascular events (MACE). Cardiovascular
(no bypass): 6 RCTs (372 participants). Moderate-certainty evidence
suggests there is probably a reduction in risk of allogeneic transfusion
with CS (RR 0.82, 95% CI 0.69 to 0.97; 3 RCTs, 169 participants). Very
low- to low-certainty evidence means we are uncertain whether there is a
difference for volume transfused, blood loss, mortality, re-operation for
bleeding, infection, wound complication, myocardial infarction (MI),
stroke, and hospital length of stay (LOS). There were no analysable data
reported for thrombosis, DVT, pulmonary embolism (PE), and MACE.
Cardiovascular (with bypass): 29 RCTs (2936 participants). Low-certainty
evidence suggests there may be a reduction in the risk of allogeneic
transfusion with CS, and suggests there may be no difference in risk of
infection and hospital LOS. Very low- to moderate-certainty evidence means
we are uncertain whether there is a reduction in volume transfused because
of CS, or if there is any difference for mortality, blood loss,
re-operation for bleeding, wound complication, thrombosis, DVT, PE, MACE,
and MI, and probably no difference in risk of stroke. Obstetrics: 1 RCT
(1356 participants). High-certainty evidence shows there is no difference
between groups for mean volume of allogeneic blood transfused (mean
difference (MD) -0.02 units, 95% CI -0.08 to 0.04; 1 RCT, 1349
participants). Low-certainty evidence suggests there may be no difference
for risk of allogeneic transfusion. There were no analysable data reported
for the remaining outcomes. Orthopaedic (hip only): 17 RCTs (2055
participants). Very low-certainty evidence means we are uncertain if CS
reduces the risk of allogeneic transfusion, and the volume transfused, or
if there is any difference between groups for mortality, blood loss,
re-operation for bleeding, infection, wound complication, prosthetic joint
infection (PJI), thrombosis, DVT, PE, stroke, and hospital LOS. There were
no analysable data reported for MACE and MI. Orthopaedic (knee only): 26
RCTs (2568 participants). Very low- to low-certainty evidence means we are
uncertain if CS reduces the risk of allogeneic transfusion, and the volume
transfused, and whether there is a difference for blood loss, re-operation
for bleeding, infection, wound complication, PJI, DVT, PE, MI, MACE,
stroke, and hospital LOS. There were no analysable data reported for
mortality and thrombosis. Orthopaedic (spine only): 6 RCTs (404
participants). Moderate-certainty evidence suggests there is probably a
reduction in the need for allogeneic transfusion with CS (RR 0.44, 95% CI
0.31 to 0.63; 3 RCTs, 194 participants). Very low- to moderate-certainty
evidence suggests there may be no difference for volume transfused, blood
loss, infection, wound complication, and PE. There were no analysable data
reported for mortality, re-operation for bleeding, PJI, thrombosis, DVT,
MACE, MI, stroke, and hospital LOS. Orthopaedic (mixed): 14 RCTs (4374
participants). Very low- to low-certainty evidence means we are uncertain
if there is a reduction in the need for allogeneic transfusion with CS, or
if there is any difference between groups for volume transfused,
mortality, blood loss, infection, wound complication, PJI, thrombosis,
DVT, MI, and hospital LOS. There were no analysable data reported for
re-operation for bleeding, MACE, and stroke. Authors' conclusions: In some
types of elective surgery, cell salvage may reduce the need for and volume
of allogeneic transfusion, alongside evidence of no difference in adverse
events, when compared to no cell salvage. Further research is required to
establish why other surgeries show no benefit from CS, through further
analysis of the current evidence. More large RCTs in under-reported
specialities are needed to expand the evidence base for exploring the
impact of CS. Copyright © 2023 The Authors. Cochrane Database of
Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The
Cochrane Collaboration.

<73>
Accession Number
2026725669
Title
Pulmonary Vasodilator and Inodilator Drugs in Cardiac Surgery: A
Systematic Review With Bayesian Network Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(11) (pp 2261-2271),
2023. Date of Publication: November 2023.
Author
Sardo S.; Tripodi V.F.; Guerzoni F.; Musu M.; Cortegiani A.; Finco G.
Institution
(Sardo, Guerzoni, Musu, Finco) Department of Medical Sciences and Public
Health, University of Cagliari, Monserrato, Italy
(Tripodi) Department of Human Pathology, Unit of Anesthesia and Intensive
Care, University Hospital of Messina, Messina, Italy
(Cortegiani) Department of Surgical Oncological and Oral Science,
University of Palermo, Palermo, Italy
(Cortegiani) Department of Anesthesia Intensive Care and Emergency,
University Hospital "Policlinico Paolo Giaccone", Palermo, Italy
Publisher
W.B. Saunders
Abstract
Objective: The authors performed a systematic review to evaluate the
effect of pharmacologic therapy on pulmonary hypertension in the
perioperative setting of elective cardiac surgery (PROSPERO
CRD42023321041). Design(s): Systematic review of randomized
controlled trials with a Bayesian network meta-analysis. Setting(s):
The authors searched biomedical databases for randomized controlled trials
on the perioperative use of inodilators and pulmonary vasodilators in
adult cardiac surgery, with in-hospital mortality as the primary outcome
and duration of ventilation, length of stay in the intensive care unit,
stage 3 acute kidney injury, cardiogenic shock requiring mechanical
support, and change in mean pulmonary artery pressure as secondary
outcomes. Participant(s): Twenty-eight studies randomizing 1,879
patients were included. Intervention(s): Catecholamines and
noncatecholamine inodilators, arterial pulmonary vasodilators,
vasodilators, or their combination were considered eligible interventions
compared with placebo or standard care. Measurements and Main
Results: Ten studies reported in-hospital mortality and assigned 855
patients to 12 interventions. Only inhaled prostacyclin use was supported
by a statistically discernible improvement in mortality, with a
number-needed-to-treat estimate of at least 3.3, but a wide credible
interval (relative risk 1.26 x 10-17 - 0.7). Inhaled
prostacyclin and nitric oxide were associated with a reduction in
intensive care unit stay, and none of the included interventions reached a
statistically evident difference compared to usual care or placebo in the
other secondary clinical outcomes. Conclusion(s): Inhaled
prostacyclin was the only pharmacologic intervention whose use is
supported by a statistically discernible improvement in mortality in the
perioperative cardiac surgery setting as treatment of pulmonary
hypertension. However, available evidence has significant limitations,
mainly the low number of events and imprecision. Copyright © 2023
The Author(s)

<74>
Accession Number
2026725324
Title
Red Blood Cell Transfusion Guided by Hemoglobin Only or Integrating
Perfusion Markers in Patients Undergoing Cardiac Surgery: A Systematic
Review and Meta-Analysis With Trial Sequential Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(11) (pp 2252-2260),
2023. Date of Publication: November 2023.
Author
Putaggio A.; Tigano S.; Caruso A.; La Via L.; Sanfilippo F.
Institution
(Putaggio) School of Anesthesia and Intensive Care, University Magna
Graecia, Catanzaro, Italy
(Tigano, Caruso) School of Anesthesia and Intensive Care, University of
Catania, Catania, Italy
(La Via, Sanfilippo) University Hospital Policlinico, G. Rodolico - San
Marco, Catania, Italy
(Sanfilippo) Department of Surgery and Medical-Surgical Specialties,
University of Catania, Catania, Italy
Publisher
W.B. Saunders
Abstract
Objective: Strategies for red blood cell (RBC) transfusion in patients
undergoing cardiac surgery have been traditionally anchored to hemoglobin
(Hb) targets. A more physiologic approach would consider markers of organ
hypoperfusion. Design(s): The authors conducted a systematic review
and meta-analysis with trial sequential analysis of randomized controlled
trials (RCTs). Setting(s): Cardiac surgery. Participant(s):
Adult patients. Intervention(s): RBC transfusion targeting only Hb
levels compared with strategies combining Hb values with markers of organ
hypoperfusion. Measurements and Main Results: Primary outcomes were
the number of RBC units transfused, the number of patients transfused at
least once, and the average number of transfusions. Secondary outcomes
were postoperative complications, intensive care (ICU) and hospital
lengths of stay, and mortality. Only 2 RCTs were included (n = 257
patients), and both used central venous oxygen saturation
(ScvO<inf>2</inf>) as a marker of organ hypoperfusion (cut-off: <70% or
<=65%). A transfusion protocol combining Hb and ScvO<inf>2</inf> reduced
the overall number of RBC units transfused (risk ratio [RR]: 1.57
[1.33-1.85]; p < 0.0001, I2 = 0%), and the number of patients
transfused at least once (RR: 1.33 [1.16-1.53]; p < 0.0001, I2
= 41%), but not the average number of transfusions (mean difference [MD]:
0.18 [-0.11 to 0.47]; p = 0.24, I2 = 66%), with moderate
certainty of evidence. Mortality (RR: 1.29, [0.29-5.77]; p = 0.73,
I2 = 0%), ICU length-of-stay (MD: -0.06 [-0.58 to 0.46]; p =
0.81, I2 = 0%), hospital length-of-stay (MD: -0.05 [-1.49 to
1.39];p = 0.95, I2 = 0%), and all postoperative complications
were not affected. Conclusion(s): In adult patients undergoing
cardiac surgery, a restrictive protocol integrating Hb values with a
marker of organ hypoperfusion (ScvO<inf>2</inf>) reduces the number of RBC
units transfused and the number of patients transfused at least once
without apparent signals of harm. These findings were preliminary and
warrant further multicentric research. Copyright © 2023 The
Author(s)

<75>
Accession Number
2026433177
Title
Appraisal of Postoperative Outcomes of Volatile and Intravenous
Anesthetics: A Network Meta-Analysis of Patients Undergoing Cardiac
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(11) (pp 2215-2222),
2023. Date of Publication: November 2023.
Author
Heybati K.; Zhou F.; Baltazar M.; Poudel K.; Ochal D.; Ellythy L.; Deng
J.; Chelf C.J.; Welker C.; Ramakrishna H.
Institution
(Heybati, Poudel, Ochal, Ellythy) Mayo Clinic Alix School of Medicine,
Mayo Clinic - Rochester, Rochester, MN, United States
(Zhou) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Baltazar) Philadelphia College of Osteopathic Medicine, Philadelphia, PA,
United States
(Deng) Temerty Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
(Chelf) Mayo Clinic Libraries, Rochester, MN, United States
(Welker, Ramakrishna) Department of Anesthesiology and Perioperative
Medicine, Mayo Clinic - Rochester, Rochester, MN, United States
Publisher
W.B. Saunders
Abstract
Objectives: To determine the relative efficacy of specific regimens used
as primary anesthetics, as well as the potential combination of volatile
and intravenous anesthetics among patients undergoing cardiac, thoracic,
and vascular surgery. Design(s): This frequentist, random-effects
network meta-analysis was registered prospectively (CRD42022316328) and
conducted according to the PRISMA-NMA framework. Literature searches were
conducted up to April 1, 2022 across relevant databases. Risk of bias
(RoB) and confidence of evidence were assessed by RoB-2 and CINeMA,
respectively. Pooled treatment effects were compared with propofol
monotherapy. Setting(s): Fifty-three randomized controlled trials (N
= 8,085) were included, of which 46 trials (N = 6,604) enrolled patients
undergoing cardiac surgery. Participant(s): Trials enrolling adults
(>=18) undergoing cardiac, thoracic, and vascular surgery, using the same
induction regimens, and comparing volatile and/or total intravenous
anesthesia for the maintenance of anesthesia. Given that the majority of
trials focused on those undergoing cardiac surgery and the heterogeneity,
analyses were restricted to this population. Measurement and Main Results:
Outcomes of interest included intensive care unit (ICU) length of stay
(LOS), myocardial infarction, in-hospital and 30-day mortality, stroke,
and delirium. Across 19 trials (N = 1,821; 9 arms; I2 = 64.5%),
sevoflurane combined with propofol decreased ICU LOS (mean difference [MD]
-18.26 hours; 95% CI -34.78 to -1.73 hours), whereas midazolam with
propofol (MD 17.51 hours; 95% CI 2.78-32.25 hours) was associated with a
significant increase in ICU LOS, when compared with propofol monotherapy.
Among 27 trials (N = 4,080; 10 arms; I2 = 0%), midazolam was
associated with significantly greater risk of myocardial infarction versus
propofol (risk ratio 1.94; 95% CI 1.01-3.71). There were no significant
differences across other outcomes. Conclusion(s): In patients
undergoing cardiac surgery, sevoflurane with propofol was associated with
decreased ICU LOS compared with propofol monotherapy. Midazolam with
propofol increased ICU LOS compared with propofol alone. The combined use
of intravenous and volatile anesthetics should be explored further. Future
trials in thoracic and vascular surgery are warranted. Copyright
© 2023 Elsevier Inc.

<76>
Accession Number
2025206316
Title
Efficacy of intraoperative thoracoscopic intercostal nerve blocks in
nonintubated and intubated video-assisted thoracic surgery: A randomized
study.
Source
Journal of the Formosan Medical Association. 122(10) (pp 986-993), 2023.
Date of Publication: October 2023.
Author
Chan K.-C.; Wu L.-L.; Han S.-C.; Chen J.-S.; Cheng Y.-J.
Institution
(Chan) Department of Anesthesiology, National Taiwan University Hospital,
Taipei, Taiwan (Republic of China)
(Wu, Han, Cheng) Department of Anesthesiology, National Taiwan University
Cancer Center, National Taiwan University College of Medicine, Taipei,
Taiwan (Republic of China)
(Chen) Department of Surgery, National Taiwan University Cancer Center,
National Taiwan University College of Medicine, Taipei, Taiwan (Republic
of China)
Publisher
Elsevier B.V.
Abstract
Background: The efficacy of thoracoscopic intercostal nerve blocks (TINBs)
for noxious stimulation from video-assisted thoracic surgery (VATS)
remains unclear. The efficacy of TINBs may also be different between
nonintubated VATS (NIVATS) and intubated VATS (IVATS). We aim to compare
the efficacy of TINBs on analgesia and sedation for NIVATS and IVATs
intraoperatively. Method(s): Sixty patients randomized to the NIVATS
or IVATS group (30 each) received target-controlled propofol and
remifentanil infusions, with bispectral index (BIS) maintained at 40-60,
and multilevel (T3-T8) TINBs before surgical manipulations. Intraoperative
monitoring data, including pulse oximetry, mean arterial pressure (MAP),
heart rate, BIS, density spectral arrays (DSAs), and propofol and
remifentanil effect-site concentration (Ce) at different time points. A
two way ANOVA with post hoc analysis was applied to analyze the
differences and interactions of groups and time points. Result(s): In
both groups, DSA monitoring revealed burst suppression and alpha dropout
immediately after the TINBs. The Ce of the propofol infusion had to be
reduced within 5 min post-TINBs in both NIVATS (p < 0.001) and IVATS (p =
0.252) groups. The Ce of remifentanil infusion was significantly reduced
after TINBs in both groups (p < 0.001), and was significantly lower in
NIVATS (p < 0.001) without group interactions. Conclusion(s): The
surgeon-performed intraoperative multilevel TINBs allow reduced anesthetic
and analgesic requirement for VATS. With lower requirement of remifentanil
infusion, NIVATS presents a significantly higher risk of hypotension after
TINBs. DSA is beneficial for providing real-time data that facilitate the
preemptive management, especially for NIVATS. Copyright © 2023

<77>
Accession Number
2024058204
Title
Diuresis-matched versus standard hydration in patients undergoing
percutaneous cardiovascular procedures: meta-analysis of randomized
clinical trials.
Source
Revista Espanola de Cardiologia. 76(10) (pp 759-766), 2023. Date of
Publication: October 2023.
Author
Occhipinti G.; Laudani C.; Spagnolo M.; Greco A.; Capodanno D.
Institution
(Occhipinti, Laudani, Spagnolo, Greco, Capodanno) Division of Cardiology,
Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco,
University of Catania, Catania, Italy
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Contrast-associated acute kidney injury
(CA-AKI) is a potential complication of procedures requiring
administration of iodinated contrast medium. RenalGuard, which provides
real-time matching of intravenous hydration with furosemide-induced
diuresis, is an alternative to standard periprocedural hydration
strategies. The evidence on RenalGuard in patients undergoing percutaneous
cardiovascular procedures is sparse. We used a Bayesian framework to
perform a meta-analysis of RenalGuard as a CA-AKI preventive strategy.
 Method(s): We searched Medline, Cochrane Library and Web of Science
for randomized trials of RenalGuard vs standard periprocedural hydration
strategies. The primary outcome was CA-AKI. Secondary outcomes were
all-cause death, cardiogenic shock, acute pulmonary edema, and renal
failure requiring renal replacement therapy. A Bayesian random-effect risk
ratio (RR) with corresponding 95% credibility interval (95%CrI) was
calculated for each outcome. PROSPERO database number CRD42022378489.
 Result(s): Six studies were included. RenalGuard was associated with
a significant relative reduction in CA-AKI (median RR, 0.54; 95%CrI,
0.31-0.86) and acute pulmonary edema (median RR, 0.35; 95%CrI, 0.12-0.87).
No significant differences were observed for the other secondary endpoints
[all-cause death (RR, 0.49; 95%CrI, 0.13-1.08), cardiogenic shock (RR,
0.06; 95%CrI, 0.00-1.91), and renal replacement therapy (RR, 0.52; 95%CrI,
0.18-1.18)]. The Bayesian analysis also showed that RenalGuard had a high
probability of ranking first for all the secondary outcomes. These results
were consistent in multiple sensitivity analyses. Conclusion(s): In
patients undergoing percutaneous cardiovascular procedures, RenalGuard was
associated with a reduced risk of CA-AKI and acute pulmonary edema
compared with standard periprocedural hydration strategies. Copyright
© 2023

<78>
Accession Number
2018016667
Title
Combined Programmed Intermittent Bolus Infusion With Continuous Infusion
for the Thoracic Paravertebral Block in Patients Undergoing Thoracoscopic
Surgery A Prospective, Randomized, and Double-blinded Study.
Source
Clinical Journal of Pain. 38(6) (pp 410-417), 2022. Date of Publication:
2022.
Author
Yang L.; Huang X.; Cui Y.; Xiao Y.; Zhao X.; Xu J.
Institution
(Yang, Huang, Cui, Xiao, Zhao, Xu) Department of Anesthesiology, The
Second Xiangya Hospital, Central South University, Hunan Province,
Changsha, China
(Yang, Huang, Cui, Xiao, Xu) Hunan Province Center for Clinical Anesthesia
and Anesthesiology, Research Institute of Central South University, Hunan
Province, Changsha, China
(Zhao) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-sen University, Guangdong Province, Guangzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Continuous thoracic paravertebral block (TPVB) connected with
patient-controlled analgesia (PCA) pump is an effective modality to reduce
postoperative pain following thoracic surgery. For the PCA settings, the
programmed intermittent bolus infusion (PIBI) and continuous infusion (CI)
are commonly practiced. However, the comparative effectiveness between the
2 approaches has been inconsistent. Thus, the aim of this study was to
explore the optimal PCA settings to treat postthoracotomy pain by combing
PIBI and CI together. Method(s): All enrolled patients undergoing
thoracoscopic surgery accepted ultrasound-guided TPVB catheterization
before the surgery and then were randomly allocated in to 3 groups
depending on different settings of the PCA pump connecting to the TPVB
catheter: the PIBI+CI, PIBI, and CI groups. Numerical Rating Scales were
evaluated for each patient at T1 (1 h after extubation), T2 (12 h after
the surgery), T3 (24 h after the surgery), T4 (36 h after the surgery),
and T5 (48 h after the surgery). Besides, the consumptions of PCA
ropivacaine, the number of blocked dermatomes at T3, and the requirement
for extra dezocine for pain relief among the 3 groups were also compared.
 Result(s): First, the Numerical Rating Scale scores in the PIBI+CI
group were lower than the CI group at T2 and T3 (P < 0.05) when patients
were at rest and were also lower than the CI group at T2, T3, and T4 (P <
0.01) and the PIBI group at T3 when patients were coughing (P < 0.01).
Second, the 2-day cumulative dosage of PCA in the PIBI+CI group was lower
than both the CI and PIBI groups (P < 0.01). Third, the number of blocked
dermatomes in the PIBI and PIBI+CI groups were comparable and were both
wider than the CI group at T3 (P < 0.01). Finally, a smaller proportion
(not statistically significant) of patients in the PIBI+CI group (5.26%,
2/38) had required dezocine for pain relief when compared with the PIBI
group (19.44%, 7/36) and the CI group (15.79%, 6/38). Conclusion(s):
The combination of PIBI and CI provides superior analgesic modality to
either PIBI or CI alone in patients undergoing thoracoscopic surgery.
Therefore, it should be advocated to improve the management of
postoperative pain, clinical outcomes, and ultimately patient
satisfaction. Copyright © 2022 The Author(s). Published by
Wolters Kluwer Health, Inc.

<79>
Accession Number
634920883
Title
Do existing real-world data sources generate suitable evidence for the HTA
of medical devices in Europe? Mapping and critical appraisal.
Source
International Journal of Technology Assessment in Health Care. 37(1) (no
pagination), 2021. Article Number: e62. Date of Publication: 2021.
Author
Pongiglione B.; Torbica A.; Blommestein H.; de Groot S.; Ciani O.; Walker
S.; Dams F.; Blankart R.; Mollenkamp M.; Kovacs S.; Tarricone R.; Drummond
M.
Institution
(Pongiglione, Torbica, Ciani, Tarricone) Centre for Research on Health and
Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi
University, Milano, Italy
(Blommestein, de Groot) Erasmus School of Health Policy & Management,
Erasmus University Rotterdam, Rotterdam, Netherlands
(Ciani) College of Medicine and Health, Institute of Health Research,
University of Exeter, Exeter, United Kingdom
(Walker) Exeter University, Exeter, United Kingdom
(Dams, Blankart) KPM Center for Public Management, University of Bern,
Bern, Switzerland
(Blankart) Sitem-insel AG, Swiss Institute for Translational and
Entrepreneurial Medicine, Bern, Switzerland
(Mollenkamp) Hamburg Center for Health Economics, Universitat Hamburg,
Hamburg, Germany
(Kovacs) Syreon Research Institute, Budapest, Hungary
(Drummond) Centre for Health Economics, University of York, York, United
Kingdom
Publisher
Cambridge University Press
Abstract
Aim. Technological and computational advancements offer new tools for the
collection and analysis of real-world data (RWD). Considering the
substantial effort and resources devoted to collecting RWD, a greater
return would be achieved if real-world evidence (RWE) was effectively used
to support Health Technology Assessment (HTA) and decision making on
medical technologies. A useful question is: To what extent are RWD
suitable for generating RWE? Methods. We mapped existing RWD sources in
Europe for three case studies: hip and knee arthroplasty, transcatheter
aortic valve implantation (TAVI) and mitral valve repair (TMVR), and
robotic surgery procedures. We provided a comprehensive assessment of
their content and appropriateness for conducting the HTA of medical
devices. The identification of RWD sources was performed combining a
systematic search on PubMed with gray literature scoping, covering fifteen
European countries. Results. We identified seventy-one RWD sources on
arthroplasties; ninety-five on TAVI and TMVR; and seventy-seven on robotic
procedures. The number, content, and integrity of the sources varied
dramatically across countries. Most sources included at least one health
outcome (97.5%), with mortality and rehospitalization/reoperation the most
common; 80% of sources included resource outcomes, with length of stay the
most common, and comparators were available in almost 70% of sources.
Conclusions. RWD sources bear the potential for the HTA of medical
devices. The main challenges are data accessibility, a lack of
standardization of health and economic outcomes, and inadequate
comparators. These findings are crucial to enabling the incorporation of
RWD into decision making and represent a readily available tool for
getting acquainted with existing information sources. Copyright ©
The Author(s), 2021. Published by Cambridge University Press.

<80>
Accession Number
642371825
Title
The Effect of Bone Wax Application in Cardiac Surgery: A Systematic
Review.
Source
British Journal of Surgery. Conference: ASiT Surgical Conference 2023.
Liverpool United Kingdom. 110(Supplement 7) (pp vii7-vii8), 2023. Date of
Publication: September 2023.
Author
Shah A.; Kumar N.; Raja S.; Bhudia S.
Institution
(Shah) University College London (UCL), London, United Kingdom
(Shah, Kumar) National Medical Research Association (NMRA) UK, London,
United Kingdom
(Raja, Bhudia) Royal Brompton and Harefield NHS Foundation Trust, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Aim: There is limited and conflicting evidence on whether bone wax usage
in cardiac surgery increases infection risk. A systematic review was
conducted to examine cardiac surgery postoperative outcomes following bone
wax application. Method(s): This systematic review was conducted
using Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. The MEDLINE, EMBASE, and Scopus databases were
searched for studies evaluating perioperative bone wax usage in the
English language. All relevant synonyms of "Cardiac Surgery", "Bone wax",
"Infection", and "Healing" were used to identify papers. The outcomes of
interest were wound infection, sternal dehiscence, postoperative sternal
bleeding, postoperative chest drainage and mortality. Result(s): From
the 66 articles found, 5 were included following full-text screening. No
statistically significant difference in infection risk between the bone
wax (BW) and comparator groups existed. However, the evidence suggests
bone wax significantly increases the risk of sternal dehiscence. Studies
reporting postoperative bleeding showed a significantly greater mean
volume in the BW group. All studies reporting postoperative chest drainage
(n = 3) showed a greater mean volume in the BW group, of which two were
significant. Of the three papers reporting mortality, two showed an
increased risk in the BW group. Conclusion(s): Current evidence
indicates no significant association between bone wax and wound infection.
Bone wax is associated with a greater risk of sternal dehiscence,
postoperative sternal bleeding, postoperative chest drainage and
mortality. Greater emphasis should be placed on bone wax alternatives in
clinical practice. Limited data necessitates larger studies, and for
clearer guidelines to be established around them.

<81>
Accession Number
642371757
Title
Impact of Frailty on Patient Outcomes After Cardiac Surgery: An Updated
Systematic Review and Meta-Analysis.
Source
British Journal of Surgery. Conference: ASiT Surgical Conference 2023.
Liverpool United Kingdom. 110(Supplement 7) (pp vii20), 2023. Date of
Publication: September 2023.
Author
Elhadi M.; Faraj H.; Khaled A.; BenGhatnsh A.; Msherghi A.
Institution
(Elhadi, Faraj, Khaled, Khaled, Msherghi) Faculty of Medicine, University
of Tripoli, Tripoli, Libyan Arab Jamahiriya
(BenGhatnsh) National Heart Centre, Tripoli, Libyan Arab Jamahiriya
Publisher
Oxford University Press
Abstract
Aim: To determine the impact of frailty on patient outcomes after
undergoing cardiac surgery. Method(s): An analysis of frail versus
non-frail patients who had undergone cardiac surgery was conducted using
data from Pubmed/ Medline, EMBASE, Cochrane, Web of Science, Scopus, and
grey literature, all searched in April 2022. The primary outcomes of early
postoperative mortality and major adverse cardiovascular events (MACE)
were examined, as well as secondary outcomes, including long-term
mortality and complications. Data were analyzed using R version 4.0.3.
 Result(s): A total of 22 studies, including 102,323 frail and
2,187,814 non-frail patients, were included in the analysis. Frailty was
found to be significantly associated with higher early mortality (RR:
2.93; 95% CI, 2.19-3.93; P < 0.01; I2 = 17.2%) and MACE (RR: 2.07; 95% CI,
1.21-3.55; P = 0.03; I2 = 22.9%) compared to non-frail patients. Frailty
was also associated with a higher risk of acute kidney injury and renal
impairment (RR: 3.67; 95% CI, 2.85-4.73; P = 0.03; I2 = 3.9%). In the long
term, a higher mortality rate was observed in frail patients (RR: 2.93;
95% CI, 1.69-5.07; P = 0.02; I2 = 22.4%). However, no significant
differences were found in pneumonia, respiratory complications, sepsis, or
reoperation rates between frail and non-frail patients.
 Conclusion(s): Frailty is associated with higher mortality and MACE
in patients undergoing cardiac surgery and a higher risk of acute kidney
injury. Frailty should be considered an important factor in preoperative
risk assessment and perioperative care for these patients.

<82>
Accession Number
642371735
Title
Video-Assisted Thoracoscopic Surgery Versus Robot-Assisted Thoracoscopic
Surgery in Early-Stage Lung Cancer: A Systematic Review and Meta-Analysis.
Source
British Journal of Surgery. Conference: ASiT Surgical Conference 2023.
Liverpool United Kingdom. 110(Supplement 7) (pp vii19), 2023. Date of
Publication: September 2023.
Author
Shirke M.; Soh V.; Azmi A.; Wee A.
Institution
(Shirke, Soh, Azmi, Wee) Queen's University Belfast, Belfast, United
Kingdom
Publisher
Oxford University Press
Abstract
Aim: Video-assisted thoracic surgery (VATS) remains the main surgical
procedure for lung cancer resection. However, it is associated with
technical limitations and a steep learning curve. Hence, alternative
approaches like robot-assisted thoracic surgery (RATS) have been explored.
This review aims to compare the clinical outcomes of VATS versus RATS in
early-stage lung cancer patients. Method(s): A systematic, electronic
search was performed according to PRISMA guidelines to identify relevant
articles that compared outcomes of the VATS versus RATS procedures in
patients with early-stage lung cancer. Result(s): Seventeen studies
were identified, enrolling 17,111 patients. The mean tumor size was
12.58+/-7.21cm in the RATS group and 5 +/-2.5cm in the VATS group, with
most patients in the Stage 1 cancer group. The primary outcomes, length of
hospital stay (MD 0.37, 95% CI [-0.15, 0.89], and conversion (OR 0.99, 95%
CI [0.68, 1.43]), were not statistically significant. Although more lymph
nodes were retrieved during the RATS procedure (MD -0.70, 95% CI [-1.18,
-0.21]), no significant differences were observed in other secondary
outcomes such as operative duration (MD -0.14, 95% CI [-1.00, 0.73]),
reintervention (OR 1.47, 95% CI[0.22, 9.79]), infection (OR 0.89, 95% CI
[0.52, 1.54]), and bleeding (OR 1.15, 95% CI [0.52, 2.55]).
 Conclusion(s): The RATS and VATS procedures have comparable outcomes,
thus proving the RATS procedure to be a safe alternative. However, the
technical feasibility and cost-effectiveness need to be thoroughly
studied. This review calls for robust trials comparing the two techniques
to further evaluate the value of the RATS procedure in early-stage lung
cancer.

<83>
Accession Number
642371647
Title
Computed Tomography Scanning for Sternal Wound Infections: A Systematic
Review.
Source
British Journal of Surgery. Conference: ASiT Surgical Conference 2023.
Liverpool United Kingdom. 110(Supplement 7) (pp vii54-vii55), 2023. Date
of Publication: September 2023.
Author
Shirke M.M.; Dominic C.; Debnath P.; Sunny J.T.; Haq M.; Nawaz H.; Harky
A.
Institution
(Shirke) Queen's University Belfast, Belfast, Ireland
(Dominic, Nawaz) Queen Mary University, London, United Kingdom
(Debnath) University of Nottingham, Nottingham, United Kingdom
(Sunny) Queen Elizabeth Hospital King's Lynn, King's Lynn, United Kingdom
(Haq) St George's University, London, United Kingdom
(Harky) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
Aim: Sternal wound infection (SWI) has always been a significant risk in
patients who undergo sternotomies as part of their cardiac surgical
procedures. Computed tomography (CT) imaging is often used to diagnose and
assess sternal wound infections. Its purpose includes identifying and
locating infection and any sternal dehiscence. Method(s): A
systematic literature review across PubMed, Embase and Ovid was performed
according to PRISMA guidelines to identify relevant articles that
discussed the utility of CT scanning for SWI, common features identified,
patient outcomes and sensitivity/ specificity (Figure 1). Result(s):
25 papers were included. 100% (n = 25) of the papers were published in
peer-reviewed journals. CT scans in SWIs can be seen as a beneficial aid
in diagnosing as well as determining the components of infection.
Commonalities were identified such as fluid collection in the mediastinum,
free gas, pleural effusions, and sternal dehiscence which point towards
sternal wound infection. Conclusion(s): CT scanning is a novel and
emerging methodology for imaging in SWI and post-sternotomy complications;
hence, increased research is required to expand the literature on this
area and create guidelines and cut-offs or signs for radiology
professionals to identify and determine the extent of infection.

<84>
Accession Number
642371445
Title
A Systematic Review of Surgical Intervention Criteria for Thoracic Aortic
Aneurysms.
Source
British Journal of Surgery. Conference: ASiT Surgical Conference 2023.
Liverpool United Kingdom. 110(Supplement 7) (pp vii181), 2023. Date of
Publication: September 2023.
Author
Neill H.; Taylor S.
Institution
(Neill, Taylor) Queen's University Belfast, Belfast, United Kingdom
Publisher
Oxford University Press
Abstract
Aim: Elective surgical repair of thoracic aortic aneurysms (TAAs) is the
only treatment that prevents dissection or rupture. Current guidelines
from the American College of Cardiology/American Heart Association and the
European Society of Cardiology, recommend an aortic diameter threshold of
5.5cm for surgical intervention of TAAs. Recent studies have questioned
the efficacy of current guidelines as they highlighted that the majority
of dissections occur before reaching the threshold. This review aims to
determine if an aortic diameter of 5.5cm is an appropriate threshold for
prophylactic surgical repair of non-syndromic ascending TAAs.
 Method(s): A search of Ovid MEDLINE and Pubmed databases was
performed. Search terms included "ascending thoracic aortic aneurysm",
"ATAA", "aortic diameter" and "aortic size paradox". Non-English papers,
animal studies and case reports were excluded. Reference lists from each
article were assessed for further literature which met the inclusion
criteria. Result(s): 22 studies were included. Four themes emerged
from these papers which support lowering the threshold for prophylactic
surgery: quantifying the changes in aortic diameter that occur during
dissection, the discovery of the aortic size paradox, the identification
of a new hinge point, and the improved safety of modern surgery.
Regardless of this evidence, it appears to be unjustified to lower the
threshold based on relative risk calculations. Conclusion(s): Despite
current guidelines, the use of aortic diameter as a risk assessment tool
for TAAs is inadequate. Multiple studies have shown the ineffectiveness of
a 5.5cm threshold, suggesting revision of current surgical guidelines is
warranted.

