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<1>
Accession Number
2028892671
Title
The postoperative analgesia of retrolaminar block in patients undergoing
surgery with general anesthesia: a systematic review.
Source
Minerva Anestesiologica. 89 (pp 1127-1133), 2023. Date of Publication:
2023.
Author
Hu X.; Jiao B.; Zhou R.; Zhu T.
Institution
(Hu, Jiao, Zhou, Zhu) Department of Anesthesiology, West China Hospital,
Sichuan University, Sichuan, Chengdu, China
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Postoperative pain has always been a difficult problem in
anesthesia management. The neurological block technique has been used for
postoperative analgesia management, but compared with the traditional
block method, the effect of postoperative analgesia after layer block is
still controversial, and a clear literature review is needed. This
systematic review's goal was to investigate RLB's impact on postoperative
analgesia. EVIDENCE ACQUISITION: The literature search was performed using
the PubMed, Web of Science, Embase, and Cochrane Central Register of
Controlled Trials (CENTRAL) databases. Patients aged 18 years who
underwent retrolaminar block were considered eligible. The article must
report the results of the original study related to postoperative
analgesia. The characteristics of the study sample and evaluating the RLB
for postoperative analgesia were extracted from each included article and
concluded. EVIDENCE SYNTHESIS: Eleven randomized controlled trials (726
patients) were included. After summarizing the analysis of the results of
RLB on changing postoperative analgesia indexes in different surgeries, we
concluded that PVB is better used for postoperative analgesia compared
with RLB. The analgesic effect of RLB provides advantages compared with
EPSB, SCPB, etc. CONCLUSION(S): Based on the results of this review,
RLB can be applied to thoracic surgery, abdominal surgery and parotid
surgery, but its analgesic effect is not significant enough, and further
research is needed in the future to provide stronger evidence for
postoperative analgesia in surgical patients. Copyright © 2023
Edizioni Minerva Medica. All rights reserved.

<2>
Accession Number
2028763030
Title
Volatiles Benefit on Postoperative Cognitive Outcomes in Older Patients
with Cardiovascular Surgery: A Systematic Review and Meta-Analysis.
Source
International Journal of Gerontology. 17(4) (pp 212-219), 2023. Date of
Publication: 2023.
Author
Yang Y.-J.; Chang J.-Y.; Lin Y.-C.
Institution
(Yang, Lin) MacKay Medical College, New Taipei City, Taiwan (Republic of
China)
(Yang, Lin) Department of Anesthesia, MacKay Memorial Hospital, Taipei,
Taiwan (Republic of China)
(Chang) BinKun Women's Children's Hospital, Taoyuan City, Taiwan (Republic
of China)
(Lin) Institute of Epidemology and Preventive Medicine, National Taiwan
University, College of Public Health, Taipei, Taiwan (Republic of China)
Publisher
Taiwan Society of Geriatric Emergency and Critical Care Medicine (TSGECM)
Abstract
Total intravenous anesthesia (TIVA) has a lower incidence of postoperative
cognitive dysfunction (POCD) compared with inhalation agents in older
patients undergoing non-cardiac surgery. This systematic review aimed to
investigate the postoperative cognitive function in elderly patients
following cardiac surgery with TIVA versus inhalation anesthesia. We
searched the databases, Cochrane, MED-LINE, and EMBASE, up to May 2022 and
selected relevant randomized controlled trials. For the meta-analysis, the
random-effects model on the standardized mean difference for continuous
outcomes and risk ratio for dichotomous outcomes were used. Five RCTs (590
participants) were included in the final analysis. The result showed that
the cognitive score reduced less after the operation in patients receiving
volatile anesthesia compared with those receiving propofol-based TIVA,
three days (SMD -2.31, 95% CI: [-4.63, 0.01], I2 = 96%, p <
0.01) and five days later (SMD -2.29, 95% CI: [-3.90, -0.68),
I2 = 97%, p < 0.01). In contrast, The POCD five days after the
operation did not lower significantly in patient receiving volatile
anesthesia (RR 2.25, 95% CI: [0.51, 10.02], I2 = 61%, p =
0.11). Our findings indicated that for elderly patients undergoing
elective cardiac surgery, the cognitive assessment score was reduced less
with volatile anesthetics than with TIVA. The incidence of POCD was not
significantly different. More studies to verify these
results. Copyright © 2023, Taiwan Society of Geriatric Emergency
& Critical Care Medicine.

<3>
Accession Number
2028681057
Title
Correspondence: Authors' reply to Critical appraisal of "Goetz G, Wernly
B, Wild C (2023) Wearable cardioverter defibrillator for preventing sudden
cardiac death in patients at risk: An updated systematic review of
comparative effectiveness and safety. IJC Heart & Vasculature 45 (2023)
101189" by M. Nurnberg, F. Semrau.
Source
IJC Heart and Vasculature. 49 (no pagination), 2023. Article Number:
101299. Date of Publication: December 2023.
Author
Wild C.; Gotz G.; Wernly B.
Institution
(Wild, Gotz) Austrian Institute for Health Technology Assessment (AIHTA),
Austria
(Wernly) Department of Internal Medicine, General Hospital Oberndorf,
Teaching Hospital of the Paracelsus Medical University Salzburg, and
Institute of General Practice, Family Medicine and Preventive Medicine,
Paracelsus Medical University, Salzburg, Austria
Publisher
Elsevier Ireland Ltd

<4>
Accession Number
2028633747
Title
Tight perioperative blood pressure management to reduce complications: A
randomised feasibility trial.
Source
BMJ Open. 13(11) (no pagination), 2023. Article Number: e071328. Date of
Publication: 17 Nov 2023.
Author
Li K.; Hu Z.; Li W.; Shah K.; Sessler D.
Institution
(Li, Hu, Li) Department of Anesthesiology, China-Japan Union Hospital of
Jilin University, Jilin, Changchun, China
(Shah) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Shah, Sessler) Outcomes Research, Cleveland Clinic, Cleveland, OH, United
States
Publisher
BMJ Publishing Group
Abstract
Objective Evaluate the feasibility of a trial of perioperative hypotension
and serious complications. Design A patient and assessor-blinded
randomised feasibility trial. Setting We included patients in a tertiary
university hospital. Participants We enrolled 80 adults scheduled for
major non-cardiac surgery. Interventions In patients randomised to tight
blood pressure control, intraoperative mean arterial pressure (MAP) was
targeted to >=85 mm Hg maintained with norepinephrine infusion, and
restarting chronic antihypertensive medications was delayed until the
third postoperative day. In the reference group, intraoperative blood
pressure was managed per routine and antihypertensive medications were
restarted immediately after surgery. Primary and secondary outcome
measures Our first co-primary outcome was the fraction of time when
intraoperative MAP was >85 mm Hg, intraoperative area (time integral) of
MAP >85 mm Hg and MAP <65 mm Hg. The second co-primary outcome was time
until antihypertensive medications were restarted after surgery. Secondary
outcomes were time-weighted average intraoperative MAP, cumulative minimum
MAP for 10 min, average postoperative systolic blood pressure (SBP) and
mean of the lowest three postoperative SBPs. Results Forty patients in
each group were analysed. The median for intraoperative area of MAP >85 mm
Hg was 1303 (772-2419) mm Hg*min in routine blood pressure (BP) cases and
2425 (1926-3545) mm Hg*min in tight BP control. The area for
intraoperative MAP <65 mm Hg was 7 (0-40) mm Hg*min with routine BP
management, and 0 (0-0) mm Hg*min with tight BP control. The fraction of
time with MAP >85 mm Hg was 0.52 (0.25) and 0.87 (0.15). Antihypertensive
medications were restarted 2 (1-3) days later in tight BP control cases.
However, postoperative SBPs were similar. Conclusions Tight BP management
markedly increased intraoperative MAP and reduced the amount of
hypotension. In contrast, delaying chronic antihypertensive medications
had little effect on postoperative SBP. The full trial appears feasible
and remains necessary but should not include postoperative
antihypertensive management. Trial registration NCT04789733. Copyright
© 2023 Author(s). Published by BMJ.

<5>
Accession Number
2028633737
Title
Postoperative stellate ganglion block to reduce myocardial injury after
laparoscopic radical resection for colorectal cancer: Protocol for a
randomised trial.
Source
BMJ Open. 13(11) (no pagination), 2023. Article Number: 069183. Date of
Publication: 17 Nov 2023.
Author
Hu Z.; Li W.; Zhao G.; Liang C.; Li K.
Institution
(Hu) Department of Anesthesiology, Hospital of Chengdu University of
Traditional Chinese Medicine, Sichuan, Chengdu, China
(Li) Department of Pain Management, Fujian Provincial Hospital, Shengli
Clinical Medical College of Fujian Medical University, Fujian, Fuzhou,
China
(Zhao) Jilin University, Jilin, Changchun, China
(Liang) New York University, New York, NY, United States
(Li) Department of Anesthesiology, China-Japan Union Hospital of Jilin
University, Jilin, Changchun, China
Publisher
BMJ Publishing Group
Abstract
Introduction Stellate ganglion block (SGB) is usually used in the
department of algiatry. But preoperative SGB may reduce adverse
cardiovascular events in high-risk patients, although evidence remains
sparse. Therefore, we aim to determine whether a single-shot postoperative
SGB can reduce the incidence of myocardial injury after non-cardiac
surgery (MINS) and improve recovery in patients undergoing laparoscopic
radical resection for colorectal cancer. Methods and analysis This is an
investigator-initiated, single-centre, randomised, two-arm clinical trial
enrolling patients aged over 45 years and scheduled for elective
laparoscopic radical colorectal surgery with at least one risk factor for
MINS. A total of 950 eligible patients will be randomised into a routine
or block groups. The primary outcome is the incidence of MINS. The
secondary outcomes include the Visual Analogue Scale of pain during rest
and movement, the incidence of delirium, quality of recovery (QOR)
assessed by QOR-15, and sleep quality assessed by Richards Campbell Sleep
Questionnaire. Tertiary outcomes include time to first flatus,
gastrointestinal complications such as anastomotic leak or ileus, length
of hospital stay, collapse incidence of severe cardiovascular and
cerebrovascular complications of myocardial infarction, cardiac arrest,
ischaemic or haemorrhagic stroke, and all-cause mortality within 30 days
after the operation. Ethics and dissemination The protocol was approved by
Medical Ethics Committee of the China-Japan Union Hospital, Jilin
University (Approval number: 2021081018) prior to recruitment. The study
will be performed according to the guidelines of the Declaration of
Helsinki. The findings of this study will be published and presented
through various scientific forums. Trial registration number
ChiCTR2200055319. Copyright © 2023 Author(s). Published by BMJ.

<6>
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Accession Number
2028589518
Title
Robotic Lobectomy Is Cost-effective and Provides Comparable Health Utility
Scores to Video-assisted Lobectomy: Early Results of the RAVAL Trial.
Source
Annals of Surgery. 278(6) (pp 841-849), 2023. Date of Publication: 01 Dec
2023.
Author
Patel Y.S.; Baste J.-M.; Shargall Y.; Waddell T.K.; Yasufuku K.; Machuca
T.N.; Xie F.; Thabane L.; Hanna W.C.
Institution
(Patel, Shargall, Hanna) Department of Surgery, Division of Thoracic
Surgery, McMaster University, Hamilton, ON, Canada
(Baste) Department of Surgery, Division of Thoracic Surgery, Rouen
Normandy University, Rouen Cedex, France
(Waddell, Yasufuku) Department of Surgery, Division of Thoracic Surgery,
University of Toronto, Toronto, ON, Canada
(Machuca) Department of Surgery, Division of Thoracic and Cardiovascular
Surgery, University of Florida, Gainesville, FL, United States
(Xie, Thabane) Department of Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
Publisher
Wolters Kluwer Health
Abstract
Objective: The aim of this study was to determine if robotic-assisted
lobectomy (RPL-4) is cost-effective and offers improved patient-reported
health utility for patients with early-stage non-small cell lung cancer
when compared with video-assisted thoracic surgery lobectomy
(VATS-lobectomy). Background(s): Barriers against the adoption of
RPL-4 in publicly funded health care include the paucity of high-quality
prospective trials and the perceived high cost of robotic surgery.
 Method(s): Patients were enrolled in a blinded, multicentered,
randomized controlled trial in Canada, the United States, and France, and
were randomized 1:1 to either RPL-4 or VATS-lobectomy. EuroQol 5 Dimension
5 Level (EQ-5D-5L) was administered at baseline and postoperative day 1;
weeks 3, 7, 12; and months 6 and 12. Direct and indirect costs were
tracked using standard methods. Seemingly Unrelated Regression was applied
to estimate the cost effect, adjusting for baseline health utility. The
incremental cost-effectiveness ratio was generated by 10,000 bootstrap
samples with multivariate imputation by chained equations. Result(s):
Of 406 patients screened, 186 were randomized, and 164 analyzed after the
final eligibility review (RPL-4: n=81; VATS-lobectomy: n=83). Twelve-month
follow-up was completed by 94.51% (155/164) of participants. The median
age was 68 (60-74). There were no significant differences in body mass
index, comorbidity, pulmonary function, smoking status, baseline health
utility, or tumor characteristics between arms. The mean 12-week health
utility score was 0.85 (0.10) for RPL-4 and 0.80 (0.19) for VATS-lobectomy
(P=0.02). Significantly more lymph nodes were sampled [10 (8-13) vs 8
(5-10); P=0.003] in the RPL-4 arm. The incremental cost/quality-adjusted
life year of RPL-4 was $14,925.62 (95% CI: $6843.69, $23,007.56) at 12
months. Conclusion(s): Early results of the RAVAL trial suggest that
RPL-4 is cost-effective and associated with comparable short-term
patient-reported health utility scores when compared with
VATS-lobectomy. Copyright © 2023 Lippincott Williams and Wilkins.
All rights reserved.

<7>
Accession Number
2027008662
Title
Identifying a target group for selenium supplementation in high-risk
cardiac surgery: a secondary analysis of the SUSTAIN CSX trial.
Source
Intensive Care Medicine Experimental. 11(1) (no pagination), 2023. Article
Number: 89. Date of Publication: December 2023.
Author
Notz Q.; Heyland D.K.; Lee Z.-Y.; Menger J.; Herrmann J.; Chillon T.S.;
Fremes S.; Mohammadi S.; Elke G.; Mazer C.D.; Hill A.; Velten M.; Ott S.;
Kleine-Brueggeney M.; Meybohm P.; Schomburg L.; Stoppe C.
Institution
(Notz, Menger, Herrmann, Meybohm, Stoppe) Department of Anaesthesiology,
Intensive Care, Emergency and Pain Medicine, University Hospital Wurzburg,
Oberdurrbacher Str. 6, Wurzburg 97080, Germany
(Heyland) Clinical Evaluation Research Unit, Kingston General Hospital, 76
Stuart St, Kingston, ON K7L 2V7, Canada
(Heyland, Stoppe) Department of Critical Care Medicine, Queen's
University, 99 University Ave, Kingston, ON K7L 3N6, Canada
(Lee) Department of Anaesthesiology, University of Malaya, Lingkungan
Budi, Kuala Lumpur 50603, Malaysia
(Lee, Ott, Kleine-Brueggeney) Department of Cardiac Anaesthesiology and
Intensive Care Medicine, Deutsches Herzzentrum der Charite, Augustenburger
Platz 1, Berlin 13353, Germany
(Chillon, Schomburg) Charite Berlin, Institute for Experimental
Endocrinology, Hessische Str. 4, Berlin 10115, Germany
(Fremes) University of Toronto, Sunnybrook Research Institute, 2075
Bayview Ave, Toronto, ON M4N 3M5, Canada
(Mohammadi) Laval University, Quebec Heart and Lung Institute, 2725 Ch
Ste-Foy, Quebec City, QC G1V 4G5, Canada
(Elke) Department of Anaesthesiology and Intensive Care Medicine,
University Medical Center Schleswig-Holstein, Campus Kiel,
Arnold-Heller-Str. 3, Kiel 24105, Germany
(Mazer) St. Michael's Hospital, Li Ka Shing Knowledge Institute, 38 Shuter
St, Toronto, ON M5B 1A6, Canada
(Mazer) Departments of Anesthesiology and Pain Medicine, Physiology and
Pharmacology, University of Toronto, 123 Edward Street, Toronto, ON M5G
1E2, Canada
(Hill) Department of Anaesthesiology and Operative Intensive Care
Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, Aachen 52074,
Germany
(Velten) Department of Anaesthesiology and Operative Intensive Care
Medicine, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127,
Germany
(Ott) Department of Outcomes Research, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44195, United States
(Ott) German Center for Cardiovascular Research, Partner Site Berlin,
Potsdamer Str. 58, Berlin 10785, Germany
(Kleine-Brueggeney) Charite-Universitatsmedizin Berlin, Corporate Member
of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, Chariteplatz
1, Berlin 10117, Germany
Publisher
Springer Nature
Abstract
Background: Recent data from the randomized SUSTAIN CSX trial could not
confirm clinical benefits from perioperative selenium treatment in
high-risk cardiac surgery patients. Underlying reasons may involve
inadequate biosynthesis of glutathione peroxidase (GPx3), which is a key
mediator of selenium's antioxidant effects. This secondary analysis aimed
to identify patients with an increase in GPx3 activity following selenium
treatment. We hypothesize that these responders might benefit from
perioperative selenium treatment. Method(s): Patients were selected
based on the availability of selenium biomarker information. Four
subgroups were defined according to the patient's baseline status,
including those with normal kidney function, reduced kidney function,
selenium deficiency, and submaximal GPx3 activity. Result(s): Two
hundred and forty-four patients were included in this analysis. Overall,
higher serum concentrations of selenium, selenoprotein P (SELENOP) and
GPx3 were correlated with less organ injury. GPx3 activity at baseline was
predictive of 6-month survival (AUC 0.73; p = 0.03). While selenium
treatment elevated serum selenium and SELENOP concentrations but not GPx3
activity in the full patient cohort, subgroup analyses revealed that GPx3
activity increased in patients with reduced kidney function, selenium
deficiency and low to moderate GPx3 activity. Clinical outcomes did not
vary between selenium treatment and placebo in any of these subgroups,
though the study was not powered to conclusively detect differences in
outcomes. Conclusion(s): The identification of GPx3 responders
encourages further refined investigations into the treatment effects of
selenium in high-risk cardiac surgery patients. Graphical Abstract:
[Figure not available: see fulltext.] Copyright © 2023, The
Author(s).

<8>
Accession Number
2026879725
Title
A Comparison of the Efficacy and Safety of Acenocoumarol and Warfarin in
Valve Replaced Patients with Rheumatic Heart Disease.
Source
Research Journal of Pharmacology. 17(2) (pp 10-17), 2023. Date of
Publication: 2023.
Author
Vihan S.; Agarwal R.
Institution
(Vihan) Department of Pharmacology, Armed Forces Medical College (AFMC)
Pune, Southern Command, Solapur-Pune Highway, Near Race Course, Wanowrie,
Maharashtra, Pune 411040, India
(Agarwal) Department of Anaesthesia, Command Hospital (Eastern Command),
Alipore, West Bengal, Kolkata 700027, India
Publisher
MAK Hill Publications
Abstract
Rheumatic valvular heart disease is a long term sequelae of rheumatic
fever worldwide and the latter is the most common cause. Prevalence of
rheumatic valvular heart disease is 15.7 million persons worldwide. To
assess and compare the efficacy of Acenocoumarol and Warfarin in valve
replaced patients with Rheumatic heart disease. To assess and compare the
safety and tolerability of Acenocoumarol and Warfarin in valve replaced
patients with Rheumatic heart disease. The present study was a randomized,
prospective, open label, comparative study. This study was conducted from
January 2018 to December 2018 at Department of Pharmacology in
collaboration with Department of Cardio-Thoracic and Vascular Surgery
(CTVS) at Institute of Post Graduate Medical Education and Research,
Kolkata. RHD primarily affects the mitral valve (in approximately 2/3 rd
of patients), as in this study, total 46.66% cases of MS, MR and MVR
operations were noted due to RHD. As total 77.27% ADRs (100% in
Acenocoumarol group and 58.33% in Warfarin group) were definitely
preventable, precaution must be taken to prevent ADRs. As total 77.27%
ADRs (100% in Acenocoumarol group and 58.33% in Warfarin group) were mild,
it is important to follow-up for ADRs to prevent further complications.
The study therefore concluded that Acenocoumarol and Warfarin are equally
efficacious. After comparing overall safety in both groups or after
comparing overall adverse drug reaction (ADRs) between Acenocoumarol group
and Warfarin group, it is observed that according to severity of ADRs,
Acenocoumarol is better and safer than Warfarin. This study showed that
Vitamin K antagonists (VKAs) like Acenocoumarol or Warfarin must be
administered as oral anticoagulants, after heart valve replacement
surgery, in post-operative patients and both Acenocoumarol and Warfarin
are equally effective in maintaining INR within therapeutic target
range. Copyright © 2023, MAK Hill Publications. All rights
reserved.

<9>
Accession Number
2026810809
Title
Revascularization and Mortality at 5 Years After Treatment Guided By
Instantaneous Wave-Free Ratio and Fractional Flow Reserve: A Systematic
Review and Meta-Analysis of Randomized Controlled Trials.
Source
Journal of the American Heart Association. 12(22) (no pagination), 2023.
Article Number: e032015. Date of Publication: 21 Nov 2023.
Author
Sreenivasan J.; Jamil Y.; Ahmad Y.
Institution
(Sreenivasan, Jamil, Ahmad) Section of Cardiovascular Medicine, Yale
University, New Haven, CT, United States
Publisher
American Heart Association Inc.

<10>
Accession Number
2024855348
Title
Hybrid delivery of behavioral health screening and prevention intervention
for pediatric heart transplant recipients and families: A randomized pilot
study.
Source
Pediatric Transplantation. 27(8) (no pagination), 2023. Article Number:
e14577. Date of Publication: December 2023.
Author
Wijesekera K.; Kiff C.; Aralis H.; Sinclair M.; Bursch B.; Alejos J.C.;
Lester P.
Institution
(Wijesekera, Kiff, Aralis, Sinclair, Bursch, Lester) Department of
Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at
UCLA, Los Angeles, CA, United States
(Bursch, Alejos) Department of Pediatrics, David Geffen School of Medicine
at UCLA, Los Angeles, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: A significant number of pediatric heart transplant recipients
and their families experience post-traumatic stress symptoms following
transplantation, which can impact recipient behavioral and medical health
outcomes. Preventive behavioral health interventions may improve outcomes,
especially if interventions can be delivered at a distance to decrease
barriers to mental health care. This pilot study examined the
acceptability and accessibility of an evidence-informed resilience
training program delivered using a video telehealth platform. A secondary
aim was to assess the preliminary efficacy of the intervention on
recipient behavioral health outcomes, perceived barriers to recipient
medication adherence, parent behavioral health outcomes, and family
functioning. Method(s): Seventeen heart transplant recipients (8-18
years old) and their families were recruited and randomly assigned to a
treatment as usual (n = 8) or an intervention group (n = 9). Baseline
assessment data collected included demographic information and validated
behavioral health measures. Follow-up assessments included the validated
measures and acceptability and satisfaction ratings. Result(s): The
study demonstrated that the program has high acceptability by recipients
and parents, and a positive impact on recipients and parents, including
significant reductions in youth behavioral difficulties as well as parent
depression and post-traumatic stress symptoms. Conclusion(s): Results
of this study are promising and call for further evaluation of hybrid
delivery models for behavioral health screening and prevention
interventions for pediatric heart transplant recipients and their
families. Copyright © 2023 The Authors. Pediatric Transplantation
published by Wiley Periodicals LLC.

<11>
Accession Number
2028135612
Title
Sex disparities in patients with acute aortic dissection: A scoping
review.
Source
Seminars in Vascular Surgery. 36(4) (pp 492-500), 2023. Date of
Publication: December 2023.
Author
Filiberto A.C.; Ramadan O.I.; Wang G.J.; Cooper M.A.
Institution
(Filiberto, Cooper) Department of Surgery, Division of Vascular Surgery,
University of Florida, Gainesville, FL 32610, United States
(Ramadan, Wang) Department of Surgery, University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, United States
(Ramadan, Wang) Leonard Davis Institute of Health Economics, University of
Pennsylvania, Philadelphia, PA, United States
Publisher
W.B. Saunders
Abstract
Disparities in outcomes for patients with cardiovascular disease and those
undergoing cardiac or vascular operations are well-established. These
disparities often span several dimensions and persist despite advancements
in medical and surgical care; sex is among the most pervasive.
Specifically, females sex has been implicated as a predictor of poor
outcomes in both patients with acute type A aortic dissections (ATAADs)
and type B aortic dissections (TBADs). For instance, one study, using the
International Registry of Acute Aortic Dissection database, found that
females with acute aortic dissection-including ATAAD and TBAD that were
either medically or surgically managed-had 40% higher odds of in-hospital
mortality than men. Notably, both types of acute aortic dissections affect
men more commonly than females and can be life-threatening without prompt,
appropriate treatment. The underlying mechanisms for these disparities are
unclear but are thought to be multifactorial. The association of sex with
patterns of disease and outcomes in patients with ATAAD or TBAD remains
unclear, with conflicting reports from different studies. Thus, we sought
to review the literature regarding sex disparities in patients with ATAAD
and TBAD. Copyright © 2023 Elsevier Inc.

<12>
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Accession Number
2028942976
Title
Sex-Related Differences in Postoperative Outcomes After Transcatheter
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Cardiology in Review. 32(1) (pp 30-44), 2024. Date of Publication: 01 Jan
2024.
Author
Bozso S.J.; El-Andari R.; J.h. Kang J.; Eckstein J.; Nagendran J.
Institution
(Bozso, J.h. Kang, Nagendran) The Division of Cardiac Surgery, Department
of Surgery, University of Alberta, Edmonton, AB, Canada
(El-Andari) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(Eckstein) Division of Cardiology, Royal University Hospital, Saskatoon,
SK, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Aortic stenosis is the most common valvular disease of the heart and is
increasing in prevalence. Previous literature has found inferior outcomes
for females undergoing surgical aortic valve replacement, while recent
investigations have found equivalent or superior outcomes for females
undergoing transcatheter aortic valve replacement (TAVR). PubMed and
Medline were systematically searched for articles published from January
1, 2010, to April 30, 2021, for retrospective and prospective studies
comparing outcomes between males and females undergoing TAVR. One thousand
one hundred eighty titles and abstracts were screened, and 28 were
included in this review. Risk of bias was assessed using questions derived
from the ROBINS-I tool and previous literature. The data were compiled and
analyzed using the RevMan 5.4 software. The results of this review confirm
the previously published literature and have found rates of acute kidney
injury (P = 0.05) and postoperative pacemaker insertion (P < 0.00001)
favoring females and in-hospital mortality (P = 0.04), stroke (P <
0.00001), bleeding complications (P < 0.00001), and vascular complications
(P < 0.00001) favoring males. The previously published literature has
demonstrated consistently inferior outcomes for females undergoing heart
valve surgery when compared to males. However, contemporary literature
investigating sex differences after TAVR has found comparable outcomes for
females. While the postoperative outcomes after surgical aortic valve
replacement and TAVR are well established, the causal factors are still
unidentified. Future studies utilizing matching based on preoperative
characteristics and follow-up including collection of postoperative
ventricular remodeling and prosthetic valve performance data will aid in
elucidating the causal factors impacting outcomes for males and females
after TAVR. Copyright © 2022 Wolters Kluwer Health, Inc. All
rights reserved.

