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<1>
Accession Number
2041374815
Title
Total Intravenous Versus Volatile Anesthesia in Pediatric Cardiac Surgery:
Inflammatory Response and Early Recovery Profiles.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 162-169),
2026. Date of Publication: 01 Jan 2026.
Author
Patel G.; Mandal B.; Kahlon S.; Garg V.; Puri G.D.; Kst S.; Rawat A.
Institution
(Patel, Mandal, Kahlon, Garg, Puri) Department of Anesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh, India
(Kst) Department of Cardiovascular and Thoracic Surgery, Postgraduate
Institute of Medical Education and Research (PGIMER), Chandigarh, India
(Rawat) Pediatric Allergy and Immunology Unit, Postgraduate Institute of
Medical Education and Research (PGIMER), Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objectives: To compare the effects of total intravenous anesthesia (TIVA)
versus volatile anesthesia on systemic inflammation and early
postoperative cognitive recovery in pediatric patients undergoing cardiac
surgery with cardiopulmonary bypass. Design(s): Prospective,
randomized controlled trial. Setting(s): A tertiary care center
specializing in pediatric cardiac surgery. Participant(s): Fifty
children aged 1 to 12 years undergoing elective open heart surgery
requiring cardiopulmonary bypass. Intervention(s): Participants were
randomized to receive either propofol-based TIVA or sevoflurane-based
volatile anesthesia. All patients were managed under standardized
protocols for intraoperative monitoring and postoperative intensive care
unit care. Measurements and Main Results: The primary outcome was the
interleukin-6 concentration measured at baseline, 6 hours, and 24 hours
postoperatively. Interleukin-6 levels increased significantly in both
groups but showed no difference between groups at any time point.
Secondary outcomes included Mini-Mental State Examination (MMSE) scores
and duration of mechanical ventilation. Cognitive recovery was assessed in
34 children aged 4 years and older using a pediatric-adapted MMSE. At 24
hours post extubation, the mean MMSE scores were significantly higher in
the TIVA group (23.7 +/- 2.1) than in the volatile group (15.1 +/- 3.0; p
< 0.01), and the difference persisted at 48 hours (27.2 +/- 1.4 vs 23.6
+/- 2.8; p < 0.05). Ventilation duration was also shorter in the TIVA
group (12.4 +/- 3.2 hours vs 20.0 +/- 4.6 hours; p = 0.045).
 Conclusion(s): Interleukin-6 responses, the primary outcome, were
comparable between groups. However, TIVA was associated with higher early
MMSE scores and shorter ventilation duration, suggesting potential
neuroprotective benefits. Copyright © 2025 Elsevier Inc.

<2>
Accession Number
2042025482
Title
S3115 Prevalence and Incidence of Gastroparesis Following Lung or Heart
Transplantation: A Systematic Review and Meta-Analysis.
Source
American Journal of Gastroenterology. 120(10S2) (pp S671-S671), 2025. Date
of Publication: 01 Oct 2025.
Author
Eldesouki M.; Marey M.; Ali M.A.; Othman A.; Mahmoud Genidy A.; Ibrahim
A.; Gamal M.; Mohamed A.N.; Aldemerdash M.A.; Sharma A.
Publisher
Wolters Kluwer Health

<3>
Accession Number
2041657751
Title
The Efficacy of a Multidisciplinary Perianesthetic Management Bundle for
Alleviating Delirium After Thoracic Surgery: A Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 290-299),
2026. Date of Publication: 01 Jan 2026.
Author
Xu M.; Wu Y.; Wang R.; Luo C.; Chen J.; Yang J.
Institution
(Xu, Wu, Wang, Luo, Chen, Yang) Department of Anesthesiology, West China
Hospital, Sichuan University, Sichuan, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Postoperative delirium significantly worsens surgery
prognosis. Here, the authors assessed the ability of comprehensive
perianesthetic management to reduce the risk of delirium after thoracic
surgery. Design(s): This was a prospective, randomized, single-blind
study. Setting(s): The study was conducted at a tertiary care
institution and university-level teaching hospital. Participant(s): A
total of 508 patients scheduled to undergo elective thoracic surgeries
with an expected anesthesia duration of at least 2 hours were enrolled.
 Intervention(s): All eligible participants received routine pre- and
postoperative nonpharmacologic interventions, and the intervention group
also received comprehensive perianesthetic management, including
perioperative pain control, rational medication, refined intraoperative
management, and cognitive training. Delirium was assessed using the
Confusion Assessment Method. Measurements and Main Results: Of the
508 randomized patients, 497 were included in the final analysis.
Postoperative delirium occurred in 9 of 247 patients (3.6%) in the
intervention group and in 23 of 250 patients (9.2%) in the control group.
Bundle perianesthetic management was associated with a significantly lower
risk of delirium, both in per-protocol analysis (relative risk 0.40, 95%
confidence interval 0.19-0.84, p = 0.012) and intention-to-treat analysis
(relative risk 0.39, 95% confidence interval 0.19-0.84, p = 0.011). No
significant differences were observed between the groups in terms of
delirium duration, postoperative pain, ability to perform activities of
daily living, hospitalization duration, or hospital-related costs.
 Conclusion(s): The findings support integrating this bundle into
perioperative pathways to reduce the risk of delirium after thoracic
surgery. Further studies are warranted to evaluate its feasibility,
generalizability, and safety in broader clinical settings. Copyright
© 2025 Elsevier Inc.

<4>
Accession Number
2040473207
Title
The Effects of Nonpharmacological Interventions on Sleep Quality in
Cardiac Surgical Patients: A Prospective Randomised Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 229-234),
2026. Date of Publication: 01 Jan 2026.
Author
Gayatri A.; Panidapu N.; Neema P.K.; Madathil T.; Poduval D.; Palamattam
D.J.; Varma P.K.
Institution
(Gayatri, Panidapu, Neema, Madathil, Poduval, Palamattam) Department of
Cardiac Anesthesia & Critical Care, Amrita Institute of Medical Sciences,
Kochi, India
(Varma) Department of Cardiac Surgery, Amrita Institute of Medical
Sciences, Kochi, India
Publisher
W.B. Saunders
Abstract
Objectives: The primary objective of the current study was to evaluate
whether the use of eye masks and ear plugs improves postoperative sleep
quality in patients undergoing cardiac surgery. The secondary objectives
include the evaluation of nonpharmacological interventions on daytime
sleepiness, opioid consumption, and postoperative complications Design:
Prospective, randomized, controlled, parallel-group study. Participants
and setting: The study was conducted in 100 adult patients undergoing
elective cardiac surgery in a quaternary care hospital.
 Intervention(s): The intervention group received ear plugs and an eye
mask from 10:00 PM to 6:00 AM. The quality of sleep was assessed on the
morning of the next day using the Richards-Campbell Sleep Questionnaire.
 Measurements and Main Results: The intervention group had
significantly higher Richards-Campbell Sleep Questionnaire scores (78 v
62; p < 0.05) and a significant reduction in daytime sleepiness (30% v
62%; p < 0.05) and opioid consumption (7.35 mg v 12.75 mg; p < 0.05). The
incidence of postoperative atrial fibrillation, delirium, and length of
stay in the intensive care unit were comparable between the groups.
 Conclusion(s): Eye masks and ear plugs improve the quality of sleep
and reduce daytime sleepiness and opioid consumption in patients
undergoing cardiac surgery. Copyright © 2025 Elsevier Inc.

<5>
Accession Number
2037446828
Title
End-tidal CO<inf>2</inf> response to passive leg raise for fluid
management in lung resections: A randomized controlled trial.
Source
Pakistan Journal of Medical Sciences. 41(12) (pp 3393-3398), 2025. Date of
Publication: 01 Dec 2025.
Author
Uzan H.S.A.; Yuceyar L.; Sayilgan N.C.
Institution
(Uzan) Department of Anesthesiology and Reanimation, Edirne State
Hospital, Saglik Mah. Dr. Sadik Ahmet Cad. No: 8, Edirne, Turkey
(Uzan, Yuceyar, Sayilgan) Department of Anesthesiology and Reanimation,
Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul,
Fatih, Turkey
(Yuceyar, Sayilgan) Cerrahpasa Medical Faculty, Istanbul
University-Cerrahpasa, Istanbul, Fatih, Turkey
Publisher
Professional Medical Publications
Abstract
Objective: To evaluate whether changes in end-tidal carbon dioxide (EtCO)
following passive leg raise (PLR) can predict fluid responsiveness and
guide fluid therapy in patients undergoing Lung Resection Surgery (LRS).
Methodology: This prospective randomized controlled trial was conducted at
Istanbul University-Cerrahpasa Medical Faculty Hospital, Istanbul, Turkey,
between August 2020 and March 2021. Fifty patients undergoing elective LRS
were enrolled. After anesthesia induction, EtCO<inf>2</inf> was measured
before and one minute after PLR. A >=2 mmHg increase was considered
responsive. Responders were randomized into a study group (fluid bolus)
and a control group (maintenance fluid only); non-responders formed a
third group. Hemodynamic parameters, fluid balance, urea, creatinine and
lactate levels were recorded perioperatively. Result(s): The
proportion of fluid responders was 62%. The study group received
significantly more intravenous fluid and showed no cases of acute kidney
injury (AKI), while AKI was observed in the control and unresponsive
groups. Postoperative urea levels increased significantly only in the
control group. Lactate levels rose intraoperatively in all groups but
normalized within 24 hours. A positive correlation was found between
surgical duration and lactate levels. EtCO<inf>2</inf> and heart rate did
not differ significantly between groups. Conclusion(s):
EtCO<inf>2</inf> changes in response to PLR may provide a simple,
non-invasive indicator of fluid responsiveness in thoracic surgery.
Targeted fluid supplementation in responsive patients appears to improve
renal outcomes. Further studies are needed to validate these
findings. Copyright © 2025, Professional Medical Publications.
All rights reserved.

<6>
Accession Number
2040656287
Title
Challenges and solutions for optimizing outcomes in patients undergoing
surgical left atrial appendage closure.
Source
Future Cardiology. 21(12) (pp 1143-1153), 2025. Date of Publication: 2025.
Author
Huang C.; Chen Z.; Li S.; Lu H.; Zhang X.
Institution
(Huang, Chen, Li, Lu, Zhang) Department of Cardiovascular Surgery, The
First Affiliated Hospital, Jinan University, Guangzhou, China
Publisher
Taylor and Francis Ltd.
Abstract
Left atrial appendage closure (LAAC) during cardiac surgery is a pivotal
strategy for stroke prevention in atrial fibrillation (AF), gaining
recognition in guidelines (Class I AHA 2023, Class IIa ESC 2024). This
review identifies critical challenges and proposes solutions for
optimizing outcomes. Challenges 1) Patient Selection: Significant
controversy exists regarding extending LAAC to high-stroke-risk patients
without documented AF;(CHA2DS2-VASc >=2), where 50% of post-cardiac
surgery strokes occur, creating an evidence-practice gap. Conflicting
meta-analyses exist (Baudo et al. vs. Kowalewski et al.). 2) Technique
Standardization: Marked heterogeneity in surgical techniques (suture,
excision, stapling) and lack of standardized protocols lead to highly
variable success rates (0%-100%), unlike standardized clipping (AtriClip;
> 93% success). 3)Post-procedural Management: Unresolved debates persist
on optimal post-surgical antithrombotic regimens and the standalone
efficacy of LAAC vs. anticoagulation. Solutions 1) Ongoing RCTs (LeAAPS,
LAA-CLOSURE, LAACS-2) aim to define LAAC efficacy in non-AF populations.
2) Implement evidence-based standardized operating procedures (SOPs) for
each technique, prioritizing validated clipping devices. Promote unified
imaging criteria (transesophageal echocardiography(TEE) intra-operation,
Cardiac Computed Tomography Angiography(CCTA) follow-up) per AHA 2023
guidelines. 3) The LAA-CLIP trial is evaluating thoracoscopic clipping vs.
DOACs, potentially supporting anticoagulation simplification post-LAAC.
Addressing these challenges through standardization and targeted trials is
crucial for maximizing LAAC efficacy. Plain Language Summary: Left atrial
appendage closure(LAAC) during heart surgery has become a key procedure
for stroke prevention in patients with atrial fibrillation (AF), and is
now strongly recommended by major international guidelines. However,
several important challenges remain that affect its broader application. A
significant controversy is whether LAAC should also be performed in
patients who do not have AF but are at high risk of stroke. In addition,
there is considerable variation in the techniques used to close the
appendage, such as suturing, cutting, or stapling, leading to inconsistent
success rates. The use of approved clipping devices, in contrast, offers
much more reliable outcomes. Furthermore, there is ongoing debate
regarding the optimal use of medications after surgery and whether LAAC
alone can replace long-term anticoagulation. To address these issues,
multiple clinical trials are underway to evaluate the benefits of LAAC in
patients without AF, efforts are being made to standardize surgical
methods and verification imaging, and studies are exploring simplified
drug regimens post-surgery. Successfully overcoming these challenges will
enhance the consistency and effectiveness of LAAC, making it a more
trusted option in preventing strokes. Copyright © 2025 Informa UK
Limited, trading as Taylor & Francis Group.

<7>
Accession Number
2039975343
Title
Effects of Individualized Positive End-Expiratory Pressure on Patients
Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 364-371),
2026. Date of Publication: 01 Jan 2026.
Author
Sun X.; Gao Y.; Jin X.; Lin W.
Institution
(Sun, Jin, Lin) Department of Anesthesiology, The First Affiliated
Hospital, Zhejiang University School of Medicine, Zhejiang, China
(Gao) Department of Anesthesiology, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Zhejiang, China
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the impact of individualized positive
end-expiratory pressure (PEEP) versus fixed PEEP on postoperative
pulmonary complications (PPCs), intraoperative oxygenation, and
respiratory mechanics in thoracic surgery. One-lung ventilation (OLV)
poses potential risks of PPCs. PEEP may mitigate lung injury, but the
optimal PEEP level remains uncertain. Method(s): We searched PubMed,
Embase, Web of Science, and Cochrane for randomized controlled trials
(RCTs) comparing individualized PEEP versus fixed PEEP during OLV
published up to December 2024. The primary outcome was the occurrence of
overall PPCs during hospitalization. Secondary outcomes included
postoperative hypoxemia, atelectasis, pneumonia, acute respiratory
distress syndrome (ARDS), intraoperative oxygenation, dynamic compliance,
driving pressure, and hospital length of stay. Risk ratios (RRs) and mean
differences were calculated using the DerSimonian-Laird method. Study
quality was evaluated using the Cochrane Risk of Bias tool version 2 for
RCTs trials. Trial sequential analysis (TSA) was used to assess result
reliability. Result(s): Six RCTs (with a total of 1,844 patients)
were included, with 5 studies (1,814 patients) reporting PPCs.
Individualized PEEP did not significantly reduce overall PPCs (RR, 0.78;
95% confidence interval, 0.59-1.03; p = 0.08), hypoxemia, pneumonia, or
atelectasis; however, it reduced postoperative ARDS and improved
intraoperative oxygenation and lung compliance. TSA revealed that the
current sample size of 1,814 in PPCs was below the required 3,660, and
that the z-curve did not cross the TSA monitoring boundaries.
 Conclusion(s): Individualized PEEP in thoracic surgery may improve
intraoperative oxygenation, pulmonary mechanics, and reduce postoperative
ARDS but does not significantly lower overall PPCs. Overall, the quality
of the evidence is low and inconclusive, and further investigation is
warranted. Copyright © 2025 Elsevier Inc.

<8>
Accession Number
2041927464
Title
Comparative analysis of robot-assisted minimally invasive esophagectomy
versus conventional minimally invasive esophagectomy, a systematic review
and meta-analysis.
Source
Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number:
98. Date of Publication: 01 Dec 2026.
Author
Shah N.A.; Ali L.; Arif A.; Khan A.; Khan J.; Rahman O.U.; Ullah R.;
Shaheen M.; Batool Z.; Jan A.; Haseeb A.
Institution
(Shah, Arif, Khan, Rahman, Ullah, Jan) Khyber Teaching Hospital, Peshawar,
Pakistan
(Ali, Ullah) Khyber Medical College, Peshawar, Pakistan
(Khan, Haseeb) Hayatabad Medical Complex, Peshawar, Pakistan
(Shaheen, Batool) Riphah International University, Rawalpindi, Pakistan
Publisher
Springer Nature
Abstract
Robot-assisted minimally invasive esophagectomy (RAMIE) may enhance
visualization and lymph-node dissection compared with conventional
minimally invasive esophagectomy (cMIE), but comparative effectiveness
remains uncertain. We performed a PRISMA-compliant systematic review and
meta-analysis of randomized controlled trials and propensity-matched
cohort studies comparing RAMIE with MIE (from 2013 to August 26th, 2025).
PubMed, Cochrane Library, Embase, and Web of Science were searched.
Continuous outcomes were pooled as mean differences (MD) and dichotomous
outcomes as risk ratio (RR) using randomized-effects models; heterogeneity
was assessed with I2. Risk of bias was evaluated with RoB-2 for
trials and the Newcastle-Ottawa Scale for cohorts. Twenty-five studies (~
8,900 patients; RAMIE = 4,200; MIE = 4,700) met eligibility criteria.
Total operative time was longer with RAMIE (MD 38.91 min, 95% CI
16.05-61.76; p = 0.0008; I2=97%), while thoracic operative time alone was
not significantly different (MD 16.18 min, 95% CI - 2.46 to 34.82; p =
0.09; I2=94%). Estimated blood loss was modestly lower with RAMIE (MD -
12.73 mL, 95% CI - 25.25 to - 0.21; p = 0.05; I2=86%). RAMIE achieved a
higher total lymph node yield (MD 2.01 nodes, 95% CI 1.05-2.96; p < 0.001;
I2=57%) and retrieved more left RLN lymph nodes (MD 0.60, 95% CI
0.13-1.08; p = 0.01), with no significant difference in right RLN nodes
(MD 0.11, 95% CI - 0.02 to 0.24; p = 0.09; I2 = 31%). In-hospital
mortality (RR 0.76, 95% CI 0.42-1.39; p = 0.38; I2=0%) and 90-day
mortality (RR 0.97, 95% CI 0.53-1.77; p = 0.91; I2=0%) were similar.
Overall complications (RR 0.90, 95% CI 0.79-1.02; p = 0.09) and major
complications (RR 0.80, 95% CI 0.63-1.01; p = 0.06) did not differ.
Pulmonary complications trended lower (RR 0.88, 95% CI 0.76-1.02; p =
0.10), and recurrent laryngeal nerve palsy was borderline lower (RR 0.79,
95% CI 0.62-1.00; p = 0.05). Length of stay was shorter with RAMIE (MD -
1.28 days, 95% CI - 2.26 to - 0.34; p = 0.01; I2=84%), whereas ICU stay
was longer (MD 2.68 days, 95% CI 0.51-4.84; p = 0.02; I2=98%). Publication
bias signals for thoracic operative time and length of stay were driven by
outlier on sensitivity analysis. RAMIE and cMIE are both safe. RAMIE
involves a longer operative time but yields lower estimated blood loss, a
higher total lymph nodes harvest-particularly along the left RLN- fewer
pulmonary complications by trend, and a shorter length of stay, with no
significant difference in anastomotic leak or early mortality. These
results support patient-centered selection between RAMIE and cMIE, taking
center experience and the learning curve into account. PROSPERO
CRD420251134020. Copyright © The Author(s), under exclusive
licence to Springer-Verlag London Ltd., part of Springer Nature 2025.

<9>
Accession Number
2041286638
Title
Combination of Serratus Anterior and Deep Parasternal Intercostal Plane
Blocks versus Erector Spinae Plane Block for Acute Pain Management After
Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 256-265),
2026. Date of Publication: 01 Jan 2026.
Author
Aydin M.E.; Karapinar Y.E.; Medetoglu Koksal E.N.; Yilmaz M.A.; Yayik
A.M.; Celik E.C.; Oral Ahiskalioglu E.; Erkut B.; Ahiskalioglu A.
Institution
(Aydin, Karapinar, Yilmaz, Yayik, Celik, Oral Ahiskalioglu, Ahiskalioglu)
Department of Anesthesiology and Reanimation, Ataturk University School of
Medicine, Erzurum, Turkey
(Medetoglu Koksal) Department of Anesthesiology and Reanimation,
University of Health Sciences, Erzurum City Hospital, Erzurum, Turkey
(Erkut) Department of Cardiovascular Surgery, Ataturk University School of
Medicine, Erzurum, Turkey
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the analgesic efficacy of bilateral erector spinae
plane block (ESPB) versus the combination of deep parasternal intercostal
plane block (DPIPB) and serratus anterior plane block (SAPB) for managing
acute pain after cardiac surgery. Design(s): Prospective, randomized,
assessor-blinded controlled trial Setting: A single institution, an
academic university hospital Participants: Sixty patients scheduled for
elective on-pump cardiac surgery through median sternotomy Interventions:
Patients were allocated at random into 2 groups: bilateral ESPB (n = 30)
and combined DPIPB and SAPB (n = 30). Measurements and Main Results:
The primary outcome was postoperative opioid consumption over the first 24
hours. Secondary outcomes included pain scores at rest and during
coughing, rescue analgesia requirements, and opioid-related adverse
effects. Cumulative opioid consumption was significantly lower in the ESPB
group compared to the DPIPB+SAPB group (mean, 330.00 +/- 206.82 microg v
464.17 +/- 232.74 microg; p = 0.022). No significant differences were
observed in pain scores at the sternotomy or drain sites at rest or during
coughing at any time point (p > 0.05). Additionally, there were no
significant differences in rescue analgesic requirements or opioid-related
side effects between the 2 groups (p > 0.05). Conclusion(s): In
patients undergoing open-heart surgery through median sternotomy,
bilateral ESPB provided more effective opioid-sparing analgesia compared
to the combined DPIPB+SAPB technique, despite similar subjective pain
scores and side effect profiles. These findings support the broader
dermatomal spread and prolonged efficacy of ESPB, although both techniques
appear to be clinically effective as components of multimodal analgesia
strategies. Copyright © 2025

<10>
Accession Number
2042004264
Title
Effects of Bariatric Surgery on the Pharmacokinetics of Cardiovascular
Drugs: A Systematic Review and Meta-Analysis.
Source
Obesity Surgery. (no pagination), 2025. Date of Publication: 2025.
Author
Zarinfar Y.; Babaei S.; Majidzadeh M.J.; Masoumipoya Z.; Gheymati A.;
Eslami V.
Institution
(Zarinfar) School of Medicine, Shahid Beheshti University of Medical
Science, Tehran, Iran, Islamic Republic of
(Babaei, Majidzadeh, Masoumipoya) Department of Medicine, Arak University
of Medical Science, Arak, Iran, Islamic Republic of
(Gheymati) Tehran University of Medical Sciences, School of Pharmacy,
Tehran, Iran, Islamic Republic of
(Eslami) Shahid Beheshti University of Medical Sciences, Cardiovascular
Research Center, Shahid Modarres Hospital, Tehran, Iran, Islamic Republic
of
Publisher
Springer
Abstract
Background: Obesity is a global health issue associated with increased
cardiovascular risk. Bariatric surgery is the most effective long-term
treatment for severe obesity, but it may alter drug pharmacokinetics,
impacting the management of cardiovascular medications. Method(s): A
systematic review and meta-analysis were conducted according to PRISMA
2020 guidelines. Four databases (PubMed, Embase, Web of Science, Scopus)
were searched for studies examining the pharmacokinetics of cardiovascular
drugs before and after bariatric surgery. After duplicate removal, titles
and abstracts were screened, followed by a full-text review with inclusion
criteria of adult patients undergoing bariatric surgery who reported
pharmacokinetic or pharmacodynamic outcomes for cardiovascular drugs.
Meta-analysis was performed using a random-effects model in R (meta and
metafor packages), with effect sizes and heterogeneity (I2) reported.
 Result(s): From 817 identified records, 24 studies met the inclusion
criteria, revealing that bariatric surgery has varied and drug-specific
effects on the pharmacokinetics of cardiovascular medications. Among
anticoagulants, systemic exposure of all of them did not significantly
change. Rivaroxaban and apixaban pharmacokinetics remained largely
unchanged, and warfarin dosing requirements slightly decreased. The impact
of beta-blockers was highly dependent on the specific drug and
formulation; peak concentrations (Cmax) of atenolol increased slightly,
whereas those of immediate-release metoprolol tended to increase, but both
types of carvedilols (S- and R-carvedilol) and controlled-release
metoprolol and propranolol showed a decrease. Regarding statins,
atorvastatin absorption was significantly delayed, as shown by a prolonged
time to peak concentration Tmax (pooled SMD = 0.99, p < 0.05), without a
significant change in Cmax (slightly decreased). Both rosuvastatin and
simvastatin showed transient changes in exposure, which normalized over
time. Conclusion(s): Bariatric surgery can significantly impact the
pharmacokinetics of cardiovascular drugs, especially atorvastatin and
beta-blockers, highlighting the need for individualized dose adjustments
and therapeutic monitoring. These findings provide essential evidence for
optimizing cardiovascular pharmacotherapy in post-bariatric surgery
patients, supporting the development of tailored dosing
guidelines. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2025.

<11>
Accession Number
2041808848
Title
Efficacy and safety of transcatheter aortic valves in patients with aortic
stenosis: a network meta-analysis.
Source
Future Cardiology. 21(12) (pp 1081-1090), 2025. Date of Publication: 2025.
Author
Adnan M.; Ahmed Usman M.; Akhtar M.; Hameed H.; Hussain Bakhtiari M.I.;
Hamza M.; Zaheer W.; Shoaib I.; Saleem A.; Basit J.; Alraies M.C.
Institution
(Adnan, Ahmed Usman, Akhtar, Hameed, Hussain Bakhtiari, Zaheer, Shoaib,
Saleem) Department of Medicine, Gujranwala Medical College, Gujranwala,
Pakistan
(Hamza) Department of Hospital Medicine, Guthrie Medical Group, Cortland,
NY, United States
(Basit) Department of Medicine, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Alraies) Detroit Medical Center, Wayne State University, Detroit, MI,
United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: Patients with aortic stenosis have a high mortality risk
treatable by transcatheter aortic valve replacement (TAVR). We conducted a
network meta-analysis to compare the efficacy and safety of transcatheter
aortic valves in aortic stenosis patients. Method(s): A systematic
search of PubMed, Embase, and Cochrane was conducted. Randomized
controlled trials (RCTs) that included adult patients with aortic stenosis
undergoing TAVR, which compared clinical efficacy and safety between any
of the transcatheter aortic valves, were included. Random effects
meta-analysis was employed. Result(s): A total of 4687 patients from
9 RCTs were included. Sapien XT had a significantly higher risk of stroke
compared to Sapien 3 RR = 31.38 (95% CI: 1.12 to 876, p = 0.043), while
other devices showed no significant differences. Evolut had a
significantly increased risk of permanent pacemaker placement compared to
Sapien 3 RR = 1.36 (95% CI: 1.07-1.74, p = 0.013). No significant
differences were observed between valves for any of the other analyzed
outcomes. Conclusion(s): While most TAVR devices showed comparable
safety profiles, Evolut was associated with increased pacemaker
implantation risk. The higher stroke risk with Sapien XT should be
interpreted with caution. Protocol Registration: This review was
registered with PROSPERO (CRD42024563628). Plain Language Summary: Aortic
stenosis is a common heart condition in which the main heart valve becomes
narrow and stiff, reducing blood flow from the heart to the rest of the
body. In recent years, a less invasive treatment called transcatheter
aortic valve replacement (TAVR) has become an important alternative to
open-heart surgery, especially for older adults or patients at higher
surgical risk. Several transcatheter valves are available, each with
distinct structural and technical features. Selecting the most appropriate
valve for each patient is therefore a key clinical decision. To compare
their safety and effectiveness, we combined results from major randomized
clinical trials using a method called network meta-analysis, which allows
comparisons between multiple valves even when they have not been directly
compared in a single study. Our study evaluated key outcomes at one year
after TAVR, including survival, stroke, bleeding, heart-failure
rehospitalization, and the need for a permanent pacemaker. Overall, most
modern valves demonstrated comparable safety and survival outcomes.
However, the Evolut valve was associated with a higher likelihood of
requiring a pacemaker, while the Sapien XT valve showed an uncertain but
possible higher risk of stroke. The Sapien 3, a newer-generation valve,
showed favorable safety results. These findings suggest that while
contemporary TAVR devices generally perform well, the choice of valve
should be guided by each patient's anatomy, coexisting medical conditions,
and the experience of the treating team. Further long-term research is
needed to clarify device durability and patient outcomes over
time. Copyright © 2025 Informa UK Limited, trading as Taylor &
Francis Group.

<12>
Accession Number
2041887160
Title
Outcomes of Adding Computed Tomography Angiography for Pre-procedural
Planning of Left Atrial Appendage Occlusion: a Systematic Review and
Meta-analysis.
Source
Current Cardiology Reports. 28(1) (no pagination), 2026. Article Number:
1. Date of Publication: 01 Dec 2026.
Author
Pereira V.; Fernandes J.; Pinheiro R.P.S.; Andrade N.; Katsuyama E.;
Ezenna C.; Krishna M.M.; Joseph M.; Goldsweig A.M.; Gomes W.F.
Institution
(Pereira) Facultad de Ciencias Biomedicas, Universidad Austral, Buenos
Aires, Pilar, Argentina
(Fernandes) Centro de Ensino e Pesquisa Albert Einstein, Faculdade
Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, Brazil
(Pinheiro) Faculdade de Medicina, Universidade Federal do Rio de Janeiro,
Rio de Janeiro, Brazil
(Andrade) Faculdade de Medicina, Escola Bahiana de Medicina e Saude
Publica, Bahia, Salvador, Brazil
(Katsuyama) Faculdade de Medicina do ABC, Sao Paulo, Brazil
(Krishna) Internal Medicine, Medical College Thiruvananthapuram,
Mavelikara, India
(Joseph) Medical College Thiruvananthapuram, Thodupuzha, India
(Ezenna) Department of Medicine, University of Massachusetts - Baystate
Medical Center, Springfield, MA, United States
(Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center
and Division of Cardiovascular Medicine, University of
Massachusetts-Baystate, Springfield, MA, United States
(Gomes) Department of Interventional Cardiology, INC Hospital,
Universidade Federal do Parana, Jeremias Meciel Perretto 300, Parana,
Curitiba, Brazil
(Gomes) Faculdades Pequeno Principe, Curitiba, Brazil
(Gomes) Santa Casa de Misericordia de Curitiba, Curitiba, Brazil
Publisher
Springer
Abstract
Background: Multi-society expert consensus statements on catheter-based
left atrial appendage occlusion (LAAO) suggest transesophageal
echocardiography (TEE) or cardiac computed tomography angiography (CCTA)
for pre-procedural planning. However, evidence comparing the outcomes of
adding CCTA to TEE on procedural success is limited. Objective(s):
Perform a systematic review and meta-analysis to determine the impact of
adding CCTA to TEE for pre-procedural planning in patients undergoing
LAAO. Method(s): We systematically searched Cochrane, Embase, and
Medline for observational studies and randomized controlled trials (RCTs)
comparing the addition of CCTA vs. TEE alone. The primary endpoint was
procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs)
were pooled across studies using a random-effects model. Result(s):
Systematic review identified four studies for meta-analysis, three RCTs
and one observational study, including a total of 824 patients, of whom
496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural
success was higher with added CCTA (RR 1.10; 95% CI 1.01-1.19; p = 0.022;
I2=52%). A subgroup analysis of only RCTs confirmed these findings with a
slightly higher magnitude of effect and lower heterogeneity (RR 1.15; 95%
CI: 1.06-1.25; I2 = 0%). Copyright © The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature 2025.

<13>
Accession Number
2034470092
Title
The effects of del Nido cardioplegia combined with dexmedetomidine on
cardiac surgery with cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 41(1) (pp 86-94), 2026. Date of Publication:
01 Jan 2026.
Author
Jiang X.; Zhou X.; Yao L.; Li L.; Gu T.
Institution
(Jiang, Yao, Li, Gu) Department of Anesthesiology, Affiliated Hospital 2
of Nantong University, Nantong, China
(Zhou) Department of Cardiovascular Surgery, Shanghai Chest Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
Publisher
SAGE Publications Ltd
Abstract
Objective: To evaluate the effects of dexmedetomidine administration and
the use of del Nido cardioplegia in reducing the incidence of atrial
fibrillation (AF) and delirium during the perioperative period.
 Method(s): 448 patients were randomized into two groups: the
treatment group received dexmedetomidine combined with del Nido
cardioplegia, and the control group received normal saline placebo
combined with Buckberg traditional cardioplegia. Each group included 224
patients. The occurrence of AF and delirium within 5 days after surgery,
as well as other intraoperative and postoperative indicators, were noted.
 Result(s): There were no significant differences in preoperative
indicators between the two groups. The incidences of AF and delirium
events were significantly higher in the control group than in the
treatment group. Conclusion(s): We found that del Nido cardioplegia
combined with dexmedetomidine was safe in cardiac surgery with CPB and
effectively reduced the incidence of postoperative AF and
delirium. Copyright © The Author(s) 2025

<14>
Accession Number
2041921407
Title
Preoperative patient risk factors for intraoperative hypotension: a
systematic review and meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1709004. Date of Publication: 2025.
Author
Daum N.; Bill D.; Thiele M.; Felber J.; von Wedel D.; Spies C.; Balzer F.;
Morgeli R.; Hunsicker O.; Muller A.; Contag D.; Pohrt A.; Bald A.; Kayser
M.; Treskatsch S.; Markus M.
Institution
(Daum, Bill, Spies, Morgeli, Hunsicker, Muller, Contag, Bald, Kayser,
Markus) Department of Anesthesiology and Intensive Care Medicine
(CCM/CVK), Charite - Universitatsmedizin Berlin, Freie Universitat Berlin
and Humboldt, Universitat zu Berlin, Berlin, Germany
(Daum, Thiele, Felber, von Wedel, Balzer) Institute of Medical
Informatics, Charite-Universitatsmedizin Berlin, Freie Universitat Berlin
and Humboldt Universitat zu Berlin, Berlin, Germany
(Pohrt) Institute for Biometry and Clinical Epidemiology,
Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat
Berlin and Humboldt Universitat zu Berlin, Berlin, Germany
(Treskatsch) Department of Anesthesiology and Intensive Care Medicine
(CBF), Charite - Universitatsmedizin Berlin, Freie Universitat Berlin and
Humboldt, Universitat zu Berlin, Berlin, Germany
Publisher
Frontiers Media SA
Abstract
Background: Intraoperative hypotension (IOH) presents a risk factor for
postoperative organ dysfunction. However, as a unique definition of IOH is
still missing, the influence of individual preoperative patient
characteristics on IOH remains poorly understood. This systematic review
aimed to examine the variability in IOH definitions and to identify
preoperative risk factors associated with IOH. Method(s): A
systematic literature search was conducted from inception to March 2,
2024. Studies reporting on IOH and from which the association between
preoperative characteristics and IOH in cardiac and non-cardiac surgery
could be derived were included. Odds ratios (ORs) were either extracted
directly or calculated based on available patient-level data. Pooled
estimates were generated using a random-effects model. Result(s): Out
of 7,361 screened studies, 78 met the inclusion criteria. Heterogeneity
was high due to varying IOH definitions. 14 preoperative factors were
included in the meta-analysis. Older age (OR 1.03, 95% CI 1.02-1.04) and
female sex (OR 1.16, 95% CI 1.08-1.24) were associated with increased IOH
risk. ASA-II was linked to lower risk compared to ASA-III (OR 0.80, 95% CI
0.70-0.91). Diabetes mellitus (OR 1.18, 95% CI 1.04-1.35) and arterial
hypertension (OR 1.56, 95% CI 1.33-1.83) were independent predictors. ACE
inhibitor use (angiotensin-converting enzyme inhibitor use; OR 1.63, 95%
CI 1.42-1.88), angiotensin receptor blocker (ARB) use (OR 1.38, 95% CI
1.01-1.89), and emergent surgery (OR 1.25, 95% CI 1.09-1.42) also
increased IOH incidence. The risk of bias was low to moderate.
 Conclusion(s): The substantial variability in IOH definitions and
several preoperative IOH influencing patient characteristics highlight the
need for standardized criteria to improve comparability and guide
personalized perioperative management. Systematic Review Registration:
identifier PROSPERO CRD42024514229. Copyright 2025 Daum, Bill, Thiele,
Felber, von Wedel, Spies, Balzer, Morgeli, Hunsicker, Muller, Contag,
Pohrt, Bald, Kayser, Treskatsch and Markus.

<15>
Accession Number
2034662763
Title
Does the venous cannulation method affect gaseous embolic load to the
patient during extracorporeal circulation?.
Source
Perfusion (United Kingdom). 41(1) (pp 102-109), 2026. Date of Publication:
01 Jan 2026.
Author
Torild P.; Corderfeldt Keiller A.; Damen T.
Institution
(Torild, Corderfeldt Keiller) Department of Perfusion, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Corderfeldt Keiller, Damen) Department of Anesthesiology and Intensive
Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Damen) Department of Cardiothoracic Anaesthesia and Intensive Care,
Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
SAGE Publications Ltd
Abstract
Introduction: Cardiopulmonary bypass (CPB) is essential for cardiac
surgery but poses risks, including gaseous micro emboli (GME). While the
incidence of stroke-a common clinical consequence of embolism-ranges from
1-5% in cardiac surgery, prevalence of GME during CPB remain poorly
understood. Objective(s): To quantitatively compare GME incidence in
the arterial line between cavoatrial and bicaval cannulation during
open-heart surgery. Secondary exploratory objectives include evaluating
the impact of venous reservoir volume on GME, and the correlation between
GME in the venous and arterial lines. Method(s): This single center
randomized controlled trial was conducted at Sahlgrenska University
Hospital, Sweden. Patients >=18 years undergoing planned aortic valve
repair/replacement with cavoatrial cannulation, or mitral valve
repair/replacement with bicaval cannulation, with or without coronary
artery revascularization, were screened for eligibility. Patients were
further randomized to either venous reservoir volume of >=300 mL (control)
or 200-300mL (intervention). GME detection was performed using GAMPT
BCC300 with probes positioned at multiple locations within the CPB
circuit. Result(s): 39 patients were included. No significant
differences in GME quantity in the arterial line were observed between the
cannulation methods (count p=.444; volume p=967). Similarly, no
significant differences were found based on venous reservoir volume (count
p=.074; volume p=.166). Furthermore, no significant correlation was
observed between GME in venous line entering the arterial line (count
p-value=492; volume p-value=.750). The CPB circuit effectively removed
99.14% of GME, with no adverse events reported. Conclusion(s): No
significant differences were found in arterial GME count or volume between
cavoatrial and bicaval cannulation during CPB. These findings underscore
the importance of the bypass circuit's air-handling capacity, as well as
the role of modern oxygenators and arterial line filters in effectively
minimizing the passage of GME. Trial Registration:ClinicalTrials.gov
Identifier: NCT05820828URL:
https://clinicaltrials.gov/ct2/show/NCT05820828 Copyright © The
Author(s) 2025

<16>
Accession Number
2041921143
Title
The impact of operating room teamwork on patients outcomes: A systematic
review.
Source
Current Problems in Surgery. 74 (no pagination), 2026. Article Number:
101946. Date of Publication: 01 Jan 2026.
Author
Moreal C.; Mecozzi I.; Giacomini V.; Dentice S.; Magro G.; Dussi G.;
Chiappinotto S.; Palese A.
Institution
(Moreal, Mecozzi, Giacomini, Dentice, Magro, Dussi, Chiappinotto, Palese)
Department of Medicine, University of Udine, Udine, Italy
Publisher
Elsevier Inc.

<17>
Accession Number
2042031423
Title
Reduction of Thrombus Burden With Short-Term, Low-Dose Rivaroxaban Use in
Acute Myocardial Infarction: The ARISE-ARMYDA 7 Randomized Trial.
Source
Journal of the American Heart Association. 14(22) (no pagination), 2025.
Article Number: e041993. Date of Publication: 06 Nov 2025.
Author
Mennuni M.G.; Grisafi L.; Anastasia G.; Solli M.; Galiffa V.; Villa M.;
Bosco M.; Incaminato E.; Rosso R.; De Crescenzo F.; D'Amario D.; Vergallo
R.; Rippa R.; Patti G.
Institution
(Mennuni, Villa, Bosco, Incaminato, Rosso, D'Amario, Patti) Department of
Translational Medicine, University of Eastern Piedmont, Novara, Italy
(Mennuni, Grisafi, Solli, Galiffa, Rosso, De Crescenzo, D'Amario, Patti)
Maggiore della Carita Hospital, Novara, Italy
(Anastasia, Vergallo, Rippa) Department of Internal Medicine and Medical
Specialties, University of Genoa, Genoa, Italy
(Anastasia, Vergallo, Rippa) IRCCS San Martino Polyclinic Hospital, Genoa,
Italy
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Managing large coronary thrombus burden (LCTB) in patients
with ST-segment- elevation myocardial infarction (STEMI) remains
challenging. Although deferred stenting emerged to potentially improve
outcomes in this high-risk population, the optimal antithrombotic regimen
remains unclear. The ARISE-ARMYDA 7 (Alternative Anti-Thrombotic Pathways
in Acute Myocardial Infarction-Antiplatelet Therapy for Reduction of
Myocardial Damage 7) trial evaluated low-dose rivaroxaban in addition to
dual antiplatelet therapy for LCTB reduction in patients with STEMI
managed with deferred stenting. METHOD(S): This single-center,
randomized, pilot study included patients with STEMI with angiographic
evidence of LCTB undergoing primary percutaneous coronary intervention and
deferred stenting. Patients were randomized to rivaroxaban 2.5 mg BID plus
aspirin and ticagrelor or aspirin plus ticagrelor alone. Thrombus burden
was assessed by optical coherence tomography at baseline and after 5 to 7
days of treatment. The primary end point was reduction of thrombus score
after this period. RESULT(S): A total of 40 patients with STEMI and
LCTB were randomized 1:1. Posttreatment thrombus score at re-optical
coherence tomography imaging was significantly lower in the rivaroxaban
arm (39 [27-52] versus 82 [50-111] in controls, P=0.005). Relative
reduction of the thrombus score versus baseline was greater with
rivaroxaban use (61% [50%-81%] versus 36% [0%-50%], P=0.002). The relative
thrombus volume decrease was 77% with rivaroxaban versus 39% in the
control arm (P=0.001). Deferred stenting was safe, with no abrupt vessel
closures, distal embolization, or no reflow. Clinical outcomes at 30 days,
including major adverse cardiovascular events and bleeding complications,
were not significantly different. CONCLUSION(S): The ARISE-ARMYDA 7
trial shows that adding low-dose rivaroxaban to dual antiplatelet therapy
significantly reduces thrombus burden in patients with STEMI with LCTB,
while maintaining a favorable safety profile. Copyright © 2025
The Author(s). Published on behalf of the American Heart Association,
Inc., by Wiley. This is an open access article under the terms of the
Creative Commons Attribution License, which permits use, distribution and
reproduction in any medium, provided the original work is properly cited.

<18>
Accession Number
2037458280
Title
Intravenous Lidocaine Decreases Pain Scores 24 Hours Post Cardiac Surgery:
Substudy of a Randomized Controlled Trial.
Source
Pain Physician. 28(6) (pp 511-518), 2025. Date of Publication: 01 Nov
2025.
Author
Klinger R.; Strickland A.; Wright M.; Mathew J.P.; Gulur P.
Institution
(Klinger, Wright, Mathew, Gulur) Department of Anesthesiology, Duke
University Medical Center, Durham, NC, United States
(Strickland) TSAOG Orthopedics & Spine, San Antonio, TX, United States
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Post cardiac surgery pain remains a problem for a significant
number of patients. While opioids have long been used for cardiac surgery
pain control and hemodynamic stability, methods to improve pain control
while also reducing reliance on opioids are desired.Intravenous lidocaine
has shown promise for pain and opioid reduction in multiple operative
settings, yet its role in cardiac surgery lacks conclusive data.
 Objective(s): To determine the effect of intravenous lidocaine on
pain scores and opioid consumption in the first 48 hours post cardiac
surgery. Study Design: Preplanned substudy of a single-center,
double-blind, placebo-controlled, randomized controlled trial.
 Setting(s): This study was conducted in a tertiary/quaternary care
academic hospital in the United States. Method(s): Following
institutional review board approval and informed consent, a total of 449
patients who met the inclusion criteria were enrolled and randomized to
receive either a bolus of one mg/kg of lidocaine administered after
anesthesia induction followed immediately by a continuous infusion at 48
mug/kg/min for the first hour, 24 mug/kg/min for the second hour, and 10
mug/kg/min for the next 46 hours (lidocaine group) or normal saline
(placebo group). Primary outcomes were Visual Analog Scale (VAS) scores
and opioid consumption in of morphine milligram equivalents at 24 and 48
hours post surgery. Secondary endpoints included the administration of
other nonopiod analgesic medications, postoperative antiemetic medication
use, intensive care unit length of stay, hospital length of stay, and time
to return of bowel function. Univariable and multivariable regression
analyses were performed. Result(s): A total of 215 patients who
received a placebo and 218 patients who received lidocaine were evaluated.
We observed a statistically significant difference in VAS pain score at
postoperative 24 hours (adjusted mean difference-0.68; 95%CI,-1.23 to
0.13; P=0.016) between patients treated with lidocaine vs placebo;
however, no difference was observed at postoperative 48 hours. The
cumulative opioid use in morphine milligram equivalents was not
significant, both in univariable and multivariable analysis, at all
timepoints between patients receiving lidocaine vs placebo. Among
secondary outcomes, the only significant effect was a decrease in odds of
acetaminophen use in the first postoperative 48 hours (adj. odds ratio
0.54; 95% CI 0.32 to 0.90, P=0.018). Limitation(s): Although pain
scores were a preplanned outcome of the parent study, opioid consumption
was not. Furthermore, postoperative pain management was not specifically
standardized for this study. Conclusion(s): We found that intravenous
lidocaine resulted in a statistically significant decrease in VAS pain
scores at 24 hours post cardiac surgery, with no difference in opioid
consumption. While this pain benefit has been noted in other surgical
patient populations, our findings are important since patients undergoing
cardiac surgery are unique given the physiologic changes associated with
cardiopulmonary bypass graft. Copyright © 2025, American Society
of Interventional Pain Physicians. All rights reserved.

<19>
[Use Link to view the full text]
Accession Number
648956006
Title
Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing
Device Thrombosis Following Left Atrial Appendage Closure: The ANDES
Randomized Clinical Trial.
Source
Circulation. 152(25) (pp 1759-1768), 2025. Date of Publication: 23 Dec
2025.
Author
Rodes-Cabau J.; Nombela-Franco L.; Cruz-Gonzalez I.; Hibbert B.; Freixa
X.; Masson J.-B.; Ibrahim R.; Estevez-Loureiro R.; Millan X.; Kass M.;
Paradis J.-M.; Champagne J.; Salinas P.; Laffond A.; Abdel-Razek O.;
Labinaz M.; Cepas-Guillen P.; Arzamendi D.; Vidal-Cales P.; Pavesi M.;
Cote M.; O'Hara G.; Salaun E.
Institution
(Rodes-Cabau, Paradis, Champagne, Vidal-Cales, Cote, O'Hara, Salaun)
Quebec Heart and Lung Institute, Laval University, G.O., Quebec City, QC,
Canada
(Rodes-Cabau, Freixa, Cepas-Guillen) BarcelonaPhilippines
(Rodes-Cabau, Pavesi) Barcelona Clinical Coordinating Center, Mon Clinic
Foundation, Barcelona, Philippines
(Nombela-Franco, Salinas) Hospital Clinico San Carlos, Instituto de
Investigacion Sanitaria Hospital Clinico San Carlos, Madrid, Spain
(Cruz-Gonzalez, Laffond) Hospital Universitario de Salamanca, IBSAL,
Salamanca, Mexico
(Hibbert, Abdel-Razek, Labinaz) Ottawa Heart Institute, Ottawa, ON, Canada
(B.H., O.A.-R., M.L.)
(Hibbert) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
United Kingdom
(Masson) Centre Hospitalier Universitaire de Montreal, Montreal, QC,
Canada
(Ibrahim) Montreal Heart Institute, Montreal, QC, Canada
(Estevez-Loureiro) Hospital Universitario Alvaro Cunqueiro, Vigo, Italy
(Millan, Arzamendi) Department of Cardiology, Hospital Universitari de la
Santa Creu i Sant Pau, Barcelona, Philippines
(Kass) Saint Boniface Hospital, Winnipeg, MB, Canada
Abstract
BACKGROUND: The optimal antithrombotic treatment after transcatheter left
atrial appendage closure (LAAC) remains to be determined. The objective of
this trial was to compare anticoagulation and antiplatelet therapy for
preventing device-related thrombosis (DRT) after LAAC. METHOD(S):
This was a prospective multicenter international randomized trial
comparing 2 different antithrombotic strategies for preventing DRT after
LAAC in patients with nonvalvular atrial fibrillation. Patients were
randomized (1:1) to receive direct oral anticoagulants (DOACs) or dual
antiplatelet therapy (DAPT; aspirin+clopidogrel) for 60 days. Patients
underwent transesophageal echocardiography at 60 days, and the images were
analyzed in a central echocardiography laboratory by experienced
echocardiographers blinded to the allocated treatment. The primary outcome
was DRT as determined by transesophageal echocardiography 60 days after
LAAC in patients receiving the allocated treatment at the time of
transesophageal echocardiography (per-protocol analysis). The safety
outcome included all-cause mortality, stroke, bleeding, or site-reported
DRT within 60 days after LAAC in all randomized patients
(intention-to-treat analysis). RESULT(S): A total of 510 patients
(mean age 77+/-9 years, 35% women) were included between October 2018 and
May 2025, and 253 and 257 patients were randomized to the DOAC and DAPT
groups, respectively. Of these, 399 patients underwent transesophageal
echocardiography and were receiving the allocated treatment at 60 days
after LAAC. The primary outcome occurred in 3 patients (1.5%) in the DOAC
group compared with 8 patients (4.1%) in the DAPT group (difference, -2.7%
[95% CI, -6.0% to 0.6%]; P=0.110). The safety outcome occurred in 52
patients (22.5%) in the DOAC group compared with 82 patients (34.9%) in
the DAPT group (difference, -12.4% [95% CI, -20.6% to -4.2%]; P=0.003),
and differences were mainly driven by a lower rate of bleeding events in
the DOAC group (44 patients [17.4%] versus 64 patients [24.9%];
difference, -7.5% [95% CI, -14.6% to -0.4%]; P=0.038). CONCLUSION(S):
The use of DOACs after LAAC failed to reduce DRT compared with DAPT, but
it was associated with an improved safety profile. The results of this
study should be interpreted with caution because of statistical power
issues related to the narrower-than-expected between-group differences and
will need confirmation in future larger studies. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT03568890.

<20>
Accession Number
649271551
Title
Natural history of unrepaired bicuspid aortic valve at diagnosis:
meta-analysis and reconstruction of time-to-event data.
Source
The Journal of cardiovascular surgery. 66(6) (pp 517-524), 2025. Date of
Publication: 01 Dec 2025.
Author
Ogami T.; Yokoyama Y.; Sa M.P.; Takagi H.; Fukuhara S.; Sultan I.; Kuno T.
Institution
(Ogami, Sultan) Department of Cardiothoracic Surgery, University of
Pittsburgh Medical Center, PA, United States
(Ogami, Sultan) Heart and Vascular Institute, University of Pittsburgh
Medical Center, PA, United States
(Yokoyama, Fukuhara) Department of Cardiac Surgery, University of
Michigan, Ann Arbor, MI, United States
(Sa) Division of Cardiovascular Surgery, Heart, Vascular and Thoracic
Institute, Cleveland Clinic Florida, Weston, FL, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Abstract
INTRODUCTION: While outcomes after surgical or transcatheter aortic valve
replacement between bicuspid aortic valve (BAV) and tricuspid aortic valve
have been reported, the natural history of unrepaired BAV is sparse in the
literature. EVIDENCE ACQUISITION: The MEDLINE and EMBASE databases were
searched to identify relevant studies. The search was conducted through
February 2024. Time-to-event data was synthesized to reconstruct survival
curves. EVIDENCE SYNTHESIS: A total of 20 studies were identified. Nine
studies were included to reconstruct the Kaplan-Meier survival curves,
enrolling 5819 patients with BAV. Expected survival was 97.6+/-0.2%,
91.9+/-0.4%, 84.3+/-0.6%, and 76.0+/-0.9% at 1-, 5-, 10-, and 15-year,
respectively. Long-term survival was similar between patients with
unrepaired BAV and the general population (HR 1.15, 95% CI: 0.86 to 1.55,
I2=0). Five studies were included to synthesize freedom from cardiac
surgery, enrolling 2962 patients. Expected freedom cardiac surgery were
88.5+/-0.6%, 82.1+/-0.7%, and 70.0+/-1.5% at 1, 5, and 10 years,
respectively. The risk of thoracic aortic dissection was 0.06 per 100
patient years (95% CI: 0.01 to 0.12, I2=30%). CONCLUSION(S): The
estimated survival of patients with BAV was 91.9% at 5 years and 84.3% at
10 years after the diagnosis. Survival of patients with BAV may be
comparable to that of the general population. The need for an intervention
to either aortic valve or thoracic aorta was 30% at 10 years.

<21>
Accession Number
2042357735
Title
Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery
Syndrome in Adults: A Case-Based Clinical Review.
Source
Turk Kardiyoloji Dernegi Arsivi. 53(8) (pp 607-614), 2025. Date of
Publication: 01 Dec 2025.
Author
Spiljak A.
Institution
(Spiljak) Institute for Healthcare of Transportation Employees Sarajevo,
Bosnia and Herzegovina
Publisher
Turkish Society of Cardiology
Abstract
This review provides a structured overview of ten published case reports
of anomalous origin of the left coronary artery from the pulmonary artery
(ALCAPA) syndrome in adults, with a focus on clinical presentation,
diagnostic methods, and treatment approaches. A narrative review was
conducted using the PubMed database to identify English-language case
reports of adult patients with ALCAPA. Ten cases were selected based on
clearly reported clinical features, diagnostic methods, and treatment
approach. The most common symptoms included atrial fibrillation, chest
pain, dyspnea, and syncope. Surgical correction was performed in four
cases, while others were managed conservatively or with medical therapy.
Adult-type ALCAPA presents with variable clinical manifestations and
requires individualized treatment. Timely diagnosis and appropriate
management are crucial for optimal outcomes. Copyright@Author(s).
Content of this journal is licensed under a Creative Commons Attribution
NonCommercial-NoDerivatives 4.0 International License.
https://creativecommons.org/licenses/by-nc-nd/4.0/

<22>
Accession Number
2041879355
Title
Pericoronary adipose tissue attenuation on CCTA as a marker of
cardiovascular risk: A systematic review and meta-analysis.
Source
European Journal of Radiology. 195 (no pagination), 2026. Article Number:
112607. Date of Publication: 01 Feb 2026.
Author
Sagoo N.S.; Sagoo R.; LeGate J.; Sathyamoorthy M.
Institution
(Sagoo, Sagoo, LeGate, Sathyamoorthy) Sathyamoorthy Lab, Department of
Internal Medicine, Burnett School of Medicine at Texas Christian
University, Fort Worth, TX, United States
(Sagoo) College of Science and Engineering, Texas Christian University,
Fort Worth, TX, United States
(Sagoo) University of Tennessee-Chattanooga, 975 E 3rd Street, Hospital
Box 88, Chattanooga, TN, United States
(Sathyamoorthy) Consultants in Cardiovascular Medicine and Science, Fort
Worth, TX, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background Pericoronary adipose tissue (PCAT) attenuation on coronary
computed tomography angiography (CCTA) reflects local vascular
inflammation, but its prognostic performance across heterogeneous imaging
protocols and follow-up durations remains uncertain. Methods MEDLINE via
Pubmed, Scopus, and Cochrane were searched through June 2025 for
longitudinal CCTA studies reporting multivariable-adjusted associations
between attenuation-based PCAT metrics and major adverse cardiovascular
events (MACE). Hazard ratios (HRs) were standardized to a per-1-Hounsfield
unit (HU) scale and pooled using random-effects models, with estimates
presented per 5 HU. Follow-up was stratified as short (<=3 years),
intermediate ('3-5 years), and long-term (>=5 years). Studies evaluating
fat attenuation index (FAI), change in FAI (DELTAFAI), thresholds, or
artificial intelligence (AI)-derived perivascular metrics were synthesized
qualitatively. Results Seventeen studies (n = 57,862) met inclusion
criteria; seven cohorts (n = 5,922) contributed to the HU-based meta
-analysis. Higher PCAT attenuation was associated with increased MACE risk
(HR 1.29 per 5 HU; 95 % confidence interval [CI] 1.09-1.53;
I2=84 %). Across follow-up strata, effect estimates remained
directionally consistent: short-term HR 1.22 per 5 HU (95 % CI 1.04-1.43),
intermediate-term HR 1.38 (95 % CI 0.98-1.95), and long-term HR 1.50 (95 %
CI 0.86-2.62), without significant between-group differences. Subgroup
analyses showed similar effect sizes in studies using standardized right
coronary artery (RCA) PCAT versus lesion-specific or multivessel
approaches. Ten additional studies evaluating FAI, DELTAFAI, HU
thresholds, or composite or AI-based metrics showed higher risk with more
inflamed perivascular attenuation phenotypes. Conclusion Higher PCAT
attenuation is associated with increased MACE risk across diverse imaging
platforms and follow-up horizons and appears to be a marker of
inflammation-related coronary vulnerability. Copyright © 2025
Elsevier B.V.

<23>
Accession Number
2040489627
Title
Efficacy and Safety of Pulmonary Vasodilator and Inodilator Drugs in
Congenital Heart Disease Surgery: A Systematic Review and Network
Meta-Analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 333-346),
2026. Date of Publication: 01 Jan 2026.
Author
Ollosu M.; Tripodi V.F.; Aresu C.; Ledda G.; Manai F.; Marini C.; Musu M.;
Ippolito M.; Cortegiani A.; Finco G.; Sardo S.
Institution
(Ollosu, Aresu, Ledda, Manai, Marini, Musu, Finco, Sardo) Department of
Medical Sciences and Public Health, University of Cagliari, Monserrato,
Italy
(Tripodi) Anesthesia and Intensive Care, Human Pathology Department,
"Gaetano Martino" University Hospital, Messina, Italy
(Ippolito, Cortegiani) Department of Anesthesia, Analgesia, Intensive Care
and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo,
Italy
(Ippolito, Cortegiani) Department of Precision Medicine in Medical,
Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
Publisher
W.B. Saunders
Abstract
Background: Perioperative management of congenital heart disease (CHD)
surgery presents a unique challenge due to significant pathophysiological
alterations, with pulmonary hypertension contributing substantially to
morbidity and mortality. Although pulmonary vasodilators and inodilators
are commonly used, evidence of their efficacy and safety remains limited.
 Objective(s): To evaluate the effectiveness and safety of
vasodilators and inodilators in pediatric patients undergoing CHD surgery.
 Design(s): Systematic review with network meta-analysis. Data
Sources: PubMed, CENTRAL, and Embase. Eligibility Criteria: We included
single- or double-blind, parallel-group, randomized controlled trials
comparing the perioperative use of vasodilators and inodilators in
pediatric CHD surgery. We selected only English-language studies. We
excluded crossover, non randomized trials and trials comparing the same
drugs in all study arms. Result(s): We included 28 randomized
controlled trials involving 3118 patients. Intravenous levosimendan ranked
highest in decreasing postoperative mortality, although the effect was not
statistically significant. Intravenous sildenafil and inhaled nitric oxide
(NO) significantly reduced the duration of mechanical ventilation, and
inhaled NO also significantly shortened the length of intensive care unit
stay. Inhaled iloprost, NO, and enteral sildenafil reduced mean pulmonary
artery pressure. No intervention significantly affected the incidence of
acute kidney injury. Conclusion(s): Vasodilators and inodilators did
not significantly decrease perioperative mortality in pediatric CHD. Some
agents, such as intravenous sildenafil and inhaled NO, demonstrated modest
benefits of questionable clinical significance regarding duration of
mechanical ventilation, intensive care unit stay, and pulmonary pressure.
The results are limited by small sample sizes, study heterogeneity,
variability in standard care, and risk of bias, requiring cautious
interpretation. Registration: CRD42024552531. Copyright © 2025
The Authors

<24>
Accession Number
2041117357
Title
Does Autologous Platelet-Rich Plasma Improve Blood Conservation and
Postoperative Outcomes in Acute Type A Aortic Dissection Surgery? A
Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 49-57), 2026.
Date of Publication: 01 Jan 2026.
Author
Santos K.; Oya K.; Umibe T.; Patel N.; Abo T.; Sakai W.; Plonek T.
Institution
(Santos, Patel) New Vision University School of Medicine, Tbilisi, Georgia
(Santos, Plonek) Department of Cardiothoracic Surgery, Medisch Spectrum
Twente, Enschede, Netherlands
(Oya, Umibe, Abo, Sakai) Department of Surgery, National Center for Global
Health and Medicine, Tokyo, Japan
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate whether autologous platelet-rich plasma (aPRP)
improves blood conservation and postoperative outcomes in emergency
surgery for acute type A aortic dissection (ATAAD). Design(s):
Systematic review and meta-analysis of randomized controlled trials and
observational studies. Setting(s): Cardiac surgery centers from
multiple institutions. Participant(s): Six studies comprising 2,150
adult patients undergoing ATAAD repair, of whom 906 (42.1%) received
intraoperative aPRP. Intervention(s): Use of intraoperative aPRP
versus no aPRP during ATAAD repair. Measurements and Main Results:
Primary outcomes included reoperation for bleeding and allogeneic blood
product transfusion volumes. Secondary outcomes were mechanical
ventilation duration, hospital stay, and postoperative complications. aPRP
was associated with significantly shorter mechanical ventilation time (MD
-13.8 hours; 95% CI -23.9 to -3.7; p = 0.008), lower incidence of
prolonged ventilation (OR 0.3; 95% CI 0.2 to 0.7; p = 0.004), reduced
reoperation rates (OR 0.4; 95% CI 0.2 to 0.7; p = 0.005), and decreased
platelet (MD -2.2 units; 95% CI -3.5 to -0.9; p = 0.001) and
cryoprecipitate use (MD -1.9 units; 95% CI -3.0 to -0.8; p < 0.001). No
differences were observed in mortality, hospital stay, or rates of
neurological or renal complications. Subgroup analysis of randomized
controlled trial and propensity-matched data confirmed several of these
findings and additionally showed reduced plasma transfusion volumes.
 Conclusion(s): In ATAAD surgery, aPRP may reduce transfusion needs,
reoperations, and ventilation duration without increasing adverse
outcomes. Given that most evidence is observational, high-quality
randomized trials are needed to confirm these findings. Copyright
© 2025 Elsevier Inc.

<25>
Accession Number
2034220147
Title
Sex-related outcomes during short-term mechanical circulatory support: A
systematic review and meta-analysis of propensity-score matched studies.
Source
Perfusion (United Kingdom). 41(1) (pp 5-14), 2026. Date of Publication: 01
Jan 2026.
Author
Luiz L.; Mesadri Gewehr D.; Picado-Loaiza S.; Ohashi L.; Goebel N.; Rylski
B.; Ayala R.
Institution
(Luiz) Department of Medicine, University of the Region of Joinville,
Joinville, Brazil
(Mesadri Gewehr) Curitiba Heart Institute, Curitiba, Brazil
(Picado-Loaiza) Department of Cardiovascular Surgery, Hospital Mexico, San
Jose, Costa Rica
(Ohashi) Department of Cardiovascular Surgery, Federal University Sao
Paulo, Sao Paulo, Brazil
(Goebel, Rylski, Ayala) Department of Cardiovascular Surgery, Robert Bosch
Hospital, Stuttgart, Germany
Publisher
SAGE Publications Ltd
Abstract
Background: The association between sex and cardiovascular risk and
different responses to heart failure therapies is well established.
However, sex related outcomes of different types of short-term mechanical
circulatory support (MCS) therapy remains controversial. Method(s):
We performed a systematic review and meta-analysis of studies comparing
outcomes of MCS between sexes. We restricted inclusion to propensity score
matched studies to minimize the risk of confounding. We pooled binary and
continuous outcomes with odds ratio (OR) and mean differences (MD),
respectively, under a random effects model. Result(s): We pooled 6
propensity score matched studies evaluating sex related outcomes during
short-term MCS, with 18,720 patients, of whom 9442 (50.5%) were male and
9278 (49.5%) were female. Subgroup analysis showed higher 30-day mortality
during ECMO (OR 1.11; 95% CI 1.01-1.22; p = .038; I2 = 0%) in
males, but lower 30-day mortality during Impella therapy than females (OR
0.87; 95% CI 0.80-0.94; p = .001; I2 = 0%). Males had a higher
need of myocardial revascularization (OR 3.09; 95% CI 1.56-5.99; p = .001;
I2 = 0%), but a higher risk of acute kidney injury (OR 1.20;
95% CI 1.09-1.31; p < .001; I2 = 18%). Conclusion(s):
In-hospital and 30-day mortality were similar between females and
males. Copyright © The Author(s) 2025

<26>
Accession Number
2041807902
Title
Three-Year Outcomes of Catheter Ablation in Patients With End-Stage Heart
Failure and Atrial Fibrillation.
Source
Circulation. 152(15) (pp 1118-1121), 2025. Date of Publication: 14 Oct
2025.
Author
Sohns C.; Moersdorf M.; Marrouche N.F.; Costard-Jaeckle A.; Crijns
H.J.G.M.; Bergau L.; Fox H.; Hindricks G.; Dagres N.; Sossalla S.; Schramm
R.; Fink T.; Hamriti M.E.; Sciacca V.; Didenko M.; Konietschke F.; Rudolph
V.; Gummert J.; Tijssen J.G.P.; Sommer P.
Institution
(Sohns, Moersdorf, Bergau, Fink, Hamriti, Sciacca, Didenko, Sommer)
Department of Electrophysiology, Med. Fakultat OWL (Universitat
Bielefeld), Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad
Oeynhausen, Germany
(Costard-Jaeckle, Fox, Schramm) Clinic for Thoracic and Cardiovascular
Surgery, Med. Fakultat OWL (Universitat Bielefeld), Herz- und
Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Costard-Jaeckle, Fox, Schramm) Heart Failure Department, Med. Fakultat
OWL (Universitat Bielefeld), Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Rudolph) Clinic for General and Interventional Cardiology/Angiology, Med.
Fakultat OWL (Universitat Bielefeld), Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Marrouche, Gummert) Cardiology Department, Tulane University School of
Medicine, New Orleans, United States
(Crijns) Department of Cardiology and CARIM, Maastricht University,
Cardiovascular Research Institute Maastricht, Netherlands
(Hindricks, Dagres) Department of Cardiology, Angiology and Intensive Care
Medicine, Charite Campus Mitte, German Heart Center of the
Charite-University Medicine Berlin, Germany
(Sossalla) Department of Cardiology and Angiology, University of Giessen &
Kerckhoff Heart Center, Bad Nauheim, Germany
(Konietschke) Institute of Biometry and Clinical Epidemiology,
Charite-Universitatsmedizin Berlin, Germany
(Tijssen) Department of Cardiology, Amsterdam UMC, University of
Amsterdam, Netherlands
Publisher
Lippincott Williams and Wilkins

<27>
Accession Number
2034207377
Title
Geranylgeranylacetone as Prevention for Postoperative Atrial Fibrillation
(GENIALITY).
Source
Cardiovascular Drugs and Therapy. 39(6) (pp 1589-1595), 2025. Date of
Publication: 01 Dec 2025.
Author
S. Ramos K.; Nassiri S.; Wijdeveld L.F.J.; van der Palen R.L.; Kuipers
M.F.; Hills M.T.; Slijkerman P.; van Raalte D.H.; Handoko M.L.; de Groot
N.M.S.; Grewal N.; Klautz R.J.M.; Eringa E.C.; Brundel B.J.J.M.
Institution
(S. Ramos, Wijdeveld, van der Palen, Eringa, Brundel) Amsterdam
Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam
University Medical Center, Location Vrije Universiteit Amsterdam, De
Boelelaan 1117, Physiology, Netherlands
(Nassiri, Handoko) Department of Cardiology, Amsterdam University Medical
Center, Amsterdam, Netherlands
(Kuipers) AFIP Foundation, Amsterdam, Netherlands
(Hills) Stopafib.Org, American Foundation for Women'S Health, Decatur, TX,
United States
(Slijkerman) Innovation Exchange Amsterdam, Amsterdam University Medical
Center, Amsterdam, Netherlands
(van Raalte) Diabetes Center, Department of Internal Medicine, Amsterdam
University Medical Center, Amsterdam, Netherlands
(de Groot) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Grewal, Klautz) Department of Cardiothoracic Surgery, Amsterdam
University Medical Center, Amsterdam, Netherlands
(Grewal, Klautz) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Eringa) Department of Physiology, Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
Publisher
Springer
Abstract
Purpose: Abstract: Interestingly, 30-50% of patients undergoing elective
cardiothoracic surgery develop postoperative AF (PoAF). Unfortunately,
preventive PoAF therapy is still suboptimal. In our previous studies, we
showed that oral Geranylgeranylacetone (GGA) administration increased
cardioprotective heat shock protein (HSP) protecting against AF onset and
progression in clinically relevant animal model studies. Method(s):
The GENIALITY study is a phase II single-center, double-blind,
placebo-controlled randomized trial comparing the efficacy of GGA in
preventing PoAF. Participants (N = 146) are adult patients, without any
registered history of AF, undergoing elective open-heart surgery for
valvular disease, coronary artery bypass grafting, or concomitant, and are
allocated with ratio 1:1 in treatment or placebo groups. Daily
administration of 300 mg of GGA or placebo starts 5 days before until 3
days after surgery. Cardiac rhythm will be monitored using a Holter
monitoring post-surgery until hospital discharge. Additionally, blood
samples, right atrial appendage tissue, and epicardial adipose tissue will
be collected to assess proteostasis levels. Result(s): The primary
endpoint is the assessment of PoAF incidence in the GGA group compared to
the placebo group. Secondary endpoints include the evaluation of HSP
levels through biochemical analysis in both blood and atrial tissue.
 Conclusion(s): The GENIALITY study aims to reduce PoAF incidence in
the GGA group compared to the placebo group. Herewith, we expect to obtain
proof of concept for a beneficial effect of GGA in preventing PoAF in
patients undergoing cardiothoracic surgery. Trial Registration: Clinical
Trial Information System (CTIS) registry: 2024-514743-28-00. Authorized on
September 30th 2024. Copyright © The Author(s) 2025.

<28>
Accession Number
2041959752
Title
Efficacy of PCSK9 Inhibitors on Clinical Outcomes in Patients with
Established Atherosclerotic Cardiovascular Disease: A Network
Meta-analysis.
Source
American Journal of Cardiovascular Drugs. (no pagination), 2025. Date of
Publication: 2025.
Author
Raone L.; Gritti V.; Mandurino-Mirizzi A.; Sparasci F.M.; Scotti V.;
Currao A.; Colonna G.; Ferlini M.; De Luca L.
Institution
(Raone, Sparasci) Department of Molecular Medicine, University of Pavia,
Pavia, Italy, Corso Strada Nuova, 65, Pavia, Italy
(Raone, Gritti, Sparasci, Currao, Ferlini, De Luca) Division of
Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Mandurino-Mirizzi, Colonna) Division of Cardiology, Vito Fazzi Hospital,
Lecce, Italy
(Mandurino-Mirizzi) Department of Experimental Medicine (DiMeS),
University of Salento, Lecce, Italy
(Scotti) Centre for Scientific Documentation, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
(Currao) Department of Internal Medicine and Medical Therapy, University
of Pavia, Pavia, Italy
Publisher
Adis
Abstract
Aims: Residual cardiovascular risk remains substantial in patients with
atherosclerotic cardiovascular disease (ASCVD) despite high-intensity
statin therapy. Proprotein convertase subtilisin/kexin type 9 inhibitors
(PCSK9i), including monoclonal antibodies and small-interfering RNA
agents, offer additional risk reduction, yet comparative evidence across
individual regimens remains limited. Methods and Results: We
conducted a systematic review and network meta-analysis of randomized
controlled trials evaluating approved PCSK9i dosages in patients with
ASCVD. The primary outcome was major adverse cardiovascular events (MACE);
the secondary outcomes included myocardial infarction, stroke, coronary
revascularization, cardiovascular mortality, and all-cause death. A total
of eight trials involving 49,847 patients were included. Evolocumab (140
mg every 2 weeks or 420 mg monthly) and alirocumab 150 mg every 2 weeks
significantly reduced MACE compared with placebo (risk ratios (RR): 0.78,
95% confidence intervals (CI): 0.66-0.93 and RR: 0.47, 95% CI 0.25-0.86,
respectively). Evolocumab was also associated with reductions in
myocardial infarction, stroke, and revascularization. Alirocumab 150 mg
demonstrated the most pronounced effect on revascularization and was
superior to both evolocumab and the lower alirocumab dose in this outcome.
No regimen significantly reduced cardiovascular or all-cause mortality.
 Conclusion(s): These findings suggest that PCSK9 inhibitors are
effective in ASCVD, with generally similar efficacy across agents;
however, regimens achieving lower and sustained low-density lipoprotein
cholesterol levels may confer greater benefit, in line with the concept
that "the lower, the better." Trial Registration: PROSPERO identifier no.
CRD420251022108. Copyright © The Author(s) 2025.

<29>
Accession Number
2042276812
Title
Atrial fibrillation and atherosclerosis cause different vascular brain
lesions on magnetic resonance imaging.
Source
European Heart Journal. 46(47) (pp 5177-5188), 2025. Date of Publication:
14 Dec 2025.
Author
Stegmann T.; Joundi R.A.; Srivastava A.; Sinnecker T.; Aeschbacher S.;
Eikelboom J.W.; Wachter R.; Smith E.E.; Rodondi N.; Bosch J.; Blum M.R.;
Connolly S.J.; Beer J.H.; Reeh K.W.; Reichlin T.; Lonn E.M.; Yi Q.; Muller
A.S.; Branch K.R.H.; Di Valentino M.; Avezum A.; Fox K.A.A.; Ammann P.;
Bonati L.H.; Moschovitis G.; Krisai P.; Kuhne M.; Osswald S.; Sharma M.;
Conen D.
Institution
(Stegmann, Joundi, Srivastava, Eikelboom, Bosch, Connolly, Reeh, Lonn, Yi,
Sharma, Conen) Population Health Research Institute, McMaster University,
237 Barton Street East, Hamilton, ON, Canada
(Stegmann, Wachter) Department of Cardiology, Leipzig University Hospital,
Liebigstrasse 20, Leipzig, Germany
(Sinnecker, Bonati) Department of Neurology and Stroke Center, University
Hospital Basel, University of Basel, Basel, Switzerland
(Sinnecker) Department of Biomedical Engineering, University of Basel,
Medical Image Analysis Center (MIAC), Basel, Switzerland
(Aeschbacher, Krisai, Kuhne, Osswald) Cardiology/Electrophysiology
Division, University Heart Center, University Hospital Basel, University
of Basel, Basel, Switzerland
(Aeschbacher, Krisai, Kuhne, Osswald) Cardiovascular Research Institute
Basel, University Hospital Basel, University of Basel, Basel, Switzerland
(Smith) Department of Clinical Neurosciences and Hotchkiss Brain
Institute, University of Calgary, Calgary, AB, Canada
(Rodondi) Institute of Primary Health Care (BIHAM), Faculty of Medicine,
University of Bern, Bern, Switzerland
(Rodondi, Blum) Department of General Internal Medicine, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Beer) Department of Medicine, University Hospital of Zurich, Cantonal
Hospital of Baden, Zurich, Switzerland
(Reichlin) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Lonn) Department of Medicine, McMaster University, Hamilton, Canada
(Muller) Department of Cardiology, Triemli Hospital Zurich, Zurich,
Switzerland
(Branch) Heart Institute, Division of Cardiology, University of Washington
Medical Center, Seattle, WA, United States
(Di Valentino) Department of Cardiology, Clinica Luganese Moncucco,
Lugano, Switzerland
(Di Valentino) Faculty of Biomedical Sciences, Universita Della Svizzera
Italiana, Lugano, Switzerland
(Avezum) Dante Pazzanese Institute of Cardiology, Sao Paulo University,
Research Division, Sao Paulo, Brazil
(Fox) Department of Cardiology, University of Edinburgh, Edinburgh, United
Kingdom
(Ammann) Department of Cardiology, Kantonsspital St Gallen, St Gallen,
Switzerland
(Moschovitis) Division of Cardiology, Cardiocentro Ticino Institute,
Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano,
Switzerland
Publisher
Oxford University Press
Abstract
Background and Aims Atrial fibrillation (AF) and atherosclerosis
pre-dispose to the occurrence of vascular brain lesions compared with the
general population, yet direct comparisons of brain lesion patterns
between these two cardiovascular patient groups are lacking. This study
sought to compare the prevalence and distribution of vascular brain
lesions on cerebral magnetic resonance imaging (MRI) between patients with
AF and those with atherosclerosis. Methods Baseline clinical data and
standardized brain MRI scans from the Swiss Atrial Fibrillation cohort
study (Swiss-AF; representing patients with AF) and the COMPASS MRI
sub-study (COMPASS MIND; representing patients with atherosclerosis
without AF) were used to compare the prevalence of lacunar and non-lacunar
infarcts, periventricular and deep white matter hyperintensities (WMH),
and cerebral micro-bleeds (CMB) between groups. Results Overall, 3508
patients were included (AF: n = 1748; atherosclerosis: n = 1760). Mean age
was 73 (+/-8) years in the AF cohort and 71 (+/-6) years in the
atherosclerosis cohort, 28% and 23% were female, 90% of the AF patients
took oral anti-coagulation, 93% of the atherosclerosis patients took
anti-platelet therapy. AF patients were more likely to have non-lacunar
infarcts (22% vs 10%; P < .001), and atherosclerosis patients were more
likely to have lacunar infarcts (21% vs 26%; P = .001). A higher grade of
periventricular WMH was seen in AF patients (49% vs 37%; P < .001). The
presence of CMB were more common in atherosclerosis patients (22% vs 29%;
P < .001). In multi-variable analyses, AF patients had a higher odds ratio
(OR) of non-lacunar infarcts (OR 2.28, 95% confidence interval [CI]
1.86-2.81; P < .001), lower odds of lacunar infarcts (OR 0.66, 95% CI
0.56-0.79; P < .001), and higher odds of severe periventricular WMH (OR
1.42, 95% CI 1.22-1.67; P < .001) compared with atherosclerosis patients.
Conclusions Patients with AF had a higher rate of non-lacunar infarcts,
multi-infarct patterns and more severe periventricular white matter
disease compared with patients with atherosclerosis. These findings
support disease-specific mechanisms in the development of vascular brain
lesions in patients with cardiovascular disease. Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved.

<30>
Accession Number
2042451101
Title
Use of Video Laryngoscope to Reduce Complications of Transesophageal
Echocardiography Probe Insertion in Children.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Gayathri G.; Divya Jacob P.; Nayanar V.K.N.; Vipin Raj V.; Babu S.;
Unnikrishnan K.P.; Koshy T.
Institution
(Gayathri, Divya Jacob, Nayanar, Vipin Raj, Babu, Unnikrishnan, Koshy)
Division of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal
Institute for Medical Sciences and Technology, Thiruvananthapuram, India
Publisher
W.B. Saunders
Abstract
Objectives: To test the hypothesis of whether using a video laryngoscope
reduces complications related to transesophageal echocardiography (TEE)
probe insertion in children. Design(s): Randomized controlled study.
 Setting(s): Pediatric cardiac surgical operating rooms in a tertiary
care level hospital. Participant(s): One hundred thirty children aged
0 to 18 years undergoing elective cardiac surgery. Intervention(s):
TEE probe insertion. Measurements and Main Results: The patients were
randomized into 2 groups: conventional (C) group (n = 64) and video
laryngoscopy (VL) group (n = 66). The primary endpoint of the study was
the incidence of oropharyngeal injury. The secondary endpoints were the
number of attempts required for successful TEE probe insertion and the
relation between the esophageal inlet and the larynx. The overall
incidence of oropharyngeal injuries was 7.7%, with 4 injuries (6.3%)
occurring in the C group and 6 injuries (9.1%) occurring in the VL group
(p = 0.543). Most children (90.8%) required only 1 attempt to insert the
TEE probe, with no significant difference between groups (p = 0.579). A
higher percentage increase in mean blood pressure during probe insertion
and a higher heart rate increase after probe insertion were observed in
the VL group (p < 0.05). The most common relationship with the larynx was
posterior (62%), followed by left posterolateral (20.9%) and right
posterolateral (17.1%). Conclusion(s): VL does not demonstrate
superiority over conventional methods of TEE probe insertion in children
regarding injury incidence or first-attempt success rate. Copyright
© 2025 Elsevier Inc.

