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<1>
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Accession Number
648435790
Title
Beta-Blockers after Myocardial Infarction in Patients without Heart
Failure.
Source
The New England journal of medicine. 393(19) (pp 1901-1911), 2025. Date of
Publication: 13 Nov 2025.
Author
Munkhaugen J.; Kristensen A.M.D.; Halvorsen S.; Holmager T.; Olsen M.H.;
Bakken A.; Sehested T.S.G.; Ruddox V.; Maeng M.; Vikenes K.; Jensen S.E.;
Steigen T.; Lambrechtsen J.; Jortveit J.; Bovin A.; Schirmer H.;
Christiansen M.K.; Wiseth R.; Mikkelsen D.; Larsen A.I.; Kjaergaard C.L.;
Andresen K.; Gustafsson I.; Tuseth V.; Larsen M.L.; Deeg P.S.; Veien K.;
Bohmer E.; Botker H.E.; Brattrud A.O.; Bronnum-Schou J.; Pettersen A.R.;
Bang L.E.; Oie E.; Engstrom T.; Borg E.B.; Kristensen K.; Nymo S.H.;
Gislason G.; Vethe N.T.; Abdulla J.A.M.; Dammen T.; Mouridsen M.R.; Bendz
B.; Bertelsen M.L.N.; Hove J.D.; Schierbeck L.; Snoer M.; Davidsen C.;
Egholm G.; Thomsen K.K.; Jadou G.; Poenaru M.; Krarup N.T.; Bottcher M.;
Staehr P.B.; Zwisler A.-D.; Edvardsen T.; Torp-Pedersen C.; Otterstad
J.E.; Lange T.; Fagerland M.W.; Atar D.; Prescott E.
Institution
(Munkhaugen) Department of Medicine, Drammen Hospital, Vestre Viken Trust,
Drammen, Norway
(Munkhaugen) Department of Behavioural Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Kristensen, Holmager, Kjaergaard, Gustafsson, Prescott) Department of
Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Halvorsen, Bakken, Atar) Department of Cardiology, Oslo University
Hospital Ullevaal, Oslo, Norway
(Halvorsen, Schirmer, Andresen, Oie, Dammen, Bendz, Edvardsen, Atar)
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo,
Oslo, Norway
(Olsen) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
(Olsen) Department of Internal Medicine, Holbaek Hospital, Denmark
(Sehested, Bang, Engstrom) Department of Cardiology, Copenhagen University
Hospital-Rigshospitalet, Copenhagen, Denmark
(Ruddox, Otterstad) Department for Cardiology, Vestfold Hospital Trust,
Vestfold, Norway
(Maeng) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Vikenes, Tuseth) Department of Heart Disease, Haukeland University
Hospital
(Vikenes, Tuseth, Davidsen) University of Bergen, Bergen, Norway
(Jensen, Larsen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Steigen) Department of Cardiology, Tromso, University Hospital of North
Norway and the Arctic University of Tromso, Norway
(Lambrechtsen) Odense University Hospital Svendborg and Cardiovascular
Research Unit, Odense, Denmark
(Jortveit) Department of Cardiology, Sorlandet Hospital Arendal, Arendal,
Norway
(Bovin) Department of Cardiology, Sygehus Lillebaelt, Vejle, Denmark
(Schirmer) Department of Cardiology, Akershus University Hospital, Norway
(Christiansen) Department of Internal Medicine, Horsens Regional Hospital,
Viborg, Denmark
(Christiansen, Krarup) Department of Cardiology, Viborg Regional Hospital,
Viborg, Denmark
(Wiseth) Clinic of Cardiology, St. Olavs University Hospital, Trondheim,
Norway
(Wiseth) Norwegian University of Science and Technology, Trondheim, Norway
(Mikkelsen) Department of Cardiology, Copenhagen University Hospital -
Naestved, Slagelse, and Ringsted, Slagelse, Denmark
(Mikkelsen) Slagelse Hospital, Slagelse, Denmark
(Larsen) Department of Cardiology, Stavanger University Hospital and
University of Bergen, Stavanger, Norway
(Andresen, Bendz, Edvardsen) Department of Cardiology, Oslo University
Hospital Rikshospitalet, Oslo, Norway
(Deeg) Department of Cardiology, Ostfold Hospital Trust Kalnes, Norway
(Veien, Egholm) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Bohmer) Innlandet Hospital Trust, Lillehammer, Norway
(Botker) Department of Clinical Medicine, Section of Clinical Epidemiology
and Cardiology, Health, Aarhus University, Aarhus, Denmark
(Brattrud) Innlandet Hospital Trust, Hamar, Norway
(Bronnum-Schou) Department of Cardiology, Copenhagen University Hospital -
Amager and Hvidovre, Denmark
(Pettersen) Department of Medicine, Vestre Viken Hospital Trust, Ringerike
Hospital, Buskerud, Norway
(Oie) Department of Internal Medicine, Diakonhjemmet Hospital, Oslo,
Norway
(Borg) Innlandet Hospital Trust, Norway
(Kristensen) Department of Internal Medicine, Copenhagen University
Hospital, Denmark
(Nymo) Department of Cardiology, Nordland Hospital Trust, Bodo, Norway
(Gislason) Department of Cardiology, Copenhagen University Hospital -
Herlev and Gentofte, Gentofte, Denmark
(Vethe) Department of Pharmacology, Oslo University Hospital and
Department of Pharmacy, University of Oslo, Oslo, Norway
(Abdulla) Department of Medicine, Section of Cardiology, Glostrup
Hospital, Copenhagen, Denmark
(Dammen) Division of Mental Health and Addiction, Department of Research
and Innovation, Oslo University Hospital, Oslo, Norway
(Mouridsen) Department of Cardiology, Copenhagen University Hospital,
Herlev, Denmark
(Bertelsen, Schierbeck, Torp-Pedersen) Department of Cardiology,
Copenhagen University Hospital-North Zealand Hospital, Denmark
(Hove) Department of Cardiology, Copenhagen University Hospital - Amager
and Hvidovre, Hvidovre, Denmark
(Snoer) Department of Cardiology, Zealand University Hospital Roskilde,
Roskilde, Denmark
(Thomsen) Department of Cardiology, Sydvestjysk Sygehus, Esbjerg, Denmark
(Jadou) Department of Cardiology, Sygehus Sonderjylland, Aabenraa, Denmark
(Poenaru) Department of Cardiology, Sygehus Lillebaelt, Kolding, Denmark
(Bottcher) Department of Cardiology, Godstrup Hospital, Herning, Denmark
(Staehr) Department of Cardiology, North Denmark Regional Hospital,
Denmark
(Zwisler) Clinic for Palliative Medicine, Rehabilitation and
Patient-centered Care, Department of Oncology, Rigshospitalet, Copenhagen,
Denmark
(Zwisler) Department of Clinical Medicine, Faculty of Health and Medical
Sciences, University of Copenhagen, Copenhagen, Denmark
(Lange) Section of Biostatistics, Department of Public Health, University
of Copenhagen, Copenhagen, Denmark
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Oslo, Norway
Abstract
BACKGROUND: The evidence supporting beta-blocker therapy after myocardial
infarction was established before the introduction of modern coronary
reperfusion therapy and secondary prevention strategies. METHOD(S):
In an open-label, randomized trial with blinded end-point evaluation,
conducted in Denmark and Norway, we assigned patients who had had a
myocardial infarction and who had a left ventricular ejection fraction of
at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy
within 14 days after the event or no beta-blocker therapy. The primary end
point was a composite of death from any cause or major adverse
cardiovascular events (new myocardial infarction, unplanned coronary
revascularization, ischemic stroke, heart failure, or malignant
ventricular arrhythmias). RESULT(S): A total of 5574 patients
underwent randomization and were included in the main analyses - 2783 in
the beta-blocker group and 2791 in the no-beta-blocker group. After a
median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary
end-point event had occurred in 394 patients (14.2%) in the beta-blocker
group and in 454 patients (16.3%) in the no-beta-blocker group (hazard
ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death
from any cause occurred in 4.2% of the patients in the beta-blocker group
and in 4.4% of those in the no-beta-blocker group; myocardial infarction
occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59
to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic
stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant
ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in
safety outcomes were observed between the groups. CONCLUSION(S):
Among patients with a myocardial infarction and a left ventricular
ejection fraction of at least 40%, beta-blocker therapy led to a lower
risk of death or major adverse cardiovascular events than no beta-blocker
therapy. (Funded by the Health South-East research program in Norway and
others; BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and
NCT03778554.). Copyright © 2025 Massachusetts Medical Society.

<2>
Accession Number
648435674
Title
Fractional Flow Reserve-Guided Complete vs Culprit-Only Revascularization
in Non-ST-Elevation Myocardial Infarction and Multivessel Disease: The
SLIM Randomized Clinical Trial.
Source
JAMA. 334(18) (pp 1628-1637), 2025. Date of Publication: 11 Nov 2025.
Author
Pustjens T.F.S.; Veenstra L.; Camaro C.; Ruiters A.W.; Lux A.; Ruzsa Z.;
Piroth Z.; Ilhan M.; Vainer J.; Gho B.; Winkler P.J.C.; Stein M.;
Theunissen R.A.L.J.; Kala P.; Polad J.; Berta B.; Gabrio A.; van Royen N.;
van 't Hof A.W.J.; Rasoul S.
Institution
(Pustjens, Veenstra, Ruiters, Ilhan, Gho, Winkler, Stein, van 't Hof,
Rasoul) Department of Cardiology, Zuyderland Medical Centre, Heerlen,
Netherlands
(Pustjens, Lux, van 't Hof, Rasoul) Department of Cardiovascular Research
Institute Maastricht (CARIM), Maastricht University, Maastricht,
Netherlands
(Pustjens, Veenstra, Lux, Ilhan, Vainer, Theunissen, van 't Hof, Rasoul)
Department of Cardiology, Maastricht University Medical Centre,
Maastricht, Netherlands
(Camaro, van Royen) Department of Cardiology, Radboud University Medical
Centre, Nijmegen, Netherlands
(Ruzsa) Invasive Cardiology Division, Internal Medicine Department,
University of Szeged, Szeged, Hungary
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
(Kala) Clinic of Cardiology, Masaryk University and University Hospital
Brno, Brno, Czechia
(Polad) Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch,
Netherlands
(Berta) Invasive Cardiology Department, Bacs-Kiskun County Hospital,
Kecskemet, Hungary
(Gabrio) Department of Methodology and Statistics, Faculty of Health
Medicine and Life Science, Maastricht University, Maastricht, Netherlands
Abstract
Importance: The benefits of fractional flow reserve (FFR)-guided complete
coronary revascularization in patients with non-ST-segment elevation
myocardial infarction (NSTEMI) and multivessel disease remain unclear.
 Objective(s): To compare FFR-guided complete revascularization of
nonculprit lesions vs culprit-only revascularization in patients with
NSTEMI and multivessel disease. Design, Setting, and Participant(s):
This prospective, investigator-initiated, multicenter, international
randomized clinical trial was conducted at 9 hospitals in Europe. Patients
with NSTEMI and multivessel disease who had successful revascularization
of the culprit lesion were enrolled between June 2018 and July 2024, and
final follow-up was completed on July 21, 2025. The analysis was conducted
on July 28, 2025. Eligibility criteria included the presence of at least 1
stenosis of at least 50% in a nonculprit lesion amendable for
revascularization. Intervention(s): Patients were randomized to
receive either FFR-guided complete or culprit-only revascularization
during the index procedure. Staged revascularization within 6 weeks after
the index procedure was allowed in the culprit-only group. Main
Outcomes and Measures: The primary outcome was a composite of all-cause
death, nonfatal myocardial infarction, any revascularization, and stroke
at 1 year. Key secondary outcomes included individual components of the
primary outcome, net adverse clinical events, all-cause death or nonfatal
myocardial infarction, cardiac rehospitalization, and bleeding events.
 Result(s): Among 478 randomized patients (mean [SD] age, 65.9 [10.6]
years; 347 [72.9%] males), 240 were randomized to receive FFR-guided
complete revascularization and 238 were randomized to receive culprit-only
revascularization, with crossover occurring in 7 patients in the
culprit-only group. The primary outcome occurred in 13 patients (5.5%) in
the FFR-guided complete revascularization group vs 32 patients (13.6%) in
the culprit-only group (hazard ratio [HR], 0.38 [95% CI, 0.20-0.72]; P =
.003). Rates of any revascularization (3.0% vs 11.5%; HR, 0.24 [95% CI,
0.11-0.56]; P < .001) and net adverse clinical events (6.3% vs 15.3%; HR,
0.39 [95% CI, 0.21-0.70]; P = .002) were also significantly lower in the
complete revascularization group, while there were no significant
differences in the remaining secondary outcomes. Conclusion and Relevance:
FFR-guided complete revascularization during the index procedure resulted
in a significant reduction in the composite of all-cause death, nonfatal
myocardial infarction, any revascularization, and stroke at 1 year. This
was mainly driven by reduced repeat revascularization. Trial Registration:
ClinicalTrials.gov Identifier: NCT03562572.

<3>
Accession Number
2040584638
Title
TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and
Cognitive Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(12) (pp 3306-3312),
2025. Date of Publication: 01 Dec 2025.
Author
Garg V.; Patel G.; Mandal B.; Kahlon S.; Puri G.D.; Kst S.; Rawat A.
Institution
(Garg, Patel, Mandal, Kahlon, Puri) Department of Anesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh, India
(Kst) Department of Cardiovascular and Thoracic Surgery, Postgraduate
Institute of Medical Education and Research (PGIMER), Chandigarh, India
(Rawat) Pediatric Allergy and Immunology Unit, Postgraduate Institute of
Medical Education and Research (PGIMER), Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objectives: To compare the perioperative inflammatory response and early
neurocognitive outcomes in adult patients undergoing elective coronary
artery bypass grafting (CABG) under total intravenous anesthesia (TIVA)
versus volatile anesthesia. Design(s): Prospective, randomized
controlled trial. Setting(s): A tertiary care academic medical
center. Participant(s): Fifty adult patients aged 18 to 65 years
scheduled for elective on-pump CABG surgery. Intervention(s):
Patients were randomized to receive either propofol-based TIVA (Group P)
or sevoflurane-based volatile anesthesia (group S). Standardized surgical
and cardiopulmonary bypass protocols were followed in all patients.
 Measurements and Main Results: Serum interleukin-6 (IL-6) levels were
measured preoperatively and at 24 and 48 hours postoperatively. Secondary
outcomes included Mini-Mental State Examination scores, ventilation
duration, vasoactive-inotropic score, renal function, and intensive care
unit stay. IL-6 levels had increased significantly at 24 hours and
decreased by 48 hours in both groups, with no significant intergroup
difference at any time point. Mini-Mental State Examination scores at 24
and 48 hours were significantly higher in the TIVA group. TIVA was also
associated with shorter mechanical ventilation duration. VIS, cardiac
function, renal parameters, and intensive care unit stay duration were
comparable between groups. Conclusion(s): TIVA and volatile
anesthesia resulted in similar perioperative IL-6 responses in patients
undergoing CABG. However, TIVA was associated with better early
postoperative cognitive function and faster emergence from mechanical
ventilation. These findings suggest a potential neurocognitive benefit of
TIVA in this surgical population. Copyright © 2025 Elsevier Inc.

<4>
Accession Number
2040468170
Title
Erector Spinae Plane Block Versus Retrolaminar Block for Perioperative
Analgesia in Pediatric Cardiac Surgery: A Randomized, Double-blinded,
Noninferiority Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(12) (pp 3455-3464),
2025. Date of Publication: 01 Dec 2025.
Author
Gopalakrishnan R.M.; Shinde N.; Meghalakshmi A.R.; Gutjahr G.;
Krishnakumar M.; Leeladharan S.P.; Thomas D.; Padmanabhan S.; Krishnakumar
R.
Institution
(Gopalakrishnan, Padmanabhan) Department of Pediatric Cardiac Anesthesia
and Intensive Care, Amrita Institute of Medical Sciences and Research
Centre, Kerala, Kochi, India
(Shinde, Meghalakshmi, Leeladharan, Thomas) Department of Cardiac
Anesthesia, Amrita Institute of Medical Sciences and Research Centre,
Kerala, Kochi, India
(Gutjahr, Krishnakumar) Department of Health Science Research, Amrita
Institute of Medical Sciences and Research Centre, Kerala, Kochi, India
(Krishnakumar) Department of Pediatric Cardiology, Amrita Institute of
Medical Sciences and Research Centre, Kerala, Kochi, India
Publisher
W.B. Saunders
Abstract
Objective: To compare the efficacy and safety of retrolaminar block (RLB)
with erector spinae plane block (ESPB) for perioperative analgesia in
pediatric cardiac surgery. Design(s): Prospective, randomized,
double-blinded, controlled, noninferiority trial. Setting(s): A
pediatric cardiac surgical unit at a tertiary care referral center in
South India. Participant(s): Children aged between 1 day and 18 years
who were scheduled for elective cardiac surgery (Risk adjustment for
congenital heart surgery categories 1-6) were enrolled in the study. A
total of 298 patients were randomly assigned to receive either an ESPB or
RLB, with 149 patients in each group. Intervention(s): Myofascial
blocks were performed by one of four anesthesiologists, each administering
either ESPB or RLB under ultrasound guidance according to the assigned
group. The treating anesthesiologist and intensive care unit (ICU)
intensivist were blinded to group allocation. Measurements and Main
Results: This study compared RLB, a safer and less commonly used posterior
myofascial block, with ESPB, a widely adopted technique with few reported
complications, to establish the noninferiority of RLB. The primary outcome
was hemodynamic response to surgical incision, defined as a greater than
10% rise in heart rate. Secondary outcomes included block administration
time; intraoperative inhalational anesthetic; dexmedetomidine and opioid
use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU
outcomes such as duration of mechanical ventilation, ICU length of stay,
reintubation rate, and cost of ventilator disposables and oxygen. The
groups were comparable in baseline characteristics. A rise in heart rate
of more than 10% was observed in 46% of patients in the ESPB group and 50%
in the RLB group (p = 0.3). Intraoperative drug consumption, pain and
sedation scores, as well as ICU outcomes, were similar between the groups.
 Conclusion(s): RLB is noninferior to ESPB in pediatric cardiac
surgery, providing comparable analgesic efficacy, safety, and
postoperative recovery outcomes. Copyright © 2025 Elsevier Inc.

<5>
Accession Number
2041520183
Title
Effectiveness of cerebral embolic protection during transcatheter aortic
valve replacement: A systematic review and meta-analysis of randomized
trials.
Source
IJC Heart and Vasculature. 61 (no pagination), 2025. Article Number:
101842. Date of Publication: 01 Dec 2025.
Author
Caminiti R.; Ielasi A.; Vetta G.; Parlavecchio A.; Della Rocca D.G.;
Moscardelli S.; Marrone A.; Laterra G.; Tespili M.; Vizzari G.; Barbanti
M.; Micari A.
Institution
(Caminiti, Ielasi, Moscardelli, Marrone, Tespili) U.O. Cardiologia
Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
(Caminiti, Parlavecchio, Vizzari, Micari) Cardiology Unit, Department of
Clinical and Experimental Medicine, University of Messina, Messina, Italy
(Vetta, Della Rocca) Heart Rhythm Management Centre, Postgraduate Program
in Cardiac Electrophysiology and Pacing, UniversitairZiekenhuis
Brussel-Vrije Universiteit Brussel, European Reference Networks
Guard-Heart, Brussels, Belgium
(Laterra, Barbanti) Universita degli Studi di Enna "Kore", Enna, Italy
(Laterra, Barbanti) Division of Cardiology, Umberto I Hospital, ASP 4 di
Enna, Enna, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cerebral embolism remains a concern during transcatheter
aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices
have been developed to mitigate this risk, but their clinical benefit
remains unclear. Method(s): We conducted a systematic review and
meta-analysis of randomized controlled trials comparing TAVR with and
without CEP devices. Primary endpoint was overall stroke; secondary
endpoints included disabling stroke, all-cause mortality, life-treating
bleeding, vascular complications related to CEP access and acute kidney
injury. Result(s): Eight trials comprising 11,625 patients (group
CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5
mean age years) were included. No significant differences were found for
primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82-1.29), and
secondary outcomes between CEP and non-CEP groups at 30 days follow-up.
Complications related to CEP access were minimal, 1.1 % (95 % CI: -0.6 to
2.8). Conclusion(s): CEP devices do not significantly reduce
short-term stroke or major complications after TAVR. However, given the
prevalence of silent cerebral ischemia, further studies are needed to
assess long-term neurological outcomes and identify high-risk subgroups
who may benefit. Copyright © 2025

<6>
Accession Number
2041511034
Title
Assessing the impact of a semi-structured intraoperative anaesthesia
handoff cognitive aid on surgical patient outcomes: study protocol for a
cluster randomised trial.
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e110401. Date of
Publication: 04 Nov 2025.
Author
Samost-Williams A.; Green C.E.; Kao L.S.; Sridhar S.; Sessler D.I.; Turan
A.; Thomas E.J.
Institution
(Samost-Williams, Sridhar, Sessler, Turan) The University of Texas Health
Science Center at Houston, Houston, TX, United States
(Samost-Williams, Sessler, Turan) Center for Outcomes Research, Houston,
TX, United States
(Green) Psychiatry and Pediatrics, The University of Texas Health Science
Center at Houston, Houston, TX, United States
(Kao) Center for Surgical Trials and Evidence-based Practice, The
University of Texas Health Science Center, Surgery, Houston, TX, United
States
(Thomas) University of Texas, Health Scince Center, Houston, TX, United
States
Publisher
BMJ Publishing Group
Abstract
Introduction Intraoperative anaesthesia handoffs represent a risk point in
the care of surgical patients. Although often necessary to prevent
fatigue, improve vigilance and optimise operational efficiency, critical
information can be lost, potentially leading to postoperative
complications. Structured handoffs can increase the transfer of knowledge
during intraoperative anaesthesia handoffs, improving their quality. We
therefore propose to test the primary hypothesis that a semi-structured
intraoperative anaesthesia handoff cognitive aid reduces the number of
serious 30-day complications in surgical patients. Methods and analysis We
will enrol adults having non-cardiac surgery who are scheduled to have an
intraoperative anaesthesia handoff for operational reasons. We plan a
cluster randomised trial (enrolling over 18 months, anticipated sample
size approximately 4500 patients) that will compare the Epic Electronic
Health Record intraoperative anaesthesia handoff cognitive aid to routine
handoffs. Our primary outcome will be the number of serious postoperative
complications within 30 days. Our secondary outcomes will be: (1) the
number of minor complications; and (2) the duration of postoperative
hospitalisation. Bayesian analysis with generalised linear multilevel
modelling will be used to estimate the effect of structured handoffs on
the primary and secondary outcomes. Ethics and dissemination This study
has been approved by the local institutional review board with a waiver of
informed consent. Results will be disseminated in the medical literature
with de-identified data available on request. Copyright ©
Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<7>
Accession Number
2040490254
Title
Bentall Versus David Procedure for Aortic Root Replacement in Patients
With Bicuspid Aortic Valve: Systematic Review and Meta-Analysis Using
Reconstructed Time-to-Event Data.
Source
Heart Lung and Circulation. 34(11) (pp 1209-1217), 2025. Date of
Publication: 01 Nov 2025.
Author
Zoupas I.; Sarantopoulos A.; Schizas N.; Boultadakis E.; Koukis I.; Manna
I.; Iliopoulos D.C.
Institution
(Zoupas, Sarantopoulos, Schizas, Boultadakis, Koukis, Manna, Iliopoulos)
4th Department of Cardiac Surgery, Hygeia Hospital, Athens,
Greece
(Sarantopoulos) Medical School, European University Cyprus, Nicosia,
Cyprus
(Iliopoulos) Department of Cardiac Surgery, Faculty of Medicine, National
and Kapodistrian University of Athens, Athens, Greece
(Iliopoulos) Department of Cardiothoracic and Vascular Surgery, UTHealth
Houston, Houston, TX, United States
Publisher
Elsevier Ltd
Abstract
Background: There is little evidence comparing the effectiveness of
valve-sparing aortic root replacement with the David procedure and
replacement with a composite graft (Bentall procedure) for patients with
bicuspid aortic valves (BAV). This systematic review and meta-analysis
compared the overall survival and the freedom from re-intervention in BAV
patients who underwent root replacement with either the David or Bentall
procedure. Method(s): Two databases were searched for studies
including BAV patients who underwent either the David or Bentall
operation. This review was performed in accordance with the
recommendations of the PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-analyses) statement. One-stage and two-stage
meta-analyses were conducted with Kaplan-Meier-derived individual patient
data and a random-effects model. Result(s): Thirteen studies were
included, providing data about 1,264 BAV patients who underwent a Bentall
procedure and 602 patients who underwent a David procedure. During a
follow-up period of 8 years, overall survival rates were significantly
improved in the David group compared with the Bentall group (hazard ratio
[HR] 0.19, 95% confidence interval [CI] 0.08-0.42; p<0.001). This was
confirmed by the two-stage meta-analysis (HR 0.22, 95% CI 0.09-0.55;
p=0.00, I2=0.00%). Regarding freedom from re-intervention,
splitting timepoint analysis revealed that no arm offered a statistically
significant advantage (HR 1.24, 95% CI 0.58-2.63; p=0.575). Finally, the
David operation was associated with fewer postoperative complications.
 Conclusion(s): The David operation is associated with improved
survival and lower complication rates than the Bentall procedure for
patients with BAV. However, freedom from re-operation rates were
comparable between the two procedures. Copyright © 2025
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<8>
[Use Link to view the full text]
Accession Number
648443492
Title
Three-Year Follow-Up of the NOTION-2 Trial: TAVR Versus SAVR to Treat
Younger Low-Risk Patients With Tricuspid or Bicuspid Aortic Stenosis.
Source
Circulation. 152(19) (pp 1326-1337), 2025. Date of Publication: 11 Nov
2025.
Author
Jorgensen T.H.; Savontaus M.; Willemen Y.; Bleie O.; Tang M.; Angeras O.;
Niemela M.; Gudmundsdottir I.J.; Khokhar A.; Sartipy U.; Dagnegard H.;
Laine M.; Ruck A.; Piuhola J.; Petursson P.; Christiansen E.H.; Malmberg
M.; Olsen P.S.; Haaverstad R.; Prendergast B.; Sondergaard L.; Horsted
Thyregod H.G.; De Backer O.
Institution
(Jorgensen, Savontaus, Willemen, Tang, Angeras, Khokhar, Dagnegard,
Petursson, Christiansen, Malmberg, Olsen, Haaverstad, Horsted Thyregod, De
Backer) Department of Cardiology (T.H.J., Rigshospitalet, Copenhagen
University Hospital, A.K, Denmark
(Bleie) Department of Cardiology, Haukeland University Hospital, Bergen,
Germany
(Niemela, Piuhola) Department of Cardiology, Medical Research Center,
Finland (M.N., Oulu University Hospital
(Gudmundsdottir) Department of Cardiology, Landspitali, Reykjavik
(Sartipy) Department of Cardiothoracic Surgery (U.S.), Karolinska
University Hospital, Stockholm, Sweden
(Dagnegard) Department of Cardiothoracic Surgery, Odense University
Hospital, Denmark
(Laine) Department of Cardiology, Helsinki University Central Hospital,
Finland (M.L.), Finland
(Ruck) Department of Cardiology (A.R.), Karolinska University Hospital,
Stockholm, Sweden
(Prendergast) Department of Cardiology, St Thomas' Hospital and Cleveland
Clinic London, United Kingdom (B.P.), United Kingdom
(Sondergaard) Abbott Structural Heart, Santa Clara, Mexico
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly
performed in younger, low surgical risk patients. The NOTION-2 study (The
Nordic Aortic Valve Intervention) reports midterm outcomes in low-risk
patients age 60 to 75 years with severe tricuspid or bicuspid aortic
stenosis undergoing TAVR or surgical valve replacement. METHOD(S): A
total of 370 patients (mean age, 71.1 years; mean Society of Thoracic
Surgeons Predicted Risk of Mortality, 1.2%) were enrolled and randomized
1:1 to TAVR or surgery. This follow-up study reports clinical and
echocardiographic outcomes up to 3 years of follow-up. RESULT(S): At
3 years, the primary composite end point (death, stroke, or procedure-,
valve-, or heart failure-related hospitalization) occurred in 16.1% of
patients with TAVR versus 12.6% in surgical patients (hazard ratio, 1.3;
95% CI, 0.8-2.2%; I=0.4). Among patients with tricuspid aortic stenosis,
rates were similar (14.5% versus 14.4%), whereas patients with bicuspid
aortic stenosis had a statistically nonsignificant higher risk with TAVR
(20.4% versus 7.8%; hazard ratio, 2.9; 95% CI, 0.9-9.0). The risk of
moderate or greater structural valve deterioration at 3 years was 4.5% and
5.2% for transcatheter and surgical aortic bioprostheses, respectively
(hazard ratio, 1.2; 95% CI, 0.4-3.1). Bioprosthetic valve failure rates
were also comparable: 1.6% in the TAVR group and 2.9% in the surgical
group. CONCLUSION(S): For patients age 60 to 75 years with severe
aortic stenosis who are at low surgical risk, 3-year clinical outcomes are
similar between TAVR and surgery. Both procedures are associated with low
rates of structural valve deterioration and need for reintervention.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02825134.

<9>
Accession Number
648440175
Title
Physiology-Guided Complete Revascularization in Older Patients With
Myocardial Infarction: Three-Year Outcomes of a Randomized Clinical Trial.
Source
JAMA cardiology. 10(11) (pp 1130-1137), 2025. Date of Publication: 01 Nov
2025.
Author
Biscaglia S.; Erriquez A.; Guiducci V.; Escaned J.; Moreno R.; Lanzilotti
V.; Santarelli A.; Cerrato E.; Sacchetta G.; Menozzi A.; Amat-Santos I.;
Diez Gil J.L.; Ruozzi M.; Barbierato M.; Fileti L.; Picchi A.; Pavasini
R.; Cimaglia P.; Colaiori I.; Casella G.; Menozzi M.; Cavazza C.; Caretta
G.; Scarsini R.; D'Amico G.; Vadala G.; Pilato G.; Moscarella E.; Tebaldi
M.; Campo G.
Institution
(Biscaglia, Erriquez, Pavasini, Cimaglia, Campo) Cardiology Unit, Azienda
Ospedaliero Universitaria di Ferrara, Ferrara, Italy
(Guiducci) Cardiology Unit, SMaria Nuova Hospital, Reggio Emilia, Italy
(Escaned) Hospital Clinico San Carlos IDISCC, Complutense University of
Madrid, Madrid, Spain
(Moreno) Centro de Investigacion Biomedica en Red en Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain
(Moreno) Instituto de Investigacion Hospital La Paz (IDIPAZ), University
Hospital La Paz, Madrid, Spain
(Lanzilotti, Casella) Cardiology Unit, Ospedale Maggiore ,Largo Nigrisoli
2, Bologna, Italy
(Santarelli) Cardiology Unit, Bufalini Hospital, Cesena, Italy
(Cerrato) Interventional Cardiology Unit, San Luigi Gonzaga University
Hospital, Orbassano, and Rivoli Infermi Hospital ASLTO3, Rivoli, Turin,
Italy
(Sacchetta) Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa,
Italy
(Menozzi, Caretta) S.C. Cardiologia, Ospedale Sant'Andrea, La Spezia,
Italy
(Amat-Santos) Department of Cardiology, Centro de Investigacion Biomedica
en Red en Enfermedades Cardiovasculares (CIBERCV), Hospital Clinico
Universitario, Valladolid, Spain
(Diez Gil) Department of Cardiology, Centro de Investigation Biomedica end
Red en Enfermedades Cardiovasculares, Valencia, Spain
(Ruozzi) Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara
(Modena), Italy
(Barbierato, D'Amico) Cardiology Unit, Ospedale Dell'Angelo, Mestre, Italy
(Fileti) Department of Cardiology, SMaria delle Croci Hospital, Ravenna,
Italy
(Picchi) Cardiovascular Department, Azienda USL Toscana SudEst,
Misericordia Hospital, Grosseto, Italy
(Colaiori) Cardiology Unit, Ospedale Santa Maria Goretti, Latina, Italy
(Menozzi, Cavazza) Cardiovascular Department, Infermi Hospital, Rimini,
Italy
(Scarsini) Division of Cardiology, Department of Medicina, University of
Verona, Verona, Italy
(Vadala) Department of Health Promotion, Mother and Child Care, Internal
Medicine and Medical Specialties (ProMISE), University of Palermo,
Palermo, Italy
(Pilato) Department of Interventional Cardiology, San Giovanni Di Dio
Hospital, Agrigento, Italy
(Moscarella) Department of Translational Medical Sciences, University of
Campania "Luigi Vanvitelli, Italy
(Moscarella) Division of Clinical Cardiology, A.O.R.N "Sant'Anna e San
Sebastiano, Italy
(Tebaldi) Cardiology Unit, Infermi Hospital, AUSL Romagna, Faenza, Italy
Abstract
Importance: Complete revascularization in older patients with myocardial
infarction (MI) and multivessel disease has been shown to reduce
cardiovascular death and MI at 1 year. However, the durability of this
benefit over longer follow-up periods has been questioned by recent
studies. Objective(s): To determine whether the benefit of
physiology-guided complete treatment, compared with culprit-only
treatment, is sustained at 3 years in older patients with MI and
multivessel disease. Design, Setting, and Participant(s): This
randomized clinical trial, Functional Assessment in Elderly MI Patients
With Multivessel Disease (FIRE), was an investigator-initiated,
multicenter, prospective, superiority trial conducted at 34 centers across
3 countries from July 18, 2019, to October 25, 2021. Participants were
patients with MI (either ST segment or non-ST segment elevated) and
multivessel disease who were hospitalized after successful treatment of
the culprit lesion. Major exclusion criteria included a nonculprit lesion
in the left main coronary artery and unclear identification of the culprit
lesion. Data analysis was performed from March to May 2025.
 Intervention(s): Culprit-only treatment or physiology-guided complete
revascularization of nonculprit lesions. Main Outcomes and Measures:
The primary outcome was a patient-oriented composite end point of death,
MI, stroke, or ischemia-driven revascularization. Secondary end points
included a composite of cardiovascular death or MI and rate of heart
failure hospitalizations. Result(s): Among 1445 patients enrolled in
the trial, the median (IQR) age was 80 (77-84) years; 917 patients were
male (63.5%) and 528 female (36.5%). At 3 years, the primary outcome
occurred in 165 patients (22.9%) in the physiology-guided complete
revascularization group and 216 patients (29.8%) in the culprit-only group
(hazard ratio [HR], 0.72; 95% CI, 0.58-0.88; P = .002). The key secondary
outcome of cardiovascular death or MI occurred in a significantly lower
number of patients in the physiology-guided complete revascularization
group (92 patients [12.8%]) compared with the culprit-only group (132
patients [18.2%]; HR, 0.66; 95% CI, 0.50-0.88; P = .004). Hospitalizations
for heart failure were more frequent in the culprit-only group compared
with the physiology-guided complete group (143 [19.7%] vs 103 [14.3%]; HR,
0.73; 95% CI, 0.54-0.97; P = .03). Conclusions and Relevance: In
patients 75 years or older with MI and multivessel disease, the benefit of
physiology-guided complete revascularization over culprit-lesion-only
treatment was sustained at 3 years. Trial Registration: ClinicalTrials.gov
Identifier: NCT03772743.

<10>
Accession Number
2035653926
Title
Rationale and design of the TRIC-I-HF-DZHK24 (TRICuspid Intervention in
Heart Failure) trial.
Source
European Journal of Heart Failure. 27(10) (pp 1895-1904), 2025. Date of
Publication: 01 Oct 2025.
Author
von Bardeleben R.S.; Leistner D.M.; Kehl V.; Grzeschniok M.; Hagendorff
A.; Hausleiter J.; Stocker T.J.; Massberg S.; Stolz L.; Nabauer M.;
Weckbach L.; Doldi P.; Novotny J.; Geisler T.; Gawaz M.; Goldschmidt A.;
Zdanyte M.; Rottbauer W.; Kessler M.; Lubos E.; Frerker C.; Saraei R.;
Eitel I.; Schmidt T.; Stiermaier T.; Dejanovikj M.; Kupp S.; Alhagi M.;
Schofer N.; Kalbacher D.; Frank J.; Frank D.; Lutz M.; Saad M.; von
Bardeleben S.; Lurz P.; Ruf T.; Gossler T.; Rudolph V.; Friedrichs K.P.;
Rudolph T.; Ivannikova M.; Scholtz W.; Omran H.; Kister T.; Thiele H.;
Osteresch R.; Hambrecht R.; Lauten A.; Rassaf T.; Mahabadi A.A.; Rothe J.;
Besler C.; Wild M.; Westermann D.; Loffelhardt N.; Pfister R.; Baldus S.;
Iliadis C.; Mehrkens D.; Xhepa E.; Joner M.; Trenkwalder T.; Covarrubias
H.A.; Schurmann F.; Schunkert H.; Leistner D.; Polzin A.; Kelm M.; Horn
P.; Westenfeld R.; Tigges E.; Nickenig G.; Weber M.; Schulz M.; Vogelhuber
J.; Nelles D.; Butter C.; Konstandin M.; Frey N.; Nikolai P.; Bekeredjian
R.; Wolf A.; Vorpahl M.M.; Landmesser U.; Barbieri M.R.F.; Schofer J.;
Brinkmann C.; Unsold B.; Piayda K.; Mobius-Winkler S.; Schulze C.
Institution
(Stocker, Stolz, Massberg, Hausleiter) Department of Cardiology,
Department of Medicine I, LMU University Hospital, LMU Munich, Munich,
Germany
(Stocker, Stolz, Massberg, Hausleiter) German Center for Cardiovascular
Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
(Geisler) Department of Cardiology and Angiology, Eberhard Karls
University Tubingen, Tubingen, Germany
(Rottbauer) Department of Cardiology, University Heart Center, Ulm,
Germany
(Lubos) Department of Internal Medicine and Cardiology, Katholisches
Marienkrankenhaus, Hamburg, Germany
(Frerker) University Heart Center, Schleswig-Holstein University, Lubeck,
Germany
(Frerker, Schofer, Frank) German Center for Cardiovascular Research
(DZHK), partner site Hamburg-Kiel-Lubeck, Lubeck, Germany
(Schofer) Department of Cardiology, University Heart and Vascular Center
Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Frank) Department of Internal Medicine III, Cardiology, Angiologyand
Intensive Care Medicine, University Hospital Schleswig-Holstein Kiel,
Kiel, Germany
(von Bardeleben, Lurz) Department of Cardiology, Universitatsmedizin
Johannes Gutenberg-University, Mainz, Germany
(von Bardeleben, Leistner, Lurz) German Center for Cardiac and Vascular
Research (DZHK), partner site Rhein-Main, Germany
(Kister) Department of Cardiology, Heart Center Leipzig at University of
Leipzig, Leipzig, Germany
(Osteresch) Bremen Institute for Heart and Circulation Research (BIHKF) at
the Klinikum Links der Weser, Bremen, Germany
(Lauten) Department of General and Interventional Cardiology and
Rhythmology, Helios Klinikum Erfurt, Erfurt, Germany
(Rassaf) Department of Cardiology and Vascular Medicine, West German Heart
and Vascular Center, University Hospital Essen, Essen, Germany
(Rothe) Division of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Leistner) Department of Cardiology and Angiology, Goethe University,
Frankfurt am Main, Germany
(Kehl, Grzeschniok) Munchner Studienzentrum (MSZ), TUM School of Medicine
and Health, Technical University of Munich, Munich, Germany
(Hagendorff) Department of Cardiology, Leipzig University Hospital,
Leipzig, Germany
(Rudolph) General and Interventional Cardiology, Heart & Diabetes Center
NRW, Bad Oeynhausen, Germany
(Baldus) Department of Cardiology, University of Cologne, Cologne, Germany
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Tricuspid regurgitation (TR) is a detrimental disease frequently
diagnosed in patients with right-sided heart failure (HF). While
transcatheter tricuspid valve interventions (TTVI) effectively reduce TR
and improve quality of life (QoL) in earlier stages of the disease, their
effect on reducing HF hospitalizations (HFH) and improving survival
remains unclear. Method(s): TRIC-I-HF-DZHK24 (NCT04634266) is an
investigator-initiated, prospective, randomized, open-label, multicentre
strategy trial. Approximately 360 patients with severe TR and manifest
right-sided HF will be enrolled. In contrast to previous trials, subjects
with increased risk for HFH will be selected as facilitated by specific
inclusion criteria: HFH in the previous year, or presence of cardio-renal
syndrome, or evidence for cardio-hepatic syndrome. Subjects will be
randomized 2:1 to TTVI and optimal medical therapy (OMT) or continuation
of OMT alone. All CE-marked transcatheter repair devices including
tricuspid transcatheter edge-to-edge repair (T-TEER) or transcatheter
tricuspid annuloplasty can be used for TTVI. The participating 29 study
sites are highly experienced and treated a mean of 176 patients in 4.5
years with T-TEER before study activation. The primary outcome will be
assessed at 1 year. First, a composite of all-cause mortality, HFH, and
QoL improvement will be tested hierarchically. If positive, the
combination of hard clinical endpoints including all-cause mortality and
HFH will be tested. Patients will be followed for a total of 3 years. The
safety outcome comprises complications of TTVI, life-threatening bleeding
and death. Conclusion(s): The TRIC-I-HF-DZHK24 trial will define the
role of TTVI in patients with severe TR and right-sided HF. Copyright
© 2025 The Author(s). European Journal of Heart Failure published by
John Wiley & Sons Ltd on behalf of European Society of Cardiology.

<11>
Accession Number
2041006176
Title
Circulating microRNAs in viral myocarditis: Advancements in biological
understanding and potential clinical applications.
Source
Gene. 975 (no pagination), 2026. Article Number: 149866. Date of
Publication: 10 Jan 2026.
Author
Ma M.-R.; Song X.; Wang X.-K.; Liu Y.; Cai X.-Q.; Zheng R.-R.; Liu M.-H.;
Ma J.; Wang F.; Ma L.
Institution
(Ma, Song, Wang, Liu, Cai, Zheng, Wang, Ma) Department of Cardiology, The
940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou,
China
(Liu) Department of Cardiology, Fuwai Hospital, National Center of
Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Ma) Laboratory of Basic Medical Science Research, The 940th Hospital of
Joint Logistics Support Force of Chinese PLA, Lanzhou, China
(Ma) Key Laboratory of Stem Cells and Gene Drugs, Lanzhou, China
Publisher
Elsevier B.V.
Abstract
Viral myocarditis (VMC) is a prevalent inflammatory cardiac condition,
characterized by highly variable clinical manifestations that present
significant challenges for early diagnosis and the development of
personalized treatment strategies. Consequently, there is an urgent need
to develop novel biomarkers and targeted therapeutic approaches to enhance
its clinical management. Circulating microRNAs (miRNAs) have emerged as
promising candidates for disease diagnosis and treatment due to their
stability as intercellular communication molecules and resistance to
nuclease degradation. Their significance in various disease contexts has
garnered considerable research attention. Recent advancements in
high-throughput sequencing technologies, coupled with deep learning and
the integration of artificial intelligence (AI) into RNA/protein structure
prediction, have improved our understanding of the roles of regulatory
networks involving circulating microRNAs in the pathogenesis of viral
myocarditis. This systematic review covers recent evidence for the
clinical applicability and limitations of the use of circulating miRNAs as
specific diagnostic and therapeutic targets for viral myocarditis. It was
performed with the aim of establishing a theoretical foundation and
strategic framework to improve the precision of this condition's diagnosis
and treatment. Copyright © 2025 Elsevier B.V.

<12>
Accession Number
2040471851
Title
Geographical and Temporal Variation in Coronary Intravascular Imaging
Utilisation and Barriers to Wider Adoption: A Systematic Review and Pooled
Analysis.
Source
Heart Lung and Circulation. 34(11) (pp 1179-1193), 2025. Date of
Publication: 01 Nov 2025.
Author
Norman S.; Koshy A.N.; Wan A.; Biswas S.; Wilson W.; Eccleston D.;
Lefkovits J.
Institution
(Norman, Koshy, Wan, Biswas, Wilson, Eccleston, Lefkovits) Department of
Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
(Koshy, Wilson, Eccleston) Faculty of Medicine, The University of
Melbourne, Melbourne, VIC, Australia
(Biswas) Department of Cardiology, The Alfred Hospital, Melbourne, VIC,
Australia
(Biswas) School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
Publisher
Elsevier Ltd
Abstract
Background: Despite the accumulation of randomised data demonstrating
improved outcomes with intravascular imaging (IVI)-guided percutaneous
coronary intervention (PCI), utilisation is uncommon in most countries.
This systematic review maps geographical and temporal trends in IVI use
using PCI registry and government data. Method(s): A systematic
review adhering to the PRISMA framework was conducted to identify
provincial, national, and international data sets reporting real-world IVI
rates published between 2014 and 2024. Result(s): A total of 36
publications from 24 countries were included, totalling 9,459,897
patients. Intravascular ultrasound was the preferred imaging modality,
with optical coherence tomography accounting for <10% of IVI. Most
countries reported low rates of IVI uptake, however, significant increases
over time were observed. Rates varied significantly between and within
regions and countries. Asia had the highest mean utilisation rate (35.4%;
standard deviation, 35.9), followed by the Americas (9.3%; 5.7), Europe
(5.7%; 4.9), and Oceania (4.5%; 2.6). Conclusion(s): Significant
variability in IVI utilisation was observed across regions and countries.
Most countries reported low IVI rates; however, adoption increased over
time in most areas. Local variables such as health care system
characteristics, physician preferences, and financial considerations
appear to inform IVI rates more than clinical factors. Copyright
© 2025 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<13>
Accession Number
2041059049
Title
Effect of preoperative thoracic paravertebral block using liposomal
bupivacaine combined with drainage-tube patient-controlled analgesia on
postoperative pain after thoracoscopic lobectomy: a prospective,
multicentre, double-blind, randomized controlled study protocol.
Source
Perioperative Medicine. 14(1) (no pagination), 2025. Article Number: 122.
Date of Publication: 01 Dec 2025.
Author
Sun Y.; Guo N.; Fang T.; Feng Y.; Liu P.; Sun D.; Li Y.; Liu K.; Ren Y.;
Li M.; Liu Q.; Yang X.; Chi Y.; Liu Z.; Yuan L.; Lang B.; Yang Z.; Feng
N.; You P.; Zhang W.; Su D.; Wu J.
Institution
(Sun, Guo, Fang, Feng, Liu, Ren, Li, Liu, Yang, Wu) Department of
Anesthesiology, The First Affiliated Hospital of Shandong First Medical
University & Shandong Provincial Qianfoshan Hospital, Jinan, China
(Sun, Guo, Fang, Feng, Wu) Shandong Institute of Anesthesia and
Respiratory Critical Medicine, Jinan, China
(Sun, Guo, Fang, Feng, Wu) Shandong Provincial Clinical Research Center
for Anesthesiology, Jinan, China
(Sun, Li) Department of Thoracic Surgery, The First Affiliated Hospital of
Shandong First Medical University & Shandong Provincial Qianfoshan
Hospital, Jinan, China
(Liu) Department of Anesthesiology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
(Su) Department of Anaesthesiology, The First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, China
(Liu) Shandong Second Medical University, Weifang, China
(Liu, Ren, Li, Yang) Shandong Provincial Qianfoshan Hospital, Shandong
University, Jinan, China
(Chi) Department of Anesthesiology, Affiliated Hospital of Shandong
University of Traditional Chinese Medicine, Jinan, China
(Liu) Department of Anesthesiology, Linyi people's Hospital, Linyi, China
(Yuan) Department of Anesthesiology, The Affiliated Hospital of Qingdao
University, Qingdao, China
(Lang) Department of Anesthesiology, The First Affiliated Hospital of
Shandong Second Medical University, Weifang, China
(Yang) Department of Anesthesiology, Taian City Central Hospital, Taian,
China
(Feng) Department of Anesthesiology, Zibo Central Hospital, Zibo, China
(You) Department of Anesthesiology, Jining City First People's Hospital,
Jining, China
(Zhang) Department of Anesthesiology, The Second Affiliated Hospital of
Shandong First Medical University, Taian, China
Publisher
BioMed Central Ltd
Abstract
Background: Thoracic paravertebral block (TPVB) with liposomal bupivacaine
(LB) is increasingly used for postoperative pain control in patients
undergoing thoracic surgery, but relevant data are scarce, and there are
few data on LB-TPVB combined with drainage tube patient-controlled
analgesia (PCA). The aim of this study is to explore the effect of LB-TPVB
combined with drainage-tube PCA on postoperative pain after thoracoscopic
lobectomy. Method(s): This is a prospective, multicentre,
double-blind, randomized controlled study. Participants will be randomly
assigned to the standard bupivacaine (SB) group, SB + drainage-tube PCA
(DTA) group, LB group, or LB + DTA group. The primary outcome is the 72-h
mean Numerical Rating Scale (NRS) pain score at rest. The target sample
size is 228 patients, with 57 patients in each group. Discussion(s):
Our study hypothesizes that preoperative ultrasound-guided thoracic nerve
block combined with drainage tube self-controlled analgesia is more
effective in reducing postoperative pain following thoracoscopic lobe
resection compared to thoracic nerve block alone. Additionally, liposomal
bupivacaine was found to be more effective than standard bupivacaine in
this context. These results will have implications for improving
postoperative analgesia protocols for patients undergoing thoracoscopic
lung surgery. Trial registration: ClinicalTrials.gov, NCT06165991.
Registered 29 November 2023,
https://clinicaltrials.gov/study/NCT06165991. Copyright © The
Author(s) 2025.