<13>
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Accession Number
2028942958
Title
Epidural analgesia versus oral morphine for postoperative pain management
following video-assisted thoracic surgery: A randomised, controlled,
double-blind trial.
Source
European Journal of Anaesthesiology. 41(1) (pp 61-69), 2024. Date of
Publication: 01 Jan 2024.
Author
Holm J.H.; Andersen C.; Toft P.
Institution
(Holm, Andersen, Toft) The Department of Anaesthesiology and Intensive
Care, Odense University Hospital, Odense, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUNDThe use of thoracic epidural analgesia for postoperative pain
management in video-assisted thoracic surgery (VATS) is controversial.
Still, the evidence on omitting it in favour of systemic opioids is
inconclusive, and studies are small and non-blinded.OBJECTIVEWe aimed to
compare pain after VATS using epidural analgesia or enteral opioids for
postoperative pain management.DESIGN/SETTING/PATIENTS/INTERVENTIONA
randomised, double-blind, controlled trial at a Danish tertiary hospital.
Adult patients scheduled for VATS were assigned to multimodal non-opioid
baseline analgesia supplemented with either thoracic epidural analgesia
(TE Group) or oral morphine (OM Group) for postoperative pain management.
We recorded pain five times a day, both at rest and during activity, using
the Numeric Rating Scale (NRS) and categorised it into "acceptable pain"or
"unacceptable pain". Unacceptable pain was defined as NRS (at rest) >=3 or
NRS (with activity) >=5 when supplementary analgesics were given.MAIN
OUTCOME MEASURESThe primary outcomes were the proportions of patients
experiencing "unacceptable pain"during the postoperative period and the
use of intravenous "rescue"opioids.RESULTSOf the 161 included patients,
146 received the allocated treatment and their data were analysed. At
rest, 34% of patients in the TE Group and 64% of patients in the OM Group
experienced unacceptable pain during the study period, a significant
between-group difference of 30% (P < 0.0005). During activity these
percentages were 32% of patients in the TE Group and 59% in the OM group,
a difference of 27% (P < 0.005). The median intravenous rescue morphine
consumption during the study period was 4.5 [interquartile range (IQR),
0-10.0] mg in the TE Group and 7.5 [0-19.0] mg in the OM Group (P <
0.005).CONCLUSIONEpidural analgesia provided better pain relief after VATS
than oral morphine. The between-group difference in rescue intravenous
morphine consumption was statistically significant but clinically
irrelevant. Copyright © 2023 The Author(s).

<14>
Accession Number
2027009680
Title
External Stenting for Saphenous Vein Grafts in Coronary Surgery: A
Systematic Review and Meta-Analysis.
Source
Journal of Clinical Medicine. 12(23) (no pagination), 2023. Article
Number: 7395. Date of Publication: December 2023.
Author
Soletti G.J.; Dimagli A.; Harik L.; Cancelli G.; Perezgrovas-Olaria R.;
Alzghari T.; Dell'Aquila M.; Leith J.; Castagnini S.; Lau C.; Girardi
L.N.; Gaudino M.
Institution
(Soletti, Dimagli, Harik, Cancelli, Perezgrovas-Olaria, Alzghari,
Dell'Aquila, Leith, Lau, Girardi, Gaudino) Department of Cardiothoracic
Surgery, Weill Cornell Medicine, New York, NY 10065, United States
(Castagnini) Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital,
Bologna 40138, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
The external stenting of saphenous vein grafts (SVGs) during coronary
artery bypass grafting (CABG) has been proven to reduce intimal
hyperplasia (IH) in animal models, paving the way for human randomized
controlled trials (RCTs) to be conducted. Herein, we performed a
study-level meta-analysis to assess the impact of the Venous External
SupporT (VEST) device, an external stent, on the outcomes of SVGs. A
systematic search was conducted to identify all RCTs comparing
VEST-stented to non-stented SVGs in patients undergoing CABG. The primary
outcome was graft occlusion. The main secondary outcomes were repeat
revascularization, SVG IH area, and intimal-medial thickness. Two RCTs
totaling 407 patients were included. At a mean follow-up of 1.5 years,
there was no difference in graft occlusion between groups (incidence rate
ratio: 1.11; 95% confidence interval (CI): 0.80-1.53). The rate of repeat
revascularization was also similar (odds ratio: 0.66; 95% CI: 0.27-1.64).
The IH area (standardized mean difference (SMD): -0.45; 95% CI: -0.79 to
-0.10) and intimal-medial thickness (SMD: -0.50; 95% CI: -0.90 to -0.10)
were significantly reduced in the VEST group. Our findings show that
significant reductions in the IH area and the intimal-medial thickness in
VEST-stented SVGs do not currently translate into a lesser need for repeat
revascularization or less graft occlusion events compared to non-stented
SVGs at 1.5 years after CABG. Copyright © 2023 by the authors.

<15>
Accession Number
2028759492
Title
Preloaded combination nicotine replacement therapy for smoking cessation
in Kazakhstan: A randomized controlled trial study protocol.
Source
PLoS ONE. 18(11 November) (no pagination), 2023. Article Number: e0292490.
Date of Publication: November 2023.
Author
Purushothama C.; Crape B.L.; Stolyarov V.; Jaxybayeva A.; La Fleur P.;
Olickal J.J.
Institution
(Purushothama) School of Sciences & Humanities, Nazarbayev University,
Nur-Sultan city, Kazakhstan
(Crape, Stolyarov) Nazarbayev University School of Medicine, Nur-Sultan
city, Kazakhstan
(Jaxybayeva) Astana Medical University, Astana, Kazakhstan
(La Fleur) Department of Medicine, Nazarbayev University School of
Medicine, Astana, Kazakhstan
(Olickal) Department of Public Health, Amrita Institute of Medical
Sciences, Kerala, Kochi, India
Publisher
Public Library of Science
Abstract
Background Tobacco use is a major cause of premature death and disease in
Kazakhstan, with over 22,500 deaths per year. Although efforts have been
made to control tobacco use, smokingrelated deaths have continued to
increase. One strategy to help smokers quit is to use nicotine replacement
therapy (NRT), with combination NRT resulting in higher long-term quit
rates than a single form of NRT. A study aims to determine the
effectiveness of preloaded combination NRT on smoking cessation, the
change in health-related quality of life due to smoking cessation, and
explore treatment adherence perceptions. Methods and analysis The study
will be conducted as a randomized, single-blind superiority trial, with
100 participants in each arm. The trial will be carried out at the
National Research Cardiac Surgery Center, Astana, Kazakhstan, and will
recruit current smokers aged 18 years and above with a motivation to quit.
Participants will be randomly allocated to either the intervention group
or the control group. The former will receive preloaded combination NRT,
while the latter will receive fast-acting NRT alone. The primary outcome
measure will be sustained abstinence from smoking after six months.
Secondary outcome measures will include health-related quality of life and
adherence to the treatment. Discussion The study may gather further
evidence that a combination NRT is more efficient than a fastacting NRT
alone. The findings of this study may help to improve tobacco cessation
strategies in Kazakhstan and other countries with high smoking prevalence
rates. Copyright: Copyright © 2023 Purushothama et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<16>
[Use Link to view the full text]
Accession Number
2028943241
Title
Influence of Regional Nerve Block in Addition to General Anesthesia on
Postoperative Delirium, Pain, and In-hospital Stay in Patients Undergoing
Cardiothoracic Surgery: A Meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 82(6) (pp 496-503), 2023. Date of
Publication: 06 Dec 2023.
Author
Li L.; Liu M.; Li S.; Xu J.; Zheng J.; Lv C.; Wu L.; Heng L.
Institution
(Li, Lv) Department of Critical Care Medicine, First People's Hospital of
Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,
Affiliated Hospital of Mining and Technology of China University, Jiangsu,
Xuzhou, China
(Liu) Department of Thoracic Surgery, Xuzhou Central Hospital, Jiangsu,
Xuzhou, China
(Li, Zheng) Department of Orthopedics, First People's Hospital of Xuzhou,
Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,
Affiliated Hospital of Mining and Technology of China University, Jiangsu,
Xuzhou, China
(Xu) Department of Ophthalmology, First People's Hospital of Xuzhou,
Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,
Affiliated Hospital of Mining and Technology of China University, Jiangsu,
Xuzhou, China
(Wu) Department of Hemodialysis, First People's Hospital of Xuzhou, Xuzhou
Municipal Hospital Affiliated to Xuzhou Medical University, Affiliated
Hospital of Mining and Technology of China University, Jiangsu, Xuzhou,
China
(Heng) Department of Anesthesiology, Xuzhou Cancer Hospital, Jiangsu
Province, Xuzhou City, China
(Heng) Department of Anesthesiology, Xuzhou New Healthy Geriatric
Hospital, Jiangsu Province, Xuzhou City, China
(Heng) Department of Anesthesiology, The Affiliated Xuzhou Hospital of
JiangSu University, Jiangsu Province, Xuzhou City, China
Publisher
Lippincott Williams and Wilkins
Abstract
This study aims to investigate whether venous injection of sedative agent
or regional nerve block in alliance with major anesthesia could decrease
the risk of postoperative delirium occurrence in patients receiving
cardiothoracic surgery. Electronic academic databases were retrieved for
related publications, and statistical software was used for data pooling
and analysis. Forest plot was used to show the pooled sensitivity,
specificity, and diagnostic odds ratio. Combined receiver operating
characteristic curve was used to show the area under the curve of complex
data. Seven studies were included for analysis. The risk of occurrence of
delirium still showed no difference (risk rate = 0.93, 95% CI, 0.85-1.03)
between the intervention group and placebo group. Postoperative pain
feeling was more alleviated in patients with prophylactic application of
regional nerve block. In addition, prophylactic application of regional
nerve block could decrease the risk of postoperative in-hospital stay
(risk rate = 0.28, 95% CI, 0.02-0.54). Our study demonstrated that, in
elderly patients or pediatric patients undergoing cardiac surgery,
prophylactic application of regional nerve block failed to decrease the
incidence of postoperative delirium. However, the option of regional nerve
block could decrease the duration of in-hospitalization stay and alleviate
the acute pain during the postoperative period after open-heart
surgery. Copyright © 2023 Lippincott Williams and Wilkins. All
rights reserved.

<17>
Accession Number
2026823937
Title
Vasopressin in vasoplegic shock in surgical patients: systematic review
and meta-analysis.
Source
Acta Cirurgica Brasileira. 38 (no pagination), 2023. Article Number:
e387523. Date of Publication: 2023.
Author
Szeles T.F.; de Almeida J.P.; da Cruz J.A.S.; Artifon E.L.A.
Institution
(Szeles, de Almeida, da Cruz, Artifon) Universidade de Sao Paulo, Medical
School, Anesthesiology Department, SP, Sao Paulo, Brazil
Publisher
Sociedade Brasileira para o Desenvolvimento de Pesquisa em Cirurgia
Abstract
Purpose: Vasoplegia, or vasoplegic shock, is a syndrome whose main
characteristic is reducing blood pressure in the presence of a standard or
high cardiac output. For the treatment, vasopressors are recommended, and
the most used is norepinephrine. However, new drugs have been evaluated,
and conflicting results exist in the literature. Method(s): This is a
systematic review of the literature with meta-analysis, written according
to the recommendations of the PRISMA report. The SCOPUS, PubMed, and
ScienceDirect databases were used to select the scientific articles
included in the study. Searches were conducted in December 2022 using the
terms "vasopressin," "norepinephrine," "vasoplegic shock,"
"postoperative," and "surgery." Meta-analysis was performed using Review
Manager (RevMan) 5.4. The endpoint associated with the study was
efficiency in treating vasoplegic shock and reduced risk of death.
 Result(s): In total, 2,090 articles were retrieved; after applying
the inclusion and exclusion criteria, ten studies were selected to compose
the present review. We found no significant difference when assessing the
outcome mortality comparing vasopressin versus norepinephrine (odds ratio
= 1.60; confidence interval 0.47-5.50), nor when comparing studies on
vasopressin versus placebo. When we analyzed the length of hospital stay
compared to the use of vasopressin and norepinephrine, we identified a
shorter length of hospital stay in cases that used vasopressin; however,
the meta-analysis did not demonstrate statistical significance.
 Conclusion(s): Considering the outcomes included in our study, it is
worth noting that most studies showed that using vasopressin was safe and
can be considered in managing postoperative vasoplegic
shock. Copyright © 2023, Sociedade Brasileira para o
Desenvolvimento de Pesquisa em Cirurgia. All rights reserved.

<18>
Accession Number
2028676044
Title
Impact of Oral Anticoagulation on Clinical Outcomes in Postoperative
Atrial Fibrillation.
Source
Journal of Surgical Research. 295 (pp 122-130), 2024. Date of Publication:
March 2024.
Author
Almassi G.H.; Quin J.A.; Stock E.M.; DeMatt E.J.; Biswas K.; Hattler B.;
Tseng E.; Zenati M.A.
Institution
(Almassi) Division of Cardiothoracic Surgery, Zablocki Veterans Affairs
(VA) Medical Center, Milwaukee, WI, United States
(Almassi) Department of Surgery, Medical College of Wisconsin, Milwaukee,
WI, United States
(Quin, Zenati) Department of Surgery, VA Boston Healthcare System, Boston,
Massachusetts, United States
(Quin, Zenati) Harvard Medical School, Boston, Massachusetts, United
States
(Stock, DeMatt, Biswas) Cooperative Studies Program, Perry Point/Baltimore
Coordinating Center, Office of Research and Development, U.S. Department
of Veterans Affairs, Perry Point, MD, United States
(Hattler) Department of Medicine, Rocky Mountain Regional VA Medical
Center, Aurora, Colorado, United States
(Hattler) University of Colorado Anschutz School of Medicine, Aurora,
Colorado, United States
(Tseng) Cardiothoracic Surgery, San Francisco Veterans Affairs Medical
Center, San Francisco, California, United States
(Tseng) Department of Surgery, University of California in San Francisco,
San Francisco, California, United States
Publisher
Academic Press Inc.
Abstract
Introduction: The impact of postoperative oral anticoagulation (OAC) with
warfarin on postoperative atrial fibrillation (POAF) after coronary artery
bypass grafting (CABG) was the focus of this examination of patients from
the randomized endo-vein graft prospective (REGROUP) Trial.
 Material(s) and Method(s): REGROUP was a prospective randomized
Veterans Affairs cooperative study comparing endoscopic versus open vein
harvest in elective CABG patients (March 2014-April 2017) at 16 Veterans
Affairs facilities. This study compared new-onset POAF patients who were
treated with warfarin versus no-warfarin. Outcomes included stroke during
active follow-up and a major adverse cardiac event composite of mortality,
acute myocardial infarction, and repeat revascularization during active
and passive follow-up. Result(s): Of the 316/1103 (28.6%) of REGROUP
patients who developed new-onset POAF, 45 patients were excluded - mainly
for preoperative warfarin use. Of the remaining 269 patients, 85 received
OAC with warfarin (OAC group); 184 did not (no-OAC group). Stroke rates
during active follow-up (32 [IQR 24-38] mo) were 3.5% OAC group versus
5.4% no-OAC group (P = 0.76); major adverse cardiac eventrates were 20%
OAC versus 11.4% no-OAC (P = 0.06). On longer follow-up of (median 4.61
[IQR 3.9-5.1] y), discharge OAC use was associated with all-cause
mortality after adjusting for Society of Thoracic Surgeons mortality risk
(20.0% versus 11.4% no-OAC use; HR = 2.00, 95% CI: 1.05-3.81, P = 0.035).
 Conclusion(s): REGROUP patients with POAF treated with OAC had
similar stroke and higher mortality rates versus no-OAC patients. Further
investigation of the risk-benefit ratio of OAC in post-CABG patients and
which POAF patient subgroups might derive the most benefit with
anticoagulation appears warranted. Copyright © 2023

<19>
Accession Number
2028633742
Title
The risk factors for and the frequency and outcomes of subsyndromal
delirium among patients who have undergone cardiac surgery: A protocol for
systematic review and meta-analysis.
Source
BMJ Open. 13(11) (no pagination), 2023. Article Number: e070624. Date of
Publication: 15 Nov 2023.
Author
Gao Y.; Bai X.; Zhang H.; Yang L.; Wu T.; Gan X.
Institution
(Gao, Bai, Zhang, Yang, Wu, Gan) Nursing Department, Second Affiliated
Hospital of Chongqing Medical University, Chongqing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Several key symptoms must be present for the accurate
diagnosis of patients with postoperative cardiac delirium. Some patients
present with symptoms of delirium but do not meet the diagnostic criteria
for delirium; such individuals are considered to have having subsyndromal
delirium (SSD). SSD is associated with misdiagnosis and poor outcomes.
However, to date, no systematic review (SR) has examined the frequency of,
risk factors for, and outcomes of SSD among adults who have undergone
cardiac surgery. Methods and analysis The aim of this SR is to identify
those studies that have explored SSD after cardiac surgery. MeSH and free
entry terms associated with "subsyndromal delirium"and "subclinical
delirium"will be used to search for relevant studies. The PubMed, Web of
Science, OVID, Cochrane Library, CINAHL, EMBASE, PsycINFO, China National
Knowledge Infrastructure, Wanfang data, VIP database and SinoMed will be
searched from inception to the date of retrieval without any restrictions.
The primary outcomes will be the frequency of SSD, the risk factors for
SSD, and the outcomes of SSD. Analyses will be performed using STATA
V.16.0, and descriptive analyses will be performed if the data are not
suitable for meta-analysis (ie, data with significant heterogeneity or
from different comparisons). Ethics and dissemination The SR will examine
the frequency of, risk factors for and outcomes of SSD in adults who have
undergone cardiac surgery. The results will provide guidance for the
identification of knowledge gaps in this field, and areas for further
research will be highlighted. The review protocol will be submitted for
publication in peer-reviewed journals for dissemination of the findings.
Individual patient data will not be included in this protocol, so ethical
approval will not be needed. PROSPERO registration number
CRD42022379211. Copyright © 2023 Author(s). Published by BMJ.

<20>
Accession Number
2028591353
Title
Systematic review of current natural language processing methods and
applications in cardiology.
Source
Heart. 108(12) (pp 909-916), 2022. Date of Publication: June 2022.
Author
Turchioe M.R.; Volodarskiy A.; Pathak J.; Wright D.N.; Tcheng J.E.;
Slotwiner D.
Institution
(Turchioe, Pathak, Slotwiner) Department of Population Health Sciences,
Division of Health Informatics, Weill Cornell Medicine, New York, NY,
United States
(Volodarskiy, Slotwiner) Department of Medicine, Division of Cardiology,
NewYork-Presbyterian Hospital, New York, NY, United States
(Wright) Samuel J. Wood Library & C.V. Starr Biomedical Information
Center, Weill Cornell Medical College, New York, NY, United States
(Tcheng) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
Publisher
BMJ Publishing Group
Abstract
Natural language processing (NLP) is a set of automated methods to
organise and evaluate the information contained in unstructured clinical
notes, which are a rich source of real-world data from clinical care that
may be used to improve outcomes and understanding of disease in
cardiology. The purpose of this systematic review is to provide an
understanding of NLP, review how it has been used to date within
cardiology and illustrate the opportunities that this approach provides
for both research and clinical care. We systematically searched six
scholarly databases (ACM Digital Library, Arxiv, Embase, IEEE Explore,
PubMed and Scopus) for studies published in 2015-2020 describing the
development or application of NLP methods for clinical text focused on
cardiac disease. Studies not published in English, lacking a description
of NLP methods, non-cardiac focused and duplicates were excluded. Two
independent reviewers extracted general study information, clinical
details and NLP details and appraised quality using a checklist of quality
indicators for NLP studies. We identified 37 studies developing and
applying NLP in heart failure, imaging, coronary artery disease,
electrophysiology, general cardiology and valvular heart disease. Most
studies used NLP to identify patients with a specific diagnosis and
extract disease severity using rule-based NLP methods. Some used NLP
algorithms to predict clinical outcomes. A major limitation is the
inability to aggregate findings across studies due to vastly different NLP
methods, evaluation and reporting. This review reveals numerous
opportunities for future NLP work in cardiology with more diverse patient
samples, cardiac diseases, datasets, methods and
applications. Copyright © Author(s) (or their employer(s)) 2022.

<21>
Accession Number
2028575493
Title
A Randomized Comparison of Two Doses of Tranexamic Acid in High-Risk
Open-Heart Surgery.
Source
Nepalese Heart Journal. 20(5) (pp 1-6), 2023. Date of Publication: 2023.
Author
Shrestha B.K.; Khadka R.; Bhusal S.; Baidya R.; Bhandari S.; Suraj K.C.
Institution
(Shrestha, Baidya, Bhandari) Department of Anesthesiology, Shahid Gangalal
National Heart Center, Bansbari, Kathmandu, Nepal
(Khadka) Department of Anesthesiology, National Trauma Center, Kathmandu,
Nepal
(Bhusal) Department of Anesthesiology, National Academy of Medical
Sciences, Kathmandu, Nepal
(Suraj) B P Koirala Institute of Health Sciences, Dharan, Nepal
Publisher
Cardiac Society of Nepal
Abstract
Background and aims: Tranexamic acid is commonly used in cardiac surgery
to minimize perioperative bleeding. There are wide variations in dose of
this drug. This study aims to find out the minimal effective dose of
tranexamic acid. Method(s): Patients were randomized into low dose
group receiving 10 mg/kg and high dose group receiving 30 mg/kg bolus of
tranexamic acid each followed by an infusion of 1mg/kg/hr until the end of
surgery. Primary objective was to compare blood loss during the first
postoperative day. Secondary objectives were to compare total blood
products transfused during 24 hours post-operative period, to compare the
incidence of re-explorations and to compare the adverse drug reactions
between the groups. Result(s): There were sixty patients in each
group. There was a significant difference in blood loss (435.17+/- 299.91
ml vs 528.64 +/-254.04 ml) between the low dose group and High dose group
(p=0.010). Transfusion of packed red blood cell, re-exploration and
adverse drug reactions were higher in high dose group however these were
not statistically significant. Conclusion(s): Higher dose of
tranexamic acid is not effective in reducing blood loss in open heart
surgery in first postoperative day. Copyright © 2023 Cardiac
Society of Nepal. All rights reserved.

<22>
Accession Number
2028341509
Title
Transcatheter edge-to-edge repair in mitral regurgitation: A comparison of
device systems and recommendations for tailored device selection. A
systematic review and meta-analysis.
Source
Progress in Cardiovascular Diseases. 81 (pp 98-104), 2023. Date of
Publication: 01 Nov 2023.
Author
Alqeeq B.F.; Al-Tawil M.; Hamam M.; Aboabdo M.; Elrayes M.I.; Leick J.;
Zeinah M.; Haneya A.; Harky A.
Institution
(Alqeeq, Hamam, Aboabdo) Faculty of Medicine, Islamic University of Gaza,
Gaza, Palestine
(Al-Tawil) Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
(Elrayes) Department of Pediatric Surgery, Great Ormond Street Hospital
for Children, London, United Kingdom
(Leick) Department of Cardiology, Heart Center Trier, Trier, Germany
(Zeinah) School of Medicine, Ain Shams University, Cairo, Egypt
(Zeinah, Harky) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Haneya) Department of Cardiac and Thoracic Surgery, Heart Center Trier,
Trier, Germany
Publisher
W.B. Saunders
Abstract
Background: Mitral valve transcatheter edge-to-edge repair (M-TEER) is a
minimally invasive method for the treatment of mitral regurgitation (MR)
in patients with prohibitive surgical risks. The traditionally used
device, MitraClip, showed both safety and effectiveness in M-TEER. PASCAL
is a newer device that has emerged as another feasible option to be used
in this procedure. Method(s): We searched for observational studies
that compared PASCAL to MitraClip devices in M-TEER. The electronic
databases searched for relevant studies were PubMed/MEDLINE, Scopus, and
Embase. The primary outcomes were technical success and the grade of MR at
follow-up. Secondary outcomes included all-cause mortality, bleeding,
device success and reintervention. Result(s): Technical success
(PASCAL: 96.5% vs MitraClip: 97.6%, p = 0.24) and MR <= 2 at 30-day
follow-up (PASCAL: 89.4vs MitraClip 89.9%, p = 0.51) were comparable
between both groups. Both devices showed similar outcomes including
all-cause mortality (RR: 0.68 [0.34, 1.38]; P = 0.28), major bleeding (RR:
1.87 [0.68, 5.10]; P = 0.22) and reintervention (RR: 1.02 [0.33, 3.16]; P
= 0.97). Device success was more frequent with PASCAL device (PASCAL: 86%
vs MitraClip 68.5%; P = 0.44), however, the results did not reach
statistical significance. Conclusion(s): Clinical outcomes of PASCAL
were comparable to those of MitraClip with no significant difference in
safety and effectiveness. The choice between MitraClip and PASCAL devices
should be guided by various factors, including mitral valve anatomy,
etiology of regurgitation, and device-specific
characteristics. Copyright © 2023 Elsevier Inc.