<31>
Accession Number
2040577264
Title
The role of enhanced stent visualization imaging in percutaneous coronary
intervention: a systematic review of efficacy and clinical outcomes.
Source
Expert Review of Cardiovascular Therapy. 23(12) (pp 915-921), 2025. Date
of Publication: 2025.
Author
Sant Bakshsingh V.; Bundhoo S.S.; Protty M.B.
Institution
(Sant Bakshsingh, Bundhoo) Department of Cardiology, Grange University
Hospital, Cwmbran, United Kingdom
(Protty) Systems Immunity Research Institute, Cardiff University, Cardiff,
United Kingdom
(Protty) Department of Cardiology, University Hospital of Wales, Cardiff,
United Kingdom
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Coronary artery disease (CAD) is a major global cause of
morbidity and mortality. Percutaneous coronary intervention (PCI) is
central to its management, and optimal stent deployment is critical. This
systematic review evaluates the efficacy and clinical outcomes associated
with enhanced stent visualization (ESV) systems-X-ray-based fluoroscopic
tools such as StentBoost and CLEARstent-in PCI. Method(s): A
systematic literature search of PubMed, PubMed Central, and Cochrane
Library was conducted according to PRISMA guidelines. Inclusion criteria
comprised all study types evaluating ESV use in PCI, excluding case
reports and non-English articles. Study quality was assessed using
Newcastle-Ottawa tool. Result(s): Twelve studies involving ESV were
included. ESV improved detection of stent expansion and deployment versus
standard angiography and showed strong agreement with OCT and IVUS.
ESV-guided PCI was associated with reduced rates of major adverse cardiac
events (MACE), particularly in long-term follow-up. Radiation exposure was
modestly increased but deemed acceptable. Conclusion(s): ESV systems
enhance stent deployment accuracy and clinical outcomes in PCI, offering a
cost-effective and accessible alternative to OCT and IVUS. Evidence
supports routine integration of ESV in PCI workflows, although further
large-scale trials are warranted. Registration: PROSPERO identifier is
CRD420251020834. Copyright © 2025 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<32>
Accession Number
2042408145
Title
Vacuum-assisted venous drainage versus gravitational venous drainage in
patients undergoing cardiac surgery: A meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2025. Date of Publication:
2025.
Author
Motawea K.R.; Gadelmawla A.F.; Ibrahim M.M.; Soliman T.; Kheuka Y.A.;
Tzagournis A.; El Diasty M.; Abu-Omar Y.; Pelletier M.
Institution
(Motawea, Tzagournis, El Diasty, Abu-Omar) Department of Cardiac Surgery,
University Hospitals Cleveland Medical Center, Cleveland, OH, United
States
(Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Gadelmawla) Medical Research Group of Egypt (MRGE), Negida Academy,
Arlington, MA, United States
(Ibrahim) Deapartment of Cardiology, Banner University Medical Center,
Phoenix, AZ, United States
(Soliman) Department of Cardiothoracic Surgery, Sheikh Zayed Specialized
Hospital, Giza, Egypt
(Kheuka) Department of Medicine, Azerbaijan Medical University, Baku,
Azerbaijan
(Pelletier) Division of Cardiac Surgery, Yale School of Medicine, New
Haven, CT, United States
Publisher
SAGE Publications Ltd
Abstract
Introduction: Vacuum-assisted venous drainage (VAVD) has been proposed as
a better alternative option than conventional gravitational venous
drainage (GVD) in cardiac surgery. However, the literature reports
conflicting results between both methods in terms of post-cardiac surgery
complications. Therefore, we aimed to perform a meta-analysis to compare
clinical outcomes between VAVD and GVD in patients undergoing cardiac
surgery. Method(s): PubMed, Scopus, and Web of Science databases were
searched for any randomized control trials or cohort studies that compared
clinical outcomes between VAVD and GVD in patients undergoing cardiac
surgery. Result(s): Sixteen studies with 8426 patients were included
in our study. The pooled effect estimate of the postoperative results
showed a statistically significant association between VAVD and decreased
blood loss/chest tube drainage (MD = -88.7, 95% CI = -154.71 to -22.69,
p-value = 0.008), amount of packed red blood cells (pRBC) transfusion (MD
= -0.25, 95% CI = -0.27 to -0.22, p < 0.00,001), re-exploration (RR = 0.6,
95% CI = 0.35 to 1, p = 0.05), and re-operation (RR = 0.47, 95% CI = 0.23
to 0.99, p-value = 0.05). However, our study revealed no significant
difference between both groups in terms of postoperative mortality,
hospital/ICU stay, other blood product transfusions, change of free
hemoglobin at 24 h, and other clinical outcomes. Conclusion(s): Our
study revealed that VAVD is at least equivalent and may provide some
benefits compared to GVD in patients undergoing cardiac surgery. While,
VAVD requires specific expertise and training in order to optimize its
outcomes, its ability to reduce blood loss and blood transfusion, support
its use as a valuable alternative for GVD in high-risk
groups. Copyright © The Author(s) 2025

<33>
Accession Number
2041868768
Title
Comprehensive Multimodal Prehabilitation for Lung Cancer: A Systematic
Review of Randomized Controlled Trials.
Source
Therapeutics and Clinical Risk Management. 21 (pp 1735-1745), 2025. Date
of Publication: 2025.
Author
Mania K.; Pieczynska A.; Hojan K.
Institution
(Mania) Department of Occupational Therapy, Poznan University of Medical
Sciences, Poznan, Poland
(Pieczynska, Hojan) Poznan University of Medical Sciences, Department of
Occupational Therapy, Poznan, Poland
(Hojan) Greater Poland Cancer Centre, Department of Rehabilitation,
Poznan, Poland
(Hojan) Greater Poland Provincial Hospital in Poznan, Neurorehabilitation
Ward, Poznan, Poland
Publisher
Dove Medical Press Ltd
Abstract
Introduction: Surgical resection is a cornerstone of curative treatment
for early-stage lung cancer. Multimodal prehabilitation, a comprehensive,
patient-centered program integrating physical exercise, nutritional
status, and psychological support, has emerged as a promising approach to
enhance patients' physiological and psychological resilience prior to
surgery. While multimodal prehabilitation is valuable for optimizing
patients' tolerance of oncological treatment, there is a scarcity of
studies incorporating multimodal interventions, likely due to the absence
of clear guidelines for lung cancer patients. This systematic review aimed
to assess the comprehensiveness and effectiveness of prehabilitation
activities for lung cancer patients undergoing thoracic surgery.
 Evidence Acquisition: A systematic literature search was conducted
according to PRISMA guidelines. The search was performed in PubMed, Google
Scholar, PEDro, and Cochrane Library, with additional publications
identified from reference lists. The search was completed on February 27,
2024. Studies published between 2019 and 2024 were included to capture the
most recent evidence. The study was registered in PROSPERO (registration
number CRD42024499622). Evidence Synthesis: Out of 1233 identified
studies, 10 randomized controlled trials were included. Prehabilitation
programs varied in duration and setting. Only three studies (Liu et al,
2020; Yao et al, 2022; Ferreira et al, 2021) employed a comprehensive
multimodal approach integrating physical exercise, psychological care, and
nutrition interventions. Prehabilitation was associated with improved
exercise capacity (eg, increased 6MWT distance), reduced postoperative
complications, and potential benefits for quality of life and
psychological well-being. However, the impact on length of stay and
cognitive function remains unclear. Conclusion(s): This review
highlights a significant gap in the implementation of comprehensive
multimodal prehabilitation for lung cancer patients. While physical
exercise is widely adopted, psychological and nutritional components are
often overlooked. Further research is needed to establish clear guidelines
and elucidate the full benefits of a comprehensive multimodal
prehabilitation approach, particularly regarding its impact on mental
health, quality of life, and long-term outcomes in lung cancer
patients. Copyright © 2025 Mania et al.

<34>
Accession Number
2031076839
Title
Neuromonitoring practices for neonates with congenital heart disease: a
scoping review.
Source
Pediatric Research. 97(5) (pp 1492-1506), 2025. Date of Publication: 01
Apr 2025.
Author
Pardo A.C.; Carrasco M.; Wintermark P.; Nunes D.; Chock V.Y.; Sen S.;
Wusthoff C.J.; Selvanathan T.; Nakwa F.; Leijser L.M.; Peeples E.; Gano
D.; Boardman J.P.; deVeber G.; Lemmon M.; Glass H.; Chau V.; Aly H.;
Bonifacio S.
Institution
(Pardo) Department of Pediatrics (Neurology and Epilepsy). Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Carrasco) Department of Neurology. University of Wisconsin School of
Medicine and Public Health, Madison, WI, United States
(Wintermark) Department of Pediatrics, Faculty of Medicine and Health
Sciences, McGill University, Montreal, QC, Canada
(Nunes) Galter Health Sciences Library. Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Chock, Bonifacio) Department of Pediatrics (Neonatology), Lucile Packard
Children's Hospital and Stanford University, Palo Alto, CA, United States
(Sen) Department of Pediatrics (Neonatology). Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Sen) Department of Pediatrics, University of California Irvine, Orange,
CA, United States
(Wusthoff) Department of Neurology, Stanford University, Palo Alto, CA,
United States
(Aly) Division of Neonatology, Cleveland Clinic Children's Hospital,
Cleveland, OH, United States
(deVeber, Chau) Department of Pediatrics (Neurology), The Hospital for
Sick Children, SickKids Research Institute (Neuroscience and Mental
Health) and University of Toronto, Toronto, ON, Canada
(Gano, Glass) Departments of Neurology & Pediatrics, UCSF School of
Medicine, University of California, San Francisco, San Francisco, CA,
United States
(Lemmon) Department of Pediatrics, Duke University School of Medicine,
Durham, NC, United States
(Lemmon) Department of Population Health Sciences, Duke University School
of Medicine, Durham, NC, United States
(Boardman) Centre for Reproductive Health, Institute for Regeneration and
Repair, University of Edinburgh, IL, Edinburgh, United Kingdom
(Boardman) Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Peeples) Department of Pediatrics, Children's Nebraska, Omaha, NE, United
States
(Leijser) Department of Pediatrics, Section of Neonatology, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada
(Nakwa) Department of Paediatrics and Child Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
(Selvanathan) Department of Pediatrics, BC Children's Hospital Research
Institute and University of British Columbia, Vancouver, BC, Canada
Publisher
Springer Nature
Abstract
Abstract: Neonates with congenital heart disease (CHD) are at risk for
adverse neurodevelopmental outcomes. This scoping review summarizes
neuromonitoring methods in neonates with CHD. We identified 84 studies
investigating the use of near-infrared spectroscopy (NIRS) (n = 37),
electroencephalography (EEG) (n = 20), amplitude-integrated
electroencephalography (aEEG) (n = 10), transcranial Doppler sonography
(TCD) (n = 6), and multimodal monitoring (n = 11). NIRS was used to
evaluate cerebral oxygenation, identify risk thresholds and adverse events
in the intensive care unit (ICU), and outcomes. EEG was utilized to screen
for seizures and to predict adverse outcomes. Studies of aEEG have focused
on characterizing background patterns, detecting seizures, and outcomes.
Studies of TCD have focused on correlation with short-term clinical
outcomes. Multimodal monitoring studies characterized cerebral physiologic
dynamics. Most of the studies were performed in single centers, had a
limited number of neonates (range 3-183), demonstrated variability in
neuromonitoring practices, and lacked standardized approaches to
neurodevelopmental testing. We identified areas of improvement for future
research: (1) large multicenter studies to evaluate developmental
correlates of neuromonitoring practices; (2) guidelines to standardize
neurodevelopmental testing methodologies; (3) research to address
geographic variation in resource utilization; (4) integration and
synchronization of multimodal monitoring; and (5) research to establish a
standardized framework for neuromonitoring techniques across diverse
settings. Impact: This scoping review summarizes the literature regarding
neuromonitoring practices in neonates with congenital heart disease (CHD).
The identification of low cerebral oxygenation thresholds with NIRS may be
used to identify neonates at risk for adverse events in the ICU or adverse
neurodevelopmental outcomes. Postoperative neuromonitoring with continuous
EEG screening for subclinical seizures and status epilepticus, allow for
early and appropriate therapy. Future studies should focus on enrolling
larger multicenter cohorts of neonates with CHD with a standardized
framework of neuromonitoring practices in this population. Postoperative
neurodevelopmental testing should utilize standard assessments and testing
intervals. Copyright © The Author(s) 2024.

<35>
Accession Number
2039873105
Title
Automated 3D Computed Tomography Bronchography and Angiography as a Useful
Tool for the Clinical Medicine Education of Lung Segmentectomy.
Source
American Surgeon. 92(2) (pp 360-368), 2026. Date of Publication: 01 Feb
2026.
Author
Zhao Y.; Yuan F.; Liu W.; Zuo J.; Zhang R.
Institution
(Zhao, Yuan, Liu, Zuo, Zhang) Department of Thoracic Surgery, The First
Affiliated Hospital, Anhui Medical University, Hefei, China
Publisher
SAGE Publications Inc.
Abstract
Objective: As pulmonary segmentectomy becomes increasingly common in the
treatment of early-stage lung cancer, providing relevant clinical training
for residents is essential. However, understanding pulmonary segment
anatomy can be challenging due to its complex and variable structures.
This study aimed to evaluate the value of automated three-dimensional CT
bronchography and angiography (3D-CTBA) technology in training surgical
residents for segmentectomy. Method(s): Fifty-two surgical residents
were randomized into 2 groups: the 3D-CTBA group and the control group.
The 3D-CTBA group utilized automated 3D-CTBA technology alongside specific
case for segmentectomy training, while the control group relied on
traditional teaching methods. After the training sessions, all
participants completed a post-training assessment and questionnaires.
Additionally, we collected feedback from instructors regarding the
residents' performance through a separate questionnaire. Result(s):
Residents in the 3D-CTBA group achieved significantly higher scores on the
post-training assessments than those in the control group (83.46 +/- 6.75
vs 68.27 +/- 8.12, P < 0.001). Subjective survey results indicated that
automated 3D-CTBA technology greatly benefited residents in preoperatively
identifying tumor locations, recognizing anatomical variations during
surgery, and mastering relevant surgical techniques. Feedback from
instructors indicated that residents in the 3D-CTBA group performed better
intraoperatively than those in the control group. Furthermore, residents
in the 3D-CTBA group expressed greater interest in learning and higher
satisfaction with the course. Conclusion(s): Automated 3D-CTBA
technology significantly improved residents' comprehension of the complex
and variable anatomy of pulmonary segments, thereby enhancing their
related surgical skills. Copyright © The Author(s) 2025

<36>
Accession Number
2042296983
Title
Towards a More Standardized Bicuspid Aortic Valve Repair: Rationale and
Design of the CONTOUR Trial.
Source
European Journal of Cardio-thoracic Surgery. 67(12) (no pagination), 2025.
Article Number: ezaf360. Date of Publication: 01 Dec 2025.
Author
Girdauskas E.; Stock S.; Hofbauer D.; Petersen J.; Reichenspurner H.;
Holubec T.; Walther T.; Vogl T.; Borger M.; Gutberlet M.; Kroncke T.;
Decker J.; Zapf A.; Lezius S.; Lenz A.; Lansac E.; Bannas P.
Institution
(Girdauskas, Stock, Hofbauer) Department of Cardiovascular and Thoracic
Surgery, University Hospital Augsburg, Augsburg, Germany
(Girdauskas, Petersen, Reichenspurner) Department of Cardiovascular
Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
(Holubec, Walther) Department of Cardiovascular Surgery, University
Hospital, Frankfurt, Germany
(Vogl) Department of Diagnostic and Interventional Radiology, University
Hospital, Frankfurt, Germany
(Borger) Department Cardiac Surgery, Leipzig Heart Center, Leipzig,
Germany
(Gutberlet) Department of Diagnostic and Interventional Radiology, Leipzig
Heart Center, Leipzig, Germany
(Kroncke, Decker) Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg, Augsburg, Germany
(Zapf, Lezius) Institute of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Lenz, Bannas) Department of Diagnostic and Interventional Radiology and
Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
(Lansac) Department of Cardiothoracic Surgery, Hopital de La
Pitie-Salpetriere, AP-HP, Sorbonne Universite, Paris, France
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives Aortic valve repair is an evolving and still underused strategy
in young bicuspid aortic valve (BAV) patients with aortic regurgitation
(AR). The lack of standardization remains the main limitation of current
repair techniques, resulting in an increased risk of AR recurrence and
reoperation. The most controversial issue is the stabilization of the BAV
annulus. Methods The CONTOUR trial is a multicentre RCT designed to
compare 2 aortic valve annuloplasty concepts in 100 consecutive BAV
patients. BAV AR patients with an asymmetric configuration and without
aortopathy will be randomized 1:1 to undergo aortic valve repair using an
internal HAART 200 annuloplasty device (INTERNAL group) or double external
annuloplasty using Extra Aortic ring (EXTERNAL group). 4 D flow magnetic
resonance imaging (MRI) will be performed preoperatively (t1),
postoperatively at discharge (t2), and at 1-year follow-up (t3) for
rater-blinded assessment of haemodynamic profiles (ie, flow eccentricity)
and regurgitation fraction at the MRI core-lab. Two hierarchically ordered
primary end-points will be considered: (1) postoperative reduction of flow
eccentricity at hospital discharge and (2) regurgitation fraction (%) at
1-year follow-up. Results The CONTOUR trial is the first RCT designed to
compare 2 different annuloplasty techniques in their effectivity to create
a completely symmetric post-repair BAV geometry and to achieve superior
aortic valve repair outcomes. Conclusions The study findings are expected
to significantly influence aortic valve repair practice and contribute to
the refinement of guideline recommendations in the management of BAV
patients with AR. Copyright © The Author(s) 2025. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<37>
Accession Number
2042281911
Title
Efficacy and safety of PM-AR-T versus edwards MC3 rings in tricuspid
regurgitation: A non-inferiority, randomized controlled trial.
Source
PLOS ONE. 20(12 December) (no pagination), 2025. Article Number: e0333891.
Date of Publication: 01 Dec 2025.
Author
Xu Z.; Li J.; Xu W.; Zong Q.; Ji W.; Xu Y.; Su Y.; Li K.; Wang D.; Pan J.
Institution
(Xu, Xu, Zong, Ji, Xu, Su, Li, Wang, Pan) Department of Cardiothoracic
Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing
University Medical School, Nanjing, China
(Li) Department of Ultrasound Imaging, Surgery, Nanjing Drum Tower
Hospital, The Affiliated Hospital of Nanjing University Medical School,
Nanjing, China
Publisher
Public Library of Science
Abstract
Objectives Tricuspid valve repair, particularly with annuloplasty rings,
is increasingly recognized as an effective treatment. PM-AR-T is a
semi-rigid annuloplasty ring based on a nickel-titanium alloy which has
made progress in animal models, however, studies on PM-AR-T's performance
in patients with tricuspid regurgitation (TR) are lacking. This study
aimed to compare the efficacy and safety of the PM-AR-T with the Edwards
MC3 ring for the TR treatment. Methods A non-inferiority, randomized
controlled trial was conducted in 20 centers across China, enrolling
patients with tricuspid valve disease requiring surgical repair. Patients
were randomized to receive either PM-AR-T or Edwards MC3 ring. The primary
endpoint was the success rate of valve repair at 6 months. Results A total
of 164 patients underwent valve annuloplasty, 83 and 81 in the PM-AR-T and
Edwards MC3 groups. Valve repair success rates were 92.8% and 93.8% in the
PM-AR-T and Edwards MC3 groups, demonstrating non-inferiority with a
difference of -1.1% (95% confidence interval [CI]: -9.5 to 7.4), which was
less than the pre-specified non-inferiority margin of -10%. No significant
intergroup differences were found in valve regurgitation,
echocardiographic parameters, and New York Heart Association (NYHA)
functional classification at any postoperative time point. At 12 months,
the proportions of patients without regurgitation were comparable, 30.4%
and 27.8% in the PM-AR-T and Edwards MC3 groups (P = 0.705). Improvement
to NYHA functional class I status was detected in 46.2% and 45.6% of the
two groups by 12 months (P = 0.893). Both rings exhibited comparable
safety profiles, with no device-related serious adverse events,
cardiovascular deaths, major bleeding events, severe structural damage,
infective endocarditis, or thromboembolic events. Conclusions The PM-AR-T
tricuspid valve semi-rigid ring is effective in improving TR,
demonstrating non-inferiority to the Edwards MC3 ring, with a favorable
safety profile. Copyright © 2025 Xu 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.

<38>
Accession Number
2041165616
Title
Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic
Review and Management Algorithm.
Source
Vascular and Endovascular Surgery. 60(2) (pp 135-144), 2026. Date of
Publication: 01 Feb 2026.
Author
Pegler A.; Sivakumaran Y.
Institution
(Pegler, Sivakumaran) Princess Alexandra Hospital, Brisbane, QLD,
Australia
Publisher
SAGE Publications Inc.
Abstract
Background: Aortic dissection following endovascular aneurysm repair
(EVAR) may be iatrogenic or a de-novo event. This study aims to
systematically review all cases of dissection following EVAR to identify
complications specific to each scenario and develop a management algorithm
depending on the clinical presentation. Method(s): A comprehensive
literature search of MEDLINE, Embase, and CENTRAL databases was performed
for all studies relating to dissection following EVAR or
fenestrated/branched EVAR (F/BrEVAR). Data collected included timing
(differentiating iatrogenic and de-novo events), entry tear location,
endograft involved, complications, management, and subsequent outcomes.
Due to limited data availability, descriptive data was collected and
outcomes compared depending on dissection type and timing. Risk of bias
was assessed using a standardised tool for case reports. Result(s):
46 patients in 37 studies were included. Complications included endograft
compression (52.2%), endoleak (15.2%), and rupture (13.0%). Compression
was less likely in endografts with proximal fixation (41.9%), compared to
those without (69.2%). Type A dissection after EVAR required cardiac
surgery with a high mortality (20.0%). In Type B dissection, 2 cases were
diagnosed intra-operatively during F/BrEVAR, 1 died. 8 were diagnosed <4
weeks post-operatively, all managed medically with no complications or
mortality. 31 were diagnosed >4 weeks, with mortality of 25.8% and high
rates of endograft compression (58.1%), endoleak (16.1%), and rupture
(19.4%). Conclusion(s): Aortic dissection following EVAR may cause
endograft compression, endoleak, or rupture, with significant mortality.
Complications are more frequent following Type A dissection and late Type
B dissection. Early Type B dissection may be amenable to medical
management. Copyright © The Author(s) 2025

<39>
Accession Number
2030550707
Title
Off-pump Versus On-pump Coronary Artery Bypass Grafting in Diabetic
patients: A Meta-analysis of Observational Studies with a Propensity-Score
Analysis.
Source
Cardiovascular Drugs and Therapy. 39(6) (pp 1365-1374), 2025. Date of
Publication: 01 Dec 2025.
Author
Ren Q.; Li G.; Chu T.; Liu Q.; Huang Y.; Liu K.; Pan J.; Wu Z.
Institution
(Ren, Li, Chu, Liu, Huang, Liu, Pan, Wu) Department of Cardiac Surgery,
First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
(Ren, Li, Chu, Liu, Huang, Liu, Pan, Wu) NHC Key Laboratory of Assisted
Circulation, Sun Yat-Sen University, Guangzhou, China
Publisher
Springer
Abstract
Purpose: The debate between off-pump coronary artery bypass grafting
(OPCAB) and on-pump coronary artery bypass grafting (ONCAB) in diabetic
patients remains. This meta-analysis aimed to investigate outcomes after
OPCAB versus ONCAB for patients with diabetes. Method(s): Literature
research was conducted up to December 2023 using Ovid Medline, EMBASE, and
the Cochrane Library. Eligible studies were observational studies with a
propensity-score analysis of OPCAB versus ONCAB. The primary outcomes were
early mortality and mid-term survival. The secondary outcomes were
cerebrovascular accidents, reoperation for bleeding, incomplete
revascularization, myocardial infarction, low cardiac output, and renal
replacement therapy. Result(s): Our research identified seven
observational studies with a propensity-score analysis enrolling 13,085
patients. There was no significant difference between OPCAB and ONCAB for
early mortality, mid-term survival, myocardial infarction, low cardiac
output, and renal replacement therapy. OPCAB was associated with a lower
risk of cerebrovascular accidents (OR 0.43; 95% CI, 0.24-0.76, P = 0.004)
and reoperation for bleeding (OR 0.60; 95% CI, 0.41-0.88, P = 0.009).
However, OPCAB was associated with a higher risk of incomplete
revascularization (OR 2.07; 95% CI, 1.60-2.68, P < 0.00001).
 Conclusion(s): Among patients with diabetes, no difference in early
mortality and mid-term survival was observed. However, OPCAB was
associated with a lower incidence of morbidity, including cerebrovascular
accidents and reoperation for bleeding. Copyright © The Author(s)
2024.

<40>
Accession Number
2041858807
Title
Effects of perioperative dexmedetomidine on renal vascular function and
renovascular histopathology in ovine cardiopulmonary bypass.
Source
Intensive Care Medicine Experimental. 13(1) (no pagination), 2025. Article
Number: 128. Date of Publication: 01 Dec 2025.
Author
Betrie A.H.; Jufar A.H.; Evans R.G.; Cochrane A.D.; Marino B.; Birchall
I.; Hood S.G.; McCall P.R.; Ayton S.; Miles L.F.; May C.N.; Lankadeva Y.R.
Institution
(Betrie, Jufar, Evans, Cochrane, Birchall, Hood, Miles, May, Lankadeva)
Florey Institute of Neuroscience and Mental Health, The University of
Melbourne, VIC, Australia
(Betrie, Ayton) Florey Department of Neuroscience and Mental Health, The
University of Melbourne, VIC, Australia
(Evans) Biomedicine Discovery Institute and Department of Physiology,
Monash University, Melbourne, VIC, Australia
(Cochrane) Department of Cardiothoracic Surgery, Monash Health and
Department of Surgery, Monash University, Melbourne, VIC, Australia
(Marino) Cellsaving and Perfusion Resources, Melbourne, VIC, Australia
(Birchall) Department of Surgery, The University of Melbourne, VIC,
Australia
(McCall, Miles, Lankadeva) Department of Anaesthesia, Austin Hospital,
Melbourne, Australia
(Miles, May, Lankadeva) Department of Critical Care, Melbourne Medical
School, The University of Melbourne, VIC, Australia
(Lankadeva) Translational Cardiovascular and Renal Research Group, The
Florey Institute of Neuroscience and Mental Health, 30 Royal Parade,
Parkville, VIC, Australia
Publisher
Springer Nature
Abstract
Background: Cardiopulmonary bypass (CPB) is integral to the conduct of
cardiac surgery but is associated with postoperative acute kidney injury
(AKI). Dexmedetomidine, an alpha-adrenoceptor agonist with
anti-inflammatory and sympatholytic properties, has putative
renoprotective effects. In a recent meta-analysis, dexmedetomidine during
CPB reduced AKI; conversely, a large, randomised trial reported an
increase in postoperative AKI. Further, we found increased renal tubular
injury in sheep receiving dexmedetomidine during CPB. Here, we aimed to
determine whether dexmedetomidine during CPB induces changes in renal
vascular reactivity or endothelial integrity that could explain focal
renal tubular injury. Method(s): Fourteen instrumented Merino ewes
underwent 2 h of non-pulsatile CPB (flow 70 mL/kg/min; MAP 65-75 mmHg;
cooled by 3 degreeC) under standardised propofol-fentanyl-sevoflurane
anaesthesia. Animals were randomly allocated to dexmedetomidine (0.4-0.8
microg/kg/h, n = 7) or fluid-matched saline (n = 7) from induction of
anesthesia to end-CPB. Arterial pressure, renal blood flow, cortical and
medullary perfusion and PO were measured in vivo (n = 7/group). Post-CPB,
renal interlobar arteries were isolated for wire myography. Due to
standardisation failures, in vitro analyses of dose-response curves for
phenylephrine were performed in n = 6 per group, while
endothelial-dependent and independent relaxation responses were performed
in n = 7 per group. Endothelial histology of CPB arteries was compared
with arteries from a separate cohort of healthy Merino ewes (n = 7).
 Result(s): In vitro functional investigations demonstrated that
interlobar arteries from dexmedetomidine-treated sheep exhibited a
2.3-fold increase in phenylephrine sensitivity (pEC 5.82 +/- 0.27 vs. 5.45
+/- 0.23; p = 0.034), with unchanged maximal contraction.
Endothelium-dependent and independent relaxations were similar between
groups, though inhibitor studies indicated a shift towards
cyclooxygenase-mediated dilation under dexmedetomidine. Histology revealed
intact endothelial architecture and no damage to endothelial integrity in
all groups. Conclusion(s): Perioperative dexmedetomidine during CPB
enhanced alpha1-adrenergic vasoconstrictor sensitivity in renal interlobar
arteries without disrupting endothelial integrity or compromising renal
blood flow or intrarenal perfusion. The enhanced vasoreactivity may
contribute to focal renal ischaemia and tubular injury during CPB, which
cannot be detected by in vivo measurements of global and regional kidney
perfusion and oxygenation. Further investigation is warranted to elucidate
the pathways through which dexmedetomidine contributes to renal tubular
injury during CPB. Copyright © The Author(s) 2025.

<41>
Accession Number
2039208346
Title
Baseline right ventricular-to-pulmonary artery coupling and outcomes after
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Hellenic Journal of Cardiology. 86 (pp 148-151), 2025. Date of
Publication: 01 Nov 2025.
Author
Theofilis P.; Sakalidis A.; Vlachakis P.K.; Mantzouranis E.; Karakasis P.;
Pamporis K.; Dardas S.; Oikonomou E.; Drakopoulou M.; Dimitriadis K.;
Aggeli K.; Tsioufis K.; Tousoulis D.
Institution
(Theofilis, Sakalidis, Vlachakis, Mantzouranis, Pamporis, Drakopoulou,
Dimitriadis, Aggeli, Tsioufis, Tousoulis) Department of Cardiology,
"Hippokration" General Hospital of Athens, Athens, Greece
(Karakasis) Department of Cardiology, Ippokrateio General Hospital of
Thessaloniki, Thessaloniki, Greece
(Dardas) London Health Sciences Center, ON, Canada
(Oikonomou) Department of Cardiology, Sotiria General Hospital, Athens,
Greece
Publisher
Hellenic Cardiological Society

<42>
Accession Number
2041880950
Title
Orforglipron, an oral small-molecule GLP-1 receptor agonist, for the
treatment of obesity in people with type 2 diabetes (ATTAIN-2): a phase 3,
double-blind, randomised, multicentre, placebo-controlled trial.
Source
The Lancet. 406(10522) (pp 2927-2944), 2025. Date of Publication: 20 Dec
2025.
Author
Horn D.B.; Ryan D.H.; Kis S.G.; Alves B.; Mu Y.; Kim S.G.; Aberle J.; Bain
S.C.; Allen S.; Sarker E.; Wu Q.; Stefanski A.; Jouravskaya I.
Institution
(Horn) Department of Surgery, University of Texas McGovern Medical School,
Center for Obesity Medicine and Metabolic Performance, Houston, TX, United
States
(Ryan) Pennington Biomedical Research Center, Baton Rouge, LA, United
States
(Kis, Allen, Sarker, Wu, Stefanski, Jouravskaya) Eli Lilly and Company,
Indianapolis, IN, United States
(Alves) Centro Paulista De Investigacao Clinica (Cepic), Sao Paulo, Brazil
(Mu) Department of Endocrinology, First Medical Centre of Chinese PLA
General Hospital, Beijing, China
(Kim) Department of Internal Medicine, Korea University College of
Medicine, Seoul, South Korea
(Aberle) University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Bain) Swansea University Medical School, Swansea, United Kingdom
Publisher
Elsevier B.V.
Abstract
Background Obesity is a chronic disease that significantly contributes to
type 2 diabetes and its complications. We aimed to evaluate orforglipron,
an oral small-molecule (non-peptide) GLP-1 receptor agonist, for obesity
treatment in adults with type 2 diabetes. Methods This 72-week, phase 3,
double-blind, placebo-controlled trial was conducted across 136 sites in
ten countries. Participants with a BMI of 27 kg/m2 or higher
and glycated haemoglobin (HbA<inf>1c</inf>) of 7-10% (53-86 mmol/mol) were
randomly assigned (1:1:1:2) to once-daily orforglipron 6 mg, 12 mg, 36 mg,
or placebo. The primary endpoint was the mean percent change in bodyweight
from baseline to week 72. The treatment regimen estimand (using data from
all randomly assigned participants, regardless of intercurrent events) was
the primary estimand, with the efficacy estimand considered supportive.
Safety was assessed in all patients who received at least one dose of
study drug. This trial was registered at ClinicalTrials.gov ( NCT05872620
) and is completed. Findings From June 5, 2023, to Feb 15, 2024, 2859
participants were screened, and 1613 (757 [46.9%] female) were randomly
assigned, following a dose-escalation phase, to receive orforglipron 6 mg
(n=329), 12 mg (n=332), 36 mg (n=322), or placebo (n=630), as an adjunct
to lifestyle modification; 1444 (89.5%) completed the study. Baseline
bodyweight was 101.4 kg (SD 22.5), BMI 35.6 kg/m2 (SD 6.6), and
HbA<inf>1c</inf> 8.05% (SD 0.75; 64.4 mmol/mol [SD 8.2]). For the
treatment regimen estimand, the mean percent change in bodyweight from
baseline to week 72 was -5.1% (95% CI -6.0 to -4.2) with 6 mg (estimated
treatment difference [ETD] -2.7 [95% CI -3.7 to -1.6]; p<0.0001), -7.0%
(-7.8 to -6.2) with 12 mg (ETD -4.5 [-5.5 to -3.6]; p<0.0001), and -9.6%
(-10.5 to -8.7) with 36 mg orforglipron (ETD -7.1 [-8.2 to -6.1];
p<0.0001), versus -2.5% (-3.0 to -1.9) with placebo (all p<0.0001 compared
with placebo). All prespecified weight and cardiometabolic measures
including HbA<inf>1c</inf> statistically significantly improved with
orforglipron. Treatment discontinuations due to adverse events (mainly
gastrointestinal-related) were higher for orforglipron (6.1-9.9%) versus
placebo (4.1%). The most common adverse events with orforglipron were
mild-to-moderate gastrointestinal events, predominantly occurring during
dose escalation. Ten deaths were reported during the study: six with
orforglipron and four with placebo. Investigators deemed all deaths
unrelated to the study treatment, except for one case in the placebo group
and one case in the 12 mg orforglipron group. For the case in the
orforglipron group, no treatment-related association was reported.
Interpretation In adults with obesity or overweight and type 2 diabetes,
statistically superior reduction in bodyweight compared with placebo was
demonstrated by once-daily orforglipron as an adjunct to lifestyle
modification, with a safety profile similar to other GLP-1 receptor
agonists. Funding Eli Lilly and Company. Copyright © 2025
Elsevier Ltd.

<43>
Accession Number
2031011308
Title
Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants
Compared with Vitamin K Antagonists in Patients with Atrial Fibrillation
and Type 2 Valvular Heart Disease: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Drugs and Therapy. 39(6) (pp 1375-1386), 2025. Date of
Publication: 01 Dec 2025.
Author
Liang X.; Liu S.; Ji L.; Ma F.; Song G.; Li F.; Liu G.
Institution
(Liang, Liu, Ji, Ma, Song, Li, Liu) Department of Cardiology, The First
Hospital of Hebei Medical University, Hebei, Shijiazhuang, China
(Liu) Hebei Key Laboratory of Cardiac Injury Repair Mechanism Study,
Hebei, Shijiazhuang, China
(Liu) Hebei Key Laboratory of Heart and Metabolism, Hebei, Shijiazhuang,
China
(Liu) Hebei Engineering Research Center of Intelligent Medical Clinical
Application, Hebei, Shijiazhuang, China
(Liu) Hebei International Joint Research Center for Structural Heart
Disease, Hebei, Shijiazhuang, China
Publisher
Springer
Abstract
Purpose: This meta-analysis aimed to evaluate the efficacy and safety of
non-vitamin K antagonist oral anticoagulants (NOACs) compared with vitamin
K antagonists (VKAs) in patients with atrial fibrillation (AF) and type 2
valvular heart disease (VHD). Method(s): We searched the PubMed,
LILACS, and MEDLINE databases to retrieve, randomized controlled trials
(RCTs) comparing NOACs and VKAs in patients with AF and type 2 VHD,
excluding mitral stenosis (moderate to severe, of rheumatic origin) or
mechanical heart valves. The efficacy outcomes assessed were stroke and
systemic embolism (SE), while safety outcomes included major bleeding and
intracranial hemorrhage (ICH). Result(s): Seven RCTs, including
16,070 patients with AF and type 2 VHD, were included. NOACs reduced the
risk of stroke/SE (relative risk [RR], 0.75; 95% confidence interval [CI],
0.64-0.89; P = 0.0005), with no significant difference in major bleeding
(RR, 0.88; 95% CI, 0.64-1.21; P = 0.43). The risk of ICH was reduced with
NOACs (RR, 0.46; 95% CI, 0.27-0.77; P = 0.003). For patients with AF and
bioprosthetic heart valve (five trials, 2805 patients), stroke/SE risks
(RR, 0.65, 95% CI, 0.44-0.96) with NOACs were superior to VKAs. Major
bleeding risks without ENVISAGE TAVI AF trial (RR, 0.53; 95% CI,
0.30-0.94; P = 0.03) with NOACs were superior to VKAs. The risks of ICH
(RR, 0.61; 95% CI 0.34-1.09; P = 0.09) with NOACs were comparable to VKAs.
 Conclusion(s): NOACs demonstrate efficacy and safety in patients with
AF and type 2 VHD and reduce the risk of stroke/SE and ICH when compared
with those with VKAs. Copyright © The Author(s) 2024.

<44>
Accession Number
2035832909
Title
Phenotype characterization of heart failure with preserved ejection
fraction in medical device and surgical trials.
Source
ESC Heart Failure. 12(6) (pp 3878-3898), 2025. Date of Publication: 01 Dec
2025.
Author
Araz K.; Fioretti F.; Ladak S.; Obaidan M.; Butler J.; Hameed A.
Institution
(Araz, Ladak) School of Medicine, RCSI University of Medicine and Health
Sciences, Dublin, Ireland
(Fioretti, Butler) Baylor Scott & White Research Institute, Dallas, TX,
United States
(Obaidan) UCD School of Medicine, UCD Health Sciences Centre, University
College Dublin, Dublin, Ireland
(Butler) University of Mississippi, Jackson, MS, United States
(Hameed) Tissue Engineering Research Group (TERG), Department of Anatomy
and Regenerative Medicine, RCSI University of Medicine and Health
Sciences, Dublin, Ireland
(Hameed) Trinity Centre for Biomedical Engineering (TCBE), Trinity College
Dublin (TCD), Dublin, Ireland
Publisher
John Wiley and Sons Inc
Abstract
Aims: Heart failure with preserved ejection fraction (HFpEF) prevalence is
nearing 50% of all heart failure cases and is often associated with
advanced age, obesity, atrial fibrillation and hypertension, and medical
approaches are limited. This review aims to determine the potential of
medical devices or surgical interventions in treating HFpEF and to propose
specific phenotypes of HFpEF. Methods and Results: A systematic
review was conducted using various clinical trial databases and the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines followed by descriptive analysis and methodology
quality assessment. Inclusion criteria included a medical device or
surgical intervention involving HFpEF patients defined by a left
ventricular ejection fraction (LVEF) >=50% and signs of diastolic
dysfunction. Twenty-four novel trials were identified involving n = 1752
participants: 17 medical device trials [3 interatrial shunt device trials
(n = 1069), 1 atrial flow regulator trial (n = 41), 3 vagal nerve
stimulation trials (n = 112), 1 baroreflex activation therapy trial (n =
21), 1 cardiac contractility modulator trial (n = 47), 6 cardiac
resynchronization therapy trials (n = 178) and 2 functional electrical
stimulation therapy trials (n = 89)] and 7 surgical intervention trials [1
renal denervation trial (n = 25), 3 greater splanchnic nerve ablation
trials (n = 111), 2 catheter ablation trials (n = 55) and 1 pericardiotomy
procedure trial (n = 4)]. One trial completed phase 3 trials, 20 trials
completed phase 1 trials with further trials, and 5 trials completed phase
1 trials without further trials. Conclusion(s): Overall, 16 out of 24
trials have at least demonstrated safety and feasibility. However, despite
many trials of a medical device or surgical procedure showing proof of
concept to treat HFpEF phenotypes, they do not provide sufficient evidence
of long-term benefit. More robust and phenotype-based clinical trials are
needed to ensure evidence-based solutions are developed in
HFpEF. Copyright © 2025 The Author(s). ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of European Society of
Cardiology.

<45>
Accession Number
2033337287
Title
Pericardiocentesis Versus Surgical Pericardiotomy for Malignant
Pericardial Effusion: A Systematic Review and Meta-Analysis.
Source
Indian Journal of Surgical Oncology. 16(6) (pp 1403-1412), 2025. Date of
Publication: 01 Dec 2025.
Author
da Nobrega Oliveira R.E.N.; de Andrade Pontual Peres C.; Oliveira A.C.;
Onyeji P.; Kemczenski F.
Institution
(da Nobrega Oliveira) Departament of Thoracic Surgery, Barretos Cancer
Hospital, Street Antenor Duarte Vilela, 1331 - Dr. Paulo Prata, SP,
Barretos, Brazil
(de Andrade Pontual Peres) University of Pernambuco, Recife, Brazil
(Oliveira) Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
(Onyeji) All Saints University, Goodwill, Dominica
(Kemczenski) University of Joinville'S Region, Joinville, Brazil
Publisher
Springer
Abstract
To compare the effectiveness and safety of pericardiocentesis versus
surgical pericardiotomy in managing malignant pericardial effusion (MPE).
We searched PubMed, Embase, and Cochrane databases for studies comparing
pericardiocentesis with surgical pericardial window in patients with MPE.
We computed mean differences (MDs) for continuous endpoints and odds
ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs).
Trial registry: International Prospective Register of Systematic Reviews;
N: CRD42024572468. A total of 12 studies comprising 3,721 patients were
included in this meta-analysis. There was a significant increase in
re-accumulation of pericardial effusion in patients undergoing
pericardiocentesis (OR 3.81; 95% CI 1.99-7.31). However, there were no
significant difference between groups for in-hospital mortality (OR 0.99;
95% CI 0.68-1.46), bleeding (OR 0.05; 95% CI 0.00-2.18), atrial
fibrillation (OR 0.50; 95% CI 0.05-5.12), paradoxical hemodynamic
instability (OR 0.67; 95% CI 0.32-1.38), and length of stay (MD -0.93; 95%
CI -6.17, 4.31). Significant heterogeneity was observed in the length of
hospital stay outcome (I2 = 79%). Additionally, the included
studies had a moderate risk of bias. Pericardiocentesis was associated
with an increase in re-accumulation of pericardial effusion compared with
surgical pericardial window in patients with MPE. However, there was no
significant difference between groups for in-hospital mortality, bleeding,
atrial fibrillation, paradoxical hemodynamic instability, and length of
stay. Copyright © The Author(s), under exclusive licence to
Indian Association of Surgical Oncology 2025.

<46>
Accession Number
2033501313
Title
Oral vs. Outpatient Parenteral Antimicrobial Treatment for Infective
Endocarditis: Study Protocol for the Spanish OraPAT-IE GAMES Trial.
Source
Infectious Diseases and Therapy. 14(3) (pp 643-655), 2025. Article Number:
100213. Date of Publication: 01 Mar 2025.
Author
de Alarcon A.; Alonso-Socas M.M.; Lopez-Lirola A.; Goikoetxea-Agirre A.J.;
Ribas M.A.; Navarro D.; Sala C.; Ambrosioni J.; Olivares P.; Lopez-Cortes
L.E.; Morales I.; Mendez I.; de Cueto M.; Calvo-Jambrina R.; Barquero
J.M.; Araji O.; Almendro-Delia M.; Brase A.; Calvo-Fernandez A.; Tauron
M.; Recasens L.; Sorli L.; Suarez M.; Silverio A.; Sanchez F.; Ribas N.;
Serrat R.; Molina L.; Mestres A.; Mas A.; Ginel A.J.; Horcajada-Gallego
J.P.; Ble M.; Lopez-Montesinos I.; Salavert-Lleti M.; Garcia-Bustos V.;
Fernandez-Navarro J.A.; Calabuig-Munoz E.; Montero-Alonso M.;
Tasias-Pitarch M.; Domingo-Valero D.; Arnau-Vives M.A.; Blanes-Hernandez
R.; Vives-Borras M.; Vidal-Bonet L.; Ruiz de Gopegui-Bordes E.;
Ribas-Blanco M.A.; Zarauza J.; Teira R.; Ruiz-Alonso N.; Parra J.A.;
Pajaron M.; Gutierrez-Diez J.; Gutierrez-Cuadra M.; Gutierrez-Fernandez
L.; Gonzalez-Rico C.; Garrido R.; Garcia I.; Fernandez-Sampedro M.;
Farinas-Alvarez C.; Farinas M.C.; Cobo-Belaustegui M.; Arnaiz de las
Revillas F.; Arminanzas-Castillo C.; Amado-Fernandez C.; Aguero-Balbin J.;
Martin-Blanco N.; Oteo J.A.; Garcia-Alvarez L.; Corral-Armas E.; Blanco
J.R.; Azcona-Gutierrez J.M.; Azcarate P.; Alonso L.J.; Saura D.;
Roura-Piloto A.; Perez-Andreu J.; Ortin A.; Oliva M.J.; Moral-Escudero E.;
Martinez-Toldos M.C.; de Gea J.H.; de la Morena Valenzuela G.; Blazquez
A.; Hernandez-Torres A.; Vazquez E.G.; Canovas S.; Albert L.;
Rivera-Martinez M.A.; Lopez-Contreras J.; Leta-Petracca R.; Grillo S.;
Ginel-Iglesias A.; Barros-Membrilla A.; Camprecios M.; Gasch O.; Monsalvez
V.; Gomila A.; Calzado S.; Diaz E.; Lozano L.; Capilla S.; Guillamon L.;
Guillaumet E.; Castaldo F.; Araujo G.; Dietl B.; Ibars S.; Xercavins M.;
Boix-Palop L.; Badia C.; Rosillo S.; Romero M.; Rial-Baston V.; Ramirez
U.; Moreno M.; Loeches B.; Antorrena I.; Ruiz S.; Rodriguez-Roda-Stuart
J.; del Rio A.; Oliva E.; Navas E.; Martin-Davila P.; Moya J.L.; Hermida
J.M.; Centella T.; Sanchez-Rodriguez I.; Gracia-Sanchez L.; Blasco A.;
Sbraga F.; Ruiz-Majoral A.; Alegre O.; Sanchez-Salado J.C.; Berbel D.;
Ardanuy C.; Grau I.; Carratala J.; Escrihuela-Vidal F.;
Gonzalez-de-la-Aleja P.; Pinargote-Celorio H.; Reus S.; Plazas J.; Merino
E.; Llamas P.; Climent V.; Carrasco R.; Goyeneche M.; Bidegain M.; Sanchez
S.; Zabalo-Arrieta M.; Villanueva-Benito I.; Vicente-Anza D.;
Unamuno-Ugartemendia I.; Solla-Ruiz I.; Sebastian-Alda R.; Sanchez-Haza
E.; Saez-Berbejillo A.; Reviejo K.; Rengel-Jimenez A.;
Perez-Moreiras-Lopez J.I.; Kortajarena-Urkola X.; Iribarren J.A.;
Granda-Bauza A.; Goyeneche del Rio M.; Goenaga M.A.; Fuentes A.;
Eizaguirre-Yarza A.; Echeverria T.; del Bosque-Martin C.;
Bustinduy-Odriozola M.J.; Berritu-Boronat E.; Azkune-Galparsoro H.; Camino
X.; Alvarez-Rodriguez I.; Voces R.; Vitoria Y.; Rodriguez R.; Rodrigo D.;
Nieto J.; Montejo M.; Lopez-Soria L.; Irurzun-Zuazabal J.; Iruretagoyena
J.R.; Ibarrola-Hierro M.; Goikoetxea A.J.; Euba-Ugarte G.; Del Alamo
Martinez de Lagos M.; Guio-Carrion L.; Crespo A.; Campana-Lazaro M.; Boado
M.V.; Blanco R.; Blanco-Vidal M.J.; Bereciartua E.; de la Villa S.;
Verde-Moreno E.; Vazquez P.; Valerio M.; Segado A.; Sanchez-Perez E.;
Rodriguez-Abella H.; Rincon C.; Pinto A.; Pinilla B.; Pedraz A.; Olmedo
M.; Monzon D.; Munoz P.; Melero R.; Martinez-Selles M.; Marin M.; Machado
M.; Hualde A.M.; Kestler-Hernandez M.; Gonzalez-Ramallo V.;
Gonzalez-Moraga F.J.; Mansilla A.G.; Garcia-Leoni M.E.; Gargallo E.;
Fortuny-Ribas R.; Estevez A.; Delgado-Montero A.; Cuerpo-Caballero G.;
Calatayud J.; Bouza E.; Bermejo J.; Alvarez-Uria A.; Alonso J.C.; Adan I.;
Rodriguez-Moreno F.; Prada-Arrondo P.; Perez-Ramirez A.; Lorenzo de la
Pena L.; Lacalzada J.; Gonzalez Gonzalez J.; Garcia-Rosado D.;
Fernandez-Sarabia J.; Delgado-Melian T.; Castro B.; Alonso M.D.M.;
Poyato-Borrego M.; Sanchez-Dominguez E.; Ortiz-Carrellan A.; Marin G.;
Luque-Marquez R.; Lopez-Haldon J.; Lepe J.A.; Gutierrez-Carretero E.;
Navarro-Amuedo D.; Vila J.; Tuset M.; Vidal B.; Urra X.; Tolosana J.M.;
Tellez A.; Soy D.; Sitges M.; Sanchis L.; Sandoval E.; Rovira I.; Roque
M.; Roca C.; Regueiro A.; Ramirez J.; Quintana E.; Pomar J.L.;
Perissinotti A.; Pericas J.M.; Pereda D.; Pare C.; Ortiz J.; Ninot S.;
Nicolas D.; Moreno A.; Miro J.M.; Marco F.; Lopez T.; Llopis-Perez J.;
Hernandez-Meneses M.; Garcia-Pares D.; Garcia de la Maria C.; Fuster D.;
Fita G.; Fernandez-Pittol M.; Espasa M.; Falces C.; de Diego O.; Cuervo
G.; Canas M.A.; Castella M.; Cartana R.; Brunet M.; Azqueta M.; Ascaso M.;
Alcocer J.; Almela M.; Andrea R.
Institution
(Cuervo, Hernandez-Meneses, Moreno, Sala, Ambrosioni, Miro) Infectious
Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona,
Villarroel 170, Barcelona, Spain
(Nicolas) Internal Medicine-Home Hospitalization Unit, Hospital
Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
(Vidal) Cardiology Department, Hospital Clinic-IDIBAPS, University of
Barcelona, Barcelona, Spain
(Fernandez-Pittol) Microbiology Department, Hospital Clinic-IDIBAPS,
University of Barcelona, Barcelona, Spain
(Cuervo, de Alarcon, Martin-Davila, Lopez-Montesinos, Lopez-Cortes,
Ambrosioni, Miro) CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
(de Alarcon, Luque-Marquez, Navarro) Clinical Unit of Infectious Diseases,
Microbiology and Parasitology (UCEIMP), Institute of Biomedicine of
Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of
Seville, Seville, Spain
(Alonso-Socas, Lopez-Lirola) Hospital Universitario de Canarias, Tenerife,
Spain
(Gonzalez-Ramallo) Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Goikoetxea-Agirre) Hospital Universitario de Cruces, Bilbao, Spain
(Goenaga) Hospital Universitario Donosti, Instituto Investigacion
Biogipuzkoa, San Sebastian, Spain
(Merino) Unit of Infectious Diseases, Alicante General University Hospital
- Alicante Institute of Health and Biomedical Research (ISABIAL),
Alicante, Spain
(Merino) Clinical Medicine Department, Miguel Hernandez University, Elche,
Spain
(Escrihuela-Vidal) Hospital Universitario de Bellvitge, Barcelona, Spain
(Martin-Davila) Hospital Universitario Ramon y Cajal, Instituto Ramon y
Cajal de Investigacion Sanitaria (IRYCIS), Madrid, Spain
(Loeches) Hospital Universitario La Paz, Madrid, Spain
(Boix-Palop) Hospital Mutua de Terrassa, Terrassa, Spain
(Gasch) Servei de Malalties Infeccioses, Hospital Universitari Parc Tauli,
Institut d'Investigacio i Innovacio Parc Tauli (I3PT-CERCA), Universitat
Autonoma de Barcelona, Sabadell, Spain
(Camprecios) Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
(Hernandez-Torres) Hospital Virgen de la Arrixaca, Murcia, Spain
(Garcia-Alvarez) Hospital San Pedro-CIBIR, Logrono, Spain
(Pajaron) Hospital Marques de Valdecilla, Santander, Spain
(Ribas) Hospital Son Espases, Palma, Spain
(Blanes-Hernandez) Hospital de La Fe, Valencia, Spain
(Lopez-Montesinos) Hospital del Mar, Barcelona, Spain
(Lopez-Cortes) Unidad Clinica de Enfermedades Infecciosas y Microbiologia,
Hospital Universitario Virgen Macarena, Seville, Spain
(Lopez-Cortes) Departamentos de Medicina y Microbiologia, Facultad de
Medicina, Universidad de Sevilla, Seville, Spain
(Lopez-Cortes) Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Seville,
Spain
Publisher
Adis
Abstract
Introduction: The POET trial demonstrated that moving from intravenous to
oral antibiotics in stable patients with left-sided infective endocarditis
(IE) was noninferior to fully parenteral treatment. However, it did not
compare outpatient strategies. Method(s): The OraPAT-IE GAMES trial
is a noninferiority, multicenter, randomized, open-label study aimed to
compare partial oral versus outpatient parenteral antibiotic therapy
(OPAT) for consolidation of antibiotic treatment in left-sided IE. A total
of 342 stable patients with IE caused by selected micro-organisms will
eventually be included. After a minimum of 10 days of parenteral
treatment, stable patients are randomized to oral therapy or OPAT. The
primary end-point is a composite of all-cause mortality, unplanned cardiac
surgery, relapse of positive blood cultures and/or unplanned hospital
admission. Patients are followed-up for 6 months after completing
antibiotic therapy. Planned Outcome: This trial seeks to demonstrate the
equivalent efficacy of the two outpatient strategies currently available
for stable patients with IE in the consolidation phase of antibiotic
treatment. Conclusion(s): In a global context of limited healthcare
resources and a sustained increase in elderly and frail patients, it is of
great importance to demonstrate the effectiveness and safety of outpatient
management strategies that could reduce the duration of conventional
hospitalizations with their potential complications and inherent costs.
Trial Registration: EudraCT: 2020-001024-34. ClinicalTrials.gov
identifier: NCT05398679. Copyright © The Author(s) 2025.

<47>
Accession Number
2041879079
Title
Letter to the Editor: Effects of levosimendan on weaning from mechanical
ventilation: A systematic review and meta-analysis.
Source
Journal of Critical Care. 92 (no pagination), 2026. Article Number:
155414. Date of Publication: 01 Apr 2026.
Author
De Lissnyder N.; Blackman S.; Oueslati I.; Lefevre A.; Slibani H.; Errais
O.; Honore P.M.
Institution
(De Lissnyder) VUB University, Brussels, Belgium
(Blackman) CHIREC, ULB University, Brussels, Belgium
(Oueslati, Errais) ULB University, Brussels, Belgium
(Lefevre) CHU Marie Curie, ULB University, Brussels, Belgium
(Slibani) Hassan 2 University, Casablanca, Morocco
(Honore) ICU, CHU UCL Godinne Namur, UCLouvain Medical School, Belgium
Publisher
W.B. Saunders

<48>
Accession Number
2042350708
Title
The Effects of Daytime Variation on Short-Term Outcomes of Cardiac
Surgical Patients: A PRISMA-Compliant Systemic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Yao Y.-T.; Huang S.; Chao M.; More A.
Institution
(Yao, Huang) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Peking; Union Medical College and Chinese
Academy of Medical Sciences, Beijing, China
(Yao, Huang) Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing,
China
(Yao, Chao, More) Center of Outcomes Research, Department of
Anesthesiology, Critical Care and Pain Medicine, University of Texas,
Houston, TX, United States
(Yao, Chao, More) Outcomes Research Consortium, Houston, TX, United States
Publisher
W.B. Saunders
Abstract
Objective: Circadian rhythms influence cardiovascular physiology and
surgical stress responses, raising the possibility that the timing of
cardiac surgery may affect outcomes. Previous studies have reported
conflicting results regarding whether morning (AM) versus afternoon (AF)
surgery influences perioperative morbidity and mortality. The present
study aimed to systematically evaluate whether the timing of cardiac
surgery, specifically AM versus AF procedures, influences short-term
outcomes. Design(s): A meta-analysis of observational cohort studies.
 Setting(s): Cardiovascular centers. Participant(s): Patients who
underwent elective cardiac surgery. Intervention(s): The AM or the AF
group. Measurements: The primary outcome was hospitalized mortality.
Secondary outcomes included major morbidities (new-onset atrial
fibrillation, myocardial infarction, stroke, renal and infectious
complications, reexploration, mechanical circulatory support) and
postoperative recovery profiles (mechanical ventilation duration, length
of stay [LOS] in the intensive care unit and hospital). Main
Result(s): Fourteen observational studies involving 135,672 patients
(81,391 in the AM group and 54,281 in the AF group) were included. Pooled
analysis showed no significant difference in hospitalized mortality
between the two groups (1.25% [998/79,550] v 1.17% [615/52,442], OR =
1.09, 95% CI = 0.99 to 1.21; p = 0.08]. The incidences of myocardial
infarction, stroke, renal and infectious complications, reexploration, and
mechanical circulatory support use were also comparable. However, AM
surgery was associated with a modestly higher incidence of new-onset
atrial fibrillation (26.05% [2,319/8,907] v 25.50% [1,000/3,921], OR =
1.11, 95% CI = 1.01 to 1.21; p = 0.03). No significant differences were
observed in mechanical ventilation duration [MD = -0.20 hours, 95% CI =
-0.40 to 0.00; p = 0.05], intensive care unit LOS [MD = -0.35 hours, 95%
CI = -6.14 to 5.43; p = 0.90], or hospital LOS [MD = -0.10 days, 95% CI =
-0.39 to 0.19; p = 0.49]. Conclusion(s): These findings suggest that
circadian influences on elective cardiac surgical outcomes are limited.
Future multicenter prospective studies are warranted to further define the
role of surgery timing in high-risk populations. Copyright © 2025
Elsevier Inc.

<49>
Accession Number
2042352020
Title
Driving Pressure-Guided Tidal Volume Titration Reduces Lung Injury in
Thoracic Surgery With One-Lung Ventilation: A Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Yan Y.; Liu X.; Liu Z.; Li Z.; Cai H.; Li W.; Zhao J.
Institution
(Yan, Li, Cai, Zhao) Department of Anesthesiology, China-Japan Friendship
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Yan, Liu, Liu, Li, Cai, Li, Zhao) Department of Anesthesiology,
China-Japan Friendship Hospital, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: The optimal tidal volume for patients undergoing thoracic
surgery with one-lung ventilation (OLV) remains unclear. This study aimed
to evaluate whether driving pressure-guided tidal volume titration could
reduce lung injury in these patients. Design(s): Prospective,
single-center, randomized controlled trial. Setting(s): Single-center
academic hospital in China. Participant(s): A total of 96 patients
undergoing thoracic surgery with OLV. Intervention(s): Patients were
randomly assigned to either the driving pressure-guided tidal volume group
(n = 46) or the control group (n = 50). In the control group, tidal volume
was set at 8 mL/kg of predicted body weight (PBW) during OLV. In the
driving pressure-guided group, tidal volume was adjusted to maintain a
driving pressure between 8 and 10 cm H<inf>2</inf>O, with modifications
within 4 to 8 mL/kg PBW during OLV. Measurements and Main Results:
The primary outcome was the concentration of interleukin 6 (IL-6) in the
dependent lung following OLV. The tidal volume in the driving
pressure-guided group was 4.65 [4.23-5.65] mL/kg at 15 minutes and 4.58
[4.27-5.41] mL/kg at 45 minutes of OLV. The concentration of IL-6 in the
dependent lung after OLV was significantly lower in the driving pressure
group (5.31 [3.62]) compared to the control group (7.37 [5.21]) (mean
difference: -0.46 [-0.86 to -0.05] cm H<inf>2</inf>O; p = 0.025). There
were no significant differences between groups in the incidence of
postoperative pulmonary complications or in the oxygenation index 45
minutes after the start of OLV. Conclusion(s): Driving
pressure-guided tidal volume titration significantly reduces IL-6 levels
in bronchoalveolar lavage fluid from the dependent lung following OLV in
patients undergoing thoracic surgery, compared to conventional ventilation
using 8 mL/kg PBW. Copyright © 2025 Elsevier Inc.

<50>
Accession Number
2041896634
Title
Valvular Complications Related to Microaxial Assist Device Use: A
Case-Level Systematic Review.
Source
Artificial Organs. (no pagination), 2025. Date of Publication: 2025.
Author
Nolan G.P.; Hammond M.C.; Rahimov D.; Karimanasseri C.; Nasher N.;
Macmillan T.R.; Entwistle J.W.; Rajagopal K.; Hoopes C.W.;
Tchantchaleishvili V.
Institution
(Nolan) Drexel University College of Medicine, Philadelphia, PA, United
States
(Nolan, Hammond, Rahimov, Karimanasseri, Nasher, Macmillan, Entwistle,
Rajagopal, Hoopes, Tchantchaleishvili) Department of Cardiac Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Hammond) The Lawrenceville School, Lawrenceville, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Microaxial devices provide effective short-term hemodynamic
support in patients with cardiogenic shock or during high-risk procedures.
However, there is a paucity of data regarding device-associated valvular
complications. We sought to pool existing data to understand its
incidence, management, and outcomes. Method(s): An electronic search
was conducted in October 2024 to identify studies reporting microaxial
device-associated valvular complications that did not resolve with device
explantation. A total of 26 case reports and case series, representing 27
patients, were included. Patient-level data were extracted for analysis.
 Result(s): The median age was 50 years [IQR 34-65], and 78% (21/27)
were male. The indications for microaxial support were cardiogenic shock
(85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high-risk
percutaneous coronary intervention (7.4%, 2/27). The most commonly used
devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27).
Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral
regurgitation (MR) developed in 33% (9/27) of patients, all of which were
severe. The median duration of microaxial support was 10 [3-15] days.
Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27)
underwent transcatheter treatment, and 15% (4/27) were managed
nonoperatively. In-hospital/30-day mortality was 11% (3/27), including two
deaths among patients with MR (22%) and one in a patient with AR (5.6%)
with a pre-existing bioprosthetic aortic valve (p = 0.19). When
considering the patients with only native valves and excluding the
bioprosthetic aortic valve, mortality was significantly higher among MR
patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a
median follow-up of 183 [30-365] days, overall survival was 89% (24/27).
 Conclusion(s): AR was more common than MR; however, all MR cases were
severe. MR may be associated with worse outcomes. Surgical management
appears to be the most frequently employed strategy for valvular
injury. Copyright © 2025 International Center for Artificial
Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.

<51>
Accession Number
648739377
Title
A randomised pilot study evaluating music therapy and virtual reality
mindfulness sessions for reducing anxiety and stress in patients
undergoing first-time elective cardiac surgery.
Source
Journal of perioperative practice. 36(1-2) (pp 59-67), 2026. Date of
Publication: 01 Jan 2026.
Author
Krishnamoorthy B.; Abdelghafar M.; Air R.; Halyckyj-Smith J.; Citarella
A.; McLaughlin E.; Iles-Smith H.; Elliott R.; Barnard J.; Rajai A.;
Venkateswaran R.
Institution
(Krishnamoorthy, Iles-Smith) Directorate of Nursing and Midwifery and
School of Health and Society, University of Salford, Salford, United
Kingdom
(Krishnamoorthy, Abdelghafar, Air, Halyckyj-Smith, Citarella, McLaughlin,
Barnard, Venkateswaran) Department of Cardiothoracic Surgery, Manchester
Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
(Krishnamoorthy) Faculty of Health, Department of Cardiovascular Sciences,
Biology and Medicine, University of Manchester, Manchester, United Kingdom
(Elliott) Faculty of Biology, Division of Psychology and Mental Health,
Medicine and Health, University of Manchester, Manchester, United Kingdom
(Rajai) Manchester University NHS Foundation Trust, Manchester Academic
Health Science Centre, Manchester, United Kingdom
(Rajai) Centre for Biostatistics, Division of Population Health,
University of Manchester, Manchester, United Kingdom
Abstract
Cardiac surgery patients may experience stress and anxiety, negatively
impacting recovery. Pharmacological treatments are frequently used but may
result in side effects. We aimed to assess the effectiveness of immersive
virtual reality mindfulness and music therapy in reducing preoperative and
postoperative anxiety. Between March and July 2024, 36 participants were
randomised to 15 min of either virtual reality (n = 19) or music therapy
(n = 17) preoperatively and on postoperative day 3. Primary endpoints were
anxiety levels and salivary cortisol, assessed before and after
intervention using the paired Wilcoxon test. Median age was 66
(interquartile range = 58-73); 64% were male. Both music therapy and
virtual reality groups showed significant preoperative Spielberger
State-Trait Anxiety Inventory score reductions after intervention: music
therapy from 40 (30-48) to 23 (21-24) and virtual reality from 40 (31-54)
to 23 (20-35) (both p < 0.001); there was no significant difference
between groups (p = 0.7). Median virtual reality immersion and absorption
scores were 90/100 (interquartile range = 80-90; 80-94). Cortisol levels
did not significantly change. Postoperatively, 21 patients participated
(virtual reality n = 11, music therapy n = 8), showing reduced anxiety:
music therapy from 31 (26-32) to 23 (20-27), virtual reality from 33
(23-41) to 24 (22-30). Results show feasibility, tolerability, and
preliminary evidence of anxiety reduction, supporting further research
into music therapy and virtual reality for cardiac surgery patients. The
trial was registered with the International Standard Randomised Controlled
Trial Number Registry (ISRCTN51014051)
(https://doi.org/10.1186/ISRCTN51014051).

<52>
Accession Number
2042302295
Title
Prevention of Infections in Cardiac Surgery (PICS)-Prevena Study - A
pilot/vanguard factorial cluster cross-over RCT.
Source
PLOS ONE. 20(12 December) (no pagination), 2025. Article Number: e0338300.
Date of Publication: 01 Dec 2025.
Author
Scheier T.C.; Whitlock R.; Loeb M.; Devereaux P.J.; Lamy A.; McGillion M.;
Quantz M.; Copland I.; Lee S.-F.; Mertz D.
Institution
(Scheier, Whitlock, Loeb, Devereaux, Lamy, McGillion, Copland, Lee, Mertz)
Population Health Research Institute, McMaster University and Hamilton
Health Sciences, Hamilton, ON, Canada
(Whitlock, Loeb, Devereaux, Lee, Mertz) Department of Health Research
Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Loeb, Mertz) Division of Infectious Diseases, Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Devereaux) World Health Research Trust, Hamilton, ON, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Quantz) Department of Surgery, Division of Cardiac Surgery, Schulich
School for Medicine & Dentistry, London, ON, Canada
Publisher
Public Library of Science
Abstract
Sternal surgical site infections after cardiac surgery can lead to
significant morbidity, mortality, and cost. The effects of negative
pressure wound management and adding vancomycin as perioperative
antimicrobial prophylaxis are unknown. The PICSPREVENA pilot/vanguard
trial, a 2x2 factorial, open label, cluster-randomized crossover trial
with 4 periods, was conducted at two major cardiac surgery hospitals in
Ontario, Canada. Sites were randomized to one of eight sequences of the
four study arms (Cefazolin or Cefazolin + Vancomycin (not analyzed) and
standard wound dressing or a negative pressure 3M Prevena incision
management system (Prevena). Only diabetic or obese patients were eligible
for the latter comparison. This trial investigated feasability including
adherence to protocol of each intervention (goal: > 90% each) and loss to
follow-up (goal: < 10%). Among the 4107 included patients, 2230 were
obese/diabetic (1208 standard wound dressing period, 1022 during Prevena
period). Compliance to wound management and antimicrobial prophylaxis was
68.1% and 98.7%, respectively. Loss to follow-up was 3.6%.
Deep/organ-space sternal surgical site infections occurred in 16 (1.6%)
patients in the Prevena allocated periods and in 17 (1.4%) patients in the
standard wound dressing allocated periods (OR= 1.11, 95% CI: 0.56-2.20).
Other clinical outcomes did not suggest a difference and a post-hoc
as-treated analysis showed similar results. This study showed challenges
with introducing a novel technology as standard of care, with
non-compliance mostly driven by one of the sites. No firm conclusions
should be drawn regarding the effectiveness of Prevena, as this vanguard
trial was not powered for clinical outcomes. Copyright © 2025
Scheier 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.

<53>
Accession Number
2041843896
Title
Advancing the Design of Observational Studies in Drug-Coated Balloon
Angioplasty: Bridging Practice With Evidence-Based Standards.
Source
Clinical Cardiology. 48(12) (no pagination), 2025. Article Number: e70238.
Date of Publication: 01 Dec 2025.
Author
Mahajan K.; Sharma J.; Himral S.; Rana V.; Vohra S.
Institution
(Mahajan, Sharma, Himral) Himachal Heart Institute, Himachal Pradesh,
Mandi, India
(Rana) Innocent Heart Hospital, Punjab, Jalandhar, India
(Vohra) Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai,
New York City, NY, United States
Publisher
John Wiley and Sons Inc

<54>
Accession Number
2041016656
Title
Autograft reinforcement in the Ross procedure: A systematic review and
patient-level meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 171(1) (pp 259-276.e18),
2026. Date of Publication: 01 Jan 2026.
Author
Mylonas K.S.; Zoupas I.; Sarantou S.; Kourampi I.; Meintanopoulos A.S.;
Iliopoulos D.C.; Stavridis G.T.; Avgerinos D.V.; LaPar D.J.
Institution
(Mylonas, Stavridis, Avgerinos) Department of Cardiac Surgery, Onassis
Cardiac Surgery Center, Athens, Greece
(Zoupas, Sarantou, Kourampi, Meintanopoulos) Cardiothoracic and Vascular
Surgery Working Group, Society of Junior Doctors, Athens, Greece
(Zoupas, Iliopoulos) 4th Department of Cardiac Surgery, Hygeia Hospital,
Athens, Greece
(Zoupas, LaPar) Department of Pediatric and Congenital Heart Surgery,
Children's Heart Institute, Memorial Hermann Children's Hospital,
University of Texas Health Science Center at Houston, McGovern Medical
School, Houston, Tex, United States
(Meintanopoulos) Global Health - Disaster Medicine, National and
Kapodistrian University of Athens, Athens, Greece
(Iliopoulos) Department of Cardiovascular Surgery, University of Texas
Health Science Center at Houston, McGovern Medical School, Houston, Tex,
United States
(Iliopoulos) Division of Cardiac Surgery, National and Kapodistrian
University of Athens, Athens, Greece
Publisher
Elsevier Inc.
Abstract
Background: The Ross procedure is a well-established option for aortic
valve replacement, although progressive autograft dilation remains a
significant long-term complication. Although several reinforcement
techniques have been proposed to address this issue, their effectiveness
has yet to be rigorously evaluated. Method(s): A Preferred Reporting
Items for Systematic reviews and Meta-Analyses-compliant search was
conducted for studies involving reinforced Ross and nonreinforced Ross
procedures. Meta-analysis with individual patient data assessed survival
and freedom from autograft reoperation rates. Subgroup analyses were
conducted for the various reinforcement methods. Result(s): Sixteen
cohort studies comprising 2514 patients with the reinforced Ross procedure
and 595 patients with the nonreinforced Ross procedure were included.
Preoperative and perioperative characteristics were comparable between
groups. Individual patient data analysis of comparative studies
demonstrated superior survival in the reinforced Ross group, with 5-, 10-,
and 15-year survivals of 100%, 98.8%, and 98.8% compared with 95.0%,
93.7%, and 82.6%, respectively, in the nonreinforced group (hazard ratio,
11.9, P = .016). Likewise, freedom from autograft reoperation at 5, 10,
and 15 years was 96.4%, 94.2%, and 86.6% in the reinforced Ross group
versus 95.8%, 87.6%, and 77.7% in the nonreinforced group, respectively
(hazard ratio, 2.06, P < .001). Subgroup analysis showed comparable
outcomes across different reinforcement techniques. Conclusion(s):
Reinforced Ross procedures are associated with improved survival and
freedom from autograft reoperation rates compared with unsupported
pulmonary autografts. Copyright © 2025 The American Association
for Thoracic Surgery

<55>
Accession Number
2038671196
Title
Intracoronary Structural-Molecular Imaging for Multitargeted
Characterization of High-Risk Plaque: First-in-Human OCT-FLIm.
Source
JAMA Cardiology. 10(7) (pp 708-717), 2025. Date of Publication: 2025.
Author
Kim S.; Nam H.S.; Kang D.O.; Han J.; Kim H.; Song J.W.; Park E.J.; Kim
R.H.; Kim H.J.; Kim J.H.; Lee S.; Kim Y.S.; Park P.; Baik M.-J.; Yoo H.;
Kim J.W.
Institution
(Kim, Kang, Song, Park, Kim, Kim, Kim, Lee, Kim) Multimodal Imaging and
Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital,
Seoul, South Korea
(Kim) Department of Cardiology, Korea University Ansan Hospital, Ansan,
South Korea
(Nam, Han, Yoo) Department of Mechanical Engineering, Korea Advanced
Institute of Science and Technology, Daejeon, South Korea
(Kim, Kim, Baik) Department of Thoracic and Cardiovascular Surgery, Korea
University Guro Hospital, Seoul, South Korea
(Park) Division of Transplantation and Vascular Surgery, Korea University
Guro Hospital, Seoul, South Korea
Publisher
American Medical Association
Abstract
IMPORTANCE Fluorescence lifetime imaging (FLIm) is a molecular imaging
technique used to visualize the biochemical composition of
atherosclerosis. Novel dual-modal imaging using optical coherence
tomography (OCT)-FLIm has the potential to provide both microstructural
and biocompositional information on coronary plaques; however, it needs
validation for clinical application. OBJECTIVE To investigate the clinical
feasibility and safety of OCT-FLIm for characterizing plaque compositions
in patients with coronary artery disease (CAD) undergoing
revascularization therapy. DESIGN, SETTING, AND PARTICIPANTS A
prospective, open-label, single-center diagnostic feasibility study
involving 40 patients with significant CAD requiring coronary
revascularization. This first-in-human clinical study of the novel
intracoronary OCT-FLIm imaging was conducted between February and August
2022. The analyses were performed from August 2022 to July 2023.
INTERVENTIONS An OCT-FLIm system with 2.6-F catheters was constructed. All
patients underwent OCT-FLIm for target/culprit and nontarget/nonculprit
lesions during coronary revascularization. Intravascular ultrasound
imaging was performed for comparison. MAIN OUTCOMES AND MEASURES The
primary outcome was to assess the FLIm-derived molecular readouts of
prespecified plaque compositions. The secondary outcome was the
feasibility of OCT-FLIm in determining target/culprit plaque compositions
across different subsets of atherosclerotic disease activity: (1) acute
coronary syndrome (ACS) vs chronic stable angina (CSA) and (2)
angiographic rapid disease progression vs nonprogressive controls. RESULTS
We prospectively enrolled 40 patients (mean [SD] age, 63.1 [8.1] years; 32
men [80.0%]), of whom 20 presented with ACS and 20 with CSA. OCT provided
the structural features of plaques, and FLIm characterized the molecular
signatures of atheroma compositions, including macrophages, healed
plaques, superficial calcification, and fibrosis, in a reproducible
manner. Fluorescence lifetime (FL) values of the plaque compositions
correlated with findings from prior autopsy studies. Plaque inflammation
was significantly greater in patients with ACS than those with CSA. The
mean (SD) of inflammation-FL was 7.59 (0.96) nanoseconds for patients with
ACS vs 6.46 (0.87) nanoseconds for patients with CSA (P < .001). The
healed plaque phenotype was more prominently distributed in the segments
of rapid disease progression than in nonprogressive controls. The mean
(SD) healed plaque-FL was 5.31 (0.20) nanoseconds for the rapidly
progressive lesions vs 4.81 (0.30) nanoseconds for the rapidly
nonprogressive lesions (P < .001). All patients underwent OCT-FLIm safely
without adverse clinical events. CONCLUSIONS AND RELEVANCE This diagnostic
feasibility study found that an OCT-FLIm structural-molecular
intracoronary imaging is clinically feasible and safe for the
comprehensive characterization of human atheromas, supporting its
potential role in the diagnosis and biological understanding of high-risk
plaques. Copyright © 2025 Kim S et al. JAMA Cardiology.

<56>
Accession Number
2042034656
Title
Comparative Outcomes of Right Anterior Minithoracotomy and Ministernotomy
for Aortic Valve Replacement: An Updated Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 20(6) (pp 534-546), 2025. Date of Publication: 01 Nov 2025.
Author
Santos K.; Campoverde Farez C.; Zecchin Ferrara V.; Oya K.; Samaniego
M.A.; Chacon Quiros M.; Lopez Barrios V.; Plonek T.
Institution
(Santos, Plonek) Department of Cardiothoracic Surgery, Medisch Spectrum
Twente, Enschede, Netherlands
(Santos) New Vision University School of Medicine, Tbilisi, Georgia
(Campoverde Farez) Faculty of Medical Sciences, Universidad de Cuenca,
Ecuador
(Zecchin Ferrara) University of Padova, Italy
(Oya) National Center for Global Health and Medicine, Tokyo, Japan
(Samaniego) Universidad Autonoma Metropolitana, Ciudad de Mexico, Mexico
(Chacon Quiros) Universidad de Costa Rica, San Jose, Costa Rica
(Lopez Barrios) Centro Cardiovascular SM, San Jose, Costa Rica
Publisher
SAGE Publications Ltd
Abstract
Objective: Right anterior minithoracotomy (RAMT) and ministernotomy (MS)
are established approaches for minimally invasive aortic valve replacement
(MIAVR). There is no consensus about which technique offers better
results. Method(s): A literature search was conducted in MEDLINE,
Scopus, and Cochrane Library, focusing on studies that compared RAMT and
MS for MIAVR. RevMan 8.13.0 (The Cochrane Collaboration, London, UK) was
used to calculate effect estimates reported as odds ratios (ORs) or mean
differences (MDs) with 95% confidence intervals (CIs). Result(s): We
included 21 studies with 6,986 patients, of whom 45.8% underwent RAMT.
RAMT was associated with a shorter hospital stay (MD = -0.8 days, 95% CI:
-1.4 to -0.2, P = 0.002) and reduced blood loss (MD = -22.3 mL, 95% CI:
-32.8 to -11.8, P < 0.001), transfusion rates (OR = 0.7, 95% CI: 0.5 to
0.9, P = 0.01), and incidence of acute kidney injury (AKI; OR = 0.7, 95%
CI: 0.5 to 0.9, P = 0.02). However, RAMT was also associated with a
slightly longer cardiopulmonary bypass (CPB) time (MD = 9.0 min, 95% CI:
0.7 to 17.3, P = 0.03, I2 = 97%) and incisional pain score (standardized
MD = 0.5, 95% CI: 0.4 to 0.6, P < 0.001). Mortality, stroke, and other
complications were similar between the 2 techniques. Conclusion(s):
RAMT offers advantages including shorter hospital stay and reduced blood
loss, transfusion, and AKI rates but at the cost of slightly longer CPB
time and greater incisional pain. These findings underscore the need for
individualized patient selection based on surgical risk, anatomical
considerations, and recovery priorities. Copyright © The
Author(s) 2025

<57>
Accession Number
2040124511
Title
Quality of evidence: Randomized trials in coronary disease and moving the
goalposts.
Source
Journal of Thoracic and Cardiovascular Surgery. 171(1) (pp 196-200.e3),
2026. Date of Publication: 01 Jan 2026.
Author
Alshneikat M.; Awad A.K.; Bakaeen F.G.
Institution
(Alshneikat, Awad, Bakaeen) Department of Thoracic and Cardiovascular
Surgery, Cleveland Clinic, Cleveland, Ohio, United States
Publisher
Elsevier Inc.

