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<1>
Accession Number
2040585919
Title
Practice changing updates in perioperative medicine literature 2024. A
systematic review.
Source
American Journal of Medicine. 139(1) (pp 33-41.e1), 2026. Date of
Publication: 01 Jan 2026.
Author
Khambaty M.; Silbert R.E.; Stephenson C.R.; Bartlett M.A.; Regan D.W.;
Sanchez J.J.; Sundsted K.K.; Mauck K.F.
Institution
(Silbert, Stephenson, Bartlett, Mauck) Division of General Internal
Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of
Medicine, Rochester, MN, United States
(Khambaty, Regan, Sanchez, Sundsted) Division of Hospital Internal
Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of
Medicine, Rochester, MN, United States
Publisher
Elsevier Inc.
Abstract
Every year, new publications advance our understanding of perioperative
medicine. These publications are spread over a variety of journals that
require dedicated effort to identify. To aid this task, we have undertaken
a multi-database literature search from January to December of 2024. We
included original research articles, systematic reviews, meta-analyses,
and guidelines. We excluded abstracts, case reports, letters, or
literature pertaining to cardiovascular surgery, pediatrics, and
obstetrics. Two authors reviewed each reference using the Distiller SR
systematic review software (Evidence Partners Inc., Ottawa, Ontario,
Canada). A modified Delphi technique was used to narrow down to seven of
the most impactful publications and another seven tabular summaries. The
purpose of this review is to understand the strength and limitations of
the new literature in order to improve perioperative outcomes for
patients. Copyright © 2025 Elsevier Inc.

<2>
Accession Number
2040831322
Title
Empagliflozin Reduces Risk of Hospitalization in Patients With Chronic
Kidney Disease in the EMPA-KIDNEY Trial.
Source
Clinical Therapeutics. 47(12) (pp 1091-1096), 2025. Date of Publication:
01 Dec 2025.
Author
Uster A.; Desai N.; Navaneethan S.D.; Pfarr E.; Mazo A.R.
Institution
(Uster, Pfarr, Mazo) Boehringer Ingelheim International GmbH,
Ingelheim-am-Rhein, Germany
(Desai) Section of Cardiovascular Medicine, Yale School of Medicine, New
Haven, Connecticut, United States
(Navaneethan) Selzman Institute for Kidney Health, Section of Nephrology,
Department of Medicine, Baylor College of Medicine, Houston, Texas, United
States
Publisher
Elsevier Inc.
Abstract
Purpose: Chronic kidney disease (CKD) increases hospitalization risk. In
the randomized, phase III, EMPA-KIDNEY trial, empagliflozin significantly
reduced risk of all-cause hospitalizations (ACH; first and recurrent) vs
placebo. This post hoc analysis of the EMPA-KIDNEY trial examines the
burden of ACH in CKD and the effects of empagliflozin on ACH.
 Method(s): Participants with CKD (n = 6609) were randomized to
empagliflozin 10 mg or placebo. Reasons for hospitalizations were derived
from adverse events leading to hospitalization, assessed by system organ
class. Finding(s): Overall, 1995 participants (1035 placebo, 960
empagliflozin) had >=1 ACH (1895 ACH in placebo and 1611 in the
empagliflozin 10-mg groups). The estimated mortality rate after first
hospitalization in participants with >=1 hospitalization was 12% after 1
year and 18% after 2 years, and risk of death was ~10 times higher vs
those without (hazard ratio [HR] 9.53; 95% confidence interval [CI],
7.18-12.64; P < 0.0001). The most common reasons for hospitalization were
infections and infestations, surgical and medical procedures,
investigations, cardiac disorders, renal and urinary disorders, and
metabolic disorders. Risk of ACH was significantly reduced for
empagliflozin vs placebo (HR: 0.86, 95% CI, 0.78-0.95, P = 0.003). This
was consistent regardless of baseline diabetes status, estimated
glomerular filtration rate, or urinary albumin-to-creatinine ratio. Mean
cumulative incidence of ACH in empagliflozin and placebo groups diverged
shortly after randomization and separated further over time. Risk of
hospital admissions from cardiovascular (CV), renal, or metabolic
conditions was significantly lower with empagliflozin vs placebo (P <
0.05). Implications: Treatment with empagliflozin significantly reduced
risk of ACH, including those attributed to CV, renal, or metabolic
conditions. ClinicalTrials.gov number: NCT03594110 Copyright ©
2025 The Author(s)

<3>
Accession Number
2041494714
Title
A Narrative Review on Current Status of Conscious Sedation for
Transcatheter Aortic Valve Implantation.
Source
Medicina (Lithuania). 61(11) (no pagination), 2025. Article Number: 1980.
Date of Publication: 01 Nov 2025.
Author
Nazou G.; Schizas N.; Romana K.N.; Androutsopoulou V.; Magira E.;
Sarantopoulos A.; Iliopoulos D.; Mentzelopoulos S.D.
Institution
(Nazou, Romana) Anaesthesiology Department, Evangelismos General Hospital,
Athens, Greece
(Schizas, Magira, Iliopoulos, Mentzelopoulos) School of Medicine, National
and Kapodistrian University of Athens, Athens, Greece
(Schizas, Iliopoulos) 4th Cardiac Surgery Department, Hygeia Hospital,
Athens, Greece
(Androutsopoulou) Department of Cardiothoracic Surgery, University
Hospital of Larissa, Larissa, Greece
(Magira, Mentzelopoulos) 1st Department of Critical Care and Pulmonary
Services, Evangelismos General Hospital, Athens, Greece
(Sarantopoulos) NCH Rooney Heart Institute, Naples, FL, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Anesthesiologic management of Transcatheter Aortic Valve Implantation
(TAVI) is a key factor in procedural success and effectiveness. Although
general anesthesia was the main anesthesiologic approach during the early
years of the development of TAVI, over the last decade, there has been a
shift towards sedation. Hemodynamic stability is the main concern of
intraoperative anesthesiologic management. Preprocedural,
multidisciplinary assessment of the patient is essential prior to TAVI and
should include a full anesthesiologic evaluation. TAVI offers a number of
advantages to patients and medical teams, but important accompanying
complications and anesthesiologic risks remain. In this narrative review,
all aspects of sedation in TAVI are presented and analyzed, including
methods, patient selection, contraindications, drug administration,
intraprocedural parameters, outcomes, and future developments in this
field. Copyright © 2025 by the authors.

<4>
Accession Number
2041238671
Title
Outcomes of Early vs Delayed Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. 18(22) (pp 2761-2773), 2025. Date of
Publication: 24 Nov 2025.
Author
Genereux P.; Schwartz A.; Pibarot P.; Lindman B.R.; Cohen D.J.; Oldemeyer
J.B.; Fearon W.F.; Babaliaros V.; Daniels D.; Chhatriwalla A.K.; Suradi
H.S.; Shah P.B.; Szerlip M.; Mack M.J.; Dahle T.; Goel K.; O'Neill W.W.;
Davidson C.J.; Makkar R.R.; Sheth T.; Williams M.; Russo M.J.; Guerrero
M.; McCabe J.; Leipsic J.; Zhao Y.; Hahn R.T.; Blanke P.; Leon M.B.
Institution
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Schwartz, Cohen, Hahn, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Pibarot) Department of Cardiology, Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Lindman, Goel) Division of Cardiovascular Medicine, Vanderbilt University
Medical Center, Nashville, TN, United States
(Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United
States
(Cohen) St. Francis Hospital and Heart Center, Roslyn, NY, United States
(Oldemeyer) University of Colorado Health, Loveland, CO, United States
(Fearon) Interventional Cardiology Section, Division of Cardiovascular
Medicine, Department of Medicine, Stanford University School of Medicine,
Stanford, CA, United States
(Babaliaros) Emory School of Medicine, Atlanta, GA, United States
(Daniels) Division of Cardiology, California Pacific Medical Center, San
Francisco, CA, United States
(Chhatriwalla) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Suradi) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Shah) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, United States
(Szerlip, Mack) Baylor Scott & White Heart Hospital, Plano, TX, United
States
(Dahle) CentraCare Heart & Vascular Center, St. Cloud, MN, United States
(O'Neill) Center for Structural Heart Disease, Henry Ford Health System,
Detroit, MI, United States
(Davidson) Northwestern University Feinberg School of Medicine, Chicago,
IL, United States
(Makkar) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Sheth) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(Williams) New York University Langone Medical Center, New York, NY,
United States
(Russo) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Guerrero) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(McCabe) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Leipsic, Blanke) St. Paul's Hospital and University of British Columbia,
Vancouver, BC, Canada
(Zhao) Edwards Lifesciences, Irvine, CA, United States
Publisher
Elsevier Inc.
Abstract
Background For patients with asymptomatic, severe aortic stenosis (AS),
the EARLY TAVR (Evaluation of TAVR Compared to Surveillance for Patients
With Asymptomatic Severe Aortic Stenosis) trial demonstrated that early
transcatheter aortic valve replacement (TAVR) was superior to clinical
surveillance (CS) with respect to the primary endpoint in the
intention-to-treat population. Objectives The aim of this study was to
compare postprocedural outcomes in the valve implant population. Methods
The valve implant population comprised patients randomized to early TAVR
who underwent the procedure and those randomized to CS who underwent
delayed aortic valve replacement (AVR). The impact of the clinical
presentation at time of delayed AVR was also assessed as progressive valve
syndrome (eg, NYHA functional class II) vs acute valve syndrome (AVS; eg,
NYHA functional class III or IV, syncope). The primary outcome was the
composite of death, stroke, or heart failure hospitalization 2 years
postprocedure. Results Across 75 sites, 97.6% of early TAVR patients (444
of 455) underwent the index procedure, and 87.0% of CS patients (388 of
446) underwent delayed AVR through 5 years; 39.2% presented with AVS and
58.5% with progressive valve syndrome (median time to delayed AVR 11.1
months). Early TAVR demonstrated a benefit compared with delayed AVR for
the primary composite (adjusted HR [aHR]: 0.61; 95% CI: 0.38-0.99; P =
0.045). When examined by clinical presentation, delayed AVR with AVS was
significantly associated with worse outcomes compared with early TAVR
(aHR: 2.12; 95% CI: 1.19-3.78; P = 0.01), driven largely by stroke (aHR:
2.92; 95% CI: 1.26-6.76; P = 0.01). Conclusions Among patients with
asymptomatic, severe AS, delayed AVR with AVS is associated with higher
rates of death, stroke, or heart failure hospitalization compared with
early TAVR, highlighting a benefit for early TAVR before symptoms develop
given the unpredictability of AS progression. (Evaluation of TAVR Compared
to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis
[EARLY TAVR]; NCT03042104 ) Copyright © 2025 American College of
Cardiology Foundation.

