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<1>
Accession Number
2042040728
Title
Incidence and predictors of persistent left atrial appendage patency and
its subtypes after percutaneous closure: a pre-specified analysis of the
SWISS-APERO trial.
Source
European Heart Journal Cardiovascular Imaging. 26(11) (pp 1795-1803),
2025. Date of Publication: 01 Nov 2025.
Author
Galea R.; Perich Krsnik J.; Peters A.A.; De Marco F.; Aminian A.; Meneveau
N.; Heg D.; Grani C.; Anselme F.; Franzone A.; Vranckx P.; Fischer U.;
Bedogni F.; Raber L.; Valgimigli M.
Institution
(Galea, Perich Krsnik, Grani, Raber, Valgimigli) Department of Cardiology,
Bern University Hospital, University of Bern, Freiburgstrasse 20, Bern,
Switzerland
(Galea) Department of Cardiology, Hospital Centre of Biel, Biel,
Switzerland
(Peters) Department of Diagnostic, Interventional and Pediatric Radiology,
Bern University Hospital, University of Bern, Bern, Switzerland
(De Marco) Department of Cardiology, Monzino Cardiology Center, Milan,
Italy
(Aminian) Department of Cardiology, Centre Hospitalier Universitaire de
Charleroi, Charleroi, Belgium
(Meneveau) Department of Cardiology, Besancon University Hospital,
University of Burgundy Franche-Comte, EA3920, Besancon, France
(Heg) Department of Clinical Research, CTU Bern, University of Bern, Bern,
Switzerland
(Anselme) Department of Cardiology, University Hospital of Rouen, Rouen,
France
(Franzone) Department of Advanced Biomedical Sciences, University Federico
II, Naples, Italy
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Hasselt, Belgium
(Fischer) Department of Neurology, Bern University Hospital, University of
Bern, Bern, Switzerland
(Bedogni) Department of Cardiology, IRCCS Policlinico San Donato, San
Donato Milanese, Milan, Italy
(Valgimigli) Cardiocentro Ticino Institute, Universita Della Svizzera
Italiana, Via Tesserete 48, Lugano, Switzerland
Publisher
Oxford University Press
Abstract
Aims Left atrial appendage (LAA) patency after percutaneous closure is
associated with higher thromboembolic risk, especially when detected at
later time points after procedure. We aim to investigate the incidence and
predictors of persistent LAA patency and its different subtypes at cardiac
computed tomography angiography (CCTA) during the first year after LAA
closure (LAAC). Methods and results In the SWISS APERO trial, patients
undergoing LAAC were randomly assigned (1:1) to Amulet or Watchman/FLX
across eight European centers and received CCTA follow-up at 45 days and
13 months. The presence, the type and predictors of persistent or
new-onset LAA patency at 13 months were investigated by matching 45-day
and 13-month CCTAs in an imaging core-lab. Of the 221 randomized patients,
158 (71.5%) were included in the matched 45-day and 13-month CCTA
analysis. Residual LAA patency decreased from 66.4 to 50.6% with
approximately one-third (30.5%) of 45-day patent appendages (PA) resolved
at 13 months. Side-gap leaks at 45 days were the PA subtypes associated
with the highest likelihood (86%) of persistence. At 45-day CCTA, the
presence of at least two factors among side-gap leak proximal area >37.7
mm2, radial diameter >3 mm or LAA-device angle
>39.4degree ('ARA LAAO' score >= 2) predicted leak persistence
at 13-month CCTA with 94.1% sensitivity and 70% specificity. Conclusion In
a prospective multi-centre cohort of clinically indicated LAAC,
approximately two-thirds of 45-day PAs, especially those related to large
side-gap leaks with bigger LAA-device off-axis angle, persisted at 13
months, whereas new-onset PA occurred in roughly 1 in every 10 patients.
Clinical Trial Registration: URL https://clinicaltrials.gov Unique
Identifier NCT03399851 Copyright © The Author(s) 2025. Published
by Oxford University Press on behalf of the European Society of
Cardiology. All rights reserved.

<2>
Accession Number
2042101620
Title
The Effect of Music Intervention on Analgesia During Bed Baths in the
Immediate Postoperative Period of Cardiac Surgery: A Randomized Clinical
Trial.
Source
Global Advances in Integrative Medicine and Health. 14 (no pagination),
2025. Date of Publication: 01 Jan 2025.
Author
Sarmento S.D.G.; Araujo N.M.D.; Santos K.V.G.D.; Leal K.C.D.S.; Teixeira
F.D.C.; Ribeiro K.R.B.; Dantas D.V.; Dantas R.A.N.
Institution
(Sarmento, Araujo, Santos, Leal, Teixeira, Ribeiro, Dantas, Dantas)
Department of Nursing, Federal University of Rio Grande Do Norte, Natal,
Brazil
(Teixeira) Nursing Sector, University Hospital Onofre Lopes (HUOL/EBSERH),
Natal, Brazil
Publisher
SAGE Publications Inc.
Abstract
Background: Pain is a significant complication following cardiac surgery.
While pharmacological treatments are standard, non-pharmacological
interventions like music offer a promising, low-cost adjunct for pain
management. Objective(s): To evaluate the effect of a music
intervention on pain and vital signs during the first postoperative bed
bath for patients recovering from cardiac surgery. Method(s): This
study was a single-blind, randomized controlled trial involving 38
patients who had undergone Coronary Artery Bypass Grafting (CABG).
Patients were allocated to either an experimental group (n = 19), which
listened to self-selected music via headphones, or a control group (n =
19), which wore headphones with no audio. The primary outcome, pain, was
measured using the Numerical Rating Scale (NRS) and the Wong-Baker FACES
Scale (WBS) during and after the bed bath. Result(s): The music
intervention group demonstrated a statistically significant reduction in
pain scores both during and after the bath. Compared to the control group,
the experimental group's pain scores decreased by a mean of 2.41 points on
the NRS (P < 0.001) and 2.11 points on the WBS (P < 0.001). Furthermore, a
significant reduction in heart rate (P = 0.019) was observed in the
experimental group. Conclusion(s): Music intervention effectively
reduced pain and stabilized heart rate during a potentially painful
routine procedure in the immediate postoperative period of cardiac
surgery. Copyright © The Author(s) 2025. This article is
distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 License
(https://creativecommons.org/licenses/by-nc/4.0/) which permits
non-commercial use, reproduction and distribution of the work without
further permission provided the original work is attributed as specified
on the SAGE and Open Access pages
(https://us.sagepub.com/en-us/nam/open-access-at-sage).

<3>
Accession Number
2040744287
Title
Effects of Intraoperative Ventilation Strategies on Ventilation
Inhomogeneity and Inflammatory Response in Pediatric Cardiac Surgery-A
Randomized Pilot Study.
Source
Paediatric Anaesthesia. 36(1) (pp 88-99), 2026. Date of Publication: 01
Jan 2026.
Author
Billstein C.; Schenk A.; Vergnat M.; Jakobs P.; Frede S.; Putensen C.P.;
Muders T.; Schindler E.
Institution
(Billstein, Jakobs, Frede, Putensen, Muders, Schindler) Department of
Anesthesiology and Intensive Care Medicine, University Hospital Bonn,
Bonn, Germany
(Schenk) Institute of Medical Biometry, Informatics and Epidemiology,
University Hospital Bonn, Bonn, Germany
(Vergnat) Department of Pediatric Cardiac Surgery, University Hospital
Bonn, Bonn, Germany
Publisher
John Wiley and Sons Inc
Abstract
Background: Respiratory arrest during cardiopulmonary bypass (CPB) in
pediatric cardiac surgery risks lung dysfunction including derecruitment,
atelectasis, and inflammation. Continuous positive airway pressure (CPAP)
and lung-protective ventilation (LPV) during aortic cross-clamping show
inconsistent results in mitigating these risks. Aim(s): To
investigate whether LPV during aortic cross-clamping under CPB affects
postoperative respiratory mechanics and ventilation inhomogeneity compared
to apnea or CPAP. Method(s): This prospective, randomized pilot study
compared three ventilation strategies during aortic cross-clamping under
CPB: apnea, CPAP (5 mbar), and LPV. LPV was standardized using
pressure-controlled ventilation at a positive end-expiratory pressure of 5
mbar, individualized driving pressure (20% of the pre-cross clamp
inspiratory pressure), and age-adjusted respiratory rate. Recruitment
maneuvers were applied at the end of CPB. Respiratory mechanics were
assessed. Ventilation distribution was measured preoperatively and
postoperatively under spontaneous breathing and mechanical ventilation
using Electrical Impedance Tomography. Blood was analyzed pre- and
postoperatively for pulmonary and systemic inflammatory markers.
Feasibility of LPV was assessed. Statistical analysis used linear
mixed-effects models. Result(s): Driving pressure increased (11.8
(2.6) to 12.9 (2.6) mbar) and dynamic compliance decreased (9.9 (7.3) to
8.5 (7.4) Pa L-1) statistically significantly preoperatively to
postoperatively. The number of ventilated pixels increased statistically
significantly from spontaneous breathing (408.2 (77.2)) to mechanical
ventilation (495.1 (44.9)) and returned toward baseline postoperatively
(433.9 (72.6)). The Center of Ventilation shifted statistically
significantly ventrally during mechanical ventilation (0.491 (0.039) to
0.442 (0.027)) and normalized afterward (0.485 (0.037)). These changes
were unaffected by the ventilation strategy. Biomarker analysis showed no
statistically significant changes between groups. LPV during aortic
cross-clamping was feasible. Conclusion(s): In this pilot study,
ventilation strategies did not differ in their effect on ventilation
distribution, respiratory mechanics, or inflammatory markers when
recruitment maneuvers were uniformly applied after CPB. LPV was feasible.
Trial Registration: German Clinical Trials Register: DRKS00030219;
https://drks.de/search/de/trial/DRKS00030219. Copyright © 2025
The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.

<4>
Accession Number
2034669239
Title
European Stroke Organisation (ESO) and European Association of
Neurosurgical Societies (EANS) guideline on stroke due to spontaneous
intracerebral haemorrhage.
Source
European Stroke Journal. 10(4) (pp 1007-1086), 2025. Date of Publication:
01 Dec 2025.
Author
Steiner T.; Purrucker J.C.; Aguiar de Sousa D.; Apostolaki-Hansson T.;
Beck J.; Christensen H.; Cordonnier C.; Downer M.B.; Eilertsen H.; Gartly
R.; Gerner S.T.; Ho L.; Holt Jahr S.; Klijn C.J.M.; Martinez-Majander N.;
Orav K.; Petersson J.; Raabe A.; Sandset E.C.; Schreuder F.H.; Seiffge D.;
Al-Shahi Salman R.
Institution
(Steiner) Department of Neurology, Varisano Klinikum Frankfurt, Frankfurt,
Germany
(Steiner, Purrucker) Department of Neurology, Heidelberg University
Hospital, Heidelberg, Germany
(Aguiar de Sousa) Stroke Center, Lisbon Central University Hospital, ULS
Sao Jose, Lisbon, Portugal
(Aguiar de Sousa) Faculdade de Medicina, Universidade de Lisboa, Lisbon,
Portugal
(Aguiar de Sousa) Gulbenkian Institute for Molecular Medicine, Lisbon,
Portugal
(Apostolaki-Hansson) Department of Neurology, Skane University Hospital,
Malmo, Sweden
(Beck) Department of Neurosurgery, Medical Center, University of Freiburg,
Freiburg, Germany
(Christensen) Copenhagen University Hospital, Bispebjerg, Denmark
(Cordonnier) University of Lille, Inserm, CHU Lille, LilNCog - Lille
Neuroscience and Cognition, Lille, France
(Downer) Wolfson Centre for Prevention of Stroke and Dementia, Nuffield
Department of Clinical Neurosciences, University of Oxford, Oxford, United
Kingdom
(Downer) Faculty of Medicine, Memorial University of Newfoundland, St.
John's, Canada
(Eilertsen) Institute of Clinical Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Eilertsen) Department of Geriatric Medicine Oslo University Hospital,
Oslo, Norway
(Gartly) School of Medicine, Dentistry & Nursing, University of Glasgow,
Glasgow, United Kingdom
(Gerner) Department of Neurology, University Hospital Erlangen, Erlangen,
Germany
(Ho) European Stroke Organisation, Basel, Switzerland
(Ho) Advanced Care Research Centre, University of Edinburgh, Edinburgh,
United Kingdom
(Holt Jahr) Department of Neurology, Akershus University Hospital,
Lorenskog, Norway
(Klijn, Schreuder) Department of Neurology, Donders Institute for Brain,
Cognition and Behaviour, Radboud University Medical Centre, Nijmegen,
Netherlands
(Martinez-Majander) Department of Neurology, Helsinki University Hospital,
Helsinki, Finland
(Orav) Department of Neurology, North Estonia Medical Centre, Tallinn,
Estonia
(Petersson) Region Skane, Malmo & Department of Neurology, Lund
University, Lund, Sweden
(Raabe) University Department of Neurosurgery, Inselspital, Bern,
Switzerland
(Sandset) University of Oslo, Institute of Clinical Medicine, Department
of Neurology, Oslo, Norway
(Seiffge) Department of Neurology, Inselspital University Hospital and
University of Bern, Bern, Switzerland
(Al-Shahi Salman) Centre for Clinical Brain Sciences, The University of
Edinburgh, Edinburgh, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Spontaneous (non-traumatic) intracerebral haemorrhage (ICH) affects ~3.4
million people worldwide each year, causing ~2.8 million deaths. Many
randomised controlled trials and high-quality observational studies have
added to the evidence base for the management of people with ICH since the
last European Stroke Organisation (ESO) guidelines for the management of
spontaneous ICH were published in 2014, so we updated the ESO guideline.
This guideline update was guided by the European Stroke Organisation (ESO)
standard operating procedures for guidelines and the Grading of
Recommendations, Assessment, Development and Evaluation (GRADE) framework,
in collaboration with the European Association of Neurosurgical Societies
(EANS). We identified 37 Population, Intervention, Comparator, Outcome
(PICO) questions and prioritised clinical outcomes. We conducted
systematic literature searches, tailored to each PICO, seeking randomised
controlled trials (RCT) - or observational studies when RCTs were not
appropriate, or not available - that investigated interventions to improve
clinical outcomes. A group of co-authors allocated to each PICO screened
titles, abstracts, and full texts and extracted data from included
studies. A methodologist conducted study-level meta-analyses and created
summaries of findings tables. The same group of co-authors graded the
quality of evidence, and drafted recommendations that were reviewed,
revised and approved by the entire group. When there was insufficient
evidence to make a recommendation, each group of co-authors drafted an
expert consensus statement, which was reviewed, revised and voted on by
the entire group. The systematic literature search revealed 115,647
articles. We included 208 studies. We found strong evidence for treatment
of people with ICH on organised stroke units, and secondary prevention of
stroke with blood pressure lowering. We found weak evidence for scores for
predicting macrovascular causes underlying ICH; acute blood pressure
lowering; open surgery via craniotomy for supratentorial ICH; minimally
invasive surgery for supratentorial ICH; decompressive surgery for deep
supratentorial ICH; evacuation of cerebellar ICH > 15 mL; external
ventricular drainage with intraventricular thrombolysis for
intraventricular extension; minimally invasive surgical evacuation of
intraventricular blood; intermittent pneumatic compression to prevent
proximal deep vein thrombosis; antiplatelet therapy for a licensed
indication for secondary prevention; and applying a care bundle. We found
strong evidence against anti-inflammatory drug use outside of clinical
trials. We found weak evidence against routine use of rFVIIa, platelet
transfusions for antiplatelet-associated ICH, general policies that limit
treatment within 24 h of ICH onset, temperature and glucose management as
single measures (outside of care bundles), prophylactic anti-seizures
medicines, and prophylactic use of temperature-lowering measures,
prokinetic anti-emetics, and/or antibiotics. New evidence about the
management of ICH has emerged since 2014, enabling this update of the ESO
guideline to provide new recommendations and consensus statements.
Although we made strong recommendations for and against a few
interventions, we were only able to make weak recommendations for and
against many others, or produce consensus statements where the evidence
was insufficient to guide clinical decisions. Although progress has been
made, many interventions still require definitive, high-quality evidence,
underpinning the need for embedding clinical trials in routine clinical
practice for ICH. Copyright © European Stroke Organisation 2025

<5>
Accession Number
2036240252
Title
Optimizing left ventricular assist device speed: a systematic review for
the heart failure clinician.
Source
Future Cardiology. 21(11) (pp 979-986), 2025. Date of Publication: 2025.
Author
Jimenez Y.; Tsai C.; Mrizigue F.; Ahmed M.M.
Institution
(Jimenez, Tsai, Ahmed) Division of Cardiovascular Medicine, University of
Florida, Gainesville, FL, United States
(Mrizigue) Department of Neuroscience, University of Washington, Seattle,
WA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Left ventricular assist devices have been demonstrated to
improve both quality of life and improve survival in patients with
end-stage heart failure. Ideal speed setting of these devices is necessary
to provide adequate left ventricular unloading while not disadvantaging
the right heart. This highlights the potential utility of speed titration
studies. Method(s): PubMed, Scopus, and the Cumulative Index to
Nursing and Allied Health Literature databases were searched for: (LVAD)
OR (Left Ventricular Assist Device) OR (VAD) OR (Ventricular Assist
Device) AND (Speed Optimization) OR (Ramp Study) from inception to April
2025. Result(s): 22 studies with 749 total patients were included,
45% of whom had a Heart Mate 3. Outcomes of interest included mortality,
readmission, RV function, speed change at conclusion of the study, and
quality of life. Only 1 out of 22 studies reported all 5 outcomes, with
64% reporting 2 or fewer outcomes of interest. Conclusion(s): There
exists limited data on speed optimization in the HM3, and that which has
been reported lacks a standardization regarding method of evaluation as
well as outcomes reporting. Prospective studies, with a standard method of
speed optimization and more detailed outcomes reporting, are necessary in
order to define best practices. Copyright © 2025 Informa UK
Limited, trading as Taylor & Francis Group.

<6>
Accession Number
2041683394
Title
The Effect of Landiolol in Patients With Critical Illness: A Systematic
Review and Meta-Analysis.
Source
International Journal of Clinical Practice. 2025(1) (no pagination), 2025.
Article Number: 8739008. Date of Publication: 2025.
Author
Kuang H.; Zhu J.Q.; Xie Y.Q.; Zhu Y.; Luo X.
Institution
(Kuang, Zhu, Xie, Zhu, Luo) Department of Intensive Care Unit, Guangzhou
Red Cross Hospital, Jinan University, Guangdong, Guangzhou, China
Publisher
John Wiley and Sons Ltd
Abstract
Background: Patients with critical illnesses frequently experience
tachyarrhythmias as a result of excessive sympathetic hyperactivity and
high levels of inflammatory cytokines. Ultrashort-acting beta-blockers
like landiolol are commonly utilized in intensive care units (ICUs)
because of their unique features. Method(s): Electronic databases
(Cochrane Library, PubMed, Web of Science, and Embase) were searched for
randomized controlled trials (RCTs) from inception to September 1, 2025
assessing the efficacy of landiolol in critically ill patients. The
primary outcome was new-onset arrhythmias. All-cause mortality, heart rate
(HR), length of ICU and hospital stay, and need for norepinephrine
following landiolol therapy were the secondary outcomes. Trial sequential
analysis (TSA) was performed to further evaluate the robustness of
findings. The quality of evidence was evaluated through the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) method.
 Result(s): Nine studies totaling 836 patients were included. Overall,
our meta-analysis exhibited that landiolol might considerably lower the
incidence of new-onset arrhythmias when compared to the control treatment
(9 studies [836 patients]; odds ratio [OR], 0.44; 95% confidence interval
[CI] 0.23 to 0.82; p = 0.01), and TSA agreed with this finding. We also
observed that landiolol could reduce HR (mean difference [MD], -6.41, 95%
CI, -8.63 to -4.18, p < 0.001). However, there was no considerable
decrease in requirement of norepinephrine dose (MD, 0.04, 95% CI, -0.01 to
0.09, p = 0.11), length of hospital stay (MD, -0.87, 95% CI, -7.40 to
5.65, p = 0.79), or all-cause mortality (OR, 1.10, 95% CI, 0.62 to 1.96, p
= 0.75). Additionally, the length of ICU stay in the landiolol group was
longer than that in the control group (MD, 0.19; 95% CI 0.01 to 0.37; p =
0.03). Conclusion(s): New-onset arrhythmias and HR were significantly
reduced in critical illness patients receiving landiolol. Copyright
© 2025 Huanming Kuang et al. International Journal of Clinical
Practice published by John Wiley & Sons Ltd.

<7>
Accession Number
2041645909
Title
Cardiac Angiosarcoma With Lung Metastasis Presenting as Granuloma-Like
Lesions: One Case Report and Literature Review.
Source
Respirology Case Reports. 13(12) (no pagination), 2025. Article Number:
e70426. Date of Publication: 01 Dec 2025.
Author
Mao W.; Chen X.; Xu J.; Xie L.; Wu X.; Chen L.; Song Y.; She J.
Institution
(Mao, Chen, Xu, Xie, Wu, Song, She) Department of Respiratory and Critical
Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
(Chen) Department of Pathology, Zhongshan Hospital, Fudan University,
Shanghai, China
Publisher
John Wiley and Sons Inc
Abstract
Metastatic pulmonary angiosarcoma exhibits highly heterogeneous clinical,
imaging and pathological features, with an extremely poor prognosis. This
case report describes a 30-year-old woman who presented with recurrent
hemoptysis and multiple pulmonary nodules with exudative changes in the
lung, pathologically resembling granulomatous lesions and eventually
confirmed as primary cardiac angiosarcoma with pulmonary metastasis.
Twenty-two cases of metastatic pulmonary angiosarcoma from the literature
were reviewed. For cases with recurrent hemoptysis, multiple pulmonary
nodules or thin-walled cysts and 'halo sign' or ground-glass opacities,
metastatic pulmonary angiosarcoma should be highly suspected.
Histopathology remains the gold standard for diagnosis. Early biopsies or
small biopsy specimens carry a risk of false negativity; adequate tissue
samplings are essential to improve diagnostic accuracy. Copyright
© 2025 The Author(s). Respirology Case Reports published by John
Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of
Respirology.

<8>
Accession Number
2036046527
Title
beta-blocker and clinical outcomes in patients after myocardial
infarction: a systematic review and meta-analysis.
Source
European Journal of Clinical Pharmacology. 81(12) (pp 1807-1817), 2025.
Date of Publication: 01 Dec 2025.
Author
Yang W.; Sun X.; Zhang Y.; Lu Z.; Shu Z.; Zhang K.
Institution
(Yang) Department of Physiology, West China School of Basic Medical
Sciences & Forensic Medicine, Sichuan University, Chengdu, China
(Sun, Zhang, Lu, Shu, Zhang) Department of Forensic Pathology, West China
School of Basic Medical Sciences & Forensic Medicine, Sichuan University,
Chengdu, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background and objective: While current clinical guidelines generally
advocate for beta-blocker therapy following acute myocardial infarction
(AMI), conflicting findings have surfaced through large-scale
observational studies and meta-analyses. We conducted this systematic
review and meta-analysis of published observational studies to quantify
the long-term therapeutic impact of beta-blocker across heterogeneous AMI
populations. Method(s): We conducted comprehensive searches of the
PubMed, Embase, Cochrane, and Web of Science databases for articles
published from 2000 to 2025 that examine the link between beta-blocker
therapy and clinical outcomes (last search update: March 1, 2025). We used
the odds ratio (OR) with its 95% confidence interval (95% CI) to evaluate
the effect of beta-blocker therapy on all-cause mortality, cardiac death,
or major adverse cardiac events (MACE) in AMI patients. Our analysis
stratified these effects by study type, ejection fraction (EF), sample
size, follow-up duration, and patient characteristics including primary
coronary revascularization, ST-segment elevation status, and
comorbidities. Result(s): This meta-analysis incorporated 34
observational studies covering 233,303 AMI patients. Our results showed
beta-blockers reduced all-cause (OR = 0.73, 95% CI = 0.64-0.82) and
cardiac mortality (OR = 0.79, 95% CI = 0.70-0.89) in post-AMI patients,
with no significant effect on MACE. In these patients, post-PCI and STEMI
patients, beta-blockers lowered all-cause mortality but not MACE risk.
Subgroup analysis revealed that beta-blockers decreased all-cause death in
post-AMI patients with diabetes and COPD, but not in those with
hypertension and AF. Stratified by EF, beta-blockers were beneficial for
all-cause death (OR = 0.75, 95% CI = 0.60-0.93), cardiac death (OR = 0.72,
95% CI = 0.56-0.92), and MACE (OR = 0.85, 95% CI = 0.76-0.96) in post-AMI
patients with reduced EF and only decreased all-cause death in those with
preserved EF. Conclusion(s): Our meta-analysis suggests beta-blockers
may offer long-term clinical benefits to AMI patients, particularly those
with reduced EF. However, this is not conclusive for AMI patients with
comorbidities or preserved EF. Copyright © The Author(s), under
exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature
2025.

<9>
Accession Number
2040515803
Title
Contemporary Outcomes of Ventricular Tachycardia Ablation in Left
Ventricular Assist Device Therapy: A Meta-Analysis.
Source
Journal of Cardiovascular Electrophysiology. 36(12) (pp 3270-3285), 2025.
Date of Publication: 01 Dec 2025.
Author
Barrera N.; Kushnir Y.; Solorzano M.; Gallegos-Koyner F.; Lynch P.T.;
Queiroga F.; Giorgi J.; Brigido A.R.D.; de Carvalho G.D.; Chelu M.G.;
Colombo P.C.; D'Avila A.
Institution
(Barrera, Colombo) Division of Cardiology, Columbia University College of
Physicians and Surgeons, New York Presbyterian Hospital, New York, NY,
United States
(Kushnir, Solorzano, Gallegos-Koyner) Department of Medicine, SBH Health
System, New York, NY, United States
(Lynch, Chelu) Department of Medicine (Division of Cardiology), Baylor
College of Medicine, Houston, TX, United States
(Queiroga) Deparment of Medicine, Emory University School of Medicine,
Atlanta, GA, United States
(Giorgi) Division of Cardiology, Sirio Libanes Hospital, Sao Paulo, Sao
Paulo, Brazil
(Brigido) Division of Cardiology, Heart Institute (InCor), Hospital das
Clinicas, Faculty of Medicine, Sao Paulo, Sao Paulo, Brazil
(de Carvalho) Division of Cardiac Arrhythmias and Electrophysiology, Dante
Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Chelu) Cardiovascular Research Institute, Houston, TX, United States
(Chelu) Division of Cardiology, Texas Heart Institute at Baylor College of
Medicine and Baylor St. Luke's Medical Center, Houston, TX, United States
(D'Avila) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background and Objective: Ventricular arrhythmias (VAs) remain a pervasive
and deadly arrhythmia in patients with left ventricular assist devices
(LVADs). Catheter ablation has emerged as a treatment option for
refractory VAs, yet evidence in the era of the HeartMate 3 (HM3) remains
limited. This review aims to synthesize contemporary evidence for VA
ablation in LVAD recipients. Method(s): A systematic review was
performed across major electronic databases. The primary efficacy outcome
was the recurrence of ventricular tachycardia (VT), and the primary safety
outcome was the rate of procedural complications. The secondary outcomes
were inability to induce any VT, all-cause mortality at 12 months,
orthotropic heart transplantation (OHT). Sub-analyses were performed for
patients with HM3 LVADs. Result(s): Twenty-seven studies encompassing
300 LVAD recipients undergoing 325 VT ablations, after a mean follow-up of
327 +/- 175 days post VT ablation, VT recurred in 38% (95% CI, 28% to 49%)
of cases and the complication rate was 8% (95% CI, 1.6% to 15.7%). VT was
non-inducible in 61% of cases. One-year all-cause mortality was 26%, and
16% had OHT. Among HM3 recipients, electromagnetic interference (EMI)
occurred in 51%, and no cases of device thrombosis were reported; one
stroke was observed. Conclusion(s): Catheter ablation is a safe and
feasible treatment for refractory VAs in LVAD patients as evidenced by low
complication rates and reasonable acute success. Yet, the persistence of
considerable VT recurrence and all-cause mortality reflects the clinical
complexity of this population. Procedural challenges include mapping
limitations caused by EMI, particularly in the HM3 era. Copyright
© 2025 Wiley Periodicals LLC.

<10>
Accession Number
2041714445
Title
Cerebral Embolic Protection Devices for the Prevention of Stroke in
Patients Undergoing Transcatheter Aortic Valve Implantation: An Updated
Meta-Analysis of Randomized Controlled Trials.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Nazmy A.; Sobhy A.; Elshahat A.; Abdelaziz A.; Makhlouf E.; El-Nemr A.F.;
Hassanin M.S.; Atta K.; Shaban A.Y.; Nazmy M.; Kharbanda R.K.; Abdelazeem
B.; Mamas M.A.
Institution
(Nazmy, Sobhy, Elshahat, Abdelaziz, Makhlouf, El-Nemr, Hassanin, Atta,
Shaban, Nazmy, Abdelazeem) Medical Research Group of Egypt (MRGE), Negida
Academy, Arlington, MA, United States
(Nazmy, Sobhy, Nazmy) Faculty of Medicine, Kafr-Elsheikh University,
Kafr-Elsheikh, Egypt
(Elshahat, El-Nemr, Hassanin) Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
(Abdelaziz) Division of Cardiology, Montefiore Health System/Albert
Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United
States
(Makhlouf) Department of Cardiology, Faculty of Medicine, Minia
University, Minia, Egypt
(Atta) Institute of Medicine, National Research Mordovia State University,
Saransk, Russian Federation
(Shaban) Department of Hematology and Oncology, Mayo Clinic, Rochester,
MN, United States
(Kharbanda) Division of Cardiovascular Medicine, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Abdelazeem) Department of Cardiology, West Virginia University,
Morgantown, WV, United States
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute of Primary Care and Health Sciences, Keele University,
Stoke-on-Trent, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Stroke remains one of the most devastating complications following
transcatheter aortic valve implantation (TAVI). Although cerebral embolic
protection devices (CEPDs) have emerged to mitigate patients' risks, their
impact on stroke risk, as well as other clinical and neurocognitive
outcomes after TAVI, remains uncertain. We aimed to assess whether CEPDs
alleviate stroke risks and neurocognitive outcomes after TAVI. We
systematically searched MEDLINE, Scopus, Web of Science (WOS), and the
Cochrane CENTRAL from inception until May 2025. We included randomized
controlled trials (RCTs) that assessed the effectiveness of CEPD compared
to the control group (no CEPD) in adult patients (> 18 years) undergoing
TAVI. The primary endpoint was the incidence of all-cause stroke. In
contrast, the secondary endpoints included disabling stroke, systemic
bleeding, transient ischemic attack (TIA), and major adverse
cardiovascular and cerebrovascular events (MACCE). Additionally, we
assessed neurological outcomes, including changes in the Montreal
Cognitive Assessment (MoCA) score, the National Institutes of Health
Stroke Scale (NIHSS) score, and the presence of new ischemic lesions. Nine
RCTs comprising 11,696 patients were included in the final analysis. The
use of CEPDs showed no statistical difference in reducing all-cause stroke
compared to the control group (OR = 0.91, 95% CI [0.73-1.15], p = 0.44).
Additionally, there was no significant difference in other studies'
secondary outcomes, including disabling stroke, MACCE, systemic bleeding,
or neurological outcomes, such as worsening NISSS, decline in MoCA score,
and the presence of new ischemic lesions. The use of CEPD during TAVI
showed no benefit in reducing the risks of all-cause stroke and other
neurological outcomes studied. Copyright © 2025 Wiley Periodicals
LLC.

<11>
Accession Number
2035689837
Title
On-Table Extubation After Pediatric Cardiac Surgery: A Systematic Review.
Source
Paediatric Anaesthesia. 36(1) (pp 5-20), 2026. Date of Publication: 01 Jan
2026.
Author
Tapioca V.; Caetano L.; Gibicoski T.; Alrayashi W.; Amaral S.
Institution
(Tapioca) Department of Medicine, Bahiana School of Medicine and Public
Health, Salvador, Brazil
(Caetano) Department of Medicine, Federal University of Paraiba, Joao
Pessoa, Brazil
(Gibicoski) Department of Medicine, Federal University of Health Sciences
of Porto Alegre, Porto Alegre, Brazil
(Alrayashi) Department of Anesthesiology, Harvard Medical School, Boston,
MA, United States
(Amaral) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
Publisher
John Wiley and Sons Inc
Abstract
Context: On-table extubation after pediatric cardiac surgery has been
increasingly considered a safe and effective strategy to reduce
postoperative ventilation time. However, concerns regarding reintubation
risk, patient selection, and variability in outcomes remain.
 Objective(s): To systematically review the available literature on
the effectiveness and safety of on-table extubation compared to off-table
extubation in pediatric cardiac surgery. Primary outcomes were
reintubation rate, mortality, intensive care unit (ICU) and hospital
length of stay (LOS). Secondary outcomes were arterial pH, lactate, and
PaCO<inf>2</inf> after surgery. Data Sources: MEDLINE, Cochrane
Library, Web of Science, and Embase were searched from inception to
January 8th, 2025, without language or date restrictions. Additional
studies were identified through the backward snowballing technique. Study
Selection: We included randomized controlled trials (RCTs) and
observational studies comparing on-table and off-table extubation in
pediatric patients (< 18 years) undergoing cardiovascular surgery. Studies
with overlapping populations or conference abstracts were excluded.
 Data Extraction: Two independent reviewers screened studies completed
a quality assessment, and extracted data. Result(s): Twenty-nine
studies (2 RCTs, 27 observational), including 9070 patients, met the
eligibility criteria. On-table extubation was associated with lower
reintubation rates in most studies, though findings were not consistent
across all. Mortality rates were generally comparable between groups. ICU
and hospital LOS were consistently shorter in the on-table group.
Postoperative blood gas analyses showed a better arterial pH, lactate, and
PaCO<inf>2</inf> profile in the on-table group. The risk of bias was
elevated between observational studies. Limitation(s): Selection bias
was present, as the majority of studies were observational, and the
decision for on-table extubation was largely based on clinician assessment
of suitability and stability at the end of surgery. High heterogeneity
across studies limited meta-analysis feasibility. Conclusion(s):
Although this systematic review suggests that on-table extubation may be
associated with potentially better outcomes following pediatric cardiac
surgery, no safe conclusions can be drawn about its benefit due to the
high heterogeneity and potential high risk of bias of most included
studies. Well-designed RCTs are needed to confirm the benefits and safety
of on-table extubation and to guide appropriate patient selection. Trial
Registration: International Prospective Register of Systematic Reviews
(PROSPERO): CRD42025644238. Copyright © 2025 John Wiley & Sons
Ltd.

<12>
Accession Number
2036779394
Title
Critique on "Efficacy of Cerebral Embolic Protection Device in
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis".
Source
Catheterization and Cardiovascular Interventions. 106(7) (pp 3572-3573),
2025. Date of Publication: 01 Dec 2025.
Author
Azmat W.
Institution
(Azmat) Fatima Jinnah Medical University, Lahore, Pakistan
Publisher
John Wiley and Sons Inc

<13>
Accession Number
2041621246
Title
I want to get better; I don't want to just stay at home: a theory-driven
qualitative exploration of participation in a home-based lung cancer
exercise clinical trial.
Source
Supportive Care in Cancer. 34(1) (no pagination), 2026. Article Number: 2.
Date of Publication: 01 Jan 2026.
Author
Whish-Wilson G.A.; Edbrooke L.; Krishnasamy M.; Visentin E.; Kinnersly E.;
Mitchell R.; Granger C.L.; Parry S.M.
Institution
(Whish-Wilson, Edbrooke, Visentin, Kinnersly, Granger, Parry) Department
of Physiotherapy, School of Health Sciences, The University of Melbourne,
161 Barry Street, Parkville, VIC, Australia
(Edbrooke, Krishnasamy) Department of Health Services Research, Peter
MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, Australia
(Krishnasamy) Department of Nursing, School of Health Sciences, The
University of Melbourne, 161 Barry Street, Parkville, VIC, Australia
(Visentin, Kinnersly, Mitchell, Granger, Parry) Department of
Physiotherapy, The Royal Melbourne Hospital, 300 Grattan Street,
Parkville, VIC, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: We conducted a multi-site randomised controlled trial (RCT) of
home-based exercise and self-management for patients after lung cancer
surgery, which improved the intervention group's exercise capacity and
self-efficacy and objectively measured physical function. We conducted
this qualitative evaluation of the RCT to explore participants'
experiences of the program and understand factors influencing
participation, behaviour change, and acceptability. Method(s): A
qualitative study nested within an RCT (ACTRN12617001283369), informed by
the Theoretical Domains Framework (TDF) and Theoretical Framework of
Acceptability (TFA). The intervention group participated in a 12-week
postoperative remotely delivered exercise and self-management program.
Following intervention maturation, consecutive intervention participants
participated in individual, semi-structured telephone interviews at
program discharge. Interviews were audio recorded, transcribed verbatim,
cross-checked, and analysed using directed content analysis.
 Result(s): Twenty-one participants took part in interviews (88% of
those approached). Thirty-three themes were developed from the qualitative
data and mapped to TDF and TFA domains. Key TDF domains driving behaviour
change included reinforcement, skills, and social influences. Examples of
exercise enablers included regular physiotherapy phone consultations and
activity tracking tools. Barriers to exercise included symptoms, poor
weather, and competing priorities. Perceived effectiveness was a key TFA
domain driving intervention acceptability. Most participants felt the
program improved their physical health, exercise self-efficacy and
capacity, and physical activity levels. Minor areas for improving
acceptability included increased flexibility/tailoring and exercise
supervision/demonstration. Conclusion(s): The program was acceptable
to participants and facilitated meaningful behaviour change. Qualitative
findings aligned with quantitative RCT findings, particularly regarding
improvements to exercise self-efficacy and capacity at program discharge.
Trial registration: Australian New Zealand Clinical Trials Registry
(http://anzctr.org.au). Registered on 06/09/2017.
Identifier:ACTRN12617001283369. Copyright © The Author(s), under
exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature
2025.

<14>
Accession Number
2039662921
Title
Multimodal prehabilitation as. strategy to reduce postoperative
complications in cardiac surgery.
Source
European Journal of Anaesthesiology. 42(11) (pp 987-996), 2025. Date of
Publication: 01 Nov 2025.
Author
Lopez-Hernandez A.; Gimeno-Santos E.; Navarro-Ripoll R.; Arguis M.J.;
Lopez-Baamonde M.; Sanz-de la Garza M.; Sandoval E.; Castella M.;
Martinez-Palli G.
Institution
(Lopez-Hernandez) Universitat de Barcelona, Spain
(Lopez-Hernandez, Navarro-Ripoll, Arguis, Lopez-Baamonde, Martinez-Palli)
Anaesthesiology Department
(Lopez-Hernandez, Gimeno-Santos, Navarro-Ripoll, Lopez-Baamonde)
Prehabilitation Unit, Hospital Clinic de Barcelona, Spain
(Gimeno-Santos, Arguis, Sanz-de la Garza, Sandoval, Castella,
Martinez-Palli) Fundacio de Recerca Clinic Barcelona - Institut
d'Investigacions Biomediques August Pi. Sunyer (FRCB-IDIBAPS) , Spain
(Sandoval, Castella) Cardiovascular Institute (MSdlG) and Cardiovascular
Surgery Department, Hospital Clinic de Barcelona, Barcelona, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND - Prehabilitation has shown efficacy in improving postoperative
outcomes in abdominal surgery. Data on cardiac surgery are
controversial.OBJECTIVE - To determine if. multimodal prehabilitation
programme reduces the rate of postoperative complications after elective
cardiac surgery.DESIGN - Randomised controlled trial.SETTING -
Single-centre study in. tertiary hospital with inclusion period spanned
from March 2018 to June 2021.PATIENTS - One hundred and fifty-one
patients, with an expected waiting time before surgery of 6 weeks or more,
completed the study. Excluded were those with functional, anatomical or
cognitive impairment; cardiac instability; dynamic left ventricle outflow
tract obstruction or proven exercise-induced arrhythmias.INTERVENTION -
Four to six weeks of. multimodal prehabilitation programme, including
exercise training, psychological and nutritional support.MAIN OUTCOME -
Incidence of postoperative complications.RESULTS - No differences were
found in the rate of postoperative complications (80% in both groups, P =
0.968), most of which were mild, with. Comprehensive Complication Index of
21 and more than 70% with Clavien-Dindo grade. or II. Prehabilitated
patients showed. significant improvement in endurance time assessed by.
constant-work rate cycling exercise test: preintervention vs.
postintervention (301 +/- 109 vs. 578 +/- 257 s, P = 0.001), and in 6-min
walk test (6MWT) (487 +/- 77 vs. 504 +/- 74 min, P = 0.001). No patients
experienced adverse events attributable to the intervention.. sub-analysis
restricted to prehabilitated patients who showed. meaningful response to
exercise assessed by the 6MWT (increase >= 30 m) showed. reduction in the
number and severity of postoperative complications, compared to
nonresponders (1.1 +/- 0.9 vs. 2 +/- 2 complications per patient, P =
0.038); and the Comprehensive Complication Index (16 +/- 15 vs. 25 +/- 19,
P = 0.044).CONCLUSION -. multimodal prehabilitation programme before
elective cardiac surgery did not reduce the incidence of postoperative
complications. Nevertheless, when analysis was restricted to meaningful
responders to intervention,. significant reduction in postoperative
complications and their severity was observed.TRIAL REGISTRATION -
ClinicalTrials.gov (NCT03466606). Copyright © 2025 European
Society of Anaesthesiology and Intensive Care. Unauthorized reproduction
of this article is prohibited.

<15>
Accession Number
2041629413
Title
Assessing the timing of invasive intervention in NSTE-ACS: insights from a
meta-analysis and sequential trial evaluation.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1712137. Date of Publication: 2025.
Author
Yang W.; Ge X.-Z.; Wang C.-H.
Institution
(Yang, Ge) Department of Cardiology, Capital Medical University School of
Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation
Research Center, Beijing, China
(Wang) Department of Cardiology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences & Peking Union Medical College,
Beijing, China
Publisher
Frontiers Media SA
Abstract
Background: Invasive approaches are commonly recommended for treating
patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) to
lower the risk of death caused by myocardial infarction (MI). However, the
timing for implementing relevant interventions remains challenging to be
determined, largely due to poorly understanding of the long-term clinical
outcomes. Method(s): A meta analysis with trial sequential analysis
(TSA) was conducted to evaluate the impact of timing on the outcomes of
invasive interventions for NSTE-ACS patients. A comprehensive search of
PubMed and EMBASE databases identified 14 randomized controlled trials
(RCTs), encompassing 16 studies with a total of 9,436 patients, in which
two trials have additional long-term follow-up studies. Based on the
timing of catheterization, all studies were categorized into two groups:
early intervention group (median intervention time <24 h; range from
0.5-9.3 h) and delayed intervention group (median intervention time >=24
h; range from 18.3-86 h). Clinical outcomes were assessed for primary
endpoints (all-cause death or MI) and secondary endpoints (recurrent
ischemia, requiring cardiac revascularization or major bleeding)
respectively. Result(s): Early intervention did not significantly
reduce all-cause mortality or the incidence of MI compared with delayed
intervention. The frequency of revascularization and major bleeding were
also similar between the two groups. A significant reduction was observed
for the incidence of recurrent ischemia in early intervention group.
Further analyses confirmed those findings across both short-term follow-up
(30 days) and mid-to-long-term follow-up (180 days to 5 years). TSA
provided additional evidence supporting the protective benefit of early
intervention for recurrent ischemia but not for others.
 Conclusion(s): For patients with NSTE-ACS, early invasive treatment
does not reduce all-cause mortality or incidence of MI but is associated
with a lower frequency of recurrent ischemia. Copyright 2025 Yang, Ge
and Wang.

<16>
Accession Number
2037693617
Title
Similar Goals, Divergent Paths: Exploring Approaches to Hepatitis C
Treatment Protocols in Heart Transplantation.
Source
Journal of Cardiac Failure. 31(12) (pp 1795-1805), 2025. Date of
Publication: 01 Dec 2025.
Author
Rao R.A.; Abraham S.; Vest A.R.; Munnagala M.; Bhardwaj A.; Contreras J.;
Rajapreyer I.; Hall S.
Institution
(Rao) Division of Cardiovascular Medicine, Indiana University School of
Medicine, Indianapolis, IN, United States
(Abraham) Division of Cardiovascular Medicine, Feinberg School of
Medicine, Northwestern University, Chicago, IL, United States
(Vest) Division of Cardiovascular Medicine, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Munnagala) Department of Cardiology, Miller School of Medicine,
University of Miami, Miami, FL, United States
(Bhardwaj) Department of Cardiology, McGovern Medical School, University
of Texas, Texas Medical Center Houston, Houston, TX, United States
(Contreras) Department of Cardiology, Mount Sinai Medical School, New
York, NY, United States
(Rajapreyer) Department of Cardiology, Tufts Medical Center, Boston, MA,
United States
(Hall) Department of Cardiology, Baylor Scott and White Medical Center
Houston, Dallas, TX, United States
Publisher
Elsevier B.V.
Abstract
Background Heart transplantation from hepatitis C-positive donors is on
the rise, yet there exists divergence in approaches to managing recipients
of these organs. Practices range from prophylactic treatment of recipients
prior to transplantation to delayed treatment following the detection of
viremia, with no established consensus on the optimal approach. Methods An
online survey was conducted among the heart transplant centers in the
United States and Canada from January 2023-February 2024. The survey
gathered comprehensive information from the institutions regarding direct
antiviral (DAA) therapies used, timing and duration of DAA, frequency of
viral load testing, adverse effects, virological response, and
immunosuppressive therapy modifications. The treatment pathways were
categorized based on the timing of treatment initiation into prophylactic,
preemptive or reactive approaches. Analysis was restricted to adult
transplant programs in the U.S. that had an HCV transplant protocol and
performed at least 1 HCV NAT-positive transplant. The Scientific Registry
of Transplant Recipients database was queried for total heart transplants
using hepatitis C virus nucleic acid testing (HCV NAT)-positive donors.
Results Of 122 heart transplant programs, 35 (28.7%) institutions
responded; 689 heart transplants (49.1%) using HCV NAT-positive donors
were captured across institutions. Among 30 U.S. institutions performing
adult heart transplantation with HCV NAT-positive donor hearts, 5 (16.7%)
used prophylactic, 9 (30%) preemptive and 16 (53.3%) reactive treatment
pathways. Most employed pan-genotype DAA therapies for a median of 12
weeks. Significant heterogeneity existed in treatment and monitoring
protocols. Conclusion Practice patterns for management of HCV NAT-positive
donor hearts vary significantly. Establishing registries and randomized
control trials for these patients is crucial for guiding future
practices. Copyright © 2025 Elsevier Inc.

<17>
Accession Number
2040773683
Title
Perioperative plasma lidocaine concentrations and their impact on pain
control. A systematic review and meta-analysis.
Source
Pain Management. 15(12) (pp 1065-1078), 2025. Date of Publication: 2025.
Author
Foong K.W.; Lo Y.L.; Chaw S.H.; Loh P.S.
Institution
(Foong, Chaw, Loh) Department of Anaesthesiology, Faculty of Medicine,
Universiti Malaya, Kuala Lumpur, Malaysia
(Lo) Department of Pharmacy Practice, School of Pharmacy, IMU University,
Kuala Lumpur, Malaysia
Publisher
Taylor and Francis Ltd.
Abstract
Aim: To review the relationship between drug concentrations of
perioperative intravenous lidocaine and their analgesic effects.
 Method(s): We systematically searched SCOPUS, Medline, EMBASE,
CENTRAL, and Web of Science (inception to March 2024) for randomized
controlled trials comparing intraoperative lidocaine to placebo or control
in adults undergoing non-cardiac surgery. Studies reported pain outcomes
and plasma lidocaine concentrations. Bias was assessed using the Cochrane
risk-of-bias tool, and data was analyzed with a random-effects model to
determine mean difference (MD) and 95% confidence intervals (CI).
 Result(s): Fifteen studies (445 lidocaine, 453 control patients) were
included. Lidocaine lowered post-anesthetic care unit (PACU) opioid use (8
studies, MD: -3.00, 95% CI [-5.00, -1.01], p = 0.0092, I2 =
57%), with meta-regression indicating greater reduction at higher plasma
concentrations (regression coefficient: -3.05, 95% CI [-4.48, -1.61], p =
0.002). However, 11 studies found no significant difference in 24-hour
postoperative opioid consumption or pain scores. Nausea and vomiting
incidence were similar between groups, and a few patients experienced
lidocaine-related adverse events. Conclusion(s): Perioperative
lidocaine infusion reduces PACU opioid consumption, with greater effects
at higher concentrations, although significant heterogeneity was noted.
Further research is needed to identify optimal concentrations for
clinically significant analgesic benefits. Protocol Registration:
International Platform of Registered Systematic Review and Meta-analysis
Protocols (INPLASY) ID: INPLASY202180046, DOI:
10.37766/inplasy2021.8.0046. Copyright © 2025 Informa UK Limited,
trading as Taylor & Francis Group.

<18>
Accession Number
2040486115
Title
On Table Extubation After Heart Surgery in Children, Infants and Neonates.
Source
Paediatric Anaesthesia. 36(1) (pp 3-4), 2026. Date of Publication: 01 Jan
2026.
Author
Arnold P.; Murphy T.
Institution
(Arnold) Jackson Rees Department of Paediatric Anaesthesia, Alder Hey
Children Hospital, Liverpool, United Kingdom
(Murphy) Bristol Royal Hospital for Children, Bristol, United Kingdom
Publisher
John Wiley and Sons Inc

<19>
Accession Number
2040691375
Title
Sentinel Cerebral Protection System in TAVI: An Updated Meta-Analysis of
Randomized and Propensity-Matched Studies.
Source
Catheterization and Cardiovascular Interventions. 106(7) (pp 3919-3927),
2025. Date of Publication: 01 Dec 2025.
Author
Braite M.; Portilho N.D.P.; Lara L.B.D.S.M.C.; Cavalcante D.V.S.; Scheffer
E.C.; Machado M.F.; Neto I.Q.C.; Barbosa E.R.F.; Tarantini G.
Institution
(Braite) Hospital of Love, Sao Paulo, Barretos, Brazil
(Portilho) Federal District Military Firefighter Brigade, Distrito
Federal, Brasilia, Brazil
(Lara) IDOMED-Instituto de Educacao Medica, Rio de janeiro, Brazil
(Cavalcante) University of North Texas Health Science Center, Fort Worth,
TX, United States
(Scheffer) EMESCAM-Escola Superior de Ciencias da Santa Casa de
Misericordia de Vitoria, Espirito Santo, Brazil
(Machado) UNIFIPMOC-Faculdades Integradas Pitagoras de Montes Claros,
Minas Gerais, Brazil
(Neto) Department of Radiology, University of Wisconsin-Madison, Madison,
WI, United States
(Barbosa) Military Police of Goias State, Valparaiso de Goias, Brazil
(Tarantini) Department of Cardiac, Thoracic and Vascular Sciences and
Public Health, University of Padova, Padova, Italy
Publisher
John Wiley and Sons Inc
Abstract
Backgrounds: Stroke remains a serious complication of transcatheter aortic
valve implantation (TAVI). The Sentinel cerebral embolic protection (CEP)
system is designed to mitigate this risk by capturing embolic debris, but
its clinical benefit remains uncertain. Aim(s): This meta-analysis
evaluated the impact of Sentinel CEP on stroke and related outcomes in
TAVI. Method(s): PubMed, Embase, and Cochrane were searched for
randomized controlled trials (RCTs) and propensity score-matched (PSM)
studies comparing TAVI with and without Sentinel CEP. The outcomes were
periprocedural ischemic stroke, total stroke, disabling stroke, 30-day
mortality, in-hospital mortality, composite death or stroke, acute kidney
injury (AKI), and major vascular complications. Risk ratios (RRs) with 95%
confidence intervals (CIs) were pooled using a random-effects model.
 Result(s): Eight studies (five RCTs, three PSM studies) encompassing
33,111 patients were analyzed, with 50.1% receiving Sentinel. In pooled
analysis, Sentinel CEP significantly reduced 30-day mortality (RR 0.75,
95% CI 0.58-0.97; p = 0.03) and AKI (RR 0.90, 95% CI 0.82-0.98; p = 0.01).
No significant effect was observed for periprocedural ischemic stroke (RR
0.92, CI 0.79-1.07; p = 0.28), total stroke (RR 0.79, CI 0.59-1.05; p =
0.10), in-hospital mortality (RR 0.86, CI 0.57-1.31; p = 0.47), composite
death or stroke, or major vascular complications. RCT-only analyses
confirmed no significant effect on any outcome. Conclusion(s):
Sentinel CEP was associated with lower 30-day mortality and AKI in pooled
cohorts, but did not reduce stroke. The absence of benefit in RCTs
underscores the need for further studies in high-risk TAVI
populations. Copyright © 2025 Wiley Periodicals LLC.

<20>
[Use Link to view the full text]
Accession Number
2039653795
Title
Comparison of the Incidence of Arterial Pressure Line Insufficiency
Between Polyethylene and Polyurethane Catheters in the ICU: A Randomized
Study.
Source
Critical Care Medicine. 53(10) (pp e1973-e1981), 2025. Date of
Publication: 19 Nov 2025.
Author
Minami K.; Kazawa M.; Shimatani T.; Morinaga M.; Shimokawa A.; Maeda T.;
Takeuchi M.
Institution
(Minami, Kazawa, Shimatani, Takeuchi) Department of Critical Care
Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
(Morinaga, Shimokawa, Maeda) Department of Anesthesiology, National
Cerebral and Cardiovascular Center, Osaka, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: - Continuous arterial pressure monitoring is crucial for
critically ill patients. However, the impact of catheter type on arterial
line insufficiency remains unexamined. DESIGN: - Double-blinded,
superiority, randomized controlled trial. SETTING: - A cardiovascular
center in Japan. PATIENTS: - Adult patients scheduled for elective
cardiovascular surgery and postoperative admission to the ICU.
INTERVENTIONS: - Patients were randomly assigned either polyethylene or
polyurethane catheters. MEASUREMENTS AND MAIN RESULTS: - The outcome of
interest was arterial line insufficiency, defined by one or more of the
following four criteria: flattened or overdamped blood pressure waveform,
sluggish free backflow of blood (> 2 s) when the stopcock was opened to
the atmosphere, inability to draw blood from the arterial line, and
inability to flush the catheter. The frequency of arterial line
insufficiency was observed at the first noon after ICU admission. An
interim analysis using the chi-square test was performed after half of the
participants were enrolled, with early termination if p value of less than
0.005 based on the O'Brien-Fleming method. Interim analysis of 132
patients revealed significant differences in primary outcomes, leading to
early termination of the trial. Arterial line insufficiency occurred in
four of 69 patients (5.8%) with polyethylene catheters and 18 of 63
patients (28.6%) with polyurethane catheters (relative risk, 0.15; 95% CI,
0.05-0.48; p = 0.001). CONCLUSION(S): - This study demonstrated a
lower occurrence rate of arterial line insufficiency with polyethylene
arterial catheters than polyurethane catheters. Copyright © 2025

<21>
Accession Number
2042002214
Title
Five-Year Outcomes of Transcatheter Versus Surgical Aortic Valve
Replacement in Women: A Systematic Review and Meta-Analysis.
Source
European Journal of Cardio-thoracic Surgery. 67(12) (no pagination), 2025.
Article Number: ezaf400. Date of Publication: 01 Dec 2025.
Author
Wolf S.E.M.; Kucera J.A.; Gregg A.C.; Di Franco A.; Rahouma M.; Redfors
B.; Reardon M.; Pineda A.M.; Gaca J.G.; Zwischenberger B.A.
Institution
(Wolf, Kucera, Gaca, Zwischenberger) Duke University Medical Center,
Division of Cardiothoracic Surgery, Department of Surgery, Durham, NC,
United States
(Gregg, Di Franco, Rahouma, Redfors) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
(Redfors) Department of Population Health Sciences, Weill Cornell
Medicine, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Department of Molecular and Clinical Medicine, Gothenburg
University, Gothenburg, Sweden
(Reardon) Department of Cardiovascular Surgery, Houston Methodist
Hospital, Houston, TX, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives Women patients with aortic stenosis (AS) exhibit distinct
anatomic and physiologic features that may influence outcomes after valve
replacement. While transcatheter aortic valve replacement (TAVR) has shown
early advantages over surgical aortic valve replacement (SAVR) in women,
long-term sex-specific outcomes remain unclear. To evaluate outcomes at 5
years comparing TAVR versus SAVR a systematic review and meta-analysis was
performed. Methods A systematic literature review was conducted,
identifying all randomized controlled trials (RCTs) comparing TAVR with
SAVR which included women with completed 5-year follow-up. The primary
outcome was the composite of all-cause mortality or disabling stroke.
Meta-analysis was performed using both random-effects and fixed-effect
models. The study protocol was registered in PROSPERO (CRD420251004394).
Results Six RCTs were included with a total of 3094 women (1587 TAVR and
1507 SAVR). Overall, no significant difference was observed in the primary
outcome between TAVR and SAVR (incidence rate ratios [IRRs] 1.00, 95%
confidence interval [CI]: 0.88-1.13, P=.98). Meta-regression did not find
any association between key clinical covariates and the primary outcome.
Trial sequential analysis demonstrated that the extracted sample size met
the required information size, but a definitive treatment effect was not
confirmed. Conclusions While TAVR shows an advantage over SAVR at 1-year
follow-up in women, all-cause mortality or disabling stroke is similar in
TAVR and SAVR at 5 years. Future studies must include sex-disaggregated
reporting of both primary and secondary outcomes in order to
comprehensively weigh risks and benefits of each intervention and inform
personalized treatment strategies. Copyright © The Author(s)
2025. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<22>
[Use Link to view the full text]
Accession Number
2041216500
Title
Bispectral Index-Guided Anesthesia for Older Patients Having Non-Cardiac
Surgery: A Randomized Multicenter Trial.
Source
Anesthesiology. Publish Ahead of Print (no pagination), 2025. Date of
Publication: 11 Oct 2025.
Author
Zhou L.; Ding L.; Yang H.; Li C.; Yu Z.; Ma W.; Chen Q.; Zhang Y.; Mao Q.;
Cheng M.; Gong G.; Wang E.; Liu C.; Hao W.; Li H.; Chen C.; Fan Y.; Su Z.;
Cai X.; Zhang X.; Li Z.; Zhang B.; Li Y.; Jiang C.; Yin Q.; Jiao J.;
Sessler D.I.; Li Q.; Liu J.
Institution
(Zhou, Ding, Yang, Li, Ma, Yin, Li, Liu) Department of Anesthesiology,
West China Hospital, Sichuan University, Chengdu, China
(Li) Department of Clinical Research Management, West China Hospital,
Sichuan University, Chengdu, China
(Yu) Department of Bioinformatics and Biostatistics, School of Life
Sciences and Biotechnology and SJTU-Yale Joint Center for Biostatistics,
Shanghai Jiao Tong University, Shanghai, China
(Chen) Department of Anesthesiology, Dazhou Central Hospital, Dazhou,
China
(Zhang) Department of Anesthesiology, Liuzhou Worker's Hospital, The
Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
(Li) Department of Anesthesiology, the Second Clinical Medical College of
Guangzhou University of Chinese Medicine, Guangzhou, China
(Mao) Department of Anesthesiology, Army Medical Center of PLA, Chongqing,
China
(Cheng) Department of Anesthesiology, the First Affiliated Hospital of
Shantou University Medical College, Shantou, China
(Gong) Department of Anesthesiology, General Hospital of Western Theater
Command, Chengdu, China
(Wang) Department of Anesthesiology, the First Affiliated Hospital of Army
Military Medical University, Chongqing, China
(Liu, Chen) Department of Anesthesiology, First Affiliated Hospital with
Nanjing Medical University, Nanjing, China
(Hao) Department of Anesthesiology, First Affiliated Hospital of Hebei
University of Traditional Chinese Medicine, Shijiazhuang, China
(Li) Department of Anesthesiology, Second Affiliated Hospital of Army
Military Medical University, China
(Chen) Department of Anesthesiology, Affiliated Hospital of North Sichuan
Medical College, Nanchong, China
(Fan) Department of Anesthesiology, People's Hospital of Leshan, Leshan,
China
(Su) Department of Anesthesiology, China-Japan Union Hospital of Jilin
University, Changchun, China
(Cai) Department of Anesthesiology, the Fifth Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Zhang) Department of Anesthesiology, Ya'an People's Hospital, Ya'an,
China
(Li) Department of Anesthesiology, the Affiliated Yantai Yuhuangding
Hospital of Qingdao University Medical College, Yantai, China
(Zhang) Department of Anesthesiology, the Third Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Li) Department of Anesthesiology, Lanzhou University Second Hospital,
Lanzhou, China
(Jiang) Department of Anesthesiology, Chongqing General Hospital,
Chongqing, China
(Jiao) Institute of Translational Medicine, Shanghai Jiao Tong University,
Shanghai, China
(Sessler) Professor and Vice-president for Clinical and Outcomes Research,
Center for Outcomes Research and Department of Anesthesiology, UTHealth,
Houston, TX, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: - Older surgical patients are at risk because of age-related
physiologic decline and comorbidities. Some guidelines recommend
Bispectral Index (BIS) monitoring to optimize anesthetic depth, but robust
evidence supporting improved outcomes is lacking. Method(s): - We
conducted a randomized, multicenter, double-blind trial across 21
tertiary-care hospitals in China (March 17, 2015 to February 5, 2022).
Patients aged 65 years or older scheduled for elective non-cardiac surgery
(ASA I to IV) were randomized 1:1 to BIS-guided or routine anesthetic
management. In patients assigned to BIS guidance, hypnotic depth was
adjusted to maintain BIS between 40 and 60. Hypnotic depth in patients
assigned to routine-care per clinical judgment with masked BIS monitors.
The primary outcome was 1-year all-cause mortality. Secondary outcomes
included moderate-to-severe complications within 30 days, functional
independence, quality of life, the duration of postoperative critical
care, the duration of postoperative hospitalization, unplanned ICU
admission, and hospital cost. Result(s): - Among 6982 patients (mean
age 71 [SD 5] years), BIS values averaged 47 (BIS-guided) versus 46
(routine). 1-year mortality was similar in BIS-guided patients [10.2%
(356/3485)] and routinely managed patients [10.0% (351/3497)]: HR 1.02,
95% CI 0.88-1.17; P = 0.812). The incidence of complications within 30
days after surgery were also comparable in each group: 10.4% versus 10.6%
(RR 0.99, 95% CI 0.85-1.16; P = 0.938). No significant differences were
observed in functional independence or quality of life.
 Conclusion(s): - Hypnotic depth, as assessed by BIS, was similar in
patients with or without BIS-guided anesthetic titration.
Anesthesiologists thus apparently titrate hypnotic depth appropriately
even without BIS guidance. Unsurprisingly, outcomes including
postoperative 1-year mortality and 30-day complications were similar in
each group. Copyright © 2025

<23>
Accession Number
2039155751
Title
Safety and Feasibility of Novel Single-Port Robotic-Assisted
Lobectomy/Segmentectomy for Lung Cancer.
Source
Annals of Thoracic Surgery. 121(1) (pp 205-214), 2026. Date of
Publication: 01 Jan 2026.
Author
Liang H.; Wang W.; Zhang M.; Wang R.; Jiang S.; Xu F.; Yang C.; Huang J.;
Li S.; Zhang Z.; Wu W.; Gonzalez-Rivas D.; He J.
Institution
(Liang, Wang, Zhang, Wang, Jiang, Xu, Yang, Huang, Li, He) Department of
Thoracic Surgery, National Clinical Research Center for Respiratory
Disease, the First Affiliated Hospital of Guangzhou Medical University,
Guangzhou, China
(Zhang) Department of Operating Room, the First Affiliated Hospital of
Guangzhou Medical University, Guangzhou, China
(Wu) Mingyi SuperMed View Technology Company, Guangzhou, China
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, A Coruna, Spain
Publisher
Elsevier Inc.
Abstract
Background Robotic-assisted thoracic surgery (RATS) has advanced lung
cancer treatment with precise robotic arm maneuvers and 3-dimensional
visualization. Whereas conventional RATS systems require multiple
incisions, a uniportal approach is increasingly favored. However, current
systems face challenges with maneuverability and incision size. The SHURUI
single-portal (SP) robotic system (Beijing Shurui Technology Co, Ltd),
with its total-flex single-arm design, addresses these limitations,
especially for patients with narrow intercostal spaces or limited
intrathoracic space. Methods This phase 1/2 single-arm registry trial
assessed the safety and feasibility of lobectomy/segmentectomy using the
SHURUI SP robotic system. The study enrolled patients aged 18 to 75 with
lung cancer from November 2023 to April 2024. The SHURUI SP system's
"deformable dual continuum mechanism" technology enabled precise surgical
maneuvers, evaluating primary end points such as conversion rates, blood
loss, lymph node retrieval, transfusion needs, and intraoperative
complications. Results Thirty-five patients, median age 58 years,
underwent lobectomy/segmentectomy, with successful procedures in all
cases. No conversions to video-assisted thoracic surgery or open surgery
were needed, and no additional trocars were used. Median operative time
was 155 minutes, docking time was 3 minutes, and console time was 81
minutes. Median blood loss was 10 mL, with no transfusions required. The
30-day morbidity rate was 11.43%, with no major complications or
rehospitalizations. All patients were discharged after a mean hospital
stay of 4 days. Conclusions The SHURUI SP robotic system demonstrates
safety and feasibility for RATS in lung cancer. A large-scale, multicenter
randomized controlled trial is needed to further validate this
technology's efficacy and safety across a broader patient
population. Copyright © 2025 The Society of Thoracic Surgeons.

<24>
Accession Number
2032392818
Title
Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention
in Patients with Chronic Total Occlusion.
Source
Thoracic and Cardiovascular Surgeon. 73(8) (pp 609-617), 2025. Date of
Publication: 01 Dec 2025.
Author
Kirov H.; Fischer J.; Caldonazo T.; Tasoudis P.; Runkel A.; Soletti G.J.;
Cancelli G.; Dell'Aquila M.; Mukharyamov M.; Doenst T.
Institution
(Kirov, Fischer, Caldonazo, Runkel, Mukharyamov, Doenst) Department of
Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
(Tasoudis) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, United States
(Soletti, Cancelli, Dell'Aquila) Weill Cornell Medicine, New York, NY,
United States
Publisher
Georg Thieme Verlag
Abstract
Objectives Mechanisms of coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI) differ as CABG provides surgical
collateralization and may prolong life by preventing future myocardial
infarctions (MIs). However, evidence for CABG in patients with chronic
total occlusion (CTO) has not been fully elucidated and the impact of PCI
is discussed controversially. Methods We performed a meta-analysis of
studies comparing outcomes in patients with/without multivessel disease
undergoing CABG or PCI for CTO. The primary outcome was long-term
all-cause mortality (>=5 years). Secondary outcomes were MIs, repeat
revascularization, cardiac mortality, major adverse cardiovascular events,
and stroke, as well as short-term mortality (30 days/in-hospital) and
stroke. A pooled Kaplan-Meier survival curve after reconstruction analysis
was generated. Random-effects models were used. Results Six studies
totaling 12,504 patients were included. In the pooled Kaplan-Meier
analysis, PCI showed a significantly higher risk of death in the follow-up
compared with CABG (hazard ratio [HR]: 2.12, 95% confidence interval [CI]:
1.88-2.38, p < 0.01). During the observation period, PCI was also
associated with higher rates of MI (odds ratio [OR]: 2.86, 95% CI:
1.82-4.48, p < 0.01) and more repeat revascularization (OR: 4.88, 95% CI:
1.99-11.91, p = 0.0005). The other outcomes did not show significant
differences. Conclusion CABG is associated with superior survival to PCI
over time in patients with CTO who are eligible for both PCI and CABG.
This survival advantage is associated with fewer events of MI and repeat
revascularization. Copyright © 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG.

<25>
Accession Number
2037646331
Title
Hybrid coronary revascularization versus traditional coronary artery
bypass grafting for left main coronary artery disease.
Source
Cardiovascular Revascularization Medicine. 81 (pp 11-15), 2025. Date of
Publication: 01 Dec 2025.
Author
Hebbo E.; Barker M.; Gold D.A.; Hassan M.E.; Sawan M.; Rab T.; Nicholson
W.J.; Halkos M.E.; Jaber W.A.; Sandesara P.B.
Institution
(Hebbo, Barker, Gold, Hassan, Sawan, Rab, Nicholson, Jaber, Sandesara)
Emory Clinical Cardiovascular Research Institute, Division of Cardiology,
Department of Medicine, Emory University School of Medicine, Atlanta, GA,
United States
(Halkos) Division of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
Publisher
Elsevier Inc.
Abstract
Background The current recommended intervention for significant left main
(LM) stenosis, especially in patients with complex and high SYNTAX score
disease, is coronary artery bypass grafting (CABG). Hybrid coronary
revascularization (HCR) combines robotic coronary artery bypass and
percutaneous coronary intervention, offering a less invasive approach for
patients with LM disease. Objectives We compare clinical outcomes between
HCR and CABG in patients with LM disease. Methods We retrospectively
screened all patients treated for LM disease between 2019 and 2023 at a
single institution. Propensity matching was used for baseline
characteristics. The primary outcome was major adverse cardiovascular
events (MACE) at 30 days, 6 months and 1 year. Secondary outcomes included
death, myocardial infarction, repeat revascularization and stroke. Results
Out of a total of 761 patients treated for LM disease, 59 HCR patients
were propensity matched to 59 CABG patients and were included in the final
analysis. SYNTAX score was >33 for 49.1 % of HCR patients and 67.3 % of
CABG patients (p = 0.15). Hospital length of stay was significantly
shorter for HCR patients compared to CABG (4.07 days vs. 7.58 days, p <
0.001). MACE were significantly lower in the HCR group at 30 days (0 % vs
10.2 %; p = 0.01), 6 months (0 % vs 17 %; p = 0.002) and 1 year (2.4 % vs
20.5 %; p = 0.01) compared to CABG group. Additionally, there was a lower
rate of repeat revascularization at 6 months in the HCR group (0 % vs 10.9
%; p = 0.02). Conclusions This retrospective study demonstrates that HCR
is a safe and viable alternative to CABG in patients with LM disease.
Randomized clinical trials comparing the two treatment modalities are
needed to confirm these findings. Copyright © 2025 Elsevier Inc.

<26>
Accession Number
2034501698
Title
Vancomycin Antibiotic Prophylaxis Compared to Cefazolin Increases Risk of
Surgical Site Infection Following Spine Surgery.
Source
Global Spine Journal. 16(1) (pp 230-239), 2026. Date of Publication: 01
Jan 2026.
Author
Herrington B.J.; Urquhart J.C.; Rasoulinejad P.; Siddiqi F.; Gurr K.;
Bailey C.S.
Institution
(Herrington, Urquhart, Rasoulinejad, Siddiqi, Gurr, Bailey) London Health
Sciences Centre, London, ON, Canada
(Herrington, Urquhart, Rasoulinejad, Siddiqi, Gurr, Bailey) London Health
Sciences Centre Research Institute, London, ON, Canada
(Herrington, Rasoulinejad, Siddiqi, Gurr, Bailey) Department of Surgery,
Division of Orthopaedics, Schulich School of Medicine and Dentistry,
University of Western Ontario, London, ON, Canada
Publisher
SAGE Publications Ltd
Abstract
Study Design: Retrospective analysis of randomized controlled trial.
 Objective(s): Surgical site infection (SSI) after spine surgery has
severe negative health and financial consequences. Surgical antibiotic
prophylaxis (SAP) is a routinely used method to prevent SSIs in the spine
patient population. The most commonly used antibiotic is cefazolin, with
vancomycin often being substituted in the case of penicillin or
cephalosporin allergy. Vancomycin as SAP has been associated with
increased SSI in the joint replacement literature, but this is not yet
well defined in the spinal surgery population. The purpose of this study
was to determine whether vancomycin SAP compared to cefazolin SAP is
associated with increased risk of SSI. Method(s): 535 patients, aged
16 years or older, underwent elective multi-level open posterior spinal
fusion surgery at the thoracic, thoracolumbar, or lumbar levels.
Demographic and operative characteristics as well as post-operative
outcomes were compared between the following groups: (1)
noninfected-cefazolin, (2) noninfected-vancomycin, (3) infected-cefazolin,
and (4) infected-vancomycin. Primary outcomes were superficial and
complicated (deep and organ/space) infections. Result(s): The
following risk factors for SSI were identified in a logistic regression
analysis: vancomycin (OR 2.498, 95% CI, 1.085-5.73, P = 0.031), increasing
operating time (OR 1.006, 95% CI, 1.001-1.010 P = 0.010), weight (OR
1.020, 95% CI 1.006-1.034, P = 0.005), revision procedure (OR 2.343, 95%
CI 1.283-4.277, P = 0.006), and depression (OR 2.366, 95% CI 1.284-4.360,
P = 0.006). Conclusion(s): In open posterior approach spinal fusion
surgery, vancomycin SAP is associated with increased risk of infection
compared to cefazolin SAP. Copyright © The Author(s) 2025. This
article is distributed under the terms of the Creative Commons Attribution
4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits
any use, reproduction and distribution of the work without further
permission provided the original work is attributed as specified on the
SAGE and Open Access pages
(https://us.sagepub.com/en-us/nam/open-access-at-sage).

<27>
Accession Number
2036220856
Title
Effect of Diabetes Mellitus on Clinical Outcomes After Transcatheter
Aortic Valve Implantation: An Updated Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. 106(7) (pp 3444-3455),
2025. Date of Publication: 01 Dec 2025.
Author
Gomes R.A.P.; Suruagy Motta R.F.O.; Filho E.M.; Cheidde L.; Dos Santos
K.D.A.; Assumpcao J.V.A.; Anselmi L.F.; Neto A.P.D.M.; Pantaleao A.N.;
Harmouch K.M.; Modi K.
Institution
(Gomes, Cheidde) Faculty of Medicine, Pontifical Catholic University of
Sao Paulo, Sorocaba, Brazil
(Suruagy Motta) Department of Medicine, Cesmac University Center, Maceio,
Brazil
(Filho) Santa Casa de Misericordia Hospital, Maceio, Brazil
(Dos Santos, Neto) Faculty of Medicine, Federal University of Roraima, Boa
Vista, Brazil
(Assumpcao) Faculty of Medicine, Pontifical Catholic University of Parana,
Curitiba, Brazil
(Anselmi) Mackenzie Evangelical College of Parana, Curitiba, Brazil
(Pantaleao) School of Medicine, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Harmouch) Department of Internal Medicine, Wayne State University School
of Medicine, Detroit, MI, United States
(Modi) LSU Health, Shreveport, LA, United States
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TARV) is a
widely established treatment for symptomatic severe aortic stenosis (AS)
in patients with high or intermediate surgical risk. Diabetes mellitus
(DM) is prevalent in TAVR patients and is associated with an increased
risk of cardiovascular events, which may elevate procedural risks. A
systematic review and meta-analysis were conducted following PRISMA
guidelines. PubMed, Web of Science, and Cochrane databases were searched.
A random-effects model was applied, with 95% confidence intervals (CIs)
and a 5% significance level. Statistical analyses were performed using
RStudio version 4.4.1. Twelve studies with 214,444 patients were included,
comprising 74,294 diabetic and 140,150 nondiabetic individuals. The
analysis revealed no significant differences in all-cause mortality,
procedure mortality, 30-day mortality, or complications such as bleeding,
myocardial infarction, and major complications. However, 1-year mortality
was significantly higher in the diabetic group (RR: 1.51, 95% CI:
1.08-2.13). Diabetic patients were at higher risk for renal injury (RR:
1.46, 95% CI: 1.40-1.51) and lower risk of stroke (RR: 0.91, 95% CI:
0.83-0.99). The length of hospital stay and other major complications
showed no significant differences. There was an increased risk of 1-year
mortality and renal injury in diabetic patients undergoing TAVI compared
to non-diabetics. Surprisingly, the risk for developing stroke in the
diabetic group was significantly lower. In any case, the study emphasizes
the need for tighter DM control to decrease the risk of such complications
in the future. Copyright © 2025 Wiley Periodicals LLC.

<28>
Accession Number
2041146448
Title
Subcutaneous Nitroglycerin to Prevent Radial Artery Occlusion in Pediatric
Patients: A Randomized Clinical Trial.
Source
JAMA Pediatrics. 179(12) (pp 1283-1290), 2025. Date of Publication: 01 Dec
2025.
Author
Park J.-B.; Ji S.-H.; Kim E.-H.; Lee J.-H.; Kim H.-S.; Kim J.-T.; Jang
Y.-E.
Institution
(Park, Ji, Kim, Lee, Kim, Kim, Jang) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, Seoul, South Korea
Publisher
American Medical Association
Abstract
Importance Pediatric patients are at an increased risk of postprocedural
radial artery occlusion (RAO) owing to their small vessels and high
tendency for vasospasm after catheterization. Although subcutaneous
nitroglycerin increases the success rate of radial artery catheterization
by vasodilation and preventing vasospasm, its effect on RAO prevention
after catheter removal remains unknown. Objective To evaluate the efficacy
and safety of subcutaneous nitroglycerin for RAO prevention. Design,
Setting, and Participants This double-blind randomized clinical trial was
conducted at a single tertiary center and included pediatric patients
younger than 3 years who required radial artery catheterization during
general anesthesia. Study data were analyzed from April to July 2025.
Interventions Patients were randomized to receive either subcutaneous
nitroglycerin (5 mug/kg/0.5 mL) or normal saline (0.5 mL) above the chosen
radial artery before radial arterial catheterization and catheter removal
under ultrasound guidance. Main Outcomes and Measures The primary outcome
was the RAO incidence after catheter removal, assessed using the reverse
Barbeau test with pulse oximetry on the ipsilateral index finger. Results
A total of 200 pediatric patients were initially enrolled, but 68 were
excluded for protocol violations. In the per-protocol analysis with 132
participants (median [IQR] age, 5.5 [2.0-16.6] months; 73 female [55.3%]),
RAO incidence was lower in the nitroglycerin group than in the control
group (25.4% [17 of 67] vs 73.8% [48 of 65]; P < .001; odds ratio [OR],
0.12; 95% CI, 0.06-0.26; absolute risk reduction, 48.5%; 95% CI,
33.6%-63.4%). After catheter removal, the nitroglycerin group showed
higher peak blood flow velocity (mean [SD], 13.0 [11.0] cm/s vs 7.4 [9.2]
cm/s; 95% CI for mean difference, 2.1-9.1 cm/s; P = .002) and perfusion
index (mean [SD], 1.37 [1.09] vs 0.65 [0.49]; 95% CI for mean difference,
0.43-1.01; P < .001) of the radial artery than did the control group.
There was no significant intergroup difference in RAO duration. There was
no hypotension or localized adverse effects. Conclusions and Relevance
Subcutaneous nitroglycerin injection before radial artery catheterization
and catheter removal significantly reduced the incidence of RAO after
catheter removal and may promote safe recovery in pediatric patients
younger than 3 years. Copyright 2025 American Medical Association. All
rights reserved, including those for text and data mining, AI training,
and similar technologies.

<29>
Accession Number
2041268986
Title
Early Surgery Versus Conventional Treatment for Asymptomatic Severe Aortic
Regurgitation: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 34(12) (pp 1373-1378), 2025. Date of
Publication: 01 Dec 2025.
Author
Moreira Moreira E.G.; Berriel A.S.; Lacerda Guedes G.P.M.D.; Barg M.M.;
Sena M.D.B.; Dantas D.C.; Issa M.; Arnoni R.T.
Institution
(Moreira Moreira, Berriel, Lacerda Guedes, Barg, Sena, Dantas, Issa,
Arnoni) Department of Cardiac Surgery, Dante Pazzanese Institute of
Cardiology, Sao Paulo, Brazil
Publisher
Elsevier Ltd
Abstract
Background: The management of patients with severe asymptomatic aortic
regurgitation remains controversial. This systematic review and
meta-analysis aimed to assess and compare long-term outcomes between early
surgery and conventional treatment (CT) for severe asymptomatic aortic
regurgitation in patients with preserved left ventricular systolic
function. Method(s): We conducted a systematic search in the EMBASE,
PubMed, and Cochrane databases for studies comparing early surgery with
CT. The analysed outcome was death from all causes. We evaluated the risk
of bias in the included studies using the ROBINS-I (Risk Of Bias In
Non-randomised Studies of Interventions) tool. Result(s): Three
studies, involving 469 patients, were included. Of the participants
studied, 57% underwent early surgery, and 43% underwent CT. Early surgery
did significantly reduce all-cause mortality (odds ratio 0.35; 95%
confidence interval 0.12-1.00; p=0.05; I2=54%).
 Conclusion(s): Our study provides evidence supporting the idea that
early surgery, in comparison to conservative management, is associated
with better long-term outcomes in patients with severe asymptomatic aortic
regurgitation and normal ventricular function. Copyright © 2025
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<30>
Accession Number
2042172243
Title
Perioperative Multimodal General Anesthesia Focusing on Specific Central
Nervous System Targets Does Not Reduce Postoperative Interleukin-6 and
Neurofilament Light Levels in Patients Undergoing Cardiac Surgeries: A
Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Janga S.R.; Li M.H.; Kveraga K.; Ramachandran R.V.; Sharkey A.; Bose R.;
Sehgal S.; Brown E.N.; Subramaniam B.
Institution
(Janga, Li, Kveraga, Sharkey, Bose, Sehgal, Subramaniam) Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Ramachandran) Department of Anesthesiology and Pain Medicine, University
of Washington, Seattle, WA, United States
(Brown) Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
Objectives: Interleukin-6 (IL-6) and neurofilament light chain (NFL) are
predictive biomarkers of postoperative delirium in patients undergoing
cardiac surgery. This study was designed to compare postoperative changes
in IL-6 and NFL between patients receiving multimodal general anesthesia
(MMGA) guided by electroencephalography (EEG) versus standard-of-care
anesthesia. Design(s): Randomized, controlled, investigator-blinded
clinical trial. Setting(s): A single-center, tertiary referral
hospital. Participant(s): Adults >=60 years old undergoing coronary
artery bypass grafting, valve, or combined procedures.
 Intervention(s): MMGA included intraoperative EEG monitoring, total
intravenous anesthesia with propofol, remifentanil, ketamine,
dexmedetomidine, pecto-intercostal fascial block, and postoperative
pecto-intercostal fascial block. Controls received inhaled anesthetics and
intravenous fentanyl, without EEG guidance. Measurements and Main
Results: IL-6 and NFL were measured at baseline, postoperative day 1, and
postoperative day 2. EEG was recorded intraoperatively and
postoperatively. Cognition was assessed using the Confusion Assessment
Method and Montreal Cognitive Assessment up to 6 months. No significant
differences were observed in IL-6 or NFL levels at any time point.
Delirium incidence and long-term cognitive dysfunction were also similar.
However, burst suppression duration was significantly longer in the MMGA
group (mean = 4.83 minutes, standard deviation = 3.47) versus controls
(mean = 1.68 minutes, standard deviation = 2.2), particularly during and
after cardiopulmonary bypass in male patients. Conclusion(s): MMGA
did not reduce postoperative IL-6 or NFL levels, nor did it improve
neurocognitive outcomes, compared with standard of care. The higher burst
suppression in the MMGA group underscores the need for structured EEG
education among cardiac anesthesiologists. Future studies should explore
other EEG metrics and multimodal strategies for perioperative brain
protection. Copyright © 2025 Elsevier Inc.

