EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 87

Results Generated From:
Embase <1980 to 2024 Week 17>
Embase Weekly Updates (updates since 2024-04-19)

<1>
Accession Number
2031645345
Title
Extracorporeal vs. conventional CPR for out-of-hospital cardiac arrest: A
systematic review and meta-analysis.
Source
American Journal of Emergency Medicine. 80 (pp 185-193), 2024. Date of
Publication: June 2024.
Author
Wang J.-Y.; Chen Y.; Dong R.; Li S.; Peng J.-M.; Hu X.-Y.; Jiang W.; Wang
C.-Y.; Weng L.; Du B.
Institution
(Wang, Chen, Dong, Li, Peng, Hu, Jiang, Wang, Weng, Du) Medical Intensive
Care Unit, State Key Laboratory of Complex Severe and Rare Diseases,
Peking Union Medical College Hospital, Peking Union Medical College &
Chinese Academy of Medical Sciences, Beijing, China
Publisher
W.B. Saunders
Abstract
Background: Out-of-hospital cardiac arrest (OHCA) remains a significant
cause of mortality and morbidity worldwide. Extracorporeal cardiopulmonary
resuscitation (ECPR) is a potential intervention for OHCA, but its
effectiveness compared to conventional cardiopulmonary resuscitation
(CCPR) needs further evaluation. <br/>Method(s): We systematically
searched PubMed, Embase, the Cochrane Library, Web of Science, and
ClinicalTrials.gov for relevant studies from January 2010 to March 2023.
Pooled meta-analysis was performed to investigate any potential
association between ECPR and improved survival and neurological outcomes.
<br/>Result(s): This systematic review and meta-analysis included two
randomized controlled trials enrolling 162 participants and 10
observational cohort studies enrolling 4507 participants. The pooled
meta-analysis demonstrated that compared to CCRP, ECPR did not improve
survival and neurological outcomes at 180 days following OHCA (RR: 3.39,
95% CI: 0.79 to 14.64; RR: 2.35, 95% CI: 0.97 to 5.67). While a beneficial
effect of ECPR was obtained regarding 30-day survival and neurological
outcomes. Furthermore, ECPR was associated with a higher risk of bleeding
complications. Subgroup analysis showed that ECPR was prominently
beneficial when exclusively initiated in the emergency department.
Additional post-resuscitation treatments did not significantly impact the
efficacy of ECPR on 180-day survival with favorable neurological outcomes.
<br/>Conclusion(s): There is no high-quality evidence supporting the
superiority of ECPR over CCPR in terms of survival and neurological
outcomes in OHCA patients. However, due to the potential for bias,
heterogeneity among studies, and inconsistency in practice, the
non-significant results do not preclude the potential benefits of ECPR.
Further high-quality research is warranted to optimize ECPR practice and
provide more generalizable evidence. Clinical trial registration PROSPERO,
https://www.crd.york.ac.uk/prospero/, registry number:
CRD42023402211.<br/>Copyright &#xa9; 2024 The Authors

<2>
Accession Number
2031474307
Title
Lipoprotein(a): An Equal Opportunity Risk Factor.
Source
Journal of the American College of Cardiology. 83(16) (pp 1526-1528),
2024. Date of Publication: 23 Apr 2024.
Author
Schwartz G.G.
Institution
(Schwartz) Rocky Mountain Regional VA Medical Center and University of
Colorado School of Medicine, Aurora, CO, United States
Publisher
Elsevier Inc.

<3>
Accession Number
2028217629
Title
Phenotyping Down syndrome: discovery and predictive modelling with
electronic medical records.
Source
Journal of Intellectual Disability Research. 68(5) (pp 491-511), 2024.
Date of Publication: May 2024.
Author
Nguyen T.Q.; Kerley C.I.; Key A.P.; Maxwell-Horn A.C.; Wells Q.S.; Neul
J.L.; Cutting L.E.; Landman B.A.
Institution
(Nguyen, Key, Neul, Cutting, Landman) Vanderbilt Brain Institute,
Vanderbilt University, Nashville, TN, United States
(Nguyen, Cutting) Peabody College of Education and Human Development,
Vanderbilt University, Nashville, TN, United States
(Kerley, Landman) School of Engineering, Vanderbilt University, Nashville,
TN, United States
(Key, Neul, Cutting, Landman) Vanderbilt Kennedy Center, Vanderbilt
University Medical Center, Nashville, TN, United States
(Key) Department of Speech and Hearing Sciences, Vanderbilt University
Medical Center, Nashville, TN, United States
(Maxwell-Horn, Neul, Cutting) Department of Pediatrics, Vanderbilt
University Medical Center, Nashville, TN, United States
(Wells) Division of Cardiovascular Medicine, Vanderbilt University Medical
Center, Nashville, TN, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Individuals with Down syndrome (DS) have a heightened risk for
various co-occurring health conditions, including congenital heart disease
(CHD). In this two-part study, electronic medical records (EMRs) were
leveraged to examine co-occurring health conditions among individuals with
DS (Study 1) and to investigate health conditions linked to surgical
intervention among DS cases with CHD (Study 2). <br/>Method(s):
De-identified EMRs were acquired from Vanderbilt University Medical Center
and facilitated creating a cohort of N = 2282 DS cases (55% females),
along with comparison groups for each study. In Study 1, DS cases were
one-by-two sex and age matched with samples of case-controls and of
individuals with other intellectual and developmental difficulties (IDDs).
The phenome-disease association study (PheDAS) strategy was employed to
reveal co-occurring health conditions in DS versus comparison groups,
which were then ranked for how often they are discussed in relation to DS
using the PubMed database and Novelty Finding Index. In Study 2, a subset
of DS individuals with CHD [N = 1098 (48%)] were identified to create
longitudinal data for N = 204 cases with surgical intervention (19%)
versus 204 case-controls. Data were included in predictive models and
assessed which model-based health conditions, when more prevalent, would
increase the likelihood of surgical intervention. <br/>Result(s): In Study
1, relative to case-controls and those with other IDDs, co-occurring
health conditions among individuals with DS were confirmed to include
heart failure, pulmonary heart disease, atrioventricular block, heart
transplant/surgery and primary pulmonary hypertension (circulatory);
hypothyroidism (endocrine/metabolic); and speech and language disorder and
Alzheimer's disease (neurological/mental). Findings also revealed more
versus less prevalent co-occurring health conditions in individuals with
DS when comparing with those with other IDDs. Findings with high Novelty
Finding Index were abnormal electrocardiogram, non-rheumatic aortic valve
disorders and heart failure (circulatory); acid-base balance disorder
(endocrine/metabolism); and abnormal blood chemistry (symptoms). In Study
2, the predictive models revealed that among individuals with DS and CHD,
presence of health conditions such as congestive heart failure
(circulatory), valvular heart disease and cardiac shunt (congenital), and
pleural effusion and pulmonary collapse (respiratory) were associated with
increased likelihood of surgical intervention. <br/>Conclusion(s):
Research efforts using EMRs and rigorous statistical methods could shed
light on the complexity in health profile among individuals with DS and
other IDDs and motivate precision-care development.<br/>Copyright &#xa9;
2024 John Wiley & Sons and MENCAP.

<4>
Accession Number
2028055114
Title
Clinical impact of cerebral protection during transcatheter aortic valve
implantation.
Source
European Journal of Clinical Investigation. 54(5) (no pagination), 2024.
Article Number: e14166. Date of Publication: May 2024.
Author
Boccuto F.; Carabetta N.; Cacia M.A.; Kanagala S.G.; Panuccio G.; Torella
D.; DeRosa S.
Institution
(Boccuto, Carabetta, Cacia, Panuccio, De Rosa) Department of Medical and
Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
(Kanagala) Department of Internal Medicine, Metropolitan Hospital Center,
New York, NY, United States
(Torella) Department of Experimental and Clinical Medicine, Magna Graecia
University, Catanzaro, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Embolization of debris can complicate transcatheter aortic
valve implantation (TAVI) causing stroke. Cerebral embolism protection
(CEP) devices can divert or trap debris. <br/>Purpose(s): To evaluate the
efficacy of CEP during TAVI vs the standard procedure. <br/>Data Sources:
PubMed, SCOPUS and DOAJ 1/01/2014-04/12/2023. Study Selection: Randomized
and observational studies comparing CEP versus standard TAVI, according to
PRISMA. <br/>Primary Outcome: stroke. <br/>Secondary Outcomes: death,
bleeding, vascular access complications, acute kidney injury and infarct
area. <br/>Data Extraction: Two investigators independently assessed study
quality and extracted data. <br/>Data Synthesis: Twenty-six articles were
included (540.247 patients). The primary endpoint was significantly lower
(RR = 0.800 95%CI:0.682-0.940; p = 0.007) with CEP. Similarly, death rates
were significantly lower with CEP (RR = 0.610 95%CI:0.482-0.771; p <
0.001). No difference was found for bleeding (RR = 1.053
95%CI:0.793-1.398; p = 0.721), vascular complications (RR = 0.937
95%CI:0.820-1.070; p = 0.334) or AKI (RR = 0.982 95%CI:0.754-1.279; p =
0.891). <br/>Conclusion(s): Use of CEP during TAVI is associated with
improved outcomes. Future studies will identify patients who benefit most
from CEP.<br/>Copyright &#xa9; 2024 The Authors. European Journal of
Clinical Investigation published by John Wiley & Sons Ltd on behalf of
Stichting European Society for Clinical Investigation Journal Foundation.

<5>
Accession Number
2031691358
Title
Coronary sinus reducer for the treatment of refractory angina
(ORBITA-COSMIC): a randomised, placebo-controlled trial.
Source
The Lancet. 403(10436) (pp 1543-1553), 2024. Date of Publication: 20 Apr
2024.
Author
Foley M.J.; Rajkumar C.A.; Ahmed-Jushuf F.; Simader F.A.; Chotai S.;
Pathimagaraj R.H.; Mohsin M.; Salih A.; Wang D.; Dixit P.; Davies J.R.;
Keeble T.R.; Cosgrove C.; Spratt J.C.; O'Kane P.D.; De Silva R.; Hill
J.M.; Nijjer S.S.; Sen S.; Petraco R.; Mikhail G.W.; Khamis R.; Kotecha
T.; Harrell F.E.; Kellman P.; Francis D.P.; Howard J.P.; Cole G.D.;
Shun-Shin M.J.; Al-Lamee R.K.
Institution
(Foley, Rajkumar, Ahmed-Jushuf, Simader, Chotai, Pathimagaraj, Mohsin,
Salih, Wang, Dixit, Francis, Howard, Cole, Shun-Shin, Al-Lamee) National
Heart and Lung Institute, Imperial College London, London, United Kingdom
(Foley, Rajkumar, Pathimagaraj, Nijjer, Sen, Petraco, Mikhail, Khamis,
Francis, Howard, Cole, Shun-Shin, Al-Lamee) Imperial College Healthcare
NHS Trust, London, United Kingdom
(Davies, Keeble) Essex Cardiothoracic Centre, Mid and South Essex NHS
Foundation Trust, Basildon, United Kingdom
(Davies, Keeble) Medical Technology Research Centre, Anglia Ruskin
University School of Medicine, Chelmsford, United Kingdom
(Cosgrove, Spratt) St George's University Hospitals NHS Foundation Trust,
London, United Kingdom
(Cosgrove, Spratt) St George's, University of London, London, United
Kingdom
(O'Kane) University Hospitals of Dorset NHS Foundation Trust, Bournemouth,
United Kingdom
(De Silva, Hill) The Royal Brompton Hospital, Guy's and St Thomas' NHS
Foundation Trust, London, United Kingdom
(Kotecha) Royal Free London NHS Foundation Trust, London, United Kingdom
(Harrell) Vanderbilt University School of Medicine, Nashville, TN, United
States
(Kellman) Department of Health and Human Services, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, MD, United
States
Publisher
Elsevier B.V.
Abstract
Background: The coronary sinus reducer (CSR) is proposed to reduce angina
in patients with stable coronary artery disease by improving myocardial
perfusion. We aimed to measure its efficacy, compared with placebo, on
myocardial ischaemia reduction and symptom improvement. <br/>Method(s):
ORBITA-COSMIC was a double-blind, randomised, placebo-controlled trial
conducted at six UK hospitals. Patients aged 18 years or older with
angina, stable coronary artery disease, ischaemia, and no further options
for treatment were eligible. All patients completed a quantitative
adenosine-stress perfusion cardiac magnetic resonance scan, symptom and
quality-of-life questionnaires, and a treadmill exercise test before
entering a 2-week symptom assessment phase, in which patients reported
their angina symptoms using a smartphone application (ORBITA-app).
Patients were randomly assigned (1:1) to receive either CSR or placebo.
Both participants and investigators were masked to study assignment. After
the CSR implantation or placebo procedure, patients entered a 6-month
blinded follow-up phase in which they reported their daily symptoms in the
ORBITA-app. At 6 months, all assessments were repeated. The primary
outcome was myocardial blood flow in segments designated ischaemic at
enrolment during the adenosine-stress perfusion cardiac magnetic resonance
scan. The primary symptom outcome was the number of daily angina episodes.
Analysis was done by intention-to-treat and followed Bayesian methodology.
The study is registered with ClinicalTrials.gov, NCT04892537, and
completed. <br/>Finding(s): Between May 26, 2021, and June 28, 2023, 61
patients were enrolled, of whom 51 (44 [86%] male; seven [14%] female)
were randomly assigned to either the CSR group (n=25) or the placebo group
(n=26). Of these, 50 patients were included in the intention-to-treat
analysis (24 in the CSR group and 26 in the placebo group). 454 (57%) of
800 imaged cardiac segments were ischaemic at enrolment, with a median
stress myocardial blood flow of 1.08 mL/min per g (IQR 0.77-1.41).
Myocardial blood flow in ischaemic segments did not improve with CSR
compared with placebo (difference 0.06 mL/min per g [95% CrI -0.09 to
0.20]; Pr(Benefit)=78.8%). The number of daily angina episodes was reduced
with CSR compared with placebo (OR 1.40 [95% CrI 1.08 to 1.83];
Pr(Benefit)=99.4%). There were two CSR embolisation events in the CSR
group, and no acute coronary syndrome events or deaths in either group.
<br/>Interpretation(s): ORBITA-COSMIC found no evidence that the CSR
improved transmural myocardial perfusion, but the CSR did improve angina
compared with placebo. These findings provide evidence for the use of CSR
as a further antianginal option for patients with stable coronary artery
disease. <br/>Funding(s): Medical Research Council, Imperial College
Healthcare Charity, National Institute for Health and Care Research
Imperial Biomedical Research Centre, St Mary's Coronary Flow Trust,
British Heart Foundation.<br/>Copyright &#xa9; 2024 The Author(s).
Published by Elsevier Ltd. This is an Open Access article under the CC BY
4.0 license.

<6>
Accession Number
2031579767
Title
10-Year Mortality of Off-Pump Versus On-Pump Coronary Artery Bypass
Grafting: An Updated Systematic Review, Meta-Analysis, and
Meta-Regression.
Source
American Journal of Cardiology. 219 (pp 77-84), 2024. Date of Publication:
15 May 2024.
Author
Comanici M.; Bulut H.I.; Raja S.G.
Institution
(Comanici, Bulut, Raja) Department of Cardiac Surgery, Harefield Hospital,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
The longstanding debate on off-pump coronary artery bypass grafting
(OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) has
primarily focused on short-term and mid-term outcomes, with limited
attention to long-term survival. This study aims to address this gap by
providing an updated analysis of 10-year mortality rates after OPCAB
versus ONCAB. We have conducted a systematic review and meta-analysis,
incorporating 22 studies comprising 69,449 patients. The primary end point
was all-cause mortality at 10 years. Meta-regression analysis explored
sources of heterogeneity. The meta-analysis revealed no significant
difference in long-term all-cause mortality between OPCAB and ONCAB
(hazard ratio 1.000, 95% confidence interval 0.92 to 1.08, p = 0.95).
Although substantial heterogeneity existed across studies, meta-regression
identified older age as a significant factor favoring OPCAB. However,
patient characteristics like gender, co-morbidities, and graft numbers did
not significantly influence the choice of surgical technique. In
conclusion, this study challenges historical concerns regarding OPCAB's
quality of revascularization and long-term survival demonstrating
comparable outcomes to ONCAB in well-selected patients when performed by
experienced surgeons. The results emphasize the importance of surgeon
proficiency and advocate for recognizing surgical revascularization as a
subspecialty.<br/>Copyright &#xa9; 2024 Elsevier Inc.

<7>
Accession Number
2031276214
Title
The early safety profile of simultaneous vaccination against influenza and
Respiratory Syncytial Virus (RSV) in patients with high-risk heart
failure.
Source
Vaccine. 42(12) (pp 2937-2940), 2024. Date of Publication: 30 Apr 2024.
Author
Biegus J.; Szenborn L.; Zymlinski R.; Zakliczynski M.; Reczuch K.; Guzik
M.; Urban S.; Rosiek-Biegus M.; Jankowiak B.; Iwanek G.; Fudim M.;
Ponikowski P.
Institution
(Biegus, Zymlinski, Zakliczynski, Reczuch, Guzik, Urban, Jankowiak,
Iwanek, Ponikowski) Institute of Heart Diseases, Wroclaw Medical
University, Wroclaw, Poland
(Szenborn) Department of Paediatrics and Infectious Diseases, Wroclaw
Medical University, Wroclaw, Poland
(Rosiek-Biegus) Department and Clinic of Internal Medicine, Pneumology and
Allergology, Wroclaw Medical University, Wroclaw, Poland
(Fudim) Division of Cardiology, Duke University School of Medicine,
Durham, NC, United States
Publisher
Elsevier Ltd
Abstract
The safety of simultaneous vaccination for Respiratory Syncytial Virus
(RSV) and influenza in vulnerable high-risk heart failure (HF) patients
remains unclear. In an open-label, prospective study, 105 patients
received concurrent influenza (Vaxigrip Tetra, season 2023/2024, Sanofi)
and RSV (Arexvy, GSK) vaccinations from September 15th to November 17th,
2023. Adverse events were collected on the fourth-day post-vaccination.
Overall, the vaccination was well tolerated, with the most common reaction
being injection site pain (63 %). General symptoms occurred in 33 % of
patients, predominantly fatigue (23 %), myalgia (12 %), and headache (9
%). Grade 3 reactions were observed in 6 % of patients, and a few
experienced temperature elevation or flu-like symptoms, managing them with
antipyretics. Notably, there were no exacerbations of HF,
hospitalizations, or deaths within a week post-vaccination. This study
indicates the safety of simultaneous influenza and RSV vaccination in
high-risk HF patients, with a low incidence of mild adverse
events.<br/>Copyright &#xa9; 2024 The Author(s)

<8>
Accession Number
2030766471
Title
Left atrial strain analysis and new-onset atrial fibrillation in patients
with ST-segment elevation myocardial infarction: A prospective
echocardiography study.
Source
Archives of Cardiovascular Diseases. 117(4) (pp 266-274), 2024. Date of
Publication: April 2024.
Author
Beyls C.; Hermida A.; Nicolas M.; Debrigode R.; Vialatte A.; Peschanski
J.; Bunelle C.; Fournier A.; Jarry G.; Landemaine T.; Malaquin D.; Kubala
M.; Mahjoub Y.; Leborgne L.
Institution
(Beyls, Peschanski, Bunelle, Mahjoub) Department of Anaesthesiology and
Critical Care Medicine, Amiens University Hospital, Amiens 80054, France
(Beyls) UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical
Patients) Research Unit, University of Picardie Jules-Verne, Amiens 80054,
France
(Hermida, Kubala) Department of Cardiology, Rhythmology unit, Amiens
University Hospital, Amiens 80054, France
(Nicolas, Debrigode, Vialatte, Fournier, Jarry, Landemaine, Malaquin,
Leborgne) Department of Cardiology, Cardiac intensive care unit, Amiens
University Hospital, Amiens 80054, France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: New-onset atrial fibrillation (NOAF) is a well-known
complication of ST-segment elevation myocardial infarction (STEMI),
probably due to left atrial (LA) remodelling. LA strain (LAS) can predict
NOAF in several cardiovascular diseases. <br/>Objective(s): To assess
whether LAS predicts NOAF in sinus rhythm patients with STEMI during
hospitalization. <br/>Method(s): Adults with a STEMI and transthoracic
echocardiography performed within 48 hours of admission were included. LAS
analysis, performed by automated software, recorded LAS during the
reservoir phase (LASr), the conduit phase (LAScd) and the contraction
phase (LASct). <br/>Result(s): From May 2021 to November 2022, 175
patients were included, 21 (12%) of whom developed NOAF. NOAF patients
were older (median [Q1-Q3]: 67 [59-80] vs 59 [51-67] years; P = 0.006) and
had a higher Thrombolysis In Myocardial Infarction scores (4 [2-7] vs 3
[1-4]; P = 0.005). All LAS parameters were significantly impaired in NOAF
patients, especially LASr (13.0% [10.5-28.4] vs 36.6% [29.0-44.9]; P =
0.001). An LASr cut-off of 27% had a sensitivity of 81% and a specificity
of 80% to identify patients with NOAF. In a multivariable model, LASr was
significantly associated with NOAF (odds ratio 1.18, 95% confidence
interval 1.09-1.26; P = 0.003). The cumulative risk of NOAF during
hospital stay was 30% (18-43 with LASr < 27% and 4% [1.5-8.5] with LASr >=
27% [P < 0.0001]). <br/>Conclusion(s): NOAF is a frequent complication of
STEMI. LASr seems helpful for identifying patients at high risk of NOAF
during hospitalization.<br/>Copyright &#xa9; 2024 The Authors

<9>
Accession Number
644028204
Title
Comparison Between the Protective Effect of Isoflurane and Propofol on
Myocardium During Coronary Artery Bypass Grafting: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials.
Source
Brazilian journal of cardiovascular surgery. 39(3) (pp e20210424), 2024.
Date of Publication: 17 Apr 2024.
Author
Bao Q.; Lei M.; Xiao D.; Xie J.
Institution
(Bao, Lei, Xiao, Xie) Department of Anesthesiology, Sir Run Run Shaw
Hospital, School of Medicine, Zhejiang University, Zhejiang, China
Abstract
OBJECTIVE: Intravenous non-volatile anaesthetics like propofol are
commonly used in cardiac surgeries across several countries. Volatile
anaesthetics like isoflurane may help in protecting the myocardium and
minimize ischaemia-reperfusion injury. Hence, we did this review to
compare the cardioprotective effect of isoflurane and propofol among
patients undergoing coronary artery bypass grafting (CABG).
<br/>METHOD(S): We conducted a search in the databases Medical Literature
Analysis and Retrieval System Online (or MEDLINE), Embase, PubMed Central,
ScienceDirect, Google Scholar, and Cochrane Library from inception until
April 2021. We carried out a meta-analysis with random-effects model and
reported pooled risk ratio (RR) or standardized mean difference (SMD) with
95% confidence interval (CI) depending on the type of outcome.
<br/>RESULT(S): We analysed 13 studies including 808 participants. Almost
all were low-quality studies. For cardiac index, the pooled SMD was 0.14
(95% CI: -0.22 to 0.50); for cardiac troponin I, pooled SMD was 0.10 (95%
CI: -0.28 to 0.48). For mortality, the RR was 3.00 (95% CI: 0.32 to
28.43); for MI, pooled RR was 1.58 (95% CI: 0.59 to 4.20); and for
inotropic drug use, pooled RR was 1.04 (95% CI: 0.90 to 1.21). For length
of intensive care unit stay, the pooled SMD was 0.13 (95% CI: -0.29 to
0.55), while pooled SMD for mechanical ventilation time was -0.02 (95% CI:
-0.54 to 0.51). <br/>CONCLUSION(S): Isoflurane did not have significant
cardioprotective effect compared to propofol following CABG. Hence, the
anaesthetists need to check some viable alternatives to manage these
patients and reduce the rate of postoperative complications.

<10>
Accession Number
644027950
Title
Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac
Surgery on Clinical Outcomes and Length of Hospital and Intensive Care
Unit Stay? A Systematic Review with Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 39(3) (pp e20220319), 2024.
Date of Publication: 17 Apr 2024.
Author
Silva H.V.C.; Lunardi A.C.; Pinto A.C.P.N.; Macedo J.R.F.F.; Santos
E.D.C.D.
Institution
(Silva, Pinto, Santos) Department of Biological and Health Sciences,
Universidade Federal do Amapa, Macapa, Amapa, Brazil
(Lunardi) Programa de Pos-Graduacao Stricto Sensu em Fisioterapia,
Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
(Lunardi) Department of Physical Therapy, Escola de Medicina, Universidade
de Sao Paulo, Sao Paulo, Brazil
(Pinto) Department of Physical Therapy, University of Pittsburgh, PA,
United States
(Macedo) Department of Health Sciences, Catholic University of Louvain,
Brussels, Belgium
Abstract
INTRODUCTION: Cardiac surgery is a frequent surgical procedure and may
present a high risk of complications. Among the prophylactic strategies
studied to decrease the rates of negative outcomes, respiratory care seems
to reduce pulmonary complications. Incentive spirometry (IS) is a
low-cost, respiratory exercise technique, used for the prevention and
treatment of postoperative pulmonary complications (PPC). The aim of this
review was to evaluate whether IS is superior to respiratory care,
mobilization exercises, and noninvasive ventilation on PPC, and clinical
outcomes. <br/>METHOD(S): Systematic review. Medical Literature Analysis
and Retrieval System Online (or MEDLINE), Embase, Cochrane Central
Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence
Database (or PEDro), Cumulative Index of Nursing and Allied Health (or
CINAHL), Latin American and Caribbean Health Sciences Literature (or
LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus,
and OpenGrey databases, clinical trial registration sites, conferences,
congresses, and symposiums were searched. <br/>RESULT(S): Twenty-one
randomized trials and one quasi-randomized trial (1,677 participants) were
included. For partial pressure of oxygen (PaO2), IS was inferior to
respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI]
-8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2
(MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care,
flow-oriented IS was superior on recovery vital capacity.
<br/>CONCLUSION(S): This meta-analysis revealed that IS was not superior
to standard respiratory care for PPCs and clinical outcomes, therefore its
use should not be widely recommended until further studies with high
quality be performed to ensure this clinical guidance.

<11>
Accession Number
644027577
Title
Immediate or staged complete revascularisation in patients presenting with
acute coronary syndrome by number of diseased vessels: a substudy of the
BIOVASC randomised trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
20(8) (pp e479-e486), 2024. Date of Publication: 15 Apr 2024.
Author
Kakar H.; Elscot J.J.; Scarparo P.; Den Dekker W.K.; Bennett J.; Sabate
M.; Esposito G.; Amat-Santos I.; Boersma E.; Van Mieghem N.M.; Diletti R.
Institution
(Kakar, Elscot, Scarparo, Den Dekker, Boersma, Van Mieghem, Diletti)
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center,
Rotterdam, Netherlands
(Bennett) Department of Cardiovascular Medicine, University Hospital
Leuven, Leuven, Belgium
(Sabate) Interventional Cardiology Department, Hospital Clinic, Instituto
de Investigaciones Biomedicas August Pi i Sunyer (IDIBAPS), University of
Barcelona, Barcelona, Spain
(Esposito) Department of Advanced Biomedical Sciences, University of
Naples Federico II, Naples, Italy
(Amat-Santos) Cardiology Department, Hospital Clinico de Valladolid,
Valladolid, Spain
Abstract
BACKGROUND: In patients presenting with acute coronary syndrome (ACS), the
number of diseased vessels may affect the efficacy of a complete
revascularisation strategy. AIMS: The authors sought to evaluate the
safety and efficacy of immediate complete revascularisation (ICR) and
staged complete revascularisation (SCR) in patients presenting with ACS
stratified by the number of diseased vessels. <br/>METHOD(S): In this
prespecified analysis of the BIOVASC trial, ICR was compared with SCR in
patients with two-vessel disease (2VD) or three-vessel disease (3VD). The
primary endpoint was a composite of all-cause mortality, myocardial
infarction (MI), any unplanned ischaemia-driven revascularisation or
cerebrovascular events at 1 year after the index procedure. Comparisons
were performed using Cox regression. <br/>RESULT(S): A total of 1,525
patients were enrolled in the BIOVASC trial, of whom 1,177 presented with
2VD and 265 with 3VD. In the 2VD group, 613 patients were assigned to ICR
and 564 to SCR. In the 3VD group, 117 patients were assigned to ICR and
148 to SCR. ICR and SCR led to similar results in both the 2VD (hazard
ratio [HR] 0.76, 95% confidence interval [CI]: 0.50-1.13; p=0.18) and 3VD
groups (HR 0.79, 95% CI: 0.39-1.59; p=0.51) (pinteraction=0.91) in terms
of the primary endpoint. ICR was associated with a lower rate of MI in
patients with 3VD (HR 0.21, 95% CI: 0.046-0.93; p=0.04)
(pinteraction=0.30). <br/>CONCLUSION(S): ICR might be an option in
patients presenting with extensive 3VD and might be associated with a
lower rate of myocardial infarction compared with SCR.