<14>
Accession Number
2040476182
Title
Effects of Volatile Sedation Versus Propofol on Time to Extubation in the
Intensive Care Unit After Cardiac Surgery: A Systematic Review and
Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(12) (pp 3576-3588),
2025. Date of Publication: 01 Dec 2025.
Author
Garo M.L.; Rinaldi P.; Galderisi A.; Di Folco M.; Ruggiero A.; Mattei A.;
Schiavoni L.; Nasso G.; Pascarella G.; Chello M.; Lusini M.; Cataldo R.;
Carassiti M.; Agro F.E.; Strumia A.
Institution
(Garo, Rinaldi, Galderisi, Di Folco, Ruggiero, Mattei, Schiavoni,
Pascarella, Cataldo, Carassiti, Agro, Strumia) Anesthesia and Intensive
Care Research Unit, Campus Bio-Medico University, Rome, Italy
(Rinaldi) Department of Anesthesiology, Unit of Emergency Anesthesia, Burn
Intensive Care and Poison Control Center, AORN Antonio Cardarelli, Naples,
Italy
(Mattei, Schiavoni, Pascarella, Cataldo, Carassiti, Agro, Strumia)
Anesthesia and Intensive Care Operative Unit, Fondazione Policlinico
Universitario Campus Bio-Medico, Rome, Italy
(Nasso) Anthea Hospital, GVM Care & Research, Bari, Italy
(Chello, Lusini) Research Unit of Cardiac Surgery, Department of
Cardiovascular Surgery, Campus Bio-Medico University, Rome, Italy
(Chello, Lusini) Operative Unit of Cardiac Surgery, Fondazione Policlinico
Universitario Campus Bio-Medico, Rome, Italy
Publisher
W.B. Saunders
Abstract
Background: Optimal sedation management is critical in the postoperative
care of cardiac surgery patients admitted to the intensive care unit
(ICU), where sedative choice may influence respiratory, hemodynamic, and
recovery outcomes. Propofol is the most widely used sedative, but volatile
anesthetics are gaining interest due to their pharmacologic advantages.
This systematic review and meta-analysis was designed to compare volatile
anesthetics with propofol for ICU sedation after cardiac surgery, focusing
on time to extubation as the primary outcome, and ICU and hospital length
of stay, hemodynamic support, and postoperative complications as secondary
outcomes. Method(s): PubMed, Web of Science, and Scopus were searched
from July to October 2024 without language or date restrictions. Eligible
studies were randomized controlled trials comparing volatile anesthetics
with propofol for postoperative ICU sedation in adult cardiac surgery
patients. Studies without extractable data were excluded. Risk of bias was
assessed using the Cochrane risk-of-bias 2.0 tool. Meta-analyses were
performed using random-effects models. Result(s): Five randomized
controlled trials involving 384 patients were included. Sedation with
volatile anesthetics significantly reduced time to extubation compared
with propofol (weighted mean difference [WMD] = -55 minutes, 95% CI -93 to
-17, p < 0.001), although heterogeneity was high (I2 = 95.9%, tau2 =
1,731.95, p < 0.001). No significant differences were observed for ICU
(WMD = -4.26 hours, 95% CI: -17.07 to 8.55, I2 = 89.9%,
t2 = 143.76, z = -0.65, p = 0.51) or hospital (WMD = -1.94
days, 95% CI: -4.17 to 0.30, I2 = 65.1%, t2 = 2.53)
length of stay. Secondary outcomes (use of vasopressors and/or positive
inotropes, postoperative atrial fibrillation, and nausea and/or vomiting)
were inconsistently reported and showed no clear pattern.
 Discussion(s): Volatile anesthetics reduce extubation time compared
with propofol in adult cardiac surgery patients sedated in the ICU.
However, evidence on secondary outcomes remains inconclusive due to
limited and heterogeneous data. Copyright © 2025 Elsevier Inc.

<15>
Accession Number
2041561096
Title
Efficacy of transcutaneous electrical acupoint stimulation for the
treatment of gastrointestinal dysfunction in patients after cardiac
surgery with cardiopulmonary bypass: study protocol for a superiority,
single-centre, single-blind, randomised controlled clinical trial.
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e108309. Date of
Publication: 04 Nov 2025.
Author
Liao Y.; Gao Q.; Chen Y.; Li H.; Wang J.; Zheng F.; Lin S.
Institution
(Liao, Gao, Chen, Li, Wang, Zheng, Lin) Department of Cardiovascular
Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
Publisher
BMJ Publishing Group
Abstract
Objective Gastrointestinal dysfunction is one of the most frequent
complications in patients after cardiac surgery with cardiopulmonary
bypass (CPB). It can seriously affect the patient's quality of life,
increase the length of hospitalisation and in severe cases trigger cardiac
arrest. This single-centre randomised controlled study aims to investigate
whether transcutaneous electrical acupoint stimulation (TEAS) can
effectively relieve gastrointestinal discomfort and improve the quality of
life of patients after cardiac surgery. Methods and analysis A total of
426 patients after cardiac surgery with CPB will be randomly assigned to
the control group or intervention group (1:1 ratio) to receive either
acupressure or TEAS for 3 days. The patients will be recruited from the
Department of Cardiovascular Surgery of Nanfang Hospital. The primary
outcome is the time of the first postoperative anal defecation, the
secondary outcomes include the first postoperative anal exsufflation time,
the number of bowel sounds, the proportion of postoperative laxatives used
in the two groups, abdominal girth, stool frequency per day and length of
postoperative hospital stay. Ethics and dissemination The procedures have
been approved by the Guangdong Regional Medical Ethics Committee of
Nanfang Hospital (NFEC-2023-404) and conformed to the Declaration of
Helsinki. Written informed consent will be obtained from all the
participants. Results will be disseminated through workshops,
peer-reviewed publications and conferences. Copyright © Author(s)
(or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<16>
Accession Number
2040286516
Title
Effects of Preoperative Oral Carbohydrates on Insulin Resistance and
Postoperative Recovery in Diabetic Patients Undergoing Coronary Artery
Bypass Grafting: A Preliminary Prospective, Single-Blinded, Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(12) (pp 3338-3349),
2025. Date of Publication: 01 Dec 2025.
Author
Zhang S.; He L.; Yu Y.; Yuan X.; Yang T.; Yan F.; Xu F.; Zhang Y.; Pan S.;
Zhang H.; Chen Z.; Xie L.; Wu R.; Feng W.; Yao Y.
Institution
(Zhang, Yuan, Yang, Xu, Zhang, Pan, Zhang, Xie, Feng) Department of
Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular
Diseases, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing, China
(Yan, Yao) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Peking Union Medical College and Chinese
Academy of Medical Sciences, Beijing, China
(Chen, Wu) The Department of Intensive Care Unit, Chinese Academy of
Medical Sciences and Peking Union Medical College, Fuwai Hospital,
Beijing, China
(He) Department of Anesthesiology, Fuwai Yunnan Hospital, Chinese Academy
of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical
University
(Yu) Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital
Medical University, Beijing, China
(Yao) Center of Outcomes Research, Department of Anesthesiology, Critical
Care and Pain Medicine, University of Texas, Houston, TX, United States
(Yao) Outcomes Research Consortium, Houston, TX, United States
Publisher
W.B. Saunders
Abstract
Objective: Previous studies have demonstrated that preoperative oral
carbohydrates (CHO) can alleviate postoperative insulin resistance (IR)
and enhance recovery in non-diabetic patients undergoing cardiac surgery.
However, the potential benefits in diabetic patients remain unclear. This
study aimed to investigate the effects of preoperative CHO on IR and
postoperative recovery in diabetic patients undergoing off-pump coronary
artery bypass grafting (OPCAB). Design(s): A prospective,
single-center, single-blind, randomized controlled trial. Setting(s):
The study was conducted in the Adult Cardiac Surgery Ward 6 of a
large-volume cardiovascular center. Participant(s): A total of 62
consecutive diabetic patients scheduled for isolated OPCAB were
prospectively enrolled between July 8, 2022, and April 28, 2023.
Participants were randomized in a 1:1 ratio to the CHO group or the
control (CTRL) group using computer-generated random numbers.
 Intervention(s): Patients in the CHO group received 335 mL of a
carbohydrate drink containing 50 g of carbohydrates 8 to 12 hours before
surgery, while those in the CTRL group followed routine fasting protocols.
 Measurements and Main Results: The primary endpoint was postoperative
IR, assessed by the homeostasis model assessment. Secondary endpoints
included postoperative inflammatory markers and stress responses (e.g.,
serum cortisol levels), while exploratory endpoints focused on in-hospital
clinical outcomes. Baseline characteristics were comparable between
groups. CHO administration significantly reduced postoperative
inflammatory markers but did not significantly improve IR. Stress response
was attenuated in the CHO group, though the difference was not
statistically significant. Postoperative drainage was higher in the CHO
group, but no differences were observed in other clinical outcomes.
 Conclusion(s): Preoperative CHO may attenuate inflammatory and stress
responses without increasing perioperative risk in diabetic patients
undergoing OPCAB, although its effect IR remains uncertain. Copyright
© 2025 Elsevier Inc.

<17>
Accession Number
2040831742
Title
The Effect of Thoracic Paravertebral Block on Postoperative Pain After
Coronary Artery Bypass Graft Surgery: A Retrospective Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(12) (pp 3437-3442),
2025. Date of Publication: 01 Dec 2025.
Author
Nezir Y.; Cengiz G.; Abdurrahman D.
Institution
(Nezir, Abdurrahman) Department of Anesthesiology and Reanimation,
Adiyaman University, Adiyaman, Turkey
(Cengiz) Department of Cardiovascular Surgery, Adiyaman University,
Adiyaman, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the effect of bilateral single-shot thoracic
paravertebral block (PVB) on postoperative analgesia in patients
undergoing coronary artery bypass grafting (CABG) surgery. Design(s):
A retrospective cohort study. Setting(s): A single tertiary
university hospital. Participant(s): Patients who underwent elective
CABG surgery. Intervention(s): Among 110 patients included in the
study, 59 received general anesthesia alone (Group C: control group),
while 51 received general anesthesia combined with a bilateral single-dose
thoracic PVB (Group B: block group). Measurements and Main Results:
Demographic characteristics, intraoperative fentanyl consumption,
postoperative paracetamol requirements, and pain scores-documented in
patient records using the visual analog scale at 2, 4, 16, and 24
hours-along with extubation time, intensive care unit and hospital length
of stay, time to first mobilization, and time to chest drain removal were
retrospectively collected and analyzed. Group B showed significantly lower
intraoperative fentanyl and postoperative paracetamol use compared with
Group C (p < 0.05). Visual analog scale scores were significantly lower in
Group B (p < 0.05). Additionally, extubation time, intensive care unit
length of stay, and time to mobilization were significantly shorter in
Group B (p < 0.05). No significant differences were observed in total
hospital length of stay or chest drain removal time (p > 0.05).
 Conclusion(s): Bilateral single-shot thoracic PVB may be a safe and
effective adjunct to general anesthesia in patients undergoing CABG
surgery. In this retrospective study, PVB was associated with superior
analgesia, decreased opioid consumption, and improved early recovery
parameters. These findings support the integration of PVB into multimodal
analgesia protocols; however, prospective randomized controlled trials are
needed to validate these results. Copyright © 2025 Elsevier Inc.

<18>
Accession Number
649103590
Title
Minimally invasive thoracoscopically-guided right minithoracotomy versus
conventional sternotomy for mitral valve repair: the UK Mini Mitral
multicentre RCT.
Source
Health technology assessment (Winchester, England). 29(55) (pp 1-121),
2025. Date of Publication: 01 Nov 2025.
Author
Akowuah E.F.; Maier R.H.; Hancock H.C.; Wagnild J.; Vale L.;
Fernandez-Garcia C.; Kharati E.; Ogundimu E.; Mathias A.; Walmsley Z.;
Howe N.; Graham R.; Ainsworth K.; Zacharias J.
Institution
(Akowuah, Graham, Ainsworth) Department of Cardiac Surgery, James Cook
University Hospital, South Tees NHS Foundation Trust, Middlesbrough,
United Kingdom
(Akowuah) Newcastle University Translational and Clinical Research
Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
(Maier) Academic Cardiovascular Unit, James Cook University Hospital,
South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
(Hancock, Mathias, Walmsley, Howe) Newcastle Clinical Trials Unit,
Population Health Sciences Institute, Newcastle University, Newcastle Upon
Tyne, United Kingdom
(Wagnild, Kharati) Department of Anthropology, Durham University, Durham,
United Kingdom
(Vale, Fernandez-Garcia) Health Economics Group, Population Health
Sciences Institute, Newcastle University, Newcastle Upon Tyne, United
Kingdom
(Ogundimu) Department of Mathematical Sciences, Durham University, Durham,
United Kingdom
(Zacharias) Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS
Foundation Trust, Blackpool, United Kingdom
Abstract
Background: The safety, effectiveness and cost-effectiveness of mitral
valve repair via thoracoscopically guided minithoracotomy compared with
conventional median sternotomy (Sternotomy) in patients with degenerative
mitral valve regurgitation is uncertain and widely debated.
 Objective(s): To determine if Mini was more effective than Sternotomy
in terms of physical functioning and associated return to usual activities
and was cost-effective compared with Sternotomy. Design(s): A
pragmatic, multicentre, expertise-based, superiority, randomised trial.
 Participant(s): Adults with degenerative mitral valve regurgitation
undergoing mitral valve repair surgery. Setting(s): Ten tertiary care
institutions in the United Kingdom. Intervention(s): Mini or
Sternotomy mitral valve repair performed by an expert surgeon. Blinding:
Primary outcome measure [Short Form 36-item Health Survey, version 2
(SF-36v2) physical functioning score] was measured by an independent
assessor, blinded to allocation. Echocardiographic findings were measured
in a core laboratory, blinded to allocation. Outcome Measures: Primary
outcomes were physical functioning and associated return to usual
activities measured by change from baseline in SF-36v2 physical function
domain at 12 weeks following index surgery. The primary economic measure
was incremental cost per quality-adjusted life-year over the year
following surgery. Secondary outcomes included recurrent mitral
regurgitation grade, physical activity and quality of life measured at
time points to 1 year. Safety outcomes included death, repeat mitral valve
surgery or heart failure hospitalisation up to 1 year. Result(s):
Between November 2016 and January 2021, 330 participants were randomised;
166 to Mini and 164 to Sternotomy. Of these, 309 underwent surgery and 294
reported the primary outcome. Thirty per cent were female. At 12 weeks,
mean difference between groups in the change in SF-36v2 physical function
T-scores was 0.68 (95% confidence interval -1.89 to 3.26). Valve repair
rates (96%) were similar in both groups. Echocardiography demonstrated
mitral regurgitation severity as none or mild for 92% of participants at 1
year in both groups. The composite safety outcome occurred in 5.4% (9/166)
of Mini and 6.1% (10/163) of Sternotomy participants at 1 year. On
average, Mini was more costly 29,424 (95% confidence interval 26,909 to
31,940) versus 27,397 (95% confidence interval 25,172 to 29,620) and more
effective 0.81 quality-adjusted life-years (95% confidence interval 0.78
to 0.84) versus 0.78 (95% confidence interval 0.75 to 0.81) than
Sternotomy. The adjusted incremental cost-effectiveness ratio was 74,863
per quality-adjusted life-year for the comparison between Mini and
Sternotomy. Mini has a probability of < 50% of being cost-effective at the
range of willingness-to-pay values considered. Limitation(s): To
minimise bias, SF-36v2 and all echocardiographic measures were
independently assessed by personnel blinded to allocation. Expertise-based
randomisation was important to address the limitations of previous
studies; however, it is possible that it may have introduced potential
confounders. Conclusion(s): Mini is not superior to Sternotomy in
recovery of physical function at 12 weeks. Mini achieves high rates and
quality of valve repair and has similar safety outcomes at 1 year to
Sternotomy. The balance of probabilities favoured Sternotomy as the
preferred surgical procedure in the base-case analysis over the range of
willingness-to-pay values society might consider worthwhile for a
quality-adjusted life-year. Nevertheless, additional factors such as
equity or patient preferences for one procedure over another may need to
also be taken into account. Results provide high-quality evidence to
inform shared decision-making and treatment guidelines. Future work: Work
is ongoing to disseminate findings and influence guidelines; patients have
consented to longer-term follow-up. From an economics perspective, the
currently available evidence shows that further research into patient
preferences is important to inform the choice of surgical procedure. Trial
registration: This trial is registered as ISRCTN 13930454.
 Funding(s): This award was funded by the National Institute for
Health and Care Research (NIHR) Health Technology Assessment programme
(NIHR award ref: 14/192/110) and is published in full in Health Technology
Assessment; Vol. 29, No. 55. See the NIHR Funding and Awards website for
further award information.

<19>
Accession Number
2037514673
Title
Bioprosthetic Valve Fracture for Transcatheter Aortic Valve-in-Valve
Replacement: A Systematic Literature Review.
Source
Annals of Thoracic Surgery. 120(5) (pp 817-825), 2025. Date of
Publication: 01 Nov 2025.
Author
Chopko T.C.; Afoke J.N.; Khan F.W.; Rowse P.G.
Institution
(Chopko) Department of Surgery, Mayo Clinic, Rochester, MN, United States
(Afoke, Khan, Rowse) Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, United States
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve-in-valve replacement presents a viable,
minimally invasive approach to replacing degraded bioprosthetic surgical
valves. The major drawback of this technique is poor hemodynamics in the
form of patient-prosthesis mismatch and high transvalvular gradients. This
is commonly attributable to the reduced valvular diameter from the
transcatheter heart valve fixed inside the degraded bioprosthesis.
Maximizing this diameter by bioprosthetic valve fracture occurs through a
noncompliant, high-pressure balloon to splay the degraded valve outward.
Despite its novelty, this has demonstrated improved hemodynamic outcomes
and optimal valvular expansion with slightly increased operative risk. In
this review, we highlight the technique of bioprosthetic valve fracture,
types of suitable balloons and valves, timing in relation to
valve-in-valve implantation, safety and efficacy, implications, and future
directions. Copyright © 2025 The Authors.

<20>
Accession Number
2030338356
Title
Efficacy and Safety of Edoxaban in Anticoagulant Therapy Early After
Surgical Bioprosthetic Valve Replacement: Rationale and Design of the
ENBALV Trial.
Source
Cardiovascular Drugs and Therapy. 39(5) (pp 1215-1221), 2025. Date of
Publication: 01 Oct 2025.
Author
Izumi C.; Amano M.; Fukushima S.; Yaku H.; Eishi K.; Sakaguchi T.; Minami
M.; Yamamoto H.; Onda K.; Omae K.
Institution
(Izumi, Amano) Department of Heart Failure and Transplant, National
Cerebral and Cardiovascular Center, 6-1 Kishibe Shimmachi, Suita-City,
Osaka, Japan
(Fukushima) Department of Cardiovascular Surgery, National Cerebral and
Cardiovascular Center, Suita, Japan
(Yaku) Department of Cardiovascular Surgery, Kyoto Prefectural University
of Medicine, Kyoto, Japan
(Eishi) Department of Cardiovascular Surgery, Hakujyuji Hospital, Fukuoka,
Japan
(Sakaguchi) Department of Cardiovascular Surgery, Hyogo Medical
University, Nishinomiya, Japan
(Minami, Yamamoto, Onda, Omae) Department of Data Science, National
Cerebral and Cardiovascular Center, Suita, Japan
Publisher
Springer
Abstract
Background and Purpose: Anticoagulant therapy with vitamin K antagonists
is recommended within 3 to 6 months after bioprosthetic valve replacement
to prevent thromboembolic events. However, data regarding whether direct
oral anticoagulants can be an alternative to warfarin in such patients are
limited. The purpose of this study is to compare the efficacy and safety
of edoxaban versus warfarin within 3 months after bioprosthetic valve
replacement. Method(s): The ENBALV trial is an
investigator-initiated, phase 3, randomized, open-label, multicenter
study. It involves patients aged 18 to 85 years undergoing bioprosthetic
valve replacement at the aortic and/or mitral position. They are
randomized 1:1 to receive either edoxaban or warfarin. Administration of
edoxaban or warfarin is to be continued for 12 weeks after surgery. The
primary outcome is the occurrence rate of stroke or systemic embolism at
12 weeks after surgery. The net clinical outcome is a composite of stroke,
systemic embolism, or major bleeding, which is included in the secondary
outcomes. Conclusion(s): The ENBALV trial demonstrates the efficacy
and safety of edoxaban compared with warfarin in patients early after
bioprosthetic valve replacement, including patients with sinus rhythm,
which will bring a significant benefit to patients in clinical practice.
Trial Registration: Japan Registry of Clinical Trials (jRCT) 2051210209.
30 Mar 2022
https://jrct.niph.go.jp/latest-detail/jRCT2051210209. Copyright ©
The Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2024.

<21>
Accession Number
648444854
Title
Transcatheter or Surgical Treatment of Patients With Aortic Stenosis at
Low to Intermediate Risk: An Individual Participant Data Meta-Analysis.
Source
JAMA cardiology. 10(11) (pp 1175-1185), 2025. Date of Publication: 01 Nov
2025.
Author
Ludwig S.; Klimek M.; Bay B.; Blankenberg S.; Granada J.F.; Hildick-Smith
D.; Hudson J.; Jorgensen T.H.; Leon M.B.; Magnussen C.; Thiele H.; Horsted
Thyregod H.G.; Wendler O.; de Backer O.; Toff W.D.; Ziegler A.; Seiffert
M.
Institution
(Ludwig, Bay, Blankenberg, Magnussen, Ziegler) Department of Cardiology,
University Heart and Vascular Center Hamburg, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Ludwig, Bay, Blankenberg, Magnussen, Ziegler) Centre for Population
Health Innovation, University Heart and Vascular Center Hamburg,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Ludwig, Bay, Blankenberg, Magnussen, Thiele, Seiffert) German Centre for
Cardiovascular Research Partner Site North, Germany
(Ludwig, Granada, Leon) Cardiovascular Research Foundation, NY, United
States
(Klimek, Blankenberg, Ziegler) Medizincampus Davos, Davos, Switzerland
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals National Health Service Trust, Brighton, United Kingdom
(Hudson) Aberdeen Centre for Evaluation, University of Aberdeen, Aberdeen,
United Kingdom
(Jorgensen, Horsted Thyregod, de Backer) Rigshospitalet, Copenhagen,
Denmark
(Leon) NewYork-Presbyterian Hospital/Columbia University Irving Medical
Center, NY, United States
(Thiele) Department of Cardiology, Heart Center Leipzig at Leipzig
University and Leipzig Heart Science, Leipzig, Germany
(Wendler) Cleveland Clinic, London, United Kingdom
(Toff) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Toff) National Institute for Health Research Biomedical Research Centre,
Glenfield Hospital, Leicester, United Kingdom
(Ziegler) School of Mathematics, Statistics and Computer Science,
University of KwaZulu-Natal, Pietermaritzburg, South Africa
(Seiffert) Department of Cardiology and Angiology, BG University Hospital
Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
Abstract
Importance: Mounting evidence suggests transcatheter aortic valve
implantation (TAVI) as preferred treatment for patients at low to
intermediate surgical risk. However, limitations in study design and
statistical power raise concerns about the generalizability of individual
randomized clinical trials (RCTs) comparing TAVI and surgical aortic valve
replacement (SAVR) to routine clinical practice. Objective(s): To
compare 1-year outcomes of TAVI vs SAVR in patients with severe
symptomatic aortic stenosis at low to intermediate surgical risk applying
a 2-stage individual participant data (IPD) and aggregate meta-analyses.
 Data Sources: MEDLINE databases were searched for RCTs comparing TAVI
and SAVR in patients with aortic stenosis until June 15, 2025. Study
Selection: RCTs were selected comparing TAVI vs SAVR in patients with
severe symptomatic aortic stenosis at low or intermediate surgical risk
with 1-year follow-up. Data Extraction and Synthesis: IPD were obtained
from all investigator-initiated RCTs (DEDICATE, NOTION, NOTION-2, and UK
TAVI) and analyzed in 1- and 2-stage IPD meta-analyses. An overall
meta-analysis was performed by adding aggregate data from
industry-sponsored RCTs. Main Outcomes and Measures: The primary end
point was all-cause death or any stroke 1 year after randomization.
Secondary end points included all-cause death, any stroke, disabling
stroke, cardiovascular death, rehospitalization for cardiovascular cause,
myocardial infarction, new-onset atrial fibrillation, new permanent
pacemaker implantation, and aortic valve reintervention. Result(s):
The IPD meta-analysis included 4 RCTs comprising 2873 patients (mean [SD]
age, 76.7 [5.5] years; 805 [56.1%] male) at low to intermediate surgical
risk randomly assigned to TAVI (n = 1439) or SAVR (n = 1434). At 1 year,
the hazard ratio (HR) for the primary end point for TAVI compared to SAVR
was 0.73 (95% CI, 0.56-0.95) in the 1-stage and 0.79 (95% CI, 0.49-1.27)
in the 2-stage IPD meta-analysis. In the 2-stage overall meta-analysis the
HR for the primary end point was 0.76 (95% CI, 0.60-0.97).
 Conclusions and Relevance: In this IPD meta-analysis of 4 RCTs, and
an overall meta-analysis of 8 RCTs of patients with severe symptomatic AS
at low to intermediate risk, TAVI was associated with a reduction in the
1-year incidence of all-cause death or any stroke. These findings
emphasize TAVI as alternative option in patients at low to intermediate
risk. Long-term follow-up is warranted to evaluate sustainability of these
findings.

<22>
Accession Number
2040694954
Title
A Systematic Review of the Prognostic Value of Cardiopulmonary Exercise
Testing in Patients with Ischemic and Nonischemic Cardiomyopathy.
Source
CJC Open. 7(11) (pp 1441-1450), 2025. Date of Publication: 01 Nov 2025.
Author
Lowes H.; Brenner I.; Woodend K.; West S.; Sunner M.; Khehra B.;
Orchanian-Cheff A.; Rodriguez Arias J.J.; Foroutan F.; Fan C.P.S.;
Rodenas-Alesina E.; Posada J.D.; Ross H.J.; Moayedi Y.
Institution
(Lowes, Brenner, Woodend, West) Environmental and Life Sciences, Trent
University, Peterborough, ON, Canada
(Lowes, Sunner, Khehra, Orchanian-Cheff, Rodriguez Arias, Foroutan, Fan,
Rodenas-Alesina, Posada, Ross, Moayedi) Ted Rogers Centre for Heart
Research, Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: The prognostic utility of cardiopulmonary exercise testing
(CPET) in heart failure (HF) is well established; however, whether optimal
CPET parameter thresholds differ across HF etiologies remains unclear.
This systematic review aimed to determine how CPET-derived parameters and
their prognostic threshold values differ, and their association with
adverse outcomes, in patients with ischemic vs nonischemic cardiomyopathy.
 Method(s): Eligible studies assessed adult HF patients and reported
outcomes of all-cause mortality, left ventricular assist device
implantation, heart transplantation, or hospitalization. CPET parameters
and associated threshold values were extracted, and risk of bias was
assessed using the Joanna Briggs Institute checklist for cohort studies.
 Result(s): Four studies comprising 491 ischemic and 218 nonischemic
HF patients were included. Peak oxygen consumption (pVO<inf>2</inf>) was
the only CPET parameter unanimously reported. In ischemic HF, the optimal
pVO<inf>2</inf> thresholds, in mL/kg/min, were <= 14.10 (hazard ratio [HR]
3.3; confidence interval [CI]: 1.9-5.8), <= 10.0 (HR 0.76; CI: 0.59-0.98),
<= 15.20, and <= 14.0 (used in one study as a guideline comparator),
yielding a mean threshold of <= 13.33 mL/kg/min ( +/- 2.28). In
nonischemic HF, optimal thresholds in mL/kg/min were <= 14.60 (HR 4.30
[CI: 2.10-8.90]) and <= 14.0, yielding a mean of <= 14.30 mL/kg/min ( +/-
0.42). Conclusion(s): Significant heterogeneity was present in study
design, patient populations, and CPET variables assessed. The few
consistently assessed prognostic thresholds were similar across HF
etiologies. Peak oxygen consumption (pVO<inf>2</inf>) remains a robust
prognostic marker in both ischemic and nonischemic cardiomyopathy.
Although patients with ischemic cardiomyopathy generally have worse
clinical profiles, this review suggests that no meaningful differences
occur in a few key CPET prognostic thresholds, namely pVO<inf>2</inf>,
across etiologies. These findings support continued use of established
guideline-recommended thresholds for risk stratification, irrespective of
HF subtype, but require further confirmation. Copyright © 2025
The Authors

<23>
Accession Number
2041032397
Title
Tongxinluo capsule for acute myocardial infarction: a systematic review
and meta-analysis.
Source
Frontiers in Pharmacology. 16 (no pagination), 2025. Article Number:
1632809. Date of Publication: 2025.
Author
Wu Y.; Guo J.; Fan J.; Wang X.
Institution
(Wu, Guo, Fan) Department of Cardiology, Dongzhimen Hospital, Beijing
University of Chinese Medicine, Beijing, China
(Wu, Guo, Fan, Wang) Institute of Cardiovascular Diseases, Beijing
University of Chinese Medicine, Beijing, China
Publisher
Frontiers Media SA
Abstract
Objective: To evaluate the clinical and preclinical effects of Tongxinluo
Capsule (TXL) on acute myocardial infarction (AMI) and to summarize
reported mechanisms of action, thereby informing clinical decision-making
and future research. Method(s): A comprehensive computerized search
of eight databases and four clinical trial registries was performed from
their inception until 1 April 2025. Data extraction, quality assessment
and analysis were conducted in strict accordance with predefined
protocols. The methodological quality of included studies was evaluated
using the RoB-2 and SYRCLE tools. Statistical analyses were carried out
using RevMan 5.4 software, employing fixed-effect or random-effects models
as appropriate. Result(s): This review included 54 clinical studies
(4,353 patients in trail group; 4,296 patients in control group) and 11
animal studies (95 animals in trail group; 94 animals in control group).
Meta-analysis of clinical studies indicated that, compared with control
groups, TXL was associated with lower all-cause mortality, cardiovascular
mortality, and incidence of myocardial reinfarction (P < 0.05). Compared
with control groups, TXL was associated with lower incidence of repeated
revascularization, heart failure, angina pectoris, and arrhythmias (P <
0.05). Furthermore, TXL demonstrated greater improvement in cardiac
function indicators and vascular endothelial function (P < 0.001),
alongside significant reductions in blood lipids levels (TC, TG, HDL-C,
LDL-C; P < 0.05) and inflammation markers. TXL was associated with fewer
adverse reactions (P = 0.01), primarily gastrointestinal in nature. In
animal studies, TXL was correlated with lower myocardial infarction area
and the no-reflow area (P < 0.001), higher cardiac function indicators
(LVEF and LVFS; P < 0.05) and better vascular endothelial function (P <
0.05) compared to control group. Reported biological mechanisms of TXL
include inhibition of apoptosis, suppression of inflammation, protection
of cardiomyocytes and endothelial cells, promotion of angiogenesis, and
synergistic lipid-lowering and plaque-stabilization effects.
 Conclusion(s): This study is the first meta-analysis to integrate
both clinical and animal research on TXL for AMI. The finding suggests
that TXL may be associated with alterations in left ventricular systolic
function and clinical prognosis, potentially mediated through mechanisms
such as inhibition of apoptosis, protecting endothelial function, reducing
of inflammation, preservation of cardiomyocytes, and promotion of
angiogenesis. Limitations of the included studies constrain the strength
of these conclusions, and further validation through larger, high-quality
randomized controlled trials is warranted. Copyright © 2025 Wu,
Guo, Fan and Wang.

<24>
Accession Number
2041506198
Title
Leadless vs. transvenous pacemakers following transcatheter aortic valve
replacement: A dual-centre propensity score-matched observational study.
Source
Europace. 27(11) (no pagination), 2025. Article Number: euaf264. Date of
Publication: 01 Nov 2025.
Author
Venier S.; Ben Kilani M.; Olivier M.; Leguily G.; Carabelli A.; Benali R.;
Desbiolles A.; Diouf Y.; Jacon P.; Defaye P.
Institution
(Venier, Olivier, Carabelli, Benali, Desbiolles, Diouf, Jacon, Defaye)
Department of Cardiology, Grenoble Alpes University Hospital, CS10217,
Cedex 9, Grenoble, France
(Venier, Carabelli, Defaye) University Grenoble Alpes, INSERM, CHU
Grenoble Alpes, LRB, Grenoble, France
(Ben Kilani, Leguily) Department of Cardiology, Angers University
Hospital, Angers, France
Publisher
Oxford University Press

<25>
Accession Number
2041091786
Title
The effect of exosome-related therapy in cardiac revascularization
procedures: a systematic review.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
793. Date of Publication: 01 Dec 2025.
Author
Shojaei S.; Mirhosseini S.A.; Mousavi A.; Zooravar D.; Ranjbar M.;
Aghajani S.; Attar A.
Institution
(Shojaei, Mousavi) Cardiovascular Diseases Research Institute, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Shojaei, Mousavi) Students' Scientific Research Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mirhosseini) Cardiovascular Research Center, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Zooravar) School of Medicine, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Ranjbar) MD-MPH Department, School of Medicine, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Aghajani) Department of Medicine, School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Attar) Department of Cardiology, School of Medicine, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Cardiovascular diseases (CVDs) remain the leading global cause
of mortality despite advances in revascularization strategies like
coronary artery bypass grafting (CABG) and percutaneous interventions.
Exosomes have emerged as dual-function agents, acting both as paracrine
mediators of vascular repair and as drug-delivery vehicles. This
systematic review evaluates the therapeutic efficacy of exosome-based
therapies in cardiac revascularization procedures. Method(s): A
comprehensive search of Embase, PubMed, Scopus, and Web of Science was
conducted from inception to January 2025. We included experimental
studies, evaluating animal subjects undergoing revascularizations. Risk of
bias was assessed using SYRCLE's tool. Study characteristics, population
characteristics, intervention details, various outcomes, and limitations
of each study were extracted from each included study. Result(s):
Eight preclinical studies met our inclusion criteria. We observed that
exosome therapies demonstrated significant benefits. Sirolimus-loaded
exosomes (SIR-EXO) reduced stenosis to 5% vs. 59% in controls.
Exosome-coated stents (ACC-Exo-REDV) suppressed neointimal hyperplasia by
60% compared to bare stents. Brown adipose tissue-derived exosomes
increased left ventricular ejection fraction, while CABG + exosome patches
restored diastolic function. Exosome-eluting stents reduced
pro-inflammatory cytokines (IL-1beta, TNF-alpha) by 93% and promoted M2
macrophage polarization. Exosome-enhanced stents improved endothelial cell
proliferation by 40% and reduced platelet adhesion by 70%.
 Conclusion(s): Exosome-based therapies show promise in enhancing
vascular repair, mitigating restenosis, and modulating
post-revascularization inflammation. Copyright © The Author(s)
2025.

<26>
Accession Number
2037441058
Title
Six-month safety and efficacy outcomes from the randomized-controlled arm
of the WRAPSODY Arteriovenous Access Efficacy (WAVE) trial.
Source
Kidney International. 107(4) (pp 740-750), 2025. Date of Publication: 01
Apr 2025.
Author
Razavi M.K.; Balamuthusamy S.; Makris A.N.; Hoggard J.G.; Harduin L.O.;
Roy-Chaudhury P.; Jones R.G.
Institution
(Razavi) St. Joseph Heart and Vascular Center, Orange, CA, United States
(Balamuthusamy) Texas Research Institute, PPG Health, Fort Worth, TX,
United States
(Makris) Chicago Access Care, Westmont, IL, United States
(Hoggard) North Carolina Nephrology, Raleigh, NC, United States
(Harduin) University of Rio de Janeiro State, Rio de Janeiro, Rio de
Janeiro, Brazil
(Roy-Chaudhury) University of North Carolina Kidney Center, Chapel Hill,
NC, United States
(Roy-Chaudhury) W.G. (Bill) Hefner Salisbury Department of Veterans
Affairs Medical Center, Salisbury, NC, United States
(Jones) Department of Interventional Radiology, Queen Elizabeth Hospital
Birmingham, University Hospital, Birmingham, United Kingdom
Publisher
Elsevier B.V.
Abstract
Stenosis within the arteriovenous fistula (AVF) of hemodialysis patients
leads to vascular access dysfunction and inadequate hemodialysis.
Percutaneous transluminal angioplasty (PTA) is the standard therapy for
stenosis. However, rates of restenosis and loss of access patency remain
high. Outcomes of a novel cell-impermeable endoprosthesis (CIE) have not
been investigated in this setting. Therefore, our study was designed to
address this as a prospective, international, multicenter pivotal trial
(NCT04540302) with 245 patients with stenosis in their venous outflow
circuit randomized to treatment: 122 receiving CIE and 123 receiving PTA
across 43 international centers. Primary endpoints included target lesion
primary patency (TLPP) at six months (freedom from clinically driven
target lesion revascularization or target lesion thrombosis) and freedom
from safety events through 30 days post-index procedure that affected the
access circuit and resulted in reintervention, hospitalization, or death.
Access circuit primary patency (ACPP) was evaluated as a secondary
efficacy endpoint. Six-month TLPP and ACPP were significantly higher for
the CIE cohort versus PTA (TLPP: 89.6% vs. 62.3%; ACPP: 72.2% vs. 57.0%).
Thirty days post-index procedure, there was no statistically significant
difference in the freedom from safety events for the CIE versus PTA (96.6
vs. 95.0%). No differences were observed in adverse events between either
cohort. Our study shows that among patients with stenosis in their AVF,
the CIE was superior to PTA with respect to six-month TLPP and ACPP with
no observed difference in 30-day primary safety events. Copyright
© 2025 International Society of Nephrology

<27>
Accession Number
2041566778
Title
Postoperative Cost-effectiveness of Prophylactic Amino Acid Therapy for
Renal Protection: A Modeled Economic Evaluation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Carrandi A.; Faggery M.; Losiggio R.; Pontillo D.; Pruna A.; Landoni G.;
Bellomo R.; Higgins A.M.
Institution
(Carrandi, Faggery, Bellomo, Higgins) Australian and New Zealand Intensive
Care Research Centre (ANZIC-RC), School of Public Health and Preventive
Medicine, Monash University, Melbourne, Australia
(Losiggio, Pontillo, Pruna, Landoni) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
(Bellomo) Intensive Care Unit, Austin Hospital, Heidelberg, VIC, Australia
(Bellomo) Department of Critical Care, University of Melbourne, Parkville,
VIC, Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Heidelberg, VIC, Australia
Publisher
W.B. Saunders
Abstract
Objective: To assess the cost-effectiveness of intravenous amino acids
(AA) versus placebo in decreasing cardiac surgery-associated acute kidney
injury (AKI) among adult patients after cardiac surgery. Design(s):
Data on resource use and outcomes were obtained from relevant studies
reported in a recent meta-analysis. Cost-effectiveness analyses were
conducted using a decision tree model to quantify the incremental costs
and health outcomes of AA versus placebo. Setting(s):
Cost-effectiveness analyses were conducted separately for Australia, the
United States, China, Italy, and the United Kingdom using local unit
costs. Participant(s): Adult patients after cardiac surgery.
 Intervention(s): Intravenous AA versus placebo. Measurements and
Main Results: The cost-effectiveness analyses expressed outcomes in terms
of cost per instance of AKI averted with an in-hospital time horizon and
from a healthcare payer perspective. The expected total healthcare cost
after surgery in patients treated with AA ranged from $1,871 in China to
$37,692 in the United States versus $2,055 in China to $40,213 in the
United States for the placebo group, with a per patient cost saving
ranging from $184 (95% confidence interval [CI], -$331 to -$32) in China
to $2,521 (95% CI, -$3,770 to -$1,260) in the United States. AA also
resulted in a 5.2% (95% CI, 5.1%-5.3%) absolute risk reduction in AKI. AA
was dominant (cost-saving and cost-effective) across all jurisdictions.
 Conclusion(s): Compared with placebo, AA infusion decreases the
occurrence of AKI and is cost-saving. Perioperative AA therapy is a
rational approach to patient care that simultaneously protects renal
function and decreases healthcare costs. Copyright © 2025 The
Authors

<28>
Accession Number
648716162
Title
Tricuspid Valve Repair in Pediatric Patients Using Artificial Neochordae:
Systematic Review of Current Evidence.
Source
World journal for pediatric & congenital heart surgery. 17(1) (pp
113-119), 2026. Date of Publication: 01 Jan 2026.
Author
Crea D.; Padalino M.; Bortolotti U.; Stellin G.
Institution
(Crea, Stellin) Division of Pediatric Cardiac Surgery, University of
Padova, Padova, Italy
(Padalino) Department of Precision and Regenerative Medicine and Jonic
Area, University of Bari "Aldo Moro", Bari, Italy
(Bortolotti) Cardiothoracic and Vascular Department, Section of Cardiac
Surgery, University of Pisa, Pisa, Italy
Abstract
Artificial neochordae crafted from expanded polytetrafluoroethylene are
commonly utilized in mitral valve repair. Yet their application in
tricuspid valve repair, particularly in the pediatric demographic, remains
relatively unexplored. Upon reviewing the available literature, we have
identified pediatric patients with tricuspid valve regurgitation,
primarily of congenital origin and diagnosed at birth, who underwent
repair procedures involving artificial neochordal implantation.
Postoperatively, trivial-to-mild tricuspid regurgitation was predominantly
observed in most cases. Operative mortality appears to be low, but a
reliable estimate of operative mortality rates, early failure, and
reoperation was not possible due to incomplete data reporting in the
studies reviewed. Moreover, long-term data are not available since in most
reports, postoperative evaluation was obtained early after repair. Our
review suggests that artificial neochordal repair of the tricuspid valve
may be a feasible surgical option to prosthetic valve replacement in
pediatric patients. However, comprehensive data and further late follow-up
are needed to analyze long-term effectiveness and clinical outcomes.

<29>
Accession Number
2030181219
Title
Cardioprotection with Intralipid During Coronary Artery Bypass Grafting
Surgery on Cardiopulmonary Bypass: A Randomized Clinical Trial.
Source
Cardiovascular Drugs and Therapy. 39(5) (pp 1045-1052), 2025. Date of
Publication: 01 Oct 2025.
Author
Hadebe N.; Cour M.; Imamdin A.; Petersen T.; Pennel T.; Scherman J.;
Snowball J.; Ntsekhe M.; Zilla P.; Swanevelder J.; Lecour S.
Institution
(Hadebe, Cour, Imamdin, Petersen, Snowball, Lecour) Cardioprotection
Group, Faculty of Health Sciences, Cape Heart Institute, University of
Cape Town, Anzio Road, Observatory, Cape Town, South Africa
(Hadebe, Swanevelder) Department of Anaesthesia, Faculty of Health
Sciences, University of Cape Town, Cape Town, South Africa
(Pennel, Scherman, Zilla) Chris Barnard Division of Cardiothoracic
Surgery, University of Cape Town, Cape Town, South Africa
(Ntsekhe) Division of Cardiology, Faculty of Health Sciences, University
of Cape Town, Cape Town, South Africa
Publisher
Springer
Abstract
Purpose: Coronary artery bypass grafting (CABG) on cardiopulmonary bypass
(CPB) is associated with myocardial ischemia-reperfusion injury (IRI),
which may limit the benefit of the surgery. Both experimental and clinical
studies suggest that Intralipid, a lipid emulsion commonly used for
parenteral nutrition, can limit myocardial IRI. We therefore aimed to
investigate whether Intralipid administered at reperfusion can reduce
myocardial IRI in patients undergoing CABG on CPB. Method(s): We
conducted a randomized, double-blind, pilot trial in which 29 adult
patients scheduled for CABG were randomly assigned (on a 1:1 basis) to
receive either 1.5 ml/kg Intralipid 20% or Ringer's Lactate 3 min before
aortic cross unclamping. The primary endpoint was the 72-h area under the
curve (AUC) for troponin I. Result(s): Of the 29 patients randomized,
26 were included in the study (two withdrew consent and one was excluded
before surgery). The 72-h AUC for troponin I did not significantly differ
between the control and Intralipid group (546437 +/- 205518 versus 487561
+/- 115724 arbitrary units, respectively; P = 0.804). Other outcomes
(including 72-h AUC for CK-MB, C-reactive protein, need for
defibrillation, time to extubation, length of ICU and hospital stay, and
serious adverse events) were similar between the two groups.
 Conclusion(s): In patients undergoing CABG on CPB, Intralipid did not
limit myocardial IRI compared to placebo. Trial Registration:
ClinicalTrials.gov Identifier: NCT02807727 (registration date: 16 June
2016). Copyright © The Author(s) 2024.