<31>
Accession Number
2041694505
Title
Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation
in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE
Randomized Clinical Trial.
Source
JAMA Cardiology. 10(10) (pp 990-999), 2025. Date of Publication: 08 Oct
2025.
Author
Yamaguchi J.; Arashi H.; Hagiwara N.; Yasuda S.; Kaikita K.; Akao M.; Ako
J.; Matoba T.; Nakamura M.; Miyauchi K.; Matsui K.; Nakamura A.; Tamiya
E.; Yamamoto T.; Suetake S.; Noguchi T.; Nakamura S.; Kojima J.; Yamaguchi
H.; Suwa S.; Yasu T.; Nakajima A.; Yamada T.; Arai H.; Hata Y.; Sakanashi
T.; Tateishi H.; Nakayama T.; Nozaki Y.; Okumura Y.; Tokue M.; Kuroki N.;
Maruyama Y.; Suzuki H.; Nishida Y.; Ajioka M.; Yumoto K.; Shimizu S.;
Shimomura H.; Takeda T.; Oshiro K.; Sugishita N.; Shibata Y.; Otonari T.;
Shimizu M.; Kihara H.; Ogawa H.; Ono A.; Hazama M.; Tsukahara K.; Haruta
S.; Haruna T.; Ito M.; Fujii K.; Atsuchi N.; Sata M.; Wakeyama T.; Hasebe
N.; Kobayasi Y.; Osato K.; Hironaga K.; Naganuma Y.; Anzaki K.; Okazaki
S.; Nakagawa Y.; Tokuhiro K.; Tanaka K.; Momose T.; Fukushima Y.; Kametani
R.; Kawamitsu K.; Saito Y.; Akashi S.; Kumagai K.; Eshima K.; Tobaru T.;
Seo T.; Okuhara K.; Kozuma K.; Ikari Y.; Takahashi T.; Oiwa K.; Michishita
I.; Fujikura H.; Momomura S.; Yamamoto Y.; Otomo K.; Matsubara T.; Tashiro
H.; Inoue T.; Ishihara M.; Shiojima I.; Tachibana E.; Sumii K.; Yamamoto
N.; Omura N.; Takahashi N.; Morita Y.; Watanabe K.; Fujinaga H.; Maruyama
M.; Oka T.; Shirayama T.; Amano T.; Fukui K.; Ando K.; Oshima S.; Kagiyama
S.; Teragawa H.; Yuge M.; Ono S.; Koga T.; Fujiu K.; Kuwabara M.; Oya Y.;
Yumoto Y.; Kuji N.; Ikemura M.; Kario K.; Chatani K.; Sato K.; Miyagi H.;
Murakami M.; Saito K.; Hoshiga M.; Sato S.; Kubo N.; Sakamoto Y.; Ashida
K.; Sakamoto H.; Murasaki S.; Uehara H.; Akasaka T.; Oba Y.; Nakahara S.;
Hanaoka Y.; Nishimiya T.; Tsunoda R.; Onuma Y.; Higuchi S.; Tani A.; Wada
A.; Kato M.; Obata H.; Higuchi Y.; Endo T.; Kato R.; Matsunaga T.;
Matsuoka T.; Noguchi H.; Usui M.; Hayashi T.; Otsuji Y.; Osaki T.; Zaizen
H.; Yoshihara H.; Kadota K.; Hirose T.; Miyazawa T.; Mori A.; Takano M.;
Shimizu W.; Wake M.; Oriso S.; Yoshiyama M.; Kakinoki S.; Nishioka T.;
Ozaki T.; Nomoto K.; Seki K.; Kawai K.; Ozaki Y.; Miura S.; Kawasaki M.;
Funada R.; Dote K.; Okamoto S.; Owada T.; Doke T.; Matsumura T.; Kubo T.;
Horiuchi M.; Nagano T.; Takaishi A.; Yamamoto M.; Nakashima H.; Murozono
Y.; Munemasa M.; Sakata Y.; Inoue N.; Ota T.; Hamano Y.; Abe N.; Tsubokura
T.; Goto M.; Kubota I.; Yano M.; Umetani K.; Date T.; Morimoto H.; Noda
T.; Goto S.; Hibi K.; Nakano A.; Hiramitsu S.; Kihara Y.; Sugi M.; Shiba
N.; Izumi D.; Sato T.; Ajiki K.; Oishi M.; Kiryu M.; Ko T.; Ando H.;
Miyazaki S.; Kinugawa T.; Otake H.; Kitaoka H.; Tayama S.; Hirata Y.;
Honda S.; Manita M.; Ishii Y.; Oka H.; Nanba Y.; Nishino M.; Sakamoto T.;
Saito T.; Sakai H.; Ichikawa M.; Namiuchi S.; Matsui T.; Inoue K.;
Komiyama N.; Akashi Y.; Matsumura A.; Nakamura Y.; Komaru T.; Hosokawa T.;
Chikamori T.; Tanaka H.; Suzuki A.; Arasaki O.; Aonuma K.; Wakasa Y.;
Yoshizawa T.; Sugano T.; Yokota N.; Kakutani A.; Suzuki T.; Abe Y.;
Kataoka T.; Okayama H.; Yokoi H.; Chin K.; Hasegawa K.; Tomita H.; Honzyo
H.; Kawai H.; Morino Y.; Tsujiyama S.; Yoshimura M.; Hamasaki S.; Niijima
Y.; Aoyama T.; Mizuno Y.; Maki A.; Tanabe K.; Murohara T.; Nakamura T.;
Naomi S.; Matsumoto N.; Minamino T.; Sairenji H.; Miyamoto N.; Arikawa M.;
Ito H.; Matsuura Y.; Hata S.; Nakatsu Y.; Onodera T.; Kato T.; Amano H.;
Tokutake E.; Kasao M.; Moriguchi M.; Yamamoto K.; Tsuji M.; Yamamoto H.;
Yanbe Y.; Iwasawa T.; Suzuki M.; Mori H.; Shibahashi E.; Takita M.; Kimura
K.
Institution
(Yamaguchi, Arashi, Hagiwara) Department of Cardiology, Tokyo Women's
Medical University, Tokyo, Japan
(Yasuda) Department of Cardiovascular Medicine, Tohoku University,
Graduate School of Medicine, Miyagi, Japan
(Yasuda) National Cerebral and Cardiovascular Center, Osaka, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, Kumamoto, Japan
(Kaikita) Division of Cardiovascular Medicine and Nephrology, Department
of Internal Medicine, Faculty of Medicine, University of Miyazaki,
Miyazaki, Japan
(Akao) Department of Cardiology, National Hospital Organization, Kyoto
Medical Center, Kyoto, Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University, School
of Medicine, Kanagawa, Japan
(Matoba) Department of Cardiovascular Medicine, Faculty of Medical
Sciences, Kyushu University, Fukuoka, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University, Ohashi
Medical Center, Tokyo, Japan
(Miyauchi) Department of Cardiovascular Medicine, Juntendo Tokyo Koto
Geriatric Medical Center, Tokyo, Japan
(Matsui) Department of General Medicine and Primary Care, Kumamoto
University Hospital, Kumamoto, Japan
(Ogawa) Kumamoto University, Kumamoto, Japan
(Nakamura) Iwate Prefectural Central Hospital, Japan
(Tamiya) Koto Hospital, Japan
(Yamamoto) Hokkaido Cardiovascular Hospital, Japan
(Suetake) Kaetsu Hospital, Japan
(Noguchi) National Cerebral and Cardiovascular Center, Japan
(Nakamura) Hitoyoshi Medhical Center, Japan
(Matsumura) Kameda Medical Center, Japan
(Kojima) Kojima Clinic, Japan
(Yamaguchi) Hiroshi YamaguchI Clinic, Japan
(Suwa) Juntendo University Shizuoka Hospital, Japan
(Yasu) Dokkyo Medhical University Nikko Medical Center, Japan
(Nakajima) New Tokyo Hospital, Japan
(Yamada) Osaka General Medical Center, Japan
(Arai) Kanoya Heart Center, Japan
(Hata) Minamino Cardiovascular Hospital, Japan
(Sakanashi) Sakanashi Heart Clinic, Japan
(Tateishi) Koyo Newtown Hospital, Japan
(Nakayama) Nakayama Clinic, Japan
(Nozaki) Hokkokinen Hospital, Japan
(Okumura) Nihon University Itabashi Hospital, Japan
(Tokue) Toho University Medical Center Ohashi Hospital, Japan
(Kuroki) Tokyo Metropolitan Bokutoh Hospital, Japan
(Maruyama) Iwatsuki-minami Hospital, Japan
(Suzuki) Showa University Fujigaoka Hospital, Japan
(Nishida) Kouseikai Takai Hospital, Japan
(Ajioka) Tosei General Hospital, Japan
(Yumoto) Yokohama Rosai Hospital, Japan
(Shimizu) Mashiko Hospital, Japan
(Aoyama) Fukui Prefectural Hospital, Japan
(Shimomura) Fukuoka Tokushukai Hospital, Japan
(Takeda) Koto Memorial Hospital, Japan
(Oshiro) Ohama Dai-ichi Hospital, Japan
(Sugishita) Sugishita Clinic, Japan
(Shibata) Miyazaki Medical Association Hospital, Japan
(Otonari) Otonari Clinic, Japan
(Shimizu) International Goodwill Hospital, Japan
(Kihara) Kihara Cardiovascular Clinic, Japan
(Ogawa) Kitaakita Municipal Hospital, Japan
(Ono) Medical Corporation Shoikai Kasai Shoikai Hospital, Japan
(Hazama) Nijigaoka Hospital, Japan
(Tsukahara) Fujisawa City Hospital, Japan
(Haruta) Fukuyama Cardiovascular Hospital, Japan
(Haruna) Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
(Ito) Mie University Hospital, Japan
(Fujii) Sakurabashi Watanabe Hospital, Japan
(Atsuchi) Tenyokai Central Clinic, Japan
(Sata) Tokushima University Hospital, Japan
(Wakeyama) Tokuyama Central Hospital, Japan
(Hasebe) Asahikawa Medical University Hospital, Japan
(Kobayasi) Chiba University Hospita, Japan
(Osato) Fukui CardioVascular Center, Japan
(Hironaga) Fukuoka City Hospital, Japan
(Naganuma) Hachinohe Red Cross Hospital, Japan
(Anzaki) Izumi Regional Medical Center, Japan
(Okazaki) Juntendo University Hospital, Japan
(Nakagawa) Kawanishi City Hospital, Japan
(Tokuhiro) Misato Central General Hospital, Japan
(Tanaka) Miyoshi Central Hospital, Japan
(Momose) Nagano Matsushiro General Hospital, Japan
(Fukushima) Nagatsuda Kosei General Hospital, Japan
(Kametani) Nagoya Tokushukai General Hospital, Japan
(Kawamitsu) Nanbu Tokushukai Hospital, Japan
(Saito) Nara Medical University, Japan
(Akashi) National Hospital Organization Hamada Medical Center, Japan
(Kumagai) Odawara Cardiovascular Hospital, Japan
(Eshima) Saga-Ken Medical Centre Koseikan, Japan
(Tobaru) Sakakibara Heart Institute, Japan
(Seo) Seo Heart Clinic, Japan
(Okuhara) Shobara Red Cross Hospital, Japan
(Kozuma) Teikyo University Hospital, Japan
(Ikari) Tokai University Hospital, Japan
(Takahashi) Tokyo Saiseikai Central Hospital, Japan
(Oiwa) Yokohama Chuo Hospital, Japan
(Michishita) Yokohama Sakae Kyosai Hospital, Japan
(Fujikura) Fujikura Clnic, Japan
(Momomura) Jichi Medical University Saitama Medical Center, Japan
(Yamamoto) Kansai Medical University Medical Center, Japan
(Otomo) Ome Municipal Hospital, Japan
(Matsubara) Shinrakuen Hospital, Japan
(Tashiro) St.Mary's Hospital, Japan
(Inoue) Dokkyo Medical University Hospital, Japan
(Ishihara) Hyogo College of Medicine College Hospital, Japan
(Shiojima) Kansai Medical University Hospital, Japan
(Tachibana) Kawaguchi Municipal Medical Center, Japan
(Sumii) MAZDA Hospital, Japan
(Yamamoto) Miyazaki Prefectural Nobeoka Hospita, Japan
(Omura) Nakata Clinic, Japan
(Nakamura) National Hospital Organization Kyushu Medical Center, Japan
(Takahashi) Oita University Hospital, Japan
(Morita) SAGAMIHARA NATIONAL HOSPITAL, Japan
(Watanabe) Saiseikai Matsuyama Hospital, Japan
(Fujinaga) Tokushima Prefectural Central Hospital, Japan
(Maruyama) Toyama Prefectural Central Hospital, Japan
(Oka) Tsuyama Chuo Hospital, Japan
(Shirayama) University Hospital, Kyoto Prefectural University of Medicine,
Japan
(Amano) Aichi Medical University Hospital, Japan
(Fukui) Kanagawa Cardiovascular and Respiratory Center, Japan
(Ando) Kokura Memorial Hospital, Japan
(Oshima) Kumamoto Chuo Hospital, Japan
(Kagiyama) Kyushu Central Hospital of the Mutual Aid Association of
Public, Japan
(Teragawa) Medical Corporation JR Hiroshima Hospital, Japan
(Yuge) Odawara Municipal Hospital, Japan
(Ono) Saiseikai Yamaguchi Hospita, Japan
(Koga) Steel Memorial Yawata Hospital, Japan
(Fujiu) The University of Tokyo Hospital, Japan
(Kuwabara) Toranomon Hospital, Japan
(Oya) University of the Ryukyus Hospital, Japan
(Yumoto) Fuji Hospital, Japan
(Kuji) Good Heart Clinic, Japan
(Ikemura) Ikemura Medical Clinic, Japan
(Kario) Jichi Medical University Hospital, Japan
(Chatani) Kawasaki Municipal Tama Hospital, Japan
(Sato) Kumamoto City Hospital, Japan
(Miyagi) Miyagi Clinic, Japan
(Murakami) Murakami Clinic, Japan
(Saito) Nishiarai Heart Center Hospital, Japan
(Hoshiga) Osaka Medical College Hospital, Japan
(Sato) Saiseikai Imabari Hospital, Japan
(Kubo) Saitama Medhical Center, Japan
(Sakamoto) Sakamoto Cardiovascular Clinic, Japan
(Ashida) Seirei Yokohama Hospital, Japan
(Sakamoto) Shizuoka Prefectural Hospital, Japan
(Murasaki) Tama-Hokubu Medical Center, Japan
(Uehara) Urasoe General Hospital, Japan
(Akasaka) Wakayama Medical University Hospital, Japan
(Oba) Chihaya Hospital, Japan
(Nakahara) Dokkyo Medical University Saitama Medical Center, Japan
(Hanaoka) Hanaoka Cardiovascular Clinic, Japan
(Nishimiya) Japanese Red Cross Asahikawa Hospital, Japan
(Tsunoda) Japanese Red Cross Kumamoto Hospital, Japan
(Onuma) JR Sapporo Hospital, Japan
(Higuchi) Kamiamakusa General Hospital, Japan
(Tani) Kano General Hospital, Japan
(Wada) Kusatsu General Hospital, Japan
(Kato) Mie Heart Center, Japan
(Obata) National Hospital Organization Obihiro Hospital, Japan
(Higuchi) Osaka Police Hospital, Japan
(Endo) Saiseikai Yokohamashi Nanbu Hospital, Japan
(Kato) Saitama Medical University International Medical Center, Japan
(Matsunaga) Suizenji Tohya Hospital, Japan
(Matsuoka) Uji Tokushukai Medical Center, Japan
(Noguchi) Fukuoka Wajiro Hospital, Japan
(Usui) Hamanomachi Hospital, Japan
(Hayashi) Hayashi Medical Clinic, Japan
(Otsuji) Hospital of the University of Occupational and Environmental
Health, Japan
(Osaki) Iwate Prefectual Kuji Hospital, Japan
(Zaizen) JA Oita Koseiren TsurumiI Hospital, Japan
(Yoshihara) JA Toride Medical Center, Japan
(Kadota) Kurashiki Central Hospital, Japan
(Hirose) Minamata City Hospital & Medical Center, Japan
(Miyazawa) Miyazawa Heart Clinic, Japan
(Mori) National Hospital Organization Iwakuni Clinical Center, Japan
(Takano) Nippon Medical School Chiba Hokusoh Hospital, Japan
(Shimizu) Nippon Medical School Hospital, Japan
(Wake) Okinawa Prefectural Chubu Hospital, Japan
(Oriso) Oriso Internal Medicine & Cardiology Clinic, Japan
(Yoshiyama) Osaka City University Hospital, Japan
(Kakinoki) Otaru Kyokai Hospital, Japan
(Nishioka) Saitama-Medhical Center, Japan
(Ozaki) Sapporo Orthopaedics and Cardiovascular Hospital, Japan
(Nomoto) Tokyo Rinkai Hospital, Japan
(Seki) Yamaguchi Rosai Hospital, Japan
(Kawai) Chikamori Hospital, Japan
(Ozaki) Fujita Health University Hospital, Japan
(Miura) Fukuoka University Hospital, Japan
(Kawasaki) Gifu University Hospital, Japan
(Funada) Gunma University Hospital, Japan
(Dote) Hiroshima City Asa Citizens Hospital, Japan
(Okamoto) Iwasaki Hospital, Japan
(Owada) Japanese Red Cross Society Fukushima Hospital, Japan
(Doke) Kohka Public Hospital, Japan
(Matsumura) Kumamoto Rosai Hospital, Japan
(Kubo) Japanese Red Cross Matsuyama Hospital, Japan
(Horiuchi) Medical Association Sugimura Hospital, Japan
(Nagano) Iwasa Hospital Iwasa Maternity, Japan
(Takaishi) Mitoyo General Hospital, Japan
(Yamamoto) National Center for Global Health and Medicine, Japan
(Nakashima) National Hospital Organization Kagoshima Medical Center, Japan
(Murozono) Japanese Red Cross Oita Hospital, Japan
(Munemasa) National Hospital Organization Okayama Medical Center, Japan
(Sakata) Osaka University Hospital, Japan
(Inoue) Sendai Kousei Hospital, Japan
(Ota) Takanohara Central Hospital, Japan
(Hamano) Tawaramachi Hamano Hospital, Japan
(Abe) Tokyo Medical University Ibaraki Medical Center, Japan
(Tsubokura) Tsubokura Cardiovascular Clinic, Japan
(Goto) Watanabe Hospital, Japan
(Kubota) Yamagata University Hospital, Japan
(Yano) Yamaguchi University Hospital, Japan
(Umetani) Yamanashi Prefectural Central Hospital, Japan
(Date) Date Naika Clinic, Japan
(Morimoto) Fukagawa Municipal Hospital, Japan
(Noda) Gifu Prefectural General Medical Center, Japan
(Goto) Goto Clinic, Japan
(Hibi) Gumyoji Eye Heart Clinic, Japan
(Nakano) Hikone Municipal Hospital, Japan
(Hiramitsu) Hiramitsu Heart Clinic, Japan
(Kihara) Hiroshima University Hospital, Japan
(Sugi) Imaki City Medical Center, Japan
(Shiba) International University of Health and Welfare Hospital, Japan
(Izumi) Japanese Red Cross Ise Hospital, Japan
(Sato) Japanese Red Cross Okayama Hospital, Japan
(Ajiki) JR Tokyo General Hospital, Japan
(Oishi) Kagoshima University Hospital, Japan
(Kiryu) Kanagawa Cardiovascular Medicine, Japan
(Ko) Kashima Heart Clinic, Japan
(Ando) Keiai Hospital, Japan
(Miyazaki) Kindai University Hospital, Japan
(Kinugawa) Kinugawa Cardiology Clinic, Japan
(Otake) Kobe University Hospital, Japan
(Kitaoka) Kochi Medical School Hospital, Japan
(Tayama) JCHO Kumamoto General Hospital, Japan
(Hirata) Kumamoto Regional Medical Center, Japan
(Honda) Minami Municipal National Insurance Hospital, Japan
(Manita) Naha City Hospital, Japan
(Ishii) Ogikubo Hospital, Japan
(Oka) Oka Clinic, Japan
(Nanba) Okayama Rosai Hospital, Japan
(Nishino) Osaka Rosai Hospital, Japan
(Sakamoto) Saiseikai Kumamoto Hospital, Japan
(Saito) Saito Clinic, Japan
(Sakai) Sakai Clinic, Japan
(Ichikawa) Sekishindo Hospital, Japan
(Namiuchi) Sendai Open Hospital, Japan
(Matsui) JCHO Shiga Hospital, Japan
(Inoue) South Miyagi Medical Center, Japan
(Komiyama) St. Luke's International Hospital, Japan
(Akashi) St. Marianna University School of Medicine Hospital, Japan
(Matsumura) Awa Regional Medical Center, Japan
(Nakamura) Takeda General Hospital, Japan
(Komaru) Tohoku Medical and Pharmaceutical University Hospital, Japan
(Hosokawa) Tokyo Haert Center, Japan
(Chikamori) Tokyo Medical University Hospital, Japan
(Tanaka) Tokyo Metropolitan Tama Medical Center, Japan
(Suzuki) JCHO Tokyo Yamate Medical Center, Japan
(Arasaki) Tomishiro Central Hospital, Japan
(Aonuma) University of Tsukuba Hospital, Japan
(Wakasa) Wakasa Medical Clinic, Japan
(Yoshizawa) Yamato Municipal Hospital, Japan
(Sugano) Yokohama City University Hospital, Japan
(Yokota) Yokota Naika, Japan
(Kakutani) Yoshinoawa Medical Center, Japan
(Suzuki) Aizawa Hospital, Japan
(Abe) Akeno Clinic, Japan
(Kataoka) Bellland General Hospital, Japan
(Okayama) Ehime Prefectural Central Hospital, Japan
(Yokoi) Fukuoka Sanno Hospital, Japan
(Chin) Hakuai Clinic, Japan
(Hasegawa) Hasegawa Outpatients Clinic for Cardiovascular Disease, Japan
(Tomita) Hirosaki University Hospital, Japan
(Honzyo) Honzyo Medical Hospital, Japan
(Kawai) Hyogo Brain and Heart CenterAt Himeji, Japan
(Yamamoto) Iida Municipal Hospital, Japan
(Morino) Iwate Medical University Hospital, Japan
(Tsujiyama) JA Hiroshima General Hospital, Japan
(Yoshimura) The Jikei University Hospital, Japan
(Hamasaki) Kagoshima City Hospital, Japan
(Niijima) Kan-etsu Chu-oh Hospital, Japan
(Aoyama) Kizawa Memorial Hospital, Japan
(Mizuno) Kumamoto Kinoh Hospital, Japan
(Maki) Maki Clinic, Japan
(Tanabe) Mitsui Memorial Hospital, Japan
(Murohara) Nagoya University Hospital, Japan
(Nakamura) Nakamura Clinic, Japan
(Naomi) Naomi Medicinal Clinic, Japan
(Matsumoto) Nihon University Hospital, Japan
(Minamino) Niigata University Medical & Dental Hospital, Japan
(Sairenji) Nishiyama Ichou Jyunkanki Geka Clinic, Japan
(Miyamoto) NTT-East Sapporo Hospital, Japan
(Arikawa) National Hospital Organization Oita Medical Center, Japan
(Ito) Okayama University Hospital, Japan
(Matsuura) Sakaemachi Clinic, Japan
(Hata) Sasebo City General Hospital, Japan
(Nakatsu) Shioda Memorial Hospital, Japan
(Onodera) Shizuoka City Shizuoka Hospital, Japan
(Kato) National Hospital Organization Tochigi Medical Center, Japan
(Amano) Toho University Omori Medical Center, Japan
(Tokutake) Tokutake Clinic, Japan
(Kasao) Tokyo Metropolitan Police Hospital, Japan
(Moriguchi) Toshiba Rinkan Hospital, Japan
(Yamamoto) Tottori University Hospital, Japan
(Tsuji) Tsuji Internal Medicine and Cardiology and Dental Clinic, Japan
(Yamamoto) Yamamoto Clinic, Japan
(Yanbe) Yokohama General Hospital, Japan
(Iwasawa) Yokohama General Hospital Uwamachi, Japan
(Suzuki) Yokohama Minami Kyousai Hospital, Japan
(Mori) Yokohama Sotetsu Building Clinic, Japan
(Shibahashi) Tokyo Women's Medical University, Japan
(Takita) Mebix, Japan
(Kimura) Yokohama City University Medical Center, Japan
Publisher
American Medical Association
Abstract
Importance: Antithrombotic therapy is crucial for older patients with
coronary artery disease (CAD) and atrial fibrillation (AF) who are at a
high risk of bleeding and thrombotic events. Objective(s): To examine
the age-stratified effects of rivaroxaban monotherapy compared with those
of rivaroxaban plus antiplatelet agent combination therapy. Design,
Setting, and Participant(s): This was a post hoc secondary analysis of the
Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With
Stable Coronary Artery Disease (AFIRE) open-label randomized clinical
trial. This was a multicenter study conducted in Japan from February 23,
2015, to July 31, 2018. Patients with AF and stable CAD who had undergone
percutaneous coronary intervention or coronary artery bypass grafting 1 or
more years earlier or who had angiographically confirmed CAD that did not
require revascularization were enrolled. Participants were stratified into
4 groups by age (<70 years, 70-74 years, 75-79 years, and >=80 years).
Study data were analyzed from August 2024 to July 2025.
 Intervention(s): Rivaroxaban monotherapy or rivaroxaban plus
antiplatelet agent therapy. Main Outcomes and Measures: The primary
efficacy end point was a major adverse cardiovascular event, defined as a
composite of stroke, systemic embolism, myocardial infarction, unstable
angina requiring revascularization, or death from any cause. The primary
safety end point was major bleeding. Result(s): This study included a
total of 2215 participants (mean [SD] age, 74.3 [8.2] years; 1751 male
[79.1%]). The incidence of primary efficacy end points per patient-year
for rivaroxaban monotherapy vs rivaroxaban plus antiplatelet agent therapy
was 3.2% vs 4.3% (<70 years), 3.2% vs 2.8% (70-74 years), 3.8% vs 5.3%
(75-79 years), and 6.2% vs 10.3% (>=80 years). The hazard ratios were 0.74
(95% CI, 0.40-1.37) for those younger than 70 years, 1.16 (95% CI,
0.55-2.45) for those aged 70 to 74 years, 0.72 (95% CI, 0.41-1.26) for
those aged 75 to 79 years, and 0.61 (95% CI, 0.40-0.93) for those 80 years
and older (P for interaction =.51). For the primary safety end points, the
incidence was 0.5% vs 2.3% (<70 years), 2.2% vs 2.4% (70-74 years), 1.1%
vs 2.1% (75-79 years), and 2.9% vs 4.3% (>=80 years). The hazard ratios
were 0.23 (95% CI, 0.06-0.79) for those younger than 70 years, 0.91 (95%
CI, 0.39-2.15) for those aged 70 to 74 years, 0.52 (95% CI, 0.19-1.42) for
those aged 75 to 79 years, and 0.67 (95% CI, 0.35-1.27) for those 80 years
and older (P for interaction =.33). Conclusions and Relevance:
Results of this post hoc analysis of the AFIRE randomized clinical trial
reveal that rivaroxaban monotherapy reduced the risk of major
cardiovascular events and major bleeding across the broad range of age in
patients with AF and stable CAD. Possible age-related differences in
trends, with more pronounced efficacy in older patients and more
pronounced safety in younger patients, should be considered as hypothesis
generating and require further research. Copyright © 2025
American Medical Association.

<32>
Accession Number
2041628817
Title
Burden of non-rheumatic valvular heart disease globally and in China from
1990 to 2021: a systematic analysis for the global burden of disease study
2021.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1641448. Date of Publication: 2025.
Author
Chen W.; Wei J.; Zheng X.; Lan Y.; Zheng B.
Institution
(Chen, Zheng) Department of Cardiothoracic Surgery, The First Affliated
Hospital of Guangxi Medical University, Guangxi, Nanning, China
(Chen, Zheng) Department of Thoracic and Cardiovascular Surgery, The First
People's Hospital of Nanning, The Fifth Affiliated Hospital of Guangxi
Medical University, Guangxi, Nanning, China
(Wei) Department of Orthopedic Surgery, The First People's Hospital of
Nanning, The Fifth Affiliated Hospital of Guangxi Medical University,
Guangxi, Nanning, China
(Lan) Department of Pharmacy, The People's Hospital of Guangxi Zhuang
Autonomous Region & Guangxi Academy of Medical Sciences, Guangxi, Nanning,
China
Publisher
Frontiers Media SA
Abstract
Background: Non-rheumatic valvular heart disease (NRVHD), driven by aging
populations and epidemiological transitions, has become the dominant form
of valvular heart disease globally, yet its burden trends and demographic
disparities remain undercharacterized. This study quantifies the global
and Chinese burden of NRVHD from 1990 to 2021, analyzing age-sex
disparities and temporal trends. Method(s): Using data from the
Global Burden of Disease (GBD) 2021 Study. First, the number of incidence,
prevalence, deaths, and disability-adjusted life years (DALYs) cases,
along with their corresponding age-standardized rates (ASRs), were
reported globally and in China, stratified by different sub-types in 2021.
These sub-types included sex and age groups. Second, to explore the
temporal trend of the disease burden, data from 1990 to 2021 were analyzed
both globally and by sub-types. The estimated annual percentage change
(EAPC) value was calculated using a linear regression model.
 Result(s): In 2021, NRVHD caused 2,206,928 global incidence cases
(ASR: 25.0/100,000) and 28.4 million prevalence cases (ASR:
335.3/100,000), with 181,078 deaths (ASR: 2.31/100,000) and 3.24 million
DALYs (ASR: 39.7/100,000). China accounted for 292,215 incidence cases
(ASR: 12.8/100,000) and 3.28 million prevalence cases (ASR:
156.2/100,000), demonstrating lower deaths cases (ASDR: 0.13 vs. global
2.31/100,000) but accelerated burden growth. From 1990 to 2021, global
incidence rose 129%, while China's surged 220%. Age-standardized deaths
rate declined globally and in China, contrasting with rising prevalence.
Males bore higher burdens globally and in China, with elderly populations
disproportionately affected. Conclusion(s): NRVHD burden has
escalated globally, characterized by rising morbidity amid declining
mortality, a paradox amplified in China. While therapeutic advances and
hypertension control contributed to mortality reductions, persistent
sex-age disparities and rural-urban inequities demand targeted strategies.
China's rapid epidemiological transition underscores the urgency of
integrating primary prevention, equitable technology access, and enhanced
surveillance to address aging-related valvulopathies. Copyright 2025
Chen, Wei, Zheng, Lan and Zheng.

<33>
Accession Number
2022708433
Title
Pragmatic evaluation of events and benefits of lipid lowering in older
adults (PREVENTABLE): Trial design and rationale.
Source
Journal of the American Geriatrics Society. 71(6) (pp 1701-1713), 2023.
Date of Publication: 01 Jun 2023.
Author
Joseph J.; Pajewski N.M.; Dolor R.J.; Sellers M.A.; Perdue L.H.; Peeples
S.R.; Henrie A.M.; Woolard N.; Jones W.S.; Benziger C.P.; Orkaby A.R.;
Mixon A.S.; VanWormer J.J.; Shapiro M.D.; Kistler C.E.; Polonsky T.S.;
Chatterjee R.; Chamberlain A.M.; Forman D.E.; Knowlton K.U.; Gill T.M.;
Newby L.K.; Hammill B.G.; Cicek M.S.; Williams N.A.; Decker J.E.; Ou J.;
Choudhary G.; Gazmuri R.J.; Schmader K.E.; Roumie C.L.; Vaughan C.P.;
Effron M.B.; Cooper-DeHoff R.M.; Supiano M.A.; Shah R.C.; Whittle J.C.;
Hernandez A.F.; Ambrosius W.T.; Williamson J.D.; Alexander K.P.; Romashkan
S.; Fine L.; Weiner M.; Cooper-DeHoff R.; Callahan K.; Espinoza S.;
Rubinstein J.; Snyder H.; Carrillo M.; Rothman R.; Shenkman B.; Carton T.;
Nauman B.; McTique K.; Jefferson M.; Wing J.; Bloodworth S.; Owens A.;
Bordelon L.; Heimberg M.; Massey J.; Gonzalez M.; Brashears B.; Kaczkowski
K.; King M.; Hoisington K.; Lovato J.; Almonte J.; White J.; Gaziano M.;
Lovato L.; Poddar K.; Taylor Z.; Hunt D.; Hervey J.; Kelsey M.; Leverty
R.; Batch B.; Richmond A.; Hufstedler M.; Chang A.; Hetzel J.; Laffey M.;
Pahor M.; Houston D.; Kitzman D.; Rapp S.; Sachs B.; Lang S.; Nulph R.;
Rives E.; Zieman S.; Newman A.; Kapitanovsky K.; Reboussin D.; Cicek M.;
Halverson K.; Gaussoin S.; Dohner C.; Monds P.; Alred C.; Bowman J.; Bunke
J.; Deckard N.; Lowe T.; Thiel R.; VanDoren K.; Whiteside H.; Reuben D.;
Peduzzi P.; Solomon S.; Florez H.; Breitner J.; Greenland P.; Travison T.;
Waitman R.; Bancks M.; Burnet K.; Telzak A.; Vanterpool Y.E.; Oberembt S.;
Davies I.; Shade L.; Strout K.; Kitzman H.; Patel M.; Rao G.; Ufholz K.;
Rao S.; Cardoso E.; Allen J.; Kulshreshtha A.; Brown W.; Cripps S.; Ford
D.; Gauvey-Kern M.; Meilander A.; Kohnhorst D.; Rosas S.; Druckrey J.;
Loepfe T.; Kaseno J.; Berendt M.; Akatue R.; Houtschilt S.; Linder J.;
Brown T.; Bazzano L.; Williams S.; Brill S.; Jindra M.; Yurko E.; Tapan
M.; Kirkwood L.; Azhar G.; Pangle A.; Carlson M.; Lu J.; Wells B.; Gordon
H.; Ashley N.; Ernst M.; Grdinovac K.; Lower E.; Hart J.; Carrasquillo O.;
Linares V.; Hall M.; Boyer L.; Hahn-Cover K.; Grieshaber V.; Fisher A.;
Kirke S.; Ake J.; Klawson E.; Lee J.; Johnson K.; Musi N.; Brown K.; Rubin
C.; Thompson G.; Bah H.; Wharton J.; Wall M.; Zamora E.; Betancourt J.;
Binder E.; Young A.; Goyal P.; Park F.; Almonte A.; Carlsson C.; Zylstra
H.; Munoz A.; Tinker A.; Soe K.; Clarke J.-A.; Vu K.; Hy C.; Lee C.; Zeng
A.; Hallock A.; Reuben-Hallock K.; Malm B.; Spreyer K.; Yaksic E.; Lee P.;
Runge C.; Kundu S.; Chau K.; Rodriguez-Cintron W.; Fuentes-Medina S.;
White S.M.; Liu M.; Romero I.; Tavabi A.; Penny W.; St. John M.; Eleazer
P.; Thongsa S.; Krishnasamy S.; Ricks J.; Walsh J.; Espique L.; Fernandes
J.; Willis T.; Ricci A.; Peek B.; Michael J.; Lockhart M.; Hall D.; Withee
C.; Markland A.; Davis D.; Todela T.; Sullivan D.; Sawyer L.; Lorscheter
J.; Gupta A.; Castle T.; Reynolds J.; Kramer H.; Kirchner K.; Spencer
A.K.; Godschalk M.; Taylor C.; Atlas S.; Guerrero R.B.; Kansal M.; Tenorio
J.; Singh V.; Kiran S.; Albert M.; Knipping V.; Childress R.; Beaverson
B.; Tamariz L.; Denizard J.; Peruvemba S.; Venetucci J.; Shivaswamy V.;
Ramalingam R.
Institution
(Joseph) VA Providence Healthcare System, Providence, RI, United States
(Pajewski, Perdue, Woolard, Shapiro, Ambrosius, Williamson) Wake Forest
University School of Medicine, Winston-Salem, NC, United States
(Dolor, Sellers, Jones, Chatterjee, Newby, Hammill, Hernandez, Alexander)
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, United States
(Peeples) VA Boston Healthcare System, Boston, MA, United States
(Henrie) Cooperative Studies Program Clinical Research Pharmacy
Coordinating Center, Office of Research and Development, Department of
Veterans Affairs, Albuquerque, NM, United States
(Benziger) Essentia Health, Duluth, MN, United States
(Orkaby) New England Geriatric Research, Education, and Clinical Center
(GRECC), VA Boston Healthcare System, and Division of Aging, Brigham &
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Mixon, Roumie) Vanderbilt University Medical Center and Geriatric
Research Education and Clinical Center (GRECC), VA Tennessee Valley
Healthcare System, Nashville, TN, United States
(VanWormer) Marshfield Clinical Research Institute, Marshfield, WI, United
States
(Kistler) Department of Family Medicine, School of Medicine, University of
North Carolina at Chapel Hill, NC, United States
(Polonsky) University of Chicago Medicine, Chicago, IL, United States
(Chamberlain, Cicek) Mayo Clinic, Rochester, MN, United States
(Forman) Department of Medicine, Sections of Geriatrics and Cardiology,
University of Pittsburgh, Pittsburgh GRECC, VA Pittsburgh Healthcare
System, Pittsburgh, PA, United States
(Knowlton) Intermountain Healthcare, Salt Lake City, UT, United States
(Gill) Yale School of Medicine, New Haven, CT, United States
(Williams) TN CEAL, Nashville, TN, United States
(Decker) Section of Primary Care Medicine, Medical College of Wisconsin,
Milwaukee, WI, United States
(Ou) Cardiology Division, John Cochran VA Medical Center and Cardiology
Division, Washington University School of Medicine, St. Louis, MO, United
States
(Rubinstein) Division of Cardiology, Cincinnati VAMC and Division of
Cardiovascular Diseases, Department of Internal Medicine, College of
Medicine, University of Cincinnati, Cincinnati, OH, United States
(Choudhary) Providence VA Medical Center, and Lifespan Cardiovascular
Institute, Alpert Medical School of Brown University, Providence, RI,
United States
(Gazmuri) Captain James A. Lovell Federal Health Care Center, Rosalind
Franklin University of Medicine and Science, Chicago, IL, United States
(Schmader) Duke University and GRECC, Durham VA Medical Center, Durham,
NC, United States
(Vaughan) Birmingham/Atlanta Geriatric Research Education and Clinical
Center (GRECC), Department of Veterans Affairs, and Division of Geriatrics
& Gerontology, Department of Medicine, Emory University, Atlanta, GA,
United States
(Effron) John Ochsner Heart and Vascular Institute, The University of
Queensland Ochsner Clinical School, New Orleans, LA, United States
(Cooper-DeHoff) University of Florida, College of Pharmacy and College of
Medicine, Gainesville, FL, United States
(Supiano) The University of Utah, Salt Lake, UT, United States
(Shah) Family & Preventive Medicine and the Rush Alzheimer's Disease
Center, Rush University, Chicago, IL, United States
(Whittle) Clement J Zablocki VA Medical Center, Milwaukee, WI, United
States
Publisher
John Wiley and Sons Inc
Abstract
Whether initiation of statins could increase survival free of dementia and
disability in adults aged >=75 years is unknown. PREVENTABLE, a
double-blind, placebo-controlled randomized pragmatic clinical trial, will
compare high-intensity statin therapy (atorvastatin 40 mg) with placebo in
20,000 community-dwelling adults aged >=75 years without cardiovascular
disease, disability, or dementia at baseline. Exclusion criteria include
statin use in the prior year or for >5 years and inability to take a
statin. Potential participants are identified using computable phenotypes
derived from the electronic health record and local referrals from the
community. Participants will undergo baseline cognitive testing, with
physical testing and a blinded lipid panel if feasible. Cognitive testing
and disability screening will be conducted annually. Multiple data sources
will be queried for cardiovascular events, dementia, and disability;
survival is site-reported and supplemented by a National Death Index
search. The primary outcome is survival free of new dementia or persisting
disability. Co-secondary outcomes are a composite of cardiovascular death,
hospitalization for unstable angina or myocardial infarction, heart
failure, stroke, or coronary revascularization; and a composite of mild
cognitive impairment or dementia. Ancillary studies will offer mechanistic
insights into the effects of statins on key outcomes. Biorepository
samples are obtained and stored for future study. These results will
inform the benefit of statins for increasing survival free of dementia and
disability among older adults. This is a pioneering pragmatic study
testing important questions with low participant burden to align with the
needs of the growing population of older adults. Copyright © 2023
The American Geriatrics Society. This article has been contributed to by
U.S. Government employees and their work is in the public domain in the
USA.

<34>
Accession Number
2035606163
Title
Continuous vital sign monitoring on surgical wards: The COSMOS pilot.
Source
Journal of Clinical Anesthesia. 99 (no pagination), 2024. Article Number:
111661. Date of Publication: 01 Dec 2024.
Author
Anusic N.; Gulluoglu A.; Ekrami E.; Mascha E.J.; Li S.; Coffeng R.; Turan
A.; Clemens A.; Perez C.; Beard J.W.; Sessler D.I.; Rodriguez F.;
Mueller-Wirtz L.; Mueller C.M.; Slife M.; Mosqueda M.; Gatt R.; Nikoo
M.Z.; Cekmecelioglu B.T.; Kopac O.; Singh S.; Corrales Martinez M.J.;
Karki D.; Medellin S.; Erazo V.L.; Brooker J.; Rossler J.; Mukhia R.; Pu
X.
Institution
(Anusic, Gulluoglu, Ekrami) Research Fellow, OUTCOMES RESEARCH Consortium,
Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United
States
(Mascha) Staff Biostatistician, Department of Quantitative Health
Sciences, OUTCOMES RESEARCH Consortium, Department of Anesthesiology,
Cleveland Clinic, Cleveland, OH, United States
(Li) Statistical Programmer, Department of Quantitative Health Sciences,
OUTCOMES RESEARCH Consortium, Department of Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Coffeng) GE HealthCare - Patient Care Solutions, Helsinki, Finland
(Turan) Director, Outcomes Research Consortium, Professor of
Anesthesiology, Department of Anesthesiology and Center for OUTCOMES
RESEARCH, University of Texas Health Science Center, Houston, TX, United
States
(Clemens, Perez) Nurse Manager, Office of Nursing Research and Innovation,
Zielony Nursing Institute, Cleveland Clinic, Cleveland, OH, United States
(Beard) Chief Medical Officer, GE HealthCare - Patient Care Solutions,
Chicago, IL, United States
(Sessler) Vice-President for Clinical and Outcomes Research, Professor of
Anesthesiology, Department of Anesthesiology and Center for OUTCOMES
RESEARCH, University of Texas Health Science Center, Houston, TX, United
States
(Rodriguez, Mueller-Wirtz, Mueller, Slife, Mosqueda, Gatt, Nikoo,
Cekmecelioglu, Kopac, Singh, Corrales Martinez, Karki, Medellin, Erazo,
Brooker, Rossler, Mukhia, Pu) Outcomes Research Consortium, Department of
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Study objectives: Alerts for vital sign abnormalities seek to identify
meaningful patient instability while limiting alarm fatigue. Optimal vital
sign alarm settings for postoperative patients remain unknown, as is
whether alerts lead to effective clinical responses reducing vital sign
disturbances. We conducted a 2-phase pilot study to identify thresholds
and delays and test the hypothesis that alerts from continuous monitoring
reduce the duration of vital sign abnormalities. Design(s): Two-phase
pilot. Patient(s): 250 adults having major non-cardiac surgery.
 Setting(s): Surgical wards. Intervention(s): All patients had
routine vital sign monitoring by nurses at 4-h intervals. We initially
continuously recorded clinician-blinded saturation, heart rate, and
respiratory rate in 100 patients. In the second phase, we randomized 150
patients to blinded versus unblinded continuous vital sign monitoring. In
unblinded patients, nurses were verbally alerted to abnormal vital signs.
Measurements: In the first phase, we modeled expected alarm counts using
6082 h of continuous oxygen saturation, heart rate, and respiratory rate
data. Thresholds and delays targeting ~3 alarms per patient per day were
selected for phase two. Primary analysis assessed the effect of unblinded
monitoring across a 5-component primary composite of cumulative durations
of vital sign abnormalities. Secondary outcomes included fraction of
alerts deemed meaningful by nurses and number of clinical interventions.
 Result(s): In phase one, we identified alarm settings that yielded an
average of 2.3 alerts per patient per day. In phase two, the average
relative effect ratio of geometric duration means for vital signs
exceeding thresholds was 0.75 [95 % CI: 0.51, 1.1], P = 0.17. Sixty alarms
(82 %) were deemed useful in unblinded patients, leading to 60 % more
interventions in unblinded patients. Conclusion(s): We were able to
select continuous saturation, heart rate, and respiratory rate thresholds
that generated about 2 alerts per patient per day, nearly all of which
were considered useful by nurses. Unblinded monitoring and nursing alerts
led to interventions (mostly increasing oxygen delivery) that
non-significantly reduced vital sign abnormalities by 25 %.
ClinicalTrials.gov registration: NCT05280574. Copyright © 2024

<35>
Accession Number
2042055588
Title
The relationship between sleep disorders and postoperative delirium in
adult patients: Protocol for an updated systematic review and
meta-analysis.
Source
PLOS ONE. 20(12 December) (no pagination), 2025. Article Number: e0337598.
Date of Publication: 01 Dec 2025.
Author
Huang Q.; Shao C.; Peng L.; Wei W.
Institution
(Huang, Peng, Wei) Department of Anesthesiology, West China Hospital,
Sichuan University, Sichuan, Chengdu, China
(Huang) Department of Anesthesiology, Chengdu Women's and Children's
Central Hospital, School of Medicine, University of Electronic Science and
Technology of China, Sichuan, Chengdu, China
(Shao) Department of Anesthesiology, Chengdu integrated TCM & Western
Medicine Hospital, Sichuan, Chengdu, China
Publisher
Public Library of Science
Abstract
Introduction Postoperative delirium (POD) is a common complication after
surgery. The association between sleep disorders and the risk of POD has
been widely studied. Sleep disorders have emerged as a potential risk
factor for POD, but recent studies provide conflicting evidence regarding
the existence and the extent of the association. The aim of this
systematic review and meta-analysis will be to estimate the association
between sleep disorders and the risk of POD in adult patients. Methods and
analysis A systematic review will be conducted to estimate the association
between sleep disorders and the risk of POD in adult patients. This
systematic review protocol follows the Preferred Reporting Items for
Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement.
Literature searches will be carried out in the PubMed, Embase, CINAHL, and
PsycINFO databases from inception until August 2025 without language
restrictions. Only observational studies that investigated the association
between sleep disorders and POD will be included. Two independent
reviewers will be responsible for the selection of studies, extraction of
information and risk of bias assessment of the articles. A random effects
model will be used to calculate the pooled risk estimates for the outcome.
Subgroup analysis will be conducted to explore potential sources of
heterogeneity. Publication bias will be estimated by funnel plots and
Egger's test. Sensitivity analysis will also be performed to explore the
stability of the overall effect size. Also, evidence quality will be
assessed. All data will be analysed using Review Manager (V.5.3) and Stata
(V.14.0) statistical software. Discussion The proposed systematic review
and meta-analysis will highlight the association of sleep disorders and
the risk of POD in adult patients. The findings of this review and
meta-analysis will help clinicians consider the sleep disorders to make
better health decisions. Copyright © 2025 Huang 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.

<36>
Accession Number
2040433695
Title
Comparison of clopidogrel monotherapy versus prolonged DAPT based on the
GRACE risk score in patients with acute coronary syndromes at high
ischemic and bleeding risk: a subgroup analysis of the OPT-BIRISK
randomized clinical trial.
Source
European Journal of Pharmacology. 1006 (no pagination), 2025. Article
Number: 178151. Date of Publication: 05 Nov 2025.
Author
Zhang S.; Li J.; Qiu M.; Li Y.; Wang X.; Wang Z.; Su S.; Zhang Y.; Liu A.;
Han Y.
Institution
(Zhang, Li, Qiu, Li, Wang, Han) State Key Laboratory of Frigid Zone
Cardiovascular Disease, Department of Cardiology, The General Hospital of
Northern Theater Command, Shenyang, China
(Zhang) Postgraduate Training Base of the General Hospital of Northern
Theater of Operations, China Medical University, Shenyang, China
(Wang, Su) Xinxiang Central Hospital, Xinxiang, China
(Zhang) Xuzhou Cancer Hospital, Xuzhou, China
(Liu) Benxi Central Hospital, Benxi, China
Publisher
Elsevier B.V.
Abstract
Objective: This study assessed the effect of clopidogrel monotherapy
versus extended Dual antiplatelet therapy (DAPT) on outcomes in patients
with acute coronary syndromes (ACS) who have completed 9-12 months of DAPT
after Percutaneous Coronary Intervention (PCI) and meet both high bleeding
and high ischemia risk (birisk), stratified by Global Registry of Acute
Coronary Events (GRACE) risk score. Method(s): In the OPT-BIRISK
study, 7758 ACS Patients who completed 9-12 months of DAPT after PCI were
randomized either to clopidogrel monotherapy or extended DAPT. This
prespecified subgroup analysis categorized patients by GRACE score into
intermediate-high-risk (>88) and low-risk (<=88) groups. The primary
endpoint of the study was BARC 2, 3, or 5 bleeding. The key secondary
endpoint was the rate of major adverse cardio-cerebral events (MACCE; the
composite of all-cause death, myocardial infarction, stroke or clinically
driven revascularization). Finding(s): In low-risk patients, BARC 2,
3, or 5 bleeding occurred in 49 (2.7 %) with clopidogrel monotherapy
versus 69 (3.6 %) with extended DAPT (HR 0.73, 95 % CI 0.50-1.05; p =
0.088).In intermediate-high-risk patients, clopidogrel monotherapy versus
extended DAPT showed comparable BARC 2, 3, or 5 bleeding (2.3 % vs. 3.0 %;
HR 0.77, 95 % CI 0.52-1.14; p = 0.8377), but significantly reduced MACCE
(2.9 % vs. 4.1 %; HR 0.69, 95 % CI 0.49-0.97; p = 0.0332). In the overall
trial population, there was no significant interaction between the GRACE
score and treatment group for the primary or key secondary endpoints (P >
0.05 for all outcomes). Conclusion(s): Among birisk patients with
ACS, clopidogrel monotherapy was associated with lower incidence of all
bleeding events (BARC 1-5) versus extended DAPT regardless of GRACE score,
but showed no significant difference in BARC 2, 3, or 5 bleeding.
Moreover, it was associated with lower MACCE incidence versus extended
DAPT in intermediate-high-risk groups. Copyright © 2025

<37>
Accession Number
2040552390
Title
Retatrutide for the treatment of obesity, obstructive sleep apnea and knee
osteoarthritis: Rationale and design of the TRIUMPH registrational
clinical trials.
Source
Diabetes, Obesity and Metabolism. 28(1) (pp 83-93), 2026. Date of
Publication: 01 Jan 2026.
Author
Giblin K.; Kaplan L.M.; Somers V.K.; Le Roux C.W.; Hunter D.J.; Wu Q.;
Lalonde A.; Ahmad N.; Bethel M.A.
Institution
(Giblin, Wu, Ahmad, Bethel) Eli Lilly and Company, Indianapolis, IN,
United States
(Kaplan) The Obesity and Metabolism Institute, Boston, MA, United States
(Somers) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Le Roux, Lalonde) Diabetes Complications Research Centre, University
College Dublin, Dublin, Ireland
(Hunter) Sydney Musculoskeletal Health, Kolling Institute of Medical
Research, The University of Sydney, Sydney, NSW, Australia
(Hunter) Department of Rheumatology, Royal North Shore Hospital, Sydney,
NSW, Australia
Publisher
John Wiley and Sons Inc
Abstract
Aims: Retatrutide, a novel synthetic molecule, is a triple agonist
activating the glucose-dependent insulinotropic polypeptide, glucagon-like
peptide-1 and glucagon receptors. The TRIUMPH clinical development program
evaluates its safety and efficacy concurrently for the treatment of
obesity and two related complications-obstructive sleep apnea (OSA) and
knee osteoarthritis (OA). A novel basket trial design simultaneously
evaluates retatrutide treatment across these multiple adiposity-related
disease states. Material(s) and Method(s): TRIUMPH consists of four
Phase 3, multicenter, randomized, double-blind studies assessing weekly
subcutaneous retatrutide compared to placebo, in conjunction with healthy
diet and physical activity in over 5800 participants. The four trials
consist of two weight management basket trials (TRIUMPH-1 and TRIUMPH-2)
with OSA and/or OA protocols nested within the weight management trial;
one weight management trial in a population with CVD (TRIUMPH-3); and one
stand-alone OA trial (TRIUMPH-4). The primary endpoint for weight
management is percent change in body weight, for OSA is change in
Apnea-Hypopnea Index and for knee OA includes change in the Western
Ontario and McMaster Universities Osteoarthritis Index pain subscale
score. The basket trial permits independent analysis of weight management,
OSA and OA studies with type I error rate controlled at alpha = 0.05,
split between the overarching weight management and each basket trial.
 Conclusion(s): By recruiting participants with shared disease
exposures, the TRIUMPH program will assess the safety and efficacy of
retatrutide for the treatment of adults with obesity and two of its common
complications-OSA and OA. Copyright © 2025 Eli Lilly and Company
and The Author(s). Diabetes, Obesity and Metabolism published by John
Wiley & Sons Ltd.

<38>
Accession Number
2039776713
Title
A Prospective, Multicentre Randomised Controlled Study of Angiographic and
Clinical Outcomes in Total Arterial Coronary Bypass Grafting: The TA Trial
Protocol.
Source
Heart Lung and Circulation. 34(12) (pp 1478-1486), 2025. Date of
Publication: 01 Dec 2025.
Author
Royse A.; Ren J.; Bowyer A.; Reid C.M.; Bellomo R.; Smith J.A.; Bannon P.;
Eccleston D.; Vallely M.; Lui E.; Ludbrook G.; Clarke S.; Tian D.H.; Royse
C.
Institution
(Royse, Ren, Bowyer, Tian, Royse) Department of Surgery, The University of
Melbourne, Melbourne, VIC, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Royse) Department of Surgery, Universiti Kebangsaan Malaysia, Kuala
Lumpur, Malaysia
(Bowyer, Royse) Department of Anesthesia and Pain Management, Royal
Melbourne Hospital, Melbourne, VIC, Australia
(Bowyer, Royse) Outcomes Research, University of Texas Heath, Houston, TX,
United States
(Reid) Population Health, Curtin University, Perth, WA, Australia
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, VIC, Australia
(Bellomo) Department of Anaesthesia, Austin Health, Melbourne, VIC,
Australia
(Smith) Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, VIC, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne,
VIC, Australia
(Bannon) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, NSW, Australia
(Bannon) Faculty of Medicine and Health, Central Clinical School, The
University of Sydney, Sydney, NSW, Australia
(Eccleston) Department of Cardiology, Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Eccleston) Department of Medicine, The University of Melbourne,
Melbourne, VIC, Australia
(Vallely) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, NSW, Australia
(Vallely) Faculty of Medicine, Macquarie University, Sydney, NSW,
Australia
(Lui) Department of Medical Imaging, Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Lui) Department of Radiology, The University of Melbourne, Melbourne,
VIC, Australia
(Ludbrook) Discipline of Acute Care Medicine, The University of Adelaide,
Adelaide, SA, Australia
(Clarke) Statistical Consulting Centre, The University of Melbourne,
Melbourne, VIC, Australia
(Tian) Department of Anesthesia and Perioperative Medicine, Westmead
Hospital, Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background & Aim: Conventional coronary artery bypass grafting (CABG)
procedures typically utilise the left internal mammary artery and
supplementary saphenous vein grafts (SVGs) to re-establish adequate
coronary blood flow to ischaemic territories. However, extensive
observational studies have consistently demonstrated that SVGs are prone
to accelerated atherosclerosis and progressive failure compared to
arterial conduits. These limitations have heightened interest in total
arterial revascularisation (TAR) as a potentially superior strategy.
 Objective(s): The Total Arterial (TA) Trial, fully funded through the
Medical Research Future Fund Cardiovascular Health Mission, aims to
determine the angiographic and clinical outcomes of TAR compared to
conventional non-TAR operations. Method(s): Design: This study is an
open-label, multicentre, randomised controlled trial including 1,000 CABG
patients from multiple cardiac institutions across Australia, with an
allocation ratio of 1:1. Randomisation occurs at a standardised
perioperative time point via computer-generated sequences with variable
block size The trial does not impose specific procedural requirements
regarding the type of arterial conduit, revascularisation or
reconstruction technique, use of sequential or composite methods, or any
perioperative management. Intervention(s): Total arterial CABG with
no use of SVG. Control: Non-total-arterial CABG with at least one SVG.
Main outcomes: The primary endpoint will be perfect graft patency at 24
months postoperatively. The secondary endpoints include patency, major
adverse cardiac and cerebrovascular events, quality of life, all-cause and
cardiac mortality. Clinical follow-up visits will be scheduled at 6-month
intervals, and angiographic assessments at 3 months and 24 months.
Subgroup analyses by diabetes, sex, age, and conduit types are proposed to
examine the potential interactions with treatment effects.
 Conclusion(s): The TA Trial is one of the largest multicentre trials
in the field of coronary revascularisation research, evaluating the graft
status and clinical endpoints of TAR versus non-TAR procedures. The study
design will provide valuable insights into whether differences in graft
failure of SVG translate into differences in survival and cardiac
outcomes. Early postoperative coronary angiography may improve
understanding of the impact of competitive flow on graft function. The
findings from this study will contribute to an improved understanding and
help inform the optimal approach for coronary revascularisation,
supporting evidence-based improvements in patient care. Ethics: Ethical
approval has been granted by the Melbourne Health Institutional Review
Board (HREC/92839/MH-2023), Australia. Trial registration: The trial has
been registered under the Australian New Zealand Clinical Trial Registry
(registration number: ACTRN12623000864628). Dissemination of results: The
analysed results will be published in a peer-reviewed journal on
completion of the clinical trial. Copyright © 2025

<39>
Accession Number
2041417464
Title
Rationale and design of REAC-TAVI 2: Single antiplatelet treatment with
ticagrelor vs aspirin after transcatheter aortic valve implantation.
Source
American Heart Journal. 292 (no pagination), 2026. Article Number: 107293.
Date of Publication: 01 Feb 2026.
Author
Hemelrijk K.I.; Jimenez-Diaz V.A.; Vilchez J.P.; Oteo J.F.; Gomez-Blazquez
I.; Sabate M.; Vilalta V.; Jofresa A.B.; Asmarats L.; Amat-Santos I.J.;
Tello-Montoliu A.; de la Torre Hernandez J.M.; Flores X.; Gheorghe L.;
Peral V.; Munoz-Garcia A.J.; Alfonso F.; Tirado-Conte G.; Brugaletta S.;
Veiga G.; Rodriguez-Gabella T.; Regueiro A.; De Lara J.G.; Valle-Fernandez
R.D.; Nodar J.M.R.; Mazuecos J.J.; Pan M.; Baz J.A.; Fernandez J.F.D.;
Guerreiro C.; Jorge E.; Silva M.T.; Marques J.S.; Rodrigues I.; Neves D.;
Braga J.P.; Testa L.; Costa G.; Stefanini G.; Pesarini G.; Sisinni A.;
Capodanno D.; Ribichini F.; Salvadores P.J.; Delewi R.; Angiolillo D.J.;
Garcia-Garcia H.M.; Iniguez A.; Nombela-Franco L.
Institution
(Hemelrijk, Tirado-Conte, Nombela-Franco) Cardiovascular Institute,
Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del
Hospital Clinico San Carlos (IdISSC), Madrid, Spain
(Hemelrijk, Delewi) Heart Center, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Jimenez-Diaz, Baz, Salvadores, Iniguez) Department of Cardiology,
Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
(Vilchez) Hospital Universitario y Politecnico la Fe de Valencia,
Valencia, Spain
(Oteo) Hospital Universitario Puerta de Hierro-Majadahonda, Spain
(Gomez-Blazquez) Department of Cardiology, Hospital Universitario 12 de
Octubre. Instituto de Investigacion Sanitaria Hospital 12 de Octubre
(imas12), Madrid, Spain
(Sabate, Brugaletta, Regueiro) Department of Cardiology, Cardiovascular
Institute, Hospital Clinic of Barcelona, Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), CIBER-CV, Spain
(Vilalta) Department of Interventional Cardiology, Germans Trias i Pujol
University Hospital, Badalona, Spain
(Jofresa) Servicio de Cardiologia, Consorcio Hospital General
Universitario de Valencia, Spain
(Asmarats) Department of Cardiology, Hospital Santa Creu i Sant Pau,
Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain
(Amat-Santos) CIBERCV, Instituto de Ciencias del Corazon (ICICOR),
Hospital Clinico Universitario de Valladolid, Valladolid, Spain
(Tello-Montoliu, De Lara) Servicio de Cardiologia, Hospital Universitario
Virgen de la Arrixaca, Murcia, Spain
(de la Torre Hernandez, Veiga) Hospital Universitario Marques de
Valdecilla, IDIVAL, Santander, Spain
(Flores) Hospital Universitario de A Coruna, Spain
(Gheorghe) Department of Cardiology, Hospital Universitario Puerta del
Mar, Cadiz, Spain
(Peral, Rodriguez-Gabella) Department of Cardiology University Hospital
Son Espases, Health Research Institute of the Balearic Islands (IdISBa),
Balearic Islands, Palma, Spain
(Munoz-Garcia) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Alfonso) Department of Cardiology. Hospital Universitario de la Princesa.
CIBER-CV. IIS-IP. Universidad Autonoma de Madrid. Madrid, Spain
(Valle-Fernandez) Department of Cardiology. Asturias Central University
Hospital, Oviedo, Spain
(Nodar) Department of Cardiology. Hospital General Universitario de
Alicante, Instituto de Investigacion Sanitaria y Biomedica de Alicante
ISABIAL, CIBER-CV, Alicante, Spain
(Mazuecos) Complejo Hospitalario Universitario Albacete, Albacete, Spain
(Pan) Department of Cardiology. Hospital Universitario Reina Sofia,
IMIBIC, CIVERCV, Cordoba, Spain
(Fernandez) Department of Cardiology. Hospital Universitario Virgen del
Rocio. Sevilla, Spain
(Guerreiro, Braga) Department of Cardiology, Vila Nova de Gaia/Espinho
Hospital Center, Vila Nova de Gaia, Portugal
(Jorge) Department of Cardiology, ULS Coimbra, Portugal/ Faculty of
Medicine, University of Coimbra, Coimbra, Portugal
(Silva) Department of Cardiology, ULS Sao Joao, EPE, RISE-Health, Surgegy
and Physiology Department, Faculty of Medicine, University of Porto,
Porto, Portugal
(Marques) Department of Cardiology, ULS Santa Maria Hospital, Lisbon,
Portugal
(Rodrigues) Cardiology Department, Hospital de Santa Marta, Centro
Hospitalar de Lisboa Central, Lisbon, Portugal
(Neves) Servico de Cardiologia, Hospital Espirito Santo, Evora, Portugal
(Testa, Sisinni) IRCCS Policlinico San Donato, Milan, San Donato Milanese,
Italy
(Costa, Capodanno) Division of Cardiology, Azienda
Ospedaliero-Universitaria "G. Rodolico-San Marco", University of Catania,
Catania, Italy
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Milan, Pieve Emanuele, Italy
(Stefanini) IRCSS Humanitas Research Hospital, Milan, Rozzano, Italy
(Pesarini, Ribichini) Division of Cardiology, Department of Medicine,
Verona University Hospital, Verona, Italy
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Garcia-Garcia) Department of Interventional Cardiology at MedStar
Washington Hospital Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background Patients undergoing transcatheter aortic valve implantation
(TAVI) frequently experience life-threatening ischemic and bleeding
complications. However, management of antithrombotic therapy after TAVI in
patients without oral anticoagulation (OAC), particularly in patients with
high burden for subsequent ischemic events, has limited evidence from
randomized controlled trials. Methods The REAC TAVI2 trial is a
prospective, multicenter, open-label, phase III randomized trial
(NCT05283356). A total of 1206 patients undergoing TAVI with high ischemic
risk (defined as concomitant coronary artery disease, diabetes mellitus or
peripheral vascular disease) will be randomized in a 1:1 ratio to single
antiplatelet therapy with aspirin (100 mg once daily) or low-dose
ticagrelor (60 mg twice daily). The primary endpoint is the incidence of a
net adverse clinical event (NACE) at 1-year after TAVI. NACE is defined as
a composite of all-cause mortality, cerebrovascular events, myocardial
infarction, progressive angina leading to emergency evaluation,
rehospitalization or new coronary angiogram, clinical valve thrombosis,
acute limb ischemia leading to hospitalization, and type 2, 3, or 5
bleeding. The secondary endpoint is the incidence of subclinical valve
thrombosis detected by hypo-attenuated leaflet thickening and reduced
leaflet motion at 3 and 12 months post-TAVI assessed by 4-dimensional
computed tomography. Summary In patients undergoing TAVI without an
indication for OAC, there is a need for antiplatelet therapy that provides
protection against ischemic events without increasing bleeding,
particularly in the subset of patients at heightened risk of ischemic
events. The REAC-TAVI 2 is a randomized multicenter clinical trial
designed to study the effect of single antiplatelet therapy with aspirin
compared to low-dose ticagrelor on a composite outcome of all-cause
mortality, ischemic, and bleeding events after TAVI. Copyright ©
2025 Elsevier Inc.

<40>
[Use Link to view the full text]
Accession Number
2041691199
Title
Multivariable Prediction Models for Atrial Fibrillation after Cardiac
Surgery: A Systematic Review and Critical Appraisal.
Source
Anesthesiology. 143(6) (pp 1643-1655), 2025. Date of Publication: 18 Nov
2025.
Author
Fields K.G.; Milner G.D.M.; Ma J.; Dhiman P.; Redfern O.C.; Karamnov S.;
He J.; Gerry S.; Alhassan H.; Providencia R.; Lip G.Y.H.; Bedford J.P.;
Clifton D.A.; O'Brien B.; Watkinson P.J.; Collins G.S.; Muehlschlegel J.D.
Institution
(Fields) Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Milner) Kadoorie Centre for Critical Care Research and Education,
Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, United Kingdom
(Ma) Centre for Statistics in Medicine, Nuffield Department of
Orthopedics, Rheumatology and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Dhiman) Centre for Statistics in Medicine, Nuffield Department of
Orthopedics, Rheumatology and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Redfern) Kadoorie Centre for Critical Care Research and Education,
Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, United Kingdom
(Karamnov) Department of Anesthesiology, Perioperative and Pain Medicine,
University of Massachusetts, Chan Medical School, Worcester,
Massachusetts, United States
(He) Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopedics, Rheumatology and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Alhassan) Division of Cardiology, Department of Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,
United States
(Providencia) Institute of Health Informatics Research, University College
London, London, United Kingdom
(Providencia) Department of Cardiac Electrophysiology, Barts Heart Centre,
St. Bartholomew's Hospital, Barts Health National Health Service Trust,
London, United Kingdom
(Lip) Liverpool Centre for Cardiovascular Science at University of
Liverpool, Liverpool John Moores University and Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Lip) Department of Clinical Medicine, Aalborg University, Aalborg,
Denmark
(Bedford) Kadoorie Centre for Critical Care Research and Education,
Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, United Kingdom
(Clifton) Institute of Biomedical Engineering, Department of Engineering
Science, University of Oxford, Oxford, United Kingdom
(Clifton) Oxford Suzhou Centre for Advanced Research, University of
Oxford, Suzhou, China
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Deutsches Herzzentrum der Charite, Charite Universitatsmedizin
Berlin, Berlin, Germany
(O'Brien) Department of Perioperative Medicine, St. Bartholomew's Hospital
and Barts Heart Centre, Barts Health National Health Service Trust,
London, United Kingdom
(O'Brien) Outcomes Research Consortium, UTHealth, Houston, Texas, United
States
(Watkinson) Kadoorie Centre for Critical Care Research and Education,
Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, United Kingdom
(Watkinson) Oxford University Hospitals National Health Service Trust,
Oxford, United Kingdom
(Watkinson) National Institute for Health and Care Research Biomedical
Research Centre, Oxford University Hospitals National Health Service
Foundation Trust, Oxford, United Kingdom
(Collins) Centre for Statistics in Medicine, Nuffield Department of
Orthopedics, Rheumatology and Musculoskeletal Sciences, University of
Oxford, Oxford, United Kingdom
(Muehlschlegel) Department of Anesthesiology and Critical Care Medicine,
Johns Hopkins University School of Medicine, Baltimore, Maryland, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Atrial fibrillation is a common complication of cardiac surgery. Multiple
models exist to estimate the risk of atrial fibrillation after cardiac
surgery (AFACS) and improve targeting of preventative measures, yet none
have been consistently adopted into clinical use. This study performed a
comprehensive systematic review, assessing quality and risk of bias of
studies describing the development or external validation of AFACS
prediction models. Although some models performed well in development and
external validation (median C-statistic for apparent validation alone,
0.71; range, 0.60 to 0.98; external validation, 0.61; range, 0.51 to
0.77), all model analyses were rated at high risk of bias. Common causes
for this were small sample size, data-driven predictor selection, and
inadequate internal validation. Overall, no individual model could be
recommended for clinical use given the methodologic limitations
identified, emphasizing the need for improvements in future AFACS
prediction models to facilitate improved targeting of
prophylaxis. Copyright © 2025

<41>
Accession Number
2042118484
Title
Development of a Cellular Senescence-Related Risk Model as a Prognostic
Biomarker and Immunotherapy Response in Lung Squamous Cell Carcinoma.
Source
Journal of the College of Physicians and Surgeons Pakistan. 35(12) (pp
1546-1556), 2025. Date of Publication: 01 Dec 2025.
Author
Kang K.; Wang S.; Liang X.; Mao Y.
Institution
(Kang, Wang) Department of Thoracic Surgery, Hubei Cancer Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Hubei,
China
(Liang) Department of Abdominal Oncology, Hubei Cancer Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Hubei,
China
(Mao) Shanghai Pulmonary Hospital, Tongji University School of Medicine,
Shanghai, China
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Objective: To identify cellular senescence-associated genes in lung
squamous cell carcinoma (LUSC) and explore their relationship with tumour
microenvironment, immunotherapy response, and prognosis. Study
Design: An observational study. Place and Duration of the Study:
Department of Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Hubei, China, from
September to October 2023. Methodology: Prognostic genes and clinical
information of LUSC were derived from the Cancer Genome Atlas (TCGA).
Subsequently, R packages were used to obtain differentially expressed
genes (DEGs) associated with cellular senescence prognosis. In addition,
univariate and least absolute shrinkage and selection operator (LASSO) Cox
regression analyses were used to construct cellular senescence-related
gene signatures to determine the degree of risk. Sensitivity to immune
checkpoint inhibitors (ICI) was evaluated according to the median risk
score, which served as an independent prognostic factor. Result(s):
By univariate Cox regression analysis of gene expression data and overall
survival data in the TCGA-LUSC cohort, 11 DEGs associated with prognostic
cellular senescence were identified. The ageing prognostic models include
genes of IGFBP1, SERPINE1, SIX1, and TRPM8. Tumour immune dysfunction and
exclusion (TIDE) score and tumour mutation burden (TMB) score were better
in the low-risk group, with advantages in terms of prognostic and
immunotherapy response rate. Conclusion(s): The results suggest that
senescence-related determinants are involved in the tumour
microenvironment through senescence-related secretory phenotypes and can
be used as reliable biomarkers for LUSC immunotherapy and
prognosis. Copyright © 2025 College of Physicians and Surgeons
Pakistan. All rights reserved.

<42>
Accession Number
2041403127
Title
Surgical complications of cardiac implantable electronic devices: a
systematic review and meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1667583. Date of Publication: 2025.
Author
Suarez-Paul I.; Redondo-Castro B.; Gutierrez Pastor J.M.; Membrive-Jimenez
M.J.; Caballero-Mateos A.; Romero-Bejar J.L.; Canadas-De la Fuente G.A.
Institution
(Suarez-Paul) San Agustin University Hospital, Department of Intensive
Care, Andalusian Health Service, Linares, Spain
(Redondo-Castro) Son Llatzer Hospital, Balearic Islands Health Service,
Palma, Spain
(Gutierrez Pastor, Canadas-De la Fuente) Faculty of Health Sciences,
University of Granada, Granada, Spain
(Membrive-Jimenez) Faculty of Health Sciences of Ceuta, University of
Granada, Ceuta, Spain
(Caballero-Mateos) Department of Gastroenterology, San Cecilio University
Hospital, Andalusian Health Service, Granada, Spain
(Caballero-Mateos) Department of Internal Medicine, Gastroenterology
Section, Santa Ana Hospital, Andalusian Health Service, Granada, Spain
(Romero-Bejar) Department of Statistics and Operations Research,
University of Granada, Granada, Spain
(Romero-Bejar) Instituto de Investigacion Biosanitaria (ibs. GRANADA),
Granada, Spain
(Romero-Bejar) Institute of Mathematics, University of Granada (IMAG),
Granada, Spain
(Canadas-De la Fuente) Brain, Mind and Behaviour Research Center (CIMCYC),
University of Granada, Campus Universitario de Cartuja, Granada, Spain
Publisher
Frontiers Media SA
Abstract
Aim: To identify the most common complications that occur after the
implantation of a permanent pacemaker, and to estimate their prevalence.
 Method(s): systematic review and meta-analysis. Selection
Criteria: quantitative primary sources, written in English, no age
restriction, published between 1 January 2018 and 1 March 2025.
Information sources: This 30 systematic review is based on a search of the
PubMed scientific database, using descriptors from the MESH thesaurus in
the following search equation: "Pacemaker, artificial AND Surgery AND
Postoperative complications". Risk of Bias: Studies were assessed
following the Mixed Methods Appraisal Tool (MMAT) guidelines. Results
synthesis: descriptive analysis was used for the systematic review and
random effects meta-analysis were performed. Result(s): Pacemaker
implantation is a fairly common intervention, but it is not free of
complications. The most frequent are pacemaker pocket infection, contusion
or haematoma at the insertion site, painful shoulder and displacement of
the generator or electrodes. Conclusion(s): It is important to take
into account the patient's medical history and comorbidities, in order to
match the device and its upkeep to the patient's characteristics, in order
to minimise the risk of complications. Copyright 2025 Suarez-Paul,
Redondo-Castro, Gutierrez Pastor, Membrive-Jimenez, Caballero-Mateos,
Romero-Bejar and Canadas-De la Fuente.

<43>
Accession Number
2040980108
Title
Renal Function-Stratified Comparison of Complete vs Culprit-Only
Revascularization in Older Patients With Myocardial Infarction and
Multivessel Disease.
Source
JACC: Cardiovascular Interventions. 18(23) (pp 2849-2859), 2025. Date of
Publication: 08 Dec 2025.
Author
Cantone A.; Verardi F.M.; Vadala G.; Guiducci V.; Casella G.; Cavazza C.;
Cerrato E.; Sacchetta G.; Moreno R.; Serenelli M.; Amat Santos I.; Diez
Gil J.L.; Scarsini R.; Picchi A.; Cocco M.; Colaiori I.; Barbierato M.;
Arioti M.; Marchini F.; Pavasini R.; Caglioni S.; Lanzilotti V.; Menozzi
M.; Erriquez A.; Campo G.; Biscaglia S.
Institution
(Cantone, Verardi, Serenelli, Cocco, Marchini, Pavasini, Caglioni,
Erriquez, Campo, Biscaglia) Cardiology Unit, Azienda Ospedaliero
Universitaria di Ferrara, Ferrara, Italy
(Vadala) Azienda Ospedaliero Universitaria Policlinico Paolo Giaccone,
Palermo, Italy
(Guiducci) Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, S. Maria
Nuova Hospital, Reggio Emilia, Italy
(Casella, Lanzilotti) Cardiology Unit, Ospedale Maggiore, Bologna, Italy
(Cavazza, Menozzi) Cardiovascular Department, Infermi Hospital, Rimini,
Italy
(Cerrato) Interventional Cardiology Unit, San Luigi Gonzaga University
Hospital, Orbassano, and Rivoli Infermi Hospital ASLTO3, Turin, Rivoli,
Italy
(Sacchetta) Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa,
Italy
(Moreno) Centro de Investigacion Biomedica en Red en Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain, Instituto de Investigacion
Hospital La Paz (IDIPAZ), University Hospital La Paz, Madrid, Spain
(Amat Santos) Centro de Investigacion Biomedica en Red en Enfermedades
Cardiovasculares (CIBERCV), Cardiology Department, Hospital Clinico
Universitario, Valladolid, Spain
(Diez Gil) Centro de Investigation Biomedica end Red en Enfermedades
Cardiovasculares, Cardiology Department, H. Universitario y Politecnico La
Fe, Valencia, Spain
(Scarsini) Azienda Ospedaliero Universitaria Integrata di Verona, Verona,
Italy
(Picchi) Cardiovascular Department, Azienda Unita Sanitaria Locale (AUSL)
Toscana Sud-Est, Misericordia Hospital, Grosseto, Italy
(Colaiori) Cardiology Unit, Ospedale Santa Maria Goretti, Latina, Italy
(Barbierato) Interventional Cardiology, Department of Cardio-Thoracic and
Vascular Sciences, Ospedale dell'Angelo, (Venice), Mestre, Italy
(Arioti) Ospedale Santa Maria delle Croci, AUSL Romagna, Ravenna, Italy
Publisher
Elsevier Inc.
Abstract
Background Chronic kidney disease is a major risk factor for
cardiovascular events and complicates revascularization decisions in
patients with myocardial infarction (MI). However, data on optimal
strategies in this population remain limited. Objectives The authors
sought to determine whether the benefits of physiology-guided complete
revascularization are consistent across subpopulations of older MI
patients stratified by renal function. Methods In the FIRE (Functional
Assessment in Elderly MI Patients with Multivessel Disease (FIRE) trial,
1,445 patients aged >=75 years with MI and multivessel disease were
randomized to receive physiology-guided complete or culprit-only
revascularization. Patients were stratified based on baseline estimated
glomerular filtration rate (eGFR) (>=60 vs <60 mL/min/1.73 m2).
The primary outcome was a 3-year composite of death, MI, stroke, or
ischemia-driven revascularization. Results A total of 662 patients (45.8
%) had eGFR <60 mL/min/1.73 m2. The primary endpoint occurred
in 222 patients (33.5%) with eGFR <60 vs 159 patients (20.3%) with eGFR
>=60 mL/min/1.73 m2. Lower eGFR was independently associated
with higher risk of the primary endpoint (adjusted HR: 1.42; 95% CI:
1.15-1.76; P < 0.001). Complete revascularization reduced the primary
endpoint in both subgroups (HR: 0.68; 95% CI: 0.52-0.89 for patients with
eGFR <60 mL/min/1.73 m2; HR: 0.80; 95% CI: 0.59-1.10 for those
with eGFR >=60 mL/min/1.73 m2) without significant interaction
( P > 0.42). HR for complete vs culprit-only revascularization remained
stable across the continuous eGFR range. Contrast-associated acute kidney
injury occurred in 245 patients (17%), increased progressively across
Kidney Disease: Improving Global Outcomes (KDIGO) stages ( P < 0.001), and
was similar between treatment arms (HR: 1.11; 95% CI: 0.87-1.43).
Conclusions Kidney function remains a strong prognostic factor in older MI
patients. Physiology-guided complete revascularization is effective
regardless of renal function and may provide greater absolute clinical
benefit in patients with chronic kidney disease due to their elevated
baseline risk. Copyright © 2025. Published by Elsevier Inc.

<44>
Accession Number
2041620016
Title
Effects of Different Concentrations of Inhaled Oxygen on Lung Collapse and
Oxidative Stress in Patients With One Lung Ventilation, a Single-Center
Prospective, Double-Blinded, Randomized Controlled Trial.
Source
Health Science Reports. 8(12) (no pagination), 2025. Article Number:
e71600. Date of Publication: 01 Dec 2025.
Author
Zhao D.; Wu C.; Zhu H.; Lin J.; Zhang W.; Fang J.
Institution
(Zhao) Department of Anesthesiology, ShenZhen People's Hospital (The
Second Clinical Medical College, Jinan University; The First Affiliated
Hospital, Southern University of Science and Technology), Shenzhen,
Guangdong, China
(Zhao, Wu, Zhang, Fang) Department of Anesthesia, the First Affiliated
Hospital, Sun yat-sen University, Guangzhou, China
(Zhu) Department of thoracic surgery, the First Affiliated Hospital, Sun
yat-sen University, Guangzhou, China
(Lin) Department of Anesthesia, Guangzhou Women and Children's Medical
Center, Guangzhou Medical University, Guangzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Background: During thoracoscopic surgery, the anestheologist assure an
adequate oxygen supply to the body, but at the same time, to improve the
surgical field by completely collapsing the lung on the surgical side.
However, incomplete lung collapse remains problematic. Increasing the
inhaled oxygen concentration might accelerate gas dispersion from the
alveoli, but continuous high oxygen may aggravate oxidative stress. The
selection of inhaled oxygen concentration during OLV is still
controversial. This study intends to explore this issue from the
perspective of collapse effect and the degree of oxidative stress.
 Method(s): This study included patients aged 18-65 undergoing
thoracoscopic lobectomy, divided into two groups: one receiving 70% oxygen
(70% group) and the other 100% oxygen (100% group) during surgery. Lung
collapse was evaluated upon camera entry into the chest cavity, and blood
samples were collected preoperatively, 30 min after OLV, and on the second
postoperative day. Result(s): Both groups were similar in baseline
characteristics. The 100% oxygen group showed significantly greater
declines in lung volume and elasticity scores at 5 and 10 min
post-thoracic entry compared to the 70% group (p < 0.05). Oxygenation was
significantly lower in the 70% group post-OLV (p < 0.05) during surgery,
and oxidative stress markers were higher in the 100% group during surgery
(p < 0.05). By the second postoperative day, oxidative stress markers
increased in both groups with no significant difference. There was no
significant difference in safety outcomes between the two groups of
patients. Conclusion(s): High/pure inhaled oxygen may improve the
lung collapse speed and provide a better field of vision for thoracic
surgery. Although pure oxygen ventilation aggravated short-term oxidative
stress, the effect was insignificant on the second postoperative
day. Copyright © 2025 The Author(s). Health Science Reports
published by Wiley Periodicals LLC.

<45>
Accession Number
2040958321
Title
Tricuspid Valve Transcatheter Edge-to-Edge Repair in Patients With Cardiac
Implantable Electronic Devices.
Source
JACC: Cardiovascular Interventions. 18(23) (pp 2878-2891), 2025. Date of
Publication: 08 Dec 2025.
Author
von Stein J.; von Stein P.; Pfister R.; Kresoja K.-P.; Fortmeier V.; Koell
B.; Rottbauer W.; Kassar M.; Goebel B.; Denti P.; Achouh P.; Rassaf T.;
Barreiro-Perez M.; Boekstegers P.; Ruck A.; Zdanyte M.; Adamo M.; Vincent
F.; Schlegel P.; Rosch S.; Wild M.G.; Besler C.; Toggweiler S.; Brunner
S.; Grapsa J.; Patterson T.; Thiele H.; Kister T.; Tarantini G.; Masiero
G.; De Carlo M.; Sticchi A.; Voss F.; Polzin A.; Rubbio A.P.; Bedogni F.;
Stolte T.; Nestelberger T.; Benito Gonzalez T.; Konstandin M.H.; Van Belle
E.; Metra M.; Geisler T.; Estevez-Loureiro R.; Mahabadi A.A.; Karam N.;
Maisano F.; Lauten P.; Praz F.; Kessler M.; Kalbacher D.; Rudolph V.; Lurz
P.; Granada J.F.; Hausleiter J.; Stolz L.; Iliadis C.
Institution
(von Stein, von Stein, Pfister, Iliadis) Department of Cardiology, Heart
Center, University of Cologne, Cologne, Germany
(von Stein, von Stein, Granada) Cardiovascular Research Foundation, New
York, NY, United States
(Kresoja, Rosch, Lurz) Department of Cardiology, Cardiology I, University
Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany
(Fortmeier, Kassar, Rudolph) Clinic for General and Interventional
Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Universitatsklinik
der Ruhr-Universitat Bochum, Medizinische Fakultat OWL (Universitat
Bielefeld), Bad Oeynhausen, Germany
(Koell, Kalbacher) Department of Cardiology, University Heart and Vascular
Centre Hamburg, Hamburg, Germany
(Koell, Kalbacher) German Center of Cardiovascular Research, Partner Site
Hamburg/Kiel/Lubeck, Hamburg, Germany
(Rottbauer, Kessler) Department of Cardiology, University Heart Center
Ulm, Ulm, Germany
(Kassar) Department of Cardiology, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
(Kassar, Praz) Graduate School for Health Sciences, University of Bern,
Bern, Switzerland
(Goebel, Lauten) Department of Cardiology, Heart Center, Zentralklinik Bad
Berka, Bad Berka, Germany
(Denti, Metra, Maisano) Heart Valve Center, Cardio-Thoracic-Vascular
Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Achouh, Karam) Cardiology Department, European Hospital Georges Pompidou,
Universite Paris Cite, Paris, France
(Rassaf, Mahabadi) University Hospital Essen, University of
Duisburg-Essen, West German Heart and Vascular Center, Department of
Cardiology and Vascular Medicine, Essen, Germany
(Barreiro-Perez, Estevez-Loureiro) Hospital Alvaro Cunqueiro, Vigo, Spain
(Boekstegers) Department of Cardiology, Helios Klinikum Siegburg,
Siegburg, Germany
(Ruck) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
(Zdanyte, Geisler) Medical Clinic III, University Hospital Tubingen,
Tubingen, Germany
(Adamo) ASST Spedali Civili di Brescia and Department of Medical and
Surgical Specialties, Radiological Sciences, and Public Health, University
of Brescia, Brescia, Italy
(Vincent, Van Belle) Cardiology Department, Centre Hospitalier
Universitaire de Lille, Lille, France
(Schlegel, Konstandin) Division of Cardiology, Department of Internal
Medicine III, University Hospital Heidelberg, Ruprecht-Karl University
Heidelberg, Heidelberg, Germany
(Wild, Besler) University Heart Center Freiburg/Bad Krozingen, Bad
Krozingen, Germany
(Toggweiler, Brunner) Heart Center Lucerne, Luzerner Kantonsspital,
Lucerne, Switzerland
(Grapsa, Patterson) Department of Cardiology, Guy's and St. Thomas' NHS
Trust, London, United Kingdom
(Thiele, Kister) Department of Cardiology, Heart Center Leipzig at Leipzig
University, Leipzig, Germany
(Tarantini, Masiero) Department of Cardiac, Thoracic Vascular Sciences and
Public Health, University of Padua, Padua, Italy
(De Carlo, Sticchi) Cardiothoracic and Vascular Department, Azienda
Ospedaliero-Universitaria Pisana, Pisa, Italy
(Voss, Polzin) Department of Cardiology, Pulmonology and Angiology,
Medical Faculty, Heinrich Heine University of Dusseldorf, Dusseldorf,
Germany
(Rubbio, Bedogni) Department of Cardiology, IRCCS Policlinico San Donato,
San Donato Milanese, Milan, Italy
(Stolte, Nestelberger) Department of Cardiology and Cardiovascular
Research Institute Basel, University Hospital Basel, University of Basel,
Basel, Switzerland
(Benito Gonzalez) Departamento de Cardiologia, Complejo Asistencial
Universitario de Leon, Leon, Spain
(Hausleiter, Stolz) Medizinische Klinik und Poliklinik I, LMU Klinikum,
LMU Munchen, Munich, Germany
(Hausleiter, Stolz) German Center for Cardiovascular Research, Partner
Site Munich Heart Alliance, Munich, Germany
Publisher
Elsevier Inc.
Abstract
Background Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is
increasingly used in patients with severe tricuspid regurgitation (TR) at
high surgical risk. Long-term outcomes in those with transvalvular cardiac
implantable electronic devices (CIEDs) remain insufficiently
characterized. Objectives The aim of this study was to evaluate procedural
and clinical outcomes of T-TEER in patients with CIED leads in a
real-world cohort. Methods Among 3,025 patients undergoing T-TEER at 26
centers (2016-2024), 851 (28.1%) had transvalvular CIED leads. Residual TR
at discharge and follow-up and the composite of all-cause mortality or
heart failure hospitalization at 2 years were assessed. CIED function was
evaluated preprocedure and postprocedure. Propensity score matching (1:1)
was conducted to compare outcomes between patients with and those without
CIEDs. Results CIED function remained stable, and no lead revision was
required. At discharge, TR <=1+ and <=2+ was achieved in 39.9% and 79.8%,
respectively; at follow-up (median 269 days; Q1-Q3: 63-423 days), TR <=1+
and <=2+ persisted in 29.3% and 69.1%. In 385 matched pairs, residual TR,
functional status, and 2-year heart failure hospitalization-free survival
were comparable between patients with and those without CIEDs (67.1% [95%
CI: 62.1%-72.5%] vs 73.6% [95% CI: 68.9%-78.6%]; P = 0.176). CIED presence
showed a nonsignificant association with more adverse outcomes (HR: 1.31;
95% CI: 0.99-1.74; P = 0.063) but was not associated with residual TR >2+
(OR: 0.98; 95% CI: 0.70-1.38; P = 0.915). Achieving residual TR <=2+
conferred significantly better survival irrespective of CIED presence ( P
< 0.001). Conclusions T-TEER is safe and effective in selected patients
with transvalvular CIED leads. Effective TR reduction remains
prognostically relevant, even in this high-risk real-world
population. Copyright © 2025 The Authors.