<23>
Accession Number
2028083153
Title
Systematic Review of the Use of the 6-Minute Walk Test in Measuring and
Improving Prognosis in Patients With Ischemic Heart Disease.
Source
CJC Open. 5(11) (pp 816-825), 2023. Date of Publication: November 2023.
Author
Coulshed A.; Coulshed D.; Pathan F.
Institution
(Coulshed) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Coulshed, Pathan) Department of Cardiology, Nepean Hospital, University
of Sydney, Penrith, NSW, Australia
Publisher
Elsevier Inc.
Abstract
Introduction: The 6-minute walk test (6MWT) has been used for over 30
years to assess exercise capacity in patients with respiratory disease,
and more recently, in those with heart failure. However, despite being a
simple and reproducible test of real-world exercise capacity, its use in
patients with ischemic heart disease (IHD) is less well accepted. We
sought to review systematically the evidence surrounding the 6MWT in IHD.
 Method(s): We searched the Medline, PubMed, Embase, and Scopus
databases for the following key terms: "six minute walk test/6 minute walk
test/6MWT" and "angina/coronary artery disease/coronary
disease/IHD/ischemic heart disease." We followed Preferred Reporting Items
for Systematic Reviews and Meta-analysis (PRISMA) guidelines to select
publications for full-text review and analyzed the collated data.
 Result(s): A total of 1228 unique papers were found, of which 71 were
chosen for full-text review and 37 for detailed analysis. Most (23)
concerned the effect on 6MWT distance (6MWTd) of cardiac rehabilitation,
with measurements commenced after an intervention (acute myocardial
infarction, n = 4; open heart surgery (OHS), n = 5; percutaneous coronary
intervention (PCI), n = 3; or other, n = 11). The effect on 6MWTd of OHS
was investigated in 6 studies and of PCI in one study. The 6MWT is a
useful measurement of physical capacity; data are limited on its ability
to assess benefit following PCI. Conclusion(s): The 6MWT has been
studied inconsistently in IHD. The majority of data are on patients before
and after CR. Data are limited concerning the effect on 6MWTd of OHS or
PCI. The available data support the 6MWT as a measure of change in
performance status following coronary intervention. More work is required
to confirm this hypothesis. Copyright © 2023 The Authors

<24>
Accession Number
2027902180
Title
Extracorporeal cardiopulmonary resuscitation-based approach to refractory
out-of-hospital cardiac arrest: A focus on organ donation, a secondary
analysis of a Prague OHCA randomized study.
Source
Resuscitation. 193 (no pagination), 2023. Article Number: 109993. Date of
Publication: December 2023.
Author
Smalcova J.; Havranek S.; Pokorna E.; Franek O.; Huptych M.; Kavalkova P.;
Pudil J.; Rob D.; Dusik M.; Belohlavek J.
Institution
(Smalcova, Havranek, Kavalkova, Pudil, Rob, Dusik, Belohlavek) 2nd
Department of Cardiovascular Medicine, General University Hospital in
Prague, First Faculty of Medicine, Charles University in Prague, Prague,
Czechia
(Pokorna) Institute for Clinical and Experimental Medicine, Prague,
Czechia
(Smalcova, Franek) Emergency Medical Service Prague, Prague, Czechia
(Huptych) Czech Institute of Informatics, Robotics and Cybernetics
(CIIRC), Czech Technical University in Prague, Prague, Czechia
Publisher
Elsevier Ireland Ltd
Abstract
Background: Refractory out-of-hospital cardiac arrest (OHCA) has a poor
outcome. In patients, who cannot be rescued despite using advanced
techniques like extracorporeal cardiopulmonary resuscitation (ECPR), organ
donation may be considered. This study aims to evaluate, in refractory
OHCA, how ECPR versus a standard-based approach allows organ donorship.
 Method(s): The Prague OHCA trial randomized adults with a witnessed
refractory OHCA of presumed cardiac origin to either an ECPR-based or
standard approach. Patients who died of brain death or those who died of
primary circulatory reasons and were not candidates for cardiac
transplantation or durable ventricle assist device were evaluated as
potential organ donors by a transplant center. In this post-hoc analysis,
the effect on organ donation rates and one-year organ survival in
recipients was examined. Result(s): Out of 256 enrolled patients, 75
(29%) died prehospitally or within 1 hour after admission and 107 (42%)
during the hospital stay. From a total of 24 considered donors, 21 and 3
(p = 0.01) were recruited from the ECPR vs standard approach arm,
respectively. Fifteen brain-dead and none cardiac-dead subjects were
ultimately accepted, 13 from the ECPR and two from the standard strategy
group. A total of 36 organs were harvested. The organs were successfully
transplanted into 34 recipients. All transplanted organs were fully
functional, and none of the recipients died due to graft failure within
the one-year period post-transplant. Conclusion(s): The ECPR-based
approach in the refractory OHCA trial is associated with increased organ
donorship and an excellent outcome of transplanted organs. Trial
registration: ClinicalTrials.gov Identifier: NCT 01511666. Registered
January 19, 2012. Copyright © 2023 The Authors

<25>
Accession Number
2027355764
Title
Cognitive Deficits in Executive and Language Functions Predict
Postoperative Delirium.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 37(12) (pp 2552-2560),
2023. Date of Publication: December 2023.
Author
Olotu C.; Lebherz L.; Ascone L.; Scherwath A.; Kuhn S.; Harter M.;
Kiefmann R.
Institution
(Olotu, Kiefmann) Department of Anaesthesiology, University Medical Center
Hamburg, Hamburg, Germany
(Lebherz, Scherwath, Harter) Institute of Medical Psychology, University
Medical Center Hamburg, Hamburg, Germany
(Ascone, Kuhn) Department of Psychiatry and Psychotherapy, University
Medical Center Hamburg, Hamburg, Germany
(Scherwath) Department of Stem Cell Transplantation, University Medical
Center Hamburg, Hamburg, Germany
(Kiefmann) Anesthesia Department, Rotkreuzklinikum Munich, Munich, Germany
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative delirium (POD) remains the most common
complication in older adults, with cognitive impairment being the main
risk factor. Patients with mild cognitive impairment, in particular, have
much to lose from delirium; despite this, their cognitive impairment might
be clinically overlooked. Understanding which cognitive domains are
particularly predictive in this regard may improve the sensitivity of
preoperative testing and allow for a more targeted application of
resource-intensive measures to prevent delirium in the perioperative
period. The authors conducted this study with the aim of identifying the
most indicative cognitive domains. Design(s): A secondary analysis of
a randomized controlled trial. Setting(s): At a single center, the
University Medical Centre Hamburg in Hamburg, Germany.
 Participant(s): Patients >=60 years without major neurocognitive
disorders (dementia, Mini-Mental State Examination score <=23) scheduled
for cardiovascular surgery. Measurements and Main Results:
Preoperative neuropsychologic testing and delirium screening were
performed twice daily until postoperative day 5. A multiple logistic
regression model was applied to determine the predictive ability of test
performances for the development of delirium. Result(s): A total of
541 patients were included in the analysis; the delirium rate was 15.6%.
After controlling for confounders, only low performance within the Trail
Making Test B/A (odds ratio [OR] = 1.32; 95% CI: 1.05-1.66) and letter
fluency (OR = 0.66; 95% CI: 0.45-0.96) predicted a particularly high risk
for delirium development. The discriminative ability of the final multiple
logistic regression model to predict POD had an area under the curve of
0.786. Conclusion(s): Impairment in the cognitive domains of
executive function and language skills associated with memory, inhibition,
and access speed seem to be particularly associated with the development
of delirium after surgery in adults >=65 years of age without apparent
preoperative neurocognitive impairment. Copyright © 2023 Elsevier
Inc.

<26>
Accession Number
2026976015
Title
Effects of intravenous glucocorticoids on postoperative delirium in adult
patients undergoing major surgery: a systematic review and meta-analysis
with trial sequential analysis.
Source
BMC Anesthesiology. 23(1) (no pagination), 2023. Article Number: 399. Date
of Publication: December 2023.
Author
Li C.; Zhang Z.; Xu L.; Lin X.; Sun X.; Li J.; Wei P.
Institution
(Li, Zhang, Xu, Lin, Sun, Li, Wei) Department of Anesthesiology, Qilu
Hospital (Qingdao), Cheeloo College of Medicine, Shandong University,
Qingdao 266035, China
(Li, Zhang, Lin, Sun, Li) Department of Anesthesiology, Qilu Hospital of
Shandong University, Jinan 250000, China
Publisher
BioMed Central Ltd
Abstract
Background: The effects of intravenous glucocorticoids on postoperative
delirium (POD) in adult patients undergoing major surgery remain
controversial. Therefore, we conducted this meta-analysis to assess
whether intravenous glucocorticoids can decrease POD incidence in the
entire adult population undergoing major surgery and its association with
patients age, type of surgery, and type of glucocorticoid. Method(s):
We searched the relevant literature published before November 3, 2023,
through Cochrane Library, PubMed, Embase, and Web of Science. The primary
outcome was POD incidence. The risk ratio for the primary outcome was
calculated using the Mantel-Haenszel method. The secondary outcomes
included 30-day mortality, length of hospital stay, ICU duration,
mechanical ventilation duration, and occurrence of glucocorticoid-related
adverse effects (e.g., infection and hyperglycemia). This meta-analysis
was registered in PROSPERO: CRD42022345997. Result(s): We included
eight randomized controlled studies involving 8972 patients. For the
entire adult population undergoing major surgery, intravenous
glucocorticoids reduced the POD incidence (risk ratio = 0.704, 95%
confidence interval, 0.519-0.955; P = 0.024). However, subgroups defined
by type of surgery showed differential effects of glucocorticoids on POD.
Intravenous glucocorticoids can not reduce POD incidence in adult patients
undergoing cardiac surgery (risk ratio = 0.961, 95% confidence interval,
0.769-1.202; P = 0.728), with firm evidence from trial sequential
analysis. However, in major non-cardiac surgery, perioperative intravenous
glucocorticoid reduced the incidence of POD (risk ratio = 0.491, 95%
confidence interval, 0.338-0.714; P < 0.001), which warrants further
studies due to inconclusive evidence by trial sequence analysis. In
addition, the use of glucocorticoids may reduce the mechanical ventilation
time (weighted mean difference, -1.350; 95% confidence interval, -1.846 to
-0.854; P < 0.001) and ICU duration (weighted mean difference = -7.866;
95% confidence interval, -15.620 to -0.112; P = 0.047).
 Conclusion(s): For the entire adult population undergoing major
surgery, glucocorticoids reduced the POD incidence. However, the effects
of glucocorticoids on POD appear to vary according to the type of surgery.
In patients receiving major non-cardiac surgery, glucocorticoid may be an
attractive drug in the prevention of POD, and further studies are needed
to draw a definitive conclusion. In cardiac surgery, intravenous
glucocorticoids have no such effect. Copyright © 2023, The
Author(s).

<27>
Accession Number
2025212754
Title
Transcatheter vacuum aspiration of valvular and lead related infective
endocarditis.
Source
Cardiovascular Revascularization Medicine. 57 (pp 8-15), 2023. Date of
Publication: December 2023.
Author
Gill G.S.; Chakrala T.; Kanmanthareddy A.; Alla V.M.
Institution
(Gill, Kanmanthareddy, Alla) Division of Cardiovascular Disease, Creighton
University School of Medicine, Omaha, NE, United States
(Chakrala) Department on Medicine, University of Florida, Gainesville, FL,
United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aspiration is utilized for removal of thrombi
and vegetations in inoperable patients and high-risk surgical candidates
where medical therapy alone is unlikely to achieve desired outcome. A
number of case reports and series have been published since the
introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012
where this technology was used in the treatment of endocarditis. However,
there is a lack of consolidated data reporting on patient selection,
safety and outcomes. Method(s): PubMed and Google Scholar databases
were queried for publications reporting cases where transcatheter
aspiration was used for endocarditis vegetation debulking or removal. Data
on patient characteristics, outcomes and complications from select reports
were extracted and systematically reviewed. Result(s): Data from 11
publications with 232 patients were included in the final analyses. Of
these, 124 had lead vegetation aspiration, 105 had valvular vegetation
aspiration, and 3 had both lead as well as valvular vegetation aspiration.
Among the 105 valvular endocarditis cases, 102 (97 %) patients had right
sided vegetation removal. Patients with valvular endocarditis were younger
(mean age 35 years) vs. patients with lead vegetations (mean age 66
years). Among the valvular endocarditis cases, there was a 50-85 %
reduction in vegetation size, 14 % had worsening valvular regurgitation, 8
% had persistent bacteremia and 37 % required blood transfusion. Surgical
valve repair or replacement was subsequently performed in 3 % and
in-hospital mortality was 11 %. Among patients with lead infection,
procedural success rate was reported at 86 %, 2 % had vascular
complications and in-hospital mortality was 6 %. Persistent bacteremia,
renal failure requiring hemodialysis, and clinically significant pulmonary
embolism occurred in about 1 % each. Conclusion(s): Transcatheter
aspiration of vegetations in infective endocarditis has acceptable success
rates in vegetation debulking as well as rates of morbidity or mortality.
Large prospective multi-center studies are warranted to determine
predictors of complications, thus helping identify suitable
patients. Copyright © 2023 Elsevier Inc.

<28>
Accession Number
2021213240
Title
Authorship Trends and Disparities in Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. 116(6) (pp 1329-1334), 2023. Date of
Publication: December 2023.
Author
Papageorge M.V.; Luc J.G.Y.; Olive J.K.; Antonoff M.B.
Institution
(Papageorge) Department of Surgery, Yale University School of Medicine,
New Haven, Connecticut, United States
(Luc) Division of Cardiovascular Surgery, University of British Columbia,
Vancouver, BC, Canada
(Olive) Division of Cardiothoracic Surgery, Department of Surgery, Duke
University School of Medicine, Durham, North Carolina, United States
(Antonoff) Division of Surgery, Department of Thoracic and Cardiovascular
Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas,
United States
Publisher
Elsevier Inc.
Abstract
Background: Previous investigations have revealed significant gender
disparities in the academic arenas of cardiothoracic surgery. However, the
status of gender representation in cardiothoracic publications has not
been well described. This study aimed to evaluate authorship trends by
gender in two high-impact cardiothoracic surgical journals.
 Method(s): In this bibliometric analysis, PubMed was searched for
articles published in The Annals of Thoracic Surgery and the Journal of
Thoracic and Cardiovascular Surgery from 2010 to 2021. The web-based
application Genderize.io was used to classify names of first and last
authors as men vs women. The Cochran-Armitage trend test and multivariable
logistic regression were used to evaluate authorship per year and the
association of first and last author gender, respectively. Result(s):
Among 14,443 articles, 16.7% had women first authors and 8.1% had women
last authors. The proportion of articles written by women authors
increased, rising from 12.6% to 21.1% (P < .0001) for first and 5.4% to
11.5% (P < .0001) for last authors. Papers written with women as first
author were associated with 2.0 higher odds of having a woman as last
author (95% CI, 1.7-2.3; P < .0001). The mean number of last author
publications was higher for men than for women (2.4 vs 1.7, P < .0001).
 Conclusion(s): Over the past decade, despite a welcomed increase in
women authorship in high-impact journals in cardiothoracic surgery, women
represent a small proportion of published authors. Women first authors are
more likely to publish with women last authors, demonstrating the impact
of same-gender collaborations while emphasizing a need for cross-gender
mentorship. Copyright © 2023 The Society of Thoracic Surgeons

<29>
Accession Number
2019495186
Title
Randomized Trial of Surgical Left Atrial Appendage Closure: Protection
Against Cerebrovascular Events.
Source
Seminars in Thoracic and Cardiovascular Surgery. 35(4) (pp 664-672), 2023.
Date of Publication: Winter 2023.
Author
Madsen C.V.; Park-Hansen J.; Holme S.J.V.; Irmukhamedov A.; Carranza C.L.;
Greve A.M.; Al-Farra G.; Riis R.G.C.; Nilsson B.; Clausen J.S.R.; Norskov
A.S.; Kruuse C.; Truelsen T.C.; Dominguez H.
Institution
(Madsen, Park-Hansen, Clausen, Norskov, Dominguez) Department of
Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg,
Copenhagen, Denmark
(Madsen, Clausen, Norskov, Dominguez) Department of Biomedical Science,
University of Copenhagen, Copenhagen, Denmark
(Holme, Carranza) Department of Cardio-Thoracic Surgery, Copenhagen
University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
(Irmukhamedov) Department of Heart, Lung, and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Greve) Department of Clinical Biochemistry, Copenhagen University
Hospital - Herlev and Gentofte, Herlev, Denmark
(Al-Farra) Department of Radiology, Copenhagen University Hospital -
Herlev and Gentofte, Herlev, Denmark
(Riis) Department of Radiology, Copenhagen University Hospital -
Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
(Nilsson) Department of Cardiology, Copenhagen University Hospital -
Amager and Hvidovre, Hvidovre, Denmark
(Kruuse) Department of Neurology, Neurovascular Research Unit, Copenhagen
University Hospital - Herlev and Gentofte, Herlev, Denmark
(Truelsen) Department of Neurology, Copenhagen University Hospital -
Rigshospitalet-Glostrup, Copenhagen, Denmark
Publisher
W.B. Saunders
Abstract
Following open-heart surgery, atrial fibrillation and stroke occur
frequently. Left atrial appendage closure added to elective open-heart
surgery could reduce the risk of ischemic stroke. We aim to examine if
routine closure of the left atrial appendage in patients undergoing
open-heart surgery provides long-term protection against cerebrovascular
events independently of atrial fibrillation history, stroke risk, and oral
anticoagulation use. Long-term follow-up of patients enrolled in the
prospective, randomized, open-label, blinded evaluation trial entitled
left atrial appendage closure by surgery (NCT02378116). Patients were
stratified by oral anticoagulation status and randomized (1:1) to left
atrial appendage closure in addition to elective open-heart surgery vs
standard care. The primary composite endpoint was ischemic stroke events,
transient ischemic attacks, and imaging findings of silent cerebral
ischemic lesions. Two neurologists blinded for treatment assignment
adjudicated cerebrovascular events. In total, 186 patients (82% males)
were reviewed. At baseline, mean (standard deviation (SD)) age was68 (9)
years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation.
Median [interquartile range (IQR)] CHA<inf>2</inf>DS<inf>2</inf>-VASc was
3 [2,4] and 25.9% (n = 48/186) were receiving oral anticoagulants. Mean
follow-up was 6.2 (2.5) years. The left atrial appendage closure group
experienced fewer cerebrovascular events; intention-to-treat 11 vs 19 (P =
0.033, n = 186) and per-protocol 9 vs 17 (P = 0.186, n = 141). Left atrial
appendage closure as an add-on open-heart surgery, regardless of
pre-surgery atrial fibrillation and oral anticoagulation status, seems
safe and may reduce cerebrovascular events in long-term follow-up. More
extensive randomized clinical trials investigating left atrial appendage
closure in patients without atrial fibrillation and high stroke risk are
warranted. Copyright © 2022 The Author(s)

<30>
Accession Number
2018076864
Title
Negative pressure wound therapy in patients with diabetes undergoing left
internal thoracic artery harvest: A randomized control trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 167(1) (pp 256-268), 2024.
Date of Publication: January 2024.
Author
Jenkins S.; Komber M.; Mattam K.; Briffa N.
Institution
(Jenkins, Briffa) Department of Infection, Immunity, and Cardiovascular
Disease, The University of Sheffield, Sheffield, United Kingdom
(Komber, Mattam, Briffa) Department of Cardiothoracic Surgery, Sheffield
Teaching Hospitals, NHS Foundation Trust, Sheffield, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Patients with diabetes undergoing CABG are at risk of wound
infection. Incisional negative pressure wound therapy has been shown to be
effective in decreasing incidence of infection in high-risk wounds. Near
infrared spectroscopy (NIRS) can be used to assess wound oxygenation and
low values can predict infection. Objective(s): To evaluate utility
of NIRS to assess wound oxygenation, to assess effect of sternotomy, left
internal thoracic artery harvest, and wound dressing type on wound edge
oxygenation. Method(s): In this blinded randomized control trial,
patients with diabetes undergoing isolated coronary artery bypass grafting
with a left internal thoracic artery were randomized to receive either
incisional negative pressure wound therapy dressing or a standard
dressing. NIRS measurements were made on the left upper arm (control), and
left and right parasternal regions on day -1 (preoperative), day 5, and
week 6 after surgery. Results were analyzed using repeated measures
parametric methods. Result(s): Eighty patients with diabetes were
recruited, 40 to the incisional negative pressure wound therapy group and
40 to the standard dressing group. Adjusted NIRS readings dropped
significantly in all patients by day 5 and partially recovered by week 6.
In both groups, there was no difference between readings on the left and
right. At all time points and on both sides, there was no difference in
readings between patients in the 2 groups. Conclusion(s): NIRS can be
used to assess oxygenation adjacent to a sternotomy wound. Adjusted tissue
oxygen levels change with time after sternotomy and left internal thoracic
artery harvest in patients with diabetes. Wound dressing type does not
influence day 5 wound edge oxygenation. Copyright © 2022

<31>
Accession Number
642476674
Title
Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer
Care Ontario) Guideline.
Source
Journal of clinical oncology : official journal of the American Society of
Clinical Oncology. 41(35) (pp 5448-5472), 2023. Date of Publication: 10
Dec 2023.
Author
Khurshid H.; Ismaila N.; Bian J.; Dabney R.; Das M.; Ellis P.; Feldman J.;
Hann C.; Kulkarni S.; Laskin J.; Manochakian R.; Mishra D.R.; Preeshagul
I.; Reddy P.; Saxena A.; Weinberg F.; Kalemkerian G.P.
Institution
(Khurshid) Brown University, Providence, RI, United States
(Ismaila) American Society of Clinical Oncology (ASCO), Alexandria, VA
(Bian) Maine Health, South Portland, ME, United States
(Dabney) Texas Oncology, Grapevine, TX, United States
(Das) Stanford University, Stanford, CA, United States
(Ellis) Juravinski Cancer Center, Hamilton Health Sciences, Hamilton,
Ontario, Canada
(Feldman) EGFR Resisters Patient Advocacy Group, Deerfield, IL, United
States
(Hann) Johns Hopkins University, Baltimore, MD, Liberia
(Kulkarni) Western University, Windsor Regional Cancer Program, Windsor,
ON, Canada
(Laskin) University of British Columbia, Vancouver, BC, Canada
(Manochakian) Mayo Clinic, Jacksonville, FL, Puerto Rico
(Mishra) KathmanduNepal
(Preeshagul) Memorial Sloan Kettering Cancer Center, Montvale, NJ, United
States
(Reddy) Cancer Center of Kansas, Wichita, KS, United States
(Saxena) Weill Cornell Medicine, New York, NY
(Weinberg) University of Illinois, Chicago, IL, United States
(Kalemkerian) University of Michigan, Ann Arbor, MI, United States
Abstract
PURPOSE: To provide evidence-based recommendations to practicing
clinicians on the management of patients with small-cell lung cancer.
 METHOD(S): An Expert Panel of medical oncology, thoracic surgery,
radiation oncology, pulmonary, community oncology, research methodology,
and advocacy experts were convened to conduct a literature search, which
included systematic reviews, meta-analyses, and randomized controlled
trials published from 1990 through 2022. Outcomes of interest included
response rates, overall survival, disease-free survival or recurrence-free
survival, and quality of life. Expert Panel members used available
evidence and informal consensus to develop evidence-based guideline
recommendations. RESULT(S): The literature search identified 95
relevant studies to inform the evidence base for this guideline.
RECOMMENDATIONS: Evidence-based recommendations were developed to address
systemic therapy options, timing of therapy, treatment in patients who are
older or with poor performance status, role of biomarkers, and use of
myeloid-supporting agents in patients with small-cell lung
cancer.Additional information is available at
www.asco.org/thoracic-cancer-guidelines.

<32>
Accession Number
642951768
Title
The Potential Impact of Sublobar Resection for NSCLC Management in an
Irish Setting.
Source
Irish Journal of Medical Science. Conference: Irish Thoracic Society
Annual Scientific Meeting 2023. Limerick Ireland. 192(Supplement 2) (pp
S118), 2023. Date of Publication: November 2023.
Author
Weedle R.; Whooley J.; Young V.; Fitzmaurice G.J.; Ryan R.
Institution
(Weedle, Whooley, Young, Fitzmaurice, Ryan) St James's Hospital, Dublin,
Ireland
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Sublobar resection is non-inferior to lobectomy in
carefully-staged clinical stage 1A NSCLC based on two recent large
multi-centre RCTs. These trials have been heralded as establishing
sublobar resection as the standard of care for this subset of patients.
Implementing these findings into practice in Ireland will require
additional resources. The aim of this study was to establish what
proportion of patients undergoing lung resection for NSCLC would meet the
trials' radiological inclusion criteria. Method(s): A retrospective
review was conducted on all patients who underwent lung resection for
NSCLC in a single tertiary referral unit over a two-year period. This
cohort was screened for patients who had a peripheral tumour, excluding
the right middle lobe, measuring <=2cm, with a consolidation-to-tumour
ratio of >0.5, and clinically node-negative. Result(s): 417 NSCLC
resections were performed. 114 patients met the clinical TNM criteria. Of
these, 71 patients had tumours located in the outer third of the lung.
Resection was by lobectomy (n=58), segmentectomy (n=2), or wedge resection
(n=11). Four patients (6%) had pre-operative invasive mediastinal staging.
Six patients (8%) had nodal metastasis on final histopathology.
 Conclusion(s): Approximately 17% of patients undergoing surgical
management of NSCLC could be considered for sublobar resection if the
findings of JCOG 0802 and CALGB 140503 are accepted into practice.
Adequate resources and further collaboration between cardiothoracic
surgery, respiratory medicine and histopathology would be required to
ensure these patients are appropriately staged and selected.

<33>
Accession Number
2027009875
Title
Beyond Conventional Operations: Embracing the Era of Contemporary
Minimally Invasive Cardiac Surgery.
Source
Journal of Clinical Medicine. 12(23) (no pagination), 2023. Article
Number: 7210. Date of Publication: December 2023.
Author
Ilcheva L.; Risteski P.; Tudorache I.; Haussler A.; Papadopoulos N.;
Odavic D.; Rodriguez Cetina Biefer H.; Dzemali O.
Institution
(Ilcheva, Risteski, Tudorache, Haussler, Papadopoulos, Odavic, Rodriguez
Cetina Biefer, Dzemali) Department of Cardiac Surgery, University Hospital
Zurich, Zurich 8091, Switzerland
(Risteski, Tudorache, Haussler, Papadopoulos, Odavic, Rodriguez Cetina
Biefer, Dzemali) Department of Cardiac Surgery, Zurich City
Hospital-Triemli, Zurich 8055, Switzerland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has
gained a significant place due to the emergence of innovative tools and
improvements in surgical techniques, offering comparable efficacy and
safety to traditional surgical methods. This review provides an overview
of the history of MICS, its current state, and its prospects and
highlights its advantages and limitations. Additionally, we highlight the
growing trends and potential pathways for the expansion of MICS,
underscoring the crucial role of technological advancements in shaping the
future of this field. Recognizing the challenges, we strive to pave the
way for further breakthroughs in minimally invasive cardiac
procedures. Copyright © 2023 by the authors.

<34>
Accession Number
642946945
Title
Proprotein convertase subtilisn/kexin type 9 inhibitors and small
interfering RNA therapy for cardiovascular risk reduction: A systematic
review and meta-analysis.
Source
PloS one. 18(12) (pp e0295359), 2023. Date of Publication: 2023.
Author
Imran T.F.; Khan A.A.; Has P.; Jacobson A.; Bogin S.; Khalid M.; Khan A.;
Kim S.; Erqou S.; Choudhary G.; Aspry K.; Wu W.-C.
Institution
(Imran, Erqou, Choudhary, Wu) Providence VA Medical Center, Providence,
RI, United States
(Imran, Has, Khalid, Erqou, Choudhary, Aspry, Wu) Lifespan Cardiovascular
Institute, Rhode Island and Miriam Hospitals, Providence, RI, United
States
(Imran, Khan, Has, Jacobson, Bogin, Erqou, Choudhary, Aspry, Wu) Warren
Alpert Medical School of Brown University, Providence, RI, United States
(Khan) Northwestern University, Evanston, IL, United States
(Kim) Weil Cornell College of Medicine, NY, United States
Abstract
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading
cause of mortality worldwide. Atherosclerosis occurs due to accumulation
of low-density lipoprotein cholesterol (LDL-c) in the arterial system.
Thus, lipid lowering therapy is essential for both primary and secondary
prevention. Proprotein convertase subtilisn/kexin type 9 (PCSK9)
inhibitors (Evolocumab, Alirocumab) and small interfering RNA (siRNA)
therapy (Inclisiran) have been demonstrated to lower LDL-c and ASCVD
events in conjunction with maximally tolerated statin therapy. However,
the degree of LDL-c reduction and the impact on reducing major adverse
cardiac events, including their impact on mortality, remains unclear.
 OBJECTIVE(S): The purpose of this study is to examine the effects of
PCSK9 inhibitors and small interfering RNA (siRNA) therapy on LDL-c
reduction and major adverse cardiac events (MACE) and mortality by
conducting a meta-analysis of randomized controlled trials.
 METHOD(S): Using Pubmed, Embase, Cochrane Library and
clinicaltrials.gov until April 2023, we extracted randomized controlled
trials (RCTs) of PCSK9 inhibitors (Evolocumab, Alirocumab) and siRNA
therapy (Inclisiran) for lipid lowering and risk of MACE. Using
random-effects models, we pooled the relative risks and 95% CIs and
weighted least-squares mean difference in LDL-c levels. We estimated odds
ratios with 95% CIs among MACE subtypes and all-cause mortality.
Fixed-effect model was used, and heterogeneity was assessed using the I2
statistic. RESULT(S): In all, 54 studies with 87,669 participants
(142,262 person-years) met criteria for inclusion. LDL-c percent change
was reported in 47 studies (n = 62,634) evaluating two PCSK9 inhibitors
and siRNA therapy. Of those, 21 studies (n = 41,361) included treatment
with Evolocumab (140mg), 22 (n = 11,751) included Alirocumab (75mg), and 4
studies (n = 9,522) included Inclisiran (284mg and 300mg). Compared with
placebo, after a median of 24 weeks (IQR 12-52), Evolocumab reduced LDL-c
by -61.09% (95% CI: -64.81, -57.38, p<0.01) and Alirocumab reduced LDL-c
by -46.35% (95% CI: -51.75, -41.13, p<0.01). Inclisiran 284mg reduced
LDL-c by -54.83% (95% CI: -59.04, -50.62, p = 0.05) and Inclisiran 300mg
reduced LDL-c by -43.11% (95% CI: -52.42, -33.80, p = 0.01). After a
median of 8 months (IQR 6-15), Evolocumab reduced the risk of myocardial
infarction (MI), OR 0.72 (95% CI: 0.64, 0.81, p<0.01), coronary
revascularization, 0.77 (95% CI: 0.70, 0.84, p<0.01), stroke, 0.79 (95%
CI: 0.66, 0.94, p = 0.01) and overall MACE 0.85 (95% CI: 0.80, 0.89,
p<0.01). Alirocumab reduced MI, 0.57 (0.38, 0.86, p = 0.01),
cardiovascular mortality 0.35 (95% CI: 0.16, 0.77, p = 0.01), all-cause
mortality 0.60 (95% CI: 0.43, 0.84, p<0.01), and overall MACE 0.35 (0.16,
0.77, p = 0.01). CONCLUSION(S): PCSK9 inhibitors (Evolocumab,
Alirocumab) and siRNA therapy (Inclisiran) significantly reduced LDL-c by
>40% in high-risk individuals. Additionally, both Alirocumab and
Evolocumab reduced the risk of MACE, and Alirocumab reduced cardiovascular
and all-cause mortality. Copyright: This is an open access article,
free of all copyright, and may be freely reproduced, distributed,
transmitted, modified, built upon, or otherwise used by anyone for any
lawful purpose. The work is made available under the Creative Commons CC0
public domain dedication.