<30>
Accession Number
2041239597
Title
The effectiveness of high versus lower enteral protein intake, considering
energy intake, on clinical outcomes in critically ill children: A
systematic review and meta-analysis.
Source
Clinical Nutrition. 54 (pp 220-232), 2025. Date of Publication: 01 Nov
2025.
Author
Jotterand Chaparro C.; Bertoni Maluf V.A.; Pabion C.; Stern F.; Moullet
C.; Kiszio B.; Pugliese M.-T.; Ramelet A.-S.; Morice C.; Valla F.V.; Tume
L.N.
Institution
(Jotterand Chaparro, Bertoni Maluf, Pabion, Moullet, Tume) Department of
Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO
University of Applied Sciences and Arts Western Switzerland, Rue des
Caroubiers 25, Carouge, Switzerland
(Jotterand Chaparro, Kiszio, Ramelet) Bureau d'Echange des Savoirs pour
des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence,
Switzerland
(Stern, Pugliese) Geneva School of Health Sciences, HES-SO University of
Applied Sciences and Arts Western Switzerland, Avenue de Champel 47,
Geneva, Switzerland
(Kiszio) La Source, School of Nursing Sciences, HES-SO University of
Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
(Ramelet) University Institute of Higher Education and Research in
Healthcare, Faculty of Biology and Medicine, University of Lausanne,
Switzerland
(Ramelet) Lausanne University Hospital, Lausanne, Switzerland
(Morice) Geneva University Hospital, Geneva, Switzerland
(Valla) Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, Lyon,
France
(Tume) Faculty of Health, Social Care & Medicine, Edge Hill University, St
Helens Road, Ormskirk, United Kingdom
Publisher
Churchill Livingstone
Abstract
Background & aims: The optimal protein intake for critically ill children
remains uncertain. This systematic review aimed to evaluate the
effectiveness of high versus lower enteral protein intake, accounting for
energy intake, on clinical and nutritional outcomes in children
hospitalized in pediatric intensive care units (PICU). Method(s):
Following the JBI methodology, a comprehensive search was conducted across
Medline, CINAHL Ultimate, Embase, and Cochrane Library from inception to
March 18, 2024. Randomized controlled trials (RCTs) involving critically
ill children admitted to PICU for >=48 h and receiving enteral nutrition
were eligible. Studies comparing protein intake of <1.1 g/kg/day or >2
g/kg/day to internationally recommended intakes were included. Two
independent reviewers screened, selected, extracted the data, and assessed
the risk of bias using the JBI critical appraisal checklist for RCTs; a
third reviewer resolved any disagreements. Meta-analyses were performed
for nitrogen balance, PICU length of stay, prealbumin and blood urea
levels using a random-effects model to account for between-study
heterogeneity. Result(s): Eight RCTs were included, assessing high (n
= 6) and low (n = 2) enteral protein intake versus the recommended intake,
mostly in infants aged 2-4 months, with bronchiolitis or after cardiac
surgery. Four studies presented an unclear risk of bias and four a high
risk. High protein intake (~3 g/kg/day) was associated with significantly
higher nitrogen balance values (effect size: 0.59; 95 % CI: 0.18-1.01; p =
0.0055) compared to the recommended intake (~1.6 g/kg/day) but had no
impact on PICU length of stay and was associated with increased blood urea
levels. Among four RCTs assessing gastrointestinal tolerance, two reported
increased diarrhea or gastric retention. Data on low versus recommended
intake were limited to two studies. Conclusion(s): High enteral
protein intake may increase nitrogen balance in this PICU population, but
potential adverse effects and the lack of evidence for clinical benefit
raise concerns about its safety. Further well-powered RCTs are needed to
evaluate the effects of protein doses within the 1-2.2 g/kg/day ranges in
more diverse PICU populations. Registration and publication of the
protocol: This study protocol was registered in PROSPERO (number:
CRD42022315325) and subsequently published in JBI Evidence Synthesis (DOI:
10.11124/JBIES-22-00133). Copyright © 2025 The Authors. Published
by Elsevier Ltd. This is an open access article under the CC BY license.
http://creativecommons.org/licenses/by/4.0/

<31>
Accession Number
2039906353
Title
The Trials of Interpreting Clinical Trials-A Bayesian Perspective on
Colchicine After an Acute Coronary Syndrome.
Source
Canadian Journal of Cardiology. 41(10) (pp 1929-1935), 2025. Date of
Publication: 01 Oct 2025.
Author
Brophy J.M.
Institution
(Brophy) McGill University Health Center Centre for Health Outcomes
Research (CORE), and Department of Medicine, and Department of
Epidemiology, Biostatistics and Occupational Health, McGill University,
Montreal, QC, Canada
Publisher
Elsevier Inc.
Abstract
Background A 2022 meta-analysis concluded colchicine reduced the cardiac
risk in secondary prevention. Nevertheless, a large, randomized clinical
trial continued to randomize patients to colchicine or placebo and in 2025
published findings of no benefit. Bayesian sequential analyses and
hierarchical meta-analysis can assist in understanding not only the
interpretation of this latest trial but also the totality of the evidence.
Methods A systematic review and Bayesian meta-analysis including the
recent CLEAR trial results was performed. The primary outcome was major
adverse cardiovascular events (MACE), a composite of death from
cardiovascular causes, recurrent myocardial infarction, stroke, or
unplanned ischemia-driven coronary revascularization. Bayesian sequential
analyses were performed with vague (results dominated by CLEAR), fully
informative (on the basis of all previous studies), and "focused"
(considering only the largest and most similar previous trial) priors and
results compared in a hierarchical meta-analysis. The probabilities of
clinically meaningful results were based on an absolute > 15% MACE
reduction. Results Although the 2022 meta-analysis suggested a
statistically significant MACE decrease with colchicine, the Bayesian
reanalysis showed a 95% relative risk credible interval of 0.26-1.70 for
the next study, justifying CLEAR continuation. The Bayesian sequential
analyses using vague, all-inclusive, and focused priors showed 58%, 100%,
and 92% probabilities, respectively, of MACE decrease with use of
colchicine. Clinically meaningful probability decreases, based on > an
absolute 15% reduction, were smaller, ranging between 2% and 41%.
Conclusions Bayesian analyses offer advantages in trial design and
interpretation, suggesting some benefit for colchicine in secondary
cardiovascular prevention, but considerably less certainty of its clinical
importance. Copyright © 2025 Canadian Cardiovascular Society.

<32>
Accession Number
2039229260
Title
Comparative outcomes of clopidogrel vs aspirin monotherapy in post-PCI
patients: An updated systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 80 (pp 122-130), 2025. Date of
Publication: 01 Nov 2025.
Author
Wani S.A.; Naveed M.A.; Azeem B.; Ashraf S.; Ali A.; Ali T.; Fatima F.;
Shah M.; Neppala S.; Ahmed R.
Institution
(Wani) Wayne State University, United States
(Naveed) Department of Cardiology, Dow Medical College, Dow University of
Health Sciences, Karachi, Pakistan
(Azeem) Department of Cardiology, Shaheed Muhtarma Benazir Bhutto liyari
Medical College, Karachi, Pakistan
(Ashraf, Ali) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Ali) Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi,
Pakistan
(Fatima) Services Institute of Medical Sciences Lahore, Pakistan
(Shah) University of Toledo Medical Center, United States
(Neppala) Division of Cardiology, The University of Texas Health Sciences
Center, San Antonio, TX, United States
(Ahmed) National Heart and Lung Institute, Imperial College London, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Current guidelines recommend 6-12 months of dual antiplatelet therapy
(DAPT) after percutaneous coronary intervention (PCI) followed by aspirin
monotherapy indefinitely. We aimed to assess efficacy and safety of
Clopidogrel as compared to aspirin in patients undrgoing PCI after
completing DAPT. We systematically searched 3 electronic databases and
identified studies comparing clopidogrel to aspirin in post PCI population
after completing DAPT. We included 7 studies with 20,360 patients. We
pooled outcomes for major adverse cardiac events (MACE), typically
comprising a composite of death, myocardial infarction (MI), or stroke;
all-cause mortality; cardiac death; major bleeding; any stroke; ischemic
stroke; hemorrhagic stroke; repeat revascularization; target-vessel
revascularization (TVR); and definite stent thrombosis. Mean follow up was
12-36 months. Duration of DAPT was 1-18 months. Clopidogrel was associated
with reductions in MACE than aspirin (RR: 0.82; 95 % CI: 0.69-0.98; p =
0.03), showed reduced risk of MI (RR 0.93 CI 0.60-1.44; p 0.74,
I2 63%) indicating a relative reduction of 7 %, reduced strokes
numerically but non-significantly (RR: 0.72; 95 % CI: 0.48-1.07; p =
0.11), RRR 28 %, all cause mortality did not exhibit a significant
difference between clopidogrel and aspirin (RR: 0.99; 95 % CI: 0.67-1.44;
p = 0.94). Cardiac death (RR: 0.81; 95 % CI: 0.56-1.17; p = 0.26), major
bleeding (RR: 0.90; 95 % CI: 0.61-1.33; p = 0.61), reflecting a 10 %
non-significant relative reduction, repeat revascularization showed no
significant difference (RR: 0.95; 95 % CI: 0.74-1.23; p = 0.72)
representing a slight 5 % relative reduction, target vessel
revascularization did not reveal any significant differences (RR: 0.89; 95
% CI: 0.69-1.16; p = 0.40) corresponding to a non-significant relative
risk reduction of 11 %, stent thrombosis demonstrated no statistically
significant difference (RR: 0.78; 95 % CI: 0.27-2.31; p = 0.66) RRR of 22
%. Compared to aspirin Clopidogrel was associated with reduction in MACE
with no significant differences in Mortality, Major bleeding, MI, and
repeat revascularization between groups. Prospero Registration Number
CRD420251042349. Copyright © 2025 The Authors.

<33>
Accession Number
2040961749
Title
Perioperative tight glucose control regimens for preventing surgical site
infections following cardiac surgery-a systematic review and metanalysis
of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 108 (no pagination), 2026. Article Number:
112051. Date of Publication: 01 Jan 2026.
Author
Sun Y.; Wen Z.; Ren Y.; Hua Z.
Institution
(Sun, Ren, Hua) Department of Anesthesiology, Beijing Hospital, National
Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of
Medical Sciences, Beijing, China
(Wen) Medical school, Jiamusi University, Heilongjiang, Jiamusi, China
Publisher
Elsevier Inc.
Abstract
Background Perioperative hyperglycemia is common during cardiac surgery
and has been linked to an increased risk of surgical site infections
(SSIs). However, the benefits of perioperative tight glucose control (TGC)
remain debated, largely due to concerns about hypoglycemia. This
systematic review assessed the effects and safety of TGC on SSIs in adults
undergoing cardiac surgery. Methods We searched MEDLINE, Embase, and
Cochrane databases for randomized controlled trials (RCTs) comparing TGC
(upper blood glucose target <=150 mg/dL or 8.3 mmol/L) with conventional
glucose management in adults undergoing cardiac surgery. The primary
outcome was incidence of SSIs. Secondary outcomes included hypoglycemia,
length of intensive care unit (ICU) stay, incidence of neurological
deficits and all-cause mortality within 30 days after surgery. The
certainty of evidence was evaluated using the GRADE approach. Results
Twenty-six RCTs including 17,990 participants were analyzed. TGC compared
with control group was associated with reducing the risk of SSIs (risk
ratio [RR]: 0.53; 95 % confidence interval [CI]: 0.42-0.68; I2
= 0 %; low certainty evidence), particularly when initiated at the start
of surgery (RR: 0.50, 95 %CI: 0.39-0.66, I2 = 0; low certainty
evidence) but not postoperatively (RR = 0.80, 95 % CI: 0.39-1.66;
I2 = 0; very low certainty evidence). TGC also shortened ICU
stay by 7.03 h compared to the control group (95 % CI: -10.83 to -3.22;
very low certainty evidence), though heterogeneity was considerable
(I2 = 92 %). However, TGC was associated with a higher risk of
hypoglycemia (RR: 3.14; 95 % CI: 2.37-4.16; I2 = 0; moderate
certainty evidence). No significant effects were observed on neurological
deficits or all-cause mortality. Conclusion This systematic review of the
available evidence suggests that perioperative TGC, particularly when
initiated at the start of surgery, may reduce the risk of SSIs following
cardiac surgery. However, it increases the risk of hypoglycemia and does
not significantly impact neurological outcomes and all-cause
mortality. Copyright © 2025. Published by Elsevier Inc.

<34>
Accession Number
2040694485
Title
Systematic review on radiation-induced DNA damage and cancer risk in
endovascular operators.
Source
Journal of Vascular Surgery. 82(6) (pp 2283-2297.e1), 2025. Date of
Publication: 01 Dec 2025.
Author
Maris E.-L.; Klaassen J.; Hazenberg C.E.V.B.; Petri B.-J.; Trimarchi S.;
van Herwaarden J.A.
Institution
(Maris, Klaassen, Hazenberg, Petri, van Herwaarden) Department of Vascular
Surgery, Utrecht Medical Centre Utrecht, Utrecht, Netherlands
(Trimarchi) Section of Vascular Surgery, Cardiac Thoracic Vascular
Department, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico,
Milan, Italy
(Trimarchi) Department of Clinical and Community Sciences, University of
Milan, Milan, Italy
Publisher
Elsevier Inc.
Abstract
Objective: Endovascular interventions have increasingly replaced open
surgery owing to their minimally invasive nature and benefits such as
faster recovery and fewer wound complications. This shift has led to
greater reliance on fluoroscopy, raising concerns about occupational
radiation exposure. Ionizing radiation, although essential for guiding
procedures, can damage living tissue and potentially induce long-term
health effects. Recent guidelines from the European Society for Vascular
Surgery and the Cardiovascular and Interventional Radiological Society of
Europe emphasize growing radiation risks and advocate for dose
optimization and protective strategies. Endovascular specialists-vascular
surgeons, interventional cardiologists, and radiologists-are among the
most exposed hospital staff. Yet, limited studies have specifically
examined the effects of fluoroscopy-induced DNA damage and carcinogenesis
in these professionals. The aim of this systematic review was to evaluate
the extent to which occupational radiation exposure contributes to DNA
damage and cancer risk in endovascular operators. Method(s): A
systematic search of the literature from 2000 to April 2025 of PubMed and
EMBASE was conducted following the PRISMA guidelines. All experimental
studies, observational studies, and case reports that examined DNA damage
or cancer occurrence in operators performing endovascular procedures owing
to occupational radiation exposure were included in this review. Studies
were categorized into two primary outcomes: cancer and DNA damage. A risk
of bias assessment was performed according to Cochrane guidelines.
 Result(s): Twenty-five studies were identified. The findings from
these studies suggest that occupational radiation exposure in endovascular
operators may lead to early-stage DNA damage shortly after exposure.
Additionally, the studies observed chronic DNA damage, including
double-strand DNA breaks and chromosomal aberrations, which are
hypothesized to be a contributing factor to genomic instability and
carcinogenesis. Furthermore, the studies researching carcinogenesis
suggest an increased risk of cancer development in endovascular operators,
with particular emphasis on cancer localizations that are more susceptible
to radiation, such as leukemia and thyroid cancer, and in unprotected body
areas, such as the skin and the brain. Conclusion(s): This systematic
review suggests that endovascular operators involved in fluoroscopy-guided
interventional procedures may face an increased risk of stochastic health
effects, with a particular emphasis on chronic DNA damage and
carcinogenesis in locations more vulnerable to radiation. This review
highlights the critical need for enhanced radiation safety measures,
awareness, and preventative strategies. Copyright © 2025 The
Author(s)

<35>
Accession Number
2041093676
Title
Effectiveness and safety of low-dose intraoperative tranexamic acid in
cardiac surgery: a retrospective before-and-after study.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 550. Date
of Publication: 01 Dec 2025.
Author
Chung J.; Kim I.J.; Ju J.-W.; Hong C.-H.; Cho Y.J.; Jeon Y.; Nam K.
Institution
(Chung, Kim, Ju, Hong, Cho, Jeon, Nam) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, Seoul National
University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South
Korea
Publisher
BioMed Central Ltd
Abstract
Background: Tranexamic acid (TXA) is widely used to reduce perioperative
bleeding and transfusion requirements; however, its optimal dosing,
efficacy, and safety remain uncertain, particularly in cardiac surgery
patients. Method(s): This single-center, retrospective
before-and-after study consecutively included adult patients who underwent
cardiac and/or thoracic aortic surgery with cardiopulmonary bypass between
2011 and 2024. Patients were categorized into the before-TXA and after-TXA
groups based on the implementation of a routine intraoperative low-dose
TXA protocol in December 2017. This protocol included a loading dose (5
mg/kg) drawn from a 500 mg ampoule and administered at anesthesia
induction, with the remaining dose added to the CPB priming volume. A
maintenance infusion was administered at 5 mg/kg/h throughout surgery. The
primary outcome was chest tube output during the first 12 h after surgery.
Secondary safety outcomes included thrombotic complications and
postoperative seizures. Outcomes were compared using interrupted time
series analysis after stabilized inverse probability of treatment
weighting. Result(s): A total of 4,425 patients were analyzed (2,131
in the before-TXA group and 2,294 in the after-TXA group). The median
(interquartile range) chest tube output during the first 12 h
postoperatively was 480 mL (270-860 mL) in the before-TXA group and 400 mL
(230-710 mL) in the after-TXA group. In the interrupted time series
analysis, the intercept of log-transformed monthly chest tube output
significantly decreased after TXA implementation (beta<inf>2</inf> =
-0.285; 95% confidence interval, -0.392 to -0.178). There was no
significant increase in thrombotic complications or postoperative seizures
following intraoperative TXA implementation. Conclusion(s): The
routine implementation of low-dose intraoperative TXA in cardiac surgery
was associated with a significant reduction in bleeding after cardiac
surgery, without an increased risk of thrombotic complications or
seizures. Copyright © The Author(s) 2025.

<36>
Accession Number
2035398871
Title
Association of body composition trajectories with changes in cognitive
performance in the Look AHEAD study.
Source
Obesity. 33(S1) (pp 86-95), 2025. Date of Publication: 01 Nov 2025.
Author
Mongraw-Chaffin M.; Evans J.K.; Shappell H.M.; Espeland M.A.; Hayden K.M.
Institution
(Mongraw-Chaffin) Department of Epidemiology and Prevention, Wake Forest
School of Medicine, Winston-Salem, NC, United States
(Evans, Shappell, Espeland) Department of Biostatistics and Data Sciences,
Wake Forest School of Medicine, Winston-Salem, NC, United States
(Espeland) Department of Geriatrics and Gerontology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Hayden) Department of Social Sciences and Health Policy, Wake Forest
School of Medicine, Winston-Salem, NC, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The objective of this study was to investigate the longitudinal
association of total body fat and appendicular lean mass (ALM), as well as
sarcopenia, with cognitive decline after weight loss intervention.
 Method(s): Among 972 Look AHEAD-MIND participants with type 2
diabetes and overweight or obesity, we investigated the longitudinal
association of dual-energy x-ray absorptiometry body composition
trajectories with cognitive change. We identified three latent
trajectories each for total body fat and ALM. Mixed linear regression
models were adjusted for the following: repeated measures; order of
cognitive test; years from randomization; randomization arm; age; sex;
race and ethnicity; and education. We also investigated differences in
cognitive score by sarcopenia and BMI categories. Result(s): A
gradual decrease in total body fat and no decrease in ALM were
significantly independently associated with higher cognitive scores
compared with other trajectories. Differences in cognitive score were
large for sarcopenia, but not for obesity. Full adjustment for demographic
and socioeconomic factors substantially attenuated the estimates.
 Conclusion(s): Weight loss approaches that preserve ALM and function
may lead to reduced cognitive decline compared with weight loss alone. The
improved ability to target interventions toward those who are more
resilient to aging-related body composition changes may prevent unintended
consequences of weight loss. Copyright © 2025 The Obesity
Society.

<37>
Accession Number
2041461886
Title
High-Intensity Statin versus Upfront Equivalent-Dose Combination of
Moderate-Intensity Statin with Ezetimibe Following Acute Myocardial
Infarction (ROSUZET-AMI): protocol of a multicentre, open-label,
randomised non-inferiority trial.
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e104127. Date of
Publication: 01 Nov 2025.
Author
Choo E.H.; Kim C.J.; Hwang B.-H.; Lee K.Y.; Oh G.C.; Lim S.; Choi I.J.;
Kim D.-B.; Kwon O.S.; Lee S.; Choi Y.; Park C.-S.; Park M.-W.; Kim H.-Y.;
Lee H.C.; Kang T.S.; Sung J.K.; Woo S.-I.; Park H.S.; Yun K.H.; Chang K.
Institution
(Choo, Hwang, Lee, Oh, Choi, Chang) Seoul St.Mary's Hospital, The Catholic
University of Korea, Seoul, South Korea
(Kim, Lim) Uijeongbu St.Mary's Hospital, The Catholic University of Korea,
Uijeongbu, South Korea
(Choi) Incheon St. Mary's Hospital, The Catholic University of Korea,
Incheon, South Korea
(Kim, Kim) Bucheon St. Mary's Hospital, The Catholic University of Korea,
Bucheon, South Korea
(Kwon) Eunpyeong St.Mary's Hospital, The Catholic University of Korea,
Seoul, South Korea
(Lee) St. Vincent Hospital, The Catholic University of Korea, Suwon, South
Korea
(Park) Yeouido St. Mary's Hospital, The Catholic University of Korea,
Seoul, South Korea
(Park) Daejeon St.Mary's Hospital, The Catholic University of Korea,
Daejeon, South Korea
(Lee) Pusan National University Hospital, Busan, South Korea
(Kang) Dankook University Hospital, Cheonan-si, South Korea
(Sung) Andong Medical Group Hospital, Andong, South Korea
(Woo) Inha University Hospital, Incheon, South Korea
(Park) Kyungpook National University Hospital, Daegu, South Korea
(Yun) Wonkwang University Hospital, Iksan-si, South Korea
Publisher
BMJ Publishing Group
Abstract
Introduction High-intensity statin therapy is recommended as a first-line
strategy for lowering lowdensity lipoprotein cholesterol (LDL-C) levels in
patients with acute myocardial infarction (AMI). A combination of
moderate-intensity statin and ezetimibe at an equivalent dose to
high-intensity statin may achieve similar LDL-C reduction with fewer side
effects. This study evaluates the long-term efficacy and safety of this
approach, initiated following AMI, compared with high-intensity statin
monotherapy. Methods and analysis The ROSUZET-AMI trial is a multicentre,
prospective, open-label, randomised, non-inferiority trial. Patients with
AMI who underwent percutaneous coronary intervention were randomised 1:1
to receive either moderate-intensity statin with ezetimibe (rosuvastatin
5mg with ezetimibe 10mg) or high-intensity statin monotherapy
(rosuvastatin 20mg). The primary endpoint is the composite of
cardiovascular death, major coronary events (non-fatal myocardial
infarction, documented unstable angina requiring hospitalisation and all
coronary revascularisation events occurring at least 30 days after
randomisation), or non-fatal stroke. Ethics and dissemination Ethics
approval for this study was obtained from the Institutional Review Board
of Seoul St. Mary's Hospital (No. 2020-0424-0003). Informed consent is
obtained from every participant before randomisation. The results of this
study will be submitted for publication in international peer-reviewed
journals, and the key findings will be presented at international
scientific conferences. Copyright © Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<38>
Accession Number
2039345221
Title
The Safety and Feasibility of Same-Day Discharge for Patients Undergoing
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
Canadian Journal of Cardiology. 41(10) (pp 1902-1914), 2025. Date of
Publication: 01 Oct 2025.
Author
Litkouhi P.N.; Rao K.; Baer A.; Hansen P.S.; Bhindi R.
Institution
(Litkouhi, Rao, Baer, Hansen, Bhindi) Department of Cardiology, Royal
North Shore Hospital, St Leonards, Australia
(Litkouhi, Rao, Hansen, Bhindi) School of Medicine, University of Sydney,
Camperdown, Australia
Publisher
Elsevier Inc.
Abstract
Background Next-day discharge (NDD) after transcatheter aortic valve
replacement (TAVR) has been shown to be safe in appropriately selected
patients and has been implemented into clinical practice. As the demand
for TAVR grows, improving its accessibility is crucial. Several studies
have trialled same-day discharge (SDD) after TAVR, but a review has not
been performed. Methods Five databases were searched. Baseline
demographics, study characteristics and the assessment criteria used to
determine eligibility for SDD were extracted and compared. Proportional
meta-analysis was used to compare post-TAVI outcomes between SDD and NDD
patients. Results Six studies were included from 1734 screened articles.
Of 3519 patients, 318 (9.0%) underwent SDD (mean age 78.2 +/- 8.7 years,
59.3% male). Balloon-expandable valves were used in 91.6% of cases, and
self-expanding valves in the remaining 8.4%. Patients that underwent SDD
experienced lower rates of mortality (OR 0.104, 95% CI 0.015-0.998),
all-cause readmission (OR 0.194, 95% CI 0.052-0.717), cardiovascular
readmissions (OR 0.155, 95% CI 0.026-0.971), and new pacemaker requirement
(OR 0.167, 95% CI 0.028-0.995) at 30 days after TAVR compared with
patients that underwent NDD. There was no difference in rates of stroke
(OR 0.407, 95% CI 0.015-16.694) or major vascular complications (0.0% vs
0.0%). Conclusions Current evidence supports the safety and feasibility of
SDD after elective transfemoral TAVR in appropriately selected patients.
Heterogeneity between eligibility criteria used to select patients for
SDD, especially related to conduction disease, poses a barrier to
implementation. Further research on self-expanding valves is
needed. Copyright © 2025 Canadian Cardiovascular Society.

<39>
Accession Number
2041083985
Title
The Relationship Between Frailty and Postoperative Atrial Fibrillation in
Patients Undergoing Cardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
1336346. Date of Publication: 2025.
Author
Dorey T.W.; Bohne L.J.; Fatehi Hassanabad A.; Duttchen K.; Wilton S.B.;
Chun R.
Institution
(Dorey, Duttchen, Chun) Department of Anesthesiology, Perioperative and
Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary,
AB, Canada
(Bohne) Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
(Fatehi Hassanabad) Department of Cardiac Surgery, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
(Fatehi Hassanabad, Wilton, Chun) Libin Cardiovascular Institute, Cumming
School of Medicine, University of Calgary, Calgary, AB, Canada
(Wilton, Chun) Department of Cardiac Sciences, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
(Wilton) Department of Community Health Sciences, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Postoperative atrial fibrillation (POAF) occurs in roughly
one-third of patients undergoing cardiac surgery, increasing mortality,
morbidity, and healthcare costs. Frailty, a syndrome of physiological
decline, is associated with poor outcomes after cardiac surgery. The link
between frailty and POAF has not been clearly established. Method(s):
A systematic search of PubMed and EMBASE was conducted up to January 2025
for studies reporting preoperative frailty scores and POAF rates
postcardiac surgery. Transcatheter aortic valve replacement (TAVR) studies
were assessed separately. Pooled risk ratios (RRs) and 95% confidence
intervals (CIs) for frail vs. nonfrail patients were calculated using a
random-effect model. Result(s): Eighteen studies involving 9098
patients (undergoing coronary artery bypass, surgical valve replacement,
or both) were included. Meta-analysis indicated that frailty was
associated with a higher risk of POAF (RR 1.20; 95% CI 1.08-1.33, p =
0.0008). Subgroup analyses showed consistent frailty effects across
different patient ages, study designs, surgery types, and sample sizes.
Notably, POAF risk was higher in studies using clinical frailty scales (RR
1.33; 95% CI 1.15-1.54, p < 0.0001) compared to those using surrogate
imaging/lab-based methods (RR 1.10; 95% CI 0.92-1.33, p = 0.24) though
comparison between subgroups did not reach statistical significance (p =
0.08). In 3 studies for patients undergoing TAVR, there was no association
between frailty and POAF (RR 1.24; 95% CI 0.81-1.88, p = 0.32).
 Conclusion(s): This meta-analysis underscores the association between
frailty and increased POAF risk in cardiac surgery patients, highlighting
the need for comprehensive clinical frailty assessments in preoperative
evaluations to identify high-risk patients and optimize perioperative
management. Copyright © 2025 Tristan W. Dorey et al. Journal of
Cardiac Surgery published by John Wiley & Sons Ltd.

<40>
Accession Number
2040827539
Title
Prolonged duration of pharmacological thromboprophylaxis following
oncologic surgery: A systematic review and meta-analysis of RCTs.
Source
Thrombosis Research. 255 (no pagination), 2025. Article Number: 109500.
Date of Publication: 01 Nov 2025.
Author
Wang Z.; Yu Z.; Niu T.
Institution
(Wang, Yu, Niu) Department of Hematology, West China Hospital, Sichuan
University, Chengdu, China
(Niu) State Key Laboratory of Biotherapy, Collaborative Innovation Center
of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
(Niu) National Facility for Translational Medicine (Sichuan), West China
Hospital, Sichuan University, Chengdu, China
Publisher
Elsevier Ltd
Abstract
Background: Venous thromboembolism (VTE) is the leading cause of 30-day
postoperative mortality, with current guidelines recommending
extended-duration thromboprophylaxis despite limited evidence on its
impact on clinically meaningful benefits. Objective(s): To evaluate
the efficacy and safety of prolonged anticoagulant prophylaxis versus
in-hospital only prophylaxis in cancer surgery patients using a
meta-analysis of randomized controlled trials (RCTs). Method(s): We
conducted a systematic review and meta-analysis of 10 RCTs. The primary
outcomes included overall VTE, symptomatic VTE, pulmonary embolism (PE),
major bleeding, and all-cause mortality. Results were summarized using
relative ratios (RR) and 95 % confidence intervals (CIs). Result(s):
Prolonged prophylaxis significantly reduced the 30-day incidence of
overall VTE (4.0 % vs. 10.0 %; RR 0.40, 95 %CI 0.22-0.76). No significant
differences were observed in the 30-day incidence of symptomatic VTE (0.7
% vs. 1.1 %; RR 0.66, 95 %CI 0.29-1.48), PE (0.5 % vs. 0.5 %), or 90-day
mortality (1.4 % vs. 1.6 %). A non-significant increase in major bleeding
occurred (0.9 % vs. 0.2 %; RR 2.37, 95 %CI 0.79-7.11). Subgroup analyses
indicated heterogeneity in primary outcomes based on surgical site
(abdominopelvic vs. thoracic surgery). Conclusion(s): While prolonged
duration of pharmacological thromboprophylaxis reduces the incidence of
overall VTE, it does not demonstrate clinically meaningful benefits for
symptomatic events or survival. Current risk-stratification tools may
overestimate thrombotic risk in cancer surgery patients receiving standard
in-hospital prophylaxis. Our findings support a selective, rather than
universal, approach to prolonged prophylaxis, emphasizing individualized
risk assessment. Copyright © 2025 Elsevier Ltd. All rights are
reserved, including those for text and data mining, AI training, and
similar technologies.

<41>
Accession Number
2040851027
Title
Role of Point-of-Care Ultrasound in Inpatient Perioperative Medical
Management: A Systematic Review.
Source
Journal of Clinical Medicine. 14(20) (no pagination), 2025. Article
Number: 7429. Date of Publication: 01 Oct 2025.
Author
Jarsania D.M.; Breunig M.J.; Kolar G.J.; Issa M.; Kingsley R.; Bhuiyan
M.N.; Chelf C.J.; Kirchoff R.W.
Institution
(Jarsania, Breunig, Kolar, Issa, Kingsley) Division of Hospital Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Bhuiyan) Division of General Internal Medicine, Mayo Clinic, Rochester,
MN, United States
(Chelf) Department of Library-Public Services, Mayo Clinic, Rochester, MN,
United States
(Kirchoff) Division of Hospital Internal Medicine, Mayo Clinic, Phoenix,
AZ, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Point-of-care ultrasonography (POCUS) is becoming an
increasingly relevant tool in hospital medicine, but its effective
application in inpatient perioperative medicine remains to be determined.
Much of the POCUS literature describes its use by anesthesiologists to
evaluate cardiac function, volume status, pulmonary findings, and gastric
volume. Objective(s): To identify, evaluate, and synthesize all
available literature investigating the use of point-of-care ultrasound and
associated clinical outcomes in inpatient perioperative medical
management. Patients and Methods: A systematic review was designed
using the PRISMA guidelines with sources of literature including Ovid,
PubMed, Scopus, and the Web of Science. Literature search was conducted
for published works between 1 January 2002 to 8 February 2024.
 Result(s): Three hundred sixty-seven abstracts were identified in our
search, and, ultimately, 24 studies were included in this review. Most
studies were done by anesthesiology evaluating cardiopulmonary and gastric
POCUS. Studies supported using POCUS to expedite cardiac examination,
promptly diagnose postoperative pulmonary complications, and optimize
surgical timing. Conclusion(s): POCUS is a versatile tool in the
perioperative setting; however, few studies were powered to assess
clinical outcomes, and even fewer showed conclusive evidence of improved
clinical outcomes. Furthermore, only two studies evaluated the use of
POCUS specifically by acute care providers; more extensive studies are
needed from their perspective as they take on increasing perioperative
responsibilities. Copyright © 2025 by the authors.

<42>
Accession Number
2041122940
Title
Conversion to Cardiac Surgery During Elective and Urgent Transcatheter
Aortic Valve Implantation: A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Ktenopoulos N.; Apostolos A.; Chlorogiannis D.-D.; Kachrimanidis I.;
Vlachakis P.; Sagris M.; Theodoropoulou T.; Drakopoulou M.; Synetos A.;
Latsios G.; Aggeli C.; Tsioufis K.; Toutouzas K.
Institution
(Ktenopoulos, Apostolos, Kachrimanidis, Vlachakis, Sagris, Theodoropoulou,
Drakopoulou, Synetos, Latsios, Aggeli, Tsioufis, Toutouzas) First
Department of Cardiology, Hippokration General Hospital of Athens,
National and Kapodistrian University of Athens, Athens, Greece
(Ktenopoulos, Apostolos, Kachrimanidis, Vlachakis, Sagris, Theodoropoulou,
Drakopoulou, Synetos, Latsios, Aggeli, Tsioufis, Toutouzas) Unit of
Structural Heart Diseases, First Department of Cardiology, Medical School,
Hippocration General Hospital of Athens, National and Kapodistrian
University of Athens, Athens, Greece
(Chlorogiannis) Department of Radiology, Brigham and Women's Hospital,
Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established
treatment for severe aortic stenosis. However, the need for unplanned
conversion to cardiac surgery (CS) during TAVI remains an infrequent but
critical event. It is unclear whether this risk is higher in patients
undergoing urgent procedures. We conducted a systematic review and
meta-analysis to compare the incidence of unplanned conversion to CS
between patients undergoing urgent versus elective TAVI. A systematic
search of PubMed, SCOPUS, and Cochrane databases was performed to identify
eligible studies. The primary outcome was the rate of unplanned conversion
to CS. Secondary outcomes included mortality, device success, vascular
complications, device embolization, acute kidney injury (AKI), stroke,
permanent pacemaker implantation (PPI), moderate-or-severe paravalvular
regurgitation (PVL), need for second valve implantation, bleeding, and
duration of hospitalization. Seven studies comprising 71,909 patients were
analyzed; 5108 underwent urgent TAVI and 66,801 underwent elective TAVI.
No significant difference in conversion to CS was observed between the
groups (RR: 0.89; 95% CI: 0.65-1.22). Device success rates were similar
(RR: 0.99; 95% CI: 0.97-1.00). Urgent TAVI was associated with prolonged
hospitalization (mean difference: 7.75 days; 95% CI: 4.06-11.45) and
increased AKI risk (RR: 2.20; 95% CI: 1.53-3.16). Vascular complications,
device embolization, stroke, PPI, PVL, second valve implantation, and
major bleeding rates were comparable between the groups. Urgent TAVI is
not associated with an increased risk of unplanned conversion to surgery.
The observed higher AKI rates and longer hospital stay suggest that
patient-related factors beyond procedural urgency may contribute to
adverse outcomes. Copyright © 2025 The Author(s). Catheterization
and Cardiovascular Interventions published by Wiley Periodicals LLC.

<43>
Accession Number
2040488880
Title
Incidence of staphylococcus aureus infections after surgical
interventions: a systematic review and meta-analysis.
Source
Expert Review of Anti-Infective Therapy. 23(10) (pp 1011-1029), 2025. Date
of Publication: 2025.
Author
Elezbawy B.; Abaza N.; Fasseeh M.; Elshahawy R.; S. Mahmoud Y.; Hendawy
H.; Konstantinov S.R.; Ruiz-Guinazu J.; Willame C.; Geurtsen J.; Poolman
J.; Voko Z.; Nagy D.; Zelei T.; Kovacs S.; Lohner S.
Institution
(Elezbawy) Semmelweis University Doctoral School, Budapest, Hungary
(Elezbawy, Abaza, Fasseeh, Elshahawy, S. Mahmoud, Hendawy) Syreon Middle
East, Alexandria, Egypt
(Konstantinov, Geurtsen, Poolman) Janssen Vaccines and Prevention B.V,
Leiden, Netherlands
(Ruiz-Guinazu, Willame) Janssen Research and Development, Beerse, Belgium
(Voko, Nagy, Zelei, Kovacs, Lohner) Syreon Research Institute, Budapest,
Hungary
(Voko, Nagy) Center for Health Technology Assessment, Semmelweis
University, Budapest, Hungary
(Lohner) Department of Public Health Medicine, University of Pecs Medical
School, Pecs, Hungary
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Postoperative Staphylococcus aureus (S. aureus) infections
are associated with increased morbidity and mortality. This systematic
review and meta-analysis aimed to summarize the incidence of postoperative
S. aureus infections. Method(s): We searched MEDLINE, CENTRAL, and
Embase (2008-2023) for studies reporting S. aureus infections after hip or
knee replacement, spinal surgery, craniotomy, coronary artery bypass
surgery (CABG), open colon surgery, abdominal hysterectomy, cesarean
section, peripheral vascular bypass, or elective plastic surgery in
selected developed countries were considered. We conducted meta-analysis
with a generalized linear mixed model and assessed risk of bias. This
study is registered with PROSPERO,CRD42023416876. Result(s): Data
from 224 studies indicated a cumulative incidence of deep S. aureus
infection after hip surgery 5.05 infections/1000 procedures (95% CI
3.29-7.74), 5.59 (95% CI 3.62-8.63) after knee surgery, 11.74 (95% CI
9.08-15.16) after spinal surgery, and 7.23 (95% CI 1.63-31.86) after CABG
surgery. S. aureus infections were associated with increased all-cause
mortality among CABG, hip, knee, and spinal surgeries. Patients cohorts
who received antibiotic prophylaxis and/or underwent decolonization
demonstrated lower incidence of S. aureus infections. Conclusion(s):
The incidence of S. aureus infections varies by procedure, with highest
rates seen after spinal surgeries and hysterectomies. Findings highlight
the importance of standardized prevention across surgical
settings. Copyright © 2025 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<44>
Accession Number
2041051604
Title
Clinical value and cost effectiveness of FFR-CT in guiding
revascularization and predicting major adverse cardiac events: A
meta-analysis.
Source
Clinical Imaging. 129 (no pagination), 2026. Article Number: 110659. Date
of Publication: 01 Jan 2026.
Author
Alabdullah A.A.; Marey A.; Li Y.; Jha S.; Rogers C.; Abdulla J.; Umair M.
Institution
(Alabdullah) Department of Radiology, The University of Texas Medical
Branch, Galveston, TX, United States
(Marey) Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
(Li, Jha) Department of Political Science and Economics, Rowan University,
Glassboro, NJ, United States
(Rogers) HeartFlow Inc, Redwood City, CA, United States
(Abdulla) Department of Cardiology, Amager-Hvidovre Hospital, Copenhagen,
Denmark
(Umair) Russell H. Morgan Department of Radiology and Radiological
Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Purpose To assess the clinical value of FFR-CT (Computed Tomography
Fractional Flow Reserve) in guiding revascularization, predicting major
adverse cardiac events (MACE), and conducting a cost-effectiveness
analysis in patients with low-to-moderate risk coronary artery disease.
Methods We identified 15 studies evaluating FFR-CT in patients with
suspected or known coronary artery disease. Primary outcomes included
revascularization rates and MACE occurrence, categorized into FFR-CT
negative (FFR-CT > 0.8) and positive (FFR-CT <= 0.8) groups. A systematic
review of the cost of FFR-CT was also performed. Results In 13,224
patients from 11 studies, the revascularization rate was significantly
lower in the FFR-CT negative group (5.8 %) than the positive group (41.4
%) (OR 13.02, 95 % CI 7.08-23.94, p < 0.0001). Unplanned revascularization
rates were not significantly different (p = 0.09). In 11,814 patients from
seven studies, MACE events were lower in the FFR-CT negative group (0.9 %)
than the positive group (2.6 %) (OR 3.62, 95 % CI 1.87-6.97, p = 0.0001).
Cost analysis, based on 10 studies, suggested potential savings, though
results were heterogeneous due to healthcare cost disparities and lack of
long-term follow-up. Conclusion FFR-CT can predict MACE and
revascularization needs, potentially improving outcomes and reducing
costs. However, it was not effective in guiding unplanned
revascularization, and further research is needed to confirm these
findings in larger trials. Copyright © 2025. Published by
Elsevier Inc.

<45>
Accession Number
2040701327
Title
The organ protective effects of penehyclidine hydrochloride (PHC) in
patients undergoing cardiac surgery: a systematic review and
meta-analysis.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 516. Date
of Publication: 01 Dec 2025.
Author
Tian L.; Guo J.; Yao Y.
Institution
(Tian, Guo, Yao) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Yao) Center of Outcomes Research, Department of Anesthesiology, Critical
Care and Pain Medicine, University of Texas, Houston, TX, United States
(Yao) Outcomes research Consortium, Houston, TX, United States
Publisher
BioMed Central Ltd
Abstract
Background: As a novel selective anticholinergic drug, penehyclidine
hydrochloride (PHC) provided the potential to protect organs by inhibiting
the inflammatory response, attenuating oxidative stress, and alleviating
ischemia / reperfusion injury. This study aimed to evaluate the organ
protective effects of PHC in patients undergoing cardiac surgery.
 Method(s): Six electronic databases were searched systematically for
randomized-controlled trials (RCTs) published April 30th 2025 that
explored the application of PHC on cardiac surgical patients. Primary
outcomes of interest included the biomarkers and variables of major organs
(e.g. heart, lung, gastrointestinal tract and immune system) injury.
Secondary outcomes of interest included the mechanical ventilation
duration and hospital length of stay (LOS). Mean difference (MD) with 95%
confidence interval (CI) or odds ratios (OR) with 95% CI were employed to
analyze the data. Result(s): A total of 37 RCTs with 1929 cardiac
surgical patients (PHC group, 1043 patients; Control group, 886 patients)
were included. The current study demonstrated that the adult patients in
PHC group had lower cardiac troponin I (cTnI) [MD: -1.70, 95%CI: -2.63 to
-0.77, P = 0.0003, with heterogeneity (P < 0.00001)] and creatine kinase
(CK)-MB levels on post-operative day (POD)-1 after cardiac surgery, while
the pediatric patients had lower cardiac troponin T (cTnT) (MD: -0.10,
95%CI: -0.12 to -0.09, P < 0.00001, without heterogeneity) in PHC group on
POD-1. The levels of interleukin (IL)-6 and tumor necrosis factor
(TNF)-alpha were significantly lower in both adult and pediatric patients
of PHC group on POD-1. The incidence of postoperative pulmonary infection
was significantly reduced in the PHC group, and the duration of mechanical
ventilation and hospital LOS were shortened in adult patients.
 Conclusion(s): This meta-analysis demonstrated that PHC could provide
myocardial protection and suppress the inflammatory response in patients
undergoing cardiac surgery, thereby potentially facilitating rapid
recovery. Clinical trial number: PROSPERO registration number
CRD42020183260. Copyright © The Author(s) 2025.

<46>
Accession Number
2041559729
Title
Postoperative antithrombotic therapy after coronary artery bypass grafting
combined with coronary endarterectomy (PATH-CARE): study protocol for a
randomised controlled clinical trial.
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e104950. Date of
Publication: 09 Nov 2025.
Author
Tiemuerniyazi X.; Yang Z.; Yang E.; He L.; Chen L.; Huang S.; Nan Y.; Song
Y.; Xu F.; Yuan X.; Hu Z.; Zhao W.; Feng W.
Institution
(Tiemuerniyazi, Yang, He, Chen, Huang, Nan, Song, Xu, Yuan, Hu, Zhao,
Feng) Department of Cardiovascular Surgery, Chinese Academy of Medical
Sciences, Peking Union Medical College Fuwai Hospital, Beijing, China
(Yang) Department of Cardiovascular Surgery, Fuwai Yunnan Cardiovascular
Hospital, Yunnan, Kunming, China
Publisher
BMJ Publishing Group
Abstract
Introduction Coronary endarterectomy (CE) combined with coronary artery
bypass grafting (CABG) has been associated with poor graft patency, which
might be attributed to the activation of coagulation cascade caused by the
exposure of the subendothelial tissue to the blood stream, which could
necessitate anticoagulation therapy. However, the optimal antithrombotic
therapy after CE+CABG remains unclear. Methods and analysis The PATH-CARE
is a double-centre, two-armed, blinded to outcome assessed, randomised
controlled trial, aimed to determine the optimal antithrombotic therapy
after CE+CABG. A total of 202 patients are expected to be recruited.
Patients will be randomly assigned in a 1:1 ratio to the control (dual
antiplatelet therapy (AT) group) and the intervention (dual AT+warfarin
(ATW) group). Patients in the AT group will receive aspirin plus
clopidogrel for 1 year, while patients in the ATW group receive aspirin
plus clopidogrel for 1 year with extra warfarin therapy for the first 3
months postoperatively. All patients will receive life-long aspirin
treatment after the first year. All of the patients will be required to
complete a 6-month follow-up. The primary endpoint is the patency of
CE-targeted coronary grafts, assessed through coronary CT angiography or
coronary angiography. Secondary outcomes include the occurrence of major
adverse cardiovascular and cerebrovascular events and bleeding events.
Ethics approval and dissemination This study was approved by the
Institutional Review Board of Fuwai Hospital (No.: 2022-1849), and Yunnan
Fuwai Cardiovascular Hospital (No.: 2023-048-01). Findings of this trial
will be disseminated via peer-reviewed research papers and academic
conference presentations. Copyright © Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<47>
Accession Number
2035835534
Title
Evening home pulse pressure predicted cardiovascular events and mortality
in older adults with hypertension: findings based on the STEP trial.
Source
Hypertension Research. 48(11) (pp 2801-2810), 2025. Date of Publication:
01 Nov 2025.
Author
Ji Y.; Peng X.; Chen S.; Song Q.; Bai J.; Cai J.
Institution
(Ji, Peng, Chen, Song) Hypertension Center, Fuwai Hospital, State Key
Laboratory of Cardiovascular Disease, National Center for Cardiovascular
Diseases, Peking Union Medical College, Chinese Academy of Medical
Sciences, Beijing, China
(Peng, Bai, Cai) Beijing Anzhen Hospital, Capital Medical University,
Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
(Cai) Hypertension Center, Fuwai Hospital, Peking Union Medical College,
Chinese Academy of Medical Sciences, Beijing, China
Publisher
Springer Nature
Abstract
Hypertension is a key predictor of cardiovascular disease (CVD) and
mortality. Home blood pressure monitoring (HBPM) is a cost-effective way
to assess CVD risk, though existing research mainly focuses on morning
systolic (SBP) and diastolic (DBP) blood pressure measurements. This study
aimed to evaluate whether evening pulse pressure (PP) measured at home
could better predict CVD risk and mortality in Chinese older adults with
hypertension. Data from the STEP trial, a multicenter, randomized
controlled trial, were analyzed. Morning and evening home BP was measured
twice a day at least once a week from enrollment to 12 months of
follow-up, based on which PP was calculated and categorized into tertiles.
The primary outcome was a composite of cardiovascular events and all-cause
mortality. Among 7703 participants included in this analysis, 284
composite events occurred during a median follow-up of 3.43 years.
Compared to the first tertile evening PP group, the third tertile evening
PP group exhibited a 60% (HR = 1.60; 95% CI: 1.12-2.29) higher risk of
primary outcome in the final adjusted model. A 26% increased risk was
observed with each tertile increment (HR = 1.26; 95% CI: 1.05-1.50,
P<inf>trend</inf> = 0.0112). For each 10 mmHg increase in evening PP, the
risk of outcome events increased by approximately 33%. Higher evening home
PP significantly predicts an increased risk of composite events (NRI:
0.16, 95% CI: 0.02-0.29), unlike morning SBP, PP, or evening SBP. Efforts
to monitor evening home PP may be an effective strategy to improve BP
control and prevent CVD and mortality. Trial Registration: STEP
ClinicalTrials.gov number, NCT03015311. Copyright © The Author(s)
2025.