<12>
Accession Number
644026625
Title
A randomised multicentre study of angiography- versus physiologyguided
percutaneous coronary intervention in patients with coronary artery
disease undergoing TAVI: design and rationale of the FAITAVI trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
20(8) (pp e504-e510), 2024. Date of Publication: 15 Apr 2024.
Author
Ribichini F.; Pesarini G.; Fabris T.; Lunardi M.; Barbierato M.; D'Amico
G.; Zanchettin C.; Gregori D.; Piva T.; Nicolini E.; Gandolfo C.; Fineschi
M.; Petronio A.S.; Berti S.; Caprioglio F.; Saia F.; Sclafani R.; Esposito
G.; D'Ascenzo F.; Tarantini G.
Institution
(Ribichini, Pesarini, Lunardi) Department of Medicine, Division of
Cardiology, University of Verona, Verona, Italy
(Fabris, Zanchettin, Gregori, Tarantini) Department of Cardiac, Thoracic
and Vascular Science, University of Padova, Padova, Italy
(Barbierato, D'Amico, Zanchettin) Division of Cardiology, Ospedale
dell'Angelo di Mestre, Chirignago-Zelarino, Italy
(Piva, Nicolini) Division of Cardiology, Azienda Ospedaliero Universitaria
delle Marche, Ancona, Italy
(Gandolfo) Division of Cardiology, Palermo, Italy
(Fineschi) Division of Cardiology, Azienda Ospedaliera Universitaria
Senese, Siena, Italy
(Petronio) Division of Cardiology, Azienda Ospedaliero Universitaria
Pisana, Pisa, Italy
(Berti) Division of Cardiology, Ospedale del Cuore - Fondazione
Monasterio, Massa, Italy
(Caprioglio) Division of Cardiology, Ospedale San Bortolo di Vicenza,
Vicenza, Italy
(Saia) Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna,
Italy
(Sclafani) Division of Cardiology, Azienda Ospedaliera di Perugia -
Ospedale S. Maria della Misericordia, Perugia, Italy
(Esposito) Division of Cardiology, Policlinico Universitario Federico II
di Napoli, Napoli, Italy
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences,
Hospital University of Turin, Citta della Salute e della Scienza, Torino,
Italy
Abstract
The treatment of coronary artery disease (CAD) in patients with severe
aortic valve stenosis (AVS) eligible for transcatheter aortic valve
implantation (TAVI) is not supported by clinical evidence, and the role of
physiology over anatomy as well as the timing of coronary intervention are
not defined. FAITAVI (ClinicalTrials.gov: NCT03360591) is a nationwide
prospective, open-label, multicentre, randomised controlled study
comparing the angiography-guided versus the physiology-guided coronary
revascularisation strategy in patients with combined significant CAD and
severe AVS undergoing TAVI. Significant CAD will be defined as coronary
stenosis >=50%, as assessed by visual estimation in vessels >=2.5 mm.
Physiology will be tested by fractional flow reserve (FFR) and
instantaneous wave-free ratio (iFR). The study will be conducted at 15
sites in Italy. In the angiography arm, percutaneous coronary intervention
(PCI) will be performed either before TAVI, during the TAVI procedure -
before or after the valve implantation - or within 1 month+/-5 days of the
valve implantation, left to the operator's decision. In the physiology
arm, FFR and iFR will be performed before TAVI, and PCI will be indicated
for FFR <=0.80, otherwise the intervention will be deferred. In case of
borderline values (0.81-0.85), FFR and iFR will be repeated after TAVI,
with PCI performed when needed. With a sample size of 320 patients, the
study is powered to evaluate the primary endpoint (a composite of death,
myocardial infarction, stroke, major bleeding, or ischaemia-driven target
vessel revascularisation). TAVI indication, strategy and medical treatment
will be the same in both groups. After discharge, patients will be
contacted at 1, 6, 12 and 24 months after the procedure to assess their
general clinical status, and at 12 months for the occurrence of events
included in the primary and secondary endpoints. FAITAVI is the first
randomised clinical trial to investigate "optimal" percutaneous coronary
intervention associated with TAVI in patients with severe AVS and CAD.

<13>
Accession Number
643852485
Title
Stroke prevention strategies for cardiac surgery: a systematic review and
meta-analysis of randomized controlled trials.
Source
ANZ journal of surgery. 94(4) (pp 522-535), 2024. Date of Publication: 01
Apr 2024.
Author
Fong K.Y.; Yeo S.; Luo H.; Kofidis T.; Teoh K.L.K.; Kang G.S.
Institution
(Fong, Yeo) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Luo, Kofidis, Teoh, Kang) Department of Cardiac, Thoracic and Vascular
Surgery, National University Heart Centre, Singapore
Abstract
BACKGROUND: Stroke is a much-feared complication of cardiac surgery, but
existing literature on preventive strategies is fragmented. Hence, a
systematic review and meta-analysis of stroke prevention strategies for
cardiac surgery was conducted. <br/>METHOD(S): An electronic literature
search was conducted to retrieve randomized controlled trials (RCTs)
investigating perioperative interventions for cardiac surgery, with stroke
as an outcome. Random-effects meta-analyses were conducted to generate
risk ratios (RRs), 95% confidence intervals (95% CI), and forest plots.
Descriptive analysis and synthesis of literature was conducted for
interventions not amenable to meta-analysis, focusing on risks of stroke,
myocardial infarction and study-defined major adverse cardiovascular
events (MACE). <br/>RESULT(S): Fifty-six RCTs (61894 patients) were
retrieved. Many included trials were underpowered to detect differences in
stroke risk. Among pharmacological therapies, only preoperative amiodarone
was shown to reduce stroke risk in one trial. Concomitant left atrial
appendage closure (LAAC) significantly reduced stroke risk (RR=0.55, 95%
CI=0.36-0.84, P=0.006) in patients with preoperative atrial fibrillation,
and there was no difference in on-pump versus off-pump coronary artery
bypass grafting (CABG) (RR=0.94, 95% CI=0.64-1.37, P=0.735). Much
controversy exists in literature on the timing of carotid endarterectomy
relative to CABG in patients with severe carotid stenosis. The use of
preoperative remote ischemic preconditioning was not found to reduce rates
of stroke or MACE. <br/>CONCLUSION(S): This review presents a
comprehensive synthesis of existing interventions for stroke prevention in
cardiac surgery, and identifies gaps in research which may benefit from
future, large-scale RCTs. LAAC should be considered to reduce stroke
incidence in patients with preoperative atrial fibrillation.<br/>Copyright
&#xa9; 2024 Royal Australasian College of Surgeons.

<14>
Accession Number
2029500467
Title
Efficacy of early administration of sacubitril/valsartan after coronary
artery revascularization in patients with acute myocardial infarction
complicated by moderate-to-severe mitral regurgitation: a randomized
controlled trial.
Source
Heart and Vessels. (no pagination), 2024. Date of Publication: 2024.
Author
Yin H.; Ma L.; Tang X.; Li R.; Zhou Y.; Shi J.; Zhang J.
Institution
(Yin, Zhang) Tianjin Medical University, Tianjin 300000, China
(Yin, Ma, Tang, Zhou) Department of Cardiology, The First Hospital of
Qinhuangdao, Hebei, Qinhuangdao 066000, China
(Zhou, Shi) The First Hospital of Qinhuangdao, Hebei, Qinhuangdao 066000,
China
(Li) Department of Critical Care Medicine, People's Hospital of Yangjiang,
Guangdong, Yangjiang 529500, China
(Zhang) Depatment of Cardiology, Cangzhou Central Hospital, Tianjin
Medical University Teaching Hospital, Hebei, Cangzhou 061000, China
Publisher
Springer
Abstract
Effects of angiotensin receptor/neprilysin inhibitors (ARNI) on
ventricular remodeling in patients with heart failure, especially heart
failure with reduced ejection fraction (HFrEF), are better than those of
angiotensin-converting enzyme inhibitors (ACEI). Acute myocardial
infarction (AMI) complicated by mitral regurgitation exacerbates
ventricular remodeling and increases the risk of heart failure. There is
limited evidence on the effects of early administration of ARNI in
patients with AMI complicated by mitral regurgitation. The aim of this
trial was to examine the effectiveness and the safety of early
administration of sacubitril/valsartan after coronary artery
revascularization in patients with AMI complicated by moderate-to-severe
mitral regurgitation. This was a randomized, single-blind, parallel-group,
controlled trial. From June 2021 to June 2022, we enrolled 142 consecutive
patients with AMI complicated by moderate-to-severe mitral regurgitation
and followed them for 12 months. The patients received standard treatment
for AMI and were randomly assigned to receive ARNI or benazepril. The
primary efficacy end points were the differences in mitral regurgitant jet
area (MRJA), mitral regurgitant volume (MRV), concentration of n-terminal
pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection
fraction (LVEF), and left ventricular end-diastolic volume and
end-systolic volume (LVEDV and LVESV) between groups and within groups at
baseline, 1, 3, 6, and 12 months. Secondary end points included the rates
of heart failure hospitalization, all-cause mortality, refractory angina,
malignant arrhythmias, recurrent myocardial infarction, and stroke. Safety
end points included the rates of hyperkalemia, renal dysfunction,
hypotension, angioedema, and cough. The ARNI group had significantly lower
NT-proBNP levels than the benazepril group at 1 month and later (P <
0.001). MRJA and MRV significantly improved in the ARNI group compared
with the benazepril group at 12 months (MRJA: - 3.21 +/- 2.18
cm² vs. - 1.83 +/- 2.81 cm², P < 0.05; MRV: - 27.22
+/- 15.22 mL vs. - 13.67 +/- 21.02 mL, P < 0.001). The ARNI group also
showed significant reductions in LVEDV and LVESV (P < 0.05) and
improvement in LVEF (P < 0.05). Secondary end point analysis showed a
significantly higher rate of heart failure hospitalization in the
benazepril group compared with the ARNI group (HR = 2.03, 95% CI
1.12-3.68, P = 0.021). Safety end point analysis showed a higher rate of
hypotension in the ARNI group (P < 0.05). Early use of
sacubitril/valsartan after coronary artery revascularization in patients
with AMI complicated by moderate-to-severe mitral regurgitation can
significantly reduce mitral regurgitation, improve ventricular remodeling,
and decrease heart failure hospitalization. Nevertheless, caution is
needed to avoid hypotension. Chinese Clinical Trial Registry
(ChiCTR2100054255) registered on December 11, 2021.<br/>Copyright &#xa9;
Springer Nature Japan KK, part of Springer Nature 2024.

<15>
Accession Number
2029473917
Title
Noteworthy in Cardiothoracic Surgery 2023.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. (no pagination),
2024. Date of Publication: 2024.
Author
Rove J.Y.; Cain M.T.; Hoffman J.R.; Reece T.B.
Institution
(Rove, Cain, Hoffman, Reece) Department of Surgery, Division of
Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus,
Aurora, CO, United States
Publisher
SAGE Publications Inc.
Abstract
Noteworthy in Cardiothoracic Surgery 2023 summarizes a few of the most
high-impact trials and provocative trends in cardiothoracic surgery and
transplantation this past year. Transplantation using organs procured from
donation after circulatory death (DCD) continues to increase, and the
American Society of Transplant Surgeons released recommendations on best
practices in 2023. We review a summary of data on the impact of DCD on
heart and lung transplantation. There has been increased interest in
extracorporeal life support (ECLS), particularly after the COVID-19
pandemic, and we review the results of the highly discussed ECLS-SHOCK
trial, which randomized patients in cardiogenic shock with planned
revascularization to ECLS vs usual care. With improving survival outcomes
in complex aortic surgery, there is a need for higher-quality evidence to
guide which cooling and cerebral perfusion strategies may optimize
cognitive outcomes in these patients. We review the short-term outcomes of
the GOT ICE trial (Cognitive Effects of Body Temperature During
Hypothermic Circulatory Arrest), a multicenter, randomized controlled
trial of three different nadir temperatures, evaluating outcomes in
cognition and associated changes in functional magnetic resonance imaging.
Finally, both the Society of Thoracic Surgeons (STS) and the American
College of Cardiology, American Heart Association, American College of
Chest Physicians and Heart Rhythm Society (ACC/AHA/ACCP/HRS) updated
atrial fibrillation guidelines in 2023, and we review surgically relevant
updates to the guidelines and the evidence behind them.<br/>Copyright
&#xa9; The Author(s) 2024.

<16>
Accession Number
2029010686
Title
Antithrombotic strategies for preventing graft failure in coronary artery
bypass graft.
Source
Journal of Thrombosis and Thrombolysis. 57(4) (pp 547-557), 2024. Date of
Publication: April 2024.
Author
Mauro M.S.; Finocchiaro S.; Calderone D.; Rochira C.; Agnello F.; Scalia
L.; Capodanno D.
Institution
(Mauro, Finocchiaro, Calderone, Rochira, Agnello, Scalia, Capodanno)
Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G.
Rodolico-San Marco", University of Catania, Via Santa Sofia, 78, Catania,
Italy
Publisher
Springer
Abstract
Coronary artery bypass graft (CABG) procedures face challenges related to
graft failure, driven by factors such as acute thrombosis, neointimal
hyperplasia, and atherosclerotic plaque formation. Despite extensive
efforts over four decades, the optimal antithrombotic strategy to prevent
graft occlusion while minimizing bleeding risks remains uncertain, relying
heavily on expert opinions rather than definitive guidelines. To address
this uncertainty, we conducted a review of randomized clinical trials and
meta-analyses of antithrombotic therapy for patients with CABG. These
studies examined various antithrombotic regimens in CABG such as single
antiplatelet therapy (aspirin or P2Y<inf>12</inf> inhibitors), dual
antiplatelet therapy, and anticoagulation therapy. We evaluated outcomes
including the patency of grafts, major adverse cardiovascular events, and
bleeding complications and also explored future perspectives to enhance
long-term outcomes for CABG patients. Early studies established aspirin as
a key component of antithrombotic pharmacotherapy after CABG. Subsequent
randomized controlled trials focused on adding a P2Y<inf>12</inf>
inhibitor (such as clopidogrel, ticagrelor, or prasugrel) to aspirin,
yielding mixed results. This article aims to inform clinical
decision-making and guide the selection of antithrombotic strategies after
CABG.<br/>Copyright &#xa9; The Author(s) 2024.

<17>
Accession Number
2027244814
Title
Rescue designs in analgesic trials from 0 to 2 years of age: scoping
review.
Source
Pediatric Research. 95(5) (pp 1237-1245), 2024. Date of Publication: April
2024.
Author
Haskes K.; Donado C.; Carbajal R.; Berde C.B.; Kossowsky J.
Institution
(Haskes, Donado, Berde, Kossowsky) Department of Anesthesiology, Critical
Care & Pain Medicine, Boston Children's Hospital, Boston, MA, United
States
(Donado, Berde, Kossowsky) Department of Anaesthesia, Harvard Medical
School, Boston, MA, United States
(Carbajal) Pediatric Emergency Department, Assistance Publique-Hopitaux de
Paris, Hopital Armand Trousseau-Sorbonne Universite, Paris, France
(Carbajal) Institut National de La Sante et de La Recherche Medicale,
Paris UMR1153, France
Publisher
Springer Nature
Abstract
Abstract: Pediatric analgesic trials are challenging, especially in
newborns and infants. Following an FDA-academic consensus meeting, we
analyzed pragmatic rescue designs in postoperative trials of local
anesthetics, acetaminophen, opioids, and NSAIDs involving children ages
0-2 years and assessed surgical volumes to provide trial design
recommendations. Searches of PubMed, Embase, CINAHL, The Cochrane Library,
and Web of Science were conducted. A scoping approach identified trends in
analgesic trials with an emphasis on randomized controlled trials (RCTs)
utilizing immediate rescue designs. Age-specific surgical volumes were
estimated from French national databases. Of 3563 studies identified, 23
RCTs used study medication(s) of interest and immediate rescue paradigms
in children ages 0-2 years. A total of 270 studies met at least one of
these criteria. Add-on and head-to-head designs were common and often used
sparing of non-opioid or opioid rescue medication as a primary outcome
measure. According to French national data, inguinal and penile surgeries
were most frequent in ages 1 month to 2 years; abdominal and thoracic
surgeries comprise approximately 75% of newborn surgeries. Analgesic
trials with rescue sparing paradigm are currently sparse among children
ages 0-2 years. Future trials could consider age-specific surgical
procedures and use of add-on or head-to-head designs. Impact: Clinical
trials of analgesic medications have been challenging in pediatrics,
especially in the group from newborns to 2 years of age. Following an
FDA-academic workshop, we analyzed features of completed analgesic trials
in this age group. Studies using immediate rescue in placebo control,
add-on, and head-to-head trial designs are pragmatic approaches that can
provide important information regarding clinical effectiveness, side
effects, and safety. Using a French national dataset with a granular
profile of inpatient, outpatient, and short-stay surgeries, we provide
information to future investigators on relative frequencies of different
operations in neonates and through the first 2 years of
life.<br/>Copyright &#xa9; The Author(s), under exclusive licence to the
International Pediatric Research Foundation, Inc 2023.

<18>
Accession Number
644031236
Title
To repair or to replace in mitral valve infective endocarditis? an updated
meta-analysis.
Source
Journal of cardiothoracic surgery. 19(1) (pp 247), 2024. Date of
Publication: 18 Apr 2024.
Author
Awad A.K.; Wilson K.; Elnagar M.A.; Elbadawy M.A.; Fathy M.H.
Institution
(Awad, Wilson, Elnagar, Elbadawy, Fathy) Faculty of Medicine, Ain-Shams
University, Cairo, Egypt
(Awad) Department of Cardiothoracic Surgery, Ain-Shams University
Hospitals, Cairo, Egypt
Abstract
BACKGROUND: Valve infective endocarditis (IE) is a potentially
life-threatening condition that affects patients' livelihoods. Current
surgical options in mitral valve IE include mitral valve repair (MVr) or
replacement (MVR). While each procedure boasts its merits, doubt remains
as to which type of surgery is superior. <br/>METHOD(S): We searched
PubMed, Scopus, Web of Science, and Cochrane literature databases for
studies comparing MVR and MVr in mitral valve IE. Any randomized
controlled trial (RCT) or observational studies that compare MVR vs. MVr
in mitral valve IE were eligible. Our dichotomous outcomes were extracted
in the form of event and total, and risk and hazard ratio (RR)(HR) with
95% confidence interval (CI) and were pooled and calculated using RevMan
5.0. <br/>RESULT(S): Our study included 23 studies with a total population
of 11,802 patients. Compared to MVR, MVr had statistically significant
lower risks of both early mortality with RR [0.44; 95% CI, 0.38-0.51;
p<0.001] and long-term follow-up mortality with HR [0.70; 95% CI,
0.58-0.85; p=0.0004]. Moreover, MVr was associated with a statistically
significant lower risk of IE recurrence with RR [0.43; 95% CI, 0.32-0.58;
p<0.001]; however, no statistically significant differences between both
groups in terms of re-operations with RR [0.83; 95% CI, 0.41-1.67;
p=0.60]. <br/>CONCLUSION(S): Our results suggest that MVr was superior in
terms of in-hospital mortality, long-term survival, and risk of recurrence
without significance in valve reoperation. Therefore, MVr is appropriate
as a primary treatment choice and should be considered whenever possible
in most IE patients.<br/>Copyright &#xa9; 2024. The Author(s).

<19>
Accession Number
2031750587
Title
Eliminate LDL cholesterol after heart attack ... but only for a while.
Source
European Heart Journal, Supplement. 26(Supplement_1) (pp i99-i101), 2024.
Date of Publication: 01 Apr 2024.
Author
Prati F.; Biccire F.G.; Sammartini E.; Gatto L.
Institution
(Prati, Biccire, Gatto) Department of Cardiovascular Sciences, San
Giovanni Addolorata Hospital, Rome, Italy
(Prati, Biccire, Sammartini, Gatto) Center for the Fight Against Heart
Attack - Cli Foundation, Rome, Italy
(Prati) Cardiology, UniCamillus - Saint Camillus International University
of Health Sciences, Rome, Italy
(Biccire) Department of General and Specialized Surgery Paride Stefanini,
Sapienza University, Rome, Italy
Publisher
Oxford University Press
Abstract
There is a clear demonstration of the inverse linear correlation between
LDL cholesterol levels and clinical benefit. However, the timing of the
action of lipid-lowering drugs is not clear. According to animal studies
with recombinant lipoprotein A-1, the composition of atherosclerosis
changes within 40 h (with variations in lipid and inflammatory contents).
Progression-regression studies of atherosclerosis in humans confirm the
data, highlighting a rapid change in the plaque over 5 weeks. The data are
also in line with what emerges from the survival curves of the old study
comparing atorvastatin 80 mg vs. placebo (Myocardial Ischaemia Reduction
with Aggressive Cholesterol Lowering). The spacing of the curves occurs
after only 4 weeks, indicating the precociousness of the favourable
effects of powerful statins. Finally, a recent Odyssey post hoc analysis
compared the risk of cardiac death and coronary revascularization between
a group in which alirocumab lowered LDL cholesterol to below 15 mg (Group
1 and in which the drug was therefore stopped) against the subjects in the
placebo group (Group 2), applying a propensity score matching. The primary
endpoint occurred in a lower percentage of patients in Group 1 (6.4 vs.
8.4%). Furthermore, patients in Group 1 had a significantly lower hazard
ratio (HR) for major adverse cardiovascular events [0.72; 95% confidence
interval (CI) 0.51-0.997; P = 0.047] compared with the entire alirocumab
group vs. placebo (HR 0.85; 95% CI 0.78-0.93; P < 0.001). According to
these preliminary observations, aggressive and early treatment of
hypercholesterolaemia in subjects with acute coronary syndrome translates
into improved clinical results compared with a strategy that provides for
more gradual control. These data will need to be confirmed through further
prospective clinical studies and ideally with early conducted
atherosclerosis regression studies. <br/>Copyright &#xa9; 2024 The
Author(s). Published by Oxford University Press on behalf of the European
Society of Cardiology.

<20>
Accession Number
2031743593
Title
Moderate aortic stenosis in the dysfunctional ventricle: should it be
treated?.
Source
European Heart Journal, Supplement. 26(Supplement_1) (pp i113-i116), 2024.
Date of Publication: 01 Apr 2024.
Author
Sciatti E.; Calabrese A.; Duino V.; D'isa S.; Di Odoardo L.A.F.; D'elia
E.; Senni M.
Institution
(Sciatti, Calabrese, Duino, D'isa, Di Odoardo, D'elia, Senni)
Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
(Senni) Milano-Bicocca University, Milan, Italy
Publisher
Oxford University Press
Abstract
Moderate aortic stenosis is associated with a worse prognosis than milder
degrees. Pathophysiologically, this condition in a dysfunctional ventricle
could lead to a further mechanism of haemodynamic worsening, so its
treatment should lead to clinical advantages for the patient. The low risk
of complications associated with percutaneous correction of aortic valve
disease (transcatheter aortic valve implantation) should also be
considered, which would seem to favour an interventional approach even in
the aforementioned condition. However, sparse data and small population
studies make this approach still controversial. Three randomized
controlled trials are underway to shed definitive light on the topic.
<br/>Copyright &#xa9; The Author(s) 2024.

<21>
Accession Number
2031585390
Title
Gastrointestinal complications after cardiac surgery.
Source
Trauma Surgery and Acute Care Open. 9(1) (no pagination), 2024. Article
Number: e001324. Date of Publication: 09 Apr 2024.
Author
Schwarzova K.; Damle S.; Sellke F.W.; Robich M.P.
Institution
(Schwarzova, Damle) Department of Surgery, Ascension Saint Agnes Hospital,
Baltimore, MD, United States
(Sellke) Department of Cardiac Surgery, Warren Alpert Medical School,
Brown University, Providence, RI, United States
(Robich) Department of Cardiac Surgery, Johns Hopkins Medical Institutions
Campus, Baltimore, MD, United States
Publisher
BMJ Publishing Group
Abstract
Gastrointestinal complications after cardiac surgery are relatively rare
entities but carry a high mortality. We identified over 70 articles
written since 2010 using the PubMed database. We included 40 in our
review. The most common complications include paralytic ileus,
gastrointestinal bleeding, and bowel ischemia. Patients who undergo
cardiac procedures are at risk for poor perfusion of the gastrointestinal
tract and, thus, at risk for resulting complications. Risk factors for
these complications include peri-operative use of vasopressors, prolonged
operative time, and the time of cardiopulmonary bypass. Presentation of
gastrointestinal complications tends to differ as patients after open
heart surgery can remain intubated, and exams can be limited. Early
recognition and aggressive therapy are paramount. We aim to provide a
review that will help the reader get familiar with the most common
gastrointestinal complications that can negatively affect outcomes after
cardiac surgery.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2024.

<22>
Accession Number
2029538835
Title
Impact of perioperative low-molecular-weight heparin therapy on clinical
events of elderly patients with prior coronary stents implanted > 12
months undergoing non-cardiac surgery: a randomized, placebo-controlled
trial.
Source
BMC Medicine. 22(1) (no pagination), 2024. Article Number: 171. Date of
Publication: December 2024.
Author
Wang B.; Su Y.; Ma C.; Xu L.; Mao Q.; Cheng W.; Lu Q.; Zhang Y.; Wang R.;
Lu Y.; He J.; Chen S.; Chen L.; Li T.; Gao L.
Institution
(Wang, Su, Xu, Cheng, Lu, Zhang, Wang, Lu, He, Chen, Li, Gao) Department
of Comprehensive Surgery, The Second Medical Center & amp; National
Clinical Research Center for Geriatric Diseases, Chinese PLA General
Hospital, Beijing 100853, China
(Ma) Health Management Institute, The Second Medical Center & amp;
National Clinical Research Center for Geriatric Diseases, Chinese PLA
General Hospital, Beijing, China
(Mao) National Research Institute for Family Planning, Beijing, China
(Chen) Department of Thoracic Surgery of The First Medical Center, General
Hospital of Chinese People's Liberation Army, Beijing 100853, China
Publisher
BioMed Central Ltd
Abstract
Background: Little is known about the safety and efficacy of discontinuing
antiplatelet therapy via LMWH bridging therapy in elderly patients with
coronary stents implanted for > 12 months undergoing non-cardiac surgery.
This randomized trial was designed to compare the clinical benefits and
risks of antiplatelet drug discontinuation via LMWH bridging therapy.
<br/>Method(s): Patients were randomized 1:1 to receive subcutaneous
injections of either dalteparin sodium or placebo. The primary efficacy
endpoint was cardiac or cerebrovascular events. The primary safety
endpoint was major bleeding. <br/>Result(s): Among 2476 randomized
patients, the variables (sex, age, body mass index, comorbidities,
medications, and procedural characteristics) and percutaneous coronary
intervention information were not significantly different between the
bridging and non-bridging groups. During the follow-up period, the rate of
the combined endpoint in the bridging group was significantly lower than
in the non-bridging group (5.79% vs. 8.42%, p = 0.012). The incidence of
myocardial injury in the bridging group was significantly lower than in
the non-bridging group (3.14% vs. 5.19%, p = 0.011). Deep vein thrombosis
occurred more frequently in the non-bridging group (1.21% vs. 0.4%, p =
0.024), and there was a trend toward a higher rate of pulmonary embolism
(0.32% vs. 0.08%, p = 0.177). There was no significant difference between
the groups in the rates of acute myocardial infarction (0.81% vs. 1.38%),
cardiac death (0.24% vs. 0.41%), stroke (0.16% vs. 0.24%), or major
bleeding (1.22% vs. 1.45%). Multivariable analysis showed that LMWH
bridging, creatinine clearance < 30 mL/min, preoperative hemoglobin < 10
g/dL, and diabetes mellitus were independent predictors of ischemic
events. LMWH bridging and a preoperative platelet count of < 70 x
10⁹/L were independent predictors of minor bleeding events.
<br/>Conclusion(s): This study showed the safety and efficacy of
perioperative LMWH bridging therapy in elderly patients with coronary
stents implanted > 12 months undergoing non-cardiac surgery. An
alternative approach might be the use of bridging therapy with half-dose
LMWH. Trial registration: ISRCTN65203415.<br/>Copyright &#xa9; The
Author(s) 2024.

<23>
Accession Number
2029520676
Title
Outcomes of Percutaneous Revascularization in Severe Ischemic Left
Ventricular Dysfunction.
Source
Current Cardiology Reports. (no pagination), 2024. Date of Publication:
2024.
Author
Bista R.; Zghouzi M.; Jasti M.; Lichaa H.; Kerrigan J.; Haddad E.; Alraies
M.C.; Paul T.K.
Institution
(Bista, Zghouzi, Jasti, Lichaa, Kerrigan, Haddad, Paul) University of
Tennessee Health Science Center, Nashville, TN, United States
(Bista, Zghouzi, Jasti, Lichaa, Kerrigan, Haddad, Paul) Ascension St.,
Thomas Hospital, Nashville, TN, United States
(Alraies) Detroit Medical Center, Cardiovascular Institute, Heart
Hospital, Detroit, MI, United States
Publisher
Springer
Abstract
Purpose of Review: This article presents a comprehensive review of
coronary revascularization versus optimal medical therapy (OMT) in
patients with severe ischemic left ventricular dysfunction. Recent
Findings: The REVIVED-BCIS2 trial randomized 700 patients with extensive
coronary artery disease and left ventricular (LV) ejection fraction (LVEF)
<= 35% and viability in more than four dysfunctional myocardial segments
to percutaneous coronary intervention (PCI) plus OMT versus OMT alone.
Over a median duration of 41 months, there was no difference in the
composite of all-cause mortality, heart failure hospitalization, or
improvement in LVEF with PCI plus OMT versus OMT alone at 6 and 12 months,
quality of life scores at 24 months, or fatal ventricular arrhythmia. The
STICH randomized trial was conducted between 2002 and 2007, involving
patients with LV dysfunction and coronary artery disease. The patients
were assigned to either CABG plus medical therapy or medical therapy
alone. At the 5-year follow-up, the trial showed that CABG plus medical
therapy reduced cardiovascular disease-related deaths and hospitalizations
but no reduction in all-cause mortality. However, a 10-year follow-up
showed a significant decrease in all-cause mortality with CABG.
<br/>Summary: The currently available evidence showed no apparent benefit
of PCI in severe ischemic cardiomyopathy as compared to OMT, but that CABG
improves outcomes in this patient population. The paucity of data on the
advantages of PCI in this patient population underscores the critical need
for optimization of medical therapy for better survival and quality of
life until further evidence from RCTs is available.<br/>Copyright &#xa9;
The Author(s) 2024.

