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<1>
Accession Number
2037992848
Title
Survival after heart transplants from circulatory-dead versus brain-dead
donors: Meta-analysis of reconstructed time-to-event data.
Source
Transplantation Reviews. 39(2) (no pagination), 2025. Article Number:
100917. Date of Publication: 01 Apr 2025.
Author
Al-Tawil M.; Wang W.; Chandiramani A.; Zaqout F.; Diab A.H.; Sicouri S.;
Ramlawi B.; Haneya A.
Institution
(Al-Tawil, Diab, Haneya) Department of Cardiac and Thoracic Surgery, Heart
Center Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany
(Al-Tawil, Sicouri, Ramlawi) Department of Cardiothoracic Surgery
Research, Lankenau Institute for Medical Research, Wynnewood, PA, United
States
(Wang) Department of Surgery, Broomfield Hospital, Essex, Chelmsford,
United Kingdom
(Chandiramani) Department of Cardiology, Royal Papworth Hospital,
Cambridge, United Kingdom
(Zaqout) Department of Surgery, University College London, London, United
Kingdom
(Ramlawi) Lankenau Heart Institute, Wynnewood, PA, United States
Publisher
Elsevier Inc.
Abstract
Background: Heart transplantation (HTx) using donors after circulatory
death (DCD) has the potential to significantly boost overall transplant
rates. This study aims to reconstruct data from individual studies
comparing survival between HTx from DCD recipients and donation after
brain (DBD) recipients. Method(s): MEDLINE, Embase, Scopus, were
searched up to August 2024. We included studies that reported a
Kaplan-Meier summary of survival comparing DCD and DBD HTx. Digitization
of the Kaplan-Meier curves and reconstruction of individual patient data
followed by survival analysis that was conducted using R software.
 Result(s): Six studies including a total of 3240 patients (2242 DBD
and 998 DCD) were included in the final analysis. There was no significant
difference in the overall survival rates between DCD and DBD patients
(Hazard Ratio (HR): 1.01, 95 % CI [0.81-1.25], P = 0.91). However, the
proportional hazard assumption was violated, deeming such results
inconclusive. Time-varying flexible parametric model revealed a
significantly declining survival in DCD recipients 3 years after surgery.
Landmark analyses further suggest this declining trend in the DCD group at
the two-year landmark (HR: 1.67, p = 0.021) and the four-year mark (HR:
2.78, p = 0.002). However, data beyond 6 years is limited. Evidence
comparing direct procurement and normothermic regional perfusion is
scarce, with no significant survival differences observed.
 Conclusion(s): This meta-analysis shows that, despite similar early
survival outcomes, DCD heart transplants showed a trend towards a lower
long-term survival, with the difference becoming evident around three
years post-transplantation. These findings highlight the need for enhanced
monitoring and optimized post-transplant care in DCD recipients. Further
studies with strict and long-term follow-up are warranted to confirm these
results. Copyright © 2025 Elsevier Inc.

<2>
Accession Number
2037958528
Title
Early Aortic Valve Replacement in Asymptomatic Severe Aortic Stenosis: A
Meta-Analysis of Randomized Controlled Trials.
Source
American Journal of Cardiology. 245 (pp 11-16), 2025. Date of Publication:
15 Jun 2025.
Author
Brar S.K.; Leong D.W.; Razi R.R.; Moore N.; Zadegan R.; Mansukhani P.;
Brar S.S.
Institution
(Brar, Leong, Moore, Zadegan, Mansukhani, Brar) Regional Department of
Cardiac Catheterization, Kaiser Permanente, Los Angeles, California,
United States
(Razi, Brar) Kaiser Permanente School of Medicine, Pasadena, California,
United States
Publisher
Elsevier Inc.
Abstract
Determining the best time for aortic valve replacement (AVR) in
asymptomatic severe aortic stenosis (AS) with preserved left ventricular
function remains controversial, as current guidelines recommend waiting
until symptoms appear. Recent evidence suggests that early AVR may improve
outcomes for select patients. This meta-analysis of randomized controlled
trials evaluated the efficacy of early AVR, including surgical and
transcatheter approaches, versus conservative management in asymptomatic
severe AS. We systematically searched PubMed, Embase, CENTRAL, and
ClinicalTrials.gov to identify eligible trials. The outcomes of interest
included all-cause mortality, unplanned hospitalization, stroke, as well
as the composite endpoint of each trial, which was derived from
combinations of these outcomes. Four trials involving 1,427 patients were
included. Early AVR significantly reduced the risk of unplanned
hospitalizations (HR 0.42, 95% CI 0.33 to 0.53, p <0.001, I2 = 0%).
Although there was a trend towards reduced all-cause mortality, it did not
reach statistical significance (HR 0.76, 95% CI 0.48 to 1.21, I2 = 42%).
Stroke also trended lower with early AVR (HR 0.63, 95% CI 0.40 to 1.00, p
= 0.05, I2 = 0%). In conclusion, these findings indicate that early AVR
may provide clinical benefits by reducing adverse events in asymptomatic
severe AS, in particular unplanned rehospitalization, suggesting that
early AVR could be beneficial and should be considered in future guideline
revisions. Copyright © 2025 Elsevier Inc.

<3>
Accession Number
2037839843
Title
Outcomes of Deferring Percutaneous Coronary Intervention Without
Physiologic Assessment for Intermediate Coronary Lesions.
Source
Korean Circulation Journal. 55(3) (pp 186-195), 2025. Date of Publication:
01 Mar 2025.
Author
Kim J.; Lim S.-H.; Hahn J.-Y.; Jeong J.-O.; Park Y.H.; Chun W.J.; Oh J.H.;
Cho D.K.; Choi Y.J.; Im E.-S.; Won K.-H.; Lee S.Y.; Kim S.-W.; Choi K.H.;
Lee J.M.; Park T.K.; Yang J.H.; Song Y.B.; Choi S.-H.; Gwon H.-C.
Institution
(Kim, Hahn, Choi, Lee, Park, Yang, Song, Choi, Gwon) Department of
Medicine, Division of Cardiology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Lim) Department of Internal Medicine, Division of Cardiovascular
Medicine, Dankook University Hospital, Cheonan, South Korea
(Jeong) Cardiovascular Center, Chungnam National University Hospital,
Daejeon, South Korea
(Park, Chun, Oh) Department of Internal Medicine, Division of Cardiology,
Sungkyunkwan University School of Medicine, Samsung Changwon Hospital,
Changwon, South Korea
(Cho) Heart-Well Cardiology Clinic, Jeju, South Korea
(Choi) Division of Cardiology, Eulji Medical Center, Eulji University,
Daejeon, South Korea
(Im) Division of Cardiology, Dongsuwon General Hospital, Suwon, South
Korea
(Won) Department of Cardiology, Cardiovascular Center, Seoul, South Korea
(Lee) Department of Internal Medicine, Inje University Ilsan Paik
Hospital, Goyang, South Korea
(Kim) Department of Internal Medicine, Chung-Ang University College of
Medicine, Chung-Ang University Hospital, Seoul, South Korea
Publisher
Korean Society of Cardiology
Abstract
Background and Objectives: Outcomes of deferring percutaneous coronary
intervention (PCI) without invasive physiologic assessment for
intermediate coronary lesions is uncertain. We sought to compare long-term
outcomes between medical treatment and PCI of intermediate lesions without
invasive physiologic assessment. Method(s): A total of 899 patients
with intermediate coronary lesions between 50% and 70% diameter-stenosis
were randomized to the conservative group (n=449) or the aggressive group
(n=450). For intermediate lesions, PCI was performed in the aggressive
group, but was deferred in the conservative group. The primary endpoint
was major adverse cardiac events (MACE, a composite of all-cause death,
myocardial infarction [MI], or ischemia-driven any revascularization) at 3
years. Result(s): The number of treated lesions per patient was
0.8+/-0.9 in the conservative group and 1.7+/-0.9 in the aggressive group
(p=0.001). At 3 years, the conservative group had a significantly higher
incidence of MACE than the aggressive group (13.8% vs. 9.3%; hazard ratio
[HR], 1.49; 95% confidence interval [CI], 1.00-2.21; p=0.049), mainly
driven by revascularization of target intermediate lesion (6.5% vs. 1.1%;
HR, 5.69; 95% CI, 2.20-14.73; p<0.001). Between 1 and 3 years after the
index procedure, compared to the aggressive group, the conservative group
had significantly higher incidence of cardiac death or MI (3.2% vs. 0.7%;
HR, 4.34; 95% CI, 1.24-15.22; p=0.022) and ischemia-driven any
revascularization. Conclusion(s): For intermediate lesions, medical
therapy alone, guided only by angiography, was associated with a higher
risk of MACE at 3 years compared with performing PCI, mainly due to
increased revascularization. Copyright © 2025.

<4>
Accession Number
2036208939
Title
Reduced direct oral anticoagulant dose vs dual antiplatelet therapy after
left atrial appendage closure in patients with nonvalvular atrial
fibrillation: A systematic review and meta-analysis.
Source
Heart Rhythm. 22(4) (pp 979-986), 2025. Date of Publication: 01 Apr 2025.
Author
Lima N.A.; Filho F.W.P.A.; Mendes B.X.; Neto V.L.M.; d'Avila A.L.B.
Institution
(Lima, Mendes) Department of Medicine, Christus University Center, Ceara,
Fortaleza, Brazil
(Filho, Neto) Department of Medicine, Federal University of Ceara, Ceara,
Sobral, Brazil
(d'Avila) Departments of Medicine, Beth Israel Deaconess Medical Center
and Harvard Medical School, Boston, Massachusetts, United States
Publisher
Elsevier B.V.
Abstract
Background: Left atrial appendage closure (LAAC) is an alternative therapy
for patients with nonvalvular atrial fibrillation who are not eligible for
long-term oral anticoagulation. However, the optimal therapy after this
procedure still is controversial, especially in a subgroup of patients
with severe renal dysfunction. Objective(s): The purpose of this
study was to evaluate the use of low-dose direct oral anticoagulation
(l-DOAC) vs dual antiplatelet therapy (DAPT) after LAAC in patients with
nonvalvular atrial fibrillation. Method(s): We systematically
searched PubMed, Embase and Cochrane. Outcomes were the incidence of
device-related thrombus (DRT), major bleeding, stroke, cardiovascular
mortality, all-cause mortality, thromboembolic events (DRT, ischemic
stroke, transient ischemic attack, peripheral thromboembolism), and the
composite outcome of thromboembolic events and major bleeding. Risk ratios
(RRs) with 95% confidence intervals (CIs) were calculated using a random
effects model. Review Manager 5.4.1 was used for statistical analyses.
Heterogeneity was assessed with I2 statistics. Result(s): A total of
1015 participants from 2 randomized controlled trials and 3 nonrandomized
cohorts were included. The incidence of DRT was significantly reduced with
l-DOAC relative to DAPT (0.81% vs 5.08%, respectively; RR 0.37; 95% CI
0.15-0.94; P = .04; I2 = 0%). We also found the patients who
used l-DOAC had a reduction in the composite outcomes of thromboembolic
events and major bleeding (1.41% vs 11.13%; RR 0.14; 95% CI 0.05-0.36; P
<.0001; I2 = 0%). Conclusion(s): In this systematic review
and meta-analysis, the use of l-DOACs in patients with nonvalvular atrial
fibrillation who underwent LAAC reduces the occurrence of the DRT and
composite outcomes of thromboembolic events and major
bleeding. Copyright © 2024 Heart Rhythm Society

<5>
Accession Number
2037119512
Title
Percutaneous coronary intervention (PCI) in patients of rheumatoid
arthritis(RA): A systematic review and meta-analysis.
Source
Indian Heart Journal. 77(1) (pp 7-13), 2025. Date of Publication: 01 Jan
2025.
Author
Piplani S.; Kostojchin A.; Kong S.; Brown D.; Jelic V.; Chaturvedi S.;
Reddy V.; Chang Pieri K.; Akpan E.; Simpson T.; Xiao W.; Sakellakis M.;
Sharma A.; Jain P.; Radulovic M.
Institution
(Piplani, Kong, Brown, Jelic, Chaturvedi, Reddy, Chang Pieri, Akpan,
Simpson, Xiao, Sakellakis, Sharma, Radulovic) Jacobi Medical Center/North
Central Bronx, Albert Einstein College of Medicine, NYC Health and
Hospitals, 3424 Kossuth Avenue, Bronx, NY, United States
(Kostojchin) Department of Cardiology North Central Bronx Hospital/VA
Medical Center, Icahn School of Mount Sinai, 3424 Kossuth Avenue, Bronx,
NY, United States
(Sharma) Department of Cardiology, Yale School of Medicine, New Haven, CT,
333 Cedar Street, New Haven, CT, United States
(Jain) Department of Internal Medicine, Jawaharlal Nehru Medical College,
Karnataka, Belagavi, India
Publisher
Elsevier B.V.
Abstract
Aim: The present study aims to investigate the outcomes of Percutaneous
coronary intervention (PCI) in patients with Rheumatoid arthritis (RA).
 Method(s): A systemic search was conducted from electronic databases
(PubMed/Medline, Cochrane Library, and Google Scholar) from inception to
15th September 2023. All statistical analyses were conducted using Review
Manager 5.4.1. Studies meeting inclusion criteria were selected. A
random-effect model was used when heterogeneity was seen to pool the
studies, and the result was reported in the odds ratio (OR) and the
corresponding 95 % confidence interval (CI). Result(s): Eight
observational studies were selected to conduct the analysis. A
statistically significant increase in major adverse cardiovascular event
(MACE) was seen in RA patients after undergoing PCI as compared to the
control group (OR = 1.18 (1.16, 1.21); p < 0.00001; I2 = 0 %). There was
no significant difference found in the long-term revascularization outcome
between the RA and non-RA patients (OR = 1.18 (0.81, 1.71); p = 0.39; I2 =
93 %). Survival rates of all-cause mortality in the long-term outcome were
statistically insignificant among the two groups (OR = 1.21 (0.84, 1.74);
p = 0.31; I2 = 99 %). Conclusion(s): Percutaneous coronary
intervention is an important intervention to reduce morbidity and
mortality but special precautions and attention should be made when it
comes to patients with RA. Different precautions such as close monitoring
for medication interaction, and tailored post-procedural care are
essential in reducing morbidity and mortality. Copyright © 2024

<6>
Accession Number
2037799449
Title
Prognostic value of myocardial computed tomography-derived extracellular
volume in severe aortic stenosis requiring aortic valve replacement: A
systematic review and meta-analysis.
Source
European Heart Journal Cardiovascular Imaging. 26(3) (pp 518-531), 2025.
Date of Publication: 01 Mar 2025.
Author
Faggiano A.; Gherbesi E.; Carugo S.; Brusamolino M.; Cozac D.A.; Cozza E.;
Savo M.T.; Cannata F.; Guglielmo M.; La Mura L.; Fazzari F.; Carrabba N.;
Conte E.; Mushtaq S.; Baggiano A.; Guaricci A.I.; Pedrinelli R.; Indolfi
C.; Sinagra G.; Perrone Filardi P.; Pergola V.; Pontone G.
Institution
(Faggiano, Gherbesi, Carugo) Department of Cardio-Thoracic-Vascular
Diseases, Foundation Irccs Ca' Granda Ospedale Maggiore Policlinico,
Milan, Italy
(Faggiano, Carugo, Brusamolino) Department of Clinical Sciences and
Community Health, University of Milan, Milan, Italy
(Brusamolino, Cannata, Fazzari, Mushtaq, Baggiano, Pontone) Department of
Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico
Monzino Irccs, Via C. Parea 4, Milan, Italy
(Cozac, Cozza, Savo, Pergola) Department of Cardiac, Cardiology Clinic,
Department of Cardiac, Thoracic, Vascular Sciences and Public Health,
Padova, Italy
(Cozac) Department of Physiology, University of Medicine, Pharmacy,
Science and Technology 'George Emil Palade' of Targu Mures, Targu Mures,
Romania
(Guglielmo) Department of Cardiology, Division of Heart and Lungs, Utrecht
University Medical Center, Utrecht University, Utrecht, Netherlands
(Guglielmo) Department of Cardiology, Haga Teaching Hospital, The Hague,
Netherlands
(La Mura, Perrone Filardi) Department of Advanced Biomedical Sciences,
University Federico Ii of Naples, Naples, Italy
(Carrabba) Department of Cardiothoracovascular Medicine, Azienda
Ospedaliero-Universitaria Careggi, Florence, Italy
(Conte) Department of Clinical Cardiology and Cardiovascular Imaging,
Galeazzi-Sant'Ambrogio Hospital Irccs, Milan, Italy
(Guaricci) Interdisciplinary Department of Medicine, University Cardiology
Unit, University of Bari Aldo Moro, Bari, Italy
(Pedrinelli) Cardiac, Thoracic and Vascular Department, University of
Pisa, Pisa, Italy
(Indolfi) Dipartimento di Scienze Mediche e Chirurgiche, Istituto di
Cardiologia, Universita Degli Studi 'Magna Graecia', Catanzaro, Italy
(Sinagra) Cardiology Specialty School, University of Trieste, Trieste,
Italy
(Sinagra) Cardiovascular Department, Center for Diagnosis and Treatment of
Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina
(ASUGI), Trieste, Italy
(Pontone) Department of Biomedical, Surgical and Dental Sciences,
University of Milan, Milan, Italy
Publisher
Oxford University Press
Abstract
Computed tomography (CT)-derived extracellular volume (ECV) fraction is a
non-invasive method to quantify myocardial fibrosis. Evaluating CT-ECV
during aortic valve replacement (AVR) planning CT in severe aortic
stenosis (AS) may aid prognostic stratification. This meta-analysis
evaluated the prognostic significance of CT-ECV in severe AS necessitating
AVR. Electronic database searches of PubMed, Ovid MEDLINE, and Cochrane
Library were performed. The primary outcome was to compare the occurrence
of a composite of cardiovascular outcomes in patients with severe AS
undergoing AVR with elevated myocardial CT-ECV values vs. patients with
normal values. Secondary outcomes included all-cause mortality and heart
failure (HF)-related hospitalization. A total of 1223 patients undergoing
AVR for severe AS were included in 10 studies: 524 patients with high
values of CT-ECV and 699 with normal values of CT-ECV. The pooled CT-ECV
cut-off to define elevated values and predict prognosis was 30.7% [95%
confidence interval (CI): 28.5-33.7%]. At a mean follow-up of 17.9 +/- 2.3
months after AVR, patients with elevated CT-ECV experienced a
significantly higher number of cardiovascular events [43.4 vs. 14.0%; odds
ratio (OR): 4.3, 95% CI: 3.192-5.764, P < 0.001]. Regarding secondary
outcomes, all-cause mortality occurred in 29.3% of patients with elevated
CT-ECV vs. 11.6% with CT-ECV below the cut-off (OR: 3.5, 95% CI:
2.276-5.311, P < 0.001), whereas HF hospitalization was observed in 25.5%
vs. 5.9% (OR: 4.9, 95% CI: 2.283-10.376, P < 0.001). Patients undergoing
AVR for severe AS with elevated CT-ECV values experience a worse
post-intervention prognosis. The implementation of CT-ECV evaluation in
routine AVR planning protocols should be considered. Copyright ©
The Author(s) 2025.

<7>
Accession Number
2037346943
Title
Efficacy of surgical ablation and left atrial appendage occlusion in
patients with AF undergoing coronary artery bypass grafting: A network
meta-analysis.
Source
Journal of Cardiology. 85(3) (pp 177-185), 2025. Date of Publication: 01
Mar 2025.
Author
Awad A.K.; Elbahloul M.A.; Gamal A.; Attia A.N.; Hamed S.M.; Elsekhary
A.I.; Sa M.P.
Institution
(Awad) Faculty of Medicine, Ain-Shams University, Cairo, Egypt
(Awad) Department of Cardiothoracic Surgery, Ain-Shams University
Hospitals, Cairo, Egypt
(Elbahloul) Faculty of Medicine, Kafr El-Shaikh University, Kafr
El-Shaikh, Egypt
(Gamal) Clinical Pharmacy Department, Faculty of Pharmacy, Deraya
University, Minia, Egypt
(Attia, Elsekhary) Kasr Alainy School of Medicine, Cairo University,
Cairo, Egypt
(Hamed) Faculty of Medicine, Mansura University, Dakahlia, Egypt
(Sa) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia
that greatly elevates the risk of stroke. This risk increases both during
and after cardiac procedures, such as coronary artery bypass grafting
(CABG). There is an increasing interest in non-pharmacological treatments
such as left atrial appendage occlusion (LAAO) and surgical ablation,
intending to enhance both immediate and long-term postoperative results.
 Objective(s): To investigate the efficacy of surgical ablation (SA),
LAAO, or both in patients with AF undergoing CABG. Method(s): We
searched four electronic databases: PubMed, Scopus, Cochrane Library, and
WOS. We analyzed data using R language and "netmeta" and "netrank"
packages of meta-insight software. Pooled outcomes were reported as mean
difference or risk ratio (RR) with 95 % confidence interval (CI) in a
random effect method. Result(s): A total of 16 studies were included
with 594,312 patients included. The 30-day mortality showed a
non-statistically significant difference between CABG-LAAO compared to
CABG alone and CABG-SA with RR of 1.70 (95%CI 0.38-7.61) and 0.62 (95%CI
0.10-3.94). However, compared to CABG alone, CABG-SA + LAAO, CABG-LAAO,
and CABG-SA had significantly lower risk of long-term mortality with RR
0.75 (95%CI 0.57-0.98), 0.78 (95%CI 0.65-0.94), and 0.73 (95%CI
0.61-0.88), respectively. CABG-SA + LAAO, CABG-LAAO, and CABG-SA reduced
the risk of short-term stroke compared to CABG alone with RR of 0.73
(95%CI 0.43-1.24), 0.93 (95%CI 0.78-1.11), and 1.01 (95%CI 0.75-1.36),
respectively. Moreover, only CABG-SA + LAAO and CABG-LAAO showed a
statistically significant reduction in long term stroke and
hospitalization due to heart failure while CABG-SA showed no statistically
significant difference. Furthermore, there was no statistically
significant difference between our interventions in terms of 30-day
rehospitalization, intra-aortic balloon pump support, and risk of
hemorrhage. Conclusion(s): Among patients with AF undergoing CABG,
whether undergoing SA alone or LAAO alone or both showed significant
clinical outcomes such as reduced risk of both short- and long-term
mortality and short-term stroke. Copyright © 2025 Elsevier Ltd

<8>
Accession Number
2038005393
Title
Donor-derived cell-free dna as a diagnostic biomarker for acute rejection
in heart transplantation: A systematic review and meta-analysis.
Source
Transplantation Reviews. 39(2) (no pagination), 2025. Article Number:
100916. Date of Publication: 01 Apr 2025.
Author
Wang L.; Liu S.; Zhao Y.
Institution
(Liu, Wang, Liu, Zhao) Department of Nuclear Medicine, The Second Hospital
of Jilin University, Changchun, China
Publisher
Elsevier Inc.
Abstract
Background: Endomyocardial biopsy is widely acknowledged as the gold
standard for detecting rejection following heart transplantation. However,
the operation itself carries a risk of myocardial tissue damage and
associated complications during and after surgery. Given the limitations
of existing diagnostic approaches, non-invasive biomarkers are crucial.
 Objective(s): This study assessed the diagnostic utility of
donor-derived cell-free DNA (dd-cfDNA) in detecting AR in heart transplant
recipients. Method(s): A systematic literature search was conducted
across PubMed, Embase, Cochrane Library, and Web of Science from inception
to August 1, 2024, to identify studies evaluating the diagnostic
performance of dd-cfDNA for AR in heart transplant recipients. Retrieved
studies were screened using EndNote X9. Meta-analysis was performed using
Meta-Disc software version 1.4 and STATA/SE 14.0. Result(s): Ten
studies were included in the meta-analysis. The pooled sensitivity,
specificity, and area under the receiver operating characteristic curve
with 95 % confidence intervals (CIs) were 65 % (95 % CI, 61-68 %), 79 %
(95 % CI, 78-80 %), and 0.83, respectively. Conclusion(s): This
meta-analysis indicates that plasma dd-cfDNA may serve as a promising
non-invasive biomarker for the diagnosis of acute rejection in heart
transplant recipients. However, further research is warranted to
investigate factors influencing diagnostic performance and optimize
clinical utility. Copyright © 2025 Elsevier Inc.

<9>
Accession Number
2023834352
Title
The " L -Sandwich" Strategy for True Coronary Bifurcation Lesions: A
Randomized Clinical Trial.
Source
Journal of Interventional Cardiology. 2023 (no pagination), 2023. Article
Number: 6889836. Date of Publication: 2023.
Author
Guo Q.; Peng L.; Rao L.; Ma C.; Zhao K.; Zhao Z.; Tang H.; Li M.
Institution
(Guo, Li) Department of Cardiology, Henan Provincial People's Hospital,
People's Hospital of Zhengzhou University, Henan, Zhengzhou, China
(Guo, Peng, Rao, Ma, Zhao, Zhao, Tang, Li) Department of Coronary Heart
Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary
Heart Disease, Central China Fuwai of Zhengzhou University, Henan,
Zhengzhou, China
Publisher
Hindawi Limited
Abstract
Background. This study explored the efficacy of the "L-sandwich"strategy,
which involves the implantation of stents in the main vessel (MV) and
shaft of the side branch (SB) with a drug-coated balloon (DCB) applied to
the SB ostium, for coronary true bifurcation lesions. Methods and Results.
Of 99 patients with true bifurcation lesions, 38 patients underwent the
"L-sandwich"strategy (group A), 32 patients underwent a two-stent strategy
(group B), and 29 patients underwent a single-stent + DCB strategy (group
C). Angiography outcomes (late lumen loss [LLL], minimum lumen diameter
[MLD]), and clinical outcomes (major adverse cardiac events [MACEs]) were
analyzed. At 6 months, the MLD of the SB ostium in groups A and B were
similar (P>0.05) and group A larger than group C (P<0.05). The LLL of
group B was the largest among the three groups (P<0.05). The MLD of the SB
shaft in groups A and B were larger than in group C (P<0.05). The LLL of
the SB shaft in group C was the lowest (P<0.05). Two patients in group B
received target vessel revascularization at the 6-month followup (P>0.05),
and patients in the other groups had no MACEs. Conclusions. The
"L-sandwich"strategy was feasible for the treatment of true coronary
bifurcation lesions. It is a simpler procedure with similar acute lumen
gain than the two-stent strategy, results in a larger SB lumen than the
single-stent + DCB strategy, and it can also be used as a remedy for
dissection following the single-stent + DCB strategy. Copyright ©
2023 Quan Guo et al.

<10>
Accession Number
2037118155
Title
The Renal Effect of 20% Human Albumin Solution Fluid Bolus Therapy in
Patients After Cardiac Surgery. A Secondary Analysis of the HAS FLAIR II
Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(4) (pp 967-974),
2025. Date of Publication: 01 Apr 2025.
Author
Wigmore G.J.; Deane A.M.; Presneill J.J.; Serpa Neto A.; Eastwood G.;
Maiden M.J.; Bihari S.; Baker R.A.; Bennetts J.S.; Ghanpur R.; Anstey
J.R.; Raman J.; Bellomo R.
Institution
(Wigmore, Deane, Presneill, Serpa Neto, Maiden, Bellomo) Department of
Critical Care, Melbourne Medical School, University of Melbourne,
Parkville, VIC, Australia
(Wigmore) Department of Anaesthesia and Pain Medicine, Western Health,
Melbourne, VIC, Australia
(Deane, Presneill, Maiden, Anstey, Bellomo) Department of Intensive Care,
Royal Melbourne Hospital, Melbourne, VIC, Australia
(Presneill, Serpa Neto, Bellomo) Australian and New Zealand Intensive Care
Research Centre (ANZIC-RC), School of Public Health and Preventive
Medicine, Monash University, Melbourne, VIC, Australia
(Serpa Neto, Eastwood, Raman, Bellomo) Department of Intensive Care,
Austin Hospital, Melbourne, VIC, Australia
(Serpa Neto) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Maiden) Intensive Care Unit, Barwon Health, Geelong, VIC, Australia
(Bihari) College of Medicine and Public Health, Flinders University,
Bedford Park, SA, Australia
(Bihari) Department of ICCU, Flinders Medical Centre, Bedford Park, SA,
Australia
(Baker, Bennetts) Cardiothoracic Quality and Outcomes, Flinders Medical
Centre and College of Medicine and Public Health Flinders University, SA,
Australia
(Ghanpur) Department of Intensive Care, Warringal Private Hospital,
Melbourne, Australia
(Raman) University of Melbourne, Parkville, VIC, Australia
(Raman) St Vincent's Hospital, Melbourne, VIC, Australia
(Raman) Department of Cardiothoracic Surgery, Townsville University
Hospital, Townsville, QLD, Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Melbourne, VIC, Australia
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of fluid bolus therapy (FBT) with 20%
albumin to crystalloid FBT on the incidence of cardiac surgery-associated
acute kidney injury (CSA-AKI) and its severity and duration.
 Design(s): Secondary analysis of the multicenter, parallel-group,
open-label, randomized HAS FLAIR-II trial. Setting(s): Six intensive
care units. Participant(s): Patients who required
clinician-determined FBT after cardiac surgery requiring cardiopulmonary
bypass. Intervention(s): Patients were randomized to receive FBT with
20% albumin (up to 400 mL/day) or crystalloid fluid for all FBTs in the
intensive care unit. Measurements and Main Results: A total of 452
patients were included in the modified intention-to-treat population (224
in the 20% albumin group and 228 in the crystalloid group). AKI occurred
in 54 (24%) patients in the 20% albumin group and 50 (22%) in the
crystalloid group (odds ratio: 1.13, 95% confidence interval [CI]: 0.73 to
1.76). However, in patients who developed stages 2 and 3 AKI, those
allocated to 20% albumin had a significantly lower median time-weighted
average (TWA) creatinine: 144 micromol/L (interquartile range [IQR]: 109
to 162) versus 254 micromol/L (IQR: 182 to 294) than the crystalloid group
(difference -105 micromol/L, [95% CI -170 to -41], p = 0.003) and a lower
peak serum creatinine (-110 micromol/L [-189 to -32], p = 0.01). The
reduced TWA creatinine in the 20% albumin group was seen in patients with
both a low (p = 0.04) and normal preoperative serum albumin concentration
(p < 0.001). Conclusion(s): FBT with 20% albumin compared with
crystalloid-based regimen did not reduce the occurrence of AKI in patients
after cardiac surgery. However, it reduced the severity and duration of
stages 2 and 3 AKI. Copyright © 2025 The Authors

<11>
Accession Number
2037231062
Title
Regional Analgesia in Pediatric Cardiothoracic Surgery: A Bayesian Network
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(4) (pp 1037-1048),
2025. Date of Publication: 01 Apr 2025.
Author
Ren Y.; Li L.; Gao J.; Hua L.; Zheng T.; Wang F.; Zhang J.
Institution
(Ren, Li, Hua, Zheng, Wang, Zhang) Department of Anesthesiology, Beijing
Children's Hospital, Capital Medical University, National Center for
Children's Health, China
(Gao) Department of Orthopedics, Beijing Children's Hospital, Capital
Medical University, National Center for Children's Health, China
Publisher
W.B. Saunders
Abstract
Various regional analgesia techniques are used to reduce postoperative
pain in pediatric patients undergoing cardiothoracic surgeries. This study
aimed to determine the relative efficacy of regional analgesic
interventions. PubMed, EMBASE, Web of Science, and Cochrane databases were
searched to identify all randomized controlled studies evaluating the
effects of regional block after cardiothoracic surgery. The primary
endpoint was opioid consumption within 24 hours postoperatively, Pain
scores, the time to first rescue analgesic, and the incidence of
postoperative nausea and vomiting were also collected. A Bayesian NMA was
performed to compare the outcomes of interest. A total of 24 studies
involving 1602 patients and 13 regional blocks were included. All
techniques reduced opioid consumption within 24 hours postoperatively. The
largest decrease was in the thoracic retrolaminar block group, with a WMD
of -0.97 (95% CrI -1.1, -0.84) mg/kg morphine equivalent. In terms of pain
scores, there was no significant difference between any block and the
control at any time point except for the thoracic retrolaminar block group
at 0 hours postoperatively. In addition, all regional blocks prolonged the
time to first rescue analgesic, which was the longest in the pectoral
nerve block group. The incidence of postoperative nausea and vomiting was
the lowest in the epidural anesthesia group, followed by the transversus
thoracis muscle plane block group. Regional anesthesia revealed
significant opioid-sparing effects following pediatric cardiothoracic
surgery. However, indirect comparisons are limited because of the
heterogeneity of previous studies, and direct comparisons are needed to
establish the relative efficacies of different blocks. Copyright
© 2024

<12>
Accession Number
2037130822
Title
Entrapment of Pulmonary Artery Catheters in Cardiac Surgery: A Structured
Literature Review and Analysis of Published Case Reports.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(4) (pp 916-924),
2025. Date of Publication: 01 Apr 2025.
Author
Kumar N.; Toda C.; Couture E.J.; Vlahakes G.J.; Fitzsimons M.G.
Institution
(Kumar, Fitzsimons) Department of Anesthesia, Critical Care, and Pain
Medicine, Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Toda) Department of Anesthesia, TidalHealth Peninsula Regional,
Salisbury, MD, United States
(Couture) Department of Anesthesiology & Division of Intensive Care
Medicine, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(Vlahakes) Cardiac Surgery Division, Department of Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
Objectives: This systematic review aims to tabulate and analyze the
published literature regarding pulmonary artery catheter (PAC) entrapment
during cardiac surgery. Design(s): Systematic review.
 Setting(s): Case reports and series. Participant(s): Adults
undergoing cardiac surgery. Intervention(s): None. Measurements
and Main Results: 223 distinct incidents of PAC entrapment were published
across 77 case reports and 3 retrospective studies. The reported incidence
of an entrapped PAC was 137/200,831 (0.068%, 95% confidence interval:
0.067%, 0.069%). Reported PAC entrapment was most seen in the setting of
mitral valve surgery and was not discovered until the postoperative period
in 77% of cases. Inadvertent fixation to cardiac structures was the most
common mechanism of PAC entrapment. A total of 75% of patients with an
entrapped PAC required an immediate redo sternotomy for PAC retrieval.
After PAC retrieval, these patients still had longer hospital length of
stay compared with the Society of Thoracic Surgeons Adult Cardiac Surgery
Database averages. Conclusion(s): Although PAC entrapment during
cardiac surgery is rare, an entrapped PAC increases patient morbidity,
delays recovery, and increases hospital length of stay. Surgeons and
anesthesiologists are encouraged to be attentive to PAC entrapment before
chest closure. Copyright © 2025 Elsevier Inc.

<13>
Accession Number
2037428651
Title
Early Versus Bail-Out Left Ventricular Unloading During Venoarterial
Extracorporeal Membrane Oxygenation: A Systematic Review And
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(4) (pp 1015-1025),
2025. Date of Publication: 01 Apr 2025.
Author
Picado-Loaiza S.; Ayala R.; Ferreira R.O.M.; Zeledon F.; Almeidinha L.;
Clemente M.; Bittar de Pontes V.; Lee E.C.
Institution
(Picado-Loaiza, Zeledon) Cardiovascular Surgery Department, Caja
Costarricense del Seguro Social, San Jose, Costa Rica
(Ayala) Cardiovascular Surgery Department, Robert Bosch Hospital,
Stuttgart, Germany
(Ferreira) Federal University of Santa Catarina, Florianopolis, Brazil
(Almeidinha) Rochester General Hospital, Rochester, NY, United States
(Clemente) Petropolis School of Medicine, Petropolis, Brazil
(Bittar de Pontes) University Centre of Associated Colleges of Education,
Sao Joao da Boa Vista, Sao Paulo, Brazil
(Lee) Sands Constellation Heart Institute, Rochester, NY, United States
Publisher
W.B. Saunders
Abstract
Left ventricular (LV) unloading has demonstrated favorable outcomes in
patients undergoing venoarterial extracorporeal membrane oxygenation
(VA-ECMO). However, the optimal timing for LV unloading during VA-ECMO
remains controversial. PubMed, Embase, and Cochrane were searched for
studies comparing early versus bail-out LV unloading in patients
undergoing VA-ECMO. We computed mean differences (MD) for continuous
outcomes and risk ratios (RR) for binary outcomes, with 95% confidence
intervals (95%CIs). Heterogeneity was assessed using I2 statistics.
Statistical analyses were performed using R version 4.2.3. Six studies
comprising 1,556 participants were included in the meta-analysis, of whom
936 (60%) were referred to early LV unloading. There were no significant
differences between groups in weaning from VA-ECMO (MD 1.07; 95% CI 0.86 -
1.33; p = 0.55; I2 = 26%), in-hospital mortality (RR 0.95; 95% CI 0.86 -
1.05; p = 0.28; I2 = 0%), 30-day mortality (RR 0.75; 95% CI 0.52 - 1.10; p
= 0.14; I2 = 64%), or duration of VA-ECMO (MD 0.37; 95% CI -1.57 - 2.32; p
= 0.71; I2 = 20%). Sepsis (RR 0.84; 95% CI 0.63 - 1.11; p = 0.22; I2 =
0%), stroke (RR 0.90; 95% CI 0.52 - 1.56; p = 0.70; I2 = 48%), and bridge
to heart transplantation or left ventricular assist device (RR 1.20; 95%
CI 0.90 - 1.62; p = 0.22; I2 = 0%) also did not differ significantly
between the groups. In patients undergoing VA-ECMO, early LV unloading was
not associated with improved efficacy and safety outcomes when compared to
the bail-out strategy for LV unloading. Copyright © 2025 Elsevier
Inc.

<14>
Accession Number
2037130891
Title
Advances in Anesthesia Techniques for Postoperative Pain Management in
Minimally Invasive Cardiac Surgery: An Expert Opinion.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(4) (pp 1026-1036),
2025. Date of Publication: 01 Apr 2025.
Author
Yuan K.; Cui B.; Lin D.; Sun H.; Ma J.
Institution
(Yuan, Cui, Lin, Sun, Ma) Department of Anesthesiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Minimally invasive cardiac surgery (MICS) often leads to severe
postoperative pain. At present, multimodal analgesia schemes for MICS have
attracted much attention, and the application of various chest wall
analgesia techniques is becoming increasingly widespread. However,
research on anesthesia techniques for postoperative pain management in
MICS remains relatively limited at present. We searched for relevant
literature and summarized recent related research in eight MICS
techniques, including thoracic epidural anesthesia, spinal anesthesia,
thoracic paravertebral plane block, erector spinae plane block, serratus
anterior plane block, pectoral nerve block, intercostal nerve block, and
parasternal block. This article provides an overview of the anatomy and
procedures involved in these analgesic techniques, their mechanisms of
action, and the latest clinical trial evidence. It also evaluates their
progress in MICS, compares their advantages and disadvantages, and
discusses practical challenges. Copyright © 2025 Elsevier Inc.

<15>
Accession Number
2032920306
Title
Human leukocyte antigen alloimmunization in a randomized trial of
amustaline/glutathione pathogen-reduced red cells in complex cardiac
surgery patients.
Source
Transfusion. 65(3) (pp 459-465), 2025. Date of Publication: 01 Mar 2025.
Author
Norris P.J.; Stone M.; Di Germanio C.; Balasko B.; Kaidarova Z.; Friend
H.; Varrone J.; Corash L.; Mufti N.; Benjamin R.J.
Institution
(Norris, Stone, Di Germanio, Balasko, Kaidarova) Vitalant Research
Institute, San Francisco, CA, United States
(Norris, Stone, Di Germanio) Department of Laboratory Medicine, University
of California, San Francisco, San Francisco, CA, United States
(Norris) Department of Medicine, University of California, San Francisco,
San Francisco, CA, United States
(Friend, Varrone, Corash, Mufti, Benjamin) Cerus Corporation, Concord, CA,
United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Although alloimmunization risk of pathogen-reduced (PR)
platelets has been studied, the risk has not been reported with PR red
blood cells (RBCs). Study Design and Methods: In a Phase III, randomized,
controlled trial (Red Cell Pathogen Inactivation), cardiac or
thoracic-aorta surgery patients were randomized to transfusion with
amustaline/glutathione PR versus conventional RBCs. Pre-transfusion and
Day 28 samples were evaluated for Human leukocyte antigen (HLA) Class I
and Class II antibodies at low, medium, and high cutoff values.
 Result(s): The HLA alloimmunization analysis included 114
participants (53% female) in the PR and 113 (51% female) in the
conventional RBC arms. In a modified intention-to-treat analysis, 13.7% (N
= 29) and 7.2% (N = 15) developed new high-level HLA Class I or Class II
antibodies, respectively; however, there was no signal that PR-RBCs
affected the rate of HLA Class I (odds ratio (OR) 1.3 [95% confidence
interval (CI) 0.62-2.9]) or Class II antibody formation (OR 0.99 [95% CI
0.35-2.8]). Female transfusion recipients had higher risk of developing
new high-level HLA Class I antibodies (OR 12.0 [95% CI 3.5-40.9]) and
Class II antibodies (OR 5.0 [95% CI 1.4-17]). The mean number of RBC (5.5
vs. 3.6 units, p = 0.018) and platelet (1.8 vs. 1.1 units, p = 0.043)
transfusions was higher in subjects with new high-level HLA Class II
antibodies. Discussion(s): Receipt of amustaline/glutathione PR-RBC
units did not affect HLA alloimmunization risk. Female sex and number of
RBC and platelet transfusions were risk factors for the development of new
high-level HLA Class I and Class II antibodies. Copyright © 2025
AABB.

<16>
Accession Number
2033660912
Title
Comparison of the analgesic efficacy of ultrasound-guided superficial
serratus anterior plane block and intercostal nerve block for rib
fractures: a randomized controlled trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 122. Date
of Publication: 01 Dec 2025.
Author
Zengin M.; Kucuk O.; Aslan M.; Findik G.; Alagoz A.
Institution
(Zengin) Department of Anesthesiology and Reanimation, University of
Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey
(Kucuk, Alagoz) Department of Anesthesiology and Reanimation, University
of Health Sciences, Ankara Ataturk Sanatorium Training and Research
Hospital, Ankara, Turkey
(Aslan) Department of Thoracic Surgery, Diyarbakir Gazi Yasargil Training
and Research Hospital, Diyarbakir, Turkey
(Findik) Department of Thoracic Surgery, University of Health Sciences,
Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, Turkey
Publisher
BioMed Central Ltd
Abstract
Background: Various regional analgesic methods are frequently incorporated
into multimodal analgesia strategies for managing rib fractures. This
study aimed to compare the analgesic efficacy of ultrasound-guided
superficial serratus anterior plane block (S-SAPB) and intercostal nerve
block (ICNB) in patients with isolated rib fractures. Method(s): This
randomized controlled trial included patients aged 18-65 years with
unilateral isolated rib fractures (<= 6 ribs) resulting from trauma.
Patients underwent ultrasound-guided S-SAPB (20 ml 0.25% bupivacaine) or
ICNB (3 ml 0.25% bupivacaine for each fractured rib). Pain levels were
assessed using the Visual Analogue Scale (VAS) both prior to the procedure
(Pre-Block, (T0)) and at specific time points following the intervention:
1st hour (T1), 2nd hour (T2), 4th hour (T4), 8th hour (T8), 16th hour
(T16), and 24th hour (T24). The changes in observed values over time were
expressed as delta (DELTA). Result(s): Both S-SAPB and ICNB provided
effective analgesia. In the first 4 h, ICNB demonstrated a greater
reduction in VAS scores, particularly in patients with 10th and
11th rib fractures. However, S-SAPB resulted in significantly
longer-lasting analgesia, with greater pain relief after 8 h (T8-T24)
compared to ICNB (p < 0.05). Patients in the S-SAPB group required no
additional analgesia, whereas 43.3% of ICNB patients required supplemental
tramadol (p < 0.001). Both techniques were well tolerated, with no
reported complications. Conclusion(s): S-SAPB provides prolonged
analgesia and may be preferable for managing rib fracture pain beyond the
initial 8 h. However, ICNB offers superior pain relief in the early
postoperative period, especially for lower rib fractures
(10th-11th ribs). A combined approach that includes
both blocks may optimize pain control in patients with multiple rib
fractures involving the 10th and 11th
ribs. Copyright © The Author(s) 2025.

<17>
Accession Number
2037873309
Title
Waist circumference and body surface area and the risk of developing
new-onset atrial fibrillation: A systematic review and meta-analysis of
observational studies.
Source
Heart and Lung. 72 (pp 1-12), 2025. Date of Publication: 01 Jul 2025.
Author
Shojaei S.; Radkhah H.; Akhlaghipour I.; Shad A.N.; Azarboo A.; Mousavi A.
Institution
(Shojaei, Azarboo, Mousavi) Tehran Heart Center, Cardiovascular Diseases
Research Institute, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Shojaei, Mousavi) School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Radkhah) Sina Hospital Department of Internal Medicine, Tehran, Iran,
Islamic Republic of
(Akhlaghipour, Shad) Student Research Committee, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia
with significant health consequences. Identifying modifiable risk factors,
such as obesity, is crucial. While body mass index (BMI) is linked to
increased AF risk, the association between new-onset AF (NOAF) and other
anthropometric measures like waist circumference (WC) and body surface
area (BSA) warrants further investigation. Objective(s): This
systematic review and meta-analysis aimed to compare mean WC and BSA
between individuals who developed NOAF and those who did not.
 Method(s): We conducted a comprehensive search up to February 2024
for studies comparing mean WC and BSA in groups with and without incident
NOAF. Participants had no prior AF history. We used a random-effects model
to calculate standardized mean differences (SMDs) and 95 % confidence
intervals (CIs). Subgroup analyses explored NOAF occurrence following
coronary artery bypass graft (CABG) surgery, in the absence of any
preceding procedure, and after other cardiac procedures. Result(s):
Our analysis of 34 studies revealed that adults with NOAF had
significantly higher WC (SMD = 0.20, 95 % CI 0.01; 0.39) and BSA (SMD =
0.06, 95 % CI 0.01; 0.11) compared to those without NOAF. Subgroup
analysis showed a more pronounced association in individuals developing
NOAF after CABG (SMD = 0.33, 95 % CI 0.17; 0.48) and in those without any
prior procedure before NOAF diagnosis (SMD = 0.23, 95 % CI 0.08; 0.38)
versus those without NOAF. Conclusion(s): Higher WC and BSA appear to
be significantly associated with an increased risk of NOAF, with the
relations being more pronounced in specific subgroups. Copyright
© 2025

<18>
Accession Number
2035934552
Title
The Effects of Different Ciprofol Doses on Hemodynamics During Anesthesia
Induction in Patients Undergoing Cardiac Surgery: A Randomized,
Double-Blind, Controlled Study.
Source
Drug Design, Development and Therapy. 19 (pp 1671-1679), 2025. Date of
Publication: 2025.
Author
Zhou Y.; Liu Z.; Li Q.; Ni P.; Li Z.; Yang J.; Xie Y.; Yu B.; Zhang M.
Institution
(Zhou, Liu, Li, Ni, Yang, Xie, Zhang) Department of Anesthesiology, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Anhui, Hefei, China
(Li, Yu) First Clinical Medical College, Gannan Medical University,
Jiangxi, Ganzhou, China
Publisher
Dove Medical Press Ltd
Abstract
Objective: To evaluate the effects of different ciprofol doses on
hemodynamics in patients undergoing cardiac surgery. Method(s): 209
patients were randomly divided into four groups: 0.2 mg/kg etomidate group
(group E, n = 50), 0.2 mg/kg, 0.3mg/kg, 0.4mg/kg ciprofol group (group A,
n = 53, group B, n = 51, group C, n = 54). Mean arterial pressure (MAP),
heart rate (HR), cardiac output (CO), stroke volume (SV), systemic
vascular resistance (SVR), and bispectral index were recorded at the
following time points: 5 minutes after entering the operating room
(T<inf>0</inf>); before anesthesia induction (T<inf>1</inf>); immediately
after induction (T<inf>2</inf>); 1 minute and 2 minutes after induction
(T<inf>3</inf> ~T<inf>4</inf>); at intubation (T<inf>5</inf>); 1 minute, 3
minutes, 5 minutes and 10 minutes after intubation (T<inf>6</inf>
~T<inf>9</inf>); at skin incision (T<inf>10</inf>). The incidence of
hypotension and bradycardia and the doses of vasoactive drugs were
recorded. Result(s): Compared with T<inf>0</inf>, HR, MAP, SV, CO all
decreased to varying degrees after administration, and the decrease time
in Group B and Group C were earlier than that in other two groups (P <
0.05). SVR increased slowly after T<inf>4</inf> in all groups, but there
was no significant differences (P > 0.05). Compared with group E, the
norepinephrine dose was significantly lower in groups A and B (both P <
0.05). Group C showed a greater decline in CO and SV than the other three
groups from T<inf>7</inf> to T<inf>10</inf> (P < 0.05), while there was no
significant difference between groups A and E in CO and groups A, B, and E
in SV (P > 0.05). No significant differences were observed in MAP, SVR,
and the incidences of hypotension and bradycardia among the four groups (P
> 0.05). Conclusion(s): 0.2 mg/kg ciprofol has the least impact on
hemodynamics in patients undergoing cardiac surgery, and reduced
norepinephrine use. Copyright © 2025 Zhou et al.

<19>
Accession Number
2038027363
Title
Management of angina pectoris.
Source
Trends in Cardiovascular Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Rinaldi R.; Kunadian V.; Crea F.; Montone R.A.
Institution
(Rinaldi, Crea, Montone) Department of Cardiovascular and Pulmonary
Sciences, Catholic University of the Sacred Heart, Rome, Italy
(Rinaldi) Cardiology Unit, Infermi Hospital, Rimini, Italy
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University, 4th Floor William Leech Building,
Newcastle-upon-Tyne, United Kingdom
(Kunadian) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne
Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
(Crea) Center of Excellence of Cardiovascular Sciences, Ospedale Isola
Tiberina - Gemelli Isola, Rome, Italy
(Montone) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCCS, Rome, Italy
Publisher
Elsevier Inc.
Abstract
Angina pectoris, a primary manifestation of ischemic heart disease,
imposes a significant clinical and economic burden globally. This review
highlights recent advancements in the management of angina, emphasizing a
patient-centred approach that integrates pharmacological, interventional,
and lifestyle strategies to reduce cardiovascular risk and improve patient
outcomes. For obstructive coronary artery disease, optimal medical therapy
represents the cornerstone of treatment. Individualized regimens should be
tailored to clinical factors such as blood pressure, heart rate, left
ventricular function, comorbidities like heart failure and diabetes,
concomitant medications, patient preferences, and drug availability.
Myocardial revascularization is reserved for select cases to alleviate
symptoms or improve prognosis. For angina or ischemia with non-obstructive
coronary arteries (ANOCA/INOCA), precise endotype classification,
differentiating microvascular angina, vasospastic angina, mixed type and
non-coronary chest pain, enables personalized treatment strategies.
Lifestyle interventions, including smoking cessation, weight management,
adherence to Mediterranean diet, and exercise therapy, are essential
components of care, promoting improved cardiovascular outcomes and quality
of life. Structured exercise programs, particularly within cardiac
rehabilitation settings, have demonstrated efficacy in enhancing
functional capacity and reducing adverse events. Emerging therapies,
including pharmacological agents and novel interventional approaches such
as the coronary sinus reducer, hold promise for addressing unmet needs in
refractory angina and challenging ANOCA/INOCA cases. Future directions
should prioritize the integration of precision medicine, digital health
technologies, and multidisciplinary care to optimize outcomes and advance
personalized angina management. Copyright © 2025 The Authors

<20>
Accession Number
2037868956
Title
Routine anaesthesia ward-based patient visits in surgery: 1-year outcomes
of the TRACE randomized clinical trial.
Source
British Journal of Surgery. 112(3) (no pagination), 2025. Article Number:
znaf019. Date of Publication: 01 Mar 2025.
Author
Smit-Fun V.M.; De Korte-De Boer D.; Damen T.; Stolze A.; Posthuma L.M.;
Hollmann M.W.; Buhre W.F.F.A.; Boer C.; van Kuijk S.; Noordzij P.G.; Rinia
M.; Hering J.P.; In't Veld B.; Scheffer G.J.; Breel J.S.; Bouw T.; van
Dijk F.; Geurts J.; Glas W.; van Gorp R.; Jwair A.; Koca F.; Lange I.;
Preckel B.; van Roy J.P.; Theunissen M.; Wensing A.G.C.L.; Werger A.
Institution
(Smit-Fun, De Korte-De Boer, Damen) Department of Anaesthesia and Pain
Medicine, Maastricht University Medical Centre +, Maastricht, Netherlands
(Stolze, Hollmann) Department of Anaesthesia, Amsterdam University Medical
Centre, Amsterdam, Netherlands
(Posthuma) Department of Anaesthesia and Intensive Care, Albert Schweitzer
Hospital, Dordrecht, Netherlands
(Buhre) Department of Anaesthesia, University Medical Centre Utrecht,
Utrecht, Netherlands
(Boer, In't Veld, Breel, Jwair, Koca, Preckel, Wensing) Amsterdam
University Medical Centre, Amsterdam, Netherlands
(van Kuijk, Bouw, van Gorp, Theunissen) Maastricht University Medical
Centre +, Maastricht, Netherlands
(Noordzij, Lange) St. Antonius Hospital, Nieuwegein, Netherlands
(Rinia, van Dijk, Geurts) Rijnstate Hospital, Arnhem, Netherlands
(Hering, Glas, van Roy) Dijklander Hospital, Hoorn, Netherlands
(Werger) Medical Centre Haaglanden, The Hague, Netherlands
(Scheffer) Radboud University Medical Centre, Nijmegen, Netherlands
(van Kuijk) Maastricht University, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Background: The TRACE (Routine posTsuRgical Anaesthesia visit to improve
patient outComE) RCT did not show any perioperative benefit from
ward-based visits by anaesthetists after surgery. The aim of this study
was to evaluate the impact of this intervention on longer-term outcomes.
 Method(s): Patients were followed up in the TRACE RCT to 1 year in
nine hospitals in the Netherlands. Patients undergoing elective
non-cardiac surgery, and at risk for adverse postoperative outcome, were
included. Patients in the intervention group additionally received routine
anaesthesia visits on postoperative days 1 and 3. Clinical outcome
measures included 1-year mortality, hospital readmission, and reoperation.
Functional recovery (FR) was measured using the patient-reported global
surgical recovery (GSR) index, ability to perform activities of daily
living (ADL), and functional recovery index (FRI). Quality of life (QoL)
was measured using EQ-5D-5L. Result(s): Some 5473 adult patients were
followed up. No differences were found between the control and
intervention groups for clinical, FR, and QoL outcome measures. One-year
mortality was 5.4% in the control group and 5.8% in the intervention
group, readmission was 27% and 26% respectively, and reoperation was 20%
and 18% respectively. At 1 year, FR and QoL had recovered to preoperative
levels. However, 30% of patients were not able to fully perform ADL and
40%-51% of patients still reported a problem in the EQ-5D-5L dimensions
mobility, usual activities, and pain/discomfort. Conclusion(s):
Routine postoperative anaesthesia ward visits of patients did not improve
clinical, functional, and QoL outcomes. A substantial proportion of
patients still experienced health-related limitations in daily life 1 year
after surgery. In conclusion, an early postoperative intervention with
postoperative anaesthesia visits in the ward after non-cardiac surgery had
no effect on 30-day or 1-year clinical outcome. Remarkably, TRACE shows
that compared with data sampled 10 years ago, 1-year mortality has not
improved in the Netherlands. At 1 year, functional recovery or QoL showed
little improvement compared with baseline. Importantly, a substantial
number of patients still reported incomplete recovery and problems that
limit QoL, which indicate that there is still room for
improvement. Copyright © 2025 The Author(s). Published by Oxford
University Press on behalf of BJS Foundation Ltd.