<85>
Accession Number
642371166
Title
Analysis of the Intra and Post-Operative Complications of Minimally
Invasive vs Open Adrenalectomy in Patients with Phaeochromocytoma: A
Systematic Literature Review.
Source
British Journal of Surgery. Conference: ASiT Surgical Conference 2023.
Liverpool United Kingdom. 110(Supplement 7) (pp vii1), 2023. Date of
Publication: September 2023.
Author
Papaioannou C.; Druce M.
Institution
(Papaioannou, Druce) Centre for Endocrinology, William Harvey Research
Institute, Barts and the London School of Medicine and Dentistry, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Aim: Phaeochromocytoma is a rare type of neuroendocrine tumour arising
from the chromaffin cells of the adrenal medulla. The Endocrine Society
suggest that minimally invasive (laparoscopic or robotic) adrenalectomy
(MIA) should be performed unless the tumour is >6cm or invasive where open
adrenalectomy (OA) is preferred. The aim of this review is to describe the
intra and post-operative complications between the two surgical
approaches. Method(s): A thorough search was conducted on PubMed,
EMBASE and Cochrane Library to find papers which analysed the intra and
post-operative morbidity of adult patients with phaeochromocytoma. This
review included only original studies written in English, after the year
2000. Our search strategy identified 10 papers which fulfilled our
inclusion criteria. The PRISMA system was used for standardization.
 Result(s): Haemodynamic instability was the major intra-operative
complication. Patients having OA had significantly more frequent and
greater fluctuations in their blood pressure during surgery. This was both
in terms of hypertensive crises and hypotension too. Furthermore,
significantly more patients required blood transfusion if they had an OA
due to the higher degree of blood loss compared to the MIA (p<0.05).
Themedian number of days spent in the hospital post-operatively was
significantly more for patients having OA (8.3 days vs 4.2 days). Finally,
two papers analysing the number of patients having post-operative
cardiovascular complications deduced that a higher proportion sustained
such complications after OA thanMIA (p = 0.002 and p = 0.041).
 Conclusion(s): The results highlight the superiority of the MIA in
terms of safety during and shortly after the procedure.

<86>
Accession Number
642364240
Title
A SYSTEMATIC LITERATURE REVIEW OF RANDOMISED CONTROLLED TRIALS EVALUATING
COLCHICINE FOR CARDIOVASCULAR PREVENTION: THERE IS AN ELEPHANT IN THE
ROOM.
Source
Annals of the Rheumatic Diseases. Conference: Annual Meeting of the
European Alliance of Associations for Rheumatology, EULAR 2023. Milan
Italy. 82(Supplement 1) (pp 439), 2023. Date of Publication: June 2023.
Author
Alunno A.; Martini C.; Moronti V.; Santilli J.; Carubbi F.; Schoones J.;
Ferri C.
Institution
(Alunno, Martini, Moronti, Santilli, Carubbi, Ferri) University of
L'Aquila and Internal Medicine and Nephrology Division, ASL 1
Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
(Schoones) Leiden University Medical Center, Directorate of Research
Policy, Leiden, Netherlands
Publisher
BMJ Publishing Group
Abstract
Background: Colchicine (COL) is widely used in rheumatology for treatment
and prophylaxis of acute gout flares, other crystal diseases, and
autoinflammatory diseases. In recent years evidence on the efficacy of COL
for the prevention and treatment of cardiovascular diseases (CVD) has
accrued. Since patients with gout and other inflammatory RMDs have a
higher CV risk, COL may be a useful resource for CV prevention in
rheumatology. Objective(s): To review the randomised controlled
trials (RCT) investigating the use of COL for CV prevention from a
rheumatology perspective. Method(s): A systematic literature review
(SLR) of 7 databases was conducted following the PICO framework. Three
researchers independently screened abstracts and titles and then full
texts were reviewed to determine eligibility (RCTs enrolling adult
subjects with or w/o history of CVD treated with COL for CV prevention).
Data from eligible articles were extracted and risk of bias (RoB) was
assessed with validated tools. Result(s): A total of 3867 articles
were retrieved and screened, 174 articles were read in full and 20 of them
were eligible for inclusion. of 19440 enrolled patients, 9655 were
randomised to receive COL at a dose varying between 0.5mg/day and 2mg/day
and for a period ranging between 10 days and several months (covering in
part or in full the study follow-up period). Main inclusion criteria were
recent acute coronary syndrome or planned cardiac surgery. In two studies,
patients with stable chronic heart failure or stable coronary disease were
recruited. The primary outcome varied across studies, being for example
new-onset CV events, need of hospital admission, CV death, a composite
index including all of these, or serum concentrations of high-sensitivity
C-reactive protein. Median follow up time was largely different across
studies allowing to stratify them in short term (<1 month, 2 studies),
medium term (1-3 months, 7 studies), long term (4-6 months, 4 studies),
very long term (>6 months, 4 studies) studies. The remaining studies
assessed in-hospital events. In 7 out of 20 RCTs previous or ongoing COL
use for any indication was as exclusion criterion. However, no further
details about the reason for taking COL was provided. Male gender was
predominant in all studies (between 65 and 96%) whereas mean age ranged
between 59 and 69 years. A thorough CV history was collected at
recruitment, however there was no mention to uric acid levels or a
previous diagnosis of gout. Furthermore, 3 RCTs excluded patients with
known autoimmune/inflammatory disease (in 2 of them ongoing
immunosuppressive or steroid therapy was an additional exclusion
criterion) however the other RCTs did not mention coexisting
autoimmune/inflammatory diseases. The primary endpoint was met by 0/2 (0%)
short term studies, 4/7 (57%) medium term studies, 2/4 (50%) long term
studies and 2/4 (50%) very long-term studies. Neither of the studies
assessing in-hospital events met the primary endpoint. Conclusion(s):
Our SLR of RCTs showed that COL may be useful in preventing new CV
events/CV death in the general population when administrated for at least
on month. However, the overall lack of information about coexisting
gout/other inflammatory RMDs does not allow to derive meaningful data to
be applied in rheumatology practice. Future RCTs should consider this
aspect when defining the eligibility criteria and describing the patient
cohorts since COL may be even more effective in patients that display a
higher CV risk due to an underlying inflammatory disease. This may
ultimately increase the likelihood to achieve the study primary endpoints.
.

<87>
Accession Number
2027227549
Title
WHEN INFECTION TAKES A DETOUR: A RARE CASE OF AORTO-CARDIAC FISTULA
SECONDARY TO STREPTOCOCCUS INFANTARIUS ENDOCARDITIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A564-A565), 2023. Date of Publication: October 2023.
Author
KAUSHAL J.; KHURANA S.; PEDNEKAR P.; ANDOH-DUKU A.; QUIEN M.A.R.Y.; GARCIA
A.; MURALIDHARAN K.; GOPALRATNAM K.; WOLFF A.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease: Hearts and Bugs SESSION TYPE: Rapid
Fire Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am
INTRODUCTION: Aorto-cardiac fistula (ACF) is a rare life-threatening
condition characterised by abnormal connection between the aorta and
cardiac chambers. ACF is a rare complication of infective endocarditis
(IE). In our case, periannular extension of bioprosthetic valve
endocarditis led to abscess formation with further deterioration to ACF
which occurs in only 3.5% of IE cases. CASE PRESENTATION: A 64-year-old
male with history of poorly controlled diabetes, coronary artery disease,
transcatheter aortic valve replacement (TAVR) with bioprosthetic valve,
presented with two weeks of generalised weakness and chills. He was
afebrile, hemodynamically stable, slightly tachycardic, and saturating
well on ambient air. His EKG showed new onset first-degree AV block.
Initial workup was suggestive of Diabetic Ketoacidosis (DKA) with mild
leukocytosis. A sepsis workup was initiated. Initial Chest X-Ray showed
multifocal consolidation. The patient was managed for DKA and was placed
on empiric antibiotics (azithromycin and ceftriaxone). He started spiking
fevers and course was complicated by acute hypoxic respiratory failure
requiring intubation. A CT chest with contrast showed multi-lobar
pneumonia and fusiform ascending aortic aneurysm of 4.7 cm with
multi-chamber cardiomegaly. He had ongoing hemodynamic instability
requiring vasopressor support. Blood cultures isolated Streptococcus
infantarius. A transesophageal echocardiography (TEE) showed a large 1.2
cm fistula between the aorta and the left atrium emanating from the
non-coronary sinus of Valsalva with normally functioning bioprosthetic
aortic valve without obvious vegetation. Patient could not be medically
optimized for cardiothoracic surgery. Given his poor prognosis, care was
changed to a conservative approach with transition to comfort measures
only. DISCUSSION: Risk factors for ACF are presence of a prosthetic valve,
valvular regurgitation, and paravalvular abscess. Injection drug use and
aortic valve involvement are independent risk factors for paravalvular
abscess formation which is more common in prosthetic compared to native
valve endocarditis. The most common organism implicated is staphylococcus
in 58% of cases, followed by streptococci, and enterococci. Prosthetic
valve endocarditis (PVE) post-TAVR has an incidence of 0.3%-1.2% per
patient-year. A literature review revealed several articles with
streptococcus spp. causing fistulizing disease which is likely related to
its unique framework. In a study on animal infective endocarditis, it was
discovered that Streptococcus infantarius could stick to various
extracellular matrix components such as collagen IV, laminin, fibronectin,
and hyaluronic acid. The bacteria were also capable of entering cell lines
due to presence of mucoid hyaluronic capsule and showed survival inside
macrophages for several hours, leading to invasive infections.
Additionally, Streptococcus infantarius bacteraemia has been associated
with noncolonic digestive neoplasia. Combined transthoracic and
transesophageal echocardiography have a detection rate of 97%. If TEE is
inconclusive, F-fluorodeoxyglucose positron emission tomography/computed
tomography (FDG-PET/CT) are useful. CONCLUSION(S): To the best of our
knowledge, this is a novel case of fistulizing IE secondary to
Streptococcus infantarius. The treatment of ACF should be prompt, given
its high mortality rate of up to 40%. Early surgical intervention is
indicated in patients with left sided PVE in the presence of penetrating
destructive abscesses independent of completion of antibiotic course.
Moderate-severe heart failure and need for emergent surgery increase the
operative risk independently. REFERENCE #1: Fierro EA, Sikachi RR, Agrawal
A, Verma I, Ojrzanowski M, Sahni S. Aorto-Atrial Fistulas: A Contemporary
Review. Cardiol Rev. 2018;26(3):137-144. doi:10.1097/CRD.0000000000000182
REFERENCE #2: Anguera I, Miro JM, San Roman JA, et al. Periannular
complications in infective endocarditis involving prosthetic aortic
valves. Am J Cardiol. 2006;98(9):1261-1268.
doi:10.1016/j.amjcard.2006.05.066 REFERENCE #3: Foster TJ, Amin AH, Busu
T, et al. Aorto-cardiac fistula etiology, presentation, and management: A
systematic review. Heart Lung J Crit Care. 2020;49(3):317-323.
doi:10.1016/j.hrtlng.2019.11.002 DISCLOSURES: No relevant relationships by
Augustine Andoh-Duku No relevant relationships by Alejandro Garcia No
relevant relationships by Kavitha Gopalratnam No relevant relationships by
Jessica Kaushal No relevant relationships by sumit khurana No relevant
relationships by Karthik Muralidharan No disclosure on file for Prachi
Pednekar No relevant relationships by Mary Quien No relevant relationships
by Armand Wolff Copyright © 2023 American College of Chest
Physicians

<88>
Accession Number
2027227462
Title
NOVEL APPLICATION OF LARYNGEAL MASK AIRWAY (LMA) TO FACILITATE ACCESS TO
SUPERIOR PARATRACHEAL LYMPH NODES DURING ROBOTIC NAVIGATION BRONCHOSCOPY.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A5401-A5402), 2023. Date of Publication: October
2023.
Author
GADODIA R.; FINE A.; CAO C.; WANG MEMOLI J.; RANI R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Report Posters 4 SESSION TYPE: Case Report
Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: A
motionless patient is preferred during Robotic Navigation Bronchoscopy
(RNB), usually necessitating general anesthesia (GA), paralysis, and
intubation. The role of the laryngeal mask airway (LMA) during RNB is
unclear. CASE PRESENTATION: Case 1: A 62-year-old man, BMI 21.9 kg/m2,
presented with cough for 2 months. Computed tomography (CT) chest followed
by positron-emission tomography (PET) showed a hypermetabolic right middle
lobe (RML) peripheral lung nodule and superior right paratracheal
lymphadenopathy (station 2R). To facilitate access to 2R for EBUS
(endobronchial ultrasound)-TBNA (transbronchial needle aspiration), LMA
placed with GA. Subsequently, because LMA already in place, we attempted
RNB through the LMA. The Monarch Auris robotic bronchoscope was advanced
to the RML, but despite being within 20 mm of the target lesion and
visualization on fluoroscopy, no visualization was noted on radial EBUS.
TBNA, bronchial brush, and biopsies were non-diagnostic. Subsequent
CT-guided transthoracic needle aspiration was positive for Mycobacterium
abscesses.Case 2: 81-year-old man, BMI 18.21 kg/m2, presented with
increasing lingular nodule with 100-pack-year smoking history. Since the
prior above procedure was successful, anesthesia was agreeable to RNB
under GA with LMA. The bronchoscope was navigated to the nodule as
verified by radial EBUS and fluoroscopy. Bronchial brush, transbronchial
biopsy, and fine needle aspiration were performed with preliminary
pathology consistent with non-small cell lung cancer. Linear EBUS then
performed for mediastinal evaluation of stations 4R, 7, and 11L. The final
pathology is consistent with clinical stage IA3 (T1cN0M0) adenocarcinoma.
The patient is currently being planned for a left upper lobe lobectomy and
lymph node dissection. DISCUSSION: Deep sedation is often recommended in
patients undergoing RNB biopsies of lung nodules to avoid CT-body
divergence and atelectasis. Despite no clear evidence for benefit of
anesthesia type on diagnostic yield, Pritchett et al recommend intubation
with the largest feasible ETT in an effort to accommodate high airway
pressure and minimize atelectasis (1). The authors argue that LMA may
increase the risk of aspiration at higher pressures but may be feasible in
patients <80 kgs. To our knowledge, there is no literature demonstrating
the use of LMAs for RNB.In case 1, the finding of malignancy on the 2R
station would negate the need to biopsy the lung nodule, but the distal
end of the ETT could obstruct access. Hence, the decision was made with
anesthesia to place ETT if the patient did not tolerate the LMA.
Anesthesia applied a pressure-controlled ventilator mode to ensure that
the peak inspiratory pressure was less than 20 cmH20, to avoid the
theoretical risk of aspiration at pressures higher than the lower
esophageal gastric junction sphincter pressure. After the success of the
first procedure, we chose to attempt the RNB via LMA for the second
patient who also tolerated the procedure well. CONCLUSION(S): In both
cases, we successfully used an LMA for RNB and EBUS. Both patients were
<80 kgs and necessary tidal volumes of as high as 900mL and PEEP of up to
8.5 was achieved. Larger cohort studies are warranted to further define
the role of LMA in robotic navigation bronchoscopy. REFERENCE #1:
Pritchett, M. A., Lau, K., Skibo, S., Phillips, K. A., & Bhadra, K.
(2021). Anesthesia considerations to reduce motion and atelectasis during
advanced guided bronchoscopy. BMC Pulmonary Medicine, 21(1), 240.
https://doi.org/10.1186/s12890-021-01584-6 REFERENCE #2: Mao, S., Du, X.,
Ma, J., Zhang, G., & Cui, J. (2018). A comparison between laryngeal mask
airway and endotracheal intubation for anaesthesia in adult patients
undergoing NUSS procedure. Journal of Thoracic Disease, 10(6), 3216-3224.
https://doi.org/10.21037/jtd.2018.05.74 REFERENCE #3: Kumar, A., Caceres,
J. D., Vaithilingam, S., Sandhu, G., & Meena, N. K. (2021). Robotic
Bronchoscopy for Peripheral Pulmonary Lesion Biopsy: Evidence-Based Review
of the Two Platforms. Diagnostics, 11(8), 1479.
https://doi.org/10.3390/diagnostics11081479 DISCLOSURES: No relevant
relationships by Cathy Cao No relevant relationships by Alexandra Fine No
relevant relationships by Ritika Gadodia No relevant relationships by
Reema Rani No relevant relationships by Jessica Wang Memoli Copyright
© 2023 American College of Chest Physicians

<89>
Accession Number
2027227362
Title
NAVIGATING THE DIAGNOSTIC CONUNDRUM OF RECURRENT PLEURAL EFFUSIONS IN A
YOUNG PATIENT: A LESSON LEARNED.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A3621), 2023. Date of Publication: October 2023.
Author
DASGUPTA R.; CABRERA R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of Pleura Case Report Posters 3 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am
INTRODUCTION: Recurrent bilateral pleural effusions in young patients
usually denotes both infectious, non-infectious, and malignant etiologies.
We present a young patient with no recorded medical history presenting
with bilateral pleural effusions and found to have nodular sclerosis
classic Hodgkin lymphoma. CASE PRESENTATION: A 34-year-old Bahamian male
presented with complaints of chest pain, dyspnea, and night sweats ongoing
for several weeks. The patient presented with tachycardia with heart rate
of 141 beats per minute, leukocytosis, thrombocytosis, and elevated dimer.
CT angiographic imaging showed large bilateral pleural effusions,
mediastinal, and axillary lymphadenopathy. He had previously been
hospitalized for similar complaints and required pericardiocentesis for
cardiac tamponade. He underwent left thoracentesis, echocardiogram, and
right-sided axillary lymph node biopsy, all of which were negative for
malignancy. The patient continued to have persistent tachycardia, was
febrile, and had a recurrence of pleural effusion. Patient underwent left
thoracentesis demonstrating exudative effusion with growth of few
mesothelial cells and histiocytes. Echocardiogram demonstrated moderate to
large pericardial effusion, Cardiology performed pericardiocentesis, which
was negative for malignancy. Repeat right sided axillary lymph node biopsy
demonstrated necrotic tissue. Repeat chest imaging demonstrated recurrence
of left sided pleural effusion, with follow up Echocardiogram obtained for
persistent tachycardia demonstrating redemonstration of pericardial
effusion. The patient was re-evaluated by Cardiothoracic Surgery, and
underwent fiberoptic bronchoscopy, anterior pericardiectomy, biopsy of a
pericardial mass, left thoracotomy, lysis of pleural adhesions, indwelling
left sided pleural catheter insertion, and chest tube insertion.
Ultimately, the biopsy of the pericardial mass revealed nodular sclerosis
classic Hodgkin lymphoma, and was ultimately transferred to an outside
hospital for induction of therapy. DISCUSSION: This case highlights the
challenges in diagnosing young patients with recurrent bilateral pleural
effusions, particularly when initial diagnostic tests are negative.
According to a recent study, nearly 25% of patients with Hodgkin lymphoma
present with pleural effusions, making it important to consider as part of
the differential diagnosis (Khan et al., 2020). The patient's presentation
and history suggested a variety of potential causes, but ultimately the
diagnosis was only made after an extensive workup. CONCLUSION(S):
This case emphasizes the importance of a thorough and systematic approach
to diagnosing young patients with recurrent bilateral pleural effusions,
even in the setting of initial negative diagnostic testing. Consideration
should be given to a broad range of potential causes and clinicians should
remain vigilant for unexpected diagnoses, as was the case with our
patient. REFERENCE #1: 1. Liang QL, Shi HZ, Qin XJ, Liang XD, Jiang J,
Yang HB. Diagnostic accuracy of adenosine deaminase in malignant pleural
effusion: a meta-analysis. Respir Med. 2008 Jul;102(7):1093-8. REFERENCE
#2: 2. Agarwal R, Aggarwal AN, Gupta D. Etiology and clinical presentation
of patients with pleural effusion in a tertiary care hospital. Monaldi
Arch Chest Dis. 2008 Sep;69(3):99-104. REFERENCE #3: 3. Giron J, Poletti
V, Cancellieri A, Puntoni R, Merlo DF. Diagnostic accuracy of thoracoscopy
for mediastinal lymphadenopathy: a systematic review and meta-analysis. J
Thorac Dis. 2017 Jun;9(6):1527-1539. DISCLOSURES: No relevant
relationships by Ruben Cabrera No relevant relationships by Rahul
Dasgupta Copyright © 2023 American College of Chest Physicians

<90>
Accession Number
2027227205
Title
ONGOING DILEMMA IN MANAGEMENT OF A RIGHT HEART THROMBUS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A5737-A5738), 2023. Date of Publication: October
2023.
Author
LEVKIAVSKA Y.; ABDULWAHAB N.; WILKERSON Z.O.L.A.; LE Q.; LEE S.E.A.N.;
PUNSALAN R.Y.A.N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report
Posters 8 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00
pm - 12:45 pm INTRODUCTION: Right heart thrombi (RHT) are an uncommon
phenomenon that are usually concurrently found with pulmonary embolism
(PE). Combination of these findings, especially if the thrombus is mobile,
pose a high risk for acute decompensation and/or mortality. Given that RHT
are being detected more frequently on PE work up, there is an increased
need for a standardized management of this complex medical scenario. We
present a unique case of RHT in probable transit and bilateral PEs in a
65-year-old female with a history of lung adenocarcinoma who was managed
with anticoagulation with a favorable outcome. CASE PRESENTATION: A
65-year-old female former smoker with past medical history of poorly
differentiated adenocarcinoma of the lung with extensive metastasis on
chemotherapy presented with worsening pain and swelling of bilateral lower
extremities associated with shortness of breath for 4 days. Her vital
signs were stable on arrival. Labs significant for WBC of 17,000/mcL,
platelets of 83,000/mcL, troponin <0.03, BNP 27 pg/mL. CTA of the chest
revealed new bilateral segmental PE. Transthoracic echocardiogram was
notable for a mass in the right atrium (RA) probable for a thrombus in
transit, dilated right ventricle (RV) with no evidence of RV strain and
ejection fraction of 50-55%. Bilateral lower extremity venous ultrasound
showed extensive DVT. EKG with normal sinus rhythm, occasional premature
atrial complexes and no signs of right heart strain. Patient's hospital
stay was complicated by paroxysmal atrial fibrillation, treated with
digoxin with subsequent conversion to sinus rhythm. Case was discussed
with Vascular and Cardiothoracic surgery, however given patient's
thrombocytopenia and comorbidities, patient was elected to be treated
conservatively with a heparin drip, and later transitioned to Apixaban.
Patient noted significant symptomatic improvement, and was discharged on
day 5 without further hospital complications. DISCUSSION: Intracardiac
thrombi are found in about 4-18% of cases of PE, and pose a significant
mortality of over 40% [1]. Primary etiologies of RHT include stasis in the
setting of heart failure, atrial fibrillation, foreign body, VTE, and
hypercoagulable states, especially malignancies. Although anticoagulation
therapy, systemic thrombolysis, and surgical embolectomy are treatment
options for RHT with concurrent PE, there are no randomized controlled
trials comparing these three widely used management strategies. The
literature shows that embolectomy and thrombolytic therapy may lead to
lower mortality rates when compared to anticoagulation alone, but factors
such as hemodynamic stability, comorbidities, and sequelae of these
interventions must also be considered [2]. Based on our case described,
treatment of RHT and PE with anticoagulation was a reasonable option in
this high risk patient given the high risk for morbidity and mortality
associated with surgery, and thrombolysis. In such scenarios, further
studies need to be explored to determine the best treatment options.
 CONCLUSION(S): Management of RHT has proven to be challenging, and
controversial due to infrequency of this disease process, and lack of
evidence based guidelines for treatment management. Further prospective
studies building upon the safety and efficacy of current treatment regimen
are warranted to develop a standardized treatment algorithm for RHT in the
setting of PE. REFERENCE #1: Chapoutot L;Tassigny C;Nazeyrollas P;Poismans
P;Maillier B;Maes D;Metz D;Elaerts J; (no date) [pulmonary embolism and
thrombi of the right heart], Archives des maladies du coeur et des
vaisseaux. U.S. National Library of Medicine. Available at:
https://pubmed.ncbi.nlm.nih.gov/8815832/ (Accessed: March 31, 2023).
REFERENCE #2: Athappan, G. et al. (2015) "Comparative efficacy of
different modalities for treatment of right heart thrombi in transit: A
pooled analysis," Vascular Medicine, 20(2), pp. 131-138. Available at:
https://doi.org/10.1177/1358863x15569009. REFERENCE #3: Jenab, Y. et al.
(2021) Pulmonary embolism and right heart thrombi: A single-center
experience, The journal of Tehran Heart Center. U.S. National Library of
Medicine. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728864/ (Accessed: March 31,
2023). DISCLOSURES: No relevant relationships by Nadia Abdulwahab No
relevant relationships by Quynh Le No relevant relationships by Sean Lee
No relevant relationships by Yuliya Levkiavska No relevant relationships
by Ryan Punsalan No relevant relationships by Zola Wilkerson Copyright
© 2023 American College of Chest Physicians

<91>
Accession Number
2027226863
Title
ECMO CANNULATION FOR 100 DAYS AND BEYOND: "SO MANY DIFFERENT LENGTHS OF
TIME".
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A6407-A6408), 2023. Date of Publication: October
2023.
Author
SAEED M.; ZAHID A.N.Z.A.; BAVARE C.; SUAREZ E.R.I.K.; ZAINAB A.S.M.A.;
RATNANI I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Transplantation Posters 2 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm
PURPOSE: Utilization of extracorporeal membrane oxygenation (ECMO) in
patients with cardiorespiratory failure is on the rise with improved
outcomes. Coronavirus disease-19 (COVID-19) related acute respiratory
distress syndrome (ARDS) further propagated the use of ECMO as a bridge to
transplant. Based on systematic reviews, the daily cost of ECMO varies
between US $20,000 and US $40,000.1,2 However, current
knowledge regarding the optimal time on ECMO, contemporary analysis on
charges, and mortality associated with ECMO remains limited. We present a
mono-centric case series of three patients at our institute managed on
ECMO while awaiting lung transplant. METHOD(S): We conducted
retrospective data abstraction of patients who were on ECMO for >100 days
and admitted in the Cardiac ICU at Houston Methodist Hospital between
January 2021 - December 2022. Data included age, gender, race, reason for
ECMO cannulation, days on ECMO, change in cannula insertion site,
complications, transplant status, post-transplant mortality, and average
estimated cost. RESULT(S): All patients in our study had COVID
related refractory ARDS with pulmonary fibrosis and required lung
transplantation. Two patients were cannulated for ECMO at an outside
hospital. All patients were cannulated in the right internal jugular vein;
however, Patient 3 developed a superior vena cava thrombus leading to
decannulation and re-insertion of the cannula into the femoral vein.
Patients 1, 2, and 3 were on ECMO for 189, 416, and 317 days,
respectively. Patients 2 and 3 underwent lung transplant, while Patient 1
awaits transplant as of December 31st, 2022. The estimated cumulative cost
of ECMO for our patients ranged between $8 million to $17 million for
Patient 2, $6 million to $13 million for Patient 3, and $4 million to $8
million for Patient 1 who still remains on ECMO. There were no reported
deaths after decannulation and lung transplant in Patients 2 and 3.
 CONCLUSION(S): ECMO can serve as an effective bridge to transplant
for >100 days in patients with COVID related ARDS. However, the optimal
time on ECMO remains obscure due to paucity of data on safety,
post-transplant recovery, and daily cost. Although outcomes are favorable,
patients incur tremendous cost with longer ICU-stays and are at increased
risk of complications. Large multicenter studies are required to determine
an efficient, structured, and cost-effective timeline for optimizing
patients on ECMO as a bridge to transplant. References: 1. Mahle WT,
Forbess JM, Kirshbom PM, Cuadrado AR, Simsic JM, Kanter KR. Cost-utility
analysis of salvage cardiac extracorporeal membrane oxygenation in
children. Journal of Thoracic and Cardiovascular Surgery.
2005;129(5):1084-1090. doi:10.1016/j.jtcvs.2004.08.012 2. Harvey MJ, Gaies
MG, Prosser LA. US and International In-Hospital Costs of Extracorporeal
Membrane Oxygenation: a Systematic Review. Appl Health Econ Health Policy.
2015;13(4). doi:10.1007/s40258-015-0170-9 CLINICAL IMPLICATIONS: In this
case series we elaborate on the utility of ECMO as a bridge to lung
transplant for >100 days in critically ill patients. However, large
population studies need to be conducted to determine an efficient timeline
for patients on ECMO as a bridge to tranplant in order to decrease
healthcare cost, reduce complications, and lower mortality. DISCLOSURES:
No relevant relationships by CHARUDATTA BAVARE No relevant relationships
by Iqbal Ratnani No relevant relationships by Mujtaba Saeed No relevant
relationships by Erik Suarez No relevant relationships by Anza Zahid No
relevant relationships by Asma Zainab Copyright © 2023 American
College of Chest Physicians

<92>
Accession Number
2027226852
Title
A NEWLY DISCOVERED HETEROZYGOUS PROTHROMBIN G20210A GENE MUTATION IN A
YOUNG PATIENT WITH DEEP VEIN THROMBOSIS AND PRIOR NSTEMI STATUS POST
CORONARY ARTERY BYPASS GRAFT.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A425), 2023. Date of Publication: October 2023.
Author
SARANTOPOULOS C.; QAZI M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 19 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am
INTRODUCTION: The association of thrombophilia and coronary arterial
disease (CAD) is currently under investigation. Studies have demonstrated
that in those with thrombophilia mutations, CAD is observed more
frequently. [1] Furthermore, meta-analysis have demonstrated that G20210A
prothrombin gene mutations may represent a separate risk factor for the
development of CAD. [2] We describe a unique case of a patient recently
discovered to be heterozygous for the G20210A prothrombin gene variant
with a history of myocardial infarction and coronary arterial bypass graft
at the age of 30. CASE PRESENTATION: The patient is a 38 year-old
Caucasian female with a history of venous thrombosis, CAD status post
coronary artery bypass graft (CABG) of LIMA to LAD, hyperlipidemia, asthma
and myocardial infarction who presented to hematology for a thrombophilia
evaluation. She was referred for further work-up of thrombophilia in the
setting of her unusual history of unprovoked deep vein thrombosis (DVT)
and early CAD. A thrombophilia work-up was positive for heterozygous
Prothrombin G20210A variant, cardiolipin antibody IgM, and HLAB-27.
Otherwise, Factor V, Antithrombin, Protein C and S, JAK 2, beta-2
microglobulin, a lupus anticoagulant profile, ESR, CRP, and ANA were
within normal limits. Her most recent transthoracic echocardiogram
demonstrated an EF of 40-45% with left ventricular hypertrophy. Left heart
catheterization was positive for chronic mid segment stenosis of the LAD
and ABI testing demonstrated peripheral artery disease of the left lower
extremity. DISCUSSION: Our patient was started on Apixaban for
anticoagulation provided her history of unprovoked deep venous thrombosis
as well as Aspirin by her cardiologist and encouraged to adhere to a vegan
diet and regular exercise regimen. Given our patient's course, her
presentation with an early MI and ongoing research into association of
thrombophilia as a risk factor for CAD, it may be valuable to perform
genetic screening in individuals with a significant family history for
Inherited thrombophilia. (1) Certain tests that should be ordered for
thrombophilia disorders could include Prothrombin, Anticardiolipin
Antibody, Beta 2 Glycoprotein, Factor V Leiden, Protein C and S levels.
Management for these patients should include adherence to a vegan or plant
based diet low in saturated fats, management of dyslipidemia with LDL
lowering medications as well as lifelong anticoagulation for patients with
a history of unprovoked thrombosis. (2) The risks and benefits of starting
anticoagulation in those without a prior thrombus but at risk for
thrombosis should be discussed with a hematologist. In conclusion, we
recommend thrombophilia testing be performed in all young patients with a
history of thrombosis and be considered in those with a family history of
early CAD. CONCLUSION(S): In conclusion, we report a case of a
patient with a history CABG, who presented with an unprovoked DVT and was
found to have a prothrombin gene mutation. This case highlights the
increased risk of DVT and the potential contribution of prothrombin gene
mutation to the development of thrombotic events and association with CAD.
REFERENCE #1: 1. Ercan B;Tamer L;Sucu N;Pekdemir H;Camsari A;Atik U;
"Factor Vleiden and Prothrombin G20210A Gene Polymorphisms in Patients
with Coronary Artery Disease." Yonsei Medical Journal, U.S. National
Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/18452260/. REFERENCE
#2: 2. Burzotta, F, et al. "G20210A Prothrombin Gene Polymorphism and
Coronary Ischaemic Syndromes: A Phenotype-Specific Meta-Analysis of 12 034
Subjects." Heart, BMJ Publishing Group Ltd, 1 Jan. 2004,
https://heart.bmj.com/content/90/1/82.short. DISCLOSURES: No relevant
relationships by Mariam Qazi No relevant relationships by Christos
Sarantopoulos Copyright © 2023 American College of Chest
Physicians