<48>
Accession Number
2041494420
Title
Full Heparin Reversal With Protamine After Transcatheter Aortic Valve
Replacement: A Systematic Review and Meta-Analysis.
Source
American Journal of Cardiology. 258 (pp 239-246), 2026. Date of
Publication: 01 Jan 2026.
Author
Silva J.P.M.R.J.; Nogueira B.V.; Mussolini M.C.B.; Bisneto O.I.D.M.; Gomes
W.F.
Institution
(Silva) Department of Medicine, Federal University of Rio de Janeiro, Rio
de Janeiro, Brazil
(Nogueira) Department of Medicine, University of Sao Paulo, Sao Paulo,
Brazil
(Mussolini) Department of Medicine, School of Medicine of Araraquara,
Araraquara, Brazil
(Bisneto) Department of Medicine, Federal University of Campina Grande,
Cajazeiras, Brazil
(Gomes) Department of Interventional Cardiology, INC Hospital, Curitiba,
Brazil
(Gomes) Department of Internal Medicine, Faculdades Pequeno Principe,
Curitiba, Brazil
(Gomes) Department of Interventional Cardiology, Irmandade da Santa Casa
de Misericordia de Curitiba, Curitiba, Brazil
Publisher
Elsevier Inc.
Abstract
Protamine sulfate is widely used to reverse unfractionated heparin during
transfemoral transcatheter aortic valve replacement (TAVR), but the
optimal reversal strategy remains uncertain. We conducted a systematic
review and meta-analysis of randomized controlled trials and observational
studies comparing full heparin reversal (1 mg protamine per 100 units
heparin) with partial or no reversal in transfemoral TAVR. The primary
outcome was a composite of all-cause mortality, major bleeding, and major
vascular complications, defined according to VARC-3 criteria, while
secondary outcomes included each component of the composite and stroke.
Five studies (two randomized trials, three cohort studies) involving 3,089
patients were included. Full-dose protamine significantly reduced the
composite outcome (RR 0.46, 95% CI 0.36-0.60), driven by reductions in
major bleeding (RR 0.41, 95% CI 0.28-0.59) and major vascular
complications (RR 0.44, 95% CI 0.30-0.65). No excess risk was observed for
all-cause mortality (RR 0.94, 95% CI 0.65-1.36) or stroke (RR 0.67, 95% CI
0.40-1.12). Leave-one-out and subgroup analyses confirmed the robustness
of these findings, and no evidence of publication bias was identified. In
conclusion, full heparin reversal with protamine during TAVR is associated
with lower bleeding and vascular complications without increasing
thromboembolic risk, supporting its use as a bleeding-avoidance
strategy. Copyright © 2025 Elsevier Inc.

<49>
Accession Number
2040988435
Title
Cognitive Function Among Heart Transplant Recipients Before and After
Intravenous Iron Supplement for Iron Deficiency: Results From a
Randomized, Placebo-Controlled, Double-Blind Treatment Trial.
Source
Clinical Transplantation. 39(11) (no pagination), 2025. Article Number:
e70370. Date of Publication: 01 Nov 2025.
Author
Burker B.S.; Brautaset Englund K.V.; Myrdal Ostby C.; Andersson S.;
Gullestad L.; Broch K.
Institution
(Burker) Norwegian National Unit for Sensory Loss and Mental Health, Oslo
University Hospital, Oslo, Norway
(Burker, Brautaset Englund, Myrdal Ostby, Gullestad, Broch) Department of
Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
(Brautaset Englund) Division of Medicine, Akershus University Hospital,
Lorenskog, Norway
(Andersson) Department of Psychology, University of Oslo, Oslo, Norway
(Gullestad) Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
Publisher
John Wiley and Sons Inc
Abstract
Background: Cognitive dysfunction after successful heart transplantation
(HTx) is not uncommon. Lower hemoglobin levels have previously been
associated with cognitive dysfunction in heart transplant recipients (HTx
recipients). In a randomized, placebo-controlled, double-blind treatment
trial, we assessed as a pre-specified secondary outcome whether a single
intravenous iron supplement for iron deficiency in HTx recipients resulted
in changes in cognitive function after 6 months. Method(s): In the
"Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant
Recipients" (IronIC) trial, we assessed cognitive function at baseline and
at 6-month follow-up with the following tests of the Cambridge
Neuropsychological Test Automated Battery: Reaction Time, Paired
Associates Learning, and Spatial Working Memory. Of 94 participants with
cognitive data at baseline and follow-up, 49 were randomized to the single
intravenous iron supplement, while 45 received placebo. Result(s):
Raw score changes from baseline to follow-up did not differ statistically
significantly between study groups (two measures of each test analyzed).
In the total sample, 27%-44% of participants performed at baseline at
least one standard deviation below the normative mean on measures of
memory and working memory/executive functions. Exploratory analyses
indicated that performance on measures of memory might decrease more than
expected with increasing age. Conclusion(s): A single intravenous
iron supplement for iron deficiency in HTx recipients did not result in
statistically significant cognitive changes after 6 months. The group as a
whole performed approximately half a standard deviation below the
normative mean on measures of memory and working memory/executive
functions. Regular cognitive screening after HTx is recommended. Clinical
Trial Registration: Trial Registration: ClinicalTrials.gov identifier:
NCT03662789. Copyright © 2025 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<50>
Accession Number
2041058527
Title
Costs of medical treatment of advanced heart failure: a scoping review.
Source
Systematic Reviews. 14(1) (no pagination), 2025. Article Number: 215. Date
of Publication: 01 Dec 2025.
Author
Goldraich L.A.; do Nascimento D.M.; Santos L.P.; Lemos D.M.; Marcolino
M.A.Z.; Clausell N.; da Silva Etges A.P.B.
Institution
(Goldraich, Clausell) Advanced Heart Failure and Heart Transplant Program,
Division of Cardiology, Hospital de Clinicas de Porto Alegre, RS, Porto
Alegre, Brazil
(Goldraich, do Nascimento, Clausell) Post-Graduate Program in Cardiology,
Medical School, Universidade Federal Do Rio Grande Do Sul, RS, Porto
Alegre, Brazil
(Goldraich, Lemos, Clausell, da Silva Etges) Hospital de Clinicas de Porto
Alegre, RS, Porto Alegre, Brazil
(do Nascimento) Physical Activity, Diabetes and Cardiovascular Disease
Laboratory, Hospital de Clinicas de Porto Alegre, RS, Porto Alegre, Brazil
(Santos) Applied Physiology & Nutrition Group, Center of Lifestyle
Medicine, School of Medicine, University of Sao Paulo, SP, Sao Paulo,
Brazil
(Lemos) Graduate Program in Nursing, Universidade Federal Do Rio Grande Do
Sul, RS, Porto Alegre, Brazil
(Marcolino, Clausell, da Silva Etges) National Institute of Science for
Health Technology Assessment (IATS), CNPq, RS, Porto Alegre, Brazil
(da Silva Etges) Post-Graduate Program in Epidemiology, Medical School,
Universidade Federal Do Rio Grande Do Sul, RS, Porto Alegre, Brazil
Publisher
BioMed Central Ltd
Abstract
Background: An estimated 10-15% of patients with heart failure (HF)
progress to an advanced disease stage. The majority of patients with
advanced HF, who are ineligible and/or have no access to expensive,
specific therapies such as heart transplant and left ventricular assist
devices, are medically managed. The cost of medical treatment for advanced
HF is largely unknown. The objective of this scoping review is to
summarize the evidence on costs of advanced HF patients who are not
treated with advanced therapies, to understand the main settings of this
health expenditure, and to map the main cost drivers in this disease
stage. Method(s): The PubMed/MEDLINE, Embase, Scopus, and BVS were
used as data sources for literature searches evaluating direct costs of
patients with advanced HF who were not treated with advanced therapies.
Cost methodological categorization, such as micro or macrocosting, payment
perspectives, and cost information reported, including the total cost per
patient and the main cost drivers, were extracted. Cost methodology
heterogeneity was also observed. Despite this, in most studies, cost
information was derived from observational cohorts or clinical trials and
used either macrocosting or microcosting methods from a public payer
perspective. Result(s): A total of 8157 records were identified, and
16 were included in the review. Criteria for advanced HF varied among
studies. Hospitalizations emerged as the main cost driver in the majority
of reports. The mean total annual cost per patient was 48,309
international dollars (SD 34,874). Studies from the USA reported higher
costs than in other countries. Conclusion(s): This review showed that
cost methodology to address care of patients with advanced HF is
heterogeneous across countries. Despite this heterogeneity, overall, the
expenditure could be considered significant, mainly driven by
hospitalizations. Further studies with comprehensive cost methodologies
are needed to address health expenditure in the advanced HF population.
OSF identifier: https://doi.org/10.17605/OSF.IO/54GQN. Copyright
© The Author(s) 2025.

<51>
Accession Number
2039602194
Title
Impact of olive oil consumption on surgical outcomes in patients
undergoing open heart surgery: a randomized clinical trial.
Source
Journal of Complementary and Integrative Medicine. 22(3) (pp 522-529),
2025. Date of Publication: 01 Sep 2025.
Author
Bahrami R.; Ebadi A.; Saeid Y.; Farzam S.S.; Gomrokchian E.; Moayed M.S.
Institution
(Bahrami) Student Research Committee, Faculty of Nursing, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ebadi, Saeid, Moayed) Nursing Care Research Center, Clinical Sciences
Institute, Faculty of Nursing, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Farzam) Department of Cardiology, School of Medicine Bu Ali Sina,
Teaching Hospital Qazvin, University of Medical Sciences, Qazvin, Iran,
Islamic Republic of
(Gomrokchian) Teaching Hospital Qazvin University of Medical Sciences,
Qazvin, Iran, Islamic Republic of
Publisher
Walter de Gruyter GmbH
Abstract
Introduction: The incidence of post-surgery outcomes, such as pain and
constipation, in patients undergoing coronary artery bypass surgery can
impact the healing process and the quality of life of patients. This study
aimed to investigate the effect of olive oil consumption on pain and
constipation in adult coronary bypass surgery patients. Method(s): A
randomized controlled trial in Qazvin, Iran (2022-2023) assigned 110
patients scheduled for coronary artery bypass surgery to two groups using
four-block randomization. In the intervention group, patients received 30
cc of extra virgin olive oil daily with food from the day before the
operation to 30 days after. The control group received usual care. Pain
and constipation levels were measured before and after surgery and up to
30 days post-surgery using the visual pain scale (VAS) and Bristol stool
form scale (BSFS). Result(s): With similar background variables
between the two groups, the results indicated that the average pain and
constipation scores in the intervention group decreased more than in the
control group (p-value < 0.05). Conclusion(s): Based on the study's
findings and the positive impact of olive oil consumption on reducing pain
and constipation, incorporating olive oil into the diet of heart surgery
patients is recommended. Copyright © 2025 Walter de Gruyter GmbH,
Berlin/Boston.

<52>
Accession Number
2041488720
Title
Prevalence and clinical impact of baseline atherosclerotic vascular
disease in patients undergoing transcatheter aortic valve implantation: A
meta-analysis.
Source
International Journal of Cardiology. 444 (no pagination), 2026. Article
Number: 134004. Date of Publication: 01 Feb 2026.
Author
Papazoglou A.S.; Tsiartas E.; Kyriakoulis K.G.; Moysidis D.V.; Daios S.;
Anastasiou V.; Kamperidis V.; Ziakas A.; Fragakis N.; Vassilikos V.;
Giannakoulas G.
Institution
(Papazoglou) Athens Naval Hospital, Athens, Greece
(Tsiartas) Royal Devon & Exeter Hospital, Royal Devon University
Healthcare NHS Foundation Trust, Exeter, United Kingdom
(Kyriakoulis) National and Kapodistrian University of Athens, School of
Medicine, Athens, Greece
(Moysidis) School of Medicine, Aristotle University of Thessaloniki,
Thessaloniki, Greece
(Daios, Anastasiou, Kamperidis, Ziakas, Giannakoulas) First Department of
Cardiology, AHEPA University Hospital of Thessaloniki, Thessaloniki,
Greece
(Fragakis) Second Department of Cardiology, Hippokrateion Hospital of
Thessaloniki, Thessaloniki, Greece
(Vassilikos) Third Department of Cardiology, Hippokrateion Hospital of
Thessaloniki, Thessaloniki, Greece
Publisher
Elsevier Ireland Ltd
Abstract
Background: Degenerative aortic valve disease and atherosclerotic vascular
disease (ASCVD) frequently coexist. ASCVD may impact pre-procedural
planning and patient outcomes. Aim(s): To systematically quantify the
prevalence and prognostic significance of prior coronary artery disease
(CAD), peripheral artery disease (PAD), and cerebrovascular event (CVE) in
patients undergoing transcatheter aortic valve implantation (TAVI).
 Method(s): A systematic literature search was conducted to identify
studies reporting the prevalence of baseline ASCVD in patients undergoing
TAVI. Meta-analyses were conducted to synthesize 1) the prevalence of
pre-existing CAD, PAD and CVE in patients undergoing TAVI and 2) the
prognostic effects of these comorbidities for post-TAVI mortality.
 Result(s): A total of 43 studies (14 randomized) fulfilled the
inclusion criteria encompassing a total of 732,895 patients undergoing
TAVI (51 % males, pooled mean age of 81.2 years and Society of Thoracic
Surgeons' score of 5.3). Of these, 48 % (42-55 %) had pre-existing CAD, 16
% (13-20 %) had PAD, and 11 % (9-12 %) had suffered a prior CVE. The
baseline presence of CAD, PAD and CVE was independently linked with worse
prognosis. Significant heterogeneity was observed among included studies,
partially explained by differences in sample size, geographical location,
and baseline patient characteristics. Conclusion(s): This aggregate
meta-analysis of large-scale studies yielded a high prevalence of ASCVD in
patients undergoing TAVI. Every second patient had CAD, every sixth
patient had PAD and 1 out of 10 had CVE. The presence of each comorbidity
increased independently the risk of long-term mortality. These findings
can help navigate pre-procedural planning, resource allocation, and
ultimately optimize overall TAVI outcomes. Copyright © 2025
Elsevier B.V.

<53>
Accession Number
2041463974
Title
Arrhythmogenic cardiomyopathy diagnosis and management: a systematic
review of clinical practice guidelines and recommendations with insights
for future research.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 11(7) (pp
1033-1069), 2025. Date of Publication: 01 Nov 2025.
Author
Iezzi L.; Sorella A.; Galanti K.; Gallina S.; Chahal A.A.; Bauce B.;
Cipriani A.; Providencia R.; Lopes L.R.; Ricci F.; Khanji M.Y.
Institution
(Iezzi, Sorella, Galanti, Gallina, Ricci) Department of Neuroscience,
Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara,
Chieti, Italy
(Gallina, Ricci) University Cardiology Division, Heart Department, SS.
Annunziata Polyclinic, Chieti, Italy
(Gallina, Ricci) Institute for Advanced Biomedical Technologies, G.
D'Annunzio University of Chieti-Pescara, Via Luigi Polacchi, 11, Chieti,
Italy
(Chahal, Providencia, Lopes, Khanji) Barts Heart Centre, St. Bartholomew's
Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
(Chahal) Center for Inherited Cardiovascular Diseases, Department of
Cardiology, WellSpan Health, 30 Monument Rd, York, PA, United States
(Chahal, Khanji) William Harvey Research Institute, NIHR Barts Biomedical
Centre, Queen Mary University of London, Charterhouse Square, London,
United Kingdom
(Chahal) Department of Cardiovascular Medicine, Mayo Clinic, 200 First
Str, SW, Rochester, MN, United States
(Bauce, Cipriani) Department of Cardiac, Thoracic and Vascular Sciences,
University of Padua, Via Giustiniani, 2, Padua, Italy
(Lopes) Institute of Cardiovascular Science, University College London,
London, United Kingdom
(Khanji) Department of Cardiology, Newham University Hospital, Barts
Health NHS Trust, London, United Kingdom
Publisher
Oxford University Press
Abstract
Arrhythmogenic cardiomyopathy (ACM) is addressed in international
guidelines and expert consensus statements. To assist clinicians in their
routine practice and support decision-making, we performed a systematic
review of the most relevant guidelines and recommendations for ACM
diagnosis and management. Our search, covering MEDLINE, EMBASE, and
resources from scientific societies over the last 10 years, identified two
guidelines and three consensus statements that met rigorous inclusion
criteria for detailed analysis. In the examined documents, key areas of
agreement included the critical role of cardiac imaging for initial
diagnosis and ongoing monitoring, genetic testing in index patients,
ventricular arrhythmia management, catheter ablation indications, heart
failure treatment strategies, and exercise recommendations. However,
significant differences were found in definitions and diagnostic criteria
for ACM, interpretation of phenocopies, management of family members, and
criteria for implantable cardioverter defibrillator implantation.
Additional discrepancies emerged regarding the role of multidisciplinary
teams, non-cardiac surgical considerations, atrial fibrillation
management, and reproductive issues. Crucially, there remain considerable
gaps in evidence, especially in areas such as the management and follow-up
of patients with potential or borderline ACM diagnoses, as well as the
care of their relatives. The clinical implications of genetic findings,
along with the clinical management of left-dominant, biventricular
phenotypes, and hot phases of disease, are also insufficiently addressed.
Furthermore, a critical shortfall is the lack of externally validated risk
assessment tools to guide clinical decision-making. Bridging these gaps
could help guiding future research and guideline development towards
improving patient outcomes. Copyright © The Author(s) 2025.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<54>
Accession Number
2041445142
Title
Infective endocarditis meets native vertebral osteomyelitis: a mortality
perspective.
Source
Journal of Bone and Joint Infection. 10(6) (pp 425-435), 2025. Date of
Publication: 05 Nov 2025.
Author
Borgonovo F.; Petri F.; Matsuo T.; Igwilo-Alaneme R.; Alavi M.S.A.;
Mahmoud O.K.; Zein S.E.; Passerini M.; Murad M.H.; DeSimone D.C.; Nassr
A.; Tande A.J.; Gori A.; Berbari E.F.
Institution
(Borgonovo, Petri, Passerini, Gori) Department of Infectious Diseases,
ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Milan, Italy
(Borgonovo, Petri, Matsuo, Igwilo-Alaneme, Mahmoud, Zein, Murad, DeSimone,
Tande, Berbari) Division of Public Health, Infectious Diseases and
Occupational Medicine, Department of Medicine, Mayo Clinic College of
Medicine and Science, Mayo Clinic, Rochester, MN, United States
(Alavi) Faculty of Medicine, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Passerini, Gori) Department of Pathophysiology and Transplantation,
University of Milan, Milan, Italy
(Murad) Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, United
States
(Nassr) Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,
United States
(Gori) Centre for Multidisciplinary Research in Health Science (MACH),
University of Milan, Milan, Italy
Publisher
Copernicus Publications
Abstract
Background: Native vertebral osteomyelitis and infective endocarditis (NVO
+ IE) are increasingly recognized as overlapping entities, sharing common
risk factors (e.g., advanced age, immunosuppression) and similar pathogen
profiles, most commonly Staphylococcus aureus and streptococci. Concurrent
infection presents unique diagnostic and therapeutic challenges, leading
to uncertainty regarding clinical outcomes and mortality. Therefore, we
aimed to systematically evaluate the combined mortality associated with
concomitant NVO + IE and to summarize the available clinical
characteristics from published studies. Method(s): A systematic
review was conducted following the PRISMA framework. The databases
searched included MEDLINE, Embase, Cochrane Library, and Scopus from 1970
to October 2023. Studies were included if they involved at least 10 adult
patients diagnosed with NVO and IE and provided mortality data. Two
reviewers independently screened the references, extracted the data, and
evaluated the methodological quality using a dedicated tool. A
random-effects meta-analysis was performed to aggregate in-hospital,
1-month, 1-year, and 3-year mortality rates. Result(s): A total of 16
studies (12 retrospective, 3 prospective, 1 mixed) were included,
involving 641 patients (mean age 67.1 years) with NVO + IE. In-hospital
mortality was 14.0 % (95 % CI: 10.0 %-20.0 %). At 1 month, mortality was
9.0 % (95 % CI: 5.0 %-17.0 %), rising to 18.0 % (95 % CI: 13.0 %-24.0 %)
by 1 year and 16.0 % (95 % CI: 3.0 %-50.0 %) by 3 years. Significant
between-study heterogeneity was observed (I2 range: 3 %-70 %).
Common co-morbidities included diabetes mellitus (23.7 %), chronic renal
failure (15.0 %), and immunosuppression (15.0 %). Streptococci (31.5 %),
S. aureus (25.2 %), and enterococci (17.7 %) were the primary pathogens.
Cardiac valve surgery and spinal surgery were reported in 47.5 % and 29.9
% of patients, respectively. A subgroup analysis on 1-month mortality
showed that S. aureus predominance was associated with a significantly
higher mortality compared to streptococci. Certainty in the estimates was
low due to imprecision and methodological limitations. Conclusion(s):
Concomitant NVO + IE is associated with substantial mortality, especially
for S. aureus, underscoring the need for earlier diagnosis, coordinated
multidisciplinary management, and standardized treatment protocols. Future
prospective, high-quality studies are needed to clarify optimal strategies
for diagnostic workup and surgical intervention for this complex clinical
scenario. Copyright © Author(s) 2025.

<55>
Accession Number
2040995777
Title
Protocol for a randomized controlled trial of Xueshuantong injection on
myocardial injury and residual cardiovascular risk in patients with
unstable angina.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1602666. Date of Publication: 2025.
Author
Wang Y.; Liu G.; Lu Z.; Xi J.; Feng W.; Ma Y.; Lyu J.; Xie Y.
Institution
(Wang, Liu, Lyu) Xiyuan Hospital, China Academy of Chinese Medical
Sciences, Beijing, China
(Wang, Lu, Feng, Ma, Xie) Institute of Basic Research in Clinical
Medicine, China Academy of Chinese Medical Sciences, Beijing, China
(Liu, Xi) Wangjing Hospital, China Academy of Chinese Medical Sciences,
Beijing, China
(Xi) Key Laboratory of Chinese Internal Medicine of Ministry of Education,
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing,
China
Publisher
Frontiers Media SA
Abstract
Background: Unstable angina (UA) is a critical subtype of acute coronary
syndrome (ACS). Myocardial injury is a key determinant of disease
progression and long-term prognosis, yet it often persists despite
standard therapy. In addition, residual inflammation remains an important
risk factor for adverse outcomes. Xueshuantong Injection Lyophilized
(XST), derived from Panax notoginseng saponins (PNS), has shown potential
to reduce myocardial injury and modulate inflammatory responses in
cardiovascular disease, but its efficacy in UA has not been fully
evaluated. Method(s): This is a randomized, parallel control,
double-blind, small-sample exploratory clinical trail. Participants will
be recruited from Xiyuan Hospital, China Academy of Chinese Medical
Sciences (Beijing, China). Eligible patients with UA will be randomized
into two groups. The intervention group will receive XST 500 mg
intravenously once daily for 7 days, and the control group will receive
XST 25 mg intravenously once daily for 7 days. The primary outcome is
CK-MB at Day 7. Secondary outcomes are cTnT, NT-proBNP,
inflammatory/endothelial biomarkers (hs-CRP, IL-6, MMP-9, VEGF, HMGB1),
and angina-related parameters (attack frequency, symptom severity). Ethics
and Registration: The trial has been approved by the Ethics Committee of
Xiyuan Hospital and registered in the ITMCTR on March 21, 2025,
http://itmctr.ccebtcm.org.cn (No. ITMCTR2025000552). Conclusion(s):
This exploratory study will evaluate the efficacy and safety of XST in
reducing myocardial injury and residual risk in UA patients, providing
evidence for future large-scale confirmatory trials. Copyright 2025
Wang, Liu, Lu, Xi, Feng, Ma, Lyu and Xie.

<56>
Accession Number
2039155744
Title
Machine learning approaches for cardiovascular disease prediction: A
review.
Source
Archives of Cardiovascular Diseases. 118(10) (pp 554-562), 2025. Date of
Publication: 01 Oct 2025.
Author
Wan S.; Wan F.; Dai X.-J.
Institution
(Wan, Dai) Department of Radiology, The Second Affiliated Hospital,
Jiangxi Medical College, Nanchang University, Nanchang, China
(Wan, Dai) Jiangxi Provincial Key Laboratory of Intelligent Medical
Imaging, Nanchang, China
(Wan, Wan) Department of Electrical and Computer Engineering, Faculty of
Science and Technology, University of Macau, Taipa, Macao
Publisher
Elsevier Masson s.r.l.
Abstract
Cardiovascular disease is a leading cause of death worldwide and is
associated with significant morbidity and mortality. The use of artificial
intelligence techniques, particularly machine learning algorithms, has
emerged as a transformative approach for enhancing early diagnostic
accuracy of disease compared with conventional diagnostic methods. This
systematic review examines three core aspects: (1) comparative analysis of
current machine learning algorithms in early diagnosis of cardiovascular
disease, (2) operational frameworks for clinical implementation, and (3)
critical evaluation of regulatory compliance and ethical implications. It
summarizes recent advancements in machine learning-based heart disease
prediction, outlines a typical workflow for applying machine learning in
clinical settings, and discusses the regulatory and ethical challenges
associated with its implementation. Finally, this review explores
potential directions for future research in this rapidly evolving
field. Copyright © 2025 Elsevier Masson SAS.

<57>
Accession Number
2041271516
Title
Validation of the Mayo Clinic Percutaneous Coronary Intervention Risk
Prediction Score in Patients With Acute Coronary Syndrome.
Source
Journal of the American Heart Association. 14(20) (no pagination), 2025.
Article Number: e043012. Date of Publication: 09 Oct 2025.
Author
Landi A.; Zito A.; Singh M.; Angiolillo D.J.; Capodanno D.; Frigoli E.;
Milzi A.; Rao S.V.; Urban P.; Valgimigli M.
Institution
(Landi, Zito, Frigoli, Milzi, Valgimigli) Cardiocentro Ticino Institute,
Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
(Landi, Milzi, Valgimigli) Faculty of Biomedical Sciences, University of
Italian Switzerland, Lugano, Switzerland
(Zito) Department of Cardiovascular and Pulmonary Sciences, Universita
Cattolica del Sacro Cuore, Rome, Italy
(Singh) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN,
United States
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine-Jacksonville, FL, United States
(Capodanno) Division of Cardiology, Azienda Ospedaliero Universitaria
Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
(Rao) New York University Grossman School of Medicine, New York, NY,
United States
(Urban) Hopital de la Tour, Geneva, Switzerland
(Valgimigli) University of Bern, Switzerland
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: A contemporary, comprehensive risk score for the prediction of
in-hospital fatal and nonfatal adverse events after percutaneous coronary
intervention has been recently developed, albeit its external validation
in patients with acute coronary syndrome is lacking. The objective of this
study is to validate the Mayo Clinic integer risk score in a large cohort
of patients with acute coronary syndrome undergoing percutaneous coronary
intervention from the MATRIX (Minimizing Adverse Haemorrhagic Events by
Transradial Access Site and Systemic Implementation of Angiox) trial.
 METHOD(S): The risk score is composed of a common set of 23 clinical
and procedural variables (model A) and 18 preprocedural variables (model
B). The primary objective was to appraise the receiver-operator
characteristics of both models for in-hospital mortality, bleeding,
contrast-associated acute kidney injury, and stroke. The impact of risk
score categories on 1-year out comes was also investigated.
 RESULT(S): Among the 6724 patients undergoing percutaneous coronary
intervention in the MATRIX trial, the receiver- operator
characteristics-area under the curves for in-hospital mortality, bleeding,
contrast- associated acute kidney injury, and stroke were 0.88 (95% CI,
0.85-0.91), 0.66 (95% CI, 0.63-0.69), 0.70 (95% CI, 0.67-0.72), and 0.65
(95% CI, 0.52-0.78) for model A and 0.88 (95% CI, 0.84-0.92), 0.63 (95%
CI, 0.60-0.66), 0.66 (95% CI, 0.63-0.69), and 0.65 (95% CI, 0.52-0.78) for
model B, respectively. Mortality (model A), bleeding, and stroke risks
were well calibrated, whereas mortality (model B) and contrast-associated
acute kidney injury risk were underestimated. There was a gradual risk
increase for 1- year mortality and bleeding as a function of the risk
score tertile using both models. CONCLUSION(S): The risk score
identifies patients with acute coronary syndrome at incremental risk of
in-hospital mortality, bleeding, contrast-associated acute kidney injury,
and stroke, representing a valuable tool for mitigation of modifiable risk
factors. Copyright © 2025 The Author(s). Published on behalf of
the American Heart Association, Inc., by Wiley. This is an open access
article under the terms of the Creative Commons
Attribution-NonCommercial-NoDerivs License, which permits use and
distribution in any medium, provided the original work is properly cited,
the use is non-commercial and no modifications or adaptations are made.

<58>
Accession Number
2041457756
Title
Standardized and hierarchically classified heart failure and complementary
disease monitoring outcome measures: European Unified Registries for Heart
Care Evaluation and Randomised Trials (EuroHeart).
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 11(7) (pp
900-909), 2025. Date of Publication: 01 Nov 2025.
Author
Bhatty A.; Wilkinson C.; Batra G.; Aktaa S.; Smith A.B.; Wahab A.;
Chappell S.; Alfredsson J.; Erlinge D.; Ferreira J.; Gudmundsdottir I.J.;
Hrafnkelsdottir P.J.; Ingimarsdottir I.J.; Irs A.; Janosi A.; Jarai Z.;
Oliveira-Santos M.; Popescu B.A.; Vasko P.; Vinereanu D.; Yap J.;
Bugiardini R.; Cenko E.; Nadarajah R.; Sydes M.R.; James S.; Maggioni
A.P.; Wallentin L.; Casadei B.; Gale C.P.
Institution
(Bhatty, Aktaa, Smith, Wahab, Chappell, Nadarajah, Gale) Leeds Institute
of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds,
United Kingdom
(Bhatty, Smith, Wahab, Chappell, Nadarajah, Gale) Leeds Institute for Data
Analytics, University of Leeds, Leeds, United Kingdom
(Bhatty, Aktaa, Wahab, Nadarajah, Gale) Department of Cardiology, Leeds
Teaching Hospitals NHS Trust, Leeds, United Kingdom
(Wilkinson) Hull York Medical School, University of York, York, United
Kingdom
(Wilkinson) Academic Cardiovascular Unit, South Tees NHS Foundation Trust,
James Cook University Hospital, Middlesbrough, United Kingdom
(Batra, James, Wallentin) Department of Medical Sciences, Cardiology and
Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
(Alfredsson, Vasko) Linkoping University Hospital, Linkoping, Sweden
(Erlinge) Lund University, Sweden
(Ferreira) Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental,
Portugal
(Gumundsdottir, Hrafnkelsdottir, Ingimarsdottir) Department of Cardiology,
Landspitali University Hospital, Reykjavik, Iceland
(Gumundsdottir, Hrafnkelsdottir, Ingimarsdottir) Department of Health
Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
(Irs) Tartu University Hospital, Estonia
(Janosi) Gyorgy Gottsegen National Cardiovascular Institute, Hungary
(Jarai) South Buda Center Hospital, Szent Imre Teaching Hospital, Hungary
(Oliveira-Santos) Cardiology Department, Unidade Local de Saude de
Coimbra, Portugal
(Popescu, Vinereanu) University of Medicine and Pharmacy Carol Davila,
Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
(Yap) National Heart Centre Singapore, Singapore, Singapore
(Bugiardini, Cenko, Maggioni) ANMCO Research Centre, Heart Care
Foundation, Florence, Italy
(Sydes) MRC Clinical Trials Unit at UCL, University College London,
London, United Kingdom
(Sydes) BHF Data Science Centre, Health Data Research UK, London, United
Kingdom
(Sydes) Data for R&D Programme, NHS England, London, United Kingdom
(Casadei) Division of Cardiovascular Medicine, NIHR Oxford Biomedical
Research Centre, University of Oxford, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Aims The lack of standardized definitions for heart failure outcome
measures limits the ability to reliably assess the effectiveness of heart
failure therapies. The European Unified Registries for Heart Care
Evaluation and Randomised Trials (EuroHeart) aimed to produce a catalogue
of internationally endorsed data definitions for heart failure outcome
measures. Methods and results Following the EuroHeart methods for the
development of cardiovascular data standards, a working group was formed
of representatives from the European Society of Cardiology Heart Failure
Association and other leading heart failure experts. A systematic review
of observational and randomized clinical trials identified current outcome
measures, which was supplemented by clinical practice guidelines and
existing registries for contemporary definitions. A modified Delphi
process was employed to gain consensus for variable inclusion and whether
collection should be mandatory (Level 1) or optional (Level 2) within
EuroHeart. In addition, a set of complementary outcome measures were
identified by the working group as of scientific and clinical importance
for longitudinal monitoring for people with heart failure. Five Level 1
and two Level 2 outcome measures were selected and defined, alongside five
complementary monitoring outcomes for patients with heart failure.
Conclusion We present a structured, hierarchical catalogue of
internationally endorsed heart failure outcome measures. This will
facilitate quality improvement, high quality observational research,
registry-based trials, and post-market surveillance of medical
devices. Copyright © 2024 The Author(s). Published by Oxford
University Press on behalf of the European Society of Cardiology.

<59>
Accession Number
2041270807
Title
Adherence to Lipid-Lowering Therapies and Cardiovascular Outcomes in
Patients With Atherosclerotic Cardiovascular Disease: A Systematic Review
and Meta-Analysis.
Source
Journal of the American Heart Association. 14(17) (pp 1-16), 2025. Date of
Publication: 29 Aug 2025.
Author
Jones L.K.; East C.; Ganda O.P.; Gionfriddo M.R.
Institution
(Jones) Department of Genomic Health, Research Institute, Geisinger,
Danville, United States
(East) Baylor Research Institute, Jack and Jane Hamilton Heart and
Vascular Hospital, Dallas, United States
(Ganda) Joslin Diabetes Center, Boston, United States
(Gionfriddo) Division of Pharmaceutical, Administrative, and Social
Sciences, School of Pharmacy, Duquesne University, Pittsburgh, United
States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Persistently elevated low-density lipoprotein cholesterol is a
major risk factor for atherosclerotic cardiovascular disease (ASCVD).
Despite the availability of lipid-lowering therapy (LLT), most patients
with ASCVD do not achieve guideline-recommended low-density lipoprotein
cholesterol goals. Poor adherence to LLT is a key barrier to low-density
lipoprotein cholesterol lowering and may be associated with adverse
cardiovascular outcomes. We conducted a systematic review and
meta-analysis to clarify the relationship between adherence to LLT and
cardiovascular outcomes in patients with ASCVD. METHOD(S): Systematic
searches of PubMed, Embase, Scopus, and Cumulative Index to Nursing and
Allied Health Literature were performed in March 2023 (updated September
2024). Observational studies in adults with clinical ASCVD reporting
objective measures of adherence or persistence to LLT and cardiovascular
outcomes, including death, cardiovascular death, and major adverse
cardiovascular events, were included. Risk of bias was assessed using the
Clinical Advances Through Research and Information Translation tool.
 RESULT(S): Of 12 466 unique records identified, 39 met the inclusion
criteria. Most studies only reported adherence to statins (33/39), and
most measured adherence using proportion of days covered (25/39). Using an
adherence threshold of >=80%, adherence to LLT was shown to statistically
significantly reduce risk of death (hazard ratio [HR], 0.56 [95% CI,
0.34-0.92]; P=0.0268; I2 95%), major adverse cardiovascular events (HR,
0.77 [95% CI, 0.68-0.86]; P=0.0007; I2 83%), myocardial infarction (HR,
0.86 [95% CI, 0.79-0.95]; P=0.0147; I2 0%), and non-statistically
significant reductions in cardiovascular death (HR, 0.44 [95% CI,
0.12-1.60]; P=0.1528; I2 92%) and ischemic stroke (HR, 0.83 [95% CI,
0.58-1.18]; P=0.1856; I2 52%). CONCLUSION(S): In this systematic
review and meta-analysis, adherence to LLT was associated with reduced
risk of cardiovascular events in patients with clinical ASCVD.
REGISTRATION: URL: https:// www. crd. york. ac. uk/ prosp ero/;
identifier: CRD42023427146. Copyright © 2025 The Author(s).
Published on behalf of the American Heart Association, Inc., by Wiley.
This is an open access article under the terms of the Creative Commons
Attribution-NonCommercial License, which permits use, distribution and
reproduction in any medium, provided the original work is properly cited
and is not used for commercial purposes

<60>
Accession Number
2036454643
Title
Cardiac repair and regeneration: cell therapy, in vivo reprogramming, and
the promise of extracellular vesicles.
Source
Experimental and Molecular Medicine. 57(10) (pp 2182-2200), 2025. Date of
Publication: 01 Oct 2025.
Author
Karim Rony R.M.I.; Tompkins J.D.
Institution
(Karim Rony, Tompkins) Department of Diabetes Complications and
Metabolism, Arthur Riggs Diabetes and Metabolism Research Institute, City
of Hope, Duarte, CA, United States
Publisher
Springer Nature
Abstract
Therapeutic interventions to replenish lost cardiomyocytes and recover
myocardium functions following ischemic myocardial infarction (MI) remain
major goals in the cardiac regeneration field. Clinical trials harnessing
autologous or allogeneic cell therapy approaches from both cardiac and
noncardiac cells sources, thus far, demonstrate marginal improvement.
Moreover, complications such as arrythmias and graft rejections associated
with cellular or organ-based therapies continue to prevail. Extracellular
vesicles, on the other hand, are cell-derived, nano-sized,
cargo-containing biomolecules that have emerged as potent alternatives to
cell-based cardiac regeneration/replacement therapy. Recent studies
demonstrate that most stem-cell-derived extracellular vesicles (Stem-EVs)
are nonimmunogenic and carry cardioprotective therapeutic cargos.
Moreover, administration of multiple Stem-EV types in animal models of
acute MI results in reduced inflammation, apoptosis, smaller infarct size
and improved cardiac functionality. With recent developments, engineered
Stem-EVs with enhanced cardiac targeting, prolonged circulation and
recombinant therapeutic cargos may tilt the cardiac regeneration field
toward these novel cell-free biologics. Here we provide a brief overview
of current approaches to repair and replenish damaged cardiomyocytes
following MI via cell therapy and in vivo reprogramming, and we delve
deeply into the therapeutic potentials of Stem-EVs in cardiac repair and
regeneration. Copyright © The Author(s) 2025.

<61>
Accession Number
2041330865
Title
Impact of intraoperatiVe moderAte positive end-expiratory pressure with
reCruitment mAnoeuvres versus low positive end-expiRatory pressure on
major postoperative pulMonary complications and death after on-pump
cardiac surgery in high-risk patients: the VACARM randomised clinical
trial-study protocol.
Source
BMJ Open. 15(10) (no pagination), 2025. Article Number: e104179. Date of
Publication: 29 Oct 2025.
Author
Demaure N.; Le Cunff J.; Duchene M.; Rozec B.; Espitalier F.; Cabon J.-M.;
Oilleau J.-F.; Guerci P.; Labaste F.; Abou-Arab O.; Guinot P.-G.; Duval
P.; Besnier E.; Flecher E.; Leroyer I.; Morcet J.; Fougerou-Leurent C.;
Mansour A.; Nesseler N.
Institution
(Demaure, Le Cunff) Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre
d'Investigation Clinique de Rennes), Department of Anesthesia and Critical
Care, Pontchaillou, Rennes University Hospital, Brittany, Rennes, France
(Duchene) Department of Anesthesia and Critical Care, University Hospital
Centre Nantes, Pays de la Loire, Nantes, France
(Rozec) Department of Anesthesia and Critical Care, Laennec Hospital,
University Hospital of Nantes and Nantes Universite, CHU Nantes, CNRS,
INSERM, l'Institut du Thorax, University Hospital Centre Nantes, Pays de
la Loire, Nantes, France
(Espitalier) Department of Anesthesia and Critical Care, Regional
University Hospital Centre Tours, Centre-Val de Loire, Tours, France
(Cabon) Department of Anesthesia and Critical Care, CHU de Brest,
Brittany, Brest, France
(Oilleau) Departement d'Anesthesie et Reanimation Chirurgicale, Brest
University Hospital Centre, Brittany, Brest, France
(Guerci) Department of Anesthesia and Critical Care, CHU de Nancy,
Lorraine, Nancy, France
(Labaste) Department of Anesthesia and Critical Care, University Hospital
of Toulouse, Toulouse, France
(Abou-Arab) Department of Anesthesia and Critical Care, Amiens-Picardy
University Hospital, Hauts-de-France, Amiens, France
(Guinot) Burgundy Franche-Comte University, Besancon, France
(Duval, Besnier) Department of Anesthesia and Critical Care, University
Hospital Centre Rouen, Normandy, Rouen, France
(Flecher) Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de
Rennes, Bretagne, Rennes, France
(Leroyer) Univ Rennes, CHU de Rennes, Department of Research and
Innovation, University Hospital of Rennes, Rennes University Hospital,
Brittany, Rennes, France
(Morcet) Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes),
Rennes University Hospital, Brittany, Rennes, France
(Fougerou-Leurent) Pharmacology, University Hospital Centre Rennes,
Rennes, France
(Fougerou-Leurent) CIC 1414, INSERM, Rennes, France
(Mansour) Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre
d'Investigation Clinique de Rennes), Inra, Inserm, Institut NUMECAN -
UMR_A 1341, UMR_S 1241, Department of Anesthesia and Critical Care,
Pontchaillou, University Hospital of Rennes, Rennes University Hospital,
Rennes, France
(Nesseler) Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre
d'Investigation Clinique de Rennes), Inra, Inserm, Institut NUMECAN -
UMR_A 1341, UMR_S 1241, Department of Anesthesia and Critical Care,
Pontchaillou, Rennes University Hospital, Brittany, Rennes, France
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative pulmonary complications (PPCs) are common after
cardiac surgery and are associated with significant morbidity and
mortality. Lung-protective ventilation strategies have been proposed to
reduce PPCs, but the optimal level of positive end-expiratory pressure
(PEEP) and the use of alveolar recruitment manoeuvres (RMs) remain
controversial. Methods/analysis In this investigator-initiated,
multicentre, open, randomised, parallel-group, superiority clinical trial,
elective cardiac surgery patients at risk of PPCs will be assigned to one
of two intraoperative ventilation strategies: (1) an open-lung ventilation
strategy with protective ventilation, moderate PEEP and RMs or (2) a
standard protective ventilation with low PEEP and no RM. The primary
outcome will be a composite of prolonged (>24 hour) postoperative
mechanical ventilation, reintubation for any cause or hospital-acquired
pneumonia within 7 days of surgery, or death within 28 days of surgery.
Data will be analysed on an intention-to-treat basis. Ethics and
dissemination The VACARM (impact of intraoperatiVe moderAte positive
end-expiratory pressure with reCruitment mAnoeuvres versus low positive
end-expiRatory pressure on major postoperative pulMonary complications and
death after on-pump cardiac surgery in high-risk patients) trial has been
approved by an independent ethics committee for all study centres.
Recruitment began in July 2021. Results will be published in international
peer-reviewed medical journals. Copyright © Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<62>
Accession Number
2041004958
Title
Inclusion and reporting by age, sex, and ethnicity in clinical studies of
high-risk medical devices approved in the European Union.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 11(7) (pp
962-968), 2025. Date of Publication: 01 Nov 2025.
Author
Coughlan J.J.; Byrne R.A.; Siontis G.C.M.; McGovern L.; Durand R.; Lubbeke
A.; Bano A.; Fraser A.G.
Institution
(Coughlan, Byrne, McGovern, Durand) Department of Cardiology,
Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network,
Eccles Street 73, Dublin, Ireland
(Coughlan, Byrne) School of Pharmacy and Biomolecular Sciences, RCSI
University of Medicine and Health Sciences, 123 St Stephen's Green,
Dublin, Ireland
(Siontis) Department of Cardiology, Bern University Hospital, University
of Bern, Freiburgstrasse 18, Bern, Switzerland
(Lubbeke) Division of Orthopedic Surgery & Traumatology, Geneva University
Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneve,
Switzerland
(Lubbeke) Botnar Research Centre, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Rd,
Headington, Oxford, United Kingdom
(Bano) Institute of Social and Preventive Medicine, University of Bern,
Mittelstrasse 43, Bern, Switzerland
(Fraser) Department of Cardiology, University Hospital of Wales, Heath
Park Way, Cardiff, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction Adequate inclusion and representation of patients in clinical
studies is critical for the generalizability of research findings. The aim
of this analysis was to determine inclusion and reporting by age, sex, and
ethnicity in clinical studies of high-risk medical devices (orthopaedic,
diabetes, and cardiovascular) approved in the European Union. Methods This
is an analysis of data from three co-ordinated systematic reviews of
clinical evidence for high-risk medical devices. This analysis includes
641 studies, reporting on more than 1.9 million patients treated with
high-risk orthopaedic, diabetes, and cardiovascular medical devices. The
main outcomes were the proportions of studies providing data on the age,
sex, and ethnicity of participants, and the performance of stratified
analyses based on these factors. Results The majority (>90%) of studies in
all three device categories (orthopaedics, diabetes, and cardiovascular)
provided data on the age and sex of participants, but only a minority
(<10%) provided information on ethnicity. Female patients comprised over
half of the patients in the included orthopaedic and diabetes device
studies, but <40% of patients in the included cardiovascular device
studies (P < 0.001). A minority of studies performed analyses stratified
by age (14.6%) or sex (10.4%), although those were more frequently
reported in randomized studies. Conclusions Almost all studies in this
analysis provided demographic data on age and sex, but only a small
minority had analysed whether these factors had any impact on device
performance. Very few studies provided information on the ethnicity of
study participants. Cardiovascular device studies enrolled a lower
proportion of female patients in comparison to orthopaedic and diabetes
device studies. Study registration Cardiovascular device systematic
review: PROSPERO (CRD42022308593). Diabetes device systematic review:
PROSPERO (CRD42022366871). Orthopaedic device systematic review: open
science framework (https://osf.io/6gmyx). Copyright © 2025 The
Author(s). Published by Oxford University Press on behalf of the European
Society of Cardiology.