<5>
Accession Number
2041238234
Title
Clinical Impact of In-Hospital Hemoglobin Decline Without Overt Bleeding
After Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. 18(22) (pp 2744-2757), 2025. Date of
Publication: 24 Nov 2025.
Author
Avvedimento M.; Cepas-Guillen P.; Nuche J.; Ternacle J.; Urena M.; Alperi
A.; Cheema A.; Veiga-Fernandez G.; Nombela-Franco L.; Vilalta V.; Esposito
G.; Campelo-Parada F.; Idolfi C.; del Trigo M.; Munoz-Garcia A.; Asmarats
L.; Regueiro A.; del Val D.; Auffret V.; Maneiro Melon N.; Bonnet G.;
Jonveaux M.; Mesnier J.; Avanzas P.; Rezaei E.; Fradejas-Sastre V.;
Tirado-Conte G.; Fernandez-Nofrerias E.; Franzone A.; Guitteny T.;
Sorrentino S.; Oteo J.F.; Gutierrez-Alonso L.; Flores-Umanzor E.; Alfonso
F.; Nolf M.; Cote M.; Pelletier-Beaumont E.; Rodes-Cabau J.
Institution
(Avvedimento, Cepas-Guillen, Cote, Pelletier-Beaumont, Rodes-Cabau) Quebec
Heart & Lung Institute, Laval University, Quebec City, QC, Canada
(Nuche, Maneiro Melon) Cardiology Department, Hospital Universitario 12 de
Octubre, Instituto de Investigacion Sanitaria 12 de Octubre, Madrid, Spain
(Nuche) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares, Madrid, Spain
(Ternacle, Bonnet, Jonveaux) Hopital Cardiologique Haut-Leveque, CHU de
Bordeaux, Bordeaux, France
(Urena, Mesnier) Cardiology Department, Bichat-Claude Bernard Hospital,
Assistance Publique-Hopitaux de Paris, Paris, France
(Alperi, Avanzas) Cardiology Department, Hospital Universitario Central de
Asturias, Oviedo, Spain
(Cheema, Rezaei) Southlake Regional Health Centre Newmarket, Ontario,
Canada
(Veiga-Fernandez, Fradejas-Sastre) Cardiology Department, Hospital Marques
de Valdecilla, Santander, Spain
(Nombela-Franco, Tirado-Conte) Cardiology Department, Instituto
Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
(Vilalta, Fernandez-Nofrerias) Cardiology Department, Hospital Germans
Trias i Pujol, Badalona, Spain
(Esposito, Franzone) Department of Advanced Biomedical Sciences,
University of Naples Federico II, Naples, Italy
(Campelo-Parada, Guitteny) Cardiology Department, Toulouse University
Hospital, Toulouse, France
(Idolfi, Sorrentino) Department of Medical and Surgical Sciences, Division
of Cardiology, "Magna Graecia" University, Catanzaro, Italy
(del Trigo, Oteo) Cardiology Department, Hospital Puerta de Hierro,
Madrid, Spain
(Munoz-Garcia) Cardiology Department, Hospital Regional Virgen de la
Victoria, Malaga, Spain
(Asmarats, Gutierrez-Alonso) Cardiology Department, Hospital de la Santa
Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
(Regueiro, Flores-Umanzor, Rodes-Cabau) Cardiology Department, Institut
Clinic Cardiovascular, Hospital Clinic, Institut d'Investigacions
Biomediques August Pi I Sunyer, Barcelona, Spain
(del Val, Alfonso) Cardiology Department, Hospital de La Princesa, Madrid,
Spain
(Auffret, Nolf) University of Rennes, Department of Cardiology, Rennes
University Hospital, Rennes, France
Publisher
Elsevier Inc.
Abstract
Background The Valve Academic Research Consortium recently expanded its
bleeding endpoint definition, recommending that any procedure-related
blood loss should be classified as bleeding, even in the absence of a
clinically evident source. However, the lack of specific reference
thresholds for hemoglobin decline limits the ability to discriminate
clinically relevant events and the prognostic utility of these criteria.
Objectives To evaluate the incidence, predictors, and prognostic
implications of hemoglobin declines without overt bleeding in patients
undergoing transcatheter aortic valve replacement (TAVR). Methods In this
multicenter study, 9,759 TAVR patients were stratified according to the
presence or absence of overt bleeding during hospitalization. Among
patients without overt bleeding, hemoglobin decrease was classified
according to baseline and nadir in-hospital values as minimal (>1 and <3
g/dL), minor (>=3 and <5 g/dL), or major (>=5 g/dL). The median follow-up
duration was 28 months (Q1-Q3: 12-48 months). Results Hemoglobin decreases
occurred in 5,645 patients (57.8%), classified as minimal in 79.1%, minor
in 18.3%, and major in 2.6%. Female sex, dual antiplatelet therapy,
chronic kidney disease, and higher baseline hemoglobin determined an
increased risk for significant decline ( P < 0.01 for all), whereas radial
secondary access acted as a protective factor ( P = 0.001). A major
hemoglobin decline significantly increased 30-day mortality (adjusted HR
[aHR]: 3.05; 95% CI: 1.15-8.96). At 1 year, both minor (aHR: 1.42; 95% CI:
1.09-1.86) and major (aHR: 1.85; 95% CI: 1.13-3.03) declines were
independently associated with up to a 2-fold increase in mortality risk.
Conclusions An in-hospital hemoglobin decrease >=3 g/dL after TAVR, even
in the absence of overt bleeding, was very common and independently
associated with worse outcomes. Stratifying periprocedural hemoglobin loss
may support early risk identification, guide postprocedural management,
and refine future endpoint definitions. Copyright © 2025 American
College of Cardiology Foundation.

<6>
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.