<93>
Accession Number
2027226824
Title
PANCREATIC PLEURAL EFFUSION AS A PROGNOSTIC FACTOR.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A3745-A3746), 2023. Date of Publication: October
2023.
Author
OTERO-COLON J.; KANG J.; AKELLA J.; IQBAL J.; ZAKI K.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of Pleura Case Report Posters 8 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am
INTRODUCTION: Pancreatitis is the activation of pancreatic enzymes
affecting peripheral structures with edema, hemorrhage and necrosis.
Complications include pseudocysts, splenic vein thrombosis,
gastrointestinal hemorrhage and disconnected pancreatic duct syndrome.
Pancreatic pleural effusions (PPE) can occur through pleuroperitoneal
fistulas or through a diaphragmatic defect. The pleural fluid can be
described as transparent to turbid purulent, hemorrhagic, bilious, milky
secondary to chylous effusion, or rarely black colored fluid. PPE is an
indicator of poor prognosis in pancreatitis. The constellation of
complications associated with severe pancreatitis can make the diagnosis
of PPE difficult, which is an important indicator that can help elucidate
the overall prognosis. We present a rare case of severe pancreatitis
associated with recurrent pleural and pericardial effusions. CASE
PRESENTATION: A 33 year old female presented with a productive cough
associated with dyspnea and palpitations. Physical exam was significant
for mild respiratory distress. Significant labs were serum amylase of 264
U/L, lipase of 151 U/L and LDH of 345U/L. Imaging studies revealed the
evidence of bilateral pleural effusions. Thoracentesis demonstrated
pleural fluid of turbid brown consistent with hemorrhagic neutrophilic
exudative effusion. Pleural analysis shows amylase >4200U/L and negative
for malignancy with elevated serum CA125. The diagnosis of PPE was
demonstrated by an amylase-rich fluid, greater than the limits of normal
for serum or a fluid to serum ratio greater than 1. Due to worsening
pleural effusions, bilateral chest tubes were placed and the patient
underwent bilateral VATS procedure. Echocardiogram revealed a large
pericardial effusion (PCE) with impending tamponade requiring a
pericardial window. Our patient's clinical course continued to have
complications of recurrent bilateral PPE and required endoscopic
ultrasound guided cystogastrostomy vs debridement of walled-off necrosis.
Patient transferred to an Advanced Endoscopy and Biliary facility for the
procedure. DISCUSSION: Thoracic complications of pancreatitis include
pleural effusion, pulmonary consolidation, atelectasis, pericardial
effusion, elevated diaphragms, mediastinal pseudocysts, and pulmonary
embolism. Outcomes of patients with pancreatitis significantly worsen in
the presence of PPE and cardiac tamponade. PPE has an associated mortality
rate of 20.8% and recurrence rate of 52%. Pancreatitis associated with
pleural effusion resulted in having a 5.5 times higher chance of surgery
indicating severe pancreatitis. Maringhini et al. used ultrasonography and
multivariate analysis to demonstrate that pleural effusion is an accurate,
independent predictor of severity. Minimal research has been performed on
the correlation between outcomes with pericardial effusion and
pancreatitis. Previous case studies suggest that PPE can help establish
the severity of disease and further prognosticate overall survival.
 CONCLUSION(S): Pancreatitis is a severe disease with multiple
potential complications which are important to elucidate as they can
demonstrate poor prognosis. This case highlights how PPE and PCE can help
reveal disease severity and overall prognosis, prompting aggressive
therapy. To the best of our knowledge, there are currently no large
studies that have established therapeutic guidelines for management, which
is important to investigate given its prognostic potential. However, until
further studies are conducted, due its high mortality rate, it is
paramount to diligently identify cases of PPE to prevent fatal outcomes.
REFERENCE #1: Yan, G., Li, H., Bhetuwal, A., McClure, M. A., Li, Y., Yang,
G., ... & Fan, X. (2021). Pleural effusion volume in patients with acute
pancreatitis: a retrospective study from three acute pancreatitis centers.
Annals of Medicine, 53(1), 1993-2008. REFERENCE #2: Yousaf, Z., Ata, F.,
Chaudhary, H., Krause, F., Illigens, B. M. W., & Siepmann, T. (2022).
Etiology, pathological characteristics, and clinical management of black
pleural effusion: A systematic review. Medicine, 101(8). REFERENCE #3:
Jany, B., & Welte, T. (2019). Pleural effusion in adults-etiology,
diagnosis, and treatment. Deutsches Arzteblatt International, 116(21),
377. DISCLOSURES: No relevant relationships by Jagadish Akella No relevant
relationships by Javed Iqbal No relevant relationships by James Kang No
relevant relationships by Jonathan Otero-Colon No relevant relationships
by Khawaja Zaki Copyright © 2023 American College of Chest
Physicians

<94>
Accession Number
2027226766
Title
A POKE OF THE PERICARDIUM: A RARE CASE OF BACTERIAL PERICARDIAL EFFUSION
FOLLOWING ENDOBRONCHIAL ULTRASOUND TRANSBRONCHIAL NEEDLE ASPIRATION
(EBUS-TBNA).
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A5410-A5411), 2023. Date of Publication: October
2023.
Author
SALWEN B.D.; FRECHTLING D.A.N.; PALOMINO J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Unusual Procedural Findings SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am INTRODUCTION:
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is
widely used for diagnosis and staging of lung cancer. It is well tolerated
with few reported complications; overall rate ranging from 0.07-.15%(1).
Due to its low complication rate and high diagnostic yield it is widely
used for examining mediastinal and hilar lymph nodes. Per literature
review pericardial effusion secondary to EBUS-TBNA has only been reported
7 times (2-8). CASE PRESENTATION: An 80-year-old male patient with a
history of interstitial lung disease was admitted for 3 days of
non-productive cough and dyspnea. He received a computed tomography scan
(CT) revealing chronic fibrosis, a new mass in the right upper lobe and
enlarged mediastinal and right hilar lymph nodes. EBUS-TBNA was used to
biopsy the endobronchial mass and two lymph nodes (4R and 11RS).Four days
post EBUS his oxygen requirement increased. An EKG showed diffuse ST
elevations; troponins were negative and CRP was elevated. One week
post-EBUS his white blood cell count (WBC) increased, he developed an
acute kidney injury (AKI) and shock liver. CT chest revealed development
of a pericardial effusion with tamponade physiology. He received a
pericardiocentesis with drainage of 800ml of yellow/turbid fluid. Cell
count showed 125K WBC, 60% neutrophils, gram positive cocci in pairs and
clusters. Culture grew actinomyces odontolyticus, streptococcus
constellatus and eikenella corrodens consistent with oropharyngeal flora.
There was no growth on peripheral blood culture. He was treated with
appropriate antibiotics, there was a decrease in pericardial fluid
observed on follow up TTE. His medical condition improved, and he was
discharged. DISCUSSION: We present a rare case of pericardial empyema
following EBUS-TBNA. After biopsy of stations 4R and 11RS, our patient
developed a pericardial effusion comprised of oropharyngeal bacteria.
Notably, our patient did not have an alternative source for the
pericardial empyema. On literature review, 5/7 previous cases included
biopsies of 4R(2,3,7,8). The stations were unspecified in the other two.
Anatomically the biopsied lymph nodes are not normally contiguous with the
pericardium, 4R is superior lateral and 11RS is lateral. However, in some
individuals the superior pericardial recess can have supra-aortic
extension into the high right paratracheal region(9). We hypothesize that
in our case, there was direct seeding of the pericardium as the needle
passed through the superior recess to sample 4R. CONCLUSION(S):
Bacterial pericardial effusion following EBUS-TBNA is a rare, but
potentially life-threatening complication. Due to its severity, clinicians
should be aware of possibility that pericardial effusion can occur
following EBUS-TBNA when sampling 4R lymph nodes. REFERENCE #1: 1. Gu P,
Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided
transbronchial needle aspiration for staging of lung cancer: A systematic
review and meta-analysis. Eur J Cancer. 2009;45(8):1389-1396.
doi:10.1016/j.ejca.2008.11.043 REFERENCE #2: 2. Matsuoka K, Ito A, Murata
Y, et al. Severe mediastinitis and pericarditis after transbronchial
needle aspiration. Annals of Thoracic Surgery. 2015;100(5):1881-1883.
doi:10.1016/j.athoracsur.2014.12.0933. Inoue T, Nishikawa T, Kunimasa K,
et al. Infectious pericarditis caused by Gemella sanguinis induced by
Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
(EBUS-TBNA): A case report. Respir Med Case Rep. 2020;30:101057.
doi:10.1016/J.RMCR.2020.1010574. Asano F, Aoe M, Ohsaki Y, et al.
Complications associated with endobronchial ultrasound-guided
transbronchial needle aspiration: a nationwide survey by the Japan Society
for Respiratory Endoscopy. Respir Res. 2013;14(1):50.
doi:10.1186/1465-9921-14-505. Epstein SK, Winslow CJ, Brecher SM, Faling
LJ. Polymicrobial Bacterial Pericarditis after Transbronchial Needle
Aspiration: Case Report with an Investigation on the Risk of Bacterial
Contamination during Fiberoptic Bronchoscopy.
https://doi.org/101164/ajrccm/1462523. 2012;146(2):523-525.
doi:10.1164/AJRCCM/146.2.5236. Haas AR. Infectious complications from full
extension endobronchial ultrasound transbronchial needle aspiration. Eur
Respir J. 2009;33(4):935-938. doi:10.1183/09031936.000257087. Sayan M,
Arpag H. A rare complication of endobronchial ultrasound-guided
transbronchial needle aspiration: Pericardial empyema. Lung India.
2019;36(2):154. doi:10.4103/LUNGINDIA.LUNGINDIA_262_188. Lee HY, Kim J, Jo
YS, Park YS. Bacterial pericarditis as a fatal complication after
endobronchial ultrasound-guided transbronchial needle aspiration. European
Journal of Cardio-Thoracic Surgery. 2015;48(4):630-632.
doi:10.1093/EJCTS/EZU477 REFERENCE #3: 9. Kuperberg SJ, Shostak E.
High-riding superior pericardial recess: A key pitfall in
misinterpretation during CT evaluation of the mediastinum. J Bronchology
Interv Pulmonol. 2019;26(1):71-73. doi:10.1097/LBR.0000000000000530
DISCLOSURES: No relevant relationships by Dan Frechtling No relevant
relationships by Jaime Palomino No relevant relationships by Benjamin
Salwen Copyright © 2023 American College of Chest Physicians

<95>
Accession Number
2027225576
Title
SYSTEMIC LUPUS ERYTHEMATOSUS-ASSOCIATED SEVERE PULMONARY HYPERTENSION: A
CAUTIONARY TALE OF PERICARDIAL EFFUSIONS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A6129-A6130), 2023. Date of Publication: October
2023.
Author
MURALI V.; RAZIA D.; ARIF M.Z.; FELDMAN J.P.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Pulmonary Vascular Disease Case Report Posters 5 SESSION
TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm
INTRODUCTION: Pulmonary arterial hypertension (PAH) is a rare but
potentially lethal manifestation of systemic lupus erythematosus (SLE).
Between 0.5% to 17.5% of patients with SLE develop PAH with variable time
of onset relative to other lupus manifestations. We present a case of
newly diagnosed SLE associated with severe PAH resulting in right heart
failure. CASE PRESENTATION: A 37-year-old female had a six-month prodrome
of progressive dyspnea and exercise intolerance for which she was
initially diagnosed with hypothyroidism. She continued to deteriorate and
presented to an outside hospital for progressively worsening dyspnea on
exertion, dry cough, and pleuritic chest pain. She also had severe
bilateral upper extremity joint pain, diffuse adenopathy, and leukopenia.
On admission, she had tachycardia, mild hypotension, and hypoxia. Labs
showed elevated D-Dimer and creatinine as well as positive ANA, Anti-Sm,
and Anti-dsDNA. Urinalysis showed microscopic hematuria and proteinuria.
Chest imaging was negative for pulmonary embolism, but revealed a pleural
effusion, pericardial effusion, and dilated right heart. Echocardiogram
showed dilated right heart chambers with a flattened interventricular
septum, moderate pericardial effusion, and pulmonary artery pressure of
78mmHg. Due to concerns for tamponade, the patient received a
pericardiostomy. Shortly after the removal of the pericardial drain, the
patient developed profound hypotension requiring pressor support in the
ICU. A bedside pulmonary artery catheter was placed showing PAP 66/29mmHg,
PWP 16mmHg, and PVR 7.75. The patient was then emergently transferred to
our hospital where we confirmed SLE associated PAH and started treatment
with inhaled nitric oxide, sildenafil, and treprostinil. We were concerned
for glomerulonephritis but felt the patient was too unstable for renal
biopsy. Thus, we treated her with pulse corticosteroids and
cyclophosphamide. The patient was successfully weaned off pressors and
echocardiogram after one week showed significant improvement in right
ventricle size, function, and pulmonary pressures. Patient was discharged
on ambrisentan, tadalafil, subcutaneous treprostinil, atovaquone,
hydroxychloroquine, and methylprednisolone. She showed continued
improvement in exercise tolerance and renal function in outpatient
follow-up. DISCUSSION: This patient likely had longstanding undiagnosed
SLE that resulted in severe untreated PAH and right-heart failure.
Pathogenesis of PAH in SLE may relate to immune complex deposition,
pulmonary vasculitis, and pulmonary endothelial cell dysfunction leading
to vasoconstriction and abnormal vascular remodeling. We treat SLE
associated PAH with the usual approved PAH medications with a low
threshold to use immunosuppression. Both SLE and PAH can lead to
pericardial effusions. It is critical to determine if the effusion is
driven by active serositis or the PAH. Pericardiocentesis is only
indicated when effusions result in cardiac tamponade, which can be fatal
if not addressed. We believe that our patient may not have had tamponade
and the PAH literature includes various reports of precipitous decline
after pericardial drainage in PAH patients. Thus, we always obtain
invasive hemodynamics to identify equalization of diastolic pressures when
there is a concern for tamponade in a PAH patient with pericardial
effusion. CONCLUSION(S): This case demonstrates the necessity for
prompt recognition and treatment of PAH in SLE. It also highlights the
importance of distinguishing a PAH associated pericardial effusion from
tamponade. REFERENCE #1: Pahuja, M., Weeratunga, A., & Feldman, J. (2016).
Severe Pulmonary Artery Hypertension (PAH) and Pericardial Effusion (PE):
A Deadly Combination: A Case Series and Review of Literature. Chest,
150(4), 1168A. https://doi.org/10.1016/j.chest.2016.08.1277 REFERENCE #2:
Tselios, K., Gladman, D. D., & Urowitz, M. B. (2016). Systemic lupus
erythematosus and pulmonary arterial hypertension: Links, risks, and
management strategies. Open Access Rheumatology : Research and Reviews, 9,
1-9. https://doi.org/10.2147/OARRR.S123549 REFERENCE #3: Sahay, S., &
Tonelli, A. R. (2013). Pericardial effusion in pulmonary arterial
hypertension. Pulmonary Circulation, 3(3), 467-477.
https://doi.org/10.1086/674302 DISCLOSURES: No relevant relationships by
Muhammad Arif No disclosure on file for Jeremy Feldman No relevant
relationships by Vaibhav Murali No relevant relationships by Deepika
Razia Copyright © 2023 American College of Chest Physicians

<96>
Accession Number
2027225511
Title
A CASE OF STAGE IV NON-SMALL CELL LUNG CANCER MANAGEMENT IN THE MODERN
ERA: HOW MUCH IS TOO MUCH?.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A4449), 2023. Date of Publication: October 2023.
Author
SCHEID Z.; SALIM K.; ABEDEEN D.; RAMESH N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Cancer Case Report Posters 14 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION:
The 5-year relative survival rate for patients with stage IV non-small
cell lung cancer (NSCLC) is around 9%. The use of modern treatments and
targeted immunotherapies can have negative implications on the patient,
including decreased quality of life, financial burden, and the potential
for significant side effects. CASE PRESENTATION: A 62 year-old-female
initially presented in November of 2020 with sore throat, dysphagia,
odynophagia and 30 lb weight loss in 8 months. At that time, she had a CT
scan of her neck which noted a 2.8 x 2.0 cm spiculated mass in the right
upper lobe (RUL) with numerous bilateral smaller pulmonary nodules and
multifocal mediastinal lymphadenopathy. Dedicated CT scan of her chest
confirmed numerous scattered masses/nodules concerning for metastatic
disease. Bronchoscopy revealed an endobronchial mass that occluded almost
the entirety of the right upper lobe. Biopsy and PET results returned
positive for Stage IV adenocarcinoma of the RUL, T1N3M1, with metastatic
sites to the lungs, adrenal and brain. Lung biomarkers were significant
for PD-L1 positive (20%). She was started on monotherapy with
pembrolizumab and began Whole Brain Radiation Therapy (WBRT). Following
two months of treatment, PET/CT and markers noted disease response to
therapies in the lungs, adrenal glands and nodes, however there was
evidence of pericardial effusion, concerning for cardiac tamponade. She
returned to the hospital and underwent pericardiocentesis. The effusion
was thought to be secondary to an immune mediated reaction. Given the
continued progression of her disease, she was started on pemetrexed in
addition to pembrolizumab. She was then subsequently switched to
transtuzumab following Her-2 amplified molecular studies. She was noted to
have returned to the emergency department on two separate occasions for
adrenal insufficiency with hypotension. She was given a chemotherapy
holiday following her last treatment with transtuzumab. DISCUSSION: While
aggressive treatment for Stage IV NSCLC may slightly prolong survival in
some cases, it is important to consider the potential for negative impact
on quality of life in these patients. This patient underwent immunotherapy
with pembrolizumab and likely developed life-threatening cardiac tamponade
as a result. She was also seen in the emergency room on two separate
occasions for hypotension. Taken together, these findings suggest that a
more personalized and realistic approach may need to be considered in
helping our patients preserve a better quality of life.
 CONCLUSION(S): While the advent of new treatment options for advanced
NSCLC has provided new hope for patients, it is important to to consider
the negative effects of aggressive treatment. REFERENCE #1: Canale, M.L.,
Camerini, A., Casolo, G. et al. Incidence of Pericardial Effusion in
Patients with Advanced Non-Small Cell Lung Cancer Receiving Immunotherapy.
Adv Ther 37, 3178-3184 (2020). REFERENCE #2: Schneider BJ, Naidoo J,
Santomasso BD, et al. Management of Immune-Related Adverse Events in
Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline
Update. J Clin Oncol 2021; 39:4073. REFERENCE #3: Wang DY, Salem JE, Cohen
JV, et al. Fatal Toxic Effects Associated With Immune Checkpoint
Inhibitors: A Systematic Review and Meta-analysis. JAMA Oncol 2018;
4:1721. DISCLOSURES: No relevant relationships by Danya Abedeen No
relevant relationships by Navitha Ramesh No relevant relationships by
Kinza Salim No relevant relationships by Zachary Scheid Copyright
© 2023 American College of Chest Physicians

<97>
Accession Number
2027225496
Title
A UNIQUE CASE OF PREGNANCY-ASSOCIATED SPONTANEOUS CORONARY ARTERY
DISSECTION PRESENTING AS GENERALIZED TONIC CLONIC SEIZURES.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A508-A509), 2023. Date of Publication: October 2023.
Author
UR RAHMAN S.A.A.D.; IMTIAZ GILL S.; RANA M.; MEHTA S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 20 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm
INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a
non-atherosclerotic coronary artery disease, defined as the development of
sudden tear in one or more layers of coronary arteries. P-SCAD
(pregnancy-associated SCAD) is even a rare form of SCAD, that occurs
either during pregnancy or within 3 months post-partum. We report a unique
case of P-SCAD that presented with generalized tonic-clonic seizure in the
setting of ventricular fibrillation. CASE PRESENTATION: A 31-year-old
G2P2A0 female without any significant past medical history and ten days
post-partum from cesarean section presented to the emergency department
after a witnessed episode of generalized tonic-clonic seizure and reported
post-ictal chest pain for the last 1 hour. Shortly after the initial
presentation, the patient had another episode of generalized tonic-clonic
seizure followed by loss of pulse. Telemetry was remarkable for
ventricular fibrillation following which patient underwent two cycles of
cardiopulmonary resuscitation and defibrillation before the return of
spontaneous circulation (ROSC) was attained. Post-ROSC, EKG showed
ST-segment elevation myocardial infarction (STEMI) in anterolateral leads
(V2, V3, I, and AVL). Urgent CT brain and CTA chest were unremarkable.
Patient received aspirin and was placed on heparin drip. She endorsed
improvement in chest pain, however, she was taken for emergent left heart
catheterization for further evaluation. Her coronary angiogram was
remarkable for SCAD of the proximal left anterior descending artery (LAD)
extending into the proximal to mid-LAD and the first diagonal artery. As
the patient was hemodynamically stable with minimal symptoms, she was
managed conservatively. She was discharged in stable condition on dual
antiplatelet therapy, beta-blocker, and a life vest with a 4-week
follow-up for placement of an automatic implantable
cardioverter-defibrillator (AICD). DISCUSSION: P-SCAD is a unique cause of
acute coronary syndrome (ACS) and myocardial infarction (MI), with an
incidence of 1.8 per 100000 pregnancies. While most cases present as
isolated chest pain, seizure as presenting symptom is extremely rare. The
underlying pathophysiology of P-SCAD is unknown but likely related to
increased hemodynamic stresses or hormonal effects leading to weakening of
coronary arteries. In most cases, patients with P-SCAD are managed
conservatively, however percutaneous coronary intervention (PCI) or
coronary bypass surgery (CABG) should be considered in hemodynamically
unstable patients or those with recurrent chest pain. In rare instances
when a patient presents with ventricular fibrillation or sustained
ventricular tachycardia, AICD placement is recommended.
 CONCLUSION(S): P-SCAD is a rare cause of non-atherosclerotic MI that
can present as a generalized tonic-clonic seizure. High index of suspicion
of P-SCAD should be kept particularly in post-partum young females
presenting with chest pain, seizures, or ventricular fibrillation.
REFERENCE #1: Roman A, Agdamag A, et al. SEIZURE AS INITIAL MANIFESTATION
OF LEFT MAIN SPONTANEOUS CORONARY ARTERY DISSECTION. J Am Coll Cardiol.
2021 May, 77 (18_Supplement_1) 2565. REFERENCE #2: Weber A, Elliott J,
Gopalakrishnan P (2020) Recurrent Spontaneous Coronary Artery Dissection
Leading to Recurrent Sudden Cardiac Arrests: Who is at Risk?. Int J Clin
Cardiol 7:197. doi.org/10.23937/2378-2951/1410197 REFERENCE #3: Elizabeth
D. Paratz, Chien Kao, Andrew I. MacIsaac, Jithendra Somaratne, Robert
Whitbourn, Evolving management and improving outcomes of
pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a
systematic review, IJC Heart & Vasculature, Volume 18, 2018, Pages 1-6,
ISSN 2352-9067. DISCLOSURES: No relevant relationships by Seemab Imtiaz
Gill No relevant relationships by Saad Ur Rahman No relevant relationships
by Muhammad Rana No disclosure on file for Sanjay Mehta Copyright
© 2023 American College of Chest Physicians

<98>
Accession Number
2027225270
Title
NODULAR PULMONARY AMYLOIDOMA MASQUERADING AS A CANCEROUS NODULE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A4787-A4788), 2023. Date of Publication: October
2023.
Author
RAMAKRISHNAN S.; AHMED MALIK M.; CHETANA SHANMUKHAPPA S.; LAL MANNUMBETH
RENJITHLAL S.; SHAUKAT F.A.H.D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Pathology Case Report Posters 13 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION:
A pulmonary amyloid nodule is a frequent finding in imaging with the
advent of screening guidelines for lung cancer. We present a case of
amyloid nodule that mimics a primary lung cancer in an asymptomatic
elderly individual. CASE PRESENTATION: A 79-year-old male with a history
of hypertension, diabetes, remote nicotine use, and obstructive sleep
apnea had an incidental finding of a right upper lobe nodule on a chest
radiograph. He had further work-up with a CT chest which showed a
centrally located spiculated right upper lobe nodule of size 1.7 cm x 1.3
cm which prompted evaluation with a Positron Emission Tomography (PET)
scan revealing PET positive nodule of size 2 cm with Standardized Uptake
Value (SUV) of 2.5 that was suggestive of primary lung cancer as well as
borderline PET positive right hilar lymph node. The patient underwent
bronchoscopy with endobronchial ultrasound-guided fine needle aspiration
cytology of the lymph node, which surprisingly did not show any evidence
of malignancy or infection. Bronchial washings were also negative for
malignancy. The patient subsequently underwent video-assisted thoracic
surgery for a right upper lobectomy. Pathology results were consistent
with nodular pulmonary amyloidoma (NPA). Serum protein electrophoresis and
urine protein electrophoresis were unremarkable, and serum immunoglobulins
were also normal. Cardiac involvement was questionable as the
echocardiogram showed features of heart failure with preserved ejection
fraction. The workup of systemic inflammatory disorders was negative.
Patient was advised to undergo frequent monitoring. DISCUSSION:
Amyloidosis is a heterogeneous disorder characterized by the deposition of
misfolded proteins in extracellular tissues. Localized pulmonary
amyloidosis presents in three forms: tracheobronchial, diffuse alveolar
septal, and nodular pulmonary amyloidoma. Remembering that a NPA can
present either as an incidental finding or as a locally destructive mass
with pain and respiratory distress is essential. The presentation of NPA
as a solitary nodule often resembles primary bronchogenic cancer, which is
the case in our patient. PET-CT with fluorodeoxyglucose (FDG) has high
sensitivity and specificity for identifying malignant nodules. Based on
the literature review, amyloid nodules have been known to have different
FDG uptakes on PET scans (1). In our case, the patient had a PET-positive
2 cm right upper lobe nodule which was suspicious for a malignant process
but proved to be an amyloidoma. CONCLUSION(S): Nodular pulmonary
amyloid can masquerade as primary lung cancer on a PET scan leading to a
series of invasive procedures. Malignancy should be excluded in such
cases. REFERENCE #1: Quan, Xiao-Qing, Tie-Jun Yin, Cun-Tai Zhang, Jian
Liu, Li-Fen Qiao, and Chang-Shu Ke. "18F-FDG PET/CT in Patients with
Nodular Pulmonary Amyloidosis: Case Report and Literature Review." Case
Reports in Oncology 7, no. 3 (November 28, 2014): 789-98. REFERENCE #2:
Crain, Matthew A., Georgia M. Vasilakis, Jessica R. Adkins, Ayodele
Adelanwa, Jeffery P. Hogg, Dhairya A. Lakhani, and Cathy Kim. "Primary
Nodular Chest Amyloidoma: A Case Report and Review of Literature."
Radiology Case Reports 17, no. 3 (December 21, 2021): 631-37. REFERENCE
#3: DeCicco, Danielle, Esra Alshaikhnassir, Vishal Deepak, Sarah Hadique,
and Rahul Sangani. "Isolated Pulmonary Amyloidoma: A Rare Cause of
Solitary Pulmonary Nodule." Respiratory Medicine Case Reports 42 (February
19, 2023): 101820. DISCLOSURES: No relevant relationships by Sanjana
Chetana Shanmukhappa No relevant relationships by Muhammad Ahmed Malik No
relevant relationships by Sarath Lal Mannumbeth renjithlal No relevant
relationships by Sanjana Ramakrishnan No relevant relationships by Fahd
Shaukat Copyright © 2023 American College of Chest Physicians

<99>
Accession Number
2027225107
Title
A RARE CASE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS EPIDERMIDIS NATIVE
MITRAL VALVE INFECTIVE ENDOCARDITIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A449-A450), 2023. Date of Publication: October 2023.
Author
ADHIKARI R.; BOWLER S.; MUTYALA M.; SLIM J.; MATTI-OROZCO B.; WHITE C.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 1 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm
INTRODUCTION: Staphylococcus epidermidis (S. epidermidis) is a
catalase-positive, coagulase-negative gram-positive cocci, the most common
commensal organism in the human skin flora. Prosthetic devices such as
heart valves, joints, indwelling catheters, and immune compromise are risk
factors for S. epidermidis infection. We present a rare case of
community-acquired methicillin-resistant S. epidermidis infective
endocarditis (IE) of the native mitral valve. CASE PRESENTATION: An
80-year-old Hispanic male with hypertension, hyperlipidemia, type 2
diabetes mellitus, and COVID-19 infection six months earlier, presented to
the hospital with three days of diarrhea, cough, fever, rigors, dizziness,
and anorexia. He denied known sick contacts, recent antibiotic use, or
dietary changes. He had no history of recent surgery, prosthesis or
foreign body, intravenous drug use, hospitalization, or traumatic injury.
On admission, the patient was febrile to 100.6degreeF; no rash or heart
murmur noted. Laboratory findings on presentation were notable for
leukocyte count of 10.2 x 103/microl, BUN of 38 mg/dL, creatinine of 1.7
mg/dL, ESR of 71 mm/hr and CRP of 15.6 mg/dL. Transesophageal
echocardiogram showed a moderate-sized mitral valve vegetation. Blood
cultures yielded S. epidermidis, resistant to oxacillin and vancomycin
with minimum inhibitory concentration (MIC) of 4 microg/ml. The patient
was switched from IV vancomycin to IV daptomycin (10 mg/kg/day); he
responded well and was discharged home to complete six weeks of IV
daptomycin with outpatient follow-up. DISCUSSION: Infective endocarditis
(IE) of a prosthetic heart valve by coagulase-negative Staphylococcus
(CoNS) is common but infection of the native valve by CoNS is relatively
rare. This case reports a native mitral valve IE caused by CoNS in our
patient with no known risk factors and no prior IE or prosthetic heart
valve. Studies show that nosocomial-acquired native valve IE by CoNS have
higher rates of methicillin resistance versus those acquired in the
community. Native valve IE with this etiology has higher likelihood of
persistent bacteremia, intracardiac abscess (15-38%) and in-hospital
mortality (19-36%), thus a potent antibiotic therapy is needed to treat
effectively. Our patient is rare for his community-acquired
methicillin-resistant S. epidermidis native valve IE where antibiotic
susceptibility testing (AST) showed a vancomycin MIC of 4microg/ml and
helped guide antibiotic therapy. CONCLUSION(S): This is a rare case
report of native valve IE caused by methicillin-resistant S. epidermidis
with resistance to oxacillin and high vancomycin MIC (4microg/ml), treated
successfully with IV daptomycin for six weeks. A high index of suspicion
for IE should remain even in patients without typical signs and symptoms,
or without a history of valvular pathology. Blood culture and imaging
tests are essential to confirm diagnosis and AST to help guide antibiotic
therapy. REFERENCE #1: Slipczuk L, Codolosa JN, Davila CD, et al.
Infective endocarditis epidemiology over five decades: a systematic
review. PLoS One. 2013;8(12):e82665-e82665. REFERENCE #2: Chu VH, Woods
CW, Miro JM, et al. Emergence of coagulase-negative staphylococci as a
cause of native valve endocarditis. Clin Infect Dis. 2008;46(2):232-242.
REFERENCE #3: Meagan Mayo, et al. Staphylococcus Epidermidis Native Valve
Endocarditis. Crit Care Med J. 2022;50(1S):170, January 2022. DISCLOSURES:
No relevant relationships by Raksha Adhikari No relevant relationships by
Raksha Adhikari No relevant relationships by Selina Bowler No relevant
relationships by Brenda Matti-Orozco No relevant relationships by Monica
Mutyala No relevant relationships by jihad slim No relevant relationships
by Cilian White Copyright © 2023 American College of Chest
Physicians

<100>
Accession Number
2027224772
Title
HELLP SYNDROME COMPLICATED BY RUPTURED HEPATIC SUBCAPSULAR HEMATOMA AND
CARDIAC TAMPONADE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1959-A1960), 2023. Date of Publication: October
2023.
Author
WADUD N.; WARD J.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters 69 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION:
HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, a
low-incidence condition of uncertain pathogenesis associated with
pregnancy hypertensive syndromes. Ruptured subcapsular liver hematoma
complicated with hemoperitoneum and pericardial tamponade is an uncommon
but very serious condition where early recognition and multidisciplinary
management are key to reduce its associated maternal mortality and
morbidity. CASE PRESENTATION: 34 year old female G3P0122 who presented
with HELLP Syndrome in the setting of pre eclampsia during her pregnancy
with twins. She had an emergent c-section delivery at 28 weeks,
complicated by post c-section ruptured subcapsular hematoma 10x4x2 cm
during the same admission requiring exploratory laparotomy with evacuation
of 1.5 L hemoperitonium. Post operative course complicated by vaginal
bleeding and dyspnea secondary to right sided pleural effusion for which
she had pigtail catheter placed, removed after 4 days. She had duplex
ultrasound and PE scan which were negative. She was again readmitted after
3 weeks with new onset fever, chest pain, difficulty taking deep breath
with recurrence of right sided pleural effusion, 850 ml of tea colored
fluid was drained. CT chest showed moderate right hydropneumothorax, no
clear infectious etiology was identified. Patient was again admitted in
about a month with shortness of breath, chest pain and syncope with large
pericardial effusion with tamponade physiology noted by echocardiography.
She underwent pericardiocentesis ( 490 ml serosanguinous fluid). She
continued to experience dyspnea on exertion even after discharge. She was
hospitalized after 2 weeks for pericarditis related chest pain. CT chest
demonstrated moderate pericardial effusion with moderate left sided
pleural effusion, medically managed with colchicine and ibuprofen. She had
a repeat echo and CT chest done after a month showed decrease moderate
pericardial effusion and small right pleural effusion but increased
moderate left pleural effusion. Upon discharge there was concern for lupus
for anemia, pleural/pericardial effusion and postpartum hematoma. Work up
showed elevated ESR and C3. ANA and double stranded DNA was normal.
Cytology of pleural fluid showed reactive mesothelial cells and marked
acute inflammation, pericardial fluid also showed mixed acute and chronic
inflammatory cells. She was managed by multidisciplinary team of
intensivist, cardiologist, rheumatologist and maternal fetal medicine.
DISCUSSION: Through pubmed search we were able to find a handful of cases,
but our case is probably very rare where we had two catastrophic
complications of the HELLP syndrome both ruptured subcapsular liver
hematoma and pericardial tamponade. An aggressive multidisciplinary
approach has considerably improved the morbidity and mortality associated
with these complications. CONCLUSION(S): HELLP syndrome is associated
with increased complement activation, serious complications occur in
12.5-65% of cases and are associated with a maternal mortality of 18% to
86% in cases of hepatic rupture. Early diagnosis and aggressively
management of rare complications is crucial for favorable outcome.
REFERENCE #1: Garcia Gonzalez LA, Rodriguez Uria R, Noriega Menendez P,
Solar Garcia L, Miyar de Leon A, Gonzalez-Pinto Arrillaga IM, Granero
Trancon JE. Ruptured subcapsular liver hematoma as a rare complication of
HELLP syndrome. A therapeutic challenge. Rev Esp Enferm Dig. 2022 Nov 25.
doi: 10.17235/reed.2022.9276/2022. Epub ahead of print. PMID: 36426863.
REFERENCE #2: S. Kinthala, M. Fakoory, T. Greaves, L. Kandamaran, H.
Thomas, S. Moe, Subcapsular liver hematoma causing cardiac tamponade in
HELLP syndrome,International Journal of Obstetric Anesthesia,Volume 21,
Issue 3,2012,Pages 276-279,ISSN
0959-289X,https://doi.org/10.1016/j.ijoa.2012.04.007. REFERENCE #3: Quiroz
MN, Rodriguez HX, Lara DS. Derrame pericardico y serositis pleural en
pacientes con preeclampsia severa y sindrome HELLP. Reporte de dos casos
[Pericardial effusion and pleural serositis in patients with severe
preeclampsia and HELLP syndrome]. Ginecol Obstet Mex. 2009
Nov;77(11):523-8. Spanish. PMID: 20085137. DISCLOSURES: No relevant
relationships by Nafisa Wadud No relevant relationships by Jared
Ward Copyright © 2023 American College of Chest Physicians

