bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care in cardiac intensive care units (CICUs): Insights from the Critical Care Cardiology Trials Network (CCCTN) registry
Authors: Fagundes Junior A , Berg DD , Bohula EA , Baird-Zars VM , Guo J , Katz JN , Alviar CL , Van Diepen S , Morrow DA 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Critical Care Cardiology Trials Network (CCCTN) registry

Introduction
Palliative care is a practice focused on providing relief of symptoms of illness, while optimizing the quality of life for patients and families. We aimed to quantify palliative care (PC) practices and end-of-life decision-making in critically ill cardiac patients in contemporary CICUs.

Methods
The CCCTN Registry is a network of tertiary care CICUs in the United States and Canada. Between 2017 and 2020, up to 26 centers contributed an annual 2-month snapshot of all consecutive admissions to the CICU. We captured code status, rates of palliative care consultation, and decisions for comfort measures only (CMO) before all deaths in the CICU.

Results

Of 8231 admissions, 10% ended with death in the CICU and 2.6% were discharges to hospice. Of deceased patients, 68% were CMO before death. The median age of CMO patients was 70y (25th-75th: 59-78) vs. 67 (56-77) among deaths without CMO. In the CMO group, only 13% were DNR/DNI at admission, and the remainder were full code. Respiratory insufficiency and non-cardiogenic shock were the CICU indications most frequently associated with CMO. The median time from CICU admission to CMO decision was 3.4 days (25th-75th: 1.2-7.7) and was ≥7 days in 27% (Figure). Time from CMO decision to death was &lt;24h in 88%, with a median of 3.8h (25th-75th 1.0-10.3). Before a CMO decision, 73% received mechanical ventilation and 25% mechanical circulatory support. Of total deaths, 34% of intubated patients were palliatively extubated. Formal PC services were engaged in only 28% of deaths.

Conclusions
In contemporary CICUs, CMO preceded death in 2/3 of cases. The high use of advanced ICU therapies, lengthy times to a CMO decision, and the very short time from CMO to death, highlight a potential opportunity for greater PC consultation, as well as training programs to build skills in PC for practitioners in the CICU. Abstract Figure
Clinical outcomes of early infective endocarditis vegetation extraction with AngioVac sytem
Authors: Chang E 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Purpose
To describe our institutional experience in right-sided vegetation extraction using a percutaneous system and report our outcomes including mortality, ICU length of stay (LOS), hospital length of stay, decline in inflammatory markers, leukocytosis and bacteremia.

Background
Right-sided infective endocarditis (IE) has become increasingly common due to the growing incidence of intravenous drugs use (IVDU). Patients with large vegetations are often considered candidates for surgical extraction. However, high rates of recurrence in IVDU population and high surgical mortality are prohibitive of surgeries. Percutaneous extraction of right-sided masses has become an alternative to open heart surgery and can be performed with lower morbidity and mortality in patients with right sided IE. Percutaneous vegetation extraction facilitates functional recovery in critical care setting and influence outcomes in patients with elevated perioperative risk or concerns for recurrent IE.

Methods
A total of 3 patients with right sided IE underwent percutaneous vegetation extraction with AngioVac® system (AngioDynamics Inc., Latham, NY) under combined fluoroscopy and transesophageal echocardiography (TEE) guidance.

Results
In hospital mortality was 0%, average ICU LOS was 8 days and average hospital LOS was 4 weeks. There was a decrease in inflammatory marker and white blood cell (WBC) count after AngioVac procedure.

Conclusion
We report our experience with high risk IE patients. These patients had large vegetations, persistent bacteremia, right heart failure with prohibitive risk profiles during the perioperative period. AngioVac was effective in reducing bacteremia burden and reducing ICU stay. There were no procedure related complications. Overall percutaneous extraction of right-sided masses and vegetations have the potential of improving outcomes, reducing complications and healthcare costs in patients with right-sided IE. Table 1AgeSexVegetation LocationDevice usedMicroorganismPatient intubated for the procedure (y/n)ICU LOSHospital LOSDischarge death or aliveDecrease in WBCDecrease in ESRPatient #122MTVAngioVacMSSAY2 days3 weeksAlive768Patient #2`38MTVAngioVacMSSAY1 day2 weeksAlive229Patient #334FTV, RVOTAngioVacMRSAY20 days8 weeksAlive8Clinical characteristics and outcomes of patients with IE undergoing percutaneous extractions of right-sided vegetationsAbstract Figure. Picture 1
The effect of loading dose of rosuvastatin on peri-procedural myocardial infarction
Authors: Sinan UY , Keskin B , Serin E , Arat-Ozkan A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
The aim of this study is to investigate the effect of rosuvastatin loading dose on peri-procedural myocardial infarction (PPMI) and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing elective PCI according to their statin use.

