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<1>
Accession Number
2034595999
Title
Comparison of prewarming plus intraoperative warming with intraoperative
warming alone in patients undergoing minimally invasive thoracic or
abdominal surgery: A systematic review and meta-analysis.
Source
PLoS ONE. 19(9 September) (no pagination), 2024. Article Number: e0310096.
Date of Publication: September 2024.
Author
Ding N.; Yang J.; Wu C.
Institution
(Ding, Wu) Operating Room, Ningbo Medical Center LiHuiLi Hospital,
Zhejiang, Ningbo, China
(Yang) Department of Cardiac Vascular Surgery, Ningbo Medical Center
LiHuiLi Hospital, Zhejiang, Ningbo, China
Publisher
Public Library of Science
Abstract
Objective Prewarming has been recommended to reduce intraoperative
hypothermia. However, the evidence is unclear. This review examined if
prewarming can prevent intraoperative hypothermia in patients undergoing
thoracoscopic and laparoscopic surgeries. Methods PubMed, CENTRAL, Web of
Science, and Embase databases were searched for randomized controlled
trials (RCTs) up to 15th January 2024. The primary outcome of
interest was the difference in intraoperative core temperature. The
secondary outcomes were intraoperative hypothermia (<36degree) and
postoperative shivering. Results Seven RCTs were eligible. Meta-analysis
showed that intraoperative core temperature was significantly higher at
the start or within 30mins of the start of the surgery (MD: 0.32 95% CI:
0.15, 0.50 I2 = 94% p = 0.0003), 60 mins after the start of the
surgery (MD: 0.37 95% CI: 0.24, 0.50 I2 = 81% p<0.00001), 120
mins after the start of the surgery (MD: 0.34 95% CI: 0.12, 0.56
I2 = 88% p = 0.003), and at the end of the surgery (MD: 0.35
95% CI: 0.25, 0.45 I2 = 61% p<0.00001). The incidence of
shivering was also significantly lower in the prewarming group (OR: 0.18
95% CI: 0.08, 0.43 I2 = 0%). Prewarming was also associated
with a significant reduction in the risk of hypothermia (OR: 0.20 95% CI:
0.10, 0.41 I2 = 0% p<0.0001). The certainty of the evidence
assessed by GRADE was "moderate" for intraoperative core temperatures at
all time points and "low" for minimal intraoperative core temperature,
shivering, and hypothermia. Conclusion Moderate to low-quality evidence
shows that prewarming combined with intraoperative warming, as compared to
intraoperative warming alone, can improve intraoperative temperature
control and reduce the risk of hypothermia and shivering in patients
undergoing thoracoscopic and laparoscopic procedures. Copyright ©
2024 Ding 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.

<2>
Accession Number
2031632714
Title
The effectiveness of music in improving the recovery of cardiothoracic
surgery: a systematic review with meta-analysis and trial sequential
analysis.
Source
BMC Anesthesiology. 24(1) (no pagination), 2024. Article Number: 339. Date
of Publication: December 2024.
Author
Li T.; Guo Y.; Lyu D.; Xue J.; Sheng M.; Jia L.; Jin X.; Yu W.; Weng Y.;
Wu Y.
Institution
(Li, Xue, Jin) School of Medicine, Nankai University, Tianjin 300071,
China
(Guo) School of Public Health, Gansu University of Chinese Medicine,
Lanzhou 730000, China
(Lyu) Department of Pain, Tianjin First Central Hospital, Tianjin 300192,
China
(Sheng, Jia, Yu, Weng, Wu) Department of Anesthesiology, Tianjin First
Central Hospital, Tianjin 300192, China
Publisher
BioMed Central Ltd
Abstract
Aim: This study aimed to compile data on the effectiveness of music
therapy for patients undergoing cardiothoracic surgery.
 Background(s): After cardiac and thoracic surgery, patients often
experience physiological and psychological complications, such as anxiety,
pain, stress, depression and changes in vital signs, which have a great
impact on prognosis. Method(s): A systematic search of six databases
was performed to identify randomized controlled trials investigating music
therapy and cardiothoracic surgery. The data were extracted from the
qualified research, the data without heterogeneity were analysed by
random-effects model (REM) meta-analysis, and the data with heterogeneity
were analysed by fixed-effects model (FEM) meta-analysis. We evaluated
anxiety, pain, duration of mechanical ventilation, hospital length of
stay, stress hormones, opioid consumption, and vital signs, including
heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2),
diastolic blood pressure (DBP), and systolic blood pressure (SBP) after
cardiothoracic surgery. The meta-analysis and sensitivity analysis were
performed with RevMan 5.4 and Stata 14 software, and trial sequential
analysis was conducted using TSA 0.9.5.10 Beta software. This study was
conducted in accordance with the PRISMA guidelines and was registered with
PROSPERO. Result(s): The study included 24 randomized controlled
trials with a total of 1576 patients. Our analysis showed that music
therapy can significantly reduce the anxiety scores (SMD= -0.74, 95% CI
[-0.96, -0.53], p < 0.01) and pain scores (SMD= -1.21, 95% CI [-1.78,
-0.65], p < 0.01) of patients after cardiothoracic surgery. Compared with
the control group, music therapy dramatically raised postoperative SpO2
(SMD = 0.75, 95% CI [0.11, 1.39], p = 0.02). In addition, the experimental
group had significant statistical significance in reducing HR, SBP and
opioid consumption. However, there was no significant difference in
respiratory rate, stress hormones, diastolic blood pressure, length of
hospital stay, or the duration of mechanical ventilation between the two
groups. Conclusion(s): Music therapy can significantly reduce
anxiety, pain, HR, SBP, and postoperative opioid use and even improve SpO2
in patients who undergo cardiothoracic surgery. Music therapy has a
positive effect on patients after cardiothoracic surgery with few side
effects, so it is promising for use in clinics. Trial registration:
RROSPERO (registration number: CRD42023424602). Copyright © The
Author(s) 2024.

<3>
Accession Number
2024852830
Title
Tricuspid Valve Repair Can Restore the Prognosis of Patients with
Hypoplastic Left Heart Syndrome and Tricuspid Valve Regurgitation: A
Meta-analysis.
Source
Pediatric Cardiology. 45(8) (pp 1702-1712), 2024. Date of Publication:
December 2024.
Author
Ponzoni M.; Azzolina D.; Vedovelli L.; Gregori D.; Vida V.L.; Padalino
M.A.
Institution
(Ponzoni, Vida, Padalino) Pediatric and Congenital Cardiac Surgery Unit,
Department of Cardiac, Thoracic Vascular Sciences and Public Health,
University of Padua Medical School, Via Giustiniani 2, Padua 35128, Italy
(Azzolina, Vedovelli, Gregori) Unit of Biostatistics, Epidemiology and
Public Health, Department of Cardiac Thoracic and Vascular Sciences,
University of Padua Medical School, Padua, Italy
(Azzolina) Department of Environmental and Preventive Sciences, University
of Ferrara, Ferrara, Italy
Publisher
Springer
Abstract
To date, evidence supporting the efficacy of tricuspid valve (TV) repair
in interrupting the progression of systemic right ventricular (RV) adverse
remodeling in hypoplastic left heart syndrome (HLHS) is conflicting. We
conducted a systematic review and meta-analysis of scientific literature
to assess the impact of TV repair in effectively modifying the prognosis
of patients with HLHS. We conducted a systematic review of PubMed, Web of
Science, and Scopus databases. A random-effect meta-analysis was performed
and transplant-free survival, freedom from TV regurgitation, and TV
reoperation data were reconstructed using the published Kaplan-Meier
curves. Nine studies were included, comprising 203 HLHS patients
undergoing TV repair and 323 HLHS controls. The estimated transplant-free
survival at 1, 5, and 10 years of follow-up was 75.5% [95% confidence
interval (CI) = 67.6-84.3%], 63.6% [95% CI = 54.6-73.9%], and 61.9% [95%
CI = 52.7-72.6%], respectively. Transplant-free survival was comparable to
HLHS peers without TV regurgitation (p = 0.59). Five-year freedom from
recurrence of TV regurgitation and freedom from TV reoperation was 57%
[95% CI = 46.7-69.7%] and 63.6% [95% CI = 54.5-74.3%], respectively.
Younger age and TV repair at the time of Norwood operation increased the
risk of TV regurgitation recurrence and the need for TV reoperation. Our
meta-analysis supports the efficacy of TV repair in favorably modifying
the prognosis of patients with HLHS and TV regurgitation, reestablishing a
medium-term transplant-free survival which is comparable to HLHS peers.
However, durability of surgery and long-term fate of TV and RV performance
are still unclear. Graphical Abstract: (Figure presented.) Copyright
© The Author(s) 2023.

<4>
Accession Number
2034835244
Title
Effects of Cycloergometer on Cardiopulmonary Function in Elderly Patients
after Coronary Artery Bypass Grafting: Clinical Trial.
Source
Cardiology Research and Practice. 2024 (no pagination), 2024. Date of
Publication: 2024.
Author
Lisboa Cordeiro A.L.; Mascarenhas Barbosa H.D.C.; Vaz K.P.; Souza L.S.E.;
De Souza L.B.; De Oliveira Matos T.; Franca Guimaraes A.R.
Institution
(Lisboa Cordeiro) Bahiana School of Medicine and Public Health, Bahia,
Salvador, Brazil
(Mascarenhas Barbosa, Vaz, Souza, De Souza, De Oliveira Matos) Nobre
University Center, Bahia, Feira de Santana, Brazil
(Franca Guimaraes) Nobre Institute of Cardiology, Bahia, Feira de Santana,
Brazil
Publisher
Hindawi Limited
Abstract
Introduction. Despite all the improvements in surgical and anesthetic
techniques, this procedure is still associated with pulmonary and
cardiovascular complications in the postoperative period, and early
rehabilitation, done through the use of cycloergometer, can minimize such
complications, besides reducing the length of hospital stay. Objective.
Terefore, the aim of the study was to assess the impact of cardiovascular
exercise on lung function, respiratory muscle strength, and functional
capacity in elderly patients after heart bypass surgery. Methods. To this
purpose, a randomized and controlled clinical trial was conducted.
Research participants were randomized to the cycle ergometer group (CEG)
or to the control group (CG). Te CG was managed based on the institution's
protocol. Te CEG also carried out all the activities of the control group,
but there was the inclusion of cycle ergometry through a device built by
the researchers. Pulmonary function (vital capacity (VC) and peak
expiratory fow (PEF)), ventilatory muscle strength (maximum inspiratory
pressure (MIP) and maximal expiratory pressure (MEP)), and functional
capacity (six-minute walk test) were evaluated before surgery, at ICU, and
hospital discharge. Results. During the research period, 122 patients were
evaluated, 61 in each group. Te MIP of the cycle ergometry group was
higher at discharge from the ICU 95% CI 8 (5.46 to 10.54) and at hospital
discharge 95% CI 14 (16.89 to 11.11). MEP was higher in the cycle
ergometry group at discharge from the ICU with 95% CI 6 (8.18 to 3.82) and
at hospital discharge with 95% CI 9 (11.69 a 6.31). Vital capacity at ICU
discharge with 95% CI 6 (7.98 to 4.02) and at hospital discharge with 95%
CI 7 (8.98 to 5.02), as well as peak fow at ICU discharge with 95% CI 43
(75.27 to 10.73), showed relevance, being higher in the group that used
the cycle ergometer. Te CEG showed improvement in functional capacity at
the time of hospital discharge with a 95% CI 56 (30.37 to 81.63).
Conclusion. We conclude that application of cycloergometry after CABG
decreases the loss of pulmonary function, muscle strength, and functional
capacity. This trial is registered with RBR-39yrht6. Copyright ©
2024 Andre Luiz Lisboa Cordeiro et al.

<5>
Accession Number
2031767636
Title
Bariatric surgeries and cardiac structure and function: Systematic review
and network meta-analysis.
Source
Obesity Reviews. (no pagination), 2024. Date of Publication: 2024.
Author
Zhang X.-Q.; Chen K.-N.; Zhang N.-R.; Zheng F.-J.-Y.; Zhou B.; Meng H.;
Zhang Z.-X.; Niu W.-Q.
Institution
(Zhang, Zhang) Graduate School, Beijing University of Chinese Medicine,
Beijing, China
(Zhang, Zhang, Zhang) Department of Pediatrics, China-Japan Friendship
Hospital, Beijing, China
(Chen) Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing, China
(Chen) Institute of Clinical Medical Sciences, China-Japan Friendship
Hospital, Beijing, China
(Zhang, Zhou, Meng) Department of General Surgery and Obesity and
Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
(Zheng, Niu) Center for Evidence-Based Medicine, Capital Institute of
Pediatrics, Beijing, China
(Zhang) International Medical Services, China-Japan Friendship Hospital,
Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Obesity, a global health problem, is causally implicated in
the development of cardiovascular disease. Bariatric surgeries are
effective treatment options for obesity; however, the effectiveness of
different bariatric surgeries on cardiac structure and function is not
fully understood. We undertook a systematic review and network
meta-analysis to comprehensively assess this effectiveness. Data source:
PubMed, Web of Science, and EMBASE were searched from their inception
until November 11, 2023. Studies that compared bariatric surgeries
vis-a-vis non-surgical treatment, placebo, and other bariatric surgeries,
as well as reported changes in left ventricular mass or its index (LVM or
LVMI) or left ventricular ejection fraction (LVEF), were summarized.
 Result(s): Total 19 studies (17 cohort studies and 2 randomized
controlled trials) and 2012 adults were meta-analyzed. Patients receiving
gastric bypass had appreciably lowered LVM (weighted mean difference
[WMD]: -43.86 g, 95% confidence interval [CI] -61.09 to -26.63, p < 0.01)
and LVMI (standardized mean difference: -0.67, 95% CI -1.03 to -0.32, p <
0.01) compared with other bariatric surgeries. No significant improvement
in LVEF was noted across all surgeries. The drop in body mass index was
most pronounced for biliopancreatic diversion with duodenal switch (WMD
-16.33 kg/m2, 95% CI -21.60 to -11.05, p < 0.01).
 Conclusion(s): Our findings of this network meta-analysis indicated
that gastric bypass proved best for the improvement in cardiac structure,
and there was no obvious improvement in cardiac function for all bariatric
surgeries. Further studies are required to better understand the differing
effectiveness of bariatric surgeries on cardiac structure and function and
the underlying molecular mechanisms. Copyright © 2024 World
Obesity Federation.

<6>
Accession Number
2027793890
Title
The Effect of Proton-Pump Inhibitors the on Development of Arrhythmia and
Hypomagnesemia After Off-Pump Coronary Artery Bypass Surgery.
Source
Journal of Kerman University of Medical Sciences. 30(6) (pp 344-348),
2023. Date of Publication: JAN 2023.
Author
Abbaspour H.; Yazdi A.P.; Vakili V.; Purafzali Firuzabadi S.J.; Abbasi
Tashnizi M.; Amini S.
Institution
(Abbaspour, Yazdi, Amini) Department of Anesthesiology and Critical Care,
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad,
Iran, Islamic Republic of
(Vakili) Department of Family Medicine, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Purafzali Firuzabadi) Department of Anesthesiology and Critical Care and
Student Research Committee, Faculty of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Abbasi Tashnizi) Department of Cardiac Surgery, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Kerman University of Medical Sciences
Abstract
Background: Long-term use of proton-pump inhibitors (PPI) can result in
hypomagnesemia and arrhythmia. This study aimed to compare the effect of
PPI and histamine 2-receptor antagonists (H<inf>2</inf> RA) on the
incidence of hypomagnesemia and arrhythmia in patients following off-pump
coronary artery bypass surgery (CABG). Method(s): In this
randomized-controlled clinical trial 290 patients admitted to the ICU
after off-pump CABG were randomly divided into two groups of H<inf>2</inf>
RA (n = 145) and PPI (n = 145). For patients in the H<inf>2</inf> RA
group, 50 mg intravenous ranitidine was prescribed every 8 hours after the
nothing by mouth (NPO) period, followed by 40 mg famotidine tablets after
starting the oral regimen (PO). The PPI group received 40 mg pantozol IV
injections every 12 hours during the NPO period and 40 mg pantozol tablets
once daily after becoming PO. The patients were investigated for the
development of hypomagnesemia and associated arrhythmia. Result(s):
In total 271 patients with a mean age of 59.3 +/- 10 years completed the
study (female/male = 32.8%). Hypomagnesemia occurred in 60.1% of the
patients, 76 (56.7%) in the H<inf>2</inf> RA group and 87 (63.5%) in the
PPI group (P = 0.245), whereas arrhythmia had a prevalence of 12 (9.6%)
and 15 (11.1%) cases, respectively (P = 0.690). The mean time of
occurrence of hypomagnesemia and arrhythmia was 1.75 +/- 1.08 and 3.0 +/-
0.9 days after the operation in the H<inf>2</inf> RA group (P = 0.111) and
1.47 +/- 0.7 and 2.9 +/- 1.5 days in the PPI group (P = 0.897),
respectively. Conclusion(s): Our study revealed that the short-term
use of PPIs does not result in higher rates of hypomagnesemia and
associated arrhythmia in comparison to H<inf>2</inf> RA consumption after
off-pump CABG. Copyright © 2023 The Author(s).

<7>
Accession Number
2010126569
Title
Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence
after ischaemic stroke: Systematic review and meta-analysis.
Source
European Stroke Journal. 6(1) (pp 62-71), 2021. Date of Publication: March
2021.
Author
McCabe J.J.; O'Reilly E.; Coveney S.; Collins R.; Healy L.; McManus J.;
Mulcahy R.; Moynihan B.; Cassidy T.; Hsu F.; Worrall B.; Murphy S.;
O'Donnell M.; Kelly P.J.
Institution
(McCabe, O'Reilly, Coveney, Collins, Healy, McManus, Mulcahy, Moynihan,
Murphy, O'Donnell, Kelly) Health Research Board (HRB) Stroke Clinical
Trials Network Ireland (SCTNI), Dublin, Ireland
(McCabe, Coveney, Murphy, Kelly) Neurovascular Unit for Applied
Translational and Therapeutics Research, Catherine McAuley Centre, Dublin,
Ireland
(McCabe, Cassidy, Murphy) School of Medicine, University College Dublin,
Dublin, Ireland
(McCabe, Murphy) Medicine for the Elderly Department/Stroke Medicine,
Mater Misericordiae University Hospital, Dublin, Ireland
(Coveney, Collins) Department of Geriatric Medicine, Tallaght University
Hospital, Dublin, Ireland
(Healy) Department of Geriatric Medicine, Cork University Hospital, Cork,
Ireland
(McManus) Department of Geriatric Medicine, University Hospital Limerick,
Ireland
(Mulcahy) Department of Geriatric Medicine, Waterford University Hospital,
Waterford, Ireland
(Moynihan) Department of Medicine, Royal College of Surgeons in Ireland,
Dublin, Ireland
(Cassidy) Department of Geriatric and Stroke Medicine, St Vincent's
University Hospital, Dublin, Ireland
(Hsu) The Department of Biostatistical Sciences, Division of Public Health
Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
(Worrall) Departments of Neurology and Public Health Sciences, University
of Virginia, Charlottesville, VA, United States
(O'Donnell) Department of Geriatric Medicine, University Hospital Galway,
Galway, Ireland
(O'Donnell) Department of Translational Medicine, National University of
Ireland Galway, Ireland
(Kelly) Department of Neurology/Stroke Medicine, Mater Misericordiae
University Hospital, Dublin, Ireland
Publisher
SAGE Publications Ltd
Abstract
Background: Recent randomised trials showed benefit for anti-inflammatory
therapies in coronary disease but excluded stroke. The prognostic value of
blood inflammatory markers after stroke is uncertain and guidelines do not
recommend their routine measurement for risk stratification.
 Method(s): We performed a systematic review and meta-analysis of
studies investigating the association of C-reactive protein (CRP),
interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major
vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19.
Random-effects meta-analysis was performed for studies reporting
comparable effect measures. Result(s): Of 2,515 reports identified,
39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n =
16). An association with recurrent stroke was reported in 12/26 studies
(CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis
of comparable studies, CRP was associated with an increased risk of
recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD)
increase in log<inf>e</inf>-CRP (1.14, 95% CI 1.06-1.22, p < 0.01)] and
MVEs (pooled HR 1.21, CI 1.10-1.34, p < 0.01). Fibrinogen was also
associated with recurrent stroke (HR 1.26, CI 1.07-1.47, p < 0.01) and
MVEs (HR 1.31, 95% CI 1.15-1.49, p < 0.01). Trends were identified for
IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97-1.41, p =
0.10) and MVEs (HR 1.22, CI 0.96-1.55, p = 0.10). Conclusion(s):
Despite evidence suggesting an association between inflammatory markers
and post-stroke vascular recurrence, substantial methodological
heterogeneity was apparent between studies. Individual-patient pooled
analysis and standardisation of methods are needed to determine the
prognostic role of blood inflammatory markers and to improve patient
selection for randomised trials of inflammatory therapies. Copyright
© European Stroke Organisation 2021.

<8>
Accession Number
2034749821
Title
Should renin-Angiotensin system inhibitors be stopped or not before
non-cardiac surgery?.
Source
European Heart Journal: Acute Cardiovascular Care. 13(9) (pp 670-671),
2024. Date of Publication: 01 Sep 2024.
Author
Halvorsen S.; Vranckx P.; Van Diepen S.
Institution
(Halvorsen) Department of Cardiology, Oslo University Hospital Ulleval,
P.O. Box 4956 Nydalen, Oslo N-0424, Norway
(Halvorsen) Institute of Clinical Medicine, University of Oslo, P.O. Box
1171 Blindern, Oslo 0318, Norway
(Vranckx) Department of Cardiology and Critical Care Medicine, Jessa
Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, University of Hasselt,
Hasselt, Belgium
(Van Diepen) Department of Critical Care Medicine, University of Alberta,
Edmonton, AB, Canada
(Van Diepen) Division of Cardiology, Department of Medicine, University of
Alberta, Edmonton, AB, Canada
(Van Diepen) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
Publisher
Oxford University Press

<9>
Accession Number
2034749817
Title
Potassium supplementation and the prevention of atrial fibrillation after
cardiac surgery (TIGHT-K) trial.
Source
European Heart Journal: Acute Cardiovascular Care. 13(9) (pp 672-673),
2024. Date of Publication: 01 Sep 2024.
Author
Verbrugge F.H.; Menon V.
Institution
(Verbrugge) Centre for Cardiovascular Diseases, University Hospital
Brussels, Laarbeeklaan 101, Jette 1090, Belgium
(Verbrugge) Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel,
Laarbeeklaan 101, Jette 1090, Belgium
(Menon) Department of Cardiovascular Medicine, Heart, Vascular, and
Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
Oxford University Press

<10>
Accession Number
2034749794
Title
AbetaYSS trial in perspective: Beta-blockers following myocardial
infarction among patients with preserved ejection fraction.
Source
European Heart Journal: Acute Cardiovascular Care. 13(9) (pp 674-676),
2024. Date of Publication: 01 Sep 2024.
Author
Platz E.; Morrow D.A.
Institution
(Platz, Morrow) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Harvard Medical School, 221 Longwood Ave., Boston, MA 02115,
United States
(Morrow) TIMI Study Group, Critical Care Cardiology Trials Network,
Boston, United States
Publisher
Oxford University Press

<11>
Accession Number
2034583054
Title
Semaglutide Effects on Cardiovascular Outcomes in People With Overweight
or Obesity (SELECT): Outcomes by Sex.
Source
Journal of the American College of Cardiology. 84(17) (pp 1678-1682),
2024. Date of Publication: 22 Oct 2024.
Author
Verma S.; Colhoun H.M.; Dicker D.; Hovingh G.K.; Kahn S.E.; Kautzky-Willer
A.; Lingvay I.; Plutzky J.; Rasmussen S.; Rathor N.; Hoff S.T.; Lincoff
A.M.
Institution
(Verma) St Michael's Hospital and University of Toronto, Toronto, ON,
Canada
(Colhoun) Institute of Genetics and Cancer, University of Edinburgh,
Edinburgh, United Kingdom
(Dicker) Internal Medicine Department D, Hasharon Hospital-Rabin Medical
Center, Petah Tikva, Israel
(Dicker) Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
(Hovingh, Rasmussen, Rathor, Hoff) Novo Nordisk A/S, Soborg, Denmark
(Hovingh) Department of Vascular Medicine, Amsterdam University Medical
Centers, Amsterdam, Netherlands
(Kahn) VA Puget Sound Health Care System and Department of Medicine,
University of Washington, Seattle, WA, United States
(Kautzky-Willer) Division of Endocrinology and Metabolism, Department of
Internal Medicine III, Medical University of Vienna, Vienna, Austria
(Lingvay) Division of Endocrinology, Department of Internal Medicine and
Peter O'Donnell Jr School of Public Health, UT Southwestern Medical
Center, Dallas, TX, United States
(Plutzky) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Lincoff) Cleveland Clinic Lerner College of Medicine, Case Western
Reserve University, Cleveland, OH, United States
Publisher
Elsevier Inc.

<12>
Accession Number
2033048834
Title
Outcomes of mitral TEER in non-responders to cardiac resynchronization
therapy: A systematic review and meta-analysis.
Source
Journal of Cardiology. 84(5) (pp 317-325), 2024. Date of Publication:
November 2024.
Author
Rmilah A.A.; Abdelhafez M.; Balla A.K.; Ahmad S.; Jaber S.; Latif O.; Haq
I.; Alzu'Bi H.; Al-Abdouh A.; Assali M.; Ghaly R.; Prokop L.; Guerrero
M.E.
Institution
(Rmilah, Balla, Guerrero) Department of Cardiovascular Medicine, Mayo
Clinic, Rochester, MN, United States
(Abdelhafez) Department of Internal Medicine, Al-Quds University School of
Medicine, Jerusalem, Palestine
(Ahmad) Department of Internal Medicine, East Carolina University
Hospital, Greenville, NC, United States
(Jaber) Department of Internal Medicine, Al-Habib Hospital, Riyadh, Saudi
Arabia
(Latif, Haq) Department of Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Alzu'Bi) Department of Cardiovascular Medicine, Mount Sinai Hospital,
Miami, FL, United States
(Al-Abdouh) Department of Internal Medicine, University of Kentucky
Hospital, Lexington, KY, United States
(Assali) Department of Cardiovascular Medicine, Hennepin Medical Center,
Minneapolis, MN, United States
(Ghaly) Department of Internal Medicine, University of Missouri, Kansas
City, MO, United States
(Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Secondary mitral regurgitation (MR) worsens in 10-15 % of
heart failure (HF) patients receiving cardiac resynchronization therapy
(CRT). Transcatheter edge-to-edge repair (TEER) with Mitra-Clip (Abbot
Vascular, Santa Clara, CA, USA) therapy is associated with improved
survival and decreased rates of hospitalization for HF in selected
patients with secondary MR. Data on TEER outcomes in CRT-non-responders
are limited. The purpose of this meta-analysis was to evaluate outcomes of
mitral TEER with Mitra-Clip in CRT-non-responders. Method(s):
Cochrane, Scopus, MEDLINE, and EMBASE were searched for studies discussing
outcomes of Mitra-Clip in CRT non-responders. Two reviewers were
independently involved in screening studies and extracting relevant data.
Individual study incidence rate estimates underwent logit transformation
to calculate the weighted summary proportion under the random effect
model. Result(s): A total of eight reports met the inclusion criteria
(439 patients). Mitra-Clip improved MR grade to <=2+ in 83.8 % and 86.8 %
of CRT non-responders at six months and one year, respectively.
Symptomatic improvement (New York Heart Association class <=II) was also
found in 71 % and 78.1 % of CRT non-responders at six months and one year,
respectively. The pooled overall incidence estimates of mortality at 30
days, 6 months, 1 year, and 2 years were 3.6 %, 9.2 %, 17.8 %, and 25.9 %,
respectively. Conclusion(s): TEER with Mitra-Clip in patients with
significant secondary MR who do not respond to CRT was associated with MR
improvement, alleviation of symptoms, and mortality rates similar to those
in the COAPT trial. Copyright © 2024

<13>
Accession Number
2021014558
Title
Vascular Closure Devices For Axillary Artery Access: A Systematic Review
and Meta-Analysis.
Source
Journal of Endovascular Therapy. 31(5) (pp 763-771), 2024. Date of
Publication: October 2024.
Author
Koziarz A.; Kennedy S.A.; Awad El-Karim G.; Tan K.T.; Oreopoulos G.D.;
Kalra S.; Etz C.D.; Rajan D.K.; Mafeld S.
Institution
(Koziarz) Department of Radiology, McMaster University, Hamilton, ON,
Canada
(Kennedy, Awad El-Karim, Tan, Oreopoulos, Rajan, Mafeld) Division of
Vascular and Interventional Radiology, Department of Medical Imaging,
Toronto General Hospital, University of Toronto, Toronto, ON, Canada
(Oreopoulos) Division of Vascular Surgery, University Health Network,
Toronto, ON, Canada
(Kalra) Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, Toronto, ON, Canada
(Etz) Department of Cardiac Surgery, Heart Center, University of Leipzig,
Leipzig, Germany
Publisher
SAGE Publications Inc.
Abstract
Purpose: To evaluate the technical success and complication rates of
vascular closure devices (VCDs) in the axillary artery. Material(s)
and Method(s): MEDLINE and Embase were searched independently by two
reviewers to identify observational studies from inception through October
2021. The following outcomes were meta-analyzed: technical success,
hematoma, dissection, pseudoaneurysm, infection, and local neurological
complications. Complications were also graded as mild, moderate, and
severe. A logistic regression evaluating the influence of sheath size for
the outcome of technical success rate was performed using individual
patient-level data. Result(s): Of 1496 unique records, 20
observational studies were included, totaling 915 unique arterial access
sites. Pooled estimates were as follows: technical success 84.8% (95%
confidence interval [CI]: 78%-89.7%, I2=60.4%), hematoma 7.9%
(95% CI: 5.8%-10.6%, I2=0%), dissection 3.1% (95% CI:
1.3%-7.3%, I2=0%), pseudoaneurysm 2.7% (95% CI: 1.3%-5.7%,
I2=0%), infection <1% (95% CI: 0%-5.7%, I2=20.5%),
and local neurological complications 2.7% (95% CI: 1.7%-4.4%,
I2=0%). There was a significant negative association between
sheath size and technical success rate (odds ratio [OR]: 0.87 per 1 French
(Fr) increase in sheath size, 95% CI: 0.80-0.94, p=0.0005). Larger sheath
sizes were associated with a greater number of access-site complications
(adjusted odds ratio [aOR]: 1.21 per 1 Fr increase sheath size, 95% CI:
1.04-1.40, p=0.013). Conclusion(s): Off-label use of VCDs in the
axillary artery provides an 85% successful closure rate and variable
complication rate, depending on the primary procedure and sheath size.
Larger sheaths were associated with a lower technical success and greater
rate of access-related complications. Clinical Impact: Safe arterial
access is the foundation for arterial intervention. While the common
femoral artery is a well established access site, alternative arterial
access sites capable of larger sheath sizes are needed in the modern
endovascular era. This article provides the largest synthesis to date on
the use of vascular closure devices for percutaneous axillary artery
access in endovascular intervention. It should serve clinicians with added
confidence around this approach in terms of providing a reference for
technical success and complications. Clinically, this data is relevant for
patient consent purposes as well as for practice quality improvement in
setting safety standards for this access site. Copyright © The
Author(s) 2023.

<14>
Accession Number
2034820601
Title
Intervention Effect of the Mobile Phone APP Based Continuous Care on
Patients after Mechanical Heart Valve Replacement: A Randomised Controlled
Trials.
Source
Reviews in Cardiovascular Medicine. 25(9) (no pagination), 2024. Article
Number: 314. Date of Publication: 2024.
Author
Ding N.; Luo X.; Zhou J.; Jiang X.; Wang X.
Institution
(Ding) Vascular Surgery Department, The Affiliated Hospital of Guizhou
Medical University, Guizhou, Guiyang 550004, China
(Luo) The First Ward of the Neurosurgery Department, Affiliated Hospital
of Zunyi Medical University, Guizhou, Zunyi 563099, China
(Zhou) Cardiac Surgery Department, Affiliated Hospital of Zunyi Medical
University, Guizhou, Zunyi 563099, China
(Jiang) Nursing Department, Puding County People's Hospital, Guizhou,
Anshun 562199, China
(Wang) School of Information Engineering, Zunyi Medical University,
Guizhou, Zunyi 563006, China
Publisher
IMR Press Limited
Abstract
Background: To determine the effect of continuous care based on mobile
application on patients' quality of life and self-care ability after
mechanical heart valve replacement. Method(s): Ninety patients who
underwent cardiac mechanical valve replacement in the cardiovascular
surgery department of a tertiary general hospital in Guizhou Province from
September 2020 to January 2022 were selected for the study. The subjects
were randomly divided into a control group and an intervention group using
the SPSS25.0 software, with 45 patients in the two groups. The control
group received routine nursing care during hospitalization, health
education the day before discharge, and regular telephone and outpatient
follow-up 6 months after discharge. Based on the control group's care, the
intervention group received Mobile APP continuous care for 6 months. The
effectiveness of patient's quality of life, medication adherence,
international normalized ratio (INR) value compliance rates and self-care
ability following mechanical heart valve replacement were evaluated the
day before discharge and at the 1, 3 and 6 months after discharge.
 Result(s): Scores of quality of life, warfarin medication adherence,
and self-care ability rose considerably in the intervention group compared
to the control group, and the differences were statistically significant.
 Conclusion(s): The mobile phone application (APP)'s continuity of
care could improve patients' quality of life, medication adherence, INR
value compliance rates, and self-care ability. Clinical Trial
Registration: No: ChiCTR2400081250. Registered 27 February, 2024,
https://www.chictr.org.cn. Copyright © 2024 The Author(s).

<15>
Accession Number
2034837216
Title
Mortality and Survival after Norwood Procedure Comparison between Shunt
Type in Patients with Hypoplastic Left Heart Syndrome or Its Variants: A
Systematic Review and Meta-Analysis Study.
Source
Journal of Cardiac Surgery. 2023 (no pagination), 2023. Article Number:
8534205. Date of Publication: 2023.
Author
Arnaout A.Y.; Nerabani Y.; Alhaj Ali H.; Shahrour M.Z.; Fallaha M.Y.;
Arnaout I.; Sajee A.; Morjan M.; Al-Kanj H.
Institution
(Arnaout, Nerabani, Alhaj Ali, Shahrour, Fallaha, Arnaout, Sajee) Faculty
of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
(Morjan) Department of Pediatric Surgery, Aleppo University Hospital,
Aleppo 15310, Syrian Arab Republic
(Al-Kanj) Cardiovascular Surgery Department, Aleppo University Hospital,
Aleppo 15310, Syrian Arab Republic
Publisher
Wiley-Hindawi
Abstract
Background. In the Norwood procedure, a conduit is performed either from
the subclavian artery to the pulmonary artery, Blalock-Taussig shunt
(mBTs), or from the right ventricle to the pulmonary artery (RV-PA shunt).
There are some concerns regarding the two shunts and which one is better
according to morbidity and mortality in patients with hypoplastic left
heart syndrome or its variants. Methods. We systematically searched
PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases
from inception to 04/June/2021 to collect articles reporting a comparison
of RV-PA shunt and mBTs. Results. Our meta-analysis showed that the
mortality rate after 6 months, 1, 2, 3, 4, 5, and 6 years for the mBTS
group was 16.3%, 28.6%, 34.8%, 42.4%, 44.6%, 45.1%, and 39.6%,
respectively, and for the RV-PAS, 14.8%, 26.6%, 31%, 40.1%, 36.1%, 37.5%,
and 34.0%, respectively. The mortality rate was significantly higher in
the mBTs group at 1 and 2 years; otherwise, there is no significance
differences. Overall complications rate was higher in the mBTs group than
in the RV-PAs group (17.8% vs. 8.5%). In contrast, the rate of cardiac
complications was higher in the RV-PAS group. Conclusions. The RV-PA shunt
had lower mortality and overall complications rate than mBT shunt at the
short-term outcome within the first two years, but at the long term, there
was no difference between the two shunts. On the other hand, the mBT shunt
had a lower incidence of cardiac complications at the early stage after
the operations. However, some studies are poor due to the difficulties in
conducting original research in this field. Therefore, we recommend
conducting systematic reviews and original studies to compare these and
other therapeutic procedures for these patients. Copyright © 2023
Ahmad Yamen Arnaout et al.

<16>
Accession Number
642259969
Title
Conventional anatomical landmark versus preprocedural ultrasound for
thoracic epidural analgesia: A systematic review and meta-analysis.
Source
Journal of perioperative practice. 34(10) (pp 315-325), 2024. Date of
Publication: 01 Oct 2024.
Author
Sharapi M.; Mahfouz A.; Philip K.; Mektebi A.; Albakri K.
Institution
(Sharapi) Department of Anaesthesiology and Intensive Care Medicine,
Beaumont Hospital, RCSI Hospital Group, Dublin, Ireland
(Mahfouz) Faculty of Medicine, Kafrelsheikh University, Egypt
(Philip) Faculty of Medicine, Sohag University, Sohag, Egypt
(Mektebi) Faculty of Medicine, Kutahya Health Sciences University,
Kutahya, Turkey
(Albakri) Faculty of Medicine, Hashemite University, Zarqa, Jordan
Abstract
BACKGROUND: Thoracic epidural analgesia is the gold standard for major
thoracic and abdominal surgeries. AIM: Ultrasound-guided and
landmark-based thoracic epidural insertion are compared in this systematic
review. METHOD(S): Randomised controlled trials were sought in six
databases for a systematic review and meta-analysis. With a 95% confidence
interval, a fixed-effects model calculated risk ratio or mean difference.
Cochrane risk of bias assessed bias. Four randomised controlled trials
were examined. FINDINGS: Preprocedural ultrasound increased thoracic
epidural placement first-puncture success rate (risk ratio = 1.28, 95%
confidence interval (1.05 to 1.56), p value = 0.02) and decreased the need
for two or more skin punctures (mean difference = -2.41, 95% confidence
interval (-3.34 to -1.47), p value = 0.00001). The ultrasound group
reduced needle redirections (risk ratio = 0.6, 95% confidence interval
(0.38 to 0.94), p value = 0.02). The epidural block success rate was equal
in both groups (risk ratio = 1.02, 95% confidence interval (0.96 to 1.07),
p value = 0.6). CONCLUSION(S): Thoracic epidural insertion is
improved by ultrasound but not the success rate. Quality research with
larger samples is needed to emphasise these conclusions.

<17>
Accession Number
645452431
Title
Role of Prophylactic N-Acetylcysteine Supplementation on Postoperative
Outcomes in Patients Undergoing Elective Double-Valve Replacement (Aortic
and Mitral Valve).
Source
Annals of cardiac anaesthesia. 27(4) (pp 324-329), 2024. Date of
Publication: 01 Oct 2024.
Author
Ram Kiran K.S.; Trivedi V.; Rajesh V.S.P.; Sharma M.; Haranal M.; Pandya
H.
Institution
(Ram Kiran, Trivedi, Rajesh, Sharma) Department of Cardiac Anesthesia,
U.N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil
Hospital (Medicity Campus), Ahmedabad, Gujarat, India
(Haranal) Department of Cardiovascular and Thoracic Surgery, UN Mehta
Hospital, Ahmedabad, Gujarat, India
(Pandya) Department of Reaseach, UN Mehta Hospital, Ahmedabad, Gujarat,
India
Abstract
AIMS AND OBJECTIVES: The incidence of postoperative liver dysfunction is
high in patients undergoing double-valve replacement - mitral and aortic
valve replacement (DVR). This study aims to evaluate N-acetylcysteine's
free radical scavenging property (NAC) to prevent postoperative liver
dysfunction in these patients, thus affecting overall clinical outcomes.
 METHOD(S): A single-center, prospective, randomized, double-blinded
interventional study of 60 patients divided into two groups of 30 each.
Group N received prophylactic intravenous NAC, and Group C received
volume-matched 5% dextrose. Data comprised demographics, liver function
tests (LFT), renal function tests (RFT), vasoactive-inotropic scores (VIS)
score, and C-reactive protein (CRP) at various time intervals.
Postoperative parameters such as ventilation duration, length of stay in
ICU (LOS-ICU), length of hospital stay (LOHS), atrial fibrillation (AF),
acute kidney injury (AKI) requiring hemodialysis, and mortality were
noted. Statistical analysis was performed with the Student's t-test and
Chi-square test (SPSS 22 software). RESULT(S): All postoperative LFT
parameters (total bilirubin, serum glutamic oxaloacetic transaminase
(SGOT), serum glutamic pyruvate transaminase (SGPT), and alkaline
phosphatase (ALP)) were significantly lower (P < 0.05) at 24, 48, and 72
hours in Group N compared to Group C. RFT and VIS scores were lower in
Group N; however, were not statistically significant except for Serum
Creatinine at 48 hours (P = 0.0478). Ventilation duration (P = 0.0465) and
LOS-ICU (P = 0.0431) were significantly lower in Group N. Other outcomes
like AF, LOHS, and mortality were lower in Group N but were not
statistically significant. CONCLUSION(S): Our study showed that
prophylactic administration of NAC in patients undergoing DVR is
associated with a reduction in the incidence of postoperative liver
dysfunction with a positive impact on postoperative
outcomes. Copyright © 2024 Copyright: © 2024 Annals of
Cardiac Anaesthesia.

<18>
Accession Number
645451598
Title
Bilateral Ultrasound-Guided Erector Spinae Plane Block for Management of
Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries
Through a Midline Sternotomy.
Source
Annals of cardiac anaesthesia. 27(4) (pp 316-323), 2024. Date of
Publication: 01 Oct 2024.
Author
Mogahed M.M.; Abd El-Ghaffar M.S.; Elkahwagy M.S.
Institution
(Mogahed) Department of Anesthesiology, Faculty of Medicine, Tanta
University, Egypt
(Abd El-Ghaffar) Department of Surgical ICU and Pain Medicine, Faculty of
Medicine, Tanta University, Egypt
(Elkahwagy) Department of Cardiothoracic Surgery, Faculty of Medicine,
Tanta University, Egypt
Abstract
BACKGROUND: Ultrasound (US) guided erector spinae plane block (ESPB) is a
safe and effective technique in providing perioperative pain management in
pediatrics with a high success rate. THE AIM OF THIS STUDY: Was to compare
the efficacy of bilateral ultrasound-guided erector spinae plane block for
management of acute postoperative surgical pain after pediatric cardiac
surgeries through a midline sternotomy. METHOD(S): One hundred
patients aged 4-12 years were randomly assigned into two groups, both
groups received general anesthesia followed by bilateral sham erector
spinae plane block at the level of T6 transverse process using 0.4 ml/kg
normal saline on each side in the control group (group C) or bilateral
ultrasound-guided erector spinae plane block at the level of T6 transverse
process using 0.4 ml/kg ropivacaine 0.2% with a maximum dose of 2 mg/kg
mixed with adrenaline 2 mcg/ml in erector spinae plane block group (group
E). The postoperative pain scores were evaluated immediately
post-extubation, at 1 hour, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24
hours after extubation, total consumption of intraoperative fentanyl and
time to first rescue analgesic administration were also recorded.
 RESULT(S): There was a statistically high significant delay in the
group E (314.72 +/- 45.94) compared with the group C (36.7 +/- 7.22) as
regards to the mean (SD) of the time of the rescue analgesia (P < 0.001)
(with 95% CI), moreover; the number of rescue analgesic was significantly
higher in the group C compared with the group E (P < 0.001) (with 95% CI)
and the mean (SD) of total intraoperative and postoperative levels
fentanyl requirements in the group C were significantly higher compared
with the group E (6.47 +/- 0.98 and 5.09 +/- 0.83) (with 95% CI) in group
C versus (4.69 +/- 0.71 and 2.31 +/- 0.66) (with 95% CI) in group E
respectively (P < 0.001) (with 95% CI). CONCLUSION(S):
Ultrasound-guided bilateral ESPB with ropivacaine and adrenaline delays
the postoperative need of analgesia and reduces postoperative fentanyl
consumption at 24 h in pediatric patients undergoing cardiac surgery
through midline sternotomy. Copyright © 2024 Copyright: ©
2024 Annals of Cardiac Anaesthesia.

<19>
Accession Number
645450966
Title
To Study the Efficacy of Ultrasound Guided Pecto-Intercostal Fascial Plane
Block in Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A
Randomized Prospective Comparative Study.
Source
Annals of cardiac anaesthesia. 27(4) (pp 301-308), 2024. Date of
Publication: 01 Oct 2024.
Author
Singh G.; Dhiraaj S.; Shamshery C.; Agarwal S.K.; Goyal P.; Ambasta S.
Institution
(Singh, Dhiraaj, Shamshery, Goyal, Ambasta) Department of Anaesthesiology,
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar
Pradesh, India
(Agarwal) Department of Cardio Thoracic and Vascular Surgery, Sanjay
Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar
Pradesh, India
Abstract
BACKGROUND: The incidence of acute poststernotomy pain after cardiac
surgery is 80%1. Pecto-intercostal fascial plane block (PIFB) adjacent to
the sternum anesthetizes the anterior cutaneous branches of the
intercostal nerves and may provide effective analgesia after sternotomy.
METHODOLOGY: A randomized controlled, double-blinded, prospective
comparative trial was conducted at a tertiary care center on patients of
midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open
cardiac surgery with the primary aim to evaluate analgesia on deep
breathing after 3 hours of PIFB block bilaterally. A total of 60 patients
were enrolled and randomly divided into three groups. PIFB was
administered bilaterally before extubation, with 15 ml 0.125% bupivacaine
plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group
C did not receive any intervention. All patients received acetaminophen 1
gram three times a day and injectable tramadol 1 mg/kg as a rescue
analgesic. RESULT(S): Baseline characteristics were similar among all
the groups. The Numeric Rating Scale (NRS) for pain was statistically
lower (P < 0.05) in Groups B and B+C compared to Group C at rest, deep
breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on
deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours,
(2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5,
3.6)} at 24 hours after extubation. The peak expiratory flow rate was the
highest in Group B. Rescue analgesia was not required in Group B.
 CONCLUSION(S): PIFB reduces sternotomy pain compared to the control
group on deep breathing at 3 hours after block, with delayed requirement
of rescue analgesia and improved respiratory mechanics in terms of peak
expiratory flow rate at all time points. There is no benefit from adding
clonidine. Copyright © 2024 Copyright: © 2024 Annals of
Cardiac Anaesthesia.