<35>
Accession Number
2028901998
Title
Endovascular treatment of mycotic aneurysms: An update meta-analysis.
Source
Clinical Neurology and Neurosurgery. 236 (no pagination), 2024. Article
Number: 108068. Date of Publication: January 2024.
Author
Batista S.; Oliveira L.D.B.; Filho J.A.A.; Abreu L.V.; Andreao F.F.;
Palavani L.B.; Bertani R.; Alves Filho C.A.F.; de Oliveira Braga F.;
Machado E.A.T.; da Mata Pereira P.J.; Filho P.N.; Pereira V.M.
Institution
(Batista, Abreu, Andreao) Faculty of Medicine, Federal University of Rio
de Janeiro, Rio de Janeiro, Brazil
(Oliveira) Faculty of medicine, State University of Ponta Grossa, Faculty
of Medicine, Parana, Brazil
(Filho) Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio
de Janeiro, Brazil
(Palavani) Faculty of Medicine, Max Planck University Center, SP,
Indaiatuba, Brazil
(Bertani) Department of Neurosurgery, University of Sao Paulo
(da Mata Pereira, Filho) Department of Neurosurgery, Paulo Niemeyer State
Brain Institute, Rio de Janeiro, Brazil
(Filho, Alves Filho, de Oliveira Braga, Machado) Department of
Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de
Janeiro, Brazil
(Pereira) Division of Neuroradiology, Department of Medical Imaging and
Division of Neurosurgery, Department of Surgery, University Health
Network, Toronto Western Hospital, Toronto, ON, Canada
Publisher
Elsevier B.V.
Abstract
Introduction: Intracranial mycotic or infectious aneurysms result from the
infection of arterial walls, most caused by bacterial or fungal organisms.
These infections can weaken the arterial wall, leading to the formation of
an aneurysm, a localized dilation, or a bulge. The management can be
conservative mainly based on antibiotics or invasive methods such as
clipping or endovascular treatment. Purpose(s): We performed a
systematic review and meta-analysis of the current literature on
endovascular treatment of mycotic aneurysms, analyzing the safety and
efficacy associated with this procedure. Method(s): We systematically
searched on PUBMED, Cochrane Library, Embase, and Web of Science
databases. Our search strategy was carefully crafted to conduct a thorough
investigation of the topic, utilizing a comprehensive combination of
relevant keywords. This meta-analysis included all studies that reported
endovascular treatment of mycotic aneurysms. To minimize the risk of bias,
studies with fewer than four patients, studies where the main outcome was
not found, and studies with no clear differentiation between microsurgical
and endovascular treatment were excluded. Result(s): In a
comprehensive analysis of 134 patients, it was observed that all except
one patient received antibiotics as part of their treatment. Among the
patients, 56% (a total of 51 out of 90 patients) underwent cardiac
surgery. Additionally, three patients required a craniotomy following
endovascular treatment. 12 patients experienced morbidity related to the
procedures performed, indicating complications arising from the
interventions. Furthermore, four aneurysms experienced rebleeding while
treatment. A pooled analysis of the endovascular treatment of the mycotic
aneurysm revealed a good level of technical success, achieving a 100%
success rate in 12 out of 14 studies (97-100%; CI 95%; I2 =
0%), as illustrated in Fig. 2. Similarly, the aneurysm occlusion rate
demonstrated a notable efficacy, with a success rate of 97% observed in 12
out of 14 studies (97-100%; CI 95%; I2 = 0%), as depicted in
Fig. 3. Conclusion(s): The results strongly support the efficacy of
endovascular treatment in achieving technical success, complete aneurysm
occlusion, and favorable neurological outcomes. Additionally, the notably
low incidence of complications and procedure-related mortality reaffirms
the safety and benefits associated with this intervention. Copyright
© 2023 Elsevier B.V.

<36>
Accession Number
2028934830
Title
Down the rabbit hole: reviewing the evidence for primary prevention of
cardiovascular disease in people with obesity.
Source
European Journal of Preventive Cardiology. 30(17) (pp 1895-1905), 2023.
Date of Publication: 01 Nov 2023.
Author
Stumpf M.A.M.; Cercato C.; De Melo M.E.; Santos R.D.; Mancini M.C.
Institution
(Stumpf, Cercato, De Melo, Mancini) Obesity Unit, Division of
Endocrinology and Metabolism, University of Sao Paulo Medical School
Hospital, Street Dr. Ovidio Pires de Campos, Sao Paulo 05403-010, Brazil
(Santos) Lipid Clinic Heart Institute (InCor), University of Sao Paulo
Medical School Hospital, Sao Paulo, Brazil
(Santos) Academic Research Organization, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
Obesity is a prevalent chronic disorder and a well-known risk factor for
cardiovascular disease. However, the evidence of treating obesity for
primary prevention of major cardiovascular events is still scarce and
controversial. In this review, we provided a comprehensive description of
the current evidence in treating obesity regarding cardiovascular
protection. Bariatric surgery appears to be the most robust method to
reduce events in people without established cardiovascular disease. High
compliance to lifestyle interventions can further reduce cardiovascular
risk. Concerning pharmacological therapies, a post hoc analysis from
SUSTAIN-6 and a meta-analysis from STEP trials suggest that semaglutide, a
GLP-1 receptor agonist, could reduce cardiovascular events in people
without established cardiovascular disease. The first study addressed
specifically a high-risk population with diabetes and, the second, low- or
intermediary-risk individuals without diabetes. Tirzepatide, a novel dual
GIP/GLP-1 agonist, although not yet tested in specific cardiovascular
outcomes trials, could be an alternative since it induces loss in weight
similar to the achieved by bariatric surgery. Therefore, extrapolated data
in distinct baseline cardiovascular risk populations suggest that these
two drugs could be used in primary prevention with the aim of preventing
cardiovascular events, but the grade of this evidence is still low.
Specifically designed studies are needed to address this specific topic.
 Copyright © 2023 The Author(s). Published by Oxford University
Press on behalf of the European Society of Cardiology. All rights
reserved.

<37>
Accession Number
2027049376
Title
Evaluation of the efficacy and safety of amustaline/glutathione
pathogen-reduced RBCs in complex cardiac surgery: the Red Cell Pathogen
Inactivation (ReCePI) study-protocol for a phase 3, randomized, controlled
trial.
Source
Trials. 24(1) (no pagination), 2023. Article Number: 799. Date of
Publication: December 2023.
Author
Snyder E.L.; Sekela M.E.; Welsby I.J.; Toyoda Y.; Alsammak M.; Sodha N.R.;
Beaver T.M.; Pelletier J.P.R.; Gorham J.D.; McNeil J.S.; Sniecinski R.M.;
Pearl R.G.; Nuttall G.A.; Sarode R.; Reece T.B.; Kaplan A.; Davenport
R.D.; Ipe T.S.; Benharash P.; Lopez-Plaza I.; Gammon R.R.; Sadler P.;
Pitman J.P.; Liu K.; Bentow S.; Corash L.; Mufti N.; Varrone J.; Benjamin
R.J.
Institution
(Snyder) Yale University School of Medicine, New Haven, CT, United States
(Sekela) Gill Heart Institute University of Kentucky, Lexington, KY,
United States
(Welsby) Duke University Medical Center, Durham, NC, United States
(Toyoda) Temple University Hospital, Philadelphia, PA, United States
(Alsammak) Temple University Health System, Philadelphia, PA, United
States
(Sodha) Rhode Island Hospital, Providence, RI, United States
(Beaver, Pelletier) University of Florida, Gainesville, FL, United States
(Kaplan) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Sniecinski) Emory University, Atlanta, GA, United States
(Reece) University of Colorado Hospital, Denver, CO, United States
(Pearl) Stanford University, Stanford, CA, United States
(Davenport) University of Michigan, Ann Arbor, MI, United States
(Gorham, McNeil) University of Virginia Health System, Charlottesville,
VA, United States
(Sarode) University of Texas, Southwestern, Dallas, TX, United States
(Ipe) Our Blood Institute, Oklahoma City, OK, United States
(Ipe) University of Arkansas for Medical Sciences, Little Rock, AR, United
States
(Nuttall) Mayo Clinic, Rochester, MN, United States
(Benharash) UCLA, Los Angeles, CA, United States
(Lopez-Plaza) Henry Ford Hospital, Detroit, MI, United States
(Gammon) Scientific, Medical and Technical and Research Department,
OneBlood, Orlando, FL, United States
(Sadler) Central California Blood Center, Fresno, CA, United States
(Pitman, Liu, Bentow, Corash, Mufti, Varrone, Benjamin) Cerus Corporation,
1220 Concord Ave, Concord, CA 94520, United States
(Kaplan) Vitalant, Pittsburgh, PA, United States
Publisher
BioMed Central Ltd
Abstract
Background: Red blood cell (RBC) transfusion is a critical supportive
therapy in cardiovascular surgery (CVS). Donor selection and testing have
reduced the risk of transfusion-transmitted infections; however, risks
remain from bacteria, emerging viruses, pathogens for which testing is not
performed and from residual donor leukocytes. Amustaline
(S-303)/glutathione (GSH) treatment pathogen reduction technology is
designed to inactivate a broad spectrum of infectious agents and
leukocytes in RBC concentrates. The ReCePI study is a Phase 3 clinical
trial designed to evaluate the efficacy and safety of pathogen-reduced
RBCs transfused for acute anemia in CVS compared to conventional RBCs, and
to assess the clinical significance of treatment-emergent RBC antibodies.
 Method(s): ReCePI is a prospective, multicenter, randomized,
double-blinded, active-controlled, parallel-design, non-inferiority study.
Eligible subjects will be randomized up to 7 days before surgery to
receive either leukoreduced Test (pathogen reduced) or Control
(conventional) RBCs from surgery up to day 7 post-surgery. The primary
efficacy endpoint is the proportion of patients transfused with at least
one study transfusion with an acute kidney injury (AKI) diagnosis defined
as any increased serum creatinine (sCr) level >= 0.3 mg/dL (or 26.5
micromol/L) from pre-surgery baseline within 48 +/- 4 h of the end of
surgery. The primary safety endpoints are the proportion of patients with
any treatment-emergent adverse events (TEAEs) related to study RBC
transfusion through 28 days, and the proportion of patients with
treatment-emergent antibodies with confirmed specificity to
pathogen-reduced RBCs through 75 days after the last study transfusion.
With >= 292 evaluable, transfused patients (> 146 per arm), the study has
80% power to demonstrate non-inferiority, defined as a Test group AKI
incidence increase of no more than 50% of the Control group rate, assuming
a Control incidence of 30%. Discussion(s): RBCs are transfused to
prevent tissue hypoxia caused by surgery-induced bleeding and anemia. AKI
is a sensitive indicator of renal hypoxia and a novel endpoint for
assessing RBC efficacy. The ReCePI study is intended to demonstrate the
non-inferiority of pathogen-reduced RBCs to conventional RBCs in the
support of renal tissue oxygenation due to acute anemia and to
characterize the incidence of treatment-related antibodies to
RBCs. Copyright © 2023, The Author(s).

<38>
Accession Number
2027010014
Title
Percutaneous Left Atrial Appendage Occlusion-Current Evidence and Future
Directions.
Source
Journal of Clinical Medicine. 12(23) (no pagination), 2023. Article
Number: 7292. Date of Publication: December 2023.
Author
Rotta detto Loria J.; Desch S.; Poss J.; Kirsch K.; Thiele H.; Sandri M.
Institution
(Rotta detto Loria, Desch, Poss, Kirsch, Thiele, Sandri) Department of
Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig 04289,
Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Over the past two decades, percutaneous left atrial appendage occlusion
(LAAO) has proven to be a viable alternative to oral anticoagulation (OAC)
for stroke prevention in patients with atrial fibrillation (AF), in
particular in those patients who are at increased risk for stroke and
bleeding complications. This systematic review provides a comprehensive
evaluation of anatomical features, patient selection, procedural planning
and execution, complications, medical treatment following the procedure,
and contemporary outcome data. Copyright © 2023 by the authors.

<39>
Accession Number
2027009956
Title
Worth a Double Take? An In-Depth Review of Lung Retransplantation.
Source
Journal of Clinical Medicine. 12(23) (no pagination), 2023. Article
Number: 7418. Date of Publication: December 2023.
Author
Dawodu G.; Gulati S.; Bugacov H.; Laskey D.; Housman B.; Seethamraju H.;
Scheinin S.
Institution
(Dawodu, Laskey, Housman, Scheinin) Department of Thoracic Surgery, Icahn
School of Medicine at Mount Sinai, New York, NY 10029, United States
(Dawodu, Laskey, Housman, Seethamraju, Scheinin) Division of Lung
Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY
10029, United States
(Gulati, Bugacov) Icahn School of Medicine at Mount Sinai, 1 Gustave L.
Levy Pl, New York, NY 10029, United States
(Seethamraju) Department of Pulmonary Medicine and Critical Care, Icahn
School of Medicine at Mount Sinai, New York, NY 10029, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Provided advancements in Lung Transplantation (LT) survival, the efficacy
of Lung Retransplantation (LRT) has often been debated. Decades of
retrospective analyses on thousands of LRT cases provide insight enabling
predictive patient criteria for retransplantation. This review used the
Preferred Reporting Items for Systematic Reviews and Meta Analyses
(PRISMA) guidelines. The PubMed search engine was utilized for articles
relating to LRT published through August 2023, and a systematic review was
performed using Covidence software version 2.0 (Veritas Health Innovation,
Australia). Careful patient selection is vital for successful LRT, and the
benefit leans in favor of those in optimal health following their initial
transplant. However, the lack of a standardized approach remains apparent.
Through an in-depth review, we will address considerations such as chronic
lung allograft dysfunction, timing to LRT, surgical and perioperative
complexity, and critical ethical concerns that guide the current practice
as it relates to this subset of patients for whom LRT is the only
therapeutic option available. Copyright © 2023 by the authors.

<40>
Accession Number
2027009840
Title
A Meta-Analysis of Short-Term Outcomes of TAVR versus SAVR in Bicuspid
Aortic Valve Stenosis and TAVR Results in Different Bicuspid Valve
Anatomies.
Source
Journal of Clinical Medicine. 12(23) (no pagination), 2023. Article
Number: 7371. Date of Publication: December 2023.
Author
Improta R.; Di Pietro G.; Kola N.; Birtolo L.I.; Colantonio R.; Bruno E.;
Tocci M.; Giansante A.; Sannino M.; Zullino V.; Monosilio S.; Cimino S.;
Maestrini V.; Severino P.; Badagliacca R.; Lavalle C.; Celli P.; Saade W.;
Musto C.; D'Ascenzo F.; Miraldi F.; Vizza C.D.; Sardella G.; Mancone M.
Institution
(Improta, Di Pietro, Kola, Birtolo, Colantonio, Bruno, Tocci, Giansante,
Sannino, Monosilio, Cimino, Maestrini, Severino, Badagliacca, Lavalle,
Saade, Miraldi, Vizza, Sardella, Mancone) Department of Clinical,
Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital,
Sapienza University of Rome, Roma 00161, Italy
(Zullino, Celli) Anesthesia and Resuscitation in Specialistic Surgeries
and Transplants, Umberto I Hospital, Roma 00161, Italy
(Musto) San Camillo-Forlanini Hospital, Rome 00152, Italy
(D'Ascenzo) Department of Medical Science, Division of Cardiology,
Molinette Hospital, Turin University, Torino 10126, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: To provide a comprehensive analysis of the current literature
comparing the outcomes of surgical aortic valve replacement (SAVR) and
transcatheter aortic valve replacement (TAVR) in patients with bicuspid
aortic stenosis (BAS), with particular attention to BAV morphology in
patients undergoing TAVR. Method(s): Following PRISMA guidelines, all
relevant articles with no design restrictions from PubMed, CCTR (Cochrane
Controlled Trials Register), and Google Scholar were screened for
inclusion. Studies were included if they reported clinical endpoints for
SAVR and TAVR or, in BAS treated with TAVR, for type 1 and non-type 1
morphology. Odds ratio and Cohen's D were considered as effect size
measurements for qualitative and quantitative variables, respectively.
 Result(s): A total of eight studies comparing short-term outcomes
between SAVR and TAVR and nine studies with outcomes data between type 1
and non-type 1 BAS treated with TAVR were considered for the final
analysis. No statistically significant difference was found for what
concerns the rates of death, stroke, and acute kidney injury between SAVR
and TAVR. In comparison to patients undergoing SAVR, the incidence of PPI
(permanent pacemaker implantation) was greater in the TAVR group (OR 0.35,
95% CI 0.15-0.79, p = 0.01), and the frequency of bleeding events was
found to be higher among patients undergoing SAVR (OR 4.3, 95% CI 2.9-6.4,
p < 0.001). The probabilities of 30-day mortality, stroke, and any
bleeding were not significantly affected by bicuspid valve morphology in
TAVR patients. PPI or development of new conduction anomalies was found to
be more frequent in type 1 anatomies (OR 0.46, 95% CI 0.30-0.70, p
<0.001). Mildly lower post-procedural transprothesic gradients were found
in patients with type 1 morphology. Conclusion(s): In BAS patients,
TAVR has comparable short-term outcomes rates with SAVR, but higher PPI
rates and lower incidence of bleeding events. In patients undergoing TAVR,
type 1 BAS is associated with lower postoperative transvalvular gradients
but higher PPI rates and conduction abnormalities. Copyright ©
2023 by the authors.

<41>
Accession Number
2027008144
Title
Drug-coated balloons versus drug-eluting stents in patients with acute
myocardial infarction undergoing percutaneous coronary intervention: an
updated meta-analysis with trial sequential analysis.
Source
BMC Cardiovascular Disorders. 23(1) (no pagination), 2023. Article Number:
605. Date of Publication: December 2023.
Author
Abdelaziz A.; Hafez A.; Atta K.; Elsayed H.; Abdelaziz M.; Elaraby A.;
Kadhim H.; Mechi A.; Ezzat M.; Fadel A.; Nasr A.; Bakr A.; Ghaith H.S.
Institution
(Abdelaziz, Hafez, Atta, Elsayed, Abdelaziz, Elaraby, Ezzat, Fadel, Bakr,
Ghaith) Medical Research Group of Egypt (MRGE), Cairo, Egypt
(Abdelaziz, Abdelaziz, Elaraby, Bakr, Ghaith) Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
(Hafez, Atta) Institute of Medicine, National Research Mordovia State
University, Saransk, Russian Federation
(Elsayed) Faculty of Medicine, Zagazig University, Zagazig, Egypt
(Kadhim) Al Muthanna University College of Medicine, Samawah, Iraq
(Mechi) Medicine College, Internal Medicine Department, University of
Kufa, Najaf, Iraq
(Ezzat) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Fadel) Faculty of Medicine, Sohag University, Sohag, Egypt
(Nasr) Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Publisher
BioMed Central Ltd
Abstract
Background: Drug-coated balloons (DCBs) are an established strategy for
coronary artery disease. However, the new generation drug-eluting stent
(DES) is recommended for patients with Acute myocardial infarction (AMI)
for coronary artery revascularization. Our aim is to provide a
comprehensive appraisal of the efficacy of DCBs in patients with AMI
undergoing PCI. Method(s): We searched the WOS, PubMed, Scopus, and
Cochrane CENTRAL till March 2023, for studies that compared DCBs versus
DES in patients with AMI undergoing PCI. We used a random-effects model to
compare major adverse cardiac events (MACE), cardiac death, all-cause
death, myocardial infarction, target lesion revascularization (TLR), stent
thrombosis, Late lumen Loss (LLL), and minimum lumen diameter (MLD)
between the two groups. Result(s): Thirteen studies comprising 2644
patients were included. The pooled OR showed non-inferiority of DCB over
DES in terms of MACE (OR = 0.89, 95% CI [0.57 to 1.40], p = 0.63). When we
defined MACE as a composite of cardiac death, MI, and TLR; the pooled OR
favored DCB over DES (OR = 0.50, 95% CI [0.28 to 0.9], p = 0.02).
Moreover, DCB was not inferior to DES in terms of all-cause mortality (OR
= 0.88, 95% CI: 0.43 to 1.8, p = 0.73), cardiac mortality, (OR = 0.59, 95%
CI: 0.22 to 1.56, p = 0.29), MI (OR = 0.88, 95% CI: 0.34 to 2.29, p =
0.79), stent thrombosis (OR = 1.21, 95% CI: 0.35 to 4.23, p = 0.76), TLR
(OR = 0.9, 95% CI: 0.43 to 1.93, p = 0.8), LLL (MD = -0.6, 95% CI: -0.3 to
0.19, p = 0.64), or MLD (MD = -0.4, 95% CI: -0.33 to 0.25, p = 0.76).
 Conclusion(s): Our meta-analysis indicated that DCB intervention was
not inferior to DES in the PCI setting in patients with AMI, and can be
recommended as a feasible strategy in AMI. PROSPERO registration:
CRD42023412757. Copyright © 2023, The Author(s).

<42>
Accession Number
2027007921
Title
Donor Heart Preservation: Current Knowledge and the New Era of Machine
Perfusion.
Source
International Journal of Molecular Sciences. 24(23) (no pagination), 2023.
Article Number: 16693. Date of Publication: December 2023.
Author
Kounatidis D.; Brozou V.; Anagnostopoulos D.; Pantos C.; Lourbopoulos A.;
Mourouzis I.
Institution
(Kounatidis, Brozou, Anagnostopoulos, Pantos, Lourbopoulos, Mourouzis)
Department of Pharmacology, National and Kapodistrian University of
Athens, Athens 11527, Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Heart transplantation remains the conventional treatment in end-stage
heart failure, with static cold storage (SCS) being the standard technique
used for donor preservation. Nevertheless, prolonged cold ischemic storage
is associated with the increased risk of early graft dysfunction
attributed to residual ischemia, reperfusion, and rewarming damage. In
addition, the demand for the use of marginal grafts requires the
development of new methods for organ preservation and repair. In this
review, we focus on current knowledge and novel methods of donor
preservation in heart transplantation. Hypothermic or normothermic machine
perfusion may be a promising novel method of donor preservation based on
the administration of cardioprotective agents. Machine perfusion seems to
be comparable to cold cardioplegia regarding donor preservation and allows
potential repair treatments to be employed and the assessment of graft
function before implantation. It is also a promising platform for using
marginal organs and increasing donor pool. New pharmacological cardiac
repair treatments, as well as cardioprotective interventions have emerged
and could allow for the optimization of this modality, making it more
practical and cost-effective for the real world of transplantation.
Recently, the use of triiodothyronine during normothermic perfusion has
shown a favorable profile on cardiac function and microvascular
dysfunction, likely by suppressing pro-apoptotic signaling and increasing
the expression of cardioprotective molecules. Copyright © 2023 by
the authors.

<43>
Accession Number
2028896768
Title
Twelve-month follow-up effects of cognitive training after heart valve
surgery on cognitive functions and health-related quality of life: A
randomised clinical trial.
Source
Open Heart. 10(2) (no pagination), 2023. Article Number: e002411. Date of
Publication: 27 Nov 2023.
Author
Butz M.; Gerriets T.; Sammer G.; El-Shazly J.; Tschernatsch M.; Braun T.;
Meyer R.; Schramm P.; Doeppner T.R.; Boning A.; Mengden T.; Choi Y.-H.;
Schonburg M.; Juenemann M.
Institution
(Butz, Gerriets, Sammer, Tschernatsch, Braun, Meyer, Schramm, Schonburg,
Juenemann) Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim,
Germany
(Butz, Gerriets, Tschernatsch, Braun, Schramm, Doeppner, Juenemann)
Department of Neurology, University Hospitals Giessen, Marburg Campus
Giessen, Giessen, Germany
(Sammer) Department of Psychology, University of Giessen, Giessen, Germany
(El-Shazly) Department of Psychocardiology, Kerckhoff Clinic, Bad Nauheim,
Germany
(Boning) Department of Cardiovascular Surgery, University Hospitals
Giessen, Marburg Campus Giessen, Giessen, Germany
(Mengden) Department of Rehabilitation, Kerckhoff Clinic, Bad Nauheim,
Germany
(Choi, Schonburg) Department of Cardiac Surgery, Kerckhoff Clinic, Bad
Nauheim, Germany
Publisher
BMJ Publishing Group
Abstract
Objectives Postoperative cognitive decline (POCD) or decreased
health-related quality of life (HQL) have been reported after cardiac
surgery. A previous investigation showed beneficial effects of
postoperative cognitive training on POCD and HQL 3 months after heart
surgery. Here, we present the 12-month follow-up results. Methods This
bicentric, 1:1 randomised and treatment-as-usual controlled trial included
elderly patients scheduled for elective heart valve surgery. The training
consisted of paper-and-pencil-based exercises practising multiple
cognitive functions for 36 min/day 6 days/week over a period of 3 weeks.
Neuropsychological tests and questionnaires assessing HQL (36-Item Short
Form Health Survey (SF-36)) and cognitive failures in daily living
(Cognitive Failures Questionnaire) were performed presurgery and 12 months
after training. Results Twelve months post training, the training group
(n=30) showed improvements in HQL compared with the control group (n=28),
especially in role limitations due to physical health (U=-2.447, p=0.015,
* 2 =0.109), role limitations due to emotional problems (U=-2.245,
p=0.025, * 2 =0.092), pain (U=-1.979, p=0.049, * 2 =0.068), average of all
SF-36 factors (U=-3.237, p<0.001, * 2 =0.181), health change from the past
year to the present time (U=-2.091, p=0.037, * 2 =0.075), physical
component summary (U=-2.803, p=0.005, * 2 =0.138), and mental component
summary (U=-2.350, p=0.018, * 2 =0.095). Furthermore, the training group
(n=19) showed an improvement compared with the control group (n=27) in
visual recognition memory (U=-2.137, p=0.034, * 2 =0.099). POCD frequency
was 22% (n=6) in the control group and 11% (n=2) in the training group
(chi2(1) =1.06, p=0.440; OR=2.43, 95% CI 0.43 to 13.61). Conclusion In
conclusion, postoperative cognitive training shows enhancing effects on
HQL in cardiac surgery patients after 12 months. Copyright ©
2023 BMJ Publishing Group Limited.