<46>
Accession Number
2038878617
Title
Association of increased red blood cell distribution width with adverse
cardiorenal outcomes after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(6) (pp e148-e155),
2025. Date of Publication: 01 Dec 2025.
Author
Verma R.; Hibino M.; Dhingra N.K.; Patel S.K.; Mehta C.; Shehata N.; Yau
T.M.; Mazer C.D.
Institution
(Verma) School of Medicine, Royal College of Surgeons in Ireland, Dublin,
Ireland
(Hibino) Cardiovascular & Thoracic Surgery, Cleveland Clinic, Cleveland,
Ohio, United States
(Dhingra, Yau) Division of Cardiac Surgery, University of Toronto,
Toronto, ON, Canada
(Dhingra, Patel, Shehata, Yau, Mazer) Temerty Faculty of Medicine,
University of Toronto, Toronto, ON, Canada
(Mehta) Epic Hospital, Ahmedabad, India
(Shehata) Division of Hematology, Mount Sinai Hospital, Toronto, ON,
Canada
(Shehata) Division of Medical Oncology and Hematology, University Health
Network, Toronto, ON, Canada
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
University of Toronto, Toronto, ON, Canada
(Shehata) Institute of Health Policy Management and Evaluation, University
of Toronto, Toronto, ON, Canada
(Yau) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
University Health Network, Toronto, ON, Canada
(Yau) Department of Surgery, University of Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Mazer) Department of Physiology, University of Toronto, Toronto, ON,
Canada
(Mazer) Department of Pharmacology and Toxicology, University of Toronto,
Toronto, ON, Canada
Publisher
Elsevier Inc.

<47>
Accession Number
2042063128
Title
Narrative review on the management of post-thrombotic syndrome:
approaching the emerging technologies.
Source
International Angiology. 44(5) (pp 353-365), 2025. Date of Publication: 01
Oct 2025.
Author
Figueroa A.V.; Cifuentes S.; Tabiei A.; Pizano A.; Rasmussen T.E.;
Labropoulos N.; Ulloa J.H.
Institution
(Figueroa) Division of Vascular and Endovascular Surgery, Department of
Surgery, UT Southwestern Medical Center, Dallas, TX, United States
(Cifuentes, Tabiei, Rasmussen) Division of Vascular and Endovascular
Surgery, Mayo Clinic, Rochester, MN, United States
(Pizano) Department of Surgery, Nassau University Medical Center -
Northwell, East Meadow, NY, United States
(Labropoulos) Division of Vascular Surgery, State University of New York,
Stony Brook, NY, United States
(Ulloa) Universidad de los Andres, Bogota, Colombia
Publisher
Edizioni Minerva Medica
Abstract
Post-thrombotic syndrome (PTS) is a long-term complication of deep vein
thrombosis (DVT) and the most challenging form of chronic venous disease.
Up to 50% of patients who suffer DVT will develop PTS. Clinical
manifestations such as limb pain, edema, skin damage, and ulceration
result from venous hypertension due to reflux, obstruction, or a
combination of both. The current treatment option is conservative
management with limited efficiency. PTS severely affects the quality of
life, and definitive surgical treatment is urgently needed. This article
aims to review the current management paradigm and introduce new
in-development surgical alternatives. A narrative review of the literature
published between 2010 and 2025 was conducted in PubMed, Embase and the
Cochrane Library. Reviewed articles included management guidelines, trial
reports, reviews, and cohort studies regarding the management of
post-thrombotic syndrome and deep valvular insufficiency. The SANRA
Guidelines for narrative reviews were followed. Sixty-seven articles
addressing current and future treatment options for PTS were included.
Over the last five decades, previous unsuccessful attempts to restore deep
valvular function provided the knowledge ground for promising candidates.
Technological improvements within the last decade have taken a novel
implantable bioprosthetic valve, an endovascular neovalve creation device,
and a transcatheter-based venous valve replacement system remarkably close
to being the next-generation armamentarium for treating PTS. The efficacy
of current management alternatives for PTS remains limited. The experience
gained over the last 50 years has propelled the development of novel
prosthetic devices and endovascular systems in response to the unmet need
for an effective PTS treatment. Early-phase results are promising and have
granted the buildout of larger ongoing trials. Copyright © 2025
EDIZIONI MINERVA MEDICA.

<48>
Accession Number
2041529063
Title
Impact of Intoxicated Donors on Recipient Survival in Cardiac
Transplantation: A Systematic Review and Meta-Analysis.
Source
Clinical Transplantation. 39(12) (no pagination), 2025. Article Number:
e70404. Date of Publication: 01 Dec 2025.
Author
Souza L.B.D.; Ximenes G.F.; Filho G.F.B.; Marinho J.D.S.F.; Alencar
L.F.T.D.; Feitosa M.P.M.; Vieira J.L.
Institution
(Souza, Ximenes, Filho, Marinho, Alencar, Feitosa) Department of Medicine,
University of Fortaleza, Ceara, Brazil
(Vieira) Hospital De Messejana Dr. Carlos Alberto Studart, Ceara,
Fortaleza, Brazil
(Vieira) Universidade Federal do Ceara, Ceara, Fortaleza, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Background: Heart transplantation remains the main treatment for end-stage
heart failure. The opioid crisis has increased donor availability,
including organs from intoxicated individuals, but the impact on outcomes
is uncertain. Method(s): Following PRISMA 2020, we searched MEDLINE,
Embase, and Web of Science for studies on adult heart transplant
recipients with donors exposed to substances like cocaine, heroin,
marijuana, tobacco, or opioids. Eligible studies met PICOS criteria, and
meta-analyses used a random-effects model. Result(s): Twelve
retrospective cohorts were included, totaling 189 935 recipients, 33 393
of whom received organs from intoxicated donors. The most reported
substances were cocaine, alcohol, and tobacco. No significant differences
were found in 5-year survival (HR = 1.05; CI = 0.94-1.17), 10-year
survival (HR = 0.94; CI = 0.88-1.00), or survival with overdose-related
donors (HR = 0.96; CI = 0.84-1.09). Rates of allograft rejection (HR =
0.99; CI = 0.21-0.88) and cardiac allograft vasculopathy (HR = 1.02; CI =
0.95-1.11) were also similar. Subgroup and sensitivity analyses confirmed
result consistency. Conclusion(s): Organs from intoxicated donors do
not compromise long-term outcomes and may help address donor
shortages. Copyright © 2025 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<49>
Accession Number
2041538485
Title
To clip or not to clip? A review of precise risk assessment in the
contemporary era of transcatheter edge-to-edge mitral and tricuspid valve
repair.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1693291. Date of Publication: 2025.
Author
Ausbuettel F.; Fichera C.-F.
Institution
(Ausbuettel) Department of Cardiology, University Hospital Marburg,
Marburg, Germany
(Fichera) County Hospital Loerrach, Department of Cardiology, Loerrach,
Germany
Publisher
Frontiers Media SA
Abstract
Transcatheter edge-to-edge mitral and tricuspid valve repair (M-TEER,
T-TEER) have emerged as meaningful treatment modalities among patients at
high surgical risk suffering from valvular heart disease. While previous
research has shown that optimal patient selection is crucial for treatment
outcomes, recent studies have identified a multitude of factors that
independently influence mortality. Although these findings can
significantly support clinical decision-making, the large number of
available studies renders an overview of this topic challenging. In this
review, we provide a comprehensive overview of the currently identified
factors associated with increased mortality after TEER. We also summarize
the current evidence on published risk scores that stratify mortality risk
after M-TEER and T-TEER. We aimed to provide clinical decision-making
support for optimal patient selection and referral to TEER and to identify
remaining gaps in evidence. Copyright 2025 Ausbuettel and Fichera.

<50>
Accession Number
2041475623
Title
Evaluating the efficacy of a continuous comprehensive nursing system on
postoperative hemoglobin levels and quality of life in coronary artery
bypass surgery: a randomized controlled trial.
Source
Perioperative Medicine. 14(1) (no pagination), 2025. Article Number: 131.
Date of Publication: 01 Dec 2025.
Author
Liu P.; Xing B.; Wang S.; Liu H.; Wang J.; Zhang M.; Shen H.
Institution
(Liu, Liu) Department of Cardiac Surgery, The First Hospital of Hebei
Medical University, Hebei, Shijiazhuang, China
(Xing) Department of Emergency, The First Hospital of Hebei Medical
University, No.89 Donggang Road, Yuhua District, Hebei, Shijiazhuang,
China
(Wang) Third Department of Cardiovascular Medicine, The First Hospital of
Hebei Medical University, Hebei, Shijiazhuang, China
(Wang) School of Health, The First Hospital of Hebei Medical University,
Hebei, Shijiazhuang, China
(Zhang) Department of Thoracic Surgery, The First Hospital of Hebei
Medical University, Hebei, Shijiazhuang, China
(Shen) Department of Nursing, The First Hospital of Hebei Medical
University, Hebei, Shijiazhuang, China
Publisher
BioMed Central Ltd
Abstract
Objective: This study aimed to investigate the effects of a continuous
comprehensive nursing (CCN) system compared to routine care on
postoperative hemoglobin (Hb) levels and quality of life (QoL) in patients
undergoing coronary artery bypass grafting (CABG). Method(s): This
randomized controlled trial (RCT) enrolled 120 patients undergoing CABG.
Patients were allocated using computer-generated random numbers (1:1) to
either the intervention group (n = 60), receiving a CCN plan, or the
control group (n = 60), receiving standard postoperative care. The CCN
intervention provided a patient-centered approach encompassing
preoperative education, psychological support, continuous postoperative
monitoring, personalized care plans, rehabilitation guidance, and
structured follow-up extending for three months beyond discharge.
 Result(s): Although baseline differences in BMI and Hb were noted,
both groups were otherwise comparable. While Hb levels initially declined
in both groups, by day 7 post-surgery, the CCN group demonstrated
significantly higher Hb levels compared to the control group (12.28 +/-
0.47 g/L vs. 9.16 +/- 0.41 g/L; P < 0.001). The intervention group also
showed significantly improved red blood cell morphology (lower MCV, P <
0.001; lower RDW, P < 0.001; higher HCT, P < 0.001), changes in IL-2 and
IL-6 levels suggesting an immune response difference (higher IL-2, P <
0.001; lower IL-6, P < 0.001), superior QoL scores across all WHOQOL
domains (psychological, social, environmental, physical; all P < 0.001),
reduced depressive (CES-D, P < 0.001) and anxiety symptoms (SAS, P <
0.001), and significantly higher patient satisfaction (P < 0.001).
 Conclusion(s): Implementing a continuous comprehensive nursing system
after CABG significantly benefits postoperative recovery, leading to
improved hemoglobin levels, favorable red blood cell indices, measurable
changes in immune markers, enhanced quality of life, improved mental
health outcomes, and greater patient satisfaction compared to routine
care. These findings suggest CCN is a promising strategy to optimize
post-CABG patient outcomes. Copyright © The Author(s) 2025.

<51>
Accession Number
2041466058
Title
High-flow Oxygen and Nitric Oxide inhalation versus high-flow oxygen alone
to prevent intubation in hypoxaemic Respiratory failure (HONOR): a pilot
randomised controlled trial protocol.
Source
Pilot and Feasibility Studies. 11(1) (no pagination), 2025. Article
Number: 149. Date of Publication: 01 Dec 2025.
Author
Churchill L.; Tronstad O.; Hay K.; Thomas P.J.; Shekar K.
Institution
(Churchill, Tronstad) Physiotherapy Department, The Prince Charles
Hospital, Chermside, Brisbane, QLD, Australia
(Churchill, Tronstad) Critical Care Research Group, The Prince Charles
Hospital, Brisbane, Australia
(Hay) QIMR Berghofer Medical Research Institute, Brisbane, Australia
(Thomas) Department of Physiotherapy, Royal Brisbane and Women's Hospital,
Brisbane, Australia
(Thomas) Department of Intensive Care, Royal Brisbane and Women's
Hospital, Brisbane, Australia
(Shekar) Adult Intensive Care Services, The Prince Charles Hospital,
Brisbane, Australia
(Shekar) School of Medicine, The University of Queensland, Brisbane,
Australia
Publisher
BioMed Central Ltd
Abstract
Background: When conventional oxygen therapies fail, endotracheal
intubation and invasive mechanical ventilation are the current standard of
care in patients with acute hypoxaemic respiratory failure. However,
invasive mechanical ventilation is associated with increased hospital and
intensive care length of stay, healthcare costs, and morbidity and
mortality. Inhaled nitric oxide has the potential to treat hypoxaemia and
potentially prevent the need for invasive mechanical ventilation. Aims and
objectives: The objective of this study is to examine the feasibility and
effectiveness of high-flow oxygen and nitric oxide gas inhalation compared
with high-flow oxygen alone in preventing invasive mechanical ventilation
for patients with acute hypoxaemic respiratory failure. Method(s): In
this pilot, randomised controlled feasibility study, 40 patients admitted
to the intensive care unit with acute hypoxaemic respiratory failure will
be randomised on a 1:1 ratio to receive one of two interventions:
high-flow oxygen and nitric oxide gas inhalation (intervention) or
high-flow oxygen alone (control) via high-flow nasal cannula. Feasibility,
demographic, outcome, and safety data will be collected at several
timepoints during participants' admission. Discussion(s): This
protocol outlines a structured method for investigating the effects of
inhaled nitric oxide gas in preventing invasive mechanical ventilation for
patients with acute hypoxaemic respiratory failure. Considering the risks,
costs, and poorer outcomes associated with invasive mechanical
ventilation, less invasive means of respiratory support warrant further
investigation. The study will assist in planning a larger, multi-centre
definitive trial. Trial registration: This study is registered on the
Australian New Zealand Clinical Trials Registry (ANZCTR):
ACTRN12622001411730. Registered 4th September 2022,
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384881.Copyright © The Author(s) 2025.

<52>
[Use Link to view the full text]
Accession Number
604363342
Title
The impact of anesthesiologists on coronary artery bypass graft surgery
outcomes.
Source
Anesthesia and Analgesia. 120(3) (pp 526-533), 2015. Date of Publication:
04 Mar 2015.
Author
Glance L.G.; Kellermann A.L.; Hannan E.L.; Fleisher L.A.; Eaton M.P.;
Dutton R.P.; Lustik S.J.; Li Y.; Dick A.W.
Institution
(Glance, Eaton, Lustik) Department of Anesthesiology, University of
Rochester School of Medicine, Rochester, NY, United States
(Li) Department of Public Health Sciences, University of Rochester School
of Medicine, Rochester, NY, United States
(Glance, Dick) RAND Health, RAND, Boston, MA, United States
(Kellermann) F. Edward Hebert School of Medicine, Uniformed Services
University of the Health Sciences, Bethesda, MD, United States
(Hannan) School of Public Health, University at Albany, State University
of New York, Albany, NY, United States
(Fleisher) Department of Anesthesiology and Critical Care, University of
Pennsylvania Health System, Philadelphia, PA, United States
(Dutton) Anesthesia Quality Institute, Park Ridge, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: One of every 150 hospitalized patients experiences a lethal
adverse event; nearly half of these events involves surgical patients.
Although variations in surgeon performance and quality have been reported
in the literature, less is known about the influence of anesthesiologists
on outcomes after major surgery. Our goal of this study was to determine
whether there is significant variation in outcomes between
anesthesiologists after controlling for patient case mix and hospital
quality. METHOD(S): Using clinical data from the New York State
Cardiac Surgery Reporting System, we conducted a retrospective
observational study of 7920 patients undergoing isolated coronary artery
bypass graft surgery. Multivariable logistic regression modeling was used
to examine the variation in death or major complications (Q-wave
myocardial infarction, renal failure, stroke) across anesthesiologists,
controlling for patient demographics, severity of disease, comorbidities,
and hospital quality. RESULT(S): Anesthesiologist performance was
quantified using fixed-effects modeling. The variability across
anesthesiologists was highly significant (P < 0.001). Patients managed by
low-performance anesthesiologists (corresponding to the 25th percentile of
the distribution of anesthesiologist risk-adjusted outcomes) experienced
nearly twice the rate of death or serious complications (adjusted rate
3.33%; 95% confidence interval [CI], 3.09%-3.58%) as patients managed by
high-performance anesthesiologists (corresponding to the 75th percentile)
(adjusted rate 1.82%; 95% CI, 1.58%-2.10%). This performance gap was
observed across all patient risk groups. CONCLUSION(S): The rate of
death or major complications among patients undergoing coronary artery
bypass graft surgery varies markedly across anesthesiologists. These
findings suggest that there may be opportunities to improve perioperative
management to improve outcomes among high-risk surgical
patients. Copyright © 2015 International Anesthesia Research
Society.

<53>
Accession Number
2037523460
Title
Alterations in the intestinal microbiome and immune dysregulation in
infants with CHD undergoing cardiopulmonary bypass: a scoping review.
Source
Cardiology in the Young. 35(3) (pp 444-449), 2025. Date of Publication: 01
Mar 2025.
Author
Prout A.J.; Meert K.L.; Al-Ahmadi M.; Dickson R.P.
Institution
(Prout, Meert) Department of Pediatrics, Central Michigan University
College of Medicine, Mt. Pleasant, MI, United States
(Prout, Meert) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
(Al-Ahmadi) Division of Pediatric Cardiovascular Surgery, Department of
Surgery, Children's Hospital of Michigan, Detroit, MI, United States
(Dickson) Division of Pulmonary and Critical Care Medicine, Department of
Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,
United States
(Dickson) Department of Microbiology and Immunology, University of
Michigan Medical School, Ann Arbor, MI, United States
(Dickson) Weil Institute for Critical Care Research & Innovation, Ann
Arbor, MI, United States
Publisher
Cambridge University Press
Abstract
Background: Infants who require cardiopulmonary bypass for surgical repair
of CHD are at high risk for secondary infections, which cause significant
death and disability. The risk of secondary infection is increased by
immune dysfunction. The intestinal microbiome calibrates immune function.
Infants with CHD have substantial changes in their intestinal microbiome.
We performed this scoping review to describe the current understanding of
the relationship between the intestinal microbiome and immune function
after pediatric cardiac surgery with cardiopulmonary bypass.
 Method(s): We searched the PubMed, Cumulative Index to Nursing and
Allied Health Literature, Cochrane, and Scopus databases with the
assistance of a medical librarian. We included trials that analysed
intestinal microbiome composition and immune function after cardiac
surgery with cardiopulmonary bypass in infants. Result(s): We found
two observational cohorts and two interventional trials describing
composition of intestinal microbiome and some measures of immune function
after heart surgery with cardiopulmonary bypass in infants. A total of 114
children were analysed. Three trials were exclusively in infants, and one
was in older children and infants. All trials found a differential
composition of the intestinal microbiome in infants with CHD compared to
those without CHD, and one described a robust correlation between
composition of the intestinal microbiome with cytokine profile and adverse
outcomes. Conclusion(s): Despite robust preclinical data and data
from other disease states, there is minimal data about the correlation
between immune function and intestinal microbiome composition in infants
with CHD after cardiopulmonary bypass. Copyright © The Author(s),
2025.

<54>
Accession Number
2041463381
Title
Progression of Untreated Mild Aortic Valve Disease in Patients Undergoing
Rheumatic Mitral Valve Surgery: A Meta-Analysis of Reconstructed
Time-to-Event Data.
Source
Journal of Cardiovascular Development and Disease. 12(11) (no pagination),
2025. Article Number: 426. Date of Publication: 01 Nov 2025.
Author
Luo C.; Qin X.; Yue H.; Liang W.; Wu Z.
Institution
(Luo, Qin, Yue, Liang, Wu) Department of Cardiovascular Surgery, West
China Hospital, Sichuan University, Chengdu, China
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
(1) Background: Concomitant mild aortic valve disease is frequently found
in patients undergoing rheumatic mitral valve surgery. To date, only a
limited number of single-center studies have specifically addressed the
untreated baseline aortic valve disease long-term progression and
reoperation rate. Thus, we conducted a meta and landmark analysis to
systematically review the issue. (2) Methods: This study investigated the
long-term prognostic of baseline mild aortic valve disease in patients
undergoing rheumatic mitral valve surgery, based on evidence from PubMed,
Embase, Cochrane Library, and Web of Science databases. (3) Results: Meta
analysis revealed that patients with mild aortic valve disease had a
higher risk of disease progression, with a 3.3-fold risk in the 0-5-year
follow-up, which jumped to a hazard ratio of 6.42 in longer-term follow-up
(5-25 years). Patients with aortic stenosis had an 8.37-fold risk of
progression compared with aortic regurgitation and appeared to be poorly
related to the time cut-off. Similarly, higher reoperation rates at
long-term follow-up were seen in aortic stenosis patients. (4)
 Conclusion(s): This study suggests that patients with mild aortic
valve disease at baseline have poorer long-term aortic valve-related
progression and reoperation rates, especially aortic stenosis. For those
with concomitant aortic stenosis, further investigation of the impact of
lesion progression is warranted. Copyright © 2025 by the authors.

<55>
[Use Link to view the full text]
Accession Number
51807685
Title
Comparison between valsartan and amlodipine regarding cardiovascular
morbidity and mortality in hypertensive patients with glucose intolerance:
NAGOYA HEART study.
Source
Hypertension. 59(3) (pp 580-586), 2012. Date of Publication: March 2012.
Author
Muramatsu T.; Matsushita K.; Yamashita K.; Kondo T.; Maeda K.; Shintani
S.; Ichimiya S.; Ohno M.; Sone T.; Ikeda N.; Watarai M.; Murohara T.
Institution
(Muramatsu, Matsushita, Yamashita, Kondo, Maeda, Shintani, Murohara)
Department of Cardiology, Nagoya University Graduate, School of Medicine,
65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
(Ichimiya, Ohno) Yokkaichi Municipal Hospital, Yokkaichi, Japan
(Shintani) Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
(Sone) Ogaki Municipal Hospital, Ogaki, Japan
(Ikeda) Chunichi Hospital, Nagoya, Japan
(Watarai) Anjo Kosei Hospital, Anjo, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
It has not been fully examined whether angiotensin II receptor blocker is
superior to calcium channel blocker to reduce cardiovascular events in
hypertensive patients with glucose intolerance. A prospective,
open-labeled, randomized, controlled trial was conducted for Japanese
hypertensive patients with type 2 diabetes mellitus or impaired glucose
tolerance. A total of 1150 patients (women: 34%; mean age: 63 years;
diabetes mellitus: 82%) were randomly assigned to receive either
valsartan- or amlodipine-based antihypertensive treatment. Primary outcome
was a composite of acute myocardial infarction, stroke, coronary
revascularization, admission attributed to heart failure, or sudden
cardiac death. Blood pressure was 145/82 and 144/81 mm Hg, and
glycosylated hemoglobin was 7.0% and 6.9% at baseline in the valsartan
group and the amlodipine group, respectively. Both of them were equally
controlled between the 2 groups during the study. The median follow-up
period was 3.2 years, and primary outcome had occurred in 54 patients in
the valsartan group and 56 in the amlodipine group (hazard ratio: 0.97
[95% CI: 0.66-1.40]; P=0.85). Patients in the valsartan group had a
significantly lower incidence of heart failure than in the amlodipine
group (hazard ratio: 0.20 [95% CI: 0.06-0.69]; P=0.01). Other components
and all-cause mortality were not significantly different between the 2
groups. Composite cardiovascular outcomes were comparable between the
valsartan- and amlodipine-based treatments in Japanese hypertensive
patients with glucose intolerance. Admission because of heart failure was
significantly less in the valsartan group. © 2012 American Heart
Association, Inc.

<56>
Accession Number
2040515808
Title
Efficacy and Safety of Colchicine for Secondary Prevention of
Cardiovascular Disease: A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. 106(7) (pp 3675-3689),
2025. Date of Publication: 01 Dec 2025.
Author
Ahmed M.; Fahim M.A.A.; Humayun M.; Sajid B.; Ahmad S.; Asghar M.S.
Institution
(Ahmed) Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto
Medical College Lyari, Karachi, Pakistan
(Fahim, Humayun) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Sajid) Department of Internal Medicine, Jinnah Sindh Medical University,
Karachi, Pakistan
(Ahmad) Department of Internal Medicine, Aga Khan University and Hospital,
Karachi, Pakistan
(Asghar) AdventHealth, Altamonte Springs, FL, United States
Publisher
John Wiley and Sons Inc
Abstract
Colchicine may reduce cardiovascular events in coronary artery disease
(CAD) through its anti-inflammatory effects. PubMed, Scopus, and Cochrane
Library were searched from inception to May 10, 2025, for randomized
controlled trials (RCTs) comparing colchicine with placebo or usual care
in patients with CAD. Eligible trials had >= 30 days of colchicine use and
reported cardiovascular outcomes. The primary outcome was major adverse
cardiovascular events (MACE). Secondary outcomes included extended MACE
(eMACE), myocardial infarction (MI), stroke, all-cause mortality,
cardiovascular mortality, coronary revascularization, gastrointestinal
events, infection, myalgia, arrhythmia, cancer, alopecia, and treatment
discontinuation. Random-effects models were used to calculate risk ratios
with 95% CIs. Heterogeneity was assessed using the I2 statistic, and
meta-regression analysis was conducted to explore heterogeneity and
potential effect modifiers. Eleven studies included 19,618 patients with
9814 and 9804 patients in the colchicine and control groups, respectively.
The colchicine group was significantly associated with a lower rate of
MACE compared to the control group (RR = 0.73, 95% CI = 0.59-0.92, p =
0.006; I2 = 44%). From the secondary outcomes, eMACE (RR = 0.66, 95% CI =
0.52-0.85; p = 0.001; I2 = 73%), MI (RR = 0.82, 95% CI = 0.70-0.96, p =
0.01), and coronary revascularization (RR = 0.60, 95% CI = 0.41-0.87, p =
0.007) were found to be significantly lower in the colchicine group. All
the other secondary outcomes did not reach statistical significance.
Meta-regression analysis for MACE showed a statistically significant
association with diabetes (coefficient: -0.0778, p = 0.0013), indicating a
potential modifying effect. Other covariates, including mean age,
hypertension, smoking, and prior revascularization, did not demonstrate
statistically significant associations. Colchicine reduces MACE, MI, and
revascularization in CAD patients, supporting its use for secondary
prevention. Copyright © 2025 Wiley Periodicals LLC.

<57>
Accession Number
2040879049
Title
Neonatal SONography Assisted Resuscitation (NeoSONAR): Scoping review of
the current literature and future directions.
Source
Journal of Perinatology. 45(11) (pp 1586-1594), 2025. Date of Publication:
01 Nov 2025.
Author
Singh Y.; Lakshminrusimha S.; Chan B.
Institution
(Singh, Lakshminrusimha, Chan) Division of Neonatology, Department of
Pediatrics, University of California Davis Children's Hospital,
Sacramento, CA, United States
Publisher
Springer Nature
Abstract
Ultrasound is increasingly utilized during cardiac arrest in adult
populations. The European Society of Pediatric and Neonatal Intensive Care
and the American Academy of Pediatrics have published guidelines on the
use of point-of-care ultrasound (POCUS) in neonates and children. However,
there were no specific recommendations for its use during the Neonatal
Resuscitation Program (NRP) algorithm. In this narrative review, we map
the existing evidence to evaluate its role, potential benefits, and
limitations of POCUS integration during neonatal resuscitation. The
limited available studies, mostly case reports, suggest that POCUS can aid
in the early identification of correctable or modifiable causes,
evaluation of cardiac function, detection of heart rate or pulseless
electrical activity, and guidance of resuscitative efforts. Significant
gaps remain in knowledge, research studying its feasibility and benefits,
and a lack of specific training and standardized protocols for integrating
POCUS into the NRP algorithm, emphasizing the need for further
research. Copyright © The Author(s) 2025.

<58>
Accession Number
2041917796
Title
Enhanced recovery in lung surgery: coaxial versus conventional chest
drains following video-assisted thoracoscopic surgery lobectomy-a
prospective randomized trial.
Source
Journal of Thoracic Disease. 17(11) (pp 10262-10271), 2025. Date of
Publication: 30 Nov 2025.
Author
Salama M.; Mueller M.R.
Institution
(Salama) Department of Thoracic Surgery, Clinic Floridsdorf, Vienna,
Austria
(Salama, Mueller) Institute for Thoracic Oncology, Karl Landsteiner
Society, St. Poelten, Austria
(Salama, Mueller) Medical Faculty, Sigmund Freud University, Vienna,
Austria
(Salama, Mueller) Private Clinic Dobling, Vienna, Austria
Publisher
AME Publishing Company
Abstract
Background: Effective chest drainage is essential in thoracic surgery to
prevent postoperative complications such as pneumothorax, subcutaneous
emphysema, and retained pleural fluid. Although conventional single-lumen
chest tubes have been standard practice, their limitations-particularly in
the presence of high air leak or bloody effusions-have prompted
investigation into more efficient alternatives such as coaxial drains.
This study compares the clinical performance of conventional and coaxial
drainage systems following video-assisted thoracoscopic surgery (VATS)
lobectomy. Method(s): In a prospective, randomized trial, 300
patients undergoing VATS lobectomy for non-small cell lung cancer were
assigned to receive either a 24 F conventional tube (CT) group (n=150) or
a 24 F coaxial drain (CD) group (n=150). All drains were connected to a
digital suction device. Recorded parameters included air flow, pleural
fluid volume, drain occlusion, subcutaneous emphysema, drainage duration,
hospital stay, and C-reactive protein (CRP) levels from postoperative day
(POD) 1 to 5. Result(s): Drainage duration was significantly shorter
in the coaxial group (4+/-2 days) compared with the conventional group
(6+/-3 days, P=0.04). Tube occlusion occurred in 30% of CTs versus 4% of
coaxial drains (P=0.02). Subcutaneous emphysema was more frequent in the
conventional group (56% vs. 38%, P=0.03). CRP levels were significantly
lower in the coaxial group on PODs 3 to 5 (P<0.01). Fluid output
thresholds on the operative day (>1,000 mL) and POD 1 (>500 mL) were
predictive of prolonged drainage. Conclusion(s): Coaxial chest drains
offer superior performance in cases of significant air leakage, reducing
complications and postoperative inflammation. Combined with digital
drainage systems, they support faster recovery and better compliance with
Enhanced Recovery After Surgery (ERAS) protocols. These findings advocate
for broader adoption of coaxial drains in thoracic surgical
practice. Copyright © AME Publishing Company.

<59>
Accession Number
2041978727
Title
Serum biomarkers in cardiac allograft vasculopathy: A systematic review.
Source
Transplantation Reports. 10(4) (no pagination), 2025. Article Number:
100186. Date of Publication: 01 Dec 2025.
Author
Ishaq F.; Fida N.; Thandavarayan R.A.; Casarin S.; Guha A.
Institution
(Ishaq, Fida, Thandavarayan, Guha) Department of Cardiology, Houston
Methodist Hospital, Houston, TX, United States
(Ishaq) Center for Connected Care Innovation & Implementation Research,
Houston Methodist Hospital, Houston, TX, United States
(Casarin) Center for Precision Surgery, Houston Methodist Research
Institute, Houston, TX, United States
(Casarin) LaSIE, UMR 7356 CNRS, La Rochelle Universite, La Rochelle, FR,
United States
(Casarin) Department of Surgery, Houston Methodist Hospital, Houston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Introduction: Cardiac Allograft Vasculopathy (CAV) is a progressive
manifestation of chronic allograft rejection in heart transplant
recipients. While current diagnostic tools involve invasive and
non-invasive imaging of coronary arterial anatomy and blood flow,
circulating biomarkers can lead to earlier detection non-invasively.
 Objective(s): The aim of this systematic review is to synthesize
existing literature of prognostic and diagnostic circulating peripheral
biomarkers of CAV. Method(s): A thorough literature search was
performed on Pubmed, CINAHL, Scopus and Medline using the terms "cardiac
allograft vasculopathy," "CAV," and "biomarkers." Results: The search
yielded 1648 studies; 109 were included for the final review. Quality of
evidence and risk of bias varied across the studies. Conclusion(s):
Multiple circulating biomarkers could help diagnose and prognosticate in
the presence of CAV with variable diagnostic accuracy and predictability.
The role of incorporating these biomarkers in traditional coronary imaging
diagnostic paradigm of CAV remains to be studied. Copyright ©
2025 The Author(s)

<60>
[Use Link to view the full text]
Accession Number
2041216494
Title
Impact of Preoperative Cardiac Computed Tomography Angiography on Left
Atrial Appendage Closure: A Systematic Review and Meta-Analysis.
Source
Journal of Computer Assisted Tomography. Publish Ahead of Print (no
pagination), 2025. Date of Publication: 11 Oct 2025.
Author
Lin Q.; Duan H.; Li K.; Ma Z.-Y.
Institution
(Lin, Duan, Li, Ma) Department of Radiology, The First Affiliated Hospital
of Kunming Medical University, Kunming, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: - Our aim is to evaluate the impact of preoperative cardiac CT
on LAAC. Method(s): - This research followed the protocols outlined
in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) 2020 checklist, and it adhered to the previously described
established methodologies. A search strategy was designed to utilize
PubMed, EMBASE, Cochrane Library, and Web of Science for studies showing
the effect of preoperative CCTA on LAAC from December 08, 2017, to June
12, 2023. For continuous outcome variables, the weighted mean difference
(WMD) was used to estimate the effect size, whereas the odds ratio (OR)
was used for dichotomous outcomes. We performed meta-regression to explore
the heterogeneity among the included studies. Result(s): - Eight
cohort studies (including one published only as an abstract) that
evaluated the impact of preoperative CCTA for LAAC were identified and
included in this meta-analysis. Compared with the CCTA negative group,
patients in the CCTA positive group experienced a significantly shorter
LAAC procedure time (WMD: -0.69; 95% CI: -1.11 to -0.28; P=0.00;
I2=95.39%). In contrast, there were no significant differences in
implantation success (OR: 1.04; 95% CI: 0.98-1.11; P=0.18; I2=45.61%),
contrast volume (WMD: -0.07; 95% CI: -0.28 to 0.14; P=0.51; I2=77.38%),
peri-device leak (OR: 0.56; 95% CI: 0.29-1.11; P=0.10; I2=87.33%),
device-related thrombus (OR: 0.70; 95% CI: 0.36-1.35; P=0.29; I2=0%),
pericardial effusion requiring intervention (OR: 1.09; 95% CI: 0.95-1.25;
P=0.21; I2=0%), major adverse events (OR: 0.99; 95% CI: 0.89-1.09; P=0.78;
I2=0%), and all-cause mortality (OR: 0.79; 95% CI: 0.54-1.16; P= 0.23;
I2=0%). Conclusion(s): - Preoperative CCTA is associated with a
shorter procedure time, but other parameters did not differ significantly
between patients who underwent preoperative CCTA and those who did
not. Copyright © 2025

<61>
Accession Number
2037374028
Title
Mid-term Outcomes of Transcatheter Aortic Valve Replacement vs. Surgical
Aortic Valve Replacement in Low-to-Moderate Risk Patients with Severe
Aortic Stenosis: A Systematic Review and Meta-analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 41(1) (no pagination), 2026.
Article Number: e20240250. Date of Publication: 01 Jan 2026.
Author
Pascoal C.A.D.; Faria H.S.; Francisco A.J.; Peres C.A.P.; Tavares L.F.;
Masiero B.B.; Doma M.; Manuel V.
Institution
(Pascoal, Francisco) Department of Medicine, Universidade Agostinho Neto,
Luanda, Angola
(Faria) Escola de Medicina, Universidade Federal de Santa Maria, Rio
Grande do Sul, Santa Maria, Brazil
(Peres) Department of Medicine, Universidade de Pernambuco, Pernambuco,
Recife, Brazil
(Tavares) Department of Medicine, Universidade Federal de Alfenas, Minas
Gerais, Alfenas, Brazil
(Masiero) Department of Medicine, Pontificia Universidade Catolica do Rio
Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
(Doma) Alexandria Faculty of Medicine, Alexandria, Egypt
(Manuel) Complexo Hospitalar de Doencas Cardio-Pulmonares Cardeal Dom
Alexandre do Nascimento, Luanda, Angola
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Several clinical trials have demonstrated the
non-inferiority of transcatheter aortic valve replacement compared with
surgical aortic valve replacement in patients with severe aortic stenosis
and low to intermediate surgical risk. However, mid-term results are still
contentious. We performed this meta-analysis to compare the safety and
efficacy of transcatheter vs. surgical aortic valve replacement in the
mid-term in patients with aortic stenosis at low to moderate surgical
risk. Method(s): We searched Embase, PubMed, and Cochrane databases
for randomized clinical trials that compared transcatheter with surgical
aortic valve replacement in patients with symptomatic severe aortic
stenosis with a follow-up of at least four years. Outcomes of interest
were all-cause mortality and disabling stroke. Result(s): We included
six randomized clinical trials encompassing 6,444 patients with severe
aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic
valve replacement. There was no difference in all-cause mortality (risk
ratio [RR] 1.08; 95% confidence interval [CI] 0.94-1.25; P = 0.30) and
disabling stroke (RR 0.95; 95% CI 0.75-1.21; P = 0.67) between groups. In
the subgroup analysis, five-year mortality (RR 1.28; 95% CI 1.10-1.49) was
higher in the transcatheter group. The new pacemaker implantation (RR
2.22; 95% CI 1.42-3.45) rate was higher in the transcatheter group.
However, the new atrial fibrillation (RR 0.40; 95% CI 0.31-0.52) rate was
higher in the surgical group. Conclusion(s): Mid-term mortality and
disabling stroke rates in patients with severe aortic stenosis treated
with either transcatheter or surgical aortic valve replacement were
similar. Copyright © 2026, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<62>
Accession Number
2010533659
Title
Chinese clinical practice guidelines for perioperative blood glucose
management.
Source
Diabetes/Metabolism Research and Reviews. 37(7) (no pagination), 2021.
Article Number: e3439. Date of Publication: 01 Oct 2021.
Author
Wang J.; Chen K.; Luo X.; Yu M.; Lv Z.; Dou J.; Chen Y.; Ji L.; Mu Y.; An
P.; Wang H.; Jin X.; Li Z.; Bai B.; Wu H.; Ba J.; Gu W.; Pei Y.; Zhou X.;
Hong T.; Guo X.; Zhang J.; Xing X.; Zhang B.; Xiao X.; Zhong L.; Guo L.;
Li X.; Shan Z.; Ji Q.; Bao Y.; Li Y.; Qin G.; Chen B.; Shi L.; Liu J.; Sun
Z.; Zou D.; Chen L.; Zhao J.; Yang T.; Shi Y.; Yu X.; Li Q.; Gong Y.; Chen
W.; Li H.; Kang J.; Wang X.; Du W.; Tan H.
Institution
(Wang, Chen, Jin, Lv, Dou, Mu, An, Wang, Ba, Gu, Pei) Department of
Endocrinology, the First Medical Center, Chinese PLA General Hospital,
Beijing, China
(Wang) Department of Endocrinology, Fifth Medical Centre, Chinese PLA
General Hospital, Beijing, China
(Luo) School of Public Health, Lanzhou University, Lanzhou, China
(Li) Department of Dry Therapy, First Affiliated Hospital of Kunming
Medical University, Kunming, China
(Jin) Department of Nephrology, Hainan Hospital of Chinese PLA General
Hospital, the Hainan Academician Team Innovation Center, Hainan, China
(Yu, Xiao) Department of Endocrinology, Key Laboratory of Endocrinology,
National Health Commission, Peking Union Medical College Hospital, Peking
Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
(Zhang, Jin, Li, Xing, Zhang) Department of Endocrinology, China-Japan
Friendship Hospital, Beijing, China
(Chen) Institute of Health Data Science, Lanzhou University, Lanzhou,
China
(Chen) Evidence-Based Medicine Center, School of Basic Medical Sciences,
Lanzhou University, Lanzhou, China
(Chen) WHO Collaborating Centre for Guideline Implementation and Knowledge
Translation, Lanzhou, China
(Ji, Zhou) Department of Endocrinology and Metabolism, Peking University
people's Hospital, Peking University Diabetes Center, Beijing, China
(Luo) Lanzhou University GRADE Center, Lanzhou, China
(Bai, Wu) Department of Endocrinology, Peking Union Medical College
Hospital, Beijing, China
(Hong) Department of Endocrinology, Peking University Third Hospital,
Beijing, China
(Guo, Zhang) Department of Endocrinology, Peking University First
Hospital, Beijing, China
(Chen) Chinese GRADE Center, Lanzhou, China
(Zhong) Department of Endocrinology, Beijing Tian Tan Hospital, Capital
Medical University, Beijing, China
(Li) Department of Endocrinology, PLA Rocket Force General Hospital,
Beijing, China
(Guo) Department of Endocrinology, Beijing Hospital, Beijing, China
(Li) Department of Endocrinology, Zhongshan Hospital Affiliated to Fudan
University, Shanghai, China
(Li) Department of Endocrinology, the 2nd Affiliated Hospital of Harbin
Medical University, Harbin, China
(Shan) Department of Endocrinology, the First Hospital of China Medical
University, Shenyang, China
(Ji) Department of Endocrinology, Xijing Hospital, Xi'an, China
(Bao) Department of Endocrinology, the Sixth People's Hospital, Jiaotong
University, Shanghai, China
(Li) Department of Endocrinology, Sun Yet-sen Memorial Hospital, Sun
Yet-sen University, Guangzhou, China
(Qin) Department of Endocrinology, the First Affiliated Hospital of
Zhengzhou University, Zhengzhou, China
(Chen) Department of Endocrinology, the Southwest Hospital of the Army
Medical University, Chongqing, China
(Shi) Department of Endocrinology, the Affiliated Hospital of Guizhou
Medical University, Guizhou, China
(Liu) Department of Endocrinology, the Affiliated Hospital of Nanchang
University, Nanchang, China
(Sun) Department of Endocrinology, Zhongda Hospital Southeast University,
Nanjing, China
(Zou) Tongji University Tenth People's Hospital, Shanghai, China
(Zou) Department of Endocrinology, Changhai Hospital Affiliated to
Shanghai Second Military Medical University, Shanghai, China
(Chen) Department of Endocrinology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
(Zhao) Department of Endocrinology, Shandong Provincial Hospital, Ji'nan,
China
(Yang) Department of Endocrinology, Jiangsu Province Hospital, Nanjing,
China
(Shi) Department of Endocrinology, Long March Hospital Affiliated to Naval
Military Medical University, Shanghai, China
(Yu) Department of Endocrinology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
(Li) Department of Endocrinology, the First Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Gong) Department of Endocrinology, Pingxiang People's Hospital,
Pingxiang, China
(Chen, Li, Kang) Department of Parenteral and Enteral Nutrition, Peking
Union Medical College Hospital, Beijing, China
(Wang, Du) ICU, Peking Union Medical College Hospital, Beijing, China
(Tan) Department of Hepatobiliary Surgery, China-Japan Friendship
Hospital, Beijing, China
Publisher
John Wiley and Sons Ltd
Abstract
With the increased incidence of diabetes, the number of diabetic patients
who require surgical treatment is also increasing. Unfortunately,
practices in this area lack standardisation. The purpose of this
multidisciplinary, evidence-based guidelines for perioperative blood
glucose management is to provide a comprehensive set of recommendations
for clinicians treating diabetes with different types of surgery. The
intended audience comprises Chinese endocrinologists, surgeons,
anaesthetists, clinical pharmacists, nurses and professionals involved in
perioperative blood glucose management. The guidelines were formulated as
follows. First, a multidisciplinary expert group was established to
identify and formulate key research questions on topics of priority
according to the Population, Intervention, Comparator and Outcomes (PICO)
process. We conducted a meta-analysis of available studies using Review
Manager version 5.3, as appropriate. We pooled crude estimates as odds
ratios with 95% confidence intervals using a random-effects model, and
used the Grading of Recommendations Assessment, Development, and
Evaluation methods to assess the quality of the retrieved evidence.
Finally, 32 recommendations were gathered that covered 11
fields-management and coordination, endocrinologists' consultation,
diabetes diagnosis, surgery timing and anaesthesia method, blood glucose
target values and monitoring frequency, hypoglycaemia treatment, oral
administration of blood glucose lowering drugs, use of insulin, enteral
and parenteral nutritional, postoperative treatment and medication and
education and training. Twenty-five systematic reviews and meta-analyses
were conducted for these guidelines to address the PICO questions. These
guidelines are intended to improve perioperative blood glucose management
and help doctors in specifying medical diagnosis and treatment, and will
be implemented / disseminated extensively in China. Copyright ©
2021 John Wiley & Sons Ltd.

<63>
Accession Number
2042006661
Title
Coronary Revascularization in the Era of TAVR: Timing, Strategy, and
Outcomes.
Source
Clinical Medicine Insights: Cardiology. 19 (no pagination), 2025. Date of
Publication: 01 Jan 2025.
Author
Love A.; O'Leary C.; Shahab S.
Institution
(Love, O'Leary, Shahab) The University of Texas Medical Branch, Galveston,
United States
Publisher
SAGE Publications Ltd
Abstract
Background: Coronary artery disease (CAD) is prevalent among patients
undergoing transcatheter aortic valve replacement (TAVR), complicating
clinical decision-making regarding optimal timing of percutaneous coronary
intervention (PCI). Despite widespread clinical experience, there is
ongoing controversy and limited consensus regarding when PCI, before,
during, or after TAVR, offers the best risk-benefit balance.
 Objective(s): To synthesize and critically evaluate the current
evidence on different PCI timing strategies in patients undergoing TAVR
and to identify areas of uncertainty and clinical complexity. Review:
Randomized trials, including ACTIVATION and NOTION-3, have yielded mixed
findings, highlighting a modest reduction in ischemic events with pre-TAVR
PCI but increased procedural bleeding risks. Observational registries
(REVASC-TAVI and the National Readmissions Database) have similarly shown
that pre- and peri-TAVR PCI strategies carry heightened risks of
complications without clear long-term mortality benefits. Recent
meta-analyses reinforce these findings, indicating that no PCI timing
strategy conclusively outperforms others in reducing long-term mortality.
Key considerations such as anatomical complexity, frailty, bleeding risk,
and valve type significantly influence optimal PCI timing.
 Conclusion(s): Current evidence supports a personalized,
patient-centered approach to PCI timing in TAVR candidates, emphasizing
careful consideration of individual anatomical and clinical factors rather
than a standardized timing protocol. Further research exploring advanced
risk stratification, imaging modalities, and long-term clinical outcomes
is essential to refine current guidelines and practice. Copyright
© The Author(s) 2025. This article is distributed under the terms of
the Creative Commons Attribution 4.0 License
(https://creativecommons.org/licenses/by/4.0/) which permits any use,
reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open
Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

<64>
Accession Number
2035168647
Title
Protamine sulphate for heparin reversal in percutaneous cardiac
interventions: a systematic review and meta-analysis of randomized
controlled trials.
Source
Naunyn-Schmiedeberg's Archives of Pharmacology. 398(12) (pp 16507-16520),
2025. Date of Publication: 01 Dec 2025.
Author
Balbaa E.; Gadelmawla A.F.; Tawfik A.M.; Naeem A.; Elbataa A.; Bazzazeh
M.; Fatiem A.R.; Ali K.; Altobaishat O.; Abuelazm M.
Institution
(Balbaa, Tawfik, Bazzazeh, Fatiem) Faculty of Medicine, Alexandria
University, Alexandria, Egypt
(Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Naeem) Faculty of Medicine, Al-Azhar University, Asyut, Egypt
(Elbataa) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Ali) Internal Medicine, Rosalind Franklin University of Medicine and
Science, Chicago, United States
(Altobaishat) Faculty of Medicine, Jordan University of Science and
Technology, Irbid, Jordan
(Abuelazm) Faculty of Medicine, Tanta University, Tanta, Egypt
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Vascular complications after percutaneous cardiac interventions are a
significant cause of morbidity that affects post-procedural prognosis.
Data about the efficacy and safety of routine protamine sulphate to
prevent these complications remain scarce. Hence, we aim to assess the
efficacy and safety of routine protamine sulphate use for heparin reversal
in patients undergoing percutaneous cardiac interventions. We
systematically searched PubMed, Embase, Cochrane, Scopus, and Web of
Science for randomized controlled trials (RCTs) until September 2024. The
RCTs' quality was assessed using the Cochrane tool (RoB 2). Using R, we
pooled dichotomous outcomes using risk ratios (RR) and continuous outcomes
using mean differences (MD), both along the corresponding 95% Confidence
interval (CI). PROSPERO ID: (CRD42024593002). Six RCTs with 1,076 patients
were eligible. Hemostasis success was significantly higher in the
protamine group (RR, 1.06; 95% CI [1.01-1.10]; P = 0.01), and the length
of hospital stay was significantly shorter (MD, -0.46; 95% CI [-0.65,
-0.26]; P < 0.01). There was no significant difference between both groups
in stroke (RR, 0.60; 95% CI [0.18-2.03]; P = 0.41), major bleeding (P =
0.25), minor bleeding (P = 0.11), life-threatening bleeding (P = 0.65),
time to ambulation (P = 0.13), all-cause mortality (P = 0.92),
hematoma/pseudoaneurysm (P = 0.92), and major vascular complications (P =
0.70). While protamine improved hemostasis success, its effect on reducing
bleeding events and time to ambulation was insignificant. Also, reducing
the length of hospital stay in the protamine group highlights its
potential clinical benefit. Copyright © The Author(s) 2025.

<65>
Accession Number
2001983601
Title
Effect of perioperative administration of dexmedetomidine on delirium
after cardiac surgery in elderly patients: A double-blinded, multi-center,
randomized study.
Source
Clinical Interventions in Aging. 14 (pp 571-575), 2019. Date of
Publication: 2019.
Author
Shi C.; Jin J.; Qiao L.; Li T.; Ma J.; Ma Z.
Institution
(Shi, Jin, Qiao, Li, Ma, Ma) Department of Anesthesiology, The Affiliated
Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
Publisher
Dove Medical Press Ltd
Abstract
Objective: Postoperative delirium (POD) is a serious complication in
elderly patients undergoing cardiac surgery. This study was aimed at
investigating the effect of perioperative administration of
dexmedetomidine for general anesthesia maintenance on occurrence and
duration of POD in elderly patients after cardiac surgery. Method(s):
One hundred and sixty-four patients were enrolled after cardiac surgery
between June 2009 and December 2016. Patients were assigned by a
computer-generated randomization sequence in a 1:1 ratio to receive
dexmedetomidine general anesthesia maintenance or propofol general
anesthesia maintenance. POD was assessed every day with confusion
assessment method for intensive care units (ICU) during the first 5
postoperative days. Result(s): There was no significance in incidence
of POD between the dexmedetomidine group and the propofol group
(P=0.0758). In patients treated with dexmedetomidine, the median onset
time of delirium was delayed (second day vs first day) and the duration of
delirium reduced (2 days vs 3 days) when compared with propofol-treated
patients. The dexmedetomidine-treated patients also displayed a lower VAS
score and less opiate analgesic consumption. No difference was observed in
respect to other postoperative outcomes. Conclusion(s): For elderly
patients, perioperative administration of dexmedetomidine reduced
incidence, delayed onset and shortened duration of POD after cardiac
surgery. Copyright © 2019 Shi et al.

<66>
Accession Number
2041432715
Title
Role of Cerebral Oximetry in Reducing Postoperative End-Organ Dysfunction
After Major Non-Cardiac Surgery: A Randomised Controlled Trial.
Source
Clinics and Practice. 15(11) (no pagination), 2025. Article Number: 213.
Date of Publication: 01 Nov 2025.
Author
Bieze M.; Foley K.; Beattie W.S.; Carroll J.; Poonawala H.; Ti L.-K.;
Djaiani G.
Institution
(Bieze, Foley, Beattie, Carroll, Poonawala, Djaiani) Department of
Anesthesia & Pain Management, University of Toronto, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Ti) Department of Anesthesia, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: An increasing number of older individuals require
general anaesthesia for major non-cardiac surgery, with 20% displaying
postoperative complications. Regional cerebral oxygen saturation
(rSO<inf>2</inf>) correlates with the gold standard of mixed venous oxygen
saturation, indicating global perfusion. We hypothesised that
rSO<inf>2</inf>-based anaesthesia reduces organ dysfunction and morbidity
after major non-cardiac surgery. Method(s): In Singapore and Toronto,
we conducted a prospective, double-blind, randomised controlled trial in
elderly patients undergoing major non-cardiac surgery, after obtaining
research ethics board permission and informed consent. This RCT followed
the CONSORT guidelines. Patients received bilateral cerebral oximetry
sensors, and the control group received standard care. In the intervention
group, an algorithm restored rSO<inf>2</inf> if it dropped 10% below
baseline for >15 s by adjusting cerebral perfusion pressure, inspired
oxygen concentration, end-tidal carbon dioxide, depth of anaesthesia,
haemoglobin, and cardiac index. Postoperative complications and outcomes
were noted. Categorical data were analysed using Chi-square or Fisher's
exact tests and continuous data using a t-test or a Mann-Whitney U test.
The study was powered for 394 patients, but due to the COVID-19 pandemic
and funding constraints, this study was terminated at 101 patients.
 Result(s): Of 101 patients, 49 were randomised to the control and 52
to the intervention group. A total of 31 (63%) patients in the control
group and 30 (58%) in the interventional exhibited bilateral cerebral
desaturation. Time of cumulative cerebral desaturation was longer in the
control group (23 +/- 48 min vs. 9 +/- 15 min, respectively, p = 0.01). A
total of 142 algorithm-based treatments were employed, restoring
rSO<inf>2</inf> in 29 (86%) patients. Both groups displayed equal
postoperative outcomes. Conclusion(s): In major non-cardiac surgery,
cerebral desaturation is prevalent in over 85% of patients. Although
algorithm-guided therapy restored rSO<inf>2</inf> in the majority of
patients, it did not result in reduced postoperative
morbidity. Copyright © 2025 by the authors.

<67>
Accession Number
2041902754
Title
Myval versus Contemporary Valves in Patients Undergoing Transcatheter
Aortic Valve Implantation: A Systematic Review and Meta-Analysis.
Source
Anatolian Journal of Cardiology. 29(12) (pp 675-686), 2025. Date of
Publication: 01 Dec 2025.
Author
Mansuri Z.; Rajith G.; Taikadan T.; Ashraf H.; Ayesha A.; Cavalcante
L.F.F.
Institution
(Mansuri) Department of Cardiology, Gujarat Cancer Society Medical College
and Research Centre, Ahmedabad, India
(Rajith) All India Institute of Medical Sciences, Guwahati, India
(Taikadan) Calicut Medical College, Government Medical College, Kozhikode,
India
(Ashraf) Rawalpindi Medical University, Rawalpindi, Pakistan
(Ayesha) Shifa College of Medicine, Islamabad, Pakistan
(Cavalcante) Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo-SP,
Brazil
Publisher
Turkish Society of Cardiology
Abstract
Background: Myval is a balloon-expandable valve (BEV) used in
transcatheter aortic valve implantation (TAVI) with distinguished
features. Data comparing Myval with contemporary transcatheter heart
valves (THVs) is limited. The authors performed a meta-analysis of studies
comparing Myval with contemporary THVs (Sapien series and Evolut series).
 Method(s): The authors searched PubMed, EMBASE, and Cochrane
databases. The primary composite endpoint of early safety (freedom from
death and major complications) and other outcomes were extracted as
defined by the Valve Academic Research Consortium 3 (VARC 3). The authors
computed risk ratios (RRs) with 95% CIs using a Mantel-Haenszel method
with a random-effects model with Review Manager (Cochrane Collaboration).
 Result(s): Six studies with 2084 patients were included. Myval had
better early safety at 30 days as per VARC 3 (RR 1.12; 95% CI: 1.02-1.22;
P =.01) and lower need for permanent pacemaker implantation (PPI) (RR
0.62; 95% CI: 0.45-0.86; P =.004). Other outcomes were comparable in both
groups. Vis-a-vis Evolut, Myval had better 30-day device success and lower
rates of moderate or severe paravalvular leak (PVL) in addition to better
early safety and lower need for PPI. Subgroup analyses of Myval with
Sapien showed non-inferiority of Myval. Conclusion(s): Myval showed
better safety and lower need for PPI and may become a promising
alternative for concurrent THVs. Copyright @ Author(s) - Available
online at anatoljcardiol.com. Content of this journal is licensed under a
Creative Commons Attribution-NonCommercial 4.0 International License.

<68>
Accession Number
358858061
Title
Volume Replacement With a Balanced Hydroxyethyl Starch (HES) Preparation
in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(3) (pp 399-407),
2010. Date of Publication: 2010.
Author
Boldt J.; Mayer J.; Brosch C.; Lehmann A.; Mengistu A.
Institution
(Boldt, Mayer, Brosch, Lehmann, Mengistu) Department of Anesthesiology and
Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen,
Germany
Publisher
W.B. Saunders
Abstract
Objective: Balanced fluids appear to be have advantages over unbalanced
fluids for correcting hypovolemia. The effects of a new balanced
hydroxyethyl starch (HES) were studied in cardiac surgery patients.
 Design(s): Prospective, randomized, unblinded study. Setting(s):
Clinical study in a single cardiac surgery institution.
 Participant(s): Sixty patients undergoing elective cardiac surgery
with cardiopulmonary bypass. Intervention(s): Patients received
either a balanced 6% HES 130/0.4 plus a balanced crystalloid (n = 30) or
an unbalanced HES-in-saline plus saline (n = 30) to keep cardiac index
>2.5 L/min/m2. Measurements and Main Results: Base excess
(BE), kidney function, inflammatory response (interleukins-6, -10),
endothelial activation (intercellular adhesion molecule-1 [ICAM]), and
coagulation (thromboelastometry, whole blood aggregation) were measured
after induction of anesthesia, after surgery and 5 hours later, and at the
1st and 2nd postoperative days; 2,950 +/- 530 mL of balanced and 3,050 +/-
560 mL of unbalanced HES were given. BE was reduced significantly in the
unbalanced group (from 1.11 +/- 0.71 mmol/L to -5.11 +/- 0.48 mmol/L after
surgery) and remained unchanged in the balanced group. Balanced volume
replacement resulted in significantly lower IL-6, IL-10, and ICAM plasma
concentrations and lower urine concentrations of kidney-specific proteins
than in the unbalanced group. After surgery, thromboelastometry data and
platelet function were changed significantly in both groups; 5 hours
thereafter they were significantly changed only in the unbalanced group.
 Conclusion(s): A plasma-adapted HES preparation in addition to a
balanced crystalloid resulted in significantly less decline in BE, less
increase in concentrations of kidney-specific proteins, less inflammatory
response and endothelial damage, and fewer changes in hemostasis compared
with an unbalanced fluid strategy. © 2010 Elsevier Inc. All rights
reserved.

<69>
Accession Number
2037374041
Title
N-terminal Pro-brain Natriuretic Peptide as a Prognostic Biomarker for
Cardiac Surgeries: A Systematic Review.
Source
Brazilian Journal of Cardiovascular Surgery. 41(1) (no pagination), 2026.
Article Number: e20240417. Date of Publication: 01 Jan 2026.
Author
Queiroz B.G.S.S.; Arruda A.M.; Villa-Chan L.M.M.S.a.; Costa L.S.S.D.;
Monteiro Junior J.G.M.; Santos A.C.O.
Institution
(Queiroz, Arruda, Monteiro Junior, Santos) Programa de Pos-Graduacao em
Ciencias da Saude, Faculdade de Ciencias Medicas, Universidade de
Pernambuco, Pernambuco, Recife, Brazil
(Villa-Chan, Costa) Faculdade de Ciencias Medicas, Universidade de
Pernambuco, Pernambuco, Recife, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a
biomarker for heart stress and heart failure, with its production
triggered by the stretching of cardiac fibers. This study investigates if
elevated NT-proBNP levels can independently predict poor outcomes for
patients undergoing heart surgery. Method(s): A systematic review was
performed in the PubMed, Latin American and Caribbean Health Sciences
Literature (or LILACS), Physiotherapy Evidence Database (PEDro), Web of
Science, and Embase databases, with the following descriptors: "NT-proBNP"
OR "NTproBNP" OR "N-terminal pro-B-type natriuretic peptide" OR
"N-terminal pro brain natriuretic peptide" OR "amino terminal pro brain
natriuretic peptide" AND "Cardiovascular Surgical Procedures" NOT
"Pediatric" OR "children" NOT "cancer" OR "oncology" NOT "animal*".
Articles that evaluated NT-proBNP and adverse outcomes in cardiac surgical
patients were chosen. The levels of evidence and the strength of
recommendation were assessed considering the Grading of Recommendations,
Assessment, Development and Evaluation (or GRADE) system and validity by
the PEDro scale. For systematic review, the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (or PRISMA) criteria and the
Population, Intervention, Comparison, Outcome (or PICO) strategy were
followed. Result(s): Forty-seven articles were included, of which 17
were related to serious complications, including mortality.
 Conclusion(s): Preoperative NT-proBNP is a prognostic marker for
mortality, length of stay in the postoperative intensive care unit,
postoperative acute kidney injury, postoperative atrial fibrillation,
postoperative low cardiac output, postoperative prolonged mechanical
ventilation time, prolonged hospitalization time, unscheduled hospital
readmission related to heart problems, and postoperative heart
failure. Copyright © 2026, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<70>
Accession Number
2041062624
Title
Cardiac geometry alterations following bariatric surgery in severely obese
adolescents: a one-year follow-up study of a randomised controlled trial.
Source
Cardiology in the Young. 35(11) (pp 2276-2282), 2025. Date of Publication:
01 Nov 2025.
Author
Talib A.; Roebroek Y.; Paulus G.; De Boom F.; Winkens B.; Bouvy N.; Van
Heurn E.
Institution
(Talib, Roebroek, Paulus, De Boom, Bouvy, Van Heurn) Department of
Surgery, Maastricht University Medical Center, Maastricht, Netherlands
(Talib, Roebroek, Paulus, De Boom, Bouvy, Van Heurn) NUTRIM School for
Nutrition and Translational Research in Metabolism, Maastricht University,
Maastricht, Netherlands
(Roebroek) Department of General Surgery, Maxima Medical Center,
Veldhoven, Netherlands
(Paulus) Department of General Surgery, Spaarne Gasthuis, Hoofddorp,
Netherlands
(Winkens) Department of Methodology and Statistics, CAPHRI Care and Public
Health Research Institute, Maastricht University, Maastricht, Netherlands
(Bouvy, Van Heurn) Department of Surgery, Leiden University Medical
Center, Leiden, Netherlands
Publisher
Cambridge University Press
Abstract
Background: Severe obesity in adolescents is a public health crisis of
increasing concern. Cardiac maladaptation, such as left ventricular
hypertrophy, increases the risk of future cardiovascular disease. This
study aims to evaluate the impact of weight loss surgery on cardiac
geometry in morbidly obese adolescents. Method(s): A single-centre,
randomised controlled trial titled comparing laparoscopic adjustable
gastric banding with multidisciplinary lifestyle intervention against a
control group with multidisciplinary lifestyle intervention alone. The
trial included severely obese adolescents aged 14-16 who had not responded
to a minimum of 12 months of multidisciplinary lifestyle intervention. The
primary outcome measured was the percentage change in total body weight
one year after surgery. Left ventricular geometry was evaluated
ultrasonographically before and one year after bariatric surgery.
 Result(s): In the intervention and control group, a total of 10 and 8
patients received both the baseline and follow-up ultrasonographic
examination. BMI significantly decreased in the intervention group
compared to the control group (-6.75; 95% CI: -10.28 - -3.23). Moreover,
left ventricular mass index (-8.21; 95% CI: -15.43 - -0.98) and relative
left ventricular wall thickness (-0.04; 95% CI: -0.07 - 0.00)
significantly decreased within the intervention group, reflecting
amelioration of adverse remodelling, albeit without statistically
significant intervention effect when compared to the control group.
 Conclusion(s): Significant weight loss through bariatric surgery may
improve left ventricular geometry in severely obese adolescents. These
findings support the potential of bariatric surgery not only for reducing
weight loss but also for improving cardiac health. Copyright ©
The Author(s), 2025. Published by Cambridge University Press.

<71>
Accession Number
354604316
Title
Continuous Arterial Pressure Waveform-Based Cardiac Output Using the
FloTrac/Vigileo: A Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 23(3) (pp 401-406),
2009. Date of Publication: June 2009.
Author
Mayer J.; Boldt J.; Poland R.; Peterson A.; Manecke G.R.
Institution
(Mayer, Boldt) Department of Anesthesiology and Intensive Care Medicine,
Klinikum Ludwigshafen, Ludwigshafen, Germany
(Poland, Peterson, Manecke) Department of Anesthesiology, University of
California San Diego School of Medicine, San Diego, CA, United States
Publisher
W.B. Saunders

<72>
Accession Number
50730489
Title
A New Plasma-Adapted Hydroxyethyl Starch Preparation: In Vitro Coagulation
Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(3) (pp 394-398),
2010. Date of Publication: 2010.
Author
Boldt J.; Mengistu A.
Institution
(Boldt, Mengistu) Department of Anesthesiology and Intensive Care
Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
Publisher
W.B. Saunders
Abstract
Objective: Preparing hydroxyethyl starch (HES) in a plasma-adapted
solution is supposed to improve safety with regard to coagulation. The
influence of a new plasma-adapted HES preparation on coagulation was
studied. Design(s): Operator-blinded, randomized study.
 Setting(s): Laboratory in vitro study. Participant(s): Fifteen
healthy young men scheduled for blood donation. Intervention(s):
Blood was diluted by 10%, 30%, and 50% using either a plasma-adapted or
nonplasma-adapted (prepared in saline solution) potato-derived 6% HES
130/0.42. Only the composition of the solvent of the 2 HES preparations
was different. Measurements and Main Results: Rotation
thromboelastometry (ROTEM; Pentapharm, Munich, Germany) was used to assess
changes in coagulation; whole blood aggregometry with 3 inducers was used
to assess effects of dilution with HES on platelet function. Clotting time
(CT) and clot formation time were significantly prolonged by 30% and 50%
dilution, showing significantly longer times in the non-plasma-adapted
than in the plasma-adapted HES group (eg, intrinsic CT at the 30% dilution
level: plasma-adapted HES 228 +/- 26 seconds [within normal range] v 269
+/- 29 seconds in the nonplasma-adapted HES group). Clot strengthening and
clot firmness were significantly reduced by the non-plasma-adapted HES at
the 30% dilution level. Platelet aggregation was significantly more
reduced by the non-plasma-adapted HES at the 30% and 50% dilution levels.
 Conclusion(s): Dilution with the nonplasma-adapted HES 130/0.42 was
associated with more negative effects on thromboelastometry and platelet
aggregation than the same HES 130/0.4 dissolved in a plasma-adapted
solution. The benefits of using a plasma-adapted modern HES preparation on
blood loss and use of blood/blood products in cardiac surgery need to be
studied. © 2010 Elsevier Inc. All rights reserved.

<73>
Accession Number
2041413484
Title
Comparative effects of remimazolam and propofol on hemodynamic stability
during sedation for painless gastroscopy: a randomized clinical trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 587. Date
of Publication: 01 Dec 2025.
Author
Gong F.; Gui Q.; Lan L.; Zhou G.; Wen Q.; Wei Y.; Li X.; Cao X.
Institution
(Gong, Gui, Lan, Zhou, Wen, Wei, Li, Cao) Department of Anesthesiology,
Dongguan Tungwah Hospital, Dongguan, China
(Gong, Gui, Lan, Zhou, Wen, Wei, Li, Cao) Dongguan Key Laboratory of
Anesthesia and Enhanced Recovery after Surgery, Dongguan, China
Publisher
BioMed Central Ltd
Abstract
Background: Remimazolam, a novel ultra-short-acting benzodiazepine, shows
promise for sedation in endoscopic procedures. However, its cardiovascular
effects during painless gastroscopy remain unclear. This study compared
the effects of remimazolam and propofol on hemodynamic stability in
patients undergoing painless gastroscopy using continuous non-invasive
arterial pressure (CNAP) monitoring. Method(s): A total of 300
patients scheduled for sedation during upper gastrointestinal endoscopy
were randomly assigned to either the remimazolam group (Group R, n = 150)
or the propofol group (Group P, n = 150). Group R received remimazolam
tosilate (0.2 mg/kg), while Group P received propofol (2 mg/kg). Primary
outcomes were mean arterial pressure (MAP) and cardiac output (CO),
recorded at two time points: the start (T1) and completion (T2) of the
examination. Secondary outcomes included adverse events such as
injection-related pain, hypotension, hypoxemia, respiratory depression,
and bradycardia. Result(s): At both assessment points, MAP was
significantly higher in Group R than in Group P (82.5 vs. 75.0 mmHg at T1,
p < 0.001; 82.0 vs. 77.0 mmHg at T2, p = 0.002). Additionally, CO was
significantly higher in Group R (5.7 vs. 5.4 L/min, p = 0.017). The
incidence of adverse events was greater in Group P compared to Group R,
including injection pain (25.3% vs. 6.7%), hypotension (24.7% vs. 5.3%),
hypoxia (5.3% vs. 0%), and bradycardia (14.7% vs. 0%). Conclusion(s):
Both remimazolam and propofol provide effective sedation for painless
gastroscopy. However, remimazolam offers superior hemodynamic stability
and significantly fewer adverse events. Trial registration: The study was
subsequently documented in the Chinese Clinical Trial Registry
(identifier: ChiCTR2300068901; registration date: March 1,
2023). Copyright © The Author(s) 2025.

<74>
Accession Number
629785128
Title
Bronchial blocker versus double-lumen endobronchial tube in minimally
invasive cardiac surgery.
Source
BMC Pulmonary Medicine. 19(1) (no pagination), 2019. Article Number: 207.
Date of Publication: 09 Nov 2019.
Author
Zhang C.; Yue J.; Li M.; Jiang W.; Pan Y.; Song Z.; Shi C.; Fan W.; Pan Z.
Institution
(Zhang, Yue, Li, Jiang, Song, Shi, Pan) Department of Anesthesiology,
Second Hospital of Jilin University, No.218 Ziqiang Street, Nanguan
District, Changchun,Jilin province, China
(Pan) Yanbian University, Yanbian,Jilin province, China
(Fan) Department of Intensive Care Unit, Second Hospital of Jilin
University, Changchun,Jilin province, China
Publisher
BioMed Central Ltd
Abstract
Background: To compare the therapeutic value of a bronchial blocker (BB)
with a double-lumen tube (DLT) in minimally invasive cardiac surgery
(MICS). Method(s): Sixty patients who underwent MICS were randomized
to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed
was omitted). The following data were collected: Time of intubation and
tube localization; incidence of tube displacement; postoperative sore
throat and hoarseness; time of cardiopulmonary bypass; maintenance time
for SpO<inf>2</inf> < 90% (PaCO<inf>2</inf> < 60 mmHg); mean arterial
pressure and heart rate; SpO<inf>2</inf>, PaO<inf>2</inf>,
PaCO<inf>2</inf>, EtCO<inf>2</inf>, mean airway pressure, and airway peak
pressure; surgeons' satisfaction with anesthesia; and short-term
complications. Result(s): The times of intubation and tube
localization were significantly longer in Group B than in Group D (P <
0.05). Patients in Group B exhibited significantly lower incidence of tube
displacement, postoperative sore throat, and hoarseness when compared with
patients in Group D (P < 0.05). Mean arterial pressure and heart rate were
significantly lower in Group B than in Group D after tracheal intubation
(P < 0.05). The mean airway pressure and airway peak pressure were
significantly lower in Group B than in Group D after one-lung ventilation
(P < 0.05). SpO<inf>2</inf> and PaO<inf>2</inf> in Group B were
significantly higher than in group D after cardiopulmonary bypass (P <
0.05). No short-term postoperative complications were observed in patients
of Groups B and D during 3 month follow-up. Conclusion(s): BB can be
a potential alternative to the conventional DLT for lung isolation in
MICS. Trial registration: ChiCTR1900024250, July 2, 2019. Copyright
© 2019 The Author(s).

<75>
Accession Number
2041435606
Title
Hybrid procedures in the management of hypoplastic left heart syndrome: A
systematic review.
Source
Cardiology in the Young. 35(11) (pp 2200-2221), 2025. Date of Publication:
01 Nov 2025.
Author
Labartkava N.
Institution
(Labartkava) University of Bergamo, Italy
Publisher
Cambridge University Press
Abstract
Background/Objectives: Hypoplastic left heart syndrome is considered one
of the most severe CHDs and occurs in approximately 2-3% of all CHD cases.
Hybrid procedures have been introduced as an alternative to traditional
surgical techniques, such as the Norwood procedure, particularly for
neonates at high risk. Although hybrid approaches claim to reduce surgical
risks and improve recovery, little is known regarding their comparative
effectiveness and safety. This review aims to describe the contribution of
hybrid procedures in hypoplastic left heart syndrome management regarding
survival rates, postoperative complications, and quality of life, through
recovery outcomes and long-term results, in light of conventional surgical
techniques. Method(s): A systematic review was carried out following
the PRISMA guidelines. Data were retrieved from PubMed, Scopus, Web of
Science, and Cochrane Library. The search articles were published from
January 2014 to November 2024. Inclusion was focused on paediatric
patients diagnosed with hypoplastic left heart syndrome and studies
comparing hybrid procedures versus traditional surgical methods. All
screening, data extraction, and quality assessment were done by two
independent reviewers. Result(s): This review analysed data from 11
studies comprising 934 neonates with hypoplastic left heart syndrome, of
whom 371 underwent hybrid procedures (HP) and 563 received the Norwood
procedure. The findings demonstrated that both approaches achieved
comparable survival rates at 1, 3, and 5 years. Hybrid procedures were
linked to slightly earlier interventions (standardised mean difference =
-0.10, 95% confidence interval: -0.61 to 0.41, p = 0.77) and were favored
for high-risk neonates due to reduced invasiveness. However, hybrid
procedures showed a higher rate of interstage events (risk ratio = 0.81),
95% confidence interval: -0.62 to 2.25, p = 0.09) and higher rates of
pulmonary artery stenosis requiring reinterventions (30% vs. 18% for
Norwood). Norwood procedures were associated with fewer reinterventions
and lower interstage event rates, highlighting their effectiveness for
stable patients. Conclusion(s): Hybrid procedures offer a practical
alternative to the Norwood procedure, especially for high-risk neonates.
Although both approaches show similar long-term survival rates, hybrid
procedures are associated with a higher risk of complications, including
increased interstage mortality. These challenges highlight the need for
continued advancements to refine hybrid techniques and to improve
long-term outcomes. This review emphasises the critical role of tailored
patient selection and calls for further research to enhance hybrid
procedure protocols and optimise their effectiveness for specific patient
populations. Copyright © The Author(s), 2025. Published by
Cambridge University Press.

<76>
Accession Number
2040842933
Title
POINTER: study protocol for a phase 2b, randomised, placebo-controlled,
double-blind, parallel group dose-finding clinical study to evaluate the
efficacy of RMC-035 on renal function and safety, in participants at high
risk for kidney injury, following open-chest cardiac surgery.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 449. Date of
Publication: 01 Dec 2025.
Author
Zarbock A.; Strauss C.; Laflamme M.; Myjavec A.; Bohm J.; Burkert J.;
Mazer C.D.; de Varennes B.; Iglesias A.G.; Matschke K.; Larsson T.E.;
Reusch M.
Institution
(Zarbock, Strauss) Department of Anaesthesiology, Intensive Care and Pain
Medicine, University Hospital Munster, Munster, Germany
(Laflamme) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, Canada
(Myjavec) Department of Cardiac Surgery, Faculty of Medicine, Charles
University, University Hospital in Hradec Kralove, Hradec Kralove, Czechia
(Bohm) Department of Cardiovascular Surgery, Institute Insure, German
Heart Center Munich, Technical University of Munich, Munich, Germany
(Burkert) Fakultni Nemocnice V Motole, Prague, Czechia
(Mazer) St. Michael's Hospital, University of Toronto, Toronto, Canada
(de Varennes) McGill University Health Centre - Royal Victoria Hospital,
Montreal, Canada
(Iglesias) Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
(Matschke) Klinik fur Herzchirurgie, Herzzentrum Dresden
Universitatsklinik, Dresden, Germany
(Larsson, Reusch) Guard Therapeutics International AB, Stockholm, Sweden
Publisher
BioMed Central Ltd
Abstract
Background: Cardiac surgery with cardiopulmonary bypass invariably induces
renal stress and risk of irreversible kidney function loss, with no
approved drug treatments. RMC-035, a recombinant human
alpha-1-microglobulin with potent heme-binding and antioxidant capacity,
has shown promising long-term kidney-protective effects in a phase 2a
trial of patients undergoing cardiac surgery. The primary objective of
this phase 2b dose-optimisation trial is to demonstrate that RMC-035
(pooled dose groups) is superior to placebo in preserving renal function
at 90 days after surgery. Method(s): This randomised, blinded,
placebo-controlled, multicentre study evaluates the efficacy and safety of
RMC-035 among approximately 161 high-risk patients undergoing cardiac
surgery who are randomised into one of three treatment groups in a 2:2:3
ratio: RMC-035 (30 mg or 60 mg) or placebo. The study drug is administered
via three intravenous infusions, with the first dose given
intraoperatively, followed by additional doses at 6 and 24 h,
respectively. The primary endpoint is the change in estimated glomerular
filtration rate (eGFR) from baseline (pre-surgery) to Day 90. Important
secondary endpoints include the incidence of major adverse kidney events
at Day 90 and short-term outcomes reflecting changes in renal filtration
markers up to Day 7. Safety assessments encompass adverse events, vital
signs, electrocardiograms and routine safety laboratory tests. Additional
evaluations include pharmacokinetics, anti-drug antibodies and
immunological biomarkers. Discussion(s): This multicentre,
multinational phase 2b trial, will assess the change in eGFR within 90
days of the first dose, providing additional evidence of the long-term
kidney-protective potential of RMC-035 in patients undergoing cardiac
surgery at high risk for kidney injury. Trial outcomes will inform the
preferred dose, dosing regimen, and benefit-risk profile related to
cardiac surgery for a future pivotal phase 3 trial. Trial registration:
The trial was registered June 20, 2024, at Clinicaltrials.gov (NCT06475274
https://clinicaltrials.gov/study/NCT06475274). The trial including the
participating EU countries is also registered with the EUCT number
2024-510658-28 under
https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2024-
510658-28-00. The first patient was enrolled August 26,
2024. Copyright © The Author(s) 2025.

<77>
Accession Number
2037380727
Title
Perioperative Risk Factors for Permanent Pacemaker Implantation After
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Reviews in Cardiovascular Medicine. 26(10) (no pagination), 2025. Article
Number: 39299. Date of Publication: 01 Oct 2025.
Author
Peng X.; Chen N.; Li P.; Zhu F.-H.; Li M.; Zhao X.-H.; Zhang H.-P.
Institution
(Peng, Chen, Zhu, Li, Zhao, Zhang) Department of Cardiology, Beijing
Hospital, National Center of Gerontology, Institute of Geriatric Medicine,
Chinese Academy of Medical Sciences, Beijing, China
(Peng) Arrhythmia Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Li) The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics,
Institute of Geriatric Medicine, Chinese Academy of Medical Sciences,
Beijing Hospital/National Center of Gerontology of National Health
Commission, Beijing, China
Publisher
IMR Press Limited
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has become the
preferred treatment for severe aortic stenosis, particularly in patients
at high surgical risk. Conduction block requiring permanent pacemaker
(PPM) implantation remains a common complica-tion post-TAVR. This
systematic review and meta-analysis aimed to clarify perioperative
(<=30-day) predictors of PPM implantation. Method(s): A systematic
search was performed using the PubMed, Web of Science, and Embase
databases to gather all relevant studies examining the relationship
between TAVR and pacemaker implantation outcomes within 30 days of the
procedure. Pooled odds ratios (ORs) with 95% confidence intervals (CIs)
were calculated using a random-effects model. Result(s): A total of
82 studies comprising 124,808 patients were included. The overall
incidence of PPM implantation within 30 days post-TAVR was 17.5%. Key
baseline risk factors included right bundle branch block (RBBB) (OR, 5.48
95% CI, 4.52-6.64) and first-degree atrioventricular block (AVB) (OR, 2.30
95% CI, 1.82-2.90). Baseline left bundle branch block (LBBB), mitral
annular calcification, and male sex were not significantly associated with
PPM implantation. A longer membranous septum (MS) length was associated
with a reduced risk (OR, 0.78 95% CI, 0.66-0.93). Additionally, procedural
risk factors included greater implant depth (OR, 1.20 95% CI, 1.13-1.28),
the use of self-expanding valves (OR, 2.59 95% CI, 2.06-3.27), and balloon
predilation (OR, 1.37 95% CI, 1.10-1.71). The cusp overlap technique (COT)
significantly reduced PPM risk (OR, 0.45 95% CI, 0.35-0.58). Furthermore,
a greater difference between MS length and implantation depth (MSID) was
inversely correlated with PPM implantation risk (OR, 1.36 95% CI,
1.22-1.50), and post-TAVR new-onset LBBB was a strong predictor of PPM
implantation (OR, 2.26 95% CI, 1.66-3.07). Conclusion(s): This
meta-analysis identified key perioperative predictors of PPM implantation
following TAVR. RBBB, first-degree AVB, increased implant depth,
self-expanding valves, and predila-tion all have been shown to increase
PPM risk, whereas COT and lower MSID are protective factors. The PROSPERO
Registration: CRD42023438228, URL:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023438228. Copyright
© 2025 The Author(s).

<78>
Accession Number
649502450
Title
Impact of fluid overload on postoperative outcomes following cardiac
surgery: A systematic review and meta-analysis.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Melo R.; Cappellaro A.; Almeida L.; Felicio A.
Institution
(Melo, Felicio) Critical Care Unit, HMVSC Dr.Gilson de Cassia Marques de
Carvalho, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Cappellaro) Faculty of Medicine, UNINASSAU BARREIRAS, Barreiras, Brazil
(Almeida) Faculty of Medicine, Universidade Federal Fluminense (Campus
Gragoata), Rio de Janeiro, Brazil
Publisher
Springer Nature
Abstract
Introduction: Fluid overload has emerged as a critical factor associated
with adverse outcomes in critically ill patients, including renal failure,
prolonged mechanical ventilation, and increased mortality. Although its
impact is well established in conditions such as sepsis and acute lung
injury, its role in the context of cardiac surgery remains poorly
understood. Objective(s): We conducted a systematic review and
meta-analysis to investigate the effect of fluid overload on postoperative
outcomes in patients undergoing cardiac surgery. Method(s): We
systematically searched PubMed, Embase, and Cochrane to find clinical
trials (CTs) comparing postoperative outcomes in cardiac surgery patients
with fluid overload versus those managed with a restrictive fluid
strategy. Outcomes of interest included incidence of acute kidney injury
(AKI), all-cause mortality, postoperative atrial fibrillation (POAF),
intensive care unit length of stay (ICU-LOS), and total hospital length of
stay (HLOS). Data were analyzed using random-effects models with 95%
confidence intervals (CI). Result(s): Of the 3,311 studies initially
screened, 17 clinical trials comprising a total of 11,349 patients met the
inclusion criteria. Compared with those with fluid overload, patients
managed with a restrictive fluid strategy following cardiac surgery had a
significantly shorter HLOS (MD =- 1.03 days; 95% CI: - 1.72 to - 0.33; p <
0.05). In addition, fluid overload was associated with a significantly
higher risk of all-cause mortality compared to the restrictive group (OR =
1.65; 95% CI: 1.03-2.63; p < 0.05). No significant differences in the
incidence of AKI were observed between the groups (OR = 1.17; 95% CI:
0.69-1.99; p = 0.56). Similarly, no significant differences were found for
POAF or ICU-LOS. Conclusion(s): In patients undergoing cardiac
surgery, a restrictive fluid management strategy was associated with a
reduced hospital length of stay and decreased all-cause mortality. These
findings support the potential benefits of a restrictive fluid approach in
this patient population, warranting further investigation.

<79>
Accession Number
649492538
Title
Outcomes of CT-or CMR-guided TAVR according to sex: a secondary analysis
of the randomized TAVR-CMR trial.
Source
Wiener Klinische Wochenschrift. Conference: Annual Meeting of the Austrian
Society of Cardiology 2024. Salzburg Austria. 136(Supplement 6) (pp
S184-S185), 2024. Date of Publication: 01 May 2024.
Author
Oberhollenzer F.; Lechner I.; Reindl M.; Tiller C.; Holzknecht M.; Von Der
Emde S.; Binder R.; Klug G.; Bauer A.; Mayr A.; Reinstadler S.; Metzler B.
Institution
(Oberhollenzer, Lechner, Reindl, Tiller, Holzknecht, Von Der Emde, Bauer,
Reinstadler, Metzler) Universitatsklinik fur Innere Medizin III,
Kardiologie und Angiologie, Innsbruck, Austria
(Binder) Innere Medizin II, Wels, Austria
(Klug) Innere Medizin, Bruck an der Mur, Austria
(Mayr) Universitatsklinik fur Radiologie, Innsbruck, Austria
Publisher
Springer
Abstract
Introduction: Previous studies have reported sex differences in
pre-procedural imaging characteristics of patients undergoing
transcatheter aortic valve replacement (TAVR) evaluation. Whether these
differences affect the outcome of computed tomography (CT)-guided or
cardiac magnetic resonance (CMR)-guided TAVR has not been studied. This
analysis aimed to evaluate sex-based differences in imaging findings and
outcomes in patients undergoing TAVR for severe aortic valve stenosis.
 Method(s): This was a secondary analysis of the TAVR-CMR trial, a
randomized clinical trial comparing TAVR planning by CT or CMR. Outcomes
(based on the Valve Academic Research Consortium (VARC)-2 definition) with
each imaging strategy were compared according to sex. Result(s): Of
380 patient randomized into the TAVR-CMR trial, 194 (51.1%) were female
and 186 (48.9%) were male. Of these, 267 patients eventually underwent
TAVR (133 women (49.8%) and 134 men (50.2%), p = 0.457). Imaging findings
differed between the sexes for both imaging modalities. The compari-son
between CT and CMR to assess the access route and landing zone showed no
difference in both women and men (all p > 0.05). Implantation success was
not significantly different between imaging strategies for both women
(84.7% (CT group) vs. 93.2% (CMR group), p = 0.16) and men (95.7% (CT
group) vs. 93.8% (CMR group), p = 0.71). All-cause mortality at 6 months
was not significantly different between imaging strategies for both women
(10.2% (CT group) vs. 8.1% (CMR group), p = 0.77) and men (4.3% (CT group)
vs. 9.4% (CMR group), p = 0.31). Conclusion(s): This secondary
analysis has confirmed sexrelated differences in pre-procedural imaging
characteristics, with no influence of the imaging modality used. Similar
outcomes were observed in both female and male patients when the TAVR was
guided by either a CMR or a CT scan.