<20>
Accession Number
2034938357
Title
Colchicine for secondary prevention of ischaemic stroke and
atherosclerotic events: a meta-analysis of randomised trials.
Source
eClinicalMedicine. 76 (no pagination), 2024. Article Number: 102835. Date
of Publication: October 2024.
Author
Fiolet A.T.L.; Poorthuis M.H.F.; Opstal T.S.J.; Amarenco P.; Boczar K.E.;
Buysschaert I.; Budgeon C.; Chan N.C.; Cornel J.H.; Jolly S.S.; Layland
J.; Lemmens R.; Mewton N.; Nidorf S.M.; Pascual-Figal D.A.; Price C.; Shah
B.; Tardif J.-C.; Thompson P.L.; Tijssen J.G.P.; Tsivgoulis G.; Walsh C.;
Wang Y.; Weimar C.; Eikelboom J.W.; Mosterd A.; Kelly P.J.
Institution
(Fiolet) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Fiolet, Cornel, Mosterd) Dutch Network for Cardiovascular Research (WCN),
Utrecht, Netherlands
(Poorthuis) Department of Neurology, University Medical Center Utrecht,
Utrecht, Netherlands
(Opstal) Department of Cardiology, University Medical Center Amsterdam,
Amsterdam, Netherlands
(Amarenco) Department of Neurology, Bichat University Hospital, Paris,
France
(Amarenco) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Boczar) Department of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Buysschaert) Department of Cardiology, Sint-Jan Hospital, Brugge, Belgium
(Budgeon, Thompson) Cardiovascular Epidemiology Research Centre, School of
Population and Global Health, University of Western Australia, Perth,
Australia
(Chan) Department of Haematology and Thromboembolism, McMaster University,
Hamilton, ON, Canada
(Cornel) Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
(Cornel) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Jolly, Eikelboom) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Layland) Cardiology, Department of Medicine, Peninsula Health, Peninsula
Clinical School, Central Clinical School, Monash University, VIC,
Australia
(Layland) Peninsula Clinical School, Central Clinical School, Monash
University, VIC, Australia
(Lemmens) Department of Neurology, University Hospitals Leuven, Leuven,
Belgium
(Lemmens) Department of Neurosciences, Experimental Neurology and Leuven
Research Institute for Neuroscience and Disease (LIND), KU Leuven -
University of Leuven, Leuven, Belgium
(Mewton) Department of Cardiology, Institut de Cardiologie des Hospices
Civils de Lyon, Lyon, France
(Nidorf, Thompson) Harry Perkins Institute of Medical Research, Perth,
Australia
(Pascual-Figal) Department of Cardiology, Hospital Virgen de la Arrixaca,
University of Murcia, Murcia, Spain
(Pascual-Figal) Centro Nacional de Investigaciones Cardiovasculares
(CNIC), Madrid, Spain
(Price) Stroke Research Group, Population Health Sciences Institute,
Newcastle University, Newcastle Upon Tyne, United Kingdom
(Shah) VA New York Harbor Healthcare System, New York, United States
(Shah) Leon H Charney Division of Cardiology, NYU Grossman School of
Medicine, New York, NY, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Thompson) Sir Charles Gairdner Hospital, Perth, Australia
(Thompson) Heart and Vascular Research Institute of Western Australia,
Australia
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
Amsterdam, Netherlands
(Tsivgoulis) Second Department of Neurology, National & Kapodistrian
University of Athens, "Attikon" University Hospital, Athens, Greece
(Walsh) TCD Biostatistics Unit, Discipline of Public Health and Primary
Care, School of Medicine, Trinity College Dublin, Ireland
(Wang) Department of Neurology, Beijing Tiantan Hospital, Beijing, China
(Weimar) Institute for Medical Informatics, Biometry and Epidemiology,
University Hospital, University Duisburg-Essen, Germany
(Mosterd) Department of Cardiology, Meander Medical Centre, Amersfoort,
Netherlands
(Kelly) Mater Misericordiae University Hospital and School of Medicine,
University College Dublin, Ireland
(Kelly) Health Research Board Stroke Clinical Trials Network Dublin
Ireland, Ireland
Publisher
Elsevier Ltd
Abstract
Background: Guidelines recommend low-dose colchicine for secondary
prevention in cardiovascular disease, but uncertainty remains concerning
its efficacy for stroke, efficacy in key subgroups and about uncommon but
serious safety outcomes. Method(s): In this trial-level
meta-analysis, we searched bibliographic databases and trial registries
form inception to May 16, 2024. We included randomised trials of
colchicine for secondary prevention of ischaemic stroke and major adverse
cardiovascular events (MACE: ischaemic stroke, myocardial infarction,
coronary revascularisation, or cardiovascular death). Secondary outcomes
were serious safety outcomes and mortality. A fixed-effect
inverse-variance model was used to generate a pooled estimate of relative
risk (RR) with 95% confidence intervals (CI). This study is registered
with PROSPERO, CRD42024540320. Finding(s): Six trials involving
14,934 patients with prior stroke or coronary disease were included. In
all patients, colchicine compared with placebo or no colchicine reduced
the risk for ischaemic stroke by 27% (132 [1.8%] events versus 186 [2.5%]
events, RR 0.73 [95% CI 0.58-0.90]) and MACE by 27% (505 [6.8%] events
versus 693 [9.4%] events, with RR 0.73 [0.65-0.81]). Efficacy was
consistent in key subgroups (females versus males, age below versus above
70, with versus without diabetes, statin versus non-statin users).
Colchicine was not associated with an increase in serious safety outcomes:
hospitalisation for pneumonia (109 [1.5%] versus 106 [1.5%], RR 0.99
[0.76-1.30]), cancer (247 [3.5%] versus 255 [3.6%], RR 0.97 [0.82-1.15]),
and gastro-intestinal events (153 [2.1%] versus 135 [1.9%]), RR 1.15
[0.91-1.44]. There was no difference in all-cause death (201 [2.7%] versus
181 [2.4%], RR 1.09 [0.89-1.33]), cardiovascular death (70 [0.9%] versus
80 [1.1%], RR 0.89 [0.65-1.23]), or non-cardiovascular death (131 [1.8%]
versus 101 [1.4%], RR 1.26 [0.98-1.64]). Interpretation(s): In
patients with prior stroke or coronary disease, colchicine reduced
ischaemic stroke and MACE, with consistent treatment effect in key
subgroups, and did not increase serious safety events or death.
 Funding(s): There was no funding source for this study. Copyright
© 2024 The Authors

<21>
Accession Number
2031637517
Title
A multi-center, double-blind, placebo-controlled, randomized,
parallel-group, non-inferiority study to compare the efficacy of
goal-directed tranexamic acid administration based on viscoelastic test
versus preemptive tranexamic acid administration on postoperative bleeding
in cardiovascular surgery (GDT trial).
Source
Trials. 25(1) (no pagination), 2024. Article Number: 623. Date of
Publication: December 2024.
Author
Nam J.-S.; Oh C.-S.; Kim J.-Y.; Choi D.-K.; Oh A.R.; Park J.; Lee J.-H.;
Yun S.-C.; Kim K.W.; Jang M.U.; Kim T.-Y.; Choi I.-C.
Institution
(Nam, Kim, Choi, Choi) Department of Anesthesiology and Pain Medicine,
Asan Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
(Oh, Kim) Department of Anesthesiology, Konkuk University Medical Center,
Konkuk University School of Medicine, Seoul, and Institution for
Patient-Centered Goal-Directed Strategy, Chungju, South Korea
(Oh, Kim) Institution for Patient-Centered Goal-Directed Strategy, Konkuk
University, Chungju, South Korea
(Oh, Park, Lee) Department of Anesthesiology and Pain Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Yun) Department of Biostatistics, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Soonchunhyang
University Seoul Hospital, Seoul, South Korea
(Jang) Cheorwon Public Health Center, Cheorwon-Gun, Gangwon-Do, South
Korea
Publisher
BioMed Central Ltd
Abstract
Background: Tranexamic acid (TXA) effectively attenuates hyperfibrinolysis
and preemptive administration has been employed to reduce bleeding and
blood transfusions in various surgical settings. However, TXA
administration could be associated with adverse effects, such as seizures
and thromboembolic risks. While patients with fibrinolysis shutdown showed
greater thromboembolic complications and mortality, TXA administration may
aggravate the degree of shutdown in these patients. Selective TXA
administration based on the results of rotational thromboelastometry
(ROTEM) would be non-inferior to preemptive TXA administration in reducing
postoperative bleeding and beneficial in reducing its risks in patients
undergoing cardiovascular surgery. Method(s): This non-inferiority,
randomized, double-blind, placebo-controlled, multicenter trial will be
performed in 3 tertiary university hospitals from August 2023 to March
2025. Seven hundred sixty-four patients undergoing cardiovascular surgery
will be randomly allocated to get TXA as a preemptive (Group-P) or
goal-directed strategy (Group-GDT) in each institution (with a 1:1
allocation ratio). After anesthesia induction, TXA (10 mg/kg and 2
mg/kg/h) and a placebo are administered after anesthesia induction in
Group-P and Group-GDT, respectively. ROTEM tests are performed immediately
before weaning from CPB and at the considerable bleeding post-CPB period.
After getting the test results, a placebo is administered in Group-P
(regardless of the test results). In Group-GDT, placebo or TXA is
administered according to the results: placebo is administered if the
amplitude at 10 min (A10-EXTEM) is >= 40 mm and lysis within 60 min
(LI60-EXTEM) of EXTEM assay is >= 85%, or TXA (20 mg/kg) is administered
if A10-EXTEM is < 40 mm or LI60-EXTEM is < 85%. The primary outcome is
inter-group comparisons of postoperative bleeding (for 24 h). The
secondary measures include comparisons of perioperative blood transfusion,
coagulation profiles, reoperation, thromboembolic complications, seizures,
in-hospital mortality, fibrinolysis phenotypes, and hospital costs.
 Discussion(s): The absence of inter-group differences in
postoperative bleeding would support the selective strategy's
non-inferiority in reducing postoperative bleeding in these patients. The
possible reduction in thromboembolic risks, seizures, and fibrinolysis
shutdown in Group-GDT would support its superiority in reducing
TXA-induced adverse events and the cost of their management. Trial
registration: This trial was registered at ClinicalTrials.gov with the
registration number NCT05806346 on March 28, 2023. Trial status:
recruiting. Issue date: 2023 March 28 (by Tae-Yop Kim, MD, PhD). The trial
was registered in the clinical registration on March 28, 2023
(ClinicalTrials.gov, NCT05806346) and revised to the latest version of its
protocol (version no. 8, August 26, 2024) approved by the institutional
review boards (IRBs) of all 3 university hospitals (Konkuk University
Medical Center, 2023-07-005-001, Asan Medical Center, 2023-0248, and
Samsung Medical Center, SMC 2023-06-048-002). Its recruitment was started
on August 1, 2023, and will be completed on December 31, 2024. Protocol
amendment number: 08 (protocol version 08, August 26, 2024). Revision
chronology: 2023 March 28:Original. 2023 April 10:Amendment No 01. The
primary reason for the amendment is the modification of Arms (adding one
arm for sub-group analyses) and Interventions, Outcome Measures, Study
Design, Study Description, Study Status, Eligibility, and Study
Identification. 2023 May 03:Amendment No 02. The primary reason for the
amendment is to modify the Outcome Measures and update the study status.
2023 July 06:Amendment No 03. The primary reason for amendment is to
update the chronological study status. 2023 July 07:Amendment No 04. The
primary reason for the amendment is the modification of study information
(the treatment category was changed to diagnostic, and Phase 4 was changed
to not applicable) and a chronological update on the study status. 2023
September 12:Amendment No 06. The primary reason for the amendment is a
chronological update in the study status and the inclusion of additional
information regarding contacts/locations and oversight. 2023 December
29:Amendment No 07. The primary reason for the amendment is to modify the
outcome measures (including detailed information on outcome measures,
addition of extra secondary measures, and chronological updates in study
status). 2024 August 26:Amendment No 08. The primary reason for the
amendment is to add detailed descriptions regarding data handling and the
names and roles of the participating institutions and to update the
chronological process of the trial. Copyright © The Author(s)
2024.

<22>
Accession Number
2031637516
Title
Trial Of Pathogen-reduced Cryoprecipitate vs. Cryoprecipitated AHF to
Lower Operative Transfusions (TOP-CLOT): study protocol for a single
center, prospective, cluster randomized trial.
Source
Trials. 25(1) (no pagination), 2024. Article Number: 625. Date of
Publication: December 2024.
Author
Cushing M.M.; Cohen T.; Fitzgerald M.M.; Rand S.; Sinfort A.; Chen D.;
Keltner N.; Ong S.; Parra P.; Benabdessadek D.; Jimenez A.; Haas T.; Lau
C.; Girardi N.I.; DeSimone R.A.
Institution
(Cushing, Cohen, Rand, Sinfort, Jimenez, DeSimone) Department of
Pathology, Weill Cornell Medicine, 1300 York Avenue, New York, NY, United
States
(Fitzgerald, Girardi) Department of Anesthesiology, Weill Cornell
Medicine, 1300 York Avenue, New York, NY, United States
(Chen, Ong, Parra, Benabdessadek) Transfusion Medicine Department,
NewYork-Presbyterian Hospital/Weill Cornell Medicine Center, New York, NY,
United States
(Keltner) Cerus Corporation, 1220 Concord Ave Suite 600, Concord, CA,
United States
(Haas) Department of Anesthesiology, University of Florida School of
Medicine, 1600 SW Archer Rd, Gainesville, FL, United States
(Lau) Department of Cardiothoracic Surgery, Weill Cornell Medicine, 1300
York Avenue, New York, NY, United States
Publisher
BioMed Central Ltd
Abstract
Background: Intraoperative hemorrhage in cardiac surgery increases risk of
morbidity and mortality. Low pre-operative and perioperative levels of
fibrinogen, a key clotting factor, are associated with severity of
hemorrhage and increased transfusion of blood components. The ability to
supplement fibrinogen during hemorrhagic resuscitation is delayed 45-60
min because cryoprecipitated antihemophilic factor (cryo AHF) is stored
frozen, due to a short post-thaw shelf life. Pathogen Reduced
Cryoprecipitated Fibrinogen Complex (INTERCEPT Fibrinogen Complex, IFC)
can be kept thawed, at room temperature, for up to 5 days, making it
possible to be immediately available for hemorrhaging patients. This trial
will investigate if earlier correction of acquired hypofibrinogenemia with
IFC in hemorrhaging cardiac surgery patients reduces the total number of
perioperatively transfused allogeneic blood products (red blood cells,
plasma, and platelets) as compared to cryo AHF. Method(s): This is a
single center, prospective, cluster randomized trial with an adaptive
design. Acquired hypofibrinogenemia will be assessed by rotational
thromboelastometry (ROTEM) and the threshold for cryo AHF/IFC transfusion
defined as FIBTEM A10 <= 10 mm in bleeding patients. IFC/cryo AHF will be
randomized by 1-month blocks. Cardiac surgery patients will be enrolled in
the study if they have an eligible procedure and at least one dose of a
cryo AHF/IFC product (approximately 2 g fibrinogen) is transfused. Data
from the electronic health record, including the blood bank and lab
information systems, will be prospectively collected from the health
system's data warehouse. Discussion(s): This trial aims to provide
evidence of the clinical efficacy of utilizing readily available thawed
IFC during acute bleeding in the cardiac surgery setting compared to
traditional cryo AHF. Trial registration: ClinicalTrials.gov NCT05711524.
Feb 3, 2023. Copyright © The Author(s) 2024.

<23>
Accession Number
2034908107
Title
Effect of Intensive Nursing Care in Elderly Patients undergoing
Video-assisted Thoracoscopic Lung Cancer Surgery: A Randomised Control
Study.
Source
Journal of Clinical and Diagnostic Research. 18(5) (pp LC15-LC18), 2024.
Date of Publication: May 2024.
Author
Liu L.; Su C.
Institution
(Liu, Su) Department of Division 1 of Thoracic Surgery, Handan Central
Hospital, No. 20 Zhonghua South Street, Hebei Province, Handan City, China
Publisher
JCDR Research and Publications Pvt Ltd
Abstract
Introduction: Lung Cancer (LC) is a prominent cause of death worldwide,
with both non small cell and small cell types increasing in prevalence.
Multiple therapeutic options such as chemotherapy, radiation, and surgery,
including Video-assisted Thoracoscopic Surgery (VATS), have been
developed, although postoperative complications remain a concern. Nursing
care has been advocated as a means to mitigate these adverse effects.
However, the actual association between nursing care and LC postoperative
complications and outcomes remains unknown. Aim(s): To assess the
effects of Intensive Nursing Care (INC) on LC patients treated with VATS.
 Material(s) and Method(s): The present study was a randomised control
study in which a total of 256 Non Small Cell Lung Cancer (NSCLC) patients
over the age of 60 years who underwent VATS in the Division 1 of Thoracic
Surgery at Handan Central Hospital between January 2021 and January 2023
were included. The participants were randomly allocated to different
groups: an INC group (n=126) and a control group receiving normal care
(n=130). Lung function, reported symptoms, hospitalisation duration,
psychological wellbeing (anxiety and depression scores), and occurrence of
postsurgery symptoms (pain, fatigue, insomnia, dyspnea, nausea/vomiting)
were assessed. T-tests or Fisher's-Exact tests were used to compare
baseline and postsurgical variables between the INC and Normal Nursing
Care (NNC) groups using IBM Statistical Package for Social Sciences (SPSS)
version 26.0 software. Result(s): The study population consisted of
53.1% females with an average age of 73.51+/-7.61 years, ranging from 60
to 85 years. INC significantly improved hospitalisation duration {Mean
Difference (MD)=-1.9; 95% Confidence Interval (CI), -2.6 to -1.2; p-value
<0.001}, the occurrence of postsurgery symptoms (p-value <0.001), and
psychological states assessed by both the Self-rating Anxiety Scale (SRAS)
(MD=-17.99; 95% CI, -18.63 to -17.35; p-value=0.001) and the Self-rating
Depression Scale (SRDS) (MD= -9.04; 95% CI, -9.95 to -8.13; p-value=0.008)
in comparison to NNC patients. Conclusion(s): Given the global burden
of LC, it is crucial to emphasise not only the development of treatments
for this illness but also care regimens that alleviate complications
associated with these therapies. In this study, INC as an alternative to
routine nursing care in postsurgery recovery has proven to be more
beneficial to patients by decreasing their hospitalisation stay, the
occurrence of postsurgery symptoms, and by enhancing their mental
state. Copyright © 2024 JCDR Research and Publications Pvt Ltd.
All rights reserved.

<24>
Accession Number
2034864763
Title
Evaluation of growth and feeding tolerance in infants with
single-ventricle physiology receiving retrospective standard of care
feeding regimens compared with protocolised formula or exclusive human
milk feeding regimens.
Source
Cardiology in the Young. (no pagination), 2024. Date of Publication:
2024.
Author
Horsley M.; Trauth A.; Cooper D.S.; Blanco C.; Gao Z.; Justice L.
Institution
(Horsley, Trauth, Cooper, Gao, Justice) The Heart Institute, Cincinnati
Children's Hospital, Medical Center, Cincinnati, OH, United States
(Blanco) Division of Neonatology, Department of Pediatrics, University of
Texas, Health Science Center San Antonio, Women's and Children's Hospital,
San Antonio, TX, United States
Publisher
Cambridge University Press
Abstract
Objective: Determine whether weight gain velocity (g/day) 30 days after
initiating feeds following cardiac surgery and other clinical outcomes
improve in infants with single-ventricle physiology fed an exclusive human
milk (EHM) diet with early fortification compared to non-protocolised
"standard of care."Methods: This retrospective cohort study compares term
infants with single-ventricle physiology who underwent neonatal surgical
palliation. The retrospective control group (RCG) was fed according to
non-protocolised standard of care at a single centre and was compared with
infants in a previous protocolised multi-site randomised controlled trial
assigned to either an EHM group or a control group (TCG). The primary
outcome measure is weight gain velocity. Secondary outcomes include change
in weight z-score, and incidence of feeding intolerance and necrotising
enterocolitis. Result(s): We evaluated 45 surgically palliated
neonates with single-ventricle physiology compared to the prior trial
patients (EHM = 55, TCG = 52). Baseline demographics were similar between
groups, except the RCG had fewer patients with hypoplastic left heart
syndrome (51% vs. 77% vs. 84%, p = 0.0009). The RCG grew similarly to the
TCG (7.5 g/day vs. 8.2 g/day), and both groups had significantly lower
growth than the EHM group (12 g/day). Necrotising enterocolitis/suspected
necrotising enterocolitis were similar in the RCG versus TCG but
significantly higher in the RCG compared to the EHM group (20.5% vs. 3.6%,
p = 0.033). Incidences of other morbidities were similar.
 Conclusion(s): Neonates with single-ventricle physiology have
improved short-term growth and decreased risk of necrotising enterocolitis
or suspected necrotising enterocolitis when receiving an EHM diet after
surgical palliation compared to non-protocolised feeding with bovine
formula. Copyright © The Author(s), 2024. Published by Cambridge
University Press.

<25>
Accession Number
645451867
Title
Direct Oral Anticoagulants for Rheumatic Heart Disease-Associated Atrial
Fibrillation Post-Bioprosthetic Mitral Valve Replacement.
Source
JACC. Clinical electrophysiology. (no pagination), 2024. Date of
Publication: 19 Sep 2024.
Author
Fath A.R.; Aglan A.; Altaee O.; Fichardt H.; Mansoor H.; Almomani A.;
Hammadah M.; Vinas A.; Nayak H.; Jneid H.; Saad M.; Elgendy I.Y.
Institution
(Fath, Fichardt, Almomani, Hammadah, Vinas, Nayak) Division of Cardiology,
University of Texas Health Science Center, San Antonio, TX, United States
(Aglan) Cardiology Department, Westchester Medical Center, New York
Medical College, Valhalla, NY, United States
(Altaee, Mansoor) Department of Pharmacy, Practice and Science, College of
Pharmacy University of Kentucky, Lexington, KY, United States
(Jneid) Division of Cardiology, University of Texas Medical Branch,
Galveston, TX, United States
(Saad) Lifespan Cardiovascular Institute, Providence, Rhode Island, USA;
Department of Cardiology, Warren Alpert Medical School of Brown
University, Providence, Rhode Island, USA
(Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute,
University of Kentucky, Lexington, KY, United States
Abstract
BACKGROUND: The efficacy of direct oral anticoagulants (DOACs) in
preventing ischemic and thromboembolic events may be suboptimal in atrial
fibrillation (AF) patients with rheumatic mitral stenosis. However, their
safety and effectiveness after mitral valve replacement (MVR) using
bioprosthetic valves is unclear. OBJECTIVE(S): This study sought to
evaluate the safety and effectiveness of DOACs vs warfarin among patients
with rheumatic heart disease (RHD)-associated AF after bioprosthetic MVR.
 METHOD(S): We performed an observational analysis identifying
patients with RHD and AF who underwent bioprosthetic MVR. Primary
effectiveness and safety outcomes were ischemic events and major bleeding,
respectively. Secondary outcomes included all-cause mortality, cardiac
thrombosis, myocardial infarction, and all-cause hospitalization.
Propensity score matching was performed to account for the differences in
baseline characteristics and comorbidities. RESULT(S): A total of
3,950 patients were identified; 76% were on warfarin and 24% on DOAC
post-MVR. The DOAC group had a higher burden of baseline comorbidities and
prior cardiovascular procedures compared with the warfarin group. The
propensity score matching balanced baseline characteristics in 1,832
patients (916 in each group), with a mean age of 69 years. At the 5-year
follow-up, DOACs were associated with a lower incidence of major bleeding
compared with warfarin (HR: 0.76; 95% CI: 0.62-0.94), with no significant
difference in ischemic events, mortality, cardiac thrombosis, myocardial
infarction, or hospitalization. CONCLUSION(S): Among patients with
RHD-associated AF patients post-bioprosthetic MVR, DOACs are associated
with lower major bleeding and comparable effectiveness, indicating a
potential alternative to warfarin. Further randomized controlled trials
are warranted to validate these findings in this population. Copyright
© 2024 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<26>
Accession Number
2031651621
Title
Prospective case-control study on pain intensity after the use of
promethazine in patients undergoing videothoracoscopy.
Source
Frontiers in Medicine. 11 (no pagination), 2024. Article Number: 1453694.
Date of Publication: 2024.
Author
Zhou X.; He B.; Zheng X.; Li C.; Mi Z.; Peng M.; Li M.
Institution
(Zhou, He, Zheng, Peng, Li) Department of Anesthesiology and Perioperative
Medicine, The Affiliated Yongchuan Hospital of Chongqing Medical
University, Chongqing, China
(Li, Mi) Department of Thoracic and Cardiovascular Surgery, The Affiliated
Yongchuan Hospital of Chongqing Medical University, Chongqing, China
Publisher
Frontiers Media SA
Abstract
Objective: Effective and secure pain management following video-assisted
thoracoscopic surgery (VATS) is crucial for rapid postoperative recovery.
This study evaluated analgesic and sedative effects of sufentanil and
promethazine in patient-controlled intravenous analgesia (PCIA)
post-thoracic surgery, along with potential adverse reactions.
 Method(s): In this prospective, randomized, controlled, double-blind,
clinical study, 60 patients (American Society of Anesthesiologists status
I-III) undergoing VATS were enrolled. The patients were randomized into
experimental (Group P) or control (Group C) groups. PCIA was administered
post-general anesthesia using a double-blind method. Group P received
sufentanil (3 mug/kg) + promethazine (1 mg/kg) + 0.9% sodium chloride
solution (100 mL total), while Group C received sufentanil (3 mug/kg) +
0.9% sodium chloride solution (100 mL total). PCIA settings included a
1-mL bolus and 15-min locking time. The primary outcomes were the visual
analog scale (VAS) at rest and during coughing and sedation (Ramsay)
scores at 6, 12, 24, and 48 h. The secondary outcomes were rescue drug use
rate, hemodynamic parameters (mean arterial pressure and heart rate),
percutaneous oxygen saturation, respiratory rate, and occurrence of
adverse reactions. Result(s): Group P exhibited lower resting and
coughing VAS scores at 6, 12, 24, and 48 h, plus decreased incidence of
nausea and vomiting within 48 h post-surgery compared with Group C (p <
0.05). No significant differences were observed in pruritus, sedation
(Ramsay) scores, mean arterial pressure, heart rate, oxygen saturation, or
respiratory rate between the two groups (p > 0.05). Discussion(s):
The combination of sufentanil and promethazine for postoperative
intravenous analgesia could effectively reduce adverse effects such as
nausea and vomiting, contributing to postoperative pain
relief. Copyright © 2024 Zhou, He, Zheng, Li, Mi, Peng and Li.

<27>
Accession Number
2031012609
Title
Bronchiolar adenoma/ciliated muconodular papillary tumor complicated by
lymphoid interstitial pneumonia in a patient with Sjogren's disease: A
case report and systematic review.
Source
Thoracic Cancer. 15(28) (pp 1975-1988), 2024. Date of Publication: October
2024.
Author
Cagan P.; Kimiaei A.; Safaei S.; Youcefi H.E.; Abu Saadeh A.; Yaman F.;
Yapicier O.; Kutlu C.A.
Institution
(Cagan, Kimiaei, Safaei, Youcefi, Abu Saadeh, Kutlu) Department of
Thoracic Surgery, Bahcesehir University, Istanbul, Turkey
(Yaman) Department of Pulmonology, Bahcesehir University, Istanbul, Turkey
(Yapicier) Department of Pathology, Bahcesehir University School of
Medicine, Goztepe Medical Park Training and Education Hospital, Istanbul,
Turkey
Publisher
John Wiley and Sons Inc
Abstract
Bronchiolar adenoma (BA)/ciliated muconodular papillary tumor (CMPT) is a
rare pulmonary neoplasm, with less than 150 cases documented in the
literature. We report a unique case of BA/CMPT complicated by lymphoid
interstitial pneumonia (LIP) in a 55-year-old male with Sjogren's disease.
This is the first documented instance of such a comorbidity. Through a
systematic review of PubMed, we also summarize the demographic, clinical,
radiological, histopathological, and treatment characteristics of
CMPT. Copyright © 2024 The Author(s). Thoracic Cancer published
by John Wiley & Sons Australia, Ltd.

<28>
Accession Number
2029312023
Title
Preoperative localization for pulmonary nodules: a meta-analysis of coil
and liquid materials.
Source
Minimally Invasive Therapy and Allied Technologies. 33(5) (pp 270-277),
2024. Date of Publication: 2024.
Author
Sun Z.-H.; Cheng H.; Su J.; Sun Q.-L.
Institution
(Sun, Cheng, Su) Geriatrics Department, Second Affiliated Hospital of
Shandong University of Traditional Chinese Medicine, Jinan, China
(Sun) Tumor Minimally Invasive Department, Second Affiliated Hospital of
Shandong University of Traditional Chinese Medicine, Jinan, China
Publisher
Taylor and Francis Ltd.
Abstract
Purpose: This study was designed to conduct pooled comparisons of the
relative clinical efficacy and safety of computed tomography (CT)-guided
localization for pulmonary nodules (PNs) using either coil- or liquid
material-based approaches. Material(s) and Method(s): Relevant
articles published as of July 2023 were identified in the Web of Science,
PubMed, and Wanfang databases, and pooled analyses of relevant endpoints
were then conducted. Result(s): Six articles that enrolled 287
patients (341 PNs) and 247 patients (301 PNs) that had respectively
undergone CT-guided localization procedures using coil- and liquid
material-based approaches prior to video-assisted thoracic surgery (VATS)
were included in this meta-analysis. The liquid material group exhibited a
significantly higher pooled successful localization rate as compared to
the coil group (p = 0.01), together with significantly lower pooled total
complication rates (p = 0.0008) and pneumothorax rates (p = 0.01). Both
groups exhibited similar rates of pulmonary hemorrhage (p = 0.44) and
successful wedge resection (p = 0.26). Liquid-based localization was also
associated with significant reductions in pooled localization and VATS
procedure durations (p = 0.004 and 0.007). Conclusion(s): These data
are consistent with CT-guided localization procedures performed using
liquid materials being safer and more efficacious than coil-based
localization in patients with PNs prior to VATS resection. Copyright
© 2024 Society of Medical Innovation and Technology.

<29>
Accession Number
2025401434
Title
Direct oral anticoagulants versus vitamin K antagonists: Which one is more
effective in atrial fibrillation.
Source
Perfusion (United Kingdom). 39(7) (pp 1286-1294), 2024. Date of
Publication: October 2024.
Author
Khodadadiyan A.; Jazi K.; Bazrafshan drissi H.; Bazroodi H.; Mashayekh M.;
Sadeghi E.; Gholamabbas G.; Bazrafshan M.; Rahmanian M.
Institution
(Khodadadiyan, Bazroodi) Student Research Committee, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Jazi) Student Research Committee, Faculty of Medicine, Medical University
of Qom, Qom, Iran, Islamic Republic of
(Bazrafshan drissi, Bazrafshan, Rahmanian) Cardiovascular Research Center,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Mashayekh, Gholamabbas) Shiraz Nephro-Urology Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Sadeghi) Research Consultation Center (RCC), Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
SAGE Publications Ltd
Abstract
Background: The optimal approach for anticoagulation in patients with
bioprosthetic valves and atrial fibrillation (AF) remains a subject of
debate. A meta-analysis using updated evidence to evaluate the efficacy
and safety of direct oral anticoagulants (DOACs) compared to vitamin K
antagonists (VKAs) in patients with AF and bioprosthetic valves to address
this controversy. Method(s): A comprehensive search was conducted in
multiple databases, including PubMed, Scopus, Web of Science, ProQuest,
and the Cochrane Central Register of Controlled Trials, up until March
2023. The search aimed to identify relevant randomized controlled trials
(RCTs) that examined the efficacy and safety outcomes of both direct oral
anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with
bioprosthetic valves and atrial fibrillation. The primary outcomes of
interest were major bleeding and all-cause mortality. Result(s): Our
study demonstrated that despite the difference was not significant, the
hazard of all-cause mortality was 2.5% higher in the DOAC group (HR =
1.03, 95% CI = [0.88, 1.19], p-value =.75). Similarly, the hazard of
stroke (HR = 1.03, 95% CI = [0.87, 1.32], p-value =.71) and major bleeding
(HR = 1.11, 95% CI = [0.89, 1.38], p-value =.36) were found to be
respectively 3.2 and 10.7% higher in the DOAC group, although the
difference was not significant. However, the hazard of intracranial
hemorrhage was found to be 28.8 lower in the DOAC treatment group (HR =
0.71, 95% CI = [0.39, 1.31], p-value =.27), which again was not
statistically significant. Conclusion(s): Our meta-analysis
demonstrates that in patients undergoing bioprosthetic valve surgery and
presenting with AF afterward, DOAC and VKA are similar regarding
life-threatening and all-cause mortality outcomes, including major
bleeding, stroke, and intracranial hemorrhage. Copyright © The
Author(s) 2023.

<30>
Accession Number
2034811326
Title
Is there an obesity paradox in cardiovascular outcomes for patients
undergoing Transcatheter Edge-to-Edge Repair? A pilot meta-analysis.
Source
IJC Heart and Vasculature. 55 (no pagination), 2024. Article Number:
101519. Date of Publication: December 2024.
Author
Goyal A.; Maheshwari S.; Tariq M.D.; Zulfiqar E.; Khan A.M.; Saeed H.;
Daoud M.; Mahalwar G.
Institution
(Goyal) Department of Internal Medicine, Seth GS Medical College and KEM
Hospital, Mumbai, India
(Maheshwari) Department of Internal Medicine, University of Alabama,
Montgomery, AL, United States
(Tariq) Department of Internal Medicine, Foundation University Medical
College, Islamabad, Pakistan
(Zulfiqar) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Khan) Department of Internal Medicine, Ayub Medical College, Abbottabad,
Pakistan
(Saeed) Department of Internal Medicine, Rawalpindi Medical University,
Rawalpindi, Pakistan
(Daoud) Department of Internal Medicine, Bogomolets National Medical
University, Kyiv, Ukraine
(Mahalwar) Department of Internal Medicine, Cleveland Clinic Foundation,
Cleveland, OH, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The impact of body mass index (BMI) on Transcatheter
Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies
showing conflicting results. Some suggest an 'obesity paradox' exists,
favoring better outcomes for obese patients and worse outcomes for
underweight patients, while others report no significant impact of BMI.
Methodology: We systematically searched major databases for studies on
baseline BMI and post-procedural outcomes in TEER patients. Patients were
grouped by BMI: underweight (<18.5 kg/m2), normal (18.5-24.9
kg/m2), overweight (25-29.9 kg/m2), and obese (>=30
kg/m2). Data were pooled using a random-effects model, with
risk ratios (RRs) and their 95 % confidence intervals (CIs) as effect
measures. Statistical significance was set at p < 0.05. Result(s):
Our study, analyzing five observational studies with 7580 obese and 74,717
non-obese patients, found no significant difference in in-hospital
mortality between the groups (RR: 0.85; p = 0.427). Subgroup analysis
indicated a higher mortality risk for underweight patients compared to
overweight (RR: 1.48; p = 0.006) and obese patients (RR: 1.40; p = 0.036),
though the difference between underweight and normal-weight patients was
not significant (RR: 1.18; p = 0.216). The risks of myocardial infarction
(RR: 1.10; p = 0.592) and stroke (RR: 0.43; p = 0.166) were also similar
between obese and non-obese patients. Conclusion(s): In conclusion,
our analysis found no significant difference in in-hospital mortality,
myocardial infarction or stroke risk between obese and non-obese patients
undergoing TEER. However, underweight patients may have a higher risk of
in-hospital mortality compared to overweight and obese individuals,
highlighting the potential impact of BMI on outcomes in TEER
patients. Copyright © 2024 The Author(s)

<31>
Accession Number
2034841681
Title
Antegrade approach versus retrograde approach percutaneous coronary
intervention for chronic total occlusion: An updated meta-analysis.
Source
Current Problems in Cardiology. 49(12) (no pagination), 2024. Article
Number: 102832. Date of Publication: December 2024.
Author
Abdelaziz A.; Hafez A.; Atta K.; Elsayed H.; Elaraby A.; Ibrahim A.A.;
Gadelmawla A.F.; Helmi A.; Abdelazeem B.; Lavie C.J.; Tafur-Soto J.
Institution
(Abdelaziz, Hafez, Atta, Elsayed, Elaraby, Ibrahim, Gadelmawla, Helmi,
Abdelazeem) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, United States
(Abdelaziz, Hafez, Elaraby) Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
(Atta) Institute of Medicine, National Research Mordovia State University,
Saransk, Russian Federation
(Elsayed) Faculty of Medicine, Zagazig University, Zagazig, Egypt
(Ibrahim, Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia,
Egypt
(Helmi) Faculty of Medicine, Alexandria University, Alexandria, Egypt
(Abdelazeem) Department of Cardiology, West Virginia University,
Morgantown, WV, United States
(Lavie, Tafur-Soto) John Ochsner Heart and Vascular Institute, Department
of Cardiovascular Diseases, Ochsner Clinical School, The University of
Queensland School of Medicine, New Orleans, LA, United States
Publisher
Elsevier Inc.
Abstract
Background: Retrograde approach has notably improved success rates of
chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
However, longer procedural time, increase use of fluoroscopy and contrast
dye have been reported in retrograde techniques in CTO PCI. We aimed to
study in-hospital and long-term outcomes of retrograde approach versus
antegrade approach in CTO PCI. Method(s): We searched PubMed, Scopus,
WOS, and Cochrane Central until June 2023 to include all relevant studies
that compared retrograde approach versus antegrade approach in patients
with CTO PCI. We synthesized the outcome data using a random-effects
model, expressing the effect estimates as odds ratios (OR) or mean
difference (MD) with corresponding 95 % confidence intervals (CI).
 Result(s): A total of 18 studies comprising 21,276 patients were
included in the analysis. Regarding in-hospital outcomes, antegrade
approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23
to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR=
0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 %
CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural
complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation
(OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with
higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22). Conclusion(s):
Compared to antegrade technique, retrograde was associated with higher
risk for in-hospital and long-term adverse events, and preferably should
be performed in more complex CTO lesions. Copyright © 2024

<32>
Accession Number
2034818637
Title
Prevalence and risk factors for ventilator-associated pneumonia after
cardiac surgery: a systematic review and meta-analysis.
Source
Journal of Thoracic Disease. 16(9) (pp 5946-5957), 2024. Date of
Publication: 30 Sep 2024.
Author
Wu G.; Fu Y.; Feng W.; Liu C.; Li J.; Gao H.; Yang G.; Zhang X.; Zhang P.
Institution
(Wu, Fu, Feng, Liu, Li, Gao, Yang, Zhang, Zhang) Department of
Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen,
China
Publisher
AME Publishing Company
Abstract
Background: There is currently significant variation in the reported
incidence of ventilator-associated pneumonia (VAP) among postoperative
cardiac patients. Moreover, the risk factors for VAP in postoperative
cardiac patients remain controversial. This study aims to assess the
incidence and risk factors of VAP in postoperative cardiac patients to
provide a basis for further prevention and treatment of VAP.
 Method(s): We systematically reviewed PubMed, EMBASE, and Cochrane
Library databases to select studies that met the inclusion criteria until
November 2023. Result(s): Fifteen studies involving 10,478 patients
who underwent cardiac surgery were selected for meta-analysis. The
incidence of VAP in postoperative cardiac patients was 10%. The
preoperative risk factors for VAP after cardiac surgery included age >70
years, chronic obstructive pulmonary disease (COPD), peripheral vascular
disease, renal disease, and severe pulmonary hypertension. Furthermore,
the perioperative risk factors for VAP after cardiac surgery included
emergency surgery, redo surgery, airway instrumentation, gastric
aspiration, reintubation, mechanical ventilation duration >3 days,
intra-aortic balloon, New York Heart Association >3, American Society of
Anesthesiologists >3, need for transfusion during surgery, and ascending
aortic surgery. Conclusion(s): The incidence of VAP after cardiac
surgery was found to be 10%, and the comprehensive risk factors for VAP
were identified, emphasizing the critical need for targeted interventions,
including optimization of preoperative health and refined surgical
protocols, to effectively reduce the occurrence of VAP in postoperative
cardiac patients. Copyright © AME Publishing Company.

<33>
Accession Number
644529727
Title
Continuous Erector Spinae Plane Block for Postoperative Analgesia in
Elderly Patients After Thoracoscopic Lobectomy.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 39(5) (pp 887-891), 2024. Date of
Publication: 01 Oct 2024.
Author
Sun L.; Mu J.; Yu L.; Hu J.; Hu Y.; He H.
Institution
(Sun, Mu, Yu, Hu, Hu) Department of Anesthesiology, Huzhou Central
Hospital, Huzhou, China
(He) Department of Anesthesiology, Huzhou Central Hospital, Huzhou, China
Abstract
PURPOSE: The purpose of this study was to compare the effect of
ultrasound-guided continuous erector spinae plane block to continuous
thoracic paravertebral block on postoperative analgesia in elderly
patients who underwent thoracoscopic lobectomy. DESIGN: Randomized
controlled trial. METHOD(S): Elderly patients (N = 50) who underwent
nonemergent thoracoscopic lobectomy in the thoracic surgery department of
our hospital from January 2019 to December 2020 were selected and randomly
divided into continuous erector spinae block (ESPB; n = 25) group and
continuous thoracic paravertebral block (TPVB; n = 25) group. The patients
in the two groups were guided by ultrasound with ESPB or TPVB before
anesthesia induction. The visual analog scale at rest and cough in 2
hours, 6 hours, 8 hours, 12 hours, 24 hours, 48 hours after surgery, the
supplementary analgesic dosage of tramadol, time of tube placement, the
stay time in postanesthesia care unit (PACU), the first ambulation time
after surgery, the length of postoperative hospital stay and postoperative
complications were recorded. FINDINGS: There were no significant
differences between the two groups in visual analog scale score at rest
and cough at each time point and supplementary analgesic dosage of
tramadol within 48 hours after surgery (P > .05). The time of tube
placement and the postoperative hospital stay in ESPB group was
significantly shorter than that in TPVB group (P < .05). There were no
differences in PACU residence time and first ambulation time between the
two groups (P > .05). There were 4 patients in TPVB group and 2 patients
in ESPB group who had nausea and vomiting (P > .05), 1 case of
pneumothorax and 1 case of fever in the TPVB group. There were no incision
infections or respiratory depression requiring clinical intervention in
either group. CONCLUSION(S): Both ESPB and TPVB alleviated the
patients postoperative pain effectively for elderly patients underwent
thoracoscopic lobectomy. Compared with TPVB, patients with ESPB have a
shorter tube placement time, fewer complications and faster postoperative
recovery. Copyright © 2024 The American Society of PeriAnesthesia
Nurses. Published by Elsevier Inc. All rights reserved.

<34>
Accession Number
644336553
Title
The Effect of Providing Education to Patients Undergoing Coronary
Angiography on Vital Signs.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 39(5) (pp 824-830), 2024. Date of
Publication: 01 Oct 2024.
Author
Veremci S.; Pamuk Cebeci S.
Institution
(Veremci) Eskisehir Osmangazi University/Institute of Health Sciences,
Department of Fundamentals of Nursing, Eskisehir, Turkey
(Pamuk Cebeci) Eskisehir Osmangazi University/Faculty of Health Sciences,
Department of Fundamentals of Nursing, Eskisehir, Turkey
Abstract
PURPOSE: This study was conducted to determine the effect of providing
preprocedural education to patients undergoing coronary angiography on
their vital signs. DESIGN: The study was a randomized controlled
experimental study with a pretest/post-test control group design.
 METHOD(S): The study was conducted in the Cardiology Service of a
hospital in Eskisehir between November 2021 and April 2022. Power analysis
identified that it was appropriate to include 79 individuals in the
experimental group, 79 individuals in the control group, and a total of
158 individuals. The experimental group was trained using the "Structured
Education Manual" prepared by the researchers. FINDINGS: The education had
an influence on the stabilization of vital signs after the procedure
compared to preprocedure. When the comparison of vital signs before and
after the education was analyzed, systolic blood pressure and diastolic
blood pressure differed significantly between 11 measurements in both
groups (P < .05). The systolic and diastolic blood pressure of the
experimental group measured before the procedure was higher than their
other measurements after the procedure. Heart rate, respiratory rate, and
saturation value in both groups displayed a statistically significant
difference between 11 measurements (P < .05). In the experimental group,
heart rate and respiratory rate before the procedure were higher than the
postprocedure measurements. The saturation value of the experimental group
at 150 minutes after the procedure was higher than the other measurements.
 CONCLUSION(S): Education given to patients before undergoing a
coronary angiography procedure had a positive effect on the patients'
vital signs. It is recommended that patients undergoing a coronary
angiography procedure be provided with audio-visual training by nurses
before the procedure. Copyright © 2024 The American Society of
PeriAnesthesia Nurses. All rights reserved.

<35>
Accession Number
644084825
Title
Effects of dexmedetomidine on renal function after cardiac surgery for
infective endocarditis: An interim analysis of a randomized controlled
trial.
Source
Asian journal of surgery. 47(10) (pp 4322-4329), 2024. Date of
Publication: 01 Oct 2024.
Author
Ham S.Y.; Shim J.-K.; Lee S.; Ko S.H.; Soh S.; Kwak Y.-L.
Institution
(Ham, Shim, Ko, Soh, Kwak) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, Seoul, Republic of Korea;
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, Seoul, Republic of Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Yonsei University
College of Medicine, Seoul, South Korea
Abstract
BACKGROUND: Patients undergoing cardiac surgery for infective endocarditis
(IE) are at a high risk of postoperative acute kidney injury (AKI) owing
to heightened systemic inflammation. Therefore, we aimed to investigate
the effect of dexmedetomidine on postoperative AKI in patients who
underwent cardiac surgery for IE. METHOD(S): A total of 63 patients
who underwent cardiac surgery for IE were randomly assigned to receive
either intravenous dexmedetomidine infusion of 0.4 mug kg-1 h-1 (DEX
group) or normal saline infusion (control group) for 24 h after induction
of anesthesia. The occurrence of AKI within seven days postoperation,
epinephrine, norepinephrine, and interleukin-6 levels, as well as
postoperative morbidities, were assessed. An intertrim analysis was
conducted using Pocock's alpha spending function at alpha = 0.05 and beta
= 0.2. RESULT(S): This trial was early terminated according to the
results of interim analysis performed when 60 % of the pre-set number of
patients have been collected. The incidence of AKI was significantly lower
in the DEX group than in the control group (32.3 % vs. 9.4 %, p = 0.025).
Patients in the DEX group had significantly lower epinephrine levels than
those in the control group, whereas norepinephrine and interleukin-6
levels were similar. Perioperative mean arterial pressure or heart rate
did not differ between the groups. CONCLUSION(S): Dexmedetomidine
administration for 24 h starting from induction of anesthesia
significantly reduced the incidence of postoperative AKI after cardiac
surgery for IE (by 29 % vs. control) without hemodynamic side effects.
This was accompanied by a significant attenuation of postoperative
increase in serum epinephrine levels. Copyright © 2024 Asian
Surgical Association and Taiwan Society of Coloproctology. Published by
Elsevier B.V. All rights reserved.

<36>
Accession Number
643622962
Title
Effectiveness of Peer-Based and Conventional Video Education in Reducing
Perioperative Depression and Anxiety Among Coronary Artery Bypass Grafting
Patients: A Randomized Controlled Trial.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 39(5) (pp 741-749), 2024. Date of
Publication: 01 Oct 2024.
Author
Pedramrazi S.; Mohammadabadi A.; Rooddehghan Z.; Haghani S.
Institution
(Pedramrazi) Faculty of Nursing and Midwifery, Department of Nursing and
Midwifery, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Mohammadabadi, Rooddehghan, Haghani) Nursing Care Research Center,
Department of Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Abstract
PURPOSE: Depression and anxiety are common comorbidities in patients
undergoing coronary artery bypass grafting (CABG), with potential adverse
effects on surgical outcomes. Effective interventions to reduce depression
and anxiety in these patients are therefore warranted. This study
investigated the effectiveness of peer-based video education compared to
conventional video education in reducing perioperative depression and
anxiety in CABG patients. DESIGN: A three-arm, parallel, randomized,
controlled trial design was employed. METHOD(S): A total of 114
participants were randomly assigned to 1 of 3 groups (n = 38 per group):
standard education (control), conventional video education, and peer-based
video education. State anxiety levels were measured using the Spielberger
State Anxiety Questionnaire at 1 day before surgery (baseline), 1 hour
before surgery, and 4 weeks after surgery. Depression levels were measured
using the Beck Depression Inventory Short-Form at baseline and 4 weeks
after surgery. Statistical analyses, including chi2, Fisher's exact test,
one-way analysis of variance, and repeated-measures analysis of variance,
were applied to analyze the collected data. FINDINGS: Both peer-based and
conventional video education groups demonstrated lower preoperative
anxiety levels compared to the control group. However, only the peer-based
video education group exhibited a statistically significant difference (P
< .05). Four weeks after surgery, anxiety and depression levels decreased
in all participants compared to baseline, with no statistically
significant differences among the three groups. CONCLUSION(S): Our
findings suggest that peer-based video education is more effective in
controlling preoperative anxiety in patients undergoing CABG than
conventional video education and standard education. Moreover, video-based
education, whether conventional or peer-based, appears to be as effective
as standard education in reducing anxiety and depression 4 weeks after
CABG surgery. Further research is warranted to investigate the influence
of content and presentation methods on patient outcomes and explore the
potential long-term benefits of video-based education in promoting patient
care. Copyright © 2024 The American Society of PeriAnesthesia
Nurses. Published by Elsevier Inc. All rights reserved.