<21>
Accession Number
2030306992
Title
Therapeutic Enoxaparin Dosing in Obesity.
Source
Annals of Pharmacotherapy. 59(3) (pp 262-276), 2025. Date of Publication:
01 Mar 2025.
Author
Appay M.; Kharadi S.; Nanayakkara S.; Ryu J.S.; Pasalic L.; Alffenaar
J.-W.
Institution
(Appay, Kharadi, Nanayakkara, Ryu, Alffenaar) School of Pharmacy, Faculty
of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
(Appay) Department of Pharmacy, John Hunter Hospital, Newcastle, NSW,
Australia
(Pasalic) School of Medicine, Faculty of Medicine and Health, The
University of Sydney, Sydney, NSW, Australia
(Pasalic) Institute of Clinical Pathology and Medical Research, NSW Health
Pathology, Sydney, NSW, Australia
(Pasalic) Department of Haematology, Westmead Hospital, Sydney, NSW,
Australia
(Alffenaar) Department of Pharmacy, Westmead Hospital, Sydney, NSW,
Australia
Publisher
SAGE Publications Inc.
Abstract
Objective: This review aims to systematically summarize the available data
on efficacy and safety of therapeutic enoxaparin in obese patients and to
identify gaps to guide future research. Data Sources: Medline and
Embase were systematically searched for eligible studies (last searched
December 20, 2023). Studies were included if they reported on therapeutic
dosing regimens, adverse bleeding, thrombotic outcomes, or antifactor Xa
(AFXa) monitoring in obese adult patients. Study Selection and Data
Extraction: The systematic review management tool Covidence was used to
manage the study selection and data extraction process. The reference list
from eligible studies was screened to determine any additional eligible
studies. Data Synthesis: Sixteen studies were included in the
analysis. Studies used a variety of doses, indications, and study designs
making comparison difficult. Twelve studies reported the incidence of
thrombotic events (median = 1.3% [interquartile range [IQR] = 0.3%-2.3%])
and all studies reported the incidence of bleeding events (median = 5.7%
[IQR = 2.4%-14.5%]). Two of the 8 studies analyzing the influence of
weight/body mass index (BMI) or dose per kg on AFXa levels reported
statistically significant results. One study concluded that BMI did not
affect achievement of target AFXa levels. However, the second study found
that dosing using actual body weight was an independent predictor of
supratherapeutic AFXa levels in the obese population. Relevance to Patient
Care and Clinical Practice: This is the first comprehensive review with a
focus on therapeutic dosing of enoxaparin in obesity and has been
conducted in accordance with the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) 2020 statement. Seven of the included
studies were published since 2018 indicating that new evidence on this
topic is emerging. Conclusion(s): There was inadequate evidence to
support an optimal dosing strategy in obese patients due to the
heterogeneity of the studies. The AFXa monitoring may be appropriate to
guide dosing in this population. Further research is required to determine
a suitable dosing regimen. Copyright © The Author(s) 2024.

<22>
Accession Number
2037905280
Title
Growth differentiation factor 15: A biomarker to guide empagliflozin
treatment in acute myocardial infarction?.
Source
International Journal of Cardiology. 429 (no pagination), 2025. Article
Number: 133167. Date of Publication: 15 Jun 2025.
Author
Peiro O.M.; Bardaji A.; Carrasquer A.; Cediel G.; Serrano I.; Bonet G.;
Ferrero M.; Del-Moral-Ronda V.; Rocamora-Horrach M.; Ferreiro J.L.
Institution
(Peiro, Bardaji, Carrasquer, Cediel, Serrano, Bonet, Ferrero,
Del-Moral-Ronda, Rocamora-Horrach, Ferreiro) Department of Cardiology,
Joan XXIII University Hospital, Tarragona, Spain
(Peiro, Bardaji, Carrasquer, Cediel, Bonet, Ferreiro) Pere Virgili Health
Research Institute (IISPV), Tarragona, Spain
(Peiro, Bardaji, Carrasquer, Cediel, Serrano, Bonet, Rocamora-Horrach,
Ferreiro) Rovira i Virgili University, Tarragona, Spain
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Growth Differentiation Factor-15 (GDF-15) has been proven
useful as a prognostic biomarker after an acute myocardial infarction (MI)
and might be used to refine the selection of high-risk patients that could
benefit from empagliflozin therapy. This study aims to compare the
prognostic performance of GDF-15 with the inclusion criteria of the
EMPACT-MI trial to identify patients at high risk of developing heart
failure (HF) after an acute MI. Methods and Results: A cohort of 275
acute MI patients with GDF-15 concentration available and long-term
follow-up was analyzed. Patients were classified into two categories, high
risk (HRHF) or no high risk of development of HF (NHRHF), according to two
models: 1) GDF-15: HRHF if >1800 ng/L and NHRHF if <=1800 ng/L; and 2)
EMPACT-MI criteria: HRHF if meeting the trial inclusion criteria. Cox
regression and ROC curve analyses were used to evaluate the prognostic
performance of both models. GDF-15 showed a stronger association with the
composite endpoint of all-cause death or first hospitalization for HF (HR
10.7, 95 % CI 5.5-21.0) compared to EMPACT-MI inclusion criteria (HR 3.9,
95 % CI 2.2-6.8). Additionally, GDF-15 had superior discriminative ability
(c-index 0.790 vs 0.629, p = 0.004). Similar results were obtained for HF
first hospitalization. Conclusion(s): GDF-15 may have a better
discriminative ability than the inclusion criteria of the EMPACT-MI trial
to identify those patients at higher risk of death and HF after an acute
MI, who could potentially benefit from empagliflozin
therapy. Copyright © 2025

<23>
Accession Number
2035604259
Title
Percutaneous coronary intervention strategies in non-ST segment elevation
acute coronary syndrome patients with multivessel coronary artery disease:
Systematic review pairwise and network meta-analysis.
Source
Cardiovascular Revascularization Medicine. 72 (pp 66-80), 2025. Date of
Publication: 01 Mar 2025.
Author
Huang W.; Flindy S.; Nurhafizah A.; Nafisa K.A.; Frederich A.; Martha J.W.
Institution
(Huang, Flindy, Nurhafizah, Nafisa, Frederich) Medical School, Faculty of
Medicine, University of Padjadjaran, Bandung, Indonesia
(Martha) Department of Cardiology and Vascular Medicine, University of
Padjadjaran, Bandung, Indonesia
Publisher
Elsevier Inc.
Abstract
Background: More than half of NSTEACS patients are presented with
multivessel CAD. Culprit vessel only or complete revascularization (CR)
guided either by angiography or fractional flow reserve (FFR) is available
percutaneous coronary intervention (PCI) options. This study aims to
compare different PCI strategies in NSTEACS patients with multivessel CAD.
 Method(s): Observational and RCTs studies are selected and compared
for short- and long-term outcomes of all-cause mortality, MACE, and repeat
revascularization. Odds ratio (OR) and SUCRA ranking of 4 interventions;
(A) culprit vessel only revascularization, (B) single stage CR guided by
angiography, (C) single stage CR guided by FFR, and (D) multistage CR
guided by angiography are reported as pairwise and pooled network
frequentist analysis conducted using RevMan and R software.
 Result(s): Thirty- six studies with 213,254 patients were included.
Pairwise analysis of A vs B shows no significant difference in short term
outcomes. Pooled network analysis demonstrates that B, C, and D resulted
in a significantly lower odds of long-term all-cause mortality compared to
A (OR 0.42-0.77, 95 % CrI: 0.19-0.91). SUCRA ranking shows that C is more
favorable compared to other interventions to reduce long term all-cause
mortality and MACE (SUCRA 0.932 and 0.953). Sensitivity analysis with only
RCTs and propensity matched scoring observational studies retains the
significance and ranking of the interventions. Conclusion(s): CR is
just as safe as culprit vessel revascularization and single stage CR
guided by FFR is the most preferable strategy to reduce risk of all- cause
mortality and MACE. PROSPERO ID: CRD42023491792. Copyright © 2024
Elsevier Inc.

<24>
Accession Number
2037886198
Title
Handling non-ignorable missing intimal hyperplasia data - Lessons from the
VEST trial.
Source
Contemporary Clinical Trials. 152 (no pagination), 2025. Article Number:
107878. Date of Publication: 01 May 2025.
Author
Overbey J.R.; Raymond S.; Chang H.; Bagiella E.
Institution
(Overbey, Raymond, Chang, Bagiella) Center for Biostatistics, Department
of Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Overbey) Berry Consultants, Austin, TX, United States
Publisher
Elsevier Inc.
Abstract
Non-ignorable missing data arise often in clinical trials. The VEST trial,
a randomized, within-patient-controlled study, assessed the effect of an
external scaffold for saphenous vein grafts on intimal hyperplasia (IH)
one year after coronary artery bypass graft surgery. It was anticipated
that approximately 13 % of grafts would be occluded and unsuitable for
intravascular ultrasound, resulting in missing IH values at 1-year. Given
graft occlusion is a negative outcome and higher IH is associated with
occlusion, this missing data is non-ignorable. To address this, we
developed a novel two-part method for the MNAR (missing not at random)
scenario in the VEST trial. This method combines penalized multiple
imputation with a modified Wilcoxon signed-rank test. We evaluated the
approach's performance against alternatives in a series of simulation
studies. The new method did not show type I error inflation. Under trial
assumptions, it provided adequate power. However, if missing data exceeds
20 %, power decreases notably with the double penalization method due to
underestimation of the treatment effect. When missing data is balanced
between arms, penalized multiple imputation alone is more powerful and
unbiased. Conversely, for unbalanced MNAR data, as might occur with a
treatment effect on IH, the penalized multiple imputation with a modified
Wilcoxon signed-rank test approach is more powerful. The VEST trial showed
more occlusions than expected, balanced across arms, resulting in
potential underestimation of the true treatment effect. However, given the
potential for unbalanced missingness, this approach was suitable and could
be applied in other settings with similar challenges. Copyright ©
2025 Elsevier Inc.

<25>
Accession Number
2033071543
Title
Transcatheter management of residual mitral regurgitation after
transcatheter edge-to-edge repair: a systematic review.
Source
Cardiovascular Intervention and Therapeutics. 40(2) (pp 255-267), 2025.
Article Number: 100234. Date of Publication: 01 Apr 2025.
Author
Baudo M.; Cuko B.; Ternacle J.; Sicouri S.; Busuttil O.; Denti P.; Godino
C.; De Vincentiis C.; Ramlawi B.; Leroux L.; Modine T.; Palloshi A.;
Maisano F.
Institution
(Baudo, Sicouri, Ramlawi) Department of Cardiac Surgery Research, Lankenau
Institute for Medical Research, Main Line Health, 100 E Lancaster Avenue,
Wynnewood, PA, United States
(Cuko, Ternacle, Busuttil, Leroux, Modine) Department of Cardiology and
Cardio-Vascular Surgery, Hopital Cardiologique du Haut-Leveque, Bordeaux
University Hospital, Pessac, France
(Denti, Godino, Palloshi, Maisano) Heart Valve Center, IRCCS San Raffaele,
Milan, Italy
(De Vincentiis) Department of Cardiac Surgery, IRCCS San Donato, Milan,
Italy
(Ramlawi) Department of Cardiac Surgery, Lankenau Heart Institute, Main
Line Health, Wynnewood, PA, United States
(Palloshi) Department of Interventional Cardiology, Istituto Clinico Citta
Studi, Milan, Italy
Publisher
Springer
Abstract
Background: Treatment of residual mitral regurgitation (MR) with different
percutaneous devices after transcatheter edge-to-edge repair (TEER) has
been reported as an alternative option to reclipping or surgery. This
review aims at describing the different transcatheter strategies available
and their results when managing residual MR after TEER. Method(s): A
literature search was undertaken across Pubmed, ScienceDirect, SciELO,
DOAJ, and Cochrane library databases, to identify article reporting
patients with post-TEER residual MR managed by a transcatheter approach
that did not involve only the implantation of new clips. Result(s):
From 439 deduplicated studies, 24 articles ultimately met the inclusion
criteria. Fifteen described an occluder device implantation, 12 with an
Amplatzer and 3 with a Cardioform. The most feared complications were
hemolysis and device embolization. Three cases of transcatheter
annuloplasty were reported in patients with residual functional MR. An
electrosurgical detachment of the TEER device from the anterior mitral
leaflet (ELASTA-Clip) before mitral valve replacement was reported in 6
articles. Conclusion(s): Transcatheter procedures addressing residual
MR after TEER in carefully selected patients are feasible in experienced
centers. Outcomes are promising despite some technical issues.
Percutaneous strategies and related complications should be anticipated
using multimodality imaging. Copyright © The Author(s) under
exclusive licence to Japanese Association of Cardiovascular Intervention
and Therapeutics 2025.

<26>
Accession Number
2033650696
Title
Management of Acute Ischemic Stroke Following Transcatheter Aortic Valve
Implantation: A Systematic Review and Multidisciplinary Treatment
Recommendations.
Source
Journal of Clinical Medicine. 13(23) (no pagination), 2024. Article
Number: 7437. Date of Publication: 01 Dec 2024.
Author
Hammond-Haley M.; Almohtadi A.; Gonnah A.R.; Raha O.; Khokhar A.; Hartley
A.; Khawaja S.; Hadjiloizou N.; Ruparelia N.; Mikhail G.; Malik I.;
Banerjee S.; Kwan J.
Institution
(Hammond-Haley, Almohtadi, Gonnah, Khokhar, Hartley, Khawaja, Hadjiloizou,
Ruparelia, Mikhail, Malik) National Heart and Lung Institute, Hammersmith
Hospital, Imperial College London, London, United Kingdom
(Raha) Oxford University Hospitals NHS Trust, Oxford, United Kingdom
(Banerjee, Kwan) Department of Brain Sciences, Imperial College London,
London, United Kingdom
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Acute ischemic stroke is an uncommon but
potentially devastating complication of Transcatheter Aortic Valve
Implantation (TAVI). Despite improvements in device technology and
procedural techniques, stroke rates have remained stable, with cerebral
embolic protection devices demonstrating only limited efficacy to date.
Therefore, the management of acute ischemic stroke complicating TAVI
(AISCT) remains a key priority. We conducted a systematic review of the
management of AISCT and provided multidisciplinary consensus
recommendations for optimal management. Method(s): PubMed, Google
Scholar, and Cochrane databases were searched from inception to October
2023. All the original studies focusing on the treatment of AISCT were
included. Non-English language studies, review articles, and studies in
pediatric populations were excluded. Consensus recommendations were made
by a working group comprising experts in stroke medicine and structural
interventional cardiology. Result(s): A total of 18 studies met the
inclusion criteria, including 14 case reports/series and 4 observational
studies. No clinical trials were identified. The included case reports and
series suggest that tissue-type plasminogen activator (tPA) and mechanical
thrombectomy (MT) might be effective strategies for managing AISCT.
However, significant bleeding complications were reported in two out of
the four patients receiving tPA. Four observational studies also suggest
an association between tPA and/or MT and improved functional outcomes and
survival compared to conservative management. Higher bleeding rates were
reported following tPA. Observational data suggest that there is currently
little real-world utilization of either reperfusion strategy.
 Conclusion(s): There is an absence of high-quality randomized data to
guide clinical decision making in this important area. Observational data
suggest reperfusion strategies are associated with improved clinical
outcomes once important confounders such as stroke severity have been
accounted for. While MT can be recommended as the standard of care in
appropriately selected patients, significantly increased rates of bleeding
with tPA following large-bore arterial access raise important safety
concerns. We present simple clinical guidance for AISCT based on the
limited available data. Close multidisciplinary work and patient-specific
consideration of ischemic and bleeding risk is essential. Copyright
© 2024 by the authors.

<27>
Accession Number
2027253652
Title
Medical graphics to improve patient understanding and anxiety in elderly
and cognitively impaired patients scheduled for transcatheter aortic valve
implantation (TAVI).
Source
Clinical Research in Cardiology. 114(3) (pp 302-312), 2025. Article
Number: e015975. Date of Publication: 01 Mar 2025.
Author
Brand A.; Hornig C.; Crayen C.; Hamann A.; Martineck S.; Leistner D.M.;
Dreger H.; Sundermann S.; Unbehaun A.; Sherif M.; Haghikia A.; Bischoff
S.; Lueg J.; Kuhnle Y.; Paul O.; Squier S.; Stangl K.; Falk V.; Landmesser
U.; Stangl V.
Institution
(Brand, Hornig, Dreger, Bischoff, Lueg, Stangl, Stangl) Department of
Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum
der Charite, Campus Charite Mitte, Berlin, Germany
(Brand, Leistner, Haghikia, Landmesser) Department of Cardiology,
Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite,
Campus Benjamin Franklin, Berlin, Germany
(Brand, Leistner, Dreger, Sundermann, Haghikia, Falk, Landmesser, Stangl)
DZHK (German Centre for Cardiovascular Research), partner Site Berlin,
Berlin, Germany
(Crayen) Department of Education and Psychology, Freie Universitat Berlin,
Habelschwerdter Allee 45, Berlin, Germany
(Hamann) Mintwissen-Science Communication Agency and Publishing House,
Paulusstr. 11, Dusseldorf, Germany
(Martineck) Kollwitzstrase 52, Berlin, Germany
(Sundermann, Unbehaun, Falk) Department of Cardiothoracic and Vascular
Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany
(Sherif, Kuhnle, Paul) Department of Cardiology, Angiology and Intensive
Care Medicine, Deutsches Herzzentrum der Charite, Campus Virchow Klinikum,
Berlin, Germany
(Squier) English and Women's, Gender and Sexuality Studies, The
Pennsylvania State University, University Park, PA, United States
(Leistner) Department of Cardiology, Angiology and Intensive Care
Medicine, Goethe University Hospital, Universitares Herz- und
Gefasszentrum Frankfurt, Frankfurt am Main, Frankfurt, Germany
(Leistner) DZHK (German Centre for Cardiovascular Research), partner site
Rhein-Main, Munich, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Anxiety and limited patient comprehension may pose significant
barriers when informing elderly patients about complex procedures such as
transcatheter aortic valve implantation (TAVI). Objective(s): We
aimed to evaluate the utility of medical graphics to improve the patient
informed consent (IC) before TAVI. Method(s): In this prospective,
randomized dual center study, 301 patients were assigned to a patient
brochure containing medical graphics (Comic group, n = 153) or sham
information (Control group, n = 148) on top of usual IC. Primary outcomes
were patient understanding of central IC-related aspects and
periprocedural anxiety assessed by the validated Spielberger State Trait
Anxiety Inventory (STAI), both analyzed by cognitive status according to
the Montreal Cognitive Assessment (MoCA). Result(s): Patient
understanding was significantly higher in the Comic group [mean number of
correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI
1.2-1.8); p < 0.001]. This effect was more pronounced in the presence of
cognitive dysfunction (MoCA < 26) [12.6 (1.2) in the Comic vs. 10.9 (1.6)
in the Control group; mean difference 1.8 (1.4-2.2), p < 0.001]. Mean STAI
score declined by 5.7 (95% CI 5.1-6.3; p < 0.001) in the Comic and 0.8
points (0.2-1.4; p = 0.015) in the Control group. Finally, mean STAI score
decreased in the Comic group by 4.7 (3.8-5.6) in cognitively impaired
patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive
function (p < 0.001 each). Conclusion(s): Our results prove
beneficial effects for using medical graphics to inform elderly patients
about TAVI by improving patient understanding and reducing periprocedural
anxiety (DRKS00021661; 23/Oct/2020). Copyright © The Author(s)
2023.

<28>
[Use Link to view the full text]
Accession Number
646146020
Title
The association between diabetes mellitus and postoperative cognitive
dysfunction: a systematic review and meta-analysis.
Source
International journal of surgery (London, England). 111(3) (pp 2633-2650),
2025. Date of Publication: 01 Mar 2025.
Author
Liu H.; Chen J.; Ling J.; Wu Y.; Yang P.; Liu X.; Liu J.; Zhang D.; Yin
X.; Yu P.; Zhang J.
Institution
(Liu) Jiujiang Clinical Precision Medicine Research Center, Jiujiang,
China
(Liu, Chen) First Clinical Medical College, Jiangxi Medical College,
Nanchang University, Nanchang, Jiangxi, China
(Ling, Wu, Yang, Liu, Yu) School of Stomatology, Jiangxi Medical College,
Nanchang University, Nanchang, Jiangxi, China
(Liu) Department of Endocrinology and Metabolism, Second Affiliated
Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi,
China
(Zhang) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun
Yat-sen University, Guangzhou, China
(Zhang, Yin) Food and Nutritional Sciences, School of Biological Sciences,
University of Hong Kong, Hong Kong, China
(Zhang, Yin, Zhang) Department of Neurology, Clinical Medical School of
Jiujiang University, Jiujiang, Jiangxi, China
(Zhang) Jiujiang Clinical Precision Medicine Research Center, Jiujiang,
Jiangxi, China
Abstract
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a typical
consequence following surgery, particularly in cardiac surgeries. Despite
its high incidence, the underlying etiology remains unclear. While
diabetes mellitus (DM) has been associated with cognitive impairment, its
specific function in POCD development remains unidentified. This study
aims to evaluate the connection between DM and the risk of POCD.
 METHOD(S): We conducted a comprehensive search of PubMed, Embase, Web
of Science, and the Cochrane Library databases for studies of DM and risk
with POCD, collecting data up to 14 September 2023. We assessed
publication bias, heterogeneity, and study quality, adhering to PRISMA and
AMSTAR guidelines. RESULT(S): Our study comprised 38 trials involving
8748 individuals, with 7734 patients undergoing follow-up. The pooled
results showed that individuals with DM had an increased incidence of POCD
compared to nondiabetic individuals (RR: 1.44, 95% CI: 1.26-1.65). The
incidence of POCD was significantly higher in the group of patients with
an average age older than 65 years (RR: 1.69, 95% CI: 1.30-2.20) compared
with diabetic patients with an average age younger than 65 years (RR:
1.29, 95% CI: 1.09-1.64). Compared with diabetic patients undergoing
cardiac surgery (RR: 1.33, 95% CI: 1.15-1.53), patients receiving
non-cardiac surgery showed a greater incidence of POCD (RR: 2.01, 95% CI:
1.43-2.84). CONCLUSION(S): Current evidence underscores that diabetic
patients face a significantly higher risk of POCD compared to their
nondiabetic counterparts. Further research is warranted to clarify the
precise mechanisms of this relationship and explore potential preventive
strategies for diabetic patients. Copyright © 2025 The Author(s).
Published by Wolters Kluwer Health, Inc.

<29>
[Use Link to view the full text]
Accession Number
646518214
Title
Exercise-based cardiac rehabilitation for patients undergoing coronary
artery operation: a systematic review and meta-analysis based on current
randomized controlled trials.
Source
International journal of surgery (London, England). 111(3) (pp 2708-2721),
2025. Date of Publication: 01 Mar 2025.
Author
Shi Y.; Xu H.; Dong J.
Institution
(Shi, Dong) Rehabilitation Treatment Center of Wangjing Hospital, Chinese
Academy of Traditional Chinese Medicine, Beijing, China
(Xu) Department of Anesthesiology, Wangjing Hospital, Chinese Academy of
Traditional Chinese Medicine, Beijing, China
Abstract
BACKGROUND: Currently, exercise-based cardiac rehabilitation (CR) has been
receiving increasing interest for its potentially beneficial effects on
the health related quality of life (HRQoL) and outcomes of patients with
coronary heart disease (CHD). The aim of this study was to evaluate the
effect of exercise-based CR on patients after coronary artery bypass graft
(CABG) and percutaneous coronary interventions (PCI). METHOD(S): We
searched PubMed, Embase, Cochrane Library, and Web of Science from
inception to 1 December 2023 for relevant studies that evaluated the
effect of exercise-based CR on patients after CABG and PCI. Our primary
outcomes included mortality, complications, hospital admissions, and HRQoL
between patients receiving exercise-based CR and usual care. All
statistical analyses were performed using the standard statistical
procedures provided in Review Manager 5.2 and Stata 12.0. RESULT(S):
We finally indicated and included 25 randomized controlled trials (RCTs)
with 4106 participants for the present analysis. Our pooled results
indicated that, compared to usual care, exercise-based CR did not increase
the all-cause (relative risk, RR: 0.84; 95% confidence interval, CI:
0.54-1.31) and cardiovascular (RR: 0.98; 95% CI: 0.38-2.54) mortality for
patients after coronary artery operation. Similarly, exercise-based CR had
an equal effect on coronary artery complications for patients after
coronary artery surgery, including CABG (RR: 0.60; 95% CI: 0.32 - 1.15)
and PCI (RR: 0.92; 95% CI: 0.55-1.54). It was indicated that
exercise-based CR significantly reduced the incidence of myocardial
infarction (MI) by half with an RR of 0.50 (95% CI: 0.28-0.90). In
addition, exercise-based CR also significantly reduced all-cause hospital
admissions with an RR of 0.74 (95% CI: 0.62-0.88). Compared to usual care,
exercise-based CR obviously improved HRQoL of patients after coronary
artery operation evaluated with SF-36 summary scores (standardized mean
difference, SMD: 0.24; 95% CI: 0.11-0.38) and SF-36 8 domains (SMD: 0.35;
95% CI: 0.24-0.46). CONCLUSION(S): Our analysis indicated that
exercise-based CR had a significant effect on the improvement of HRQoL in
patients after coronary artery surgeries without increasing mortality or
the incidence of re-intervention with operations. Copyright ©
2025 The Author(s). Published by Wolters Kluwer Health, Inc.

<30>
Accession Number
2037118457
Title
Combined Short-Long Axis Versus Medial Oblique Axis for Internal Jugular
Vein Cannulation: A Prospective Single-Blinded Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 39(4) (pp 910-915),
2025. Date of Publication: 01 Apr 2025.
Author
Afifi S.; Soltan S.A.; Farag A.M.G.
Institution
(Afifi) Department of Anesthesia, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
(Afifi, Soltan) Specialized Anesthesia Department, King Abdullah Medical
City in Holy Capital KAMC-HC, Makkah, Saudi Arabia
(Soltan) Department of Anesthesia, Faculty of Medicine, Al Azhar
University, Cairo, Egypt
(Farag) Department of Cardiac Anesthesia, King Abdullah Medical City in
Holy Capital KAMC-HC, Makkah, Saudi Arabia
Publisher
W.B. Saunders
Abstract
Objective(s): Previous literature suggested the advantage of combined
short-long axis (CSLA) technique to avoid posterior wall puncture during
internal jugular vein (IJV) cannulation. The purpose of this study is to
define the best ultrasound-guided IJV cannulation technique regarding the
success rate in the first trial of insertion, time to successful central
line placement, number of attempts, procedural complications, and operator
satisfaction. Design(s): Single-blinded, prospective randomized
clinical trial. Setting(s): Elective cardiac surgeries in a tertiary
care center. Participant(s): One hundred seventy-eight elective
cardiac surgery patients older than 18 years accepted to participate in
the study and signed the informed consent. Intervention(s): Patients
were randomized into two equal groups: medial oblique axis and CSLA.
During the technique, vein dimensions, patient characteristics, technique
duration, posterior wall puncture, number of attempts, complications, and
operator satisfaction were documented. Measurements and Main Results:
Apart from body weight, there were no significant differences in baseline
characteristics between both groups. Compared to the CSLA, the medial
oblique approach showed significantly higher first-trial success rate
(92.1% v 75.0%, p = 0.002), less time for successful insertion (mean +/-
SD, 60.9 +/- 54.9 seconds v 110.7 +/- 101.6 seconds, p < 0.001),
accomplishment with fewer attempts (mean +/- SD, 1.09 +/- 0.28 v 1.44 +/-
0.81, p < 0.001), and higher operator satisfaction (mean +/- SD, 4.45 +/-
0.92 v 3.46 +/- 1.32, p < 0.001). No significant difference in
complications, including posterior wall puncture (p = 0.469), was noted
between both groups. Conclusion(s): This study demonstrated the
medial oblique axis approach was superior to the CSLA approach regarding
first-trial success rate, time to successful line placement, number of
attempts, and operator satisfaction when used during elective cannulation
of the IJV. However, regarding the incidence of complications, there was
no advantage of one approach over the other. Further research is needed to
confirm these results among specific groups of operators, with awake
patients and in emergent situations. Copyright © 2025 Elsevier
Inc.

<31>
Accession Number
2037908259
Title
Assessing the gaps in cardiovascular disease risk assessment and
management in primary care for Maori and Pacific peoples in Aotearoa New
Zealand- a systematic review.
Source
The Lancet Regional Health - Western Pacific. 56 (no pagination), 2025.
Article Number: 101511. Date of Publication: 01 Mar 2025.
Author
Wheeler A.; Rahiri J.-L.; Ellison-Lupena R.; Hanchard S.; Brewer K.M.;
Paynter J.; Winter-Smith J.; Selak V.; Ameratunga S.; Grey C.; Harwood M.
Institution
(Wheeler, Rahiri, Hanchard, Brewer, Paynter, Grey) Department of General
Practice and Primary Health Care, School of Population Health, Faculty of
Medical and Health Sciences, The University of Auckland, Auckland, New
Zealand
(Ellison-Lupena) School of Health, Victoria University of Wellington,
Wellington, New Zealand
(Winter-Smith, Selak, Ameratunga) Section of Epidemiology & Biostatistics,
School of Population Health, Faculty of Medical & Health Sciences,
University of Auckland, Auckland, New Zealand
(Harwood) Faculty of Medical and Health Sciences, University of Auckland,
Auckland, New Zealand
Publisher
Elsevier Ltd
Abstract
Background: Maori and Pacific peoples carry the highest burden of
cardiovascular disease in New Zealand (NZ). This systematic review aimed
to determine access to evidence-based cardiovascular disease risk
assessment (CVDRA) and management in primary care for Maori and Pacific
peoples compared with other ethnicities in NZ, as well as factors
contributing to reduced access. Method(s): In this systematic review
with a narrative synthesis, keywords related to Maori and Pacific peoples,
cardiovascular disease, and primary care were used to search MEDLINE
(OVID), EMBASE, Scopus, CINAHL, NZresearch.org, National Library Catalogue
(Te Puna), Index New Zealand (INNZ), and Australia/New Zealand Reference
Centre, grey literature and hand search sources from 1 January 2000 to 31
December 2024. Two reviewers screened texts and three reviewers extracted
data and assessed quality. High quality was defined using Western (Mixed
Methods Appraisal Tool, MMAT, >=80% compliance) and Indigenous
(CONSolIDated critERtia for strengthening the reporting of health research
involving Indigenous Peoples, CONSIDER) research tools. The protocol for
this systematic review was registered at:
https://doi.org/10.17605/OSF.IO/VUDE9. Finding(s): A total of 2765
texts were identified of which 69 were included. This review identified
inadequate levels of CVDRA in Maori and Pacific peoples when measured
against the 90% national target. While the provision of primary prevention
medications was higher (antihypertensives) or similar (lipid-lowering)
compared to that for other ethnic groups, adherence was lower for Maori
and Pacific peoples compared to other groups. Maori and Pacific peoples
were less likely than others to receive antiplatelets and lipid-lowering
therapy for secondary prevention. Evidence for antihypertensives in
secondary prevention and combination therapy (in primary or secondary
prevention) was mixed. Maori and Pacific peoples experienced reduced
access to revascularisation compared with other ethnic groups, an inequity
that persisted over time. Factors contributing to CVDRA and management
were provision of adequate health literacy, relationships with providers
and whanau, access to care, and cultural safety. While 64% of studies were
>=80% compliant with the MMAT, suggesting high quality from a Western
research perspective, 71% of studies had an adapted CONSIDER score <=2,
suggesting low quality from an Indigenous perspective. The CONSIDER
domains with the highest levels of reporting were Prioritisation, and
Analysis and interpretation, while Capacity and Dissemination were the
least reported domains. Qualitative studies had generally higher levels of
CONSIDER reporting than mixed methods and quantitative studies. Kaupapa
Maori Research was of the highest quality, followed by studies focused on
Maori and/or Pacific peoples, while studies not focused on Maori and/or
Pacific peoples had the lowest levels of CONSIDER reporting.
 Interpretation(s): Extensive and inequitable gaps in CVDRA and
management for Maori and Pacific peoples were identified. Opportunities
for reducing these gaps include providing adequate CVD literacy,
involvement of whanau, patient-provider relationships, access to care, and
enhancing cultural safety. Our findings will contribute to the development
of a cardiovascular care equity roadmap in NZ. There are opportunities to
improve reporting against the adapted CONSIDER criteria, which involves
critical inquiry and a strength-based approach inclusive of Maori and
Pacific values, particularly in quantitative research and research
including but not focusing on Maori and Pacific peoples. Funding(s):
The Heart Foundation of New Zealand and Healthier Lives National Science
Challenge, grant number 1819. Copyright © 2025 The Authors

<32>
Accession Number
2037916262
Title
Invasive vs Conservative Management of Patients With Chronic Total
Occlusion: Results From the ISCHEMIA Trial.
Source
Journal of the American College of Cardiology. 85(12) (pp 1335-1349),
2025. Date of Publication: 01 Apr 2025.
Author
Bangalore S.; Mancini G.B.J.; Leipsic J.; Budoff M.J.; Xu Y.; Anthopolos
R.; Brilakis E.S.; Dwivedi A.; Spertus J.A.; Jones P.G.; Cho Y.J.; Mark
D.B.; Hague C.J.; Min J.K.; Reynolds H.R.; Elghamaz A.; Nair R.G.;
Mavromatis K.; Gosselin G.; Banerjee S.; Pejkov H.; Lindsay S.; Grantham
J.A.; Williams D.O.; Stone G.W.; O'Brien S.M.; Hochman J.S.; Maron D.J.
Institution
(Bangalore, Xu, Anthopolos, Reynolds, Hochman) New York University
Grossman School of Medicine, New York, NY, United States
(Mancini, Leipsic, Hague) University of British Columbia, Vancouver, BC,
Canada
(Budoff) Lundquist Institute, Los Angeles, CA, United States
(Brilakis) Minneapolis Heart Institute and Minneapolis Heart Institute
Foundation, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Dwivedi) Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Northwell Health, Hempstead, NY, United States
(Dwivedi) Division of Cardiology, Lenox Hill Hospital, Northwell Health,
New York, NY, United States
(Spertus, Jones, Cho, Grantham) University of Missouri-Kansas City's
Healthcare Institute for Innovations in Quality and Saint Luke's Mid
America Heart Institute, Kansas City, MO, United States
(Mark, O'Brien) Duke Clinical Research Institute and Duke University,
Durham, NC, United States
(Min) Cleerly, New York, NY, United States
(Elghamaz) Northwick Park Hospital-Royal Brompton Hospital, London, United
Kingdom
(Nair) Government Medical College, Kerala, India
(Mavromatis) Emory University School of Medicine and Atlanta VA Healthcare
System, Atlanta, GA, United States
(Gosselin) Montreal Heart Institute, Montreal, QC, Canada
(Banerjee) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Pejkov) University Clinic of Cardiology, Skopje, North Macedonia
(Lindsay) Bradford Teaching Hospitals NHS Foundation Trust, Bradford,
United Kingdom
(Williams) Brigham and Women's Hospital, Boston, MA, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Maron) Department of Medicine, Stanford University, Stanford, CA, United
States
Publisher
Elsevier Inc.
Abstract
Background: Randomized trials of chronic total occlusion (CTO)
revascularization vs medical therapy have yielded inconsistent results.
 Objective(s): The aim of this study was to evaluate outcomes with an
initial invasive strategy (INV) vs an initial conservative strategy (CON)
in patients with coronary computed tomographic angiography
(CCTA)-determined CTO in the ISCHEMIA (International Study of Comparative
Health Effectiveness With Medical and Invasive Approaches) trial.
 Method(s): Participants in ISCHEMIA who underwent CCTA evaluated for
CTO by the core laboratory (3,113 of 5,179 randomized patients [60%]) were
categorized into subgroups with (100% stenosis) and without (<100%
stenosis) CTO. Primary analysis compared outcomes in those randomized to
INV vs CON using an intention-to-treat approach. Secondary analyses
compared outcomes using inverse probability weighting to model successful
CTO revascularization (REV) in all INV participants vs CON participants.
 Result(s): Of the 3,113 CCTA-evaluable participants, 1,470 had at
least 1 CTO (752 INV and 718 CON). INV did not reduce cardiovascular (CV)
death or myocardial infarction (MI) (5-year difference -3.5%; 95% CI:
-7.8% to 0.8%) and resulted in more procedural MIs (2.5%; 95% CI:
1.0%-4.0%) but fewer spontaneous MIs (-6.3%; 95% CI: -9.7% to -3.2%) than
CON. CTO REV modeled across INV had a high probability (>90%) of any lower
CV death or MI, MI, spontaneous MI, unstable angina, and heart failure
counterbalanced by a higher rate of procedural MI. CTO REV significantly
improved angina-related quality of life (mean difference 4.6 points), Rose
Dyspnea Scale score (rescaled) (mean difference 5.3 points), and EQ-5D
visual analog scale score (4.6 points). Conclusion(s): In the
ISCHEMIA trial, the risks and benefits of INV compared with CON were
similar among patients with and without CCTA-determined CTO (more frequent
procedural MI, less frequent spontaneous MI, and significantly improved
angina and dyspnea-related quality of life). In an observational
comparison, successful CTO REV was associated with a high probability of
lower CV death or MI (driven by lower MI) compared with CON.
(International Study of Comparative Health Effectiveness With Medical and
Invasive Approaches [ISCHEMIA]; NCT01471522) Copyright © 2025
American College of Cardiology Foundation

<33>
Accession Number
2035086891
Title
Transcatheter versus surgical aortic valve replacement: a meta-analysis of
comparative outcomes in low- and intermediate-risk patients with severe
aortic stenosis.
Source
Heart, Vessels and Transplantation. 8(4) (no pagination), 2024. Date of
Publication: 2024.
Author
Almuzainy S.; Hamodat O.S.; Nizar S.
Institution
(Almuzainy, Hamodat, Nizar) Faculty of Medicine, University of Sharjah,
Sharjah, United Arab Emirates
Publisher
Bishkek: Center for Scientific Research and Development of Education
Abstract
Objective: Aortic stenosis is the most common valvular heart disease. This
study aims to systematically analyze randomized clinical trials (RCTs)
data comparing transcatheter aortic valve replacement (TAVR) and surgical
aortic valve replacement (SAVR) in intermediate and low-risk patients with
severe symptomatic aortic stenosis. Method(s): We conducted a
meta-analysis of RCTs, performing an exhaustive search of major databases
to identify studies comparing TAVR and SAVR in low- to intermediate-risk
patients. We assessed mortality, stroke, length of hospital stay, and
other perioperative outcomes. Result(s): Nine RCTs with 8,884
patients (average age 77.76 years; 49.47% male) met the inclusion
criteria. Baseline characteristics were comparable between TAVR and SAVR
groups, with a low risk of bias. Pooled results showed a significant
reduction in mortality for TAVR compared to SAVR (RR 0.75, 95% CI
0.61-0.92, p = 0.007, I2 = 51%). TAVR significantly reduced
stroke incidence (RR 0.66, 95% CI 0.49-0.89, p = 0.007, I2 =
69%) and myocardial infarction (RR 0.60, 95% CI 0.37-0.96, p = 0.03,
I2 = 0%). No significant difference was found for prosthetic
valve endocarditis (RR 1.06, 95% CI 0.55-2.06, p = 0.85, I2 =
0%). Length of stay was significantly shorter for TAVR (MD -4.30 days, 95%
CI -5.03 to - 3.57, p = 0.00001, I2 = 93%). Conclusion(s):
TAVR is a viable option for intermediate and low-risk patients with severe
symptomatic aortic stenosis. Future research should focus on long-term
outcomes and TAVR device durability, especially in younger, lower-risk
populations. Copyright ©2024 Heart, Vessels and Transplantation.

<34>
Accession Number
50914248
Title
Association of estimated glomerular filtration rate and albuminuria with
all-cause and cardiovascular mortality in general population cohorts: a
collaborative meta-analysis.
Source
The Lancet. 375(9731) (pp 2073-2081), 2010. Date of Publication: 12 Jun
2010.
Author
Matsushita K.; van der Velde M.; Astor B.C.; Woodward M.; Levey A.S.; de
Jong P.E.; Coresh J.; Gansevoort R.T.; El-Nahas M.; Eckardt K.-U.; Kasiske
B.L.; Tonelli M.; Hemmelgarn B.; Wang Y.; Atkins R.C.; Polkinghorne K.R.;
Chadban S.J.; Shankar A.; Klein R.; Klein B.E.K.; Wang H.; Wang F.; Zhang
L.; Liu L.; Shlipak M.; Jafar T.; Islam M.; Hatcher J.; Poulter N.;
Chaturvedi N.; Rothenbacher D.; Brenner H.; Raum E.; Koenig W.; Fox C.S.;
Hwang S.-J.; Meigs J.B.; Cirillo M.; Hallan S.; Lydersen S.; Holmen J.;
Sarnak M.J.; Katz R.; Fried L.P.; Roderick P.; Nitsch D.; Fletcher A.;
Bulpitt C.; Ohkubo T.; Metoki H.; Nakayama M.; Kikuya M.; Imai Y.; Jassal
S.K.; Barrett-Connor E.; Bergstrom J.; Warnock D.G.; Muntner P.; Judd S.;
McClellan W.M.; Cushman M.; Howard G.; McClure L.A.; Jee S.H.; Kimm H.;
Yun J.E.; Wen C.-P.; Wen S.-F.; Tsao C.-K.; Tsai M.-K.; Arnlov J.; Auguste
P.; Veldhuis K.; Camarata L.; Thomas B.; Manley T.
Institution
(Matsushita, Astor, Coresh) Department of Epidemiology, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, United States
(van der Velde, de Jong, Gansevoort) Department of Nephrology, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Woodward) George Institute, University of Sydney, Sydney, Australia
(Levey) Division of Nephrology, Tufts Medical Center, Boston, MA, United
States
(Tonelli, Hemmelgarn) AKDN
(Matsushita, Astor, Coresh, Wang) ARIC
(Shlipak, Sarnak, Katz, Fried) CHS, United States
(Islam, Hatcher, Poulter, Chaturvedi) COBRA, Pakistan
(Rothenbacher, Brenner, Raum, Koenig) ESTHER, Germany
Publisher
Elsevier B.V.
Abstract
Background: Substantial controversy surrounds the use of estimated
glomerular filtration rate (eGFR) and albuminuria to define chronic kidney
disease and assign its stages. We undertook a meta-analysis to assess the
independent and combined associations of eGFR and albuminuria with
mortality. Method(s): In this collaborative meta-analysis of general
population cohorts, we pooled standardised data for all-cause and
cardiovascular mortality from studies containing at least 1000
participants and baseline information about eGFR and urine albumin
concentrations. Cox proportional hazards models were used to estimate
hazard ratios (HRs) for all-cause and cardiovascular mortality associated
with eGFR and albuminuria, adjusted for potential confounders.
 Finding(s): The analysis included 105 872 participants (730 577
person-years) from 14 studies with urine albumin-to-creatinine ratio (ACR)
measurements and 1 128 310 participants (4 732 110 person-years) from
seven studies with urine protein dipstick measurements. In studies with
ACR measurements, risk of mortality was unrelated to eGFR between 75
mL/min/1.73 m2 and 105 mL/min/1.73 m2 and increased
at lower eGFRs. Compared with eGFR 95 mL/min/1.73 m2, adjusted
HRs for all-cause mortality were 1.18 (95% CI 1.05-1.32) for eGFR 60
mL/min/1.73 m2, 1.57 (1.39-1.78) for 45 mL/min/1.73
m2, and 3.14 (2.39-4.13) for 15 mL/min/1.73 m2. ACR
was associated with risk of mortality linearly on the log-log scale
without threshold effects. Compared with ACR 0.6 mg/mmol, adjusted HRs for
all-cause mortality were 1.20 (1.15-1.26) for ACR 1.1 mg/mmol, 1.63
(1.50-1.77) for 3.4 mg/mmol, and 2.22 (1.97-2.51) for 33.9 mg/mmol. eGFR
and ACR were multiplicatively associated with risk of mortality without
evidence of interaction. Similar findings were recorded for cardiovascular
mortality and in studies with dipstick measurements.
 Interpretation(s): eGFR less than 60 mL/min/1.73 m2 and
ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of mortality
risk in the general population. This study provides quantitative data for
use of both kidney measures for risk assessment and definition and staging
of chronic kidney disease. Funding(s): Kidney Disease: Improving
Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney
Foundation. © 2010 Elsevier Ltd. All rights reserved.

<35>
Accession Number
2033637079
Title
Central Venous Pressure as a Predictor of Acute Kidney Injury in Cardiac
Surgery: A Systematic Review of Observational Studies.
Source
Diagnostics. 15(5) (no pagination), 2025. Article Number: 530. Date of
Publication: 01 Mar 2025.
Author
Griva P.; Griva V.; Samara D.; Talliou C.; Panagouli K.; Roungeris L.
Institution
(Griva, Panagouli) Department of Anesthesiology, University General
Hospital Attikon, Athens, Greece
(Griva) Department of Internal Medicine, General Hospital of Athens
"Sismanoglio", Athens, Greece
(Samara, Talliou) School of Medicine, National and Kapodistrian University
of Athens, Athens, Greece
(Roungeris) Department of Anaesthesiology, Rea Maternity Hospital, Athens,
Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Acute kidney injury (AKI) is a syndrome
characterized by impaired kidney function, which is associated with
reduced survival and increased morbidity. Central venous pressure (CVP) is
a widely used hemodynamic parameter for assessing the volume status of
patients and evaluating their response to fluid resuscitation. This
systematic review aims to analyze various prospective and retrospective
observational and controlled trials to determine the association between
CVP and the risk of developing AKI in patients undergoing cardiac surgery.
Additionally, it examines whether elevated CVP serves as an accurate
predictor of AKI in this patient population. Method(s): A systematic
review was conducted following the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines, using PubMed as the
primary database. The search focused on studies published after 2014 that
included adult patients undergoing cardiac surgery with reported
measurements of CVP and kidney function assessment. Studies conducted on
animals, pediatric populations, those published before 2014, or in
languages other than English were excluded from the review.
 Result(s): Through the analysis of 21 studies, a clear association
between higher CVP and increased AKI risk emerged. The most critical CVP
thresholds identified were 10 mmHg, 12 mmHg, 14 mmHg, and 20 mmHg, with
risk increasing progressively beyond these values. CVP >= 10 mmHg was the
most commonly reported cutoff for elevated AKI risk, showing 1.42 to 4.53
times increased odds. CVP >= 12 mmHg further amplified the risk, while CVP
>= 14 mmHg was consistently associated with severe AKI and the need for
RRT. The highest threshold (CVP >= 20 mmHg) showed the greatest risk
escalation, linked to fluid overload, right heart failure, and mortality.
Studies also suggest an optimal CVP range of 6-8 mmHg to minimize AKI
incidence. Conclusion(s): Elevated CVP is an independent risk factor
for the development of AKI in patients undergoing cardiac surgery. These
findings suggest that CVP monitoring can play a significant role in
predicting AKI and guiding perioperative management
strategies. Copyright © 2025 by the authors.

<36>
Accession Number
2033078550
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
chronic obstructive pulmonary disease: a systematic review and
meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. 73(4) (pp 201-208), 2025.
Article Number: e14388. Date of Publication: 01 Apr 2025.
Author
Cappellaro A.P.; de Almeida L.F.C.; Pinto M.L.; Martins M.A.B.; Sousa
A.G.E.; Gadelha J.G.; Vieira A.C.P.; Rocha L.F.R.; Thet M.S.
Institution
(Cappellaro) Centro Universitario Mauricio de Nassau de Barreiras,
Barreiras, Brazil
(de Almeida, Rocha) Department of Surgery, Federal Fluminense University,
Niteroi, Brazil
(Pinto) Universidade Federal de Ciencias da Saude de Porto Alegre, Porto
Alegre, Brazil
(Martins) Universidade Federal de Ouro Preto, Ouro Preto, Brazil
(Sousa) Centro Universitario de Anapolis, Anapolis, Brazil
(Gadelha) Afya Faculdade de Ciencias Medicas da Paraiba, Joao Pessoa,
Brazil
(Vieira) Universidade Santo Amaro, Sao Paulo, Brazil
(Thet) Department of Surgery & Cancer, Imperial College London, South
Kensington, United Kingdom
Publisher
Springer
Abstract
Introduction: Off-pump coronary artery bypass graft surgery (OPCAB) has
been suggested as superior to on-pump coronary artery bypass graft surgery
(ONCAB) in certain high-risk subgroups, but its benefit in patients with
chronic obstructive pulmonary disease (COPD) remains controversial. This
meta-analysis aimed to evaluate OPCAB versus ONCAB outcomes in COPD
patients. Method(s): We followed PRISMA guidelines and searched
PubMed, Embase, and the Cochrane Library in August 2024 for studies
comparing OPCAB and ONCAB in COPD patients. Statistical analysis was
conducted using Review Manager 5.4.1 and Rstudio with a fixed or random
effects model. Result(s): Six studies with a total of 1,687 patients
were included, of which 1,062 (62.95%) underwent OPCAB. The mean patient
age was 63.6 years. OPCAB did not significantly affect all-cause mortality
compared to ONCAB (OR 1.14; 95% CI 0.65-1.99). There were no significant
differences in reintubation (OR 0.81; 95% CI 0.53-1.23), prolonged
ventilation (OR 0.54; 95% CI 0.24-1.22), post-operative atrial
fibrillation (OR 0.90; 95% CI 0.70-1.15), or ARDS (OR 0.43; 95% CI
0.14-1.33). However, ventilation time was significantly shorter in the
OPCAB group (MD - 5.30 h; 95% CI - 7.22 to - 3.38). Conclusion(s):
OPCAB is associated with reduced ventilation time in COPD patients though
it shows no significant difference in all-cause mortality or other
post-operative complications compared to ONCAB. Copyright © The
Author(s) 2025.

<37>
Accession Number
2033594447
Title
Efficacy and safety of gastrodin in preventing postoperative delirium
following cardiac surgery: a randomized placebo controlled clinical trial.
Source
Critical Care. 29(1) (no pagination), 2025. Article Number: 108. Date of
Publication: 01 Dec 2025.
Author
Bai Y.-X.; Wu H.-L.; Xie W.-L.; Li X.; Han J.-J.; Liu J.; Chen S.-Q.; Yin
P.; Dong N.-G.; Wu Q.-P.
Institution
(Bai, Xie, Li, Han, Liu, Chen, Wu) Department of Anesthesiology, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Bai, Xie, Li, Han, Liu, Chen, Wu) Institute of Anesthesia and Critical
Care Medicine, Union Hospital, Tongji Medical College, Huazhong University
of Science and Technology, Wuhan, China
(Bai, Xie, Li, Han, Liu, Chen, Wu) Key Laboratory of Anesthesiology and
Resuscitation (Huazhong University of Science and Technology), Ministry of
Education, Wuhan, China
(Wu, Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
(Yin) Department of Epidemiology and Biostatistics, School of Public
Health, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Publisher
BioMed Central Ltd
Abstract
Background: Delirium and postoperative cognitive dysfunction (POCD) are
common complications post-cardiac surgery, yet no specific medical
intervention is currently recommended for prevention. This study aimed to
evaluate the efficacy of gastrodin infusion in preventing delirium and
POCD in critically ill patients following cardiac surgery.
 Material(s) and Method(s): A double-blind, randomized,
placebo-controlled trial was conducted on patients aged 18-75, scheduled
for coronary artery bypass grafting (CABG) surgery, with or without valve
replacement. Participants were randomized in a 1:1 ratio to receive
gastrodin infusion 600 mg twice daily or placebo from the day of surgery
until the postoperative day (POD) 6. The co-primary outcomes were the
incidences of delirium and POCD, assessed from ICU admission until POD 7
and at 1 and 3 months postoperatively. This study was registered with the
Chinese Clinical Trials Registry (ChiCTR1800020414). Result(s): Of
160 randomized participants, 155 were analyzed (77 gastrodin, 78 placebo)
according to a modified intention to treat principle. The incidence of
postoperative delirium was 19.5% in the gastrodin group and 35.9% in the
placebo group, with a significant relative risk of 0.54 (95% CI 0.32-0.93,
p = 0.022). The incidence of in-hospital POCD was 2.9% and 4.0% in the
placebo and gastrodin groups, respectively. The odds of hospital discharge
were significantly greater in the gastrodin group (subhazard ratio, 1.20;
95% CI 1.00-1.84; p = 0.049). Adverse events occurred in 9.1% (7/77) of
patients administered gastrodin and 14.1% (11/78) of patients administered
the placebo, with none being drug-related. Conclusion(s): Gastrodin
infusion significantly reduced postoperative delirium and improved
discharge outcomes in patients undergoing CABG, but larger studies are
needed to confirm its efficacy in preventing delirium. Copyright
© The Author(s) 2025.