<58>
Accession Number
2042139742
Title
Effects of Virtual Reality-guided Imagery Relaxation Intervention in
Improving Anxiety Among Lung Cancer Patients: A Randomized Controlled
Trial.
Source
Asian Nursing Research. 19(5) (pp 509-517), 2025. Date of Publication: 01
Dec 2025.
Author
Li H.; Liu F.; Li S.; Li C.; Tian Z.
Institution
(Li, Liu, Li, Li, Tian) The Fourth Hospital of Hebei Medical University,
Hebei Province, Shijiazhuang City, China
Publisher
Korean Society of Nursing Science
Abstract
Purpose: To examine the effectiveness of virtual reality-guided imagery
relaxation (VRGI) intervention in reducing anxiety among lung cancer
surgery patients. Method(s): In a randomized clinical trial, 98
patients were assigned to a control group (CG) receiving routine treatment
and staged care in thoracic surgery, or an experimental group (EG)
receiving additional VRGI in addition to the CG's protocol. Anxiety (using
the State-Trait Anxiety Inventory) and physiological stress markers
[systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart
rate (HR)] were assessed on the day of admission (T1), immediately before
surgery (T2), and at discharge (T3). Result(s): A total of 98
participants were recruited and randomized to the CG (n=53) and EG (n=45).
The age [beta, 6.29; p = .005], education level (beta, 5.57; p = .011),
awareness of the disease (beta, 6.11; p = .007), and gender (beta, 5.75; p
= .018) were the major influencing factors of preoperative anxiety.
Compared with the CG, the EG showed a smaller increase in State Anxiety
Inventory (SAI, t = 2.20; p = .003), SBP (t = 2.75; p = .007), DBP (t =
2.53; p = .013), and HR (t = 2.17; p = .033) at T2, and significant
decreases in SAI (t = 4.79; p < .001), SBP (t = 3.25; p = .0027), DBP (t =
2.96; p = .004), and HR (t = 4.26; p < .001) at T3. The results of the
repeated measures ANOVA demonstrated statistically significant differences
in the SAI score, SBP, DBP, and HR across time effect, group effect and
time x group interaction effect (p < .05), with the EG exhibited superior
outcomes. Conclusion(s): VRGI is a feasible and effective
intervention for reducing perioperative anxiety and physiological stress
in lung cancer surgery patients, warranting further large-scale trials.
Trial registration: This study is retrospectively registered with the
ITMCTR (identifier: ITMCTR2025001481, registered 26 July 2025).
http://itmctr.ccebtcm.org.cn/zh-CN/UserPlatform/ProjectView?Pid=48c26a67-4
e2b-4aea-a504-f379602513b0. Copyright © 2025

<59>
[Use Link to view the full text]
Accession Number
648942518
Title
Five-Year Clinical Outcomes and Durability of a Self-Expanding
Transcatheter Heart Valve With Intra-Annular Leaflets.
Source
Circulation. Cardiovascular interventions. 18(12) (pp e015430), 2025. Date
of Publication: 01 Dec 2025.
Author
Puri R.; Thiele H.; Fichtlscherer S.; Westermann D.; Makkar R.; Waksman
R.; Hakmi S.; Sondergaard L.; Groh M.; Montarello J.K.; Kempfert J.; Yong
G.; Bedogni F.; Maisano F.; Worthley S.G.; Rodes-Cabau J.; Fontana G.P.;
Mollmann H.
Institution
(Puri) Cleveland Clinic
(Thiele) Heart Center Leipzig at Leipzig University, Germany (H.T.),
Germany
(Fichtlscherer) University Heart and Vascular Center Frankfurt and Bad
Segeberg, Germany (S.F.), Germany
(Westermann) University Heart Center, University of Freiburg, Germany
(D.W.), Germany
(Makkar) Cedars-Sinai Medical Center, Los Angeles, Mexico
(Waksman) MedStar Washington Hospital Center (R.W.)
(Hakmi) Germany (S.H.), Asklepios Klinik St. Georg
(Sondergaard) Abbott Structural Heart, Santa Clara, Mexico
(Groh) Asheville Heart, NC (M.G.)
(Montarello) Royal Adelaide Hospital, Australia
(Kempfert) German Heart Institute Berlin, Germany (J.K.), Germany
(Yong) Hollywood Medical Centre, Australia
(Bedogni) IRCCS Policlinico San Donato
(Maisano) IRCCS Ospedale San Raffaele, Italy
(Worthley) St. Andrew's Hospital, Australia
(Rodes-Cabau) Quebec Heart & Lung Institute, Canada
(Fontana) Cardiovascular Institute of the HCA Los Robles Health System,
Thousand Oaks
(Mollmann) St.-Johannes-Hospital Dortmund, Germany (H.M.), Germany
Abstract
BACKGROUND: There is a paucity of data regarding the longer-term
durability of transcatheter heart valves. This analysis aimed to describe
the 5-year clinical outcomes and valve durability for patients treated
with the Portico transcatheter heart valves across 3 studies harmonized in
their prospective enrollment, inclusion/exclusion criteria, centralized
independent core laboratory echocardiographic analysis, and independent
clinical events committee adjudication. METHOD(S): Patient-level data
from the PORTICO IDE randomized controlled trial, the PORTICO I postmarket
study, and the PORTICO continued access protocol were pooled using a
random-effects meta-analysis model. All 3 studies collected follow-up data
at discharge, 30 days, and annually through 5 years. Adverse events and
pooled echocardiographic data were assessed using Valve Academic Research
Consortium-2 definitions. Durability definitions were adapted from Valve
Academic Research Consortium-3 and European Association of Percutaneous
Cardiovascular Interventions/European Society of Cardiology/European
Association for Cardio-Thoracic Surgery consensus guidelines.
 RESULT(S): A total of 1464 patients with severe symptomatic aortic
stenosis and high or extreme surgical risk were included. Median age was
83 years, 61.7% were women, and the median Society of Thoracic Surgeons
score was 4.9%. At 5 years, all-cause mortality and stroke rates were
49.4% and 12.3%, respectively. Transvalvular gradient and effective
orifice area at 5 years were 6.2 mm Hg and 1.83 cm2, respectively, with
paravalvular leak >=moderate severity occurring in 1.9%. The 5-year
bioprosthetic valve failure rate was 2.7%, including a 0.7% valve-related
death rate and a 2.0% valve reintervention rate, but no patients with
severe hemodynamic structural valve deterioration. Moderate hemodynamic
structural valve deterioration occurred in 0.9% of the patients at 5
years. Hemodynamic performance and transcatheter heart valve durability
remained stable irrespective of annular size. CONCLUSION(S): The use
of the Portico transcatheter heart valve system in patients at high or
extreme surgical risk demonstrated favorable clinical outcomes and
hemodynamic performance with low transvalvular gradients and greater than
mild paravalvular leak. Furthermore, bioprosthetic valve failure rates
were low with no incidence of severe hemodynamic structural valve
deterioration at 5 years, irrespective of annular size. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT02000115 and
NCT01802788.

<60>
Accession Number
2041675568
Title
The Effect of Acupuncture on Pain, Prostaglandin E2, and Interleukin-6 in
Septorhinoplasty Operations: A Randomized Clinical Trial.
Source
Anesthesiology Research and Practice. 2025(1) (no pagination), 2025.
Article Number: 7816719. Date of Publication: 2025.
Author
Orak Y.; Baylan F.A.; Bilgen F.; Orak F.; Ural A.; Yildiz S.; Sagiroglu
S.; Karaduman H.; Doganer A.
Institution
(Orak) Faculty of Medicine, Department of Anesthesiology and Reanimation,
Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
(Baylan) Faculty of Medicine, Department of Biochemistry, Kahramanmaras
Sutcu Imam University, Kahramanmaras, Turkey
(Bilgen) Department of Plastic, Reconstructive and Aesthetic Surgery,
Medilife Health Group, Istanbul, Turkey
(Orak) Faculty of Medicine, Department of Microbiology, Kahramanmaras
Sutcu Imam University, Kahramanmaras, Turkey
(Ural) Department of Plastic, Reconstructive and Aesthetic Surgery,
Memorial Ankara Hospital, Ankara, Turkey
(Yildiz) Physical Medicine and Rehabilitation Department, Private Doctor's
Office, Isparta, Turkey
(Sagiroglu) Faculty of Medicine, Department of Otorhinolaryngology,
Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
(Karaduman) Faculty of Medicine, Department of Plastic, Reconstructive and
Aesthetic Surgery, Kahramanmaras Sutcu Imam University, Kahramanmaras,
Turkey
(Doganer) Faculty of Medicine, Department of Biostatistics and Medical
Informatics, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
Publisher
John Wiley and Sons Ltd
Abstract
Objective: The purpose of this study was to investigate the effects of
acupuncture on pain, prostaglandin E2 (PGE2), and interleukin-6 (IL-6)
levels during septorhinoplasty surgeries. Material(s) and Method(s):
This randomized, controlled study included 70 patients. The patients were
divided into two groups: an acupuncture group (n = 35) and a control group
(n = 35). The acupuncture group received bilateral press needle
acupuncture at the PC 6 and ST 36 points 24 h before surgery. Blood
samples were collected for analysis and comparison of preoperative and
postoperative levels of IL-6 and PGE2. The primary outcomes were the
postoperative visual analog scale (VAS) scores. Result(s): In terms
of evaluating postoperative pain, no statistically significant differences
were observed between the study groups with regard to VAS scores. At 30
min after surgery, fewer patients in the acupuncture group needed
analgesics than in the control group (p = 0.044). Postoperative IL-6
levels were lower in the acupuncture group than in the control group (p =
0.014). There was no significant difference in postoperative PGE2 levels
between the groups (p = 0.568). The acupuncture group had lower diastolic
blood pressure (DBP) and mean arterial blood pressure (MAP) at 30 min
intraoperatively and lower DBP at 60 min (p = 0.012, p = 0.026, and p =
0.012, respectively). At 15 min into the operation, the heart rate was
higher in the acupuncture group than in the control group (p = 0.039).
After surgery, the acupuncture group had lower blood pressure at 5 min and
6 h after surgery than the control group (p = 0.034 and p = 0.041,
respectively). Conclusion(s): The evidence from this study suggests
that acupuncture can reduce the need for pain medication after
septorhinoplasty surgery, and by decreasing IL-6 levels, it may contribute
to the inflammatory process. Trial Registration: ClinicalTrials.gov:
NCT04009070. Copyright © 2025 Yavuz Orak et al. Anesthesiology
Research and Practice published by John Wiley & Sons Ltd.

<61>
Accession Number
2041838799
Title
Conventional hybrid coronary vs. robot-assisted minimally invasive direct
revascularization: a meta-analysis and systematic review.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1650138. Date of Publication: 2025.
Author
Schuering C.L.; Zwaans V.I.T.; Huang A.; Kohler-Seuster M.; von Mackensen
J.K.R.; Iske J.; Stein J.; Kaemmel J.; Heck R.; Starck C.T.; Kempfert J.;
Jacobs S.; Falk V.; Wert L.
Institution
(Schuering, Zwaans, Huang, Kohler-Seuster, von Mackensen, Iske, Stein,
Kaemmel, Heck, Starck, Kempfert, Jacobs, Falk, Wert) Department of
Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite
(DHZC), Berlin, Germany
(Kaemmel, Starck, Kempfert, Jacobs, Falk) DZHK (German Center for
Cardiovascular Research), Berlin, Germany
(Falk) Department of Cardiothoracic Surgery, Charite-Universitatsmedizin
Berlin, Corporate Member of Freie Universitat Berlin and
Humboldt-Universitat zu Berlin, Berlin, Germany
(Falk) Department of Health Sciences and Technology, ETH Zurich, Zurich,
Switzerland
Publisher
Frontiers Media SA
Abstract
Objectives: Hybrid coronary revascularization (HCR), a revascularization
strategy that amalgamates the minimally invasive direct coronary artery
bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI),
represents a significant advancement in coronary artery disease treatment.
This study compares conventional and robotic approaches in HCR.
 Method(s): A systematic literature review and individual patient data
analysis was conducted via PubMed following PRISMA guidelines, including
original works published until 28 February 2025. Result(s): 32
publications met the inclusion criteria, providing individual data from
2,048 patients. All patients underwent MIDCAB for LAD lesions and
perioperative PCI for non-LAD lesions. 903 patients (670 male, 233 female;
mean age 51.69 +/- 7.77 years; BMI 34.66 +/- 13.13) were treated with
robot-assisted HCR, whilst 1,145 patients (890 male, 255 female; mean age
69.62 +/- 8.42 years; BMI 26.62 +/- 1.30) underwent conventional HCR. The
robot-assisted group showed significantly higher rates of right coronary
artery (RCA) stenosis (18.60% vs. 16.07%, p = 0.004) and drug-eluting
stent use (62.68% vs. 5.42%, p = 0.027), along with significantly shorter
hospital stays (4.27 +/- 1.34 vs. 10.27 +/- 7.34 days, p = 0.001).
Although not statistically significant, wound complications were more
frequent in the robot-assisted cohort (0.66% vs. 0.09%), whereas pleural
effusion (10.74% vs. 0.00%), pericardial effusion (0.61% vs. 0.11%), and
pneumothorax (1.83% vs. 0.11%) were more frequent in the conventional
group. Mortality was low in both cohorts (robotic vs. conventional):
intra-operative (0% vs. 0.09%, p = 0.73), 30-day (0.44% vs. 0.70%, p =
0.82), follow-up (2.66% vs. 4.72%, p = 0.41). Conclusion(s): Hybrid
coronary revascularization offers a less invasive alternative with
potential benefits. Robotic assistance may enhance outcomes, but limited
adoption and heterogeneous data underscore the need for further
investigation and validation. Copyright 2025 Schuering, Zwaans, Huang,
Kohler-Seuster, von Mackensen, Iske, Stein, Kaemmel, Heck, Starck,
Kempfert, Jacobs, Falk and Wert.

<62>
Accession Number
649655853
Title
Clinical outcomes of patients undergoing percutaneous coronary
intervention and transcatheter aortic valve implantation versus coronary
artery bypass grafting and surgical aortic valve replacement.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Karampinos K.; Ktenopoulos N.; Apostolos A.; Karanasos A.; Vlachakis P.;
Kachrimanidis I.; Koliastasis L.; Simopoulou C.; Tsalamandris S.;
Drakopoulou M.; Synetos A.; Latsios G.; Aggeli C.; Tsioufis K.; Toutouzas
K.
Institution
(Karampinos, Ktenopoulos, Apostolos, Vlachakis, Kachrimanidis,
Koliastasis, Simopoulou, Tsalamandris, Drakopoulou, Synetos, Latsios,
Aggeli, Tsioufis, Toutouzas) Ippokrateio General Hospital of Athens, First
Department of Cardiology, Athens, Greece
(Karanasos) General University Hospital of Patras, Department of
Cardiology, University of Patras, Patra, Greece
Publisher
Oxford University Press
Abstract
Background: Patients with concomitant severe aortic stenosis and coronary
artery disease pose a significant challenge in cardiovascular
management.While traditional treatment involved surgical aortic valve
replacement(SAVR) combined with coronary artery bypass grafting(CABG)
transcatheter aortic valve implantation(TAVI) with percutaneous coronary
intervention(PCI) has emerged as a less invasive alternative.
 Purpose(s): This meta-analysis aimed to compare the short-term
clinical outcomes of patients undergoing PCI-TAVI versus CABG-SAVR.
 Method(s): A systematic search of the PubMed, Cochrane, and Scopus
databases was conducted to identify relevant studies that reported
distinct short-term outcomes for patients undergoing PCI-TAVI versus
CABG-SAVR, published up to January 15th 2025.The primary endpoint was
30-day all-cause mortality and stroke rates.Secondary endpoints included
in-hospital major vascular complications,permanent pacemaker
implantation(PPI) and acute kidney injury(AKI). Result(s): A total of
136,763 patients from 7 observational and 2 randomized controlled
trials(RCTs) were included, comprising 101,529 patients who underwent
PCI-TAVI and 35,234 patients who received CABG-SAVR. No statistically
significant difference was observed in 30-day mortality between the 2
groups(RRmortality,0.83[95%CI,0.61-1.14],P=0.25),though a trend favouring
PCI-TAVI was noted.Similarly,no significant difference was found in major
vascular complications(RRvascular,1.76[95%CI,0.51-6.09],P=0.37),although
there was a trend toward a higher incidence in the PCI-TAVI
group.Furthermore, PCI-TAVI was associated with significantly lower rates
of 30-day stroke(RRstroke,0.85[95%CI,0.73-1.00],P=0.048) and in-hospital
AKI(RRAKI,0.56[95%CI,0.36-0.88],P=0.01) compared to CABG-SAVR.Publication
bias was not detected in funnel plot analysis,and Egger's regression test
confirmed no significant asymmetry.High heterogeneity was detected in 3/5
examined outcomes,particularly mortality.Sensitivity analysis revealed
that a single study(Patlolla et al,2022) had a significant impact on the
overall effect size.When this study was excluded,the adjusted analysis
demonstrated a statistically significant survival advantage for
PCI-TAVI,with lower 30-day
mortality(RR'mortality,0.66[95%CI,0.54-0.81],P<0.001).The robustness and
reliability of findings across different study subsets and analysis
methods were confirmed through cumulative and sensitivity analyses.
 Conclusion(s): This meta-analysis demonstrates that PCI-TAVI is
associated with significantly lower 30-day rates of stroke and in-hospital
AKI compared to CABG-SAVR, while 30-day mortality remains statistically
comparable between the 2 groups.These findings highlight the evolving role
of PCI-TAVI and future RCTs are necessary to validate these results.

<63>
Accession Number
649656724
Title
Early aortic valve replacement in asymptomatic severe aortic stenosis: a
systematic review and meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Lucena L.; De Oliveira W.; Gomes R.M.; Freitas M.A.; Cavalcante D.; De
Oliveira A.L.; Borges R.; Duarte I.; Giorgi J.; Carvalho N.; De Oliveira
Neto N.
Institution
(Lucena, De Oliveira, Gomes, De Oliveira, Borges, Duarte, Carvalho)
Federal University of Rio Grande do Norte, Natal, Brazil
(Freitas) UEMASUL - State University of the Tocantina Region of Maranhao,
Imperatriz, Brazil
(Cavalcante) Federal University of Maranhao, Sao Luis, Brazil
(Giorgi) Hospital Sirio-Libanes, Sao Paulo, Brazil
(De Oliveira Neto) Onofre Lopes University Hospital, Natal, Brazil
Publisher
Oxford University Press
Abstract
Background: Aortic stenosis (AS) is a progressive disease with high
morbidity. Early aortic valve replacement (AVR), including transcatheter
aortic valve replacement (TAVR) and surgical aortic valve replacement
(SAVR), may prevent complications and improve outcomes. However, the
benefits of early intervention versus conservative management in
asymptomatic severe AS remain unclear. Purpose(s): This systematic
review and meta-analysis aimed to compare early AVR (TAVR/SAVR) with
conservative management in asymptomatic patients with severe AS.
 Method(s): We conducted a comprehensive search of PubMed, Embase, and
the Cochrane Central Register of Controlled Trials to identify randomized
controlled trials (RCTs) comparing AVR with standard conservative therapy
in asymptomatic patients with severe AS. Statistical analysis was carried
out utilizing Review Manager version 5.4. Heterogeneity was assessed with
I2 statistics; p-values inferior to 0.05 and I2>25%
were considered significant heterogeneity. The outcomes assessed included
stroke incidence, all-cause mortality, cardiovascular death, new-onset
atrial fibrillation (AF), and major bleeding. Result(s): Four RCTs
were included, comprising 1,427 participants, 927 of whom underwent TAVR.
The incidence of stroke was significantly lower in the AVR group compared
to the conservative group (RR 0.62; 95% CI: 0.40-0.95; p = 0.03; Figure
1). However, there was no significant reduction in all-cause mortality (HR
0.68; 95% CI: 0.40-1.17; p = 0.17), cardiovascular mortality (RR 0.97; 95%
CI: 0.55-1.72; p = 0.92), or myocardial infarction (RR 0.23; 95% CI:
0.05-1.06; p = 0.06). The incidence of new-onset AF (RR 1.10; 95% CI:
0.80-1.52; p = 0.56) and major bleeding (RR 0.80; 95% CI: 0.43-1.52; p =
0.50) were similar between the groups. Conclusion(s): Our systematic
review and meta-analysis suggest that early aortic valve replacement
reduces stroke risk in asymptomatic severe aortic stenosis but has no
significant impact on mortality or other major outcomes.

<64>
Accession Number
649656664
Title
Physiology- versus angiography-guided complete coronary revascularization
in STEMI patients with multivessel disease: a network meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Martino G.; Quarta R.; Greco F.F.; Romano L.R.; Spaccarotella C.; Indolfi
C.; Curcio A.; Polimeni A.
Institution
(Martino) Magna Graecia University of Catanzaro, Catanzaro, Italy
(Quarta, Romano, Indolfi, Curcio, Polimeni) University of Calabria,
Department of Pharmacy, Health and Nutritional Sciences, Rende, Italy
(Greco) Annunziata Hospital, Division of Interventional Cardiology,
Cosenza, Italy
(Spaccarotella) University of Naples Federico II, Division of Cardiology,
Department of Advanced Biomedical Sciences, Federico II University,
Naples, Italy
Publisher
Oxford University Press
Abstract
Background: In patients with ST-segment elevation myocardial infarction
(STEMI) and multivessel disease (MVD), complete revascularization (CR) is
recommended over culprit-only PCI to reduce adverse cardiovascular
outcomes. However, the optimal strategy for CR, whether angiography
(Angio)-guided or physiology-guided, remains uncertain. Method(s):
This network meta-analysis included 14 randomized controlled trials (RCTs)
with 11,568 patients to compare the efficacy of angio-guided CR,
physiology-guided CR, and culprit-only PCI in reducing major adverse
cardiovascular events (MACE), all-cause mortality, recurrent myocardial
infarction (MI), cardiovascular (CV) death, and unplanned
revascularization. The frequentist and Bayesian approaches were applied to
assess the effectiveness of each strategy. Result(s): The pairwise
meta-analysis showed that angio-guided CR showed superior efficacy,
significantly reducing MACE (OR = 0.44; 95% CI: 0.37-0.52), recurrent
myocardial infarction, and unplanned revascularization compared to
culprit-only PCI. Physiology-guided CR also reduced MACE (OR = 0.64, 95%
CI: 0.45-0.91) and unplanned revascularization. The network metanalysis
showed that CV death was lower in the physiology-guided CR group (OR 0.56;
95% CI 0.25-1.05), suggesting a protective effect, but the difference did
not reach statistical significance. Furthermore, physiology-guided CR was
not significantly better than angio-guided CR in most outcomes.
 Conclusion(s): Angio-guided CR appears to provide the best overall
outcomes for patients with STEMI and MVD, outperforming physiology-guided
CR in most endpoints. Further large-scale trials are needed to clarify the
relative efficacy of angio-guided CR and physiology-guided CR in this
patient population.

<65>
Accession Number
649654800
Title
Incidence and predictors of complications after transcatheter aortic valve
implantation (TAVI) according to VARC-3 criteria: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Giacobbe F.; Brero M.; Solano A.; Meynet P.; Pilia R.; Capoccia S.; Bruno
F.; De Filippo O.; Omede P.; Montefusco A.; Conrotto F.; D'ascenzo F.; De
Ferrari G.M.
Institution
(Giacobbe, Brero, Solano, Meynet, Pilia, Capoccia, Bruno, De Filippo,
Omede, Montefusco, Conrotto, D'ascenzo, De Ferrari) Hospital Citta Della
Salute e della Scienza di Torino, Turin, Italy
Publisher
Oxford University Press
Abstract
Background: Despite continuous advancements in devices and procedural
techniques, Transcatheter Aortic Valve Implantation (TAVI) is still
associated with a range of complications that may significantly affect
outcomes. The Valve Academic Research Consortium recently renewed the
classification of TAVI procedural complications introducing the VARC-3
criteria. However, only few data are currently available on TAVI
complications applying this new classification. Aim(s): The aim of
our study was to assess the incidence of main TAVI complications,
classified according to the most recent VARC-3 criteria. Furthermore, we
evaluated the main predictors of complications available in literature and
performed a pooled analysis of the significant ones. Method(s): We
conducted a systematic literature review and meta-analysis including 60
eligible studies reporting data on complications after TAVI according to
VARC-3 criteria. The primary endpoint was the incidence of technical
success according to VARC-3 and all-cause mortality whereas the major
complications defined according to VARC-3 criteria were the secondary
ones. We further analyzed pooled OR to identify the key predictors of
major complications after TAVI Results: A total of 60 studies encompassing
75,014 patients was included in the analysis. The average age of our
cohort was 81,7 yo, 51,7% were women, mean ejection fraction was 55,5%,
mean aortic gradient was 43 mmHg and the overall surgical risk profile was
low-to-moderate (STS PROM 4,1%). There was a slight prevalence of balloon
expandable valve (BEV) implantations (52,2%). In our cohort technical
success was achieved in 95% of cases, with a 66% 30-days early safety and
90% device success. On average 8 months follow-up (IQR 1-21) all-cause
mortality occurred in 11% cases, with periprocedural death representing
3%. Overall vascular complications incidence was 13%, 5% of which was
represented by major events. Stroke or TIA occurred in 3%, as well as
Acute Kidney Injury (AKI). Incidence of major bleedings (type 2 and
beyond) was 10%, permanent PM implantation was reported in 13% of cases.
Significant paravalvular regurgitation (PVR) was reported in 4% of cases
while moderate to severe patient prosthetic mismatch (PPM) occurred in 8%.
Stage 3 or 4 AKI, significant PVR, bleeding type >=2 non-structural valve
dysfunction and STS score resulted independent predictors of all-cause
mortality, whereas high aortic valve calcification and eccentric calcium
were predictors of significant PVR. At meta regression analysis
moderate-to-severe PPM was associated with high mortality.
 Conclusion(s): TAVI shows high technical success and early safety,
but significant complications remain relevant. High aortic valve
calcification and eccentric calcium predicted paravalvular regurgitation,
while AKI, non-structural valve dysfunction, and PPM were linked to higher
mortality.

<66>
Accession Number
2034968139
Title
Frailty assessment tools for evaluating older adults prior to surgery by
clinicians without geriatrics expertise: a scoping review.
Source
Journal of Geriatric Oncology. Conference: Abstracts of the SIOG 2024
Annual Conference. Montreal Canada. 15(7 Supplement 1) (pp S8-S8), 2024.
Date of Publication: 01 Oct 2024.
Author
Chesney T.R.; Wong C.; Tricco A.C.; Wijeysundera D.N.; Ladha K.S.; Kishibe
T.; Dube S.; Puts M.; Alibhai S.M.; Daza J.F.
Institution
(Chesney, Daza) University of Toronto, Department of Surgery, Division of
General Surgery, Toronto, Canada
(Chesney, Wong, Kishibe) St. Michael's Hospital, Unity Health Toronto, Li
Ka Shing Knowledge Institute, Toronto, Canada
(Wong) St. Michael's Hospital, Unity Health Toronto, Division of Geriatric
Medicine, Toronto, Canada
(Tricco) St. Michael's Hospital, Unity Health Toronto, Knowledge
Translation Program, Li Ka Shing Knowledge Institute, Toronto, Canada
(Tricco) School of Nursing, Queen's University, Queen's Collaboration for
Health Care Quality JBI Centre of Excellence, Kingston, Canada
(Wijeysundera, Ladha) St. Michael's Hospital and University of Toronto,
Department of Anesthesiology and Pain Medicine, Toronto, Canada
(Wijeysundera, Ladha, Alibhai, Daza) University of Toronto, Institute of
Health Policy, Management and Evaluation, Toronto, Canada
(Dube) Universite de Montreal, Division of Gynecologic Oncology, Montreal,
Canada
(Puts) University of Toronto, Lawrence S. Bloomberg Faculty of Nursing,
Toronto, Canada
(Alibhai) University Health Network and Universityof Toronto, Departmentof
Medicine, Toronto, Canada
Publisher
Elsevier Ltd
Abstract
Introduction: Implementation of frailty assessment for older adults having
surgery is limited due to lack of comprehensive evaluation of tool
performance. Objective(s):Thisreviewaimedtosummarizeextentofdataonsix
key performance metrics of frailty tools for preoperative use by
clinicians without geriatric expertise: validity (construct, concur rent,
predictive), reliability, clinical impact and pragmatic factors.
 Method(s):MEDLINE,EMBASE,CENTRAL,CINAHLweresearched 2005-Oct 2021 and
update July 2023. Studies of frailty assessment tool performance in
preoperative setting for adults aged 65+ undergoing major intracavitary
non-cardiac surgery were included. Two independent reviewers completed
screening and data charting. Result(s):
Of8,981records,35toolsfrom123studiesmetcriteria. Investigation varied;
nearly half had only one study, and 69% had less than three. Predictive
validity was most studied, while reliability, clinical impact, and
pragmatic factors received less attention. Standout tools emerged.
Clinical Frailty Scale (CFS): extensively studied (4/6 metrics), covering
various outcomes, settings, and surgeries. Requires training for
administration. Edmonton Frail Scale (EFS): investigated across all
metrics, with data on clinical impact, but relies on performance/cognitive
testing which may be an implemen tation barrier. Both CFS and EFS have
ordinal scales of frailty severity. FRAIL scale: simple, self-administered
questionnaire, 5/6 metrics, including clinical impact, but only binary
output. Conclusion(s): Several tools show promise, but further
research is needed on clinical impact, pragmatic factors, and
tool-specific meta-analysis. This review can guide clinical teams in
selecting tools for their needs. Copyright © 2024 Published by
Elsevier Ltd.

<67>
Accession Number
649655818
Title
Outcomes of transcatheter edge-to-edge repair in patients with previous
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Haidarah A.; Fei C.; Benhammou M.; Elhadi M.; Alsawidi H.; Abdo F.; Mao C.
Institution
(Haidarah, Fei, Alsawidi, Abdo, Mao) West China Hospital, Sichuan
University, Chengdu, China
(Benhammou) University of Oran 1 Ahmed Ben Bella, Oran, Algeria
(Elhadi) Korea University, College of Medicine, seoul, South Korea
Publisher
Oxford University Press
Abstract
Background: Coexisting mitral regurgitation (MR) is a frequent finding in
patients undergoing transcatheter aortic valve replacement (TAVR) for
aortic diseases. Surgical repair remains the leading option for the
majority of MR patients. However, for those with high or prohibitive
surgical risk, catheter-based interventions are considered an alternative
solution. While the use of transcatheter edge-to-edge repair (TEER) is
expanding in clinical settings, its application remains challenging due to
anatomical complexities, such as broad leaflet structures, subvalvular
pathology, and left ventricular remodeling. Purpose(s): Given the
limited data on the safety, efficacy, and feasibility of TEER in patients
with prior TAVR, we aim to provide a comprehensive analysis of clinical
outcomes and associated complications in this population. Method(s):
We conducted a systematic review and meta-analysis across PubMed, Scopus,
Embase, and the Cochrane Central Register of Controlled Trials up to
December 2024. Studies investigating TEER outcomes in patients with prior
TAVR were included. The primary outcomes were in-hospital, cardiovascular,
and all-cause mortality. Secondary outcomes included the incidence of
acute kidney injury (AKI), stroke bleeding, length of stay (LOS),
rehospitalization rates, and changes in New York Heart Association (NYHA)
functional class and MR grade after TEER. The cumulative incidence and 95%
confidence intervals (CIs) were calculated. A random-effects model was
performed to assess heterogeneity using I2. All statistical
analyses were performed using Comprehensive Meta-Analysis Software (CMA).
 Result(s): Six studies with 650 patients (428 males, 222 females) who
underwent TEER after TAVR were included in the analysis. The results
revealed a cumulative incidence of 1.9% [95% CI: 0.8-4.3] for in-hospital
mortality, 20.1% [95% CI: 9.4-38] for cardiovascular mortality, and 16%
[95% CI: 5.3-39.3] for all-cause mortality. Additionally, 7.8% [95% CI:
3.4-17.1] of patients experienced AKI, while 1.5% [95% CI: 0.6-4.1]
developed stroke/TIA during their hospital stay. Bleeding complications
were occurred in 10.9% [95% CI: 4.2-25.6], and the mean LOS was 3.86 +/-
0.61 days [Mean +/- Standard Error], with 31.9% [95% CI: 28-36.1] of
patients being rehospitalized. Across all included studies, TEER was
associated with a significant improvement in both NYHA functional class
and MR grade. Conclusion(s): Given the complexity of multivalve
disease, our meta-analysis supports the feasibility and safety of TEER for
managing MR in TAVR patients, offering a viable alternative for those
unsuitable for traditional surgical interventions and demonstrating
significant improvements in cardiac function. However, larger prospective
studies are needed to further validate its feasibility and safety.

<68>
Accession Number
649655314
Title
The impact of NYHA and physical activity level on standardized mortality
ratio in adults with congenital heart disease.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Johansson B.; Hahlin E.; Baroudi Y.; Sandberg C.; Rinstrom D.
Institution
(Johansson) Umea University, Department of Public Health and Clinical
Medicine, Umea, Sweden
(Hahlin, Baroudi, Rinstrom) Umea University, Department of Diagnostics and
Intervention, Umea, Sweden
(Sandberg) Umea University, Department of Community Medicine and
Rehabilitation, Umea, Sweden
Publisher
Oxford University Press
Abstract
Background: When more patients with congenital heart disease reach adult
age, there is a need of new prognostic markers. NYHA class and physical
activity level, both related to exercise capacity, are potential
prognostic variables. Here we have calculated the SMR in NYHA class and
physical activity level. Method(s): This a register-based study where
9,303 patients with adult congenital heart disease (median age at baseline
28 years, IQR 20-44, 48 % women) were followed for 8.8+/-5.6 years. The
outcome was death or heart transplantation. The standardized mortality
ratio (SMR) was calculated as the ratio between observed deaths in the
study cohort and the expected deaths if the general population had the
same age and gender distribution, using data in the Human Mortality
Database. The lesions were stratified into the three groups; mild,
moderate and severe, based on the heart lesion. Result(s): In total
552 deaths occurred. In all patients, SMR was [1.8 (1.5-2.1)] and in NYHA
III-IV [5.5 (4.0-7.3)]. The same pattern was seen in mild, moderate and
severe ACHD. In patients with severe lesions and NYHA I, SMR was
[7.0(4.5-10.2)] and [17.2(10.7-25.9)] in NYHA III-IV. Patients who
exercised regularly had a consistent lower SMR than those who did not. In
patients with regular physical activity, there was no difference in SMR
compared to the general population. In patients with the lowest physical
activity level, the SMR was [3.2 (2.6-3.8)] for all lesions.
 Conclusion(s): Easily available clinical variables such as NYHA class
and physical activity level are potential markers for prognosis in adult
congenital heart disease.

<69>
Accession Number
649655449
Title
The impact of the diameter of coronary stenosis on outcomes in patients
undergoing percutaneous coronary intervention with transcatheter aortic
valve implantation.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Riihiniemi M.; Marquard J.; Piuhola J.; Niemela M.; Junttila J.; De Backer
O.; Engstrom T.; Lonborg J.
Institution
(Riihiniemi, Junttila) Medical Research Center Oulu, Oulu, Finland
(Marquard, De Backer, Engstrom, Lonborg) Rigshospitalet - Copenhagen
University Hospital, Department of Cardiology, Copenhagen, Denmark
(Piuhola, Niemela) Oulu University Hospital, Department of Cardiology,
Oulu, Finland
Publisher
Oxford University Press
Abstract
Background: Coronary artery disease (CAD) is common in patients undergoing
transcatheter aortic valve implantation (TAVI), and optimal treatment
strategy of CAD in this population remains debated. Purpose(s): To
analyse the impact of the diameter of coronary stenosis on outcomes in
patients undergoing percutaneous coronary intervention (PCI) with TAVI.
 Method(s): This study was based on the NOTION-3 trial, which
randomized 455 patients (median age 82 years; 67% male; median Society of
Thoracic Surgeons-Predicted Risk of Mortality score 3%) with severe
symptomatic aortic stenosis and coexisting stable CAD to receive either
PCI or conservative treatment of CAD with TAVI. In this sub-analysis,
patients were stratified to three groups according to the diameter of
coronary stenosis (50-69%, N=40; 70-89%, N=144; and >=90%, N=271). The
primary outcome was major adverse cardiovascular events (MACE), a
composite of all-cause death, myocardial infarction and urgent
revascularization. Result(s): At a median follow-up of 2 years
(interquartile range 1-4), PCI was not associated with lower incidence of
MACE in patients with coronary stenosis of 50-69% (28% vs. 32%; hazard
ratio (HR): 0.94, 95% confidence interval (CI): 0.30-2.97, p=0.78) and
70-89% (31% vs. 34%; HR: 1.06, 95% CI: 0.60-1.88, p=0.76) compared to
conservative treatment. In patients with coronary stenosis of >=90%, the
incidence of MACE was significantly lower in patients undergoing PCI (24%
vs. 37%; HR: 0.53, 95% CI: 0.34-0.82, p=0.017), mainly driven by reduction
in the incidence of myocardial infarction (6.5% vs. 17%; HR: 0.34, 95% CI:
0.15-0.73, p=0.005) and urgent revascularization (1.4% vs. 14%; HR: 0.10,
95% CI: 0.02-0.42, p<0.001). Conclusion(s): In patients undergoing
TAVI with coexisting stable CAD, PCI in case of a coronary stenosis of
>=90% was associated with a lower incidence of a composite of all-cause
death, myocardial infarction and urgent revascularization compared to
conservative treatment, suggesting the use of PCI in this population.

<70>
Accession Number
649656270
Title
Diagnostic accuracy of non-invasive imaging to evaluate heart transplant
recipients: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Bisaccia G.; La Vecchia G.; Leo I.; Licordari R.; Perotto M.; Procopio
M.C.; Ricci F.; Gallina S.; Wong J.; Bucciarelli-Ducci C.
Institution
(Bisaccia, La Vecchia, Leo, Licordari, Perotto, Procopio, Wong,
Bucciarelli-Ducci) Royal Brompton and Harefield NHS Foundation Trust, CMR
Unit, London, United Kingdom
(Ricci, Gallina) G. d Annunzio University, Chieti, Italy
Publisher
Oxford University Press
Abstract
Background: Endomyocardial biopsy (EBM) and invasive angiography (ICA) are
the gold standard for the detection of graft rejection (GR) and coronary
allograft vasculopathy (CAV). Non-invasive imaging strategies are used to
detect such complications in heart transplant (HT) recipients.
 Method(s): We performed a prespecified systematic review and
meta-analysis of studies reporting on the diagnostic accuracy of
echocardiography, cardiac magnetic resonance (CMR), single photon emission
computed tomography (SPECT), and positron emission tomography (PET) to
diagnose CAV and ACR. Clinical utility was represented with decision
curves. Result(s): We identified 80 studies pooling 10,416 HT
recipients (mean age years, 54% males). The median prevalence was 20% for
CAV and 25% for GR. For detecting CAV, stress CMR yielded the highest
accuracy compared to stress echocardiography and SPECT, with areas under
the curve (AUC) of 0.811(95%CI0.49-0.95), 0.752(0.61-0.85), and
0.752(0.68-0.81). For GR, parametric CMR demonstrated the higher
diagnostic performance (AUC 0.854[95%CI0.76-0.91] for T1 and of
0.845[95%CI0.75-0.91] for T2 mapping, respectively). Conclusion(s):
CMR shows high performance for detecting CAV and GR. Parametric CMR is
likely the most accurate method for GR surveillance. Data is limited on
quantitative stress perfusion; direct comparisons between quantitative
stress CMR and PET are lacking for CAV detection.

<71>
Accession Number
649653067
Title
Short-term effects of blood pressure lowering drugs on cardiovascular
events: a systematic review and meta-analysis of randomised,
placebo-controlled, doubled-blind trials.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Gnanenthiran S.; Kaistha P.; Pant R.; Dhurjati R.; Kumar A.; Haghdoost F.;
Kota V.; Wang N.; Rodgers A.; Salam A.
Institution
(Gnanenthiran, Kaistha, Pant, Dhurjati, Kumar, Haghdoost, Kota, Wang,
Rodgers, Salam) George Institute for Global Health, Sydney, Australia
Publisher
Oxford University Press
Abstract
Background: There remains uncertainty about the short-term effects of
blood pressure (BP) lowering drugs on cardiovascular events. Whether the
speed of BP lowering matters is also unknown. As a result, BP guidelines
vary in their recommendation for when target BP should be achieved. A
greater understanding of the short-term benefits of therapy is imperative
to guide clinical decisions about the benefits of early initiation of
treatment. Purpose(s): We performed a meta-analysis of double-blind,
short-term randomised trials to evaluate the effect of BP-lowering drugs
on cardiovascular events compared to placebo. Method(s): A systematic
search for relevant trials was performed in the following databases:
MEDLINE, Cochrane Central Register of Controlled Trials Library, and
Epistemonikos. Trials satisfying the following criteria were included: (i)
randomized, double-blind placebo-controlled trials of 2-26 weeks published
in English language; (ii) adults (age >=18 years) with hypertension (BP
>=140/90 mmHg or taking BP-lowering drugs); (iii) intervention: oral fixed
dose of BP-lowering drug(s) as either monotherapy or combination therapy
from five major classes (angiotensin converting enzyme, angiotensin-II
receptor blockers, calcium channel blockers, beta-blockers, and
diuretics); (iv) placebo comparator; (v) reported data on cardiovascular
events; (vi). The primary outcome was major adverse cardiovascular events
(MACE), defined as stroke transient ischaemic attack (TIA), myocardial
infarction, heart failure hospitalisation, angina or coronary
revascularisation. Result(s): 451 trials (93,121 participants [mean
age 54 years, 56% males, mean follow-up 8 weeks], with a total of 250
cardiovascular events were included. There was no effect of the
intervention compared to placebo on MACE (0.19% versus 0.43%; relative
risk [RR] 0.89, 95% CI 0.69-1.14, p=0.35). There was a significant
reduction in stroke (0.01% versus 0.05%; RR 0.37 [0.19-0.72]; p<0.001) and
TIA (0.001% versus 0.01%; RR 0.26 [0.08-0.82]; p=0.02). Subgroup analysis
suggested combination therapy provided the most benefit in stroke
reduction (RR 0.21 [0.04-1.01], p=0.05), but benefits were observed across
all anti-hypertensive groups for TIA outcomes. There were no between group
differences in all-cause or cardiovascular mortality, myocardial
infarction, heart failure, angina or coronary revascularisation.
 Conclusion(s): This meta-analysis of placebo-controlled RCTs
demonstrated reduced cerebrovascular events with BP-lowering drugs even at
short-term follow up. These findings suggest BP lowering treatment should
be initiated as soon as possible in at risk individuals because even 8
weeks of treatment can significantly reduce the risk of stroke/TIA.
Shorter time to BP control should be considered in future hypertension
guidelines. Summary of Cardiovascular Events.

<72>
Accession Number
649654229
Title
Analytical approaches to open label extension (OLE) after cardiovascular
outocmes trials: Observations from the FOURIER and FOURIER-OLE trials.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Walsh E.L.; Kyungah I.; Giugliano R.P.; Odonoghue M.L.; Wang H.; Paiva Da
Silva Lima G.; Atar D.; Keech A.; George J.T.; Sabatine M.S.; Ohman E.M.
Institution
(Walsh, Wang, Paiva Da Silva Lima, George) AMGEN, Thousand Oaks, United
States
(Kyungah, Giugliano, Odonoghue, Sabatine) Brigham and Women's Hospital,
Harvard Medical School, Boston, United States
(Atar) Oslo University Hospital Ulleval, Oslo, Norway
(Keech) University of Sydney, Sydney, Australia
(Ohman) Duke University Medical Center, Durham, United States
Publisher
Oxford University Press
Abstract
Background: Continued access to study medications in both active and
placebo-treated subjects is frequently advocated after randomized clinical
trial (RCT) completion. There is uncertainty how such OLE trials should be
analyzed as all subjects are receiving the active therapy, yet some
therapies have a legacy effect on outcomes. We sought to explore different
analytical approaches to adjust for the lack of a control arm in an OLE
phase clinical trial. Purpose(s): Explore analytical approaches to
evaluate CV outcomes in the OLE phase after a RCT trial using a
counterfactual derived placebo arm when treatment effects are delayed.
 Method(s): We analyzed data from the FOURIER RCT (N=27,564) who were
followed for a median of 2.2 years and the FOURIER-OLE (N=6,635) for a
median of 5 years. In the RCT, half of patients received evolocumab (EVO)
and half received placebo. After the RCT subjects entered the OLE phase
where all patients received EVO. The primary cardiovascular (CV) composite
endpoint PEP (CV death, MI, stroke, hospitalization for UA, or coronary
revascularization) was analyzed using Cox model and generating hazard
ratio (HR), and 95% CI with prespecified stratification factors at initial
randomization and FOURIER-OLE study protocol. In an additional analysis,
we used rank preserving structural failure time (RPSFT) that modelled the
treatment effect in the cross-over of subjects randomized to placebo
during FOURIER who received EVO in the OLE phase. RPSFT estimates the
counterfactual time-to-event for FOURIER placebo subjects throughout the
OLE period by assuming the FOURIER observed treatment effect within the
OLE period. This method was evaluated in the FOURIER + OLE trial for PEP.
 Result(s): Using the Cox-model analysis patients initially randomized
to EVO in the RCT continued to have lower incidence of PEP in the OLE; HR
0.85 95% CI 0.75-0.96, p=0.008 compared to those receiving EVO after 2.2
years of placebo. A delayed treatment effect was evident using observed
data (by comparing early initiated EVO group versus late initiated EVO
group). Using RPSFT analysis, strong long-term treatment benefit of EVO
was estimated for PEP, a HR = 0.81 (95% CI: 0.76, 0.87) in the overall
FOURIER + OLE cohort between the counterfactual placebo arm and observed
long-term EVO arm. Results were robust to sensitivity analyses. Data
displayed for the combined analysis for PEP (figure 1) and the individual
endpoint of MI (figure 2) HR = 0.66 (95% CI: 0.59-0.74).
 Conclusion(s): Open label extension designs have limitations for
analytical purposes given the absence of a control arm. We propose an
analytical counterfactual framework (RPSFT) that could be used to explore
long-term efficacy endpoints in OLE trials. The counterfactual analysis,
including both the RCT and OLE part, shows a large treatment difference
and the results based on observed data only may potentially underestimate
the true long-term cardiovascular effects.

<73>
Accession Number
649657774
Title
B-type natriuretic peptide reverses vascular endothelial insulin
resistance and ameliorates dysregulated redox signalling when administered
alongside insulin in human atherosclerosis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Foran D.; Badi I.; Katsouda A.; Polkinghorne M.; D'alessio A.; Sastry P.;
Kourliouros A.; Walcot N.; Srivastava V.; Krasopoulos G.; Sayeed R.;
Antonopoulos A.; Channon K.; Akoumianakis I.; Antoniades C.
Institution
(Foran, Badi, Katsouda, Antonopoulos, Channon, Akoumianakis, Antoniades)
University of Oxford, Oxford, United Kingdom
(Polkinghorne) Imperial College London, Department of Metabolism,
Digestion and Reproduction, London, United Kingdom
(D'alessio, Sastry, Kourliouros, Walcot, Srivastava, Krasopoulos, Sayeed)
Oxford University Hospitals NHS Foundation Trust, Department of
Cardiothoracic Surgery, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Aim: Atherosclerosis is a leading complication of type 2 diabetes.
Physiologically, in endothelial cells, insulin stimulates activation of
endothelial nitric oxide (NO) synthase (eNOS), producing the vasorelaxant,
anti-inflammatory, and atheroprotective NO. Atherosclerosis patients
exhibit vascular endothelial insulin resistance regardless of diabetic
status. When these patients are given insulin, a pathological signalling
cascade activates NADPH oxidase (NOX) and uncouples eNOS, resulting in
excess production of superoxide and, consequently, vasoconstriction,
inflammation, oxidative stress, and atherogenesis. Hence, diabetics on
aggressive insulin therapy have poor cardiovascular outcomes.
Dipeptidyl-peptidase-IV (DPPIV) inhibitors ameliorate this phenotype ex
vivo but do not confer prognostic cardiovascular benefits clinically.
B-type natriuretic peptide (BNP) is a DPPIV substrate that may modulate
endothelial insulin and redox signalling. Method(s): Samples of
plasma, intact internal mammary artery (IMA) and saphenous vein (SV) were
collected from 128 adults undergoing coronary bypass surgery. Plasma BNP
and insulin were measured by ELISA. Sequential rings of vessels were
incubated in four conditions (control, insulin, BNP, insulin & BNP).
Baseline, NOX-derived and LNAME-delta superoxide production were measured
in IMAs through chemiluminescent luminometry. Endothelial function was
quantified in SVs with vasomotor studies assessing endothelium-dependent
relaxation with acetylcholine and bradykinin. Western blotting quantified
relative activation of intracellular signalling molecules (AKT, ERK, eNOS,
IRS1). Result(s): In patients with low plasma BNP, increased
endogenous insulin levels are significantly associated with increased IMA
NOX-derived superoxide production (p=0.034). This effect is abolished in
patients with BNP excess (p=0.50). Insulin significantly increases
endothelium-dependent vasoconstriction (p=0.01) whilst BNP with insulin
significantly reduces endothelium-dependent vasoconstriction (p=0.04).
Insulin significantly increases IMA resting (p<0.0001) and NOX-derived
(p=0.0005) superoxide production and uncouples eNOS NO production
(p=0.027), whilst BNP combined with insulin restores these to normal
levels. BNP with and without insulin recouples eNOS NO production
(p=0.037). Insulin alone increases endothelial ERK (p=0.004) and IRS1
(p=0.03) phosphorylation but does not activate AKT or eNOS. Insulin with
BNP increases AKT (P=0.004) and eNOS (p=0.03) phosphorylation and reduces
IRS1 phosphorylation. A SNP responsible for increased nppb expression and
plasma BNP (rs198983) is associated with increased NOX-derived superoxide
(p<0.05) and increased major adverse cardiovascular events (p=0.03).
 Conclusion(s): BNP resensitises the vascular endothelium to and
ameliorates pathological redox signalling when co-administered with
insulin. BNP may have a role as a future therapeutic in preventing and
treating atherosclerosis with comorbid diabetes.

<74>
Accession Number
649653101
Title
Impact of colchicine on atrial fibrillation recurrence following pulmonary
vein isolation.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Fretz T.; Dasari S.; Sakaleros J.; Alam Kayani A.; Garcia A.; Lemus R.
Institution
(Fretz, Dasari, Sakaleros, Alam Kayani, Garcia, Lemus) Indiana University,
School of Medicine, Indianapolis, United States
Publisher
Oxford University Press
Abstract
Background: Recurrence of atrial fibrillation (AF) following pulmonary
vein isolation (PVI) is common. Inflammation is hypothesized to be a
driver of recurrent AF and is of particular importance in the context of
PVI given the elevated inflammatory state following the procedure.
Colchicine is a widely available anti-inflammatory that has been shown to
reduce perioperative AF following cardiac surgery. It is plausible
colchicine following PVI may reduce recurrent AF given its
anti-inflammatory properties. Purpose(s): The purpose of this
analysis is to determine the effects of colchicine on clinical outcomes
following AF ablation. Method(s): PubMed, EMBASE, and Cochrane
databases were queried from inception to January 2025 to identify studies
that examined the impact of colchicine use on outcomes of interest such as
AF recurrence, pericarditis, hospitalizations, and other adverse events.
Two independent reviewers extracted data, and disagreements were resolved
by consensus or a third author. Effect estimates were pooled using a
random-effects model and reported as odds ratios (OR) for dichotomous
outcomes with 95% confidence intervals. Result(s): Among 311 studies
identified on initial search, seven studies met inclusion criteria. Three
studies were randomized controlled trials, and the remainder were
propensity-score matched observational studies. These studies included
2,554 patients in total - 1,209 patients in the colchicine group and 1,345
in the control group. Patients were 69.1% male, mean age of 66.9 +/- 8.4
years and 62.0% had paroxysmal AF. The average ejection fraction was 55.7
+/- 5.6%. Colchicine was associated with a statistically significant lower
incidence of AF following ablation compared to placebo (OR: 0.67; [0.55,
0.81], p<0.001). Colchicine use was also associated with a statistically
significant increase in gastrointestinal side effects (OR: 3.40; [1.38,
8.38], p<0.001). There are trends toward decreased rates of pericarditis
(OR: 0.47; [0.20, 1.09], p=0.08) and decreased hospitalizations (OR: 0.83;
[0.54, 1.26], p=0.38) with colchicine use, though these did not reach
statistical significance. Conclusion(s): The use of colchicine is
associated with a reduced incidence of AF recurrence following ablation,
though at the cost of increased gastrointestinal side effects.

<75>
Accession Number
649655216
Title
Three-year outcome after coronary stenting in all-comer patients: Impact
of diabetes and peripheral arterial disease.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Van Vliet D.; Pinxterhuis T.H.; Ploumen E.H.; Kok M.M.; Buiten R.A.; Zocca
G.P.; Roguin A.; Schotborgh C.E.; Anthonio R.L.; Danse P.W.; Benit E.;
Aminian A.; Doggen C.J.M.; Von Birgelen C.
Institution
(Van Vliet, Pinxterhuis, Ploumen, Kok, Buiten, Zocca, Von Birgelen) Thorax
Centre in Medisch Spectrum Twente (MST), Enschede, Netherlands
(Roguin) Hillel Yaffe Medical Center, Department of cardiology, Hadera,
Israel
(Schotborgh) Haga Hospital, Department of cardiology, Den Haag,
Netherlands
(Anthonio) Treant Zorggroep Scheper Hospital, Department of cardiology,
Emmen, Netherlands
(Danse) Rijnstate Hospital, Department of cardiology, Arnhem, Netherlands
(Benit) Jessa clinic Hasselt, Department of cardiology, Hasselt, Belgium
(Aminian) CHU Charleroi, Department of cardiology, Charleroi, Belgium
(Doggen) University of Twente, Department of Health Technology and
Services Research, Faculty BMS, Technical Medical Centre, Enschede,
Netherlands
Publisher
Oxford University Press
Abstract
Background: Diabetes is a well-established risk factor for atherosclerosis
and associated with an increased risk of adverse events after percutaneous
coronary intervention (PCI) with drug-eluting stents. Similarly, patients
with obstructive coronary artery disease are more likely to have
atherosclerosis in additional vascular beds. These patients with
concomitant peripheral arterial disease (PADs) also have an elevated risk
of adverse events following PCI. Yet, it is unclear whether PCI patients
with diabetes, PADs, or both characteristics differ in risk of adverse
clinical events. Purpose(s): To evaluate the impact of diabetes in
PCI patients with or without concomitant PADs at 3-year follow-up.
 Method(s): Data were pooled from a patient-level database of 4
randomized clinical trials that enrolled all-comer PCI patients treated
with new-generation drug-eluting coronary stents. The study population was
divided in patients with or without concomitant PADs. In these two groups,
we identified patients with or without medically-treated diabetes. The
main composite endpoint was major adverse cardiac event (MACE: any
myocardial infarction, emergent coronary bypass surgery, clinically
indicated target lesion revascularization, or all-cause mortality).
 Result(s): Of 9,204 all-comer PCI patients, 695 were known with PADs,
of whom 208 (29.9%) had diabetes. Of the 8,454 patients without PADs,
1,539 (18.2%) had diabetes. 55 patients were excluded due to an unknown
PADs status. Regardless of the presence of PADs, patients with diabetes at
baseline were older, had a higher BMI, and a higher prevalence of
hypertension than those without diabetes. At 3-year follow-up, the
incidence of MACE was significantly higher in PADs patients with diabetes
than in those without diabetes (24.6% vs. 16.4%, HR: 1.56, 95%CI:
1.10-2.22, p=0.01). In patients without PAD's, there was a similar
increase in MACE associated with diabetes (16.7% vs. 9.5%, HR: 1.83, 95%
CI: 1.58-2.11, p<0.01). The absolute increase in MACE rate associated with
the presence of diabetes was +8.2% in patients with PADs and +7.2% in
those without PADs. Conclusion(s): In the high-risk population of PCI
patients with and without PADs, the presence of diabetes represents a
profoundly relevant additional cardiovascular risk factor, associated with
a similar increase in adverse clinical events at long-term follow-up after
coronary stenting. MACE in PCI patients with PADs.

<76>
Accession Number
649657573
Title
Global prevalence and outcomes of transcatheter aortic valve replacement
and surgical aortic valve replacement: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Ong L.; Chng A.; Kuntjoro I.; Lim Y.; Yip J.; Chai P.; Yeo T.; Poh K.;
Kong W.; Sia C.
Institution
(Ong, Chng, Kuntjoro, Lim, Yip, Chai, Yeo, Poh, Kong, Sia) National
University Heart Center Singapore, Singapore, Singapore
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
an minimally invasive alternative to surgical aortic valve replacement
(SAVR). Purpose(s): This study aimed to compare the use of TAVR and
SAVR in real-world patient populations. Method(s): We searched PubMed
and Embase from inception to 31st July 2024 to identify relevant studies.
Population-based studies and registries were included in this study.
Prevalences were expressed as proportions with 95% confidence interval
(CI) and dichotomous data were expressed using risk ratio (RR) with 95%
CI. The DerSimonian and Laird random-effects model was used to compute the
pooled estimates. Statistical analysis was conducted in Rstudio.
 Result(s): We identified 311 studies (n = 11 069 277) from 26
countries. Among patients undergoing aortic valve replacement (AVR), 39.1%
(95% CI, 36.3 - 41.9%) underwent TAVR and 60.9% (95% CI, 58.1 - 63.7%)
went SAVR. The prevalence of TAVR was 48.1% (95% CI, 39.8 - 56.5%) in
Asia, 43.6% (95% CI, 9.7 - 84.8%) in Oceania, 42.3% (95% CI, 38.3 - 46.4%)
in Europe, and 33.8% (95% CI, 29.8 - 38.1%) in North America. Overall, the
proportion of TAVR remained consistent in studies conducted from 2015
(42.0%, 95% CI, 38.3 - 46.4%) to 2024 (45.1%, 95% CI, 37.9 - 52.5%).
However, there was an increasing trend in North America, with TAVR rising
from 21.5% (95% CI, 1.9 - 79.8%) in 2015 to 49.1% (95% CI, 37.6 - 60.9%)
in 2024. Clinically, TAVR was associated with lower risks of atrial
fibrillation (RR: 0.35, 95% CI 0.28 - 0.43), acute kidney injury or
dialysis (RR: 0.69, 95% CI 0.62 - 0.76), bleeding or blood transfusion
(RR: 0.46, 95% CI 0.41 - 0.52) but higher risks of permanent pacemaker
implantation (RR: 2.50, 95% CI 2.26 - 2.75) and vascular complications
(RR: 3.00, 95% CI 2.23 - 4.03) compared to SAVR. However, no significant
differences were observed in the risks of mortality, myocardial
infarction, stroke, and aortic reintervention. Conclusion(s): This
study highlights the widespread adoption of TAVR as a treatment option for
patients undergoing AVR. However, the higher risks of permanent pacemaker
implantation and vascular complications associated with TAVR emphasize the
need for careful patient selection.

<77>
Accession Number
649655228
Title
Direct versus deferred left atrial appendage closure in patients with left
atrial appendage thrombus via the guidance of intracardiac
echocardiography.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Wang B.; Chu H.; Feng M.; Du X.; Yu Y.; Fu G.; Gao F.; Jin H.; Jiang Y.;
Shen C.; Fang R.; Zhuo W.; Xu Y.; Yu J.; Sun Y.
Institution
(Wang, Chu, Feng, Du, Yu, Fu, Gao, Jin, Jiang, Shen, Fang, Zhuo, Xu, Yu,
Sun) First Affiliated of Ningbo University, Arrhythmia Center, Ningbo,
China
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) is associated with a markedly
increased risk of stroke. Most thrombus originate in the left atrial
appendage (LAA). The risk of stroke has been reported relatively high in
patients with LAA thrombus (LAAT) during oral anticoagulation (OAC)
therapy. LAA closure (LAAC) may be safe and feasible in patient with LAAT.
The optional timing of LAAC in patients with LAAT is controversial.
 Purpose(s): This study aimed to compare the clinical outcomes between
direct and deferred LAAC in patients with LAAT guided by intracardiac
echocardiography (ICE). Method(s): Patients with AF and LAAT who
underwent LAAC between May 2022 and December 2024 were consecutively
included. The study population was divided into direct LAAC group and
deferred LAAC group. LAAC was performed by experienced operators via the
guidance of ICE. Patient characteristics and clinical outcomes were
compared between the two groups. Result(s): A total of 34 patients
(aged 67.2+/-9.6 years, 82.4% males) with AF and LAAT were included.
Direct LAAC was performed in 21 patients (2 with contraindications to OAC,
11 with high bleeding risk, 5 with LAAT and prevalent stroke during prior
intensive OAC, 3 for patient's preference). Deferred LAAC was arranged in
the rest 13 patients with persistent LAAT after OAC therapy with a median
period of 125 days (interquartile range 51-349 days). Three patients
(3/13, 23.1%) experienced stroke and 2 (2/13, 15.4%) had bleeding events
during OAC therapy in the deferred LAAC group. Thrombus at the proximal
and distal LAA was detected in 15 (direct LAAC group 9, deferred LAAC
group 6) and 19 patients (direct LAAC group 12, deferred LAAC group 7),
respectively (Figure 1). Lobe and disc devices (33 LAmbre device, 1 SeaLA
device) were used and successfully implanted in all patients. Only 1
patient experienced pseudoaneurysm periprocedurally and recovered after
surgery. No peridevice leak > 5 mm was detected during transesophageal
echocardiography or cardiac CT follow-up. Device-related thrombus occurred
in 1 patient in the deferred LAAC group. After a median follow-up period
of 383 days (interquartile range 150-645 days), none of the patients
experienced death, stroke/transient ischemic attack, or systemic embolism.
Two patients in the deferred LAAC group suffered gastrointestinal bleeding
during follow-up. None of the clinical outcomes was statistical
significance between the two groups (Table 1). Conclusion(s): Direct
LAAC via the guidance of ICE may be safe and feasible in patients with
LAAT by experienced operators with high procedural success and absence of
periprocedural thromboembolic complications. Further randomized controlled
trial with large study population is needed to confirm this finding.

<78>
Accession Number
649657015
Title
Safety and efficacy of the Myval transcatheter heart valve: a systematic
review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Apostolos A.; Ktenopoulos N.; Kachrimanidis I.; Vlachakis P.; Sagris M.;
Koliastasis L.; Benetos G.; Tsalamandris S.; Drakopoulou M.; Synetos A.;
Latsios G.; Karanasos A.; Tsioufis K.; Toutouzas K.
Institution
(Apostolos, Ktenopoulos, Kachrimanidis, Vlachakis, Sagris, Koliastasis,
Benetos, Tsalamandris, Drakopoulou, Synetos, Latsios, Tsioufis, Toutouzas)
National and Kapodistrian University of Athens Medical School, Athens,
Greece
(Karanasos) University Hospital of Patras, Rio-Patras, Greece
Publisher
Oxford University Press
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) has been
established as a first-line treatment for severe aortic valve stenosis.
The Myval transcatheter heart valve (THV) is a novel balloon-expandable
platform designed to reduce conduction disturbances and improve
hemodynamic performance. Purpose(s): Our systematic review and
meta-analysis aimed to assess the safety and efficacy of the Myval THV in
patients undergoing TAVI. Method(s): We screened the three major
databases to identify relevant studies published up to December 19th,
2024. Primary outcomes included in-hospital, 30-day, and 1-year all-cause
mortality rates. Secondary outcomes assessed in-hospital, 30-day, and
1-year stroke and permanent pacemaker implantation(PPI) rates, along with
in-hospital and 30-day acute kidney injury(AKI), major and minor bleeding,
and aortic regurgitation (paravalvular and transvalvular AR) and
in-hospital annular rupture, convert to surgery, need for >1 THV, need for
re-intervention, rehospitalization, device embolization and cardiac
tamponade. Result(s): We included 17 studies comprising 2,060
patients undergoing TAVI with the Myval THV. In-hospital all-cause
mortality rate was 0.4% (95%CI:0%-0.99%), increasing to 2%
(95%CI:1.2%-2.9%) at 30 days and 8.6% (95%CI:6%-11.3%) at one year. Stroke
rates remained low, with in-hospital, 30-day and 1-year rates of 0.9%
(95%CI:0%-2%), 1.5% (95% CI:0.7%-2.4%) and 3.2% (95%CI:0.3%-6.1%),
respectively. The 30-day PPI rate was 10.6% (95%CI:7%-14.2%), while AKI
occurred in 1.7% (95%CI:0.55%-2.9%) of patients during hospitalization.
Bleeding complications were infrequent, with in-hospital and 30-day major
bleeding rates of 1.5% (95%CI:0%-2.9%) and 1.6% (95%CI:0%- 3.2%),
respectively, while in-hospital minor bleeding was reported in 13.6%
(95%CI:4.7%-22.5%). The incidence of greater-than-mild paravalvular AR was
0.4% (95%CI:0%-1.5%) in-hospital and 1.1% (95%CI:0%-2.2%) at 30 days,
while moderate to severe transvalvular AR was observed in 0.15%
(95%CI:0%-1.3%) of cases in-hospital and 4.4% (95%CI:1.1%-7.7%) at 30
days. Conversion to surgery occured in 0.28% (95%CI:0%-1%) of patients,
and the need for >1 THV in 0.27% (95%CI:0%-0.88%). Rehospitalization was
required in 1.6% (95% CI:0%-3.5%). Device-related complications were
infrequent, with in-hospital device embolization occurring in 0.3%
(95%CI:0%-1.3%) of cases and cardiac tamponade in 0.18%(95%CI:0%-1.1%).
 Conclusion(s): Our findings show that the Myval THV offers a safe and
effective alternative for patients undergoing TAVI, with low mortality,
stroke, PPI and periprocedural complications rates. Further large-scale
prospective studies are warranted to confirm these findings.

<79>
Accession Number
649656686
Title
Pre- and post-dilatation practices in transcatheter aortic valve
implantation using self-expanding valves: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Soh B.W.T.; Pollock A.; Butler D.; Mcinerney A.; Mylotte D.
Institution
(Soh) University of Galway, School of Medicine, Galway, Ireland
(Pollock) Tallaght University Hospital, Department of Cardiology, Dublin,
Ireland
(Butler, Mcinerney, Mylotte) Galway University Hospital, Department of
Cardiology, Galway, Ireland
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a standard
treatment for symptomatic severe aortic stenosis (AS). Pre-implantation
balloon aortic valvuloplasty (BAV) is routinely performed to prepare the
device landing zone and facilitate TAVI expansion, but concerns have
arisen regarding its association with haemodynamic instability, permanent
pacemaker (PPM) implantation, and cerebrovascular accidents (CVA).
Similarly, balloon post-dilatation (BPD) aims to improve expansion of an
implanted transcatheter heart valve (THV), reduce paravalvular leaks (PVL)
and optimize haemodynamic result. BPD has however been linked to higher
risks of CVA, mortality, and bioprosthetic leaflets damage, which impairs
durability. These concerns have led to a shift toward TAVI techniques
avoiding both BAV and BPD. More recently, THV malexpansion with
self-expanding valves (SEV) has been associated with adverse clinical
outcomes. Given conflicting evidence, this systematic review evaluates the
available literature on the impact of BAV and BPD during TAVI with SEVs.
 Purpose(s): This systematic review and meta-analysis assesses
clinical outcomes of BAV or BPD compared to no balloon dilatation in TAVI
with SEVs. Method(s): A systematic search was conducted across
PubMed, Embase, Cochrane Library, and Scopus databases. Studies reporting
clinical and echocardiographic outcomes of adult patients undergoing SEV
TAVI for AS, comparing BAV or BPD with no balloon dilatation, were
included. Random effects meta-analysis with HKSJ adjustment was used to
analyse pooled odds ratios for key TAVI outcomes. Result(s): Eight
studies (6 observational, 2 randomised) with 4699 patients, were included
for BAV, and six observational studies with 8902 patients were included
for BPD. Of these, 3560 patients (75.8%) underwent BAV and 2181 patients
(24.5%) underwent BPD. In the BAV meta-analysis, no significant
differences were found across all key outcomes between BAV and no BAV.
However, when considering only randomised studies, BAV was associated with
reduced odds of requiring BPD (OR 0.43; 95% CI 0.42-0.43). In contrast,
BPD was linked to higher odds of 30-day mortality (OR 1.32; 95% CI
1.15-1.52), myocardial infarction (MI) (OR 1.25; 95% CI 1.02- 1.54), and
PVL2+ (OR 3.65; 95% CI 2.59-5.15) compared to no BPD. All BPD studies were
observational, with inherent selection bias, as operators decided on BPD
based on clinical need, considering THV performance factors like
significant PVL, incomplete THV expansion, and elevated THV gradients.
Neither BAV nor BPD was associated with increased risk of CVA or PPM
implantation. Conclusion(s): In patients undergoing SEV TAVI, BAV was
not associated with higher risks of adverse outcomes compared to no BAV.
Randomised data suggest BAV reduces the odds of requiring BPD. BPD was
associated with increased odds of 30-day mortality, MI, and PVL2 +, though
these findings are based on observational data and may be influenced by
selection bias.

<80>
Accession Number
649657332
Title
Automated survival prediction based on body composition analysis of
Pre-TAVI-Procedural CT scans.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Lind C.; Voran J.; Ulrich H.; Frank D.; Mueller D.
Institution
(Lind, Frank) University Hospital Schleswig-Holstein, Department of
Internal Medicine III, Cardiology and Intensive Care, Kiel, Germany
(Voran) University Hospital Schleswig-Holstein, Department of Internal
Medicine III, Cardiology and Angiology, Kiel, Germany
(Ulrich, Mueller) University Hospital Schleswig-Holstein, Institute for
Medical Informatics and Statistics, Kiel, Germany
Publisher
Oxford University Press
Abstract
Background: Computed tomography (CT) is an integral part of planning a
transcatheter aortic valve implantation (TAVI). We developed an automated
image analysis pipeline to analyze CT scans and identify anatomical
features significantly associated with patient survival outcomes.
 Method(s): We have analyzed consecutive 299 TAVI patients
(2016-2024), all of whom underwent pre-procedural CT scans including the
heart and femoral arteries prior to TAVI. The CT scans were automatically
processed from our hospital's PACS by the Body and Organ Analysis
framework (UMEssen), which integrates TotalSegementator and Body
Composition Analysis. We assessed correlations between the radiomics
features and survival outcomes using the Bonferroni method with
Benjamini-Hochberg correction. Based on the derived features, we trained a
machine learning model to predict short (<12months), intermediate (>12m &
<36m) and long term (>36m) survival. Result(s): In our cohort, the
median age was 82 (IQR: 79 - 85) years, 155 (51.8%) were women, and the
median BMI was 26.3 kg/m2. Survival rates were 90% at 6 months, 86% at 12
months, 79% at 24 months and 70% at 36 months post-TAVI. Based solely on
the radiomics data, our machine learning model reached an AUROC 0.727 for
short 0.374 for intermediate and 0.620 for long term survival. The F1
score indicates that the model is more accurate in predicting short- and
long-term survival than intermediate-term, with scores of 0.833
(long-term), 0.133 (intermediate-term), and 0.608 (short-term). We found
key predictors for patients survival including pulmonary fat, vertebral
bone volume, intermuscular adipose tissue, subcutaneous adipose tissue,
and organ volumes (kidney, spleen, pancreas, esophagus, adrenal glands).
 Conclusion(s): We have developed an unbiased analysis pipeline for
existing pre-TAVI CT scans, deriving valuable data that would otherwise
remain unutilized. Our approach corroborated established prognostic
factors, such as bone volume and intermuscular adipose tissue, while also
identifying novel survival predictors, including pulmonary fat. Following
validation in a randomized controlled trial (RCT), the data obtained
through this method could inform clinical decision-making, particularly in
optimizing personalized follow-up care.

<81>
Accession Number
649655606
Title
SGLT2 inhibitors on the prevention of contrast-induced acute kidney injury
in patients with type 2 diabetes after coronary revascularization: a
systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Vakka A.; Dimitriadis K.; Pyrpyris N.; Theofilis P.; Koutsopoulos G.;
Tsioufis P.; Konstantinidis D.; Soulaidopoulos S.; Petras D.; Aznaouridis
K.; Tsioufis K.
Institution
(Vakka, Dimitriadis, Pyrpyris, Theofilis, Koutsopoulos, Tsioufis,
Konstantinidis, Soulaidopoulos, Petras, Aznaouridis, Tsioufis)
Hippokration General Hospital, Athens, Greece
Publisher
Oxford University Press
Abstract
Introduction: Contrast-induced acute kidney injury (CI-AKI) is a common
complication of iodinated contrast administration during coronary
procedures, especially in patients with diabetes mellitus (DM), which are
considered higher risk. Besides periprocedural hydration and statins, no
other pharmacological strategies have shown positive results on CI-AKI
prevention. Purpose(s): This study aims to evaluate the efficacy of
chronic use of sodium-glucose co-transporter 2 (SGLT2) inhibitors on the
prevention of CI-AKI in patients with type 2 DM following coronary
procedures. Method(s): A systematic literature search of MEDLINE,
Google Scholar, Embase, and Cochrane Library was performed. Relevant
observational studies and randomized controlled studies (RCTs) were
identified. Results were pooled using a random-effect model meta-analysis.
Subgroup analyses were performed to evaluate the potential benefit of
SGLT2 inhibitors on the prevention of CI-AKI in patients undergoing urgent
or elective coronary angiography/percutaneous coronary interventions
(CAG/PCI). Result(s): A total of 8 studies and 2740 patients were
included. Chronic treatment (minimum duration 2 weeks to 6 months) with an
SGLT2 inhibitor was associated with a significantly reduced risk of CI-AKI
in diabetic patients undergoing coronary procedures compared with the
control group [risk ratio (RR) 0.48; 95% confidence interval (CI)
0.39-0.59; p < 0.001). Results of subsequent subgroup analysis showed a
significant reduction in the incidence of CI-AKI in diabetic patients
undergoing both elective CAG/PCI (RR 0.49; 95% CI 0.35-0.68; p<0.001) and
urgent CAG/PCI (RR 0.48; 95% Cl 0.35-0.66; p < 0.001). Discussion(s):
Chronic use of SGLT2 inhibitors may be preventative against the incidence
of CI-AKI in patients with type 2 DM undergoing coronary interventions.

<82>
Accession Number
649654917
Title
Combined use of suture and plug-based devices for femoral access
hemostasis and vascular outcomes in transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Volucke G.; Moez A.; Shah S.; Huma S.; Ali A.; Bacha Z.; Khan A.; Zafar
L.; Afridi A.
Institution
(Volucke) University Hospitals Plymouth NHS Trust, Plymouth, United
Kingdom
(Moez, Shah, Huma, Ali, Bacha, Khan, Zafar, Afridi) Khyber Medical
College, Peshawar, Pakistan
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter Aortic Valve Replacement (TAVR) is the
preferred treatment for severe aortic stenosis. However, vascular
complications and bleeding remain common after transfemoral TAVR,
impacting outcomes. While suture-based and plug-based vascular closure
devices (VCDs) are used, a combined suture and plug-based approach may
offer benefits. Purpose(s): This study compares the effectiveness of
dual suture-based arterial closure versus combined suture and plug-based
closure in achieving hemostasis after TAVR. Methodology: A systematic
search of PubMed, Web of Science, and Embase was conducted until October
2024. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for
randomized controlled trials and the Newcastle-Ottawa Scale for cohort
studies. Data analysis was performed using Review Manager version 5.4,
with pooled outcomes reported as risk ratios or mean differences (MD) with
95% confidence intervals (CI). Result(s): The meta-analysis included
up to 2,304 patients across multiple studies. Major vascular bleeding (RR:
0.72, 95% CI: 0.39-1.34, p = 0.30) and minor vascular bleeding (RR: 0.86,
95% CI: 0.58-1.28, p = 0.47) showed no significant difference in the two
groups. However, the suture plus plug-based vascular closure device
significantly reduced major vascular complications by 50% (RR: 0.50, 95%
CI: 0.33-0.76, p = 0.001) and minor vascular complications by 30% (RR:
0.70, 95% CI: 0.51-0.96, p = 0.03). VCD failure was 74% lower (RR: 0.26,
95% CI: 0.15- 0.47, p < 0.00001) in the suture plus plug-based group and
unplanned interventions showed no significant difference (RR: 0.68, 95%
CI: 0.38- 1.22, p = 0.19) in this group. Conclusion(s): The suture
plus plug-based VCD demonstrated superiority over dual suture device by
significantly reducing vascular complications and device failure
incidents.

<83>
Accession Number
649654001
Title
Exponential growth of tricuspid interventions in Germany.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Voran J.; Kreidel F.K.; Frank D.F.
Institution
(Voran) University Medical Center of Schleswig-Holstein, Kiel, Germany
(Kreidel, Frank) University Medical Center of Schleswig-Holstein - Campus
Kiel, Kiel, Germany
Publisher
Oxford University Press
Abstract
Objective: Here we aim to report the evolving usage of interventional
therapies for TR in Germany. Design, settings and participants: We
investigated all transcatheter tricuspid valve therapies in Germany
(DRG-Statistics) from 2012 to 2023. From 2021 the differentiation between
TEER, percutaneous annuloplasty and "other catheter-based interventions"
became possible. We assessed comorbidities using ICD-10-GM data. Data from
RCT studies were derived from trials' main publication for TRISCEND II
TRILUMINATE pivotal and TRI.Fr. Result(s): We identified N=13,165
cases with an endovascular intervention of the tricuspid valve. In-depth
characterization was eligible for all cases from 2016 (N=13,091). Cases
increased from a total of 74 in 2012 to 2015 to 4298 cases in 2023 by an
exponential rise (lm[log(n) ~ year]: beta = 0.5; p = 4.79e-06). TEER was
most frequently used (9,274/10,048 cases (92%) in 2021-2023). Median age
was 81 years, 58% were female. Compared to TRI.FR and TRISCEND II trial,
patients treated in Germany had a higher mean age. Patients had a median
length of hospital stay of 8 days which was longer than in all three
comparators. In-hospital mortality rate declined from >4% to 1.6%
(TRILUMINATE pivotal: 0%; TRI.FR 0.6%). We further found that the
in-hospital mortality was significantly higher in centers with a lower
number of cases per year, but this effect was confounded by the year in
which the case was registered. Conclusion and relevance: This first
comprehensive real-world data analysis of percutaneous tricuspid valve
treatment in Germany showed an exponential increase in procedures in
Germany proving very rapid adoption of another novel transcatheter concept
in structural heart disease treatment. Real-world intra-hospital mortality
decreased over the last years but was still slightly higher than reported
in trials.