<63>
Accession Number
2041271377
Title
Antithrombotic Monotherapy or Combination Therapy for Atrial Fibrillation
in Stable Coronary Artery Disease: A Meta-Analysis of Randomized Trials.
Source
Journal of the American Heart Association. 14(20) (pp 1-10), 2025. Article
Number: e041422. Date of Publication: 21 Oct 2025.
Author
Reddy K.; Koeckerling D.; Lip Y.H.; Howard J.P.; Ahmad Y.
Institution
(Reddy, Howard) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
Nuffield Department of Population Health, University of Oxford, Oxford,
United Kingdom
(Koeckerling) Department of Cardiology, Angiology and Respiratory
Medicine,Heidelberg University Hospital, Heidelberg, Germany
(Lip) Liverpool Centre for Cardiovascular Science at University of
Liverpool, Liverpool John MooresUniversity and Liverpool Heart & Chest
Hospital, Liverpool, United Kingdom
Danish Center for Health Services Research, Department of Clinical
Medicine, Aalborg University, Aalborg, Denmark
(Ahmad) Division of Cardiology, University of California, San Francisco,
CA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In patients with atrial fibrillation and stable coronary
artery disease, guidelines recommend oral anticoagulation monotherapy
after periods on dual antithrombotic therapy. These recommendations are
based on evidence from prematurely terminated randomized controlled trials
that were underpowered for bleeding and mortality end points. New data are
available, so we conducted a systematic review and meta-analysis to pool
the totality of randomized evidence. METHOD(S): This investigation
was preregistered on International Prospective Register of Systematic
Reviews (CRD42024590457). Systematic searches and data extraction were
performed independently and in duplicate for randomized controlled trials
enrolling patients with atrial fibrillation and stable coronary artery
disease that reported clinical end points. The prespecified coprimary end
points were major bleeding and all-cause death. Prespecified secondary
outcomes included all bleeding, cardiovascular death, noncardiovascular
death, myocardial infarction, stroke, the composite of net adverse
cardiovascular events and coronary revascularization. End point data were
pooled using fixed and random effect models, to generate hazard ratios
(HR) and relative risks and corresponding 95% CIs. RESULT(S): Four
randomized controlled trials enrolling 4092 patients were eligible, with
2049 randomized to monotherapy and 2043 randomized to dual therapy.
Monotherapy reduced the hazard of major bleeding by 41% (HR, 0.59 [95% CI,
0.44-0.79], P<0.001, I2=29%). There was no statistically significant
difference in hazard of all-cause death (HR, 0.89 [95% CI, 0.45-1.74],
P=0.73, I2=72%), or other secondary outcomes. CONCLUSION(S): In
patients with stable coronary artery disease and atrial fibrillation, oral
anticoagulation monotherapy reduces major bleeding compared with dual
antithrombotic therapy. There were no significant differences in all-cause
and cardiovascular death, myocardial infarction, stroke, adverse
cardiovascular events, and coronary revascularization. Copyright
© 2025 The Author(s). Published on behalf of the American Heart
Association, Inc., by Wiley. This is an open access article under the
terms of the Creative Commons Attribution-NonCommercial License, which
permits use, distribution and reproduction in any medium, provided the
original work is properly cited and is not used for commercial purposes.

<64>
Accession Number
2041445932
Title
Effect of Dexmedetomidine on Endothelial Glycocalyx in Patients Undergoing
Cardiac Surgery with Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Fan Y.; Chen B.; Fang F.; Gao W.; Wu Q.; Wang W.; He G.
Institution
(Fan) Department of Anesthesiology, Women's Hospital School of Medicine
Zhejiang University, Zhejiang Province, Hangzhou, China
(Chen) Department of Anesthesiology, Taizhou Hospital of Zhejiang Province
affiliated to Wenzhou Medical University, Zhejiang, Linhai, China
(Fang) Department of Anaesthesiology, The First Affiliated Hospital,
Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
(Gao, Wu, Wang, He) Department of Anesthesiology, The First Affiliated
Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou, China
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the protective role of dexmedetomidine on
endothelial glycocalyx in cardiac surgery patients undergoing
cardiopulmonary bypass (CPB). Design(s): Randomized controlled trial.
 Setting(s): Single-center study conducted from June 2022 to December
2022. Participant(s): Fifty-eight patients who underwent elective
valvular cardiac surgery with CPB. Intervention(s): Patients were
randomly assigned to either the dexmedetomidine group (n = 29) or the
saline group (n = 29), with infusion starting 10 minutes before anesthesia
induction and continuing throughout the maintenance phase.
 Measurements and Main Results: Radial artery blood samples were
collected at 4 time points: T1, before anesthesia induction; T2, 5 minutes
after aortic unclamping; T3, 1 hour postoperatively; and T4, 24 hours
postoperatively. The primary endpoint was plasma syndecan-1 concentration,
and secondary endpoints were heparin sulfate and tumor necrosis
factor-alpha (TNF-alpha) levels, and long-term clinical outcomes. Compared
with controls, the dexmedetomidine group showed significantly less
glycocalyx shedding, an effect that persisted throughout CPB and recovery.
TNF-alpha levels were significantly lower at T2-T3, along with reduced
lactate levels on aortic unclamping. Conclusion(s): Dexmedetomidine
preserves endothelial glycocalyx integrity and attenuates systemic
inflammation in CPB patients. Copyright © 2025 Elsevier Inc.

<65>
Accession Number
2041407058
Title
Cardiac magnetic resonance imaging reduces radiation exposure in emergency
department patients with chest pain: A secondary analysis from the CMR
IMPACT trial.
Source
American Journal of Emergency Medicine. 99 (pp 405-410), 2026. Date of
Publication: 01 Jan 2026.
Author
Lefebvre C.; Snavely A.C.; Ashburn N.P.; Supples M.W.; Stopyra J.P.; Park
C.J.; Vasu S.; Hundley W.G.; Mahler S.A.; Miller C.D.; Raman S.V.;
Caterino J.M.; Clark C.L.; Hiestand B.C.
Institution
(Lefebvre, Ashburn, Supples, Stopyra, Mahler, Miller, Hiestand) Department
of Emergency Medicine, Wake Forest University School of Medicine,
Winston-Salem, NC, United States
(Snavely) Department of Biostatistics and Data Science, Wake Forest
University School of Medicine, Winston-Salem, NC, United States
(Park, Vasu) Department of Cardiovascular Medicine, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
(Hundley) Division of Cardiology, Department of Internal Medicine,
Virginia Commonwealth University, Richmond, VA, United States
(Mahler) Department of Epidemiology and Prevention, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
(Mahler) Department of Implementation Science, Wake Forest University
School of Medicine, Winston-Salem, NC, United States
(Raman) OhioHealth, Columbus, OH, United States
(Caterino) Department of Emergency Medicine, The Ohio State University,
Columbus, OH, United States
(Clark) Department of Emergency Medicine, Corewell Health William Beaumont
University Hospital, Royal Oak, MI, United States
Publisher
W.B. Saunders
Abstract
Background: Patients presenting to the Emergency Department (ED) with
chest pain who have an indeterminate (detectable to mildly elevated)
troponin are often evaluated with tests that use ionizing radiation. We
hypothesized that patients initially evaluated with stress cardiac
magnetic resonance (CMR) imaging receive less ionizing radiation through
one year of follow-up than those initially evaluated with invasive
angiography. Method(s): We conducted a secondary analysis of the
CMR-IMPACT trial, which randomized adult patients at 4 U.S. sites
(9/2013-7/2018) with a contemporary troponin of 0.006-1.0 ng/mL to either
CMR imaging or invasive angiography. Cumulative radiation exposure from
coronary computed tomography angiography, nuclear medicine stress imaging,
cardiac catheterization, and percutaneous coronary intervention was
assessed from index through one year using validated radiation dose
estimates. Radiation doses at index and one year were compared between
arms using linear regression adjusted for the stratification factors of
initial troponin and known coronary artery disease in both
intention-to-treat (ITT) and per-protocol (PP) populations.
 Result(s): During the study period, 312 patients were enrolled, with
156 randomized to each arm (CMR vs. invasive angiography). In the ITT
analysis, patients in the CMR arm had less radiation exposure at index
compared to patients in the invasive angiography arm (4.7 +/- 5.7 mSv vs.
7.8 +/- 5.8 mSv; p < 0.001). The difference in radiation exposure at one
year was 7.5 +/- 10.9 mSv vs. 9.5 +/- 8.4 mSv (p = 0.06). In the PP
analysis, patients receiving CMR (N = 102) had less radiation exposure
than those receiving invasive angiography (N = 104) at index (3.5 +/- 5.1
mSv vs. 9.3 +/- 3.7 mSv; p < 0.001) and one year (5.8 +/- 10.9 mSv vs.
11.2 +/- 8.1 mSv; p < 0.001). Conclusion(s): CMR was associated with
decreased radiation exposure compared to invasive
angiography. Copyright © 2025 Elsevier Inc.

<66>
Accession Number
2035571376
Title
Letter to the Editor Concerning the Article: "Transcatheter Versus
Surgical Approach for the Treatment of Aortic Stenosis in Patients With
Concomitant Coronary Artery Disease: A Systematic Review and
Meta-Analysis".
Source
Catheterization and Cardiovascular Interventions. 106(4) (pp 2311-2312),
2025. Date of Publication: 01 Oct 2025.
Author
Salazar Ore J.V.; Alonso Ramirez A.C.; Calderon Martinez E.; Sanchez Cruz
C.
Institution
(Salazar Ore) Facultad de Ciencias Medicas, Universidad de Buenos Aires,
Buenos Aires, Argentina
(Alonso Ramirez) Department of Neurology, Stroke Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, MA, United
States
(Calderon Martinez) Department of Internal Medicine, The University of
Texas Health Science Center at Houston, Houston, TX, United States
(Sanchez Cruz) Universidad Nacional Autonoma de Mexico, Ciudad de Mexico,
Mexico
Publisher
John Wiley and Sons Inc

<67>
Accession Number
2041271069
Title
Unsupervised Learning Analysis of Triglycerides, Inflammation,
Cholesterol, and the Risks of Incident Cardiovascular Disease and Type 2
Diabetes in the Women's Health Study.
Source
Journal of the American Heart Association. 14(18) (no pagination), 2025.
Article Number: e039381. Date of Publication: 05 Sep 2025.
Author
Duran E.K.; Cook N.R.; Aday A.W.; Buring J.E.; Ridker P.M.; Pradhan A.D.
Institution
(Duran, Cook, Buring, Ridker, Pradhan) Division of Preventive Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Duran, Ridker) Division of Cardiovascular Medicine, Department of
Medicine, University of California San Diego, La Jolla, CA, United States
(Ridker) Brigham and Women's Hospital, Harvard Medical School,
Cardiovascular Medicine, Boston, MA, United States
(Aday) Vanderbilt Translational and Clinical Cardiovascular Research
Center, Division of Cardiovascular Medicine, Vanderbilt University Medical
Center, Nashville, TN, United States
(Pradhan) Division of Cardiovascular Medicine, VA Boston Medical Center,
Boston, MA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Traditional cardiovascular risk assessment entails
investigator-defined exposure levels and individual risk markers in
multivariable analysis. We sought to determine whether an alternative
unbiased learning analysis might provide further insights into vascular
risk. METHOD(S): We conducted an unsupervised learning (k-means
cluster) analysis in the Women's Health Study (N=26443) using baseline
levels of triglycerides, high-sensitivity C-reactive protein, and
low-density lipoprotein cholesterol to form novel exposures. We then
evaluated cluster-based risk of incident coronary, cerebrovascular, and
limb events using the Kaplan- Meier method and multivariable Cox models,
followed by comparison with established clinical biomarker thresholds.
Finally, we illustrated clinical applicability to a nonvascular outcome
(type 2 diabetes). RESULT(S): Four clusters emerged and were named
according to aggregate biomarker profiles: Cluster 1 ("healthy," n=12101),
cluster 2 ("hypercholesterolemic," n=7424), cluster 3 ("inflammatory,"
n=5056), and cluster 4 ("triglyceride-rich," n=1862). Triglyceride-rich
cluster identity conferred the highest risk of future cardiovascular
events (adjusted hazard ratio [HRadj], 2.24 [95% CI, 1.93-2.60]) compared
with those in the healthy cluster (reference group). Risk was intermediate
in the hypercholesterolemic (predominantly elevated low-density
lipoprotein cholesterol) and inflammatory (predominantly elevated
high-sensitivity C-reactive protein) clusters (HRadj, 1.44 [95% CI,
1.28-1.61]; and 1.54 [95% CI, 1.35-1.75], respectively). Clustering
yielded stronger total cardiovascular disease risk associations than
traditionally defined mixed dyslipidemia with modest improvement in
reclassification statistics. Cluster identities also predicted incident
type 2 diabetes, with the greatest risk among the triglyceride-rich
cluster (HRadj, 3.78 [95% CI, 3.29-4.35]). CONCLUSION(S):
Unsupervised learning analyses demonstrated associations that may be
useful when refining cardiovascular risk and may inform atherosclerosis
development in healthy individuals better than traditional classification
methods. Copyright © 2025 The Author(s). Published on behalf of
the American Heart Association, Inc., by Wiley. This is an open access
article under the terms of the Creative Commons Attribution-NonCommercial
License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited and is not used for
commercial purposes.

<68>
Accession Number
2037294628
Title
Antiplatelet Therapy in Chronic Coronary Artery Disease Patients With a
History of Angioplasty. When is Aspirin Not Enough? A Systematic Review.
Source
Reviews in Cardiovascular Medicine. 26(9) (no pagination), 2025. Article
Number: 44227. Date of Publication: 01 Sep 2025.
Author
Fiflis S.; Papamichalis M.; Xanthopoulos A.
Institution
(Fiflis, Papamichalis, Xanthopoulos) Department of Cardiology, University
Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa,
Greece
Publisher
IMR Press Limited
Abstract
Background: Antiplatelet therapy represents a cornerstone of secondary
prevention in patients with chronic coronary syndrome (CCS) who have
undergone percutaneous coronary intervention (PCI). However, the optimal
antiplatelet regimen and optimal duration remain under investigation, as
treatment must be individualized to balance the thrombotic and bleeding
risks. Thus, this systematic review aimed to present the most recent
evidence on antiplatelet strategies in chronic coronary syndrome patients
with prior PCI, highlighting findings relevant to subgroups with increased
thrombotic risk. Method(s): A systematic search of the PubMed
database, the Cochrane Library, and ClinicalTrials.gov was conducted up to
29 May 2025. Studies were screened and selected based on predefined
eligibility criteria. A total of 14 studies were included and were
synthesized narratively. Result(s): Extended dual antiplatelet
therapy (DAPT) with ticagrelor plus aspirin, compared to aspirin alone,
improved primary outcomes in 5101 patients with stable coronary disease
and diabetes mellitus (hazard ratio (HR) 0.81 95% confidence interval
(CI), 0.71-0.93 p = 0.003), and reduced major adverse cardiovascular
events (HR 0.85 95% CI, 0.75-0.96 p = 0.009) among 11,260 patients with
history of prior myocardial infarction and additional risk factors such as
multivessel coronary artery disease or chronic kidney disease. In 2431
patients, long-term clopidogrel monotherapy, compared to aspirin
monotherapy, was associated with improved primary outcomes (HR 0.74 95% CI
0.63-0.86 p < 0.001) along with a reduction in major bleeding (HR 0.65 95%
CI 0.47-0.90 p = 0.008). Long-term ticagrelor monotherapy, compared to
aspirin, was associated with fewer ischemic events, as defined by the
primary endpoint (HR 0.73 95% CI 0.57-0.94 p = 0.014), but an increased
risk of Bleeding Academic Research Consortium (BARC) type 2,3, or 5
bleeding (HR 1.52 95% CI 1.11-2.08 p = 0.009). Subgroup analyses suggested
benefits of extended DAPT versus aspirin in patients with peripheral
artery disease (n = 246 HR 0.54 95% CI 0.31-0.95 p = 0.03), in those with
two or more implanted stents (n = 505 p = 0.02), and in patients treated
for in-stent restenosis (n = 224 p = 0.034). Conclusion(s): Extended
DAPT demonstrated benefits over 30 months, while clopidogrel monotherapy
has shown sustained effectiveness for up to 5.8 years in CCS patients with
a history of PCI. Individualized treatment based on thrombotic and
bleeding risk remains essential. Largescale randomized trials are
warranted to define the populations most likely to benefit from long-term
intensified antiplatelet therapy. The PROSPERO Registration:
CRD420251069004,
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251069004. Copyright
© 2025 The Author(s).

<69>
Accession Number
2041514566
Title
Low dose of landiolol does not prevent postoperative atrial fibrillation
after cardiac surgery in non-Asian patients: a multicentre randomised
study.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Amour J.; Naudin C.; Besnard A.; Merzoug M.; Laverdure F.; Frossard B.;
Morichau-Beauchant T.; Geri G.; Squara P.
Institution
(Amour, Besnard, Laverdure, Frossard) Department of Cardiac
Anaesthesiology and Intensive Care Medicine, Institute of Perfusion,
Intensive Care Medicine and Anaesthesiology (IPRA), Hopital Prive Jacques
Cartier-Ramsay Sante, Massy, France
(Naudin, Merzoug, Geri, Squara) Department of Cardiology and Intensive
Care Medicine-Groupe Hospitalier Prive Ambroise Pare-Hartmann,
Neuilly-Sur-Seine, France
(Morichau-Beauchant) Department of Intensive Care Medicine, Centre
Cardiologique du Nord, Saint Denis, France
Publisher
Elsevier Ltd
Abstract
Background: Postoperative atrial fibrillation (POAF) affects 30% of
patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Beta-blockers are the first-line agents recommended for POAF prevention.
Landiolol, an ultra-short-acting, highly selective beta-1-blocker, has
been shown to be effective in reducing POAF in Asian patients at a low
dose of 2 mug kg-1 min-1. The aim of this study was
to evaluate the effect of a low dose of landiolol for the prevention of
POAF in non-Asian patients after cardiac surgery. Method(s): This
multicentre, double-blind, randomised, placebo-controlled superiority
trial was conducted from January 2021 to July 2023 at three hospitals in
France. Participants were non-Asians >=65 yr undergoing elective cardiac
surgery with CPB and a left ventricular ejection fraction >=40%. Treatment
was started in the ICU and continued for up to 24 h, after which oral
beta-blockers were administered. The primary endpoint was the incidence of
POAF while in the ICU, analysed by intention to treat. Secondary outcomes
included in-hospital and 30-day POAF, ICU and hospital length of stay, and
safety outcomes. Result(s): A total of 318 participants (mean age: 71
[range: 68-76] yr; 21.4% female) were randomised. POAF in ICU occurred in
51/160 (31.9%) participants who received placebo, compared with 47/158
(29.8%) who received a low-dose landiolol infusion (relative risk: 0.93
[95% confidence interval, 0.67-1.30]; P=0.77). No differences were
observed in secondary endpoints, including in-hospital POAF and safety
outcomes. Conclusion(s): In non-Asian patients undergoing cardiac
surgery with CPB, a low-dose 24-h infusion of landiolol, used as a bridge
to oral beta-blockers, did not reduce the incidence of postoperative
atrial fibrillation. Clinical trial registration: ClinicalTrials.gov
(NCT04607122). Copyright © 2025 British Journal of Anaesthesia

<70>
Accession Number
2040629239
Title
Efficacy and Safety of Direct Oral Anticoagulants in Patients After Heart
Valve Replacement or Repair: A Systematic Review and Network
Meta-Analysis.
Source
Clinical Therapeutics. 47(11) (pp 1061-1068), 2025. Date of Publication:
01 Nov 2025.
Author
Gao W.; Zhang Z.; Jia P.; Dong L.; Li R.; Xu J.; Zhang J.; Chen W.
Institution
(Gao, Zhang, Jia, Dong, Li, Xu, Zhang, Chen) Third Hospital of Shanxi
Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical
Sciences, Tongji Shanxi Hospital, Taiyuan, China
(Zhang, Jia, Dong, Chen) School of Pharmacy, Shanxi Medical University,
Taiyuan, China
Publisher
Elsevier Inc.
Abstract
Purpose: The optimal anticoagulation strategy following bioprosthetic
heart valve replacement or valve repair remains controversial. Therefore,
we conducted a meta-analysis to compare the efficacy and safety of direct
oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients
with heart valve disease. Method(s): We searched PubMed, Cochrane
Library, Embase, Web of Science, CNKI, and Wanfang for clinical studies
comparing DOACs and VKAs in patients following bioprosthetic heart valve
replacement or repair, up to November 1, 2023. The meta-analysis was
conducted using RevMan 5.3 and Stata 17.0. Finding(s): Thirty-three
studies involving 59,660 individuals were included in the meta-analysis.
Compared with VKAs, DOACs may reduce the risk of stroke or systemic
embolism (risk ratios [RR] = 0.83, 95% confidence interval [CI] 0.75-0.93,
P = 0.0007) and major bleeding (RR = 0.76, 95% CI 0.62-0.94, P = 0.009),
while the risks of all-cause death and intracranial bleeding were similar.
DOACs may increase the risk of gastrointestinal bleeding (RR = 1.42, 95%
CI 1.04-1.95, P = 0.03). Twelve studies (4,789 patients) were included in
a network meta-analysis. Indirect comparisons suggested rivaroxaban
appears most favorable in reducing stroke or systemic embolism and major
bleeding, though based on indirect evidence. Implications: In patients
following bioprosthetic heart valve replacement or repair, DOACs may
reduce the risk of stroke or systemic embolism and major bleeding, but may
increase gastrointestinal bleeding compared with VKAs. Among DOACs,
rivaroxaban appears to be the optimal choice. These findings should be
interpreted cautiously due to limited RCT evidence and incomplete
drug-specific reporting. Copyright © 2025 Elsevier Inc.

<71>
Accession Number
2037294064
Title
Efficacy and Safety Profile of Low-Dose Tranexamic Acid Regimen in Cardiac
Surgery: A Meta-Analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 40(5) (no pagination), 2025.
Article Number: e20240022. Date of Publication: 01 Sep 2025.
Author
Wardhana A.; Ghea C.; Nugroho A.; Kinasih N.C.P.; Nugroho J.
Institution
(Wardhana) Department of Anesthesiology, Faculty of Medicine, Universitas
Surabaya, East Java, Surabaya, Indonesia
(Ghea, Nugroho) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Airlangga University, Dr. Soetomo General Hospital, East Java,
Surabaya, Indonesia
(Nugroho, Kinasih) Faculty of Medicine, Public Health and Nursing, Gadjah
Mada University, Special Region of Yogyakarta, Yogyakarta, Indonesia
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Various dosing regimens of tranexamic acid have been
reported to exhibit varying efficacy and safety profiles. Herein, we
conducted a meta-analysis to evaluate the efficacy and safety of low-dose
regimens in open-heart surgery. Method(s): Three databases were
systematically searched for randomized trials examining the bleeding
reduction effect of tranexamic acid in open-heart surgery. The pooled data
of the low-dose group was then compared with the control, high-dose, and
epsilon aminocaproic acid groups. The boundary between the low-and
high-dose groups was a bolus of 30 mg/kg followed by 16 mg/kg/hour.
 Result(s): The meta-analysis included 81 studies. The low-dose
tranexamic acid regimen was associated with a decreased incidence of
reoperation (risk ratio: 0.52; 95% confidence interval: 0.39-0.69; high
quality of evidence), perioperative myocardial infarction (risk ratio:
0.64; 95% confidence interval: 0.43-0.95; high quality of evidence), the
amount of postoperative bleeding in 24 hours, and the need for transfusion
of packed red cells compared to control, without increasing the rates of
mortality, venous thromboembolism, or stroke. Compared with the high-dose
group, the low-dose group had a lower incidence of seizures and stroke.
The low-dose of tranexamic acid group also showed significantly reduced
postoperative bleeding; however, the cost of an increased risk of seizure
events was higher in the low-dose group than in the epsilon aminocaproic
acid group. Conclusion(s): Low-dose tranexamic acid effectively
reduced bleeding, the risk of reoperation, and myocardial infarction
without increasing the risk of adverse events. Copyright © 2025,
Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.

<72>
Accession Number
2041086293
Title
Immediate and Midterm Efficacy and Safety of Intravascular Lithotripsy for
Calcified In-Stent Restenosis: A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Eri R.R.; Zahrani S.; Andriono P.; Silalahi T.D.A.
Institution
(Eri, Andriono) Abdi Waluyo Hospital, Jakarta, Indonesia
(Eri) Gatot Soebroto Army Central Hospital, Jakarta, Indonesia
(Zahrani) Faculty of Medicine, Universitas Indonesia, West Java, Indonesia
(Silalahi) Faculty of Medicine, Universitas Prima Indonesia, West Java,
Indonesia
Publisher
John Wiley and Sons Inc
Abstract
Background: In-stent restenosis (ISR) remains a major challenge in
coronary revascularization, especially in lesions with heavy
calcification, where recurrence rates are high. The lack of data on newer
treatment options often creates dilemmas for both physicians and patients.
Intravascular lithotripsy (IVL) is a relatively new technique that has
shown promise in managing calcified ISR. This meta-analysis aims to
evaluate the procedural success and clinical outcomes of IVL in this
setting. Method(s): Following PRISMA 2020 guidelines, a systematic
search was conducted on PubMed, ScienceDirect, and SCOPUS. Studies
reporting procedural success and major adverse cardiovascular events
(MACE) of IVL for calcified ISR during follow-up were included. The
Newcastle-Ottawa Scale was used to assess study quality. Data analysis was
performed using RevMan 5.4.0 and SPSS v25. Result(s): Five studies
with a total of 207 patients and 212 lesions treated were analyzed. Acute
procedural success was 85% (95% CI 0.76-0.91, I2 = 42.0%). At 1-year
follow-up, major adverse cardiac events (MACE) included myocardial
infarction (MI) in 6% of patients (95% CI 0.02-0.16, I2 = 52.5%), target
lesion revascularization in 13% (95% CI 0.08-0.20, I2 = 45.8%), and
cardiac death in 4% (95% CI 0.02-0.08, I2 = 0.0%). The rate of
periprocedural MI was 1.5% (95% CI 0.01-0.05, I2 = 0.0%), while
no reflow phenomenon was 0.5% (95% CI 0.01-0.06, I2 = 0.0%),
with no other procedural complication occured. The overall incidence of
MACE was 16% (95% CI 0.07-0.33, I2 = 69.8%). Conclusion(s): IVL shows
potential as a treatment option for for calcified-ISR, demonstrating high
acute procedural success and acceptable 1-year clinical outcomes. The
1-year TLR (13%) and MACE (16%) rates compare favorably with historical
data for non-IVL strategies. Further large-scale, controlled studies with
longer follow-up are needed to further validate its long-term safety and
effectiveness. Copyright © 2025 Wiley Periodicals LLC.

<73>
[Use Link to view the full text]
Accession Number
649141992
Title
Intraoperative mechanical ventilation during thoracic surgery:
contemporary controversies and evolving strategies.
Source
Current opinion in anaesthesiology. (no pagination), 2025. Date of
Publication: 27 Oct 2025.
Author
Wittenstein J.; Piccioni F.; Vanpeteghem C.M.; Gama de Abreu M.
Institution
(Wittenstein, Gama de Abreu) Department of Anesthesiology and Intensive
Care Medicine, Pulmonary Engineering Group, Faculty of Medicine and
University Hospital Carl Gustav Carus, TUD Dresden University of
Technology, Dresden, Germany
(Piccioni) Department of Anesthesia and Intensive Care, IRCCS Humanitas
Research Hospital, Milan, Italy
(Vanpeteghem) Department of Anesthesiology and Perioperative Medicine,
University Hospital Ghent, Belgium
(Gama de Abreu) Department of Anesthesiology, Integrated Health Care
Institute
(Gama de Abreu) Outcomes Research Consortium, Department of
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
Abstract
PURPOSE OF REVIEW: To investigate and synthesize recent evidence on
intraoperative mechanical ventilation strategies during thoracic surgery,
with a focus on the controversies of fixed versus individualized positive
end-expiratory pressure (PEEP), high versus low PEEP, mechanical and
chemical power, driving pressure, and the integration of therapy bundles.
RECENT FINDINGS: Recent randomized controlled trials and meta-analyses
have claimed that individualized PEEP titration reduces postoperative
pulmonary complications (PPCs) compared with fixed PEEP. High PEEP does
not universally confer benefit and may increase hemodynamic risk, while
low PEEP risks atelectasis. Driving pressure has emerged as a potential
modifiable risk factor for PPCs, with individualized strategies to
minimize driving pressure showing improved outcomes. Mechanical power, is
increasingly recognized as a predictor of PPCs, while chemical power is
emerging as a new concept. Therapy bundles, including perioperative
open-lung approaches and individualized postoperative care, are promising
but require further validation. SUMMARY: The current literature shows a
trend toward individualized perioperative ventilation strategies in
thoracic surgery, particularly individualized PEEP titration. Therapy
bundles and individualized postoperative care, including high-flow nasal
oxygen, are emerging as adjuncts to reduce PPCs. Large-scale, definitive
trials are needed to determine the clinical value of these strategies and
clarify the role of chemical power and therapy bundles. Copyright
© 2025 Wolters Kluwer Health, Inc. All rights reserved.

<74>
Accession Number
649140289
Title
Adrenalectomy improves cardiovascular risk factors in patients with mild
autonomous cortisol secretion: results of a RCT.
Source
Journal of the Endocrine Society. Conference: ENDO 2025. San Francisco, CA
United States. 9(Supplement 1) (pp A228), 2025. Date of Publication: 01
Oct 2025.
Author
Morelli V.; Strata M.; Palmieri S.; Aresta C.; Favero V.; Frigerio S.;
Pugliese F.; Musolino A.; Dall'Antonia A.; Corbetta S.; Arosio M.;
Scillitani A.; Chiodini I.
Institution
(Morelli) Istituto Auxologico Italiano, Milan, Italy
(Strata) IRCCS Ca Granda, Milano, Italy
(Palmieri) IRCCS Ca Granda, Milan, Italy
(Aresta, Musolino, Dall'Antonia, Arosio, Chiodini) University of Milan,
Milano, Italy
(Favero) University of Milan, Milan, Italy
(Frigerio) ASST Lecco, Lecco, Italy
(Pugliese) IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
(Corbetta) University of Milan, Monticello Brianza, Italy
(Scillitani) Casa Sollievo Sofferenza Hospital, San Giovanni Rotondo,
Italy
Publisher
Endocrine Society
Abstract
Context: The best therapeutic approach in patients with mild autonomous
cortisol secretion (MACS) is debated. Objective(s): to evaluate the
effect of adrenalectomyonblood pressure (BP), glycometabolic control,
cardiac structure and coagulation factors in patients with MACS.
 Design(s): prospective randomized controlled trial. Setting(s):
outpatients. Patient(s): patients with adrenal incidentaloma (AI)>1
cmand cortisol after 1mg dexamethasone suppression test (F-1mgDST) between
1.8 (50 nmol/L) and 5 mug/dL (138 nmol/L). Intervention(s):
randomization to adrenalectomy (Arm-A) or conservative approach (Arm-B).
Main Outcomes measure: BP, coagulation factors, echocardiography and
glycemic control, parameters and medical therapy changes assessed at
baseline and 12 months after recovery or observation, inArm-A andArm-B,
respectively. Result(s): 51 subjects (23/28 in Arm-A/Arm-B) were
enrolled. At follow-up the prevalence of BP improvement was higher in
Arm-A (43.5%) than in Arm-B patients (14.3%, p=0.020).Theimprovement
ofBPcontrol was5.4-foldmore frequent in Arm-A patients (CI, 1.16-24.9
p=0.031), regardless of confounding factors. Left ventricular (LV)mass and
Left atrial (LA) area decreased at follow-up in Arm-A (96.4+/-28.8 vs 87.6
+/-25,6 g/m2, p=0.039; 28.4+/-9.9 vs 22.6+/-12.4 cm2, p=0.037,
respectively), whereas they remained stable in Arm-B. At the end of
follow-up, Arm-A patients had a lower prevalence of altered anti-coagulant
parameters (10% vs 50%, respectively, p=0.005). The improvement of >=1 out
of hypertension, LV hypertrophy or LA dilatation and coagulation state was
observed in 82.5% of patients of Arm-A and in 49.1% of Arm-B group
(p=0.015) Conclusion(s): In patients withMACS surgery ameliorates BP,
cardiac structure, and coagulation factors.

<75>
Accession Number
2041633579
Title
Comparison of 40% Glucose Solution and Autologous Blood Patch Pleurodesis
for the Treatment of Postoperative Air Leak after Lung Resections: A
Prospective Randomized Controlled Study.
Source
European Journal of Cardio-thoracic Surgery. 67(11) (no pagination), 2025.
Article Number: ezaf382. Date of Publication: 01 Nov 2025.
Author
Skrzypczak P.J.; Dobiecki T.; Rozmiarek M.; Gabryel P.; Kasprzyk M.;
Piwkowski C.
Institution
(Skrzypczak, Dobiecki, Rozmiarek, Gabryel, Kasprzyk, Piwkowski) Department
of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives Postoperative air leak is among the most common complications
in thoracic surgery. Current management strategies are often suboptimal.
Intrapleural administration of a glucose solution has emerged as a novel
therapeutic approach; however, its clinical value has not been thoroughly
investigated. This study aimed to compare the effectiveness of
intrapleural 40% glucose solution vs autologous blood patch pleurodesis in
managing postoperative air leak. Methods This prospective, randomized,
controlled study enrolled patients who underwent anatomical lung
resections (segmentectomy, lobectomy, or bilobectomy) at the Department of
Thoracic Surgery, Poznan University of Medical Sciences, between November
2023 and December 2024. Patients with postoperative air leak were
randomized to receive either 40% glucose (study group) or autologous blood
(control group). The primary end-point was cessation of postoperative air
leak. Secondary end-points included incidence of residual air space, chest
pain, and reoperation. Results A total of 110 patients were included: 47
in the glucose group and 63 in the blood group. Glucose administration
resulted in a higher rate of postoperative air leak resolution (95.7% vs
82.5%, P =. 033; 95% CI: 2.2% to 24.2%). The glucose group had a shorter
postoperative hospital stay (7 vs 9 days, P =. 036). Chest pain occurred
more frequently in the glucose group, but the difference was not
statistically significant (10.6% vs 4.8%, P =. 24). No major infectious
complications were observed. Residual air space occurrence and reoperation
rates were comparable. Conclusions Intrapleural 40% glucose solution
achieved a higher resolution rate of postoperative air leak compared to
autologous blood patch pleurodesis, with a comparable safety profile.
Clinical Registration Number NCT06936969
(ClinicalTrials.gov). Copyright © 2025 The Author(s). Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<76>
Accession Number
2040980752
Title
Dual antiplatelet therapy after percutaneous coronary intervention
according to bleeding risk (HOST-BR): an open-label, multicentre,
randomised clinical trial.
Source
The Lancet. 406(10516) (pp 2244-2256), 2025. Date of Publication: 08 Nov
2025.
Author
Park K.W.; Han J.-K.; Hwang D.; Yang H.-M.; Park S.; Kang T.S.; Koh J.-S.;
Bang D.W.; Yoon H.-J.; Kim H.-S.; Kang J.; Lim Y.-H.; Lee S.R.; Choi Y.J.;
Ahn H.-S.; Hwang K.-K.; Kim B.G.; Jeong J.-O.; Ahn J.-H.; Rhew J.Y.; Jang
J.Y.; Park H.; Kang T.-S.; Koh J.S.; Park K.-T.; Bang D.-W.; Goh C.-W.;
Yoon H.J.; Jo S.-H.; Ki Y.-J.; Kim Y.H.; Park M.-W.; Yang T.-H.; Hong
S.J.; Park S.-H.; Kwon S.-W.; Han G.-R.; Chae I.-H.; Han S.H.; Lee N.; Cho
J.-M.; Ahn S.-K.; Kim S.-Y.; Lee H.-C.; Lee S.-J.; Seo S.-M.; Oh J.-H.;
Kang S.H.; Heo J.H.; Rha S.-W.; Woo J.S.; Kim S.; Kim S.-H.; Shin E.-S.;
Kim C.-H.; Park W.J.; Lee C.-H.; Her S.-H.; Jeon D.-S.; Lee K.-S.; Lee
S.-U.; Kim U.
Institution
(Kang, Park, Han, Hwang, Yang, Park, Kim, Kim, Kang, Lim, Lee, Choi, Ahn,
Hwang, Kim, Jeong, Ahn, Rhew, Jang, Park, Kang, Koh, Park, Bang, Goh,
Yoon, Jo, Ki, Kim, Park, Yang, Hong, Park, Kwon, Han, Chae, Han, Lee, Cho,
Ahn, Kim, Lee, Lee, Seo, Oh, Kang, Heo, Rha, Woo, Kim, Kim, Shin, Kim,
Park, Lee, Her, Jeon, Lee, Lee, Kim) Seoul National University Hospital,
Seoul, South Korea
(Kang, Park, Han, Hwang, Yang, Park, Kim, Kim, Kang, Lim, Lee, Choi, Ahn,
Hwang, Kim, Jeong, Ahn, Rhew, Jang, Park, Kang, Koh, Park, Bang, Goh,
Yoon, Jo, Ki, Kim, Park, Yang, Hong, Park, Kwon, Han, Chae, Han, Lee, Cho,
Ahn, Kim, Lee, Lee, Seo, Oh, Kang, Heo, Rha, Woo, Kim, Kim, Shin, Kim,
Park, Lee, Her, Jeon, Lee, Lee, Kim) Seoul National University College of
Medicine, Seoul, South Korea
(Ahn, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Uijeongbu St Mary's Hospital, Seoul, South Korea
(Hwang, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew,
Jang, Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang,
Hong, Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh,
Kang, Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee,
Kim) Chungbuk National University Hospital, Cheongju, South Korea
(Kim, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Sanggye Paik Hospital, Seoul, South Korea
(Jeong, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew,
Jang, Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang,
Hong, Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh,
Kang, Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee,
Kim) Chungnam National University Hospital, Daejeon, South Korea
(Ahn, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Gyeongsang National University Changwon Hospital, Changwon, South Korea
(Rhew, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Presbyterian Medical Center, Jeonju, South Korea
(Park, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Gangneung Asan Hospital, Gangneung, South Korea
(Kang, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Dankook University Hospital, Cheonan, South Korea
(Koh, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Gyeongsang National University Hospital, Jinju, South Korea
(Park, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Chung-Ang University Hospital, Seoul, South Korea
(Bang, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Soonchunhyang University Seoul Hospital, Seoul, South Korea
(Goh, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Ewha Womans University Seoul Hospital, Seoul, South Korea
(Yoon, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Keimyung University Dongsan Hospital, Daegu, South Korea
(Jo, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Hallym University Sacred Heart Hospital, Anyang, South Korea
(Jang, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
National Health Insurance Service Ilsan Hospital, Goyang, South Korea
(Choi, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Sejong General Hospital, Bucheon, South Korea
(Lee, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Jeonbuk National University Hospital, Jeonju, South Korea
(Lim, Kim, Kang, Lim, Lee, Choi, Ahn, Hwang, Kim, Jeong, Ahn, Rhew, Jang,
Park, Kang, Koh, Park, Bang, Goh, Yoon, Jo, Ki, Kim, Park, Yang, Hong,
Park, Kwon, Han, Chae, Han, Lee, Cho, Ahn, Kim, Lee, Lee, Seo, Oh, Kang,
Heo, Rha, Woo, Kim, Kim, Shin, Kim, Park, Lee, Her, Jeon, Lee, Lee, Kim)
Hanyang University Seoul Hospital, Seoul, South Korea
Publisher
Elsevier B.V.
Abstract
Background The optimal duration of dual antiplatelet therapy (DAPT) after
coronary stenting according to bleeding risk is not well established. We
aimed to evaluate the optimal duration of DAPT after coronary stenting
according to bleeding risk. Methods In this open-label, multicentre,
randomised clinical trial, patients aged 19 years and older who received
percutaneous coronary intervention with a drug-eluting stent at 50
high-volume cardiology centres in South Korea were stratified into high
bleeding risk (HBR) or non-HBR strata, according to Academic Research
Consortium for High Bleeding Risk criteria. Patients in the HBR stratum
were randomly assigned (1:1) to 1-month or 3-month DAPT, and those in the
non-HBR stratum were randomly assigned (1:1) to 3-month or 12-month DAPT.
The three coprimary endpoints were net adverse clinical events (all-cause
death, myocardial infarction, stent thrombosis, stroke, or major
bleeding), major adverse cardiac or cerebral events (cardiovascular death,
myocardial infarction, definite or probable stent thrombosis, or ischaemic
stroke), and any actionable non-surgical bleeding at 1 year after
randomisation. Primary endpoints were assessed in hierarchical order in
the intention-to-treat population. This study is registered with
cris.nih.go.kr, KCT0005356, and ClinicalTrials.gov , NCT05631769 , and is
complete. Findings From July 24, 2020, to Sept 25, 2023, 4897 patients
were enrolled (1598 in the HBR stratum and 3299 in the non-HBR stratum).
In the HBR stratum, 1-month compared with 3-month DAPT did not reach
non-inferiority for net adverse clinical events (144 [18.4%] of 798 vs 110
[14.0%] of 800 patients; hazard ratio [HR] 1.337 [95% CI 1.043-1.713];
p=0.82 for non-inferiority). Major adverse cardiac or cerebral events
occurred in 74 (9.8%) patients in the 1-month DAPT group and 44 (5.8%) in
the 3-month group; bleeding occurred in 105 (13.8%) patients in the
1-month group and 122 (15.8%) in the 3-month group. In the non-HBR
stratum, 3-month was non-inferior to 12-month DAPT regarding net adverse
clinical events (47 [2.9%] of 1649 vs 72 [4.4%] of 1650 patients; HR 0.657
[0.455-0.949]; p<0.0001 for non-inferiority) and major adverse cardiac or
cerebral events (36 [2.2%] vs 37 [2.3%]; HR 0.984 [0.622-1.558]; p=0.0082
for non-inferiority), and superior for bleeding (120 [7.4%] vs 190
[11.7%]; HR 0.631 [0.502-0.793]; p<0.0001). Interpretation In east Asian
patients with HBR, 1-month DAPT did not reach non-inferiority to 3-month
DAPT for net adverse clinical events. In patients without HBR, 3-month
DAPT was non-inferior to 12-month DAPT regarding net adverse clinical
events and major adverse cardiac or cerebral events, and superior for
bleeding. Funding Medtronic and Abbott. Copyright © 2025 Elsevier
Ltd.

<77>
Accession Number
2041626929
Title
Effect Of Breathing Exercises On Postoperative Recovery After Cardiac
Surgery.
Source
Vascular and Endovascular Review. 8(9 S) (pp 254-261), 2025. Date of
Publication: 2025.
Author
Bhojak N.; Mathew R.; Khan A.; Gupta P.; Rao M.; Tabassum F.; Naqvi S.;
Rajauria G.
Institution
(Bhojak) GCRC, Govt Dungar College (NAAC 'A' Grade), MGS University,
Bikaner, India
(Mathew) Dayanand Sagar University, College of Pharmaceutical Sciences,
Devarakaggalahalli, Harohalli, Kanakapura Road, South District, Bengaluru,
India
(Khan) Department of Pharmaceutics, ERA College of Pharmacy, ERA
University, Sarfarazganj, Uttar Pradesh, Lucknow, India
(Gupta) Career Point School of Pharmacy, Career Point University,
Rajasthan, Kota, India
(Rao) GokulAyurvedic College, Gokul Global University, Near SujanpurPatia,
GJ SH 41, Gujarat, Sidhpur, India
(Tabassum) Department of Nursing, Alghad International Colleges of Applied
Medical Sciences, Al-Ghuwaila Agricultural Plans, Najran, Saudi Arabia
(Naqvi) Physiotherapy MGH Mahatma Gandhi Physiotherapy College MGUMST
Sitapura, Rajasthan, Jaipur, India
(Rajauria) Institute of Pharmacy and Paramedical Sciences, Dr.
BhimraoAmbedkar University, Agra, India
Publisher
SCARLET PUBLISHING SOLUTIONS
Abstract
Cardiac surgery is frequently associated with postoperative pulmonary
complications, prolonged hospitalization, and delayed recovery. Breathing
exercises, including diaphragmatic breathing, incentive spirometry, and
pursed-lip breathing, have been shown to enhance lung expansion, improve
oxygenation, and accelerate rehabilitation in postoperative patients. The
present study aimed to evaluate the effect of structured breathing
exercises on postoperative recovery outcomes among cardiac surgery
patients. A randomized controlled approach was employed, with patients
divided into two groups: those receiving conventional postoperative care
and those receiving an additional breathing exercise program. Recovery was
assessed using parameters such as pulmonary function tests, oxygen
saturation, incidence of pulmonary complications, duration of hospital
stay, and patient-reported quality of life. Findings revealed that
patients in the intervention group demonstrated significantly improved
pulmonary function, reduced incidence of complications, shorter
hospitalization, and better subjective recovery outcomes compared to the
control group. This suggests that incorporation of simple, non-invasive
breathing exercises into postoperative care may contribute substantially
to improved recovery following cardiac surgery. Copyright © 2025
SCARLET PUBLISHING SOLUTIONS. All rights reserved.

<78>
Accession Number
649140246
Title
Randomized Trial of Adrenalectomy Versus Best Medical Practice for Mild
Autonomous Cortisol Secretion.
Source
Journal of the Endocrine Society. Conference: ENDO 2025. San Francisco, CA
United States. 9(Supplement 1) (pp A227), 2025. Date of Publication: 01
Oct 2025.
Author
Ueland G.O.; Ragnarsson O.; Heie A.; Kjellbom A.; Lindgren O.; Muth A.;
Palazzo F.; Poulsen P.L.; Rolighed L.; Thordarson H.; Wernig F.;
Bergenfelz A.
Institution
(Ueland, Thordarson) Department of Medicine, Haukeland University
Hopsital, Bergen, Norway
(Ragnarsson) Department of Endocrinology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Ragnarsson) Department of Internal Medicine and Clinical Nutrition,
Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
(Heie) Departmendt of surgery, Haukeland University Hopstal, Bergen,
Norway
(Kjellbom, Lindgren, Bergenfelz) Lund University, Faculty of Medicine,
Department of Clinical Sciences, Lund, Sweden
(Lindgren) Region Skane, Lund, Sweden
(Muth) Department of Surgery, Institute of Clinical Sciences, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Muth) Region Vastra Gotaland, Sahlgrenska University Hospital, Department
of Surgery, Gothenburg, Sweden
(Palazzo, Wernig) Imperial College School of Medicine, London, United
Kingdom
(Poulsen) Medical Dep M, Hojbjerg, Denmark
(Rolighed) Department of Surgery and Department of Otorhinolaryngology,
Aarhus University Hospital, Aarhus, Denmark
Publisher
Endocrine Society
Abstract
Objective: To evaluate the impact of adrenalectomy on blood pressure
andmetabolic parameters in patients with mild autonomous cortisol
secretion (MACS). Method(s): A multicenter prospective randomized
clinical trial was conducted, comparing adrenalectomy with conservative
management. Blood pressure and metabolic parameters were assessed at
baseline and after two years. Result(s): Forty-three patients with
MACS and a single adrenal adenoma were randomized to either adrenalectomy
(n=21) or conservative management (n=22). At baseline, 33 patients had
hypertension, 13 had type 2 diabetes (T2D), 18 were treated with statins,
and 9 patients had established osteoporosis. At two-year follow-up,
normalization of cortisol levels post 1mg dexamethasone suppression test
(DST) was achieved in 19/21 of adrenalectomy patient compared to 2/22
patients in the conservative group (p<0.01). All patients in the
adrenalectomy group had a significant increase in ACTH and DHEA-S. Office
systolic blood pressure was significantly reduced in the adrenalectomy
group (125 vs 140 mmHg, p=0.03), and a higher proportion of patients in
the adrenalectomy group had an improved blood pressure compared with those
not operated (14/21 vs. 4/22 patients respectively, p=0.03). The relative
risk of improvement of blood pressure in the adrenalectomy group was 7.20
(95% CI 1.53-33.8) compared with the conservative group. Among patients
without T2D, the 120-minute glucose level during an oral glucose tolerance
test was significantly lower in the adrenalectomy group compared with
controls (6.2 vs. 7.3 mmol/L, p=0.04). Conclusion(s): Adrenalectomy
significantly improved blood pressure and glucose metabolismin patients
with MACS, suggesting that surgery may reduce cardiovascular risk in
patients with MACS and metabolic complications.