<38>
Accession Number
2037883776
Title
Myocardial revascularization in patients with chronic kidney disease: a
systematic review and meta-analysis of surgical versus percutaneous
coronary revascularization.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 40(3) (no
pagination), 2025. Article Number: ivaf021. Date of Publication: 01 Mar
2025.
Author
Grazioli V.; Di Mauro M.; Perocchio G.; Gerometta P.; Agnino A.; Pin M.;
Meani P.; Matteucci M.; Ronco D.; Massimi G.; Maessen J.; Corradi D.;
Gaudino M.; Lorusso R.
Institution
(Grazioli, Meani, Matteucci, Ronco, Massimi, Maessen, Lorusso)
Cardio-Thoracic Surgery Department, Maastricht University Medical Centre
(MUMC), Maastricht, Netherlands
(Grazioli, Gerometta) Department of Cardiac Surgery, Cliniche Humanitas
Gavazzeni, Bergamo, Italy
(Di Mauro) Faculty of Health, Medicine and Life Sciences, Maastricht
University, Maastricht, Netherlands
(Perocchio) Division of Cardiac Surgery, Ospedale Policlinico San Martino,
Genova, Italy
(Agnino) Department of Cardiovascular Surgery, Division of Robotic and
Minimally-Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo,
Italy
(Pin) Cardiovascular Department, Maria Cecilia Hospital, GVM Care &
Research, Cotignola, Ravenna, Italy
(Matteucci) Cardiac Surgery Unit, ASST Sette Laghi, Varese, Italy
(Ronco) Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda,
Milano, Italy
(Massimi) Cardiac Surgery Unit, Santa Maria Hospital, Terni, Italy
(Maessen, Lorusso) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
(Corradi) Department of Medicine and Surgery, Unit of Pathology,
University of Parma, Parma, Italy
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
Presbyterian Hospital, New York, NY, United States
Publisher
Oxford University Press
Abstract
OBJECTIVES: To compare outcomes of two different revascularization
strategies in chronic kidney disease (CKD) patients: coronary artery
bypass grafting (CABG) versus percutaneous coronary intervention (PCI).
 METHOD(S): We conducted this meta-analysis according to Preferred
Reporting Items for Systematic Review and Meta-Analyses guidelines and
registered with PROSPERO (CRD42021238659), evaluated studies comparing
CABG and PCI in patients with CAD and CKD (defined by KDIGO guidelines).
Data were extracted from PubMed, EMBASE and Cochrane from 2000 to 2023.
The primary end-point was long-term major adverse cardiovascular and
cerebrovascular event rates, with secondary end-points including 30-day
mortality, stroke, myocardial infarction (MI) and repeat
revascularization. Statistical analyses included Kaplan-Meier estimations,
Cox regression, and meta-regression to address heterogeneity. Publication
bias was assessed via funnel plots. No funding was received, and the
authors report no conflicts of interest. RESULT(S): We included 33
studies with 402 300 patients (eGFR <60 ml/min/1.73 m2). The
cohort comprised 132 314 coronary artery bypass graft and 269 986 PCI
patients. Over 3 years, coronary artery bypass group provided protection
against major adverse cardiac and cerebrovascular events, MI, and repeat
revascularization compared to PCI. However, PCI showed better short-term
outcomes, including lower 30-day mortality. Coronary artery bypass group
was linked to a higher stroke risk over the 3-year follow-up.
 CONCLUSION(S): Revascularization strategies for CKD and coronary
artery disease patients should balance PCI's short-term benefits with
CABG's long-term advantages. Copyright © The Author(s) 2025.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<39>
Accession Number
2035968718
Title
Association of revascularization with risk of ventricular arrhythmias in
patients with chronic total occlusion of coronary arteries: Systematic
review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. 72 (pp 81-85), 2025. Date of
Publication: 01 Mar 2025.
Author
Al-Sadawi M.; Tao M.; Zhang D.; Wanamaker B.L.; Deshmukh A.; Ghannam M.;
Bogun F.; Liang J.J.
Institution
(Al-Sadawi, Wanamaker, Deshmukh, Ghannam, Bogun, Liang) University of
Michigan Hospital, 1500 E Medical Center Dr, Ann Arbor, MI, United States
(Tao, Zhang) Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook,
NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Coronary chronic total occlusion (CTO) can result in ischemic
cardiomyopathy which may create substrate supportive of ventricular
arrhythmias (VA). The purpose of this meta-analysis is to evaluate the
association of CTOs with risk of ventricular arrhythmias (VAs) and to
assess the utility of CTO percutaneous coronary intervention (PCI) in this
setting. Method(s): A literature search was conducted for studies
reporting an association between CTOs and VAs and PCI VAs among patients
with CTO. VAs were defined as ventricular tachycardia, ventricular
fibrillation, sudden cardiac death, and appropriate implantable cardiac
defibrillator therapy. The search included the following databases: Ovid
MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not
restricted to time or publication status. Result(s): Nine studies
with 3068 participants (1405 with CTOs and 1663 with coronary artery
disease [CAD]) met inclusion criteria. CTOs were associated with
significantly higher risk of VAs compared with patients with CAD without
CTOs (OR 2.25, 95 % CI 1.92-2.64; p < 0.01). Three studies with 1830
patients with CTOs (970 revascularized, 860 on optimal medical therapy)
met inclusion criteria for evaluating the association of CTO
revascularization and VAs. CTO PCI was associated with a significantly
lower risk of VAs compared with patients treated with optimal medical
therapy. Conclusion(s): Patients with CTOs appear to have a higher
burden of VAs compared with patients with CAD without CTOs.
Revascularization of CTOs was found to be associated with significant
reduction in risk of VAs, however additional high-quality studies are
required to further evaluate this association. Copyright © 2024
Elsevier Inc.

<40>
Accession Number
2036791908
Title
The Prognostic Relevance of a New Bundle Branch Block After Transcatheter
Aortic Valve Implantation: A Systematic Review and Meta-Analysis.
Source
Structural Heart. 9(3) (no pagination), 2025. Article Number: 100392. Date
of Publication: 01 Mar 2025.
Author
Rao K.; Ahmed M.; Brieger D.; Baer A.; Hansen P.; Bhindi R.
Institution
(Rao, Brieger, Hansen, Bhindi) Royal North Shore Hospital, Sydney,
Australia
(Rao, Baer, Hansen, Bhindi) North Shore Private Hospital, Sydney,
Australia
(Rao, Ahmed, Bhindi) University of Sydney, Australia
Publisher
Cardiovascular Research Foundation
Abstract
Background: Interference with the cardiac conduction system is common
after transcatheter aortic valve implantation (TAVI), manifesting as
atrioventricular block, or more commonly, new-onset persistent left bundle
branch block (NOP-LBBB). Bundle branch block results in ventricular
dyssynchrony and reduced cardiac output and may be associated with a
poorer prognosis. This systematic review and meta-analysis evaluates the
prognostic impact of a left or right bundle branch block after TAVI.
 Method(s): A systematic review was performed of the following online
databases: PubMed, Medline, Scopus, and Web of Science, including English
language studies from 2014 to 2024. Two separate searches for conducted
for NOP-LBBB and new-onset persistent right bundle branch block
(NOP-RBBB). The Newcastle-Ottawa Scale was used to evaluate risk of bias.
 Result(s): Twenty-three studies totaling 18875 patients were included
for NOP-LBBB, whilst 5 studies with a total of 3525 patients were included
for NOP-RBBB. NOP-LBBB was associated with higher all-cause mortality at 1
year (risk ratio [RR] 1.41 [95% CI 1.12-1.78], I2 = 49%, p <
0.01), cardiovascular mortality (RR 1.34 [95% CI 1.02-1.75], I2
= 60%, p = 0.02), heart failure-related rehospitalization (RR 1.56 [95% CI
1.31-1.84], I2 = 47%, p < 0.01), and permanent pacemaker
implantation at 1 year (RR 3.05 [95% CI 2.39-3.89], I2 = 14%, p
< 0.01). NOP-RBBB was not associated with higher all-cause mortality at 1
year (RR 1.74 [95% CI 0.88-3.46], I2 = 93%, p = 0.11), however
increased the risk of pacemaker implantation at 1 year (RR 4.68 [95% CI
3.60-6.08], I2 = 67%, p < 0.01). Conclusion(s): NOP-LBBB
is associated with higher mortality and heart failure rehospitalization
after TAVI, whilst both NOP-LBBB and NOP-RBBB increase the risk of
permanent pacemaker implantation at 1 year after TAVI. Copyright
© 2024 The Authors

<41>
Accession Number
2037833884
Title
Accuracy of Large Language Models for Literature Screening in Thoracic
Surgery: Diagnostic Study.
Source
Journal of Medical Internet Research. 27 (no pagination), 2025. Article
Number: e67488. Date of Publication: 2025.
Author
Dai Z.-Y.; Wang F.-Q.; Shen C.; Ji Y.-L.; Li Z.-Y.; Wang Y.; Pu Q.
Institution
(Dai, Wang, Shen, Ji, Li, Wang, Pu) Department of Thoracic Surgery, West
China Hospital of Sichuan University, Chengdu, China
Publisher
JMIR Publications Inc.
Abstract
Background: Systematic reviews and meta-analyses rely on labor-intensive
literature screening. While machine learning offers potential automation,
its accuracy remains suboptimal. This raises the question of whether
emerging large language models (LLMs) can provide a more accurate and
efficient approach. Objective(s): This paper evaluates the
sensitivity, specificity, and summary receiver operating characteristic
(SROC) curve of LLM-assisted literature screening. Method(s): We
conducted a diagnostic study comparing the accuracy of LLM-assisted
screening versus manual literature screening across 6 thoracic surgery
meta-analyses. Manual screening by 2 investigators served as the reference
standard. LLM-assisted screening was performed using ChatGPT-4o (OpenAI)
and Claude-3.5 (Anthropic) sonnet, with discrepancies resolved by
Gemini-1.5 pro (Google). In addition, 2 open-source, machine
learning-based screening tools, ASReview (Utrecht University) and
Abstrackr (Center for Evidence Synthesis in Health, Brown University
School of Public Health), were also evaluated. We calculated sensitivity,
specificity, and 95% CIs for the title and abstract, as well as full-text
screening, generating pooled estimates and SROC curves. LLM prompts were
revised based on a post hoc error analysis. Result(s): LLM-assisted
full-text screening demonstrated high pooled sensitivity (0.87, 95% CI
0.77-0.99) and specificity (0.96, 95% CI 0.91-0.98), with the area under
the curve (AUC) of 0.96 (95% CI 0.94-0.97). Title and abstract screening
achieved a pooled sensitivity of 0.73 (95% CI 0.57-0.85) and specificity
of 0.99 (95% CI 0.97-0.99), with an AUC of 0.97 (95% CI 0.96-0.99). Post
hoc revisions improved sensitivity to 0.98 (95% CI 0.74-1.00) while
maintaining high specificity (0.98, 95% CI 0.94-0.99). In comparison, the
pooled sensitivity and specificity of ASReview tool-assisted screening
were 0.58 (95% CI 0.53-0.64) and 0.97 (95% CI 0.91-0.99), respectively,
with an AUC of 0.66 (95% CI 0.62-0.70). The pooled sensitivity and
specificity of Abstrackr tool-assisted screening were 0.48 (95% CI
0.35-0.62) and 0.96 (95% CI 0.88-0.99), respectively, with an AUC of 0.78
(95% CI 0.74-0.82). A post hoc meta-analysis revealed comparable effect
sizes between LLM-assisted and conventional screening. Conclusion(s):
LLMs hold significant potential for streamlining literature screening in
systematic reviews, reducing workload without sacrificing quality.
Importantly, LLMs outperformed traditional machine learning-based tools
(ASReview and Abstrackr) in both sensitivity and AUC values, suggesting
that LLMs offer a more accurate and efficient approach to literature
screening. Copyright © 2025 JMIR Publications Inc.. All rights
reserved.

<42>
Accession Number
2037633995
Title
Antithrombotic Therapy to Minimize Total Events After ACS or PCI in Atrial
Fibrillation: Insights From AUGUSTUS.
Source
Journal of the American College of Cardiology. 85(11) (pp 1157-1168),
2025. Date of Publication: 25 Mar 2025.
Author
Tannu M.; Lopes R.D.; Wojdyla D.M.; Goodman S.G.; Aronson R.; Mehran R.;
Granger C.B.; Windecker S.; Alexander J.H.; Jones W.S.
Institution
(Tannu, Lopes, Granger, Alexander, Jones) Division of Cardiology, Duke
University School of Medicine, Durham, NC, United States
(Tannu, Lopes, Wojdyla, Granger, Alexander, Jones) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Goodman) St Michael's Hospital, Unity Health Toronto, and Peter Munk
Cardiac Centre, University Health Network, University of Toronto, Toronto,
ON, Canada
(Aronson) Bristol Myers Squibb, Lawrenceville, NJ, United States
(Mehran) The Zena and Michael A. Weiner Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, and Cardiovascular Research Foundation,
New York, NY, United States
(Windecker) Bern University Hospital, Inselspital, University of Bern,
Bern, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Limited data exist on the optimal antithrombotic strategy to
minimize total bleeding and ischemic events for patients with recent acute
coronary syndrome (ACS) or percutaneous coronary intervention (PCI) and
atrial fibrillation (AF). Objective(s): The authors sought to
identify the antithrombotic regimen that minimized total major or
clinically relevant nonmajor bleeding events, ischemic events, and
hospitalizations after ACS or PCI in AF. Method(s): We conducted a
secondary analysis of AUGUSTUS (Open-label, 2x2 Factorial, Randomized,
Controlled Clinical Trial to Evaluate the Safety of Apixaban vs Vitamin K
Antagonist and Aspirin vs Placebo in Patients with Atrial Fibrillation and
Acute Coronary Syndrome and/or Percutaneous Coronary Intervention), a 2x2
factorial, randomized trial evaluating apixaban vs a vitamin K antagonist
(VKA) and aspirin vs placebo in patients with AF and ACS or PCI who were
on P2Y<inf>12</inf> inhibitor therapy. We determined the incidence of
total major or clinically relevant nonmajor bleeding events in patients
receiving at least 1 dose of study therapy, total ischemic events, and
total hospitalizations among patients randomized to each antithrombotic
strategy. Result(s): Over 6 months of follow-up, 573 of 4,568 (12.5%)
patients experienced at least 1 bleeding event while on study drug; among
them, 110 (19.2%) had multiple bleeding events. Compared with those with 1
bleeding event, patients with multiple bleeding events were more likely to
be on a high-potency P2Y<inf>12</inf> inhibitor (prasugrel or ticagrelor
vs clopidogrel). Of the 4,614 randomized participants, 219 (4.7%) had at
least 1 ischemic event, among whom 75 (34.2%) had multiple ischemic
events. At least 1 hospitalization occurred in 1,125 (24.4%) patients;
among them, 384 (34.1%) had multiple hospitalizations. Apixaban, compared
with VKA, significantly reduced the risk of total bleeding (rate ratio
[RR]: 0.66; 95% CI: 0.55-0.80). Apixaban had similar rates of total
ischemic events (RR: 0.83; 95% CI: 0.58-1.20) and total hospitalizations
(RR: 0.90; 95% CI: 0.79-1.03) compared with VKA. Aspirin, compared with
placebo, significantly increased the risk of total bleeding (RR: 2.14; 95%
CI: 1.75-2.60). The rates of total ischemic events (RR: 0.75; 95% CI:
0.52-1.08) and total hospitalizations (RR: 1.11; 95% CI: 0.97-1.27) with
aspirin and placebo were similar. Conclusion(s): Among patients with
AF and recent ACS or PCI, apixaban significantly reduced total bleeding
risk compared with VKA. Aspirin doubled total bleeding risk compared with
placebo without a significant change in total ischemic events. Based on
this assessment of total events, our findings support the use of apixaban
plus a low-potency P2Y<inf>12</inf> inhibitor (ie, clopidogrel) without
aspirin as the standard therapy for this high-risk patient population. (A
Study of Apixaban in Patients With Atrial Fibrillation, Not Caused by a
Heart Valve Problem, Who Are at Risk for Thrombosis [Blood Clots] Due to
Having Had a Recent Coronary Event, Such as a Heart Attack or a Procedure
to Open the Vessels of the Heart; NCT02415400) Copyright © 2025
American College of Cardiology Foundation

<43>
[Use Link to view the full text]
Accession Number
2037724688
Title
Evaluating the Appropriate Use Criteria for Coronary Revascularization in
Stable Ischemic Heart Disease Using Randomized Data From the ISCHEMIA
Trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 18(3) (pp e010849),
2025. Date of Publication: 01 Mar 2025.
Author
Slater J.; Maron D.J.; Jones P.G.; Bangalore S.; Reynolds H.R.; Fu Z.;
Stone G.W.; Kirby R.; Hochman J.S.; Spertus J.A.; Mavromatis K.; Linefsky
J.; Miller T.; Banerjee S.; Newman J.D.; Donnino R.M.; Saric M.;
Abdul-Nour K.; Stone P.H.; Jang J.J.; Yee G.; Weitz S.; Arnold S.; O'keefe
J.H.; Shapiro M.D.; Fein S.A.; Torosoff M.T.; Lyubarova R.; Mookherjee S.;
Drzymalski K.; Mcfalls E.O.; Garcia S.A.; Bertog S.C.; Siddiqui R.A.;
Ishani A.; Hansen R.A.; Khouri M.G.; Goldberg J.L.; Goldweit R.; Cohen
R.A.; Mirrer B.; Navarro V.; Winchester D.E.; Kronenberg M.; Mcfarren C.;
Heitner J.F.; Dauber I.M.; Cannan C.; Sudarshan S.; Mehta P.K.; Mcdaniel
M.; Lerakis S.; Quyyumi A.; Wenger N.K.; Hedgepeth C.M.; Hurlburt H.;
Rosen A.; Sahul Z.; Leung S.; Reda H.; Ziada K.; Setty S.; Barua R.S.;
Hage F.; Davies J.E.; Leesar M.; Heo J.; Iskandrian A.; Al Solaiman F.;
Dajani K.; El-Hajjar M.; Der Mesropian P.; Sacco J.; Mccandless B.; Orgera
M.; Sidhu M.S.; Arif I.; Kerr H.; Trejo J.F.; Fletcher G.; Lane G.E.;
Neeson L.M.; Parikh P.P.; Pollak P.M.; Shapiro B.P.; Landolfo K.;
Gemignani A.; O'rourke D.; Meadows J.L.; Call J.T.; Hannan J.; Bojar R.;
Kumar D.; Mukai J.; Martin E.T.; Vorobiof G.; Moorman A.; Kinlay S.;
Hamburger R.J.; Rocco T.P.; Bhatt D.L.; Croce K.; Quin J.A.; Anumpa J.;
Zenati M.; Faxon D.P.; Rayos G.; Seedhom A.; Sullenberger L.; Kumkumian
G.; Sedlis S.P.; Lorin J.; Tamis-Holland J.E.; Kornberg R.; Leber R.; Saba
S.; Lee M.W.; Small D.R.; Nona W.; Alexander P.B.; Rehman I.; Badami U.;
Marzo K.; Robbins I.H.; Levite H.A.; Shetty S.; Patel M.; Hamroff G.S.;
Little R.W.; Zimbelman B.D.; Lui C.Y.; Smith B.R.; Vezina D.P.; Khor L.L.;
Abraham J.D.; Bull D.A.; Mckellar S.H.; Booth D.; Kotter J.; Abdel-Latif
A.; Hu B.; Labovitz A.J.; Berlowitz M.; Rogal P.; Matar F.; Caldeira C.;
Rodriguez F.; Schnittger I.; Fearon W.F.; Deedwania P.; Reddy K.; Sweeny
J.; Spizzieri C.; Hochberg C.P.; Salerno W.D.; Wyman R.; Zarka A.; Shah
A.V.; Haldis T.; Kohn J.A.; Girotra S.; Almousalli O.; Krishnam M.S.;
Milliken J.C.; Patel P.M.; Seto A.H.; Harley K.T.; Gibson M.A.; Allen
B.J.; Coram R.; Thomas S.; Schwartz R.G.; Chen W.; El Shahawy M.; Stafford
J.; Abernethy W.B.; Zurick A.; Meyer T.M.; Morford R.G.; Rutkin B.;
Bokhari S.; Sokol S.I.; Meisner J.; Hamzeh I.; Misra A.; Wall M.; De Rosen
V.L.; Alam M.; Turner M.C.; Mulhearn T.J.; Good A.P.; Shammas N.W.;
Chilton R.; Nguyen P.K.; Jezior M.; Gordon P.C.; Crain T.; Stenberg R.;
Pedalino R.P.; Wiesel J.; Juang G.J.; Al-Amoodi M.; Wohns D.; Lader E.W.;
Mumma M.; Dharmarajan L.; Mcgarvey J.F.X.; Downes T.R.; Luckasen G.J.;
Cheong B.; Potluri S.; Mastouri R.A.; Breall J.A.; Revtyak G.E.; Bazeley
J.W.; Giedd K.; Old W.; Burt F.; Sokhon K.; Gopal D.; Valeti U.S.;
Kobashigawa J.; Govindan S.C.; Nair R.G.; Manjunath C.N.; Moorthy N.;
Manjunath S.C.; Narayanappa S.; Pandit N.; Nath R.K.; Dwivedi S.K.; Narain
V.S.; Chandra S.; Wander G.S.; Tandon R.; Ralhan S.; Aslam N.; Karthikeyan
G.; Ramakrishnan S.; Seth S.; Yadav R.; Roy A.; Parakh N.; Verma S.K.;
Narang R.; Mishra S.; Naik N.; Sharma G.; Choudhary S.K.; Patel C.; Gulati
G.; Sharma S.; Bahl V.K.; Mathew A.; Punnoose E.; Gadage S.; Umesh Pillay
T.; Satheesh S.; Mathur A.; Christopher J.; Menon R.; Kumar N.; Oomman A.;
Mao R.; Solomon H.; Parveen Khan S.; Grant P.; Kachru R.; Kumar A.;
Ganapathi S.; Jayakumar V.K.; Sivadasanpillai K.H.; Sasidharan B.;
Kapilamoorthy T.R.; Polamuri P.; Kaul U.; Fox K.A.A.; Carruthers K.;
Elghamaz A.; Gurunathan S.; Karogiannis N.; Shah B.N.; Trimlett R.H.J.;
Rubens M.B.; Nicol E.D.; Mittal T.K.; Hampson R.; Gamma R.A.; De Belder
M.A.; Thambyrajah J.; Nageh T.; Davies J.R.; Lindsay S.J.; Kurian J.;
Jamil H.; Raheem O.; Hoye A.; Donnelly P.; Valecka B.; Chauhan A.; Barr
C.; Alfakih K.; Byrne J.; Webb I.; Henriksen P.; Okane P.; De Silva R.;
Conway D.S.G.; Sirker A.A.; Hoole S.P.; Witherow F.N.; Harbinson M.; Walsh
S.; Douglas H.; Luckie M.; Sobolewska J.; Jeetley P.; Patel N.; Kotecha
T.; Travill C.; Karimullah I.; Al-Bustami M.; Braganza D.; Henderson R.;
Pointon K.; Naik S.; Mathew T.; Berry C.; Collison D.; Roditi G.; Moriarty
A.J.; Glover J.D.; Pradhan J.; Ghada M.; Francis D.P.; Dzavik V.; Diaz A.;
Rheault P.; Barrero M.; Gagne C.-E.; Pepin-Dubois Y.; Costa R.; Sia Y.T.;
Lemay C.; Gisbert A.; Gervais P.; Rheault A.; Carl Phaneuf D.; Gosselin
G.; Garg P.; Hessian R.C.; Beanlands R.S.; Davies R.F.; Bagai A.; Wald R.;
Goodman S.; Graham J.J.; Peterson M.; Chow C.-M.; Abramson B.; Cheema
A.N.; Tariq Vakani M.; Cha J.; Howarth A.G.; Uxa A.; Galiwango P.; Kassam
S.; Mukherjee A.; Joseph Ricci A.; Lam A.; Mehta S.; Udell J.; Genereux
P.; Hameed A.; Daba L.; Hueb W.; Cury Rezende P.; Hueb A.C.; Poggio Smanio
P.E.; De Quadros A.S.; Karam Kalil R.A.; Da Costa Vieira J.L.; Grossmann
G.; De Oliveira P.P.; Bridi L.; Savaris S.; Vitola J.V.; Cerci R.J.;
Farias F.R.; Fernandes M.M.; Marin-Neto J.A.; Schmidt A.; De Oliveira Lima
Filho M.; Mendes Oliveira R.; Abbud Chierice J.R.; Polanczyk C.A.; Furtado
M.V.; Smidt L.F.; Carlos Carvalho A.; Pucci G.; Lyra F.; Alves A.R.;
Dracoulakis M.D.A.; Lima R.G.S.D.; Figueiredo E.; Caramori P.R.; Tumelero
R.; Dall'orto F.; Mesquita C.T.; Colafranseschi A.S.; Oliveira A.C.;
Carvalho L.A.; Palazzo I.C.; Sousa A.S.; Da Silva E.E.R.; De Barros E
Silva P.G.M.; De Padua Silva Baptista L.; Rodrigues M.J.; De Resende
M.V.C.; Saraiva J.F.; Costantini C.; Ruzyllo W.; Demkow M.; Pracon R.;
Kepka C.; Teresinska A.; Kryczka K.; Henzel J.; Solecki M.; Kaczmarska E.;
Mazurek T.; Drozdz J.; Czarniak B.; Frach M.; Szymczyk K.; Niedzwiecka I.;
Sobczak S.; Ciurus T.; Jakubowski P.; Misztal-Teodorczyk M.; Teodorczyk
D.; Fratczak A.; Szkopiak M.; Lebioda P.; Wlodarczyk M.; Plachcinska A.;
Kusmierek J.; Miller M.; Marciniak H.; Wojtczak-Soska K.; Luczak K.;
Tarchalski T.; Cichocka-Radwan A.; Anna Szulczyk G.; Witkowski A.; Kukula
K.; Celinska-Spodar M.; Zalewska J.; Gajos G.; Bury K.; Pruszczyk P.; Roik
M.; Loboz-Grudzien K.; Sokalski L.; Brzezinska B.; Lesiak M.; Lanocha M.;
Reczuch K.W.; Kalarus Z.; Swiatkowski A.; Szulik M.; Musial W.J.; Bockeria
L.; Petrosyan K.; Trifonova T.; Chernyavskiy A.M.; Kretov E.I.;
Grazhdankin I.O.; Bershtein L.L.; Sayganov S.A.; Kuzmina-Krutetskaya A.M.;
Zbyshevskaya E.V.; Katamadze N.O.; Demchenko E.A.; Kozlov P.S.; Kozulin
V.Y.; Lubinskaya E.I.; Lopez-Sendon J.; Castro A.; Refoyo Salicio E.;
Guzman G.; Galeote G.; Valbuena S.; Peteiro J.; Martinez-Ruiz M.D.;
Perez-Fernandez R.; Cuenca-Castillo J.J.; Flores-Rios X.; Prada-Delgado
O.; Barge-Caballero G.; Gonzalez Juanatey J.R.; Bayarri M.S.; Pubull Nunez
V.; Sanchez R.O.; Alvarez B.C.; Gil C.P.; Monzonis A.M.; Sionis A.; Vila
Perales M.; Padro J.M.; Penaranda A.S.; Garcia Picart J.; Ginel Iglesias
A.; Marimon X.G.-M.; Llado G.P.; Costa F.C.; Miro V.; Diez J.L.; Calvillo
P.; Marin Ortuno F.; Valdes Chavarri M.; Tello Montolliu A.; Pinar
Bermudez E.; De La Morena G.; Gracida Blancas M.; Castillo Luena J.E.;
Fernandez-Aviles F.; Chen J.; Wu Y.; Ma Y.; Yang Y.; Ji Z.; Yang X.; Lin
W.; Zeng H.; Fu X.; Wang S.; Cheng G.; Fang X.; Zeng Q.; Li Q.; Nie S.-P.;
Yu Q.; Wang J.; Zhang S.; Liu Z.; Maggioni A.P.; Perna G.P.; Marini M.;
Gabrielli G.; Provasoli S.; Verna E.; Monti L.; Nardi B.; Di Chiara A.;
Mortara A.; Galvani M.; Ottani F.; Sicuro M.; Calabro P.; Formisano T.;
Tarantini G.; Cucchini U.; Andres A.L.; Racca E.; Briguori C.; Amati R.;
Vergoni W.; Russo A.; Fanelli R.; Poh K.-K.; Chai P.; Lau T.; Loh J.P.;
Tay E.L.; Teoh K.; Teo L.L.; Ong C.-C.; Wong R.C.; Loh P.-H.; Kofidis T.;
Chan W.X.; Chan K.H.; Foo D.; Kong J.L.K.; Er C.M.; Jafary F.H.; Chua T.;
Stumpf J.; Matschke K.; Simonis G.; Kadalie C.T.; Sechtem U.; Christian
Schulze P.; Goebel B.; Lenk K.; Nickenig G.; Schuchlenz H.; Weikl S.;
Marthe Lang I.; Huber K.; Jakl-Kotauschek G.; Keltai M.; Vertes A.; Varga
A.; Fontos G.; Merkely B.; Kerecsen G.; Hinic S.; Zdravkovic M.;
Mudrenovic V.; Crnokrak B.; Beleslin B.D.; Boskovic N.N.; Petrovic M.T.;
Dobric M.R.; Markovic Z.Z.; Mladenovic A.S.; Cemerlic-Adjic N.; Davidovic
G.; Vucic R.; Nikola Dekleva M.; Stankovic G.; Apostolovic S.; Escobedo
J.; Baleon-Espinosa R.; Campos-Santaolalla A.S.; Duran-Cortes E.;
Flores-Palacios J.M.; Garcia-Rincon A.; Jimenez-Santos M.; Penafiel J.V.;
Ortega-Ramirez J.A.; Valdespino-Estrada A.; Alexanderson Rosas E.; Murphy
D.; Selvanayagam J.B.; Joseph M.X.; Thambar S.T.; Rankin J.; Beltrame
J.F.; Hillis G.S.; Thuaire C.; Dutoiu T.; Juliard J.-M.; Slama M.S.; El
Mahmoud R.; Nicollet E.; Goube P.; Barone-Rochette G.; Furber A.; Biere
L.; Laucevicius A.; Kedhi E.; Timmer J.; Hermanides R.; Kaplan E.;
Riezebos R.K.; Samadi P.; Van Dongen E.; Niehe S.R.; Suryapranata H.; Van
Vugt S.; Cacela D.; Santana A.; Fiarresga A.; Sousa L.; Marques H.;
Patricio L.; Bernanrdes L.; Rio P.; Carvalho R.; Ferreira R.; Rodrigues
I.; Modas P.; Portugal G.; Fragata J.; Pinto F.J.; Menezes M.N.; Cantinho
Lopes G.; Almeida A.G.; Silva P.C.; Nobre A.; Francisco A.R.; Ferreira N.;
Lopes R.L.; Diaz R.; Guzman L.; Cesar Figal J.; Mendiz O.; Cortes C.; Rene
Favaloro R.; Alvarez C.; Courtis J.; Zeballos G.; Schiavi L.; Rubio M.;
Alsweiler C.; Patrick Devlin G.; Fisher R.; Huston Stewart R.A.; Douglas
White H.; Benatar J.; Kedev S.; Peovska Mitevska I.; Srbinovska Kostovska
E.; Pejkov H.; Held C.; Eggers K.; Frostfelt G.; Johnston N.; Olsowka M.;
Akerblom A.; Soveri I.; Aspberg J.; Beyar R.; Nikolsky E.; Sharir T.;
Elian D.; Kerner A.; Massalha S.; Fukuda K.; Kohsaka S.; Yasuda S.;
Nishimura S.; Van De Werf F.; Claes K.; Hung C.-L.; Yun C.-H.; Hou
C.J.-Y.; Kuo J.-Y.; Yeh H.-I.; Hung T.-C.; Li J.-Y.; Chien C.-Y.; Tsai
C.-T.; Liu C.-C.; Yu F.-C.; Lin Y.-H.; Lan W.-R.; Yen C.-H.; Tsai J.-P.;
Sung K.-T.; Ntsekhe M.; Pandie S.; Viljoen C.A.; De Andrade M.; Moccetti
T.; Grazia Rossi M.; Abdelhamid M.; Adel A.; Kamal A.; Mahrous H.; El
Kaffas S.; El Fishawy H.; Pop C.; Claudia M.; Popescu B.A.; Ginghina C.;
Deleanu D.; Iliescu V.A.; Al-Mallah M.H.; Aljzeeri A.; Najm H.; Alghamdi
A.; Mogrovejo Ramos W.E.; Kuanprasert S.; Prommintikul A.; Nawarawong W.;
Woragidpoonpol S.; Tepsuwan T.; Taksaudom N.; Rimsukcharoenchai C.;
Euathrongchit J.; Wannasopha Y.; Yamwong S.; Sritara P.; Aramcharoen S.;
Meemuk K.; Khairuddin A.; Abd Hadi H.; Azmi Yahaya S.; Doan J.; Lee R.;
Patel R.; Yang Cho S.; Milbrandt S.; Shelstad D.; Kamath P.; Tejani I.;
Quiles K.J.; Schley A.; Golden H.; Osseni H.; Wiyarand C.; Douglass P.;
Pomeroy H.; Craft A.; Harvey B.; Anaya O.; Goold P.; Giovannone S.;
Pritchard L.; Gans R.; Kennedy P.; Ganesan S.; Schlichting D.; Naher A.;
Stewart W.L.; Salmi K.M.; Johnson D.K.; Herrmann R.R.; Arges K.; Lefevre
M.; Tomfohr J.; Ann Byrne K.; Zappernick T.; Canada S.; Kakade M.; Mieses
P.; Cobos S.E.; Dwyer R.R.; Espinosa D.; Rantinella M.; Rodriguez J.;
Mancilla O.; Stinson S.; Weyand T.; Crook S.C.; Ho J.; Khan S.; Mohamed
M.; Soltau M.R.; Rose D.K.; Wimmer R.J.; Siegel K.E.; Derbyshire S.; Dixon
M.; Leonard G.; Heard C.; Gabriel V.; Desire S.; Rashid F.; Asier S.;
Patel K.; Gillis J.; Manocchia M.; Moore S.; Congdon E.; Brandt G.;
Marchelletta N.; Wippler K.; Halverson K.E.; Roraff C.; Thorsen J.;
Ojajuni A.; Olurinde O.; Surineni K.; Valaiyapathi B.; Kartje C.M.;
Rawlins M.; Thomson J.; Colleen Rogge M.; Bunke J.; Unterbrink K.; Fannon
J.; Burman C.; Dubin M.F.; Beaudry S.; Tirado S.A.; Halliday J.; Julian
P.; Lane S.M.; Stanford J.L.; Arsenault P.; Sigel P.; Brooks M.;
Douangvila L.; Gevorgyan R.; Ranjbaran F.; Smith B.; Ohmart C.; Ly S.;
Quinn M.C.; Temiyasathit S.; Do J.; Tobin D.; Langdon J.; Werner Bayer M.;
O'malley A.; Orvis E.; Murphy M.; Greenberg A.; Iraola M.; Maranan L.C.;
Malinay A.; Edillo C.P.; Ostrander A.; Wasmiller S.; Drewes W.; Patel D.;
White J.M.; Hallam A.; Spooner B.J.; Hollenweger L.M.; Little H.; Little
T.; Eskelson N.A.; Taul Y.; Rodgers C.; Isaacs J.; Bulkley V.; Kaneshiro
R.; Kirby B.J.; Tran N.N.; Jahrsdorfer C.; Yunis R.; Patro J.; Vega A.;
Bloise-Adames H.; Jimenez S.; Saint Vrestil N.; Bhandari R.; Schade D.;
Yost R.; Beardsley P.; Fine D.; Tancredi J.; Arakelian P.; Mathus S.;
O'neill D.; Burkhardt J.; Hosino S.; Lubyanaya O.A.; Salas J.D.; Aguirre
M.; Dhawan M.; Parra D.; Tran T.; Fowler-Lehman K.; Spitzer N.; Riedberger
C.; Weick C.; Drum C.; Miller-Cox K.; Ollinger A.; Capasso-Gulve E.;
Melanie Loehr A.; Mosley M.; Heydari S.; Lundeen A.M.; Karanjah E.;
Marfori W.C.; Hernandez-Rangel E.; Singh P.; Webb A.M.; Fridell E.; Wilson
H.; Kim A.; Wilmot P.; Stevens R.; Black L.; Hull A.B.; Lim O.J.; Tucker
H.C.; Putnam N.C.; Hall L.L.; Cauthren T.; Tucker T.; Horton H.; Orga J.;
White J.R.; Baumann C.; Seeratan V.; Jimenez M.; Schultz C.; Russo J.;
Huda Z.; Boan A.; Hinton C.R.; Archer B.A.; Dionne J.S.; Allardyce C.A.;
Sikora L.N.; Czerniak J.H.; Mull J.A.; Ferguson E.; Laube F.; Shammas
G.A.; Christensen L.; Park H.; Hecht J.; Vo D.; Hirsch J.; Bindeman J.;
Salkind S.; Desimone L.-A.; Felix-Stern L.; Gomes J.; Gordon C.; Mann A.;
Mccreary T.; Gopaul C.; Hultberg K.; Huk T.; Hussain A.; Zambrano Y.;
Rodriguez S.M.; Milner T.; Mulder A.; Van Oosterhout S.; Meyer M.; Clapp
N.L.; Barrentine H.; Jose J.M.; Manchery J.; Mckinney V.; Schwarz L.;
Kaczkowski S.M.; Jaskowiak A.J.; Klitch J.; Dees D.; Vasquez P.; Hannemann
E.L.; Mae Foltz J.; Derosa E.; Jorgenson B.; Riestenberg-Smith J.;
Bariciano R.; Waldron J.; Mayon M.; Ann Peichel G.; Starks B.; Garcia L.;
Thottam M.; Anand A.; Raj J.; Ravindran R.; Rajalekshmi V.S.; Nataraj N.;
Bajaj S.; Yadav V.; Mishra G.; Tewari R.; Mishra M.; Patel S.; Singh S.;
Kaur B.; Gupta S.; Suvarna C.; Kurian B.M.; Rupesh Karwa S.; Kolhe S.;
Vindhya R.J.; Jain P.; Seth A.; Meharwal Z.S.; Verma A.; Bhatia M.;
Sachdeva A.; Indira Devi T.; Jungla N.; Manjula Rani K.; Sowjanya Reddy
M.; Sidh R.R.; Priya V.; Preethi K.; Hande S.; Dubey A.; Rawat, Vineeth
K.; Chacko C.M.; Babu S.; Reddy S.; Rani M.; Arambam P.; Singh B.; Young
G.M.; Kinsey C.; Kavalakkat R.; Evans J.; Hassan I.; Williams S.; Holland
K.; Swan K.; Atkinson B.; Kunhunny S.; Atkinson C.; Krannila C.; Vinod M.;
Chaytor L.; Cox L.; Morrow J.; Rowe K.; Kelly S.; Regan S.; Turnbull D.;
Fleming C.; Ghosh A.; Gratrix K.; Preston S.; Cartwright A.; Knightonc A.;
Martin K.; Flint L.; Harrison J.; Lakeman N.; Ljubez A.; Wright J.; Exley
D.; Andiapen M.; Richards A.J.; Wong L.; Munro M.J.; Mcevoy M.; Brown C.;
Charles T.; Kolakaluri L.; Phillips H.; Morby L.; Hallett K.; Corbett C.;
Winstanley L.; Smit A.; Gent S.; Hussain N.; Haines F.; Taaffe J.; Burton
J.; Colton M.; King R.; Brown A.; Docherty A.; Mccloy L.; Robb K.;
Paterson C.; Crawford W.; Kelly J.; Mcgregor L.; Mackin A.; Knight J.P.;
Bose T.; Proietti A.; Brousseau M.; Corfias M.; Blaise P.; Harvey L.;
Alarie P.; Arcand L.; Roy I.; Montpetit E.; Drouin K.; Bergeron C.;
Shelley C.; Masson C.; Carr S.; Bone C.; Moga E.; Kourzenkova J.; Walter
O.; Hogg N.; Welsh S.; Hussain M.; Bello O.; Syed I.; Kushniriuk K.; Otis
J.; Otis R.; Seib M.M.; Rivest S.M.; Sandonato R.; Chow J.; Starovoytov
A.; Uchida N.; Meadows N.; Asif N.; Tavares S.; Bozek B.; Shier M.;
Larmand L.-A.; Janmohamed A.; Hart B.; Marucci J.; Tai S.; Brons S.; Beck
C.; Wong G.; Etherington K.; Arumairajah T.; Aprile M.; Karlsson S.;
Webber S.; Mercure C.; Aedy N.; Farquharson F.; Siddiqui A.; Takiuti M.E.;
Caetano L.P.; Deiro A.P.; Muller A.M.; De Moraes M.A.P.; Ascoli B.M.;
Poletti S.Z.; Zier S.S.; Veiga V.; Da Cunha D.F.; Rucatti G.G.; Igansi F.;
Haeffner M.P.; Almeida V.; De Souza G.S.; Almeida M.; Dos Santos V.;
Oliveira N.S.; Azevedo B.E.P.; Santos M.B.; Germann A.; Gomes V.; Homem
R.; Magedanz E.; Laimer R.; Tognon A.; Santos R.P.; Okada M.Y.; Batista
A.P.; Rabaca A.N.; Trama L.M.; Silva T.; De Souza Ormundo C.T.; Vicente
C.; Pinheiro C.; Komar D.; Walesiak O.; Malinowska K.; Maksym J.; Wojtera
K.; Fojt A.; Szczerba E.; Swiderek M.; Wojtala E.; Karwowski J.; Labyk A.;
Szramowska A.; Zdonczyk O.; Jaroch J.; Kolodziej A.; Marcinkiewicz-Siemion
M.; Bockeria O.; Kudzoeva Z.; Aripova N.; Naryshkin I.A.; Kuleshova A.;
Malaev D.; Subbotina I.; Gumerova V.; Nikolaeva O.B.; Fernandez-Figares
V.; Blanco-Calvo M.; Alonso-Alvarez E.; Garcia-Gonzalez P.; Seijas Amigo
J.; Fernandez Martinez A.; Igual B.; Quintana Giner M.; Romero Aniorte
A.I.; Rivera Caravaca J.M.; Canavate O.; Guerrero S.; Riera S.; Lasala M.;
Lorenzo M.; Sobrino O.; Vazquez A.; Dong H.; He P.; Xia C.; Yang J.; Zhong
Q.; Tian Y.; Li D.; Ma X.; Yu Z.; Zhao Q.; Li C.; Zhu B.; Chen M.; Chi H.;
Jing R.; Zhou Q.; Xu C.; Li Z.; Xiong L.; Gao D.; Jiang D.; Leng R.; Yuan
Q.; Bai Z.; Qi J.; Wang F.; Wang H.; Yang B.; Yue Z.; Zhang Z.; Dong Y.;
Mao J.; Zhang B.; Li X.; Yao X.; Zhong N.; Zhou N.; Huang Y.; Zhou P.; Su
W.; Kunwu Y.; Peng Y.; Su X.; Wang C.; Zhao Y.; Geng Y.; Wang Y.; Fan
J.-Y.; Feng S.-T.; Wang X.; Yan Y.; Zhang H.-M.; Chi L.; Liu F.; Chen H.;
Jiang J.; Li H.; Han Y.; Xu L.; Chen G.; Hu R.; Pietrucci F.; Di Donato
A.; Pezzetta F.; Casali V.; Attanasio C.; Leone G.; Pisano F.; Bare C.;
Fimiani F.; Barioli A.; Ramani F.; Rolfo F.; Goletto C.; De Micco F.; Di
Marco S.; Tricoli M.; Villella M.; Tan S.-Y.V.; Sia W.C.; Leong A.W.; Yan
L.H.; Ismail N.; Kyaw M.T.; Yip D.; Grahl D.; Guenther F.; Bonin K.;
Wenzelburger I.; Gruensfelder S.; Sinning J.-M.; Weber M.; Werner N.;
Steinmaurer G.; Winter M.-P.; Andric T.; Tscharre M.; Wegmayrc C.; Jager
B.; Egger F.; Sebo J.; Davidovits Z.; Matics L.; Agoston G.; Dekany G.;
Bartykowszki A.; Jakal A.; Djokic J.; Djordjevic-Dikic A.D.; Giga V.L.;
Stepanovic J.J.; Velicki L.; Pupic L.; Simovic S.M.; Stevo Martinovic M.;
Stevanovic G.; Dobric M.; Martinovic S.S.; Stanojevic D.; De Jesus-Perez
R.; Brassetti M.F.C.; Vences Anaya D.A.; Garcia M.P.; Carvajal Juarez
I.E.; Madero Rovalo M.; Lee S.; Thomas P.; Chaplin M.D.; Stansborough
J.K.; Black M.; Bonner M.M.; Ireland K.F.; Venn-Edmonds C.; Thobois C.;
Tachot E.; Laure C.; Vassaliere C.; Abergel H.; Fuentes A.; Eliahou L.;
Dubourg O.; Michaud P.; Hadjih S.; Brito P.; Cornet C.; Rautureau J.;
Juceviciene A.; Kalibataite-Rutkauskiene I.; Keinaite L.; Laukyte M.;
Mikolaitiene G.; Smigelskaite A.; Tamasauskiene I.; Urboniene A.; Bouwhuis
I.; Nijmeijer L.; Schoep J.J.M.; Janzen E.M.; Ahoud S.; Selas M.; Silva
F.; Freixo C.; Cabrita I.Z.; Rocha A.; Figueiras F.P.; Coelho A.; Capinha
M.; Caetano M.I.; Silva S.; Tinnirello V.; Mungo M.N.; Garcia M.; Godoy
V.; Actis M.V.; Scaro G.; Low L.; Scales J.; Abercrombie K.; Howell L.;
Patten C.; Bjorklund C.; Andreasson M.; Essermark M.; Persson L.; Harel
O.; Bentzvi M.; Helmer L.; Ueda I.; Fujita J.; Furukawa A.; Hirase K.;
Nagai T.; Otsuka F.; Nakano S.; Robesyn V.; Yang Y.-H.; Mtana N.; Anesini
A.; Maspoli S.; Mombelli M.; Talaat A.; Rosca M.; Beladan C.C.; Zahrani
S.; Davila M.A.M.; Khwakhong S.; Chaiyasri A.; Mekara W.; Kulthawong S.;
Amaritakomol A.; Panpunuan P.; Mokhtar N.S.; Asiah Basri N.; Yusnida I.;
Hashim H.; Berger J.; Williams D.; Harrington R.; Jiang L.; Lopes R.D.;
Noel Bairey Merz C.; Weintraub W.; Rodriguez E.D.M.; Maurovich-Horvat P.;
Sonawane P.; Francis R.; Ramakrishnan T.; Nayak S.; Boer S.C.; Rosenberg
Y.; Hamm C.; Helm M.; Peterson E.; Ballantyne C.; Calfas K.; Champagne
M.A.; Fleg J.; Mccullough P.A.; Menasche P.; Davidson M.; Fremes S.;
Guyton R.; Mack M.; Mohr F.; Rao A.; Sabik J.; Shapira O.; Taggart D.;
Tatoulis J.; Blankenship J.; Brener S.; Buller C.; Colombo A.; De Bruyne
B.; Kereiakes D.; Lefevre T.; Moses J.; Mahaffey K.; Cruz-Flores S.;
Danchin N.; Feen E.; Garcia M.J.; Hauptman P.; Laddu A.A.; Passamani E.;
Pina I.L.; Simoons M.; Skali H.; Thygesen K.; Waters D.; Endsley P.;
Esposito G.; Kanters J.; Pownall J.; Stournaras D.; Friedrich M.;
Hachamovitch R.; Oliver D.; Harrell F.; Blume J.; Lee K.; Kullo I.;
Mcmanus B.; Newby K.; Cohen D.; Bugiardini R.; Mattina D.; Ali Z.; Mathew
R.; Friedman L.; Anderson J.; Berg J.; Demets D.; Michael Gibson C.; Lamas
G.; Deming N.; Himmelfarb J.; Ouyang P.; Woodard P.; Nwosu S.; Jeffries
N.; Denaro J.E.; Mavromichalis S.; Chan K.; Cobb G.; Contreras A.; Cukali
D.; Ferket S.; Gabriel A.; Hansen A.; Roberts A.; Chang M.; Islam S.;
Wayser G.; Yakubov S.; Yee M.; Callison C.; Hogan I.; Qelaj A.; Pirro C.;
Van Loo K.; Wisniewski B.; Gilsenan M.; Lang B.; Mohamed S.;
Esquenazi-Karonika S.; Mathews P.D.; Naumova A.; Lyo J.; Setang V.; Xavier
M.; Anstrom K.; Baloch K.; Blount J.; Cowper P.; Davidson-Ray L.; Drew L.;
Harding T.; David Knight J.; Minshall Liu D.; O'neal B.; Redick T.; Jones
P.; Nugent K.; Jingyan Wang G.; Goyal A.; Hetrick H.; Hayes S.W.; Friedman
J.D.; James Gerlach R.; Hyun M.; Miranda-Peats R.; Slomka P.; Thomson L.;
Pierre Mongeon F.; Michael S.; Hung J.; Zeng X.; Eckstein J.; Guruge B.;
Streif M.; Alfonso M.A.; Corral M.P.; Garcia J.J.; Horst J.; Jankovic I.;
Konigstein M.; Lustre M.B.; Peralta Y.; Sanchez R.; Arsanjani R.; Elmore
K.; Gomez M.; Hindoyan N.; Nakanishi R.; Barbara Srichai-Parsia M.; Yeoh
E.; Youn T.; Bianchini F.; Ceseri M.; Lorimer A.; Magnoni M.; Orso F.;
Sarti L.; Mazza Barbosa L.; Bello Duarte T.; Colaiacovo Soares T.; De
Aveiro Morata J.; Carvalho P.; De Carvalho Maffei N.; Egydio F.; Kawakami
A.; Oliveira J.; Restelli Piloto E.; Pozzibon J.; Camara D.; Mowafy N.;
Spindler C.; Dai H.; Feng F.; Li J.; Li L.; Liu J.; Xie Q.; Zhang H.;
Zhang J.; Zhang L.; Zhang N.; Zhong H.; Escobar C.; Eugenia Martin M.;
Pascual A.; Moraga P.; Hernandez V.; Posada M.; Fernandez S.; Villanueva
J.L.N.; Selgas R.; Luyten A.; Garcevic N.; Stojkovic J.; Ahmed A.; Bhatt
R.; Chadha N.; Kumar V.; Lubna S.; Naik P.; Pandey S.; Ramasamy K.; Saleem
M.; Sharma P.; Siddaram H.
Institution
(Slater, Bangalore, Reynolds, Hochman) NYU Grossman School of Medicine,
New York, NY, United States
(Maron) Department of Medicine, Stanford University School of Medicine,
CA, United States
(Jones, Fu, Spertus) University of Missouri, Kansas City's Healthcare
Institute for Innovations in Quality, Saint Luke's Mid America Heart
Institute, United States
(Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Kirby) National Heart Lung and Blood Institute, National Institutes of
Health, Bethesda, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The appropriate use criteria for revascularization of stable
ischemic heart disease have not been evaluated using randomized data.
Using data from the randomized ISCHEMIA trial (International Study of
Comparative Health Effectiveness with Medical and Invasive Approaches;
July 2012 to January 2018, 37 countries), the health status benefits of an
invasive strategy over a conservative one were examined within appropriate
use criteria scenarios. METHOD(S): Among 1833 participants mapped to
36 appropriate use criteria scenarios, symptom status was assessed using
the Seattle Angina Questionnaire-7 at 1 year for each scenario and for
each of the 6 patient characteristics used to define the scenarios.
Coronary anatomy and SYNTAX(Synergy between percutaneous coronary
intervention with Taxus and cardiac surgery) scores were measured using
coronary computed tomography angiography. Treatment effects are expressed
as an odds ratio for a better health status outcome with an invasive
versus conservative treatment strategy using Bayesian hierarchical
proportional odds models. Differences in the primary clinical outcome were
similarly examined. RESULT(S): The mean age was 63 years, 81% were
male, and 71% were White. Diabetes was present in 28% and multivessel
disease in 51%. Most clinical scenarios favored invasive for better 1-year
health status. The benefit of an invasive strategy on Seattle Angina
Questionnaire angina frequency scores was reduced for asymptomatic
patients (odds ratio [95% credible interval], 1.16 [0.66-1.71] versus 2.26
[1.75-2.80]), as well as for those on no antianginal medications.
Diabetes, number of diseased vessels, proximal left anterior descending
coronary artery location, and SYNTAX score did not effectively identify
patients with better health status after invasive treatment, and minimal
differences in clinical events were observed. CONCLUSION(S): Applying
the randomization scheme from the ISCHEMIA trial to appropriate clinical
scenarios revealed baseline symptoms and antianginal therapy to be the
primary drivers of health status benefits from invasive management.
Consideration should be given to reducing the patient characteristics
collected to generate appropriateness ratings to improve the feasibility
of future data collection. Copyright © 2025 American Heart
Association, Inc.