<37>
Accession Number
2034839857
Title
Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive
Strategy to Facilitate Cardiopulmonary Bypass in Patients with
Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2024.
Date of Publication: 2024.
Author
Del Vecchio A.; Pham L.-P.; McNeil J.; Singh K.; Tanaka K.; Eaton M.;
Mazzeffi M.
Institution
(Del Vecchio, Pham) University of Virginia School of Medicine,
Charlottesville, VA, United States
(Tanaka) Oklahoma University College of Medicine, Department of
Anesthesiology, Oklahoma City, OK, United States
(Eaton) University of Rochester School of Medicine, Department of
Anesthesiology, Rochester, NY, United States
(McNeil, Singh, Mazzeffi) University of Virginia School of Medicine,
Department of Anesthesiology, Charlottesville, VA, United States
Publisher
W.B. Saunders
Abstract
Objective: Conduct a systematic review and meta-analysis of the efficacy
of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent
thromboembolism in patients with heparin-induced thrombocytopenia (HIT)
who undergo cardiopulmonary bypass (CPB) with heparin. Design(s):
Systematic review and meta-analysis. Setting(s): N/A.
 Participant(s): Adults having cardiac surgery with a history of HIT
who received preoperative or intraoperative TPE or intravenous cangrelor
as an adjunct to CPB with heparin. Intervention(s): None
 Measurements and Main Results: A systematic review was performed
using MEDLINE, PubMed, and Google Scholar. The primary outcome was
avoidance of thromboembolism (venous or arterial) during or after CPB.
Proportional meta-analysis with a random effects model was used to
calculate a weighted-pooled proportion/efficacy for the study's primary
outcome. Fifty-seven patients in 17 reports received TPE as an adjunctive
treatment to prevent HIT-related thrombosis related to heparinization
during CPB and 3 (5.3%) experienced thrombosis. Proportional meta-analysis
suggested a weighted-pooled freedom from perioperative thromboembolism
rate of 91.0% (95% CI 82.6%-96.9%). Fifteen patients in 6 reports received
intravenous cangrelor as an adjunctive treatment to prevent HIT-related
thrombosis related to heparinization during CPB and 2 (13.3%) experienced
thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom
from perioperative thromboembolism rate of 83.0% (95% CI 61.2%- 97.6%).
 Conclusion(s): TPE and cangrelor are feasible strategies to prevent
thromboembolism in adults with HIT who require CPB with heparin. Given the
relatively small number of cases in the published literature and a high
likelihood for publication and detection biases, prudence remains
warranted when using these strategies. Copyright © 2024 Elsevier
Inc.

<38>
Accession Number
2031711785
Title
Incidence of aortic valve reintervention in patients with aortic stenosis
undergoing transcatheter aortic valve implantation versus surgical aortic
valve replacement: a systematic review and updated meta-analysis of
randomized studies.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2024. Date
of Publication: 2024.
Author
Groberio J.G.; Reginato P.H.; Streit R.E.; Rocha A.V.; Udoma-Udofa O.C.;
de Mesquita C.F.; Rivera A.; Ulbrich A.Z.; Farias F.R.; Gomes W.F.
Institution
(Groberio) Faculty of Medicine, Vila Velha University, Espirito Santo,
Vila Velha, Brazil
(Reginato, Streit, Rocha, Ulbrich, Farias) Faculty of Medicine, Federal
University of Parana, Parana, Curitiba, Brazil
(Udoma-Udofa) Faculty of Medicine, Federal University of Juiz de Fora,
Minas Gerais, Juiz de Fora, Brazil
(de Mesquita) School for Medical Sciences, Federal University of
Pernambuco, Pernambuco, Recife, Brazil
(Rivera) Faculty of Medicine, Nove de Julho University, Sao Paulo, Sao
Bernardo do Campo, Brazil
(Gomes) INC Hospital, Rua Jeremias Maciel Perretto, 300, Campo Comprido,
Parana, Curitiba, Brazil
Publisher
Springer
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) and surgical
aortic valve replacement (SAVR) are established interventions for
alleviating symptoms and enhancing survival in individuals with severe
aortic stenosis (AS). However, the long-term outcomes and incidence of
reintervention associated with TAVI and SAVR remain uncertain.
 Method(s): We conducted a systematic review and meta-analysis to
compare the incidence of reintervention in TAVI versus SAVR. PubMed,
Embase, and Cochrane databases were searched for randomized controlled
trials (RCTs). Risk ratios (RR) and 95% confidence intervals (CI) were
pooled with a random-effects model. A p-value < 0.05 was considered
statistically significant. Result(s): Nine RCTs were included, with
5144 (50.9%) patients randomized to TAVI. Compared with SAVR, TAVI
increased reinterventions (RR 1.89; 95% CI 1.29-2.76; p < 0.01) and the
need for pacemakers (RR 1.91; 95% CI 1.49-2.45; p < 0.01). In addition,
TAVI significantly reduced the incidence of new-onset atrial fibrillation
(RR 0.43; 95% CI 0.32- 0.59; p < 0.01). There were no significant
differences in all-cause mortality (RR 1.04; 95% CI 0.92-1.16; p = 0.55),
cardiovascular mortality (RR 1.04; 95% CI 0.94-1.17; p = 0.44), stroke (RR
0.97; 95% CI 0.80-1.17; p = 0.76), endocarditis (RR 0.96; 95% CI
0.70-1.33; p = 0.82), and myocardial infarction (RR 1.06; 95% CI
0.79-1.41; p = 0.72) between groups. Conclusion(s): In patients with
severe AS, TAVI significantly increased the incidence of reinterventions
and the need for pacemakers as compared with SAVR. Copyright ©
The Author(s), under exclusive licence to The Japanese Association for
Thoracic Surgery 2024.

<39>
Accession Number
645434811
Title
Progressive Structured Simulation-based Surgical Training Program
(PROCESS) - Open Vascular Surgery: Study Protocol For A Cross-over,
Randomized, Doubleblinded Clinical Trial.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. Conference: American
Heart Association's Vascular Discovery: From Genes to Medicine 2024
Scientific Sessions. Chicago, IL United States. 44(Supplement 1) (no
pagination), 2024. Date of Publication: May 2024.
Author
Uribe-Ramirez S.; Velandia-Sanchez A.; Polania-Sandoval C.A.;
Alvarez-Martinez J.V.; Tello-Pirateque J.; Perez-Rivera C.J.;
Avila-Madrigal J.P.; Cruz-Reyes D.L.; Briceno J.C.; Gomez-Galan S.;
Reijnen M.M.; Camacho-Mackenzie J.; Barrera-Carvajal J.G.
Institution
(Uribe-Ramirez, Velandia-Sanchez, Polania-Sandoval, Perez-Rivera,
Avila-Madrigal, Gomez-Galan, Camacho-Mackenzie, Barrera-Carvajal) Vascular
and Endovascular Surgery Rsch Group, Fundacion Cardioinfantil-Instituto de
Cardiologia., Bogota DC, Colombia
(Alvarez-Martinez, Tello-Pirateque, Cruz-Reyes) Universidad del Rosario,
Sch of Medicine and Health Sciences., Bogota DC, Colombia
(Briceno) Dept of Biomedical Engineering, Universidad de Los Andes, Bogota
DC, Colombia
(Reijnen) Dept of Surgery, Rijnstate, Arhenm, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Vascular surgery has been directed towards endovascular
approaches; however, not all patients qualify for these procedures. Open
vascular surgery (OVS) remains an alternative, demanding a steep learning
curve. Exposure to these procedures has declined resulting in a lack of
standardization in acquiring OVS skills. Simulation is a solution to this
challenge. However, in OVS, there is scarce evidence for structured
programs. The measurement of surgical skills is based on objectively
assessable subjective tools; yet, they have limitations as evaluators may
introduce inherent individual biases. We aim to compare the effectiveness
of technical surgical competencies acquisition between a structured
progressive simulation-based training program and isolated
experience-based training in OVS. Method(s): We will conduct a
randomized double-blind crossover clinical trial. A control sequence and
an intervention sequence of three subgroups with different exposure levels
to the simulation program are proposed using 3D printed models. Group 1:
open abdominal aortic repair (AAOR), Group 2: vascular anastomosis (VA)
and AAOR, and Group 3: specific micro-surgical skills, VA and AAOR.
Surgical residents of general, vascular, or cardiovascular surgery
programs will be included. Sample size calculation resulted in 45
participants, 15 in each group. Double blinding will involve participants
and external evaluators. Randomization will occur in block randomization
and permuted block randomization. Result(s): We anticipated that the
structured and progressive simulation-based training program objectively
enhances technical surgical competencies. We expect to determine a
significant difference in the acquisition of technical surgical
competencies based on the progression through different modules within the
program and validate the reliability of an assessment tool based on
objective metrics for technical surgical competencies in OVS.
 Conclusion(s): We hope this initiative will impact the formation of
future vascular surgeons, complementing experience-based training with
simulation-based programs in OVS. Ensuring that the trainee obtains all
the necessary tools to perform OVS and standardize an objective assessment
evaluation method.

<40>
Accession Number
645436400
Title
The Efficacy and Safety of the Rhomboid Intercostal Block for
Postoperative Analgesia in Chest Surgery and Breast Surgery: A Systemic
Review and Meta-Analysis.
Source
Pain physician. 27(7) (pp 375-385), 2024. Date of Publication: 01 Sep
2024.
Author
Shen Q.H.; Lv Y.-Z.; Shi Y.-F.; Lai L.; Chen Y.-J.; Zhou Q.-H.
Institution
(Shen, Lv, Shi, Lai, Chen, Zhou) Department of Anesthesiology, Affiliated
Hospital of Jiaxing University, Jiaxing, Zhejiang, China
Abstract
BACKGROUND: Prior research has suggested that the rhomboid intercostal
block (RIB) may contribute to postoperative analgesia after surgeries of
the chest and breast. OBJECTIVE(S): To explore the effectiveness and
safety of RIB for postoperative analgesia, as well as whether RIB is
superior to other types of nerve blocks. STUDY DESIGN: A systematic review
and meta-analysis. SETTING: Querying electronic databases, including the
Cochrane Library, PubMed, Embase, and Web of Science, was part of the
process in searching for eligible clinical trials for this meta-analysis
and systematic review. METHOD(S): The Cochrane Collaboration's tool
for quality evaluation was utilized in assessing the bias risk in the
selected randomized controlled trials (RCTs). meta-analysis was
facilitated through the utilization of Review Manager 5.3. The
determination of the evidence's quality adhered to the Grading of
Recommendations Assessment, Development, and Evaluation (GRADE) approach.
 RESULT(S): After the inclusion and exclusion criteria were
established, the incorporation of 8 RCTs, encompassing 714 patients, took
place. During the first 24 hours after the operation, patients in the RIB
group exhibited lower pain scores and less opioid consumption than did
those in the no-block group. Furthermore, a decrease in the incidence of
postoperative vomiting and nausea was noted in the RIB group.
Nevertheless, when comparing outcomes, it was revealed that the RIB group
and the other nerve block group did not differ significantly. LIMITATIONS:
No subgroup analysis to investigate the sources of heterogeneity was
performed. The number of studies in this meta-analysis of RIB compared to
those that focus on other types of nerve block is relatively small. The
optimal concentrations and volumes of local anesthetics were not
evaluated. CONCLUSION(S): RIB may be a new option for pain relief
after chest and breast surgery.

<41>
Accession Number
2031677261
Title
Multicentre, randomized, double-blind, prospective study on the effects of
ImmunoAdSorptiOn on cardiac function in patients with Dilated
CardioMyopathy (IASO-DCM): Rationale and design.
Source
European Journal of Heart Failure. (no pagination), 2024. Date of
Publication: 2024.
Author
Dorr M.; Bohm M.; Erdmann E.; Gross S.; Mahabadi A.-A.; Nauck M.;
Nickening G.; Schultheiss H.-P.; Staudt A.; Werdan K.; Waagstein F.;
Hjalmarson A.; Felix S.B.
Institution
(Dorr, Gros, Felix) Department of Internal Medicine B, University
Medicine, Greifswald, Germany
(Dorr, Gros, Nauck, Felix) DZHK (German Center for Cardiovascular
Research), Partner site Greifswald, Greifswald, Germany
(Bohm) Department of Internal Medicine III, Saarland University, Homburg,
Germany
(Erdmann) Department of Internal Medicine III, University of Cologne,
Cologne, Germany
(Mahabadi) Department of Cardiology and Vascular Medicine, West German
Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
(Nauck) Institute of Clinical Chemistry and Laboratory Medicine,
University Medicine, Greifswald, Germany
(Nickening) Department of Internal Medicine II - Pneumology/Cardiology,
University Hospital Bonn, Bonn, Germany
(Schultheiss) Institute of Cardiac Diagnostics and Therapy, IKDT GmbH,
Berlin, Germany
(Staudt) Helios-Kliniken Schwerin, Department of Cardiology and Angiology,
Schwerin, Germany
(Werdan) Department of Internal Medicine III - Cardiology, Angiology and
Internal Intensive Care Medicine, Mid-German Heart Center, University
Hospital Halle (Saale), Halle, Germany
(Waagstein, Hjalmarson) Wallenberg Laboratory, Sahlgrenska University
Hospital, Goteborg, Sweden
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Pilot studies indicate that immunoadsorption with subsequent IgG
substitution (IA/IgG) induces beneficial effects in patients with dilated
cardiomyopathy (DCM) and heart failure. This placebo-controlled study
investigates whether IA/IgG treatment enhances left ventricular (LV)
systolic function as compared to a control group receiving
pseudo-treatment. Method(s): This multicentre, randomized,
double-blind, parallel-group trial aims to include 200 patients with heart
failure due to DCM (LV ejection fraction [LVEF] <40%) on optimized
guideline-directed heart failure medication. Participants are randomly
assigned in a 1:1 ratio to IA/IgG using protein-A columns, or to
pseudo-immunoadsorption followed by an intravenous infusion without IgG.
Follow-up visits take place by telephone after 1 and 3 months and at the
study centres after 6, 12 and 24 months. The primary efficacy endpoint is
the change in LVEF from baseline to 6 months determined by contrast
echocardiography, analysed at a core lab. In addition, LV end-diastolic
and end-systolic volumes will be analysed as secondary endpoints over the
entire study period to assess whether IA/IgG affects LV remodelling. As
main secondary outcome, a composite of all-cause death, cardiac
resuscitation, hospitalization for heart failure, and need for cardiac
surgery to improve myocardial pump function will be evaluated after 24
months. In addition, exploratory outcomes as well as safety endpoints
related to the treatment will be assessed throughout the whole study
period. Conclusion(s): IASO-DCM is a randomized study which will
provide comprehensive insights into the effects of immunoadsorption with
subsequent IgG substitution in patients with DCM. Copyright ©
2024 The Author(s). European Journal of Heart Failure published by John
Wiley & Sons Ltd on behalf of European Society of Cardiology.

<42>
Accession Number
645431101
Title
Tranexamic Acid During Radical Cystectomy: A Randomized Clinical Trial.
Source
JAMA surgery. (no pagination), 2024. Date of Publication: 02 Oct 2024.
Author
Breau R.H.; Lavallee L.T.; Cagiannos I.; Momoli F.; Bryson G.L.; Kanji S.;
Morash C.; Turgeon A.F.; Zarychanski R.; Houston B.L.; McIsaac D.I.;
Mallick R.; Knoll G.A.; Kulkarni G.; Izawa J.; Saad F.; Kassouf W.; Fradet
V.; Rendon R.; Shayegan B.; Fairey A.; Drachenberg D.E.; Fergusson D.
Institution
(Breau, Lavallee, Kanji, McIsaac, Mallick, Fergusson) Ottawa Hospital
Research Institute, Ottawa, ON, Canada
(Cagiannos, Morash) Ottawa Hospital, Ottawa, ON, Canada
(Momoli) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
(Bryson, McIsaac) Departments of Anesthesiology and Pain Medicine,
University of Ottawa, Ottawa, ON, Canada
(Turgeon) Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, Universite Laval, Quebec City, Quebec,
Canada
(Turgeon) Population Health and Optimal Health Practices Research Unit
(Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval
Research Center, Quebec City, Quebec, Canada
(Zarychanski, Houston) Department of Internal Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Zarychanski, Houston) Department of Medical Oncology and Haematology,
Cancercare Manitoba, Winnipeg, MB, Canada
(Knoll) Department of Medicine (Nephrology), Ottawa Hospital, Ottawa, ON,
Canada
(Kulkarni) Division of Urology, Department of Surgery, University of
Toronto, Toronto, ON, Canada
(Izawa) Department of Surgery & Oncology, Division of Urology, Western
University, London, ON, Canada
(Saad) University of Montreal Hospital Center (CHUM), Montreal, Quebec,
Canada
(Kassouf) Department of Surgery (Urology), McGill University Health
Center, Montreal, Quebec, Canada
(Fradet) Department of Surgery (Urology), CHU de Quebec - Universite
Laval, Quebec City, Quebec, Canada
(Rendon) Department of Urology, Dalhousie University and Nova Scotia
Health Authority, Halifax, NS, Canada
(Shayegan) Division of Urology, McMaster University, Hamilton, Ontario,
Canada
(Fairey) Division of Urology, University of Alberta, Edmonton, AB, Canada
(Drachenberg) Urologic Oncologist, Section of Urology, Department of
Surgery, University of Manitoba, Winnipeg, MB, Canada
Abstract
Importance: Among cancer surgeries, patients requiring open radical
cystectomy have the highest risk of red blood cell (RBC) transfusion.
Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and
orthopedic surgery, and it is possible that similar effects of TXA would
be observed during radical cystectomy. Objective(s): To determine
whether TXA, administered before incision and for the duration of radical
cystectomy, reduced the number of RBC transfusions received by patients up
to 30 days after surgery. Design, Setting, and Participant(s): The
Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind,
placebo-controlled, randomized clinical trial with enrollment between June
2013 and January 2021. This multicenter trial was conducted in 10 academic
centers. A consecutive sample of patients was eligible if the patients had
a planned open radical cystectomy for the treatment of bladder cancer.
 Intervention(s): Before incision, patients in the intervention arm
received a loading dose of intravenous TXA, 10 mg/kg, followed by a
maintenance infusion of 5 mg/kg per hour for the duration of the surgery.
In the control arm, patients received indistinguishable matching placebo.
 Main Outcomes and Measures: The primary outcome was receipt of RBC
transfusion up to 30 days after surgery. Result(s): A total of 386
patients were assessed for eligibility, and 33 did not meet eligibility.
Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male
[74.5%]), 344 were included in the intention-to-treat analysis. RBC
transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the
TXA group and 64 of 171 patients (37.4%) in the placebo group (relative
risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary
outcomes among the TXA group vs placebo group including mean (SD) number
of RBC units transfused (0.9[1.5] U vs 1.1[1.8] U; P=.43), estimated blood
loss (927[733] mL vs 963[624] mL; P=.52), intraoperative transfusion
(28.3% [49 of 173] vs 24.0% [41 of 171]; P=.08), or venous thromboembolic
events (3.5% [6 of 173] vs 2.9% [5 of 171]; P=.57).
Non-transfusion-related adverse events were similar between groups.
 Conclusions and Relevance: Results of this randomized clinical trial
reveal that TXA did not reduce blood transfusion in patients undergoing
open radical cystectomy for bladder cancer. Based on this trial, routine
use of TXA during open radical cystectomy is not recommended. Trial
Registration: ClinicalTrials.gov Identifier: NCT01869413.

<43>
Accession Number
641008011
Title
Risk predictors and outcomes of infective endocarditis among adult
patients with congenital heart disease.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1843), 2022. Date of Publication: September 2022.
Author
Fedchenko M.; Giang K.W.; Snygg-Martin U.; Dellborg M.; Mandalenakis Z.
Institution
(Fedchenko, Giang, Dellborg, Mandalenakis) Institute of Medicine -
Sahlgrenska Academy, University of Gothenburg, Department of Molecular and
Clinical Medicine/Cardiology, Gothenburg, Sweden
(Snygg-Martin) Institute of Biomedicine, Sahlgrenska Academy, Department
of Infectious Diseases, Gothenburg, Sweden
Publisher
European Respiratory Society
Abstract
Background: Infective endocarditis (IE) is a serious disease associated
with increased morbidity and mortality. Patients with adult congenital
heart disease (ACHD) have been reported to be at a particularly increased
risk of infective endocarditis (IE). Purpose(s): To investigate the
risk predictors of IE, and the long-term risk of IE among ACHD patients
aged 18-65 years, compared with matched controls without ACHD, in a
nationwide setting. Method(s): All patients with ACHD in Sweden born
in years 1952-1999 and who survived until 18 years of age were followed in
the National Patient Register and Cause of Death Register until year 2017.
For each case of ACHD, approximately ten controls without ACHD were
randomly selected from the Total Population Register and matched by birth
year and sex. The study population was followed from 18 years of age and
until a first time diagnosis of IE, death or end of study. Both
comorbidities and occurrence of ACHD related surgery were collected from
1970 and onwards. Cox proportional hazard models were used to predict the
risk of IE. Result(s): Altogether, 36,189 ACHD patients and 403,962
controls without ACHD were included. A total of 706 (1.95%) ACHD patients
and 147 (0.04%) controls developed IE during a median follow-up of 15.5
(interquartile range (IQR) 6.9-28.5) years (ACHD) and 15.5 (IQR 7.5-28.5)
years (controls). ACHD patients were somewhat younger at age of IE
diagnosis compared with controls, median age 33.9 (IQR 25.4-44.1) years in
ACHD vs 39.8 (IQR 30.6-52.0) years in controls. The overall risk of IE was
markedly higher among ACHD patients compared with controls, with a hazard
ratio (HR) of 54.8 (95% confidence interval (CI), 45.9-65.5). More than
one third of the ACHD patients with IE (n=272, 38.5%) had undergone any
kind of previous congenital heart surgery whereof 122 (44.9%) had
undergone valve replacement (mechanical/biological) prior to IE. In ACHD
patients, the most important risk predictors for IE were ACHD related
cardiac surgery and valve replacement surgery, HR 117 (95% CI 93.0-148)
and HR 74.8 (95% CI 56.4-99.2), respectively. Diabetes mellitus, previous
ischemic stroke and presence of an intracardiac electronic device also
predicted the risk of IE, however, they were less important predictors
(diabetes: HR 1.69, 95% CI 1.01-2.82, ischemic stroke: HR 1.75, 95% CI
1.21-2.52, electronic device: HR 1.59, 95% CI 1.05-2.39).
 Conclusion(s): The risk of developing IE was found to be almost 55
times higher in patients with ACHD aged 18-65 years compared with matched
controls. Previous ACHD related surgery and valve replacement were the
most significant risk predictors. These results underscore the need of
continuous clinical follow-up as well as the need of further research to
prevent this serious complication of ACHD.

<44>
Accession Number
641007957
Title
Cost-effectiveness of statin therapy in categories of patients in the UK.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2841), 2022. Date of Publication: September 2022.
Author
Mihaylova B.; Wu R.; Williams C.; Zhou J.; Schlackow I.; Emberson J.;
Reith C.; Keech A.; Robson J.; Wilkinson K.; Armitage J.; Collins R.; Gray
A.; Simes J.; Baigent C.
Institution
(Mihaylova, Williams, Zhou, Emberson, Reith, Armitage, Collins, Gray,
Baigent) University of Oxford, Nuffield Department of Population Health,
Oxford, United Kingdom
(Wu, Robson) Queen Mary University of London, Wolfson Institute of
Population Health, London, United Kingdom
(Schlackow) University of Oxford, Oxford, United Kingdom
(Keech, Simes) University of Sydney, NHMRC Clinical Trials Centre, Sydney,
Australia
(Wilkinson) Public Representative, Oxford, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: Cardiovascular disease (CVD) mortality has declined steadily
over the last few decades across Europe and North America.
 Purpose(s): To provide contemporary estimates of long-term
effectiveness and cost-effectiveness of statin therapy in different
categories of patients in UK. Method(s): The CTT-UKB micro-simulation
model, developed using the Cholesterol Treatment Trialists' Collaboration
data (CTT: 118,000 participants; 5 years follow-up), and calibrated in the
UK Biobank cohort (UKB: 502,000 participants; 9 years follow-up). The
model integrates parametric risk equations for incident myocardial
infarction, stroke, coronary revascularization, diabetes, cancer and
vascular and nonvascular death, and projects annually these endpoints and
survival using patient characteristics at entry. UKB data and linked
primary and hospital care data informed healthcare costs in the model
(2020 UK); 2021 UK NHS Drug Tariff informed statin costs (atorvastatin
40mg at 1.22 and 80mg at 1.68 per 28 tablets); and Health Survey for
England data informed health-related quality of life in the model.
Previous CTT meta-analysis, atorvastatin doseresponse randomized trials,
and further meta-analyses of statin trials and cohort studies informed
effects of 40mg/80mg atorvastatin therapy daily on rates of incident
myocardial infarction, stroke, coronary revascularization, vascular death,
diabetes, myopathy and rhabdomyolysis. The model was used to project gains
in quality-adjusted life years (QALYs) and additional cost per QALY with
lifetime use of atorvastatin 40mg or 80mg daily in categories of UKB
participants by sex, age at statin initiation (40-49; 50-59 and 60-70
years), and 10-year CVD risk (QRISK3 risk (%): <5; 5-10, 10-15, 15-20,
>=20). Further scenarios explored effects of 5-year delay of statin
initiation in people under 45 years of age or stopping statin therapy at
80 years of age. Result(s): Across men and women in categories by age
and CVD risk, lifetime use of atorvastatin 40mg daily was associated with
increases in survival by 0.44-1.69 years (0.28-1.02 QALYs), and
atorvastatin 80mg daily with increases in survival of 0.45-1.87 years
(0.32-1.13 QALYs; Figure 1) with gains larger among participants at higher
CVD risk. Both atorvastatin 40mg and 80mg doses were in the range of
cost-effective treatments with incremental cost per QALY gained with
atorvastatin 40mg daily versus no statin therapy below 7200/QALY and with
atorvastatin 80mg vs 40mg daily below 16000/QALY (Figure 2) across all
patient categories studied. Compared to lifetime statin therapy, stopping
therapy at 80 years of age substantially reduced benefits and was not
cost-effective in any patient category studied. Similarly, compared to
immediate initiation, 5-year delay of statin therapy in 40-45 years old
patients was not a cost-effective. Conclusion(s): In the UK, statin
therapy remains highly cost-effective across men and women 40-70 years
old, including those at 10-year CVD risk <5%.

<45>
Accession Number
641006954
Title
Comparing direct oral anticoagulants versus vitamin K antagonist in
patients with atrial fibrillation after transcatheter aortic valve
replacement: An updated meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1631), 2022. Date of Publication: September 2022.
Author
Dhaliwal A.; Kaur A.; Konje S.; Bhatia K.; Sohal S.; Rawal H.; Turagam M.;
Gwon Y.; Mamas M.; Dominguez A.; Bhatt D.; Velagapudi P.
Institution
(Dhaliwal) New York Hand Surgery, New York, United States
(Kaur, Konje, Bhatia, Dominguez) Mount Sinai St Luke's and Mount Sinai
West Hospital, New York, United States
(Sohal) Newark Beth Israel Medical Center, Newark, United States
(Rawal) Insight Hospital and Medical Center, Chicago, United States
(Turagam) Mount Sinai Hospital, New York, United States
(Gwon, Velagapudi) University of Nebraska Medical Center, Omaha, United
States
(Mamas) Keele University, Keele, United Kingdom
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
European Respiratory Society
Abstract
Background: Oral anticoagulation therapy is indicated for patients
undergoing transcatheter aortic valve replacement (TAVR) with concomitant
or new onset atrial fibrillation (AF). However the data on optimal
anticoagulation regimen in this population remains unclear.
 Purpose(s): To compare efficacy and safety outcomes of direct oral
anticoagulants (DOACs) versus Vitamin K antagonists (VKA) in patients with
AF post TAVR. Method(s): We searched electronic databases (PubMed,
Embase, Scopus, Cochrane) from inception to February28th, 2022 using MeSH
terms and keywords for DOACs, AF or TAVR. Primary outcome of interest was
allcause stroke or systemic embolic event. Secondary safety outcomes were
major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95%
confidence interval (CI) were calculated using a random-effects model.
Interstudy heterogeneity was assessed using the Higgins I 2 value. All
statistical analysis were performed using RevMan 5.4.1 software.
 Result(s): We identified five eligible studies (1RCT, 4
observational) including 3694 patients (DOAC n=1581, VKA n=2113). The mean
age was 81.4+/-0.9 years. The mean follow-up was 12.4+/-14.3 months. Type
of DOACs included apixaban (n=394, 24.9%), rivaroxaban (n=354, 22.4%),
dabigatran (n=119, 7.5%) and edoxaban (n=714, 45.2%).There was no
significant difference in primary outcome of stroke or systemic embolic
event (RR: 0.93; CI: 0.65-1.33; p>0.05; I2=5%), or in secondary
outcomes of major bleeding (RR: 1.02; CI: 0.78-1.34; p>0.05;
I2=44%) and all-cause mortality (RR: 0.87; CI: 0.59-1.27;
p>0.05; I2=56%) between DOACs and VKA groups.
 Conclusion(s): This meta-analysis shows anticoagulation therapy with
DOACs has similar safety and efficacy outcomes compared to VKA in patients
with AF undergoing TAVR. (Figure Presented).

<46>
Accession Number
641006919
Title
Proprotein convertase subtilisin/kexin type 9 (PCSK9), platelet activation
and interaction with the vascular endothelium: The impact of PCSK9
inhibition with evolocumab in acute coronary syndrome.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1281), 2022. Date of Publication: September 2022.
Author
Ziogos E.; Chelko S.P.; Walsh E.; Engel M.; Gerstenblith G.; Halushka
M.K.; Leucker T.M.
Institution
(Ziogos, Gerstenblith, Leucker) Johns Hopkins University, School of
Medicine, Department of Medicine, Baltimore, United States
(Chelko, Engel) Florida State University, College of Medicine, Department
of Biomedical Sciences, Tallahassee, United States
(Walsh, Halushka) Johns Hopkins University, School of Medicine, Department
of Pathology, Baltimore, United States
Publisher
European Respiratory Society
Abstract
Background/Introduction: Platelet activation and endothelial dysfunction
may contribute to adverse outcomes in patients with acute myocardial
infarction. Pre-clinical studies indicate PCSK9 enhances platelet
activation. Purpose(s): Our goals were (1) to examine the role of
PCSK9 as a potential mediator of platelet activation in patients with
acute coronary syndrome (ACS) and (2) to perform immunohistochemical
studies of left internal mammary artery (LIMA) specimens to examine
interactions among PCSK9, platelets, and endothelial cells in specimens
obtained during coronary bypass surgery. Method(s): Participants from
the Evolocumab in Acute Coronary Syndrome trials (EVACS; NCT03515304,
NCT04082442), with a NSTEMI and a troponin-I of >5 ng/ml or a STEMI were
randomized to placebo or to 420 mg SC of evolocumab, a monoclonal
anti-PCSK9 antibody, within 24 hours of hospitalization. We performed
serial ex vivo analysis of PF4, a marker of platelet activation, in serum
samples obtained at baseline (prior to study drug administration) and at
day 30. PF4 values were normalized to total platelet count. All of the
participants were on guideline-directed therapies for ACS. Additionally,
LIMA samples from patients undergoing coronary bypass surgery were
immunostained with PCSK9, the endothelial cell transmembrane glycoprotein
CD31 (platelet endothelial cell adhesion molecule- 1) and the platelet
surface marker CD61 (integrin beta-3). Outcome data were summarized using
medians and interquartile ranges. Result(s): Forty-six participants
were randomized in a 1:1 fashion to placebo or to evolocumab. Mean (+/-SD)
age of the cohort was 60+/-13 years, 48% were women and 22% were African
American. Baseline PF4 levels (expressed as ng/1k platelets) were similar
between the two groups (placebo: 9.3 [4-12] vs evolocumab 8.0 [4-12],
p=0.8). In the placebo group, there was a significant increase in PF4 at
30 days to 13.1 [11-14], p<0.01 (baseline vs 30 days). In contrast, there
was no significant change from baseline in the evolocumab group at 30 days
(10.7 [6-13]), which was significantly lower than the placebo group
(p=0.04). Furthermore, immunostaining of LIMA specimens obtained from
patients during coronary artery bypass surgery revealed colocalization of
PCSK9, CD31, and CD61 on the vascular endothelial cell surface (see
Figure). Conclusion(s): PCSK9 inhibition with evolocumab decreases
platelet activation in ACS patients on dual anti-platelet therapy. PCSK9
is associated with platelets and endothelial cells at the vascular
endothelium. PCSK9 is a potential mediator of the interaction between
platelets and vascular endothelial cells in patients with coronary artery
disease. (Figure Presented).

<47>
Accession Number
641006905
Title
To compare efficacy and safety of direct oral anticoagulants in patients
with concurrent atrial fibrillation and bioprosthetic heart valve repair
or replacement: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1630), 2022. Date of Publication: September 2022.
Author
Kaur A.; Dhaliwal A.; Khandait H.; Konje S.; Bhatia K.; Sohal S.; Turagam
M.; Gwon Y.; Mamas M.; Dominguez A.; Bhatt D.; Velagapudi P.
Institution
(Kaur, Konje, Bhatia, Dominguez) Icahn School of Medicine at Mount Sinai
Morningside West, New York City, United States
(Dhaliwal) New York Hand Surgery, New York, United States
(Khandait) Trinitas Regional Medical Center, Elizabeth, NJ, United States
(Sohal) Newark Beth Israel Medical Center, Newark, United States
(Turagam) Mount Sinai Hospital, New York, United States
(Gwon, Velagapudi) University of Nebraska Medical Center, Omaha, United
States
(Mamas) Keele University, Keele, United Kingdom
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
Publisher
European Respiratory Society
Abstract
Background: Use of direct oral anticoagulants (DOACs) is contraindicated
in patients with mechanical valves. However data on their use in patients
with atrial fibrillation (AF) and bioprosthetic valves (BV) is still
limited. Purpose(s): To assess the safety and efficacy of DOACs
versus Vitamin K antagonist (VKA) in patients with AF after BV repair or
replacement. Method(s): We performed a comprehensive review of
electronic databases (PubMed, Embase, Scopus, Cochrane) using MeSH terms
and keywords for DOACs, AF and BVs from inception through December 2021.
Randomized clinical trials (RCT) or observational studies that reported
clinical outcomes comparing DOACs versus VKA in patients with AF and BVs
were eligible for inclusion. Ten articles were reviewed for full text.
Primary outcome was a composite of all cause stroke or systemic embolic
event. Secondary outcomes included major bleeding and all-cause mortality.
Subgroup analysis stratified by study design was performed. Pooled risk
ratio (RR) and 95% confidence interval (CI) were calculated using Mantel-
Haenszel method with DerSimonian-Laird estimator for tau2 for random
effects model. Interstudy heterogeneity was assessed using the Higgins I 2
value. All statistical analysis was performed using RevMan 5.4.1 software.
 Result(s): Ten studies (5 RCTs, 5 observational studies) with a total
of 5,333 patients (DOACs n=2434; VKA n=2899) were included. Aortic, mitral
and mixed BV repair or replacement were 74.2%, 25.6% and 0.02%
respectively. The mean age was 72.6+/-11.9 years. The mean follow-up was
15.7+/-12.9 months. Type of DOACs included apixaban (n=553, 22.7%),
rivaroxaban (n=893, 36.7%), dabigatran (n=151, 6.2%) and edoxaban (n=837,
34.4%). There was no significant difference in primary outcome of stroke
or systemic embolic event (RR: 0.79; CI: 0.56-1.11; p>0.05;
I2=12%) or secondary outcomes of major bleeding (RR: 0.84; CI:
0.64- 1.11; p>0.05; I2=45%), and all-cause mortality (RR: 0.84;
CI: 0.64-1.11; p>0.05; I2=29%) between DOACs compared with VKA.
 Conclusion(s): In patients with AF and BV, DOACs are non-inferior to
VKA for risk of stroke or systemic embolism, major bleeding, and all-cause
mortality. Thus, DOACs can serve as a viable alternative to VKAs which
have a narrow therapeutic index, multiple drug interactions, and require
frequent monitoring. (Figure Presented).

<48>
Accession Number
641006900
Title
Activation of mitochondrial telomerase reverses relative lymphopenia post
myocardial infarction: Results from the randomised, double-blinded TACTIC
phase IIa pilot trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1225), 2022. Date of Publication: September 2022.
Author
Spyridopoulos I.; Bawamia B.; Spray L.; Wangsaputra V.; Stellos K.;
Bennaceur K.; Kharatikoopaei E.; Ogundimu E.; Gale C.P.; Keavney B.; Maier
R.; Hancock H.; Richardson G.; Austin D.
Institution
(Spyridopoulos, Bawamia, Spray, Wangsaputra, Bennaceur, Maier, Hancock,
Richardson) Newcastle University, Newcastle-Upon-Tyne, United Kingdom
(Stellos) European Center for Angioscience, Mannheim, Germany
(Kharatikoopaei, Ogundimu) Durham University, Durham, United Kingdom
(Gale) Leeds Teaching Hospitals, Leeds, United Kingdom
(Keavney) University of Manchester, Manchester, United Kingdom
(Austin) James Cook University Hospital, Middlesbrough, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: Immune ageing is a phenomenon which includes lymphopenia,
expansion of pro-inflammatory T-lymphocyte subsets and telomere
shortening. While lymphopenia predicts mortality after myocardial
infarction (MI), MI itself leads to both an increase in terminally
differentiated memory CD8+ T-lymphocytes (CD8+ TEMRAs) and a decrease in
telomere length. Activation of telomerase has been shown to ameliorate
lymphopenia, and improve heart function after MI in mouse models. TA-65 is
an oral telomerase activator, which may ameliorate immune ageing and
improve outcome after MI. Method(s): This double-blinded, randomized
placebo-controlled pilot study evaluated the use of TA-65 in 90 MI
patients over 65 years, the average onset age for immune ageing. Patients
were randomised to either TA-65 (16 mg daily, n=45) or placebo (n=45) for
12 months. The majority of patients underwent percutaneous coronary
intervention (87%) or coronary artery bypass surgery (2%) as treatment for
their index MI. The pre-defined primary endpoint was the proportion of
CD8+ TEMRA T-lymphocytes at 12 months, a marker of immune ageing. A linear
mixed effects model was used for the analysis. Result(s): The
proportion of CD8+ TEMRAs after 12 months did not differ between the 2
treatment groups, although only increased significantly in the placebo
group (+2.2%, 95% CI: 0.14-4.24). TA-65 was well tolerated, with total
adverse events lower in the treatment group (TA-65 vs. placebo group:
N=130 vs. n=185). We observed at 12 months a 62% reduction in mean
high-sensitivity CRP (hsCRP: TA-65 vs. placebo group: 1.1+/-0.9 vs.
2.9+/-6.4 mg/L) and a 15%-increase in mean peripheral blood lymphocytes in
TA-65 after 12 months. In the whole sample, among those who were treated
with TA-65 compared to Placebo, after 12 months peripheral blood
lymphocytes increased (+285 cells /mul, 95% CI: 117-452). The latter was
due to significant increases in the TA-65 group from baseline to 12 months
across all major lymphocyte populations: CD3+ (+15%), CD4+ (+14%),CD8+
T-lymphocytes (+19%), B-lymphocytes (+17%) and natural killer cells
(+12%), while no changes occurred in major lymphocyte populations in the
placebo group over the course of the study. Conclusion(s): In this
randomised clinical trial, we found that while CD8+ TEMRAs were not
significantly altered after 12 months, the telomerase activator TA-65
significantly increased all major lymphocyte subsets and substantially
reduced hsCRP at 12 months in patients with MI. These findings suggest
TA-65 holds great promise in potentially reducing inflammation while
improving an age-related decline in major lymphocyte populations, thereby
enhancing immunity. A larger, multicentre, powered phase IIb efficacy
trial to examine the potential effect of TA-65 in prognosis and heart
function after MI is therefore warranted.

<49>
Accession Number
641006860
Title
Early aortic valve replacement improves exercise capacity in truly
asymptomatic patients with severe aortic stenosis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1629), 2022. Date of Publication: September 2022.
Author
Banovic M.; Boskovic N.; Bojanic M.; Nedeljkovic I.; Jovanovic M.; Penicka
M.; Bartunek J.
Institution
(Banovic, Boskovic, Bojanic, Nedeljkovic, Jovanovic) Clinical center of
Serbia, Belgrade, Serbia
(Penicka, Bartunek) Olv Hospital Aalst, Aalst, Belgium
Publisher
European Respiratory Society
Abstract
Background: Exercise capacity is a strong predictor of morbidity and
mortality overall. In severe aortic stenosis (AS) ustained pressure
overload during watchful waiting is associated with LV structural and
functional deterioration and impaired clinical outcome both pre- and post
aortic valve replacement (AVR). The effect of early surgical aortic valve
replacement (SAVR) in asymptomatic patients with severe AS and normal left
ventricular function on exercise capacity in unknown. Aim(s):We
investigated whether the early surgical AVR in truly asymptomatic patients
with severe aortic stenosis and normal LVEF improves the exercise
capacity. Method(s): This is a sub-analysis or the AVATAR trial
(NCT02436655), which is international prospective randomized controlled
trial that evaluated the safety and efficacy of early SAVR in the
treatment of asymptomatic patients with severe AS, according to common
criteria (valve area <=1 cm2 with aortic jet velocity >4 m/s or
a mean transaortic gradient >=40 mm Hg), and with normal left ventricular
function. Patients underwent cardiopulmonary exercise testing (supine
bicycle, ramp protocol, 15 W/min) at the baseline and 12 months following
the randomization. Patients who had positive exercise testing at baseline
visit were excluded. We compared the value of workload (in WATs), VO2 max,
VO2 AT, VE/VCO2 and PETCO2 slope at the inclusion and at 12 months.
 Result(s): Total of 157 patients (mean age, 67 years; 57% men) were
randomly allocated to early surgery (n=78) or conservative treatment
(n=79). Mean LVEF and Vmax in early surgery and conservative treatment
group were 70% and 4.5m/s and 69% and 4.5m/s, respectively. After 12
months in patients with conservative treatment there was a slight decrease
in the values of workload, VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope, but
without statistical significance. However operated patients showed a
significant increase in workload (115.4+/-38.4 watts at 12 months vs
104.8+/-42.2 at inclusion, p=0.038) and VO2 max (19.7+/-6.8 at 12 months
vs 16.2+/-5.4 at the inclusion, p=0.048), while there was slight increase
in the values of VO2 AT, VEVCO2 and PETCO2 but without statistical
significance. Conclusion(s): Early SAVR improve the functional
capacity in asymptomatic patients with severe aortic stenosis and normal
left ventricular ejection fraction.

<50>
Accession Number
641006831
Title
Factors associated with outcome five years after infectious endocarditis -
the POET trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1675), 2022. Date of Publication: September 2022.
Author
Pries-Heje M.
Institution
(Pries-Heje) Rigshospitalet - Copenhagen University Hospital, Copenhagen,
Denmark
Publisher
European Respiratory Society
Abstract
Introduction: In stabilized patients with left-sided infectious
endocarditis (IE) a shift to oral antibiotic treatment was non-inferior
compared to conventional intravenous antibiotic treatment as assessed six
months after randomization (1). After 5 years the primary outcome was
superior in the orally treated group (2). Factors associated with primary
outcome in the POET trial have not previously been reported.
 Purpose(s): To identify factors associated with the occurrence of the
primary outcome in the POET trial (Partial Oral Antibiotic Endocarditis
Treatment) after 5-years of follow-up. Method(s): The POET trial was
a Danish national randomized clinical trial with inclusion from 2011-2017.
Patients were randomized 1:1 to shift to partial oral versus continued
intravenous antibiotic treatment after fulfilling stabilization criteria.
Patients were followed from randomization until July 2020. The primary
outcome was a composite outcome including the occurrence of 1) all-cause
mortality, 2) non-intended heart valve surgery, 3) embolization or 4)
relapse of positive blood culture with the primary IE causing bacteria.
Associations between baseline characteristics and IEspecific factors and
the occurrence of the primary outcome were examined using univariate
cox-regression analysis and a multivariate model was constructed using
backwards elimination at p>0.05. The proportional hazard assumption was
assessed with Schoenfeld residuals. Result(s): A total of 400
patients with left-sided endocarditis were randomized. After a median
follow-up of 5.4 years (IQR 4.0-6.9), one or more of the components of the
primary outcome had occurred in 156 patients (Table 1) (mean age 71.5
years (SD 10.0), 119 males (76.3%)). Patients who reached a primary
outcome were older, more comorbid, more often had an existing prosthetic
valve at time of IE admission, had IE localized to the aortic valve, had
vegetations >9 mm or valvular incompetence at time of admission. In
multivariable regression analysis older age (HR 1.03; 95% CI 1.02-1.05,
p<0.001), diabetes (HR 1.56; 95% CI 1.06-2.30, p=0.025), renal failure (HR
2.13; 95% CI 1.40-3.24, p<0.001), and prosthetic aortic valve (HR 1.52;
95% CI 1.08-2.14, p=0.016) were associated with a risk of reaching a
primary outcome, while heart valve surgery during primary admission for
endocarditis (HR 0.41; 95% CI 0.27-0.62, p<0.001) and shift to oral
antibiotic treatment (HR 0.69; 95% CI 0.50-0.95, p=0.022) were associated
with a lower risk (Table 2). Conclusion(s): In the POET-trial older
age, diabetes, renal failure and prosthetic aortic valve at baseline were
independently associated with a higher risk of reaching a primary outcome,
while heart valve surgery and shift to oral antibiotic treatment were
associated with a lower risk. These findings may inform future guidelines
for treatment of endocarditis. (Table Presented).

<51>
Accession Number
641006822
Title
Early intervention versus conservative management of asymptomatic severe
aortic stenosis: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1628), 2022. Date of Publication: September 2022.
Author
Costa G.; Cardoso J.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic
Surgery, Vila Nova de Gaia, Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
(Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Aortic stenosis (AS) is the most common valvular disease in
developed countries. However, the specific timing of intervention for
asymptomatic patients with severe AS remains controversial.
 Purpose(s): To compare the outcomes of early aortic valve replacement
(AVR) versus watchful waiting (WW) in asymptomatic patients with AS.
 Method(s): We systematically searched PubMed, Embase and Cochrane
databases, in December 2021, for both interventional or observational
studies comparing early AVR with WW in the treatment of asymptomatic
severe AS. Random-effects meta-analysis was performed. Result(s):
Thirteen studies were included in which two were randomised clinical
trials. A total of 4,679 patients were included, providing a 1,268 pooled
death events (327 in early AVR and 941 in WW). Our meta-analysis showed a
significantly lower all-cause mortality for the early-AVR compared with WW
group, although with a moderate amount of heterogeneity between studies in
the magnitude of the effect (pooled odds ratio [OR], 0.41; 95% confidence
interval [CI] 0.34, 0.50, P<0.01; I2=60%). An early surgery
strategy displayed a significantly lower cardiovascular mortality (pooled
OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I 2=64%) and heart failure
hospitalisations (pooled OR 0.19; 95% CI [0.10, 0.39], P<0.01,
I2=7%). However, both groups had similar rates of stroke
(pooled OR 1.30; 95% CI [0.73, 2.29], P=0.36, I2=0%) and
myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P=0.14,
I2=0%). Conclusion(s): Our pooled data suggest that an
early-AVR strategy is preferable for asymptomatic patients with severe AS.
(Figure Presented).