<80>
Accession Number
649492444
Title
Enhanced sternal closure after minimally invasive cardiac surgery -first
report on the use of a specially designed rigid plate fixation system.
Source
Wiener Klinische Wochenschrift. Conference: Annual Meeting of the Austrian
Society of Cardiology 2024. Salzburg Austria. 136(Supplement 6) (pp
S265-S266), 2024. Date of Publication: 01 May 2024.
Author
Miazza J.; Reuthebuch B.; Koechlin L.; Vasiloi I.; Gahl B.; Voehringer L.;
Reuthebuch O.; Eckstein F.; Santer D.
Institution
(Miazza, Reuthebuch, Koechlin, Vasiloi, Gahl, Voehringer, Reuthebuch,
Eckstein, Santer) Department of Cardiac Surgery, University Hospital
Basel, Basel, Switzerland
Publisher
Springer
Abstract
Introduction: Partial upper sternotomy (MICS) has gained popularity over
the last decades aiming to reduce the surgical burden. While sternal
plating has been shown to reduce postoperative sternal complications after
full sternotomy, reports about rigid plate fixation (RPF) after MICS are
scarce. In this retrospective study we provide, to the best of our
knowledge, the first data on a specially designed RPF system for MICS.
 Method(s): This retrospective analysis included all patients
undergoing MICS with RPF at our institution. Primary endpoint was the
incidence of sternal complications at discharge. Data are presented as
mean and standard deviation and median and interquartile ranges.
 Result(s): Between June and December 2023, 12 patients underwent MICS
followed by RPF. Median (IQR) age was 63.5 years (61.5 to 66.5) and 25% (n
= 3) were female. All patients underwent aortic valve replacement, with
one patient (8%) undergoing concomitant replacement of the ascending aorta
and hemiarch. RPF was successfully performed in all patients. Median
operative time was 207.1 minutes (188.7 to 223). Median length of
intensive care unit (ICU) and in-hospital stay were 1 day (1 to 1) and 8.5
days (7.75 to 10.75), respectively. Median time to first mobilization was
2 (1 to 2) days and 33% (n = 4) required opiates once admitted to the
general ward. In-hospi-tal mortality was 0%. At discharge, there was no
case of sternal pain, sternal instability or infection.
 Conclusion(s): This is, to the best of our knowledge, the first
report on the use of a specially designed RPF system for sternal closure
after MICS. These first results showed the technique to be safe and
feasible. Follow-up data are currently collected. Nevertheless, a
randomized controlled trial of RPF versus sternal wiring after MICS is
needed for further conclusions.

<81>
Accession Number
649502651
Title
Electrical impedance tomography-based evaluation of regional lung
ventilation according to ventilation strategy during cardiopulmonary
bypass in minimally invasive cardiac surgery: A prospective randomized
controlled trial.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Kim H.Y.; Yeo H.J.; Je H.G.; Kim H.J.; Park S.; Yoon J.P.; Ju M.H.; Lim
M.H.; Lee C.H.
Institution
(Kim, Park, Yoon) School of Medicine, Pusan National University,
Yangsan-si, South Korea
(Yeo) Department of Internal Medicine, Pusan National University School of
Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
(Je) Seoul National University Bundang Hospital, Seoul, South Korea
(Kim, Lee) Department of Anesthesia and Pain Medicine, Pusan National
University Yangsan Hospital, Yangsan-si, South Korea
(Ju, Lim) School of Medicine, Pusan National University, Yangsan, South
Korea
Publisher
Springer Nature
Abstract
Introduction: Despite the potential benefits of minimally invasive cardiac
surgery (MICS), cardiopulmonary bypass (CPB) during MICS can cause
pulmonary complications. However, the optimal ventilation strategy for the
left lung under CPB during MICS remains unclear. Objective(s): Thus,
this study aimed to evaluate differences in postoperative pulmonary
ventilation and complications according to ventilation strategy during
MICS. Method(s): This prospective, randomized controlled trial
included 60 patients who underwent MICS with one-lung ventilation. They
were randomly assigned to either the nonventilation (NV) group, in which
ventilation was halted during CPB, or the ventilation (V) group, in which
ventilation at a tidal volume of 5 ml/kg was maintained during CPB.
Electrical impedance tomography (EIT) monitoring was performed immediately
after surgery to evaluate differences in regional ventilation and
ventilation heterogeneity. Result(s): The V group exhibited better
ventilation homogeneity across the entire lung (0.5 +/- 0.1 vs. 0.6 +/-
0.2, P = 0.020) and increased ventilation in the left posterior region
(1.3 +/- 0.4 vs. 1.0 +/- 0.3, P = 0.003). However, no differences were
found in the clinical outcomes, including arterial blood gas analysis and
postoperative respiratory complications. Conclusion(s): Ventilation
of the left lung during CPB in MICS showed better ventilation homogeneity
and ventilation of the left posterior lung area, but did not result in
differences in early complications, including respiratory issues.
Therefore, in MICS with a CPB duration Table 1 (abstract 000709) Regional
ventilation ratio, and GI index of < 90 min, ventilating the left lung
during CPB may not be required.

<82>
Accession Number
649501612
Title
Tumor necrosis factor-alpha dynamics and endotoxin tolerance in cardiac
surgery: A secondary analysis of the SIRAKI02 trial.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Ulsamer A.; Boronat-Garcia P.; Hernandez-Jimenez E.; Campos A.;
Betbese-Roig A.J.; Sbraga F.; Sabater Riera J.; Perez Fernandez X.
Institution
(Ulsamer) Innate Immunity and Pathology of the Critical Patient, IDIBELL
Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat,
Spain
(Boronat-Garcia) Intensive Care Department, Hospital Universitari Germans
Trias i Pujol, Badalona, Spain
(Hernandez-Jimenez) R&D, Loop Diagnostics S.L., Barcelona, Spain
(Campos) Intensive Care Department, Germans Trias i Pujol Hospital,
Badalona, Spain
(Betbese-Roig) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Sbraga) Servei de Cirugia Cardiaca, Hospital Universitari de Bellvitge,
L'Hospitalet de Llobregat, Spain
(Sabater Riera) Hospital Universitario de Bellvitge, Barcelona, Spain
(Perez Fernandez) Intensive Care Dpt., Hospital Universitari de Bellvitge,
L'Hospitalet de Llobregat, Spain
Publisher
Springer Nature
Abstract
Introduction: Cardiopulmonary bypass (CPB) produces systemic inflammation
that has been implicated in the pathophysiology of cardiac
surgery-associated acute kidney injury (CSA-AKI). Our previous work
demonstrated that extracorporeal blood purification (EBP) attenuates
perioperative TNFalpha release. However, the clinical relevance of this
modulation remains unclear. Objective(s): To analyze the relationship
of TNFalpha changes with CSAAKI, particularly in vulnerable subphenotypes,
and to explore the relevance of immunoparalysis defined by endotoxin
tolerance (ET) in this context. Method(s): A secondary analysis of
the SIRAKI02 randomized clinical trial (n = 343), which evaluated EBP
during cardiac surgery, was conducted. We analyzed the association between
TNFalpha increase from baseline (T0) to end of surgery (T1) and the
development of CSA-AKI, defined by KDIGO criteria. Comparative subgroup
analyses were performed in patients with diabetes, hypertension, chronic
kidney disease (CKD) or reduced left ventricular ejection fraction (LVEF <
40%). In addition, in a subgroup of 40 patients (20 per group), ET was
assessed ex vivo by measuring TNFalpha production after lipopolysaccharide
(LPS) stimulation of whole blood samples collected at T0, T1, 3 h(T2) and
24 h(T3) after surgery. Result(s): A TNFalpha increase (T0 vs T1)
over a certain threshold, associated with higher CSA-AKI risk. Patients in
the EBP group had lower increases in TNFalpha when compared with standard
care group. This effect of EBP was stronger in high-risk subphenotypes
(i.e., diabetes, CKD, and low LVEF). In the ET substudy, TNFalpha
production after LPS stimulation was significantly reduced at T1 compared
to T0, indicating strong immunoparalysis, with no differences between EBP
and standard care groups. Of note, this effect was partially reversed at 3
h and was completely inverted at 24 h postoperatively. Conclusion(s):
TNFalpha increase during surgery is associated with risk of CSA-AKI. EBP
appears to mitigate this risk, at least in part, by modulating TNFalpha
dynamics specially in high-risk subphenotypes. These results support the
role of immune modulation during cardiac surgery in preventing AKI. The
absence of differences in ET between intervention and standard care groups
excludes any effect of EBP on the occurrence of ET.

<83>
Accession Number
649501924
Title
Comparison of hemodynamic stability during anesthesia using remimazolam
and sevoflurane in patients undergoing minimally invasive aortic valve
replacement surgery: A prospective randomized controlled study.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Lee J.; Yoon J.P.; Kim H.J.; Shon H.S.; Lee D.E.; Kim H.Y.
Institution
(Lee, Yoon, Kim, Shon, Lee) Anesthesiology and Pain Department, Pusan
National University Yangsan Hospital, Yangsan-si, South Korea
(Kim) Department of Anesthesia and Pain Medicine, School of Medicine,
Pusan National University, Yangsan-si, South Korea
Publisher
Springer Nature
Abstract
Introduction: Anesthetic agents can cause hypotension, and be especially
dangerous in patients with severe aortic stenosis, which can lead to even
circulatory collapse. Remimazolam is known for its hemodynamic stability
compared to propofol. This study is designed to compare effects of
remimazolam vs. sevoflurane anesthesia on intra-operative hemodynamics in
patients with severe aortic valve stenosis. Method(s): Patients were
divided into remimazolam (R) and sevoflurane (S) group. Remimazolam group
received remimazolam 6 mg/kg/h with remifentanil during induction and were
maintained under anesthesia with remimazolam 1-2 mg/kg/h combined with
remifentanil throughout surgery. Sevoflurane group received propofol 1%
1-2 mg/ kg with remifentanil for anesthesia induction and were maintained
under anesthesia with sevoflurane and remifentanil. Primary endpoint was
the comparison of the amount of vasopressors used, and secondary endpoints
were the comparison of mean arterial pressure (MAP) at fixed time points,
hypotensive and bradycardia events, extubation time, and
sedation-agitation-scale at ICU. Result(s): After excluding one
patient with change of surgical plan, sixty-three patients were enrolled.
When comparing percentage change from baseline MAP, R group showed smaller
fall from initial MAP at the start of CPB [-5.6 +/- 14.9 vs. -10.1 +/-
21.6; p = 0.047] and at the end of anesthesia[-30.7 +/- 13.9%, vs. -38.1
+/- 14.3%; p = 0.005] (Fig. 1). Section 1 was defined as start of
anesthesia to start of CPB, Sect. 2 from start of CPB to end of CPB, Sect.
3 from end of CPB to end of anesthesia and Sect. 4 from start of
anesthesia to the end of anesthesia. Proportion of hypotension was
significantly lower in the R group at Sect. 1[34.9 +/- 24.3% vs.48.1 +/-
21.4; p = 0.025], Sect. 3 [80.2 +/- 21.5% vs.91.9 +/- 25.2; p = 0.011]and
also in Sect. 4 [66.5 +/- 16.9% vs.76.0 +/- 16.2%; p = 0.007] (Fig. 2).
Norepinephrine use was lower during Sect. 1[0.003 +/- 0.008 mcg/kg/min vs.
0.017 +/- 0.030 mcg/kg/min; p = 0.015], and Sect. 3[0.040 +/- 0.051
mcg/kg/min vs. 0.085 +/- 0.080 mcg/kg/min; p = 0.007] in the R group.
Phenylephrine use was lower in Sect. 1[0.037 +/- 0.061 mcg/kg/min vs.
0.073 +/- 0.088 mcg/kg/min; p = 0.042] in the R group. Nicardipine use was
higher in the R group in Sect. 3 [0.719 +/- 0.547 mcg/kg/min vs. 0.233 +/-
0.318 mcg/kg/min; p < 0.001], and Sect. 4[0.270 +/- 0.185 mcg/kg/min vs.
0.109 +/- 0.137 mcg/kg/min; p < 0.001] (Fig. 3). Extubation time was
significantly shorter in the R group [4.4 +/- 3.3 min vs. 9.6 +/- 3.0 min;
p < 0.001]. Sedation agitation score and intraoperative arrhythmia,
postoperative complication did not show any significant difference between
the two groups (Table 4). Conclusion(s): Remimazolam anesthesia
resulted in less use of norepinephrine and phenylephrine before start of
CPB and less use of nor-epinephrine after CPB compared to sevoflurane
anesthesia in patients undergoing minimally invasive aortic valve
replacement surgery.

<84>
Accession Number
649501290
Title
Effects on inhaled nitric oxide with and without lung recruitment on right
ventricular function after cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Magana Bru I.; Sanchez Giralt J.A.; Alvargonzalez Riera C.; Sanchez
Galindo M.; Montes A.; Carrapiso P.; Delgado A.; Gonzalez B.; Mejias A.;
Perez Lucendo M.A.; Suarez Sipmann F.
Institution
(Magana Bru, Sanchez Giralt, Alvargonzalez Riera, Sanchez Galindo,
Carrapiso, Delgado, Gonzalez, Mejias, Suarez Sipmann) Hospital de la
Princesa, Madrid, Spain
(Montes) Hospital de la Princesa, Madrid, Spain
Publisher
Springer Nature
Abstract
Introduction: Right ventricular (RV) dysfunction is a frequent
perioperative complication after cardiac surgery under cardiopulmonary
bypass (CPB). An underrecognized factor is the presence of lung collapse
that increases pulmonary vascular resistance contributing to an increased
afterload in an recovering ischemic RV. Objective(s): To study the
effects of inhaled nitric oxide (iNO) alone or in combination with lung
recruitment to mitigate the effects of lung collapse on RV function after
cardiac surgery. Method(s): This was a prospective, single-center,
randomized study conducted in patients after cardiac surgery. We included
patients with preserved heart function, without pulmonary hypertension
that underwent uncomplicated cardiac surgery. Patients were under passive
mechanical ventilation ventilated with PEEP 5 cmH2O and VT 6'8 ml/kg, with
postoperative lung collapse: compliance >= 35 ml/ cmH2O, and dorsal
electrical impedance tomography (EIT) distribution of ventilation < 40%,
were randomized into one of three groups: Control: standard postoperative
management; iNO: 60 min of 40 ppm iNO and RM-iNO: lung recruitment and
postrecruitment PEEP 10 - 12 cmH2O + 60 min of 40 ppm iNO. Measures: gas
exchange, lung mechanics, hemodynamic parameters, EIT relative
distribution of ventilation-perfusion and RV function by transesophageal
echocardiography. This measures were obtained at baseline and after 60
min. Result(s): We included 17 patients in this preliminary analysis
underwent different types of cardiac surgery, such as coronary (7) or
valvular (10) procedures.The left ventricular ejection fraction was 65 +/-
9%. The median age was 65 years (range 55-76), and the mean BMI was 30 +/-
4. At baseline, EIT dorsal ventilation was 34 +/- 4% 1. Control group gas
exchange, lung mechanics, hemodynamics, and RV function remained unchange
(table) 2. INO group we observed a significant redistribution of pulmonary
perfusion towards the ventral regions of the lung (table), improving the
V/Q ratio and reducing shunt, which led to improved oxygenation. TEE
determined pulmonary artery systolic pressure decreased by 8% and stroke
volume increased by 10%. Respecting RV function contractilty parameters
slightly improved as did right ventricle ejection efficiency a parameter
intimately related to ventricular vascular coupling 3. MR-INO group we
observed significant improvements in lung mechanics, gas exchange, and
hemodynamic parameters. Pulmonary perfusion was redistributed to the
ventral regions (51% to 56%), with decreased lung collapse (increase in
dorsal ventilation from 29 to 44%), leading to improved V/Q matching and
ventricular-vascular coupling, and consequently, improvement in all
parameters of RV function Conclusion(s): The postoperative use of iNO
decreases pulmonary artery pressure improving ventricular-vascular
coupling, with the consequent improvement of RV function in patients under
cardiac surgery. All this is enhanced by the combination with lung
recruitment, also improving pulmonary mechanics and oxygenation.

<85>
Accession Number
648819010
Title
The effect of hypothermic compared to normothermic cardiopulmonary bypass
temperature on postoperative outcomes in adults undergoing non-aortic
cardiac surgery: A systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 38-39), 2025. Date of Publication: 01 Jul 2025.
Author
Chander N.; Sadeghirad B.; Chen M.; Desai K.; Gaudino M.; Fremes S.;
Whitlock R.; Belley-Cote E.; Spence J.
Institution
(Chander, Sadeghirad, Chen, Desai, Whitlock, Belley-Cote, Spence) Faculty
of Health Sciences, McMaster University, Hamilton, ON, Canada
(Sadeghirad, Spence) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Sadeghirad, Whitlock, Belley-Cote, Spence) Department of Health Research
METHODS , Evaluaton, and Impact, McMaster University, Hamilton, ON, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian Hospital, New York, NY, United States
(Fremes) Department of Surgery (Cardiac Surgery), Sunnybrook Hospital,
University of Toronto, Toronto, ON, Canada
(Whitlock) Department of Surgery (Cardiac Surgery), Hamilton General
Hospital, McMaster University, Hamilton, ON, Canada
(Whitlock, Belley-Cote, Spence) Populaton Health Research Insttute,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine (Cardiology), McMaster University,
Hamilton, ON, Canada
Publisher
Springer
Abstract
INTRODUCTION Cardiopulmonary bypass (CPB) is employed during cardiac
surgery to replace the physiologic roles of the heart and lungs and allow
for a bloodless feld. Hypothermia is a technique used during CPB in ?90%
of cases because of presumed cardioprotectve and neuroprotectve efects,1
despite limited supportng evidence. Given that hypothermia in other setngs
is associated with adverse efects,2,3 normothermia represents an atractve
alternatve. We undertook a systematc review and meta-analysis of
randomized controlled trials (RCTs) evaluatng the risks, benefts, and
resource implicatons of hypothermic vs normothermic CPB. Our primary
objectve was to inform a large randomized controlled trial examining this
queston.METHODS We searched MEDLINE, EMBASE, Cochrane CENTRAL, and Web of
Science for potentally relevant studies. We included trials in adults
undergoing non-aortc cardiac surgery comparing normothermia (= 35 degreeC)
with hypothermia (< 35 degreeC) during CPB. Outcomes of interest were
categorized as direct measures of morbidity and mortality (e.g.,
mortality, stroke, postoperatve cognitve decline), measures of resource
consumpton (e.g., CPB duraton, length of hospitalizaton), and surrogate
markers of morbidity and mortality (e.g., inotrope use). A pair of
reviewers independently extracted outcome data and assessed risk of bias
using a modifed Cochrane risk of bias tool (RoB 2.0). We used a
DerSimonian'Laird random-efects model for meta-analysis of all outcomes
and performed indirect treatment comparison meta-analysisusing a
frequentst approach to compare mild and moderate hypothermia with
normothermia. We used the Grading of Recommendatons Assessment,
Development, and Evaluaton (GRADE) approach to assess the certainty of
evidence across outcomes.4RESULTS We identfed 4,905 publicatons, screened
134 full texts, and included 50 RCTs including 5,536 partcipants. Most
trials (42/50; 84%) were at high risk of bias; the largest trial included
1,001 patents (Mean [SD], 111 [152]). For most outcomes, we found no
diference between patents undergoing hypothermic vs normothermic CPB,
including all measures of neurologic and cardiac injury (e.g., stroke,
delirium, myocardial infarcton, major arrhythmia, mortality; low to very
low quality of evidence). Postoperatve cognitve outcomes were poorly
reported. Patents undergoing hypothermic CPB had a higher incidence and
volume of transfusion (relatve risk [RR], 1.3; 95% confdence interval
[CI], 1.1 to 1.4, moderate quality; mean diference [MD], 1.5 units; 95%
CI, 0.2 to 2.9, low quality]) and longer CPB and operatve tmes (MD, 5 min;
95% CI, 2 to 8, low quality and MD, 15 min; 95% CI, 8 to 21, moderate
quality). Indirect treatment comparison showed no diference between mild
and moderate hypothermia across all outcomes.DISCUSSION In our systematc
review and meta-analysis of 50 RCTs including 5,536 partcipants,
hypothermia compared to normothermia had litle to no efect on major
morbidity and mortality afer cardiac surgery, but the evidence is of low
to very low certainty. Hypothermia compared to normothermia during CPB may
slightly increase CPB and operatve tmes, and the incidence and volume of
perioperatve transfusion (low to moderate certainty). A large and rigorous
multcentre RCT is required to determine the optmal temperature management
strategy during CPB.

<86>
Accession Number
648819056
Title
Pneumothorax rates following cardiac surgery with and without serratus
anterior plane blocks: A retrospective cohort study.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 194-196), 2025. Date of Publication: 01 Jul 2025.
Author
Saeed H.; Kang S.; Uppal V.; Ho L.; Bailey J.G.
Institution
(Saeed) College of Medicine, University of Saskatchewan, Saskatoon, SK,
Canada
(Kang, Uppal, Ho, Bailey) Department of Anesthesia, Pain Management and
Perioperatve Medicine, Dalhousie University, Halifax, NS, Canada
Publisher
Springer
Abstract
INTRODUCTION Moderate to severe pain is a common challenge afer cardiac
surgery, with the worst pain occurring during the frst two postoperatve
days. Pain originates from sternotomy, chest tubes, rib fractures, and
vein harvestng. Inefectve pain management prolongs intensive care unit
(ICU) stays, increases health care costs, and ofen leads to chronic pain.1
Enhanced recovery afer surgery (ERAS) protocols prioritze multmodal
analgesia and reduced opioid reliance, with regional anesthesia techniques
playing a key role.2 Serratus anterior plane blocks (SAPB) ofer efectve
pain control in thoracic surgery and were being investgated for
efectveness in sternotomy patents. Patents in a randomized trial had
higher than expected rates of pneumothoraxes. However, cardiac surgery
patents may have a higher pneumothorax risk due to pleural disrupton,
barotrauma, and chronic obstructve pulmonary disease (COPD).3This study
evaluates pneumothorax rates and respiratory complicatons in cardiac
surgery patents receiving SAPB compared to standard analgesia, aiming to
assess its safety and feasibility.METHODS We conducted a retrospectve
cohort study comparing patents from the Cardiac-SAP randomized controlled
trial (N = 50, 2021'2023) with a historical control cohort (N = 1,498,
2017'2020) at our insttuton. Both cohorts included adults (> 18 yr)
undergoing valvular replacement/repair and/or coronary artery bypass
grafing via median sternotomy. Exclusion criteria included emergency
surgeries (< 2 hr), ejecton fracton < 30%, extracorporeal membrane
oxygenaton, intra-aortc balloon pump, preoperatve vasopressors or
inotropes, severe liver disease, severe kidney disease, or planned
circulatory arrest. Pneumothorax was defned as clinically relevant,
requiring chest tube inserton. Secondary outcomes including ICU
readmissions, ventlaton duraton, and hospital length of stay. Trial
patents were matched to controls using propensity score matching (1:20) to
balance variables such as age, sex, smoking status, surgery type, and
COPD, with a caliper of 0.2. Univariate analyses used Chi square and
Fisher exact tests for dichotomous outcomes. Contnuous medians were
compared using thepercentle bootstrapping method with 2,000 repettons. A
prior study reported a 1.5% pneumothorax rate in cardiac surgery patents.
With alpha 5% and power 80%, 817 patents were needed to detect a 1%
increase.RESULTS The 50 patents in the Cardiac SAP trial were matched to
1,050 patents from a historic control. The pneumothorax rate was
signifcantly higher in the SAPB cohort compared to the historical control
group (12% vs 2.5%; odds rato, 5.3; 95% confdence interval, 2.1 to 13.6; P
< 0.001). Intensive care unit readmissions and ventlaton requirements were
comparable. Notably, SAPB patents had shorter ventlaton duratons (18.1 vs
35.5 hr; P = 0.03) and hospital stays (9.4 vs 9.7 days; P = 0.03). There
were no signifcant diferences in the overall rate of chest tube placement,
cardiovascular intensive care unit (CVICU) readmissions, or ventlaton on
readmission. There was also no diference in the length of ventlaton, CVICU
stay, or hospital stay.DISCUSSION We found that matched patents receiving
SAP catheter in the Cardiac-SAP pilot study had higher rates of
pneumothoraxes compared to historic controls. While there are several
reasons for pneumothorax following cardiac surgery, this raises safety
concerns around SAP catheters. We cannot be sure of the etology of the
pneumothoraxes and there were potental diferences in the monitoring inside
the trial compared to usual practces. Uncertainty about procedural
complicaton rates is a drawback of double blinded trials. Heightened
vigilance and maintaining careful needle visualizaton during chest wall
blocks is recommended.

<87>
Accession Number
648818996
Title
Preoperative frailty and its associated outcomes in older adults
undergoing cardiac surgery: A systematic review and meta-analysis.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 30-32), 2025. Date of Publication: 01 Jul 2025.
Author
Thangavelu V.; Bhata O.; Hasija A.; Rajapakse N.; Yan E.; Saripella A.;
Englesakis M.; Chung F.
Institution
(Thangavelu, Bhata, Rajapakse) Temerty Faculty of Medicine, University of
Toronto, Toronto, ON, Canada
(Hasija) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Yan, Saripella, Chung) Department of Anesthesia and Pain Management,
Toronto Western Hospital, University Health Network, University of
Toronto, Toronto, ON, Canada
(Yan, Chung) Insttute of Medical Science, Temerty Faculty of Medicine,
University of Toronto, Toronto, ON, Canada
(Englesakis) Library and Informaton Services, University Health Network,
Toronto, ON, Canada
Publisher
Springer
Abstract
INTRODUCTION Frailty, characterized by reduced physiological resilience,
has emerged as a pivotal risk factor in older adults undergoing major
cardiac procedures.1 Although previous analyses have linked frailty to
adverse surgical outcomes, knowledge gaps persist regarding its overall
prevalence across multple validated measurement tools and its specifc
associaton with postoperatve complicatons such as delirium, infecton, and
renal dysfuncton. This systematc review and meta-analysis synthesizes
contemporary evidence on frailty in cardiac surgery to refne preoperatve
risk stratfcaton and guide targeted perioperatve strategies. Identfying
frailty and understanding its prognostc impact will enhance the quality of
care and reduce the strain on health care systems. The objectve of our
systematc review and meta-analysis is to determine the prevalence of
preoperatve frailty and the associated adverse outcomes in older adults
undergoing cardiac surgery.METHODS A pre-specifed protocol was registered
with PROSPERO (CRD#42024574916), following PRISMA guidelines.2 We
systematcally searched MEDLINE, Embase, and Cochrane databases (24 June
2024) for English-language studies enrolling older adults (= 60 yr)
undergoing cardiac surgery (e.g., coronary artery bypass grafing, valve
procedures). Studies had to use validated frailty instruments (Fried
Frailty Phenotype, Clinical Frailty Scale, or Edmonton Frail Scale) to
identfy preoperatve frailty and report at least one postoperatve endpoint
(e.g., mortality, delirium, infecton, renal complicatons, hospital length
of stay). Non-cardiac surgeries, minor procedures (e.g., pacemaker
insertons), case reports, reviews, and non-English artcles were excluded.
Four reviewers independently screened ttles, abstracts, and full texts,
resolving disagreements with a ffh reviewer. Risk of bias was assessed
using the Newcastle-Otawa Scale for observatonalstudies. We applied GRADE
to evaluate overall evidence certainty. Random-efects meta-analyses in
RStudio and RevMan 5.4 generated pooled odds ratos (ORs) or mean
diferences (MDs) with 95% confdence intervals (CI), with heterogeneity
quantfed by the I statstc. Funnel plots and Egger's regression tested
publicaton bias, and leave-one-out sensitvity analyses identfed potental
sources of heterogeneity.RESULTS Twenty studies were included (n = 11,176;
mean age 72 +/- 4 yr, 29% female). The pooled prevalence of preoperatve
frailty was 18%. Frailty was signifcantly associated with higher odds of
delirium (OR, 4.11; 95% CI, 2.00 to 8.45), infecton (OR, 3.72; 95% CI,
2.27 to 6.13), and renal complicatons (OR, 2.72; 95% CI, 2.05 to 3.60).
Lastly, hospital (MD, 2.43 days; 95% CI, 1.07 to 3.80) and intensive care
unit (ICU) length of stay (MD, 1.07 days; 95% CI, 0.52 to 1.62) were
signifcantly longer among frail vs robust individuals. Meta-analysis
demonstrated that frail patents had higher odds of 30-day mortality (OR,
1.96; 95% CI, 1.09 to 2.82) and one-year mortality (OR, 1.86; 95% CI, 1.28
to 2.44) than robust patents (Figure). Overall evidence quality was
moderate; heterogeneity ranged from low to high.DISCUSSION The prevalence
of frailty, afectng 18% of older adults undergoing cardiac surgery,
represents a signifcant burden. We found frailty was associated with a
4-fold increase in delirium, a 3.7-fold increase in infecton, a 2.7-fold
increase in renal complicatons, extended length of stay, and an almost
2-fold increase in mortality. Multdisciplinary interventons-including
prehabilitaton, nutritonal optmizaton, and enhanced perioperatve
monitoring-may mitgate these risks. Future randomized trials are needed to
determine best practces for systematc frailty assessment in cardiac
surgery. This review highlights the urgency of recognizing and addressing
frailty as a potentally modifable factor in cardiac surgical care.

<88>
Accession Number
649492732
Title
Der Einfluss von Prehabilitation bei koronararterieller Bypassoperation.
Source
Wiener Klinische Wochenschrift. Conference: Annual Meeting of the Austrian
Society of Cardiology 2024. Salzburg Austria. 136(Supplement 6) (pp S254),
2024. Date of Publication: 01 May 2024.
Author
Rainer V.
Institution
(Rainer) FhGesundheit Innsbruck, Innsbruck, Austria
Publisher
Springer
Abstract
Introduction: Cardiovascular diseases are the number one cause of death
worldwide. Coronary artery bypass surgery is performed in patients to
ensure sufficient oxygen supply to the heart. Prehabilitation includes
individually tailored exercise and sports therapies prior to surgery to
establish physical and mental conditions for a complication-free recovery
and rapid recuperation. Method(s): To develop this paper, the EMED
format was employed, encompassing the sections of Introduction,
Methodology, Results and Discussion. The literature search was conducted
between December 2022 and May 2023 using the nursing databases CINHAL
Complete via EBSCO, Medline Complete via EBSCO and Medline via PubMed. The
selection of studies was based on a critical evaluation according to
Panfil, resulting in the inclusion of seven studies. Result(s): A
total of 1464 patients participated in the studies, of which 417 received
preoperative training. No negative effects were observed during the
prehabilitation phase. Significant differences were found in terms of
hospital stay duration, complications and postoperative physical fitness.
 Conclusion(s): This literature search has revealed that
prehabilitation has a positive effect. The investigated
interventionmethods differed and therefore further research is needed to
confirm their effectiveness.

<89>
Accession Number
649492655
Title
Age-related Outcomes in CMR versus CT-Guided TAVR: A Secondary Analysis of
the TAVR-CMR Trial.
Source
Wiener Klinische Wochenschrift. Conference: Annual Meeting of the Austrian
Society of Cardiology 2024. Salzburg Austria. 136(Supplement 6) (pp S154),
2024. Date of Publication: 01 May 2024.
Author
Lechner I.; Reindl M.; Holzknecht M.; Tiller C.; Oberhollenzer F.; Von Der
Emde S.; Binder R.; Klug G.; Mayr A.; Bauer A.; Reinstadler S.; Metzler B.
Institution
(Lechner, Reindl, Holzknecht, Tiller, Oberhollenzer, Von Der Emde, Bauer,
Reinstadler, Metzler) Universitatsklinik fur Innere Medizin III
-Kardiologie und Angiologie, Medizinische Universitat Innsbruck,
Innsbruck, Austria
(Binder) Abteilung fur Kardiologie und Intensivmedizin, Wels, Austria
(Klug) LKH Bruck an der Mur, Bruck, Austria
(Mayr) Universitatsklinik fur Radiologie, Medizinische Universitat
Innsbruck, Innsbruck, Austria
Publisher
Springer
Abstract
Introduction: The TAVR-CMR (Cardiac Magnetic Resonance Imaging Versus
Computed Tomography to Guide Transcatheter Aortic Valve Replacement) trial
demonstrated that cardiac magnetic resonance (CMR)-guided transcatheter
aortic valve replacement (TAVR) was non-inferior to computed tomography
(CT)-guided TAVR. This analysis aims to evaluate the impact of age on
outcomes in patients undergoing TAVR for severe aortic valve stenosis.
 Method(s): This was a secondary analysis of the TAVR-CMR trial, a
randomized clinical trial comparing TAVR planning by CT or CMR. Outcomes
(based on the Valve Academic Research Consortium (VARC)-2 definition) with
each imaging strategy were compared according to median age into those <=
82 and > 82 years. Result(s): In TAVR-CMR, of 380 randomized
patients, 267 underwent TAVR based on the heart team decision. There was
no significant age-related difference in TAVR selection between patients
<= 82 and > 82 years (66% vs. 76%, p = 0.124). Implantation success was
not significantly different between imaging strategies for patients <= 82
years (92% (CT group) vs. 95% (CMR group), p = 0.524) and patients > 82
years (89.4% (CT group) vs. 91.9% (CMR group), p = 0.622). All-cause
mortality at 6 months was not significantly different between imaging
strategies for patients <= 82 years (4.8% (CT group) vs. 5.3% (CMR group),
p = 0.839) and > 82 years (9.1% (CT group) vs. 12.9% (CMR group), p =
0.490). Conclusion(s): CMR-guided TAVR was associated with similar
TAVR outcomes compared with CT-guided TAVR irrespective of age.

<90>
Accession Number
649502426
Title
Underrepresentation and mortality outcomes of oncology patients in
randomized clinical trials in intensive care medicine: A systematic
review.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Melo R.; Gioli-Pereira L.; Felicio A.; Bustamante M.; Correa T.; Passos R.
Institution
(Melo, Gioli-Pereira, Felicio, Bustamante) Critical Care Unit, HMVSC
Dr.Gilson de Cassia Marques de Carvalho, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Correa, Passos) Department of Critical Care Medicine, Albert Einstein
Israelita Hospital, Sao Paulo, Brazil
Publisher
Springer Nature
Abstract
Introduction. Cancer patients increasingly require intensive care due to
complications related to malignancy or its treatment. Yet, their
representation in randomized controlled trials (RCTs) that shape critical
care guidelines remains unclear. This systematic review aimed to evaluate
how oncology patients are included, excluded, and analyzed in critical
care setting RCTs focused on mortality outcomes. Objectives. To assess the
inclusion or exclusion of oncology patients in intensive care units (ICU)
RCTs and analyze the mortality outcomes specifically within this subgroup.
Methods. We performed a systematic search of PubMed, Embase, and the
Cochrane Library for multicenter RCTs published between January 2010 and
January 2025. Eligible studies enrolled adult ICU patients and reported
mortality as a primary or co-primary endpoint. We excluded trials focused
exclusively on trauma, cardiac surgery, or COVID-19. We used Pubmed's core
clinical journals filter as inclusion criteria. Two independent reviewers
extracted data on oncologic exclusion criteria, the proportion of cancer
patients enrolled, and whether subgroup analyses involving malignancy were
conducted. Results. A total of 63 RCTs met inclusion criteria encompassing
110,908 patients. Among these, 34 trials (54%) did not specify the
inclusion or exclusion of oncology patients, and 11 trials (17.4%)
explicitly excluded them. Only 18 articles (28.5%) allowed the inclusion
of patients with cancer. Among these, 17 articles reported the number of
cancer patients enrolled, with proportions ranging from 0.5% to 33%, with
most of them (n = 13) reporting a prevalence less than 20%. None of the
trials performed dedicated subgroup analyses assessing mortality outcomes
specifically in oncology patients. No RCT was designed specifically to
assess outcomes in critically ill oncology populations. Conclusions.
Critically ill cancer patients are substantially underrepresented in large
ICU RCTs, with the majority of trials either excluding them or failing to
report their inclusion status. Even when included, subgroup analyses are
infrequent and often inadequately powered to inform oncologic
subpopulations. This limits the generalizability of ICU trial data to
cancer patients and undermines evidence-based decision-making in this
growing and high-risk population. Future studies should prioritize
transparent reporting, inclusive eligibility criteria, and oncologic
stratification to improve the applicability of critical care research to
patients with cancer.

<91>
Accession Number
649502376
Title
Impact of anaesthetics on the renoprotective effect of remote ischemic
preconditioning: The HypnoRenalRIP randomized clinical trial.
Source
Intensive Care Medicine Experimental. Conference: 38th ESICM LIVE Annual
Congress. Munich Germany. 13(1 Supplement) (no pagination), 2025. Date of
Publication: 01 Oct 2025.
Author
Zarbock A.; Weiss R.; Gerss J.; Kellum J.; Schone L.; Strauss C.; Sadjadi
M.; Booke H.
Institution
(Zarbock, Weiss, Schone, Straus, Sadjadi, Booke) Department of
Anaesthesiology, Intensive Care and Pain Medicine, University Hospital
Munster, Munster, Germany
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
(Kellum) Department of Critical Care Medicine, University of Pittsburgh,
Pittsburgh, United States
Publisher
Springer Nature
Abstract
Introduction: Remote ischemic preconditioning (RIPC) has been shown to
reduce acute kidney injury (AKI) in high-risk patients after cardiac
surgery. The protective effects are restricted to patients with early and
transient increases of the two cell cycle arrest markers, tissue inhibitor
of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding
protein 7 (IGFBP7) in the urine. The studies suggest that propofol may
attenuate the preconditioning effect on the myocardium. Objective(s):
The purpose of this study was to investigate whether propofol also
diminishes the preconditioning effect on the kidneys by measuring
[TIMP-2]*[IGFBP7]. Method(s): This is a single-center, randomized
clinical trial among high-risk patients undergoing cardiac surgery with
cardiopulmonary bypass. Patients were randomized to receive either
propofol+ sham- RIPC, propofol+ RIPC, sevoflurane+ sham- RIPC or
sevoflurane+ RIPC. The primary endpoint was the change in urinary
[TIMP2]*[IGFBP7] between post- and preintervention. Secondary outcomes
included the incidence of AKI within 72 h after cardiac surgery.
 Result(s): The results are presented in Table 1. 160 patients were
included in the trial (propofol + sham-RIPC: n = 20, propofol + RIPC: n =
60, sevoflurane + sham-RIPC: n = 20, sevoflurane + RIPC: n = 60). Median
change in [TIMP2]*[IGFBP7] before and after RIPC was significantly greater
in patients receiving sevoflurane (0.070; IQR -0.120, 0.418) compared with
those receiving propofol (-0.015; IQR -0.138, 0.068; p = 0.029). Four
hours after CPB, [TIMP2]*[IGFBP7] did not increase with sevoflurane + RIPC
group whereas it did in the other groups (p = 0.001). There were no
statistically significant differences in patient-centred outcomes,
including AKI, between the groups. Conclusion(s): RIPC-induced
transient changes of [TIMP2]*[IGFBP7], which are associated with
renoprotective effects, were only seen with sevoflurane anesthesia, but
not when propofol was used. These results may explain the lack of
renoprotection in propofol-anesthetized patients receiving RIPC.

<92>
Accession Number
2041999412
Title
Efficacy and Safety of Protamine Use following Transcatheter Aortic Valve
Implantation for Minimizing Post-Procedural Bleeding Risk: A Systematic
Review and Meta-Analysis.
Source
Cardiology (Switzerland). (pp 1-9), 2025. Date of Publication: 2025.
Author
Kara A.O.; Beshr M.S.; Abdelaziz A.M.; Alzubi A.S.; Alansari A.H.A.;
Arhaym E.; Aburawi D.M.; El Awami M.; Farag A.; Almezghwi H.; Abdulsalam
A.A.; Shahin H.N.; Elhadi M.; Mamas M.
Institution
(Kara, Arhaym, El Awami) Faculty of Medicine, University of Benghazi,
Benghazi, Libyan Arab Jamahiriya
(Beshr) Sana'a University, Faculty of Medicine and Health Sciences, Sanaa,
Yemen
(Abdelaziz) Alexandria University Faculty of Medicine, Alexandria, Egypt
(Alzubi) Internal Medicine, Marshall University Joan C. Edwards School of
Medicine, Huntington, West Virginia, United States
(Alansari) Gharyan University, Gharyan, Libyan Arab Jamahiriya
(Aburawi) Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab
Jamahiriya
(Farag) Internal Medicine, East Carolina University, Greenville, South
Carolina, United States
(Almezghwi) Metiga Hospital, Tripoli, Libyan Arab Jamahiriya
(Abdulsalam) Omar Almukhtar University, Al Bayda, Libyan Arab Jamahiriya
(Shahin) Faculty of Medicine, South Valley University, Qena, Egypt
(Elhadi) College of Medicine, Korea University, Seoul, South Korea
(Mamas) Keele Cardiovascular Research Group, Keele University, Keele,
United Kingdom
Publisher
S. Karger AG
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) may be
complicated by postoperative bleeding due to heparin use. Heparin
antagonists, such as protamine, have shown potential in reducing bleeding
risks. This meta-analysis assesses the efficacy and safety of protamine in
reducing bleeding complications after TAVI. Method(s): A systematic
search was conducted up to March 2025. Inclusion criteria encompassed
studies reporting the use of protamine post-TAVI with a control group.
Primary outcomes included major bleeding events as the efficacy endpoint,
30-day mortality, and ischemic events (stroke and transient ischemic
attack, or TIA) as safety endpoints. Secondary outcomes included
life-threatening bleeding events and the need for blood transfusion. A
random-effects model was used to calculate odds ratios (ORs).
 Result(s): Four studies involving 1,569 patients were included. As
compared to the control group, protamine was not associated with a
statistically significant difference in major bleeding events (OR = 0.59,
95% CI = 0.26-1.34, p = 0.21), life-threatening bleeding events (OR = 0.3,
95% CI = 0.06-1.62, p = 0.16), need for blood transfusions (OR = 0.75, 95%
CI = 0.46-1.24, p = 0.27), 30-day mortality (OR = 1.07, 95% CI =
0.54-2.11, p = 0.85), or rate of stroke and TIA (OR = 0.86, 95% CI =
0.05-13.58, p = 0.91). Conclusion(s): Protamine use after TAVI
appeared to be safe with no increase in 30-day mortality or stroke and TIA
rates, but there was no observed statistically significant benefit in the
reduction of major or life-threatening bleeding events and the need for
blood transfusions. These findings are based on a limited number of
studies, and larger randomized controlled trials are warranted to confirm
them. Copyright © 2025 Emerald Publishing Limited

<93>
Accession Number
649493674
Title
Rationale, Design, and Baseline Clinical Characteristics of the
Ziltivekimab Cardiovascular Outcomes Trial: Interleukin-6 Inhibition and
Atherosclerotic Event Rate Reduction.
Source
JAMA cardiology. (no pagination), 2025. Date of Publication: 10 Dec 2025.
Author
Ridker P.M.; Baeres F.M.M.; Hveplund A.; Engelmann M.M.D.; Hovingh G.K.;
Lincoff A.M.; Marx N.; Navar A.M.; Sattar N.; Tuttle K.; Perkovic V.
Institution
(Ridker) Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Boston, MA, United States
(Ridker) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Baeres, Hveplund, Engelmann, Hovingh) Novo Nordisk, Copenhagen, Denmark
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, United States
(Marx) Department of Internal Medicine I, University Hospital RWTH Aachen,
Aachen, Germany
(Navar) Department of Medicine, UT Southwestern Medical Center, Dallas,
TX, United States
(Navar) JAMA Cardiology
(Sattar) School of Cardiovascular and Metabolic Health, University of
Glasgow, Glasgow, United Kingdom
(Tuttle) Providence Medical Research Center, Providence Inland Northwest
Health, Spokane, WA, United States
(Perkovic) University of New South Wales Sydney, Sydney, NSW, Australia
Abstract
Importance: Cardiovascular inflammation is a major determinant of
atherosclerotic disease, and inhibition of the central signaling cytokine,
interleukin 6 (IL-6), is a promising target for intervention. Patients
with chronic kidney disease (CKD) commonly have plasma elevations of
inflammatory biomarkers, such as high-sensitivity C-reactive protein
(hsCRP) and IL-6, and are at high risk for life-threatening
atherosclerotic events as well as loss of kidney function and might
therefore benefit from IL-6 inhibition. Observations: The Ziltivekimab
Cardiovascular Outcomes Trial (ZEUS; NCT05021835) will determine the
safety and efficacy of IL-6 inhibition with ziltivekimab among patients
with atherosclerotic cardiovascular disease (ASCVD), CKD, and systemic
inflammation. ZEUS is a multinational, double-blind, placebo-controlled,
event-driven, randomized clinical trial inclusive of 6376 participants
with ASCVD, CKD, and an hsCRP level greater than or equal to 2 mg/L who
were randomized in a 1:1 fashion to receive either ziltivekimab, 15 mg,
administered subcutaneously every month or matching placebo. At
randomization, mean age was 69.5 years, 27.5% were female, 92.0% had
hypertension, 65.7% had diabetes, and 41.3% had heart failure. At
baseline, the mean estimated glomerular filtration rate (eGFR) was 44.5
mL/min/1.73 m2, mean low-density lipoprotein cholesterol level was 77.7
mg/dL, median hsCRP level was 4.5 mg/L, and median IL-6 level was 4.9
pg/mL. At enrollment, sodium-glucose cotransporter-2 inhibitors and
glucagon-like peptide-1 receptor agonists were being used by 36.8% and
11.3% of the cohort, respectively. The primary outcome is 3-point major
adverse cardiovascular events. Secondary cardiovascular outcomes include
(1) an expanded major adverse cardiovascular event outcome including
hospitalization for unstable angina requiring urgent coronary
revascularization, (2) hospitalizations for heart failure or urgent heart
failure visits or cardiovascular death, and (3) all-cause mortality. The
secondary kidney outcome is a composite of greater than 40% decline in
eGFR, eGFR less than 15 mL/min/1.73 m2, dialysis, kidney transplant, death
from kidney disease, or cardiovascular death. Conclusions and
Relevance: The ZEUS randomized clinical trial will formally test the
hypothesis that IL-6 inhibition with ziltivekimab will lower incident
cardiovascular event rates and potentially slow kidney decline among
participants with known ASCVD, CKD, and elevated hsCRP. If successful, the
ZEUS trial would provide a fully novel approach for prevention of
myocardial infarction, stroke, cardiovascular death, and kidney function
decline among high-risk patients with CKD.

<94>
Accession Number
648819005
Title
Melatonin for preventing postoperative delirium in elderly patients: A
multicentre randomized placebo-controlled pilot study.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 166-169), 2025. Date of Publication: 01 Jul 2025.
Author
Khaled M.; Chui J.; Ewusie J.; Agzarian J.; Bogach J.; Gomez M.; Shayegan
B.; Shargall Y.; Alkhamesi N.; Paul J.; Thabane L.; Shanthanna H.
Institution
(Khaled, Paul, Shanthanna) Department of Anesthesia, McMaster University,
Hamilton, ON, Canada
(Khaled) Perioperatve and Surgery Research Program, Populaton Health
Research Insttute, Hamilton, ON, Canada
(Chui, Gomez) Department of Anesthesia and Perioperatve Medicine, Western
University, University Hospital, London, ON, Canada
(Ewusie, Paul, Thabane, Shanthanna) Department of Health Research METHODS
, Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Agzarian) Department of Surgery, St. Joseph's Healthcare Hamilton,
Hamilton, ON, Canada
(Bogach, Shayegan, Shargall) Department of Surgery, McMaster University,
Insttute for Applied Health Sciences, Hamilton, ON, Canada
(Alkhamesi) Department of Surgery, Western University, St. Joseph's
Hospital, London, ON, Canada
Publisher
Springer
Abstract
INTRODUCTION Delirium is an acute and fuctuatng state of confusion
characterized by alteratons in the level of atenton and awareness and
disturbance of cogniton.1 Postoperatve delirium (POD) in older adults is
common and is associated with a high risk of morbidity and mortality.2
With limited treatment optons, preventon of POD is essental. Melatonin, a
pineal gland hormone, has been suggested to prevent delirium through
regulatng the sleep-wake cycle and serotonin metabolism, which has been
shown to be disrupted in patents with POD.3,4 Few randomized controlled
trials (RCTs) have evaluated melatonin for delirium preventon however with
several limitatons including variatons the dose and duraton of treatment
and outcome assessment (tming and consistency of delirium assessment).5
Hence, the evidence regarding the use of melatonin for POD preventon is
limited and inconclusive. We conducted a pilot RCT to evaluate the efect
of melatonin on POD incidence afer noncardiac surgery in patents > 65
yr.METHODS This placebo-controlled, two-arm parallel-design multcenter
pilot RCT was approved by the local Research Ethics Board and registered
on clinicaltrials.gov. We included patents > 65 yr of age, undergoing
major electve noncardiac surgery (vascular, thoracic, gynecological,
otolaryngeal, general and gastrointestnal) with an expected hospital stay
of = 2 days and able to provide informed consent. Exclusion criteria were:
1) refusing to partcipate; 2) actve delirium or dementa; 3) planned
postoperatve ventlaton; 4) previous study partcipaton; 5) allergy to
melatonin; 6) hepatc impairment defned as alanine aminotransferase greater
than 500 IU*L-1; 7) previous liver transplant or liver cirrhosis of
Child'Pugh classes B and C; 8) language barrier;or 9) pregnant or
breasteeding women. Patents were randomized, centrally in a 1:1 rato,
using a computer-generated, permuted, variable block randomizaton,
stratfed by site, to treatment (3 mg oral melatonin) or placebo once
preoperatvely and for 7 days postoperatvely. Patents were assessed twice
daily for delirium and followed at 3 months postoperatvely. Patents,
research assistants involved in patent recruitment and follow-up, health
care providers, and data analysts were blinded. Feasibility outcomes were
recruitment rate, medicaton adherence, and proporton completng 3-month
follow-up. Clinical outcomes were delirium incidence, sleep quality,
insttutonal discharge, and cognitve status at 3 months.RESULTS Between
September 2021 and June 2023, 85 patents were randomized (?1 patent/week);
of these, 92.9% adhered to study medicatons and 87.1% completed the
3-month follow-up. Due to the COVID-19 pandemic, there were signifcant
interruptons to the study and challenges to patent recruitment. Due to
contnued challenges in recruitment and need for important changes to the
study protocol to establish feasibility (including the need to involve
other sites and funding), the study was terminated for futlity in June
2023 afer recruitng 76% of our target sample size. Baseline and
perioperatve characteristcs (age, sex, comorbidites, medicatons, history
of delirium, surgical diagnosis, cognitve status, sleep quality,and
depression) were similar between the groups. Postoperatve delirium
occurred in 9 patents (10.6%) with no statstcal diference between the
groups (melatonin group, n = 7; placebo group, n = 2; adjusted odds rato:
1.12; 95% confdence interval, 0.006 to 150.1). There were no statstcal
diferences in other clinical outcomes between the two groups
(Table).DISCUSSION We assessed the feasibility of conductng a large RCT to
evaluate the efect of perioperatve melatonin on the incidence of POD afer
noncardiac surgery and explored its efects on clinical outcomes. We showed
lower recruitment and retenton rates than our prespecifed acceptable rates
for advancing to the main trial. We did not observe important diferences
in the incidence of POD or other clinical outcomes. Based on our
observatons, a large sample size is required for a defnitve trial to
evaluate the role of melatonin in POD preventon. We highlight
consideratons to address feasibility challenges and ongoing post-pandemic
patent care modifcatons.

<95>
Accession Number
648819478
Title
Comparative Effectiveness of Left Atrial Appendage Occlusion versus Oral
Anticoagulants in Older Atrial Fibrillation Patients.
Source
Pharmacoepidemiology and Drug Safety. Conference: 41st International
Society for Pharmacoepidemiology International Conference, ISPEs 2025.
Washington, DC United States. 34(Supplement 1) (no pagination), 2025. Date
of Publication: 01 Aug 2025.
Author
Liu X.; Schneeweiss S.; Singer D.E.; Avorn J.; Heist E.K.; Lin K.J.
Institution
(Liu, Schneeweiss, Lin) Brigham and Women's Hospital and Harvard Medical
School, United States
(Singer, Heist) Massachusetts General Hospital and Harvard Medical School,
United States
(Avorn) Brigham and Women's Hosp., Harvard Medical School, United States
Publisher
John Wiley and Sons Ltd
Abstract
Background: Real-world evidence evaluating left atrial appendage occlusion
(LAAO) devices in patients with nonvalvular atrial fibrillation (AF)
remain limited. Objective(s): To compare the effectiveness and safety
of LAAO device versus oral anticoagulants (OAC) in patients with
nonvalvular AF. Method(s): A population-based cohort study using a
target trial emulation approach included nonvalvular AF patients aged = 65
years with a CHA2DS2-VASc score of = 2 (men) or = 3 (women), from Medicare
(2016 to 2022) and commercial (2016 to 2025) claims data. Patients who
received LAAO in conjunction with a postprocedural antithrombotic regimen
of either OAC or P2Y12 inhibitor (LAAO strategy) were 1:1 matched to
patients who received OAC or P2Y12 inhibitor alone (antithrombotic
strategy) via propensity score matching. Primary outcomes included
hospitalization for major bleeding events, ischemic stroke, and all-cause
death. Follow-up was censored at 2 years or upon treatment deviation (OAC
discontinuation or LAAO implantation in OAC users, and OAC continuation
beyond 90 days in LAAO users). Database-specific rate ratios were
estimated via Poisson regression weighted by inverse probability of
censoring weighting to account for potential informative censoring and
competing risk be death and pooled using fixed-effect meta-analysis.
 Result(s): A total of 61,742 patients were included (median age 77;
46% female). Among patients following the LAAO strategy (n = 30,871), 5%
had discontinued their antithrombotic treatment by 45 days and 60% by 6
months. For the OAC strategy, the 2-year major bleeding rate was 2.09 per
100 patient-years, and the ischemic stroke rate was 0.85. Compared to the
OAC strategy, the LAAO strategy had a higher rate of bleeding within the
first 45 days (rate ratio [RR] 2.91; 95% confidence interval [CI]
2.16-3.92) and 46 days to 6 months (RR 1.52; 95% CI: 1.28-1.81)
post-implantation, but a reduced rate of bleeding beyond 6 months (RR
0.66; 0.55-0.79). The LAAO strategy was associated with a higher rate of
ischemic stroke 6 months after LAAO (RR 1.67; 1.30-2.16), but such
association was not observed during the initial 6 months. Results for the
P2Y12 inhibitor strategy were directionally similar but attenuated and
based on fewer events for the major bleeding outcome and showed no
significant difference for the ischemic stroke outcome.
 Conclusion(s): Compared to the antithrombotic therapy, the LAAO
strategy was associated with an increased bleeding risk during the first 6
months post-implantation. After 6 months, the LAAO strategy had a
substantially lower bleeding risk but a higher risk of ischemic stroke.
These findings may help inform clinical decision-making regarding the use
of LAAO.

<96>
Accession Number
648820542
Title
Effects of Different Sedation Regimens on Mortality in Post-Cardiac
Surgery Patients: A Target Trial Emulation Study.
Source
Pharmacoepidemiology and Drug Safety. Conference: 41st International
Society for Pharmacoepidemiology International Conference, ISPEs 2025.
Washington, DC United States. 34(Supplement 1) (no pagination), 2025. Date
of Publication: 01 Aug 2025.
Author
Lin X.; Yin X.; Kong S.; Chen L.; Zhu J.; Zhou J.
Institution
(Lin) School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical
University, Jiangsu, China
(Yin, Kong) School of International Business, China Pharmaceutical
University, Jiangsu, China
(Chen) Department of Anesthesiology, Perioperative and Pain Medicine,
Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
(Zhu) Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical
University, Jiangsu, China
(Zhou) China Pharmaceutical University, China
Publisher
John Wiley and Sons Ltd
Abstract
Background: Sedation management in critically ill post-cardiac surgery
patients is crucial, yet the impact of different sedation regimens on
mortality remains uncertain. Randomized controlled trials (RCTs) are often
impractical due to ethical and logistical constraints, making real-world
data (RWD) a valuable alternative for evaluating clinical interventions.
This study leverages electronic health records (EHR) to emulate a target
trial comparing sedation strategies and their effects on long-term
mortality. Objective(s): To assess the impact of propofol alone
versus propofol combined with dexmedetomidine or midazolam on 28-day,
90-day, and 180-day mortality in post-cardiac surgery patients admitted to
the intensive care unit (ICU). Method(s): Using a target trial
emulation (TTE) approach, we analyzed data from MIMIC-IV (v3.1), a large
deidentified critical care dataset from Beth Israel Deaconess Medical
Center (BIDMC). Patients aged = 18 who underwent cardiac surgery and
received sedation within 24 hours of ICU admission were included.
Exclusion criteria included ICU stays < 48 hours and missing mortality
data. Propensity score matching (PSM) and inverse probability of treatment
weighting (IPTW) were applied to adjust for baseline confounders. The
primary outcome was mortality at 28, 90, and 180 days. Secondary outcomes
included ventilator-free and vasopressor-free days, ICU length of stay,
and maximum norepinephrine dose. Result(s): Among 4,913 eligible
patients, 3,351 received propofol alone, 1,225 received
propofol-dexmedetomidine, and 337 received propofol-midazolam.
Propofol-dexmedetomidine was associated with significantly lower 28-day
mortality (HR = 0.69, 95% CI 0.55-0.86, p < 0.01), with consistent
benefits at 90 and 180 days. Propofol-midazolam was associated with
significantly higher 28-day mortality (HR = 5.47, 95% CI 3.60-8.32, p <
0.001), as well as increased norepinephrine use (2.9 vs. 1.6 mg/min, p <
0.001), longer vasopressor dependence (23.8 vs. 20.3 days, p < 0.001), and
prolonged mechanical ventilation (21.2 vs. 17.6 days, p < 0.01).
 Conclusion(s): This study demonstrates the potential of real-world
evidence (RWE) from EHR-based databases in guiding sedation strategies in
ICU settings. Propofol-dexmedetomidine is associated with improved
survival, while propofol-midazolam is linked to increased mortality and
prolonged ICU interventions. Given the challenges of conducting RCTs in
ICU sedation, real-world studies using advanced analytical frameworks,
such as TTE, are essential for informing regulatory and clinical
decision-making. Further research is needed to optimize sedation protocols
for post-cardiac surgery patients.

<97>
Accession Number
648819120
Title
CAS 2025 Annual Meeting.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(no pagination), 2025. Date of Publication: 01 Jul 2025.
Author
Anonymous
Publisher
Springer
Abstract
The proceedings contain 86 papers. The topics discussed include:
intravenous versus oral sedation for cataract surgery: a systematic review
and meta-analysis; streamlining perioperative care: evaluating the impact
of a direct to phase ii protocol on hip and knee arthroplasty outcomes and
hospital efficiency; association of perioperative echocardiographic right
ventricular function with outcomes after cardiac surgery: a retrospective
cohort study; intercostal nerve cryoablation for postoperative analgesia
in minimally invasive valve surgery: a single center retrospective cohort
study; isolated intraventricular hemorrhage following cerebrospinal fluid
drain placement postthoracic endovascular aortic repair: a case report;
and overhead arm positioning for challenging fenestrated endovascular
aneurysm repair in a patient with severe hypertrophic obstructive
cardiomyopathy: a case report.

<98>
Accession Number
648818980
Title
Isolated intraventricular hemorrhage following cerebrospinal fluid drain
placement postthoracic endovascular aortic repair: A case report.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 21-22), 2025. Date of Publication: 01 Jul 2025.
Author
Moir A.; Foglia J.
Institution
(Moir) Faculty of Medicine, University of Britsh Columbia, Vancouver, BC,
Canada
(Foglia) Division of Cardiac Anesthesia, Vancouver General Hospital,
Vancouver, BC, Canada
Publisher
Springer
Abstract
INTRODUCTION Spinal cord injury (SCI) afer thoracic endovascular aortc
repair (TEVAR) is a devastatng complicaton, with consequences ranging from
temporary paraparesis and lower extremity weakness to permanent
paraparesis.1 Placement of a cerebrospinal fuid (CSF) drain is a
prophylactc measure based on randomized control trials demonstratng their
utlity for open thoracic aortc aneurysm repairs. The largest trial
demonstrated a decrease in paraplegia risk from 13% to 2.6%.2 However, no
large, randomized control trials exist for their use in TEVARs. Earlier
literature demonstrated the efcacy of CSF drains for reducing SCI3 and in
2010, the American Heart Associaton endorsed prophylactc CSF drains for
TEVARs.4 Unfortunately, retrospectve studies have cast doubt on the
reducton of SCI in high-risk TEVARs.5 To date, there is no consensus
regarding preventatve CSF drain use for routne TEVARs. This report
presents a case showing a novel complicaton of prophylactc CSF drain use,
which has not been reported in the literature and has implicatons for
high-risk TEVAR management.CASE PRESENTATIONWe present a 78-year-old
female with complicated aortc disease who underwent TEVAR. A CSF drain was
non-traumatcally inserted preoperatvely. The case proceeded with systolic
blood pressure over 130 mm Hg and hemoglobin over 100 g*L-1. The CSF drain
was maintained at 10 mm Hg and 13 mL of CSF was drained over the 2-hour
case. Afer the procedure, the patent was extubated and documented to be
moving all extremites on command before being transferred to the Cardiac
Surgery Intensive Care Unit. There, the CSF drain was set to drain 15
mL*hr-1 at 12'21 mm Hg. Norepinephrine and dobutamine were administered
for cardiac output and blood pressure goals according to a high-risk
protocol. On postoperatve day (POD) 1, she had nausea, vomitng, and bloody
CSF drainage. The drain was clamped. Labs showed coagulopathies and the
patent was transitoned to a low-risk protocol. On post-op day 2, she had
ongoing nausea and vomitng, which is atypical for TEVAR cases. A
non-contrast head computed tomography scan was ordered to rule out
subarachnoid or subdural hemorrhage. A new small, volume-dependent
intraventricular hemorrhage with no clear intracranial etologywas found.
It was postulated that bloody CSF had redistributed from the spinal canal
given her supine positon. Repeat imaging the next day showed a marginal
increase in the hemorrhage size and reduced atenuaton consistent with the
normal temporal evoluton of blood. No new hemorrhage was seen elsewhere.
The CSF drain was removed intact on post-op day 3. There was no blood at
the site nor on the tp. The patent was transferred to the ward and quickly
met her recovery milestones. She had no neurological defcits throughout
her hospitalizaton.CONCLUSIONCerebrospinal fuid drains have been
associated with complicatons ranging from headache to intracranial
hemorrhage with neurological symptoms. We present a case demonstratng the
novel complicaton of intraventricular hemorrhage, accompanied by
signifcant nausea and vomitng. This report contributes to the literature
regarding complicatons from CSF drain use for the preventon of SCI
following TEVAR. It reminds us that we must be vigilant for unrecognized
complicatons in the context of evolving expert recommendatons for the use
of prophylactc CSF drains in high-risk TEVARs.

<99>
Accession Number
648818972
Title
Association of right ventricular function with outcomes after cardiac
surgery: A systematic review.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 14-15), 2025. Date of Publication: 01 Jul 2025.
Author
Alavi N.; Van Klei W.; Agyei K.; Zabida A.; Abraha M.; Salvatori M.;
Mashari A.; Bartoszko J.
Institution
(Alavi, Van Klei, Zabida, Salvatori, Mashari, Bartoszko) Department of
Anesthesia and Pain Management, Sinai Health System, Women's College
Hospital, University Health Network, Toronto, ON, Canada
(Bartoszko) Insttute of Medical Science, University of Toronto, Toronto,
ON, Canada
(Van Klei, Salvatori, Mashari, Bartoszko) Department of Anesthesiology and
Pain Medicine, University of Toronto, Toronto, ON, Canada
(Van Klei, Bartoszko) Peter Munk Cardiac Centre, University Health
Network, Toronto, ON, Canada
(Van Klei, Agyei, Abraha, Bartoszko) Temerty Faculty of Medicine,
University of Toronto, ON, Canada
(Van Klei) Department of Anesthesiology, Intensive Care and Emergency
Medicine, University Medical Center Utrecht, Utrecht, Netherlands
Publisher
Springer
Abstract
INTRODUCTION Growing recogniton of the impact of right ventricular (RV)
functon on patent outcomes in heart failure and other populatons has
increased the volume of literature published in this area.1,2 However, the
associaton of RV functon with outcomes in cardiac surgical patents is less
well characterized, despite most of these patents undergoing comprehensive
echocardiography assessments prior to, during, and afer surgery.
Therefore, the aim of this study was to determine which quanttatve
echocardiographic parameters that assess RV functon have the strongest
prognostc implicatons. We explored the reported associatons between
quanttatve RV functon parameters and postoperatve outcomes in cardiac
surgery patents.METHODS This was a systematc review of randomized
controlled trials or observatonal studies (retrospectve or prospectve
cohort or case control). Case reports and series were excluded. Databases
included PubMed and MEDLINE from 1 January 1990 to 22 April 2024.
Inclusion criteria were adult patents over 18 yr old undergoing coronary
artery bypass grafing, valve repairs/replacements, or other major
procedures that required the use of cardiopulmonary bypass with an
echocardiogram report conducted within six months of surgery,
intraoperatvely, or shortly afer surgery. All studies also had to include
quanttatve parameters assessing RV functon reported in relaton to
postoperatve outcomes. The primary predictors of interest were any
quanttatve RV functon parameter. The primary outcome was postoperatve
mortality up to 5 years and the secondary outcome was all major adverse
cardiac events (MACE). This systematc review was registered in PROSPERO
(CRD42023387383). Insttutonal research ethics board approval was not
required as data was already published and publicly available.RESULTS Our
search identfed a total of 7,187 potentally relevant studies, and 27
studies were ultmately included. Seventeen studies reported estmates for
mortality in relaton to the patent's perioperatve RV functon, and 17
studies reported estmates for MACE. Right ventricular fractonal area
change (RVFAC) was the most reported marker, though it was inconsistently
associated with mortality and MACE. Despite it being the most frequently
reported, several other parameters (tricuspid annular plane systolic
excursion [TAPSE], RV myocardial performance index, peak RV systolic
velocity of tricuspid annulus, RV global longitudinal strain, and RV
longitudinal peak systolic strain) also emerged as potental predictors of
clinical outcomes. Tricuspid annular plane systolic excursion and measures
of strain were consistently signifcant predictors of mortality and RV
Myocardial Performance Index (MPI) was the most consistent signifcant
predictor of MACE.DISCUSSION Although a robust associaton between RV
functon parameters and outcomes was not found in each study, those
reportng TAPSE, strain, or RV MPI found the most consistent associatons
with outcomes. Our fndings suggest incremental prognostc value in reportng
at least one or ideally two quanttatve parameters in cardiac surgical
patents. Larger, adequately powered studies with uniform patent samples
and standardized tming of RV assessments are needed to beter stratfy
perioperatve risk according to RV functon measures. Such studies would
have the potental to change therapeutc interventons with the knowledge of
how RV functon efects patent outcomes.

<100>
Accession Number
649499969
Title
Erythropoietin to reduce blood transfusions, results of the first 115
cases.
Source
Vox Sanguinis. Conference: 33rd Regional Congress of the ISBT. Gothenburg
Sweden. 118(Supplement 1) (pp 355-356), 2023. Date of Publication: 01 Jun
2023.
Author
Shiner M.; Leviner D.; Abraham D.; Schwartz N.; Lavon O.; Sharoni E.
Institution
(Shiner) Blood Bank, Haifa, Israel
(Leviner, Abraham, Sharoni) Department of Cardiothoracic surgery, Carmel
Medical Center, Haifa, Israel
(Leviner, Abraham, Sharoni) Ruth and Baruch Rappaport Faculty of Medicine,
Technion - Institute of Technology, Haifa, Israel
(Schwartz) Department of Biostatistics, Haifa, Israel
(Lavon) Clinical pharmacology and toxicology unit, Carmel Medical Center,
Haifa, Israel
Publisher
John Wiley and Sons Inc
Abstract
Background: Preoperative anaemia is associated with adverse clinical
outcomes after cardiac surgery such as increased perioperative packed red
blood cell transfusions, acute kidney injury and death. Intraoperative
packed red blood cell transfusions in patients having cardiac surgery is
related to longer hospital stay, increased incidence of mortality and
morbidity, including ischemic and infectious complications and increased
hospital costs. A recent double-blind randomised controlled trial examined
the effect of an ultra-short-term treatment protocol based on
erythropoietin before cardiac surgery in patients with anaemia or iron
deficiency on reducing perioperative packed red blood cell transfusions.
The study reported a significant reduction of perioperative packed red
blood cell transfusions in the treatment group during the first week
postoperative compared with the control group. Our treatment protocol is
based on this study results and on the guidelines of the European
Association for Cardio-Thoracic Surgery and the European Association of
Cardiothoracic Anaesthesiology. Aim(s): To assess whether
implementation of an immediate preoperative treatment in anaemic patients
could result in fewer perioperative packed red blood cell transfusions and
improved outcomes in a realworld setting. Method(s): Starting on
January 1st, 2020, we implemented a perioperative protocol for anaemic
patients (women Hb < 11.5 g/dL, men Hb < 12.5 g/dL), which included
subcutaneous erythropoietin alpha, intravenous Iron, intramuscular vitamin
B12 and per os Iron and folic acid given once a day postoperatively. We
retrospectively compared all patients receiving the protocol to all
eligible patients who were operated on in the four years prior to
implementation of the protocol. Primary outcome was amount of packed red
blood cell transfusions during surgery and index admission. Secondary
outcomes were other blood product administration. Result(s): In the
22 months after protocol implementation, 115 patients who received the
treatment protocol were compared to 188 anaemic patients in the four years
prior who did not receive the protocol. The treatment reduced total packed
red blood cell use (treatment group median 5 [3-8] units vs. control 2
[1-3] units, p < 0.0001) and the incidence of post-operative blood
products transfusions (treatment group 58 patients, 50.4% vs control group
141 patients, 75%, p < 0.0001). Haemoglobin prior to discharge was higher
in the protocol group (treatment median 9 [8.35-9.5] g/dL vs. control 8.6
[8.1-9.1] g/dL, p = 0.0086). In addition, the incidence of postoperative
acute renal failure was lower among the protocol group (treatment group
5.26% vs control group 12.23% p = 0.0462). Summary/Conclusions:
Implementation of a perioperative treatment protocol for anaemic patients
significantly decreased intraoperative and postoperative packed red blood
cell transfusions. Despite the use of a cheaper type of IV iron (ferric
hydroxide sucrose) compared to previously described protocols, the
protocol was still effective in reducing the intake of packed red blood
cell. The study results support that the protocol is also effective in
real world setting.

<101>
Accession Number
648819004
Title
The effect of a novel multimodal analgesia protocol on acute
poststernotomy pain and perioperative outcomes in adult cardiac surgical
patients.
Source
Canadian Journal of Anesthesia. Conference: Canadian Anesthesiologists'
Society Annual Meeting, CAS 2025. St. John's, NL Canada. 72(2 Supplement)
(pp 35-37), 2025. Date of Publication: 01 Jul 2025.
Author
Dudar K.; Nalla B.; Leshchyshyn Y.; Atoui R.; Bitra B.; Runions K.; Roy D.
Institution
(Dudar, Nalla, Leshchyshyn) Deptartment of Anesthesiology, Health Sciences
North, Sudbury, ON, Canada
(Atoui, Bitra) Deptartment of Cardiac Surgery, Health Sciences North,
Sudbury, ON, Canada
(Runions) Health Sciences North Research Insttute, Sudbury, ON, Canada
(Roy) School of Epidemiology and Public Health, University of Otawa,
Otawa, ON, Canada
Publisher
Springer
Abstract
INTRODUCTION Cardiac surgery is associated with signifcant acute
postoperatve pain leading to deleterious consequences and poor patent
experience. High dose opioids have traditonally been the mainstay of
analgesia in cardiac surgery, but are commonly associated with multple
adverse efects and the potental for dependency.1,2 These side efects are
dose-dependent, and have been estmated to be experienced by approximately
one-third of cardiac surgery patents.3Current ERAS guidelines support the
use of opioid-sparing multmodal analgesia in cardiac surgery, though
specifc protocols have yet to be defned.4,5 Our study aimed to assess
feasibility and safety of implementng a multmodal analgesia protocol for
adult patents undergoing electve cardiac surgery for coronary artery
bypass graf or valve replacement. Our multmodal protocol included the
combined use of both Dexmedetomidine and Ketamine, which to our knowledge
has not yet been published.METHODS Following local research ethics board
(REB) approval, we conducted a single-centre prospectve randomized
controlled trial involving adult patents (aged 18'79) undergoing cardiac
surgery. Patents were assigned to a multmodal analgesia protocol or a
standard opioid-based regime based on the usual practce of the atending
anesthesiologist. The multmodal protocol included preoperatve
Acetaminophen, Dexmedetomidine infusion at 0.2'0.7 mu g*kg-1*hr-1 and a
Ketamine bolus of 0.5 mg*kg-1 [max 40 mg] at inducton, followed by an
infusion of 0.5 mg*kg-1*hr-1. Sufentanil 5 mu g iv prn was given for
rescue analgesia. The standard opioid-based regime avoided the use of
Dexmedetomidine or Ketamine intraoperatvely.Both patents and intensive
care nurses recording outcome measures were blinded to group allocaton.
Our primary outcome was Numerical Ratng Scale (NRS) pain scores over 24
hrat defned tme-intervals. Secondary outcomes included: tme to fulfll
extubaton criteria, opioid requirements and antemetc use.The Wilcoxon
Rank-Sum test was used to determine signifcant diferences between groups
on all outcome variables. To compare opioid requirements between groups,
all intravenous (IV) and oral opioids administered were converted to
fentanyl-equivalents (expressed in mcg) using an opioid-equianalgesic
table. All summary measurements were reported using median and
interquartle ranges.RESULTS Fify patents were randomized to a multmodal (n
= 21) or standard opioid-regime (n = 29). Intraoperatve opioid usage was
signifcantly lower in the multmodal group (200 mu g vs 600 mu g; P <
0.0001). There were no deviatons from the multmodal protocol and
hemodynamic parameters were similar in both groups.In the early
postoperatve period (6 hr), NRS scores were higher in the multmodal group
(at rest: 4.0 vs 3.0; P = 0.04; with cough: 7.3 vs 5.0; P = 0.03) but
similar 24 hr postoperatvely (at rest: 3.0 vs 3.5; P = 0.91; with cough:
5.0 vs 6.0; P = 0.68). Total 24 hr opioid usage was signifcantly lower in
the multmodal group (537 mcg vs 695 mcg; P = 0.002). There was a signal
towards earlier tme to meet extubaton criteria in the multmodal analgesia
group (150 min vs 180 min; P = 0.78).DISCUSSION Our pilot study
demonstrated the feasibility and safety of a multmodal analgesia strategy
in cardiac surgery combining the use of Dexmedetomidine and Ketamine as an
opioid-sparing technique. Postoperatve pain scores were comparable in both
groups with a signifcant reducton in 24 hr opioid usage and a trend
towards earlier extubaton in the multmodal group. The study was
underpowered to detect diferences in delirium or postoperatve nausea and
vomitng rates. Larger studies would be warranted to explore diferences in
opioid-related complicatons and to evaluate patent-centred quality of
recovery scores following the use of multmodal opioid-sparing strategies.

<102>
Accession Number
2041015426
Title
Major Clinical Outcomes in Patients With Carotid Artery Stenosis
Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
American Journal of Cardiology. 256 (pp 145-154), 2025. Date of
Publication: 01 Dec 2025.
Author
Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Ktenopoulos N.;
Koliastasis L.; Synetos A.; Drakopoulou M.; Tsalamandris S.; Latsios G.;
Tsioufis K.; Toutouzas K.
Institution
(Theodoropoulou, Apostolos, Ktenopoulos, Koliastasis, Synetos,
Drakopoulou, Tsalamandris, Latsios, Tsioufis, Toutouzas) Unit for
Structural Heart Diseases and Valvulopathies, First Department of
Cardiology, Athens School of Medicine, Hippokration Hospital, Athens,
Greece
(Vythoulkas-Biotis) Third Departmnent of Cardiology, Athens School of
Medicine, Sotiria Thoracic Diseases Hospital of Athens, Athens, Greece
(Apostolos) Department of Cardiology, Harefield Hospital, Royal Brompton
and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust,
London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Data on carotid artery stenosis (CAS) prevalence in patients undergoing
transcatheter aortic valve replacement (TAVR) are limited. It remains
unclear whether CAS serves as a predictor of worse outcomes following
TAVR. This meta-analysis aims to assess the impact of CAS on major
clinical outcomes in this population. A comprehensive literature search
was conducted across 3 databases to identify relevant studies. The primary
endpoint was the 30-day incidence of Stroke or Transient Ischemic Attack
(TIA) in patients with CAS>=50% and CAS>=70%, respectively. Secondary
endpoints included in-hospital Stroke/TIA, in-hospital mortality, 30-day
mortality, bleeding events, myocardial infarction (MI), acute kidney
injury (AKI), periprocedural vascular complications, and permanent
pacemaker implantation (PPM) up to 30 days. A total of 15 studies,
involving 129,155 patients, were included in the meta-analysis. CAS was
associated with higher rates of 30-day Stroke/TIA: 1) CAS >=50% (Risk
Ratio (RR): 1.38, 95% Confidence Intervals (CI): 1.19, 1.59), 2) CAS >=70%
(RR: 1.61, 95% CI: 1.10, 2.36). CAS comorbidity was also linked to
increased risk for in-hospital stroke/TIA (RR: 1.73, 95% CI: 1.28, 2.33),
30-day mortality (RR: 1.29, 95% CI: 1.13, 1.47), and 30-day bleeding
events (RR: 1.15, 95% CI: 1.08, 1.23). No differences were observed in the
rest secondary endpoints. In conclusion, CAS was associated with a higher
risk of 30-day and in-hospital cerebrovascular events following TAVR.
Patients with CAS are at an increased risk of 30-day all-cause mortality
without any impact on in-hospital mortality. Further studies are required
to validate our results. Copyright © 2025

<103>
Accession Number
2041745371
Title
High-Flow Nasal Oxygenation During Sedation for Transcatheter Aortic Valve
Replacement: The HIGH-OXY-TAVR Randomised-Controlled Trial.
Source
Journal of Clinical Medicine. 14(23) (no pagination), 2025. Article
Number: 8347. Date of Publication: 01 Dec 2025.
Author
Gimenez-Mila M.; Manzano-Valls A.; Abdul-Jawad O.; Arguis M.J.; Brugaletta
S.; Carnaval T.; Carretero M.J.; Flores-Umanzor E.; Freixa X.; Ibanez C.;
Italiano S.; Lopez-Baamonde M.; Martinez-Otero S.; Matute P.; Pozo M.;
Navarro-Ripoll R.; Perdomo J.M.; Regueiro A.; Rovira I.; Vega F.J.; Videla
S.; Sabate M.
Institution
(Gimenez-Mila, Manzano-Valls, Arguis, Carretero, Ibanez, Italiano,
Lopez-Baamonde, Martinez-Otero, Matute, Pozo, Navarro-Ripoll, Perdomo,
Rovira, Vega) Department of Anaesthesia and Intensive Care, Hospital
Clinic of Barcelona, Barcelona, Spain
(Gimenez-Mila, Arguis, Navarro-Ripoll, Sabate) Institut d'Investigacio
August Pi I Sunyer (IDIBAPS), Barcelona, Spain
(Manzano-Valls, Sabate) Facultat de Medicina i Ciencies de La Salut,
Universitat de Barcelona (UB), c. Casanova, Barcelona, Spain
(Abdul-Jawad, Brugaletta, Flores-Umanzor, Freixa, Regueiro, Sabate)
Cardiology Department, Hospital Clinic, Universitat de Barcelona,
Barcelona, Spain
(Carnaval) Pharmacology Unit, Department of Pathology and Experimental
Therapeutics, School of Medicine and Health Sciences, IDIBELL, University
of Barcelona, L'Hospitalet de Llobregat, Spain
(Videla) Clinical Research Support Area, Clinical Pharmacology Department,
Hospital Universitari Germans Trias i Pujol, Badalona, Spain
(Videla) Department of Pharmacology, Therapeutics and Toxicology,
Autonomous University of Barcelona, Bellaterra, Spain
(Sabate) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Data on high flow nasal oxygenation (HFNO) efficacy in hypoxia
prevention in transcatheter aortic valve replacement (TAVR) are
conflictive. We aimed to determine the benefit of HFNO in preventing the
occurrence of desaturations during TAVR. Method(s): An
investigator-initiated, proof of concept, single-centre, randomised, and
controlled trial on 132 adult patients who were scheduled to undergo
transfemoral TAVR was conducted. Patients were randomised (1:1) to HFNO
(H-group) with a flow rate of 50 L min-1 and FiO<inf>2</inf>
0.6 or standard of care oxygen therapy (S-group). The primary endpoint was
the number of patients with a desaturation episode (SpO<inf>2</inf> < 93%)
for >10 s during TAVR. Secondary outcomes included arterial partial
pressure of oxygen (pO<inf>2</inf>) 45 min from sedation start and changes
in glomerular filtration rate from baseline to 12 h post-procedure.
 Result(s): Between 23 November and 24 July, a per-protocol analysis
was performed in a total of 125 patients (H-group n = 64; S- group n = 61;
49 females). The number of patients with any desaturation episode was
significantly lower in the H-group [13/64 (20%, 95% CI: 12-32%)] than in
the S-group [31/61 (51%, 95% CI: 39-63%), RR: 0.39 (95%CI: 0.23-0.68)]. At
45 min, mean (SD) pO<inf>2</inf> was higher in the H-group (24(9.8) kPa
vs. 16.7(7.5) kPa; p < 0.005). A significant improvement in delta median
(IQR) difference on glomerular filtration rate was observed in the H-group
[1.6(-1-7.9) mL min-1 1.73 m-2] with respect to the
S-group [0.2(-6.1-3.1) mL min-1 1.73 m-2; p-value:
0.013]. Conclusion(s): This trial demonstrated that HFNO provides a
better oxygenation pattern than standard oxygen therapy during TAVR.
Larger studies focusing on long-term clinical outcomes are warranted to
evaluate the benefit of HFNO during sedation for TAVR
procedures. Copyright © 2025 by the authors.

<104>
Accession Number
649494350
Title
Evaluating Surgical Approaches in Early NSCLC: A Meta-Analysis of
Robot-Assisted and Video-Assisted Techniques.
Source
Annals of surgical oncology. (no pagination), 2025. Date of Publication:
10 Dec 2025.
Author
Khan W.; Ali T.; Bilal M.; Ahmad W.; Ali S.A.; Hashim A.; Khan A.Z.; Kumar
A.; Abdullah M.; Khan S.; Ahmed A.; Jawad M.
Institution
(Khan, Abdullah, Jawad) Dow Medical College, Dow University of Health
Sciences, Karachi, Pakistan
(Ali) Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi,
Pakistan
(Bilal) Peshawar Medical College, Peshawar, Pakistan
(Ahmad) King Edward Medical University, Lahore, Pakistan
(Ali) Bahria Medical College, Karachi, Pakistan
(Hashim, Khan) Al-Aleem Medical College, Lahore, Pakistan
(Kumar, Ahmed) Ziauddin Medical College, Ziauddin University, Karachi,
Pakistan
(Khan) Nishtar Medical College, Multan, Pakistan
Abstract
BACKGROUND: Lung cancer, especially non-small cell lung cancer (NSCLC), is
a leading cause of cancer death. Surgical resection is the primary
treatment for early-stage NSCLC. Video-assisted thoracoscopic surgery
(VATS) and robot-assisted thoracic surgery (RATS) are minimally invasive
options, with RATS offering better precision at higher costs. This
meta-analysis compared the perioperative outcomes of both techniques in
NSCLC. METHOD(S): A systematic search in PubMed, Web of Science, NLM,
CNKI, and Wanfang was conducted for RCTs published between 31 July 2021
and 31 December 2024. Primary outcomes included operation time, blood
loss, lymph node dissection, conversion to thoracotomy, chest drainage
time, and hospital stay. Statistical analyses were performed using RevMan
5.3, with heterogeneity assessed using the I2 statistic. A p value lower
than 0.05 was considered significant. RESULT(S): Three RCTs were
analyzed. Blood loss showed no significant difference between VATs and
RATs (mean difference [MD], -33.00; 95% CI, -85.51 to 22.89; p = 0.07).
Conversion to thoracotomy was comparable (MD, 0.69; 95% CI, 0.37 to 1.28;
p = 0.24). Hospital stay did not differ significantly (MD, 0.13; 95% CI,
-0.58 to 0.84; p = 0.74). Operation time remained similar (MD, -4.63; 95%
CI, -10.93 to 1.67; p = 0.15). The VATS procedure enabled significantly
greater lymph node dissection (MD, 1.83; 95% CI, 0.16 to 3.49; p = 0.03).
Chest drainage duration showed no difference (MD, 0.00; 95% CI, -0.27 to
0.27; p = 1.00). CONCLUSION(S): In NSCLC, RATS and VATS yield
comparable outcomes, with RATS potentially reducing blood loss and VATS
allowing more lymph node dissection. Further high-quality RCTs are needed
to clarify the optimal approach for NSCLC. Copyright © 2025.
Society of Surgical Oncology.