<7>
Accession Number
2038588211
Title
No-touch versus conventional vein in coronary artery bypass grafting:
Three year follow-up of multicentre randomised PATENCY trial.
Source
BMJ. 389 (no pagination), 2025. Article Number: e082883. Date of
Publication: 2025.
Author
Tian M.; Wang X.; Feng W.; Wang H.; Liu S.; Liu Z.; Chen Y.; Miao Q.; Su
P.; Li X.; Wang Y.; Lu B.; Chen K.; Zhang C.; Hu S.
Institution
(Tian, Wang, Feng, Chen, Zhang, Hu) Department of Surgery, National Center
for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Wang) Beijing Hospital, Beijing, China
(Liu) The Second Hospital of Hebei Medical University, Hebei Province,
Shijiazhuang, China
(Liu) Teda International Cardiovascular Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Tianjin, China
(Chen) The Second People's Hospital of Anhui Province, Anhui Province,
Hefei, China
(Miao) Peking Union Medical College Hospital, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Su) Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
(Li) National Clinical Research Center for Cardiovascular Diseases,
National Center for Cardiovascular Disease, China & Fuwai Hospital,
Chinese Academy of Medical Sciences, Peking Union Medical College,
Beijing, China
(Wang) Medical Research & Biometrics Center, National Center for
Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Lu) Department of Radiology, National Center for Cardiovascular Disease,
China & Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
Publisher
BMJ Publishing Group
Abstract
OBJECTIVE To assess the three year outcomes of the no-touch vein
harvesting technique in coronary artery bypass grafting surgery compared
with the conventional approach. DESIGN Three year extended follow-up of
the randomised PATENCY (graft patency between the no-touch vein harvesting
technique and conventional approach in coronary artery bypass graft
surgery) trial. SETTING Seven cardiac surgery centres in China; enrolment
between April 2017 and June 2019. PARTICIPANTS 2655 participants aged 18
and older undergoing isolated coronary artery bypass grafting surgery.
INTERVENTIONS Patients were randomly assigned 1:1 to the no-touch vein
harvesting technique group or the conventional approach group during
surgery and followed up. MAIN OUTCOME MEASURES Vein graft occlusion (based
on computed tomography angiography) at three years. RESULTS Mean age of
participants was 61 years (standard deviation +/-8 years) and 22% were
women. 99.4% (2621) attended the three year follow-up visit, while 86.5%
(2281) received computed tomography angiography. At three years, the
no-touch group showed a significantly lower vein graft occlusion rate
(5.7% v 9.0%, P<0.001) than the conventional group (odds ratio 0.62, 95%
confidence interval 0.48 to 0.80), with absolute risk difference of -3.2%
(95% confidence interval -5.0% to -1.4%). The intentionto- treat analysis,
including all 2655 randomised patients with multiple imputations for
missing data, showed consistent findings, with occlusion rates of 6.1% in
the no-touch group versus 9.3% in the conventional group (odds ratio 0.63,
95% confidence interval 0.51 to 0.81; absolute risk difference-3.1%, 95%
confidence interval -4.9% to -1.4%; P<0.001). These results confirm the
robustness of the no-touch technique in reducing vein graft occlusion.
CONCLUSIONS The no-touch technique consistently and robustly reduced the
risk of vein graft occlusion and several cardiac events by one third to
one half within three years after coronary artery bypass grafting
surgery. Copyright © 2025 BMJ Publishing Group. All rights
reserved.

<8>
Accession Number
2040694216
Title
Outcomes of Left Atrial Appendage Patency After Device Closure Detected by
Cardiac CT: A Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 18(12) (pp 1348-1359), 2025. Date of
Publication: 01 Dec 2025.
Author
Jacquemyn X.; Sa M.P.; Korsholm K.; Nielsen-Kudsk J.E.; Iriart X.; Saw J.;
Alkhouli M.; Jain S.; Bittencourt M.S.; Sultan I.
Institution
(Jacquemyn, Sultan) Department of Cardiothoracic Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(Jacquemyn, Jain, Sultan) UPMC Heart and Vascular Institute, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Sa) Cleveland Clinic Florida, Weston, FL, United States
(Korsholm, Nielsen-Kudsk) Department of Cardiology, Aarhus University
Hospital, Skejby, Denmark
(Iriart) Department of Pediatric and Adult Congenital Cardiology, Hopital
Cardiologique du Haut-Leveque, CHU de Bordeaux, Bordeaux-Pessac, France
(Saw) Division of Interventional Cardiology, Vancouver General Hospital
and the University of British Columbia, Vancouver, BC, Canada
(Alkhouli) Department of Cardiology, Mayo Clinic School of Medicine
Rochester, MN, United States
(Bittencourt) Department of Medicine and Radiology University of
Pittsburgh, Pittsburgh, United States
Publisher
Elsevier Inc.
Abstract
Background: Residual leaks are common after left atrial appendage
occlusion (LAAO). Objective(s): The authors aimed to systematically
evaluate the prognostic implications of residual left atrial appendage
(LAA) patency and peridevice leaks (PDLs) detected by cardiac computed
tomography (CT) following LAAO. Method(s): The authors used
traditional meta-analytical methods and a Bayesian framework to assess the
probability of increased risks associated with these residual leaks.
 Result(s): Seventeen studies encompassing 2,036 patients met the
inclusion criteria. During follow-up, the presence of any LAA patency was
significantly associated with an almost 2-fold increased OR of
thromboembolism (pooled OR: 1.87, 95% CI: 1.08-3.24), corresponding to 28
(95% CI: 3-68) additional events per 1,000 patients. Although PDL showed a
similar trend, it was not significantly associated with increased
thromboembolism risk (pooled OR: 1.50, 95% CI: 0.85-2.65). For
thromboembolism with LAA patency, under a noninformative prior, the mean
logOR was 0.59 (95% credible interval [Crl]: 0.06-1.15), and translated
median OR of 1.87 (95% CrI: 1.06-3.14) and a mean absolute risk difference
(ARD) of 2.8% (95% CrI: 0.2%-6.8%). The posterior probability of ARD >0%
was 98.5%. For any PDL, the mean logOR was 0.38 (95% CrI: -0.22 to 0.95),
with a median OR of 1.53 (95% CrI: 0.80-2.59) and mean ARD of 1.9% (95%
CrI: -0.7% to 5.4%). The posterior probability of ARD >0% was 89.8%.
 Conclusion(s): LAA patency and PDL identified by CT may be associated
with an increased risk of thromboembolism. These findings indicate that
residual leaks detected by CT may be clinically significant and should not
be regarded as benign. Copyright © 2025 The Authors

<9>
Accession Number
2035123226
Title
Comparing the effect of three levels of end-expiratory pressure during
facemask ventilation on gastric insufflation in patients with obesity: a
randomized controlled trial.
Source
Journal of Anesthesia. 39(6) (pp 887-895), 2025. Date of Publication: 01
Dec 2025.
Author
Mostafa M.; Hasanin A.; Zakaria M.M.; Kandel H.; Hamimy W.; Abougabal A.;
Elshal M.M.
Institution
(Mostafa, Hasanin, Zakaria, Kandel, Hamimy, Abougabal) Department of
Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
(Elshal) Department of Anesthesia and Critical Care Medicine, National
Cancer Institute, Cairo University, Cairo, Egypt
Publisher
Springer
Abstract
Background: We compared the effect of three levels of end-expiratory
pressure on the incidence of gastric insufflation during face-mask
ventilation in patients with obesity. Method(s): This randomized
controlled trial included adult obese patients undergoing elective
non-cardiac surgery under general anesthesia with neuromuscular blockade.
Patients were randomized to receive either zero-end-expiratory pressure
(ZEEP group), 4-cmH<inf>2</inf>O positive end-expiratory pressure (PEEP)
(low-PEEP group), or 8-cmH<inf>2</inf>O PEEP (high-PEEP group) during
volume-controlled mask ventilation. Gastric antral cross-sectional area
(CSA) was assessed using ultrasonography before induction of anesthesia
and after intubation. The percentage of change (delta) in the CSA was
calculated and gastric insufflation was considered significant when the
delta CSA was > 30%. The primary outcome was the incidence of gastric
insufflation. Secondary outcomes were antral CSA before induction of
anesthesia and after intubation in addition to ventilatory variables
(end-tidal CO<inf>2</inf>, peak airway pressure, and tidal volume) during
face-mask ventilation. Result(s): We analyzed data from 160 patients.
The antral CSA increased after intubation in all groups. The incidence of
gastric insufflation was higher in the high-PEEP group (32/54[59%]) than
that in the ZEEP group (6/52[12%]) and low-PEEP group (15/54[28%]). Delta
CSA, antral CSA after intubation, and incidence of gastric insufflation
were not significantly different between the ZEEP and low-PEEP groups.
Ventilatory variables were comparable between the groups.
 Conclusion(s): In obese paralyzed patients, gastric insufflation can
occur during face-mask ventilation whatever the level of end-expiratory
pressure; however, the use of ZEEP or 4-cmH<inf>2</inf>O PEEP was
associated with lower incidence of gastric insufflation compared to
8-cmH<inf>2</inf>O PEEP. Clinical trial registration: Clinical trial
registration at clinicaltrials.gov NCT05979129.
https://classic.clinicaltrials.gov/ct2/show/NCT05979129 Copyright
© The Author(s) 2025.