Background
High-dose statin therapy before PCI is thought to reduce the occurrence of PPMI, which is known to be associated with increased mortality and prolonged hospitalization, especially in statin naïve patients.

Methods
One hundred sixty-five patients were included in the study and divided into two groups as patients already on statin treatment (n:126) and statin naive patients (n:39). Both groups were randomly assigned to high-dose (40 mg) rosuvastatin (n:86) or control group (n:79). The primary endpoint was the incidence of peri-procedural myocardial infarction, and the secondary endpoint was MACCE.

Results
There was 30 patients (19 in high dose statin group, and 11 in control group) diagnosed as PPMI after percutaneous coronary intervention (PCI). Loading dose of statin therapy did not prohibit occurrence of PPMI. A positive correlation between PPMI and creatinine (r:0.199, p:0.011), lesion complexity (r:0.189, p:0.015) and negative correlation between GFR and PPMI (r:-0.158 p:0,043) was remarkable.

Conclusions
Pre-procedural administration of high dose rosuvastatin in patients with stable coronary artery disease has failed to decrease PPMI independent of chronic statin use. Table 1. Termβ estimates with standard errorsORp valueConstant (β0)0.656 ± 1.122-0.559Lesion type (β1)1.224 ± 0.4453.4010.006Gfr (β2)-0.031 ± 0.0130.9700.015GFR and lesion type relationships with peri-procedural MI
Complete percutaneous angio-guided implantation and explantation of VA-ECMO using preclosing for cardiogenic shock or cardiac arrest
Authors: Gallet R , Martin-Tuffreau AS , Bagate F , Boukantar M , Saiydoun G , Folliguet T , Teiger E 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Angio-guided percutaneous implantation and explantation could decrease vascular complications.

Purpose
We sought to describe the feasibility and safety of complete percutaneous angio-guided ECMO implantation and explantation using preclosing.
Methods. All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-09/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under fluoroscopic guidance. The occurrence of vascular complication was recorded.
Results. Forty-nine patients underwent percutaneous VA-ECMO implantation for cardiogenic shock (n = 36) or refractory cardiac arrest (n = 13). Femoral vessel cannulations were successful in all patients and total cannulation time was 21± 8 min. Weaning from ECMO was possible in 23 patients (47%) and 11 (22%) patients were alive at 30-day. Significant vascular complications occurred in 3 patients (6%); all were related to distal perfusion line. One patient experienced major bleeding, and 2 experienced lower limb ischemia requiring vascular intervention (one failure of distal perfusion sheath implantation and one self-uprooting of the reperfusion cannula). Percutaneous decannulation was performed in 17 patients with 16/17 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. Among these patients, none required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO.
Conclusion. Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique is an effective and safe strategy in patients referred for refractory cardiogenic shock or cardiac arrest.
The biofeedback training, controlled by capnometry is a successful method of rehabilitation after myocardial infarction
Authors: Leonova I , Yarmosh I , Boldueva S , Suvorov N , Sergeev T 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
The increasing activity of the sympathetic nervous system was shown during myocardial infarction (MI). There are data that bio management application increases the vagal influences on a heart rate for patients with chronic coronary artery disease.
The purpose of this study was the assessment of changes of vegetative regulation of heart rate in patients with MI, receiving along with standard methods of treatment and rehabilitation sessions of cardiorespiratory training (KRT).
48 patients with IM in an early period of disease at the age from 40 till 70 years were surveyed. The main group was created from 29 people by whom KRT (5–10 sessions) was carried out. The assessment of efficiency and safety of KRT was carried out on a clinical picture and parameters of heart rate variability (HRV) before, after, and during KRT. The Control group consisted of 19 patients receiving only standard treatment. To exclude hyperventilation syndrome, capnometry was performed before the start of the KRT session to determine the FetCO2 individual norm for the certain patient to control the training process in a particular session. After each active sample, the concentration of carbon dioxide in the air exhaled by the patient was measured, and when it decreased below 95% of the initial value, the depth of breathing was adjusted. The use of capnometry in the study avoided adverse events during the sessions.
During carrying out of KRT, and after KRT worsening of the clinical picture at patients of the main group was not observed. HRV analysis at patients of the main group showed that after the end of KRT decrease in an index of tension (p &lt; 0,05), an increase in an indicator of the general dispersion of heart rate (p &lt; 0,05), and also a tendency to increase of vagal part of total power during spectral analysis (р=0,05) was observed. Normalization of heart rate and arterial pressure, growth of cardiorespiratory index, and index of a variation took place, cardiorespiratory synchronization was restored. Persons from the control group had no such changes.
Thus, the application of KRT realizing a mode of functional bio management of heart rate, as the instrument of psychophysiological support of standard medicament therapy showed the efficiency of its use in the program of rehabilitation of patients with myocardial infarction. The result of a comprehensive approach is the reduction of sympathetic and increase of vagal influences on heart rate, normalization of the main indicators of the cardiovascular system.
Features of emotional status in patient with unstable angina
Authors: Ibatov A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
to study emotional status at patients with unstable angina.