<44>
Accession Number
2028892675
Title
Rescue analgesia with serratus anterior plane block improved pain relief
after thoracic surgery.
Source
Minerva Anestesiologica. 89 (pp 1082-1091), 2023. Date of Publication:
2023.
Author
Wu X.; Chen H.; Wang M.; Wang P.; Zhang Y.; Wu Y.
Institution
(Wu, Chen, Wang, Wang, Zhang, Wu) Department of Anesthesiology and
Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical
University, Anhui, Hefei, China
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Video-assisted thoracic surgery (VATSvats) is frequently
associated with substantial postoperative pain, which may lead to
hypopnea. Rescue analgesia using opioids has adverse effects. We aimed to
evaluate the effects of rescue analgesia with serratus anterior plane
block (SA PB) on moderate-to-severe pain and oxygenation in patients
undergoing VATSvats. MET HODS: Eighty patients undergoing VATS and
reporting a numeric rating scale (NRS, ranging from 0-10) score of cough
pain >=4 on the first postoperative day were randomized to receive either
sufentanil or SAPB for rescue analgesia. The primary outcome was the
degree of relief in cough pain 30 min after rescue analgesia. Arterial
oxygen pressure (PaO2), opioid consumption after rescue analgesia and the
incidence of chronic pain were also assessed. RESULT(S): The NRS
scores were significantly reduced after rescue analgesia in both groups
(Ppaired <0.001). Notably, the degree of relief in cough pain was
significantly higher in the SAPB group than that in the sufentanil group
(medians [interquartiles]: -3 [-4, -2] vs. -2 [-3, -1], P<0.001).
Moreover, patients receiving SAPB exhibited significantly higher PaO2 than
those before receiving rescue analgesia (Ppaired=0.007). However, there
were no significant differences in the PaO2 before and after receiving
rescue analgesia in the sufentanil group. No significant differences in
opioid consumption or the incidence of chronic pain were observed between
groups. CONCLUSION(S): Rescue analgesia with SAPB on the first
postoperative day had a greater effect on pain relief and oxygenation
after VATSvats. However, its long-term effect on chronic pain requires
further research. Copyright © 2023 Edizioni Minerva Medica. All
rights reserved.

<45>
Accession Number
2026912704
Title
Assessment and Management of Ischaemic Heart Disease in Non-Cardiac
Surgery.
Source
Heart International. 17(2) (pp 19-26), 2023. Date of Publication: 2023.
Author
Morgan H.; Ezad S.M.; Rahman H.; De Silva K.; Partridge J.S.L.; Perera D.
Institution
(Morgan, Ezad, Rahman, De Silva, Partridge, Perera) British Heart
Foundation Centre of Research Excellence, School of Cardiovascular and
Metabolic Medicine and Sciences, King's College, London, United Kingdom
(Partridge, Perera) Guy's and St Thomas' NHS Foundation Trust, London,
United Kingdom
Publisher
Touch Medical Media
Abstract
In the setting of non-cardiac surgery, cardiac complications contribute to
over a third of perioperative deaths. With over 230 million major
surgeries performed annually, and an increasing prevalence of
cardiovascular risk factors and ischaemic heart disease, the incidence of
perioperative myocardial infarction is also rising. The recent European
Society of Cardiology guidelines on cardiovascular risk in non-cardiac
surgery elevated practices aiming to identify those at most risk,
including biomarker monitoring and stress testing. However the current
evidence base on if, and how, the risk of cardiac events can be modified
is lacking. This review focuses on patient, surgical and cardiac risk
assessment, as well as exploring the data on perioperative
revascularization and other risk-reduction strategies. Copyright
© 2023, Touch Medical Media. All rights reserved.

<46>
Accession Number
642918383
Title
Limited versus full sternotomy for aortic valve replacement.
Source
Cochrane Database of Systematic Reviews. 2023(12) (no pagination), 2023.
Article Number: CD011793. Date of Publication: 06 Dec 2023.
Author
Kirmani B.H.; Jones S.G.; Muir A.; Malaisrie S.C.; Chung D.A.; Williams
R.J.N.N.; Akowuah E.
Institution
(Kirmani, Muir, Williams) Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Kirmani) University of Liverpool, Liverpool, United Kingdom
(Kirmani) Liverpool Centre for Cardiovascular Science, Liverpool, United
Kingdom
(Jones) Department of Cardiac Surgery, University Hospital Coventry and
Warwickshire, Coventry, United Kingdom
(Malaisrie) Division of Cardiac Surgery, Northwestern University, Chicago,
IL, United States
(Chung) High Lane Medical Centre, Stockport, United Kingdom
(Akowuah) Academic Cardiovascular Unit, South Tees Hospitals NHS
Foundation Trust, Middlesbrough, United Kingdom
(Akowuah) Translational and Clinical Research Institute, Newcastle
University, Newcastle, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Aortic valve disease is a common condition easily treatable
with cardiac surgery. This is conventionally performed by opening the
sternum ('median sternotomy') and replacing the valve under
cardiopulmonary bypass. Median sternotomy is well tolerated, but as less
invasive options become available, the efficacy of limited incisions has
been called into question. In particular, the effects of reducing the
visibility and surgical access have raised safety concerns with regard to
the placement of cannulae, venting of the heart, epicardial wire
placement, and de-airing of the heart at the end of the procedure. These
difficulties may increase operating times, affecting outcome. The benefits
of smaller incisions are thought to include decreased pain; improved
respiratory mechanics; reductions in wound infections, bleeding, and need
for transfusion; shorter intensive care stay; better cosmesis; and a
quicker return to normal activity. This is an update of a Cochrane review
first published in 2017, with seven new studies. Objective(s): To
assess the effects of minimally invasive aortic valve replacement via a
limited sternotomy versus conventional aortic valve replacement via median
sternotomy in people with aortic valve disease requiring surgical
replacement. Search Method(s): We performed searches of CENTRAL,
MEDLINE and Embase from inception to August 2021, with no language
limitations. We also searched two clinical trials registries and
manufacturers' websites. We reviewed references of primary studies to
identify any further studies of relevance. Selection Criteria: We
included randomised controlled trials comparing aortic valve replacement
via a median sternotomy versus aortic valve replacement via a limited
sternotomy. We excluded trials that performed other minimally invasive
incisions such as mini-thoracotomies, port access, transapical,
transfemoral or robotic procedures. Although some well-conducted
prospective and retrospective case-control and cohort studies exist, these
were not included in this review. Data Collection and Analysis: Two
review authors independently assessed trial papers to extract data, assess
quality, and identify risk of bias. A third review author provided
arbitration where required. We determined the certainty of evidence using
the GRADE methodology and summarised results of patient-relevant outcomes
in a summary of findings table. Main Result(s): The review included
14 trials with 1395 participants. Most studies had at least two domains at
high risk of bias. We analysed 14 outcomes investigating the effects of
minimally invasive limited upper hemi-sternotomy on aortic valve
replacement as compared to surgery performed via full median sternotomy.
Upper hemi-sternotomy may have little to no effect on mortality versus
full median sternotomy (risk ratio (RR) 0.93, 95% confidence interval (CI)
0.45 to 1.94; 10 studies, 985 participants; low-certainty evidence). Upper
hemi-sternotomy for aortic valve replacement may increase cardiopulmonary
bypass time slightly, although the evidence is very uncertain (mean
difference (MD) 10.63 minutes, 95% CI 3.39 to 17.88; 10 studies, 1043
participants; very low-certainty evidence) and may increase aortic
cross-clamp time slightly (MD 6.07 minutes, 95% CI 0.79 to 11.35; 12
studies, 1235 participants; very low-certainty evidence), although the
evidence is very uncertain. Most studies had at least two domains at high
risk of bias. Postoperative blood loss was probably lower in the upper
hemi-sternotomy group (MD -153 mL, 95% CI -246 to -60; 8 studies, 767
participants; moderate-certainty evidence). Low-certainty evidence
suggested that there may be no change in pain scores by upper
hemi-sternotomy (standardised mean difference (SMD) -0.19, 95% CI -0.43 to
0.04; 5 studies, 649 participants). Upper hemi-sternotomy may result in
little to no difference in quality of life (MD 0.03 higher, 95% CI 0 to
0.06 higher; 4 studies, 624 participants; low-certainty evidence). Two
studies reporting index admission costs concluded that limited sternotomy
may be more costly at index admission in the UK National Health Service
(MD 1190 GBP more, 95% CI 420 GBP to 1970 GBP, 2 studies, 492
participants; low-certainty evidence). Authors' conclusions: The evidence
was of very low to moderate certainty. Sample sizes were small and
underpowered to demonstrate differences in some outcomes. Clinical
heterogeneity was also noted. Considering these limitations, there may be
little to no effect on mortality. Differences in extracorporeal support
times are uncertain, comparing upper hemi-sternotomy to full sternotomy
for aortic valve replacement. Before widespread adoption of the minimally
invasive approach can be recommended, there is a need for a well-designed
and adequately powered prospective randomised controlled trial. Such a
study would benefit from also performing a robust cost analysis. Growing
patient preference for minimally invasive techniques merits thorough
quality of life analyses to be included as end points, as well as
quantitative measures of physiological reserve. Copyright © 2023
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<47>
Accession Number
642947371
Title
Design and Rationale of the Evaluation of Transcatheter Aortic Valve
Replacement Compared to SurveilLance for Patients with AsYmptomatic Severe
Aortic Stenosis: The EARLY TAVR Trial.
Source
American heart journal. (no pagination), 2023. Date of Publication: 04
Dec 2023.
Author
Genereux P.; Schwartz A.; Oldemeyer B.; Cohen D.J.; Redfors B.; Prince H.;
Zhao Y.; Lindman B.R.; Pibarot P.; Leon M.B.
Institution
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Schwartz) Columbia University Medical Center/NewYork-Presbyterian
Hospital, New York, NY, USA
(Oldemeyer) University of Colorado Health, Loveland, CO, United States
(Cohen) Cardiovascular Research Foundation, New York, NY, USA; St. Francis
Hospital and Heart Center, Roslyn, NY, USA
(Redfors) Sahlgrenska University Hospital, Gothenburg, Sweden; Quebec
Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
(Prince, Zhao) Edwards Lifesciences, Irvine, CA, United States
(Lindman) Vanderbilt University Medical Center, Nashville, TN, United
States
(Pibarot) Department of Cardiology
(Leon) Columbia University Medical Center/NewYork-Presbyterian Hospital,
New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
Abstract
BACKGROUND: For patients with asymptomatic, severe aortic stenosis (AS)
and preserved left ventricular ejection fraction, current guidelines
recommend clinical surveillance every 6 to 12 months. To date, no
randomized trials have examined whether an early intervention with
transcatheter aortic valve replacement (TAVR) will improve outcomes among
these patients. STUDY DESIGN AND OBJECTIVES: EARLY TAVR is a prospective,
randomized, controlled, multicenter trial, with an event-based design.
Asymptomatic severe AS patients (n=900) are randomized 1:1 to either
clinical surveillance or TAVR with the Edwards SAPIEN 3/SAPIEN 3 Ultra
transcatheter heart valve. Patients are stratified by whether they are
able to perform a treadmill stress test. The primary endpoint is death,
stroke, or unplanned cardiovascular hospitalization. Patients who are
asymptomatic but have a positive stress test will be followed in a
registry and undergo aortic valve replacement as per current guidelines.
 CONCLUSION(S): EARLY TAVR is the largest randomized trial to date
assessing the role of early intervention among patients with asymptomatic
severe AS compared to clinical surveillance, and the first to study the
role of TAVR. TRIAL REGISTRATION NUMBER: NCT03042104. Copyright ©
2023. Published by Elsevier Inc.

<48>
Accession Number
2028856636
Title
Efficacy of neuromuscular electrical stimulation for thoracic and
abdominal surgery: A systematic review and meta-analysis.
Source
PLoS ONE. 18(11 November) (no pagination), 2023. Article Number: e0294965.
Date of Publication: November 2023.
Author
Nakashima Y.; Iwaki D.; Kataoka Y.; Ariie T.; Taito S.; Nishikawa Y.; Mio
N.; Mikami Y.
Institution
(Nakashima, Iwaki, Taito, Mio) Division of Rehabilitation, Department of
Clinical Practice and Support, Hiroshima University Hospital, Hiroshima,
Japan
(Nakashima, Kataoka, Ariie, Taito) Scientific Research WorkS Peer Support
Group (SRWS-PSG), Osaka, Japan
(Iwaki) Department of Neuromechanics, Graduate School of Biomedical and
Health Sciences, Hiroshima University, Hiroshima, Japan
(Kataoka) Department of Internal Medicine, Kyoto Min-iren Asukai Hospital,
Kyoto, Japan
(Kataoka) Section of Clinical Epidemiology, Department of Community
Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
(Kataoka) Department of Healthcare Epidemiology, Kyoto University Graduate
School of Medicine / Public Health, Kyoto, Japan
(Ariie) Department of Physical Therapy, School of Health Sciences at
Fukuoka, International University of Health and Welfare, Fukuoka, Japan
(Nishikawa) Faculty of Frontier Engineering, Institute of Science &
Engineering, Kanazawa University, Kanazawa, Japan
(Mikami) Department of Rehabilitation Medicine, Hiroshima University
Hospital, Hiroshima, Japan
Publisher
Public Library of Science
Abstract
This systematic review and meta-analysis examined the efficacy of
neuromuscular electrical stimulation (NMES) on lower limb muscle strength
and health-related quality of life (HRQOL) after thoracic and abdominal
surgery. We searched the Cochrane Central Register of Controlled Trials,
MEDLINE via PubMed, Excerpta Medica Database via Elsevier, Physiotherapy
Evidence Database, Cumulative Index to Nursing and Allied Health
Literature, World Health Organization International Clinical Trials
Registry Platform via their dedicated search portal, and
ClinicalTrials.gov on November 2021 and updated in April 2023 to identify
randomized controlled trials that examined the effects of NMES after
thoracic and abdominal surgery. The primary outcomes were lower limb
muscle strength, HR-QOL, and adverse events. We used the Cochrane Risk of
Bias Tool and the Grading of Recommendations, Assessment, Development, and
Evaluation approach to assess the certainty of evidence. A total of 18
randomized control trials involving 915 participants, including 10 on
cardiovascular surgery, two on pulmonary surgery, five on digestive system
surgery, and one on other surgery, were included. NMES slightly increased
lower limb muscle strength and adverse events in cardiovascular surgery.
Adverse events (hypotension, pain, and muscle discomfort) occurred in
seven patients. HR-QOL was measured in two studies on cardiovascular
surgery, but these were not pooled due to concept heterogeneity. Overall,
NMES slightly increases lower limb muscle strength after cardiovascular
surgery without serious adverse events. However, higher-quality randomized
control trials in thoracic and abdominal surgeries are
needed. Copyright © 2023 Nakashima et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<49>
[Use Link to view the full text]
Accession Number
2028846704
Title
Coronary Computed Tomography Angiography Versus Invasive Coronary
Angiography in Stable Chest Pain: A Meta-Analysis of Randomized Controlled
Trials.
Source
Circulation: Cardiovascular Imaging. 16(11) (pp E015800), 2023. Date of
Publication: 01 Nov 2023.
Author
Machado M.F.; Felix N.; Melo P.H.C.; Gauza M.M.; Calomeni P.; Generoso G.;
Khatri S.; Altmayer S.; Blankstein R.; Bittencourt M.S.; Cardoso R.
Institution
(Machado) Division of Cardiovascular Medicine, Faculdades Integradas
Pitagoras de Montes Claros, Brazil
(Felix) Division of Cardiovascular Medicine, Federal University of Campina
Grande, Brazil
(Melo) Division of Cardiovascular Medicine, Cardiovascular Research
Foundation, New York, NY, United States
(Gauza) Division of Cardiovascular Medicine, University of the Region,
Joinville, Brazil
(Calomeni) Division of Cardiovascular Medicine, InCor Heart Institute,
University of Sao Paulo, Medical School, Brazil
(Generoso) Hospital Sirio-Libanes, Sao Paulo, Brazil
(Khatri) Department of Internal Medicine, University of Pittsburgh,
Medical Center, Pittsburgh, PA, United States
(Bittencourt) Division of Cardiology, Department of Internal Medicine,
University of Pittsburgh, Medical Center, Pittsburgh, PA, United States
(Altmayer) Division of Cardiovascular Medicine, Stanford University,
Stanford, CA, United States
(Blankstein, Cardoso) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The efficacy of coronary computed tomography angiography
(CCTA) versus invasive coronary angiography (ICA) among patients with
stable chest pain has been studied in several trials with conflicting
results. METHOD(S): We performed a systematic review and
meta-analysis comparing CCTA first versus direct ICA among patients with
stable chest pain, who were initially referred to ICA. PubMed, EMBASE, and
Cochrane Central were searched for randomized controlled trials comparing
the 2 strategies. Risk ratios (RRs) and mean differences with 95% CIs were
computed for binary and continuous outcomes, respectively. RESULT(S):
Five randomized controlled trials with a total of 5727 patients were
included, of whom 51.1% were referred to CCTA and 22.5% of patients had
evidence of ischemia on a prior functional test. In the follow-up ranging
from 1 to 3.5 years, 660 of the 2928 patients randomized to CCTA first
underwent ICA (23%). Patients who underwent CCTA had lower rates of
coronary revascularization (RR, 0.74 [95% CI, 0.66-0.84]; P<0.001) and
stroke (RR, 0.50 [95% CI, 0.26-0.98]; P=0.043). Cardiovascular mortality
(RR, 0.55 [95% CI, 0.24-1.23]; P=0.146), major adverse cardiovascular
events (RR, 0.84 [95% CI, 0.64-1.10]; P=0.198), nonfatal myocardial
infarction (RR, 1.09 [95% CI, 0.63-1.88]; P=0.768), and cardiovascular
hospitalizations (RR, 0.91 [95% CI, 0.59-1.39]; P=0.669) did not differ
significantly between groups. CONCLUSION(S): In patients with stable
chest pain referred for ICA, CCTA avoided the need for ICA in 77% of
patients otherwise referred for ICA. CCTA was associated with a reduction
in the rates of coronary revascularization and stroke compared with direct
ICA. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique
identifier: CRD42023383143. Copyright © 2023 Lippincott Williams
and Wilkins. All rights reserved.

<50>
Accession Number
2028722381
Title
Intravascular lithotripsy for severe coronary calcification: a systematic
review.
Source
Minerva Cardiology and Angiology. 71(6) (pp 643-652), 2023. Date of
Publication: 2023.
Author
Sheikh A.S.; Connolly D.L.; Abdul F.; Varma C.; Sharma V.
Institution
(Sheikh, Connolly, Abdul, Varma, Sharma) Department of Cardiology,
Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United
Kingdom
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Coronary artery calcification remains a challenge in
percutaneous coronary interventions, due to the higher risk of suboptimal
result with subsequent poor clinical outcomes. Intravascular lithotripsy
is a novel way of treating severe coronary calcification as it has the
ability to modify calcium both circumferentially as well as transmurally,
facilitating stent expansion and apposition. We conducted a systematic
overview of the published literature on intravascular lithotripsy (IVL)
assessing the efficacy and feasibility of IVL in treating severe coronary
calcification. EVIDENCE ACQUISITION: Of the retrieved publications, 62 met
our inclusion criteria and were included. A total of 1389 patients (1414
lesions) with significant coronary calcification or under-expanded stents
underwent IVL. EVIDENCE SYNTHESIS: The mean age was 72.03 years (74.7%
male). There was a significant improvement in acute and sustained vessel
patency, with mean minimal lumen diameter of 2.78+/-0.46 mm, resulting in
acute gain of 1.72+/-0.51 mm. The acute procedural success rate was 78.2
to 100% with in-hospital complication rate of 5.6 to 7.0%. The majority of
the studies reported 30-day MACE, which was between 2.2 to 7.8%.
 CONCLUSION(S): The recent studies have highlighted that the use of
IVL with adjuvant intracoronary imaging has revolutionized the way of
treating heavily calcified, non-dilatable coronary lesions and is likely
to succeed the conventional ways of treating these complex lesions. We
need further studies to gauge the long-term efficacy and safety of IVL
against techniques currently available for calcium modification including
conventional balloons, cutting or scoring balloons, rotational atherectomy
and laser atherectomy. Copyright © 2021 EDIZIONI MINERVA MEDICA

<51>
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Accession Number
2028718420
Title
Association between Intraoperative Landiolol Use and In-Hospital Mortality
after Coronary Artery Bypass Grafting: A Nationwide Observational Study in
Japan.
Source
Anesthesia and Analgesia. 137(6) (pp 1208-1215), 2023. Date of
Publication: 01 Dec 2023.
Author
Iwasaki Y.; Ohbe H.; Nakajima M.; Sasabuchi Y.; Ikumi S.; Kaiho Y.;
Yamauchi M.; Fushimi K.; Yasunaga H.
Institution
(Iwasaki, Ikumi, Kaiho, Yamauchi) Department of Anesthesiology and
Perioperative Medicine, Tohoku University Graduate School of Medicine,
Miyagi, Japan
(Ohbe, Nakajima, Yasunaga) Department of Clinical Epidemiology and Health
Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
(Nakajima) Emergency Life-Saving Technique Academy of Tokyo, Foundation
for Ambulance Service Development, Tokyo, Japan
(Nakajima) Emergency and Critical Care Center, Tokyo Metropolitan Hiroo
Hospital, Tokyo, Japan
(Sasabuchi) Data Science Center, Jichi Medical University, Tochigi, Japan
(Fushimi) Department of Health Policy and Informatics, Tokyo Medical and
Dental University Graduate School of Medicine, Tokyo, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Ischemic heart disease is a leading cause of death worldwide,
and coronary artery bypass grafting (CABG) is a major treatment. Landiolol
is an ultra-short-acting beta-antagonist known to prevent postoperative
atrial fibrillation. However, the effectiveness of intraoperative
landiolol on mortality remains unknown. This study aimed to evaluate the
association between intraoperative landiolol use and the in-hospital
mortality in patients undergoing CABG. METHOD(S): To conduct this
retrospective cohort study, we used data from the Japanese Diagnosis
Procedure Combination inpatient database. All patients who underwent CABG
during hospitalization between July 1, 2010, and March 31, 2020, were
included. Patients who received intraoperative landiolol were defined as
the landiolol group, whereas the other patients were defined as the
control group. The primary outcome was in-hospital mortality. Propensity
score matching was used to compare the landiolol and control groups.
 RESULT(S): In total, 118,506 patients were eligible for this study,
including 25,219 (21%) in the landiolol group and 93,287 (79%) in the
control group. One-to-one propensity score matching created 24,893 pairs.
After propensity score matching, the in-hospital mortality was
significantly lower in the landiolol group than that in the control group
(3.7% vs 4.3%; odds ratio 0.85; 95% confidence interval 0.78 to 0.94; P
=.010). CONCLUSION(S): Intraoperative landiolol use was associated
with decreased in-hospital mortality in patients undergoing CABG. Further
randomized controlled trials are required to confirm these
findings. Copyright © 2023 Lippincott Williams and Wilkins. All
rights reserved.