<101>
Accession Number
2027224597
Title
UPDATES ON MEDICAL MANAGEMENT OF DELIRIUM IN ICU PATIENTS: A SYSTEMATIC
REVIEW OF CLINICAL TRIALS IN THE LAST 5 YEARS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1766), 2023. Date of Publication: October 2023.
Author
AIMAN W.; ASHAR ALI M.; ABUSHANAB M.; QIREM M.; SAI PULAKURTHI Y.; CHOW
P.; RENGARAJAN H.; BELLARY S.S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Posters 2 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm
PURPOSE: Delirium is an acute disturbance in awareness and attention in
critically ill patients and affects 30-50% of the patients in intensive
care units (ICU). Multiple antipsychotic and insomnia medications are used
for delirium. In this article, we will assess the effectiveness of drugs
in the management of delirium in ICU patients in light of recent clinical
trials. METHOD(S): A literature search was performed on PubMed and
Embase with keywords "delirium" AND "drug therapy" AND "intensive care
unit" from 1/1/2018 to 3/15/2023. 1,894 articles were screened and 9
randomized clinical trials (RCTs, N=1,831) were included. PRISMA
guidelines were followed to conduct this systematic review.
 RESULT(S): In 9 clinical trials (N=1,831), haloperidol was used in
600, quetiapine in 53, dexmedetomidine in 30, ketamine in 47,
ramelteon/melatonin in 164, and placebo in 937 patients. 120 patients were
admitted to ICU due to thromboendarterectomy, 210 due to cardiac surgery,
131 due to trauma, and the remaining due to general ICU admissions. In an
RCT by Anderson et al. (N=1000), mean hospital stay was 28.8
(CI=26.7-30.8) vs. 26.4 (CI=24.4-28.5) days, morality was 36.30% vs.
43.30%, and use of rescue medications was 57% vs. 62% with haloperidol vs.
placebo, respectively. In RCT by Garg et al., mean days without delirium
were 9.45+/-3.4, 8.64+/-2.46, and 8.57+/-2.35 with haloperidol,
quetiapine, and placebo, respectively. In RCT by Hollinger et al. (N=182),
11.1%, 6.4%, and 9.1% of patients treated with haloperidol, ketamine, and
placebo developed delirium. In an RCT by Soltana et al. (N=60), mean days
in ICU were 11.8 vs. 12.2 and the incidence of delirium was 40% vs. 20%
with haloperidol vs. dexmedetomidine. In 3 RCTs (N=436), the incidence of
delirium was 56/211 (26.5%) vs. 67/216 (31%) with melatonin/ramelteon vs.
placebo, respectively. In 2 RCTs (N=106), delirium was reported in 17/37
(45.9%) and 49/69 (71%) patients treated with quetiapine and placebo,
respectively. CONCLUSION(S): Haloperidol didn't improve delirium,
hospital stay, or mortality as compared to a placebo in ICU patients. The
incidence of delirium with haloperidol was similar to ketamine,
quetiapine, and placebo. Dexmedetomidine was significantly better than
haloperidol for the incidence of delirium. Ramelteon/melatonin didn't
improve the incidence of delirium as compared to the placebo.
Contradictory results were reported in small-scale RCTs on quetiapine vs.
placebo and large-scale RCTs are needed to confirm these results. CLINICAL
IMPLICATIONS: This will help understand the effectiveness of drugs in
delirium in ICU patients. DISCLOSURES: No relevant relationships by
Mohammad Abushanab No relevant relationships by Wajeeha Aiman No relevant
relationships by Muhammad Ashar Ali No relevant relationships by Sharath
Bellary No relevant relationships by Priscilla Chow No relevant
relationships by YASHWITHA SAI PULAKURTHI No relevant relationships by
Murad Qirem No relevant relationships by Harish Rengarajan Copyright
© 2023 American College of Chest Physicians

<102>
Accession Number
2027223912
Title
DELAYED-ONSET POST-CARDIAC ARREST PERICARDIAL TAMPONADE TREATED WITH
SUBXIPHOID PERICARDIOCENTESIS WITH ULTRASOUND GUIDANCE DESPITE GIANT
ABDOMINAL AORTIC ANEURYSM.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1969), 2023. Date of Publication: October 2023.
Author
CRAVENS M.; RIKER R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters 14 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION:
Cardiopulmonary resuscitation (CPR) has a high rate of iatrogenic injury,
and post-resuscitation imaging with computerized tomography (CT) and
point-of-care ultrasound (POCUS) are recommended to define the etiology of
arrest and identify associated injuries. We present a case of post-cardiac
arrest delayed-onset pericardial tamponade with challenging
pericardiocentesis due to a giant abdominal aortic aneurysm (AAA). CASE
PRESENTATION: A 75-year-old man presented with witnessed out-of-hospital
ventricular fibrillation, with return of spontaneous circulation after 15
minutes. In the ED, he was unresponsive with mottled extremities and a
pulsatile abdominal mass. Electrocardiogram demonstrated inferior
ST-elevation myocardial infarction. POCUS identified the AAA, and CT
angiography confirmed a 10cm AAA without rupture, multiple rib fractures,
and no pericardial effusion. Vascular surgery declined intervention, and
over the next 45 minutes, progressive hypotension despite fluids,
norepinephrine, vasopressin, epinephrine, and dobutamine prompted repeat
POCUS, which identified a large pericardial effusion and right atrial and
ventricular diastolic collapse. Cardiology declined intervention for the
tamponade due to the giant AAA. With progressive shock and after shared
decision making with the family, pericardiocentesis was performed via the
subxiphoid approach using dynamic ultrasound guidance, yielding 60 mL of
dark non-clotting blood with immediate improvement of systolic blood
pressure by 40 mmHg. No pericardial drain was available, so a central
venous catheter was placed into the pericardial space via Seldinger
technique, and a total of 120 mL of blood was initially aspirated.
Contrast echocardiogram demonstrated resolution of tamponade, correct
catheter placement, and no evidence of free wall rupture. Hypotension
recurred several times, and was responsive to aspiration of blood from
pericardial drain. Family decided cardiac surgery was not within the
patient's goals of care, and comfort was identified as the care priority.
Pressors were discontinued, and the patient expired comfortably with
family at his side. DISCUSSION: After cardiac arrest and CPR, CT and POCUS
are recommended as important early diagnostic tests to define the etiology
of the collapse and identify associated injuries. These showed no
pericardial effusion, but with progressive hypotension, repeat POCUS
identified delayed onset pericardial tamponade. Despite the giant AAA,
subxiphoid pericardiocentesis and drain placement was successful, but
definitive surgical intervention was not pursued given chronic medical
conditions and patient and family preferences. CONCLUSION(S): Delayed
presentation of pericardial tamponade after cardiac arrest must be
considered despite negative initial imaging, and subxiphoid
pericardiocentesis is possible despite the presence of a giant AAA using
dynamic ultrasound guidance. REFERENCE #1: Miller AC, Rosati SF,
Suffredini AF, Schrump DS. A systematic review and pooled analysis of
CPR-associated cardiovascular and thoracic injuries. Resuscitation
2014;85(6):724-31. REFERENCE #2: Adel J, Akin M, Garcheva V, et al.
Computed-tomography as first-line diagnostic procedure in patients with
out-of-hospital cardiac arrest. Front Cardiovasc Med 2022;9:799446.
REFERENCE #3: Blanco P, Figueroa L, Menendez MF, Berrueta B.
Pericardiocentesis: ultrasound guidance is essential. Ultrasound J
2022;14(1):9. DISCLOSURES: No relevant relationships by Matthew Cravens No
relevant relationships by Richard Riker Copyright © 2023 American
College of Chest Physicians

<103>
Accession Number
2027081664
Title
Patient blood management, an essential step in enhanced recovery after
surgery programs.
Source
Clinical Nutrition ESPEN. Conference: BAPEN 2022. Edinburgh United
Kingdom. 57 (pp 811-812), 2023. Date of Publication: October 2023.
Author
Puig G.; Mendez E.; Barquero M.; Leon A.; Bellafont J.; Colomina M.J.
Institution
(Puig, Mendez, Barquero, Leon, Bellafont, Colomina) Anaesthesiology and
Intensive Care, Bellvitge Hospital, Barcelona, Spain
Publisher
Elsevier Ltd
Abstract
Background: The aim of perioperative medicine is to provide comprehensive,
patient-centred care through 2 multimodal, multidimensional programmes:
enhanced recovery after surgery (ERAS) and patient blood management (PBM).
The aim of ERAS programmes is to improve outcomes and optimize patient
recovery by reducing the stress response to surgery. The aim of PBM
programmes is to improve outcomes by boosting and conserving the patient's
own blood. Both programmes require a multidisciplinary effort throughout
the perioperative process, which often makes their actual implementation
difficult. Given that both programmes pursue the same objective of
improving postoperative patient outcomes, we considered conducting this
systematic review to analyse and document the presence of PBM
recommendations in ERAS guidelines published by the ERAS Society.
 Method(s): We analysed clinical guidelines for scheduled surgery in
adults published by the ERAS Society between 2018 and 2022. The guidelines
selected were searched for recommendations related to the 3 pillars of
PBM. Result(s): We selected 15 ERAS guidelines in programmed surgery
in adults. Until 2018, none of the ERAS guidelines analysed included any
recommendations related to pillars I and III of PBM. In 2019,
recommendations related to the 3 pillars of PBM were introduced in the
ERAS clinical guidelines for colorectal surgery, gynecological/oncology
surgery, and lung resection surgery. However, many ERAS guidelines for
surgeries with a high risk of bleeding, such as cardiac surgery, contain
no clear recommendations on the management of preoperative anaemia.
 Conclusion(s): This review shows that the ERAS guidelines published
to date make very few recommendations related to PBM. The authors want to
emphasize the need to include the most efficient PBM recommendations in
the ERAS clinical guidelines, given the improvement of outcomes with a
good perioperative management of blood transfusion. Copyright ©
2023

<104>
Accession Number
2026810191
Title
A compressive vascular ring: A case report and review of literature.
Source
Archives of Cardiovascular Diseases Supplements. Conference: FCPC 2023.
Marseille France. 15(4) (pp 296), 2023. Date of Publication: September
2023.
Author
Jarraya M.; Gargouri R.; Fendri H.; Makni A.; Charfeddine S.; Abid L.
Institution
(Jarraya, Gargouri, Makni) Service de cardiologie, hopital Hedi Chaker,
Sfax, Tunisia
(Fendri, Charfeddine, Abid) Service de radiologie, CHU Hedi Chaker, Sfax,
Tunisia
Publisher
Elsevier Masson s.r.l.
Abstract
Introduction: Double aortic arch (DAA) is one of the classes of congenital
anomalies of the aortic arch system called vascular ring. Abnormal
circular formation of blood vessels are incircled around the trachea and
oesophagus resulting in airway compression. Objective(s): We report a
case of a 2-month-old infant that was born at full term and had no medical
or surgical history who presented with progressive stridor and dyspnea
reported by the parents. Method(s): On examination, we noticed a
stridor, with suprasternal and intercostal recessions. Oxygen saturations
on room air was 93% and chest auscultation revealed bilateral transmitted
stridor. A chest X-ray was normal. Echocardiography was performed and
revealed a left-right shunting atrial septal defect with dilated right
chambers, in addition to a persistent ductus arteriosus with a doubt on
double aortic arch. Results/Expected results: Thoracic computed tomography
(CT) was performed and a vascular ring, consisting of a double aortic
arch, was found compressing and narrowing the trachea (Figure 1). The CT
allowed confirmation of the anomaly, its location and the severity of
airway and oesophageal compression. Three-dimensional reconstruction
helped to plan surgical intervention. The patient was then referred to the
cardiothoracic surgery. The intervention consisted of resecting the minor
arch freeing the trachea. Conclusion/Perspectives: DAA is a rare issue
mostly diagnosed in childhood due to symptoms related to oesophageal
and/or tracheal compression and obstruction. It can be associated to
cardiac malformations including ventricular septal defect and Fallot's
tetralogy. Left untreated, it may lead to significant morbidity and
mortality from airway obstruction. Surgical repair remains the mainstay of
treatment and is indicated for patients with symptoms of airway or
digestive compression or as a supplementary procedure in patients
undergoing other cardiac surgery. The principle of surgery is to relieve
the vascular compression on the trachea and/or esophagus by the division
of the lesser arch. Copyright © 2023

<105>
Accession Number
2027128497
Title
Expert systematic review on the choice of conduits for coronary artery
bypass grafting: endorsed by the European Association for Cardio-Thoracic
Surgery (EACTS) and The Society of Thoracic Surgeons (STS).
Source
European Journal of Cardio-thoracic Surgery. 64(2) (no pagination), 2023.
Article Number: ezad163. Date of Publication: 01 Aug 2023.
Author
Gaudino M.; Bakaeen F.G.; Sandner S.; Aldea G.S.; Arai H.; Chikwe J.;
Firestone S.; Fremes S.E.; Gomes W.J.; Bong-Kim K.; Kisson K.; Kurlansky
P.; Lawton J.; Navia D.; Puskas J.D.; Ruel M.; Sabik J.F.; Schwann T.A.;
Taggart D.P.; Tatoulis J.; Wyler Von Ballmoos M.
Institution
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York-Presbyterian Hospital, New York, NY, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Sandner) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Aldea) Division of Cardiothoracic Surgery, University of Washington
School of Medicine, Seattle, WA, United States
(Arai) Department of Cardiovascular Surgery, Graduate School of Medical
and Dental Science, Tokyo Medical and Dental University (TMDU), Tokyo,
Japan
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Firestone, Kisson, Kurlansky) The Society of Thoracic Surgeons, Chicago,
IL, United States
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Gomes) Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo
Hospital, Escola Paulista de Medicina, Universidade Federal de Sao Paulo
(Unifesp), SP, Sao Paulo, Brazil
(Bong-Kim) Cardiovascular Center, Myong-ji Hospital, Gyeonggi-do, South
Korea
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, Baltimore, MD, United States
(Navia) Department of Cardiac Surgery, ICBA Instituto Cardiovascular,
Buenos Aires, Argentina
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's,
New York, NY, United States
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
(Schwann) Division of Cardiac Surgery, Baystate Health, Springfield, MA,
United States
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Tatoulis) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
University of Melbourne, Melbourne, Australia
(Wyler Von Ballmoos) Division of Cardiothoracic Surgery, Houston Methodist
DeBakey Heart & Vascular Center, Houston, TX, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Preamble: The finalized document was endorsed by the EACTS Council and STS
Executive Committee before being simultaneously published in the European
Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic
Surgery (The Annals) and the Journal of Thoracic and Cardiovascular
Surgery (JTCVS). Copyright © 2023 This article has been
co-published with permission in the European Journal of Cardio-Thoracic
Surgery, The Annals of Thoracic Surgery, and the Journal of Thoracic and
Cardiovascular Surgery. All rights reserved.

<106>
Accession Number
2025690821
Title
Lung Ultrasound Reduces Chest X-rays in Postoperative Care after Thoracic
Surgery: Is There a Role for Artificial Intelligence?-Systematic Review.
Source
Diagnostics. 13(18) (no pagination), 2023. Article Number: 2995. Date of
Publication: September 2023.
Author
Malik M.; Dzian A.; Stevik M.; Veteskova S.; Al Hakim A.; Hliboky M.;
Magyar J.; Kolarik M.; Bundzel M.; Babic F.
Institution
(Malik, Dzian, Al Hakim) Department of Thoracic Surgery, Jessenius Faculty
of Medicine in Martin, Comenius University in Bratislava and University
Hospital in Martin, Kollarova 4248/2, Martin 036 59, Slovakia
(Stevik, Veteskova) Radiology Department, Jessenius Faculty of Medicine in
Martin, Comenius University in Bratislava and University Hospital in
Martin, Kollarova 4248/2, Martin 036 59, Slovakia
(Hliboky, Magyar, Kolarik, Bundzel, Babic) Department of Cybernetics and
Artificial Intelligence, Faculty of Electrical Engineering and
Informatics, Technical University of Kosice, Letna 9, Kosice 040 01,
Slovakia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Chest X-ray (CXR) remains the standard imaging modality in
postoperative care after non-cardiac thoracic surgery. Lung ultrasound
(LUS) showed promising results in CXR reduction. The aim of this review
was to identify areas where the evaluation of LUS videos by artificial
intelligence could improve the implementation of LUS in thoracic surgery.
 Method(s): A literature review of the replacement of the CXR by LUS
after thoracic surgery and the evaluation of LUS videos by artificial
intelligence after thoracic surgery was conducted in Medline.
 Result(s): Here, eight out of 10 reviewed studies evaluating LUS in
CXR reduction showed that LUS can reduce CXR without a negative impact on
patient outcome after thoracic surgery. No studies on the evaluation of
LUS signs by artificial intelligence after thoracic surgery were found.
 Conclusion(s): LUS can reduce CXR after thoracic surgery. We presume
that artificial intelligence could help increase the LUS accuracy,
objectify the LUS findings, shorten the learning curve, and decrease the
number of inconclusive results. To confirm this assumption, clinical
trials are necessary. This research is funded by the Slovak Research and
Development Agency, grant number APVV 20-0232. Copyright © 2023
by the authors.

<107>
Accession Number
2027203694
Title
Recurrent Cardiac Sarcoidosis and Giant Cell Myocarditis After Heart
Transplant: A Case Report and Systematic Literature Review.
Source
American Journal of Cardiology. 207 (pp 271-279), 2023. Date of
Publication: 15 Nov 2023.
Author
Stein A.P.; Stewart B.D.; Patel D.C.; Al-Ani M.; Vilaro J.; Aranda J.M.;
Ahmed M.M.; Parker A.M.
Institution
(Stein) Department of Medicine
(Stewart) Department of Pathology
(Patel) Division of Pulmonary, Critical Care and Sleep Medicine
(Al-Ani, Vilaro, Aranda, Ahmed, Parker) Division of Cardiology, Department
of Medicine, University of Florida Gainesville, Florida, United States
Publisher
Elsevier Inc.
Abstract
Recurrence of cardiac sarcoidosis (CS) and giant cell myocarditis (GCM)
after heart transplant is rare, with rates of 5% in CS and 8% in GCM. We
aim to identify all reported cases of recurrence in the literature and to
assess clinical course, treatments, and outcomes to improve understanding
of the conditions. A systematic review, utilizing Preferred Reporting
Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, was
conducted by searching MEDLINE/PubMed and Embase of all available
literature describing post-transplant recurrent granulomatous myocarditis,
CS, or GCM. Data on demographics, transplant, recurrence, management, and
outcomes data were collected from each publication. Comparison between the
2 groups were made using standard statistical approaches. Post-transplant
GM recurrence was identified in 39 patients in 33 total publications.
Reported cases included 24 GCM, 12 CS, and 3 suspected cases. Case reports
were the most frequent form of publication. Mean age of patients
experiencing recurrence was 42 years for GCM and 48 years for CS and
favored males (62%). Time to recurrence ranged from 2 weeks to 9 years
post-transplant, occurring earlier in GCM (mean 1.8 vs 3.0 years).
Endomyocardial biopsies (89%) were the most utilized diagnostic method
over cardiac magnetic resonance and positron emission tomography.
Recurrence treatment regimens involved only steroids in 40% of CS, whereas
other immunomodulatory regimens were utilized in 70% of GCM. In
conclusion, GCM and CS recurrence after cardiac transplantation holds
associated risks including concurrent acute cellular rejection, a higher
therapeutic demand for GCM recurrence compared with CS, and mortality. New
noninvasive screening techniques may help modify post-transplant
monitoring regimens to increase both early detection and treatment of
recurrence. Copyright © 2023

<108>
Accession Number
2027291293
Title
Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in
Diabetics: The BEST Extended Follow-Up Study.
Source
JACC: Cardiovascular Interventions. 16(19) (pp 2412-2422), 2023. Date of
Publication: 09 Oct 2023.
Author
Kim H.; Kang D.-Y.; Ahn J.-M.; Lee J.; Choi Y.; Hur S.H.; Park H.-J.;
Tresukosol D.; Kang W.C.; Kwon H.M.; Rha S.-W.; Lim D.-S.; Jeong M.-H.;
Lee B.-K.; Huang H.; Lim Y.-H.; Bae J.H.; Kim B.O.; Ong T.K.; Ahn S.G.;
Chung C.-H.; Park D.-W.; Park S.-J.
Institution
(Kim, Kang, Ahn, Lee, Choi, Chung, Park, Park) Heart Institute, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Park) Catholic University of Korea, Seoul St. Mary's Hospital, Seoul,
South Korea
(Tresukosol) Siriraj Hospital, Bangkok, Thailand
(Kang) Gachon University Gil Hospital, Incheon, South Korea
(Kwon) Gangnam Severance Hospital, Seoul, South Korea
(Rha) Korea University Guro, Seoul, South Korea
(Lim) Anam Hospital, Seoul, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Lee) Kangwon National University Hospital, Chuncheon, South Korea
(Huang) Sir Run Run Shaw Hospital, Zhejiang, Hangzhou, China
(Lim) Hanyang University Hospital, Seoul, South Korea
(Bae) Konyang University Hospital, Daejeon, South Korea
(Kim) Inje University Sanggye Paik Hospital, Seoul, South Korea
(Ong) Sarawak General Hospital, Sarawak, Kuching, Malaysia
(Ahn) Yonsei University Wonju Severance Christian Hospital, Wonju, South
Korea
Publisher
Elsevier Inc.
Abstract
Background: Diabetes mellitus is associated with more complex coronary
artery diseases. Coronary artery bypass grafting (CABG) is a preferred
revascularization strategy over percutaneous coronary intervention (PCI)
in diabetics with multivessel coronary artery disease (MVD).
 Objective(s): This study sought to examine the different prognostic
effects of revascularization strategies according to the diabetes status
from the randomized BEST (Randomized Comparison of Coronary Artery Bypass
Surgery and Everolimus-Eluting Stent Implantation in the Treatment of
Patients With Multivessel Coronary Artery Disease) trial. Method(s):
Patients (n = 880) with MVD were randomly assigned to undergo PCI with an
everolimus-eluting stent vs CABG stratified by diabetics (n = 363) and
nondiabetics (n = 517). The primary endpoint was the composite of death,
myocardial infarction, or target vessel revascularization during a median
follow-up of 11.8 years (IQR: 10.6-12.5 years). Result(s): In
diabetics, the primary endpoint rate was significantly higher in the PCI
group than in the CABG group (43% and 32%; HR: 1.53; 95% CI: 1.12-2.08; P
= 0.008). However, in nondiabetics, no significant difference was found
between the groups (PCI group, 29%; CABG group, 29%; HR: 0.97; 95% CI:
0.67-1.39; P = 0.86; P<inf>interaction</inf> = 0.009). Irrespective of the
presence of diabetes, no significant between-group differences were found
in the rate of a safety composite of death, myocardial infarction, or
stroke and mortality rate. However, the rate of any repeat
revascularization was significantly higher in the PCI group than in the
CABG group. Conclusion(s): In diabetics with MVD, CABG was associated
with better clinical outcomes than PCI. However, the mortality rate was
similar between PCI and CABG irrespective of diabetes status during an
extended follow-up. (Ten-Year Outcomes of Randomized Comparison of
Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation
in the Treatment of Patients With Multivessel Coronary Artery Disease
[BEST Extended], NCT05125367; Randomized Comparison of Coronary Artery
Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment
of Patients With Multivessel Coronary Artery Disease [BEST],
NCT00997828) Copyright © 2023 American College of Cardiology
Foundation

<109>
Accession Number
2025707773
Title
Transcatheter aortic valve replacement among heart transplant recipients
with donor aortic valve diseases: a systematic review of the literature.
Source
American Journal of Cardiovascular Disease. 13(4) (pp 235-246), 2023.
Article Number: AJCD0150829. Date of Publication: 2023.
Author
Shoar S.; Chaudhary A.; Bansro V.; Sadegh Asadi M.
Institution
(Shoar) Department of Clinical Research, Scientific Collaborative
Initiative, Largo, MD, United States
(Shoar) Department of Clinical Research, Scientific Collaborative
Initiative, Houston, TX, United States
(Chaudhary) Department of Internal Medicine, Griffin Hospital, Derby, CT,
United States
(Bansro) Department of Internal Medicine, University of Maryland Capital
Region Health, Largo, MD, United States
(Sadegh Asadi) Division of Heart Failure, Department of Medicine,
University of Maryland School of Medicine, Baltimore, MD, United States
Publisher
E-Century Publishing Corporation
Abstract
Background: Despite high surgical risk among heart transplant (HTx)
recipients, who develop aortic valve diseases (AVD), transcutaneous aortic
valve replacement (TAVR) has been scarcely reported as a viable option in
this patient population. Method(s): A systematic review was conducted
to identify studies reporting the outcomes of HTx recipients who developed
AVD of the donor heart and underwent TAVR. Studies were eligible if they
provided individual-level data for HTx recipients, who underwent TAVR on
the donor heart. Review articles, editorials or com-mentaries, studies
lacking original data, or those reporting surgical valve replacement for
AVD in HTx recipients were excluded. Result(s): A total of 15 case
reports, encompassing 15 patients, describing characteristics and outcomes
of HTx recipients undergoing TAVR were included. These included 13 males
and 2 females with an average age of 63.6+/-15 years. The indications for
HTx were non-ischemic dilated cardiomyopathy, ischemic cardiomyopathy and
ischemic dilated cardiomyopathy in 42.9%, 35.7%, and 21.4% of the
patients, respectively. The main indication for aortic valve replacement
(AVR) among HTx recipients was aortic stenosis (73.3%). The transcutaneous
approach was preferred over surgical AVR due to high surgical risk in >
50% of the patients. Both pre-TAVR transvalvular pressure gradient and the
peak aortic pressure gradient decreased after the TAVR. Paravalvular leak
was minimal/ none to mild in all the patients post-TAVR. Most patients had
an uneventful post-TAVR recovery with no recurrence of the symptoms or
echocardiographic finings at a median follow-up of 6 months.
 Conclusion(s): TAVR seems to be a viable option for HTx recipients
who develop donor aortic valve diseases. However, there is a paucity of
knowledge on the long-term survivability of the replaced aortic valves and
the clinical and echocardiographic outcomes of HTx recipients undergoing
TAVR. Copyright © 2023, E-Century Publishing Corporation. All
rights reserved.

<110>
Accession Number
2027119359
Title
PROSPECTIVE STUDY TO COMPARE EFFECTIVENESS OF UFH AND LMWH IN PATIENTS
RECEIVING IABP UNDERGOING ELECTIVE CABG SURGERY.
Source
Journal of Cardiovascular Disease Research. 13(8) (pp 2088-2094), 2022.
Date of Publication: 2022.
Author
Minda S.; Mohire V.; Khatnani L.; Rai N.; Sulya D.; Jain A.
Institution
(Minda, Khatnani, Rai, Sulya, Jain) Department of Cardiothoracic and
Vascular Surgery, NSCB Medical College, Jabalpur, India
(Mohire) Department of Anesthesia, NSCB Medical College, Jabalpur, India
Publisher
EManuscript Technologies
Abstract
Objective- Our study aimed to compare effectiveness and safety of low
molecular weight heparin (LMWH) and unfractionated heparin (UFH) in
patients undergoing elective coronary artery bypass grafting with
prophylactically inserted intra-aortic balloon counterpulsation(IABP).
Material and methods - We included patients scheduled for CABG with
ejection fraction less than 40% and prophylactically inserted IABP.
Patients were randomized with computer generated sequence to receive LMWH
or UFH . 30 patients received UFH (a bolus of injection 70 u/kg
immediately after IABP, followed by infusion at a rate of 15 u/Kg/hr) and
targeted APT T of 50-70 seconds. Another set of 30 patients received
LMWH(subcutaneous injection of 1 mg/kg every 12 hrs). Total of 60 patients
were included in study .Major end-points included were thrombotic events
and bleeding events. Thrombotic events included arterial thromboembolism
and leg-ischemia. Bleeding events included major access and nonaccess site
bleeding. Major bleeding was defined by as a hemoglobin decrease by
>50mg/l or bleeding that caused hemodynamic shock or life threatening or
requiring blood transfusion. Results- Subjects receiving UFH and LMWH were
similar in baseline characteristics. Arterial thromboemolism occured in
(2/30) patients in UFH group and (1/30) patients in LMWH. Major bleeding
occured in 3 and 2 patients in UFH and LMWH groups respectively. Linear
Regression analysis indicated no association between ischemia or bleeding
with heparin type. Conclusion- LMWH can reduce complications like ischemia
and bleeding, but for statistical significancea larger sample size is
needed. Copyright © 2022 EManuscript Technologies. All rights
reserved.

<111>
Accession Number
2027200631
Title
Impact of Neoadjuvant Immune Checkpoint Inhibitors on Surgery and
Perioperative Complications in Patients With Non-small-cell Lung Cancer: A
Systematic Review.
Source
Clinical Lung Cancer. (no pagination), 2023. Date of Publication: 2023.
Author
Takada K.; Takamori S.; Brunetti L.; Crucitti P.; Cortellini A.
Institution
(Takada) Department of Surgery, Saiseikai Fukuoka General Hospital,
Fukuoka, Japan
(Takamori) Department of Surgery and Science, Graduate School of Medical
Sciences, Kyushu University, Fukuoka, Japan
(Brunetti, Cortellini) Medical Oncology Department, Fondazione Policlinico
Universitario Campus Bio-Medico, Rome, Italy
(Crucitti, Cortellini) Department of Surgery and Cancer, Hammersmith
Hospital Campus, Imperial College London, London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Several clinical trials are currently underway to evaluate immune
checkpoint inhibitors (ICIs) as neoadjuvant treatment for patients with
early-stage non-small-cell lung cancer (NSCLC), and their use in clinical
practice is expected to increase in the future. Therefore, a proper
assessment of surgical outcomes and perioperative complications after
neoadjuvant ICIs is essential to establish recommendations and guidelines.
We performed a systematic literature review in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
guidelines (PRISMA), searching the PubMed and Scopus databases from the
January 1, 2017, to the July 27, 2023, to identify potentially relevant
published trials of neoadjuvant ICIs in patients with reseactable NSCLC
with available information on surgical outcomes and perioperative
complications. A total of 18 studies were included in the review. The
rates of surgery cancellation ranged from 0% to 45.8%. Importantly,
adverse events (AEs) were the least reported underlying cause, while
disease progression caused from 0% to 75% of cancellations. Surgery delays
ranged from 0% to 31.3% with AEs as the most frequently reported
underlying cause. However, 6 out of 13 trials (46.2%) reported no surgery
delays. Conversion rates from minimally invasive to open chest surgery
were available for 7 trials and ranged from 0% to 53.8%. Thirty-day
mortality rates ranged from 0% to 5.4%, with 11 out of 16 trials reporting
0%. A few reports described perioperative complications in detail.
Considering the limited evidence available, we can preliminarily confirm
that preoperative ICIs are safe and well tolerated even from the surgical
perspective. Additional details on intraoperative findings from
prospective controlled trials are needed to establish and disseminate
guidelines and recommendations for thoracic surgeons. Copyright ©
2023 The Authors

<112>
Accession Number
2027200422
Title
Long-term sex-based outcomes after surgery for acute type A aortic
dissection: Meta-analysis of reconstructed time-to-event data.
Source
American Journal of Surgery. (no pagination), 2023. Date of Publication:
2023.
Author
Sa M.P.; Tasoudis P.; Jacquemyn X.; Ahmad D.; Diaz-Castrillon C.E.; Brown
J.A.; Yousef S.; Zhang D.; Dufendach K.; Serna-Gallegos D.; Sultan I.
Institution
(Sa, Ahmad, Diaz-Castrillon, Brown, Yousef, Zhang, Dufendach,
Serna-Gallegos, Sultan) Department of Cardiothoracic Surgery, University
of Pittsburgh, Pittsburgh, PA, United States
(Sa, Ahmad, Diaz-Castrillon, Brown, Yousef, Zhang, Dufendach,
Serna-Gallegos, Sultan) UPMC Heart and Vascular Institute, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Tasoudis) Department of Surgery, Division of Cardiothoracic Surgery,
University of North Carolina, Chapel Hill, NC, United States
(Jacquemyn) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
Publisher
Elsevier Inc.
Abstract
Background: The influence of sex on outcomes of surgery for acute type A
aortic dissection remains incompletely characterized. We sought to
evaluate post-procedural survival in the follow-up of females versus
males. Method(s): We carried out a systematic review with
meta-analysis of Kaplan-Meier-derived time-to-event data from studies
published by June 2023 in the following databases: PubMed/MEDLINE, EMBASE,
Web of Science and CENTRAL/CCTR (Cochrane Controlled Trials Register).
 Result(s): Twelve studies met our eligibility criteria, including
11,696 patients (3753 females; 7943 males). The mean age ranged from 41.2
to 72.6 years with low prevalence of bicuspid aortic valve (ranging from
0.0% to 12.0%) and connective tissue disorders (ranging from 0.8% to
7.3%). We found a considerable prevalence of coronary artery disease
(ranging from 12.1% to 21.1%) and malperfusion (ranging from 20.0% to
46.3%). At 10 years, females undergoing surgery had a significantly higher
risk of all-cause mortality compared with males (HR 1.25, 95%CI 1.14-1.38,
P < 0.001). Conclusion(s): In the follow-up of patients undergoing
surgery for type A aortic dissection, females presented poorer overall
survival in comparison with males. Copyright © 2023 Elsevier Inc.