Materials and methods
42 men with unstable angina in the age from 40 till 65 years (average age 55.8 ± 1.3 years) were examined. A level of anxiety and the depression were examined by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the MMPI questionnaire.

Results
The patients with unstable angina had 5.4 ± 0.6 (from 2 till 12) score of anxiety level and 5.5 ± 0.6 (from 0 till 16) score of depression level accordingly. Besides 23.5 % of the patients with unstable angina had clinical and subclinical level of anxiety (score &gt; 7 by HADS), 76.5 % of the patients with unstable angina had no anxiety (score ≤ 7 by HADS). However 35.3% of patients with unstable angina had clinical and subclinical level of depression (score &gt; 7 by HADS) and 64.7 % of patients with unstable angina had no depression (score ≤ 7 by HADS). The patients with unstable angina had the such MMPI test parameters accordingly: on scale of Hypochondriasis – 54.2 ± 1.0 score; on scale of Depression – 44.8 ± 2.2 score; on scale of Hysteria – 52.4 ± 1.1 score; on scale of Psychopathic Deviate – 43.5 ± 2.0 score; on scale of Paranoia – 52.2 ± 2.5 score; on scale of Psychasthenia – 48.6 ± 2.4 score; on scale of Schizophrenia – 48.7 ± 2.2 score; on scale of Hypomania – 45.1 ± 1.2 score.

Conclusion
23.5 % of the patients with unstable angina had clinical and subclinical level of anxiety and 35.3% - depression. These patients need correction of anxiety and depression, that should be considered in treatment and rehabilitation.
Risk evaluation in adult congenital heart surgery: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database risk models on data from the European Congenital Heart Surgeons Association Congenital Database
Authors: Pabst von Ohain Jelena , Sarris Georgios , Tobota Zdzislaw , Maruszewski Bohdan , Vida Vladimiro L , Hörer J 
Published: April 2021

Abstract

OBJECTIVES
We sought to evaluate the predictive power of the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STAT) mortality score and the adult congenital heart surgery (ACHS) mortality score for the adults undergoing congenital heart operations entered into the European Congenital Heart Surgeons Association (ECHSA) database.

METHODS
The data set comprised 17 662 major operations performed between 1997 and 2019, on patients 18 years of age or older, in European centres participating in the ECHSA database. Each operation was assigned a STAT mortality score and category and an ACHS mortality score. Operative mortality was based on the 30-day status and on the status at hospital discharge. The discriminatory power of the STAT and ACHS scores was assessed using the area under the receiver operating characteristic curve (c-index).