<52>
Accession Number
641006727
Title
Specific characteristics of STEMI in COVID-19 patients and their practical
implications: A systematic review.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1424), 2022. Date of Publication: September 2022.
Author
Gitto M.; Novelli L.; Cozzi O.; Reimers B.; Condorelli G.; Stefanini G.G.
Institution
(Gitto, Novelli, Cozzi, Reimers, Condorelli, Stefanini) Humanitas Research
Hospital, Milan, Italy
Publisher
European Respiratory Society
Abstract
Introduction: STEMI is one of the cardiac emergencies whose management has
been mostly challenged by the COVID-19 pandemic. Patients presenting with
the "lethal combo" of STEMI and concomitant SARS-CoV- 2 infection have
faced dramatic issues related to need for self-isolation, systemic
inflammation with multi-organ disease, and difficulties to obtain timely
diagnosis and treatment. Method(s):We performed a systematic search
of three electronic databases from February 1st 2020 to January 31st 2022.
We included all studies reporting crude rates of in-hospital outcomes of
STEMI patients with concomitant COVID-19. Result(s): A total of 9
observational studies were identified, mainly conducted during the first
wave of the pandemic. STEMI patients with COVID -19 were more likely
Afro-American and displayed higher rates of hypertension and diabetes with
lower smoking prevalence. Associated comorbidities, including coronary
artery disease, prior stroke and chronic kidney disease were also more
common in those with SARS-CoV-2 infection. At coronary angiography, a
higher thrombus burden in COVID-19 positive STEMI patients was
highlighted, with up to 10-fold higher rates of stent thrombosis and
greater need for glycoprotein IIb/IIa inhibitors and aspiration
thrombectomy; this was not always associated with prolonged times from
symptom onset to hospital admission and door-to-balloon. COVID-19 positive
STEMI patients were less likely to receive coronary angiography and
primary PCI, and more likely to be treated with fibrinolytics only. At the
same time, patients with Covid-19 were more prone to present MINOCA.
In-hospital mortality ranged from 15% to 40%, with consistent variability
across different studies and subjects who tested positive for SARS-CoV- 2
did also present higher rates of cardiogenic shock, cardiac arrest,
prolonged ICU stay, mechanical ventilation, major bleeding, and stroke.
 Conclusion(s): The coexistence of STEMI and COVID-19 was associated
with increased in-hospital mortality and poor short-term prognosis. This
was not entirely attributable to logistic issues determining delayed
coronary revascularization, since patients' specific clinical and
angiographic characteristics, including higher burden of cardiovascular
risk factors and greater coronary thrombogenicity might have substantially
contributed to this trend. (Figure Presented).

<53>
Accession Number
641006604
Title
High-sensitive Troponin T is not associated with the progression of
asymptomatic mild to moderate aortic stenosis: A post hoc substudy of the
SEAS trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2291), 2022. Date of Publication: September 2022.
Author
Hadziselimovic E.; Greve A.M.; Sajadieh A.; Olsen M.H.; Kesaniemi Y.A.;
Nienaber C.A.; Ray S.G.; Rossebo A.B.; Willenheimer R.; Wachtell K.;
Nielsen O.W.
Institution
(Hadziselimovic, Sajadieh, Nielsen) Bispebjerg University Hospital,
Department of Cardiology, Copenhagen, Denmark
(Greve) Rigshospitalet - Copenhagen University Hospital, Department of
Clinical Biochemistry 3011, Copenhagen, Denmark
(Olsen) Holbaek Hospital, Department of Cardiology, Holbaek, Denmark
(Kesaniemi) Oulu University Hospital, Medical Research Center Oulu,
Research Unit of Internal Medicine, Oulu, Finland
(Nienaber) Imperial College London, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
(Ray) Manchester University Hospitals, Manchester, United Kingdom
(Rossebo) Oslo University Hospital Ulleval, Department of Cardiology,
Oslo, Norway
(Willenheimer) Lund University, Heart Health Group, Malmo, Sweden
(Wachtell) Weill Cornell Medicine, Division of Cardiology, New York,
United States
Publisher
European Respiratory Society
Abstract
Background: Aortic stenosis (AS) and coronary artery disease (CAD) share
pathophysiological pathways, as reflected by frequent concomitant
revascularization in patients undergoing aortic valve replacement (AVR).
High-sensitive Troponin T (hsTnT) is a proven biomarker of cardiomyocyte
overload and injury, and predicts postoperative mortality after AVR.
However, it is unknown if hsTnT can predict AVR, mortality or ischemic
coronary events (ICE) in asymptomatic AS patients. Purpose(s): To
investigate the hypothesis that increased hsTnT is associated with more
severe AS and a higher risk of adverse outcomes in asymptomatic AS
patients without overt CAD. Method(s): HsTnT concentrations were
examined at baseline and after 1- year follow-up in 1739 asymptomatic AS
patients enrolled in the randomized, double-blind Simvastatin and
Ezetimibe in Aortic Stenosis (SEAS) study. The main inclusion criteria
were: Left ventricular (LV) ejection fraction >55%, transaortic maximal
velocity between 2.5-4.0 m/s, and no history of CAD. The primary exposure
variable was increased hsTnT (>14 pg/mL according to the assay
manufacturer, Roche). This study's primary endpoint was a composite of
competing risk outcomes: All-cause mortality as the first event, AVR
without revascularization, and ICE (defined as myocardial infarction
before AVR, PCI before or combined with AVR, or any CABG). Multivariable
regression examined associations between hsTnT and clinical variables. Cox
proportional hazards regression models were adjusted for age, sex,
creatinine, LV mass index, mean aortic pressure gradient (Pmean) and
stratified by center and lipid-lowering treatment. We analyzed outcomes
during 5-year follow-up from baseline. Result(s): At baseline, 453
(26.0%) patients had increased hsTnT and 302 (17.4%) had moderate-severe
AS with a mean (SD) aortic valve area of 0.8 (0.2) cm2 and
Pmean of 33.2 (8.8) mmHg. The median annual hsTnT change from baseline to
year 1 was 0.8 pg/mL (IQR, -0.4 to 2.3), regardless of AS severity
(P=0.08). In adjusted models, log(hsTnT at baseline) was associated with
age, sex, creatinine, and LV mass index (all P<0.05), but not with AS
severity (P=0.36). The incidence rate ratio for ICE (Figure 1) in patients
with increased vs normal baseline hsTnT concentrations was 2.32 (95% CI,
1.72-3.11, P<0.001). In adjusted Cox regression, increased hsTnT was
associated with an increased 5-year ICE risk (HR 1.64; 95% CI, 1.18-2.29,
P=0.003), but neither with AVR without revascularization nor death (Figure
1). Conclusion(s): In these asymptomatic AS patients without overt
CAD, hsTnT is often normal and remains stable during 1 year of follow-up
regardless of AS severity. Increased hsTnT is associated with CAD-related
events, but neither to AS severity nor AVR without concomitant
revascularization. This analysis does not support routine hsTnT
measurement in asymptomatic AS to predict AVR related to AS progression,
although hsTnT could improve the risk assessment for ICE. (Figure
Presented).

<54>
Accession Number
641006592
Title
Long-term impact of persistent vegetations at 6 month followup after
treatment of infective endocarditis: A substudy of the Partial Oral vs
Intravenous Antibiotic Treatment of Endocarditis (POET) tria.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1670), 2022. Date of Publication: September 2022.
Author
Hjulmand J.; Pries-Heje M.; Try Lenz I.; Carter-Storch R.; Gill S.; Bruun
N.E.; Povlsen J.A.; Christiansen U.; Helweg-Larsen J.; Fosboel E.; Toender
N.; Moser C.; Iversen K.; Ihlemann N.; Bundgaard H.
Institution
(Hjulmand, Pries-Heje, Try Lenz, Helweg-Larsen, Fosboel, Moser, Bundgaard)
Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
(Carter-Storch, Gill, Ihlemann) Odense University Hospital, Odense,
Denmark
(Bruun) Roskilde University Hospital, Roskilde, Denmark
(Povlsen) Aarhus University Hospital, Aarhus, Denmark
(Christiansen) Aalborg University Hospital, Aalborg, Denmark
(Toender) Nordsjaellands Hospital, Hilleroed, Denmark
(Iversen) Herlev Hospital, Herlev, Denmark
Publisher
European Respiratory Society
Abstract
Background: Our knowledge of changes in vegetation size throughout the
course of infective endocarditis (IE) and the impact of persistent
vegetations on mortality or embolization after completed antibiotic
treatment is sparse. No study has previously investigated the prevalence
or clinical impact of persistent vegetations on transthoracic
echocardiography (TTE) at 6-months follow-up after ended IE treatment.
 Purpose(s): To investigate the association between persistent
vegetations at the 6-months TTE after treatment for IE and long-term
prognosis as assessed in the POET trial. Method(s): The POET trial
was a nationwide, multicenter RCT, randomizing 400 patients to either
partial oral or intravenous (IV) antibiotic treatment of left-sided IE,
after initial stabilization of infection using conventional IV therapy. A
persistent vegetation was defined as a vegetation seen on 6-months
follow-up TTE (4-7 months) after ended antibiotic treatment for IE. In the
POET trial, primary outcome was defined as 1) all-cause mortality, 2)
unplanned cardiac surgery, 3) embolic events or 4) relapse of bacteremia,
in the 5-year follow-up period. Patients without TTE due to death or lack
of available TTE were excluded. Result(s): Out of 400 patients, 20
were excluded due to death during 6- months follow-up, and 201 were
excluded due to unavailable TTE, leaving 179 TTEs for analysis. At
6-months follow-up, a persistent vegetation was seen in 30 patients
(16.7%, 21 males (70%), mean age 69.6 years (SD 7.7)) (Table 1). Seventeen
patients (56.7%) had a persistent vegetation on the aortic valve and 13
patients (43.3%) on the mitral valve. More patients without a persistent
vegetation had undergone initial surgical treatment of IE than those with
a vegetation (57.7 vs 23.3%, p=0.001). In all surgically treated patients
with persistent vegetation at 6-months follow-up, the vegetation was found
on another valve than the operated valve. The composite primary outcome
from 6-months follow-up and until 5-year follow-up occurred in 8 patients
(26.7%) with a persistent vegetation, compared to 38 patients (25.5%)
(p=1.00) without. (Table 2) In patients randomized for peroral treatment,
no significant difference in prevalence of persistent vegetation was found
(15 patients (50%) with persistent vegetations vs. 74 patients (49.7%)
without, p=1.00). Conclusion(s): The occurrence of persistent
vegetations at 6 months followup was 16.7%. There was no association
between persistent vegetations at 6-months follow-up and the occurrence of
the primary outcome after 5 years follow-up, suggesting that the risk
associated with residual vegetations after end of antibiotic treatment is
negligible after 6-months. (Table Presented).

<55>
Accession Number
641006591
Title
Revascularization strategies versus optimal medical therapy in chronic
coronary syndrome: A systematic review and network meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2143), 2022. Date of Publication: September 2022.
Author
Galli M.; Benenati S.; Zito A.; Capodanno D.; Biondi-Zoccai G.; Ortega-Paz
L.; D'Amario D.; Porto I.; Burzotta F.; Trani C.; De Caterina R.; Escaned
J.; Gaudino M.; Angiolillo D.J.; Crea F.
Institution
(Galli, Burzotta, Trani, Crea) Catholic University of the Sacred Heart,
Rome, Italy
(Benenati, Porto) Ospedale Policlinico San Martino IRCCS, Genoa, Italy
(Zito, D'Amario) IRCCS Foundation Agostino Gemelli University Hospital,
Rome, Italy
(Capodanno) AOU Policlinico - Vittorio Emanuele, Catania, Italy
(Biondi-Zoccai) Sapienza University of Rome, Rome, Italy
(Ortega-Paz, Angiolillo) University of Florida, College of Medicine,
Jacksonville, United States
(De Caterina) University of Pisa, Pisa, Italy
(Escaned) Hospital Clinico San Carlos, Madrid, Spain
(Gaudino) Weill Cornell Medicine, New York, United States
Publisher
European Respiratory Society
Abstract
Background: Whether revascularization reduces ischemic events and improves
prognosis in patients with chronic coronary artery syndrome (CCS) without
left main (LM) disease or reduced left ventricle ejection fraction (LVEF)
remains a topic of debate. Nevertheless, the impact of revascularization
on outcomes in patients with CCS may be influenced by the
revascularization strategy adopted. Purpose(s): We aimed at
evaluating the comparative effects of different revascularization
strategies in patients with CCS. Method(s): A total of 18 randomized
controlled trials including angiographyguided percutaneous coronary
intervention (PCI), physiology-guided PCI and coronary artery bypass graft
(CABG), were included. Effect estimates included direct comparisons for
all treatments and direct and indirect evidence were in agreement for all
included outcomes, fulfilling the consistency assumption. Incidence rate
ratios (IRR) and associated 95% confidence intervals (CIs) were used to
adjust outcomes according to follow-up durations. Medical therapy was used
as reference strategy. Result(s): Compared with medical therapy, at a
mean follow-up of 5.1 years, all revascularization strategies were
associated with a reduction of the primary endpoint, as defined in each
trial, the extent of which was modest with angiography-guided PCI (IRR
0.86, 95% CI 0.75-0.99) and greater with physiology-guided PCI (IRR 0.60,
95% CI 0.47-0.77) and CABG (IRR 0.58, 95% CI 0.48-0.70). Moreover,
angiography-guided PCI was associated with increased primary endpoint
compared to physiology-guided PCI (IRR 1.43, 95% CI 1.14-1.79) and CABG
(IRR 1.49, 95% CI 1.27-1.74). CABG was the only strategy associated with
reduced myocardial infarction (IRR 0.68, 95% CI 0.52-0.90), cardiovascular
death (IRR 0.76, 95% CI 0.64-0.89), and all-cause death (IRR 0.87, 95% CI
0.77-0.99), but increased stroke (IRR 1.69, 95% CI 1.04-2.76). Results
were consistent at secondary analysis exploring the impact on outcomes of
baseline characteristics, such as 3-vessel disease, diabetes mellitus,
year of publication or stents used. Conclusion(s): In CCS patients
without LM disease or reduced LVEF, physiology-guided PCI and CABG were
associated with better outcomes than angiography-guided PCI. Compared with
medical therapy, CABG was the only revascularization strategy associated
with a reduction of myocardial infarction and death rates, at the cost of
higher risk of stroke.(Figure Presented).

<56>
Accession Number
641006589
Title
Clinical outcome up to 2 years after percutaneous coronary intervention in
all-comers with concomitant symptomatic peripheral arterial disease: A
pooled analysis in 9,204 randomized trial participants.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2044), 2022. Date of Publication: September 2022.
Author
Pinxterhuis T.H.; Ploumen E.H.; Zocca P.; Doggen C.J.M.; Schotborgh C.E.;
Anthonio R.L.; Roguin A.; Danse P.W.; Benit E.; Aminian A.; Stoel M.G.;
Linssen G.C.M.; Geelkerken R.H.; Von Birgelen C.
Institution
(Pinxterhuis, Ploumen, Zocca, Stoel, Geelkerken, Von Birgelen) Thorax
Centre in Medisch Spectrum Twente (MST), Enschede, Netherlands
(Doggen) University of Twente, Enschede, Netherlands
(Schotborgh) Haga Hospital, Den Haag, Netherlands
(Anthonio) Treant Zorggroep Scheper Hospital, Emmen, Netherlands
(Roguin) Hillel Yaffe Medical Center, Hadera, Israel
(Danse) Rijnstate Hospital, Arnhem, Netherlands
(Benit) Jessa Hospital, Hasselt, Belgium
(Aminian) CHU Charleroi, Charleroi, Belgium
(Linssen) Twente Hospital Group, Almelo, Netherlands
Publisher
European Respiratory Society
Abstract
Background: An increasing number of patients with coronary artery disease,
who undergo percutaneous coronary intervention, also have symptomatic
peripheral arterial disease. These patients have a worse long-term
prognosis, but it is unclear whether the inferior outcome can be seen as
early as during the first 2 years from coronary stenting. Purpose(s):
The aim of this study in all-comers was to evaluate the impact of
symptomatic peripheral arterial disease on 1- and 2-year clinical outcome
after coronary stenting. Method(s): Patient-level data from four
large-scale randomised coronary drug-eluting stent trials in all-comers
(TWENTE (clinicaltrials. gov: NCT01066650), DUTCH PEERS (NCT01331707),
BIO-RESORT (NCT01674803), and BIONYX (NCT02508714)) were pooled to
evaluate the impact of symptomatic peripheral arterial disease on clinical
outcome after coronary stenting. Peripheral arterial disease was defined
as a history (by anamnesis or medical record) of an obstructive arterial
lesion, resulting from atherosclerosis in peripheral locations including
the lower and upper extremities, carotid or vertebral arteries, and
mesenteric or renal arteries. Main clinical endpoint was target vessel
failure, a composite of cardiac death, target vessel related myocardial
infarction, or clinically indicated target vessel revascularisation.
 Result(s): Of all 9,204 trial participants, 695 (7.6%) had
symptomatic peripheral arterial disease. These patients were older and had
a higher cardiovascular risk profile, including a higher prevalence of
diabetes, renal failure, hypertension, hypercholesterolemia, and prior
stroke. At 1-year followup, patients with peripheral arterial disease
showed significantly higher event rates of some endpoints. At 2-year
follow-up, patients with peripheral arterial disease showed significantly
higher rates of various clinical endpoints, including mortality (7.1% vs.
3.0%, p<0.001), myocardial infarction (4.8% vs. 3.4%, p0.04), repeated
revascularisation (6.7% vs 4.5%, p<0.04), and major adverse cardiac events
(14.6% vs. 8.3%, p<0.001, Figure 1). After multivariate adjustment for
confounders, symptomatic peripheral arterial disease was found to be
independently associated with the 2-year risks of target vessel and lesion
failure, major adverse cardiac events, and all-cause death (p<0.02, for
all, Table 1). Conclusion(s): Obstructive coronary artery disease
with concomitant symptomatic peripheral arterial disease resulted in
higher cardiovascular risk profiles and higher rates of all-cause
mortality and various composite clinical endpoints during the first two
years of follow-up after coronary stenting. Knowledge of these findings
allows to identify patients with an increased short- and medium-term
adverse event risk after percutaneous coronary intervention, which is
useful for both Heart Team and informed consent discussions. (Figure
Presented).

<57>
Accession Number
641006583
Title
The music therapy effectiveness in hypertensive patients with acute
myocardial infarction after previous coronary artery bypass surgery;
18-year experience of the MUSIC study.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2197), 2022. Date of Publication: September 2022.
Author
Mitrovic P.; Paladin A.; Radovanovic M.; Radovanovic N.; Rajic D.; Matic
G.; Jozic T.; Dizdarevic I.; Jankovic J.; Radovanovic M.N.
Institution
(Mitrovic, Radovanovic, Radovanovic) Clinical center of Serbia and School
of Medicine, University of Belgrade, Department of Emergency Cardiology,
Belgrade, Serbia
(Paladin) Serbian National Broadcasting Agency, Belgrade, Serbia
(Rajic, Matic, Jozic, Dizdarevic, Jankovic, Radovanovic) Clinical center
of Serbia, Department of Emergency Cardiology, Cardiology Clinic,
Belgrade, Serbia
Publisher
European Respiratory Society
Abstract
Patients who have clinical evidence of hypertension (HT) after coronary
artery bypass surgery (CABS) have a poor prognosis in expression of acute
myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can
produce an increase in sympathetic nervous system activity leading to an
increase in cardiac workload. The purpose of this study was to evaluate
the effectiveness of music therapy on prognosis of patients with HT and
AMI, after CABS. Method(s): 314 patients (males 78.4%, mean age
59.8+/-1.2 yrs) with AMI after previous CABS have been selected from the
patients consecutively submitted from January 2003 to January 2019. HT was
registered in 166 (53.0%) pts with AMI after previous CABS. All patients
with HT were randomized and divided in 2 groups: Study group of 83
patients treated with music therapy and Control group of 83 patients with
no music therapy. Each patient in study group underwent two sessions of
medical therapy (12 minutes) in a day. Both groups were similar in
baselines, post-AMI characteristics and post-AMI medical therapy. The
plasma cytokine and catecholamine were measured in both groups.
 Result(s): In the Study group, heart rate was significantly decreased
by music therapy (p=0.0196). In the Control group, there were no
significant changes in heart rate. Among cytokines (p=0.0160), plasma
interleukin- 6 (IL-6) (p=0.0179) in the Study group was significantly
lower than those in the Control group, as well as plasma adrenaline
(p=0.0162) and noradrenalin (p=0.0218) levels. Conclusion(s): This
study provides support for the use of musical therapy in patients with HT
and AMI after previous CABS. The positive effects of music therapy, in
these patients, are probably because of enhanced of parasympathetic
activities and reduction of plasma cytokine and catecholamine levels.

<58>
Accession Number
641006534
Title
Performance assessment of unfractionated heparin protocol in pediatric
patients supported on extracorporeal membrane oxygenation.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2696), 2022. Date of Publication: September 2022.
Author
Shorog E.; Aljazairi A.; Aljasser R.; Owaidah T.; Al-Mehizia R.; Adalaty
H.; Alhashim S.
Institution
(Shorog) King Faisal Specialist Hospital and Research Centre, King Khalid
University, Riyadh, Abha, Saudi Arabia
(Aljazairi, Aljasser, Owaidah, Al-Mehizia, Adalaty, Alhashim) King Faisal
Specialist Hospital and Research Centre, Pharmaceutical Care Division,
Riyadh, Saudi Arabia
Publisher
European Respiratory Society
Abstract
Background: Using extracorporeal membrane oxygenation in critical care
setting is evolving. Unfractionated heparin is the most commonly used
anticoagulant and a well-designed protocol is needed. However, there is no
consensus from any organization regarding standard protocol. We developed
UFH protocol taking into consideration best available evidence and
anecdotal ECMO data. This study aims to assess ability of current protocol
to achieve anti-Xa assay therapeutic target. Method(s): Prospective
cohort, single-arm study conducted in Pediatric Cardiac Surgery Intensive
Care Unit. Twenty patients were required. Anti- Xa assay therapeutic range
is 0.1-0.3 U/mL for bleeding and 0.3-0.7 U/mL for non-bleeding patients.
The protocol was developed after comprehensive literature review and
continuous strict review process by a multidisciplinary ECMO team. It
identifies initial UFH infusion dosing and subsequent adjustment,
frequency of monitoring Anti-Xa assay, and other laboratory parameters. To
ensure protocol adherence, teaching sessions were provided. Finally, we
explored survival to discharge rate. The study was approved by the Office
of Research Affairs with verbal consent. Result(s): Twenty patients
were included, half of them were female. Mean age of 35 months +/- SD 52.5
and mean weight of 5.7 kg +/- SD 3.8-14.1. Mean estimated glomerular
filtration rate using schwartz equation was 80 mL/min/1.73 m2 +/- SD 34.7.
Main indications of ECMO use were failure to wean after surgery (45%).
Median ECMO duration was 6 days+ (IQR: 4.5-7.5). Baseline Anti-Xa assay
before cannulation was 0.1 IU/mL. Another important baseline laboratory
value was antithrombin III, the mean was 21.1 +/- SD 14.3. Selection of
bleeding protocol is based on a set of criteria in the bleeding section
(Appendix 1). Pre-canulation heparin bolus of 50-100 units/kg was given if
ACT is <300 seconds for 11 patients (55%). Holding unfractionated heparin
was required in 8 patients (40). Median time UFH was on-hold 13.5 hours
(IQR: 10.5-27.5). Achieving Anti-Xa assay therapeutic target thorough out
study period was reported in 70% of patients. Median time to achieve
target was 41 hours (IQR: 0-91.5) and maintained for 8 hours (IQR: 0-22).
Hemorrhagic complications were reported in 8 patients (40%) while
thrombotic complications in 5 patients (25%). Both peripheral cannulation
site bleeding and gastrointestinal bleeding occurred in 5%. Surgical
exploration was needed in 6 patients (30%). Median time to first
replacement was 80.5 hours (IQR: 19.5- 228.5). Median hospital length of
stay was 37 + IQR: 43-22 with survival rate at discharge of 75%.
 Conclusion(s): Implemented UFH protocol in pediatric ECMO failed to
achieve target in early hours after cannulation. However, the majority of
those critically ill patients achieved Anti-Xa assay target and maintained
it after the third day until day ten. Thromboembolic, hemorrhagic
complications, and survival rates were consistent with the reported data.

<59>
Accession Number
641006518
Title
Ten years survival benefit of CABG or PCI based on individual prediction.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2043), 2022. Date of Publication: September 2022.
Author
Serruys P.W.; Gao C.; Ninomiya K.; Hara H.; Garg S.; Onuma Y.; Kappetein
A.P.; Mohr F.W.; Mack M.
Institution
(Serruys, Gao, Ninomiya, Hara, Onuma) National University of Ireland,
Galway, Ireland
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Kappetein) Erasmus University Medical Centre, Rotterdam, Netherlands
(Mohr) Heart Center of Leipzig, Leipzig, Germany
(Mack) Baylor Scott and White The Heart Hospital, Plano, United States
Publisher
European Respiratory Society
Abstract
Background: To compare the observed and individual predicted mortalities
according to the SYNTAX score II 2020 (SSII-2020) in the all-comers SYNTAX
population, and retrospectively assess the appropriateness of
revascularization with percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG) in patients with three vessel
disease (3VD) and/or left main disease (LMCAD). Method(s): Internal
and external validation of the SSII-2020 to predict 10- year all-cause
death was performed in the respective randomized and registry SYNTAX
populations. Differences in individual predicted mortalities following
CABG or PCI were ranked and displayed with the observed mortalities. The
proportions of screened patients deriving a survival benefit from CABG or
PCI were determined retrospectively. Result(s): A total of 2602
participants (as-treated population) were included in the randomized and
registry cohorts. In the randomized cohort, all-cause mortality at 10
years, as an average treatment effect, was 23.8% (199/865) with CABG and
28.6% (249/901) with PCI, with a differential survival benefit of 4.6%
(95% CI: 0.58% to 8.7%, log-rank p value=0.023). In the CABG and PCI
registries, mortalities were 27.8% (167/644) and 55.4% (99/192),
respectively. Calibration and discrimination of the SSII-2020 was helpful
in CABG and PCI patients in the randomized and registry cohorts. In the
PCI registry, the SSII-2020 underestimated mortality since specific
comorbidities that entail high mortality are not included in the formula
(C-index: 0.72, intercept: 0.38, slope: 0.66), whilst in the CABG
registry, it predicted mortality with a helpful calibration and
discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The
proportions of patients with a predicted survival benefit following CABG
and PCI were respectively 78.3% (1383/1766) and 21.7% (383/1766) in the
randomized cohort, and 82.4% (2143/2602) and 17.7% (459/2602) in the whole
SYNTAX trial population. Conclusion(s): In the randomized and
registry cohort of this all-comers population with 3VD and/or LMCAD, there
was reasonable agreement between the individual predicted and observed
mortalities after CABG or PCI, such that the predicted 10-year survival
benefit might be helpful in determining the appropriateness of each
modality of revascularization. (Figure Presented).

<60>
Accession Number
641006383
Title
Total arterial revascularization is associated with long-term survival
benefit in coronary artery bypass grafting: Systematic review with
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2139), 2022. Date of Publication: September 2022.
Author
Ren J.; Royse A.; Tian D.; Royse C.; Boggett S.; Bellomo R.; Gaudino M.;
Fremes S.
Institution
(Ren, Royse, Royse, Boggett, Bellomo) University of Melbourne, Melbourne,
Australia
(Tian) University of Sydney, Sydney, Australia
(Gaudino) Weill Cornell Medicine,We, New York, United States
(Fremes) Sunnybrook Health Sciences Centre, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Importance: Total arterial revascularization (TAR), the complete avoidance
of saphenous vein grafting (SVG) in coronary artery bypass grafting
(CABG), is advocated based on the superior conduit durability and
resistance against atherosclerosis. However, the low adoption rate of TAR
indicates a high level of controversy. Objective(s): To compare
long-term survival between TAR and conventional CABG involving SVG. Data
sources: A comprehensive literature search was conducted through digital
databases including MEDLINE, Embase, and Cochrane Central Register of
Controlled Trials from the inception to May 2021. Study selection: The
inclusion criteria were randomized clinical trials, or propensity-score
balanced or multivariable-adjusted observational studies with a sample
size of at least 100 patients in each arm, isolated CABG, comparing TAR
(SVG=0) vs. non-TAR (SVG>=1), and inclusion of all-cause mortality. Data
extraction and synthesis: Two reviewers performed independent extraction
following Preferred Reporting Items for Systematic Reviews and
Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) and 95%
confidence intervals (CI) were estimated with random-effect and
fixedeffect models using generic inverse variance weighting. Individual
patient time-to-event data were reconstructed to create an overall
Kaplan-Meier survival function for matched studies. Sensitivity analyses
were performed according to the risk of bias, matching status, and source
of HR. Main Outcomes and Measures: The primary endpoint was all-cause
mortality. Result(s): A total of 23 studies (100,314 patients), all
with a retrospective observational design, were identified. The weighted
mean follow-up time was 8.8 years post-operatively. Total arterial
revascularization was associated with greater freedom from all-cause
mortality than non-TAR (HR, 0.77, 95% CI, 0.71 to 0.84, p<0.001). There
was evidence of low heterogeneity (I2=45%) across studies. Low
publication bias was observed. Leave-oneout influence analysis and
sensitivity analyses produced consistent results. Cochrane Collaboration
signaling domains showed no critical risk of bias. Conclusions and
relevance: This meta-analysis found superior late survival associated with
total arterial revascularization. Further randomized clinical trials are
needed.

<61>
Accession Number
641006372
Title
The impact of statin on post-operative atrial fibrillation after discharge
from cardiac surgery: Secondary analysis of the SEARCH-AF CardioLink-1
randomized trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2342), 2022. Date of Publication: September 2022.
Author
Hibibo M.; Verma S.; Pandey A.; Quan A.; Verma A.; Bisleri G.; Ha A.;
Mazer C.D.
Institution
(Hibibo, Verma, Pandey, Quan, Bisleri, Mazer) St. Michael's Hospital,
Cardiac surgery, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Ha) UHN-University of Toronto, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Background: There is conflicting evidence regarding the use of statins to
reduce the risk of post-operative atrial fibrillation (POAF) in patients
undergoing cardiac surgery. Purpose(s):We sought to determine the
effects of statin use on the burden of new-onset post-discharge POAF in
the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial
Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial.
 Method(s): In the SEARCH-AF trial, 336 patients with risk factors for
stroke (CHA2DS2-VASc score >=2) and no history of preoperative AF were
randomized to usual care or continuous cardiac rhythm monitoring for 30
days after discharge from cardiac surgery with a wearable, patched-based
device. The primary endpoint was the occurrence of cumulative atrial
fibrillation/ flutter (AF/AFL) lasting for >=6 minutes detected by
continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram
within 30 days of randomization. Using time-to-event analysis and Cox
regression, we evaluated the association between the risk of
post-operative AF in relation to statin use and dosing intensity (low,
moderate, high) at the time of discharge. We excluded patients who
experienced post-operative AF during hospitalization in this analysis.
 Result(s): In the overall cohort (n=336), 260 (77.4%) patients were
treated with statins at the time of hospital discharge. There were 18
(5.4%) patients who experienced post-operative AF during hospitalization.
Patients prescribed with statins were more likely to be male (p=0.018),
had lower CHA2DS2-VASc scores (p=0.011), and were more likely to undergo
isolated coronary artery bypass grafting (CABG) (p=0.083). Baseline
characteristics were otherwise similar between the 2 groups. Patients
treated with statins at discharge had a 2-fold lower rate of
post-operative AF than those who were not treated with statins in the
overall cohort (17.6% vs. 8.2%, Log-Rank p=0.017) and among those who were
randomized to continuous cardiac rhythm monitoring (31.6% vs. 16.0%,
Log-Rank p=0.027) (Figure). After adjusting for surgery type (CABG vs.
valve surgery) and the CHA2DS2-VASc score, statin use at discharge was
associated with a lower risk of post-operative AF within 30 days after
surgery (hazard ratio 0.48, 95% CI 0.24-0.97). Furthermore, increasing
intensity of statin therapy was associated with lower risk of POAF
(ptrend=0.0012) (Figure 1) Conclusion(s): Among cardiac surgery
patients with risk factors for stroke and no history of pre-operative AF,
the use of statins was associated with a reduction in post-operative AF
risk within 30 days of discharge. The routine use of high-intensity statin
to prevent post-operative AF after cardiac surgery deserves further study.

<62>
Accession Number
641006359
Title
Comparison of the safety and efficacy of antithrombotic regimens following
TAVR in patients without having an indication for chronic oral
anticoagulation.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2090), 2022. Date of Publication: September 2022.
Author
Guedeney P.; Roule V.; Mesnier J.; Chapelle C.; Portal J.J.; Laporte S.;
Ollier E.; Zeitouni M.; Kerneis M.; Barthelemy O.; Sorrentino S.; Silvain
J.; Vicaut E.; Montalescot G.; Collet J.P.
Institution
(Guedeney, Zeitouni, Kerneis, Barthelemy, Silvain, Montalescot, Collet)
Hospital Pitie-Salpetriere, Paris, France
(Roule) University Hospital of Caen, Department of Cardiology, Caen,
France
(Mesnier) Bichat Hospital, University Paris-Diderot, INSERM-UMR1148,FACT
French Alliance for Cardiovascular T, Paris, France
(Chapelle, Laporte, Ollier) University Hospital of Saint-Etienne, Unite de
Recherche Clinique Innovation et Pharmacologie, Saint-Etienne, France
(Portal, Vicaut) Lariboisiere APHP Site of Saint Louis University
Hospital, Unite de Recherche Clinique, Paris, France
(Sorrentino) Magna Graecia University of Catanzaro, Cardiology, Catanzaro,
Italy
Publisher
European Respiratory Society
Abstract
Aims: To compare the safety and efficacy of antithrombotic regimens
following transcatheter aortic valve replacement (TAVR) in patients
without having an indication for chronic oral anticoagulation Methods
and Results: We conducted a Prospero-registered systematic review and
network meta-analysis of randomized controlled trials evaluating post-TAVR
antithrombotic regimens up to March 2021. We estimated the relative risk
and 95% confidence intervals using a fixed effect model in a frequentist
pairwise and network metanalytic approach. We included 6 studies
comprising of 3,777 patients with a mean weighted follow-up of 13.3
months. Single antiplatelet therapy (SAPT) was associated with a
significant reduction of life-threatening, disabling, or major bleeding
compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95%
confidence interval [CI]: 0.28-0.69), apixaban (RR: 0.47, 95% CI
0.26-0.84) and lowdose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI:
0.16-0.57). Risk of all-cause death was significantly reduced with DAPT
compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI:
0.41-0.88) and a consistent reduction was observed with SAPT and DAPT
compared to apixaban (RR: 0.60, 95% CI: 0.31-1.16 and RR: 0.58, 95% CI:
0.32-1.04, respectively). There were no differences between the various
regimens with respect to myocardial infarction and stroke. Apixaban
significantly reduced the risk of pulmonary embolism, valve thrombosis and
grade 3 or 4 reduced leaflet motion. Conclusion(s): Following TAVR in
patients without an indication for chronic oral anticoagulant, SAPT was
associated with the lowest risk of bleeding compared to DAPT and direct
oral anticoagulant-based regimens without significant ischemic offset.
(Figure Presented).

<63>
Accession Number
641006322
Title
Outcomes following acute myocardial injury and type 2 myocardial
infarction in patients with and without coronary artery disease.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1149), 2022. Date of Publication: September 2022.
Author
Taggart C.; Gard A.; Bularga A.; Wereski R.; Kimenai D.; Chapman A.R.;
Lindahl B.; Mills N.L.; Eggers K.
Institution
(Taggart, Bularga, Wereski, Kimenai, Chapman, Mills) University of
Edinburgh, Edinburgh, United Kingdom
(Gard, Lindahl, Eggers) Uppsala University, Uppsala, Sweden
Publisher
European Respiratory Society
Abstract
Background: Acute myocardial injury and type 2 myocardial infarction
typically occur in the setting of a concurrent illness. Differentiating
acute myocardial injury from type 2 myocardial infarction is challenging
as it relies on the assessment of myocardial ischaemia. Indeed, some have
questioned whether this distinction is important, as patients with both
conditions are at increased risk of future cardiovascular events. Whether
this risk is similar and the role of identifying those with coronary
artery disease is uncertain. Purpose(s): To determine whether future
risk of cardiovascular events and death differs in patients with type 2
myocardial infarction and acute myocardial injury according to the
presence or absence of prior coronary artery disease. Method(s): We
conducted a secondary analysis of a multi-centre randomised controlled
trial of 48,282 consecutive patients with suspected acute coronary
syndrome. Patients with an adjudicated index diagnosis of acute myocardial
injury and type 2 myocardial infarction were stratified according to
whether they were known previously to have coronary artery disease defined
as prior coronary revascularisation, myocardial infarction, or angina.
Cardiovascular death or myocardial infarction adjusted for the competing
risk of non-cardiovascular death and all-cause death at one year was
compared. Result(s): In 9,115 patients with elevated cardiac troponin
concentrations, 1,676 (18%) and 1,121 (12%) had acute myocardial injury
and type 2 myocardial infarction, respectively. Patients with either
condition known to have coronary artery disease were older (mean [standard
deviation] age 78 [11] versus 73 [16] years) and more likely to be female
(55% versus 45%) than those with no prior history. Coronary artery disease
was previously identified in 40% (454/1,121) and 30% (509/1,167) of those
with type 2 myocardial infarction and acute myocardial injury,
respectively. Cardiovascular death or myocardial infarction at one year
was more common in patients known to have coronary artery disease than
those without for both acute myocardial injury (23% [115/509]) versus 14%
[158/1,167]; P<0.001) and type 2 myocardial infarction (20% [91/454]
versus 10% [69/667]; logrank P<0.001) (Figure 1). Similarly all-cause
death at one year was higher in patients with known coronary artery
disease for both acute myocardial injury (31% [357/1,167] versus 18%
[123/667]; P<0.001) and type 2 myocardial infarction (40% [115/509] versus
30% [135/454]; P<0.001) (Figure 2). Conclusion(s): Coronary artery
disease is recognised in around one third of patients with acute
myocardial injury and type 2 myocardial infarction and is associated with
higher rates of cardiovascular events and all-cause death. Risk doubled in
those with coronary artery disease and was similar whether the index
diagnosis was myocardial injury or infarction, suggesting that coronary
investigation and secondary prevention may have a role in both conditions.

<64>
Accession Number
641006300
Title
Long-term toxicity of radiosurgery for ablation of ventricular
tachycardia.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 701), 2022. Date of Publication: September 2022.
Author
Cvek J.; Peichel P.; Knybel L.; Jiravsky O.; Sramko M.; Hecko J.; Neuwirth
R.; Plasek J.; Kautzner J.
Institution
(Cvek) University Hospital Ostrava, Oncology, Ostrava, Czechia
(Peichel, Sramko, Kautzner) Institute for Clinical and Experimental
Medicine (IKEM), Prague, Czechia
(Knybel, Plasek) University Hospital Ostrava, Ostrava, Czechia
(Jiravsky, Hecko, Neuwirth) Hospital Podlesi, Cardiology, Trinec, Czechia
Publisher
European Respiratory Society
Abstract
Introduction: There is a rising interest in using radiosurgery to modify
arrhythmogenic substrate in patients with recurrent VT. However, data on
the safety are still inadequate. Purpose(s): This is update of
toxicity evaluation based on the compilation from our case series, NIRA-VT
and STAR-VT. Method(s): Between 2014 and March 2021, 36 patients (33
male, 3 females; mean age 66+/-10 years) with structural heart disease
(ischemic cardiopathy, dilated cardiopathy or fibroma associated scar)
from two electrophysiology centers in the Czech Republic (Trinec, Prague)
underwent radiosurgery for recurrent VT. Radiosurgery was performed after
at least one failed catheter ablation for VT. The critical part of the VT
substrate was identified by electroanatomic mapping using a combination of
voltage mapping, pace mapping, and activation mapping; and it was marked
on a contrast-enhanced computer tomography study as a CTV. In NIRA-VT
trial, CTV included scar based on PET/CT evaluation. Radiosurgery system
with real-time motion tracking using the tip of the electrode of an
indwelling defibrillator as a fiducial marker was used. A total radiation
dose of 25 Gy was delivered to the ablation target in a single session
during free breathing. Radiation-induced toxicity was evaluated according
to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
Only patients with follow up longer than 6 months were included in long
term radiation related side effects evaluation. Result(s): The mean
CTV and PTV were 26+/-11 ml and 41+/-22 ml respectively. No patient
exhibited acute (up to 3 months) elevation of troponin, pericardial
effusion, or a decrease in left ventricular ejection fraction from
baseline. Four patients developed acute mild nausea, which waned after
antiemetic drugs. Long-term radiation related side effects were evaluated
in 19 patients. Two patients (11%) presented radiological signs of lung
fibrosis in small area in close distance from PTV. There was no
significant decrease in left ventricular ejection fraction during follow
up. Six patients (33%) gradually developed significant progression of
known mitral regurgitation after SBRT, two (11%) of them had to undergo
mitral valve replacement (grade 4 toxicity). Two cases of esophagitis
(12%) were seen with one radiation toxicity related death (grade 5
toxicity) due to the unresectable esophagi-pericardial fistula (6%).
 Conclusion(s): Our data indicate the feasibility of radiosurgery,
majority of patients presented no/mild radiation related toxicity and
decrease of VT burden. However, we have seen three cases of grade 4,5
toxicity. To further investigate long-term safety and efficacy of
radiosuergery for VT, enrolling into a randomized prospective study is in
progress.

<65>
Accession Number
641006284
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
with stenting for multivessel coronary artery disease without left main
coronary disease:reconstructed individual patient data.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1416), 2022. Date of Publication: September 2022.
Author
Chew N.W.S.; Ng C.H.; Xiao J.L.; Chan K.H.; Loh P.H.; Low A.; Lee C.H.;
Tan H.C.; Chan M.Y.
Institution
(Chew, Chan, Loh, Low, Lee, Tan, Chan) National University Heart Centre,
Singapore, Singapore
(Ng, Xiao) National University of Singapore, Singapore, Singapore
Publisher
European Respiratory Society
Abstract
Background and aims: Data are emerging on 10-year mortality comparing
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) with stenting for multivessel disease (MVD) without
left main (LM) involvement. We conducted an updated two-stage metaanalysis
using reconstructed individual patient data to compare long-term mortality
between CABG and PCI for patients with MVD without significant LM coronary
disease. Method(s): Medline and Embase databases were searched for
articles comparing CABG with PCI for MVD. A two-stage meta-analysis was
conducted using reconstructed patient level survival data for all-cause
mortality with subgroups by SYNTAX score. The shared-frailty and
stratified Cox models were fitted to compare survival endpoints.
 Result(s): We screened 1496 studies and included six randomized
controlled trials with 7181 patients. PCI was associated with greater
10-year all-cause mortality risk (HR: 1.282, CI: 1.118-1.469, p<0.001)
compared with CABG. In patients with low SYNTAX score, 10-year all-cause
mortality after PCI was comparable to CABG (HR: 1.102, 0.822-1.479,
p=0.516). However, in patients with moderate to high SYNTAX score, 10-year
allcause mortality was significantly higher after PCI compared with CABG
(HR: 1.444, 1.122-1.858, p<0.001; HR: 1.856, 1.380-2.497, p<0.001
respectively). Conclusion(s): This updated reconstructed individual
patient-data metaanalysis revealed a sustained lower cumulative all-cause
mortality of CABG over PCI for multivessel disease without LM involvement.
(Figure Presented).

<66>
Accession Number
641006227
Title
Reconstructed meta-analysis of percutaneous coronary intervention versus
coronary artery bypass grafting for left main disease.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1415), 2022. Date of Publication: September 2022.
Author
Chew N.W.S.; Ng C.H.; Kong G.; Tan D.; Lim W.H.; Kofidis T.; Yip J.; Loh
P.H.; Chan K.H.; Low A.; Lee C.H.; Yeo T.C.; Tan H.C.; Chan M.Y.
Institution
(Chew, Kofidis, Yip, Loh, Chan, Low, Lee, Yeo, Tan, Chan) National
University Heart Centre, Singapore, Singapore
(Ng, Kong, Tan, Lim) National University of Singapore, Singapore,
Singapore
Publisher
European Respiratory Society
Abstract
Background: Randomized controlled trials (RCTs) comparing percutaneous
coronary intervention (PCI) with drug-eluting stents and coronary artery
bypass grafting (CABG) for patients with left main coronary artery disease
(LMCAD) have reported conflicting results. Objective(s): We performed
a systematic review from inception to 23 May 2021 and one-stage
reconstructed individual-patient data meta-analysis (IPDMA) that included
10-year mortality outcomes. Method(s): The primary outcome was
10-year all-cause mortality. Secondary outcomes included myocardial
infarction (MI), stroke and unplanned revascularization at 5 years. We did
IPDMA using published Kaplan-Meier curves to provide individual data
points in coordinates and numbers at risk were used to increase the
calibration accuracy of the reconstructed data. Shared frailty model or,
when proportionality assumptions were not met, a restricted mean survival
time model were fitted to compare outcomes between treatment groups.
 Result(s): Of 583 articles retrieved, 5 RCTs were included. A total
of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297)
or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and
CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925- 1.292;
p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI:
0.992-1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998- 1.013,
p=0.133) at 5 years. Unplanned revascularization was more frequent
following PCI compared with CABG (HR 1.807, 95% CI: 1.524- 2.144, p<0.001)
at 5 years. Conclusion(s): This meta-analysis using reconstructed
participant-level time-to-event data showed no statistically significant
difference in cumulative 10-year all-cause mortality between PCI versus
CABG in the treatment of LMCAD. (Figure Presented).

<67>
Accession Number
641006165
Title
Dual versus single antiplatelet therapy after transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2087), 2022. Date of Publication: September 2022.
Author
Eikelboom R.; Qiu Y.; Kim K.; Whitlock R.; Belley-Cote E.
Institution
(Eikelboom, Qiu, Kim) McMaster University, Hamilton, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
Canada
Publisher
European Respiratory Society
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is the
intervention of choice for patients with severe symptomatic aortic
stenosis who have high or intermediate surgical risk. TAVR valves are at
risk of thrombosis and serious sequelae including stroke, peripheral
embolism, and valve dysfunction requiring intervention. The optimal method
of antithrombotic therapy to reduce risk of thrombosis with an acceptable
increase in risk of bleeding is uncertain. Objective(s): This
systematic review and meta-analysis assesses the effects of dual
antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) on
mortality, thrombosis and bleeding in patients undergoing TAVR.
 Method(s): We systematically searched EMBASE, MEDLINE and CENTRAL
from January 1, 2002 until February 9, 2021 for randomized trials
comparing DAPT to SAPT after TAVR. Two reviewers independently screened
titles and abstracts, and then the full text of potentially relevant
articles in duplicate. Data abstraction and risk of bias was also
performed in duplicate. Risk ratios and 95% confidence intervals were
pooled using the Mantel-Haenzel method and random effects modelling. We
assessed the certainty of the evidence for each outcome using the Grading
of Recommendations, Assessments, Development and Evaluation (GRADE)
approach. Result(s): We included 4 randomized controlled trials of
1086 patients. Risk of bias was low or somewhat concerning for all
studies. We found no difference in mortality (risk ratio (RR) 1.02, 95%
confidence interval (CI), 0.63 to 1.63) or stroke (RR 1.03, 95% CI
0.57-1.84), but a significant increase in major bleeding (RR 2.04, 95% CI,
1.31-3.19), with DAPT compared to SAPT. There were too few events to
conduct meta-analysis for clinical valve thrombosis, subclinical valve
thrombosis, transvalvular gradients on echocardiography, or aortic valve
reintervention. The certainty of the evidence was low or very low due to
risk of bias, inconsistency, and imprecision. Conclusion(s): There is
very low certainty evidence that DAPT has little to no effect compared to
SAPT on mortality and stroke. There is low certainty evidence that DAPT
likely causes more major bleeding than SAPT.

<68>
Accession Number
641006147
Title
Midodrine in treatment of post coronary revascularization vasoplagia;
pilot, open label, assessor blinded randomized clinical trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1098), 2022. Date of Publication: September 2022.
Author
Sheikhy A.; Ziaoddini M.; Navid H.; Ahmadi-Tafti H.; Hosseini K.
Institution
(Sheikhy, Ziaoddini, Navid, Ahmadi-Tafti, Hosseini) Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
European Respiratory Society
Abstract
Purpose: Post cardiac surgery hypotension and inotrope dependence are
among major causes of prolonged intensive care unit (ICU) stay. Besides
routine managements, catecholamine inotrope-vasopressors are the
traditional treatment. However, there is an increasing interest to
catecholaminesparing agents, such as Midodrine, oral alfa1 agonist, in
patients with vasoplegia. Up to now there are no randomized study with
midodrine on post cardiac surgery patients. Material(s) and
Method(s): In this pilot, open label, assessor blind, randomized clinical
trial from June 2020 to December 2021, 65 patients with refractory (more
than 24 hours inotropes) hypotension after coronary revascularization were
included. Patients were randomly assigned to receive Midodrine add-on
therapy (10 mg stat and 5 mg po every 12 hours) or placebo addon routine
treatment. The primary outcome was liberation time from IV
inotrope-support. Secondary outcomes were ICU admission time and total
vasopressor dosage after randomization. Result(s): 32 patients
enrolled in Midodrine group, with a mean age of 60.72, and 33 patients
received placebo with mean age of 63.27. Median liberation time from
inotrope was 27 hours in Midodrine group and 49 hours in placebo group
(p=0.022). ICU admission time for Midodrine and placebo groups were 115
and 121 hours, respectively (p=0.990). Total vasopressor dosage after
randomization were similar in two studied groups, 4352 mug in Midodrine
group and 5637 mug in placebo group (p=0.405). No adverse event was
observed in Midodrine group. Conclusion(s): Midodrine add-on inotrope
therapy was a safe medication with appropriate compliance in ICU admitted
patients after cardiac surgery, which seems to decrease the inotrope
dependent time.