<105>
Accession Number
2042163911
Title
Tenecteplase vs Alteplase in Mechanical Prosthetic Heart Valve Thrombosis
The TENET Randomized Clinical Trial.
Source
JAMA Cardiology. (no pagination), 2025. Date of Publication: 2025.
Author
Sharma G.; Akkineni K.P.; Makkar N.; Shukla A.; Haldar P.; Velayoudam D.;
Kamal K.; Kumar S.; Naik N.; Roy A.; Singh S.; Seth S.; Bhatia R.
Institution
(Sharma, Akkineni, Makkar, Kamal, Naik, Roy, Singh, Seth) Department of
Cardiology, All India Institute of Medical Sciences, New Delhi, India
(Shukla) Centre for Integrative Medicine and Research, All India Institute
of Medical Sciences, New Delhi, India
(Haldar) Centre for Community Medicine, All India Institute of Medical
Sciences, New Delhi, India
(Velayoudam) Department of Cardiothoracic & Vascular Surgery, All India
Institute of Medical Sciences, New Delhi, India
(Kumar) Department of Cardiac Vascular Radiology & Endovascular
Interventions, All India Institute of Medical Sciences, New Delhi, India
(Bhatia) Department of Neurology, All India Institute of Medical Sciences,
New Delhi, India
Publisher
American Medical Association
Abstract
IMPORTANCE For patients presenting with symptomatic prosthetic valve
thrombosis (PVT) after mechanical heart valve replacement, thrombolytic
therapy with alteplase is accepted as a first-line therapeutic
alternative. The utility of tenecteplase compared with conventional
regimens remains unstudied, to the authors' knowledge, in this patient
population. OBJECTIVE To assess the relative safety and efficacy of
tenecteplase compared with standard infusions of alteplase in patients
with PVT. DESIGN, SETTING AND PARTICIPANTS This was an open-label,
parallel-group, non-inferiority randomized clinical trial among
consecutive adult patients presenting with obstructive PVT of a mechanical
prosthetic valve over the study period from October 2022 to August 2024 to
a single tertiary care center in India. INTERVENTIONS Patients received
thrombolytic therapy with a low-dose slow infusion alteplase or
weight-based bolus doses of tenecteplase. MAIN OUTCOMES AND MEASURES The
primary outcomes were to determine the rates of complete thrombolytic
success and the incidence of major complications. RESULTS A total of 83
patients (mean [SD] age, 39.6 [12.4] years, 42 male [50.6%]) were
randomized to receive alteplase (n = 43) or tenecteplase (n = 40). The
rates of the primary efficacy end point (complete thrombolytic success)
were significantly higher (risk ratio, 1.18; 95% CI, 1.03-1.39; P = .02
for noninferiority) in the tenecteplase group (39 patients [97.5%])
compared with the alteplase group (35 patients [81.5%]). Additionally,
patients treated with tenecteplase had higher rates of complete success
with the first administered dose and a shorter duration of hospital stay
(median [IQR], 4.1 [3.2-5.1] days vs 6.5 [4.3-9.2] days; P < .001). The
rates of major and minor adverse events were similar. CONCLUSIONS AND
RELEVANCE Tenecteplase may be a safe and effective alternative to
alteplase in patients presenting with obstructive PVT. Patients treated
with tenecteplase in our study had higher rates of complete thrombolytic
success and a shorter duration of hospital stay. Furthermore, the relative
ease of drug administration with tenecteplase may translate to greater
clinical benefit in a real-world setting. TRIAL REGISTRATION Clinical
Trials Registry of India: CTRI/2022/10/046127 Copyright © 2025
American Medical Association. All rights reserved, including those for
text and data mining, AI training, and similar technologies.

<106>
Accession Number
2037437143
Title
Novel Triple-Cuff versus Conventional Double-Cuff Double-Lumen
Endobronchial Tube in Patients with Risk Factors for Tube Misdirection.
Source
Yonsei Medical Journal. 66(12) (pp 866-873), 2025. Date of Publication: 01
Dec 2025.
Author
Kim N.; Oh Y.J.; Kim H.J.; Lee K.
Institution
(Kim, Oh, Kim, Lee) Department of Anesthesiology and Pain Medicine, Yonsei
University College of Medicine, Seoul, South Korea
(Kim, Oh, Kim, Lee) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Accurate positioning of the double-lumen endobronchial tube (DLT)
is crucial for successful lung isolation during thoracic surgery. However,
misdirection of the left-sided DLT into the right main bronchus frequently
occurs in short, obese females with narrow airways. A novel triple-cuff
DLT features an additional carinal cuff positioned on the right side of
the tube, which differentiates it from conventional double-cuff DLTs. We
hypothesized that inflating the carinal cuff would direct the bronchial
tip of the triple-cuff DLT toward the left main bronchus, thereby reducing
the likelihood of DLT misdirection when compared to the conventional
double-cuff DLT. Material(s) and Method(s): In this single-center,
unblinded randomized controlled trial, short, obese females with narrow
airways were randomly assigned to either the triple-cuff or double-cuff
group (n=77 each) and were intubated with the respective DLTs. The DLT
misdirection rate, adjustment depth for optimal positioning, intubation
time, and the incidence of hypoxia, airway injury, and postoperative
airway complications were assessed. Result(s): Data from 143 patients
were analyzed. The triple-cuff group exhibited a lower DLT misdirection
rate compared to the doublecuff group (15.3% vs. 46.5%, odds ratio 4.81,
95% confidence interval 2.18-10.64, p<0.001). Triple-cuff DLT was also
associated with fewer adjustments, shorter intubation times, and lower
incidences of hypoxia, airway injury, and sore throat than double-cuff
DLT. Conclusion(s): Triple-cuff DLT was superior to conventional DLT
in reducing DLT misdirection in short, obese females with narrow airways.
Furthermore, it facilitated a faster intubation process and reduced airway
complications, thereby enhancing patient safety. Clinical Trial
Registration: NCT06061055 (ClinicalTrials.gov). © Copyright:
Yonsei University College of Medicine 2025.

<107>
Accession Number
2041762193
Title
Protocol for the ELISPOT-TC Trial: A Randomized Controlled Study
Evaluating CMV-Specific Cellular Immune Monitoring in Heart Transplant
Recipients.
Source
Transplant International. 38 (no pagination), 2025. Article Number: 15565.
Date of Publication: 2025.
Author
Garcia-Romero E.; Diez-Lopez C.; Kervella D.; Donoso V.; Garcia-Cosio
M.D.; Ortiz-Bautista C.; Hernandez-Perez F.J.; Couto-Mallon D.;
Gonzalez-Vilchez F.; De la Fuente-Galan L.; Lopez-Lopez L.; Grande-Trillo
A.; Gomez-Molina M.; Catala P.; Herrador L.; Rosenfeld L.; Ibanez S.;
Donadeu L.; Sabe N.; Comin-Colet J.; Bestard O.; Gonzalez-Costello J.
Institution
(Garcia-Romero, Diez-Lopez, Herrador, Rosenfeld, Ibanez, Comin-Colet,
Gonzalez-Costello) Cardiology Department, Bellvitge University Hospital,
Barcelona, Spain
(Garcia-Romero, Diez-Lopez, Herrador, Rosenfeld, Ibanez, Comin-Colet,
Gonzalez-Costello) Department of Cardiology, The First Affiliated Hospital
of Zhengzhou University, Zhengzhou, China
(Garcia-Romero, Diez-Lopez, Garcia-Cosio, Ortiz-Bautista, Couto-Mallon, De
la Fuente-Galan, Herrador, Comin-Colet, Gonzalez-Costello) Ciber
Cardiovascular group (CIBER-CV), Instituto Salud Carlos III, Madrid, Spain
(Garcia-Romero, Diez-Lopez, Herrador, Comin-Colet, Gonzalez-Costello)
Universitat de Barcelona, Barcelona, Spain
(Kervella, Donadeu, Bestard) Experimental Nephrology Laboratory, Vall
d'Hebron Research Institute, VHIR, Barcelona, Spain
(Donoso) Cardiology Department, Hospital Universitari i Politecnic La Fe,
Valencia, Spain
(Garcia-Cosio) Cardiology Department, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Ortiz-Bautista) Cardiology Department, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Hernandez-Perez) Cardiology Department, Hospital Universitario Puerta de
Hierro Majadahonda, Majadahonda, Spain
(Couto-Mallon) Cardiology Department, Complexo Hospitalario Universitario
A Coruna, A Coruna, Spain
(Gonzalez-Vilchez) Cardiology Department, Hospital Universitario Marques
de Valdecilla, Santander, Spain
(De la Fuente-Galan, Catala) Cardiology Department, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Lopez-Lopez) Cardiology Department, Hospital de la Santa Creu i Sant Pau,
Barcelona, Spain
(Grande-Trillo) Cardiology Department, Hospital Universitario Virgen del
Rocio, Seville, Spain
(Gomez-Molina) Cardiology Department, Hospital Clinico Universitario
Virgen de la Arrixaca, Murcia, Spain
(Sabe) Infectious Diseases Department, Bellvitge University Hospital,
Barcelona, Spain
(Bestard) Nephrology Department, Hospital Universitari Vall d'Hebron,
Barcelona, Spain
Publisher
Frontiers Media SA

<108>
Accession Number
649493721
Title
Sex does not influence outcomes in valvular heart surgery due to infective
endocarditis: A systematic review and meta-analysis.
Source
Asian cardiovascular & thoracic annals. (pp 2184923251405504), 2025. Date
of Publication: 10 Dec 2025.
Author
Zeb R.; Sharma S.; Abdullah R.; Patel M.; Nallamotu S.; Veintemilla-Burgos
F.; Kovil Thangam B.M.; Sai B.A.; Kaur G.
Institution
(Zeb) Army Medical College, Rawalpindi, Pakistan
(Sharma) Riga Stradins University, Riga, Latvia
(Abdullah) Foundation University Medical College, Islamabad, Pakistan
(Patel) NHL Municipal Medical College, Ahmedabad, Gujarat, India
(Nallamotu) Kasturba Medical College, Manipal, Karnataka, India
(Veintemilla-Burgos) Universidad Catolica de Santiago de Guayaquil,
Guayaquil, Ecuador
(Kovil Thangam) Spartan Health Sciences University, Vieux Fort, Saint
Lucia
(Sai) Kamineni Academy of Medical Sciences and Research, Hyderabad,
Telangana, India
(Kaur) American University of Antigua School of Medicine, Antigua and
Barbuda
Abstract
This systematic review and meta-analysis aimed to evaluate sex-based
differences in surgical outcomes among patients with infective
endocarditis (IE). A comprehensive search of three major medical databases
identified ten studies encompassing 16,763 patients who underwent valvular
surgery for IE. Of these, 70.8% were male (n = 11,873), and 29.2% were
female (n = 4890). Female patients were generally older at the time of
surgery. The most common causative pathogen was Staphylococcus aureus
(28.4%), followed by Streptococcus (22.5%) and Enterococcus (4.1%).
Females demonstrated lower aortic valve involvement (risk ratio [RR]:
0.80, 95% confidence interval [CI]: 0.67-0.96) but higher mitral valve
involvement (RR: 1.30, 95% CI: 1.17-1.45, p < 0.001). They also had a
reduced prevalence of Streptococcus (RR: 0.89, 95% CI: 0.81-0.98, p =
0.02) and Enterococcus (RR: 0.71, 95% CI: 0.62-0.82, p = 0.03) infections
and a lower risk of abscess formation (RR: 0.87, 95% CI: 0.76-0.99, p =
0.03) compared to males. There was a significant difference in the
in-hospital mortality between female and male patients (RR: 1.30, 95% CI:
1.04-1.61, p = 0.02). No significant sex-related differences were observed
in the duration of hospitalization. However, significant sex-related
differences were observed in the incidence of postoperative stroke (RR:
1.10, 95% CI: 1.02-1.20, p = 0.02). In summary, female patients undergoing
surgery for IE face a higher risk of both in-hospital mortality and
postoperative stroke compared to males, underscoring clinically meaningful
sex-based disparities in short-term surgical outcomes. These findings
emphasize the need for further studies to clarify these observations.
(PROSPERO Registration: CRD42024602013).

<109>
Accession Number
2041734354
Title
Thoracoscopy-Guided vs. Ultrasound-Guided Paravertebral Block in
Thoracoscopic Surgery: A Non-Inferiority Randomized Trial.
Source
Journal of Clinical Medicine. 14(23) (no pagination), 2025. Article
Number: 8493. Date of Publication: 01 Dec 2025.
Author
Hong S.B.; Hyun K.; Choi H.
Institution
(Hong) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Hyun) Department of Thoracic and Cardiovascular Surgery, St. Vincent's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Choi) Department of Anesthesiology and Pain Medicine, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Thoracic paravertebral block (TPVB) is an established
component of multimodal analgesia and enhanced recovery pathways following
thoracoscopic lung resection. A surgeon-performed, thoracoscopy-guided
approach has been proposed to improve intraoperative workflow, but
high-quality comparative data are limited. Method(s): In this
single-center, randomized, non-inferiority trial, adult patients
undergoing thoracoscopic lobectomy or segmentectomy received either
thoracoscopy-guided TPBV (T-TPVB) conducted by surgeons or
ultrasound-guided TPBV (U-TPVB) conducted by anesthesiologists. Blocks
were performed at the end of surgery at the T4 and T7 vertebra levels,
using 10 mL of 0.5% ropivacaine per level. The primary outcome was dynamic
pain during coughing at 1-6 h postoperatively (visual analog scale, VAS).
Secondary outcomes included resting/dynamic pain scores, opioid
consumption over 48 h, block-related complications, and procedural time.
 Result(s): Seventy-three patients were included in the
intention-to-treat analysis. Mean dynamic VAS scores at 1-6 h were 3.3
(T-TPVB) and 3.1 (U-TPVB), with a mean difference of 0.2 (95% CI: -0.3 to
0.7), meeting the non-inferiority criterion (margin 0.9). Secondary
outcomes, including pain trajectories and opioid consumption, were
comparable between groups. Procedural time was significantly shorter in
the T-TPVB group, with no differences in complication rates.
 Conclusion(s): Surgeon-performed thoracoscopy-guided TPVB was
non-inferior to the standard ultrasound-guided technique for early
postoperative pain after thoracoscopic lung resection. Both methods
provided comparable analgesic efficacy and safety profiles, while T-TPVB
significantly reduced procedural time. This approach may support
streamlined perioperative workflows and optimize enhanced recovery
protocols in thoracic surgery. (Trial registration number,
KCT0006471). Copyright © 2025 by the authors.

<110>
Accession Number
649476282
Title
SINGLE VERSUS DUAL ANTIPLATELET THERAPY FOLLOWING PVI.
Source
Vascular Medicine (United Kingdom). Conference: Original Research
Abstracts Presented at the 2024 Vascular Scientific Sessions of the
Society for Vascular Medicine. Houston, TX United States. 29(5) (pp 606),
2024. Date of Publication: 01 Sep 2024.
Author
Chamseddine H.; Boules T.; Shepard A.; Eldrup-Jorgensen J.; Aronow H.;
Mansour A.; Kashyap V.S.; Chaar C.I.O.; Kabbani L.
Institution
(Chamseddine, Boules, Shepard, Aronow, Kabbani) Henry Ford Hospital,
United States
(Eldrup-Jorgensen) Maine Medical Center, United States
(Mansour) Spectrum Health, United States
(Kashyap) Frederik Meijer Heart and Vascular Institute, United States
(Chaar) Yale University School of Medicine, United States
Publisher
SAGE Publications Ltd
Abstract
Background: The best antiplatelet therapy following endo-vascular
peripheral vascular intervention (PVI) remains understudied. While
proponents of dual antiplatelet therapy (DAPT) believe that it offers an
advantage over single anti-platelet therapy (SAPT), there is a paucity of
data to support this contention. This study aims to compare the outcomes
of SAPT and DAPT following PVI. Method(s): Patients receiving PVI for
lower extremity peripheral arterial disease between 2004-2019 were
identi-fied in the Vascular Quality Initiative (VQI). Patients were
divided based on the antiplatelet regimen used post-PVI. Exclusion
criteria included arrhythmia, preoperative or dis-charge anticoagulation,
and cases involving concomitant arterial procedures. Multivariate
Cox-regression analysis was done to evaluate the independent association
of anti-platelet therapy with the primary outcomes of amputation,
reintervention, major adverse limb events (MALE), and mortality.
 Result(s): Of 108,896 patients included, 31,225 (29%) received SAPT
whereas 77,671 (71%) received DAPT. Patients treated with DAPT were more
likely to have coro-nary artery disease (34.7% vs 24.9%, p< 0.001), prior
PVI (26.1% vs 19.3%, p< 0.001), prior PCI (28.3% vs 17.0%, p< 0.001), and
prior CABG (21.6% vs 15.6%, p< 0.001) com-pared to those treated with
SAPT. At one year, the rate of reintervention was similar between the two
groups (SAPT 14.7% vs DAPT 14.5%, p=0.549). Patients treated with DAPT had
a lower rate of amputation (4.2% vs 5.2%, p< 0.001) and MALE (17.5% vs
18.7%, p=0.010) at 1-year com-pared to those on SAPT. 1-year mortality was
also lower for patients on DAPT (6.2% vs 7.1%, p< 0.001). On
Cox-regression analysis, patients on DAPT had a 14% lower haz-ard of
amputation (HR 0.86, 95% CI 0.77-0.97) and 8% lower hazard of MALE (HR
0.92, 95% CI 0.87-0.97) compared to those on SAPT. No differences were
observed regarding rein-tervention and mortality. Conclusion(s):
Patients placed on DAPT post-PVI demonstrated lower incidence of
amputation and MALE than those on SAPT. This study provides evidence
favoring DAPT as a more effective antiplatelet regimen following PVI. A
randomized controlled trial is needed to better characterize this
relationship.

<111>
[Use Link to view the full text]
Accession Number
649473828
Title
Balloon-Expandable Valves Versus Self-Expanding Valves in Patients With
Small Aortic Annulus Undergoing Transcatheter Aortic Valve Replacement: A
Systematic Review and Meta-Analysis.
Source
Cardiology in review. (no pagination), 2025. Date of Publication: 09 Dec
2025.
Author
Tabassum S.; Burhan M.; Shehada W.; Naeem F.; Lashin A.A.; Wagdy M.; Naeem
A.; Abdelazeem B.; Minhas A.M.K.; Virk H.U.H.; Velagapudi P.
Institution
(Tabassum, Naeem) From the Department of Internal Medicine, Wright Center
for Graduate Medical Education, Scranton, PA, United States
(Burhan) Department of Internal Medicine, Rawalpindi Medical University,
Rawalpindi, Pakistan
(Shehada) Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
(Naeem) Department of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
(Lashin) Faculty of Medicine, Benha University, Egypt
(Wagdy) Faculty of Medicine, Modern University for Technology and
Information, Cairo, Egypt
(Abdelazeem) Department of Cardiology, West Virginia University,
Morgantown, WV, United States
(Minhas) Section of Cardiology, Department of Medicine, Baylor College of
Medicine, Houston, TX, United States
(Virk) Harrington Heart & Vascular Institute, Case Western Reserve
University, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Velagapudi) Division of Cardiology, BJC Cardiology, St Louis, MO, United
States
Abstract
Patients with a small aortic annulus (SAA) undergoing transcatheter aortic
valve replacement (TAVR) face a high risk of prosthesis-patient mismatch
and adverse outcomes. The 2 most studied valve types, balloon-expandable
valves (BEVs) and self-expanding valves (SEVs), differ in structure and
deployment, potentially impacting outcomes in this subgroup. To compare
the hemodynamic and clinical outcomes of BEVs versus SEVs in SAA patients
undergoing TAVR. A systematic search of major databases through March 2025
identified randomized controlled trials and propensity score matching
studies comparing BEVs and SEVs. Pooled analyses were conducted using a
random-effects model to derive mean differences (MDs) and odds ratios
(ORs) with 95% confidence intervals (CIs) in R (version 4.4.1). Thirteen
studies (n = 4582; BEV: 2290; SEV: 2292) were included. BEVs were
associated with smaller indexed effective orifice area (iEOA) (MD: -0.15
cm2/m2), higher mean (MD: 4.92 mm Hg) and peak (MD: 4.78 mm Hg)
transvalvular gradients, and higher overall (OR: 2.64) and severe (OR:
2.72) prosthesis-patient mismatch rates. However, BEVs had a significantly
lower risk of permanent pacemaker implantation (OR: 0.62). No significant
differences were found in mortality, stroke, bleeding, acute kidney
injury, paravalvular leak, myocardial infarction, vascular complications,
or heart failure hospitalization. BEVs and SEVs demonstrate comparable
mortality in SAA patients undergoing TAVR. SEVs offer superior hemodynamic
outcomes, while BEVs reduce pacemaker need. Prosthetic valve selection
should be individualized based on anatomy, clinical profile, and
procedural factors. Future randomized trials with long-term follow-up are
warranted to inform optimal device selection in this
population. Copyright © 2025 Wolters Kluwer Health, Inc. All
rights reserved.

<112>
Accession Number
2041863879
Title
NOT YOUR ORDINARY SORE THROAT.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4173-A4174),
2025. Date of Publication: 01 Oct 2025.
Author
Koehler Z.; Noor A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Mediastinum Case Report Posters (C)
SESSION TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm -
01:15 pm INTRODUCTION: Descending necrotizing mediastinitis is a rare and
rapidly progressive form of mediastinitis. Infection most often originates
from an odontogenic or oropharyngeal source. Common species include
Streptococcus, Staphylococcus, Bacteroides, and Peptostreptococcus. There
are rare cases of Proteus following cardiothoracic surgery. We present a
case of Proteus mediastinitis in a young female with no history of
cardiothoracic surgery. CASE PRESENTATION: A 29-year-old female with no
prior medical history presented to the emergency department with sore
throat and fevers. She was diagnosed with pharyngitis and discharged with
oral Amoxicillin. She presented back to the emergency department a few
days later for worsening symptoms along with new dyspnea and chest
tightness. Patient was afebrile, tachycardic, and tachypneic. She had a
leukocytosis to 27.9 k/cumm and a d-dimer of 3410 ng/mL. Her troponins
were within normal limits. She had a CTA chest that showed extensive soft
tissue densities throughout the mediastinum compressing multiple
mediastinal structures, as well as a left loculated pleural effusion. A
large infectious and autoimmune workup were sent and broad-spectrum
antibiotics were started. She underwent EUS with gastroenterology for
biopsy and preliminary cytology was suggestive of an abscess. Cultures
later returned with Proteus mirabilis. She had a chest tube placed that
drained purulent material, which also grew Proteus mirabilis. She
underwent VATS decortication and mediastinal incision and drainage, which
showed necrosis and extensive fibrinopurulent material. She was eventually
discharged on Trimethoprim/Sulfamethoxazole. DISCUSSION(S):
Descending necrotizing mediastinitis is a rare, rapidly progressive form
of mediastinitis that carries a high mortality rate. It is most commonly
associated with pharyngeal infection. Other sources include neck
infection, odontogenic infection, ingested foreign bodies, and iatrogenic
causes. Infection can extend inferiorly due to multiple mechanisms:
gravity, negative intrathoracic pressure during inspiration, and lack of
barriers in the fascial planes. Common organisms include Streptococcus,
Staphylococcus, Bacteroides, and Peptostreptococcus. About half of cases
are polymicrobial. Thus far, Proteus has not been commonly isolated except
in cases following cardiothoracic surgery. Diagnostic criteria typically
includes clinical manifestations of infect, characteristic radiographic
findings, necrotizing infection during surgery, and infection associated
with descending mediastinitis. There are two common classification
systems, Endo and Guan. The Guan classification is more recent and has
been associated with a lower mortality rate. Treatment involves
antibiotics and surgery. Surgical approach depends on the specific case;
however, many patients will require multiple surgical interventions.
Hyperbaric oxygen therapy has been used in cases as well. Despite
widespread use of antibiotics and improvements in diagnostic and surgical
management, mortality remains high. CONCLUSION(S): Descending
necrotizing mediastinitis is a rare, rapidly progressive form of
mediastinitis. It typically originates from oropharyngeal and odontogenic
infections. Multiple bacterial species have been associated with
descending mediastinitis; however, Proteus is incredibly rare outside of
cases following cardiothoracic interventions. Despite improvements in
diagnosis and treatment, it continues to carry a high mortality rate.
REFERENCE #1: 1.Ridder, G.J., et al. Descending Necrotizing Mediastinitis:
Contemporary Trends in Etiology, Diagnosis, Management, and Outcome.
Annals of Surgery, 2010, 251(3):528-534.2.Prado-Calleros, H.M., et al.
Descending Necrotizing Mediastinitis: Systematic Review on its Treatment
in the Last 6 years, 75 Years After its Description. Head Neck, 2016,
38:E2275-E2283.3.Reuter, T.C., et al. Descending Necrotizing
Mediastinitis: Etiopathogenesis, Diagnosis, Treatment and Long-Term
Consequences-a Retrospective Follow-Up Study. European Archives of
Oto-Rhin-Laryngology, 2023, 280:1983-1990.4.Estera, A.S., et al.
Descending Necrotizing Mediastinitis. Surgery, gynecology, & obstetrics,
1983, 157(6):545-552. 5.Endo, S., et al. Guideline of Surgical Management
Based on Diffusion of Descending Necrotizing Mediastinitis. Japanese
Journal of Thoracic and Cardiovascular Surgery, 1999, 47(1):14-19.6.Guan,
X., et al. A New Classification of Descending Necrotizing Mediastinitis
and Surgical Strategies. Annals of Translational Medicine, 2021, 9(4):356.
DISCLOSURES: No relevant relationships by Zachary Koehler No relevant
relationships by Aliya Noor Copyright © 2025 American College of
Chest Physicians

<113>
Accession Number
2041863402
Title
THORACIC ENDOMETRIOSIS: A CASE OF RECURRENT PNEUMOTHORAX DURING MENSES.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A6378-A6379),
2025. Date of Publication: 01 Oct 2025.
Author
Partyka K.; Glassberg M.K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Pulm Manifestations/Systemic Disease Case Report Posters
(H) SESSION TYPE: Case Report Posters PRESENTED ON: 10/21/2025 10:20 am -
11:05 am INTRODUCTION: Thoracic endometriosis syndrome (TES) occurs when
ectopic endometrial tissue deposits within the thorax and can cause
pneumothorax, hemoptysis, hemothorax, or pulmonary nodules [1,6].
Catamenial pneumothorax is defined by recurrent pneumothorax occurring 24
hours before to 72 hours after menses [1]. TES is most common in females
in the fourth or fifth decades of life with a mean age of 34-35 years
[1,2,5]. Pelvic endometriosis generally precedes thoracic involvement by
5-7 years [1,5]. Thoracic endometriosis contributes to only 3-6% of
spontaneous pneumothorax cases in females [1] but is found in 18-35% of
females who undergo surgery for recurrent spontaneous pneumothorax [1,3].
The majority of cases occur on the right side [2,5] and are characterized
by a high recurrence rate, up to 40% [1]. CASE PRESENTATION: A 39-year-old
female with history of dysmenorrhea, menorrhagia and right spontaneous
pneumothorax (PTX) one month prior was admitted for recurrent large right
PTX. Previous PTX was treated with a large bore chest tube and follow-up
chest radiograph revealed trace right apical pneumothorax. Computed
tomography (CT) of the chest confirmed normal parenchyma. Patient
underwent video-assisted thoracic surgery (VATS) revealing chocolate cysts
deposited on the parietal and visceral pleura, several sub-centimeter
defects within the diaphragm and adhesions near right apex of lung.
Visible deposits were resected. Wedge resection of the right middle upper
lobe was performed with pathology showing rare clusters of subpleural
spindle cells positive for estrogen receptor concerning for stromal
endometriosis. The patient was diagnosed with thoracic endometriosis. Her
course was complicated by enlarging pneumothorax after chest tube removal
and she was discharged with Heimlich one-way valve, which was removed as
an outpatient. She was referred to gynecology and treated with
norethindrone acetate. DISCUSSION(S): When TES is suspected, chest
and abdominal magnetic resonance imaging (MRI) should be performed to
evaluate for diaphragmatic deposits. It is best to obtain imaging during
menses when deposits are most prominent given imaging may normalize
between cycles [5]. Definitive diagnosis is made by VATS biopsy [5].
Diaphragmatic disease, including endometrial deposits or fenestrations,
are the most common findings followed by parenchymal and pleural lesions
[1,5,6]. The classic triad seen on histopathology includes endometrial
glands, endometrial stroma and hemosiderin-laden macrophages [4]. However,
a case series reported that 56% of cases show endometrial stroma alone
[7]. Immunohistochemistry with estrogen receptor, progesterone receptor
and cluster of differentiation 10 (CD10) positivity may increase
diagnostic yield from 10% to 52% [5]. The goal of surgery is to remove all
visible endometrial foci and perform pleurodesis, which can lower
recurrence rates [5,6]. Concurrent laparoscopy should also be considered
to evaluate for endometrial deposits below the diaphragm [5,6]. The
recommended treatment approach to TES is surgery followed by hormonal
therapy guided by a gynecologist [5,6]. CONCLUSION(S): Diagnosis of
TES requires a high index of suspicion and should be considered in any
biologic female with more than one episode of spontaneous PTX and history
of dysmenorrhea. REFERENCE #1: 1. Visouli AN, Zarogoulidis K, Kougioumtzi
I, Huang H, Li Q, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N,
Katsikogiannis N, Papaiwannou A, Lampaki S, Zaric B, Branislav P, Porpodis
K, Zarogoulidis P. Catamenial pneumothorax. J Thorac Dis. 2014 Oct;6(Suppl
4):S448-60. doi: 10.3978/j.issn.2072-1439.2014.08.49. PMID: 25337402;
PMCID: PMC4203986.2. Nikolettos K, Patsouras A, Kotanidou S, Garmpis N,
Psilopatis I, Garmpi A, Effraimidou EI, Daniilidis A, Dimitroulis D,
Nikolettos N, Tsikouras P, Gerede A, Papoutsas D, Kontomanolis E, Damaskos
C. Pulmonary Endometriosis: A Systematic Review. J Pers Med. 2024 Oct
31;14(11):1085. doi: 10.3390/jpm14111085. PMID: 39590577; PMCID:
PMC115957403. Legras A, Mansuet-Lupo A, Rousset-Jablonski C, Bobbio A,
Magdeleinat P, Roche N, Regnard JF, Gompel A, Damotte D, Alifano M.
Pneumothorax in women of child-bearing age: an update classification based
on clinical and pathologic findings. Chest. 2014 Feb;145(2):354-360. doi:
10.1378/chest.13-1284. PMID: 24091546. REFERENCE #2: 4. Kawaguchi Y,
Hanaoka J, Ohshio Y, Igarashi T, Okamoto K, Kaku R, Hayashi K, Ishida M.
Diagnosis of thoracic endometriosis with immunohistochemistry. J Thorac
Dis. 2018 Jun;10(6):3468-3472. doi: 10.21037/jtd.2018.05.121. PMID:
30069342; PMCID: PMC6051878.5. Nezhat C, Amirlatifi N, Najmi Z, Tsuei A.
Thoracic Endometriosis Syndrome: A Comprehensive Review and
Multidisciplinary Approach to Management. J Clin Med. 2024 Dec
13;13(24):7602. doi: 10.3390/jcm13247602. PMID: 39768527; PMCID:
PMC11678721.6. Ciriaco P, Muriana P, Lembo R, Carretta A, Negri G.
Treatment of Thoracic Endometriosis Syndrome: A Meta-Analysis and Review.
Ann Thorac Surg. 2022 Jan;113(1):324-336. doi:
10.1016/j.athoracsur.2020.09.064. Epub 2020 Dec 18. PMID: 33345783.
REFERENCE #3: 7. Ghigna MR, Mercier O, Mussot S, Fabre D, Fadel E,
Dorfmuller P, de Montpreville VT. Thoracic endometriosis:
clinicopathologic updates and issues about 18 cases from a tertiary
referring center. Ann Diagn Pathol. 2015 Oct;19(5):320-5. doi:
10.1016/j.anndiagpath.2015.07.001. Epub 2015 Jul 8. PMID: 26243726.
DISCLOSURES: MKG serves as the DSMB co-chair of Redx relationship with
Red-X Please note: 2022-present by Marilyn Glassberg, value=Consulting fee
Advisory relationship with Bristol Myers Squibb Please note: 2022-present
by Marilyn Glassberg, value=Consulting Advisory Committee Member
relationship with Structure Therapeutics Please note: 2023-present by
Marilyn Glassberg, value=Consulting fee Advisory Committee Member
relationship with SynDevRx Please note: 2022-present by Marilyn Glassberg,
value=Consulting fee Removed 03/02/2025 by Marilyn Glassberg, source=Web
Response No relevant relationships by Katherine Partyka Copyright
© 2025 American College of Chest Physicians

<114>
Accession Number
2042225509
Title
Acute Kidney Injury in Cardiac Surgery: A Comprehensive Review of
Perioperative Strategies and Emerging Biomarkers.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Cuttone G.; La Via L.; SenussiTesta T.; Sinatra N.; Deana C.; Roberti E.;
Montisci A.; Pappalardo F.
Institution
(Cuttone) Anesthesia and Intensive Care, 'Abele Ajello' Hospital, ASP
Trapani, Mazara del Vallo, Italy
(La Via) Department of Anesthesia and Intensive Care, University Hospital
Policlinico G. Rodolico-San Marco, Catania, Italy
(SenussiTesta) Department of Cardiac Anesthesia and Intensive Care,
Cardiovascular Network, IRCCS Policlinico San Martino Hospital, Genova,
Italy
(Sinatra) Nephrology and Dialysis Unit, "Paolo Borsellino" Hospital, ASP
Trapani, Marsala, Italy
(Deana) Anesthesia and Intensive Care 1, Department of Emergency, Academic
Hospital "S.M. della Misericordia", Health Integrated Agency of Friuli
Centrale, Udine, Italy
(Roberti) Department of Anesthesia, Intensive Care and Emergency Medicine,
ASST Spedali Civili, Brescia, Italy
(Montisci) Division of Cardiothoracic Intensive Care, ASST Spedali Civili,
Brescia, Italy
(Pappalardo) Faculty of Medicine and Surgery, Kore University of Enna,
Enna, Italy
(Pappalardo) Centro Cuore GB Morgagni, Catania, Italy
Publisher
W.B. Saunders
Abstract
Acute kidney injury (AKI) is a significant complication following cardiac
surgery, affecting 20% to 30% of patients and contributing to increased
morbidity and mortality. Cardiac surgery-associated AKI (CSA-AKI) is
linked to higher short-term mortality rates, extended intensive care unit
stays, and substantial health care costs. This review examines the
multifactorial pathophysiology of CSA-AKI, which includes renal
hypoperfusion, systemic inflammatory response, and nephrotoxic exposures.
Current definitions of AKI, primarily based on KDIGO criteria, highlight
the limitations of serum creatinine as a diagnostic marker. Preoperative
optimization is essential for risk stratification, using validated
prediction models like the Cleveland Clinic score and EuroSCORE II. The
article discusses the importance of volume status assessment and careful
management of nephrotoxic medications. Intraoperative strategies, such as
surgical technique selection and hemodynamic optimization, are crucial for
preventing AKI during surgery. Postoperatively, maintaining fluid balance
and avoiding nephrotoxin exposure are vital. Implementing KDIGO care
bundles has demonstrated effectiveness in reducing AKI incidence. Emerging
biomarkers, such as NGAL and KIM-1, offer promising avenues for early
detection of renal injury, potentially enabling timely interventions. In
conclusion, comprehensive prevention of AKI in cardiac surgery demands a
multimodal approach, integrating preoperative risk assessment,
intraoperative management, and postoperative care. Advances in biomarker
research and monitoring technologies may facilitate earlier and more
effective interventions, ultimately reducing the incidence of AKI in
high-risk patients. Copyright © 2025 Elsevier Inc.

<115>
Accession Number
2042216836
Title
Prophylactic norepinephrine infusion to reduce severe hypotension during
induction of anaesthesia in patients undergoing cardiac surgery: a
randomised controlled single-centre clinical trial.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Gaillard C.; Breul L.; Foucher A.; Rigal J.-C.; David C.-H.; Souab F.;
Canevet M.; Ryan M.; Bailly A.; Morin H.; Cadiet J.; Geay C.; Rozec B.;
Vourc'h M.
Institution
(Gaillard, Breul, Rigal, Souab, Canevet, Ryan, Bailly, Morin, Cadiet,
Rozec, Vourc'h) Anesthesie et reanimation chirurgie cardiaque, Hopital
Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite,
Nantes, France
(Foucher) Anesthesie et reanimation Polyvalente, Hopital Laennec, Centre
Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France
(David) Department of Thoracic and Cardiovascular Surgery, l'Institut du
Thorax, Hopital Laennec, Centre Hospitalier Universitaire de Nantes,
Nantes Universite, Nantes, France
(Geay) Plateforme de Methodologie et Biostatistique, Direction de la
Recherche et de l'Innovation, Centre Hospitalier Universitaire, Nantes,
France
(Rozec) Nantes Universite, CNRS, InsERM, l'institut du thorax, Nantes,
France
(Vourc'h) INSERM CIC 0004 Immunologie et infectiologie, Nantes Universite,
Nantes, France
Publisher
Elsevier Ltd
Abstract
Background: The EPITUBE trial aimed to determine whether a prophylactic
infusion of norepinephrine reduced severe hypotension after induction of
general anaesthesia and tracheal intubation in patients undergoing cardiac
surgery. Method(s): We performed a randomised controlled
single-centre clinical trial including patients undergoing cardiac
surgery. In the experimental group, infusion of norepinephrine started
from the start of preoxygenation at an infusion rate of 0.06 mug
kg-1 min-1, secondarily titrated to maintain mean
arterial pressure (MAP) between 65 and 80 mm Hg. In the control group,
ephedrine was administered if MAP decreased <65 mm Hg. Primary outcome was
the occurrence of MAP <55 mm Hg. Secondary measures included tracheal
intubation-related complications, postoperative complications, duration of
ICU stay, and mortality. Result(s): Of 210 patients randomised and
analysed in the intention-to-treat analysis, the incidence of severe
hypotension was not different between the groups: 43.8% in the
norepinephrine group vs 44.8% in the control group (odds ratio 0.96, 95%
confidence interval [CI] 0.56-1.66, P=0.99). The incidence of MAP <65 mm
Hg was lower in the norepinephrine group than in the control group: 63.8%
vs 78.1% (odds ratio 0.49, 95% CI 0.26-0.90, P=0.02). The rate of
intubation-related complications was not different between the
norepinephrine and control groups, 22.9% vs 32.4%, respectively (odds
ratio 0.62, 95% CI 0.33-1.14, P=0.13). There was no difference in
postoperative outcomes including acute kidney injury, time on ventilator,
or length of stay in the ICU. Conclusion(s): In patients undergoing
cardiac surgery, infusion of norepinephrine before general anaesthesia at
a starting dose of 0.06 mug kg-1 min-1 did not
reduce severe hypotension compared with on-demand ephedrine. Clinical
trial registration: ClinicalTrials.gov Identifier:
NCT05335954. Copyright © 2025 British Journal of Anaesthesia

<116>
Accession Number
2041627732
Title
Rationale and Design of the EPISODE Trial: A Randomized Controlled Trial
on the Effect of PCSK9 Inhibitors in Calcific Aortic Valve Stenosis.
Source
Journal of the American Heart Association. 14(19) (no pagination), 2025.
Article Number: e042112. Date of Publication: 19 Sep 2025.
Author
Zheng Y.; Li Q.; Yang Y.; Yang J.; Liu Z.; Ma X.; Wang Z.
Institution
(Zheng, Li, Yang, Yang, Liu, Ma, Wang) Department of Cardiology, Beijing
Anzhen Hospital, Clinical Center for Coronary Heart Disease, Capital
Medical University, Beijing, China
(Ma, Wang) Beijing Institute of Heart Lung and Blood Vessel Disease,
Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic
Disease, Clinical Center for Coronary Heart Disease, Capital Medical
University, Beijing, China
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Calcific aortic valve stenosis (CAVS) can lead to cardiac
adverse outcomes; however, currently, no effective pharmacological
interventions are available to prevent or delay disease progression.
Emerging evidence has identified significant associations between CAVS and
key biomarkers, including Lp(a) (lipoprotein [a]), low-density lipoprotein
cholesterol, and PCSK9 (proprotein convertase subtilisin/kexin type 9).
However, robust evidence from randomized controlled trials is still
lacking to substantiate these associations. METHOD(S): The EPISODE
(Effect of PCSK9 Inhibitors on Calcific Aortic Valve Stenosis) trial is a
prospective, evaluator-blinded, randomized controlled trial designed to
assess the therapeutic efficacy of PCSK9 inhibitors in patients with CAVS.
A total of 160 patients with mild-to-moderate or asymptomatic severe CAVS
will be randomly assigned to receive either statin monotherapy or a
combination of statins and PCSK9 inhibitors. Participants will undergo
follow-up assessments at 3-month intervals for 24 months, including
transthoracic ultrasonic cardiogram, computed tomography, and quality-of-
life evaluations using the EuroQol-5 Dimension-3 Level questionnaire. The
primary end point is the annualized change in peak aortic jet velocity,
whereas secondary end points encompass changes in aortic valve area,
calcification score, incidence of heart valve surgery, and quality of
life. Safety end points include all-cause mortality and cardiovascular
events. CONCLUSION(S): The trial aims to evaluate the efficacy of
PCSK9 inhibitors in modulating disease progression, reducing adverse
cardiovascular events, and improving clinical outcomes in patients with
CAVS. The anticipated findings are expected to provide critical insights
for developing novel therapeutic strategies for early intervention in
CAVS. Copyright © The Author(s). Published on behalf of the
American Heart Association, Inc., by Wiley. This is an open access article
under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs
License, which permits use and distribution in any medium, provided the
original work is properly cited, the use is non-commercial and no
modifications or adaptations are made.

<117>
Accession Number
2041703974
Title
Thoracic Ultrasound-Guided Regional Nerve Blockade for Pain Management
Following Open Heart Surgery in Children: A Systematic Review and Network
Meta-analysis of Analgesic Efficacy and Impact on Postoperative Opioid
Requirements.
Source
Pediatric Cardiology. (no pagination), 2025. Date of Publication: 2025.
Author
Abdelhady E.; Elmitwalli I.; Saber A.; Elhamrawy A.; Tobias J.D.
Institution
(Abdelhady, Tobias) Department of Anesthesiology & Pain Medicine,
Nationwide Children's Hospital, Columbus, OH, United States
(Elmitwalli) Department of Pediatrics, University of Oklahoma Children's
Hospital, Oklahoma City, OK, United States
(Saber) Department of Cardiology, Minia Cardiothoracic University
Hospital, New Minya, Egypt
(Elhamrawy) Detroit Medical Center, Wayne State University, Detroit, MI,
United States
(Tobias) Department of Anesthesiology & Pain Medicine, The Ohio State
University College of Medicine, Columbus, OH, United States
Publisher
Springer
Abstract
A new era of multimodal opioid-sparing pain management strategies has
begun, aiming to control pain while limiting the use of opioids and their
associated adverse effects. Peripheral nerve blockade, either single-shot
or continuous catheter techniques, constitute an important cornerstone of
these strategies. This systematic review and network meta-analysis aimed
to compare and evaluate the effects of different single-shot
ultrasound-guided regional anesthetic techniques on pain control following
open cardiac surgical procedures in pediatric patients. A systematic
review and comprehensive search were conducted to retrieve available
randomized clinical trials focusing on the use of ultrasound-guided
regional anesthesia nerve blockade as part of a multimodal analgesia
approach in pediatric patients undergoing open cardiac surgery through
median sternotomy. Our search was conducted in major databases, including
MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Central Register of
Controlled Trials. The main outcomes of interest were perioperative opioid
consumption and postoperative pain scores. A total of 1,511 articles were
retrieved for the initial screening of titles, with 16 RCTs deemed
eligible and included after full-text screening. Eleven different regional
nerve blocks were assessed in the studies, including erector spinae plane
block (ESPB), thoracic paravertebral block (PVB), deep parasternal block
(DPB), superficial parasternal block (SPB), thoracic retrolaminar
paravertebral block (TRLB), pectoral nerve block type II (PECS II), and
multiple injection costotransverse block (MICB). Compared to no
intervention, parasternal blocks particularly DPB and SPB were associated
with a significant reduction in both intraoperative and 24-h postoperative
fentanyl consumption. Postoperatively, fentanyl consumption was reduced by
-4.92 microg/kg (95% CI: [-6.58 to -3.26]) with DPB, -2.54 microg/kg (95%
CI: [-4.16 to -0.91]) with SPB, and -5.6 microg/kg (95% CI: [-8.31 to
-2.89]) with TRLB. Intraoperatively, SPB reduced fentanyl use by -5.12
microg/kg (95% CI: [-6.8 to -3.43]) and DPB by -4.31 microg/kg (95% CI:
[-5.9 to -2.71]). No significant postoperative opioid-sparing effect was
observed with other blocks, such as ESPB, PVB, MICB, or PECS II. The
pooled estimates showed considerable heterogeneity, with I2 values of
90.9% for intraoperative and 94.7% for postoperative fentanyl consumption.
Ultrasound-guided regional anesthesia-particularly parasternal blocks-may
offer superior opioid-sparing effects and enhanced recovery in children
undergoing open-heart surgery, making them promising adjuncts to
multimodal analgesia. In contrast, blocks such as ESPB, PVB, and MICB
showed limited benefit for median sternotomy pain. Given the substantial
heterogeneity in the current evidence, the routine use of these techniques
should be guided by institutional experience and individualized patient
factors. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2025.

<118>
Accession Number
2042209163
Title
Cold-stored platelets: A systematic review of recovery in healthy adults
and chest drain output in cardiothoracic surgery patients.
Source
Hematology, Transfusion and Cell Therapy. 48(1) (no pagination), 2026.
Article Number: 106226. Date of Publication: 01 Jan 2026.
Author
Keane C.; Sharif H.; Jackson D.
Institution
(Keane, Sharif, Jackson) Thrombosis and Vascular Diseases Laboratory,
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC,
Australia
Publisher
Elsevier Editora Ltda
Abstract
Cold-stored platelets were abandoned in the 1960s after demonstration of
an increased clearance in vivo due to an irreversible activated phenotype.
Difficulties in storage, logistics, and the increased requirement of
therapeutic platelet transfusions for haemostasis have sparked renewed
interest in cold-stored platelets. This systematic review compared two
primary outcomes: in vivo recovery for autologous cold-stored platelets
versus room-temperature platelets in healthy volunteers, and chest drain
output at 24 h for allogeneic cold-stored platelets versus
room-temperature platelets after complex cardiothoracic surgery. A total
of 4215 articles were found in the ProQuest, PubMed, Scopus, Embase, and
Cochrane electronic databases. Seven eligible papers were included in this
meta-analysis. Cold-stored platelets showed a decreased in vivo recovery
two hours after retransfusion following storage for two to seven days
compared to a room-temperature platelet control group (mean difference:
-25.85 %; 95 % confidence interval: -41.98 to -9.71 %; p-value = 0.002).
Further, cold-stored platelets showed a decreased chest cavity output when
transfused within 24 h after complex cardiothoracic surgery (mean
difference: 249.68 mL; 95 % confidence interval: 85.68 to 413.67 mL;
p-value = 0.003). While cold-stored platelets are not a substitute for
room-temperature platelets in a prophylactic scenario, their ability to
significantly reduce chest cavity output suggests they may be optimal for
the management of bleeding in surgical patients, especially in the context
of logistical difficulties. Copyright © 2025 Associacao
Brasileira de Hematologia, Hemoterapia e Terapia Celular

<119>
Accession Number
2041594768
Title
Routine versus selective protamine administration to reduce bleeding after
TAVI: Rationale and design of the POPular ACE TAVI trial.
Source
American Heart Journal. 293 (no pagination), 2026. Article Number: 107296.
Date of Publication: 01 Mar 2026.
Author
Overduin D.C.; van Ginkel D.J.; Dubois C.; Lesizza P.; Broeze G.M.;
Montero-Cabezas J.M.; Rosseel L.; van der Kley F.; van Nuland P.J.A.;
Smits T.P.M.; Hemelrijk K.I.; Aarts H.M.; Rensing B.J.W.M.; Timmers L.;
Swaans M.J.; Sonker U.; Veenstra L.; van 't Hof A.W.J.; Peper J.; Tijssen
J.G.P.; Delewi R.; Vriesendorp P.A.; ten Berg J.M.
Institution
(Overduin, van Ginkel, van Nuland, Smits, Rensing, Timmers, Swaans,
Sonker, Peper, ten Berg) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Dubois, Lesizza) Department of Cardiovascular Medicine, University
Hospital Leuven, Leuven, Belgium
(Broeze, Hemelrijk, Aarts, Tijssen, Delewi) Department of Cardiology,
Amsterdam UMC, Amsterdam, Netherlands
(Montero-Cabezas, van der Kley) Department of Cardiology, Leiden
University Medical Center, Leiden, Netherlands
(Rosseel) Department of Cardiology, Hartcentrum Aalst, Aalst, Azorg,
Belgium
(Veenstra, van 't Hof, Vriesendorp, ten Berg) Department of Cardiology,
Maastricht University Medical Center, Maastricht, Netherlands
(Veenstra, van 't Hof, Vriesendorp, ten Berg) Cardiovascular Research
Institute Maastricht (CARIM), Maastricht, Netherlands
Publisher
Elsevier Inc.
Abstract
Background Unfractionated heparin is routinely used during transcatheter
aortic valve implantation (TAVI) to reduce catheter thrombosis and
thromboembolism. Protamine reverses the effect of heparin and may lower
bleeding risk, but it can also trigger severe allergic reactions. Robust
data on the safety and efficacy of routine protamine administration after
TAVI is lacking. Methods The ``routine versus selective protamine
administration to reduce bleeding complications after transcatheter aortic
valve implantation (POPular ACE TAVI)'' is an investigator-initiated,
multicenter, double-blind, placebo-controlled, randomized clinical trial.
A total of 1000 patients will be randomized 1:1 to routine versus
selective protamine administration, stratified by study site and
antithrombotic therapy. Primary and secondary outcomes are defined
according to the Valve Academic Research Consortium-3 (VARC-3) criteria.
The primary outcome is a composite of all-cause mortality and clinically
relevant bleeding (type 1-4) within 30 days after TAVI. Ranked secondary
outcomes include clinically relevant bleeding; major, life-threatening or
fatal bleeding (type 2-4); major vascular complications; cardiovascular
mortality; and all-cause mortality. Safety outcomes include anaphylaxis
and thromboembolic events defined as the composite of myocardial
infarction, ischemic stroke, transient ischemic attack, or noncerebral
distal embolization. Recruitment began in November 2023 and will continue
until 1,000 patients are randomized. The trial will end after 30-day
follow-up of the last patient. Conclusion The POPular ACE TAVI trial
(NCT05774691) will evaluate whether routine protamine administration
reduces all-cause mortality or clinically relevant bleeding after TAVI
compared with selective use. Trial registration clinicaltrials.gov .
Unique identifier NCT05774691. Copyright © 2025 Elsevier Inc.

<120>
Accession Number
2042168513
Title
Obstructive Coronary Artery Disease and Health Status in Transcatheter
Aortic Valve Replacement: A Post Hoc Analysis of the SCOPE I Randomized
Clinical Trial.
Source
JAMA Network Open. 8(12) (no pagination), 2025. Article Number: e2547111.
Date of Publication: 2025.
Author
Tomii D.; Lanz J.; Thiele H.; Heg D.; Kim W.-K.; Joner M.; Mollmann H.;
Burgdorf C.; Linke A.; Redwood S.; Hilker M.; Conradi L.; Kerber S.; Thilo
C.; Toggweiler S.; Walther T.; Prendergast B.; Windecker S.; Pilgrim T.
Institution
(Tomii, Lanz, Windecker, Pilgrim) Department of Cardiology, Bern
University Hospital, University of Bern, Inselspital, Bern, Switzerland
(Thiele) Heart Centre Leipzig, Leipzig University, Leipzig, Germany
(Heg) Department of Clinical Research, University of Bern, Bern,
Switzerland
(Kim) Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad
Nauheim, Germany
(Joner) German Heart Centre, Technical University of Munich, Munich,
Germany
(Mollmann) Department of Internal Medicine I, St-Johannes-Hospital,
Dortmund, Germany
(Burgdorf) Heart and Vascular Centre, Bad Bevensen, Germany
(Linke) Department of Internal Medicine and Cardiology, Heart Centre
Dresden, Technische Universitat Dresden, Dresden, Germany
(Redwood, Prendergast) Department of Cardiology, St Thomas' Hospital,
Cleveland Clinic London, London, United Kingdom
(Hilker) Department of Cardiothoracic Surgery, University Medical Centre,
Regensburg, Germany
(Conradi) Department of Cardiovascular Surgery, University Heart Centre
Hamburg, Hamburg, Germany
(Kerber) Department of Cardiology, Cardiovascular Centre Bad Neustadt, Bad
Neustadt, Germany
(Thilo) Department of Internal Medicine I, RoMed Klinikum Rosenheim,
Rosenheim, Germany
(Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Lucerne,
Switzerland
(Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery,
University Hospital Frankfurt, Frankfurt, Germany
Publisher
American Medical Association
Abstract
IMPORTANCE Aortic stenosis (AS) and obstructive coronary artery disease
(CAD) often coexist, yet the impact of obstructive CAD on clinical and
patient-reported outcomes in patients undergoing transcatheter aortic
valve replacement (TAVR) remains a subject of ongoing debate. OBJECTIVES
To investigate the association of obstructive CAD with clinical outcomes
and health status among patients with symptomatic severe AS undergoing
TAVR. DESIGN, SETTING, AND PARTICIPANTS This post hoc analysis of the
investigator-initiated, multicenter SCOPE I (Safety and Efficacy of the
Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for
Transcatheter Aortic Valve Implantation by Transfemoral Approach)
randomized clinical trial was conducted at 20 tertiary heart centers in
Europe from February 8, 2017, to February 2, 2019, with follow-up through
3 years. Data were analyzed from February 17 through August 13, 2025.
EXPOSURE Presence vs absence of obstructive CAD, defined as greater than
50% stenosis in at least 1 major epicardial coronary vessel. MAIN OUTCOMES
AND MEASURES Parameters of interest included vital and patient-reported
disease-specific health status (Kansas City Cardiomyopathy Questionnaire
[KCCQ] scores, ranging from 0 to 100, with higher numbers indicating
better health status), and clinical efficacy according to Valve Academic
Research Consortium (VARC)-3 definitions. Analyses were conducted using
the as treated population. RESULTS Of 732 patients with symptomatic severe
AS undergoing TAVR (mean [SD] age, 82 [4] years; 416 [56.8%] female),
obstructive CAD was identified in 373 (51.0%), 144 (38.6%) of whom
underwent elective percutaneous coronary intervention (PCI) during the
periprocedural period. At 3 years after TAVR, there were no statistically
significant differences in patient-reported health status (eg, median
[IQR] baseline overall KCCQ scores with CAD, 54.2 [40.3-69.8] vs without
CAD, 55.2 [38.5-72.9] and at 3-year follow-up with CAD, 79.7 [64.4-90.6]
vs without CAD, 82.3 [68.2-91.7]), mortality (all-cause death: 88 of 373
[24.7%] vs 76 of 359 [22.3%], adjusted hazard ratio, [HR], 0.97 [95% CI,
0.66-1.43]; cardiovascular death: 59 of 373 [17.6%] vs 51 of 359 [15.5%],
adjusted HR, 0.87 [95% CI, 0.54-1.42]), and clinical efficacy of TAVR (163
of 313 [52.1%] vs 159 of 298 [53.4%]; adjusted risk ratio, 1.10 [95% CI,
0.92-1.32]) between patients with vs without obstructive CAD. Having (vs
not having) obstructive CAD was associated with a numerically albeit not
statistically significantly higher risk of myocardial infarction (18 of
372 [5.5%] vs 3 of 359 [1.1%]; adjusted HR, 3.83 [95% CI, 0.96-15.31]).
Periprocedural PCI among patients with obstructive CAD did not improve
clinical outcomes, patient-reported health status, nor the integrated end
points of clinical outcomes and quality of life measures. CONCLUSIONS AND
RELEVANCE In this post hoc analysis of SCOPE I, patients with obstructive
CAD who underwent TAVR had no statistically significant differences in
survival, patient-reported health status, or VARC-3 clinical efficacy
compared with patients without CAD through 3 years of follow-up. Findings
suggest that a tailored approach may be essential in the treatment of TAVR
candidates with severe AS and CAD. Copyright © 2025 Tomii D et
al.

<121>
Accession Number
2041744500
Title
The effect of perioperative erythropoietin-stimulating agents and
intravenous iron on patient outcomes following solid organ
transplantation: A systematic review.
Source
Transfusion Medicine. (no pagination), 2025. Date of Publication: 2025.
Author
Lee F.; Eichbaum Q.; Cserti-Gazdewich C.; Mullane D.; Lombard F.W.; Jacobs
J.W.; Pavenski K.; Englesakis M.; Dotto A.; Cho T.; Leonard-Reixa A.;
Trudeau J.; Shih A.W.; Bartoszko J.
Institution
(Lee, Bartoszko) Department of Anesthesiology and Pain Medicine,
University of Toronto, Toronto, ON, Canada
(Eichbaum, Jacobs) Vanderbilt University School of Medicine, Nashville,
TN, United States
(Eichbaum, Jacobs) Department of Pathology, Microbiology, and Immunology,
Vanderbilt University Medical Center, Nashville, TN, United States
(Cserti-Gazdewich, Pavenski) Department of Laboratory Medicine and
Pathobiology, University of Toronto, Toronto, ON, Canada
(Mullane, Dotto, Trudeau) Department of Anesthesiology, Pharmacology, &
Therapeutics, The University of British Columbia, Vancouver, BC, Canada
(Lombard) Department of Anesthesiology, Vanderbilt University Medical
Center, Nashville, TN, United States
(Englesakis) Library & Information Services, University Health
Network-Toronto General Hospital, Toronto, ON, Canada
(Cho) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Leonard-Reixa, Bartoszko) Department of Anesthesia and Pain Management,
Sinai Health System, Women's College Hospital, University Health Network,
Toronto, ON, Canada
(Shih) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Solid organ transplant is associated with high rates of anaemia and
transfusion, but there is little comparative data on interventions such as
erythropoietin-stimulating agents (ESAs) and intravenous (IV) iron. We
conducted a systematic review examining the association of ESAs and IV
iron with outcomes in adults undergoing solid organ transplant. This
review was registered with PROSPERO (CRD42023474722). EMBASE and MEDLINE
were searched from inception to April 11, 2025. Identified studies
included adults (>=18 years of age) undergoing heart, liver, lung, or
kidney transplant who received any ESA and/or IV iron before, during, or
up to 1 month following solid organ transplant surgery compared to
patients who did not. Article screening, full text review and data
extraction were performed by two independent reviewers. The primary
outcome of interest was transfusion volume, with secondary outcomes
including haematological parameters, graft-related outcomes and rates of
major morbidity and mortality. Results were analysed descriptively and
compiled into tables, and the risk of bias was assessed using the CLARITY
framework. From 1693 studies identified, 22 were included (kidney
transplant, n = 16; heart transplant or Left Ventricular Assist Device as
a bridge to transplant, n = 4; liver transplant, n = 2). Due to
heterogeneity in design, interventions and outcomes, meta-analysis was not
attempted. The quality of evidence was graded as Very Low. On the whole, a
comprehensive strategy implementing ESAs and IV iron may improve
haematological parameters and facilitate transfusion avoidance.
High-quality prospective studies assessing the impact of protocols for
haemoglobin optimisation and transfusion avoidance in solid organ
transplant are needed. Copyright © 2025 The Author(s).
Transfusion Medicine published by John Wiley & Sons Ltd on behalf of
British Blood Transfusion Society.

<122>
Accession Number
2042168523
Title
Cost-Effectiveness of Cryopreserved vs Liquid-Stored Platelets for
Managing Surgical Bleeding.
Source
JAMA Network Open. 8(12) (no pagination), 2025. Article Number: e2554363.
Date of Publication: 2025.
Author
Orman Z.; Reade M.C.; Marks D.C.; Howe B.D.; Bailey M.; Carrandi A.;
McQuilten Z.K.; Higgins A.M.
Institution
(Orman, Howe, Bailey, Carrandi, McQuilten, Higgins) Australian and New
Zealand Intensive Care Research Centre, School of Public Health and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Reade) Medical School, University of Queensland, Brisbane, QLD, Australia
(Reade) Joint Health Command, Australian Defence Force, Australian Capital
Territory, Canberra, Australia
(Marks) Australian Red Cross Lifeblood, Sydney, NSW, Australia
(McQuilten) Transfusion Research Unit, School of Public Health and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
Publisher
American Medical Association
Abstract
IMPORTANCE Platelet transfusion is critical in managing major bleeding,
but access to liquid-stored platelets is limited by their 5- to 7-day
shelf life. Cryopreserved platelets last up to 2 years and may improve
availability, although their cost-effectiveness remains uncertain.
OBJECTIVE To evaluate the cost-effectiveness of cryopreserved platelets vs
liquid-stored platelets for managing surgical bleeding. DESIGN, SETTING,
AND PARTICIPANTS An economic evaluation was conducted from the Australian
government funder perspective alongside the CLIP-II randomized clinical
trial, following intention-to-treat principles. Adult patients (age >=18
years) undergoing cardiac surgery at 11 Australian tertiary hospitals
between August 2021 and April 2024 were screened for eligibility. Eligible
patients were those at high risk for platelet transfusion, identified by
risk prediction score or clinician judgment, excluding female patients
aged 18 to 55 years who were rhesus D (RhD) negative or with unknown RhD
status and patients with coagulopathy or prior thromboembolism. Data were
analyzed between January and April 2025. INTERVENTIONS Participants
received at least 3 units of either cryopreserved or liquid-stored
platelets intraoperatively or within 24 hours postsurgery. MAIN OUTCOMES
AND MEASURES Costs were estimated in 2023 Australian dollars (A$) by
assigning unit costs to patient-level resource use in each trial group,
including intensive care unit (ICU) admissions, hospitalizations, and
blood products. Effectiveness measures included postoperative bleeding
volume (first 24 hours post-ICU admission and total), 90-day mortality,
type 4 bleeding (based on the Bleeding Academic Research Consortium
criteria), and serious adverse events. Given the 90-day follow-up period,
discounting was not applied. RESULTS Among 202 participants (median [IQR]
age, 66 [57-74] years, 153 [75.7%] male), 104 received cryopreserved
platelets and 98 received liquid-stored platelets. The mean difference in
per-patient cost was A$15 035 (95% CI, -A$1878 to A$31 949) with
cryopreserved platelets vs liquid-stored platelets. Mean blood loss within
24 hours following ICU admission was 121 (95% CI, 5 to 237) mL higher,
total postoperative blood loss was 504 (95% CI, 145 to 862) mL higher, and
type 4 bleeding was 12.3% (95% CI, 1% to 23.6%) higher with cryopreserved
platelets compared with liquid-stored platelets. The difference in 90-day
mortality between cryopreserved platelet and liquid-stored platelet groups
was not statistically significant (7.4% [95% CI, -0.3% to 15.1%]). Only 1
serious adverse event was observed in each group. CONCLUSIONS AND
RELEVANCE In this economic evaluation, cryopreserved platelets were
dominated by liquid-stored platelets for managing bleeding in cardiac
surgery. Further research is needed to assess the potential economic
benefits of cryopreserved platelets in broader populations, particularly
in regional and remote hospitals where platelet availability is
limited. Copyright © 2025 Orman Z et al.

<123>
Accession Number
649473431
Title
Cryopreserved vs Liquid-Stored Platelets for the Treatment of Surgical
Bleeding: The CLIP-II Randomized Noninferiority Clinical Trial.
Source
JAMA. (no pagination), 2025. Date of Publication: 08 Dec 2025.
Author
Reade M.C.; Marks D.C.; Howe B.D.; Bailey M.J.; Bannon P.G.; Eastwood
G.M.; French C.J.; Gattas D.J.; Higgins A.M.; Holley A.D.; Hu R.T.; Irving
D.O.; Johnson L.; McGuinness S.P.; McQuilten Z.K.; Royse A.G.; Smith J.A.;
Weinberg L.; Wood E.M.
Institution
(Reade, Holley) Medical School, University of Queensland, Brisbane, QLD,
Australia
(Reade, Holley) Joint Health Command, Australian Defence Force, Canberra,
Australian Capital Territory, Australia
(Marks, Irving, Johnson) Australian Red Cross Lifeblood, Alexandria, New
South Wales, Australia
(Howe, Bailey, French, Higgins) Australian and New Zealand Intensive Care
Research Centre, Monash University, Melbourne, VIC, Australia
(Bannon, Gattas) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Bannon, Gattas) Sydney Medical School, Sydney, NSW, Australia
(Eastwood, Hu, Weinberg) Austin Hospital, Melbourne, VIC, Australia
(Eastwood, Hu, Royse, Weinberg) University of Melbourne, Melbourne, VIC,
Australia
(French) Western Hospital, Melbourne, VIC, Australia
(McGuinness) Cardiothoracic and Vascular Intensive Care and High
Dependency Unit, Auckland, New Zealand
(McQuilten) School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Royse) Royal Melbourne Hospital, Melbourne, VIC, Australia
(Royse) Australian Army, Melbourne, VIC, Australia
(Smith) Victorian Heart Hospital, Melbourne, VIC, Australia
(Smith) Monash University, Melbourne, VIC, Australia
(Wood) Transfusion Research Unit, Monash University, Melbourne, VIC,
Australia
Abstract
Importance: Liquid-stored platelets have a shelf-life of 5 to 7 days,
limiting availability and resulting in wastage. Objective(s): To
assess the effectiveness and safety of dimethyl sulfoxide-cryopreserved
platelets, which have a shelf-life of 2 years, as a treatment for cardiac
surgery bleeding. Design, Setting, and Participant(s): The
Cryopreserved vs Liquid Platelets II (CLIP-II) trial was a multicenter,
randomized, double-blind, parallel-group noninferiority trial, which
enrolled patients between August 2021 and April 2024 at 11 Australian
tertiary hospitals, with follow-up completed in July 2024. Patients at
high risk of platelet transfusion were eligible. Patients were excluded if
they had a history of deep vein thrombosis or pulmonary embolism, were
coagulopathic, or were females aged 18 to 55 years who were rhesus D (RhD)
negative or of unknown RhD status. Of 879 patients meeting inclusion
criteria, 182 were excluded and 285 did not consent, leaving 412. Of
these, 388 were randomized and 202 received study platelets.
 Intervention(s): Patients received up to 3 units of either group O
cryopreserved platelets or conventional liquid-stored platelets,
commencing intraoperatively or in the first 24 postoperative hours.
 Main Outcomes and Measures: The primary outcome was postsurgical
chest drain bleeding within the first 24 hours following intensive care
unit admission. Noninferiority was defined prospectively as less than 20%
greater bleeding in this period. Five secondary and 42 tertiary outcomes
were defined a priori. Result(s): Of the 202 transfused patients
(mean [SD] age, 64.4 [13] years; 75.7% male), 61 (30.2%) underwent
nonelective surgery. The primary outcome did not differ between groups
(605 mL in cryopreserved platelet group vs 535 mL in liquid-stored
platelet group; ratio of geometric means [cryopreserved to liquid ratio],
1.13 [95% CI, 0.96-1.34]; P = .07). As the confidence interval includes
bleeding exceeding the noninferiority margin, noninferiority was not
established. Cryopreserved platelet transfusion was associated with higher
intraoperative and total perioperative blood loss (ratio of geometric
means [cryopreserved to liquid ratio], 1.42 [95% CI, 1.12-1.80]; 1.31 [95%
CI, 1.07-1.60], respectively), and increased red cell, plasma, and
cryoprecipitate transfusion. While there were no differences in the
incidence of prespecified adverse events, patients receiving cryopreserved
platelets experienced longer times to extubation and intensive care
unit/hospital discharge (median [IQR] duration of ventilation, 25.5 hours
[16.1-77.3] vs 23.6 hours [13.1-52.8]; median [IQR] intensive care unit
length of stay, 3.8 days [2.0-6.0] vs 3.0 days [1.9-4.9]; median hospital
length of stay, 10.9 days [7.87-17.0] vs 9.1 [6.9-14.9]). Conclusions
and Relevance: Cryopreserved platelets did not meet the predefined
threshold for noninferiority in hemostatic effectiveness at 24 hours after
ICU admission. Additional predefined end points consistently indicated
diminished hemostatic effectiveness, although prespecified adverse events
were comparable. Trial Registration: ClinicalTrials.gov Identifier:
NCT03991481.

<124>
Accession Number
649488125
Title
Measurement Properties of Patient-Reported Outcome Measures for Heart
conditions: A COSMIN Systematic Review.
Source
Quality of Life Research. Conference: 31st Annual Conference of the
International Society for Quality of Life Research, ISOQOL 2024. Cologne
Germany. 33(1 Supplement) (pp S189), 2024. Date of Publication: 01 Oct
2024.
Author
Munyombwe T.; Scherrenberg M.; Haris M.; Bhatty A.; Nadarajah R.;
Wilkinson C.; Batra G.; Back M.; Gale C.
Institution
(Munyombwe) University of Leeds, Leeds, United Kingdom
(Scherrenberg) Jessa Hospital, Department of Cardiology, Wilrijk, Belgium
(Haris, Bhatty, Nadarajah) Department of Cardiology, Leeds General
Infirmary, Leeds, United Kingdom
(Wilkinson) Newcastle University, Newcastle, United Kingdom
(Batra) Department of Medical Sciences Cardiology, Uppsala University,
Uppsala, Sweden
(Back) Department of Health, Medicine and Caring Sciences, Linkoping
University, Linkoping, Sweden
(Gale) Leeds Institute of Data Analytics, University of Leeds, Leeds,
United Kingdom
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: Several patient-reported outcome measures (PROMs) are available for
use in patients with heart conditions, however, little evidence is
available on the most suitable PROMs to use for patients with heart
conditions. The three aims of this systematic review were to (a) provide
an overview of a range of PROMs used in: Heart failure (HF), Myocardial
infarction (MI), Atrial fibrillation (AF), Transcatheter aortic valve
implantation (TAVI), percutaneous coronary intervention (PCI), and Angina;
(b) assess the quality of studies that report the development and
validation of PROMs for heart conditions using the Consensus-based
Standards for selection of health Measurement Instruments (COSMIN)
framework; (c) identify aspects that are missing in the existing PROMs
that may need further research. Method(s): A systematic review of
PROMs used for patients with heart condition, was conducted in PubMed, Web
of Science, CINAHL, and Embase. Two researchers independently screened
abstracts and full texts, selected papers, and extracted data on study
characteristics and PROM measurement properties. The risk of bias
informing the development or validation of PROMs was assessed using the
COSMIN framework. Result(s): A total of 45 PROMs (described in 53
studies) were identified, of which 21 were disease specific for HF, 10 for
AF, three for MI, two for vascularisation (PCI, CABG, TAVI), two for
Angina, three generic, and four for coronary artery disease or
cardiovascular disease. The Kansas City Cardiomyopathy Questionnaire,
Minnesota living with heart failure, HeartQoL had the best ratings across
measurement properties for heart failure PROMs; MacNew and MIDAS for
Myocardial Infarction; Seattle Angina Questionnaire for Angina; Atrial
Fibrillation Effect on quality of life, and AF Impact for AF. The commonly
assessed measurement properties were structural validity, reliability,
internal consistency, and criterion validity. Five (9%) studies assessed
cross-cultural validity and 15 (28%) responsiveness, and none assessed
measurement error. Conclusion(s): Of the 45 PROMs validated in
patients with heart conditions, only a few reported on the validation of
all nine measurement properties recommended by the COSMIN guidelines. We
suggest that future research should focus on assessing cross-cultural
validation and measurement error of the PROMs used for patients with heart
conditions.

<125>
Accession Number
649472423
Title
THE APPLICATION of MACHINE LEARNING to OUTCOME PREDICTION in PAEDIATRIC
SOLID ORGAN TRANSPLANTATION: A SYSTEMATIC REVIEW.
Source
Pediatric Nephrology. Conference: European Society for Paediatric
Nephrology Congress, ESPN 2025. Athens Greece. 40(1 Supplement) (pp S53),
2025. Date of Publication: 01 Nov 2025.
Author
Burns C.; Marks S.
Institution
(Burns) UCL Great Ormond Street Institute of Child Health, London, United
Kingdom
(Marks) UCL Great Ormond Street, London, United Kingdom
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims/Purpose: Accurate prognostication in paediatric solid organ
transplantation (SOT) is essential for patient-specific risk
stratification. Ongoing advances in machine learning (ML), paired with
expanding data from electronic health records and transplant registries,
have led to a growing interest in data-driven outcome prediction. However,
evidence supporting ML-based prediction in paediatric SOT remains limited.
Therefore, this systematic review aimed to: (1) identify and evaluate ML
models developed to predict outcomes in paediatric kidney, lung and heart
transplant recipients, and (2) evaluate their quality, risk of bias, and
applicability using the updated PROBAST-AI (Prediction model Risk Of Bias
ASsessment Tool - Artificial Intelligence) criteria. Method(s): A
comprehensive systematic search was conducted in February 2025 across OVID
Medline, PubMed, Scopus, and Web of Science. Studies were eligible if they
applied ML to predict post-transplant outcomes in SOT recipients (<=18
years). Studies using ML for phenotypic clustering or diagnostic purposes
were excluded. Data extraction included both model details (eg.,
algorithms, feature selection methods) and clinical context (eg.,
transplant type, outcome predicted). Model quality, risk of bias, and
applicability were assessed using PROBAST+AI, which includes 34 signalling
questions across four domains: participants, predictors, outcome, and
analysis. Result(s): Of 453 records screened, 12 met the inclusion
criteria. Sample sizes ranged from 68 to 8,349 patients, with larger
datasets sourced from national transplant registries. Most studies focused
on modelling patient and allograft survival. Frequently used algorithms
included random forest, gradient boosting, support vector machines, and
neural networks. Random forest outperformed other models in six of the
seven studies where it was evaluated. PROBAST-AI found high or unclear
risk of bias and quality concerns in most studies, mainly in the analysis
domain. Key issues included small datasets, univariate feature selection
and inconsistent handling of missing data. Only two studies shared their
code publicly, and none conducted external validation. Conclusion(s):
This is the first systematic review to evaluate ML-based outcome
prediction in paediatric SOT. While these studies support proof-of-concept
for using ML for predicting prognosis, future efforts must prioritise
externally validated models co-developed by clinicians and data scientists
to support safe and effective integration into clinical practice.

<126>
Accession Number
2041863333
Title
BLUE HOPE AMIDST CRISIS: THE RAPID COURSE OF VASOPLEGIC SHOCK.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A3527-A3528),
2025. Date of Publication: 01 Oct 2025.
Author
Holzapfel H.; Holbert K.; Kaul M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (AQ) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION:
Vasoplegia, characterized by extreme vasodilation and vascular
hyperresponsiveness, is a well-established phenomenon in septic shock that
often proves refractory to standard vasopressor therapy, posing
significant management challenges. In cases of refractory vasoplegic
shock, methylene blue should be an early consideration as an adjunct
therapy. CASE PRESENTATION: A 57-year-old man with primary central nervous
system lymphoma, human immunodeficiency virus, secondary adrenal
insufficiency, and pulmonary aspergillosis was admitted for scheduled
chemotherapy. Initially well-appearing and asymptomatic, before ever
receiving chemotherapy, he developed significant left-sided pleuritic
chest pain and shortness of breath requiring supplemental oxygen. He
subsequently became hypotensive requiring vasopressors and was transferred
to the intensive care unit. Empiric antibiotics (vancomycin,
piperacillin-tazobactam, and azithromycin) were started. Laboratory tests
revealed severe neutropenia, a stark contrast to his normal white blood
cell and neutrophil count just hours earlier. A CT Angiogram ruled out
pulmonary embolism but revealed multifocal pneumonia and new cavitary lung
lesions. Due to concerns for recurrence of his pulmonary aspergillosis,
amphotericin B was started.Despite aggressive fluid resuscitation and
stress dose steroids, his hypotension persisted, requiring rapidly
escalating doses of vasopressors. His respiratory status deteriorated,
requiring endotracheal intubation and mechanical ventilation. Intravenous
methylene blue (2 mg/kg) was administered for refractory vasoplegic shock
with transient improvement in vasopressor requirement. Shortly thereafter,
the patient again required maximum doses of vasopressors and subsequently
developed severe metabolic acidosis, acute kidney injury with anuria, and
hyperkalemia. His mean arterial pressures remained ~30, rendering him
unsuitable for continuous veno-venous hemofiltration. Attempts with
bicarbonate infusion and ventilator adjustments failed to improve his
acidosis, ultimately leading to cardiac arrest. Postmortem, his blood
cultures identified pan-susceptible Escherichia coli. DISCUSSION(S):
This case highlights the rapid and severe progression of gram-negative
sepsis, ultimately resulting in refractory vasoplegia. Within just 18
hours, the patient deteriorated from being asymptomatic to succumbing to
refractory vasoplegic shock. Vasoplegia can be refractory to standard
vasopressor treatments, often prompting consideration of alternative
therapies such as methylene blue. Sepsis causes nitric oxide production
leading to profound vasodilation and vascular permeability characteristic
of vasoplegic shock. Methylene blue counteracts this effect by inhibiting
nitric oxide synthase and guanylate cyclase. Early consideration of
methylene blue is crucial, as it can help stabilize refractory shock,
providing additional time for antibiotics to take effect, especially in
rapidly progressing infections such as gram-negative sepsis. Yet,
methylene blue is often a forgotten tool to manage refractory shock as it
is not commonly used outside of the cardiac surgery realm. Research
increasingly supports the potential of methylene blue as a valuable
adjunct in managing refractory septic shock, highlighting its importance
as an additional therapeutic tool when standard vasopressors prove
insufficient. CONCLUSION(S): Refractory vasoplegia limits treatment
options and significantly contributes to mortality. Although methylene
blue is rarely used in clinical practice for sepsis, ongoing research is
exploring its efficacy and safety as an early adjunct treatment in
vasoplegic shock. However, outcomes with methylene blue use remain
variable, as highlighted by this case, and additional research is needed
to identify biomarkers that could predict which patients would most
benefit from this treatment. REFERENCE #1: Ibarra-Estrada, Miguel, Eduardo
Kattan, Pavel Aguilera-Gonzalez, Laura Sandoval-Plascencia, Uriel
Rico-Jauregui, Carlos A. Gomez-Partida, Iris X. Ortiz-Macias et al. "Early
adjunctive methylene blue in patients with septic shock: a randomized
controlled trial." Critical Care 27, no. 1 (2023): 110. REFERENCE #2:
Lambden, Simon. "Bench to bedside review: therapeutic modulation of nitric
oxide in sepsis-an update." Intensive care medicine experimental 7, no. 1
(2019): 64. DISCLOSURES: No relevant relationships by Kelsey Holbert No
relevant relationships by Hadassa Holzapfel No relevant relationships by
Malvika Kaul Copyright © 2025 American College of Chest
Physicians

<127>
Accession Number
649487898
Title
Postoperative quality of life in thoracic surgery patients using
electronic patient-reports outcomes.
Source
Quality of Life Research. Conference: 31st Annual Conference of the
International Society for Quality of Life Research, ISOQOL 2024. Cologne
Germany. 33(1 Supplement) (pp S128-S129), 2024. Date of Publication: 01
Oct 2024.
Author
Cox C.; Hoch C.; Gentry A.; Deal A.; Wang M.; Williams B.; Long J.;
Haithcock B.; Basch E.; Bennett A.; Mody G.; Kwong E.
Institution
(Cox, Hoch, Gentry, Deal, Wang, Long, Haithcock, Basch, Bennett, Mody,
Kwong) University of North Carolina at Chapel Hill, Chapel Hill, NC,
United States
(Williams) Emory University, Atlanta, GA, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: Prior studies have shown quality of life (QOL) after lung resection
is persistently reduced for up to 1 year, even after minimally invasive
surgery. We examined whether post-discharge remote electronic
patient-reported outcome (ePRO) symptom measurement with and without
alerts to providers impacts QOL after thoracic surgery. Method(s):
From 2020 2022, we enrolled patients planned for thoracic surgery to a
randomized controlled trial on measuring symptoms remotely using ePROs
(NCT04342260). All participants received webbased ePRO surveys on symptoms
(e.g. pain) using the PRO-CTCAE and physical functioning (PROMIS SF4a)
after discharge (daily surveys day 0 14 then weekly day 15 90) (Fig. 1).
Providers received alerts for severe/worsening symptoms in the alerting
arm. Change from baseline at each time point was compared between arms.
Minimally important difference (MID) was set at 10 points. The study was
powered to detect a difference in global health status between arms.
 Result(s): Of 113 participants randomized, 99 began post-discharge
ePROs measurement. The arms were similar in demographics (Table 1). Alerts
were trigged in 88% of participants in the alerting arm. Clinical action
(e.g. prescribing meds) was made in response to 64% of alerts. Global
health status (-11.9, sd = 19.2), physical function (-11.8, sd = 14.5),
social function (-12.4, sd = 18.7), and fatigue (13.7, sd = 21.8) from the
QLQC30; and pain in chest (23.7, sd = 32.4) from the LC13 showed
statistically significant worsening at Day 7 and returned to baseline by
month 2 in the alerting group. Physical function (-12.3, sd = 20.9), role
function (-23.2, sd = 35.5), social function (-22, sd = 32.1), and pain
(19, sd = 33.2) from the QLQ-C30 showed statistically significant
worsening at Day 7 in the measurement only group with return to baseline
bymonth 2 (Fig. 2). No differences in QOL between arms were observed.
 Conclusion(s): While alerting providers about concerning ePROs had no
influence on QOL, thoracic surgery patients engaged in ePRO measurement
had shorter durations of deterioration inQOL than described in previous
studies; suggesting measurement of PROs postoperatively enhances outcomes.
Future studies should aimto elucidate themediators of the influence of
ePROs on QOL after surgery.