<24>
Accession Number
644027608
Title
Impact of Local Forearm Heating on Pain Intensity and Hemorrhage in
Patients Undergoing Radial Artery Cardiac Catheterization: A Pilot Study.
Source
Anatolian journal of cardiology. (no pagination), 2024. Date of
Publication: 17 Apr 2024.
Author
Shamsian A.; Mehr A.Z.; Tayebi P.; Fathollahi M.S.; Amin K.; Shabani F.;
Daryabari Y.
Institution
(Shamsian, Shabani) Cardiovascular Nursing Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mehr) Cardiovascular Intervention Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Tayebi, Daryabari) Department of Vascular and Endovascular Surgery,
Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran,
Islamic Republic of
(Fathollahi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Amin) Department of Cardiology, Faculty of Medicine, Babol University of
Medical Sciences, Babol, Iran, Islamic Republic of
Abstract
BACKGROUND: Radial artery cardiac catheterization is a common diagnostic
and interventional procedure for cardiovascular conditions. Pain and
hemorrhage at the access site can cause patient discomfort and
complications. This pilot study investigates the potential of local
forearm heating to reduce pain and hemorrhage in patients undergoing
radial artery cardiac catheterization. <br/>METHOD(S): We enrolled 100
patients scheduled for radial artery cardiac catheterization and randomly
assigned them to the heating or control group. The heating group received
local forearm heating before sheath removal, while the control group did
not. Pain intensity was assessed with a visual analog scale, and
hemorrhage was measured by assessing ecchymosis or hematoma size at the
catheterization site. Hemodynamic parameters were also monitored.
Statistical analysis compared outcomes between the groups. <br/>RESULT(S):
Patients who received local forearm heating had significantly lower pain
intensity (4.15 +/- 2.73) compared to the control group (5.84 +/- 3.34) (P
=.009). Hemodynamic parameters and the extent of hemorrhage at the
catheterization site did not significantly differ between the heating and
control groups (P >.05). No adverse effects related to forearm heating
were reported. <br/>CONCLUSION(S): Local forearm heating is a promising
intervention to reduce pain intensity without increasing hemorrhage or
affecting hemodynamic parameters during radial artery cardiac
catheterization. This simple, noninvasive approach has the potential to
enhance patient comfort and safety post procedure.

<25>
Accession Number
644026277
Title
Managing One-Lung Ventilation in Tracheostomized Patients: A 6-Year
Retrospective Analysis.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2024. Date of
Publication: 16 Apr 2024.
Author
Golditz T.; Schmidt J.; Ackermann A.; Danzl A.; Birkholz T.; Sirbu H.;
Irouschek A.
Institution
(Golditz, Schmidt, Ackermann, Danzl, Birkholz, Irouschek) Department of
Anesthesiology, Faculty of Medicine, University Hospital Erlangen,
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
(Sirbu) Department of Thoracic Surgery, Universitatsklinikum Erlangen,
Erlangen, Germany
Abstract
BACKGROUND: To ensure safe and optimal surgical conditions in thoracic
surgery, one-lung ventilation is crucial. Various techniques exist to
achieve one-lung ventilation. Tracheotomized patients who require one-lung
ventilation represent a unique and rare subgroup that demands specialized
knowledge and skills. The very limited literature has discussed
alternative methods, no randomized controlled trials have addressed this
issue yet. <br/>METHOD(S): We performed a retrospective analysis of
patients who underwent one-lung ventilation in the Department of Thoracic
Surgery of a German University Hospital between 2016 and 2021. The study
assessed patient demographics, airway management techniques, ventilation
parameters, and adverse events. <br/>RESULT(S): In 3,197 anesthesia
procedures during the observation period, 152 patients had an existing
tracheostomy, of which 56 required one-lung ventilation. Among others in
42 cases, a tracheostomy tube was combined with a bronchial blocker, and
in 10 cases, a double-lumen tracheostomy tube was used. There were no
severe complications. Intraoperative dislocations that required
repositioning of the device occurred in six patients (13.3%) with
bronchial blockers and one patient with double-lumen tracheostomy tube
(10%). <br/>CONCLUSION(S): The management of one-lung ventilation in
tracheotomized patients presents unique challenges. While double-lumen
tracheostomy tubes have specific advantages, we recommend considering
their use carefully. For most tracheotomized patients, bronchial blockers
in conjunction with a tracheostomy tube are used, which offers safety and
practicality, irrespective of the tracheostomy's age or type. Further
research and randomized controlled trials are warranted to establish best
practices for one-lung ventilation in this unique patient
population.<br/>Copyright Thieme. All rights reserved.

<26>
Accession Number
644023429
Title
Clinical outcomes of on-pump versus off-pump coronary-artery bypass
surgery: a meta-analysis.
Source
International journal of surgery (London, England). (no pagination),
2024. Date of Publication: 16 Apr 2024.
Author
He L.; Tiemuerniyazi X.; Chen L.; Yang Z.; Huang S.; Nan Y.; Song Y.; Feng
W.
Institution
(He) Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
Abstract
BACKGROUND: The ongoing debate regarding off-pump CABG and on-pump CABG
has endured for over three decades. Although numerous randomized
controlled trials (RCTs) and meta-analyses have been reported, new
evidence has emerged. Therefore, an updated and comprehensive
meta-analysis to guide clinical practice is essential. MATERIALS AND
METHODS: A comprehensive search for eligible articles published after
2000, reporting RCTs involving at least 100 patients and comparing
off-pump CABG with on-pump CABG, was performed throughout the databases
including Embase, Ovid Medline and Web of Science. The primary interested
outcomes included the short-term incidence of stroke and long-term
mortality. The primary analysis utilized Fixed-effect model with the
inverse variance method. The Grade of Recommendations Assessment,
Development, and Evaluation (GRADE) was used to evaluate the certainty of
evidence. <br/>RESULT(S): After thorough screening, 39 articles were
included, consisting of 28 RCTs and involving a total of 16090 patients.
Off-pump CABG significantly reduced the incidence of short-term stroke
(1.27% vs. 1.78%, OR: 0.74, P=0.03, high certainty). However, it was
observed to be associated with increased mid-term coronary reintervention
(2.77% vs. 1.85%, RR: 1.49, P<0.01, high certainty) and long-term
mortality (21.8% vs. 21.0%, RR: 1.09, P=0.02, moderate certainty).
<br/>CONCLUSION(S): Off-pump CABG significantly reduces the short-term
incidence of stroke, but it also increases the incidence of mid-term
coronary reintervention. Moreover, it may increase long-term
mortality.<br/>Copyright &#xa9; 2024 The Author(s). Published by Wolters
Kluwer Health, Inc.

<27>
Accession Number
2031659016
Title
Impact of cancer in patients with aortic stenosis undergoing transcatheter
aortic valve replacement: A systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 52 (no pagination), 2024. Article Number:
101410. Date of Publication: June 2024.
Author
Osawa T.; Tajiri K.; Hoshi T.; Ieda M.; Ishizu T.
Institution
(Osawa, Hoshi, Ieda, Ishizu) Department of Cardiology, Institute of
Medicine, University of Tsukuba, Japan
(Osawa) Department of Cardiology, Tsukuba Medical Center Hospital, Japan
(Osawa, Tajiri) Department of Cardiology, National Cancer Center Hospital
East, Japan
(Tajiri) Tsukuba Life Science Innovation Program (T-LSI), School of
Integrative and Global Majors (SIGMA), University of Tsukuba, Japan
(Ieda) Department of Cardiology, Keio University School of Medicine, Japan
Publisher
Elsevier Ireland Ltd
Abstract
Background: Owing to the minimally invasive nature of transcatheter aortic
valve replacement (TAVR), TAVR seems to be preferred in patients with
cancer; however, related research on the clinical efficacy and safety of
TAVR in patients with cancer and severe aortic stenosis is limited, and
conclusions are controversial. This study aimed to evaluate the clinical
outcomes of patients with cancer who underwent TAVR. Method and results:
We conducted a systematic review and meta-analysis to investigate the
clinical outcomes in patients with and without cancer who underwent TAVR.
We systematically reviewed and analyzed 15 studies (195,658 patients)
published in PubMed and Cochrane Library databases between January 2022
and January 2023. The primary outcomes were short-term (in-hospital or
30-day) and long-term (>=12 months) mortality. The prevalence of current
or previous cancer in the patients undergoing TAVR was 19.8 % (38,695
patients). Patients with cancer had a lower risk of short-term mortality
(odds ratio [OR] 0.69, 95 % confidence interval [CI] 0.61-0.77, P < 0.001)
but a higher risk of long-term mortality (OR 1.54, 95 % CI 1.35-1.76, P <
0.001) than those without cancer. Patients with cancer had a lower
incidence of postprocedural stroke and acute kidney injury but a higher
incidence of pacemaker implantation than patients without cancer.
<br/>Conclusion(s): Patients with cancer undergoing TAVR have a good
short-term prognosis and acceptable perioperative complications compared
with patients without cancer. However, the long-term outcomes are
contingent on cancer survival.<br/>Copyright &#xa9; 2024 The Author(s)

<28>
[Use Link to view the full text]
Accession Number
2031654491
Title
Effectiveness of an ERAS-based exercise-nutrition management model in
enhancing postoperative recovery for thoracoscopic radical resection of
lung cancer: A randomized controlled trial.
Source
Medicine (United States). 103(15) (no pagination), 2024. Article Number:
E37667. Date of Publication: 12 Apr 2024.
Author
Huang L.; Hu Y.; Chen J.
Institution
(Huang, Hu) Department of Surgery, Jinhua Hospital of Chinese Medicine,
Zhejiang, Jinhua, China
(Chen) Department of Nutrition, Jinhua Hospital of Traditional Chinese
Medicine, Zhejiang, Jinhua, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: To analyze the effect of an exercise-nutrition management
model based on the Enhanced Recovery After Surgery (ERAS) concept on
patients undergoing thoracoscopic radical surgery for lung cancer.
<br/>Method(s): From June 2019 to December 2022, 85 lung cancer patients
who underwent thoracoscopic radical lung cancer surgery were randomly
divided into 2 groups. The control group, consisting of 42 patients,
received routine nursing care during the perioperative period. The study
group, comprising 43 patients, implemented an exercise-nutrition
management model based on the ERAS concept during the perioperative
period. We compared general data, perioperative indicators, compliance,
and complications between the 2 groups. Additionally, we assessed the
nutritional status using the patient-generated subjective global
assessment (PG-SGA), albumin (ALB), prealbumin (PA), and hemoglobin (Hb),
as well as lung function, including forced expiratory volume in the first
second (FEV1) and maximum voluntary ventilation (MVV), in the patient
population following the Piper intervention. <br/>Result(s): In the study
group, the times to first defecation and getting out of bed, the duration
of thoracic drainage tube indwelling, and the length of hospital stay were
shorter than those in the control group. The VAS scores on the 2nd and 3rd
postoperative days were lower in the study group than in the control group
(P < .05). Medication compliance was higher in the study group compared to
the control group (P < .05). Post-intervention, the PG-SGA scores in the
study group were lower, while PA, ALB, and Hb levels were higher than
those in the control group (P < .05). The MVV, FEV1, and FVC values were
higher in the study group than in the control group after the intervention
(P < .05). The PFS and mMRC scores were lower in the study group compared
to the control group after the intervention, and the QLQ-C30 scores were
higher (P < .05). The incidence of complications was 6.98% in the study
group, which was not significantly different from 11.90% in the control
group (P > .05). <br/>Conclusion(s): The exercise-nutrition management
model, based on the ERAS concept, exhibits significant perioperative
effects in patients undergoing thoracoscopic radical resection of lung
cancer, improving their nutritional status and reducing
complications.<br/>Copyright &#xa9; 2024 Lippincott Williams and Wilkins.
All rights reserved.

<29>
Accession Number
2031654281
Title
Postprocedural Anticoagulation after Primary Percutaneous Coronary
Intervention for ST-Segment-Elevation Myocardial Infarction: A
Multicenter, Randomized, Double-Blind Trial.
Source
Circulation. 149(16) (pp 1258-1267), 2024. Date of Publication: 16 Apr
2024.
Author
Yan Y.; Guo J.; Wang X.; Wang G.; Fan Z.; Yin D.; Wang Z.; Zhang F.; Tian
C.; Gong W.; Liu J.; Lu J.; Li Y.; Ma C.; Vicaut E.; Montalescot G.; Nie
S.
Institution
(Yan, Wang, Wang, Gong, Nie) Center for Coronary Artery Disease, Division
of Cardiology, Beijing Anzhen Hospital, Capital Medical University,
Beijing, China
(Ma) Arrhythmia Center, Division of Cardiology, Beijing Anzhen Hospital,
Capital Medical University, Beijing, China
(Yan, Wang, Wang, Ma, Nie) National Clinical Research Center of
Cardiovascular Diseases, Beijing, China
(Yan, Wang, Wang, Ma, Nie) Beijing Institute of Heart, Lung, and Blood
Vessel Diseases, China
(Guo, Wang) Beijing Luhe Hospital, Capital Medical University, Beijing,
China
(Fan) Civil Aviation General Hospital, Beijing, China
(Yin) The First People's Hospital of Lianyungang, Jiangsu, China
(Wang) Xinxiang Central Hospital, Henan, China
(Zhang) Beijing Haidian Hospital, Beijing, China
(Tian) The People's Hospital of Yongcheng, Henan, China
(Liu) NHC Key Laboratory of Clinical Research for Cardiovascular
Medications, China
(Lu) National Clinical Research Center for Cardiovascular Diseases, State
Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy
of Medical Sciences, Peking Union Medical College, National Center for
Cardiovascular Diseases, Beijing, China
(Li) The Second Hospital of Hebei Medical University, Shijiazhuang, China
(Vicaut) ACTION Study Group, Epidemiology and Clinic Research Unit,
Lariboisiere University Hospital, Paris, France
(Montalescot) Sorbonne Universite, ACTION Study Group, INSERM, UMRS 1166,
Institut de Cardiologie, Hopital Pitie-Salpetriere (AP-HP), Paris, France
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Postprocedural anticoagulation (PPA) is frequently
administered after primary percutaneous coronary intervention in
ST-segment-elevation myocardial infarction, although no conclusive data
support this practice. <br/>METHOD(S): The RIGHT trial (Comparison of
Anticoagulation Prolongation vs no Anticoagulation in STEMI Patients After
Primary PCI) was an investigator-initiated, multicenter, randomized,
double-blind, placebo-controlled, superiority trial conducted at 53
centers in China. Patients with ST-segment-elevation myocardial infarction
undergoing primary percutaneous coronary intervention were randomly
assigned by center to receive low-dose PPA or matching placebo for at
least 48 hours. Before trial initiation, each center selected 1 of 3 PPA
regimens (40 mg of enoxaparin once daily subcutaneously; 10 U.kg.h of
unfractionated heparin intravenously, adjusted to maintain activated
clotting time between 150 and 220 seconds; or 0.2 mg.kg.h of bivalirudin
intravenously). The primary efficacy objective was to demonstrate
superiority of PPA to reduce the primary efficacy end point of all-cause
death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis
(definite), or urgent revascularization (any vessel) within 30 days. The
key secondary objective was to evaluate the effect of each specific
anticoagulation regimen (enoxaparin, unfractionated heparin, or
bivalirudin) on the primary efficacy end point. The primary safety end
point was Bleeding Academic Research Consortium 3 to 5 bleeding at 30
days. <br/>RESULT(S): Between January 10, 2019, and September 18, 2021, a
total of 2989 patients were randomized. The primary efficacy end point
occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard
ratio, 1.00 [95% CI, 0.63 to 1.57]). The incidence of Bleeding Academic
Research Consortium 3 to 5 bleeding did not differ between the PPA and
placebo groups (8 [0.5%] vs 11 [0.7%] patients; hazard ratio, 0.74 [95%
CI, 0.30 to 1.83]). <br/>CONCLUSION(S): Routine PPA after primary
percutaneous coronary intervention was safe but did not reduce 30-day
ischemic events. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT03664180.<br/>Copyright &#xa9; 2024 Lippincott Williams and
Wilkins. All rights reserved.

<30>
Accession Number
2031653169
Title
Perioperative adverse cardiac events in maxillofacial surgery: A
systematic review and meta-analysis.
Source
Indian Journal of Anaesthesia. 68(5) (pp 426-438), 2024. Date of
Publication: May 2024.
Author
Chohan M.; Liu W.; Chowdhury T.
Institution
(Chohan) Department of Health Science, Queen's University, Kingston, ON,
Canada
(Liu) Michael G. DeGroote School of Medicine, McMaster, Hamilton, ON,
Canada
(Chowdhury) Department of Anaesthesiology and Pain Medicine, Toronto
Western Hospital, Toronto, ON, Canada
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Maxillofacial surgeries, including procedures to the
face, oral cavity, jaw, and head and neck, are common in adults . However,
they impose a risk of adverse cardiac events (ACEs). While ACEs are well
understood for other non-cardiac surgeries, there is a paucity of data
about maxillofacial surgeries. This systematic review and meta-analysis
report the incidence and presentation of perioperative ACEs during
maxillofacial surgery. <br/>Method(s): We included primary studies that
reported on perioperative ACEs in adults. To standardise reporting, ACEs
were categorised as 1. heart rate and rhythm disturbances, 2. blood
pressure disturbances, 3. ischaemic heart disease and 4. heart failure and
other complications. The primary outcome was ACE presentation and
incidence during the perioperative period. Secondary outcomes included the
surgical outcome according to the Clavien-Dindo classification and
trigeminocardiac reflex involvement. STATA version 17.0 and MetaProp were
used to delineate proportion as effect size with a 95% confidence interval
(CI). <br/>Result(s): Twelve studies (34,227 patients) were included. The
incidence of perioperative ACEs was 2.58% (95% CI 1.70, 3.45, I2 = 96.17%,
P = 0.001). Heart rate and rhythm disturbances resulted in the greatest
incidence at 3.84% among the four categories. Most commonly, these ACEs
resulted in intensive care unit admission (i.e. Clavien-Dindo score of 4).
<br/>Conclusion(s): Despite an incidence of 2.58%, ACEs can
disproportionately impact surgical outcomes. Future research should
include large-scale prospective studies that may provide a better
understanding of the contributory factors and long-term effects of ACEs in
patients during maxillofacial surgery.<br/>Copyright &#xa9; 2024 Indian
Journal of Anaesthesia.

<31>
Accession Number
2031605502
Title
Impact of Rapid Up-Titration of Guideline-Directed Medical Therapies on
Quality of Life: Insights from the STRONG-HF Trial.
Source
Circulation: Heart Failure. 17(4) (pp E011221), 2024. Date of Publication:
01 Apr 2024.
Author
Celutkiene J.; Cerlinskaite-Bajore K.; Cotter G.; Edwards C.; Adamo M.;
Arrigo M.; Barros M.; Biegus J.; Chioncel O.; Cohen-Solal A.; Damasceno
A.; Diaz R.; Filippatos G.; Gayat E.; Kimmoun A.; Leopold V.; Metra M.;
Novosadova M.; Pagnesi M.; Pang P.S.; Ponikowski P.; Saidu H.; Sliwa K.;
Takagi K.; Ter Maaten J.M.; Tomasoni D.; Lam C.S.P.; Voors A.A.; Mebazaa
A.; Davison B.
Institution
(Celutkiene, Cerlinskaite-Bajore) Clinic of Cardiac and Vascular Diseases,
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University,
Lithuania
(Cotter, Cohen-Solal, Gayat, Leopold, Mebazaa, Davison) Universite Paris
Cite, INSERM UMR-S 942 (MASCOT), France
(Cotter, Davison) Heart Initiative, Durham, NC, United States
(Cotter, Edwards, Barros, Novosadova, Takagi, Davison) Momentum Research,
Inc, Durham, NC, United States
(Adamo, Metra, Pagnesi, Tomasoni) ASST Spedali Civili, Department of
Medical and Surgical Specialties, Radiological Sciences, and Public
Health, University of Brescia, Italy
(Arrigo) Department of Internal Medicine, Stadtspital Zurich, Switzerland
(Biegus, Ponikowski) Institute of Heart Diseases, Wroclaw Medical
University, Poland
(Chioncel) Emergency Institute for Cardiovascular Diseases Prof.
C.C.Iliescu, University of Medicine Carol Davila, Bucharest, Romania
(Cohen-Solal) Department of Cardiology, APHP Nord, Lariboisiere University
Hospital, Paris, France
(Damasceno) Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
(Diaz) Estudios Clinicos Latinoamerica, Instituto Cardiovascular de
Rosario, Argentina
(Filippatos) National and Kapodistrian University of Athens, School of
Medicine, Attikon University Hospital, Greece
(Gayat, Leopold, Mebazaa) Department of Anesthesiology, Critical Care and
Burn Unit, Saint-Louis and Lariboisiere Hospitals, FHU PROMICE, DMU
Parabol, APHP Nord, Paris, France
(Kimmoun) Universite de Lorraine, Nancy, INSERM, Defaillance Circulatoire
Aigue et Chronique, Service de Medecine Intensive et Reanimation Brabois,
CHRU de Nancy, France
(Pang) Departments of Emergency Medicine and Medicine, Indiana University
School of Medicine, Indianapolis, United States
(Saidu) Murtala Muhammed Specialist Hospital, Bayero University Kano,
Nigeria
(Sliwa) Cape Heart Institute, Division of Cardiology, Department of
Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
(Ter Maaten, Voors) Department of Cardiology, Medical Centre Groningen,
Netherlands
(Lam) National Heart Centre Singapore, Duke-National University of
Singapore, Singapore
(Lam) Baim Institute for Clinical Research, Boston, MA, United States
(Lam) University Medical Centre Groningen, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: This analysis provides details on baseline and changes in
quality of life (QoL) and its components as measured by EQ-5D-5L
questionnaire, as well as association with objective outcomes, applying
high-intensity heart failure (HF) care in patients with acute HF.
<br/>METHOD(S): In STRONG-HF trial (Safety, Tolerability, and Efficacy of
Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure
Therapies) patients with acute HF were randomized just before discharge to
either usual care or a high-intensity care strategy of guideline-directed
medical therapy up-titration. Patients ranked their state of health on the
EQ-5D visual analog scale score ranging from 0 (the worst imaginable
health) to 100 (the best imaginable health) at baseline and at 90 days
follow-up. <br/>RESULT(S): In 1072 patients with acute HF with available
assessment of QoL (539/533 patients assigned high-intensity care/usual
care) the mean baseline EQ-visual analog scale score was 59.2 (SD, 15.1)
with no difference between the treatment groups. Patients with lower
baseline EQ-visual analog scale (meaning worse QoL) were more likely to be
women, self-reported Black and non-European (P<0.001). The strongest
independent predictors of a greater improvement in QoL were younger age
(P<0.001), no HF hospitalization in the previous year (P<0.001), lower
NYHA class before hospital admission (P<0.001) and high-intensity care
treatment (mean difference, 4.2 [95% CI, 2.5-5.8]; P<0.001). No
statistically significant heterogeneity in the benefits of high-intensity
care was seen across patient subgroups of different ages, with left
ventricular ejection fraction above or below 40%, NT-proBNP (N-terminal
pro-B-type natriuretic peptide) and systolic blood pressure above or below
the median value. The treatment effect on the primary end point did not
vary significantly across baseline EQ-visual analog scale
(Pinteraction=0.87). <br/>CONCLUSION(S): Early up-titration of
guideline-directed medical therapy significantly improves all dimensions
of QoL in patients with HF and improves prognosis regardless of baseline
self-assessed health status. The likelihood of achieving optimal doses of
HF medications does not depend on baseline QoL.<br/>Copyright &#xa9; 2024
American Heart Association, Inc.

<32>
Accession Number
2031582838
Title
Cardiovascular disease in patients with metabolic dysfunction-associated
steatohepatitis compared with metabolic dysfunction-associated steatotic
liver disease and other liver diseases: A systematic review.
Source
American Heart Journal Plus: Cardiology Research and Practice. 41 (no
pagination), 2024. Article Number: 100386. Date of Publication: May 2024.
Author
Sanyal A.J.; Husain M.; Diab C.; Mangla K.K.; Shoeb A.; Lingvay I.; Tapper
E.B.
Institution
(Sanyal) Department of Internal Medicine, Medical College of Virginia,
Richmond, VA, United States
(Husain) Ted Rogers Centre for Heart Research, Department of Medicine,
University of Toronto, Toronto, ON, Canada
(Diab, Mangla, Shoeb) Novo Nordisk A/S, Soborg, Denmark
(Lingvay) Department of Internal Medicine/Endocrinology and Peter O'Donnel
Jr School of Public Health, University of Texas Southwestern Medical
Center, Dallas, TX, United States
(Tapper) Division of Gastroenterology and Hepatology, University of
Michigan, Ann Arbor, MA, United States
Publisher
Elsevier Inc.
Abstract
The burden of cardiovascular disease (CVD) in patients with metabolic
dysfunction-associated steatohepatitis (MASH) is poorly characterized,
particularly vs other liver diseases including metabolic
dysfunction-associated steatotic liver disease (MASLD). To identify
available evidence, Embase, MEDLINE, and Cochrane database searches (main
search: 2011-September 6, 2021; additional ad hoc search [MEDLINE only]:
September 7, 2021-February 15, 2023), plus manual searches (2019-September
2021), were performed. Studies reporting CVD outcomes (angina, coronary
artery disease [CAD], heart failure, myocardial infarction, peripheral
artery disease, stroke, venous thromboembolic disease, and CV mortality)
in adults with histologically confirmed MASH and MASLD or other liver
diseases were identified, with studies of MASLD without confirmed MASH
excluded. Of 8732 studies, 21 were included. An increased incidence or
prevalence of CVD in patients with MASH vs other conditions was reported
in 12 studies; odds ratios (OR), where reported, ranged from 3.12 (95 %
CI: 1.33-5.32) to 4.12 (95 % CI: 1.91-8.90). The risk of CAD was increased
in people with MASH in 6 of 7 studies, while the risk of stroke was
increased in 6 of 6 studies, and heart failure in 2 of 4 studies. Three of
6 studies provided evidence of increased CVD-related mortality in patients
with MASH vs those without. In conclusion, this literature review suggests
that CVD is prevalent in patients with MASH and may contribute to
increased mortality. Accordingly, cardiovascular risk factors should be
aggressively managed in this population. Whether the CVD burden in
patients with MASH is a direct consequence of MASH itself requires further
study.<br/>Copyright &#xa9; 2024