<69>
Accession Number
641006070
Title
Clinical impact of peri-device leaks following percutaneous left atrial
appendage occlusion: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2135), 2022. Date of Publication: September 2022.
Author
Samaras A.; Papazoglou A.; Balomenakis C.; Bekiaridou A.; Moysidis D.;
Patsiou V.; Orfanidis A.; Feidakis A.; Giannakoulas G.; Tzikas A.
Institution
(Samaras, Papazoglou, Balomenakis, Bekiaridou, Moysidis, Patsiou,
Orfanidis, Feidakis, Giannakoulas, Tzikas) Ahepa University Hospital,
Cardiology Department, Thessaloniki, Greece
Publisher
European Respiratory Society
Abstract
Background: Peri-device leaks (PDL) are quite common after left-atrial
appendage occlusion (LAAO) given the complex anatomy of LAA and
surrounding structures. However, there is uncertainty regarding the
prognostic implications of PDL. Material(s) and Method(s): Literature
search was conducted in MEDLINE (PubMed), EMBASE, Scopus by ELSEVIER and
Cochrane Central Register of Controlled Trials (CENTRAL) databases until
12 October 2021. A random-effects meta-analysis was performed to assess
the effect of PDL presence on thromboembolism, all-cause mortality and
major bleeding occurrence. Sensitivity analyses accounted for: I. the
combined AF ablation performance, ii. the anticoagulation strategy
followed after LAAO, iii. mean PDL size, and iv. mean female percentage.
 Result(s): Of 699 articles initially retrieved, 46 were deemed
eligible for this analysis (9,184 AF patients undergoing LAAO out of whom
1,446 had PDL). PDL presence was significantly associated with elevated
odds of thromboembolism (FIgure 1) [pooled odds ratio (pOR) 3.05, 95%
confidence interval (CI) 1.94-4.81; I2=37%]; yet PDL was not
significantly linked with mortality (pOR=0.86, 95% CI: 0.25-2.95;
I2=69%) and major bleeding rates (0.95, 95% CI: 0.27-3.35;
I2=72%). AF-ablation did not significantly interact with the
prognostic impact of PDL when performed in conjunction with LAAO (p for
subgroup= 0.17). Antiplatelet discharge medication affected the prognostic
value of PDL (p for subgroup <0.01 and =0.04, respectively). The
prognostic significance of mean PDL size [periprocedural or at 1-3 months
or D(mean size)/D(time of follow-up)] on the risk of thromboembolism did
not yield any significant association (p values >0.05). Meta-regression
analysis of the mean female percentage demonstrated a non-significant
trend towards a positive linear correlation between female percentage and
risk of thromboembolism (p=0.10) (FIgure 2). Conclusion(s): This is
the first meta-analysis on the prognostic impact of PDL after LAAO. The
findings highlighted a significant association between PDL and
thromboembolic events, warranting careful post-LAAO device surveillance.
(Figure Presented).

<70>
Accession Number
641006048
Title
Prognostic value of left ventricular global longitudinal strain in
patients with severe aortic stenosis for transcatheter aortic valve
implantation-related morbidity and mortality: A meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2085), 2022. Date of Publication: September 2022.
Author
Stens N.A.; Van Iersel O.; Rooijakkers M.J.P.; Van Wely M.H.; Nijveldt R.;
Bakker E.A.; Van Royen N.; Thijssen D.H.J.
Institution
(Stens, Van Iersel, Rooijakkers, Van Wely, Nijveldt, Bakker, Van Royen,
Thijssen) Radboud University Medical Centre, Nijmegen, Netherlands
Publisher
European Respiratory Society
Abstract
Aims: Current methods, including left ventricular ejection fraction
(LVEF), demonstrate limited prognostic value for post-Transcatheter Aortic
Valve Implantation (TAVI) outcomes. Studies elaborating on LV global
longitudinal strain (GLS) showed promising results, but are often
underpowered. Purpose(s): This meta-analysis aims to evaluate the
prognostic value of preprocedural global longitudinal strain (GLS) for
post-TAVI mortality and morbidity. Method(s): A systematic search was
conducted in PubMed, Embase and Web of Science from 2001 to 2021. All
studies that comprised patients with severe aortic stenosis who underwent
TAVI and investigated the association between preprocedural
speckle-tracking-derived GLS and clinical outcomes, were included. An
inversely-weighted random effects metaanalysis was adopted to investigate
the association between preprocedural GLS vs primary (i.e. all-cause
mortality) and secondary (i.e. major cardiovascular events [MACE])
post-TAVI outcomes. Result(s): Of the 1,057 identified records, 12
were eligible, all of which had a low-to-moderate risk of bias
(Newcastle-Ottawa scale). On average, the 2,068 unique patients
demonstrated preserved ejection fraction but impaired longitudinal
function (mean LVEF 52.2+/-4.4%, GLS -13.5+/-1.6%). Patients with a lower
GLS had a higher all-cause mortality (pooled hazard ratio (HR) 1.99 [95%
confidence interval (CI): 1.59, 2.50]) and MACE (1.26 [95% CI: 1.08,
1.46]) risk compared to patients with higher GLS. In addition, each 1%
decrease of GLS was associated with an increased postprocedural mortality
(HR 1.06 [95% CI: 1.03, 1.08]) and MACE risk (pooled HR 1.08 [95% CI:
1.01, 1.15]). Conclusion(s): Preprocedural GLS was significantly
associated with post- TAVI mortality and morbidity. This suggests a
potential clinically important role of pre-TAVI evaluation of GLS for risk
stratification of patients with severe aortic stenosis. (Figure
Presented).

<71>
Accession Number
641005855
Title
Impact of left ventricular ejection fraction on 10-year mortality after
percutaneous coronary intervention or coronary artery bypass grafting.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2033), 2022. Date of Publication: September 2022.
Author
Masuda S.; Ninomiya K.; Kageyama S.; Kotoku N.; Mack M.J.; Kappetein A.P.;
Morice M.C.; Onuma Y.; Serruys P.W.
Institution
(Masuda, Ninomiya, Kageyama, Kotoku, Onuma, Serruys) National University
of Ireland, Galway, Ireland
(Mack) Baylor University Medical Center, Dallas, United States
(Kappetein) Erasmus University Rotterdam, Rotterdam, Netherlands
(Morice) Jacques Cartier Private Hospital, Massy, France
Publisher
European Respiratory Society
Abstract
Backgrounds: The impact on vital prognosis at very long-term of
percutaneous coronary intervention (PCI) and coronary artery bypass
grafting (CABG) in patients with reduced ejection fraction (EF) remains to
be elucidated. Objective(s): To investigate the impact of left
ventricular ejection fraction (LVEF) on 10-year mortality after PCI and
CABG in the SYNTAX trial. Method(s): In the SYNTAXES study, 1,800
randomized patients were categorized into three groups according to the
current guidelines; (1) reduced EF (rEF; LVEF <=40%), (2) mildly reduced
EF (mrEF; LVEF 41-49%), (3) preserved EF (pEF; LVEF >=50%). The primary
endpoint was 10-year allcause mortality. Event rate up to 10 years was
estimated according to the Kaplan-Meier method, and the log-rank test was
performed to examine the differences among LVEF subgroups. The SYNTAX
score 2020 (SS-2020) was compared between the patients with reduced (LVEF
<50%) and preserved EF (LVEF >=50%) in order to better refine their
respective personalized vital prognosis and assess in cross-validation the
value of the risk score. Result(s): The population was stratified as
rEF (n=168), mrEF (n=179), and pEF (n=1453). Ten-year all-cause mortality
were 44.0% vs. 31.8% vs. 22.6% (P<0.001), in patients with rEF, mrEF and
pEF, respectively. The significant interaction was not identified between
LVEF classification and treatment (P interaction = 0.183). In patients
with rEF, there was a tendency toward higher mortality in PCI group than
CABG (52.9% vs 39.6%, P=0.054), and no significant differences in patients
with mrEF (36.0% vs. 28.6%, P=0.273) and pEF (23.9% vs. 22.2%, P=0.275).
According to the SS-2020, PCI was a relatively safe modality of
revascularization in 37.8% of the patients with reduced EF (LVEF <50%). In
the population with preserved EF (LVEF >=50%), the proportion of patients
eligible to PCI with predicted equipoise in mortality with CABG was 57.5%.
 Conclusion(s): LVEF could an important factor for determining the
revascularization treatment in patients presenting with complex coronary
artery disease. Calculation of individualized 10-year prognosis using the
SS-2020 may be a viable option in decision-making. (Figure Presented).

<72>
Accession Number
641005794
Title
Association of late gadolinium enhancement in cardiac magnetic resonance
with heart failure outcomes in patients with non-ischemic cardiomyopathy.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 286), 2022. Date of Publication: September 2022.
Author
Tao M.; Al-Sadawi M.; Aslam F.; Mann N.; Goldschmidt M.; Tam E.
Institution
(Tao, Al-Sadawi, Aslam, Mann, Goldschmidt, Tam) Stony Brook University
Hospital, Stony Brook, United States
Publisher
European Respiratory Society
Abstract
Background: Late-gadolinium enhancement (LGE) in cardiac magnetic
resonance (CMR) has been found to be associated with increased mortality
in patients with non-ischemic cardiomyopathy (NICM). The correlation
between LGE and heart failure (HF) hospitalization, referral for heart
transplant, and ejection fraction (EF) improvement have not been well
established. Purpose(s): This meta-analysis assessed the relationship
between LGE in CMR with HF hospitalization, referral for heart transplant
and EF improvement in patients with NICM. Method(s): We searched the
databases for studies reporting the association between LGE in CMR for
NICM and HF outcomes including Ovid MEDLINE, EMBASE, Web of Science, and
Google Scholar for all studies. The search was not restricted to time or
publication status. The minimal follow up duration is one year.
 Result(s): A total of 216 studies resulted from the literature
search. A total of 25 studies and 3,039 patients (1,265 with LGE vs 1,774
without LGE) were included; mean follow up is around 33 months (ranging
between 13 to 71 months). Our analysis demonstrated that LGE in NICM was
associated with increased risk of HF hospitalization (odds ratio 3.38, 95%
confidence interval 2.27-5.04; P<0.01), referral for transplant (odds
ratio 5.08, 95% confidence interval 2.49-10.35; P<0.01), and lower chance
for EF improvement (odds ratio 0.16, 95% confidence interval 0.03-0.85; P
0.03). Heterogeneity is moderate: chi2=49.5, df=21 (P=0.001),
I2=57%. (Figures 1 and 2) Conclusion(s): Our results
suggest that LGE is associated with increased risk of HF hospitalization
and referral for heart transplant and lower chance for EF improvement in
long-term follow up.

<73>
Accession Number
641005729
Title
The influence of rivaroxaban compared to vitamin K antagonist treatment
upon development of cardiovascular calcification the IRIVASC-trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 185), 2022. Date of Publication: September 2022.
Author
Stoehr R.; Marx N.; Schuh A.; Brandenburg V.
Institution
(Stoehr, Marx) RWTH University Hospital Aachen, Internal Medicine I,
Cardiology, Pulmonology and Vascular Medicine, Aachen, Germany
(Schuh) St Katharinen KH, Innere I, Frechen, Germany
(Brandenburg) Rhein-Maas Clinic, Wurselen, Germany
Publisher
European Respiratory Society
Abstract
Vitamin K antagonists (VKA) such as warfarin or phenprocoumon are the
mainstay of therapy for patients with several specific indications for
longterm oral anticoagulant therapy (OAT). Due to interferences with
Matrix-Gla protein, an important vitamin K-dependent local calcification
inhibitor in cardiovascular structures, VKAs are theoretically linked to
the development of increased cardiovascular calcification (CVC). The
IRIVASC trial was a multi-center, prospective, controlled, open,
randomized, interventional clinical trial and included 192 patients with
atrial fibrillation or pulmonary embolism and an indication for oral
anticoagulation >12 months. In short, patients with an indication for OAT
were randomized to receive either Rivaroxaban (n=96) or VKA (n=96) and
followed up over 12 months. MultiSlice CT (MSCT) was performed at baseline
and after 12-month follow up. The primary endpoint of the study was the
progression of coronary artery and aortic valve (AV) calcification, as
determined by MSCT (volume score). Baseline demographic and laboratory
values were comparable between the VKA and the Rivaroxaban groups (median
age 72 vs 68, 73.6 vs 69.9 male). The main indication for anticoagulation
was AF (95.4% vs 96.6%) After 12-month follow-up complete data sets were
available for 164 patients (86%) for coronary calcification and 67
patients for valvular calcification (per protocol analysis). Overall, we
found no differences in the primary endpoints. Development of coronary
artery calcification was similar within the 2 groups as evidenced by
similar developments of the coronary agatston score (804.8+/-1062.3 vs
946.7+/-1024.4, p=0.38), the coronary volume score (571.9+/-855.6 ml vs
791.7+/-820.1 ml, p=0.359) and the coronary mass score (143.2+/-195.9 mg
vs. 172.2+/-190.8 mg, p=0.335) after 12 month. Similarly, there was no
difference in the development of aortic valve calcification (AV) (AV
Agatston score 441.6+/-711.9 vs. 352.6+/-751.2, p=0.621. AV volume score
388.2+/-589.0 ml vs 354.3+/-654.3, ml p=0.824 and AV Mass Score
75.7+/-135.1 mg vs 60.2+/-122.9, p=0.626 mg) (Table 1). To our knowledge
this is the first multicenter prospective, randomized trial to ever
investigate the effects of VKA vs rivaroxaban treatment regarding the
development of coronary and valvular calcification. Our findings are
clinically relevant as VKA will remain the mainstay of treatment for
several conditions including mechanical valve replacement or
antiphospholipid syndrome and hence include patients at cardiovascular
risk. Our data point towards a comparable risk of overt CVC progression as
detectable by CT-scans in patients irrespective of VKA or NOAK treatment.

<74>
Accession Number
641005706
Title
Systolic blood pressure time in range and long-term clinical outcomes in
patients with ischaemic cardiomyopathy.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 838), 2022. Date of Publication: September 2022.
Author
Zhou Z.; Fu G.; Jian B.; Liang M.; Chen G.; Wu Z.
Institution
(Zhou, Fu, Jian, Liang, Chen, Wu) First Affiliated Hospital of Sun Yat-sen
University, Department of Cardiac Surgery, Guangzhou, China
Publisher
European Respiratory Society
Abstract
Background: The relationship between systolic blood pressure (SBP) control
and long-term clinical outcomes in patients with ischaemic cardiomyopathy
remains unclear. It has been previously reported that either too high or
too low SBP may lead to a poorer prognosis. But current SBP control
metrics may not take into account the possible effects of fluctuating SBP
overtime on patients. Purpose(s): This study aimed to estimate the
association between time in range (TIR) of SBP and long-term clinical
outcomes in patients with ischaemic cardiomyopathy. Method(s): This
study was a post-hoc analysis of The Surgical Treatment of Ischaemic Heart
Failure (STICH) trial, a randomized controlled trial with two hypotheses
that enrolled participants with coronary artery disease and left
ventricular ejection fraction <=35%. The SBP target range of the TIR was
defined as 110 to 130 mmHg and the SBP TIR was calculated by linear
interpolation method. Patients were equally divided into four groups by
quartiles of TIR. Multivariable-adjusted Cox proportional hazards
regression models were constructed to compare the effects of different
levels of TIR on a 10-year prognosis. The primary outcome was all-cause
mortality. Subgroup analyses were performed according to whether patients
were assigned to coronary artery bypass grafting (CABG) or medical therapy
(MED), and in populations with different baseline SBP. Result(s): A
total of 1194 eligible patients were included according to the purpose of
our study. Compared with patients in the quartile 4 group (TIR
77.87-100%), the fully adjusted hazard ratios (aHRs) and 95% confidence
intervals (CIs) of all-cause mortality were 1.32 (0.98-1.78) for quartile
3 group (TIR 54.81-77.63%), 1.40 (1.03-1.90) for quartile 2 group (TIR
32.59-54.67%), and 1.53 (1.14-2.04) for quartile 1 group (TIR 0-32.56%) (P
for trend = 0.005). When evaluated TIR as a continuous variable, per 1-SD
decrement (29.28%) in TIR significantly increased the incidence of
all-cause mortality [1.15 (1.04-1.26)]. Similarly, the decrement in TIR
significantly elevated the risk of cardiovascular (CV) mortality and the
risk of all-cause mortality plus CV rehospitalization. Consistent results
were also observed in subgroup analyses of either CABG or MED, or
different baseline SBP, indicating the robustness of our findings.
 Conclusion(s): This study suggested that in patients with ischaemic
cardiomyopathy, a higher SBP TIR was significantly associated with a
decreased risk of all-cause mortality, CV mortality and the composite of
allcause mortality plus CV rehospitalization, regardless of whether the
patient received CABG or MED, and the level of baseline SBP. Our findings
support that TIR might be a substitutable metric of SBP control for
long-term clinical outcomes in patients with ischaemic cardiomyopathy.

<75>
Accession Number
641005652
Title
Severe early-onset cardiomyopathy and poor prognosis observed in 73
patients with pathogenic KLHL24 variants.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 887), 2022. Date of Publication: September 2022.
Author
Vermeer M.; Arevalo Gomez K.F.; Hoes M.F.; Tromp J.; Verdonschot J.A.J.;
Henkens M.T.H.M.; Sillje H.H.W.; Bolling M.C.; Van Der Meer P.
Institution
(Vermeer, Arevalo Gomez, Sillje, Van Der Meer) University Medical Center
Groningen, Department of Cardiology, Groningen, Netherlands
(Hoes, Henkens) Maastricht University Medical Centre (MUMC), Cardiology,
Maastricht, Netherlands
(Tromp) Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
(Verdonschot) Maastricht University Medical Centre (MUMC), Clinical
Genetics, Maastricht, Netherlands
(Bolling) University Medical Center Groningen, Department of Dermatology,
Groningen, Netherlands
Publisher
European Respiratory Society
Abstract
Background/Introduction: Pathogenic variants in KLHL24 might cause skin
fragility or cardiomyopathy. KLHL24 controls desmin turnover and patients
with heterozygous gain-of-function variants (HET-GOF; i.e. overactivity),
typically born with epidermolysis bullosa simplex (EBS), can develop
dilated cardiomyopathy (DCM), whereas patients with homozygous
lossof-function variants (HOM-LOF) can develop hypertrophic cardiomyopathy
(HCM). Purpose(s): This study aims to characterize the cardiac
phenotype and prognosis of patients with pathogenic KLHL24 variants.
 Method(s): Observational studies on KLHL24 found in PUBMED were
included in this analysis. Patients were stratified according to their
genotype and the study outcomes were cardiomyopathy diagnosis and
cardiovascular (CV) events. CV events were defined as sudden cardiac death
(SCD), death from heart failure (HF) or heart transplantation (HTx).
Kaplan-Meier (KM) curves were constructed to visualize the age at
diagnosis and CV event free-survival. For the HET-GOF group, this analysis
was stratified by sex and log-rank testing was used to test for
significant differences in the distribution. To achieve between group
balance, the sex-stratified KM curves were weighted for age and cohort.
 Result(s): In total, 73 patients from 14 studies were included in
this analysis and Figure 1A shows their geographic distribution. In
general, patients have a median age [IQR] of 18 [7-33]), 53% were men, 38%
were diagnosed with cardiomyopathy, and 84% were patients with HETGOF
variants. Patients with HOM-LOF variants have a median age of 27 [26-31]
and 55% is male (Figure 1B). HOM-LOF variants c.917G>A [p.(Arg306His)] and
c.1048G>T [p.(Glu350*)] segregated in 2 Middle Eastern families, reporting
11 patients born from seemingly unaffected consanguineous heterozygous
parents. All HOM-LOF patients were diagnosed with HCM before the age of 32
(27, [26-31]; Figure 1C), resulting in 4 CV events (SCD n=3; HTx n=1;
Figure 1D). Patients with HET-GOF variants have a median age of 14 [6-33]
and 53% were men (Figure 1B). HETGOF variants c.1A>G, c.1A>T, c.2T>C,
c.3G>T, c.3G>A and c.22A>T [p.(Val2-Met29)] segregated with disease in 34
families, reporting 62 patients in 14 countries. All patients with HET-GOF
had EBS at birth and 27% was diagnosed with DCM. The probability of
diagnosis during lifetime was significantly different (p<0.001, weighted
p<0.001) between men (25 [16- 34], n=9) and women (45 [31-47], n=8; Figure
1E). In total, 7 CV events (SCD n=1; HF n=4; HTx n=2) were reported for
patients with HET-GOF variants. Figure 1F shows the general differences in
CV events between sexes (p=0.026, weighted p=0.073). The median age of CV
events for men was 20 (n=4) and 54 for women (n=3). Conclusion(s):
Patients with HOM-LOF variants were diagnosed at an early age with a
severe form of HCM. Men with HET-GOF variants were diagnosed with DCM
earlier than women. Men also have a higher probability for CV events at a
younger age than women.

<76>
Accession Number
641005651
Title
Geographic disparity in 10-year mortality after coronary artery
revascularization in the SYNTAXES trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2030), 2022. Date of Publication: September 2022.
Author
Kageyama S.; Serruys P.W.; Masuda S.; Ninomiya K.; Kotoku N.; Onuma Y.
Institution
(Kageyama, Serruys, Masuda, Ninomiya, Kotoku, Onuma) National University
of Ireland Galway, Galway, Ireland
Publisher
European Respiratory Society
Abstract
Aims: To investigate geographic disparity in long-term mortality following
revascularization in patients with complex coronary artery disease (CAD).
 Methods and Results: The SYNTAXES trial randomized 1800 patients with
three-vessel and/or left main CAD to percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) and assessed their
survival at 10-years. Patients were stratified according to the region of
recruitment: North America (N-A, n=245), Eastern Europe (E-E: Poland,
Hungary, Czech, n=189), Northern Europe (N-E: United Kingdom, Sweden,
Norway, Latvia, Finland, and Denmark, n=425), Southern Europe (S-E: Spain,
Portugal, and Italy, n=263), andWestern Europe (W-E: Netherlands, Germany,
France, Belgium, and Austria, n=678), which also served as the reference
group. Compared to W-E, patients were younger in E-E (62 vs 65 years,
p<0.001), and less frequently male in N-A (65.3% vs 79.6%, p<0.001).
Diabetes (16.0% vs 25.4%, p<0.001) and peripheral vascular disease (6.8%
vs 10.9%, p=0.025) were less frequent in N-E than W-E. Ejection fraction
was highest in W-E (62% vs 56%, p<0.001). Compared to W-E, the mean
anatomic SYNTAX score was higher in S-E (29 vs 31, p=0.008) and lower in
N-A (26, p<0.001). Crude ten-year mortality was similar in N-A (31.6%),
and W-E (30.7%), and significantly lower in E-E (22.5%, p=0.041), N-E
(21.9%, p=0.003) and S-E (22.0%, p=0.014) as presented in left-middle
lower of the graphical abstract.We adjusted the survival curves by
following factors based on previous report; age, sex, medically treated
diabetes, current smokers, peripheral vascular disease, chronic
obstructive pulmonary disease, chronic kidney disease, left ventricular
ejection fraction, disease type, and anatomical SYNTAX score [1]. When the
differences in baseline characteristics were adjusted, mortality was still
significantly lower in NE (HR 0.85, 95% CI [0.74-0.97], p=0.019) and
trended lower in S-E (HR 0.72 95% CI [0.52-0.99] p=0.043) compared to W-E
(right middle-lower of the graphical abstract). However, no significant
interaction (P interaction = 0.728) between region and modality of
revascularization was seen. Discussion and conclusions: The main findings
of this study are: 1. Rates of crude 10-year mortality were significantly
lower in E-E, N-E, and S-E compared to W-E and N-A. 2. The differences in
10-year mortality remained significantly lower with N-E and S-E even after
adjustment for confounding factors. 3. However, when comparing PCI to CABG
in the five geographic regions, there were no statistically significant
interactions between the geographic disparity in pre- and peri-procedural
characteristics and all-cause mortality. In the era of globalization,
knowledge and understanding of geographic disparity are of paramount
importance for the correct interpretation of global studies. (Figure
Presented).

<77>
Accession Number
641005591
Title
Quantitative angiographic assessment of aortic regurgitation post 11
different types of TAVI devices a multicentre pooled analysis of 2665
valves.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2078), 2022. Date of Publication: September 2022.
Author
Abdelshafy M.; Soliman O.; Kim W.; Ruck A.; Elkoumy A.; Elzomor H.; Wang
R.; Tao L.; Garg S.; Mylotte D.; Onuma Y.; Serruys P.
Institution
(Abdelshafy, Soliman, Elkoumy, Elzomor, Mylotte, Onuma, Serruys) National
University of Ireland, Galway, Ireland
(Kim) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Ruck) Karolinska Institute, Stockholm, Sweden
(Wang, Tao) Xijing Hospital of the Fourth Military Medical University,
Xi'an, China
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: Regurgitation following TAVR impacts all-cause mortality. So
far, no quantitative comparison of regurgitation by the same core lab has
been performed among the various commercially available transcatheter
heart valves (THV) We aimed to compare quantitative angiographic aortic
regurgitation (AR) of 11 different types of THVs. Method(s): This is
a multicentre retrospective corelab pooled analysis of aortograms from
2704 consecutive patients treated with 11 different THV devices. Analysis
was done by quantitative videodensitometric aortography (LVOT-AR), which
is an objective, accurate, and reproducible tool for assessment of AR
following TAVR. This method relies on time density changes in contrast
medium after injection in the ascending aorta and its regurgitation (and
subsequent density increase) in the LVOT. The ratio between the areas
under the two-time density curves of these regions quantifies the AR in
absolute percentage. The valves evaluated include ACURATE neo2 (n=120),
Lotus (n=546), Myval (n=108), VitaFlow (n=105), Evolut PRO (n=95), SAPIEN
3 (n=397), Evolut R (n=295), SAPIEN XT (n=239), ACURATE neo (n=120),
Venus-A (n=113) and CoreValve (n=532). Stratification of continuous
variable regurgitation into categorical variables was performed according
to the following pre-determined threshold criteria: 1) none/trace
regurgitation (LVOT-AR<6%); 2) mild (6%<= LVOT-AR <=17%); and 3) moderate
or severe (LVOT-AR >17%). Result(s): The addition of anti PVR sealing
features to the new generations ACURATE neo2 THV proved to be effective in
reduction the incidence of significant PVR In comparison with the first
generation ACURATE neo. Myval, VitaFlow and Venus-A THVs are showing
promising results. Although the incidence of moderate/severe AR has
regressed over time with new generations of THVs, the incidence of mild AR
is still prominent with all THVs still exhibiting mild AR with an
incidence ranging between 30% and 50% with the exception of the Lotus
valve that had an 19% incidence of mild AR Conclusion(s): ACURATE
neo2 had the lowest severe/moderate percentage of AR showing significant
improvements in comparison to ACURATE neo. Myval, VitaFlow and Venus-A are
promising options in the THV armamentarium. These results should be
confirmed in prospective randomized, head-to-head comparisons between
THVs. (Figure Presented).

<78>
Accession Number
641005405
Title
Left atrial appendage occlusion versus standard of care in patients with
atrial fibrillation and a prior thrombo-embolic event despite oral
anticoagulant therapy: A propensity score matched comparison.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 632), 2022. Date of Publication: September 2022.
Author
Maarse M.; Seiffge D.; Fierro N.; Tondo C.; Pracon R.; De Backer O.;
Nielsen-Kudsk J.; Estevez-Loureiro R.; Benito-Gonzalez T.; Nombela-Franco
L.; Arzamendi D.; Alla V.; Swaans M.; Werring D.; Boersma L.
Institution
(Maarse, Swaans, Boersma) St Antonius Hospital, Nieuwegein, Netherlands
(Seiffge) Bern University Hospital, Inselspital, Neurology, Bern,
Switzerland
(Fierro) San Raffaele Hospital, Cardiology, Milan, Italy
(Tondo) Centro cardiologico Monzino, Cardiology, Milan, Italy
(Pracon) National Institute of Cardiology, Cardiology, Warsaw, Poland
(De Backer) Rigshospitalet - Copenhagen University Hospital, Cardiology,
Copenhagen, Denmark
(Nielsen-Kudsk) Aarhus University Hospital, Cardiology, Aarhus, Denmark
(Estevez-Loureiro) University Hospital Complex of Vigo, Cardiology, Vigo,
Spain
(Benito-Gonzalez) Leon Hospital (University Assistance Complex of Leon),
Cardiology, Leon, Spain
(Nombela-Franco) Hospital Clinico San Carlos, Cardiology, Madrid, Spain
(Arzamendi) Centro Medico Teknon, Cardiology, Barcelona, Spain
(Alla) Creighton University Medical Centre, Cardiology, Omaha, United
States
(Werring) University College London, Neurology, London, United Kingdom
Publisher
European Respiratory Society
Abstract
Introduction: Patients with atrial fibrillation (AF) that suffer from
ischemic stroke despite oral anticoagulant (OAC) therapy have a very high
risk of recurrent stroke and better prevention strategies are needed. Left
atrial appendage occlusion (LAAO) is a promising secondary prevention
strategy that may provide mechanical protection in patients that suffer
from thrombo-embolic events under OAC. However, evidence showing
effectiveness of LAAO in this population is scarce and the current
international guidelines only consider LAAO in patients with a
contra-indication for OAC. Purpose(s): To compare percutaneous LAAO
to standard-of-care including continuing/switching anticoagulation therapy
for secondary stroke prevention in patients with AF and a prior
thrombo-embolic event and/or LAA thrombus under OAC therapy.
 Method(s): The STR-OAC LAAO cohort is an international collaboration
combining a selection of patients from multiple LAAO registries (22
participating centers). Patients that underwent percutaneous LAAO because
of a thrombo-embolic event and/or LAA thrombus on OAC were included.
Propensity score matching (optimal matching method, 1:1 ratio) with a
previously published multi-center dataset of patients continuing/switching
anticoagulation treatment after a thrombo-embolic event was performed to
adjust for imbalances in age, sex, hypertension, diabetes mellitus and
CHA2DS2-VASc score. The primary outcome was ischemic stroke. Time-to-event
analysis was performed with Kaplan-Meier curves and Coxproportional-
hazard regression analyses. Result(s): A total of 404 patients
underwent LAAO between 2010-2021 and were included in the STR-OAC LAAO
cohort. Mean age was 72+/-9 years; 44% was female and mean CHA2DS2-VASc
and HAS-BLED score were 4.8+/-1.7 and 2.5+/-1.4, respectively. Most
patients received a Watchman or Amplatzer device (53% and 43%). Oral
anticoagulation was discontinued after LAAO at discharge or after
confirmation of adequate LAA closure at 1-3 months follow-up in 44% or
20%, respectively. The remaining 35% of patients continued OAC after LAAO
as an adjunctive strategy. All LAAO patients were propensity-score matched
and included in the primary outcome analysis. Baseline characteristics
were well balanced after matching (Table 1). During follow up including
1406 patient-years (LAAO 1007; control 399) a total of 61 patients
experienced an ischemic stroke: 2.2% per patient-year in LAAO group versus
9.8% per patient-year in the control group. LAAO was associated with a
significantly lower risk of ischemic stroke (HR 0.33, 95% CI [0.19-0.59],
p<0.001) compared to standard-of-care (Figure 1). Conclusion(s): In
this propensity-score matched study, LAAO was associated with a lower risk
of ischemic stroke compared to standard-of-care in patients with a
thrombo-embolic event and/or LAA thrombus despite OAC treatment.
Randomized controlled trial data may further confirm the effectiveness of
LAAO in this very high-risk population.

<79>
Accession Number
641005297
Title
Perioperative rosuvastatin therapy increases creatine kinase and the risk
of acute kidney injury in patients undergoing cardiac surgery.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2675), 2022. Date of Publication: September 2022.
Author
Wijesurendra R.; Sardell R.; Hill M.; Jayaram R.; Samuel N.; Staplin N.;
Emberson J.; Collins R.; Zheng Z.; Haynes R.; Casadei B.
Institution
(Wijesurendra, Sardell, Hill, Samuel, Staplin, Emberson, Collins, Haynes)
University of Oxford, Nuffield Department of Population Health, Oxford,
United Kingdom
(Jayaram, Casadei) University of Oxford, Division of Cardiovascular
Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
(Zheng) Fuwai Hospital, Beijing, China
Publisher
European Respiratory Society
Abstract
Introduction: In patients undergoing cardiac surgery, perioperative statin
therapy does not prevent atrial fibrillation or myocardial injury, but
results in increased creatinine levels after surgery. Here we investigated
the incidence of acute kidney injury (AKI) in 1922 patients scheduled for
elective cardiac surgery who were randomized to perioperative rosuvastatin
(20 mg once daily) or placebo in the Statin Therapy In Cardiac Surgery
(STICS) trial. Method(s): AKI post-surgery was defined according to
international guidelines using plasma creatinine. Biomarkers related to
kidney function, muscle injury and inflammation were investigated,
including cystatin C, total creatine kinase (CK), troponin I, growth
differentiation factor 15 (GDF-15), interleukin-6 (IL-6), procalcitonin,
and placental growth factor (PGF). Result(s): At 48 hours
post-surgery, AKI was significantly more common in patients allocated to
rosuvastatin compared to placebo when defined by creatinine (24.7% vs
19.3%; OR 1.37 [95% CI 1.10-1.70]; p=0.005; Figure 1A) or by cystatin C
(9.2% vs 5.1%; OR 1.86 [95% CI 1.29-2.67]; p<0.001; Figure 1B). Elevations
in CK to >10x and >40x baseline level were also more frequent in
rosuvastatin-allocated patients compared to placebo (30.9% vs 26.5%,
p=0.02, and 2.1% vs 0.7%, p=0.02, respectively; Figure 1C). Post-operative
concentrations of troponin I, GDF-15, IL-6, procalcitonin, and PGF were
similar between the groups (Table 1). Conclusion(s): Perioperative
rosuvastatin initiation increased the absolute risk of AKI after cardiac
surgery by 4-5%. Rosuvastatin also led to greater elevations in
post-operative creatine kinase, but did not affect other biomarkers of
tissue injury, inflammation, and myocardial injury. Further research is
needed to delineate the underlying mechanism of AKI with perioperative
rosuvastatin. (Table Presented).

<80>
Accession Number
641005285
Title
Ventricular arrhythmias and sudden cardiac death caused by mitral valve
prolapse: Should we operate and when.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1647), 2022. Date of Publication: September 2022.
Author
Cameron J.; Sutherland N.; Han H.C.; Raman J.; Lim H.
Institution
(Cameron, Han) Austin Hospital, Cardiology, Melbourne, Australia
(Sutherland) Northern Health, Cardiology, Melbourne, Australia
(Raman, Lim) University of Melbourne, Medicine, Melbourne, Australia
Publisher
European Respiratory Society
Abstract
Background: Several autopsy and observational studies have investigated
the link between mitral valve prolapse (MVP) and sudden cardiac death
(SCD) due to the well accepted yet rare occurrence of complex ventricular
arrhythmia (VA) in this cohort. Few studies however have investigated
whether arrhythmia burden and more importantly SCD are reduced following
surgical correction of MVP. Purpose(s): To investigate the impact of
mitral valve surgery (MVS) (replacement or repair) on VA and SCD in
patients with MVP. Method(s): A systematic review of the current
literature was conducted using an electronic search of the PubMed database
in October 2021. Studies were included if subjects had undergone mitral
valve (MV) repair or replacement with documented rates of arrythmias/SCD
pre- and postintervention. Small patient numbers in individual reports
precluded formal meta-analysis and results were reported on a per study
basis. Result(s): 19 identified studies (10 cohort studies, nine case
studies) comprised 1322 patients with a pooled mean age of 63.4 years and
38.9% were female. 748 of the 1322 patients underwent MVS: 263 MV repair,
18 MV replacement (one with leaflet and papillary muscle excision), two MV
repair with Maze procedure, 177 percutaneous transcatheter MV repair, 45
annuloplasty with or without valve repair, and in 243 cases the surgical
method was not specified. Of the 10 included cohort studies, seven of the
eight which investigated rates of VA post MVS concluded there was a
significant reduction, while one reported the predisposition to arrythmia
persisted after relieving the abnormal mechanical effects of non-ischaemic
MR (75% due to MVP). One study reported a reduction in SCD post MVS. Each
of the nine included case studies showed a reduction in VA post MVS. One
study showed mitral annular disjunction (MAD) was independently associated
with a higher risk of arrhythmic events, this link persisting with time
dependent MVS although reduced compared to medical management.
 Conclusion(s): The underlying mechanisms for VA and SCD associated
with MVP are not completely understood, and guidelines for the surgical
correction of MVP based on arrhythmic and SCD risk are lacking. This
systematic review illustrates a possible reduction in VA following MVS.
Further identification of patients at risk of SCD, and potential use of
risk stratification algorithms, would allow for consideration of earlier
management and appropriate use of implantable cardioverter-defibrillators
(ICD) placement / MVS with an expected survival benefit.

<81>
Accession Number
641005270
Title
Recurrent atherosclerotic cardiovascular disease events preventable with
guideline recommended lipid-lowering treatment following myocardial
infarction.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2374), 2022. Date of Publication: September 2022.
Author
Sakhuja S.; Bittner V.A.; Brown T.M.; Farkouh M.E.; Levitan E.B.; Rosenson
R.; Safford M.M.; Muntner P.; Chen L.; Sun R.; Noshad S.; Dhalwani N.;
Woodward M.; Colantonio L.D.
Institution
(Sakhuja, Levitan, Muntner, Chen, Sun, Colantonio) University of Alabama
Birmingham, School of Public Health, Birmingham, United States
(Bittner, Brown) University of Alabama Birmingham, Department of Medicine,
Division of Cardiovascular Disease, Birmingham, United States
(Farkouh) University of Toronto, Toronto, Canada
(Rosenson) Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New
York, United States
(Safford) Weill Cornell Medicine, New York, United States
(Noshad, Dhalwani) Amgen Inc., Thousand Oaks, United States
(Woodward) Imperial College London, George Institute for Global Health,
London, United Kingdom
Publisher
European Respiratory Society
Abstract
Background: The 2018 American Heart Association/American College of
Cardiology (AHA/ACC) cholesterol guideline provides recommendations for
lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein
convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent
atherosclerotic cardiovascular disease (ASCVD) events in adults with
established ASCVD. Many adults with ASCVD who are recommended to take
statins, ezetimibe and/or PCSK9i do not receive these medications.
 Purpose(s): To estimate the number of recurrent ASCVD events
potentially prevented by population-wide use of guideline recommended LLT
following a myocardial infarction (MI). Method(s): We simulated the
population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline
recommended LLT over 3 and 5 years among US adults with government health
insurance through Medicare or commercial health insurance following
hospital discharge for MI. We used data from patients with an MI
hospitalization in 2018-2019 to estimate the percentage receiving
guideline recommended LLT defined by having the medications available to
take in the 30 days after their discharge date. We used data from patients
with an MI hospitalization in 2013-2016 to estimate the 3 and 5-year
cumulative incidence of recurrent ASCVD events (i.e., MI, coronary
revascularization or ischemic stroke). The reduction in ASCVD events
associated with guideline recommended LLT was estimated from a
meta-analysis by the Cholesterol-Lowering Treatment Trialists
Collaboration. We conducted a sensitivity analysis estimating the number
and percentage of ASCVD events prevented if LLT recommendations from the
2019 European Society of Cardiology/European Atherosclerosis Society
(ESC/EAS) cholesterol guideline were followed. We repeated all analyses
with recurrent coronary heart disease (i.e., MI or coronary
revascularization) and ischemic stroke events as separate outcomes.
 Result(s): Among 279,395 adults with an MI hospitalization in
2018-2019 (mean age 75 years, 54% men, mean low-density lipoprotein
cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With
current lipid-lowering medication use, we estimated that 70,698 (95% CI:
70,311- 71,077) and 89,255 (95% CI: 88,841-89,730) ASCVD events would
occur in 3 and 5 years, respectively, after MI hospital discharge (Table,
top panel). If all patients were to receive 2018 AHA/ACC guideline
recommended LLT, the number of ASCVD events was estimated to be reduced by
21.6%, representing 15,264 (95% CI: 14,451-16,679) events prevented over 3
years and 19,271 (95% CI: 18,245-21,055) events prevented over 5 years. A
higher number of recurrent ASCVD events were estimated to be averted
following the LLT recommendations of the 2019 ESC/EAS cholesterol
guideline (Table, bottom panel). Conclusion(s): Population-wide
implementation of guideline recommended LLT in adults with an MI
hospitalization could prevent a substantial number of recurrent ASCVD
events.

<82>
Accession Number
641005206
Title
Revascularization of significant coronary artery disease in patients
undergoing transcatheter aortic valve implantation: A systematic review
and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1597), 2022. Date of Publication: September 2022.
Author
Aarts H.; Van Hemert N.D.; Meijs T.A.; Van Nieuwkerk A.C.; Voskuil M.;
Delewi R.
Institution
(Aarts, Van Hemert, Meijs, Voskuil) University Medical Center Utrecht,
Cardiology, Utrecht, Netherlands
(Van Nieuwkerk, Delewi) Amsterdam University Medical Center, Cardiology,
Amsterdam, Netherlands
Publisher
European Respiratory Society
Abstract
Background: The prevalence of coronary artery disease (CAD) in patients
with severe aortic valve stenosis undergoing transcatheter aortic valve
implantation (TAVI) is high. However, the importance of a percutaneous
coronary intervention (PCI) prior to TAVI has been matter of debate.
Importantly, patients undergoing TAVI are characterized by high age often
accompanied by highly calcified coronary arteries, increasing the risk of
severe periprocedural complications. Moreover, patients with a severe
aortic valve stenosis are limited in their ability to compensate for these
lifethreatening complications. Together with the necessity of dual
antiplatelet therapy after PCI, this may explain a possible negative
effect of PCI in this patient population. However, there is still
insufficient evidence regarding the importance of PCI in patients
undergoing TAVI. Purpose(s): The aim of this systematic review and
meta-analysis was to assess the need for PCI in patients with significant
CAD undergoing TAVI. Method(s): A systematic search was conducted to
identify studies comparing optimal medical treatment only versus PCI in
patients with significant CAD undergoing TAVI. Endpoints were all-cause
mortality, cardiac death, stroke, myocardial infarction, and major
bleeding which were assessed at 30 days, one year, and beyond one year
following TAVI. Result(s): A total of 14 studies was included in this
meta-analysis, including 3838 patients of which 1806 patients (47.1%)
underwent PCI before TAVI. All-cause mortality was not significantly
different between optimal medical treatment only and PCI at 30 days (OR:
1.27; 95% CI, 0.91-1.77; p=0.17; I2=0%), at one year (OR: 0.91;
95% CI, 0.64-1.29; p=0.59; I2=45%), and beyond one year (OR
0.68; 95% CI, 0.42-1.08; p=0.10; I2=49%). Cardiac death and
myocardial infarction was similar across the groups at 30 days (OR cardiac
death: 1.94; 95% CI, 0.36-10.56; p=0.45; I2=28%; OR myocardial
infarction: 0.50; 95% CI, 0.13-1.91; p=0.31; I2=0%), and at one
year (OR cardiac death: 0.77; 95% CI, 0.19-3.13; p=0.72;
I2=84%; OR myocardial infarction: 0.74; 95% CI, 0.21-2.66;
p=0.64; I2=18%). Stroke did not significantly differ between
PCI and optimal medical treatment groups at 30 days (OR: 0.77; 95% CI,
0.31-1.92; p=0.57; I2=0%). However, patients that underwent
TAVI without preceding PCI had significantly lower risk of major bleeding
at 30 days (OR: 0.66; 95% CI, 0.46-0.94; p=0.022; I2=0%).
 Conclusion(s): This systematic review and meta-analysis showed no
significant differences in clinical outcomes between patients with and
without PCI prior to TAVI at both short- and long-term follow-up, apart
from a higher risk of major bleeding within 30 days in patients undergoing
PCI before TAVI.

<83>
Accession Number
641005204
Title
Clinical factors affecting survival in patients with D-transposition of
the great arteries after atrial switch repair: A meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 680), 2022. Date of Publication: September 2022.
Author
Nartowicz S.; Jakielska E.; Cieplucha A.; Ratajczak P.; Grajek S.N.;
Lesiak M.; Trojnarska O.
Institution
(Nartowicz, Jakielska) Poznan University of Medical Sciences, Poznan,
Poland
(Cieplucha, Grajek, Lesiak, Trojnarska) Poznan University of Medical
Sciences, Department of Cardiology, Poznan, Poland
(Ratajczak) Poznan University of Medical Sciences, Department of
Pharmacoeconomics and Social Pharmacy, Poznan, Poland
Publisher
European Respiratory Society
Abstract
Background: Atrial switch repair (AtrSR) was the initial method of
operation in patients with D-transposition of the great arteries (D-TGA)
constituting the right ventricle as a systemic one. Currently, it has been
replaced with arterial switch operation (ASO), but the cohort of adults
after AtrSR is still large and requires strict cardiological management of
late complications. For this reason, we aimed to evaluate potential
long-term mortality risk factors in patients with D-TGA after AtrSR
(either Mustard or Senning procedure) Method: We searched MEDLINE database
for suitable trials. We included 22 retrospective and prospective cohort
studies of patients with D-TGA with at least 5 years mean/median follow-up
time after Mustard or Senning procedure, with an end-point of non-sudden
cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30
days after surgery. Result(s): A total of 2912 patients were
enrolled, of which 351 met the combined endpoint of n-SCD/SCD. The
long-term mortality risk factors were: NYHA>II/heart failure
hospitalization (OR=7.25; p=0.0001), tricuspid valve regurgitation
(OR=4.64; p=0.0005), Mustard procedure (OR=2.15; p=0.0008), complex D-TGA
(OR=2.41; p=0.005), right ventricle dysfunction (OR=1.94; p=0.05).
Supraventricular arrhythmia (SVT; OR=2.07; p=0.09) and pacemaker
implantation (OR=2.37; p=0.29) did not affect long-term survival in this
group of patients. In an additional analysis, SVT showed a statistically
significant impact on SCD (OR=2.74; p=0.005) but not on n-SCD (OR=1.5;
p=0.57). Conclusion(s): This meta-analysis identified that at least
moderate tricuspid valve regurgitation, NYHA class > II/heart failure
hospitalization, right ventricle dysfunction, complex D-TGA and Mustard
procedure as risk factors of long-term mortality in patients after AtrSR.