<52>
Accession Number
2028717681
Title
Effectiveness and safety of short-term anticoagulant regimens after left
atrial appendage occlusion: A systematic review and meta-analysis.
Source
Thrombosis Research. 233 (pp 88-98), 2024. Date of Publication: January
2024.
Author
Zhou Q.; Liu X.; Yang X.; Huang X.-H.; Wu Y.-Z.; Tao Y.-Y.; Wei M.
Institution
(Zhou, Huang, Wu, Tao, Wei) Department of Clinical Pharmacy, Jinling
Hospital, Affiliated Hospital of Medical School, Nanjing University,
Nanjing, China
(Liu) Department of Pharmacy and Traditional Chinese Pharmacy, Jiangsu
College of Nursing, Huaian, China
(Yang) Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated
Hospital of Medical School, Nanjing University, Nanjing, China
Publisher
Elsevier Ltd
Abstract
Introduction: Left atrial appendage occlusion (LAAO) provides an
alternative for poor candidates of long-term oral anticoagulant (OAC)
therapy; however, anticoagulant therapy after surgical procedures has
limited use due to associated uncertainties. We aimed to evaluate the
effectiveness and safety of the short-term use of direct oral
anticoagulant (DOAC) and warfarin after LAAO. Method(s): Electronic
databases such as PubMed, Embase, Medline, and Cochrane Library databases
were searched up to November 11, 2022. Our study compared DOAC therapy and
warfarin in patients after LAAO. A meta-analysis was conducted with the
Review Manager software (version 5.4). Result(s): The meta-analysis
included 13 cohort studies with a total of 32,607 patients. Our findings
indicated that the incidence of stroke/TIA/SE, peri-device leaks>5 mm,
device-related thrombosis, and all-cause mortality were not significantly
different between the two groups after LAAO (P > 0.05). The DOAC group had
a significantly lower incidence of major bleeding (OR = 0.83, 95 % CI:
0.74-0.94, P = 0.003), any bleeding (OR = 0.34, 95 % CI: 0.23-0.51, P <
0.001), stroke/TIA/SE and major bleeding (OR = 0.57, 95 % CI: 0.34-0.95, P
= 0.03), and any major adverse event (OR = 0.89, 95 % CI:0.82-0.97, P =
0.010) than the warfarin group. The subgroup analysis revealed that the
rate of stroke/TIA/SE was similar in the two groups in terms of the
different regions, follow-up time, study type, anticoagulant strategy, and
bleeding risk. The incidence of major bleeding in the DOAC group was
significantly lower than that in the warfarin group in North America, as
well as at follow-up period <=6 months, retrospective cohort, HAS-BLED
average score >= 3. In addition, the risk of major bleeding was higher
with the combination of OAC and single antiplatelet therapy (SAPT) than
with OAC alone. Finally, in the North American region, retrospective
cohort, and HAS-BLED average score >= 3, the incidence of any serious
adverse event in the DOAC group was still significantly lower than that in
the warfarin group. Conclusion(s): Compared to warfarin, DOAC reduced
the risk of major bleeding and any serious adverse event in patients after
LAAO. This advantage was particularly notable in North America and
high-risk populations for bleeding. In addition, the incidence of
device-related thrombosis, peri-device leaks, stroke/TIA/SE and all-cause
mortality were similar in both groups. The risk of major bleeding was
lower in patients taking OAC alone compared with those taking OAC plus
SAPT, without increasing the risk of thrombosis. Copyright © 2023
Elsevier Ltd

<53>
[Use Link to view the full text]
Accession Number
2028665046
Title
Effects of music therapy on pain relief during fundus screening in infants
Randomized controlled clinical trial.
Source
Medicine (United States). 102(44) (pp E35878), 2023. Date of Publication:
03 Nov 2023.
Author
Chen R.; Duan S.; Wang Y.; He F.; Ren L.; Peng W.
Institution
(Chen, Duan, Wang, He, Ren, Peng) Department of Nursing, West China Second
University Hospital, Sichuan University, Key Laboratory of Birth Defects
and Related Diseases of Women and Children (Sichuan University, Ministry
of Education, Sichuan, Chengdu, China
(Chen, Peng) West China School of Nursing, Sichuan University, Sichuan,
Chengdu, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: To determine the efficacy of music therapy on pain relief
during fundus screening in infants. Method(s): The sample consisted
of infants aged 0 to 3 months who required fundus screening. Infants were
randomized to fast music, slow music, and control groups. All groups
underwent fundus screening under topical anesthesia. Music therapy was
provided to the music groups prior to, during, and after the operation.
The patient's heart rate (HR), transcutaneous oxygen saturation, and
crying decibel were measured. The Face, Legs, Activity, Cry, Consolability
scale was used for pain measurement. Result(s): A total of 300
subjects' data were collected. The quantitative analysis revealed that in
both music groups, peripheral capillary oxygen saturation and satisfaction
levels increased while pain scores decreased (P < .05). The slow music
group's HR was shown to have significantly decreased (P < .05).
 Conclusion(s): Music therapy can effectively reduce pain and crying,
and increase blood oxygen saturation during fundus examination of infants.
Music with a rhythm of 60 to 80 beats per minute can decrease HR. Music
therapy must be remembered to increase infants' comfort during fundus
examination. Abbreviations: FLACC = Face, Legs, Activity, Cry,
Consolability, HR = heart rate, ROP = retinopathy of prematurity,
SpO<inf>2</inf> = peripheral capillary oxygen saturation. Copyright
© 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

<54>
[Use Link to view the full text]
Accession Number
2028398016
Title
OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions.
Source
New England Journal of Medicine. 389(16) (pp 1477-1487), 2023. Date of
Publication: 2023.
Author
Holm N.R.; Andreasen L.N.; Neghabat O.; Laanmets P.; Kumsars I.; Bennett
J.; Olsen N.T.; Odenstedt J.; Hoffmann P.; Dens J.; Chowdhary S.; O'Kane
P.; Bulow Rasmussen S.-H.; Heigert M.; Havndrup O.; Van Kuijk J.P.;
Biscaglia S.; Mogensen L.J.H.; Henareh L.; Burzotta F.; Eek C.H.; Mylotte
D.; Llinas M.S.; Koltowski L.; Knaapen P.; Calic S.; Witt N.; Santos-Pardo
I.; Watkins S.; Lonborg J.; Kristensen A.T.; Jensen L.O.; Calais F.;
Cockburn J.; McNeice A.; Kajander O.A.; Heestermans T.; Kische S.;
Eftekhari A.; Spratt J.C.; Christiansen E.H.
Institution
(Holm, Andreasen, Neghabat, Bulow Rasmussen, Mogensen, Llinas,
Christiansen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Olsen, Kristensen) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Havndrup) Department of Cardiology, Zealand University Hospital,
Roskilde, Denmark
(Lonborg) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Eftekhari) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Laanmets) Department of Cardiology, North Estonia Medical Center,
Tallinn, Estonia
(Kumsars) Pauls Stradins Clinical University Hospital, University of
Latvia, Riga, Latvia
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Dens) Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
(Odenstedt) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Henareh) Department of Cardiology, Karolinska University Hospital, Unit
of Cardiology, Sodersjukhuset, Stockholm, Sweden
(Witt, Santos-Pardo) Department of Clinical Science and Education,
Karolinska Institute, Unit of Cardiology, Sodersjukhuset, Stockholm,
Sweden
(Calais) Department of Cardiology, Orebro University Hospital, Orebro,
Sweden
(Hoffmann) Department of Cardiology, Oslo University Hospital, Ulleval,
Norway
(Heigert) Department of Cardiology, Trondheim University Hospital,
Trondheim, Norway
(Eek) Department of Cardiology, Oslo University Hospital, Oslo, Norway
(Calic) Department of Cardiology, Sorlandet Sykehus Arendal, Arendal,
Norway
(Chowdhary) Department of Cardiology, Manchester Academic Health Science
Centre, Wythenshawe Hospital, Manchester, United Kingdom
(O'Kane) Department of Cardiology, Royal Bournemouth Hospital,
Bournemouth, United Kingdom
(Watkins) Department of Cardiology, Golden Jubilee Hospital, Glasgow,
United Kingdom
(Cockburn) Department of Cardiology, Sussex Cardiac Centre, Brighton,
United Kingdom
(McNeice) Department of Cardiology, Belfast Health and Social Care Trust,
Belfast, United Kingdom
(Spratt) Cardiology Care Group, St. George s University Hospitals Nhs
Foundation Trust and Cardiovascular Clinical Academic Group, St. George s
University of London, London, United Kingdom
(Van Kuijk) Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein,
Netherlands
(Knaapen) Department of Cardiology, Amsterdam Umc, Amsterdam, Netherlands
(Heestermans) Department of Cardiology, Northwest Hospital Alkmaar,
Alkmaar, Netherlands
(Biscaglia) Azienda Ospedaliero Universitaria di Ferrara, Cardiology Unit,
Ferrara, Italy
(Burzotta) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario Agostino Gemelli Irccs, Universita Cattolica Del Sacro
Cuore, Rome, Italy
(Mylotte) Department of Cardiology, University Hospital Galway, Galway,
Ireland
(Koltowski) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Kajander) Tampere Heart Hospital, Tampere University Hospital, Tampere,
Finland
(Kische) Vivantes Klinikum im Friedrichshain, Berlin, Germany
Publisher
Massachussetts Medical Society
Abstract
Abstract Background Imaging-guided percutaneous coronary intervention
(PCI) is associated with better clinical outcomes than angiography-guided
PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of
lesions involving coronary-artery branch points (bifurcations) improves
clinical outcomes as compared with angiographic guidance is uncertain.
Methods We conducted a multicenter, randomized, open-label trial at 38
centers in Europe. Patients with a clinical indication for PCI and a
complex bifurcation lesion identified by means of coronary angiography
were randomly assigned in a 1:1 ratio to OCT-guided PCI or
angiography-guided PCI. The primary end point was a composite of major
adverse cardiac events (MACE), defined as death from a cardiac cause,
target-lesion myocardial infarction, or ischemia-driven target-lesion
revascularization at a median follow-up of 2 years. Results We assigned
1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI
(601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI
group and 116 (19.3%) in the angiography-guided PCI group had a
bifurcation lesion involving the left main coronary artery. At 2 years, a
primary end-point event had occurred in 59 patients (10.1%) in the
OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided
PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98;
P=0.035). Procedure-related complications occurred in 41 patients (6.8%)
in the OCT-guided PCI group and 34 patients (5.7%) in the
angiography-guided PCI group. Conclusions Among patients with complex
coronary-artery bifurcation lesions, OCT-guided PCI was associated with a
lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by
Abbott Vascular and others; OCTOBER ClinicalTrials.gov number,
NCT03171311.) Copyright © 2023 Massachusetts Medical Society.

<55>
Accession Number
2026934660
Title
Anti-CMV therapy, what next? A systematic review.
Source
Frontiers in Microbiology. 14 (no pagination), 2023. Article Number:
1321116. Date of Publication: 2023.
Author
Gourin C.; Alain S.; Hantz S.
Institution
(Gourin, Alain, Hantz) INSERM, CHU Limoges, University of Limoges,
RESINFIT, Limoges, France
(Alain, Hantz) CHU Limoges, Laboratoire de
Bacteriologie-Virologie-Hygiene, National Reference Center for
Herpesviruses, Limoges, France
Publisher
Frontiers Media SA
Abstract
Human cytomegalovirus (HCMV) is one of the main causes of serious
complications in immunocompromised patients and after congenital
infection. There are currently drugs available to treat HCMV infection,
targeting viral polymerase, whose use is complicated by toxicity and the
emergence of resistance. Maribavir and letermovir are the latest
antivirals to have been developed with other targets. The approval of
letermovir represents an important innovation for CMV prevention in
hematopoietic stem cell transplant recipients, whereas maribavir allowed
improving the management of refractory or resistant infections in
transplant recipients. However, in case of multidrug resistance or for the
prevention and treatment of congenital CMV infection, finding new
antivirals or molecules able to inhibit CMV replication with the lowest
toxicity remains a critical need. This review presents a range of
molecules known to be effective against HCMV. Molecules with a direct
action against HCMV include brincidofovir, cyclopropavir and
anti-terminase benzimidazole analogs. Artemisinin derivatives, quercetin
and baicalein, and anti-cyclooxygenase-2 are derived from natural
molecules and are generally used for different indications. Although they
have demonstrated indirect anti-CMV activity, few clinical studies were
performed with these compounds. Immunomodulating molecules such as
leflunomide and everolimus have also demonstrated indirect antiviral
activity against HCMV and could be an interesting complement to antiviral
therapy. The efficacy of anti-CMV immunoglobulins are discussed in CMV
congenital infection and in association with direct antiviral therapy in
heart transplanted patients. All molecules are described, with their mode
of action against HCMV, preclinical tests, clinical studies and possible
resistance. All these molecules have shown anti-HCMV potential as
monotherapy or in combination with others. These new approaches could be
interesting to validate in clinical trials. Copyright © 2023
Gourin, Alain and Hantz.

<56>
Accession Number
2026811805
Title
Association between delirium and grip strength in ICU patients for cardiac
surgery (D-GRIP study).
Source
JA Clinical Reports. 9(1) (no pagination), 2023. Article Number: 81. Date
of Publication: December 2023.
Author
Kotani T.; Inoue S.; Ida M.; Naito Y.; Kawawguchi M.
Institution
(Kotani, Ida, Naito, Kawawguchi) Department of Anesthesiology, Nara
Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan
(Inoue) Department of Anesthesiology, Fukushima Medical University,
Fukushima, Japan
Publisher
Springer Science and Business Media Deutschland GmbH

<57>
Accession Number
2026392898
Title
The Effect of Bariatric Surgery on Patients with Heart Failure: a
Systematic Review and Meta-analysis.
Source
Obesity Surgery. 33(12) (pp 4125-4136), 2023. Date of Publication:
December 2023.
Author
Esparham A.; Mehri A.; Hadian H.; Taheri M.; Anari Moghadam H.; Kalantari
A.; Fogli M.J.; Khorgami Z.
Institution
(Esparham, Anari Moghadam) School of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Mehri) Endoscopic and Minimally Invasive Surgery Research Center, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Hadian) Heshmatieh Hospital, Naieen City, Iran, Islamic Republic of
(Taheri, Fogli) Department of Cardiology, Ascension St. John Medical
Center, Tulsa, OK, United States
(Kalantari, Khorgami) Department of Surgery, University of Oklahoma School
of Community Medicine, Tulsa, OK, United States
(Khorgami) Harold Hamm Diabetes Center, University of Oklahoma Health
Sciences Center, Oklahoma City, OK, United States
(Fogli) Department of Internal Medicine, University of Oklahoma School of
Community Medicine, Tulsa, Oklahoma, United States
Publisher
Springer
Abstract
The current study aims to evaluate the effect of bariatric metabolic
surgery (BMS) on the New York Heart Association (NYHA) class and left
ventricular ejection fraction (LVEF) in patients with diagnosed heart
failure (HF). Fourteen related articles with 217 patients were included in
the final analysis. LVEF significantly improved after BMS in patients with
HF with a mean difference of 7.78% (CI 95%: 3.72, 11.84, I 2 =
83.75, p-value < 0.001). Also, the NYHA class significantly decreased
after BMS with a mean difference of - 0.40 (CI 95%: - 0.62, - 0.19, I
2: 47.03, p-value < 0.001). A total of 27 patients with obesity
and HF were listed for cardiac transplantation after BMS. Of those, 20
patients successfully underwent heart transplantation after
BMS. Copyright © 2023, The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature.

<58>
Accession Number
2015866081
Title
Efficacy and safety of catheter ablation for Brugada syndrome: an updated
systematic review.
Source
Clinical Research in Cardiology. 112(12) (pp 1715-1726), 2023. Date of
Publication: December 2023.
Author
Kotake Y.; Barua S.; Kazi S.; Virk S.; Bhaskaran A.; Campbell T.; Bennett
R.G.; Kumar S.
Institution
(Kotake, Barua, Kazi, Virk, Bhaskaran, Campbell, Bennett, Kumar)
Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
(Kotake, Bhaskaran, Campbell, Bennett, Kumar) Westmead Applied Research
Centre, University of Sydney, Westmead, NSW, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Patients with Brugada syndrome (BrS) may experience recurrent
ventricular arrhythmias (VAs). Catheter ablation is becoming an emerging
paradigm for treatment of BrS. Objective(s): To assess the efficacy
and safety of catheter ablation in BrS in an updated systematic review.
 Method(s): We comprehensively searched the databases of
Pubmed/Medline, EMBASE, and Cochrane Central Register of Controlled Trials
from inception to 11th of August 2021. Result(s): Fifty-six studies
involving 388 patients were included. A substrate-based strategy was used
in 338 cases (87%), and a strategy of targeting premature ventricular
complex (PVCs)/ventricular tachycardias (VTs) that triggered ventricular
fibrillation (VF) in 47 cases (12%), with combined abnormal electrogram
and PVC/VT ablation in 3 cases (1%). Sodium channel blocker was frequently
used to augment the arrhythmogenic substrate in 309/388 cases (80%), which
included a variety of agents, of which ajmaline was most commonly used.
After ablation procedure, the pooled incidence of non-inducibility of VA
was 87.1% (95% confidence interval [CI], 73.4-94.3; I 2 = 51%),
and acute resolution of type I ECG was seen in 74.5% (95% CI [52.3-88.6];
I 2 = 75%). Over a weighted mean follow up of 28 months, 7.6%
(95% CI [2.1-24]; I 2 = 67%) had recurrence of type I ECG
either spontaneously or with drug challenge and 17.6% (95% CI [10.2-28.6];
I 2 = 60%) had recurrence of VA. Conclusion(s): Catheter
ablation appears to be an efficacious strategy for elimination of
arrhythmias or substrate associated with BrS. Further study is needed to
identify which patients stand to benefit, and optimal provocation protocol
for identifying ablation targets. Graphical abstract: [Figure not
available: see fulltext.]. Copyright © 2022, Crown.

<59>
Accession Number
2028851784
Title
Development and Validation of Scores to Predict Prolonged Mechanical
Ventilation after Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
O'Brien Z.; Bellomo R.; Williams-Spence J.; Reid C.M.; Coulson T.
Institution
(O'Brien, Bellomo, Coulson) Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(O'Brien, Bellomo, Coulson) Department of Critical Care, University of
Melbourne, Melbourne, VIC, Australia
(O'Brien, Bellomo) Department of Intensive Care, Austin Hospital,
Heidelberg, Melbourne, VIC, Australia
(Bellomo) Data Analytics, Research, and Evaluation Centre, Austin
Hospital, University of Melbourne, Melbourne, VIC, Australia
(Williams-Spence, Reid) Department of Epidemiology and Preventive
Medicine, Monash University, Melbourne, VIC, Australia
(Reid) School of Public Health, Curtin University, Perth, Australia
(Coulson) Department of Anaesthesia, The Alfred Hospital, Melbourne, VIC,
Australia
Publisher
W.B. Saunders
Abstract
Objectives: To optimize the early prediction of prolonged postoperative
mechanical ventilation after cardiac surgery (>24 hours postoperatively).
 Design(s): The authors performed a retrospective analysis.
 Setting(s): The Australian and New Zealand Society of Cardiac and
Thoracic Surgeons (ANZSCTS) database was utilized. Participant(s):
All patients included in the ANZSCTS database between January 2015 and
December 2018 were analyzed. Intervention(s): No interventions were
performed in this observational study. Measurements and Main Results:
A previously developed model was modified to allow retrospective risk
calculation and model assessment (Modified Hessels score). The database
was split into development and validation sets. A new risk model was
developed using forward and backward stepwise elimination (ANZ-PreVent
score). The authors assessed 48,382 patients, of whom 5004 (10.3%) were
ventilated mechanically for >24 hours post-operatively. The Modified
Hessels score demonstrated good performance in this database, with a
c-index of 0.78 (95% CI 0.77-0.78) and a Brier score of 0.08. The newly
developed ANZ-PreVent score demonstrated better performance (validation
cohort, n = 12,229), with a c-index of 0.84 (95% CI 0.83-0.85) (p <
0.0001) and a Brier score of 0.07. Both scores performed better than the
severity of illness scores commonly used to predict outcomes in intensive
care. Conclusion(s): The authors validated a modified version of an
existing prediction score and developed the ANZ-PreVent score, with
improved performance for identifying patients at risk of ventilation for
>24 hours. The improved score can be used to identify high-risk patients
for targeted interventions in future randomized controlled
trials. Copyright © 2023 The Authors

<60>
Accession Number
2027356724
Title
Scoping review of percutaneous mechanical aspiration for valvular and
cardiac implantable electronic device infective endocarditis.
Source
Clinical Microbiology and Infection. 29(12) (pp 1508-1515), 2023. Date of
Publication: December 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

<61>
Accession Number
641029667
Title
Individualized red-cell transfusion strategy for non-cardiac surgery in
adults: a randomized controlled trial.
Source
Chinese medical journal. 136(23) (pp 2857-2866), 2023. Date of
Publication: 05 Dec 2023.
Author
Liao R.; Liu J.; Zhang W.; Zheng H.; Zhu Z.; Sun H.; Yu Z.; Jia H.; Sun
Y.; Qin L.; Yu W.; Luo Z.; Chen Y.; Zhang K.; Ma L.; Yang H.; Wu H.; Liu
L.; Yuan F.; Xu H.; Zhang J.; Zhang L.; Liu D.; Huang H.
Institution
(Liao, Liu, Luo, Xu) Department of Anesthesiology, Research Unit for
Perioperative Stress Assessment and Clinical Decision, Chinese Academy of
Medical Sciences (2018RU012), West China Hospital of Sichuan University,
Chengdu, Sichuan 610041, China
(Zhang, Zhang) Department of Anesthesiology, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, Henan 450052, China
(Zheng, Zhang) Department of Anesthesiology, First Affiliated Hospital of
Xinjiang Medical University, Urumqi, Xinjiang 830054, China
(Zhu, Liu) Department of Anesthesiology, Affiliated Hospital of Zunyi
Medical College, Zunyi, Guizhou 563003, China
(Sun) Department of Anesthesiology, Beijing Friendship Hospital of Capital
Medical University, Beijing 100069, China
(Yu) Department of Bioinformatics and Biostatistics, School of Life
Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240,
China
(Jia) Department of Anesthesiology, Fourth Hospital of Hebei Medical
University, Hebei 050019, China
(Sun) Department of Anesthesiology, Xijing Hospital of the Fourth Military
Medical University, Xi'an, Shaanxi 710032, China
(Qin) Department of Transfusion, West China Hospital of Sichuan
University, Chengdu, Sichuan 610041, China
(Yu) Department of Anesthesiology, Tianjin First Center Hospital, Tianjin
300192, China
(Chen) Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou,
Fujian 350001, China
(Zhang) Department of Anesthesiology, Sichuan Cancer Hospital & Institute,
Chengdu, Sichuan 610041, China
(Ma) Department of Anesthesiology, Peking Union Medical College Hospital,
Beijing 100032, China
(Yang) Department of Anesthesiology, Tongji Hospital of Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, Hubei
430030, China
(Wu) Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital of
Sichuan University, Chengdu, Sichuan 610041, China
(Liu) Department of Orthopedic Surgery, West China Hospital of Sichuan
University, Chengdu, Sichuan 610041, China
(Yuan) Department of Anesthesiology, General Hospital Affiliated to
Tianjin Medical University, Tianjin 300052, China
(Huang) Department of Anesthesiology and Translational Neuroscience
Center, West China Second University Hospital of Sichuan University,
Chengdu, Sichuan 610041, China
Abstract
BACKGROUND: Red-cell transfusion is critical for surgery during the
peri-operative period; however, the transfusion threshold remains
controversial mainly owing to the diversity among patients. The patient's
medical status should be evaluated before making a transfusion decision.
Herein, we developed an individualized transfusion strategy using the
West-China-Liu's Score based on the physiology of oxygen
delivery/consumption balance and designed an open-label, multicenter,
randomized clinical trial to verify whether it reduced red cell
requirement as compared with that associated with restrictive and liberal
strategies safely and effectively, providing valid evidence for
peri-operative transfusion. METHOD(S): Patients aged >14 years
undergoing elective non-cardiac surgery with estimated blood loss > 1000
mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly
assigned to an individualized strategy, a restrictive strategy following
China's guideline or a liberal strategy with a transfusion threshold of
hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the
proportion of patients who received red blood cells (superiority test) and
a composite of in-hospital complications and all-cause mortality by day 30
(non-inferiority test). RESULT(S): We enrolled 1182 patients: 379,
419, and 384 received individualized, restrictive, and liberal strategies,
respectively. Approximately 30.6% (116/379) of patients in the
individualized strategy received a red-cell transfusion, less than 62.5%
(262/419) in the restrictive strategy (absolute risk difference, 31.92%;
97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI:
2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy
(absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio,
20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant
differences were found in the composite of in-hospital complications and
mortality by day 30 among the three strategies. CONCLUSION(S): The
individualized red-cell transfusion strategy using the West-China-Liu's
Score reduced red-cell transfusion without increasing in-hospital
complications and mortality by day 30 when compared with restrictive and
liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION:
ClinicalTrials.gov, NCT01597232. Copyright © 2023 The Chinese
Medical Association, produced by Wolters Kluwer, Inc. under the
CC-BY-NC-ND license.

<62>
Accession Number
642927924
Title
Spinal Anesthesia in patients with aortic stenosis- Across the line?.
Source
Signa Vitae. Conference: 7th National Congress of the Romanian Association
of Regional Anesthesia and Pain Therapy, ARAR. Cluj-Napoca Romania. 19(6)
(pp 216-219), 2023. Date of Publication: November 2023.
Author
Cotae A.-M.; Ungureanu R.; Mirea L.
Institution
(Cotae, Ungureanu, Mirea) Faculty of Medicine, "Carol-Davila" University
of Medicine and Pharmacy, Bucharest, Romania
(Cotae, Ungureanu, Mirea) Anaesthesiology and Intensive Care Clinic,
Clinical Emergency Hospital Bucharest, Romania
Publisher
Pharmamed Mado Ltd
Abstract
Background: Aortic stenosis is recognized as a valvular lesion that gives
rise to several hemodynamic challenges for the anesthesia team [1, 2]. The
use of neuraxial anaesthesia is traditionally regarded as contraindicated
in patients with aortic stenosis, due to severe hypotension that may
result secondary to sympatholysis and further decline of vascular tone, in
the settings of an already decreased cardiac output [3-5]. The need for
patients with aortic stenosis to undergo non-cardiac surgery has increased
significantly recently, and consequently the concern for unwanted
cardiovascular events or risk of death in the perioperative settings [6,
7]. Among the non-cardiac surgical emergencies in the geriatric population
one of the most common is the hip fracture [7]. For these patients the
prevalence of severe aortic stenosis (valve area <1 cm2) is estimated
between 5-10% [6]. In this scenario, minimizing time to surgery is one of
the most important and also a modifiable risk factor for reducing
mortality, along with avoiding perioperative hypotension [8, 9]. An
audible cardiac murmur is identified during examination in a quarter of
patients with hip fracture and usually no documented evidence of the
valvular lesion is available at the time of admission [10]. Although it is
prudent to assess patients with high risk for cardiovascular events,
recent data recommends not to delay surgery pending the results of
transthoracic echocardiography [11-13]. Instead, Focused cardiac
ultrasound is a goal-directed, short form of echocardiography, which may
be performed by anesthetists [14]. Without delaying surgery, it increases
bed-side clinical assessment, enhances diagnostic accuracy and guides
acute management [10, 14, 15]. Currently there are no randomised clinical
trials on the prognostic role of aortic stenosis in hip fracture surgery
and existing literature is extremely sparse. A literature overview
concluded that overall neuraxial anaesthesia is correlated with a reduced
in-hospital mortality and length of hospital stay in comparison to general
anesthesia [16]. Also, an interesting comparison in patients with several
grades of aortic stenosis who received either spinal anesthesia or general
anesthesia for lower extremity surgery, found no significant differences
in regard to mortality and serious complications (deep vein thrombosis,
pulmonary embolism, myocardial infarction, and stroke) between the groups
[17]. Adapting neuraxial anesthesia through several means may be the key
for a positive outcome in patients with hip fracture who associate aortic
stenosis. Avoiding hypotension, regardless the anesthetic technique, may
be our primary goal, since mortality increases statistically significant
as blood pressure incremental decreases [18, 19]. Recent findings describe
hypotensive events more often during general anaesthesia than spinal
anaesthesia [18]. Lowering the intrathecal dose of bupivacaine towards
1.4-1.5 mL and adding additives such as vasoconstrictors,
alpha-2-adrenergic agonists, opioids or dexamethasone may significantly
contribute to a more hemodynamically stable profile [18-21]. Moreover,
reducing the speed of local anesthetic injection in spinal anesthesia may
help to avoid usage of vasopressors [22]. Although age is not a modifiable
risk factor, we must keep in mind that it is possible for the cerebral
spinal fluid volume to shrink and the spinal nerves become more responsive
to local anaesthetics in geriatric population [23, 24]. Also, by providing
preoperative efficient analgesia through an ultrasound guided fascia
iliaca compartment nerve block, we can increase patients' tolerance for a
lateral decubitus position and thus perform spinal hemianesthesia, in
order to reduce cardiovascular changes and restrict the motor and
sensitive block to the side to be operated [25, 26]. Case Series: A series
of 3 elderly patients, with ages between 83-87 years old, were brought to
our emergency department after a mechanical fall from standing height and
diagnosed with proximal femoral pertrochanteric fracture type III. For
more clarity we provide the medical records and chronic treatment of the
patients in Table 1. All had in common hypertension grade II-III and long
treatment with beta blockers. The clinical examination of the patients
revealed nothing outstanding, except for an audible ejection systolic
reverse splitting of the second heart sound in the aortic area. None of
them described signs of acute heart failure, nor history of syncope or
angina pectoris. No particular paraclinical findings were identified and
the electrocardiogram of all three of them exhibited sinus rhythm. Given
the emergency scenarios we have performed a Focused cardiac ultrasound and
identified in the first patient moderate stenosis with mild left
ventricular hypertrophy, in the second patient severe aortic stenosis with
mild septal ventricular hypertrophy, as for the third patient severe
aortic stenosis with mild concentric left ventricular hypertrophy. Peak
aortic jet velocity <4.5 m/s and a mean gradient <43 mmHg was identified
in all the 3 cases. No low gradient, low flow aortic stenosis was
identified, and the left ventricular ejection was estimated for more than
45% in all the 3 cases. After discussing with the patients and family the
perioperative plan, informed consent for every patient was provided. Each
of the three patients opted for spinal hemianesthesia. The perioperative
plan was shared and approved together with the orthopedic team. In the
preoperative area an intravenous line was placed, crystalloid solutions
began to be infused, antibiotic prophylaxis and premedication was
administered. An ultrasound guided fascia iliaca block (Ropivacaine 0.25%)
was performed 30 minutes prior to surgical intervention. Under standard
monitoring and after appropriate identification of the spines' bony
landmarks, spinal hemianesthesia was performed in lateral position,
through a midline or paramedian approach using either a 25 or a 27 gauge
(anesthetist preference). Then, 8 mg hyperbaric bupivacaine and 0.025 mg
fentanyl was slowly injected and lateral position was maintained for a
further 10-15 minutes to enhance preferential lateral distribution.
Hemodynamic parameters remained unchanged. Sensory level was examined and
considered adequate for surgery to proceed. A dynamic hip screw procedure
was performed in all 3 scenarios. The intraoperative blood loss was
minimal. During surgery and in the immediate postoperative period, no
significant blood pressure or heart rate variation was encountered. The
mean arterial pressure maintained above 65 mmHg and vasopressors were not
needed to be administer throughout this period. Sensory and motor
functioned returned shortly after the procedure and no severe
complications were encountered in the postoperative period. The patients
were discharged in the following days. Discussion(s): Up to the
present moment there is no strong evidence to avoid spinal anesthesia in
patients with aortic stenosis, including severe aortic stenosis. We
acknowledge the dilemma whether or not to choose regional over general
anesthesia for the anesthetic management of patients with hip fracture
will not be solved for the time being and will remain an ongoing topic for
debate. Independently of the result, we must bear in mind that both a
negative or a positive result should not interfere with our clinical
judgement. Furthermore, we consider that carefully managed neuroaxial
blockade could become a useful alternative to general anaesthesia in
selected cases. In order to establish which of the patients associating
hip fracture with aortic stenosis may benefit from neuroaxial blockade,
large randomized clinical studies are necessary.