<113>
Accession Number
2026671641
Title
A systematic review of contrast-enhanced computed tomography calcium
scoring methodologies and impact of aortic valve calcium burden on TAVI
clinical outcomes.
Source
Journal of Cardiovascular Computed Tomography. (no pagination), 2023.
Date of Publication: 2023.
Author
Flores-Umanzor E.; Keshvara R.; Reza S.; Asghar A.; Rashidul Anwar M.;
Cepas-Guillen P.L.; Osten M.; Halankar J.; Abrahamyan L.; Horlick E.
Institution
(Flores-Umanzor, Keshvara, Osten, Horlick) Toronto Congenital Cardiac
Centre for Adults, Peter Munk Cardiac Centre, University Health Network,
Toronto, ON, Canada
(Reza, Asghar, Rashidul Anwar, Abrahamyan) Toronto General Hospital
Research Institute, University Health Network (UHN), Toronto, ON, Canada
(Reza, Asghar, Rashidul Anwar, Abrahamyan) Institute for Health Policy,
Management, and Evaluation, University of Toronto, ON, Canada
(Cepas-Guillen) Cardiology Department, Cardiovascular Institute, Hospital
Clinic, University of Barcelona, Spain
(Halankar) Joint Department of Medical Imaging, Toronto General Hospital,
Peter Munk Cardiac Centre, University Health Network, University of
Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Different methodologies have been used to assess the role of AV
calcification (AVC) on TAVI outcomes. This systematic review aims to
describe the burden of AVC, synthesize the different methods of calcium
score quantification, and evaluate the impact of AVC on outcomes after
TAVI. We included studies of TAVI patients who had reported AV calcium
scoring by contrast-enhanced multidetector CT and the Agatston method. The
impact of calcification on TAVI outcomes without restrictions on follow-up
time or outcome type was evaluated. Results were reported descriptively,
and a meta-analysis was conducted when feasible. Sixty-eight articles were
included, with sample sizes ranging from 23 to 1425 patients.
Contrast-enhanced calcium scoring was reported in 30 studies, calcium
volume score in 28 studies, and unique scoring methods in two. All studies
with calcium volume scores had variable protocols, but most utilized a
modified Agatston method with variable attenuation threshold values of
300-850 HU. Eight studies used the Agatston method, with the overall mean
AV calcium score in studies published from 2010 to 2012 of 3342.9 AU
[95%CI: 3150.4; 3535.4, I2 = 0%]. The overall mean score was lower and
heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI:
2517.3; 2800.5, I2 = 79%]. Most studies reported a positive association
between calcium burden and increased risk of adverse outcomes, including
implantation of permanent pacemaker (7/8 studies), paravalvular leak
(13/13 studies), and risk of aortic rupture (2/2 studies). AVC
quantification methodology with contrast-enhanced CT is still variable.
AVC negatively impacts TAVI outcomes independently of the quantification
method. Copyright © 2023

<114>
Accession Number
2027146671
Title
Prognostic value of positron emission tomography derived myocardial flow
reserve: A systematic review and meta-analysis.
Source
Atherosclerosis. 382 (no pagination), 2023. Article Number: 117280. Date
of Publication: October 2023.
Author
Ahmed A.I.; Saad J.M.; Alahdab F.; Han Y.; Nayfeh M.; Alfawara M.S.;
Al-Rifai M.; Al-mallah M.
Institution
(Ahmed, Saad, Alahdab, Han, Nayfeh, Alfawara, Al-Rifai, Al-mallah) Houston
Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
(Ahmed) Yale School of Medicine, New Haven, CT, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: Positron Emission Tomography (PET)-derived myocardial
flow reserve (MFR) has been shown to have a role in the diagnosis and
prognosis of patients with coronary artery disease (CAD). We performed a
systematic review and meta-analysis to summarize the body of literature
and synthesize the evidence on the prognostic role of PET-derived MFR in
patients with known or suspected CAD. Method(s): A comprehensive
literature search of the Medline database from its inception to August
2023, in humans, in any language, was conducted for clinical studies
examining the prognostic value of PET imaging in patients of any age, sex,
and CAD status. Systematic screening and data extraction of the identified
studies were followed by quantitative meta-analysis of PET-MFR's role in
predicting adverse clinical events using random effect model. Studies were
appraised using the modified Newcastle-Ottawa tool. Result(s): A
total of 21 studies assessing the prognostic role of PET derived MFR in
46,815 patients with known and/or suspected CAD were included (mean (SD)
age 66 (4) years, 48% women). The mean follow-up duration was 36 months
(range 10-96). Cardiovascular risk factors were prevalent (73%
hypertension, 35% diabetes and 67% dyslipidemia). The definition of the
composite outcome varied between studies, with various combinations of
mortality, non-fatal myocardial infarction, hospitalization, and coronary
revascularization. Pooled impaired MFR was significantly associated with
an increased risk of adverse outcomes (RR = 2.94, 95% CI 2.42-3.56, p <
0.001). Results were similar in a subgroup of patients with suspected CAD.
 Conclusion(s): The available body of evidence shows that impaired
PET-derived MFR measured using different tracers and PET systems is
strongly associated with an increased risk of adverse cardiovascular
events. Limitations of this review include observational nature of
studies, marked heterogeneity in patient populations, inconsistency in
thresholds to define abnormal MFR, and differing components for the
composite outcome. Copyright © 2023 Elsevier B.V.

<115>
Accession Number
2026347215
Title
Efficacy and safety of selenium or vitamin E administration alone or in
combination in ICU patients: A systematic review and meta-analysis.
Source
Clinical Nutrition ESPEN. 57 (pp 550-560), 2023. Date of Publication:
October 2023.
Author
Lu X.; Wang Z.; Chen L.; Wei X.; Ma Y.; Tu Y.
Institution
(Lu, Wang, Ma, Tu) Department of Pharmacy, Shanghai East Hospital, School
of Medicine, Tongji University, Shanghai 200092, China
(Lu, Wang, Chen) Department of Critical Care Medicine, School of
Anesthesiology, Naval Medical University, Shanghai 200433, China
(Wei) Department of Clinical Pharmacy, Xinhua Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Publisher
Elsevier Ltd
Abstract
Background: Micronutrient administration that contributes to antioxidant
defense has been extensively studied in critically ill patients, but
consensus remains elusive. Selenium and vitamin E are two important
micronutrients that have synergistic antioxidant effects. This
meta-analysis aimed to assess the effect of selenium or vitamin E
administration alone and the combination of both on clinical outcomes in
patients hospitalized in the ICU. Method(s): After electronic
searches on PubMed, Embase, Cochrane Library, Web of Science, China
National Knowledge Infrastructure (CNKI), SinoMed, VIP database and
Wanfang data, initially 1767 papers were found, and 30 interventional
studies were included in this analysis. We assessed the risk-difference
between treatment and control (standard treatment) groups by pooling
available data on length of stay (ICU length of stay and hospital length
of stay), mortality (ICU mortality, hospital mortality, 28-day mortality,
6-month mortality and all-cause mortality), duration of mechanical
ventilation, adverse events and new infections. Result(s): By
analyzing the included studies, we found no significant effect of selenium
administration alone on mortality, mechanical ventilation duration, or
adverse events in ICU patients. However, after excluding studies with high
heterogeneity, the meta-analysis showed that selenium alone reduced the
length of hospital stay (MD: -1.38; 95% CI: -2.52, -0.23; I-square: 0%).
Vitamin E administration alone had no significant effect on mortality,
duration of mechanical ventilation, or adverse events in ICU patients.
However, after excluding studies with high heterogeneity, the
meta-analysis showed that vitamin E alone could reduce the length of ICU
stay (MD: -1.27; 95% CI: -1.86, -0.67; I-square: 16%). Combined
administration of selenium and vitamin E had no significant effect on
primary outcomes in ICU patients. Conclusion(s): Selenium
administration alone may shorten the length of hospital stay, while
vitamin E alone may reduce the length of ICU stay. The putative
synergistic beneficial effect of combined administration of selenium and
vitamin E in ICU patients has not been observed, but more clinical studies
are pending to confirm it further. Copyright © 2023 European
Society for Clinical Nutrition and Metabolism

<116>
Accession Number
2011486117
Title
European Resuscitation Council Guidelines 2021: Executive summary.
Source
Resuscitation. 161 (pp 1-60), 2021. Date of Publication: April 2021.
Author
Perkins G.D.; Graesner J.-T.; Semeraro F.; Olasveengen T.; Soar J.; Lott
C.; Van de Voorde P.; Madar J.; Zideman D.; Mentzelopoulos S.; Bossaert
L.; Greif R.; Monsieurs K.; Svavarsdottir H.; Nolan J.P.
Institution
(Perkins, Nolan) Warwick Clinical Trials Unit, Warwick Medical School,
University of Warwick, Coventry CV4 7AL, United Kingdom
(Perkins) University Hospitals Birmingham, Birmingham B9 5SS, United
Kingdom
(Graesner) University Hospital Schleswig-Holstein, Institute for Emergency
Medicine, Kiel, Germany
(Semeraro) Department of Anaesthesia, Intensive Care and Emergency Medical
Services, Maggiore Hospital, Bologna, Italy
(Olasveengen) Department of Anesthesiology, Oslo University Hospital and
Institute of Clinical Medicine, University of Oslo, Norway
(Soar) Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB,
United Kingdom
(Lott) Department of Anesthesiology, University Medical Center, Johannes
Gutenberg-University Mainz, Germany
(Van de Voorde) Department of Emergency Medicine, Faculty of Medicine
Ghent University, Ghent, Belgium
(Van de Voorde) EMS Dispatch Center, East-West Flanders, Federal
Department of Health, Belgium
(Madar) Department of Neonatology, University Hospitals Plymouth,
Plymouth, United Kingdom
(Zideman) Thames Valley Air Ambulance, Stokenchurch, United Kingdom
(Mentzelopoulos) National and Kapodistrian University of Athens Medical
School, Athens, Greece
(Bossaert) University of Antwerp, Antwerp, Belgium
(Greif) Department of Anaesthesiology and Pain Medicine, Bern University
Hospital, University of Bern, Bern, Switzerland
(Greif) School of Medicine, Sigmund Freud University Vienna, Vienna,
Austria
(Monsieurs) Department of Emergency Medicine, Antwerp University Hospital
and University of Antwerp, Belgium
(Svavarsdottir) Akureyri Hospital, Akureyri, Iceland
(Svavarsdottir) University of Akureyri, Akureyri, Iceland
(Nolan) Royal United Hospital, Bath BA1 3NG, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Informed by a series of systematic reviews, scoping reviews and evidence
updates from the International Liaison Committee on Resuscitation, the
2021 European Resuscitation Council Guidelines present the most up to date
evidence-based guidelines for the practice of resuscitation across Europe.
The guidelines cover the epidemiology of cardiac arrest; the role that
systems play in saving lives, adult basic life support, adult advanced
life support, resuscitation in special circumstances, post resuscitation
care, first aid, neonatal life support, paediatric life support, ethics
and education. Copyright © 2021

<117>
Accession Number
2027186601
Title
Effectiveness of aortic valve replacement in Heyde syndrome: a
meta-analysis.
Source
European Heart Journal. 44(33) (pp 3168-3177), 2023. Date of Publication:
01 Sep 2023.
Author
Goltstein L.C.M.J.; Rooijakkers M.J.P.; Hoeks M.; Li W.W.L.; Van Wely
M.H.; Rodwell L.; Van Royen N.; Drenth J.P.H.; Van Geenen E.-J.M.
Institution
(Goltstein, Drenth, Van Geenen) Department of Gastroenterology and
Hepatology, Radboud University Medical Center, Geert Grooteplein Zuid 10,
P.O. Box 9101, Nijmegen 6500 HB, Netherlands
(Rooijakkers, Van Wely, Van Royen) Department of Cardiology, Radboud
University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101,
Nijmegen 6500 HB, Netherlands
(Hoeks) Department of Haematology, Radboud University Medical Center,
Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen 6500 HB, Netherlands
(Li) Department of Cardiothoracic Surgery, Radboud University Medical
Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen 6500 HB,
Netherlands
(Rodwell) Department of Health Evidence, Radboud Institute for Health
Sciences, Radboud University Medical Center, Section Biostatistics, Geert
Grooteplein Zuid 10, P.O. Box 9101, Nijmegen 6500 HB, Netherlands
Publisher
Oxford University Press
Abstract
Aims: Heyde syndrome is the co-occurrence of aortic stenosis, acquired von
Willebrand syndrome, and gastrointestinal bleeding. Aortic valve
replacement has been demonstrated to resolve all three associated
disorders. A systematic review and meta-analysis were performed to obtain
best estimates of the effect of aortic valve replacement on acquired von
Willebrand syndrome and gastrointestinal bleeding. Methods and
Results: A literature search was performed to identify articles on Heyde
syndrome and aortic valve replacement up to 25 October 2022. Primary
outcomes were the proportion of patients with recovery of acquired von
Willebrand syndrome within 24 h (T1), 24-72 h (T2), 3-21 days (T3), and 4
weeks to 2 years (T4) after aortic valve replacement and the proportion of
patients with cessation of gastrointestinal bleeding. Pooled proportions
and risk ratios were calculated using random-effects models. Thirty-three
studies (32 observational studies and one randomized controlled trial) on
acquired von Willebrand syndrome (n = 1054), and 11 observational studies
on gastrointestinal bleeding (n = 300) were identified. One study reported
on both associated disorders (n = 6). The pooled proportion of Heyde
patients with acquired von Willebrand syndrome recovery was 86% (95% CI,
79%-91%) at T1, 90% (74%-96%) at T2, 92% (84%-96%) at T3, and 87%
(67%-96%) at T4. The pooled proportion of Heyde patients with
gastrointestinal bleeding cessation was 73% (62%-81%). Residual aortic
valve disease was associated with lower recovery rates of acquired von
Willebrand syndrome (RR 0.20; 0.05-0.72; P = 0.014) and gastrointestinal
bleeding (RR 0.57; 0.40-0.81; P = 0.002). Conclusion(s): Aortic valve
replacement is associated with rapid recovery of the bleeding diathesis in
Heyde syndrome and gastrointestinal bleeding cessation. Residual valve
disease compromises clinical benefits. Copyright © 2023 The
Author(s). Published by Oxford University Press on behalf of the European
Society of Cardiology.

<118>
Accession Number
2026985268
Title
Rationale and design of the ULYSS trial: A randomized multicenter
evaluation of the efficacy of early Impella CP implantation in acute
coronary syndrome complicated by cardiogenic shock.
Source
American Heart Journal. 265 (pp 203-212), 2023. Date of Publication:
November 2023.
Author
Delmas C.; Laine M.; Schurtz G.; Roubille F.; Coste P.; Leurent G.;
Hraiech S.; Pankert M.; Gonzalo Q.; Dabry T.; Letocart V.; Loubiere S.;
Resseguier N.; Bonello L.
Institution
(Delmas) Department of Cardiology, Intensive Cardiac Care Unit, Rangueil
University Hospital, Toulouse, France
(Delmas) INSERM U1048, I2MC, Toulouse, France
(Delmas) REICATRA, Institut Saint Jacques, Toulouse, France
(Laine, Bonello) Aix-Marseille Universite, F-13385 Marseille, France;
Intensive Care Unit, Department of Cardiology, Assistance
Publique-Hopitaux de Marseille, Hopital Nord, F-13385 Marseille, France;
Mediterranean Association for Research and Studies in Cardiology (MARS
Cardio), Marseille, France
(Schurtz) Department of Cardiology, Intensive Cardiac Care Unit, Lille
University Hospital, Lille, France
(Roubille) PhyMedExp, Universite de Montpellier, INSERM, CNRS, Cardiology
Department, CHU de Montpellier, France
(Coste) Cardiology Department, Bordeaux University Hospital, Pessac,
France
(Leurent) Intensive Cardiac Care Unit, Cardiology Department, Rennes
University Hospital, Rennes, France
(Hraiech) Medical Intensive Care Unit, Assistance Publique-Hopitaux de
Marseille, Hopital Nord, Marseille, France
(Pankert) Cardiology Department, CH Avignon, France
(Gonzalo) Cardiology Department, CH Toulon, France
(Dabry) Cardiology Department, CH Aix en Provence, France
(Letocart) Department of Cardiology, Nantes Universite, CHU Nantes,
l'institut du thorax, Nantes, France
(Loubiere, Resseguier) Department of Epidemiology and Health Economics,
APHM, Marseille, France
(Loubiere, Resseguier) CEReSS-Health Service Research and Quality of Life
Center, School of Medicine Aix-Marseille University Marseille France,
France
Publisher
Elsevier Inc.
Abstract
Context: Despite 20 years of improvement in acute coronary syndromes care,
patients with acute myocardial infarction complicated by cardiogenic shock
(AMICS) remains a major clinical challenge with a stable incidence and
mortality. While intra-aortic balloon pump (IABP) did not meet its
expectations, percutaneous mechanical circulatory supports (pMCS) with
higher hemodynamic support, large availability and quick implementation
may improve AMICS prognosis by enabling early hemodynamic stabilization
and unloading. Both interventional and observational studies suggested a
clinical benefit in selected patients of the IMPELLA CP device within in a
well-defined therapeutic strategy. While promising, these preliminary
results are challenged by others suggesting a higher rate of complications
and possible poorer outcome. Given these conflicting data and its high
cost, a randomized clinical trial is warranted to delineate the benefits
and risks of this new therapeutic strategy. Design(s): The ULYSS
trial is a prospective randomized open label, 2 parallel multicenter
clinical trial that plans to enroll patients with AMICS for whom an
emergent percutaneous coronary intervention (PCI) is intended. Patients
will be randomized to an experimental therapeutic strategy with pre-PCI
implantation of an IMPELLA CP device on top of standard medical therapy or
to a control group undergoing PCI and standard medical therapy. The
primary objective of this study is to compare the efficacy of this
experimental strategy by a composite end point of death, need to escalate
to ECMO, long-term left ventricular assist device or heart transplantation
at 1 month. Among secondary objectives 1-year efficacy, safety and cost
effectiveness will be assessed. Clinical Trial Registration:
NCT05366452 Copyright © 2023 Elsevier Inc.

<119>
Accession Number
2026614862
Title
Tafamidis treatment in patients with transthyretin amyloid cardiomyopathy:
a systematic review and meta-analysis.
Source
eClinicalMedicine. 63 (no pagination), 2023. Article Number: 102172. Date
of Publication: September 2023.
Author
Wang J.; Chen H.; Tang Z.; Zhang J.; Xu Y.; Wan K.; Hussain K.; Gkoutos
G.V.; Han Y.; Chen Y.
Institution
(Wang, Xu, Chen) Department of Cardiology, West China Hospital, Sichuan
University, Sichuan, Chengdu, China
(Wang, Gkoutos) College of Medical and Dental Sciences, Institute of
Cancer and Genomic Sciences, University of Birmingham, Birmingham, United
Kingdom
(Chen, Tang) West China School of Public Health, Sichuan University,
Sichuan, Chengdu, China
(Zhang) Division of Informatics, Imaging, and Data Sciences, Faculty of
Biology, Medicine and Health, University of Manchester, Manchester, United
Kingdom
(Wan) Department of Geriatrics, West China Hospital, Sichuan University,
Sichuan, Chengdu, China
(Hussain) Department of Cardiology, NorthShore University Health Systems,
Evanston, IL, United States
(Gkoutos) Institute of Translational Medicine, University Hospitals
Birmingham NHS Foundation Trust, Birmingham, United Kingdom
(Gkoutos) Health Data Research UK (HDR), Midlands Site, United Kingdom
(Gkoutos) Centre for Health Data Science, University of Birmingham,
Birmingham, United Kingdom
(Han) Cardiovascular Division, Wexner Medical Centre, The Ohio State
University, United States
(Chen) Centre of Rare Diseases, West China Hospital, Sichuan University,
Sichuan, Chengdu, China
Publisher
Elsevier Ltd
Abstract
Background: Previous studies have reported that tafamidis treatment was
associated with better outcomes in patients with transthyretin amyloid
cardiomyopathy (ATTR-CM) compared with those without tafamidis treatment.
Therefore, we aimed to systematically assess the association of tafamidis
treatment with outcomes in patients with ATTR-CM. Method(s): The
protocol for this systematic review and meta-analysis was registered in
the PROSPERO (CRD42022381985). Pubmed, Ovid Embase, Scopus, Cochrane
Library, and Web of Science were interrogated to identify studies that
evaluated the impact of tafamidis on prognosis in ATTR-CM, from January 1,
2000 to June 1, 2023. A random-effects model was used to determine the
pooled risk ratio (RR) for the adverse endpoints. In addition, the main
outcomes included all-cause death or heart transplantation, the composite
endpoints included all-cause death, heart transplantation, cardiac-assist
device implantation, heart failure exacerbations, and hospitalization.
 Finding(s): Fifteen studies comprising 2765 patients (mean age 75.9
+/- 9.3 years; 83.7% male) with a mean follow-up duration of 18.7 +/- 17.1
months were included in the meta-analysis. There was a decrease in left
ventricular ejection fraction (LVEF) (standard mean differences (SMD:
-0.17; 95% confidence interval (CI), -0.31 to -0.03; P = 0.02) but were no
significant differences in intraventricular septum (IVS) thickness or
global longitudinal strain (GLS) after tafamidis treatment. However,
subgroup analysis showed no significant deterioration in LVEF in the
patients with wild-type ATTR after tafamidis treatment (SMD: -0.11; 95%
CI, -0.34 to 0.12, P = 0.34). In addition, the group with tafamidis
treatment had a decreased risk for all-cause death or heart
transplantation compared to patients without treatment (the pooled RR,
0.44; 95% CI, 0.31-0.65; P < 0.01). Subgroup analysis showed that there
was no significant difference of tafamidis on the outcomes in patients
with wild-type or hereditary ATTR (RR, 0.44; 95% CI, 0.27-0.73 versus
0.21, 95% CI, 0.11-0.40, P = 0.08). Furthermore, tafamidis treatment was
associated with a lower risk of the composite endpoint (RR, 0.57; 95% CI,
0.42-0.77; P < 0.01). Interpretation(s): Our findings suggested that
there was no significant deterioration in LVEF in the patients with
wild-type ATTR after tafamidis treatment. In addition, tafamidis treatment
was associated with a low risk of all-cause death and adverse
cardiovascular events. Funding(s): This work was supported by grants
from theNatural Science Foundation of Sichuan Province [Grant
Number:23NSFSC4589] and theNational Natural Science Foundation of China
[Grant Number:82202248]. Copyright © 2023 The Author(s)

<120>
Accession Number
2026448325
Title
Clinical Efficacy and Safety of Bempedoic Acid in High Cardiovascular Risk
Patients: A Systematic Review and Meta-analysis of Randomized Controlled
Trials.
Source
Current Problems in Cardiology. 48(12) (no pagination), 2023. Article
Number: 102003. Date of Publication: December 2023.
Author
Uddin N.; Syed A.A.; Ismail S.M.; Ashraf M.T.; Khan M.K.; Sohail A.
Institution
(Uddin, Syed, Ismail, Ashraf, Khan, Sohail) Department of Internal
Medicine, Dow University of Health Sciences, Karachi, Pakistan
Publisher
Elsevier Inc.
Abstract
Bempedoic acid (BA) is the new addition to lipid-lowering medications.
This systematic review and meta-analysis of randomized controlled trials
(RCTs) assess the clinical efficacy and safety of BA in high
cardiovascular (CV) risk patients along with its effects on low-density
lipoprotein cholesterol (LDL-C) and total cholesterol. PubMed, Google
Scholar, Cochrane Central Register of Controlled Trials, Embase, and
ClinicalTrials.gov were searched for RCTs comparing BA with placebo,
reporting CV outcomes. Seven RCTs with a total of 17,816 patients were
selected for the analysis. Results showed that BA significantly reduced
the risk of MACE (RR 0.87, 95% CI 0.80-0.94; P = 0.007), nonfatal
myocardial infarction (RR 0.73; 95% CI 0.62-0.85; P < 0.0001),
hospitalization for unstable angina (RR 0.69; 95%CI 0.54-0.88; P = 0.003),
coronary and noncoronary revascularization (RR 0.82; 95%CI 0.73-0.92; P =
0.0007) and (RR 0.41; 95%CI 0.18-0.96; P = 0.04), respectively. However,
BA increased the risk of gout (RR 1.55; 95% CI 1.26-1.90; P < 0.0001),
hyperuricemia (RR 1.94; 95% CI 1.73-2.18; P < 0.00001) and worsening renal
function (RR 1.34; 95%CI 1.21-1.48; P < 0.00001). BA also reduced LDL-C
(MD -22.38%; 95% CI -25.94 to - 18.82; P < 0.00001) and total cholesterol
(MD -13.86%; 95% CI -15.82 to -11.91; P < 0.0000) compared with placebo.
Bempedoic acid is an addition to the arsenal of lipid-lowering drugs used
in patients that are statin intolerant or need additional lipid-lowering
therapy. Copyright © 2023 Elsevier Inc.

<121>
Accession Number
2025458843
Title
Effect of intravenous vs. inhaled penehyclidine on respiratory mechanics
in patients during one-lung ventilation for thoracoscopic surgery: a
prospective, double-blind, randomised controlled trial.
Source
BMC Pulmonary Medicine. 23(1) (no pagination), 2023. Article Number: 353.
Date of Publication: December 2023.
Author
An M.-Z.; Xu C.-Y.; Hou Y.-R.; Li Z.-P.; Gao T.-S.; Zhou Q.-H.
Institution
(An, Xu, Hou) Anesthesia Medicine, Jiaxing University Master Degree
Cultivation Base, Zhejiang Chinese Medical University, Zhejiang Province,
Hangzhou, China
(An, Gao) Department of anaesthesiology, Jiaxing Chinese Medical Hospital,
No. 1501, Zhongshan East Road, Zhejiang Province, Jiaxing, China
(Xu, Hou, Li, Zhou) Department of anaesthesiology and pain medicine,
affiliated hospital of Jiaxing University, No.1882, South Central Road,
Zhejiang Province, Jiaxing, China
Publisher
BioMed Central Ltd
Abstract
Background: Minimising postoperative pulmonary complications (PPCs) after
thoracic surgery is of utmost importance. A major factor contributing to
PPCs is the driving pressure, which is determined by the ratio of tidal
volume to lung compliance. Inhalation and intravenous administration of
penehyclidine can improve lung compliance during intraoperative mechanical
ventilation. Therefore, our study aimed to compare the efficacy of inhaled
vs. intravenous penehyclidine during one-lung ventilation (OLV) in
mitigating driving pressure and mechanical power among patients undergoing
thoracic surgery. Method(s): A double-blind, prospective, randomised
study involving 176 patients scheduled for elective thoracic surgery was
conducted. These patients were randomly divided into two groups, namely
the penehyclidine inhalation group and the intravenous group before their
surgery. Driving pressure was assessed at T<inf>1</inf> (5 min after OLV),
T<inf>2</inf> (15 min after OLV), T<inf>3</inf> (30 min after OLV), and
T<inf>4</inf> (45 min after OLV) in both groups. The primary outcome of
this study was the composite measure of driving pressure during OLV. The
area under the curve (AUC) of driving pressure from T<inf>1</inf> to
T<inf>4</inf> was computed. Additionally, the secondary outcomes included
mechanical power, lung compliance and the incidence of PPCs.
 Result(s): All 167 participants, 83 from the intravenous group and 84
from the inhalation group, completed the trial. The AUC of driving
pressure for the intravenous group was 39.50 +/- 9.42, while the
inhalation group showed a value of 41.50 +/- 8.03 (P = 0.138). The
incidence of PPCs within 7 days after surgery was 27.7% in the intravenous
group and 23.8% in the inhalation group (P = 0.564). No significant
differences were observed in any of the other secondary outcomes between
the two groups (all P > 0.05). Conclusion(s): Our study found that
among patients undergoing thoracoscopic surgery, no significant
differences were observed in the driving pressure and mechanical power
during OLV between those who received an intravenous injection of
penehyclidine and those who inhaled it. Moreover, no significant
difference was observed in the incidence of PPCs between the two
groups. Copyright © 2023, BioMed Central Ltd., part of Springer
Nature.

<122>
Accession Number
2024859373
Title
The efficacy and safety of haloperidol for the treatment of delirium in
critically ill patients: a systematic review and meta-analysis of
randomized controlled trials.
Source
Frontiers in Medicine. 10 (no pagination), 2023. Article Number: 1200314.
Date of Publication: 2023.
Author
Huang J.; Zheng H.; Zhu X.; Zhang K.; Ping X.
Institution
(Huang, Zhu, Ping) Department of Critical Care Medicine, Hangzhou Ninth
People's Hospital, Hangzhou, China
(Zheng) Department of Emergency Medicine, Hangzhou Ninth People's
Hospital, Hangzhou, China
(Zhang) Department of Critical Care Medicine, Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
Publisher
Frontiers Media SA
Abstract
Purpose: Delirium is common during critical illness and is associated with
poor outcomes. Therefore, we conducted this meta-analysis to investigate
the efficacy and safety of haloperidol for the treatment of delirium in
critically ill patients. Method(s): Randomized controlled trials
enrolling critically ill adult patients to compare haloperidol with
placebo were searched from inception through to February 20th, 2023. The
primary outcome were delirium-free days and overall mortality, secondary
outcomes were length of intensive care unit stay, length of hospital stay,
and adverse events. Result(s): Nine trials were included in our
meta-analysis, with a total of 3,916 critically ill patients. Overall, the
pooled analyses showed no significant difference between critically ill
patients treated with haloperidol and placebo for the delirium-free days
(MD -0.01, 95%CI -0.36 to 0.34, p = 0.95, I2 = 30%), overall
mortality (OR 0.89, 95%CI 0.76 to 1.04, p = 0.14, I2 = 0%),
length of intensive care unit stay (MD -0.06, 95%CI -0.16 to 0.03, p =
0.19, I2 = 0%), length of hospital stay (MD -0.06, 95%CI -0.61
to 0.49, p = 0.83, I2 = 0%), and adverse events (OR 0.90, 95%CI
0.60 to 1.37, p = 0.63, I2 = 0%). Conclusion(s): Among
critically ill patients, the use of haloperidol as compared to placebo has
no significant effect on delirium-free days, overall mortality, length of
intensive care unit and/or hospital stay. Moreover, the use of haloperidol
did not increase the risk of adverse events. Copyright © 2023
Huang, Zheng, Zhu, Zhang and Ping.

<123>
Accession Number
2021935965
Title
A series of experiences with TissuePatchTM for alveolar air leak after
pulmonary resection.
Source
General Thoracic and Cardiovascular Surgery. 71(10) (pp 570-576), 2023.
Date of Publication: October 2023.
Author
Homma T.
Institution
(Homma) Division of Thoracic Surgery, Kurobe City Hospital, 1108-1
Mikkaichi, Toyama, Kurobe 938-8502, Japan
(Homma) Division of Thoracic Surgery, University of Toyama, Toyama, Japan
Publisher
Springer
Abstract
Objectives: Prolonged air leak after pulmonary resection strongly
influences chest tube duration and hospitalization. This prospective study
aimed to report a series of experiences with a synthetic sealant
(TissuePatchTM) and compare them with a combination covering method
(polyglycolic acid sheet + fibrin glue) for air leaks after pulmonary
surgery. Method(s): We included 51 patients (age: 20-89 years) who
underwent lung resection. Patients who presented with alveolar air leak
during the intraoperative water sealing test were randomly assigned to the
TissuePatchTM or combination covering method groups. The chest tube was
removed when there was no air leak over a period of 6 h, and no active
bleeding under continuous monitoring using a digital drainage system. The
chest tube duration was assessed, and various perioperative factors (such
as the index of prolonged air leak score) were evaluated. Result(s):
Twenty (39.2%) patients developed intraoperative air leak; ten patients
received TissuePatchTM; and one patient who was receiving TissuePatchTM
switched to the combination covering method because of broken
TissuePatchTM. The chest tube duration, index of prolonged air leak score,
prolonged air leak, other complications, and postoperative hospitalization
in both groups were similar. No TissuePatchTM-related adverse events were
reported. Conclusion(s): Results from the use of TissuePatchTM were
almost similar to those associated with the use of combination covering
method in preventing prolonged postoperative air leak after pulmonary
resection. Randomized, double-arm studies are required to confirm the
efficacy of TissuePatchTM observed during this study. Copyright ©
2023, The Author(s), under exclusive licence to The Japanese Association
for Thoracic Surgery.

<124>
Accession Number
2021337370
Title
Niche Roles for Dexmedetomidine in the Intensive Care Unit.
Source
Annals of Pharmacotherapy. 57(10) (pp 1207-1220), 2023. Date of
Publication: October 2023.
Author
Wiegand A.; Behal M.; Robbins B.; Bissell B.; Pandya K.; Mefford B.
Institution
(Wiegand, Behal, Robbins, Bissell, Pandya, Mefford) Department of Pharmacy
Services, University of Kentucky HealthCare, Lexington, KY, United States
(Behal) Department of Pharmacy Practice & Science, University of Kentucky
College of Pharmacy, Lexington, KY, United States
Publisher
SAGE Publications Inc.
Abstract
Objective: Review dexmedetomidine use in critically ill patients for niche
indications including sleep, delirium, alcohol withdrawal, sepsis, and
immunomodulation. Data Sources: Literature was sought using PubMed
(February 2012-November 2022). Search terms included dexmedetomidine AND
(hypnotics OR sedatives OR sleep OR delirium OR immunomodulation OR sepsis
OR alcohol withdrawal). Study Selection and Data Extraction: Relevant
studies conducted in humans >=18 years published in English were included.
Exclusion criteria included systematic reviews, meta-analyses, and studies
evaluating oral dexmedetomidine or other alpha-2 agonists. Data
Synthesis: A total of 231 articles were retrieved. After removal of
duplicates, title and abstract screening, and application of inclusion
criteria, 35 articles were included. Across the clinical conditions
included in this review, varying clinical outcomes were seen.
Dexmedetomidine may improve morbidity outcomes in delirium, sleep, and
alcohol withdrawal syndrome. Due to limited human studies and poor quality
of evidence, no conclusions can be drawn regarding the role of
dexmedetomidine in immunomodulation or sepsis. Relevance to Patient Care
and Clinical Practice: This review presents data for potential niche roles
of dexmedetomidine aside from sedation in critically ill patients. This
may serve as a guide for sedation selection in critically ill patients who
may also benefit from the pleiotropic effects of dexmedetomidine due to a
clinical condition discussed in this review. Conclusion(s): While
further studies are needed, dexmedetomidine may provide benefit in other
indications in critically ill patients including delirium, sleep, and
alcohol withdrawal. Given the poor quality of evidence of dexmedetomidine
use in immunomodulation and sepsis, no conclusions can be
drawn. Copyright © The Author(s) 2023.