<84>
Accession Number
641005126
Title
Infective endocarditis of mitral valve, valve replacement or repair - a
meta-analysis of 10,965 patients.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2122), 2022. Date of Publication: September 2022.
Author
Fathy M.H.; Elnagar M.A.; Elbadawi M.A.; Awad A.K.
Institution
(Fathy, Elnagar, Elbadawi, Awad) Ain Shams University Hospital, Cairo,
Egypt
Publisher
European Respiratory Society
Abstract
Background: Being characterized by high mortality and recurrence rates,
native mitral valve infective endocarditis (IE) constitutes a burden on
both patients and surgeons from its poor prognosis and debatable
interventions. Mitral valve repair (MVRr) and mitral valve replacement
(MVRp) are two main surgical methods. Nevertheless, which of them carries
an outweigh benefit over the other is still controversial. Thus, in our
meta-analysis we aimed to further investigate the efficacy of each
technique on both short term and long-term outcomes. Method(s): Our
search strategy was applied on several databases including the PubMed,
Scopus, Web of science, and Cochrane literature databases to compare MVP
and MVR, with data extracted for baseline characteristics, mortality,
survival, recurrent endocarditis, and valve reoperation. Risk and hazard
ratio (RR and HR) and 95% confidence interval (CI) were pooled and
analyzed using RevMan 5.0. Result(s): A total of 22 relevant
publications with a total population of 10,965 patients, with 3,557
patients having undergone MVRr and 7,408 patients having undergone MVRp,
respectively, were analyzed. Patients who underwent MVP may benefit from a
lower risk of early mortality (RR 0.44; 95% CI, 0.38-0.51; p<0.00001;
I2=0%), a higher long-term survival rate (HR 0.56; 95% CI,
0.36-0.76; p<0.001; I2=0%), and a lower risk of recurrence (RR
0.66; 95% CI, 0.40-0.93; p=0.05; I2=0%). Although the risk of
reoperation was observed lower for MVRr, it was not statistically
significant (RR, 0.86; 95% CI, 0.36-1.36; p=0.76; I2=37%).
 Conclusion(s): Our results suggests that MVRr showed superiority in
the terms of in hospital mortality and long-term survival. Furthermore, it
has lower risk of recurrence and valve reoperation. Therefore, MVRr is an
appropriate as a primary treatment choice and should be considered
whenever possible in most IE patients. Conclusion(s): Our results
suggests that MVRr showed superiority in the terms of in hospital
mortality and long-term survival. Furthermore, it has lower risk of
recurrence and valve reoperation. Therefore, MVRr is an appropriate as a
primary treatment choice and should be considered whenever possible in
most IE patients. (Figure Presented).

<85>
Accession Number
641005108
Title
Prognostic value of left and right ventricular strain in heart failure
with reduced and preserved ejection fraction: A meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 75), 2022. Date of Publication: September 2022.
Author
Pastore M.C.; Fusini L.; Mandoli G.E.; Carrucola C.; Vigna M.; Muratori
M.; Pepi M.; Cavigli L.; D'Ascenzi F.; Focardi M.; Valente S.; Mondillo
S.; Pontone G.; Patti G.; Cameli M.
Institution
(Pastore, Mandoli, Carrucola, Vigna, Cavigli, D'Ascenzi, Focardi, Valente,
Mondillo, Pontone) University of Siena, Siena, Italy
(Fusini, Muratori, Pepi) IRCCS Monzino Cardiology Center, Milan, Italy
(Patti, Cameli) University of Eastern Piedmont, Novara, Italy
Publisher
European Respiratory Society
Abstract
Background: The association of speckle tracking echocardiography measures
of left ventricular (LV) and right ventricular (RV) strain with clinical
outcome in heart failure with reduced and preserved ejection fraction
(HFrEF and HFpEF) has been extensively investigated. In fact, while the
contribute of LV ejection fraction (LVEF) for prognosis is controversial,
myocardial strain has proven to be a strong and independent prognostic
predictor in many HF studies. Purpose(s): The aim of this
meta-analysis was to assess the prognostic value of LV global longitudinal
strain (GLS) and free wall RV longitudinal strain (fwRVLS) by
2-dimensional speckle tracking echocardiography in patients with HFrEF, HF
with mildly-reduced ejection fraction (HFmrEF) and HFpEF. Method(s):
A systematic literature search of medical databases including Pubmed,
Scopus, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of
Controlled Trials, Scopus was performed using PRISMA principles. All
relevant studies in English language reporting the predictive value of LV
GLS and/or fwRVLS for mortality and/or cardiovascular events in HFrEF,
HFmrEF and HFpEF, with follow up >6 months, were identified. Case
reports/series and abstract congresses were excluded (Fig. 1). All-cause
mortality and a composite endpoint of cardiovascular death,
rehospitalization for HF, cardiac transplantation, ventricular assist
device implantation were analyzed. Hazard ratios (HR) were extracted from
univariate and multivariate random-effects models reporting on the
association of LV GLS and fwRVLS and outcome and described as pooled
estimates with 95% confidence intervals (CI). Result(s): Fifty
studies (n=18276 patients) satisfied the inclusion criteria (35 studies in
chronic HF, 15 studies in acute HF). Most studies (n=36) included patients
with HFrEF, while 14 studies included patients with HFmrEF (n=3) and with
HFpEF (n=11); thus HFmrEF and HFpEF were grouped together for the
analysis. Overall, 48 studies included LV GLS (median value = -9% [from
-17% to -11%], 17 studies included fwRVLS (median value = -18% [from -24%
to -14%]). Over a median follow up of 32 [from 7 to 67] months follow up,
5618 (31%) had a cardiovascular event or died. LV GLS and fwRVLS were
independently associated with all-cause mortality and the composite
outcome, regardless of LVEF (Fig. 2), both in HFrEF (HR 1.26; 95% CI
[1.15; 1.37]; p<0.01 for LV GLS and HR 1.06; 95% CI [1.03; 1.09]; p<0.01
for fwRVLS) and in HFpEF (HR 1.07; 95% CI [1.03; 1.12]; p<0.01 for LV GLS
and HR 1.08; 95% CI [0.96; 1.21]; p<0.01 for fwRVLS). Conclusion(s):
These meta-analysis data demonstrate that LV and RV strain are associated
with mortality and cardiovascular events in patients with HF, HFmrEF and
HFpEF and may provide important additive prognostic information. These
findings emphasize the potential usefulness of LV GLS and fwRVLS in
clinical practice to improve the risk stratification and management of
patients with HF regardless of LVEF.

<86>
Accession Number
641005080
Title
Transcatheter mitral-valve repair for functional mitral regurgitation data
from the real-life in comparison with landmark randomized trials.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2121), 2022. Date of Publication: September 2022.
Author
Kaddoura R.; Al-Badriyeh D.B.; Abushanab D.A.; Al-Hijji M.A.
Institution
(Kaddoura, Abushanab, Al-Hijji) Hamad Medical Corporation Heart Hospital,
Doha, Qatar
(Al-Badriyeh) Qatar University, Doha, Qatar
Publisher
European Respiratory Society
Abstract
Background: Publication of COAPT and MITRA-FR trials on the use of
transcatheter mitral-valve repair (TMVR) for functional mitral
regurgitation (MR) in 2018, has raised many questions due to their
divergent results despite having similar objectives. Purpose(s): To
investigate the characteristics and outcomes of patients from real-life
data who underwent TMVR for functional MR, in comparison with the two
landmark trials. Method(s): A meta-analysis was performed according
to Cochrane Handbook for Systematic Reviews and the Preferred Reporting
Items for Systematic Reviews and Meta-analyses statement. A comprehensive
systematic literature search was conducted to identify observational
studies that enrolled patients with functional MR, published in 2020 and
2021. No further restrictions were implemented. Independent reviewers
performed study selection, data extraction, risk-of-bias and
quality-of-evidence assessments. Variables of interest were related to
patient demographics, medications, echocardiogram parameters, and
outcomes. Patient variables from observational studies were compared with
those reported in randomized trials, using a random-effects model for each
variable. Mean difference (MD) and odds ratio (OR), with 95% confidence
intervals (95% CI), were used to compare continuous and categorical data,
respectively. Variables that were not reported in both COAPT and MITRA-FR
trials were not presented. R software was used for non-comparative pooling
of variables, and RevMan software was used for comparative meta-analysis.
 Result(s): Thirty-two studies, enrolling 9497 patients, were
included. Patients were found to be older in real-life than in landmark
trials ([MD -2.73; 95% CI: -4.06, -1.40] for COAPT; [MD -4.33; 95% CI:
-5.94, -2.72] for MITRA-FR), while more males were recruited in MITRA-FR
trial (OR 1.71; 95% CI: 1.15-2.52). Moreover, patients in MITRA-FR trial
were less likely to have atrial fibrillation or renal insufficiency.
Patients from real-life were more likely to be more symptomatic (i.e., New
York Heart Association (NYHA) class III/IV) and less likely to have
implanted cardiac devices than those in randomized trials. MITRA-FR trial
patients had better compliance with guideline-directed therapies for heart
failure with reduced ejection fraction. Ejection fraction ranged from
31.3% to 33.9% between three study arms. More patients in randomized
trials presented with moderate-tosevere MR (grade 3+), whereas severe MR
(grade 4+) was more common among patients from real-life. Procedure
success, defined as MR grade <=2+, was more frequent in randomized trials,
with better symptoms' relief in COAPT trial (NYHA class I/II). There was
no difference in number of devices implanted between real-life and
landmark trials data. [Tables 1 and 2] Conclusion(s): Real-life data
on TMVR in functional MR, as presented by low-quality and heterogenous
observational studies, showed substantial differences from the results of
the main randomized trials. (Table Presented).

<87>
Accession Number
641005060
Title
CAD in kidney transplant recipients: A real-world assessment
pre-ISCHEMIA-CKD.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2619), 2022. Date of Publication: September 2022.
Author
Rocha B.; Amador R.; Maltes S.; Cunha G.; Mateus C.; Aguiar C.; Weigert
A.; Mendes M.
Institution
(Rocha, Amador, Maltes, Cunha, Mateus, Aguiar, Weigert, Mendes) Hospital
de Santa Cruz, Lisbon, Portugal
Publisher
European Respiratory Society
Abstract
Background: The ISCHEMIA-CKD trial has shown that an initial invasive
strategy, as compared to conservative treatment, did not reduce the risk
of death and non-fatal myocardial infarction, nor did it improve
quality-oflife in patients with advanced chronic kidney disease (CKD) and
coronary artery disease (CAD) with moderate-to-severe ischemia. Similar
findings were reported in patients with CKD enlisted for kidney
transplantation (KT). We aimed to evaluate screening and treatment CAD
strategies in patients who ultimately underwent KT at our center.
 Method(s): This is a single-center study of consecutive patients who
received a KT from 2015 to 2020. Obstructive CAD was defined whenever one
of the following criteria was met: Lesion with a stenosis >70% (or >50%,
if left main disease) or CAD requiring revascularization, as per the Heart
Team discussion. CAD evaluation refers to non-invasive or invasive
coronary angiography and/or stress testing, irrespective of clinical
scenario. Result(s): A total of 324 patients underwent KT [mean age
55+/-12 years; 65.1% male; CKD most often due to hypertensive or diabetic
nephropathy and polycystic kidney disease - 41.8%; median time from renal
replacement therapy (RRT) to KT - 60 (40-88) months]. A flow-chart
summarizing CAD diagnosis over time is depicted in Figure 1. Overall, 119
(36.7%) patients had CAD evaluation prior to KT, of whom 21 underwent
myocardial revascularization - 8, 12 and 1 patients with acute coronary
syndrome (ACS), chronic coronary syndrome (CCS) and silent ischaemia,
respectively. At a median time of 46 (25-66) months after KT, 36 (11.1%)
more patients had CAD evaluation, of whom 8 underwent percutaneous
myocardial revascularization - 6 and 2 for ACS and CCS, respectively.
Those with obstructive CAD were older (64 vs 54 years-old; p<0.001), with
a higher burden of cardiovascular (CV) risk factors (p<0.001) and more
likely to have had a CV death (9.5 vs. 1.0%; p=0.025) or CV
hospitalization (38.1 vs. 13.4%; p=0.007). CAD status (revascularized vs.
non-revascularized) was not associated with improved major outcomes at
follow-up. We found no strong predictors of CAD requiring
revascularization post-KT, including time from RRT to KT. There were no
patients with refractory angina, left main disease or reduced left
ventricular ejection fraction (<40%) in need of myocardial
revascularization over follow-up. Conclusion(s): Obstructive CAD was
uncommon in our cohort of patients who received a KT, most of whom with
asymptomatic or mildly (monthly angina) symptomatic CCS or non-fatal ACS.
These findings, together with the most recent evidence, may argue against
routine CAD screening in all patients being enlisted for KT.
Notwithstanding, randomized evidence is eagerly awaited to further guide
treatment decisions in the post-ISCHEMIACKD era. (Table Presented).

<88>
Accession Number
641005029
Title
Early aortic valve replacement in asymptomatic severe aortic stenosis with
preserved ejection fraction.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1593), 2022. Date of Publication: September 2022.
Author
Costa G.; Cardoso J.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic
Surgery, Vila Nova de Gaia, Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
(Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Aortic stenosis (AS) is the most common valvular disease in
developed countries. Specific timing of intervention for asymptomatic
patients with severe aortic stenosis and preserved ejection fraction
remains controversial. Purpose(s): To compare the outcomes of early
aortic valve replacement (AVR) versus watchful waiting (WW) in
asymptomatic AS patients with preserved ejection. Method(s): We
systematically searched PubMed, Embase and Cochrane databases, in November
2021, for both interventional or observational studies comparing early-AVR
with WW in the treatment of asymptomatic severeAS with preserved ejection
fraction criteria. Random-effects metaanalysis was performed.
 Result(s): Eight studies were included in which two were randomized
clinical trials. A total of 2672 patients were included, providing a 642
pooled death events (327 in early-AVR and 941 in watchful waiting). In our
metaanalysis, early-AVR revealed a significant lower all-cause mortality
(pooled OR, 0.39; 95% CI [0.30, 0.51], P<0.01; I2=47%).
Additionally, the early- AVR group presented a lower rate of
cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01;
I2=64%). Both strategies had similar rate of stroke (pooled OR,
1.30; 95% CI [0.39, 4.27], P=0.67; I2=0%) and myocardial
infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28;
I2=0%). Heart Failure hospitalizations presented a lower trend
early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36;
I2=36%). Conclusion(s): Our pooled data suggests that
early-AVR strategy is preferable for asymptomatic severe AS patients with
preserved ejection fraction. (Figure Presented).

<89>
Accession Number
641004983
Title
Concomitant tricuspid repair in mitral regurgitation surgery: A systematic
review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1592), 2022. Date of Publication: September 2022.
Author
Costa G.; Cardoso J.; Donato H.; Goncalves L.; Teixeira R.
Institution
(Costa) Centro Hospitalar de Coimbra, Coimbra, Portugal
(Cardoso) Hospital Center of Vila Nova de Gaia/Espinho, Cardiothoracic
Surgery, Vila Nova de Gaia, Portugal
(Donato, Teixeira) Centro Hospitalar Universitario de Coimbra, Coimbra,
Portugal
(Goncalves) Coimbra Institute for Clinical and Biomedical Research,
Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Tricuspid Regurgitation (TR) is common in patients with severe
mitral disease. However, the evidence is insufficient to inform a decision
about whether to perform prophylactic tricuspid-valve repair during
mitral-valve surgery in patients who have moderate TR or less-thanmoderate
regurgitation. Purpose(s): To compare the outcomes of concomitant
tricuspid repair in mitral valve surgery versus no concomitant tricuspid
repair in less-thansevere TR patients. Method(s): We systematically
searched PubMed, Embase and Cochrane databases, in December 2021, for
interventional studies comparing concomitant tricuspid repair in mitral
valve surgery versus no tricuspid intervention. Random-effects
meta-analysis was performed. Result(s): Four randomised trials were
included, providing a total of 651 patients (323 in prophylactic tricuspid
intervention group and 328 patients in conservative group). Our
meta-analysis showed a similar all-cause mortality for concomitant
prophylactic tricuspid repair compared with no tricuspid intervention
(pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I2=0%).
Additionally, there is a similar New York Heart Association (NYHA) III-IV
classes in both groups, despite a lower trend in the tricuspid
intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08;
I2=0%) (Figure 3). However, there was a significant lower
progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01;
I2=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11,
0.46], P<0.01; I2=27%). Conclusion(s): Our pooled analysis
suggests that a tricuspid-valve repair at the time of mitral-valve surgery
in patients with moderate or less-thanmoderate TR does not impact
perioperative or postoperative all-cause mortality, despite reducing TR
severity and progression of TR following intervention. (Figure Presented).

<90>
Accession Number
641004960
Title
Efficacy of controlvit as a complementary strategy in reducing
hospitalizations in patients with heart failure. Randomized clinical
trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2820), 2022. Date of Publication: September 2022.
Author
Achury D.M.; Garcia A.G.; Marino A.M.; Bohorquez W.B.; Gonzalez R.G.
Institution
(Achury, Gonzalez) Javeriana University, Bogota, Colombia
(Garcia, Marino, Bohorquez) San Ignacio Hospital, Bogota, Colombia
Publisher
European Respiratory Society
Abstract
Introduction: In patients with heart failure, the main cause of hospital
admissions is due to episodes of decompensation, which are associated with
an increase in the costs and resources needed for care; they have a
negative impact on the quality of life and prognosis of the disease.
Therefore, it is necessary to design, evaluate and implement alternatives
to achieve efficient follow-up and monitoring, improving adherence to
treatment and helping identify decompensation episodes that facilitate
their early treatment, so new hospital admissions can be avoided. For this
reason, the use of information and communication technologies (apps) is
emerging as an excellent strategy for the possibility of improving
coverage, real-time monitoring and timeliness of care. ControlVitR is an
electronic application that allows permanent, real-time monitoring of
biomedical measurements for early detection of complications.
 Objective(s): To determine the efficacy of ControlVitR as a
complementary strategy in reducing hospital admissions in patients in a
heart failure program. Methodology: A randomized, placebo-controlled,
open-label clinical trial was conducted, (n=140), included patients with
heart failure under controlled clinical follow-up in a structured heart
failure program, into NYHA FC II-IV, capable of handling smartphones and
with permanent internet connectivity. All patients were provided with
educational elements, a scale and a blood pressure monitor to enter
clinical data and a symptom questionnaire necessary for follow-up. The
patients were randomized to 2 groups: Intervention: Use of ControlVitR vs.
placebo, with a 6-month follow-up. The primary outcome was the difference
in readmissions for heart failure between the 2 groups. Patients on the
waiting list for heart transplantation or use of ventricular assist
devices were excluded. All participants signed informed consent and the
protocol was approved by the institutional ethics committee.
 Result(s): A total of 140 patients were included in the study
(intervention = 71, placebo = 69), with an average age of 66 years, 71%
were men, the main etiology of heart failure was ischemic (60%), the main
comorbidities were arterial hypertension (44%), dyslipidemia (42%),
hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus
(27%). During follow-up, there were 6 deaths (3 in each group) and 17
readmissions (3 in the intervention group and 14 in the control group).
After adjustment for comorbidities, HR 0.72 CI95 (0.52; 0.92), p=0.0325
was found. Conclusion(s): In patients with heart failure, ControlVitR
is a useful and complementary tool for follow-up, which reduces hospital
admissions due to episodes of decompensation.

<91>
Accession Number
641004959
Title
Prognostic utility of left ventricular global longitudinal strain in
patients with systemic amyloidosis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 270), 2022. Date of Publication: September 2022.
Author
Bhatia K.; Aggarwal D.; Ochoa-Jimenez R.; Lopez P.; Konje S.; Argulian E.
Institution
(Bhatia, Ochoa-Jimenez, Lopez, Konje, Argulian) Mount Sinai Heart, Mount
Sinai Morningside, New York, United States
(Aggarwal) Beaumont Health System, Internal Medicine, Troy, United States
Publisher
European Respiratory Society
Abstract
Background: Myocardial deposition of amyloid proteins results in
restrictive cardiomyopathy. Left ventricular global longitudinal strain
(GLS) has emerged as a sensitive measure for detecting subclinical cardiac
dysfunction over traditional echocardiographic parameters. However,
multiple studies have provided differing conclusions regarding prognostic
utility of impaired GLS in patients with systemic amyloidosis.
 Purpose(s): We conducted a systematic review and meta-analysis to
evaluate whether impaired GLS was associated with increased mortality or
major adverse cardiovascular events (MACE) in patients with systemic
amyloidosis. Method(s): We performed a literature search of Embase,
Medline and Web of Science databases to identify studies that reported the
association of GLS with clinical outcomes in patients with systemic
amyloidosis (light chain or TTR amyloidosis). Outcomes of interest
included all-cause mortality and MACE, defined as a composite of death or
heart transplant or heart failure hospitalization. Unadjusted and adjusted
hazard ratio (uHR and aHR respectively) were pooled using a random effects
model. Heterogeneity among the studies was assessed using the Higgins I2
value. Result(s): Out of 2139 initial citations, 28 observational
studies with a total of 2713 patients were included in the analysis. The
mean age ranged between 58-78 years and 62% of the patients were male.
Most patients had cardiac amyloidosis (83%) and light-chain amyloidosis
accounted for 69% of cases. Mean follow-up ranged between 1 and 5 years.
GLS was significantly higher (less negative) (mean difference (MD) -3.69
[-5.94, -1.44], I2=87, p<0.01) in non-survivors compared with
survivors. Similarly, patients who experienced MACE had a significantly
higher mean GLS (MD -3.22, [-5.21, -1.22,], I2=82, p<0.01]. The
risk of both mortality and MACE increased significantly for every -1%
increase in GLS. In unadjusted models, a GLS above the defined threshold
value was associated with a significantly higher risk of mortality (uHR:
1.66 [1.22, 5.21], I2=85.2, p<0.01) and MACE (uHR: 2.24 [1.28,
3.92], I2=39, p<0.01). In multivariable models an increase in
GLS by -1% was an independent predictor of mortality (aHR: 1.09
[1.01,1.16], I2=53, p=0.02) and MACE (aHR: 1.24 [1.14,1.36],
I2=0, p<0.01). Conclusion(s): In patient with amyloidosis,
the baseline left ventricular GLS may help identify patients with a higher
risk of mortality and MACE.

<92>
Accession Number
641004906
Title
Meta-analysis comparing outcomes in patients undergoing transcatheter
aortic valve implantation with versus without percutaneous coronary
intervention.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1590), 2022. Date of Publication: September 2022.
Author
Costa G.; Marinho V.; Costa M.; Goncalves L.; Teixeira R.
Institution
(Costa, Teixeira) Centro hospitalar de Coimbra, Coimbra, Portugal
(Marinho, Costa, Goncalves) Centro Hospitalar Universitario de Coimbra,
Coimbra, Portugal
Publisher
European Respiratory Society
Abstract
Background: Patients having transcatheter aortic valve implantation (TAVI)
routinely undergo coronary angiography before the procedure to define the
coronary anatomy and to evaluate the extend of coronary artery disease
(CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant
with TAVI confers any additional clinical benefit in patients with CAD
remains unclear. Purpose(s): To compare the outcomes of PCI prior to
TAVI in patients with significant coronary artery disease and severe
aortic stenosis. Method(s): We systematically searched PubMed, Embase
and Cochrane databases, in November 2021, for both retrospective and
prospective studies comparing TAVI with PCI versus TAVI alone.
Random-effects metaanalysis was performed. Result(s): Eleven studies
were included in which one was a randomized clinical trial. A total of
2530 patients were included, providing a 145 pooled death events (64 in
TAVI with PCI and 81 in TAVI only). In terms of 30-day clinical outcomes,
our pooled analysis revealed a similar all-cause mortality (pooled OR,
1.24; 95% CI [0.80, 1.93], P=0.34; I2=27% - Figure),
cardiovascular mortality (pooled OR, 1.44; 95% CI [0.56, 3.75], P=0.45;
I2=57%) and stroke (pooled OR, 1.07; 95% CI [0.53, 2.13],
P=0.86; I2=0%). However, our analysis revealed a higher rate of
myocardial infarction (pooled OR, 4.28; 95% CI [1.56, 11.69], P<0.01;
I2=0%) and major bleeding events (pooled OR, 1.40; 95% CI
[1.02, 1.93], P=0.04; I2=0%) in the TAVI with PCI group. A
1-year clinical outcomes analysis revealed a trend for lower allcause
mortality in TAVI only group (pooled OR, 1.37; 95% CI [0.98, 1.91],
P=0.06; I2=0%), similar cardiovascular death rate (pooled OR,
1.15; 95% CI [0.70, 1.89], P=0.59; I2=6%) and major bleeding
events (pooled OR, 1.62; 95% CI [0.95, 2.76], P=0.07; I2=0%).
 Conclusion(s): Our pooled data suggests that PCI with TAVI in
patients with severe aortic stenosis and concomitant CAD grants no
additional clinical advantage. (Figure Presented).

<93>
Accession Number
641004738
Title
Lipoprotein(a) and the effect of alirocumab on coronary and non-coronary
revascularization following acute coronary syndrome.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 1386), 2022. Date of Publication: September 2022.
Author
Steg P.; Szarek M.; Valgimigli M.; Islam S.; Zeiher A.M.; Bhatt D.L.;
Bittner V.A.; Diaz R.; Goodman S.G.; Harrington R.A.; Jukema J.W.; Pordy
R.; Scemama M.; White H.D.; Schwartz G.G.
Institution
(Steg) Hospital Bichat-Claude Bernard, Paris, France
(Szarek) State University of New York, Downstate Medical Center, New York,
United States
(Valgimigli) Cardiocentro Ticino Institute, Lugano, Switzerland
(Islam) NYU Long Island School of Medicine, Division of Health Services
Research, Mineola, United States
(Zeiher) Goethe University Hospital, Frankfurt, Germany
(Bhatt) Brigham and Women's Hospital, Boston, United States
(Bittner) University of Alabama Birmingham, Birmingham, United States
(Diaz) Estudios Cardiologicos Latinoamerica (ECLA), Rosario, Argentina
(Goodman) St. Michael's Hospital, Toronto, Canada
(Harrington) School of Medicine, Stanford, United States
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Pordy) Regeneron Pharmaceuticals,Inc., Tarrytown, United States
(Scemama) Sanofi, Paris, France
(White) Auckland City Hospital, Auckland, New Zealand
(Schwartz) University of Colorado, Aurora, United States
Publisher
European Respiratory Society
Abstract
Background: Many patients require arterial revascularization after an
index ACS. Lipoprotein(a) is thought to play a pathogenic role in
atherothrombosis. In the ODYSSEY OUTCOMES trial, the PCSK9 inhibitor
alirocumab reduced major adverse cardiovascular events after ACS, with
greater reduction among those with higher lipoprotein(a).
 Objective(s): We determined whether the risk of first coronary or any
(coronary, peripheral artery or carotid) revascularization after ACS was
modified by the level of lipoprotein(a) and treatment with alirocumab or
placebo. Method(s): The ODYSSEY OUTCOMES trial (NCT01663402) compared
alirocumab with placebo in 18,924 patients with ACS and elevated
atherogenic lipoproteins despite optimized statin treatment. Treatment
effects were summarized by competing-risks proportional hazard models.
 Result(s): A total of 1559 (8.2%) patients had coronary, 204 (1.1%)
peripheral artery, and 40 (0.2%) carotid revascularization after
randomization. Alirocumab reduced first coronary revascularization (9.6%
vs. 11.3% at 4 years; hazard ratio [HR] 0.88, 95% confidence interval [CI]
0.80-0.97; p=0.01) and any first revascularization (10.8% vs. 13.0%; HR
0.85, 95% CI 0.78-0.94; p=0.001). Baseline lipoprotein(a) quartile was
directly associated with risk of coronary or any revascularization in the
placebo arm (ptrend <0.0001) and inversely related to treatment HRs
(ptrend <0.001). The greatest benefits of alirocumab on coronary or any
revascularization were observed in patients with baseline lipoprotein(a)
in the top quartile (>=59.6 mg/dL) (figures). Conclusion(s):
Alirocumab reduced revascularization after ACS. The risk of
revascularization and reduction in that risk with alirocumab were greatest
in patients with elevated lipoprotein(a) at baseline. (Figure Presented).

<94>
Accession Number
641004655
Title
Predictors of mitral valve hemodynamics after mitral valve repair for
degenerative mitral regurgitation: A subanalysis of the CAMRA randomized
trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2115), 2022. Date of Publication: September 2022.
Author
Rumman R.; Verma S.; Chan V.; Mazer D.; Quan A.; De Varennes B.E.; Chu
M.W.A.; Latter D.; Teoh H.; Yanagawa B.; Leong-Poi H.; Connelly K.
Institution
(Rumman) St. Michael's Hospital, Department of Medicine, Toronto, Canada
(Verma, Latter, Yanagawa) St. Michael's Hospital, Cardiac Surgery,
Toronto, Canada
(Chan) Ottawa Heart Institute, Cardiac Surgery, Ottawa, Canada
(Mazer) St. Michael's Hospital, Anesthesia, Toronto, Canada
(Quan, Teoh) St. Michael's Hospital, Toronto, Canada
(De Varennes) McGill University Health Centre, Cardiac Surgery, Montreal,
Canada
(Chu) London Health Sciences Centre, Cardiac Surgery, London, Canada
(Leong-Poi, Connelly) St. Michael's Hospital, Cardiology, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Introduction: Intra-operative predictors of mid-to-late mitral valve
dysfunction after surgical repair of mitral regurgitation (MR) caused by
prolapse remain poorly characterized. This study aims to evaluate the
effect of annuloplasty prosthesis size on post-operative MV hemodynamics
at rest and during exercise, and to identify perioperative predictors of
MV dysfunction. Method(s): 104 patients were randomly assigned to
resection and preservation for surgical treatment of posterior leaflet
prolapse in the Canadian Mitral Research Alliance CardioLink-2 study.
Echocardiograms were performed at baseline and 1 year postoperatively.
Intraoperative TEE was performed to assess immediate MV gradients.
Exercise TTE was performed 1 year after repair. Linear regression analysis
was used to identify associations between MV indices (rest and peak
exercise gradients) at 12 months, and perioperative echocardiographic and
clinical factors. Result(s): Mean age of participants was 65+/-10
years, and 83% were male. Larger annuloplasty size was associated with
lower transmitral gradients at rest and during peak exercise. In
multivariable analysis, annuloplasty size >=34mm was associated with lower
mean and peak rest and exercise gradients at 12 months, after adjustment
for repair type, age, sex, and BSA (p<0.001). Higher pre-operative
pulmonary artery pressures were associated with reduced functional
capacity post-operatively. Intra-operative TEE gradients predict resting
and exercise MV hemodynamics at 1 year. Conclusion(s): Annuloplasty
size >=34mm is associated with improved MV hemodynamics at rest and during
peak exercise 1 year post MV repair. MV repair prior to onset of pulmonary
hypertension confers favourable post operative functional capacity.
Finally, intra-operative TEE can be used to identify patients at risk of
mitral valve dysfunction within 1 year of repair. (Figure Presented).

<95>
Accession Number
641004626
Title
Coronary perforation incidence and temporal trends (COPIT): Systematic
review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2064), 2022. Date of Publication: September 2022.
Author
Mikhail P.; Howden N.; Monjur M.; Said C.; Jeyaprakash P.; Bland A.;
Collison D.; McCartney P.; Adamson C.; Morrow A.; Carrick D.; McEntegart
M.; Ford T.
Institution
(Mikhail, Howden, Said, Bland, Ford) Gosford Hospital, Gosford, Australia
(Monjur) St George Hospital, Sydney, Australia
(Jeyaprakash) Nepean Hospital, Sydney, Australia
(Collison) Golden Jubilee National Hospital, Glasgow, United Kingdom
(McCartney, Adamson, Morrow) University of Glasgow, Glasgow, United
Kingdom
(Carrick) Hairmyres Hospital, East Kilbride, United Kingdom
(McEntegart) Columbia University, New York, United States
Publisher
European Respiratory Society
Abstract
Background: Despite advancements in Percutaneous Coronary Intervention
(PCI) technology and techniques, iatrogenic coronary artery perforation
(CAP) remains a dreaded potential complication within the cardiac
catheterisation laboratory. Data detailing the incidence of coronary
perforation during PCI has previously been obtained from relatively small
datasets. A swell of large data published in recent times provides
invaluable information regarding PCI related CAP. Purpose(s): COPIT
is a systematic review and meta-analysis targeted at detailing the
incidence, outcomes, etiology and treatment modalities of PCI related CAP
including evaluation of temporal trends since the inception of PCI to
contemporary practice. Additionally, COPIT provides hypothesis generating
data regarding predictors of CAP during PCI. Method(s): A prospective
systematic review and meta-analysis using MEDLINE and EMBASE via the OVID
interface (PROSPERO ID: CRD42020207881) was performed according to the
PRISMA guidelines. Identified relevant studies were used in a
pre-specified sensitivity analysis to detail incidence, outcomes,
etiology, treatment modalities and risk factors of PCI complicated by CAP.
Studies limited to PCI in high risk populations only such as CTO-PCI or
rotational atherectomy only were excluded. Result(s): 67 studies met
eligibility criteria detailing 5,568,191 PCIs over a 38-year period
(1982-2020). The pooled incidence of CAP was 0.39% (95% CI: 0.34-0.45%)
with no change in incidence over that time. Approximately 1 in 5
perforations led to cardiac tamponade (21.1%). Ellis 3 perforations are
increasing in frequency and account for 43% of all perforations. Mortality
due to perforation occurs in 7.5% of all CAP (95% CI 6.7% - 8.4%) but has
declined over the studied period. Meta-regression suggested that female
gender, hypertension, chronic kidney disease and previous coronary bypass
grafting were all associated with higher incidence of CAP. Coronary
perforation was most frequently caused by distal wire exit (37%) followed
by balloon dilation catheters (28%). Covered stents were used to treat 25%
of perforations, with emergency cardiac surgery needed in 17%.
 Conclusion(s): Coronary perforations occurs in approximately 1 in 250
allcomer PCI procedures. A tendency towards increase in coronary
perforations is likely reflective of contemporary trends towards high
pressure post-dilatation with 1:1 vessel sizing as well as an ageing
population with increasingly complex, calcific coronary disease. However,
reduction in CAP related mortality suggests earlier recognition and
effective treatment with transcatheter techniques. (Figure Presented).

<96>
Accession Number
641004532
Title
Outcomes comparison between robotic and conventional mitral valve surgery:
A systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2164), 2022. Date of Publication: September 2022.
Author
Pratita J.; Ardaya R.; Pritazahra A.; Rahman F.H.F.
Institution
(Pratita) Fakultas Kedokteran Universitas Indonesia (FKUI), Division of
Cardiothoracic and Vascular Surgery, Department of Surgery, Central
Jakarta, Indonesia
(Ardaya) University College London, School of Surgical and Interventional
Sciences, London, United Kingdom
(Pritazahra) University College London, Institute of Cardiovascular
Science, London, United Kingdom
(Rahman) MMC Hospital, South Jakarta, Indonesia
Publisher
European Respiratory Society
Abstract
Background: Robotic-assisted cardiac surgery has emerged as a popular
minimal invasive cardiac surgery approach, as it provides several
advantages compared to conventional and other minimally invasive
approaches. Mitral valve surgeries, including repair and replacement, are
currently the most common cardiac surgeries performed with a robotic
approach. However, there are concerns that surgeon's learning curve and
prolonged operation time associated with this approach could compromise
the surgical outcomes, hence the low acceptance of the technique in the
clinical setting. In addition, despite various studies comparing robotic
and conventional mitral surgery, it remains unclear whether the former
would give comparable, if not better, outcomes. Purpose(s): This
study aims to compare the outcomes of robotic and conventional sternotomy
mitral valve surgeries. Method(s): A comprehensive literature search
was performed through Pubmed, CENTRAL, and ScienceDirect for studies
comparing robotic and sternotomy approach for mitral valve repair and
replacement. Studies were screened with our eligibility criteria, and
their quality was examined using the Newcastle-Ottawa scale. The primary
outcome analysed in this study was the perioperative mortality.
 Result(s): Twelve studies involving 4300 patients (2223 experienced
robotic surgery) were included. Pooled analysis showed that patients who
underwent robotic surgery had a significant decrease in perioperative
mortality compared to those who underwent sternotomy surgery (RR 0.33, 95%
CI 0.18, 0.60, p=0.0003, I2=0%). Moreover, ICU length of stay
was also shorter in the robotic group (MD -13.67, 95% CI -20.04, -7.29,
p<0.0001, I2=93%). Re-operation risk due to bleeding was not
significantly different between both groups (RR 1.13, 95% CI 0.79, 1.62,
p=0.51, I2=0%). Egger's test result showed no evidence of
small-study effects (p=0.83), and the funnel plot appeared symmetrical,
meaning there was no publication bias. Conclusion(s): Results from
our meta-analysis refute the current concerns limiting the acceptance of
robotic approach in mitral valve surgeries, showing significantly lower
perioperative mortality and ICU length of stay, as well as a comparable
re-operation risk due to bleeding with the conventional approach. (Figure
Presented).

<97>
Accession Number
641004512
Title
Valvular surgery is associated with an increased risk of post-operative
atrial fibrillation: Secondary analysis of the SEARCH-AF CardioLink-1
randomized trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2163), 2022. Date of Publication: September 2022.
Author
Hibino M.; Verma S.; Pandey A.; Quan A.; Verma A.; Bisleri G.; Mazer C.D.;
Ha A.
Institution
(Hibino, Verma, Pandey, Quan, Bisleri, Mazer) St. Michael's Hospital,
Cardiac Surgery, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
Publisher
European Respiratory Society
Abstract
Background: Patients undergoing valve surgery have a higher risk of
developing post-operative atrial fibrillation (POAF) relative to those
undergoing isolated coronary artery bypass grafting (CABG). Whether this
risk extends beyond hospital discharge is unknown. Purpose(s): We
examined the association between surgery type (isolated CABG vs. valve
repair/replacement) on the incidence of post-operative atrial fibrillation
(POAF) by conducting a secondary analysis of the Post- Surgical Enhanced
Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF)
CardioLink-1 randomized trial. Method(s): In the SEARCH-AF trial, 336
patients with risk factors for stroke (CHA2DS2-VASc score >=2) and no
history of preoperative AF were randomized to usual care or continuous
cardiac rhythm monitoring for 30 days after discharge from cardiac surgery
with a wearable, patched-based device. The primary outcome was occurrence
of cumulative atrial fibrillation/ flutter (AF/AFL) lasting for >=6
minutes detected by continuous monitoring or AF/AFL documented by a
12-lead ECG within 30 days of randomization. We compared the risk of POAF
between patients who underwent CABG vs. valve repair/replacement. Patients
who experienced postoperative AF during hospitalization were excluded from
this analysis. Result(s): The overall cohort consisted of 255, 39,
and 42 patients who underwent isolated CABG, isolated valve
replacement/repair, and CABG + valve repair/replacement, respectively.
Baseline characteristics were similar among the groups except for younger
age (p=0.0014), higher prevalence of preoperative myocardial infarction
(p=0.002) and lower ejection fraction (p=0.025) in the isolated CABG
group. Eighteen patients experienced post-operative AF during
hospitalization. Patients who underwent CABG + valve surgery or isolated
valve surgery were more likely to experience post-operative AF compared
with those who underwent isolated CABG (Log-Rank ptrend=0.0096). Among
patients who were randomized to continuous cardiac rhythm monitoring, the
probability of post-operative AF among patients who underwent isolated
CABG, valve surgery, and CABG + valve surgery was 15.8%, 29.4%, and 35.0%,
respectively (Log- Rank ptrend=0.017). After multivariable adjustment, the
risk of developing post-operative AF within 30 days after discharge
remained higher among patients who underwent valve surgery compared with
those who underwent isolated CABG (hazard ratio (HR) 2.22, 95% CI
1.01-4.87. Patients who underwent CABG + repair/replacement had the
highest risk of experiencing post-operative AF when compared to patients
who underwent isolated CABG (HR 2.78, 95% CI 1.12-6.86).
 Conclusion(s): Patients undergoing valve repair or bioprosthetic
valve replacement have a substantial risk of post-operative AF within 30
days after discharge from surgery. An aggressive cardiac rhythm monitoring
strategy during this vulnerable period should be considered for this
high-risk patient population. (Figure Presented).

<98>
Accession Number
641004442
Title
Impact of diabetes and glucose-lowering therapy on post-operative atrial
fibrillation after cardiac surgery: Secondary analysis of the SEARCH-AF
CardioLink-1 randomized clinical trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 508), 2022. Date of Publication: September 2022.
Author
Pandey A.; Hibino M.; Ha A.; Quan A.; Verma A.; Bisleri A.; Mazer C.D.;
Verma S.
Institution
(Pandey, Hibino, Quan, Bisleri, Mazer, Verma) St. Michael's Hospital,
Cardiac surgery, Toronto, Canada
(Ha) UHN - University of Toronto, Toronto, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
Publisher
European Respiratory Society
Abstract
Background: Diabetes mellitus is an important risk factor for atrial
fibrillation (AF) and is associated with an increased risk of
complications for patients with AF. The impact of diabetes on
post-operative AF after cardiac surgery is not well-defined.
 Purpose(s): We sought to characterize the effect of diabetes,
insulin, and oral hypoglycemic agents on the incidence of post-operative
atrial fibrillation (POAF) after cardiac surgery. Accordingly, we
conducted a secondary analysis of the Post-Surgical Enhanced Monitoring
for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1
randomized trial. Method(s): In the SEARCH-AF trial, 336 patients
with risk factors for stroke (CHA2DS2-VASc score >=2) and no history of
preoperative AF were randomized to usual care or continuous cardiac rhythm
monitoring for 30 days after discharge from cardiac surgery with a
wearable, patched-based device. The primary outcome was occurrence of
cumulative atrial fibrillation/ flutter (AF/AFL) lasting for >=6 minutes
detected by continuous monitoring or AF/AFL documented by a 12-lead
electrocardiogram within 30 days of randomization. We assessed the
association between diabetes and occurrence of post-operative AF. In
addition, we examined the association between POAF and glucose-lowering
therapy among patients with diabetes. Result(s): Among the 176 (52%)
patients with diabetes in the study cohort, 80 (45%) patients were treated
with at least 1 oral hypoglycemic agent and 44 (25%) patients were treated
with insulin. The incidence of POAF occurring within 30 days after
discharge from surgery was similar between patients with or without
diabetes (cumulative incidence: 10.8% vs. 10.0%, log-rank p=0.77). Among
patients with diabetes, the incidence of POAF was highest in those who
were not treated with glucose-lowering therapy (17.3%) when compared with
those treated with oral hypoglycemic agents (10.0%) or insulin (4.5%)
(log-rank ptrend=0.045 among the 3 groups). In an exploratory analysis, we
observed a trend suggesting a lower incidence of POAF among cardiac
surgical patients who were treated with SGLT-2 inhibitors (log-rank
ptrend=0.084). Conclusion(s): The incidence of POAF occurring after
discharge from cardiac surgery is equally high among patients with or
without diabetes. Our results suggest a potential association between
specific glucose-lowering therapies and risk of POAF after cardiac
surgery, meriting further investigations.

<99>
Accession Number
641004403
Title
Determinants of myocardial injury following transcatheter aortic valve
implantation: A pre-specified substudy from the POPular TAVI trial.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2106), 2022. Date of Publication: September 2022.
Author
Van Ginkel D.J.; Brouwer J.; Nijenhuis V.J.; Delewi R.; Swaans M.J.;
Timmers L.; Rensing B.J.W.M.; Baan J.; Ten Berg J.M.
Institution
(Van Ginkel, Brouwer, Nijenhuis, Swaans, Timmers, Rensing, Ten Berg) St
Antonius Hospital, Cardiology, Nieuwegein, Netherlands
(Delewi, Baan) Amsterdam UMC - Location Academic Medical Center,
Cardiology, Amsterdam, Netherlands
Publisher
European Respiratory Society
Abstract
Background: Myocardial injury is frequently observed in patients
undergoing transcatheter aortic valve implantation (TAVI) and has been
linked to worse prognosis [1,2]. Yet, knowledge concerning the underlying
mechanisms and preventive strategies is scarce. Purpose(s): To
identify clinical determinants and the effect of periprocedural
antithrombotic strategies on markers of myocardial injury after TAVI.
 Method(s): The POPular TAVI trial was a prospective, open label,
multicentre randomized controlled trial, investigating the addition of
clopidogrel to aspirin (cohort A) or oral anticoagulation (OAC) (cohort B)
in patients undergoing TAVI [3] Patients randomised to clopidogrel
received a 300mg loading dose before TAVI, followed by a 75mg maintenance
dose once daily. In patients using OAC, this was continued during TAVI
with an international normalized ratio aimed at 2.0. All OAC patients used
a vitamin-K antagonist. Blood samples were taken at baseline, 6, 24, 48,
and 72 hours following TAVI to determine myocardial injury using Creatine
Kinase-MB (CK-MB) and high-sensitive cardiac troponin T (hs-cTnT)
according to the VARC-2 criteria. Also, baseline and procedural variables
were collected in detail. A linear mixed effects model was used for
pair-wise analysis of the changes in enzyme levels at different time
points between groups. Regression analysis was performed using the
logistic regression model. Statistical analyses were performed using R
(version 3.4.1). Result(s): In total, 131 patients undergoing
transfemoral TAVI were included at two study sites, of whom 63 (48%)
received clopidogrel and 68 (52%) did not. Almost half of the patients
(45%) were on OAC. The rise in CK-MB (mean peak 23.4+/-13.3 U/l) and
hs-cTnT (mean peak of 0.23+/-0.33 ug/) was maximal at 6 and 24 hours,
respectively. The CK-MB and hs-cTnT levels did not differ between the
clopidogrel and no clopidogrel group at any time point (figure 1).
Myocardial injury occurred in 18 (30.1%) patients receiving OAC versus 39
(54.2%) patients not receiving OAC (p=0.007). The course of hs-cTnT
reached higher levels in patients with chronic kidney disease (p<0.001)
and in patients with a preserved left ventricular ejection fraction (LVEF)
(p=0.008). Also, the use of a controlled mechanical expanding prosthesis
was associated with a higher rise of hs-cTnT (p=0.007). (Figure 2) In
multivariable analysis, predictors of a maximal increase in hs-cTnT were a
preserved LVEF (OR 1.15, 95% CI 1.02-1.30) and chronic kidney disease (OR
1.13, 95% CI 1.01-1.28). Other procedural factors, like balloon dilation
and rapid ventricular pacing, were not associated with myocardial injury.
 Conclusion(s): The addition of clopidogrel to aspirin or OAC during
TAVI was not associated with a reduction in myocardial injury. Instead,
OAC therapy, as compared to aspirin, was associated with a reduction in
rise and fall of hs-cTnT. Also, patients with a preserved LVEF or chronic
kidney disease observed higher levels of hs-cTnT. (Figure Presented).

<100>
Accession Number
641004326
Title
The effect of cryothermic and radiofrequency Cox maze IV ablation on
atrial size and function assessed by 3D echocardiography, a randomized
trial. To freeze or to burn.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 102), 2022. Date of Publication: September 2022.
Author
Boano G.; Farkas V.; Astrom Aneq M.
Institution
(Boano, Farkas, Astrom Aneq) Department of Medical and Health Sciences
Linkoping University, Linkoping, Sweden
Publisher
European Respiratory Society
Abstract
Background: The Cox maze procedures have been shown to be safe methods for
restoring sinus rhythm (SR) in patient with atrial fibrillation and often
performed concomitant to mitral valve (MV) surgery. Cryothermy (Cryo) and
Radiofrequency (RF) are available techniques to achieve atrial linear
scars. The differences between the effect of these energy sources on late
left atrial (LA) reverse remodeling are not fully described.
 Purpose(s): This study aims to compare the impact of Cryo and RF
procedures on left atrial (LA) size and function one year after Cox-maze
IV concomitant to MV surgery using 3-dimensional echocardiography (3DE).
 Method(s): Seventy-two patients with MV disease and atrial
fibrillation were randomized to either Cryo (35) or RF (37) ablation.
Another 33 patients were enrolled according to the protocol without
concomitant ablation (No-Maze group). All patients had an echocardiogram
before and one year after surgery. Result(s): The 42 ablated patients
who recovered sinus rhythm (SR) one year after surgery had comparable left
and right systolic ventricular function and a mean reduction of LA size by
23% (LA volume index decreased from 66+/-24 to 54+/-13ml/m2,
p=0.004). The 3DE extracted reservoir and booster function showed higher
values after RF ablation compared to Cryo (37+/-10% vs 26+/-6%; p<0.001
resp. 18+/-9 vs 7+/-4%, p<0.001), while passive conduit function was
comparable (24+/-11 vs 20+/-8%; p=0.17). Patients with restored SR without
ablation had more preserved systolic atrial function but similar LA size
reduction as those who underwent maze surgery. Conclusion(s): SR
restoration after MV surgery and maze results in LA size reduction
irrespective of the energy source used. By 3DE we could show that,
compared to RF maze, the extension of ablation area produced by Cryo
implies a major LA structural remodeling affecting LA systolic function.
The reverse size remodeling seems to be the least, the longer AF history.