<33>
Accession Number
2031392767
Title
Discontinuation vs. continuation of renin-angiotensin system inhibition
before non-cardiac surgery: the SPACE trial.
Source
European Heart Journal. 45(13) (pp 1146-1155), 2024. Date of Publication:
01 Apr 2024.
Author
Ackland G.L.; Patel A.; Abbott T.E.F.; Begum S.; Dias P.; Crane D.R.;
Somanath S.; Middleditch A.; Cleland S.; del Arroyo A.G.; Brealey D.;
Pearse R.M.
Institution
(Ackland, Patel, Abbott, Begum, Dias, Crane, del Arroyo, Pearse)
Translational Medicine and Therapeutics, William Harvey Research
Institute, Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, United Kingdom
(Somanath) County Durham and Darlington NHS Foundation Trust, Darlington,
United Kingdom
(Middleditch) University Hospitals Bristol NHS Foundation Trust, United
Kingdom
(Cleland) University Hospitals Plymouth NHS Trust, United Kingdom
(Brealey) Bloomsbury Institute of Intensive Care Medicine, University
College London, London, United Kingdom
(Brealey) UCL Hospitals NHS Foundation Trust, London, United Kingdom
(Brealey) NIHR University College London Hospitals Biomedical Research
Centre, London, United Kingdom
Publisher
Oxford University Press
Abstract
Background and Haemodynamic instability is associated with peri-operative
myocardial injury, particularly in patients receiving renin-angioAims
tensin system (RAS) inhibitors (angiotensin-converting-enzyme
inhibitors/angiotensin II receptor blockers). Whether stopping RAS
inhibitors to minimise hypotension, or continuing RAS inhibitors to avoid
hypertension, reduces peri-operative myocardial injury remains unclear. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . Methods From 31 July 2017 to 1 October 2021, patients aged >=60
years undergoing elective non-cardiac surgery were randomly assigned to
either discontinue or continue RAS inhibitors prescribed for existing
medical conditions in six UK centres. Renin-angiotensin system inhibitors
were withheld for different durations (2-3 days) before surgery, according
to their pharmacokinetic profile. The primary outcome, masked to
investigators, clinicians, and patients, was myocardial injury [plasma
high-sensitivity troponin-T (hs-TnT) >= 15 ng/L within 48 h after surgery,
or >=5 ng/L increase when pre-operative hs-TnT >=15 ng/L]. Pre-specified
adverse haemodynamic events occurring within 48 h of surgery included
acute hypertension (>180 mmHg) and hypotension requiring vasoactive
therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . Results Two hundred and sixty-two participants were
randomized to continue (n = 132) or stop (n = 130) RAS inhibitors.
Myocardial injury occurred in 58 (48.3%) patients randomized to
discontinue, compared with 50 (41.3%) patients who continued, RAS
inhibitors [odds ratio (for continuing): 0.77; 95% confidence interval
(CI) 0.45-1.31]. Hypertensive adverse events were more frequent when RAS
inhibitors were stopped [16 (12.4%)], compared with 7 (5.3%) who continued
RAS inhibitors [odds ratio (for continuing): 0.4; 95% CI 0.16-1.00].
Hypotension rates were similar when RAS inhibitors were stopped [12
(9.3%)] or continued [11 (8.4%)]. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . Conclusions Discontinuing RAS
inhibitors before non-cardiac surgery did not reduce myocardial injury,
and could increase the risk of clinically significant acute hypertension.
These findings require confirmation in future studies. Structured
Graphical Abstract Key Question Does discontinuing renin-angiotensin II
system inhibitors (RAS inhibitors) before elective non-cardiac surgery
reduce myocardial injury? Key Finding In a randomized controlled trial
enrolling 260 patients preoperative BP was higher when RAS inhibitors were
stopped. A total of 48% patients sustained myocardial injury after
stopping RAS inhibitors, compared with 41% patients who continued therapy.
Hypertensive adverse events were more frequent when RAS inhibitors were
stopped, without affecting hypotension rates. Take Home Message
Discontinuing RAS inhibitors before non-cardiac surgery does not reduce
myocardial injury, and may increase the risk of clinically significant
acute hypertension. Pre-op Surgery Post-op STOP Primary 24h 48h Adverse
outcome events 48% 9% 12% ACE-I and/or Randomize ARB Low High Troponin 41%
8% 5% 24h 48h Pre-op Surgery Post-op CONTINUE In a randomized controlled
trial enrolling 260 patients, did stopping renin-angiotensin system (RAS)
inhibitors [angiotensin-converting-enzyme inhibitors (ACE-I)/angiotensin
II receptor blockers (ARB)] before elective non-cardiac surgery reduce
myocardial injury, taking into account the pharmacokinetic profile of
individual RAS inhibitors? Pre-operative blood pressure was higher when
RAS inhibitors were stopped. Forty-eight per cent of patients sustained
myocardial injury after stopping RAS inhibitors, compared with 41% of
patients who continued therapy. Hypertensive adverse events were more
frequent when RAS inhibitors were stopped, without affecting hypotension
rates. Discontinuing RAS inhibitors before non-cardiac surgery does not
appear to reduce myocardial injury, and could increase the risk of
clinically significant acute hypertension.<br/>Copyright &#xa9; The
Author(s) 2023. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<34>
Accession Number
2030821951
Title
Novel Polygenic Risk Score and Established Clinical Risk Factors for Risk
Estimation of Aortic Stenosis.
Source
JAMA Cardiology. 9(4) (pp 357-366), 2024. Date of Publication: 10 Apr
2024.
Author
Small A.M.; Melloni G.E.M.; Kamanu F.K.; Bergmark B.A.; Bonaca M.P.;
O'Donoghue M.L.; Giugliano R.P.; Scirica B.M.; Bhatt D.; Antman E.M.; Raz
I.; Wiviott S.D.; Truong B.; Wilson P.W.F.; Cho K.; O'Donnell C.J.;
Braunwald E.; Lubitz S.A.; Ellinor P.; Peloso G.M.; Ruff C.T.; Sabatine
M.S.; Natarajan P.; Marston N.A.
Institution
(Small, Bergmark, O'Donoghue, Giugliano, Scirica, Antman, Wiviott,
O'Donnell, Braunwald, Lubitz, Ruff, Sabatine, Marston) Cardiovascular
Medicine Division, Department of Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Small, O'Donnell) Department of Cardiology, Boston Veterans Affairs
Healthcare System, West Roxbury, MA, United States
(Melloni, Kamanu, Bergmark, O'Donoghue, Giugliano, Scirica, Antman,
Wiviott, Braunwald, Ruff, Sabatine, Marston) TIMI Study Group, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Bonaca) Department of Medicine Cardiology and Vascular Medicine,
University of Colorado, School of Medicine, Aurora, United States
(Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Raz) Department of Endocrinology and Metabolism, Hadassah Hebrew
University Hospital, Jerusalem, Israel
(Truong, Lubitz, Ellinor, Natarajan) Cardiovascular Disease Initiative,
The Broad Institute, MIT and Harvard, Cambridge, MA, United States
(Wilson) Atlanta Veterans Affairs Medical Center, Decatur, GA, United
States
(Wilson) Division of Cardiology, Department of Medicine, Emory University,
School of Medicine, Atlanta, GA, United States
(Cho, Peloso) Veterans Affairs Healthcare System, Boston, MA, United
States
(Cho) Division of Aging, Mass General Brigham, Department of Medicine,
Harvard Medical School, Boston, MA, United States
(Lubitz, Ellinor, Natarajan) Cardiovascular Research Center, Massachusetts
General Hospital, Boston, United States
(Ellinor, Natarajan) Division of Cardiology, Department of Medicine,
Massachusetts General Hospital, Boston, United States
(Peloso) Department of Biostatistics, Boston University, School of Public
Health, Boston, MA, United States
(Natarajan) Center for Genomic Medicine, Massachusetts General Hospital,
Boston, United States
Publisher
American Medical Association
Abstract
Importance: Polygenic risk scores (PRSs) have proven to be as strong as or
stronger than established clinical risk factors for many cardiovascular
phenotypes. Whether this is true for aortic stenosis remains unknown.
<br/>Objective(s): To develop a novel aortic stenosis PRS and compare its
aortic stenosis risk estimation to established clinical risk factors.
<br/>Design, Setting, and Participant(s): This was a longitudinal cohort
study using data from the Million Veteran Program (MVP; 2011-2020), UK
Biobank (2006-2010), and 6 Thrombolysis in Myocardial Infarction (TIMI)
trials, including DECLARE-TIMI 58 (2013-2018), FOURIER (TIMI 59;
2013-2017), PEGASUS-TIMI 54 (2010-2014), SAVOR-TIMI 53 (2010-2013),
SOLID-TIMI 52 (2009-2014), and ENGAGE AF-TIMI 48 (2008-2013), which were a
mix of population-based and randomized clinical trials. Individuals from
UK Biobank and the MVP meeting a previously validated case/control
definition for aortic stenosis were included. All individuals from TIMI
trials were included unless they had a documented preexisting aortic valve
replacement. Analysis took place from January 2022 to December 2023.
Exposures: PRS for aortic stenosis (developed using data from MVP and
validated in UK Biobank) and other previously validated cardiovascular
PRSs, defined either as a continuous variable or as low (bottom 20%),
intermediate, and high (top 20%), and clinical risk factors. Main
Outcomes: Aortic stenosis (defined using International Classification of
Diseases or Current Procedural Terminology codes in UK Biobank and MVP or
safety event data in the TIMI trials). <br/>Result(s): The median (IQR)
age in MVP was 67 (57-73) years, and 135140 of 147104 participants (92%)
were male. The median (IQR) age in the TIMI trials was 66 (54-78) years,
and 45524 of 59866 participants (71%) were male. The best aortic stenosis
PRS incorporated 5170041 single-nucleotide variants and was associated
with aortic stenosis in both the MVP testing sample (odds ratio, 1.41; 95%
CI, 1.37-1.45 per 1 SD PRS; P = 4.6 x 10^-116) and TIMI trials
(hazard ratio, 1.44; 95% CI, 1.27-1.62 per 1 SD PRS; P = 3.2 x
10^-9). Among genetic and clinical risk factors, the aortic
stenosis PRS performed comparably to most risk factors besides age, and
within a given age range, the combination of clinical and genetic risk
factors was additive, providing a 3- to 4-fold increased gradient of risk
of aortic stenosis. However, the addition of the aortic stenosis PRS to a
model including clinical risk factors only improved risk discrimination of
aortic stenosis by 0.01 to 0.02 (C index in MVP: 0.78 with clinical risk
factors, 0.79 with risk factors and aortic stenosis PRS; C index in TIMI:
0.71 with clinical risk factors, 0.73 with risk factors and aortic
stenosis PRS). <br/>Conclusion(s): This study developed and validated 1 of
the first aortic stenosis PRSs. While aortic stenosis genetic risk was
independent from clinical risk factors and performed comparably to all
other risk factors besides age, genetic risk resulted in only a small
improvement in overall aortic stenosis risk discrimination beyond age and
clinical risk factors. This work sets the stage for further development of
an aortic stenosis PRS..<br/>Copyright &#xa9; 2024 American Medical
Association. All rights reserved.

<35>
Accession Number
2029473958
Title
Intravenous infusion of dexmedetomidine during the surgery to prevent
postoperative delirium and postoperative cognitive dysfunction undergoing
non-cardiac surgery: a meta-analysis of randomized controlled trials.
Source
European Journal of Medical Research. 29(1) (no pagination), 2024. Article
Number: 239. Date of Publication: December 2024.
Author
Wang D.; Liu Z.; Zhang W.; Zu G.; Tao H.; Bi C.
Institution
(Wang, Liu, Zhang, Tao, Bi) Department of Anaesthesiology, Dalian
Municipal Central Hospital Affiliated to Dalian University of Technology,
Liaoning, Dalian, China
(Liu, Zhang) China Medical University, Shenyang, China
(Wang) Dalian Medical University, Dalian, China
(Zu) Department of Gastroenterology, Dalian Municipal Central Hospital
Affiliated to Dalian University of Technology, Liaoning, Dalian, China
Publisher
BioMed Central Ltd
Abstract
Background: Dexmedetomidine plays a pivotal role in mitigating
postoperative delirium and cognitive dysfunction while enhancing the
overall quality of life among surgical patients. Nevertheless, the
influence of dexmedetomidine on such complications in various anaesthesia
techniques remains inadequately explored. As such, in the present study, a
meta-analysis was conducted to comprehensively evaluate its effects on
postoperative delirium and cognitive dysfunction. <br/>Method(s): A number
of databases were searched for randomised controlled trials comparing
intravenous dexmedetomidine to other interventions in preventing
postoperative delirium and cognitive dysfunction in non-cardiac and
non-neurosurgical patients. These databases included PubMed, Embase, and
Cochrane Library. Statistical analysis and graphing were performed using
Review Manager, STATA, the second version of the Cochrane risk-of-bias
tool for randomised controlled trials, and GRADE profiler. <br/>Main
Result(s): This meta-analysis comprised a total of 24 randomised
controlled trials, including 20 trials assessing postoperative delirium
and 6 trials assessing postoperative cognitive dysfunction. Across these
24 studies, a statistically significant positive association was observed
between intravenous administration of dexmedetomidine and a reduced
incidence of postoperative delirium (RR: 0.55; 95% CI 0.47 to 0.64, p <
0.00001, I² = 2%) and postoperative cognitive dysfunction (RR:
0.60; 95% CI 0.38 to 0.96, p = 0.03, I² = 60%). Subgroup
analysis did not reveal a significant difference in the incidence of
postoperative delirium between the general anaesthesia and non-general
anaesthesia groups, but a significant difference was observed in the
incidence of postoperative cognitive dysfunction. Nonetheless, when the
data were pooled, it was evident that the utilisation of dexmedetomidine
was associated with an increased incidence of hypotension (RR: 1.42; 95%
CI 1.08 to 1.86, p = 0.01, I² = 0%) and bradycardia (RR: 1.66;
95% CI 1.23 to 2.26, p = 0.001, I² = 0%) compared with other
interventions. However, there was no significantly higher occurrence of
hypertension in the DEX groups (RR = 1.35, 95% CI 0.81-2.24, p = 0.25,
I² = 0%). <br/>Conclusion(s): Compared with other
interventions, intravenous dexmedetomidine infusion during non-cardiac and
non-neurosurgical procedures may significantly reduce the risk of
postoperative delirium and cognitive dysfunction. The results of subgroup
analysis reveal a consistent preventive effect on postoperative delirium
in both general and non-general anaesthesia groups. Meanwhile, continuous
infusion during general anaesthesia was more effective in reducing the
risk of cognitive dysfunction. Despite such findings, hypotension and
bradycardia were more frequent in patients who received dexmedetomidine
during surgery.<br/>Copyright &#xa9; The Author(s) 2024.

<36>
Accession Number
2028951476
Title
Identification of Preoperative Risk Factors for the Development of Cardiac
Allograft Vasculopathy: A Systematic Review.
Source
Current Surgery Reports. 12(5) (pp 104-110), 2024. Date of Publication:
May 2024.
Author
Roberts W.S.; Pirovic A.; Ionescu A.; Ryan M.; Schaffer S.; Nguyen H.
Institution
(Roberts, Pirovic, Ionescu, Ryan, Schaffer) Osteopathic Medicine, Nova
Southeastern University Dr. Kiran C. Patel College of Osteopathic
Medicine, 3400 Gulf to Bay Blvd, Clearwater, FL 33759, United States
(Nguyen) Foundational Sciences, Nova Southeastern University Dr. Kiran C.
Patel College of Osteopathic Medicine, Clearwater, United States
Publisher
Springer
Abstract
Purpose of Review: The purpose of this systematic review was to analyze
the current literature and identify all known preoperative risk factors
associated with an increased incidence of cardiac allograft vasculopathy.
Recent Findings: A total of 7 independent preoperative risk factors for
cardiac allograft vasculopathy were identified, namely T. gondii
seropositivity (HR 4.39, 1.26-15.62, p < 0.02), elevated body mass index
(HR 1.116, 1.015-1.23, p < 0.02), 2-1 haptoglobin phenotype (HR 2.73,
1.03-7.19, p < 0.01), elevated low-density lipoproteins (OR 2.14,
1.02-4.46, p < 0.04), single-nucleotide polymorphism -201 matching (HR
11.9, 4.3-32.9, p < 0.01), stroke cause of death (HR 1.47, 1.04-2.09, p <
0.03), and pre-transplant hemodynamic instability (HR 1.79, 1.15-2.77, p <
0.01). <br/>Summary: Cardiac allograft vasculopathy is the leading cause
of death in patients who survive more than a few years following
transplantation and is likely the limiting factor in expanding the average
life expectancy post-transplant. The development of therapeutics targeting
the multifactorial etiology of this vasculopathy would undoubtedly provide
hope for patients whose time is currently limited.<br/>Copyright &#xa9;
The Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2024.

<37>
Accession Number
2031432636
Title
Comparison of risk stratification scoring system as a predictor of
mortality and morbidity in congenital heart disease patients requiring
surgery.
Source
Annals of Pediatric Cardiology. 16(5) (pp 349-353), 2023. Date of
Publication: 2023.
Author
Fakhri D.; Damayanti N.M.A.S.; Nurhanif M.
Institution
(Fakhri, Damayanti, Nurhanif) Department of Cardio-Thoracic-Vascular
Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(Fakhri) Department of Surgery, Pediatric and Congenital Heart Surgery
Unit, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Backgrounds: Risk stratification systems have been important in reducing
morbidity and mortality among congenital heart disease (CHD) patients
requiring cardiac surgery. Multiple risk stratification scoring systems
have been developed, including Aristotle Basic Complexity Score (ABC),
Aristotle Comprehensive Complexity Score (ACC), Society of Thoracic
Surgeons and European Association for Cardiothoracic Surgery (STS-EACTS),
and Risk Adjustment in Congenital Heart Surgery (RACHS-1). This study aims
to access the superior risk stratification scoring system model in
predicting mortality and morbidity. <br/>Method(s): The authors used
Embase, PubMed, Scopus, and ProQuest as the primary databases for
searching and included studies from hand searching. The area under the
receiver operating characteristic curve was compared. <br/>Result(s): A
total of 11 articles were included in this review. The AUC of ABC for
predicting mortality ranges from 0.59 to 0.71, and morbidity ranges from
0.673 to 0.743. The AUC of ACC score for predicting mortality ranges from
0.704 to 0.87, and a study revealed the AUC of morbidity is 0.730. The AUC
of RACHS-1 for predicting mortality ranges from 0.68 to 0.782. The AUC of
STS-EACTS for predicting mortality ranges from 0.739 to 0.8 and 0.732 for
predicting morbidity. <br/>Conclusion(s): ABC, ACC, RACHS-1, and STS-EACTS
have acceptable to excellent discriminatory ability in predicting
mortality and morbidity among CHD patients requiring cardiac
surgery.<br/>Copyright &#xa9; 2024 Annals of Pediatric Cardiology.

<38>
Accession Number
2031547438
Title
Postoperative Delirium with Intravenous Patient-controlled Analgesia
(IVPCA) Compared with Regional Analgesia for General Anesthesia:
Systematic Review and Meta-analysis.
Source
Iranian Red Crescent Medical Journal. 25(12) (no pagination), 2023.
Article Number: e2653. Date of Publication: December 2023.
Author
Vatankhah M.; Jahromi M.S.S.; Deilami M.; Ghaedi M.; Zabetian H.; Mehrpour
S.; Abiri S.; Taheri L.; Razavi B.M.; Zanbagh S.; Kalani N.; Adibi P.
Institution
(Vatankhah, Razavi, Zanbagh, Adibi) Anesthesiology, Critical Care and Pain
Management Research Center, Hormozgan University of Medical Sciences,
Bandar Abbas, Iran, Islamic Republic of
(Jahromi, Ghaedi, Zabetian) Research Center for Noncommunicable Diseases,
Jahrom University of Medical Sciences, Jahrom, Iran, Islamic Republic of
(Deilami) Department of Anesthesiology and Critical Care, 5 Azar Hospital,
Golestan University of Medical Sciences, Golestan, Iran, Islamic Republic
of
(Mehrpour) Department of Anesthesiology, Shahid Beheshti Hospital, Qom
University of Medical sciences, Qom, Iran, Islamic Republic of
(Abiri) Department of Emergency Medicine, Jahrom University of Medical
Sciences, Jahrom, Iran, Islamic Republic of
(Taheri) Department of Surgery, Jahrom University of Medical Sciences,
Jahrom, Iran, Islamic Republic of
(Kalani) Research Center for Social Determinants of Health, Jahrom
University of Medical Sciences, Jahrom, Iran, Islamic Republic of
Publisher
ZamenPub
Abstract
Background: Although the use of systemic narcotics has been established as
the gold standard in pain control after surgery, the literature shows the
possibility of a higher incidence of delirium after systemic
administration of analgesics compared to regional methods, such as
epidural and paravertebral analgesia. <br/>Objective(s): To compare the
rate of postoperative delirium when treated with systemic intravenous
patient-controlled analgesia (IVPCA) with regional analgesia methods
(continuous or patient-controlled). <br/>Method(s): We searched PubMed,
Web of Science, Embase, and Scopus databases for relevant papers reporting
delirium after surgery based on the regional analgesia methods compared
with systemic IV analgesia. Risk ratios for delirium were pooled using a
random effects model. <br/>Result(s): 6 randomized clinical trials (RCT)
with a total of 898 cases were selected in which delirium was observed 2
to 7 days after the operation. In a random-effect model of the risk ratio
of delirium in patients receiving IVPCA versus patients receiving regional
PCA, with 487 and 486 participants in each arm, there was a
retrospective1.85 -fold higher risk of delirium with a 95% confidence
interval of 1.35 to 2.53 compared with regional methods of analgesia
(I2=0%; low heterogenicity). Although we attempted a comprehensive review
of the literature, publication bias occurred, so we imputed the missing
studies to the literature by the trim-and-fill method, which forced us to
imput the missed studies of the literature by trim and fill method that
showed the similar adjusted results of RR=1.75, 95% CI: 1.29 to 2.39. The
RCTs assessed had relatively low quality evidence. <br/>Conclusion(s):
There appears to be a large difference in delirium risk between the
methods compared, with blinded trials with larger sample sizes required
Safety and cost-benefit aspects should also be considered before the
clinical application of these results.<br/>Copyright &#xa9; 2023,
Author(s).

<39>
Accession Number
2029423760
Title
Prominent crista terminalis mimicking a right atrial mass: a systematic
literature review and meta-analysis.
Source
Acta Radiologica. (no pagination), 2024. Date of Publication: 2024.
Author
Matusik P.S.; Mikrut K.; Bryll A.; Podolec M.; Popiela T.J.; Matusik P.T.
Institution
(Matusik, Bryll, Popiela) Department of Diagnostic Imaging, University
Hospital, Krakow, Poland
(Matusik, Popiela) Chair of Radiology, Jagiellonian University Medical
College, Krakow, Poland
(Mikrut) Department of Cardiology, The Ohio State University Wexner
Medical Center, Columbus, OH, United States
(Bryll) Jagiellonian University Medical College, Krakow, Poland
(Podolec) Department of Coronary Artery Disease and Heart Failure, St John
Paul II Hospital, Krakow, Poland
(Podolec) Center for Innovative Medical Education, Jagiellonian University
Medical College, Krakow, Poland
(Matusik) Department of Electrocardiology, Institute of Cardiology,
Faculty of Medicine, Jagiellonian University Medical College, Krakow,
Poland
(Matusik) Department of Electrocardiology, St John Paul II Hospital,
Krakow, Poland
Publisher
SAGE Publications Inc.
Abstract
The crista terminalis is an anatomical structure localized on the
posterolateral wall of the right atrium (RA). We performed a systematic
review of the literature and meta-analysis concerning cases of unusual
prominent crista terminalis mimicking RA mass. Moreover, we described the
differential diagnosis of cardiac masses with the use of echocardiography,
computed tomography, and cardiac magnetic resonance (CMR). We also
emphasize the potential importance of this structure in
electrophysiological procedures, including its role in exaggerated
arrhythmias. Prominent crista terminalis may be a potential obstacle
during invasive cardiac procedures or catheter ablation target. In
analyzed cases, the crista terminalis was often erroneously interpreted as
pathologic and at first confused with a thrombus or tumor during
transthoracic echocardiography examination. The correct final diagnoses
were mostly made with used transesophageal echocardiography or CMR. The
most important imaging findings suggestive of prominent crista terminalis
rather than tumor were a similar echogenicity/intensity with adjacent
myocardium, the location on posterolateral wall of the RA, the phasic
change in size, and no enhancement after contrast injection. We describe
up to date and detailed imaging features for the differential diagnostics
of selected intracardiac masses using various imaging techniques,
including multimodality cardiac imaging. Familiarity with the anatomy and
the imaging findings of the prominent crista terminalis will reduce
misdiagnosis and avoid additional tests and unwarranted clinical
interventions, while in patients considered for invasive cardiac
procedures it might increase their efficacy and safety.<br/>Copyright
&#xa9; The Foundation Acta Radiologica 2024.

<40>
Accession Number
2029413021
Title
Rationale and Design of the IMPROVE Trial: A Multicenter, Randomized,
Controlled, Open-label, Blinded-endpoint Trial Assessing the Efficacy of
Remote Ischemic Conditioning in Patients Undergoing Off-Pump Coronary
Artery Bypass Grafting.
Source
Advances in Therapy. (no pagination), 2024. Date of Publication: 2024.
Author
Yan Y.; Zhao C.; Niu J.; Yan P.; Li J.; Wang D.; Li G.
Institution
(Yan, Zhao, Niu, Yan, Li, Wang) Department of Cardiovascular Surgery, The
First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
(Li) Department of Cardiovascular Surgery, People's Hospital of Qinghai
Province, Xining, China
(Wang) Department of Clinical Sciences, Liverpool School of Tropical
Medicine, Pembroke Place, Liverpool, United Kingdom
(Wang) Department of Neurology, Guangdong Key Laboratory of Age-Related
Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical
University, Zhanjiang, China
(Li) Department of Cardiovascular Medicine, The First Affiliated Hospital
of Xi'an Jiaotong University, Xi'an, China
Publisher
Adis
Abstract
Introduction: Despite the appearance of off-pump coronary artery bypass
grafting (CABG), ischemia-reperfusion injury (IRI) in the perioperative
period still arouses concerns of clinicians. Remote ischemic conditioning
(RIC) is the process of repeated ischemia and reperfusion in the
peripheral vessels, which is proven to reduce IRI in vital organs.
However, the effect of RIC in patients undergoing off-pump CABG is still
unclear. <br/>Method(s): This IMPROVE trial is a national, multicenter,
randomized, controlled, open-label, blinded-endpoint clinical trial
designed to assess whether RIC intervention can improve short-term
prognosis of patients undergoing off-pump CABG. It plans to enroll 648
patients who will be randomly assigned into a RIC group or control group.
Patients in the RIC group will receive four cycles of 5 min of
pressurization (about 200 mmHg) and 5 min of rest in the 3 days before and
7 days after the surgery. Planned Outcomes: The primary outcome is the
occurrence of major adverse cardiovascular and cerebrovascular events
(MACCE) within the 3-month follow-up. MACCE is defined as all-cause death,
myocardial infarction, stroke, and coronary revascularization surgery.
Clinical Trial Registration: NCT06141525
(ClinicalTrials.gov).<br/>Copyright &#xa9; The Author(s), under exclusive
licence to Springer Healthcare Ltd., part of Springer Nature 2024.

<41>
Accession Number
2031785493
Title
Digital tools in cardiac reperfusion pathways: A systematic review.
Source
Future Healthcare Journal. 11(1) (no pagination), 2024. Article Number:
100128. Date of Publication: March 2024.
Author
Chhatwal K.; Deighton A.; Dhir A.; Kumar V.V.; Titus-Glover S.; Shah D.;
Holt L.
Institution
(Chhatwal) Medical student, Imperial College London, London, United
Kingdom
(Deighton) Foundation year 1 doctor, Homerton Healthcare NHS Foundation
Trust, London, United Kingdom
(Dhir) Foundation year 1 doctor, North Devon Healthcare NHS Foundation
Trust, Exeter, United Kingdom
(Kumar, Titus-Glover, Shah, Holt) Medical student, Barts and the London
School of Medicine and Dentistry, London, United Kingdom
Publisher
Elsevier B.V.
Abstract
With health and surgery increasingly aided by digital technologies, there
exists a growing impetus to understand how such tools must integrate into
existing clinical pathways to ensure a positive impact on patient and
organisational outcomes. Consequently, this study sought to collate
evidence on the use of digital technology in cardiac reperfusion
surgeries. We systematically searched three scientific databases for
relevant articles. In total, 1,092 articles were retrieved, with 126
screened using inclusion/exclusion criteria, and 21 selected for analysis.
Articles reported on the use of virtual reality, mHealth and telehealth in
cardiovascular reperfusion procedures, ranging from surgical training
regimens to postoperative rehabilitation. Here, despite clinical
advantages, limitations were highlighted, including cost, ineffective
interfaces and extensive training needed to operate novel digital tools.
Nevertheless with further development and input from patient stakeholders,
many limitations look set to dematerialise and provide tangible
improvements to the benefit of patients and hard-pressed health
institutions.<br/>Copyright &#xa9; 2024

<42>
Accession Number
2029524111
Title
Predictors, clinical impact, and management strategies for conduction
abnormalities after transcatheter aortic valve replacement: an updated
review.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1370244. Date of Publication: 2024.
Author
Yu Q.; Fu Q.; Xia Y.; Wu Y.
Institution
(Yu, Fu, Xia, Wu) Department of Cardiology, The Second Affiliated Hospital
of Nanchang University, Nanchang, China
Publisher
Frontiers Media SA
Abstract
Transcatheter aortic valve replacement (TAVR) has increasingly become a
safe, feasible, and widely accepted alternative surgical treatment for
patients with severe symptomatic aortic stenosis. However, the incidence
of conduction abnormalities associated with TAVR, including left bundle
branch block (LBBB) and high-degree atrioventricular block (HAVB), remains
high and is often correlated with risk factors such as the severity of
valvular calcification, preexisting conditions in patients, and procedural
factors. The existing research results on the impact of post-TAVR
conduction abnormalities and permanent pacemaker (PPM) requirements on
prognosis, including all-cause mortality and rehospitalization, remain
contradictory, with varied management strategies for post-TAVR conduction
system diseases across different institutions. This review integrates the
latest research in the field, offering a comprehensive discussion of the
mechanisms, risk factors, consequences, and management of post-TAVR
conduction abnormalities. This study provides insights into optimizing
patient prognosis and explores the potential of novel strategies, such as
conduction system pacing, to minimize the risk of adverse clinical
outcomes.<br/>Copyright 2024 Yu, Fu, Xia and Wu.

<43>
Accession Number
2029501272
Title
Inhaled NO at a crossroads in cardiac surgery: current need to improve
mechanistic understanding, clinical trial design and scientific evidence.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1374635. Date of Publication: 2024.
Author
Muenster S.; Zarragoikoetxea I.; Moscatelli A.; Balcells J.; Gaudard P.;
Pouard P.; Marczin N.; Janssens S.P.
Institution
(Muenster) Department of Anesthesiology and Intensive Care Medicine,
University Hospital Bonn, Bonn, Germany
(Zarragoikoetxea) Department of Anesthesiology and Intensive Care
Medicine, Hospital Universitari I Politecnic Fe, Valencia, Spain
(Moscatelli) Neonatal and Pediatric Intensive Care Unit, Emergency
Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
(Balcells) Pediatric Intensive Care Unit, Vall d'Hebron Barcelona Campus
Hospitalari, Universitari Vall d'Hebron, Barcelona, Spain
(Gaudard) [5] Department of Anesthesiology and Critical Care Medicine
Arnaud de Villeneuve, CHU Montpellier, University of Montpellier,
PhyMedExp, INSERM, CNRS, Montpellier, France
(Pouard) Department of Anesthesiology and Critical Care, Assistance
Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
(Marczin) Department of Surgery and Cancer, Imperial College, London,
United Kingdom
(Janssens) Cardiac Intensive Care, Department of Cardiovascular Diseases,
University Hospital Leuven, Leuven, Belgium
Publisher
Frontiers Media SA
Abstract
Inhaled nitric oxide (NO) has been used in pediatric and adult
perioperative cardiac intensive care for over three decades. NO is a
cellular signaling molecule that induces smooth muscle relaxation in the
mammalian vasculature. Inhaled NO has the unique ability to exert its
vasodilatory effects in the pulmonary vasculature without any hypotensive
side-effects in the systemic circulation. In patients undergoing cardiac
surgery, NO has been reported in numerous studies to exert beneficial
effects on acutely lowering pulmonary artery pressure and reversing right
ventricular dysfunction and/or failure. Yet, various investigations failed
to demonstrate significant differences in long-term clinical outcomes. The
authors, serving as an advisory board of international experts in the
field of inhaled NO within pediatric and adult cardiac surgery, will
discuss how the existing scientific evidence can be further improved. We
will summarize the basic mechanisms underlying the clinical applications
of inhaled NO and how this translates into the mandate for inhaled NO in
cardiac surgery. We will move on to the popular use of inhaled NO and will
talk about the evidence base of the use of this selective pulmonary
vasodilator. This review will elucidate what kind of clinical and
biological barriers and gaps in knowledge need to be solved and how this
has impacted in the development of clinical trials. The authors will
elaborate on how the optimization of inhaled NO therapy, the development
of biomarkers to identify the target population and the definition of
response can improve the design of future large clinical trials. We will
explain why it is mandatory to gain an international consensus for the
state of the art of NO therapy far beyond this expert advisory board by
including the different major players in the field, such as the different
medical societies and the pharma industry to improve our understanding of
the real-life effects of inhaled NO in large scale observational studies.
The design for future innovative randomized controlled trials on inhaled
NO therapy in cardiac surgery, adequately powered and based on enhanced
biological phenotyping, will be crucial to eventually provide scientific
evidence of its clinical efficacy beyond its beneficial hemodynamic
properties.<br/>Copyright 2024 Muenster, Zarragoikoetxea, Moscatelli,
Balcells, Gaudard, Pouard, Marczin and Janssens.