<44>
[Use Link to view the full text]
Accession Number
2037724967
Title
Protamine Dosing for Heparin Reversal after Cardiopulmonary Bypass: A
Double-blinded Prospective Randomized Control Trial Comparing Two
Strategies.
Source
Anesthesiology. 142(1) (pp 98-106), 2025. Date of Publication: 01 Jan
2025.
Author
Jain P.; Silva-De Las Salas A.; Bedi K.; Lamelas J.; Epstein R.H.; Fabbro
M.
Institution
(Jain, Silva-De Las Salas, Epstein, Fabbro) Department of Anesthesiology,
Perioperative Medicine, and Pain Management, University of Miami Miller
School of Medicine, Miami, FL, United States
(Bedi) University of Miami, Miller School of Medicine, Miami, FL, United
States
(Lamelas) Department of Surgery, University of Miami Miller School of
Medicine, Miami, FL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Drug shortages are a frequent challenge in current clinical
practice. Certain drugs (e.g., protamine) lack alternatives, and
inadequate supplies can limit access to services. Conventional protamine
dosing uses heparin ratio-based calculations for heparin reversal after
cardiopulmonary bypass and may result in excess protamine utilization and
potential harm due to its intrinsic anticoagulation. This study
hypothesized that a fixed 250-mg protamine dose would be comparable, as
measured by the activated clotting time, to a 1:1 (1 mg for every 100 U)
protamine-to-heparin ratio-based strategy for heparin reversal and that
protamine would be conserved. Method(s): In a single-center,
double-blinded trial, consenting elective adult cardiac surgical patients
without preexisting coagulopathy or ongoing anticoagulation and a
calculated initial heparin dose greater than or equal to 27,500 U were
randomized to receive, after cardiopulmonary bypass, protamine as a fixed
dose (250 mg) or a ratio-based dose (1 mg:100 U heparin). The primary
outcome was the activated clotting time after initial protamine
administration, assessed by Student's t test. Secondary outcomes included
total protamine, the need for additional protamine, and the cumulative
24-h chest tube output. Result(s): There were 62 and 63 patients in
the fixed- and ratio-based dose groups, respectively. The mean
postprotamine activated clotting time was not different between groups
(-2.0 s; 95% CI, -7.2 to 3.3 s; P = 0.47). Less total protamine per case
was administered in the fixed-dose group (-2.1 50-mg vials; 95% CI, -2.4
to -1.8; P < 0.0001). There was no difference in the cumulative 24-h chest
tube output (difference, -77 ml; 95% CI, 220 to 65 ml; P = 0.28).
 Conclusion(s): A 1:1 heparin ratio-based protamine dosing strategy
compared to a fixed 250-mg dose resulted in the administration of a larger
total dose of protamine but no difference in either the initial activated
clotting time or the amount postoperative chest-tube
bleeding. Copyright © 2024 American Society of Anesthesiologists.
All Rights Reserved.

<45>
Accession Number
2037625914
Title
Efficacy and Safety of Robot-Assisted and Sternotomy for Mitral Valve
Repair in the Treatment of Mitral Regurgitation: A Systematic Review and
Meta-Analysis.
Source
Heart Surgery Forum. 28(2) (pp E219-E227), 2025. Date of Publication:
2025.
Author
Fu T.; Huang Y.F.; Guo H.Y.; Long J.T.; Qian C.; Xiao F.; Chen T.J.
Institution
(Fu, Huang, Guo, Long, Qian, Xiao, Chen) Department of Heart Center, The
People's Hospital of Mengzi, Yunnan, Mengzi, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Current research comparing the efficacy of robot-assisted
mitral valve repair with sternotomy presents inconsistent results. This
meta-analysis compares the advantages and disadvantages of robot-assisted
mitral valve repair versus sternotomy, providing clinicians with a clearer
reference for surgical decision-making. Method(s): We systematically
searched the PubMed, Embase, and Cochrane Library databases for studies
published from inception to September 2021. Cohort studies were included
where the observation group underwent robot-assisted surgery, and the
control group received sternotomy. We excluded repeated publications,
studies lacking full text, incomplete data, animal studies, and
reviews/systematic reviews. Data were analyzed using STATA 15.1.
 Result(s): The pooled results showed that the operation time
(weighted mean difference (WMD) = 43.95, 95% confidence interval (CI):
36.53-51.36), aortic cross-clamp time (WMD = 26.72, 95% CI: 15.48-37.96),
and cardiopulmonary bypass time (WMD = 39.50, 95% CI: 29.52-49.47) were
significantly longer for robotic surgery compared to the sternotomy group.
However, robotic surgery resulted in significantly shorter lengths of
intensive care unit (ICU) stay (WMD = -25.43, 95% CI: -37.21-13.66) and
hospital stay (WMD = -1.58, 95% CI: -2.26- -0.89) compared to sternotomy.
The blood transfusion rate was significantly lower in the robotic surgery
group (odds ratio (OR) = 0.66, 95% CI: 0.47-0.94). Furthermore, the
mortality rate was significantly lower for robotic surgery (OR = 0.32, 95%
CI: 0.17-0.60). Conclusion(s): Although robot-assisted mitral valve
repair requires longer cross-clamp time, cardiopulmonary bypass time, and
operation time compared to sternotomy, it results in shorter ICU and
hospital stays, a lower blood transfusion rate, and a reduced mortality
rate. Copyright © 2025 The Author(s).

<46>
Accession Number
2033605336
Title
Evaluation of Vitamin D Supplementation in Critically Ill Patients-A
Narrative Review of Randomized Controlled Trials Published in the Last 5
Years.
Source
Nutrients. 17(5) (no pagination), 2025. Article Number: 816. Date of
Publication: 01 Mar 2025.
Author
Wang S.; Ren R.; Wang K.; Leo C.; Li M.; Chow A.; Yang A.K.; Lu Y.
Institution
(Wang) NYU Langone Hospital-Long Island, Mineola, NY, United States
(Ren, Lu) College of Pharmacy, University of Minnesota, Minneapolis, MN,
United States
(Wang) Fairbanks Memorial Hospital, 340 Cowles Street, Fairbanks, AK,
United States
(Leo) Duke Raleigh Hospital, a Campus of Duke University Hospital, School
of Medicine, Duke University, Durham, NC, United States
(Li) Brigham and Women's Hospital, Boston, MA, United States
(Chow) College of Arts and Science, New York University, New York, NY,
United States
(Yang) Dartmouth College, Hanover, NH, United States
(Lu) Department of Pharmacy, Hennepin Healthcare System, Minneapolis, MN,
United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
The prevalence of vitamin D deficiency among intensive care unit (ICU)
patients is potentially associated with an increased risk of mechanical
ventilation, sepsis, prolonged hospital stays, and mortality. Although ICU
patient care has significantly improved in recent years, the role of
vitamin D supplementation remains under investigation. A literature review
was conducted using PubMed, Web of Science, Embase, and Cochrane
databases, focusing on randomized controlled trials published in the past
five years on vitamin D supplementation in adult ICU patients. Patients'
baseline vitamin D levels, administration routes, doses, biomarker
changes, mechanical ventilation duration, length of hospital stay, and
mortality were analyzed. Although vitamin D supplementation appears safe
and may reduce ICU stay duration and mechanical ventilation time and
improve SOFA scores, its impact on overall mortality remains uncertain.
Routine supplementation for all ICU patients is not currently recommended;
clinical decisions should consider individual baseline vitamin D levels,
patient characteristics, severity of illness, doses, and administration
methods. Copyright © 2025 by the authors.

<47>
Accession Number
2037899666
Title
Outcomes of transcatheter aortic valve implantation in Africa: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 429 (no pagination), 2025. Article
Number: 133139. Date of Publication: 15 Jun 2025.
Author
Ahmed A.; Safiriyu I.; Kaddoura R.; Mohyeldin M.; Nwokeocha N.; Sandeep
N.; Khalil H.; Alhusain R.; Zarich S.
Institution
(Ahmed, Sandeep) Department of Internal Medicine, Yale University School
of Medicine, Bridgeport Hospital, Bridgeport, CT, United States
(Safiriyu) Division of Cardiology, Yale University School of Medicine,
Yale New Haven Hospital, New Haven, CT, United States
(Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical
Corporation, Doha, Qatar
(Mohyeldin) Department of Internal Medicine, Icahn School of Medicine, NY,
United States
(Nwokeocha, Zarich) Division of Cardiology, Yale University School of
Medicine, Bridgeport Hospital, Bridgeport, CT, United States
(Khalil) Division of Cardiology, Tufts University, MA, United States
(Alhusain) Division of Cardiology, Mayo Clinic, FL, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) has become the
routine standard of care in patients with severe aortic stenosis and
prohibitive surgical risk worldwide. However, data on TAVI outcomes from
Africa remain sparse. This study aimed to evaluate the outcomes of TAVI in
Africa. Method(s): We systematically searched PubMed, Scopus and
Embase from inception to August 15th, 2024, in addition to the gray
literature, and a single proportion meta-analysis was performed to pool
proportions and means of categorical and continuous variables,
respectively, with 95 % confidence interval (95 % CI). continuous variable
reported as median (interquartile range) was converted into a mean
(standard deviation). Inconsistency factor (I2) values greater
than 50 % represent high heterogeneity. The analysis was performed by R
software (RStudio). Result(s): Of 177 articles, we identified seven
observational studies in Africa (n = 704). The mean age was 79.18 years
(95 % CI: 77.26-81.10; I2 = 97 %) and 52 % were male.
Procedural success rate in Africa was 91 % (95 % CI: 86 %-94 %;
I2 = 38 %), however, In-hospital all-cause mortality was 5.0 %
(95 % CI: 3 %-8 %; I2 = 35 %) and all-cause mortality at 1-year
follow-up was 11.0 % (95 % CI: 6 %-20 %; I2 = 61 %). In terms
of adverse events, PPM was in 7.0 % (4.0-11.0, I2 = 14 %),
major bleeding occurred in 8.0 % (4.0-14.0, I2 = 78 %), and
stroke/TIA 2.0 % (1.0-4.0), I2 = 41 %). Conclusion(s): The
procedural success is high in Africa, however, the mortality rate and
adverse events are notable. More national registries are required to
accurately identify these outcomes to improve the healthcare
system. Copyright © 2025 Elsevier B.V.

<48>
Accession Number
646461356
Title
Colchicine for the primary prevention of cardiovascular events.
Source
Cochrane Database of Systematic Reviews. 2025(2) (no pagination), 2025.
Article Number: CD015003. Date of Publication: 10 Feb 2025.
Author
Marti-Carvajal A.J.; Gemmato-Valecillos M.A.; Monge Martin D.; De Sanctis
J.B.; Marti-Amarista C.E.; Hidalgo R.; Alegria-Barrero E.; Riera Lizardo
R.J.; Correa-Perez A.
Institution
(Marti-Carvajal, Hidalgo) Universidad UTE, Facultad de Ciencias de la
Salud Eugenio Espejo, Centro Asociado Cochrane Ecuador, Centro de
Investigacion en Salud Publica y Epidemiologia Clinica (CISPEC), Quito,
Ecuador, Universidad UTE, Quito, Ecuador
(Marti-Carvajal, Monge Martin, Alegria-Barrero, Correa-Perez) Faculty of
Medicine, Universidad Francisco de Vitoria, Madrid, Spain
(Marti-Carvajal, Riera Lizardo) Catedra Rectoral de Medicina Basada en la
Evidencia, Universidad de Carabobo, Valencia, Venezuela
(Gemmato-Valecillos) Department of Medicine, NYC Health + Hospitals /
Elmhurst, Icahn School of Medicine at Mount Sinai, New York, United States
(De Sanctis) The Institute of Molecular and Translational Medicine,
Palacky University Olomouc, Faculty of Medicine and Dentistry, Olomouc,
Czechia
(Marti-Amarista) Jencare Senior Medical Center, Geriatric Medicine
Department, Berwyn, IL, United States
(Riera Lizardo) Medicine Department, Rheumatology Unit, Universidad de
Carabobo, Valencia, Venezuela
(Correa-Perez) Department of Hospital Pharmacy and Medical Devices,
Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
Publisher
John Wiley and Sons Ltd
Abstract
Background: Atherosclerotic cardiovascular diseases (ACVDs), a condition
characterised by lipid accumulation in arterial walls, which is often
exacerbated by chronic inflammation disorders, is the major cause of
mortality and morbidity worldwide. Colchicine, with its first medicinal
use in ancient Egypt, is an inexpensive drug with anti-inflammatory
properties. However, its role in primary prevention of ACVDs in the
general population remains unknown. Objective(s): To assess the
clinical benefits and harms of colchicine as primary prevention of
cardiovascular outcomes in the general population. Search Method(s):
We searched the Cochrane Heart Specialised Register, the Cochrane Central
Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including
In-Process & Other Non-Indexed Citations), Ovid Embase, Web of Science,
and LILACS. We searched ClinicalTrials.gov and WHO ICTRP for ongoing and
unpublished studies. We also scanned the reference lists of relevant
included studies, reviews, meta-analyses, and health technology reports to
identify additional studies. There were no limitations on language, date
of publication, or study setting. The search results were updated on 31
May 2023. Selection Criteria: Randomised controlled trials (RCTs) in
any setting, recruiting adults without pre-existing cardiovascular
disease. We included trials that compared colchicine versus placebo,
non-steroidal anti-inflammatory drugs, corticosteroids, immunomodulating
drugs, or usual care. Our primary outcomes were all-cause mortality,
non-fatal myocardial infarction, stroke, and adverse events. Data
Collection and Analysis: Two or more review authors independently selected
studies, extracted data, and performed risk of bias and GRADE assessments.
 Main Result(s): We identified 15 RCTs (1721 participants randomised;
1412 participants analysed) with follow-up periods ranging from 4 to 728
weeks. The intervention was oral colchicine compared with placebo,
immunomodulating drugs, or usual care or no treatment. Due to biases and
imprecision, the evidence was very uncertain for all outcomes. All trials
but one had a high risk of bias. Five out of seven meta-analyses included
fewer than six trials (71.4%). The objectives of the review were to assess
cardiovascular outcomes in the general population, but many of the
included trials focused on liver disease. Colchicine compared to placebo.
Colchicine may reduce all-cause mortality compared to placebo in primary
prevention, but the evidence is very uncertain (risk ratio (RR) 0.68, 95%
confidence interval (CI) 0.51 to 0.91; 6 studies, 463 participants; very
low-certainty evidence; number needed to treat for an additional
beneficial outcome (NNTB) 11, 95% CI 6 to 67). Colchicine may result in
little to no difference in non-fatal myocardial infarction, but the
evidence is very uncertain (RR 0.87, 95% CI 0.41 to 1.82; 1 study, 100
participants; very low-certainty evidence). Colchicine may not reduce the
incidence of stroke, but the evidence is very uncertain (RR 2.43, 95% CI
0.67 to 8.86; 1 study, 100 participants; very low-certainty evidence).
Regarding adverse events, colchicine may increase the incidence of
diarrhoea (RR 3.99, 95% CI 1.44 to 11.06; 8 studies, 605 participants;
very low-certainty evidence; number needed to treat for an additional
harmful outcome (NNTH) 10, 95% CI 6 to 17), and may have little to no
effect on neurological outcomes such as seizure or mental confusion (RR
0.72, 95% CI 0.31 to 1.66; 2 studies, 155 participants; very low-certainty
evidence), but the evidence is very uncertain. The effect of colchicine on
cardiovascular mortality is also very uncertain (RR 1.27, 95% CI 0.03 to
62.43; 2 studies, 160 participants; very low-certainty evidence).
Colchicine may not reduce post-cardiac procedure atrial fibrillation, but
the evidence is very uncertain (RR 0.74, 95% CI 0.25 to 2.19; 1 study, 100
participants). We found no trials reporting on pericardial effusion,
peripheral artery disease, heart failure, or unstable angina. Colchicine
compared to methotrexate (immunomodulating drug). Colchicine may result in
little to no difference in all-cause mortality compared to methotrexate,
but the evidence is very uncertain (RR 0.42, 95% CI 0.12 to 1.51; 1 study,
85 participants; very low-certainty evidence). We found no trials
reporting other cardiovascular outcomes or adverse events for this
comparison. Colchicine compared to usual care or no treatment. The
evidence is very uncertain about the effect of colchicine compared with
usual care on all-cause mortality in primary prevention (RR 1.07, 95% CI
0.90 to 1.27; 2 studies, 729 participants; very low-certainty evidence).
Regarding adverse events, colchicine may increase the incidence of
diarrhoea compared to usual care, but the evidence is very uncertain (RR
3.32, 95% CI 1.56 to 7.03; 2 studies, 729 participants; very low-certainty
evidence; NNTH 18, 95% CI 12 to 42). No trials reported other
cardiovascular outcomes for this comparison. Authors' conclusions: This
Cochrane review evaluated the clinical benefits and harms of using
colchicine for the primary prevention of cardiovascular events in the
general population. Comparisons were made against placebo,
immunomodulating medications, or usual care or no treatment. However, the
certainty of the evidence for the predefined outcomes was very low,
highlighting the pressing need for high-quality, rigorous studies to
ascertain colchicine's clinical impact definitively. We identified
numerous biases and inaccuracies in the included studies, limiting their
generalisability and precluding a conclusive determination of colchicine's
efficacy in preventing cardiovascular events. The existing evidence
regarding colchicine's potential cardiovascular benefits or harms for
primary prevention is inconclusive owing to the limitations inherent in
the current studies. More robust clinical trials are needed to bridge this
evidence gap effectively. Copyright © 2025 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<49>
Accession Number
2032147130
Title
Transcatheter versus surgical aortic valve replacement for severe aortic
valve stenosis: Meta-analysis with trial sequential analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 169(4) (pp 1214-1225.e5),
2025. Date of Publication: 01 Apr 2025.
Author
Jacquemyn X.; Sa M.P.; Rega F.; Verbrugghe P.; Meuris B.; Serna-Gallegos
D.; Brown J.A.; Clavel M.-A.; Pibarot P.; Sultan I.
Institution
(Jacquemyn, Rega, Verbrugghe, Meuris) Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium
(Sa, Serna-Gallegos, Brown, Sultan) Department of Cardiothoracic Surgery,
University of Pittsburgh, Pittsburgh, PA, United States
(Sa, Serna-Gallegos, Brown, Sultan) UPMC Heart and Vascular Institute,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Rega, Verbrugghe, Meuris) Department of Cardiac Surgery, University
Hospitals Leuven, Leuven, Belgium
(Clavel, Pibarot) Centre de Recherche de l'Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Clavel, Pibarot) Department of Medicine, Faculty of Medicine, Universite
Laval, Quebec City, Quebec, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: Randomized controlled trials comparing transcatheter aortic
valve implantation with surgical aortic valve replacement demonstrate
conflicting evidence, particularly in low-risk patients. We aim to
reevaluate the evidence using trial sequential analysis, balancing type I
and II errors, and compare with conventional meta-analysis.
 Method(s): Databases were searched for randomized controlled trials,
which were divided into higher-risk and lower-risk randomized controlled
trials according to a pragmatic risk classification. Primary outcomes were
death and a composite end point of death or disabling stroke assessed at 1
year and maximum follow-up. Conventional meta-analysis and trial
sequential analysis were performed, and the required information size was
calculated considering a type I error of 5% and a power of 90%.
 Result(s): Eight randomized controlled trials (n = 5274 higher-risk
and 3661 lower-risk patients) were included. Higher-risk trials showed no
significant reduction in death at 1 year with transcatheter aortic valve
implantation (relative risk, 0.93, 95% CI, 0.81-1.08, P = .345).
Lower-risk trials suggested lower death risk on conventional meta-analysis
(relative risk, 0.67, 95% CI, 0.47-0.96, P = .031), but trial sequential
analysis indicated potential spurious evidence (P = .116), necessitating
more data for conclusive benefit (required information size = 5944
[59.8%]). For death or disabling stroke at 1 year, higher-risk trials
lacked evidence (relative risk, 0.90, 95% CI, 0.79-1.02, P = .108). In
lower-risk trials, transcatheter aortic valve implantation indicated lower
risk in conventional meta-analysis (relative risk, 0.68, 95% CI,
0.50-0.93, P = .014), but trial sequential analysis suggested potential
spurious evidence (P = .053), necessitating more data for conclusive
benefit (required information size = 5122 [69.4%]). Follow-up results
provided inconclusive evidence for both primary outcomes across risk
categories. Conclusion(s): Conventional meta-analysis methods may
have prematurely declared an early reduction of negative outcomes after
transcatheter aortic valve implantation when compared with surgical aortic
valve replacement. Copyright © 2024 The American Association for
Thoracic Surgery

<50>
Accession Number
2033560315
Title
Echocardiographic and biomarker characteristics in diabetes, coronary
artery disease or both: insights from HOMAGE trial.
Source
Cardiovascular Diabetology. 24(1) (no pagination), 2025. Article Number:
111. Date of Publication: 01 Dec 2025.
Author
Monzo L.; Kobayashi M.; Ferreira J.P.; Lamiral Z.; Delles C.; Clark A.L.;
Edelmann F.; Gonzalez A.; Heymans S.; Pellicori P.; Petutschnigg J.;
Verdonschot J.A.J.; Rossignol P.; Cleland J.G.F.; Zannad F.; Girerd N.
Institution
(Monzo, Kobayashi, Ferreira, Lamiral, Rossignol, Zannad, Girerd) Centre
d'Investigations Cliniques Plurithematique 1433 and Inserm U1116, CHRU
Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists),
Universite de Lorraine, Nancy, France
(Kobayashi) Department of Cardiology, Tokyo Medical University Hospital,
Tokyo, Japan
(Ferreira) Department of Surgery and Physiology, Cardiovascular Research
and Development Center, Faculty of Medicine, University of Porto, Porto,
Portugal
(Delles) School of Cardiovascular and Metabolic Health, University of
Glasgow, Glasgow, United Kingdom
(Clark) Department of Cardiology, Castle Hill Hospital, University of
Hull, East Riding of Yorkshire, United Kingdom
(Edelmann, Petutschnigg) Deutsches Herzzentrum der Charite, Klinik fur
Kardiologie, Angiologie & Intensivmedizin, Augustenburger Platz 1, Berlin,
Germany
(Edelmann, Petutschnigg) Charite - Universitatsmedizin Berlin, Corporate
Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin,
Chariteplatz 1, Berlin, Germany
(Edelmann, Petutschnigg) DZHK (German Centre for Cardiovascular Research),
Partner Site Berlin, Berlin, Germany
(Gonzalez) Department of Pathology, Anatomy and Physiology Universidad de
Navarra and IdiSNA, CIMA Universidad de Navarra, Pamplona, Spain
(Gonzalez) CIBERCV, Carlos III Institute of Health, Madrid, Spain
(Heymans, Verdonschot) Department of Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(Rossignol) Department of Medicine and Nephrology-Hemodialysis, Princess
Grace Hospital, Monaco, Monaco
(Rossignol) M-CRIN (Monaco Clinical Research Infrastructure Network),
Monaco, Monaco
(Rossignol) Monaco Private Hemodialysis Centre, Monaco, Monaco
(Pellicori, Cleland) Robertson Centre for Biostatistics and Clinical
Trials, Institute of Health and Wellbeing, University of Glasgow, Glasgow,
United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Coronary artery disease (CAD) and diabetes mellitus (DM) can
induce changes in myocardial structure and function, thereby increasing
the risk of heart failure (HF). We aimed to identify the alterations in
echocardiographic variables and circulating biomarkers associated with DM,
CAD, or both and to assess the effect of spironolactone on them.
 Method(s): The "Heart OMics in AGEing" (HOMAGE) trial evaluated the
effect of spironolactone on circulating markers of fibrosis over 9 months
of follow-up in people at risk for HF. From the initial population (N =
527) of the HOMAGE trial, a total of 495 participants (mean age 74 years,
25% women) were categorized according to clinical phenotype (DM-/CAD + vs.
DM+/CAD- vs. DM+/CAD+), while the DM-/CAD- group was excluded due to the
low sample size (N = 32). Multivariable linear regression analysis was
used to assess the relations between variables and DM/CAD status.
 Result(s): At baseline, participants with DM, whether or not they had
CAD, showed lower markers of type I collagen synthesis (procollagen type I
C-terminal propeptide; beta [95% CI]: DM+/CAD-: -6.973 [-13.778; -0.167];
DM+/CAD+: -9.039 [-15.174; -2.903]), reduced left ventricular volumes
(beta [95% CI]: end-diastolic, DM+/CAD-: -6.323 [-9.696; -2.951];
DM+/CAD+: -2.503 [-5.531; 0.526]; end-systolic, DM+/CAD-: -2.905 [-4.817;
-0.992]; DM+/CAD+: -1.400 [-3.120; 0.320]) and higher levels of galectin-3
(Exponential beta [95% CI]: DM+/CAD-: 1.127 [1.050; 1.209]; DM+/CAD+:
1.118 [1.048; 1.192]), and growth differentiation factor-15 (Exponential
beta [95% CI]: DM+/CAD-: 1.542 [1.360; 1.747]; DM+/CAD+: 1.535 [1.370;
1.720]), along with an elevated E/e' ratio (beta [95% CI]: DM+/CAD-: 1.355
[0.462; 2.248]; DM+/CAD+: 0.879 [0.067; 1.690]), compared with DM-/CAD +
individuals (all p < 0.05). At follow-up, the effect of spironolactone on
echocardiographic variables and circulating biomarkers was not
significantly different across DM/CAD phenotypes (all p-interaction >
0.05), except for a more pronounced reduction in GDF-15 in the DM+/CAD +
group at the 1-month visit (p-interaction = 0.03). Conclusion(s):
Among HOMAGE trial participants, diabetes was a powerful driver of
biomarker and echocardiographic alterations irrespectively of CAD. These
alterations were mainly related to the domains of inflammation and
diastolic function. Graphic abstract: Summary of the study design and key
findings. Abbreviations: CAD, coronary artery disease; DM, diabetes
mellitus; LV, left ventricular; M0, baseline; M1, 1-month follow-up; M9,
9-month follow-up; PICP, procollagen type I C-terminal propeptide. (Figure
presented.) Copyright © The Author(s) 2025.

<51>
Accession Number
2036876140
Title
Bacterial air contamination and the protective effect of coverage for
sterile surgical goods: A randomized controlled trial.
Source
American Journal of Infection Control. 53(4) (pp 467-472), 2025. Date of
Publication: 01 Apr 2025.
Author
Wistrand C.; Soderquist B.; Friberg O.; Sundqvist A.-S.
Institution
(Wistrand, Sundqvist) University Health Care Research Centre, Faculty of
Medicine and Health, Orebro University, Orebro, Sweden
(Wistrand, Friberg) Department of Cardiothoracic and Vascular Surgery,
Orebro University Hospital, Orebro, Sweden
(Soderquist, Friberg) School of Medical Sciences, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
(Soderquist) Department of Laboratory Medicine, Faculty of Medicine and
Health, Orebro University, Orebro, Sweden
Publisher
Elsevier Inc.
Abstract
Background: There is limited knowledge regarding how long prepared sterile
goods can wait before becoming contaminated. We investigated whether
surgical goods could be prepared the day before surgery and kept sterile
overnight in the operating room, if protected by sterile covers.
 Method(s): Sterile surgical goods for open-heart surgeries (n = 70)
were randomized to preparation on the morning of the operation or on the
previous evening. Exposure time was the total time between preparation and
use. Primary outcome was bacterial growth reported as colony forming units
(cfu), isolated on 840 agar plates. The protocol was registered with
ClinicalTrials.gov (NCT05597072). Result(s): When the agar plates
were protected with sterile covers, exposure time had no impact
(intervention group: 7 cfu, control group: 17 cfu). Without protection,
longer exposure time was associated with more cfu (P =.016). A total of
499 cfu were isolated, displaying 59 different types of bacteria including
13 resistant Staphylococcus epidermidis, 6 (46%) of which were multidrug
resistant. Conclusion(s): Sterile goods could wait in the operating
room for at least 15 hours before use without increased risk of bacterial
air contamination, if protected with sterile covers. However, if the goods
were not covered, bacterial air contamination occurred over
time. Copyright © 2025 The Authors

<52>
Accession Number
2033089172
Title
Intracardiac or transesophageal echocardiography for left atrial appendage
occlusion: an updated systematic review and meta-analysis.
Source
International Journal of Cardiovascular Imaging. 41(3) (pp 489-505), 2025.
Date of Publication: 01 Mar 2025.
Author
Beneki E.; Dimitriadis K.; Theofilis P.; Pyrpyris N.; Iliakis P.;
Kalompatsou A.; Kostakis P.; Koukos M.; Soulaidopoulos S.; Tzimas G.;
Tsioufis K.; Lancellotti P.; Aggeli C.
Institution
(Beneki, Dimitriadis, Theofilis, Pyrpyris, Iliakis, Kalompatsou, Kostakis,
Koukos, Soulaidopoulos, Tsioufis, Aggeli) First Cardiology Department,
School of Medicine, Hippokration General Hospital, National and
Kapodistrian University of Athens, Athens, Greece
(Beneki, Tzimas) Department of Cardiology, Lausanne University Hospital
and University of Lausanne, Lausanne, Switzerland
(Lancellotti) Department of Cardiology, University Hospital Center, Liege,
Belgium
Publisher
Springer Science and Business Media B.V.
Abstract
Background: Intracardiac echocardiography (ICE) appears to be a potential
alternative for percutaneous left atrial appendage occlusion (LAAO) to
transesophageal echocardiography (TEE). Thus, a meta-analysis was
performed comparing ICE vs. TEE for LAAO guidance. Method(s): A
comprehensive literature search was performed using MEDLINE, Scopus and
Web of Science electronic databases from their inception to November 2023.
 Result(s): 18 studies (124,230 patients) were included. Technical
success was higher in ICE- compared to TEE-guidance (OR: 1.36, 95% CI 1.14
to 1.63, p = 0.006) and fewer devices employed (SMD: -0.22, 95% CI -0.43
to -0.01, p = 0.04, I2 = 62%). ICE guidance related with more pericardial
effusion/tamponade and iatrogenic residual shunts (logRR: 0.62, 95% CI
0.36 to 0.89, p < 0.001 and RR: 1.53, 95% CI 1.12 to 2.09, p = 0.02, I2 =
1%, respectively). More vascular complications were noted in ICE group
(logRR: 0.45, 95% CI 0.11 to 0.78, p = 0.009). Conclusion(s):
ICE-guided imaging is an effective alternative to TEE in LAAO, as it shows
better efficacy than TEE, considering technical success. However, the
higher rates of adverse events should be carefully
considered. Copyright © The Author(s) 2025.

<53>
Accession Number
2037747224
Title
Diagnosis and management of dilated cardiomyopathy: a systematic review of
clinical practice guidelines and recommendations.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 11(2) (pp
206-222), 2025. Date of Publication: 01 Mar 2025.
Author
Sorella A.; Galanti K.; Iezzi L.; Gallina S.; Mohammed S.F.; Sekhri N.;
Akhtar M.M.; Prasad S.K.; Chahal C.A.A.; Ricci F.; Khanji M.Y.
Institution
(Sorella, Galanti, Iezzi, 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, Chieti, Italy
(Mohammed) Department of Cardiology, Creighton University, School of
Medicine, Omaha, NE, United States
(Sekhri, Chahal, Khanji) Barts Heart Centre, St. Bartholomew's Hospital,
Barts Health NHS Trust, West Smithfield, London, United Kingdom
(Sekhri, Khanji) Newham University Hospital, Barts Health NHS Trust,
London, United Kingdom
(Sekhri, Chahal, Khanji) William Harvey Research Institute, NIHR Barts
Biomedical Centre, Queen Mary University of London, Charterhouse Square,
London, United Kingdom
(Akhtar, Prasad) Royal Brompton and Harefield Hospitals, Guy's and St
Thomas' NHS Foundation Trust, London, United Kingdom
(Prasad) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Chahal) Center for Inherited Cardiovascular Diseases, Department of
Cardiology, WellSpan Health, 30 Monument Rd, York, PA, United States
(Chahal) Department of Cardiovascular Medicine, Mayo Clinic, 200 First
Str, SW, Rochester, MN, United States
Publisher
Oxford University Press
Abstract
Dilated cardiomyopathy (DCM) is extensively discussed in numerous expert
consensus documents and international guidelines, with differing
recommendations. To support clinicians in daily practice and
decision-making, we conducted a systematic review of key guidelines and
recommendations concerning the diagnosis and clinical management of DCM.
Our research encompassed MEDLINE and EMBASE databases for relevant
articles published, as well as the websites of relevant scientific
societies. We identified two guidelines and one scientific statement that
met stringent criteria, thereby qualifying them for detailed systematic
analysis. Our review revealed consensus on several key aspects: the
definition of DCM, the use of B-type natriuretic peptides and
high-sensitivity troponin in laboratory testing, the essential role of
multimodality cardiovascular imaging for initial diagnosis, genetic
counselling, and the management of advanced disease. Nonetheless, notable
areas of variation included the formation of multidisciplinary management
teams, the role of cascade genetic testing, pathways for arrhythmic risk
stratification, and the criteria for prophylactic defibrillator
implantation. Significant evidence gaps persist, particularly regarding
the clinical trajectory of genetic, non-genetic and gene-elusive forms of
DCM, the use of cardiovascular magnetic resonance in phenotype-negative
family members with genotype-positive probands, and the development of
potential aetiology-oriented therapies. Addressing these gaps could
enhance clinical outcomes and inform future research directions and
guideline development. Copyright © 2024 The Author(s).

<54>
Accession Number
2037745280
Title
A systematic review and meta-analysis of the hemodynamics and outcomes of
the Myval balloon-expandable valve in patients with severe aortic stenosis
and with aortic regurgitation.
Source
IJC Heart and Vasculature. 58 (no pagination), 2025. Article Number:
101641. Date of Publication: 01 Jun 2025.
Author
Hasabo E.A.; Aboali A.A.; Hemmeda L.; Elgadi A.; Alrawa S.S.; Ahmed A.S.;
Abdalmotalib M.M.; Eissa A.Y.H.; Fadelallah Eljack M.M.; Sultan S.;
Soliman O.
Institution
(Hasabo, Soliman) Royal College of Surgeons in Ireland (RCSI) University
of Medicine and Health Sciences, Dublin, Ireland
(Hasabo, Soliman) Precision Cardiovascular Medicine & Innovation Institute
(PCMI), Cardiovascular Research Institute Dublin (CVRI), Mater Private
Network, Eccles Street, Dublin, Ireland
(Aboali) Damanhour Teaching Hospital, General Organization for Teaching
Hospitals and Institutes, Damanhour, Egypt
(Aboali) Faculty of Medicine, Alexandria University, Alexandria, Egypt
(Hemmeda, Elgadi, Alrawa, Ahmed, Abdalmotalib, Eissa) Faculty of Medicine,
University of Khartoum, Khartoum, Sudan
(Fadelallah Eljack) Faculty of Medicine, University of Bakht Alruda, Al
Dwuaym, Sudan
(Sultan) Department of Vascular and Endovascular Surgery, Western Vascular
Institute, University College Hospital, Galway, Ireland
(Soliman) Euro Heart Foundation, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has been
growing rapidly. We aim to evaluate the performance and outcomes of the
Myval transcatheter heart valve (THV) in patients with severe aortic
stenosis and its use in quantitative videodensimetry, transcatheter
valve-in-valve (ViV), and non-calcified aortic regurgitation (NCAR).
 Method(s): A systematic search was done in PubMed, Scopus, Web of
Science, Embase, and Cochrane from inception to October 2024. We used the
relevant keywords to include studies that reported the outcomes of
patients with severe aortic stenosis who underwent TAVI using the Myval
THV and off-label usage in transcatheter ViV and NCAR. Data analysis was
done using R software. Result(s): A total of 29 studies were included
in this study. The results of the mean aortic gradient at discharge,
30-day, one-year, and 2-year were 9.25 mmHg (95 % CI [8.20, 10.29]), 8.46
(95 % CI [7.57, 9.34]). 10.63 (95 % CI [9.12, 12.14]), and 7.2 (95 % CI
[6.78, 7.63]), respectively. Additionally, the pooled percentages of
patients with >= moderate aortic regurgitation were found in 1 % (95 % CI
[1,2]) at discharge, 3 % (95 % CI [2,4]) at 30-day, 4 % (95 % CI [2,7]) at
one-year follow-up and 5 % (95 % CI [3,8]) at 2-year. Furthermore, usage
of the Myval THV in transcatheter ViV and NCAR led to a reduction in mean
aortic gradient and incidence of aortic regurgitation, respectively.
 Conclusion(s): The Myval THV showed good safety and efficacy outcomes
in short- and long-term follow-ups following the TAVI. Also, it showed
promising results during transcatheter ViV and NCAR. Copyright ©
2025 The Author(s)

<55>
Accession Number
2037914635
Title
Contemporary risk models for transcatheter aortic valve replacement: A
narrative review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Chan N.; Agrawal A.; Arockiam A.D.; Majid M.; Haroun E.; Shah A.; Puri R.;
Griffin B.; Wang T.K.M.
Institution
(Chan) Section of Cardiovascular Medicine, Heart and Vascular Center,
Dartmouth-Hitchcock Health System, Lebanon, NH, United States
(Agrawal, Arockiam, Majid, Haroun, Shah, Puri, Griffin, Wang) Department
of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Aortic stenosis (AS) is the most common form of valvular heart disease in
older adults requiring intervention. Severe symptomatic AS, if left
untreated, is typically associated with a poor prognosis. Over the past
two decades, there have been significant advances in the field of
transcatheter aortic valve replacement (TAVR), leading to its emergence as
an alternative to the well-established surgical aortic valve replacement
(SAVR) for treating severe AS. Multiple randomized clinical trials have
demonstrated comparable efficacy and safety outcomes of TAVR vs SAVR in
high, intermediate, and low-risk surgical candidates. In the process,
multiple risk scores, both traditional surgical and TAVR-specific, have
been developed to better risk stratify patients as well as guide
periprocedural management and patient counseling. This review aims to
discuss the currently available risk models for risk prediction in TAVR
patients, highlighting their strengths, limitations, and applicability to
different patient populations. Copyright © 2025 The Authors

<56>
Accession Number
2036263446
Title
5-Year Results From the AMPLATZER Amulet Left Atrial Appendage Occluder
Randomized Controlled Trial.
Source
Journal of the American College of Cardiology. 85(11) (pp 1141-1153),
2025. Date of Publication: 25 Mar 2025.
Author
Lakkireddy D.; Ellis C.R.; Thaler D.; Swarup V.; Gambhir A.; Hermiller J.;
Nielsen-Kudsk J.E.; Worthley S.; Nair D.; Schmidt B.; Horton R.; Gupta N.;
Anderson J.A.; Zhao H.; Alkhouli M.; Windecker S.
Institution
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Overland Park, KS, United States
(Ellis) Vanderbilt Heart Institute, Nashville, TN, United States
(Thaler) Tufts Medical Center, Boston, MA, United States
(Swarup) Arizona Cardiovascular Research Center, Phoenix, AZ, United
States
(Gambhir) Northside Hospital Cardiovascular Institute, Atlanta, GA, United
States
(Hermiller) St Vincent Medical Group, Inc, Indianapolis, IN, United States
(Nielsen-Kudsk) Aarhus University Hospital, Aarhus, Denmark
(Worthley) Macquarie University Hospital, Macquarie Park, NSW, Australia
(Nair) St Bernards Healthcare Cardiology Associates, Batesville, AR,
United States
(Schmidt) Cardiovascular Center Bethanien, Frankfurt, Germany
(Horton) Texas Cardiac Arrhythmia, Austin, TX, United States
(Gupta) Los Angeles Medical Center, Los Angeles, CA, United States
(Anderson, Zhao) Abbott Structural Heart, Plymouth, MN, United States
(Alkhouli) Mayo Clinic, Rochester, MN, United States
(Windecker) University Hospital of Bern, Bern, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: The Amulet IDE trial (AMPLATZER Amulet Left Atrial Appendage
Occluder [LAAO] Investigational Device Exemption [IDE] Trial) evaluated
the safety and effectiveness of the Amulet occluder (Abbott) in patients
with nonvalvular atrial fibrillation. The Amulet IDE trial is the largest
randomized LAAO trial, comparing the Amulet occluder with the Watchman 2.5
device (Boston Scientific). Objective(s): This analysis presents the
5-year results from the trial comparing the 2 devices head to head.
 Method(s): Patients enrolled in the Amulet IDE trial were at a high
risk of stroke or systemic embolism defined as a CHADS<inf>2</inf> score
>=2 or CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=3. Oral anticoagulation
(OAC) use and key clinical outcomes are presented through 5 years.
 Result(s): A total of 1,878 patients were randomized, with 1,833
undergoing a device implantation attempt (n = 917, Amulet occluder; and n
= 916, Watchman device). A significantly higher percentage of patients
were free of OAC in the Amulet occluder group at each follow-up visit,
with 94.0% and 90.9% free of OAC at the last 5-year follow-up visit in the
Amulet and Watchman device groups, respectively (P = 0.009). The 5-year
clinical outcomes were similar between the Amulet and Watchman devices,
including the composite of ischemic stroke or systemic embolism (7.4% vs
7.1%; P = 0.851), the composite of stroke, systemic embolism, or
cardiovascular death (20.3% vs 20.7%; P = 0.666), major bleeding (20.1% vs
20.0%; P = 0.882), cardiovascular (CV) death (14.3% vs 15.4%; P = 0.429),
and all-cause death (28.7% vs 31.1%; P = 0.217). Annualized ischemic
stroke rates at 5 years were low and the same for Amulet (1.6%/y) and
Watchman (1.6%/y) devices. Strokes in patients with the Amulet occluder
were less severe (n = 38, nondisabling; n = 11, disabling; n = 11, fatal;
n = 12, unknown) than strokes in patients with the Watchman device (n =
19, nondisabling; n = 22, disabling; n = 17, fatal; n = 10, unknown).
Moreover, device factors (device-related thrombus or peridevice leak >=3
mm) preceded stroke events and CV deaths more frequently in patients with
the Watchman device (n = 63) compared with patients with the Amulet
occluder (n = 31). Conclusion(s): The 5-year outcomes from the
largest randomized LAAO clinical trial demonstrated the long-term safety
and effectiveness of the Amulet occluder and Watchman 2.5 devices. The
dual-seal Amulet occluder reduces atrial fibrillation-related
thromboembolic events while eliminating the need for long-term OAC.
(AMPLATZER Amulet Left Atrial Appendage Occluder [LAAO] Investigational
Device Exemption [IDE] Trial [Amulet IDE trial];
NCT02879448) Copyright © 2025 American College of Cardiology
Foundation

<57>
Accession Number
2033650687
Title
Pregnancy Outcomes in Women with Biventricular Circulation and a Systemic
Right Ventricle: A Systematic Review.
Source
Journal of Clinical Medicine. 13(23) (no pagination), 2024. Article
Number: 7281. Date of Publication: 01 Dec 2024.
Author
Grantza T.; Arvanitaki A.; Baroutidou A.; Tsakiridis I.; Mamopoulos A.;
Giannopoulos A.; Ziakas A.; Giannakoulas G.
Institution
(Grantza, Arvanitaki, Baroutidou, Ziakas, Giannakoulas) First Department
of Cardiology, AHEPA University General Hospital, School of Medicine,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Arvanitaki) Adult Congenital Heart Centre and National Centre for
Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guy's and
St Thomas's NHS Foundation Trust, Imperial College, London, United Kingdom
(Tsakiridis, Mamopoulos) Third Department of Obstetrics and Gynecology,
School of Medicine, Faculty of Health Sciences, Aristotle University of
Thessaloniki, Thessaloniki, Greece
(Giannopoulos) Pediatric Department, AHEPA University General Hospital,
School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,
Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Pregnancy in women with biventricular circulation and a
systemic right ventricle (sRV) is considered high risk, with limited data
available on pregnancy outcomes. This study aimed to investigate pregnancy
outcomes in this population. Material(s) and Method(s): A systematic
review was conducted using four major electronic databases. Pregnant women
with a complete transposition of great arteries (d-TGA) after an atrial
switch operation or a congenitally corrected transposition of the great
arteries (ccTGA) were included. Result(s): In total, 15 studies
including 632 pregnancies in 415 women with an sRV and biventricular
circulation were identified, of whom 299 (72%) had d-TGA and 116 (28%)
ccTGA. Maternal mortality or cardiac transplantation occurred in 0.8% of
pregnancies. The most frequent maternal complications were the worsening
of systemic atrioventricular valve regurgitation [pooled estimate (PE):
16%, 95% CI: 5;26], the deterioration of sRV function (PE: 15%, 95% CI:
2;27), the worsening of the NYHA class (PE: 13%, 95% CI: 6;20), all-cause
hospitalization (PE): 10%, 95% CI: 7;12), arrhythmias (PE: 8%, 95% CI:
5;11), and symptomatic heart failure (PE: 6%, 95% CI: 3;10). Stillbirth
occurred in 0.7% of pregnancies and neonatal death in 0.4%.
Small-for-gestational-age neonates were encountered in 36% (95% CI: 21;52)
of pregnancies and preterm delivery in 22% (95% CI: 14;30). A subgroup
analysis showed no significant difference in outcomes between women with
d-TGA and those with ccTGA, except for the worsening of the NYHA class,
which occurred more often in d-TGA (18%, 95% CI: 12;27 vs. 6%, 95% CI:
3;15, respectively, p = 0.03). Conclusion(s): Maternal and
fetal/neonatal mortality are low among pregnant women with biventricular
circulation and an sRV. However, significant maternal morbidity and poor
neonatal outcomes are frequently encountered, rendering management in
specialized centers imperative. Copyright © 2024 by the authors.

<58>
Accession Number
2030599688
Title
Natural history of initially asymptomatic severe aortic stenosis: a
one-stage meta-analysis.
Source
Clinical Research in Cardiology. 114(3) (pp 350-367), 2025. Date of
Publication: 01 Mar 2025.
Author
Tan J.T.A.; He G.S.; Chia J.L.L.; Tan G.Q.X.; Teo Y.N.; Teo Y.H.; Syn
N.L.; Chai P.; Wong R.C.C.; Yeo T.-C.; Kong W.K.F.; Poh K.-K.; Sia C.-H.
Institution
(Tan, He, Chia, Tan, Teo, Syn, Chai, Wong, Yeo, Kong, Poh, Sia) Department
of Medicine, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Teo) Department of Medicine, National University Hospital, Singapore,
Singapore
(Chai, Wong, Yeo, Kong, Poh, Sia) Department of Cardiology, National
University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block
Level 9, Singapore, Singapore
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Current guidelines on the management strategy for patients
with asymptomatic severe aortic stenosis (AS) remain unclear. This
uncertainty stems from the lack of data regarding the natural history of
these patients. To address this gap, we performed a systematic review and
meta-analysis examining the natural history of asymptomatic severe AS
patients receiving conservative treatment. Method(s): The PubMed,
Cochrane, and Embase databases were searched from inception to 24 January
2024 using the keywords "asymptomatic" AND "aortic" AND "stenosis". We
included studies examining patients with asymptomatic severe AS. In
interventional trials, only data from conservatively managed arms were
collected. A one-stage meta-analysis was conducted using individual
patient data reconstructed from published Kaplan-Meier curves. Sensitivity
analysis was performed for major adverse cardiovascular outcomes in
patients who remained asymptomatic throughout follow-up. Result(s): A
total of 46 studies were included (n = 9545). The median time to the
development of symptoms was 1.11 years (95% CI 0.90-1.53). 49.36%
(40.85-58.59) of patients who were asymptomatic had suffered a major
adverse cardiovascular event by 5 years. The median event-free time for
heart failure hospitalization (HFH) was 5.50 years (95% CI 5.14-5.91) with
36.34% (95% CI 33.34-39.41) of patients experiencing an HFH by year 5. By
5 years, 79.81% (95% CI 69.26-88.58) of patients developed symptoms
(angina, dyspnoea, syncope and others) and 12.36% (95% CI 10.01-15.22) of
patients died of cardiovascular causes. For all-cause mortality, the
median survival time was 9.15 years (95% CI 8.50-9.96) with 39.43% (CI
33.41-36.40) of patients dying by 5 years. The median time to AVR was 4.77
years (95% CI 4.39-5.17), with 52.64% (95% CI 49.85-55.48) of patients
requiring an AVR by 5 years. Conclusion(s): Our results reveal poor
cardiovascular outcomes for patients with asymptomatic severe AS on
conservative treatment. A significant proportion eventually requires an
AVR. Further research is needed to determine if early intervention with
AVR is more effective than conservative treatment. Copyright ©
Springer-Verlag GmbH Germany, part of Springer Nature 2024.

<59>
Accession Number
2031446364
Title
A Study of Safety and Effectiveness of Evicel Fibrin Sealant as an
Adjunctive Hemostat in Pediatric Surgery.
Source
European Journal of Pediatric Surgery. 34(6) (pp 512-521), 2024. Date of
Publication: 01 Dec 2024.
Author
Kenny S.; Gabra H.; Hall N.J.; Flageole H.; Illie B.; Barnett E.;
Kocharian R.; Sharif K.
Institution
(Kenny) Department of Paediatric Surgery, Alder Hey Children's Hospital,
Merseyside, Liverpool, United Kingdom
(Gabra) Department of Children's Surgery, Great North Children's Hospital,
Newcastle, United Kingdom
(Hall) Department of Neonatal and Paediatric Surgery, Southampton
Children's Hospital, Southampton, United Kingdom
(Flageole) Department of Pediatric Surgery, McMaster Children's Hospital,
Hamilton, ON, Canada
(Illie, Kocharian) Department of Scientific Affairs, Ethicon Inc, Raritan,
NJ, United States
(Barnett) Department of Scientific Affairs, Ethicon UK, Livingston, United
Kingdom
(Sharif) Department of Paediatric Surgery, Birmingham Children's Hospital
NHS Foundation Trust, Birmingham, United Kingdom
Publisher
Georg Thieme Verlag
Abstract
Introduction Data on the use of fibrin sealants to control intraoperative
bleeding in children are scarce. Evicel Fibrin Sealant (Ethicon Inc.,
Raritan, New Jersey, United States) was found safe and effective in
clinical trials of adults undergoing various surgery types. We evaluated
the safety and efficacy of Evicel versus Surgicel Absorbable Hemostat
(Ethicon Inc.) as adjunctive topical hemostats for mild/moderate
raw-surface bleeding in pediatric surgery. Methods A phase III randomized
clinical trial was designed as required by the European Medicines Agency's
Evicel Pediatric Investigation Plan: 40 pediatric subjects undergoing
abdominal, retroperitoneal, pelvic, or thoracic surgery were randomized to
Evicel or Surgicel, to treat intraoperative mild-to-moderate bleeding.
Descriptive analyses included time-to-hemostasis and rates of treatment
success (4, 7, 10 minutes), intraoperative treatment failure, rebleeding,
and thromboembolic events. Results Forty of 130 screened subjects aged 0.9
to 17 years were randomized 1:1 to Evicel or Surgicel. Surgeries were
predominantly open abdominal procedures. The median bleeding area was 4.0
cm 2 for Evicel and 1.0 cm 2 for Surgicel. The
median time-to-hemostasis was 4.0 minutes for both groups. The 4-, 7-, and
10-minute treatment success rates were 80.0% versus 65.0%, 100.0% versus
80.0%, and 95.0% versus 90.0%, whereas treatment failure rates were 5.0%
versus 25.0%, for Evicel and Surgicel, respectively. No deaths or
thrombotic events occurred. Re-bleeding occurred in 5.0% of Evicel and
10.0% of Surgicel subjects. Conclusions In accordance with adult clinical
trials, this randomized study supports the safety and efficacy of Evicel
for controlling mild-to-moderate surgical bleeding in a broad range of
pediatric surgical procedures. Copyright © 2024. The Author(s).

<60>
Accession Number
646775650
Title
A PILOT FEASIBILITY TRIAL OF PHYSICAL AND COGNITIVE PREHABILITATION TO
IMPROVE OUTCOMES IN SURGICAL PATIENTS.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 837-838), 2019. Date
of Publication: 01 May 2019.
Author
Rengel K.; Mehdiratta N.; Vanston S.; Swygert K.; Jackson J.;
Pandharipande P.; Hughes C.G.
Institution
(Rengel, Vanston, Swygert, Pandharipande, Hughes) Vanderbilt University
Medical Center, United States
(Mehdiratta, Jackson) Vanderbilt University, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Surgery, and its accompanying period of acute illness, is
associated with postoperative functional decline that may result in
prolonged disability.1 Postoperative cognitive dysfunction is also
prevalent2 and linked to worse functional status. Further, activities that
integrate strength, cognition, and endurance require a longer recovery
period than more basic tasks. Preoperative functional impairment and
cognitive dysfunction are associated with prolonged and worsened
disability after surgery.1,3 Physical therapy interventions to improve
functional status prior to surgery, termed prehabilitation, have
demonstrated success in reducing time to recovery of baseline function.4
We hypothesized that prehabilitation with both physical and cognitive
exercises is feasible and would be associated with improved postoperative
functional and cognitive outcomes. METHOD(S): We conducted an
open-label controlled pilot feasibility trial, enrolling adult patients at
least 1 week prior to elective major non-cardiac surgery requiring >=3
days hospitalization in a 2:1 ratio of intervention to control. The
intervention group received a resistance-based exercise program and an
adaptive tablet-based cognitive training program to both be completed
daily prior to surgery. The control group received general health
information and a control tablet game. Physical and cognitive assessments
were performed at enrollment and 1 month after surgery. Physical function
was assessed with Instrumental Activities of Daily Living (IADLs), grip
strength, and 2-minute walk test (2-MWT). Cognitive function was assessed
with the Dimensional Card Change Sorting (DCCS), Flanker Inhibitory, and
Pattern Comparison tests. We used multivariable linear regression to
evaluate the independent effect of the prehabilitation intervention on
change in physical and cognitive function from baseline, adjusting for
age. RESULT(S): Our study enrolled 32 patients, 4 of whom withdrew
from the study and 3 of whom had their surgeries cancelled. The 17
patients in the intervention group had a median age of 62.5 years and ASA
classification of 3 compared to 56 years and ASA of 3 in the 8 patients in
the control group. The intervention was feasible, with 88% and 82% of
subjects participating in physical exercise and cognitive training,
respectively. Patients in the intervention group, in general, had similar
decline in physical function and less decline in cognitive function
compared to controls despite their older age (Figure 1). Though not
statistically significant given the sample size, the intervention had
beneficial effects on IADLs, grip strength, and 2-MWT outcomes compared to
the active control (Table 1). Further, the intervention had beneficial
effects on DCCS, Flanker Inhibitory, and Pattern Comparison cognitive
testing outcomes (Table 1). CONCLUSION(S): Combined physical and
cognitive training prior to surgery is feasible, and patients who
participate in a prescribed physical and cognitive exercise program may
have less decline in functionality and cognition after surgery. Larger
randomized trials of prehabilitation interventions that include physical
and cognitive training are needed to determine their impact on
postoperative outcomes. (Table Presented).