<10>
Accession Number
2041353604
Title
Ivabradine for prevention of myocardial injury after noncardiac surgery
(PREVENT-MINS trial): study protocol for a randomized controlled trial.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 533. Date of
Publication: 01 Dec 2025.
Author
Szczeklik W.; Fronczek J.; Putowski Z.; Wludarczyk A.; Gorka J.; Seczynska
B.; Gryszowka D.; Widawska A.; Bialka S.; Palaczynski P.; Borys M.; Kutnik
P.; Czarnik T.; Krolicki T.; Szczepanska A.; Hajder N.; Mozanski M.;
Onichimowski D.; Kotfis K.; Trzebicki J.; Sadowski L.; Solek-Pastuszka J.;
Grudzien P.; Mudyna W.; Misiewska-Kaczur A.; Owczuk R.; Kudlinski B.;
Studzinska D.; Pawlik J.; Makowski A.; Zietkiewicz M.; Przydacz M.;
Gozdzik W.; Gola W.; Jasiewicz P.; Zhao Z.; Shyr Y.; Devereaux P.J.
Institution
(Szczeklik, Fronczek, Putowski, Wludarczyk, Gorka, Seczynska, Studzinska)
Centre for Intensive Care and Perioperative Medicine, Jagiellonian
University Medical College, Krakow, Poland
(Gryszowka, Widawska) Jagiellonian Center for Clinical Trials,
Jagiellonian University Medical College, Krakow, Poland
(Bialka, Palaczynski) Department of Anesthesiology and Intensive Care,
Faculty of Medical Sciences in Zabrze, Medical University of Silesia,
Katowice, Poland
(Borys, Kutnik) Institute of Medical Sciences, Faculty of Medicine, The
John Paul II Catholic University of Lublin, Lublin, Poland
(Borys, Kutnik) Center of Oncology of the Lublin Region, Lublin, Poland
(Czarnik, Krolicki) Department of Anaesthesiology and Intensive Care,
Institute of Medical Sciences, University of Opole, Opole, Poland
(Szczepanska, Hajder) Department of Anaesthesiology and Intensive Care,
Medical University of Silesia, Katowice, Poland
(Mozanski) Department of Anesthesiology and Intensive Care, Military
Institute of Medicine-National Research Institute, Warsaw, Poland
(Onichimowski) Department of Anaesthesiology and Intensive Care, Faculty
of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn,
Poland
(Kotfis) Department of Anesthesiology, Intensive Care and Pain Management,
Pomeranian Medical University, Szczecin, Poland
(Trzebicki) 1 st Department of Anesthesiology and Intensive Care, Medical
University of Warsaw, Warsaw, Poland
(Sadowski) Department of Anaesthesiology and Intensive Therapy, Central
Teaching Hospital of the Medical University of Lodz, Lodz, Poland
(Solek-Pastuszka) Department of Anaesthesiology and Intensive Therapy,
Pomeranian Medical University, Szczecin, Poland
(Grudzien) Department of Anaesthesiology and Intensive Therapy, E.
Szczeklik Specialist Hospital in Tarnow, Tarnow, Poland
(Mudyna) Department of Anaesthesiology and Intensive Therapy, Ludwik
Rydygier Memorial Specialist Hospital in Krakow, Krakow, Poland
(Misiewska-Kaczur) Department of Anesthesiology and Intensive Care,
Silesian Hospital in Cieszyn, Cieszyn, Poland
(Owczuk) Department of Anaesthesiology and Intensive Therapy, Faculty of
Medicine, Medical University of Gdansk, Gdansk, Poland
(Kudlinski) Department of Anesthetics, Intensive Care and Emergency
Medicine, Collegium Medicum, University of Zielona Gora, Zielona Gora,
Poland
(Studzinska) Faculty of Medical Sciences, Academy of Silesia, Katowice,
Poland
(Pawlik) Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski
Krakow University, Krakow, Poland
(Makowski) 2nd Department of Anesthesiology and Intensive Care, Medical
University of Warsaw, Warsaw, Poland
(Zietkiewicz) 2nd Department of Anaesthesiology and Intensive Care, John
Paul II Hospital in Krakow, Krakow, Poland
(Zietkiewicz) Department of Anaesthesiology and Intensive Care,
Jagiellonian University Medical College, Krakow, Poland
(Przydacz) Department of Urology, Jagiellonian University Medical College,
Krakow, Poland
(Gozdzik) Clinical Department of Anesthesiology and Intensive Therapy,
Wroclaw Medical University, Wroclaw, Poland
(Gola) Collegium Medicum, Jan Kochanowski University in Kielce, Kielce,
Poland
(Jasiewicz) Department of Anesthesiology and Intensive Care, Collegium
Medicum, Nicolaus Copernicus University, Torun, Poland
(Zhao, Shyr) Department of Biostatistics and Center for Quantitative
Sciences, Vanderbilt University School of Medicine, Nashville, TN, United
States
(Devereaux) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Devereaux) Departments of Health Evidence and Impact and Medicine,
McMaster University, Hamilton, ON, Canada
(Devereaux) World Health Research Institute, Hamilton, ON, Canada
(Devereaux) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Publisher
BioMed Central Ltd
Abstract
Background: Myocardial injury is a major cause of death after noncardiac
surgery and is associated with long-term cardiovascular outcomes.
Perioperative tachycardia increases this risk. Although perioperative beta
blockers prevent myocardial injury, they increase the risk of death and
stroke, which analyses suggest is due to a significant increase in
hypotension. Ivabradine, a selective heart rate-lowering drug, may offer a
safer alternative. The primary objective of the PREVENT-MINS trial is to
determine whether perioperative administration of ivabradine is superior
to placebo for the prevention of myocardial injury after noncardiac
surgery (MINS) in patients with or at risk of atherosclerotic disease
having noncardiac surgery. Method(s): The PREVENT-MINS trial is a
multicentre, parallel-group, blinded, placebo-controlled trial conducted
in 26 hospitals in Poland. It will enroll 2500 patients aged >= 45 years
undergoing noncardiac surgery with at least one risk factor for myocardial
injury. Participants will be randomized in a 1:1 ratio to receive
ivabradine 5 mg orally twice daily for 7 days starting 1 h before surgery
or placebo. The primary outcome is MINS within 30 days after
randomization; independent experts will adjudicate this outcome. Secondary
outcomes include vascular complications, mortality, haemodynamics, and
quality of life at 30 days. Additional tertiary and 1-year outcomes will
assess long-term cardiovascular and surgical complications. Analyses will
follow an intention-to-treat approach. For the primary outcome, a
chi-squared test will be conducted, with results presented as unadjusted
relative risk (RR) accompanied by 95% confidence intervals (CIs) and
p-values. Discussion(s): This trial will generate high-quality,
generalizable data due to its large population and rigorous design,
including blinding. Moreover, it will be one of the first large-scale
trials specifically focused on preventing MINS. Trial registration:
ClinicalTrials.gov NCT05279651. Registered on 4 March 2022. Copyright
© The Author(s) 2025.

<11>
Accession Number
2039745674
Title
Revascularization in Stable Coronary Disease: A Systematic Review and
Meta-Analysis of Randomized Clinical Trials.
Source
International Journal of Angiology. 34(4) (pp 360-369), 2025. Date of
Publication: 01 Dec 2025.
Author
Sultana N.; Ha F.J.; White A.; Brown A.J.; Nerlekar N.
Institution
(Sultana, Ha, White, Brown, Nerlekar) Department of Cardiology, Victorian
Heart Hospital, Monash Health, Melbourne, Australia
(White, Brown, Nerlekar) Department of Cardiology, Victorian Heart
Institute, Monash University, Melbourne, Australia
(Nerlekar) Department of Imaging Research, Baker Heart and Diabetes
Institute, Melbourne, Australia
Publisher
Thieme Medical Publishers, Inc.
Abstract
The optimal management strategy for stable coronary artery disease (CAD)
remains contentious. While revascularization benefits acute coronary
syndromes, its role in stable CAD compared with medical therapy (MT) is
less clear. This systematic review and meta-analysis evaluated the safety
and efficacy of coronary revascularization (percutaneous coronary
intervention [PCI] or coronary artery bypass grafting [CABG]) versus MT in
patients with stable CAD. A systematic search identified randomized trials
comparing revascularization with optimal MT in stable CAD. Trials included
documented CAD via angiography and excluded acute coronary syndromes. The
primary safety endpoint was all-cause mortality, non-fatal myocardial
infarction (MI), and stroke. The primary efficacy endpoint also included
unplanned revascularization, cardiac hospitalization, and major bleeding.
The secondary endpoint included the percentage free from angina. Relative
risk (RR) was calculated using random-effects models. Ten trials with
14,171 participants were included. There was no difference in the primary
safety endpoint (RR 0.96 [0.90-1.03], p = 0.23). The primary efficacy
endpoint favored revascularization (RR 0.81 [0.69-0.96], p = 0.01),
primarily driven by unplanned revascularization (RR 0.5 [0.29-0.85], p =
0.01), though with increased procedural MI risk (RR 2.21 [1.44-3.39], p <
0.001). More patients had freedom from angina with revascularization
compared with MT (71.8% vs. 62.9%, p < 0.001). In stable CAD, initial
revascularization did not improve outcomes for the primary safety
endpoint; however, it did reduce unplanned revascularization compared with
MT. More patients had freedom from angina in the revascularization arm, at
the cost of increased procedural MI. Decision regarding optimal management
strategy for stable CAD remains a patient-centered discussion, recognizing
the largely symptomatic rather than prognostic benefit that patients
derive from early revascularization. Copyright © 2025.
International College of Angiology. All rights reserved.