<44>
Accession Number
2029409422
Title
Mortality Rates in Patients Undergoing Urgent Versus Elective
Transcatheter Aortic Valve Replacement: A Meta-analysis.
Source
Angiology. (no pagination), 2024. Date of Publication: 2024.
Author
Apostolos A.; Ktenopoulos N.; Chlorogiannis D.-D.; Katsaros O.;
Konstantinou K.; Drakopoulou M.; Tsalamandris S.; Karanasos A.; Synetos
A.; Latsios G.; Aggeli C.; Panoulas V.; Tsioufis C.; Toutouzas K.
Institution
(Apostolos, Ktenopoulos, Katsaros, Drakopoulou, Tsalamandris, Karanasos,
Synetos, Latsios, Aggeli, Tsioufis, Toutouzas) First Department of
Cardiology, Medical School, Hippokration General Hospital, National and
Kapodistrian University of Athens, Athens, Greece
(Chlorogiannis) Department of Radiology, Brigham and Women's Hospital,
Boston, MA, United States
(Konstantinou, Panoulas) Department of Cardiology, Royal Brompton and
Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London,
United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Patients with severe aortic stenosis (AoS) often present with acute heart
failure and compensation, frequently leading to cardiogenic shock.
Transcatheter Aortic Valve Replacement (TAVR) has been recently performed
as a bailout treatment in such patients. The aim of our meta-analysis is
to compare urgent TAVR with elective procedures. We systematically
screened three databases searching for studies comparing urgent vs
elective TAVR. Primary endpoint is the 30-days mortality. Secondary
endpoints included in-hospital mortality, device success, periprocedural
vascular complications, 30-days stroke, 30-days acute kidney injury (AKI),
permanent pacemaker implantation (PPM), moderate or severe paravalvular
leakage, and 30-days bleeding. Seventeen studies were included, with a
total of 84,495 patients. Urgent TAVR was associated with an increased
risk for 30-days mortality [Risk Ratio (RR): 2.53, 95% Confidence
Intervals (CI): 1.81-3.54)], in-hospital mortality (RR: 2.67, 95% CI:
1.94-3.68), periprocedural vascular complications (RR: 1.91, 95% CI:
1.28-2.85) and AKI (RR: 2.83, 95% CI: 1.93-4.14), compared with elective
procedure. No differences were observed in the other secondary endpoints.
Urgent TAVR was associated with higher in-hospital and 30-days mortality,
possibly driven by the increased incidence of AKI and vascular
complications in urgent TAVR. The results highlight the importance of
early TAVR in stable AoS patients.<br/>Copyright &#xa9; The Author(s)
2024.

<45>
Accession Number
644019740
Title
Inspiratory Muscle Training in Phase 1 and 2 Postoperative Cardiac
Rehabilitation Following Coronary Artery Bypass Graft Surgery: Systematic
Review with Meta-Analysis.
Source
Physical therapy. (no pagination), 2024. Date of Publication: 16 Apr
2024.
Author
Araujo C.O.; Araujo Alves C.C.; Santos F.R.A.; Cahalin L.P.; Cipriano
G.F.B.; Cipriano G.
Institution
(Araujo, Araujo Alves, Santos, Cipriano, Cipriano) Science and Technology
in Health Program, University of Brasilia, Brasilia, Brazil
(Cahalin) Graduate Program in Human Movement and Rehabilitation of
Unievangelica, University of Goias, Anapolis, Brazil
(Cipriano, Cipriano) Science of Rehabilitation Program, University of
Brasilia, Brasilia, Brazil
(Cipriano) Department of Physical Therapy. Leonard M. Miller School of
Medicine. University of Miami, Miami, FL, United States
Abstract
OBJECTIVE: This study aimed to determine the effects of inspiratory muscle
training (IMT) on exercise capacity, respiratory muscle strength, length
of hospital stay (LOS), and quality of life (QOL) following coronary
artery bypass graft surgery. <br/>METHOD(S): The search was conducted in
accordance with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) and the Cochrane Handbook and included the
databases MEDLINE, EMBASE, CINAHL, Scopus, and CENTRAL. The review
included randomized controlled trials utilizing IMT during phase 1 or 2
postoperative cardiac rehabilitation (PoCR) versus alternative treatment
(active or passive control) in patients following coronary artery bypass
graft surgery. <br/>RESULT(S): Fifteen studies were included (11 phase 1
studies, 4 phase 2 studies) with no reported adverse events. In phase 1
PoCR, IMT reduced the LOS (-1.02 days; 95% CI=-2.00 to -0.03) and
increased exercise capacity (6-minute walk distance [6MWD]).(+75.46 m; 95%
CI=52.34 to 98.57), and maximal inspiratory pressure (MIP) (10.46 cm H2O;
95% CI=2.83 to 18.10), but had no effect on maximal expiratory pressure.
In phase 2 PoCR, IMT increased 6MWD (45.84 m; 95% CI=10.89 to 80.80), MIP
(-23.19 cm H2O; 95% CI=-31.31 to -15), maximal expiratory pressure (20.18
cm H2O; 95% CI=9.60 to 30.76), and QOL (-11.17; 95% CI=-17.98 to -4.36),
with no effect on peak oxygen uptake. There was a high risk of bias for
MIP (75% of the phase 1 studies) and 6MWT (1 of 4 phase 2 studies). The
quality of the evidence ranged from very low to moderate.
<br/>CONCLUSION(S): IMT significantly improves exercise capacity,
respiratory muscle strength, LOS, and QOL in phase 1 and 2 PoCR. IMPACT:
IMT may benefit patients during phase 1 and 2 of PoCR, considering the
safety, low cost, and potential benefits.<br/>Copyright &#xa9; The
Author(s) 2024. Published by Oxford University Press on behalf of the
American Physical Therapy Association. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.

<46>
Accession Number
644019538
Title
A review and analysis of outcomes in randomized clinical trials of plasma
transfusion in patients with bleeding or for the prevention of bleeding:
The BEST collaborative study.
Source
Transfusion. (no pagination), 2024. Date of Publication: 16 Apr 2024.
Author
Apelseth T.O.; Raza S.; Callum J.; Ipe T.; Blackwood B.; Akhtar A.; Hess
J.R.; Marks D.C.; Brown B.; Delaney M.; Wendel S.; Stanworth S.J.
Institution
(Apelseth) Department of Immunology and Transfusion Medicine, Haukeland
University Hospital, Bergen, Norway
(Apelseth) Faculty of Medicine, University of Bergen, Bergen, Norway
(Apelseth) Norwegian Armed Forces Joint Medical Services, Oslo, Norway
(Raza) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre and Queen's University, Kingston, Canada
(Ipe) Oklahoma CityOKUnited States
(Ipe) Department of Pathology, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Blackwood) Wellcome-Wolfson Institute for Experimental Medicine, Queen's
University, Belfast, United Kingdom
(Akhtar) Royal Victoria Hospital, Belfast, United Kingdom
(Hess) Department of Laboratory Medicine and Pathology, University of
Washington School of Medicine, Seattle, WA, United States
(Marks) Research and Development, Sydney, Australia
(Brown) Medical and Scientific Office, American Red Cross, WA, United
States
(Delaney) Childrens National Hospital, WA, United States
(Wendel) Hospital Sirio Libanes, Sao Paulo, Brazil
(Stanworth) NHSBT, Oxford University Hospitals NHS Trust; Blood
Transfusion Research Unit (BTRU), University of Oxford, Oxford, UK
Abstract
BACKGROUND: Previous systematic reviews have revealed an inconsistency of
outcome definitions as a major barrier in providing evidence-based
guidance for the use of plasma transfusion to prevent or treat bleeding.
We reviewed and analyzed outcomes in randomized controlled trials (RCTs)
to provide a methodology for describing and classifying outcomes. STUDY
DESIGN AND METHODS: RCTs involving transfusion of plasma published after
2000 were identified from a prior review (Yang 2012) and combined with an
updated systematic literature search of multiple databases (July 1, 2011
to January 17, 2023). Inclusion of publications, data extraction, and risk
of bias assessments were performed in duplicate. (PROSPERO registration
number is: CRD42020158581). <br/>RESULT(S): In total, 5579 citations were
identified in the new systematic search and 22 were included. Six
additional trials were identified from the previous review, resulting in a
total of 28 trials: 23 therapeutic and five prophylactic studies. An
increasing number of studies in the setting of major bleeding such as in
cardiovascular surgery and trauma were identified. Eighty-seven outcomes
were reported with a mean of 11 (min-max. 4-32) per study. There was
substantial variation in outcomes used with a preponderance of surrogate
measures for clinical effect such as laboratory parameters and blood
usage. <br/>CONCLUSION(S): There is an expanding literature on plasma
transfusion to inform guidelines. However, considerable heterogeneity of
reported outcomes constrains comparisons. A core outcome set should be
developed for plasma transfusion studies. Standardization of outcomes will
motivate better study design, facilitate comparison, and improve clinical
relevance for future trials of plasma transfusion.<br/>Copyright &#xa9;
2024 The Authors. Transfusion published by Wiley Periodicals LLC on behalf
of AABB.

<47>
Accession Number
644019095
Title
Long-term clinical outcomes of intravascular imaging-guided percutaneous
coronary intervention versus angiography-guided percutaneous coronary
intervention in complex coronary lesions: a systematic review and
meta-analysis.
Source
Future cardiology. (no pagination), 2024. Date of Publication: 16 Apr
2024.
Author
Ashraf D.A.; Ahmed U.; Khan Z.Z.; Mushtaq F.; Bano S.; Khan A.R.; Azam S.;
Haroon A.; Malik S.A.; Aslam R.; Kumar J.; Khan F.Z.; Faheem A.; Kumar S.;
Hassan S.
Institution
(Ashraf, Hassan) Department of Internal Medicine, Foundation University
Medical College, Islamabad 44000, Pakistan
(Ahmed) Department of Internal Medicine, Rawalpindi Medically University,
Rawalpindi 46000, Pakistan
(Khan) Department of Internal Medicine, CMH Lahore Medical & Dental
College, Lahore 54810, Pakistan
(Mushtaq) Department of Internal Medicine, Allama Iqbal Medical College,
Lahore 54700, Pakistan
(Bano) Department of Internal Medicine, Gujranwala Medical College,
Gujranwala, Pakistan
(Khan, Malik, Aslam) Department of Internal Medicine, Nishtar Medical
University, Multan 66000, Pakistan
(Azam) Department of Internal Medicine, Shaikh Khalifa Bin Zayed Al Nahyan
Medical & Dental College, Lahore, Pakistan
(Haroon) Department of Internal Medicine, Ziauddin Medical College,
Karachi 75600, Pakistan
(Kumar, Kumar) Department of Internal Medicine, Wayne State School of
Medicine, Detroit, United States
(Khan) Department of Internal Medicine, Al-Nafees Medical College,
Islamabad 44000, Pakistan
(Faheem) Department of Internal Medicine, Abbottabad Int. Medical College,
Abbottabad, Pakistan
Abstract
Background: In this study, we aim to discuss the long-term clinical
outcomes of intravascular ultrasound imaging-guided percutaneous
intervention (IVUS-PCI) versus angiography-guided percutaneous coronary
intervention (PCI) in complex coronary lesions over a mean period of 2
years. <br/>Method(s): A systematic search and meta-analysis were
conducted to assess the efficacy of using intravascular ultrasound or
optical coherence tomography guidance in coronary artery stenting compared
to angiography. <br/>Result(s): A total of 11 randomized controlled trials
with 6740 patients were included. For the primary outcome, a pooled
analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly
low in image-guided percutaneous intervention compared with angiography.
<br/>Conclusion(s): Intravascular imaging-guided PCI is significantly more
effective than angiography-guided PCI in reducing the risk of target
lesion revascularization, target vessel revascularization, cardiac death,
major adverse cardiovascular events and stent thrombosis.

<48>
Accession Number
2024818471
Title
Albumin Infusion and Blood Loss After Cardiac Surgery.
Source
Annals of Thoracic Surgery. 116(2) (pp 392-399), 2023. Date of
Publication: August 2023.
Author
Talvasto A.; Ilmakunnas M.; Raivio P.; Vlasov H.; Hiippala S.; Suojaranta
R.; Wilkman E.; Petaja L.; Helve O.; Juvonen T.; Pesonen E.
Institution
(Talvasto, Ilmakunnas, Vlasov, Hiippala, Suojaranta, Wilkman, Petaja,
Pesonen) Department of Anesthesiology and Intensive Care Medicine,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Raivio, Juvonen) Department of Cardiac Surgery, Heart and Lung Center,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Helve) Pediatric Research Center, Children's Hospital, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Helve) Department of Health Security, Finnish Institute for Health and
Welfare, Helsinki, Finland
Publisher
Elsevier Inc.
Abstract
Background: In the recent ALBICS (ALBumin In Cardiac Surgery) trial, 4%
albumin used for cardiopulmonary bypass priming and volume replacement
increased perioperative bleeding compared with Ringer acetate. In the
present exploratory study, albumin-related bleeding was further
characterized. <br/>Method(s): Ringer acetate and 4% albumin were compared
in a randomized, double-blinded fashion in 1386 on-pump adult cardiac
surgery patients. The study end points for bleeding were the Universal
Definition of Perioperative Bleeding (UDPB) class and its components.
<br/>Result(s): The UDPB bleeding grades were higher in the albumin group
than the Ringer group: "insignificant" (albumin vs Ringer: 47.5% vs
62.9%), "mild" (12.7% vs 8.9%), "moderate" (28.7% vs 24.4%), "severe"
(10.2% vs 3.2%), and "massive" (0.9% vs. 0.6%; P < .001). Patients in the
albumin group received red blood cells (45.2% vs 31.5%; odds ratio [OR],
1.80; 95% CI, 1.44-2.24; P < .001), platelets (33.3% vs 21.8%; OR, 1.79;
95% CI, 1.41-2.28; P < .001), and fibrinogen (5.6% vs 2.6%; OR, 2.24; 95%
CI, 1.27-3.95; P < .05), and underwent resternotomy (5.3% vs 1.9%; OR,
2.95; 95% CI, 1.55-5.60, P < .001) more often than patients in the Ringer
group. The strongest predictors of bleeding were albumin group allocation
(OR, 2.18; 95% CI, 1.74-2.74) and complex (OR, 2.61; 95% CI, 2.02-3.37)
and urgent surgery (OR, 1.63; 95% CI, 1.26-2.13). In interaction analysis,
the effect of albumin on the risk of bleeding was stronger in patients on
preoperative acetylsalicylic acid. <br/>Conclusion(s): Perioperative
administration of albumin, compared with Ringer's acetate, resulted in
increased blood loss and higher UDBP class. The magnitude of this effect
was similar to the complexity and urgency of the surgery.<br/>Copyright
&#xa9; 2023 The Society of Thoracic Surgeons

<49>
[Use Link to view the full text]
Accession Number
361103610
Title
Preoperative proteinuria predicts adverse renal outcomes after coronary
artery bypass grafting.
Source
Journal of the American Society of Nephrology. 22(1) (pp 156-163), 2011.
Date of Publication: January 2011.
Author
Huang T.-M.; Wu V.-C.; Young G.-H.; Lin Y.-F.; Shiao C.-C.; Wu P.-C.; Li
W.-Y.; Yu H.-Y.; Hu F.-C.; Lin J.-W.; Chen Y.-S.; Lin Y.-H.; Wang S.-S.;
Hsu R.-B.; Chang F.-C.; Chou N.-K.; Chu T.-S.; Yeh Y.-C.; Tsai P.-R.;
Huang J.-W.; Lin S.-L.; Chen Y.-M.; Ko W.-J.; Wu K.-D.
Institution
(Huang, Li, Lin, Lin, Chang, Chu) Department of Internal Medicine,
National Taiwan University Hospital, Yun-Lin Branch, Douliou City, Taiwan
(Republic of China)
(Wu, Lin, Wu, Lin, Huang, Lin, Chen, Wu) Department of Internal Medicine,
National Taiwan University Hospital and College of Medicine, National
Taiwan University, Taipei, Taiwan (Republic of China)
(Young, Yu, Chen, Wang, Hsu, Chou, Yeh, Tsai, Ko) Department of Surgery,
National Taiwan University Hospital and College of Medicine, National
Taiwan University, Taipei, Taiwan (Republic of China)
(Shiao) Division of Nephrology, Department of Internal Medicine, Saint
Mary's Hospital, Lotung, I-Lan County, Taiwan (Republic of China)
(Hu) Department of Medical Research, Graduate Institutes of Clinical
Medicine and Nursing, National Taiwan University, Taipei, Taiwan (Republic
of China)
Publisher
American Society of Nephrology
Abstract
Whether preoperative proteinuria associates with adverse renal outcomes
after cardiac surgery is unknown. Here, we performed a secondary analysis
of a prospectively enrolled cohort of adult patients undergoing coronary
artery bypass grafting (CABG) at a medical center and its two affiliate
hospitals between 2003 and 2007. We excluded patients with stage 5 CKD or
those who received dialysis previously. We defined proteinuria, measured
with a dipstick, as mild (trace to 1+) or heavy (2+ to 4+). Among a total
of 1052 patients, cardiac surgery-associated acute kidney injury (CSA-AKI)
developed in 183 (17.4%) patients and required renal replacement therapy
(RRT) in 50 (4.8%) patients. In a multiple logistic regression model, mild
and heavy proteinuria each associated with an increased odds of CSA-AKI,
independent of CKD stage and the presence of diabetes mellitus (mild: OR
1.66, 95% CI 1.09 to 2.52; heavy: OR 2.30, 95% CI 1.35 to 3.90). Heavy
proteinuria also associated with increased odds of postoperative RRT (OR
7.29, 95% CI 3.00 to 17.73). In summary, these data suggest that
preoperative proteinuria is a predictor of CSA-AKI among patients
undergoing CABG. Copyright &#xa9; 2011 by the American Society of
Nephrology.

<50>
[Use Link to view the full text]
Accession Number
2031588006
Title
Sugammadex shortens operation time and improves operation turnover
efficacy in video-assisted thoracoscopic surgery.
Source
Journal of the Chinese Medical Association. 87(4) (pp 448-452), 2024. Date
of Publication: 01 Apr 2024.
Author
Lin Y.-T.; Ting C.-K.; Hsu H.-S.
Institution
(Lin, Ting, Hsu) Institute of Emergency and Critical Care Medicine, School
of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
(Republic of China)
(Lin) Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
(Republic of China)
(Ting) Department of Anesthesiology, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
(Ting) Department of Anesthesiology, School of Medicine, National Yang
Ming Chiao Tung University, Taipei, Taiwan (Republic of China)
(Hsu) Division of Thoracic Surgery, Department of Surgery, Taipei Veterans
General Hospital, Taipei, Taiwan (Republic of China)
Publisher
Wolters Kluwer Health
Abstract
Background: This study compared sugammadex and neostigmine as agents for
routine neuromuscular blockade reversal in video-assisted thoracoscopic
surgery (VATS) to determine the optimal choice that achieves a shorter
operation time and improved turnover efficiency while enhancing
postoperative outcomes and ensuring patient safety during thoracic
surgery. <br/>Method(s): This prospective study, conducted from July 2022
to March 2023, compared the effect of sugammadex and neostigmine on
operation time and turnover efficiency in VATS, involving 60 participants
randomly assigned to either group, with the primary objective of
identifying the optimal anesthesia reversal choice for improved outcomes
and patient safety during thoracic surgery. <br/>Result(s): In the study,
the sugammadex group showed a significantly shorter total operation room
occupancy time (130 +/- 7 vs 157 +/- 7 minutes; p = 0.009) than the
neostigmine group. Patients in the neostigmine group had higher mean pulse
rates when leaving the operation room (85 +/- 3 vs 73 +/- 3 beats/min; p =
0.002) and 120 minutes later in the postanesthesia care unit (76 +/- 2 vs
68 +/- 2; p = 0.016). <br/>Conclusion(s): This study's findings suggest
that sugammadex may enhance total operating room occupancy time, operation
turnover efficacy, and respiratory recovery outcomes in VATS, potentially
improving patient care and anesthesia management.<br/>Copyright &#xa9;
2024 Wolters Kluwer Health. All rights reserved.

<51>
[Use Link to view the full text]
Accession Number
2031587859
Title
Aortic Valve Replacement: Is Minimally Invasive Really Better? A
Contemporary Systematic Review and Meta-Analysis.
Source
Cardiology in Review. 32(3) (pp 217-242), 2024. Date of Publication: 01
May 2024.
Author
El-Andari R.; Fialka N.M.; Shan S.; White A.; Manikala V.K.; Wang S.
Institution
(El-Andari, Shan, White, Manikala, Wang) The Division of Cardiac Surgery,
Department of Surgery, University of Alberta, Edmonton, AB, Canada
(Fialka) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
In recent years, minimally invasive cardiac surgery has increased in
prevalence. There has been significant debate regarding the optimal
approach to isolated aortic valve replacement between conventional midline
sternotomy and minimally invasive approaches. We performed a systematic
review of the contemporary literature comparing minimally invasive to full
sternotomy aortic valve replacement. PubMed and Embase were systematically
searched for articles published from 2010-2021. A total of 1215 studies
were screened and 45 studies (148,606 patients total) met the inclusion
criteria. This study found rates of in-hospital mortality were higher with
full sternotomy than ministernotomy (P = 0.02). 30-day mortality was
higher with full sternotomy compared to right anterior thoracotomy (P =
0.006). Renal complications were more common with full sternotomy versus
ministernotomy (P < 0.00001) and right anterior thoracotomy (P < 0.0001).
Rates of wound infections were greater with full sternotomy than
ministernotomy (P = 0.02) and right anterior thoracotomy (P < 0.00001).
Intensive care unit length of stay (P = 0.0001) and hospital length of
stay (P < 0.0001) were shorter with ministernotomy compared to full
sternotomy. This review found that minimally invasive approaches to
isolated aortic valve replacement result in reduced early mortality and
select measures of postoperative morbidity; however, long-term mortality
is not significantly different based on surgical approach. An analysis of
mortality alone is not sufficient for the selection of the optimal
approach to isolated aortic valve replacement. Surgeon experience,
individual patient characteristics, and preference require thorough
consideration, and additional studies investigating quality of life
measures will be imperative in identifying the optimal approach to
isolated aortic valve replacement.<br/>Copyright &#xa9; 2022 Wolters
Kluwer Health, Inc. All rights reserved.

<52>
[Use Link to view the full text]
Accession Number
2031587857
Title
Ultra-Early Hemostatic Therapy for Acute Intracerebral Hemorrhage: An
Updated Review.
Source
Cardiology in Review. 32(3) (pp 194-202), 2024. Date of Publication: 01
May 2024.
Author
Fortunato M.; Subah G.; Thomas A.D.; Nolan B.; Mureb M.; Uddin A.;
Upadhyay K.; Ogulnick J.V.; Damodara N.; Bond C.; Gandhi C.D.; Mayer S.A.;
Al-Mufti F.
Institution
(Fortunato) The School of Medicine, New York Medical College, Valhalla,
NY, United States
(Subah, Thomas, Nolan, Mureb, Uddin, Damodara, Gandhi, Mayer, Al-Mufti)
Department of Neurosurgery, Westchester Medical Center, New York Medical
College, Valhalla, NY, United States
(Upadhyay) Department of Medicine, New York University Langone, Long
Island, Mineola, NY, United States
(Ogulnick) Department of Neurology, Stony Brook University Hospital, Stony
Brook, NY, United States
(Bond) Department of Pharmacy, Westchester Medical Center, Valhalla, NY,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Intracerebral hemorrhage (ICH) is the second most common type of stroke,
accounting for approximately 10-20% of all strokes, and is linked to
severe neurological disability and death. Since the most accurate
predictor of outcome in patients with ICH is hematoma volume, there is a
great need for pharmacologic therapy that can reduce hematoma expansion
and resultant mass effect and edema. This is especially critical within
the ultra-early window of 3-4 hours after the presentation. Hemostatic
therapies are exceptionally important for those patients taking
antiplatelet or anticoagulant medications to reverse the effects of these
medications and therefore prevent hematoma expansion. Furthermore, the
recent publication of the 2023 Guideline for the Management of Patients
with Aneurysmal Subarachnoid Hemorrhage by the American Heart
Association/American Stroke Association, the first update to the
guidelines since 2012, underscores the importance of optimizing
anticoagulation reversal for this population. The purpose of this
selective, nonsystematic review is to examine current literature regarding
the use of hemostatic therapies in ICH, with particular attention paid to
antiplatelet, anticoagulation, and antifibrinolytic
therapies.<br/>Copyright &#xa9; 2024 Wolters Kluwer Health, Inc. All
rights reserved.

<53>
Accession Number
2031585206
Title
Perioperative mental health intervention for depression and anxiety
symptoms in older adults study protocol: design and methods for three
linked randomised controlled trials.
Source
BMJ Open. 14(4) (no pagination), 2024. Article Number: e082656. Date of
Publication: 03 Apr 2024.
Author
Holzer K.J.; Bartosiak K.A.; Calfee R.P.; Hammill C.W.; Haroutounian S.;
Kozower B.D.; Cordner T.A.; Lenard E.M.; Freedland K.E.; Tellor Pennington
B.R.; Wolfe R.C.; Miller J.P.; Politi M.C.; Zhang Y.; Yingling M.D.;
Baumann A.A.; Kannampallil T.; Schweiger J.A.; McKinnon S.L.; Avidan M.S.;
Lenze E.J.; Abraham J.
Institution
(Holzer, Haroutounian, Cordner, Tellor Pennington, Kannampallil, McKinnon,
Avidan, Abraham) Department of Anesthesiology, Washington University
School of Medicine in Saint Louis, St Louis, MO, United States
(Bartosiak, Calfee) Department of Orthopaedics, Washington University
School of Medicine in Saint Louis, St Louis, MO, United States
(Hammill, Kozower, Politi, Baumann) Department of Surgery, Washington
University School of Medicine in Saint Louis, St Louis, MO, United States
(Lenard, Freedland, Zhang, Yingling, Schweiger, Lenze) Department of
Psychiatry, Washington University School of Medicine in Saint Louis, St
Louis, MO, United States
(Wolfe) Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO,
United States
(Miller, Kannampallil, Abraham) Institute for Informatics, Data Science
and Biostatistics, Washington University School of Medicine in Saint
Louis, St. Louis, MO, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Preoperative anxiety and depression symptoms among older
surgical patients are associated with poor postoperative outcomes, yet
evidence-based interventions for anxiety and depression have not been
applied within this setting. We present a protocol for randomised
controlled trials (RCTs) in three surgical cohorts: cardiac, oncological
and orthopaedic, investigating whether a perioperative mental health
intervention, with psychological and pharmacological components, reduces
perioperative symptoms of depression and anxiety in older surgical
patients. Methods and analysis Adults >=60 years undergoing cardiac,
orthopaedic or oncological surgery will be enrolled in one of three-linked
type 1 hybrid effectiveness/ implementation RCTs that will be conducted in
tandem with similar methods. In each trial, 100 participants will be
randomised to a remotely delivered perioperative behavioural treatment
incorporating principles of behavioural activation, compassion and care
coordination, and medication optimisation, or enhanced usual care with
mental health-related resources for this population. The primary outcome
is change in depression and anxiety symptoms assessed with the Patient
Health Questionnaire-Anxiety Depression Scale from baseline to 3 months
post surgery. Other outcomes include quality of life, delirium, length of
stay, falls, rehospitalisation, pain and implementation outcomes,
including study and intervention reach, acceptability, feasibility and
appropriateness, and patient experience with the intervention. Ethics and
dissemination The trials have received ethics approval from the Washington
University School of Medicine Institutional Review Board. Informed consent
is required for participation in the trials. The results will be submitted
for publication in peer-reviewed journals, presented at clinical research
conferences and disseminated via the Center for Perioperative Mental
Health website.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2024.