<125>
Accession Number
2020084251
Title
Culprit vessel revascularization first with primary use of a dedicated
transradial guiding catheter to reduce door to balloon time in primary
percutaneous coronary intervention.
Source
Frontiers in Cardiovascular Medicine. 9 (no pagination), 2022. Article
Number: 1022488. Date of Publication: 28 Oct 2022.
Author
Guo J.; Wang G.; Li Z.; Liu Z.; Wang S.; Wu Y.; Wang H.; Wang Y.; Zhang
L.; Hua Q.
Institution
(Guo, Li, Liu, Wang, Wang, Wang, Wu, Wang, Wang, Zhang) Division of
Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing,
China
(Wang, Hua) Division of Cardiology, Beijing Xuanwu Hospital, Capital
Medical University, Beijing, China
Publisher
Frontiers Media SA
Abstract
Background: The effect of a single transradial guiding catheter (STGC) for
culprit vessel percutaneous coronary intervention (PCI) first on
door-to-balloon (D2B) time remains unclear. Material(s) and
Method(s): Between February 2017 and July 2019, 560 patients with
ST-elevation myocardial infarction (STEMI) were randomized into either the
STGC group (n = 280) or the control group (n = 280) according to direct
culprit vessel PCI with a STGC. In the STGC group, a dedicated transraidal
guiding catheter (6F either MAC3.5 or JL3.5) was used for the treatment of
electrocardiogram (ECG)-guided culprit vessel first and later
contralateral angiography. In the control group, a universal diagnostic
catheter (5F Tiger II) was used for complete coronary angiography,
followed by guiding catheter selection for culprit vessel PCI. The primary
endpoint was D2B time, and the secondary endpoint included catheterization
laboratory door-to-balloon (C2B), procedural, fluoroscopy times, and major
adverse cardiac events (MACE) at 30 days. Result(s): The median D2B
time was significantly shorter in the STGC group compared to the control
group (53.9 vs. 58.4 min; p = 0.003). The C2B, procedural, and fluoroscopy
times were also shorter in the STGC group (C2B: 17.3 vs. 24.5 min, p <
0.001; procedural: 45.2 vs. 49.0 min, p = 0.012; and fluoroscopy: 9.7 vs.
11.3 min, p = 0.025). More patients achieved the goal of D2B time within
90 min (93.9% vs. 87.1%, p = 0.006) and 60 min (61.4% vs. 51.1%, p =
0.013) in the STGC group. Radial artery perforation (RAP) was
significantly reduced in the STGC group compared with the control group
(0.7% vs. 3.2%, P = 0.033). MACE at 30 days was similar (2.5% vs. 4.6%, P
= 0.172) between the two groups. Conclusion(s): ECG-guided immediate
intervention on culprit vessel with a STGC can reduce D2B, C2B,
procedural, and fluoroscopy times (ECG-guided Immediate Primary PCI for
Culprit Vessel to Reduce Door to Device Time; NCT03272451). Copyright
© 2022 Guo, Wang, Li, Liu, Wang, Wang, Wang, Wu, Wang, Wang, Zhang
and Hua.

<126>
Accession Number
2027145770
Title
Intraoperative hypotension and postoperative outcomes: a meta-analysis of
randomised trials.
Source
British Journal of Anaesthesia. (no pagination), 2023. Date of
Publication: 2023.
Author
D'Amico F.; Fominskiy E.V.; Turi S.; Pruna A.; Fresilli S.; Triulzi M.;
Zangrillo A.; Landoni G.
Institution
(D'Amico, Fominskiy, Turi, Pruna, Fresilli, Triulzi, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Zangrillo, Landoni) School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
Publisher
Elsevier Ltd
Abstract
Introduction: Intraoperative hypotension is associated with adverse
postoperative outcomes; however these findings are supported only by
observational studies. The aim of this meta-analysis of randomised trials
was to compare the postoperative effects permissive management with
targeted management of intraoperative blood pressure. Method(s): We
searched PubMed, Cochrane, and Embase up to June 2023 for studies
comparing permissive (mean arterial pressure <=60 mm Hg) with targeted
(mean arterial pressure >60 mm Hg) intraoperative blood pressure
management. Primary outcome was all-cause mortality at the longest
follow-up available. Secondary outcomes were atrial fibrillation,
myocardial infarction, acute kidney injury, delirium, stroke, number of
patients requiring transfusion, time on mechanical ventilation, and length
of hospital stay. Result(s): We included 10 randomised trials
including a total of 9359 patients. Mortality was similar between
permissive and targeted blood pressure management groups (89/4644 [1.9%]
vs 99/4643 [2.1%], odds ratio 0.88, 95% confidence interval [CI],
0.65-1.18, P=0.38, I2=0% with nine studies included). Atrial
fibrillation (102/3896 [2.6%] vs 130/3887 [3.3%] odds ratio 0.71, 95% CI
0.53-0.96, P=0.03, I2=0%), and length of hospital stay (mean
difference -0.20 days, 95% CI -0.26 to -0.13, P<0.001, I2=0%)
were reduced in the permissive management group. No significant
differences were found in subgroup analysis for cardiac and noncardiac
surgery. Conclusion(s): Pooled randomised evidence shows that a
target intraoperative mean arterial pressure <=60 mm Hg is not associated
with increased mortality; nevertheless it is surprisingly associated with
a reduced rate of atrial fibrillation and of length of hospital stay.
Systematic review protocol: PROSPERO CRD42023393725. Copyright ©
2023 British Journal of Anaesthesia

<127>
Accession Number
2027124525
Title
Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A
Systematic Review and Meta-Analysis.
Source
American Journal of Cardiology. 207 (pp 159-169), 2023. Date of
Publication: 15 Nov 2023.
Author
Kaddoura R.; Bhattarai S.; Abushanab D.; Al-Hijji M.
Institution
(Kaddoura) Pharmacy Department, Heart Hospital, Hamad Medical Corporation,
Doha, Qatar
(Bhattarai) Department of hematology and oncology, Bhaktapur Cancer
Hospital, Bhaktapur, Dudhpati, Nepal
(Abushanab) Drug Information Center, Hamad Medical Corporation, Qatar,
Doha, Qatar
(Al-Hijji) Interventional Cardiology Department, Heart Hospital, Hamad
Medical Corporation, Qatar, Doha, Qatar
Publisher
Elsevier Inc.
Abstract
This systematic review and meta-analysis aimed to investigate whether
percutaneous mitral valve repair (PMVr) using MitraClip was more effective
than surgery or medical therapy for long-term morbidity and mortality. We
searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to
identify relevant studies that recruited adult patients with functional or
secondary mitral valve regurgitation who underwent PMVr with MitraClip
implantation using appropriate search terms and Boolean operators. The
odds ratios (ORs) were pooled using the random-effects model. A total of
14 studies recruiting 2,593 patients were included. Within 12 months of
follow-up, patients who underwent PMVr did not maintain mitral valve
regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to
0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart
failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p
= 0.66) compared with their surgical counterparts. Patients were more
likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to
5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no
difference between the groups in terms of all-cause or cardiovascular
mortality. Whereas, in comparison with medical therapy, PMVr significantly
reduced all-cause mortality at 12 and >=24 months of follow-up (OR 0.41,
95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55,
95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45,
respectively). In conclusion, there was no difference in all-cause death
at 12 or 24 months of follow-up between PMVr and the surgical approach,
but the durability of valvular repair was inferior to PMVr. In comparison
with medical therapy, there was a significant reduction in mortality with
PMVr. Copyright © 2023 The Author(s)

<128>
Accession Number
2027114486
Title
Predictors of All-Cause Mortality After Successful Transcatheter Aortic
Valve Implantation in Patients With Atrial Fibrillation.
Source
American Journal of Cardiology. 207 (pp 150-158), 2023. Date of
Publication: 15 Nov 2023.
Author
Yamamoto M.; Hayashida K.; Hengstenberg C.; Watanabe Y.; Van Mieghem N.M.;
Jin J.; Saito S.; Valgimigli M.; Nicolas J.; Mehran R.; Moreno R.; Kimura
T.; Chen C.; Unverdorben M.; Dangas G.D.
Institution
(Yamamoto) Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Hengstenberg) Division of Cardiology, Department of Internal Medicine II,
Vienna General Hospital, Medical University, Vienna, Austria
(Watanabe) Division of Cardiology, Teikyo University Hospital, Tokyo,
Japan
(Van Mieghem) Department of Cardiology, Erasmus University Medical Center,
Thoraxcenter, Rotterdam, Netherlands
(Jin, Chen, Unverdorben) Global Specialty Medical Affairs, Daiichi Sankyo,
Inc., Basking Ridge, NJ, United States
(Saito) Division of Cardiology & Catheterization Laboratories, Shonan
Kamakura General Hospital, Kamakura, Japan
(Valgimigli) Division of Cardiocentro Ticino Institute, Ente Ospedaliero
Cantonale, Universita della Svizzera Italiana (USI), Lugano, Switzerland
(Valgimigli) Department of Cardiology, University of Bern, Bern,
Switzerland
(Nicolas) Icahn School of Medicine, New York, NY, United States
(Mehran, Dangas) Zena and Michael A. Wiener Cardiovascular Institute,
Mount Sinai Hospital, New York, New York, United States
(Moreno) Department of Cardiology, University Hospital La Paz, Madrid,
Spain
(Kimura) Primary Medical Science Department, Daiichi Sankyo Co., Ltd.,
Tokyo, Japan
Publisher
Elsevier Inc.
Abstract
Prevalent and incident atrial fibrillation are common in patients who
undergo transcatheter aortic valve implantation and are associated with
impaired postprocedural outcomes, including mortality. We determined
predictors of long-term mortality in patients with atrial fibrillation
after successful transcatheter aortic valve implantation. The EdoxabaN
Versus standard of care and theIr effectS on clinical outcomes in pAtients
havinG undergonE Transcatheter Aortic Valve Implantation-Atrial
Fibrillation (ENVISAGE-TAVI AF) trial (NCT02943785) was a multicenter,
prospective, randomized controlled trial in patients with prevalent or
incident atrial fibrillation after successful transcatheter aortic valve
implantation who received edoxaban or vitamin K antagonists. A Cox
proportional hazard model was performed to identify predictors of
all-cause mortality using a stepwise approach for multiple regression
analysis. In addition, we assessed the performance of different risk
scores and prediction models using ENVISAGE-TAVI AF data. Of 1,426
patients in ENVISAGE-TAVI AF, 178 (12.5%) died during the follow-up period
(median 548 days). Our stepwise approach identified greater risk of
mortality with older age, impaired renal function, nonparoxysmal atrial
fibrillation, excessive alcohol use, New York Heart Association heart
failure class III/IV, peripheral artery disease, and history of major
bleeding or predisposition to bleeding. The present model (concordance
statistic [c-statistic] 0.67) was a better discriminator than were other
frequently used risk scores, such as the Society of Thoracic Surgeons
score (c-statistic 0.56); Congestive heart failure, Hypertension, Age
>=75, Diabetes, Stroke, Vascular disease, Age 65 to 74 years, and Sex
category (CHA<inf>2</inf>DS<inf>2</inf>-VASc) score (c-statistic 0.54); or
Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or
predisposition, Labile international normalized ratio, Elderly, and
Drugs/alcohol concomitantly (HAS-BLED) score (c-statistic 0.58). In
ENVISAGE-TAVI AF, several modifiable and nonmodifiable clinical
characteristics were significantly associated with greater long-term
all-cause mortality. Improved risk stratification to estimate the
probability of mortality after successful transcatheter aortic valve
implantation in patients with atrial fibrillation may improve long-term
patient prognosis. Copyright © 2023 The Author(s)

<129>
Accession Number
2025629388
Title
Keeping It "Current": A Review of Treatment Options for the Management of
Supraventricular Tachycardia.
Source
Annals of Pharmacotherapy. (no pagination), 2023. Date of Publication:
2023.
Author
Tednes P.; Marquardt S.; Kuhrau S.; Heagler K.; Rech M.
Institution
(Tednes, Marquardt) Department of Pharmacy, Ascension Resurrection Medical
Center, Chicago, IL, United States
(Kuhrau, Heagler) Department of Pharmacy, Loyola University Medical
Center, Maywood, IL, United States
(Rech) Department of Veterans Affairs, Center of Innovation for Complex
Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United
States
(Rech) Department of Emergency Medicine, Stritch School of Medicine,
Loyola University Chicago, Maywood, IL, United States
Publisher
SAGE Publications Inc.
Abstract
Objective: To review treatment options and updates that exist for the
management of paroxysmal supraventricular tachycardia (PSVT). Data
Sources: A literature search of PubMed was performed including articles
from 1974 to June 2023 using the terms: arrhythmias, adenosine, verapamil,
diltiazem, esmolol, propranolol, metoprolol, beta-blockers, amiodarone,
PSVT, synchronized cardioversion, methylxanthines, dipyridamole,
pediatrics, heart transplant, and pregnancy. Primary literature and
guidelines were reviewed. Study Selection and Data Extraction: Studies
were considered if they were available in English and conducted in humans.
 Data Synthesis: PSVT is a subset of supraventricular tachycardia
(SVT) that presents as a rapid, regular tachycardia with an abrupt onset
and termination. Due to frequent emergency department (ED) visits annually
with symptoms of PSVT, appropriate and efficient management of these
patients is vital. This review provides an overview of the pathophysiology
of PSVT, while also describing the literature behind nonpharmacologic and
pharmacologic management of PSVT. Relevance to Patient Care and Clinical
Practice: This review describes new literature regarding the improved
success of the modified Valsalva maneuver as a nonpharmacologic therapy in
PSVT. In addition, it describes a new technique in administration of
adenosine that has improved outcomes, defines dose adjustments needed for
drug interactions with adenosine, compares the utilization of
nondihydropyridine calcium channel blockers with adenosine, and provides
management recommendations for patients in special populations.
 Conclusion(s): With high annual rates of ED visits for SVT, providers
should be aware of the data behind management and modifications of therapy
based on patient-specific factors (ie, patient preference,
pharmacokinetics/pharmacodynamics, drug interactions, and special
populations). Copyright © The Author(s) 2023.

<130>
Accession Number
2025620507
Title
The percutaneous management of pulmonary metastases.
Source
Journal of Medical Imaging and Radiation Oncology. (no pagination), 2023.
Date of Publication: 2023.
Author
de Baere T.; Bonnet B.; Tselikas L.; Deschamps F.
Institution
(de Baere, Bonnet, Tselikas, Deschamps) Department of Interventional
Radiology, Gustave Roussy, Villejuif, France
(de Baere, Tselikas) University of Paris-Saclay, UFR Medecine Le
Kremlin-Bicetre, Le Kremlin-Bicetre, France
(de Baere, Tselikas) Centre d'Investigation Clinique BIOTHERIS, INSERM
CIC1428, Villejuif, France
Publisher
John Wiley and Sons Inc
Abstract
Local treatment of lung metastases has been in the front scene since late
90s when an international registry of thoracic surgery reported a median
overall survival of 35 months in resected patients versus 15 months in
non-resected patients. Today, other local therapies are available for
patients with oligometastatic lung disease, including image guided thermal
ablation, such as ablation, microwave ablation, and cryoablation.
Image-guided ablation is increasingly offered, and now recommended in
guidelines as option to surgery. Today, the size of the target tumour
remains the main driver of success and selection of patients with limited
tumour size allowing for local tumour control in the range of 90% in most
recent and larger series targeting lung metastases up to 3.5 cm. Overall
survival exceeding five-years in large series of thermal ablation for lung
metastases from colorectal origin are align with outcome of same patients
treated with surgical resection. Moreover, thermal ablation in such
population allows for one-year chemotherapy holidays in all comers and
over 18 months in lung only metastatic patients, allowing for improved
patient quality of life and preserving further lines of systemic treatment
when needed. Tolerance of thermal ablation is excellent and better than
surgery with no lost in respiratory function, allowing for repeated
treatment when needed. In the future, it is likely that practice of lung
surgery for small oligometastatic lung disease will decrease, and that
minimally invasive techniques will replace surgery in such indications.
Randomized study will be difficult to obtain as demonstrated by
discontinuation of many studies testing the hypothesis of surgery versus
observation, or surgery versus SBRT. Copyright © 2023 Royal
Australian and New Zealand College of Radiologists.

<131>
Accession Number
2025580386
Title
Effects of negative pressure wound therapy on surgical site wound
infections after cardiac surgery: A meta-analysis.
Source
International Wound Journal. (no pagination), 2023. Date of Publication:
2023.
Author
Tao Y.; Zhang Y.; Liu Y.; Tang S.
Institution
(Tao) Department of Cardiovascular Medicine, The First Affiliated Hospital
of Guizhou University of Traditional Chinese Medicine, Guiyang, China
(Zhang) Interventional Surgery of Radiology, The First Affiliated Hospital
of Guizhou University of Traditional Chinese Medicine, Guiyang, China
(Liu) Department of Scientific Research Division, The First Affiliated
Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang,
China
(Tang) Department of Anaesthesia, The First Affiliated Hospital of Guizhou
University of Traditional Chinese Medicine, Guiyang, China
Publisher
John Wiley and Sons Inc
Abstract
We conducted a comprehensive analysis to evaluate the benefits of negative
pressure wound therapy (NPWT) versus traditional dressings in preventing
surgical site infections in patients undergoing cardiac surgery. We
thoroughly examined several databases, including PubMed, EMBASE, Cochrane
Library, China National Knowledge Infrastructure (CNKI), VIP, Chinese
Biomedical Literature Database (CBM) and Wanfang, from inception until
July 2023. Two independent researchers were responsible for the literature
screening, data extraction and quality assessment; analyses were performed
using RevMan 5.4 software. Thirteen studies comprising 8495 patients were
deemed relevant. A total of 2685 patients were treated with NPWT, whereas
5810 received conventional dressings. The findings revealed that NPWT was
more effective in reducing surgical site infections after cardiac surgery
than conventional dressings (4.88% vs. 5.87%, odds ratio [OR]: 0.50, 95%
confidence intervals [CIs]: 0.40-0.63, p < 0.001). Additionally, NPWT was
more effective in reducing deep wound infections (1.48% vs. 4.15%, OR:
0.36, 95% CI: 0.23-0.56, p < 0.001) and resulted in shorter hospital stays
(SMD: -0.33, 95% CIs: -0.54 to -0.13, p = 0.001). However, the rate of
superficial wound infections was not significantly affected by the method
of wound care (3.72% vs. 5.51%, OR: 0.63, 95% CI: 0.32-1.23, p = 0.180).
In conclusion, NPWT was shown to be advantageous in preventing
postoperative infections and reducing hospital stay durations in patients
undergoing cardiac surgery. Nonetheless, given the limitations in the
number and quality of the included studies, further research is
recommended to validate these findings. Copyright © 2023 The
Authors. International Wound Journal published by Medicalhelplines.com Inc
and John Wiley & Sons Ltd.

<132>
Accession Number
641967109
Title
Psychological outcomes of the systematic interventions based on the
stress-induced situation, affective, bodily, and cognitive reactions
framework for patients with lung cancer: A randomized clinical trial.
Source
International journal of nursing studies. 146 (pp 104566), 2023. Date of
Publication: 01 Oct 2023.
Author
Zhang Q.; Tang L.; Chen H.; Chen S.; Luo M.; He Y.; Liu M.
Institution
(Zhang, Chen) Department of Medical Psychology, Second Affiliated Hospital
of Army Medical University, Chongqing 400037, China
(Tang, Luo, He) Department of Thoracic Surgery, Second Affiliated Hospital
of Army Medical University, Chongqing 400037, China
(Chen) Digestive Department, Second Affiliated Hospital of Army Medical
University, Chongqing 400037, China
(Liu) Emergency Department, First Affiliated Hospital of Army Medical
University, Chongqing 400038, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Psychological distress is a multi-factorial unpleasant
experience of a psychological, social, spiritual, and/or physical nature
that may interfere with one's ability to cope effectively with cancer,
physical symptoms and treatment. Psychological distress is common and
affects the prognosis of cancer patients. Lung cancer accounted for 11.4%
of all new cancer cases and 18% of all cancer mortality for 36 cancers in
185 countries. The prevalence of distress among Chinese lung cancer
patients ranged from 10.1% to 61.29%. However, the existing intervention
studies on the psychological distress in lung cancer patients are limited
and intervention results may be different. OBJECTIVE(S): To explore
the psychological outcomes of a nurse-led systematic intervention program
based on the stress-induced situation, affective, bodily, and cognitive
reactions framework for patients with lung cancer undergoing operation at
anxiety and depression. DESIGN: A randomized clinical trial. SETTING:
Thoracic surgery ward in a tertiary hospital in China. PARTICIPANTS: Lung
cancer patients undergoing surgery. METHOD(S): This is a 12-month
longitudinal randomized controlled study in a tertiary hospital in China.
A total of 240 lung cancer patients were randomly divided into either the
control group or the intervention group. The nurse-led systematic
intervention contents include psychological education, intervention
measures based on the stress-induced situation, affective, bodily, and
cognitive reactions framework, issuance of daily lifestyle cards, and
regular follow-ups. The Hospital Anxiety and Depression Scale, Functional
Assessment of Chronic Illness Therapy-Fatigue Scale, and Satisfaction with
Life Scale were used for the baseline assessment within 48h upon
admission. The same assessment was performed respectively at 1, 3, 6 and
12months after the intervention started. The effects of the systematic
interventions on depression, anxiety, fatigue, and life satisfaction were
tested by a linear mixed effects model. RESULT(S): Overall
time-by-group interaction effects were significantly different with regard
to anxiety, depression, and fatigue after controlling for the covariates,
while a significant time-by-group interaction effect was not found for
life satisfaction. Changes for anxiety and depression scores at 6 and
12months after initiation of the intervention were significantly greater
in the intervention group compared with those in the control group
(t=3.046, p=0.002, t=3.190, p=0.001; t=3.735, p=0.000, t=2.979, p=0.002),
whereas scores for fatigue were significantly higher in the intervention
group at 6 and 12months (t=-3.096, p=0.002, t=-2.784, p=0.005).
 CONCLUSION(S): The systematic intervention program based on the
stress-induced situation, affective, bodily, and cognitive reactions
framework may effectively relieve anxiety, depression, and fatigue in lung
cancer patients undergoing surgery. REGISTRATION: This study was
registered on December 22, 2019 with the registration number
ChiCTR1900028487, and the date of first recruitment was Jan 5,
2020. Copyright © 2023 Elsevier Ltd. All rights reserved.

<133>
Accession Number
2027239321
Title
HEMORRHAGIC PERICARDIAL EFFUSION WITH CARDIAC TAMPONADE PHYSIOLOGY: AN
UNUSUAL COVID-19 PRESENTATION.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A554-A555), 2023. Date of Publication: October 2023.
Author
FAIZ M.; FARRUKH L.; WAJID S.; HALASA I.; EHTESHAM M.O.I.Z.; HAREEM WAQAR
H.; BACHMAN W.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 6 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm
INTRODUCTION: The severe acute respiratory syndrome coronavirus-2
(SARS-COV-2) can cause multiple respiratory and systemic complications.
Although the lungs are the main organ involved in COVID-19, a wide range
of cardiovascular manifestations have also been reported in patients
infected with SARS-CoV-2. On rare occasions, pericardial effusion has also
been documented in association with COVID-19, which is mostly
non-hemorrhagic. We present a rare case of spontaneous hemorrhagic
pericardial effusion complicated by cardiac tamponade in a patient after a
recent COVID-19 infection [1,2]. CASE PRESENTATION: A 75-year-old man with
a past medical history of diabetes, severe aortic stenosis status
post-TAVR, and hypertension presented to the clinic with the complaint of
progressive dyspnea. The patient reported a recent COVID-19 infection one
month. He was found to have volume overload and EKG revealed atrial
flutter with a rapid ventricular response. The patient was sent to our
hospital for further management. Initial vitals showed blood pressure of
116/96 mmHg, heart rate of 137 bpm, and oxygen saturation of 93% on room
air. Physical examination was significant for marked peripheral edema and
irregularly irregular heartbeat. Repeat EKG demonstrated atrial flutter
with variable A-V block and low voltage QRS (Figure 1). Chest X-ray showed
cardiomegaly with moderate bilateral pleural effusions and a left basilar
opacity. Echocardiogram revealed a large circumferential pericardial
effusion (Figure 2). Initial labs showed normal high-sensitivity troponin
and BNP. CBC was significant for an elevated WBC count of 11.8x 10*3/UL
and hemoglobin of 12.5 g/dL. The patient was found to be SARS-CoV-2
positive on PCR. Treatment was initiated with aggressive diuresis and
beta-blocker for atrial flutter. However, the patient continued to
deteriorate. A repeat echocardiogram revealed an interval increase in
pericardial effusion, now with tamponade physiology. He underwent an
emergent subxiphoid pericardial window with 1L of hemorrhagic fluid
drainage. Limited follow-up echo showed marked improvement of the
pericardial effusion. His hospital course was complicated by recurrent
atrial fibrillation which was treated with a higher dose of beta-blocker;
Apixaban was initiated. The patient's clinical status gradually improved
and he was discharged with cardiology follow-up as an outpatient.
DISCUSSION: Most COVID-19-related pericardial effusion (PE) reports have
been non-hemorrhagic, with only a few hemorrhagic cases reported in the
literature. This makes COVID-19 only the second viral infection that can
lead to hemorrhagic PE, in addition to Coxsackievirus. There are currently
no specific blood biomarkers for the diagnosis of PE; however, it is often
associated with elevated inflammatory markers like ESR, CRP, and d-dimer.
If PE is suspected, an echocardiogram can be used to confirm the
diagnosis. There is no standard management approach regarding PE related
to COVID-19. Medications are usually ineffective in the case of a giant or
hemorrhagic PE; hence, both require drainage for resolution [1,3].
 CONCLUSION(S): In conclusion, hemorrhagic pericardial effusion with
subsequent cardiac tamponade must be considered as a potentially lethal
late manifestation of COVID-19 infection, which can be treated with
drainage if diagnosed early. REFERENCE #1: 1. Kermani-Alghoraishi, M.,
Pouramini, A., Kafi, F., & Khosravi, A. (2022). Coronavirus Disease 2019
(COVID-19) and Severe Pericardial Effusion: From Pathogenesis to
Management: A Case Report Based Systematic Review. Current problems in
cardiology, 47(2), 100933. https://doi.org/10.1016/j.cpcardiol.2021.100933
REFERENCE #2: 2. Brogi, E., Marino, F., Bertini, P., Tavazzi, G., Corradi,
F., & Forfori, F. (2022). Cardiac complications in patients with COVID-19:
a systematic review. Journal of Anesthesia, Analgesia and Critical Care,
2(1), 18. https://doi.org/10.1186/s44158-022-00046-7 REFERENCE #3: 3.
Long, B., Brady, W. J., Koyfman, A., & Gottlieb, M. (2020). Cardiovascular
complications in COVID-19. The American journal of emergency medicine,
38(7), 1504-1507. https://doi.org/10.1016/j.ajem.2020.04.048 DISCLOSURES:
No relevant relationships by William Bachman No relevant relationships by
Moiz Ehtesham No relevant relationships by Marium Faiz No relevant
relationships by Larabe Farrukh No relevant relationships by Issam Halasa
No relevant relationships by Sumbal Wajid No relevant relationships by
Hafiza Hareem Waqar Copyright © 2023 American College of Chest
Physicians

<134>
Accession Number
2027236559
Title
TRACHEOESOPHAGEAL FISTULA IN A CRITICALLY ILL POST-ESOPHAGECTOMY PATIENT.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A279-A280), 2023. Date of Publication: October 2023.
Author
PANDHAIR O.M.A.R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Report Posters 4 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm
INTRODUCTION: Esophageal cancer and esophagectomy both carry the risk of
developing an anomalous connection between the esophagus and bronchi or
trachea, known as a tracheoesophageal fistula (TEF). This rare
complication occurs in approximately 1% of post-esophagectomy patients (1)
and in 5% of esophageal carcinoma patients overall (2). CASE PRESENTATION:
A 74-year-old man with metastatic esophageal adenocarcinoma who recently
underwent distal esophagectomy was admitted to the ICU for acute hypoxemic
respiratory failure. He was diagnosed five months prior after noticing
unintentional weight loss and dysphagia and underwent neoadjuvant
chemoradiation prior to esophagectomy four weeks before this
hospitalization. He was receiving most of his nutrition through a
gastrostomy tube and while feeding that morning, he began coughing up
material that closely resembled his tube feeds and developed dyspnea and
hypoxemia. Despite initial improvement on high flow nasal cannula, he
developed worsening respiratory distress and transferred to the ICU for
urgent endotracheal intubation. Intubation was successful with an 8 mm
endotracheal tube, though a large air leak became evident shortly
afterwards. Despite both full inflation of the cuff and replacement with
an 8.5 mm tube, the leak persisted. Chest CT demonstrated a possible tiny
fistula in the left mainstem bronchus 2 cm distal to the carina.
Bronchoscopy was performed and confirmed a 2 mm fistulous connection to
the esophagus. The patient was transferred to another center for placement
of a left mainstem bronchial stent. He developed recurrent aspiration
pneumonia and persistent respiratory failure and was ultimately
transitioned to comfort measures and passed away. DISCUSSION:
Post-esophagectomy TEF most commonly presents with cough, especially if
associated with feeding and recumbent positioning (1). Development of this
condition is strongly associated with an anastomotic leak causing
inflammation in the posterior esophageal wall. As in our patient, CT scan
and bronchoscopy are the preferred methods for making the diagnosis,
though sometimes radiographic contrast swallow study is recommended to
investigate for anastomotic leaks (2). Definitive treatment involves
surgical correction and is associated with 38% survival at nine months
(1). Unfortunately, many of these patients are chronically malnourished,
quite sick, and not able to tolerate surgery, which does carry a 40%
complication rate. Alternatives include placement of tracheal or bronchial
stents, usually silicone or covered self-expanding stents (3), though
nine-month survival was only 13% in those patients and this treatment is
often considered temporizing or palliative (4). One study proposed a
classifying TEFs as either Type I (digestive tract fistula higher than
airway) or Type 2 (fistulas in the same plane), and found that both Type 2
patients and those who were mechanically ventilated had higher mortality
rates, which is consistent with our patient's course (2).
 CONCLUSION(S): The presence of a TEF merits consideration in
post-esophagectomy patients who present with cough, especially if
associated with feeding. Bronchoscopy is the preferred method for
diagnosis. Surgical treatment is definitive and carries a high
complication rate, but significantly decreases long-term mortality. Airway
stent placement is associated with comparatively lower rates of survival,
but can palliate symptoms. Patients with severe respiratory failure are
unlikely to survive. REFERENCE #1: Li, Yahua, et al. "Management of
Thoracogastric Airway Fistula after Esophagectomy for Esophageal Cancer: A
Systematic Literature Review." Journal of International Medical Research,
vol. 48, no. 5, 27 May 2020, p. 030006052092602.,
https://doi.org/10.1177/0300060520926025. REFERENCE #2: Wang, Changchun,
et al. "The Classification and Treatment Strategies of Post-Esophagectomy
Airway-Gastric Fistula." Journal of Thoracic Disease, vol. 12, no. 7, 12
July 2020, pp. 3602-3610., https://doi.org/10.21037/jtd-20-284. REFERENCE
#3: Chaddha, Udit, et al. "Perspective on Airway Stenting in Inoperable
Patients with Tracheoesophageal Fistula after Curative-Intent Treatment
for Esophageal Cancer." Journal of Thoracic Disease, vol. 11, no. 5, May
2019, pp. 2165-2174., https://doi.org/10.21037/jtd.2018.12. DISCLOSURES:
No relevant relationships by Omar Pandhair Copyright © 2023
American College of Chest Physicians