<12>
Accession Number
2041342325
Title
The effect of esketamine on postoperative delirium in patients undergoing
general anesthesia: a systematic review and meta-analysis.
Source
Frontiers in Pharmacology. 16 (no pagination), 2025. Article Number:
1681531. Date of Publication: 2025.
Author
Chao-Xu; Tong R.-J.; Shen Q.-H.; Zhao J.
Institution
(Chao-Xu, Tong, Zhao) Department of Anesthesiology, Jiashan First People's
Hospital, Jiaxing, China
(Shen) Department of Anesthesiology, First Hospital of Jiaxing, Jiaxing,
China
Publisher
Frontiers Media SA
Abstract
Background: Postoperative delirium (POD), a prevalent neurological
complication, is strongly associated with adverse clinical outcomes. This
meta-analysis aimed to evaluate the efficacy of esketamine in preventing
POD among patients receiving general anesthesia. Method(s): We
systematically searched PubMed, Embase, Cochrane Library, Web of Science,
clinical trial registries and major conference proceedings for randomized
controlled trials (RCTs) examining esketamine's impact on POD in general
anesthesia patients, from inception through 30 June 2025. Statistical
analyses were performed using RevMan 5.4 and Stata 12.0. Dichotomous
outcomes were expressed as risk ratios (RR) with 95% confidence intervals
(CI), while continuous variables were analyzed via mean differences (MD).
Study bias was assessed with the Cochrane ROB 2.0 tool. Result(s):
Thirteen RCTs involving 1,873 elective surgery patients under general
anesthesia were included. Esketamine administration was associated with a
lower POD incidence (RR: 0.66; 95% CI: 0.49-0.91; P < 0.05). Subgroup
analyses revealed potentially significant reductions in adult populations
and cardiac surgery cohorts. The postoperative nausea and vomiting (PONV)
rate decreased in the esketamine group. Additionally, esketamine was
associated with reduced pain scores at 24 h postoperatively.
 Conclusion(s): Our findings suggest that esketamine may be associated
with a lower POD risk following general anesthesia. Further large-scale
trials are warranted to validate these preliminary findings. Systematic
Review Registration:
https://www.crd.york.ac.uk/PROSPERO/recorddashboard. Copyright ©
2025 Chao-Xu, Tong, Shen and Zhao.

<13>
Accession Number
2041851054
Title
Ultrasound-guided thoracic paravertebral block versus erector spinae plane
block analgesia for cardiac surgery with median sternotomy: a
noninferiority randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Montandrau O.; Kattou F.; Arana H.; Rekik M.; Ait Hamou N.; Weisslinger
S.-J.; Teil E.; Mekaouar S.; Bargaoui A.; Bouattour K.; Bey Boumezrag C.;
Lacombe J.-M.; Lebatard N.; Zannis K.; Beaussier M.
Institution
(Montandrau, Kattou, Arana, Rekik, Ait Hamou, Weisslinger, Bargaoui,
Bouattour, Beaussier) Department of Anaesthesia, Institut Mutualiste
Montsouris, Paris, France
(Teil, Mekaouar) Department of Intensive Care Unit, Institut Mutualiste
Montsouris, Paris, France
(Bey Boumezrag, Lacombe) Department of Clinical Research, Institut
Mutualiste Montsouris, Paris, France
(Lebatard, Zannis) Department of Cardiac Surgery, Institut Mutualiste
Montsouris, Paris, France
Publisher
Elsevier Ltd
Abstract
Background: Effective postoperative analgesia after cardiac surgery with
median sternotomy is essential to minimise complications and promote
recovery. Bilateral thoracic paravertebral block (TPVB) is an established
technique in cardiac surgery but carries potential risks. Erector spinae
plane block (ESPB) could offer a simpler and safer alternative.
 Method(s): In this prospective, patient- and assessor-blinded,
noninferiority, randomised controlled trial, adults undergoing median
sternotomy for planned cardiac surgery were allocated to receive
ultrasound-guided single-shot ESPB or TPVB with 20 ml of ropivacaine
0.375% per side performed under general anaesthesia in the left lateral
decubitus position. The primary outcome was pain during forced expiration,
assessed using the numerical rating scale (NRS) at 6 h after surgery.
Secondary outcomes included opioid consumption and block-related adverse
events. Result(s): We enrolled 74 participants. At 6 h, mean (SD) NRS
pain scores were 3.5 (2.6) for ESPB and 3.0 (2.1) for TPVB (95% confidence
interval, -0.48 to 1.34). As the upper bound of the 95% confidence
interval exceeded the predefined margin of 1 NRS point, noninferiority of
ESPB could not be demonstrated. Opioid consumption, NRS pain scores at 24
and 48 h, and ICU or hospital length of stay were comparable between
groups. ESPB participants experienced more intraoperative hypertension
than TPVB participants. No serious block-related complications were
observed. Conclusion(s): ESPB did not demonstrate noninferiority to
TPVB for early dynamic analgesia after median sternotomy. Clinical trial
registration: NCT04546113. Copyright © 2025 British Journal of
Anaesthesia

<14>
Accession Number
2035129972
Title
Analgesic efficacy and serum ropivacaine concentration of postoperative
programmed intermittent bolus infusion with serratus anterior plane block
in patients undergoing minimally invasive cardiac surgery: A randomized,
double-blind, controlled trial.
Source
Journal of Anesthesia. 39(6) (pp 940-947), 2025. Date of Publication: 01
Dec 2025.
Author
Kumagai M.; Kaiho Y.; Sugino S.; Sekine T.; Taguri M.; Inoue H.; Ito J.;
Sato Y.; Sato T.; Maekawa M.; Yamauchi M.
Institution
(Sato, Kaiho, Sugino, Sekine, Yamauchi) Department of Anesthesiology and
Perioperative Medicine, Tohoku University Graduate School of Medicine,
2-1, Seiryo-Machi, Aoba-Ku, Sendai, Japan
(Kumagai) Department of Anesthesiology, Japan Red Cross Ishinomaki
Hospital, Ishinomaki, Japan
(Taguri) Department of Health Data Science, Tokyo Medical University,
Shinjuku City, Japan
(Inoue) Department of Anesthesiology, Southern Tohoku General Hospital,
Iwanuma, Japan
(Ito) Department of Anesthesiology, Sendai Kousei Hospital, Sendai, Japan
(Sato, Sato, Maekawa) Department of Pharmaceutical Sciences, Tohoku
University Hospital, Sendai, Japan
Publisher
Springer
Abstract
Purpose: Minimally invasive cardiac surgery (MICS) involves fewer
complications than median sternotomy. However, difficulties in post-MICS
analgesia can undermine these advantages. The serratus anterior plane
block (SAPB), an effective analgesic for thoracic surgery, could benefit
post-MICS analgesia using programmed intermittent bolus infusion (PIBI).
We investigated whether PIBI with SAPB can reduce post-MICS fentanyl
administration and evaluated its safety profile. Method(s): This
randomized, double-blind, controlled trial included 20 patients (age 20-80
years; Eastern Cooperative Oncology Group Performance Status 0-II;
scheduled for elective MICS) randomly allocated to two groups (SAPB or
control). All patients underwent preoperative SAPB with catheterization,
followed by either 20 mL 0.25% ropivacaine or saline bolus every 6 h
postoperatively. All patients received intravenous fentanyl via
patient-controlled analgesia. Blood samples were collected 10, 20, 30, and
60 min after preoperative ropivacaine infusion; during and after
cardiopulmonary bypass; and on postoperative days 1-5. The primary outcome
was cumulative fentanyl consumption up to postoperative day 5. Secondary
outcomes included numerical rating scale scores, rehabilitation
preoperatively and postoperatively, postoperative nausea and vomiting,
ropivacaine toxicity, and PIBI with SAPB complications. Result(s):
After excluding three patients, data from 17 patients were analyzed. No
significant difference in cumulative fentanyl consumption on postoperative
day 5 was observed (SAPB: median [interquartile range], 512 microg
[457-753] vs. control: 654 microg [439-982], P = 0.96). Serum ropivacaine
concentration remained below the toxicity threshold. Conclusion(s):
PIBI with SAPB did not reduce post-MICS fentanyl consumption, and serum
ropivacaine concentration did not reach the toxicity
threshold. Copyright © The Author(s) 2025.