<101>
Accession Number
641004294
Title
Outcomes of heart transplantation in adults and pediatrics congenital
heart disease: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2153), 2022. Date of Publication: September 2022.
Author
Mendel B.M.; Holiyono H.I.H.; Angellia P.A.; Prakoso R.P.; Siagian S.N.S.
Institution
(Mendel, Prakoso, Siagian) National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Holiyono, Angellia) University of Indonesia Hospital, Depok, Indonesia
Publisher
European Respiratory Society
Abstract
Background: Heart transplantation (HTx) has progressed from an
experimental therapy option to a well-established therapeutic option for
congenital heart disease (CHD) patients in end-stage heart failure, thus
we can expect a large number of people with CHD to be evaluated for HTx in
the next decades. Objective(s): To create a systematic review and
meta-analysis regarding short-term and long-term outcomes of HTx in
end-stage adults and pediatrics CHD patients. Method(s): Four online
databases were screened from the date of inception to January 2022, where
the acquired studies were assessed using the PRISMA statement. The
inclusion criteria were cohort studies that evaluated outcomes of heart
transplantation in end-stage congenital heart disease patients. The
mortality of adults and pediatrics population were analyzed using
random-effect model, showed as summary statistics of overall risk ratio
(RR) with 95% confidence interval (CI). Quality appraisal was conducted
using the STROBE statement. Result(s): Ten studies met the inclusion
criteria and were eligible to be analyzed. The pediatric population had
stronger 1-year mortality risk [Std. Mean difference 0.62, 95% CI, 0.12 to
3.07; P<0.00001] and 5-year mortality risk [Std. Mean difference 0.82, 95%
CI, 0.37 to 1.84; P<0.00001], while adult population were found to have
higher overall post-transplantation mortality risk [Std. mean difference
1.17, 95% CI 0.66 to 2.08; P<0.00001]. Conclusion(s): Adults CHD
patients experienced higher mortality rate following heart
transplantation, with improved long-term survival in comparison to
pediatrics CHD recipients. However, further study should be conducted with
standardized subjects as there is moderate quality of evidence and higher
heterogeneity during our meta-analysis. (Figure Presented).

<102>
Accession Number
641004259
Title
Meta-analysis on the comparison of direct oral anticoagulants versus
vitamin K antagonists after transcatheter aortic valve implantation in
patients with pre-existing atrial fibrillation.
Source
European Heart Journal. Conference: ESC Congress 2022. Barcelona Spain.
43(Supplement 2) (pp 2100), 2022. Date of Publication: September 2022.
Author
Mateo Q.; Tiongco R.; Bernardo J.
Institution
(Mateo, Tiongco, Bernardo) Saint Lukes Medical Center Global City, Taguig,
Philippines
Publisher
European Respiratory Society
Abstract
Background: Transcatheter aortic valve replacement is a treatment option
for symptomatic patients with severe aortic stenosis who are candidates
for a bioprosthesis across the entire spectrum of risk. TAVR carries a
risk for thrombotic and bleeding events, underscoring the importance of
defining the optimal adjuvant antithrombotic regimen. Antithrombotic
consideration is complicated by the fact that many patients undergoing
TAVR are generally elderly with multiple comorbidities, including
conditions that may require long-term oral anticoagulation such as atrial
fibrillation. The optimal antithrombotic regimen for patients with AF
undergoing TAVR is currently unknown. The objective of this meta-analysis
is to add knowledge to existing data involving the use of direct oral
anticoagulant in patients with pre-existing atrial fibrillation undergoing
TAVI and to explore the safety and efficacy of DOACs compared with VKA in
this population Methods: A systematic search for randomized controlled
trials which compare direct oral anticoagulant and vitamin K antagonist
was done using PubMed, Cochrane, MEDLINE and Clinicaltrials.gov. Studies
which were done in the last five years (January 2016-October 2021) and
those that involved human subjects were included in the study. Search
terms include "Direct Oral Anticoagulant", "Vitamin K Antagonist", "TAVR",
"atrial fibrillation", "DOAC" AND "TAVI" OR "VKA" AND "TAVI" AND "atrial
fibrillation" AND "randomized controlled trial". Result(s): Five
retrospective observational studies and two RCTs (3,998) were included in
this meta-analysis comparing direct oral anticoagulant vs vitamin K
antagonist in patients with known atrial fibrillation post TAVI.
Dabigatran, Rivaroxaban, Apixaban, and Edoxaban were used in these
different studies. Among patients with concomitant indication of oral
anticoagulant like atrial fibrillation, there is no significant difference
between direct oral anticoagulant and vitamin K antagonist in terms of
outcomes on allcause mortality, major and/or life threatening bleeding and
stroke as shown in these values, (OR 1.05, 95% CI: 0.89-1.25, P=0.57,
I2=39%), (OR=1.04, 95% CI: 0.85-1.27, P=0.70,
I2=45%) and (OR=1.10, 95% CI: 0.80-1.51, p=0.56,
I2=0%), respectively. When only the two RCTs are compared,
still there is no significant difference on the outcomes mentioned above
between direct oral anticoagulant and vitamin K antagonist based on these
values (OR=1.07, 95% CI: 0.85-1.36, P=0.57, I2=0%), (OR=1.15,
95% CI: 0.59-2.24, P=0.68, I2=66%) and (OR=0.99, 95% CI:
0.65-1.49, p=0.95, I2=39%), respectively. Conclusion(s):
Use of direct oral anticoagulant was non inferior with vitamin K
antagonist in terms of outcomes on all-cause mortality, major and/or life
threatening bleeding and stroke. Direct oral anticoagulant is easier to
use with its known safety profile, hence, it is a plausible alternative to
warfarin in this population in patients with known atrial fibrillation
post TAVR.

<103>
Accession Number
2034301908
Title
Effect of Prehospital Digital Electrocardiogram Transmission on
Revascularization Delays and Mortality in ST-Elevation Myocardial
Infarction Patients: Systematic Review and Meta-Analysis.
Source
CJC Open. 6(10) (pp 1199-1206), 2024. Date of Publication: October 2024.
Author
Moxham R.N.; d'Entremont M.-A.; Mir H.; Schwalm J.D.; Natarajan M.K.;
Jolly S.S.
Institution
(Moxham, d'Entremont, Schwalm, Natarajan, Jolly) McMaster University and
Population Health Research Institute, Hamilton Health Sciences, Hamilton,
ON, Canada
(d'Entremont) Centre Hospitalier, University of Sherbrooke, Sherbrooke,
QC, Canada
(Mir) University of Ottawa Heart Institute, University of Ottawa, Ottawa,
ON, Canada
(Schwalm) Centre for Evidence-Based Medicine (CEBI), United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Prehospital transmission of the 12-lead electrocardiogram
(ECG) to the interventional cardiologist has become the standard of care
in many ST-elevation myocardial infarction (STEMI) networks but has not
been adopted universally. In this systematic review and meta-analysis, we
assess the effect of prehospital digital ECG transmission in STEMI
patients on door-to-device times, first medical contact-to-device times,
and mortality. Method(s): We performed a systematic review of all
English-language studies in MEDLINE, Embase, and CENTRAL (from inception
to July 24, 2023), comparing the effect of prehospital digital ECG
transmission to that of no ECG transmission in STEMI patients. We
performed a random-effects meta-analysis. Result(s): We included 17
observational studies totalling 4306 patients. Door-to-device times were
reduced by 33.3 minutes in patients with prehospital digital ECG
transmission (95% confidence intervals [CIs] -50.5, -16.2 minutes; P <
0.001; I2 99%). First-medical-contact-to-device time also was
reduced with prehospital digital ECG transmission (mean difference, -24.7
minutes; 95% CI -37.1, -12.3 minutes; P < 0.001; I2 96%).
Prehospital digital ECG transmissions was associated with a 47% reduction
in mortality compared to no prehospital digital ECG transmission (117 of
1322 (8.9%) vs 181 of 1322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; P
< 0.001; I2 = 0%). Conclusion(s): Prehospital ECG
transmission in STEMI patients, coupled with a systems of care reduced
door-to-device times, first-medical-contact-to-device times, and
mortality. STEMI networks should consider these findings to advocate for
prehospital ECG transmission within their systems of care. Study
Registration: CRD42024509271 (PROSPERO). Copyright © 2024 The
Authors

<104>
Accession Number
2017665058
Title
American College of Gastroenterology-Canadian Association of
Gastroenterology Clinical Practice Guideline: Management of Anticoagulants
and Antiplatelets during Acute Gastrointestinal Bleeding and the
Periendoscopic Period.
Source
Journal of the Canadian Association of Gastroenterology. 5(2) (pp
E39-E56), 2022. Date of Publication: 01 Apr 2022.
Author
Abraham N.S.; Barkun A.N.; Sauer B.G.; Douketis J.; Laine L.; Noseworthy
P.A.; Telford J.J.; Leontiadis G.I.
Institution
(Abraham) Division of Gastroenterology and Hepatology, Department of
Medicine, Mayo Clinic, Scottsdale, AZ, United States
(Barkun) Division of Gastroenterology, Department of Medicine, McGill
University, Montreal, QC, Canada
(Sauer) Division of Gastroenterology and Hepatology, University of
Virginia, Charlottesville, VA, United States
(Douketis) Department of Medicine, St. Joseph's Healthcare Hamilton and
McMaster University, Hamilton, ON, Canada
(Laine) Yale School of Medicine, New Haven, CT, United States
(Laine) Virginia Connecticut Healthcare System, West Haven, CT, United
States
(Noseworthy) Department of Cardiovascular Diseases, Electrophysiology,
Mayo Clinic, Rochester, MN, United States
(Telford) Division of Gastroenterology, Department of Medicine, University
of British Columbia, Vancouver, BC, Canada
(Leontiadis) Division of Gastroenterology and Farncombe Family Digestive
Health Research Institute, Department of Medicine, McMaster University,
Hamilton, ON, Canada
Publisher
Oxford University Press
Abstract
We conducted systematic reviews of predefined clinical questions and used
the Grading of Recommendations, Assessment, Development and Evaluations
approach to develop recommendations for the periendoscopic management of
anticoagulant and antiplatelet drugs during acute gastrointestinal (GI)
bleeding and the elective endoscopic setting. The following
recommendations target patients presenting with acute GI bleeding: For
patients on warfarin, we suggest against giving fresh frozen plasma or
vitamin K; if needed, we suggest prothrombin complex concentrate (PCC)
compared with fresh frozen plasma administration; for patients on direct
oral anticoagulants (DOACs), we suggest against PCC administration; if on
dabigatran, we suggest against the administration of idarucizumab, and if
on rivaroxaban or apixaban, we suggest against andexanet alfa
administration; for patients on antiplatelet agents, we suggest against
platelet transfusions; and for patients on cardiac acetylsalicylic acid
(ASA) for secondary prevention, we suggest against holding it, but if the
ASA has been interrupted, we suggest resumption on the day hemostasis is
endoscopically confirmed. The following recommendations target patients in
the elective (planned) endoscopy setting: For patients on warfarin, we
suggest continuation as opposed to temporary interruption (1-7 days), but
if it is held for procedures with high risk of GI bleeding, we suggest
against bridging anticoagulation unless the patient has a mechanical heart
valve; for patients on DOACs, we suggest temporarily interrupting rather
than continuing these; for patients on dual antiplatelet therapy for
secondary prevention, we suggest temporary interruption of the P2Y12
receptor inhibitor while continuing ASA; and if on cardiac ASA monotherapy
for secondary prevention, we suggest against its interruption. Evidence
was insufficient in the following settings to permit recommendations. With
acute GI bleeding in patients on warfarin, we could not recommend for or
against PCC administration when compared with placebo. In the elective
periprocedural endoscopy setting, we could not recommend for or against
temporary interruption of the P2Y12 receptor inhibitor for patients on a
single P2Y12 inhibiting agent. We were also unable to make a
recommendation regarding same-day resumption of the drug vs 1-7 days after
the procedure among patients prescribed anticoagulants (warfarin or DOACs)
or P2Y12 receptor inhibitor drugs because of insufficient
evidence. Copyright © 2022 The Authors, 2022. This article is a
co-publication between the Journal of the Canadian Association of
Gastroenterology and The American Journal of Gastroenterology.

<105>
Accession Number
2034835669
Title
Paclitaxel-Coated Balloon Versus Uncoated Balloon Angioplasty for Coronary
In-Stent Restenosis: A Systematic Review and Meta-Analysis of Randomized
Controlled Trials.
Source
American Journal of Cardiology. 231 (pp 82-89), 2024. Date of Publication:
15 Nov 2024.
Author
Al-Abdouh A.; Samadi D.; Sukhon F.; Mhanna M.; Jabri A.; Alhuneafat L.;
Alabduh T.; Bizanti A.; Madanat L.; Alqarqaz M.; Paul T.K.; Kundu A.
Institution
(Al-Abdouh, Samadi) Departments of Medicine, University of Kentucky,
Lexington, Kentucky, United States
(Sukhon) Department of Cardiovascular Medicine, MetroHealth Medical
Center, Cleveland, Ohio, United States
(Mhanna) Department of Cardiovascular Medicine, University of Iowa, Iowa
City, IA, United States
(Jabri, Alqarqaz) Department of Cardiovascular Medicine, Henry Ford
Hospital, Detroit, MI, United States
(Alhuneafat) Department of Cardiovascular Medicine, University of
Minnesota, Minneapolis, MN, United States
(Alabduh) Department of Medicine, Yarmouk University, Jordan, Irbid,
Jordan
(Bizanti) Department of Medicine, Lakeland Regional Health, Lakeland, FL,
United States
(Madanat) Department of Cardiovascular Medicine, Beaumont Health System,
Royal Oak, MI, United States
(Paul) Department of Medical Education, University of Tennessee at
Nashville, Ascension St. Thomas Heath, Tennessee, United States
(Kundu) Departments of Cardiovascular Medicine, University of Kentucky,
Lexington, Kentucky, United States
Publisher
Elsevier Inc.
Abstract
In-stent restenosis (ISR) accounts for 10% of percutaneous coronary
intervention (PCI) in the United States. Paclitaxel-coated balloons (PCBs)
have been evaluated as a therapy for coronary ISR in multiple randomized
controlled trials (RCTs). We searched PubMed/MEDLINE, Cochrane Library,
and ClinicalTrials.gov (from inception to April 1, 2024) for RCTs
evaluating PCBs versus uncoated balloon angioplasty (BA) in patients with
coronary ISR. The outcomes of interest were target lesion
revascularization (TLR), major adverse cardiovascular events (MACEs),
all-cause mortality, cardiovascular mortality, myocardial infarction (MI),
and stent thrombosis. We pooled the estimates using an inverse variance
random-effects model. The effect sizes were reported as risk ratio (RR)
with 95% confidence interval (CI). A total of 6 RCTs with 1,343 patients
were included. At a follow-up ranging from 6 to 12 months from
randomization, the use of PCBs was associated with a statistically
significant decrease in TLR (RR 0.28, 95% CI 0.11 to 0.68) and MACE (RR
0.35, 95% CI 0.20 to 0.64) compared with BA for coronary ISR. However,
there was no significant difference in risk between PCBs and BA in terms
of all-cause mortality (RR 0.56, 95% CI 0.14 to 2.31), cardiovascular
mortality (RR 0.61, 95% CI 0.02 to 16.85), MI (RR 0.60, 95% CI 0.27 to
1.31), and stent thrombosis (RR 0.13, 95% CI 0.00 to 5.06). In conclusion,
this meta-analysis suggests that PCBs compared with uncoated BA for the
treatment of coronary ISR at intermediate-term follow-up of 1 year were
associated with a significant decrease in TLR and MACE without any
difference in mortality, MI, or stent thrombosis. Copyright ©
2024 Elsevier Inc.

<106>
Accession Number
2034818667
Title
Bibliometric and knowledge map analysis of one lung ventilation.
Source
Journal of Thoracic Disease. 16(9) (pp 6123-6139), 2024. Date of
Publication: 30 Sep 2024.
Author
Zhong Z.; Wan Y.; Lin Z.; Chen J.; Ye J.
Institution
(Zhong) Department of Anesthesiology, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Wan) Guangdong Provincial Key Laboratory of Proteomics, Department of
Pathophysiology, School of Basic Medical Sciences, Southern Medical
University, Guangzhou, China
(Lin, Ye) Department of Anesthesiology, Zhujiang Hospital of Southern
Medical University, Guangzhou, China
(Chen) Department of Anesthesiology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
Publisher
AME Publishing Company
Abstract
Background: One lung ventilation (OLV) is an essential method of lung
isolation to protect the ventilated lung from soiling by the contralateral
lung and obtain optimal surgical exposure in thoracic surgery. This study
aims to examine the trends and developments in OLV research from 1982 to
2024 through bibliometric analysis. Method(s): The literature on OLV
was systematically searched in the Web of Science Core Collection database
for this study. VOSviewer and CiteSpace were utilized to perform
comprehensive bibliometric and visual analyses of global
publication/trends, countries/institutions, authors/co-cited authors,
journals/co-cited journals, co-cited references, and keywords in the field
of OLV. Result(s): A total of 1,682 articles and reviews on OLV
research were identified, which showed an overall growing trend from 1982
to 2024. The United States was the leader in this field, accounting for
the largest number of publications (n=299). Among all institutions, Yonsei
University had the largest number of publications (n=23), but National
Taiwan University Hospital had the highest number of cited publications
(n=876). The papers related to OLV were mainly published in Journal of
Cardiothoracic and Vascular Anesthesia (n=147) and the most productive
author was Cheng YJ (n=15). After keywords analysis, "infants",
"dexmedetomidine", "inflammation", and "airway management" were newly
emergent research hotspots. Conclusion(s): Through bibliometric and
visualization methods, we undertook a comprehensive analysis in the field
of OLV. The United States maintained a top position in this field, the
emerging hotspots of OLV changed from basic research to clinical research
and the further innovation of OLV management. This study provides new
ideas for scholars in their future works. Copyright © AME
Publishing Company.

<107>
Accession Number
2034815302
Title
A Three-Day Prehabilitation Program is Cost-Effective for Preventing
Pulmonary Complications after Heart Valve Surgery: A Health Economic
Analysis of a Randomized Trial.
Source
Reviews in Cardiovascular Medicine. 25(9) (no pagination), 2024. Article
Number: 323. Date of Publication: September 2024.
Author
Huang W.; Wang Y.; Luo Z.; Zhang X.; Yang M.; Su J.; Guo Y.; Yu P.
Institution
(Huang, Luo, Zhang, Yang, Su, Yu) Department of Rehabilitation Medicine,
West China Hospital, Sichuan University, Sichuan, Chengdu 610041, China
(Wang, Guo) Department of Cardiac Surgery, West China Hospital, Sichuan
University, Sichuan, Chengdu 610041, China
Publisher
IMR Press Limited
Abstract
Background: While prehabilitation (pre surgical exercise) effectively
prevents postoperative pulmonary complications (PPCs), its
cost-effectiveness in valve heart disease (VHD) remains unexplored. This
study aims to evaluate the cost-effectiveness of a three-day
prehabilitation program for reducing PPCs and improving quality adjusted
life years (QALYs) in Chinese VHD patients. Method(s): A
cost-effectiveness analysis was conducted alongside a randomized
controlled trial featuring concealed allocation, blinded evaluators, and
an intention-to-treat analysis. In total, 165 patients scheduled for
elective heart valve surgery at West China Hospital were randomized into
intervention and control groups. The intervention group participated in a
three-day prehabilitation exercise program supervised by a physiotherapist
while the control group received only standard preoperative education.
Postoperative hospital costs were audited through the Hospital Information
System, and the EuroQol five-dimensional questionnaire was used to provide
a 12-month estimation of QALY. Cost and effect differences were calculated
through the bootstrapping method, with results presented in
cost-effectiveness planes, alongside the associated cost-effectiveness
acceptability curve (CEAC). All costs were denominated in Chinese Yuan
(CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022.
 Result(s): There were no statistically significant differences in
postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140)
or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034)
between the intervention and control groups. However, costs for
antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus
1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685
versus 929 CNY, 95% CI -421 to -67) were significantly lower in the
intervention group than in the control group. The CEAC indicated that the
prehabilitation program has a 92.6% and 93% probability of being
cost-effective in preventing PPCs and improving QALYs without incurring
additional costs. Conclusion(s): While the three-day prehabilitation
program did not significantly improve health-related quality of life, it
led to a reduction in postoperative hospital resource utilization.
Furthermore, it showed a high probability of being cost-effective in both
preventing PPCs and improving QALYs in Chinese patients undergoing valve
surgery. Clinical Registration Number: This trial is registered in the
Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the
registration identifier ChiCTR2000039671. Copyright © 2024 The
Author(s). Published by IMR Press.

<108>
Accession Number
2033296622
Title
The Influences of SES on Patient Choice of Doctor: A Systematic Review.
Source
American Journal of Preventive Medicine. 67(5) (pp 759-769), 2024. Date of
Publication: November 2024.
Author
Lin C.; Tu P.; Parker T.; Mella-Velazquez A.; Bier B.; Braund W.E.
Institution
(Lin, Tu, Parker, Mella-Velazquez, Bier) Policy and Organizational
Management Program, Duke University, Durham, North Carolina, United States
(Braund) Pennsylvania Department of Health, Harrisburg, Pennsylvania,
United States
Publisher
Elsevier Inc.
Abstract
Introduction: As patients become increasingly involved in healthcare
decision-making, it is important to examine the drivers behind patient
choice of doctor (PCOD); the initial decision can have lasting impacts on
patients' trust in providers and health outcomes. However, limited studies
have explored PCOD relative to socioeconomic status (SES) or health
disparity. This review identified similar preferences and varied decision
criteria in PCOD across SES groups. Method(s): PubMed, PsycINFO, Web
of Science, and relevant cross-references were searched for articles
published between January 2007-September 2022. Papers were screened using
Covidence. Included studies examined PCOD by income and/or educational
levels. Analysis was performed in 2022-2023. Result(s): From 4,449
search results, 29 articles were selected (16 countries, 14 medical
specialties, total of 32,651 participants). Individuals of higher SES
ranked physician characteristics (e.g., qualifications, empathy) or
performance more important than cost or convenience. Individuals of lower
SES often had to prioritize logistical factors (e.g., insurance coverage,
distance) due to resource constraints and gaps in knowledge or awareness
about options. Despite differing healthcare systems, such divergence in
PCOD were relatively consistent across countries. Some patients,
especially females and disadvantaged groups, favored gender-concordant
physicians for intimate medical matters (e.g., gynecologist); this
partiality was not limited to conservative cultures. Few researchers
investigated the outcomes of PCOD and indicated that lower-SES populations
inadvertently chose, experienced, or perceived lower quality of care.
 Discussion(s): Patients' decision criteria varied by SES, even under
national systems intended for universal access, indicating the impacts of
social determinants and structural inequities. Health education supporting
patient decision-making and research on how SES affects PCOD and outcomes
could help reduce health disparity. Copyright © 2024 The
Author(s)

<109>
Accession Number
2031598604
Title
Uniportal Laser-Assisted Video-Assisted Thoracoscopy (U-LA-VATS) for Lung
Metastasectomy: Technical Description, Peri-Operative Results and
Pertinent Literature Review.
Source
Journal of Clinical Medicine. 13(18) (no pagination), 2024. Article
Number: 5346. Date of Publication: September 2024.
Author
Sassorossi C.; Chiappetta M.; Nachira D.; Campanella A.; Santoro G.;
Calabrese G.; Scognamiglio C.; Napolitano A.G.; Senatore A.; Petracca
Ciavarella L.; Vita M.L.; Margaritora S.; Lococo F.
Institution
(Sassorossi, Chiappetta, Nachira, Campanella, Calabrese, Scognamiglio,
Napolitano, Senatore, Petracca Ciavarella, Vita, Margaritora, Lococo)
Thoracic Surgery, A, Gemelli University Hospital Foundation IRCCS, Rome
00168, Italy
(Nachira, Calabrese, Margaritora, Lococo) Thoracic Surgery, Catholic
University of Sacred Heart, Rome 10123, Italy
(Santoro) UOC di Chirurgia Generale, Fondazione Policlinico Universitario
A. Gemelli IRCCS, Rome 00168, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Pulmonary metastasectomy (PM) is a well-established treatment that is able
to contribute to the cure of oligometastatic cancer. Surgery should adopt
the most lung-sparing approach possible to preserve pulmonary function
(and, consequently, the quality of life) and to spare the lung for
potential additional lung resections. In this framework, laser technology
has been introduced in recent decades, but only few experiences combining
laser technology with VATS approaches have been reported till now. The
main focus of this manuscript is to report our institutional experience in
performing lung-sparing laser-assisted PM by uniportal VATS (uniportal
laser-assisted VATS: U-LA-VATS). The surgical technique and peri-operative
results from our series of patients were herein presented and compared
with the pertinent literature. Method(s): Between March 2021 and
November 2023, among 98 patients who underwent PM, a total of 24 patients
(18 men (75%); 6 women (25%); mean age 61.4 years; age range 13-83 years)
were treated with laser-assisted PM at our institution. Patients who
underwent anatomical resection were excluded for the purpose of the
analysis. The U-LA-VATS procedure adopted a modified laser-assisted lung
resection technique for performing PM via VATS. Dedicated instruments are
used, characterized by a long shape and a curved shape, with distal and
proximal articulations. A surgical laser system (Thulium + Diodo OUTPUT
30-10 W, Quanta System S.p.a., Solbiate Olona, Italy) was used, and a
550-mum sterile optical fibre conducted through a specific thoracoscopic
handpiece was introduced in the lowest part of the incision.
Peri-operative results were analysed in all cohort and compared according
to the surgical technique. Moreover, these results were compared with
those reported in the literature. Comprehensive research of the literature
was conducted on PubMed from 2000 to 2024. A review was performed and
reported in line with the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) statement. Result(s): In 12 cases (50%),
thulium laser-assisted resection was performed using uniportal
video-assisted thoracic surgery (VATS), and in the other cases (12, 50%),
a (mini)thoracotomy access was adopted. In the thoracotomy group, the mean
duration of surgery was 95 +/- 57.7 min; meanwhile, it was 73.5 +/- 35.5
in the uniportal VATS group. At the univariate analysis, this difference
resulted to be statistically significant (p value 0.025). We did not
observe intra-operative complications or remarkable malfunction of the
laser system. We also did not report major complications after surgery;
also the air-leak rate was 8.3% and 0% after thoracotomic and VATS
procedures, respectively. Surgical margins were free from disease in all
cases. Major and minor post-op complication rates were similar in both
groups. The mean hospitalization after surgery was 2.9 +/- 0.3 days for
the uniportal VATS group and 3.7 +/- 0.9 days for the thoracotomy group,
this difference being statistically significant at the univariate analysis
(p value = 0.015). Conclusion(s): U-LA-VATS is a safe and effective
procedure, able to combine a parenchymal sparing exeresis with a
mini-invasive approach. This procedure is associated with a shorter
hospital stay compared with PM performed by a thoracotomic approach.
Compared with the selected works for the review, our series is the only
one describing the use of laser resection combined with a uniportal VATS
approach. Copyright © 2024 by the authors.

<110>
Accession Number
2031179799
Title
Relationship Between Infarct Artery, Myocardial Injury, and Outcomes After
Primary Percutaneous Coronary Intervention in ST-Segment-Elevation
Myocardial Infarction.
Source
Journal of the American Heart Association. 13(18) (no pagination), 2024.
Article Number: e034748. Date of Publication: 17 Sep 2024.
Author
de Waha S.; Patel M.R.; Thiele H.; Udelson J.E.; Granger C.B.; Ben-Yehuda
O.; Kotinkaduwa L.; Redfors B.; Eitel I.; Selker H.P.; Maehara A.; Stone
G.W.
Institution
(de Waha, Thiele) Heart Center Leipzig at the University of Leipzig,
Leipzig, Germany
(Patel, Granger) Duke University Medical Center, Durham, NC, United States
(Udelson, Selker) Institute for Clinical Research and Health Policy
Studies, Tufts Medical Center, Boston, MA, United States
(Ben-Yehuda) University of California San Diego, San Diego, CA, United
States
(Kotinkaduwa, Redfors, Maehara) The Cardiovascular Research Foundation,
New York, NY, United States
(de Waha, Eitel) University Heart Center Lubeck and the German Center for
Cardiovascular Research, Lubeck, Germany
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The extent to which infarct artery impacts the extent of
myocardial injury and outcomes in patients with ST-segment-elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention is uncertain. METHODS AND RESULTS: We performed a pooled
analysis using individual patient data from 7 randomized STEMI trials in
which myocardial injury within 30 days after primary percutaneous coronary
intervention was assessed in 1774 patients by cardiac magnetic resonance
(n=1318) or technetium-99m sestamibi single-photon emission computed
tomography (n=456). Clinical follow-up was performed at a median duration
of 351 days (interquartile range, 184-368 days). Infarct size and outcomes
were assessed in anterior (infarct vessel=left anterior descending) versus
nonanterior (non-left anterior descending) STEMI. Median infarct size
(percentage left ventricular myocardial mass) was larger in patients with
anterior compared with nonanterior STEMI (19.7% [interquartile range,
9.4%-31.7%] versus 12.6% [interquartile range, 5.1%-20.5%]; P<0.001).
Patients with anterior compared with nonanterior STEMI were at higher risk
for 1-year all-cause mortality (6.2% versus 3.6%; adjusted hazard ratio
[HR], 1.66 [95% CI, 1.02-2.69]; P=0.04) and heart failure hospitalization
(4.4% versus 2.6%; adjusted HR, 1.96 [95% CI, 1.15-3.36]; P=0.01). Infarct
size was a predictor of subsequent all-cause mortality or heart failure
hospitalization in anterior STEMI (adjusted HR per 1% increase, 1.05 [95%
CI, 1.03-1.07]; P<0.001), but not in nonanterior STEMI (adjusted HR, 1.02
[95% CI, 0.99-1.05]; P=0.19). The P value for this interaction was 0.04.
 CONCLUSION(S): Anterior STEMI was associated with substantially
greater myonecrosis after primary percutaneous coronary intervention
compared with nonanterior STEMI, contributing in large part to the worse
prognosis in patients with anterior infarction. Copyright © 2024
The Author(s).

<111>
Accession Number
2031173995
Title
Effect of Denosumab or Alendronate on Vascular Calcification: Secondary
Analysis of SALTIRE2 Randomized Controlled Trial.
Source
Journal of the American Heart Association. 13(18) (no pagination), 2024.
Article Number: e032571. Date of Publication: 17 Sep 2024.
Author
Geers J.; Bing R.; Pawade T.A.; Doris M.K.; Daghem M.; Fletcher A.J.;
White A.C.; Forsyth L.; Evans E.; Kwiecinski J.; Williams M.C.; van Beek
E.J.R.; Kwak S.; Peeters F.E.C.M.; Tzolos E.; Slomka P.J.; Lucatelli C.;
Ralston S.H.; Prendergast B.; Newby D.E.; Dweck M.R.
Institution
(Geers, Bing, Pawade, Doris, Daghem, Fletcher, White, Williams, van Beek,
Tzolos, Newby, Dweck) BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, United Kingdom
(Geers) Department of Cardiology, Universitair Ziekenhuis Brussel (UZ
Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
(Fletcher) Department of Child Health, University of Glasgow, Glasgow,
United Kingdom
(Forsyth) Edinburgh Clinical Trials Unit, University of Edinburgh,
Edinburgh, United Kingdom
(Evans, Lucatelli) Edinburgh Clinical Research Facility, University of
Edinburgh, Edinburgh, United Kingdom
(Kwiecinski) Department of Interventional Cardiology and Angiology,
Institute of Cardiology, Warsaw, Poland
(Williams, van Beek) Edinburgh Imaging, University of Edinburgh,
Edinburgh, United Kingdom
(Kwak) Department of Internal Medicine, Seoul National University
Hospital, Seoul, South Korea
(Peeters) Maastricht University Medical Centre, Maastricht, Netherlands
(Slomka) Departments of Biomedical Sciences and Medicine, Cedars-Sinai
Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA,
United States
(Ralston) Institute of Genetics and Molecular Medicine, University of
Edinburgh, Edinburgh, United Kingdom
(Prendergast) St Thomas' Hospital and Cleveland Clinic London, London,
United Kingdom
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Patients with osteoporosis demonstrate increased vascular
calcification but the effect of osteoporosis treatments on vascular
calcification remains unclear. The present study aimed to examine whether
coronary or aortic calcification are influenced by denosumab and
alendronic acid treatment. METHODS AND RESULTS: In a double-blind
randomized controlled SALTIRE2 (Study Investigating the Effect of Drugs
Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis)
trial, patients with aortic stenosis were randomized 2:1:2:1 to denosumab,
placebo injection, alendronic acid, or placebo capsule. Participants
underwent serial imaging with computed tomography and 18F-sodium fluoride
positron emission tomography for the assessment of vascular calcium burden
and calcification activity, respectively. We report the prespecified
secondary analyses of 24-month change in coronary calcium score, and
12-month changes in thoracic aorta calcium score, coronary and aortic
18F-sodium fluoride activity. One hundred fifty patients with aortic
stenosis (72+/-8 years; 21% female) were randomized to denosumab (n=49),
alendronic acid (n=51), and placebo (injection n=25, capsule n=25). There
were no differences in change in coronary calcium scores between placebo
(16 [-64 to 148] Agatston units) and either denosumab (94 [0-212] Agatston
units, P=0.24) or alendronic acid (34 [-62 to 134], P=0.99). There were no
differences in change in thoracic aorta calcium scores between placebo
(132 [22-512] Agatston units) and either denosumab (118 [11-340], P=0.75)
or alendronic acid (116 [26-498] Agatston units, P=0.62). There were no
differences in changes in coronary or aortic 18F-sodium fluoride activity
between treatment groups. CONCLUSION(S): Neither alendronic acid nor
denosumab are associated with changes in the activity or progression of
coronary or aortic calcification. Osteoporosis treatments do not appear to
have major impact on vascular calcification of atherosclerosis.
REGISTRATION: https://www.clinicaltrials.gov; Unique identifier:
NCT02132026. Copyright © 2024 The Authors.

<112>
Accession Number
645409412
Title
Low Frequency Ventilation During Cardiopulmonary Bypass to Protect
Postoperative Lung Function in Cardiac Valvular Surgery: The PROTECTION
Phase II Randomized Trial.
Source
Journal of the American Heart Association. 13(19) (pp e035011), 2024. Date
of Publication: 01 Oct 2024.
Author
Rogers C.A.; Mazza G.; Maishman R.; Thirard R.; Evans J.; de Jesus S.;
Beard C.; Angelini G.; Millar A.; Jarad N.; Tomkins S.; Hillier J.;
Suleiman M.-S.; Ascione R.
Institution
(Rogers, Mazza, Maishman, Thirard, Evans, de Jesus, Beard) Bristol Trials
Centre, Bristol Medical School University of Bristol UK
(Angelini, Tomkins, Hillier, Suleiman, Ascione) Faculty of Life and Health
Sciences, Bristol Heart Institute University of Bristol UK
(Millar) Respiratory Medicine Southmead Hospital Bristol UK
(Jarad) Department of Respiratory Medicine University Hospital Bristol and
Weston NHS Foundation Trust Bristol UK
Abstract
BACKGROUND: Cardiac surgery with cardiopulmonary bypass (CPB) triggers
pulmonary injury. In this trial we assessed the feasibility, safety, and
efficacy of low frequency ventilation (LFV) during CPB in patients
undergoing valvular surgery. METHODS AND RESULTS: Patients with severe
mitral or aortic valve disease were randomized to either LFV or usual
care. Primary outcomes included release of generic inflammatory and
vascular biomarkers and the lung-specific biomarker sRAGE (soluble
receptor for advance glycation end products) up to 24 hours postsurgery.
Secondary outcomes included pulmonary function tests and 6-minute walking
test up to 8weeks postdischarge. Sixty-three patients were randomized (33
LFV versus 30 usual care). Mean age was 66.8years and 30% were female. LFV
was associated with changes of sRAGE (soluble receptor for advance
glycation end products) levels (geometric mean ratio, 3.05; [95% CI,
1.13-8.24] 10minutes post CPB, and 1.07 [95% CI, 0.64-1.79], 0.84 [95% CI,
0.55-1.27], 0.67 [95% CI, 0.42-1.07], and 0.62 [95% CI, 0.45-0.85] at 2,
6, 12, and 24hours post CPB respectively). No changes were observed for
any of the generic biomarkers. Respiratory index soon after surgery (mean
difference, -0.61 [95% CI, -1.24 to 0.015] 10minutes post end of CPB),
forced expiratory volume after 1second/forced vital capacity ratio (0.050
[95% CI, 0.007-0.093] at 6 to 8weeks pos-surgery), Forced vital capacity
alone (95% CI, -0.191L [-0.394 to 0.012]) and 6-minute walking test score
at discharge (63.2m [95% CI, 12.9-113.6]) were better preserved in the LFV
group. No other differences were noted. CONCLUSION(S): The use of LFV
during CPB in patients undergoing valvular surgery was feasible and safe
and was associated with changes in sRAGE levels along with better
preserved lung function and walking performance. These observations
warrant further investigation in larger future studies. REGISTRATION: URL:
https://www.isrctn.com; Unique Identifier: ISRCTN75795633.

<113>
Accession Number
645324692
Title
Ramipril After Transcatheter Aortic Valve Implantation in Patients Without
Reduced Ejection Fraction: The RASTAVI Randomized Clinical Trial.
Source
Journal of the American Heart Association. 13(19) (pp e035460), 2024. Date
of Publication: 01 Oct 2024.
Author
Amat-Santos I.J.; Lopez-Otero D.; Nombela-Franco L.; Peral-Disdier V.;
Gutierrez-Ibanes E.; Jimenez-Diaz V.; Munoz-Garcia A.; Del Valle R.;
Regueiro A.; Ibanez B.; Romaguera R.; Cuellas Ramon C.; Garcia B.; Sanchez
P.L.; Gomez-Herrero J.; Gonzalez-Juanatey J.R.; Tirado-Conte G.;
Fernandez-Aviles F.; Raposeiras S.; Revilla-Orodea A.; Lopez-Diaz J.;
Gomez I.; Carrasco-Moraleja M.; San Roman J.A.
Institution
(Amat-Santos, Gomez-Herrero, Revilla-Orodea, Lopez-Diaz, San Roman)
Cardiology Department Hospital Clinico Universitario de Valladolid Spain,
Spain
(Amat-Santos, Lopez-Otero, Peral-Disdier, Gutierrez-Ibanes, Munoz-Garcia,
Del Valle, Regueiro, Ibanez, Cuellas Ramon, Garcia, Sanchez,
Gonzalez-Juanatey, Fernandez-Aviles, Revilla-Orodea, Lopez-Diaz, Gomez,
Carrasco-Moraleja, San Roman) CIBERCV (Centro de Investigacion biomedica
en red-Enfermedades Cardiovasculares) Instituto de Salud Carlos III Madrid
Spain, Spain
(Lopez-Otero, Gonzalez-Juanatey) Cardiology Department, IDIS Complejo
Hospitalario Universitario de Santiago de Compostela Spain, Spain
(Nombela-Franco, Tirado-Conte) Cardiovascular Institute, Hospital Clinico
San Carlos Instituto de Investigacion Sanitaria Hospital Clinico San
Carlos (IdISSC) Madrid Spain, Spain
(Peral-Disdier) Cardiology Department, Hospital Universitari Son Espases
(HUSE) Institut d'Investigacio Sanitaria Illes Balears (IdISBa) Palma
Balearic Islands Spain, Spain
(Gutierrez-Ibanes, Fernandez-Aviles) Cardiology Department Hospital
Gregorio Maranon Madrid Spain, Spain
(Jimenez-Diaz, Raposeiras) Cardiology Department, Hospital Alvaro
Cunqueiro University Hospital of Vigo Pontevedra Spain, Spain
(Munoz-Garcia) Cardiology Department Hospital Virgen de la Victoria Malaga
Spain, Spain
(Del Valle) Cardiology Department Hospital U. Central de Asturias Oviedo
Spain, Spain
(Regueiro) Cardiology Department, Instituto Clinic Cardiovascular,
Hospital Clinic Institut d'Investigacions Biomediques August Pi i Sunyer
(IDIBAPS) Barcelona Spain, Spain
(Ibanez) Cardiology Department Fundacion Jimenez Diaz Madrid Spain, Spain
(Ibanez) Centro Nacional de Investigaciones Cardiovasculares (CNIC) Madrid
Spain, Spain
(Romaguera) Cardiology Department Hospital Bellvitge Barcelona Spain,
Spain
(Cuellas Ramon) Cardiology Department Hospital Clinico de Leon Spain,
Spain
(Garcia) Cardiology Department Hospital Vall d'Hebron Barcelona Spain,
Spain
(Sanchez) Cardiology Department Hospital Clinico de Salamanca Spain, Spain
Abstract
BACKGROUND: Patients with aortic stenosis may continue to have an
increased risk of heart failure, arrhythmias, and death after successful
transcatheter aortic valve implantation. Renin-angiotensin system
inhibitors may be beneficial in this setting. We aimed to explore whether
ramipril improves the outcomes of patients with aortic stenosis after
transcatheter aortic valve implantation. METHODS AND RESULTS: PROBE
(Prospective Randomized Open, Blinded Endpoint) was a multicenter trial
comparing ramipril with standard care (control) following successful
transcatheter aortic valve implantation in patients with left ventricular
ejection fraction >40%. The primary end point was the composite of cardiac
mortality, heart failure readmission, and stroke at 1-year follow-up.
Secondary end points included left ventricular remodeling and fibrosis. A
total of 186 patients with median age 83years (range 79-86), 58.1% women,
and EuroSCORE-II 3.75% (range 3.08-4.97) were randomized to receive either
ramipril (n=94) or standard treatment (n=92). There were no significant
baseline, procedural, or in-hospital differences. The primary end point
occurred in 10.6% in the ramipril group versus 12% in the control group
(P=0.776), with no differences in cardiac mortality (ramipril 1.1% versus
control group 2.2%, P=0.619) but lower rate of heart failure readmissions
in the ramipril group (3.2% versus 10.9%, P=0.040). Cardiac magnetic
resonance analysis demonstrated better remodeling in the ramipril compared
with the control group, with greater reduction in end-systolic and
end-diastolic left ventricular volumes, but nonsignificant differences
were found in the percentage of myocardial fibrosis. CONCLUSION(S):
Ramipril administration after transcatheter aortic valve implantation in
patients with preserved left ventricular function did not meet the primary
end point but was associated with a reduction in heart failure
re-admissions at 1-year follow-up. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique Identifier: NCT03201185.

<114>
Accession Number
645324602
Title
Surgery Versus Thrombolytic Therapy for the Management of Left-Sided
Prosthetic Valve Thrombosis Without Hemodynamic Compromise: A Systematic
Review and Meta-Analysis.
Source
Journal of the American Heart Association. 13(19) (pp e035143), 2024. Date
of Publication: 01 Oct 2024.
Author
Chopard R.; Vidoni C.; Besutti M.; Ismail M.; Ecarnot F.; Favoulet B.;
Badoz M.; Schiele F.; Perrotti A.; Meneveau N.
Institution
(Chopard, Vidoni, Besutti, Ecarnot, Favoulet, Badoz, Schiele, Meneveau)
Department of Cardiology University Hospital Besancon France, France
(Chopard, Ecarnot, Badoz, Schiele, Meneveau) SINERGIES University of
Franche-Comte Besancon France, France
(Ismail, Perrotti) Department of Thoracic and Cardio-Vascular Surgery
University Hospital Besancon France, France
Abstract
BACKGROUND: The optimal strategy in prosthetic heart valve thrombosis
(PVT) remains controversial, with no randomized trials and conflicting
observational data. We performed a systematic review and meta-analysis of
evidence comparing systemic thrombolysis and cardiac surgery in PVT.
METHODS AND RESULTS: We searched PubMed, the Cochrane Library, and Embase
for studies on treatment strategies in patients with left-sided PVT since
2000. The primary outcome was death, and the secondary outcomes were major
bleeding and thromboembolism during follow-up (International Prospective
Register of Systematic Reviews No. CRD42022384092). We identified 2298
studies, of which 16 were included, comprising 1389 patients with PVT
(mean age, 50.4+/-9.3years; 60.0% women). Among them, 67.2% were New York
Heart Association stage III/IV at admission. Overall, 48.1% were treated
with systemic thrombolysis and 51.9% with cardiac surgery. The mortality
rate was 10.8% in the thrombolysis group and 15.3% in the surgery group.
The pooled risk difference for death with systemic thrombolysis was 1.13
(exact CI, 0.74-1.79; zeta2=0.89; P<0.001) versus cardiac surgery. Rates
of both transient ischemic attack and non-central nervous system embolism
were higher in the thrombolysis group (P=0.002 and P=0.02, respectively).
Treatment success, major bleeding, and stroke were similar between groups.
Sensitivity analysis including studies that used low-dose or slow-infusion
thrombolysis showed that the mortality rate was lower, and treatment
success was higher, in patients referred to systemic thrombolysis, with
similar rates of other secondary outcomes. CONCLUSION(S): There is
evidence to suggest that thrombolysis might be the preferred option for
the management of PVT without cardiogenic shock, pending future randomized
controlled trials or larger observational studies.

<115>
Accession Number
645419968
Title
Optimal Timing for Cardiac Surgery in Patients with Infective Endocarditis
Complicated by Acute Septic Embolic Ischemic Stroke: A Systematic Review
and Metaanalysis.
Source
Neurology. Conference: Annual Meeting of the American Academy of
Neurology, AAN 2024. Denver, CO United States. 102(17 Supplement 1) (no
pagination), 2024. Date of Publication: April 2024.
Author
Asmar A.; Waseem S.; Melkumova E.
Institution
(Asmar) Houston Methodist Neurological Institute, United States
(Waseem) Dow University of Health Sciences, United States
(Melkumova) Neurology,Tufts University, School of Medicine, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To define optimal timing for cardiac surgery in infective
endocarditis (IE) patients with acute ischemic stroke (AIS) and to analyze
the risk of peri-operative stroke and mortality after early surgery (< 14
days) compared to delayed surgery (> 14 days) Background: Multiple factors
come into play when deciding the timing for surgery in patients with IE
who develop AIS such as the size of vegetations, persistent bacteremia,
area of infarction, and presence of hemorrhagic transformation. Although
current cardiothoracic surgery guidelines recommend delaying cardiac
surgery for 4 weeks in patients with IE complicated by an AIS in light of
the increased peri-operative risk of stroke and mortality, recent studies
have shown an increasing trend toward the safety of earlier surgery
Design/Methods: A comprehensive literature review was performed using
PubMed, Embase, and Cochrane, from inception till May 2023 that included
22 observational studies analyzing the risk of mortality and
peri-operative neurological complications in IE patients who underwent
cardiac surgery within 7-14 days when compared to patients operated upon
after 14 days. Comprehensive Meta-Analysis (CMA) version 3.0 was used
Results:A total of 1818 patients were included in the analysis with 758 in
the early surgery group and 1100 undergoing delayedsurgery. There was a
significantly increased risk of peri-operative mortality in the early
group (RR<=1.480, 95% [CI<= 1.124-1.949], p<=0.000), but no statistically
significant difference in the risk for peri-operative neurological
complications(RR<=1.493, [95% CI<=0.799-2.792], p<=0.975). Sub-group
analysis based on the timing of early surgery showed similar results.
 Conclusion(s):Early cardiac surgery (<14 days) in IE patients with
embolic AIS increases the risk of peri-operative mortality
withoutworsening neurological complications. Surgery performed 14 days
after AIS is not associated with an increased risk of peri-operative
mortality nor neurological complications, and therefore, can be considered
as the optimal timing but there is aneed for more supportive evidence.