<135>
Accession Number
2027236515
Title
SCLEROSING PERICARDITIS AND DECOMPENSATED HEART FAILURE AFTER COVID-19
INFECTION.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A611-A612), 2023. Date of Publication: October 2023.
Author
NGUYEN C.; GITZEL L.; JACUBOWSKY A.; DOGRA S.; PUSUKUR B.; SHAH S.;
PARFIANOWICZ D.; RAHMAN N.; CLARK A.; KRANICK S.; FEINER E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 13 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am
INTRODUCTION: Cardiac manifestations from SARS-CoV-2 (COVID-19) infection
include acute myocardial injury, acute coronary syndrome, myocarditis, and
pericarditis. Our case highlights a rare presentation of sclerosing
pericarditis with decompensated heart failure from a COVID-19 infection.
CASE PRESENTATION: A 55-year-old female with a past medical history of
HFpEF, Type II Diabetes, and a COVID-19 infection one month prior
presented with dyspnea on exertion and pleuritic chest pain. The patient
reported being diagnosed with COVID-19 and treated with symptomatic
management. She received two Moderna COVID-19 vaccinations, but no
subsequent booster vaccinations. High Sensitivity Troponin on admission
was 2.0 and CRP was 74. Transthoracic echocardiogram showed normal
biventricular function with a small pericardial effusion. She was
diagnosed with acute pericarditis and was started on colchicine and
ibuprofen. After one month without resolution of her symptoms and
undetectable CRP, she underwent nuclear stress testing which showed no
perfusion defects. A rheumatologic workup for autoimmune pericarditis was
unremarkable and colchicine and ibuprofen were continued for
management.Four months later, her symptoms persisted with new orthopnea.
Cardiac MRI showed mild, diffuse pericardial thickening and diffuse
pericardial late enhancement, suggesting pericarditis. She was started on
prednisone and maintained on colchicine. One month later, she was admitted
for decompensated heart failure with weight gain, lower extremity edema
and shortness of breath. Right heart catheterization showed severely
elevated right and left sided filling pressures and equalization of
diastolic pressures with RV and LV discordance, consistent with
constrictive pericarditis. She was evaluated by cardiothoracic surgery and
ultimately underwent pericardiectomy. The pericardium was 50mm in
thickness and pathology reported a thickened membrane covered by fibrin.
DISCUSSION: Since the patient developed pleuritic chest pain and dyspnea
one month after COVID-19 infection, we suspected that her underlying
constrictive pericarditis was from COVID-19. The typical pericardium is 2
mm thick, and this patient's pericardium was 50 mm thick with fibrinous
morphology consistent with sclerosing pericarditis. Previous case reports
have documented transient pericarditis associated with recent COVID-19
infection or vaccination; however, the development of persistent
constrictive pericarditis with new decompensated heart failure is rare.
Medical management for COVID-19 pericarditis includes corticosteroids,
colchicine, and NSAIDs with resolution of symptoms. In this case, surgical
intervention with pericardiectomy was pursued for definitive management,
which is rare for COVID-19 related pericarditis. CONCLUSION(S): As
COVID-19 remains prevalent, it is essential to identify the development of
constrictive sclerosis pericarditis after recent infection. REFERENCE #1:
Hoit, B. D. (2002). Management of effusive and constrictive pericardial
heart disease. Circulation, 105(25), 2939-2942. REFERENCE #2: Imazio, M.
(2021). COVID-19 as a Possible Cause of Myocarditis and Pericarditis.
American college of cardiology. REFERENCE #3: Theetha Kariyanna P, Sabih
A, Sutarjono B, et al. A Systematic Review of COVID-19 and Pericarditis.
Cureus. 2022;14(8):e27948. Published 2022 Aug 12. doi:10.7759/cureus.27948
DISCLOSURES: No relevant relationships by Aubrey Clark No relevant
relationships by Sonia Dogra No relevant relationships by Ellina Feiner No
relevant relationships by Lucas Gitzel No relevant relationships by Amanda
Jacubowsky No relevant relationships by Stephen Kranick No relevant
relationships by Catherine Nguyen No relevant relationships by Dominic
Parfianowicz No relevant relationships by Bharani Pusukur No relevant
relationships by Naveed Rahman No relevant relationships by Swara
Shah Copyright © 2023 American College of Chest Physicians

<136>
Accession Number
2027236352
Title
FATAL PSEUDOMONAS AERUGINOSA PROSTHETIC VALVE ENDOCARDITIS AFTER
TRANSCATHETER AORTIC VALVE REPLACEMENT.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1214-A1215), 2023. Date of Publication: October
2023.
Author
BOYLAN K.A.T.E.; MYER A.B.; DEVAULT K.Y.L.E.; LUTTMANN K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Bacterial Invasion and Systemic Complications SESSION TYPE:
Rapid Fire Case Reports PRESENTED ON: 10/11/2023 09:40 am - 10:25 am
INTRODUCTION: In patients unsuitable for surgical aortic valve replacement
(SAVR), transcatheter aortic valve replacement (TAVR) is an alternative
for treatment of severe aortic stenosis (AS). Prosthetic valve
endocarditis (PVE) is a rare complication of TAVR that typically occurs
within the first year. Clinical manifestations may be subtle and
transesophageal echocardiogram (TEE) may be inconclusive. Surgical repair
to cure TAVR-PVE is rarely undertaken since patients are often deemed a
prohibitive surgical risk. On review of literature, we found only three
individual case reports of Pseudomonas aeruginosa TAVR-PVE. We herein
report the fourth such case. CASE PRESENTATION: A 70-year-old female with
a history of atrial fibrillation, recent hemorrhagic stroke, severe AS s/p
TAVR two months prior, and recent Pseudomonas aeruginosa bacteremia (PAB)
of unknown source presented to the ED five days after completing a
six-week course of cefepime for PAB. She had fever, rigors and altered
mental status. Patient met clinical criteria for septic shock and was
started on vancomycin and cefepime. Pseudomonas was isolated from 2/2
blood cultures. Infectious work-up, including chest x-ray, urinalysis, and
CT head, was unremarkable. Initial TEE was negative for vegetation, root
abscess, or new aortic regurgitation but evaluation limited by artifact
from stents of prosthesis. Surgical intervention discussed at hospital's
multidisciplinary valve conference but was rejected due to extremely high
operative mortality risk. Plan was to complete another six weeks of
cefepime followed by long-term suppressive therapy with ciprofloxacin.
Prior to completion of cefepime, repeat TEE performed due to worsening
mental status and continued concern for an infected aortic valve. This
showed a 1.5 x 0.8cm vegetation on the aortic valve (Figures 1 and 2).
Cardiothoracic surgery did not find patient to be a viable surgical
candidate. MRI of the brain showed scattered bilateral punctate foci
within the cerebrum and cerebellum thought to be from vegetation emboli
(Figure 3). Patient transitioned to hospice and died five days later.
DISCUSSION: This is the fourth reported case of Pseudomonas TAVR-PVE.
Enterococcus faecalis is the most common etiology for PVE in TAVR.
Diagnosis is difficult even by TEE because the view is often obstructed by
prosthetic materials and the vegetations are extremely small.
Complications include abscesses, fistulae, embolism, and heart failure.
Because TEE is not always diagnostic the physician must have a high index
of suspicion for endocarditis whenever bacteremia complicates TAVR.
Medical (antimicrobial) management is preferred, but this entails a high
risk of failure with subsequent relapse as in our patient.
 CONCLUSION(S): TAVR-PVE caused by resilient organisms such as
Pseudomonas aeruginosa is a disease looking for new options for therapy or
safer surgical interventional techniques. REFERENCE #1: Amat-Santos,
Ignacio J., et al. "Prosthetic Valve Endocarditis after Transcatheter
Valve Replacement." JACC: Cardiovascular Interventions, vol. 8, no. 2,
2015, pp. 334-346., https://doi.org/10.1016/j.jcin.2014.09.013. REFERENCE
#2: Dapas, Juan Ignacio, et al. "Pseudomonas Aeruginosa Infective
Endocarditis Following Transcatheter Aortic Valve Implantation: A Note of
Caution." The Open Cardiovascular Medicine Journal, vol. 10, no. 1, 2016,
pp. 28-34., https://doi.org/10.2174/1874192401610010028. REFERENCE #3:
Kuttamperoor, Francis, et al. "Infectious Endocarditis after Transcatheter
Aortic Valve Replacement." Cardiology in Review, vol. 27, no. 5, 2019, pp.
236-241., https://doi.org/10.1097/crd.0000000000000244. DISCLOSURES: No
relevant relationships by Kate Boylan No relevant relationships by Kyle
DeVault No relevant relationships by Kelly Luttmann No relevant
relationships by Ashley Myer Copyright © 2023 American College of
Chest Physicians

<137>
Accession Number
2027229549
Title
UNDIFFERENTIATED PLEOMORPHIC SARCOMA, PAZOPANIB, AND SECONDARY SPONTANEOUS
PNEUMOTHORAX.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A4530-A4531), 2023. Date of Publication: October
2023.
Author
ALEUY L.A.N.A.; VERMA D.; JERNIGAN A.B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Cancer Case Report Posters 1 SESSION TYPE: Case Report
Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION:
Secondary spontaneous pneumothoraces (SSP) are non-traumatic
pneumothoraces in patients with underlying pulmonary disease leading to
air entrapment in the pleural cavity and resultant lung collapse. SSPs are
known to occur in patients with lung disease secondary to sarcomas and
seem to be more common in patients taking pazopanib but the mechanism for
this association remains unclear [1]. This is a case of undifferentiated
pleomorphic sarcoma with metastases to the lungs responding to pazopanib
resulting in degeneration into necrotic air-filled lung cavities leading
to a secondary spontaneous pneumothorax. CASE PRESENTATION: A 72-year-old
woman with undifferentiated pleomorphic sarcoma of the right shoulder
presented to her oncologist with dyspnea. She had undergone resection of
the mass followed by radiation therapy, traditional chemotherapy and then
immunotherapy, all with disease progression. She was started on pazopanib
one month prior to the presentation. Computed tomography (CT) imaging of
the chest showed a large left-sided pneumothorax and she was admitted for
expedited treatment. On presentation, she was tachycardic to 108 but had a
normal blood pressure and oxygen saturation on room air. Interventional
pulmonology placed a 14-french pigtail chest tube with resultant
evacuation of air from the thorax. The CT also demonstrated thin wall
cavitary lesions corresponding with the areas of previously recognized
pulmonary metastases, indicating a favorable disease response to pazopanib
therapy. The pneumothorax was attributed to a ruptured metastatic lesion.
Pazopanib was held due to literature reporting its increased association
with pneumothoraces. It is unclear whether she will continue pazopanib,
given the treatment response, or if she will be switched to doxorubicin.
Cardiothoracic surgery suggested surgical resection of the metastases and
mechanical pleurodesis should this occur again. DISCUSSION: Pazopanib is a
tyrosine kinase inhibitor that targets various mediators of angiogenesis,
including endothelial growth factor receptors and platelet-derived growth
factor receptors [2]. It was approved for use in patients with soft tissue
sarcomas in 2012 after the PALETTE study showed a three month increase in
progression-free survival and is used as a third-line agent after
traditional chemotherapy failure. The incidence of pneumothoraces in the
PALETTE study was comparable to that in the control arm (3% vs. 1%); thus,
pneumothoraces were not reported as an adverse effect of the drug.
Instead, the pneumothoraces were presumed to be secondary to direct damage
of the metastases leading to airway obstruction and tissue infarction [3].
This patient had a secondary spontaneous pneumothorax after being started
on pazopanib. Her metastases went from solid nodules and masses to
involuted cavities after medication initiation, and likely caused a
bronchopleural fistula leading to her pneumothorax. The treatment of
choice for these pneumothoraces is initially tube thoracostomy but may
require pleurodesis and/or wedge resection of affected areas of the lung,
depending on the patient's response to different treatment strategies.
 CONCLUSION(S): Secondary spontaneous pneumothoraces can occur with
pazopanib and most likely result from pulmonary disease responding
favorably to pazopanib resulting in necrotic cavities that cause air leaks
and, ultimately, pneumothoraces. It is important to consider
pneumothoraces when patients on pazopanib with known lung metastases
present with dyspnea. REFERENCE #1: Sebanayagam, Vinoja, et al. "Tension
Pneumothorax: Is it Sarcoma or Pazopanib?." Cureus 12.10 (2020). REFERENCE
#2: Verschoor, Arie J., and Hans Gelderblom. "Pneumothorax as adverse
event in patients with lung metastases of soft tissue sarcoma treated with
pazopanib: a single reference centre case series." Clinical sarcoma
research 4 (2014): 1-6. REFERENCE #3: Van Der Graaf, Winette TA, et al.
"Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised,
double-blind, placebo-controlled phase 3 trial." The Lancet 379.9829
(2012): 1879-1886. DISCLOSURES: No relevant relationships by Lana Aleuy No
relevant relationships by Audrey Jernigan No relevant relationships by
Divya Verma Copyright © 2023 American College of Chest Physicians

<138>
Accession Number
2027229511
Title
SYSTEMATIC REVIEW AND META-ANALYSIS OF MYCOTIC CORONARY ARTERY ANEURYSM:
INCIDENCE, RISK FACTORS, ETIOLOGIES, CLINICAL PRESENTATION, DIAGNOSTIC
APPROACH, AND MANAGEMENT.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A367), 2023. Date of Publication: October 2023.
Author
CONTEH; BOLAJI O.; OUEDRAOGO F.; ADABALE O.; UNAMBA U.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Posters 4 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm
PURPOSE: Mycotic coronary artery aneurysm (MCAA) is a rare but serious
complication associated with the percutaneous coronary intervention and
systemic infections. This study aimed to conduct a systematic review and
meta-analysis of case reports to contribute to the existing knowledge
regarding the incidence, etiologies, risk factors, clinical presentation,
diagnostic approach, and management of MCAA. METHOD(S): We conducted
a systematic literature search from 1970 to 2021 on five databases and
Google Scholar. A total of 121 case reports were included for data
analysis. The data were analyzed using STATA (Version 17.0) software.
 RESULT(S): The average age of the patients was 57 years, and the
majority (81.8%) were men. The most common clinical presentations were
fever (84%) followed by dyspnea (45%), chest pain (45%), and myocardial
infarction (10.2%). The right coronary artery was the most commonly
affected vessel (41%). Staphylococcus aureus was the most common culprit
organism identified (84%). Surgical management was associated with the
best outcome, with 71% of patients undergoing surgery. The mortality rate
was 37.2%, with higher odds of dying from MCAA among patients with a
history of percutaneous coronary intervention, infective endocarditis,
diabetes, and coronary artery bypass graft. CONCLUSION(S): MCAA is a
rare but catastrophic clinical entity that can lead to a high mortality
rate. The incidence of MCAA is likely to increase due to the rise in
percutaneous coronary interventions, and there is no consensus on the
diagnostic approach and optimal management. Early recognition and
appropriate management are essential to reduce morbidity and mortality.
CLINICAL IMPLICATIONS: This study highlights the need for clinicians to be
aware of the potential for MCAA in patients undergoing PCI, particularly
those with risk factors such as a history of PCI, infective endocarditis,
diabetes, or CABG. Further research is needed to identify optimal
diagnostic and management strategies to reduce the high mortality rate
associated with MCAA. DISCLOSURES: No relevant relationships by Olanrewaju
Adabale No relevant relationships by Olayiwola Bolaji No relevant
relationships by Muhammad-Abbas Conteh No relevant relationships by Faizal
Ouedraogo No disclosure on file for Uchenna Unamba Copyright ©
2023 American College of Chest Physicians

<139>
Accession Number
2027228415
Title
FROM JOINT TO HEART: A CASE OF STAPHYLOCOCCUS LUGDUNENSIS INFECTION
CAUSING ENDOCARDITIS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A556-A557), 2023. Date of Publication: October 2023.
Author
ALI R.; MIRZA T.; KOVALENKO I.; SONI B.; AMIRIAN A.; GOLUBYKH K.;
BOBRYSHEVA H.; RAMESH N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters 3 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm
INTRODUCTION: Staphylococcus lugdunensis is a coagulase negative that can
be found on human skin and mucous membranes. While relatively uncommon, S.
lugdunensis is known for its ability to cause severe infections, including
endocarditis. CASE PRESENTATION: A 41-year-old male with no significant
medical history presented with right foot pain. Vitals on presentation
showed a blood pressure of 110/58 mm Hg, respiratory rate of 28/min, heart
rate of 112/min, and temperature of 101 F. Physical exam was grossly
normal except for a swollen and tender right ankle and the patient was
noted to be septic with cellulitis. Orthopedic surgery was consulted, and
the patient eventually underwent joint aspiration with white cell count of
574 and blood cultures grew Staphylococcus lugdunensis. The patient was
maintained on antibiotics and initially had a good recovery. However, 2
days later he was noted to be acutely encephalopathic, tachycardic and
hypoxic, and requiring 40 L of oxygen. He was noted to have a positive
jugular venous distension, coarse crackles in the lungs and was
subsequently intubated. Chest x-ray showed extensive bilateral airspace
opacities. A bedside point of care ultrasound was performed which showed
possible echogenic density on the mitral valve. A stat echocardiogram
showed significant vegetations on both aortic and mitral valve concern for
perforation of the valve. A CT of the chest showed extensive multifocal
consolidative changes throughout both lungs. The patient's antibiotics
were broadened vancomycin and cefepime. The patient then developed septic
shock, requiring increasing doses of pressors. Transesophageal
echocardiogram was performed which showed an aortic root abscess, mitral
valve, and aortic valve vegetations. This is also followed by a cardiac
catheterization which showed no occlusive coronary artery disease. He
underwent aortic valve replacement with patch repair of aortic annulus and
mitral valve repair. The repeat blood cultures showed no further growth.
The patient was eventually extubated and discharged home with long term
antibiotics and appropriate follow up. DISCUSSION: Patients with joint
infections caused by S. lugdunensis should be closely monitored for the
development of endocarditis, and this is particularly important if they
have risk factors such as prosthetic heart valves or a prior history of
endocarditis. (1) The choice of antibiotics is known to be challenging in
cases of S. lugdunensis endocarditis, as it is often resistant to multiple
antibiotics. (2) CONCLUSION(S): It is important for clinicians to be
aware of the potential for this organism to cause endocarditis and should
monitor patients with joint infections closely. REFERENCE #1: Rathod M,
Goregaonkar AB, Pandit SP. Staphylococcus lugdunensis endocarditis: A
report of two cases and review of literature. Indian J Med Microbiol.
2016;34(3):365-368 REFERENCE #2: Leblebicioglu H, Esen S, Bektore B, et
al. Staphylococcus lugdunensis endocarditis of native mitral valve: Case
report and review of the literature. Turk Kardiyol Dern Ars. 2013;41(3):
DISCLOSURES: No relevant relationships by Rimsha Ali No relevant
relationships by Aslan Amirian No relevant relationships by Hanna
Bobrysheva No relevant relationships by Konstantin Golubykh No relevant
relationships by Iuliia Kovalenko No relevant relationships by Taaha Mirza
No relevant relationships by Navitha Ramesh No relevant relationships by
Bosky Soni Copyright © 2023 American College of Chest Physicians

<140>
Accession Number
2027227615
Title
NATIVE VALVE CORYNEBACTERIUM ENDOCARDITIS WITH CONCURRENT PROSTHETIC
VALVE: WHY THIS VALVE?.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A1255-A1256), 2023. Date of Publication: October
2023.
Author
CHAJKOWSKI A.; PENG ANG S.O.N.G.; KHAN W.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Report Posters 7 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION:
Corynebacterium striatum (C. striatum) is a gram-positive bacillus that is
normally found in mucous membranes of healthy humans. Non-diphtheriae
Corynebacterium are typically dismissed in blood cultures as a contaminant
due to low virulence. C. striatum causes infections in immunocompromised
individuals, however there is some evidence of serious nosocomial
infections in immunocompetent hosts as well. These infections in
immunocompetent individuals are typically associated with devices such as
intravascular catheters. C. striatum can cause infective endocarditis (IE)
of prostatic valves, but rarely reported in the literature is C. striatum
IE of a native valve in a patient with concurrent prosthetic valve. CASE
PRESENTATION: An 82-year-old female with a history including mitral valve
replacement on warfarin with pacemaker, along with history of endocarditis
of prosthetic mitral valve 1-year prior presented to the hospital for
evaluation of anemia and hypotension. She was found to be in septic shock,
requiring vasopressor therapy. She was resuscitated with intravenous (IV)
fluids, and received broad spectrum antibiotics. She was admitted to the
intensive care unit, where transthoracic echocardiogram revealed a normal
prosthetic mitral valve, but interestingly there was a small vegetation on
the native aortic valve. She subsequently underwent a transesophageal
echocardiogram, which demonstrated adequate opening of the mitral valve
mechanical leaflets, however vegetation was seen on the native aortic
valve. Blood cultures from admission revealed Corynebacterium striatum.
The antibiotics were adjusted to Cefepime, Vancomycin, and Flagyl. Repeat
blood cultures two days later persistently grew Corynebacterium striatum.
Unfortunately, the patient began to clinically deteriorate and required
escalating vasopressors and began to develop acute renal failure. Given
her clinical deterioration, the patient was deemed not a candidate for
surgical intervention. Her condition continued to decline, and per family
request the patient was transferred to hospice and eventually expired.
DISCUSSION: C. striatum native valve endocarditis is unusual, and
exceedingly rare in a patient with a coexisting prosthetic valve. It is
unclear why a vegetation did not manifest on the patient's prosthetic
valve. It is hypothesized that the presence of a pacemaker along with
history of prosthetic valve endocarditis played a role in disease
manifestation. These risk factors, along with long term stay in a nursing
facility aided in virulence of C. striatum in our patient. Antibiotic
susceptibility data is limited for C. striatum, but data suggests
vancomycin is the most effective. CONCLUSION(S): Corynebacterium
species are typically low virulence in immunocompetent individuals. In
immunocompromised individuals, C. striatum in blood cultures should not be
discounted. Implanted hardware or indwelling catheters can potentially aid
in virulence of C. striatum as demonstrated in our case above. REFERENCE
#1: Milosavljevic MN, Milosavljevic JZ, Kocovic AG, Stefanovic SM,
Jankovic SM, Djesevic M, Milentijevic MN. Antimicrobial treatment of
Corynebacterium striatum invasive infections: a systematic review. Rev
Inst Med Trop Sao Paulo. 2021 Jun 18;63:e49. doi:
10.1590/S1678-9946202163049. PMID: 34161555; PMCID: PMC8216692. REFERENCE
#2: Lee PP, Ferguson DA Jr, Sarubbi FA. Corynebacterium striatum: an
underappreciated community and nosocomial pathogen. J Infect. 2005
May;50(4):338-43. doi: 10.1016/j.jinf.2004.05.005. PMID: 15845432.
REFERENCE #3: Hong HL, Koh HI, Lee AJ. Native Valve Endocarditis due to
Corynebacterium striatum confirmed by 16S Ribosomal RNA Sequencing: A Case
Report and Literature Review. Infect Chemother. 2016 Sep;48(3):239-245.
doi: 10.3947/ic.2016.48.3.239. Epub 2016 Sep 19. PMID: 27659439; PMCID:
PMC5048009. DISCLOSURES: No relevant relationships by Song Peng Ang No
relevant relationships by Amanda Chajkowski No relevant relationships by
Wajahat Khan Copyright © 2023 American College of Chest
Physicians

<141>
Accession Number
2027225203
Title
LOOKING IN THE "RIGHT" PLACE: DYNAMIC RIGHT VENTRICULAR OUTFLOW TRACT
OBSTRUCTION IN ACUTE LIVER FAILURE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A2393), 2023. Date of Publication: October 2023.
Author
GANERIWAL S.; MANEK G.; SIUBA M.T.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters 19 SESSION TYPE: Case
Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION:
Right ventricular outflow tract obstruction (RVOTO) has been described as
a rare cause of hemodynamic instability. However, the majority of these
cases have been described in congenital heart disease or post
cardiothoracic surgery. CASE PRESENTATION: A 41 year old male, with no
contributory past medical history, is admitted to the ICU with acute liver
failure due to intentional acetaminophen overdose. He was intubated for
airway protection. MELD-Na score was 41. Early in his course, he became
hypotensive, and a focused, bedside cardiac ultrasound was performed. This
revealed a normal left and right ventricular size with hyperdynamic
contractility, without a pericardial effusion. Inferior vena cava was not
assessed given he was on positive pressure ventilation. His work of
breathing was very high. The left ventricular outflow tract had no
significant gradient, but the right ventricular outflow tract (RVOT) was
collapsing, and demonstrated a high gradient (51.84mmHg). Sedation (to
mitigate respiratory effort) and crystalloid bolus were administered,
resulting in normalization of the RVOT gradient (10.24mmHg). DISCUSSION:
Hypotension in acute liver failure has a multitude of causes, including
dynamic left ventricular outflow tract obstruction secondary to systolic
anterior motion of the mitral valve or midcavitary obstruction. To the
best of our knowledge, this is the first case describing the presence of a
dynamic RVOTO in acute liver failure. The majority of previously described
RVOTO cases have been secondary to mechanical and/or extrinsic causes.
RVOTO has been associated with hemodynamic instability in the majority of
cases where it is found. This phenomenon could have significant
hemodynamic implications for fluid resuscitation, and the choice of
inotrope and vasopressor, intra-operatively, during liver transplant.
 CONCLUSION(S): Dynamic RVOTO is a cause of reversible hemodynamic
compromise in patients with acute liver failure and can be detected by
cardiac point-of-care ultrasonography. REFERENCE #1: Denault AY, Chaput M,
Couture P, Hebert Y, Haddad F, Tardif J-C. Dynamic right ventricular
outflow tract obstruction in cardiac surgery. J Thorac Cardiovasc Surg
2006;132(1):43-49. REFERENCE #2: Piangatelli C, Dottori M, Lisanti I,
Cerutti E. Dynamic LVOT Finding in Patients with End Stage Liver Disease
Candidates to Liver Transplantation Perioperative Assessment. Ann Clin
Anesth Res. 2020; 4(1): 1030. REFERENCE #3: Zeng YH, Calderone A,
Rousseau-Saine N, et al. Right Ventricular Outflow Tract Obstruction in
Adults: A Systematic Review and Meta-analysis. CJC Open
2021;3(9):1153-1168. DISCLOSURES: No relevant relationships by Simran
Ganeriwal No relevant relationships by Gaurav Manek No relevant
relationships by Matthew Siuba Copyright © 2023 American College
of Chest Physicians

<142>
Accession Number
2027224828
Title
CEREBRAL EMBOLIC PROTECTION FOR TRANSCATHETER AORTIC VALVE REPLACEMENT: A
SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A145-A146), 2023. Date of Publication: October 2023.
Author
ALI R.; AMIRIAN A.; MIRZA T.; SONI B.; RAJAK K.; ALJASSANI K.; HALDER A.;
CUNNINGHAM J.; RAMESH N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Posters 2 SESSION TYPE: Original
Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm
PURPOSE: Transcatheter Aortic-Valve Replacement (TAVR) is now considered
the intervention of choice for aortic stenosis, but disseminated debris
can significantly increase the risk of stroke which is a known
complication of the procedure. (1) Cerebral Embolic Protection (CEP)
devices were developed with the aim of capturing the debris and decreasing
the risk of post-procedural stroke. (2) We performed a systematic review
and meta-analysis of randomized controlled trials to assess the safety and
efficacy of CEP devices in TAVR. METHOD(S): A search was performed on
PubMed, Cochrane, and Web of Science and the Medical Subject Headings
terms for "(cerebral embolic protection) AND (Transcatheter aortic-valve
replacement)" were searched from the conception of data to 10/06/2022. A
total of 308 articles were screened by two independent reviewers and 24
full length articles were evaluated for eligibility. We included a total
of seven randomized controlled trials that compared any form of cerebral
embolic protection device to placebo in adult patients undergoing TAVR.
 RESULT(S): The total population of patients was 4321, with 2151
patients in the CEP group and 1848 in the placebo group. The mean age was
81 years and the follow-up period for most trials was 30 days. The primary
outcomes assessed included all-cause mortality and stroke with secondary
outcomes including disabling stroke and new ischemic lesions on magnetic
resonance imaging. Mortality at 30 days in the CEP group was 0.83%
(18/2151) compared to 0.59% (11/1848) in the placebo group. The random
effects model meta-analysis showed a Mantel-Haenszel (MH) odds ratio of
1.15 (confidence interval 0.52-2.5, p value 0.72), with an I2 of 0.00,
showing low heterogeneity. Stroke was noted in 3.77% (81/2148) compared to
3.81% (74/1941) in the CEP and placebo groups respectively, a random
effects model meta-analysis showed a MH odds ratio of 0.89 (confidence
interval 0.48-1.6; p value 0.72) with an I2 of 52.4. There was a small yet
significant difference in the rate of disabling stroke between the two
groups with the random effect model meta-analysis showing an MH odds ratio
of 0.472 (confidence interval 0.23-0.95; p value 0.03), favoring the CEP
group. Similarly, a fewer number of new MRI lesions were noted in the CEP
group compared to placebo with an MH odds ratio of 0.40 (CI 0.22-0.74; p
value 0.004). The most common adverse effects included acute kidney injury
and vascular complications with meta-analyses showing no difference among
the two groups. CONCLUSION(S): Cerebral embolic protection devices
for transcatheter aortic-valve replacement have not been shown to be
efficacious in terms of reducing mortality or risk of stroke, however,
they may decrease the risk of development of disabling stroke or new
lesions on MRI. Use of cerebral embolic protection device should be
considered based on individual patient factors. CLINICAL IMPLICATIONS: Use
of cerebral embolic protection device should be considered based on
individual patient factors. DISCLOSURES: No relevant relationships by
Rimsha Ali No relevant relationships by Khaldoon Aljassani No relevant
relationships by Aslan Amirian No relevant relationships by Jessica
Cunningham No relevant relationships by Anupam Halder No relevant
relationships by Taaha Mirza No relevant relationships by Kripa Rajak No
relevant relationships by Navitha Ramesh No relevant relationships by
Bosky Soni Copyright © 2023 American College of Chest Physicians

<143>
Accession Number
2027224029
Title
PRIMARY CARDIAC ANGIOSARCOMA WITH CARDIAC TAMPONADE.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A214-A215), 2023. Date of Publication: October 2023.
Author
SHETH N.; CORRIGAN A.; SCHUBACH S.L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: CT surgery: Something Is Not Where It Should Be SESSION
TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am
INTRODUCTION: Cardiac angiosarcomas have a reported incidence of 0.001% to
0.03% at autopsy, or about 1 in 500 cardiac surgical cases. They occur
most frequently in middle-age males. Almost 90% of tumors originate in the
right atrium with high rates of early metastasis and post-operative
recurrence. Clinical features include weight loss, anemia, pulmonary
embolism, chest pain, arrhythmias, tamponade, peripheral edema and
exertional dyspnea. Approximately 56% of patients present with pericardial
effusion, highlighting this tumor's predilection for atrial wall and
pericardial invasion. Right ventricular involvement is rare. Surgical
excision remains the mainstay of treatment and has been shown to increase
survival. Measures to improve rates of clear surgical margins have not
sufficiently been studied. CASE PRESENTATION: A 47-year-old man with a
history of hyperparathyroidism presented with four months of palpitations
and atypical chest pain. His vitals were stable. Physical exam was
unremarkable other than a regular tachycardia. His labwork was normal,
including D-dimer, TSH, HIV, Troponin I, and BNP. His EKG revealed atrial
flutter. An echocardiogram demonstrated a large mass along the lateral
right atrial wall, and a pericardial effusion with tamponade physiology. A
CT and cardiac MRI found a 4.7 x 3.7 cm hypo-attenuating mass in the
lateral wall of the right atrium. Coronary angiography demonstrated his
right coronary artery supplied vascularization to the right atrial mass.
The patient elected to undergo resection of the mass. Intraoperatively,
700 cc of bloody fluid was released and contained malignant cells. The
infiltrating mass in the right atrium extended to the right ventricular
free wall and encircled the right coronary artery. Unfortunately, the mass
was deemed unresectable. Pathology revealed high-grade angiosarcoma.
DISCUSSION: Data on cardiac angiosarcomas are limited to case reports,
series, and retrospective cohort studies, with many underpowered to
compare management strategies. In fact, no randomized clinical trials were
identified. In one case series of 12 patients who underwent surgical
resection, 58% showed macroscopically positive margins (R2), which was
associated with significantly lower progression-free survival (PFS) (12.6
vs 2.7 months) and overall survival (OS) (21.8 vs 7.2 months) than with
negative (R0) or microscopically-positive margins (R1). In one
retrospective study, only one third achieved R0 margins. Neoadjuvant
chemotherapy has shown to significantly increase OS perhaps as it may
facilitate more complete surgical resection. There is also a paucity of
data regarding mutational analysis which is crucial in designing targeted
therapies. This patient's tumor showed a rearrangement in exon 4 of MEN1,
which was not seen in the literature or in 52 samples analyzed in the
Catalogue of Somatic Mutations in Cancer (COSMIC). Curiously, this patient
also had a history of multiple parathyroid adenomas. CONCLUSION(S):
This case report points out patterns which may lead to an alternative
treatment plan. For example, connecting this tumor's propensity for
right-atrial involvement and frequency of atrial and pericardial invasion
with this patient's effusion and atrial arrhythmia may next time raise
earlier suspicion of a malignant cardiac tumor. Leading to preoperative
pursuit of pericardial fluid cytology and subsequent neoadjuvant
chemotherapy to increase survival time and increase chances of attaining
negative surgical margins. REFERENCE #1: Yu, JF., Cui, H., Ji, GM. et al.
Clinical and imaging manifestations of primary cardiac angiosarcoma. BMC
Med Imaging 19, 16 (2019). https://doi.org/10.1186/s12880-019-0318-4
REFERENCE #2: Hillock R, Lainchbury J, Robinson B. Images in cardiology:
Cardiac angiosarcoma: diagnosis by coronary angiography. Heart. 2005
Oct;91(10):1270. doi: 10.1136/hrt.2004.051482. PMID: 16162611; PMCID:
PMC1769124. REFERENCE #3: Patel SD, Peterson A, Bartczak A, Lee S,
Chojnowski S, Gajewski P, Loukas M. Primary cardiac angiosarcoma - a
review. Med Sci Monit. 2014 Jan 23;20:103-9. doi: 10.12659/MSM.889875.
PMID: 24452054; PMCID: PMC3907509. DISCLOSURES: No relevant relationships
by Andrew Corrigan No relevant relationships by Scott Schubach No relevant
relationships by Nikhil Sheth Copyright © 2023 American College
of Chest Physicians