<15>
Accession Number
2039162524
Title
Perioperative Normoxia vs Hyperoxia in Neonates With Cyanotic Heart
Disease Undergoing Cardiac Surgery: A Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 120(5) (pp 898-906), 2025. Date of
Publication: 01 Nov 2025.
Author
Sznycer-Taub N.; Peng Y.-W.; Yu S.; Batazzi A.; Les A.; Lowery R.;
Griffith K.; Sturmer D.; Ohye R.G.; Russell M.W.; Pasquali S.K.; Charpie
J.
Institution
(Sznycer-Taub, Peng, Yu, Batazzi, Lowery, Russell, Pasquali, Charpie)
Division of Pediatric Cardiology, Department of Pediatrics, University of
Michigan, Ann Arbor, MI, United States
(Les, Griffith, Sturmer) Department of Perfusion, Department of Cardiac
Surgery, University of Michigan, Ann Arbor, MI, United States
(Ohye) Section of Pediatric Cardiovascular Surgery, Department of Cardiac
Surgery, University of Michigan, Ann Arbor, MI, United States
Publisher
Elsevier Inc.
Abstract
Background Exposure to supraphysiologic levels of oxygen has been
associated with end-organ damage and worse outcomes across multiple
populations related to oxidative stress and inflammation. There is limited
evidence to guide practice in children undergoing surgery with
cardiopulmonary bypass, including neonates with cyanotic congenital heart
disease, who are particularly vulnerable to oxidative stress due to
immature and depleted antioxidant defenses. Methods We conducted a
randomized trial of perioperative normoxia (goal PaO<inf>2</inf> 60-100 mm
Hg during cardiopulmonary bypass and for the first 24 hours) vs hyperoxia
(goal PaO<inf>2</inf> 200-300 mm Hg during cardiopulmonary bypass)
exclusively in cyanotic neonates to examine feasibility, systemic
oxidative stress response, and safety. The primary outcome was a serum
measure of oxidative stress: thiobarbituric acid reactive substances.
Additional biomarkers and clinical outcomes were collected. Results
Twenty-nine neonates (median age, 5 days) were enrolled. Mean
PaO<inf>2</inf> in the normoxia arm (n = 15) during cardiopulmonary bypass
was 106 +/- 27 mm Hg (vs hyperoxia 256 +/- 29 mm Hg, P < .0001). Mean
postoperative thiobarbituric acid reactive substances expressed as
fold-change from baseline was lower in the normoxia arm at 2 hours (1.21
+/- 0.26 vs 1.93 +/- 0.63), 6 hours (1.09 +/- 0.25 vs 1.77 +/- 0.7), and
24 hours (0.96 +/- 0.16 vs 1.41 +/- 0.29); all P < .01. Other biomarkers
of oxidative stress were significantly lower in the normoxia arm (all time
points P < .01). Safety outcomes including in-hospital mortality and
morbidities were similar between arms. Conclusions Controlled normoxia
during cardiopulmonary bypass in cyanotic neonates is feasible, safe, and
associated with significant improvement in measures of oxidative stress.
These data are critical in informing larger-scale studies of end-organ
injury and clinical outcomes. Copyright © 2025 The Society of
Thoracic Surgeons.

<16>
Accession Number
2041829267
Title
Drug-induced pericarditis: a systematic review of all published cases.
Source
International Journal of Cardiology. 445 (no pagination), 2026. Article
Number: 134000. Date of Publication: 15 Feb 2026.
Author
Collini V.; Vignut L.S.; Venturelli F.; Imazio M.
Institution
(Collini, Vignut, Venturelli, Imazio) Cardiology and Cardiothoracic
Department, University Hospital Santa Maria della Misericordia, ASUFC,
Udine and Department of Medicine, University of Udine, Italy
(Vignut) Cardiovascular Department, Azienda Sanitaria Universitaria
Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
(Imazio) Department of Medicine (DMED), University of Udine, Udine, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: No large case series nor clinical trials on drug-induced
pericarditis have been reported. This study analyses data from previously
reported cases to provide a comprehensive understanding of the aetiology,
clinical presentation, management strategies, and outcomes of this rare
and often underestimated aetiology of pericarditis. Method(s): A
systematic review according to PRISMA guidelines was conducted,
identifying 121 cases of drug-induced pericarditis. All references found,
upon initial assessment at title and abstract level for suitability, were
consequently retrieved as full reports for inclusion in this review.
 Result(s): Among the 121 cases, 37 were related to anti-cancer,
immunosuppressive, immunomodulatory drugs, 27 to anti-inflammatory drugs,
33 to central nervous system agents, 10 to cardiovascular drugs and 18 to
other drugs. Median age was 45 (27, 59), 38.8 % were females, the most
frequent symptom was pericardial chest pain, described in 86.8 % of
patients. Many patients presented associated systemic symptoms;
concomitant minor myocardial involvement was found in about half of the
patients. All patients were hospitalized and withdrew the drug at the time
of diagnosis. Symptoms resolved in an average of 5 +/- 4 days and all
patients who resumed the drug experienced a new recurrence. 18 patients
underwent pericardiocentesis for cardiac tamponade, 9 underwent
pericardiectomy. Four patients died during the follow-up.
 Conclusion(s): Although uncommon, drug-induced pericarditis can be a
life-threatening condition, causing cardiac tamponade or constrictive
pericarditis. It is therefore crucial to increase awareness and knowledge
of this rare aetiology of pericarditis to ensure prompt diagnosis and
timely withdrawal of the causative drug. Copyright © 2025

<17>
Accession Number
2041401510
Title
The Extended Safety and Efficacy of Indobufen in Conjunction With P2Y12
Receptor Inhibitors Among Patients Undergoing Revascularization: A
Meta-Analysis and Overview.
Source
Cardiovascular Therapeutics. 2025(1) (no pagination), 2025. Article
Number: 5374818. Date of Publication: 2025.
Author
Yi M.; Cao Q.; Sheng Y.-H.; Wu L.; Ke X.
Institution
(Yi, Sheng, Wu) Department of Cardiology, Liuyang Hospital of Traditional
Chinese Medicine, Liuyang, China
(Yi, Ke) Department of Cardiology, Fuwai Hospital, Chinese Academy of
Medical Sciences, Shenzhen, (Shenzhen Sun Yat-sen Cardiovascular
Hospital), Shenzhen, China
(Cao) Department of Cardiology, The Fourth Hospital of Changsha, Changsha
Hospital Affiliated to Hunan Normal University, Changsha, China
Publisher
John Wiley and Sons Inc
Abstract
Background/Objectives: Dual antiplatelet therapy (DAPT), which combines
aspirin with a P2Y12 receptor inhibitor for platelets, is crucial for the
prevention of cardiac and systemic ischemic events in patients with
coronary artery disease who have undergone revascularization procedures.
Although indobufen is suggested as an alternative for individuals who
exhibit intolerance to aspirin, the long-term safety and efficacy of
indobufen-based DAPT treatment for the prevention of cardiac and systemic
ischemic events in these patients remain ambiguous. This meta-analysis
seeks to examine the long-term safety and efficacy of DAPT based on
indobufen in the context of revascularization procedures for patients.
 Method(s): A thorough search was performed across PubMed, Embase, the
Cochrane Library, Web of Science, ClinicalTrials.gov, and CNKI, covering
all records from each database's inception to October 10, 2024. Included
were randomized trials analyzing oral DAPT antiplatelet agents for
coronary artery disease patients who received revascularization. Two
reviewers independently handled the selection process: screening articles,
overview, extracting data, and assessing study quality in accordance with
PRISMA guidelines. The pooled data were later subjected to analysis using
a random-effects model meta-analysis. Result(s): The final analysis
included three randomized controlled trials, which yielded the following
findings regarding major adverse cardiovascular and cerebrovascular events
(MACCEs): The relative risk (RR) was 1.58 (95% CI, 0.72-3.38); for BARC
Type 2, 3, or 5 bleeding events, the RR was 0.35 (95% CI, 0.18-0.67); and
for gastrointestinal intolerance events, the RR was 0.06 (95% CI,
0.03-0.18). Conclusion(s): Indobufen-based DAPT may potentially
increase the risk of ischemic events without compromising safety for
revascularization, as its upper RR limit exceeds 1 for
MACCEs. Copyright © 2025 Ming Yi et al. Cardiovascular
Therapeutics published by John Wiley & Sons Ltd.