<84>
Accession Number
649654375
Title
Intravascular imaging-guided PCI versus coronary artery bypass grafting
for left main or three-vessel disease.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Lee J.M.; Cho Y.H.; Sung K.; Kim W.S.; Lee J.Y.; Lee S.H.; Lee S.Y.; Kim
S.M.; Yun K.H.; Kim C.J.; Yoon H.J.; Song Y.B.; Hahn J.Y.; Jeong D.S.
Institution
(Lee, Lee, Cho, Sung, Kim, Song, Hahn, Jeong) Samsung Medical Center,
Seoul, South Korea
(Lee) Kangbuk Samsung Hospital, Seoul, South Korea
(Lee) Chonnam National University Hospital, Gwangju, South Korea
(Lee) Chung-Ang University, Gwangmyeong Hospital, Gwangmyeong, South Korea
(Kim) Chungbuk National University, College of Medicine, Cheongju, South
Korea
(Yun) Wonkwang University Hospital, Iksan, South Korea
(Kim) Catholic University of Korea, Seoul St. Mary's Hospital, Seoul,
South Korea
(Yoon) Keimyung University, Dongsan Hospital, Daegu, South Korea
Publisher
Oxford University Press
Abstract
Background and Aims: Previous randomized controlled trials have shown that
coronary artery bypass graft (CABG) has better clinical outcomes compared
with percutaneous coronary intervention (PCI) for patients with left main
or three-vessel disease. However, it is unclear whether intravascular
imaging (IVI)-guided PCI would reduce the difference in clinical events
compared those with CABG. Therefore, the present study sought to compare
the clinical outcomes of patients with left main or three-vessel disease
who underwent IVI-guided PCI with those who underwent CABG.
 Method(s): A total of 6,962 patients with left main or three-vessel
disease from the RENOVATE-COMPLEX-PCI trial (1,639 patients) and the
institutional registry of a medical center (2,972 patients underwent PCI
and 6,600 patients underwent CABG) were classified according to their
treatment groups. The primary outcome was a composite of death from any
cause, non-fatal myocardial infarction (MI), or stroke at 3 years.
 Result(s): Among the study population, 848 patients underwent
IVI-guided PCI, 987 patients underwent angiography-guided PCI, and 5,127
patients underwent CABG. Patients treated with PCI had significantly
higher risk of primary outcome than patients underwent CABG (13.3% vs.
10.8%; hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.05-1.44;
P=0.013). However, the risk of primary outcome was comparable between
patients who underwent IVI-guided PCI and those who underwent CABG (8.7%
vs. 10.8%; HR 0.77; 0.59-1.01; P=0.058). The propensity-score matched
analysis showed similar results between IVI-guided PCI and CABG (9.2% vs.
10.0%; HR 0.90; 95% CI 0.64-1.27; P=0.548). Conclusion(s): In this
hypothesis-generating study, PCI had significantly higher risk of a
composite of death, non-fatal MI, or stroke than CABG. However, IVI-guided
PCI had comparable risk of clinical events compared with CABG. Further
randomized controlled trial is needed to confirm this finding.

<85>
Accession Number
649657755
Title
Assessing the CHA2DS2-VASc score in risk stratification and management of
oral anticoagulation during TAVI.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Van Ginkel D.J.; Bor W.L.; Overduin D.C.; Ten Berg J.M.
Institution
(Van Ginkel, Bor, Overduin, Ten Berg) St Antonius Hospital, Nieuwegein,
Netherlands
Publisher
Oxford University Press
Abstract
Background: International guidelines advise perioperative risk
stratification to guide oral anticoagulation management in patients
receiving long-term oral anticoagulation who require an elective
procedure.1,2 In patients with atrial fibrillation (AF), thromboembolic
risk is frequently stratified based on the CHA2DS2VASc score.1,2 The
validity of this approach and its interaction with oral anticoagulation
management in AF patients undergoing transcatheter aortic valve
implantation (TAVI) has not been well studied. Method(s): Data were
obtained from the POPular PAUSE TAVI trial (NCT04437303), a randomized
clinical trial comparing interruption versus continuation of oral
anticoagulation during TAVI. Items of the CHA2DS2VASc score were
registered at baseline. Patients were classified into three pre-defined
risk groups: CHA2DS2VASc score >= 7 (high risk); 5-6 (moderate risk), and
1-4 (low risk). Outcomes of interest were thromboembolic events (ischemic
stroke, transient ischemic attack, myocardial infarction or systemic
embolism); cerebrovascular events (ischemic stroke or transient ischemic
attack); and major bleeding (type 2-4), defined according to the Valve
Academic Research Consortium-3 criteria. Result(s): A total of 818
patients were included: 63 (7.7%) with a high, 318 (38.9%) with a
moderate, and 437 (53.3%) with a low CHA2DS2VASc score. The incidence of
thromboembolic events was 9.5% in the high risk group, 8.5% in the
moderate risk group, and 8.7% in the low risk group. Incidences of
cerebrovascular events were 6.3%, 6.3%, and 6.4% across the risk groups,
respectively. Major bleeding occurred in 12.7% in the high risk group, in
10.1% in the moderate risk group, and in 9.4% in the low risk group. There
was no significant interaction between the randomized strategy and
CHA2DS2VASc score for the occurrence of thromboembolic events, either when
the CHA2DS2VASc score was modeled as a three-group ordinal variable
(p=0.28) or as a continuous variable (p=0.65). Conclusion(s): Among
patients with AF undergoing TAVI, the CHA2DS2VASc score did not identify
subgroups of patients at higher risk for thromboembolic events.
Additionally, no effect modification was observed regarding continuation
of oral anticoagulation during TAVI in patients with higher CHA2DS2VASc
scores. Considering the outcomes from the main trial, we generally
recommend interrupting oral anticoagulation during TAVI and found no
evidence to support individualizing anticoagulation management based on
the CHA2DS2VASc score.

<86>
Accession Number
649657692
Title
Clinical validation of a point of care whole blood high sensitive cardiac
troponin I assay: a prospective real time study on 3306 consecutive
presentations with suspected acute coronary syndrome.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Khand A.; Dakshi A.; Shaw M.; Phillips S.; Bailey L.; Davies S.; Collinson
P.O.; Fisher M.; Miller G.; Meah N.; Hatherley J.
Institution
(Khand, Dakshi, Phillips, Bailey, Davies, Miller, Meah, Hatherley)
Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
(Shaw) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Collinson) St George's University Hospital NHS Foundation Trust, London,
United Kingdom
(Fisher) Liverpool Centre for Cardiovascular Science, Liverpool, United
Kingdom
Publisher
Oxford University Press
Abstract
Introduction: A point of care (POC) high sensitive cardiac troponin
(hs-cTn) can improve early discharge and rule-in for suspected acute
coronary syndrome (ACS) but large-scale prospective studies assessing
clinical performance of whole blood POC troponin in the emergency
department (ED) are lacking. Method(s): This was a preplanned nested
cohort study of the MACROS trial, a randomised controlled study of the ESC
0-1 versus 0-3 hour pathway for suspected ACS. As well as central
laboratory hs-cTn sampling all patients had real time whole blood (WB)
sampling for Quidel TriageTrue POC hs-cTn I by non-laboratory operators at
presentation and at 1 or 3 hours according to randomisation. The hs-cTn T
(Roche, elecsys) biomarker was used for all clinical decisions. Subsequent
event adjudication was undertaken in a blinded fashion using Abbott
allinity hs-cTn I. The performance of the POC hs-cTn I assays was assessed
using prespecified, and previously published criteria for single sample
rule-out (SSRO) and the ESC 0-1 hour and 0-3 hour pathway. The clinical
endpoints were by adjudicated type 1 or 2 MI (4th universal definition)
and major adverse cardiac events (MACE), defined as adjudicated type 1 MI,
cardiovascular death and urgent coronary revascularisation at 30 days.
 Result(s): 3306 presentations in 3163 patients recruited from 2 large
EDs in North England form the study population. The mean age was 59 years,
1755 (53.4%) were male, 206 (6.2%) an index type 1 MI and 237 (7.2%) had a
MACE within 30 days. The median time, from blood sampling to result, for
Quidel TriageTrue POC hs-cTn I and central laboratory hs-cTnT was 29 and
79 minutes respectively. Safety for SSRO, both for index MI and MACE at 30
days, for TriageTrue POC hs-cTn I (table) was equivalent to central
laboratory troponins but the clinical efficiency (% cohort rule-out) was
greater. Performance of triage true POC hs-cTn I in both the ESC 0-1 and
0-3 hour pathway was impressive, demonstrating rule-out of >60% and
rule-in of approximately 10% with safety parameters similar to central
laboratory hs-cTnT. The figure illustrates classification and performance
metrics for MACE at 30 days in the 0-1 hour pathway Conclusion(s):
This is the first large prospective multicentre study that comprehensively
determines clinical performance of POC hs-cTn I assay, when analysed in
real time in ED. Triagetrue POC hs-cTn I has equivalent clinical
performance to central laboratory hs-cTns but with a much faster
turn-around time.

<87>
Accession Number
649655341
Title
Sex-based differences in outcomes of transcatheter aortic valve
replacement: a meta-analysis and meta-regression of 657,850 patients.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Benhammou M.; Al Othman A.; Zreigh S.; Al-Allawee A.S.; Guerguer W.;
Dervis M.; Haidarah A.; Almzainy S.; Shawesh Q.E.; Khalid S.; Vall Nounou
M.; Elmezayen R.W.; Alzubi M.; Abuajamieh M.; Elhadi M.
Institution
(Benhammou) University of Oran 1 Ahmed Ben Bella, Faculty of medicine,
Oran, Algeria
(Al Othman) Near East University, Faculty of Medicine, Nicosia, Cyprus
(Zreigh, Dervis) Ankara Yildirim Beyazit University, Faculty of Medicine,
Ankara, Turkey
(Al-Allawee) University of Fallujah, Faculty of Medicine, Fallujah, Iraq
(Guerguer) University of Algiers 1 Algeria, Faculty of medicine, Algiers,
Algeria
(Haidarah) Sichuan University, Department of Cardiology, West China
Hospital, Sichuan, China
(Almzainy, Shawesh) University of Tripoli, Faculty of Medicine, Tripoli,
Libyan Arab Jamahiriya
(Khalid) Benghazi university, Faculty of medicine, Benghazi, Libyan Arab
Jamahiriya
(Vall Nounou) University of Nouakchott Al Aasrya, Faculty of medicine,
Nouakchott, Mauritania
(Elmezayen) Kafrelsheikh University, Kafr El Sheikh, Egypt
(Alzubi) Hashemite University, Faculty of Medicine, Zarqa, Jordan
(Abuajamieh) Cairo University, Faculty of Medicine, Cairo, Egypt
(Elhadi) Korea University, College of Medicine, Seoul, South Korea
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an effective
treatment for symptomatic aortic stenosis (AS). Sex-based morphological
and physiological differences may influence TAVR outcomes. These
differences and variations in baseline characteristics may impact outcomes
after TAVR between the sexes. Purpose(s): This meta-analysis aimed to
compare sex-related outcomes in over half a million patients undergoing
TAVR and assess the influence of baseline characteristics via
meta-regression analysis. Result(s): The meta-analysis included 58
studies with 657,850 patients (351,927 males; 305,923 females). Females
were older (81.3 vs. 80.2 years; p <0.01) with better LVEF%, while males
had more comorbidities. Meta-analysis of primary outcomes showed that
females had higher in-hospital mortality (RR 1.16, 95% CI 1.02-1.32; p =
0.02, I2 = 76%) but lower 1-year mortality (RR 0.87, 95% CI
0.82-0.93; p < 0.01, I2 = 44%). No sex differences were
observed in 30-day mortality (RR 1.02, 95% CI 0.95-1.10; p = 0.52,
I2 = 5%) or cardiovascular mortality at 30 days (RR 1.04, 95%
CI 0.92-1.18; p = 0.56, I2 = 0%) and 1 year (RR 1.09, 95% CI
0.92-1.29; p = 0.31, I2 = 26%). Meta-regression identified
confounders (e.g., age, hypertension,heart failure with New Work Heart
Association (NYHA) III/IV, prior stroke, prior atrial fibrillation, Prior
percutaneous coronary intervention, prior pacemaker and valve type)
explaining heterogeneity in in-hospital mortality. Females had higher
risks of major bleeding (RR 1.28, 95% CI 1.16-1.41; p < 0.01,
I2 = 79%), vascular complications (RR 1.42, 95% CI 1.25-1.62; p
< 0.01, I2 = 69%), and stroke (in-hospital: RR 1.25, 95% CI
1.15-1.37; p < 0.01, I2 = 40%; 30-day: RR 1.24, 95% CI
1.07-1.44; p < 0.01, I2 = 0%). Conversely, acute kidney injury
(AKI) was less frequent in females (RR 0.91, 95% CI 0.86-0.97; p < 0.01,
I2 = 54%). Conclusion(s): Our meta-analysis, the largest
and most comprehensive of its kind, reveals that females face higher
short-term risks (in-hospital mortality, stroke, bleeding, vascular
complications), while males have higher 1-year mortality and AKI. Despite
lower 1-year mortality, females show no difference in 1-year
cardiovascular mortality, suggesting their survival advantage may reflect
longer life expectancy rather than TAVR effects. Peri-procedural care for
females should be enhanced, and sex-specific TAVR treatment guidelines are
needed.

<88>
Accession Number
649657773
Title
Long-term outcomes of treatment strategies for ischemic cardiomyopathy, a
network meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Perez Camargo D.; Travieso A.; Goirigolzarri J.; Montero Cruces L.;
Carnero Alcazar M.; Cobiella Carnicer J.; Campelos Fernandez P.; Reguillo
Lacruz F.; Nunez Gil I.; Maroto Castellanos L.
Institution
(Perez Camargo, Montero Cruces, Carnero Alcazar, Cobiella Carnicer,
Campelos Fernandez, Reguillo Lacruz, Maroto Castellanos) Hospital Clinico
San Carlos, Cardiac Surgery Department, Madrid, Spain
(Travieso, Goirigolzarri) Hospital Clinico San Carlos, Cardiology
Department, Madrid, Spain
(Nunez Gil) UNIVERSITY HOSPITAL OF TORREJON, Cardiology Department,
Torrejon de Ardoz, Spain
Publisher
Oxford University Press
Abstract
Introduction: Ischemic heart disease is the leading cause of heart failure
(HF), with a poor prognosis despite advances in pharmacological and
interventional therapies. Current guidelines assign Class IIa and IIb
recommendations to coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI) in ischemic cardiomyopathy, respectively,
reflecting the limited evidence available and an ongoing knowledge gap
regarding the optimal treatment strategy. Purpose(s): This study
compares long-term outcomes of medical therapy (MT), PCI and CABG in
ischemic cardiomyopathy using a network meta-analysis. Method(s): A
systematic search of the Cochrane Library, EMBASE and MEDLINE was
conducted for English-language studies published from January 2000 to
February 2025. Eligible studies compared MT, PCI and CABG in ischemic
cardiomyopathy. Data were analyzed using a frequentist network
meta-analysis with a multivariate random-effects model. The primary
endpoint was all-cause mortality, while secondary endpoints included
myocardial infarction (MI), any revascularization, HF hospitalization and
stroke. Outcomes were assessed at the longest available follow-up.
 Result(s): Thirty studies (4 randomized controlled trials and 26
adjusted observational studies) met inclusion criteria, comprising 4809
patients in the MT group, 18034 in the PCI group, and 20739 in the CABG
group. The median follow-up was 60 months (IQR: 36-120). Median age was
62.5 years (62-66.8) for MT, 66 years (65-68.8) for PCI, and 65 years
(63-65.8) for CABG. 34.5% (29.8-58.8) of MT, 36% (20.8-43.3) of PCI and
48% (36.5-56) of CABG presented NYHA Class III-IV. Median left ventricular
ejection fraction was 27% (26-30) for MT, 29.5% (26.8- 37.7) for PCI and
29.5% (26.8- 33.8) for CABG. Left main disease was present in 14% (4-33.5)
of MT, 17% (13-29) of PCI, and 30% of CABG (19-44), while three- vessel
disease was found in 51% (39-59) of MT, 51% (41.5-59) of PCI and 62%
(47.8-72.8) CABG patients. Complete revascularization was achieved in 45%
(24.5-55) of PCI patients and 84% (68-92) of CABG patients. MT and PCI
were associated with a higher risk of all-cause mortality compared to
CABG. Additionally, both MT and PCI were linked with an increased risk of
MI and revascularization, while PCI was associated to a higher risk of HF
hospitalization compared to CABG. No significant differences were observed
in stroke among the treatment groups. Findings remained consistent in an
analysis restricted to studies published between 2010- 2025.
 Conclusion(s): In this network meta-analysis, CABG was associated
with a lower risk of all-cause mortality compared to MT and PCI, along
with a reduced risk of MI, revascularization and HF hospitalization. No
significant differences in stroke incidence were observed. While these
findings suggest potential benefits of CABG in ischemic cardiomyopathy,
further randomized trials are needed to confirm the optimal treatment
strategy and guide clinical decision-making.

<89>
Accession Number
649654537
Title
Sex differences in bleeding and ischemic outcomes after TAVI in patients
on oral anticoagulants: a POPULAR PAUSE TAVI sub-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Van Bergeijk K.; Overduin D.C.; Venema C.S.; Van Ginkel D.J.; Bor W.L.;
Van Der Werf H.W.; Van Den Heuvel A.F.M.; Voors A.A.; Wykrzykowska J.J.;
Ten Berg J.M.
Institution
(Van Bergeijk, Venema, Van Der Werf, Van Den Heuvel, Wykrzykowska)
University Medical Center Groningen, Groningen, Netherlands
(Overduin, Van Ginkel, Bor, Ten Berg) St Antonius Hospital, Nieuwegein,
Netherlands
(Voors) University Medical Centre Groningen, Groningen, Netherlands
Publisher
Oxford University Press
Abstract
Purpose: In this sub-analysis of the POPular PAUSE TAVI trial, we aim to
study sex differences in bleeding and ischemic outcomes after
transcatheter aortic valve implantation (TAVI) depending on the oral
anticoagulation (OAC, Vitamin K antagonist (VKA) and Direct OAC (DOAC))
regiments used. Method(s): The POPular PAUSE TAVI was a randomized
clinical trial to compare outcomes between patients that continued or
interrupted OAC during TAVI. The outcomes of interest in this sub-analysis
were a combination of cardiovascular mortality, stroke, myocardial
infarction, major vascular complications or major bleeding (VARC-3, type
2,3,4) at 30 days stratified by type of OAC regimen (DOAC or VKA) and sex.
 Result(s): In total, 296 women (35%) (mean age 81.6) and 562 men
(65%, mean age 80.1) were included in this study. After 30 days follow-up,
44 (14.9%) women reached the combined endpoint, comparable to men (90,
(16%), p=0.732). Overall, rate of stroke (10 in women (3.4%) versus 23 in
men (4.1%), p=0.741), major vascular complications (26 (8.8%) vs. 51
(9.1%), p=0.987) and major bleeding (26 (8.8%) vs. 60 (10.7%) p=0.449)
were also similar. There was, however, a numerically higher combined event
rate in women using VKA compared to DOAC, while this was the opposite for
men. This was mainly driven by major bleedings (18 events (7.6%) in women
on DOAC vs. 8 in women on VKA (13.3%). Conversely, 53 (11.3%) men on DOAC
and 7 men on VKA (7.4%), experienced major bleedings, albeit event numbers
were low. The interaction between sex and type of OAC for the combined
endpoint was statistically significant (p=0.090), even after correcting
for OAC indication randomization, BMI, small femoral artery size,
calcified femoral artery and tortuosity. Conclusion(s): During 30-day
follow-up after TAVI in patients on OAC, outcomes were comparable between
sexes. There was, however, a higher number of events in women treated with
VKA and an interaction between sex and type of OAC was statistically
significant. These exploratory findings need further confirmation in
larger patient populations.

<90>
Accession Number
649657255
Title
Self-care interventions in valvular heart disease improve important
patient outcomes: results from a systematic review.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Dollaku H.; Buccione E.; Rollo R.; Giuliano M.; Ferri N.; Grifoni C.;
Zipoli R.; Fabbri V.; Iovino P.; Vellone E.; Magi C.E.
Institution
(Dollaku, Rollo, Giuliano, Grifoni, Zipoli, Fabbri) Don Carlo Gnocchi -
Onlus Foundation, Florence, Italy
(Buccione) Spirito Santo Pescara Hospital, Pescara, Italy
(Ferri, Vellone) University of Rome Tor Vergata, Department of Biomedicine
and Prevention, Rome, Italy
(Iovino, Magi) University of Florence, Health Sciences Department,
Florence, Italy
Publisher
Oxford University Press
Abstract
Background: Valvular heart disease (VHD) is a growing global health
concern, with rising prevalence in aging populations. Surgical valve
replacement remains the primary treatment of VHD, requiring effective
self-care to optimize outcomes and prevent complications (e.g.,
thromboembolism, prosthetic valve dysfunction, hospital readmissions).
Despite self-care's critical role, its impact on post-surgical recovery in
patients with VHD remains insufficiently explored. Purpose(s): This
systematic review assesses the effectiveness of educational interventions
in improving self-care behaviors and clinical outcomes in heart valve
surgery patients, while mapping intervention types and characteristics.
 Method(s): Following PRISMA guidelines, we conducted a comprehensive
search in PubMed, Scopus, Web of Science, and CINAHL for randomized
controlled trials (RCTs) evaluating self-care educational interventions in
post-valve surgery patients. Inclusion criteria focused on interventions
targeting self-care maintenance (i.e., behaviors to maintain VHD
stability), self-care monitoring (i.e., tracking signs and symptoms of
exacerbations), and self-care management (i.e., responses to symptoms),
based on the Middle-Range Theory of Self-Care. Result(s): We selected
15 RCTs involving 9,110 patients (mean age: 57.9 years, SD=5.6; 53% male),
mostly targeting mechanical heart valve patients. All educational
interventions were face-to-face (n=15, 100%), with some incorporating
technology-based and telephone support (n=3, 20%). Behavioral techniques
included goal setting (n=12, 80%) and problem-solving (n=5, 33%).
Self-care interventions improved anticoagulation, reducing thromboembolic
(n=5, 33%) and hemorrhagic complications (n=7, 47%), and increasing INR
stability (n=11, 73%). Interventions targeted self-care maintenance (e.g.,
physical activities, diet, lifestyle, psychosocial aspects; n=3, 20%),
self-care monitoring (e.g., INR self-testing, physical activity, vital
signs, diet; n=15, 100%), and self-care management (e.g., medication
adjustments, dietary changes, symptom control; n=15, 100%). Additional
improvements were seen in quality of life (n=6, 40%), pain (n=1, 7%),
mental health (n=2, 13%), self-efficacy (n=4, 27%), and therapy adherence
(n=4, 27%). Conclusion(s): Evidence suggests educational
interventions enhance self-care behaviors and clinical outcomes in VHD
patients' post-surgery. However, effectiveness varies due to differences
in design, delivery, and patient engagement. Future research should
optimize self-care strategies via personalized, tech-assisted
interventions for long-term behaviors and better outcomes.

<91>
Accession Number
649655540
Title
The impact of residual cholesterol and inflammation risks on acute kidney
injury after coronary artery bypass grafting: a large-scale cohort study.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Chen R.; Lin S.; Sun R.; Su X.; Zheng Z.
Institution
(Chen, Lin, Sun, Su, Zheng) State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular D, Beijing,
China
Publisher
Oxford University Press
Abstract
Background: Acute kidney injury (AKI) is a common complication after
coronary artery bypass grafting (CABG), and is associated with increased
mortality. Randomized controlled trials demonstrated that residual
cholesterol and inflammation risks remained in patients with
cardiovascular disease. However, few studies have investigated the impact
of residual risk profiles on AKI in patients after CABG. Purpose(s):
This study aims to assess the impact of residual risk profiles on
postoperative AKI and long-term mortality in patients undergoing CABG,
while also investigating their potential role in guiding personalized
perioperative statin therapy decisions. Method(s): A total of 35,788
consecutive patients undergoing CABG were enrolled between 1 January, 2013
and 1 October, 2022. Participants were categorized into four groups based
on the levels of remnant cholesterol and hypersensitive C-reactive
protein: no residual risk, residual inflammatory risk (RIR), residual
cholesterol risk (RCR), and combined residual cholesterol and inflammatory
risk (RCIR). The study outcomes included postoperative AKI, as defined by
the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and 5-year
mortality. Logistic regression and Cox proportional hazard models were
used to evaluate the association between residual risk profiles and
adverse outcomes. Additional analyses investigated the heterogeneity in
the effects of statin treatment on severe AKI across residual risk
profiles. Result(s): Compared to patients with no residual risk,
those with RIR exhibited an increased risk of developing AKI after
multiple adjustments. Specifically, RIR was associated with a 14% higher
risk of any AKI (OR: 1.14, 95% CI: 1.08-1.21) and a 61% increased risk for
severe AKI (KDIGO stages 2/3) (OR: 1.61, 95% CI: 1.41-1.84). In contrast,
RCR was significantly related to severe AKI only in patients with diabetes
(OR: 1.39, 95% CI: 1.04-1.83). Moreover, the combination of both residual
risks further exacerbated the risk of severe AKI (OR: 1.77, 95% CI:
1.38-2.23), with diabetic patients experiencing a higher risk (OR: 1.90,
95% CI: 1.38-2.56) compared to non-diabetic patients (OR: 1.58, 95% CI:
1.06-2.28). Regarding therapeutic implications, perioperative statin
therapy increased the risk of severe AKI in patients with no residual risk
(OR: 1.27, 95% CI: 1.04-1.53), but conferred significant protection
against AKI in those with RCR (OR: 0.58, 95% CI: 0.34-0.96). For long-term
outcomes, patients with RIR exhibited a 34% higher 5-year mortality risk
(HR 1.34, 95% CI 1.19-1.52). Conclusion(s): Residual inflammation
significantly increased the risk of postoperative AKI and long-term
mortality after CABG, whereas residual cholesterol was associated with
severe AKI only in diabetic patients. The combination of both residual
risks exhibited a more pronounced effect on severe AKI. Residual risk
profiles may guide personalized statin use to improve kidney outcomes
after CABG.

<92>
Accession Number
649655571
Title
Low femoral artery puncture for transfemoral TAVR.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Jeyalan V.; Hesse K.; Gilbert G.; Austin D.; Telyuk P.; Vijayan S.; Muir
D.; Williams P.
Institution
(Jeyalan, Hesse, Muir, Williams) James Cook University Hospital,
Middlesbrough, United Kingdom
(Gilbert, Austin, Telyuk, Vijayan) James Cook University Hospital,
Middlesbrough, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Access site complications remain common during transfemoral
transcatheter aortic valve replacement (TAVR). Femoral arterial access is
conventionally performed at the level of the mid-femoral head. Anatomical
studies have suggested that a low puncture height below the mid-femoral
height may be optimal but there is little clinical evidence on the safety
of this approach. Objective(s): We evaluated vascular and bleeding
complications following intended low femoral arterial puncture compared to
intended conventional height puncture for patients undergoing transfemoral
TAVR. Method(s): Patients undergoing percutaneous transfemoral TAVR
between 2014 and 2022 at a tertiary cardiothoracic centre in the North
East of England were included. Procedures with intended conventional
mid-femoral puncture were compared with procedures with intended
low-femoral puncture. Femoral angiograms were analysed for sheath
insertion height and anatomical landmarks. The primary endpoint was a
composite of in-hospital death, major vascular access-related
complications, major/life-threatening bleeding, and unplanned endovascular
intervention. Secondary endpoints include individual components of the
primary endpoint and rates of minor vascular access-related complications,
minor bleeding, myocardial infarction, stroke or TIA, acute kidney injury,
and post-procedure pacemaker implantation. Bleeding and vascular
complications were defined by the Valve Academic Research Consortium-2
criteria. Result(s): Out of 917 transfemoral TAVR procedures, there
were 509 patients in the intended low puncture group and 408 patients in
the intended conventional puncture group. Optimal puncture was achieved
more frequently in the low puncture group than in the conventional
puncture group (95.7% vs 65.1%; p < 0.001). Suboptimal high puncture
occurred more frequently in the conventional puncture group (34.9% vs
4.3%; p< 0.001). The composite endpoint occurred in 8/509 patients (1.6%),
who underwent TAVR with a low femoral puncture target strategy in
comparison to 19/407 patients (4.7%), who underwent TAVR with a
conventional femoral puncture target strategy. A low puncture strategy
resulted in statistically lower rates of unplanned vascular intervention
(2.5% vs 0.4% p = 0.008). There were no safety issues identified with low
femoral artery puncture. Conclusion(s): Low femoral puncture for
transfemoral arterial access during TAVR is safe, leads to a higher rate
of optimal puncture height, and is associated with lower rates of
access-related major vascular complications, bleeding and unplanned
vascular intervention compared to conventional height puncture. Low
femoral puncture may be the preferred access height for transfemoral TAVR.

<93>
Accession Number
649654969
Title
Prognostic significance of concomitant transthyretin cardiac amyloidosis
and severe aortic stenosis: insights from a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Zaka A.; Mutahar D.
Institution
(Zaka, Mutahar) Gold Coast Hospital And Health Service, Gold Coast,
Australia
Publisher
Oxford University Press
Abstract
Background: Severe aortic stenosis (AS) and cardiac amyloidosis (CA)
frequently coexist in elderly populations. The prognostic significance of
dual pathology CA-AS in the context of transcatheter aortic valve
implantation (TAVI) is not widely established. We performed a systematic
review and meta-analysis to compare 1-year mortality of patients with
concomitant CA-AS to those with isolated AS. Background(s): PubMed,
EMBASE, Web of Science and Cochrane databases were searched until February
16th 2025 for all multivariable-adjusted or propensity-matched
observational studies evaluating clinical outcomes in CA-AS patients.
Summary odds ratios with 95% confidence intervals (CI) were calculated
using random-effects model, with pre-specified subgroup analyses for
patients undergoing TAVI. Result(s): Fifteen observational studies
(775319 severe AS patients) met inclusion criteria. The mean follow-up
duration was 22.4 months, mean age was 81.5 years and 56.3% were men. The
pooled odds ratio for all-cause mortality in CA-AS patients was 1.21 (95%
CI 0.81-1.80). There was no statistically significant difference in 1-year
all-cause mortality between CA-AS and isolated AS (OR 1.38, 95% CI
0.80-2.37) or between CA-AS patients undergoing TAVI compared to medical
management (OR 0.94, 95% CI 0.56-1.58). Conclusion(s): The presence
of concomitant CA does not significantly impact the 1-year all-cause
mortality of patients with severe AS undergoing TAVI.

<94>
Accession Number
649654843
Title
Does obesity impact outcomes in TAVI? A systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Dexheimer Da Silva L.; Cadorin L.; Ribeiro F.; Sousa P.A.; S Spina G.
Institution
(Dexheimer Da Silva, Cadorin, Ribeiro, Sousa) Sao Paulo University Medical
School, Sao Paulo, Brazil
(S Spina) Heart Institute of the University of Sao Paulo (InCor), Sao
Paulo, Brazil
Publisher
Oxford University Press
Abstract
Background: Obesity has been associated with a paradoxical survival
benefit in certain cardiovascular conditions, a phenomenon known as the
"obesity paradox." However, its impact on outcomes following transcatheter
aortic valve implantation (TAVI) remains unclear. Method(s): A
systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane,
LILACS, and Google Scholar. We included studies published between 2018 and
2024 that compared obese (BMI >= 30) and non-obese (BMI 18.5-25) patients
undergoing TAVI. The primary outcome was one-year all-cause mortality,
while secondary outcomes included stroke and bleeding complications.
 Result(s): After a systematic review of 13 studies, comprising 38962
patients, it was possible to look over the prospect of the "obesity
paradox" in TAVI. The findings challenge the assumption that obesity
offers a protective effect, as most studies reported lower mortality and
bleeding rates in obese patients. However, this "protective"
interpretation has limitations, given that BMI doesn't differentiate
between fat and muscle mass leading to big misclassifications. Notably,
studies focusing on severely obese individuals showed worse outcomes,
suggesting that excess adiposity may still be harmful. In this same way,
the meta-analysis revealed no significant difference in all-cause
mortality (OR 0.84, 95% CI 0.48-1.46, p = 0.543), a non-significant
increase in stroke risk (OR 1.14, 95% CI 0.91-1.43, p = 0.239), and a
non-significant lower bleeding risk (OR 1.07, 95% CI 0.48-2.40, p =
0.863). Sensitivity analyses supported the robustness of these findings.
 Conclusion(s): This systematic review and meta-analysis suggest that
obesity does not confer a survival benefit in TAVI. While mild obesity is
not associated with increased mortality, severe obesity may be linked to
worse outcomes. Further standardized studies are needed to clarify the
true impact of BMI on TAVI outcomes.

<95>
Accession Number
649653961
Title
Planning of transcatheter aortic valve implantation using computed
tomography and virtual reality - a prospective, randomized controlled
trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Kanschik D.; Steinhoff D.; Klein K.; Lichtenberg A.; Ballazs C.; Stadnik
D.; Scherner M.; Antoch G.; Kelm M.; Zeus T.; Jung C.
Institution
(Kanschik, Steinhoff, Klein, Lichtenberg, Ballazs, Stadnik, Scherner,
Antoch, Kelm, Zeus, Jung) University Hospital Duesseldorf, Duesseldorf,
Germany
Publisher
Oxford University Press
Abstract
Background: Successful transcatheter aortic valve implantation (TAVI)
requires precise preprocedural planning and is essential for patient
safety and valve longevity. Three-dimensional (3D) imaging plays a crucial
role in this. Virtual reality (VR) can optimize the planning of
interventions through the detailed visualization of cardiac, extracardiac
and vascular structures. Purpose(s): The study investigated whether
the inclusion of VR in preprocedural planning, which is currently
performed using multi-slice computed tomography (MSCT), can improve the
understanding of individual patient anatomy and optimize the performance
of interventions. Method(s): This randomized, prospective, controlled
study included 140 patients who underwent TAVI or valve-in-valve TAVI at
our hospital. In the control arm, preprocedural visualizations and
measurements were performed based on MSCT data using the 3mensio software
(3mensio Structural HeartTM, Pie Medical Imaging BV, Maastricht,
Netherlands). In the intervention group, planning was performed additively
using VR software (Medicalholodeck, Zurich, Switzerland). In addition, the
interventionalists used a structured questionnaire to evaluate numerous
aspects of preprocedural TAVI planning with 3mensio and the VR software.
 Result(s): The evaluation did not reveal any relevant differences in
patient characteristics. In terms of visualization of anatomy,
understanding of 3D relationships between structures, and assessment of
access routes, VR was superior to 3mensio software, especially in terms of
depth perception, visualization of atherosclerotic plaques at access
sites, and iliofemoral tortuosity (237 individual assessments by
cardiologists and cardiac surgeons). Both methods were found to be useful
and helpful in preparing for the procedure. There were no significant
differences in procedural data between the two groups. However, the VR
group had a lower rate of bleeding at the access site (p<0.05). There was
no significant difference in the length of hospital stay and
post-procedural transthoracic echocardiography data evaluations.
 Conclusion(s): The data show that virtual reality visualization can
optimize preparation for the procedure by improving the 3D understanding
of the aortic valve and adjacent structures. The detailed visualization of
the access routes can lead to a reduction in periprocedural complications.

<96>
Accession Number
649655371
Title
A novel strategy for reducing time between antiplatelet drug cessation and
urgent CABG surgery following acute coronary syndromes.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Faizur Rahman M.E.; Parker W.A.E.; Sammut M.A.; Dirir O.; Elamin N.;
Mcmellon H.C.; Judge H.M.; Hunter S.; Storey R.F.
Institution
(Faizur Rahman, Parker, Sammut, Dirir, Elamin, Mcmellon, Judge, Storey)
University of Sheffield, Division of Clinical Medicine, Sheffield, United
Kingdom
(Hunter) Sheffield Teaching Hospitals NHS Foundation Trust, South
Yorkshire Cardiothoracic Centre, Sheffield, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Patients with acute coronary syndromes (ACS) who have received
dual antiplatelet therapy with aspirin and ticagrelor prior to coronary
angiography and subsequently require urgent coronary artery bypass graft
(CABG) surgery may face delays to surgery and potential risk associated
with cessation of ticagrelor for 3 days or more. Haemoadsorption with the
CytoSorb device during cardiopulmonary bypass (CPB) is a potential means
of removing ticagrelor and might reduce time delays and associated risk.
 Purpose(s): To assess whether a novel strategy incorporating the
CytoSorb device allows a shorter window between antiplatelet drug
cessation and CABG surgery. Method(s): ACS patients treated with
aspirin and ticagrelor who were referred for urgent CABG surgery were
randomized to 2 groups: (A) cessation of aspirin and ticagrelor 2 days
prior to surgery and use of the CytoSorb device during CPB; (B) local
standard of care with continuation of aspirin and cessation of ticagrelor
at least 5 days prior to surgery. Platelet function and skin bleeding time
were assessed immediately prior to surgery and after completion of CPB.
Chest tube drainage (CTD) and bleeding events according to Universal
Definition of Perioperative Bleeding (UDPB) criteria were recorded. The
primary outcome was platelet aggregation induced by collagen 4 ug/mL,
assessed by light transmittance aggregometry (LTA) post-CPB; the
difference between the means was assessed with a one-tailed unpaired t
test with a non-inferiority margin of -21.5% for the lower 95% confidence
limit. Result(s): 30 patients were randomized and completed surgery
(n=15 each group). There were no significant differences in participant
characteristics and EuroScore II between the two groups. Maximum mean (+/-
SD) LTA response to collagen following CPB was 48% (+/-22%) in group A and
51% (+/-24%) in group B (P=0.38), which met the non-inferiority criterion
for the experimental approach (Figure 1). Platelet P2Y12 inhibition and
serum thromboxane B2 levels post-CPB were both significantly higher in
group A compared to group B; bleeding time and 24-hour CTD were not
significantly different between the groups (Figure 2). 7 patients in each
group had UDPB class 2 or 3 bleeding and none had UDPB class 4 bleeding.
 Conclusion(s): Stopping ticagrelor and aspirin 2 days before urgent
CABG surgery and using the CytoSorb device during CPB was non-inferior in
its effect on collagen-induced platelet aggregation after CPB and was
associated with similar haemostasis compared with cessation of ticagrelor
5 days before surgery and continuation of aspirin.

<97>
Accession Number
649657344
Title
A systematic-scoping review on sex-based differences in type-2 myocardial
infarction (T2MI).
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Lalani S.; Yordanova M.; D'angelo M.; Bottega N.
Institution
(Lalani, Yordanova, D'angelo) Mcgill University, Montreal, Canada
(Bottega) Mcgill University, Department of Cardiology, Montreal, Canada
Publisher
Oxford University Press
Abstract
Background: Worldwide, cardiovascular disease remains a primary cause of
death, with notable differences between sexes. While sex differences in
Type 1 myocardial infarction (T1MI) are well recognized, those in Type 2
myocardial infarction (T2MI) are less understood and may influence
clinical practice and provide valuable prognostic insights.
 Purpose(s): We aimed to provide a comprehensive overview of sex-based
differences in incidence, comorbidities, clinical management, and outcomes
of T2MI. Method(s): A systematic-scoping review of retrospective and
prospective studies examining the differences in T2MI by sex was conducted
by three-independent reviewers. Six databases were included in the search
strategy (Web of Science, OVID, SCOPUS, EMBASE, CINAHL, PUBMED), and were
last searched on November 29, 2024. Pooled odds ratios (OR) with 95%
confidence interval (CI) of T2MI gender differences were calculated using
aggregated meta-analyses in Stata. Result(s): The search strategy
resulted in 1388 articles and 28 studies were included after the full-text
screening (Figure 1). Thirteen of these were included in the meta-analysis
on the likelihood of T2MI by gender, with 3,292,727 participants in total
(618,535 T2MI, of which 47.5% were female). Meta-analysis displayed that
men were significantly less likely than women to have T2MI (OR 0.69; 95%
CI, 0.63-0.74; P<0.001) (Figure 2). Women with T2MI were generally older
and had a higher prevalence of hypertension than men (n=5). While some
studies found higher diabetes rates in men (n=2), others reported a
greater history of prior PCI or CABG in this group (n=4). Coronary artery
disease (CAD) was less frequently observed on angiography in women (n=3)
compared to men. Mortality, both short- and long-term, was higher in men
(n=4), though one study contradicted this finding (n=1). Although data on
treatment differences were limited, some evidence suggested greater ASA
use in men (n=2). Conclusion(s): This is the first comprehensive
overview of sex-based differences in T2MI. Our study demonstrated that
T2MIs are more prevalent in females, highlighting key differences among
genders. In sum, data is limited, and further research is needed on
gender-specific factors in T2MI to improve diagnosis, management, and
mortality rates.

<98>
Accession Number
649657004
Title
Clinical predictors of major adverse cardiovascular events in patients
with left ventricular assist devices: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Wilson D.; Mubashir M.; Khanna S.; Bhat A.; Ying V.; Ghelani D.
Institution
(Wilson, Mubashir, Khanna, Bhat, Ying, Ghelani) Blacktown Hospital,
Blacktown, Australia
Publisher
Oxford University Press
Abstract
Background: Durable left ventricular assist devices (LVAD) are a vital
therapeutic modality in the setting of refractory advanced heart (HF) and
limited availability of cardiac transplantation. Major adverse
cardiovascular events (MACE) post LVAD implantation are complications
associated with increased morbidity and mortality thereby resulting in
longer hospital admissions. The aim of our systematic review and
meta-analysis was to evaluate pre-implantation clinical, biochemical and
device-specific factors that were associated with MACE, including
ventricular arrhythmias, right heart failure, stroke and need for ischemic
revascularisation, in patients post-LVAD implantation. Methodology: A
comprehensive literature search of medical databases (PubMed, Cochrane,
Medline, Embase, BMJ) and grey literature was conducted. Studies were
included if they reported MACE and other pre-implantation clinical,
biochemical and device-specific parameters in patients post durable LVAD
insertion (2000-2025; English Only). Data for all variables were extracted
and those with low heterogeneity were then meta-analysed using a
random-effect model for odds ratios (OR) or standardised mean differences
(SMD). Result(s): Out of a total of 1710 studies that were screened,
48 peer-reviewed articles fulfilled criteria for inclusion. A total of
9532 patients were included in the meta-analysis, with 35 factors
assessed. Our meta-analysis identified that predictors of MACE in patients
post-LVAD included clinical variables: intra-aortic balloon pump (OR
1.291, p=0.048), extracorporeal membrane oxygenation (OR 1.568, p=0.049),
ventilator support (OR 1.882, p=0.003), existing implantable
cardioverter-defibrillator (OR 1.518, p<0.001), use of anti-arrhythmic
drugs (OR 1.768, p<0.001), previous cerebrovascular accident (OR 1.648,
p=0.016), previous ventricular arrhythmia (OR 2.420, p<0.001); biochemical
variables: creatinine (SMD 0.250, p<0.001) and bilirubin (SMD 0.263,
p=0.007); device-specific variables: destination therapy (OR 1.176,
p=0.049). Conclusion(s): The findings of our meta-analysis highlight
several key prognostic pre-implantation factors that appear to be
associated with increased MACE post-LVAD implantation, which may be
utilised in clinical decision-making regarding patient eligibility,
suitability and prognosis for mechanical cardiac assist device therapy.

<99>
Accession Number
649656883
Title
Clinical outcomes with early discharge versus late discharge in
transcatheter aortic valve replacement: A meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Jain H.; Warsi T.; Passey S.; Oza J.; Naveed H.; Soni K.; Kelkar R.; Barve
N.; Ahmed R.; Deora S.
Institution
(Jain, Deora) All India Institute of Medical Sciences, Jodhpur, India
(Warsi) Derriford Hospital, Plymouth, United Kingdom
(Passey) University of Connecticut, Hartford, United States
(Oza) MacNeal Hospital, Berwyn, United States
(Naveed) Hca - Kingwood Medical Center, Kingwood, United States
(Soni) Sardar Patel Medical College, Bikaner, India
(Kelkar) Wentworth Douglass Hospital, Dover, United States
(Barve) Lowell General Hospital, Lowell, United States
(Ahmed) National Heart and Lung Institute Imperial College, London, United
Kingdom
Publisher
Oxford University Press
Abstract
Background: With the rise of TAVR, "minimalist" approaches are being
developed to provide early discharge after TAVR as a potentially viable
option. Early discharge (< 3 days) after TAVR reduces the length of
hospital stay, reduces hospitalization costs, and may mitigate the risk of
nosocomial infection. Purpose(s): This systematic review and
meta-analysis aimed to compare clinical outcomes with early versus late
discharge post-TAVR. Method(s): A systematic literature search on
PubMed, Embase, and the Cochrane Library was performed to retrieve
relevant studies. Pooled risk ratios (RR) with 95% CIs were calculated
using a random-effects model, with a p-value of <0.05 considered
statistically significant. Result(s): 13 studies with 1,42,564
patients undergoing TAVR (62,658: early discharge; 79,906: late discharge)
were included. Early discharge for patients post-TAVR was associated with
a statistically significant reduced risk of stroke [RR: 0.17; 95% CI:
0.11, 0.27; p<0.00001], vascular complications [RR: 0.28; 95% CI: 0.17,
0.45; p<0.00001], bleeding complications [RR: 0.43; 95% CI: 0.37, 0.50;
p<0.00001], and new permanent pacemaker implantation [RR: 0.37; 95% CI:
0.28, 0.49; p<0.00001] compared to patients with late discharge. The risks
of all-cause mortality [RR: 1.39; 95% CI: 0.62, 3.11] and readmission [RR:
0.75; 95% CI: 0.50, 1.13] were comparable between the two groups.
 Conclusion(s): Early discharge after TAVR is associated with lower
risks of stroke, readmission, vascular complications, and bleeding
complications than late discharge (> 3 days). This meta-analysis concludes
the safety of early discharge following TAVR.

<100>
Accession Number
649654932
Title
Relationship between baseline LDL cholesterol levels and cardiovascular
outcomes in adults with cardiovascular disease and overweight or obesity:
an exploratory analysis of the SELECT trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Shechter M.; Aroda V.R.; Hovingh G.K.; Lincoff A.M.; Lingvay I.; De Souza
Almeida Matos A.L.; Musinga D.; Ostrominski J.W.; Scirica B.M.; Weeke
P.E.; Plutzky J.
Institution
(Shechter) Leviev Cardiothoracic and Vascular Center, Sheba Medical
Center, Tel HaShomer, Israel
(Aroda) Division of Endocrinology,Diabetes and Hypertension, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Hovingh, De Souza Almeida Matos, Musinga, Weeke) Novo Nordisk A/S,
Soborg, Denmark
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic and
Cleveland Clinic Lerner College of Medicine of Case, Western Reserve
University, Cleveland, Ohio, United States
(Lingvay) Department of Internal Medicine/Endocrinology and Peter
O'Donnell Jr. School of Public Health, University of Texas, Southwestern
Medical Center, Dallas, TX, United States
(Ostrominski, Plutzky) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Scirica) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
Publisher
Oxford University Press
Abstract
Background: In the SELECT trial, semaglutide reduced the risk of major
adverse cardiovascular events (MACE) in patients with established
cardiovascular (CV) disease (CVD) and obesity without diabetes. The impact
of baseline low-density lipoprotein cholesterol (LDL-C) levels on the
effects of semaglutide in SELECT is yet to be explored. Purpose(s):
To evaluate whether the effect of semaglutide on MACE varies as a function
of baseline LDL-C levels in SELECT. Method(s): SELECT was a
double-blind, randomised, placebo-controlled trial that compared the
effect of once-weekly subcutaneous semaglutide 2.4 mg versus placebo in
patients aged >=45 years with established CVD and a body mass index (BMI)
of >=27 kg/m2 without diabetes. In this exploratory analysis,
the primary endpoint of time to first occurrence of a three-component MACE
(CV death, non-fatal myocardial infarction and non-fatal stroke) was
evaluated according to tertiles of LDL-C and non-high-density lipoprotein
cholesterol (non-HDL-C) at baseline. Data were analysed using a Cox
proportional hazards model with treatment (semaglutide, placebo), subgroup
and treatment-by-subgroup interaction as fixed factors. Result(s): Of
the 17,113 patients with LDL-C data available for this analysis, median
LDL-C tertiles were 54.4 mg/dL (Tertile 1, n=5692), 78.0 mg/ dL (Tertile
2, n=5685) and 116.2 mg/dL (Tertile 3, n=5736). Patients in Tertile 1 were
more often male, non-smokers and were more likely to have had coronary
revascularisation compared with patients in Tertiles 2 and 3. Patients in
Tertile 1 also exhibited the lowest median value for high-sensitivity
C-reactive protein. Additionally, patients in Tertiles 1 and 2 had lower
median triglyceride levels and a higher proportion were receiving
lipid-lowering therapies and statins compared with those in Tertile 3.
Over a mean follow-up of 39.8 months, semaglutide consistently reduced the
risk of MACE versus placebo, irrespective of baseline LDL-C tertile:
Tertile 1 (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.61,
0.95), Tertile 2 (HR 0.74, 95% CI 0.61, 0.90) and Tertile 3 (HR 0.87, 95%
CI 0.73, 1.04) (p for interaction=0.44) (Figure 1). Similar results were
observed when baseline LDL-C was evaluated as a continuous variable
(Figure 2A). Semaglutide also consistently reduced the risk of MACE versus
placebo, irrespective of baseline non-HDL-C tertiles: Tertile 1 (HR 0.75,
95% CI 0.61, 0.93), Tertile 2 (HR 0.78, 95% CI 0.64, 0.95) and Tertile 3
(HR 0.86, 95% CI 0.72, 1.02) (p for interaction=0.63) and when baseline
non-HDL-C was evaluated as a continuous variable (Figure 2B).
 Conclusion(s): Semaglutide treatment reduced the risk of MACE versus
placebo in patients with established CVD and a BMI of >=27
kg/m2 without diabetes, irrespective of baseline LDL-C and
non-HDL-C levels. These findings support the use of semaglutide to improve
CV outcomes in this high-risk population, across a broad spectrum of
LDL-C.

<101>
Accession Number
649655690
Title
A randomized controlled clinical trial evaluating the safety and efficacy
of a radiofrequency ablation transseptal puncture system.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Chu H.M.; Yu Y.B.; Jiang Y.X.
Institution
(Chu, Yu, Jiang) First affiliated hospital of Ningbo University, Rhythmia
Center, Ningbo, China
Publisher
Oxford University Press
Abstract
Background: Transseptal puncture (TSP) is a critical technique for
left-heart interventional therapies, widely used in cardiac catheter
ablation left atrial appendage closure, and mitral valve interventions.
Conventional mechanical puncture systems face limitations such as
technical complexity, steep learning curves, and high risks in challenging
TSP procedures. Radiofrequency (RF) ablation-assisted transseptal puncture
may enhance needle stability through thermal energy application. This
study aimed to evaluate the safety and efficacy of a novel radiofrequency
ablation transseptal puncture system Methods: This prospective,
multicenter, randomized controlled non-inferiority trial enrolled patients
undergoing left-heart radiofrequency ablation via TSP. Participants were
randomized 1:1 to the experimental group (RF system) or control group
(mechanical system). The RF system featured an integrated puncture needle,
guidewire, and RF generator, with enhanced intracardiac echocardiography
visibility for sheaths, needles, and guidewires. The primary efficacy
endpoint was TSP success rate. Secondary endpoints included puncture time
crossover rate after failure, and device performance. Safety endpoints
comprised adverse events (AEs) and complications Results: A total of 181
patients from four centers were enrolled (experimental group: n=91;
control group: n=90). Males comprised 52.5%, with a mean age of 68.3
years. The primary endpoint success rate was 98.9% (90/91) in the
experimental group and 100% (90/90) in the control group, demonstrating
non-inferiority (95% CI lower limit >-10%; P >0.05). Mean puncture time
was significantly shorter in the experimental group (7.8+/-5.4 s vs.
144.6+/-242.3 s; P <0.001). AE rates were 38.89% (35/91) and 35.56%
(32/90) in the experimental and control groups respectively, with no
severe device-related complications Conclusion(s): The novel RF
ablation transseptal puncture system demonstrated superior procedural
efficiency and operability compared to conventional mechanical systems,
highlighting its high clinical value.

<102>
Accession Number
649654117
Title
Management of arrhythmias in mitral valve prolapse: are we making the
right choises for our patients?.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Bugge C.; Five C.K.; Bergh J.; Castrini A.I.; Hasselberg N.E.; Dejgaard
L.A.; Haugaa K.H.; Aabel E.W.
Institution
(Bugge, Five, Bergh, Castrini, Hasselberg, Dejgaard, Haugaa, Aabel) Oslo
University Hospital Rikshospitalet, Oslo, Norway
Publisher
Oxford University Press
Abstract
Background: For patients with mitral valve prolapse (MVP) there is no
established medical therapy to suppress ventricular arrhythmias and
relieve arrhythmic symptoms since antiarrhythmic medication for MVP has
not been evaluated in randomized controlled trials. Additionally, patients
with MVP are underrepresented in studies examining the effect of
antiarrhythmic medication on the reduction of premature ventricular
complexes (PVCs). Purpose(s): We aimed to evaluate the antiarrhythmic
drug use for ventricular arrhythmias in MVP patients, and to assess the
potential efficacy of different antiarrhythmic medications on the
reduction of ventricular arrhythmias. We hypothesized that betablockers
are widely used but have a minor effect on ventricular arrhythmia
reduction, while other less commonly used antiarrhythmic medications have
a greater efficacy. Method(s): This retrospective longitudinal
observational study included patients with MVP referred to our tertiary
centre that underwent Holter monitoring. PVC and non-sustained ventricular
tachycardia (NSVT) burden were assessed by repeated Holter monitorings.
Patients undergoing mitral valve surgery or catheter ablation treatment
were censored from follow-up analysis from the time of the procedure.
Associations were assessed by mixed linear or negative binomial regression
with random effects on individual level, as appropriate. Result(s):
We included 119 MVP patients (median age 46 years [interquartile range,
IQR, 35-59], 67% female) with a total of 302 Holter monitorings. Of these
were 72 (61%) patients treated with antiarrhythmic medication and 196
(65%) Holter monitorings were performed on antiarrhythmic treatment. Total
burden of PVCs at first Holter monitoring was 0.6% per 24 hours (IQR
0.06-3.6) (0.5% [IQR 0.03-3.3] on treatment and 0.9% [IQR 0.1-3.8] on no
treatment). Betablocker was the most commonly used antiarrhythmic
medication (137 Holter monitorings [45%] in 64 [54%] patients), followed
by flecainide (38 [13%) in 13 [3%] patients), non-dihydropyridine calcium
channel blocker (11 [4%] in 4 [3%] patients), sotalol (7 [2%] in 2 [2%]
patients) and dronedarone (3 [1%] in 1 [1%] patient). Compared to no
treatment, only flecainide was associated with a lower PVC burden (-2.2%
per 24 hours [95% confidence interval, CI, -4.2 to -0.3], p<0.03), with no
increased rate of NSVT (p>0.05). Regarding NSVT, only sotalol showed a
reduction in NSVT incidence (incidence rate ratio 0.02 [95% CI
0.002-0.29], p=0.004). Conclusion(s): Betablocker was the most
commonly used antiarrhythmic medication in MVP patients but showed no
reduction in ventricular arrhythmias. Flecainide and sotalol were less
frequent used but our study suggested a reduction in ventricular
arrhythmias. Randomized control trials are needed to assess the efficacy
and safety of different antiarrhythmic medications in MVP.

<103>
Accession Number
649653588
Title
Tafamidis in patients with amyloid cardiomyopathy: a systematic review and
meta-analysis of 14 studies.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Elmorsy A.; Afify R.; Shams M.; Elnady M.; Ibrahim A.; Abdou K.;
Elsharkawy A.; Khayat I.; Hegazi F.; Nassar M.
Institution
(Elmorsy, Afify, Shams, Elsharkawy, Khayat, Nassar) Faculty Of Medicine,
Tanta University, Tanta, Egypt
(Elnady) Kafrelsheikh University, Kafr El Sheikh, Egypt
(Ibrahim) Faculty of medicine, Menoufia University, Menoufia, Egypt
(Abdou, Hegazi) Mansoura University, Mansoura, Egypt
Publisher
Oxford University Press
Abstract
Introduction: Amyloid cardiomyopathy is a form of restrictive
cardiomyopathy where beta blockers and ACE inhibitors were used for
symptomatic relief without reversal of the underlying disease. Studies
reported that tafamidis delays structural and functional changes in the
heart with conflicting results. Aim(s): We aimed to give a
comprehensive analysis of the effect of tafamidis on cardiovascular
outcomes. Method(s): PubMed, Scopus, WOS, and Cochrane were retrieved
from inception until May 2024 for relevant studies that assessed the
effect of tafamidis compared to standard of care in patients with amyloid
cardiomyopathy. Clinical parameters of the heart, such as ejection
fraction, interventricular septum thickness, and percentage of global
longitudinal strain, were studied, as well as cardiovascular outcomes such
as all-cause mortality and hospitalization from cardiovascular causes.
 Result(s): 14 studies were included in this meta-analysis with a
total of 3615 patients., tafamidis showed a significant reduction in
all-cause mortality and heart transplantation compared to standard care
(RR 0.60, 95%CI [0.54 to 0.68]) and hospitalization rates (RR 0.80, 95%CI
[0.70 to 0.90]). Regarding functional and structural heart outcomes,
tafamidis showed an increase in left ventricle ejection fraction (MD,
1.32, 95% CI [-1.13 to 3.77]), It also showed a decrease in
interventricular septum thickness (MD, -0.88, 95%CI [-1.86 to 0.10]).
 Conclusion(s): Tafamidis was associated with favorable outcomes
regarding all cause mortality, heart transplantation and hospitalization,
it also showed delay in structural changes compared to standard of care
but Large-volume RCTs are warranted to validate the current findings. All
cause mortality and HT Hospitalization.

<104>
Accession Number
649655435
Title
Benefits of physiology-guided complete revascularization of non-culprit
lesions in elderly patients with myocardial infarction across the spectrum
of GRACE score: insights from the FIRE trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Spadafora L.; Bernardi M.; Biondi Zoccai G.; Colaiori I.; Campo G.;
Biscaglia S.; Versaci F.
Institution
(Spadafora, Bernardi, Biondi Zoccai) Sapienza University of Rome, Latina,
Italy
(Colaiori, Versaci) Santa Maria Goretti Hospital, Latina, Italy
(Campo, Biscaglia) University Hospital of Ferrara, Cardiology Unit,
Ferrara, Italy
Publisher
Oxford University Press
Abstract
Background: The GRACE score is a well-established tool for predicting
mortality outcomes in patients with myocardial infarction (MI) (1).
However, its interaction with revascularization strategies in older
patients with MI remains unclear. The FIRE trial demonstrated the benefits
of complete physiology-guided revascularization in this clinical setting
(2). Purpose(s): This study aimed to assess whether the GRACE score
was predictive of adverse events in the FIRE trial cohort and whether the
benefits of complete revascularization were independent of GRACE score
tertiles. Method(s): The FIRE trial randomized 1,445 patients aged 75
years or older with MI and multivessel coronary artery disease to receive
either culprit-only or complete revascularization. In this sub-analysis,
patients were stratified according to GRACE score tertiles: the first
tertile (GRACE 92.6-128.0), the second tertile (GRACE 128.1-146.5), and
the third tertile (GRACE 146.6-236.0). The primary endpoint was all-cause
mortality at one-year. Secondary endpoints included cardiovascular (CV)
death and a composite of CV death or MI at one-year. Outcomes at one-month
were also evaluated. Interaction analyses were conducted to evaluate
whether the GRACE score modified the benefits of complete coronary
revascularization. Result(s): According to GRACE score tertiles, 487
patients were in the first tertile (33.7%), 477 in the second tertile
(33.0%), and 481 in the third tertile (33.3%). Patients in the third
tertile were more compromised in terms of cardiovascular risk factors and
comorbidities. At one-year, all-cause mortality was significantly higher
in the third tertile (p < 0.0001), as well as CV death (p < 0.0001) and
the composite of CV death or MI (p < 0.0001). However, the effect of
physiology-guided revascularization did not differ across GRACE score
tertiles (p for interaction > 0.05 for all the outcomes of interest). The
same effect was observed at one-month (all p for interaction > 0.05).
Survival analysis showed that the GRACE score was significantly associated
with increased all-cause mortality (HR 1.027, 95% CI 1.021-1.033, p <
0.001), CV death (HR 1.031, 95% CI 1.023-1.039, p < 0.001), and the
composite of CV death or MI (HR 1.020, 95% CI 1.013-1.026, p < 0.001).
Again, no interaction was found between revascularization strategy and
GRACE score classes (all p for interaction > 0.05). Physiology-guided
revascularization was protective for all the outcomes of interest (all HRs
< 1, all p < 0.05). Conclusion(s): The GRACE score was confirmed to
be predictive of mortality outcomes in the FIRE cohort. However, the
benefits of physiology-guided complete revascularization were maintained
across the entire spectrum of GRACE score. Older patients with MI and
multivessel disease should receive complete physiology-guided
revascularization, regardless of the severity of their GRACE score.

<105>
Accession Number
649654860
Title
Prognostic significance of QFR-based SYNTAX score in patients with
coronary artery disease: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Dimitriadis K.; Pyrpyris N.; Theofilis P.; Tsioufis P.; Koutsopoulos G.;
Konstantinidis D.; Antonopoulos A.; Aznaouridis K.; Tsioufis K.
Institution
(Dimitriadis, Pyrpyris, Theofilis, Tsioufis, Koutsopoulos, Konstantinidis,
Antonopoulos, Aznaouridis, Tsioufis) Hippokration General Hospital,
Athens, Greece
Publisher
Oxford University Press
Abstract
Background: The Synergy Between Percutaneous Coronary Intervention With
Taxus and Cardiac Surgery (SYNTAX) score (SS) is a well-established
angiographic scoring system which allows to assess lesion characteristics,
as well as to predict cardiovascular events in patients undergoing
coronary revascularization. However, as recent evidence document the
superiority of physiology-based revascularization, over angiography-based
revascularization, functional parameters have been added to SS, therefore
creating the functional SS (FSS). Quantitative flow ratio (QFR) is a
novel, non-invasive method for accurately calculating a lesion's
fractional flow reserve, with good diagnostic accuracy when compared to
invasive indices in identifying significant epicardial stenoses.
 Purpose(s): The aim of this systematic review and meta-analysis is to
evaluate the prognostic effect of the QFR-based FSS (QFRFSS) in patients
undergoing percutaneous coronary interventions. Method(s): We
performed a systematic search in 3 different databases (MEDLINE/PubMed,
Web of Science and Scopus). After selecting all appropriate studies
according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines, a random effect meta-analysis was
performed. Result(s): A total of 4 studies and 1,315 patients were
included, with a mean follow-up of 22.5 months. Among included
individuals, a low QFRFSS (<13) was present in 563 patients (42.8%), an
intermediate QFRFSS in 411 (31.3%) and a high QFRFSS in 343 patients
(25.9%). Comparing the low with the high cohorts, patients with low QFRFSS
has significantly lower risk for major adverse cardiovascular events [Risk
Ratio (RR): 0.40; 95% Confidence Interval (CI): 0.23-0.70], cardiovascular
morality (RR: 0.29; 95%CI: 0.10-0.84), as well as recurrent myocardial
infarction (RR: 0.46; 95%CI: 0.25-0.86). However, a non-significant trend
was found regarding ischemia-driven revascularization events (RR: 0.74;
95%CI: 0.44-1.27). Similarly, a significant increase of cardiovascular
events for those with high QFRFSS was found when comparing intermediate
with high QFRFSS, with the exception of cardiovascular mortality. Finally,
no significant differences were found in the comparison of the low and
intermediate QFRFSS cohorts. Conclusion(s): The presence of a high
QFRFSS score is significantly associated with worse cardiovascular
outcomes in patients with coronary artery disease. Implementing physiology
along with anatomical lesion assessment has the potential to enhance the
selection of revascularization strategies in the everyday practice.

<106>
Accession Number
649655079
Title
Reduced left atrial reservoir strain is associated with an increased risk
of postoperative atrial fibrillation after cardiac surgery: a systematic
review and prognostic meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Nin R.; Clark L.; Ratan P.; Florio L.
Institution
(Nin, Florio) Sanatorio Americano, Montevideo, Uruguay
(Clark) Memorial Hospital West, Miami, United States
(Ratan) Patna Medical College and Hospital (PMCH), Patna, India
Publisher
Oxford University Press
Abstract
Background/Introduction: Postoperative atrial fibrillation (POAF) is a
common complication of cardiac surgery in adults and is associated with
prolonged hospitalisation, an increased incidence of stroke and a higher
risk of atrial fibrillation recurrence. However, reliable tools for
identifying patients at an increased risk of POAF are lacking. Left atrial
reservoir strain (LASr), measured by speckle tracking or Doppler
echocardiography, has previously been associated with a higher risk of
atrial fibrillation in other clinical settings, but its role in predicting
POAF is less well established. Purpose(s): To explore the association
between LASr and POAF in adult patients undergoing cardiac surgery.
 Method(s): We systematically searched in PubMed, Embase, and Cochrane
up to December 2024. The primary outcome was the predictive value of LASr
for POAF in cardiac surgery. Secondary outcomes included the same analysis
stratified by the type of surgery. Forest plots were created in Review
Manager 5.4 using the generic inverse variance method and a random-effects
model for either adjusted odds ratios (OR) or adjusted hazard ratios (HR).
Risk of bias was assessed using QUIPS tool. Result(s): Twenty-one
studies were included in the review, 18 of which, encompassing 1,675
patients, were eligible for the meta-analysis (see selection flow diagram,
Figure 1). The mean age was 64.4 years in the POAF group and 60.5 in the
NO-POAF group. The proportion of male patients was 70.7% in the POAF group
and 69.5% in the NO-POAF group. The overall frequency of POAF was 36%.
LASr was significantly lower in the POAF group across all studies (21.4%
vs. 29.1%). Higher LASr was significantly associated with a lower risk of
POAF (see Figure 2, forest plot), (OR=0.82 95% CI [0.77, 0.89]), and also
in coronary artery bypass (CABG) surgery (CABG, OR=0.84, 95% CI [0.76,
0.91]) and valvular surgery (Valvular, OR=0.64 95% CI [0.48, 0.87],
HR=0.96 95% CI [0.94, 0.98]). Conclusion(s): LASr is significantly
associated with the risk of POAF in adult patients undergoing cardiac
surgery. These findings suggest that LASr could aid clinicians in
improving risk stratification and individualising treatment strategies
before cardiac surgery.

<107>
Accession Number
2035291268
Title
The Critical Role of Nurses in Interdisciplinary Teams for Cardiothoracic
Surgery Patients with Cardiac Arrest: A Bibliographic Review.
Source
Resuscitation. Conference: Resuscitation. Athens Greece. 203(Supplement 1)
(pp S171-S171), 2024. Date of Publication: 01 Nov 2024.
Author
Andreopoulou E.; Kipourgos G.; Kafetzaki V.; Charalampopoulou A.; Tzenalis
A.; Charokopos N.
Institution
(Andreopoulou, Kafetzaki, Charalampopoulou) Cardiothoracic Department,
University Hospital of Patras, Patras, Greece
(Kipourgos) Cardiac Surgical Intensive Care Unit, University Hospital of
Patras, Patras, Greece
(Tzenalis) Nursing Department, University of Patras, Patras, Greece
(Charokopos) Cardiothoracic Department, University Hospital of Patras,
Patras, Greece
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Cardiothoracic surgery patients are at heightened risk for
cardiac arrest due to the complexity and invasiveness of their procedures.
The role of nurses as first responders extends beyond basic life support
to include specific interventions tailored to postcardiothoracic surgery
patients. Effective management hinges on seamless collaboration within the
interdisciplinary team. Their role in post-resuscitation care is also
determinant. Aim(s): This bibliographic review investigates the role
of nurses within interdisciplinary teams in the context of cardiac arrest
among cardiothoracic surgery patients. Method(s): The electronic
databases PubMed, ScienceDirect, and Google Scholar were systematically
searched using keywords like "nurses," "interdisciplinary team," "cardiac
arrest," and "cardiothoracic surgery," focusing on peer-reviewed articles
published in English in the last five years. Result(s): Nurses play a
key role in the early detection and confirmation of cardiac arrest and are
also integral and essential members of the resuscitation team called upon
to implement Cardiac Surgery Advanced Life Support Protocols. Nurses may
undertake advanced interventions such as defibrillation and drug
administration. They can also undertake airway and ventilation management
and rehabilitation, which is also another role of the team. Alternatively,
they can perform chest compressions, as well as assist during the
preparation and performance of an emergency thoracotomy. Finally, nurses
may have a coordinating role and may be responsible for documenting the
practices performed by the team in writing. Conclusion(s): The
ability of nurses to immediately recognize cardiac arrest, initiate prompt
and appropriate interventions and provide postresuscitation care has a
significant impact on the survival and recovery of cardiac surgery
patients. Excellent training, effective communication and teamwork are
vital for successful outcomes. Copyright © 2024 All rights
reserved.

<108>
Accession Number
2036052481
Title
ASAVS. CLOPIDOGRELVS. ANTICOAGULANTS FOLLOWING MITRAL VALVE REPAIR:
NETWORK-META-ANALYSIS.
Source
Atherosclerosis. Conference: The Abstract from ISA 2024 conference. Oman.
399(Supplement 1) (pp 18-18), 2024. Date of Publication: 01 Dec 2024.
Author
Gbreel M.I.; Balata M.; Elkasaby M.H.; Hassan M.; Becher M.U.
Institution
(Gbreel) October 6 University, Cairo, Egypt
(Balata, Becher) Department of Internal Medicine and Polyclinic II,
University Hospital Bonn, Germany
(Elkasaby) Faculty of Medicine and surgery, Al-Azhar University, Cairo,
Egypt
(Hassan) Department of Immunology and Endocrinology, Theodor Bilharz
Research Institute, Giza, Egypt
Publisher
Elsevier Ireland Ltd
Abstract
Purpose of the study: Mitral regurgitation (MR) poses thromboembolic risks
post-surgery despite varied repair options. Anticoagulation guidelines
lack consensus. In this paper, we aim to compare post-mitral valve repair
(MVR) antithrombotic medications. Material(s) and Method(s):
Following Cochrane Handbook and PRISMA guidelines, databases (PubMed,
Scopus, Ovid, Cochrane, Web of Science) were systematically searched until
June 27, 2023, for TMVR studies meeting specific criteria. Quality
assessment employed the Newcastle-Ottawa scale. Data extraction
encompassed study details and outcomes, focusing on thromboembolic events
and bleeding within six months. Statistical analysis, conducted using R
software. Result(s): From the 121 articles screened,12were included
in the study. These cohort studies, involving 20,644 participants, spanned
from 2008 to 2022. While most studies were of good to high quality, some
exhibited lower quality. Analysis favored oral anticoagulants (OAC) over
single antiplatelet therapy (SAPT) for reducing bleeding risk (RR 0.31,
95% CI:[0.11-0.87], P < 0.05), with moderate heterogeneity. Thromboembolic
events did not significantly differ among interventions. Transient
ischemic attacks and stroke outcomes were similar between SAPT and vitamin
K antagonists (VKA). Six-month mortality rates were comparable between
SAPT and VKA, with notable heterogeneity and higher mortality with SAPT in
one study. Qualitative synthesis highlighted procedural success rates and
bleeding complications across different interventions in transcatheter MVR
studies. Conclusion(s): The administration of antithrombotic
medications following MVR appears to be associated with a favourable risk
profile, showing no significant increase in bleeding or stroke incidence.
These findings imply potential advantages in postoperative
management. Copyright © Elsevier Ltd. All rights reserved.

<109>
Accession Number
2042499984
Title
Transcatheter or Surgical Strategy for Aortic Stenosis and Coronary Artery
Disease: A Kaplan-Meier-Derived Meta-Analysis.
Source
American Journal of Cardiology. 260 (pp 80-88), 2026. Date of Publication:
01 Feb 2026.
Author
Baudo M.; Leone P.P.; Sicouri S.; Magouliotis D.E.; Yamashita Y.; Cabrucci
F.; Sturla M.; Latib A.; Ramlawi B.
Institution
(Baudo, Sicouri, Magouliotis, Yamashita, Cabrucci, Ramlawi) Department of
Cardiac Surgery Research, Lankenau Institute for Medical Research, Main
Line Health, Wynnewood, PA, United States
(Leone, Sturla, Latib) Division of Cardiology, Montefiore Medical Center,
Bronx, NY, United States
(Yamashita, Ramlawi) Department of Cardiac Surgery, Lankenau Heart
Institute, Main Line Health, Wynnewood, PA, United States
Publisher
Elsevier Inc.
Abstract
Coronary artery disease (CAD) is commonly found in patients with severe
aortic stenosis (AS) and combined surgical aortic valve replacement (SAVR)
and coronary artery bypass grafting (CABG) is currently recommended as the
preferred treatment in this setting. Transcatheter aortic valve
replacement (TAVR) and percutaneous coronary intervention (PCI) represent
a valid alternative. This study sought to investigate clinical outcomes
after TAVR+PCI versus SAVR+CABG in patients with severe AS and CAD. A
systematic review was conducted from inception until December 2024 for
randomized controlled and propensity score-matched studies comparing
TAVR+PCI and SAVR+CABG for patients with severe AS and CAD.
Kaplan-Meier-derived individual patient data was retrieved when available.
Primary endpoint was all-cause mortality. The study was registered with
PROSPERO (CRD42025642206). Six studies met our inclusion criteria with a
total of 1,998 patients: 1,007 in the TAVR+PCI group and 991 in the
SAVR+CABG group. The hazard ratio of all-cause mortality varied over time
between groups: TAVR+PCI showed a lower incidence of all-cause mortality
in the first 19 days, with a reversal at 73 days favoring SAVR+CABG.
Patients undergoing TAVR+PCI group experienced lower rates of stroke-free
survival (p = 0.039), postoperative reintervention (p = 0.020), atrial
fibrillation (p <0.001), and acute kidney injury (p = 0.001) rates, while
they were at higher risk of postoperative moderate/severe aortic
regurgitation (p <0.001), permanent pacemaker implantation (p = 0.005) and
major vascular complication (p <0.001). Major bleeding didn't differ (p =
0.358). A percutaneous treatment approach offered an early survival
benefit over a surgical approach in patients with severe AS and CAD but
was associated with worse survival at mid-term follow-up. Copyright
© 2025 Elsevier Inc.

<110>
Accession Number
2037469669
Title
Lipoprotein A and the Association With Peripheral Arterial Disease: A
Review of the Risk in Peripheral Arterial Disease.
Source
Reviews in Cardiovascular Medicine. 26(11) (no pagination), 2025. Article
Number: 41551. Date of Publication: 01 Nov 2025.
Author
Kar S.
Institution
(Kar) Division of Cardiology, Virginia Commonwealth University Veterans
Affairs Medical Center, Richmond, VA, United States
Publisher
IMR Press Limited
Abstract
Peripheral arterial disease (PAD) is a global atherosclerotic disease
which can lead to acute limb ischemia, chronic limb-threatening ischemia,
and limb amputation. It has similar risk factors to coronary artery
disease (CAD). Elevated lipoprotein A (Lp[a]) is associated with CAD,
myocardial infarction, and PAD. Patients with PAD can have CAD and
polyvascular disease. An extensive PubMed and Cochrane library search was
performed in April 2025 using the words "Lipoprotein A and PAD", "Elevated
lipoprotein A and PAD", and "High Lipoprotein A and PAD" to obtain
relevant English articles for this systematic review. An elevated Lp(a)
may enhance the risk of PAD. Elevated Lp(a) can amplify the risk of CAD,
PAD, and polyvascular disease. It may portend worse outcomes in patients
with CAD and PAD. It can increase the risk of acute limb ischemia,
coronary revascularization, peripheral revascularization, cardiovascular
death, and all-cause mortality. Hence, elevated Lp(a) may serve as a risk
factor for patients with CAD who could potentially develop PAD. No
currently approved medical therapy aimed at Lp(a) reduction exists; only
lipoprotein apheresis is approved to lower Lp(a) levels in these patients.
This systematic review discusses the role of an elevated Lp(a) in PAD,
clinical research in PAD with elevated Lp(a), and the current treatment
for PAD and elevated Lp(a). Copyright © 2025 The Author(s).
Published by IMR Press.

<111>
Accession Number
2042470815
Title
Post-operative atrial fibrillation and stroke after non-cardiac surgery: a
systematic review and meta-analysis.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 11(8) (pp
682-697), 2025. Date of Publication: 01 Dec 2025.
Author
Donati J.; Morrone D.; Verheugt F.W.A.; De Caterina R.
Institution
(Donati, Morrone, De Caterina) University of Pisa, Cardiovascular
Division, Pisa University Hospital, Via Paradisa, 2, Pisa, Italy
(Verheugt) AmsterdamNetherlands
Publisher
Oxford University Press
Abstract
Post-operative atrial fibrillation (POAF) is common after non-cardiac
surgery. Because often transient, there are uncertainties on the
associated risk of stroke, possibly driving the need for long-term
anticoagulation. We performed a systematic PubMed search until 16 January
2025, related to the incidence of stroke in patients with POAF after
non-cardiac surgery. We included papers reporting outcomes, excluding
studies only dealing with epidemiology, mechanisms, management, and
treatment. We excluded studies reporting on POAF after cardiac surgery.
Risk of bias was assessed for each study, and the certainty of evidence
was evaluated using the GRADE methodology. We retrieved and included 40
studies (including review papers) for the systematic review. These were
then further selected to create a final list of 19 studies included in the
meta-analysis. The reported incidence of stroke after POAF was found to be
widely variable, ranging between 0.4% and 16.7% at 1 year. Stroke
incidence also varies widely according to the type of surgery and patient
characteristics. With only three exceptions, all studies, however,
reported a risk of stroke higher in the POAF group than in the no-POAF
group, with a mean odds ratio of 3.02. POAF on average triples the risk of
stroke, with variations related to patient characteristics and type of
surgery. Patients after non-cardiac surgery should be monitored at least
during hospitalisation to detect POAF. Future studies are necessary to
evaluate optimal duration and modalities of monitoring, as well as to
assess the relevance of symptomatic vs asymptomatic AF
episodes. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of European Society of Cardiology.

<112>
Accession Number
2042354984
Title
Colchicine in coronary artery and cerebrovascular disease: "Old skin for
the new ceremony".
Source
World Journal of Cardiology. 17(11) (pp 1-14), 2025. Article Number:
110563. Date of Publication: 26 Nov 2025.
Author
Animati F.M.; Cappannoli L.; Proietti S.; Fracassi F.; Montone R.A.;
Ierardi C.; Aurigemma C.; Romagnoli E.; Paraggio L.; Lunardi M.; Bianchini
F.; Leone A.M.; Trani C.; Liuzzo G.; Burzotta F.
Institution
(Animati, Cappannoli, Proietti, Fracassi, Montone, Ierardi, Aurigemma,
Romagnoli, Paraggio, Lunardi, Bianchini, Trani, Liuzzo, Burzotta)
Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCCS, Lazio, Rome, Italy
(Leone) Department of Diagnostic and Interventional Cardiology, Center of
Excellence in Cardiovascular Science, Ospedale Isola Tiberina-Gemelli
Isola, Lazio, Rome, Italy
Publisher
Baishideng Publishing Group Inc
Abstract
Colchicine is one of the most widely used drugs in the world. While it is
most commonly used in the treatment and prevention of gout, it is also
widely used to treat other chronic inflammatory diseases, such as familial
Mediterranean fever and Behcet's disease. Regarding cardiovascular
disease, an established use of colchicine concerns pericarditis, both
acute and chronic, and its effectiveness in this context is supported by
multiple studies and robust evidence. Regarding coronary artery disease
(CAD), colchicine use has been endorsed in both acute and chronic coronary
syndromes (CCS), primarily because of two randomized controlled trials:
The COLCOT trial for patients with acute coronary syndromes (ACS) and the
LoDoCo2 trial for patients with CCS. Considering this robust evidence, CCS
2024 European Society of Cardiology (ESC) Guidelines recommended 0.5 mg
daily colchicine in patients with atherosclerotic CAD to reduce the risk
of myocardial infarction, stroke and need for revascularization. However,
a few months after the publication of 2024 ESC Guidelines on CCS, the
"CLEAR" trial demonstrated that among patients who had experienced an
acute myocardial infarction, when initiated shortly after the event and
continued for a median of 3 years, colchicine did not reduce the incidence
of the composite outcome of death from cardiovascular causes, recurrent
myocardial infarction, stroke, or unplanned ischemia-driven coronary
revascularization. This result casts doubt on the indication for
colchicine use in ACS and weakens evidence that had previously led to the
routine use of colchicine in clinical cardiology practice. This review
aims to shed light on the current and past scientific evidence underlying
the use of colchicine in ACS, CCS and cerebrovascular disease, and thus
seeks to provide a quick yet effective tool for cardiologists facing the
long-standing issue of reducing residual inflammatory risk in patients
with coronary atherosclerotic disease. Copyright ©The Author(s)
2025.