<144>
Accession Number
2027224025
Title
FROM HEMO TO CHEMO.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A3710), 2023. Date of Publication: October 2023.
Author
MUDIGONDA G.; HODGEMAN N.; THI M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of Pleura Case Report Posters 7 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am
INTRODUCTION: A spontaneous hemothorax is a relatively uncommon condition
that can result from malignancy, vascular insults, pulmonary infarction,
or coagulopathy. Epithelioid angiosarcoma is an aggressive epithelial cell
malignancy arising from the adrenals, thyroid, skin, or bone. We present a
case of an epithelioid angiosarcoma presenting as a spontaneous
hemothorax. CASE PRESENTATION: A 59 year old female with type 2 diabetes
mellitus and hyperlipidemia presented with subacute worsening back pain
and dyspnea. On presentation, a chest radiograph showed a large left sided
pleural effusion with near complete opacification of the left hemithorax.
A thoracentesis was performed with a pleural fluid hematocrit of 39%
(serum 28%), 3.9 million RBC, and 6,500 nucleated cells (87% neutrophils).
A chest tube was subsequently placed with drainage of 1500cc of blood over
the following three days. Following complete evacuation of the thoracic
cavity, a computed topography of the chest revealed numerous bilateral
pulmonary nodules with surrounding groundglass opacification. An
endobronchial ultrasound with navigational bronchoscopy was performed and
did not reveal evidence of malignancy. Three days after, she presented
with a recurrent hemothorax. Video-assisted thoracic surgery with pleural
biopsies was performed, revealing poorly formed epithelioid angiosarcoma.
She received chemotherapy with paclitaxel, but unfortunately her condition
continued to deteriorate, and she was ultimately transitioned to comfort
care. DISCUSSION: Lung malignancies are often associated with pleural
effusions caused by the accumulation of fluid in the pleural space and is
thought to be due to tumor cell infiltration into the pleural space which
blocks lymphatic drainage of pleural fluid. (Psallidas et al. 2016) In
addition to tumor cell infiltration in the pleural space, tumor rupture
and/or vascular invasion is thought to be a major cause of hemothorax in
malignancy. Several case studies have also reported
angiosarcoma-associated hemothorax, however presentations varied with
bilateral effusions, pneumomediastinum, diaphragmatic tumors. (Janik et
al. 2014) Interestingly, several patients had bilateral cystic lesions
with hemothorax at the time of diagnosis. It is unclear if our patient had
primary pulmonary angiosarcoma (PPA) or metastatic disease, though her
presentation resembles that of others with PPA. (Krenke et al. 2011) The
majority of patients with spontaneous hemothorax related to PPA were older
than 70 and had poor outcomes. (Krenke et al. 2011) It is possible that
certain patterns exist in patients with angiosarcoma-related hemothorax.
 CONCLUSION(S): Spontaneous hemothorax due to neoplastic causes is
rare and has mostly been reported only in association with
Neurofibromatosis type 1. (Janik et al. 2014) Our case demonstrates that
more research is needed to delineate patterns in malignancy-induced
hemothorax to help patients with early diagnosis and treatment. REFERENCE
#1: Janik, Martin, Lubomir Straka, Jozef Krajcovic, Petr Hejna, Julian
Hamzik, and Frantisek Novomesky. 2014. "Non-Traumatic and Spontaneous
Hemothorax in the Setting of Forensic Medical Examination: A Systematic
Literature Survey." Forensic Science International 236 (March): 22-29.
https://doi.org/10.1016/J.FORSCIINT.2013.12.013. REFERENCE #2: Krenke,
Rafal, Joanna Klimiuk, Piotr Korczynski, Wlodzimierz Kupis, Malgorzata
Szolkowska, and Ryszarda Chazan. 2011. "Hemoptysis and Spontaneous
Hemothorax in a Patient with Multifocal Nodular Lung Lesions." Chest 140
(1): 245-51. https://doi.org/10.1378/chest.10-1865. REFERENCE #3:
Psallidas, Ioannis, Ioannis Kalomenidis, Jose M. Porcel, Bruce W.
Robinson, and Georgios T. Stathopoulos. 2016. "Malignant Pleural Effusion:
From Bench to Bedside." European Respiratory Review : An Official Journal
of the European Respiratory Society 25 (140): 189-98.
https://doi.org/10.1183/16000617.0019-2016. DISCLOSURES: No relevant
relationships by Nicholas Hodgeman No relevant relationships by Ghanshyam
Mudigonda No relevant relationships by Meilinh Thi Copyright ©
2023 American College of Chest Physicians

<145>
Accession Number
2027223929
Title
RARE CARDIAC TUMOR: DO WE KNOW ALL ABOUT CARDIAC MYXOFIBROSARCOMA?.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A224-A225), 2023. Date of Publication: October 2023.
Author
SAVANI S.; PAWA A.; PATEL M.; PATEL H.E.T.; SYED M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Report Posters 4 SESSION TYPE:
Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm
INTRODUCTION: Primary cardiac tumors (PCTs) are less frequent and carry an
incidence of 1.38 per 100,000 population per year [1]. Myxofibrosarcomas
are reported as one of the rarest forms of cardiac sarcomas, mostly with
mesenchymal origin and located in left atrium [2]. Current research
indicates an increase in median survival from 14 months to 36 months
following complete resection and chemo-radiotherapy [2]. CASE
PRESENTATION: A 55/F Caucasian with c/o brief self-resolving episodes of
memory loss, aphasia following migraine headaches since last few months
with associated exertional dyspnea and episodes of hypotension. Her vitals
were normal other than BP: 88/76 mmhg and examination revealed right sided
facial droop with cardiac rub and murmur on auscultation. MRI brain was
recommended which revealed a non-hemorrhagic infarct, a small old left
cerebellar and multiple watershed infarcts. She denied smoking, using
recreational drugs however reported social drinking. On initial work up,
EKG findings suggested tachycardia with left atrial enlargement and low
voltage QRS with normal lab work. The Trans-esophageal echocardiography
revealed a large mass of around 5 cm in size located at the posterior wall
of left atrium extending to left ventricle causing mitral stenosis, high
pulmonary artery pressure and left atrial dilatation (Fig A). Patient was
initially managed conservatively and referred to cardiothoracic surgery.
She underwent a complete surgical resection without any postoperative
events. The histopathological report indicated proliferation of malignant
spindle cells with foci of necrosis and prominent mitotic figures with
FNCLCC grade 3 of 3. The spindle cell population was positive for CD31 and
was weakly positive for pancytokeratin indicating the presence of a
primary cardiac sarcoma (Fig B1 & B2). A Positron-emission-therapy (PET)
scan carried out on day 38 postoperatively showed mild metabolic activity
in lower right paratracheal and right subcarinal lymph nodes along with an
enlarged node in the right cervical chain at level 4 indicating a reactive
process. Patient was referred to hematology-oncology for further
management. DISCUSSION: We would like to highlight the severity of illness
in spite of subtle symptoms in this case. The patient's tumor involved the
left atrial wall and posterior leaflet of mitral valve, which itself
increases the risk of left ventricular inlet obstruction and
thromboembolic events. Literature suggests, these tumors are rare and
associated with vicious recurrence one year after complete resection,
which leads to high mortality. Hence, early diagnosis and aggressive
management is the key for better outcome. In addition, future studies are
needed to assess the location of the tumor and its relationship with
prognosis. CONCLUSION(S): Here, patient presented with neurological
symptoms and exertional dyspnea which prompted the diagnostic workup.
Considering its rare nature and lack of diagnostic methods for early
detection and prevention, tumor was already 5 cm in size at the time of
diagnosis. Current literature states that tumors larger than 4 cm
with/without high grade differentiation are associated with a worse
prognosis [3]. Complete resection of the tumor along with chemo and radio
therapy improves survival time from 14 months to 36 months, Multimodal
therapy is the key for better long-term survival [2]. REFERENCE #1: Cresti
A, Chiavarelli M, Glauber M, Tanganelli P, Scalese M, Cesareo F, Guerrini
F, Capati E, Focardi M, Severi S. Incidence rate of primary cardiac
tumors: a 14-year population study. J Cardiovasc Med (Hagerstown). 2016
Jan;17(1):37-43. doi: 10.2459/JCM.0000000000000059. PMID: 25022931.
REFERENCE #2: Randhawa JS, Budd GT, Randhawa M, Ahluwalia M, Jia X, Daw H,
Spiro T, Haddad A. Primary Cardiac Sarcoma: 25-Year Cleveland Clinic
Experience. Am J Clin Oncol. 2016 Dec;39(6):593-599. doi:
10.1097/COC.0000000000000106. PMID: 25036471. REFERENCE #3: Sun, D., Wu,
Y., Liu, Y. et al. Primary cardiac myxofibrosarcoma: case report,
literature review and pooled analysis. BMC Cancer 18, 512 (2018).
https://doi.org/10.1186/s12885-018-4434-2 DISCLOSURES: No relevant
relationships by Mihir Patel No relevant relationships by Het Patel No
relevant relationships by Arpita Pawa No relevant relationships by Saloni
Savani No relevant relationships by Mohammed Syed Copyright ©
2023 American College of Chest Physicians

<146>
Accession Number
2027204007
Title
RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION SECONDARY TO METASTATIC
PULMONARY ADENOCARCINOMA.
Source
Chest. Conference: CHEST 2023 Annual Meeting. Honolulu United States.
164(4 Supplement) (pp A4260-A4261), 2023. Date of Publication: October
2023.
Author
CONDIT D.W.; SABHARWAL S.; FISCUS G.; MAGGE A.N.I.L.; KAUR A.; GERARDI
D.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Rare Presentations of Cancer SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am INTRODUCTION: Right
ventricular outflow tract obstruction (RVOTO) is an uncommon cause of
right ventricular dysfunction in adults. Etiologies of this syndrome
include pulmonary artery and trunk neoplasm, cardiac metastatic disease,
double-chambered right ventricle, hypertrophic cardiomyopathy, and sinus
of Valsalva aneurysm (1). Herein we present a case of RVOTO secondary to
metastatic primary lung cancer which required surgical management to
relieve obstruction. CASE PRESENTATION: A 50-year-old female with history
of metastatic, epidermal growth factor receptor (EGFR) exon 19 mutation
positive, pulmonary adenocarcinoma on osmeritinib, presented to our
hospital with several day history of progressive exertional dyspnea,
left-sided chest pressure and dizziness. She had a recent diagnosis of
pulmonary embolism treated with apixaban. In the emergency department, she
was tachycardic and tachypneic. Her blood pressure was 92/72mmHg, with a
peripheral oxygen saturation of 95% on ambient air. Her breathing was
labored. The patient's bloodwork revealed high sensitivity troponin level
of 26ng/dL, brain natriuretic peptide level of 1,530pg/mL, and lactic acid
of 2.8 mmol/L. CT angiography of the chest demonstrated an irregular mass
in the left ventricular basal anterior wall and ventricular septum
extending into the RVOT and pulmonary trunk lumen (Figure 1). Additionally
observed was an enlarging left hilar mass causing extrinsic compression of
the left upper lobe segmental pulmonary artery branches and airways, and a
small, hyperdense pericardial effusion. The patient was therefore admitted
to the medical-surgical ward for further evaluation and management.
Echocardiography (Figure 2) and cardiac MRI (Figure 3) confirmed a
lobulated, enhancing mass from the basal anterior right and left
ventricular wall and intraventricular septum, narrowing the RVOT and
pulmonary artery lumen. On the third hospital day, the patient developed
near-syncope and was transferred to the cardiac critical care unit for
closer monitoring. A multi-disciplinary meeting including pulmonology
medicine, medical oncology and cardiothoracic surgery was held, and a
decision was made to pursue surgical debulking of the RVOT. The following
day the patient was taken to the operating room and placed on
cardiopulmonary bypass with subsequent debulking of the RVOT through an
incision in the main pulmonary artery. Intraoperative transesophageal
echocardiogram following debulking revealed normal biventricular function.
She returned from the operating room in stable condition. She remains
hospitalized with plans to continue treatment with stereotactic radiation
therapy to the metastatic cardiac mass. DISCUSSION: Our patient
experienced RVOTO from cardiac metastasis of her EGFR exon 19 mutation
positive pulmonary adenocarcinoma despite targeted therapy with
osmeritinib. A systemic review on adult RVOTO which included 291 patients
from 233 available reports demonstrated that extracardiac metastasis was
the etiology in 13.7% of cases (1). Lung cancer is the most common
malignancy that metastasizes to the heart, representing 36 to 39% of
secondary cardiac malignancy (2). Cardiac metastasis of primary lung
cancer is a poor prognostic marker (3). CONCLUSION(S): RVOTO from
tumor mass effect should be on the differential of patients with
metastatic primary lung cancer presenting with new orthostatic signs and
symptoms. REFERENCE #1: Zeng, Yu Hao, Alexander Calderone, Nicolas
Rousseau-Saine, Mahsa Elmi-Sarabi, Stephanie Jarry, Etienne J. Couture,
Matthew P. Aldred, et al. 2021. "Right Ventricular Outflow Tract
Obstruction in Adults: A Systematic Review and Meta-Analysis." CJC Open 3
(9): 1153-68. REFERENCE #2: Goldberg, Aaron D., Ron Blankstein, and Robert
F. Padera. 2013. "Tumors Metastatic to the Heart." Circulation 128 (16):
1790-94. REFERENCE #3: Lichtenberger, John P., 3rd, David A. Reynolds,
Jonathan Keung, Elaine Keung, and Brett W. Carter. 2016. "Metastasis to
the Heart: A Radiologic Approach to Diagnosis With Pathologic
Correlation." AJR. American Journal of Roentgenology 207 (4): 764-72.
DISCLOSURES: No relevant relationships by Daniel Condit No relevant
relationships by Garrett Fiscus Speaker/Speaker's Bureau relationship with
Astra Zeneca, GSK Please note: $1001 - $5000 by Daniel Gerardi,
value=Honoraria No relevant relationships by Antarpreet Kaur No relevant
relationships by Anil Magge No relevant relationships by Simrina
Sabharwal Copyright © 2023 American College of Chest Physicians

<147>
Accession Number
2025666320
Title
Is There a Future for Minimal Access and Robots in Cardiac Surgery?.
Source
Journal of Cardiovascular Development and Disease. 10(9) (no pagination),
2023. Article Number: 380. Date of Publication: September 2023.
Author
Faerber G.; Mukharyamov M.; Doenst T.
Institution
(Faerber, Mukharyamov, Doenst) Department of Cardiothoracic Surgery, Jena
University Hospital, Friedrich Schiller University, Am Klinikum 1, Jena
07747, Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Minimally invasive techniques in cardiac surgery have found increasing use
in recent years. Both patients and physicians often associate smaller
incisions with improved outcomes (i.e., less risk, shorter hospital stay,
and a faster recovery). Videoscopic and robotic assistance has been
introduced, but their routine use requires specialized training and is
associated with potentially longer operating times and higher costs.
Randomized evidence is scarce and transcatheter treatment alternatives are
increasing rapidly. As a result, the concept of minimally invasive cardiac
surgery may be viewed with skepticism. In this review, we examine the
current status and potential future perspectives of minimally invasive and
robotic cardiac surgery. Copyright © 2023 by the authors.

<148>
Accession Number
2027188586
Title
Moderate-Intensity Statin with Ezetimibe Combination Therapy vs
High-Intensity Statin Monotherapy in Patients at Very High Risk of
Atherosclerotic Cardiovascular Disease: A Post Hoc Analysis from the
RACING Randomized Clinical Trial.
Source
JAMA Cardiology. 8(9) (pp 853-858), 2023. Date of Publication: 13 Sep
2023.
Author
Lee S.-J.; Cha J.-J.; Choi W.G.; Lee W.-S.; Jeong J.-O.; Choi S.; Cho
Y.-H.; Park W.; Yoon C.-H.; Lee Y.-J.; Hong S.-J.; Ahn C.-M.; Kim B.-K.;
Ko Y.-G.; Choi D.; Hong M.-K.; Jang Y.; Hong S.J.; Kim J.-S.
Institution
(Lee, Lee, Hong, Ahn, Kim, Ko, Choi, Hong, Kim) Division of Cardiology,
Severance Hospital, Yonsei University, College of Medicine, Seoul, South
Korea
(Cha, Hong) Department of Cardiology, Cardiovascular Center, Korea
University, Anam Hospital, Korea University College of Medicine, Seoul,
South Korea
(Choi) Konkuk University, Chungju Hospital, Chungju, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Chung-Ang
University, College of Medicine, Seoul, South Korea
(Jeong) Chungnam National University Hospital, Daejeon, South Korea
(Choi) Division of Cardiology, Department of Internal Medicine, Kangnam
Sacred Heart Hospital, Hallym University, College of Medicine, Seoul,
South Korea
(Cho) Buchon Soonchunhyang Hospital, Soonchunhyang University, College of
Medicine, Bucheon, South Korea
(Park) Cardiovascular Division, Department of Internal Medicine, Hallym
University, Medical Center, Anyang, South Korea
(Yoon) Division of Cardiology, Department of Internal Medicine, Seoul
National University, Bundang Hospital, Seongnam, South Korea
(Jang) CHA University, College of Medicine, Seongnam, South Korea
Publisher
American Medical Association
Abstract
Importance: High-intensity statin is strongly recommended in patients at
very high risk (VHR) of atherosclerotic cardiovascular disease (ASCVD).
However, concerns about statin-associated adverse effects result in
underuse of this strategy in practice. Objective(s): To evaluate the
outcomes of a moderate-intensity statin with ezetimibe combination in VHR
and non-VHR patients with ASCVD. Design, Setting, and Participant(s):
This was a post hoc analysis of the Randomized Comparison of Efficacy and
Safety of Lipid Lowering With Statin Monotherapy vs Statin/Ezetimibe
Combination for High-Risk Cardiovascular Disease (RACING) open-label,
multicenter, randomized clinical trial. The study was conducted from
February 2017 to December 2018 at 26 centers in Korea. Study participants
included patients with documented ASCVD. Data were analyzed from April to
June 2022. Intervention(s): Patients were randomly assigned to
moderate-intensity statin with ezetimibe (rosuvastatin, 10 mg, with
ezetimibe, 10 mg) or high-intensity statin monotherapy (rosuvastatin, 20
mg). Patients at VHR for ASCVD were defined according to the 2018 American
Heart Association/American College of Cardiology guidelines. Main
Outcomes and Measures: The primary end point was the 3-year outcome of
cardiovascular death, coronary or peripheral revascularization,
hospitalization of cardiovascular events, or nonfatal stroke.
 Result(s): A total of 3780 patients (mean [SD] age, 64 [10] years;
2826 male [75%]) in the RACING trial, 1511 (40.0%) were categorized as
VHR, which was associated with a greater occurrence of the primary end
point (hazard ratio [HR], 1.42; 95% CI, 1.15-1.75). There was no
significant difference in the primary end point between those who received
combination therapy and high-intensity statin monotherapy among patients
with VHR disease (11.2% vs 11.7%; HR, 0.96; 95% CI, 0.71-1.30) and non-VHR
disease (7.7% vs 8.7%; HR, 0.88; 95% CI, 0.66-1.18). The median
low-density lipoprotein cholesterol (LDL-C) level was significantly lower
in the combination therapy group than in the high-intensity statin group
(VHR, 1 year: 57 [47-71] mg/dL vs 65 [53-78] mg/dL; non-VHR, 1 year: 58
mg/dL vs 68 mg/dL; P <.001). Furthermore, in both the VHR and non-VHR
groups, combination therapy was associated with a significantly greater
mean change in LDL-C level (VHR, 1 year: -19.1 mg/dL vs -10.1 mg/dL; 2
years: -22.3 mg/dL vs -13.0 mg/dL; 3 years: -18.8 mg/dL vs -9.7 mg/dL;
non-VHR, 1 year: -23.7 mg/dL vs -12.5 mg/dL; 2 years: -25.2 mg/dL vs -15.1
mg/dL; 3 years: -23.5 mg/dL vs -12.6 mg/dL; all P <.001) and proportion of
patients with LDL-C level less than 70 mg/dL (VHR, 1 year: 73% vs 58%;
non-VHR, 1 year: 72% vs 53%; P <.001). Discontinuation or dose reduction
of the lipid-lowering drug due to intolerance occurred less frequently in
the combination therapy group (VHR, 4.6% vs 7.7%; P =.02; non-VHR, 5.0% vs
8.7%; P =.001). Conclusions and Relevance: Results suggest that the
outcomes of ezetimibe combination observed in the RACING trial were
consistent among patients at VHR of ASCVD. Copyright © 2023
American Medical Association. All rights reserved.

<149>
Accession Number
2025928431
Title
THE USE OF DISTAL FEMORAL VENOUS ACCESS FOR PULMONARY VEIN CRYOBALLOON
ABLATION AND LEFT ATRIAL APPENDAGE OCCLUDER IMPLANTATION: RANDOMIZED STUDY
DESIGN AND PRELIMINARY RESULTS.
Source
Journal of Arrhythmology. 30(3) (pp 5-15), 2023. Date of Publication:
2023.
Author
Abdullaev A.M.; Davtyan K.V.; Topchyan A.G.
Institution
(Abdullaev, Davtyan, Topchyan) Federal State Budgetary Institution
<<National Medical Research Center for Therapy and Preventive Medicine>>
of Ministry of Health of Russian Federation, 10 Petroverigsky lane,
Moscow, Russian Federation
Publisher
NJSC Institute of Cardiological Technology (INCART)
Abstract
Aim. This study aims to compare the results of the distal femoral access
with the classic approach in patients undergoing pulmonary vein
cryoballoon ablation and left atrial appendage occluder implantation.
Methods. The primary results of the 1:1 randomized single-center study are
presented. The study group recruited 47 patients who underwent the
catheter-based procedure using ultrasound-assisted distal femoral access.
38 patients with traditional ultrasound-guided proximal femoral access
were involved in the control group. Results. Total 85 patients were
included: 47 in the study group and 38 in the control group. The median
age was 61 years, and pulmonary vein cryo-ablation was performed in 84%.
95% of patients were taking direct oral anticoagulants. In the study
group, the most frequent topographic and anatomical variant was the
location of the superficial femoral vein on the lateral side from the
artery (81%), whereas in the control group it was on the medial side
(81%). The median access time was 30 s in the study group for the right
leg and 35 s for the left leg. In the control group, access time was 33 s
and 39 s for the right and left leg respectively. Unintentional arterial
puncture occurred more frequently in both groups when the vein was fully
overlapped by the artery for both right and left legs, but the differences
were statistical unsignificant (p>0.05 and p=0.09 in the main group,
p=0.24 and p=0.72 in the control group). In a correlation analysis,
neither body mass index (p=0.19) nor femoral circumference (p=0.19 for
right and p=0.06 for left legs) influenced the access time and did not
increase the number of unintended arterial punctures. Two patients in the
control group required additional manual hemostasis. There was no
postprocedural venous thrombosis in both groups. Back pain was observed
only in patients in the control group. Conclusion. The efficacy and safety
of the distal femoral access approach are comparable to the traditional
proximal approach. Earlier postprocedural activation of patients can help
improve quality of life. Copyright © Autors 2023.

<150>
Accession Number
2025666355
Title
A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve
(BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in
Light of Recent Guidelines.
Source
Journal of Cardiovascular Development and Disease. 10(9) (no pagination),
2023. Article Number: 398. Date of Publication: September 2023.
Author
Bulut H.I.; Arjomandi Rad A.; Syrengela A.-A.; Ttofi I.; Djordjevic J.;
Kaur R.; Keiralla A.; Krasopoulos G.
Institution
(Bulut) Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa,
Istanbul 34098, Turkey
(Arjomandi Rad) Medical Sciences Division, University of Oxford, Oxford
OX1 3AZ, United Kingdom
(Syrengela) School of Medicine of Crete, Heraklion 71500, Greece
(Ttofi, Djordjevic, Kaur, Keiralla, Krasopoulos) Department of
Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust,
Oxford OX3 9DU, United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Objective: bicuspid aortic valve (BAV) stands as the most prevalent
congenital heart condition intricately linked to aortic pathologies
encompassing aortic regurgitation (AR), aortic stenosis, aortic root
dilation, and aortic dissection. The aetiology of BAV is notably
intricate, involving a spectrum of genes and polymorphisms. Moreover, BAV
lays the groundwork for an array of structural heart and aortic disorders,
presenting varying degrees of severity. Establishing a tailored clinical
approach amid this diverse range of BAV-related conditions is of utmost
significance. In this comprehensive review, we delve into the
epidemiology, aetiology, associated ailments, and clinical management of
BAV, encompassing imaging to aortic surgery. Our exploration is guided by
the perspectives of the aortic team, spanning six distinct guidelines.
 Method(s): We conducted an exhaustive search across databases like
PubMed, Ovid, Scopus, and Embase to extract relevant studies. Our review
incorporates 84 references and integrates insights from six different
guidelines to create a comprehensive clinical management section.
 Result(s): BAV presents complexities in its aetiology, with specific
polymorphisms and gene disorders observed in groups with elevated BAV
prevalence, contributing to increased susceptibility to other
cardiovascular conditions. The altered hemodynamics inherent to BAV
instigate adverse remodelling of the aorta and heart, thus fostering the
development of epigenetically linked aortic and heart diseases. Employing
TTE screening for first-degree relatives of BAV patients might be
beneficial for disease tracking and enhancing clinical outcomes. While
SAVR is the primary recommendation for indicated AVR in BAV, TAVR might be
an option for certain patients endorsed by adept aortic teams. In
addition, proficient teams can perform aortic valve repair for AR cases.
Aortic surgery necessitates personalized evaluation, accounting for
genetic makeup and risk factors. While the standard aortic replacement
threshold stands at 55 mm, it may be tailored to 50 mm or even 45 mm based
on patient-specific considerations. Conclusion(s): This review
reiterates the significance of considering the multifactorial nature of
BAV as well as the need for further research to be carried out in the
field. Copyright © 2023 by the authors.

<151>
Accession Number
642358833
Title
Impact of New Cardiovascular Events on Quality of Life and Hospital Costs
in People With Cardiovascular Disease in the United Kingdom and United
States.
Source
Journal of the American Heart Association. (pp e030766), 2023. Date of
Publication: 26 Sep 2023.
Author
Lui J.N.M.; Williams C.; Keng M.J.; Hopewell J.C.; Sammons E.; Chen F.;
Gray A.; Bowman L.; Landray S.M.J.; Mihaylova B.
Institution
(Lui, Williams, Keng, Gray) Health Economics Research Centre, Nuffield
Department of Population Health University of Oxford Oxford United
Kingdom, United Kingdom
(Hopewell, Sammons, Chen, Bowman, Landray) Clinical Trial Service Unit and
Epidemiological Studies Unit Nuffield Department of Population Health
University of Oxford United Kingdom, United Kingdom
(Bowman) Medical Research Council Population Health Research Unit,
Nuffield Department of Population Health University of Oxford United
Kingdom, United Kingdom
(Mihaylova) Health Economics and Policy Research Unit, Wolfson Institute
of Population Health Queen Mary University of London United Kingdom,
United Kingdom
Publisher
NLM (Medline)
Abstract
Background Despite optimized risk factor control, people with prior
cardiovascular disease remain at high cardiovascular disease risk. We
assess the immediate- and longer-term impacts of new vascular and
nonvascular events on quality of life (QoL) and hospital costs among
participants in the REVEAL (Randomized Evaluation of the Effects of
Anacetrapib Through Lipid Modification) trial in secondary prevention.
Methods and Results Data on demographic and clinical characteristics,
health-related quality of life (QoL: EuroQoL 5-Dimension-5-Level), adverse
events, and hospital admissions during the 4-year follow-up of the 21820
participants recruited in Europe and North America informed assessments of
the impacts of new adverse events on QoL and hospital costs from the UK
and US health systems' perspectives using generalized linear regression
models. Reductions in QoL were estimated in the years of event occurrence
for nonhemorrhagic stroke (-0.067 [United Kingdom], -0.069 [US]), heart
failure admission (-0.072 [United Kingdom], -0.103 [US]), incident cancer
(-0.064 [United Kingdom], -0.068 [US]), and noncoronary revascularization
(-0.071 [United Kingdom], -0.061 [US]), as well as in subsequent years
following these events. Myocardial infarction and coronary
revascularization (CRV) procedures were not found to affect QoL. All
adverse events were associated with additional hospital costs in the years
of events and in subsequent years, with the highest additional costs in
the years of noncoronary revascularization (5830 [United Kingdom], $14133
[US Medicare]), of myocardial infarction with urgent CRV procedure (5614,
$24722), and of urgent/nonurgent CRV procedure without myocardial
infarction (4674/4651 and $15251/$17539). Conclusions Stroke, heart
failure, and noncoronary revascularization procedures substantially reduce
QoL, and all cardiovascular disease events increase hospital costs. These
estimates are useful in informing cost-effectiveness of interventions to
reduce cardiovascular disease risk in secondary prevention. Registration
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01252953;
https://www.Isrctn.com. Unique identifier: ISRCTN48678192;
https://www.clinicaltrialsregister.eu. Unique identifier: 2010-023467-18.

<152>
Accession Number
642345780
Title
Epigenetic MicroRNAs As Prognostic Markers of Post-Operative Atrial
Fibrillation, A Systematic Review.
Source
Current problems in cardiology. (pp 102106), 2023. Date of Publication:
21 Sep 2023.
Author
Lee J.; Lee H.; Sherbini A.E.; Baghaie L.; Leroy F.; Abdel-Qadir H.;
Szewczuk M.R.; El-Diasty M.
Institution
(Lee) Faculty of Health Sciences, Queen's University, Kingston, ON,
Canada. Electronic address: 20jl193@queensu.ca
(Lee, Sherbini) Faculty of Health Sciences, Queen's University, Kingston,
ON, Canada
(Baghaie) Department of Biomedical & Molecular Sciences, Queen's
University, Kingston, ON, Canada. Electronic address: 16lbn1@queensu.ca
(Leroy) Department of Biomedical & Molecular Sciences, Queen's University,
Kingston, ON, Canada; Faculte de Medecine, Maieutique et Sciences de la
Sante, Universite de Strasbourg, F-67000, Strasbourg, France
(Abdel-Qadir) Women's College Hospital, Peter Munk Cardiac Center, 585
University Ave, Toronto, ON M5G 2N2, Canada
(Szewczuk) Department of Biomedical & Molecular Sciences, Queen's
University, Kingston, ON, Canada
(El-Diasty) Harrington Heart and Vascular Institute, Department of Cardiac
Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
44106, United States
Publisher
NLM (Medline)
Abstract
Post-operative atrial fibrillation (POAF) is a common complication after
cardiac surgery, increasing the risk for adverse outcomes such as
perioperative and long-term mortality, stroke, myocardial infarction, and
other thromboembolic events. Epigenetic biomarkers show promise as
prognostic tools for POAF. Epigenetic changes, such as DNA methylation,
histone modification, and microRNAs (miRNA), can result in altered gene
expression and the development of various pathological conditions. This
systematic review aims to present the current literature on the
association between various epigenetic markers and the development of POAF
following cardiac surgery. Here, an electronic literature search was
performed using MEDLINE, EMBASE, Cochrane Central Register of Controlled
Trials, ClinicalTrials.gov, and Google Scholar to identify studies that
reported the role of epigenetic markers in the development of POAF. Five
of the six studies focused on miRNAs and their association with POAF. In
POAF patients, the expression of miR-1 and miR-483-5p were upregulated in
the right atrial appendage (RAA), while the levels of miR-133A, miR-208a,
miR-23a, miR-26a, miR-29a, miR-29b, and miR-29c were decreased in the RAA
and venous blood. One study examined cytosines followed by guanines (CpGs)
as DNA methylation markers. Across all studies, 488 human subjects who had
undergone cardiac surgery were investigated, and 195 subjects (39.9%)
developed new-onset POAF. The current literature suggests that miRNAs may
play a role in predicting the development of atrial fibrillation after
cardiac surgery. However, more robust clinical data are required to
justify their role in routine clinical practice. Copyright ©
2023. Published by Elsevier Inc.

<153>
Accession Number
642345773
Title
Frequency of Stroke in Intermediate-Risk Patients in the Long Term
Undergoing TAVR vs. SAVR: A Systematic Review and Meta-Analysis.
Source
Current problems in cardiology. (pp 102099), 2023. Date of Publication:
21 Sep 2023.
Author
Llerena-Velastegui J.; Navarrete-Cadena C.; Delgado-Quijano F.;
Trujillo-Delgado M.; Aguayo-Zambrano J.; Villacis-Lopez C.; Marcalla-Rocha
M.; Benitez-Acosta K.; Vega-Zapata J.
Institution
(Llerena-Velastegui) Pontifical Catholic University of Ecuador, Medical
School, Quito, Ecuador
(Navarrete-Cadena) Pontifical Catholic University of Ecuador, Medical
School, Quito, Ecuador
(Delgado-Quijano) Vantage Healthcare, Rehabilitation Center, MA, United
States
(Trujillo-Delgado) Catholic University of Santiago de Guayaquil, Medical
School, Guayaquil, Ecuador
(Aguayo-Zambrano) Catholic University of Santiago de Guayaquil, Medical
School, Guayaquil, Ecuador
(Villacis-Lopez) Central University of Ecuador, Medical School, Quito,
Ecuador
(Marcalla-Rocha) National University of Chimborazo, Medical School,
Riobamba, Ecuador
(Benitez-Acosta) La Sabana University, Medical School, Bogota, Colombia
(Vega-Zapata) Regional Autonomous University of Los Andes, Medical School,
Ambato, Ecuador
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this research is to compare the long-term incidence
of stroke in intermediate-risk patients who have undergone either
Transcatheter Aortic Valve Replacement (TAVR) or Surgical Aortic Valve
Replacement (SAVR) procedures. The objective is to identify which method
exhibits a higher propensity for stroke occurrence, potentially
contributing to disability or stroke-related mortality. METHOD(S): We
conducted a systematic review and meta-analysis to evaluate the frequency
of stroke post-TAVR and SAVR procedures. Data were compiled from a diverse
array of research articles, retrieved from the Embase, Cochrane Library,
and PubMed databases. Conclusions were derived from the comprehensive
analysis of forest plots. FINDINGS: The analysis indicates no significant
reduction in stroke incidence among patients undergoing TAVR compared to
those receiving SAVR. This conclusion, underscored by a P-value of 0.76
and a 95% confidence interval (CI) ranging from 0.80 to 1.17, arises from
a careful review of multiple pertinent studies. The meta-analysis of
pooled data does not reveal a significant decrease in stroke frequency
associated with TAVR. CONCLUSION(S): For intermediate-risk patients,
both TAVR and SAVR present similar stroke risks, indicating no procedure
is inherently safer. Healthcare providers must take this into account when
counseling patients, considering each procedure's benefits and drawbacks.
This study focuses specifically on intermediate-risk individuals, so
results may not apply universally. Further research across different risk
categories is needed. This study emphasizes the need for individualized
patient care and informed decision-making in aortic stenosis
management. Copyright © 2023 Elsevier Ltd. All rights reserved.

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