<18>
Accession Number
2041593385
Title
Optimising adherence to inpatient rehabilitation trial protocols: A
mixed-methods systematic review.
Source
Clinical Trials. 22(6) (pp 728-744), 2025. Date of Publication: 01 Dec
2025.
Author
Logan A.; Marsden J.; Freeman J.; Cork E.; Kent B.
Institution
(Logan, Cork) Royal Devon University Healthcare NHS Foundation Trust,
Devon, United Kingdom
(Logan, Marsden, Freeman, Cork, Kent) Faculty of Health, University of
Plymouth, Devon, United Kingdom
(Kent) Centre of Implementation Science, University of Plymouth, A JBI
Centre of Excellence, Devon, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background: The results of rehabilitation clinical trials can be
negatively affected by adherence to trial protocols. Adherence is
multi-factorial, but studies often look at adherence factors separately.
Therefore, a systematic review to appraise and synthesise the evidence is
warranted to determine the barriers, facilitators and predictors
associated with adherence to inpatient rehabilitation trial protocols,
whether and how factors interact with one another, and how adherence to
rehabilitation protocols can be optimised. Method(s): A mixed-methods
systematic review was conducted and reported in accordance with Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Databases searched were PubMed (Ovid), EMBASE (Ovid), MEDLINE (Ovid),
CINAHL (Ovid), PsycINFO (Ovid), Cochrane Library, Health Technology
Assessment Database, Web of Science and grey literature up to April 2024.
A cohesive, integrated methodology was employed, leveraging the
Consolidated Framework for Implementation Research (CFIR) 2.0, to
transform, synthesise and integrate data from various methodologies to
address the review objectives. Result(s): Twenty-seven studies met
the inclusion criteria (randomised controlled trials, qualitative studies
related to randomised controlled trials or mixed-methods). Most of the
studies were in stroke (n = 17), but other studies included neurological,
respiratory, cardiovascular, post-surgical, osteoarthritis and elderly
medical. Multiple factors affecting adherence protocols were identified.
Adherence was measured in various ways, and setting pre-specified
adherence levels was uncommon. Conclusion(s): Adherence to inpatient
rehabilitation trial protocols is multi-dimensional and multi-factorial.
Consensus of adherence measurement and interpretation of adherence levels
is needed to make meaningful comparisons between trials. A standardised
approach, including adopting a traffic light system, would enable
trialists to implement changes mid-trial or stop the trial to avoid
research waste. Adopting approaches from behavioural science in the design
and conduct of inpatient rehabilitation trials may overcome some of the
behavioural barriers identified and optimise adherence for those
delivering and receiving the intervention. Review registration:
Prospective Register of Systematic Reviews, registration number
CRD42021270121. Copyright © The Author(s) 2025

<19>
Accession Number
2034207843
Title
Left ventricular unloading and survival outcomes in pediatric acute
fulminant myocarditis patients receiving extracorporeal membrane
oxygenation: A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). 40(8) (pp 1817-1830), 2025. Date of
Publication: 01 Nov 2025.
Author
Cho H.J.; Habimana R.; Choi I.; Song M.-K.; Yang J.-H.; Lee Y.; Ko H.; Di
Nardo M.; Jeong I.S.
Institution
(Cho, Choi) Department of Pediatrics, Chonnam National University
Children's Hospital and Medical School, Gwangju, South Korea
(Cho, Habimana, Choi, Jeong) Extracorporeal Circulation Research Team,
Chonnam National University Hospital, Gwangju, South Korea
(Habimana) Chonnam National University Graduate School, Gwangju, South
Korea
(Song) Department of Physical and Rehabilitation Medicine, Chonnam
National University Medical School, Gwangju, South Korea
(Yang, Lee) Department of Thoracic and Cardiovascular Surgery, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Ko) Department of Pediatrics, Pusan National University Yangsan Hospital,
Pusan National University School of Medicine, South Korea
(Di Nardo) Pediatric Intensive Care Unit, Bambino Gesu Children's
Hospital, IRCCS, Rome, Italy
(Jeong) Department of Thoracic and Cardiovascular Surgery, Chonnam
National University Hospital and Medical School, Gwangju, South Korea
Publisher
SAGE Publications Ltd
Abstract
Background: Acute fulminant myocarditis (AFM) is a severe condition in
pediatric patients. Extracorporeal membrane oxygenation (ECMO) is often
used as a supportive therapy, but survival rates and the impact of
adjunctive therapies like left ventricular (LV) unloading and
bridge-to-heart transplantation remain unclear. This meta-analysis
evaluates survival outcomes in pediatric AFM patients treated with ECMO
and assesses the influence of these strategies. Method(s): This
systematic review and meta-analysis followed PRISMA guidelines. Databases,
including PubMed, Embase, and the Cochrane Library, were searched for
studies published in the last 10 years. Inclusion criteria were studies
reporting survival rates of pediatric AFM patients treated with ECMO. Data
were analyzed using fixed and random-effects models. Subgroup and
univariable meta-regression analyses identified factors associated with
survival. Result(s): From 2308 articles, 10 studies met the inclusion
criteria, totaling 210 pediatric patients. The pooled survival rate was
67% (95% CI: 37%-97%). Subgroup analyses showed higher survival in
patients receiving LV unloading (82% vs 63%; p < .01) and those bridged to
heart transplantation, though not statistically significant. Univariable
meta-regression identified LV unloading as a significant predictor of
survival (p = .02). Other factors, such as age, gender, and cardiac arrest
before ECMO, showed no significant associations with survival. Cumulative
meta-analysis indicated an improving trend in survival over the years.
 Conclusion(s): This meta-analysis suggests an association between
ECMO and improved survival in children with AFM. While LV unloading may
offer benefits, the retrospective nature of the included studies, along
with potential confounding factors, necessitates cautious interpretation.
Further well-designed prospective studies are required to establish its
optimal role, indications, and timing in pediatric ECMO patients with
AFM. Copyright © The Author(s) 2025

<20>
Accession Number
2040475696
Title
Machine perfusion across different donor pathways in heart
transplantation: A systematic review and network meta-analysis.
Source
Journal of Heart and Lung Transplantation. 44(12) (pp 1920-1932), 2025.
Date of Publication: 01 Dec 2025.
Author
Kim D.-Y.; Kang M.; Kim J.; Choi D.; Lee S.-J.
Institution
(Kim, Kang, Kim, Choi) Department of Surgery, Hanyang University College
of Medicine, Seoul, South Korea
(Choi) Research Institute of Regenerative Medicine and Stem Cells, Hanyang
University, Seoul, South Korea
(Choi) Hanyang Institute of Bioscience and Biotechnology, Hanyang
University, Seoul, South Korea
(Choi) Department of HY-KIST Bio-convergence, Hanyang University, Seoul,
South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Dongtan
Sacred Heart Hospital, Hallym University, Hwaseong, South Korea
Publisher
Elsevier Inc.
Abstract
Background The shortage of donor hearts significantly limits heart
transplantation. Innovative machine perfusion strategies have emerged to
address the shortcomings of traditional static cold storage after brain
death (SCS-DBD), potentially enhancing outcomes and broadening donor
eligibility. We performed a systematic review and network meta-analysis to
compare the effectiveness of heart transplantation using machine perfusion
techniques with conventional SCS-DBD. Methods The MEDLINE, Embase, and
PubMed databases were systematically searched for articles published
between January 2024 and March 2025. Additional relevant studies from
2014-2023 were identified through previous systematic reviews and
reference lists. Included were randomized clinical trials and
nonrandomized studies evaluating outcomes of heart transplantation methods
utilizing hearts from donors after brain death (DBD) and donors after
circulatory death (DCD). Meta-analysis was performed examining 30-day and
1-year survival, acute rejection, and primary graft dysfunction. Results
From 1,758 screened records, 19 studies involving 22,029 patients met the
inclusion criteria. No significant differences in 30-day mortality were
observed between preservation methods. At 1 year, direct procurement with
perfusion of DCD (risk ratio [RR] 0.63 [95% credible interval [CrI]
0.45-0.89]; high certainty) and normothermic regional perfusion of DCD (RR
0.68 [CrI 0.47-0.96]; low certainty) significantly reduced mortality
compared with SCS-DBD. Among DBD groups, no mortality differences emerged.
Hypothermic oxygenated machine perfusion of DBD significantly reduced
severe primary graft dysfunction compared with SCS-DBD (0.27 [0.10-0.63];
high certainty), but acute rejection rates were similar across all
methods. Conclusions Outcomes of machine perfusion strategies appear
noninferior to those of the conventional SCS, proving its potential to
broaden the donor pool. Copyright © 2025 International Society
for the Heart and Lung Transplantation.