<61>
Accession Number
646775730
Title
THORACIC EPIDURAL VS INTERCOSTAL NERVE BLOCKS WITH LIPOSOMAL BUPIVICAINE
FOR POST-OPERATIVE PAIN CONTROL IN PATIENTS UNDERGOING VIDEO-ASSISTED
THORACOSCOPIC SURGERY.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 841), 2019. Date of
Publication: 01 May 2019.
Author
Moss L.; Low Y.H.
Institution
(Moss) Dartmouth Hitchcock, United States
(Low) Dartmouth-Hitchcock Medical Center, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Thoracic epidurals are often used as part of multi-modal
analgesia to reduce postoperative pain in video-assisted thoracoscopic
surgery (VATs). Thoracic epidurals have been shown to reduce opioid
consumption and postoperative pulmonary complications. Intercostal nerve
blocks with liposomal bupivacaine have been used more recently, although
with conflicting evidence about whether this affects postoperative opioid
requirements and pain scores. The goal of this study was to compare the
outcomes between patients receiving thoracic epidurals and
surgeon-performed intercostal nerve blocks with liposomal bupivacaine.
 METHOD(S): After IRB approval, retrospective data was collected on
all patients undergoing video-assisted thoracoscopic lobe resection at our
institution between August 2017 and September 2018. Around February 2018,
there was a transition in the institution's practice toward performing
fewer thoracic epidurals for these procedures, forming a natural split in
the population. Data was obtained from the hospital's electronic medical
record. The primary outcome was escalation of care to step-down or
intensive care status, that was not anticipated at the time of surgical
posting. Secondary outcomes included adverse respiratory outcomes such as
the need for rescue CPAP, BiPAP or controlled ventilator support in the
first 48 hours post-op, and the length of stay in PACU, step-down unit, or
ICU, and total hospital admission duration. RESULT(S): A total of 165
patients who underwent videoassisted lobe resections during the above time
period were identified, of whom 51 received thoracic epidurals and 113
received intercostal nerve blocks. Preliminary data shows that compared to
patients who received a thoracic epidural, patients that received
intercostal nerve blocks were less likely to require escalation of care to
step-down or intensive care status (7% vs 2%, p= 0.06). Complete
statistical analysis is currently in progress and we will perform analyses
for the secondary outcomes listed above. CONCLUSION(S): Our current
preliminary data suggests that there is a small but non-statistically
significant (p=0.06) reduction in the need for escalation of care in
patients that receive intercostal nerve blocks with liposomal bupivicaine
versus thoracic epidurals. This is in agreement with current literature on
the subject, with lack of demonstration of superiority for either pain
control technique. As this is our preliminary data, we are performing
further statistical analysis as well as collecting earlier data for a more
balanced comparison of thoracic epidurals numbers to intercostal nerve
blocks (IRB approved, data collection ongoing). As current literature is
conflicting about the subject it is our hope that, with the increased
study sample, we will be able to elucidate patient specific
characteristics suggestive of success or failure with one technique versus
the other. Ultimately a large prospective randomized control trial will be
needed for further clarification on the subject.

<62>
Accession Number
2037651613
Title
Fasting vs No Fasting Prior to Percutaneous Cardiovascular Procedures: A
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 18(5) (pp 682-684), 2025. Date of
Publication: 10 Mar 2025.
Author
Maqsood M.H.; Tamis-Holland J.E.; Mamas M.A.; Capodanno D.; Bhatt D.L.;
Bangalore S.
Publisher
Elsevier Inc.

<63>
Accession Number
2037882235
Title
Surgical ablation in patients with atrial fibrillation and left
ventricular dysfunction: A systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 58 (no pagination), 2025. Article Number:
101648. Date of Publication: 01 Jun 2025.
Author
Consoli L.N.; Cetinel E.; Majeed M.W.; Lajczak P.; Koziakas I.G.; Wijaya
P.; Apostolou A.; Ahmed R.; Perreas K.
Institution
(Consoli) Federal University of Bahia, Bahia, Brazil
(Cetinel) San Raffaele University, Milan, Italy
(Majeed) Government Medical College Srinagar, J&K, India
(Lajczak) Medical University of Silesia, Poland
(Koziakas, Perreas) Onassis Cardiac Surgery Center, Greece
(Wijaya) Cardiac Surgery Department, Universitas Indonesia, Indonesia
(Apostolou) Hospital Clinic Zurich, Switzerland
(Ahmed) Cardiology Department, Royal Brompton Hospital, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Atrial fibrillation (AF) and left ventricular dysfunction
(LVD) are common conditions that often coexist, with about 25% of patients
in NYHA classes I-II having AF. Efficacy and safety of surgical ablation
(SA) in this population remains unclear. Method(s): We aimed to
perform a single-arm meta-analysis to assess the outcomes of standalone
and concomitant SA in adult patients with AF and LVD. We searched PubMed,
Scopus and the Cochrane Library. Endpoints of interest were maintenance of
sinus rhythm, freedom from anti-arrhythmic drug (AAD) use, change in LVEF,
30-day mortality, 1 year mortality and major procedural complications. We
calculated pooled proportions or means for binary and continuous
endpoints, respectively, with a 95 % confidence interval (CI).
 Result(s): Ten observational studies comprising 863 patients (mean
follow-up of 19 months) were included. At 1 year, SA resulted in a sinus
rhythm rate of 83.9 % (95 % CI: 69.5-92.3); freedom from AAD use of 81.6 %
(95 % CI: 64.7-91.7); and mortality of 5.77 (95 % CI:3.7-8.9). 30-day
mortality was 2.16 % (95 % CI: 0.9-4.9); major complications 16.73 % (95 %
CI: 12-23); and an improvement in LVEF of 12 % (95 % CI: 9-17).
 Conclusion(s): This meta-analysis found that SA appears to be an
effective strategy to achieve sinus rhythm in patients with AF and LVD,
with a pooled 30-day mortality of 2.2%. Comparative studies are warranted
to evaluate the relative safety and efficacy of SA compared with other
rhythm control strategies in this population. Copyright © 2025
The Authors

<64>
Accession Number
2037671252
Title
Efficacy of Acoramidis on All-Cause Mortality and Cardiovascular
Hospitalization in Transthyretin Amyloid Cardiomyopathy.
Source
Journal of the American College of Cardiology. 85(10) (pp 1003-1014),
2025. Date of Publication: 18 Mar 2025.
Author
Judge D.P.; Alexander K.M.; Cappelli F.; Fontana M.; Garcia-Pavia P.;
Gibbs S.D.J.; Grogan M.; Hanna M.; Masri A.; Maurer M.S.; Obici L.; Soman
P.; Cao X.; Lystig T.; Tamby J.-F.; Siddhanti S.; Castano A.; Katz L.; Fox
J.C.; Mahaffey K.W.; Gillmore J.D.
Institution
(Judge) Division of Cardiology, Medical University of South Carolina,
Charleston, SC, United States
(Alexander) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University School of Medicine, Palo Alto, CA, United States
(Alexander, Mahaffey) Stanford Center for Clinical Research, Stanford
School of Medicine, Palo Alto, CA, United States
(Cappelli) Tuscan Regional Amyloidosis Centre, Careggi University
Hospital, Florence, Italy
(Fontana, Gillmore) National Amyloidosis Centre, University College
London, Royal Free Hospital, London, United Kingdom
(Garcia-Pavia) Department of Cardiology, Hospital Universitario Puerta de
Hierro Majadahonda and Centro Nacional de Investigaciones Cardiovasculares
(CNIC), Madrid, Spain
(Gibbs) Victorian and Tasmanian Amyloidosis Service, Eastern Health,
Melbourne, VIC, Australia
(Gibbs) Epworth HealthCare, East Melbourne, VIC, Australia
(Grogan) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Hanna) Cleveland Clinic, Cleveland, OH, United States
(Masri) Division of Cardiology, Oregon Health & Science University,
Portland, OR, United States
(Maurer) Department of Medicine, Columbia University Irving Medical
Center, New York, NY, United States
(Obici) Amyloidosis Research and Treatment Centre, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Soman) Division of Cardiology, University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Cao, Lystig, Tamby, Siddhanti, Castano, Katz, Fox) BridgeBio Pharma, Inc,
San Francisco, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an
underdiagnosed chronic disease associated with progressive heart failure
that results in impaired quality of life, repeated hospitalizations, and
premature death. Acoramidis is a selective, oral transthyretin stabilizer
recently approved by the U.S. Food and Drug Administration for the
treatment of ATTR-CM. In a phase 3, randomized, double-blind study
(ATTRibute-CM [Efficacy and Safety of AG10 in Subjects With Transthyretin
Amyloid Cardiomyopathy]), acoramidis was well tolerated and showed
clinical efficacy in improving the primary endpoint, a hierarchical
combination of all-cause mortality (ACM), cardiovascular-related
hospitalization (CVH), N-terminal pro-B-type natriuretic peptide level,
and 6-minute walk distance. Objective(s): The goal of this study was
to characterize the efficacy of acoramidis on ACM and CVH. Method(s):
In ATTRibute-CM, participants with ATTR-CM were randomized 2:1 to receive
acoramidis hydrochloride (800 mg twice daily) or placebo for 30 months.
Efficacy analyses were conducted in the modified intention-to-treat
population (participants with a baseline estimated glomerular filtration
rate >=30 mL/min/1.73 m2). CVH and the composite of ACM or
first CVH were plotted by using Kaplan-Meier curves and summarized with a
stratified Cox proportional hazards model. The annualized frequency of CVH
was analyzed by using a negative binomial regression model. Subgroup
analyses were conducted for the composite of ACM or first CVH.
 Result(s): Of the 632 participants randomized to treatment, 611 (97%)
were included in efficacy analyses (acoramidis, n = 409; placebo, n =
202). Compared with placebo, acoramidis reduced the occurrence of the
composite of ACM or first CVH (acoramidis, 35.9%; placebo, 50.5%; HR:
0.64; 95% CI: 0.50-0.83; P = 0.0008) and of first CVH (acoramidis, 26.7%;
placebo, 42.6%; HR: 0.60; 95% CI: 0.45-0.80; P = 0.0005), with
Kaplan-Meier curves separating at month 3 and continuing to diverge
through month 30. Annualized frequency of CVH was reduced with acoramidis
compared with placebo (acoramidis, 0.22; placebo, 0.45; relative risk
ratio: 50%; 95% CI: 0.36-0.70; P < 0.0001). The efficacy of acoramidis on
the composite of ACM or first CVH was consistent across subgroups.
Acoramidis was well tolerated, with no safety signals of potential
clinical concern identified. Conclusion(s): In participants with
ATTR-CM, acoramidis reduced the composite of ACM or first CVH vs placebo,
with an early effect driven by a reduction in CVH. (Efficacy and Safety of
AG10 in Subjects With Transthyretin Amyloid Cardiomyopathy [ATTRibute-CM];
NCT03860935) Copyright © 2025 The Authors

<65>
Accession Number
2037874099
Title
Completeness, timing, and guidance of percutaneous coronary intervention
for myocardial infarction and multivessel disease: a systematic review and
network meta-analysis.
Source
EuroIntervention. 21(4) (pp e203-e216), 2025. Date of Publication: 2025.
Author
Laudani C.; Occhipinti G.; Greco A.; Spagnolo M.; Giacoppo D.; Capodanno
D.
Institution
(Laudani, Occhipinti, Greco, Spagnolo, Giacoppo, Capodanno) Division of
Cardiology, Azienda Ospedaliero-Universitaria Policlinico "Rodolico - San
Marco", University of Catania Catania, Italy
Publisher
Europa Group
Abstract
BACKGROUND: Trials assessing the prognostic influence of the completeness,
timing, and guidance of percutaneous coronary intervention (PCI) for
haemodynamically stable acute myocardial infarction (MI) and multivessel
coronary artery disease (MV-CAD) have provided heterogeneous results.
AIMS: We aimed to comprehensively and simultaneously assess the available
evidence on the completeness, timing, and guidance of PCI for acute MI and
MV-CAD. METHOD(S): Major electronic databases were screened to
identify randomised trials comparing at least two PCI strategies for acute
MI and MV-CAD. Recurrent MI and cardiac death were the primary and
co-primary outcomes. Frequentist and Bayesian 5- and 3-node network
meta-analyses were conducted along with complementary analyses to explore
potential sources of heterogeneity. RESULT(S): Fourteen trials,
including 14,433 patients, were pooled. In the frequentist 5-node
analysis, angiography-guided immediate complete revascularisation (CR)
reduced MI compared with infarct-related artery (IRA)-only
revascularisation (hazard ratio [HR] 0.42, 95% confidence interval [CI]:
0.27-0.66), angiography-guided staged CR (HR 0.56, 95% CI: 0.36-0.87), and
functionally guided staged CR (HR 0.37, 95% CI: 0.20-0.69). Functionally
guided immediate CR was associated with reduced MI compared with IRA-only
revascularisation (HR 0.53, 95% CI 0.34-0.82). The Bayesian analysis
confirmed only an advantage of angiography-guided immediate CR over
IRA-only revascularisation. In frequentist 3-node analysis, immediate CR
reduced MI (HR 0.51, 95% CI: 0.37-0.70) and cardiac death (HR 0.68, 95%
CI: 0.50-0.93) compared with IRA-only revascularisation and MI compared
with staged CR (HR 0.55, 95% CI: 0.38-0.79). The Bayesian analysis did not
confirm the reduction in cardiac death. CR, regardless of the type of
guidance and especially when immediate, reduced the rate of any
revascularisation compared with IRA-only revascularisation.
 CONCLUSION(S): In haemodynamically stable patients with acute MI and
non-complex MV-CAD undergoing PCI, immediate CR following successful
culprit lesion treatment reduces recurrent MI compared with IRA-only
revascularisation and staged CR. Whether CR is associated with reduced
cardiovascular death remains uncertain. Copyright © Europa Group
2025. All rights reserved.

<66>
Accession Number
2037915051
Title
Vasoplegia in Cardiac Surgery: A Systematic Review and Meta-analysis of
Current Definitions and Their Influence on Clinical Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Papazisi O.; van der Schoot M.M.; Berendsen R.R.; Arbous S.M.; le Cessie
S.; Dekkers O.M.; Klautz R.J.M.; Marczin N.; Palmen M.; de Waal E.E.C.
Institution
(Papazisi, Klautz, Palmen, de Waal) Department of Cardiothoracic surgery,
Leiden University Medical Center, Leiden, Netherlands
(van der Schoot, Berendsen) Department of Anesthesiology, Leiden
University Medical Center, Leiden, Netherlands
(Arbous) Department of Intensive Care, Leiden University Medical Center,
Leiden, Netherlands
(le Cessie, Dekkers) Department of Clinical Epidemiology, Leiden
University Medical Center, Leiden, Netherlands
(le Cessie) Department of Biomedical Data Sciences, Leiden University
Medical Center, Leiden, Netherlands
(Klautz) Department of Cardiothoracic surgery, Amsterdam University
Medical Center, Amsterdam, Netherlands
(Marczin) Division of Anaesthesia, Pain Medicine and Intensive Care,
Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St.
Thomas' NHS, London, United Kingdom
(Marczin) Department of Anesthesia and Intensive Care, Semmelweis
University, Budapest, Hungary
(de Waal) Department of Anesthesiology, University Medical Center Utrecht,
Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: To identify differences in the reported vasoplegia incidence,
intensive care unit (ICU) length of stay (LOS), and 30-day mortality rates
as influenced by different vasoplegia definitions used in cardiac surgery
studies. Design(s): A systematic review was performed covering the
period 1977 to 2023 using PubMed/MEDLINE, Embase, Web of Science, Cochrane
Library, and Emcare and a meta-analysis (PROSPERO: CRD42021258328) was
performed. Setting and Participants: One hundred studies defining
vasoplegia in cardiac surgery patients were systematically reviewed. Sixty
studies with 20 or more patients, irrespective of design, reporting
vasoplegia incidence, ICU LOS, or 30-day mortality were included for
meta-analysis. Intervention(s): Cardiac surgery on cardiopulmonary
bypass. Measurements and Main Results: Studies were categorized
depending on the used mean arterial pressure (MAP) thresholds. Random
intercept logistic regression models were used for meta-analysis of
incidence and mortality. Random effect meta-analysis was used for ICU LOS.
One hundred studies were reviewed systematically. MAP and cardiac index
thresholds varied considerably (<50-80 mmHg and 2.0-3.5
L.min-1m-2, respectively). Vasopressor dosages also
differed between definitions. The reported incidence (60 studies; mean
incidence, 19.9%; 95% confidence interval [CI], 16.1-24.4) varied largely
between studies (2.5%-66.3%; I2 = 97%; p < 0.0001).
Meta-regression models, including the MAP-threshold, did not explain this
heterogeneity. Similarly, the effect of vasoplegia on ICU LOS, and 30-day
mortality was very heterogeneous among studies (I2 = 99% and
I2 = 73%, respectively). Conclusion(s): The large
variability in vasoplegia definitions is associated with significant
heterogeneity regarding incidence and clinical outcomes, which cannot be
explained by factors included in our models. Such variations in
definitions leads to inconsistent patient diagnosis and renders published
vasoplegia research incomparable. Copyright © 2025 The Authors

<67>
Accession Number
2032112115
Title
Incidence of Infective Endocarditis Post-TPVR with MELODY Valve in
Pediatric Patients: A Systematic Review and Meta-Analysis.
Source
Current Cardiology Reviews. 21(1) (no pagination), 2025. Article Number:
E1573403X324878. Date of Publication: 2025.
Author
Veldurthy S.; Shrivastava D.; Majeed F.; Ayaz T.; Munir A.; Haider A.;
Mylavarapu M.
Institution
(Veldurthy) Department of Pediatrics, Mediciti Institute of Medical
Sciences, Telangana, India
(Shrivastava) Department of Anesthesia, University of Minnesota,
Minneapolis, United States
(Majeed) Department of Medicine, Pakistan Medical and Dental Council,
Islamabad, Pakistan
(Ayaz) Department of Medicine, Baqai Medical University, Karachi, Pakistan
(Munir) Department of Anesthesia, Mayo Hospital, Lahore, Pakistan
(Haider) Department of Allied Health Sciences, The University of Lahore,
Gujrat, Pakistan
(Mylavarapu) Department of Public Health, Adelphi University, NY, United
States
Publisher
Bentham Science Publishers
Abstract
Introduction: Infective Endocarditis (IE) has emerged to be one of the
most impactful adverse complications post-transcatheter procedures,
especially Transcatheter Pulmonary Valve Replacement (TPVR). We conducted
a systematic review and meta-analysis with the aim of identifying the
incidence of IE post-TPVR with the MELODY valve in the pediatric
population. Method(s): A comprehensive literature search was
performed across several prominent databases, including PubMed/MEDLINE,
SCOPUS, and Science Direct. Studies compared the clinical outcomes of
pediatric patients who received TPVR using the MELODY valve. Data
extraction was done for variables like the total pediatric patient
population that underwent TPVR with MELODY valve, mean age, the sex of the
patients, the incidence rate of IE following the procedure, and the
duration between the procedure and the occurrence of IE. Inverse Variance
was used to estimate the incidence of IE in patients who underwent TPVR
with respective 95% confidence interval (CI). Result(s): In total, 4
studies with 414 pediatric patients who underwent TPVR using the MELODY
valve were included in the study. The mean age of the study population was
12.7 +/- 3.11 years. The pooled incidence of IE following TPVR with MELODY
valve in the pediatric population was 17.70% (95% Cl 3.84-31.55;
p<0.00001). Additionally, the mean length of duration to develop IE
following TPVR with MELODY valve in the pediatric population was 2.18
years (95% Cl 0.35-4.01; p<0.00001). Conclusion(s): Our meta-analysis
reveals that IE post-TPVR with MELODY valve in pediatric patients is a
significant complication, clinically and statistically. Further research
needs to be done to understand the risk factors and develop better
management strategies. Copyright © 2025 Bentham Science
Publishers.

<68>
[Use Link to view the full text]
Accession Number
2037332181
Title
Stepwise Provisional Versus Systematic Dual-Stent Strategies for Treatment
of True Left Main Coronary Bifurcation Lesions.
Source
Circulation. 151(9) (pp 612-622), 2025. Date of Publication: 04 Mar 2025.
Author
Arunothayaraj S.; Egred M.; Banning A.P.; Brunel P.; Ferenc M.; Hovasse
T.; Wlodarczak A.; Pan M.; Schmitz T.; Silvestri M.; Erglis A.; Kretov E.;
Lassen J.F.; Chieffo A.; Lefevre T.; Burzotta F.; Cockburn J.; Darremont
O.; Stankovic G.; Morice M.-C.; Louvard Y.; Hildick-Smith D.
Institution
(Arunothayaraj, Cockburn, Hildick-Smith) Department of Cardiology, Sussex
Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, United
Kingdom
(Egred) Department of Cardiology, Freeman Hospital and Newcastle
University, Newcastle upon Tyne, United Kingdom
(Banning) Department of Cardiology, Oxford Heart Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Brunel) Interventional Cardiology Unit, Clinique de Fontaine, Dijon,
France
(Ferenc) Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Germany
(Hovasse, Lefevre, Morice, Louvard) Department of Cardiology, Institut
Cardiovasculaire Paris Sud, Ramsay Sante, Massy, France
(Wlodarczak) Department of Cardiology, Poland Miedziowe Centrum Zdrowia
Lubin, Poland
(Pan) Department of Cardiology, Reina Sofia Hospital, University of
Cordoba, Spain
(Schmitz) Contilia Heart and Vascular Center, Elisabeth Krankenhaus Essen,
Germany
(Silvestri) Department of Cardiology, GCS Axium, Rambot, Aix en Provence,
France
(Erglis) Department of Cardiology, Pauls Stradins Clinical University
Hospital, University of Latvia, Riga, Latvia
(Kretov) Interventional Cardiology Unit, Sibirskiy Federal Biomedical
Research Center Novosibirsk, Russian Federation
(Lassen) Department of Cardiology, Odense University Hospital, Denmark
(Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Burzotta) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore,
Rome, Italy
(Darremont) Department of Cardiology, Clinique Saint-Augustin-Elsan,
Bordeaux, France
(Stankovic) Department of Cardiology, University Clinical Center of
Serbia, Faculty of Medicine, University of Belgrade, Serbia
(Ferenc) Institute of Heart Diseases, Wroclaw Medical University, Poland
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The optimal coronary stenting technique for true left main
bifurcation lesions is uncertain. EBC MAIN (European Bifurcation Club Left
Main Trial) aimed to evaluate clinical outcomes of a stepwise provisional
strategy compared with a systematic dual-stent approach. METHOD(S):
EBC MAIN was a randomized, investigator-initiated, open-label,
multicenter, parallel-group trial conducted across 35 hospitals in 11
European countries. A total of 467 participants undergoing percutaneous
coronary intervention for unprotected true left main bifurcation lesions
were randomly assigned to the stepwise provisional strategy (n=230) or an
upfront dual-stent approach (n=237). The mean (SD) age was 71 (10) years
and 23% of participants were women. The primary end point was a composite
of major adverse cardiac events, defined as all-cause mortality, all
myocardial infarction, or clinically driven target lesion
revascularization. Events were adjudicated by an independent clinical
events committee and all analyses were by the intention-to-treat
principle. RESULT(S): At 3 years, the primary end point occurred in
54 of 230 (23.5%) stepwise provisional and 70 of 237 (29.5%) dual-stent
patients (hazard ratio, 0.75 [95% CI, 0.53-1.07]; P=0.11). There was no
significant difference in all-cause mortality (10.0% versus 13.1%) or
myocardial infarction (12.2% versus 11.0%). However, target lesion
revascularization was significantly lower in the stepwise provisional
group (8.3% versus 15.6%; hazard ratio, 0.50 [95% CI, 0.29-0.86];
P=0.013). In this population, the mean side vessel diameter by
quantitative angiography was 2.9 mm, and median side vessel lesion length
was 5 mm. Significant interactions were identified between the assigned
bifurcation strategy and both side vessel diameter and lesion length with
respect to the primary outcome (P=0.009 and P=0.005, respectively), with
smaller vessels (<3.25 mm diameter) and shorter lesions (<10 mm length)
favoring the provisional approach. CONCLUSION(S): In a European
population with true left main stem bifurcation coronary disease requiring
intervention, there was no difference in major adverse cardiovascular
events between stepwise provisional and systematic dual-stent strategies
at 3 years. Target lesion revascularization was significantly less
frequent with the stepwise provisional approach, which should be the
default strategy for noncomplex left main bifurcation coronary
intervention. Copyright © 2025 American Heart Association, Inc.

<69>
[Use Link to view the full text]
Accession Number
2035023290
Title
A Randomized Controlled Trial Comparing Effectiveness of Different
Fibrinogen Preparations in Restoring Clot Firmness.
Source
Anesthesia and Analgesia. 140(4) (pp 966-973), 2025. Date of Publication:
01 Apr 2025.
Author
Baryshnikova E.; Aloisio T.; Di Dedda U.; Anguissola M.; Barbaria A.;
Caravella G.; Ranucci M.
Institution
(Baryshnikova, Aloisio, Di Dedda, Anguissola, Barbaria, Ranucci)
Departments of Cardiovascular Anesthesia and Intensive Care, IRCCS
Policlinico San Donato, Milan, San Donato Milanese, Italy
(Caravella) Departments of Pharmacy Service, IRCCS Policlinico San Donato,
Milan, San Donato Milanese, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Different preparations of fibrinogen concentrate are currently
available. Two in vitro studies demonstrated the superiority of FibCLOT
(LFB) in increasing clot firmness with respect to RiaSTAP (CSL Behring).
The present trial involved a clinical model to test the hypothesis of
superiority, with the increase in clot firmness as the primary end point.
 METHOD(S): Forty cardiac surgery patients were randomly allocated to
receive a dose of 30 mg/kg FibCLOT or RiaSTAP after protamine
administration in the presence of microvascular bleeding and a FIBTEM
maximum clot firmness (MCF) <10 mm. Viscoelastic parameters were measured
before and after fibrinogen supplementation: FIBTEM MCF, EXTEM MCF, and
EXTEM clotting time (CT). RESULT(S): The mean increase in FIBTEM MCF
was 4 +/- 1.2 mm (mean and standard deviation) in the FibCLOT group and 4
+/- 1.6 mm in the RiaSTAP group (P = 1.000); the mean decrease in CT was
11. 2 +/- 12.2 (mean and standard deviation) seconds in the FibCLOT group
and 14. 8 +/- 13 seconds in the RiaSTAP group (P = .372). In both groups,
fibrinogen supplementation induced a significant (P = .001) increase in
the FIBTEM MCF and EXTEM CT. The proportions of patients who did not
experience an increase of 4 mm in the RiaSTAP group and the FibCLOT group
were not statistically significantly higher (35% vs 20%, respectively,
relative risk 2.15, 95% confidence interval 0.52-9.00, P = .288).
 CONCLUSION(S): In contrast to previous in vitro studies, we found
that the effect of FibCLOT on MCF and CT was not significantly greater
than that of RiaSTAP in cardiac surgery patients. Further studies in other
clinical settings are warranted. Copyright © 2025 International
Anesthesia Research Society.

<70>
Accession Number
2036442680
Title
Goal-directed Perfusion to Reduce Acute Kidney Injury After Pediatric
Cardiac Operation.
Source
Annals of Thoracic Surgery. 119(4) (pp 891-898), 2025. Date of
Publication: 01 Apr 2025.
Author
Long F.; Zhang Y.; Luo M.; Liu T.; Qin Z.; Wang B.; Zhou Y.; Zhou R.
Institution
(Long, Zhang, Luo, Liu, Qin, Wang, Zhou) Department of Anesthesiology,
West China Hospital of Sichuan University, Sichuan, Chengdu, China
(Zhou) Department of Clinical Medicine, Henan Medical College of Zhengzhou
University, Zhengzhou, China
Publisher
Elsevier Inc.
Abstract
Background: Although goal-directed perfusion (GDP) during cardiopulmonary
bypass (CPB) has been discussed extensively in adult studies, no pediatric
indexed oxygen delivery (DO<inf>2</inf>i) thresholds are universally
accepted, and no pediatric randomized controlled trial has been reported.
This study aimed to determine whether the GDP initiative (maintaining
DO<inf>2</inf>i >=360 mL/min/m2 during CPB) could reduce the
incidence of acute kidney injury (AKI) after pediatric cardiac operation
and improve clinical outcomes. Method(s): This single-center
randomized controlled trial enrolled 312 pediatric patients, who were
randomized to receive either the GDP strategy or a conventional perfusion
strategy during CPB. The primary outcome was the rate of postoperative
AKI. Secondary outcomes included major postoperative complications,
all-cause mortality within 30 days, and short-term clinical outcomes after
operation. Result(s): AKI occurred in 43 patients (28.1%) in the GDP
group and in 65 patients (42.2%) in the control group (relative risk,
0.67; 95% CI, 0.49-0.91; P =.010). In the subgroup analysis, the GDP group
had a lower AKI rate compared with the control group among patients aged
less than 1 year, with a nadir temperature greater than 32 degreeC and a
nadir hemoglobin value less than 8 g/L during CPB, with preoperative
cyanosis, and with CPB duration from 60 to 120 minutes.
 Conclusion(s): The GDP strategy aimed at maintaining DO<inf>2</inf>i
>=360 mL/min/m2 during CPB is effective in reducing the risk of
AKI after pediatric cardiac operation. Copyright © 2025 The
Society of Thoracic Surgeons

<71>
Accession Number
2037903521
Title
Effects of naloxegol on transit recovery in patients undergoing cardiac
surgery: A randomized, double-blind, placebo-controlled trial.
Source
Anaesthesia Critical Care and Pain Medicine. 44(2) (no pagination), 2025.
Article Number: 101498. Date of Publication: 01 Apr 2025.
Author
Laghlam D.; Gibert H.; Merzoug M.; Leclerc D.; Coroyer L.; Estagnasie P.;
Squara P.; Nguyen L.S.; Geri G.
Institution
(Laghlam, Coroyer, Estagnasie, Squara, Nguyen, Geri) From the Department
of Cardiology and Critical Care, CMC Ambroise Pare-Hartmann, 48 Ter
boulevard Victor Hugo, Neuilly-sur-Seine, France
(Gibert, Leclerc) From the Department of Cardiovascular Anesthesiology,
CMC Ambroise Pare-Hartmann, 48 Ter boulevard Victor Hugo,
Neuilly-sur-Seine, France
(Merzoug) From the Department of Clinical Research, CMC Ambroise
Pare-Hartmann, 48 Ter boulevard Victor Hugo, Neuilly-sur-Seine, France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Paralytic ileus is a major surrounding after cardiac surgery
and worsens patients' prognosis. Method(s): We conducted a
single-centre, randomized, double-blind, placebo-controlled phase 3 study.
We enrolled patients over 18 years old who underwent non-urgent cardiac
surgery. Eligible patients were randomly allocated to Naloxegol or
matching placebo in an equal ratio. The participants were randomly
assigned to one of the following groups: (1) Naloxegol 12,5 mg 2 h before
index surgery, and then Naloxegol 25 mg once daily, or (2) matching
placebo. Naloxegol or placebo was administered for up to 5 days and
permanently stopped if the patient had transit recovery. The primary
endpoint was the time of postoperative gastrointestinal transit recovery
after the index cardiac surgery, defined as the time in hours between the
anaesthetic induction and the emission of the first significant stool.
 Result(s): Between October 14, 2020, and January 28, 2022, 299
participants were included in modified intention-to-treat efficacy
analyses (151 in the Naloxegol group and 148 in placebo). The mean age was
62 +/- 10.1 years old, 81.6% were male, 53.8% had hypertension, 20.7% had
diabetes mellitus, and the median body mass index was 25.9 (IQR 23.7-29.4)
kg/m2. Time-to-transit recovery did not differ between
Naloxegol group and placebo (76.0, [IQR 69.3-93.5] vs. 78.3, [IQR
70.0-95.8] h, p value = 0.40). We did not observe any difference in the
prespecified secondary efficacy between both groups. Pain levels and a
number of serious adverse events were not different in both groups.
 Conclusion(s): Naloxegol was not found to be effective in improving
the transit time recovery after elective cardiac surgery. The trial was
registered on ClinicalTrials.gov (NCT04433390) on June 16th,
2020. Copyright © 2025 Societe Francaise d'Anesthesie et de
Reanimation (SFAR)

<72>
Accession Number
2033629952
Title
Multiparametric Outcome Assessment After Transcatheter Aortic Valve
Implantation-A Systematic Review.
Source
Journal of Clinical Medicine. 14(5) (no pagination), 2025. Article Number:
1426. Date of Publication: 01 Mar 2025.
Author
Swiatoniowska-Lonc N.; Klausa F.; Sciborski K.; Wysokinska-Kordybach A.;
Banasiak W.; Doroszko A.
Institution
(Swiatoniowska-Lonc, Sciborski, Wysokinska-Kordybach, Banasiak, Doroszko)
Department of Cardiology, Centre for Heart Diseases, 4th Military
Hospital, Wroclaw, Poland
(Klausa) Department of Cardiac Surgery, Centre for Heart Diseases, 4th
Military Hospital, Wroclaw, Poland
(Banasiak, Doroszko) Clinical Department of Cardiology, Faculty of
Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Backround/Objectives: Aortic stenosis (AS) is the most commonly acquired
valvular disorder. Patient risk stratification and the development of an
accurate and reliable tool are crucial in identifying suitable candidates
for TAVI. The present review summarized the current state of knowledge on
the influence of selected factors on the outcomes and course of patients
with AS undergoing transcatheter aortic valve implantation (TAVI).
 Method(s): The inclusion criteria for the present systematic review
were as follows: (1) studies indexed in the medical databases PubMed,
MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus; (2) full-text
articles available in English; (3) papers published between 2013 and 2023;
and (4) addressing the topic of assessing the impact of factors on the
outcomes of patients with aortic stenosis undergoing TAVI. This review
used PRISMA 2020 reporting guidelines for systematic reviews and
meta-analyses. Result(s): One hundred and thirty-two studies were
eligible for this review. The available studies showed an association of
psychosocial and socioeconomic factors, valve parameters, comorbidities,
clinical factors, treatment-related factors, biomarkers, and treatment
methods with the outcomes of patients with AS undergoing TAVI.
 Conclusion(s): Given the conflicting results obtained regarding the
impact of right ventricular dysfunction, paravalvular leaks, and treatment
method on the mortality of patients undergoing aortic valve implantation,
further research in these areas is needed. In view of the researchers'
differing views on some of the factors affecting patient outcomes after
TAVI, further analysis is needed to develop a new tool for assessing
predictive outcomes in AS patients. This study is registered at PROSPERO
(CRD42024612752). Copyright © 2025 by the authors.

<73>
Accession Number
2037744800
Title
A predictive model for early postoperative hypoxemia after mitral valve
replacement combined with pulmonary arterial hypertension.
Source
Surgery (United States). 181 (no pagination), 2025. Article Number:
109280. Date of Publication: 01 May 2025.
Author
Lv X.; Tang M.; Li W.; Liu K.; Liu C.
Institution
(Lv, Tang, Liu, Liu) Department of Cardiovascular Surgery, Qilu Hospital
of Shandong University, Shandong, Jinan, China
(Lv) Department of Cardiovascular Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Shandong, Jinan, China
(Li) Cardiac Surgery, Heart Centre, The Affiliated Taian City Central
Hospital of Qingdao University, Shandong, Taian, China
(Liu) College of Electrical Engineering, Shandong University, Shandong,
Jinan, China
(Liu) Pantheum Biotechnology Co, Ltd, Shandong, Jinan, China
Publisher
Elsevier Inc.
Abstract
Background: To establish and validate a novel scoring system on the basis
of a nomogram for preoperative prediction of early hypoxemia after mitral
valve replacement combined with pulmonary arterial hypertension.
 Method(s): For this retrospective cohort study, clinical data from
430 patients with mitral valve disease combined with pulmonary arterial
hypertension were collected. Early postoperative hypoxemia was defined as
hypoxemia that occurred within 24 hours after operation. Clinical data
from 430 patients were subjected to univariate logistic regression
analysis (P < .05), and the results were then included in a stepwise
multivariate logistic regression analysis (P < .05) to derive independent
risk factors for postoperative hypoxemia. All the data from 430 patients
were randomly divided into the training and validation cohorts. Nomogram
prediction models for postoperative hypoxemia were established using the
training cohorts and validated with the validation cohorts.
 Result(s): Univariate and stepwise multivariate logistic regression
analyses suggested that the systolic pulmonary artery pressure, smoking,
age, left atrial end-systolic dimension, and whether patients with
accompanying atrial fibrillation underwent maze surgery (we replaced this
factor with "atrial fibrillation-maze category" in the article that
follows) were independent risk factors. A nomogram prediction model was
developed accordingly. The area under the curve values of the training and
validation cohorts were 0.838 (95% confidence interval, 0.783-0.892) and
0.799 (95% confidence interval, 0.730-0.869), respectively. The
calibration curves were close to the ideal diagonal, and the decision
curve analysis indicated a significant net benefit. Conclusion(s):
The risk prediction model developed in this study is a desirable predictor
of early postoperative hypoxemia after mitral valve replacement combined
with pulmonary arterial hypertension. Copyright © 2025 Elsevier
Inc.

<74>
Accession Number
2033618835
Title
Characterizing Cardiotoxicity of FDA-Approved Soft Tissue Sarcoma Targeted
Therapies and Immune Checkpoint Inhibitors: A Systematic Review.
Source
Cancers. 17(5) (no pagination), 2025. Article Number: 827. Date of
Publication: 01 Mar 2025.
Author
Houmsse M.; Muskara A.; Pasca D.; Roy A.; Sughra S.; Ghazi S.; Addison D.;
Husain M.
Institution
(Houmsse, Muskara) College of Medicine, Northeast Ohio Medical University,
Rootstown, OH, United States
(Pasca, Roy) College of Graduate Studies, Northeast Ohio Medical
University, Rootstown, OH, United States
(Sughra, Ghazi, Addison) Cardio-Oncology Program, Division of Cardiology,
The Ohio State University Wexner Medical Center, Columbus, OH, United
States
(Addison) Division of Cancer Control and Prevention, James Cancer
Hospital, The Ohio State University, Columbus, OH, United States
(Husain) Division of Medical Oncology, Department of Internal Medicine,
The Ohio State University Wexner Medical Center, Columbus, OH, United
States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Soft tissue sarcomas (STS) are aggressive cancers that show
increasing response to novel targeted-therapies and
immune-checkpoint-inhibitors. Despite anecdotal reports of cardiovascular
adverse events (AEs) and major adverse cardiovascular events (MACE)
potentially hindering their utility, the true cardiotoxic profile of these
novel-therapies in STS has been largely understudied. Method(s): We
assessed the incidence and severity of AEs and MACE of contemporary
FDA-approved targeted and immune-based therapies for STS, using data from
landmark clinical trials supporting FDA-approval. We also analyzed data
from the FDA adverse-event-reporting-system-(FAERS) for FDA-approved STS
targeted and immune-based therapies for comparative real-world validation.
 Result(s): Overall, 12 clinical trials supporting FDA-approval of STS
targeted-therapies and immune-checkpoint-inhibitors, incorporating 1249
patients, were identified. These clinical trials revealed 751 AEs
including, hypertension (382, 50.87%), atrial fibrillation (3, 0.40%),
myocardial infarction (2, 0.27%), cardiac failure (congestive included)
(9, 1.20%), and cardiac failure (heart failure included) (7, 0.93%).
Compared to placebo, those treated saw higher MACE (OR: 3.27, p < 0.001).
The FAERS data showed 489 reported AEs including hypertension (275,
56.24%), atrial fibrillation (31, 6.34%), myocardial infarction (15,
3.07%), and cardiac failure (congestive included) (30, 6.13%). Programmed
death-ligand 1 (PD-L1) inhibitors had the highest probability of AEs
(0.65, 1.17), followed by tyrosine kinase inhibitors (0.66, 0.11),
tropomyosin receptor kinase inhibitors (0.25, 0.13), mammalian target of
rapamycin inhibitors (0.21, 0.09), and enhancer of zeste homologue 2
inhibitors (0.11, 0.06). Proportions were calculated from the samples in
clinical trials supporting FDA-approval and FAERS, respectively.
 Conclusion(s): In this investigation, contemporary FDA-approved
therapies for STS are associated with increased risk of AEs Copyright
© 2025 by the authors.

<75>
Accession Number
2037186026
Title
Continuous serratus anterior block for sternotomy analgesia after cardiac
surgery: a single-centre feasibility study.
Source
British Journal of Anaesthesia. 134(4) (pp 1161-1169), 2025. Date of
Publication: 01 Apr 2025.
Author
Bailey J.G.; Hendy A.; Neira V.; Chedrawy E.; Uppal V.
Institution
(Bailey, Hendy, Neira, Uppal) Department of Anesthesia, Pain Management &
Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
(Chedrawy) Division of Cardiac Surgery, Dalhousie University, Halifax, NS,
Canada
Publisher
Elsevier Ltd
Abstract
Background: Moderate-to-severe pain is common after cardiac surgery,
peaking during the first and second postoperative days. Several nerve
blocks for sternotomy have been described; however, the optimal location
for continuous catheters has not been established. This study assessed the
feasibility of a larger trial evaluating the efficacy of serratus anterior
plane (SAP) catheter analgesia for sternotomy pain. Method(s): This
double-blinded trial included patients undergoing cardiac surgery via
sternotomy. Bilateral SAP catheters were placed in all participants, and
randomised to ropivacaine or placebo. We assessed feasibility based on
predetermined endpoints: (1) average recruitment rate >4 per month; (2)
protocol adherence rate >90%; (3) primary outcome measurement rate >90%;
and (4) significant catheter-related adverse event rate <=2%. The quality
of recovery index (QoR-15) was compared using an independent t-test.
 Result(s): Of 52 participants randomised, feasibility data were
available for 50. A definitive study was deemed 'not feasible' in our
standalone centre owing to a low recruitment rate (2.4 per month) and a
high adverse event rate (pneumothorax rate 12%). There were no major
protocol deviations but minor deviations in 12% of participants. Pain,
opioid consumption, complications, and quality of recovery were not
different between groups. Long-term pain at 3 months was low in both
groups. Conclusion(s): A single-centre trial was deemed not feasible
for our setting. With limited data, the quality of recovery was not
different with ropivacaine dosing of bilateral SAP catheters for
sternotomy pain. Clinical trial registration: NCT04648774. Copyright
© 2025 The Author(s)

<76>
Accession Number
2037281968
Title
The Society of Thoracic Surgeons Expert Consensus Statements on a
Framework for a Standardized National Robotic Curriculum for Thoracic
Surgery Trainees.
Source
Annals of Thoracic Surgery. 119(4) (pp 719-732), 2025. Date of
Publication: 01 Apr 2025.
Author
Kim S.S.; Schumacher L.; Cooke D.T.; Servais E.; Rice D.; Sarkaria I.;
Yang S.; Abbas A.; Sanchetti M.; Long J.; Kotova S.; Park B.J.; D'Souza
D.; Shah-Jadeja M.; Ajouz H.; Godoy L.; Bahatyrevich N.; Hayanga J.; Lazar
J.
Institution
(Kim) Canning Thoracic Institute, Northwestern Memorial Hospital,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
(Schumacher) Division of General Thoracic Surgery, Tufts University School
of Medicine, Boston, MA, United States
(Cooke, Godoy, Bahatyrevich) Division of General Thoracic Surgery,
University of California, Davis Health, Sacramento, CA, United States
(Servais) Division of Thoracic Surgery, Lahey Hospital and Medical Center,
UMass Chan Medical School, Burlington, MA, United States
(Rice) Division of Thoracic Surgery, MD Anderson Cancer Center, University
of Texas, Houston, TX, United States
(Sarkaria) Division of Thoracic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Yang) Division of Thoracic Surgery, The Johns Hopkins University School
of Medicine, Baltimore, MD, United States
(Abbas, Ajouz) Division of Thoracic Surgery, Brown University School of
Medicine, Providence, RI, United States
(Sanchetti) Division of Thoracic Surgery, Emory School of Medicine,
Atlanta, GA, United States
(Long) Division of Cardiothoracic Surgery, University of North Carolina at
Chapel Hill School of Medicine, Chapel Hill, NC, United States
(Kotova) Division of Thoracic Surgery, Oregon Health and Science
University School of Medicine, Portland, OR, United States
(Park) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
(D'Souza) Division of Thoracic Surgery, Ohio State University, Columbus,
OH, United States
(Shah-Jadeja) Division of Thoracic Surgery, University of Kentucky,
Lexington, KY, United States
(Hayanga) Department of Cardiothoracic and Vascular Surgery, West Virginia
University Medicine, Morgantown, WV, United States
(Lazar) Division of Thoracic Surgery, Ascension Saint Thomas Hospital,
University of Tennessee Health Science Center, Nashville, TN, United
States
Publisher
Elsevier Inc.
Abstract
Objective: With robotic technology's rapid growth and integration, an
urgent need to bridge the educational gap in thoracic surgical training
has emerged. This document, a result of consensus among a group of experts
in the practice and training of robotic surgery from The Society of
Thoracic Surgeons, aims to provide a framework for a standardized national
robotic curriculum for thoracic surgery trainees. Method(s): The
Society of Thoracic Surgeons Task Force on Robotic Thoracic Surgery and
Workforce on E-learning and Educational Innovation assembled an expert
group with the input of the Thoracic Surgery Director's Association. A
focused literature review was performed, and expert consensus statements
were developed using a modified Delphi process to address 3 major themes:
(1) program expectations, (2) components of training, and (3) assessment
and feedback. Result(s): A consensus was reached on 12
recommendations. These consensus statements reflect updated insights on
developing a standardized robotics curriculum based on the latest
literature and current educational experience, focusing on program
expectations and educational guidelines to develop an optimal training
curriculum. Conclusion(s): The expert panel provides several key
recommendations to provide a framework for developing a standardized
national robotic thoracic curriculum, which would improve resident
education and abridge any educational disparity that may exist among
programs. Copyright © 2025 The Authors

<77>
[Use Link to view the full text]
Accession Number
646855450
Title
RECOMBINANT FACTOR VIIA VS PROTHROMBIN COMPLEX CONCENTRATE FOR BLEEDING IN
CARDIOVASCULAR SURGERY.
Source
Critical Care Medicine. Conference: 54th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2025. Orlando, FL United States.
53(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jan 2025.
Author
Wang E.; Menich B.
Institution
(Wang) University of Chicago Medicine, Chicago, IL, United States
(Menich) Rush University Medical Center, Chicago, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Recombinant factor VIIa (rFVIIa) and prothrombin complex
concentrate (PCC) have been historically used to help achieve hemostasis
in patients with significant bleeding during cardiothoracic surgery. Due
to the increasing evidence favoring PCC in this patient population, the
formal factor pathway for refractory bleeding developed at Rush University
Medical Center (RUMC) removed rFVIIa and switched to PCC in April of 2020.
The purpose of this study was to assess the overall impacts to patients at
RUMC since switching factor products by evaluating factor efficacy,
patient safety, and cost. METHOD(S): This was a single-center,
retrospective, observational, cohort study of adult cardiovascular surgery
patients who received either rFVIIa or PCC identified through Epic
SlicerDicer. Outcomes of interest included the amount of blood products
transfused post factor administration, chest tube output post factor
administration, acute kidney injury, thromboembolic events, and 30-day
mortality. RESULT(S): Of the 198 cardiovascular surgery patients
screened, 67 met inclusion criteria. No differences were observed in the
amount of blood products (both total use and individual products) between
the two groups. There was also no difference in chest tube output at 2, 6,
and 24 hours; failed chest closure; mortality; or thromboembolic events.
There was a higher incidence of AKI in the rFVIIa group (43.5% vs 11.4%, p
= 0.005) with a trend towards higher rates of new post-operative
hemodialysis. Finally, there was no difference between the two groups in
rates of thromboembolic events or mortality. The cost analysis revealed
lower median costs of PCC at $2,020.00 per patient compared to rFVIIa at
$2,175.62 per patient (p = 0.001). CONCLUSION(S): Both factor
products demonstrated similar effectiveness in achieving hemostasis.
However, there was a lower incidence of AKI and reduced factor costs
associated with PCC administration. Large, randomized, controlled trials
are necessary to further compare efficacy and safety between the two
products.

<78>
Accession Number
2033963755
Title
Immunosuppressant adherence after heart transplantation: a review on
detection, prevention, and intervention strategies in a multidisciplinary.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1558082. Date of Publication: 2025.
Author
Fan Z.; Han Y.; Sun G.; Dong Z.
Institution
(Fan, Sun, Dong) Institute of Pharmaceutical Preparations, Department of
Pharmacy, Zhejiang University of Technology, Hangzhou, China
(Han) Department of Pharmacy, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Publisher
Frontiers Media SA
Abstract
Heart transplantation is an effective treatment for end-stage heart
disease, and postoperative patients' medication adherence is crucial for
transplantation outcomes and long-term survival. By reviewing a large
amount of related literature, this review summarizes the current status,
evaluation methods, influencing factors, and intervention strategies of
medication adherence after heart transplantation, emphasizes the important
role of multidisciplinary teams in improving medication adherence, and
discusses the importance of transplantation multidisciplinary teams and
holistic management. By integrating the research results from various
fields such as medicine, pharmacy, psychology, and sociology, it provides
a more comprehensive theoretical support and practical guidance for
improving medication adherence in heart transplant patients. Copyright
2025 Fan, Han, Sun and Dong.

<79>
Accession Number
2035974625
Title
The Effect of Intraoperative Dexmedetomidine on Postoperative Delirium
Sedation Agitation Score in cardiac surgery.
Source
Anesthesiology and Pain Medicine. 15(2) (no pagination), 2025. Article
Number: e156544. Date of Publication: 30 Apr 2025.
Author
Ghanbarpour M.H.; Dabbagh A.; Jahangirifard A.; Shafigh N.; Fani M.; Fani
K.
Institution
(Ghanbarpour) Department of Anesthesiology, School of Medicine, Zanjan
University of Medical Sciences, Zanjan, Iran, Islamic Republic of
(Dabbagh) Department of Anesthesiology, Anesthesiology Research Center,
School of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Jahangirifard) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shafigh) Department of Anesthesiology and Critical Care Medicine, School
of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Fani) School of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Fani) Department of Anesthesiology, School of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Brieflands
Abstract
Background: Postoperative delirium is a significant problem that
deteriorates the cognitive state of patients after cardiac surgery, which
can be a short-or long-term complication. Objective(s): This study
was conducted to evaluate the efficacy of dexmedetomidine, commenced
simultaneously with anesthesia induction and continued throughout the
surgical operation, on postoperative delirium after cardiac surgery with
cardiopulmonary bypass. Method(s): This randomized, double-blind,
case-control trial was conducted on sixty-one patients undergoing cardiac
surgery. The patients were randomly divided into dexmedetomidine (case)
and normal saline (control) groups. The primary outcome was the incidence
of delirium, as screened by the Confusion Assessment Method for the ICU
(CAM-ICU). Result(s): There was no distinction in CAM-ICU outcomes
between the two groups at 6 and 24 hours postoperatively. However, the
difference in non-positive CAM-ICU results was statistically significant
at 24 hours for +1 and-1 Richmond Agitation-Sedation Scale scores.
 Conclusion(s): Starting dexmedetomidine before cardiopulmonary bypass
did not significantly affect the delirium rate based on CAM-ICU
assessments. Further research examining larger groups is necessary to
clarify the efficacy of perioperative dexmedetomidine on postoperative
delirium. Copyright © 2025, Ghanbarpour et al.

<80>
[Use Link to view the full text]
Accession Number
646854482
Title
SAFETY OF INTRAVENOUS KETOROLAC POST-CORONARY ARTERY BYPASS GRAFT SURGERY.
Source
Critical Care Medicine. Conference: 54th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2025. Orlando, FL United States.
53(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jan 2025.
Author
Montero J.; Semanco M.
Institution
(Montero) Lakeland Regional Medical Center, United States
(Semanco) Lakeland Regional Health Medical Center, Valrico, FL, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Following a randomized controlled trial demonstrating
significant adverse CV events with the use of selective COX-2 inhibitors
in patients undergoing Coronary Artery Bypass Graft (CABG) surgery, the
FDA issued a boxed warning and contraindication for all NSAIDs use during
CABG surgery. Nevertheless, IV ketorolac continues to be used for
postoperative pain management post CABG. This study aimed to assess the
safety of IV ketorolac for patients undergoing isolated CABG surgery and
identify the characteristics of patients to whom it was administered.
 METHOD(S): This was an IRB approved, single-center, retrospective
evaluation of patients who received IV ketorolac post CABG surgery.
Subjects were identified via an adult isolated CABG surgery report from
June 1, 2018 to June 30, 2023. Patients with ESRD, HF, hypercoagulopathic
conditions, pregnant or incarcerated were excluded. The primary outcome
was to evaluate rates of cardiovascular events including MI, ischemic
strokes and thrombotic events such as DVT and PE. Secondary outcomes
included bleeding rates, ICU and hospital lengths of stay, and inpatient
mortality. Patient demographics, surgery characteristics, and ketorolac
use was also collected. Data analysis was conducted using descriptive
statistics. RESULT(S): Sixty-one patients were screened for inclusion
and 50 patients were included for analysis. The majority of patients were
males with an average age of 62 years. The median baseline CrCl was 82.7
mL/min. Nine patients had a CrCl < 60 ml/min. 94% of patients were on
concomitant aspirin and 77% of those were receiving aspirin plus another
antiplatelet or anticoagulant. All patients received ketorolac at 15mg,
with most patients prescribed PRN doses q6h, the median number of
administrations was five. Two patients experienced a DVT and no patients
developed a MI or ischemic stroke. Five patients had a Hgb decrease >
2g/dL. Of these, two patients received blood products and one had
ketorolac discontinued. Three patients died in the hospital, none of which
experienced bleeding or a DVT. CONCLUSION(S): Ketorolac administered
at doses of 15mg for post-operative pain control is safe in patients
undergoing isolated CABG. The rates of bleeding, MI, ischemic strokes,
DVT, PE, and in-patient mortality were less than those reported in
previous literature.