<54>
Accession Number
2031585100
Title
Skeletal muscle relaxants as adjunctive pain control following
cardiothoracic surgery: a systematic review protocol.
Source
BMJ Open. 14(3) (no pagination), 2024. Article Number: e079685. Date of
Publication: 25 Mar 2024.
Author
Kabir S.; Whaley Q.; Fernandez M.; Murphy T.W.
Institution
(Kabir) College of Osteopathic Medicine, Nova Southeastern University
Health Professions Division, Fort Lauderdale, FL, United States
(Whaley, Fernandez, Murphy) Miami Transplant Institute, Miami, FL, United
States
(Murphy) Department of Surgery, Division of Emergency Medicine, University
of Miami School of Medicine, Miami, FL, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Multimodal pain control following cardiothoracic surgery
remains a focus in international guidelines. We hypothesise that
non-depolarising skeletal muscle relaxants can prove to be a useful
adjunct for this population. Methods/analysis This systematic review will
focus on human adult studies of pain control using muscle relaxants within
1 week following cardiac and thoracic surgery available in PubMed,
Cochrane Central, Web of Science and EMBASE. Target studies will have a
primary focus on measured effects on quality of pain control and reduction
in opioid usage. Studies that include non-depolarising skeletal muscle
relaxants given during cardiothoracic surgery or in the week after will be
included. Study selection will be in keeping with Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. Procedures and
agents used will be analysed together, and a meta-analysis will be
conducted then compared with current therapies recommended in
international practice guidelines. Ethics and dissemination Formal ethical
approval will not be required as primary data will not be collected. The
results will be disseminated through peer-reviewed publication, conference
presentation and lay press.<br/>Copyright &#xa9; Author(s) (or their
employer(s)) 2024.

<55>
[Use Link to view the full text]
Accession Number
2031563339
Title
Impact of Early Mobilization Within the Intensive Care Unit after Coronary
Artery Bypass Grafting: A Systematic Review.
Source
Cardiopulmonary Physical Therapy Journal. 35(2) (pp 56-70), 2024. Date of
Publication: 01 Apr 2024.
Author
Thomas B.; Morgan S.; Smith J.M.
Institution
(Thomas) School of Physical Therapy and Rehabilitation Sciences,
University of South Florida, Tampa, FL, United States
(Morgan) College of Nursing, University of South Florida, Tampa, FL,
United States
(Smith) Department of Physical Therapy, University of Connecticut, Storrs,
CT, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose:Coronary artery bypass grafting (CABG) surgery treats
complications from coronary artery diseases, and its recovery
traditionally consisted of bedrest. Recent research emphasizes the
benefits of early mobilization for hospitalized patients. However, the
functional outcomes and effectiveness of early mobilization for persons
within the intensive care units after CABG has not been investigated thus
far. The objective of this review was to determine the effectiveness of
early mobilization in reducing hospital and intensive care unit length of
stay (LoS) and improving functional outcomes of persons after CABG.
<br/>Method(s):This study was registered with PROSPERO and followed PRISMA
guidelines. PubMed, Embase, CINAHL, and PEDro databases were searched
using MeSH terms. Studies with early mobilization interventions for adults
in the intensive care unit after CABG that recorded outcomes of LoS or
functioning were included. Methodological quality was measured using the
PEDro scale and Oxford Level of Evidence. <br/>Result(s):This systematic
review collectively addressed 2280 participants through 14 studies in 7
countries. The initiation time frames for early mobilization varied, with
the majority beginning within 24 to 48 hours after surgery and
interventions were heterogenous. Early mobility was found to be effective
in reducing atelectasis, improving oxygen saturation, and decreasing time
spent on mechanical ventilation. Among early mobilization participants,
the LoS was reduced in all studies; intensive care unit LoS decreased by
one day or greater in 6 of 14 studies, and hospital LoS decreased by one
day or greater in 5 of 7 studies. <br/>Conclusion(s):Data analysis found
that early mobilization achieved better functional outcomes. It was found
that implementing early mobilization led to decreased intensive care and
hospital lengths of stay, reduced atelectasis and pleural effusion, and
improved functional and respiratory outcomes in persons who underwent CABG
surgery.<br/>Copyright &#xa9; Cardiovascular and Pulmonary Section, APTA.

<56>
[Use Link to view the full text]
Accession Number
2031563129
Title
Nondual Antiplatelet Therapy Versus Dual Antiplatelet Therapy before
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
Journal of Cardiovascular Pharmacology. 83(4) (pp 297-305), 2024. Date of
Publication: 06 Apr 2024.
Author
Zhang M.; Peng W.; Yin S.; Zhao Y.; Lin Y.
Institution
(Zhang, Peng, Yin, Zhao, Lin) Department of Pharmacy, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(Zhang, Yin, Zhao) School of Pharmaceutical Sciences, Capital Medical
University, Beijing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Transcatheter aortic valve replacement (TAVR) is an interventional
procedure performed in patients with severe aortic stenosis and often
required perioperative antiplatelet therapy. Most previous studies have
focused on antiplatelet therapy following TAVR. However, few studies have
investigated the prognostic effect of preoperative antiplatelet therapy in
patients undergoing TAVR. This study aimed to compare the efficacy and
safety of nondual antiplatelet therapy (non-DAPT) and DAPT before TAVR. We
performed a systematic search of Embase, PubMed, and Web of Science until
February 2023. Studies were eligible if they compared non-DAPT (single
antiplatelet therapy or no antiplatelet therapy) with DAPT in patients
before TAVR. A total of 5 studies, including 2329 patients, met the
inclusion criteria and were included in the meta-analysis. Preoperative
non-DAPT significantly decreased minor bleeding events compared with
preoperative DAPT [odds ratio 0.58; 95% confidence interval: 0.44-0.76].
There were no significant differences in the incidence of other bleeding
events, transfusions, stroke, myocardial infarction, or all-cause death.
Preoperative single antiplatelet therapy significantly decreased the
incidence of major bleeding compared with DAPT (odds ratio 0.14; 95%
confidence interval: 0.04-0.48). Preoperative non-DAPT significantly
reduced minor bleeding events in patients undergoing TAVR, without
increasing the risk of stroke and myocardial infarction.<br/>Copyright
&#xa9; 2024 Lippincott Williams and Wilkins. All rights reserved.

<57>
Accession Number
2029263078
Title
A systematic review and meta-analysis of the diagnosis and surgical
management of carcinoid heart disease.
Source
Frontiers in Cardiovascular Medicine. 11 (no pagination), 2024. Article
Number: 1353612. Date of Publication: 2024.
Author
Namkoong J.; Andraweera P.H.; Pathirana M.; Munawar D.; Downie M.; Edwards
S.; Averbuj P.; Arstall M.A.
Institution
(Namkoong, Andraweera, Pathirana, Munawar, Averbuj, Arstall) Department of
Cardiology, Lyell McEwin Hospital, SA Health, Elizabeth Vale, SA,
Australia
(Andraweera, Pathirana, Edwards, Arstall) Adelaide Medical School, The
University of Adelaide, North Terrace, Adelaide, SA, Australia
(Downie) SA Health Library Service, Lyell McEwin Hospital, SA Health,
Elizabeth Vale, SA, Australia
Publisher
Frontiers Media SA
Abstract
Introduction: Carcinoid heart disease (CHD), a complication of carcinoid
syndrome (CS), is a rare condition that can lead to right sided valvular
heart disease and has been traditionally associated with a poor prognosis.
We conducted a systematic review and meta-analysis to explore the accuracy
of biomarkers and echocardiography in diagnosing CHD amongst patients who
are already known to have neuroendocrine tumours and to assess whether
surgical management of CHD leads to a reduction in mortality.
<br/>Method(s): A systematic literature search of MEDLINE, EMBASE, EBM
Reviews, Google Scholar, ClinicalTrials.gov was conducted. All studies on
patients with carcinoid heart disease (CHD) reporting on biomarkers,
echocardiographic and surgical outcomes were included. The National Heart,
Lung, and Blood Institute quality assessment tool was used to assess the
methodological study quality. Data analysis was performed using Stata
Statistical Software and R Studio, and individual meta-analyses were
performed for biomarkers, echocardiographic findings, and surgical
outcomes. <br/>Result(s): A total of 36 articles were included in the
systematic review analysis. N terminal pro-brain natriuretic peptide
(NTproBNP) and 5-hydroxyindole acetate (5-HIAA) levels were higher in
patients with CHD compared with those without CHD. 32% of CS patients had
echocardiographic evidence of cardiac involvement, of which 79% involved
tricuspid valve abnormalities. Moderate-severe tricuspid regurgitation was
the most common echocardiographic abnormality (70% of patients). However,
these analyses had substantial heterogeneity due to the high variability
of cardiac involvement across studies. Pooled surgical mortality for CHD
was 11% at 1 month, 31% at 12 months and 56% at 24 months. When assessing
surgical outcomes longitudinally, the one-month surgical results showed a
trend towards more recent surgeries having lower mortality rates than
those reported in earlier years, however this was not statistically
significant. <br/>Discussion(s): There is not enough data in current
literature to determine a clear cut-off value of NTproBNP and 5-HIAA to
help diagnose or determine CHD severity. Surgical management of CHD is yet
to show significant mortality benefit, and there are no consistent
comparisons to medical treatment in current literature.<br/>Copyright 2024
Namkoong, Andraweera, Pathirana, Munawar, Downie, Edwards, Averbuj and
Arstall.

<58>
Accession Number
2029215132
Title
Right Ventricular Dysfunction before and after Cardiac Surgery: Prognostic
Implications.
Source
Journal of Clinical Medicine. 13(6) (no pagination), 2024. Article Number:
1609. Date of Publication: March 2024.
Author
Merlo A.; Cirelli C.; Vizzardi E.; Fiorendi L.; Roncali F.; Marino M.;
Merlo M.; Senni M.; Sciatti E.
Institution
(Merlo, Cirelli, Senni) School of Medicine and Surgery, University of
Milan-Bicocca, Milan 20126, Italy
(Vizzardi) Section of Cardiovascular Disease, Department of Medical and
Surgical Specialties, Radiological Sciences and Public Health, University
of Brescia, Brescia 25133, Italy
(Fiorendi, Roncali, Marino, Senni, Sciatti) Cardiology 1 Unit, ASST Papa
Giovanni XXIII, Bergamo 24121, Italy
(Merlo) Cardiac Surgery Unit, ASST Papa Giovanni XXIII, Bergamo 24121,
Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Right ventricular dysfunction is a prognostic factor for morbidity and
mortality across a broad spectrum of cardiovascular diseases. While the
role of the right ventricle in surgical patients has emerged, the
prognostic impact of right ventricular dysfunction remains unclear in a
large cardiac surgery population. We reviewed the existing literature
about the role of right ventricular dysfunction in adults undergoing
different kinds of cardiac surgery either present before or developed
after surgery itself. Pre- and post-operative right ventricular
dysfunction has demonstrated substantial prognostic implications. However,
there remains a lack of consensus regarding its definition and diagnostic
criteria. The available literature is limited to small-sized studies,
underscoring the need for studies with larger populations.<br/>Copyright
&#xa9; 2024 by the authors.

<59>
Accession Number
2029196830
Title
The Influence of High-Dose Parenteral Vitamin C on the Incidence and
Severity of Postoperative Pulmonary Complications in Cardiac Surgery with
Extracorporeal Circulation: A Randomized Controlled Trial.
Source
Nutrients. 16(6) (no pagination), 2024. Article Number: 761. Date of
Publication: March 2024.
Author
Karadzic Kocica M.; Ristic A.; Soldatovic I.; Lazovic D.; Cumic J.; Grujic
M.; Karan R.; Terzic D.; Palibrk I.; Kocica M.; Markovic D.
Institution
(Karadzic Kocica, Cumic, Karan, Markovic) Department of Anesthesiology,
Reanimatology and Intensive Care, Clinic for Cardiac Surgery, University
Clinical Centre of Serbia, Belgrade 11000, Serbia
(Karadzic Kocica, Ristic, Soldatovic, Lazovic, Cumic, Grujic, Karan,
Terzic, Palibrk, Markovic) School of Data Science, Fudan University,
Shanghai 200433, China
(Ristic) Clinic for Cardiology, University Clinical Centre of Serbia,
Belgrade 11000, Serbia
(Soldatovic) Department of Medical Statistics and Informatics, Medical
Faculty, University of Belgrade, Belgrade 11000, Serbia
(Lazovic, Grujic, Terzic, Kocica) Clinic for Cardiac Surgery, University
Clinical Centre of Serbia, Belgrade 11000, Serbia
(Palibrk) Department of Anesthesiology, Reanimatology and Intensive Care,
Clinic for Abdominal Surgery, University Clinical Centre of Serbia,
Belgrade 11000, Serbia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Cardiac surgery (CS) with extracorporeal circulation (ECC), induces
intense oxidative stress (OS) and systemic inflammatory response (SIR),
which may seriously affect postoperative lung function. We aimed to test
if high parenteral (200 mg/kg/24 h) daily doses of Vitamin C (VitC), given
within 48 h after the beginning of the operation, may reduce the incidence
and severity of postoperative pulmonary complications (PPCs) in CS
patients. This single-center, prospective, randomized, single-blinded,
interventional trial included 150 patients, assigned to control Group A (n
= 75) and interventional Group B (n = 75). Group B intraoperatively
received one-fourth (i.e., 50 mg/kg) of the planned daily Vit C dose,
divided into three equal parts and diluted in 10 mL of normal saline,
while Group A received an equal volume of normal saline at the same time
frames (i.e., the induction of anesthesia, aortic cross-clamp release, and
sternal closure). After 6 h from the first intraoperative dose, the
following regimen was applied: Group B: 50 mg/kg, 30 min i.v. infusion of
VitC in 50 mL of normal saline, every 6 h, for the next 48 h, and Group A:
30 min i.v. infusion of an equal volume of normal saline every 6 h, for
the next 48 h. Modified Kroenke's score was used to determine the
incidence and severity of PPCs. The overall incidence of PPCs was 36.7%
and was significantly lower in Group B (13.3% vs. 60.0%, p < 0.001). The
PPCs severity score was also significantly lower in Group B (1 vs. 3, p <
0.001). In addition, patients from Group B had significantly less damaged
lungs, better postoperative renal function, shorter ICU stays, fewer ICU
re-admissions, and lower hospital mortality. No VitC-related adverse
effects were recorded. High parenteral daily VitC doses given within 48 h
after the beginning of CS are safe and effective in reducing the incidence
and severity of PPCs. A multicenter RCT is needed to confirm these
results.<br/>Copyright &#xa9; 2024 by the authors.

<60>
Accession Number
2029134664
Title
Optimization of cardiopulmonary bypass prime fluid to preserve
microcirculatory perfusion during on-pump coronary artery bypass graft
surgery: PRIME study protocol for a double-blind randomized trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 219. Date of
Publication: December 2024.
Author
Beukers A.M.; Bulte C.S.E.; Bosch R.J.; Eberl S.; van den Brom C.E.; Loer
S.A.; Vonk A.B.A.
Institution
(Beukers, Bulte, van den Brom, Loer) Department of Anaesthesiology,
Amsterdam UMC, VU University Amsterdam, Boelelaan 1117, Amsterdam,
Netherlands
(Beukers, Bulte, van den Brom) Amsterdam Cardiovascular Sciences,
Amsterdam UMC, Amsterdam, Netherlands
(Bosch, Vonk) Department of Cardiothoracic Surgery, Amsterdam UMC,
University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
(Eberl) Department of Anesthesiology, Amsterdam UMC, University of
Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
(van den Brom) Laboratory for Experimental Intensive Care and
Anesthesiology (LEICA), Amsterdam, UMC, University of Amsterdam,
Amsterdam, Netherlands
(van den Brom) Department of Intensive Care Medicine, Amsterdam UMC,
University of Amsterdam, Amsterdam, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Acute microcirculatory perfusion disturbances and organ edema
are important factors leading to organ dysfunction during cardiac surgery
with cardiopulmonary bypass (CPB). Priming of the CPB system with
crystalloid or colloid fluids, which inevitably leads to hemodilution,
could contribute to this effect. However, there is yet no optimal
evidence-based strategy for this type of priming. Hence, we will
investigate different priming strategies to reduce hemodilution and
preserve microcirculatory perfusion. <br/>Method(s): The PRIME study is a
single-center double-blind randomized trial. Patients undergoing elective
coronary artery bypass graft surgery with CPB will be randomized into
three groups of prime fluid strategy: (1) gelofusine with crystalloid, (2)
albumin with crystalloid, or (3) crystalloid and retrograde autologous
priming. We aim to include 30 patients, 10 patients in each arm. The
primary outcome is the change in microcirculatory perfusion. Secondary
outcomes include colloid oncotic pressure; albumin; hematocrit;
electrolytes; fluid balance and requirements; transfusion rates; and
endothelial-, glycocalyx-, inflammatory- and renal injury markers.
Sublingual microcirculatory perfusion will be measured using non-invasive
sidestream dark field video microscopy. Microcirculatory and blood
measurements will be performed at five consecutive time points during
surgery up to 24 h after admission to the intensive care unit.
<br/>Discussion(s): PRIME is the first study to assess the effect of
different prime fluid strategies on microcirculatory perfusion in cardiac
surgery with CPB. If the results suggest that a specific crystalloid or
colloid prime fluid strategy better preserves microcirculatory perfusion
during on-pump cardiac surgery, the current study may help to find the
optimal pump priming in cardiac surgery. Trial registration:
ClinicalTrials.gov NCT05647057. Registered on 04/25/2023.
ClinicalTrials.gov PRS: Record Summary NCT05647057, all items can be found
in the protocol.<br/>Copyright &#xa9; The Author(s) 2024.

<61>
Accession Number
2029104315
Title
Trust in the Transplant Team Associated With the Level of Chronic Illness
Management-A Secondary Data Analysis of the International BRIGHT Study.
Source
Transplant International. 37 (no pagination), 2024. Article Number: 11704.
Date of Publication: 2024.
Author
Mielke J.; Cajita M.I.; Denhaerynck K.; Valenta S.; Dobbels F.; Russell
C.L.; De Geest S.
Institution
(Mielke, Denhaerynck, Valenta, De Geest) Department of Public Health,
Faculty of Medicine, Institute of Nursing Sciences, University of Basel,
Basel, Switzerland
(Cajita) College of Nursing, University of Illinois at Chicago, Chicago,
IL, United States
(Valenta) Practice Development and Research Division, Medical Directorate,
University Hospital Basel, Basel, Switzerland
(Dobbels, De Geest) Academic Center for Nursing and Midwifery, Department
of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven,
Belgium
(Russell) School of Nursing and Health Studies, Kansas City, MO, United
States
Publisher
Frontiers Media SA
Abstract
A trustful relationship between transplant patients and their transplant
team (interpersonal trust) is essential in order to achieve positive
health outcomes and behaviors. We aimed to 1) explore variability of trust
in transplant teams; 2) explore the association between the level of
chronic illness management and trust; 3) investigate the relationship of
trust on behavioral outcomes. A secondary data analysis of the BRIGHT
study (ID: NCT01608477;
https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was
conducted, including multicenter data from 36 heart transplant centers
from 11 countries across four different continents. A total of 1,397 heart
transplant recipients and 100 clinicians were enrolled. Trust
significantly varied among the transplant centers. Higher levels of
chronic illness management were significantly associated with greater
trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p <
0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012).
Consultation time significantly moderated the relationship between chronic
illness management levels and trust only when clinicians spent >=30 min
with patients. Trust was significantly associated with better diet
adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the
relevance of trust and chronic illness management in the transplant
ecosystem to achieve improved transplant outcomes. Thus, further
investment in re-engineering of transplant follow-up toward chronic
illness management, and sufficient time for consultations is
required.<br/>Copyright &#xa9; 2024 Mielke, Cajita, Denhaerynck, Valenta,
Dobbels, Russell, De Geest and the BRIGHT study team.

<62>
Accession Number
2027953782
Title
Outcomes of transcatheter aortic valve replacement in patients with mitral
annular calcification and concomitant mitral valve dysfunction: A
systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 61 (pp 99-109), 2024. Date of
Publication: April 2024.
Author
Ahmad S.; Yousaf A.; Ghumman G.M.; Dvalishvili M.; Ahsan M.J.; Dilibe A.;
Reis H.L.; Qavi A.H.; Szerlip M.; Goldsweig A.M.
Institution
(Ahmad, Goldsweig) Division of Cardiovascular Medicine, University of
Nebraska Medical Center, Omaha, NE, United States
(Yousaf) Department of Medicine, McLaren Flint-Michigan State University,
Flint, MI, United States
(Ghumman) Department of Cardiology, St. Vincent Mercy Medical Center,
Toledo, OH, United States
(Ahmad, Dvalishvili, Dilibe) Department of Medicine, East Carolina
University, Greenville, NC, United States
(Ahsan) Department of Cardiology, Iowa Heart Center, Des Moines, IA,
United States
(Reis) William E Laupus Health Sciences Library, East Carolina University,
Greenville, NC, United States
(Qavi) Division of Cardiovascular Medicine, East Carolina Heart Institute,
Greenville, NC, United States
(Szerlip) Department of Cardiology, Baylor Scott and White, The Heart
Hospital Plano, Plano, TX, United States
(Goldsweig) Department of Cardiology, Baystate Medical Center/UMass Chan
Medical School, Springfield, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Calcific aortic stenosis is the principal indication for
transcatheter aortic valve replacement (TAVR). Comorbid mitral annular
calcification (MAC) is often present in patients undergoing TAVR. Limited
data exist on the impact of MAC on TAVR outcomes. We conducted a
systematic review and meta-analysis to explore the effects of MAC and
concomitant mitral valve dysfunction (MVD) on TAVR outcomes.
<br/>Method(s): A comprehensive literature review was conducted using
PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for
studies until March 20, 2023. Using the random-effects Mantel-Haenszel
method, we calculated pooled risk ratios (RRs) and their corresponding 95
% confidence intervals (CIs) for all dichotomous variables.
<br/>Result(s): Six studies comprising 5822 patients (2541 with MAC
[severe MAC (>4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and
1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days
and 1 year, no significant differences were observed between the overall
MAC and no MAC groups in terms of mortality, stroke, and permanent
pacemaker implantation. However, MAC with MVD was associated with a higher
risk of all-cause mortality compared to MAC without MVD at 30 days (RR =
3.43, 95 % CI 2.04-5.76, P < 0.00001) and at 1 year (RR = 2.44, 95 % CI
1.85-3.20, P < 0.00001). Moreover, the risk of cardiovascular mortality
was higher in patients with MAC and MVD compared to those with MAC alone
(RR = 2.77, 95 % CI 1.89-4.06, P < 0.00001). Additionally, patients with
severe MAC had a higher risk of major bleeding at 30 days compared to the
non-severe MAC group (RR = 1.33, 95 % CI 1.04-1.69, P = 0.02).
<br/>Conclusion(s): TAVR appears to be safe in patients with non-severe
MAC, but severe MAC is associated with a higher risk of major bleeding and
concomitant MVD increases the mortality risk in patients undergoing
TAVR.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<63>
Accession Number
643898919
Title
Psychological interventions for depression and anxiety in patients with
coronary heart disease, heart failure or atrial fibrillation.
Source
Cochrane Database of Systematic Reviews. 2024(4) (no pagination), 2024.
Article Number: CD013508. Date of Publication: 05 Apr 2024.
Author
Ski C.F.; Taylor R.S.; McGuigan K.; Long L.; Lambert J.D.; Richards S.H.;
Thompson D.R.
Institution
(Ski, Thompson) School of Nursing and Midwifery, Queen's University
Belfast, Belfast, United Kingdom
(Ski) Australian Centre for Heart Health, Deakin University, Melbourne,
Australia
(Taylor) MRC/CSO Social and Public Health Sciences Unit & Robertson Centre
for Biostatistics, Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom
(McGuigan) Queen's Communities and Place, Queen's University Belfast,
Belfast, United Kingdom
(Long) MRC/CSO Social and Public Health Sciences Unit, School of Health
and Wellbeing, University of Glasgow, Glasgow, United Kingdom
(Lambert) Department for Health, University of Bath, Bath, United Kingdom
(Richards) Leeds Institute of Health Sciences, University of Leeds, Leeds,
United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Depression and anxiety occur frequently (with reported
prevalence rates of around 40%) in individuals with coronary heart disease
(CHD), heart failure (HF) or atrial fibrillation (AF) and are associated
with a poor prognosis, such as decreased health-related quality of life
(HRQoL), and increased morbidity and mortality. Psychological
interventions are developed and delivered by psychologists or specifically
trained healthcare workers and commonly include cognitive behavioural
therapies and mindfulness-based stress reduction. They have been shown to
reduce depression and anxiety in the general population, though the exact
mechanism of action is not well understood. Further, their effects on
psychological and clinical outcomes in patients with CHD, HF or AF are
unclear. <br/>Objective(s): To assess the effects of psychological
interventions (alone, or with cardiac rehabilitation or pharmacotherapy,
or both) in adults who have a diagnosis of CHD, HF or AF, compared to no
psychological intervention, on psychological and clinical outcomes.
<br/>Search Method(s): We searched the CENTRAL, MEDLINE, Embase, PsycINFO
and CINAHL databases from 2009 to July 2022. We also searched three
clinical trials registers in September 2020, and checked the reference
lists of included studies. No language restrictions were applied.
<br/>Selection Criteria: We included randomised controlled trials (RCTs)
comparing psychological interventions with no psychological intervention
for a minimum of six months follow-up in adults aged over 18 years with a
clinical diagnosis of CHD, HF or AF, with or without depression or
anxiety. Studies had to report on either depression or anxiety or both.
<br/>Data Collection and Analysis: We used standard Cochrane methods. Our
primary outcomes were depression and anxiety, and our secondary outcomes
of interest were HRQoL mental and physical components, all-cause mortality
and major adverse cardiovascular events (MACE). We used GRADE to assess
the certainty of evidence for each outcome. <br/>Main Result(s):
Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen
studies included people with CHD, five with HF and none with AF. Study
sample sizes ranged from 29 to 430. Twenty and 17 studies reported the
primary outcomes of depression and anxiety, respectively. Despite the high
heterogeneity and variation, we decided to pool the studies using a
random-effects model, recognising that the model does not eliminate
heterogeneity and findings should be interpreted cautiously. We found that
psychological interventions probably have a moderate effect on reducing
depression (standardised mean difference (SMD) -0.36, 95% confidence
interval (CI) -0.65 to -0.06; 20 studies, 2531 participants;
moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to
-0.18; 17 studies, 2235 participants; moderate-certainty evidence),
compared to no psychological intervention. Psychological interventions may
have little to no effect on HRQoL physical component summary scores (PCS)
(SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants;
low-certainty evidence), but may have a moderate effect on improving HRQoL
mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12
studies, 1454 participants; low-certainty evidence), compared to no
psychological intervention. Psychological interventions probably have
little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI
0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence)
and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4
studies, 450 participants; low-certainty evidence), compared to no
psychological intervention. Authors' conclusions: Current evidence
suggests that psychological interventions for depression and anxiety
probably result in a moderate reduction in depression and anxiety and may
result in a moderate improvement in HRQoL MCS, compared to no
intervention. However, they may have little to no effect on HRQoL PCS and
MACE, and probably do not reduce mortality (all-cause) in adults who have
a diagnosis of CHD or HF, compared with no psychological intervention.
There was moderate to substantial heterogeneity identified across studies.
Thus, evidence of treatment effects on these outcomes warrants careful
interpretation. As there were no studies of psychological interventions
for patients with AF included in our review, this is a gap that needs to
be addressed in future studies, particularly in view of the rapid growth
of research on management of AF. Studies investigating cost-effectiveness,
return to work and cardiovascular morbidity (revascularisation) are also
needed to better understand the benefits of psychological interventions in
populations with heart disease.<br/>Copyright &#xa9; 2024 The Authors.
Cochrane Database of Systematic Reviews published by John Wiley & Sons,
Ltd. on behalf of The Cochrane Collaboration.

<64>
Accession Number
2028637273
Title
Thinking Outside the Box: The Interventional Surgeon.
Source
Brazilian Journal of Cardiovascular Surgery. 39(3) (no pagination), 2024.
Article Number: e20230207. Date of Publication: 2024.
Author
Maia A.D.S.; Soares K.J.S.; Alvarado P.E.U.; da Silva F.V.A.; Mayer D.H.;
Camacho M.H.B.; da Fonseca J.H.A.P.
Institution
(Maia, Soares, Alvarado, da Silva) Department of Cardiovascular Surgery,
Instituto Dante Pazzanese de Cardiologia (IDPC), Sao Paulo, Sao Paulo,
Brazil
(Mayer, Camacho) Department of Cardiovascular Surgery, Hospital do Coracao
(HCor), Sao Paulo, Sao Paulo, Brazil
(da Fonseca) Department of Cardiovascular Surgery, Instituto do Coracao
(InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Advances in treatment of structural heart disease have been disruptive to
cardiovascular surgery, and there have been discussions about how to
incorporate these technologies into the surgeons' therapeutic arsenal.
Transcatheter procedures, complex redo interventions, and endovascular
aortic approaches are already practiced by cardiovascular surgeons in
Brazil. The expansion of these techniques,coupled with recent changes in
the country's medical residency program in cardiovascular surgery, has led
to an urgent need to acquire catheter-based skills. In this article, we
discuss these aspects in the light of the reality of cardiovascular
surgery training in Brazil.<br/>Copyright &#xa9; 2024, Sociedade
Brasileira de Cirurgia Cardiovascular. All rights reserved.