<63>
Accession Number
2028868551
Title
The impact of cardiopulmonary rehabilitation in phase II cardiac
rehabilitation program on the health-related quality of life of patients
undergoing coronary artery bypass graft surgery.
Source
Current Problems in Cardiology. 49(2) (no pagination), 2024. Article
Number: 102221. Date of Publication: February 2024.
Author
Akar M.; Miri K.; Mazloum S.R.; Hajiabadi F.; Hamedi Z.; Vakilian F.;
Dehghan H.
Institution
(Akar) Department of Medical - Surgical Nursing, School of Nursing and
Midwifery (MSC Student), Mashhad University of Medical Sciences, Mashhad,
Iran, Islamic Republic of
(Akar, Mazloum, Hajiabadi) Nursing and Midwifery Care Research Center,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Miri) Department of Nursing, School of Nursing and Midwifery, Torbat
Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran,
Islamic Republic of
(Mazloum, Hajiabadi) Department of Medical Surgical Nursing, School of
Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad,
Iran, Islamic Republic of
(Hamedi, Dehghan) Department of Cardiac Rehabilitation, Mashhad University
of Medical Sciences, Imam Reza Hospital, Mashhad, Iran, Islamic Republic
of
(Vakilian) Vascular Surgery Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background: Coronary artery bypass surgery is the leading cause of change
in the quality of life and pulmonary function of patients. One strategy to
enhance lung muscle strength and improve overall quality of life is
pulmonary rehabilitation. This study aimed to investigate the impact of
incorporating a pulmonary rehabilitation program into phase II cardiac
rehabilitation program on the quality of life of patients undergoing
coronary artery bypass graft surgery. Method(s): This randomized
clinical trial study included 53 patients who underwent coronary artery
bypass graft surgery at Imam Reza Hospital in Mashhad between September
2019 and March 2020. The research participants were selected based on
specific inclusion criteria and divided into two groups. The control group
followed the routine rehabilitation program, whereas the intervention
group underwent a pulmonary rehabilitation program for 20-30 min after
each session of the cardiac rehabilitation program. Data collection tools
included a demographic information questionnaire and the Ferrans and
Powers' quality of life index. The data were analyzed using the
independent t-test, Mann-Whitney test, paired t-test, Spearman
correlation, Wilcoxon test, and SPSS25. Result(s): The mean quality
of life score in the intervention group(20.7+/-1.8) was significantly
higher than that of the control group (18.8+/-2.3)(P < 0.05). Furthermore,
the intervention group exhibited significantly higher mean scores in the
physical, psychological-spiritual, and family dimensions than the control
group(P < 0.05). Conclusion(s): The study results demonstrate the
positive impact of incorporating a pulmonary rehabilitation program into
cardiac rehabilitation on the health-related quality of life of patients
undergoing coronary artery bypass graft surgery. Trial registration:
IRCT20190707044132N1 Copyright © 2023 Elsevier Inc.

<64>
Accession Number
2028873929
Title
An Accessible Pre-Rehabilitation Bundle for Patients Undergoing Elective
Heart Valve Surgery with Limited Resources: The TIME Randomized Clinical
Trial.
Source
Reviews in Cardiovascular Medicine. 24 (no pagination), 2023. Article
Number: 308. Date of Publication: 2023.
Author
Luo Z.; Zhang X.; Wang Y.; Huang W.; Chen M.; Yang M.; Yu P.
Institution
(Luo, Zhang, Huang, Yang, Yu) Department of Rehabilitation Medicine, West
China Hospital, Sichuan University, Sichuan, Chengdu 610041, China
(Wang, Chen) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Sichuan, Chengdu 610041, China
Publisher
IMR Press Limited
Abstract
Background: Despite gradually increasing evidence for pre-rehabilitation
for heart valve surgery, it remains underused, especially in developing
countries with limited resources. The study aimed to investigate the
feasibility and effects of an innovative three-day pre-rehabilitation
bundle for patients undergoing elective heart valve surgery.
 Method(s): This was a single-center, assessor-blind, randomized
clinical trial. A total of 165 patients were randomly assigned to either
usual care (control group, n = 83) or usual care with an additional 3-day
pre-rehabilitation bundle (Three-day of Inspiratory muscle training,
aerobic Muscle training, and Education (TIME) group, n = 82). The main
outcome of the study was the incidence of postoperative pulmonary
complications (PPCs). Secondary outcomes included the feasibility of the
intervention, duration of the non-invasive ventilator, length of stay, and
PPCs-related medical costs on discharge. Result(s): Of 165 patients
53.94% were male, the mean age was 63.41 years, and PPCs were present in
26 of 82 patients in the TIME group and 44 of 83 in the control group
(odds ratio (OR), 0.60; 95% CI, 0.41-0.87, p = 0.006). The feasibility of
the pre-rehabilitation bundle was good, and no adverse events were
observed. Treatment satisfaction and motivation scored on 10-point scales,
were 9.1 +/- 0.8 and 8.6 +/- 1.4, respectively. The TIME group also had
fewer additional PPCs-related medical costs compared to the control group
(6.96 vs. 9.57 thousand CNY (1.01 vs. 1.39 thousand USD), p < 0.001).
 Conclusion(s): The three-day accessible pre-rehabilitation bundle
reduces the incidence of PPCs, length of stay, and PPCs-related medical
costs in patients undergoing elective valve surgery. It may provide an
accessible model for the expansion of pre-rehabilitation in countries and
regions with limited medical resources. Clinical Trial Registration: This
trial was based on the Consolidated Standards of Reporting Trials
(CONSORT) guidelines. This trial was registered in the Chinese Clinical
Trial Registry (identifier ChiCTR2000039671). Copyright © 2023
IMR Press Limited. All rights reserved.

<65>
Accession Number
2028899698
Title
Femoral Arterial Calcification and Plug- vs. Suture-Based Closure Device
Strategies Post-Transcatheter Aortic Valve Implantation: Insights From
CHOICE-CLOSURE.
Source
Structural Heart. (no pagination), 2023. Article Number: 100236. Date of
Publication: 2023.
Author
Fitzgerald S.; Dumpies O.; Shibata M.; Hartung P.; Obradovic D.;
Boekstegers P.; Vorpahl M.; Rotta detto Loria J.; Kiefer P.; Desch S.;
Thiele H.; Abdel-Wahab M.
Institution
(Fitzgerald, Dumpies, Shibata, Hartung, Obradovic, Rotta detto Loria,
Desch, Thiele, Abdel-Wahab) Department of Cardiology, Heart Center Leipzig
at University of Leipzig, Leipzig, Germany
(Boekstegers) Department of Cardiology, Helios Clinic Siegburg, Siegburg,
Germany
(Boekstegers, Vorpahl) Witten Herdecke University, Witten, Germany
(Vorpahl) Department of Cardiology, Helios University Hospital Wuppertal,
Wuppertal, Germany
(Kiefer) Department of Cardiac Surgery, Heart Center Leipzig at University
of Leipzig, Leipzig, Germany
Publisher
Cardiovascular Research Foundation
Abstract
Background: The location and severity of vascular calcification may
influence closure device success in transfemoral transcatheter aortic
valve implantation. The aim of this study was to analyze effects of
vascular access-site calcification on vascular and bleeding outcomes
post-transcatheter aortic valve implantation. Method(s): The
Randomized Comparison of CatHeter-based Strategies fOr Interventional
ACcess SitE CLOSURE during Transfemoral Transcatheter Aortic Valve
Implantation (CHOICE-CLOSURE) trial assigned 516 patients to access site
closure using a pure plug-based technique (MANTA, Teleflex) or a primary
suture-based technique (ProGlide, Abbott Vascular). The principal finding
of the overall study was that access-site or access-related complications
were more common after the plug-based strategy compared to percutaneous
closure with a suture-based strategy. In this predefined subgroup
analysis, the overall cohort was split into patients with and without
anterior calcification at the access site and divided by degree of
calcification severity using the classification system developed in the
MANTA vs. suture-based vascular closure after transcatHeter aortic valve
replacement (MASH) trial. Differences in bleeding and vascular
complications were compared. The primary endpoint consisted of
access-site- or access-related major and minor vascular complications.
 Result(s): There were more access-site-related major and minor
vascular complications for patients with anterior wall vascular
calcification and MASH severe calcification. No significant interaction
with choice of closure technique in terms of access-site-related major and
minor vascular complications was observed (odds ratio 1.70, 95% CI
0.77-3.78, p = 0.19 for the primary endpoint in plug- vs. suture-based
strategy in patients with anterior calcification, odds ratio 1.78, 95% CI
0.56-5.65, p = 0.33 for primary endpoint in plug- vs. suture-based
strategy with MASH severe calcification, p<inf>int</inf> = 0.97 for
anterior calcification, p<inf>int</inf> = 0.95 for MASH severe
calcification). Conclusion(s): The total number of vascular
complications was found to be greater in the presence of anterior and MASH
severe calcification. Overall, the presence of anterior or severe
calcification does not significantly modify the efficacy of the
suture-based strategy compared to the plug-based strategy. Copyright
© 2023 The Authors

<66>
Accession Number
2028711245
Title
Prospective, Randomized Study of Fibrinogen Concentrate Versus
Cryoprecipitate for Correcting Hypofibrinogenemia in Cardiac Surgery
Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Ayaganov D.; Kuanyshbek A.; Vakhrushev I.; Li T.
Institution
(Ayaganov, Kuanyshbek, Vakhrushev, Li) NJSC "National Research Cardiac
Surgery Center", Astana, Kazakhstan
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgery with cardiopulmonary bypass (CPB) is associated
with hypofibrinogenemia and severe bleeding requiring transfusion.
Guidelines recommend cryoprecipitate or fibrinogen concentrate (FC) for
the treatment of acquired hypofibrinogenemia. This study compared
cryoprecipitate and FC for the correction of acquired hypofibrinogenemia
and the associated costs. Design(s): A single-center, prospective,
randomized study evaluating patients with hypofibrinogenemia after cardiac
surgery. The primary endpoint was direct treatment cost. Secondary
endpoints included the change in fibrinogen level after FC and/or
cryoprecipitate dosing. Setting(s): A single-center study in Astana,
Kazakhstan. Participant(s): Participants who underwent CPB from 2021
to 2022 and developed clinically significant bleeding and
hypofibrinogenemia. Intervention(s): Patients were randomized to
receive cryoprecipitate or FC. Measurements and Main Results:
Eighty-eight adult patients with acquired hypofibrinogenemia (<2.0 g/L)
after CPB were randomized to receive cryoprecipitate (N = 40) or FC (N =
48), with similar demographics between groups. Overall, mean +/- SD 9.33
+/- 0.94 units (range, 8-10) cryoprecipitate or 1.40 +/- 0.49 g (1-2) FC
was administered to the 2 groups. From before administration to 24 hours
after, mean plasma fibrinogen increased by a mean +/- SD of 125 +/- 65 and
96 +/- 65 mg/dL in the cryoprecipitate and FC groups, respectively. At 48
hours after administration, there was no significant difference in
fibrinogen levels between groups. The mean direct cost of treatment with
FC was significantly lower than with cryoprecipitate (p < 0.0001):
$1,505.06 +/- $152.40 and $631.75 +/- $223.67 per patient for
cryoprecipitate and FC, respectively. Conclusion(s): Analysis of
plasma fibrinogen concentration showed that cryoprecipitate and FC had
comparable effectiveness. However, FC is advantageous over cryoprecipitate
due to its ease of handling, lower cost, and high purity. Copyright
© 2023 The Authors

<67>
Accession Number
642942129
Title
Effect of Remifentanil on Acute and Chronic Postsurgical Pain in Patients
undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.
Source
The Clinical journal of pain. (no pagination), 2023. Date of Publication:
06 Dec 2023.
Author
Zhang B.; Cai C.; Pan Z.; Zhuang L.; Qi Y.
Institution
(Zhang) Department of Anesthesia, Ningbo Medical Center Li Huili Hospital,
Ningbo, China
Abstract
OBJECTIVES: Our purpose was to explore the effect of remifentanil on acute
and chronic postsurgical pain after cardiac surgery. METHOD(S):
Randomized controlled trials (RCTs) were retrieved in electronic databases
such as PubMed, Cochrane Library, CNKI databases, Scopus, and Web of
Science. A systematic review, meta-analysis, trial sequential analysis
(TSA) was performed. Basic information and outcomes were extracted from
the included studies. The primary outcome was chronic postsurgical pain.
Secondary outcomes were scores of postsurgical pain and morphine
consumption within 24 hours after cardiac surgery. Our risk of bias
assessment was based on the Cochrane risk of bias tool version 2 (ROB
2.0). The overall quality of the evidence was rated using the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) system.
 RESULT(S): Seven studies consisting of 658 patients were enrolled in
the meta-analysis. A single study had a high risk of bias and two studies
had a moderate risk of bias. The incidence of chronic postsurgical pain
(four studies [415 patients]; RR, 1.02 [95% CI, 0.53-1.95]; P =0.95;
I2=59%; TSA-adjusted CI, 0.78-1.20) and the postsurgical pain score (two
studies [196 patients]; MD 0.09 [95% CI, -0.36-0.55]; P =0.69; I2=0%;
TSA-adjusted CI, -0.36-0.55)were not statistically different between the
two groups. However, morphine consumption (six studies [569 patients]; MD
6.94 [95% CI, 3.65-10.22]; P<0.01; I2=0%; TSA-adjusted CI, 0.00-0.49) was
higher in the remifentanil group than in the control group. DISCUSSION:
There was not enough evidence to prove that remifentanil can increase the
incidence of chronic postsurgical pain after cardiac surgery, but
interestingly, the results tended to support a trend toward increased
complications in the intervention group. However, there was
moderate-certainty evidence that the use of remifentanil increases the
consumption of morphine for analgesia, and more direct comparison trials
are needed to inform clinical decision-making with greater
confidence. Copyright © 2023 Wolters Kluwer Health, Inc. All
rights reserved.

<68>
Accession Number
642940903
Title
Protein and Exercise to Reverse Frailty in Older Men and Women Undergoing
Transcatheter Aortic Valve Replacement: Design of the PERFORM-TAVR Trial.
Source
The Canadian journal of cardiology. (no pagination), 2023. Date of
Publication: 03 Dec 2023.
Author
Fountotos R.; Lauck S.; Piazza N.; Martucci G.; Arora R.; Asgar A.;
Forcillo J.; Kouz R.; Labinaz M.; Lamy A.; Peterson M.; Wijeysundera H.;
Masse L.; Ouimet M.-C.; Polderman J.; Webb J.; Afilalo J.
Abstract
BACKGROUND: Despite the high procedural success of transcatheter aortic
valve replacement (TAVR), 2 out of 5 older adults report poor physical
performance and health-related quality of life (HRQOL) in the ensuing
months, particularly those with frailty. There has yet to be a trial
examining the synergistic effects of exercise and protein supplementation
to counteract frailty and improve patient-centered outcomes following
TAVR. METHOD(S): The PERFORM-TAVR trial is a multicenter
parallel-group randomized clinical trial that is enrolling 200 frail older
adults >=70 years undergoing TAVR (NCT03522454). Patients will be randomly
allocated to one of two treatment groups: standard-of-care lifestyle
education (control group) or protein-rich oral nutritional supplement for
4 weeks pre-TAVR with the addition of home-based supervised exercise
sessions for 12 weeks post-TAVR (intervention group). The primary outcome
will be physical performance as measured by a blinded observer using the
Short Physical Performance Battery at 3 months. Secondary outcomes at 3,
6, and 12 months will include HRQOL as measured by the Short-Form 36
Physical and Mental Component summary scores, and a composite safety
endpoint. CONCLUSION(S): The PERFORM-TAVR trial is testing a novel
frailty intervention in older adults undergoing TAVR to optimize recovery
and downstream HRQOL. This represents a potential paradigm shift that
highlights the value of assessing and treating patient's frailty in
parallel with their underlying heart valve disease. Copyright ©
2023. Published by Elsevier Inc.

<69>
Accession Number
2017978415
Title
Pharmacokinetics and Safety of Erenumab after a Single Subcutaneous
Injection Dose in Healthy Chinese Subjects.
Source
Clinical Drug Investigation. 42(7) (pp 623-630), 2022. Date of
Publication: July 2022.
Author
Shen Q.; Jin Y.; Di X.; Hu C.; Liu R.; Qi X.; Wang Y.; Wang Z.
Institution
(Shen, Jin, Di, Hu, Liu, Wang, Qi, Wang, Wang) Clinical Trial Center/NMPA
Key Laboratory for Clinical Research and Evaluation of Innovative Drug,
West China Hospital of Sichuan University, No.5 Telecom Road, Wuhou
District, Chengdu 610041, China
Publisher
Adis
Abstract
Background and Objective: Erenumab is the first-in-class, selective, and
competitive human monoclonal antibody antagonist of the calcitonin
gene-related peptide (CGRP) receptor that has been shown to be effective
and well-tolerated in the preventive therapy of episodic and chronic
migraine. The pharmacokinetics of erenumab may be affected by differences
in race and ethnicity, which can lead to suboptimal outcomes. The present
study was conducted to assess the single-dose pharmacokinetics and safety
of erenumab in healthy Chinese subjects. Method(s): This was an
open-label, randomized, parallel group, non-confirmatory, single-dose
study in healthy Chinese subjects. A total of 24 healthy Chinese subjects
of both sexes aged between 14 and 45 years were administered a single
subcutaneous injection of erenumab 70 mg or 140 mg. The serum
concentration of erenumab was quantified using a validated enzyme-linked
immunosorbent assay method and pharmacokinetic parameters were determined
using non-compartmental models. Safety was also assessed. Result(s):
A total of 55 subjects were screened for eligibility and 25 subjects were
randomized to receive study treatments (12 subjects to the 70-mg erenumab
group and 13 subjects to the 140-mg erenumab group). Erenumab was absorbed
slowly with maximum serum concentration (C<inf>max</inf>) occurring 3-11
days after administration. The mean C<inf>max</inf> and area under the
serum concentration versus time curve from time 0 to infinity with
extrapolation of the terminal phase (AUC<inf>0-</inf>) were 9.20 microg/mL
and 296 day.microg/mL for the 70 mg dose group, and 15.6 microg/mL and 569
day.microg/mL for the 140 mg dose group, respectively. Serum
concentrations of erenumab exhibited low to high variability, with
variable coefficients ranging from 17.1 to 72.2% for the 70-mg dose and
32.5 to 88.5% for the 140-mg dose. All adverse events were mild or
moderate in intensity, and all resolved without intervention.
 Conclusion(s): Erenumab was safe and well tolerated after a single
subcutaneous injection in healthy Chinese subjects. The systemic exposure
in Chinese subjects in terms of AUC<inf>0-</inf> was 70% higher than that
in White subjects as previously reported. Chinese Clinical Trial Registry
no.: ChiCTR2000032435. Copyright © 2022, The Author(s), under
exclusive licence to Springer Nature Switzerland AG.

<70>
Accession Number
2028540428
Title
Dexmedetomidine improves pulmonary outcomes in thoracic surgery under
one-lung ventilation: A meta-analysis.
Source
Journal of Clinical Anesthesia. 93 (no pagination), 2024. Article Number:
111345. Date of Publication: May 2024.
Author
Zorrilla-Vaca A.; Grant M.C.; Law M.; Messinger C.J.; Pelosi P.; Varelmann
D.
Institution
(Zorrilla-Vaca, Messinger, Varelmann) Department of Anesthesiology, Pain
and Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical
School, Boston, MA, United States
(Zorrilla-Vaca) Department of Anesthesiology, Universidad del Valle, Cali,
Colombia
(Grant) Department of Anesthesiology and Critical Care Medicine, The Johns
Hopkins Hospital, Baltimore, MD, United States
(Law) Medical Research Council Biostatistics Unit, University of
Cambridge, Cambridge, United Kingdom
(Pelosi) Anesthesiology and Critical Care, San Martino Policlinico
Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
(Pelosi) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
Publisher
Elsevier Inc.
Abstract
Introduction: Dexmedetomidine improves intrapulmonary shunt in thoracic
surgery and minimizes inflammatory response during one-lung ventilation
(OLV). However, it is unclear whether such benefits translate into less
postoperative pulmonary complications (PPCs). Our objective was to
determine the impact of dexmedetomidine on the incidence of PPCs after
thoracic surgery. Method(s): Major databases were used to identify
randomized trials that compared dexmedetomidine versus placebo during
thoracic surgery in terms of PPCs. Our primary outcome was atelectasis
within 7 days after surgery. Other specific PPCs included hypoxemia,
pneumonia, and acute respiratory distress syndrome (ARDS). Secondary
outcome included intraoperative respiratory mechanics (respiratory
compliance [Cdyn]) and postoperative lung function (forced expiratory
volume [FEV1]). Random effects models were used to estimate odds ratios
(OR). Result(s): Twelve randomized trials, including 365 patients in
the dexmedetomidine group and 359 in the placebo group, were analyzed in
this meta-analysis. Patients in the dexmedetomidine group were less likely
to develop postoperative atelectasis (2.3% vs 6.8%, OR 0.42, 95%CI
0.18-0.95, P = 0.04; low certainty) and hypoxemia (3.4% vs 11.7%, OR 0.26,
95%CI 0.10-0.68, P = 0.01; moderate certainty) compared to the placebo
group. The incidence of postoperative pneumonia (3.2% vs 5.8%, OR 0.57,
95%CI 0.25-1.26, P = 0.17; moderate certainty) or ARDS (0.9% vs 3.5%, OR
0.39, 95%CI 0.07-2.08, P = 0.27; moderate certainty) was comparable
between groups. Both intraoperative Cdyn and postoperative FEV1 were
higher among patients that received dexmedetomidine with a mean difference
of 4.42 mL/cmH<inf>2</inf>O (95%CI 3.13-5.72) and 0.27 L (95%CI
0.12-0.41), respectively. Conclusion(s): Dexmedetomidine
administration during thoracic surgery may potentially reduce the risk of
postoperative atelectasis and hypoxemia. However, current evidence is
insufficient to demonstrate an effect on pneumonia or ARDS. Copyright
© 2023 Elsevier Inc.

<71>
Accession Number
2027292072
Title
Echocardiography assessment of right ventricular-pulmonary artery
coupling: Validation of surrogates and clinical utilities.
Source
International Journal of Cardiology. 394 (no pagination), 2024. Article
Number: 131358. Date of Publication: 01 Jan 2024.
Author
Li Q.; Zhang M.
Institution
(Li, Zhang) National Key Laboratory for Innovation and Transformation of
Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and
Function Research, Chinese Ministry of Education, Chinese National Health
Commission and Chinese Academy of Medical Sciences, Department of
Cardiology, Qilu Hospital of Shandong University, Jinan, China
Publisher
Elsevier Ireland Ltd
Abstract
Right ventricular-pulmonary artery (RV-PA) coupling indicates efficiency
of energy transfer from the right ventricle to the pulmonary circulation.
The gold standard measurement, end-systolic elastance/arterial elastance
ratio (Ees/Ea), is derived from invasive pressure-volume loop, which is
technically demanding, expensive and limited in clinical practice. Recent
studies have proposed various non-invasive surrogates of Ees/Ea based on
echocardiography assessment, of which TAPSE/PASP ratio is an
easily-obtained and validated parameter in severe pulmonary hypertension
and rapidly applicated in the diagnosis and risk evaluation of various
diseases and cardiac intervention. In this review, we summarized
principles and validations of echocardiographic surrogates, and their
clinical utilities and also limitations. The goal is to systematically
review the research advances of echocardiography assessment of RV-PA
coupling and help to guide clinical practice. Copyright © 2023

<72>
Accession Number
2026904283
Title
Prevention of new-onset atrial fibrillation in elderly patients undergoing
anatomic pulmonary resection by infusion of magnesium sulfate: protocol
for a randomized controlled trial.
Source
Frontiers in Cardiovascular Medicine. 10 (no pagination), 2023. Article
Number: 1171713. Date of Publication: 2023.
Author
Jin S.; An L.; Chen L.; Liu H.; Chen H.; Lv X.
Institution
(Jin, An, Chen, Liu, Lv) Department of Anesthesiology, Shanghai Pulmonary
Hospital, School of Medicine, Tongji University, Shanghai, China
(An) Department of Anesthesiology, Kashgar Regional Second People's
Hospital, Xinjiang, China
(Chen) Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
Publisher
Frontiers Media SA
Abstract
Atrial fibrillation (AF) is the most commonly sustained arrhythmia after
pulmonary resection, which has been shown to predict higher hospital
morbidity and mortality. The lack of strong evidence-based medical
evidence makes doctors have very few options for medications to prevent
new-onset AF following thoracic surgery. Magnesium can prevent
perioperative AF in patients undergoing cardiac surgery. However, this has
not yet been fully studied in patients undergoing non-cardiac thoracic
surgery, which is the aim of this study. This is a single-center,
prospective, double-blind, randomized controlled trial. In total, 838
eligible patients were randomly assigned to one of two study groups,
namely, the control group or the magnesium group. The patients in the
magnesium group preoperatively received 80 mg magnesium sulfate/kg ideal
weight in 100 ml normal saline 30 min. The control group received the same
volumes of normal saline simultaneously. The primary outcome is the
incidence of new-onset AF intra-operative and on the first, second, and
third postoperative days. The secondary outcomes are bradycardia,
hypertension, hypotension, and flushing. The occurrence of stroke or any
other type of arrhythmia is also recorded. Postoperative respiratory
suppression and gastrointestinal discomfort, intensive care unit stays and
total duration of hospital stays, in-hospital mortality, and 3-month
all-cause mortality are also recorded as important outcomes. This study
aims to prospectively evaluate the prophylactic effects of magnesium
sulfate against AF compared with a placebo control group during and
following anatomic pulmonary resection. The results may provide reliable
evidence for the prophylactic value of magnesium against AF in patients
with lung cancer. The trial was approved by the Clinical Research Ethics
Committee of Shanghai Pulmonary Hospital and has been registered at
Chinese Clinical Trial Registry: www.chictr.org.cn, identifier:
ChiCTR2300068046. Copyright 2023 Jin, An, Chen, Liu, Chen and Lv.