RESULTS
A total of 17 214 (97.46%) operations were assigned ACHS scores. The 3 most frequent primary procedures were closure of the atrial septal defect (19.0%), aortic valve replacement (8.8%) and non-valve-sparing aortic root replacement (6.1%). Operative mortality for ACHS-coded operations was 2.07%. The procedures with the highest mortality were atrial septal defect creation/enlargement (19.0%), lung transplantation (18.8%) and heart transplantation (18.2%). A total of 17 638 (99.86%) operations were assigned a STAT score and category. The operative mortality for STAT-coded operations was 2.27%. The c-index for mortality was 0.720 for the STAT mortality score and 0.701 for the ACHS score.

CONCLUSIONS
The ACHS mortality score and the STAT mortality score reached similar, moderate predictive power in adult patients undergoing congenital heart surgery in ECHSA database.
Antiplatelet therapy after transcatheter aortic valve implantation: a systematic review and meta-analysis
Authors: Costa GonçaloNuno Ferraz , Costa Marco , Gonçalves Lino , Teixeira Rogério 
Published: April 2021

Abstract

OBJECTIVES
The aim of this study was to compare antithrombotic regimens after transcatheter aortic valve implantation (TAVI) in patients without an indication for long-term anticoagulation. TAVI is a safe and effective approach for patients with symptomatic severe aortic stenosis and an intermediate-to-high surgical risk. Nevertheless, the antithrombotic regimen after procedure remains controversial.

METHODS
We systematically searched PubMed, Embase and Cochrane databases for interventional studies comparing single antiplatelet therapy with double antiplatelet therapy after TAVI. A meta-analysis was carried out to compare thrombotic and bleeding events between both strategies.

RESULTS
Four randomized clinical trials were included comprising a total of 1085 patients. Our meta-analysis revealed a higher odds ratio (OR) of major bleeding events (pooled OR 2.45, 95% confidence interval (CI) 1.29–4.67; P &lt; 0.01; I2 = 0%) and minor bleeding (pooled OR 1.73, 95% CI 1.12–2.66; P = 0.01; I2 = 0%) for the double antiplatelet therapy group compared with the single antiplatelet therapy group. There was no difference between groups in the risk of stroke (pooled OR 1.04, 95% CI 0.58–1.86; P = 0.91; I2 = 0%), myocardial infarction (pooled OR 2.10, 95% CI 0.75–5.84; P = 0.16, I2 = 0%) and all-cause mortality (pooled OR 1.07, 95% CI 0.63–1.86; P = 0.08; I2 = 0%) after TAVI.

CONCLUSIONS
Our pooled analysis suggests that for patients who underwent TAVI, double antiplatelet therapy compared with single antiplatelet therapy alone increased the risk of bleeding without reducing mortality and ischaemic events.
Cefazolin prophylaxis in children undergoing cardiac surgery with the use of cardiopulmonary bypass—is the dosing correct?
Authors: Jaworski Radoslaw , Dzierzanowska-Fangrat Katarzyna , Czajkowska Agnieszka , Maruszewski Bohdan , Kansy Andrzej 
Published: April 2021

Abstract

OBJECTIVES
To determine the recommended concentrations of cefazolin to be used for antibiotic prophylaxis during paediatric cardiac surgery with extracorporeal circulation (ECC).

METHODS
Twenty paediatric patients undergoing cardiac surgery with ECC and cefazolin antibiotic prophylaxis were included in the study. Blood samples for measurement of total cefazolin plasma concentration were collected at the following measurement time points: directly after skin incision, 15 min after ECC start, 5 min after ECC cessation and at skin closure. The target concentration was set for ≥40 mg/l, which corresponded to ≥8 mg/l of unbound cefazolin concentration.

RESULTS
The median total cefazolin plasma concentrations at the measurement time points were 62.8, 67.7, 45.8 and 34.2 mg/l, respectively, and target concentrations were achieved in 90%, 85%, 65% and 40% of children, respectively. Among patients who received ≥30 mg of cefazolin per 100 ml of ECC priming, target concentrations after ECC cessation were reached in 80% of patients, while in those with &lt;30 mg cefazolin per 100 ml in 20% of patients (P = 0.031).