<81>
[Use Link to view the full text]
Accession Number
646856249
Title
EVALUATING TCD AND ALTERNATIVE NEUROMONITORING TECHNIQUES IN CARDIAC
SURGERY.
Source
Critical Care Medicine. Conference: 54th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2025. Orlando, FL United States.
53(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jan 2025.
Author
Bethina S.V.; Tallarico R.; Godasi R.; Kung C.; Kamath U.; Venna P.; Padte
S.; Kashyap R.; Sarwal A.
Institution
(Bethina) Virginia Commonwealth University Health System, East Rutherford,
NJ, United States
(Tallarico) UCSF Health, United States
(Godasi) St. Luke's Boise Medical Center, United States
(Kung) Union College, Schenectady, NY, United States
(Kamath) Baroda Medical College, Gujarat, India
(Venna) SVS medical college, Mahbubnagar, India
(Padte) Global Remote Research Scholar Program(GRRSP), United States
(Kashyap) WellSpan York Hospital, York, PA, United States
(Sarwal) Virginia Commonwealth University Health System, Midlothian, VA,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cerebral blood flow changes during Cardiopulmonary Bypass
(CPB) are associated with neurological adverse events. Noninvasive
neuromonitoring like Transcranial Doppler (TCD) Near Infrared Regional
Saturation (NIRS), Xenon clearance, and Central Retinal Artery Doppler has
been widely used perioperatively. We report findings of a systematic
review to compare TCD with other neuromonitoring modalities during cardiac
surgery with CPB. METHOD(S): Five databases (MEDLINE Ovid, PubMed,
Embase, Web of Science, Cochrane Library) were searched systematically for
English articles studies involving adult patients undergoing cardiac
surgery with CPB. Conference abstracts, books, review articles, and
systematic reviews were excluded. Primary outcomes included stroke,
seizures, and cognitive decline. Data were collected on patient
characteristics, details of surgery, and CPB. RESULT(S): 26 of 428
studies screened were reviewed for final data extraction with 14 studies
on cerebral autoregulation (9 TCD vs NIRS, and 5 compared jugular bulb
oximeter, FGD-PET, two-channel EEG, BIS, regional cerebral venous oxygen
saturation),8 on cerebral blood flow modification(2 compared Xenon
clearance and 2 Kay Schmidt method, 2 compared NIRS, and 2 CRAD with
TCD),4 on emboli monitoring(TEE, CRAD, SB 100 level and coulter counter
method) and 7 studies evaluating multimodal neuromonitoring including TCD.
Neurological outcomes were reported in 9 of 26 (35%) of the studies. The
pooled correlation coefficient of comparative TCD-based metrics with other
methods was 0.60(data from 14/26 studies). CONCLUSION(S): This
systematic review underscores the variability in neuromonitoring methods
and parameters in cardiac surgery with cardiopulmonary bypass. Multimodal
neuromonitoring may be the most effective approach for optimal
neurological monitoring during cardiac surgery and should be investigated
further.

<82>
[Use Link to view the full text]
Accession Number
646854308
Title
EVALUATION OF ANTITHROMBIN ADMINISTRATION DURING HEPARIN ANTICOAGULATION
IN CRITICALLY ILL PATIENTS.
Source
Critical Care Medicine. Conference: 54th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2025. Orlando, FL United States.
53(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jan 2025.
Author
Tran N.; Cooper M.; Naik N.; Lawlor K.
Institution
(Tran) Cottage Health, Atlanta, GA, United States
(Cooper) Medical University of South Carolina, United States
(Naik, Lawlor) Emory University Hospital, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Antithrombin has been well-validated to mitigate heparin
resistance and reduce fresh frozen plasma requirements in cardiopulmonary
bypass. However, there is a paucity of data for antithrombin's safety and
efficacy outside of cardiac surgery. The purpose of this study was to
evaluate the efficacy and safety of antithrombin in critically ill
patients receiving intravenous heparin for anticoagulation outside of the
operating room. METHOD(S): This was a multi-center, retrospective
case series of patients admitted to an intensive care unit within the
Emory Healthcare system who received heparin for therapeutic
anticoagulation and antithrombin from July 2017 to June 2023. The primary
outcome was the incidence of patients with therapeutic anti-Xa levels
within 24 hours of antithrombin administration. Secondary outcomes
included total time in therapeutic range, heparin infusion rates, and
antithrombin activity assay levels before and after administration. Safety
outcomes included incidence of new hemorrhage and thrombosis.
 RESULT(S): A total of 63 patients with similar baseline
characteristics were included in the study. Antithrombin was administered
after a median duration of 4 days of intravenous heparin therapy. Mean
antithrombin levels were 49.9% and 79.9% prior to and after administration
of antithrombin, respectively. The incidence of therapeutic anti-Xa within
24 hours occurred in 47 out of 63 patients (74.6%). Patients remained in
therapeutic range 50% of the time seven days after antithrombin
administration, with 26 patients (41.3%) experiencing at least one
supratherapeutic anti-Xa level. Forty-two patients (66.7%) were able to
maintain their current heparin infusion rate or had it decreased after
antithrombin administration. Rates of new thrombosis or hemorrhage within
seven days were 6.3% and 4.8%, respectively. CONCLUSION(S):
Antithrombin appears to be safe and effective for mitigating heparin
resistance and achieving therapeutic anticoagulation in critically ill
patients outside of the operating room. Lower body weight and BMI and
augmented renal function may be associated with decreased heparin response
to antithrombin administration. Adequately powered randomized controlled
trials are required to further evaluate the efficacy and safety of
antithrombin.

<83>
Accession Number
2033963677
Title
Optimal antithrombotic therapy after transcatheter aortic valve
replacement: a comprehensive review.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1528071. Date of Publication: 2025.
Author
Thanh N.V.T.; Hong M.-K.; Ko Y.-G.
Institution
(Thanh) Department of Cardiovascular Surgery, University of Medicine and
Pharmacy, Ho Chi Minh City, Vietnam
(Hong, Ko) Severance Cardiovascular Hospital, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
Frontiers Media SA
Abstract
Transcatheter aortic valve replacement (TAVR) has become a leading
treatment for aortic stenosis, but managing thromboembolic and bleeding
risks post-procedure remains challenging. This review examines current
evidence on antithrombotic therapy after TAVR. Subclinical leaflet
thrombosis is observed in 10%-20% of patients, though its clinical
significance remains uncertain. Clinical valve thrombosis is rare. Current
guidelines favor single antiplatelet therapy for patients without
indications for long-term anticoagulation, as dual antiplatelet therapy
increases bleeding risk without improving outcomes. For patients requiring
long-term anticoagulation, monotherapy with direct oral anticoagulants or
vitamin K antagonists is recommended to minimize bleeding. Ongoing trials
aim to clarify optimal antithrombotic regimens and strategies for
preventing subclinical leaflet thrombosis. Individualized therapy based on
patient risk profiles is likely needed to improve the efficacy and safety
of antithrombotic treatment post-TAVR. Copyright 2025 Thanh, Hong and
Ko.

<84>
[Use Link to view the full text]
Accession Number
646855185
Title
UTILITY OF THROMBOELASTOGRAPHY DURING ACUTE GASTROINTESTINAL BLEEDING IN
CRITICALLY ILL PATIENTS.
Source
Critical Care Medicine. Conference: 54th Critical Care Congress of the
Society of Critical Care Medicine, SCCM 2025. Orlando, FL United States.
53(Supplement 1) (no pagination), 2025. Date of Publication: 01 Jan 2025.
Author
Krongold M.; Cemalovic N.
Institution
(Krongold) Lincoln Medical Center, Long Island City, NY, United States
(Cemalovic) Lincoln Medical Center, Bronx, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Acute gastrointestinal bleeding (GIB) is a common
presentation in ICU patients. It can be a life threatening emergency
requiring emergent intervention if a bleeding source is not quickly
identified. Thromboelastography (TEG) is a non-conventional coagulation
test that is infrequently utilized and shows considerable research
potential in guiding bleeding management. There has been a paucity of data
regarding standardization of TEG. This study will analyze the utility of
TEG in ICU patients with acute GIB by comparing TEG guided hemostasis vs.
standard testing. METHOD(S): A retrospective analysis of 100 patients
was performed from January- December 2023. Patients were identified using
ICD-10 codes K25, K26, K27, K28 and K92.2. EPIC EMR chart review assessed
primary and secondary outcome measures. RESULT(S): The primary
outcome was blood product utilization for patients with acute GIB with TEG
vs standard coagulation testing. 5 patients without standard testing and
15 patients without blood product administration were excluded. Of the
remaining 80 patients, 40 had a TEG. Compared to standard testing, those
with TEG received a mean of 6 units (U) of RBC's vs 2.4U RBCs, 1.87U FFP
vs 0.1U FFP, 1U platelets vs 0.2U platelets, 0.67U cryoprecipitate vs 0U
cryoprecipitate. Secondary outcome measures included length of stay (TEG
median 22.1 days vs 13.6 days with standard testing), additional bleeding
interventions (12 patients had endoscopic intervention for bleeding from
each study arm), and mortality due to GIB (6 patients expired from each
study arm). CONCLUSION(S): This study demonstrated that blood product
use increased in patients who had TEG during an acute GIB in the ICU. The
data selected during a 1 year period may not be reflective of the general
population. A potential variable was massive transfusion protocol for 4
patients in the TEG group, which did not occur in the standard testing
group. There have been many promising studies using TEG to guide blood
product management during cardiac surgery, trauma, and postpartum
hemorrhage; however, no data has been presented in patients with acute
GIB. While TEG may be a rapid assessment of bleeding parameters, it should
not replace standard coagulation testing. More research is needed to
further analyze TEG during acute GIB in critically ill patients.

<85>
Accession Number
2033963078
Title
Clinical Outcomes and Prognostic Implications of TAVR in Patients With
Active Cancer: A Meta-Analysis.
Source
Clinical Cardiology. 48(3) (no pagination), 2025. Article Number: e70121.
Date of Publication: 01 Mar 2025.
Author
Saberian P.; Contreras R.; Gurram A.; Nasrollahizadeh A.; Keetha N.R.;
Nguyen A.L.; Nayak S.S.; Keivanlou M.-H.; Hashemi M.; Amini-Salehi E.;
Ameen D.
Institution
(Saberian, Hashemi) Cardiovascular Research Center, Hormozgan University
of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
(Contreras, Nayak, Ameen) Department of Internal Medicine, Yale New Heaven
Health Bridgeport Hospital 267 Grant St, Bridgeport, CT, United States
(Gurram) Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Nasrollahizadeh) Tehran Heart Center, Cardiovascular Diseases Research
Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Keetha) Ohio Kidney and Hypertension Center 7255, Middleburg Hts, OH,
United States
(Nguyen) Division of Hematology/Oncology, Department of Internal Medicine,
UC San Diego Health Moores Cancer Center, San Diego, CA, United States
(Keivanlou, Amini-Salehi) School of Medicine, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgical aortic valve replacement (SAVR) for high-risk
patients with severe aortic stenosis (AS). However, the clinical outcomes
and prognostic implications of TAVR in patients with active cancer remain
uncertain. This meta-analysis evaluates procedural success, complications,
and survival outcomes of TAVR in patients with and without active cancer.
 Method(s): A comprehensive literature search was conducted across
PubMed, Scopus, and Web of Science databases. Statistical analysis was
performed using a random-effects model. Statistical analyses were
conducted using STATA version 18.0. Result(s): The results of the
meta-analysis showed no significant difference in in-hospital mortality
between cancer and non-cancer patients (OR = 1.17; 95% CI: 0.83, 1.65; p =
0.27). Similarly, 30-day mortality did not differ between the two groups
(OR = 0.93; 95% CI: 0.72, 1.19; p = 0.49). However, 1-year mortality was
significantly higher in cancer patients (OR = 1.93; 95% CI: 1.45, 2.56; p
< 0.01). Two-year mortality was also higher in cancer patients (OR = 2.65;
95% CI: 1.79, 3.93; p < 0.01). No significant differences were observed in
major bleeding, acute kidney injury, stroke, or permanent pacemaker
implantation between the groups. Conclusion(s): While TAVR offers
comparable in-hospital and short-term survival outcomes for cancer and
non-cancer patients, long-term mortality is significantly higher in those
with active cancer. These findings suggest that TAVR is a viable option
for cancer patients with severe AS but requires careful long-term
prognostic considerations. Further studies are needed to optimize
management strategies for this complex population. Copyright ©
2025 The Author(s). Clinical Cardiology published by Wiley Periodicals
LLC.

<86>
Accession Number
646785935
Title
Red blood cell transfusion management for people undergoing cardiac
surgery for congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2025(3) (no pagination), 2025.
Article Number: CD009752. Date of Publication: 19 Mar 2025.
Author
Wilkinson K.L.; Kimber C.; Allana A.; Doree C.; Champaneria R.; Brunskill
S.J.; Murphy M.F.
Institution
(Wilkinson) Department of Paediatric and Adult Cardiothoracic Anaesthesia,
Southampton University NHS Hospital, Southampton, United Kingdom
(Kimber, Doree, Champaneria, Brunskill) Systematic Review Initiative, NHS
Blood and Transplant, Oxford, United Kingdom
(Allana) Department of Anaesthetics, University Hospital Southampton NHS
Trust, Southampton, United Kingdom
(Murphy) NHS Blood & Transplant, Oxford University Hospitals NHS
Foundation Trust; University of Oxford, Oxford, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Congenital heart disease is the most common neonatal
congenital condition. Surgery is often necessary. Patients with congenital
heart disease are potentially exposed to red cell transfusion
preoperatively, intraoperatively and postoperatively when admitted for
cardiac surgery. There are a number of risks associated with red cell
transfusion that may increase morbidity and mortality. Objective(s):
To evaluate the association of red blood cell transfusion management with
mortality and morbidity in people with congenital heart disease who are
undergoing cardiac surgery. Search Method(s): We searched multiple
bibliographic databases and trials registries, including the Cochrane
Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase
(Ovid), CINAHL (EBSCOhost), Transfusion Evidence Library,
ClinicalTrials.gov and the World Health Organization (WHO) ICTRP. The most
recent search was on 2 January 2024, with no limitation by language of
publication. Selection Criteria: We included randomised controlled
trials (RCTs) comparing red blood cell transfusion interventions in
patients undergoing cardiac surgery for congenital heart disease.
Participants of any age (neonates, paediatrics and adults) and with any
type of congenital heart disease (cyanotic or acyanotic) were eligible for
inclusion. No comorbidities were excluded. Data Collection and
Analysis: Two of five (AA, CK, KW, SB, SF) review authors independently
extracted data and assessed the risk of bias in the trials. We contacted
study authors for additional information. Two review authors (CK, KW) used
GRADE methodology to assess evidence certainty for critical outcomes and
comparisons. Main Result(s): We identified 19 relevant trials. The
trials had 1606 participants, all of whom were neonates or children. No
trials were conducted in the preoperative period or with adults. The
trials compared different types of red blood cell transfusions. No trial
compared red blood cell transfusion versus no red blood cell transfusion.
None of the trials was at low risk of bias overall. Eight trials had a
high risk of bias in at least one domain, most commonly, blinding of
participants and personnel. For our critical outcomes, we judged the
certainty of the evidence based on GRADE criteria to be low or very low.
Five trials (497 participants) compared a restrictive versus a liberal
transfusion-trigger. It is very uncertain whether a restrictive
transfusion-trigger has an effect on all-cause mortality in the short-term
(0 to 30 days post-surgery) (risk ratio (RR) 1.12, 95% confidence interval
(CI) 0.42 to 3.00; 3 RCTs, 347 participants; very low certainty evidence)
or long term (31 days to two years post-surgery) (RR 0.33, 95% CI 0.01 to
7.87; 1 RCT, 60 participants; very low certainty evidence). The evidence
is also very uncertain on the incidence of severe adverse cardiac events
(RR 1.00, 95% CI 0.73 to 1.37; 2 RCTs, 232 participants) and infection (RR
0.81, 95% CI 0.47 to 1.39; 2 RCTs, 232 participants) (both very low
certainty evidence). A restrictive transfusion-trigger may have little to
no effect on the duration of mechanical ventilation (mean difference (MD)
-1.65, 95% CI -3.51 to 0.2; 2 RCTs, 168 participants; low-certainty
evidence) or of ICU stay (MD 0.15, 95% CI -0.72 to 1.01; 3 RCTs, 228
participants, low-certainty evidence). Five trials (231 participants)
compared washed red blood cells in CPB prime versus unwashed red blood
cells in CPB prime. Washing red blood cells in CPB prime may have little
to no effect on all-cause mortality in the short term (0 to 30 days
post-surgery) (RR 0.25, 95% CI 0.03 to 2.18; 2 RCTs, 144 participants) or
long term (31 days to 2 years post-surgery) (RR 0.50, 95% CI 0.05 to 5.38;
1 RCT, 128 participants) (both low-certainty evidence). The evidence is
very uncertain about the effect of washed CPB prime on severe cardiac
adverse events (RR 0.88, 95% CI 0.47 to 1.64), infection (RR 1.00, 95% CI
0.50 to 1.99) and duration of ICU stay (MD -0.3, 95% CI -4.32 to 3.72) (1
RCT, 128 participants; very low certainty evidence). Two trials (76
participants) compared crystalloid (bloodless) CPB prime versus
red-blood-cell-containing CPB prime. It is very uncertain whether
bloodless prime has an effect on the duration of mechanical ventilation
(median 8.0 hours, interquartile range (IQR) 6.8 to 9.0 hours versus
median 7.0 hours, IQR 6.0 to 8.0 hours; 1 RCT, 40 participants) or
duration of ICU stay (median 23.0 hours, IQR 21.8 to 41.5 hours versus
median 23.5 hours, IQR 21.0 to 29.0 hours; 1 RCT, 40 participants) (both
very low certainty evidence). Two trials (160 participants) compared
ultrafiltration of CPB prime versus no ultrafiltration. It is very
uncertain whether ultrafiltration of CPB prime has an effect on all-cause
mortality in the short term (0 to 30 days post-surgery) (RR not estimable;
1 RCT, 50 participants; very low certainty evidence). Ultrafiltration may
reduce the duration of mechanical ventilation (MD -16.00, 95% CI -25.00 to
-7.00) and the duration of ICU stay (MD -0.6, 95% CI -0.84 to -0.36) (1
RCT, 50 participants; low-certainty evidence). One trial (59 participants)
compared retrograde autologous CPB prime versus standard CPB prime. It is
very uncertain whether retrograde autologous CPB prime has an effect on
the duration of mechanical ventilation (MD 0.02, 95% CI -0.03 to 0.07) or
duration of ICU stay (MD 0, 95% CI -0.01 to 0.01) (1 RCT, 59 participants;
very low certainty evidence). One trial (178 participants) compared
'fresh' (not near expiry date) versus 'old' (near expiry date) red blood
cell transfusion but did not report on our outcomes. Authors' conclusions:
No randomised controlled trial compared red blood cell transfusion against
no red blood cell transfusion in people with congential heart disease
undergoing cardiac surgery. There are only small, heterogeneous trials in
children that compare different forms of red blood cell transfusion, and
there are no trials at all in adults. There is therefore insufficient
evidence to accurately assess the association of red blood cell
transfusion with the morbidity and mortality of patients with congenital
heart disease undergoing cardiac surgery. It is possible that trial
outcomes are affected by the presence or absence of cyanosis, so this
should be considered in future trial design. Further adequately powered,
high-quality trials in both children and adults are
required. Copyright © 2025 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<87>
Accession Number
2038009188
Title
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients
With Acute Coronary Syndromes: A Report of the American College of
Cardiology/American Heart Association Joint Committee on Clinical Practice
Guidelines.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 2025.
Author
Rao S.V.; O'Donoghue M.L.; Ruel M.; Rab T.; Tamis-Holland J.E.; Alexander
J.H.; Baber U.; Baker H.; Cohen M.G.; Cruz-Ruiz M.; Davis L.L.; de Lemos
J.A.; DeWald T.A.; Elgendy I.Y.; Feldman D.N.; Goyal A.; Isiadinso I.;
Menon V.; Morrow D.A.; Mukherjee D.; Platz E.; Promes S.B.; Sandner S.;
Sandoval Y.; Schunder R.; Shah B.; Stopyra J.P.; Talbot A.W.; Taub P.R.;
Williams M.S.; Jneid H.; Beavers C.J.; Beckie T.; Blankenship J.; Diercks
D.; Lo B.; Louis C.; Merchant F.M.; Nazir N.T.; So D.; Tomey M.; Welt F.
Publisher
Elsevier Inc.
Abstract
Aim: The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of
Patients With Acute Coronary Syndromes" incorporates new evidence since
the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial
Infarction" and the corresponding "2014 AHA/ACC Guideline for the
Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and
the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary
Intervention for Patients With ST-Elevation Myocardial Infarction." The
"2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients
With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for
Coronary Artery Revascularization" retire and replace, respectively, the
"2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet
Therapy in Patients With Coronary Artery Disease." Methods: A
comprehensive literature search was conducted from July 2023 to April
2024. Clinical studies, systematic reviews and meta-analyses, and other
evidence conducted on human participants were identified that were
published in English from MEDLINE (through PubMed), EMBASE, the Cochrane
Library, Agency for Healthcare Research and Quality, and other selected
databases relevant to this guideline. Structure: Many recommendations from
previously published guidelines have been updated with new evidence, and
new recommendations have been created when supported by published
data. Copyright © 2025 American College of Cardiology Foundation,
and the American Heart Association, Inc.

<88>
Accession Number
2038026250
Title
Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic
Muscle Plane Block Versus Erector Spinae Plane Block in Pediatric Patients
Undergoing Corrective Cardiac Surgeries: A Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Madkour M.A.F.A.; Abueldahab E.I.B.; Elela A.H.A.; Youssef M.F.; Gado A.A.
Institution
(Madkour, Abueldahab, Elela, Youssef, Gado) Department of Anesthesiology
and Intensive Care Medicine, Cairo University, Cairo, Egypt, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: Transversus thoracic plane block (TTPB) and erector spinae
plane block (ESPB) are gaining popularity in cardiac surgeries to avoid
excessive narcotic use and achieve fast-track extubation This study was
performed to compare the analgesic efficacy of TTPB to that of ESPB in
pediatric patients undergoing cardiac surgeries. The study was conducted
in a university pediatric hospital (ClinicalTrials.gov NCT05559684).
 Design(s): Single-center prospective randomized controlled study.
 Setting(s): Tertiary referring pediatric university hospital.
 Participant(s): Sixty pediatric patients undergoing corrective
cardiac surgeries during the period from November 2022 to August 2023.
 Intervention(s): Randomization was done using a sealed envelope
technique that contained 20 labels of (control), 20 labels of (ESPB), and
another 20 labels of (TTPB). Patients in the control group (n = 20) were
given fentanyl infusion at a dosage of 0.5 microg/kg/h throughout the
whole operation, in addition to 1 microg/kg during skin incision,
sternotomy, and aortic cannulation. Patients in the ESPB group (n = 20)
were given fentanyl infusion at a dose of 0.5 microg/kg/h all through the
whole operation plus ultrasound-guided ESPB done bilaterally by injecting
0.4 mL/kg (1:1 solution of Bupivacaine25 % and lidocaine 1%) on each side.
Patients in the TTPB group were given fentanyl infusion at a dose of 0.5
microg/kg/h throughout the operation plus ultrasound-guided TTPB done
bilaterally by injecting 0.4 mL/kg on each side (1:1 solution of
bupivacaine 0.25 % and lidocaine 1%). Measurements and Main Results:
Primary outcome was the total intraoperative fentanyl consumption;
secondary outcomes included hemodynamics and time to first analgesic
request (which is the elapsed time between giving the block and the
patient's FLACC score >=4), postoperative fentanyl consumption, extubation
time, and adverse events. Intraoperative fentanyl consumption was
significantly decreased in the TTPB group (3.4 +/- 2.9) compared with the
control group (6.7 +/- 4.2), mean difference = 3.35, 95% CI (0.84, 5.86),
p = 0.006. It was comparable between the ESPB group and the control group.
Also, the TTPB and ESPB groups were comparable regarding the primary
outcome, mean difference 1.2, 95% CI (-1.31, 3.71), p = 0.486. Total
fentanyl consumption in the intensive care unit was significantly
decreased in the TTPB group (1.1 +/- 1.54) than in the control group (4.6
+/- 4.25), mean difference 3.55, 95% CI (1.5, 5.6) with p = 0.001. Other
pairwise comparisons were comparable between the groups. The time to first
rescue analgesia was significantly longer in TTPB group (5.15 +/- 4.21)
compared to the control group (1.95 +/- 3.5), mean difference -3.2, 95% CI
(-5.68, -0.72), p = 0.04. Patients in ESPB needed first rescue analgesia
slightly earlier (4.9 +/- 4.4) than patients in TTPB group, mean
difference -0.25, 95% CI (-3.01, 2.51), p = 0.979 and non-significantly
longer than control group, mean difference -2.95, 95% CI (-5.5, -0.4), p =
0.064. Fast-track extubation was significantly increased in patients who
received TTPB (85%) than in those who received ESPB (50%), relative risk =
0.58, 95% CI (0.36, 0.94), p = 0.018 and those in the control group (30%),
relative risk = 0.35, 95% CI (0.17, 0.706), p < 0.001). Also,
ultrafast-track extubation was significantly increased in patients who
received TTPB (60%) than those in the control group 15%), relative risk =
0.25, 95% CI (0.08, 0.75), p = 0.007. Conclusion(s): Both TTPB and
ESPB reduced nociception and appeared comparable in providing
perioperative analgesia as they reduced pain scores and intraoperative and
postoperative narcotic dosage, which facilitated early extubation. TTPB
was superior to ESPB regarding fast-track extubation and provided a double
incidence for the ultrafast-track extubation, but this was related to the
hyper incidence of adverse events not thought related to
analgesia. Copyright © 2025 Elsevier Inc.

<89>
Accession Number
2037780968
Title
A Comparative Study of Preoperative Oral Pregabalin and Oral Clonidine in
Attenuation of Hemodynamic Stress Responses During Laryngoscopy and
Intubation.
Source
European Journal of Cardiovascular Medicine. 15(3) (pp 152-157), 2025.
Date of Publication: 01 Mar 2025.
Author
Thengumgal R.G.; Kanaki L.; Thayil P.
Institution
(Thengumgal, Kanaki, Thayil) SreeMookambika Institute of Medical
Institute, Kulashekarum, Tamilnadu, Nagercoil, India
Publisher
Healthcare Bulletin
Abstract
Background: Direct laryngoscopy and tracheal intubation can result in
severe effects such as tachycardia, hypertension, cardiac ischaemia, and
cerebral haemorrhage.Clonidine is an alpha-2 adrenergic receptor agonist
that exerts a central sympatholytic action. Clonidine premedication
mitigates the haemodynamic stress reactions associated with direct
laryngoscopy and tracheal intubation. Pregabalin, a gabapentinoid, seems
to exert an inhibitory effect on neuronal excitability. Aim(s): The
purpose of this study was to compare the effect of oral pregabalin 150 mg
& oral clonidine 0.2 mg given 90 minutes before surgery, on haemodynamic
stress response resulting from laryngoscopy and endotracheal intubation.
 Material(s) and Method(s):The present study was a
prospectiveobservational randomizedcomparativestudy performed conducted
for a period of one year in a tertiary care centre. The study comprised 60
patients classified as ASA I and II, scheduled for diverse elective
operations under general anaesthesia. The participants were randomised
into two groups, A and B, each consisting of 30 patients: the Pregabalin
group (Group A) and the Clonidine group (Group B). Group A received
premedication with 150 mg of capsaicin pregabalin, whereas Group B was
administered 0.2 mg of clonidine. Subsequently, the haemodynamic
parameters including heart rate(HR), systolic blood pressure(SBP),
diastolic blood pressure(DBP) and mean arterial pressure(MAP) were
compared between the two groups during induction, laryngoscopy, and
intubation.Result wasanalysed using SPSS 20.0 version and the association
was tested using t test. A p value less than 0.05 was considered
statistically significant. Result(s): Administration of oral
clonidine 0.2 mg 90 minutes before to surgery mitigated sympathetic
stimulation and catecholamine responses during laryngoscopy and tracheal
intubation. Our investigation revealed that the increase in HR, SBP, DBP,
and MAP after laryngoscopy and endotracheal intubation was considerably
lower in the Clonidine group compared to the Pregabalin group. The
Clonidine group exhibited superior haemodynamic stability throughout
surgery compared to the pregabalin group. Conclusion(s): When
compared to oral pregabalin, oral clonidine substantially reduces the
sympathetic responses that occur during laryngoscopy and endotracheal
intubation, while simultaneously preserving the stability of the
cardiovascular system during surgery. Copyright © 2025 Healthcare
Bulletin. All rights reserved.

<90>
Accession Number
2033683281
Title
Transcatheter Aortic Valve Replacement in Patients With Quadricuspid
Aortic Valve: A Case Series and Systematic Review.
Source
Cardiology Research and Practice. 2025(1) (no pagination), 2025. Article
Number: 7815279. Date of Publication: 2025.
Author
Sheng W.; Zhou D.; Dai H.; Zheng R.; Aihemaiti A.; Liu X.
Institution
(Sheng, Zhou, Dai, Zheng, Aihemaiti, Liu) Department of Cardiology, Second
Affiliated Hospital Zhejiang University School of Medicine, Hangzhou,
China
(Sheng, Zhou, Dai, Zheng, Aihemaiti, Liu) State Key Laboratory of
Transvascular Implantation Devices, Hangzhou, China
(Liu) Binjiang Institute of Zhejiang University, Zhejiang, Hangzhou, China
Publisher
John Wiley and Sons Ltd
Abstract
Background: Quadricuspid aortic valve (QAV) is a rare congenital cardiac
anomaly associated with symptomatic aortic regurgitation (AR) or aortic
stenosis (AS). Transcatheter aortic valve replacement (TAVR) for QAV
remains uncertain. Method(s): We retrospectively reviewed
prospectively collected data from patients with QAV undergoing TAVR in our
center and conducted a systematic literature review for further
investigation. Result(s): Five patients with QAV were treated with
TAVR between April 2016 and December 2023. The median age was 67 years
(range: 59-86), and the median Society of Thoracic Surgeons score
(STS-score) was 3.750% (range: 0.916%-11.823%). Procedural success was
achieved in all cases. The median follow-up period was 3 years (from 30
days to 7 years). Four of the patients exhibited no serious complications,
while one experienced delayed coronary obstruction. Our systematic review
included 31 cases from 21 publications and our center. The median age of
patients was 79 years (range: 57-90), including 18 males. The median STS
score was 7.835%. Severe AS was present in 64.5% of the patients and
severe AR in 41.9%. The most common QAV subtype was type B (48.4%).
Technical success was achieved in 100% of the cases, with two cases
reporting coronary obstruction and one required a permanent pacemaker
implantation. During a median follow-up period of 1 year (from 30 days to
7 years), one case experienced serious complications of delayed coronary
obstruction. Conclusion(s): The TAVR may be an alternative treatment
for patients with QAV, preliminarily demonstrating feasible early and
long-term results from current experience. However, extra precautions
regarding coronary artery obstruction complications are necessary due to
the rarity and anatomical complexity of QAV. Copyright © 2025
Wenjing Sheng et al. Cardiology Research and Practice published by John
Wiley & Sons Ltd.

<91>
Accession Number
646830686
Title
Age and Sex-Related Outcomes in CMR Versus CT-Guided TAVR: A Secondary
Analysis of a Randomized Clinical Trial.
Source
Journal of cardiovascular magnetic resonance : official journal of the
Society for Cardiovascular Magnetic Resonance. (pp 101882), 2025. Date of
Publication: 13 Mar 2025.
Author
Lechner I.; Oberhollenzer F.; Tiller C.; Holzknecht M.; Kaser A.; Binder
R.K.; Gollmann-Tepekoylu C.; Klug G.; Mayr A.; Bauer A.; Metzler B.;
Reindl M.; Reinstadler S.J.
Institution
(Lechner, Oberhollenzer, Tiller, Holzknecht, Kaser, Bauer, Metzler,
Reindl, Reinstadler) University Clinic of Internal Medicine III,
Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse
35, Innsbruck, Austria
(Binder) Department of Cardiology and Intensive Care, University Teaching
Hospital Klinikum Wels-Grieskirchen, Wels, Austria
(Gollmann-Tepekoylu) University Clinic of Cardiac Surgery, Medical
University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
(Klug) Department of Internal Medicine, County Hospital Bruck an der Mur,
Bruck an der Mur, Austria
(Mayr) University Clinic of Radiology, Medical University of Innsbruck,
Anichstrasse 35, Innsbruck, Austria
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the preferred
treatment for older patients with severe aortic stenosis with outcomes
influenced by age and sex. Computed tomography (CT) is the reference
imaging modality for TAVR planning, while cardiac magnetic resonance (CMR)
is an emerging alternative for this indication. The aim of this study was
to evaluate the impact of age and sex on implantation success in patients
undergoing CT- or CMR-guided TAVR. METHOD(S): This was a secondary
analysis of the randomized TAVR-CMR trial comparing TAVR planning by CT or
CMR (NCT03831087). Patients were categorized according to the median age
(82 years) and sex. Implantation success, defined using the Valve Academic
Research Consortium-2 definition (absence of procedural mortality, correct
positioning of a single prosthetic valve, and proper prosthetic valve
performance), was compared at hospital discharge between age groups and
sex for each imaging strategy. All-cause mortality at 6 months was
compared between imaging strategies across age groups and sex.
 RESULT(S): A total of 267 patients (median age 82 [IQR 80-85] years,
50% female) underwent TAVR at two heart centers in Austria between
September 2017 and December 2022. Implantation success did not differ
significantly between imaging strategies across age and sex subgroups. For
patients <=82 years, success rates were 92.1% (CT) vs. 94.7% (CMR)
(p=0.524), and for those >82 years, 89.4% (CT) vs. 91.9% (CMR) (p=0.622).
Among female patients, success rates were 84.7% (CT) vs. 93.2% (CMR)
(p=0.113), and among male patients, 95.7% (CT) vs. 93.8% (CMR) (p=0.610).
All-cause mortality at 6 months did not differ significantly between
imaging strategies across age and sex subgroups. Mortality rates for
patients <=82 and >82 years were 4.8% vs. 5.3% (p=0.839) and 9.1% vs.
12.9% (p=0.490) for CT and CMR, respectively. Similarly, female and male
patients had comparable mortality rates (10.2% vs. 8.1%, p=0.680; 4.3% vs.
9.4%, p=0.240). CONCLUSION(S): In this secondary analysis of the
TAVR-CMR trial, CMR-guided TAVR was associated with similar outcomes
compared with CT-guided TAVR irrespective of age and sex. Copyright
© 2025. Published by Elsevier Inc.

<92>
Accession Number
646831226
Title
Stroke in Heart Failure With Reduced Ejection Fraction: Systematic Review
and Meta-Analysis of Randomized Trials.
Source
JACC. Heart failure. (no pagination), 2025. Date of Publication: 12 Mar
2025.
Author
Gallone G.; Savoca F.; Miccoli D.; Bohm M.; De Ferrari G.M.; Gottlieb
S.S.; Lancellotti P.; Lindenfeld J.; Saldarriaga C.; Samad Z.; Teerlink
J.R.; Savarese G.; Ammirati E.
Institution
(Gallone, Savoca, Miccoli, De Ferrari) Division of Cardiology,
Cardiovascular and Thoracic Department, Citta della Salute e della
Scienza, Turin, Italy; Department of Medical Sciences, University of
Turin, Italy
(Bohm) Clinic III for Internal Medicine (Cardiology, Angiology, Intensive
Care Medicine) Saarland University, Homburg/Saar, Germany
(Gottlieb) Division of Cardiovascular Medicine, University of Maryland
School of Medicine and Baltimore; Veterans Administration Medical Center,
Baltimore, Maryland, USA
(Lancellotti) University of Liege Hospital, Department of Cardiology, CHU
SartTilman, Liege, Belgium
(Lindenfeld) Division of Cardiovascular Medicine, Vanderbilt University
Medical Center, Nashville, TN, United States
(Saldarriaga) University of Antioquia, Medellin, Colombia
(Samad) Aga Khan University, Karachi, Pakistan
(Teerlink) Section of Cardiology, San Francisco Veterans Affairs Medical
Center, School of Medicine, University of California San Francisco, San
Francisco, CA, United States
(Savarese) Department of Clinical Science, Sodersjukhuset; Karolinska
Institutet, Stockholm, Sweden
(Ammirati) De Gasperis Cardio Center, Transplant Center, Niguarda
Hospital, Milano, Italy; Department of Health Sciences, University of
Milano-Bicocca, Monza, Italy
Abstract
BACKGROUND: Patients with heart failure with reduced ejection fraction
(HFrEF) have a heightened stroke risk. However, stroke as an endpoint in
heart failure trials remains under-reported. OBJECTIVE(S): The
authors sought to define the incidence, characteristics, predictors,
modifier treatments, and prognostic impact of stroke in patients with
HFrEF who were enrolled in randomized controlled trials (RCTs).
 METHOD(S): The authors systematically reviewed MEDLINE for RCTs of
pharmacologic and nonpharmacologic treatments in HFrEF. The annualized
stroke incidence was the primary outcome. Subgroup analyses and
meta-regressions were performed to determine the baseline modulating
characteristics and to assess the association of stroke with other
clinical outcomes. RESULT(S): Of 7,104 records, 188 RCTs fulfilled
inclusion criteria for the systematic review. Of these, 158 studies
(84.0%) did not report stroke outcomes and were excluded from the
meta-analysis, leading to a final cohort of 30 studies, with 61 arms and
75,327 patients. Stroke incidence was 1.1% (95% CI: 0.9%-1.3%; I2: 74%)
with high heterogeneity across trials. Higher NYHA functional class (P <
0.001), lower systolic blood pressure (P < 0.001), diuretic use (P =
0.001), and diabetes (P < 0.001) were associated with stroke. No
association of renin-angiotensin-aldosterone inhibitors, beta-blockers,
mineralocorticoid receptor antagonists, and transcatheter mitral valve
replacement with stroke was observed. Stroke was associated with higher
risk of all-cause and cardiovascular mortality, heart failure
hospitalization and acute coronary syndromes (P < 0.001 for all).
 CONCLUSION(S): Stroke was reported in a vast minority of HFrEF RCTs
with heterogeneous definitions and no reference to underlying mechanisms.
Despite under-reporting, stroke incidence is non-negligible. Stroke is
associated with HFrEF-specific characteristics and outcomes, whereas it is
not impacted by current HFrEF treatments. There is a need for dedicated
research into preventive strategies and effective treatments to address
this debilitating and deadly comorbidity. (Stroke Events in Heart Failure
With Reduced Ejection Fraction-A Systematic Review and Meta-Analysis of
Pharmacologic Randomized Trial; CRD42023418422). Copyright © 2025
American College of Cardiology Foundation. Published by Elsevier Inc. All
rights reserved.

<93>
Accession Number
2038026244
Title
Effect of Dexmedetomidine on Cerebrovascular Carbon Dioxide Reactivity
During Pediatric Cardiac Surgery With Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Sun L.; Zhang K.; Wang H.; Ji W.; Huang Y.; Bai J.; Zheng J.
Institution
(Sun, Zhang, Ji, Huang, Bai, Zheng) Department of Anesthesiology, Shanghai
Children's Medical Center, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
(Sun, Zhang, Ji, Huang, Bai, Zheng) Department of Anesthesiology, National
Children's Medical Center, Shanghai, China
(Wang) GE Healthcare, Shanghai, China
Publisher
W.B. Saunders
Abstract
Objective: To assess the effects of dexmedetomidine (DEX) on
cerebrovascular autoregulation in children with congenital heart disease
(CHD) using transcranial color-coded duplex sonography (TCCD).
 Design(s): Randomized controlled trial. Setting(s): This
single-center study was conducted at a tertiary care center in Shanghai,
China. Patient(s): Fifty-nine children aged 0 to 6 years with CHD who
underwent cardiac surgery with cardiopulmonary bypass were enrolled.
 Intervention(s): Children were randomly assigned to receive either
DEX (DEX group) or normal saline (control group) for 10 minutes following
anesthetic induction. Cerebrovascular carbon dioxide reactivity
(CVR-CO<inf>2</inf>) was assessed by adjustment of lung ventilation.
 Measurements and Main Results: Patients underwent TCCD before and
after surgery. CVR-CO<inf>2</inf>, resistance index (RI), pulsatility
index (PI), mean blood flow velocity (V<inf>mean</inf>) of the right
middle cerebral artery, and regional cerebral oxygen saturation
(ScrO<inf>2</inf>) of the right frontal lobe were measured and analyzed at
three distinct time points, resulting in six measurements. Hemodynamic
parameters, including heart rate (HR) and mean arterial pressure (MAP),
were recorded at each time point. The parameters CVR-CO<inf>2</inf> (p =
0.402), PI (p = 0.203), RI (p = 0.290), V<inf>mean</inf> (p = 0.290),
ScrO<inf>2</inf> (p = 0.426), HR (p = 0.522), and MAP (p = 0.236) were
comparable between the two groups. In the control group, PI, RI, and HR
significantly differed before and after surgery. In the DEX group, RI,
V<inf>mean</inf>, ScrO<inf>2,</inf> and HR significantly differed before
and after surgery. Conclusion(s): A low loading dose of DEX did not
compromise CVR-CO<inf>2</inf> in children with CHD undergoing cardiac
surgery with cardiopulmonary bypass. Copyright © 2025 Elsevier
Inc.

<94>
Accession Number
2033951823
Title
Clinical Outcomes of PCI in Hospitals With or Without Surgical Backup: A
Meta-analysis.
Source
Angiology. (no pagination), 2025. Date of Publication: 2025.
Author
Haddad T.A.; Toubasi A.A.; Fahmawi A.; Zaid A.
Institution
(Haddad, Toubasi, Zaid) Faculty of Medicine, University of Jordan, Amman,
Jordan
(Fahmawi) Faculty of Medicine, Jordan University of Science and
Technology, Irbid, Jordan
Publisher
SAGE Publications Inc.
Abstract
Percutaneous coronary interventions (PCIs) have seen a steady rise. Recent
guidelines have established that PCIs conducted at non-surgical on-site
(NSOS) facilities have low complication rates and outcomes comparable to
surgical on-site (SOS) centers. However, differing perspectives in the
growing literature continue to sustain controversy. A thorough literature
review was performed across four databases, including PubMed, Cochrane
Library, Scopus, and Web of Science, to identify studies comparing
outcomes between hospitals. The primary endpoints were: 30-day mortality,
myocardial infarction (MI), cerebral vascular accident (CVA), emergency
coronary artery bypass surgery (eCABG), rePCI, and target vessel
revascularization (TVR). The final search yielded 22 studies, including a
total of 2,181,897 patients. The majority of patients (71.9%) underwent
PCI in SOS hospitals. There was a significant association of increased
eCABG (OR = 1.99; 95% CI: 1.08-3.67) and rePCI (OR = 1.62; 95% CI:
1.37-1.91) rates in SOS hospitals. However, 30-day mortality (OR = 0.91;
95% CI: 0.53-1.54), MI (OR = 1.08; 95% CI: 0.91-1.28), CVA (OR = 1.13; 95%
CI: 0.69-1.86), and TVR (OR = 1.06; 95% CI: 0.92-1.21) showed no
significant difference between hospitals. Subgroup analyses among clinical
trials and ST-segment elevation myocardial infarction (STEMI) patients
found no significant associations. Conclusively, this meta-analysis
provides updated insight into the impact of SOS on PCI outcomes, having no
difference except for eCABG and rePCI rates. Copyright © The
Author(s) 2025.

<95>
Accession Number
2033928252
Title
Antithrombotic strategy following valve-in-valve transcatheter aortic
valve replacement. A German Statutory Health Claims data analysis.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Heyne S.; Hohmann C.; Macherey-Meyer S.; Meertens M.M.; Kuhn E.; Marschall
U.; Wienemann H.; Mauri V.; Adam M.; Baldus S.; Lee S.
Institution
(Heyne, Hohmann, Macherey-Meyer, Meertens, Wienemann, Mauri, Adam, Baldus,
Lee) Clinic III for Internal Medicine, Faculty of Medicine, University
Hospital Cologne, University of Cologne, Kerpener Str. 62, Cologne,
Germany
(Kuhn) Department of Cardiac Surgery, Faculty of Medicine, University
Hospital Cologne, University of Cologne, Cologne, Germany
(Marschall) BARMER, Wuppertal, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR)
procedures are increasingly used. Specific recommendations on
antithrombotic strategies following ViV-TAVR are lacking. We aimed to
assess the efficacy of different antithrombotic strategies following
ViV-TAVR. Methods and Results: We performed a retrospective analysis
of German Statutory Health Claims data following ViV-TAVR stratified by
antithrombotic strategies according to prescription within 90 days.
Antithrombotic regimens included antiplatelet therapy (APT), direct oral
anticoagulants (DOACs) or vitamin K antagonists (VKAs). The composite
endpoint was all-cause mortality, stroke and/or systemic embolism (SSE)
and mechanical complication of heart valve prosthesis at 12 months. Cox
proportional hazard regression models were used to compare outcomes. In
total, 908 patients between 2005 and 2022 were identified. Of these, 286
received DOACs, 99 received VKAs, 351 received APT exclusively and 172 had
no prescription. The incidence of the composite endpoint was 20.8% in the
APT group, 20.3% in the DOAC group and 25.3% in the VKA group which was
not statistically significantly different. The rate of SSE in the
acetylsalicylic acid (ASA) mono group was higher compared to the dual
antiplatelet therapy (DAPT) group (27.3% vs. 12.4%, univariable HR 0.42,
95% CI [0.19, 0.95], p = 0.03). Conclusion(s): In this analysis of
German Health Claims data, DOACs seemed to be a safe alternative to VKAs
and APT. ASA monotherapy was associated with higher rates of SSE compared
to DAPT. Given the high risk of bias of this retrospective analysis and
the growing use of valve-in-valve procedures, randomized controlled trials
are needed to confirm these findings. Copyright © The Author(s)
2025.

<96>
Accession Number
2033959488
Title
Prognostic value of baseline RV dysfunction using TAPSE and TAPSE to PASP
ratio in patients undergoing mitra-clip: a systematic review and
meta-analysis.
Source
International Journal of Cardiovascular Imaging. (no pagination), 2025.
Date of Publication: 2025.
Author
Rmilah A.A.; Ghaly R.; Pfeiffer C.; Saeed M.H.; Khojah A.; Jaber S.;
Alzu'Bi H.; Tabash A.; Chib A.; Darwish R.; Prokop L.; Elajami T.K.;
Arsanjani R.
Institution
(Rmilah) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Rmilah, Pfeiffer, Tabash, Chib) Department of Internal Medicine, Magnolia
Regional Health Center, Corinth, MS, United States
(Ghaly) Department of Internal Medicine, University of Missouri-Kansas
City, Kansas City, MO, United States
(Saeed, Khojah, Jaber) Department of Internal Medicine, Al-Habib Hospital,
Riyadh, Saudi Arabia
(Alzu'Bi, Elajami) Department of Cardiovascular Medicine, Mount Sinai
Medical Center, Miami, FL, United States
(Darwish) Department of Internal Medicine, Al Salam Specialized Hospital,
Cairo, Egypt
(Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Arsanjani) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix,
AZ, United States
Publisher
Springer Science and Business Media B.V.
Abstract
Mitra-clip is an established therapy for high-risk surgical candidates who
are refractory to optimal medical treatment. Reports have shown that right
ventricular dysfunction (RVD) has been associated with increased morbidity
and mortality in heart failure (HF) patients. Our goal of this systematic
review/meta-analysis is to assess the prognosis of baseline RV function
markers including TAPSE (tricuspid annular plane systolic excursion) and
TAPSE:PASP (pulmonary artery systolic pressure) ratio after Mitra-clip.
MEDLINE and EMBASE were searched from inception to December 20th, 2023,
for studies discussing the prognostic outcome of pre-existing RVD in
Mitra-clip patients. Definition of RV dysfunction was reported as an
abnormal TAPSE (< 15-16 mm) or RV-PA (right ventricle-pulmonary artery)
uncoupling expressed as abnormal TAPSE:PASP ratio (< 0.30-0.37 mm/mmHg).
We included all original research studies (excluding reviews,
meta-analysis, commentaries/editorials, and animal studies) that assessed
the prognostic utility of TAPSE and TAPSE:PASP ratio in patients with MR
undergoing Mitra-clip. Reviewers independently screened the studies and
extracted the pertinent data. Odds ratios (OR) were calculated using a
random-effects model. Twelve reports enrolling 3526 patients were
included. Mean age ranged from 70 to 81 years and 61.1% patients were
male. Primary, secondary, and mixed MR were reported in 36.9%, 61.4%, and
1.8% respectively. Mean LVEF ranged from 27% to 57.1% and 93.7% of
patients had MR grade >= 3 + (at least moderate to severe MR). Patients
with RVD had a reduction in the overall survival (OS) after Mitra-clip at
6 months (81.8% vs 90.5%, OR = 0.45 [0.35-0.58]; P < 0.001), 1-year (71.1%
vs 85.7%, OR = 0.40 [0.33-0.48]; P < 0.001), and 2-year (60.3% vs 76.8%,
OR = 0.37 [0.31-0.45]; P < 0.001) compared to normal RV group. Likewise,
HF re-admission free survival was minimized among RVD patients at 6 months
(76.8% vs 88.1%, OR = 0.47 [0.34-0.65]; P < 0.001), 1-year (64.5% vs
81.3%, OR = 0.44 [0.35-0.55]; P < 0.001), and 2-year (58.2% vs 78.9%, OR =
0.41 [0.30-0.56]; P < 0.001) compared to normal RV group. Decreased TAPSE:
PASP was associated with lower OS at 6-month (OR = 0.46 [0.31-0.68]; P <
0.001), 1-year (OR = 0.37 [0.29-0.47]; P < 0.001), and 2-year (OR = 0.35
[0.25-0.47]; P < 0.001) and reduced HF re-admission free survival at
6-month ((OR = 0.44 [0.31-0.62]; P < 0.001), 1-year (OR = 0.41[0.31-0.54];
P < 0.001), and 2-year (OR = 0.41 [0.31-0.58]; P < 0.001) after
Mitra-clip. Furthermore, decreased TAPSE negatively impacted the OS and HF
re-admission at 6-month (OR = 0.40 [0.21-0.77]; P = 0.006), and 1-year (OR
= 0.50 [0.31-0.80]; P = 0.004) and increased HF re-admission rate at
6-month (OR = 0.27 [0.13-0.56]; P = 0.0005), and 1-year (OR = 0.30
[0.15-0.58]; P = 0.0004). Pre-existing RVD as expressed by TAPSE < 15-16
mm or TAPSE:PASP ratio < 0.30-0.37 mmHg reduced the OS and HF readmission
free survival after Mitra-clip. Copyright © The Author(s), under
exclusive licence to Springer Nature B.V. 2025.

<97>
Accession Number
2033488305
Title
High-dose inhaled NO for the prevention of nosocomial pneumonia after
cardiac surgery under cardiopulmonary bypass: A proof-of-concept
prospective randomised study.
Source
Pulmonology. 31(1) (no pagination), 2025. Article Number: 2471706. Date of
Publication: 2025.
Author
Kalashnikova T.P.; Kamenshchikov N.O.; Arsenyeva Y.A.; Podoksenov Y.K.;
Kravchenko I.V.; Kozulin M.S.; Tyo M.A.; Churilina E.A.; Kim E.B.; Svirko
Y.S.; Kozlov B.N.; Boshchenko A.A.
Institution
(Kalashnikova, Kamenshchikov, Arsenyeva, Podoksenov, Kravchenko, Kozulin,
Tyo, Churilina, Kim, Svirko, Kozlov, Boshchenko) Cardiology Research
Institute, Tomsk National Research Medical Center, Russian Academy of
Sciences, Tomsk, Russian Federation
Publisher
Taylor and Francis Ltd.
Abstract
Objective: This study aimed to assess the safety and potential efficacy of
high-dose inhaled nitric oxide therapy for the prevention of postoperative
pneumonia in cardiac surgery patients Methods: A prospective randomised
controlled pilot study included 74 patients with moderate risk of
postoperative pneumonia after elective cardiac surgery under
cardiopulmonary bypass. Patients were randomised into two groups. The main
group (NO-group) (n = 37) received inhaled nitric oxide at a dose of 200
ppm for 30 minutes 2 times a day for 5 days or until pneumonia developed.
The control group received conventional postoperative care (n = 37). The
primary endpoint was the incidence of postoperative pneumonia during
in-hospital stay. Result(s): Preventive nitric oxide inhalations were
associated with a reduced incidence of postoperative nosocomial pneumonia
(2 (5.4%) cases in the main group (NO-group) vs. 9 (24.3%) cases in the
control group, p = 0.046; OR = 0.178, 95% CI = 0.036-0.89)). There was no
decrease in either peak expiratory flow, or peak inspiratory flow in
comparison with the preoperative values in the NO-group. Inhaled nitric
oxide therapy is safe. It did not lead to an increase in the incidence of
acute kidney injury. Conclusion(s): High-dose inhaled nitric oxide
therapy is safe and effective for the prevention of postoperative
nosocomial pneumonia in cardiac surgery. Copyright © 2025 The
Author(s). Published by Informa UK Limited, trading as Taylor & Francis
Group.