<128>
Accession Number
2042216845
Title
Sex-Based Differences in Outcomes of Surgical Aortic Valve Replacement: A
Meta-Analysis with Reconstructed Time-to-Event Data.
Source
CJC Open. (no pagination), 2025. Date of Publication: 2025.
Author
Consoli L.N.; Majeed M.W.; Cetinel E.; Lajczak P.; Koziakas I.G.;
Caldonazo T.
Institution
(Consoli) Federal University of Bahia, Salvador, Brazil
(Majeed) Government Medical College Srinagar, Srinagar, India
(Cetinel) San Raffaele University, Milan, Italy
(Lajczak) Medical University of Silesia, Katowice, Poland
(Koziakas) Cardiac Surgery Department, Onassis Hospital, Athens, Greece
(Caldonazo) Department of Cardiothoracic Surgery, Jena University
Hospital, Friedrich Schiller University of Jena, Jena, Germany
(Caldonazo) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, New York, United States
Publisher
Elsevier Inc.
Abstract
Background: Results in the literature are mixed on how patient sex impacts
the outcomes of surgical aortic valve replacement (SAVR), with a high risk
of confounding bias due to different risk profiles at presentation. We
aimed to assess short- and long-term outcomes of SAVR in male and female
patients. Method(s): We searched PubMed, Embase, and the Cochrane
Library for eligible confounder-adjusted studies, including those that
used propensity-score-matching, multivariable regressions, and inverse
probability of treatment weighting. Meta-analysis was performed for
short-term (early mortality and procedural complications) and long-term
(late mortality, reoperation, and adverse events) endpoints. We compared
endpoints, using risk ratio (RR) for short-term endpoints and hazards
ratio (HR) for long-term endpoints. We calculated 95% confidence intervals
(CIs) for all outcomes. A meta-analysis of Kaplan-Meier-derived individual
patient data was done for long-term mortality. Result(s): We included
13 studies (n = 159,415). In the short-term, female patients had a higher
mortality rate (RR 1.25 [95% CI 1.19, 1.32], P < 0.001), more operative
deaths (RR 1.33 [95% CI 1.01, 1.75], P = 0.04), and required more blood
product use (RR 1.36 [95% CI 1.14, 1.63], P < 0.001). Male patients had
more transient ischemic attacks (RR 0.74 [95% CI 0.56, 0.99], P = 0.04)
and acute kidney injury (RR 0.73 [95% CI 0.7, 0.77], P < 0.001). At
long-term follow-up, male patients had a higher mortality rate (HR 0.93
[95% CI 0.88, 0.98], P = 0.001), and more reoperations; no significant
differences were seen in the rates of late stroke or bleeding.
 Conclusion(s): This meta-analysis found that, compared to male
patients, female patients had higher early mortality but lower late
mortality following SAVR. Copyright © 2025 The Authors

<129>
Accession Number
2042122876
Title
The PRINCE trial of remote ischaemic preconditioning in noncardiac surgery
to reduce myocardial injury: sign o' the times.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Ackland G.L.; Pinto B.B.
Institution
(Ackland) Translational Medicine and Therapeutics, William Harvey Research
Institute, Queen Mary University of London, London, United Kingdom
(Pinto) Department of Anaesthesiology, Pharmacology, Intensive Care and
Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
Publisher
Elsevier Ltd
Abstract
The remote ischemic PReconditioning In Non-Cardiac surgEry (PRINCE) trial
was a multinational, double-blind trial in which 1213 patients undergoing
noncardiac surgical procedures were randomly assigned to receive remote
ischaemic preconditioning (RIPC) or sham-RIPC after general anaesthesia
and before surgery to reduce myocardial injury. Postoperative myocardial
injury, defined alone by postoperative high-sensitivity troponin above the
highest 99th percentile of reference values, occurred in 215/566 patients
(38.0%) in the RIPC group and in 223/596 patients (37.4%) in the sham-RIPC
group. The PRINCE trial adds to an apparently contradictory literature on
the role of RIPC in perioperative medicine. We discuss both trial-specific
and mechanistic reasons to explain these discrepancies, and we contend
that a role for RIPC in minimising organ injury as a result of noncardiac
surgery remains possible. Copyright © 2025 British Journal of
Anaesthesia

<130>
Accession Number
2041862920
Title
IVC FILTER MIGRATION CAUSING DUODENAL PERFORATION: A CASE REPORT OF RARE
COMPLICATION.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A6728-A6729),
2025. Date of Publication: 01 Oct 2025.
Author
Abdulkader A.N.A.S.; Alanazi G.; Farnoudi N.; Siraj H.M.; Alghamdi A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Never Tell Me The Odds: Complications of Pulmonary Vascular
Procedures SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/20/2025
02:35 pm - 03:05 pm INTRODUCTION: Inferior vena cava (IVC) filters are
devices used to prevent pulmonary embolism (PE) by capturing emboli from
deep vein thrombosis (DVT) [1-2]. While IVC filters are effective,
complications such as filter penetration into surrounding structures are
rare but significant [3]. This case highlights an unusual complication
involving a permanent IVC filter perforating the duodenum, presenting
unique diagnostic and therapeutic challenges. CASE PRESENTATION: A
33-year-old male with a history of permanent IVC filter placement 20 years
ago presented with two years of intermittent epigastric pain and watery
diarrhea. The CT scan showed IVC filter struts protruding into the
duodenum, confirmed by endoscopy. Initial endoscopic removal failed due to
a fibrin sheath, but successful laser-assisted extraction was performed at
another hospital. The patient later developed a small pulmonary embolism,
bacteremia, and GI bleeding, which was managed with anticoagulation and
antibiotics, and the patient recovered with appropriate care.
 DISCUSSION(S): This case presents a rare but critical delayed
complication of IVC filters. While IVC filters play a vital role in
preventing pulmonary embolism (PE), their long-term presence can lead to
severe complications, including organ penetration, thrombosis, and
infection [3-4]. Studies suggest that caval penetration occurs in up to
19% of cases, with duodenal involvement being the most common, accounting
for 40% of penetration-related complications [3].Prolonged indwelling time
and mechanical stress from filter struts are key contributors to
perforation, leading to gastrointestinal bleeding, fistula formation, and
infections [3-6]. Early recognition through imaging techniques,
particularly CT scans, is crucial in detecting filter strut penetration
into the duodenum [7-10]. Endoscopic evaluations, such as
esophagogastroduodenoscopy (EGD), are also useful in visualizing metallic
foreign bodies within the gastrointestinal tract [11].Management
strategies for duodenal perforation vary from conservative observation to
endoscopic or surgical removal, depending on the severity of the
perforation and associated complications [10][12]. In cases where the
filter prongs embed into adjacent structures, surgical intervention,
including laparotomy for filter extraction and duodenal repair, remains
the most effective approach [13-14]. Endovascular retrieval techniques
have emerged as less invasive alternatives, with procedures such as
excimer laser sheath retrieval achieving a 99% success rate with low
complication rates [15].This case underscores the need for continuous
follow-up in patients with permanent IVC filters to effectively prevent
and manage late complications. Delayed removal increases the risks of DVT,
filter migration, and thrombus formation, emphasizing the importance of
timely filter retrieval and individualized patient management strategies
[16-19]. CONCLUSION(S): This case underscores the importance of
recognizing late complications of permanent IVC filters, particularly
penetration into adjacent organs. Early diagnosis and timely intervention
are critical to preventing severe outcomes. Clinicians should remain
vigilant in monitoring patients with long-term IVC filters for delayed
complications and ensure appropriate follow-up and management. REFERENCE
#1: 1. Greenfield, L. J., & Proctor, M. C. (1995). Twenty-year clinical
experience with the Greenfield filter. Cardiovascular Surgery, 3(2),
199-205. https://doi.org/10.1016/0967-2109(95)90895-c2. Angel, L. F.,
Tapson, V. F., Galgon, R. E., Restrepo, M. I., & Kaufman, J. A. (2011).
Systematic review of the use of retrievable inferior vena cava filters.
Journal of Vascular and Interventional Radiology, 22(11), 1522-1530.e3.
https://doi.org/10.1016/j.jvir.2011.08.0243. Jia, Z., Wu, A., Tam, M., et
al. (2015). Caval penetration by inferior vena cava filters. Circulation,
132(10), 944-952. https://doi.org/10.1161/circulationaha.115.0164684.
Kinney, T. B. (2003). Update on inferior vena cava filters. Journal of
Vascular and Interventional Radiology, 14(4), 425-440.
https://doi.org/10.1097/01.rvi.0000064860.87207.775. Desai, T. R., Morcos,
O., Lind, B., et al. (2014). Complications of indwelling retrievable
versus permanent inferior vena cava filters. Journal of Vascular Surgery:
Venous and Lymphatic Disorders, 2(2), 166-173.
https://doi.org/10.1016/j.jvsv.2013.10.0506. Salameh, H., Sharif, R.,
Larson, S., & Parupudi, S. (2013). Duodenal perforation, vertebral body
perforation, and aortic abutment after placement of retrievable inferior
vena caval filter. Endoscopy, 45, E278-E279.
https://doi.org/10.1055/s-0033-13443237. Abosheaishaa, H., Saha, U.,
Abdelhalim, O., et al. (2023). Upper gastrointestinal bleeding secondary
to duodenal wall perforation by inferior vena cava filter: A rare clinical
presentation. Cureus, 15. https://doi.org/10.7759/cureus.484488. Jehangir,
A., Rettew, A., Shaikh, B., et al. (2015). IVC filter perforation through
the duodenum found after years of abdominal pain. The American Journal of
Case Reports, 16, 292-295. https://doi.org/10.12659/AJCR.893541 REFERENCE
#2: 9. Malgor, R., & Labropoulos, N. (2012). A systematic review of
symptomatic duodenal perforation by inferior vena cava filters. Journal of
Vascular Surgery, 55(3), 856-861.e3.
https://doi.org/10.1016/j.jvs.2011.09.08210. Hongo, S., et al. (2019). Use
of EGD for foreign body retrieval. Endoscopy International Open, 7(4),
E629-E634. https://doi.org/10.1055/a-0792-000211. Chassin-Trubert, L.,
Prouse, G., Ozdemir, B., et al. (2019). Filter-associated inferior vena
cava thrombosis with duodenal perforation: Case report and literature
review. Annals of Vascular Surgery, 58, 383.e1-383.e6.
https://doi.org/10.1016/j.avsg.2018.11.021 REFERENCE #3: 12.
Fernandez-Moure, J. S., et al. (2017). Management strategies for IVC
filters. Vascular Medicine, 22(1), 63-72.
https://doi.org/10.1177/1358863x1666383613. Kuo, W. T., et al. (2020).
Excimer laser-assisted IVC filter retrieval. Journal of Vascular and
Interventional Radiology, 31(10), 1648-1655.
https://doi.org/10.1016/j.jvir.2020.06.01914. Jaberi, A., et al. (2019).
Trauma severity and filter complications. Journal of Trauma and Acute Care
Surgery, 87(5), 1230-1237. https://doi.org/10.1097/ta.000000000000244515.
Hicks, J., et al. (2022). Retrieval techniques for IVC filters. Seminars
in Vascular Surgery, 35(4), 231-242.
https://doi.org/10.1053/j.semvascsurg.2022.09.00516. Brunton, C., et al.
(2023). Timely removal of IVC filters. Vascular Medicine, 28(1), 85-92.
https://doi.org/10.1177/1358863x2311629317. Miyahara, T., et al. (2006).
Long-term outcomes after IVC filter removal. Journal of Vascular Surgery,
43(6), 1252-1260. https://doi.org/10.1016/j.jvs.2006.02.03218. Feezor, R.
J., Huber, T. S., Welborn, M., & Schell, S. R. (2002). Duodenal
perforation with an inferior vena cava filter: An unusual cause of
abdominal pain. Journal of Vascular Surgery, 35(5), 1-3.
https://doi.org/10.1067/mva.2002.12156719. Malgor, R., Hines, G., Terrana,
L., & Labropoulos, N. (2011). Persistent Abdominal Pain Caused by an
Inferior Vena Cava Filter Protruding into the Duodenum and the Aorta.
Journal of Vascular Surgery, 54, 925-926.
https://doi.org/10.1016/j.jvs.2011.06.071 DISCLOSURES: No relevant
relationships by Anas Abdulkader No relevant relationships by Ghaida
Alanazi No relevant relationships by Ahmed Alghamdi No relevant
relationships by Neeka Farnoudi No relevant relationships by Hashim
Mohamed Siraj Copyright © 2025 American College of Chest
Physicians

<131>
Accession Number
2041861146
Title
A CASE OF MASSIVE PULMONARY ARTERY ANEURYSM SECONDARY TO ATRIAL SEPTAL
DEFECT, HEADED FOR A BILATERAL LUNG TRANSPLANT.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A6757-A6758),
2025. Date of Publication: 01 Oct 2025.
Author
M V.N.; Sharma H.; Sury M.; Kubbara A.A.H.D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Under Pressure: Unique Cases in Pulmonary Vascular Medicine
SESSION TYPE: Case Reports PRESENTED ON: 10/21/2025 09:15 am - 10:15 am
INTRODUCTION: Pulmonary artery aneurysm (PAA) is a rare phenomenon (1 in
14,000), defined as a main pulmonary artery diameter greater than 40mm.
PAAs can be congenital, acquired, or idiopathic. Congenital PAAs are due
to increased pulmonary blood-flow via left-to-right shunts (PDAs, VSDs,
ASDs). Acquired PAAs are mostly due to pulmonary hypertension (PH) from
various causes, and autoimmune diseases, like Behcet's.[1,2] CASE
PRESENTATION: A 49-year-old woman presented with dyspnea. She had a
history of long-standing PH, PAA, chronic heart failure with preserved
ejection fraction(HFpEF), COPD, type-2-diabetes, hypertension. She also
had a secundum ASD repaired 15 years back during which PAA of 4.1cm
diameter was found. However, there was no evidence of PH at that time.
Seven years ago, she was diagnosed with PH by echocardiography, later
confirmed with right heart catheterization (RHC)(mPAP=32mmHg). On serial
imaging, the PAA was found enlarging(7.5 cm until 15 months ago). On
examining the patient, diffuse crackles were auscultated bilaterally. JVD
and bilateral lower limb pitting edema were present. A CXR revealed
diffusely increased interstitial lung markings, and massive dilatation of
pulmonary arteries, obscuring cardiac silhouette. CT-PA showed a PAA(8.5
cm), no emboli and moderate right ventricular/atrial dilatation. The PAA
was compressing the left lung and bronchus. Echocardiography revealed
normal LVEF of 60-65%, and dilated RV with systolic dysfunction.The
patient was diagnosed with acute decompensated HFpEF and treated with
furosemide. Due to the rapid growth of PAA over the last year, she was
considered for surgical management. Primary repair was not feasible due to
extensive involvement of the main pulmonary artery and its branches, hence
bilateral lung transplant(BLT) evaluation became the next step. RHC showed
interval worsening of PH(mPAP=42mmHg). Coronary angiogram revealed 75%
stenosis of proximal LAD. PFTs revealed both restrictive/obstructive
patterns. She was previously untreated for PH and newly started on
Tadalafil at discharge. She is currently in the process of planning for
PCI/stenting and DAPT to optimize her for BLT. Subsequently, she would be
listed for transplant. DISCUSSION(S): PAAs are mostly asymptomatic
and are incidentally detected while imaging for other conditions. When
advanced, PAAs may lead to complications presenting with dyspnea, angina,
dysphonia, or hemoptysis due to rupture.[1, 2] In our patient, the rapid
growth of the PAA in the last year (0.8 cm/year), was likely due to the
untreated PH. Large PAAs can cause complications due to mass effects-
airway obstruction, restrictive lung disease, and coronary artery
compression.[1, 2]. In our case, the patient has both
obstructive/restrictive lung disease based on PFTs, due to the 8.5cm PAA
compressing the left lung/bronchus. PAAs are considered high-risk when
they expand rapidly(> 2mm/year), diameter>75mm, are associated with PH, or
are due to infection.[3] Management of PAAs includes treating the cause
and medically managing PH. Surgical treatment includes procedures like
aneurysmectomy, lobectomy, which have high morbidity/mortality.
Endovascular techniques involve coil embolization, stent grafting.[1,4]
Lung transplantation(LT) or heart-lung en-bloc transplantation(HLT) is
suitable for giant PAAs involving main/branch pulmonary arteries.[5-7]
 CONCLUSION(S): In this rare case, we describe a massive congenital
PAA secondary to ASD, complicated by HFpEF, and requiring bilateral lung
transplantation (BLT). REFERENCE #1: 1. Gupta, M., Agrawal, A., Iakovou,
A., Cohen, S., Shah, R., & Talwar, A. (2020). Pulmonary artery aneurysm: a
review. Pulmonary Circulation, 10(1), 1-10.
https://doi.org/10.1177/2045894020908780 2. Bu, C., Zhang, M., Sun, Q.,
Zhang, H., Luo, J., Liu, Q., Sun, Z., & Li, Y. (2024). Pulmonary artery
aneurysm: computed tomography (CT) imaging findings and diagnosis.
Quantitative Imaging in Medicine and Surgery, 14(8), 6147-6160.
https://doi.org/10.21037/QIMS-24-462/COIF REFERENCE #2: 3. Duijnhouwer, A.
L., Navarese, E. P., van Dijk, A. P. J., Loeys, B., Roos-Hesselink, J. W.,
& de Boer, M. J. (2016). Aneurysm of the Pulmonary Artery, a Systematic
Review and Critical Analysis of Current Literature. Congenital Heart
Disease, 11(2), 102-109. https://doi.org/10.1111/CHD.12316 4. Samreen, I.,
Darji, P., Genobaga, S., Doosetty, S., Mohta, T., Maity, G., Vue, C.,
Nakka, S., & Umeh, C. (2023). Pulmonary Artery Aneurysm in Behcet Disease:
Medical, Endovascular or Surgical Intervention. Cureus, 15(11), e49368.
https://doi.org/10.7759/CUREUS.49368 REFERENCE #3: 5. Doi, A., Gajera, J.,
Niewodowski, D., Gangahanumaiah, S., Whitford, H., Snell, G., Kaye, D.,
Joseph, T., & McGiffin, D. (2022). Surgical management of giant pulmonary
artery aneurysms in patients with severe pulmonary arterial hypertension.
Journal of Cardiac Surgery, 37(4), 1019-1025.
https://doi.org/10.1111/JOCS.162356. Shayan, H., Sareyyupoglu, B.,
Shigemura, N., Thacker, J., Bermudez, C., & Toyoda, Y. (2012). Lung
transplant, double valve repair, and pulmonary artery aneurysm resection.
Annals of Thoracic Surgery, 93(1), e3-e5.
https://doi.org/10.1016/j.athoracsur.2011.07.0677. Worku, B., Mack, C., &
Gambardella, I. (2022). Bilateral lung transplant for pulmonary
hypertension with pulmonary artery aneurysm. Journal of Cardiac Surgery,
37(4), 1026-1027. https://doi.org/10.1111/JOCS.16233 DISCLOSURES: No
relevant relationships by Aahd Kubbara No relevant relationships by Vivek
Nayak M No relevant relationships by Harsh Sharma No relevant
relationships by Meera Sury Copyright © 2025 American College of
Chest Physicians

<132>
Accession Number
2041861073
Title
WORST SORE THROAT OF MY LIFE: DESCENDING NECROTIZING MEDIASTINITIS FROM A
RETROPHARYNGEAL ABCESS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4115-A4116),
2025. Date of Publication: 01 Oct 2025.
Author
Seeli K.; Zain R.; Oli S.; Alsheimer K.M.; Burgei J.W.; Sewell A.;
Siddiqui F.; Bailey R.S.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Uncommon Presentations of Mediastinal Disease SESSION TYPE:
Rapid Fire Case Reports PRESENTED ON: 10/21/2025 12:30 pm - 01:15 pm
INTRODUCTION: Descending Necrotizing Mediastinitis (DNM) is a
life-threatening complication of Deep Neck Infections (DNI). Its low
incidence confers the risk to delayed diagnosis and management. This is a
case of a retropharyngeal abscess that rapidly progressed to DNM and death
in an immunocompetent adult. Our goal is to increase awareness and
anticipation of DNM that can arise from a pharyngeal infection. CASE
PRESENTATION: A 69-year-old female with history of tobacco use, presented
with a sore throat and odynophagia for 3 days. CT scans of the neck and
chest with contrast revealed a 1 x 3 x 7 cm retropharyngeal abscess and a
3 x 1 cm irregularly shaped right paratracheal mediastinal density
concerning for fat stranding versus localized edema (Figure 1). Flexible
laryngoscopy revealed normal anatomy without any mass, obstruction or
ulceration. She was admitted to the medical floor for intravenous
antibiotics and short-term imaging to monitor the abscess. 12 hours into
the hospitalization, she developed respiratory distress, metabolic
acidosis and livedo reticularis of her lower extremities. She was
intubated by Anesthesia in the OR and transferred to ICU for further care.
CT scan of the neck, chest, abdomen and pelvis with contrast showed rapid
enlargement of the abscess with retropharyngeal mediastinitis and gas
tracking from the 'danger space' to the mediastinum into the left
supraclavicular region (Figures 2 and 3). Surgical course included: 2 neck
debridement and washouts with drains to the neck and mediastinum, repair
of a right pharyngotomy defect and salivary fistula with pectoralis flap
reconstruction, tracheostomy and open gastrostomy tube for feeding.
Medical problems included: Prevotella bacteremia and acute tubular
necrosis requiring renal replacement therapy. She developed worsening
chest and facial subcutaneous emphysema and was found to have two right
mainstem bronchial perforations from the mediastinitis. At this point,
despite all efforts from the treatment teams, the patient continued to
decline. She was transitioned to comfort measures by her family and passed
away. DISCUSSION(S): DNM occurs when head and neck infections descend
rapidly along the fascial planes to the mediastinum. Its incidence from
DNIs is 1.7%-5.4% and is less prevalent in western countries. Mortality
reduced from 40% to 17.5% in the post-antibiotic era according to recent
studies. Risk factors include immunocompromise, diabetes,
corticosteroid-use and reduced tissue oxygenation caused by heart failure,
respiratory insufficiency and peripheral vascular disease. Abscesses are
typically polymicrobial, containing both aerobic and anaerobic bacteria
(Prevotella and B. pyogenes in our patient). CRP and procalcitonin are
significantly elevated and are sensitive predictors of the development of
DNM from DNIs (Brajkovic et al 2021). Contrast-enhanced CT (CECT) or MRI
are the preferred imaging modalities to visualize the extent of
involvement. Antibiotics and surgical debridement are key to achieving
early source control. Various surgical approaches exist, hence early
collaboration with ENT and Thoracic Surgery is warranted. A
multidisciplinary approach between Critical Care, Anesthesia, ENT,
Thoracic Surgery and ID is crucial for optimal management of DNM.
 CONCLUSION(S): DNM has a fulminant course with high mortality.
Evaluate 'danger space' with CT or MRI. Time to diagnosis and
interdisciplinary coordination improve outcomes. REFERENCE #1:
Prado-Calleros HM, Jimenez-Fuentes E, Jimenez-Escobar I. Descending
necrotizing mediastinitis: Systematic review on its treatment in the last
6 years, 75 years after its description. Head Neck. 2016 Apr;38 Suppl
1:E2275-83. doi: 10.1002/hed.24183. Epub 2016 Feb 1. PMID: 26829352.
REFERENCE #2: Pastene B, Cassir N, Tankel J, Einav S, Fournier PE, Thomas
P, Leone M. Mediastinitis in the intensive care unit patient: a narrative
review. Clin Microbiol Infect. 2020 Jan;26(1):26-34. doi:
10.1016/j.cmi.2019.07.005. Epub 2019 Jul 12. PMID: 31306791.Brajkovic D,
Zjalic S, Kiralj A. Prognostic factors for descending necrotizing
mediastinitis development in deep space neck infections-a retrospective
study. Eur Arch Otorhinolaryngol. 2022 May;279(5):2641-2649. doi:
10.1007/s00405-021-07081-0. Epub 2021 Sep 20. PMID: 34542654. REFERENCE
#3: Ho CY, Chin SC, Chen SL. Management of Descending Necrotizing
Mediastinitis, a Severe Complication of Deep Neck Infection, Based on
Multidisciplinary Approaches and Departmental Co-Ordination. Ear Nose
Throat J. 2024 Sep;103(9):572-579. doi: 10.1177/01455613211068575. Epub
2022 Jan 13. PMID: 35023759.Nwia SM, Huebner CD, Nguyen JB. Descending
necrotizing mediastinitis secondary to retropharyngeal abscess. J Radiol
Case Rep. 2023 Aug 31;17(8):21-28. doi: 10.3941/jrcr.v17i8.5095. PMID:
38090639; PMCID: PMC10713229. DISCLOSURES: No relevant relationships by
Katie Alsheimer No relevant relationships by Rebecca Bailey No relevant
relationships by Jonathan Burgei No relevant relationships by Shital Oli
No relevant relationships by Keertana Seeli No relevant relationships by
Andrew Sewell No relevant relationships by Faraz Siddiqui No relevant
relationships by Rahul Zain Copyright © 2025 American College of
Chest Physicians

<133>
Accession Number
2041862135
Title
UNMASKING EFFORT THROMBOSIS: A RARE CASE OF PAGET-SCHROETTER SYNDROME.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A336-A337), 2025.
Date of Publication: 01 Oct 2025.
Author
Faizal F.A.; Chohan M.; Ball S.; Chuadhry I.; Nadeem S.A.N.A.; Siddiqui
A.L.I.; Wang Y.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Life-Threatening Compressions SESSION TYPE: Case Reports
PRESENTED ON: 10/21/2025 09:15 am - 10:15 am INTRODUCTION:
Paget-Schroetter Syndrome (PSS), also known as effort thrombosis, is a
rare presentation of a deep venous thrombosis (DVT) in the
subclavian-axillary vein complex, associated with subclavian compression
at the thoracic outlet. It is typically seen after repetitive, strenuous
upper extremity activities and is more commonly noted in young active
athletes or military personnel, with a male predominance. The primary
complication with PSS is a post-thrombotic syndrome, and therefore prompt
diagnosis and management of this condition is essential. CASE
PRESENTATION: A 34-year-old female with a past medical history of
migraines presented to the emergency department with a chief complaint of
left forearm swelling, ongoing for 1-2 days. The patient also noted the
onset of left forearm discoloration, which began on the morning of the
presentation. She reported having been cleaning her home with a vacuum
cleaner, during which she experienced some shoulder pain. However, she
denied any direct trauma to the affected area. The patient denied any
other associated symptoms, did not have any loss of sensation and
neurological deficits. Upon initial evaluation, the Laboratory workup was
largely unremarkable. Troponin and Creatinine Kinase were negative.
Further screening for lupus anticoagulant and a thrombophilia workup were
both negative. Ultrasound of the Left Upper Extremity (LUE) showed acute
DVT in the left subclavian, axillary, and brachial veins and acute venous
thrombosis in the left basilic vein. CTA chest pulmonary angiography
showed a filling defect in the Right Lower Lobe sub-segmental pulmonary
artery. The patient was initiated on a heparin drip. The next day, she
underwent an interventional radiology (IR)-guided mechanical thrombectomy
of the left subclavian, axillary, and brachial veins. She also underwent
angioplasty of the left subclavian artery stenosis. Post-angioplasty
imaging demonstrated worsening of stenosis when the LUE was in the
abduction position. The patient's findings and clinical presentation were
suggestive of effort-induced thrombosis known as Paget- Schroetter
syndrome. Patient was seen by the surgical team and was referred to
vascular and thoracic surgery for outpatient follow up.
 DISCUSSION(S): While anticoagulation is the first mainstay treatment,
thoracic outlet decompression is the definitive management for PSS. The
patient eventually underwent first rib resection on the left, with a
resection of the anterior scalene and subclavius muscle, as well as a
sublcavian venoplasty. She was discharged with Eliquis initially but now
is maintained on aspirin only. CONCLUSION(S): This case highlights a
rare but critical cause of upper extremity thrombosis, Paget-Schroetter
syndrome. Prompt diagnosis is essential especially when presenting in a
patient population without commonly recognized pro-thrombotic risk factors
as seen in this patient. Delayed treatment can lead to an increased risk
of recurrent thrombosis with worse functional outcomes. REFERENCE #1:
Paget-Schroetter Syndrome in Athletes: A Comprehensive and Systematic
Review.Keller RE, Croswell DP, Medina GIS, Cheng TTW, Oh LS.Journal of
Shoulder and Elbow Surgery. 2020;29(11):2417-2425.
doi:10.1016/j.jse.2020.05.015. DISCLOSURES: No relevant relationships by
Sandra Ball No relevant relationships by Mujtaba Chohan No relevant
relationships by Ikhtesham Chuadhry No relevant relationships by F.Amaani
Faizal No relevant relationships by Sana Nadeem No relevant relationships
by Ali Siddiqui No relevant relationships by Yvette Wang Copyright
© 2025 American College of Chest Physicians

<134>
Accession Number
2041862894
Title
ECHOING CLUES: THE SUBTLE DIAGNOSTIC FINDINGS OF CONSTRICTIVE
PERICARDITIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A755-A756), 2025.
Date of Publication: 01 Oct 2025.
Author
Purzycki T.; Katz M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: When the Unthinkable Strikes: Atypical and High-Risk
Cardiac Emergencies SESSION TYPE: Rapid Fire Case Reports PRESENTED ON:
10/20/2025 02:35 pm - 03:05 pm INTRODUCTION: Constrictive pericarditis is
a condition where the pericardium of the heart loses elasticity, resulting
in pericardial non-compliance. Effusive constrictive pericarditis is a
type of constrictive pericarditis that involves fluid accumulation within
the pericardial space. Etiologies of constrictive pericarditis include
post-viral, tuberculosis, post-surgical, radiation-induced, idiopathic
causes, among others. [1]. Symptoms typically mimic heart failure, making
an echocardiogram a common diagnostic tool. In the absence of increased
pericardial thickness, other echocardiographic findings can suggest the
diagnosis. CASE PRESENTATION: A 60-year-old woman with a recurrence of
breast cancer, previously treated with chemoradiation, presented with a
two-week history of worsening shortness of breath. She denied chest pain,
fever, cough, paroxysmal dyspnea, orthopnea, and edema. Vital signs were
stable and physical examination revealed decreased breath sounds. CT chest
showed bilateral pleural effusions and a pericardial effusion.
Echocardiogram confirmed pericardial effusion without tamponade.
Thoracentesis revealed an exudative effusion. Due to enlargement of
effusions, a diagnostic VATS, pericardial window, and pleurectomy were
performed. Pathology was negative for malignancy. During the
post-operative course, the patient had continued shortness of breath. A
closer look at the echocardiogram indicated signs of pericardial
constriction. There was a noticeable septal bounce and a shift of the
interventricular septum with inspiration, as well as diastolic reversals
in the hepatic vein doppler with expiration. CRP and ESR were elevated at
27.7 and 129, respectively. Heart catheterization showed normal right
atrial pressures (5 mmHg) with prominent 'x' and 'y' descent. Right atrial
pressures rose with inspiration (+Kussmaul's sign), and simultaneous
LV-PCWP pressures demonstrated thoracic ventricular dissociation. RV/LV
pressure measurements demonstrated equalization of diastolic pressures
with LV-RV discordance. She was started on Prednisone and Colchicine, with
improvement of her dyspnea. A repeat echocardiogram showed no signs of
constriction. DISCUSSION(S): There is no single echocardiographic
finding for constrictive pericarditis. Per the Mayo Clinic criteria,
respiration-related ventricular septal shift, preserved or increased
medial mitral annular e' velocity, and prominent hepatic vein expiratory
diastolic flow reversals are independently associated with constrictive
pericarditis [2]. In this case, the patient had septal shift and hepatic
vein expiratory diastolic flow reversal. Medial mitral annular e' velocity
was not assessed. Although echocardiogram is the initial test for
constrictive pericarditis, advancements in multimodality imaging, such as
CT and cardiac MRI, have improved diagnosis. CT can show pericardial
calcification, indicating chronic inflammation, while cardiac MRI better
characterizes acute and chronic inflammation, helping to guide treatment
and identify potential autoimmune causes [3]. In this case, cardiac MRI
was unavailable. The absence of pericardial calcification on CT suggests
acute constrictive pericarditis, supported by elevated ESR and CRP levels
in our patient [4]. Acute constrictive pericarditis may be treated with
medical therapy, although there are no randomized controlled studies on
anti-inflammatory agents for this condition [5]. CONCLUSION(S): This
patient, recently diagnosed with breast cancer recurrence, presented with
effusions. Therefore, malignant effusion became the top differential and
constrictive pericarditis was overlooked. It is important to consider
constrictive pericarditis in patients with shortness of breath. A closer
look at the echocardiogram might reveal subtle signs of constriction.
REFERENCE #1: 1. Yacoub M, Quintanilla Rodriguez BS, Mahajan K.
Constrictive-Effusive Pericarditis. [Updated 2023 Jul 24]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK519579/ REFERENCE
#2: 2. Welch TD, Ling LH, Espinosa RE, Anavekar NS, Wiste HJ, Lahr BD,
Schaff HV, Oh JK. Echocardiographic diagnosis of constrictive
pericarditis: Mayo Clinic criteria. Circ Cardiovasc Imaging. 2014
May;7(3):526-34. doi: 10.1161/CIRCIMAGING.113.001613. Epub 2014 Mar 14.
PMID: 24633783. REFERENCE #3: 3.
Kafil,T.S.,Wang,T.K.M.,Agrawal,A.,Majid,M.,Syed,A.B.,Hutt,E.,Klein, A. L.
(2023). Advances in multi-modality imaging for constrictive pericarditis
and pericardial inflammation: role of imaging-guided therapy. Expert
Review of Cardiovascular Therapy, 21(4), 269-279.
https://doi.org/10.1080/14779072.2023.2187377 4.
ChangSA,OhJK.ConstrictivePericarditis:AMedicalorSurgicalDisease?J
Cardiovasc Imaging. 2019 Jul;27(3):178-186. doi: 10.4250/jcvi.2019.27.e28.
Epub 2019 Apr 30. PMID: 31161752; PMCID: PMC6669181. 5. Haley JH, Tajik
AJ, Danielson GK, Schaff HV, Mulvagh SL, Oh JK. Transient constrictive
pericarditis: causes and natural history. J Am Coll Cardiol. 2004 Jan
21;43(2):271-5. doi: 10.1016/j.jacc.2003.08.032. PMID: 14736448.
DISCLOSURES: No relevant relationships by Matthew Katz No relevant
relationships by Taylor Purzycki Copyright © 2025 American
College of Chest Physicians

<135>
Accession Number
2041863679
Title
FRAILTY AS AN INDEPENDENT RISK FACTOR FOR MORTALITY AFTER HEART
TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A7165), 2025.
Date of Publication: 01 Oct 2025.
Author
Singh A.; Jena A.N.E.K.; Phadke R.; Surana A.; Bhattacharya R.I.Y.A.;
Martin K.B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Transplantation Scientific Abstract Posters (A) SESSION
TYPE: Original Investigation Posters PRESENTED ON: 10/22/2025 10:20 am -
11:05 am PURPOSE: Frailty is an important consideration among heart
transplant recipients and is known to be associated with significant
post-transplant mortality. However, its independent effect on survival
after heart transplantation remains unclear. This systematic review and
meta-analysis aim to evaluate frailty as an independent risk factor for
mortality in heart transplant recipients. METHOD(S): A systematic
review was conducted for relevant studies published until December 31,
2024, using PubMed, Embase, and Cochrane Library databases. The study
followed PRISMA guidelines, utilizing a random-effects model with the
inverse variance method to calculate the hazard ratio (HR) for mortality
in frail versus non-frail heart transplant recipients. The overall HR and
heterogeneity among studies were assessed. RESULT(S): Six studies
comprising 20,987 heart transplant recipients, met the inclusion criteria.
The meta-analysis revealed a significant association between frailty and
mortality after heart transplantation. Significant heterogeneity was
observed (p<0.01), with an I2 value of 79%, indicating substantial
variability among the studies. After the results were adjusted for age and
sex, the summarized hazard rate (HR) for frail recipients was 1.74 (95%
CI: 1.32-2.29), indicating a 74% increased risk of mortality in frail
individuals compared to non-frail individuals. The test for overall effect
was significant (p<0.05). CONCLUSION(S): Frailty is an independent
predictor of mortality following heart transplantation. Our study
demonstrates that heart transplant candidates classified as frail
exhibited a 74% higher risk of mortality compared to their non-frail
counterparts. These findings highlight the need for routine frailty
assessments in transplant candidates and emphasize the need for
integrating frailty measures into risk stratification models to optimize
clinical decision-making. CLINICAL IMPLICATIONS: Frailty assessment should
be an integral part of the pre-transplant evaluation process to identify
high-risk candidates and implement targeted interventions. Evidence
suggests that frailty is linked with poor post-transplant outcomes likely
due to impaired physiological reserve, increased susceptibility to
infections, prolonged hospital stays, and higher rates of graft failure.
Routine frailty evaluation can help optimize patient selection and improve
post-transplant care. Emerging data suggest that frailty is modifiable and
given the significant association between frailty and mortality, a
multidisciplinary approach incorporating rehabilitation programs,
nutritional optimization, and early mobilization strategies should be
considered for frail patients to improve post-transplant outcomes. Current
frailty measures vary across studies, ranging from physical performance
tests to composite scoring systems. Future research should focus on
refining frailty assessment methodologies and determining the most
effective interventions to improve it. DISCLOSURES: No relevant
relationships by Riya Bhattacharya No relevant relationships by Anek Jena
No disclosure submitted for Kevin Martin No relevant relationships by
Rachana Phadke No relevant relationships by Aditya Singh No relevant
relationships by Arihant Surana Copyright © 2025 American College
of Chest Physicians

<136>
Accession Number
2041863269
Title
COMPARING OUTCOMES OF LV UNLOADING STRATEGIES IN PATIENTS ON VENO-ARTERIAL
ECMO FOR CARDIOGENIC SHOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A526-A527), 2025.
Date of Publication: 01 Oct 2025.
Author
Ganesan A.V.; Fernandes W.; Fernandes B.; Agrawal A.; Panchal V.;
Pugazhendi I.; Mirza N.; Nookala V.; Elfandi A.L.I.; Suleiman A.D.D.I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Heart in Shock SESSION TYPE: Rapid Fire Original Inv
PRESENTED ON: 10/20/2025 10:20 am - 10:50 am PURPOSE: Temporary mechanical
circulatory support (MCS) devices such as the Impella and intra-aortic
balloon pump (IABP) have been widely adopted to counteract increased left
ventricular (LV) afterload in cardiogenic shock (CS) patients on
veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, data
comparing their effectiveness for LV unloading (LVU) is limited. This
meta-analysis evaluates the clinical outcomes of ECPELLA (Impella +
VA-ECMO) versus IABP + VA-ECMO in this setting. METHOD(S): A
systematic search of PubMed, EMBASE, and the Cochrane Library was
conducted for studies published between 2015 and 2025 comparing ECPELLA
and IABP + VA-ECMO in CS patients. Extracted data included baseline
characteristics, CS etiology, MCS duration, in-hospital mortality, and
complications. The Mantel-Haenszel method was used to compute pooled risk
ratios (RR) with 95% confidence intervals (CI). Open Meta-Analyst software
was used for statistical analysis, with a significance set at p<0.05.
 RESULT(S): Nine retrospective studies, including 8,538 patients, were
analyzed. ECPELLA was more frequently used in acute myocardial infarction
(AMI) cardiogenic shock (RR 1.33, 95% CI 1.032-1.724, p=0.002) and heart
failure-CS (RR 1.116, 95% CI 0.699-1.782, p<0.001), whereas
post-cardiotomy CS was associated with lower ECPELLA use (RR 0.072, 95% CI
0.019-0.267, p=0.833). Other etiologies, including arrhythmias and
myocarditis, showed no significant differences between groups. ECPELLA
patients had higher odds of ECMO weaning (RR 1.690, 95% CI 0.992-2.878,
p=0.111), but in-hospital mortality was also increased (RR 1.259, 95% CI
1.028-1.540, p=0.049). The 30-day survival rate was similar between groups
(OR 1.472, 95% CI 0.753-2.880, p=0.494). ECPELLA was associated with a
higher risk of major bleeding (RR 2.243, 95% CI 1.363-3.693, p<0.001),
acute kidney injury requiring hemodialysis (RR 1.296, 95% CI 0.983-1.709,
p=0.003), and hemolysis (RR 2.423, 95% CI 0.703-8.347, p=0.001). Risks of
ischemic stroke (RR 0.996, p=0.256) and infection/sepsis (RR 1.166,
p=0.569) were similar between groups. No significant differences were
observed in recovery with bridging to left ventricular assist device
(LVAD) (RR 0.811, p=0.248) or heart transplantation (RR 0.301, p=0.745).
 CONCLUSION(S): ECPELLA provides more effective LVU and higher ECMO
weaning rates than IABP but is associated with increased risks of
mortality, bleeding, and hemolysis. Device selection should align with CS
etiology-Impella preferred for AMI-CS, IABP for post-cardiotomy CS. Given
the observational nature of current data, prospective trials are needed to
define optimal LVU strategies. Until then, individualized risk-benefit
assessments considering hemodynamic severity, bleeding risk, and
institutional expertise should guide clinical decision-making. CLINICAL
IMPLICATIONS: MCS plays a critical role in managing CS patients on
VA-ECMO, but the optimal LVU strategy remains unclear. This meta-analysis
suggests ECPELLA improves ECMO weaning but is associated with higher risks
of adverse events compared to IABP-ECMO. These findings underscore the
need for prospective trials to refine LVU strategies and guide
evidence-based, individualized patient management. DISCLOSURES: No
relevant relationships by Ashita Agrawal No relevant relationships by Ali
Elfandi No relevant relationships by Bolivia Fernandes No relevant
relationships by Warren Fernandes No relevant relationships by Noreen
Mirza No relevant relationships by VINOD NOOKALA No relevant relationships
by Viraj Panchal No relevant relationships by Inban Pugazhendi No relevant
relationships by Addi Suleiman No relevant relationships by Ajitha
Virinchipuram Ganesan Copyright © 2025 American College of Chest
Physicians

<137>
Accession Number
2041686929
Title
Midterm Outcomes of the Self-Expanding Navitor Transcatheter Heart Valve:
A Systematic Review and Meta-Analysis.
Source
Structural Heart. 10(1) (no pagination), 2026. Article Number: 100750.
Date of Publication: 01 Jan 2026.
Author
Samimi S.; Kharsa C.; Kritya M.; Aoun J.; Zaid S.; Faza N.N.; Little S.H.;
Kleiman N.S.; Reardon M.J.; Goel S.S.
Institution
(Samimi, Zaid) Department of Cardiology, Baylor College of Medicine,
Houston, TX, United States
(Kharsa, Kritya, Aoun, Faza, Little, Kleiman, Goel) Department of
Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Reardon) Department of Cardiovascular Surgery, Houston Methodist
Hospital, Houston, TX, United States
Publisher
Cardiovascular Research Foundation

<138>
Accession Number
2041861075
Title
A RARE CASE OF INCIDENTAL JUXTAPLEURAL LUNG NODULE DIAGNOSED AS METASTATIC
UTERINE TUMOR RESEMBLING OVARIAN SEX CORD TUMOR.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4425-A4426),
2025. Date of Publication: 01 Oct 2025.
Author
Dollin Y.; Bylund D.; Munoz J.; Miller R.J.; Patel N.M.; Cheng G.Z.;
Nostrand K.V.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Report Posters (E) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Juxtapleural nodules are defined as nodules outside the lung
parenchyma that are attached to the pleural surface with different
possible locations such as: peri-fissural, costal pleural,
peri-mediastinal, and peri-diaphragmatic (1). While most juxtapleural
nodules are benign, there are a small number that are malignant and should
not be missed (2). We present an uncommon case of a rare Uterine Tumor
Resembling Ovarian Sex Cord Tumor (UTROSCT) in a juxapleural location.
CASE PRESENTATION: 52-year-old woman with a past medical history of remote
smoking and uterine fibroids who underwent total abdominal hysterectomy
(TAH) in May 2022. Pathology from that procedure diagnosed benign fibroid
tumor. She subsequently underwent a follow up CT abdomen and pelvis after
the surgery and an incidental 1.4cm juxtapleural nodule was found in the
left lower lobe (LLL) of the lung. In December of 2023, she was referred
to interventional pulmonology (IP) for bronchoscopic biopsy of the nodule
after it grew to 2.4cm on interval surveillance CT chest but instead
patient was sent to multi-disciplinary meeting (tumor board). It was
decided to refer the patient to cardiothoracic surgery who performed a
robotic left lower lobectomy with complete resection of the nodule.
Pathology revealed juxtapleural circumscribed tumor composed of cords of
monotonous epithelioid cells set in a fibrotic and focally myxoid stroma.
Immunohistochemical staining of the wedge resection showed the tumor to be
positive for ER, CD56, CD99, inhibin, and TFE3. The final diagnosis was
UTROSCT with negative margins and lymph nodes, and after subjecting the
previous pathology from the TAH to the same testing, the diagnosis was
confirmed on that tissue as well. To date, surveillance chest CT scans
have showed no evidence of recurrence. DISCUSSION(S): Uterine Tumor
Resembling Ovarian Sex Cord Tumor are rare neoplasms with only 150 cases
reported in the literature to date and only 10 patients (6.8%) of these
were metastatic at time of diagnosis (2). Of the ten patients, metastases
were found in the lymph nodes, appendix, omentum, ovary, peritoneum,
sigmoid colon, sacrum, and parametrium, however; none were found in the
pleura(2). Juxtapleural nodules are also rare (10.6% in one study, N=8730)
(1). Of those juxtapleural nodules only 1% were malignant. The 2017
Fleischner guidelines characterize high risk features of juxtapleural
nodules as large (greater than 10mm), spiculated border, displacement of
adjacent fissure, and in patients with a previous history of cancer (3).
The recommendation is close interval CT follow up 6-12 months (3). Our
case is an example of a rare presentation of a rare tumor that rarely
metastasizes and illustrates the importance of both screening for and
diagnosing high risk juxtapleural nodules. CONCLUSION(S): We present
a rare case of juxtapleural nodule that was difficult to diagnose and yet
found to be malignant. Juxtapleural nodules are rare and usually benign,
however; high risk nodules should be taken seriously and should follow
proper screening guidelines so that malignancies are not missed. REFERENCE
#1: Zhu, Y., Yip, R., You, N., Henschke, C. I., & Yankelevitz, D. F.
(2020). Management of nodules attached to the costal pleura at low-dose CT
screening for lung cancer. Radiology, 297(3), 710-718. REFERENCE #2:
Shibahara, M., Kurita, T., Harada, H., Tsuda, Y., Hisaoka, M., & Yoshino,
K. (2024). Therapeutic management of uterine tumours resembling ovarian
sex cord tumours including a focus on fertility: A systematic review.
European Journal of Obstetrics & Gynecology and Reproductive Biology.
REFERENCE #3: MacMahon, H., Naidich, D. P., Goo, J. M., Lee, K. S., Leung,
A. N., Mayo, J. R., & Bankier, A. A. (2017). Guidelines for management of
incidental pulmonary nodules detected on CT images: from the Fleischner
Society 2017. Radiology, 284(1), 228-243. DISCLOSURES: No relevant
relationships by David Bylund No relevant relationships by George Cheng,
value=Grant/Research Support Removed 12/04/2024 by George Cheng,
source=Web Response No relevant relationships by George Cheng,
value=Consulting fee Removed 12/04/2024 by George Cheng, source=Web
Response No relevant relationships by George Cheng, value=Consulting
Removed 12/04/2024 by George Cheng, source=Web Response No relevant
relationships by George Cheng, value=Ownership interest Removed 12/04/2024
by George Cheng, source=Web Response No relevant relationships by George
Cheng, value=Grant/Research Support Removed 12/04/2024 by George Cheng,
source=Web Response No relevant relationships by George Cheng,
value=Consulting fee Removed 12/04/2024 by George Cheng, source=Web
Response No relevant relationships by George Cheng, value=Honoraria
Removed 12/04/2024 by George Cheng, source=Web Response No relevant
relationships by George Cheng, value=Honoraria Removed 12/04/2024 by
George Cheng, source=Web Response No relevant relationships by Yonatan
Dollin No relevant relationships by Russell Miller Researcher relationship
with Ruby Robotics Please note: July 2024 - present Added 02/28/2025 by
Jorge Munoz, source=Web Response, value=Research Funding Consultant
relationship with Olympus Please note: 2022 to present Added 02/28/2025 by
Niral Patel, source=Web Response, value=Consulting fee Consultant
relationship with Intuitive Please note: 2022 to present Added 02/28/2025
by Niral Patel, source=Web Response, value=Consulting fee Consultant
relationship with Biodesix Please note: 2024 to present Added 02/27/2025
by Niral Patel, source=Web Response, value=Consulting fee Consultant
relationship with Biodesix Please note: 2024-Present Added 12/08/2024 by
Niral Patel, source=Web Response, value=Consulting fee Consultant
relationship with Intuitive Surgical Please note: 2022 to present by Niral
Patel, value=Consulting fee No relevant relationships by Keriann Van
Nostrand Copyright © 2025 American College of Chest Physicians

<139>
Accession Number
2041861110
Title
HIDDEN ENEMY, DIRE CONSEQUENCES: THE ROLE OF CYTOMEGALOVIRUS (CMV) IN
CRITICAL CARE.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A3322-A3323),
2025. Date of Publication: 01 Oct 2025.
Author
Velasquez A.C.; Hameed A.; Dinh M.; Chandy E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (AF) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am INTRODUCTION:
CMV is a dangerous pathogen in critical care settings. Our case in a
healthy 33-year-old female following cosmetic surgery complications
demonstrates how surgical trauma and immune compromise can lead to
infections. After ICU treatment, antiviral therapy successfully resolved
the infection. This case emphasizes the importance of considering CMV, as
30% of critical care patients may experience viral reactivation without
prior immune issues. CASE PRESENTATION: A 33-year-old African American
female without medical history presented 2 weeks after liposuction and
gluteal fat auto-transplantation in Turkey. After her initial surgery, she
awoke days later to find she had a colostomy and JP drain, required blood
transfusions. Later, she flew back to America, arriving in an acutely
decompensated state with severe abdominal pain, fever, and shallow
respirations. She was immediately intubated, admitted to the ICU with
septic shock. CT abdomen showed significant pus drainage requiring
surgery. Though family initially refused exploratory laparotomy, surgery
revealed large collections of frank pus in the right lower quadrant,
paracolic gutter, and spleen with diffuse pus throughout the pelvis and
abdomen. Primary closure was delayed due to wound separation risk, and
necrotic breast tissue was found, being management with abdominal and
breast wound vacuums, mesh closure, broad-spectrum antibiotics, and pain
control.After 15 days of hospitalization and three laparotomies, the wound
stopped draining pus. She showed clinical improvement with normalized
vital signs and laboratory. However, after 10 days, she developed fever
and neutropenia, as only abnormal laboratory, despite extensive
workup-including HIV testing, ANA, gram stain and culture, viral cultures,
and fungal stains. Oncology consultation with bone marrow biopsy revealed
CMV. She was treated with IV ganciclovir, achieved complete recovery from
disseminated CMV. DISCUSSION(S): Several factors contributed to the
CMV infection. The patient experienced acute and severe decompensation,
followed by febrile neutropenia of unknown origin. The inadequate
postoperative care after major cosmetic surgeries led to severe outcomes.
The patient's weakened immune system after surgery made her vulnerable to
CMV infection, which was further complicated by systemic infection.Many
patients with previous CMV infections are unaware of their condition, and
standard diagnostic methods can miss cases. PCR testing, the preferred
initial diagnostic tool for CMV, offering high sensitivity and minimal
invasiveness, though it may detect clinically insignificant latent virus
due to lower specificity. Bone marrow biopsy, while more invasive, remains
the gold standard for definitive diagnosis-particularly when other tests
are inconclusive-as it provides the highest specificity and allows direct
visualization of viral inclusions and bone marrow involvement. Recent
studies suggest antiviral prophylaxis may prevent CMV reactivation,
emphasizing the proactive care in high-risk patients. In our case, we
observed that adding antiviral treatment led to rapid improvement and
sustained recovery that broad-spectrum antibiotic therapy alone had not
achieved. CONCLUSION(S): This case demonstrates the link between
major surgeries and immune function, showing how postoperative
complications can severely compromise immunity.Early detection through
improved awareness and diagnostics can reduce mortality rates.CMV
management in critical care requires vigilant monitoring and proactive
treatment. With 30% of critically ill patients at risk of CMV
reactivation, early detection is vital. REFERENCE #1: 1. Limaye, A. P., &
Boeckh, M. (2010). CMV in critically ill patients: pathogen or bystander?
Reviews in Medical Virology, 20(6), 372-379.
https://doi.org/10.1002/RMV.6642. Perez, H. R., Kregor, A. C., Rizvi, T.
Z., & Olson, G. (2022). 1208: cmv viremia leading to multiorgan failure: a
confounded diagnosis not to be missed. Critical Care Medicine, 51(1), 602.
https://doi.org/10.1097/01.ccm.0000910568.93437.0e3. Al-Omari, A.,
Aljamaan, F., Alhazzani, W., Salih, S., & Arabi, Y. M. (2016).
Cytomegalovirus infection in immunocompetent critically ill adults:
literature review. Annals of Intensive Care, 6(1), 110.
https://doi.org/10.1186/S13613-016-0207-84. Schinas, G., Polyzou, E.,
Almyroudi, M.-P., Dimopoulos, G., & Akinosoglou, K. (2023). Targeting CMV
Reactivation to Optimize Care for Critically Ill COVID-19 Patients: A
Review on the Therapeutic Potential of Antiviral Treatment. Viruses,
15(5), 1165. https://doi.org/10.3390/v15051165 REFERENCE #2: 5. Gupta M,
Shorman M. Cytomegalovirus. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2022 [cited 2022 Aug 24]. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK459185/6. Yong MK, Slavin MA,
Kontoyiannis DP. Invasive fungal disease and cytomegalovirus infection: is
there an association? Current Opinion in Infectious Diseases. 2018
Dec;31(6):481-9.7. Chow JKL, Ruthazer R, Boucher HW, Vest AR, DeNofrio DM,
Snydman DR. Factors associated with neutropenia post heart
transplantation. Transpl Infect Dis [Internet]. 2021 Aug [cited 2022 Aug
24];23(4). Available from:
https://onlinelibrary.wiley.com/doi/10.1111/tid.136348. Stratton, C., &
Turowski, C. (2019). The Immunology of Cosmetic Procedures: A Review.
Journal of Cosmetic Dermatology, 18(2), 365-370. REFERENCE #3: 9.
Rodriguez, M., & Patterson, A. (2017). Understanding the complications
associated with CMV in immunocompromised patients. Journal of Clinical
Virology, 45(3), 213-217.10. Smith, L., & Brown, K. (2016). The impact of
cosmetic surgery on patients' health: a systematic review. Aesthetic
Surgery Journal, 36(7), 111-120.11. Rahier JF, Ben-Horin S, Chowers Y,
Conlon C, De Munter P, D'Haens G, Domenech E, Eliakim R, Eser A, Frater J,
Gassull M, Giladi M, Kaser A, Lemann M, Moreels T, Moschen A, Pollok R,
Reinisch W, Schunter M, Stange EF, Tilg H, Van Assche G, Viget N, Vucelic
B, Walsh A, Weiss G, Yazdanpanah Y, Zabana Y, Travis SP, Colombel JF;
European Crohn's and Colitis Organisation (ECCO). European evidence-based
Consensus on the prevention, diagnosis and management of opportunistic
infections in inflammatory bowel disease. J Crohns Colitis. 2009
Jun;3(2):47-91. doi: 10.1016/j.crohns.2009.02.010. Epub 2009 Apr 26. PMID:
21172250. DISCLOSURES: No relevant relationships by Elizabeth Chandy No
relevant relationships by Ana Chavez Velasquez No relevant relationships
by Michael Dinh No relevant relationships by Azfar Hameed Copyright
© 2025 American College of Chest Physicians

<140>
Accession Number
2041862975
Title
SURVIVAL AFTER HEART TRANSPLANTS FROM CIRCULATORY-DEAD VS BRAIN-DEAD
DONORS: A RECONSTRUCTED IPD META-ANALYSIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A290), 2025. Date
of Publication: 01 Oct 2025.
Author
Al-Tawil M.; Chandiramani A.; Zaqout F.; Ayasa L.; Ayyad M.; Diab A.H.;
Haneya A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Scientific Abstract Posters (A)
SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2025
01:45 pm - 02:30 pm PURPOSE: Heart transplantation (HTx) using donors
after circulatory death (DCD) has the potential to significantly boost
overall transplant rates. This report aims to reconstruct data from
individual studies comparing survival between HTx from DCD donors and
those from donation after brain death (DBD) donors. METHOD(S): We
searched MEDLINE, Embase, Scopus, and the Cochrane Library up to August
2024, including studies that reported Kaplan-Meier survival data comparing
DCD and DBD heart transplants. Kaplan-Meier curves were digitized, and
individual patient data were reconstructed for survival analysis using the
R package IPDfromKM. RESULT(S): Six studies were included in the
final analysis (one randomized, one matched, four Unmatched). There was no
significant difference in the overall survival rates between DCD and DBD
patients. However, censoring of patients in the DCD was substantially
higher when compared to the DBD group. (55% vs. 73% in the overall group
after two years of follow-up). Landmark analysis revealed significantly
lower survival rates after two years (HR: 1.67, p=0.021) and after four
years: (HR: 2.78, p=0.002) in patients who received DCD HTx.
 CONCLUSION(S): This meta-analysis found no overall survival
difference between heart transplants from circulatory-dead (DCD) and
brain-dead (DBD) donors. However, DCD recipients had higher follow-up loss
and significantly lower survival after two and four years in landmark
analysis. More robust studies are needed to confirm these findings.
CLINICAL IMPLICATIONS: DCD heart transplantation expands the donor pool
but may be associated with lower long-term survival. Close post-transplant
monitoring and optimized management strategies are essential. DISCLOSURES:
No relevant relationships by Mohammed Al-Tawil No relevant relationships
by Laith Ayasa No relevant relationships by Mohammed Ayyad No relevant
relationships by Ashwini Chandiramani No relevant relationships by Abdel
Hannan Diab No relevant relationships by Abdel Hannan Diab No disclosure
on file for Assad Haneya No relevant relationships by Feras
Zaqout Copyright © 2025 American College of Chest Physicians

<141>
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. (no pagination), 2025. Date of Publication: 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 (VR)-guided
imagery relaxation (VRGI) intervention in reducing anxiety among lung
cancer surgery patients. Method(s): A randomized clinical trial was
conducted at the Fourth Hospital of Hebei Medical University
(Shijiazhuang, Hebei, China) to recruit patients scheduled for their first
elective endoscopic lung cancer surgery under general anesthesia between
December 2023 and March 2024. Patients were randomly assigned in a 1:1
ratio to either the control group (CG), receiving routine treatment and
staged care in thoracic surgery, or the experimental group (EG), receiving
VRGI intervention in addition to the CG's protocol. The primary outcome
was the State-Trait Anxiety Inventory score for anxiety assessment.
Secondary outcomes included physiological stress marker changes [systolic
blood pressure (SBP), diastolic blood pressure (DBP), and heart rate
(HR)]. The outcomes were assessed at three timepoints: on the day of
admission (T1), immediately before surgery (T2), and at discharge (T3). A
repeated measures analysis of variance (ANOVA) was applied to compare
changes in outcomes over time. Result(s): A total of 98 participants
were included in the study, with a median age of 60.00 years [first
quartile (Q1): 54.25, third quartile (Q3): 68.00]; 39 men (39.8%) and 59
women (60.2%)] were recruited and randomized to the CG (53 participants)
and EG (45 participants). The age [beta, 6.29; 95% confidence interval
(CI), 2.09 to 10.69; p = .005], education level (beta, -5.57; 95% CI,
-9.76 to -1.37; p = .011), awareness of the disease (beta, 6.11; 95% CI,
1.80 to 10.62; p = .007), and gender (beta, 5.75; 95% CI, 1.09 to 10.40; p
= .018) were the major influencing factors of preoperative anxiety.
Compared with the CG, the VRGI EG showed an even smaller increase in the
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,
whereas it showed 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), the intervention group exhibited superior outcomes compared to the
CG. However, no statistically significant difference was observed in the
Trait Anxiety Inventory score (p > .05). Conclusion(s): The findings
of this study suggest that VRGI is a feasible and effective approach to
reducing anxiety in lung cancer patients undergoing elective endoscopic
surgery. Furthermore, it demonstrates the potential to alleviate
physiological stress responses and enhance patient self-confidence. The
positive outcomes observed in this investigation suggest that large-scale,
multicenter randomized controlled trials are needed to confirm the
intervention's efficacy across diverse clinical populations. 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

<142>
Accession Number
2041863214
Title
SYSTEMIC REVIEW AND META-SUMMARY OF CASE REPORTS ON TAKOTSUBO SYNDROME
AFTER TRANS-CATHETER AORTIC VALVE IMPLANTATION (TAVI).
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A534-A535), 2025.
Date of Publication: 01 Oct 2025.
Author
Gosai S.; Patel V.; Tera C.R.; Vatsavayi P.; Mohammed A.S.; Mourad D.;
Brereton B.J.; Vyas A.; Desai R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Valvular Heart Disease, Arrhythmias, and Anticoagulation
SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/21/2025 10:20 am -
11:05 am PURPOSE: Takotsubo syndrome (TTS) is a transient left ventricular
dysfunction, also referred to as stress cardiomyopathy or apical
ballooning syndrome, which is often induced by physical or emotional
stress. Although uncommon, TTS has emerged as a recognizable complication
that may worsen post-procedural hemodynamic instability in TAVI patients.
The pathophysiological mechanism of TTS in TAVI patients is not yet fully
understood, although rapid afterload reduction, myocardial stunning from
rapid pacing, catecholamine surge, and microvascular dysfunction have been
suggested as possible mechanisms. This systematic review aims to identify
all available reports of TTS following TAVI, describe demographic and
clinical characteristics, and review patient outcomes. METHOD(S): A
systematic search of case reports describing TTS after TAVI was conducted.
Inclusion criteria were (1) confirmed TTS following TAVI, (2) documented
echocardiographic findings demonstrating transient left ventricular
dysfunction, (3) exclusion of obstructive coronary artery disease, and (4)
availability of clinical outcomes. Data extracted included demographic
details, clinical presentation, echocardiographic findings, complications,
and prognosis. Descriptive analysis was performed to assess outcome
trends. RESULT(S): Seven case reports were analyzed, and all the
patients were female, and the age of the patients was between 69 and 87
years. Three main findings were observed in this study: the presence of
severe aortic stenosis, the presence of chronic renal disease (3/7),
diabetes mellitus (2/7), and heart failure (4/7) as comorbidities and the
use of TAVI. All cases had an acute worsening of the baseline condition
following TAVI, with manifestations of hypotension, chest pain, shortness
of breath, and/or new development of ECG abnormalities. All patients had
features suggestive of TTS on echocardiography, which included hypokinesis
of apex and hyperkinesis of base. Four cases had cardiogenic shock as a
complication and needed vasopressors or mechanical circulatory support.
One patient (Kustrzycka-Kratochwil et al., 2012) had TTS superimposed on
sepsis and required intensive care unit care for an extended period. Five
out of seven patients had a complete recovery of left ventricular function
in the period of 2-6 weeks with the help of medication. In two cases (Kim
et al., 2023), the patient died because of refractory cardiogenic shock
despite ECMO support and (Komlev et al, 2021) patient died of cardiac
arrest due to worsening heart failure and anuria. CONCLUSION(S): The
occurrence of TTS after TAVI is infrequent yet significant. The underlying
mechanisms seem to be complex, involving significant hemodynamic changes,
catecholamine surge, and the stress associated with procedures as key
contributors. Even with common early hemodynamic instability, the outlook
is generally positive, as evidenced by 5 out of 7 patients attaining
complete recovery. Timely identification and appropriate supportive
measures, including circulatory assistance when required, are essential
for achieving the best results. Future research should focus on
pinpointing high-risk groups and creating preventative measures to reduce
TTS risk in patients undergoing TAVI. CLINICAL IMPLICATIONS: Healthcare
professionals must remain vigilant for TTS in post-TAVI patients who
exhibit hemodynamic instability, especially among older female patients. A
thorough echocardiographic evaluation and prompt intervention can enhance
recovery, while approaches to minimize procedural stress, such as
meticulous pacing protocols and hemodynamic monitoring, may contribute to
prevention. DISCLOSURES: No relevant relationships by Brian Brereton No
relevant relationships by Rupak Desai No relevant relationships by Suraj
Gosai No relevant relationships by Adil Mohammed No relevant relationships
by Denise Mourad No relevant relationships by VIRALKUMAR PATEL No relevant
relationships by Chenna Reddy Tera No disclosure on file for Priyanka
Vatsavayi No relevant relationships by Ankit Vyas Copyright ©
2025 American College of Chest Physicians

<143>
Accession Number
2041671046
Title
Thoracic pedicle Subtraction osteotomies: a systematic review of
indications, correction magnitudes, and safety profile.
Source
European Spine Journal. (no pagination), 2025. Date of Publication: 2025.
Author
Hoang R.; Cowman A.W.; Jin H.; Tummala P.; Liu L.; Song J.; Theologis A.A.
Institution
(Hoang, Cowman, Jin, Tummala, Liu) University of California - Irvine,
Irvine, United States
(Song) Icahn School of Medicine at Mount Sinai, New York, United States
(Theologis) University of California - San Francisco, San Francisco,
United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Thoracic pedicle subtraction osteotomies (T-PSO) are used to
correct severe primary and revision thoracic spinal deformities. While
lumbar PSOs are well established, literature describing the efficacy and
safety of T-PSOs remains limited. This systematic review aims to
characterize indications, correction magnitudes, and complications
associated with T-PSO. Method(s): A systematic review was conducted
across PubMed, Web of Science, and Scopus in accordance with PRISMA
guidelines. Studies were included if they reported outcomes specific to
T-PSO in either primary or revision surgeries. Surgical correction
characteristics, thoracic region sub-analyses, and adverse events were
summarized. Result(s): Data were extracted from 52 studies, including
38 case reports/series and 14 retrospective chart reviews. Among 404 T-PSO
patients, 167 patients had the level of procedure reported. Most
procedures were single-level osteotomies (n = 161, 96.4%), with the most
frequent levels at T11 and T12. The most common indications for T-PSO
based on thoracic region were postoperative kyphosis (n = 15, 32.6%) for
the upper thoracic spine, thoracic kyphosis (n = 3, 37.5%) alongside
thoracic kyphoscoliosis (n = 3, 37.5%) for the middle thoracic spine, and
thoracolumbar kyphosis (n = 54, 50.5%) for the lower thoracic spine. Mean
magnitude of thoracic kyphosis correction was 25.8degree and correction at
the T-PSO level was 25.5degree. Adverse events occurred in 48.5% of
patients, including structural complications (22.5%), instrumentation
failures (11.8%), infections (10.8%), and neurologic deficits (9.8%).
Three deaths were reported. Complication rates were similar between
primary and revision procedures. Conclusion(s): T-PSO achieves
meaningful sagittal plane correction in appropriately selected patients
with severe and/or rigid primary and revision thoracic spinal deformities.
However, high complication rates emphasize the importance of careful
patient selection and surgical planning. Standardization of outcome
reporting is critical to optimize future clinical guidance. Copyright
© The Author(s), under exclusive licence to Springer-Verlag GmbH
Germany, part of Springer Nature 2025.

<144>
Accession Number
2041861590
Title
A RARE CASE OF AORTIC DISSECTION PRESENTING AS A GASTOINTESTINAL BLEED.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A3590-A3591),
2025. Date of Publication: 01 Oct 2025.
Author
El-Husari A.L.I.; Jureyda O.M.A.R.; Rizvi S.; Ali M.Q.; Khan F.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (AT) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION:
Type A aortic dissection (TAAD) is a life-threatening emergency that
occurs when an intimal tear in the aorta creates a false lumen in the
ascending aorta. Some risk factors include hypertension, smoking,
inflammatory disorders, and connective tissue disorders. Common
presentations include: a sharp chest pain that radiates to the back or
abdomen, syncope, paraplegia, or decreased urinary output (Sayed et al,
2021). Around 4-8% of cases can also present with mesenteric malperfusion
due to compression of the gastrointestinal arteries by the expanding aorta
(Di Eusanio et al, 2013; Wang et al,2023 ). Symptoms can then include
abdominal pain, increased lactic acid, or abdominal distention. In rare
instances, mesenteric ischemia from aortic dissection can lead to
gastrointestinal bleeding (Di Luozzo et al, 2007; Sadhwani et al 1999).
CASE PRESENTATION: We present a case of a 57 year old male who presented
to the emergency room with nausea, hematemesis, and near syncope. He
denied any risk factors, took no medications, and had no pain. His only
significant finding on his physical exam was a new left wrist drop and
mild suprapubic tenderness. His labs were significant for leukocytosis of
33, troponin of 6,000, and lactic acid value of 9.1. The patient had an
episode of hematochezia while in the emergency department and endorsed
experiencing two more episodes at home. After which, he was placed on
pantoprazole, octreotide, and bicarbonate drips. As the day progressed, he
became hypotensive, along with a hemoglobin drop from 12.8 to 9.8.
Emergent CTA of the chest, abdomen and pelvis showed an acute type A
ascending aortic dissection with extension into the descending thoracic
aorta. Cardiothoracic surgery was called for emergency surgical repair.
 DISCUSSION(S): A literature review on Pubmed revealed less than 7
other documented cases with gastrointestinal bleeding and aortic
dissection. All of them included a patient presenting with pain, either
chest, back or abdominal. In this particular presentation, the patient was
pain free. Our case is a reminder to clinicians about the danger of
fixation on a specific diagnosis. Although the initial presentation could
have been an acute upper gastrointestinal bleed, other differentials,
especially life threatening scenarios, should also be ruled out. This
patient with no past medical history and a sudden gastrointestinal bleed
is suspicious for acute traumatic events like aortic dissection.
 CONCLUSION(S): Aortic dissection is a life threatening emergency that
should be ruled out when treating an acutely decompensating patient. In a
case such as ours where a patient has gastrointestinal bleeding with end
organ damage all other diagnosis should be ruled out prior to fixation.
REFERENCE #1: Di Eusanio, M., Trimarchi, S., Patel, H. J., Hutchison, S.,
Suzuki, T., Peterson, M. D., Di Bartolomeo, R., Folesani, G., Pyeritz, R.
E., Braverman, A. C., Montgomery, D. G., Isselbacher, E. M., Nienaber, C.
A., Eagle, K. A., & Fattori, R. (2013). Clinical presentation, management,
and short-term outcome of patients with type A acute dissection
complicated by mesenteric malperfusion: observations from the
International Registry of Acute Aortic Dissection. The Journal of thoracic
and cardiovascular surgery, 145(2), 385-390.e1.
https://doi.org/10.1016/j.jtcvs.2012.01.042. Di Luozzo, G., Tannous, H.
J., Ellozy, S. H., Nowakowski, S., Plestis, K. A., Adams, D. H., & Griepp,
R. B. (2007). Delayed repair of acute type A aortic dissection in a
patient with gastrointestinal bleeding and pulse deficit. The Annals of
thoracic surgery, 84(6), 2097-2099.
https://doi.org/10.1016/j.athoracsur.2007.06.077 REFERENCE #2: Sadhwani,
D., & O'Mara, K. (1999). Acute dissecting thoracic aortic aneurysm
presenting with stroke, consumptive coagulopathy, and gastrointestinal
hemorrhage. The Journal of emergency medicine, 17(4), 631-635.
https://doi.org/10.1016/s0736-4679(99)00051-7Sayed A, Munir M, Bahbah EI.
Aortic Dissection: A Review of the Pathophysiology, Management and
Prospective Advances. Curr Cardiol Rev. 2021;17(4):e230421186875. doi:
10.2174/1573403X16666201014142930. PMID: 33059568; PMCID: PMC8762162.
REFERENCE #3: Wang, C., Wu, H., Xi, Z., Liu, Q., Sun, L., & Zhang, L.
(2023). Systematic Review of the Management of Acute Type A Aortic
Dissection with Mesenteric Malperfusion. Reviews in cardiovascular
medicine, 24(5), 127. https://doi.org/10.31083/j.rcm2405127 DISCLOSURES:
No relevant relationships by Muhammad qasim ali No relevant relationships
by Ali El-Husari No relevant relationships by Omar Jureyda No relevant
relationships by Farhan Khan No relevant relationships by Sadaf
Rizvi Copyright © 2025 American College of Chest Physicians

<145>
Accession Number
649469461
Title
Defining optimal muscle surface area thresholds for sarcopenia-related
mortality after cardiovascular interventions.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. (pp
14574969251397740), 2025. Date of Publication: 07 Dec 2025.
Author
Jarvinen O.; Tynkkynen J.; Lindstrom I.; Virtanen M.; Maaranen P.;
Soderlund M.; Huhtamo H.; Vakhitov D.; Laurikka J.; Oksala N.; Hernesniemi
J.
Institution
(Jarvinen) Faculty of Medicine and Health Technology Tampere University
Kalevantie 4 Tampere FI-33014 Finland Finnish Cardiovascular Research
Centre Tampere Tampere Finland
(Tynkkynen, Vakhitov, Oksala) Centre for Vascular Surgery and
Interventional Radiology, Tampere University Hospital, Tampere, Finland
(Lindstrom, Soderlund, Huhtamo, Vakhitov, Laurikka, Oksala, Hernesniemi)
Faculty of Medicine and Health Technology, Tampere University, Tampere,
Finland
(Virtanen, Maaranen, Laurikka, Hernesniemi) Heart Hospital, Tampere
University Hospital, Tampere, Finland
(Laurikka, Oksala, Hernesniemi) Finnish Cardiovascular Research Centre
Tampere, Tampere, Finland
Abstract
BACKGROUND AND AIMS: Psoas muscle surface area (PMA) can estimate
sarcopenia related long-term mortality risk. This study explored whether
this association is linear or non-linear and if a meaningful threshold
defines patients at high risk. METHOD(S): This retrospective
individual participant-level meta-analysis included four different cohorts
of 3893 patients undergoing cardiovascular interventions: 1302 abdominal
aortic aneurysm repairs (AAA), 1099 transcatheter aortic valve insertions
(TAVI), 593 surgeries for thoracic aortic and aortic valve pathology (TA)
and 899 procedures for peripheral artery disease (PAD). The association
between PMA and mortality was visualized using pooled spline curves. Cox
models were fitted separately within each cohort with three levels of
adjustment, and hazard ratios were combined using inverse-variance
meta-analysis. Results were replicated in a retrospective dataset of 561
patients undergoing carotid endarterectomy or thrombectomy for ischemic
stroke, where sarcopenia status was estimated using masseter muscle
surface area. RESULT(S): Age and sex were the most important features
associating with PMA (p < 0.001), but significant variation between the
cohorts was also observed (p < 0.001). The association between PMA and
long-term mortality was inverse and linear (p < 0.001). Patients with poor
muscle status (Z-values -1.5 or less for PMA) had significantly higher
adjusted risk of death (hazard ratio (HR) of 1.6 with 95% confidence
interval (CI) 1.3-2.0, p < 0.001) when compared to all other patients.
Similar results were observed in the replication cohort (HR 1.7, 95% CI
1.0-2.82, p = 0.04). CONCLUSION(S): Long-term mortality after a
cardiovascular intervention increases linearly as the PMA value decreases.
Patients with poor muscle status (Z-values below -1.5) seem to have
consistently elevated mortality risk independent of other risk factors.

<146>
Accession Number
2041862425
Title
META-ANALYSIS OF TRANSCATHETER AORTIC VALVE REPLACEMENT VS SURGICAL AORTIC
VAVLE REPLACEMENT AT ONE YEAR.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A532), 2025. Date
of Publication: 01 Oct 2025.
Author
Mishra U.; Acevedo J.D.; Wilbanks D.; Adedokun S.; Echefu G.I.F.T.;
Bejnood A.R.A.M.; Coleman A.D.A.M.; Ephrem G.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Valvular Heart Disease, Arrhythmias, and Anticoagulation
SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/21/2025 10:20 am -
11:05 am PURPOSE: Transcatheter aortic valve replacement (TAVR) was
initially indicated for patients deemed unsuitable for surgical aortic
valve replacement (SAVR). However, emerging evidence suggests that TAVR
may offer comparable long-term outcomes across various risk categories.
This meta-analysis evaluates the efficacy and safety of TAVR versus SAVR
with a focus on one-year follow-up. METHOD(S): We conducted a
meta-analysis of nine randomized controlled trials (RCTs) published up to
July 2024, comparing TAVR and SAVR outcomes over one year. RESULT(S):
A total of 10,108 patients were included from the nine RCTs. TAVR was
associated with a reduced risk of death compared to SAVR (RR 0.83, 95% CI
0.71-0.99), particularly in low-risk surgical patients. Additionally, TAVR
showed a lower incidence of acute kidney injury (RR 0.46, 95% CI
0.31-0.69), new-onset atrial fibrillation (RR 0.43, 95% CI 0.34-0.55), and
major bleeding (RR 0.49, 95% CI 0.38-0.63). However, it was linked to a
higher risk of vascular complications (RR 2.69, 95% CI 1.70-4.26) and
moderate paravalvular leak (RR 5.94, 95% CI 3.55-9.22). TAVR also had a
greater likelihood of requiring a permanent pacemaker (RR 1.76, 95% CI
1.36-2.29), predominantly associated with self-expanding platforms (RR
2.68, 95% CI 1.26-5.70) rather than balloon-expandable ones (RR 1.19, 95%
CI 0.94-1.49). No significant differences were observed in stroke,
cardiovascular death, or rehospitalization, except in low-risk patients,
where TAVR correlated with a lower risk of cardiovascular death (RR 0.60,
95% CI 0.42-0.85). CONCLUSION(S): TAVR demonstrated superior
short-term safety, particularly in low-risk patients, with lower
mortality, acute kidney injury, new-onset atrial fibrillation, and major
bleeding compared to SAVR. However, it carried higher risks of vascular
complications, paravalvular leak, and pacemaker implantation. These
findings support expanding TAVR's use, especially in low-risk patients,
while highlighting the need for careful patient selection and long-term
durability assessments. CLINICAL IMPLICATIONS: The observed mortality
benefit in low-risk patients suggests TAVR may become the preferred
approach in many patient populations. However, its association with
paravalvular leak and pacemaker dependence necessitates continued
advancements in valve design and procedural techniques. Further research
into long-term durability and hemodynamic performance is essential to
guide broader adoption and refine patient selection. DISCLOSURES: No
relevant relationships by Stephen Adedokun No relevant relationships by
Aram Bejnood No relevant relationships by Adam Coleman No relevant
relationships by Jesus Diaz Acevedo No relevant relationships by Gift
Echefu No relevant relationships by Georges Ephrem No relevant
relationships by Utkarsh Mishra No relevant relationships by David
Wilbanks Copyright © 2025 American College of Chest Physicians

<147>
Accession Number
2041861007
Title
GHOST CATHETER FIBRIN SHEATH (GCFS) FORMATION AFTER PERIPHERALLY INSERTED
CENTRAL CATHETER (PICC) LINE PLACEMENT, COMPLICATING INFECTIVE
ENDOCARDITIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4624), 2025.
Date of Publication: 01 Oct 2025.
Author
Garcia C.A.; Tajamal M.; Capirig C.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Imaging Case Report Posters (C) SESSION TYPE: Case Report
Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am INTRODUCTION:
Peripherally inserted central catheters (PICCs) are lines inserted in the
upper arm which serves as central venous access for patients needing
extended administration of medications. It has become a good alternative
to central venous catheter as it also offers a lower rate of
catheter-related bloodstream infections (CRBSI). Fibrin sheath formation
is common in an indwelling catheter however rare when it persists after
its removal. Its occurrence is considered benign however can be associated
with complications which poses significant diagnostic challenge and
treatment dilemma. CASE PRESENTATION: A 33-year-old woman with a history
of IV drug use and hepatitis C was brought to the Emergency Room for
evaluation of weakness. She was recently discharged from the hospital
after being diagnosed with Infective endocarditis, growing
Methicillin-resistant Staphylococcus aureus, and had PICC line placed for
completion of 6 weeks IV antibiotics wherein she completed treatment with
Ceftaroline and Daptomycin infusion. On this admission, the patient was
found to be bacteremic with blood culture growing Stenotrophomonas
maltophilia. Initial Transthoracic echocardiography (TTE) showed evidence
of a vegetation in the tricuspid valve hence Transesophageal
Echocardiography (TEE) was pursued for full evaluation. TEE showed
tricuspid vegetation (size of 1.3 to 1.7cm) and revealed a new linear,
mobile, tubular structure in the Superior vena cava (SVC) extending into
Right atrium, deemed to be a ghost catheter fibrin sheath, a remnant of
the PICC line that was removed a month ago. Further evaluation revealed
multiple scattered lung nodules, likely a consequence of septic
embolization from the vegetation or from the catheter fibrin sheath.
Infectious disease was on board and the patient was treated with IV
antibiotics and anticoagulation. Cardiothoracic surgery was consulted and
the patient was scheduled for an AngioVac procedure. DISCUSSION(S):
This report emphasizes an important however rare complication of catheter
removal. Scarcity of literature as to its diagnosis has been a challenge
for clinicians as there has been no specific guidelines regarding its
differentiation especially if with concomitant vegetations like the case
presented above. TEE is considered an excellent modality for its
detection. Clues to its diagnosis include the location, temporality and
its shape which should resemble a tubular cast. Presence of GCFS caries
risk for infection, thrombosis, and pulmonary embolism hence evaluation is
warranted. Management depends on the clinical scenario but generally
entails treatment of concomitant infection with IV antibiotics and
anticoagulation. CONCLUSION(S): GCFS is a rare sequelae of catheter
removal which poses a challenge for clinicians as there has been no
specific guidelines for its diagnosis and treatment. While its
complications are rare, likelihood should not be disregarded. REFERENCE
#1: Johansson E, Hammarskjold F, Lundberg D, Arnlind MH. Advantages and
disadvantages of peripherally inserted central venous catheters (PICC)
compared to other central venous lines: a systematic review of the
literature. Acta Oncol. 2013 Jun;52(5):886-92. REFERENCE #2: Krausz DJ,
Fisher JS, Rosen G, Haramati LB, Jain VR, Burton WB, et al. Retained
fibrin sheaths: chest computed tomography findings and clinical
associations. J Thorac Imaging 2014;29:118-24. REFERENCE #3: Jena N,
Ananthasubramaniam K. Ghost Catheter Fibrin Sleeve: Case Report and
Literature Review. CASE (Phila). 2020 Jun 19;4(5):405-409. doi:
10.1016/j.case.2020.05.011. PMID: 33117939; PMCID: PMC7581608.
DISCLOSURES: No relevant relationships by Christian John Capirig No
relevant relationships by Celine Angelica Garcia No relevant relationships
by Maryam Tajamal Copyright © 2025 American College of Chest
Physicians

<148>
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.

<149>
Accession Number
649457405
Title
Comparative efficacy of chest wall fascial plane blocks for cardiac
surgery via median sternotomy: a network meta-analysis.
Source
BMC anesthesiology. (no pagination), 2025. Date of Publication: 05 Dec
2025.
Author
Bu Y.; Savir S.; Saeed S.; Sharkey A.; Robitaille M.; Mahmood F.; Matyal
R.; Khabbaz K.
Institution
(Bu, Savir, Saeed, Sharkey, Robitaille, Mahmood, Matyal) Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Khabbaz) Department of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, 1 Deaconess Rd ,West Campus, Boston, MA,
United States
Abstract
BACKGROUND: To quantitatively evaluate and compare the relative efficacy
of different chest wall fascial plane blocks in cardiac surgery via median
sternotomy. METHOD(S): This study was conducted according to the
Preferred Reporting Items for Systematic Review and Meta-Analyses for
Network Meta-Analyses (PRISMA-NMA) utilizing a frequentist network
meta-analysis (NMA) method. Conclusions were drawn using a minimally
contextualized framework of the GRADE (Grading of Recommendations
Assessment, Development and Evaluation) approach. RESULT(S):
Twenty-four randomized controlled trials were retrieved from four
databases. A total of 1366 adult patients were included, of whom 789
(57.8%) received one of five chest wall fascial plane block modalities.
The primary outcome was 24-hour postoperative opioid consumption
(converted as intravenous morphine in mg, n = 1159). With moderate
confidence, erector spinae plane block (ESPB) plus patient-controlled
analgesia (PCA) was more efficacious in reducing 24-hour postoperative
intravenous morphine than PCA alone (Rank based on SUCRA = 1). Secondary
outcomes included postoperative mechanical ventilation time and pain
assessment scores (0, 12, and 24 h after extubation) with 1186, 664, 1054,
and 958 patients analyzed, respectively. Network meta-regression results
across primary or secondary outcomes suggested that local anesthetic type
and volume, injection timing, and a continuous block feature may
contribute to the relative efficacy of chest wall fascial plane blocks.
 CONCLUSION(S): ESPB plus PCA was found to be more efficacious in
decreasing postoperative opioid requirements for adults undergoing cardiac
surgery via median sternotomy, with moderate confidence in the current
evidence. Modifying the current fascial plane block protocols may be the
direction of future clinical studies. TRIAL REGISTRATION: PROSPERO
identifier CRD42022345047. Copyright © 2025. The Author(s).

<150>
Accession Number
649450750
Title
Risk assessment tools for predicting transfusion in surgery: a systematic
review and meta-analysis.
Source
Health technology assessment (Winchester, England). (pp 1-38), 2025. Date
of Publication: 03 Dec 2025.
Author
Seyahian A.; Taylor-Rowan M.; Nevill C.; Mulholland R.; Roxburgh C.;
Brunskill S.; Cooper N.; Noel-Storr A.; Sutton A.J.; Wu O.; Quinn T.J.
Institution
(Seyahian, Taylor-Rowan, Mulholland, Wu) Health Economics and Health
Technology Assessment, School of Health and Wellbeing, University of
Glasgow, Glasgow, United Kingdom
(Nevill, Cooper, Sutton) Department of Population Health Sciences,
University of Leicester, Leicester, United Kingdom
(Roxburgh) School of Cancer Science, University of Glasgow, Glasgow,
United Kingdom
(Brunskill) NHS Blood Transfusion, Oxford, United Kingdom
(Noel-Storr) School of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
(Quinn) School of Cardiovascular and Metabolic Health, University of
Glasgow, Glasgow, United Kingdom
Abstract
Background: United Kingdom blood shortages necessitate better prediction
of surgical blood requirement. We sought to assess the predictive accuracy
of tools designed to identify those patients requiring blood transfusion
within the perioperative period. Method(s): We searched the Cochrane
library, EMBASE, MEDLINE, ClinicalTrials.gov and WHO trials portal,
2000-July 2023. We included studies that developed and/or validated
prediction tools for blood requirement during the early perioperative
period (48 hours). Risk of bias was evaluated using the Prediction model
Risk Of Bias Assessment Tool. We pooled area under receiver operating
curve and calibration data via random effects meta-analysis. We evaluated
certainty of evidence of any estimates using the Grading of
Recommendations Assessment, Development and Evaluation framework. We used
meta-regression to describe associations between included variables/tool
characteristics with tool accuracy. Result(s): We included 50 papers,
describing 67 unique prediction tools. Most tools were at high risk of
bias, with limited external validation. Discrimination (area under
receiver operating curve) of prognostic models ranged from 0.49 to 0.96.
Only two surgery-specific tools, the McClusky Index (liver transplant
surgery) and Papworth Bleeding Risk Score (cardiothoracic surgery), had
sufficient data to enable pooling of discrimination measures. The McClusky
Index's pooled area under receiver operating curve: 0.74 (95% CI 0.61 to
0.84) and Bleeding Risk Score's area under receiver operating curve: 0.68
(95% CI 0.49 to 0.82) were both rated 'very low' certainty by Grading of
Recommendations Assessment, Development and Evaluation. Pooling
calibration data was not possible for any prediction tools.
Meta-regression suggested that fewer included variables, longer time from
surgery and independent validation studies were all associated with lower
accuracy. Limitation(s): There were insufficient studies to assess
overall tool performance via meta-analysis in other surgical subgroups
beyond cardiothoracic surgery and liver transplant. Our study population
is also predominantly made up of elective surgeries which may make our
results less generalisable to emergency settings. Future work:
Implementation and cost-effectiveness studies are needed to evaluate how
promising tools could be applied to clinical practice and the economic
impact such tools could have upon the service. Conclusion(s): Despite
the availability of multiple potential tools, available data suggest none
are currently suitable for predicting blood transfusion in surgical
practice. Our summary of the data comes with caveats around the quality of
the included papers and the limited number of tools with more than one
reported external validation. Funding(s): This article presents
independent research funded by the National Institute for Health and Care
Research (NIHR) Health Technology Assessment programme as award number
NIHR159933.

<151>
Accession Number
649450471
Title
Effects of Continuation versus Interruption of Oral Anticoagulation during
TAVI on Hemostasis Function.
Source
Journal of thrombosis and haemostasis : JTH. (no pagination), 2025. Date
of Publication: 03 Dec 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) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Stragier) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, the Netherlands; Department of Anesthesiology, Intensive Care
Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg,
Genk, Belgium
(Bor, van Lenthe, Overduin, Aarnink, Peper, Brouwer, Rensing, Timmers,
Swaans) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Rosseel) Department of Cardiology, Aalst, Belgium
(Konings, Ninivaggi, de Simone, Huskens, Roest) Department of Functional
Coagulation, Synapse Research Institute, Maastricht, Netherlands
(Rooijakkers) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Nijenhuis) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
The Netherlands; Department of Cardiology, Radboud University Medical
Center, Nijmegen, The Netherlands
(Hackeng) Department of Clinical Chemistry, St. Antonius Hospital,
Nieuwegein, Netherlands
(Ten Cate) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, the Netherlands; Department of Internal Medicine, Maastricht
University Medical Centre (MUMC+), Maastricht, The Netherlands; Department
of Biochemistry, Laboratory for Clinical Thrombosis and Hemostasis,
Maastricht University, Maastricht, The Netherlands; Thrombosis Expertise
Center, Maastricht University Medical Centre+, Maastricht, The Netherlands
(de Laat) Department of Anesthesiology, Intensive Care Medicine, Emergency
Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
(Ten Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
The Netherlands; Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, the Netherlands; Department of Cardiology, Maastricht
University Medical Center, Maastricht, the Netherlands
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. METHOD(S):
Patients were randomized 1:1 to continuation versus interruption of OAC.
Plasma samples were taken at six time points and hemostasis function was
assessed by measuring thrombin and plasmin generation, biomarkers of
coagulation, fibrinolysis, platelet activation and endothelial function.
 RESULT(S): A total of 167 patients were included: 82 were assigned to
continuation and 85 to interruption of OAC. Pre-TAVI, a significantly
lower endogenous thrombin potential (ETP) was observed in the continuation
group as compared to the interruption group. In both groups the ETP was
reduced directly post-TAVI and restoration of the ETP was significantly
slower in the continuation group. In contrast, levels of prothrombin
fragment 1+2 were similar between groups. A significantly lower endogenous
plasmin potential was observed in the continuation group from pre-TAVI
until 8 hours after 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(S):
Continuation of OAC during TAVI modestly reduced acute activation of
coagulation and fibrinolysis as compared to interruption of OAC. This did
not translate into any apparent differences in thromboembolic risk in the
main trial. However, continuation of OAC resulted into a marked
suppression of the ETP and an increased risk of bleeding. Copyright
© 2025. Published by Elsevier Inc.