<116>
Accession Number
645419631
Title
Magnitude of Effect of Low Dose Colchicine, a Newly FDA Approved Treatment
for Stroke Prevention.
Source
Neurology. Conference: Annual Meeting of the American Academy of
Neurology, AAN 2024. Denver, CO United States. 102(17 Supplement 1) (no
pagination), 2024. Date of Publication: April 2024.
Author
Escalera E.; Saver J.
Institution
(Escalera) UCLA David Geffen, School of Medicine, United States
(Saver) Neurology, UCLA Health, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To provide an updated aggregation of RCT evidence supporting
colchicine for stroke prevention. Background(s): Based on randomized
control trials showing cardiovascular benefits, including primary stroke
prevention, FDA approved low dose colchicine in June 2023 to reduce risk
of stroke, myocardial infarction, coronary revascularization, and
cardiovascular death in patients with established atherosclerotic disease
or multiple risk cardiovascular risk factors. A systematic review of RCT
stroke outcomes including most recent extended follow-up data has not been
reported. Design/Methods: We performed a formal literature search for RCTs
of long-term colchicine use in patients with atherosclerosis indications
published from 2000-2023 and study-level meta-analysis using RevMan
software. Outcomes analyzed were: stroke; MI; coronary revascularization;
cardiovascular/all-cause mortality; and combined major adverse
cardiovascular events (MACE). Heterogeneity was assessed with the I2
statistic and interaction p values and potential bias assessed with the
Risk of Bias 3.0 scale. Result(s): Four RCTs met selection criteria,
enrolling 11,285 patients (5626 colchicine, 5659 placebo), with median
follow-up of 23.3 months. Long-term colchicine doses in all trials was 0.5
mg once-daily. Colchicine treatment produced a 50% relative risk reduction
in stroke (0.43% vs 0.88%, risk ratio (RR)=0.50, 95%CI: 0.31-0.82;
p=0.006). Colchicine also produced reductions in MI (3.22% vs 4.15%),
RR=0.78, 95%CI: 0.65-0.95; p=0.01); coronary revascularization (RR=0.73,
95%CI: 0.59-0.91; p= 0.004); and MACE (RR=0.71, 95% confidence interval:
0.59-0.85; p<0.00001). However, colchicine had non-significant effect on
risk of all-cause mortality (RR: 1.17; 95%Cl: 0.91-1.51, p=0.21) and CV
death (RR: 0.90; 95%Cl: 0.60-1.34, p=0.60). No substantial heterogeneity
across trials was noted (I2 values 0%). In sensitivity analysis, adding
the one long-term trial in COVID-19 patients did not alter study findings.
 Conclusion(s): Low-dose colchicine treatment decreases stroke risk
and myocardial infarction in patients with a history of atherosclerotic
cardiovascular disease or CV risk factors. Among every 1000 patients
treated over 5 years, 11 strokes and 22 MIs are avoided. .

<117>
Accession Number
645415611
Title
A prospective study with meta-analysis of echocardiographic changes of
left ventricular function in aortic valve replacement patients.
Source
British Journal of Surgery. Conference: Annual Congress of the Association
of Surgeons of Great Britain and Ireland. Belfast United Kingdom.
111(Supplement 8) (pp viii64), 2024. Date of Publication: September 2024.
Author
Bhaskaran I.P.; Bhaskaran P.; Aslam M.
Institution
(Bhaskaran, Bhaskaran, Aslam) Imperial College, London, United Kingdom
Publisher
Oxford University Press
Abstract
Aortic valve replacement (AVR) improves cardiac function and it reverses
adverse remodeling. Measurements of left ventricular ejection fraction
(LVEF) are used to identify the patients for pharmacological therapy or
AVR. Systematic review identified the Echocardiographic indices followed
by AVR. Second part of this study compares the Echocardiographic indices
of the patients, who had followed AVR. Result(s): Overall, 145
citations were identified from the initial search, of which 43 studies
were retrieved. Later, 8 studies included in the review and 5 were
subjected to meta-analysis. There was a change in peak A-wave (MD = 7.30;
95% CI = 5.51 to 9.09), peak E-wave (MD = 3.70; 95% CI = 1.86 to 5.54)
before and after AVR. There was no change in LVEF (MD = 0.74; 95% CI =
-0.76 to 2.25), E/A ratio (MD = -0.26; 95% CI = -0.75 to 0.23), diastolic
dimension (MD = 1.10; 95% CI = -2.08 to 4.28) and systolic dimension (MD =
0.20; 95% CI = -3.41 to 3.81) among AVR cases. Prospective study includes
30 AVR cases. Of these, 23 (76.7%) males and 7 (23.3%) females with mean
age was 63.36 + 8.34. There was a change (p >0.05) in peak E-wave, peak
gradient and peak diastolic gradient from preoperative to six months after
AVR. According to literature, peak E-wave, peak gradient, and peak
diastolic gradient changed after AVR. E/A ratio, peak A-wave, E/E ratio,
LVEF, diastolic dimension, and systolic dimension were stable (p >0.05)
from preoperative to six months after AVR.

<118>
Accession Number
645415571
Title
Echocardiographic changes of left ventricular function in coronary artery
bypass graft patients - A prospective study with meta-analysis.
Source
British Journal of Surgery. Conference: Annual Congress of the Association
of Surgeons of Great Britain and Ireland. Belfast United Kingdom.
111(Supplement 8) (pp viii63), 2024. Date of Publication: September 2024.
Author
Bhaskaran I.P.; Bhaskaran P.; Aslam M.
Institution
(Bhaskaran, Bhaskaran, Aslam) Imperial College, London, United Kingdom
Publisher
Oxford University Press
Abstract
Coronary artery bypass graft (CABG) improves left ventricular function and
reverses adverse remodelling. This has resulted in improved survival rates
and decreased the incidence of cardiac events. Systematic review
identified the Echocardiographic (ECHO) indices followed by CABG from the
published data. The second part of this study compares the ECHO index of
the patients, who had CABG. Result(s): Overall, 191 citations were
identified from the initial search, of which 43 studies were retrieved.
Later, 8 studies included in the review and 6 were subjected to
meta-analysis. There was a change in E/A Ratio (MD = -0.33; 95% CI = -0.42
to -0.25), Peak A-Wave (MD = 0.57; 95% C.I = 0.20 to 0.94), and E/E' Ratio
(MD = -3.80; 95% CI = -4.87 to -2.73), Peak E-Wave (MD = 0.26; 95% CI =
-0.08 to 0.60), Left ventricular ejection fraction (LVEF) (MD = -0.43; 95%
CI = -1.79 to 0.93), diastolic dimension (MD = 0.12; 95% CI = -0.00 to
0.23). However, There was no change in systolic dimension (MD = 0.10; 95%
CI = -0.04 to 0.24) among CABG cases. The prospective study includes 30
CABG cases. Of these, 23 (76.7%) males and 7 (23.3%) females with mean age
was 62.12 + 8.16. There was a change (p <0.05) LVEF, peak systolic
gradient (PSG) from pre operative to six months after CABG.
 Conclusion(s): In spite the changes in E/A Ratio, Peak A-Wave, E/E'
Ratio, LVEF and PSG are the most important echocardiographic indices
associated with CABG.

<119>
Accession Number
2034785389
Title
Safety implications of mask use: A systematic review and evidence map.
Source
BMJ Evidence-Based Medicine. (no pagination), 2024. Article Number:
bmjebm-2024-113028. Date of Publication: 2024.
Author
Farah W.; Abusalih M.F.; Hasan B.; Lees E.H.; Fleti F.; Elkhatib W.Y.;
Johnson B.D.; Toups G.; Wolf M.; Murad M.H.
Institution
(Farah, Abusalih, Hasan, Fleti, Murad) Evidence-Based Practice Center,
Mayo Clinic, Rochester, MN, United States
(Farah) Division of Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, MN, United States
(Abusalih, Hasan, Lees, Fleti, Elkhatib, Toups, Wolf, Murad) Division of
Public Health, Infectious Diseases, and Occupational Medicine, Mayo
Clinic, Rochester, MN, United States
(Johnson) Division of Preventive Cardiology, Mayo Clinic, Rochester, MN,
United States
Publisher
BMJ Publishing Group
Abstract
Background: Widespread use of respiratory protection masks has become a
critical component of public health response. Objective(s): This
systematic review synthesises the evidence on the acute physiological,
cognitive and psychological impacts associated with different types of
masks and provides an evidence map of research gaps. Method(s): A
comprehensive search from 2000 to 2023 was conducted across multiple
databases (MEDLINE, EMBASE, Cochrane databases, Scopus and PubMed). An
umbrella systematic overview was conducted for physiological outcomes
using existing systematic reviews. We conducted de novo systematic reviews
for cognitive and psychological outcomes. Pairs of independent reviewers
determined eligibility, extracted data and assessed risk of bias.
Certainty at an outcome level was appraised using the Grading of
Recommendations Assessment, Development and Evaluation approach.
 Result(s): The search resulted in 13 370 potential citations, leading
to the inclusion of nine systematic reviews for physiological outcomes (87
primary studies) and 10 primary studies for cognitive and psychological
outcomes (3815 participants), with the majority of participants being
healthy adults. Studies evaluating physiological outcomes demonstrated
that various types of masks have little to no significant difference in
heart rate (surgical mask (mean difference (MD): 0.96 (-1.01 to 2.93)),
N95 mask (MD: 1.63 (-2.79 to 6.05)) and cloth mask (MD: -0.94 (-6.39 to
4.52))) or respiratory rate during rest or exercise (surgical mask (MD:
-1.35 (-3.00 to 0.29)), N95 mask (MD: 0.10 (-3.10 to 3.29)) and cloth mask
(MD: -2.57 (-6.44 to 1.29)) (low certainty for most outcomes)). Mask use
may be associated with very small changes in minute ventilation (surgical
mask (MD: -13.9 (-20.30 to -7.53)) and N95 mask (MD: -16.3 (-28.7 to
-3.9))), tidal volume (surgical mask (MD: -0.14 (-0.23 to -0.05)) and N95
mask (MD: -0.10 (-0.33 to 0.13))), oxygen saturation (surgical mask (MD:
-0.59% (-0.87 to -0.30)), N95 mask (MD: -0.35% (-0.75 to 0.05)) and cloth
mask (MD: -0.50% (-1.23; 0.24))), carbon dioxide partial pressure
(surgical mask (standardised MD (SMD): 1.17 (0.70 to 1.64)) and N95 mask
(SMD: 0.43 (0.08 to 0.79))) and exercise performance (surgical mask (SMD:
-0.12 (-0.39 to 0.15)), N95 mask (SMD: -0.42 (-0.76 to -0.08)) and cloth
mask (SMD: -0.26 (-0.54 to 0.02)) (low certainty for most outcomes)).
Studies evaluating cognitive outcomes showed mixed results. Some studies
reported reduced mental workload, and others showed no significant effect
or decreased performance. The impact on attention, errors and reaction
time was variable. These studies were small and at moderate to high risk
of bias. Evidence was insufficient to estimate the effect of mask use on
psychological outcomes (claustrophobia, depression and anxiety) as these
studies were small, non-longitudinal and at high risk of bias.
 Conclusion(s): This evidence map provides a comprehensive insight
into the multifaceted impact of respiratory protection mask use, and
highlights the limited certainty in the available body of evidence. This
evidence map supports the development of future research agenda.
 Copyright © Author(s) (or their employer(s)) 2024.

<120>
Accession Number
2034768992
Title
Effect of Delayed Remote Ischemic Preconditioning on Acute Kidney Injury
and Outcomes in Patients Undergoing Cardiac Surgery: A Randomized Clinical
Trial.
Source
Circulation. (no pagination), 2024. Date of Publication: 2024.
Author
Jia P.; Ji Q.; Zou Z.; Zeng Q.; Ren T.; Chen W.; Yan Z.; Shen D.; Li Y.;
Peng F.; Su Y.; Xu J.; Shen B.; Luo Z.; Wang C.; Ding X.
Institution
(Jia, Zou, Zeng, Ren, Chen, Yan, Shen, Li, Peng, Xu, Shen, Ding)
Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai
Medical Center of Kidney, Shanghai Key Laboratory of Kidney and Blood
Purification, China
(Ji, Wang) Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan
University, Shanghai, China
(Su, Luo) Cardiac Intensive Care Center, Zhongshan Hospital, Fudan
University, Shanghai, China
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Remote ischemic preconditioning (RIPC) has 2 time windows for
organ protection: acute and delayed. Previous studies have mainly focused
on the organoprotective effects of acute RIPC. We aimed to determine
whether delayed RIPC can reduce the occurrence of acute kidney injury
(AKI) and postoperative complications in patients undergoing cardiac
surgery. METHOD(S): This prospective, single-center, double-blind,
randomized controlled trial involved 509 patients at high risk for AKI who
were scheduled for elective cardiac surgery requiring cardiopulmonary
bypass. Patients were randomized to receive RIPC (4 cycles of 5-minute
inflation and 5-minute deflation on 1 upper arm with a blood pressure
cuff) 24 hours before surgery or a sham condition (control group) that was
induced by 4 cycles of 5-minute inflation to a pressure of 20 mm Hg
followed by 5-minute cuff deflation. The primary end point was the
incidence of AKI within the prior 7 days after cardiac surgery. The
secondary end points included renal replacement therapy during
hospitalization, change in urinary biomarkers of AKI and markers of
myocardial injury, duration of intensive care unit stay and mechanical
ventilation, and occurrence of nonfatal myocardial infarction, stroke, and
all-cause mortality by day 90. RESULT(S): A total of 509 patients
(mean age, 65.2+/-8.2 years; 348 men [68.4%]) were randomly assigned to
the RIPC group (n=254) or control group (n=255). AKI was significantly
reduced in the RIPC group compared with the control group (69/254 [27.2%]
versus 90/255 [35.3%]; odds ratio, 0.68 [95% CI, 0.47-1.00]; P=0.048).
There were no significant between-group differences in the secondary end
points of perioperative myocardial injury (assessed by the concentrations
of cardiac troponin T, creatine kinase myocardial isoenzyme, and NT-proBNP
[N-terminal pro-brain natriuretic peptide]), duration of stay in the
intensive care unit and hospital, and occurrence of nonfatal myocardial
infarction, stroke, and all-cause mortality by day 90. CONCLUSION(S):
Among high-risk patients undergoing cardiac surgery, delayed RIPC
significantly reduced the occurrence of AKI. REGISTRATION: URL:
https://www.chictr.org.cn; Unique identifier:
ChiCTR2000035568. Copyright © 2024 The Authors. Circulation is
published on behalf of the American Heart Association, Inc., by Wolters
Kluwer Health, Inc.

<121>
Accession Number
2034691094
Title
Interatrial Shunt Treatment for Heart Failure: The Randomized RELIEVE-HF
Trial.
Source
Circulation. (no pagination), 2024. Date of Publication: 2024.
Author
Stone G.W.; Lindenfeld J.; Rodes-Cabau J.; Anker S.D.; Zile M.R.; Kar S.;
Holcomb R.; Pfeiffer M.P.; Bayes-Genis A.; Bax J.J.; Bank A.J.; Costanzo
M.R.; Verheye S.; Roguin A.; Filippatos G.; Nunez J.; Lee E.C.;
Laufer-Perl M.; Moravsky G.; Litwin S.E.; Prihadi E.; Gada H.; Chung E.S.;
Price M.J.; Thohan V.; Schewel D.; Kumar S.; Kische S.; Shah K.S.; Donovan
D.J.; Zhang Y.; Eigler N.L.; Abraham W.T.
Institution
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Lindenfeld) Advanced Heart Failure, Vanderbilt Heart and Vascular
Institute, Nashville, TN, United States
(Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, Quebec
City, Canada
(Rodes-Cabau) Clinic Barcelona, Spain
(Anker) Department of Cardiology (CVK), German Heart Center Charite,
Institute of Health Center for Regenerative Therapies (BCRT), German
Centre for Cardiovascular Research (DZHK) partner site Berlin, Charite
University, Germany
(Zile) Division of Cardiology, Medical University of South Carolina, Ralph
H. Johnson Department of Veterans Affairs Medical Center, Charleston,
United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Holcomb) MinneapolisMNUnited States
(Pfeiffer) Penn State Heart and Vascular Institute, Hershey, PA, United
States
(Bayes-Genis) University Hospital Germans Trias and Pujol de Badalona,
Spain
(Bax) Leiden University Medical Center, Netherlands
(Bank) Allina Health Minneapolis Heart Institute-St-Paul, United States
(Costanzo) Midwest Cardiovascular Institute, Naperville, IL, United States
(Verheye, Prihadi) Antwerp Cardiovascular Center, ZNA Middelheim, Belgium
(Roguin) Hillel Yaffe Medical Center, Hadera, Israel
(Filippatos) National and Kapodistrian University of Athens, Attikon
University Hospital, Greece
(Nunez) Hospital Clinico Universitario, INCLIVA, University of Valencia,
Spain
(Lee) Rochester Regional Health, NY, United States
(Laufer-Perl) Tel Aviv Sourasky Medical Center, The Tel Aviv School of
Medicine, Tel Aviv University, Israel
(Moravsky) Assaf HaRofeh Medical Center, Be'er Ya'akov, Israel
(Litwin) Medical University of South Carolina, Charleston Antwerp
Cardiovascular Center, ZNA Middelheim Hospital, Belgium
(Gada) UPMC Pinnacle, Harrisburg, PA, United States
(Chung) The Christ Hospital Health Network, Cincinnati, OH, United States
(Price) Scripps Clinic, La Jolla, CA, United States
(Thohan) Mission Health, Ashville, NC, United States
(Schewel) Marienkrankenhaus, Hamburg, Germany
(Kumar) The University of Texas Medical Center-Houston, United States
(Kische) Vivantes Hospital Friedrichshain, Berlin, Germany
(Shah) University of Utah Health, Salt Lake City, United States
(Donovan) Methodist Cardiology Clinic of San Antonio, TX, United States
(Zhang) Cardiovascular Research Foundation, New York, NY, United States
(Eigler) V-Wave Ltd, Caesarea, Israel
(Eigler) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Abraham) Division of Cardiovascular Medicine, Davis Heart and Lung
Research Institute, The Ohio State University Wexner Medical Center,
Columbus, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: An interatrial shunt may provide an autoregulatory mechanism
to decrease left atrial pressure and improve heart failure (HF) symptoms
and prognosis. METHOD(S): Patients with symptomatic HF with any left
ventricular ejection fraction (LVEF) were randomized 1:1 to transcatheter
shunt implantation versus a placebo procedure, stratified by reduced
(<=40%) versus preserved (>40%) LVEF. The primary safety outcome was a
composite of device-related or procedure-related major adverse
cardiovascular or neurological events at 30 days compared with a
prespecified performance goal of 11%. The primary effectiveness outcome
was the hierarchical composite ranking of all-cause death, cardiac
transplantation or left ventricular assist device implantation, HF
hospitalization, outpatient worsening HF events, and change in quality of
life from baseline measured by the Kansas City Cardiomyopathy
Questionnaire overall summary score through maximum 2-year follow-up,
assessed when the last enrolled patient reached 1-year follow-up,
expressed as the win ratio. Prespecified hypothesis-generating analyses
were performed on patients with reduced and preserved LVEF.
 RESULT(S): Between October 24, 2018, and October 19, 2022, 508
patients were randomized at 94 sites in 11 countries to interatrial shunt
treatment (n=250) or a placebo procedure (n=258). Median (25th and 75th
percentiles) age was 73.0 years (66.0, 79.0), and 189 patients (37.2%)
were women. Median LVEF was reduced (<=40%) in 206 patients (40.6%) and
preserved (>40%) in 302 patients (59.4%). No primary safety events
occurred after shunt implantation (upper 97.5% confidence limit, 1.5%;
P<0.0001). There was no difference in the 2-year primary effectiveness
outcome between the shunt and placebo procedure groups (win ratio, 0.86
[95% CI, 0.61-1.22]; P=0.20). However, patients with reduced LVEF had
fewer adverse cardiovascular events with shunt treatment versus placebo
(annualized rate 49.0% versus 88.6%; relative risk, 0.55 [95% CI,
0.42-0.73]; P<0.0001), whereas patients with preserved LVEF had more
cardiovascular events with shunt treatment (annualized rate 60.2% versus
35.9%; relative risk, 1.68 [95% CI, 1.29-2.19]; P=0.0001;
P<inf>interaction</inf><0.0001). There were no between-group differences
in change in Kansas City Cardiomyopathy Questionnaire overall summary
score during follow-up in all patients or in those with reduced or
preserved LVEF. CONCLUSION(S): Transcatheter interatrial shunt
implantation was safe but did not improve outcomes in patients with HF.
However, the results from a prespecified exploratory analysis in
stratified randomized groups suggest that shunt implantation is beneficial
in patients with reduced LVEF and harmful in patients with preserved
LVEF. Copyright © 2024 The Authors.

<122>
Accession Number
645425002
Title
Comparison of Ultrathin- Versus Thin-Strut Stents in Patients With High
Bleeding Risk PCI: Results From the COMPARE 60/80 HBR Trial: An
Open-Label, Randomized, Controlled Trial.
Source
Circulation. Cardiovascular interventions. (pp e014042), 2024. Date of
Publication: 01 Oct 2024.
Author
Smits P.C.; Tonino P.A.L.; Hofma S.H.; van Kuijk J.-P.; Spano F.; Al
Mafragi A.; Pisters R.; Polad J.; Bogaerts K.; Oemrawsingh R.M.; Paradies
V.
Institution
(Smits, Paradies) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Smits) Center of European Cardiovascular Research, Massy, France
(Tonino) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Hofma) Department of Cardiology, Medical Center Leeuwarden, Netherlands
(van Kuijk) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Spano) Department of Cardiology, Meander Hospital, Amersfoort,
Netherlands
(Al Mafragi) Department of Cardiology, Zorgsaam Hospital, Terneuzen,
Netherlands
(Pisters) Department of Cardiology, Rijnstate Hospital, Arnhem,
Netherlands
(Polad) Department of Cardiology, Jeroen Bosch Hospital, Den Bosch,
Netherlands
(Bogaerts) Department of Public Health and Primary Care, KU Leuven,
Hasselt, Belgium
(Oemrawsingh) Department of Cardiology, Albert Schweitzer Hospital,
Dordrecht, South Africa
Abstract
BACKGROUND: No randomized data exist on ultrathin-strut stents in patients
at high bleeding risk (HBR) undergoing an abbreviated dual antiplatelet
therapy after coronary stenting. The aim of this study was to compare the
safety and effectiveness of the ultrathin-strut biodegradable-polymer
sirolimus-eluting Supraflex Cruz stent with the thin-strut
biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent in
patients at HBR with abbreviated dual antiplatelet therapy after stenting.
 METHOD(S): In the investigator-initiated, randomized, open-label
COMPARE 60/80 HBR trial (Comparison of the Supraflex Cruz 60 Micron Stent
Strut Versus the Ultimaster Tansei 80 Micron Stent Strut in HBR
Percutaneous Coronary Intervention Population), 741 patients at HBR
according to the Academic Research Consortium HBR criteria were randomized
to receive either the ultrathin-strut biodegradable-polymer
sirolimus-eluting Supraflex Cruz stent or thin-strut biodegradable-polymer
sirolimus-eluting Ultimaster Tansei stent. Dual antiplatelet therapy was
recommended according to the applicable guidelines and trial data for
patients at HBR. The primary outcome was net adverse clinical events, the
composite of cardiovascular death, myocardial infarction, target vessel
revascularization, stroke, and major bleeding, and was powered for
noninferiority with an absolute margin of 4.0% at 1-sided 2.5% alpha.
 RESULT(S): Between September 2020 and August 2022, 371 patients were
randomized to the ultrathin-strut biodegradable-polymer sirolimus-eluting
Supraflex Cruz stent and 370 patients to the thin-strut
biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent at 11
sites in the Netherlands. At 1 year, the primary outcome was observed in
56 (15.4%) patients in the ultrathin-strut biodegradable-polymer
sirolimus-eluting Supraflex Cruz stent group and 61 (17.1%) in the
thin-strut biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent
group (risk difference, -1.65%; upper boundary of the 1-sided 95% CI,
3.74; P=0.02 for noninferiority at a 0.025 significance level and P=0.55
for 2-sided superiority at a 0.05 significance level). CONCLUSION(S):
Among patients at HBR with abbreviated dual antiplatelet therapy
post-stenting, the use of an ultrathin-strut biodegradable-polymer
sirolimus-eluting Supraflex Cruz stent was noninferior compared with the
use of a thin-strut biodegradable-polymer sirolimus-eluting Ultimaster
Tansei stent. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT04500912.

<123>
Accession Number
2034771641
Title
The use of tranexamic acid in paediatric adenotonsillectomy - A systematic
review and meta-analysis.
Source
International Journal of Pediatric Otorhinolaryngology. 186 (no
pagination), 2024. Article Number: 112110. Date of Publication: November
2024.
Author
Hannigan A.; Bumbak P.; Brennan-Jones C.G.; Hintze J.
Institution
(Hannigan, Bumbak, Brennan-Jones) Department of Otolaryngology, Perth
Children's Hospital, Perth, WA, Australia
(Brennan-Jones) Telethon Kids Institute, The University of Western
Australia, Australia
(Brennan-Jones) Faculty of Health Sciences, Curtin University, WA,
Australia
(Hintze) Department of Otolaryngology - Head and Neck Surgery, Mayo
Clinic, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Tonsillectomy and adenoidectomy (AT) are two of the most
commonly performed ENT procedures in children, with over 500,000 cases
performed annually in the United States. Whilst generally considered a
safe and well-tolerated operation, it is not without its risks and
complications including pain, nausea, anorexia and most importantly
bleeding and post-tonsillectomy haemorrhage (PTH). Whilst tranexamic acid
(TXA) has a proven benefit in reducing bleeding and transfusion
requirements in patients undergoing trauma, spinal and cardiac surgery;
the effectiveness, timing and safety of its application in paediatric
tonsillectomy has not yet been established. Aims, objectives &
significance: To date, there has been no published systematic review of
the literature specifically looking at paediatric patients undergoing AT,
despite a massive surge in popularity of the use of TXA perioperatively.
The aim of this study is therefore to systematically review the current
literature and collate evidence regarding the efficacy and safety of using
TXA to reduce bleeding in children undergoing tonsillectomy and/or
adenoidectomy. Method(s): A structured search of bibliographic
databases (MEDLINE, EMBASE, PubMed, CINAHL, Cochrane CENTRAL) was
undertaken to retrieve randomised controlled trials, non-randomised
case-control studies and ongoing clinical trials that describe the use of
TXA in paediatric patients undergoing AT. The following search terms (and
their variations) were used as both medical subject headings (MeSH terms)
and text words: tranexamic acid, bleeding, tonsillectomy, adenoidectomy,
paediatrics. To ensure that all relevant data was captured, the search did
not contain any restrictions on language or publication time. Data
extraction and risk of bias assessment was performed independently and in
duplicate. Result(s): This review identified and included a total of
eight studies (n = 1315). Five studies reported on the intravenous use of
TXA (n = 531) whilst three studies reported on the topical use of TXA (n =
784), and these were analysed separately. The intravenous use of TXA did
not reduce intraoperative blood loss significantly (95 % CI: -0.1 to 0.33
p = 0.28) and there was not enough information to analyse the effect on
PTH in these studies. Topical TXA led to a significant reduction in both
intraoperative blood loss (95 % CI 0.11 to 5.31, p = 0.04) and post
operative bleeding rates (RR 0.04, 95 % CI 0.01 to 0.08, P = 0.02).
 Conclusion(s): The results of this systematic review and
meta-analysis suggest that TXA administered via the intravenous route does
not reduce perioperative bleeding associated with AT in paediatric
patients. However, when topical TXA is used intraoperatively at the
surgical site in paediatric patients undergoing adenoidectomy alone, there
was a significant reduction in both intraoperative blood loss and post
operative bleeding. TXA appears to be a safe and well-tolerated drug in
the paediatric population with no adverse effects reported in this review.
Nevertheless, further large and well-designed randomised controlled trials
are needed to investigate the risks and benefits of TXA in paediatric AT
with a particular focus on its use topically and in association with newly
developed surgical equipment. Copyright © 2024 Elsevier B.V.

<124>
Accession Number
2031555022
Title
Preoperative bioelectrical impedance, measured phase angle, and hand-grip
strength as predictors of postoperative outcomes in patients undergoing
cardiac surgery: a systematic review.
Source
BMC Cardiovascular Disorders. 24(1) (no pagination), 2024. Article Number:
515. Date of Publication: December 2024.
Author
Arero A.G.; Dassie G.A.
Institution
(Arero, Dassie) Department of Public Health, Adama Hospital Medical
College, Baltimore, MD, United States
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative problems are a major danger for patients after
heart surgery. Predicting postoperative outcomes for cardiac surgery is
limited by current preoperative evaluations. Handgrip strength (HGS)
testing and bioelectrical impedance analysis (BIA) may provide extra ways
to identify individuals at risk of surgical problems, enhancing risk
assessment and results. Objective(s): The purpose of this systematic
review is to assess the utility of measured phase angle (PA), HGS, and
bioelectrical impedance as perioperative risk markers in adult patients
undergoing elective heart surgery. Method(s): The PRISMA principles
were followed in this review. We searched all available electronic
databases, including the Science Direct search engine and PubMed, MEDLINE,
EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, Google
Scholar, Scopus, and the Science Direct search engine, from their creation
to the present, as well as the medRxiv pre-print site. We considered
studies with adult subjects undergoing elective heart surgery who were
monitored for problems after surgery and had perioperative BIA and HGS
testing. Result(s): As a result, out of the 1544 pieces of research
that were discovered, eight studies were deemed suitable for inclusion in
the review and supplied data from 2781 people. The findings demonstrated a
substantial correlation between poor preoperative PA and a higher risk of
serious postoperative morbidity, as well as prolonged hospital stays.
Furthermore, poor HGS and low PA were linked to greater death rates.
Additionally, there was a strong correlation found between low PA and HGS
and longer stays in the ICU, as well as an increased chance of dying from
all causes in a year. In conclusion these results imply that preoperative
HGS and PA may be significant indicators of postoperative results and may
assist in identifying patients who are more vulnerable to problems and
death. Copyright © The Author(s) 2024.

<125>
Accession Number
2034736008
Title
Feasibility Randomized Controlled Trial of Face-to-Face Counseling and
Mobile Phone Messages Compared to Usual Care for Smokeless Tobacco
Cessation in Indian Primary Care: Project CERTAIN.
Source
Nicotine and Tobacco Research. 26(10) (pp 1385-1393), 2024. Date of
Publication: 01 Oct 2024.
Author
Panda R.; Omar R.; Hunter R.; Lahoti S.; Prabhu R.R.; Vickerstaff V.;
Satapathy D.M.; Das S.; Nazareth I.
Institution
(Panda, Lahoti, Prabhu) Department of Health Policy and Research, Public
Health Foundation of India, New Delhi, India
(Omar) Department of Statistical Science, University College London,
London, United Kingdom
(Hunter, Nazareth) Department of Primary Care and Population Health,
University College London, London, United Kingdom
(Vickerstaff) PRIMENT Clinical Trials Unit, Department of Primary Care and
Population Health, University College London, London, United Kingdom
(Satapathy, Das) Department of Community Medicine, MKCG Medical College,
Odisha, Berhampur, India
Publisher
Oxford University Press
Abstract
Introduction: Smokeless tobacco (SLT) use in low- and middle-income
countries has adverse health consequences. We hypothesize that it is
feasible to test an intervention of mobile phone messages and face-to-face
counseling sessions for SLT cessation in India. Aims and Methods: We
conducted an exploratory, individual parallel two group, randomized
controlled trial (RCT), with baseline and end-point (3 months from
randomization) assessments in urban primary health centers in Odisha,
India. A total of 250 current (i.e., users in the last 3 months) SLT users
or dual users (ie, smokers and SLT users) were recruited to the trial (125
in each group). Participants were randomized to either routine care,
face-to-face counseling, and reminder mobile messages or routine care
only. The primary outcomes were to assess the feasibility of running a
full RCT including recruitment, compliance, and retention. Result(s):
A total of seven (77.8%) out of nine primary care centers took part in the
trial. Out of the 315 SLT users invited to participate, 250 provided
consent and were randomized [79.4% (95% CI: 74.5, 83.7)]. Out of the 250
randomized SLT users, 238 [95% (95% CI: 91.8, 97.5)] were followed up at 3
months (117 in the intervention group and 121 in the control group). Of
the participants in the intervention group, 74 (63.8%) reported that they
received the mobile messages. Conclusion(s): This exploratory trial
demonstrated the feasibility of delivering and evaluating an intervention
of mobile phone messages and face-to-face counseling for SLT users in
Indian primary care in a full randomized trial Implications: This study
found that combining mobile messages with face-to-face counseling for
smokeless tobacco users visiting primary health care settings in India is
feasible in terms of recruitment of users, compliance with the
intervention, and retention of study participants within the trial. The
biochemically verified smokeless tobacco abstinence rate was higher in the
intervention group compared with the control group. There was poor
agreement between self-reported tobacco cessation and the measured
salivary cotinine in smokeless tobacco users. The findings support the
feasibility and acceptability of the intervention signaling the need for a
larger clinical trial to test the effectiveness of the
intervention. Copyright © The Author(s) 2024. Published by Oxford
University Press on behalf of the Society for Research on Nicotine and
Tobacco. All rights reserved.

<126>
Accession Number
2031173042
Title
Safety and Efficacy of Adipose-Derived Mesenchymal Stem Cell Therapy for
Ischemic Heart Disease: A Systematic Review.
Source
Arquivos Brasileiros de Cardiologia. 121(9) (no pagination), 2024. Article
Number: e20230830. Date of Publication: 2024.
Author
Giugni F.R.; Giugni M.O.V.; Pinesi H.T.; Habrum F.C.; Laranjeira L.N.;
Sady E.R.R.; Suzumura E.A.; Gowdak L.H.W.; Krieger J.E.
Institution
(Giugni) The University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Giugni, Giugni, Pinesi, Habrum, Gowdak, Krieger) Instituto do Coracao
InCor, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade
de Sao Paulo, SP, Sao Paulo, Brazil
(Giugni) Baylor University Medical Center at Dallas, Dallas, TX, United
States
(Laranjeira, Sady, Krieger) Hospital do Coracao (HCor), SP, Sao Paulo,
Brazil
(Suzumura) Departmento de Medicina Preventiva, Faculdade de Medicina
FMUSP, Universidade de Sao Paulo, SP, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cardiologia
Abstract
Background: Cell therapy using adipose-derived mesenchymal stem cells
(ADSCs) shows great potential as a treatment for cardiovascular diseases.
 Objective(s): We conducted a systematic review to describe the safety
and efficacy of ADSCs in ischemic heart disease. Method(s): We
searched PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and LILACS (from
inception to March 2024) for clinical studies involving ADSCs in patients
with ischemic heart disease. We excluded studies involving patients with
other types of heart disease, studies using mesenchymal stem cells derived
from other tissues, as well as ongoing studies. Two independent reviewers
screened the retrieved citations, extracted relevant data, and assessed
the risk of bias in the included trials, using the Cochrane Collaboration
criteria modified by McMaster University and Methodological Index for
Non-Randomized Studies (MINORS). We used a narrative synthesis to present
the results. Result(s): Ten studies (comprising 29 publications) met
our inclusion criteria, including 8 randomized controlled trials and 2
uncontrolled trials. No severe adverse events associated with ADSC therapy
were reported. While most efficacy endpoints did not reach statistical
significance, there were reports of improved ischemic area, functional
capacity, symptoms, and contractility in patients treated with ADSCs.
 Conclusion(s): The findings from our review suggest that ADSC therapy
is generally safe for patients with ischemic heart disease. However,
further investigation is warranted to confirm its efficacy, particularly
with larger clinical trials and in specific conditions where improvements
in microcirculation may have a notable impact on clinical
outcomes. Copyright © 2024, Sociedade Brasileira de Cardiologia.
All rights reserved.

<127>
Accession Number
2034803978
Title
Acetylsalicylic acid alone or in combination with either enoxaparin or
unfractionated heparin for postoperative thromboprophylaxis in coronary
artery bypass surgery patients. A randomised clinical trial assessing
surrogate outcomes.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2024. Date of
Publication: 2024.
Author
Lorenzen U.S.; Arendrup H.; Johansson P.I.; Jakobsen J.C.
Institution
(Lorenzen) Department of Vascular Surgery, Rigshospitalet, Copenhagen,
Denmark
(Arendrup) Department of Thoracic Surgery, Rigshospitalet, Copenhagen,
Denmark
(Johansson) CAG Center for Endotheliomics, Rigshospitalet, Copenhagen,
Denmark
(Jakobsen) Copenhagen Trial Unit, Capitol Region, Copenhagen, Denmark
(Jakobsen) Department of Regional Health Research, The Faculty of Heath
Sciences, University of Southern Denmark, Denmark
(Johansson) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Introduction: Coronary artery bypass graft surgery has considerable
effects on patient haemostasis. Heparins as thromboprophylaxis may be
beneficial but may also increase the risk of bleeding complications.
 Objective(s): To assess the effects of heparins on haemostasis in
post-coronary artery bypass graft patients. Method(s): Across one
year, we randomised 60 participants scheduled for an elective coronary
artery bypass graft-procedure with or without aortic valve replacement.
The trial was a prospective, open-label (though blinded for the
laboratory), randomised, single-centre trial with three intervention
groups (n = 20 in each): group 1 received acetylsalicylic acid, group 2
received subcutaneous low molecular weight heparin and acetylsalicylic
acid, and group 3 received intravenous unfractionated heparin and
acetylsalicylic acid. Primary outcomes were platelet activation
(Multiplate ASPI-test) and time to clot initiation (TEG R-time). We
secondly assessed several additional Multiplate and TEG parameters.
 Result(s): Group 3 (intravenous unfractionated heparin) compared with
group 1 (acetylsalicylic acid alone) showed evidence of 1) increased clot
initiation time (R-time + 0.9 min; 95 % CI: +0.4 to +1.4 min; P = 0.009),
and 2) decreased 30-min lysis (-1.3 %; 95 % CI: -2.1 to -0.5 %; P = 0.02).
The remaining analyses of primary and secondary outcomes showed no
evidence of a difference between the three groups. Discussion(s):
Intravenous unfractionated heparins may increase the clot initiation time
post-operatively after coronary artery bypass graft surgery and reduce
lysis. Otherwise, there seems to be no effect of low molecular weight or
unfractionated heparin on haemostatic parameters after coronary artery
bypass surgery patients. Copyright © 2024 The Authors

<128>
Accession Number
2034803706
Title
Imaging-guided PCI improves outcomes in patients with multivessel disease
a meta-analysis of randomized and observational trials comparing treatment
of ACS.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2024. Date of
Publication: 2024.
Author
Saganowich J.; Powell J.; Mixon T.A.; Exaire J.E.; Otsuki H.; Fearon W.;
Widmer R.J.
Institution
(Saganowich, Powell, Mixon, Widmer) Texas A&M School of Medicine, Bryan,
TX, United States
(Mixon, Exaire, Widmer) Division of Cardiology, Department of Internal
Medicine Baylor Scott and White, Temple, TX, United States
(Otsuki, Fearon) Division of Cardiovascular Medicine and Stanford
Cardiovascular Institute, Stanford University, CA, United States
(Widmer) Medical Director of the Baylor Scott and White Cath/EP Labs &
Research Institute, Temple, TX, United States
Publisher
Elsevier Inc.
Abstract
Objective: This meta-analysis sought to investigate if IVUS-guided PCI
(IVUS-PCI) can improve outcomes compared to standard PCI and CABG in
patients with multivessel CAD. Background(s): Coronary artery disease
(CAD) is traditionally revascularized by either percutaneous coronary
intervention (PCI) or coronary artery bypass (CABG) with a historical
benefit of CABG over PCI in multivessel CAD. Intravascular
ultrasound-guided PCI (IVUS-PCI) may improve outcomes compared to
angiography alone. Method(s): We undertook a systematic search using
PubMed, MEDLINE, EMBASE, Web of Science, and Ovid from 2017 through 2022.
We included randomized controlled trials and observational trials
comparing PCI vs CABG for multivessel CAD evaluated by two independent
reviewers. We extracted baseline data and major adverse cardiovascular
events (MACE; death from any cause, MI, stroke, or repeat
revascularization) at one year. Three trials were selected based on study
arm criteria: FAME 3, BEST, and Syntax II. Result(s): IVUS-PCI
significantly reduced death from any cause (OR 0.45, CI 0.272-0.733, p =
0.001), repeat revascularization (OR 0.62, CI 0.41-0.95, p = 0.03), and
showed a non-significant reduction in MACE (OR 0.74, CI 0.54-1.01, p =
0.054) when compared to CABG. IVUS-PCI significantly reduced MACE (OR
0.52, CI 0.38-0.72, p < 0.001) and showed a non-significant reduction in
death (OR 0.66, CI 0.36-1.18, p = 0.16) and numerically reduced repeat
revascularization (OR 0.66, CI95 0.431-1.02, p = 0.06) when compared to
PCI without IVUS. Conclusion(s): IVUS-PCI reduces cardiovascular
outcomes in patients with multivessel disease compared to CABG and
angiographically-guided PCI at one year. These results reinforce the
importance of IVUS-PCI in complex CAD and provide evidence for improved
PCI outcomes compared to CABG for multivessel CAD. Copyright ©
2024 Elsevier Inc.

<129>
Accession Number
643679137
Title
Moderate ischemic mitral regurgitation in ischemic heart disease: to
operate or not? A meta-analysis.
Source
The Journal of cardiovascular surgery. 65(4) (pp 390-397), 2024. Date of
Publication: 01 Aug 2024.
Author
Alsuayri R.A.; Alassiri A.K.; Awad A.K.; Faleh M.N.; Baqays R.T.;
Porqueddu M.
Institution
(Alsuayri) Batterjee Medical College for Sciences and Technology, Jeddah,
Saudi Arabia
(Alassiri) Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Awad) Faculty of Medicine, Ain-Shams University, Cairo, Egypt
(Faleh) College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
(Baqays, Porqueddu) Department of Cardiac Surgery, King Fahd Armed Forces
Hospital, Jeddah, Saudi Arabia
Abstract
INTRODUCTION: Deciding whether to perform coronary artery bypass grafting
(CABG) alone or in combination with mitral valve repair is a common
dilemma encountered by surgeons when treating patients with ischemic
mitral regurgitation, a common condition related to coronary artery
disease. Although ischemic mitral regurgitation after CABG has been linked
to unfavorable results, the benefits of including mitral valve repair are
still unknown. This discrepancy led us to undertake a systematic review
and meta-analysis to determine whether combining CABG with mitral valve
surgery leads to better clinical results than CABG alone. EVIDENCE
ACQUISITION: Studies comparing the results of CABG versus CABG with mitral
valve replacement were searched in the databases of PubMed and Google
Scholar. There were six randomized clinical trials included in this study.
EVIDENCE SYNTHESIS: We analyzed 852 patients' data. There were no
significant variations between patients who acquired CABG alone or
CABG+(MVR) in terms of their risk of death at one year, stroke, atrial
fibrillation, or hospitalization for heart failure. For recurrent/residual
mitral regurgitation; it revealed an RR=5.42, 95% CI, 0.77 to 37.98, and a
P value of =0.065. According to the analysis of study heterogeneity, no
apparent heterogeneity was identified in the outcomes of death after one
year, stroke, atrial fibrillation, or hospitalization for heart failure.
However, the outcome of recurrent or residual mitral regurgitation showed
significant variation (I2=66%). CONCLUSION(S): Patients who underwent
CABG alone versus CABG plus MVR did not differ significantly from one
another. However, the comparison of CABG alone with CABG plus MVR
underlines the need for customized treatment plans based on the unique
characteristics of each patient.

<130>
Accession Number
645410303
Title
Concomitant Carotid and Coronary Artery Disease Management: A Review of
The Literature.
Source
Annals of vascular surgery. (no pagination), 2024. Date of Publication:
27 Sep 2024.
Author
Abou-Assi S.; Hanak C.R.; Khalifeh A.; Quatromoni J.G.; Caputo F.J.; Lyden
S.P.; Ambani R.N.
Institution
(Abou-Assi, Hanak, Khalifeh, Quatromoni, Caputo, Lyden, Ambani) Department
of Vascular Surgery, Cleveland Clinic Foundation, OH, United States
Abstract
This review examines current evidence regarding management of patients
with both coronary and carotid artery disease. It highlights the elevated
stroke risk after surgery for this cohort and scrutinizes approaches to
minimize this risk. Various revascularization methods are outlined,
including carotid endarterectomy (CEA), carotid artery stenting (CAS), and
staged versus simultaneous surgical approaches. The importance of
judiciously screening coronary artery bypass grafting (CABG) candidates
for carotid stenosis is emphasized, suggesting risk factor-based targeted
screening is non-inferior to indiscriminate screening. Efficacy
comparisons are made between revascularization strategies such as staged
versus synchronous CEA/CABG, CAS, and off-pump CABG techniques.
Controversies surrounding necessity and optimal timing of carotid
revascularization in asymptomatic patients are addressed, indicating a
need for rigorous randomized controlled trials to establish definitive
treatment algorithms. Copyright © 2024. Published by Elsevier
Inc.

<131>
Accession Number
645410214
Title
Efficacy of Sentinel Cerebral Embolic Protection Device in Transcatheter
Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials
and Propensity Score-Matched Studies.
Source
Cardiology in review. (no pagination), 2024. Date of Publication: 30 Sep
2024.
Author
Jain H.; Pervez N.; Dey D.; Odat R.M.; Jain J.; Goyal A.; Saggar A.;
Hussein A.M.; Mathur A.; Khanna S.; Ahmed R.; Shahid F.
Institution
(Jain, Jain) From the Department of Internal Medicine, All India Institute
of Medical Sciences (AIIMS), Jodhpur, India
(Pervez) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Dey) Department of Internal Medicine, Medical College and Hospital,
Kolkata, India
(Odat) Department of Internal Medicine, Faculty of Medicine, Jordan
University of Science and Technology, Irbid, Jordan
(Goyal) Department of Internal Medicine, Seth GS Medical College and KEM
Hospital, Mumbai, India
(Saggar) Department of Internal Medicine, Punjab Institute of Medical
Sciences, Jalandhar, India
(Hussein) Department of Internal Medicine, Faculty of Medicine, Al-Balqa'
Applied University, Salt, Jordan
(Mathur) Department of Internal Medicine, Jhalawar Hospital and Medical
College, Jhalawar, Rajasthan, India
(Khanna) Department of Internal Medicine, University College of Medical
Sciences and Guru Teg Bahadur Hospital, New Delhi, India
(Ahmed) Department of Cardiology, National Heart and Lung Institute,
Imperial College London, London, United Kingdom
(Shahid) Department of Interventional Cardiology, Queen Elizabeth
Hospital, Birmingham, United Kingdom
Abstract
Transcatheter aortic valve replacement (TAVR) is frequently associated
with stroke due to debris embolization. Although the risk of stroke with
newer-generation devices is lower, stroke still represents a significant
cause of mortality and morbidity post-TAVR. The Sentinel cerebral embolic
protection device (CEPD) is a dual-embolic filter device designed to
capture debris dislodged during TAVR. A systematic literature search was
performed on the major bibliographic databases to retrieve studies that
compared TAVR with and without Sentinel CEPD. Pooled odds ratios (ORs)
with 95% confidence intervals (CIs) were calculated using the
DerSimonian-Laird random-effects model, with a P value of <0.05 considered
statistically significant. This meta-analysis included 6 studies with
25,130 patients undergoing TAVR (12,608: Sentinel CEPD; 12,522: without
Sentinel CEPD). The use of the Sentinel CEPD in TAVR was associated with a
statistically significant lower risk of acute kidney injury (OR: 0.89; 95%
CI: 0.81-0.97; P = 0.01]. The use of Sentinel CEPD in TAVR was associated
with a statistically insignificant trend toward a reduction in stroke (OR:
0.80; 95% CI: 0.58-1.10; P = 0.18), all-cause mortality (OR: 0.74; 95% CI:
0.51-1.07; P = 0.11), and major vascular complications (OR: 0.74; 95% CI:
0.46-1.19; P = 0.21). The use of Sentinel CEPD in patients undergoing TAVR
does not lead to a statistically significant reduction in stroke,
all-cause mortality, or major vascular complications; however, the risk of
acute kidney injury is lower. Further randomized studies are warranted to
confirm these findings. Copyright © 2024 Wolters Kluwer Health,
Inc. All rights reserved.

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