<65>
Accession Number
2031273549
Title
Immediate postnatal prediction of death or bronchopulmonary dysplasia
among very preterm and very low birth weight infants based on gradient
boosting decision trees algorithm: A nationwide database study in Japan.
Source
PLoS ONE. 19(3 March) (no pagination), 2024. Article Number: e0300817.
Date of Publication: March 2024.
Author
Yoneda K.; Seki T.; Kawazoe Y.; Ohe K.; Takahashi N.
Institution
(Yoneda, Takahashi) Department of Pediatrics, The University of Tokyo
Hospital, Tokyo, Japan
(Seki, Kawazoe, Ohe) Department of Healthcare Information Management, The
University of Tokyo Hospital, Tokyo, Japan
(Kawazoe) Artificial Intelligence and Digital Twin in Healthcare, Graduate
School of Medicine, The University of Tokyo, Tokyo, Japan
(Ohe) Department of Biomedical Informatics, Graduate School of Medicine,
The University of Tokyo, Tokyo, Japan
Publisher
Public Library of Science
Abstract
Bronchopulmonary dysplasia (BPD) poses a substantial global health burden.
Individualized treatment strategies based on early prediction of the
development of BPD can mitigate preterm birth complications; however,
previously suggested predictive models lack early postnatal applicability.
We aimed to develop predictive models for BPD and mortality based on
immediate postnatal clinical data. Methods Clinical information on very
preterm and very low birth weight infants born between 2008 and 2018 was
extracted from a nationwide Japanese database. The gradient boosting
decision trees (GBDT) algorithm was adopted to predict BPD and mortality,
using predictors within the first 6 h postpartum. We assessed the temporal
validity and evaluated model adequacy using Shapley additive explanations
(SHAP) values. Results We developed three predictive models using data
from 39,488, 39,096, and 40,291 infants to predict "death or BPD," "death
or severe BPD," and "death before discharge," respectively. These
well-calibrated models achieved areas under the receiver operating
characteristic curve of 0.828 (95% CI: 0.828-0.828), 0.873 (0.873-0.873),
and 0.887 (0.887-0.888), respectively, outperforming the multivariable
logistic regression models. SHAP value analysis identified predictors of
BPD, including gestational age, size at birth, male sex, and persistent
pulmonary hypertension. In SHAP value-based case clustering, the "death or
BPD" prediction model stratified infants by gestational age and persistent
pulmonary hypertension, whereas the other models for "death or severe BPD"
and "death before discharge" commonly formed clusters of low mortality,
extreme prematurity, low Apgar scores, and persistent pulmonary
hypertension of the newborn. Conclusions GBDT models for predicting BPD
and mortality, designed for use within 6 h postpartum, demonstrated
superior prognostic performance. SHAP value-based clustering, a
data-driven approach, formed clusters of clinical relevance. These
findings suggest the efficacy of a GBDT algorithm for the early postnatal
prediction of BPD.<br/>Copyright: &#xa9; 2024 Yoneda 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.

<66>
Accession Number
2028952945
Title
Results beyond 5-years of surgery or percutaneous approach in severe
coronary disease. Reconstructed time-to-event meta-analysis of randomized
trials.
Source
Revista Espanola de Cardiologia. 77(5) (pp 383-392), 2024. Date of
Publication: May 2024.
Author
Formica F.; Hernandez-Vaquero D.; Tuttolomondo D.; Gallingani A.; Singh
G.; Pattuzzi C.; Niccoli G.; Lorusso R.; Nicolini F.
Institution
(Formica, Pattuzzi, Niccoli, Nicolini) Department of Medicine and Surgery,
University of Parma, Parma, Italy
(Hernandez-Vaquero) Cardiac Surgery Department, Hospital Universitario
Central de Asturias, Oviedo, Spain
(Tuttolomondo, Niccoli) Cardiology Unit, University Hospital of Parma,
Parma, Italy
(Gallingani, Pattuzzi, Nicolini) Cardiac Surgery Unit, University Hospital
of Parma, Parma, Italy
(Singh) Department of Critical Care Medicine and Division of Cardiac
Surgery, Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Lorusso) Cardio-Thoracic Department, Maastricht University Medical
Centre, Heart and Vascular Centre, Maastricht, Netherlands
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: There is controversy about the optimal
revascularization strategy in severe coronary artery disease (CAD),
including left main disease and/or multivessel disease. Several
meta-analyses have analyzed the results at 5-year follow-up but there are
no results after the fifth year. We conducted a systematic review and
meta-analysis of randomized clinical trials, comparing results after the
fifth year, between coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI) using drug-eluting stents in
patients with severe CAD. <br/>Method(s): We analyzed all clinical trials
between January 2010 and January 2023. The primary endpoint was all-cause
mortality. The databases of the original articles were reconstructed from
Kaplan-Meier curves, simulating an individual-level meta-analysis.
Comparisons were made at certain cutoff points (5 and 10 years). The
10-year restricted median survival time difference between CABG and PCI
was calculated. The random effects model and the DerSimonian-Laird method
were applied. <br/>Result(s): The meta-analysis included 5180 patients.
During the 10-year follow-up, PCI showed a higher overall incidence of
all-cause mortality (HR, 1.19; 95%CI, 1.04-1.32; P = .008)]. PCI showed an
increased risk of all-cause mortality within 5 years (HR, 1.2; 95%CI,
1.06-1.53; P = .008), while no differences in the 5-10-year period were
revealed (HR, 1.03; 95%CI, 0.84-1.26; P = .76). Life expectancy of CABG
patients was slightly higher than that of PCI patients (2.4 months more).
<br/>Conclusion(s): In patients with severe CAD, including left main
disease and/or multivessel disease, there was higher a incidence of
all-cause mortality after PCI compared with CABG at 10 years of follow-up.
Specifically, PCI has higher mortality during the first 5 years and
comparable risk beyond 5 years.<br/>Copyright &#xa9; 2023 Sociedad
Espanola de Cardiologia

<67>
Accession Number
2031605604
Title
Association of Mechanical Energy and Power with Postoperative Pulmonary
Complications in Lung Resection Surgery: A Post Hoc Analysis of Randomized
Clinical Trial Data.
Source
Anesthesiology. 140(5) (pp 920-934), 2024. Date of Publication: 01 May
2024.
Author
Yoon S.; Nam J.-S.; Blank R.S.; Ahn H.J.; Park M.; Kim H.; Kim H.J.; Choi
H.; Kang H.-U.; Lee D.-K.; Ahn J.
Institution
(Yoon) Department of Anesthesiology and Pain Medicine, Seoul National
University Hospital, University of Seoul National College of Medicine,
Seoul, South Korea
(Nam, Kang, Lee) Department of Anesthesiology and Pain Medicine, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
(Blank) Department of Anesthesiology, University of Virginia Health
System, Charlottesville, VA, United States
(Ahn, Park) Department of Anesthesiology and Pain Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Kim) Department of Anesthesiology and Pain Medicine, Korea University
Guro Hospital, Korea University College of Medicine, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, and Anesthesia and
Pain Research Institute, Yonsei University College of Medicine, Seoul,
South Korea
(Choi) Department of Anesthesiology and Pain Medicine, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Ahn) Biomedical Statistics Center, Data Science Research Institute,
Research Institute for Future Medicine, Samsung Medical Center, Seoul,
South Korea
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Mechanical power (MP), the rate of mechanical energy (ME)
delivery, is a recently introduced unifying ventilator parameter
consisting of tidal volume, airway pressures, and respiratory rates, which
predicts pulmonary complications in several clinical contexts. However, ME
has not been previously studied in the perioperative context, and neither
parameter has been studied in the context of thoracic surgery utilizing
one-lung ventilation. <br/>Method(s): The relationships between ME
variables and postoperative pulmonary complications were evaluated in this
post hoc analysis of data from a multicenter randomized clinical trial of
lung resection surgery conducted between 2020 and 2021 (n = 1,170).
Time-weighted average MP and ME (the area under the MP time curve) were
obtained for individual patients. The primary analysis was the association
of time-weighted average MP and ME with pulmonary complications within 7
postoperative days. Multivariable logistic regression was performed to
examine the relationships between energy variables and the primary
outcome. <br/>Result(s): In 1,055 patients analyzed, pulmonary
complications occurred in 41% (431 of 1,055). The median (interquartile
ranges) ME and time-weighted average MP in patients who developed
postoperative pulmonary complications versus those who did not were 1,146
(811 to 1,530) J versus 924 (730 to 1,240) J (P < 0.001), and 6.9 (5.5 to
8.7) J/min versus 6.7 (5.2 to 8.5) J/min (P = 0.091), respectively. ME was
independently associated with postoperative pulmonary complications
(ORadjusted, 1.44 [95% CI, 1.16 to 1.80]; P = 0.001). However, the
association between time-weighted average MP and postoperative pulmonary
complications was time-dependent, and time-weighted average MP was
significantly associated with postoperative pulmonary complications in
cases utilizing longer periods of mechanical ventilation (210 min or
greater; ORadjusted, 1.46 [95% CI, 1.11 to 1.93]; P = 0.007).
Normalization of ME and time-weighted average MP either to predicted body
weight or to respiratory system compliance did not alter these
associations. <br/>Conclusion(s): ME and, in cases requiring longer
periods of mechanical ventilation, MP were independently associated with
postoperative pulmonary complications in thoracic surgery.<br/>Copyright
&#xa9; 2024 Lippincott Williams and Wilkins. All rights reserved.

<68>
[Use Link to view the full text]
Accession Number
2031689702
Title
Renin as a Prognostic Marker in Intensive Care and Perioperative Settings:
A Scoping Review.
Source
Anesthesia and Analgesia. 138(5) (pp 929-936), 2024. Date of Publication:
01 May 2024.
Author
Kotani Y.; Belletti A.; Maiucci G.; Lodovici M.; Fresilli S.; Landoni G.;
Bellomo R.; Zarbock A.
Institution
(Kotani, Belletti, Maiucci, Lodovici, Fresilli, Landoni) Department of
Anesthesia and Intensive Care, IRCCS, San Raffaele Scientific Institute,
Milan, Italy
(Kotani, Landoni) School of Medicine, Vita-Salute San Raffaele University,
Milan, Italy
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, VIC, Australia
(Bellomo) Department of Critical Care, Australian and New Zealand
Intensive Care Research Centre, Monash University, Melbourne, VIC,
Australia
(Zarbock) Department of Anesthesiology, Intensive Care Medicine and Pain
Therapy, University Hospital Muenster, Muenster, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Serum renin increases in response to sympathetic nerve activation and
hypotension. Recent studies have reported the association of serum renin
levels with adverse clinical outcomes in acute care settings. This scoping
review aimed to systematically review the available literature on renin as
a prognostic marker in intensive care and perioperative patients. We
searched for studies published since inception until March 31, 2023, which
assessed the association between serum renin levels and clinical outcomes
or the effect of synthetic angiotensin II administration on serum renin
levels in critically ill and perioperative patients in PubMed, Embase, and
the Cochrane Library. The primary outcome was mortality at the longest
follow-up; the secondary outcomes were adverse renal outcomes (ie, acute
kidney injury, the need for renal replacement therapy, and major adverse
kidney events), hemodynamic instability, outcomes to angiotensin II
administration, and prognostic performance for mortality when compared
with lactate. Among the 2081 studies identified, we included 16 studies
with 1573 patients (7 studies on shock, 5 on nonspecific critical illness,
2 on cardiac surgery, 1 on noncardiac surgery, and 1 on coronavirus
disease 2019). A significant association between serum renin levels and
poor outcomes was identified in 14 studies, with 10 studies demonstrating
an association with mortality. One post hoc analysis found that
angiotensin II administration reduced mortality in patients with markedly
elevated renin values. Two studies showed that renin was superior to
lactate as a prognostic marker of mortality. Our scoping review showed
that elevated serum renin levels may be associated with clinically
relevant outcomes among various perioperative and intensive care
populations. Increased serum renin levels may identify patients in which
synthetic angiotensin II administration improves clinical outcomes and may
outperform serum lactate in predicting mortality.<br/>Copyright &#xa9;
2024 Lippincott Williams and Wilkins. All rights reserved.

<69>
Accession Number
2029493658
Title
The Preoperative Assessment of Frailty in the Setting of Transcatheter
Aortic Valve Implantation (TAVI): A Systematic Review.
Source
SN Comprehensive Clinical Medicine. 6(1) (no pagination), 2024. Article
Number: 48. Date of Publication: December 2024.
Author
Martocchia A.; Vero L.; Pezzella D.; Sciaulino S.; Caracciolo L.; De Biase
L.; Berni A.; Bianchini R.; Martelletti P.; Sesti G.
Institution
(Martocchia, Vero, Pezzella, Sciaulino, Caracciolo, Sesti) Internal
Medicine Unit, S.Andrea Hospital, Sapienza University of Rome, Via Di
Grottarossa 1035, Rome 00189, Italy
(De Biase) Heart Failure Unit, Clinical and Molecular Medicine Department,
S.Andrea Hospital, Sapienza University of Rome, Rome, Italy
(Berni) Hemodynamic Unit, S.Andrea Hospital, Sapienza University of Rome,
Rome, Italy
(Bianchini) Cardiac Surgery Unit, S.Andrea Hospital, Sapienza University
of Rome, Rome, Italy
(Martelletti) Emergency Medicine Unit, S.Andrea Hospital, Sapienza
University of Rome, Rome, Italy
Publisher
Springer Nature
Abstract
Increasing evidence in the literature suggests the assessment of the
frailty in the patients before the transcatheter aortic valve implantation
(TAVI), but there is still a matter of debate about the standardized
method to be used. We searched online the medical literature database
(PubMed) from 2006 to 2023, covering the 17-year period that marked the
development of the minimally invasive approach. We retrieved n.218
articles and 64 studies were evaluated. The preoperative assessment of
frailty in the setting of the TAVI is a key point of the evaluation by the
heart team in order to identify the patients at low or high risk of
complications after surgery and to support the clinical decision in
allocating the health care resources.<br/>Copyright &#xa9; The Author(s),
under exclusive licence to Springer Nature Switzerland AG 2024.

<70>
Accession Number
2031774883
Title
Ventilatory efficiency as a prognostic factor for postoperative
complications in patients undergoing elective major surgery: a systematic
review.
Source
British Journal of Anaesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Vetsch T.; Eggmann S.; Jardot F.; von Gernler M.; Engel D.; Beilstein
C.M.; Wuethrich P.Y.; Eser P.; Wilhelm M.
Institution
(Vetsch, Jardot, Engel, Beilstein, Wuethrich) Department of
Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
(Vetsch, Eser, Wilhelm) Centre for Rehabilitation & Sports Medicine,
Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
(Vetsch) Graduate School for Health Sciences, University of Bern, Bern,
Switzerland
(Eggmann) Department of Physiotherapy, Inselspital, Bern University
Hospital, Bern, Switzerland
(von Gernler) Medical Library, University Library of Bern, University of
Bern, Bern, Switzerland
Publisher
Elsevier Ltd
Abstract
Background: Major surgery is associated with high complication rates.
Several risk scores exist to assess individual patient risk before surgery
but have limited precision. Novel prognostic factors can be included as
additional building blocks in existing prediction models. A candidate
prognostic factor, measured by cardiopulmonary exercise testing, is
ventilatory efficiency (VE/VCO<inf>2</inf>). The aim of this systematic
review was to summarise evidence regarding VE/VCO<inf>2</inf> as a
prognostic factor for postoperative complications in patients undergoing
major surgery. <br/>Method(s): A medical library specialist developed the
search strategy. No database-provided limits, considering study types,
languages, publication years, or any other formal criteria were applied to
any of the sources. Two reviewers assessed eligibility of each record and
rated risk of bias in included studies. <br/>Result(s): From 10,082
screened records, 65 studies were identified as eligible. We extracted
adjusted associations from 32 studies and unadjusted from 33 studies. Risk
of bias was a concern in the domains 'study confounding' and 'statistical
analysis'. VE/VCO<inf>2</inf> was reported as a prognostic factor for
short-term complications after thoracic and abdominal surgery.
VE/VCO<inf>2</inf> was also reported as a prognostic factor for mid- to
long-term mortality. Data-driven covariable selection was applied in 31
studies. Eighteen studies excluded VE/VCO<inf>2</inf> from the final
multivariable regression owing to data-driven model-building approaches.
<br/>Conclusion(s): This systematic review identifies VE/VCO<inf>2</inf>
as a predictor for short-term complications after thoracic and abdominal
surgery. However, the available data do not allow conclusions about
clinical decision-making. Future studies should select covariables for
adjustment a priori based on external knowledge. Systematic review
protocol: PROSPERO (CRD42022369944).<br/>Copyright &#xa9; 2024 British
Journal of Anaesthesia

<71>
Accession Number
2031653427
Title
Epidural Catheterization in Cardiac Surgery: A Systematic Review and Risk
Assessment of Epidural Hematoma.
Source
Annals of Cardiac Anaesthesia. 27(2) (pp 111-120), 2024. Date of
Publication: 2024.
Author
Laferriere-Langlois P.; Jeffries S.; Harutyunyan R.; Hemmerling T.M.
Institution
(Laferriere-Langlois) Department of Anaesthesiology and Pain Medicine,
Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de L'Ile de Montreal,
Montreal, QC, Canada
(Jeffries, Harutyunyan, Hemmerling) Department of Experimental Surgery,
McGill University Health Centre, Montreal, Canada
(Jeffries, Harutyunyan, Hemmerling) Intelligent Technology Anaesthesia
Group (ITAG) Laboratory, McGill University, Montreal, Canada
Publisher
Wolters Kluwer Medknow Publications
Abstract
The potential benefits of epidural anesthesia on mortality, atrial
fibrillation, and pulmonary complications must be weighed against the risk
of epidural hematoma associated with intraoperative heparinization. This
study aims to provide an updated assessment of the clinical risks of
epidural anesthesia in cardiac surgery, focusing on the occurrence of
epidural hematomas and subsequent paralysis. A systematic search of
Embase, Medline, Ovid Central, Web of Science, and PubMed was conducted to
identify relevant publications between 1966 and 2022. Two independent
reviewers assessed the eligibility of the retrieved manuscripts. Studies
reporting adult patients undergoing cardiac surgery with epidural
catheterization were included. The incidence of hematomas was calculated
by dividing the number of hematomas by the total number of patients in the
included studies. Risk calculations utilized various denominators based on
the rigor of trial designs, and the risks of hematoma and paralysis were
compared to other commonly encountered risks. The analysis included a
total of 33,089 patients who underwent cardiac surgery with epidural
catheterization. No epidural hematomas were reported across all published
RCTs, prospective, and retrospective trials. Four case reports associated
epidural hematoma with epidural catheterization and perioperative
heparinization. The risks of epidural hematoma and subsequent paralysis
were estimated at 1:7643 (95% CI 1:3860 to 380,916) and 1:10,190 (95% CI
1:4781 to 0:1), respectively. The risk of hematoma is similar to the
non-obstetric population (1:5405; 95% CI 1:4784 to 6134). The risk of
hematoma in cardiac surgery patients receiving epidural anesthesia is
therefore similar to that observed in some other surgical non-obstetric
populations commonly exposed to epidural catheterization.<br/>Copyright
&#xa9; 2024 Annals of Cardiac Anaesthesia.

<72>
Accession Number
2031653423
Title
Incidence and Risk Factors for Postoperative Visual Loss after Cardiac
Surgical Procedures: A Systematic Review.
Source
Annals of Cardiac Anaesthesia. 27(2) (pp 101-110), 2024. Date of
Publication: 2024.
Author
Gupta B.; Singla D.; Gupta A.; Mahaseth R.
Institution
(Gupta, Singla, Mahaseth) Departments of Anaesthesiology, AIIMS,
Uttarakhand, Rishikesh, India
(Gupta) CTVS, AIIMS, Uttarakhand, Rishikesh, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Postoperative visual loss (POVL) is an infrequent yet consequential
complication that can follow cardiac surgical interventions. This
systematic review aims to provide a comprehensive analysis of the
incidence of POVL after cardiac surgery and to delineate the associated
risk factors. A comprehensive search was conducted in major medical
databases for relevant studies published up to September 2022. Eligible
studies reporting on the incidence of POVL and identifying risk factors in
patients undergoing cardiac surgery were included. Data extraction was
performed independently by two reviewers. The pooled incidence rates and
the identified risk factors were synthesized qualitatively. POVL after
cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per
100,000 cardiac surgical procedures. Risk factors for POVL include patient
characteristics (advanced age, diabetes, hypertension, and preexisting
ocular conditions), procedural factors (prolonged surgery duration,
cardiopulmonary bypass time, and aortic cross-clamping), anesthetic
considerations (hypotension, blood pressure fluctuations, and specific
techniques), and postoperative complications (stroke, hypotension, and
systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon
complication, associated with factors like prolonged cardiopulmonary
bypass, low hematocrit levels, excessive body weight gain, specific
medications, hypothermia, anemia, raised intraocular pressure, and
micro-embolization. Diabetic patients with severe postoperative anemia are
at increased risk for anterior ischemic optic neuropathy (AION). Posterior
ischemic optic neuropathy (PION) can occur with factors like hypertension,
postoperative edema, prolonged mechanical ventilation, micro-embolization,
inflammation, hemodilution, and hypothermia. While the overall incidence
of POVL postcardiac surgery remains modest, its potential impact is
substantial, necessitating meticulous consideration of modifiable risk
factors. Notably, prolonged surgical duration, intraoperative hypotension,
anemia, and reduced hematocrit levels remain salient contributors.
Vigilance is indispensable to promptly detect this infrequent yet visually
debilitating phenomenon in the context of postcardiac surgical
care.<br/>Copyright &#xa9; 2024 Annals of Cardiac Anaesthesia.

<73>
Accession Number
2031498563
Title
Has the time come for a systematic top-down approach in Crohn's disease?.
Source
The Lancet Gastroenterology and Hepatology. 9(5) (pp 394-395), 2024. Date
of Publication: May 2024.
Author
Fumery M.; Buisson A.
Institution
(Fumery) Department of Gastroenterology, CHU Amiens and PeriTox, UMR-I 01
INERIS, Picardie Jules. Verne University, Amiens, France
(Buisson) Universite Clermont Auvergne, 3iHP, CHU Clermont-Ferrand,
Service d'Hepato-Gastroenterologie, Inserm U1071, M2iSH, USC-INRA 2018,
Clermont-Ferrand, France
Publisher
Elsevier Ltd

<74>
Accession Number
2031669279
Title
Inhaled nitric oxide and postoperative outcomes in cardiac surgery with
cardiopulmonary bypass: A systematic review and meta-analysis.
Source
Nitric Oxide - Biology and Chemistry. 146 (pp 64-74), 2024. Date of
Publication: 01 May 2024.
Author
Yan Y.; Kamenshchikov N.; Zheng Z.; Lei C.
Institution
(Yan, Zheng, Lei) Department of Anesthesiology and Perioperative Medicine,
Xijing Hospital, The Fourth Military Medical University, Xi'an 710032,
China
(Yan) Department of Anesthesiology, China-Japan Friendship Hospital,
Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing 100029, China
(Kamenshchikov) Laboratory of Critical Care Medicine, Department of
Anesthesiology and Intensive Care, Cardiology Research Institute, Tomsk
National Research Medical Center, Russian Academy of Sciences, 111a
Kievskaya St., Tomsk 634012, Russian Federation
Publisher
Academic Press Inc.
Abstract
Cardiac surgeries under cardiopulmonary bypass (CPB) are complex
procedures with high incidence of complications, morbidity and mortality.
The inhaled nitric oxide (iNO) has been frequently used as an important
composite of perioperative management during cardiac surgery under CPB. We
conducted a meta-analysis of published randomized clinical trials (RCTs)
to assess the effects of iNO on reducing postoperative complications,
including the duration of postoperative mechanical ventilation, length of
intensive care unit (ICU) stay, length of hospital stay, mortality,
hemodynamic improvement (the composite right ventricular failure, low
cardiac output syndrome, pulmonary arterial pressure, and vasoactive
inotropic score) and myocardial injury biomarker (postoperative troponin I
levels). Subgroup analyses were performed to assess the effect of
modification and interaction. These included iNO dosage, the timing and
duration of iNO therapy, different populations (children and adults), and
comparators (other vasodilators and placebo or standard care). A
comprehensive search for iNO and cardiac surgery was performed on online
databases. Twenty-seven studies were included after removing the
duplicates and irrelevant articles. The results suggested that iNO could
reduce the duration of mechanical ventilation, but had no significance in
the ICU stay, hospital stay, and mortality. This may be attributed to the
small sample size of the most included studies and heterogeneity in
timing, dosage and duration of iNO administration. Well-designed,
large-scale, multicenter clinical trials are needed to further explore the
effect of iNO in improving postoperative prognosis in cardiovascular
surgical patients.<br/>Copyright &#xa9; 2024 Elsevier Inc.

<75>
Accession Number
2028931541
Title
Sex differences in the outcomes after transcatheter aortic valve
replacement with newer generation devices: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 103(5) (pp 808-814),
2024. Date of Publication: 01 Apr 2024.
Author
El Sherbini A.H.; Servito M.; Zidan A.; Elsherif S.; Ko G.; Elgendy I.Y.;
Ya'Qoub L.
Institution
(El Sherbini, Zidan, Ko) Department of Internal Medicine Faculty of Health
Sciences, Queen's University, Kingston, ON, Canada
(Servito) Division of Cardiac Surgery, University of Manitoba, Winnipeg,
MB, Canada
(Elsherif) Department of Internal Medicine Faculty of Health Sciences,
McMaster University, Hamilton, ON, Canada
(Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute,
University of Kentucky, Lexington, KY, United States
(Ya'Qoub) Division of Cardiovascular Medicine, University of California
San Francisco, San Francisco, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a reasonable
therapeutic approach among patients with symptomatic severe aortic
stenosis irrespective of surgical risk. Data regarding sex-specific
differences in the outcomes with newer generation valves are limited.
<br/>Method(s): Electronic databases were searched for studies assessing
sex differences in the outcomes of patients undergoing TAVR with newer
generation valves (SAPIEN 3 or Evolut). Random effects model was
constructed for summary estimates. <br/>Result(s): Four observational
studies with 4522 patients (44.8% women) were included in the
meta-analysis. Women were older and had a lower prevalence of coronary
artery disease and mean EuroScore. Women had a higher incidence of
short-term mortality (up to 30 days) (risk ratio [RR]: 1.60, 95%
confidence interval [CI]: 1.14-2.25), but no difference in 1-year
mortality (RR: 0.92, 95% CI: 0.72-1.17). There was no significant
difference in the incidence of major bleeding (RR: 1.16, 95% CI:
0.86-1.57), permanent pacemaker (PPM) (RR: 0.80, 95% CI: 0.62-1.04), or
disabling stroke (RR: 1.16, 95% CI: 0.54-2.45). <br/>Conclusion(s): In
this meta-analysis, we found that women undergoing TAVR with
newer-generation devices were older but had a lower prevalence of
comorbidities. Women had a higher incidence of short-term mortality but no
difference in the 1-year mortality, bleeding, PPM, or stroke compared with
men. Future studies are required to confirm these findings.<br/>Copyright
&#xa9; 2024 Wiley Periodicals LLC.

<76>
Accession Number
2031228336
Title
Evaluation of the efficacy and safety of robot-assisted and video assisted
thoracic surgery for early non-small cell lung cancer: A meta-analysis.
Source
Technology and Health Care. 32(2) (pp 511-523), 2024. Date of Publication:
14 Mar 2024.
Author
Wang P.; Fu Y.-H.; Qi H.-F.; He P.; Wang H.-F.; Li C.; Liu X.-C.
Institution
(Wang, Qi, He, Wang, Li, Liu) Department of Cardiothoracic Surgery, The
82nd Group Military Hospital of PLA, Hebei, Baoding, China
(Fu) Department of Rheumatology and Immunology, Baoding Children's
Hospital, Hebei, Baoding, China
Publisher
IOS Press BV
Abstract
BACKGROUND: Radical resection of lung cancer and chemotherapy are the main
methods for the treatment of early lung cancer, but surgical treatment is
still the key and preferred method. <br/>OBJECTIVE(S): To evaluate the
efficacy and safety of robotic-assisted thoracic surgery (RATS) and video
assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC).
<br/>METHOD(S): The clinical cohort studies on the comparison of the
effects of RATS and VATS in the treatment of NSCLC published in Web of
Science, PubMed, The National Library of Medicine (NLM), China National
Knowledge Infrastructure (CNKI) and Wanfang database from January 1, 2015
to December 31, 2022 were searched. Two researchers independently screened
the literature, extracted the data, such as operation time, intraoperative
conversion rate, intraoperative blood loss, number of lymph nodes
dissected, and evaluated the quality of the included literature based on
the Newcastle-Ottawa Scale (NOS). RevMan 5.3 software was used for Meat
analysis. <br/>RESULT(S): A total of 18 articles and 21,802 subjects were
included. The results of the meta-analysis showed that the intraoperative
blood loss of RATS was significantly less than that of VAS, and the
difference was statistically significant [MD =-38.43 (95% CI: -57.71,
-19.15, P< 0.001)]. Compared with VATS, the number of lymph nodes
dissected in RATS was significantly higher [MD = 2.61 (95% CI: 0.47, 4.76,
P= 0.02)]. The rate of conversion to thoracotomy in RATS was lower, and
the difference was statistically significant [OR = 0.59 (95% CI: 0.50,
0.70, P< 0.001)]. There was no significant difference between RATS and
VATS in operation time [MD =-9.34 (95% CI: -28.72, 10.04, P= 0.34)],
postoperative thoracic drainage time [MD =-0.08 (95% CI: -0.42, 0.26, P=
0.64)], postoperative hospital stay [MD =-0.05 (95% CI: -0.19, 0.08, P=
0.42)], postoperative mortality [OR = 0.88 (95% CI: 0.56, 1.36, P= 0.56)]
and postoperative complications [OR = 1.03 (95% CI: 0.93, 1.13, P= 0.57)].
<br/>CONCLUSION(S): Compared with VATS, the number of lymph nodes
dissected in RATS was significantly more, and the removal of lesions and
lymph nodes was more thorough and accurate. More flexible and precise
operation avoids the injury of important blood vessels during operation,
effectively reduces the amount of blood loss during operation, shortens
the indwelling time of thoracic drainage tube, and is conducive to
postoperative rehabilitation of patients.<br/>Copyright &#xa9; 2024 - The
authors. Published by IOS Press.