<152>
Accession Number
2042118300
Title
Strategy Optimization for a Combined Procedure in Patients With Atrial
Fibrillation The COMBINATION Randomized Clinical Trial.
Source
JAMA Network Open. 7(11) (no pagination), 2024. Article Number: e2445084.
Date of Publication: 01 Nov 2024.
Author
Du X.; Chu H.; Yang B.; Zhong J.; Ruan Z.; Chen Q.; Leng B.; Tao S.; Lai
H.; Liang J.; Xie R.; Ye P.; Zhou X.; Li Y.; Li J.; Zhao Y.; Zou C.; Sun
H.; Li X.; Rong B.; Chen G.; Hu J.; Jia J.; Fang Y.; Xia Z.; Liu Q.; Zuo
T.; Zhu X.; Xu L.; Yang S.; Luo C.; Shen C.; Feng M.; Jiang Y.; Fu G.;
Wang B.; Yu X.; Chen X.
Institution
(Du, Chu, Luo, Shen, Feng, Jiang, Fu, Wang, Yu, Chen) Arrhythmia Center,
The First Affiliated Hospital of Ningbo University, Ningbo First Hospital,
Ningbo, China
(Du, Chu, Luo, Shen, Feng, Jiang, Fu, Wang, Yu, Chen) Key Laboratory of
Precision Medicine for Atherosclerotic Diseases of Zhejiang Province,
Ningbo, China
(Yang, Li) Department of Cardiology, Shanghai East Hospital, Tongji
University, Shanghai, China
(Zhong, Rong) Department of Cardiology, Qilu Hospital, Shandong
University, Jinan, China
(Ruan, Chen) Department of Cardiology, Jiangsu Taizhou People's Hospital,
Taizhou, China
(Chen, Hu) Department of Cardiovascular Medicine, The Second Affiliated
Hospital of Nanchang University, Nanchang, China
(Leng) Department of Cardiology, Ningbo Taikang Hospital, Ningbo, China
(Tao, Jia) Department of Cardiology, The Affiliated Hospital of Yunnan
University, Kunming, China
(Lai, Fang) Department of Cardiology, Jiangxi Provincial People's
Hospital, The First Affiliated Hospital of Nanchang Medical College,
Nanchang, China
(Liang, Xia) Department of Cardiology, The Second People's Hospital of
Foshan, Foshan, China
(Xie, Liu) Department of Cardiology, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
(Ye, Zuo) Department of Cardiology, The Central Hospital of Wuhan, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
(Zhou, Li) Department of Pacing and Electrophysiology, The First
Affiliated Hospital of Xinjiang Medical University, Urumqi, China
(Li, Zhu) Department of Cardiology, The Affiliated Yantai Yuhuangding
Hospital of Qingdao University, Yantai, China
(Zhao, Xu, Yang) Department of Cardiology, Henan Cardiovascular Hospital
Affiliated to Southern Medical University, The Seventh People's Hospital
of Zhengzhou, Zhengzhou, China
(Zou) Department of Cardiology, The First Affiliated Hospital of Soochow
University, Suzhou, China
(Sun) Department of Cardiology, Cixi People's Hospital, Ningbo, China
Publisher
American Medical Association
Abstract
IMPORTANCE The optimal strategy of combining left atrial appendage
occlusion (LAAO) with catheter ablation (CA) in patients with atrial
fibrillation (AF) during a single procedure remains unclear. OBJECTIVE To
determine the effects of ablation-first vs occlusion-first strategies on
long-term clinical outcomes among patients with atrial fibrillation
undergoing a combined LAAO and CA procedure. DESIGN, SETTING, AND
PARTICIPANTS The prospective, multicenter COMBINATION randomized clinical
trial was conducted in 14 high-volume centers in China. Enrollment of
patients with nonvalvular AF referred for the combined procedure began on
July 24, 2020, and concluded on January 20, 2022. INTERVENTIONS Patients
were randomly assigned to either the ablation-first group or the
occlusion-first group. Outcomes of LAAO using an occlusion device and CA
using a contact force-sensing catheter following different combination
strategies during long-term follow-up were evaluated. MAIN OUTCOMES AND
MEASURES The primary end point was a composite of thromboembolic events
including stroke or transient ischemic attack, device-related thrombus
(DRT), clinically relevant bleeding, and cardiovascular rehospitalization
or death. Freedom from AF or atrial tachyarrhythmia (ATA) after a single
procedure without antiarrhythmic drugs, at both 1 year and long-term
follow-up, was also evaluated. RESULTS Of the 202 patients enrolled, 194
(96.0%) completed the trial (97 in the ablation-first group and 97 in the
occlusion-first group). The mean (SD) age of the cohort was 67.3 (9.2)
years, and 110 patients (56.7%) were male. All procedures achieved acute
successful LAAO and restoration of sinus rhythm, with similar incidences
of periprocedural complications. Compared with the ablation-first group,
the occlusion-first group exhibited significantly higher event-free
survival of the primary end point (83.5% vs 71.1%; hazard ratio [HR], 0.53
[95% CI, 0.29-0.95]; log-rank P = .04) during the median 2.5 (IQR,
2.3-2.8) years of follow-up. Subgroup analysis indicated that male
patients and those with higher CHA<inf>2</inf>DS<inf>2</inf>-VASc scores
(a composite of factors associated with stroke risk; higher scores
indicate higher risk) were at lower risk of thromboembolic events. Rates
of long-term freedom from AF (77.3% vs 63.5%; HR, 0.58 [95% CI,
0.34-0.97]; log-rank P = .04) and from ATA (70.1% vs 55.7%; HR, 0.62 [95%
CI, 0.39-0.99]; log-rank P = .04) were higher in the occlusion-first group
vs the ablation-first group. Additionally, a higher incidence of chronic
peridevice leak (15 [15.5%] vs 5 [5.2%]; P = .03) and DRT (8 [8.2%] vs 1
[1.0%]; P = .04) was observed in the ablation-first group vs the
occlusion-first group. CONCLUSIONS AND RELEVANCE In this randomized
clinical trial, the occlusion-first approach was superior due to its
higher event-free survival of the primary end point and long-term freedom
from ATA. These findings suggest that the occlusion-first approach should
be recommended for combined procedures with plug-like device
implantation. Copyright © 2024 Du X et al.

<153>
Accession Number
649457013
Title
Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular
Events: Post-Hoc Analysis From the ISCHEMIA Trial.
Source
JACC. Cardiovascular imaging. (no pagination), 2025. Date of Publication:
05 Dec 2025.
Author
Kwong R.Y.; Heydari B.; Abbasi S.; Mongeon F.-P.; Marcotte F.; Friedrich
M.; Shaw L.J.; Xu Y.; Anthopolos R.; Bekeredjian R.; Monti L.;
Selvanayagam J.; Lesiak M.; Picard M.H.; Berman D.S.; Bangalore S.;
Spertus J.A.; Stone G.W.; Boden W.E.; Min J.; Mancini G.B.J.; Leipsic J.;
Budoff M.; Hague C.; Hochman J.S.; Maron D.J.; Reynolds H.R.
Institution
(Kwong, Heydari) Department of Medicine, Cardiovascular Division, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Abbasi) Thousand Oaks, CA, United States
(Mongeon) Department of Specialized Medicine, Division of Non-Invasive
Cardiology, Montreal Heart Institute, Montreal, QC, Canada
(Marcotte) Mayo Clinic, Phoenix, AZ, United States
(Friedrich) Department of Specialized Medicine, Division of Non-Invasive
Cardiology, Montreal Heart Institute, Universite de Montreal, Montreal,
QC, Canada
(Shaw) Icahn School of Medicine at Mount Sinai, NY, United States
(Xu, Anthopolos) NYU Grossman School of Medicine, NY, United States
(Bekeredjian) Robert Bosch Medical Center, Stuttgart, Germany
(Monti) PaviaItaly
(Selvanayagam) Flinders Medical Centre, Adelaide, SA, Australia
(Lesiak) University Hospital of the Lords Transfiguration, Poznan, Poland
(Picard) Department of Medicine, Cardiovascular Division, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Berman) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Bangalore) Duke Clinical Research Institute, Durham, NC, United States
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, Missouri,
USA; University of Missouri-Kansas City's Healthcare Institute for
Innovations in Quality, Kansas City, Missouri, USA
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, NY, United States
(Boden) VA New England Healthcare System, Bedford, MA, United States
(Min, Hague) NYUnited States
(Mancini, Leipsic) University of British Columbia, Vancouver, BC, Canada
(Budoff) Harbor-UCLA Medical Center, Torrance, CA, United States
(Hochman, Reynolds) Cardiovascular Clinical Research Center, Leon H.
Charney Division of Cardiology, Department of Medicine, NYU Grossman
School of Medicine, NY, United States
(Maron) Department of Medicine, Stanford University School of Medicine,
Stanford, CA, United States
Abstract
BACKGROUND: Research comparing the prognostic value of stress cardiac
magnetic resonance (CMR) to other stress modalities in patients with
coronary disease is limited. OBJECTIVE(S): The authors compared the
prognostic value of stress CMR vs alternative testing by either
single-photon emission computed tomography or stress echocardiography
(SPECT/echo) in the ISCHEMIA (International Study of Comparative Health
Effectiveness with Medical and Invasive Approaches) trial. METHOD(S):
CMR vs SPECT/echo was compared in 3,909 patients randomized in ISCHEMIA
after sites' interpretation of moderate to severe ischemia. Ischemia and
infarct extent, measured by either CMR or SPECT/echo, were each associated
with the trial's primary outcome of cardiovascular death, nonfatal
myocardial infarction (MI), or hospitalization for unstable angina, heart
failure, or resuscitated cardiac arrest, at a median follow-up of 3.37
years (Q1-Q3: 2.20-4.56 years). RESULT(S): Compared with SPECT/echo
(n = 5,627), CMR participants (n = 313) were not different in key
demographic factors but were more likely to have severe ischemia (57% vs
38%; P < 0.001) and to be randomized (n = 257, 82%, vs n = 3,652, 65%; P <
0.001). Ischemia severity (no/mild, moderate, severe) by CMR core
laboratory was associated with cumulative 4-year event rates of all
trial-specific endpoints, including the primary outcome (P = 0.042),
cardiovascular death/MI (P = 0.041), and nonfatal MI (P = 0.03), but
SPECT/echo ischemia severity was not. No/mild, moderate, and severe
ischemia by CMR were associated with 0%, 14%, and 23% 4-year primary
outcome rates, respectively, compared with 18%, 15%, and 16%, by
SPECT/echo. After adjustment for age, estimated glomerular filtration
rate, and diabetes, the association between ischemia extent and the
primary endpoint differed by imaging modality, with each additional
ischemic segment on CMR associated with a 13% increase in hazard
(interaction P = 0.02). In participants assigned to initial conservative
management who had no/mild ischemia on imaging, 4-year rates of invasive
referral and coronary revascularization were lower in the CMR than
SPECT/echo group (16.7% and 0%, respectively, for CMR; and 31% and 13.3%,
respectively, for SPECT/echo). CONCLUSION(S): Ischemia severity by
CMR had a stronger association with all ISCHEMIA trial endpoints compared
with SPECT/echo. Copyright © 2025 American College of Cardiology
Foundation. Published by Elsevier Inc. All rights reserved.

<154>
Accession Number
649457421
Title
Transcatheter Aortic Valve Replacement In The Immunocompromised: A
Systematic Review And Meta-Analysis.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 03 Dec 2025.
Author
Meeus R.; Dhondt P.; Meeus N.; Ashraf H.; Minten L.; Hariyanto J.; Dubois
C.
Institution
(Meeus, Dhondt, Meeus, Minten) Department of Cardiovascular Medicine,
University Hospitals Leuven, Leuven, Belgium
(Ashraf) Rawalpindi Medical University, Rawalpindi, Pakistan
(Hariyanto) TangerangIndonesia
(Dubois) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven,
Leuven, Belgium
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 seven 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 - 3.98; p=0.297), but significantly higher 1-year all-cause
mortality (OR 2.39; 95% CI 1.55 - 3.70; p < 0.001). Notably, IC patients
demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 - 0.59; p =
0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 - 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. All
rights reserved.

<155>
Accession Number
2042106266
Title
Methodological Appraisal of Ongoing Trial of Transcatheter Aortic Valve
Implantation Versus Surgical Aortic Valve Replacement in Younger Patients:
From Incentives to Guideline-Informing Evidence.
Source
European Journal of Cardio-thoracic Surgery. 67(12) (no pagination), 2025.
Article Number: ezaf348. Date of Publication: 01 Dec 2025.
Author
Milojevic M.; Myers P.O.; Falk V.; Bavaria J.E.; Borger M.A.; Casselman
F.P.A.; Badhwar V.; Kaul S.; Siepe M.; Sadaba J.R.
Institution
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Milojevic, Myers) Department of Cardiac Surgery, University Hospital
Zurich, University of Zurich, Zurich, Switzerland
(Myers) La Tour Hospital, Geneva University Medical School, Geneva,
Switzerland
(Falk) Deutsches Herzzentrum der Charite, Charite University Medicine
Berlin, Germany
(Falk) DZHK, German Center for Cardiovascular Research, Berlin, Germany
(Falk) Swiss Federal Institute of Technology, Department of Health Science
and Technology, Zurich, Switzerland
(Bavaria) Department of Cardiovascular Surgery, Jefferson Health,
Philadelphia, United States
(Borger) University Department of Cardiac Surgery, Leipzig Heart Center,
Leipzig, Germany
(Casselman) Heart Center AZORG, Cluster Cardiovascular Surgery, Aalst,
Belgium
(Badhwar) Department of Cardiovascular and Thoracic Surgery, West Virginia
University, Morgantown, WV, United States
(Kaul) Department of Cardiology, Cedars-Sinai Medical Centre, Los Angeles,
United States
(Siepe) Department of Cardiac Surgery, University Hospital Bern,
University of Bern, Bern, Switzerland
(Sadaba) Department of Cardiac Surgery, Navarra University Hospital,
Pamplona, Spain
(Sadaba) IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives To critically appraise the design of the ongoing multicentre,
randomized START YOUNG trial comparing transcatheter aortic valve
implantation (TAVI) with bioprosthetic surgical aortic valve replacement
(SAVR) in patients aged 65-75 years with symptomatic severe aortic
stenosis (AS). Methods Publicly available trial information
(ClinicalTrials.gov: NCT06861361) was reviewed, and the design was
benchmarked against the minimum expected methodological standards for
generating practice-changing evidence in patients with very long life
expectancy (LE) following SAVR. The appraisal domains included objectives
and study endpoints; selected non-inferiority (NI) margins; adequacy of
follow-up for late events; statistical analysis plans and handling of
crossovers/missing data; consistency of surgical comparators; and
prespecified sub-groups. Results Several major concerns were identified:
(1) co-primary safety/efficacy composites mix hard adverse events (death,
stroke) with softer outcomes, with rehospitalization likely to dominate;
(2) limited duration primary follow-up (30 days/1 year), with only
optional survaillance beyond 5 years, inadequate for durability and late
hazards; (3) wide NI margins (7%-8%) that could accept clinically
meaningful inferiority; (4) an unclear statistical analysis plan; (5) a
device-specific TAVI arm versus heterogeneous SAVR comparator; and (6) up
to 25% bicuspid anatomy without stratified randomization or powered
analyses. Collectively, these choices markedly increase the risks of type
I error, and misinterpretation in a population with likely crossing hazard
curves and a long median LE comparable to that of the age-matched general
population after SAVR. Conclusions In order to generate
guideline-informing evidence for extending TAVI to younger patients with
severe AS, the trial should prioritise hard adverse endpoints, tighten NI
margins, mandate extended follow-up, standardise the surgical comparator,
and adequately power the bicuspid subgroup. Without these revisions,
continuing the study under the current protocol risks yielding biased,
non-guideline informative results. Copyright © The Author(s)
2025. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<156>
Accession Number
649450951
Title
Is the superior septal approach a safe alternative to conventional left
atriotomy for mitral valve surgery? Evidence from a systematic review and
meta-analysis.
Source
BMC cardiovascular disorders. (no pagination), 2025. Date of Publication:
05 Dec 2025.
Author
Maali A.; Hausmann H.; Flieger R.; Moawad M.H.E.D.; Ismail M.; Abdelrahman
A.M.; Abdul-Hafez H.A.; Bisht O.
Institution
(Maali, Hausmann, Flieger, Ismail, Bisht) CoswigGermany
(Moawad) Alexandria Main University Hospital, Alexandria, Egypt
(Moawad) Faculty of Medicine, Suez Canal University, Ismailia, Egypt
(Abdelrahman) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Abdul-Hafez) Department of Medicine, Faculty of Medicine and Health
Sciences, An-Najah National University, Nablus, Palestine
Abstract
BACKGROUND: The superior septal approach (SSA) was developed to improve
mitral valve exposure during surgery, particularly in patients with
complex anatomy. However, concerns regarding prolonged operative times and
rhythm disturbances have limited its widespread adoption. This systematic
review and meta-analysis aimed to compare SSA with conventional left
atriotomy (CLA) in terms of perioperative outcomes, complications, rhythm
disturbances, and mortality. METHOD(S): A systematic search of
PubMed, Scopus, and Web of Science was performed up to August 2025
according to PRISMA guidelines. Outcomes assessed included postoperative
cardiac rhythm outcomes (primary outcomes), perioperative metrics
(secondary outcomes) -including pacemaker implantation, cardiopulmonary
bypass (CPB) and cross-clamp times, intensive care unit (ICU) stay, and
hospital stay, and complications (safety outcomes). Pooled risk ratios
(RR) and mean differences (MD) with 95% confidence intervals (CI) were
calculated using a random-effects model. RESULT(S): A total of 12
cohort studies were included. Postoperative sinus rhythm (RR = 0.86, 95%
CI 0.71-1.04) and atrial fibrillation (AF) (RR = 1.12, 95% CI 0.83-1.49)
did not differ between SSA and CLA; junctional rhythm and complete
atrioventricular block (AVB) were also comparable. Within-group (pre-post)
analyses showed sinus rhythm increased after both techniques, more with
SSA (RR = 1.36) than CLA (RR = 1.20), while AF changes were
non-significant. Meta-regression indicated more recent publication year
and higher repair (vs. replacement) proportion were associated with
greater sinus rhythm benefit favoring SSA. Secondary outcomes were similar
overall; pacemaker implantation was borderline higher after SSA and became
significant in sensitivity analysis. Safety endpoints were also comparable
between approaches. CONCLUSION(S): The SSA provides equivalent
perioperative efficiency and clinical safety compared with CLA in mitral
valve surgery. Concerns about rhythm disturbances and operative burden are
not supported by pooled evidence, suggesting that SSA remains a safe and
valuable option, particularly in cases requiring enhanced exposure.
Further high-quality prospective studies are warranted to define long-term
outcomes and refine patient selection. Copyright © 2025. The
Author(s).

<157>
Accession Number
2041861391
Title
IMPACT OF STELLATE GANGLION BLOCK ON REFRACTORY VENTRICULAR ARRHYTHMIAS
AND SURVIVAL: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A613-A614), 2025.
Date of Publication: 01 Oct 2025.
Author
Sabri M.; Hennawi H.A.; Khan M.K.; Duseja N.; Muhammadzai H.; Cho
S.U.N.G.-H.A.E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Scientific Abstract Posters (H)
SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2025
10:20 am - 11:05 am PURPOSE: Stellate Ganglion Block (SGB) is an
interventional technique employed in the management of refractory
ventricular arrhythmias, including ventricular tachycardia, particularly
in cases where traditional treatments such as antiarrhythmic medications
or catheter ablation prove ineffective. This meta-analysis seeks to assess
the effectiveness of SGB as a therapeutic option for ventricular
tachycardia. METHOD(S): A search of major databases, including
PubMed, Embase, Google Scholar, Scopus, Web of Science, and the Cochrane
Library, was conducted from inception to September 2024. Studies
evaluating the role of SGB in patients with ventricular arrhythmias were
identified. Data analysis was performed using a random-effects model to
account for variability across studies. The primary outcome of the study
was a reduction in ventricular arrhythmia (VA) burden, while secondary
outcomes included reduction in VA recurrence, all-cause mortality,
cardiovascular mortality, post-procedure complications, and the
development of Horner's syndrome. RESULT(S): A total of 14 studies
were analyzed, comprising 11 single-arm and 3 double-arm observational
studies, with a combined sample of 663 patients and a mean follow-up of
27.5 months. The mean age of participants was 71.2 years. In single-arm
studies, SGB resulted in a significant 73% reduction in VA burden
(Proportion: 0.729; 95% CI: 0.605, 0.854; P < 0.001; I2 = 99.34%).
All-cause mortality was observed in 20% of patients, though this was not
statistically significant (Proportion: 0.20; 95% CI: 0.112, 0.287; P =
0.077; I2 = 52.515%). Horner's syndrome developed in 28.7% of patients,
typically resolving within 24 hours (Proportion: 0.287; 95% CI: 0.028,
0.603; P < 0.001; I2 = 95.73%). Post-procedure complications were
significantly reduced (Proportion: 0.034; 95% CI: 0.007, 0.062; P = 0.035;
I2 = 53.493%). In double-arm studies, SGB was associated with a
significant reduction in VA recurrence compared to medical or device
defibrillation (OR: 0.30; 95% CI: 0.09, 0.93; P = 0.04), as well as
reductions in all-cause mortality (OR: 0.03; 95% CI: 0.01, 0.20; P =
0.0002; I2 = 0%) and cardiovascular-related deaths (OR: 0.21; 95% CI:
0.06, 0.73; P = 0.01; I2 = 0%). CONCLUSION(S): SGB significantly
reduces ventricular arrhythmia burden and lowers all-cause and
cardiovascular mortality in patients with refractory arrhythmias. Despite
minor transient complications like Horner's syndrome, SGB proves to be an
effective treatment option when conventional therapies fail, improving
survival in high-risk patients. However, the analysis is limited by high
heterogeneity, reliance on observational studies, and few double-arm
studies, highlighting the need for further research to assess its efficacy
for VT. CLINICAL IMPLICATIONS: The clinical implications of this study
suggest that Stellate Ganglion Block (SGB) is a promising intervention for
patients with refractory ventricular arrhythmias, particularly when
traditional treatments fail. It significantly reduces ventricular
arrhythmia burden, recurrence, and mortality, including both all-cause and
cardiovascular-related deaths. While SGB may cause transient complications
like Horner's syndrome, these are typically short-lived. This treatment
offers a valuable option for high-risk patients, improving survival and
providing a potential alternative when medications and catheter ablation
prove ineffective. Its effectiveness and safety make it a beneficial
strategy for managing challenging arrhythmias in clinical practice.
DISCLOSURES: No relevant relationships by Hussam Al Hennawi No relevant
relationships by Sung-Hae Cho No relevant relationships by Nikhil Duseja
No relevant relationships by Muhammad Khuzzaim Khan No relevant
relationships by Hamza Muhammadzai No relevant relationships by Muhammad
Sabri Copyright © 2025 American College of Chest Physicians

<158>
Accession Number
649436328
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: 15 Nov 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; Center of Outcomes Research,
Department of Anesthesiology, Critical Care and Pain Medicine, University
of Texas, Houston, TX; Outcomes Research Consortium, Houston, TX
Abstract
OBJECTIVE: To assess how tranexamic acid (TXA) influences the renal
outcomes of cardiovascular surgical patients. DESIGN: Systematic review
and meta-analysis of randomized controlled trials (RCTs). SETTING: The
operating room. PARTICIPANTS: Cardiovascular surgical patients.
INTERVENTIONS: 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. All rights reserved.

<159>
Accession Number
649436821
Title
Effect of perioperative oral care on postoperative pneumonia in thoracic
surgery patients: a systematic review and meta-analysis.
Source
Scientific reports. (no pagination), 2025. Date of Publication: 05 Dec
2025.
Author
Duan L.; Li D.; Li Z.; Luo W.; Chu X.
Institution
(Duan, Li, Luo) School of Nursing, Chengdu University of Traditional
Chinese Medicine, Chengdu, China
(Li) Department of Thoracic Surgery, Suining Central Hospital, China
(Chu) Department of Nursing, Hospital of Chengdu University of Traditional
Chinese Medicine, Sichuan Province, No. 39 ,Shi-Er-Qiao Road, Chengdu,
China
Abstract
Postoperative pneumonia (POP) is a prevalent and serious complication
following thoracic surgery, substantially increasing morbidity, mortality,
and healthcare expenditures. The aim of this study was to evaluate the
efficacy of perioperative oral care (POC) in reducing the incidence of
POP. A comprehensive literature search was conducted across the Cochrane
Library, Web of Science, PubMed, and Embase from their inception through
September 26, 2024. We included all observational studies and randomized
controlled trials (RCTs) that assessed the impact of POC on POP reduction.
A total of 25 studies, involving 52,227 patients (24,964 in the POC group
and 27,263 in the control group), were included in the final analysis,
comprising 9 RCTs and 16 observational studies. The incidence of POP was
2,887 cases (11.6%) in the POC group, compared with 3,438 cases (12.6%) in
the control group. The meta-analysis revealed that POC was associated with
a significantly reduced incidence of POP in patients undergoing thoracic
surgery (RR, 0.54; 95% CI, 0.44-0.67; p < 0.001; I2 = 72%). In conclusion,
POC significantly reduces the incidence of POP in thoracic surgery
patients, and its integration into perioperative protocols may improve
clinical outcomes. Copyright © 2025. The Author(s).

<160>
Accession Number
2041861620
Title
RAPIDLY REACCUMULATING MALIGNANT PERICARDIAL EFFUSION WITH TAMPONADE: A
POOR PROGNOSIS WITH INCREASING FREQUENCY.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A2895-A2896),
2025. Date of Publication: 01 Oct 2025.
Author
Halloul F.H.; Patel K.; Abusharif A.M.I.R.; Oconnor B.; Bergman M.; Sharma
R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (J) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
Malignant pericardial effusions (MPE) are now the most common etiology of
tamponade. The incidence of MPE is estimated to be about 10-20% based on
autopsies of cancer patients. We present to you a case of recurrent
pericardial effusion with tamponade secondary to malignancy. CASE
PRESENTATION: A 61 year old female with medical history of hypertension,
gout, hyperlipidemia, and 20-pack-year smoking history presented to the
hospital with worsening shortness of breath, fatigue, nonproductive cough,
and congestion for 2 weeks. 1 week prior to admission, she received
Augmentin and prednisone 20 mg BID for 5 days from her PCP for similar
complaints with no improvement. On presentation, she was noted to be
hemodynamically stable, and physical exam was remarkable for basilar
wheezing with chronic left lower extremity swelling. CTA PE showed small
bilateral pleural effusions, large pericardial effusion with mild RV
compression, and a 1.8 cm left lower lobe nodule. Echocardiogram showed
large pericardial effusion with early tamponade physiology prompting
emergent pericardiocentesis yielding 1.2L of serosanguinous fluid. Post
procedure, her respiratory and hemodynamic status improved. Cytology
revealed malignant cells with features of metastatic adenocarcinoma and
papillary features positive for CDX2 and GATA 3. Follow up echo showed
significant recurrence of pericardial effusion within only 2 days
requiring a pericardial window. The pericardial window biopsy was
suspicious for metastatic carcinoma. Oncology recommended thorough
outpatient workup of the metastatic disease and pulmonary nodule with
plans for chemotherapy. Patient was medically stabilized and discharged
from the hospital. However, prior to receiving chemotherapy she returned
to the ED a week later with a PEA arrest and died. DISCUSSION(S):
Pericardial tamponade is a critical and life-threatening condition that
can occur as the initial presentation of MPEs. Large autopsy series
revealed 8.1% of patients with malignancy had pericardial involvement and
2.7% had a pericardial effusion. MPE is considered a marker of advanced
malignancy, with patients presenting anywhere from being asymptomatic to
having cardiac tamponade requiring emergent pericardiocentesis, or even
cardiac arrest. Previously, the primary etiology of pericardial tamponade
was myxedema, tuberculosis, or uremia. However, over the last several
years, there have been observational studies suggesting malignant
effusions are now the most common etiology of tamponade. The gold standard
for diagnosis is cytology analysis of aspirated fluid from
pericardiocentesis. Echocardiogram may reveal RA or RV chamber collapse or
increased mitral and tricuspid inflow velocity variability, and also
serves as a follow up to therapeutic measures and identification of
re-accumulation. Nevertheless, most MPE have a poor overall prognosis and
high mortality. Regardless of therapeutic modalities, the median survival
of patients with malignant cytology is about 7 to 15 weeks compared to
much higher rates for nonmalignant cytology. CONCLUSION(S): Cardiac
tamponade is a life threatening condition that warrants urgent
intervention. MPE is a poor prognostic indicator. Regardless of
therapeutic modalities with pericardiocentesis and pericardial window,
mortality remains high in such cases. With this case, we hope to
contribute to the available literature regarding MPEs and recognition of
its increased incidence and poor prognosis. REFERENCE #1: Mori, S.,
Bertamino, M., Guerisoli, L. et al. Pericardial effusion in oncological
patients: current knowledge and principles of management. Cardio-Oncology
10, 8 (2024). https://doi.org/10.1186/s40959-024-00207-3Heather L. Gornik
et al., Abnormal Cytology Predicts Poor Prognosis in Cancer Patients With
Pericardial Effusion. JCO 23, 5211-5216(2005).DOI:10.1200/JCO.2005.00.745
REFERENCE #2: Mudra SE, Rayes D, Kumar AK, et al. Malignant Pericardial
Effusion: A Systematic Review. CJC Open. 2024;6(8):967-972. Published 2024
May 15. doi:10.1016/j.cjco.2024.05.003 REFERENCE #3: Ben-Horin S, Bank I,
Guetta V, Livneh A. Large symptomatic pericardial effusion as the
presentation of unrecognized cancer: A study in 173 consecutive patients
undergoing pericardiocentesis. Medicine (Baltimore). 2006;85(1):49-53.
doi:10.1097/01.md.0000199556.69588.8e. DISCLOSURES: No relevant
relationships by Amir Abusharif No disclosure on file for Michael Bergman
No relevant relationships by Fadi Halloul No relevant relationships by
Brandon OConnor No relevant relationships by Keval Patel No relevant
relationships by Richa Sharma Copyright © 2025 American College
of Chest Physicians

<161>
Accession Number
2041859811
Title
LOW LDL, HIGH STAKES: A BLEEDING ISSUE.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A2451-A2452),
2025. Date of Publication: 01 Oct 2025.
Author
Tatapudi S.V.; Jawed S.; Murthy A.; Eldaour Y.; Zaid R.; Chaubal V.; Sarva
S.; Cao D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (N) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
Intracerebral hemorrhage accounts for approximately 10-15% of all strokes
and is associated with high morbidity and mortality. While well-known risk
factors include hypertension and anticoagulation, less commonly considered
factors such as extremely low LDL levels may play a role. This report
discusses the clinical course, management, and implications of spontaneous
ICH in a patient with an exceptionally low LDL level. CASE PRESENTATION: A
65-year-old male with a past medical history significant for hypertension,
hyperlipidemia, coronary artery disease status post-coronary artery bypass
grafting, chronic obstructive pulmonary disease on 4L home oxygen,
diabetes mellitus type 2, congestive heart failure, prior alcohol and
tobacco use, and peripheral arterial disease (PAD) status post-stenting,
presented with sudden onset of right-sided weakness and slurred
speech.Upon arrival at the emergency department, a code stroke was
initiated. Initial neurological examination revealed right hemiparesis and
dysarthria. Neuroimaging showed a left thalamic hemorrhage with
intraventricular extension. Incidental findings included an anterior
communicating artery (AComm) aneurysm and a carotid-cavernous fistula.
Neurosurgery and neuro-interventional radiology (Neuro IR) were consulted;
however, it was determined that the AComm aneurysm was not the source of
the hemorrhage.The patient was admitted to the neurocritical care unit for
close monitoring and management. Repeat neuroimaging revealed an increase
in the size of the thalamic hemorrhage. He was treated with prothrombin
complex concentrate for anticoagulation reversal and underwent platelet
transfusion due to suspected platelet dysfunction. Despite these measures,
his neurological status deteriorated, necessitating intubation and the
placement of an external ventricular drain (EVD) to manage elevated
intracranial pressure.Serum lipid analysis revealed an LDL level of 9
mg/dL, which was strikingly low. This raised concerns regarding the
potential relationship between low LDL and spontaneous hemorrhage. After
discussions with the family about the patient's poor neurological
prognosis, he was designated do-not-resuscitate (DNR) and discharged to an
inpatient hospice facility. DISCUSSION(S): This case illustrates the
complex interplay of multiple risk factors contributing to spontaneous
ICH, including hypertension, vascular comorbidities, and potentially,
extremely low LDL levels. While the benefits of aggressive LDL lowering
are well-documented for atherosclerotic cardiovascular disease prevention,
emerging data suggests that excessively low LDL levels may increase the
risk of hemorrhagic stroke. Proposed mechanisms includedecreased synthesis
of structural lipids, weakened endothelium, and microaneurysm formation,
ultimately causing ICH.This raises an important question about the lower
cut-off of LDL levels in such a population. A recent meta-analysis of
randomized controlled trials noted a higher incidence of hemorrhagic
stroke in patients with LDL levels below 50 mg/dL. In this patient, an LDL
of 9 mg/dL may have contributed to the observed hemorrhagic event. This
case underscores the need for individualized cholesterol management,
particularly in patients with multiple cerebrovascular risk factors.
 CONCLUSION(S): This report highlights a rare but clinically
significant association between extremely low LDL levels and spontaneous
ICH. Further research is needed to delineate safe lower bounds for LDL
cholesterol levels and to identify subpopulations at increased risk for
hemorrhagic complications. REFERENCE #1: Ma C, Liu Y, Zhang Y, et al.
Association of low-density lipoprotein cholesterol with risk of
intracerebral hemorrhage: A systematic review and meta-analysis. Stroke.
2022;53(2):549-556. doi:10.1161/STROKEAHA.121.037188 REFERENCE #2: Xie H,
Hu R, Wang J, et al. Low-density lipoprotein cholesterol levels and risk
of intracranial hemorrhage: A mendelian randomization study. Neurology.
2024;102(4):e491-e500. doi:10.1212/WNL.0000000000208012 REFERENCE #3:
Amarenco P, Bogousslavsky J, Callahan A, et al. High-dose atorvastatin
after stroke or transient ischemic attack. N Engl J Med.
2006;355(6):549-559. doi:10.1056/NEJMoa061894 DISCLOSURES: No relevant
relationships by Damon Cao No relevant relationships by Varun Chaubal No
relevant relationships by Yasser ElDaour No relevant relationships by
Shafaq Jawed No relevant relationships by Aishwarya Murthy No relevant
relationships by Sivatej Sarva No relevant relationships by Suhas Tatapudi
No relevant relationships by Rasheed Zaid Copyright © 2025
American College of Chest Physicians

<162>
Accession Number
2041860010
Title
RUPTURED CORDS: A "SHOCK"-ING TALE OF ENDOCARDITIS AND MITRAL MAYHEM.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A381-A382), 2025.
Date of Publication: 01 Oct 2025.
Author
Nair R.; Ahmed S.A.N.A.; Syed B.H.; Mihatov N.I.N.O.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Report Posters (B) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am
INTRODUCTION: Acute mitral regurgitation (MR) presents as a severe
condition due to the heart's inability to adapt to sudden hemodynamic
changes, leading to instability. Left atrial (LA) and left ventricular
(LV) pressures increase rapidly, causing pulmonary edema and cardiogenic
shock. Infective endocarditis (IE) is a common cause of acute MR,
requiring early recognition and intervention to prevent mortality. CASE
PRESENTATION: A 68-year-old female with asthma and mitral valve prolapse
presented with worsening shortness of breath after being treated for an
upper respiratory infection. She was transferred from an outside facility
with severe mitral regurgitation, hypoxia, tachycardia, and unstable
supraventricular tachycardia (SVT), requiring intubation and vasopressors.
Transthoracic echocardiography revealed an acute anterior mitral leaflet
flail. Blood cultures grew methicillin-sensitive Staphylococcus aureus and
Streptococcus Anginosus, raising suspicion for IE.On admission, she had an
elevated Pro-B-type Natriuretic Peptide (ProBNP) to 11,458 pg/ml, troponin
85ng/L, White Blood Cell count 26 x10^3/uL, and lactate 8.1mmol/L.
Coronary Angiography showed nonobstructive coronaries. Right heart
catheterization showed pulmonary wedge pressure of 24 mmHg and left
ventricular end diastolic pressure of 18 mmHg. An Intra-aortic balloon
pump (IABP) was placed, and hemodynamics and pulmonary edema improved over
the next several days with diuresis. Transesophageal echocardiography
confirmed a flail mitral leaflet with thickening and possible vegetations.
She underwent open mitral valve replacement, which revealed torn chordae
tendineae and vegetations on the posterior leaflet. Postoperatively, she
was extubated, weaned off inotropes, and discharged to rehabilitation.
 DISCUSSION(S): This case is notable for acute flail mitral valve,
infective endocarditis, unilateral pulmonary edema, and cardiogenic shock.
Multicenter studies report common acute MR etiologies as ischemic (45%),
myxomatous disease (26%), and endocarditis (28%). Our patient's clinical
course and positive blood cultures, along with (+) major criteria for
endocarditis and echocardiographic findings, lead us to believe that a
bacterial infection of the mitral valve likely lead to the acute mitral
regurgitation. Her underlying mitral valve prolapse likely served as an
anatomically predisposing factor. Early identification and management,
including hemodynamic stabilization with an IABP before surgical
intervention, were crucial to prevent hemodynamic collapse. Unilateral
pulmonary edema in acute MR occurs when regurgitant jets preferentially
affect specific pulmonary veins. In our case, an anterior leaflet flail
likely caused a posteriorly directed jet, contributing to selective
pulmonary congestion in the right lung.Gender can also influence acute MR
diagnosis, management, and prognosis. Studies suggest females with IE are
more often treated conservatively, leading to longer hospital stays and
higher 30-day and 1-year mortality. Chronic MR studies indicate women
undergo delayed surgery due to smaller LV dimensions and lower regurgitant
volumes, despite presenting with more severe heart failure symptoms.
 CONCLUSION(S): Few studies regarding prevalence, incidence, and risk
factors of Acute MR as it pertains to gender exist. Endeavors in these
types of studies, stratified for gender, could be valuable, and have
utility in decreasing diagnosis time and pave further way to advances in
individualized treatment modalities in acute valvopathies. REFERENCE #1:
Nishino S, Watanabe N, Kimura T, Kuriyama N, Shibata Y. "Acute Versus
Chronic Ischemic Mitral Regurgitation: An Echocardiographic Study of
Anatomy and Physiology." Circ Cardiovasc Imaging. 2018;11(4):e007028.
Grenadier E, Alpan G, Keidar S, Palant A. "The prevalence of ruptured
chordae tendineae in the mitral valve prolapse syndrome." Am Heart J. 1983
Apr;105(4):603-10. Portugese, S et al. "Clinical characteristics of
ruptured chordae tendineae in hospitalized patients: primary tear versus
infective endocarditis." Clinical cardiology vol. 21,11 (1998): 813-6.
doi:10.1002/clc.4960211106 REFERENCE #2: Otto CM, Nishimura RA, Bonow RO,
Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod
C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. "2020 ACC/AHA
Guideline for the Management of Patients With Valvular Heart Disease: A
Report of the American College of Cardiology/American Heart Association
Joint Committee on Clinical Practice Guidelines." Circulation.
2021;143(5):e72. Epub 2020 Dec 17. Lorusso R, Gelsomino S, De Cicco G,
Beghi C, Russo C, De Bonis M, Colli A, Sala A. "Mitral valve surgery in
emergency for severe acute regurgitation: analysis of postoperative
results from a multicentre study." Eur J Cardiothorac Surg.
2008;33(4):573. Ravi V, Rodriguez J, Doukky R, Pyslar N. "Acute Mitral
Regurgitation: The Dreaded Masquerader." CASE (Phila). 2018 Jan
3;2(1):12-15. doi: 10.1016/j.case.2017.10.002. PMID: 30062298; PMCID:
PMC6058764. REFERENCE #3: Slouha E, Al-Geizi H, Albalat BR, Burle VS,
Clunes LA, Kollias TF. Sex Differences in Infective Endocarditis: A
Systematic Review. Cureus. 2023 Dec 2;15(12):e49815. doi:
10.7759/cureus.49815. PMID: 38169615; PMCID: PMC10758535.Almeida, A. Sex
Differences in Primary Mitral Regurgitation Assessment: Highlighting the
Role of Regurgitant Fraction. JACC Adv. 2024 Jul, 3 (7_Part_1).
https://doi.org/10.1016/j.jacadv.2024.101020 DISCLOSURES: No relevant
relationships by Sana Ahmed No relevant relationships by Nino Mihatov No
relevant relationships by Ranjit Nair No relevant relationships by Batool
H. Syed Copyright © 2025 American College of Chest Physicians

<163>
Accession Number
649432344
Title
ESC Quality Indicators for Post-myocardial infarction Care: Transition and
Chronic Coronary Syndrome Phases. Developed in collaboration with the
European Association of Preventive Cardiology of the ESC.
Source
European journal of preventive cardiology. (no pagination), 2025. Date of
Publication: 04 Dec 2025.
Author
Gencer B.; Follonier C.; Abdelrahman A.; Rossello X.; Sionis A.; Wilhelm
M.; Koskinas K.; Moholdt T.; Panagiotakos D.; Dendale P.; Biondi-Zoccai
G.; Ahrens I.; Krychtiuk K.A.; Salzwedel A.; Cavarretta E.; Vrints C.;
Andreotti F.; Gale C.P.; Pedretti R.F.E.; Davos C.H.; Aktaa S.
Institution
(Gencer) Service of cardiology, Lausanne University Hospital, Lausanne,
Switzerland
(Follonier) Service of general internal medicine and service of
cardiology, Geneva University Hospitals, Geneva, Switzerland
(Abdelrahman) University Hospital of Wales, United Kingdom
(Rossello) Cardiology Department, University Hospital of Son Espases,
Institut d'Investigacio Sanitaria Illes Balears (IDISBA), Universitat de
les Illes Balears (UIB), Palma de Mallorca, Spain
(Sionis) Acute and intensive cardiac care unit, Hospital de la Santa Creu
I Sant Pau, Barcelona, Spain
(Wilhelm, Koskinas) Centre for Rehabilitation & Sports Medicine,
Inselspital, Bern University Hospital, University of Bern, Switzerland
(Moholdt) Department of circulation and medical imaging, Norwegian
University if Science and Technology, Trondheim, Norway
(Panagiotakos) School of Health Sciences & Education, Harokopio University
of Athens, Athens, Greece
(Dendale) Department of cardiology, Jessa Hospital and Hasselt University
Faculty of medicine and life sciences, Hasselt, Belgium
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Maria Cecilia Hospital, GVM Care & Research, Cotignola,
Italy
(Ahrens) Department of Cardiology and Medical Intensive Care, Hospital of
Cologne, Cologne, Germany
(Krychtiuk) Department of Internal Medicine II - Division of Cardiology,
Medical University of Vienna, Vienna, Austria
(Salzwedel) Department of Rehabilitation Medicine, University of Postdam,
Germany
(Cavarretta) Advanced Cardiovascular Therapies, Bambino Gesu Children
Hospital, IRCCS, Rome, Italy
(Vrints) Department of Cardiology, Antwerp University Hospital, Antwerp,
Belgium
(Andreotti) Cardiovascular Science Department, Fondazione Policlinico
Universitario Gemelli IRCCS, Rome, Italy
(Andreotti) CardioThoracic Department, Catholic University Medical School,
Rome, Italy
(Gale) Leeds Institute of Cardiovascular and Metabolic Medicine,
University of Leeds, Leeds, United Kingdom
(Pedretti) School of Medicine and Surgery, University of Milan Bicocca,
Milan, Italy
(Pedretti) Cardiology Unit, Hospital of Erba, Erba (CO), Italy
(Davos) Cardiovascular Research Laboratory, Biomedical Research
Foundation, Academy of Athens, Athens, Greece
(Aktaa) Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver,
BC, Canada
Abstract
AIMS: We aimed to develop the European Society of Cardiology (ESC) quality
indicators (QIs) for myocardial infarction (MI), from one year after
hospital discharge, corresponding to transition to the chronic coronary
syndromes phase. METHODS AND RESULTS: We collaborated with the European
Association of Preventive Cardiology (EAPC) and developed QIs for the
long-term management of patients following MI. We applied the ESC
methodology for QI development by: (i) determining key domains of post-MI
care; (ii) developing candidate QIs by performing a systematic review of
the literature, and (iii) selecting the final set of QIs using a modified
Delphi approach. In total, 18 QIs were identified across seven domains of
care including (1) structural framework, (2) risk assessment and
follow-up, (3) pharmacological management, (4) rehabilitation, behavioral
and preventive interventions, (5) coronary revascularization, (6) clinical
outcomes and (7) patient-reported outcomes. CONCLUSION(S): We present
the ESC QIs from one year after hospitalization for MI, to standardize and
address gaps in care for this high-risk group. These QIs are supported by
evidence from contemporary literature, endorsed by expert consensus and
aligned with the 2024 ESC guidelines on the management of chronic coronary
syndromes. 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

<164>
Accession Number
2041860560
Title
DEVELOPEMENT OF INTRA-HOSPITAL CEFTRIAXONE RESISTANCE OF SERRATIA
MARCESCENS ENDOCARDITIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1095-A1096),
2025. Date of Publication: 01 Oct 2025.
Author
Doraji M.M.; Malik A.; Denney M.; Chekka P.; Nerella N.K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (U) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Serratia marcescens, a gram-negative bacillus, is an
opportunistic pathogen causing infections, particularly in
immunocompromised individuals. Though rare, it can cause infective
endocarditis with significant morbidity. This case report describes a
patient who presented with Serratia infection and a brain abscess,
initially responsive to ceftriaxone. Despite clinical improvement,
subsequent blood cultures revealed ceftriaxone-resistant Serratia and
subsequent endocarditis during hospitalization. The case highlights the
potential for antibiotic resistance to develop during treatment,
emphasizing the need for vigilant monitoring of resistant pathogens in
hospitalized patients. CASE PRESENTATION: A 44-year-old male with a
history of IV drug use presented in December 2023 with fever, neck pain,
and chills. Blood cultures revealed Serratia marcescens, sensitive to
ceftriaxone and levofloxacin. A TEE showed no cardiac vegetations, and a
chest CTA found a pulmonary embolus. He was treated with ceftriaxone and
discharged on levofloxacin. In June 2024, he returned with fever, chills,
and a brain abscess, again positive for Serratia marcescens. While on
ceftriaxone, he developed a new fever, and cultures showed ESBL Serratia
marcescens, prompting a switch to meropenem. A repeat TEE revealed aortic
valve vegetation. Further complications included splenic infarct requiring
splenectomy, upper extremity DVT, and an ischemic stroke with cerebral
edema. Neurosurgery deferred valve replacement until after six weeks of
antibiotics. The patient required intubation, tracheostomy, and PEG
placement and was later discharged to LTAC on indefinite meropenem therapy
due to embolic events. The case illustrates the rapid development of
ceftriaxone resistance and the need for careful antimicrobial stewardship
in similar patients. DISCUSSION(S): Serratia marcescens is a
gram-negative, rod-shaped bacterium known for causing hospital-acquired
infections, especially catheter-associated bacteremia, UTIs, and wound
infections. Its ability to form biofilms enhances its pathogenicity and
antibiotic resistance. It survives in adverse environments like
disinfectant solutions due to metabolic versatility. Resistance mechanisms
include intrinsic, acquired, and adaptive resistance, with possible gene
transfer or AmpC beta-lactamase production contributing to resistance
against multiple antibiotics. In this case, ceftriaxone resistance
developed rapidly, possibly due to reinfection or environmental factors.
The patient, with a history of drug use, recovered initially but later
showed ceftriaxone-resistant Serratia in subsequent cultures.
 CONCLUSION(S): This case highlights the rapid development of
ceftriaxone-resistant Serratia marcescens in a hospitalized patient,
resulting in infective endocarditis, brain abscess, splenic infarct, and
stroke. The patient's course underscores the challenges posed by
antibiotic resistance, particularly with AmpC beta-lactamase production.
It also demonstrates the potential for resistance to emerge during
therapy, even with initially appropriate treatment. Vigilant monitoring,
antimicrobial stewardship, and further research into the mechanisms of
Serratia resistance are critical to improving patient outcomes in similar
cases. REFERENCE #1: Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu
VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective
endocarditis, 1990-2010: a systematic review of the literature. Glob
Heart. 2014 Mar;9(1):131-43. doi: 10.1016/j.gheart.2014.01.002. PMID:
25432123. REFERENCE #2: Aracil-Gisbert S, Fernandez-De-Bobadilla MD,
Guerra-Pinto N, Serrano-Calleja S, Perez-Cobas AE, Soriano C, de Pablo R,
Lanza VF, Perez-Viso B, Reuters S, Hasman H, Canton R, Baquero F, Coque
TM.2024.The ICU environment contributes to the endemicity of the "Serratia
marcescens complex" in the hospital setting.
mBio15:e03054-23.https://doi.org/10.1128/mbio.03054-23 REFERENCE #3:
Tavares-Carreon F, De Anda-Mora K, Rojas-Barrera IC, Andrade A. Serratia
marcescens antibiotic resistance mechanisms of an opportunistic pathogen:
a literature review. PeerJ. 2023 Jan 5;11:e14399. doi:
10.7717/peerj.14399. PMID: 36627920; PMCID: PMC9826615. DISCLOSURES: No
relevant relationships by Praveen Chekka No relevant relationships by
Michael Denney No relevant relationships by Mahyar Mahdavi Doraji No
relevant relationships by Adeel Malik No relevant relationships by Nishant
Nerella Copyright © 2025 American College of Chest Physicians

<165>
Accession Number
649438952
Title
Comparison Between Dexmedetomidine and Propofol as a Post-Operative
Sedative After Coronary Artery Bypass Graft Surgery.
Source
QJM: An International Journal of Medicine. Conference: 45th Annual Ain
Shams Medical Congress. Cairo Egypt. 118(Supplement 1) (pp i11), 2025.
Date of Publication: 01 Nov 2025.
Author
Abdel Aleem A.A.; Abdel Gawad A.T.; Nassif G.M.; Awad Fadlallah A.R.
Institution
(Abdel Aleem, Abdel Gawad, Nassif, Awad Fadlallah) Department of
Anesthesiology, Intensive Care and Pain Management Faculty of Medicine,
Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
Background: Dexmedetomidine has a pharmacological profile that should
allow rapid recovery and prevent undesirable outcomes. Post-operative use
of dexmedetomidine reduces the time spent on mechanical lung ventilation,
shorten ICU and hospital stay, and decrease post-operative complications.
 Objective(s): The primary outcome of the study was to compare the
effect of dexmedetomidine and propofol on outcomes as a post-operative
sedative after CABG surgery. While the secondary outcome of the study was
to compare the duration of mechanical ventilation, length of ICU and
hospital stay, extra analgesic requirement and incidence of post-operative
complications between dexmedetomidine and propofol as a post-operative
sedative after CABG surgery. Patients and Methods: This prospective,
randomized, single blind, controlled clinical trial was carried out on 60
patients who underwent CABG surgery admitted to Open heart surgery ICU,
Ain shams university hospital, Cairo, Egypt, from June to December 2023,
after approval from Institutional Ethical Committee. Result(s): RASS
scale measurements at baseline and 15min were insignificantly different
between both groups while measurements at 30, ,45, 60 min,
2hr,3hr,4hr,5hr,6hr,7hr and 8hr were significantly lower in group 1 than
group 2. Extra analgesic requirements were insignificantly different
between both groups. Duration of MV, length of ICU stays, and hospital
stay were significantly lower in group 1 than group2. According to
postoperative adverse events, hypotension and tachycardia were
significantly lower in group 1 than group 2 and bradycardia was
significantly higher in group 1 than group 2. While nausea was
insignificantly different between both groups. Conclusion(s):
Dexmedetomidine is more effective as a post-operative sedative after
coronary artery bypass graft surgery by lowering duration of MV, length of
ICU stays, and hospital stay with better hemodynamics and sedation level
compared to propofol group.

<166>
Accession Number
649439352
Title
Post-Operative Wound Infection in Adult Cardiac Surgery: Systematic Review
and Meta-Analysis.
Source
QJM: An International Journal of Medicine. Conference: 45th Annual Ain
Shams Medical Congress. Cairo Egypt. 118(Supplement 1) (pp i17-i18), 2025.
Date of Publication: 01 Nov 2025.
Author
Hassan R.R.; Abdel-Hamid Mourad H.E.-D.A.; Gamal Mostafa M.A.; Amar F.
Institution
(Hassan, Abdel-Hamid Mourad, Gamal Mostafa, Amar) Cardiothoracic Surgery
Department; Faculty of Medicine, Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
Background: A rare but possibly fatal side effect of heart surgery's
median stermotomy is deep sternal wound infection (DSWT), According to
reports, the prevalence of DSWI varies between 0.2% and 3%, depending on
the patient group, study design, and year of publication (1-8). DSWI has a
considerable negative impact on healthcare outcomes despite its low
occurrence These effects include elevated 30-day and 1-year death
rates(,3,5,6.9) reduced long-term survival, (6) extended hospital stays.
(5.9) and higher-than-average treatment expenditures. (5.9) Surgical site
infections (SSI) can develop directly from the wound, contiguously from
nearby tissues, descending from the head and neck, necrotizing infections,
ar by blood-borne pathways (10), Infection of the sternotomy wound can
affect the mediastinum, bone, cartilage. or subcutaneous tissue, the
latter of which can result in the dreaded complication of mediastinitis.(
11) Objective: To evaluate the outcomes & complications and mortality of
deep sternal wound infection after adult cardiac surgery Methods: All
clinical studies (of any design) reporting post-operative outcomes of deep
sternal wound infection after adult cardiac surgery, Patient diagnosed
with deep sternal wound infection after adult cardiac surgery Valvular
replacement or CABG with median sternotomy The study cases included
Patient diagnosed with deep sternal wound infection after adult cardiac
surgery while Studies reporting less than 6 cases, case reports, and
abstract only added, studies in other languages than English, articles not
published in peer-reviewed journals were excluded in our study Titles and
Abstracts of identified articles will be screened for relevance,
subsequently full text review of relevant articles will be done to asses
for eligibility criteria, when there is doubt. a second reviewer will
assess the article and consensus will be reached. Result(s): In the
study we find 1) Forest plot for overall mortality: DSWI is significantly
associated with higher risk of mortality [RR-2.68 (2.10, 3.41)]. Forest
plot for length of hospital stay (LOS): There is no significant difference
between patients with DSWI and patients without DSWI regarding length of
hospital stay [SMD-2.08 (-0.43, 4.58)] (DSWI has no effect on length of
stay). Comparison between VAC and non-VAC regarding mortality rate: 0.601)
VAC modality is significantly associated with lower mortality rate
(RR-0.35 10.21, Comparison between VAC and non-VAC regarding length of
hospital stay: No significant difference between two groups regarding
length of hospital stay (SMD-0.64-0.45, 1.74]) Conclusion(s): In the
study we concluded that DSWI is significantly associated with higher risk
of mortality, VAC modality is significantly associated with lower
mortality rate, VAC modality is significantly associated with lower
mortality rate, No significant difference between two groups tegarding
length of hospital stay.

<167>
Accession Number
2041860220
Title
A RARE CASE OF PNEUMOMEDIASTINUM, PNEUMOPERITONEUM, AND PNEUMORRHACHIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4105-A4106),
2025. Date of Publication: 01 Oct 2025.
Author
Berro J.A.N.A.; Nasr K.; Saleem T.; Gandhi Z.J.; Jokomo-Nyakabau R.;
Ashton R.W.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Mediastinal Cases That Defy the Diagnostic Norm SESSION
TYPE: Case Reports PRESENTED ON: 10/20/2025 09:15 am - 10:15 am
INTRODUCTION: Pneumomediastinum, pneumoperitoneum, and pneumorrhachis can
result from both traumatic and atraumatic etiologies. Notably,
pneumorrhachis has been observed in approximately 5.8% of patients with
pneumomediastinum (1). We present a case featuring the simultaneous
occurrence of these three phenomena, raising the possibility of a unifying
underlying pathophysiologic mechanism. CASE PRESENTATION: A 20-year-old
male with a history of an anomalous right coronary artery s/p surgical
correction and unroofing, pectus excavatum, and hyperemesis secondary to
marijuana use presented with persistent nausea, vomiting, and diarrhea
attributed to norovirus, accompanied by acute chest pain. CT with oral
contrast revealed extensive pneumomediastinum and pneumoperitoneum, as
well as free air within the cervical and thoracic epidural spaces
consistent with pneumorrhachis. He was admitted to the medical intensive
care unit for multidisciplinary evaluation by thoracic surgery and
neurosurgery and was initiated on empiric therapy with meropenem,
vancomycin, and fluconazole. A dedicated CT chest with contrast was
performed to exclude esophageal perforation, with no evidence of contrast
extravasation identified. The patient was managed conservatively,
advancing from a liquid to a regular diet, with subsequent clinical
improvement and discontinuation of antimicrobial therapy. He was
ultimately discharged, and follow-up with medical genetics was arranged to
assess for an underlying connective tissue disorder. DISCUSSION(S):
The overall reported incidence of combined spontaneous and secondary
pneumomediastinum ranges from 1 in 7000 to 45000. Its frequency appears
higher in certain high-risk groups such as young males and patients with
underlying lung pathology (2). Pneumorrhachis, a rare finding
predominantly diagnosed via imaging, may occur in traumatic or iatrogenic
settings. While usually asymptomatic, it can be associated with
complications including myelopathy, radiculopathy, and spondylodiscitis
(3,4). Pneumoperitoneum is most often iatrogenic, typically occurring
after abdominal surgery or invasive procedures; spontaneous
pneumoperitoneum, in the absence of gastrointestinal perforation, is
exceedingly rare and its exact incidence is not well defined. However,
spontaneous cases are estimated to represent only a small fraction of all
pneumoperitoneum cases (5). Moreover, the coexistence of pneumomediastinum
and pneumoperitoneum, albeit infrequently encountered, has been attributed
to anatomic communications that allow air to traverse between compartments
(6). The proposed mechanism is that the neck and mediastinum communicate
with the peritoneal and retroperitoneal cavities through sharing a common
visceral space that inverts the esophagus and the trachea and then follows
the esophagus down through the diaphragmatic hiatus (6). In our case, the
absence of esophageal perforation and the clinical context point toward
air dissection secondary to elevated intrathoracic pressure (Macklin
effect) as the most likely mechanism. Air could diffuse from the
mediastinal tissue layers through the inter-vertebral foramen leading to
pneumorrhachis. In this instance an underlying connective tissue disorder
cannot be entirely excluded that may assist in air diffusion across the
cavities. CONCLUSION(S): To our knowledge, we present the first case
of a non-iatrogenic and non-traumatic simultaneous pneumomediastinum,
pneumoperitoneum, and pneumorrhachis. This presentation underscores the
importance of comprehensive imaging and clinical evaluation, as well as
consideration of an underlying connective tissue disorder. REFERENCE #1:
(1) Behr G, Mema E, Costa K, Garg A. Proportion and Clinical Relevance of
Intraspinal Air in Patients With Pneumomediastinum. AJR Am J Roentgenol.
2018 Aug;211(2):321-326. doi: 10.2214/AJR.17.19256. Epub 2018 May 29.
PMID: 29812979; PMCID: PMC7956126. REFERENCE #2: (2) Grewal J, Gillaspie
EA. Pneumomediastinum. Thorac Surg Clin. 2024 Nov;34(4):309-319. doi:
10.1016/j.thorsurg.2024.06.001. Epub 2024 Jul 26. PMID: 39332856.(3)
Osunronbi T, Sofela A, Sharma H, Muquit S. Traumatic pneumorrhachis:
systematic review and an illustrative case. Neurosurg Rev.
2021;44(2):731-739. doi:10.1007/s10143-020-01300-8(4) Bally K, Leikin S,
Margetis K, Reynolds AS. Extensive Pneumorrhachis After Spontaneous
Pneumomediastinum. World Neurosurg. 2020;142:392-395.
doi:10.1016/j.wneu.2020.07.091 REFERENCE #3: (5) Tanner TN, Hall BR, Oran
J. Pneumoperitoneum. Surg Clin North Am. 2018 Oct;98(5):915-932. doi:
10.1016/j.suc.2018.06.004. PMID: 30243453.(6) Kourounis G, Lim QX, Rashid
T, Gurunathan S. A rare case of simultaneous pneumoperitoneum and
pneumomediastinum with a review of the literature. Ann R Coll Surg Engl.
2017;99(8):e241-e243. doi:10.1308/rcsann.2017.0165 DISCLOSURES: No
relevant relationships by Rendell Ashton No relevant relationships by Jana
Berro No relevant relationships by Zainab Gandhi No relevant relationships
by Rutendo Jokomo-Nyakabau No relevant relationships by Rutendo
Jokomo-Nyakabau No relevant relationships by Kristina Nasr No relevant
relationships by Talha Saleem Copyright © 2025 American College
of Chest Physicians

<168>
Accession Number
649438905
Title
Comparison of Ultrasound Guided Single Shot Erector Spinae Plane Block
Versus Transversus Thoracic Plane Block for Acute Post Sternotomy Pain
Management in Pediatric Cardiac Surgery: Randomized Clinical Trial.
Source
QJM: An International Journal of Medicine. Conference: 45th Annual Ain
Shams Medical Congress. Cairo Egypt. 118(Supplement 1) (pp i10), 2025.
Date of Publication: 01 Nov 2025.
Author
Mahmoud Abd-El Fattah K.A.-E.F.; Ei Magged Mohamed Altaher W.A.; Amer A.M.
Institution
(Mahmoud Abd-El Fattah, Ei Magged Mohamed Altaher, Amer) Anesthesia
Department, Faculty of Medicine, Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
Background: Ineffective management of postoperative pain following
pediatric cardiac surgery conducted through a sternotomy adversely affects
a patient's postoperative course It could result in delayed recovery,
prolonged mechanical ventilation, prolonged intensive care unit (ICU)
stay, prolonged hospital stays, and/or adverse psychological sequelae. Aim
of the Work: To compare ultrasound guided single shot ESPB versus TTPB for
acute post-sternotomy pain management in pediatric cardiac surgery as
regard the total dose of fentanyl consumption in the first 24 hours after
extubation, the intraoperative fentanyl requirement, post extubation pain
score, postoperative hemodynamic parameters, time of first rescue
analgesic requirement, and incidence of adverse events. Patients and
Methods: This prospective comparative randomized study was conducted on 50
pediatric patients undergoing elective cardiac surgical procedure through
median sternotomy in cardiac surgery operating theater in Ain Shams
university hospitals over period of 6 months. After approval of research
ethical committee of Ain Shams university, Cairo, Egypt; with
institutional review board (IRB) number FMASU MS62/2024, informed consent
was obtained from patients' guardian prior to enrollment. Result(s):
Intraoperative HR and MAP were insignificantly different in both groups.
Postoperative HR and MAP was significantly lower at 2h, 4h and 6h in ESPB
group than TTPB group. Total blood loss, total intraoperative fentanyl
consumption and time of extubation were insignificantly different between
both groups. Time of the first call of rescue analgesic dose
post-extubation was significantly delayed in ESPB group than TTPB group.
Total fentanyl consumption during 24hrs after extubation was significantly
lower in ESPB group than TTPB group. Pain score was significantly lower at
2h, 4h and 6h in ESPB group than TTPB group. Postoperative respiratory
rate was significantly lower at 2h, 4h and 6h in ESPB group than TTPB
group. Conclusion(s): Ultrasound guided single shot ESPB and TTPB
offer adequate intra and postoperative analgesia with low incidence of
adverse events in pediatric patients undergo cardiac surgical procedures
through median sternotomy approach, yet ESPB offers superior analgesic
efficacy in the late postoperative period after 3 hours post-extubation,
which is evidenced by lower pain score and opioid consumption, delayed
time to first rescue analgesic and hemodynamic stability.

<169>
Accession Number
2041860352
Title
A CASE OF BICUSPID AORTIC VALVE AND PULMONIC VALVE INFECTIVE ENDOCARDITIS
WITH AORTIC ROOT ABSCESS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1121-A1122),
2025. Date of Publication: 01 Oct 2025.
Author
Valencia S.; Sahn H.; Kanor U.N.A.; Adelkhanova A.L.L.A.; Wortsman
J.O.S.H.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (W) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Infective endocarditis (IE) is a microbial infection of the
heart valves, often affecting the left-sided heart structures, especially
the aortic valve. Risk factors include rheumatic heart disease, presence
of prosthetic heart valves, congenital heart defects, intravenous drug use
(IVDU), and a history of IE. In rare cases, the right side of the heart is
affected, occurring only in about 5-10% of all IE cases. The tricuspid
valve is preferentially affected over the pulmonic valve, with pulmonic
valve endocarditis being the rarest manifestation composing 1.5-2% of
total IE cases. This report details a young, otherwise healthy woman
diagnosed with IE complicated by an aortic root abscess and pulmonic valve
vegetation, along with previously undiagnosed bicuspid aortic valve (BAV).
CASE PRESENTATION: A 30-year-old woman with a childhood history of a heart
murmur and poor oral hygiene (Figure 1), which required multiple dental
procedures, presented with pleuritic left-sided chest pain and dyspnea.
She had no history of IVDU. During her hospitalization, she developed a
fever, prompting an infectious work-up that revealed elevated inflammatory
markers. A transthoracic echocardiogram (Figure 2) identified a Type II
BAV with mild valve thickening and abnormal flow in the aortic root. Given
the suspicion of IE, a transesophageal echocardiogram (TEE) was performed
(Figure 3), revealing small masses on the aortic valve leaflets,
suggesting vegetations, and mild regurgitation with inability to rule out
an aortic root abscess. Initial blood cultures came back positive for
Streptococcus mitis/oralis. The patient was transferred to a tertiary care
center for further evaluation and treatment. At the tertiary center, a
repeat TEE showed progression to severe aortic regurgitation and suspicion
of pulmonic valve vegetation. She underwent surgery, receiving aortic root
and pulmonary valve replacements with a pulmonary homograft. Pathology of
the BAV confirmed acute and subacute bacterial endocarditis with
gram-positive cocci. Repeat blood cultures resulted negative, and she was
discharged on a 6-week course of intravenous Ceftriaxone therapy.
 DISCUSSION(S): Infective endocarditis carries significant morbidity
and mortality, and antibiotic prophylaxis in high-risk patients is
recommended to reduce the risk of developing the condition. BAV, a common
congenital cardiac abnormality affecting 1-2% of the general population,
significantly increases the risk of developing IE. Previous studies have
shown that BAV patients are at risk for severe IE complications, such as
aortic aneurysm, dissection, rupture, and right-sided endocarditis.
Notably, these complications are comparable to those of high-risk
patients. However, these patients are still considered intermediate-risk,
and current guidelines do not recommend antibiotic prophylaxis for them.
 CONCLUSION(S): This case highlights a previously healthy young woman
with undiagnosed BAV who developed severe IE with rare complications,
including right-sided endocarditis with pulmonic valve involvement and
aortic root abscess. Given the increased risk of severe complications in
BAV patients, further studies are needed to evaluate the potential
benefits of antibiotic prophylaxis for this population. REFERENCE #1:
Pereira SC, Abrantes AL, Antonio PS, Morais P, Sousa C, David C, Pinto FJ,
Almeida AG, Caldeira D. Infective endocarditis risk in patients with
bicuspid aortic valve: Systematic review and meta-analysis. Int J Cardiol
Heart Vasc. 2023 Jul 28;47:101249. doi: 10.1016/j.ijcha.2023.101249. PMID:
37547264; PMCID: PMC10400861. REFERENCE #2: Pais JP, Sousa M, Mota R,
Cambao AR, Nascimento A. Right-Side Endocarditis: A Typical Presentation
in an Atypical Patient. Cureus. 2021 Oct 19;13(10):e18897. doi:
10.7759/cureus.18897. PMID: 34820219; PMCID: PMC8601156. REFERENCE #3:
Perez-Viloria ME, Lopez K, Malik F, Lopez O, Yatham P, Malik R, Rosen G. A
Rare Case of Pulmonic and Aortic Valve Infective Endocarditis: A Case
Report. Cureus. 2022 Nov 23;14(11):e31820. doi: 10.7759/cureus.31820.
PMID: 36579216; PMCID: PMC9788795. DISCLOSURES: No relevant relationships
by Alla Adelkhanova No relevant relationships by Una Kanor No relevant
relationships by Henry Sahn No relevant relationships by Stephanie
Valencia No relevant relationships by Josh Wortsman Copyright ©
2025 American College of Chest Physicians

<170>
Accession Number
2041863705
Title
COMPARATIVE OUTCOMES OF BALLOON-EXPANDABLE VS SELF-EXPANDABLE
TRANSCATHETER AORTIC VALVE IMPLANTATION IN BICUSPID AORTIC VALVE STENOSIS:
A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A264-A265), 2025.
Date of Publication: 01 Oct 2025.
Author
Maloth A.K.; Lefranc W.; Jangid G.; Thapa S.; Baweja T.; Shaikh A.;
Varghese R.M.; Allagoa T.T.; Das S.; Ajith P.; Kantamaneni S.; Hadeed
Khawar M.M.; Khawar M.M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Scientific Abstract Posters (A)
SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2025
01:45 pm - 02:30 pm PURPOSE: This meta-analysis aims to compare clinical
outcomes between balloon-expandable (BEV) and self-expandable (SEV)
transcatheter aortic valve implantation (TAVI) in patients with bicuspid
aortic valve (BAV) stenosis. We evaluated key post-procedural
complications, mortality, and device performance to guide clinical
decision-making. METHOD(S): A systematic search of PubMed, EMBASE,
ScienceDirect, and Cochrane databases was conducted. Studies comparing BEV
and SEV in patients with BAV stenosis undergoing TAVI were included based
on predefined eligibility criteria. Odds ratios (ORs) with 95% confidence
intervals (CIs) were used for all dichotomous outcomes. A random or
fixed-effects model was applied based on heterogeneity (I2 statistics) to
ensure accurate effect estimation. RESULT(S): This meta-analysis
included 1,650 patients (BEV=863, SEV=787). SEV was associated with
significantly higher risks of new pacemaker implantation (OR 0.59, 95% CI:
0.44-0.80, p=0.0005), moderate/severe paravalvular leak (OR 0.48, 95% CI:
0.28-0.82, p=0.008), and second valve implantation (OR 0.49, 95% CI:
0.26-0.92, p=0.03), favoring BEV in these outcomes. Additionally, AKI was
significantly lower in BEV patients (OR 0.54, 95% CI: 0.32-0.93, p=0.03),
suggesting a renal protective effect.Conversely, no significant
differences were observed in one-year mortality (OR 0.88, 95% CI:
0.61-1.28, p=0.51) or 30-day mortality (OR 0.67, 95% CI: 0.37-1.20,
p=0.18), indicating comparable survival. Similarly, annulus rupture (OR
2.44, 95% CI: 0.67-8.88, p=0.18), procedural mortality (OR 1.46, 95% CI:
0.51-4.23, p=0.48), and stroke incidence (OR 0.80, 95% CI: 0.40-1.61,
p=0.54) were not significantly different between groups.
 CONCLUSION(S): Both BEV and SEV demonstrate comparable outcomes in
terms of overall and early mortality in BAV patients undergoing TAVI.
However, BEV is associated with a lower risk of AKI, second valve
implantation, new pacemaker requirement, and moderate/severe PVL. These
findings suggest that BEV may be the preferred choice in patients at risk
of conduction disturbances or PVL, while SEV remains a viable alternative.
CLINICAL IMPLICATIONS: This analysis provides evidence for device
selection in TAVI procedures for BAV stenosis. Clinicians should consider
individual patient risk factors, particularly conduction disturbances and
the likelihood of PVL, when choosing between BEV and SEV. Further
randomized controlled trials are needed to validate these findings and
refine patient selection criteria. DISCLOSURES: No relevant relationships
by Parvathy Ajith No relevant relationships by Theresa Allagoa No relevant
relationships by Tanish Baweja No relevant relationships by Soumyadeep Das
No relevant relationships by Gurusha Jangid No relevant relationships by
Sahithi Kantamaneni No relevant relationships by Mirza M Hadeed Khawar No
relevant relationships by Muhammad Muneeb Khawar No relevant relationships
by Wodwentzky Lefranc No relevant relationships by Arun Kumar Maloth No
relevant relationships by Aliyanoor Shaikh No relevant relationships by
Sumin Thapa No relevant relationships by Rebecca Maria
Varghese Copyright © 2025 American College of Chest Physicians

<171>
Accession Number
2041863357
Title
THE JOURNEY OF RETAINED EPICARDIAL PACING WIRES: A SYSTEMATIC REVIEW OF
MIGRATION SITES AND MECHANISMS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A294-A295), 2025.
Date of Publication: 01 Oct 2025.
Author
Akele O.; Osuji E.; Shahani R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Scientific Abstract Posters (B)
SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2025
01:45 pm - 02:30 pm PURPOSE: Temporary epicardial pacing wires (TEPWs) are
routinely used post-cardiac surgery for temporary rhythm management.
However, retained TEPWs can migrate over time, leading to serious
complications such as vascular embolization, organ perforation, and
infection. The mechanisms underlying their migration remain poorly
understood. This systematic review aims to identify common migration
sites, analyze contributing factors, and propose a mechanistic framework
explaining the pathophysiology of TEPW migration. METHOD(S): A
systematic review was conducted using PRISMA guidelines across PubMed,
Embase, and ScienceDirect (last accessed February 2025). Case reports and
series documenting TEPW migration were included. Data were extracted on
demographics, surgical factors, migration locations, associated symptoms,
time to detection, and hypothesized mechanisms. The risk of bias was
assessed using the Joanna Briggs Institute Critical Appraisal Tools for
case reports and case series by two independent reviewers, with
discrepancies resolved by a third reviewer. Data were extracted and
categorized based on demographic, surgical, and migration characteristics
and potential pathophysiological mechanisms. RESULT(S): A total of 22
studies involving 23 patients with migrated TEPWs were included. Migration
varied in location and timeline, with detection ranging from days to years
postoperatively. Most cases were identified incidentally via imaging, with
computed tomography (CT) providing the most detailed visualization. Atrial
wires predominantly migrated toward the aorta and carotid arteries, while
the use of both wires resulted in variable migration sites. Less common
extracardiac migration sites included the jaw, colon, mediastinum, and
bronchi. Migration outside the cardiovascular system was frequently
symptomatic (e.g., chest pain, cough, fever, neurological symptoms),
whereas intravascular migration was often asymptomatic and detected
incidentally on imaging. A significant correlation was noted between TEPW
number and infection rates, with 7 of 16 patients (43.8%) with multiple
wires developing infections, compared to 1 of 7 (14.3%) with a single
wire. CT and echocardiography (TTE/TEE) were the most effective imaging
modalities, with CT offering superior visualization. CONCLUSION(S):
TEPW migration is a multifactorial process influenced by mechanical,
inflammatory, and hemodynamic forces. Continuous cardiac motion, pulsatile
blood flow, vascular erosion, wire material properties, fixation method,
and inflammatory responses contribute to migration, while infection and
fibrosis may exacerbate movement. Although often asymptomatic, migration
can lead to severe complications requiring intervention. Standardized
placement, monitoring, and removal protocols are needed to mitigate risks.
Further studies should refine risk stratification and develop
evidence-based guidelines to prevent migration-related morbidity. CLINICAL
IMPLICATIONS: Understanding TEPW migration is crucial for improving
postoperative care and patient safety. This review highlights the
propensity of atrial wires for ectopic migration due to pulsatile forces
and the increased infection risk associated with multiple cables. Routine
imaging should be considered for high-risk patients. Selective placement
strategies may help reduce infection and migration risks. Standardized
protocols for placement, monitoring, and removal are needed. Retained
wires should be removed when possible, with follow-up imaging for patients
with a high risk of migration. Future innovations could enhance safety,
including bioresorbable pacing wires and predictive models. Long-term
surveillance is essential for preventing adverse outcomes and optimizing
postoperative care. DISCLOSURES: No relevant relationships by Oluwakorede
Akele No relevant relationships by Evans Osuji No relevant relationships
by ROHIT SHAHANI Copyright © 2025 American College of Chest
Physicians

<172>
Accession Number
2041863451
Title
A REALLY BAD CASE OF THE FLU: INFLUENZA A MYOCARDITIS RESULTING IN CARDIAC
TAMPONADE AND CARDIOGENIC SHOCK.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1034-A1035),
2025. Date of Publication: 01 Oct 2025.
Author
Rabin S.; Tatavarthy M.; Heinrich C.; Suboc T.; Eastburg B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (R) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Influenza A has emerged as a significant public health
concern this season, with reports of 33 million illnesses, 430,000
hospitalizations, and 19,000 deaths to date (1). This year's flu season
has been characterized as "high severity," overwhelming healthcare
systems, and increasing morbidity and mortality (1). Among the less
common, yet serious, complications of influenza A is myocarditis, a
condition that poses a considerable diagnostic and therapeutic challenge
due to its rarity and potential for severe outcomes including heart
failure and cardiogenic shock (2). CASE PRESENTATION: The patient is a
26-year-old female with past medical history of mild intermittent asthma
who originally presented to the Emergency Department with chest pain and
shortness of breath. She was tachycardic to the 120s on arrival but was
otherwise afebrile, hemodynamically stable, and saturating well on room
air. She was found to be influenza A positive for which she was started on
Oseltamivir (Tamiflu). Lab work was also significant for elevated high
sensitivity troponin which peaked at 338.5 and elevated lactic acid of
6.2. She was originally admitted to the general medicine floor for further
management but quickly became more tachycardic and hypotensive with repeat
labs showing profound metabolic acidosis with pH 7.1, bicarbonate of 6,
and lactic acid of 12.8. A bedside echocardiogram was obtained which
showed a large pericardial effusion with features concerning for cardiac
tamponade. The patient was transferred to the Cardiac Intensive Care Unit
where she was emergently taken for pericardiocentesis, right heart
catheterization, and intra-aortic balloon pump (IABP) placement. Right
heart catheterization revealed biventricular failure with cardiac index of
1.7 (thought to be falsely elevated in the setting of high FiO2 as patient
was placed on non-rebreather for procedure) and pulmonary artery
pulsatility index of 0.46. She remained persistently acidotic with lactic
acid > 15 so she was ultimately cannulated onto VA ECMO and started on
inotropic support with Milrinone. She received IVIG and high dose steroids
for treatment of fulminant myocarditis and was ultimately able to be
weaned off inotropes and decannulated from ECMO. She was discharged home
in stable condition on guideline-directed medical therapy.
 DISCUSSION(S): Fulminant myocarditis is an extremely rare
complication of the flu, typically only seen in 2.5% to 10% of patients
with influenza A (3). It is even less common in young patients without
comorbid conditions, like the patient in this case. Although generally
considered a mild, self-limiting infection, influenza carries a rare but
serious risk of adverse events that must be diagnosed and acted on with
urgency to prevent significant morbidity and mortality. This patient's
condition rapidly progressed over a short period of time - without quick
identification of this life-threatening complication and immediate
intervention with pericardiocentesis, IABP, and VA ECMO, this patient may
not have survived her hospitalization. CONCLUSION(S): Utilization of
bedside point of care ultrasound and early multidisciplinary involvement
of surgical and procedural teams can result in better outcomes for
patients facing life-threatening conditions. REFERENCE #1: Centers for
Disease Control and Prevention. (2025, February 22). Influenza
surveillance report, 2025 - Week 07. Centers for Disease Control and
Prevention. REFERENCE #2: Tyrrell CS, Allen JLY, Gkrania-Klotsas E.
Influenza: epidemiology and hospital management. Medicine (Abingdon). 2021
Dec;49(12):797-804. doi: 10.1016/j.mpmed.2021.09.015. Epub 2021 Nov 12.
PMID: 34849086; PMCID: PMC8624711. REFERENCE #3: Ouranos K, Vassilopoulos
S, Vassilopoulos A, Shehadeh F, Mylonakis E. Cumulative incidence and
mortality rate of cardiovascular complications due to laboratory-confirmed
influenza virus infection: A systematic review and meta-analysis. Rev Med
Virol. 2024 Jan;34(1):e2497. doi: 10.1002/rmv.2497. Epub 2023 Dec 21.
PMID: 38126946. DISCLOSURES: No relevant relationships by Benjamin
Eastburg No disclosure submitted for Christopher Heinrich No relevant
relationships by Sydney Rabin No disclosure on file for Tisha Suboc No
relevant relationships by Manvita Tatavarthy Copyright © 2025
American College of Chest Physicians

<173>
Accession Number
2041859955
Title
THE SALAD NO ONE ORDERED: A CASE OF H. PARAINFLUENZAE ENDOCARDITIS IN A
YOUNG FEMALE.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1516-A1517),
2025. Date of Publication: 01 Oct 2025.
Author
Malik A.B.U.-B.A.K.R.; Vu M.K.; Tang H.O.A.N.G.-A.N.H.; Afroze A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Beyond the Lung: Unusual Sources of Chest Infections
SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/22/2025 10:20 am -
11:05 am INTRODUCTION: Infective endocarditis (IE) is a life-threatening
cardiac infection by bacteria or fungi, with an annual incidence of 3 to
10 cases per 100,000 people (1). Staphylococcus aureus is the most common
causative pathogen, accounting for approximately 30% of cases, while
Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella
(HACEK) - gram-negative bacteria commonly found in oral flora and the
respiratory tract - make up less than 2% (2,3). Haemophilus parainfluenzae
is exceedingly rare with just 39 cases documented (4). The mitral valve is
frequently affected in IE (5). Diagnosis of IE can be challenging,
requiring a strong clinical suspicion, multiple blood cultures, and
echocardiography. Surgical intervention, particularly mitral valve repair
or replacement, is commonly performed due to the high risk of embolism in
IE (6). Here, we present a case of H. parainfluenzae infective
endocarditis in a 25-year-old female. CASE PRESENTATION: A 25-year-old
female presented with four weeks of persistent fevers and chills of
unknown etiology. Her history was notable for recent dental work and a
self-reported absence of intravenous drug use. Upon presentation, she was
noted to have leukocytosis with an elevated procalcitonin, however soon
developed septic shock requiring vasopressor support and admission to the
intensive care unit. Blood cultures were obtained, and empiric
ceftriaxone, vancomycin, and doxycycline were started. Transesophageal
echocardiogram revealed a 2cm mitral valve vegetation and severe
regurgitation prompting urgent mitral repair with P3 quadrangular
resection and sliding plasty. Postoperatively, she required brief
ventilatory and vasopressor support, but was quickly liberated from both.
She was discharged home on ceftriaxone to complete a four-week course.
Blood cultures as well as tissue PCR on the vegetated valve ultimately
identified Haemophilus parainfluenzae. DISCUSSION(S): The management
of IE in young patients involves a multidisciplinary approach. Due to the
nature of the regurgitation and confirmation of large vegetation, a
surgical mitral valve repair to maintain the native valve was necessary to
prevent long-term anticoagulation (7). Presenting with shock due to septic
cardiomyopathy and risk of forward flow failure in the context of severe
mitral regurgitation required intensive hemodynamic and ventilatory
support in the ICU. Empiric coverage with broad-spectrum antibiotics
should begin during the diagnostic process of identifying the causative
pathogen. It is imperative to determine the organism due to the nature of
high-propensity embolization in IE, such as seen in H. parainfluenza and
other HACEK organisms (8). For this reason, prophylactic antibiotics are
required prior to all dental procedures. CONCLUSION(S): Clinicians
must remain vigilant in identifying the causative organism when managing
IE, particularly when complicated by septic shock and severe valvular
disease. Through the lens of an intensivist, it is crucial to initiate
broad-spectrum antibiotics, offer hemodynamic and ventilatory support, and
designate the most beneficial surgical intervention in a young adult.
Following the identification of H. parainfluenzae, or any other HACEK
organism, it is critical to implement antibiotic prophylaxis with future
dental procedures to mitigate the risk of complications. REFERENCE #1: 1.
Bor DH, Woolhandler S, Nardin R, Brusch J, Himmelstein DU. Infective
endocarditis in the U.S., 1998-2009: a nationwide study. PLoS One.
2013;8(3):e60033. doi:10.1371/journal.pone.00600332. Selton-Suty C, Celard
M, Le Moing V, et al. Preeminence of Staphylococcus aureus in infective
endocarditis: a 1-year population-based survey. Clin Infect Dis.
2012;54(9):1230-1239. doi:10.1093/cid/cis1993. Revest M, Egmann G, Cattoir
V, Tattevin P. HACEK endocarditis: state-of-the-art. Expert Rev Anti
Infect Ther. 2016;14(5):523-530. doi:10.1586/14787210.2016.1164032
REFERENCE #2: 4. Olagunju A, Martinez J, Kenny D, Gideon P, Mookadam F,
Unzek S. Virulent endocarditis due to Haemophilus parainfluenzae: A
systematic review of the literature. World J Cardiol. 2022;14(10):546-556.
doi:10.4330/wjc.v14.i10.5465. Murdoch DR, Corey GR, Hoen B, et al.
Clinical presentation, etiology, and outcome of infective endocarditis in
the 21st century: the International Collaboration on
Endocarditis-Prospective Cohort Study. Arch Intern Med.
2009;169(5):463-473. doi:10.1001/archinternmed.2008.6036. Kahrovic A,
Angleitner P, Andreas M, Werner P, Russo M. Editorial commentary: Native
mitral valve infective endocarditis-Surgical concerns?. J Card Surg.
2022;37(11):3720-3721. doi:10.1111/jocs.16892 REFERENCE #3: 7. Pettersson
GB, Hussain ST. Current AATS guidelines on surgical treatment of infective
endocarditis. Ann Cardiothorac Surg. 2019;8(6):630-644.
doi:10.21037/acs.2019.10.058. Liesenborghs L, Meyers S, Vanassche T,
Verhamme P. Coagulation: At the heart of infective endocarditis. J Thromb
Haemost. 2020;18(5):995-1008. doi:10.1111/jth.14736 DISCLOSURES: No
relevant relationships by Aneesa Afroze No relevant relationships by
Abu-Bakr Malik No relevant relationships by Hoang-Anh Tang No relevant
relationships by Michelle Vu Copyright © 2025 American College of
Chest Physicians

<174>
Accession Number
2041860043
Title
GUESS WHO'S BACK: RECURRENT PLEURAL EFFUSION AND INFLAMMATION AFTER
CORONARY ARTERY BYPASS GRAFT SURGERY.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4363-A4364),
2025. Date of Publication: 01 Oct 2025.
Author
Mittag S.; Chen N.E.I.L.; O'Sullivan M.A.R.Y.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Report Posters (B) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Pleural effusion is among the most common complications of
cardiac surgery and can be caused by inflammatory processes, such as
post-pericardiotomy syndrome (PPS). Even though it results in increased
morbidity, invasive procedures and hospital re-admissions, the definitive
management of PPS remains unclear. We present a case of recurrent PPS
which was successfully treated with colchicine despite delayed onset of
treatment. CASE PRESENTATION: A 74 year old male with coronary artery
disease, atrial fibrillation and hypertension reported dyspnea at his
follow-up visit 11 days after Coronary-Artery-Bypass-Graft surgery. Chest
x-ray showed small bilateral pleural effusions. Four weeks later, the
pleural effusion had progressed to moderate size and a left thoracentesis
was performed, showing lymphocytic predominant, exudative effusion. 3
weeks after thoracentesis, dyspnea and fluid re-accumulation prompted an
emergency department visit and admission. Physical exam was remarkable for
bilateral lower extremity edema and hypoxemia. Computed tomography of the
chest showed predominantly left-sided pleural effusion and scattered
opacities in the right lung. BNP was elevated to twice his baseline while
trans-thoracic echocardiogram showed left ventricular ejection fraction of
60% without signs of diastolic dysfunction. Heart failure and community
acquired pneumonia was presumed. However, infectious work up including
procalcitonin, respiratory cultures and tuberculosis testing returned
negative. CRP and ESR were elevated to 31mg/l and 30mm/hr respectively.
Inflammatory pleural effusion in the context of post-pericardiotomy
syndrome was diagnosed. Diuresis with 40mg Furosemide did not result in
clearance of the effusion. Colchicine 0.6mg daily was added to his
therapy, leading to rapid clinical and radiographic improvement. The
patient was discharged home on Torasemid and Colchicine after 5 days.
Follow-up at 6 weeks showed continued improvement of pleural effusions.
 DISCUSSION(S): Pleural effusion is a common complication of cardiac
surgery and can be of inflammatory etiology (1,2). Reliable diagnostic
criteria for PPS still need to be established, complicating diagnosis and
treatment. PPS usually presents one week to one month after surgery, and
involves elevated inflammation markers, fever and primarily left-sided,
lymphocyte-rich pleural fluid (1,3). Literature recommends treatment with
anti-inflammatory medications such as prednisone and colchicine, though
data on optimal management and timing is scarce (4). The course is usually
benign, but can lead to increased morbidity, mortality and recurrent
effusions (3). Following inadequate response to diuresis in our patient,
addition of colchicine over a month after symptom onset lead to rapid and
lasting improvement of his previously recurrent pleural effusion. This
case highlights the need for high index of suspicion for PPS and how
carefully examining the etiology of a patient's presentation is essential
for successful treatment. It also points towards a role of colchicine in
the treatment of PPS even 10 weeks post surgery. CONCLUSION(S):
Inflammatory processes can contribute to the formation of pleural
effusions after cardiac surgery. Improved risk assessment and treatment
guidelines for PPS are needed to reduce unnecessary morbidity, invasive
procedures and health care costs. Given its reported role in PPS
prevention, as well as its increasingly recognized cardiovascular
benefits, further study of the use and timing of colchicine in treatment
and prevention of PPS is warranted. REFERENCE #1: 1) Light RW, Rogers JT,
Moyers JP, et al. Prevalence and clinical course of pleural effusions at
30 days after coronary artery and cardiac surgery. American Journal of
Respiratory and Critical Care Medicine. 2002;166(12):1567-1571.
doi:10.1164/rccm.200203-184oc REFERENCE #2: 2) Hansen LS, Hjortdal VE,
Jakobsen C-J, Heiberg J, Maagaard M, Sloth E. Early, dedicated follow-up
and treatment of pleural effusions enhance the recovery rate after open
cardiac surgery: Results from a randomized, clinical trial. European
Journal of Cardio-Thoracic Surgery. 2016;51(1):58-66.
doi:10.1093/ejcts/ezw233 REFERENCE #3: 3) Lehto J, Kiviniemi T.
Postpericardiotomy syndrome after cardiac surgery. Annals of Medicine.
2020;52(6):243-264. doi:10.1080/07853890.2020.1758339. 4) Maranta F,
Cianfanelli L, Grippo R, Alfieri O, Cianflone D, Imazio M.
Post-pericardiotomy syndrome: Insights into neglected postoperative
issues. European Journal of Cardio-Thoracic Surgery. 2021;61(3):505-514.
doi:10.1093/ejcts/ezab449 DISCLOSURES: No relevant relationships by Neil
Chen No relevant relationships by Sonja Mittag No relevant relationships
by Mary O'Sullivan Copyright © 2025 American College of Chest
Physicians

<175>
Accession Number
649422170
Title
Pregnancy following transplantation: Systematic review of patient
psychology and quality of life.
Source
BJOG: An International Journal of Obstetrics and Gynaecology. Conference:
RCOG 2024. Muscat Oman. 131(Supplement 5) (pp 35), 2024. Date of
Publication: 01 Oct 2024.
Author
Papalois K.-B.; Tsarna E.; Vakas P.; Stavrou S.; Matsas A.; Christopoulos
P.
Institution
(Papalois) Royal Berkshire Nhs Foundation Trust, Reading, United Kingdom
(Tsarna, Christopoulos) Aretaieion University Hospital, National and
Kapodistrian University of Athens, Athens, Greece
(Vakas, Matsas) 2nd Department of Obstetrics and Gynecology, Aretaieion
University Hospital, Athens Medical School, Athens, Greece
(Stavrou) Third Department of Obstetrics and Gynecology, General
University Hospital, Athens, Greece
Publisher
John Wiley and Sons Inc
Abstract
Objective: Organ transplantation is a curative treatment for patients
suffering from organ failure prolonging survival and improving quality of
life. Pregnancy in women who undergo organ transplantation at reproductive
age has shown to be possible albeit synonymous with maternal and fetal
complications. Studies have explored the aforementioned complications
albeit a systematic evaluation of the psychology in this group during
pregnancy and an assessment of their quality of life has not been
conducted until now. Design(s): We conducted a systematic review
related to donors or recipients of organ transplantation and their
reported psychological parameters and quality of life measures during
pregnancy. Method(s): Relevant papers were identified by two
independent reviewers before data extraction and analysis. Our search
generated 4489 results and 12 studies were included in the final analysis,
6 focused on liver, 3 on uterine, 2 on kidney and 1 on heart
transplantation. Results from the one quantitative paper were reported,
and the Joanna Briggs Institute meta-aggregation evidence synthesis tool
was applied to the 11 qualitative studies. Risk of bias tools were used to
assess all included studies. Result(s): The qualitative studies
underwent thematic analysis and 15 categories were later grouped into 6
synthesized findings( SF) consisting of the following: (1SF) Focus of
worry centered around pregnancy and impact on expectant mother and others
(partners, recipients, donors family, society), (2SF) Fear of the effects
of pregnancy on the physical health of the fetus, (3SF) Fear of the
physical health of the mother, (4SF) Emotional burden on expectant
mothers, (5SF), Perception of pregnancy (6SF) Methods to cope with
expectations and anxiety. The quantitative paper which was included showed
that in women who had undergone a uterus transplant, their SF-36 mental
health scores were stable before and after transplantations albeit for the
women who became pregnant the SF-36 mental health components scores
increased from an average of 37.8 at baseline to 48.6 in the follow up
period of their pregnancy. Conclusion(s): This is the first
systematic review to report on the psychology and quality of life of women
during pregnancy who have previously undergone an transplant. Our results
show that concerns for the mother and the unborn child are prevalent in
all common solid transplant recipients and donors. Therefore, more studies
to further elucidate concerns and infrastructural set-up to support this
patient cohort and their families through counselling and support networks
is key to optimise health outcomes and the experience of pregnancy.