<98>
Accession Number
2033703131
Title
Robotic Congenital Cardiac Surgery Practice Worldwide: A Systematic
Review.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
4692522. Date of Publication: 2025.
Author
Lee M.E.; Amabile A.; Hameed I.; Antonios J.; Awad A.K.; Brackett A.;
Krane M.; Gruber P.J.; Geirsson A.
Institution
(Lee, Amabile, Hameed, Antonios, Awad, Gruber, Geirsson) Division of
Cardiac Surgery, Department of Surgery, Yale School of Medicine, New
Haven, CT, United States
(Brackett) Harvey Cushing/John Hay Whitney Medical Library Division, Yale
School of Medicine, New Haven, CT, United States
(Krane) Department of Cardiovascular Surgery, Institute Insure, German
Heart Center Munich, Technical University of Munich, Munich, Germany
Publisher
John Wiley and Sons Inc
Abstract
Background: With the increasing adoption of robotic technology in adult
cardiac surgery patients, improved surgeon experience and wider
utilization have been reported. However, interpreting trends in robotic
congenital surgery is more challenging. By performing a systematic review,
the authors aim to evaluate the current literature on robotic congenital
operations. Method(s): The protocol was registered with PROSPERO. The
inclusion and exclusion criteria were established based on the population,
intervention, comparison, and outcome (PICO) framework. A comprehensive
literature search was conducted from January 1998 to December 2021.
Studies involving patients undergoing congenital cardiac surgery
operations performed with robotic assistance were included. Two
independent reviewers screened titles/abstracts and then full text of
eligible studies. A third reviewer resolved any discrepancies. The
Newcastle-Ottawa Scale was applied to quantify quality assessment for
nonrandomized observational studies. Result(s): A total of
one-hundred twenty-eight publications underwent full-text review, and 66
studies were included. Overwhelmingly, the majority are from single
institutions and observational and retrospective studies. The population
was mostly adults with only 10.6% (7/66) studies solely reporting
pediatric patients. About 50% of the studies were case reports (28/66).
Selective reporting of outcomes varied widely across studies. Cumulative
mortality rates were 0.3%. The highest incidence of morbidities included
pleural effusion (12.3%), reoperation for bleeding (10.7%), atrial
fibrillation (10.7%), heart block (9.5%), and peripheral
cannulation-related complications (8.6%). The overall quality of the
studies was unsatisfactory, with the majority of studies receiving a score
of 3 out of 9. Conclusion(s): Most publications were case reports or
small case series performed in adults and restricted to a few
international institutions. To address these clinical challenges,
technological improvements and advanced training will be mandatory before
wider application to children and complex congenital diagnoses.
Unfortunately, the overall quality of studies is poor, with inconsistent
outcomes reporting. Improved and standardized reporting will be necessary
before an appropriate evaluation of robotics in the treatment of
congenital heart disease is feasible. Copyright © 2025 Madonna E.
Lee et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd.

<99>
Accession Number
2038026254
Title
Acute Pain Management with Ultrasound-Guided Erector Spinae Plane Block
and Serratus Anterior Plane Block in Patients Undergoing Coronary Artery
Bypass via Mini-thoracotomy: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Xin L.; Wang L.; Feng Y.
Institution
(Xin, Feng) Department of Anesthesiology, Peking University People's
Hospital, Beijing, China
(Wang) Department of Anesthesiology, Fuwai Hospital, Chinese Academy of
Medical Science and Peking Union Medical College, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: This study was designed to examine the analgesic efficacy of
erector spinae plane (ESP) block or combined ESP and superficial serratus
anterior plane (SAP) block in patients undergoing elective coronary artery
bypass via mini-thoracotomy. Design(s): Randomized controlled study.
 Setting(s): Operating room, intensive care unit, and ward.
 Patient(s): Fifty-four patients undergoing elective coronary artery
bypass via mini-thoracotomy. Intervention(s): Eligible patients were
randomly allocated to single-ESP block (ESP group) or combined ESP and
superficial SAP block (ESP+SAP group). Measurements and Main Results:
The primary outcome was dynamic numerical rating scale (NRS) scores (on
coughing) for the surgical incision site 6 hours after skin closure.
Secondary outcomes included dynamic NRS scores for surgical incision at
12, 18, 24, and 48 hours postoperatively plus NRS scores for the chest
tube, hydromorphone consumption, quality of recovery, and adverse events
within 48 hours postoperatively. The ESP+SAP group had lower dynamic NRS
scores for surgical incision at postoperative 6 hours (mean difference:
-2.1, 95% CI -2.8 to -1.4, adjusted p < 0.001) and 12 hours (-1.3, 95% CI
-2.0 to -0.7, adjusted p < 0.001) compared to the ESP group. The ESP+SAP
group also showed lower dynamic NRS scores for the chest tube at 6 hours
(-1.4, 95% CI -2.0 to -0.9, adjusted p < 0.001) and 12 hours (-1.2, 95% CI
-1.7 to -0.6, adjusted p < 0.001) postoperatively. Linear mixed-model
analysis showed that NRS scores for the surgical incision and chest tube
were lower in the ESP+SAP group compared to the ESP group (both p < 0.05).
 Conclusion(s): Compared with ESP block alone, ESP combined with
superficial SAP block reduced pain scores in patients undergoing coronary
artery bypass via mini-thoracotomy. Copyright © 2025

<100>
Accession Number
646828311
Title
Transformative Effects of Fluorescence Imaging Technologies on Current
Vascular Surgical Practices: An Updated Review.
Source
SLAS technology. (pp 100270), 2025. Date of Publication: 12 Mar 2025.
Author
Fang T.; Dong J.; Xie Z.
Institution
(Fang, Dong) Department of Vascular Surgery, Yantai Mountain Hospital,
Yantai, China
(Xie) Department of Vascular Surgery, Yantai Mountain Hospital, Yantai,
China
Abstract
Fluorescence imaging technologies have revolutionized vascular surgery by
enabling real-time visualization of vascular anatomy, blood circulation,
and tissue perfusion, thus improving intraoperative decision-making. This
review provides a comprehensive analysis of key fluorescence modalities,
including Fluorescence-Guided Surgery (FGS), Near-Infrared (NIR)
fluorescence imaging, and Indocyanine Green (ICG) angiography,
highlighting their roles in optimizing tissue perfusion assessment, vessel
patency evaluation, and identifying anatomical variations. Unlike existing
literature, this review addresses critical gaps in current practices by
comparing these technologies and exploring their applications across a
range of vascular procedures such as peripheral vascular surgery, coronary
artery bypass grafting, and oncological operations. The review further
delves into the potential future directions for fluorescence imaging in
vascular surgery, emphasizing emerging technologies, challenges in
clinical implementation, and how these advancements can enhance surgical
precision, patient outcomes, and intraoperative guidance. By synthesizing
the latest developments, this review offers valuable insights into the
evolving role of fluorescence imaging in vascular surgery and its
potential to transform surgical practices. Copyright © 2025.
Published by Elsevier Inc.

<101>
Accession Number
2033952195
Title
Investigating the results of transcatheter aortic valve implantation
(TAVI) in non-diabetic and diabetic patients: a systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
205. Date of Publication: 01 Dec 2025.
Author
Soleimani A.; Maghsoodi M.; Bahrani S.; Amerizadeh A.; Teimouri-Jervekani
Z.
Institution
(Soleimani, Amerizadeh, Teimouri-Jervekani) Cardiac Rehabilitation
Research Center, Isfahan Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Maghsoodi, Bahrani) Hypertension Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
an effective treatment option for patients with severe aortic stenosis,
particularly in those who are not suitable candidates for open-heart
surgery. While diabetes is known to be associated with a higher risk of
cardiovascular diseases, the impact of diabetes on the outcomes of TAVI
remains controversial. Method(s): A systematic literature search was
conducted across major databases, including PubMed, Web of Science (WOS),
and Google Scholar, for studies published in English over the past 20
years, up until July 2024. Result(s): A total of 10 observational
studies were analyzed, revealing that diabetic patients were generally
younger than non-diabetic patients. The 30-day mortality rate was lower in
non-diabetics (0.03 [0.02-0.04]) compared to diabetics (0.04 [0.03-0.05]).
However, the hazard ratio for death beyond 30 days in diabetics was 2.05
(95% CI: 0.91-4.60, p = 0.08), and at one year, it was 1.04 (95% CI:
0.78-1.39, p = 0.77), with neither result reaching statistical
significance. Meta-regression analysis showed that non-insulin-treated
diabetes was significantly associated with an increased risk of acute
kidney injury (AKI) compared to non-diabetics, with a log odds ratio
(LogOR) of 0.3393 (p = 0.035) in one analysis and 0.3166 (p = 0.028) in
another, confirming a statistically significant increase in AKI risk.
 Conclusion(s): This review highlights that while diabetes slightly
increases short-term mortality after TAVI, long-term survival remains
comparable to non-diabetic patients. However, non-insulin-treated diabetes
significantly raises the risk of acute kidney injury (AKI), emphasizing
the need for enhanced renal protection and perioperative management.
Clinical trial number: Not applicable. Copyright © The Author(s)
2025.

<102>
Accession Number
2033678986
Title
Dexmedetomidine for Prevention of Postoperative Delirium in Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Current Anesthesiology Reports. 15(1) (no pagination), 2025. Article
Number: 37. Date of Publication: 01 Dec 2025.
Author
Barbosa L.M.; Queiroz I.; Tavares A.H.; Mesquita C.F.D.; Katz J.N.
Institution
(Barbosa) Medicine Department, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Queiroz) Medicine Department, Catholic University of Pernambuco, Recife,
Brazil
(Tavares) Medicine Department, University of Pernambuco, Recife, Brazil
(Mesquita) Medicine Department, Federal University of Pernambuco, Recife,
Brazil
(Katz) Department of Medicine, NYU Grossman School of Medicine, New York,
United States
(Katz) Cardiology Department, Bellevue Hospital, New York, United States
(Queiroz) Alfredo Balena, 190, Minas Gerais, Belo Horizonte, Brazil
Publisher
Springer
Abstract
Background: Postoperative delirium is a prevalent complication following
cardiac surgery. In recent studies, dexmedetomidine has been proposed as a
potential alternative to mitigate this condition. This meta-analysis aimed
to evaluate the efficacy and safety of dexmedetomidine for preventing
postoperative delirium in cardiac surgery. Method(s): We
systematically searched PubMed, Embase, and Cochrane databases for
randomized controlled trials (RCTs), analyzing the efficacy of
dexmedetomidine compared to placebo in patients undergoing cardiac
surgery. We pooled risk ratios (RR) for binary outcomes with 95%
confidence intervals (CI) with a random-effects model. We used R version
4.4.1 for statistical analyses. The Grading of Recommendations,
Assessment, Development, and Evaluations (GRADE) approach evaluated the
quality of evidence. Result(s): Our meta-analysis included 15 RCTs
comprising 3675 patients, of whom 1842 (50.1%) were randomized to
dexmedetomidine. The mean age ranged from 43 to 74 years among studies.
Compared with placebo, dexmedetomidine significantly reduced the incidence
of postoperative delirium (RR 0.67; 95% CI: 0.51 to 0.89; p = 0.01). There
were no significant differences in hypotension (RR 1.42; 95% CI: 0.90 to
2.26; p = 0.13), mortality (RR 0.78; 95% CI: 0.44 to 1.36; p = 0.37), or
acute kidney injury (RR 0.96; 95% CI: 0.61 to 1.51; p = 0.87) between
groups. However, Trial sequential analysis showed insufficient power to
discard type 1 error for our results. Conclusion(s): Dexmedetomidine
significantly reduced the incidence of postoperative delirium in cardiac
surgery patients. Larger RCTs are warranted to validate these results.
 Level of Evidence: MD. Copyright © The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature 2025.

<103>
Accession Number
2037977885
Title
Impact of Intensified Outpatient Follow-Up on Rehospitalization After
Transcatheter Aortic Valve Implantation: Results From the HOSPITAVI Trial.
Source
American Journal of Cardiology. 245 (pp 17-24), 2025. Date of Publication:
15 Jun 2025.
Author
Baekke P.S.; Jorgensen T.H.; Bieliauskas G.; Sondergaard L.; De Backer O.
Institution
(Baekke, Jorgensen, Bieliauskas, De Backer) The Heart Center, Copenhagen,
Rigshospitalet, Denmark
(Sondergaard) Abbott, Santa Clara, California, United States
Publisher
Elsevier Inc.
Abstract
Patients undergoing transcatheter aortic valve implantation (TAVI) are at
increased risk of rehospitalization in the early period after discharge
from TAVI. The HOSPITAVI study aimed to compare the impact of a standard
versus intensified outpatient follow-up on rehospitalization rates within
90 days after TAVI discharge. Patients were 1:1 randomized to either a
standard or intensified outpatient follow-up after TAVI discharge. The
primary endpoint was the 90-day hospital rehospitalization rate. In total,
300 patients were included: 150 patients were randomized to standard
follow-up and 150 patients to intensified outpatient follow-up. The study
population had a median age of 79 years, a median EuroSCORE II of 2.9%,
and 72% were discharged the day after TAVI. Within 90 days after
discharge, the mean number of all-cause hospital readmissions per patient
was 0.44 versus 0.35 (HR 0.8 [95% CI, 0.6-1.2], p = 0.23) in the standard
versus intensified group, respectively. The mean number of cardiovascular
(CV) readmissions per patient was 0.27 versus 0.15 (HR 0.6 [95% CI,
0.4-1.0], p = 0.04) in the standard versus intensified group,
respectively. This resulted in a mean number of CV readmission days per
patient of 1.52 days versus 0.49 days within the first 90 days in the
standard versus intensified group, respectively (p < 0.05). Following TAVI
discharge, there was no significant difference in all-cause
rehospitalization rates using a standard versus intensified outpatient
follow-up approach. However, an intensified outpatient follow-up reduces
the burden of early CV rehospitalization after TAVI discharge.
(Rehospitalization after transcatheter aortic valve implantation
[HOSPITAVI]; NCT05670041). Copyright © 2025 The Author(s)

<104>
Accession Number
2035949665
Title
Multicenter Experience of Percutaneous Left Atrial Appendage Occlusion in
Current Indications and Different Anesthetic Approaches.
Source
Acta Cardiologica Sinica. 41(2) (pp 251-260), 2025. Date of Publication:
01 Mar 2025.
Author
Lin S.-I.; Chen C.-Y.; Chen W.-T.; Wang C.-H.; Hua C.-P.; Lin P.-L.; Chiou
W.-R.; Wang K.; Tsai C.-T.; Lee Y.-H.
Institution
(Lin, Chen, Hua, Tsai, Lee) Cardiovascular Center, MacKay Memorial
Hospital, Taipei, Taiwan (Republic of China)
(Lin, Chen, Wang, Chiou, Tsai, Lee) Department of Medicine, MacKay Medical
College, New Taipei City, Taiwan (Republic of China)
(Lin) Department of Nursing, MacKay Junior College of Medicine, Nursing,
and Management, Taipei, Taiwan (Republic of China)
(Chen) Division of Cardiovascular Medicine, Taipei Medical University
Hospital, Taipei, Taiwan (Republic of China)
(Chen) Department of Internal Medicine, School of Medicine, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Wang) Department of Anesthesiology, MacKay Memorial Hospital, Taipei,
Taiwan (Republic of China)
(Lin) Department of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu,
Taiwan (Republic of China)
(Chiou, Wang) Division of Cardiology, Department of Internal Medicine,
Taitung MacKay Memorial Hospital, Taitung, Taiwan (Republic of China)
(Tsai) Department of Cosmetic Applications and Management, MacKay Junior
College of Medicine, Nursing, and Management, Taipei, Taiwan (Republic of
China)
(Lee) Department of Artificial Intelligence and Medical Application,
MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
(Republic of China)
Publisher
Republic of China Society of Cardiology
Abstract
Background: Stroke remains a concern in patients with atrial fibrillation
despite the efficacy of oral anticoagulants. Left atrial appendage closure
has emerged as a treatment option for patients with suboptimal
pharmacological therapy. Objective(s): This retrospective multicenter
study aimed to evaluate the feasibility, safety, and outcomes of left
atrial appendage occlusion procedures for two different indications.
Short-term outcomes between two different methods of general anesthesia
during the procedures were also compared. Method(s): The study
included patients who underwent appendage closure between September 2017
and June 2021. Two indications for the procedures, anticoagulant
intolerance, and anticoagulant inadequacy were recorded. One-year outcomes
were analyzed between groups. Short-term outcomes were compared between
the intravenous general anesthesia with high-flow nasal cannula oxygen
therapy and intubated general anesthesia groups. Result(s): A total
of 75 consecutive patients were enrolled: 19 patients in the anticoagulant
inadequacy group and 56 in the anticoagulant intolerance group. Appendage
occlusion was effective in reducing stroke risk in atrial fibrillation
patients with suboptimal pharmacological therapy. There were no
significant differences in outcomes between the two indication groups.
Appendage closure under high-flow nasal cannula oxygen therapy was found
to be feasible and safe, with comparable results to intubated general
anesthesia. Conclusion(s): Appendage occlusion is effective and safe
for Taiwan National Health Insurance-approved indications, with no
difference between indication groups during 1-year of follow-up. Appendage
occlusion under high-flow nasal cannula oxygen therapy is feasible and
comparable to intubated general anesthesia. Larger randomized studies with
longer follow-up are needed to confirm these findings. Copyright
© 2025, Republic of China Society of Cardiology. All rights reserved.

<105>
Accession Number
2037928102
Title
A Systematic Review and Analysis of Brucella Endocarditis Cases.
Source
Anatolian Journal of Cardiology. 29(3) (pp 111-117), 2025. Date of
Publication: 2025.
Author
Basaran S.; Simsek-Yavuz S.; Saricaoglu M.E.; Aydin M.; Aygun G.; Azap A.;
Azap O.; Benli A.; Demirturk N.; Ergonul O.; Kocagul-Celikbas A.; Kuscu
F.; Ozger S.; Kutlu S.S.; Turker N.; Turkoglu-Yilmaz E.
Institution
(Basaran, Simsek-Yavuz, Benli) Department of Infectious Diseases and
Clinical Microbiology, Istanbul University, Istanbul Faculty of Medicine,
Istanbul, Turkey
(Saricaoglu, Azap) Department of Infectious Diseases and Clinical
Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
(Aydin) Department of Infectious Diseases and Clinical Microbiology,
Umraniye Training and Research Hospital, Istanbul, Turkey
(Aygun) Department of Infectious Diseases and Clinical Microbiology,
Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul,
Turkey
(Azap) Department of Infectious Diseases and Clinical Microbiology,
Faculty of Medicine, Baskent University, Ankara, Turkey
(Demirturk) Department of Infectious Diseases and Clinical Microbiology,
Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
(Ergonul) Department of Infectious Diseases and Clinical Microbiology,
Faculty of Medicine, Koc University, Istanbul, Turkey
(Kocagul-Celikbas) Department of Infectious Diseases and Clinical
Microbiology, Faculty of Medicine, Hitit University, Corum, Turkey
(Kuscu) Department of Infectious Diseases and Clinical Microbiology,
Faculty of Medicine, Cukurova University, Adana, Turkey
(Ozger) Department of Infectious Diseases and Clinical Microbiology,
Faculty of Medicine, Gazi University, Ankara, Turkey
(Kutlu) Department of Infectious Diseases and Clinical Microbiology,
Faculty of Medicine, Pamukkale University, Denizli, Turkey
(Turker) Department of Infectious Diseases and Clinical Microbiology,
Izmir Ataturk Training and Research Hospital, Izmir, Turkey
(Turkoglu-Yilmaz) Department of Infectious Diseases and Clinical
Microbiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
Publisher
Turkish Society of Cardiology
Abstract
Endocarditis is the most common cause of death from brucellosis. The
information used to guide the management of cases with Brucella
endocarditis has relied on case reports/ series. Risk factors related to
death and other adverse outcomes in patients with Brucella endocarditis
were identified by an individual-patient data analysis of all reported
Brucella endocarditis cases in the literature. The keywords "Bruce" and
"endocard" were used to search articles published until July 2022 on
PubMed and ULAKBIM databases. Case reports/series containing patients with
endocarditis caused by Brucella spp., aged >=17 years, and with data on
antimicrobial or surgical treatment were included in the study.
Epidemiological, clinical, laboratory, and treatment characteristics and
outcomes of 273 cases from 86 eligible articles were recorded. It was
found that male gender, a Wright serum tube agglutination (STA) titer of
>=1/1280 on admission, development of heart failure due to endocarditis
were independent risk factors that increase mortality, while the usage of
aminoglycoside and cardiac surgical intervention for endocarditis were
factors reducing mortality. Including streptomycin or gentamicin in the
treatment regimen may benefit patients with Brucella endocarditis. Valve
surgery could be life-saving in patients with Brucella endocarditis. An
STA titer of >=1/1280, which probably reflects long-term and advanced
disease, may be used as a marker for increased mortality. However,
additional and more reliable studies are needed to define the most
appropriate management approach in diagnosing and treating cases with
Brucella endocarditis due to the low quality of the current
evidence. Copyright@Author(s)

<106>
Accession Number
2033725662
Title
Comparative outcomes video-assisted thoracic surgery versus open thoracic
surgery in pulmonary echinococcosis: a systematic review and
meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Article Number: n71. Date of Publication: 2025.
Author
Salvador I.C.M.C.; da Nobrega Oliveira R.E.N.; de Almeida Silva I.; Torres
L.A.F.; Camarotti M.T.; Passos F.S.; Mariani A.W.
Institution
(Salvador, de Almeida Silva) University Anhembi Morumbi, Street Francisca
Julia, 563, North Zone, SP, Sao Paulo, Brazil
(da Nobrega Oliveira) Department of Thoracic Surgery, Barretos Cancer
Hospital, Barretos, Brazil
(Torres) Hospital Universitario Onofre Lopes, RN, Natal, Brazil
(Camarotti) Pernambuco's Health College, PE, Recife, Brazil
(Passos) Department of Thoracic Surgery, INCAR Hospital, Santo Antonio de
Jesus, Brazil
(Mariani) Faculty of Medicine, Heart Institute, Hospital das Clinicas,
University of Sao Paulo (HCFMUSP), SP, Sao Paulo, Brazil
Publisher
Springer
Abstract
Aim: This meta-analysis aimed to evaluate and compare the outcomes of
video-assisted thoracic surgery (VATS) and open thoracic surgery (OT) in
the management of pulmonary echinococcosis. Method(s): We conducted a
comprehensive search of PubMed, Embase, and Cochrane databases for studies
comparing VATS and OT. Odds ratios (ORs) for binary outcomes and mean
differences (MDs) for continuous variables were calculated with 95%
confidence intervals (CIs) using the DerSimonian and Laird random-effects
model. Heterogeneity was assessed using I2 statistics.
 Result(s): Seven studies involving 2292 patients were included. VATS
demonstrated significant advantages over OT, with reductions in
intraoperative blood loss (MD - 81.65 mL, 95% CI - 129.90 to - 33.40),
duration of thoracic drainage (MD - 2.29 days, 95% CI - 3.61 to - 0.98),
operative time (MD - 45.73 min, 95% CI - 68.41 to - 23.05), narcotic use
(MD -3.98 days, 95% CI - 6.21 to - 1.75), length of hospital stay (MD -
3.66 days, 95% CI - 5.66 to - 1.67), postoperative drainage volume (MD -
124.77 mL, 95% CI - 206.27 to - 43.27), and visual analogic score pain at
24 h after surgery (MD - 2.05 points, 95% CI - 2.40 to - 1.70). However,
VATS was associated with a higher incidence of atelectasis (OR 3.27, 95%
CI 1.03-10.35). No significant differences were observed in other
complications, such as bronchopulmonary fistula, surgical wound infection,
prolonged air leak, or failure of lung expansion. Conclusion(s): VATS
was associated with perioperative benefits, including reduced recovery
times and resource utilization. Nonetheless, the higher risk of
atelectasis suggests OT may remain favorable in complex cases requiring
broader surgical access. Tailoring the surgical approach to the patient's
needs remains crucial. Trial registry: International Prospective Register
of Systematic Reviews; N: CRD42025630187; URL:
https://www.crd.york.ac.uk/prospero/. Copyright © The Author(s),
under exclusive licence to The Japanese Association for Thoracic Surgery
2025.

<107>
Accession Number
2033674390
Title
Efficacy of the Renal-guard system in the prevention of contrast-induced
nephropathy following cardiac interventions among patients with chronic
kidney disease.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1438076. Date of Publication: 2025.
Author
Yasmin F.; Mashkoor Y.; Najeeb H.; Shaikh A.A.; Nusrat B.; Moeed A.;
Asghar M.S.; Alraies C.
Institution
(Yasmin, Mashkoor, Najeeb, Nusrat, Moeed) Dow University of Health
Sciences, Karachi, Pakistan
(Shaikh) Ziauddin University, Karachi, Pakistan
(Asghar) AdventHealth, Sebring, FL, United States
(Alraies) Cardiovascular Institute, Detroit Medical Center, Detroit, MI,
United States
Publisher
Frontiers Media SA
Abstract
Background: Contrast-induced nephropathy (CIN), also called as contrast
associated-acute kidney injury (CA-AKI) is a common complication following
cardiac procedures. KDIGO guidelines define CIN as a >=25% increase in
serum creatinine or an absolute increase of at least 0.5 mg/dl 48-72 h
post-contrast administration. The single most effective measure in
preventing CIN is peri-procedural intravascular hydration typically from
12 h before to 24 h after contrast media exposure but has limitations.
Recently, the RenalGuard (RG) system has emerged as a new tool,
demonstrating safer and more efficient hydration and reducing the
incidence of AKI caused by CIN. Aim(s): We conducted this
meta-analysis on the effectiveness of the RG system in preventing CIN in
patients undergoing cardiac interventions. Method(s): A comprehensive
literature search of PubMed (MEDLINE), Science Direct, and Embase was
conducted from its inception until February 2024 for randomized controlled
trials (RCTs) including patients aged >18 years undergoing cardiac
procedures with underlying chronic kidney disease (CKD), estimated
glomerular filtration rate (eGFR) 20-60 ml/min/1.73 m2 and left
ventricular ejection fraction (LVEF) >50%. The outcomes of interest were
risk of CIN, risk of renal replacement therapy (RRT), in-hospital
mortality and 30-day mortality, major adverse cardiovascular events
(MACE), changes in serum creatinine (sCr) levels, and incidence of
pulmonary edema. A random-effects meta-analysis was performed using Review
Manager (RevMan) [Computer Program] Version 5.4 Cochrane Collaboration.
 Result(s): A total of 9 RCTs including 3,215 patients with CKD
undergoing cardiac procedures on volume expansion strategies were included
with 1,802 patients on the RG system and 1,413 patients using alternate
volume expansion techniques. Pooled analysis of 9 RCTs reported a
significantly lower risk of CIN in patients using the RG system vs.
control [OR 0.51 (0.35, 0.74), P = 0.0004; I2 = 55%]. There was
no significant difference in the risks of RRT, in-hospital mortality,
30-day MACE, pulmonary edema, or change in sCr levels. Conclusion(s):
This meta-analysis indicates the beneficial utilization of the RG system
in populations with moderate-to-high risk and underlying CKD undergoing
cardiac interventions in preventing CIN. However, it did not demonstrate a
notable impact on mortality, RRT, MACE, pulmonary edema, and sCr levels
when compared to the control group. Copyright 2025 Yasmin, Mashkoor,
Najeeb, Shaikh, Nusrat, Moeed, Asghar and Alraies.

<108>
Accession Number
2037975438
Title
Impact of Transcatheter or Surgical Aortic Valve Performance on 5-Year
Outcomes in Patients at >= Intermediate Risk.
Source
Journal of the American College of Cardiology. 85(13) (pp 1419-1430),
2025. Date of Publication: 08 Apr 2025.
Author
Yakubov S.J.; Van Mieghem N.M.; Oh J.K.; Ito S.; Grubb K.J.; O'Hair D.;
Forrest J.K.; Gada H.; Mumtaz M.; Deeb G.M.; Tang G.H.L.; Rovin J.D.; Jain
R.; Windecker S.; Skelding K.A.; Kleiman N.S.; Chetcuti S.J.; Dedrick A.;
Boatman S.V.; Popma J.J.; Reardon M.J.
Institution
(Yakubov) Riverside Methodist, Ohio Health, Columbus, OH, United States
(Van Mieghem) Erasmus University Medical Center, Rotterdam, Netherlands
(Oh, Ito) Mayo Clinic, Rochester, MN, United States
(Grubb) Emory University School of Medicine, Atlanta, GA, United States
(O'Hair) Boulder Community Health, Boulder, CO, United States
(Forrest) Yale University School of Medicine, New Haven, CT, United States
(Gada, Mumtaz) University of Pittsburgh Medical Center Pinnacle Heath,
Harrisburg, PA, United States
(Deeb, Chetcuti) University of Michigan Hospitals, Ann Arbor, MI, United
States
(Tang) Mount Sinai Health System, New York, NY, United States
(Rovin) Morton Plant Hospital, Clearwater, FL, United States
(Jain) Aurora Healthcare, Milwaukee, WI, United States
(Windecker) Inselspital, University of Bern, Bern, Switzerland
(Skelding) Jersey City Medical Center, RWJBarnabas Health, Jersey City,
NJ, United States
(Kleiman, Reardon) Houston Methodist-DeBakey Heart and Vascular Center,
Houston, TX, United States
(Dedrick, Boatman, Popma) Structural Heart and Aortic, Medtronic,
Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Background: The incidence and clinical importance of bioprosthetic valve
dysfunction (BVD) in patients undergoing supra-annular, self-expanding
transcatheter aortic valve replacement (TAVR) or surgery is not well
understood. Objective(s): The purpose of this study was to evaluate
the 5-year incidence and clinical outcomes of BVD in patients undergoing
CoreValve/Evolut TAVR or surgery. Method(s): This post hoc analysis
pooled data from the U.S. High Risk Pivotal (n = 726) and SURTAVI (n =
1,618) randomized controlled trials (RCTs), the Extreme Risk Pivotal trial
(n = 608), and CoreValve Continued Access Study (n = 2,654). The primary
endpoint was the incidence of BVD through 5 years from the RCTs. The
association of BVD with 5-year clinical outcomes was evaluated in the
pooled RCT and non-RCT populations. Result(s): Of 5,606 patients
evaluated, 3,070 (54.8%) were men, and the mean age was 82.2 +/- 7.4
years. A total of 2,344 RCT patients, including 1,227 who received TAVR
and 1,117 who received surgery, and 3,262 non-RCT TAVR patients were
included. The rate of BVD was lower in RCT patients undergoing
CoreValve/Evolut TAVR compared with surgery (9.7% vs 15.3%;
subdistribution HR: 0.57; 95% CI: 0.45-0.73; P < 0.001). In the pooled RCT
and non-RCT cohort, BVD was associated with increased 5-year all-cause
mortality (HR: 1.49; 95% CI: 1.32-1.68; P < 0.001), cardiovascular
mortality (HR: 1.76; 95% CI: 1.52-2.03; P < 0.001), and hospitalization
for valve disease or worsening heart failure (HR: 1.48; 95% CI: 1.23-1.78;
P < 0.001). Conclusion(s): Five-year valve performance was
significantly better after CoreValve/Evolut TAVR compared with surgery.
Development of BVD in TAVR and surgery patients was associated with
worsened 5-year clinical outcomes. (Safety and Efficacy Study of the
Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic
Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve
Replacement, NCT01240902; Safety and Efficacy Study of the Medtronic
CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis
in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI],
NCT01586910; Safety and Efficacy Continued Access Study of the Medtronic
CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in
Very High Risk Subjects and High Risk Subjects Who Need Aortic Valve
Replacement, NCT01531374) Copyright © 2025 American College of
Cardiology Foundation

<109>
Accession Number
2035951140
Title
Analgesic Efficacy of Thoracoscopic Direct-View Versus Ultrasound-Guided
Thoracic Paravertebral Block in Multi-Port Video-Assisted Thoracoscopic
Lung Surgery: A Randomized Controlled Non-Inferiority Study.
Source
Drug Design, Development and Therapy. 19 (pp 1825-1838), 2025. Date of
Publication: 2025.
Author
Tong Y.; Wu J.; Wu X.; Mo Y.; Wang F.
Institution
(Tong, Mo) Department of Anesthesiology, the First Affiliated Hospital of
Wenzhou Medical University, Wenzhou, China
(Wu, Wang) Department of Anesthesiology, Lishui People's Hospital, Lishui
Hospital of Wenzhou Medical University, Lishui, China
(Wu) Department of Thoracic Surgery, Lishui People's Hospital, Lishui
Hospital of Wenzhou Medical University, Lishui, China
(Wang) Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision
and Brain Health), Wenzhou Medical University, Wenzhou, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: This study compares the analgesic effects of the Thoracoscopic
Direct-view Thoracic Paravertebral Nerve Block (DTPVB) with those of the
Ultrasound-guided Thoracic Paravertebral Nerve Block (UTPVB), providing a
clinical reference. Patients and Methods: Sixty-eight patients
undergoing three-port video-assisted thoracic surgery (VATS) with general
anesthesia were randomly assigned to either the DTPVB group (Group D, n =
34) or the UTPVB group (Group U, n = 34). Both groups received a 10 mL
injection of 0.75% ropivacaine at the T4 and T7 interspaces. Primary
outcomes were cumulative sufentanil equivalents from the start of lung
manipulation to 24 hours postoperatively, with group differences assessed
against a non-inferiority margin of 5 mug (DELTA). Secondary outcomes
include postoperative pain scores, analgesic consumption, patient
satisfaction, adverse effects, and other related indicators.
 Result(s): The cumulative use of sufentanil equivalents from the
start of lung manipulation to 24 hours postoperatively was 35.0 +/- 6.1
mug in Group D and 33.2 +/- 5.6 mug in Group U, with no significant
difference (P = 0.217). The difference in cumulative sufentanil
equivalents (Group D minus Group U) was 1.8 (95% CI -1.07, 4.65), within
the non-inferiority margin of 5 (DELTA). Postoperative pain scores,
analgesic consumption, adverse effects, and complications were similar
were similar between groups. However, DTPVB was associated with lower
anxiety and higher satisfaction (P<0.001). At 15 minutes post-block,
ropivacaine plasma concentrations were higher in Group D (P=0.024).
 Conclusion(s): DTPVB, via transmural pleural puncture, was
non-inferior to UTPVB in analgesic efficacy from the beginning of the
manipulation of the lungs in operation to 24h postoperatively. DTPVB
provides a good alternative, especially for patients who are anxious
before surgery, have difficulty cooperating with UTPVB, or in cases where
UTPVB puncture fails. However, when using high concentrations of
ropivacaine, greater vigilance for toxicity is required. Copyright
© 2025 Tong et al.

<110>
Accession Number
2037965012
Title
Effect of intraoperative intravenous remimazolam on the postoperative
quality of recovery after noncardiac surgery: A meta-analysis of
randomized controlled trials.
Source
PLoS ONE. 20(3 MARCH) (no pagination), 2025. Article Number: e0319044.
Date of Publication: 01 Mar 2025.
Author
Liu H.; Zhou M.; Chen X.; Esmaeili E.; Sun M.; Wu Z.
Institution
(Liu, Chen, Esmaeili, Sun, Wu) Department of Anesthesiology, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Liu, Chen, Esmaeili, Sun, Wu) Institute of Anesthesia and Critical Care
Medicine, Union Hospital, Tongji Medical College, Huazhong University of
Science and Technology, Wuhan, China
(Liu, Chen, Esmaeili, Sun, Wu) Key Laboratory of Anesthesiology and
Resuscitation, Huazhong University of Science and Technology, Ministry of
Education, China
(Zhou) Operation room, Xinzhou district people's hospital, Wuhan, China
Publisher
Public Library of Science
Abstract
Objectives The postoperative quality of recovery holds significant
economic and prognostic implications. Numerous studies have investigated
the postoperative quality of recovery following surgery. However, the
impact of intraoperative intravenous remimazolam on postoperative recovery
has yielded conflicting results. Methods In this qualitative review of
randomized controlled clinical trials assessing the use of intraoperative
remimazolam, we present the effects of intravenous remimazolam on
postoperative recovery quality in noncardiac surgery patients. We
conducted a comprehensive search of PubMed, MEDLINE, Web of Science and
Cochrane Library for randomized controlled trials published up to
September 23, 2024, without any language restrictions, to investigate the
impact of intraoperative intravenous remimazolam on the quality of
postoperative recovery following noncardiac surgery. The primary outcome
measure was the quality of postoperative recovery assessed using global
QoR-40 scores or QoR-15 scores. Secondary outcomes included five
dimensions of quality of postoperative recovery: physical comfort,
emotional state, physical independence, psychological support, and pain.
As well as time to extubation, VAS score, PACU stay, and days in hospital.
We analyzed the pooled data using a random-effects model. Results This
meta-analysis included 18 studies published between 2022 and 2024
involving 1720 patients. The quality of postoperative recovery was
assessed using the QoR-15 or QoR-40 questionnaires. The pooled results
showed no significant difference in QoR scores between the two groups on
the first postoperative day (SMD = 0.12; 95% CI -0.13-0.36; I2
= 78%; p = 0.35). Furthermore, differences in QoR dimensions, PACU
duration, extubation time, and length of hospital stay were not observed.
Conclusion Our analysis showed that the quality of recovery after general
anaesthesia in the remimazolam group was similar to that of conventional
sedation. Therefore, remimazolam may be used as a potential anaesthetic
agent as an alternative to conventional sedation for non-cardiac surgical
anaesthesia. Copyright © 2025 Liu et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<111>
Accession Number
646815319
Title
Postoperative Brain Attack: Current Perspectives and Future Directions.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2025.
Date of Publication: 11 Mar 2025.
Author
Quinlan M.; Arora R.; Cho S.M.
Institution
(Quinlan) Division of Neurosciences Critical Care, Department of
Anesthesiology & Critical Care Medicine, Johns Hopkins University School
of Medicine; Department of Neurology, Johns Hopkins University School of
Medicine; Case Western Reserve University, Department of Surgery,
Cleveland, Ohio, USA
(Arora) Harrington Heart and Vascular Institute, Division of Cardiac
Surgery, University Hospitals, Cleveland, Ohio, USA; Case Western Reserve
University, Department of Surgery, Cleveland, Ohio, USA
(Cho) Division of Neurosciences Critical Care, Department of
Anesthesiology & Critical Care Medicine, Johns Hopkins University School
of Medicine; Department of Neurology, Johns Hopkins University School of
Medicine; Division of Cardiac Surgery, Department of Surgery, Johns
Hopkins University School of Medicine; Case Western Reserve University,
Department of Surgery, Cleveland, Ohio, USA. Electronic address:
csungmi1@jhmi.edu
Abstract
The incidence of stroke after cardiac surgery poses significant
challenges. This expert review piece explores current knowledge,
challenges, future directions, and offers insights into improving patient
outcomes through optimal prevention, early recognition, and management
strategies. By addressing the challenges and opportunities in this area,
we can enhance patient care, reduce long-term disabilities, and improve
the overall quality of life for affected individuals. This expert review
aims to provide a comprehensive framework for managing postoperative
stroke: mechanisms, risk factors, diagnosis, treatment, systems of care,
and ethical considerations. Copyright © 2025 Elsevier Inc. All
rights reserved.

<112>
Accession Number
646815846
Title
Protocol and design of the REPOSE study: a double-blinded, randomised,
placebo-controlled trial to evaluate the efficacy of suvorexant to improve
postoperative sleep and reduce delirium severity in older patients
undergoing non-cardiac surgery.
Source
BMJ open. 15(3) (pp e091099), 2025. Date of Publication: 13 Mar 2025.
Author
Fallon J.M.; Hashemaghaie M.; Peterson C.E.; Tran D.; Wu S.R.; Valdes
J.M.; Pedicini N.M.; Adams M.E.; Soltis M.; Mansour W.; Wright M.C.;
Raghunathan K.; Treggiari M.M.; Sasannejad C.; Devinney M.J.
Institution
(Fallon, Valdes, Pedicini) Duke University, Trinity College of Arts and
Sciences, Durham, NC, United States
(Hashemaghaie, Peterson, Adams, Wright, Raghunathan, Treggiari, Devinney)
Department of Anesthesiology, Duke University School of Medicine, Durham,
NC, United States
(Tran) Louisiana State University School of Medicine, New Orleans, LA,
United States
(Wu) Duke University Pratt School of Engineering, Durham, NC, United
States
(Soltis, Sasannejad) Department of Neurology, Duke University School of
Medicine, Durham, NC, United States
(Mansour) Department of Medicine, Duke University School of Medicine,
Durham, NC, United States
Abstract
INTRODUCTION: Postoperative delirium occurs in up to 40% of older surgical
patients and has been associated with prolonged hospital stays, long-term
cognitive impairment and increased 1-year postoperative mortality.
Postoperative sleep disturbances may increase the risk of delirium, but
studies investigating pharmacotherapies to improve postoperative sleep to
prevent delirium remain limited. Suvorexant is a selective antagonist of
orexin 1 and 2 receptors and is approved for insomnia pharmacotherapy by
the Food and Drug Administration. It has the potential to improve
postoperative sleep and reduce postoperative delirium rates, but
randomised controlled trials (RCTs) are needed to determine the efficacy
of postoperative suvorexant administration. The REPOSE study (reducing
delirium by enhancing postoperative sleep with suvorexant) is a
single-centre, randomised, double-blinded RCT that aims to evaluate the
efficacy of suvorexant in increasing total sleep time (TST) and decreasing
delirium severity in older patients undergoing non-cardiac surgery.
METHODS AND ANALYSIS: REPOSE will enroll 130 patients (aged >=65 years)
undergoing non-cardiac surgery with a planned postoperative inpatient
stay. Participants will be randomised to receive 20 mg oral suvorexant or
placebo nightly on postoperative nights 0, 1 and 2. The primary endpoint
is TST on the first postoperative night, as measured using an
electroencephalography headband. The secondary endpoint is peak
postoperative delirium severity as measured by the 3-minute diagnostic
interview for the confusion assessment method severity scores. Primary
endpoint data will be analysed with a two-sample t-test using an
intent-to-treat approach to compare TST on the first night that a patient
received a study drug dose. Secondary and exploratory endpoint data will
be analysed using two-sample t-tests between groups. ETHICS AND
DISSEMINATION: Ethical approval was obtained from the Duke Institutional
Review Board (protocol #00111869). Results of the REPOSE study will be
published in a peer-reviewed journal and presented at academic
conferences. Trial data will be deposited in ClinicalTrials.gov. TRIAL
REGISTRATION NUMBER: NCT05733286. 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
646817974
Title
Does the surgical approach affect the incidence of postoperative atrial
fibrillation after thoracic surgery? A systematic review and
meta-analysis.
Source
Updates in surgery. (no pagination), 2025. Date of Publication: 13 Mar
2025.
Author
Brascia D.; Mangiameli G.; Giudici V.M.; Re Cecconi E.; Luppichini M.;
Marulli G.
Institution
(Brascia, Mangiameli, Marulli) Department of Biomedical Sciences,
Humanitas University, Via Rita Levi Montalcini 4Pieve Emanuele, Milan,
Italy
(Brascia, Mangiameli, Giudici, Re Cecconi, Luppichini, Marulli) Division
of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56,
20089, Rozzano, Milan, Italy
Abstract
Postoperative atrial fibrillation (PAF) is a common complication after
lung resection, since surgical stress may act as a trigger. The VATS
approach reduces surgical stress and alleviates inflammation and oxidative
stress commonly associated with open lung surgery. However, only a few
studies have investigated the possible impact of the surgical approach on
the incidence of PAF. A literature review was performed through PubMed,
EMBASE, and Google Scholar in March 2024, to identify any study published
since 2000 evaluating the role of the VATS vs the open approach to perform
lung resections as a risk factor for postoperative atrial fibrillation.
Pooled odds ratio (OR) estimates with 95% confidence intervals (CIs) were
calculated. Twenty-one studies, including 59,101 patients, met the
criteria for inclusion. Both propensity-matched and non-matched data
showed that VATS was associated with a significant reduction in PAF
compared to open thoracotomy (OT) (OR 0.73; 95% CI 0.58-0.91; I2 = 10.1%,
p = 0.349). A meta-regression was conducted to explore contributing
factors, showing the geographic regions in which the studies were
conducted may be a significant source of heterogeneity. Subgroup analyses
revealed less heterogeneity in studies conducted in Europe and on those
focused solely on lobectomy. Postoperative atrial fibrillation risk
following VATS is significantly lower than OT. Further prospective
randomized controlled trials with large sample sizes are needed to confirm
these findings. Copyright © 2025. Italian Society of Surgery
(SIC).

<114>
Accession Number
646812410
Title
Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in
Patients With Calcific Aortic Valve Stenosis.
Source
Journal of the American Heart Association. (pp e038955), 2025. Date of
Publication: 13 Mar 2025.
Author
Girard A.S.; Paulin A.; Manikpurage H.D.; Lajeunesse E.; Clavel M.-A.;
Pibarot P.; Krege J.H.; Mathieu P.; Theriault S.; Arsenault B.J.
Institution
(Girard, Paulin, Manikpurage, Lajeunesse, Clavel, Pibarot, Mathieu,
Theriault, Arsenault) Centre de recherche de l'Institut universitaire de
cardiologie et de pneumologie de Quebec-Universite Laval Quebec QC Canada,
Canada
(Clavel, Pibarot, Arsenault) Department of Medicine, Faculty of Medicine
Universite Laval Quebec QC Canada, Canada
(Krege) Eli Lilly Indianapolis IN USA
(Mathieu) Department of Surgery, Faculty of Medicine Universite Laval
Quebec QC Canada, Canada
(Theriault) Department of Molecular Biology, Medical Biochemistry and
Pathology, Faculty of Medicine Universite Laval Quebec QC Canada, Canada
Abstract
BACKGROUND: Lp(a) (lipoprotein(a)) is an independent risk factor for
calcific aortic valve stenosis (CAVS). Whether patients with CAVS and high
Lp(a) levels are at higher risk of valvular or cardiovascular events is
unknown. The aim of this study is to determine whether higher Lp(a) levels
are associated with valvular and cardiovascular outcomes in patients with
CAVS. METHODS AND RESULTS: We identified 1962 patients from the UK Biobank
with an electronic health record or self-reported CAVS diagnosis but who
did not previously undergo aortic valve replacement (AVR) and had a
minimal follow-up time of 2.5 years. Cox proportional hazard regression
was used to evaluate the effect of Lp(a) on AVR, AVR or cardiac death, and
valvular or cardiovascular events (AVR, cardiac death, myocardial
infarction, stroke, heart failure, or coronary artery bypass grafting).
The maximal follow-up time was set to 5 years. During the follow-up, 198
patients underwent AVR, 260 had AVR or cardiac death, and 435 had at least
1 valvular or cardiovascular event. Patients with Lp(a) levels >=125
versus <125 nmol/L were at higher risk of AVR (hazard ratio [HR], 1.58
[95% CI, 1.17-2.12]), AVR or cardiac death (HR, 1.43 [95% CI, 1.10-1.86]),
and cardiovascular or valvular events (HR, 1.36 [95% CI, 1.11-1.68]).
Point estimates were comparable in men versus women, younger versus older
patients, and in patients with higher versus lower plasma C-reactive
protein levels. CONCLUSION(S): In patients with CAVS, Lp(a) levels
predicted a higher risk of valvular and cardiovascular outcomes. The
impact of Lp(a)-lowering therapies on valvular and cardiovascular health
should be assessed in a long-term randomized clinical trial.

<115>
Accession Number
2037885286
Title
Efficacy and safety of the blood-based cardioplegia solution Huaxi-1 in
cardiopulmonary bypass surgery: Protocol for a multicentre randomised
controlled trial.
Source
BMJ Open. 15(2) (no pagination), 2025. Article Number: e095660. Date of
Publication: 18 Feb 2025.
Author
Yan W.; Wang C.; Gao X.; Wen Z.; Zou T.; Wu Y.; Zhang L.; Yu F.; Jin Z.;
Wang L.; Chen T.; Yang J.; Shao Y.; Shi Y.; Duanmu J.; Zhou C.; Xiong Y.
Institution
(Yan, Wang, Gao, Wen, Zou, Wu, Xiong) Department of Cardiovascular
Surgery, The Second Xiangya Hospital of Central South University,
Changsha, China
(Yan, Wang, Gao, Wen, Xiong) Extracorporeal Life Support Center of
Cardiovascular Surgery, The Second Xiangya Hospital of Central South
University, Changsha, China
(Zhang, Yu, Zhou) Department of Cardiovascular Surgery, Guangdong
Provincial Cardiovascular Institute, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Southern Medical
University, Guangzhou, China
(Jin, Wang, Chen, Yang) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Air Force Medical University, Xian, China
(Shao, Shi, Duanmu) The First Affiliated Hospital of Nanjing Medical
University, Nanjing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Cardioplegia during cardiopulmonary bypass is essential for
ensuring a surgical field free of blood and cardiac movement. Numerous
cardioplegia solutions are available, but consensus guidelines about the
safest or most effective do not exist. The present trial will compare the
Huaxi-1 cardioplegia solution, which has been used since 2006 with good
results at a major Chinese cardiac centre not involved in this trial, with
the widely used Custodiol histidine-tryptophan-ketoglutarate (HTK)
solution in terms of safety and efficacy at inducing cardiac arrest and
protecting the myocardium during bypass. Methods and analysis A total of
160 adult patients undergoing elective cardiac surgery requiring
cardiopulmonary bypass and cardioplegic arrest will be recruited at four
medical centres in China. Recruitment is planned to begin on 1 November
2024, and is expected to conclude by 31 October 2025. Eligible patients
will be randomly allocated 1:1 to receive either Huaxi-1 or HTK
cardioplegia solution. The primary endpoint is the peak level of
high-sensitivity cardiac troponin T (hs-cTnT) within 48 hours after
surgery between the two groups. The secondary endpoints include levels of
myocardial injury markers such as the creatine kinase-myocardial band
(CK-MB) and cardiac troponin I at baseline and at 6, 12, 24 and 48 hours
after surgery. The two groups will also be compared in terms of how left
ventricular ejection fraction changes from baseline and in terms of the
rate of spontaneous cardiac recovery. Data will be analysed using SAS
V.9.4. Ethics and dissemination This trial has been approved by the ethics
committees at Guangdong Provincial People's Hospital (lead site) and the
three other study sites. The results of the study will be published in
peer-reviewed journals and presented at international
conferences. Copyright © Author(s) (or their employer(s)) 2025.

<116>
Accession Number
2037938909
Title
Prospective Randomized Comparative Study of Outcomes in Off-Pump CABG with
Low Ejection Fraction (<40%), Priorly Optimized With Levosimendan versus
Dobutamine.
Source
European Journal of Cardiovascular Medicine. 15(3) (pp 516-521), 2025.
Date of Publication: 01 Mar 2025.
Author
Chenikala S.; Nagiredi N.R.; Ahmed S.; Banda D.P.
Institution
(Chenikala) Department of Cardiovascular and Thoracic Surgery, KIMS
Hospital, Andhrapradesh, Srikakulam, India
(Nagiredi, Ahmed) Department of Cardiothoracic and Vascular Surgery,
Yashoda Hospital, Secunderabad, India
(Banda) Department of Cardiothoracic and vascular Surgery, Yashoda
Hospital, Malakpet, India
Publisher
Healthcare Bulletin
Abstract
Background: Coronary artery bypass grafting in patients with reduced left
ventricular function remains a surgical challenge. Inotropes may improve
hemodynamics in patients with low cardiac output syndrome. This study
testifies the hypothesis that prior optimization with Levosimendan
produces beneficial hemodynamic effects during and after off- pump CABG
(OPCAB) in patients with low ejection fraction compared with Dobutamine.
 Method(s): This is a prospective and randomized study was conducted
Department of Cardiothoracic surgery at Yashoda hospital, Secunderabad.
Total 100 patients of which 50 patients were randomized to Dobutamine
group and 50 patients to Levosimendan group. All-cause mortality,
haemodynamic improvement at the end of the drug infusion and Major adverse
cardiac and cerebrovascular events (MACCEs) were analysed. Result(s):
The mean age of the patients was 55.56+/-7.73 in Dobutamine group and
55.24+/-7.99 in Levosimendan group (p=0.83). The baseline characteristics
were compared between the groups and were found to be statistically
insignificant. Intraoperative characteristics were analysed between the
groups. Significant difference were observed between the groups in the
usage of grafts (Dobutamine 3.38+/-0.85 vs Levosimendan 3.68+/-0.68),
p=0.05. One (2%) mortality was observed in Dobutamine group and none in
Levosimendan group (p=0.31) with no statistically significant difference
between the groups. Atrial fibrillation occurred more in Dobutamine group
(22%) compared to Levosimendan group (8%) (p=0.04), means of Ventilator
support (p=0.03), means of ICU (p=0.002) and hospital stay (p=0.04) were
more in Dobutamine group compare to Levosimendan group. MAP (P=0.0001),
MPAP (0.0001) and mPCWP (0.0001) showed significant differences favouring
the use of Levosimendan over Dodutamine after 12 hrs of infusion.
 Conclusion(s): Pre-treatment with Levosimendan in patients undergoing
surgical myocardial revascularization with left ventricular dysfunction
resulted in lower postoperative mortality, a shorter length of Ventilator
support, ICU stay and hospital stay with significant improvement in
cardiac indices compared with Dobutamine treatment. Copyright ©
2025 Healthcare Bulletin. All rights reserved.