<77>
Accession Number
2031648066
Title
A multi-centre randomised control trial of directly observed therapy to
promote medication adherence in paediatric heart transplant recipients.
Source
Cardiology in the Young. (no pagination), 2024. Date of Publication:
2024.
Author
Killian M.O.; Mayewski S.; Gupta D.
Institution
(Killian, Mayewski) College of Social Work, Florida State University,
Tallahassee, FL, United States
(Killian) College of Medicine, Florida State University, Tallahassee, FL,
United States
(Gupta) Pediatrics, Congenital Heart Center, University of Florida,
Gainesville, FL, United States
Publisher
Cambridge University Press
Abstract
Medication non-adherence remains a significant challenge for adolescent
heart transplant recipients. Building on the success of a pilot
intervention study, herein we describe the protocol for a follow-up
randomised control trial using mobile video directly observed therapy,
featuring several innovations, to promote medication adherence in a
multi-centre sample of adolescent heart transplant patients.
<br/>Copyright &#xa9; The Author(s), 2024. Published by Cambridge
University Press.

<78>
Accession Number
2031582211
Title
Cost-Effectiveness of Cardiovascular Magnetic Resonance for Rejection
Surveillance After Cardiac Transplantation in the Australian Health Care
System.
Source
Heart Lung and Circulation. (no pagination), 2024. Date of Publication:
2024.
Author
Pouliopoulos J.; Anthony C.; Imran M.; Graham R.M.; McCrohon J.; Holloway
C.; Kotlyar E.; Muthiah K.; Keogh A.M.; Hayward C.S.; Macdonald P.S.;
Jabbour A.
Institution
(Pouliopoulos, Imran, Graham, McCrohon, Holloway, Kotlyar, Muthiah, Keogh,
Hayward, Macdonald, Jabbour) Heart and Lung Transplant Unit, St. Vincent's
Hospital, Sydney, NSW, Australia
(Pouliopoulos, Hayward, Macdonald, Jabbour) Victor Chang Cardiac Research
Institute, Sydney, NSW, Australia
(Pouliopoulos, Graham, Keogh, Macdonald, Jabbour) School of Clinical
Medicine, University of New South Wales, Sydney, NSW, Australia
(Anthony, Graham) Alfred Health and Monash University, Melbourne, VIC,
Australia
Publisher
Elsevier Ltd
Abstract
Background: Heart transplantation is an effective treatment for end-stage
congestive heart failure, however, achieving the right balance of
immunosuppression to maintain graft function while minimising adverse
effects is challenging. Serial endomyocardial biopsies (EMBs) are
currently the standard for rejection surveillance, despite being invasive.
Replacing EMB-based surveillance with cardiac magnetic resonance
(CMR)-based surveillance for acute cardiac allograft rejection has shown
feasibility. This study aimed to assess the cost-effectiveness of
CMR-based surveillance in the first year after heart transplantation.
<br/>Method(s): A prospective clinical trial was conducted with 40
orthotopic heart transplant (OHT) recipients. Participants were randomly
allocated into two surveillance groups: EMB-based, and CMR-based. The
trial included economic evaluations, comparing the frequency and cost of
surveillance modalities in relation to quality-adjusted life years (QALYs)
within the first year post-transplantation. Sensitivity analysis
encompassed modelled data from observed EMB and CMR arms, integrating two
hypothetical models of expedited CMR-based surveillance. <br/>Result(s):
In the CMR cohort, 238 CMR scans and 15 EMBs were conducted, versus (vs)
235 EMBs in the EMB group. CMR surveillance yielded comparable rejection
rates (CMR 74 vs EMB 94 events, p=0.10) and did not increase
hospitalisation risk (CMR 32 vs EMB 46 events, p=0.031). It significantly
reduced the necessity for invasive EMBs by 94%, lowered costs by an
average of AUD$32,878.61, and enhanced cumulative QALY by 0.588 compared
with EMB. Sensitivity analysis showed that increased surveillance with
expedited CMR Models 1 and 2 were more cost-effective than EMB (all
p<0.01), with CMR Model 1 achieving the greatest cost savings
(AUD$34,091.12+/-AUD$23,271.86 less) and utility increase (+0.62+/-1.49
QALYs, p=0.011), signifying an optimal cost-utility ratio. Model 2 showed
comparable utility to the base CMR model (p=0.900) while offering the
benefit of heightened surveillance frequency during periods of elevated
rejection risk. <br/>Conclusion(s): CMR-based rejection surveillance in
orthotopic heart transplant recipients provides a cost-effective
alternative to EMB-based surveillance. Furthermore, it reduces the need
for invasive procedures, without increased risk of rejection or
hospitalisation for patients, and can be incorporated economically for
expedited surveillance. These findings have important implications for
improving patient care and optimising resource allocation in
post-transplant management.<br/>Copyright &#xa9; 2024 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<79>
Accession Number
2031552062
Title
Blood bupivacaine concentrations after pecto-serratus and serratus
anterior plane injections of plain and liposomal bupivacaine in
robotically-assisted mitral valve surgery: Sub-study of a randomized
trial.
Source
Journal of Clinical Anesthesia. 95 (no pagination), 2024. Article Number:
111470. Date of Publication: August 2024.
Author
Alfirevic A.; Almonacid-Cardenas F.; Yalcin E.K.; Shah K.; Kelava M.;
Sessler D.I.; Turan A.
Institution
(Alfirevic, Kelava) Division of Cardiothoracic Anesthesiology, Department
of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
(Almonacid-Cardenas, Shah, Sessler, Turan) Outcomes Research Consortium,
Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United
States
(Yalcin, Turan) Division of Multi-specialty Anesthesiology, Department of
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Study objective: To investigate the timing of peak blood concentrations
and potential toxicity when using a combination of plain and liposomal
bupivacaine for thoracic fascial plane blocks. <br/>Design(s):
Pharmacokinetic analysis. <br/>Setting(s): Operating room.
<br/>Patient(s): Eighteen adult patients undergoing robotically-assisted
mitral valve surgery. <br/>Intervention(s): Ultrasound-guided
pecto-serratus and serratus anterior plane blocks using a mixture of 0.5%
bupivacaine HCl up to 2.5 mg/kg and liposomal bupivacaine up to 266 mg.
Measurements: Arterial plasma bupivacaine concentration. <br/>Main
Result(s): Samples from 13 participants were analyzed. There was
substantial inter-patient variability in plasma concentrations. A
geometric mean maximum bupivacaine concentration was 1492 ng/ml (range 660
to 4650 ng/ml) at median time of 30 min after injection. In 4/13 (31%)
patients, plasma bupivacaine concentrations exceeded our predefined 2000
ng/ml toxic threshold. A second much smaller peak was observed about 32 h
after the injection. No obvious signs of local anesthetic toxicity were
observed. <br/>Conclusion(s): Combined injection of plain and liposomal
bupivacaine for pecto-serratus/serratus anterior plane blocks produced a
biphasic pattern, with the highest arterial plasma concentrations observed
within 30 min. Maximum concentrations exceeded the potential toxic
threshold in nearly a third of patients, but without clinical evidence of
toxicity. Clinicians should not assume that routine combinations of plain
and liposomal bupivacaine for thoracic fascial plane blocks are inherently
safe.<br/>Copyright &#xa9; 2024 Elsevier Inc.

<80>
Accession Number
2029397282
Title
Remimazolam to prevent hemodynamic instability during catheter ablation
under general anesthesia: a randomized controlled trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2024. Date of
Publication: 2024.
Author
Yim S.; Choi C.I.; Park I.; Koo B.W.; Oh A.Y.; Song I.-A.
Institution
(Yim, Park, Koo, Oh, Song) Department of Anesthesiology and Pain Medicine,
Seoul National University Bundang Hospital, Seongnam, South Korea
(Choi) Department of Anesthesiology and Pain Medicine, Yonsei University
College of Medicine, Seoul, South Korea
(Choi) Department of Anesthesiology and Pain Medicine, Yongin Severance
Hospital, Yongin, South Korea
(Koo, Oh, Song) Department of Anesthesiology and Pain Medicine, Seoul
National University College of Medicine, Seoul, South Korea
Publisher
Springer
Abstract
Purpose: Maintaining hemodynamic stability during cardiac ablation under
general anesthesia is challenging. Remimazolam, a novel ultrashort-acting
benzodiazepine, is characterized by maintaining comparatively stable blood
pressure and does not influence the cardiac conduction system, which
renders it a reasonable choice for general anesthesia for cardiac
ablation. We aimed to evaluate whether remimazolam is associated with a
decreased incidence of intraoperative hypotension compared with
desflurane. <br/>Method(s): In this single-centre, parallel-group,
prospective, single-blind, randomized clinical trial, we randomized
patients (1:1) into a remimazolam group (remimazolam-based total
intravenous anesthesia) or desflurane group (propofol-induced and
desflurane-maintained inhalational anesthesia) during cardiac ablation
procedures for arrhythmia. The primary outcome was the incidence of
intraoperative hypotensive events, defined as mean arterial pressure of <
60 mm Hg at any period. <br/>Result(s): Overall, we enrolled 96 patients
between 2 August 2022 and 19 May 2023 (47 and 49 patients in the
remimazolam and desflurane groups, respectively). The remimazolam group
showed a significantly lower incidence of hypotensive events (14/47, 30%)
than the desflurane group (29/49, 59%; relative risk [RR], 0.5; 95%
confidence interval [CI], 0.31 to 0.83; P = 0.004). Remimazolam was
associated with a lower requirement for bolus or continuous vasopressor
infusion than desflurane was (23/47, 49% vs 43/49, 88%; RR, 0.56; 95% CI,
0.41 to 0.76; P < 0.001). No between-group differences existed in the
incidence of perioperative complications such as nausea, vomiting, oxygen
desaturation, delayed emergence, or pain. <br/>Conclusion(s): Remimazolam
was a viable option for general anesthesia for cardiac ablation.
Remimazolam-based total intravenous anesthesia was associated with
significantly fewer hypotensive events and vasopressor requirements than
desflurane-based inhalational anesthesia was, without significantly more
complications. Study registration: ClinicalTrials.gov (NCT05486377); first
submitted 1 August 2022.<br/>Copyright &#xa9; Canadian Anesthesiologists'
Society 2024.

<81>
Accession Number
2029393548
Title
Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on
postoperative opioid consumption and pain after video-assisted thoracic
surgery: a double-blind randomized controlled trial.
Source
Surgical Endoscopy. (no pagination), 2024. Date of Publication: 2024.
Author
Lee H.-J.; Choi S.; Yoon S.; Bahk J.-H.
Institution
(Lee, Choi, Yoon, Yoon, Bahk) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu,
Seoul 03080, South Korea
(Lee, Yoon, Bahk) Department of Anesthesiology and Pain Medicine, Seoul
National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul
03080, South Korea
Publisher
Springer
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) often induces
significant postoperative pain, potentially leading to chronic pain and
decreased quality of life. This study aimed to evaluate the
acetaminophen/ibuprofen combination effectiveness in reducing analgesic
requirements and pain intensity in patients undergoing VATS. Study design:
This is a double-blinded randomized controlled trial. <br/>Method(s):
Adult patients scheduled for elective VATS for lung resection were
randomized to receive either intravenous acetaminophen and ibuprofen
(intervention group) or 100 mL normal saline (control group). Treatments
were administered post-anesthesia induction and every 6 h for three
cycles. The primary outcome was total analgesic consumption at 24 h
postoperatively. Secondary outcomes were cumulative analgesic consumption
at 2 and 48 h; analgesic-related side effects at 2, 24, and 48 h; quality
of recovery at 24 h and 48 h postoperatively; pain intensity at rest and
during coughing; and rescue analgesics use. Chronic postsurgical pain
(CPSP) was assessed through telephone interviews 3 months postoperatively.
<br/>Result(s): The study included 96 participants. The intervention group
showed significantly lower analgesic consumption at 24 h and 48 h
postoperatively (24 h: median difference: - 100 microg equivalent
intravenous fentanyl [95% confidence interval (CI) - 200 to - 5 mug], P =
0.037; 48 h: median difference: - 140 mug [95% CI - 320 to - 20 mug], P =
0.035). Compared to the controls, the intervention group exhibited a
significantly lower quality of recovery 24 h post-surgery, with no
significant difference at 48 h. All pain scores except for coughing at 48
h post-surgery were significantly lower in the intervention group compared
to the controls. No significant differences were observed between the
groups in postoperative nausea and vomiting occurrence, hospital stay
length, and CPSP. <br/>Conclusion(s): Perioperative administration of
acetaminophen/ibuprofen significantly decreased analgesic needs in
patients undergoing VATS, providing an effective postoperative pain
management strategy, and potentially minimizing the need for stronger
analgesics.<br/>Copyright &#xa9; The Author(s) 2024.

<82>
Accession Number
2029391317
Title
Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive
Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2024. Date of Publication: 2024.
Author
Kirov H.; Caldonazo T.; Runkel A.; Fischer J.; Tasoudis P.; Mukharyamov
M.; Cancelli G.; Dell'Aquila M.; Doenst T.
Institution
(Kirov, Caldonazo, Runkel, Fischer, Mukharyamov, Doenst) Department of
Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
(Tasoudis) Division of Cardiothoracic Surgery, University of North
Carolina at Chapel Hill, NC, United States
(Cancelli, Dell'Aquila) Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: Minimally invasive cardiac surgery (MICS) is increasing
worldwide. In most cases, the surgical technique includes cannulation of
the groin for the establishment of cardiopulmonary bypass, requiring a
second surgical incision (SC) for exposure and cannulation of the femoral
vessels. With the introduction of arterial closure devices, percutaneous
cannulation (PC) of the groin has become a possible alternative. We
performed a meta-analysis and systematic review to compare clinical
endpoints between the patients who underwent PC and SC for MICS.
<br/>Method(s): Three databases were assessed. The primary outcome was any
access site complication. Secondary outcomes were perioperative mortality,
any wound complication, any vascular complication, lymphatic
complications, femoral/iliac stenosis, stroke, procedural duration, and
hospital length of stay (LOS). A random effects model was performed.
<br/>Result(s): A total of 5 studies with 2,038 patients were included.
When compared with PC, patients who underwent SC showed a higher incidence
of any access site complication (odds ratio [OR] = 3.09, 95% confidence
interval [CI]: 1.87 to 5.10, P < 0.01), any wound complication (OR =
10.10, 95% CI: 3.31 to 30.85, P < 0.01), lymphatic complication (OR =
9.37, 95% CI: 2.15 to 40.81, P < 0.01), and longer procedural duration
(standardized mean difference = 0.31, 95% CI: 0.12 to 0.51, P < 0.01).
There was no significant difference between the 2 groups regarding
perioperative mortality, any vascular complication, femoral/iliac
stenosis, stroke, or hospital LOS. <br/>Conclusion(s): The analysis
suggests that surgical groin cannulation in MICS is associated with a
higher incidence of any access site complication (especially wound
complication and lymphatic fistula) and with a longer procedural time
compared with PC. There was no difference in perioperative
mortality.<br/>Copyright &#xa9; The Author(s) 2024.

<83>
Accession Number
2022205975
Title
Impact of coronary-subclavian steal after surgical myocardial
revascularization with internal thoracic artery in chronic hemodialysis
patients: A meta-analysis.
Source
Trends in Cardiovascular Medicine. 34(3) (pp 183-190), 2024. Date of
Publication: April 2024.
Author
Baudo M.; Torregrossa G.; Dokollari A.; Bisleri G.; Bacco L.D.; Benussi
S.; Muneretto C.; Rosati F.
Institution
(Baudo, Bacco, Benussi, Muneretto, Rosati) Division of Cardiac Surgery,
Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili,
1, Brescia 25123, Italy
(Torregrossa, Dokollari) Division of Cardiac Surgery, Main Line Health -
Lankenau Heart Institute, Wynnewood, PA, United States
(Bisleri) Division of Cardiac Surgery, St Michael's Hospital, University
of Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Patients in hemodialysis with an arm arteriovenous fistula undergoing
coronary artery bypass grafting (CABG) with an internal thoracic artery
have been reported to suffer from coronary-subclavian steal (CSS) during
dialysis session. However, its occurrence is still debated. A systematic
literature review was performed to identify all studies investigating the
occurrence of a CSS event in this subset of patients. The primary endpoint
was the analysis of CSS and the following early and late survival
outcomes. Independent determinants of CSS and the impact of the distance
between the arteriovenous fistula (upper arm vs forearm) and the
ipsilateral internal thoracic artery graft on CSS events and mortality
were studied. Early and late survival outcomes were analyzed by comparing
ipsilateral versus contralateral arteriovenous fistula. Of the 1,383
retrieved articles, 10 were included (n = 643 patients). The pooled event
rate of CSS was 6.46% [95%CI=2.10-18.15], while of symptomatic CSS
incidence was 3.99% [95%CI=0.95-15.25]. No survival differences were noted
when comparing ipsilateral to contralateral arteriovenous fistula-internal
thoracic artery combinations. On meta-regression, the upper arm was
associated with more CSS events, while the forearm to lower late mortality
rates. Independently from arteriovenous fistula-internal thoracic artery
combination, CSS was not associated to higher mortality rates. Particular
attention is warranted when selecting the type of conduits for CABG in
patients with an arteriovenous fistula or if highly expected to need one
in the near future after surgery. A contralateral arteriovenous
fistula-internal thoracic artery combination is preferable. If this is not
possible, a forearm arteriovenous fistula position should be
preferred.<br/>Copyright &#xa9; 2023 Elsevier Inc.

<84>
[Use Link to view the full text]
Accession Number
2031587722
Title
Clinical guideline on reversal of direct oral anticoagulants in patients
with life threatening bleeding.
Source
European Journal of Anaesthesiology. 41(5) (pp 327-350), 2024. Date of
Publication: 01 May 2024.
Author
Grottke O.; Afshari A.; Ahmed A.; Arnaoutoglou E.; Bolliger D.;
Fenger-Eriksen C.; von Heymann C.
Institution
(Grottke) The Department of Anaesthesiology, RWTH Aachen University
Hospital, Pauwelsstrasse, Aachen, Germany
(Afshari) Department of Paediatric and Obstetric Anaesthesia, Juliane
Marie Centre, Rigshospitalet, Department of Clinical Medicine, Copenhagen
University, Denmark
(Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Ahmed) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Arnaoutoglou) Department of Anaesthesiology, Larissa University Hospital,
Larissa, Greece
(Bolliger) Clinic for Anaesthesia, Intermediate Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital Basel,
Spitalstrasse, Basel, Switzerland
(Fenger-Eriksen) Department of Anaesthesiology, Aarhus University
Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark
(von Heymann) Department of Anaesthesia, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain,
Landsberger Allee, Berlin, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Anticoagulation is essential for the treatment and prevention
of thromboembolic events.Current guidelines recommend direct oral
anticoagulants (DOACs)over vitamin K antagonists in DOAC-eligible
patients. The major complication of anticoagulation is serious or
life-threatening haemorrhage, which may necessitate prompt haemostatic
intervention. Reversal of DOACs may also be required for patients in need
of urgent invasive procedures. This guideline from the European Society of
Anaesthesiology and Intensive Care (ESAIC) aims to provide evidence-based
recommendations and suggestions on how to manage patients on DOACs
undergoing urgent or emergency procedures including the treatment of
DOAC-induced bleeding. DESIGN A systematic literature search was
performed, examining four drug comparators (dabigatran, rivaroxaban,
apixaban, edoxaban) and clinical scenarios ranging from planned to
emergency surgery with the outcomes of mortality, haematoma growth and
thromboembolic complications. The GRADE (Grading of Recommendations,
Assessment, Development and Evaluation) methodology was used to assess the
methodological quality of the included studies. Consensus on the wording
of the recommendations was achieved by a Delphi process. RESULTS So far,
no results from prospective randomised trials comparing two active
comparators (e.g. a direct reversal agent and an unspecific haemostatic
agent such as prothrombin complex concentrate: PCC) have been published
yet and the majority of publications were uncontrolled and observational
studies. Thus, the certainty of evidence was assessed to be either low or
very low (GRADE C). Thirtyfive recommendations and clinical practice
statements weredeveloped. During the Delphi process, strong consensus
(>90% agreement) was achieved in 97.1% of recommendations and consensus
(75 to 90% agreement) in 2.9%. DISCUSSION DOAC-specific coagulation
monitoring may help in patients at risk for elevated DOAC levels, where as
global coagulation tests are not recommended to exclude clinically
relevant DOAC levels. In urgent clinical situations, haemostatic treatment
using either the direct reversal or nonspecific haemostatic agents should
be started without waiting for DOAC level monitoring. DOAC levels above
50ng ml-1 may be considered clinically relevant necessitating haemostatic
treatment before urgent or emergency procedures. Before cardiac surgery
under activated factor Xa (FXa) inhibitors, the use of andexanet alfa is
not recommended because of inhibition of unfractionated heparin, which is
needed for extracorporeal circulation. In the situation of DOAC overdose
without bleeding, no haemostatic intervention is suggested, instead
measures to eliminate the DOACs should be taken. Due to the lack of
published results from comparative prospective, randomised studies, the
superiority of reversal treatment strategy vs. a nonspecific haemostatic
treatment is unclear for most urgent and emergency procedures and
bleeding. Due to the paucity of clinical data, no recommendations for the
use of recombinant activated factor VII as a nonspecific haemostatic agent
can be given. CONCLUSION In the clinical scenarios of DOAC intake before
urgent procedures and DOAC-induced bleeding, practitioners should evaluate
the risk of bleeding of the procedure and the severity of the DOAC-induced
bleeding before initiating treatment. Optimal reversal strategy remains to
be determined in future trials for most clinical settings.<br/>Copyright
&#xa9; 2024 Lippincott Williams and Wilkins. All rights reserved.

<85>
Accession Number
643997357
Title
Transcutaneous electrical nerve stimulation for the treatment of acute
postoperative pain following spine surgery: a scoping review.
Source
Journal of neurosurgery. Spine. (pp 1-8), 2024. Date of Publication: 12
Apr 2024.
Author
Lee J.H.; Jones J.C.; Lee D.S.; Joseph J.R.
Abstract
OBJECTIVE: Given the ubiquity and severity of postoperative pain following
spine surgery, developing adequate pain management modalities is critical.
Transcutaneous electrical nerve stimulation (TENS) is a promising
noninvasive modality that is well studied for managing postoperative pain
following a variety of surgeries, but data on using TENS for pain
management in the acute postoperative period of spine surgery are limited.
Therefore, this review aimed to recapitulate the existing evidence for the
use of TENS in postoperative pain management for spine surgery and explore
the potential of this modality moving forward. <br/>METHOD(S): A scoping
review was conducted according to 2020 PRISMA guidelines. Two
independently operating reviewers then conducted a systematic search of
PubMed, Embase, and Scopus databases to identify studies that reported the
use of TENS for the treatment of acute postoperative pain following spine
surgery. The following data were abstracted from included studies: study
type, sample size, demographics, surgery details, comparison group,
assessment parameters, timing of postoperative assessment, TENS technical
characteristics, relevant findings, length of hospital stay, complications
with TENS, and notable limitations. <br/>RESULT(S): Nine hundred
thirty-two publications were screened, resulting in 6 studies included in
this review, all of which were prospective clinical trials. The
publication dates ranged from 1980 to 2011. Spine surgery types varied;
the most common was posterior lumbar interbody fusion. No studies
evaluated pain control in cervical- or thoracic-only surgeries. All 6
studies evaluated the level of postoperative pain directly. Five of the 6
studies that directly examined postoperative pain reported lower levels of
pharmacological analgesia usage in the TENS groups compared with controls,
with 4 of these studies reporting this difference as statistically
significant. Length of hospital stay was evaluated in 2 studies, both of
which reported decreases in mean length of stay, but these differences
were not significant. Notably, every study reported distinct TENS
administration parameters while also reporting similar results.
<br/>CONCLUSION(S): This review concludes that TENS is effective at
reducing postoperative pain in spine surgery. Further investigation is
needed regarding the optimal settings for TENS administration, as well as
efficacy in the thoracic and cervical spine.

<86>
Accession Number
643988837
Title
Probiotics may alleviate intestinal damage induced by cardiopulmonary
bypass in children.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2024.
Date of Publication: 10 Apr 2024.
Author
Toritsuka D.; Aoki M.; Higashida A.; Fukahara K.; Nishida N.; Hirono K.;
Hane M.; Sugimoto T.; Asahara T.; Yoshimura N.
Institution
(Toritsuka, Aoki, Fukahara, Yoshimura) Department of Cardiovascular
Surgery, University of Toyama, Graduate School of Medicine, Toyama, Japan
(Higashida) Department of Cardiovascular Surgery, Kobe Children's
Hospital, Kobe, Japan
(Nishida, Hirono) Pediatrics, University of Toyama, Graduate School of
Medicine, Toyama, Japan
(Hane, Sugimoto, Asahara) Yakult Central Institute, Yakult Honsha Co.,
Ltd, Tokyo, Japan
Abstract
OBJECTIVES: Intestinal ischemia-reperfusion injury induced by
cardiopulmonary bypass causes intestinal epithelial barrier dysfunction,
leading to dysbiosis and bacterial translocation. We conducted a
randomized prospective study with two objectives: (1) to investigate
epithelial barrier dysfunction and bacterial translocation induced by
cardiopulmonary bypass and changes in the gut microbiota and (2) to verify
whether probiotics can improve these conditions. <br/>METHOD(S): Between
2019 and 2020, patients 0-15 years old scheduled to undergo cardiac
surgery using cardiopulmonary bypass were enrolled and randomly allocated
to 2 groups: the intervention group received probiotics, and the control
group did not receive probiotics. We analyzed the microbiota in feces and
blood, organic acid concentrations in feces, plasma intestinal fatty-acid
binding protein, and immunological responses. <br/>RESULT(S): Eighty-two
patients were enrolled in this study. The characteristics of the patients
were similar in both groups. The total number of obligate anaerobes was
higher in the intervention group than in the control group after
postoperative day 7. We identified four clusters within the perioperative
gut microbiota, and cluster changes showed a corrective effect of
probiotics on dysbiosis after postoperative day 7. Organic acid
concentrations in feces, incidence of bacterial translocation, Intestinal
fatty-acid binding protein levels, and immunological responses, except for
Interleukin -17A, were not markedly different between the two groups.
<br/>CONCLUSION(S): Administration of probiotics was able to correct
dysbiosis but did not sufficiently alleviate the intestinal damage induced
by cardiopulmonary bypass. More effective methods should be examined to
prevent disturbances induced by cardiac surgery using cardiopulmonary
bypass.<br/>Copyright &#xa9; The Author(s) 2024. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<87>
Accession Number
643986756
Title
Performance of left internal thoracic artery-left anterior descending
artery anastomosis by residents versus attendings and coronary artery
bypass grafting outcomes.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2024.
Date of Publication: 10 Apr 2024.
Author
Gikandi A.; Stock E.; DeMatt E.; Hirji S.; Awtry J.; Quin J.A.; Tolis G.;
Biswas K.; Zenati M.A.
Institution
(Gikandi, Quin, Zenati) Division of Cardiac Surgery, Veterans Affairs (VA)
Boston Healthcare System and Harvard Medical School, Boston, MA, United
States
(Gikandi, Hirji, Awtry, Tolis, Zenati) Division of Cardiac Surgery,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Stock, DeMatt, Biswas) VA Cooperative Studies Program Coordinating
Center, Office of Research and Development, U.S. Department of Veterans
Affairs, Perry Point, MD, United States
Abstract
OBJECTIVES: Performance of a technically sound Left Internal Thoracic
Artery to Left Anterior Descending Artery (LITA-LAD) anastomosis during
coronary artery bypass grafting (CABG) is critically important. We
investigated CABG outcomes according to whether a resident or attending
surgeon performed the LITA-LAD anastomosis using prospectively collected
data from the multicenter, randomized REGROUP (Randomized Endograft Vein
Perspective) Trial. <br/>METHOD(S): This was a posthoc subanalysis of the
REGROUP trial, which randomized veterans undergoing isolated on-pump CABG
to endoscopic versus open vein harvest between 2014-2017. The primary
endpoint was major cardiac adverse events (MACE), defined as the composite
of all-cause death, nonfatal myocardial infarction, or repeat
revascularization. <br/>RESULT(S): Among 1,084 patients, 344 (31.8%)
LITA-LAD anastomoses were performed by residents and 740 (68.2%) by
attending surgeons. Residents (when compared to attendings) operated on
fewer patients with high tercile SYNTAX scores (22.1% vs. 37.4%, p<0.001),
performed less multiarterial CABG (5.2% vs. 14.6%, p<0.001), and performed
more anastomoses to distal targets with diameters > 2.0mm (19.0% vs.
10.9%, p<0.001) and non-calcified landing zones (25.1% vs. 21.6%,
p<0.001). During a median observation time of 4.7 years (interquartile
range 3.84-5.45), MACE occurred in 77 patients (22.4%) in the resident
group and 169 patients (22.8%) in the attending group (unadjusted HR 1.00;
95% confidence interval, 0.76-1.33; p=0.99). Outcomes persisted on
adjusted analyses. <br/>CONCLUSION(S): Based on this REGROUP trial
subanalysis, under careful supervision and with appropriate patient
selection, LITA-LAD anastomoses performed by residents yields similar
clinical outcomes compared to attendings.<br/>Copyright &#xa9; The
Author(s) 2024. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.