<73>
Accession Number
2026760737
Title
Rationale and design of a randomized clinical trial evaluating the
efficacy of mechanical neuroprotection in reducing the risk of silent
brain infarcts associated with percutaneous left atrial appendage closure:
study protocol for a LAAC-SBI trial.
Source
Trials. 24(1) (no pagination), 2023. Article Number: 749. Date of
Publication: December 2023.
Author
Streb W.; Lasek-Bal A.; Mitrega K.; Kowalczyk J.; Podolecki T.; Kowalska
W.; Olma A.; Sobczyk A.; Kalarus Z.
Institution
(Streb, Kowalczyk, Podolecki, Kowalska, Sobczyk, Kalarus) Department of
Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of
Medical Sciences in Zabrze, Medical University of Silesia, Katowice,
Poland
(Streb, Mitrega, Kowalczyk, Podolecki, Kowalska, Olma, Sobczyk, Kalarus)
Silesian Centre for Heart Diseases in Zabrze, Curie-Sklodowskiej 9, Zabrze
41-800, Poland
(Lasek-Bal) Department of Neurology, Faculty of Health Sciences in
Katowice, Medical University of Silesia, Katowice, Poland
Publisher
BioMed Central Ltd
Abstract
Background: Left atrial appendage closure (LAAC) procedures prevent
cardioembolic stroke in patients with atrial fibrillation who have
contraindications to oral anticoagulant medications. However, these
procedures carry certain risks of peri-procedural complications. One such
complication is silent brain infarcts (SBI), which can lead to cognitive
impairment and mood disturbances. The implementation of mechanical
neuroprotection systems during LAAC procedures may reduce the risk of SBI
and associated cognitive and mood disorders. Method(s): The LAAC-SBI
trial is a prospective, multicenter, randomized, and double-blind
interventional study. The study aims to enroll a total of 240 patients,
with 120 patients allocated to each group. The study group will evaluate
the use of the Sentinel CPS during LAAC, while the control group will
undergo LAAC procedures without the Sentinel CPS. The primary endpoint of
the study is the number of new SBIs or stroke foci detected by
diffusion-weighted magnetic resonance imaging (DW MRI). Secondary
endpoints include deterioration of cognitive function, development of
dementia syndrome, and occurrence of depressive disorders. These endpoints
will be assessed using questionnaire tools such as the Montreal Cognitive
Assessment (MoCA), Trail Making Test (TMT), Controlled Oral Word
Association Test (COWAT), and Hospital Anxiety and Depression Scale
(HADS). The observational period for patients in the study is 2 years.
 Discussion(s): If the study demonstrates a favorable outcome with
reduced incidence of SBI and improved cognitive and mood outcomes in
patients receiving cerebral protection devices during LAAC, it will have
significant implications for clinical management standards. This would
support the use of neuroprotection devices not only for LAAC but also in
procedures such as atrial fibrillation ablation or transcatheter mitral
valve interventions, where the risk of embolic events and subsequent brain
injury may also be present. Trial registration: ClinicalTrials.gov
NCT05369195. Registration on 11.05.2022. Copyright © 2023, The
Author(s).

<74>
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.

<75>
Accession Number
2028808293
Title
Peripheral Regional Anesthetic Techniques in Cardiac Surgery: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2023.
Date of Publication: 2023.
Author
Schmedt J.; Oostvogels L.; Meyer-Friessem C.H.; Weibel S.; Schnabel A.
Institution
(Schmedt, Oostvogels, Schnabel) Department of Anesthesiology, Intensive
Care and Pain Medicine, University Hospital of Muenster,
Albert-Schweitzer-Campus 1, Muenster, Germany
(Meyer-Friesem) Department of Anesthesiology, Intensive Care Medicine and
Pain Medicine, BG-Universitatsklinikum Bergmannsheil gGmbH, Medical
Faculty of Ruhr University Bochum, Burkle-de-la-Camp-Platz 1, Bochum,
Germany
(Weibel) Department of Anesthesiology, Intensive Care, Emergency and Pain
Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
Publisher
W.B. Saunders
Abstract
Objective: The aim of this systematic review was to investigate
postoperative pain outcomes and adverse events after peripheral regional
anesthesia (PRA) compared to no regional anesthesia (RA), placebo, or
neuraxial anesthesia in children and adults undergoing cardiac surgery.
 Design(s): A systematic review and meta-analysis with an assessment
of the risk of bias (Cochrane RoB 1) and certainty of evidence (Grading of
Recommendations, Assessment, Development, and Evaluation).
 Setting(s): Randomized controlled trials (RCTs). Participant(s):
Adults and children undergoing heart surgery. Intervention(s): Any
kind of PRA compared to no RA or placebo or neuraxial anesthesia.
 Measurements and Main Results: In total, 33 RCTs (2,044 patients)
were included-24 of these had a high risk of bias, and 28 were performed
in adults. Compared to no RA, PRA may reduce pain intensity at rest 24
hours after surgery (mean difference [MD] -0.81 points, 95% CI -1.51 to
-0.10; I2 = 92%; very low certainty evidence). Peripheral
regional anesthesia, compared to placebo, may reduce pain intensity at
rest (MD -1.36 points, 95% CI -1.59 to -1.13; I2 = 54%; very
low certainty evidence) and during movement (MD -1.00 points, 95% CI -1.34
to -0.67; I2 = 72%; very low certainty evidence) 24 hours after surgery.
No data after pediatric cardiac surgery could be meta-analyzed due to the
low number of included trials. Conclusion(s): Compared to no RA or
placebo, PRA may reduce pain intensity at rest and during movement.
However, these results should be interpreted cautiously because the
certainty of evidence is only very low. Copyright © 2023 Elsevier
Inc.

<76>
Accession Number
2028793628
Title
Neurocognition in adults with congenital heart disease post-cardiac
surgery: A systematic review.
Source
Heart and Lung. 64 (pp 62-73), 2024. Date of Publication: 01 Mar 2024.
Author
Cabrera-Mino C.; DeVon H.A.; Aboulhosn J.; Brecht M.-L.; Choi K.R.; Pike
N.A.
Institution
(Cabrera-Mino) University of California Los Angeles, United States
(DeVon) Professor and Associate Dean for Research, University of
California Los Angeles, United States
(Aboulhosn, Pike) Professor University of California Los Angeles, United
States
(Brecht) Adjunct Professor University of California Los Angeles, United
States
(Choi) Assistant Professor University of California Los Angeles, United
States
Publisher
Elsevier Inc.
Abstract
Background: Congenital heart disease (CHD) is the most common birth defect
worldwide. Neurocognitive deficits and psychiatric disorders, which can
impact daily life, have been reported in over 50% of adolescents and young
adults with moderate to complex CHD. Objective(s): Conduct a
systematic review of sex, clinical, psychological and social determinants
of health (SDoH) factors affecting neurocognition in adults with CHD
post-cardiac surgery. Method(s): PubMed, Cumulated Index to Nursing
and Allied Health Literature, and Embase were searched for relevant
studies over the past 5 years. Thirteen articles met inclusion criteria
of: 1) CHD post-cardiac surgery, 2) age >= 18 years, and 3) used a
validated measure of neurocognition. Result(s): A total of 507
articles were identified. After screening, 30 articles underwent full text
review yielding 13 eligible articles. Twelve articles reported deficits in
multiple domains including executive function, intellectual functioning,
visuospatial ability, and verbal fluency in more complex CHD. Only three
studies examined cognition based on sex, with female and lower parental
SES associated with worse cognitive outcomes. Most studies were from
Europe, predominantly sampled Caucasian participants, had heterogeneous
samples of CHD complexity, and lacked standardized cognitive measures
which limited generalizability of findings. Conclusion(s): Adults
with CHD present with a wide variety of cognitive deficits, with some
associations with sex, clinical history, and SDoH factors. It remains
unclear to what degree these factors affect cognition in adults with
moderate to complex CHD. Future longitudinal studies should focus on
age-related effects on cognition and potential health care disparities in
diverse CHD samples. Copyright © 2023

<77>
Accession Number
2028788327
Title
Mental health and transcatheter aortic valve replacement: A scoping
systematic review.
Source
General Hospital Psychiatry. 86 (pp 10-23), 2024. Date of Publication: 01
Jan 2024.
Author
Suen W.-L.; Bhasin S.; Betti V.; Bruckel J.T.; Oldham M.A.
Institution
(Suen, Oldham) Department of Psychiatry, University of Rochester Medical
Center, United States
(Bhasin, Betti) School of Medicine & Dentistry, University of Rochester
Medical Center, United States
(Bruckel) Department of Medicine, University of Rochester Medical Center,
United States
Publisher
Elsevier Inc.
Abstract
Objective: To systematically review the literature on mental health
symptoms before and after transcatheter aortic valve replacement (TAVR)
and describe reported clinical associations with these symptoms.
 Method(s): Using the Preferred Reporting Items for Systematic reviews
and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines,
we reviewed studies involving pre- or post-TAVR mental health assessments
or psychiatric diagnoses. Result(s): Eighteen studies were included.
Before TAVR, clinically significant depression and anxiety prevalence is
15-30% and 25-30%, respectively, with only a third of these meeting
diagnostic thresholds. These symptoms generally improve over the year
post-TAVR. Depression is associated with functional impairment,
multimorbidity, and lower physical activity; few associations have been
described in relation to anxiety. Inconsistent evidence finds depression
associated with post-TAVR mortality. One notable study found persistent
depression independently predictive of 12-month mortality, and another
found depression and cognition to have additive value in predicting
mortality risk. Conclusion(s): Mental health symptoms occur in a
significant proportion of the TAVR population. Although symptoms tend to
improve, the associations with depression, particularly persistent
depression, call for further investigation to examine their associated
outcomes. Research is also needed to understand the relationships between
mental health conditions and cognition in TAVR-related
outcomes. Copyright © 2023 Elsevier Inc.

<78>
Accession Number
2023311175
Title
Exploring the link between poor oral hygiene and mesh infection after
hernia repair: a systematic review and proposed best practices.
Source
Hernia. 27(6) (pp 1387-1395), 2023. Date of Publication: December 2023.
Author
East B.; Podda M.; Beznoskova-Seydlova M.; de Beaux A.C.
Institution
(East) 3rd Department of Surgery of 1st Faculty of Medicine at Charles
University, Motol University Hospital, Prague, Czechia
(Podda) Department of Surgical Science, Emergency Surgery Unit, University
of Cagliari, Cagliari, Italy
(Beznoskova-Seydlova) Private dentist, Prague, Czechia
(de Beaux) Spire Murrayfield Hospital, Edinburgh and The University of
Edinburgh, Edinburgh, United Kingdom
Publisher
Springer-Verlag Italia s.r.l.
Abstract
Background: There is a reasonable body of evidence around oral/dental
health and implant infection in orthopaedic and cardiovascular surgery.
Another large area of surgical practice associated with a permanent
implant is mesh hernia repair. This study aimed to review the evidence
around oral/dental health and mesh infection. Method(s): The research
protocol was registered in PROSPERO (CRD42022334530). A systematic review
of the literature was undertaken according to the PRISMA 2020 statement.
The initial search identified 582 publications. A further four papers were
identified from references. After a review by title and abstract, 40
papers were read in full text. Fourteen publications were included in the
final review, and a total of 47,486 patients were included.
 Result(s): There is no published evidence investigating the state of
oral hygiene/health and the risk of mesh infection or other infections in
hernia surgery. Improvement in oral hygiene/health can reduce surgical
site infection and implant infection in colorectal, gastric, liver,
orthopaedic and cardiovascular surgery. Poor oral hygiene/health is
associated with a large increase in oral bacteria and bacteraemia in
everyday activities such as when chewing or brushing teeth. Antibiotic
prophylaxis does not appear to be necessary before invasive dental care in
patients with an implant. Conclusion(s): Good oral hygiene and oral
health is a strong public health message. The effect of poor oral hygiene
on mesh infection and other complications of mesh hernia repair is
unknown. While research is clearly needed in this area, extrapolating from
evidence in other areas of surgery where implants are used, good oral
hygiene/health should be encouraged amongst hernia patients both prior to
and after their surgery. Copyright © 2023, The Author(s).

<79>
Accession Number
642903220
Title
Several key issues must be noted in determining postoperative analgesic
efficacy of intercostal nerve block for thoracoscopic surgery.
Source
Journal of cardiothoracic surgery. 18(1) (pp 350), 2023. Date of
Publication: 01 Dec 2023.
Author
Li X.-T.; Yang W.-H.; Xue F.-S.
Institution
(Li, Yang, Xue) Department of Anesthesiology, Beijing Friendship Hospital,
Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District,
Beijing 100050, China
Abstract
The letter to the editor was written in response to "The effect of
ultrasound-guided intercostal nerve block on postoperative analgesia in
thoracoscopic surgery: a randomized, double-blinded, clinical trial",
which was recently published by Li et al. (J Cardiothorac Surg 18(1):128,
2023). In this article, Li et al. showed that addition of a preoperative
intercostal nerve block to the multimodal analgesic strategy significantly
reduced the pain scores within 48 h after surgery. However, we noted
several issues in this study that were not well addressed. They were no
use of a standard opioid-sparing multimodal analgesic strategy recommended
in the current Enhanced Recovery After Surgery protocols for thoracic
surgery, the lack of clear description for reasonable selection of rescue
analgesics, the interpretion of between-group differences in the
postoperative pain scores based on only statistical differences rather
than clinically meaningful differences, inclusion of patients who were not
blinded to study intervention, not reporting cumulative opioid consumption
and complications of intercostal nerve block. We believe that
clarification of these issues is not only useful for improving design
quality of randomized clinical trials which assess postoperative analgesic
efficacy of nerve blocks, but also is helpful for the readers who want to
use an opioid-sparing multimodal protocol including a nerve block in
patients undergoing thoracoscopic surgery. Copyright © 2023. The
Author(s).

<80>
[Use Link to view the full text]
Accession Number
2028847292
Title
Antiplatelet Agent Use after Stroke due to Intracerebral Hemorrhage.
Source
Stroke. 54(12) (pp 3173-3181), 2023. Date of Publication: 01 Dec 2023.
Author
Al-Shahi Salman R.; Greenberg S.M.
Institution
(Al-Shahi Salman) The University of Edinburgh, Royal Infirmary of
Edinburgh, United Kingdom
(Greenberg) Massachusetts General Hospital, Harvard Medical School,
Boston, United States
Publisher
Wolters Kluwer Health
Abstract
This focused update about antiplatelet agents to reduce the high risk of
major adverse cardiovascular events after stroke due to spontaneous
(nontraumatic) intracerebral hemorrhage (ICH) complements earlier updates
about blood pressure-lowering, lipid-lowering, and oral anticoagulation or
left atrial appendage occlusion for atrial fibrillation after ICH. When
used for secondary prevention in people without ICH, antiplatelet agents
reduce the risk of major adverse cardiovascular event (rate ratio, 0.81
[95% CI, 0.75-0.87]) and might increase the risk of ICH (rate ratio, 1.67
[95% CI, 0.97-2.90]). Before 2019, guidance for clinical decisions about
antiplatelet agent use after ICH has focused on estimating patients'
predicted absolute risks and severities of ischemic and hemorrhagic major
adverse cardiovascular event and applying the known effects of these drugs
in people without ICH to estimate whether individual ICH survivors in
clinical practice might be helped or harmed by antiplatelet agents. In
2019, the main results of the RESTART (Restart or Stop Antithrombotics
Randomized Trial) randomized controlled trial including 537 survivors of
ICH associated with antithrombotic drug use showed, counterintuitively,
that antiplatelet agents might not increase the risk of recurrent ICH
compared to antiplatelet agent avoidance over 2 years of follow-up (12/268
[4%] versus 23/268 [9%]; adjusted hazard ratio, 0.51 [95% CI, 0.25-1.03];
P=0.060). Guidelines in the United States, Canada, China, and the United
Kingdom and Ireland have classified the level of evidence as B and
indicated that antiplatelet agents may be considered/reasonable after ICH
associated with antithrombotic agent use. Three subsequent clinical trials
have recruited another 174 participants with ICH, but they will not be
sufficient to determine the effects of antiplatelet therapy on all major
adverse cardiovascular events reliably when pooled with RESTART.
Therefore, ASPIRING (Antiplatelet Secondary Prevention International
Randomized Study After Intracerebral Hemorrhage) aims to recruit 4148 ICH
survivors to determine the effects of antiplatelet agents after ICH
definitively overall and in subgroups. Copyright © 2023
Lippincott Williams and Wilkins. All rights reserved.

<81>
Accession Number
2028851647
Title
Efficacy and safety of bempedoic acid among patients with and without
diabetes: prespecified analysis of the CLEAR Outcomes randomised trial.
Source
The Lancet Diabetes and Endocrinology. (no pagination), 2023. Date of
Publication: 2023.
Author
Ray K.K.; Nicholls S.J.; Li N.; Louie M.J.; Brennan D.; Lincoff A.M.;
Nissen S.E.
Institution
(Ray) Imperial Centre for Cardiovascular Disease Prevention, Department of
Primary Care and Public Health, Imperial College London, London, United
Kingdom
(Nicholls) Victorian Heart Institute, Monash University, Melbourne, VIC,
Australia
(Li, Louie) Esperion Therapeutics, Ann Arbor, MI, United States
(Brennan, Lincoff, Nissen) Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Ltd
Abstract
Background: Statins reduce LDL cholesterol and cardiovascular events among
those with or without diabetes but have been reported to increase
new-onset diabetes. The CLEAR Outcomes trial demonstrated that bempedoic
acid reduced the risk of major adverse cardiovascular events among
statin-intolerant patients at high cardiovascular risk. In this
prespecified analysis, our dual aims were to evaluate the cardiovascular
benefits of bempedoic acid, an ATP-citrate lyase inhibitor, in individuals
with diabetes, and to evaluate the risk of new-onset diabetes and
HbA<inf>1c</inf> among those without diabetes in the CLEAR Outcomes trial.
 Method(s): CLEAR Outcomes was a randomised, double-blind,
placebo-controlled trial conducted across 1250 primary care and outpatient
sites in 32 countries. Patients with or without cardiovascular disease who
were unwilling or unable to take guideline-recommended doses of statins
and an LDL cholesterol of 2.59 mmol/L or more were randomly assigned (1:1)
in a double-blinded manner to either bempedoic acid 180 mg once per day or
placebo. In this prespecified analysis, the efficacy endpoint was a
time-to-event analysis of four-component major adverse cardiovascular
event (MACE-4), which is the composite of cardiovascular death, nonfatal
myocardial infarction, nonfatal stroke, or coronary revascularisation,
using the intention-to-treat population stratified by baseline glycaemia
status. The prespecified analysis of risk of new-onset diabetes and
HbA<inf>1c</inf> increase was evaluated in patients without diabetes at
baseline. The CLEAR Outcomes trial was completed on Nov 7, 2022, and is
registered with ClinicalTrials.gov (NCT02993406). Finding(s): Between
Dec 22, 2016, and Nov 7, 2022, 13 970 patients were screened and randomly
assigned; 6373 (45.6%) with diabetes, 5796 (41.5%) with prediabetes, and
1801 (12.9%) with normoglycaemia. Over a median of 3.4 years follow up,
patients with diabetes had significant relative and absolute
cardiovascular risk reductions in MACE-4 endpoints with bempedoic acid (HR
0.83; 95% CI 0.72-0.95; absolute risk reduction of 2.4%) compared to
placebo, with no statistical evidence of effect modification across
glycaemic strata (interaction p=0.42). The proportion of patients who
developed new-onset diabetes were similar between the bempedoic acid and
placebo groups, with 429 of 3848 (11.1%) with bempedoic acid versus 433 of
3749 (11.5%) with placebo (HR 0.95; 95% CI 0.83-1.09). HbA<inf>1c</inf>
concentrations at month 12 and the end of the study were similar between
randomised groups in patients who had prediabetes and normoglycaemia.
Placebo-corrected LDL cholesterol concentrations and high-sensitivity
C-reactive protein at 6 months were reduced in each glycaemic stratum
(diabetes, prediabtes, and normoglycaemia) for patients randomly assigned
to bempedoic acid (all p<0.001). Interpretation(s): Among patients
with diabetes, bempedoic acid reduces LDL cholesterol and high-sensitivity
C-reactive protein and risk of cardiovascular events. Patients without
diabetes had no increase in new-onset diabetes or worsening
HbA<inf>1c</inf> with bempedoic acid. The efficacy and cardiometabolic
safety profile of bempedoic acid makes it a clinical option for those with
and without diabetes. Funding(s): Esperion
Therapeutics. Copyright © 2023 The Author(s). Published by
Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0
license

<82>
Accession Number
642920256
Title
The prognostic impact of diastolic dysfunction after transcatheter aortic
valve replacement: A systematic review and meta-analysis.
Source
Current problems in cardiology. (pp 102228), 2023. Date of Publication:
01 Dec 2023.
Author
Stalikas N.; Anastasiou V.; Botis I.; Daios S.; Karagiannidis E.; Zegkos
T.; Karamitsos T.; Vassilikos V.; Ziakas A.; Kamperidis V.; Giannakoulas
G.; Giannopoulos G.
Institution
(Stalikas) AHEPA Hospital, Medical School, Aristotle University,
Thessaloniki, Greece
(Anastasiou, Botis, Daios, Zegkos, Karamitsos, Ziakas, Kamperidis,
Giannakoulas) AHEPA Hospital, Medical School, Aristotle University,
Thessaloniki, Greece
(Karagiannidis, Vassilikos, Giannopoulos) Ippokratio General Hospital,
Medical school, Aristotle University, Thessaloniki, Greece
Abstract
BACKGROUND: Diastolic dysfunction (DD) is a long-established marker of
disease progression in patients with aortic valve stenosis (AS),
indicating valvular myocardial damage. Recently, substantial observational
data have emerged demonstrating that worse pre-operative DD assessed using
echocardiography is associated with adverse long-term clinical outcomes
after transcatheter aortic valve replacement (TAVR). AIM: To
systematically appraise and quantitatively synthesize current evidence on
the prognostic impact of echocardiographic severe DD derived by
echocardiography before TAVR. METHOD(S): A systemic literature review
was undertaken in electronic databases to identify studies reporting the
predictive value of severe DD in AS subjects undergoing TAVR. A
random-effects meta-analysis was conducted to quantify the adjusted and
unadjusted hazard ratios (HRs) for all-cause mortality and major adverse
cardiovascular events (MACEs) for the presence of severe DD.
 RESULT(S): Ten studies were deemed eligible for inclusion. Of those,
9 provided appropriate quantitative data for the meta-analysis,
encompassing a total of 4,619 patients. The presence of severe DD was
associated with increased risk for all-cause mortality (pooled unadjusted
HR=2.56 [1.46-4.48]; p<0.01; I2=76%) and MACEs (pooled unadjusted HR=1.82
[1.29-2.58]; p<0.01; I2=86%). When adjusted for clinically-relevant
parameters, the presence of severe DD retained independent association
with all-cause mortality (pooled adjusted HR=2.35 [1.26-4.37]; p<0.01;
I2=79%) and MACEs (pooled adjusted HR= 2.52 [1.72-3.65]; p<0.01; I2=0%).
In subgroup analysis there was no difference on post-TAVR risk between the
use of different diastolic function grading scores. CONCLUSION(S):
Presence of severe DD assessed by echocardiography pre-TAVR is a major
determinant of long-term adverse outcomes after the
procedure. Copyright © 2023. Published by Elsevier Inc.

<83>
Accession Number
642920057
Title
Efficacy and Outcomes of Bempedoic Acid Versus Placebo in Patients with
Statin-Intolerance: A Pilot Systematic Review and Meta-analysis of
Randomized Controlled Trials.
Source
Current problems in cardiology. (pp 102236), 2023. Date of Publication:
01 Dec 2023.
Author
Goyal A.; Changez M.I.K.; Tariq M.D.; Mushtaq F.; Shamim U.; Sohail A.H.;
Mahalwar G.
Institution
(Goyal) Department of Internal Medicine, Seth GS Medical College and KEM
Hospital, Mumbai, India
(Changez) Department of Surgery, Quetta Institute of Medical Sciences,
Quetta, Pakistan
(Tariq) Department of Internal Medicine, Foundation University Medical
College, Islamabad, Pakistan
(Mushtaq) Department of Internal Medicine, Allama Iqbal Medical College,
Lahore, Pakistan
(Shamim) Department of Internal Medicine Aga Khan University Hospital,
Karachi, Pakistan
(Sohail) Department of Surgery, University of New Mexico Health Sciences,
Albuquerque, NM, United States
(Mahalwar) Department of Internal Medicine, Cleveland Clinic Foundation,
Cleveland, OH, United States
Abstract
INTRODUCTION: Bempedoic acid (BA) has shown significant progress in
reducing cholesterol levels and is relatively free from the many side
effects encountered with the use of other hyperlipidemic drugs such as
statins. However, its efficacy in patients with statin intolerance is
controversial with inconsistent results among studies. MATERIALS AND
METHODS: An electronic literature search was performed using various
databases such as Medline, Google Scholar, and the International Registry
of Clinical Trials. The primary endpoint was the change in LDL-C levels.
The secondary endpoints included changes in HDL-C, non-HDL-C,
triglycerides (TG), clinical outcomes such as MACE, all-cause mortality
(ACM), cardiovascular mortality, myocardial infarction (MI), and
additional safety outcomes. The least-square mean (LSM) percent change for
assessing changes in lipid parameter levels from the baseline and the risk
ratio (RR) were used for the evaluation of binary endpoints, with
statistical significance set at p<0.05. Random-effects meta-analyses were
performed for all the outcomes. RESULT(S): Our analysis included 5
randomized controlled trials (RCTs) with a total of 18,848 participants.
BA showed a significant reduction in LDL-C [LSM difference in %: -25.24;
95% CI: -30.79 to -19.69; p<0.00001], total cholesterol [LSM difference
in%:-21.28; 95% CI:-30.58 to-11.98; p < 0.00001], non-HDL-C [LSM
difference in %: -23.27; 95% Cl: -29.80 to -16.73 p<0.00001], and HDL-C
[LSM difference in%:-3.37, 95% CI:-3.73 to-3.01, p < 0.00001] compared to
placebo. In terms of clinical efficacy, BA was associated with a lower
risk of coronary revascularization [RR:0.81; 95% CI:0.66 to 0.99; p=
0.04], hospitalization for unstable angina [RR:0.67; 95% CI:0.50 to 0.88;
p= 0.005], and myocardial infarction [RR:0.76; 95% CI:0.66 to 0.88; p=
0.0004]. No significant difference was observed in MACE [RR:0.81; p=
0.15], ACM [RR:0.86; p= 0.46], cardiovascular-related mortality [RR:0.79;
p= 0.44], and stroke [RR:0.83; p= 0.08] between the two groups. In terms
of safety efficacy, the risk for myalgia was significantly lower in
BA-treated patients than in placebo [RR:0.80; p= 0.0002], while the risk
for gout [RR:1.46; p<0.0001] and hyperuricemia [RR:1.93; p<0.00001] was
higher for BA than for placebo. The risks for other adverse effects, such
as neurocognitive disorder, nasopharyngitis urinary tract infection, upper
respiratory infection, muscular disorder, and worsening hyperglycemia/DM
were comparable between the two groups. CONCLUSION(S): Our analysis
demonstrated that BA significantly reduced the levels of LDL-C, total
cholesterol, non-HDL-C, HDL-C, ApoB, and hs-CRP compared with the placebo
group. Additionally, patients who received BA had a lower likelihood of
coronary revascularization and hospitalization due to unstable angina, MI,
and myalgia. Further large-scale RCTs are required to generate more robust
evidence. Copyright © 2023. Published by Elsevier Inc.

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