<117>
Accession Number
646789998
Title
FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass
Grafting in Patients With Diabetes.
Source
JAMA cardiology. (no pagination), 2025. Date of Publication: 12 Mar 2025.
Author
Takahashi K.; Otsuki H.; Zimmermann F.M.; Ding V.Y.; Engstrom T.; Horsted
Thyregod H.G.; Beleslin B.; Putnik S.; Tapp L.; Barker T.; Redwood S.;
Young C.; Bech G.J.-W.; Hoohenkerk G.J.F.; De Bruyne B.; Pijls N.H.J.;
Fearon W.F.
Institution
(Takahashi, Otsuki, Ding, Fearon) Stanford University School of Medicine,
Stanford University, Stanford, CA, United States
(Takahashi, Otsuki, Ding, Fearon) Stanford Cardiovascular Institute,
Stanford University, Stanford, CA, United States
(Zimmermann) St Antonius Hospital, Nieuwegein, Netherlands
(Zimmermann, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Engstrom, Horsted Thyregod) Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
(Beleslin, Putnik) Medical Faculty, University Clinical Center of Serbia,
University of Belgrade, Belgrade, Serbia
(Tapp, Barker) University Hospitals Coventry and Warwickshire, Coventry,
United Kingdom
(Redwood, Young) St Thomas' Hospital, London, United Kingdom
(Bech, Hoohenkerk) Hagaziekenhuis, The Hague, Netherlands
(De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium
(Fearon) VA Palo Alto Medical Systems, Palo Alto, CA, United States
Abstract
Importance: Outcomes in patients with diabetes after fractional flow
reserve (FFR)-guided percutaneous coronary intervention (PCI) using
current-generation drug-eluting stents (DES) compared with coronary artery
bypass grafting (CABG) are unknown. Objective(s): To investigate the
relative treatment effect of PCI vs CABG according to diabetes status with
respect to major adverse cardiac and cerebrovascular events (MACCE) at 3
years and to evaluate the impact of the SYNTAX score. Design,
Setting, and Participant(s): This is a prespecified subgroup analysis of
the FAME (Fractional Flow Reserve vs Angiography for Multivessel
Evaluation) 3 trial, an investigator-initiated, randomized clinical trial
conducted at 48 centers worldwide. The FAME 3 trial enrolled patients with
3-vessel coronary artery disease not involving the left main undergoing
coronary revascularization between August 2014 and December 2019. Data
analysis was conducted in August 2023. Clinical follow-up was performed at
hospital discharge and at 1 month, 6 months, 1 year, 2 years, and 3 years
after randomization. Intervention(s): Either FFR-guided PCI with
current-generation DES or CABG. Main Outcomes and Measures: The
primary end point was MACCE, defined as the composite of all-cause death,
myocardial infarction, stroke, or repeat revascularization at 3 years.
 Result(s): Of 1500 total patients enrolled, mean (SD) patient age was
65.1 (8.4) years, and 265 patients (17.7%) were female. The FAME 3 trial
included 428 patients with diabetes (28.5%). Patients with diabetes,
especially those receiving insulin, had a higher risk of MACCE at 3 years
compared with those without diabetes. Regarding relative treatment effect,
the risk of MACCE was higher after FFR-guided PCI compared with CABG in
both patients with diabetes (hazard ratio [HR], 1.44; 95% CI, 0.91-2.28; P
= .12) and those without diabetes (HR, 1.50; 95% CI, 1.08-2.07; P = .02),
with no significant interaction (P for interaction = .94). In patients
with a low SYNTAX score (<23), there was no significant difference in
MACCE between PCI and CABG, while in patients with an intermediate to high
SYNTAX score (>=23), PCI had a higher risk of MACCE than CABG, regardless
of diabetes status. Conclusions and Relevance: In this subgroup
analysis of the FAME 3 randomized clinical trial, the relative benefit of
CABG compared with FFR-guided PCI was similar among patients with and
without diabetes. Trial Registration: ClinicalTrials.gov Identifier:
NCT02100722.

<118>
Accession Number
646799632
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in patients at lower surgical risk: meta-analysis of
randomized trials.
Source
The Canadian journal of cardiology. (no pagination), 2025. Date of
Publication: 10 Mar 2025.
Author
Lerman T.T.; Greenberg N.; Kheifets M.; Talmor-Barkan Y.; Codner P.; Perl
L.; Witberg G.; Orvin K.; Eisen A.; Grinberg T.; Skalsky K.; Shapira Y.;
Belkin D.; Jorgensen T.H.; Thyregod H.G.H.; De Backer O.; Fishman B.;
Kornowski R.; Levi A.
Institution
(Lerman, Kheifets, Talmor-Barkan, Codner, Perl, Witberg, Orvin, Eisen,
Grinberg, Skalsky, Shapira, Kornowski, Levi) Department of Cardiology,
Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel
Aviv University, Tel Aviv, Israel
(Greenberg) The Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel; Department of Internal Medicine F-Recanati, Beilinson Hospital,
Rabin Medical Center, Petah Tikva, Israel
(Belkin) Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
(Jorgensen, De Backer) Department of Cardiology, Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Thyregod) Department of Cardiothoracic Surgery, Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Fishman) The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Abstract
BACKGROUND: The use of transcatheter aortic valve implantation (TAVI) for
severe aortic stenosis is expanding to patients across the entire spectrum
of surgical risk. We aimed to perform a meta-analysis comparing TAVI and
surgical aortic valve replacement (SAVR) in trials enrolling lower risk
patients. METHOD(S): We conducted a meta-analysis of randomized
controlled trials (RCTs) comparing safety and efficacy outcomes between
TAVI and SAVR among lower risk patients (mean/median STS score <4).
Point-estimate meta-analysis and reconstructed individual patient data
(RIPD) survival analysis were conducted. Primary outcomes included
all-cause mortality, stroke, and a composite of all-cause mortality or
disabling stroke (PROSPERO CRD42024541837). RESULT(S): The analysis
included six RCTs, totaling 2668 TAVI and 2573 SAVR patients, mean
follow-up time of 3.02 years. TAVI was associated with lower risk of
all-cause mortality (RR 0.68 [95%CI 0.52-0.88]) and a composite of
all-cause mortality or disabling stroke (RR 0.69 [95%CI 0.55-0.86])
without a significant difference in stroke up to 2 years. Longer-term
point-estimate analysis showed no difference. In RIPD, TAVI was associated
with a lower risk of all-cause mortality, driven by an early advantage.
Restricted mean survival time (RMST) differences for primary outcomes were
<2.5 months and <=1 month for all-cause mortality. TAVI was associated
with a lower risk of bleeding, kidney injury and atrial fibrillation, but
a higher risk of pacemaker implantation and moderate-severe aortic
regurgitation. CONCLUSION(S): In patients at lower surgical risk,
TAVI was associated with improved short-term mortality. More data from
long-term studies are needed. Copyright © 2025. Published by
Elsevier Inc.

<119>
[Use Link to view the full text]
Accession Number
646793978
Title
COMPARISON OF TWO HAEMODYNAMIC MONITORING SYSTEMS IN THE CARDIAC
CATHETERIZATION LABORATORY: THE MANIFOLD (MANUAL) VS. AUTOMATED ACIST CVI.
Source
Journal of Hypertension. Conference: Meeting of the European Society of
Hypertension, ESH and International Society of Hypertension, ISH. Glasgow
United Kingdom. 38(e-Supplement) (pp e279), 2021. Date of Publication: 01
Apr 2021.
Author
Mahmud A.; Balghith M.; Ayoub K.; Alanezi A.F.; Alnezi A.; Alhadadi B.;
Alshammary H.; Alshehri J.; Alshammary M.; Alghamdi A.; Khan F.M.
Institution
(Mahmud, Balghith, Ayoub, Alanezi, Alnezi, Alhadadi, Alshammary, Alshehri,
Alshammary, Alghamdi, Khan) King Abdul Aziz Cardiac Center, King Abdul
Aziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Hemodynamic monitoring is an integral part of any cardiac
catheterization procedure and can be potentially prone to many
distortions, including damping and resonance. The optimum damping ratio
recommended for accurate haemodynamic monitoring ranges between 0.4 to
0.8. The most common systems used include Manifold, the manual system and
the automated, ACICT CVia device, which is claimed to be as accurate as
the manual system and easier to use. The aim of this prospective study was
to compare damping ratio, ascending aortic pressure waveform and invasive
blood pressures(BP) between manifold and ACIST CVia, in patients
undergoing cardiac catheterization. Design and method: This study was
conducted at the cardiac catheterization Laboratory at King Abdul-Aziz
Cardiac Center, National Guard Health Affairs, Riyadh in adult patients
undergoing elective cardiac catheterization procedures. The fast-flush
test was performed at the beginning of the procedure using manifold and
ACIST in a cross-over fashion. The square wave was analysed to calculate
the damping coefficient for each device. Data was analyzed by JMP Pro (SAS
for Windows, Version 13) p<0.05 considered significant. The patients gave
informed consent and the study was approved by the Institutional Ethics
Committee. Result(s): We compared the two systems in a randomised
cross-over fashion in 54 subjects (mean age 58.1+/-12, 24% females). The
mean damping ratio was 0.61+/-0.11(range 0.34-0.95) with manifold vs.
0.95+/-0.27(range 0.53-2.1) with ACIST, mean difference 0.33, p<0.0001.
The over-damped ACIST yielded lower BP measurements compared with
manifold; mean difference 6 mm Hg systolic and 5 mm Hg diastolic with
almost 30% of the subjects showing a discrepancy of > 10 mm Hg between the
two systems. Conclusion(s): To the best of our knowledge, this is the
first study comparing a manual haemdynamic monitoring system to an
automated one used widely in cardiac catheterization laboratories. In our
study, while the mannifold met the international recommendations for
accurate haemodynamic monitoring, ACIST device was overdamped, resulting
in significant underestimation of invasive pressures. We recommend using
the manifold system for studies involving haemodynamically compromised
patients and in patients depending upon accurate haemodynamics for
diagnostic purposes.

<120>
[Use Link to view the full text]
Accession Number
646795561
Title
THE SAFETY OF ANTIHYPERTENSIVE AGENTS ON PERIOPERATION OF CARDIAC SURGERY:
A SYSTEMATIC REVIEW BASED ON META-ANALYSIS.
Source
Journal of Hypertension. Conference: Meeting of the European Society of
Hypertension, ESH and International Society of Hypertension, ISH. Glasgow
United Kingdom. 38(e-Supplement) (pp e137), 2021. Date of Publication: 01
Apr 2021.
Author
Li C.; Ma L.; Wang Q.; Zhao X.; Ma R.; Li N.; Yu J.
Institution
(Li, Ma, Wang, Zhao, Ma, Li, Yu) Lanzhou University Second Hospital,
Center of Hypertension, Lanzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To assess the safety of anti-hypertensive agents including
calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors
or angiotensin receptor antagonists (ACEIs/ARBs), and beta blockers during
perioperation of cardiac surgery. Design and method: We included
randomized controlled trials investigating perioperative application of
CCBs, ACEIs/ARBs or beta blockers in cardiac surgery. We extracted data
for in-hospital mortality and serious side effects, among which atrial
fibrillation (AF), stroke and acute renal failure (ARF) were assessed
independently. Result(s): Twenty-three trials with 5378 patients were
included. There were no significant differences between CCBs and placebo,
nitroglycerin, or nitroprusside in terms of side effects, AF and ARF.
Incidences of side effects (RR [95% CI] 0.55 [0.38, 0.80], I2=0, p<0.01)
and ARF (RR [95% CI] 0.16 [0.05, 0.53], I2=0, p<0.01) were significantly
reduced in ACEIs/ARBs group, compared with placebo, while differences in
the incidences of AF and stoke were not found. No differences were found
in the incidences of in-hospital death, side effects, ARF and stroke
between beta blockers and placebo. However, use of beta blockers
significantly reduced the incidence of AF (RR [95% CI] 0.51 [0.39, 0.67],
I2=48%, p<0.01). Conclusion(s): Perioperative use of CCBs, ACEIs/ARBs
or beta blockers does not increase incidences of side effects in patients
undergoing cardiac surgery and beta blockers are more appropriate in
patients with high risk of postoperative atrial tachycardia. Large
randomized trials are needed to confirm these findings.

<121>
[Use Link to view the full text]
Accession Number
646795070
Title
ANALYZING ESC GUIDELINES (GL) OF ARTERIAL HYPERTENSION, MYOCARDIAL
REVASCULARIZATION, SYNCOPE AND PREGNANCY FOR DECISION MAKING EFFICACY: THE
WINNER IS ARTERIAL HYPERTENSION GL.
Source
Journal of Hypertension. Conference: Meeting of the European Society of
Hypertension, ESH and International Society of Hypertension, ISH. Glasgow
United Kingdom. 38(e-Supplement) (pp e383), 2021. Date of Publication: 01
Apr 2021.
Author
Koller A.; Takacs J.
Institution
(Koller, Takacs) Semmelweis University, Budapest, Hungary
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Guidelines (GLs) for medical practice are essential collection
of knowledge, helping the daily clinical decision making in specific
health conditions. Accordingly, the European Society of Cardiology (ESC)
also develops and publishes GLs. We hypothesized that not every GL of ESC
is equally efficient in decision making due to the lack of sufficient
evidence. Design and method: Design: Exploratory data analysis.
 Method(s): A total of 636 levels of evidence (LEVEL) of and classes
of recommendations (CLASS) data were processed on four ESC GLs - Arterial
Hypertension (AH), Myocardial Revascularization (MR), Syncope (S) and
Pregnancy (P). Result(s): Results: The frequency distributions of
LEVEL by CLASS showed that AH had the highest rate of Evidence A in each
class of recommendations. However, the percent of Evidence A was under 50%
on 'to do' and 'not to do' classes. MR showed a similar frequency
distribution than AH, but the frequency of Evidence A was only 36.4% on
'to do' and 25.0% on 'not to do' classes. In S and P, the percent of
Evidence B and/or C was the highest in each class of recommendations.
Percent of uncertainty was between 24.3% (AH) and 75.5% (P). The deviation
of LEVEL from an optimal decision making revealed that the observed
percentages were significantly lower in Evidence A than the expected
percentages in the studied GLs. Thus Arterial Hypertension GL provided the
highest level of Certainty, whereas Pregnancy GL the highest level of
Uncertainty. Conclusion(s): Conclusion(s): There is a great
disparity of certainty among the four ESC GLs. To ensure the relevant
level of Certainty, our findings recommend to reveal the ratio of
certainty and uncertainty in the GLs, and to increase the level of strong
evidence by conducting new basic science experimental studies and clinical
investigations, such as multiple randomized clinical trials or
meta-analyses. (Figure Presented).

<122>
Accession Number
2037905906
Title
Surgical and pathology outcome of a randomized, phase II trial of EGFR TKI
with primary tumor resection for EGFR-mutant metastatic NSCLC patients:
Feasibility evaluation.
Source
Journal of Thoracic Oncology. Conference: European Lung Cancer Congress
(ELCC) 2025. Paris France. 20(3 Supplement 1) (pp S158), 2025. Date of
Publication: 01 Mar 2025.
Author
Chen P.-H.; Hsieh M.-S.; Hsu H.-H.; Chen J.-S.
Institution
(Chen, Chen) Surgery Dept., National Taiwan University Hospital, Taipei
City, Taiwan (Republic of China)
(Hsieh, Hsu) NTUCC - National Taiwan University Cancer Center, Taipei
City, Taiwan (Republic of China)
Publisher
Elsevier Inc.
Abstract
Background Several phase II trials have explored local consolidation
therapies for EGFR-mutant advanced lung cancer, but none have specifically
assessed primary thoracic tumor resection with EGFR TKI before
progression. We hypothesize that surgery targeting resistant subclones or
reducing tumor burden could extend non-progression intervals. This
approach aims for better disease control than EGFR TKI therapy alone,
without intending to cure the disease. Methods We conducted a two-arm,
phase II trial in Taiwan with 100 EGFR-m advanced NSCLC patients. After 12
weeks of afatinib, participants were randomized (1:1) to receive either
afatinib monotherapy or surgery with/without radiation for residual
disease. The primary goal of surgery is locoregional control and a
negative resection margin. The primary endpoint is two-year
progression-free survival (PFS), with secondary endpoints including PFS
and overall survival. Results A total of 56 patients were randomized into
two groups. The hazard ratio (HR) for progression was 0.45 (95% CI:
0.19-1.05) with early unmatured data. A major pathology response was
observed in 36.4% of the patients. Pathologic complete response was
achieved in 9.1% of patients. The average postoperative hospital stay
(POD) was 4.9 days. 76.8% patients were underwent a single-wound approach,
and 58.9% of patients underwent sub-lobar resections. No mortality was
noticed in the surgical group. Patients were classified as MPR-positive (N
= 8) or MPR-negative (N = 14). With a median follow-up of 10.9 months, the
median PFS was 21.1 months for the MPR-positive group, compared with 13.9
months for the MPR-negative group. The hazard ratio (HR) for disease
progression was 0.56 (95% CI: 0.13-2.37). Conclusions This trial is the
first to use pure thoracic surgery (primary tumor resection) as local
consolidation therapy with EGFR TKI in nonoligometastatic, stage IV
patients. Minimally invasive surgery reduced risks, such as pneumonitis.
The focus was on pathology outcomes, showing promise in some subgroups.
While pathology results are encouraging, the oncological outcome is still
pending, and further follow-up is needed to assess long-term benefits.
Clinical trial identification NCT05215548. Legal entity responsible for
the study The authors. Funding Boehringer Ingelheim. Disclosure P. Chen:
Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim,
AstraZeneca; Financial Interests, Personal, Sponsor/Funding: Boehringer
Ingelheim. J. Chen: Financial Interests, Personal, Sponsor/Funding:
Boehringer Ingelheim. All other authors have declared no conflicts of
interest. Copyright © 2025 International Association for the
Study of Lung Cancer, Published by Elsevier Ltd

<123>
Accession Number
2037940938
Title
Optimal timing for percutaneous coronary intervention in patients
undergoing transcatheter aortic valve replacement: A network
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Carvalho P.E.P.; Nascimento B.R.; Gewehr D.M.; Rivera A.; Clemente M.;
Braga M.A.P.; Pansani L.N.; Almeidinha L.; Felix N.; Veiga T.M.A.;
Barbanti M.; Lemos P.A.; Marino M.A.; Taramasso M.; Garot P.
Institution
(Carvalho) Center for Coronary Artery Disease, Minneapolis Heart
Institute, Minneapolis, United States
(Gewehr) Department of Internal Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil
(Rivera) Interventional Cardiology Department, Hospital Madre Teresa, Belo
Horizonte, Brazil
(Clemente) Curitiba Heart Institute, Curitiba, Brazil
(Braga) Department of Medicine, Nove de Julho University, Sao Bernardo do
Campo, Brazil
(Pansani) Department of Medicine, Petropolis School of Medicine,
Petropolis, Brazil
(Almeidinha) Department of Medicine, Federal University of Rio de Janeiro,
Rio de Janeiro, Brazil
(Nascimento) Department of Cardiovascular Surgery, Faculty of Medicine of
Sao Jose do Rio Preto, Sao Jose do Rio Preto, Brazil
(Nascimento, Marino) Department of Internal Medicine, Rochester General
Hospital, Rochester, United States
(Felix) Department of Medicine, Federal University of Campina Grande,
Campina Grande, Brazil
(Veiga) Department of Medicine, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Barbanti) Universita degli Studi di Enna "Kore", Enna, Italy
(Barbanti) Ospedale Umberto I, ASP 4 di Enna, Enna, Italy
(Lemos) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Lemos) Heart Institute - InCor, University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Taramasso) Cardiovascular Surgical Department, University Hospital of
Zurich, Zurich, Switzerland
(Garot) Institut Cardiovasculaire Paris Sud (ICPS), Hopital Jacques
Cartier, Ramsay-Sante, Massy, France
Publisher
Elsevier Inc.
Abstract
Background: The optimal timing for percutaneous coronary intervention
(PCI) in patients undergoing transcatheter aortic valve replacement (TAVR)
is uncertain. Objective(s): To compare different PCI timings in
patients with CAD undergoing TAVR. Method(s): MEDLINE, Embase, and
Cochrane were systematically searched for studies comparing different
timings of PCI in patients with aortic stenosis and coronary artery
disease (CAD) undergoing TAVR. PCI in a staged procedure to TAVR and PCI
concomitantly to TAVR were compared with TAVR alone without PCI. A
frequentist random-effects network meta-analysis calculates the odds ratio
(OR) with a 95 % confidence interval (CI). Treatments were ranked using
P-score analysis. Result(s): Two randomized controlled trials and 24
observational studies comprising 10,901 patients with aortic stenosis and
CAD were included. Compared with PCI and concomitant TAVR, staged PCI was
associated with lower rates of stroke (OR 0.54; 95 % CI 0.37-0.78),
myocardial infarction (OR 0.54; 95 % CI 0.31-0.91), and all-cause
mortality at 30 days (OR 0.62; 95 % CI 0.41-0.95). In addition, a subgroup
analysis showed that staged PCI performed after TAVR is associated with
the lowest rates of all-cause mortality of all strategies. In P-score
analysis, staged PCI presented the highest likelihood of preventing stroke
and myocardial infarction. Conclusion(s): In patients with aortic
stenosis and CAD undergoing TAVR, staged PCI is associated with lower
rates of stroke, myocardial infarction, and short-term mortality compared
with other timings. Copyright © 2025 Elsevier Inc.

<124>
Accession Number
646775536
Title
THE NEUROBICS TRIAL - PERIOPERATIVE COGNITIVE PROTECTION: BASELINE
PARTICIPANT CHARACTERISTICS.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 487-488), 2019. Date
of Publication: 01 May 2019.
Author
Mavarez-Martinez A.C.; Turner N.; Reyes J.-P.; Esparza Gutierrez A.G.;
Roeth C.; Zuleta-Alarcon A.; Bergese S.; Humeidan M.
Institution
(Mavarez-Martinez, Reyes, Esparza Gutierrez, Zuleta-Alarcon, Bergese,
Humeidan) Ohio State University, Wexner Medical Center, United States
(Turner) Ohio State University, United States
(Roeth) Wright State University, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Postoperative delirium (POD) is characterized by impaired
attention, altered level of consciousness and disorganized thinking with
acute onset after surgery. Advanced age, preexisting cognitive impairment,
and use of narcotic medications are predisposing factors for POD. The
Neurobics Trial is a prospective, single-blind, randomized, controlled
study with the objective to evaluate the effectiveness of preoperative
cognitive exercise on lowering the incidence of POD in elderly patients.
The trial has been actively recruiting subjects since March 2015, with 242
patients having provided consent until September 2018 from the required
358. We aim to assess baseline demographics and cognitive assessments of
patients currently enrolled in this study, and compare cognitive scores
between patients in two age groups (<70 and >=70 years) and between
patients who had or had not used opioids preoperatively. METHOD(S):
The Neurobics Trial is recruiting patients >=60 years old, without a
previously diagnosed axis I or II psychiatric disorder, and scheduled for
an elective non-cardiac/non-neurological surgery requiring general
anesthesia. After informed consent is obtained, demographics are collected
from each patient's chart and cognitive assessments are performed at the
preoperative visit within one month prior to surgery. The cognitive
assessments include the Mini-Mental Status Examination (MMSE), Geriatric
Depression Scale (GDS) and Selfadministered Gerocognitive Examination
(SAGE). Out of the 242 patients enrolled in the Neurobics Trial as of
September 2018, 207 patients were included for data analysis and 35 were
excluded for incomplete baseline data. Baseline demographics and cognitive
assessments were summarized using descriptive statistics. Baseline
cognitive assessments were compared between groups using a Kruskal-Wallis
test. Summary statistics are reported as median (inter-quartile range
[IQR]) for continuous variables and frequency (percentage) for categorical
variables. RESULT(S): From the 207 analyzed patients, the median age
was 67 [63, 71] years, 134 (65%) were female and 179 (86%) Caucasian.
Median values for baseline cognitive assessments were: 29 [29, 30] for
MMSE (out of 30), 2 [1, 4] for GDS (out of 15), and 20 [17, 21] for SAGE
(out of 22). Cognitive assessment scores were statistically lower in the
70 and older group for MMSE (p=0.0308), though the clinical relevance of
this is unclear as, the difference is small and both groups were still
well above the threshold for mild-cognitive impairment (MMSE score of
<26). No age-associated difference was seen with the GDS or SAGE (p=0.0506
and p=0.7472 respectively). Out of the 207 patients, 68 (33%) were using
opioids preoperatively. When comparing cognitive test scores between
opioid users and non-users, median values were 29 and 29.5 (p=0.0002) for
MMSE, 3 and 2 for GDS (p=0.0067), and 18 and 20 for SAGE (p=0.0031).
Opioid users had significantly higher GDS scores and lower MMSE scores,
though again with unknown clinical significance based upon testing cutoffs
for depression and cognitive impairment. The SAGE scores were also
significantly lower, and just above the cutoff for cognitive impairment
(SAGE score of <16) in patients taking preoperative opiates.
 CONCLUSION(S): During Neurobics Trial enrollment,
researcher-administrated cognitive testing (MMSE), scores in patients aged
70 and older is lower than younger patients, though both age groups
perform well above a score indicative of functional decline. Preoperative
opioid use is associated with increased markers of preoperative depression
and poorer cognitive performance with selfadministered testing (SAGE) in
patients >60 years old undergoing surgery. Elderly patients may benefit
from the implementation of multimodal analgesia which avoids
opioid-associated risks, including POD.

<125>
Accession Number
646775239
Title
ENCEPHALOGRAPHY GUIDANCE OF ANESTHESIA TO ALLEVIATE GERIATRIC SYNDROMES
(ENGAGESCANADA) STUDY IN CARDIAC SURGERY PATIENTS: A PRAGMATIC, RANDOMIZED
CLINICAL TRIAL.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 138-141), 2019. Date
of Publication: 01 May 2019.
Author
Palermo J.; Overbeek C.; Vogler L.; Deschamps A.; Dumont A.A.; Karkri F.;
Schreiber S.; Jacobsohn E.; El-Gabalwy R.; Kavosh M.; Saha T.; Tanzola R.;
Chen K.; Relke N.; Dumertonshore D.; Avidan M.; Oberhaus J.
Institution
(Palermo, Overbeek, Vogler, Deschamps, Karkri, Schreiber) Universite de
Montreal, Canada
(Dumont) Montreal Health Innovations, Canada
(Jacobsohn, El-Gabalwy, Kavosh) University of Manitoba, Canada
(Saha, Tanzola, Chen, Relke, Dumertonshore) Queen's University, Canada
(Avidan, Oberhaus) Washington University, School of Medicine, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Postoperative delirium (POD) is a geriatric syndrome
characterized by an acute onset of confusion, disorganization and
inattention, with a fluctuating course1. POD is frequent in the cardiac
surgery population, with a reported incidence between 11 and 50%2-6, and
associated complications such as increased risk of falls, prolonged
hospital stay, functional/cognitive decline and increased morbidity and
mortality 7-12. Risk factors for POD are often non-modifiable, such as
older age, male sex, underlying cognitive impairment and psychiatric
conditions13-18, while risk factors more specific to the cardiac surgery
population include the type of surgery, cardiopulmonary bypass time,
transfusions, and mechanical ventilation time15- 18. Recent studies
suggest that the use of a processed EEG for titration of anesthesia can
reduce the incidence of POD across various surgical populations19-24.
Burst suppression more specifically, or the pathological patterns of
high-voltage electrical activity alternating with periods of quiescence
(Figure 1) may be associated with POD26-31. Our primary objective is to
demonstrate whether guiding anesthesia depth using an EEG monitor to avoid
episodes burst suppression can result in a decreased incidence and/ or
severity of delirium in the cardiac surgery population. Secondly, we want
to examine contributing risk factors and the downstream health sequelae of
delirium. METHOD(S): ENGAGES-Canada is an ongoing multi-center,
double-blinded, randomized controlled trial across 4 Canadian sites.
Patients included are those over the age of 60 who are able to provide
informed consent, scheduled for elective cardiac surgery with
cardiopulmonary bypass (Figure 2). Exclusion criteria are pre-operative
delirium, illiteracy or non-fluency in English or French, history of
intraoperative awareness, and planned surgery within five days of index
surgery. Using an anesthesia protocol for EEG-guided anesthesia to avoid
burst suppression (Figure 3), patients are randomized to the intervention
or the control group (non-utilization of the monitor). The anesthesia
practitioner is not blinded to the group assignation, however subjects and
primary outcome assessors are blinded. The primary outcome is defined as
the incidence of postoperative delirium, assessed using the Confusion
Assessment Method (CAM) or CAM-ICU, coupled with the Inouye Delirium Chart
Review Method32 from day one through postoperative day five. The incidence
of delirium will be compared using a chi2 test with 95%CI. Secondary
outcomes include the effect of known risk factors on the incidence of
delirium. These will be examined using exploratory subgroup analyses.
Lastly, 30- day and 1-year patient-reported outcomes of health-related
quality of life and prevention of falls will be assessed using Random
effects regression models for the former and a chi2 test for the latter.
 RESULT(S): Current enrollment includes 550 patients, out of a target
population of 1200. An interim analysis for futility was performed at 230
patients (Table 1). The incidence of delirium across all subjects was
21.7% when considering CAM or Chart Review POD 1-5 (incidence of 15.5%
using CAM only, and 10.1% when using Cart Review only), which is similar
to previously reported POD incidence. Patients in the EEG-blinded group
spent more cumulative time in burst suppression than those guided by EEG:
median 430.2 seconds versus 111.6 seconds in the blind and guided groups
respectively (Table 2). At the halfway point of 570 recruited patients, we
plan to conduct a second interim analysis. CONCLUSION(S):
ENGAGES-CANADA is the first RCT to examine whether avoidance of burst
suppression using EEG guidance can decrease the incidence and/or severity
of delirium in a cardiac surgery population.

<126>
Accession Number
646775453
Title
ASSOCIATION OF COLLOID CHOICE AND BLEEDING FOLLOWING MUSCULOSKELETAL
SURGERY: A RETROSPECTIVE COHORT STUDY AND NATURAL EXPERIMENT.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 821-824), 2019. Date
of Publication: 01 May 2019.
Author
Mclean D.J.; Krishnamoorthy V.; Ellis A.; Stefan M.; Nathanson B.; Cobert
J.; Lindenauer P.; Brookhart M.A.; Raghunathan K.
Institution
(Mclean, Krishnamoorthy, Cobert, Raghunathan) Duke University, United
States
(Ellis) North Carolina State University, United States
(Stefan, Lindenauer) University of Massachusetts Medical School, United
States
(Nathanson) Optistatim, United States
(Brookhart) University of North Carolina at Chapel Hill, Gillings School
of Public Health, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Surgery on the musculoskeletal system, primarily
lower-extremity joint replacement, is the most common major surgical
procedure performed in the United States.1 Perioperatively, intravenous
(IV) fluid therapy is administered to maintain hydration, increase cardiac
output, and replace blood loss.2 In general, the choice of IV fluids
varies, but many patients receive colloids in addition to crystalloids.3,4
Among colloids, the two most widely used in musculoskeletal surgery are
synthetic hydroxyethyl starch (HES) and human-derived albumin solutions,4
but controversy surrounds the use of HES in particular clinical settings
because of safety concerns.5,6 In patients with sepsis and in patients
undergoing cardiac surgery, meta-analyses of randomized controlled trials
comparing albumin versus HES have found that fewer patients are transfused
with RBCs when albumin is used as resuscitation fluid, compared to HES.7,8
Due to a concern for excess bleeding, as well as reports of increased
risks of renal replacement therapy and mortality in critically ill adults,
the United States Food and Drug Administration (FDA) issued a black box
safety warning on HES solutions on June 24, 2013 for patients with
critical illness, pre-existing renal dysfunction, and for those undergoing
open-heart surgery.9 HES solutions continue to be used worldwide in a
variety of other clinical settings, including for postpartum
hemorrhage,6,10 in US combat casualties with hemorrhagic shock11, and
during surgery4. The safety of HES solutions in these settings remains
unknown. To help address this gap, we measured the association of albumin,
compared to HES, with the risk of major bleeding during hospitalization
for elective musculoskeletal surgery in the United States. To support
causal inference, we made a direct comparison and also took advantage of a
natural experiment stemming from the 2013 FDA warning. METHOD(S): We
examined clinical, demographic, facility characteristics, and ICD-9 data
of 41,211 patients from 302 hospitals in the Premier Health Care Database
over 24 consecutive quarters, quarter four 2008 through quarter three
2014. This time period was intentionally selected to observe changes in
practice that occurred following the FDA black-box warning regarding
synthetic colloids. Our study population was adults (age 18 upwards) who
were electively admitted for surgery on the musculoskeletal system, and
within this population we studied those who received either synthetic
colloids or albumin. To examine the association of albumin, compared to
HES, on the risk of major bleeding following musculoskeletal surgery, we
conducted two analyses: 1) Retrospective cohort study; 2) Natural
experiment among 'switcher' hospitals (hospitals whose colloid utilization
changed from mostly HES to mostly albumin after the 2013 FDA warning).
 RESULT(S): In the full sample, 41,211 patients received a colloid
solution on the day of surgery; of those, 68% (29,549) received HES and
32% (13,905) received albumin. The adjusted relative risk for major
bleeding with albumin, compared to HES, was 0.89 (95% CI 0.84-0.93). In
the natural experiment, 23 hospitals were identified as 'switchers,'
comprising 1,892 patients in the year prior to the FDA warning and 1,186
patients in the year following the FDA warning. In the 'switchers,' the
adjusted relative risk for major bleeding, post- versus pre-FDA warning,
was 0.85 (95% CI, 0.70-1.04). There was no difference in the risk of any
secondary outcome in both the full sample and natural experiment.
 CONCLUSION(S): Compared to albumin, HES was associated with a higher
risk of major bleeding in patients undergoing musculoskeletal surgery.
Because HES is used extensively worldwide, further studies of the risks of
HES in different patient populations are needed. (Figure Presented).

<127>
Accession Number
646774735
Title
THE TRANSVERSUS THORACIC PLANE (TTP) BLOCK: A POOLED REVIEW OF 748 CASES.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 881-882), 2019. Date
of Publication: 01 May 2019.
Author
Chung K.W.; Ye Y.; Burnett G.W.; Jeng C.L.
Institution
(Chung, Ye, Burnett, Jeng) Icahn School of Medicine at Mount Sinai, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The transversus thoracic plane (TTP) block is a regional
anesthetic technique first described by Ueshima in 2015 that provides
analgesia of the internal thoracic (mammary) nerve distribution. Given its
relative novelty, most of the literature describing the TTP block is in
the form of case reports. The primary objective of this review is to
examine pooled clinical data from published literature to gain a better
understanding of the characteristics of the TTP block. METHOD(S): A
PubMed search was conducted to identify all publications in which the TTP
block was described or utilized. Given the lack of a uniformly applied
name to describe this block in the literature, search parameters included
'transversus thoracic plane block,' 'internal intercostal plane block,'
and permutations of these two names. Inclusion criteria included reports
of single-shot, intermittent bolus, and continuous TTP blocks, as well as
cadaveric studies. Only English publications were included. Measures
included type of publication, year and country of publication, journal of
publication, type of surgery, block technique, anatomic location,
additional blocks, side effects, and adverse events. Qualitative
statistics were used. RESULT(S): The initial search yielded 525
publications, and after application of inclusion and exclusion criteria,
24 publications from eight journals were included in the pooled review. In
these 24 publications, a total of 748 cases were reported from 2015 to
2018. Among cases in which the type of surgery was specified, the most
common types of surgery were cardiac (66.8%) and breast (28.5%) surgeries.
The vast majority (99.6%) of reported cases utilized a single-shot block.
Reliable sensory loss of the T2- T6 dermatomes was reported. Two instances
of infection (0.267%) and one instance of pain at the site of injection
(0.134%) were reported as adverse events. CONCLUSION(S): To our
knowledge, this is the first review providing a pooled review of TTP block
characteristics. The TTP block appears to be a safe and effective option
for analgesia of the internal thoracic nerve distribution. As the majority
of current studies are case reports, future studies may be warranted to
evaluate the effectiveness of the TTP block in improving clinical
outcomes.

<128>
Accession Number
646775470
Title
EFFECT OF INTRANASAL INSULIN ADMINISTRATION ON GLYCEMIA AND PLASMA INSULIN
IN CARDIAC SURGERY PATIENTS.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 150-151), 2019. Date
of Publication: 01 May 2019.
Author
Nakadate Y.; Roque P.; Sato H.; Sato T.; Kawakami A.; Wykes L.; Cecere R.;
Shum-Tim D.
Institution
(Nakadate) University of Yamanashi, Japan
(Roque, Sato, Kawakami, Wykes, Cecere, Shum-Tim) Mcgill University, Canada
(Sato) Mcgill University Health Centre, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Intranasal insulin administration has been shown to improve
both memory performance and metabolic integrity of the brain in patients
suffering from Alzheimer's disease (AD) or cognitive impairment1-3.
Cognitive dysfunction (POCD) detected in up to 50% of elderly patients
after cardiac surgery4,5 has been associated with poor long-term
outcome5-7. We have previously demonstrated that intravenous
administration of insulin preserves short and long-term memory function
after open heart surgery8. Although the mechanism underlying POCD are not
clear, POCD and AD share a similar pathophysiology, including
neuroinflammation and brain cell apoptosis. Hence, intranasal insulin,
which has shown cognitive benefits in patients with AD, may represent a
novel therapeutic option for the prevention of POCD. Insulin applied as
spray via the nasal route bypasses the blood-brain-barrier and causes a
sustained elevation of insulin concentrations in the cerebrospinal fluid9.
While intranasal insulin does not alter peripheral insulin levels in
non-surgical subjects (9), its influence on glycemia and plasma insulin
levels during major surgical tissue trauma remains to be investigated.
 METHOD(S): This investigation is a single-site, doubleblind
randomized placebo-controlled trial (registered at ClinicalTrail.gov
NCT02729064). With the approval of the local research ethics board, we
approached non-diabetic patients scheduled for elective cardiac surgery
requiring cardiopulmonary bypass. Patients scheduled for procedures with
anticipated deep hypothermic circulatory arrest were excluded. Consenting
patients were randomly assigned to of three groups (Group 1: placebo,
Group 2: 40 IU intranasal insulin, Group 3: 80 IU intranasal insulin).
After orator intubation, patients received either 40 IU or 80 IU of
intranasal insulin or same volume of placebo (normal saline) via a metered
nasal dispenser. Arterial blood samples were collected every 10 minutes
during the first hour and every 30 minutes thereafter. Hypoglycemia was
defined as a blood glucose level < 70mg/dL The primary outcome of the
study was to determine differences in glycemia at 30 minutes after
intranasal insulin administration. The secondary outcomes are the
incidence hypoglycemia and change of plasma insulin concentration during
surgery. Blood glucose concentrations and the change in plasma insulin
(plasma insulin value at each time point minus baseline plasma insulin
value) were compared using two-way ANOVA followed by the Bonferroni
post-hoc test. Two-sided P values less than 0.05 were considered
statistically significant. RESULT(S): We collected data from 76
patients. There was no significant difference at baseline. Blood glucose
values after intranasal insulin administration is shown in Figure 1. There
were no significant differences in blood glucose values at any time point
among the three groups and no patient showed hypoglycemia at any time
point during surgery. Figure 2 shows changes in plasma insulin. Intranasal
insulin administration did not affect plasma insulin levels and there was
no significant difference among three groups at any time point.
 CONCLUSION(S): Intranasal administration of 40IU or 80IU of insulin
did not affect blood glucose and plasma insulin levels. No hypoglycemic
episode was detected during the study period. The study demonstrated, for
the first time, that intranasal insulin administration up to 80 IU is
feasible and safe in patients undergoing cardiac surgery.

<129>
Accession Number
646775438
Title
CHILDREN AND ADULTS WITH CONGENITAL HEART DISEASE SHOW NO DIFFERENCE IN
SCORES ON MEASURES OF BEHAVIOR AS COMPARED TO THEIR HEALTHY PEERS: A
SYSTEMATIC REVIEW AND METAANALYSIS.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 716-718), 2019. Date
of Publication: 01 May 2019.
Author
Jackson W.M.; Sadat M.; Sun L.
Institution
(Jackson, Sun) Columbia University, United States
(Sadat) Columbia University Medical Center, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Children with congenital heart disease (CHD) are at higher
risk for cognitive dysfunction compared to their healthy peers.1,2 Several
reports have also indicated these children have an increased risk of
behavioral problems,3,4 which may place them at higher risk for impaired
educational attainment and a later diagnosis of mood disorders.5,6 To test
the hypothesis that children with CHD have increased behavioral problems
on validated parental and teacher reports of behavioral symptoms, we
performed a meta-analysis of Total Problems scores on behavioral measures
in children with CHD versus healthy children. METHOD(S): We conducted
a literature search in CINAHL, Pubmed, Embase, PsycInfo, Web of Science,
and the Cochrane Collaboration using broad search terms. Inclusion
criteria were studies that reported a Total Problems score on a validated
behavioral measure in children with CHD over the age of three. We excluded
studies that included children under the age of three, and those that
included children receiving heart transplantation. Titles and abstracts
were screened for potential inclusion, and full texts were reviewed by two
authors to determine whether inclusion criteria were met. Data were
extracted by hand and analyzed using CMA software (Biostat, Englewood,
NJ). RESULT(S): A total of 43,758 search results were screened for
potential studies to include. We conducted a full-text review of 52
articles and abstracts, and 16 were selected for inclusion (Figure 1). We
included Total Problems scores from the Child Behavior Checklist, the
Teacher Report Form, and the Behavioral Assessment System for Children in
the final analysis. We found an overall standardized mean difference (SMD)
of -0.129 (95% confidence interval : -0.286, 0.029, p = 0.111, Figure 2)
in children with CHD compared to healthy controls. The I2 statistic was
75%, indicating that there was significant heterogeneity between studies
(Table 1). Visual inspection of the funnel plot indicated the potential
for publication bias (Figure 3). CONCLUSION(S): A meta-analysis of
Total Problems scores in children with CHD showed no increased risk of
behavioral problems compared to healthy controls. However, there was a
substantial heterogeneity in the analysis, indicating that there may be
subgroups that are at higher risk for behavioral problems in the CHD
population. To identify these potential subgroups, we plan to perform
sensitivity analysis and meta-regression in the future. (Figure
Presented).

<130>
Accession Number
646775585
Title
PREVENTION OF EARLY POSTOPERATIVE DECLINE (PEAPOD): A RANDOMIZED
CONTROLLED TRIAL INVESTIGATING THE FEASIBILITY OF A PERIOPERATIVE
COGNITIVE TRAINING PROGRAM.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 158-161), 2019. Date
of Publication: 01 May 2019.
Author
O'Gara B.; Mueller A.; Gasangwa D.V.; Leone A.P.; Marcantonio E.;
Subramaniam B.
Institution
(O'Gara, Mueller, Gasangwa, Leone, Marcantonio, Subramaniam) Beth Israel
Deaconess Medical Center, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Older cardiac surgery patients are at the highest risk of
postoperative delirium and postoperative cognitive decline (POCD), leading
to an increased risk of in-hospital mortality and long term cognitive
deficits1,2,3. Training software may increase cognitive reserve in areas
that are affected in delirium and POCD4,5. The feasibility of this novel,
patient-led approach to prevent these conditions in the cardiac surgery
population is currently unknown. METHOD(S): PEaPoD is a randomized
controlled feasibility trial that took place at a single center from
2016-2019. Patients aged 60-90 years undergoing cardiac surgery with
cardiopulmonary bypass at least 10 days from enrollment with an
educational level of high school or equivalent were included. Those with
anxiety, depression, stroke, dementia, epilepsy, or other forms of
cognitive impairment at baseline were excluded. After enrollment, patients
were randomized to a mobile application-based cognitive training group
(CTG) or a usual care control. Cognitive training consisted of two daily
15-minute sessions starting from enrollment through one month
postoperatively. During each session, patients were instructed to train in
the following cognitive domains: memory, attention, problem solving,
flexibility and processing speed (Fig1). Descriptive statistics were
collected to evaluate study feasibility, which was defined by adequate
recruitment and protocol adherence. Secondary outcomes included the
incidence of postoperative delirium assessed daily with the Confusion
Assessment Method (CAM), and the incidence of POCD at hospital discharge
and at one, three and six months postoperatively assessed with the
Montreal Cognitive Assessment (MoCA). Patient satisfaction was assessed
with a survey consisting of standardized quantitative instruments,
true/false, and multiple-choice questions. Secondary outcomes were
analyzed using t-test, Wilcoxon, or chi-square tests as appropriate.
Logistic regression was employed to predict the incidence of POCD, defined
as a one standard deviation decrease from baseline MoCA score. P values of
less than 0.05 were considered significant. RESULT(S): 45 out of 69
eligible patients consented to participate (65%). Data from the 41
patients who completed the study was analyzed. The majority of patients
were male with a median age of 70 years (Table 1). Patients in the CTG
group felt more strongly than controls that their memory and thinking
abilities improved from participating in the study (p=0.01). CTG patients
agreed highly that cognitive training was enjoyable and easy to use (Table
2). Adherence was highest in the preoperative period and lowest in the
immediate postoperative period (Fig 2). The incidence of postoperative
delirium did not differ between groups (30% vs 14%, CTG vs control, OR
2.57 [0.55, 12.14]; p=0.28). No statistically significant difference was
observed in MoCA scores at any time point or in the incidence of POCD at
discharge (Table 3; 53 vs 37% CTG vs control, OR 1.93 [0.51, 7.31];
p=0.33). CONCLUSION(S): Older patients undergoing cardiac surgery
demonstrate sufficient interest and ability to adhere to a perioperative
cognitive training program. The preoperative period is an attractive
target of a larger, adequately powered efficacy trial evaluating whether
cognitive prehabilitation can prevent delirium and POCD.

<131>
Accession Number
646775442
Title
FACTOR VIII INHIBITOR BYPASS ACTIVITY (FEIBA) FOR THE REDUCTION OF
TRANSFUSION IN CARDIAC SURGERY: A RANDOMIZED DOUBLE BLIND PLACEBO
CONTROLLED PILOT TRIAL.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 148-149), 2019. Date
of Publication: 01 May 2019.
Author
Bingham A.; Sera V.; Song H.; Rodriguez V.; Raman J.; Tibayan F.;
Treggiari M.
Institution
(Bingham, Sera, Song, Rodriguez, Raman, Tibayan, Treggiari) Oregon Health
and Science University, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Transfusions are associated with adverse outcomes in cardiac
surgery.1 Specifically, surgical procedures involving the aorta with long
cardiopulmonary bypass (CPB) have higher risk of coagulopathy. When
transfusion does not control coagulopathy, common practice is rescue
therapy with prothrombin complex concentrates (PCC).2-4 Factor eight
inhibitor bypassing activity (FEIBA) is a PCC with Factor VIII coagulant
antigen as well as factors II, IX and X, in non-activated form, and
activated factor VIIa. We conducted a pilot study evaluating feasibility
and safety of prophylactic administration of FEIBA after CPB in cases with
anticipated coagulopathy. METHOD(S): After Institutional Review Board
approval, we conducted a randomized, double-blinded, placebocontrolled
pilot trial from August 2016 to August 2017. We included patients
scheduled for aortic surgery with CPB or deep hypothermic circulatory
arrest. Participants were randomly assigned to receive FEIBA 20 IU/kg or
placebo after separation from CPB and protamine administration. After
study drug administration, coagulopathy was managed according to a
standardized algorithm (Fig 1) that included the administration of fresh
frozen plasma (FFP), platelets and packed red blood cells (PRBC). Up to 2
apheresis platelets and 2 FFP were given empirically; additional products
based on coagulation panels. If refractory bleeding persisted after 4 FFP
and 2 platelets, rescue therapy of open-label FEIBA was given, not to
exceed a total dose of 20 IU/kg. RESULT(S): Twelve subjects were
randomized (6 FEIBA and 6 placebo). Baseline characteristics differed for
age (62.5 vs. 49.2 y), gender (females 67% vs. 0%), BMI (33 vs. 26), and
hypertension (100% vs 50%); all higher in the FEIBA group compared to
placebo. Compared to the placebo group, baseline hematocrit was lower in
the FEIBA group (39% vs 43%), and mean duration of DHCA (93 min vs. 24
min) was longer in the FEIBA group. The primary endpoint of volume of all
products transfused was not different between groups, difference -899 mL
(95%CI: -5,206 to 3,409). However, the transfusion of PRBC and
cryoprecipitate was higher in the FEIBA group (4 units vs 0 units PRBC, 3
units vs 0 units cryoprecipitate). There were no differences in the
frequency of adverse events. CONCLUSION(S): We demonstrated the
feasibility of a double-blind, placebo-controlled protocol to test whether
administration of prophylactic FEIBA decreases transfusion of blood
products in patients at high risk for coagulopathy in cardiac surgery.
Although the trial was not powered for the evaluation of efficacy, the
study provides estimates of variability for the planning of a pivotal
trial.

<132>
Accession Number
646774654
Title
RESTRICTIVE VERSUS LIBERAL TRANSFUSION STRATEGIES IN CARDIAC SURGERY: A
SYSTEMATIC REVIEW AND META-ANALYSIS WITH TRIAL SEQUENTIAL ANALYSIS.
Source
Anesthesia and Analgesi. Conference: 2019 Annual Meeting of the
International Anesthesia Research Society and International Science
Symposium. Montreal, QC Canada. 128(5 Supplement) (pp 104-107), 2019. Date
of Publication: 01 May 2019.
Author
Kashani H.; Lodewyks C.; Kavosh M.S.; Neilson C.; Rabbani R.; Abou-Setta
A.; Grocott H.P.
Institution
(Kashani, Lodewyks, Kavosh, Neilson, Rabbani, Abou-Setta, Grocott)
University of Manitoba, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Blood transfusions are often necessary in cardiac surgery,
with up to 90% of requiring transfusion of allogenic red blood cells
(RBCs). On the one hand, there is a sound physiologic basis for the use of
RBCs to improve oxygen delivery to tissues in situations of hemorrhage and
anemia. However, there is a range of risks associated with blood
transfusions, including infection, transfusion-related lung injury, and
allergic reactions. Several studies have compared a 'restrictive' strategy
[i.e., RBC transfusion at a lower hemoglobin (Hb) or hematocrit (Hct)],
with a 'liberal' strategy (i.e., RBC transfusion at a higher Hb or Hct).
Despite the large number of published studies, no clear consensus has
emerged to guide blood transfusion practice in cardiac surgery patients.
We conducted a systematic review (SR) and meta-analysis with trial
sequential analysis (TSA) to critically appraise and summarize the
evidence on the overall effect of restrictive transfusion on mortality and
other clinical outcomes compared with liberal transfusion in adult
patients undergoing cardiac surgery. METHOD(S): Our systematic review
and meta-analysis and trial sequential analysis of randomized clinical
trials (RCTs) was conducted in accordance with the Cochrane Handbook for
Systematic Reviews of Interventions and is reported as being compliant
with the PRISMA guidelines. The protocol was registered a priori with
PROSPERO (CRD42017071440). The primary outcome of our review was all-cause
mortality. The secondary outcomes were: myocardial infarction (MI), renal
failure, stroke, ICU (length of stay) LOS, hospital LOS, days on
mechanical ventilation, and transfusion requirements related outcomes. We
searched electronic databases including MEDLINE (OvidSP), EMBASE (OvidSP)
and the Cochrane Central Register of Clinical Trials (CENTRAL - Wiley),
from inception to 1 December 2017. The longest follow-ups available were
used for all reported outcomes. We calculated treatment effects for
dichotomous variables as risk ratio (RR), rate ratio for count data, and
mean differences (MD) for the continuous outcome data, all with 95%
confidence intervals (CI). The risk of bias was assessed using the
Cochrane Risk of Bias Tool, and a trial sequential analysis (TSA) was used
to pool the results from the included studies for the primary outcomes.
 RESULT(S): Following the screening of 7,908 citations retrieved from
the literature search, we included 10 trials1-10 (9,282 participants) plus
8 companion publications. Table 1 summarizes the characteristics of
included trials. Overall, there was no significant difference in mortality
(RR, 1.08; 95% CI, 0.76 to 1.27) (Figure 1). Further, the use of a
restrictive transfusion threshold did not appear to adversely impact the
rate of the secondary clinical outcomes (Table 2). The number of
individuals who received packed RBCs in the liberal group was
significantly higher than in the restrictive group (RR, 0.68; 95% CI, 0.64
to 0.73) (Figure 2).The use of a restrictive transfusion trigger resulted
in an average savings of 0.83 units of packed RBCs per transfused patient
(RR, 0.83; 95% CI, 0.77 to 0.90) (Figure 3). The TSA results, indicates
that, the required information size (i.e., 30,693 participants) for the
outcome of mortality was not reached. The boundaries for benefit, harm, or
futility were also not reached, suggesting an inconclusive result.
 CONCLUSION(S): Our analysis indicated that a restrictive transfusion
strategy decreased exposure to RBCs by more than 30%, saving an average of
0.83 units of packed RBCs per transfused patient while having no
significant impact on all-cause mortality, MI, renal failure, stroke, ICU
LOS, hospital LOS, or days on mechanical ventilation. Our meta-analysis
provides the highest-quality evidence to date that RBC transfusion is safe
(compared with available alternatives) in adults undergoing cardiac
surgery, and that transfusion should be withheld until hemoglobin
thresholds of 70-80 g/L are reached. The current evidence does not support
the notion that restrictive RBC transfusion strategies are inferior to
liberal RBC transfusion strategies in patients undergoing cardiac surgery.
In summary, a restrictive transfusion strategy decreased red cell use by
30% and was safe in patients undergoing cardiac surgery, and so we
recommend the use of a restrictive transfusion strategy of 70 to 80 g/L
for patients undergoing cardiac surgery.

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