<113>
Accession Number
2042069597
Title
Efficacy and Safety of Drug and Device Strategies for Stroke Prevention in
Atrial Fibrillation After Intracranial Hemorrhage: A Bayesian Network
Meta-Analysis.
Source
Journal of Cardiovascular Development and Disease. 12(12) (no pagination),
2025. Article Number: 464. Date of Publication: 01 Dec 2025.
Author
Qi F.; Yang Y.; Wang L.; Weng S.; Wu Q.; Liu Y.; Hu Z.; Chen L.; Wang Y.
Institution
(Qi, Yang, Wang, Weng, Wu, Liu, Hu, Chen, Wang) Department of Cardiology,
Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
(1) Background: Whether anticoagulation can be resumed in atrial
fibrillation (AF) combined with intracranial hemorrhage (ICH), and which
anticoagulation modality is used with better efficacy and safety, is
unknown. (2) Method: Randomized controlled trials (RCTs) and observational
studies on relevant topics were included by searching five databases:
PubMed, EMBASE, EBSCO, Cochrane Central Register of Controlled Trial and
ClinicalTrials. Bayesian network meta-analysis was performed to analyze
the effect of oral anticoagulant (OAC), new oral anticoagulant (NOAC),
warfarin, antiplatelet, left atrial appendage occlusion (LAAO) and no
therapy in patients with AF after intracranial hemorrhage. (3) Results: We
included 16 studies involving 25,483 patients. Compared with no
antithrombotic therapy, the risk of thromboembolism and all-cause
mortality were both reduced with OAC (OR: 0.38, 95% CI: 0.21-0.67; OR:
0.45, 95% CI: 0.25-0.8) and LAAO (OR: 0.11, 95% CI: 0.01-0.76; OR: 0.11,
95% CI: 0.01-0.88), and there was no increased risk of recurrent
intracranial hemorrhage. Regarding thromboembolism, OAC (OR: 0.28, 95% CI:
0.11-0.69) was superior to antiplatelet therapy, and antiplatelet therapy
(OR: 12.59, 95% CI: 1.57-133.50) was associated with a higher risk of
thromboembolism than LAAO. There were no significant differences in
recurrent intracranial hemorrhage between the interventions. LAAO appeared
to be the best option for reducing thromboembolism (SUCRA: 0.96),
recurrent intracranial hemorrhage (SUCRA: 0.75) and all-cause mortality
(SUCRA: 0.94). (4) Conclusion(s): Based on this network
meta-analysis, we hypothesize that LAAO has the highest likelihood of
reducing the risk of thromboembolism and recurrent intracranial
hemorrhage, as well as all-cause mortality in patients with AF after
intracranial hemorrhage, followed by OAC. Copyright © 2025 by the
authors.

<114>
Accession Number
2042004146
Title
The effect of personalized perioperative blood pressure management on
intraoperative cerebral oxygen saturation, burst suppression ratio and
postoperative neurological outcomes in patients having major non-cardiac
surgery: an observational substudy of the IMPROVE-pilot randomized
controlled trial.
Source
Journal of Clinical Monitoring and Computing. (no pagination), 2025. Date
of Publication: 2025.
Author
Khader W.; Hein M.; Kouz K.; Bergholz A.; Saugel B.; Wallqvist J.;
Goldmann S.; Grafe K.; Larmann J.; Grusser L.
Institution
(Khader, Hein, Wallqvist, Goldmann, Grafe, Larmann, Gruser) Department of
Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Kouz, Bergholz, Saugel) Department of Anesthesiology, Center of
Anesthesiology and Intensive Care Medicine, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Wallqvist) Alexianer Center for Mental Health, Aachen, Germany
Publisher
Springer Science and Business Media B.V.
Abstract
Abstract: It is not clear whether adopting personalized intraoperative
blood pressure management could lead to better intraoperative regional
cerebral saturation (rSO2), lower burst suppression ratio (BSR) or better
neurological outcomes. Therefore, we performed this prespecified
exploratory substudy of the IMPROVE-pilot trial to investigate the effects
of personalized compared to routine intraoperative blood pressure
management on the intraoperative rSO2. We also explored the effect of
personalized intraoperative blood pressure management on BSR and the
incidence of postoperative delirium (POD) and delayed neurocognitive
recovery (dNCR). We included patients aged >= 45 years with American
Society of Anesthesiologists (ASA) physical status II-IV who were
scheduled for elective major surgery. Preoperative automated nighttime
blood pressure measurements were performed. Patients were randomized to
personalized blood pressure management maintaining intraoperative mean
arterial pressure (MAP) at least at the preoperative mean nighttime MAP or
to routine blood pressure management with a lower MAP intervention
threshold of 65 mmHg. Intraoperative measurements of MAP, rSO2 on both
hemispheres, and BSR were performed. POD was assessed daily on the first 3
postoperative days using the 3D-confusion assessment method or the
confusion assessment method for the intensive care unit. We screened for
dNCR using the telephone-Montreal Cognitive Assessment on postoperative
days 3, 7, and 30. We enrolled 55 patients and randomized 50 patients. 49
patients were included in the final analysis. The median areas under the
baseline rSO2 and BSR were similar between the two groups. One patient
assigned to personalized blood pressure management and none of the
patients assigned to routine blood pressure management had POD. There was
no meaningful difference in the incidence of dNCR between the groups. In
this substudy of the IMPROVE-pilot trial, we observed no evidence of
difference in intraoperative area under baseline rSO2 between patients who
received personalized compared to routine perioperative blood pressure
management. Trial registration: This substudy was registered at the German
Clinical Trials Register (Deutsches Register Klinischer Studien
DRKS00025762, on December 3, 2021). Copyright © The Author(s)
2025.

<115>
Accession Number
2036052396
Title
EFFICACY OF INTENSIVE LIPID-LOWERING THERAPYAFTER CABG: A META-ANALYSIS.
Source
Atherosclerosis. Conference: The Abstract from ISA 2024 conference. Oman.
399(Supplement 1) (pp 73-73), 2024. Date of Publication: 01 Dec 2024.
Author
Soliman Y.; Mouffkes A.
Institution
(Soliman) Faculty of Medicine, Assiut University, Assiut, Egypt
(Mouffkes) Faculty of Medicine, University of Oran 1 Ahmed Ben Bella,
Oran, Algeria
Publisher
Elsevier Ireland Ltd
Abstract
Purpose of the Study: Intensive lipid-lowering therapy has shown potential
in reducing adverse cardiovascular events. However, its specific efficacy
in patients post-coronary bypass surgery (CABG) remains uncertain. This
meta-analysis aims to evaluate the impact of aggressive lipid-lowering
interventions on clinical outcomes in CABG patients, addressing a critical
gap in cardiovascular treatment strategies. Materials and Methods Used: We
searched PubMed, EMBASE, Scopus, Cochrane Controlled Register of Trials
(CENTRAL), and Web of Science for all randomized controlled trials (RCTs)
that examined the efficacy of more versus less intensive lipid-lowering
treatment in patients with previous CABG.We used Risk ratio (RR) as the
effect size. Data analysis was done using Review Manager software.
 Result(s): Intensive LDL-C reduction in patients post-CABG was linked
to a notable 14% decrease in all-cause mortality [RR 0.86 (95% CI, 0.74 to
0.99)] and a 25% decrease in cardiovascular mortality [RR 0.75, (95% CI,
0.65 to 0.86)]. This benefitwas observed in both stable patients and those
who developed acute coronary syndrome after CABG. Conclusion(s):
Patients with previous CABG experienced reduced allcause and
cardiovascular mortality from intensive LDL-C reduction. The benefits of
intensive LDL-C reduction were consistent regardless of patients' clinical
presentations post-CABG. Identifying the characteristics of
atherosclerotic disease may help pinpoint other high-risk groups that
could significantly benefit from additional lipidlowering
therapies. Copyright © Elsevier Ltd. All rights reserved.

<116>
Accession Number
2042440670
Title
Balloon Postdilation After Transcatheter Aortic Valve Implantation (TAVI)
Among Self- and Balloon-Expandable Valves: A Systematic Review and
Meta-Analysis.
Source
American Journal of Cardiology. 260 (pp 61-70), 2026. Date of Publication:
01 Feb 2026.
Author
Cheikh-Ibrahim M.; de Pontes V.B.; Alachkar N.; Jaramillo S.; Esteves
I.M.; Lauten A.
Institution
(Cheikh-Ibrahim, Lauten) Department of Cardiology, Helios Klinikum Erfurt,
Health and Medical University Erfurt, Germany
(de Pontes) Division of Medicine, University Centre of Associated Colleges
for Education, Sao Joao da Boa Vista, Brazil
(Alachkar) Heart Center Brandenburg, University Hospital of the Medical
School Brandenburg, Berlin, Germany
(Jaramillo) Division of Medicine, Universidad Austral, Pilar, Argentina
(Esteves) School of Medicine and Biomedical Sciences, University of Porto,
Porto, Portugal
Publisher
Elsevier Inc.
Abstract
Balloon postdilation (BPD) is used to optimize valve expansion after
transcatheter aortic valve implantation (TAVI). However, the clinical
impact, particularly between balloon-expandable (BE) and self-expanding
(SE) valves, remains unclear. We conducted a systematic search of PubMed,
Embase, and Cochrane Library to compare patients undergoing TAVI with and
without BPD. We pooled the risk ratios (RR) and mean differences (MD) for
binary and continuous outcomes, respectively. All statistical analyses
were performed using a random effects model. Sixteen observational studies
comprising 15,508 patients were included, of which 3,397 (22%) underwent
TAVI with BPD. BPD was associated with a significantly higher risk of
in-hospital stroke (RR, 1.66; 95% CI 1.15 to 2.40; p <0.01) and 30-day
mortality (RR, 1.28; 95% CI 1.05 to 1.56; p = 0.01). No significant
differences were observed in terms of 30-day, 1-year, or overall stroke;
pacemaker implantation; myocardial infarction; or cardiovascular or
all-cause mortality. Regarding echocardiographic outcomes, BPD resulted in
a larger effective orifice area (EOA) (MD 0.06; 95% CI 0.01 to 0.11; p =
0.01), with no differences in the mean transvalvular gradient and
paravalvular regurgitation. In prespecified subgroup analyses, BPD was
associated with an increased risk of 1-year stroke in patients receiving
BE valves (RR, 1.57; 95% CI, 1.11 to 2.24; p = 0.01) and a higher 30-day
mortality with SE valves (RR, 1.28; 95% CI 1.01 to 1.62; p = 0.04)
compared with non-BPD. BPD is associated with an increased risk of early
mortality and periprocedural stroke, albeit with a slightly larger EOA.
Further randomized trials are needed to confirm our
findings. Copyright © 2025 Elsevier Inc.

<117>
Accession Number
2042462450
Title
The Therapeutic Effectiveness of 3-dimensional Video-assisted Thoracic
Surgery in the Management of Oesophageal Cancer.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 40(12) (no
pagination), 2025. Article Number: ivaf289. Date of Publication: 01 Dec
2025.
Author
Xia H.; Pan K.; Jiang L.; Ma H.
Institution
(Xia, Pan, Jiang, Ma) Department of Thoracic and Cardiovascular Surgery,
The Fourth Affiliated Hospital of Soochow University, Soochow University,
Jiangsu, Suzhou, China
Publisher
Oxford University Press
Abstract
Objectives The comparative benefits of 3-dimensional (3D) versus
2-dimensional (2D) video-assisted thoracic surgery (VATS) for oesophageal
cancer remain uncertain. This meta-analysis aims to assess the efficacy
and safety profiles of 3D and 2D VATS procedures in the management of
oesophageal cancer. Methods A comprehensive literature search was
conducted utilizing the PubMed, Cochrane Library, and China National
Knowledge Infrastructure (CNKI) databases for studies published up to
August 2025. Eligible studies were those comparing the efficacy and safety
profiles of 3D versus 2D VATS. For data synthesis, continuous variables
were evaluated using standardized mean differences (SMD), while
dichotomous outcomes were assessed with odds ratios (ORs); all effect
measures are reported with 95% confidence intervals (CIs) and
corresponding P-values. Results Eight studies involving 1273 patients (608
undergoing 3D VATS and 665 undergoing 2D VATS) demonstrated that the 3D
VATS approach was associated with significantly decreased intraoperative
blood loss (-2.27; 95% CI: -3.45 to -1.09; P<.05) and reduced operative
duration (-0.65; 95% CI: -1.15 to -0.16; P<.05) compared to the 2D
technique. However, no statistically significant differences were observed
between the 2 groups in terms of postoperative drainage time,
postoperative hospitalization duration, total postoperative drainage
volume, incidence of postoperative complications, and number of lymph node
dissection. Conclusions This meta-analytic study demonstrates that
potential clinical benefits of 3D VATS over the 2D approach for
oesophageal cancer resection, such as decreased intraoperative blood loss
and reduced operative duration. Copyright © The Author(s) 2025.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<118>
Accession Number
2042454016
Title
Efficacy and safety of off-pump versus on-pump coronary artery bypass
grafting in chronic obstructive pulmonary disease patients: A systematic
review and meta-analysis.
Source
Revista Portuguesa de Cardiologia. (no pagination), 2025. Date of
Publication: 2025.
Author
Hassan D.; Zehra Manjee K.; Umar T.P.; Al Diab Al Azzawi M.; Elshenawy S.;
Ahmed Khan W.; Rayyan Ahmed S.; Sohaib Khan M.; Amjad M.; Adel Mohammed Y.
Institution
(Hassan, Zehra Manjee, Ahmed Khan, Rayyan Ahmed, Sohaib Khan, Amjad)
Faculty of Medicine, Dow University of Health Sciences, Karachi, Pakistan
(Umar) Division of Surgery and Interventional Science, Faculty of Medical
Sciences, University College London, London, United Kingdom
(Al Diab Al Azzawi) Faculty of Medicine, The National Ribat University,
Khartoum, Sudan
(Elshenawy) Faculty of Medicine Alexandria University, Alexandria, Egypt
(Adel Mohammed) Faculty of Medicine, Assiut University, Assiut, Egypt
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction and objectives: Patients with chronic obstructive pulmonary
disease (COPD) undergoing coronary artery bypass grafting (CABG) face
significant perioperative risks. The choice between off-pump and on-pump
CABG techniques can impact clinical outcomes, particularly related to
pulmonary function and postoperative recovery. This meta-analysis aims to
evaluate the clinical efficacy and safety of off-pump versus on-pump CABG
in patients with COPD. Method(s): A comprehensive search of medical
databases including PubMed and Google Scholar was conducted to identify
relevant studies comparing off-pump and on-pump CABG in COPD patients. The
main outcomes included postoperative respiratory complications, mortality
rates, length of hospital stay, and overall recovery. Results were pooled
as relative risks (RR) or mean differences (MD) with 95% confidence
intervals (CI). Result(s): A total of seven studies (two randomized
controlled trials (RCTs), one sub-study from a previous RCT, and four
observational studies) comprising 1071 patients were included in the
analysis. While postoperative respiratory complications were lower in the
off-pump group, the difference was not statistically significant. However,
off-pump CABG was significantly associated with reduced mortality (RR
0.21; 95% CI: [0.08, 0.54], p=0.001), shorter hospital stays (MD=-2.34;
95% CI: [-4.51, -0.17], p=0.03), reduced need for mechanical ventilatory
support (MD=-4.73; 95% CI: [-6.17, -3.29], p<0.00001), and lower incidence
of low cardiac output (RR=0.43, 95% CI [0.19, 0.99], p=0.05).
 Conclusion(s): Off-pump CABG provides significant benefits over
on-pump CABG in COPD patients by reducing mortality, hospital stay
duration, the need for mechanical ventilatory support, and low cardiac
output. The observed reduction in postoperative respiratory complications,
although not statistically significant, may indicate potential clinical
benefits of off-pump CABG. Further large-scale RCTs are needed to confirm
these findings. Copyright © 2025 Sociedade Portuguesa de
Cardiologia

<119>
Accession Number
2041995028
Title
State of the art of robotic lobectomy for non-small cell lung cancer: a
systematic-style evidence synthesis.
Source
Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number:
108. Date of Publication: 01 Dec 2026.
Author
Coco D.; Leanza S.
Institution
(Coco, Leanza) Department of General, Robotic, and Oncologic Surgery,
Giglio Foundation Hospital, Cefalu, Palermo, Italy
Publisher
Springer Nature
Abstract
Robotic-assisted thoracic surgery (RATS) lobectomy has diffused rapidly as
an alternative to video-assisted thoracoscopic surgery (VATS) for
resectable non-small cell lung cancer (NSCLC). A growing but heterogeneous
evidence base-including prospective cohorts, meta-analyses, economic
models, learning-curve studies and one large randomized trial-permits an
updated synthesis to guide clinicians and policy makers. We conducted a
focused, reproducible literature search of Cochrane CENTRAL,
PubMed/MEDLINE and Embase through 15 August 2025 using terms that included
"robotic lobectomy," "RATS," "VATS," "non-small cell lung cancer,"
"randomized," "meta-analysis," "cost" and "learning curve." We prioritized
randomized evidence, prospective comparative cohorts, high-quality
meta-analyses, multicenter registries, and full economic evaluations
published 2020-2025. Primary outcomes were perioperative (operative time,
blood loss, conversion, complications, length of stay), nodal harvest and
pathologic upstaging, disease-free and overall survival, quality of life
(QOL), cost and learning-curve metrics. We present a transparent search
strategy, selection criteria, and synthesized quantitative findings drawn
from high-impact sources. The RVlob randomized controlled trial (n = 320)
showed non-inferiority of robotic to VATS lobectomy for 3-year overall
survival (RAL 3-yr OS 94.6% v VAL 91.5%; HR 0.65, 95% CI 0.33-1.28;
noninferiority P = 0.0029). Observational multicenter cohorts (including a
large JAMA Network Open study, n = 1,088) found broadly comparable
clinical outcomes but longer adjusted operative duration for RATS (median
+ 20.6 min). Pooled prospective data (Frontiers 2023; pooled n = 614)
reported lower estimated blood loss with RATS (MD - 17.14 mL, 95% CI -
29.96 to - 4.33) and greater numbers of lymph-node stations sampled (MD +
1.07 stations, 95% CI 0.79-1.36). Learning-curve synthesis suggests
technical proficiency at = 25 cases (mean 25.3 +/- 12.6) with convergence
of operative times and outcomes thereafter. Cost-effectiveness analyses
are heterogeneous: Heiden et al. (Ann Thorac Surg, 2022) reported modest
per-case cost increases for RATS with ICERs that depend heavily on
perspective and assumptions, while early RCT economic analyses (RAVAL
early results / RPL-4 pathway) have reported ICERs in the range of =$15k
per QALY under favorable assumptions. RATS lobectomy is oncologically
non-inferior to VATS at mid-term follow-up and achieves perioperative
safety comparable to VATS; it is associated with lower intraoperative
blood loss, more extensive nodal station sampling in some series, and
longer operative times early in adoption. Cost-effectiveness is
context-sensitive and improves with higher case volumes, shorter OR times,
and lower disposable instrument costs. Standardized lymphadenectomy,
transparent learning-curve reporting, and longer randomized follow-up
remain priorities. Copyright © The Author(s), under exclusive
licence to Springer-Verlag London Ltd., part of Springer Nature 2025.

<120>
Accession Number
2042023939
Title
Effects of continuation versus interruption of oral anticoagulation during
transcatheter aortic valve implantation on hemostasis function.
Source
Journal of Thrombosis and Haemostasis. (no pagination), 2025. Date of
Publication: 2025.
Author
van Ginkel D.J.; Stragier H.; Bor W.L.; Rosseel L.; Konings J.; Ninivaggi
M.; de Simone I.; Huskens D.; Roest M.; van Lenthe I.; Overduin D.C.;
Aarnink E.W.; Rooijakkers M.J.P.; Peper J.; Brouwer J.; Nijenhuis V.J.;
Rensing B.J.W.M.; Timmers L.; Swaans M.J.; Hackeng C.M.; ten Cate H.; de
Laat B.; ten Berg J.M.
Institution
(van Ginkel, Bor, van Lenthe, Overduin, Aarnink, Peper, Brouwer,
Nijenhuis, Rensing, Timmers, Swaans, ten Berg) Department of Cardiology,
St. Antonius Hospital, Nieuwegein, Netherlands
(Stragier, ten Cate, ten Berg) Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
(Stragier, de Laat) Department of Anesthesiology, Intensive Care Medicine,
Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
(Rosseel) Department of Cardiology, Hartcentrum Aalst, Aalst, Belgium
(Konings, Ninivaggi, de Simone, Huskens, Roest) Department of Functional
Coagulation, Synapse Research Institute, Maastricht, Netherlands
(Rooijakkers, Nijenhuis) Department of Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Hackeng) Department of Clinical Chemistry, St. Antonius Hospital,
Nieuwegein, Netherlands
(ten Cate) Department of Internal Medicine, Maastricht University Medical
Centre, Maastricht, Netherlands
(ten Cate) Laboratory for Clinical Thrombosis and Hemostasis, Department
of Biochemistry, Maastricht University, Maastricht, Netherlands
(ten Cate) Thrombosis Expertise Center, Maastricht University Medical
Centre, Maastricht, Netherlands
(ten Berg) Department of Cardiology, Maastricht University Medical Center,
Maastricht, Netherlands
Publisher
Elsevier B.V.
Abstract
Background One-third of patients undergoing transcatheter aortic valve
implantation (TAVI) have a concomitant indication for oral anticoagulation
(OAC). Previous studies suggested that periprocedural continuation of OAC
could reduce transient hypercoagulation after TAVI. Objective To evaluate
the effects of continuation versus interruption of OAC on periprocedural
hemostasis function. Methods Patients were randomized 1:1 to OAC
continuation vs interruption. Plasma samples were taken at 6 time points,
and hemostasis function was assessed by measuring thrombin and plasmin
generation, as well as biomarkers of coagulation, fibrinolysis, platelet
activation, and endothelial function. Results A total of 167 patients were
included: 82 were assigned to OAC continuation and 85 to OAC interruption.
Pre-TAVI, a significantly lower endogenous thrombin potential (ETP) was
observed in the continuation group compared with the interruption group.
In both groups, ETP was reduced immediately post-TAVI, and its restoration
was significantly lower in the continuation group. In contrast, levels of
prothrombin fragment 1 + 2 were similar between the groups. A
significantly lower endogenous plasmin potential was observed in the
continuation group from pre-TAVI to 8 hours post-TAVI. In both groups,
fibrin degradation products increased immediately post-TAVI, while this
increase was significantly lower in the continuation group. Markers of
endothelial and platelet activation were unaffected by the randomized
strategy. Conclusion Continuation of OAC during TAVI modestly reduced the
acute activation of coagulation and fibrinolysis compared with the
interruption of OAC. This did not translate into any apparent differences
in thromboembolic risk in the main trial. However, continuation of OAC
resulted in a marked suppression of ETP and an increased risk of
bleeding. Copyright © 2025 International Society on Thrombosis
and Haemostasis.

<121>
Accession Number
2042336058
Title
Comparing Robotic-Assisted Coronary Artery Bypass Grafting Using the Da
Vinci Surgical System to a Nonrobotic Approach: A Systematic Literature
Review and Meta-Analysis.
Source
Value in Health. Conference: ISPOR Europe 2025: Powering Value and Access
Through Patient-Centered Collaboration. Glasgow United Kingdom. 28(12
Supplement 1) (pp S483-S484), 2025. Date of Publication: 01 Dec 2025.
Author
Patel N.; Yankovsky A.; Kreaden U.
Institution
(Patel, Yankovsky) Intuitive Surgical, Sunnyvale, CA, United States
(Kreaden) Biostatistics, Access & Evidence, Intuitive Surgical, Sunnyvale,
CA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: To compare the perioperative clinical outcomes of
robotic-assisted (rCABG) to non-robotic coronary artery bypass grafting
(non-rCABG). Method(s): A PRISMA-guided literature review of studies
from Pubmed, Scopus and Embase was conducted for publications between
01/01/2010 and 01/11/2024 (Prospero #CRD420250652462). Included studies
reported on adults with coronary artery disease requiring
revascularization, comparative studies including rCABG and non-robotic
CABG, in the form of RCT, large database, prospective, and retrospective
cohort studies with a sample size greater than 20 subjects in each arm and
quantifiable perioperative safety and effectiveness outcomes. Data were
pooled as odds ratios (OR) or mean differences (MD) in R using
fixed-effects or random-effects. Result(s): The search identified 31
eligible studies (27 retrospective, 3 database, and 1 prospective),
including 20,935 rCABG and 970,305 non-rCABG patients. Operative time was
comparable between both groups. rCABG patients also experienced an 18%
higher likelihood of reoperation due to bleeding (OR:1.18, [1.04, 1.34]
p<0.01). Compared to non-rCABG, patients undergoing rCABG were 71% less
likely to receive a postoperative blood transfusion (OR:0.29, [0.22, 0.39]
p<0.01), had shorter ICU stay by 0.84 days (p<0.01), shorter hospital stay
by 1.98 days ( p<0.01), were 39% less likely to have postoperative atrial
fibrillation (OR: 0.61, [0.51, 0.73] p<0.01), 43% less likely to
experience a stroke (OR: 0.57, [0.48, 0.69] p<0.01), and had less short
term mortality (OR:0.68 [0.58, 0.78], p<0.01). Both groups had comparable
rates of postoperative myocardial infarction and revascularization
post-surgery. Conclusion(s): This meta-analysis demonstrates that
rCABG is safe and effective with numerous patient benefits over non-rCABG,
but highlights gaps in high level evidence comparing rCABG to non-rCABG.
These results nevertheless may be useful for decision-making by payors,
policymakers, and Health Technology Assessment bodies. Copyright
© 2025

<122>
Accession Number
2042008358
Title
The relevance of acute kidney injury in dehydrated children.
Source
Frontiers in Pediatrics. 13 (no pagination), 2025. Article Number:
1698954. Date of Publication: 2025.
Author
Ruzgiene D.; Virsilas E.; Jankauskiene A.
Institution
(Ruzgiene, Virsilas, Jankauskiene) Clinic of Children's Diseases,
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University,
Vilnius, Lithuania
Publisher
Frontiers Media SA
Abstract
Introduction: Dehydration is the leading cause of acute kidney injury in
children, yet its true burden and clinical relevance in the general
pediatric population remain poorly characterized. The majority of existing
research on pediatric acute kidney injury primarily focuses on cases
occurring after cardiac surgery or in critically ill children, leaving
dehydration-associated AKI understudied. Method(s): A PRISMA-guided
systematic search of PubMed and EBSCO databases was conducted to identify
studies published from 2010 to 2025 investigating pediatric acute kidney
injury due to dehydration. The risk of bias was assessed using the
Newcastle-Ottawa Scale for observational studies and the modified Cochrane
Collaboration Risk of Bias 2.0 tool for randomized controlled trials.
Outcomes examined included incidence, severity, short-term and long-term
effects of acute kidney injury, and risk factors. Result(s): Out of
2,251 records, 31 studies met the inclusion criteria. Most were cohort or
case-control studies of good quality, while one randomized controlled
trial was identified as having a low risk of bias. The incidence of acute
kidney injury varied widely, with higher rates observed among younger
children. Hypovolemia, sepsis and shock were key risk factors for the
development of acute kidney injury. Stage I acute kidney injury was the
most commonly reported stage. Short-term outcomes included kidney
recovery, mortality, and hospitalization metrics; long-term data were
scarce, primarily focusing on kidney function preservation.
 Conclusion(s): Prerenal acute kidney injury dominates in high-risk
pediatric settings. Most pediatric acute kidney injury cases appear to be
unifactorial in origin. Further long-term follow-up studies are necessary
to better understand the enduring effects of acute kidney injury in
children and its potential progression to chronic kidney
disease. Copyright 2025 Ruzgiene, Virsilas and Jankauskiene.

<123>
Accession Number
2042031902
Title
Reversal of neuromuscular blockade after coronary artery bypass grafting:
a randomized control trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 612. Date
of Publication: 01 Dec 2025.
Author
Ellison M.B.; Statler A.; Grose B.; Sloyer D.; Hayanga H.; Ellison P.R.;
Funke C.
Institution
(Ellison, Statler, Grose, Sloyer, Hayanga, Ellison, Funke) West Virginia
University School of Medicine, Morgantown, WV, United States
(Ellison, Statler, Grose, Sloyer, Hayanga, Ellison) Department of
Anesthesiology, West Virginia University School of Medicine, Morgantown,
WV, United States
(Ellison, Hayanga) Division of Cardiovascular and Thoracic Anesthesiology,
West Virginia University, Morgantown, United States
(Ellison) Division of Pediatric Anesthesiology, West Virginia University,
Morgantown, United States
Publisher
BioMed Central Ltd
Abstract
Background: Early extubation in cardiac surgery improves recovery and
outcomes. Extubation of the airway after cardiac surgery in the operating
room or in the immediate postoperative period is a key component of the
optimization of outcomes in cardiac surgical patients. Specific objectives
of this study included measuring time to extubation with secondary
outcomes of post-extubation vital signs, lung function, and esophageal
motility. Exploratory parameters included ICU stay and re-intubation in 24
h. Method(s): In this study, we compare two groups of patients
undergoing coronary bypass grafting surgery (CABG) under general
anesthesia with muscle relaxation. Reversal of neuromuscular blockade
randomized to group 1: neostigmine and group 2: sugammadex. A standard
anesthetic protocol was followed throughout the perioperative period in
each of these patients with the goal of in-operating room extubation. A
two-sample t-test and/or linear model was used in the data analysis.
 Result(s): 4 subjects were not extubated in the neostigmine group
versus 1 subject in the sugammadex group. The average time to extubation
in the neostigmine group was 10.4 min, (STDEV: 5.9 min) and sugammadex was
6 min, (STDEV: 4.7 min). p = 0.001 (ANOVA). Significant secondary outcome
measures included patients who received sugammadex had higher heart rates
at the second measurement (85.0) vs. neostigmine (79.5) p = 0.047 and
higher systolic blood pressures at the second measurement point for
sugammadex (111.7) vs. neostigmine (103.9) p = 0.023. 11/36 (30%) failed
the Functional Dysphasia Screen in the neostigmine group versus 5/35 (14%)
in the sugammadex. Subjects in the neostigmine group had an average ICU
stay of 40.1 +/- 32.4 h versus 35.6 +/- 15.8 in the sugammadex group. 2
patients in the neostigmine group were re-intubated and 1 patient was
placed on non-invasive positive pressure ventilation vs. no airway
interventions in the sugammadex group. Conclusion(s): Based on the
results of this study, utilizing sugammadex for reversal of neuromuscular
blockade after CABG may increase early extubation in the operating room,
decrease the re-intubation rates, provide a very consistent level of
muscle strength for lung function, and may improve postoperative
esophageal dysmotility. Trial registration: ClinicalTrials.gov
NCT03939923, Registration date of Feb 2, 2019. Copyright © The
Author(s) 2025.

<124>
Accession Number
649655260
Title
Rilonacept as monotherapy for long-term recurrent pericarditis management:
sustained disease control over three years.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Lotan D.; Imazio M.; Klein A.L.; Brucato A.; Abbate A.; Arad A.; Cremer
P.C.; Luis S.A.; Wang S.; Curtis A.; Clair J.; Paolini J.F.
Institution
(Lotan) Columbia University Irving Medical Centre, Division of Cardiology,
Department of Medicine, New York, United States
(Imazio) University Hospital Santa Maria della Misericordia, ASUFC and
University of Udine, Cardiothoracic Department, Udine, Italy
(Klein) Cleveland Clinic, Cleveland, United States
(Brucato) University of Milan, Fatebenefratelli Hospital, Milan, Italy
(Abbate) University of Virginia, Berne Cardiovascular Research Center,
Charlottesville, United States
(Arad) Sheba Medical Center, Ramat Gan, Israel
(Cremer) Northwestern University, Chicago, United States
(Luis) Mayo Clinic, Rochester, United States
(Wang, Curtis, Clair, Paolini) Kiniksa Pharmaceuticals, Lexington, United
States
Publisher
Oxford University Press
Abstract
Background: Recurrent pericarditis (RP) predominantly shows features
consistent with IL-1-mediated chronic autoinflammatory disease (1-4). A
recent analysis suggested that supplementing anakinra with colchicine
incrementally reduced pericarditis recurrence vs. anakinra alone (5).
Rilonacept (a weekly IL-1alpha and IL-1beta cytokine trap with 6-week
washout) prevents engagement with IL-1 receptor, inhibiting both IL-1alpha
and IL-1beta activity (6). The Phase 3 trial RHAPSODY demonstrated
rilonacept efficacy in two independent analyses: Randomized Withdrawal
(RW) and Long-Term Extension (LTE) periods (7,8). Purpose(s): Assess
long-term recurrence-free persistence with rilonacept as monotherapy in
pts with RP during the combined RW and LTE periods of RHAPSODY.
 Method(s): Post-hoc analysis. Freedom from recurrence on rilonacept
monotherapy was quantified using the Kaplan-Meier (KM) method from RW
start (if randomized to rilonacept) or from initiation of bailout
rilonacept (if randomized to placebo) until the end of treatment.
Prespecified recurrence adjudication criteria were pericarditis pain
(numerical rating scale [NRS]) >=4 plus C-reactive protein (CRP) >=1
mg/dL. Per RHAPSODY protocol, background therapies were discontinued
during the Run-In Period before randomization. In pts treated with
rilonacept, concomitant colchicine was not added during theRWperiod. In
the LTE, 6.8% (5/74) of pts added colchicine: one for 2 days of chest pain
without CRP elevation, 4 in the absence of chest pain, CRP elevation, or
recurrence; these 5 pts were censored in the KM curve at 6 days after last
rilonacept dose or at colchicine initiation (whichever was first). One
additional pt added colchicine prophylactically before an intentional
rilonacept treatment interruption for elective cardiac surgery and
experienced a recurrence after this interruption; this pt was not censored
from the recurrence-free persistence analysis at colchicine initiation in
order to capture this event. Result(s): 74 pts (mean [SD] age 43.9
[15.7] years, 83.8% idiopathic pericarditis, mean [SD] disease duration
2.5 [3.2] years) were analyzed over three years. Rilonacept was well
tolerated. Recurrence-free persistence was 95.9% (n=71/74) while receiving
rilonacept as monotherapy (Figure 1). The three observed adjudicated
recurrences were each associated with temporary interruptions of 1-3 doses
of rilonacept. Conclusion(s): Rilonacept as monotherapy provided
recurrence-free persistence over the three-year trial duration when used
continuously without interruption; pericarditis recurrences occurred only
after interruptions. These findings support evidence-based use of
rilonacept as monotherapy, minimizing the need for adjunctive treatments
and reducing polypharmacy in long-term RP management. Further
investigations are warranted to address how to assess pts as candidates
for long-term treatment with rilonacept and when to cease rilonacept
treatment.

<125>
Accession Number
649653044
Title
Perioperative rehabilitation in patients undergoing elective cardiac valve
surgery--a randomised controlled trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Ma H.; Liu Y.T.; Liu F.Y.; Xu M.Y.; Wang H.C.; Bai B.Q.; Zhou H.F.; Sun
Y.J.; Cao P.H.; Chen J.Y.; Guo L.
Institution
(Ma, Liu, Liu, Xu, Wang, Bai, Zhou, Chen, Guo) Guangdong Provincial
People's Hospital, Guangzhou, China
(Sun, Cao) Clinical Research Center, Zhujiang Hospital, Southern Medical
University, Guangzhou, China
Publisher
Oxford University Press
Abstract
Background: Patients with valvular heart disease are at high risk for
postoperative pulmonary complications (PPCs), which contribute to
morbidity and mortality after surgery. However, few studies have
specifically focused on perioperative rehabilitation in this patient
population. Method(s): This single-center, randomized controlled
trial evaluated a perioperative rehabilitation (PORT) bundle comprising
four components: education, inspiratory muscle training (IMT), active
cycle of breathing techniques (ACBT), and early mobilization (EM). The
primary outcome was a composite measure of the occurrence of PPCs within
the first 7 days, postoperative hospitalization exceeding 7 days, and
in-hospital all-cause mortality, with each component also considered
individually. Secondary outcomes included the length of stay in the
surgical intensive care unit, total postoperative hospitalization 3-month
all-cause mortality, and non-surgical costs. Result(s): Both groups
were comparable at baseline. After surgery, the composite outcome was
observed in 206 (51.6%) of 399 patients in the PORT group and 224 (53.5%)
of 419 patients in the usual care group (odds ratio [OR], 0.881; 95%
confidence interval [CI], 0.663 to 1.167, p = 0.376). PPCs were present in
161 (40.4%) patients in the PORT group and 197 (47.1%) patients in the
usual care group (OR, 0.720; 95%CI, 0.541 to 0.956, p = 0.023).
Postoperative hospital stay was prolonged to more than 7 days in 241
(29.5%) of 818 patients, with no significant difference between the two
groups. Deaths occurred in 3 (0.8%) patients receiving perioperative
rehabilitation and 4 (1%) patients receiving usual care (hazard ratio [HR]
0.648; 95% CI, 0.140 to 2.993, p = 0.578). No significant differences were
found between groups for secondary outcomes. Conclusion(s): The
results of this study indicate that perioperative rehabilitation
significantly reduces the incidence of PPCs in patients with valvular
heart disease. Therefore, we recommend incorporating comprehensive
perioperative rehabilitation into the clinical management of patients
undergoing cardiac valve surgery.

<126>
Accession Number
649656831
Title
iFR vs. FFR for coronary revascularization: safety and outcomes.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Vilela M.; Menezes M.N.M.; Ferreira D.F.; Raposo M.R.; Cazeiro D.C.;
Abrantes A.A.; Gregorio C.G.; Esteves S.E.; Rodrigues T.R.; Jorge C.J.;
Marques J.M.; Carrilho P.C.; Cardoso P.C.; Pinto F.P.
Institution
(Vilela, Menezes, Ferreira, Raposo, Cazeiro, Abrantes, Gregorio, Esteves,
Rodrigues, Jorge, Marques, Carrilho, Cardoso, Pinto) Hospital Santa Maria,
Cardiology Department, ULSSM, CAML, CCULatRISE, Lisbon, Portugal
Publisher
Oxford University Press
Abstract
Introduction: Coronary revascularization guided by functional assessment
has been shown to improve patient outcomes compared to revascularization
guided by angiography alone. Randomized clinical trials have demonstrated
that coronary revascularization guided by instantaneous wave-free ratio
(iFR) is noninferior to fractional flow reserve (FFR) in terms of major
adverse cardiac events at 1 year. However, the 5-year results of the
DEFINE-FLAIR trial raised concerns due to an observed increase in
all-cause mortality in the iFR arm, contrary to the iFR SWEDEHEART trial.
The aim of this study is to validate the safety of performing iFR versus
FFR in a large real-world long term dataset, focusing on major adverse
cardiac events. Method(s): This retrospective, single-center,
observational cohort study included patients undergoing coronary
angiography guided by functional assessment from 2012 to 2022 in a
tertiary center . Two groups were analyzed: patients assessed with FFR and
those with iFR. Differences between the groups were evaluated using the
chi-square, independent t-test or Mann-Whitney U test. Kaplan-Meier
survival curves and Cox regression analysis were used to evaluate the
primary composite outcome of death or myocardial infarction at two-year
follow-up Results: A total of 543 patients were included, with a mean age
of 67+/-10 years; 77% were male. Of these, 161 underwent FFR and 382
underwent iFR. There were no significant differences between the groups in
sex distribution, relevant comorbidities, or baseline left ventricular
ejection fraction, except for a higher prevalence of previous smoking and
chronic kidney disease in the iFR group. The most commonly evaluated
vessel in both groups was the left anterior descending artery, followed by
the right coronary artery and the circumflex artery. Medical therapy was
more common in the iFR group (59% vs. 52%, p=0.02), and PCI was performed
less frequently (32% vs. 42%, p=0.03). The mean procedure time was shorter
in the iFR group (56 vs. 62 minutes, p=0.005), with lower radiation doses
(6.4 +/- 2.8 vs. 11.6 +/- 4.6 Gy). The primary composite outcome of death
or myocardial infarction occurred in 37 patients in the iFR group and 16
patients in the FFR group, with no significant difference between the
groups. Similarly, no difference was observed in all-cause mortality (7.1%
vs. 7.3%). Conclusion(s): In this real-world cohort, no significant
differences were observed in the primary composite outcome of death or
myocardial infarction at two-year follow-up between patients undergoing
coronary revascularization guided by iFR versus FFR. Although iFR was
associated with shorter procedure times, lower radiation doses, and less
frequent PCI, the safety profile of iFR appeared comparable to FFR, with
no significant differences in all-cause mortality. This result is in
agreement with the iFR Swedeheart trial, further strengthening the safety
of using iFR for revascularization decisions.

<127>
Accession Number
649657674
Title
Comparison of outcomes between TAVI and SAVR in patients with bicuspid
aortic valve stenosis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Faierstein K.; Moshkovitz D.M.; Caller T.C.; Ash A.A.; Raphael R.R.; Cohen
I.C.; Makmal N.M.; Mazor Dray E.M.; Maor E.M.; Regev E.R.; Segev A.S.;
Barbash I.B.; Fefer P.F.
Institution
(Faierstein, Moshkovitz, Caller, Ash, Raphael, Cohen, Makmal, Mazor Dray,
Maor, Regev, Segev, Barbash, Fefer) Sheba Medical Center, Division of
Cardiology, Ramat Gan, Israel
Publisher
Oxford University Press
Abstract
Background: Aortic valve stenosis may be treated surgically or
percutaneously using transcatheter aortic valve implantation (TAVI).
 Objective(s): This study aimed to compare outcomes of patients with
bicuspid valve aortic stenosis undergoing TAVI versus surgical aortic
valve replacement (SAVR). Method(s): A retrospective cohort analysis
of 581 patients with bicuspid aortic valve stenosis was conducted, of whom
71 (12%) underwent TAVI and 510 (88%) underwent SAVR. The mean age was
76+/-8 and 60+/-12 in the TAVI and SAVR groups, respectively. We excluded
patients with pure aortic insufficiency. Due to age differences, we
employed a matched model and subsequently conducted a multivariate Cox
regression analysis with adjustment for mortality predictors and baseline
characteristics. Using this model, we investigated the association between
the procedure conducted and overall survival, as well as post-procedural
clinical outcomes. Result(s): Overall, 125 patients died during a
mean follow-up period of 9+/-4 years. Of these, 24 were in the TAVI group
and 101 were in the SAVR group. The study demonstrated that patients with
bicuspid aortic valve stenosis undergoing TAVI are more likely to die
compared with SAVR [HR=6.4, 95% CI 3.9-10.4, p<0.001] (figure 1A). Fifty
patients developed life-threatening conduction abnormalities that
necessitated pacemaker implantation; 20 (28%) patients in the TAVI group
and 30 (6%) patients in the SAVR group, OR=8.2, 95% CI 3.1-21.7, p<0.001
(figure 1B). Patients in the TAVI group suffered from increased rates of
paravalvular leaks; OR=7.2, 95% CI 2.8-18.5, p<0.001, and heart failure
hospitalisations; incidence rate ratio=7.9, 95% CI 5.7-10.9, p<0.001.
There was no meaningful difference in stroke/TIA rates between the groups
(figure 1C). To overcome the differences between the groups, we applied a
1:1 match according to patients' age. The matched model demonstrated
consistent results with an increased mortality rate (HR=2.3, 95% CI
1.3-4.3, p=0.005) and elevated rates of pacemaker implantation in the TAVI
group (OR=5.5, 95% CI 2.1-14.4, p=0.005). We have demonstrated consistent
results after adjusting the model for baseline characteristics and
mortality predictors; mortality HR=2.8, 95% CI 1.2-6.5, p=0.02, pacemaker
implantation OR=5.8, 95% CI 1.6-21.2, p=0.008. The matched model also
demonstrated an elevated risk for heart failure hospitalisations; incident
risk ratio 3.2, (95% CI 2.1-4.9, p<0.001), and no meaningful differences
in stroke/TIA rates (figure 2). Conclusion(s): Patients with bicuspid
aortic valve stenosis had better outcomes when undergoing SAVR compared to
TAVI, albeit with no difference in stroke/TIA rates. Further research in
the form of a randomised controlled trial is required in order to better
understand the differences between a surgical approach and a transcatheter
approach.

<128>
Accession Number
649657293
Title
Optimal timing of percutaneous coronary intervention in patients with
severe aortic stenosis and coronary artery disease undergoing
transcatheter aortic valve implantation.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Gupta S.; Tripathi R.; Tam E.; Rahman T.; Mann N.; Tao M.
Institution
(Gupta, Tripathi, Tam, Rahman, Mann, Tao) Stony Brook University Hospital,
Stony Brook, United States
Publisher
Oxford University Press
Abstract
Background: Although patients with severe aortic stenosis (AS) often also
have significant concomitant coronary artery disease (CAD), the optimal
timing of percutaneous coronary intervention (PCI) in relation to
transcatheter aortic valve implantation (TAVI) remains uncertain.
 Purpose(s): This meta-analysis evaluates the association of pre-TAVI
PCI, concurrent PCI at the time of TAVI, and post-TAVI PCI on risk of
all-cause mortality. Method(s): A literature search was conducted
using the databases Pubmed, Embase, and Web of Science, looking for
studies that evaluated the association of different timing of PCI with
risk of the primary endpoint, all-cause mortality, in patients with CAD
and severe AS undergoing TAVI. The search was not restricted by time or
publication status. Result(s): A total of 8 studies including 8,506
patients met the inclusion criteria. Patients were categorized into three
groups: pre-TAVI PCI (n=2,323), concurrent PCI at TAVI (n=1,635), and
staged post-TAVI PCI (n=4,548). The mean follow-up duration was 10.5
months, the mean age was 81 years, and 55% of the cohort were men.
Compared to both pre-TAVI PCI and concurrent PCI strategies, post-TAVI PCI
was associated with a significantly lower risk of all-cause mortality on
follow-up in patients with CAD and severe AS (OR 2.11, 95% CI 1.41-3.17;
p<0.01; OR 1.50, 95% CI 1.0-2.23; p=0.05). There was no significant
difference in risk of all-cause mortality between pre-TAVI PCI and
concurrent PCI at the time of TAVI (OR 0.95, 95% CI 0.77-1.19; p=0.68).
 Conclusion(s): Based on the findings from this meta-analysis,
deferring PCI until after TAVI may be associated with lower risk of
mortality compared to performing PCI prior to or at the time of TAVI.
However, additional high quality studies are needed to further establish
these findings and to optimize the revascularization strategies for this
patient population.

<129>
Accession Number
649655329
Title
A head-to-head comparison of physiology versus angiography-guided coronary
artery bypass grafting.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Silva A.; Santos T.; Simoes M.; Batista G.; Fernandes R.; Lopes V.;
Resende B.; Carlos T.; Grine M.; Rocha L.; Martins J.; Costa M.; Goncalves
L.
Institution
(Silva, Santos, Simoes, Batista, Fernandes, Lopes, Resende, Carlos, Grine,
Rocha, Martins, Costa, Goncalves) Centro Hospitalar E Universitario De
Coimbra, Cardiology Department A, HUC-CHUC, Coimbra, Portugal
Publisher
Oxford University Press
Abstract
Introduction: While invasive coronary angiography is considered the gold
standard for the diagnosis of coronary artery disease (CAD) involving the
epicardial coronary vessels, coronary physiology-guided revascularization
represents a contemporary gold-standard practice for the invasive
management of patients with intermediate CAD. Nevertheless, the long-term
results of assessing the severity of stenosis through physiology compared
to the angiogram as the guide to bypass surgery - coronary artery bypass
grafting (CABG) are still uncertain. Method(s): We searched Medline,
EMBASE, and the Cochrane Library until December 2023, including all
previous studies. We aimed to assess the clinical outcomes of a
physiology-guided CABG compared to the angiography-guided CABG. A pooled
odds-ratio meta-analysis was conducted focusing on five main outcomes:
all-cause death, myocardial infarction (MI), target vessel
revascularization (TVR), major adverse cardiovascular events (MACE), and
postoperative angina. A pooled effect estimates meta-analysis was
performed with MetaXL 2.0. Result(s): We identified six studies that
included a total of 18,849 patients. The follow-up ranged from 6 months to
6 years. A pooled meta-analysis showed no significant difference between
physiology and angiography-guided strategies in all-cause death (odds
ratio [OR] = 0.80; 95%CI = 0.50-1.28; I2 = 20%; p = 0.28), MACE (OR =
0.78; 95%CI = 0.55-1.09; I2 = 0%; p = 0.99), MI (OR = 0.95; 95%CI,
0.70-1.29; I2 = 0%; p = 0.61), and TVR (OR = 1.17; 95%CI = 0.91-1.51; I2 =
0%; p = 0.67). The rates of postoperative angina were also similar in both
approaches (OR = 1.71; 95%CI = 0.39-7.38; I2 = 0%; p = 0.32).
 Conclusion(s): This meta-analysis suggests that physiology-guided and
angiography-guided CABG strategies exhibit comparable clinical outcomes,
questioning the role of coronary physiology in surgical patients. Further
research is needed to address this clinical concern.

<130>
Accession Number
649654580
Title
Enhanced recovery after surgery in minimally invasive heart valve surgery
- insights from the INCREASE trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Girdauskas E.; Petersen J.; Stock S.; Vettorazzi E.; Ozga A.K.; Zapf A.;
Brettschneider C.; Dolata L.; Loewe B.; Schmid M.; Schulte-Uentrop L.;
Dumps C.; Zastrow I.; Reichenspurner H.; Klotz S.
Institution
(Girdauskas, Stock, Schmid, Dumps) University Hospital Augsburg, Augsburg,
Germany
(Petersen, Dolata, Reichenspurner) University Heart and Vascular Centre
Hamburg (UHZ), Hamburg, Germany
(Vettorazzi, Ozga, Zapf, Brettschneider, Loewe, Schulte-Uentrop, Zastrow,
Klotz) University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Publisher
Oxford University Press
Abstract
Background: Enhanced recovery after surgery (ERAS) protocols are
patient-centered and interprofessional perioperative care models, aiming
to reduce hospital stay, complications, and to improve patient
satisfaction. However, in cardiac surgery, the evidence for ERAS is low.
 Purpose(s): The INCREASE trial aims to evaluate the efficacy and the
safety of ERAS-based intervention in cardiac surgery. Method(s): The
INCREASE trial is a randomized, parallel, two-arm trial designed to
compare the ERAS protocol with standard of care in minimally invasive
heart valve surgery. The trial was conducted in an interprofessional
consortium consisting of 2 university hospitals, 7 referring hospitals, 8
rehabilitation centers, a health insurance company and a patient
organization. The intervention group (IG) received treatment according to
the standardized ERAS protocol, which included prehabilitation, early
extubation, and modifications in the postoperative care e.g. physiotherapy
beginning at 3hours postoperatively. The control group (CG) received
treatment as usual. Two co-primary endpoints were considered: a)
in-hospital stay (days) within 1 year after surgery due to cardiac causes
(superiority hypothesis), b) physical performance measured by 6-minute
walk test (6MWT) at hospital discharge (non-inferiority hypothesis).
Primary outcome analysis included only surgically treated patients
(modified intention to treat (mITT) population). Result(s): 201
patients (mean age 57+/-13 years, 72% male) scheduled for minimally
invasive valve surgery were randomized into IG (n=101) and CG (n=100)
between 09/2021 and 05/2023. 190 patients (93 IG vs. 97 CG) served as mITT
population. Total weighted in-hospital stay (weights= individual study
duration) within 1 year after surgery due to cardiac causes was 9.0+/-11.6
days in the IG and 11.7+/-13.1 days in the CG (adjusted mean difference
-2.7, 95%CI (-6.3, 0.9), p=0.07). Sensitivity analyses using the negative
binomial model revealed an adjusted ratio of 0.71, 95% CI (0.6, 0.85),
p<0.01) in favor of IG. The 6MWT measured 380.0+/-117.5 m in the IG vs
382.8+/-106.0 m in the CG in the per-protocol (PP) population. After
adjustment for baseline 6MWT, the mean difference between the groups was
-14%, 95%CI (-43%, 15%) with the lower limit of the confidence interval
exceeding the non-inferiority margin of -15% (one-sided p=0.48). Without
adjustment for baseline, a mean difference in 6MWT values between the
groups was -1%, 95%CI (-10%, 8%), reaching non-inferiority in the IG
(one-sided p=0.001). Conclusion(s): The ERAS protocol is feasible and
safe in minimally invasive heart valve surgery. Despite the fact that the
primary endpoint was not achieved, ERAS treated patients had shorter
in-hospital stay within 1 year after surgery due to cardiac reasons
compared to the control group. Despite earlier hospital discharge, ERAS
patients had similar physical performance to the control group when the
difference in the baseline 6MWT was disregarded.

<131>
Accession Number
649656560
Title
Geranylgeranylacetone as prevention for postoperative Atrial Fibrillation
(GENIALITY trial).
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Silva Ramos K.; Nassiri S.; Wijdeveld L.F.J.; Van Der Palen R.L.; Kuipers
M.F.; True Hills M.; Slijkerman P.; Van Raalte D.H.; Handoko M.L.; De
Groot N.M.S.; Grewal N.; Klautz R.J.M.; Eringa E.C.; Brundel B.J.J.
Institution
(Silva Ramos, Wijdeveld, Van Der Palen, Eringa, Brundel) Amsterdam
University Medical Centre, Department of Physiology, Amsterdam
Cardiovascular Sciences, Amsterdam, Netherlands
(Nassiri, Handoko) Amsterdam University Medical Centre, Department of
Cardiology, Amsterdam, Netherlands
(Kuipers) AFIP foundation, Amsterdam, Netherlands
(True Hills) StopAfib.org, Decatur, TX, United States
(Slijkerman) Amsterdam University Medical Centre, Innovation Exchange
Amsterdam, Amsterdam, Netherlands
(Van Raalte) Amsterdam University Medical Centre, Diabetes Center,
Department of Internal Medicine, Amsterdam, Netherlands
(De Groot) Erasmus University Medical Centre, Department of Cardiology,
Rotterdam, Netherlands
(Grewal) Amsterdam University Medical Centre, Department of Cardiothoracic
Surgery, Amsterdam, Netherlands
(Klautz) Amsterdam University Medical Centre, Department of Cardiothoracic
surgery, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Introduction: Atrial fibrillation (AF) is the most common cardiac
arrhythmia. Interestingly 30-50% of patients undergoing elective
cardiothoracic surgery develop postoperative AF (PoAF). Unfortunately,
preventive PoAF therapy is still suboptimal. In our previous studies we
showed that cardioprotective heat shock protein (HSP) levels are increased
by oral GeranylGeranylAcetone (GGA) administration. In line, GGA treatment
protects against AF onset and progression in clinically relevant animal
model studies Purpose: To evaluate whether oral administration of GGA
protects against incidence of PoAF on patients undergoing elective
cardiothoracic surgery Methods: The trial is a phase II single-center,
double-blind, placebo-controlled randomized trial. Participants (N=146)
are adult patients without any registered history of AF, undergoing
elective open-heart surgery for mitral and/or valve repair, and/or
coronary artery bypass grafting, are allocated with ratio 1:1 in treatment
or placebo groups. Daily administration of 300mg of GGA or placebo starts
five days before until three days after surgery. In order to assess
cardiac rhythm, as primary endpoint, bedside cardiac monitoring is
performed after surgery until hospital discharge. The patients undergo
blood, right atrial appendage and epicardial adipose tissue sampling in
order to assess proteostasis levels, as secondary endpoints
 Conclusion(s): The trial aims to reduce PoAF incidence in GGA group
compared to placebo group, by increase of cardioprotective HSPs Herewith,
we expect to obtain proof of concept for a beneficial effect of GGA in
preventing PoAF in patients undergoing cardiothoracic surgery.

<132>
Accession Number
649654150
Title
Levosimendan versus milrinone in children undergoing cardiac surgery: a
systematic review and meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Abraham D.; Ribeiro V.; Soares V.; Fontenele L.; Sousa P.; Lima N.;
Bendaham L.; Faria N.; Alves Filho W.; Moulaz I.
Institution
(Abraham) Federal University of Amazonas, Manaus, Brazil
(Ribeiro) Federal University of Piaui, Teresina, Brazil
(Soares) Federal University of Jequitinhonha and Mucuri Valleys, Ouro
Preto, Brazil
(Fontenele) Universidade Federal do Delta do Parnaiba, Parnaiba, Brazil
(Sousa) Federal University of Uberlandia, Uberlandia, Brazil
(Lima) Unichristus, Fortaleza, Brazil
(Bendaham) Federal University of Roraima, Boa Vista, Brazil
(Faria, Moulaz) Heart Institute (InCor) HCFMUSP, Sao Paulo, Brazil
(Alves Filho) Federal University of Ceara, Fortaleza, Brazil
Publisher
Oxford University Press
Abstract
Background: Patients undergoing ventricular septal defect or tetralogy of
Fallot correction receive inotropic agents that are often required after
corrective surgery to support cardiac function. However, the optimal
choice between levosimendan and milrinone remains controversial.
 Purpose(s): We aimed to conduct a meta-analysis to access the main
comparison between the effect and safety of prophylactically administered
levosimendan and milrinone about patient's clinical and laboratory
improvement Methods: We systematically searched PubMed, Embase, and
Cochrane databases for randomized controlled trials (RCTs) comparing
levosimendan and milrinone about patients undergoing ventricular septal
defect or tetralogy of Fallot correction. The outcomes analyzed were:
cardiac index, cardiac index in 12h, cardiac index in 24h, lactate lactate
in 12h and lactate in 24h. Statistical analyses were performed using R
software version 5.4.1. We assessed mean differences (MD) for continuous
outcomes under a random effects model with 95% Confidence Intervals (CI),
with a p-value < 0.05 considered for statistical significance.
 Result(s): We included 4 RCTs, comprising 135 children, of whom 68
(50.3%) received levosimendan. There were no significant differences
between groups regarding cardiac index (0.09; 95% CI -0.18 to 0.37;
p=0.62; I2=0%; Figure 2.A) and lactate (-0.04; 95% CI -0.18 to
0.10; p=0.22; I2=26%, Figure 1.A). Furthermore, there was no
statistically significant difference between the groups in the subgroup
analysis for the cardiac index in 12 hours ( -0.01; 95% CI -0.54 to 0.52;
p=0.19; I2=41%, Figure 2.B) and 24 hours ( 0.21; 95% CI -0.25
to 0.66; p=0.47; I2=0% Figure 2.C) and lactate in 12 hours
(0.12; 95% CI -0.13 to 0.37; p=0.79; I2=0%, Figure 1.B) and in
24 hours ( -0.21; 95% CI -0.55 to 0.13; p=0.43; I2=0%, Figure
1.C). Conclusion(s): Our study demonstrated no significant
differences between levosimendan and milrinone regarding cardiac index and
lactate in children undergoing ventricular septal defect or tetralogy of
Fallot correction.

<133>
Accession Number
649654214
Title
Uncorrecting" congenitally corrected TGA: does double switch repair in the
contemporary era improve outcomes?.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Mishra S.; Deva M.; Khanna S.; Choudhary P.
Institution
(Mishra) Children's Hospital at Westmead, Westmead, Australia
(Deva, Choudhary) Blacktown Hospital, Department of Cardiology, Blacktown,
Australia
(Khanna) University of New South Wales Sydney, Sydney, Australia
Publisher
Oxford University Press
Abstract
Background: Congenitally corrected transposition of the great arteries is
a rare condition which can be detected late in life due to heart failure
and arrhythmia. Failure of the systemic RV is the most common cause of
death with limited pharmacologic strategies for remodelling. Double-switch
repair offers the opportunity for a systemic left ventricle with training
for systemic pressure and may improve long-term survival. Surgical
experience is limited. Aim(s): We sought to systemically review
literature to evaluate outcomes of patients undergoing double switch
repair with other forms of anatomical repair Methods: A systematic
literature review was conducted according to the PRISMA guidelines using
the databases PubMed, Cochrane Central Register of Controlled Trials,
Scopus and Medline (2000-2024; English only). Out of the 44 total studies
screened, a total of 22 peer-reviewed articles fulfilled the criteria for
inclusion. A total of 1398 patients were included in our meta-analysis,
516 of whom had double switch operation and 865 patients with a
biventricular circulation who had either no repair or repair of associated
lesions. Demographic data, peri-procedural outcomes and long-term
survival, re-intervention and pacing rates were collated as pooled data.
 Result(s): Patients with DSO were younger (mean age DSO 3.5
years/non-DSO 6.5 years, p=0.008), had a lower weight at time of operation
(DSO 10.9 kg/non-DSO 16.5 kg), and more likely to have pre-operative
tricuspid regurgitation. Post-operatively, LV dysfunction was more
prevalent in the DSO group (17.7% DSO vs. 2.8% non-DSO, p<0.001), more
likely to have reoperation on neo aortic valve (10.5% DSO vs 0.78%
non-DSO), and more likely to require permanent pacing (19% DSO vs 6.5%
non-DSO, p=0.005 ). There were no statistically significant differences in
groups in heterotaxy (3% DSO vs 4% non-DSO, p=0.7), postprocedural
mortality (13.5% DSO vs 16% non-DSO, p=0.726) and transplant free survival
at 5 years (93% DSO vs 75% non-DSO, p=0.939). Conclusion(s): There
were no significant differences in 5-year transplant free survival or in
re-intervention rates among patients who underwent DSO compared to those
who had physiological or no repair. Risk of LV dysfunction was higher as
was risk of pacemaker implantation. DSO is a viable short-term option in
patients with complicated anatomy or valvular disease, however longer-term
follow up into adulthood is important.

<134>
Accession Number
649657393
Title
Short and long-term complications of transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Castillo Perez M.; De Leon Gutierrez H.; Jerjes Sanchez C.; Royzman Rivera
L.; Paredes Vazquez J.G.; Jimenez Franco V.; Gutierrez Gallegos P.; Cabada
Garcia M.J.; Rodriguez Rivera J.; Paredes Gutierrez E.; Quevedo Salazar R.
Institution
(Castillo Perez, De Leon Gutierrez, Jerjes Sanchez, Royzman Rivera,
Paredes Vazquez, Jimenez Franco, Gutierrez Gallegos, Cabada Garcia,
Rodriguez Rivera, Paredes Gutierrez, Quevedo Salazar) Centro Medico
Zambrano Hellion - TecSalud, San Pedro Garza Garcia, Mexico
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is superior or
non-inferior to surgical aortic valve replacement (SAVR) across all
surgical risk groups in patients with severe aortic stenosis (1-3).
TAVR-related complications remain a significant concern, with their
incidence varying based on the type of prosthesis used, such as
self-expanding valves (SEVs) and balloon-expandable valves (BEVs).
 Purpose(s): To identify the cumulative incidences of short and
long-term complications among different transcatheter heart valve (THV)
prostheses used in TAVR. Method(s): We conducted a systematic review
and meta-analysis according to PRISMA and PROSPERO statements from 2002 to
April 2024. We included patients with severe aortic stenosis treated with
transfemoral TAVR who reported short or long-term complications. The
studies included in the analysis explicitly specified the type of valve
used. We calculated the cumulative incidence of each complication
according to each type of valve using the random-effects model.
 Result(s): We included 242 papers with 181,187 patients. Patients
received the THV prosthesis via transfemoral access (97.1%), with most
being BEVs (54.2%) and SEVs (43.5%). The most common short-term
complications across all models were permanent pacemaker implantation
(PPI) (12.6%), major or life-threatening bleeding (5.1%), acute kidney
injury (4.7%), major vascular complications (3.4%) and stroke (2.5%).
Long-term complications in the first year were valve dysfunction (1.2%),
endocarditis (0.9%), and valve thrombosis (0.2%). The earliest models had
the highest cumulative incidence of complications, showing significant
improvement with newer generations. The third-generation BEV had the
lowest incidence of moderate to severe paravalvular leak (PVL) (1.04, 95%
CI: 0.69 - 1.55) and stroke (1.87, 95% CI: 1.64-2.14); PPI is the most
frequent complication, with third-generation BEVs and a third-generation
SEV showing fewer cumulative incidence (7.7, 95% CI: 5.82-10.11). The
safety profile of TAVR has improved significantly, with reductions in
major vascular complications with third-generation SEVs and BEVs (3.56,
95% CI: 2.77-4.57 and 3.87, 95% CI: 3.22-4.66, respectively) and major or
life-threatening bleeding (2.96, 95% CI: 2.09-4.17 and 4.8, 95% CI:
4.04-5.69, respectively). Conclusion(s): PVL were more common among
SEVs. PPI is the most frequent complication, with some THV prostheses
showing a better safety profile. Stroke remained consistent among the new
generation of THVs. Annular rupture, coronary artery obstruction, and
valve embolization are rare complications (<1%). Longer follow-ups in
registries are necessary to provide cumulative data on long-term
complications and valve durability.

<135>
Accession Number
649653876
Title
Audiovisual distraction reduces sedative requirements and enhances patient
satisfaction during mitral transcatheter edge-to-edge repair.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Rawish E.; John M.; Lemmer F.; Constantz A.; Genske F.; Marquetand C.;
Alessandrini H.; Alhagi M.; Erber K.; Kellner P.; Saraei R.; Stiermaier
T.; Eitel I.; Frerker C.; Schmidt T.
Institution
(Rawish, John, Lemmer, Constantz, Genske, Marquetand, Alessandrini,
Alhagi, Erber, Kellner, Saraei, Stiermaier, Eitel, Frerker, Schmidt)
Schleswig-Holstein University Clinic, Lubeck Campus, Luebeck, Germany
Publisher
Oxford University Press
Abstract
Background: Transcatheter mitral-valve repair is increasingly performed
under conscious sedation to minimize the risks associated with general
anesthesia, particularly in patients with advanced cardiovascular
conditions. However, patient discomfort, anxiety, and management of
sedation levels can be challenging. Whether audiovisual distraction (AVD)
techniques can reduce sedative requirements and enhance patient
satisfaction in patients undergoing transcatheter mitral-valve repair is
unclear. Method(s): We conducted a single-center, randomized
controlled trial to assess whether AVD with video glasses and headphones
can lower the sedation dose needed during mitral transcatheter
edge-to-edge repair (M-TEER) and improve the overall procedural experience
for patients. Patients were assigned in a 1:1 ration either to inactive
video glasses (control group) or active video glasses (AVD group) during
M-TEER. The primary outcome was the dosage of administered propofol.
Secondary outcomes included procedural time, patient satisfaction (ZUF-8
score) anxiety, and pain levels before and after M-TEER. Result(s): A
total of 56 patients undergoing M-TEER underwent randomization: 26 were
assigned to the control group and 30 to the AVD group. The AVD group
required significantly less propofol (4.6 +/- 1.6 mg/kg/h vs. 5.8 +/- 1.4
mg/kg/h, p=0.005) and reported higher comfort levels during the procedure.
Procedural time did not differ significantly between groups (102.2 +/- 36
min vs. 91.0 +/- 32.7 min, p=0.24). The ZUF-8 scores indicated a
significant increase in patient satisfaction in the AVD group (24.7 +/-
3.0 vs. 22.5 +/- 3.0, p=0.008). Anxiety levels were significantly lower in
the AVD group immediately after the procedure compared with the control
group (Numeric Rating Scale , NRS 1.1 +/- 1.0 vs. 2.6 +/- 1.8; p=0.001).
Pain levels remained low in both groups without significant intergroup
differences. Conclusion(s): AVD via video glasses effectively reduces
sedative requirements and improves patient satisfaction and anxiety
management in patients undergoing M-TEER under conscious sedation. This
technique holds potential as a non-invasive adjunct to enhance procedural
comfort and reduce pharmacological sedation in interventional cardiology.
Further studies with larger samples could provide additional insights into
its benefits for patient-centered care in interventional cardiology.

<136>
Accession Number
649654854
Title
Antithrombotic strategies and DOAC dosing following left atrial appendage
occlusion: a network meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Samaras A.; Karakasis P.; Feidakis A.; Giannakoulas G.; Fragakis N.;
Nielsen-Kudsk J.E.; Freixa X.; Nair D.G.; Freeman J.V.; Bergmann M.;
Landmesser U.; Tzikas A.
Institution
(Samaras, Karakasis, Fragakis, Tzikas) Hippokration General Hospital of
Thessaloniki, Thessaloniki, Greece
(Feidakis) University hospital Koln, Cologne, Germany
(Giannakoulas) Ahepa University Hospital, 1st Cardiology department,
Thessaloniki, Greece
(Nielsen-Kudsk) Aarhus University Hospital, Aarhus, Denmark
(Freixa) Hospital Clinic of Barcelona, Barcelona, Spain
(Nair) St Bernard's Heart and Vascular Center Jonesboro, Cardiac
Electrophysiology, Arkansas, United States
(Freeman) Yale New Haven Hospital, Center for Outcomes Research and
Evaluation, New Haven, United States
(Bergmann) Asklepios Clinic Altona, Cardiology and Intensive Care
Medicine, Hamburg, Germany
(Landmesser) Charite University Hospital, German Centre for Cardiovascular
Research (DZHK), Berlin, Germany
Publisher
Oxford University Press
Abstract
Background/Introduction: The optimal short-term antithrombotic strategy
following left atrial appendage occlusion (LAAO) remains uncertain with
the need to balance thromboembolic prevention and bleeding risk presenting
a critical challenge. Recent evidence suggests that direct oral
anticoagulants (DOACs), may provide a favorable safety-efficacy profile,
with low-dose regimens showing potential benefits during the device
endothelialization period. Purpose(s): This network meta-analysis
(NMA) aimed to compare the efficacy and safety of various antithrombotic
strategies, including DOAC dosing, following LAAO. Method(s): A
systematic review and NMA were conducted following Cochrane and PRISMA
guidelines. Eligible studies included randomized controlled trials and
observational studies comparing at least two antithrombotic regimens in
patients with non-valvular atrial fibrillation undergoing LAAO. Primary
outcomes were major bleeding and thromboembolism. Secondary outcomes
included device-related thrombosis (DRT) and all-cause mortality. Pairwise
and network meta-analyses were performed using a random-effects model.
 Result(s): A total of 52 studies involving 69751 patients were
included. DOACs were consistently associated with significantly lower
rates of major bleeding and all-cause mortality than other antithrombotic
regimens. Low-dose DOACs showed a potential advantage over standard-dose
DOACs in reducing major bleeding risk (RR 0.45, 95% CI: 0.22-0.92). Both
standard- and low-dose DOACs reduced the risks of thromboembolism and DRT
compared to antiplatelet therapy. In ranking analysis, DOACs emerged as
the most effective and safest antithrombotic strategy, with low-dose DOACs
demonstrating further safety benefits in bleeding outcomes (Figure 1).
 Conclusion(s): DOACs provide a superior safety-efficacy profile
compared to other antithrombotic strategies following LAAO, significantly
reducing the risks of major bleeding, thromboembolic events, and
mortality. While low-dose DOACs may offer additional bleeding risk
reduction without compromising efficacy, further research is warranted to
confirm their role in clinical practice.

<137>
Accession Number
649655301
Title
Comparative outcomes of combined left atrial appendage occlusion and
catheter ablation versus isolated procedures in atrial fibrillation: a
network meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Benhammou M.; Haidarah A.; Guerguer W.; Saleh S.; Al-Allawee A.S.; Elhadi
M.
Institution
(Benhammou) University of Oran 1 Ahmed Ben Bella, Faculty of medicine,
Oran, Algeria
(Haidarah, Haidarah, Haidarah, Haidarah) Sichuan University, Department of
Cardiology, West China Hospital, Sichuan, China
(Guerguer, Guerguer, Guerguer) University of Algiers 1, Faculty of
Medicine, Algiers, Algeria
(Saleh, Saleh) Hashemite University, Zarqa, Jordan
(Al-Allawee) University of Fallujah, College of Medicine, Fallujah, Iraq
(Elhadi) Korea University, College of Medicine, Seoul, South Korea
Publisher
Oxford University Press
Abstract
Introduction: The left atrial appendage (LAA) is the primary source of
thrombi in over 90% of patients with non-valvular atrial fibrillation
(AF). Consequently, LAA occlusion (LAAO) has been shown to reduce stroke
risk and decrease the need for oral anticoagulation (OAC), particularly in
patients at high risk of bleeding. The combination of LAAO and catheter
ablation (CA) may offer an effective strategy for both rhythm control and
stroke prevention in AF patients. However, it remains unclear whether the
benefits of the combined procedure outweigh the risks compared to isolated
LAAO, CA alone, or CA combined with OAC. Purpose(s): The aim of this
network meta-analysis is to compare the efficacy and safety of combining
LAAO and CA versus LAAO alone, CA alone, or CA combined with OAC in
patients with atrial fibrillation. Method(s): A systematic search was
conducted across electronic databases (PubMed, Scopus, Web of Science,
Embase, and Cochrane Library) up to February 2025 for studies involving
adult patients with atrial fibrillation who underwent LAAO plus CA
compared to isolated LAAO, CA alone, or CA combined with OAC. The analyzed
outcomes included major bleeding, thromboembolic events, stroke, all-cause
mortality, AF recurrence, and pericardial effusion. A random-effects
network meta-analysis was performed to calculate odds ratios (ORs) with
95% confidence intervals (CIs) for the outcomes of interest.
 Result(s): The network meta-analysis included 23 studies comprising
46,161 patients. Among them, 22,824 patients underwent CA with LAAO, 3002
underwent LAAO alone, 18,857 underwent CA alone, and 1478 underwent CA
combined with OAC. The combination of LAAO and CA was not associated with
a higher rate of major bleeding or thromboembolic events compared to the
three comparators. Interestingly, stroke rate, all-cause mortality, and AF
recurrence were significantly lower in the CA-alone group compared to the
combined procedure (OR: 0.69; 95% CI: 0.53-0.89; OR: 0.50; 95% CI:
0.43-0.59; and OR: 0.64; 95% CI: 0.49-0.83, respectively). In contrast,
LAAO alone showed no significant difference compared to LAAO + CA for
these outcomes. No significant differences were observed in the incidence
of pericardial effusion, periprocedural complications, or vascular
complications between the combined procedure and other interventions.
 Conclusion(s): We conclude that the combination of LAAO and CA is not
associated with an increased risk of adverse events compared to isolated
procedures. However, CA alone was associated with a lower risk of stroke,
all-cause mortality, and AF recurrence. Further randomized trials are
needed to confirm these findings and inform guideline development.

<138>
Accession Number
649646146
Title
Analysis of the Effectiveness of Art Therapy Interventions on Reducing
Depression and Anxiety in Patients Undergoing Coronary Artery Bypass Graft
Surgery.
Source
Wiener Klinische Wochenschrift. Conference: International Workshop on
Pharmaceutical and Clinical Research 2024. Busan South Korea.
136(Supplement 8) (pp S445), 2024. Date of Publication: 01 Jun 2024.
Author
Zhao C.; Han L.; Han M.
Institution
(Zhao, Han) The Third People's Hospital of Henan Province, Zhengzhou,
China
(Han) Department of Industrial Design, Pukyong National University, Busan,
South Korea
Publisher
Springer
Abstract
Background: This study aims to assess the effectiveness of art therapy
interventions in reducing depression and anxiety among patients undergoing
coronary artery bypass graft (CABG) surgery. Recognizing the significant
psychological burden that accompanies CABG surgery, this research seeks to
explore alternative, non-pharmacological Method to support patients'
mental health during the postoperative period. Method(s): A
randomized controlled trial was conducted involving 120 patients scheduled
for CABG surgery. Participants were randomly assigned to either the
intervention group, which received standard postoperative care plus art
therapy sessions, or the control group, which received standard
postoperative care alone. Art therapy sessions were conducted twice a week
for four weeks, focusing on self-expression and emotional exploration
through various art mediums. Depression and anxiety levels were assessed
using the Hospital Anxiety and Depression Scale (HADS) at baseline,
immediately after the intervention, and at a one-month follow-up.
 Result(s): The findings indicated a significant reduction in both
depression and anxiety scores in the intervention group compared to the
control group. Immediately post-intervention, the intervention group
showed a marked decrease in mean HADS scores for both depression and
anxiety, which was maintained at the one-month follow-up. In contrast, the
control group exhibited minimal changes in their HADS scores throughout
the study period. Conclusion(s): The study provides evidence that art
therapy interventions can effectively reduce depression and anxiety levels
in patients undergoing CABG surgery. By facilitating emotional expression
and coping in a supportive environment, art therapy offers a valuable
complement to standard postoperative care. These findings suggest that
incorporating art therapy into the recovery process can significantly
enhance psychological well-being, underscoring the need for a holistic
approach to patient care in the postoperative setting.

<139>
Accession Number
649655151
Title
Peridevice leak and device-related thrombus in the OPTION randomized
trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Mansour M.; Ehrlich J.; Yaganti V.; Christen T.; Sutton B.; Wazni O.M.
Institution
(Mansour) Mass General Hopital (MGH), Boston, United States
(Ehrlich) St. Josefs-Hospital, Medizinische Klinik I, Wiesbaden, Germany
(Yaganti) St Mark's Hospital, Salt Lake City, United States
(Christen, Sutton) Boston Scientific Corporation, Marlborough, United
States
(Wazni) Cleveland Clinic, Cleveland, United States
Publisher
Oxford University Press
Abstract
Background/Introduction: Left atrial appendage closure (LAAC) has been
shown to be a safe and effective alternative to oral anticoagulation (OAC)
for stroke prevention in patients with AF. Purpose(s): The OPTION
trial compared LAAC to OAC for reducing the risk of thromboembolism in
patients who had a catheter ablation for atrial fibrillation (AF). This
analysis aims to assess the rate of peri-device leak (PDL) and
device-related thrombus (DRT) in the ablation+LAAC arm of the trial.
 Method(s): OPTION was a randomized controlled trial enrolling
patients undergoing catheter ablation for AF. The ablation procedure was
performed 90 to 180 days prior to or sequ concomitant with LAAC. Groups
were randomized 1:1 to either ablation+LAAC or ablation+OAC. Imaging with
transesophageal (TEE) or CT was performed at 3 and 12 months and analyzed
by an independent core laboratory. Result(s): In OPTION, 803 patients
were randomized to ablation + LAAC; 753 patients received LAAC after
catheter ablation and are the focus of this subanalysis. The procedure was
guided by TEE (97.9%) or intracardiac echocardiography (2.1%).; Complete
seal and PDL over time are shown in the Table. The rate of complete seal
was 81.0% and 79.7% at 3 and 12 months, respectively Most PDL were small
(<=3mm). DRT was found in 1.1% and 1.9% of patients at 3 and 12 months,
respectively. Most DRT had a laminar morphology and were non-mobile. No
patient with DRT experienced a stroke or systemic embolism during
follow-up and none of the patients with PDL had a DRT. No patient had a
stroke or systemic embolism related to the LAAC device. No patient
experienced a pericardial effusion related to the procedure. There was 1
device migration and 1 device embolization which led to removal of the
LAAC devices. Additional details will be available at the time of the
presentation. Conclusion(s): Among patients who underwent catheter
ablation for AF, LAAC can be safely performed with a small rates of DRT
and PDL.