<79>
Accession Number
2041169077
Title
Role of multimodality imaging in cardiac implantable electronic devices
related infection and infective endocarditis.
Source
Expert Review of Medical Devices. (no pagination), 2025. Date of
Publication: 2025.
Author
Khayata M.; Goff Z.; Gordon S.; Callahan T.; Elgharably H.; Unai S.; Xu B.
Institution
(Khayata) Robert and Suzanne Tomsich Department of Cardiovascular
Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic
Institute, Cleveland Clinic, Cleveland, OH, United States
(Goff, Xu) Section of Cardiovascular Imaging, Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Sydell and Arnold Family Heart,
Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United
States
(Gordon) Department of Infectious Diseases, Cleveland Clinic, Cleveland,
OH, United States
(Callahan) Section of Pacing and Electrophysiology, Robert and Suzanne
Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family
Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH,
United States
(Elgharably, Unai) Department of Thoracic and Cardiovascular Surgery,
Sydell and Arnold Family Heart, Vascular, and Thoracic Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Infective endocarditis (IE) is a serious and increasingly
recognized condition, associated with significant morbidity and mortality.
The diagnosis of IE is more challenging in patients with implanted cardiac
devices such as cardiac implantable electronic devices, left ventricular
assist devices, and left atrial appendage occlusion devices. Areas
covered: This review focuses on the contemporary roles and applications of
multi-modality imaging in the evaluation of patients with cardiac
implantable electronic devices related infection and IE. The role of
multi-modality imaging in the diagnosis of patients with native or
prosthetic valve IE is beyond the scope of this review. A literature
search of the PubMed database was performed between 1 June 2024, and 30
June 2025. Relevant articles on the subjects of 'infective endocarditis,'
'multi-modality imaging,' and 'implanted cardiac devices' were utilized in
our review. Expert opinion: The growing utilization of cardiac implanted
electronic devices (CIED) demands improvement in the detection of
CIED-related infections. Contemporary guidelines have considered utilizing
multimodality imaging to diagnose IE. The incremental value of
multimodality imaging remains to be rigorously examined. Large
observational studies from tertiary centers might serve as the starting
point toward building a strong evidence base. Copyright © 2025
Informa UK Limited, trading as Taylor & Francis Group.

<80>
Accession Number
2041656873
Title
Effects of Dexmedetomidine on Outcomes After Cardiac Surgery (DOCS): a
randomised double-blind, placebo-controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Lei C.; Zheng Z.; Han J.; Zhai W.; Li C.; Hou L.; Yu S.; Liu J.; Xu X.;
Wang S.; Guo X.; Zhang T.; Zhou J.; Zou J.; Tian Y.; Chi X.; Qiu L.; Xu
M.; Zhang X.; Huang W.; Chen Y.; Yan M.; Wang H.; Xia J.; Wang L.; Liu H.;
Dong H.
Institution
(Lei, Zheng, Wang, Hou, Dong) Department of Anesthesiology and
Perioperative Medicine, Xijing Hospital, the Fourth Military Medical
University, Shaanxi, Xi'an, China
(Lei, Zheng, Wang) Key Laboratory of Anesthesiology, Ministry of Education
of China, Xi'an, China
(Lei, Zheng, Dong) Anesthesia Clinical Research Center, (ACRC) Xijing
Hospital, Fourth Military Medical University, Xi'an, China
(Han, Zhai, Xia, Wang) Department of Anesthesiology, Tianjin Chest
Hospital, Tianjin, China
(Li) Department of Medical Statistics, School of Preventive Medicine,
Fourth Military Medical University, Shaanxi, Xi'an, China
(Yu, Liu, Xu) Department of Cardiovascular Surgery, Xijing Hospital, the
Fourth Military Medical University, Shaanxi, Xi'an, China
(Wang, Guo) Department of Anesthesiology, Guangdong People's Hospital,
Guangdong, Guangzhou, China
(Zhang, Zhou, Zou) Department of Anesthesiology, General Hospital of
Shenyang Military Region, Liaoning, Shenyang, China
(Tian, Chi) Department of Anesthesiology, Wuhan Tongji Hospital, Tongji
Medical College Huazhong University of Science and Technology, Hubei,
Wuhan, China
(Qiu) Department of Anesthesiology, Henan People's Hospital, Henan,
Zhengzhou, China
(Xu, Zhang) Department of Anesthesiology, Shanghai Chest Hospital,
Shanghai, China
(Huang, Chen) Department of Anesthesiology, First Affiliated Hospital, Sun
Yat-sen University, Guangdong, Guangzhou, China
(Yan, Wang) Department of Anesthesiology, the Second Affiliated Hospital
of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
(Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health System, Sacramento, CA, United States
Publisher
Elsevier Ltd
Abstract
Background: Organ dysfunction after cardiac surgery may be reduced by
dexmedetomidine. We evaluated whether perioperative dexmedetomidine
reduces complications after cardiac surgery with cardiopulmonary bypass.
 Method(s): In this randomised, double-blind, placebo-controlled trial
conducted in nine Chinese hospitals, adults scheduled for cardiac surgery
with cardiopulmonary bypass were randomly assigned to receive i.v.
dexmedetomidine (0.4 mug kg-1 h-1) or saline
(placebo) for 12 h after the induction of anaesthesia. The co-primary
outcomes were in-hospital mortality and major complications after surgery
(including stroke, myocardial infarction, heart block, cardiac arrest),
analysed by intention-to-treat. Secondary outcomes included individual
complications. Result(s): A total of 1073 participants (46% female;
mean age: 54 yr [range: 47-63 yr]) completed the study after
randomisation. Major complications occurred in 161/536 (30%) participants
who received dexmedetomidine, compared with 169/537 (32%) who received
saline (relative risk: 0.93 [95% confidence interval: 0.72-1.21]; P=0.66).
In addition, 10/536 (1.9%) participants who received dexmedetomidine died
in hospital, compared with 15/537 (2.8%) participants who received saline
(odds ratio: 0.66 [95% confidence interval: 0.29-1.49]; P=0.32). Major
complications, other than heart block, did not differ between participants
who received dexmedetomidine, compared with participants who received
saline. Safety outcomes and process measures did not differ between
participants allocated to dexmedetomidine or saline. Conclusion(s):
Perioperative use of dexmedetomidine did not reduce death, complications,
or both in adults undergoing cardiopulmonary bypass-assisted cardiac
surgery. Clinical trial registration: ClinicalTrials.gov
(NCT02237495). Copyright © 2025 British Journal of Anaesthesia

<81>
Accession Number
2041636771
Title
Design and rationale of the artificial intelligent dialogue System
assisted comprehensive Management of secondary prevention Among post
coronary aRtery bypass graft patienTs (SMART): protocol for a randomised
controlled trial for postcoronary artery bypass grafting management.
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e106447. Date of
Publication: 11 Nov 2025.
Author
Lei L.; Li J.; Zhang L.; Yuan X.; Diao X.; Qi L.; Wang Y.; Du W.; Zhao W.;
Hu S.
Institution
(Lei, Li, Zhang, Hu) National Clinical Research Center for Cardiovascular
Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
(Yuan, Hu) Department of Surgery, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Diao, Qi, Wang, Zhao) Information Center, Fuwai Hospital, Chinese Academy
of Medical Sciences, Peking Union Medical College, Beijing, China
(Du) Mianyang Central Hospital, School of Medicine, University of
Electronic Science and Technology of China, Mianyang, China
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiovascular risk factor management (ie, hypertension,
dyslipidaemia and diabetes) in post-coronary artery bypass grafting (CABG)
patients is suboptimal, with a high prevalence and low control rate due to
various barriers, including a lack of self-management awareness and
inadequate healthcare resources. Artificial intelligence (AI)
interventions are promising for improving lifestyle management and
secondary prevention; however, their effectiveness in post-CABG patients
remains unclear. We aimed to describe the protocol of the artificial
intelligence dialogue system-assisted comprehensive management of
secondary prevention among post-coronary artery bypass graft patients
(SMART) assessing the efficacy and safety of an AI-based dialogue system,
namely 'Smart Family Doctor', on blood pressure, lipids and glucose
control. Methods and analysis The SMART study is an open-label,
parallel-group, randomised controlled trial. 536 post-CABG patients with
uncontrolled hypertension, diabetes or dyslipidaemia are 1:1 randomly
assigned to either the health manager or the intervention group with the
implementation of the 'Smart Family Doctor' and followed up for 6 months
postoperatively. The 'Smart Family Doctor' runs on the WeChat service
platform, which includes an AI-based dialogue system of individual
intelligent questions and answers, physiological indicators monitoring,
medication reminders and automated message sending. Data on physical
examinations, biological samples and self-management behaviour will be
collected at baseline, 3 and 6 months after randomisation. The primary
outcome was the change from baseline to 6-month follow-up in
cardiovascular risk factors (hypertension, dyslipidaemia and diabetes)
control rates. For the primary analysis, we will use generalised
mixed-effects models to compare the control rate at the 6-month follow-up
between the intervention and control groups, accounting for study sites as
random effects. Ethics and dissemination The study was registered at
http://www.clinicaltrials.gov (NCT06615609). The central ethics committee
of Fuwai Hospital approved the SMART trial (2024-2410). All collaborating
sites obtained local approval or accepted central ethics approval. The
findings of this study will be disseminated through peer-reviewed
publications, presentations at national and international conferences, and
potentially public engagement initiatives. Copyright © Author(s)
(or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<82>
Accession Number
2041604291
Title
Meta-Analysis of Low-Intensity versus Standard Anticoagulation for
Mechanical Aortic Valves.
Source
International Journal of Angiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Naito N.; Takagi H.
Institution
(Naito, Takagi) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Publisher
Thieme Medical Publishers, Inc.
Abstract
Background This meta-analysis aimed to evaluate the long-term outcomes of
a low-intensity anticoagulation (LA) strategy in patients undergoing
mechanical aortic valve replacement. Materials and Methods A systematic
search of the databases was conducted through October 2024. Single-arm
meta-analysis was performed to estimate the pooled late outcomes
associated with LA. The Kaplan-Meier survival curve was reconstructed
using individual patient data from included studies to assess overall
survival. A standard meta-analysis was then conducted to compare outcomes
between LA and standard anticoagulation (SA). Results Eight studies,
comprising 2,426 patients and 21,062.7 patient-years, were included. Five
studies involved comparable groups, while three were single-arm studies.
The pooled valve-related mortality rate with LA was 0.05 per 100
patient-year, with incidences of prosthetic valve thrombosis, composite of
bleeding and thromboembolism, bleeding, and thromboembolism being 0.03,
1.5, 0.93, and 0.46 per 100 patient-year, respectively. The Kaplan-Meier
analysis showed overall survival rates at 10 years of 88.5%. Compared with
SA, LA was associated with significantly lower risks of all-cause
mortality (hazard ratio [HR]: 0.50; 95% confidence interval [CI]:
0.37-0.68; p < 0.01), composite outcome (HR: 0.49; 95% CI: 0.37-0.66; p <
0.01), and bleeding (HR: 0.37; 95% CI: 0.26-0.52; p < 0.01). There were no
significant differences in valve thrombosis (HR: 0.52; 95% CI: 0.13-2.11;
p = 0.36) or thromboembolic event rates (HR: 0.88; 95% CI: 0.50-1.54; p =
0.65). Conclusion This meta-analysis suggests that LA is associated with
reduced risks of all-cause mortality and bleeding compared with SA, while
thromboembolic risks remain comparable. Copyright © 2025 Thieme
Medical Publishers, Inc.. All rights reserved.

<83>
Accession Number
649140992
Title
SGLT2 Inhibitors Being Held In An Inpatient Setting Leading To Higher
Rates of DKA.
Source
Journal of the Endocrine Society. Conference: ENDO 2025. San Francisco, CA
United States. 9(Supplement 1) (pp A656-A657), 2025. Date of Publication:
01 Oct 2025.
Author
McCaskey A.
Institution
(McCaskey) UCF/HC, Ocala, FL, United States
Publisher
Endocrine Society
Abstract
SGLT2 inhibitors are becoming more widely prescribed both for their use in
diabetes as well as heart failure1 . SGLT2 inhibitors have known side
effects including higher rates of UTI and euglycemic diabetic
ketoacidosis. It is unclear whether SGLT2 inhibitors should be held upon
admission to the hospital, especially in setting of acute infection or
patients about to undergo surgery. This study was created to evaluate the
incidence of patients developing euglycemic DKA while continued on their
home SGLT2 inhibitors. 61,547 patients were analyzed in a meta-analysis
excluding patients who presented with DKA or active heart failure
exacerbation from January 2020 to March 2025. No statistical increase in
euglycemic DKA was noted in patients with acute infection: UTI (p=0.205),
pneumonia (p=0.313), sepsis (p=0.197), severe sepsis (p=0.197); between
those who continued SGLT2 inhibitors while hospitalized versus those in
which it was held during hospitalization. In these same groups, there was
noted statistical significance in patients more likely to develop
euglycemic DKA if their SGLT2 inhibitor were held with a p-value <= 0.0001
in all infection groups: UTI, pneumonia, sepsis, and severe sepsis. On the
contrary, patients continuing SGLT2 inhibitors while undergoing surgery
were more likely to develop euglycemic DKA while hospitalized (p<=0.05).
It is more recommended to hold SGLT2 inhibitors in patients undergoing
surgery. The specific surgeries studied were CABG, PCI, and hip
replacement. It was also shown that patients continuing SGLT2 inhibitors
while hospitalized had higher average length of stay of 6.40 days compared
to 5.97 days in the withheld group even though the withheld group had less
chance of developing DKA. However, patients that had their SGLT2 inhibitor
continued had less length of stay in ICU level of care of 3.96 days
compared to 4.49 days in the withheld group. Patients where SGLT2
inhibitor was continued also had significantly lower mortality of 104
compared to 1701 in the withheld group. Overall, patients had overall less
risk of euglycemic diabetic ketoacidosis, ICU length of stay, and
mortality if SGLT2 inhibitor was continued during hospitalization unless
they were to undergo surgery while hospitalized. .

<84>
Accession Number
2041657751
Title
The Efficacy of a Multidisciplinary Perianesthetic Management Bundle for
Alleviating Delirium After Thoracic Surgery: A Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Xu M.; Wu Y.; Wang R.; Luo C.; Chen J.; Yang J.
Institution
(Xu, Wu, Wang, Luo, Chen, Yang) Department of Anesthesiology, West China
Hospital, Sichuan University, Sichuan, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative delirium significantly worsens surgery
prognosis. Here, the authors assessed the ability of comprehensive
perianesthetic management to reduce the risk of delirium after thoracic
surgery. Design(s): This was a prospective, randomized, single-blind
study. Setting(s): The study was conducted at a tertiary care
institution and university-level teaching hospital. Participant(s): A
total of 508 patients scheduled to undergo elective thoracic surgeries
with an expected anesthesia duration of at least 2 hours were enrolled.
 Intervention(s): All eligible participants received routine pre- and
postoperative nonpharmacologic interventions, and the intervention group
also received comprehensive perianesthetic management, including
perioperative pain control, rational medication, refined intraoperative
management, and cognitive training. Delirium was assessed using the
Confusion Assessment Method. Measurements and Main Results: Of the
508 randomized patients, 497 were included in the final analysis.
Postoperative delirium occurred in 9 of 247 patients (3.6%) in the
intervention group and in 23 of 250 patients (9.2%) in the control group.
Bundle perianesthetic management was associated with a significantly lower
risk of delirium, both in per-protocol analysis (relative risk 0.40, 95%
confidence interval 0.19-0.84, p = 0.012) and intention-to-treat analysis
(relative risk 0.39, 95% confidence interval 0.19-0.84, p = 0.011). No
significant differences were observed between the groups in terms of
delirium duration, postoperative pain, ability to perform activities of
daily living, hospitalization duration, or hospital-related costs.
 Conclusion(s): The findings support integrating this bundle into
perioperative pathways to reduce the risk of delirium after thoracic
surgery. Further studies are warranted to evaluate its feasibility,
generalizability, and safety in broader clinical settings. Copyright
© 2025 Elsevier Inc.

<85>
Accession Number
649104310
Title
Operative outcomes following robotic-assisted and conventional minimally
invasive mitral valve surgery: A meta-analysis of propensity-matched
studies.
Source
Asian cardiovascular & thoracic annals. (pp 2184923251394563), 2025. Date
of Publication: 10 Nov 2025.
Author
Santos K.; Consoli L.; de Oliveira L.G.A.M.; Donaldy W.; Plonek T.
Institution
(Santos, Plonek) Department of Cardiothoracic Surgery, Medisch Spectrum
Twente, Enschede, Netherlands
(Santos) School of Medicine, New Vision University, Tbilisi, Georgia
(Consoli, de Oliveira) Federal University of Bahia, Salvador, Brazil
(Donaldy) New York City Health and Hospitals, New York City, NY, United
States
Abstract
BackgroundRobotic-assisted mitral valve surgery (RAMVS) has emerged as an
alternative to conventional minimally invasive mitral valve surgery
(MIMVS). However, previous studies have been limited by small sample
sizes, heterogeneous techniques and reliance on unmatched or indirectly
compared cohorts, resulting in inconclusive evidence. This meta-analysis
focuses exclusively on propensity-matched studies to provide a more robust
comparison of RAMVS and MIMVS.MethodsA comprehensive literature search was
performed to identify propensity-matched studies comparing RAMVS and
MIMVS. Pooled odds ratios (ORs) and mean differences (MDs) with 95%
confidence intervals (CIs) were calculated using RevMan 8.13.0. Subgroup
analyses, including mitral valve repair only, non-isolated mitral valve
surgery and MIMVS via right minithoracotomy, were conducted to explore
heterogeneity.ResultsEight studies comprising 3352 patients were included,
with 1578 (47.1%) undergoing RAMVS. The RAMVS was associated with a
shorter hospital stay (MD -1.8 days; 95% CI -3.0 to -0.5; p = 0.006) but
significantly longer cardiopulmonary bypass time (MD 21.8 min; 95% CI
0.8-42.9; p = 0.04), and higher odds of conversion to sternotomy (OR 2.9;
95% CI 1.6-5.4; p = 0.0007) and re-exploration for bleeding (OR 1.86; 95%
CI 1.1-3.2; p = 0.02). Intensive care unit stay, operative time and
postoperative complications were comparable. All subgroup analyses
consistently showed higher conversion rates with RAMVS.ConclusionThe RAMVS
offers potential recovery benefits but at the cost of greater
intraoperative complexity. Careful patient selection and technical
expertise are essential to maximise outcomes.

<86>
Accession Number
649114849
Title
Design and rationale of the artificial intelligent dialogue System
assisted comprehensive Management of secondary prevention Among post
coronary aRtery bypass graft patienTs (SMART): protocol for a randomised
controlled trial for postcoronary artery bypass grafting management.
Source
BMJ open. 15(11) (pp e106447), 2025. Date of Publication: 11 Nov 2025.
Author
Lei L.; Li J.; Zhang L.; Yuan X.; Diao X.; Qi L.; Wang Y.; Du W.; Zhao W.;
Hu S.
Institution
(Lei, Li, Zhang, Hu) National Clinical Research Center for Cardiovascular
Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Yuan, Hu) Department of Surgery, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Diao, Qi, Wang, Zhao) Information Center, Fuwai Hospital, Chinese Academy
of Medical Sciences and Peking Union Medical College, Beijing, China
(Du) Mianyang Central Hospital, School of Medicine, University of
Electronic Science and Technology of China, Mianyang, China
Abstract
INTRODUCTION: Cardiovascular risk factor management (ie, hypertension,
dyslipidaemia and diabetes) in post-coronary artery bypass grafting (CABG)
patients is suboptimal, with a high prevalence and low control rate due to
various barriers, including a lack of self-management awareness and
inadequate healthcare resources. Artificial intelligence (AI)
interventions are promising for improving lifestyle management and
secondary prevention; however, their effectiveness in post-CABG patients
remains unclear. We aimed to describe the protocol of the artificial
intelligence dialogue system-assisted comprehensive management of
secondary prevention among post-coronary artery bypass graft patients
(SMART) assessing the efficacy and safety of an AI-based dialogue system,
namely 'Smart Family Doctor', on blood pressure, lipids and glucose
control. METHODS AND ANALYSIS: The SMART study is an open-label,
parallel-group, randomised controlled trial. 536 post-CABG patients with
uncontrolled hypertension, diabetes or dyslipidaemia are 1:1 randomly
assigned to either the health manager or the intervention group with the
implementation of the 'Smart Family Doctor' and followed up for 6 months
postoperatively. The 'Smart Family Doctor' runs on the WeChat service
platform, which includes an AI-based dialogue system of individual
intelligent questions and answers, physiological indicators monitoring,
medication reminders and automated message sending. Data on physical
examinations, biological samples and self-management behaviour will be
collected at baseline, 3 and 6 months after randomisation. The primary
outcome was the change from baseline to 6-month follow-up in
cardiovascular risk factors (hypertension, dyslipidaemia and diabetes)
control rates. For the primary analysis, we will use generalised
mixed-effects models to compare the control rate at the 6-month follow-up
between the intervention and control groups, accounting for study sites as
random effects. ETHICS AND DISSEMINATION: The study was registered at
http://www. CLINICALTRIALS: gov (NCT06615609). The central ethics
committee of Fuwai Hospital approved the SMART trial (2024-2410). All
collaborating sites obtained local approval or accepted central ethics
approval. The findings of this study will be disseminated through
peer-reviewed publications, presentations at national and international
conferences, and potentially public engagement initiatives. TRIAL
REGISTRATION NUMBER: NCT06615609. Copyright © Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<87>
Accession Number
649113651
Title
Assessment of Noise Levels in the Intensive Care Unit in Tertiary Care
Hospital.
Source
Indian Journal of Critical Care Medicine. Conference: CRITICARE 2025.
Cochin India. 29(Supplement 1) (pp S129), 2025. Date of Publication: 01
May 2025.
Author
Manek R.C.; Solao V.
Institution
(Manek, Solao) Fortis Hospital, Mumbai, Mulund, India
Publisher
Jaypee Brothers Medical Publishers (P) Ltd
Abstract
Introduction: High noise levels in the intensive care unit (ICU) are a
well-known problem. It is clear that some noise in the ICU is
inevitable,but exceeding the normal range brings various physiologic and
psychological changes, which directly affect health. WHO
recommendedthreshold for hospital noise levels is (LAeq) = 35 dBA during
the day for in-patient care areas and LAeq = 30 dBA for night- time
backgroundnoise.1,2 To identify source of Noise and reducing it will help
to improve Quality care in ICU.3,4,7 Objectives: This study was aimed to
dosubjective and objective assessment of Noise, Mapping source of Noise
and adverse effects of Noise on the Patient. This study will alsohelp to
improve Quality of care in ICU. Material(s) and Method(s):This is a
Observational prospective randomised controlled study performedin Fortis
Hospital, Mulund, Mumbai, India (Tertiary care hospital) which includes 72
bed ICU including Medical, Surgical and Cardiac ICUas separate ICU. In
this study OBJECTIVE ASSESSMENT was done using Noise level in dbs with a
NOISH sound level meter Application iniOS and SUBJECTIVE ASSESSMENT was
done using different questionnaires to Patient and experience was recorded
in Case record form. Result(s): 51.1% patient experienced unbearable
noise in ICUs, 53.33% of patient recommended to adopt a measure to reduce
Noise and51.67% of patient's sleep got affected by Noise.5 Regarding
source of Noise most of the patients voted for Alarms and Monitors as
mainsource of Noise. 34.44% patient experienced Noise source was Staff
generated and modifiable with Behavioural adoption.
 Conclusion(s):Over all in Objective assessment mean Noise in ICU was
64.53 dbs which was higher than recommendations.1,2 In future, on the
basis ofthe results of this study, protocols will be formed and steps will
be taken to reduce the modifiable noise to bring down noise levels
furtherto ensure faster recovery and greater patient comfort.

<88>
Accession Number
2041593385
Title
Optimising adherence to inpatient rehabilitation trial protocols: A
mixed-methods systematic review.
Source
Clinical Trials. (no pagination), 2025. Date of Publication: 2025.
Author
Logan A.; Marsden J.; Freeman J.; Cork E.; Kent B.
Institution
(Logan, Cork) Royal Devon University Healthcare NHS Foundation Trust,
Devon, United Kingdom
(Logan, Marsden, Freeman, Cork, Kent) Faculty of Health, University of
Plymouth, Devon, United Kingdom
(Kent) University of Plymouth Centre of Implementation Science: A JBI
Centre of Excellence, Devon, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background: The results of rehabilitation clinical trials can be
negatively affected by adherence to trial protocols. Adherence is
multi-factorial, but studies often look at adherence factors separately.
Therefore, a systematic review to appraise and synthesise the evidence is
warranted to determine the barriers, facilitators and predictors
associated with adherence to inpatient rehabilitation trial protocols,
whether and how factors interact with one another, and how adherence to
rehabilitation protocols can be optimised. Method(s): A mixed-methods
systematic review was conducted and reported in accordance with Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Databases searched were PubMed (Ovid), EMBASE (Ovid), MEDLINE (Ovid),
CINAHL (Ovid), PsycINFO (Ovid), Cochrane Library, Health Technology
Assessment Database, Web of Science and grey literature up to April 2024.
A cohesive, integrated methodology was employed, leveraging the
Consolidated Framework for Implementation Research (CFIR) 2.0, to
transform, synthesise and integrate data from various methodologies to
address the review objectives. Result(s): Twenty-seven studies met
the inclusion criteria (randomised controlled trials, qualitative studies
related to randomised controlled trials or mixed-methods). Most of the
studies were in stroke (n = 17), but other studies included neurological,
respiratory, cardiovascular, post-surgical, osteoarthritis and elderly
medical. Multiple factors affecting adherence protocols were identified.
Adherence was measured in various ways, and setting pre-specified
adherence levels was uncommon. Conclusion(s): Adherence to inpatient
rehabilitation trial protocols is multi-dimensional and multi-factorial.
Consensus of adherence measurement and interpretation of adherence levels
is needed to make meaningful comparisons between trials. A standardised
approach, including adopting a traffic light system, would enable
trialists to implement changes mid-trial or stop the trial to avoid
research waste. Adopting approaches from behavioural science in the design
and conduct of inpatient rehabilitation trials may overcome some of the
behavioural barriers identified and optimise adherence for those
delivering and receiving the intervention. Review registration:
Prospective Register of Systematic Reviews, registration number
CRD42021270121. Copyright © The Author(s) 2025

<89>
Accession Number
2041591201
Title
Surgical Insights into the Functional Anatomy of the Neo-aortic Root.
Source
World Journal for Pediatric and Congenital Heart Surgery. (no
pagination), 2025. Date of Publication: 2025.
Author
Dakik L.; Najm H.K.; Belitsis G.; Goswami D.; Anderson R.H.; Spicer D.E.;
Tretter J.T.
Institution
(Dakik, Najm, Belitsis, Tretter) Division of Pediatric Cardiac Surgery,
Department of Pediatric Cardiology, Cleveland Clinic Children's, The
Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH,
United States
(Goswami) Department of Cardiovascular Medicine, The Heart, Vascular, and
Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Anderson) Newcastle University, Newcastle upon Tyne, United Kingdom
(Spicer) Heart Institute, Johns Hopkins All Children's Hospital, St.
Petersburg, FL, United States
Publisher
SAGE Publications Inc.
Abstract
Although the normal aortic and pulmonary roots have some features in
common, they also exhibit important anatomical and functional differences.
These differences increase when compared with surgically created
neo-aortic roots in individuals with congenitally malformed hearts, with
the substrates initially having been either a pulmonary root originating
from the right or left ventricle, or a truncal root with variable
ventricular origin. With the increasing application and success of these
surgeries, our attention has now turned toward understanding late
outcomes. Subsequent dilation, usually producing neo-aortic valvar
regurgitation, is the most common cause of reoperation in any procedure
involving a neo-aortic root. In this review, we describe and compare the
detailed anatomy of the normal aortic, pulmonary, and common truncal
roots, comparing them with the changes observed in the neo-aortic root
following various common surgeries providing biventricular repair for
congenital cardiac malformations. We focus on the dilated and
dysfunctional neo-aortic root, assessing how the anatomical information
relates to contemporary surgical techniques. Furthermore, we aim to review
risk factors as they relate to the adverse anatomical features which
become evident when the new root is dysfunctional, hoping to provide
surgical insight toward optimizing its function and
durability. Copyright © The Author(s) 2025

<90>
Accession Number
2041566787
Title
Expert Perspectives on a Randomized Controlled Trial Comparing Novel Donor
Storage Platforms to Cold-static Preservation for Heart Transplantation.
Source
CJC Open. (no pagination), 2025. Date of Publication: 2025.
Author
Alsaeid R.; Dhingra N.K.; Stevenson J.; Heo R.; Alvarez J.; Fan C.P.S.;
Foroutan F.; Aleksova N.; Ross H.J.; McDonald M.; Billia F.; Noly P.-E.;
Tremblay-Gravel M.; Nagpal D.; Truby L.; Chih S.; Rao V.; Moayedi Y.
Institution
(Alsaeid, Stevenson, Heo, Aleksova, Ross, McDonald, Billia, Moayedi)
Division of Cardiology, Peter Munk Cardiac Centre, University Health
Network, Toronto, ON, Canada
(Dhingra, Alvarez, Rao) Division of Cardiac Surgery, Peter Munk Cardiac
Centre, University Health Network, Toronto, ON, Canada
(Fan, Truby) Section of Heart Failure and Transplant, University
Southwestern Texas Medical Center, Dallas, TX, United States
(Foroutan, Chih) Ottawa Heart Institute, University of Ottawa, Ottawa, ON,
Canada
(Noly, Tremblay-Gravel) Montreal Heart Institute, Montreal, Quebec, Canada
(Nagpal) Division of Cardiovascular Surgery, London Health Sciences
Centre, London, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: There is a clinical need for randomized evidence to establish
the comparative efficacy of organ preservation techniques for heart
transplantation in Canada. In this study we used a survey to evaluate the
feasibility and value of a randomized trial comparing cold-static
preservation with novel donor storage platforms. Method(s): A
validated survey was distributed to 30 members of the Canadian Cardiac
Transplant Network, including adult heart failure cardiologists, pediatric
cardiologists, and cardiovascular surgeons. Survey sections addressed
demographics, clinical scenarios, perceived benefits, barriers, and
willingness to participate in a randomized trial. Result(s):
Twenty-six experts (87%) responded: 65% were adult heart failure
cardiologists, 27% were women, and 54% practiced in Ontario. Respondents
were evenly distributed across career stages. All expressed interest in
participating in a trial, and 88% were comfortable with study blinding.
Willingness to randomize declined with anticipated ischemic times: > 80%
for < 6 hours, 42% for 6-8 hours, and 31% for > 8 hours. Key benefits
identified included improved donor utilization (69%), better outcomes
(58%), and enhanced scientific understanding (58%). The major barrier was
device cost (73%). Conclusion(s): Canadian experts reported interest
and perceived equipoise for a randomized trial of organ preservation
strategies, although cost remains a key barrier. Such a trial could
standardize protocols and strengthen the evidence base guiding heart
transplantation practice. Copyright © 2025

<91>
Accession Number
2041602567
Title
The Effect of Parasternal Block on Postoperative Pain in Patients
Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Controlled
Trial.
Source
Journal of Cellular and Molecular Anesthesia. 10(4) (no pagination), 2025.
Article Number: e166289. Date of Publication: 01 Dec 2025.
Author
Celik E.C.; Nil Kaan M.; Durmaz S.
Institution
(Celik) Department of Anesthesiology and Reanimation, Aydin Maternity and
Child Health Hospital, Aydin, Turkey
(Nil Kaan) Department of Anesthesiology and Reanimation, Faculty of
Medicine, Adnan Menderes University, Aydin, Turkey
(Durmaz) Department of Cardiovascular Surgery, Faculty of Medicine, Adnan
Menderes University, Aydin, Turkey
Publisher
Brieflands
Abstract
Background and Objectives: This study aims to investigate the effects of
intraoperative parasternal block (PSB) on postoperative analgesia in
patients undergoing elective coronary artery bypass graft (CABG) surgery.
 Method(s): This prospective, randomized, double-blind study included
78 patients aged 30 - 80 years with an American Society of
Anesthesiologists (ASA) physical status III-IV, who were scheduled for
elective CABG surgery. Patients were randomly assigned into two groups:
The PSB group (n = 39), receiving a PSB with 0.25% bupivacaine, and the
saline group (n = 39), receiving a PSB with 0.9% NaCl. All patients were
administered a standard anesthesia protocol, and routine care and
analgesia practices during the postoperative period were not interfered
with. Patients in the intensive care unit (ICU) received intravenous
paracetamol every eight hours for analgesia. If postoperative 24-hour pain
scores in the ICU, assessed using the Behavioral Pain Scale (BPS) while
intubated and the Numeric Rating Scale (NRS) while extubated, exceeded
four, 1 mg/kg tramadol was administered. The timing and doses of the first
tramadol administration, as well as extubation times, ICU stay durations,
and discharge times, were recorded. Result(s): In the postoperative
period, BPS scores at the 8th hour and NRS scores at the 4th and 12th
hours were significantly lower in the PSB group than in the saline group
(P < 0.005). The average extubation time was 8.76 hours in the PSB group
and 14.76 hours in the saline group (P < 0.001). Among patients with pain
scores of four or higher, the total tramadol consumption in the PSB group
was 150 +/- 64.72 mg, with the first tramadol administration occurring at
17.26 +/- 4.78 hours. In the saline group, total tramadol consumption was
212.5 +/- 82.23 mg, and the first administration occurred at 12.35 +/-
5.75 hours. Conclusion(s): Our study demonstrated that PSB, as a
component of multimodal analgesia, improved postoperative analgesia levels
in CABG surgery. Therefore, we consider the PSB to be effective in pain
management following median sternotomy. Copyright © 2025,
Caglayan CELIK et al.

<92>
Accession Number
2041584664
Title
Center-mediated Differences in Postoperative Acute Kidney Injury Rates: A
Post Hoc Analysis of the PROTECTION Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Ranucci M.; Monaco F.; Bradic N.; Venditto M.; Neri G.; Barucco G.; Ti
L.K.; Porta S.; Baryshnikova E.; Pontillo D.; Silvetti S.; Federici F.;
Crescenzi G.; Cortegiani A.; Guarracino F.; Bove T.; Paternoster G.;
Anguissola M.
Institution
(Ranucci, Baryshnikova, Anguissola) Department of Cardiovascular
Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, San
Donato Milanese, Italy
(Monaco) Division of Cardiacthoracic and Vascular Anesthesia, IRCCS
Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital,
University of Bologna, Bologna, Italy
(Monaco) Department of Medical and Surgical Sciences, DIMEC, University of
Bologna, Bologna, Italy
(Bradic, Barucco, Pontillo) Clinic of Anesthesiology, Resuscitation and
Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia
(Bradic) University North, Department of Nursing, Varazdin, Croatia
(Venditto) Cardiac Anesthesia and ICU, AORN "Dei Colli," Monaldi Hospital,
Naples, Italy
(Neri) Anesthesia and Intensive care, Department of Medical and Surgical
Sciences, Magna Graecia University, Catanzaro, Italy
(Ti) Department of Anaesthesia, National University Hospital, Singapore
(Porta) S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine
Maurizio Umberto I di Torino, Turin, Italy
(Silvetti) Department of Cardiac Anesthesia and Intensive Care, Ospedale
Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova,
Italy
(Federici) UOC Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria
Sant'Andrea, Rome, Italy
(Crescenzi) IRCCS Humanitas Research Hospital, Anestesia e Terapia
Intensiva Cardiochirurgica (TIC), Milan, Rozzano, Italy
(Cortegiani) Department of Precision Medicine in Medical, Surgical and
Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy
(Cortegiani) Department of Anesthesia Analgesia Intensive Care and
Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo,
Italy
(Guarracino) Azienda Ospedaliero Universitaria Pisana, Department of
Cardiothoracic Anaesthesia and Intensive Care, Pisa, Italy
(Bove) Department of Medicine, University of Udine, Udine, Italy
(Bove) Azienda Sanitaria Universitaria Friuli Centrale, Department of
Emergency "Santa Maria Della Misericordia", University Hospital of Udine,
Italy
(Paternoster) Department of Health Science School of Medicine, University
of Basilicata, Italy
(Paternoster) Anesthesia and ICU San Carlo Hospital, Potenza, Italy
Publisher
W.B. Saunders
Abstract
Objectives: The recently published PROTECTION trial (Intravenous Amino
Acid Therapy for Kidney Protection in Cardiac Surgery) demonstrated that,
in adult cardiac surgery patients, preoperative amino acid (AA)
administration has a protective effect on renal function. However, large
differences were observed within the participating centers. We aimed to
investigate whether such center effects would remove the impact of AA on
the prevention of cardiac surgery-associated acute kidney injury
(CSA-AKI). Design(s): A post hoc analysis of data from the PROTECTION
trial was performed. Setting(s): Multi-institutional data from
centers that participated in the PROTECTION trial. Participant(s):
Adult patients undergoing cardiac surgery enrolled in the PROTECTION
trial. Intervention(s): Two centers showed a significantly lower rate
of CSA-AKI with respect to the pooled rate in all centers (low-rate
centers) and 3 centers had a significantly higher rate (high-rate centers
[HR-C]). These centers were compared for preoperative and intraoperative
variables. Result(s): Patients in the HR-C were significantly (p =
0.001) older, with lower left ventricular ejection fraction and hemoglobin
values, a higher rate of class III and IV New York Heart Association
functional class, arterial hypertension, previous myocardial infarction,
diabetes, peripheral vascular disease, and more frequently received
myocardial revascularization. During surgery, patients in the HR-C group
had a longer aortic cross-clamp time, higher temperature on
cardiopulmonary bypass, and received diuretics and hemofiltration at a
lower rate. Additionally, a greater number of patients in the HR-C group
required norepinephrine. However, once corrected for such a center effect,
AA remained significantly independently associated with a reduction in
CSA-AKI (relative risk, 0.79). Conclusion(s): HR-Cs treated patients
with greater severity (unmodifiable risk factors) and received different
operative and perioperative management. Taking into account such center
effects, however, AA therapy remained independently associated with
CSA-AKI prevention. Copyright © 2025 Elsevier Inc.

<93>
Accession Number
2041172362
Title
Beyond Mortality: Textbook Outcome as a Novel Quality Metric in
Cardiothoracic Surgical Care.
Source
Journal of Clinical Medicine. 14(21) (no pagination), 2025. Article
Number: 7660. Date of Publication: 01 Nov 2025.
Author
Magouliotis D.E.; Androutsopoulou V.; Zotos P.-A.; Cioffi U.; Minervini
F.; Sicouri N.; Zacharoulis D.; Xanthopoulos A.; Scarci M.
Institution
(Magouliotis) Department of Cardiac Surgery Research, Lankenau Institute
for Medical Research, Wynnewood, PA, United States
(Magouliotis, Androutsopoulou, Zotos) Department of Cardiothoracic
Surgery, University of Thessaly, Biopolis, Larissa, Greece
(Cioffi) Department of Surgery, University of Milan, Milan, Italy
(Minervini) Department of Thoracic Surgery, Luzern Kanton Hospital,
Luzern, Switzerland
(Sicouri) Department of Neuroscience Pittsburgh Campus, University of
Pittsburgh, Pittsburgh, PA, United States
(Zacharoulis) Department of Surgery, University of Thessaly, Biopolis,
Larissa, Greece
(Xanthopoulos) Department of Cardiology, University of Thessaly, Biopolis,
Larissa, Greece
(Scarci) Department of Cardiothoracic Surgery, Hammersmith Hospital,
Imperial College Healthcare, National Health Service (NHS) Trust, London,
United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Objective: Textbook outcome (TO) is a multidimensional composite quality
metric that integrates several desirable short-term outcomes into a single
measure representing the "ideal" perioperative course. Unlike traditional
indicators that focus narrowly on mortality or single complications, TO
captures the complexity of cardiothoracic care, encompassing oncologic
adequacy, absence of major complications, avoidance of reintervention and
readmission, and timely discharge. Method(s): In this systematic
review, we synthesize evidence on the definition, incidence, determinants,
prognostic impact, and limitations of TO across cardiothoracic surgery
(lung and esophageal resections, lung transplantation, cardiac surgery,
and adult heart transplantation) in accordance with the PRISMA guidelines.
 Result(s): Reported achievement rates range from 24% to 66% in
thoracic series, 30% after Norwood palliation, 37-45% after adult heart
transplantation, and 52% in a contemporary national cohort of lung
transplantation, with wide between-center variability. Achieving TO is
consistently associated with improved overall and disease-free survival,
lower costs, and enhanced benchmarking. Determinants of failure include
inadequate lymph node dissection, prolonged operative time, advanced
comorbidity, pretransplant organ support, and socioeconomic disadvantage.
Heterogeneity of definitions, limited incorporation of patient-reported
outcomes, and equity concerns remain barriers to its successful use.
Outside transplantation, benchmarking of TO in adult cardiac procedures
(e.g., CABG/valve) remains limited and non-standardized.
 Conclusion(s): We argue for harmonized, procedure-specific core TO
sets aligned with widely available registry fields, integration of
equity-sensitive risk adjustment, and prospective validation. TO is poised
to become a cornerstone metric of quality assessment and improvement in
cardiothoracic surgery. Copyright © 2025 by the authors.