CONCLUSIONS
Direct extrapolation of antibiotic prophylaxis recommendations from adults to children may result in suboptimal antibiotic concentrations. An additional cefazolin dose to ECC priming appears necessary and the dosing should be based on ECC priming volume rather than on the weight of the patient.
Simulation of near-fault ground strains and rotations from actual strike-slip earthquakes: case studies of the 2004Mw 6.0 Parkfield, the 1979Mw 6.5 Imperial Valley and the 1999Mw 7.5 Izmit earthquakes
Authors: Cao Yenan , Mavroeidis George P 
Published: April 2021

SUMMARYPrevious studies have demonstrated that finite-fault simulations of actual or hypothetical earthquakes using deterministic, physics-based simulation techniques constitute an effective tool for characterizing near-fault ground strains and rotations in the low-frequency range. The characteristics of these motions are further investigated in this study by performing forward ground-motion simulations of three well-documented strike-slip earthquakes (i.e. 2004 Mw 6.0 Parkfield, 1979 Mw 6.5 Imperial Valley and 1999 Mw 7.5 Izmit) using models of the seismic source and crustal structure available in the literature. Time histories of ground strains and rotations are numerically generated at near-fault stations and at a dense grid of observation points extending over the causative fault. This is achieved by finite differencing translational motions simulated at very closely spaced stations using a kinematic modelling approach. The simulation results show that the three strike-slip earthquakes produce large-amplitude pulse-like shear strain and torsion in the forward direction of rupture propagation. The time histories of specific components of displacement gradient, strain and rotation at near-fault stations can be estimated from those of ground velocities using a phase velocity, whereas peak ground torsions in the near-fault region can be reasonably estimated from peak horizontal ground velocities using a scaling factor. However, both the phase velocity and the scaling factor exhibit significant variability in the near-fault region of the considered earthquakes. The concept of isochrones is also utilized to associate fault rupture characteristics with near-fault ground strains and rotations. The results indicate that the seismic energy radiated from the high-isochrone-velocity region of the fault—which encompasses areas of large slip locally driven by high stress drop—arrives at a near-fault station in a short time interval that coincides with the time window of the large-amplitude pulse-like shear strain and torsion.
Systematic review and meta-analysis of mortality risk prediction models in adult cardiac surgery
Authors: Sinha Shubhra , Dimagli Arnaldo , Dixon Lauren , Gaudino Mario , Caputo Massimo , Vohra Hunaid A , Angelini Gianni , Benedetto Umberto 
Published: April 2021

Abstract

OBJECTIVES
The most used mortality risk prediction models in cardiac surgery are the European System for Cardiac Operative Risk Evaluation (ES) and Society of Thoracic Surgeons (STS) score. There is no agreement on which score should be considered more accurate nor which score should be utilized in each population subgroup. We sought to provide a thorough quantitative assessment of these 2 models.

METHODS
We performed a systematic literature review and captured information on discrimination, as quantified by the area under the receiver operator curve (AUC), and calibration, as quantified by the ratio of observed-to-expected mortality (O:E). We performed random effects meta-analysis of the performance of the individual models as well as pairwise comparisons and subgroup analysis by procedure type, time and continent.

RESULTS
The ES2 {AUC 0.783 [95% confidence interval (CI) 0.765–0.800]; O:E 1.102 (95% CI 0.943–1.289)} and STS [AUC 0.757 (95% CI 0.727–0.785); O:E 1.111 (95% CI 0.853–1.447)] showed good overall discrimination and calibration. There was no significant difference in the discrimination of the 2 models (difference in AUC −0.016; 95% CI −0.034 to −0.002; P = 0.09). However, the calibration of ES2 showed significant geographical variations (P &lt; 0.001) and a trend towards miscalibration with time (P=0.057). This was not seen with STS.

CONCLUSIONS
ES2 and STS are reliable predictors of short-term mortality following adult cardiac surgery in the populations from which they were derived. STS may have broader applications when comparing outcomes across continents as compared to ES2.

REGISTRATION
Prospero (https://www.crd.york.ac.uk/PROSPERO/) CRD42020220983.