<140>
Accession Number
649656476
Title
Microalbuminuria in heart transplant recipients -insights from the
randomized trial dapagliflozin for renal protection in heart transplant
recipients (DAPARHT).
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Holmen S.; Manintveld O.; Damman K.; Braun O.; Haugen Lofman I.; Szymanski
M.; Bjorkelund E.; Ravnestad H.; Gude E.; Andreassen A.; Gullestad L.;
Broch K.
Institution
(Holmen, Bjorkelund, Ravnestad, Gude, Andreassen, Gullestad, Broch) Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Manintveld) Erasmus University Medical Centre, Rotterdam, Netherlands
(Damman) University Medical Center Groningen, Groningen, Netherlands
(Braun) Skane University Hospital, Lund, Sweden
(Haugen Lofman) Karolinska University Hospital, Stockholm, Sweden
(Szymanski) University Medical Center Utrecht, Utrecht, Netherlands
Publisher
Oxford University Press
Abstract
Background: Heart transplantation is the preferred treatment for a
selected group of patients with end-stage heart failure, but kidney
function often declines after heart transplantation. Microalbuminuria is
an early indicator of kidney dysfunction. It is defined as a urinary
albumin/ creatinine ratio (UACR) >3.0 mg/mmol and <=30 mg/mmol. Sodium
glucose transporter 2 inhibitors (SGLT2i) protect against kidney failure
in patients with kidney disease or diabetes, particularly in those with
microalbuminuria. However, the association between glomerular filtration
rate and microalbuminuria in heart transplant recipients is not well
known. In the randomized DAPAgliflozin for Renal protection in Heart
Transplant Recipients (DAPARHT) trial, we assess the effect of the SGLT2i
dapagliflozin on kidney function. Purpose(s): The purpose of this
abstract is to present baseline microalbuminuria in the first 300 heart
transplant recipients enrolled in the DAPARHT trial, and to assess to what
extent microalbuminuria is associated with the eGFR in this population.
 Method(s): DAPARHT is an investigator-initiated, double-blind,
placebo-controlled, international trial designed to randomize 430 heart
transplant recipients in a 1:1 ratio to receive either 10 mg/day of the
SGLT2i dapagliflozin or matching placebo. Participants are enrolled at
least one year after transplantation. Exclusion criteria include an
estimated glomerular filtration rate (eGFR) < 25 mL/min/1.73m2,
and type 1 diabetes. The primary endpoint is the difference in the slope
of eGFR from two weeks to 12 months. A secondary endpoint is the change in
UACR from baseline to end-of-treatment. The UACR is measured in spot
urine. Result(s): Enrollment began in June 2022 in Norway, October
2023 in the Netherlands, and October 2024 in Sweden. The final patient
visit is scheduled for May 2028. Of the first 300 patients enrolled, UACR
data were available for 227 participants. The median baseline UACR was 1.2
mg/mmol [0.5 - 4.0]. At baseline, 29% of participants had a UACR > 3
mg/mmol, and 5% had a UACR > 30 mg/mmol. The mean baseline eGFR was 66 +/-
22 mL/min/1.73m2. The correlation coefficient between log-UACR
and eGFR was -0,21 (p=0,02). 14 % of patients with microalbuminuria also
had an eGFR < 60 ml/min/1.73 m2. Conclusion(s): Almost 30 % of the
heart transplant recipients participating in the DAPARHT trial had
microalbuminuria. UACR correlated weakly with eGFR. The DAPARHT trial will
provide information on the effect of dapagliflozin on microalbuminuria in
heart transplant recipients, and whether a reduction in albuminuria is
associated with improved kidney outcomes.

<141>
Accession Number
649656765
Title
Beta-blocker interruption or continuation after myocardial infarction? a
systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Lucena L.; Cavalcante D.; Freitas M.A.; Deluca A.; Huntermann R.; Molinari
M.E.; Duarte A.; Dantas G.; Fischer-Bacca C.; Maia F.G.
Institution
(Lucena, Maia) Federal University of Rio Grande do Norte, Natal, Brazil
(Cavalcante) Federal University of Maranhao, Sao Luis, Brazil
(Freitas) UEMASUL - State University of the Tocantina Region of Maranhao,
Imperatriz, Brazil
(Deluca, Huntermann, Molinari, Fischer-Bacca) University Center for the
Development of Alto Vale, Rio do Sul, Brazil
(Duarte) Federal University of Minas Gerais, Belo Horizonte, Brazil
(Dantas) Heliopolis Hospital, Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
Background: Beta-blockers (BB) have long been a cornerstone in the
management of post-myocardial infarction (MI). However, recent trials
challenge the necessity of prolonged beta-blocker use, especially in
patients with preserved left ventricular ejection fraction (LVEF).
 Purpose(s): This systematic review and meta-analysis aimed to examine
the clinical impact of beta-blocker continuation versus interruption in
post-MI patients with preserved LVEF. Method(s): We conducted a
comprehensive search of PubMed, Embase, and the Cochrane Central Register
of Controlled Trials to identify randomized controlled trials (RCT) and
observational cohorts comparing BB long-term therapy or early
discontinuation post-MI in patients without systolic dysfunction. The data
were computed using the Hazard Ratio (HR) and Risk Ratio (RR). Statistical
analysis utilized R version 4.2.2. Heterogeneity was assessed with
I2 statistics; p-values inferior to 0.05 and I2 >25%
were considered significant heterogeneity. The outcomes assessed included
MACE (cardiovascular death, myocardial infarction, stroke or transient
ischaemic attack, unplanned coronary revascularization, hospitalization
for unstable angina or heart failure), all-cause mortality, cardiovascular
death, heart failure (HF), hospitalization, MI, and stroke.
 Result(s): A total of 11 studies (3 RCTs) were included, encompassing
99,804 participants, of whom 82% remained on chronic beta-blocker therapy.
BB discontinuation was associated with an increased risk of MACE (HR 2.26;
CI: 1.78-2.87; p <0.01; Figure 1) and all-cause mortality (HR 2.41; CI:
2.11-2.75; p <0.01; Figure 2) compared to prolonged treatment.
Nevertheless, no significant differences were observed in cardiovascular
death (RR 1.05; CI: 0.90-1.22; p = 0.528), HF-related hospitalization (RR
1.24; CI: 0.97-1.58; p = 0.091), recurrent infarction (RR 1.04; CI:
0.87-1.23; p = 0.682), or stroke incidence (RR 0.95; CI: 0.68-1.33; p =
0.768). The increase in MACE remains consistent when analyzing the
subgroup that included only LVEF > 50%. However, no significant
disparities emerged between the groups in any measured endpoints when
restricting the assessment to RCTs. Conclusion(s): Our systematic
review and meta-analysis suggest that while BB discontinuation is
associated with increased MACE and mortality in post-MI patients without
reduced LVEF, RCT shows no clear advantage of prolonged therapy.

<142>
Accession Number
649653383
Title
Healthy dietary patterns for the secondary prevention of cardiovascular
diseases: a systematic review and meta-analysis of randomised controlled
trials and prospective cohort studies.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Oude Griep L.; Cruijsen E.; Goldberg A.; Sajjad W.; Suresh S.; Barker E.;
Imamura F.; Wareham N.; Forouhi N.
Institution
(Oude Griep, Imamura, Wareham, Forouhi) University of Cambridge, MRC
Epidemiology Unit, Cambridge, United Kingdom
(Cruijsen) Wageningen University UR, Division of Human Nutrition and
Health, Wageningen, Netherlands
(Goldberg, Sajjad, Suresh) University of Cambridge, School of Clinical
Medicine, Cambridge, United Kingdom
(Barker) University of Cambridge,Medical library, School of Clinical
Medicine, Cambridge, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Dietary recommendations for the public are often adopted as
guidelines for patients diagnosed with cardiovascular disease (CVD), yet
it remains unclear if the underlying evidence is generalisable to this
patient group. Purpose(s): To systematically review and meta-analyse
the evidence of healthy dietary patterns with all-cause and CVD mortality,
and recurrent CVD events in CVD patients. Method(s): Medline, Embase,
Web of Science and the Cumulative Index to Nursing and Allied Health
Literature were searched up to May 26, 2022 for randomised controlled
trials (RCTs) with >=6 months of follow-up and prospective cohort studies.
Summary relative risks (RR) and 95% confidence intervals (95%CI) were
calculated using random-effects meta-analysis. Study quality was assessed
with Cochrane risk of bias tools (RoB 2 for RCTs and ROBINS-E for
cohorts). Result(s): Of 28,291 abstracts, 41 articles met inclusion
criteria, including 19 articles from 14 unique RCTs and 22 cohort studies.
RCTs were conducted between 1956 and 2020, had a median duration of
3.3+/-2.6y and enrolled 14,065 CVD patients, of whom 84% were men, with a
median age of 56+/-5y. Among 15 comparisons across 14 RCTs, 4 focused on
fat replacement, 3 on the Mediterranean diet, 2 on low-fat diets, 2 on
combined low-fat/low sodium diets, and 2 on high fibre diets, all compared
to minimal or no dietary advice. No significant effects of any dietary
intervention were found for all-cause mortality, CVD mortality, recurrent
CVD, and coronary revascularisation. Between-study heterogeneity (I2=
34-60%) was partly explained by geographical location for all outcomes and
intervention diet for CVD mortality. Stratified meta-analysis by
intervention diet showed that a Mediterranean diet significantly reduced
CVD mortality (RR: 0.40; 95%CI: 0.19,0.83, I2:14%). Prospective cohort
studies were published after 2002 with dietary data from 1976 to 2017.
Patients had a median age of 65+/-5y of whom 67% were men and had a median
follow-up of 6.7+/-4.3y. Twenty-two cohorts (104,386 CVD patients)
primarily assessed the Mediterranean diet (60%). Compared to those with
low adherence, patients with study-specific highest adherence to any
healthy dietary pattern had a 29% lower all-cause mortality (0.71; 0.65,
0.78), 25% lower CVD mortality (0.75; 0.66, 0.84), and a 17% lower
recurrent CVD incidence (0.83; 0.75, 0.92). Significant heterogeneity was
observed (I2: 49-76%), explained by geographical location, average age,
sex, CVD diagnosis, follow-up duration, but not by type of healthy dietary
pattern. No significant associations were found for recurrent CVD. Studies
were predominantly classified as of some concerns (65% RCTs) or high risk
(52% cohorts) Conclusion(s): A healthy dietary pattern, like the
Mediterranean diet, likely benefits secondary prevention of CVD. Due to
considerable between-study heterogeneity and bias risk, well-conducted
future studies are needed using clearly defined diets to strengthen the
evidence.

<143>
Accession Number
649657068
Title
Coronary artery disease and cardiovascular outcomes in patients with type
2 myocardial infarction.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Taggart C.; Boeddinghaus J.; Ferry A.; Thurston A.; Tew Y.; Anand A.;
Wereski R.; Bularga A.; Mills N.L.; Chapman A.
Institution
(Taggart, Boeddinghaus, Ferry, Thurston, Tew, Anand, Wereski, Bularga,
Mills, Chapman) University of Edinburgh, BHF Centre for Cardiovascular
Science, Edinburgh, United Kingdom
Publisher
Oxford University Press
Abstract
Purpose: To evaluate the association of coronary artery disease with
recurrent myocardial infarction and death in consecutive patients with
type 2 myocardial infarction. Background(s): Type 2 myocardial
infarction occurs due to an imbalance in myocardial oxygen supply or an
unmet need in myocardial oxygen demand, without atherothrombosis. It often
occurs in the context of another acute illness resulting in
tachyarrhythmia, hypoxaemia or hypotension and is responsible for around
one in four myocardial infarction events. Patients with type 2 myocardial
infarction are at equivalent risk of future cardiovascular events to those
with type 1 myocardial infarction, with a six-fold increased risk of
recurrent type 2 myocardial infarction events at one year. Whether
underlying coronary artery disease is associated with future
cardiovascular events and could be a therapeutic target in type 2
myocardial infarction is uncertain. Method(s): In a secondary
analysis of a multi-centre randomised controlled trial implementing a
high-sensitivity cardiac troponin assay in 48,282 consecutive patients
with suspected acute coronary syndrome, the diagnosis of myocardial
infarction was adjudicated according to the Fourth Universal Definition.
The primary outcome of any myocardial infarction or death at five years
was compared in those with an index diagnosis of type 1 myocardial
infarction, and in type 2 myocardial infarction stratified according to
presence or absence of coronary artery disease, defined as those with or
without a history of prior myocardial infarction, percutaneous coronary
intervention or coronary artery bypass grafting. Result(s): The
primary outcome occurred in 43.2% (2,154/4,981) of patients with type 1
myocardial infarction, 47.8% (319/667) of patients with type 2 myocardial
infarction without coronary disease and 71.4% (324/454) of patients with
type 2 myocardial infarction and known coronary artery disease. Compared
to patients with type 1 myocardial infarction, patients with type 2
myocardial infarction and coronary artery disease were older (78 versus 71
years), and more likely to be male (46% versus 43%) or to have a diagnosis
of diabetes mellitus (27% versus 4%), heart failure (43% versus 15%) or
cerebrovascular disease (18% versus 8%). At five years, patients with type
2 myocardial infarction and known coronary artery disease were at highest
risk of recurrent myocardial infarction or death (Hazard Ratio [HR] 2.01,
95%CI 1.80-2.27, P<0.001, Figure) which persisted after adjustment for
co-variates (adjusted HR 1.26, 95%CI 1.12-1.42, P<0.001).
 Conclusion(s): The presence of coronary artery disease is strongly
associated with future cardiovascular risk in patients with type 2
myocardial infarction, but at present these patients are not routinely
investigated nor treated. Prospective clinical trials are required to
define the role of systematic coronary imaging, revascularisation and
secondary prevention in this population.

<144>
Accession Number
649655896
Title
Protective effects of remote ischemic preconditioning in patients
undergoing isolated valve replacement surgery: a meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Patel N.; Warsi T.; Kulkarni A.; Jain H.; Soni K.; Ahmed R.; Kelkar R.
Institution
(Patel, Jain) All India Institute of Medical Sciences, Jodhpur, India
(Warsi) Derriford Hospital, Plymouth, United Kingdom
(Kulkarni) Gujarat Medical Education and Research Society (GMERS),
Vadnagar, India
(Soni) Sardar Patel Medical College, Bikaner, India
(Ahmed) National Heart and Lung Institute Imperial College, London, United
Kingdom
(Kelkar) Wentworth Douglass Hospital, Dover, United States
Publisher
Oxford University Press
Abstract
Background: Valve replacement, often involving cardiopulmonary bypass
(CPB), can induce myocardial ischaemia and reperfusion injury despite
cardioplegia. Remote ischaemic preconditioning (RIPC), involving brief
ischaemia/reperfusion cycles in a remote limb, has emerged as a potential
strategy to mitigate this injury. While some trials suggest benefits,
others show no effect. This meta-analysis investigates the protective
effects of RIPC in patients undergoing isolated valve replacement surgery,
considering its impact on myocardial injury markers. Purpose(s): This
meta-analysis aims to resolve conflicting findings regarding the efficacy
of RIPC in valve replacement. By synthesising available evidence, we seek
to determine if RIPC reduces myocardial injury and has protective
pulmonary and renal effects. Our study will help clinicians make informed
clinical decisions and potentially improve patient outcomes. Methodology:
A comprehensive search of major databases like PubMed, Scopus, Embase,
Cochrane, and Google Scholar was conducted to retrieve eligible studies.
The inverse variance random-effects model was used to generate pooled
effects estimates of outcomes as mean difference (MD) and standard mean
difference (SMD) and risk ratios (RR) with a 95% confidence interval.
 Result(s): 9 studies were included in the analysis, with 1269
patients (636: RIPC; 633: Control). Remote ischaemic preconditioning
(RIPC) significantly reduced CK-MB levels [SMD: -0.24; 95% CI: -0.41,
-0.06; p = 0.008] and cTnI levels [SMD: -2.09; 95% CI: -3.15, -1.04; p =
0.0001] indicating myocardial protection. Additionally, RIPC significantly
decreased the duration of invasive ventilation [MD: -0.78; 95% CI: -1.48,
-0.08; p = 0.03]. However, it had no significant effect on the risk of
acute kidney injury (AKI) [RR: 0.95; 95% CI: 0.80, 1.13; p = 0.57], ICU
stay duration [MD: -2.60; 95% CI: -9.35, 4.14; p = 0.45], or hospital
length of stay [MD: -0.30; 95% CI: -0.62, 0.01; p = 0.06].
 Conclusion(s): RIPC significantly reduces myocardial injury and the
duration of the invasive ventilation required in valve replacement
demonstrating cardiopulmonary protective effects. However, we found no
significant impact on clinical outcomes such as AKI, ICU stay, or hospital
length of stay. This discrepancy suggests that while RIPC may offer
biochemical myocardial protection, its impact on broader clinical outcomes
requires further investigation, potentially focusing on specific patient
subgroups.

<145>
Accession Number
649655796
Title
Outcomes of transcatheter aortic valve implantation in young low-risk
patients: a comprehensive meta-analysis of efficacy and safety.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Rocha De Almeida A.; Lima R.; Gomes D.; Fernandes R.; Infante Oliveira E.;
Araujo Goncalves P.; Campante Teles R.; Sousa Almeida M.; Patricio L.
Institution
(Rocha De Almeida, Fernandes, Patricio) Hospital Espirito Santo de Evora,
Evora, Portugal
(Lima, Gomes, Infante Oliveira, Araujo Goncalves, Campante Teles, Sousa
Almeida) Centro Universitario, Unidade Local de Saude de Lisboa Ocidental,
Lisboa, Portugal
Publisher
Oxford University Press
Abstract
Introduction: Severe aortic stenosis (AS) was traditionally managed with
surgical aortic valve replacement (SAVR). Transcatheter aortic valve
implantation (TAVI) emerged as a less invasive alternative, originally for
high-risk patients. Its use expanded to intermediate- and low-risk older
patients based on promising results. This meta-analysis evaluates TAVI's
outcomes in younger, low-risk patients, where SAVR is currently the gold
standard. Method(s): Following PRISMA guidelines, we systematically
searched randomized controlled trials (RCTs) comparing TAVI with SAVR in
young (i.e. mean age <75 years) low-risk patients (i.e. STS score <4%)
with severe symptomatic AS. The primary endpoint was a composite of death
or disabling stroke. Secondary endpoints included all-cause mortality,
disabling stroke, atrial fibrillation (AF), permanent pacemaker
implantation (PPI), bleeding, functional class (NYHA), and quality of life
(KCCQ score) improvements and prosthesis-related outcomes. Result(s):
Four RCTs were included with 4252 patients (2125 TAVI and 2127 SAVR). At a
mean follow-up of 16+/-5 months, TAVI had a non-significantly lower
incidence of death or disabling stroke (2.8% vs. 5.1% logRR 0.02
[0.00-0.04] p=0.11), and all-cause mortality (2.1% vs. 3.7%, logRR 0.01
[0.00-0.03] p=0.15). Disabling stroke was significantly lower in the TAVI
group (0.9 vs. 2.1 logRR 0.01[0.00-0.02] p<0.01). Hospital readmission
(7.1% vs. 9.5% logRR 0.03 [0.01-0.04] p<0.01), and bleeding rates (4.7%
vs. 16%, logRR 0.14 [0.07-0.20] p<0.01) were significantly lower in the
TAVI group. On the other hand, TAVI had a higher PPI rate (14% vs. 6%,
logRR -0.08 [-0.13; -0.02], p<0,01) and significant paravalvular leak
(2,5% vs. 0,5% logRR -0,02 95%CI [-0,04; -0,00] p<0,01 I2=77%). There were
no statistically significant differences in the other prosthesis-related
outcomes between both groups. Faster symptomatic and quality of life
improvements were sustained in the TAVI group. Conclusion(s): TAVI is
a viable option for young low-risk patients with severe AS, being
non-inferior to SAVR in all short-term outcomes. The benefits of TAVI
include a lower risk of disabling strokes, reduced rates of readmission
and bleeding, and faster-sustained improvements in symptoms and quality of
life. The higher PPI and paravalvular leak rates in the TAVI group
highlight the need for careful patient selection.

<146>
Accession Number
649652677
Title
Navigating optimal antithrombotic therapy in atrial fibrillation patients
with PCI: insights from the EPIC-CAD trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Wee S.B.; Cho M.S.; Kang D.Y.; Ahn J.M.; Park S.J.; Park D.W.; Nam G.B.
Institution
(Wee, Cho, Kang, Ahn, Park, Park, Nam) Asan Medical Center, Seoul, South
Korea
Publisher
Oxford University Press
Abstract
Background: The EPIC-CAD (Edoxaban versus Edoxaban with Antiplatelet Agent
in Patients with Atrial Fibrillation and Chronic Stable Coronary Artery
Disease) trial demonstrated the superior clinical benefit of edoxaban
monotherapy compared with dual antithrombotic therapy (edoxaban plus a
single antiplatelet agent) in patients with atrial fibrillation (AF) and
stable coronary artery disease. However, debate remains regarding the
optimal long-term antithrombotic therapy in AF patients with coronary
stenting in terms of thrombotic risk management. Purpose(s): This
study aimed to compare the efficacy and safety of edoxaban monotherapy
versus dual antithrombotic therapy in AF patients with a history of
percutaneous coronary intervention (PCI), with particular focus on their
elevated thrombotic risk profile. Method(s): This prespecified main
subgroup analysis compared monotherapy versus daul antithrombotic therapy
in patients with previous PCI from the EPIC-CAD trial. The primary outcome
was a composite of all-cause mortality, myocardial infarction, stroke,
systemic embolism, unplanned urgent revascularization, and bleeding events
(major or clinically relevant nonmajor) over entire study period.
Additionally, we employed win ratio methodology to analyze hierarchical
outcomes with prioritization of ischemic risk. Result(s): Of 1040
patients in EPIC-CAD trial, 626 (60.2%) patients who underwent PCI at
least 6 months before randomization were included in the analysis. At 12
months, monotherapy (n=308) was significantly associated with a lower risk
of the primary-outcome events compared with dual antithrombotic therapy
(6.3% vs. 16.5%; hazard ratio[HR]: 0.42; 95% confidence interval [CI]:
0.26 to 0.68; P<.001), while the cumulative incidence of major ischemic
events was not significantly different (0.7% vs 1.4%; HR: 1.05; 95% CI:
0.26 to 4.20, P=0.95). The difference in the occurrence of the
primary-outcome events were primarily driven by the major bleeding or
clinically relevant nonmajor bleeding (4.7% vs 14.2%; HR: 0.35; 95% CI:
0.20 to 0.61, P<.001). In addition, edoxaban monotherapy was associated
with wins in 16.0% of pairs, compared with 6.2% in the dual antithrombotic
therapy group, resulting in a win ratio of 2.57 (95% CI: 1.55-4.25;
P<.001). Conclusion(s): In AF patients with PCI, the comparative
clinical benefit of edoxaban monotherapy compared with dual antithrombotic
therapy was consistent with those in the EPIC-CAD trial.

<147>
Accession Number
649653648
Title
Optimization of the optimal anticoagulation strategy during
cardiopulmonary bypass for neonates with congenital heart disease: a
single-center randomized controlled study.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Wang H.; Liu J.; Liu Q.D.; Gao T.Y.; Jin Y.; Liu J.P.
Institution
(Wang, Liu, Liu, Gao, Jin, Liu) Fuwai Hospital, CAMS and PUMC,
Cardiopulmonary Bypass, Beijing, China
Publisher
Oxford University Press
Abstract
Background: During cardiopulmonary bypass (CPB) for neonatal congenital
heart surgery, heparin dosing is critical due to the immature coagulation
system in neonates. Current practices often rely on adult-based
anticoagulation strategies, but no consensus exists for optimal heparin
dosing. This study aims to optimize heparin dosing, improving surgical
safety and minimizing postoperative complications. Method(s): This
two-phase study explores heparin dosing strategies. Phase 1 is a pilot
trial to determine the optimal heparin dose for neonatal CPB. Phase 2
compares this optimal dose with the traditional 400 U/kg dose in a
randomized controlled trial. Coagulation markers, bleeding volume, and
clinical outcomes, including blood product use, are analyzed.
 Result(s): In Phase 1, 30 neonates were randomized into three groups.
Higher heparin doses (500 U/kg and 600 U/kg) showed higher ACT achievement
rates, but no significant differences were found in bleeding volume,
transfusion, or thrombin generation. In Phase 2, 76 neonates (37 in each
group) were analyzed. The experimental group (600 U/kg) achieved
significantly higher ACT rates (89.19% vs. 43.24%, P < 0.001) and shorter
CPB initiation times (31.61 +/- 8.99 min vs. 37.00 +/- 10.48 min, P =
0.021). Post-CPB, the experimental group had significantly lower F1+2
levels [3.53 (2.80, 4.24) nmol/L vs 5.77 (3.79, 9.52) nmol/L, P < 0.001]
and lower thrombin generation [0.31 (0.09, 0.89) nmol/L vs 3.32 (0.95,
6.70) nmol/L, P < 0.001]. APTT was significantly longer in the
experimental group [63.35 (56.83, 71.85) s vs 54.60 (48.45, 70.45) s, P =
0.001], as was TT [19.15 (17.83, 20.38) s vs 18.40 (17.65, 19.75) s, P =
0.01]. D-Dimer was significantly lower in the experimental group [1.94
(1.25, 4.69) mug/mL vs 6.19 (2.74, 12.24) mug/mL, P = 0.002], as was FDP
[4.81 (3.19, 17.54) mug/mL vs 10.63 (6.53, 26.91) mug/mL, P = 0.004]. DIC
scores at 24 and 48 hours were lower in the experimental group (P = 0.031,
P = 0.026). There were no significant differences in blood loss, blood
product usage, or other adverse outcomes between the groups.
 Conclusion(s): An initial heparin dose of 600 U/kg optimizes
anticoagulation during CPB in neonates without increasing bleeding risk.
This strategy improves ACT achievement, reduces thrombin generation, and
lowers coagulation markers such as F1+2, D-Dimer, and FDP. It also
shortens surgery preparation time, providing a safer, more effective
anticoagulation approach. These findings support the establishment of
guidelines for heparin dosing in neonatal CPB.

<148>
Accession Number
649654708
Title
Risk factors for periprocedural stroke after transcatheter aortic valve
implantation: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Ktenopoulos N.;
Koliastasis L.; Tsalamandris S.; Drakopoulou M.; Synetos A.; Latsios G.;
Tsioufis K.; Toutouzas K.
Institution
(Theodoropoulou, Apostolos, Ktenopoulos, Koliastasis, Tsalamandris,
Drakopoulou, Synetos, Latsios, Tsioufis, Toutouzas) Hippokration General
Hospital, Athens, Greece
(Vythoulkas-Biotis) Sotiria Regional Chest Diseases Hospital, Athens,
Greece
Publisher
Oxford University Press
Abstract
Background: Stroke is a devastating complication of transcatheter valve
implantation (TAVI), affecting both patient outcomes and mortality rates.
Identifying risk factors for stroke will be essential in optimizing
patient selection and management as TAVI becomes more widely adopted.
 Purpose(s): This systematic review and meta-analysis aim to evaluate
risk factors for stroke following TAVI. Method(s): A systematic
literature search including PubMed, Scopus, and Cochrane databases was
conducted to identify studies reporting stroke events up to 30 days
post-procedure and associated patient/procedure-related risk factors
following TAVI. A meta-analysis with risk ratios (RR) was performed using
random-effects model, and heterogeneity was assessed using the
I2 statistic. Result(s): A total of 52 studies
encompassing 293,821 patients were included in the meta-analysis. Patient
characteristics were defined as the primary endpoints and procedural
details as the secondary endpoints. Significant predictors of stroke
included prior cerebrovascular events (CVE) (RR: 1.52; 95%CI: 1.31 - 1.76;
I2 = 51%), peripheral artery disease (PAD) (RR: 1.34; 95%CI:
1.11 - 1.61; I2 = 86%), chronic kidney disease (CKD) (RR: 1.26;
95%CI: 1.10 - 1.45; I2 = 3%), as well as procedural
characteristics such as self-expandable valve implantation (RR: 1.41;
95%CI: 1.32 - 1.51; I2 = 0%). In contrast, no significant risk
increase was observed in atrial fibrillation (RR: 1.11; 95%CI: 0.87-1.42;
I2 = 87%), pre-dilatation (RR: 1.08; 95%CI: 0.81 -1.42;
I2 = 44%), transapical approach (RR: 0.95; 95%CI: 0.66 - 1.38;
I2 = 46%), or valve in valve procedures (RR: 1.17; 95%CI: 0.73
- 1.85; I2 = 50%) Conclusion(s): This meta-analysis
identifies key risk factors for stroke following TAVI, including prior
CVE, PAD, CKD, and self-expandable valve implantation. Predicting stroke
risk could enhance patient selection and lead to better clinical outcomes.

<149>
Accession Number
649653433
Title
Utility of perioperative beta blocker therapy in patients undergoing
cardiac surgery.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Tripathi R.; Kaiteris A.; Gupta S.; Moussa S.; Zhang D.; Maldonado A.;
Ibtida I.; Sharma A.; Delicce A.; Jacob R.; Tam E.; Rahman T.; Mann N.;
Tao M.
Institution
(Tripathi, Kaiteris, Gupta, Moussa, Zhang, Maldonado, Ibtida, Sharma,
Delicce, Jacob, Tam, Rahman, Mann) Stony Brook University Hospital, Stony
Brook, United States
(Tao) Hartford Hospital, Hartford, United States
Publisher
Oxford University Press
Abstract
Background: Although there is abundant literature supporting the clinical
utility of beta blocker initiation before non-cardiac surgery in high-risk
patient populations, data supporting the routine initiation or
continuation of beta blockers before and after cardiac surgery remains
unclear. Purpose(s): To perform a systematic review and meta-analysis
evaluating the use of peri-operative beta-blockers in patients undergoing
cardiac surgery and evaluate clinical outcomes such as rates of
postoperative arrhythmias, cerebrovascular accidents (CVA), and
in-hospital and all-cause mortality. Method(s): A literature search
was performed using the databases PubMed, Embase, and Web of Science,
identifying studies that evaluated the association of pre-operative
initiation and continuation of beta-blocker with clinical endpoints in
patients undergoing cardiac surgery. The endpoints of interest included
development of post-operative atrial fibrillation (AFib), supraventricular
tachycardia (SVT), in-hospital mortality, all-cause mortality, and CVA.
 Result(s): 19 studies with 3749 patients (2018 treated with beta
blockers, 1731 not treated with beta blockers) met inclusion criteria. The
average follow-up duration was 12 days (ranging from 1 day to 90 days),
the mean age was 63.4 years, 70% were men. Cardiac surgeries including
coronary artery bypass grafting, aortic valve replacement, and mitral
valve replacement. In patients undergoing cardiac surgery, perioperative
use of beta blockers was associated with a significantly lower risk of
post-op AFib (OR 0.49, 95% CI 0.31-0.78; P<0.01). Subgroup analysis shows
this association was primarily with use of IV Landiolol and with a
non-statistically significant trend toward lower risk of AFib in patients
initiated or maintained on oral beta blockers (OR 0.29, 95% CI 0.20-0.41;
p<0.01; OR 0.62, 95% CI 0.33-1.16; P=0.06). There was a statistically
significantly lower risk of developing SVT after cardiac surgery in
patients treated with beta-blockers (OR 0.45, 95% CI 0.24-0.86, P=0.02).
The association between beta blocker use and other clinical endpoints
including the risk of CVA, in-hospital mortality, and all-cause mortality
were not statistically significant, however there was a trend toward lower
risk of both in-hospital and all-cause mortality in patients who were
treated with beta-blockers compared to those who were not (OR 0.46, 95% CI
0.16-1.36; P=0.16; OR 0.50, 95% CI 0.17-1.47; P=0.21). Discussion(s):
This meta-analysis demonstrates that in patients who are undergoing
cardiac surgery, preoperative initiation of beta-blockers, particularly IV
Landilol, or continuation of chronic beta-blockers is associated with a
lower risk of adverse cardiovascular outcomes, particularly post-operative
AFib and SVT. The use of beta-blockers may also be associated with a
mortality benefit, however additional high-quality studies with extended
follow-up time and monitoring are needed to fully elucidate this
association.

<150>
Accession Number
649654168
Title
The efficacy and safety of edoxaban compared to warfarin in patients with
atrial fibrillation with different clinical phenotypes: a meta-analysis of
randomized controlled trials.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Chao T.; Liao J.; Kuo L.; Lip G.Y.H.; Chen S.A.
Institution
(Chao, Liao, Kuo) Taipei Veterans General Hospital, Taipei, Taiwan
(Republic of China)
(Lip) University of Liverpool, School of Medicine, Liverpool, United
Kingdom
(Chen) Taichung Veterans General Hospital, Taichung, Taiwan (Republic of
China)
Publisher
Oxford University Press
Abstract
Background: Patients with atrial fibrillation (AF) may exhibit different
clinical phenotypes and receive various interventions, such as
percutaneous coronary intervention (PCI) for coronary artery disease,
catheter ablation, and transcatheter aortic valve implantation (TAVI) for
aortic stenosis. These patients may differ significantly in clinical
characteristics and outcomes. Therefore, whether the advantages of
edoxaban over warfarin remain consistent across these patient subgroups is
unclear. In this study, we conducted a meta-analysis of randomized
controlled trials (RCTs) to investigate this issue. Method(s): We
systematically searched the literature for randomized clinical trials
comparing edoxaban to warfarin in AF patients. Result(s): A total of
five randomized trials were identified, including ENSURE-AF (AF patients
undergoing electrical cardioversion), ENTRUST-AF PCI, ENGAGE AF-TIMI 48,
ENVISAGE-TAVI AF, and ELIMINATE-AF (AF patients undergoing catheter
ablation). Edoxaban was found to be as effective as warfarin in preventing
ischemic stroke, with a relative risk (RR) of 0.98 (95% confidence
interval [CI] 0.83-1.16; p = 0.81), and no significant heterogeneity was
observed between the different trials (Figure 1). Compared to warfarin,
edoxaban reduced the risk of cardiovascular death by 12% (RR 0.88, 95% CI
0.79-0.98; p = 0.02) (Figure 1). For the safety endpoint, the risk of
major bleeding was similar between edoxaban and warfarin (RR = 1.01, p =
0.97)(Figure 2). However, significant heterogeneity was observed, as
edoxaban reduced the risk of major bleeding by 20% (RR 0.80, 95% CI
0.70-0.90) in the ENGAGE AF-TIMI 48 trial but increased the risk by 44%
(RR 1.44, 95% CI 1.08-1.93) in the ENVISAGE-TAVI AF trial. In contrast,
edoxaban consistently reduced the risk of intracranial hemorrhage (ICH) by
48% (RR 0.52, 95% CI 0.37-0.74) across different trials without
significant heterogeneity (p = 0.38)(Figure 2). Conclusion(s): This
meta-analysis suggests that edoxaban is as effective as warfarin for
stroke prevention while reducing the risks of cardiovascular death and ICH
across different trials without significant heterogeneity. However, AF
patients with aortic stenosis undergoing TAVI may represent a unique
subgroup that requires further research to determine the optimal
antithrombotic strategy.

<151>
Accession Number
649656028
Title
Effectiveness and safety of edge-to-edge MItral vaLve repair in patients
with significant mitraL rEgurgitatioN aNd cardIac ATTR amyloidosis: design
and rationale of the MILLENNIAL trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Hauptmann L.; Kronberger C.; Tomasoni D.; Aus Dem Siepen F.; Verheyen N.;
Demirel C.; Derntl P.; Konstandin M.H.; Bonderman D.; Mascherbauer J.;
Ebner C.; Adamo M.; Bartko P.E.; Nitsche C.
Institution
(Hauptmann, Kronberger, Demirel, Bartko, Nitsche) Medical University of
Vienna, Department of Internal Medicine II, Division of Cardiology,
Vienna, Austria
(Tomasoni, Adamo) ASST Spedali Civili, Cardiology, Department of Medical
and Surgical Specialties, Radiological Sciences, and Public Health,
Bresciac, Italy
(Aus Dem Siepen, Konstandin) University Hospital Heidelberg, Department of
Internal Medicine III, Division of Cardiology, Heidelberg, Germany
(Verheyen) Medical University of Graz, Division of Cardiology, Department
of Internal Medicine, Graz, Austria
(Derntl) Sisters of Mercy Hospital Linz, Department of Cardiology, Linz,
Austria
(Bonderman) Klinik Favoriten, Medical Department of Cardiology and
Emergency Medicine, Vienna, Austria
(Mascherbauer) St. Poelten University Hospital, Department of Internal
Medicine 3, St Poelten, Austria
(Ebner) Ordensklinikum Linz Elisabethinen, Internal Medicine 2 -
Cardiology, Angiology and Internal Intensive Care Medicine, Linz, Austria
Publisher
Oxford University Press
Abstract
Background: Transcatheter edge-to-edge mitral valve repair (M-TEER) has
emerged as an effective treatment option for patients at elevated risk for
cardiac surgery, but patients with transthyretin cardiomyopathy (ATTR-CM)
were explicitly excluded from large M-TEER trials. From a
pathophysiological perspective, effective treatment of significant
regurgitant volume and consecutive improvement of forward volume appears
highly desirable in a condition with intrinsically low output. However,
whether this translates into improved clinical outcomes and better quality
of life compared to conservative heart failure management alone remains to
be investigated. The MILLENNIAL trial is designed to investigate the
effectiveness of M-TEER in patients with ATTR-CM and concomitant
significant MR. Methods and Study Design: The MILLENNIAL trial is an
investigator-driven, multi-center, prospective, parallel-group,
open-label, randomized, controlled trial. For enrolment the local heart
team must have excluded mitral valve surgery as a treatment option and
deemed patient anatomy feasible for M-TEER (Figure 1). In total, 100
participants will be randomized 1:1 to receive either a) M-TEER alongside
optimal medical therapy (OMT) or b) OMT alone (Figure 2). Randomization is
stratified according to baseline treatment with ATTR-specific medication
and concomitant TEER for the tricuspid valve. The primary endpoint is a
hierarchical combination of (i) all-cause mortality, (ii) cumulative
frequency of cardiovascular-related hospitalizations, (iii) change from
baseline in six-minute walk distance, and (iv) change from baseline in
NT-proBNP serum levels through 48 months, as analysed with the
Finkelstein-Schoenfeld method. Power calculations are based on an
anticipated win ratio of 2:1 in favour of the treatment arm. The change
from baseline in Kansas City Cardiomyopathy Questionnaire Overall Score
(KCCQ-OS) will be assessed as a secondary endpoint. Technical, device and
procedural success, intraprocedural change in haemodynamics before and
after device deployment, and change in echocardiographic parameters serve
as exploratory endpoints. On-site follow-up is at 6, 12, and 48 months.
Cross-over from control to treatment is allowed after 48 months.
 Conclusion(s): The MILLENNIAL trial will determine if minimally
invasive treatment of significant MR can improve outcome and quality of
life in patients with ATTR-CM. If positive, these findings could reshape
treatment paradigms and establish M-TEER as a standard therapeutic
approach in this high-risk population with currently limited treatment
options.

<152>
Accession Number
649655309
Title
Comparative outcomes of balloon-expandable vs. self-expanding valves in
transcatheter aortic valve implantation for aortic stenosis: a systematic
review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Ranasinghe A.; Bacha Z.; Javed J.; Shoaib M.; Afridi A.; Kakakhel M.
Institution
(Ranasinghe) Queen Elizabeth Hospital Birmingham, Birmingham, United
Kingdom
(Bacha, Shoaib, Afridi) Khyber Medical College Peshawar, swabi, Pakistan
(Javed) Jinnah Sindh Medical University, Karachi, Pakistan
(Kakakhel) Rehman Medical Institute, Peshawar, Pakistan
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is a
well-established treatment for symptomatic severe aortic stenosis, with
two primary valve types: balloon-expandable (BE) and self-expanding (SE)
prostheses. BE valves offer precise deployment with rapid post-dilation
stability but may be associated with higher radial forces and increased
risk of annular rupture. SE valves provide continuous expansion and
adaptability to anatomical variations, potentially reducing conduction
disturbances but carrying a higher risk of paravalvular leak.
 Purpose(s): This meta-analysis aims to compare the clinical and
procedural outcomes of balloon-expandable (BE) versus self-expanding (SE)
valves in patients undergoing transcatheter aortic valve implantation
(TAVI) for severe aortic stenosis. By evaluating key endpoints such as
mortality, stroke, pacemaker implantation, and paravalvular leak, this
study seeks to provide insights into the relative efficacy and safety of
these two valve types, aiding in the optimization of TAVI outcomes.
Methodology: A systematic review and meta-analysis were conducted
following PRISMA guidelines. A comprehensive literature search was
performed across PubMed, Embase, and Cochrane databases for studies
comparing balloon-expandable (BE) and self-expanding (SE) valves in TAVI
patients. Inclusion criteria encompassed randomized controlled trials and
observational studies reporting clinical and procedural outcomes. Pooled
effect sizes were calculated using random-effects model. A total of 16
studies were analyzed using Revman 5.4.1 software. Result(s): In this
meta-analysis of 16 studies, balloon-expandable valves (BEV) were
associated with an 11% reduction in all-cause mortality compared to
self-expanding valves (SEV) (OR = 0.89, p = 0.01). Cardiovascular
mortality showed no significant difference between the two valve types
(OR= 0.96, p= 0.58). BEV significantly reduced the risk of stroke by 20%
(OR = 0.80, p = 0.001), while rehospitalization for heart failure remained
incomparable between both groups (OR = 0.90, p = 0.75). Major adverse
cardiovascular and cerebrovascular events (MACCE) also showed no
significant difference (OR = 0.90, p = 0.58). However, BEV significantly
lowered the need for permanent pacemaker implantation by 37% (OR = 0.63, p
< 0.0001) and reduced the incidence of paravalvular leak by 58% (OR =
0.42, p < 0.00001). Conclusion(s): This meta-analysis suggests that
balloon-expandable valves (BEV) offer significant advantages over
self-expanding valves (SEV) in TAVI patients, including lower all-cause
mortality, reduced stroke risk, fewer permanent pacemaker implantations,
and a significantly lower incidence of paravalvular leak. However,
cardiovascular mortality, rehospitalization for heart failure, and MACCE
showed no significant differences. These findings highlight the potential
benefits of BEV in optimizing TAVI outcomes.

<153>
Accession Number
649655179
Title
Effectiveness and safety of myval versus self-expanding valves in patients
undergoing transcatheter aortic valve implantation:a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Ktenopoulos N.; Apostolos A.; Drakopoulou M.; Vlachakis P.; Kachrimanidis
I.; Koliastasis L.; Tsalamandris S.; Karanasos A.; Synetos A.; Latsios G.;
Aggeli C.; Tsioufis K.; Toutouzas K.
Institution
(Ktenopoulos, Apostolos, Drakopoulou, Vlachakis, Kachrimanidis,
Koliastasis, Tsalamandris, Synetos, Latsios, Aggeli, Tsioufis, Toutouzas)
Ippokrateio General Hospital of Athens, First Department of Cardiology,
Athens, Greece
(Karanasos) General University Hospital of Patras, Department of
Cardiology, University of Patras, Patra, Greece
Publisher
Oxford University Press
Abstract
Background: Transcatheter Aortic Valve Implantation(TAVI) is the preferred
treatment for patients with severe aortic stenosis(AS) across various
surgical risk categories.While self-expanding valves(SEV) are widely used
due to their conformability and hemodynamic profile,the Myval
transcatheter heart valve(THV),a newer-generation balloon-expandable
valve(BEV),has been designed to improve annular sealing reduce
paravalvular aortic regurgitation(AR),and lower conduction disturbances.
However, the comparative safety and efficacy of Myval versus SEV remain an
area of active investigation. Purpose(s): This study aimed to
evaluate the comparative effectiveness and safety of Myval versus SEV in
patients undergoing TAVI. Method(s): Our systematic review and
meta-analysis was conducted according to the latest PRISMA guidelines. A
comprehensive electronic literature search was performed across the three
major databases-Cochrane, Medline, and Scopus-to identify relevant studies
published up to December 19, 2024. The primary endpoint was device success
assessed periprocedurally and at 30-days.Secondary endpoints included
periprocedural,30-day and 1-year all-cause mortality,periprocedural device
embolization,need for >1 THV,coronary arteries obstruction or occlusion
and cardiac tamponade,30-day and 1-year stroke,30-day early
safety,permanent pacemaker implantation(PPI),major and minor vascular
complications,acute kidney injury(AKI),major bleeding and moderate or
severe transvalvular AR. Result(s): A systematic review and
meta-analysis were performed, incorporating data from 5 studies involving
1,996 patients undergoing TAVI.Among them,790 patients received the Myval
THV,while 1,206 were treated with SEV THVs.When compared to SEV, Myval was
associated with a 5% higher rate of periprocedural
(RR:1.05,95%CI:1.03-1.08,I2=0%) and an 8% higher rate of 30-day
device
success(RR:1.08,95%CI:1.03-1.13,I2=79%).Additionally,Myval
exhibited a 16% improvement in 30-day early safety outcomes (RR:1.16,95%
CI:1.04-1.28,I2=0%).Importantly,the risk of PPI was 40% lower
in the Myval cohort compared to SEV
(RR:0.60,95%CI:0.38-0.95,I2=44%),while Myval was associated
with a 58% lower incidence of minor vascular complications (RR: 0.42, 95%
CI: 0.18-0.98, I2=0%) and a 81% reduction in the risk of at
least moderate transvalvular AR (RR:0.19,95%CI:
0.05-0.81,I2=76%), at 30-days.No statistically significant
differences were observed between the two groups in the remaining clinical
and procedural endpoints. Conclusion(s): The Myval THV demonstrated
superior periprocedural and 30-day device success, with significantly
lower rates of PPI, minor vascular complications, and moderate or severe
transvalvular AR, compared to the SEVs. Further randomized controlled
trials with long-term follow-up are warranted to validate these findings.

<154>
Accession Number
649655217
Title
Comparative outcomes of transcatheter aortic valve replacement versus
surgical aortic valve replacement in severe aortic stenosis: a systematic
review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Ranasinghe A.; Bacha Z.; Javed J.; Khattak F.; Tanveer S.; Henna F.; Ali
M.; Alam U.; Afridi A.; Kakakhel M.; Haider M.; Noor H.; Sajjad F.; Qasim
M.; Khitab A.
Institution
(Ranasinghe) Queen Elizabeth Hospital Birmingham, Birmingham, United
Kingdom
(Bacha, Khattak, Tanveer, Ali, Alam, Afridi, Noor, Sajjad, Qasim, Khitab)
Khyber Medical College Peshawar, Swabi, Pakistan
(Javed) Jinnah Sindh Medical University, Karachi, Pakistan
(Henna) Dubai Medical College, Dubai, United Arab Emirates
(Kakakhel) Rehman Medical Institute, Peshawar, Pakistan
(Haider) Geisinger Health System, Danville, United States
Publisher
Oxford University Press
Abstract
Introduction: Aortic stenosis (AS) is a progressive and potentially fatal
condition characterized by narrowing of the aortic valve, which leads to
increased strain on the heart. Severe AS is commonly treated with either
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR). While TAVR has become a less invasive alternative to
SAVR, its long-term effectiveness compared to SAVR, especially in terms of
survival, complications, and recovery, remains unclear. Multiple studies
have investigated the outcomes of these two approaches, but a
comprehensive comparison is still needed. Purpose(s): This
meta-analysis aims to systematically evaluate and compare the outcomes of
TAVR and SAVR in patients with severe aortic stenosis. By synthesizing
data from multiple studies, this analysis seeks to provide a robust
assessment of the relative effectiveness and safety of these two treatment
strategies, focusing on key clinical outcomes such as all-cause
mortality,cardiovascular mortality, stroke, pacemaker implantation, major
bleeding, acute kidney injury, atrial fibrillation, respiratory
complications and length of hospital stay. Method(s): A systematic
literature search was conducted across major databases (PubMed, Cochrane
Library, and Scopus) for studies comparing TAVR and SAVR in patients with
severe aortic stenosis. Studies included randomized controlled trials
(RCTs), cohort studies, and observational studies. A total of 8 studies
are included in this meta-analysis. Result(s): TAVR demonstrated
significant reductions in several key outcomes compared to SAVR. All-cause
mortality was reduced by 28% (OR = 0.72, 95% CI [0.53, 0.98], p =
0.04)(figure A), cardiovascular mortality by 37% (OR = 0.63, 95% CI [0.42,
0.93](figure B), p = 0.02), and major bleeding by 56% (OR = 0.44, 95% CI
[0.27, 0.71], p = 0.0007)(figure E). Additionally, TAVR led to a 49%
reduction in acute kidney injury (OR = 0.51, 95% CI [0.26, 0.99], p =
0.05)(figure F), a 66% reduction in atrial fibrillation (OR = 0.34, 95% CI
[0.17, 0.67], p = 0.002)(figure G), and a 57% reduction in respiratory
complications (OR = 0.43, 95% CI [0.26, 0.71], p = 0.001)(figure H). TAVR
also shortened hospital stays by a mean difference of -3.39 days (SD
[-3.56, -3.21], p < 0.00001)(figure I). However, no significant difference
was observed in stroke rates between the two procedures (OR = 1.04, 95% CI
[0.71, 1.51], p = 0.85)(figure C). TAVR was associated with a higher rate
of pacemaker implantation favoring SAVR (OR = 2.28, 95% CI [1.62, 3.20], p
< 0.00001)(figure D). Conclusion(s): In conclusion, TAVR offers
significant advantages over SAVR in reducing mortality, bleeding, kidney
injury, atrial fibrillation, and hospital stay. However, it is associated
with a higher pacemaker implantation rate, and no difference in stroke
rates was found.

<155>
Accession Number
649654950
Title
Direct comparison of early survival following urgent transcatheter aortic
valve implantation versus balloon aortic valvuloplasty: a systematic
review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Dimitriadis K.; Pyrpyris N.; Kyriakoulis K.; Plaitis A.; Vakka A.; Tatakis
F.; Theofilis P.; Chrysohoou C.; Aznaouridis K.; Tsioufis K.
Institution
(Dimitriadis, Pyrpyris, Kyriakoulis, Plaitis, Vakka, Tatakis, Theofilis,
Chrysohoou, Aznaouridis, Tsioufis) Hippokration General Hospital, Athens,
Greece
Publisher
Oxford University Press
Abstract
Background: Urgent transcatheter aortic valve implantation (TAVI) is
increasingly performed in the urgent setting, in patients presenting with
aortic stenosis (AS)-related cardiogenic shock or acute decompensated
heart failure (HF), in order to timely improve patient outcomes, while
limiting the risks associated with emergency aortic valve surgery. Despite
TAVI is preferred over balloon aortic valvuloplasty (BAV), there are
limited studies directly comparing the two interventions Purpose: The aim
of this systematic review and meta-analysis is to compare urgent TAVI and
BAV in regards to early post-interventional mortality Methods: We
performed a systematic search in 3 different databases (MEDLINE/PubMed,
Web of Science and Scopus). After selecting all appropriate studies
according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines, a random effect meta-analysis was
performed. Result(s): A total of 6 studies and 21,020 individuals
were included (TAVI: 10,597; BAV: 10,423) in the meta-analysis. The most
common indication for urgent TAVI or BAV was cardiogenic shock, followed
by acute decompensated HF. In regards to in-hospital mortality, TAVI was
associated with significantly reduced mortality compared to BAV [Risk
Ratio(RR): 0.53; 95% Confidence Interval (95%CI): 0.39-0.71], while a
trend towards reduced mortality with TAVI was also noted in 30 days,
despite remaining borderline non-significant (RR: 0.53; 95%CI: 0.26-1.05).
 Conclusion(s): This systematic review and meta-analysis shows that in
the setting of urgent interventions for AS, TAVI is associated with
improved survival, compared to BAV. Considering the limited number of
studies, the observational nature of the included data and the absence of
report of other adverse events, more research, directly comparing TAVI
with BAV, is needed in order to investigate the benefit of urgent
interventions in this setting.

<156>
Accession Number
649655665
Title
Incidence and mortality rates of stroke after trancatater aortic valve
replacement: a meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Ktenopoulos N.;
Kachrimanidis I.; Drakopoulou M.; Tsalamandris S.; Synetos A.; Latsios A.;
Tsioufis K.; Toutouzas K.
Institution
(Theodoropoulou, Apostolos, Ktenopoulos, Kachrimanidis, Drakopoulou,
Tsalamandris, Synetos, Latsios, Tsioufis, Toutouzas) Hippokration General
Hospital, Athens, Greece
(Vythoulkas-Biotis) Sotiria Regional Chest Diseases Hospital, Athens,
Greece
Publisher
Oxford University Press
Abstract
Background: Despite improvements in the safety of transcatheter aortic
valve replacement (TAVR), the risk of stroke remains a significant
concern. Purpose(s): This meta-analysis aims to evaluate the
incidence of stroke and its impact on major clinical outcomes in patients
following TAVR. Method(s): A comprehensive literature search of
Pubmed, Cochrane, and Scopus databases was conducted to identify relevant
studies reporting stroke events up to 30 days post-procedure and
associated mortality rates up to 1 year. A meta-analysis with odds ratio
(OR) was performed using random effects model and heterogeneity was
assessed using the I2 statistic. Result(s): A total of 38 studies
encompassing 585,593 patients were included in the meta-analysis. The
pooled occurrence of stroke after TAVR was 3.3 % (95% CI: 2.6% to 4.2%).
Stroke after TAVR was associated with >3 times greater risk of in-hospital
mortality (OR 3.82; 95% CI: 3.43 to 4.25; p< 0.0001), >5 times greater
risk of 30-day mortality (OR; 5.22, 95% CI: 4.35 to 6.25; p< 0.0001) and 3
times greater risk of 1year mortality (OR; 2.99, 95% CI: 2.24 to 4.0; p<
0.0001 ). Meta-regression results indicated a significant reduction in
stroke incidence based on study publication year (p=0.038).
 Conclusion(s): Post-procedure stroke following TAVR remains a
significant and potentially preventable source of patient mortality.
Gaining insight into these events' short- and long-term health
implications may motivate developing and adopting effective preventive
strategies. outcomes 1.

<157>
Accession Number
649657210
Title
Tricuspid transcatheter edge to edge repair vs surgery for tricuspid
regurgitation - a systematic review and meta - analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Penteris M.; Lampropoulos K.
Institution
(Penteris, Lampropoulos) Democritus University of Thrace, Medical School,
Alexandroupolis, Greece
Publisher
Oxford University Press
Abstract
Introduction: Surgical tricuspid valve repair/replacement (TVR) is
considered the gold standard method for treating severe primary tricuspid
regurgitation (TR) and asymptomatic patients with progressive right
ventricular (RV) dilatation or RV dysfunction. However, transcatheter
tricuspid valve repair (TTVR) has emerged as a promising alternative to
surgical intervention, because it offers several potential advantages,
including avoiding open-heart surgery, shorter hospital stays, and reduced
post-procedural recovery time. The most commonly used TTVR technique is
tricuspid transcatheter edge to edge repair (T-TEER). Purpose(s): To
perform a systematic review and meta-analysis to compare the safety, early
and late mortality, morbidity and long-term function of the tricuspid
valve (TV) following T-TEER compared to TVR for either primary or organic
TR (oTR) or secondary or functional TR (fTR). Method(s): This review
investigates through PubMed and the Cochrane Library databases for
randomized control trials (RCTs) or observational studies that evaluated
patients with TR who underwent either T-TEER or TVR was until December
2024. The outcomes of interest were safety, morbidity, mortality and
long-term function following T-TEER vs TVR. A Mantel-Haenszel
random-effects model was used to calculate pooled odds ratios (ORs) for
this meta-analysis and ORs with 95% CIs were calculated to assess outcome
differences after T-TEER or TVR, using RevMan 5.4. Result(s): We
identified three retrospective observational studies, including a total of
1612 patients with TR. Short-term mortality (OR, 0.36; 95% CI, 0.13-1.04;
P=0.06) was similar between T-TEER and TVR. There was a lower risk of
acute kidney injury (AKI) (OR, 0.31; 95% CI, 0.23-0.43; P < 0.00001) and
permanent pacemaker implantation (PPI) (OR, 0.19; 95% CI, 0.10-0.35; P <
0.00001) with T-TEER, while there was no significant difference in terms
of stroke events (OR, 1.17; 95% CI, 0.68-2.01; P=0.58) and incidence of
bleeding complications (OR, 0.81; 95% CI, 0.45-1.44; P=0.47) compared to
TVR. Conclusion(s): In conclusion, T-TEER offers a promising, safe
and less-invasive alternative for managing patients with TR. Although,
T-TEER has a similar safety profile to TVR with a lower risk of AKI and
PPI, future research is needed to confirm its efficacy and safety.
Integration of T-TEER into routine practices, and future guidelines, could
optimize management of TR and offer a less invasive alternative for
high-risk patients.

<158>
Accession Number
649656740
Title
Colchicine in acute coronary syndrome: an updated meta-analysis of
randomized controlled trials.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Hosseini K.; Fallahtafti P.; Farooqi M.; Azizmohammad Looha M.; Mohsen A.;
Mohammadi Y.; Fekri M.; Jodeiri F.; Namdari Hemmati D.; Mosayebi F.;
Pirmoradian P.; Jenab Y.; Iskander F.; Hakim D.; Kolte D.
Institution
(Hosseini, Fallahtafti, Mohammadi, Fekri, Jodeiri, Namdari Hemmati,
Mosayebi, Pirmoradian, Jenab) Tehran Heart Center, Tehran, Iran, Islamic
Republic of
(Farooqi) Central Michigan University, Department of Internal Medicine,
Michigan, United States
(Azizmohammad Looha) Shahid Beheshti University of Medical Sciences,
Gastrointestinal Disorders Research Center, Tehran, Iran, Islamic Republic
of
(Mohsen) Loma Linda University Health, San Bernardino, United States
(Iskander) MedStar Union Memorial Hospital, Maryland, United States
(Hakim) Harvard Medical School, Department of cardiology, Boston, United
States
(Kolte) Massachusetts General Hospital, Cardiology Division, Boston,
United States
Publisher
Oxford University Press
Abstract
Introduction: Acute coronary syndrome (ACS) continues to be a global
health challenge despite advancements in treatment strategies. European
Society of Cardiology (ESC) has recommended low-dose colchicine in
patients with chronic coronary syndrome. However, existing studies present
conflicting evidence regarding its efficacy in ACS. Purpose(s): This
systematic review and meta-analysis aimed to assess the impact of
colchicine on cardiovascular outcomes in individuals with ACS.
 Method(s): Online databases of PubMed, Embase, and the Cochrane
Library were systematically searched for randomized controlled trials
(RCTs) evaluating the effects of colchicine in patients following ACS from
inception to November 2024. The primary endpoint was all-cause mortality.
Secondary endpoints included cardiovascular mortality, stroke, myocardial
infarction (MI), major adverse cardiovascular events (MACE), coronary
revascularization, and gastrointestinal (GI) adverse events. The outcomes
were obtained for the longest available follow-up. A Meta-analysis was
then conducted using R software, with random-effects models estimating
pooled risk ratios (RRs) to assess the effect of colchicine on the
outcomes. Study quality was assessed using the Cochrane Risk of Bias-2
(RoB-2) tool. Result(s): 12 RCTs comprising a total of 13,240
patients, 7,115 participants receiving colchicine and 6,125 participants
receiving either a placebo or no additional treatment in conjunction with
standard ACS management, were included. Meta-analysis revealed that
colchicine did not significantly reduce all-cause mortality (RR 0.95, 95%
CI 0.79-1.14) or cardiovascular mortality (RR 1.03, 95% CI 0.82-1.29) in
patients with ACS. Additionally, colchicine did not show any significant
effects on MACE (RR 0.74, 95% CI 0.50-1.09), MI (RR 0.87, 95% CI
0.72-1.05), revascularization (RR 0.60, 95% CI 0.30-1.19), or stroke (RR
0.62, 95% CI 0.29-1.31). The risk of GI adverse events was similarly not
significantly increased (RR 1.48, 95% CI 0.99-2.21). Conclusion(s):
Our study suggests that colchicine does not show significant
cardiovascular benefits in ACS patients. Further research should explore
alternative anti-inflammatory approaches for ACS management.

<159>
Accession Number
649656253
Title
Prognostic impact of different diagnostic strategies in patients with
heart failure with reduced ejection fraction.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Vieitez Florez J.M.; Abellas Sequeiros M.; Regueiro M.; Lopez A.; Abou
Jokh C.; Rivas E.; Gonzalez M.; Rios R.; Testa A.; Gonzalez Juanatey C.
Institution
(Vieitez Florez, Abellas Sequeiros, Regueiro, Lopez, Abou Jokh, Rios,
Testa, Gonzalez Juanatey) Lucus Augusti University Hospital, Lugo, Spain
(Rivas, Gonzalez) Lucus Augusti University Hospital, IDIS, Lugo, Spain
Publisher
Oxford University Press
Abstract
Introduction: Patients with heart failure with reduced ejection fraction
(HFrEF) must be studied to clarify the underlying aetiology. However,
different diagnosis schemes are being followed in clinical practice.
 Method(s): All patients with HFrEF referred to a specialized Heart
Failure Unit between 2011 and 2022 were included. Exclusion criteria were:
prior coronary artery disease or acute myocardial infarction (AMI) as
debut of HFrEF. We analysed two different diagnostic approaches:
-Non-invasive study (cardiac magnetic resonance imaging (CMR) / stress
echocardiography / coronary CT / SPECT myocardial perfusion imaging as
first test) vs invasive study (coronary -angiography (CA) as first test).
-CMR guided study (CMR as first test) vs non-invasive coronary ischemia
guided study (stress echocardiography /coronary CT/ SPECT myocardial
perfusion imaging as first test) vs coronary angiography guided study
(coronary angiography as first test). Primary endpoint was mortality.
Secondary endpoints were heart failure (HF) hospitalizations, new coronary
revascularization, AMI and improvement of ejection fraction.
 Result(s): 581 patients were included. Baseline characteristics are
shown in Table 1. -Non-invasive study vs invasive study: 381 patients were
included in the non-invasive group and 200 in the invasive group. Patients
in invasive group were older (66.8 vs 62.5 years old; p<0.001) and more
diabetic (45% vs 31%; p>0.001). No other differences in sex neither renal
function were found. No differences in mortality among groups were found.
Patients with invasive study had less HF hospitalizations (1.0% vs 5.2%;
p=0,013) (Figure 1) and a trend to greater improvement in EF (17.1% vs
14.5%; p=0.084). No differences in AMI or follow-up cardiac
revascularization were found. -CMR guided study vs non-invasive coronary
ischemia guided study vs coronary angiography guided study: 319 patients
were included in CMR guided study, 62 in non-invasive ischemia guided
study and 200 with coronary angiography. Patients in CMR group were
younger (61.7 vs 66.4 vs 66.8 years old; p<0,001). Non-invasive ischemia
group patients had better EF (33.5% vs 30.0% and 29.6%; p=0.004). No other
differences in sex, renal function or risk factors were found. Non
differences in mortality among groups were found. Patients with CMR guided
study and CA guided study had greater improvement in EF than patients with
coronary ischemia guided study (14,7% and 14,5% vs 7,35%; p<0,001).
Patients with CA had less HF hospitalizations (1.0% vs 5.2% and 5%;
p=0,045). No differences in AMI or cardiac revascularization were found.
 Conclusion(s): The use of coronary angiography as a first strategy
for the diagnosis of the aetiology in patients with HFrEF patients is
associated with fewer HF hospitalizations. No differences in mortality
were found between the different strategies. Based on this data, an
invasive study should be considered by protocol in patients with a recent
diagnosis of heart failure.

<160>
Accession Number
649655860
Title
Assessment of left ventricular global longitudinal strain (LVGLS) before
and after MiitraClip therapy in patients with heart failure and secondary
mitral regurgitation.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Khan M.; Rahman Qureshie N.; Syed T.; Mukhtar C.; Saeed K.; Maaz U.; Khan
A.; Islam S.; Arshad S.; Mutahir Hussan M.; Gul Rao A.; Saadi E.; Hamza
Bin Abdul Malik M.
Institution
(Khan) Pakistan Institute of Medical Sciences, Islamabad, Pakistan
(Rahman Qureshie) Shifa International Hospitals Limited, Islamabad,
Pakistan
(Syed, Islam) Services Institute of Medical Sciences, Lahore, Pakistan
(Mukhtar, Saadi) Abu Amara Medical and Dental College, Lahore, Pakistan
(Saeed) Hameed Latif Hospital, Lahore, Pakistan
(Maaz) Rahbar Medical and Dental College, Lahore, Pakistan
(Khan) Jinnah Sindh Medical University, Karachi, Pakistan
(Arshad) Sharif Medical City Hospital, Lahore, Pakistan
(Mutahir Hussan) CMH Karachi, Karachi, Pakistan
(Gul Rao) Dow University of Health Sciences, Karachi, Pakistan
(Hamza Bin Abdul Malik) Nuhealth (Nassau University Medical Center), East
Meadow, United States
Publisher
Oxford University Press
Abstract
Background: Mitral regurgitation (MR) is a common valvular disease that
significantly contributes to heart failure (HF). Left ventricular (LV)
dysfunction in MR is traditionally assessed using ejection fraction (EF),
which may not detect early myocardial impairment. Global longitudinal
strain (GLS) has demonstrated superior prognostic value compared to EF in
the context of transcatheter mitral valve repair (TMVr) with MitraClip.
Recent clinical trials have demonstrated mixed benefits of MitraClip.
These discrepancies may stem from differences in patient selection, LV
function, and study design. Purpose(s): This study aims to assess the
impact of MitraClip implantation on LV GLS in secondary MR patients.
Unlike previous trials, which focused on EF, our meta-analysis emphasizes
GLS as a more sensitive indicator of myocardial function. By synthesizing
data from multiple studies, we seek to determine whether MitraClip
improves LV function, reduces hospitalizations, and mortality.
Additionally, we evaluate secondary outcomes such as reverse LV remodeling
and changes in New York Heart Association (NYHA) classification to provide
a comprehensive assessment of MitraClip's therapeutic efficacy.
 Method(s): We searched PubMed, EMBASE and ScienceDirect and 18
studies (1254 patients) that reported GLS before and after MitraClip
therapy were included. Cohort studies were assessed using the
Newcastle-Ottawa Scale and clinical trials with Cochrane quality
assessment tool. Publication bias was evaluated with Egger's test and
funnel plots. Random-effects meta-analysis was conducted in Jamovi (ver
2.5) and Comprehensive Meta-analysis software to pool GLS estimates, LV
parameters, and clinical outcomes. Heterogeneity was assessed using
I2 statistics and Cochrane Q test, with leave-one-out
sensitivity analyses ensuring robustness of findings. Result(s):
Post-procedure GLS improved from baseline, with pooled estimates of -0.377
at 30 days (95% CI: -1.55 to 0.80, p<0.001) and 0.101 at six months (95%
CI: -0.095 to 0.302, p=0.308), though heterogeneity was significant
(I2 = 97%-99.2%). Hospitalisation rates post-MitraClip was
0.149 (95% CI: 0.094-0.204, p<0.001), while mortality was 0.315 (95% CI:
0.282 to 0.348, p<0.001). LVEF increased; 0.929 (95% CI: 0.898 to 0.960,
p<0.001), but LV end-diastolic and end-systolic volumes decreased. NYHA
class improved, with an odds ratio of 20.2 (95% CI: 6.5-62.4 p<0.001).
 Conclusion(s): MitraClip therapy is effective in enhancing LV
function as noted by significantly improved LV GLS and reducing
complications in patients with secondary MR. LV remodeling markers show
favorable trends albeit with higher heterogeneity. MitraClip is associated
with reduced hospitalizations and improved NYHA status, though mortality
benefits remain uncertain. These findings highlight GLS as a critical
marker in assessing MitraClip's impact, underscoring the need for further
studies to refine patient selection and optimize outcomes.

<161>
Accession Number
649656974
Title
Elevated lipoprotein(a) identifies patients with acute coronary syndrome
who derive earlier and greater cardiovascular benefit of alirocumab,
particularly for limb events.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Ray K.K.; Szarek M.; Bhatt D.L.; Bittner V.A.; Fazio S.; Goodman S.G.;
Harrington R.A.; Jukema J.W.; Stevanovic I.; White H.D.; Steg P.G.;
Schwartz G.G.
Institution
(Ray) Imperial College London, London, United Kingdom
(Szarek) Suny Downstate Medical Center, Brooklyn, United States
(Bhatt) Mount Sinai Heart, New York, United States
(Bittner) University of Alabama Birmingham, Birmingham, United States
(Fazio) Regeneron Pharmaceuticals, Inc., Tarrytown, United States
(Goodman) University of Toronto, Toronto, Canada
(Harrington) Weill Cornell Medical College, New York, United States
(Jukema) Leiden University Medical Center, Stafcentrum Hartziekten C5-P,
Leiden, Netherlands
(Stevanovic) Sanofi, Global Medical Affairs, Paris, France
(White) Green Lane Clinical Center, Auckland, New Zealand
(Steg) Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT
French Alliance for Cardiovascular T, Paris, France
(Schwartz) University of Colorado, School of Medicine, Aurora, United
States
Publisher
Oxford University Press
Abstract
Background: Lipoprotein(a) [Lp(a)] is believed to be a causal risk factor
for major adverse cardiovascular and limb events (MACE, MALE). Levels
>=50mg/dl are increasingly recognized as a risk enhancing threshold in
multiple guidelines. PCSK9 inhibitors have been shown to reduce
cardiovascular risk, including traditional MACE and MALE in patients with
ASCVD. We assessed whether significantly elevated Lp(a) levels influenced
the time to benefit of treatment with the PCSK9 inhibitor alirocumab (ALI)
in statin-treated patients with acute coronary syndrome. Method(s):
In post hoc analysis of the ODYSSEY OUTCOMES trial, patients randomized to
ALI or placebo were dichotomized by baseline Lp(a) >=50 (n=5709) or <50
mg/dL (n=13,215). Median follow up was 2.8 yrs. Time-varying treatment
hazard ratio (HR) with 95% confidence interval (CI) was determined for
MACE (CV death, MI, ischemic stroke, unstable angina, or ischemia-driven
coronary revascularization) and MALE (critical limb ischemia,
revascularization, or amputation). Result(s): In Lp(a) categories
>=50 vs <50 mg/dL, median baseline Lp(a) was 84 vs 11 mg/dL, median Lp(a)
reduction (ALI vs placebo) was 14 vs 3 mg/dL, and median LDL-C reduction
was 55 vs 54 mg/dL. There were 2775 MACE and 246 MALE. ALI reduced the
composite of MACE+ MALE in both baseline Lp(a) >=50 and <50 mg/dL
categories [HR 0.80 (95% CI 0.71, 0.91) and 0.90 (0.83, 0.99),
respectively]. However, 95% CI for MACE treatment HR was <1 at 1.25 yrs
from randomization onwards in patients with Lp(a) >=50 mg/dL vs 2.45 years
onwards with Lp(a) <50 mg/dL (FIGURE, top). Similarly, 95% CI for MALE
treatment HR was <1 at 0.24 yrs onwards for patients with Lp(a) >=50 mg/dL
but reached <1 only briefly at 0.6 yrs in those with Lp(a) <50 mg/dL
(FIGURE, bottom). Conclusion(s): In this post hoc analysis of the
ODYSSEY OUTCOMES trial, we observed that patients with Lp(a) >= 50mg/dl
derived similar LDL-C lowering, greater absolute Lp(a) lowering and an
earlier, as well as greater relative risk reduction for both MACE and MALE
compared to those with Lp(a) levels <50mg/dl. Patients with Lp(a) levels
>= 50mg/dl may represent a particularly higher risk group with early
modifiable risk from PCSK9 inhibition with ALI.

<162>
Accession Number
649655661
Title
The impact of intraoperative hemoadsorption on acute kidney injury and
renal replacement therapy in cardiovascular surgery: a systematic review
and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Merighi Moreira Salles M.; Ormanes Massoud R.; Lawall De Carvalho P.;
Martins Sobreira M.; Silva Correia J.; Hortencio Melo R.
Institution
(Merighi Moreira Salles) University of the Oeste Paulista, Jau, Brazil
(Ormanes Massoud) Universidade do Estado do Para, Belem, Brazil
(Lawall De Carvalho) Federal University of Juiz de Fora, Juiz De Fora,
Brazil
(Martins Sobreira) University of Marilia, Marilia, Brazil
(Silva Correia) University of South Florida, Morsani College of Medicine,
Tampa, United States
(Hortencio Melo) Albert Einstein Israelite Hospital, Intensive care, Sao
Paulo, Brazil
Publisher
Oxford University Press
Abstract
Background/Introduction: Cardiovascular surgery with cardiopulmonary
bypass (CPB) is associated with several potential complications including
activation of inflammatory and coagulation pathways. Cytokine release
plays a key role, contributing to microcirculation impairment vasoplegia,
organ dysfunction, and acute kidney injury (AKI). In this context, the
intraoperative use of extracorporeal cytokine adsorbers has been studied
to determine whether it impacts improving outcomes in cardiovascular
surgery. Several studies have aimed to assess the effect of hemoadsorption
during cardiac surgery on postoperative outcomes, but the results remain
inconclusive. Purpose(s): We aimed to perform a systematic review and
meta-analysis comparing the incidence of AKI and the need for renal
replacement therapy (RRT) in patients undergoing cardiovascular surgery
with and without intraoperative hemoadsorption. Method(s): A
comprehensive search of PubMed, Embase and Cochrane database was conducted
to identify observational studies and randomized controlled trials (RCTs)
comparing the use of cytokine adsorbers incorporated into the CPB circuit
with standard surgical treatment during cardiac surgery. Statistical
analysis was performed using Review Manager 5.1 with random-effects model.
Heterogeneity was assessed with I2 statistics. Result(s):
We included eighteen studies comprising 1863 patients, of whom 870
underwent hemoadsorption during CPB. The incidence of AKI was
significantly lower in the hemoadsorption group (HA) compared to the
control group (RR 0.66; 95% CI 0.49-0.87; P=0.003; figure 1A).
Additionally, the subgroup analysis of observational studies and RCTs
revealed that only the observational studies maintained a statistically
significant reduction in the incidence of AKI (RR 0.52; 95% CI 0.38-0.70;
P<0.0001; figure 1B). Although the need for RRT was lower in the HA group
(RR 0.83; 95% CI 0.63-1.08; P=0.17; figure 2), this difference did not
achieve statistical significance. Conclusion(s): In patients
undergoing cardiovascular surgery, intraoperative hemadsorption may be
associated with a lower incidence of postoperative AKI and a reduced need
for RRT when compared to standard surgical treatment. Further large-scale
studies are needed to confirm these findings.

<163>
Accession Number
649653800
Title
PREVENT-like plaque vulnerability criteria applied to AI-guided coronary
computed tomography angiography analysis: outcomes with revascularization
vs. medical therapy.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Bar S.; Knuuti J.; Saraste A.; Bax J.J.; Maaniitty T.
Institution
(Bar, Knuuti, Saraste, Maaniitty) Turku University Hospital, Turku PET
Centre, Turku, Finland
(Bax) Leiden University Medical Center, Department of Cardiology, Leiden,
Netherlands
Publisher
Oxford University Press
Abstract
Background: A recent randomized-controlled trial (Preventive percutaneous
coronary intervention versus optimal medical therapy alone for the
treatment of vulnerable atherosclerotic coronary plaques (PREVENT))
suggested prognostic benefit from preventive coronary intervention of
vulnerable plaques (VP) as defined by intracoronary imaging.
 Purpose(s): We aimed to test the feasibility of applying modified
PREVENT-like vulnerability criteria to artificial intelligence (AI)-guided
coronary computed tomography angiography (CCTA) analysis and assess
outcomes of patients with VP according to revascularization vs. medical
therapy. Method(s): This was a cohort of 2271 patients undergoing
CCTA for suspected coronary artery disease from 2007 to 2016. CCTA scans
were analyzed by AI-guided quantitative computed tomography (AI-QCT). The
modified PREVENT-like vulnerability criteria were >=70% percent atheroma
volume (PAV) or lipid-rich plaque (LRP) (i.e. low-density non-calcified
plaque (HU <30) >=2.3 mm3 and positive remodeling) on a per-segment level.
Patients were followed for a median of 7 years for major adverse
cardiovascular events (MACE) (death, myocardial infarction (MI), or
unstable angina (uAP); and acute coronary syndrome (ACS) (MI or uAP)). We
assessed the prognostic value of VP and its interaction with early
(6-month) revascularization using multivariable Cox regressions. Hazard
ratios were adjusted (HRadj) for clinical confounders (age, sex,
hypertension, diabetes, smoking, typical angina). Result(s): Mean
patient age was 62 years, 58% were females, and 212 underwent coronary
revascularization. 170 coronary segments from 133/ 2271 (5.9%) patients
fulfilled the modified PREVENT-like VP definition (Figure 1). Patients
with VP had significantly higher rates of MACE (26.3% with VP vs. 10.3%
without VP; HRadj 1.90, 95% CI 1.31-2.75, p=0.001) (Figure 2, A1), and ACS
(12.0% with VP vs. 3.9% without VP; HRadj 2.22, 95% CI 1.27-3.87, p=0.005)
(Figure 2, B1). There was significant interaction between VP and
revascularization with respect to MACE (p-interaction=0.022) and ACS
(p-interaction=0.005). Patients with VP had higher rates of MACE (HR 2.93,
95% CI 1.90-4.52, p<0.001) and ACS (HR 4.29, 95% CI 2.25-8.16, p<0.001) if
receiving medical therapy alone, but not if undergoing revascularization
(MACE: HR 1.11, 95% CI 0.57-2.17, p=0.746; ACS: HR 0.69, 95% CI 0.26-1.81,
p=0.448) (Figure 2 A2-A3/B2-B3). Conclusion(s): Vulnerable plaque
based on PREVENT-like criteria on AI-guided CCTA was associated with
increased risk of MACE and ACS if treated by medical therapy alone, but
not in patients undergoing early revascularization. This may suggest that
modified PREVENT-like VP criteria applied to CCTA could potentially help
to identify patients benefitting from revascularization in terms of
long-term outcome.

<164>
Accession Number
649655353
Title
Incidence and predictors of major ventricular arrhythmias after
myocarditis: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Morena A.; Giacobbe F.; Anselmino M.; D'ascenzo F.; De Ferrari G.M.; Dusi
V.
Institution
(Morena, Giacobbe, Anselmino, D'ascenzo, De Ferrari, Dusi) University of
Turin, Medical science, Turin, Italy
Publisher
Oxford University Press
Abstract
Introduction: The arrhythmic risk and long-term outcomes after an acute
myocarditis episode remain unclear. Recent data indicate that ventricular
arrhythmias (VAs) may be frequently observed both in the acute phase and
years after the initial event, making sudden cardiac death a prominent
cause of death in these patients. The latest European and American
guidelines support implantable cardioverter-defibrillator (ICD)
implantation as secondary prevention independently on the underlying
substrate and evolution. The initial and subsequent management of
myocarditis patients remains debated. Purpose(s): To assess the
incidence and predictors of major arrhythmic events (MAEs) after
myocarditis. Method(s): We conducted a systematic literature review
and meta-analysis of 12 eligible studies (11 retrospective, 1
prospective), including 3450 patients with prior myocarditis, with and
without MAEs at presentation, followed for a median of 24 months (IQR
18-41). MAEs were defined as a composite of sudden death (SD), aborted
cardiac arrest (ACA), sustained ventricular tachycardia (SVT) and
appropriate ICD interventions. The primary endpoint was the incidence of
MAEs, while secondary endpoint included the occurrence of each one of
components of MAEs, all-cause mortality and heart transplantation (HTx).
 Result(s): Among 3450 patients (52.5% male, mean age 46.5 years), the
majority (66%) had lymphocytic myocarditis, followed by giant cell
myocarditis (5%). At presentation, 38% (IQR 23-52%) experienced
ventricular fibrillation or SVT, with a mean left ventricular ejection
fraction (LVEF) of 42% (IQR 38-49%). Late gadolinium enhancement (LGE) on
cardiac magnetic resonance (CMR) was reported in 94% of cases. Notably,
most patients (67%; IQR 44-91%) belonged to the acute myocarditis group,
while only 9% (IQR 0-43%) had chronic myocarditis. At discharge, 60% (IQR
36-92%) required ICD implantation, and 88% (IQR 84-94%) were prescribed
beta-blocker therapy. During follow-up, the incidence of MAEs was 36% (95%
CI 23-49), including 5 SDs (1%). The median time to MAE occurrence was 12
months (IQR 11-18). The combined rate of all-cause mortality and HTx was
13% (95% CI 8-19%). Meta-regression analysis identified atrioventricular
block at presentation as a significant predictor of MAEs (p = 0.046)
during follow up, while giant cell myocarditis showed a trend toward
higher MAE risk, though without statistical significance (p = 0.067).
 Conclusion(s): Based on currently available studies, the recurrence
of MAEs after myocarditis is high, regardless the phase of disease (acute
or chronic), with a mortality/HTx rate of 13% over two years.
Atrioventricular block at presentation appears to be risk factor for MAEs,
while giant cell myocarditis is associated with a trend toward increased
risk. Future prospective studies are needed to better stratify high-risk
patients and guide decisions regarding early ICD implantation or other
antiarrhythmic strategies.