<94>
Accession Number
2034308433
Title
Treatment Planning in STereotactic Arrhythmia Radioablation: STOPSTORM.eu
Consensus Guidelines.
Source
Radiotherapy and Oncology. Conference: ESTRO 2024. Glasgow United Kingdom.
194(Supplement 1) (pp S4879-S4882), 2024. Date of Publication: 01 May
2024.
Author
Trojani V.; Grehn M.; Botti A.; Balgobind B.; Boda-Heggemann J.;
Fleckenstein J.; Miszczyk M.; Krug D.; Schmidhalter D.; Elicin O.;
Andratschke N.; Pruvot E.; Verhoeff J.; Iori M.; Blanck O.
Institution
(Trojani, Botti, Iori) AUSL-IRCCS Reggio Emilia, Department of Medical
Physics, Reggio Emilia, Italy
(Grehn, Krug, Blanck) University Medical Center of Schleswig-Holstein,
Department of Radiation Oncology, Kiel, Germany
(Balgobind) Amsterdam UMC, Department of Radiation Oncology, Amsterdam,
Netherlands
(Boda-Heggemann, Fleckenstein) University Medical Center Mannheim, Medical
Faculty Mannheim, University of Heidelberg, Department of Radiation
Oncology, Mannheim, Germany
(Miszczyk) Maria Sklodowska-Curie National Research Institute of Oncology,
IIIrd Radiotherapy and Chemotherapy Department, Gliwice, Poland
(Schmidhalter, Elicin) Bern University Hospital, University of Bern,
Division of Medical Radiation Physics and Department of Radiation
Oncology, Bern, Switzerland
(Andratschke) University Hospital of Zurich, Department of Radiation
Oncology, Zurich, Switzerland
(Pruvot) Lausanne University Hospital and University of Lausanne, Heart
and Vessel Department, Service of Cardiology, Lausanne, Switzerland
(Verhoeff) University Medical Center Utrecht, Department of Radiotherapy,
Utrecht, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Purpose/Objective: STereotactic Arrhythmia Radioablation (STAR) showed
promising safety and efficacy in patients with refractory ventricular
tachycardia (VT) and the STOPSTORM.eu consortium was established to
investigate and harmonize STAR treatments in Europe. We investigated
current practice on STAR treatment planning through a dedicated benchmark
study and now developed best practice consensus guidelines within the
STOPSTORM project. Material/Methods: Based on the treatment planning
benchmark results of the STOPSTORM project, an expert panel drafted
treatment planning guidelines for STAR on requirements [1-3], prescription
dose [4-5], trade-offs and documentation [6-9], dose inhomogeneity
[10-13], dose limitations for cardiac substructures [5, 14-15], beam
technique planning [16-17], dose calculation [1,4,18-19], and treatment
times [10, 17, 20]. In a two-step process, all participating centers voted
and commented on the guidelines in the first step and after further
refinements by the expert panel voted on the final guidelines in the
second step based on a 5-point Likert scale (1 - strongly disagree to 5 -
strongly agree). Result(s): For the guidelines, we reached strong
agreement on several aspects of STAR including beam technique planning,
dose calculation, prescription methods and trade-offs between target and
critical structures. In particular, for wellknown single fraction dose
limits of extra-cardiac OARs, 100% of the participants agreed that
Planning Target Volume (PTV) dose tradeoff must be in favor of Organs at
Risk (OARs) sparing to minimize risks of severe and fatal toxicities.
However, we found larger differences on specific cardiac substructures
(coronary arteries and valves) dose limitations takes made by the
participating institutions, especially on their dose constraints or the
lack thereof in current literature, as shown in Figure 1. No agreement
(63%) on necessary dose inhomogeneity in the target to reach a therapeutic
effect was reached. Participants were not in agreement also regarding the
use of plans with high modulation factor and the maximum dose to the ICD
electrodes (with 53% and 58% of agreement, respectively). Furthermore,
regarding ICD electronics management, the consortium reached moderate
agreement regarding the use of specific beam energies to avoid
malfunctions as well as beam avoidance of the main ICD electronics (79%
agreement). Figure 1. % of agreement regarding the dosimetric constraints
for cardiac substructures (coronary arteries on the top and valves on the
bottom) for the participating institutions. TV = Target Volume, ALARA = As
Low As Reasonably Achievable. Conclusion(s): Current treatment
planning approaches for STAR are still heterogeneous in Europe. After our
previously reported treatment planning benchmark and discussion within the
STOPSTORM.eu consortium, we observed agreements in certain planning
aspects (e.g. management of extra cardiac OARs with well-known
single-fraction dose limits), but also disagreement in many other points
and approaches. To standardize and harmonize STAR, consensus guidelines
for numerous aspects of treatment planning including prescribing,
documenting, and reporting were now established. Keywords: STAR,
ventricular tachycardia, guidelines References: [1] Schmitt D, Blanck O,
Gauer T, et al. Technological quality requirements for stereotactic
radiotherapy: Expert review group consensus from the DGMP Working Group
for Physics and Technology in Stereotactic Radiotherapy. Strahlenther
Onkol. 2020;196(5):421-443. [2] Lydiard S, Blanck O, Hugo G, et al. A
Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures,
Technology, and Future Opportunities. Int J Radiat Oncol Biol Phys.
2021;109(3):783-800. [3] Krug D, Blanck O, Andratschke N, et al.
Recommendations regarding cardiac stereotactic body radiotherapy for
treatment refractory ventricular tachycardia. Heart Rhythm.
2021;18(12):2137-2145 [4] Seuntjens J, Lartigau EF, Cora S et al (2014)
ICRU report 91. Prescribing, recording, and reporting of stereotactic
treatments with small photon beams. J ICRU 14(2):1-160. [5] Timmerman R. A
Story of Hypofractionation and the Table on the Wall. Int J Radiat Oncol
Biol Phys. 2022;112(1):4-21. [6] Diez P, Hanna GG, Aitken KL, et al. UK
2022 Consensus on Normal Tissue Dose-Volume Constraints for
Oligometastatic, Primary Lung and Hepatocellular Carcinoma Stereotactic
Ablative Radiotherapy. Clin Oncol (R Coll Radiol). 2022;34(5):288-300. [7]
Gerhard SG, Palma DA, Arifin AJ, et al. Organ at Risk Dose Constraints in
SABR: A Systematic Review of Active Clinical Trials. Pract Radiat Oncol.
2021;11(4):e355-e365. [8] Haskova J, Jedlickova K, Cvek J, et al.
Oesophagopericardial fistula as a late complication of stereotactic
radiotherapy for recurrent ventricular tachycardia. Europace.
2022;24(6):969. [9] Benedict SH, Yenice KM, Followill D, et al.
Stereotactic body radiation therapy: The report of AAPM Task Group 101.
Med. Phys 2010, 37: 4078-4101. [10] Grehn M, Mandija S, Miszczyk M, et al.
Stereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment
and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by
a Multidisciplinary consortium (STOPSTORM.eu) and review of current
patterns of STAR practice in Europe. Europace. 2023;25(4):1284-1295. [11]
Zhang DM, Navara R, Yin T, et al. Cardiac radiotherapy induces electrical
conduction reprogramming in the absence of transmural fibrosis. Nat
Commun. 2021;12:5558. [12] Miszczyk M, Sajdok M, Nozynski J, et al.
Histopathological Examination of an Explanted Heart in a Long-Term
Responder to Cardiac Stereotactic Body Radiotherapy (STereotactic
Arrhythmia Radioablation). Front Cardiovasc Med. 2022;9:1742. [13] Blanck
O, Bode F, Gebhard M, et al. Dose-escalation study for cardiac
radio-surgery in a porcine model. Int J Radiat Oncol Biol Phys.
2014;89(3):590-98. [14] Krug D, Zaman A, Eidinger L, et al. Radiosurgery
for ventricular tachycardia (RAVENTA): interim analysis of a multicenter
multiplatform feasibility trial. Strahlenther Onkol. 2023;199(7):621-630.
[15] van der Ree MH, Luca A, Herrera Siklody C, et al. Effects of
stereotactic arrhythmia radioablation on left ventricular ejection
fraction and valve function over time. Heart Rhythm.
2023:S1547-5271(23)02252-X. [16] Kluge A, Ehrbar S, Grehn M, et al.
Treatment Planning for Cardiac Radioablation: Multicenter Multiplatform
Benchmarking for the RAdiosurgery for VENtricular TAchycardia (RAVENTA)
Trial. Int J Radiat Oncol Biol Phys. 2022;114(2):360-72. [17] Giglioli FR,
Garibaldi C, Blanck O, et al. Dosimetric Multicenter Planning Comparison
Studies for Stereotactic Body Radiation Therapy: Methodology and Future
Perspectives. Int J Radiat Oncol Biol Phys. 2020;106(2):403-412. [18]
Parenica HM, Mavroidis P, Jones W, et al. VMAT Optimization and Dose
Calculation in the Presence of Metallic Hip Prostheses. Technol Cancer Res
Treat. 2019;18:1533033819892255. [19] Pawalowski, B., Ryczkowski, A.,
Panek, R. et al. Accuracy of the doses computed by the Eclipse treatment
planning system near and inside metal elements. Sci Rep 12, 5974 (2022).
[20] 19a] Blanck O, Ipsen S, Chan MK, et al. Treatment Planning
Considerations for Robotic Guided Cardiac Radiosurgery for Atrial
Fibrillation. Cureus. 2016;8(7):e705. Copyright © 2024 Elsevier
Ireland Ltd

<95>
Accession Number
649118878
Title
Modern anticoagulation strategies in cardiovascular surgery: nonvitamin K
antagonist oral anticoagulants versus warfarin after aortic bioprosthetic
valve replacement.
Source
Journal of thrombosis and thrombolysis. (no pagination), 2025. Date of
Publication: 12 Nov 2025.
Author
Chaudhri M.; Mahrizi A.D.A.; Nadeem S.A.; Canal A.; Rajendran P.; Rapelli
V.R.; Gill H.; Haroon B.; Shahzad A.; Acquah F.; Kaunzinger C.; Albert C.;
Raza M.R.
Institution
(Chaudhri, Acquah, Kaunzinger, Raza) Hackensack Meridian Ocean University
Medical Center, NJ, United States
(Chaudhri) Department of Medicine, Hackensack Meridian Ocean University
Medical Center, Brick, NJ, United States
(Mahrizi, Haroon) Faculty of Medicine and Surgery, University of Malta,
Malta
(Nadeem) Drexel University, Philadelphia, PA, United States
(Canal, Rapelli, Gill) Rowan-Virtua School of Osteopathic Medicine,
Stratford, NJ, United States
(Rajendran) Hackensack Meridian School of Medicine, Hackensack, NJ, United
States
(Shahzad) Saint Barnabas Hospital, Bronx, NY, United States
(Albert) Robert Wood Johnson University Hospital, New Brunswick, NJ,
United States
Abstract
The optimal postaortic valve replacement (AVR) anticoagulation strategy
remains poorly defined, particularly when comparing nonvitamin K
antagonist oral anticoagulants (NOACs) versus warfarin. This systematic
review and meta-analysis aimed to evaluate the safety and efficacy of
NOACs compared with warfarin in these patients. Our study was registered
on PROSPERO (ID CRD420251028998). A search of the PubMed, EMBASE, and
Cochrane databases was conducted on April 9, 2025, for studies published
between 2015 and 2025 that compared NOACs to warfarin after aortic
bioprosthetic valve replacement. Inclusion criteria included randomized
controlled trials (RCTs) and observational studies reporting
thromboembolic events, major bleeding, and mortality with at least 6
months of follow-up. Studies on mechanical valves, case reports, and
publications that could not be translated into English were excluded. Data
extraction was conducted based on study design, patient demographics,
clinical outcomes, and effect sizes, expressed as hazard ratios (HRs) with
95% confidence intervals (CIs) using a random effects model. Risk of bias
was assessed using the ROBINS-I tool. Seventeen studies (n = 93,510
participants) were included. NOACs were associated with an HR of 0.91 for
thromboembolic events (95% CI: 0.76-1.09) and a pooled HR of 1.22 for
major bleeding (95% CI: 0.88-1.68). Several studies have suggested a trend
toward lower all-cause mortality and major bleeding with NOACs,
particularly in patients with lower bleeding risk. In patients undergoing
aortic bioprosthetic valve replacement, NOACs show similar efficacy and
safety to warfarin for preventing thromboembolic events and major
bleeding. However, anticoagulation decisions should be individualized, and
larger RCTs are needed to determine the optimal approach. Copyright
© 2025. The Author(s).

<96>
Accession Number
2041546855
Title
Liberal or Restrictive Postoperative Transfusion in Patients at High
Cardiac Risk: The TOP Randomized Clinical Trial.
Source
JAMA. (no pagination), 2025. Date of Publication: 2025.
Author
Kougias P.; Sharath S.E.; Zhan M.; Carson J.L.; Norman L.E.; Mi Z.; Pal
R.; Dosluoglu H.; Modrall J.G.; Sarosi G.A.; Nelson P.; Arya S.;
Scrymgeour A.; Ollison J.; Calais L.A.; Nambi V.; Gregg L.P.; Abdullah
S.M.; Tsai S.; Becker N.; Choi J.C.; Chiu L.; Scali S.; Barshes N.R.; Awad
S.; Moursi M.; Koopmann M.C.; Sally M.; Ihnat D.; Ramaswamy A.; Gasper W.;
Tzeng E.; Wilson M.A.; Tang G.; Huang G.; Biswas K.
Institution
(Kougias, Sharath, Ollison, Becker, Choi) Operative Care Line, VA New York
Harbor Healthcare System, Department of Surgery, State University of New
York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United
States
(Zhan, Norman, Mi, Pal, Huang, Biswas) VA Cooperative Studies Program
Coordinating Center, Perry Point, MD, United States
(Carson) Division of General Internal Medicine, Department of Medicine,
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United
States
(Dosluoglu) Operative Care Line, VA Western NY Healthcare System, Division
of Vascular Surgery, Department of Surgery, State University of New York
at Buffalo, Buffalo, NY, United States
(Modrall, Tsai) Operative Care Line, Dallas VA Medical Center, Division of
Vascular Surgery, Department of Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Sarosi, Scali) Operative Care Line, Malcolm Randall Veterans Affairs
Medical Center, Department of Surgery, University of Florida College of
Medicine, Gainesville, FL, United States
(Nelson) Division of Vascular Surgery, Department of Surgery, University
of Oklahoma School of Community Medicine, Tulsa, OK, United States
(Arya) Operative Care Line, Palo Alto VA Medical Center, Division of
Vascular Surgery, Department of Surgery, Stanford University School of
Medicine, Vascular Section, Surgery Service Line, Palo Alto, CA, United
States
(Scrymgeour) Cooperative Studies Program Clinical Research Pharmacy
Coordinating Center, Albuquerque, NM, United States
(Calais) Cooperative Studies Program Site Monitoring, Auditing, and
Resource Team, Albuquerque, NM, United States
(Nambi) Michael E. DeBakey VA Medical Center, Department of
Medicine-Cardiology, Baylor College of Medicine, Houston, TX, United
States
(Gregg, Chiu) Michael E. DeBakey VA Medical Center, VA Health Systems
Research and Development Center for Innovations in Quality, Effectiveness
and Safety, Department of Medicine-Nephrology, Baylor College of Medicine,
Houston, TX, United States
(Abdullah) Dallas VA Medical Center, Department of Medicine-Cardiology,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Barshes, Awad) Operative Care Line, Michael E. DeBakey VA Medical Center,
Department of Surgery, Baylor College of Medicine, Houston, TX, United
States
(Moursi) Operative Care Line, Little Rock VA Medical Center, Department of
Surgery, University of Arkansas for Medical Services, Little Rock, AR,
United States
(Koopmann) Operative Care Division, Portland VA Medical Center, Portland,
OR, United States
(Sally) Trauma/Surgical ICU, Oregon Health Sciences University, Portland,
OR, United States
(Ihnat, Ramaswamy) Operative Care Line, Minneapolis VA Medical Center,
Department of Surgery, University of Minnesota Medical School,
Minneapolis, MN, United States
(Gasper) Operative Care Line, San Francisco VA Health System, Department
of Surgery, University of California, San Francisco, San Francisco, CA,
United States
(Tzeng, Wilson) Operative Care Line, Pittsburgh VA Medical Center,
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United
States
(Tang) Operative Care Line, Seattle VA Medical Center, Division of
Vascular Surgery, Department of Surgery, University of Washington,
Seattle, WA, United States
Publisher
American Medical Association
Abstract
Importance: Postoperative red blood cell transfusion guidelines recommend
transfusion for hemoglobin levels less than 7 g/dL. However, the safety of
this strategy in patients at high risk of cardiac events undergoing major
operations remains unclear. Objective(s): To evaluate the risk of
death or major ischemic events within 90 days after a liberal transfusion
strategy compared with a restrictive transfusion strategy in patients at
high risk of cardiac events who had undergone major vascular or general
surgery operations and developed postoperative anemia. Design,
Setting, and Participant(s): This parallel, single-blind, randomized
clinical superiority trial included 1428 veterans (>=18 y) at high cardiac
risk undergoing major vascular or general surgery operations. Participants
were enrolled from February 2018 to March 2023 across 16 Veterans Affairs
Medical Centers in the US. Intervention(s): Seven hundred fourteen
participants with postoperative hemoglobin less than 10 g/dL were
randomized to a liberal strategy (transfusion trigger at hemoglobin level
<10 g/dL) and 714 to a restrictive strategy (transfusion trigger at
hemoglobin <7 g/dL). Main Outcomes and Measures: The primary end
point was a composite of all-cause death, myocardial infarction, coronary
revascularization, acute kidney failure, or ischemic stroke within 90 days
after randomization. Secondary end points included a composite of cardiac
complications other than myocardial infarction (arrhythmias, heart
failure, and nonfatal cardiac arrest). Result(s): Of the 1424
analyzed veterans (mean age, 69.9 [SD, 7.9] years; 1393 male [97.8%]; 268
Black [18.8%]; 48 Hispanic [4.1%]; 1071 White [75.2%]), 1297 (91.1%)
underwent vascular surgical procedures. The mean hemoglobin difference
between transfusion strategies was 2.0 g/dL on day 5 after randomization.
The primary outcome rate in the liberal group was 9.1% (61 of 670)
compared with 10.1% (71 of 700) in the restrictive group (relative risk,
0.90; 95% CI, 0.65-1.24). The secondary end point of cardiac complications
without myocardial infarction, which was 1 of 5 secondary end points,
occurred in 5.9% (38 of 647) of patients in the liberal group and 9.9% (67
of 678) of patients in the restrictive group (relative risk, 0.59; 99% CI,
0.36-0.98). Conclusions and relevance: After major vascular or general
surgery operations among patients at high risk of a cardiac event, a
liberal transfusion strategy did not reduce 90-day death or major ischemic
outcome rates compared with a restrictive strategy. Copyright ©
2025 American Medical Association.

<97>
Accession Number
2041558911
Title
A real-world comparison of outcomes and healthcare resource utilization of
Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve
Replacement (SAVR).
Source
Health Policy and Technology. 15(1) (no pagination), 2026. Article Number:
101129. Date of Publication: 01 Feb 2026.
Author
Moretti G.; Seghieri C.; Passino C.; Vainieri M.
Institution
(Moretti, Seghieri, Vainieri) Management and Healthcare Laboratory,
Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
(Passino) Interdisciplinary Center for Health Sciences, Scuola Superiore
Sant'Anna, Pisa, Italy
(Passino) Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Publisher
Elsevier B.V.
Abstract
Objectives: This study aims to assess and compare the real-world outcomes
and healthcare resource utilization of Transcatheter Aortic Valve
Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR)
procedures, acknowledging the challenges associated with medical device
evaluations. Method(s): The two cohorts of TAVI and SAVR patients
were identified using individual-level administrative data in the Tuscany
region of Italy from 2016 to 2021. Patients in treatment cohorts were
followed for up to one-year post-procedure, with outcomes and costs
assessed. Clinical indicators were selected from the Valve Academic
Research Consortium-3 (VARC-3) consensus document. Follow-up costs, in
euros (), were calculated for each patient up to three years
post-procedure, from the perspective of the Italian National Healthcare
System. Result(s): No significant differences in 30-day and 1-year
mortality were found between TAVI and SAVR, though TAVI showed a slight
increase in 3-year mortality (OR 1.05, p = 0.004). TAVI patients had
higher rates of conduction disturbances and pacemaker implantation at all
time points. They also experienced more ER admissions and hospital
readmissions at 3 years, but shorter hospital stays. At 1 year, TAVI
incurred in 234 higher total costs, driven mainly by higher ER costs,
while pharmaceutical costs were similar. At 3 years, total costs were 2132
for TAVI and 1915 for SAVR, with higher ambulatory and ER costs in the
TAVI group but lower pharmaceutical costs. Conclusion(s): The study
explores the potential of Real-World Evidence to inform the clinical and
economic evaluation of new technologies and procedures. The study differs
from some prior randomized controlled trial-based studies, highlighting
the impact of diverse analytical approaches and patient populations.
Public interest abstract: Aortic stenosis (AS) is a common heart valve
disease in the elderly, whose standard treatment consists of Surgical
Aortic Valve Replacement (SAVR). For patients that are ineligible for
surgery due to high risk or comorbidities, Transcatheter Aortic Valve
Implantation (TAVI), has emerged as a less invasive option. This study
used real-world data from Tuscany, Italy, to compare clinical outcomes and
costs. We found no significant difference in mortality rates between TAVI
and SAVR at 30 days and one year and higher mortality at 3 years. TAVI
patients were more likely to experience conduction disturbances, often
requiring pacemaker implantation. Cost differences were modest, with TAVI
patients incurring 234 more in total healthcare expenses over one year and
217 at three years. These findings highlight the value of real-world
evidence in assessing the safety, effectiveness, and financial
sustainability of new treatments like TAVI. Copyright © 2025

<98>
Accession Number
2041584408
Title
Propofol-supplemented cardioplegia: A multicenter blinded 3-group
randomized trial (Propofol for Myocardial Protection Trial 2: ProMPT2).
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Date of Publication: 2025.
Author
Angelini G.D.; Smartt H.J.M.; Joyce K.; Heys R.; Maishman R.; Culliford
L.; de Jesus S.E.; Fitzgerald B.M.; Suleiman M.S.; Punjabi P.; Nwaejike
N.; Downes R.; Gibbison B.; Rogers C.A.
Institution
(Angelini, Suleiman, Gibbison) Bristol Heart Institute, University of
Bristol, Bristol, United Kingdom
(Smartt, Joyce, Heys, Maishman, Culliford, de Jesus, Fitzgerald, Rogers)
Bristol Trials Centre, Bristol Medical School, University of Bristol,
Bristol, United Kingdom
(Punjabi) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Punjabi) Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Nwaejike) Wythenshawe Hospital, Manchester University NHS Foundation
Trust, Manchester, United Kingdom
(Downes) Perfusion Department, University Hospitals Bristol and Weston NHS
Foundation Trust, Bristol, United Kingdom
Publisher
Elsevier Inc.
Abstract
Objective: Coronary artery bypass grafting using cardiopulmonary bypass
and cardioplegic arrest is an effective treatment for coronary artery
disease. Research suggests supplementing the cardioplegia solution with
propofol may be cardioprotective. Our aim was to compare the safety and
efficacy of supplementing the cardioplegia solution with different doses
of propofol in adults undergoing first-time surgery. Method(s): A
blinded, parallel group randomized controlled trial conducted in 3
hospitals in the United Kingdom compared a cardioplegia solution
supplemented with high-dose propofol (concentration 12 mug/mL), low-dose
propofol (concentration 6 mug/mL), and placebo (saline). Primary outcome
was cardiac troponin T measurements over the first 48 hours after surgery.
Participants were followed for 12 months. Result(s): In total, 240
participants, median age 66 years, 90% male, were randomly allocated: 78
to high-dose propofol, 80 to low-dose propofol, and 82 to placebo. In
total, 239 participants were included in the primary analysis. Geometric
mean cardiac troponin release at 48 hours (95% confidence interval) was
145 ng/L (125-168), 162 ng/L (138-191), and 150 ng/L (125-180) in the
high-dose propofol, low-dose propofol, and placebo groups, respectively
(adjusted geometric mean ratio 1.06; 95% confidence interval, 0.97-1.15; P
= .20, for pairwise comparisons between high- and low-dose propofol and
between low-dose propofol and placebo). A total of 96 adverse events that
prolonged the hospital stay or were life-threatening were reported (33,
26, and 37 in the high-dose propofol, low-dose propofol, and placebo
groups, respectively), as well as 4 deaths (1 low-dose propofol group, 3
placebo group). Conclusion(s): Propofol supplementation of warm blood
cardioplegia at both the lower and higher concentrations is safe, but
there is no evidence to suggest either dose is
cardioprotective. Copyright © 2025 The Authors

<99>
Accession Number
2041562181
Title
Telematic intervention on frailty in patients undergoing TAVI. Design of
the TELE-FRAIL TAVI clinical trial.
Source
REC: Interventional Cardiology. 7(4) (pp 223-228), 2025. Date of
Publication: 01 Oct 2025.
Author
Bernal-Labrador E.; Romaguera R.; Garcia-Blas S.; Regueiro A.; Serra V.;
Asmarats L.; Tizon-Marcos H.; Agudelo V.; Scardino C.; Casanova-Sandoval
J.M.; Rodriguez-Gabella T.; Jimenez-Mendez C.; Perez-Rivera A.;
Robles-Gamboa C.; Ayesta A.; Diez-Villanueva P.; Raposeiras-Roubin S.;
Amat-Santos I.J.; Esteve-Pastor A.; Veiga-Fernandez G.; Anguita M.;
Marti-Sanchez D.; Martinez-Velilla N.; Cortes L.; Calvo E.; Asimbaya S.;
Formiga F.; Ariza-Sole A.
Institution
(Bernal-Labrador, Cortes) Hospital Universitari Germans Trias i Pujol,
Servicio de Cardiologia, Badalona, Barcelona, Spain
(Romaguera, Calvo, Asimbaya, Formiga, Ariza-Sole) Hospital Universitari de
Bellvitge, Servicio de Cardiologia, L'Hospitalet de Llobregat, Barcelona,
Spain
(Garcia-Blas) Hospital Clinico Universitario de Valencia, Servicio de
Cardiologia, Valencia, Spain
(Regueiro) Hospital Clinic de Barcelona, Servicio de Cardiologia,
Barcelona, Spain
(Serra) Hospital Universitari Vall d'Hebron, Servicio de Cardiologia,
Barcelona, Spain
(Asmarats) Hospital de la Santa Creu i Sant Pau, Servicio de Cardiologia,
Instituto de Investigacion Biomedica Sant Pau (IIB Sant Pau), Barcelona,
Spain
(Tizon-Marcos) Hospital del Mar, Servicio de Cardiologia, Barcelona, Spain
(Tizon-Marcos) Departament de Salut, Generalitat de Catalunya, Barcelona,
Spain
(Tizon-Marcos, Esteve-Pastor, Calvo) Centro de Investigacion Biomedica en
Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos
III, Madrid, Spain
(Agudelo) Hospital Universitari Josep Trueta, Servicio de Cardiologia,
Girona, Spain
(Scardino) Hospital Universitari Joan XXIII, Servicio de Cardiologia,
Tarragona, Spain
(Casanova-Sandoval) Hospital Arnau de Vilanova, Servicio de Cardiologia,
Lleida, Spain
(Rodriguez-Gabella) Hospital Son Espases, Servicio de Cardiologia, Palma
de Mallorca, Spain
(Jimenez-Mendez) Hospital Puerta del Mar, Servicio de Cardiologia, Cadiz,
Spain
(Perez-Rivera) Hospital Universitario de Burgos, Servicio de Cardiologia,
Burgos, Spain
(Robles-Gamboa) Hospital Universitario de Toledo, Servicio de Cardiologia,
Toledo, Spain
(Ayesta) Hospital Universitario Central de Asturias, Servicio de
Cardiologia, Asturias, Oviedo, Spain
(Diez-Villanueva) Hospital Universitario de La Princesa, Servicio de
Cardiologia, Madrid, Spain
(Raposeiras-Roubin) Hospital Alvaro Cunqueiro, Servicio de Cardiologia,
Pontevedra, Vigo, Spain
(Amat-Santos) Hospital Clinico de Valladolid, Servicio de Cardiologia,
Valladolid, Spain
(Esteve-Pastor) Hospital Virgen de la Arrixaca, Servicio de Cardiologia,
El Palmar, Murcia, Spain
(Veiga-Fernandez) Hospital Marques de Valdecilla, Servicio de Cardiologia,
Cantabria, Santander, Spain
(Anguita) Hospital Reina Sofia, Servicio de Cardiologia, Cordoba, Spain
(Marti-Sanchez) Hospital Gomez Ulla, Servicio de Cardiologia, Madrid,
Spain
(Martinez-Velilla) Hospital Universitario de Navarra, Servicio de
Cardiologia, Navarra, Pamplona, Spain
Publisher
Sociedad Espanola de Cardiologia
Abstract
Introduction and objectives: Although transcatheter aortic valve
implantation (TAVI) is the first-line therapy for aortic stenosis (AS),
its benefit could be lower (or even disappear) in frail patients. Physical
exercise and nutritional support programs are recommended to address
frailty. Data on the application of telemedicine strategies in this
context is scarce. The objective of this study is to analyze, in older
patients with AS undergoing TAVI, the effect of a telematic intervention
on the reversal of frailty vs standard of care. Method(s): We will be
conducting a randomized multicenter study including patients aged >= 75
years with severe AS (mean aortic gradient > 40 mmHg, or aortic valve area
< 0.8 8 cm2 on echocardiogram) with baseline frailty criteria
(Short Physical Performance Battery [SPPB] < 10 and FRAIL scale >= 3)
undergoing TAVI. Prior to discharge, patients will be randomized to a) a
telematic intervention within the first 3 months (nutritional support plus
supervised physical exercise plus health education); or b) standard of
care. The primary endpoint will be the percentage of patients with frailty
reversal (SPPB >= 10) at 3 months. The estimated sample size is 206
patients (103 in each arm). Conclusion(s): The hypothesis of this
study is that telematic intervention will allow a higher percentage of
frailty reversal at 3 months vs standard of care after TAVI. The results
of this study may provide novel information on this approach to frail
patients with AS undergoing TAVI. Copyright © 2025 Sociedad
Espanola de Cardiologia. Publicado por Permanyer Publications. Este es un
articulo open access bajo la licencia CC BY-NC-ND 4.0.

<100>
Accession Number
2041167962
Title
Management of Asymptomatic Severe Aortic Stenosis: Current Evidence and
Future Directions.
Source
Journal of Clinical Medicine. 14(21) (no pagination), 2025. Article
Number: 7549. Date of Publication: 01 Nov 2025.
Author
Laterra G.; Agnello F.; Strazzieri O.; Reddavid C.; Scalia L.; Ingala S.;
Guarino S.; Barbera C.; Russo M.D.; Costa G.; Barbanti M.
Institution
(Laterra, Agnello, Barbanti) Faculty of Medicine and Surgery, Universita
degli Studi di Enna "Kore", Piazza dell'Universita, Enna, Italy
(Laterra, Agnello, Strazzieri, Reddavid, Scalia, Ingala, Guarino, Barbera,
Russo, Barbanti) Division of Cardiology, Ospedale Umberto I, ASP 4 di
Enna, Enna, Italy
(Costa) Division of Cardiology, A.O.U. Policlinico "G. Rodolico San
Marco", Catania, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Systematic Severe aortic stenosis (AS) is a progressive disease and one of
the most common valvular heart diseases in developed countries. The
management of asymptomatic severe AS remains challenging and requires a
tailored, patient-specific approach. Optimal timing of intervention in
asymptomatic patients continues to be a matter of ongoing debate. In
individuals with severe AS and reduced left ventricular ejection fraction
(LVEF), both the ESC/EACTS and ACC/AHA guidelines recommend aortic valve
replacement (AVR), regardless of symptom status. In contrast, for patients
with preserved LVEF (>=50%), the decision to proceed with AVR must be
individualized and based on a comprehensive risk assessment. Risk
stratification plays a central role in guiding early intervention
strategies and should incorporate clinical findings, echocardiographic
parameters, biomarkers, and advanced imaging techniques such as cardiac
magnetic resonance and computed tomography. Recent randomized controlled
trials have yielded mixed results regarding the mortality benefit of early
AVR but have consistently demonstrated a reduction in heart
failure-related hospitalizations. Timely intervention in carefully
selected high-risk patients may improve long-term outcomes, while avoiding
unnecessary procedures in lower-risk individuals remains equally
important. Copyright © 2025 by the authors.

<101>
Accession Number
2041179776
Title
Evaluation of Saphenous Vein Graft Patency Using Wall Shear Stress and
Geometry Post Coronary Artery Bypass Graft Surgery.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
5602643. Date of Publication: 2025.
Author
Abdel Kader H.; Kyriazis P.G.; Punjabi P.P.
Institution
(Abdel Kader) Department of General Surgery, Royal Free London NHS
Foundation Trust, London, United Kingdom
(Kyriazis, Punjabi) Imperial College London, National Heart and Lung
Institute, London, United Kingdom
(Kyriazis, Punjabi) Department of Cardiothoracic Surgery, Imperial College
Healthcare NHS Trust, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Saphenous vein grafts (SVGs) remain widely used in coronary
artery bypass grafting (CABG). This study examines the role of wall shear
stress (WSS) and graft geometry on SVG patency and evaluates the potential
of computational fluid dynamics (CFD) as an assessment tool post-CABG.
 Method(s): A systematic search was conducted in PubMed, Cochrane
Library, Scopus and EMBASE using the terms 'wall shear stress',
'geometry', 'computational fluid dynamics' and 'saphenous vein graft
patency'. From 374 articles, 82 met the inclusion criteria, focussing on
WSS and/or graft geometry in relation to SVG patency in coronary disease.
Studies limited to qualitative findings or animal models were excluded,
narrowing the selection to 64 eligible articles. Result(s): Adverse
WSS conditions were linked to pronounced intimal hyperplasia,
atherosclerosis and graft failure. Geometrical factors influencing SVG
patency included graft diameter, target coronary diameter (> 2.0 mm),
graft wall thickness (> 1.5 mm), curvature at the graft-host junction and
anastomotic angles exceeding 15-20degree. CFD-based evaluations of SVG
patency aligned with existing literature findings. Discussion(s): The
interplay between SVG patency, WSS and graft geometry is well documented.
CFD offers a promising modality for in-depth graft analysis by gauging
geometry and flow dynamics. By delivering objective information, CFD can
equip surgeons with the tools to optimise strategies and thereby enhance
CABG patient outcomes. Copyright © 2025 Hashem Abdel Kader et al.
Journal of Cardiac Surgery published by John Wiley & Sons Ltd.

<102>
Accession Number
2041596509
Title
108. Does Heart Transplant Improve Cognitive Impairment in Heart Failure
Patients as Measured by Neurocognitive Assessments: A Systematic Review.
Source
Journal of the Academy of Consultation-Liaison Psychiatry. Conference:
Academy of Consultation-Liaison Psychiatry. San Antonio United States.
66(Supplement) (pp S100-S101), 2025. Date of Publication: 01 Nov 2025.
Author
Pang H.; Gawad N.A.
Institution
(Pang, Gawad) University of Toronto, United States
Publisher
Elsevier B.V.
Abstract
Background: Neurocognitive impairment is common among patients with heart
failure, affecting multiple domains including executive function, memory,
psychomotor speed, and attention (Bhat et al., 2015). Structural brain
changes have also been observed in patients with heart failure (Davis and
Allen, 2013). These cognitive deficits hinder patients' ability to
effectively monitor and manage symptoms (Davis and Allen, 2013).
Neurocognitive impairment in patients with heart failure is associated
with a six-fold increase in impairment in activities of daily living and a
five-fold increase in mortality (Zuccala et al., 2001). Most etiological
theories, by which heart failure influences cognition, focus on two
processes: intermittent cerebral hypoperfusion which affects the brain's
oxygen and nutrient supply; and overstimulation of the sympathetic nervous
system to restore cerebral blood flow, which further strains
cardiovascular status (Gaviria et al., 2011). Heart transplantation is the
gold standard of treatment for selected patients with advanced heart
failure who remain symptomatic despite optimal medical therapy. It is
posited that improvement in cardiac output increases cerebral perfusion
and improves neurocognitive function. A recent systematic review and case
series demonstrated some degree of cognitive improvement on
neuropsychological testing six months after left ventricular assist device
implantation (Choi et al., 2022). To our knowledge, no similar systematic
reviews exist on the neurocognitive outcomes of patients with heart
failure post-heart transplantation. Method(s): We aim to conduct a
systematic review of studies with adult recipients of heart transplant
whose cognition was measured before and after the procedure. Results and
 Conclusion(s): This work is in progress and expected to be completed
by the meeting date. References: 1. Bhat, G., Yost, G., and Mahoney, E.
(2015). Cognitive function and left ventricular assist device
implantation. Journal of Heart and Lung Transplantation. 34(11):1398-405.
https://doi.org/10.1016/j.healun.2015.05.015 2. Choi, J. J., Oldham, M.
A., Pancharovski, T., Rubano, A., Walsh, P., Alexis, J. D., Gosev, I., and
Lee, H. B. (2022). Cognitive Change After Left Ventricular Assist Device
Implantation: A Case Series and Systematic Review. Journal of the Academy
of Consultation-Liaison Psychiatry. 63(6):599-606.
https://doi.org/10.1016/j.jaclp.2022.09.003 3. Davis, K. K., and Allen, J.
K. (2013). Identifying cognitive impairment in heart failure: a review of
screening measures. Heart Lung, 42(2), 92-97.
https://doi.org/10.1016/j.hrtlng.2012.11.003 4. Gaviria, M., Pliskin, N.,
and Kney, A. (2011). Cognitive impairment in patients with advanced heart
failure and its implications on decision-making capacity. Congestive Heart
Failure, 17(4), 175-179. https://doi.org/10.1111/j.1751-7133.2011.00242.x
5. Zuccala, G., Onder, G., Pedone, C., Cocchi, A., Carosella, L., Cattel,
C., Carbonin, P. U., and Bernabei, R. (2001). Cognitive dysfunction as a
major determinant of disability in patients with heart failure: results
from a multicentre survey. On behalf of the GIFA (SIGG-ONLUS)
Investigators. Journal Of Neurology, Neurosurgery, And Psychiatry, 70(1),
109-112. https://doi.org/10.1136/jnnp.70.1.109 Copyright © 2025

<103>
Accession Number
2041586119
Title
Systematic Review of The Effect Of Preoperative Cardiac Biomarkers on The
Duration of Ventilator Use in Post-Operative Cabg Patients.
Source
Vascular and Endovascular Review. 8(3s) (pp 127-138), 2025. Date of
Publication: 2025.
Author
Pratiwi F.R.; Sembiring Y.E.; Setiawan P.
Institution
(Pratiwi, Sembiring) Department of Thoracic and Cardiovascular Surgery,
Faculty of Medicine, Airlangga University, Surabaya, Indonesia
(Pratiwi, Sembiring) Department of Thoracic, Cardiac and Vascular Surgery,
Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
(Setiawan) Department of Anesthesiology and Reanimation, Faculty of
Medicine, Universitas Airlangga, Surabaya, Indonesia
(Setiawan) Department of Anesthesiology and Reanimation, Dr. Soetomo
General Academic Hospital, Surabaya, Indonesia
Publisher
SCARLET PUBLISHING SOLUTIONS
Abstract
Prolonged ventilator duration after coronary artery bypass grafting (CABG)
surgery is a critical issue in intensive care units (ICUs) as it can
increase the risk of complications, length of hospital stay, and
mortality. Several studies have shown that preoperative cardiac
biomarkers, such as NT-proBNP, troponin I/T, and C-reactive protein (CRP),
have the potential to be important predictors of ventilator duration, but
the results are mixed and have not been systematically integrated. This
study aims to comprehensively evaluate the existing evidence regarding the
effect of preoperative cardiac biomarkers on ventilator duration in
post-CABG patients. This study used a Systematic Literature Review method
with a search of articles in PubMed, Scopus, and Web of Science databases,
and followed the PRISMA guidelines for study selection. The results showed
that high preoperative levels of NT-proBNP, troponin I/T, and CRP were
consistently associated with longer ventilator requirements. Furthermore,
the integration of biomarkers with traditional clinical factors resulted
in a more accurate prediction of ventilation duration compared with
clinical factors alone. These findings underscore the importance of
preoperative cardiac biomarkers as predictive tools to assist in more
optimal planning of post-CABG patient management. Copyright ©
2025 SCARLET PUBLISHING SOLUTIONS. All rights reserved.

<104>
Accession Number
2041586094
Title
Acute Kidney Injury After Cardiac Surgery in Patients Without Chronic
Kidney Disease: Incidence, Predictors, and Outcomes.
Source
Vascular and Endovascular Review. 8(4s) (pp 344-356), 2025. Date of
Publication: 2025.
Author
Alhussaini M.A.; Salama Ayyad M.A.K.; Sadek O.A.; Othman A.I.
Institution
(Alhussaini, Salama Ayyad, Sadek, Othman) Department of Cardiothoracic
Surgery, Assiut University, Assiut, Egypt
Publisher
SCARLET PUBLISHING SOLUTIONS
Abstract
Acute kidney injury (AKI) is a frequent and serious complication following
cardiac surgery, even in patients without preexisting chronic kidney
disease (CKD). This prospective cohort study included 950 adult patients
undergoing elective cardiac surgery at Assiut University Hospital between
2021 and 2024. Using KDIGO criteria, the incidence of cardiac
surgery-associated AKI (CSA-AKI) was 42%, with 18.6% classified as severe
(stage 3). AKI patients were significantly older, more often female, and
had higher rates of hypertension, diabetes, and valvular surgery. They
also experienced longer cardiopulmonary bypass and cross-clamp times, more
postoperative hypotension and sepsis, and a greater need for renal
replacement therapy. Mortality was 22.3% compared with 6.5% in patients
without AKI. Multivariate analysis identified hypertension, diabetes, and
prolonged ICU and hospital stays as independent predictors. CSA-AKI
remains common and strongly associated with adverse outcomes, highlighting
the need for preventive perioperative management strategies. Copyright
© 2025 SCARLET PUBLISHING SOLUTIONS. All rights reserved.

<105>
Accession Number
2041126758
Title
Robotic-assisted versus video-assisted thoracoscopic surgery for
non-small-cell lung cancer: A systematic review and meta-analysis of
prospective studies.
Source
Surgical Practice. (no pagination), 2025. Date of Publication: 2025.
Author
Ausath Z.F.; Tjiaman M.P.; Zaidan M.Z.; Furqon M.A.; Faisal H.K.P.
Institution
(Ausath, Tjiaman, Zaidan) Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
(Furqon) Department of Cardiothoracic and Vascular Surgery, Persahabatan
Hospital, Jakarta, Indonesia
(Faisal) Department of Pulmonology and Respiratory Medicine, Faculty of
Medicine, Universitas Indonesia-Persahabatan Hospital, Jakarta, Indonesia
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Lung cancer is one of the most commonly encountered cancers,
with about 85% of cases classified as non-small cell lung cancer (NSCLC).
Video-assisted thoracoscopic surgery (VATS) has certain limitations such
as rigid instrument movement and poor hand-eye coordination. On the other
hand, robotic-assisted thoracic surgery (RATS) has emerged, offering
potential advantages such as a wider range of instrument manoeuvrability.
However, the comparative outcomes between the two remain debated. This
review aims to evaluate the outcomes of RATS compared with VATS in
patients with NSCLC. Method(s): This systematic review and
meta-analysis was conducted following the Cochrane Handbook for Systematic
Reviews of Interventions 6.2 and the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) checklist. The search was
performed on PubMed, Cochrane, Science Direct and Scopus starting from 22
September 2024. Result(s): A total of eight studies involving 1580
NSCLC patients were included in this research. RATS demonstrated a higher
number of dissected lymph node stations (mean difference [MD] 1. 34, CI
0.87-1.82, p <.00001, I2 = 87%) and better 3-year disease-free
survival compared with VATS (MD 2.19, CI 1.21-3.95, p =.009, I2
= 47%). Subgroup analyses, including only randomized controlled trials
(RCTs) or studies focusing exclusively on lobectomy, showed that RATS
outperformed VATS in the number of dissected lymph node stations (p <.05).
 Conclusion(s): RATS is non-inferior to VATS and demonstrates
superiority in the number of dissected lymph node stations in all
analyses. Copyright © 2025 College of Surgeons of Hong Kong.

<106>
Accession Number
649091618
Title
Cardiac Allograft Vasculopathy Inhibition with Alirocumab: The CAVIAR
Trial.
Source
Circulation. (no pagination), 2025. Date of Publication: 10 Nov 2025.
Author
Fearon W.F.; Terada K.; Takahashi K.; Skoda A.; Luikart H.I.; Lamendola
C.A.; Zimmermann F.M.; Hashikata T.; Saito K.; Yoshida A.; Varr B.;
Knowles J.W.; Woo C.; Honda Y.; Teuteberg J.; Khush K.K.
Institution
(Fearon) Division of Cardiovascular Medicine and Stanford Cardiovascular
Institute, Stanford University, Stanford, CA; VA Palo Alto Health Care
System, Palo Alto, CA
(Terada, Takahashi, Skoda, Luikart, Lamendola, Hashikata, Saito, Yoshida,
Honda, Teuteberg, Khush) Division of Cardiovascular Medicine and Stanford
Cardiovascular Institute, Stanford University, Stanford, CA, United States
(Zimmermann) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Varr, Woo) Kaiser Permanente, Santa Clara, CA, United States
(Knowles) Division of Cardiovascular Medicine and Stanford Cardiovascular
Institute, Stanford University, Stanford, CA; Stanford Diabetes Research
Center, Stanford Prevention Research Center, Stanford, CA
Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) is an important cause of
mortality after heart transplantation (HT). Dyslipidemia is a major
contributor to the development of CAV. The safety and effectiveness of
proprotein convertase subtilisin/kexin 9 (PCSK9) inhibition to lower
cholesterol and prevent CAV early after HT is not well-established.
 METHOD(S): In this investigator-initiated, prospective, multicenter,
double-blind, randomized trial, participants were randomized early after
HT to receive either alirocumab or placebo, in addition to rosuvastatin.
Prior to randomization and at one year, all participants underwent
invasive coronary assessment, including angiography, fractional flow
reserve (FFR), coronary flow reserve (CFR), the index of microcirculatory
resistance (IMR), and intravascular ultrasound with near-infrared
spectroscopy (NIRS-IVUS). Lipid values were assessed at baseline and at
prespecified intervals. The primary endpoint was the change in coronary
artery plaque volume from baseline to one year post HT based on serial
IVUS. RESULT(S): A total of 114 HT recipients were included (57
assigned to alirocumab and 57 assigned to placebo). Baseline
characteristics were well matched between the two groups. The low density
lipoprotein cholesterol (LDL-C) levels decreased significantly from
baseline to one year in the alirocumab arm (72.7 +/-31.7 to 31.5 +/-20.7
mg/dL, p<0.001) and did not change with placebo (69.0 +/-22.4 to 69.2
+/-28.1 mg/dL, p=0.92). Plaque volume increased numerically in both groups
from baseline to 12 months (alirocumab 176.3 +/-95.2 to 184.5 +/-105.4
mm3, p=0.23; placebo 173.7 +/-96.7 to 183.1 +/-109.8 mm3, p=0.15). The
change in plaque volume (mean difference in differences) did not differ
between groups (1.01 (0.89-1.14), p=0.86). FFR, CFR and IMR did not change
significantly with the addition of alirocumab. There were no significant
adverse events related to alirocumab. CONCLUSION(S): PCSK9 inhibition
with alirocumab in addition to statin therapy early after HT safely lowers
LDL-C, but did not reduce coronary artery plaque progression after one
year compared with rosuvastatin alone, in patients with a low baseline
LDL-C.

<107>
Accession Number
2041098938
Title
Anomalous left coronary artery from the pulmonary artery in adults: a
systematic review of clinical presentation, diagnosis, and outcomes.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2025.
Date of Publication: 2025.
Author
Suchodolski A.; Krolikowska M.; Kowal A.; Glowacki J.; Szulik M.
Institution
(Suchodolski, Szulik) Department of Cardiology and Electrotherapy,
Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze,
Medical University of Silesia, Marii Sklodowskiej-Curie 9 Zabrze,
Katowice, Poland
(Suchodolski) Doctoral School of the Medical University of Silesia in
Katowice, Katowice, Poland
(Krolikowska, Kowal) Student Research Group, Faculty of Medical Sciences
in Zabrze, Medical University of Silesia, Katowice, Poland
(Szulik) Collegium Medicum-Faculty of Medicine, Department of Medical and
Health Sciences, Faculty of Applied Sciences, Dabrowa Gornicza, Poland
(Glowacki) Computed Tomography Laboratory, Silesian Centre for Heart
Diseases, Zabrze, Poland
Publisher
Springer Science and Business Media B.V.
Abstract
Abnormal left coronary artery from the pulmonary artery (ALCAPA) is a rare
congenital coronary anomaly, occurring in approximately 1 in 300 000 live
births and accounting for roughly 0,5 per cent of all congenital heart
defects. Without surgical correction, in more than 90% of cases, the
defect leads to death in the first year of life. However, a small subgroup
of individuals survive into adulthood. In adults, it can manifest as
dyspnoea, angina, palpitations and eventually leads to heart failure,
arrhythmia and sudden cardiac death. We summarised 60 years of case
reports of ALCAPA syndrome in adults and identified 279 patients, the
majority of whom were women. In most cases, the diagnosis was based on
coronary angiography. The most common symptom was dyspnoea and the least
frequent were palpitations. Surgery was performed in 194 patients with a
mean age at surgery of 37,46 years. The aim of this study is to obtain
clinically relevant information that would be unattainable even in large
multicentre clinical trials, given the rarity of this anomaly. This is the
first review juxtaposing all ALCAPA cases in adults published in 60
years. Copyright © The Author(s) 2025.

<108>
Accession Number
649080516
Title
The prevalence of unrecognized cognitive impairment in geriatric surgical
patients: A systematic review and meta-analysis.
Source
Alzheimer's and Dementia. Conference: Alzheimer's Association
International Conference, AAIC 2021. Denver, CO United States.
17(Supplement 10) (no pagination), 2021. Date of Publication: 01 Dec 2021.
Author
Kapoor P.; Saripella A.; Chen L.; Riazi S.; Wong J.; Englesakis M.;
Nagappa M.; Chung F.
Institution
(Kapoor, Saripella, Chen, Riazi, Wong, Chung) Toronto Western Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Englesakis) Library and Information Services, University Health Network,
Toronto, ON, Canada
(Nagappa) University Hospital, St. Joseph's Hospital and Victoria
Hospital, London Health Sciences Centre, St. Joseph's Health Care, Western
University, Toronto, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Pre-existing cognitive impairment is emerging as a predictor
of poor postoperative outcomes in older surgical patients (Guenther,
2020). Due to a substantial under-diagnosis of cognitive impairment in the
elderly, the prevalence of undiagnosed cognitive impairment has not been
well defined in those undergoing surgery (Elman, 2018). The objective of
this systematic review and meta-analysis is to determine the pooled
prevalence of unrecognized cognitive impairment in the elderly undergoing
elective noncardiac surgery. Method(s): An expert librarian conducted
the literature search, which included MEDLINE (Ovid), PubMed (non-MEDLINE
records only), Embase, Cochrane Central, Cochrane Database of Systematic
Reviews, PsycINFO, and Emcare Nursing for relevant articles from 1946 to
April 2021. Inclusion criteria were (1) patients 60 years old undergoing
elective non-cardiac surgeries; (2) preoperative cognitive impairment
assessed by validated cognitive screening tests; (3) published in English
language. Descriptive analysis was conducted for the cognitive impairment
group. Data were extracted from each study and prevalence of cognitive
impairment with 95% confidence interval (CI) was calculated for each
study. We used the random effect model to calculate the pooled prevalence
value with 95% CI. Comprehensive meta-analysis software was used for
statistical analysis (Borenstein, 2013). Result(s): Of 8,895
citations, 20 studies were included consisting of 4,159 patients
undergoing a variety of elective non-cardiac surgeries. All but one study
were prospective cohort studies, with the exception being a
cross-sectional study. The mean age among patients with unrecognized
cognitive impairment was 73.1 +/- 7.2 years, and 43.6% were male. The
pooled prevalence of cognitive impairment was 40.2% (95% CI: 31.0%, 50.1%;
P=0.005; predictive interval: -1.47 to 2.27). The forest plot displays
non-overlapping CI's, indicating high heterogeneity within the data (I2:
97%). Influential analysis of any study showed that removal of each study
did not significantly alter the pooled prevalence result. Meta-regression
analysis based on age, gender, and body mass index (BMI) did not change
the final inference of our results. Conclusion(s): The prevalence of
unrecognized cognitive impairment is very high at 40.2% in geriatric
patients undergoing elective non-cardiac surgery.