<176>
Accession Number
2042049539
Title
An HIV-positive status and short term perioperative mortality - a
systematic review.
Source
Southern African Journal of Infectious Diseases. 32(1) (pp 12-16), 2017.
Date of Publication: 2017.
Author
Moodley Y.; Govender K.
Institution
(Moodley) Discipline of Anaesthesiology and Critical Care Medicine,
University of KwaZulu-Natal, Durban, South Africa
(Govender) Nelson R. Mandela School of Medicine, University of
KwaZulu-Natal, Durban, South Africa
Publisher
African Online Scientific Information Systems Pty Ltd
Abstract
Background: A contemporary summary describing the impact of an
HIV-positive status on short term perioperative mortality is lacking.
 Objective(s): To collate and summarise published data related to
short term perioperative mortality from studies comparing HIV-positive and
HIV-negative patient groups. Method(s): We conducted a systematic
review of the published literature by performing structured searches of
two medical literature databases. Pre-defined inclusion/exclusion criteria
were used to identify potentially relevant manuscripts. Further screening
of the reference lists of eligible manuscripts, as well as a prior
systematic review was also performed to identify any additional
manuscripts that may have been relevant. Data retrieved from eligible
manuscripts included, amongst other variables: study and population
descriptions, surgical category (cardiac or noncardiac surgery), as well
the incidence of short term perioperative mortality. Crude odds ratios
were calculated for each eligible manuscript to describe the association
between HIV status and short term perioperative mortality. Result(s):
Our systematic review consisted of 12 manuscripts describing 12 studies.
The majority of manuscripts described studies conducted in countries with
a low burden of HIV infection. Most manuscripts described findings from a
noncardiac surgery setting. Crude associations between an HIV-positive
status and a higher odds of short term perioperative mortality were noted
for data from 2 of the 12 manuscripts, while the association was unclear
in the remaining 10 manuscripts. Conclusion(s): Evidence supporting a
higher odds of short term perioperative mortality in patients with an
HIV-positive status is unconvincing. Further research is required to
adequately investigate this. Copyright © 2017 The Author(s)

<177>
Accession Number
2041616088
Title
Outcomes of Ventricular Tachycardia Ablation in Cardiac Laminopathy: An
Updated Systematic Review and Single-Arm Meta-Analysis.
Source
Journal of Cardiovascular Electrophysiology. (no pagination), 2025. Date
of Publication: 2025.
Author
Castrichini M.; Ferreira Felix I.; Karlinski Vizentin V.; Garmany R.;
Huynh T.; Haq I.U.; Swain W.H.; Siontis K.C.; Killu A.M.; Deshmukh A.J.;
Ackerman M.J.; Giudicessi J.R.
Institution
(Castrichini, Garmany, Haq, Swain, Siontis, Killu, Deshmukh, Ackerman,
Giudicessi) Department of Cardiovascular Medicine (Division of Heart
Rhythm Services), Mayo Clinic, Rochester, MN, United States
(Castrichini, Karlinski Vizentin, Garmany, Huynh, Ackerman, Giudicessi)
Department of Molecular Pharmacology and Experimental Therapeutics
(Windland Smith Rice Sudden Cardiac Death Genomics Laboratory), Mayo
Clinic, Rochester, MN, United States
(Ferreira Felix, Huynh) Department of Internal Medicine, Mayo Clinic,
Rochester, MN, United States
(Garmany) Mayo Clinic Medical Scientist Training Program, Mayo Clinic
Graduate School of Biomedical Sciences, Mayo Clinic Alix School of
Medicine, Rochester, MN, United States
(Ackerman) Department of Pediatric and Adolescent Medicine (Division of
Pediatric Cardiology), Mayo Clinic, Rochester, MN, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Ventricular tachycardia (VT) is a life-threatening arrhythmia
frequently observed in structural heart diseases, including LMNA-related
cardiomyopathy, a genetic disorder associated with high risk of sudden
cardiac death and progressive systolic dysfunction. While catheter
ablation is an established therapeutic option for VT, its efficacy in
cardiac laminopathy remains poorly defined. Objective(s): To
synthesize available evidence on the role and outcomes of VT ablation in
patients with cardiac laminopathy. Method(s): A systematic review and
single-arm meta-analysis was performed in accordance with PRISMA
guidelines. PubMed, Embase, and Cochrane databases were searched for
studies reporting VT ablation outcomes in LMNA-related cardiomyopathy. An
inverse variance random-effects model was applied for meta-analysis of
proportions. Result(s): Seven studies (six cohorts, one abstract)
comprising 62 patients (mean age 53.2 +/- 9.7 years; 85% male; 88% with
implantable cardioverter-defibrillator) were included. An
endocardial/endo-epicardial approach was used in 93% of cases. Acute
procedural success was achieved in 37% (95% CI: 14%-63%; I2 = 27.4%), and
28% required multiple procedures. Over a median follow-up of 26 (9-35)
months, VT recurrence occurred in 91% (95% CI: 76%-100%; I2 = 37.2%).
All-cause mortality was 54% (95% CI: 39%-70%; I2 = 28%), predominantly
from cardiac causes (51%, 95% CI: 25%-76%; I2 = 53%), and 14% (95% CI:
1%-34%; I2 = 42%) underwent heart transplantation. Conclusion(s): In
LMNA-related cardiomyopathy, catheter ablation is associated with high VT
recurrence, limited long-term success, and substantial cardiovascular
mortality and transplantation rates, underscoring the importance of ICD
implantation and the need for alternative strategies, including
variant-specific and molecularly targeted therapies. Copyright ©
2025 Wiley Periodicals LLC.

<178>
Accession Number
649442743
Title
Balloon Post-dilation after Transcatheter Aortic Valve Implantation (TAVI)
Among Self- and Balloon-Expandable Valves: A Systematic Review and
Meta-Analysis.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 02 Dec 2025.
Author
Cheikh-Ibrahim M.; de Pontes V.B.; Alachkar M.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) University Centre of Associated Colleges for Education, Sao
Joao da Boa Vista, Brazil
(Alachkar) Heart Center Brandenburg - University hospital of the medical
school Brandenburg, Germany
(Jaramillo) Universidad Austral, Pilar, Argentina
(Esteves) School of Medicine and Biomedical Sciences, University of Porto,
Porto, Portugal
Abstract
BACKGROUND: Balloon post-dilation (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. METHOD(S): 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. RESULT(S): 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 1.15-2.40; p<0.01) and 30-day mortality (RR,
1.28; 95% CI 1.05-1.56; 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 0.01-0.11; p=0.01), with no differences in the
mean transvalvular gradient and paravalvular regurgitation. In
pre-specified subgroup analyses, BPD was associated with an increased risk
of 1-year stroke in patients receiving BE valves (RR, 1.57; 95% CI,
1.11-2.24; p=0.01) and a higher 30-day mortality with SE valves (RR, 1.28;
95% CI 1.01-1.62; p=0.04) compared with non-BPD. CONCLUSION(S): 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.
All rights reserved.

<179>
[Use Link to view the full text]
Accession Number
2042067826
Title
Postoperative atrial fibrillation after cardiac surgery: what is new?.
Source
Current Opinion in Cardiology. 41(1) (pp 37-42), 2026. Date of
Publication: 01 Jan 2026.
Author
Lee J.G.; Ha A.C.T.
Institution
(Lee, Ha) Peter Munk Cardiac Centre, University Health Network
(Lee, Ha) Department of Medicine, University of Toronto, Toronto, Ontario,
Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review - Since postoperative atrial fibrillation (POAF) after
cardiac surgery remains a common clinical problem and is associated with
adverse clinical outcomes, considerable research efforts are spent to
better understand and inform its management. This review highlights recent
studies on this topic.Recent findings - A PubMed review of published
research on POAF after cardiac surgery over the past two years was
conducted. Papers were selected on the basis of their potential value to
enhance clinical practice. This search yielded studies which have advanced
our understanding on the incidence of late-onset POAF after cardiac
surgery and its predictive factors. This information may be useful for
clinicians on the optimal timing for atrial fibrillation detection after
cardiac surgery. Due to a lack of dedicated randomized trial data, the
optimal stroke prevention approach remains uncertain in this patient
population. Summary - POAF after cardiac surgery is an active area of
research. Recent studies have provided additional insights on the risk of
late-onset atrial fibrillation (>3 months) after cardiac surgery. This
information may help clinicians identify patients who are more likely to
experience recurrent atrial fibrillation after cardiac surgery. Ongoing
randomized trials will help clarify the optimal stroke prevention strategy
in this patient population. Copyright © 2025

<180>
Accession Number
2041860115
Title
A RARE CASE OF SERONEGATIVE STATIN-INDUCED NECROTIZING MYOSITIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A2760-A2761),
2025. Date of Publication: 01 Oct 2025.
Author
Knapp M.; Nasuti D.; Purzycki T.; Sousa D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (C) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
Statin-induced necrotizing myositis is a rare immune-mediated condition
that occurs in only 1 of 100,000 people treated with statins [1]. The
pathogenesis of this critical illness remains poorly understood. Here we
present a fatal case of immune-mediated necrotizing myositis in the
setting of recent initiation of atorvastatin following coronary artery
bypass surgery. CASE PRESENTATION: A 75-year-old male with coronary artery
disease status post bypass one month prior, discharged on atorvastatin,
presented for weakness and was found to have acute renal failure and
coagulopathy secondary to acute rhabdomyolysis (creatinine kinase > 80k).
Of note, ANA was positive at 1:320 in a nucleolar pattern. The patient was
initially managed with hemodialysis and supportive transfusions of blood
products. Given concern for inflammatory myositis, IVIG and pulse-dose
methylprednisolone were given. Despite these efforts, the patient
developed recurrent aspiration with hypoxia due to weakness and
significant bleeding from the nasopharynx, necessitating mechanical
ventilation in the medical ICU. There, continuous renal replacement
therapy and vasopressor support were also required. The corticosteroids
were transitioned to methylprednisolone 1 mg/kg/day and he completed 4
days of IVIG. MyoMarker panel showed only mild elevation of anti-SSA and
anti-Scl-100 antibodies. Anti-HMGCR and anti-SRP antibodies remained
negative. MRI of the left humerus demonstrated multifocal myositis [Figure
1]. This prompted skeletal muscle biopsy [Figure 2, 3], which would
posthumously indicate inflammatory myopathy, most compatible with
immune-mediated necrotizing myositis. The patient was extubated
successfully, however relapsed a few days later. He opted for conservative
management at that time and passed shortly thereafter. DISCUSSION(S):
Statins are generally regarded as safe, and atorvastatin is the 3rd most
commonly prescribed medication in the US [2]. Side effects of statin use
are common, with an estimated 13% of patients discontinuing the
medication, typically due to generalized myalgias [3]. A rare complication
is statin-induced necrotizing myositis. Its pathogenesis is unclear, and
it classically presents with proximal, symmetrical muscle weakness, CPK >
10-100 times the upper limit, and typically, positive anti-HMGCR or
anti-SRP antibodies [4]. Our patient had recently started statin therapy
(< 1 month), and while our patient's statin-specific antibody testing was
negative, these tests do not completely rule out statin-induced
necrotizing myositis. At least two other case reports cite evidence of
seronegative immune-mediated necrotizing myositis [5, 6] associated with
statin use (IMNM, an umbrella term which encompasses anti-HMGCR
phenotype). While the test is highly specific [7], we postulate that the
results may be affected by the early initiation of intense steroids. The
patient's muscle biopsy further supports the diagnosis, as it illustrated
significant fibroadipose replacement with scattered degenerating and
regenerating muscle fibers surrounded by rare endomysial mononuclear
inflammatory infiltrates. These inflammatory changes are the
characteristic pattern of IMNM [8]. Treatment typically consists of statin
discontinuation, high-dose corticosteroids, IVIG, and immunosuppressant
medications [9]. Plasmapheresis is sometimes required in severe cases and
could have been considered in our patient [10]. CONCLUSION(S): This
rare and severe form of myositis carries high mortality rates due to
involvement of respiratory musculature, and recognition by the critical
care physician is paramount for prompt diagnosis and appropriate
treatment. REFERENCE #1: 1. Hamann PD, Cooper RG, McHugh NJ, Chinoy H.
Statin-induced necrotizing myositis - a discrete autoimmune entity within
the "statin-induced myopathy spectrum". Autoimmun Rev. 2013
Oct;12(12):1177-81. doi: 10.1016/j.autrev.2013.07.001. Epub 2013 Jul 11.
PMID: 23851103; PMCID: PMC4589155. 2. Fuentes AV, Pineda MD, Venkata KCN.
Comprehension of Top 200 Prescribed Drugs in the US as a Resource for
Pharmacy Teaching, Training and Practice. Pharmacy (Basel). 2018 May
14;6(2):43. doi: 10.3390/pharmacy6020043. PMID: 29757930; PMCID:
PMC6025009. 3. Riaz H, Khan AR, Khan MS, Rehman KA, Alansari SAR, Gheyath
B, Raza S, Barakat A, Luni FK, Ahmed H, Krasuski RA. Meta-analysis of
Placebo-Controlled Randomized Controlled Trials on the Prevalence of
Statin Intolerance. Am J Cardiol. 2017 Sep 1;120(5):774-781. doi:
10.1016/j.amjcard.2017.05.046. Epub 2017 Jun 13. PMID: 28779871. 4.
Pinal-Fernandez I, Casal-Dominguez M, Mammen AL. Immune-Mediated
Necrotizing Myopathy. Curr Rheumatol Rep. 2018 Mar 26;20(4):21. doi:
10.1007/s11926-018-0732-6. PMID: 29582188; PMCID: PMC6019613. REFERENCE
#2: 5. Patel S, Abu-Abaa M, Mousavi F. Seronegative Immune-Mediated
Necrotizing Myopathy: A Case Report. Cureus. 2022 Aug 9;14(8):e27824. doi:
10.7759/cureus.27824. PMID: 36106264; PMCID: PMC9452053. 6. Patel, Z,
Racharla, L, Kher, A. et al. SERONEGATIVE STATIN INDUCED IMMUNE MEDIATED
NECROTIZING MYOPATHY. JACC. 2022 Mar, 79 (9_Supplement) 3181.
https://doi.org/10.1016/S0735-1097(22)04172-9 7. Mohassel P, Mammen AL.
Anti-HMGCR Myopathy. J Neuromuscul Dis. 2018;5(1):11-20. doi:
10.3233/JND-170282. PMID: 29480216; PMCID: PMC5836404. REFERENCE #3: 8.
Vattemi G, Mirabella M, Guglielmi V, Lucchini M, Tomelleri G, Ghirardello
A, Doria A. Muscle biopsy features of idiopathic inflammatory myopathies
and differential diagnosis. Auto Immun Highlights. 2014 Sep 10;5(3):77-85.
doi: 10.1007/s13317-014-0062-2. PMID: 26000159; PMCID: PMC4386579. 9.
Gawey B, Tannu M, Rim J, Sperling L, Henry TL. Statin-Induced Necrotizing
Autoimmune Myopathy. JACC Case Rep. 2020 Feb 26;2(3):440-443. doi:
10.1016/j.jaccas.2019.12.019. PMID: 34317259; PMCID: PMC8311592. 10. Kruse
RL, Albayda J, Vozniak SO, Lawrence CE, Goel R, Lokhandwala PM, Ness PM,
Tobian AAR, Bloch EM, Crowe EP. Therapeutic plasma exchange for the
treatment of refractory necrotizing autoimmune myopathy. J Clin Apher.
2022 Jun;37(3):253-262. doi: 10.1002/jca.21968. Epub 2022 Feb 4. PMID:
35119135; PMCID: PMC9303676. DISCLOSURES: No relevant relationships by
Matthew Knapp No relevant relationships by Danielle Nasuti No relevant
relationships by Taylor Purzycki No relevant relationships by David
Sousa Copyright © 2025 American College of Chest Physicians

<181>
Accession Number
2041861222
Title
GET EDDIE OUT! A PUZZLING CASE OF WIDESPREAD LIFE-THREATENING FLUID.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A2317-A2318),
2025. Date of Publication: 01 Oct 2025.
Author
Edmunds C.; Patterson M.; Cash A.; Vu-Ticar N.N.; Lalani I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (AT) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION:
Hemorrhagic-constrictive pericarditis is an infrequent cause of
obstructive shock and can occasionally present with fluid accumulation in
other areas of the body, such as a pleural effusion or ascites. The
diagnostic challenge of this presentation can be complicated by other
underlying pathologies such as heart failure, decompensated cirrhosis, and
ESRD, among other illnesses. This case highlights a rare presentation of
obstructive shock due to hemorrhagic-constrictive pericarditis with
secondary bacterial peritonitis versus spontaneous bacterial peritonitis
(SBP). CASE PRESENTATION: A 56-year-old man with ESRD, systolic and
diastolic heart failure due to idiopathic restrictive cardiomyopathy,
atrial fibrillation on apixaban, and non-alcoholic cirrhosis complicated
by SBP with Bacterioides fragilis presented to the emergency department
with worsening shortness of breath and anemia noted on routine dialysis
labs. On arrival, he was hypotensive, requiring vasopressors, and had a
lactic acid of 16 mMol/L. Physical examination and imaging revealed large
ascites, a moderate left-sided pleural effusion, and a "massive"
pericardial effusion. Bedside ultrasound showed cardiac tamponade
physiology, necessitating an emergent pericardial window. Pericardial
fluid was hemorrhagic in appearance and consistent with a hemorrhagic
etiology, and the pericardial biopsy revealed fibrous tissue and was
negative for acid-fast bacilli. A peritoneal drain was placed which
drained 16 liters of purulent ascitic fluid for his large ascites. The
ascitic fluid showed a neutrophil count of 36,695 cells/mm3 and an
elevated adenosine deaminase (ADA) level of 197 units/liter. The ascitic
fluid acid-fast bacilli stain and cultures were negative, along with
fungal PCR and RNA Polymerase II antibody. Following 10 days of
antibiotics, the patient demonstrated clinical improvement and resolution
of hypotension. DISCUSSION(S): This case illustrates the puzzling
connection between hemorrhagic-constrictive pericarditis, loculated
ascites, and secondary infection leading to shock. Typically, the
pericardial effusion associated with constrictive pericarditis does not
cause cardiac tamponade physiology; however, this patient's presentation
proved such hemodynamic deterioration is more than possible and needs to
be treated promptly. The large ascites with secondary infection, ascitic
ADA, and overall clinical picture was suspicious for tuberculosis.
However, the negative PCR, acid-fast bacilli stain, and cultures at
multiple sites (lung, heart, and abdomen) diminished the likelihood of
tuberculosis as the primary etiology. Although an ADA level, to this
extent, is not typical outside of tuberculosis, lymphoma, or other
infections, it is still possible in the setting of underlying cirrhosis
and a chronic inflammatory state. CONCLUSION(S):
Hemorrhagic-constrictive pericarditis should be considered in cases of
obstructive shock, especially in patients on anticoagulation with
overlapping cardiac and hepatic pathologies and multiple areas of fluid
buildup. Additionally, while an elevated ADA in multiple fluid samples
with a clinical picture suggesting underlying infection, such as from
tuberculosis, can lead to a diagnostic bias, it is important to always use
a multimodal approach from all areas of the clinical presentation when
treating patients. In the end, supportive care for the large ascites with
broad spectrum antimicrobial therapy and drainage of the pericardial
effusion proved to be life-saving interventions in this rare and complex
presentation. REFERENCE #1: Sagrista-Sauleda J, Angel J, Sanchez A,
Permanyer-Miralda G, Soler-Soler J. Effusive-Constrictive Pericarditis.
New England Journal of Medicine. 2004;350(5):469-475.
doi:doi:10.1056/NEJMoa035630 REFERENCE #2: Ntsekhe M, Shey Wiysonge C,
Commerford PJ, Mayosi BM. The prevalence and outcome of effusive
constrictive pericarditis: a systematic review of the literature.
Cardiovasc J Afr. Jun 2012;23(5):281-5. doi:10.5830/cvja-2011-072
REFERENCE #3: Mahajan M, Prasad ML, Kumar P, et al. An Updated Systematic
Review and Meta-Analysis for the Diagnostic Test Accuracy of Ascitic Fluid
Adenosine Deaminase in Tuberculous Peritonitis. Infect Chemother. Jun
2023;55(2):264-277. doi:10.3947/ic.2023.0014 DISCLOSURES: No relevant
relationships by Andrew Cash No relevant relationships by Carter Edmunds
No relevant relationships by Ishan Lalani No relevant relationships by
Michael Patterson No relevant relationships by Nhi Vu-Ticar Copyright
© 2025 American College of Chest Physicians

<182>
Accession Number
649429557
Title
Tenecteplase vs Alteplase in Mechanical Prosthetic Heart Valve Thrombosis:
The TENET Randomized Clinical Trial.
Source
JAMA cardiology. (no pagination), 2025. Date of Publication: 03 Dec 2025.
Author
Sharma G.; Akkineni K.P.; Makkar N.; Shukla A.; Haldar P.; Velayoudam D.;
Kamal K.; Kumar S.; Naik N.; Roy A.; Singh S.; Seth S.; Bhatia R.
Institution
(Sharma, Akkineni, Makkar, Kamal, Naik, Roy, Singh, Seth) Department of
Cardiology, All India Institute of Medical Sciences, New Delhi, India
(Shukla) Centre for Integrative Medicine and Research, All India Institute
of Medical Sciences, New Delhi, India
(Haldar) All India Institute of Medical Sciences, Centre for Community
Medicine, New Delhi, India
(Velayoudam) Department of Cardiothoracic & Vascular Surgery, All India
Institute of Medical Sciences, New Delhi, India
(Kumar) Department of Cardiac Vascular Radiology & Endovascular
Interventions, All India Institute of Medical Sciences, New Delhi, India
(Bhatia) Department of Neurology, All India Institute of Medical Sciences,
New Delhi, India
Abstract
Importance: For patients presenting with symptomatic prosthetic valve
thrombosis (PVT) after mechanical heart valve replacement, thrombolytic
therapy with alteplase is accepted as a first-line therapeutic
alternative. The utility of tenecteplase compared with conventional
regimens remains unstudied, to the authors' knowledge, in this patient
population. Objective(s): To assess the relative safety and efficacy
of tenecteplase compared with standard infusions of alteplase in patients
with PVT. Design, Setting and Participants: This was an open-label,
parallel-group, non-inferiority randomized clinical trial among
consecutive adult patients presenting with obstructive PVT of a mechanical
prosthetic valve over the study period from October 2022 to August 2024 to
a single tertiary care center in India. Intervention(s): Patients
received thrombolytic therapy with a low-dose slow infusion alteplase or
weight-based bolus doses of tenecteplase. Main Outcomes and Measures:
The primary outcomes were to determine the rates of complete thrombolytic
success and the incidence of major complications. Result(s): A total
of 83 patients (mean [SD] age, 39.6 [12.4] years, 42 male [50.6%]) were
randomized to receive alteplase (n = 43) or tenecteplase (n = 40). The
rates of the primary efficacy end point (complete thrombolytic success)
were significantly higher (risk ratio, 1.18; 95% CI, 1.03-1.39; P = .02
for noninferiority) in the tenecteplase group (39 patients [97.5%])
compared with the alteplase group (35 patients [81.5%]). Additionally,
patients treated with tenecteplase had higher rates of complete success
with the first administered dose and a shorter duration of hospital stay
(median [IQR], 4.1 [3.2-5.1] days vs 6.5 [4.3-9.2] days; P < .001). The
rates of major and minor adverse events were similar. Conclusions and
Relevance: Tenecteplase may be a safe and effective alternative to
alteplase in patients presenting with obstructive PVT. Patients treated
with tenecteplase in our study had higher rates of complete thrombolytic
success and a shorter duration of hospital stay. Furthermore, the relative
ease of drug administration with tenecteplase may translate to greater
clinical benefit in a real-world setting. Trial Registration: Clinical
Trials Registry of India: CTRI/2022/10/046127.

<183>
Accession Number
2041860703
Title
PULMONARY TUMOR THROMBOTIC MICROANGIOPATHY IN A PATIENT WITH DIFFUSELY
METASTATIC PROSTATE ADENOCARCINOMA.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A3269-A3270),
2025. Date of Publication: 01 Oct 2025.
Author
Nedunchezhian S.; Hassan A.; Chen J.; Adams-Mardi C.; Lefebvre D.;
Milojevic I.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (AC) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am INTRODUCTION:
Pulmonary tumor thrombotic microangiopathy (PTTM), which describes
malignant cells thromboembolism to pulmonary vasculature triggering
coagulation cascade and fibrocellular intimal thickening, is a fatal
phenomenon. Here we describe PTTM in a patient with known metastatic
prostate cancer resistant to all treatments. CASE PRESENTATION: A
56-year-old male with diffusely metastatic prostate adenocarcinoma and
surgically stabilized thoracic cord compression, receiving treatment with
abiraterone acetate and radium-223 through a clinical trial, history of
pulmonary embolism (PE) previously on apixaban presented with pain,
weakness, worsening pancytopenia, hemolytic anemia, dyspnea and hypoxemia
requiring supplemental oxygenation. Dyspnea and hypoxemia were initially
attributed to pneumonia, complicated by anemia and debility. There was no
definite evidence of acute PE on CT pulmonary angiography (CTPA), although
patient could not tolerate anticoagulation due to anemia and
thrombocytopenia. Viral respiratory panel, sputum and blood cultures
yielded no microbiologic diagnosis. Echocardiogram showed normal systolic
and diastolic function of both ventricles. Patient received empiric
antibiotics for pneumonia with no symptomatic improvement. Short-interval
CTPA demonstrated persistent multifocal ground glass opacities and no PE.
He was treated with red blood cell and platelet transfusions, and
cryoprecipitate. Laboratory investigations showed platelet nadir of 9,
hemoglobin nadir of 6.2, low haptoglobin, negative Direct Coombs test,
8-10 schistocytes per high power field on microscopy, low fibrinogen, high
D-dimer, and normal ADAMTS13 levels. These abnormalities were interpreted
as multifactorial in context of advanced malignancy - with bone marrow
tumor infiltration, possible bone marrow suppression from oncologic
treatments and disseminated intravascular coagulation with profound
microangiopathic hemolytic anemia. Primary thrombotic microangiopathy
syndromes such as thrombotic thrombocytopenic purpura were considered less
likely given clinical context, normal kidney function and absence of
encephalopathy, and ultimately ruled out. The absence of petechial rash
and encephalopathy argued against fat embolism. Patient's air-hunger and
work of beathing continued to increase with evidence of dead space
ventilation despite supportive measures, and transition was made towards
comfort-oriented care. Autopsy demonstrated metastatic prostate carcinoma
with significant tumor thromboembolic burden in pulmonary vasculature
suggestive of PTTM. DISCUSSION(S): Considering multisystem organ
dysfunction in critically ill patients with advanced malignancy,
ante-mortem diagnosis of PTTM is exceedingly hard to make. A pragmatic
approach would be to examine the clinical probability of potentially
treatable differential diagnoses and treatment tolerability. There was no
evidence of heart failure in our patient. We elected to trial empiric
broad spectrum antibiotics without definite evidence of infection.
Non-invasive work-up for opportunistic infections was initiated, but no
empiric treatment was started. Drug pneumonitis was also considered, but
since it has not been described in literature with Radium 223 therapy,
patient's low dose chronic prednisone therapy was not escalated.
Undetected pulmonary embolism, fat embolism and PTTM with resulting
pulmonary arterial hypertension were all considered a marker of his
progressive cancer for which risk of treatment would exceed any benefit.
 CONCLUSION(S): While clinical PTTM diagnosis is difficult and
confounded by an extensive list of potentially treatable differential
diagnoses, PTTM is a fatal process. Although there are many supportive
treatments and treatments directed at malignancy complicated by PTTM, one
must weigh their benefits against risks. REFERENCE #1: Godbole R, Ghatol
A, Betancourt J, Sacoolidge J, Kamangar N. Pulmonary Tumor Thrombotic
Microangiopathy: Clinical, Radiologic, and Histologic Correlation. J Clin
Imaging Sci. 2015;5:44. Published 2015 Jul 31.
doi:10.4103/2156-7514.161978Godbole RH, Saggar R, Kamangar N. Pulmonary
tumor thrombotic microangiopathy: a systematic review. Pulm Circ.
2019;9(2):2045894019851000. doi:10.1177/2045894019851000 REFERENCE #2:
Nayyar D, Muthiah K, Hayward CS, et al. Pulmonary tumor thrombotic
microangiopathy from metastatic prostate carcinoma. Case Rep Pulmonol.
2015;2015:286962. doi:10.1155/2015/286962Petnak T, Suwatanapongched T,
Klaisuban W, Nitiwarangkul C, Pornsuriyasak P. Initial diagnosis and
successful treatment of pulmonary tumor embolism manifesting as the first
clinical sign of prostatic adenocarcinoma. Respir Med Case Rep.
2020;31:101163. Published 2020 Jul 10. doi:10.1016/j.rmcr.2020.101163
REFERENCE #3: Smith M, Parker C, Saad F, et al. Addition of radium-223 to
abiraterone acetate and prednisone or prednisolone in patients with
castration-resistant prostate cancer and bone metastases (ERA 223): a
randomised, double-blind, placebo-controlled, phase 3 trial [published
correction appears in Lancet Oncol. 2019 Oct;20(10):e559. doi:
10.1016/S1470-2045(19)30587-X.]. Lancet Oncol. 2019;20(3):408-419.
doi:10.1016/S1470-2045(18)30860-X DISCLOSURES: No relevant relationships
by Cyrus Adams-Mardi No relevant relationships by Joyce Chen No relevant
relationships by Ahmad Hassan No relevant relationships by Danielle
Lefebvre No relevant relationships by Ivana Milojevic No relevant
relationships by Saihariharan Nedunchezhian Copyright © 2025
American College of Chest Physicians

<184>
Accession Number
2041863988
Title
TRANSCATHETER AORTIC VALVE REPLACEMENT IN CANCER PATIENTS WITH CHEST
RADIATION THERAPY: RISKS AND OUTCOMES.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A252-A253), 2025.
Date of Publication: 01 Oct 2025.
Author
Khawar M.; Shah S.A.; Das A.; Ali U.M.A.D.; Jaffar M.S.; Akhlaq M.A.;
Muhammad A.W.O.N.; Saeed H.; Imran Khan S.M.; Qadeer A.; Khawar M.M.;
Hadeed Khawar M.M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Scientific Abstract Posters (B)
SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2025
01:45 pm - 02:30 pm PURPOSE: Transcatheter aortic valve replacement (TAVR)
is a widely used treatment for severe aortic stenosis, yet its outcomes in
cancer survivors with prior chest radiation therapy (C-XRT) remain
uncertain. Radiation-induced cardiovascular disease can lead to increased
procedural risks and long-term complications, making it critical to
evaluate the safety and effectiveness of TAVR in this unique patient
population. This meta-analysis compares the clinical outcomes of TAVR
between patients with a history of C-XRT and those without prior radiation
exposure, aiming to inform clinical decision-making and optimize
management strategies. METHOD(S): A systematic review and
meta-analysis were conducted to compare outcomes between patients with
prior C-XRT and a control group without radiation exposure. Studies were
identified through a comprehensive search of major medical databases
(PubMed, Embase, Scopus, Ovid). Key clinical endpoints included long-term
and short-term mortality, access-related vascular complications, acute
kidney injury (AKI), congestive heart failure, major bleeding, need for a
permanent pacemaker, and stroke. Pooled estimates for odds ratios (OR) and
95% confidence intervals (CI) were calculated using appropriate
statistical models, with heterogeneity assessed via the I2 statistic.
Statistical significance was defined as p < 0.05. RESULT(S): A total
of nine studies, comprising 3,083 patients with prior C-XRT and 8,891
control patients, were included in the final analysis. The findings
indicate that patients with prior C-XRT undergoing TAVR had significantly
higher long-term mortality compared to the control group (OR 1.84, 95% CI
[1.08-3.13], p = 0.02). However, no significant differences were observed
in other major clinical outcomes. The risk of short-term mortality was
higher in C-XRT patients (OR 1.66, 95% CI [0.97-2.84]), but this did not
reach statistical significance (p = 0.06). Similarly, access-related
vascular complications (OR 1.12, p = 0.43), AKI (OR 0.54, p = 0.24),
congestive heart failure (OR 1.38, p = 0.16), major bleeding (OR 0.96, p =
0.67), need for a permanent pacemaker (OR 1.05, p = 0.57), and stroke (OR
1.25, p = 0.39) did not differ significantly between the two groups. These
results suggest that while TAVR is a viable option for patients with prior
C-XRT, the increased long-term mortality risk warrants further
investigation. CONCLUSION(S): Cancer survivors with prior chest
radiation therapy undergoing TAVR face a significantly higher risk of
long-term mortality compared to non-radiated patients. However, other key
clinical outcomes, including short-term mortality, vascular complications,
AKI, congestive heart failure, major bleeding, pacemaker implantation, and
stroke, appear comparable between groups. These findings suggest that
while TAVR remains a feasible intervention in this patient population,
further studies are needed to refine risk stratification, patient
selection, and post-procedural management strategies to optimize long-term
outcomes. CLINICAL IMPLICATIONS: Given the increased long-term mortality
risk in C-XRT patients, oncologic and cardiovascular risk factors should
be carefully considered when selecting candidates for TAVR. Future
research should focus on identifying predictive markers of poor outcomes,
optimizing perioperative strategies, and developing long-term surveillance
protocols for this high-risk group. A multidisciplinary approach,
integrating cardiology, oncology, and radiation oncology expertise, is
essential for improving patient outcomes. DISCLOSURES: No relevant
relationships by Syed Abdullah shah No relevant relationships by Muhammad
Armaghan Akhlaq No relevant relationships by Umad Ali No relevant
relationships by Ashesh Das No relevant relationships by Muhammad Soban
Jaffar No relevant relationships by Sardar Muhammad Imran Khan No relevant
relationships by Muneeb Khawar No relevant relationships by Muhammad
Muneeb Khawar No relevant relationships by Mirza M Hadeed Khawar No
relevant relationships by Awon Muhammad No relevant relationships by Abdul
Qadeer No relevant relationships by Hannan Saeed Copyright © 2025
American College of Chest Physicians

<185>
Accession Number
2041859605
Title
EXTENSIVE CHIARI NETWORK MIMICKING RIGHT ATRIAL THROMBUS IN TRANSIT:
DIAGNOSTIC CHALLENGES AND IMAGING INSIGHTS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A630-A631), 2025.
Date of Publication: 01 Oct 2025.
Author
Shaik A.; Gowda T.; Khan A.; Muhammad A.; Elshaer A.; Mushtaq A.L.I.;
Sabbah B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (H) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm
INTRODUCTION: The Chiari network is a rare, net-like structure in the
right atrium, near the openings of the inferior vena cava (IVC) and
coronary sinus, resulting from incomplete resorption of the right-sided
sinus venosus valve during embryogenesis. While typically incidental, it
can mimic pathological conditions like thrombus in transit or cardiac
tumors, leading to diagnostic challenges (1,2). We present a case where an
extensive Chiari network was misinterpreted as a right atrial thrombus,
emphasizing the risk of misdiagnosis and unnecessary interventions. CASE
PRESENTATION: A 72-year-old male with ulcerative colitis, diagnosed two
months prior, presented with bilateral lower extremity swelling. Doppler
ultrasound revealed extensive bilateral deep vein thrombosis (DVT), with a
nearly occluded right superficial femoral vein thrombus and a left lower
extremity thrombus extending from the posterior tibial to the proximal
superficial femoral vein. A computed tomography angiogram (CTA) showed
bilateral segmental and subsegmental pulmonary embolism (PE) without right
ventricular strain. The patient was anemic (hemoglobin 8.4 g/dL) and
ineligible for thrombolysis due to active colitis-related bleeding.An
inferior vena cava (IVC) filter was placed, and transthoracic
echocardiography (TTE) raised concern for a right atrial thrombus in
transit. The patient was scheduled for percutaneous thrombectomy via the
right internal jugular vein under transesophageal echocardiographic (TEE)
guidance. However, TEE revealed an extensive Chiari network, not thrombus.
Consequently, thrombectomy was avoided, and the patient was started on
apixaban 5 mg twice daily for anticoagulation. He was discharged with
follow-up for DVT and PE management. DISCUSSION(S): The Chiari
network, though benign, can be misinterpreted as a right atrial thrombus,
tumor, or vegetation on echocardiography. Such misdiagnoses may lead to
unnecessary interventions, including thrombectomy or prolonged
anticoagulation, particularly in patients with clotting disorders. In this
case, initial echocardiographic findings suggested thrombus in transit,
given the patient's extensive acute DVT and PE. However, TEE correctly
identified the Chiari network, preventing an unnecessary invasive
procedure.Complications from the Chiari network are rare but include clot
formation, arrhythmias, and catheter entrapment, particularly during
procedures like right heart catheterization, catheter ablation, or
implantable cardioverter-defibrillator placement. Awareness of this
anatomical variant is crucial for preventing misdiagnosis and procedural
complications (2). Advanced imaging techniques, particularly TEE, are
essential for distinguishing the Chiari network from true pathology,
improving patient management and outcomes. CONCLUSION(S): The Chiari
network can mimic thrombus in transit or other right atrial abnormalities,
posing significant diagnostic challenges. Recognizing this anatomical
variant is essential to prevent unnecessary interventions such as
thrombectomy. High-resolution imaging, especially TEE, plays a crucial
role in accurate diagnosis and optimal patient care. REFERENCE #1:
Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM,
Lang RM, Rome JJ, Wang Y; American Society of Echocardiography; Society
for Cardiac Angiography and Interventions. Guidelines for the
Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen
Ovale: From the American Society of Echocardiography and Society for
Cardiac Angiography and Interventions. J Am Soc Echocardiogr. 2015
Aug;28(8):910-58. REFERENCE #2: Ali H, Lupo P, Cristiano E, Nicoli L,
Foresti S, De Ambroggi G, Anderson RH, De Lucia C, Turturiello D, Paganini
EM, Bessi R, Farghaly AAA, Butera G, Cappato R. Chiari network for the
interventional cardiologist: A hidden enemy at the heart gate - A
systematic review of the literature. Int J Cardiol. 2023 Mar 15;375:23-28.
DISCLOSURES: No relevant relationships by Ahmed Elshaer No relevant
relationships by thejas Gowda No relevant relationships by Arshan Khan No
relevant relationships by ahmad muhammad No relevant relationships by Ali
Mushtaq No relevant relationships by Belal Sabbah No relevant
relationships by Abdullah Shaik Copyright © 2025 American College
of Chest Physicians

<186>
Accession Number
2041863979
Title
POSTERIOR PERICARDIOTOMY IN CORONARY ARTERY BYPASS GRAFTING: A SYSTEMATIC
REVIEW AND META-ANALYSIS OF SAFETY AND EFFICACY.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A254-A255), 2025.
Date of Publication: 01 Oct 2025.
Author
Hadeed Khawar M.M.; Pathak P.; Akhlaq M.A.; Khawar M.; Qadeer A.; Jaffar
M.S.; Shah S.A.; Abdullah M.; Khan A.; Saeed H.; Fatima A.; Abbasi
H.I.N.A.; Saifullah M.; Khawar M.M.; Haider M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Scientific Abstract Posters (C)
SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2025
01:45 pm - 02:30 pm PURPOSE: Atrial fibrillation and pericardial effusion
are common complications following coronary artery bypass grafting (CABG),
contributing to increased morbidity and prolonged hospitalization.
Posterior pericardiotomy has been proposed as a technique to reduce these
complications by facilitating pericardial drainage and reducing
pericardial fluid accumulation. This systematic review and meta-analysis
assess the efficacy and safety of posterior pericardiotomy in reducing
postoperative complications following CABG. METHOD(S): A
comprehensive search was conducted using PubMed, Cochrane,
ClinicalTrials.gov, and Ovid to identify randomized controlled trials
(RCTs) comparing posterior pericardiotomy with standard CABG procedures
without pericardiotomy. The primary outcomes included the incidence of
postoperative atrial fibrillation, cardiac tamponade, early and late
pericardial effusion, intensive care unit (ICU) stay, hospital length of
stay, and the need for revision surgery due to bleeding. Pooled estimates
of odds ratios (ORs) and mean differences (MD) with 95% confidence
intervals (CIs) were calculated using a random-effects model.
Heterogeneity was assessed using the I2 statistic, and a p-value < 0.05
was considered statistically significant. RESULT(S): A total of 20
randomized controlled trials, including 5,331 CABG patients, were
analyzed. Posterior pericardiotomy was found to significantly reduce the
incidence of postoperative atrial fibrillation (OR 0.41, 95% CI:
0.28-0.58, p < 0.00001), cardiac tamponade (OR 0.16, 95% CI: 0.08-0.32, p
< 0.00001), early pericardial effusion (OR 0.26, 95% CI: 0.13-0.51, p <
0.0001), and late pericardial effusion (OR 0.08, 95% CI: 0.04-0.15, p <
0.00001). Furthermore, patients who underwent posterior pericardiotomy
experienced a significantly shorter hospital stay (MD -1.23 days, 95% CI:
-1.87 to -0.59, p = 0.0002). However, the intervention did not
significantly reduce ICU stay or the need for revision surgery due to
bleeding. Notably, posterior pericardiotomy was associated with an
increased risk of pleural effusion, highlighting a potential adverse
effect of this technique. CONCLUSION(S): Posterior pericardiotomy is
a safe and effective adjunctive procedure for patients undergoing CABG,
significantly reducing the incidence of postoperative atrial fibrillation,
cardiac tamponade, pericardial effusion, and hospital stay. These findings
support its routine implementation during CABG to enhance postoperative
outcomes and minimize complications. However, the increased risk of
pleural effusion warrants further investigation to refine patient
selection and optimize perioperative management strategies. CLINICAL
IMPLICATIONS: The incorporation of posterior pericardiotomy into routine
CABG procedures may improve patient outcomes, reduce hospital resource
utilization, and enhance recovery. Given the associated risk of pleural
effusion, careful perioperative monitoring and tailored management
strategies should be considered. Future research should focus on
identifying patient subgroups that may benefit most from this intervention
and exploring techniques to minimize associated risks. DISCLOSURES: No
relevant relationships by Hina Abbasi No relevant relationships by
Muhammad Abdullah No relevant relationships by Syed Abdullah shah No
relevant relationships by Muhammad Armaghan Akhlaq No relevant
relationships by Ayesha Fatima No relevant relationships by Mobeen Haider
No relevant relationships by Muhammad Soban Jaffar No relevant
relationships by Ayesha Khan No relevant relationships by Mirza M Hadeed
Khawar No relevant relationships by Muneeb Khawar No relevant
relationships by Muhammad Muneeb Khawar No relevant relationships by
Prutha Pathak No relevant relationships by Abdul Qadeer No relevant
relationships by Hannan Saeed No relevant relationships by Muneeb
Saifullah Copyright © 2025 American College of Chest Physicians

<187>
Accession Number
2041861540
Title
A RARE AND HIDDEN DANGER: RIGHT ATRIAL THROMBUS IN CLINICAL PRACTICE.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A360-A361), 2025.
Date of Publication: 01 Oct 2025.
Author
Jayavendra R.; Bhui P.; Nyongbella J.; Saleemi A.M.A.N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Report Posters (A) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm
INTRODUCTION: A 68-year-old female presented with shortness of breath,
chest pain, and pre-syncopal episodes. CTPA showed confirmed bilateral
pulmonary emboli, and subsequent echocardiography identified a
free-floating thrombus in the right atrium. Given the severity of the
findings, the patient underwent successful thrombectomy to remove both the
pulmonary emboli and right atrial thrombus. CASE PRESENTATION: Patient is
a 68-year-old female with a past medical history significant for coronary
artery disease, ESRD on hemodialysis with Medi Port and history of DVT on
Coumadin who presented to the emergency department with complaints of
shortness of breath, chest pain and pre-syncopal episodes. In the ED,
patient was hypotension with BP 96/ 58 and MAP 71. Labs showed troponin of
0.920 and 1.00 and BNP 1700. CTPA showed bilateral acute pulmonary emboli.
RV/LV ratio was 1.7. At that time, echocardiogram noted RV strain along
with a free-floating right atrial thrombus. Patient was transferred to
cardiac catheterization lab and underwent thrombectomy with successful
removal of pulmonary emboli and right atrial thrombus. DISCUSSION(S):
The occurrence of an RA thrombus is rare and underdiagnosed, as findings
are often incidental. Right atrial thrombi are often linked to conditions
such as atrial fibrillation, venous thromboembolism, tricuspid valve
abnormalities, the use of central venous catheters, or hypercoagulable
states. In our patient, it is crucial to identify these risk factors, such
as presence of a MediPort and a history of DVT. It is suggested that
mechanical irritation of the right atrial wall by the catheter tip can
cause endothelial damage, leading to thrombus formation. When combined
with a hypercoagulable state, the risk is further amplified, creating a
site for thrombus development. Furthermore, the presence of a right atrial
thrombus significantly increases the risk of pulmonary embolism, as the
thrombus can detach from the right atrium and travel through the right
ventricle to the pulmonary arteries, resulting in PE. About 36% of
patients with a right atrial thrombus are noted to present with PE. The
diagnosis of a right atrial thrombus is often made using TEE, which offers
detailed information on its size, mobility, and potential for embolism.
Management is tailed to factors like thrombus size, mobility, and risks.
Anticoagulation is typically first-line treatment, although more severe
cases may necessitate surgery or catheter-directed thrombolysis. In our
patient's case, thrombectomy was indicated due to failure of
anticoagulation. While most right atrial thrombi are found incidentally,
early detection is critical. Given the life-threatening nature of RA
thrombi and high mortality, appropriate management is vital to reduce
complications such as pulmonary embolism or systemic embolization.
 CONCLUSION(S): Right atrial thrombus is a rare and often
underdiagnosed condition, frequently associated with risk factors such as
central venous catheters, hypercoagulable states, and previous thrombotic
events. In this patient, the presence of a MediPort and prior DVT history
compounded the risk of thrombus formation, leading to a significant
pulmonary embolism. Early detection and timely intervention, such as
thrombectomy, are crucial in managing this potentially life-threatening
condition. Proper diagnosis and management are essential to reduce the
risk of complications, including further embolic events. REFERENCE #1:
Right atrial thrombus and its causes, complications, and therapy. M.
Benjamin, A. Afzal, T. Chamogeogakis and G. Feghali REFERENCE #2:
Management of catheter-related right atrial thrombus in hemodialysis: a
systematic review. L. Chen, B. Chen, Q. Lai, X. Gao, Y. Zhou, W. Li, H.
Gan and Z.Wan DISCLOSURES: No relevant relationships by Palpasa Bhui No
relevant relationships by Rochelle Jayavendra No relevant relationships by
Joiven Nyongbella No relevant relationships by Aman Saleemi Copyright
© 2025 American College of Chest Physicians

<188>
Accession Number
2041862052
Title
HEMORRHAGIC SHOCK FROM SPLENIC RUPTURE AFTER URETEROSCOPIC LITHOTRIPSY AND
DOUBLE J STENT PLACEMENT.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A2891-A2892),
2025. Date of Publication: 01 Oct 2025.
Author
Garza J.; Kamath A.; Valiveti D.; Vakil A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (J) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
Extracorporeal shockwave lithotripsy (ESWL) is a common non-invasive
approach to treatstones within the urinary tract. It is typically safe and
efficient method to break down andfacilitate the passage of kidney and
ureteral stones. It is rarely associated with damage tosurrounding organs.
Splenic injuries are uncommonly seen as a complication of theseprocedures.
We report the case of a patient who developed hemorrhagic shock secondary
tosplenic rupture following ESWL requiring aggressive resuscitation,
pressor support andemergent splenectomy. CASE PRESENTATION: A 70-year-old
male with no significant medical history presented with flank pain
radiating to thegroin and associated hematuria for one week duration.
Patient denied any fever, chills, nausea,vomiting or abdominal pain. He
denied any similar episodes in the past and denied taking anyrecent
over-the-counter medications. Social history was non-contributory. Patient
washemodynamically stable on presentation. Physical examination revealed
left flank tendernesswithout any abdominal tenderness, rigidity or
guarding. Laboratory data showed grosshematuria without any evidence of
urinary infection and stable hemoglobin. Computerizedtomography imaging of
the abdomen and pelvis showed a 7 mm non-obstructing stone in theleft
ureter as well as12 mm stone in the left renal pelvis (Figure 1) without
any hydronephrosisor hydroureter. Appropriate cultures were collected, and
patient was started on intravenous fluidhydration, antibiotics and pain
control. Patient underwent ESWL with regional anesthesia. About3 hours
after the procedure, the patient complained of worsening left flank pain
and appearedpale. He was noted to be tachycardic and hypotensive prompting
his transfer to intensive careunit. Patient was administered fluid bolus
and given concerns for bleeding blood transfusion wasinitiated. Laboratory
data showed an acute drop in hemoglobin from 11.4 g/dL to 3.4 g/dL,
withnormal platelet count and normal coagulation profile. Rapid
transfusion protocol was activated,and patient was also started on
pressors. Repeat abdominal imaging showed fluid collection inthe left
splenic bed with hemoperitoneum and without any injury to the renal
parenchyma(Figure 2). Patient underwent emergent splenectomy and drainage
of hemoperitoneum. Herequired 8 units of packed red blood cell
transfusion. His condition stabilized after splenectomyand he experienced
an uneventful recovery. DISCUSSION(S): While blunt force abdominal
trauma is the most common cause of splenic rupture, it shouldremain a
consideration with any intra-abdominal procedure. It has also been
documented tooccur even after intra-thoracic procedures such as
thoracotomy or lobectomy. Splenic rupture israrely seen in association
with lithotripsy procedures with a few documented cases after ESWL.Unlike
our patient, most cases have been reported in patients who have portal
hypertension,coagulopathy or unusual position of the spleen. Frequent
movement or repositioning of thepatient have also been associated with
this complication. CONCLUSION(S): Clinicians should maintain a
highdegree of suspicion for this rare potentially life-threatening
complication, especially in patientswith left sided upper or mid-pole
kidney stones, who develop sudden onset worseningabdominal pain or drop in
hemoglobin. Diagnosis requires urgent abdominal imaging.Aggressive
resuscitation and emergent splenectomy can be life-saving. REFERENCE #1:
Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk
factors or previously diagnosed disease: a systematic review. BMC Emerg
Med. 2012 Aug 14;12:11. doi: 10.1186/1471-227X-12-11. PMID: 22889306;
PMCID: PMC3532171. REFERENCE #2: Nouralizadeh A, Ziaee SA, Hosseini
Sharifi SH, Basiri A, Tabibi A, Sharifiaghdas F, Zaki H, Nikkar MM, Lashay
A, Ahanian A, Soltani MH. Delayed postpercutaneous nephrolithotomy
hemorrhage: prevalence, predictive factors and management. Scand J Urol.
2014 Feb;48(1):110-5. doi: 10.3109/21681805.2013.806586. Epub 2013 Nov 21.
PMID: 24256570.Duvdevani M, Razvi H, Sofer M, Beiko DT, Nott L, Chew BH,
Denstedt JD. Third prize: contemporary percutaneous nephrolithotripsy:
1585 procedures in 1338 consecutive patients. J Endourol. 2007
Aug;21(8):824-9. doi: 10.1089/end.2007.9936. PMID: 17867936. REFERENCE #3:
Stoller ML, Wolf JS Jr, St Lezin MA. Estimated blood loss and transfusion
rates associated with percutaneous nephrolithotomy. J Urol. 1994 Dec;152(6
Pt 1):1977-81. doi: 10.1016/s0022-5347(17)32283-8. PMID: 7966654.Bansal U,
Sawant A, Dhabalia J. Subcapsular renal hematoma after ureterorenoscopy:
An unknown complication of a known procedure. Urol Ann. 2010
Sep;2(3):119-21. doi: 10.4103/0974-7796.68861. PMID: 20981200; PMCID:
PMC2955227.Nomikos MS, Chousianitis Z, Georgiou C, Georgellis C, Rikas P,
Anagnostou T. Renal Parenchyma Perforation and Hematoma Formation
following Double-J Stent Insertion in a Solitary Functioning Kidney: An
Unusual Complication. Case Rep Urol. 2012;2012:301275. doi:
10.1155/2012/301275. Epub 2012 Oct 2. PMID: 23082274; PMCID:
PMC3469072.Whitehurst LA, Somani BK. Perirenal Hematoma After
Ureteroscopy: A Systematic Review. J Endourol. 2017 May;31(5):438-445.
doi: 10.1089/end.2016.0832. Epub 2017 Jan 19. PMID: 28001097. DISCLOSURES:
No relevant relationships by Jorge Garza No relevant relationships by
Arjun Kamath No relevant relationships by Abhay Vakil No relevant
relationships by Deekshita Valiveti Copyright © 2025 American
College of Chest Physicians

<189>
Accession Number
2041861387
Title
MRSA PERICARDITIS IN 47-YEAR-OLD FEMALE.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1880-A1881),
2025. Date of Publication: 01 Oct 2025.
Author
Poluru K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Report Posters (U) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION:
Methicillin-resistant Staphylococcus aureus (MRSA) pericarditis is a rare
but life-threatening infection that can lead to pericardial effusion and
cardiac tamponade. MRSA, typically associated with skin and soft tissue
infections, can spread hematogenously leading to pericardial involvement,
often in immunocompromised or critically ill patients. Case reports have
documented the rapid progression of this condition, necessitating prompt
diagnosis and intervention, including pericardiocentesis and antibiotic
therapy. CASE PRESENTATION: A 47 year old female with past medical history
of Hepatitis C, liver cirrhosis, esophageal varices, IV drug use, and
recurrent MRSA skin infections presents due to progressively worsening
shortness of breath, exacerbated by deep inspiration and ambulation. She
had a temperature of 99.0, HR 157, BP 115/68, saturating 94% on room air.
Muffled heart sounds and elevated JVD on physical exam. Lab work was
significant for WBC 15.61, platelets 49, BUN 50, Cr 1.49. EKG showed low
voltage QRS. Initially a chest x-ray showed a marked enlargement of
cardiac silhouette. Subsequent CT scan showed a large pericardial
effusion. An ECHO revealed an EF of 60-65% with large pericardial
effusion, fibrinous appearance, with features concerning for hemodynamic
compromise with dilated IVC. Cardiology was consulted for fluoroscopy
guided pericardiocentesis. Initially 1100 mL of hemorrhagic fluid was
aspirated and a drain was placed. Subsequently 900mL and 750 mL over the
next two days. Consideration for pericardial window was discussed. Cell
count showed elevated WBC 4984 with predominance of polynuclear
neutrophils, RBC 745000, gram stain was positive for gram-positive cocci
in clusters and culture revealed growth of Methicillin-resistant
Staphylococcus aureus (MRSA). Blood cultures remained negative, no growth
after 5 days. Patient was initially started on Vancomycin, empiric therapy
for MRSA, and Ceftriaxone to cover potential co-infections, however after
pericardial fluid cultures confirmed MRSA, the antibiotic regimen was
adjusted to Vancomycin alone. Patient was improving clinically. A repeat
ECHO showed a trace pericardial effusion and the drain was pulled out. Her
hospital course was complicated by hypotension and PEA cardiac arrest due
to septic shock and tamponade. POCUS revealed reaccumulation of
pericardial fluid. There was an emergent bedside pericardiocentesis during
the code, the patient was intubated. Family elected hospice and the
patient passed peacefully after extubation. DISCUSSION(S): This case
highlights the rare but serious complication of MRSA pericardial effusion
in those with risk factors for Staphylococcus aureus infections such as
IVDU history. MRSA pericardial effusion carries the risk of pericardial
tamponade, which is a life-threatening condition requiring urgent drainage
and appropriate antibiotic therapy and close monitoring for complications.
Early recognition and intervention are key to favorable outcomes.
 CONCLUSION(S): MRSA pericardial effusion is a rare but serious
condition that can arise as a complication of hematogenous infection,
often originating from a skin or soft tissue infection. Interestingly
approximately one-third of patients with MRSA pericarditis had negative
blood cultures. Prompt diagnosis with echocardiography and pericardial
fluid analysis, along with appropriate antibiotic therapy and drainage,
are crucial for improving outcomes. This case emphasizes the importance of
considering Staphylococcus aureus in patients with unexplained pericardial
effusion, particularly those with a history of IV drug use. REFERENCE #1:
Hazique M, Ahmed S, Grewal S. A Case Report of Methicillin-Resistant
Staphylococcus aureus-Related Pericardial Empyema: A Deadly Cardiac Risk.
Cureus. 2024 Oct 2;16(10):e70684. doi: 10.7759/cureus.70684. PMID:
39493020; PMCID: PMC11528875. REFERENCE #2: Radovanovic M, Petrovic M,
Hanna RD, Nordstrom CW, Calvin AD, Barsoum MK, Milosavljevic N, Jevtic D,
Sokanovic M, Dumic I. Clinical Presentation and Management of
Methicillin-Resistant Staphylococcus aureus Pericarditis-Systematic
Review. J Cardiovasc Dev Dis. 2022 Mar 30;9(4):103. doi:
10.3390/jcdd9040103. PMID: 35448079; PMCID: PMC9024581. REFERENCE #3:
Ganji M, Ruiz J, Kogler W, Lung J, Hernandez J, Isache C.
Methicillin-resistant Staphylococcus aureus pericarditis causing cardiac
tamponade. IDCases. 2019 Aug 1;18:e00613. doi: 10.1016/j.idcr.2019.e00613.
PMID: 31453103; PMCID: PMC6704044. DISCLOSURES: No relevant relationships
by Kavya Poluru Copyright © 2025 American College of Chest
Physicians

<190>
Accession Number
2041863912
Title
SPONTANEOUS FORMATION OF HEMORRHAGIC PERICARDIAL EFFUSION IN THE SETTING
OF COVID-19-INDUCED IMMUNE THROMBOCYTOPENIC PURPURA.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1024-A1025),
2025. Date of Publication: 01 Oct 2025.
Author
Patel N.E.A.L.; Shaikh R.; Trentin C.A.I.O.; Hassan A.; Aguirre C.; Iqbal
R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (Q) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: The incidence of pericardial effusion has been noted in many
cases of COVID-19 with cardiac involvement and rarely, has been found to
progress to cardiac tamponade. While most cases of pericardial effusion
are non-hemorrhagic, hemorrhagic pericardial effusions are common in the
setting of trauma, use of blood thinners like direct oral anticoagulants
as well as in post-myocardial infarction patients with spontaneous rupture
of the myocardium. Generally, most episodes of pericardial clots have been
found in patients after open heart surgery due to various surgical
complications including myocardial trauma. CASE PRESENTATION: 72-year-old
male with a complex medical history including congestive heart failure
with single lead ICD, hypertension, hyperlipidemia, type II diabetes
mellitus, COPD, chronic kidney disease, BPH, and GERD presented to the
emergency department with dyspnea, altered mental status, hypoxia, and
peripheral cyanosis. He was placed on BiPAP support due to his hypoxic
state which was refractory to the nasal cannula. Chest X-ray revealed
evidence of pleural effusion, interstitial edema, and cardiomegaly. He
tested positive for SARS-Cov-2 via PCR. Cefepime and azithromycin were
initiated for suspected community-acquired pneumonia in the setting of
COPD exacerbation.His echocardiogram revealed a large pericardial clot
with moderate pericardial effusion causing right ventricular collapse and
dilation of the left ventricle, with an ejection fraction measured at 10
to 20%. There were no echocardiographic findings of tamponade.A workup for
possible TTP yielded negative as the patient's ADAMTS13 level was normal,
While the patient was thrombocytopenic with a platelet count of 99, his PT
INR and PTT. His fibrinogen was also normal ruling out DIC. These
laboratory findings effectively ruled out DIC but left immune
thrombocytopenic purpura in the differential. Hematology was consulted,
who started the patient on Dexamethasone 40 IV daily and agreed with ITP
diagnosis. A repeat echocardiogram demonstrated trace pericardial effusion
without evidence of a clot and an improved EF of 45%. Norepinephrine was
discontinued as hemodynamic stability was achieved. The patient regained
full awareness and transitioned from BiPAP back to nasal cannula, and was
subsequently discharged 3 days later, DISCUSSION(S): Viral etiologies
have not been implicated in the development of hemopericardium as it is
known to be secondary to some form of cardiac trauma. However, there are
incidences where Coxsackievirus has played a role not only in the
development of cardiomyopathies but also in the development of
hemopericardium. Due to its more novel nature, COVID-19 has less
correlation with hemopericardium, but there are recorded instances with
severity to the point of requiring pericardial windows due to the extent
of tamponade. The mechanism behind viral hemopericardium is poorly
understood, but it is thought to be due to the prothrombotic and
proinflammatory states that these viral infections may introduce.
 CONCLUSION(S): We postulate that the concurrent prothrombotic and
proinflammatory state induced by COVID-19 is a key contributing factor to
the development of the patient's Immune Thrombocytopenia and
hemopericardium. Early diagnosis and a proactive approach with POCUS is
paramount for such patients, potentially averting complications and
prolonged hospitalizations REFERENCE #1: Faiz, M., Farrukh, L., Wajid, S.,
Halasa, I., Ehtesham, M., Hareem Waqar, H., & Bachman, W. (2023).
Hemorrhagic pericardial effusion with cardiac tamponade physiology: An
unusual covid-19 presentation. CHEST, 164(4).
https://doi.org/10.1016/j.chest.2023.07.431. Minh LH, Abozaid AA, Ha NX,
et al.: Clinical and laboratory factors associated with coronavirus
disease 2019 (Covid-19): a systematic review and meta-analysis. Rev Med
Virol. 2021, 31:e2288. 10.1002/rmv.2288 REFERENCE #2: Maram, K., Kudumula,
V., & Paturi, V. R. (2022). Coxsackie B viral infection presenting with
hemorrhagic pericardial effusion and pleural effusion. Annals of Pediatric
Cardiology, 15(1), 87. https://doi.org/10.4103/apc.apc_21_21. Panigada M,
Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V,
Pesenti A, Peyvandi F, Tripodi A. Hypercoagulability of COVID-19 patients
in intensive care unit: A report of thromboelastography findings and other
parameters of hemostasis. J Thromb Haemost. 2020 Jul;18(7):1738-1742. doi:
10.1111/jth.14850. Epub 2020 Jun 24. PMID: 32302438; PMCID: PMC9906150.
REFERENCE #3: Zanza C, Romenskaya T, Manetti AC, Franceschi F, La Russa R,
Bertozzi G, Maiese A, Savioli G, Volonnino G, Longhitano Y. Cytokine Storm
in COVID-19: Immunopathogenesis and Therapy. Medicina (Kaunas). 2022 Jan
18;58(2):144. doi: 10.3390/medicina580201440. PMID: 35208467; PMCID:
PMC8876409. Xu, Sw., Ilyas, I. & Weng, Jp. Endothelial dysfunction in
COVID-19: an overview of evidence, biomarkers, mechanisms and potential
therapies. Acta Pharmacol Sin 44, 695-709 (2023).
https://doi.org/10.1038/s41401-022-00998-0 DISCLOSURES: No relevant
relationships by Christopher Aguirre No relevant relationships by Allia
Hassan No relevant relationships by Rahib Iqbal No relevant relationships
by Neal Patel No relevant relationships by Raheel Shaikh No relevant
relationships by CAIO TRENTIN Copyright © 2025 American College
of Chest Physicians

<191>
Accession Number
649439037
Title
Short Term Outcome of Provisional Left Main Stenting in Acute Coronary
Syndromes.
Source
QJM: An International Journal of Medicine. Conference: 45th Annual Ain
Shams Medical Congress. Cairo Egypt. 118(Supplement 1) (pp i12-i13), 2025.
Date of Publication: 01 Nov 2025.
Author
Atef M.; Raymond R.; Ali A.N.; Abd-ElMone'em M.
Institution
(Atef, Raymond, Ali, Abd-ElMone'em) Cardiology Department, Ain Shams
University, Egypt
Publisher
Oxford University Press
Abstract
Background: Left main coronary artery (LMA) disease jeopardizes a large
area of myocardium and increases the risk of major adverse cardiovascular
events. For several decades, bypass surgery has been regarded as the
treatment of choice for patients with left main coronary artery (LMCA)
disease, yet, several recent large registries and randomized controlled
trials have demonstrated that LMCA stenting yields mortality and morbidity
rates comparable to coronary artery bypass grafting (CABG). however, to
date, no uniform recommendations as to optimal stenting strategy for LMCA
bifurcation lesions exist. Aims and Objectives: The objective of this
study is to evaluate the short-term outcome of provisional left main
stenting in individuals undergoing left main intervention in the setting
of acute coronary syndromes, as regards the anticipated events and
complications e.g. (major adverse cardiovascular events (MACE), target
lesion restenosis or contrast induced nephropathy) Subjects and Methods:
Our observational pilot study was conducted on 65 patients who were
presented to us with acute coronary syndromes and after performing a
diagnostic coronary angiography, they were proven to have significant left
main disease ( defined as more than 50% angiographic narrowing ),
provisional left main stenting was performed in the absence of
intravascular imaging modalities, patients were followed up for 3 months
and the incidence of MACE or other complications was recorded. It was
carried out at Ain-Shams university hospitals and October 6 University
hospitals. Result(s): MACE occurred in only 8.1% of all patients,
Contrastinduced nephropathy (CIN) affected 14.8% of participants. Target
lesion revascularization (TLR) was rarely needed in1.6% of participants,
ejection fraction improved from a mean of 49.65% at the time of admission
to a mean of 53.75% within the 3-month follow-up (FUP) period.
 Conclusion(s): The results of this study indicates that patients were
treated well with a stepwise layered provisional approach, Therefore, it
seems reasonable to conclude that the stepwise provisional strategy should
remain the preferred approach for the majority of the left main
bifurcation interventions, even in the absence of intravascular imaging,
it is still a safe and effiecient approach and non-inferior to CABG or
double stent strategies in terms of safety and efficacy.

<192>
Accession Number
2041647463
Title
Should we unfasten our patients? A meta-analysis of randomized trials on
fasting prior to cardiac catheterization procedures.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Vargas K.G.; Karthikesan D.; Huber K.; Bekfani T.; Parco C.; Lin Y.; Wolff
G.
Institution
(Vargas, Parco, Lin, Wolff) Clinic of Cardiology, Klinikum Ibbenburen,
Grose Strase 41, Ibbenburen, Germany
(Karthikesan) Department of Cardiology, Hospital Sultanah Bahiyah, Alor
Setar, Malaysia
(Huber) Austrian Heart Foundation, Vienna, Austria
(Huber) Ludwig Boltzmann Institute for Cardiovascular Research, Vienna,
Austria
(Vargas, Bekfani) Department of Internal Medicine, Division of Cardiology
and Angiology, University Hospital Magdeburg, Magdeburg, Germany
Publisher
Springer Science and Business Media Deutschland GmbH

<193>
[Use Link to view the full text]
Accession Number
2041216073
Title
Prevention of postoperative acute kidney injury: insights from recent
clinical trials.
Source
Current Opinion in Nephrology and Hypertension. (no pagination), 2025.
Date of Publication: 09 Oct 2025.
Author
Benyahia R.; Klein J.; Faguer S.
Institution
(Benyahia, Faguer) Department of Nephrology and Organ Transplantation,
Referral Centre for Rare Kidney Diseases, French Intensive Care Renal
Network, University Hospital of Toulouse
(Benyahia, Klein, Faguer) National Institute of Health and Medical
Research (INSERM), U1297, Institute of Metabolic and Cardiovascular
Diseases (I2MC), Renal Fibrosis Lab
(Benyahia, Klein, Faguer) Faculty of Health, University of Toulouse,
Toulouse, France
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review - Postoperative acute kidney injury (PO-AKI) is a common
complication associated with increased morbidity and mortality. Despite
its frequency, guidelines for the prevention of PO-AKI are relatively
recent and still based on weak or contradictory evidence. This review aims
to summarize large recent studies published in the past 2 years that have
attempted to address these gaps. Recent findings - While the POST-CABGDM
and Stop-or-Not trials have provided additional evidence on the
preoperative prescription of RAAS and SGLT2 inhibitors in selected
surgical settings, future research must integrate preoperative risk
profiling to personalize therapy. Likewise, although the POISE-3 trial
seems to suggest that maintaining a mean arterial pressure of at least 60
mmHg is crucial in noncardiac surgery, it does not explore how targets
might be personalized. In cardiac surgery, both the SIRAKI02 trial (i.e.,
extracorporeal blood purification membrane connected to the
cardiopulmonary bypass) and the PROTECTION trial (i.e., intraoperative
amino-acid infusion) demonstrated benefit only for mild AKI, raising
questions about their mechanistic basis and clinical significance. Summary
- "Prevention is better than cure, " a principle that holds particularly
true for PO-AKI, a common complication that still lacks effective curative
treatments. Although the recent abovementioned trials have yielded
important findings, they concurrently underscore the significant obstacles
in conducting clinical trials on PO-AKI and in formulating robust
recommendations based on their outcomes. Copyright © 2025

<194>
Accession Number
2037405832
Title
Prophylactic Negative Pressure Therapy in Reducing the Risk of Sternal
Wound Infection after Cardiac Surgery.
Source
Cor et Vasa. 67(5) (pp 572-575), 2025. Date of Publication: 2025.
Author
Timbilla S.; Gofus J.; Smolak P.; Cermakova E.; Mandak J.; Vojacek J.
Institution
(Timbilla, Gofus, Smolak, Mandak, Vojacek) Department of Cardiac Surgery,
Faculty of Medicine and University Hospital in Hradec Kralove, Charles
University, Hradec Kralove, Czechia
(Cermakova) Department of Medical Biophysics, Faculty of Medicine Hradec
Kralove, Charles University, Charles University, Faculty of Medicine in
Hradec Kralove, Hradec Kralove, Czechia
Publisher
Czech Society of Cardiology Z.S
Abstract
Background: Postoperative sternal wound infections and dehiscence are
serious complications of cardiac surgery that increase the length of
hospital stay and healthcare costs. Standard wound care may be
insufficient for preventing these complications in high-risk patients.
 Method(s): We conducted a prospective, randomized study comparing the
efficacy of closed incisional negative pressure wound therapy (ciNPWT)
using Prevena (study group) versus standard wound dressing (control group)
in patients at high risk of sternal wound infections following cardiac
surgery. Primary outcomes included the incidence of sternal wound
infection at seven days and three months postoperatively, and length of
hospital stay. Result(s): The study cohort comprised 80 patients (64
male, 16 female; mean age 65.4 years) randomized into two groups with 40
patients in each. At 7 days post-operation, there were four patients with
sternal wound infection in the study group (10 %) and seven in the control
group (17.5%) (p-value=0.52). At 3 months, deep wound infections were
present in 1 patient in the study group (2.5%) and 2 in the control group
(5%) (p = 1.00). Median length of hospital stay was comparable between the
study (12 days) and control (11 days) groups (p-value = 0.75).
 Conclusion(s): Preventive negative pressure wound treatment showed a
trend towards reducing the incidence of wound healing complications in
high-risk patients following cardiac surgery, although the differences
were not statistically significant. Further large-scale studies are
warranted to establish the efficacy and cost--effectiveness of this
preventive strategy. Copyright © 2025, Czech Society of
Cardiology Z.S. All rights reserved.

<195>
Accession Number
2041647465
Title
Natural history and outcomes of medically treated coronary artery disease:
insights from reconstructed individual patient data of 29 randomized
trials.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Mahesh R.; Wong D.H.C.; Anand V.V.; Soh D.K.E.; Low G.Z.; Hao Y.; Chen Y.;
Chong B.; Hartanto A.D.; Chen J.; Sim H.W.; Ng G.; Koo C.Y.; Mehta A.;
Weight N.; Khan M.S.; Figtree G.A.; Loh P.H.; Mamas M.A.; Chan M.Y.; Chin
Y.H.; Chew N.W.S.
Institution
(Mahesh) Lee Kong Chian School of Medicine, Nanyang Technological
University, Singapore, Singapore
(Wong, Soh, Hao, Chen, Chen, Sim, Ng, Koo, Loh, Chan, Chew) Yong Loo Lin
School of Medicine, National University Singapore, Singapore, Singapore
(Anand, Chong, Chin) Ministry of Health Holdings, Ministry of Health,
Singapore, Singapore
(Low, Chen, Sim, Ng, Koo, Loh, Chan, Chew) Department of Cardiology,
National University Heart Centre, National University Health System,
Singapore, Singapore
(Hartanto, Sim, Loh) Division of Cardiology, Department of Medicine, Ng
Teng Fong General Hospital, Singapore, Singapore
(Mehta) Emory Clinical Cardiovascular Research Institute, Division of
Cardiology, Department of Medicine, Emory University School of Medicine,
Atlanta, GA, United States
(Weight, Mamas) Keele Cardiovascular Research Group, Keele University,
Keele, United Kingdom
(Weight, Mamas) Institute of Population Health, University of Manchester,
Manchester, United Kingdom
(Khan) Baylor Scott and White Research Institute, Dallas, TX, United
States
(Khan) Baylor College of Medicine, Temple, TX, United States
(Khan) The Heart Hospital, Plano, TX, United States
(Figtree) Sydney Medical School, Faculty of Medicine and Health,
University of Sydney, Sydney, NSW, Australia
(Figtree) Cardiovascular Discovery Group, Kolling Institute of Medical
Research, St Leonards, NSW, Australia
(Figtree) Department of Cardiology, Royal North Shore Hospital, St
Leonards, NSW, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The natural history of medically treated chronic CAD remains
unclear. The current study pools evidence from randomized controlled
trials to examine the natural progression and long-term outcomes in the
population with chronic CAD. Method(s): Medline, Embase, and Cochrane
databases were searched in March 2024 to identify relevant
randomized-controlled trials (RCTs) reporting long-term outcomes for
chronic CAD individuals on guideline-directed medical therapy (GDMT). A
single-arm meta-analysis of proportions and means was performed on the
baseline characteristics, primary and secondary endpoints. Individual
patient data were reconstructed from Kaplan-Meier estimates published in
the included RCTs for all-cause mortality and myocardial infarction (MI).
 Result(s): A total of 29 trials, comprising 51,275 individuals with
medically treated chronic CAD, were included. The pooled incidence rates
for all-cause mortality, MI and cardiac death were 19.3 (95%CI,
18.0-20.7), 30.0 (95%CI, 27.6-32.6), and 8.6 (95%CI, 5.8-12.7) per 1000
person-years, respectively. Incremental risks in all-cause mortality and
MI in chronic CAD were observed across time, at one (0.8% and 2.6%), two
(2.0% and 2.3%), three (3.3% and 7.5%), four (4.9% and 5.0%) and five
years (10.5% and 8.4%), respectively. The rates of angina and coronary
revascularization were 76.1 (95%CI, 31.6 to 183.4) and 37.3 (95%CI, 25.1
to 55.2) events per 1000 person-years. Conclusion(s): The
reconstructed individual patient data meta-analysis of patients with
chronic CAD over 185,455 person-years highlights that the natural
progression of chronic CAD is far from stable, with cardiovascular risks
more than doubling at >= 5 years of follow-up. Copyright ©
Springer-Verlag GmbH Germany, part of Springer Nature 2025.

<196>
Accession Number
2042047463
Title
Optimization in long-term survival after multiple arterial grafting in
coronary artery bypass: A systematic review and meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2025. Date of
Publication: 2025.
Author
Abdillah A.H.; Sofian A.; Agustian A.H.; Fadhilah A.; Fatharani A.
Institution
(Abdillah, Agustian) Faculty of Medicine, Universitas Sumatera Utara,
Medan, Indonesia
(Sofian) Department of Thoracic and Cardiovascular Surgery, Pertamina
Pusat Hospital, South Jakarta, Indonesia
(Fadhilah) Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(Fatharani) Faculty of Medicine and Life Sciences, King's College London,
London, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Introduction: Surgical revascularization through coronary artery bypass is
a widely accepted approach for treating diseases affecting multiple
coronary vessels. While the standard approach uses a single arterial graft
combined with vein grafts, using numerous arterial grafts may improve
long-term outcomes. Although supported by observational data and guideline
recommendations, the broader adoption of multiple arterial grafting has
been limited due to a lack of definitive randomized trial evidence and
uncertainties in specific patient subgroups. Method(s): A systematic
review and meta-analysis were conducted to compare long-term survival in
patients receiving multiple versus single arterial grafts during coronary
artery bypass surgery. Twenty-seven studies (including one randomized
trial) involving more than one million patients were included. The primary
outcome was long-term all-cause mortality. Hazard ratios with 95%
confidence intervals were pooled using a random-effects model. Subgroup
analyses were performed based on age, sex, diabetes status, graft conduit
type, extent of arterial revascularization, and left ventricular function.
Meta-regression examined the impact of patient characteristics.
 Result(s): Multiple arterial grafting was associated with a
significant reduction in long-term mortality compared to single arterial
grafting. The pooled hazard ratio indicated an approximate 20% relative
reduction in mortality. This survival benefit was consistent across all
evaluated subgroups. Meta-regression did not identify any patient
characteristic that significantly altered the benefit of multiple arterial
grafting. No significant publication bias was detected.
 Conclusion(s): Multiple arterial grafting is associated with improved
long-term survival in coronary artery bypass surgery. These findings
support the broader implementation of this strategy in suitable patients
while emphasizing the need for individualized surgical
decision-making. Copyright © The Author(s) 2025. This article is
distributed under the terms of the Creative Commons Attribution 4.0
License (https://creativecommons.org/licenses/by/4.0/) which permits any
use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open
Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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