<165>
Accession Number
649654620
Title
Mini-sternotomy versus conventional sternotomy for aortic valve
replacement: a meta-analysis of randomized studies.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Antonio Machado Gomes De Sousa P.; Farias C.; Abraham D.; Oldra L.;
Mazetto R.; Bulhoes E.; Oliveira V.; Neves H.; Cesar C.; Maia A.
Institution
(Antonio Machado Gomes De Sousa) Federal University of Uberlandia,
Uberlandia, Brazil
(Farias) Hospital Nove de Julho, Sao Paulo, Brazil
(Abraham) Federal University of Amazonas, Manaus, Brazil
(Oldra) Anhembi Morumbi University, Sao Paulo, Brazil
(Mazetto, Cesar) Amazonas State University, Manaus, Brazil
(Bulhoes) Faculty of Education of the Reunited Amazon, Redencao, Brazil
(Oliveira) UFG Clinical Hospital - EBSERH, Goiania, Brazil
(Neves) Federal University of Parana, Curitiba, Brazil
(Maia) Heart Hospital - Incor - FMUSP, Sao Paulo, Brazil
Publisher
Oxford University Press
Abstract
Background: Minimally invasive surgery has emerged as a relatively recent
alternative to traditional procedures. The concept of minimizing the
traumatic response and, consequently, the complications associated with
metabolic stress has gained considerable traction in leading medical
centers worldwide, necessitating that the evidence keeps pace with these
advancements. Despite the challenge of limited access due to the smaller
surgical space, the potential benefits, such as improved quality of life
and earlier discharge, have drawn significant attention. However the
plausibility and effectiveness of certain key outcomes remain subjects for
ongoing discussion. Purpose(s): Given this context, the aim of this
study was to compare mini-sternotomy with conventional sternotomy for
aortic valve replacement and to assess its safety and efficacy through a
range of outcomes. Method(s): We conducted a systematic search of
PubMed, Embase, and Cochrane Central for studies comparing mini-sternotomy
with conventional sternotomy for aortic valve replacement. Risk ratios
(RR) with 95% confidence intervals (CIs) were pooled using a
random-effects model to account for heterogeneity. Result(s): We
included eight randomized controlled trials, involving 1,296 patients, of
whom 582 (44.9%) underwent minimally invasive surgery. At 30-day
follow-up, mini-sternotomy was associated with a significantly lower chest
drain volume compared to conventional sternotomy (MD -165.8; 95% CI -298.1
to -33.4; p = 0.01, Figure 1). The risk of stroke was numerically lower in
the mini-sternotomy group, although this difference was not statistically
significant (RR 0.64; 95% CI 0.31-1.31; p = 0.37; Figure 2). No
significant differences were observed between groups for sternal wound
infection (RR 1.05; 95% CI 0.48-2.57; p = 0.92; I2 = 81%),
all-cause mortality (RR 0.91; 95% CI 0.48-1.75; p = 0.975) bypass time (MD
7.8; 95% CI -2.8 to 19.5; p = 0.15), cross-clamp time (MD 3.2; 95% CI -4.1
to 10.4; p = 0.39), or major adverse cardiac events (RR 1.00; 95% CI
0.41-2.42; p = 0.99; I2 = 0.0%). Conclusion(s):
Mini-sternotomy is a safe and effective procedure for aortic valve
surgery. Notwithstanding some anatomical limitations, it demonstrates a
significant and numerically superior advantage in chest drain volume
compared to conventional sternotomy, along with a numerically lower
incidence of stroke, although this difference is not statistically
significant. However, the current analysis exhibits considerable
heterogeneity, and the superiority of the minimally invasive technique may
be influenced by factors such as the surgical team's experience and
patient characteristics. Therefore, further studies are essential to
enhance the robustness of these findings.

<166>
Accession Number
649656439
Title
Impact of virtual reality distraction on stress and pain reduction during
implantation of cardiac pacemakers, defibrillators or cardiac
resynchronisation therapy, a randomised controlled study.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Givan A.; Jungen C.; Mathew S.; Rassaf T.; Kurt M.
Institution
(Givan, Jungen, Mathew, Rassaf, Kurt) University of Duisburg-Essen,
West-German Heart and Vascular Centre, Essen, Germany
Publisher
Oxford University Press
Abstract
Background/Introduction: Using virtual reality technology is an effective
non-pharmacological method for reducing anxiety and pain during many
surgical procedures and percutaneous interventions. To date, its benefits
for patients undergoing implantation of cardiac pacemakers defibrillators,
or cardiac resynchronisation therapy have been scarcely examined. A
randomised controlled study showed that using virtual reality headsets
reduces anxiety and pain during axillary vein puncture but not throughout
subcutaneous pocket creation in patients receiving cardiac pacemakers or
defibrillators. There is a lack of information regarding the effect of
virtual reality distraction on pain and stress during the entire procedure
of cardiac pacemaker or defibrillator implantation and in patients
receiving cardiac resynchronisation therapy Purpose: This study aimed to
evaluate whether virtual reality technology positively affects patients'
pain and anxiety throughout the entire procedure of implantation of
cardiac pacemakers, defibrillators, or cardiac resynchronisation therapy
 Methods and Results: From January 2024 to February 2025, 62 Patients
undergoing implantation of cardiac single-chamber or dual-chamber
pacemakers or defibrillators and cardiac resynchronisation therapy were
included in this study. Patients were randomly assigned to either a
control group (n=31) or an intervention group (n=31). The control group
received standard preoperative care and local anaesthesia using lidocaine.
A virtual reality headset was used in the intervention group in addition
to the standard preoperative care and local anaesthesia during the
procedure. The procedure was performed in all patients using standard
preparation and cephalic vein cutdown. The State-Trait Anxiety
Inventory-State (STAI-S) questionnaire was filled out by patients pre- and
postoperatively to determine their anxiety levels before and during the
procedure. The analysis showed that the virtual reality group experienced
significantly lower anxiety during the procedure in comparison to the
group with standard care and local anaesthesia alone (Mean STAI-S +/- SD:
31,68 +/- 7,5, vs, 40,23 +/- 11,48, p=0.001). There was no statistically
significant difference in periprocedural pain between the VR group and the
control group using the numeric rating scale (Mean +/- SD: 2,71 +/- 2,47
vs 2.06 +/- 1,73, p: 0,23). The patients in the control group reported
higher anxiety levels using the visual analogue scale compared to the
intervention group (Mean +/- SD: 2,77 +/- 2,68 vs 1,35 +/- 1,96, p:0,02)
 Conclusion(s): Distraction through virtual reality can be effectively
used to reduce perioperative anxiety in patients undergoing implantation
of cardiac pacemakers, defibrillators, and cardiac resynchronisation
therapy.

<167>
Accession Number
649655283
Title
Chronic coronary total occlusions: does surgery hold the answer?.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Silva A.; Costa G.; Simoes M.; Santos T.; Batista G.; Fernandes R.; Lopes
V.; Rocha L.; Grine M.; Carlos T.; Resende B.; Martins J.; Leite L.;
Goncalves L.
Institution
(Silva, Costa, Simoes, Santos, Batista, Fernandes, Lopes, Rocha, Grine,
Carlos, Resende, Martins, Leite, Goncalves) Centro Hospitalar E
Universitario De Coimbra, Cardiology Department A, HUC-CHUC, Coimbra,
Portugal
Publisher
Oxford University Press
Abstract
Introduction: Chronic coronary total occlusions (CTOs) optimal therapeutic
management remains a topic of debate despite its association with adverse
clinical outcomes. Purpose(s): To compare the clinical outcomes of
patients with CTO treated with surgical revascularization versus medical
therapy (MT) assessing the effect of CTO revascularization in patients
with multivessel disease undergoing coronary artery bypass graft (CABG).
 Method(s): In July 2023, PubMed, Embase, Cochrane, and Web of Science
databases were systematically searched for observational and
interventional studies comparing CTOs treated with CABG versus MT. We then
performed a sub-analysis of studies with patients submitted to CABG
comparing complete surgical revascularization, including CTO bypass,
versus revascularization without CTO bypass. A pooled odds ratio
meta-analysis was conducted for four main outcomes: mortality, acute
myocardial infarction (AMI), stroke, and major adverse cardiovascular
events (MACE). Random-effects meta-analysis was performed with Review
Manager 5.4. Result(s): Ten observational studies, including 6,458
patients, compared CABG-CTO with MT-CTO (65.9% MT; 34.1% CABG).
Meta-analysis indicated significantly lower all-cause mortality in the
CABG group (OR 0.31, 95% CI 0.24-0.40, p<0.001, I2=36%). Despite high
heterogeneity CABG exhibited reduced CV mortality and MACE (OR 0.37, 95%
CI 0.24-0.57, p<0.001, I2=59%; OR 0.37, 95% CI 0.15-0.92, p=0.03, I2=80%
respectively). Additionally, the AMI rate was lower in the CABG group (OR
0.41, 0.30-0.56, p<0.001, I2=0%). The stroke rate did not differ
significantly between the two treatment groups (OR 3.54, 95% CI
0.73-17.17, p=0.12, I2=71%). In the comparative analysis between the
bypassed and non-bypassed CTO groups involving five studies (1,949
patients, 73.7% vs 26.3% respectively), the bypassed-CTO group exhibited a
statistically significant lower MACE (OR 0.49, 95% CI 0.30-0.81, p=0.005,
I2=44%). All-cause mortality nearly reached statistical significance (OR
0.64, 95% CI 0.40-1.02, p=0.06, I2=57%). No differences were found in AMI
(OR 0.86, 95% CI 0.39-1.86, p=0.70, I2=47%) and stroke (OR 0.95, 95% CI
0.53-1.68, p=0.85, I2=0%) between the abovementioned groups.
 Conclusion(s): Our study suggests a clinical benefit of bypassing a
CTO lesion in patients with multivessel disease undergoing CABG, with a
significantly lower MACE and a marginally close value observed for
all-cause mortality. The improved clinical outcomes of CABG over MT of CTO
lesions further underscore the potential advantages of revascularizing a
CTO during CABG rather than leaving it untreated, warranting careful
consideration by the Heart Team during their decision-making.

<168>
Accession Number
649655366
Title
Drawing out Informed Consent: a graphic approach to improve patient
satisfaction in patients undergoing transcatheter aortic valve
implantation (TAVI). A secondary analysis of the TAVI Comic trial.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Wainstejn D.; Hornig C.; Dreger H.; Unbehaun A.; Falk V.; Hindricks G.;
Alogna A.; Stangl V.; Brand A.
Institution
(Wainstejn, Dreger, Alogna) Deutsches Herzzentrum der Charite (DHZC),
Department of Cardiology,Angiology and Intensive Care Medicine, Campus
Virchow Klinikum, Berlin, Germany
(Hornig, Hindricks, Stangl, Brand) Deutsches Herzzentrum der Charite
(DHZC), Department of Cardiology,Angiology and Intensive Care Medicine,
Campus Mitte, Berlin, Germany
(Unbehaun, Falk) Deutsches Herzzentrum der Charite (DHZC), Department of
Cardiothoracic and Vascular Surgery, Campus Virchow Klinikum, Berlin,
Germany
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a complex
procedure that demands clear understanding for central aspects of the
patient Informed Consent (IC). Traditional IC forms are often lengthy,
jargon-heavy and difficult to grasp. Our goal was to evaluate whether
medical graphics could improve patient satisfaction. Method(s): In
this prospective, multicentre randomised controlled trial (TAVI-Comic),
TAVI patients were assigned to either conventional IC procedures or an IC
process using additional medical graphics. We assessed the perceived
quality of IC in 300 participants using the Client Satisfaction
Questionnaire-8 as well as six custom questions (single items), with data
analysed by the Wilcoxon Rank Sum Test. Result(s): Patients in the
comic group reported higher satisfaction with the Informed Consent
process, with median CSQ-8 scores of 29 versus 25 (p < 0.0001). Patients
also felt better prepared for the procedure (79.9% vs. 74.7%, p = 0.04),
and 97.4% preferred the comic-based consent method over the conventional
IC approach. Notably, participants in both groups admitted they had not
fully read (64.0%) or understood (64.6%) the conventional IC form.
 Conclusion(s): In conclusion, incorporating medical graphic
narratives into the IC process for TAVI significantly improves patient
satisfaction and preparedness compared to conventional methods, with an
overwhelming preference for the comic approach, and highlights the
shortcomings of traditional consent forms.

<169>
Accession Number
649657145
Title
Diagnostic accuracy of CCTA versus ICA for detecting coronary artery
disease in TAVI patients: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Hosseini K.; Yahyavi Sahzabi R.; Nasrollahizadeh A.; Akbari T.; Rahmati
S.; Maroufi S.P.; Shaker F.; Ghasemi H.; Asfa E.; Assempoor R.;
Azizmohammad Looha M.; Khalique O.K.; Alsaid A.; Hakim D.
Institution
(Hosseini, Yahyavi Sahzabi, Nasrollahizadeh, Rahmati, Maroufi, Shaker,
Ghasemi, Assempoor) Tehran Heart Center, Cardiovascular Diseases Research
Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Akbari) Shahid Beheshti University of Medical Sciences, Cardiovascular
Research Center, Tehran, Iran, Islamic Republic of
(Asfa) Shahid Beheshti University of Medical Sciences, School of Medicine,
Tehran, Iran, Islamic Republic of
(Azizmohammad Looha) Research Institute for Gastroenterology and Liver
Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Khalique) Columbia-Presbyterian Medical Center, Structural Heart and
Valve Center, Division of Cardiology, Department of Medicine, New York,
United States
(Alsaid) Geisinger Medical Center, Department of Cardiology, Danville,
United States
(Hakim) Brigham and Women's Hospital, Harvard Medical School,
Cardiovascular Division, Boston, United States
Publisher
Oxford University Press
Abstract
Introduction: Current guidelines recommend screening for coronary artery
diseases before valvular interventions and computed coronary tomography
angiography (CCTA) has been widely used in patients undergoing
transcatheter aortic valve implantation (TAVI). Purpose(s): This
meta-analysis evaluates the diagnostic accuracy of CCTA versus invasive
coronary angiography (ICA) as the gold standard test, in patients
undergoing TAVI, using segment-level data. Method(s): A systematic
search identified 3723 studies; 13 studies with 2477 patients were finally
included. Quality was assessed with QUADAS-2. A random-effects
meta-analysis was performed with subgroup analyses by imaging protocol
(dual-source or photon-counting CTA, single-source CTA, CT-FFR). The
pooled diagnostic odds ratio (DOR) and area under the curve (AUC) were
computed for both 50% and 70% stenosis thresholds. Result(s): Our
analysis demonstrated pooled sensitivity of 0.83 (95% CI: 0.74-0.92) and
0.90 (95% CI: 0.83-0.98) for CCTA regarding 50% and 70% stenosis,
respectively. The pooled specificity was similarly high, at 0.83 (95% CI:
0.75-0.91) for 50% stenosis and 0.85 (95% CI: 0.79- 0.92) for 70%
stenosis. The meta-analysis revealed a pooled DOR of 41.04 (95% CI:
15.46-108.92) and 39.71 (95% CI: 32.86-47.99) in segment-level data at 50%
and 70% stenosis, respectively. Additionally, the sROC curve suggested
strong diagnostic performance of CCTA, with areas under the curve (AUC) of
92.50% and 93.18% for 50% and 70% stenosis, respectively. Regarding
subgroup analysis at 50% stenosis threshold, dual-source or
photon-counting CTA resulted in pooled sensitivity of 0.85 (95% CI:
0.78-0.93) and pooled specificity of 0.80 (95% CI: 0.71-0.92), while
single-source CTA had pooled sensitivity and specificity of 0.92 (95% CI:
0.80-1.00) and 0.83 (95% CI: 0.63-1.00), respectively. The pooled
sensitivity and specificity of CT-FFR in TAVI patients were 0.55 (95% CI:
0.50-0.62) and 0.89 (95% CI: 0.86-0.92), respectively. Additionally,
regarding the 70% stenosis threshold, dual-source or photon-counting CTA
had a pooled sensitivity of 0.90 (95% CI: 0.83-0.98) and a pooled
specificity of 0.85 (95% CI: 0.79-0.92) for detecting coronary artery
diseases. Conclusion(s): CCTA demonstrates sustained high
sensitivity, DOR, and AUC across different thresholds and imaging
protocols, making it a reliable non-invasive alternative to ICA for ruling
out significant coronary artery disease in TAVI patients. However, its
moderate specificity suggests a potential role in excluding rather than a
definitive diagnosis.

<170>
Accession Number
649654178
Title
Major clinical outcomes in patients with carotid artery stenosis
undergoing transcatheter aortic valve replacement: an updated
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Koliastasis L.;
Ktenopoulos N.; Tsalamandris S.; Latsios G.; Synetos A.; Drakopoulou M.;
Tsioufis K.; Toutouzas K.
Institution
(Theodoropoulou, Apostolos, Koliastasis, Ktenopoulos, Tsalamandris,
Latsios, Synetos, Drakopoulou, Tsioufis, Toutouzas) Hippokration General
Hospital, Athens, Greece
(Vythoulkas-Biotis) Sotiria Regional Chest Diseases Hospital, Athens,
Greece
Publisher
Oxford University Press
Abstract
Background: Data on carotid artery stenosis (CAS) prevalence in patients
undergoing transcatheter aortic valve implantation (TAVI) are limited. It
remains unclear whether CAS serves as a predictor of worse outcomes
following TAVI. Purpose(s): The porpose of this systematic review and
meta-analysis is to evaluate the impact of CAS on major clinical outcomes
in this population. Method(s): A comprehensive literature search of
three major databases (Pubmed, Cochrane and Embase) was conducted to
identify relevant studies, comparing the outcomes of patients with and
without CAS following TAVI. The primary endpoint was the 30-day incidence
of Stroke or Transient Ischemic Attack (TIA) in patients with CAS>= 50%
and CAS>= 70%. Secondary endpoints included in-hospital Stroke/TIA, 30-day
mortality, in-hospital mortality, bleeding, myocardial infarction (MI),
acute kidney injury (AKI), periprocedural vascular complications, and
permanent pacemaker implantation (PPM). Statistical analysis included Risk
Ratio (RR) with 95% confidence interval (CI) using the random-effects
model (Mantel-Haenzel). Result(s): A total of 13 studies, involving
126,660 patients, were included in the metanalysis. CAS >= 50% was
associated with a 42% higher rate of 30day Stroke/TIA (RR: 1.42, 95% CI:
1.01, 2.01) while CAS >= 70% with a 61% higher rate (RR: 1.61, 95% CI:
1.10, 2.36). CAS comorbidity was also linked to increased risk for
in-hospital stroke/TIA (RR: 1.81, 95% CI: 1.25, 2.60), 30day mortality
(RR: 1.29, 95% CI: 1.13, 1.47), and 30day bleeding events (RR: 1.15, 95%
CI: 1.08, 1.23). No differences were observed in the other secondary
endpoints. Conclusion(s): CAS was associated with a higher 30-day
mortality, possibly driven by the higher incidence of Stroke/TIA and
bleeding events following TAVI. Further studies are required to validate
our results. outcomes.

<171>
Accession Number
649655576
Title
The impact of chronic total occlusions in patient outcomes after
transcatheter aortic valve implantation: a systematic review and
meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Pyrpyris N.; Dimitriadis K.; Tatakis F.; Koutsopoulos G.; Kyriakoulis K.;
Theofilis P.; Chrysohoou C.; Aznaouridis K.; Tsioufis K.
Institution
(Pyrpyris, Dimitriadis, Tatakis, Koutsopoulos, Kyriakoulis, Theofilis,
Chrysohoou, Aznaouridis, Tsioufis) Hippokration General Hospital, Athens,
Greece
Publisher
Oxford University Press
Abstract
Introduction: The presence of chronic total occlusions (CTO) can be a
significant predictor of outcomes in patients undergoing transcatheter
aortic valve implantation (TAVI). Despite this relationship is poorly
understood in current literature, evaluating its significance is of major
importance, as it could lead to novel indications for coronary
interventions in this patient phenotype, and especially determine the
optimal timepoint for revascularization. Purpose(s): The aim of this
systematic review and meta-analysis is to investigate the impact of CTOs
in mortality and adverse in patients undergoing TAVI. Method(s): A
systematic search in 3 different databases (MEDLINE/PubMed, Web of Science
and Scopus) was conducted. After selecting all appropriate trials
according to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines, a random effect meta-analysis was
performed. Result(s): A total of 5 studies were included, with a
total population of 35,902 patients, out of which 5,867 had a CTO
(CTO-TAVI) and 30,035 did not (non-CTO-TAVI). There was no significant
difference between the two cohorts regarding in-hospital [Relative Risk
(RR): 1.15; 95% Confidence Interval (95%CI): 0.73-1.80] or 1-year
all-cause mortality (RR: 1.55; 95%CI: 0.79-3.04). Furthermore, CTO-TAVI
was associated with significantly lower rates of post intervention
pacemaker implantation (RR: 0.88, 95%CI: 0.79-0.97), whilst non-CTO-TAVI
with lower acute myocardial infarction (AMI) events (RR: 1.32, 95%CI:
1.10-1.59). No differences were found in respect to cardiogenic shock (RR:
1.17, 95%CI: 0.96-1.43), acute kidney injury (RR: 1.13, 95%CI: 0.90-1.43)
or bleeding events (RR: 1.04, 95%CI: 0.90-1.20). Finally, regarding all
death events at 1 year, evaluated at each study's last follow up, there
was still no significant difference between the two cohorts (RR: 1.26,
95%CI: 0.90-1.75). Conclusion(s): This metanalysis shows that there
is no difference in mortality in patients undergoing TAVI, irrespective of
CTO presence. Furthermore, CTO-TAVI is associated with significantly lower
new pacemaker implantation and increased AMIs, with no other differences
in adverse outcomes. Therefore, these findings suggest a modest effect of
CTO-TAVI in post-operative adverse events or mortality. However, the
observational design of the included studies and the limited available
data warrant further research of the CTO-TAVI relationship in larger
randomized clinical trials.

<172>
Accession Number
649655537
Title
Incidence, temporal trends and predictors for permanent pacemaker
implantation after transcatheter aortic valve replacement.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Broeze G.; Hemelrijk K.I.; Jimenez-Quevedo P.; Tchetche D.; De Brito F.S.;
Barbanti M.; Kornowski R.; Latib A.; D'onofrio A.; Ribichini F.;
Nombela-Franco L.; Dangas G.; Mehran R.; Van Nieuwkerk A.C.; Delewi R.
Institution
(Broeze, Hemelrijk, Van Nieuwkerk, Delewi) Amsterdam University Medical
Centre (AUMC), Amsterdam, Netherlands
(Jimenez-Quevedo, Nombela-Franco) Hospital Clinico San Carlos, Madrid,
Spain
(Tchetche) Clinic Pasteur, Toulouse, France
(De Brito) Instituto do Coracao FMUSP, Sao Paulo, Brazil
(Barbanti) Kore University, Enna, Italy
(Kornowski) Rabin Medical Center, Petah Tikva, Israel
(Latib) EMO-GVM Heart Center Columbus, Milan, Italy
(D'onofrio) University of Padua, Padova, Italy
(Ribichini) University of Verona, Verona, Italy
(Dangas, Mehran) Mount Sinai School of Medicine, New York, United States
Publisher
Oxford University Press
Abstract
Background: Conduction abnormalities requiring permanent pacemaker (PPM)
implantation are a common complication in patients undergoing
transcatheter aortic valve implantation (TAVI). Existing literature,
including studies based on large databases and meta-analyses typically
reports data up to 2019. Since then, new valve designs have been
introduced, and guidelines regarding PPM implantation have changed.
 Purpose(s): This study aims to evaluate the incidence, temporal
trends, and predictors for PPM implantation following TAVI during
hospitalization using a large, contemporary database. Method(s): The
CENTER2-study is a patient-level database that encompasses 25,771 patients
who underwent TAVI. Only patients with documented pacemaker status were
included. Logistic regression analysis was performed to identify
predictors of PPM implantation. Result(s): A total of 23,679 patients
(56% female) who underwent TAVI between 2007 and 2022 were included in the
study. In-hospital PPM implantation was observed in 3,507 patients
(14.8%). The rates of in-hospital PPM implantation increased over time
when assessed in 4-year intervals, rising from 15.1% during 2007-2010 to
16.3% during 2019-2022 (ptrend<0.001). The implantation of self-expandable
valves (SEVs) was associated with higher in-hospital PPM implantation
rates compared to balloon-expandable valves (BEVs) (18.2% vs. 9.8%; OR:
2.03; 95% CI: 1.88-2.20; p<0.001). The rate of in-hospital PPM
implantation decreased in current-generation SEVs compared to
older-generation SEVs (20.3% vs. 17.3%; OR: 0.82; 95% CI: 0.75-0.90;
p<0.001). However, current-generation BEVs were associated with a higher
in-hospital PPM implantation rate compared to older-generation BEVs (6.4%
vs. 13.1%; OR: 2.18; 95% CI: 1.89-2.50; p<0.001). The in-hospital PPM
implantation rate increased with larger valve sizes, ranging from 7.4% for
20 up to 23 mm valves to 23.9% for 34 mm valves (p<0.001; Fig. 1).
Predictors of in-hospital PPM implantation after TAVI included the
implantation of a self-expandable valve, valve size, postdilatation, and
age (Fig. 2). Conclusion(s): This study demonstrates that PPM
implantation remains a common and increasingly prevalent complication in
patients undergoing TAVI. The likelihood of PPM implantation increases
with valve size. Notably, the in-hospital PPM implantation for
current-generation BE valves is twice that of older-generation valves.
Future research should investigate the underlying causes of the increased
PPM implantation rate associated with current-generation BE valves.

<173>
Accession Number
649655311
Title
GLUCO-TAVI trial: treatment with glucocorticoids in patients undergoing
TAVI to reduce the incidence of atrioventricular block and pacemaker
implantation.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Fuertes Kenneally L.; Torres Mezcua F.; Herrero Brocal M.; Quesada Rico
J.A.; Pineda Rocamora J.; Bordes Siscar P.; Valencia Martin J.; Torres
Saura F.; Ajo Ferrer R.; Yago Riquelme C.; Martinez Lopez D.; Martinez
Martinez J.G.; Ruiz Nodar J.M.
Institution
(Fuertes Kenneally, Torres Mezcua, Herrero Brocal, Pineda Rocamora, Bordes
Siscar, Valencia Martin, Torres Saura, Ajo Ferrer, Yago Riquelme, Martinez
Lopez, Martinez Martinez, Ruiz Nodar) General University Hospital of
Alicante, Alicante, Spain
(Quesada Rico) University Miguel Hernandez, Elche, Spain
Publisher
Oxford University Press
Abstract
Background: Despite growing demand for transcatheter aortic valve
implantation (TAVI), an effective treatment for its most common
complication remains elusive. Cardiac conduction defects (CCD) often
necessitate pacemaker implantation (PPI), leading to higher morbidity and
healthcare costs (1). While mechanical injury is the main mechanism behind
post-TAVI CCD, evidence suggests that a transient inflammation-driven
mechanism may play a role (2, 3). Previous studies targeting inflammation
showed inconsistent results (4, 5). Purpose(s): This study aimed to
evaluate the safety and efficacy of glucocorticoids in preventing PPI in
patients undergoing TAVI. Method(s): In this randomized, controlled,
open-label trial, we included 100 patients who met the latest guideline
criteria for TAVI (6). These patients were randomized in a 1:1 ratio to
receive usual care or methylprednisone 7 mg/kg an hour before the
procedure, followed by prednisone 15 mg / 12 hours for 5 days (Figure 1
depicts the study protocol). Inflammatory biomarkers and
electrocardiograms were assessed pre- and post-intervention, at discharge,
and one month. The primary efficacy endpoint was the incidence of PPI at
one month. Secondary outcomes included new-onset LBBB, mortality, and
procedural complications. Result(s): A total of 100 patients met the
inclusion criteria; 60% were women with a mean age of 81.4 (SD 5.2) years.
Baseline characteristics including established risk factors for post-TAVI
CCD such as prosthetic valve type (balloon-expandable vs.
self-expandable), clinical frailty, and membranous septum length, were
balanced between groups (7). No patients were lost to follow-up.
Glucocorticoid therapy resulted in a lower increase of inflammatory
markers post-TAVI (DELTACRP OR 0.01 (- 0.16 - 0.24); p value < 0.001). The
primary efficacy outcome was observed in 16% of the control group (CG),
similar to previous studies (8), and 8% of the intervention group (IG) (OR
0.50; 95% CI 0.16-1.55; p = 0.23) suggesting a potential reduction of 50%
PPI risk, though not statistically significant. The statistical power for
this outcome was low (23.1%). LBBB was more frequent in the IG compared to
controls (OR 1.12; 95% CI 0.66 - 1.89; p value = 0.66), but a higher
one-month resolution rate was noted (63.15% vs. 47.05%; OR 0.78; 95% CI
0.31-1.93; p value 0.587). No significant differences were observed
between groups in vascular complications (10% in the IG vs. 2% in the CG;
p = 0.20) or mortality (2% vs. 4%; p = 0.60). Three adverse events related
to glucocorticoid use were detected, one hyperglycemia and two heart
failure decompensations. Tables 1 and 2 summarise clinical outcomes and
adverse events between groups. Conclusion(s): Glucocorticoid therapy
in TAVI showed a non-significant trend toward reducing PPI, without
increasing adverse events. The study was limited by low statistical power
which may have prevented the detection of a true effect. Larger studies
are needed to confirm these findings.

<174>
Accession Number
649656255
Title
Comparing DOACs and warfarin in atrial fibrillation patients with
bioprosthetic valves: a systematic review and meta-analysis.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Younas A.; Gamarra Valverde N.N.G.V.; Noor R.N.; Ashraf H.A.; Nisar M.N.;
Ihtasham A.I.; Fatima M.F.; Younas M.Y.; Khan T.K.; Irshad S.M.I.; Singh
P.K.S.; Raza A.H.M.E.D.
Institution
(Younas) Allama Iqbal Medical College, Lahore, Pakistan
(Gamarra Valverde) Universidad Peruana Cayetano Heredia, Lima, Peru
(Noor) Khyber Medical College, Peshawar, Pakistan
(Ashraf) Rawalpindi Medical University, Rawalpindi, Pakistan
(Nisar, Raza) Services Institute of Medical Sciences, Lahore, Pakistan
(Ihtasham) King Edward Medical University, Lahore, Pakistan
(Fatima) Ziauddin University, Karachi, Pakistan
(Younas) Gomal Medical College, DG khan, Pakistan
(Khan) Liaquat National Hospital and Medical College, Karachi, Pakistan
(Irshad) Ras Al Khaimah Medical and Health Sciences University, Ras Al
Khaimah, United Arab Emirates
(Singh) Kirori Mal College, Delhi, India
Publisher
Oxford University Press
Abstract
Introduction: Patients with atrial fibrillation (AF) who have
bioprosthetic valves usually need anticoagulation to lower the risk of
blood clots and stroke. Although warfarin has been the traditional
treatment, direct oral anticoagulants (DOACs) are gaining popularity as an
alternative However, the current data on the safety and effectiveness of
DOACs compared to warfarin is still incomplete. This meta-analysis brings
together existing studies to compare how DOACs and warfarin perform in
this high-risk group Purpose: The goal of this study is to evaluate key
clinical outcomes, such as overall mortality, bleeding complications,
thromboembolic events and hospitalizations, in AF patients with
bioprosthetic valves who are treated with either DOACs or warfarin
Methods: A systematic review and meta-analysis of 14 studies (including
randomized controlled trials, observational studies, retrospective
studies, and prospective cohort studies) was performed. The analysed
outcomes included all-cause mortality, cardiovascular (CV) mortality
thromboembolic events, stroke, transient ischemic attack (TIA), myocardial
infarction (MI), intracardiac thrombus, hospitalization and various
bleeding events [intracranial, gastrointestinal (GI), major, non-major,
and overall]. Pooled odds ratios (ORs) with 95% confidence intervals (CIs)
were calculated using random-effects models. Heterogeneity was assessed
using I2, Chi2, Tau2 statistics Results:
DOACs were linked to reduced all-cause mortality compared to warfarin (OR
0.75; 95% CI 0.62, 0.91; P=0.004), while CV mortality showed no
significant difference between the two groups (OR 0.72; 95% CI 0.42, 1.23;
P=0.23). Additionally, DOACs significantly lowered the risk of GI bleeding
(OR 0.74; 95% CI 0.56, 0.98; P=0.04) and thromboembolic events (OR 0.78;
95% CI 0.62, 0.98; P=0.04). Hospitalization rates were also notably lower
with DOACs (OR 0.75; 95% CI 0.62, 0.91; P=0.003). While there was a trend
toward reduced stroke or systemic embolism (OR 0.45; 95% CI 0.10, 1.91;
P=0.28), the high level of variability (I2=84%) makes
interpretation challenging. No significant differences were found in
intracranial bleeding (OR 0.83; 95% CI 0.48, 1.42; P=0.49), but major
bleeding was significantly lower with DOACs (OR 0.71; 95% CI 0.52, 0.97;
P=0.03). The risk of MI was similar between the two treatments (OR 1.00;
95% CI 0.72, 1.38; P=0.98) Conclusion(s): Our findings suggest that
DOACs may offer a safer alternative to warfarin for patients with AF and
bioprosthetic valves. In particular, DOACs are linked to significant
reductions in overall mortality, gastrointestinal bleeding, thromboembolic
events, and hospitalizations. On the other hand, rates of cardiovascular
mortality, intracranial bleeding, and myocardial infarction are similar
between the two treatments. However, the wide range of results in stroke
and systemic embolism data indicates that more research is needed to
better understand these outcomes.

<175>
Accession Number
649656661
Title
Safety of PCI in patients with coronary artery disease and aortic stenosis
undergoing TAVI.
Source
European Heart Journal. Conference: ESC Congress 2025. Madrid Spain.
46(Supplement 1) (no pagination), 2025. Date of Publication: 01 Nov 2025.
Author
Gupta S.; Kaiteris A.; Rahman T.; Tam E.; Mann N.; Al-Damluji M.; John M.;
Thande N.; Subramanian K.; Saleem U.; Tao M.
Institution
(Gupta, Kaiteris, Rahman, Tam, Mann) Stony Brook University Hospital,
Stony Brook, United States
(Al-Damluji, John, Thande, Subramanian, Saleem, Tao) Hartford Hospital,
Hartford, United States
Publisher
Oxford University Press
Abstract
Background: Coronary artery disease (CAD) is a frequent coexisting issue
in patients with severe aortic stenosis (AS). While professional societies
have recommended complete revascularization in patients undergoing
surgical aortic valve implantation, the safety and efficacy of
percutaneous coronary intervention (PCI) in patients with CAD and severe
AS who are undergoing transcatheter aortic valve implantation (TAVI)
remains unclear. Purpose(s): In this study, we performed a systematic
review and meta-analysis evaluating the safety of PCI in patients with CAD
and severe AS who are undergoing TAVI. Method(s): We performed a
literature search using the databases Pubmed, Embase, and Web of Science,
looking for studies that evaluated the association between PCI and safety
outcomes in patients with CAD and severe AS undergoing TAVI. The endpoints
of interest were risk of device-related vascular complications, major
bleeding, minor bleeding, renal failure, and cerebrovascular accident
(CVA) or transient ischemic attack (TIA). The search was not limited by
time or publication status. Result(s): A total of 11 studies with
6,758 patients with CAD and severe AS who were undergoing TAVI met
inclusion criteria. 1,842 patients received PCI while 4,916 patients did
not receive PCI. The mean follow-up duration was 4.4 months (ranging 1
month to 24 months), mean age was 82.1 years old, 49.2% were men, the mean
aortic valve area was 0.7, mean aortic valve gradient was 45 mmHg, mean
left ventricular ejection fraction was 53.6%. There was a statistically
significantly higher risk of device-related vascular complications in
patients who received PCI compared to patients who did not receive PCI (OR
1.97, 95% CI 1.47, 2.62; p<0.01). The heterogeneity for this analysis was
low (I2 = 0%). There was no statistically significant difference in risk
of major bleeding, minor bleeding, renal failure, or CVA/TIA between
patients who did or did not receive PCI (OR 1.17, 95% CI 0.81, 1.7;
p=0.41; OR 1.3, 95% CI 0.91, 1.86; p=0.15; OR 0.65, 95% CI 0.37, 1.16;
p=0.14; OR 0.74, 95% CI 0.49, 1.12; p=0.16). Conclusion(s): In
patients with both CAD and severe AS who are undergoing TAVI, PCI is
associated with significantly higher risk of device-related vascular
complications but no difference in risk of major/minor bleeding, renal
failure, or CVA/TIA. Given the potential risks for adverse events shown in
this study, additional high-quality studies are needed to better establish
the clinical benefit of performing PCI in this patient population.

<176>
Accession Number
649641868
Title
Physiology vs angiography-guided percutaneous coronary intervention in
transcatheter aortic valve implantation: the FAITAVI trial.
Source
European heart journal. (no pagination), 2025. Date of Publication: 19
Dec 2025.
Author
Ribichini F.L.; Scarsini R.; Pesarini G.; Fabris T.; Barbierato M.;
D'Amico G.; Zanchettin C.; Gregori D.; Lorenzoni G.; Piva T.; Nicolini E.;
Gandolfo C.; La Spina K.; Fineschi M.; Gallo F.; Baccani B.; Petronio
A.S.; De Carlo M.; Berti S.; Drago A.; Saia F.; Sclafani R.; Esposito G.;
D'Ascenzo F.; Tarantini G.
Institution
(Ribichini, Scarsini, Pesarini) Division of Cardiology, Department of
Medicine, University of Verona, Piazzale Aristide Stefani, Verona, Italy
(Fabris, Zanchettin, Gregori, Lorenzoni, Tarantini) Department of Cardiac,
Thoracic and Vascular Science, University of Padua, Padua, Italy
(Barbierato, D'Amico, Zanchettin, Gallo) Division of Cardiology, Ospedale
dell'Angelo, Mestre, Venice, Italy
(Piva, Nicolini) Division of Cardiology, Azienda Ospedaliero Universitaria
delle Marche, Ancona, Italy
(Gandolfo, La Spina) Division of Cardiology, Palermo, Italy
(Fineschi, Baccani) Division of Cardiology, Azienda Ospedaliera
Universitaria Senese, Siena, Italy
(Petronio, De Carlo) Division of Cardiology, Azienda Ospedaliero
Universitaria Pisana, Pisa, Italy
(Berti) Division of Cardiology, Ospedale del Cuore-Fondazione Monasterio,
Massa, Italy
(Drago) Division of Cardiology, Ospedale San Bortolo di Vicenza, Vicenza,
Italy
(Saia) Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna,
Italy
(Sclafani) Division of Cardiology, Azienda Ospedaliera di Perugia-Ospedale
S. Maria della Misericordia, Perugia, Italy
(Esposito) Division of Cardiology, Policlinico Universitario Federico II
di Napoli, Naples, Italy
(D'Ascenzo) Division of Cardiology, Department of Medical Sciences,
Hospital University of Turin, Citta della Salute e della Scienza, Turin,
Italy
Abstract
BACKGROUND AND AIMS: The optimal approach to coronary revascularization in
patients undergoing transcatheter aortic valve implantation (TAVI) remains
debated. Fractional flow reserve (FFR) may improve the identification of
ischaemia-producing lesions compared to angiographic assessment alone, but
data in the TAVI population are lacking. METHOD(S): In this
multicentric, open-label, randomized, superiority trial with blind
adjudication of adverse events, patients with aortic stenosis and
intermediate coronary lesions undergoing TAVI were randomized 1:1 to
FFR-guided or angiography-guided percutaneous coronary intervention (PCI).
The trial was registered at ClinicalTrials.gov (NCT03360591). All
randomized patients were included in the primary analysis according to the
intention-to-treat principle. The primary endpoint was a major adverse
cardiac and cerebrovascular event (MACCE) at 12 months of follow-up,
defined as a composite of all-cause death, myocardial infarction,
ischaemia-driven target vessel revascularization, disabling stroke, or
major bleeding. RESULT(S): A total of 320 patients were enrolled
across 15 Italian centres. The median age of the patients was 86 years
[interquartile range (IQR) 83-90], and the median STS score was 3% (IQR
2-5). The median SYNTAX score was 7 (IQR 5-11). FFR-guided PCI was
associated with a significantly lower rate of MACCE at 12 months compared
with angiography-guided PCI (8.5% vs 16.0%; hazard ratio .52; 95%
confidence interval .27-.99; P = .047). The difference in the primary
endpoint was primarily driven by a reduction in all-cause mortality
(hazard ratio .31; 95% confidence interval .10-.96). Other components of
the composite were numerically lower but not statistically significant.
 CONCLUSION(S): In patients undergoing TAVI with intermediate coronary
lesions, FFR-guided PCI was associated with a reduced risk of MACCE at 12
months. These findings support a physiology-based revascularization
strategy in this frail, elderly population. Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved. For commercial
re-use, please contact reprints@oup.com for reprints and translation
rights for reprints. All other permissions can be obtained through our
RightsLink service via the Permissions link on the article page on our
site-for further information please contact

<177>
Accession Number
2042339131
Title
CO2 A Systematic Literature Review and Meta-Analysis Comparing
Robotic-Assisted Mitral Valve Repair Using the Da Vinci Surgical System to
Open Mitral Valve Repair.
Source
Value in Health. Conference: ISPOR Europe 2025: Powering Value and Access
Through Patient-Centered Collaboration. Glasgow United Kingdom. 28(12
Supplement 1) (pp S41), 2025. Date of Publication: 01 Dec 2025.
Author
Yankovsky A.; Patel N.; Kreaden U.
Institution
(Yankovsky, Patel) Intuitive Surgical, Sunnyvale, CA, United States
(Kreaden) Managing Fellow, Biostatistics, Access & Evidence, Intuitive
Surgical, Sunnyvale, CA, United States
Publisher
Elsevier Ltd
Abstract
Objectives: This systematic literature review and meta-analysis compares
the perioperative clinical outcomes of robotic-assisted (rMVR), open
(oMVR) and mini-thoracotomy (mini-MVR) mitral valve repair.
 Method(s): A PRISMA-guided literature review was conducted using
Pubmed, Scopus, and Embase covering 01/01/2010 to 01/11/2024 (Prospero
#CRD420250652462). Inclusion criteria consisted of publications involving
adults with mitral valve disease requiring repair of the mitral valve, in
the form of RCTs, large database, prospective, and retrospective cohort
studies with a sample size greater than 20 in each arm and quantifiable
perioperative safety and effectiveness outcomes. Data were pooled as odds
ratios (OR) or mean differences (MD) in R using fixed-effects or
random-effects (heterogeneity significant). Result(s): The search
identified 25 eligible studies (17 retrospective, 5 database, 2
prospective, and 1 RCT), including 12,133 rMVR, 8,496 mini-MVR, and 9,685
oMVR patients. Mini-MVR and rMVR were comparable with respect to outcomes
of safety and effectiveness. Compared to oMVR, rMVR operative time was
43.5 minutes longer (p<0.01). Additionally, patients undergoing rMVR were
48% less likely to receive a blood transfusion postoperatively (OR:0.52,
[0.31, 0.88] p=0.01), had shorter ICU stay by 0.4 days (p=0.03), had
shorter hospital stay by 1.3 days ( p<0.01), were 28% less likely to
experience postoperative atrial fibrillation (OR: 0.72, [0.62, 0.84]
p<0.01) and 47% less likely to experience short-term mortality (OR: 0.53,
[0.31, 0.92] p=0.03) compared to oMVR patients. Conclusion(s):
Current evidence demonstrates that rMVR is comparable to mini-MVR repair
and offers numerous benefits over oMVR. While further prospective
comparative studies are warranted, rMVR is a safe and effective choice
over oMVR. This information may be helpful for payers, policymakers, and
Health Technology Agencies. Copyright © 2025

<178>
Accession Number
2042128717
Title
A PROSPECTIVE RANDOMIZED CONTROL STUDY BETWEEN INTRAVENOUS CLONIDINE AND
DEXMEDETOMIDINE AS PREMEDICATION FOR INDUCED HYPOTENSION IN FUNCTIONAL
ENDOSCOPIC SINUS SURGERY.
Source
International Journal of Academic Medicine and Pharmacy. 7(5) (pp
404-408), 2025. Date of Publication: 01 Jan 2025.
Author
Kavitharani K.; Anitha K.; Elavarasan D.; Akila K.
Institution
(Kavitharani, Elavarasan, Akila) Senior Assistant Professor, Department of
Anaesthesiology, KAPV Government Medical College, Tamilnadu, Trichy, India
(Anitha) Associate Professor, Department of Anaesthesiology, Government
Medical College, Tamilnadu, Ariyalur, India
Publisher
Society for Healthcare and Research Development
Abstract
Background: Functional Endoscopic Sinus Surgery (FESS) often requires a
bloodless field to optimise visibility. Controlled hypotension with
alpha-2 agonists, such as clonidine and dexmedetomidine, is commonly used
to achieve this. Objective(s): To compare the efficacy of intravenous
clonidine and dexmedetomidine as premedication for induced hypotension in
adult patients undergoing FESS, evaluating surgical field quality, surgeon
satisfaction, patient recovery, and adverse effects. Material(s) and
Method(s): Sixty ASA I/II patients scheduled for FESS were randomly
allocated to two groups. Group A received intravenous dexmedetomidine (1
mug/kg), and Group B received intravenous clonidine (2 mug/kg), both
administered 15 min before induction. The intraoperative mean arterial
pressure was maintained between 50 and 70 mmHg using isoflurane titration.
The parameters assessed included the Fromme-Boezaart surgical field score,
heart rate, blood pressure, isoflurane requirements, sedation scores, and
awakening time. Result(s): Both groups were comparable in terms of
demographic characteristics. Group A showed a significantly better
Fromme-Boezaart score (1.8 +/- 0.66 vs. 2.43 +/- 0.68), shorter awakening
time (5.23 +/- 1.33 min vs. 8.6 +/- 1.67 min), and reduced isoflurane
requirement. Heart rates were similar during surgery, except for
post-extubation, where Group A had higher rates. The mean arterial and
diastolic pressures were significantly lower in Group A, whereas the
systolic pressures were comparable. No adverse reactions were reported.
 Conclusion(s): Intravenous dexmedetomidine provided more effective
hypotensive anaesthesia than clonidine, enhancing surgical field quality,
reducing anaesthetic requirements, and improving recovery profile.
Dexmedetomidine may be preferred as premedication for induced hypotension
in FESS, with good safety and surgeon satisfaction. Copyright ©
(2025), (Society for Healthcare and Research Development). All rights
reserved.

<179>
Accession Number
2036052311
Title
CEREBRAL-EMBOLIC PROTECTION DEVICES AND TAVI. COULD NEUROLOGICAL
COMPLICATIONS BE AVOIDED?.
Source
Atherosclerosis. Conference: The Abstract from ISA 2024 conference. Oman.
399(Supplement 1) (pp 18-18), 2024. Date of Publication: 01 Dec 2024.
Author
Gbreel M.I.; Balata M.; Elkasaby M.H.; Hassan M.; Becher M.U.
Institution
(Gbreel) October 6 University, Cairo, Egypt
(Balata, Becher) Department of Internal Medicine and Polyclinic II,
University Hospital Bonn, Germany
(Elkasaby) Faculty of Medicine and surgery, Al-Azhar University, Cairo,
Egypt
(Hassan) Department of Immunology and Endocrinology, Theodor Bilharz
Research Institute, Giza, Egypt
Publisher
Elsevier Ireland Ltd
Abstract
Purpose of the study: Transcatheter aortic valve implantation (TAVI) has
become an established treatment option for aortic stenosis. Cerebral
embolic protection devices (CEPDs) were developed to protect against
embolization perioperatively. We aim to assess the effect of CEPDs used in
TAVI procedures and the risk of stroke starting from day two following
TAVI, as well as neurocognitive outcomes. Material(s) and Method(s):
Six databaseswere searched until 20 January 2024. The risk ratio (RR) and
mean difference (MD) with their corresponding 95% confidence interval (CI)
were used as effect sizes. The Cochrane Risk of Bias tool was used for
quality assessment. The analysis was performed via Review Manager
software. Result(s): Seven studies were finally included with 4091
patients who underwent TAVI with or without CEPDs. The results showed a
significant risk of disabling stroke 2-5 days postoperatively without
cerebral protection devices (RR 0.455, 95% CI:[0.214, 0.967]; P = 0.041)
but no significant associated risk following 30 days postoperatively (RR
1.295; 95 CI:[0.373, 4.493]; P = 0.684). The was no significant risk of
non-disabling stroke with 2-5 days or 30 days postoperative followup
between both the cerebral protection group and controls (RR 1.196; 95%
CI:[0.738, 1.938]; P = 0.467), (RR 0.939; 95% CI:[0.528, 1.671]; P =
0.831) respectively. The secondary outcomes (e.g., adverse cardiac events,
and major vascular complications) showed no higher risk in both groups.
 Conclusion(s): Using CEPDs in TAVI procedures can be effective in
reducing disabling stroke in the initial phase postoperatively. CEPDs also
have a protective effect against mild cognitive impairment after
TAVI. Copyright © Elsevier Ltd. All rights reserved.

<180>
Accession Number
2042339361
Title
EE309 Cost-Utility Analysis of the AlloMap Test for the Monitoring of
Patients After Heart Transplantation: Economic Evaluation Alongside the
CUPIDON Trial.
Source
Value in Health. Conference: ISPOR Europe 2025: Powering Value and Access
Through Patient-Centered Collaboration. Glasgow United Kingdom. 28(12
Supplement 1) (pp S164), 2025. Date of Publication: 01 Dec 2025.
Author
Serrier H.; Huot L.; Hanser M.; Lelong B.; Epailly E.; Boignard A.; Dorent
R.; Battistella P.; Coutance G.; Guitard J.; Pattier S.; Nafeh-Bizet C.;
Nubret K.; Baudry G.; Radosavljevic M.; Sebbag L.
Institution
(Serrier, Huot) Hopitaux de Lyon, Lyon, France
(Hanser, Baudry) Hospices Civils de Lyon, Lyon, France
(Lelong) Rennes university Hospital, Rennes, France
(Epailly) Strasbourg University Hospitals, Strasbourg, France
(Boignard) Grenoble University Hospital, Grenoble, France
(Dorent, Coutance) Assistance Publique Hopitaux de Paris URCEco, Paris,
France
(Battistella) Reunion University Hospital, Saint Denis, France
(Guitard) Toulouse University Hospital, Toulouse, France
(Pattier) Nantes University Hospital, Nantes, France
(Nafeh-Bizet) Rouen university Hospital, Rouen, France
(Nubret) Hopitaux Universitaires de Bordeaux, Bordeaux, France
(Radosavljevic) New Civil Hospital, Strasbourg, France
(Sebbag) Hopitaux de Lyon, France, France
Publisher
Elsevier Ltd
Abstract
Objectives: AlloMap is a non-invasive blood test that can identify
patients with low probability of moderate to severe acute cellular
transplant rejection. The International Society of Heart and Lung
Transplantation recommends its use for the monitoring of patients between
6 months and 5 years after heart transplantation. This test could be an
alternative to systematic biopsies but is expensive and not covered by
French health insurance. Our objective was to perform an economic
evaluation of the AlloMap test for the monitoring of patients after heart
transplantation. Method(s): Economic evaluation was conducted
alongside the CUPIDON multicenter randomized controlled trial which
enrolled patients between 2016 and 2020 in either the "AlloMap" or
"Biopsies" strategy. The evaluation was conducted from a healthcare system
perspective over a 30-month period. Costs were estimated using actual
hospital stay data and QALYs were estimated using the EQ5D-5L
questionnaire and preference scores validated in the French population.
Uncertainty was handled using the nonparametric bootstrap and univariate
analysis. Result(s): 190 patients were randomized and included in the
cost-utility analysis. Initial characteristics of the populations were
comparable. In the main analysis, the "AlloMap" strategy represented an
additional cost of around 15,380 compared with the "Biopsies" strategy.
The average cost per patient was estimated at 39,069 for the "AlloMap"
strategy and 23,689 for the "Biopsies" strategy. The average QALY per
patient was estimated at 1.87 for the "AlloMap" strategy and 1.92 for the
"Biopsies" strategy but the difference was not significant. Further
analysis showed that the "Biopsies" strategy became more costly than the
"AlloMap" strategy when the price of the test fell below 799.
 Conclusion(s): The AlloMap test is expected to be cost effective for
a price below 799 in a French setting. According to these results, there
is a need to reflect on the optimal follow-up for heart transplantation
patients. Copyright © 2025

<181>
Accession Number
2036052488
Title
HOMOCYSTEINE LEVELS FOLLOWING BARIATRIC SURGERY: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Atherosclerosis. Conference: The Abstract from ISA 2024 conference. Oman.
399(Supplement 1) (pp 59-59), 2024. Date of Publication: 01 Dec 2024.
Author
Jamialahamdi T.; Mirhadi E.; Almahmeed W.; Sukhorukov V.N.; Eid A.H.;
Salehabadi S.; Al-Rasadi K.; Sahebkar A.
Institution
(Jamialahamdi) Pharmaceutical Research Center, Pharmaceutical Technology
Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Jamialahamdi) Medical Toxicology Research Center, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Mirhadi, Sahebkar) Biotechnology Research Center, Pharmaceutical
Technology Institute, Mashhad University of Medical Sciences, Mashhad,
Iran, Islamic Republic of
(Almahmeed) Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
(Sukhorukov) Institute of General Pathology and Pathophysiology,
Baltiiskaya Street, Moscow, Russian Federation
(Eid) Department of Basic Medical Sciences, College of Medicine, QU
Health, Qatar University, Doha, Qatar
(Salehabadi, Sahebkar) Applied Biomedical Research Center, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Al-Rasadi) Medical Research Centre, Sultan Qaboos University, Muscat,
Oman
Publisher
Elsevier Ireland Ltd
Abstract
Background: Elevated levels of homocysteine, an amino acid derived from
methionine metabolism, have been linked to cardiovascular disease.
Bariatric surgery is known to reduce the risk of cardiovascular disease,
but its effect on homocysteine levels is still debated. The purpose of
this meta-analysis was to examine the impact of bariatric surgery on
circulating homocysteine levels. Method(s):We conducted a systematic
search in several databases and used Comprehensive Meta-Analysis software
for their analysis. They determined the overall effect size using a
random-effects metaanalysis and the leave-one-out approach.
 Result(s): This meta-analysis, included 18 trials and 1576
individuals, showed a non-significant increase in circulating homocysteine
levels after bariatric surgery (WMD: 0.433, 95% CI: -0.573, 1.440, 95% PI:
-4.312, 5.179 p = 0.399; I2:99.54). In sub-analyses, a significant
elevation was only observed for sleeve gastrectomy (WMD: 3.317, 95% CI:
0.071, 6.564, p = 0.045), not for RYGB. Additionally, there was no
significant change in homocysteine concentrations based on the duration of
follow-up. Conclusion(s): This systematic review and meta-analysis
indicate that bariatric surgery does not have a significant effect on
homocysteine levels. Furthermore, this lack of effect is not influenced by
the time elapsed since the surgery. Copyright © Elsevier Ltd. All
rights reserved.

<182>
Accession Number
2037470525
Title
Relationship Between the Current Definitions of Periprocedural Myocardial
Infarction and Clinical Outcomes Following Percutaneous Coronary
Revascularization.
Source
Reviews in Cardiovascular Medicine. 26(11) (no pagination), 2025. Article
Number: 43839. Date of Publication: 01 Nov 2025.
Author
Paolucci L.; Nardi G.; Lombardi M.; Occhipinti G.; Mangiacapra F.;
Vergallo R.; Musto C.; Colaiori I.; Briguori C.; Gabrielli D.; Felice F.D.
Institution
(Paolucci, Gabrielli, Felice) Interventional Cardiology Unit, San Camillo
Forlanini Hospital, Rome, Italy
(Nardi) Structural Interventional Cardiology, Careggi University Hospital,
Florence, Italy
(Lombardi, Vergallo) Department of Internal Medicine and Medical
Specialties (DIMI), Universita di Genova, Genova, Italy
(Occhipinti) Cardiovascular Clinic Institute, Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona,
Hospital Clinic de Barcelona, Catalunya, Barcelona, Spain
(Mangiacapra) Interventional Cardiology Unit, Campus Biomedico University,
Rome, Italy
(Vergallo) Cardiothoracic and Vascular Department (DICATOV), IRCCS
Ospedale Policlinico San Martino, Genova, Italy
(Musto) Cardiology Unit, PO San Giovanni Evangelista, Tivoli, Italy
(Colaiori) Interventional Cardiology Unit, Santa Maria Goretti Hospital,
Latina, Italy
(Briguori) Interventional Cardiology Unit, Clinica Mediterranea, Naples,
Italy
Publisher
IMR Press Limited
Abstract
Since the beginning of the percutaneous coronary intervention (PCI) era,
periprocedural myocardial infarction (PMI) has been recognized as a
potential source of impaired outcomes in patients undergoing
revascularization. Subsequently, several different definitions of PMI have
been provided, coming from trial research groups or international
consensus. Despite these efforts, the debate over the prognostic value or
PMI in terms of mortality risk, as well as its role in defining composite
ischemic endpoints in clinical investigations, has been extremely active.
Currently, three international definitions of PMI are available: the
Universal Definition of Myocardial Infarction (UDMI), the Academic
Research Consortium (ARC)-2 definition, and the definition by the Society
for Cardiovascular Angiography and Interventions (SCAI). These definitions
differ significantly in terms of sensitivity and prognostic relevance,
which has led to heterogeneous findings in clinical studies investigating
this topic. Thus, this review aims to provide an overview of the main
features of these definitions, their association with the risk of
mortality, and how different definitions can influence the results of
major investigations in the research setting. Copyright © 2025
The Author(s). Published by IMR Press.

<183>
Accession Number
2042354632
Title
Posterior pericardiotomy: An effective strategy for reducing post-coronary
artery bypass grafting complications, with considerations for pleural
effusion risk.
Source
World Journal of Cardiology. 17(10) (pp 1-10), 2025. Article Number:
110793. Date of Publication: 26 Oct 2025.
Author
Khawar M.; Shah S.A.; Khan A.; Waseem A.; Saeed H.; Fatima A.; Saifullah
M.; Mehdi A.M.; Qadeer A.; Khawar M.M.H.
Institution
(Khawar, Shah, Waseem, Saeed, Saifullah) Department of Medicine, King
Edward Medical University, Punjab, Lahore, Pakistan
(Khan, Fatima) Department of Medicine, Nishtar Medical University And
Hospital, Punjab, Multan, Pakistan
(Mehdi) Department of Medicine, International School of Medicine,
International University of Kyrgyzstan, Bishkek, Kyrgyztan
(Qadeer) Department of Medicine, Mayo Clinic Phoenix, Arizona City, AZ,
United States
(Khawar) Department of Medicine, Services Institute of Medical Sciences,
Punjab, Lahore, Pakistan
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND Postoperative complications such as atrial fibrillation and
pericardial effusion are frequent after coronary artery bypass grafting
(CABG), contributing to increased morbidity and prolonged hospital stays.
Posterior pericardiotomy (PP), a surgical technique involving incision of
the posterior pericardium to allow drainage, has been suggested as a
preventive measure. However, its overall efficacy and safety profile,
including potential risks like pleural effusion, require comprehensive
evaluation amid varying study qualities. We hypothesized that PP reduces
key post-CABG complications compared to standard care. AIM To determine
the efficacy of PP in reducing postoperative complications following CABG.
METHODS This systematic review and meta-analysis included randomized
controlled trials (RCTs) from PubMed, Cochrane, ClinicalTrials.gov, and
Ovid, comparing PP vs no PP in adult CABG patients. Studies were conducted
in tertiary care hospital settings. Twenty RCTs with 5331 participants
were selected based on predefined inclusion criteria. The intervention
involved intraoperative PP. Primary outcome was postoperative atrial
fibrillation (POAF); secondary outcomes included effusions, tamponade,
hospital/intensive care unit stay, and bleeding revisions. Risk ratios
(RRs), mean differences, and 95% confidence intervals (CIs) were
calculated using random-effects models; heterogeneity assessed via
I2 statistic. RESULTS Twenty RCTs analyzed 5331 patients (2665
with PP vs 2666 without). PP significantly lowered POAF (10% vs 21%; RR =
0.48, 95%CI: 0.36-0.65, P < 0.00001; I2 = 70%), cardiac
tamponade (0.5% vs 3%; RR = 0.16, 95%CI: 0.08-0.34, P < 0.00001;
I2 = 0%), early pericardial effusion (2% vs 6%; RR = 0.31,
95%CI: 0.14-0.68, P = 0.004; I2 = 96%), and late pericardial
effusion (1% vs 9%; RR = 0.11, 95%CI: 0.05-0.21, P < 0.00001;
I2 = 0%). Hospital stay decreased (mean difference = -1.23
days, 95%CI: -1.87 to -0.59, P = 0.0002; I2 = 85%). Pleural
effusion risk increased (25% vs 17%; RR = 1.46, 95%CI: 1.21-1.76, P <
0.0001; I2 = 0%). No significant effects on mortality (RR =
0.92, 95%CI: 0.48-1.76, P = 0.80; I2 = 0%), intensive care unit
stay, or bleeding revisions. CONCLUSION PP effectively reduces POAF,
pericardial effusions, tamponade, and hospital stay in CABG patients,
though it increases pleural effusion risk and shows heterogeneity in some
outcomes. Copyright ©The Author(s) 2025.

<184>
Accession Number
2042064107
Title
Regional Cerebral Oxygen Saturation and Risk of Delirium: A Systematic
Review and Meta-Analysis.
Source
Diseases. 13(12) (no pagination), 2025. Article Number: 383. Date of
Publication: 01 Dec 2025.
Author
Rochina-Rodriguez B.; Martinez-Arnau F.M.; Perez-Ros P.
Institution
(Rochina-Rodriguez, Perez-Ros) Department of Nursing, Faculty of Nursing
and Podiatry, Universitat de Valencia, Menendez Pelayo 19, Valencia, Spain
(Martinez-Arnau) Department of Physiotherapy, Universitat de Valencia,
Gasco Oliag 5, Valencia, Spain
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Delirium onset is associated with increased comorbidity and
mortality. Identifying reliable delirium biomarkers remains challenging.
Regional cerebral oxygen saturation (rSO<inf>2</inf>) offers an objective,
easily obtainable measure suitable for hospital monitoring.
 Objective(s): We aimed to analyse the relationship between regional
cerebral oxygen saturation (rSO<inf>2</inf>) values obtained by
near-infrared spectroscopy (NIRS) and the subsequent development of
delirium. Method(s): Studies eligible for inclusion in our systematic
review evaluated rSO<inf>2</inf> values obtained by NIRS or a used a
similar method to study hospitalised patients aged 18 years or older, some
of whom subsequently developed delirium. We searched MEDLINE, Scopus and
Web of Science without restrictions to 24 March 2024. Two review authors
independently assessed the methodological quality of the included studies
using Joanna Briggs Institute Critical Appraisal tools. Using a
random-effects model in RevMan v 5.4.0 (Cochrane Collaboration, Oxford,
UK), we analysed baseline and minimum rSO<inf>2</inf> values. Results were
presented as means and mean differences (MDs) with their 95% confidence
intervals (CIs). We followed PRISMA guidelines and registered our review
protocol in PROSPERO (CRD42024523573). Results (or Findings): We included
22 studies (20 in the meta-analysis) published between 2009 and 2024 and
involving 5757 participants. The delirium group had a lower mean baseline
rSO<inf>2</inf> value (62.47%, 95% CI 58.40 to 66.55) compared with the
non-delirium group (64.24%, 95% CI 61.33 to 67.15). Meta-analysis of
effect estimates confirmed this result (MD -2.92%, 95% CI -4.38 to -1.47).
The MD between the delirium and non-delirium group was larger among
patients assessed with the INVOS device and patients who underwent cardiac
surgery. Studies that analysed baseline values according to sensor
location showed a larger MD in rSO<inf>2</inf> values obtained via a
right-sided sensor. Conclusion(s): Our results show lower baseline
and minimum rSO<inf>2</inf> in hospitalised patients who subsequently
developed delirium. The difference varies according to the type of surgery
and type of NIRS monitor. Copyright © 2025 by the authors.

<185>
[Use Link to view the full text]
Accession Number
2042073778
Title
Efficacy of incentive spirometer and diaphragmatic breathing exercise on
the alteration of arterial blood gas measures in patients after coronary
artery bypass grafting: A randomized comparative trial.
Source
Medicine (United States). 104(44) (pp e45538), 2025. Date of Publication:
31 Oct 2025.
Author
Shaphe M.A.; Ali T.; Pandey S.K.; Iqbal A.; Kashoo F.Z.; Alajam R.A.; Khan
M.H.; Alghadir A.H.
Institution
(Shaphe) Department of Physical Therapy, College of Nursing and Health
Sciences, Jazan University, Jazan, Saudi Arabia
(Ali) Department of Physical Therapy, Peerless Hospitex Hospital &
Research Center, Kolkata, India
(Pandey) Department of Cardiothoracic and Vascular Surgery, Batra Hospital
& Medical Research Center, New Delhi, India
(Iqbal) Rehabilitation Research Chair, Department of Rehabilitation
Sciences, College of Applied Medical Sciences, King Saud University,
Riyadh, Saudi Arabia
(Kashoo) Department of Physical Therapy & Health Rehabilitation, College
of Applied Medical Science, Majmaah University, Majmaah, Saudi Arabia
(Alajam) Department of Physical Therapy, College of Nursing and Health
Sciences, Jazan University, Jazan, Saudi Arabia
(Khan) Department of Diagnostic Radiology, College of Nursing and Health
Sciences, Jazan University, Jazan, Saudi Arabia
(Alghadir) Rehabilitation Research Chair, Department of Rehabilitation
Sciences, College of Applied Medical Sciences, King Saud University,
Riyadh, Saudi Arabia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: - The incidence of lung-related issues after undergoing
coronary artery bypass graft (CABG) surgery is notably significant.
Initiating lung exercises soon after heart surgery plays a crucial role in
averting these issues. The purpose of this research was to examine how the
use of an incentive spirometer (IS) and diaphragmatic breathing exercises
(DBE) impacts changes in arterial blood gas (ABG) levels. Method(s):
- The study was based on a 2-arm, parallel-group, randomized comparative
design. In this study, 30 individuals who had CABG surgery were selected
based on specific criteria and randomly divided into the IS group and the
DBE group. Each group received targeted chest physiotherapy; the IS Group
had an IS, and the DBE Group had DBE. Key ABG parameters, such as blood
pH, partial pressure of arterial oxygen (PaO2), and partial pressure of
arterial carbon dioxide (PaCO2), were evaluated using an ABG analyzer.
Measurements were taken initially on the first day after extubation and
then again on the second day post-extubation. All statistical analyses
were conducted with a maintained significance threshold of 95%.
 Result(s): - The results showed no significant differences
between-group and within-group comparisons for PH, PaO2, and PaCO2
outcomes. However, the IS group patients showed a trend in the increase in
PaO2 levels and a decrease in PaCO2 levels compared to those in the DBE
group. Conclusion(s): - Despite not revealing statistically
significant differences in the alteration of ABG measures between groups,
the current study observed minimal improvements in ABG measures in the IS
Group compared to the DBE Group. Therefore, this study suggests that, in
addition to conventional chest physiotherapy, using an IS might be
superior to DBE in altering ABG measures in patients with post-CABG.
Nonetheless, we may use both intervention and conventional chest
physiotherapy postoperatively as a prophylactic regime. Copyright
© 2025

<186>
Accession Number
2042331751
Title
The 'obesity paradox' in patients undergoing transcatheter aortic valve
implantation. A specialized narrative review.
Source
American Heart Journal Plus: Cardiology Research and Practice. 61 (no
pagination), 2026. Article Number: 100695. Date of Publication: 01 Jan
2026.
Author
Escobar J.; Riaz I.; Khawaja M.; Virk H.U.H.; Hahn J.; Al-Azzam F.; Wang
Z.; Alam M.; Strauss M.; Krittanawong C.
Institution
(Escobar) Department of Internal Medicine, Mobile Infirmary Medical
Center, AL, United States
(Riaz) Division of Cardiology, Department of Internal Medicine, University
of Texas Health/McGovern Medical School, Houston, TX, United States
(Khawaja) Department of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
(Virk, Hahn) Harrington Heart & Vascular Institute, Case Western Reserve
University, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Al-Azzam) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Wang) Robert D. and Patricia E. Kern Center for the Science of Health
Care Delivery, Mayo Clinic, Rochester, MN, United States
(Wang) Division of Health Care Policy and Research, Department of Health
Sciences Research, Mayo Clinic, Rochester, MN, United States
(Alam) The Texas Heart Institute, Baylor College of Medicine, Houston, TX,
United States
(Strauss) Department of Cardiology I- Coronary and Peripheral Vascular
Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol,
Muenster, Germany
(Krittanawong) HumanX, Delaware, DE, United States
Publisher
Elsevier Inc.
Abstract
Obesity has long been identified as a noteworthy risk factor for
cardiovascular diseases, including aortic stenosis. Nevertheless, an
unexplained phenomenon known as the obesity paradox has arisen in the
context of transcatheter aortic valve implantation (TAVI), inquiring
conventional beliefs. The obesity paradox refers to better clinical
outcomes observed in obese individuals undergoing TAVI. These include
reduced all-cause mortality, lower rates of procedural complications, and
improved long-term survival rates compared to their lean counterparts.
Several theories have been proposed to explain the obesity paradox in
TAVI. One of the most popular is the adipose tissue-mediated
cardioprotective effect hypothesis. It is known that adipose tissue could
offer both protective and harmful effects on the cardiovascular system.
These effects can be linked to the adipose tissue's distribution,
extension, and intrinsic biological characteristics. Obesity has been
associated with adipose tissue malfunction, leading to proinflammatory and
deleterious effects on the cardiovascular system. As opposed to what is
believed, it is suggested that a healthy obese phenotype might be
facilitated by exercise, leading to outstanding cardiovascular benefits. A
healthy obese phenotype is also associated with a secretome profile that
has unique adipose tissue features like adequate fat storage and formation
of lipid droplets, a significant capacity for adipogenesis, minimal
extracellular matrix fibrosis, potential for angiogenesis, adipocyte
browning, and limited infiltration or activation of macrophages. This
article is presented as a specialized narrative review, synthesizing
current evidence on the relationship between obesity and outcomes in
patients undergoing TAVI. Copyright © 2025 The Authors

<187>
Accession Number
649641798
Title
Multi-center study of diaphragm pacing in high-risk cardiac surgery to
decrease postoperative mechanical ventilation.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2025.
Date of Publication: 19 Dec 2025.
Author
David C.-H.; Vourc'h M.; Guimbretiere G.; Mugniot A.; Lacoste P.; Cadiet
J.; Rozec B.; Arora R.; Pelletier M.; Sabik J.; Onders R.
Institution
(David, Guimbretiere, Mugniot, Lacoste) CHU Nantes, Service de Chirurgie
Thoracique et Cardiovasculaire, l'Institut du thorax, Nantes, France
(Vourc'h, Cadiet, Rozec) CHU Nantes, Service d'Anesthesie-Reanimation,
Hopital Laennec, Nantes, France
(Arora, Sabik, Onders) Department of Surgery, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
(Pelletier) Division of Cardiac Surgery and Heart and Vascular Center,
Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United
States
Abstract
OBJECTIVES: Prolonged mechanical ventilation after cardiac surgery occurs
in 15% of patients and significantly increases morbidity and mortality. We
investigated the potential benefits of diaphragm pacing following cardiac
surgeries to decrease ventilator burden. METHOD(S): A randomized
controlled pilot study was conducted at two centers using diaphragm pacing
in patients undergoing open cardiac surgery by median sternotomy. Enrolled
patients had at least one pre-identified high-risk criterion for requiring
prolonged ventilation. Diaphragm pacing was initiated postoperatively.
 RESULT(S): Sixty-six patients were randomized into Standard of Care
(34) and Treatment (32) groups. This study provides evidence that
diaphragm pacing may reduce mechanical ventilation time and improve
weaning success prior to 24 hours post-operatively. Treated patients had a
total of 246 hours of mechanical ventilation compared to 670 hours for the
standard of care group. Treatment group patients were more likely to be
successfully weaned at 12 hours post-operatively, 83% compared to 65%,
which represented an 18% absolute and 52% relative risk reduction. For the
subset of 14 Treatment and 19 Standard of Care patients that required
ventilation beyond six hours, those receiving diaphragm pacing had a
reduced median time on ventilation: 8.3 hours (95% CI 7.1-12.5) compared
to 16.8 hours (95% CI 8.1-23.4). CONCLUSION(S): Diaphragm pacing may
reduce the time on mechanical ventilation following cardiac surgery in
patients at risk of prolonged ventilation. These results will inform the
design of a prospective pivotal randomized controlled trial to assess the
ability of diaphragm pacing to reduce ventilator burden in high-risk
cardiac surgery patients. Copyright © The Author(s) 2025.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved. For commercial re-use,
please contact reprints@oup.com for reprints and translation rights for
reprints. All other permissions can be obtained through our RightsLink
service via the Permissions link on the article page on our site-for
further informat

<188>
Accession Number
649649326
Title
The Effects of Massage and Music Interventions on Postoperative Pain
Severity Following Cardiac Surgery: A Systematic Review and Meta-analysis
of Randomized Controlled Trials.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. (no pagination), 2025. Date of Publication: 20 Dec
2025.
Author
Aktas S.; Yilmaz M.
Institution
(Aktas) Tokat State Hospital, Tokat, Turkey
(Yilmaz) Department of Surgical Nursing, Nursing Division, Faculty of
Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
Abstract
OBJECTIVES: To investigate the impact of massage and music interventions
on alleviating pain severity in the intensive care unit (ICU) within the
first 48 hours after cardiac surgery. DESIGN: Systematic review and
meta-analysis. METHOD(S): The study has been proactively registered
in PROSPERO (CRD42022297174) to ensure transparency and compliance with
scientific standards. Studies published in the English and Turkish
languages until December 2024 were included in the search, utilizing
various scientific databases such as MEDLINE, CINAHL, Embase, Science
Direct, Web of Science, Scopus, Cumulative Index to Nursing, Cochrane
Central Register of Controlled Trials, and the Turkish academic Google
database. The Critical Evaluation 13 Model Checklist at the Joanna Briggs
Institute was utilized to assess the quality appraisal of the studies
included in the research. The data were subjected to both meta-analysis
and narrative synthesis techniques. Meta-analysis was conducted using
Review Manager 5.4.1 software. RESULT(S): The review included 19
randomized controlled trials. Eight were in massage intervention, and 11
were in music intervention. Massage intervention (p < .00001) and music
listening (p = .0008) both demonstrated a significant reduction in pain
severity within the first 48 hours of ICU admission. CONCLUSION(S):
The results of this study show that both massage and music intervention
resulted in a tangible and statistically significant reduction in pain
severity within the first 48 hours of ICU. Copyright © 2025.
Published by Elsevier Inc.

<189>
Accession Number
2042466001
Title
Combined regional anesthetic techniques enhance postoperative recovery
after cardiac surgery: a randomized controlled trial.
Source
Postgraduate Medical Journal. 102(1203) (pp 56-62), 2026. Date of
Publication: 01 Jan 2026.
Author
Dou D.; Wang L.; Yuan S.; Jia Y.; Yan F.
Institution
(Dou, Wang, Yuan, Jia, Yan) Department of Anesthesiology, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, No. 167 BeilishiRd, Xicheng District, Beijing, China
Publisher
Oxford University Press
Abstract
Background Regional anesthetic techniques are applied in cardiac surgery
to improve postoperative pain and accelerate recovery. Pecto-intercostal
fascial block (PIFB) combined with rectus sheath block (RSB) has been
proved to provide ideal analgesia for cardiac surgery, but the effects of
combing regional anesthetic techniques on postoperative recovery are
uncertain. Methods This is a prospective and randomized controlled trial
at Fuwai Hospital from 1 June 2024 to 3 July 2024. Eighty patients
undergoing elective cardiac surgery via cardiopulmonary bypass were
randomized at a 1:1 ratio to be allocated in the intervention group (PIFB
combined with RSB) or control group (without regional blocks). The primary
outcome was the global score of the 15-item quality of recovery (QoR-15)
questionnaire at 24 h after surgery. Secondary outcomes included QoR-15 at
72 h, postoperative pain scores, time to extubation, length of stay,
medical expenses in hospital and postoperative morbidities. Results The
QoR-15 global score at 24 h after cardiac surgery was 122.35+/-6.71 in the
intervention group vs 115.30+/-5.90 in the control group (P<.001). The
proportion of patients experiencing better quality of recovery
(Qor-15>=118) was higher in the intervention group (77.5% vs 55%, P=.033).
Postoperative pain scores were 1.90+/-0.18 in the intervention group
compared to 2.95+/-0.99 in the control group (P=.027) at 24 h. Time to
extubation was earlier in the intervention group (274.40+/-98.36 vs
741.28+/-93.82 min, P<.001). There were no statistically differences in
Qor-15 at 72 h and other recovery outcomes. Conclusion The administration
of PIFB combined with RSB could improve quality of recovery and relieve
postoperative pain for patients following cardiac surgery. Copyright
© The Author(s) 2025. Published by Oxford University Press on behalf
of the Fellowship of Postgraduate Medicine. All rights reserved.