<109>
[Use Link to view the full text]
Accession Number
649081792
Title
Cryoanalgesia Increases Neuropathic Pain in Adults Undergoing Minimally
Invasive Surgery: A 1-Year Follow-up of a Randomized Study.
Source
Annals of surgery. (no pagination), 2025. Date of Publication: 07 Nov
2025.
Author
Drake L.; Weksler B.; Specht K.; Kuchta P.; Crist L.; Williams B.A.;
Fernando H.C.
Institution
(Drake) Division of Thoracic and Esophageal Surgery, Cardiovascular
Institute, Allegheny Health Network, Pittsburgh, PA, United States
Abstract
OBJECTIVE: We previously reported results of a randomized trial comparing
standard intercostal nerve block (SOC) with SOC plus cryoanalgesia (CRYO)
in minimally invasive lung surgery. While no benefit was seen in early
postoperative pain or opioid use, CRYO patients had significantly higher
Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores at two
weeks. We now report one-year follow-up outcomes using LANSS and Visual
Analog Scale (VAS). METHOD(S): This randomized trial (NCT05348447)
enrolled adults undergoing minimally invasive thoracic surgery. SOC
patients received intercostal nerve blocks (INB) with bupivacaine and
lidocaine. CRYO patients received the same INB plus cryoablation of 5-6
intercostal nerves (120 seconds each). Patients were followed at 3, 6, and
12 months. LANSS scores >=12 indicated neuropathic pain. Pain severity was
assessed using VAS. RESULT(S): Follow-up data were available for 76
patients at 3 months (36 SOC, 40 CRYO), 82 at 6 months (42 SOC, 40 CRYO),
and 84 at 12 months (44 SOC, 40 CRYO). Median LANSS scores were higher in
CRYO at all timepoints: 10 vs. 0.5 (P=0.003), 8 vs. 0 (P<0.001), and 4.5
vs. 0 (P<0.001). At 3, 6, and 12 months respectively, more CRYO patients
had LANSS >=12 (40% vs. 19%, 33% vs. 10%, 30% vs. 5%; P=0.031, 0.010,
0.002), and higher VAS scores were observed at 3 and 6 months (P=0.012,
0.028) but not at 12 months (P=0.168). CONCLUSION(S): Cryoanalgesia
increased neuropathic pain incidence and severity through one year.
Without early clinical benefit, its use in minimally invasive thoracic
surgery warrants caution. Copyright © 2025 Wolters Kluwer Health,
Inc. All rights reserved.

<110>
[Use Link to view the full text]
Accession Number
649076216
Title
Effect of Remimazolam on Hemodynamic Stability in Patients Undergoing
Cardiac Surgery: A Grade-Assessed Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Cardiology in review. (no pagination), 2025. Date of Publication: 06 Nov
2025.
Author
Jamal A.; Khan S.; Qadri M.; Shah M.A.; Ahmed U.; Iftikhar H.; Uddin M.;
Bacha Z.; Khalid A.A.; Khan A.; Afridi Z.; Fatima N.E.; Ullah A.; Javed
J.; Khan H.; Mohmand M.S.; Khan F.Z.; Ulain Q.
Institution
(Jamal, Khan, Shah, Iftikhar, Uddin, Bacha, Afridi, Fatima, Ullah,
Mohmand) From the Department of Medicine, Khyber Medical College,
Peshawar, Pakistan
(Qadri, Ahmed, Javed) Department of Medicine, Jinnah Sindh Medical
University, Karachi, Pakistan
(Khalid) Department of Medicine, Peshawar Medical College, Peshawar,
Pakistan
(Khan) Department of Medicine, Khyber Girls Medical College, Peshawar,
Pakistan
(Khan) Department of Medicine, Anwar Teaching Hospital Swat, Swat,
Pakistan
(Khan) Department of Medicine, Hayatabad Medical Complex, Peshawar,
Pakistan
(Ulain) Department of Medicine, Women Medical College, Pakistan
Abstract
Hemodynamic instability during cardiac surgery, particularly procedures
requiring cardiopulmonary bypass, increases the risk of mortality and
adverse events. Conventional anesthetics such as propofol and etomidate
have limitations in maintaining stability, prompting investigation of
remimazolam, an ultra-short-acting benzodiazepine with a potentially
favorable cardiovascular profile. This systematic review and meta-analysis
evaluated the effects of remimazolam versus conventional anesthetics on
hemodynamic stability, vasopressor use, extubation time, and recovery in
cardiac surgery. Seven randomized controlled trials involving 557 patients
were included following literature searches in PubMed, Scopus, and
Cochrane Central Register of Controlled Trials. Data extraction and
risk-of-bias assessment were conducted using the Cochrane RoB 2 tool, and
certainty of evidence was graded with the Grading of Recommendations
Assessment, Development, and Evaluation approach. Pooled analysis showed
no significant differences in operative time (mean difference: 1.91
minutes, P = 0.53) or mean arterial pressure (mean difference: -0.90 mm
Hg, P = 0.80). The risk of intraoperative hypotension was higher but not
statistically significant with remimazolam (risk ratios: 1.25, P = 0.57);
however, sensitivity analysis excluding one study demonstrated a
significant 64% increase in hypotension risk (risk ratios: 1.64, P =
0.005), suggesting possible hemodynamic vulnerability. Remimazolam
significantly shortened extubation time by 27.98 minutes (P = 0.04), while
hospital stay, vasopressor use, and postoperative nausea and vomiting
showed no significant differences. Overall, remimazolam did not
significantly improve intraoperative hemodynamic stability compared with
conventional anesthetics, but its main potential advantage may lie in
enhancing recovery through faster extubation. The clinical importance of
this finding remains uncertain, and remimazolam should not currently be
regarded as superior for stability in cardiac anesthesia. Large,
standardized randomized controlled trials are required to further define
its safety and efficacy in cardiac surgery. Copyright © 2025
Wolters Kluwer Health, Inc. All rights reserved.

<111>
Accession Number
649091628
Title
Adult heart transplantation in the USA and Western Europe: state of the
art review.
Source
European heart journal. (no pagination), 2025. Date of Publication: 10
Nov 2025.
Author
Chen C.W.; Saeed D.; Woo Y.J.
Institution
(Chen, Woo) Department of Cardiothoracic Surgery, Stanford University
School of Medicine, 300 Pasteur Drive, Palo Alto, CA 94305-5407, USA
(Saeed) Department of Cardiovascular Surgery, Heart Center Niederrhein,
Health and Medical University Krefeld, Krefeld, Germany
Abstract
Heart transplantation has made remarkable strides since its inception in
the 1960s. While the transplant volume in the USA has steadily increased
over the last decade, significant disparities exist in Europe, fuelled by
cultural and legislative differences. Recent advancements such as donation
after circulatory death and use of hepatitis C positive donors are
embraced to differing degrees among countries. This review serves to
summarize the current state and ongoing challenges of heart
transplantation in the USA and Europe. Copyright © The Author(s)
2025. Published by Oxford University Press on behalf of the European
Society of Cardiology. All rights reserved. For commercial re-use, please
contact reprints@oup.com for reprints and translation rights for reprints.
All other permissions can be obtained through our RightsLink service via
the Permissions link on the article page on our site-for further
information please contact

<112>
Accession Number
2041562164
Title
Meta-analysis of the diagnostic accuracy of computed tomography
angiography compared with invasive coronary angiography in preoperative
cardiac surgery planning: a focus on valve surgery patients.
Source
Open Heart. 12(2) (no pagination), 2025. Article Number: e003768. Date of
Publication: 10 Nov 2025.
Author
Alwaheidi D.; Ehtesham A.; Azizi S.; Tbishat L.; Lateef Wani M.; Almulla
A.
Institution
(Alwaheidi, Ehtesham, Azizi, Lateef Wani, Almulla) Hamad Medical
Corporation, Doha, Qatar
(Tbishat) The University of Jordan, Amman Governorate, Amman, Jordan
Publisher
BMJ Publishing Group
Abstract
Objective To investigate the diagnostic performance of coronary CT
angiography (CCTA) for assessing significant coronary artery disease (CAD)
in patients referred for surgical aortic valve replacement or
transcatheter aortic valve implantation (TAVI)\transcatheter aortic valve
replacement (TAVR), with invasive coronary angiography (ICA) as the
reference standard. Methods We performed a meta-analysis of 28 studies to
compare CCTA with ICA for preoperative coronary evaluation. Studies were
stratified into two subgroups: the first consisting of those which
included only patients undergoing valve surgery (n=19) and the second
including TAVI or mixed (TAVI and surgical) populations (n=9).
Sensitivity, specificity, positive predictive value (PPV), negative
predictive value (NPV) and accuracy were recorded or determined, and a
summary diagnostic performance was obtained by a random effects model.
Pooled forest plots and summary receiver operating characteristic curves
were also analysed. Results The overall sensitivity of CCTA to diagnose
significant CAD varied between 18 studies, ranging from 85% to 94%; the
pooled sensitivity over all 28 studies was 91% (95% CI 88% to 93%) and the
specificity was 88% (95% CI 84% to 91%). The pooled PPV was 78% (95% CI
72% to 83%), while the NPV was 95% (95% CI 93% to 97%). The diagnostic
performance of the study was 89.8%. Conclusions CCTA is a trustworthy,
non-invasive diagnostic option to rule out significant CAD in patients
undergoing valve surgery. Its high specificity in surgical candidates
favours its use as a 'gatekeeper' to ICA with a potential reduction in
unnecessary invasive surgery. Copyright © Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<113>
Accession Number
649087000
Title
A Standardized Remediation Approach for the Integrated Cardiothoracic
Surgery Trainee: Review of Current Paradigms and Suggested Strategies.
Source
The Annals of thoracic surgery. (no pagination), 2025. Date of
Publication: 06 Nov 2025.
Author
Hutson J.; Aggarwal R.; Robinson J.; Naselsky W.; Gicovi K.; Stewart S.
Institution
(Hutson, Aggarwal) Michigan State University College of Human Medicine,
East Lansing, MI, United States
(Robinson, Gicovi, Stewart) University of Maryland School of Medicine,
Baltimore, MD, USA; University of Maryland Department of Surgery,
Baltimore, MD, USA
(Naselsky) Houston Methodist, Houston, TX, United States
Abstract
BACKGROUND: Effective remediation is essential for the success of
residency programs, yet integrated cardiothoracic (I6) surgery training
lacks standardized guidelines. Drawing from remediation practices in other
surgical subspecialties, this study evaluates existing strategies and
proposes a structured remediation framework tailored to I6 trainees.
 METHOD(S): A systematic review was conducted through December 2024,
examining remediation policies in surgical residency programs. Studies
meeting inclusion criteria were critically analyzed, and key themes were
synthesized to inform a standardized approach for I6 trainees.
 RESULT(S): Of 236 identified articles, 18 met inclusion criteria.
Findings emphasized the importance of regular assessments, structured
performance evaluations, and collaborative intervention strategies,
including faculty mentorship and success teams. Standardized remediation
protocols, as seen in neurosurgery and orthopedics, were instrumental in
addressing competency deficiencies through competency-based assessments
and curriculum refinements. CONCLUSION(S): I6 training demands a
multifaceted remediation approach encompassing technical proficiency,
clinical acumen, and professional development. By integrating best
practices from related surgical fields, this study proposes a tailored,
evidence-based remediation framework to enhance surgical education and
support struggling residents. Establishing a standardized remediation
policy across I6 programs can optimize training outcomes, ensuring
competence and preparedness among future cardiothoracic
surgeons. Copyright © 2025. Published by Elsevier Inc.

<114>
[Use Link to view the full text]
Accession Number
649082322
Title
Comparative effects of flow- versus volume-controlled one-lung ventilation
on gas exchange and respiratory system mechanics in thoracic surgery: A
randomised controlled clinical trial.
Source
European journal of anaesthesiology. (no pagination), 2025. Date of
Publication: 07 Nov 2025.
Author
Wittenstein J.; Kramer T.; Mutschke A.-K.; Huhle R.; Piorko S.; Dorfinger
L.; Tempel F.; Schweigert M.; Mauer R.; Koch T.; Schultz M.; Richter T.;
Krassler J.; Scharffenberg M.; Gama de Abreu M.
Institution
(Wittenstein) From the Pulmonary Engineering Group Dresden, Department of
Anaesthesiology and Intensive Care Medicine, TUD Dresden University of
Technology, Dresden, Germany (JW, TKr, AKM, RH, SP, LD, FT, TKo, TR,
MGdeA), The Department of Thoracic Surgery, University Hospital
Schleswig-Holstein, Luebeck, Germany (MS), The Faculty of Medicine Carl
Gustav Carus, Institute for Medical Informatics and Biometry, Technische
Universitat, Dresden, Germany (RM), The Department of Intensive Care,
Amsterdam UMC Location AMC, 1105 AZ Amsterdam, The Netherlands (MS), The
Department of Anesthesiology, Thoracic Center Coswig, Cowsig, Germany
(JK), The Division of Intensive Care and Resuscitation, Department of
Anesthesiology, Integrated Healthcare Institute, Cleveland Clinic,
Cleveland, OH, United States (MGdeA), The Outcomes Research Consortium,
Department of Anesthesiology, Integrated Healthcare Institute, Cleveland
Clinic, Cleveland, OH, United States (MGdeA)
Abstract
BACKGROUND: The effect of flow-controlled ventilation (FCV) as compared
with volume-controlled ventilation (VCV) on oxygenation and respiratory
system mechanics in patients undergoing one-lung ventilation (OLV) is
unknown. OBJECTIVE(S): To test the hypothesis that FCV would improve
oxygenation and respiratory system mechanics compared with VCV during OLV.
DESIGN: Two-centre, two-arm, randomised controlled clinical trial.
SETTING: University hospital and speciality hospital for pulmonary
diseases in Germany. PATIENTS: A total of 78 thoracic surgery patients
undergoing OLV for more than 30 min. INTERVENTIONS: Patients were randomly
assigned to OLV with FCV (n = 39), or VCV (n = 39). In both groups, OLV
was conducted with tidal volume of 5 ml kg-1, positive end-expiratory
pressure of 5 cmH2O, respiratory rate to normocapnia, and inspiratory
oxygen fraction of 1.0. MAIN OUTCOME MEASURES: The primary outcome was the
arterial partial pressure of oxygen (PaO2) 20 min after initiation of OLV.
The secondary outcomes included respiratory system mechanics, the need for
rescue due to hypoxaemia, and clinical outcome variables. RESULT(S):
The partial pressure of arterial oxygen did not differ between FCV and VCV
at 20 min after starting OLV (PaO2: 24.8 +/- 14.8 kPa vs. 26.1 +/- 15.9
kPa, mean difference -1.2 (95% confidence interval -8.2 to 5.7), P =
0.721), while mechanical power was lower during FCV compared with VCV.
Other variables did not differ at any time thereafter, except for the
compliance of the respiratory system at end of surgery. The need for
rescue manoeuvres due to hypoxemia or hypercapnia during OLV did not
differ between the groups. The incidence of postoperative pulmonary and
extrapulmonary complications, as well as the number of hospital-free days
at day 30 after surgery, did not differ between FCV and VCV.
 CONCLUSION(S): Compared with VCV in thoracic surgery patients, FCV
did not improve oxygenation or respiratory system mechanics during OLV,
nor was it associated with improved outcomes. Copyright © 2025
European Society of Anaesthesiology and Intensive Care. Unauthorized
reproduction of this article is prohibited.

<115>
Accession Number
2041100083
Title
Association Between Perioperative Sleep Disorders and Post-Operative
Delirium in Cardiac Surgeries: A Systematic Review and Meta-Analysis.
Source
Journal of Sleep Research. (no pagination), 2025. Date of Publication:
2025.
Author
Varpaei H.; Deka P.; Robbins L.B.; Farhadi K.; Reeves M.; Mowbray F.; Quan
S.F.
Institution
(Varpaei, Deka, Robbins, Mowbray) College of Nursing, Michigan State
University, East Lansing, MI, United States
(Deka) College of Nursing, Wayne State University, Detroit, MI, United
States
(Farhadi) Anesthesia, Critical Care, and Pain Management Research Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Reeves) Department of Epidemiology and Biostatistics, College of Human
Medicine, Michigan State University, East Lansing, MI, United States
(Quan) Division of Sleep and Circadian Disorders, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Post-operative delirium (POD) is an acute deterioration in cognitive
function and highly prevalent after cardiac surgery (CS; up to 55%).
Perioperative sleep disorders (PSD) are also commonly noted in surgical
patients (up to 60%). The primary aim of our systematic review is to
determine the association between PSD and POD in CS patients during their
hospital stay. We searched five databases (PubMed, CINAHL, Web of Science,
Scopus, and EMBASE) to identify studies evaluating the association between
PSD and POD amongst CS (any open-heart CS) patients, without time and
geographic restriction. Original articles that focused on adults
undergoing cardiac surgeries and assessed sleep and POD were included. We
conducted a meta-analysis using a random effects model to determine the
effect of sleep quality on POD. Thirty-three studies were included (63%
observational designs); most studies originated from China (33%). The most
frequently used subjective and objective sleep assessment tools were the
Pittsburgh Sleep Quality Index (PSQI) (33%) and polysomnography (18%).
After pooling observational data, we identified an incidence of POD
ranging from 3.6% to 73%. Increased PSQI scores (standard threshold > 5)
were associated with a greater likelihood of POD occurrence (standardised
mean difference [SMD] = 0.73, p > 0.05). Lower total sleep time (SMD =
-0.68, p < 0.05) was associated with an increased risk of POD. Poor sleep
quality, insomnia, and sleep-disordered breathing are prevalent forms of
PSD and are major risk factors for POD following CS. Additional research
is warranted to clarify when sleep quality normalises after cardiac
surgery and how targeted interventions can accelerate this
recovery. Copyright © 2025 The Author(s). Journal of Sleep
Research published by John Wiley & Sons Ltd on behalf of European Sleep
Research Society.

<116>
Accession Number
649081565
Title
The internal mammary artery - use as a free graft in coronary artery
bypass grafting - evidence, technical considerations and controversies.
Source
Perfusion. (pp 2676591251393446), 2025. Date of Publication: 06 Nov 2025.
Author
Navaratnarajah M.; Al-Zubaidi F.I.; Raja S.G.
Institution
(Navaratnarajah) Department of Cardiac Surgery, St Thomas Hospital,
London, United Kingdom
(Al-Zubaidi) Department of Cardiac Surgery, John Radcliffe Hospital,
Oxford, United Kingdom
(Raja) Department of Cardiac Surgery, Harefield Hospital, Middlesex,
United Kingdom
Abstract
BackgroundIn-situ internal mammary artery (IMA) grafting remains the gold
standard in coronary artery bypass grafting (CABG), particularly for left
anterior descending artery revascularisation. However, the role of
free-IMA grafts-especially free right IMA (RIMA) and select cases of free
left IMA (LIMA)-has expanded in response to anatomical and technical
constraints. This narrative review synthesises current evidence on
free-IMA use during CABG.MethodsA structured literature search was
conducted using PubMed (1946-2025) and Embase (1974-2025), supplemented by
Web of Science, Google Scholar, and thesis repositories. Studies were
included if they reported outcomes related to free-IMA grafting,
regardless of pump status or harvesting technique. Of 74 eligible studies,
9 chosen studies specifically reported free-RIMA outcomes and were
analysed in detail.ResultsFree-RIMA grafting demonstrated excellent
long-term patency (up to 96%) and favourable survival outcomes when used
as composite or direct aorto-coronary grafts. Multi-arterial grafting
(MAG) and total arterial grafting (TAG) strategies incorporating free-IMA
conduits were associated with reduced major adverse cardiac events (MACE)
and improved freedom from repeat revascularisation. Despite these
benefits, uptake of free-IMA techniques remains low in Europe and North
America, often limited by institutional preferences and operator
experience.ConclusionCurrent evidence supports the selective use of
free-IMA grafts in CABG, particularly when in-situ deployment is not
feasible. Prospective studies are needed to validate long-term outcomes
beyond 10 years, compare free-IMA with radial artery grafts, and define
optimal arterial configurations for durable revascularisation.

<117>
Accession Number
2041513885
Title
Use of the win ratio approach to assess outcomes in the DapaTAVI trial.
Source
Revista Espanola de Cardiologia. (no pagination), 2025. Date of
Publication: 2025.
Author
Rossello X.; Gonzalez-Manzanares R.; Amat-Santos I.; Peral Disdier V.;
Nieto Roca L.; Lopez Otero D.; Nombela Franco L.; Gheorge L.; Sanz-Sanchez
J.; Gomez Herrero J.; Gonzalez Ferreiro R.; Munoz Garcia A.J.; Vilalta V.;
Ojeda S.; Veiga Fernandez G.; Cordoba Soriano J.G.; Regueiro A.; Sandin
Rollan M.; Flores Rios X.; Uribarri A.; Martin Reyes R.; Romaguera R.;
Avanzas P.; Garcia Blas S.; Franco-Pelaez J.A.; Martin Moreiras J.;
Gonzalez Juanatey J.R.; Tirado G.; Calle G.; Diez J.L.; Santos-Martinez
S.; Melendo Viu M.; Carrillo Suarez X.; Sanmartin X.; Gonzalo N.;
Gutierrez Barrios A.; Gonzalez Bermudez I.; Real C.; Fuster V.; Ibanez B.;
Raposeiras-Roubin S.
Institution
(Rossello, Peral Disdier, Nieto Roca) Unidad de Cardiologia, Institut
d'Investigacio Sanitaria Illes Balears (IdISBa), Hospital Universitari Son
Espases, Palma de Mallorca, Baleares, Spain
(Rossello, Peral Disdier, Nieto Roca) Facultad de Medicina, Universitat de
les Illes Balears (UIB), Palma de Mallorca, Baleares, Spain
(Rossello, Peral Disdier, Nieto Roca, Real, Fuster, Ibanez,
Raposeiras-Roubin) Departamento de Investigacion Clinica, Centro Nacional
de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
(Gonzalez-Manzanares, Ojeda) Unidad de Cardiologia, Hospital Universitario
Reina Sofia, Cordoba, Spain
(Gonzalez-Manzanares, Ojeda) Instituto Maimonides de Investigacion
Biomedica de Cordoba (IMIBIC), Cordoba, Spain
(Gonzalez-Manzanares, Amat-Santos, Gomez Herrero, Avanzas, Garcia Blas,
Gonzalez Juanatey, Santos-Martinez, Ibanez) Centro de Investigacion
Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de
Salud Carlos III, Madrid, Spain
(Amat-Santos, Gomez Herrero, Santos-Martinez) Unidad de Cardiologia,
Hospital Clinico Universitario de Valladolid, Valladolid, Spain
(Lopez Otero, Sanmartin) Unidad de Cardiologia, Hospital Universitario
Montecelo, Pontevedra, Spain
(Lopez Otero, Gonzalez Juanatey, Sanmartin) Unidad de Cardiologia,
Hospital Clinico Universitario de Santiago, Santiago de Compostela, A
Coruna, Spain
(Lopez Otero, Gonzalez Ferreiro, Melendo Viu, Gonzalez Bermudez,
Raposeiras-Roubin) Instituto de Investigacion Sanitaria Galicia Sur, Vigo,
Pontevedra, Spain
(Nombela Franco, Tirado, Gonzalo, Real) Unidad de Cardiologia, Hospital
Clinico Universitario San Carlos, Madrid, Spain
(Gheorge, Calle, Gutierrez Barrios) Unidad de Cardiologia, Hospital Puerta
del Mar, Cadiz, Spain
(Sanz-Sanchez, Diez) Unidad de Cardiologia, Hospital Universitario La Fe,
Valencia, Spain
(Gonzalez Ferreiro, Melendo Viu, Gonzalez Bermudez, Raposeiras-Roubin)
Unidad de Cardiologia, Hospital Universitario Alvaro Cunqueiro, Vigo,
Pontevedra, Spain
(Munoz Garcia) Unidad de Cardiologia, Hospital Universitario Virgen de la
Victoria, Malaga, Spain
(Vilalta, Carrillo Suarez) Unidad de Cardiologia, Hospital Universitario
German Trias i Pujol, Badalona, Barcelona, Spain
(Ojeda) Departamento de Ciencias Medicas y Quirurgicas. Universidad de
Cordoba, Cordoba, Spain
(Veiga Fernandez, Sanmartin) Unidad de Cardiologia, Hospital Universitario
Marques de Valdecilla, Santander, Spain
(Veiga Fernandez) Instituto de Investigacion Valdecilla (IDIVAL),
Santander, Spain
(Cordoba Soriano) Unidad de Cardiologia, Hospital Universitario de
Albacete, Albacete, Spain
(Regueiro) Unidad de Cardiologia, Hospital Clinic, Barcelona, Spain
(Sandin Rollan) Unidad de Cardiologia, Hospital General Universitario de
Alicante, Alicante, Spain
(Flores Rios) Unidad de Cardiologia, Hospital Universitario Juan Canalejo,
A Coruna, Spain
(Uribarri) Unidad de Cardiologia, Hospital Universitario Vall d'Hebron,
Barcelona, Spain
(Martin Reyes) Unidad de Cardiologia, Hospital Universitario QuironSalud
La Luz, Madrid, Spain
(Romaguera) Unidad de Cardiologia, Hospital Universitario de Bellvitge,
L'Hospitalet de Llobregat, Barcelona, Spain
(Avanzas) Unidad de Cardiologia, Hospital Universitario Central de
Asturias, Oviedo, Spain
(Avanzas) Instituto de Investigacion Sanitaria del Principado de Asturias
(ISPA), Oviedo, Spain
(Avanzas) Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
(Garcia Blas) Hospital Clinico Universitario de Valencia, Valencia, Spain
(Garcia Blas) Instituto de Investigacion Sanitaria INCLIVA, Valencia,
Spain
(Franco-Pelaez, Ibanez) Unidad de Cardiologia, Hospital Universitario
Fundacion Jimenez Diaz, Madrid, Spain
(Martin Moreiras) Unidad de Cardiologia, Hospital Clinico Universitario de
Salamanca, Salamanca, Spain
(Gonzalez Juanatey) Instituto de Investigacion Sanitaria de Santiago
(IDIS), Santiago de Compostela, A Coruna, Spain
(Gonzalez Juanatey, Raposeiras-Roubin) Facultad de Medicina, Universidad
de Santiago de Compostela, Santiago de Compostela, A Coruna, Spain
(Fuster) Cardiovascular Institute, Icahn School of Medicine at Mount
Sinai, Nueva York, United States
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: The win ratio (WR) approach is used to assess
composite endpoints in a hierarchical fashion. This novel method offers an
excellent opportunity to assess the robustness of the findings yielded by
landmark trials, such as the DapaTAVI trial. Method(s): We applied
the WR method to evaluate the treatment effect of dapagliflozin in
hierarchically ordered clinical outcomes. Several combinations of outcomes
were tested, including time-to-event, binary, and continuous endpoints.
 Result(s): The WR of the original primary endpoint was 1.36 (95%CI,
1.03-1.78; P = .028), comparable to the reciprocal of the original hazard
ratio (1/HR, 1.38; 95%CI, 1.06-1.81). The win difference was 4.84% (95%CI,
0.55-9.12), confirming consistent findings in terms of absolute effect.
Alternative combinations of the primary outcome with different
prioritization of its components yielded similar treatment effects and
statistical significance. Ignoring a time-to-event approach and including
recurrent events did not substantially affect treatment efficacy and its
statistical significance. In contrast, the inclusion of the total length
of stay for heart failure hospitalizations in the hierarchy shifted the
point estimate toward the null. Including New York Heart Association
functional class improved the precision of the estimate (WR = 1.31; 95%CI,
1.09-1.56; P = .003). Conversely, including quality of life through Kansas
City Cardiomyopathy Questionnaire comparisons shifted the overall estimate
toward the null (WR = 1.10; 95%CI, 0.94-1.30; P = .236).
 Conclusion(s): The WR approach is a solid method to assess treatment
efficacy. We observed consistent findings using this approach in the
DapaTAVI trial. Copyright © 2025 Sociedad Espanola de Cardiologia

<118>
Accession Number
649066377
Title
Economic outcomes and quality of life after CABG or PCI for multivessel
disease: The FAME 3 Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 15 Oct 2025.
Author
Hlatky M.A.; Ding V.Y.; Zimmermann F.M.; Piroth Z.; Davidavicius G.;
Mansour S.; Kharbanda R.; Jokhaji F.; Oldroyd K.G.; Wendler O.; Reardon
M.J.; Sreckovic M.; Yeung A.C.; Pijls N.H.J.; De Bruyne B.; Desai M.;
Fearon W.F.
Institution
(Hlatky) Division of Cardiovascular Medicine and Stanford Cardiovascular
Institute, Stanford University, Stanford, CA; Department of Health Policy,
Stanford University, Stanford, CA
(Ding, Desai) Quantitative Sciences Unit, Stanford University, Stanford,
CA, United States
(Zimmermann) St. Antonius Hospital, Nieuwegein, the Netherlands, and
Catharina Hospital, Eindhoven, the Netherlands
(Piroth) Gottsegen National Cardiovascular Center, Hungary
(Davidavicius) Clinic of Cardiac and Vascular Diseases, Institute of
Clinical Medicine, Vilnius University, Lithuania and Vilnius University
Hospital Santaros Klinikos, Vilnius, Lithuania
(Mansour) Centre Hospitalier de l'Universite de Montreal, Canada
(Kharbanda) Oxford University Hospital NHS Trust, Oxford, United Kingdom
(Jokhaji) Department of Clinical Sciences, Danderyd University Hospital
and Karolinska Institutet, Stockholm, Sweden
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Wendler) LondonUnited Kingdom
(Reardon) Houston Methodist Hospital, Houston, TX, United States
(Sreckovic) Department of Cardiology, University Clinical Centre
Kragujevac, University of Kragujevac, Serbia
(Yeung) Division of Cardiovascular Medicine and Stanford Cardiovascular
Institute, Stanford University, Stanford, CA, United States
(Pijls) Catharina Hospital, Eindhoven, Netherlands
(De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium; Lausanne
University Centre Hospital, Lausanne, Switzerland
(Fearon) Division of Cardiovascular Medicine and Stanford Cardiovascular
Institute, Stanford University, Stanford, CA; VA Palo Alto Health Care
System, Palo Alto CA
Abstract
BACKGROUND: Previous studies have found coronary artery bypass grafting
(CABG) to be cost-effective compared with percutaneous coronary
intervention (PCI) among patients with multivessel coronary artery disease
(CAD), but their comparative effectiveness and economic outcomes may have
changed. OBJECTIVE(S): We sought to compare the economic and quality
of life outcomes of CABG versus PCI and determine their cost-effectiveness
in the Fractional Flow Reserve (FFR) versus Angiography for Multivessel
Evaluation (FAME) 3 randomized trial. METHOD(S): FAME 3 randomly
assigned 1500 patients with three-vessel CAD to either CABG or FFR-guided
PCI using zotarolimus drug-eluting stents (DES). We documented resource
use and quality of life over five years of follow-up. We calculated costs
by applying Medicare reimbursement rates to resources used, assessed
quality of life using the EuroQOL EQ-5D, calculated quality-adjusted
life-years (QALYs) from EQ-5D utility values, and used multivariable
regression to compare outcomes by treatment assignment. We calculated the
incremental cost-effectiveness ratio (ICER) based on five-year outcomes
and also on projected life expectancies, and assessed its variability in
10,000 bootstrap replications. RESULT(S): Cumulative costs over five
years were 30% higher in patients assigned to CABG (95% confidence
interval [CI], 16% to 46%, P<0.001). QALYs over five years did not differ
significantly between the PCI (4.05+/-0.84) and CABG groups (4.03+/-0.82),
although EQ-5D scores improved more rapidly after PCI. Patients < 65 years
of age at enrollment assigned to PCI were more likely to be employed at
five years (56% vs 47%, p=0.025). PCI had greater economic value than CABG
over five years, with lower costs and higher QALYs in 66% of replications,
and ICERs for CABG above the $150,000/QALY benchmark in 98% of bootstrap
replications. These findings were essentially unchanged in several
lifetime projections based on the outcomes documented within the trial
follow-up period. CONCLUSION(S): FFR-guided PCI using zotarolimus DES
provides significantly better long-term value than CABG for treatment of
patients with multivessel CAD, with equivalent clinical outcomes at
substantially lower cost. Copyright © 2025. Published by Elsevier
Inc.

<119>
Accession Number
649075031
Title
Mid-term Outcomes of Transcatheter Aortic Valve Replacement vs. Surgical
Aortic Valve Replacement in Low-to-Moderate Risk Patients with Severe
Aortic Stenosis: A Systematic Review and Meta-analysis.
Source
Brazilian journal of cardiovascular surgery. 41(1) (no pagination), 2026.
Date of Publication: 01 Jan 2026.
Author
Pascoal C.A.D.; Faria H.S.; Francisco A.J.; Peres C.A.P.; Tavares L.F.;
Masiero B.B.; Doma M.; Manuel V.
Institution
(Pascoal, Francisco) Universidade Agostinho Neto Department of Medicine
Luanda Angola Department of Medicine, Universidade Agostinho Neto, Luanda,
Angola
(Faria) Universidade Federal de Santa Maria, Universidade Federal de Santa
Maria Escola de Medicina Santa Maria Rio Grande do Sul Brazil Escola de
Medicina, Santa Maria, Rio Grande do Sul, Brazil
(Peres) Universidade de Pernambuco Department of Medicine Recife
Pernambuco Brazil Department of Medicine, Universidade de Pernambuco,
Recife, Pernambuco, Brazil
(Tavares) Universidade Federal de Alfenas Department of Medicine Alfenas
Minas Gerais Brazil Department of Medicine, Universidade Federal de
Alfenas, Alfenas, Minas Gerais, Brazil
(Masiero) Pontificia Universidade Catolica do Rio Grande do Sul,
Pontificia Universidade Catolica do Rio Grande do Sul Department of
Medicine Porto Alegre Rio Grande do Sul Brazil Department of Medicine,
Porto Alegre, Rio Grande do Sul, Brazil
(Doma) Alexandria Faculty of Medicine Alexandria Egypt Alexandria Faculty
of Medicine, Alexandria, Egypt
(Manuel) Complexo Hospitalar de Doencas Cardio-Pulmonares Cardeal Dom
Alexandre do Nascimento Luanda Angola Complexo Hospitalar de Doencas
Cardio-Pulmonares Cardeal Dom Alexandre do Nascimento, Luanda, Angola
Abstract
INTRODUCTION: Several clinical trials have demonstrated the
non-inferiority of transcatheter aortic valve replacement compared with
surgical aortic valve replacement in patients with severe aortic stenosis
and low to intermediate surgical risk. However, mid-term results are still
contentious. We performed this meta-analysis to compare the safety and
efficacy of transcatheter vs. surgical aortic valve replacement in the
mid-term in patients with aortic stenosis at low to moderate surgical
risk. METHOD(S): We searched Embase, PubMed, and Cochrane databases
for randomized clinical trials that compared transcatheter with surgical
aortic valve replacement in patients with symptomatic severe aortic
stenosis with a follow-up of at least four years. Outcomes of interest
were all-cause mortality and disabling stroke. RESULT(S): We included
six randomized clinical trials encompassing 6,444 patients with severe
aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic
valve replacement. There was no difference in all-cause mortality (risk
ratio [RR] 1.08; 95% confidence interval [CI] 0.94 - 1.25; P = 0.30) and
disabling stroke (RR 0.95; 95% CI 0.75 - 1.21; P = 0.67) between groups.
In the subgroup analysis, five-year mortality (RR 1.28; 95% CI 1.10 -
1.49) was higher in the transcatheter group. The new pacemaker
implantation (RR 2.22; 95% CI 1.42 - 3.45) rate was higher in the
transcatheter group. However, the new atrial fibrillation (RR 0.40; 95% CI
0.31 - 0.52) rate was higher in the surgical group. CONCLUSION(S):
Mid-term mortality and disabling stroke rates in patients with severe
aortic stenosis treated with either transcatheter or surgical aortic valve
replacement were similar.

<120>
Accession Number
649066083
Title
Neoaortic outcomes after the arterial switch operation: A systematic
review and meta-analysis.
Source
Archives of cardiovascular diseases. (no pagination), 2025. Date of
Publication: 22 Oct 2025.
Author
Negm S.; Mahmoud A.B.; Desnous B.; Elatafy E.E.; Fouilloux V.; Gran C.;
Mace L.; Lenoir M.
Institution
(Negm) Department of Cardio-Thoracic Surgery, Hopital de la Timone Enfants
et Adultes, AP-HM, Aix-Marseille University, 13385 Marseille, France;
Department of Cardio-Thoracic Surgery, Faculty of Medicine, Tanta
University, Tanta 31527, Egypt
(Mahmoud, Elatafy) Department of Cardio-Thoracic Surgery, Faculty of
Medicine, Tanta University, Egypt
(Desnous, Fouilloux, Gran, Mace, Lenoir) Department of Cardio-Thoracic
Surgery, Hopital de la Timone Enfants et Adultes, AP-HM, Aix-Marseille
University, Marseille, France
Abstract
BACKGROUND: The arterial switch operation has become the treatment of
choice for neonates with transposition of great arteries. AIM: This
systematic review and meta-analysis aimed to summarize the current
evidence regarding neoaortic root dilatation and aortic valve
insufficiency as long-term outcomes after the arterial switch operation,
and to identify associated risk factors. METHOD(S): A systematic
search of PubMed, EMBASE and Cochrane databases was conducted for human
studies published in English or French until May 2024. RESULT(S): Out
of 1480 identified records, 80 studies were included in the final
analysis. The total incidence of moderate-to-severe aortic insufficiency
was 588 out of 20,338 patients (2.89%). The total number of neoaortic
reinterventions was 306 in 11,291 patients (2.71%). The total number of
neoaortic reinterventions for aortic insufficiency was 78 in 4757 patients
(1.63%). Distensibility of both the aortic root and the ascending aorta in
patients after the arterial switch operation was significantly lower than
in the normal population. Several factors were significantly associated
with an increased risk of moderate-to-severe aortic insufficiency:
ventricular septal defect (P<0.001); pulmonary artery banding (P=0.007);
aortopulmonary mismatch (P<0.001); and neoaortic root dilatation
(P<0.001). Coronary anomalies showed a borderline association (P=0.055),
and the trapdoor technique was significant in one study (P=0.0005).
Distensibility of both the aortic root and the ascending aorta was found
to be significantly reduced in patients after the arterial switch
operation compared with healthy controls, reflecting increased vascular
stiffness. CONCLUSION(S): Significant neoaortic valve insufficiency
and reintervention remain relatively rare after the arterial switch
operation. However, measurable risk factors-including ventricular septal
defect, pulmonary artery banding, aortopulmonary mismatch and coronary
anomalies-are associated with an increased long-term risk of valve
dysfunction or surgical reintervention. Copyright © 2025 The
Authors. Published by Elsevier Masson SAS.. All rights reserved.

<121>
Accession Number
649065656
Title
Role of multimodality imaging in cardiac implantable electronic devices
related infection and infective endocarditis.
Source
Expert review of medical devices. (no pagination), 2025. Date of
Publication: 06 Nov 2025.
Author
Khayata M.; Goff Z.; Gordon S.; Callahan T.; Elgharably H.; Unai S.; Xu B.
Institution
(Khayata) Robert and Suzanne Tomsich Department of Cardiovascular
Medicine, Sydell and Arnold Family Heart, Vascular, Thoracic Institute,
Cleveland Clinic Cleveland, Oh, United States
(Goff, Xu) Ection of Cardiovascular Imaging, Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Sydell and Arnold Family Heart,
Vascular, Thoracic Institute, Cleveland Clinic Cleveland, Oh, United
States
(Gordon) Department of Infectious Diseases, Cleveland Clinic Cleveland,
Oh, United States
(Callahan) Section of Pacing and Electrophysiology, Robert and Suzanne
Tomsich Department of Cardiovascular, medicinesydell and Arnold Family
Heart, Vascular, Thoracic Institute, Oh, United States
(Elgharably, Unai) Department of Thoracic and Cardiovascular Surgery,
Sydell and Arnold Family Heart, Vascular, Thoracic Institute, Cleveland
Clinic Cleveland, Oh, United States
Abstract
INTRODUCTION: Infective endocarditis (IE) is a serious and increasingly
recognized condition, associated with significant morbidity and mortality.
The diagnosis of IE is more challenging in patients with implanted cardiac
devices such as cardiac implantable electronic devices, left ventricular
assist devices, and left atrial appendage occlusion devices. AREAS
COVERED: This review focuses on the contemporary roles and applications of
multi-modality imaging in the diagnosis and management of patients with
cardiac implantable electronic devices related infection and IE. The role
of multi-modality imaging in the diagnosis of patients with native or
prosthetic valve IE is beyond the scope of this review. A literature
search of the PubMed database was performed between 1 June 2024, and 30
June 2025. Relevant articles on the subjects of 'infective endocarditis,'
'multi-modality imaging,' and 'implanted cardiac devices' were used in our
review. EXPERT OPINION: The growth in using cardiac implanted electronic
devices (CIED) demands improvement in the detection of CIED-related
infections. Contemporary guidelines have considered utilizing
multimodality imaging to diagnose IE. The incremental value of
multimodality imaging remains to be rigorously examined, particularly, in
patients with contemporary implanted cardiac devices. Large observational
studies from tertiary centers might be the starting point toward strong
evidence of utilizing such advanced modalities.

<122>
Accession Number
2041514868
Title
Impact of Flow Status on Effective Orifice Area in Transcatheter Heart
Valves: A COMPARE-TAVI 1 Substudy.
Source
Journal of the American Society of Echocardiography. (no pagination),
2025. Date of Publication: 2025.
Author
Krasniqi L.; Terkelsen C.J.; Nissen H.; Freeman P.; Frederiksen C.A.; Vase
H.; Hejlesen K.; Fur C.B.; Thim T.; Eftekhari A.; Uttenthal F.; Ellert J.;
Borg Mogensen N.S.; Haujir A.; Christiansen E.H.; Dahl J.S.
Institution
(Krasniqi) Department of Cardiothoracic Surgery, Odense University
Hospital, Odense, Denmark
(Krasniqi, Dahl) Department of Clinical Research, University of Southern
Denmark, Odense, Denmark
(Terkelsen, Frederiksen, Vase, Hejlesen, Fur, Thim, Christiansen)
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Terkelsen, Thim, Christiansen) Department of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
(Nissen, Ellert, Borg Mogensen, Haujir, Dahl) Department of Cardiology,
Odense University Hospital, Odense, Denmark
(Freeman, Eftekhari, Uttenthal) Department of Cardiology, Aalborg
University Hospital, Aalborg, Denmark
(Dahl) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
Minnesota, United States
Publisher
Elsevier Inc.
Abstract
Objective: The aim of this study was to study the impact of flow status on
effective orifice area (EOA) in patients treated with the
balloon-expandable Myval and Sapien transcatheter heart valves (THVs).
 Method(s): We collected the core laboratory-measured EOA, mean and
peak gradients, Doppler velocity index (DVI), and stroke volume index
(SVi) from the 30-day echocardiograms in patients treated with the
balloon-expandable Myval and Sapien THVs in the COMPARE-TAVI 1 trial.
Patients were stratified according to flow into low flow (SVi <35
mL/m2), normal flow (SVi 35-50 mL/m2), and high flow
(SVi >50 mL/m2). Result(s): A total of 1,031 patients were
included in COMPARE-TAVI 1. Myval THVs (20.0-32.0 mm) exhibited overall
higher mean EOA and lower mean gradients (1.99 +/- 0.55 cm2,
9.46 +/- 3.84 mm Hg) compared to Sapien THVs (20-29 mm; 1.81 +/- 0.56
cm2, 11.47 +/- 4.47 mm Hg). Compared to normal-flow patients,
low-flow patients exhibited smaller EOA (P < .001) and lower DVI (P <
.001) in all valve sizes irrespective of THV platform, while high-flow
patients had larger EOA (P < .001) and higher DVI (P < .001). Female sex
was associated with lower stroke volume, resulting in lower mean and peak
gradients independent of valve size and platform (P < .001).
 Conclusion(s): The study indicates that EOA may be underestimated
after TAVI in patients with low-flow status, which can impact the
assessment of prosthesis-patient mismatch. Copyright © 2025
American Society of Echocardiography

<123>
Accession Number
2041527641
Title
Analgesic efficacy of continuous superficial parasternal intercostal plane
blockade in patients undergoing cardiac surgery with median sternotomy: A
randomized controlled trial.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2025. Article
Number: rapm-2025-107162. Date of Publication: 2025.
Author
Jen T.T.H.; Prabhakar C.; Matras P.-J.; Rondi K.; Bruce S.; Sun T.;
Edwards N.Y.; Mehta S.; Schwarz S.K.W.; Chau A.; Ree R.M.
Institution
(Jen, Prabhakar, Matras, Rondi, Bruce, Sun, Edwards, Schwarz, Chau, Ree)
Department of Anesthesiology, Providence Health Care, Vancouver, BC,
Canada
(Jen, Rondi, Bruce, Sun, Schwarz, Ree) Department of Anesthesiology
Pharmacology & Therapeutics, The University of British Columbia,
Vancouver, BC, Canada
(Prabhakar) Anesthesiology Pharmacology & Therapeutics, The University of
British Columbia, Vancouver, BC, Canada
(Mehta) Department of Critical Care and Department of Anaesthesia, Royal
Brompton and Harefield Hospitals, London, United Kingdom
(Chau) Department of Anesthesiology, Bc Women's Hospital and Health
Centre, Vancouver, BC, Canada
Publisher
BMJ Publishing Group
Abstract
Background Single-injection superficial parasternal intercostal plane
(SPIP) blockade provides an effective and low-risk analgesic option for
patients undergoing cardiac surgery with sternotomy, but their duration is
limited. We sought to evaluate whether continuous SPIP blockade, compared
with single-injection SPIP blockade, reduces acute sternal pain on
coughing at 24 hours after cardiac surgery. Methods We conducted a
randomized controlled parallel-arm superiority trial at a tertiary care
center in Vancouver, BC, Canada. We included English-speaking adult
patients undergoing scheduled cardiac surgery with full median sternotomy.
We randomized participants in a 1:1 ratio to intervention or control
groups, stratified by sex, using permuted block randomization with
variable block sizes of 4 or 6. Patients in both study groups received
bilateral SPIP catheters, with a 20 mL bolus of ropivacaine 0.2% through
each catheter followed by a 3 mL/hour infusion of study solution
(ropivacaine 0.2% in the intervention group and normal saline in the
control group) for 48 hours. All patients received standardized multimodal
analgesia. The primary outcome was the numeric rating scale (NRS) sternal
pain score on standardized coughing at 24 hours. Secondary outcomes
included sternal pain within 48 hours, opioid use, quality of recovery,
postoperative nausea or vomiting and chronic sternal pain. Patients,
healthcare providers, outcome collectors and data analysts were blinded to
group allocation. Results Eighty patients were randomized (n=40 per
group). Mean (SD) sternal pain (NRS) scores on coughing at 24 hours were
4.0 (2.2) in the intervention group versus 3.9 (2.2) in the control group.
The adjusted mean difference was -0.2 (95% CI -1.7 to 1.3; p=0.79). There
were no differences between the groups in secondary outcomes. One patient
in the intervention group experienced suspected local anesthetic systemic
toxicity requiring unblinding. No other major complications were noted.
Conclusions Continuous SPIP blockade did not demonstrate superiority over
single-injection SPIP blockade in reducing acute sternal pain on coughing
at 24 hours after cardiac surgery. Trial registration number
NCT05054179. Copyright © American Society of Regional Anesthesia
& Pain Medicine 2025.

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