<190>
Accession Number
2042365971
Title
Left Main Disease: The Last Frontier for Medical Therapy in Stable
Coronary Artery Disease?.
Source
European Cardiology Review. 20 (no pagination), 2025. Article Number: e24.
Date of Publication: 01 Jan 2025.
Author
Arbab-Zadeh A.; Graham M.; Garcia-Garcia H.M.; Mancini G.J.; Weintraub
W.S.; Boden W.E.
Institution
(Arbab-Zadeh) Johns Hopkins University, Baltimore, MD, United States
(Graham) University of Alberta, Mazankowski Heart Institute, Edmonton, AB,
Canada
(Garcia-Garcia, Weintraub) Interventional Cardiology, MedStar Health
Research Institute, Georgetown University, Washington, DC, United States
(Mancini) University of British Columbia, Vancouver, Canada
(Boden) VA Boston VA Healthcare System, Boston University Chobanian and
Avedisian School of Medicine, Boston, MA, United States
Publisher
Radcliffe Medical Media
Abstract
Patients with stable coronary artery disease (CAD) involving >=50%
stenosis in the left main coronary artery almost invariably undergo
revascularisation. However, there is lack of evidence from contemporary
randomised controlled clinical trials (RCTs) supporting the superiority of
this approach versus an initial strategy of intensive, multifaceted
optimal medical therapy (OMT) directed at dyslipidaemic, hypertensive,
thrombotic, metabolic and ischaemic targets. Current clinical practice
guidelines still base their recommendations on small subsets of RCTs
conducted in the 1970s and early 1980s. Given the lack of survival benefit
among patients with stable, multi-vessel coronary artery disease who do
versus those do not undergo routine revascularisation in the era of
advanced OMT, the question arises whether the current treatment
recommendations for left main disease are valid. This issue is of
considerable importance; while significant left main disease is found in
only 8-10% of diagnostic invasive angiography cases, it is a disease
entity associated with a high risk of adverse clinical events and
extensive resource use. This article discusses clinical trials data as
well as challenges to address this question in the contemporary era. It
highlights the complexities of trial planning and execution as it relates
to both feasibility and equipoise, study design, choice of trial endpoints
and duration of follow-up. The authors conclude there is a compelling need
for an RCT to test the hypothesis that the current practice of routine
revascularisation for all patients with LMD is superior to an initial
strategy of multifaceted OMT with selective use of
revascularisation. Copyright © The Author(s) 2025. This work is
open access and is licensed under CC BY-NC 4.0. Users may copy,
redistribute and make derivative works for non-commercial purposes,
provided the original work is cited correctly.

<191>
Accession Number
2042468595
Title
Management Strategies for Patients With Atrial Fibrillation-Related
Ischemic Stroke Despite Oral Anticoagulation.
Source
Circulation Journal. 90(1) (pp 12-21), 2026. Date of Publication: 01 Jan
2026.
Author
Chatani R.; Kinosada M.; Kaneda K.; Yamashita Y.; Harata H.; Fujita M.;
Nishiura N.; Mushiake K.; Ono S.; Tasaka H.; Maruo T.; Kadota K.; Chin M.;
Kubo S.
Institution
(Chatani, Harata, Fujita, Nishiura, Mushiake, Ono, Tasaka, Maruo, Kadota,
Kubo) Department of Cardiovascular Medicine, Kurashiki Central Hospital,
Okayama, Japan
(Kinosada, Chin) Department of Neurosurgery, Kurashiki Central Hospital,
Okayama, Japan
(Kaneda, Yamashita) Department of Cardiovascular Medicine, Graduate School
of Medicine, Kyoto University, Kyoto, Japan
Publisher
Japanese Circulation Society
Abstract
Background: In patients with atrial fibrillation-related ischemic stroke
despite oral anticoagulation (AFIDA), left atrial appendage closure (LAAC)
may be an additional strategy to prevent further stroke events.
 Methods and Results: AFIDA was defined as ischemic stroke occurring
despite >=3 weeks of oral anticoagulation (OAC). We evaluated patients
with AFIDA treated either with OAC alone (n=141; further divided into
aggressive OAC [n=73] and conventional OAC [n=68] subgroups) or with
additional LAAC (+LAAC; n=95; further divided into continued OAC [n=44]
and discontinued OAC within 1 year after LAAC [n=51] subgroups). Patients
in the +LAAC group were younger, had higher HAS-BLED scores, and lower
HELT-E2S2 scores. Three-year cumulative incidence rates of ischemic stroke
and major bleeding were comparable between the OAC alone and +LAAC groups
(15.2% vs. 14.5% [log-rank P=0.75] and 23.4% vs. 5.3% [log-rank P=0.38],
respectively), whereas those of fatal or disabling stroke and fatal
bleeding were lower in the +LAAC than OAC alone group (3.4% vs. 14.7%
[log-rank P=0.06] and 0% vs. 6.0% [log-rank P=0.03], respectively).
Results of propensity score-matched and subgroup analyses were largely
consistent with those of the main analysis. Notably, fatal bleeding
occurred only in patients switched to aggressive OAC. Conclusion(s):
LAAC may potentially prevent fatal or disabling stroke and fatal bleeding
in patients with AFIDA. These hypothesis-generating findings support the
need for randomized controlled trials. Copyright © 2026 Japanese
Circulation Society. All rights reserved.

<192>
Accession Number
2042446385
Title
Transcatheter Aortic Valve Replacement in the Immunocompromised: A
Systematic Review and Meta-Analysis.
Source
American Journal of Cardiology. 260 (pp 71-79), 2026. Date of Publication:
01 Feb 2026.
Author
Meeus R.; Dhondt P.; Meeus N.; Ashraf H.; Minten L.; Hariyanto J.; Dubois
C.
Institution
(Meeus, Dhondt, Meeus, Minten, Dubois) Department of Cardiovascular
Medicine, University Hospitals Leuven, Leuven, Belgium
(Ashraf) Rawalpindi Medical University, Rawalpindi, Pakistan
(Hariyanto) Gedung Fakultas Kedokteran UPH, Tangerang, Indonesia
(Dubois) Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
Publisher
Elsevier Inc.
Abstract
Data on the safety and efficacy of transcatheter aortic valve replacement
(TAVR) for the treatment of aortic valve stenosis in immunocompromised
(IC) patients is scarce, while it represents a valid alternative to
surgical AVR in this vulnerable population. This meta-analysis aims to
compare the clinical outcomes of TAVR in IC versus non-IC patients. A
comprehensive search was conducted across PubMed, EMBASE, and Cochrane
Central for randomized controlled trials and observational studies that
compared outcomes between IC and non-IC patients undergoing TAVR. Primary
outcomes included 1-year all-cause, cardiovascular (CV) and non-CV
mortality. Secondary outcomes included new permanent pacemaker
implantation (PPI) and major periprocedural complications. 4,478 patients
in 7 studies (mean age 80.5 years, 7.64% IC) were included in the
analysis. As compared with non-IC patients, IC patients exhibited a
similar 30-day death rate (Odds Ratio [OR] 1.62; 95% Confidence Interval
[CI] 0.68 to 3.98; p = 0.297), but significantly higher 1-year all-cause
mortality (OR 2.39; 95% CI 1.55 to 3.70; p <0.001). Notably, IC patients
demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 to 0.59; p =
0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 to 10.18; p
= 0.002). There was no difference in the rate of new PPI or major
periprocedural complications. In conclusion, TAVR is a safe and effective
treatment strategy in IC patients, with similar short-term mortality and
increased medium-term mortality risk as compared with non-IC patients.
(PROSPERO: CRD42024623229) Copyright © 2025 Elsevier Inc.

<193>
Accession Number
2041999641
Title
The Economics of Cardiac Rehabilitation in North, Central, and South
America: A Narrative Review.
Source
Canadian Journal of Cardiology. 41(12 Supplement) (pp S95-S104), 2025.
Date of Publication: 01 Dec 2025.
Author
Decker S.R.R.; Kazi D.S.
Institution
(Decker, Kazi) Richard A. and Susan F. Smith Center for Outcomes Research,
Beth Israel Deaconess Medical Center, Boston, MA, United States
(Decker, Kazi) Department of Medicine (Cardiology), Harvard Medical
School, Boston, MA, United States
(Decker) Department of Internal Medicine, Moinhos de Vento Hospital, Porto
Alegre, Brazil
Publisher
Elsevier Inc.
Abstract
Cardiac rehabilitation (CR) is an effective strategy for the secondary
prevention of cardiovascular disease in individuals living with ischemic
heart disease or heart failure, and among patients who have recently
undergone cardiovascular surgery. Although CR is recommended by clinical
guidelines and typically covered by payers, its uptake has been low. This
is in part because of substantial economic barriers to accessing CR.
Understanding the economics of CR from the perspective of various
stakeholders -including patients, clinicians, health systems, and payers -
is critical to developing strategies that optimize CR supply and demand,
and increase uptake among populations most likely to benefit from this
therapy. In this review, we summarize the currently available evidence,
highlight current knowledge gaps, and identify key questions that should
be prioritized in future research to guide the implementation of CR
delivery. Copyright © 2025 The Authors.

<194>
Accession Number
2042365965
Title
Innovation and Development in Polymer Heart Valves: A New Era of
Transcatheter Aortic Valve Replacement.
Source
European Cardiology Review. 20 (no pagination), 2025. Article Number: e29.
Date of Publication: 01 Jan 2025.
Author
Mao Y.; Liu F.; Chen X.; Liu Y.; Tang J.; Yang J.
Institution
(Mao, Liu, Yang) Department of Cardiovascular Surgery, Xijing Hospital,
Shaanxi, Xi'an, China
(Liu, Chen, Tang) State Key Laboratory for Strength and Vibration of
Mechanical Structures, International Center for Applied Mechanics,
Department of Engineering Mechanics, Xi'an Jiaotong University, Xi'an,
China
Publisher
Radcliffe Medical Media
Abstract
Over the 20 years of the development of the transcatheter aortic valve
replacement procedure, its indications, procedural techniques and device
innovations have evolved to a significant degree. Nevertheless, while
transcatheter aortic valve replacement has reached a relatively mature
stage, research on devices continues. The emergence of the polymer heart
valve (PHV) has added a new approach for the treatment of patients with
aortic valve disease. This review summarises the development, manufacture
and production of previously studied PHV materials. Clinical outcome data,
attractive characteristics, recent advances and potential applications in
the development of existing PHVs are also reported. Finally, the
challenges and future research directions of PHV materials are
discussed. Copyright © The Author(s) 2025. This work is open
access and is licensed under CC BY-NC 4.0. Users may copy, redistribute
and make derivative works for non-commercial purposes, provided the
original work is cited correctly.

<195>
Accession Number
2041999638
Title
Cardiac Rehabilitation After Thoracic Aortic Surgery.
Source
Canadian Journal of Cardiology. 41(12 Supplement) (pp S86-S94), 2025. Date
of Publication: 01 Dec 2025.
Author
McMurtry M.S.; Skow R.J.; Foulkes S.J.; Moulson N.; McKinney J.; Thompson
R.B.; Haykowsky M.J.
Institution
(McMurtry) Department of Medicine, University of Alberta Walter Mackenzie
Health Sciences Centre, Edmonton, AB, Canada
(Skow, Haykowsky) Faculty of Nursing, University of Alberta, Edmonton,
Canada
(Foulkes) Baker Heart and Diabetes Institute, Melbourne, Australia
(Moulson, McKinney) Division of Cardiology, University of British
Columbia, Vancouver, Canada
(Thompson) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, Canada
Publisher
Elsevier Inc.
Abstract
Thoracic aortic diseases, including aortic aneurysm and aortic dissection,
are disorders that frequently require cardiac surgical intervention.
Current clinical practice guidelines recommend cardiac rehabilitation for
patients after thoracic aortic surgery. However, the evidence to support
these recommendations remains limited, and there is a notable absence of
individualized approaches for resuming regular exercise. In this narrative
review the literature on cardiovascular rehabilitation after thoracic
aortic surgery for inherited and acquired thoracic aortic disease is
examined, a clinical case to illustrate limitations in the current
approach is presented, and how exercise-based magnetic resonance imaging
to assess aortic wall stress might support a more personalized and precise
exercise prescription is explored. Further research on the safety and
efficacy of exercise training in patients after thoracic aortic
surgery-particularly randomized controlled trials-are
needed. Copyright © 2025 The Authors.

<196>
Accession Number
2034755210
Title
The effect of continuous positive airway pressure (CPAP) on airway
problems in pediatrics's subglottic stenosis patients who underwent
balloon dilatation.
Source
Trends in Anaesthesia and Critical Care. Conference: EAC2023 Abstracts of
the 7th European Airway Management Congress. Baveno Italy. 57(Supplement
1) (pp 11-13), 2024. Date of Publication: 01 Sep 2024.
Author
Tuncel Z.; Deligoz O.; Saracoglu K.T.; Albasha A.; Saracoglu A.
Institution
(Tuncel, Deligoz, Saracoglu, Albasha, Saracoglu) Department of
Anesthesiology and Reanimation Health Sciences University Umraniye
Training and Research Hospital, Istanbul, Turkey
(Tuncel, Deligoz, Saracoglu, Albasha, Saracoglu) Department of
Anesthesiology and Reanimation Health Sciences University Haydarpasa
Numune Training and Research Hospital, Istanbul, Turkey
(Tuncel, Deligoz, Saracoglu, Albasha, Saracoglu) Department of
Anesthesiology Hamad Medical Corporation Hazm Mebaireek General Hospital,
Doha, Qatar
(Tuncel, Deligoz, Saracoglu, Albasha, Saracoglu) Qatar University College
of Medicine, Doha, Qatar
(Tuncel, Deligoz, Saracoglu, Albasha, Saracoglu) Department of
Anesthesiology Hamad Medical Corporation Hamad General Hospital, Doha,
Qatar
(Tuncel, Deligoz, Saracoglu, Albasha, Saracoglu) Department of
Anesthesiology Hamad Medical Corporation Aisha Bint Hamad Al Attiyah
Hospital, Doha, Qatar
Publisher
Churchill Livingstone
Abstract
Objective: The hypothesis of our study is that the application of
postoperative prophylactic nasal CPAP in pediatric subglottic stenosis
patients undergoing subglottic balloon dilatation, can shorten the
recovery period and reduce the incidence of postoperative airway
complications. Method(s): A total of 81 pediatric patients aged 0
months to 12 years, American Society of Anesthesiologists II and III, with
acquired or congenital subglottic stenosis undergoing elective subglottic
balloon dilatation under general anesthesia were included in this
prospective randomized controlled trial. Patients were randomized to 2
groups: Group Control (n = 41) and Group CPAP (n = 40) (Figure 1). Nasal
CPAP was applied following the subglottic balloon dilatation. Control
Group patientswere administered 3 L/min oxygen support with a nasal mask
after extubation. During the procedure, heart rate, mean arterial
pressure, and peripheral oxygen saturation were recorded in 5 different
time periods. Presence of bronchospasm, number of desaturation, recovery
time, need for tracheostomy or intensive care unit were recorded. The
level of subglottic stenosis was determined according to the Myer and
Cotton classification (Table 1).(Figure Presented) (Table Presented)
Results: Age, weight, gender, duration of the procedure and subglottic
stenosis grading did not differ significantly between the groups (p >
0.05) Complication rates are shown in Table 2. No significant difference
was observed between groups regarding the incidence of desaturation,
presence of tracheal secretion and bronchospasm rate (p > 0.05). No
significant difference was observed between groups for the need of
postoperative intensive care unit, tracheostomy or tracheal intubation (p
> 0.05). Recovery time was found to be significantly higher in Control
Group than in the CPAP Group (p = 0.001). Hemodynamic data is given in
Table 3. (Table Presented) Conclusion(s): Prophylactic CPAP
application after therapeutic subglottic balloon dilatation in children
effectively shortens recovery time and decreases postoperative pulmonary
complications. Copyright © 2024 All rights reserved.

<197>
Accession Number
649599099
Title
UK multisociety consensus statement on the emergency management and
resuscitation of patients with left-sided Impella support.
Source
Heart (British Cardiac Society). (no pagination), 2025. Date of
Publication: 18 Dec 2025.
Author
Akhtar W.; Bowles C.T.; Costanzo P.; Deakin C.D.; Elliot P.; Eladawy M.;
Gardner R.S.; Govier M.; Handslip R.; Hill J.; Jain A.; Khan S.Q.; Lewis
I.; Lim H.S.; Mariathas M.; Mellis C.; Monteagudo-Vela M.; Naldrett I.;
Ostermann M.; Perera D.; Pinto S.; Richardson C.; Ranasinghe A.; Gil F.R.;
Rosenberg A.; Schueler S.; Sinclair A.; Swanson N.; Wilson S.; Webb I.;
Webb S.; Walker C.; Panoulas V.
Institution
(Akhtar, Perera) Guy's and St Thomas' NHS Foundation Trust, St Thomas'
Hospital, London, United Kingdom
(Akhtar, Bowles, Monteagudo-Vela, Pinto, Gil, Rosenberg, Panoulas)
Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London,
United Kingdom
(Akhtar, Elliot) Faculty of Intensive Care Medicine, London, United
Kingdom
(Costanzo) Royal Papworth Hospital, Cambridge, United Kingdom
(Deakin) Resuscitation Council UK, London, United Kingdom
(Eladawy, Schueler) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Gardner, Sinclair) Golden Jubilee National Hospital, Clydebank, United
Kingdom
(Gardner) British Society for Heart Failure, London, United Kingdom
(Govier, Mariathas) University Hospitals Bristol, Bristol Royal Infirmary,
Bristol, United Kingdom
(Handslip, Wilson) St Georges University Hospital, London, United Kingdom
(Hill) Royal Brompton Hospital, Guy's and St Thomas NHS Foundation Trust,
London, United Kingdom
(Jain, Mellis) Barts Health NHS Trust, London, United Kingdom
(Khan, Lim, Richardson) University Hospitals Birmingham NHS Foundation
Trust, Birmingham, United Kingdom
(Lewis) University Hospital of Wales, Cardiff, United Kingdom
(Naldrett) British Association of Critical Care Nurses, London, United
Kingdom
(Ostermann, Webb) Intensive Care Society, London, United Kingdom
(Ranasinghe) Society for Cardiothoracic Surgery in Great Britain and
Ireland, London, United Kingdom
(Swanson) British Cardiovascular Society, London, United Kingdom
(Webb) King's College Hospital NHS Foundation Trust, London, United
Kingdom
(Walker) Association of Cardiothoracic Anaesthesia and Critical Care,
London, United Kingdom
Abstract
The use of left-sided Impella microaxial flow pumps has expanded rapidly
for the management of cardiogenic shock, left ventricular unloading and as
a bridge to heart transplantation. However, standard life support and
resuscitation algorithms are not directly applicable to patients receiving
this therapy due to fundamental alterations in circulatory physiology. To
address this gap, eleven UK Impella centres and eight national
professional societies collaborated to develop a unified national
consensus statement on the emergency management of patients with
left-sided Impella support. Using a systematic review of the literature
and a modified Delphi process guided by the European Society of Cardiology
framework for grading recommendations, expert representatives achieved
agreement on key priorities and structured actions to be undertaken in the
first few minutes of resuscitation.The consensus outlines early
recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or
end-tidal CO2 <2 kPa), prompt activation of multidisciplinary responders,
reduction of Impella power to P2 before initiating cardiopulmonary
resuscitation and structured division of patient-focused and
device-focused teams. Device-specific troubleshooting algorithms are
presented for suction, malposition, purge-system failure and mechanical
malfunction. This multisociety consensus represents the first national
standard for emergency management and resuscitation of patients supported
by a left-sided Impella device and is intended to inform structured
clinical training and improve patient outcomes through rapid, coordinated
and physiologically tailored interventions. 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.

<198>
Accession Number
649601250
Title
Low-dose direct oral anticoagulation vs dual antiplatelet therapy after
left atrial appendage occlusion: 1-year results from the ADALA trial.
Source
Revista espanola de cardiologia (English ed.). (no pagination), 2025.
Date of Publication: 16 Dec 2025.
Author
Flores-Umanzor E.; Cruz-Gonzalez I.; Cepas-Guillen P.; Millan X.;
Antunez-Muinos P.; Asmarats L.; Laffond A.; Regueiro A.; Lopez-Tejero S.;
Li C.-H.P.; Sanchis L.; Rodes-Cabau J.; Arzamendi D.; Freixa X.
Institution
(Flores-Umanzor, Cepas-Guillen, Antunez-Muinos, Regueiro, Sanchis, Freixa)
Department of Cardiology, IDIBAPS, Hospital Clinic of Barcelona,
Barcelona, Spain
(Cruz-Gonzalez, Laffond, Lopez-Tejero) Department of Cardiology, Hospital
Universitario of Salamanca, IBSAL, Salamanca, Spain
(Millan, Asmarats, Li, Arzamendi) Department of Cardiology, Hospital
Universitari de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
(Rodes-Cabau) Department of Cardiology, Institut Cardiovacular, IDIBAPS,
Hospital Clinic of Barcelona, Barcelona, Spain; Quebec Heart and Lung
Institute, Laval University, Quebec City, Quebec, Canada
Abstract
INTRODUCTION AND OBJECTIVES: The ADALA trial showed a more favorable
efficacy-safety profile with low-dose direct oral anticoagulation
(LD-DOAC) vs dual antiplatelet therapy (DAPT) at 3 months after left
atrial appendage occlusion (LAAO). However, outcomes after switching both
regimens to single antiplatelet therapy (SAPT) remain uncertain. This
study reports the 1-year results, focusing on outcomes after the switch to
SAPT. METHOD(S): The ADALA trial was a multicenter, randomized
clinical trial that enrolled 91 patients with atrial fibrillation and
contraindications to oral anticoagulation. After successful LAAO,
participants were randomized to receive LD-DOAC or DAPT for 3 months,
after which all patients transitioned to SAPT. The primary endpoint was a
composite of thromboembolic events, device-related thrombus (DRT), or
major bleeding at 1-year. RESULT(S): At 12 months, the primary
endpoint was significantly lower in the LD-DOAC group compared with the
DAPT group (9.1% vs 32.6%; HR, 0.25; 95%CI, 0.08-0.74; P = .013), mainly
driven by a reduction in DRT (0% vs 11.6%; P = .023). Major bleeding was
numerically lower with LD-DOAC (9.1% vs 19.6%; P = .167), and total
bleeding events were significantly reduced (13.6% vs 37.0%; P = .013).
Landmark analysis showed significant differences during the initial 3
months (P < .001) but not from 3 to 12 months (P = .195). All DRT cases
treated with LD-DOAC (n = 4) resolved completely without bleeding.
 CONCLUSION(S): LD-DOAC reduced thromboembolic and bleeding events
compared with DAPT during the first year after LAAO, driven by a marked
reduction in early DRT. No DRT events occurred after LD-DOAC withdrawal,
supporting a strategy of LD-DOAC for 3 months followed by SAPT in this
high-risk population. Copyright © 2025. Published by Elsevier
Espana, S.L.U.

<199>
Accession Number
2041941755
Title
Prioritizing surgical ablation for atrial fibrillation during coronary
artery bypass grafting: new evidence, old debate.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2025. Date of
Publication: 2025.
Author
Erez E.; Squiers J.J.; Dorton C.W.; Banwait J.; Gasparini A.; Mack M.;
DiMaio J.M.; Schaffer J.M.
Institution
(Erez, Dorton, Banwait, Mack, DiMaio) Baylor Scott & White Research
Institute, Dallas, TX, United States
(Squiers, DiMaio, Schaffer) Department of Cardiothoracic Surgery, Baylor
Scott & White the Heart Hospital, Plano, TX, United States
(Gasparini) Red Door Analytics AB, Stockholm, Sweden
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Atrial fibrillation (AF) affects 10-20% of patients
undergoing coronary artery bypass grafting (CABG) and is associated with
increased postoperative morbidity and mortality. Although studies support
the safety and effectiveness of surgical ablation (SA), and guidelines
recommend its use during CABG for patients with preexisting AF, clinical
adoption remains limited. Areas covered: In this review, we outline
current guideline recommendations, evaluate the evidence base, highlight
recent analyses, and examine persistent barriers to the adoption of SA
during CABG, informed by studies identified through searches of PubMed and
Google Scholar. Expert opinion: Small randomized studies demonstrate that
SA restores sinus rhythm following CABG, while observational studies
suggest rhythm restoration improves survival and reduces thromboembolic
events. Recent national database analyses have lent further support,
finding an association between SA and long-term survival. Analytic
approaches included analysis by treatment type using propensity-score risk
adjustment and, more recently, using surgeon frequency of SA as an
instrumental variable. However, concerns about unmeasured confounding,
sparse rhythm follow-up, and limited lesion-set granularity undermine
confidence and contribute to underuse. A randomized trial comparing
long-term outcomes between pulmonary vein isolation, left atrial, and
bi-atrial lesion sets is critically needed to guide optimal implementation
of SA during CABG. Copyright © 2025 Informa UK Limited, trading
as Taylor & Francis Group.

<200>
Accession Number
649600918
Title
The predictive value of right ventricle speckle tracking echocardiography
in patients undergoing cardiac surgery, a systematic review and
meta-analysis.
Source
Cardiovascular ultrasound. (no pagination), 2025. Date of Publication: 18
Dec 2025.
Author
Al-Shammari A.S.; Al Sakini A.S.; Hasan M.T.; Islam M.R.; Shahzad M.;
Alsawadi R.A.; Lingamsetty S.S.P.; Ibrahim A.; Marsool M.D.; Elgebaly M.;
Masih R.
Institution
(Al-Shammari) College of Medicine, University of Baghdad, Baghdad, Iraq
(Al Sakini) College of Medicine, University of Baghdad, Baghdad, Iraq
(Hasan) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Islam) Department of Internal Medicine, Shaheed Suhrawardy Medical
College Hospital, Dhaka, Bangladesh
(Shahzad) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Afghanistan
(Alsawadi) College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
(Lingamsetty) Department of Internal Medicine, Mamata Medical College,
Khammam, India
(Ibrahim) Faculty of Medicine, Alexandria University, Alexandria, Egypt
(Marsool) Research Fellow at Mayo clinic, AZ, United States
(Elgebaly) Faculty of Medicine, Beni-Suef University, Egypt
(Masih) Department of Cardiology, Minneapolis Heart Institute, MN, United
States
Abstract
BACKGROUND: Right ventricular (RV) dysfunction is a critical predictor of
adverse outcomes in cardiac surgery patients. The assessment of right
ventricular global longitudinal strain (GLS) echo has emerged as a
promising tool for detecting early RV dysfunction. This meta-analysis
evaluates the predictive value of RV GLS in these patients.
 METHOD(S): A comprehensive literature search was conducted. The
primary outcomes included pooled diagnostic performance measures,
including sensitivity, specificity, and the diagnostic odds ratio (DOR). A
multiple-cutoff model was employed to determine the optimal RV-GLS
threshold. RESULT(S): Ten observational studies involving 583
patients were included. RV-GLS demonstrated strong diagnostic accuracy,
with a pooled area under the summary receiver operating characteristic
curve (AUC) of 0.90 (95% CI: 0.82-1.00). The pooled DOR was 6.34 (95% CI:
3.20-12.57) with no heterogeneity (I2 = 0%). Sensitivity was 0.79 (95% CI:
0.69-0.86; I2 = 57.2%) and specificity was 0.78 (95% CI: 0.71-0.84; I2 =
20.8%). The risk of publication bias was low (LFK index = 0.6). A
multiple-threshold model identified - 15.25% as the optimal RV-GLS cutoff,
achieving balanced sensitivity and specificity of 0.7423.
 CONCLUSION(S): RV-GLS demonstrates excellent predictive value for RV
dysfunction in cardiac surgery patients. Copyright © 2025. The
Author(s).

<201>
Accession Number
649600877
Title
Effects of rhomboid intercostal and sub-serratus plane block on
perioperative analgesic efficacy and diaphragm excursion in video-assisted
thoracic surgery: a prospective, randomized controlled trial.
Source
BMC anesthesiology. (no pagination), 2025. Date of Publication: 18 Dec
2025.
Author
Zhao S.-F.; Chang Q.-Y.; Zheng Y.-R.; Qiu L.; Shen J.
Institution
(Zhao, Chang, Zheng, Qiu) Department of Anesthesiology, Third Affiliated
Hospital of Soochow University, Changzhou, Jiangsu, China
(Zhao) Department of Anesthesiology, Changzhou Fourth People's Hospital,
Changzhou, Jiangsu, China
(Chang, Zheng, Qiu) Department of Anesthesiology, Changzhou First People's
Hospital, Changzhou, Jiangsu, China
(Shen) Department of Anesthesiology, Third Affiliated Hospital of Soochow
University, Changzhou, Jiangsu, China
(Shen) Department of Anesthesiology, Changzhou First People's Hospital,
Changzhou, Jiangsu, China
Abstract
BACKGROUND: Rhomboid intercostal and sub-serratus plane (RISS) block is a
novel nerve block technique that provides good analgesia, but overall
research is scarce. This study aimed to investigate the effect of
ultrasound-guided RISS block on postoperative analgesia and diaphragmatic
excursion (DE) after video-assisted thoracic surgery (VATS) for lung
cancer. METHOD(S): One hundred patients who underwent VATS lung
resection participated in this study and were randomized to a RISS group
(Group R) or a control group (Group C). Group R underwent
ultrasound-guided RISS block with 0.25% ropivacaine hydrochloride 0.5
ml/kg immediately after surgery. Group C was given standard general
anaesthesia, and patient-controlled intravenous analgesia (PCIA) was used
in the postoperative period in both groups. The visual analogue scores
(VAS) at rest and during movement at 2 hours(h), 24 h, and 48 h
postoperatively were used as the primary outcome measures. Secondary
outcomes included postoperative consumption of sufentanil; preoperative
and postoperative left and right-sided DE during calm and deep breathing,
and the occurrence of adverse effects such as postoperative nausea and
vomiting (PONV), dizziness, somnolence, puncture site infection, and
hematoma. RESULT(S): At 2 h, 24 h, and 48 h postoperatively, patients
in Group R had lower VAS scores at rest (median [Q1, Q3]: 1.00 [1.00,
1.00]; 1.00 [1.00, 1.00]; 0.00 [0.00, 1.00]) and during movement (2.00
[2.00, 3.00]; 2.00 [2.00, 2.00]; 2.00 [1.00, 2.00]) than those in Group C
(resting: 2.00 [2.00, 2.00]; 2.00 [2.00, 2.00]; 1.00 [1.00, 2.00];
movement: 3.00 [3.00, 4.00]; 3.00 [3.00, 4.00]; 3.00 [2.00, 4.00]) (all P
< 0.0001). Sufentanil consumption at 2 h, 24 h, and 48 h postoperatively
was also significantly lower in Group R (P = 0.0002, P < 0.0001, P <
0.0001). Preoperatively, no significant difference in DE existed between
the groups (P > 0.05). At 30 min post-extubation and 2 h and 24 h
postoperatively, during both calm and deep breathing on both sides, Group
R had significantly greater DE than Group C (P < 0.05). At 48 h
postoperatively, the right-sided DE during calm breathing showed no
significant difference between the groups. PONV incidences did not differ
significantly (P = 0.2662), and Group R had less dizziness, somnolence,
higher satisfaction post-surgery, and showed no cases of puncture site
infection or hematoma. CONCLUSION(S): Ultrasound-guided RISS block
can modestly reduce postoperative pain in patients undergoing VATS, with
clinically relevant benefits, and may help alleviate diaphragmatic
dysfunction caused by surgical or anesthetic factors. TRIAL REGISTRATION:
The trial was registered at the China Clinical Trial Registry
(http://www.chictr.org.cn, ChiCTR2300070842) on 24/04/2023. Copyright
© 2025. The Author(s).

<202>
Accession Number
2041945057
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
outcomes among patients with acute coronary syndrome and unprotected left
main coronary artery disease: a meta-analysis with a reconstructed
time-to-event analysis.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2025. Date of
Publication: 2025.
Author
Elbahloul M.A.; Gadelmawla A.F.; Ali A.H.G.; Awad A.K.; Elazab A.; Mansour
A.; Mohamed A.N.; Sarhan H.; Elgendy I.Y.
Institution
(Elbahloul) Faculty of Medicine, Kafr El-Shaikh University, Kafr
El-Shaikh, Egypt
(Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Ali) Institute of Medicine, National Research Mordovia State University,
Saransk, Russian Federation
(Awad) Department of Cardiothoracic Surgery, Ain-Shams University, Cairo,
Egypt
(Elazab) Faculty of Medicine, South Valley University, Qena, Egypt
(Mansour) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Mohamed) Department of Internal Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Mohamed) Department of Internal Medicine, Charleston Area Medical Center
(CAMC), Charleston, WV, United States
(Sarhan) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Elgendy) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, KY, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Patients with an unprotected left main coronary artery
(ULMCA) presenting with acute coronary syndrome (ACS) were
underrepresented in randomized trials. We aimed to compare the outcomes of
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in these patients. Method(s): Electronic databases
were searched for studies comparing CABG vs PCI for patients with ULMCA
presenting with ACS. The primary outcome was all-cause mortality. The
outcomes were reported using a risk ratio (RR) and 95% confidence interval
(CI) using random-effect model. Result(s): A total of 7 studies with
4033 patients were included. There was no difference in the incidence of
all-cause mortality between CABG and PCI. CABG was associated with a trend
toward a higher incidence of stroke in short-term, but with lower rates of
lower target vessel revascularization, and target lesion revascularization
during long-term follow-up. Conclusion(s): CABG and PCI were
associated with comparable long-term mortality among patients with ULMCA
who presented with ACS. However, CABG was associated with a lower
incidence of MI and revascularization but a trend toward a higher
incidence of stroke. These findings could help with informed
decision-making among patients with ULMCA presenting with ACS.
Registration: The protocol was registered on PROSPERO
(CRD420251034578). Copyright © 2025 Informa UK Limited, trading
as Taylor & Francis Group.

<203>
Accession Number
2041920330
Title
Pregnancy outcomes in heart transplant recipients: a systematic review and
meta-analysis of maternal and neonatal morbidities.
Source
American Journal of Obstetrics and Gynecology. (no pagination), 2025.
Date of Publication: 2025.
Author
Albino dos Santos Silva R.R.; Gomes Batista P.; Ribera Chagas C.V.; de
Medeiros Fernandes M.; Martins Giorgi J.
Institution
(Albino dos Santos Silva, Ribera Chagas) Universidade Federal do Ceara,
Ceara, Fortaleza, Brazil
(Gomes Batista) Universidade Federal da Paraiba, Paraiba, Joao Pessoa,
Brazil
(de Medeiros Fernandes) Universidade Estadual Rio Grande do Norte, Rio
Grande do Norte, Mossoro, Brazil
(Martins Giorgi) Hospital Sirio-Libanes, Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier Inc.
Abstract
Background Advances in heart transplant (HT) have increased the number of
reproductive-aged women with grafts considering pregnancy. However, this
remains a high-risk scenario due to the potential for adverse outcomes.
Current literature on comprehensive pregnancy outcomes and long-term graft
implications remains limited. Objective To evaluate maternal and neonatal
outcomes of pregnancies in heart transplant recipients. Data sources We
searched PubMed, EMBASE, the Cochrane Library, and Web of Science from
their inception to May 2025 and reviewed the reference lists. Study
eligibility criteria We included observational cohort studies that
reported maternal and fetal pregnancy outcomes in women with prior heart
transplantation. Study appraisal and synthesis methods Statistical
analysis was performed using the R software; the pooled proportion was
estimated using random-effects models (DerSimonian-Laird method). Quality
assessment was conducted using a modified version of the Newcastle-Ottawa
scale. Results Preeclampsia occurred in 19.32% (95% confidence interval,
14.14-25.82; I2=0%). and was associated with increased maternal
mortality 19.70% (95% confidence interval, 14.80-25.75; I2=0%).
Preterm birth 41.36% (95% confidence interval, 34.03-49.09;
I2=0%) and lower birthweights (37.58%, 95% confidence interval,
30.18-45.62; I2=0.0%) were expressed. Low rates of graft loss
during pregnancy were observed in 5.56% (95% confidence interval,
3.10-9.75; I2=0%). Cesareans were performed in 43.35% (95%
confidence interval, 36.70-50.25; I2=2.2%), of patients, and
the data of unplanned pregnancy reached 59.45% (95% confidence interval,
38.53-77.43; I2=79%) Conclusion Pregnancy after HT is feasible
but high-risk, with elevated rates of maternal morbidity, preterm birth,
and neonatal complications. Preeclampsia significantly worsens neonatal
outcomes but does not impair short-term graft survival. Multidisciplinary
care, individualized immunosuppressive management, and rigorous
preconception counseling are crucial for optimizing outcomes. These
findings inform clinical decision-making and reproductive planning for HT
women. Copyright © 2025 Elsevier Inc.

<204>
Accession Number
2042403385
Title
CNS Outcomes in Patients with Frailty Undergoing Coronary Artery Bypass
Grafting and Heart Valve Surgical Procedures.
Source
Journal of Cellular and Molecular Anesthesia. 10(4) (no pagination), 2025.
Article Number: e168011. Date of Publication: 01 Dec 2025.
Author
Baniani M.; Alibeigi P.; Dabbagh A.; Tafti M.F.; Talebian N.; Shokri P.
Institution
(Baniani, Alibeigi, Dabbagh) Anesthesiology Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Tafti, Talebian, Shokri) Student Research Committee, School of Medicine,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Talebian) Preventative Gynecology Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Brieflands
Abstract
Context: Frailty, which is common among elderly patients undergoing
cardiac surgery, is associated with an increased risk of adverse central
nervous system (CNS) outcomes, including stroke, delirium, and other
cerebrovascular complications. Objective(s): This meta-analysis aimed
to clarify the impact of frailty on these outcomes in patients undergoing
coronary artery bypass grafting (CABG) and heart valve surgeries.
 Method(s): We performed a systematic search in PubMed, Scopus, and
Web of Science for studies published up to October 2024 that reported CNS
outcomes according to frailty status. Pooled effect sizes and odds ratios
(ORs) for stroke, delirium, transient ischemic attack (TIA), and
cerebrovascular complications were calculated. Result(s): Across 19
studies comprising 2,357,446 patients, frail patients exhibited
significantly higher rates of CNS events (5.05%) compared to non-frail
patients (1.81%, P < 0.05). Stroke and delirium were notably more common
in frail patients, with delirium showing an OR of 3.94. No significant
difference was observed for TIA, but cerebrovascular complications were
more frequent in frail patients. Outcomes differed by surgery type, with
higher rates observed after heart valve procedures compared to CABG.
 Conclusion(s): Frailty is strongly associated with increased CNS
complications in cardiac surgery patients, underscoring the importance of
routine frailty assessments and tailored care strategies. Copyright
© 2025, Baniani et al.

<205>
Accession Number
2042093890
Title
The Effects of Tranexamic Acid on Renal Outcomes in Patients Undergoing
Cardiovascular Surgery: A Systematic Review and Meta-Analysis Compliant
With Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Zhang B.; He L.-X.; Yao Y.-T.
Institution
(Zhang) Department of Anesthesiology, Tianjin Union Medical Center,
Tianjin, China
(He) Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital,
Kunming, China
(Yao) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Peking Union Medical College and Chinese Academy
of Medical Sciences, Beijing, China
(Yao) Center of Outcomes Research, Department of Anesthesiology, Critical
Care and Pain Medicine, University of Texas, Houston, TX, United States
(Yao) Outcomes Research Consortium, Houston, TX, United States
Publisher
W.B. Saunders
Abstract
Objective: To assess how tranexamic acid (TXA) influences the renal
outcomes of cardiovascular surgical patients. Design(s): Systematic
review and meta-analysis of randomized controlled trials (RCTs).
 Setting(s): The operating room. Participant(s): Cardiovascular
surgical patients. Intervention(s): TXA or placebo. Measurements
and Main Results: The primary outcome of interest included the incidence
of postoperative (PO) acute kidney injury (AKI). Secondary outcomes of
interest included PO-serum creatinine (SCr) levels, PO-blood urea nitrogen
(BUN) levels, intraoperative urine output volumes, the length of stay
(LOS) in the intensive care unit, the LOS in the hospital, and the 30-day
mortality rate postoperatively. A database search yielded 19 RCTs
including 6,450 patients, and 3,280 patients were allocated to the TXA
group and 3,170 to the control group (placebo). Meta-analysis suggested
that TXA did not influence the incidence of PO-AKI (4.2% v 4.3%; odds
ratio [OR], 0.96; 95% CI, 0.75-1.22; p = 0.72). Meta-analysis also
demonstrated that PO-SCr levels (weighted mean difference [WMD], 2.38; 95%
CI, -2.80 to 7.56; p = 0.37) and PO-BUN levels (WMD, -0.16; 95% CI, -0.92
to 0.61; p = 0.69) were comparable between the TXA group and the control
group, and that TXA did not influence PO-SCr and PO-BUN levels.
Additionally, TXA did not influence the incidence of patients' 30-day
mortality postoperatively (1.1% v 1.6%; OR, 0.71; 95% CI, 0.46 to 1.09; p
= 0.12). Conclusion(s): This current study suggested that TXA
administration did not influence renal outcomes in cardiovascular surgical
patients. Copyright © 2025 Elsevier Inc.

<206>
Accession Number
2042411897
Title
A Scoping Review to Assess Current Interventions and Gaps in Recruiting
for an Inclusive Surgical Workforce.
Source
Journal of Surgical Education. 83(2) (no pagination), 2026. Article
Number: 103819. Date of Publication: 01 Feb 2026.
Author
Picart J.K.; Sridhar R.; Xie S.; Gorur R.; Lemos J.E.; Mazeh M.;
MacEachern M.; Aubry S.T.; Jackson H.T.; Sandhu G.
Institution
(Picart, Xie, Jackson, Sandhu) Center for Surgical Training and Research,
Department of Surgery, University of Michigan, Ann Arbor, MI, United
States
(Sridhar, Gorur, Lemos, Mazeh) University of Michigan Medical School,
Department of Surgery, Ann Arbor, MI, United States
(Picart, Sridhar, Xie, Gorur, Lemos, Mazeh, MacEachern, Aubry, Jackson,
Sandhu) University of Michigan, Department of Surgery, Ann Arbor, MI,
United States
Publisher
Elsevier Inc.
Abstract
PURPOSE: While the diversity of the surgical workforce has well-studied
benefits for patient care, surgical subspecialties have historically been
unsuccessful in recruiting diverse trainees. Although surgical programs
have made substantial efforts to address this problem, to progress, we
need to (1) synthesize the evidence for successful strategies for
recruiting diverse surgical trainees and (2) identify the dimensions of
diversity that have not been studied. This scoping review assesses
strategies for the effective recruitment of diverse surgical trainees,
identifies the level of evidence supporting these strategies, and examines
the current gaps in the literature. METHOD(S): NLM PubMed, Elsevier
Embase, and Clarivate Web of Science were searched on September 4, 2024.
We included studies reporting original data assessing interventions to
recruit diverse trainees, defined broadly, e.g., gender and sexual
minorities, ethnic and racial minorities, persons with disabilities, and
veterans, into graduate surgical training programs (general surgery,
otolaryngology, orthopedic surgery, plastic surgery, urology,
neurosurgery, vascular surgery, oral and maxillofacial surgery, and
cardiothoracic surgery). RESULT(S): In this scoping review of 25
articles, we found the most common interventions included early exposure
programs (11 of 25 included studies; 44%), efforts to reduce bias in the
interview process (8 of 25; 32%), and improving programmatic structure to
promote inclusion (6 out of 25; 24%). We found that the highest level of
evidence achieved in the literature was level 3 (20 out of 25 included
studies; 80%). Studies most commonly intervened to increase racial and
ethnic minority representation (19/25; 76%) and women's representation
(11/25; 44%). CONCLUSION(S): This scoping review summarizes and
assesses the literature on evidence-based practices for recruiting a
diverse surgical workforce. This work outlines interventions institutions
can develop to promote diversity within the surgical workforce.
Furthermore, it provides areas for advancing the recruitment of an
inclusive surgical workforce. Copyright © 2025 The Authors

<207>
Accession Number
649598191
Title
2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of Adults With
Congenital Heart Disease: 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: 18 Dec 2025.
Author
Gurvitz M.; Krieger E.V.; Fuller S.; Davis L.L.; Kittleson M.M.; Aboulhosn
J.A.; Bradley E.A.; Buber J.; Daniels C.J.; Dimopoulos K.; Egbe A.;
Geoffrion T.R.; John A.; Khairy P.; Kim Y.Y.; Kreutzer J.; Lewis M.J.;
Menachem J.N.; Moore J.P.; Osteen K.A.; Parikh P.B.; Saidi A.; Salciccioli
K.B.; Schunder R.L.; Valente A.M.; Wald R.M.
Abstract
AIM: The "2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the Management of
Adults With Congenital Heart Disease" provides recommendations to guide
clinicians on the evaluation and treatment of adult patients with
congenital heart disease. It incorporates new evidence to replace the
"2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart
Disease." METHODS: A comprehensive literature search was conducted with a
focus on literature published from 2017 to 2024; in some instances, older
literature was also collected and reviewed. Clinical studies, systematic
reviews and meta-analyses, and other evidence conducted on human
participants and published in English were identified from MEDLINE (via
PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and
Quality, and CINAHL for selected searches. STRUCTURE: Recommendations from
the "2018 AHA/ACC Guideline for the Management of Adults With Congenital
Heart Disease" have been updated with new evidence to guide
clinicians. Copyright © 2025 American College of Cardiology
Foundation and the American Heart Association, Inc. Published by Elsevier
Inc. All rights reserved.

<208>
Accession Number
649589826
Title
Artificial Intelligence-Based Delirium Prediction Model for Post-Cardiac
Surgery Patients: A Scoping Review.
Source
Journal of advanced nursing. (no pagination), 2025. Date of Publication:
17 Dec 2025.
Author
Qin C.; Zeng L.; Zhang J.; Tao M.; Zhou J.
Institution
(Qin, Zeng, Zhang, Zhang, Tao, Zhou) Nursing Department, Affiliated
Hospital of Zunyi Medical University, Zunyi, China
(Qin, Zeng, Zhang, Zhang, Zhou) Nursing College, Zunyi Medical University,
Zunyi, China
Abstract
BACKGROUND: Delirium is a common complication following cardiac surgery
and significantly affects patient prognosis and quality of life. Recently,
the application of artificial intelligence (AI) has gained prominence in
predicting and assessing the risk of postoperative delirium, showing
considerable potential in clinical settings. OBJECTIVE(S): This
scoping review summarises existing research on AI-based prediction models
for post-cardiac surgery delirium and provides insights and
recommendations for clinical practice and future research. METHOD(S):
Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews
and Meta-Analyses extension for Scoping Reviews) guidelines, eight
databases were searched: China National Knowledge Infrastructure, Wanfang
Database, China Biomedical Literature Database, Virtual Information
Platform, PubMed, Web of Science, Medline, and Embase. Studies meeting the
inclusion criteria were screened, and data were extracted on surgery type,
delirium assessment tools, predictive factors, and AI-based prediction
models. The search covered database inception through January 12, 2025.
Two researchers independently conducted the literature review and data
analysis. RESULT(S): Ten studies from China, Canada, and Germany
involving 11,702 participants were included. The reported incidence of
postoperative delirium ranged from 5.56% to 34%. The most commonly used
assessment tools were Confusion Assessment Method for the Intensive Care
Unit, Diagnostic and Statistical Manual of Mental Disorders-5, and
Intensive Care Delirium Screening Checklist. Key predictive factors
included age, cardiopulmonary bypass time, cerebrovascular disease, and
pain scores. AI-based prediction models were primarily developed using R
(6/10, 60%) and Python (4/10, 40%). Model performance, as measured by the
area under the curve, ranged from 0.544 to 0.92. Among these models,
Random Forest (RF) was the most effective (5/10, 50%), followed by XGBoost
(3/10, 30%) and Artificial Neural Networks (2/10, 20%).
 CONCLUSION(S): AI-based models show promise for predicting
postoperative delirium in cardiac surgery patients. Future studies should
prioritise integrating these models into clinical workflows, conducting
rigorous multicenter external validation, and incorporating dynamic,
time-varying perioperative variables to enhance generalizability and
clinical utility. REPORTING METHOD: This review followed the PRISMA-ScR
(Preferred Reporting Items for Systematic Reviews and Meta-Analyses
extension for Scoping Reviews) guidelines. PATIENT OR PUBLIC CONTRIBUTION:
This study did not include patient or public involvement in its design,
conduct, or reporting. Copyright © 2025 John Wiley & Sons Ltd.

<209>
Accession Number
2042444816
Title
Effects of pre-and post-operative active cycle of breathing technique as
an add-on to routine chest physical therapy on respiratory parameters in
coronary artery bypass graft patients.
Source
Anaesthesia, Pain and Intensive Care. 29(8) (pp 962-970), 2025. Date of
Publication: 01 Nov 2025.
Author
Bukhari S.; Ashraf H.S.; Abbas Z.U.; Zulfiqar N.; Nawaz M.A.; Sharif Z.
Institution
(Bukhari) Department of Physical Therapy, The University of Faisalabad,
Faisalabad, Pakistan
(Ashraf, Zulfiqar) Department of Physical Therapy, University of Lahore,
Lahore, Pakistan
(Abbas, Nawaz) Department of Physical Therapy, Sehat Medical Complex,
Hanjarwal, Lahore, Pakistan
(Sharif) Department of Physical Therapy, Superior University, Lahore,
Pakistan
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Background & Objective: When someone has coronary artery disease, surgeons
may perform a coronary artery bypass graft (CABG) to create a new route
for blood to reach the narrowed heart arteries. CABG procedures may
increase the risk of patients having pulmonary issues after surgery. The
usefulness of active cycle of breathing technique (ACBT) in patients who
undergo CABG to lower the risk of lung problems has not been widely
recognized or experienced in Pakistan. Therefore, the purpose was to
determine the effects of pre and postoperative ACBT on oxygen saturation
(SpO2), arterial blood gas (ABG), and respiratory rate (RR) after coronary
artery bypass graft surgery (CABG). Methodology: The randomized controlled
trial took place from March to May 2024 at the Faisalabad Institute of
Cardiology (FIC) in Faisalabad. The elected 72 patients both men and women
of ages 35 to 65 were randomized using lottery method to place equal
numbers of participants in each group (n = 36 each). ACBT was applied in
addition to routine chest physical therapy in the intervention group,
while the control group received only routine chest therapy. Both patient
groups had their arterial blood gases (ABG), oxygen saturation (SpO2) and
respiratory rate (RR) checked at baseline and upto five days after surgery
(daily). Result(s): There were significant differences between the
groups for RR, SpO2 and PaCO2 over all the postoperative days (p < 0.001).
Nevertheless, there was no noticeable difference in PaO2 on Day 3 (P =
0.977), in HCO3 on Day 3 (P = 0.145) and 4 (P = 0.84), nor in pH on Days 2
(P = 0.158) and 3 (P = 0.017). SpO2 in the control group was 95 (95-96) at
the start, climbed to 99 (98-99.4) on Day 1, then dropped to 95 (95-96) by
Day 5. RR went up to 28 (27.25-30) on Day 5. For the intervention group,
the SpO2 went from 95 (95-96.75) at the beginning to 99 (98.25-100) by Day
5 and the RR was reduced from 30 (19-31) on Day 1 down to 22 (20-24) on
Day 5. Within the control group, SpO2 went down to 81% and RR went up to
36 +/- 3.75 on Day 3 which indicates the respiratory system had not
returned to normal as fast as the intervention group. Conclusion(s):
The findings of our study suggest that 'active cycle of breathing
technique' is more effective than the routine chest physical therapy alone
for improving hemodynamic and respiratory parameters including ABG, RR,
and SpO2 after CABG. Abbreviations: ABG: arterial blood gas, ACBT: Active
cycle breathing technique, CABG: Coronary artery bypass graft, RR:
respiratory rate. Copyright © 2025, Faculty of Anaesthesia, Pain
and Intensive Care, AFMS. All rights reserved.

<210>
Accession Number
649590674
Title
BEHIND THE DYSFUNCTION: A CONTEMPORARY REVIEW ON ERECTILE DYSFUNCTION
AETIOLOGIES IN MEN UNDERGOING PENILE PROSTHESIS INSERTION.
Source
Journal of Sexual Medicine. Conference: 26th Annual Fall Scientific
Meeting of the Sexual Medicine Society of North America. Grapevine, TX
United States. 22(Supplement 4) (pp iv246-iv247), 2025. Date of
Publication: 01 Nov 2025.
Author
Sim S.; Rahemtoola S.; Grice P.; Stasinou T.; Modgil V.; Pearce I.
Institution
(Sim, Rahemtoola, Grice, Stasinou, Modgil, Pearce) Manchester Royal
Infirmary, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction: Erectile dysfunction (ED) is a chronic, multifactorial
condition associated with many other diseases. Conditions such as aging,
diabetes mellitus, hypertension have an impact on the onset and
progression of ED, and influences treatment options. Penile prosthesis
implantation is an established and definitive surgical treatment when
conservative and medical management fails. This review aims to synthesize
contemporary data on the aetiology of ED in men undergoing penile
prosthesis insertion. Objective(s): To determine distribution and
prevalence of aetiology for erectile dysfunction in patients requiring
penile prosthesis insertion, using studies published in the last 5 years.
 Method(s): A structured literature review was performed using
multiple databases for publications between Jan 2020 and May 2025. The
data was managed on Covidence for screening. Eligible studies included
were adult male cohorts undergoing penile prosthesis placement for the
treatment of ED with quantitative data on underlying causes of and
contributing factors to ED. Studies that focused on a single aetiology of
ED were excluded. Data extraction, organization and analysis were done in
Microsoft excel. A narrative synthesis was performed to describe the
distribution and definitive prevalence of ED aetiologies globally.
Findings were further stratified by geographic region to explore regional
prevalence using papers with region-specific cohorts only. Result(s):
Out of the 166 studies screened, 31 papers with cohorts from USA,
Europe/United Kingdom (EU/UK), Asia and the Middle East met the inclusion
criteria. Study designs were predominantly retrospective cohort studies (n
= 28), with 2 prospective studies that included data from 3 national
registries and 1 randomised controlled trial. This yielded 26 original
patient cohorts with a total of 16,805 patients who underwent penile
prosthesis implantation for ED. The sample sizes ranged from 40 to 5289
and the pooled mean age is 60.9. The top-5 reported aetiologies across
studies in decreasing frequency include diabetes mellitus (26/26 papers),
Peyronie's disease (19/26), Post-Radical Prostatectomy (RP) or pelvic
surgery (17/26), Cardiovascular disease (17/26) and Hypertension
(12/26).Diabetesmellitus is the global predominant contributing factor
with a weighted prevalence averaging 36.7%, followed by Hypertension at
34% and Post-RP or pelvic surgery at 13.8%. Geographic analysis revealed
that Post-RP patients were most predominant in EU/UK (22.7%), hypertension
was most frequently reported in USA cohorts (55%) and diabetes was most
common in the Rest of World (RoW, 38.2%). Results of the geographical
analysis is included in the table below (table 1). Data for type of
prosthesis was available for 18401 patients with 96.4% having an
inflatable penile prosthesis instead of malleable (3.6%). Limitations of
this review include high heterogeneity in study design and primary outcome
leading to inconsistent documentation of comorbidities across studies, and
the lack of clarity of how primary aetiologies are defined and assigned.
These affect the reported rates of ED aetiology. Conclusion(s):
Despite the inter-study variation on design and primary outcome, the data
has shown that diabetes is one of the leading contributors to erectile
dysfunction across the globe and within region-specific data. Geographic
variation highlights variation in disease patterns which influences
healthcare practices and the management of ED. (Table present).

<211>
Accession Number
649579893
Title
Exercise Prehabilitation and 90-Day Self-Rated Health Status in Cardiac
Surgery Patients with Poor Early Recovery: A Secondary Analysis of a
Randomized Controlled Trial.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2025.
Date of Publication: 24 Nov 2025.
Author
Yau D.K.W.; Joynt G.M.; Ho K.M.; Lee A.
Institution
(Yau) Department of Rehabilitation Sciences,Hong Kong Polytechnic
University,Hung Hom, Hong Kong; Department of Anaesthesia and Intensive
Care,The Chinese University of Hong Kong,Shatin, Hong Kong SAR, China
(Joynt, Ho, Lee) Department of Anaesthesia and Intensive Care, Chinese
University of Hong Kong, Hong Kong SAR, Shatin, China

<212>
Accession Number
649578752
Title
Chest tube removal after cardiac surgery in first vs. second
post-operative day: a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. (no pagination), 2025. Date of
Publication: 16 Dec 2025.
Author
Rakab M.S.; Awashra A.; Radwan N.; Shubietah A.; Maamoun A.; Mattar M.;
Manasrah A.; Ghanem A.; Elbaz A.; Emara A.; Abdul-Hafez H.A.
Institution
(Rakab, Radwan, Maamoun, Ghanem, Elbaz, Emara) Faculty of Medicine,
Mansoura University, Mansoura, Egypt
(Awashra) Department of Medicine, An Najah National University, Nablus,
Palestine
(Shubietah) Department of Medicine, Advocate Illinois Masonic Medical
Center, Chicago, IL, United States
(Mattar) Faculty of Medicine, Zagazig University, Zagazig, Egypt
(Manasrah) Department of Internal Medicine, United Health Services -
Wilson Medical Center, Johnson City, NY, United States
(Abdul-Hafez) Department of Medicine, An Najah National University,
Nablus, Palestine
(Abdul-Hafez) Department of Medicine, Faculty of Medicine and Health
Sciences, An- Najah National University, Nablus, Palestine
Abstract
BACKGROUND: The optimal timing of chest tube removal after cardiac surgery
remains uncertain, with institutional practices varying widely. While
early removal may promote faster recovery, concerns persist regarding
potential complications such as fluid accumulation. This meta-analysis
compares early versus late chest tube removal and their effects on
clinical and procedural outcomes. METHOD(S): We searched Web of
Science, SCOPUS, PubMed, and Cochrane Central Register of Controlled
Trials until May 2025. Nine studies involving 8,557 patients were
included. Pooled risk ratios (RR) and mean differences (MD) with 95%
confidence intervals were calculated using either random-effects or
fixed-effects models. RESULT(S): Early chest tube removal was
associated with a significantly higher risk of pericardial effusion (RR
1.85, p = 0.0105), while pleural effusion showed an increasing trend with
marginally significant difference (RR 1.19, p = 0.0584). Hospital stay was
shorter in the early group (MD -1.00 days, p < 0.0001), yet ICU stay
showed no meaningful difference (MD -7.25 h, p = 0.217). Mortality rates
were comparable (RR 0.93, p = 0.8048). Similarly, no significant
differences were observed in postoperative infection (RR 0.85, p = 0.4403)
or atrial fibrillation rates (RR 1.01, p = 0.8649). CONCLUSION(S):
Early chest tube removal appears safe with respect to mortality,
infection, and atrial fibrillation, but is associated with a higher risk
of pericardial effusion; adoption should therefore be risk-stratified and
paired with post-removal surveillance. Copyright © 2025. The
Author(s).

<213>
Accession Number
2041561397
Title
Amustaline/glutathione pathogen-reduced red cell hemoglobin utilization in
complex cardiac surgery: A post hoc analysis of the phase 3 ReCePI trial.
Source
Transfusion. (no pagination), 2025. Date of Publication: 2025.
Author
Welsby I.J.; Sekela M.E.; Snyder E.L.; Gorham J.D.; McNeil J.S.; Liu K.;
Bentow S.; Gniadek T.; Corash L.; Mufti N.; Benjamin R.J.
Institution
(Welsby) Duke University Medical Center, Durham, NC, United States
(Sekela) Gill Heart Institute, University of Kentucky, Lexington, KY,
United States
(Snyder) Yale University School of Medicine, New Haven, CT, United States
(Gorham, McNeil) University of Virginia Health System, Charlottesville,
VA, United States
(Liu, Bentow, Gniadek, Corash, Mufti, Benjamin) Cerus Corporation,
Concord, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The ReCePI randomized, controlled trial compared
amustaline/glutathione pathogen-reduced (PR) and conventional red blood
cell (RBC) transfusions in cardiac surgery. Study design and methods: We
performed a post-hoc analysis of hemoglobin (Hb) utilization and safety
outcomes. Hb content of study RBCs was measured at manufacture. Subject Hb
levels, estimated blood loss and blood product use were recorded during
and for 7 days post-surgery. Acute kidney injury (AKI) incidence was
graded over 7 days, and adverse events were assessed for 28 days.
 Result(s): PR-RBCs contained 5.2% less Hb (mean [SD] Test 58.1 [6.5]
g; Control 61.5 [6.8] g Hb, p <.001) due to manufacturing volume losses.
Four hundred fifty-six PR- and 524 conventional RBCs were transfused to
159 Test and 162 Control subjects, respectively. Mean subject baseline and
post-surgery Hb levels, and blood loss were not different between groups.
Test subjects tended to require fewer total RBCs (3.5 [2.7] Test vs. 4.0
[3.5] Control, p =.08) resulting in 17.6% significantly less mean total Hb
transfused (Test 203.2 g; Control 246.8 g Hb, p =.01). The proportions of
subjects transfused with, and the number of platelet and cryoprecipitate
units transfused were not different. Test subjects received less plasma
(2.3 [1.8] units Test vs. 3.5 [3.8] Control, p =.03). Overall incidence of
adverse events and AKI were not clinically different. Imbalances in AKI
severity (Grade III Test 15/159 [9.4%]; Control 7/162 [4.3%], p =.07) may
suggest under-transfusion in the highest-risk Test subjects.
 Discussion(s): Test patients required less transfused Hb than control
subjects to maintain equivalent daily hemoglobin levels following similar
blood loss. Copyright © 2025 The Author(s). Transfusion published
by Wiley Periodicals LLC on behalf of AABB.

<214>
Accession Number
2041916590
Title
Lack of impact of adjunctive lipid-modifying therapy in the CLEAR Outcomes
trial.
Source
Journal of Clinical Lipidology. (no pagination), 2025. Date of
Publication: 2025.
Author
Menon V.; Bloedon L.; Li N.; Lincoff A.M.; Nicholls S.J.; Powell H.A.;
Nissen S.E.
Institution
(Menon, Lincoff, Nissen) Cleveland Clinic, Cleveland, OH, United States
(Bloedon, Li, Powell) Esperion Therapeutics, Ann Arbor, MI, United States
(Nicholls) Monash University, Melbourne, VIC, Australia
Publisher
Elsevier Ltd
Abstract
BACKGROUND Bempedoic acid is a prodrug that reduces circulating
low-density lipoprotein (LDL) cholesterol levels by inhibiting the liver
enzyme adenosine triphosphate-citrate lyase. Treatment of statin
intolerant patients with bempedoic acid was associated with a
significantly reduced risk of the primary composite endpoint
(cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or
coronary revascularization) in the CLEAR (Cholesterol Lowering via
Bempedoic Acid, an ACL-Inhibiting Regimen) Outcomes Trial. OBJECTIVE To
evaluate impact of additional lipid modifying therapy (LMT) on the primary
composite endpoint of the CLEAR Outcomes Trial. RESULTS Utilization of
adjunctive LMT was observed in 1749 (12.5%) enrolled patients. The most
common adjunctive LMT reported were statins (4.0% vs 6.5%), ezetimibe
(2.7% vs 5.5%), and PCSK9 inhibitors (2.8% vs 4.4%) in the bempedoic acid
and placebo groups, respectively. The majority of first MACE-4 events
(92.9% of events in bempedoic acid and 90.9% of events in placebo)
preceded the initiation of adjunctive LMT. When censored at the time of
initiating adjunctive LMT, primary event reduction was observed in favor
of bempedoic acid compared to placebo [HR: 0.86 (95% CI, 0.77-0.94)] which
was similar to the reduction noted with bempedoic acid in the overall
trial [HR of 0.87 (95% CI, 0.79-0.96), P = .004]. CONCLUSIONS The
utilization of additional LMT following randomization had no impact on the
observed results of the CLEAR Outcomes trial. Copyright © 2025.
Published by Elsevier Inc.

<215>
Accession Number
2041910674
Title
A Standardized Remediation Approach for the Integrated Cardiothoracic
Surgery Trainee: Review of Current Paradigms and Suggested Strategies.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
Hutson J.; Aggarwal R.; Robinson J.; Naselsky W.; Gicovi K.; Stewart S.
Institution
(Hutson, Aggarwal) Michigan State University College of Human Medicine,
East Lansing, MI, United States
(Robinson, Gicovi, Stewart) University of Maryland School of Medicine,
Baltimore, MD, United States
(Robinson, Gicovi, Stewart) Department of Surgery, University of Maryland,
Baltimore, MD, United States
(Naselsky) Houston Methodist, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background Effective remediation is essential for the success of residency
programs, yet integrated cardiothoracic (I6) surgery training lacks
standardized guidelines. Drawing from remediation practices in other
surgical subspecialties, this study evaluates existing strategies and
proposes a structured remediation framework tailored to I6 trainees.
Methods A systematic review examining remediation policies in surgical
residency programs was conducted through December 2024. Studies meeting
inclusion criteria were critically analyzed and key themes were
synthesized to inform a standardized approach for I6 trainees. Results Of
239 identified articles, 18 met inclusion criteria. Findings emphasized
the importance of regular assessments, structured performance evaluations,
and collaborative intervention strategies, including faculty mentorship
and success teams. Standardized remediation protocols, as seen in
neurosurgery and orthopedics, were instrumental in addressing competency
deficiencies through competency-based assessments and curriculum
refinements. Conclusions I6 training demands a multifaceted remediation
approach encompassing technical proficiency, clinical acumen, and
professional development. By integrating best practices from related
surgical fields, this study proposes a tailored, evidence-based
remediation framework to enhance surgical education and to support
struggling residents. Establishing a standardized remediation policy
across I6 programs can optimize training outcomes, ensuring competence and
preparedness of future cardiothoracic surgeons. Copyright © 2025.
Published by Elsevier Inc.

<216>
Accession Number
2042330306
Title
Robotic-assisted thoracic surgery in children: A systematic review and
meta-analysis.
Source
Journal of Pediatric Surgery. 61(3) (no pagination), 2026. Article Number:
162840. Date of Publication: 01 Mar 2026.
Author
Delgado-Miguel C.; Camps J.; Garavis Montagut I.; Diez R.;
Arredondo-Montero J.; Hernandez-Oliveros F.
Institution
(Delgado-Miguel, Diez) Department of Pediatric Surgery, Fundacion Jimenez
Diaz University Hospital, Madrid, Spain
(Delgado-Miguel, Hernandez-Oliveros) Institute for Health Research IdiPAZ,
La Paz University Hospital, Madrid, Spain
(Camps) Department of Pediatric Surgery, Prisma Health Children's
Hospital, Columbia, SC, United States
(Garavis Montagut) Faculty of Medicine, El Bosque University, Bogota,
Colombia
(Arredondo-Montero) Department of Pediatric Surgery, Complejo Asistencial
Universitario de Leon, Castilla y Leon, Spain
Publisher
W.B. Saunders
Abstract
Introduction: Robot-assisted thoracic surgery (RATS) has emerged as an
innovative alternative to conventional video-assisted thoracoscopic
surgery (VATS) in pediatric patients. Although individual case series have
described its feasibility and safety, no systematic synthesis has
previously addressed its role in children. Method(s): We conducted a
systematic review and meta-analysis in accordance with PRISMA guidelines,
registered in PROSPERO (CRD420251091235). A comprehensive search of
PubMed, CINAHL, Web of Science, and EMBASE was performed to identify
studies reporting pediatric RATS. For the quantitative synthesis,
random-effects meta-analyses were applied with restricted maximum
likelihood (REML) estimation, and confidence intervals were adjusted using
either the Knapp-Hartung (HKSJ) or modified Knapp-Hartung (mKH) methods to
account for small-sample uncertainty. Result(s): Thirty-six studies
encompassing 936 patients were included; 638 underwent RATS. Indications
included tracheobronchial procedures, pulmonary resections, diaphragmatic
anomalies, mediastinal tumors, and thymic disorders. Qualitative synthesis
demonstrated high feasibility, versatility, and favorable safety, with a
1.8 % conversion rate and complication rates of 5.6 %. Quantitative
synthesis included 4 studies comparing pulmonary resections, and revealed
longer operative times for RATS compared to VATS (mean difference 26.4
min, 95 % CI: 3.26 to 49.47; p = 0.04). However, RATS significantly
reduced hospital stay (-0.70 days, 95 % CI: -1.22 to -0.17; p = 0.02) and
showed a nonsignificant trend toward shorter chest tube duration.
Complication rates did not differ significantly between groups (RR 1.16;
95 % CI: 0.83 to 1.63; p = 0.39). Conclusion(s): RATS may be
considered a safe and effective minimally invasive technique for selected
pediatric thoracic conditions, offering enhanced precision and
versatility. Current evidence, although limited by the small number of
studies, suggests a potentially beneficial profile for RATS. Larger
prospective multicenter studies are needed to confirm long-term results
and optimize patient selection. Copyright © 2025 Elsevier Inc.

<217>
Accession Number
2042407441
Title
History and challenges of multi-organ allocation in the United States: A
systematic review.
Source
Transplantation Reviews. 40(1) (no pagination), 2026. Article Number:
100988. Date of Publication: 01 Jan 2026.
Author
Cheng M.; Huynh S.C.T.; Dale R.; Currie M.E.
Institution
(Cheng) Geisel School of Medicine, Dartmouth College, Hanover, NH, United
States
(Huynh, Dale, Currie) Department of Cardiothoracic Surgery, Stanford
University School of Medicine, Stanford, CA, United States
Publisher
Elsevier Inc.
Abstract
Current multi-organ candidates are prioritized primarily based on
single-organ risk scores. Once the primary organ is allocated, the
secondary organ follows to the same recipient, resulting in waitlisted
single-organ candidates being skipped in allocation. Our previous work
examined the ethical and statistical alignment of single-organ risk
scores. Here, we aim to extend our analysis to multi-organ transplantation
policies in the United States, surveying the current state of multi-organ
candidate prioritization and the challenges of conducting high-quality
research in multi-organ transplantation. We systematically searched PubMed
for published literature on the allocation of all multi-organ pairs
involving the liver, kidney, lungs, and heart. After screening based on
our inclusion and exclusion criteria, we identified 126 articles to
include in this review. These include 31 articles for Heart-Lung, 24 for
Heart-Kidney, 52 for Liver-Kidney, and 19 for Liver-Heart transplantation.
We did not discuss the remaining organ pairs due to insufficient
literature to provide a balanced analysis. Provider-, center-, and
region-dependent variations exist in multi-organ practices due to evolving
national guidelines and a lack of standardized institutional protocols for
candidate evaluation and listing. The use of single-organ risk scores in
multi-organ allocation has not been statistically validated, therefore
raising concerns about applicability. Multi-organ transplant research
relies heavily on single-center reports, case studies, and registry-based
analyses. The frequent re-use of national registry data limits the novelty
and reliability of multi-organ research. We encourage future efforts to
consider exploratory, prospective, and perhaps randomized-controlled
trials to advance understanding and strengthen the evidence base in
multi-organ transplantation. Copyright © 2025

<218>
Accession Number
2041884431
Title
Remimazolam provides better hemodynamic stability than propofol in
hypertensive surgical patients: a randomized single-blinded trial.
Source
Journal of Anesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Wang P.; Chen D.; Yu H.; Sun Y.; Xiong J.
Institution
(Wang, Chen, Yu, Sun, Xiong) Department of Anesthesiology, Shenzhen
University General Hospital, Shenzhen University, Guangdong Province,
Shenzhen, China
Publisher
Springer
Abstract
Purpose: Hypertensive surgical patients face heightened perioperative
cardiovascular risk, and propofol often induces hypotension. This trial
aimed to compare remimazolam and propofol for hemodynamic stability in
hypertensive patients undergoing non-cardiac surgery, and explore
underlying cardiac and vascular mechanisms via continuous monitoring.
 Method(s): This randomized single-blind trial enrolled 122 adults
with controlled hypertension undergoing elective non-cardiac surgery,
assigned to remimazolam-based or propofol-based total intravenous
anesthesia. Primary outcomes were intraoperative hypotension episodes
(mean arterial pressure < 65 mmHg or a > 20% decrease from baseline),
norepinephrine bolus frequency and total dose. Hemodynamics were
continuously tracked by Continuous Non-Invasive Arterial Pressure Monitor
500, with anesthesia depth maintained at a bispectral index of 40-60.
 Result(s): Baseline characteristics were comparable. The remimazolam
group had fewer hypotension episodes (remimazolam group vs. propofol
group, median episodes [interquartile range, IQR], 2 [0-3] vs. 3 [1-5]; p
= 0.003), fewer norepinephrine boluses (1 [0-3] vs. 3 [1-5]; p = 0.001),
and lower total dose (8 microg [0-24] vs. 24 microg [8-40]; p < 0.001).
Remimazolam showed non-significant trends toward smaller reductions in
cardiac output (CO, - 8.10% vs. - 13.10%, p = 0.35) and systemic vascular
resistance (SVR, - 10.83% vs. - 14.91%, p = 0.46). Extubation time and
post-anesthesia care unit stay were similar. Conclusion(s): For
hypertensive patients, remimazolam provides superior hemodynamic stability
over propofol, evidenced by fewer hypotensive episodes, reduced
norepinephrine requirements, and attenuated perturbations in CO and SVR,
without delaying recovery. It represents a valuable anesthetic alternative
for this high-risk cohort. Copyright © The Author(s) 2025.

<219>
Accession Number
2041920422
Title
Watchman FLX versus Amplatzer amulet for percutaneous left atrial
appendage occlusion: A systematic review and meta-analysis.
Source
Journal of Cardiology. (no pagination), 2025. Date of Publication: 2025.
Author
de Pontes V.B.; Carvalho P.E.P.; Felix N.; Nogueira A.; Clemente M.R.C.;
Gastaldelo V.; Preda A.; Garot P.
Institution
(de Pontes, Gastaldelo) Division of Medicine, Centro Universitario das
Faculdades Associadas de Ensino, Sao Joao da Boa Vista, Brazil
(Carvalho) Center for Coronary Artery Disease, Minneapolis Heart Institute
Foundation, Minneapolis, MN, United States
(Felix) Division of Medicine, Federal University of Campina Grande,
Campina Grande, Brazil
(Nogueira) Division of Medicine, Escola Bahiana de Medicina e Saude
Publica, Salvador, Brazil
(Clemente) Division of Medicine, Petropolis Medical School, Rio de
Janeiro, Brazil
(Preda) De Gasperis Cardio Center, Electrophysiology Unit, Niguarda
Hospital, Milan, Italy
(Garot) Institut Cardiovasculaire Paris Sud (ICPS), Hopital Jacques
Cartier, Ramsay-Sante, Massy, France
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background The comparative safety and efficacy of Watchman FLX (Boston
Scientific, Marlborough, MA, USA) and Amplatzer Amulet (Abbott, Abbott
Park, IL, USA) devices for left atrial appendage occlusion (LAAO) remain
unclear. Objective To compare Watchman FLX and Amplatzer Amulet devices
for LAAO. Methods We systematically searched PubMed, Embase, and Cochrane
Library for studies comparing Watchman FLX versus Amulet in patients with
atrial fibrillation (AF) undergoing percutaneous LAAO. We applied a
random-effects model to pool risk ratios (RR) with corresponding 95 %
confidence intervals (CI) for binary endpoints. Results We included five
studies comprising 1316 patients with AF undergoing LAAO for high bleeding
risk. A total of 629 (47.8 %) patients underwent LAAO with Watchman FLX.
Amulet was associated with lower rates of stroke or transient ischemic
attack (TIA) (RR 2.31; 95 % CI 1.02-5.25; p = 0.04; I2 = 0 %),
but no differences were observed in terms of peridevice leak (RR 1.57; 95
% CI 0.86-2.89; p = 0.14; I2 = 0 %) between Watchman and Amulet
devices. Additionally, no differences were found in terms of
device-related thrombus (RR 2.01; 95 % CI 0.87-4.68; p = 0.10;
I2 = 0 %), or pericardial effusion (RR 1.00; 95 % CI 0.17-5.96;
p = 1.00; I2 = 59.7 %) between both groups. Conclusion This
meta-analysis indicates a lower risk of stroke or TIA with Amulet compared
to Watchman FLX. Copyright © 2025 Elsevier Ltd.

<220>
Accession Number
2041911209
Title
All-Venous Grafting and Very Long-Term Survival After Coronary Artery
Bypass Grafting.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
Squiers J.J.; Shih E.; DiMaio J.M.; Banwait J.K.; Hale S.; Mack M.J.;
Schaffer J.M.
Institution
(Squiers, Shih, DiMaio, Mack, Schaffer) Department of Cardiothoracic
Surgery, Baylor Scott & White, The Heart Hospital, Plano, TX, United
States
(DiMaio, Banwait, Hale, Mack) Baylor Scott & White Research Institute,
Plano, TX, United States
Publisher
Elsevier Inc.
Abstract
Background Observational studies of coronary artery bypass grafting (CABG)
have associated single-arterial grafting with superior outcomes compared
with all-venous grafting. Current guidelines assign single-arterial
grafting a class I recommendation. However, no adequately powered
randomized controlled trials were undertaken to confirm this benefit, and
very long-term data on outcomes of various conduit strategies from more
contemporary eras remain lacking. Methods This study retrospectively
analyzed Medicare beneficiaries who underwent CABG from 1999 to 2004, the
period immediately preceding the first publication of guidelines affording
single-arterial grafting a class I indication. The study compared survival
between beneficiaries undergoing all-venous grafting and those undergoing
single-arterial grafting by using restricted mean survival times (RMSTs).
Risk adjustment was performed for all available covariates by using
overlap propensity score weighting. Results Among 640,116 Medicare
beneficiaries, 101,120 (15.8%) underwent all-venous grafting and 538,996
(84.2%) underwent single-arterial grafting. Beneficiaries undergoing
all-venous grafting, vs single-arterial grafting, were noted to have worse
risk-adjusted operative survival (30-day RMST, 28.6 [95% CI: 28.6-28.7]
days vs 29.3 [95% CI: 29.2-29.3] days; difference, 0.73 [95% CI:
0.73-0.73] days; P < .001), short-term survival (1-year RMST, 324 [95% CI:
324-325] days vs 339 [95% CI: 338-339] days; difference, 14 [95% CI:
13-15] days; P < .001), and very long-term survival (20-year RMST, 8.34
[95% CI: 8.30-8.38] vs 9.55 [95% CI: 9.51-9.59] years; difference, 1.21
years; P < .001). Conclusions Medicare beneficiaries undergoing CABG with
all-venous grafting had inferior risk-adjusted survival compared with
patients receiving single-arterial grafting. These findings support
current multidisciplinary guideline recommendations offering a class I
indication for use of at least 1 arterial graft during CABG. Copyright
© 2025 The Society of Thoracic Surgeons.

<221>
Accession Number
649578222
Title
Continuous furosemide does not prevent cardiopulmonary bypass-related
acute kidney injury in minimally invasive cardiac surgery: the randomized
furosemide trial.
Source
The journal of extra-corporeal technology. 57(4) (pp 209-217), 2025. Date
of Publication: 01 Dec 2025.
Author
Takeichi T.; Morimoto Y.; Yamada A.; Tanaka T.; Fujiwara K.; Sato M.; Toma
R.; Mitsui K.; Sugita T.; Yamada H.; Gan K.
Institution
(Takeichi, Tanaka, Fujiwara, Mitsui, Sugita, Yamada) Department of
Clinical Engineering, Kitaharima Medical Center, Hyogo, Japan
(Morimoto, Yamada, Sato, Toma, Gan) Cardiovascular Surgery, Kitaharima
Medical Center, Hyogo, Japan
Abstract
OBJECTIVES: This study aimed to assess whether continuous furosemide
administration during cardiopulmonary bypass (CPB) in minimally invasive
cardiac surgery (MICS) reduces the incidence of cardiac surgery-associated
acute kidney injury (AKI). METHOD(S): A total of 100 patients
undergoing MICS with CPB were randomly assigned to receive either
continuous furosemide infusion or no continuous furosemide during CPB. The
primary endpoint was the incidence of AKI. Secondary endpoints included
the cardiac surgery-associated neutrophil gelatinase-associated lipocalin
(CSA-NGAL) score, urine output within 12 h postoperatively, postoperative
furosemide dose requirements, red blood cell transfusion volume, PaO2/FiO2
ratio, duration of mechanical ventilation, length of stay in the intensive
care unit (ICU) and hospital, and in-hospital mortality. RESULT(S):
AKI occurred in 8 patients (16%) in the continuous furosemide group and in
6 patients (12%) in the non-continuous group (relative risk, 0.72; 95% CI,
0.23-2.23). Among the secondary endpoints, urine output within the first 3
h postoperatively and the PaO2/FiO2 ratio were significantly higher in the
continuous furosemide group. However, subgroup analyses revealed no
significant differences between the two groups. CONCLUSION(S):
Continuous furosemide administration during CPB did not effectively reduce
the incidence of AKI. However, it was associated with a significant
increase in postoperative urine output and an improvement in the PaO2/FiO2
ratio. Copyright © The Author(s), published by EDP Sciences,
2025.

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