<21>
Accession Number
2039833138
Title
Cardiac CT and PET for Surveillance of Heart Transplant Recipients:
Systematic Review and Bayesian Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 18(12) (pp 1330-1344), 2025. Date of
Publication: 01 Dec 2025.
Author
Sayed A.; Nayfeh M.; Alahdab F.; Al Rifai M.; Abramov D.; Fudim M.;
Moayedi Y.; Yousefzai R.; Al-Mallah M.H.
Institution
(Sayed, Alahdab, Al Rifai, Yousefzai, Al-Mallah) Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Sayed) Ain Shams University, Faculty of Medicine, Cairo, Egypt
(Sayed) Rochester General Hospital, Rochester, NY, United States
(Nayfeh) Vanderbilt University School of Medicine, Nashville, TN, United
States
(Alahdab) University of Missouri, Columbia, MO, United States
(Abramov) Lomda Linda University Medical Center, Loma Linda, CA, United
States
(Fudim) Duke Clinical Research Institute, NC, United States
(Fudim) Duke University School of Medicine, Durham, NC, United States
(Moayedi) Ted Rogers Centre of Excellence in Heart Research, Peter Munk
Cardiac Centre, University Health Network, Toronto, ON, Canada
(Moayedi) Ajmera Transplant Centre, University Health Network, Toronto,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: For noninvasive surveillance of cardiac allograft vasculopathy
(CAV), cardiac computed tomography (cardiac computed tomography [CT]) and
positron emission tomography (PET) received a Class IIa recommendation by
the 2023 ISHLT (International Society for Heart and Lung Transplantation)
guidelines. However, implementation has lagged behind because of concerns
about their ability to rule out disease and stratify risk.
 Objective(s): The purpose of this study was to define the diagnostic
and prognostic ability of PET and cardiac CT in cardiac transplant
recipients. Method(s): Electronic databases were searched for studies
evaluating CT or PET for their diagnostic (for detecting angiographic CAV)
and prognostic (for predicting major adverse cardiovascular outcomes)
value. Sensitivity and specificity were pooled using Bayesian bivariate
binormal-normal models with random-effects. HRs were pooled using Bayesian
normal random-effects models. Result(s): In total, 44 studies (32 CT
and 12 PET) enrolling 3,049 patients were included. Coronary computed
tomography angiography (CTA) showed high sensitivity (97.6%; 95% credible
interval [CrI]: 93.7%-99.1%) and specificity (82.3%; 95% CrI: 75.3%-88.3%)
for detecting any CAV. Coronary CTA also showed high sensitivity (92.6%;
95% CrI: 86.2%-96.2%) and specificity (92.6%; 95% CrI: 89.8%-94.9%) for
significant CAV. The PET CAV algorithm for detecting significant CAV
showed good sensitivity (83.9%; 95% CrI: 69.1%-92.4%) and specificity
(89.6%; 95% CrI: 82.2%-94.2%). PET-derived parameters including myocardial
flow reserve, stress myocardial blood flow, PET CAV score, and summed
stress score, predicted future major adverse cardiovascular outcomes.
 Conclusion(s): Both coronary CTA and PET can rule out significant
CAV; however, at higher pretest probabilities, coronary CTA may be
preferrable. Multiple PET-derived parameters may have prognostic value,
whereas there is insufficient evidence for the long-term prognostic value
of CT. Copyright © 2025 American College of Cardiology Foundation

<22>
Accession Number
2041865801
Title
Effect of esketamine on postoperative depression and anxiety in patients
undergoing cardiac valve surgery: A randomised, placebo-controlled,
double-blinded clinical trial.
Source
Pharmacological Research. 222 (no pagination), 2025. Article Number:
108047. Date of Publication: 01 Dec 2025.
Author
Zhang Z.-N.; Hao X.-Y.; Cai C.; Sun L.; Zhang Z.-Y.; Wang M.; Wu Y.-S.;
Wang Y.; Cao J.-B.; Liu Y.-H.; Lou J.-S.; Fu Q.; Jiang S.-L.; Han R.-Q.;
Mi W.-D.; Tong L.
Institution
(Zhang, Hao, Cai, Zhang, Wang, Cao, Liu, Lou, Fu, Mi, Tong) Department of
Anesthesiology, The First Medical Center of Chinese PLA General Hospital,
Beijing, China
(Zhang, Hao, Cai) Medical School of Chinese PLA General Hospital, Beijing,
China
(Sun) Department of Anesthesiology, The Sixth Medical Center of Chinese
PLA General Hospital, Beijing, China
(Wu, Han) Department of Anesthesiology, Beijing Tiantan Hospital, Capital
Medical University, Beijing, China
(Wang) Department of Psychosomatic Medicine, Honghui Hospital, Xi'an
Jiaotong University, China
(Jiang) Department of Cardiovascular Surgery, The First Medical Center of
Chinese PLA General Hospital, Beijing, China
(Mi) National Clinical Research Center for Geriatric Diseases, Chinese PLA
General Hospital, Beijing, China
Publisher
Academic Press
Abstract
This randomized, double-blind, parallel-group trial evaluated the efficacy
of a single intravenous dose of esketamine (0.3 mg/kg) administered at
anesthesia induction in reducing postoperative depression and anxiety
among patients undergoing cardiac valve surgery. A total of 142 patients
from three centers were randomly assigned to receive esketamine or saline.
The primary outcomes were the prevalence of depression and anxiety at
postoperative day (POD) 7, assessed by the Hospital Anxiety and Depression
Scale (HADS). Key secondary outcomes included delirium incidence, pain and
insomnia scores, and quality of recovery. Results showed that the
esketamine group had significantly lower rates of depression (7.0 % vs.
31.0 %; P < 0.001) and anxiety (11.3 % vs. 35.2 %; P < 0.001) at POD 7,
along with reduced delirium incidence (9.8 % vs. 22.5 %; P = 0.040).
Improvements were also observed in pain, sleep, and recovery quality.
Mechanistic analyses revealed that esketamine reduced inflammatory markers
(IL-6, CRP) and neuronal injury marker (S100beta), while increasing
brain-derived neurotrophic factor (BDNF). No significant differences in
adverse events were observed. In conclusion, a single low dose of
esketamine during induction effectively alleviates early postoperative
depression and anxiety, possibly through modulating neuroinflammation and
promoting neurotrophic signaling. (Clinicaltrials.gov, ID Number:
NCT06608030). Copyright © 2025 The Authors

<23>
Accession Number
2041789911
Title
Sex-based differences in outcomes of mitral valve surgery: A meta-analysis
of propensity score-matched studies with reconstructed time-to-event data.
Source
American Heart Journal Plus: Cardiology Research and Practice. 61 (no
pagination), 2026. Article Number: 100682. Date of Publication: 01 Jan
2026.
Author
Consoli L.; Majeed M.W.; Cetinel E.; Lajczak P.; Koziakas I.G.; Kirov H.;
Doenst T.; Caldonazo T.
Institution
(Consoli) Federal University of Bahia, Salvador, Brazil
(Majeed) Government Medical College, Jammu and Kashmir, Srinagar, India
(Cetinel) San Raffaele University, Milan, Italy
(Lajczak) Medical University of Silesia, Katowice, Poland
(Koziakas) Cardiac Surgery Department, Onassis Hospital, Athens, Greece
(Kirov, Doenst, Caldonazo) Department of Cardiothoracic Surgery, Jena
University Hospital, Friedrich Schiller University of Jena, Jena, Germany
(Caldonazo) Department of Cardiothoracic Surgery, Weil Cornell Medicine,
New York, United States
Publisher
Elsevier Inc.
Abstract
Background: Studies indicate worse outcomes for women undergoing mitral
valve surgery, but this can be biased in the context of differences in
risk profiles between sexes. We aimed to assess short- and long-term
outcomes of mitral valve surgery in men and women using
confounder-adjusted data. Method(s): We searched PubMed, Embase, and
the Cochrane Library for eligible propensity-score-matched studies.
Analysis was performed for short-term (<30 days mortality and procedural
complications) and long-term (>1 year mortality, reoperation, and mitral
regurgitation) endpoints. A pairwise random-effects meta-analysis was done
for short-term outcomes, pooling risk ratios (RR) with 95 % confidence
intervals (CIs). A meta-analysis of Kaplan-Meier derived individual
patient data was conducted for long-term endpoints. Cox frailty regression
analysis was used to obtain hazard ratios (HR). Result(s): We
included 12 studies (n = 55,616). No significant differences were observed
in the short-term risks of death (RR 1.02; 95 % CI: 0.91-1.15; p = 0.72),
stroke (RR 1.04; 95 % CI: 0.87-1.26; p = 0.65), kidney injury (RR 0.97; 95
% CI: 0.71-1.32; p = 0.85), atrial fibrillation (RR 0.96; 95 % CI:
0.81-1.14; p = 0.61), or pacemaker implantation (RR 0.93; 95 % CI:
0.84-1.02; p = 0.1). The hazards of long-term mortality (HR 0.97; 95 % CI:
0.91-1.03; p = 0.3) and reoperation (HR 1.65; 95 % CI: 0.39-6.91; p = 0.5)
were similar between sexes. However, women had a higher hazard of
recurrent mitral regurgitation (HR 1.61; 95 % CI: 1.08-2.37; p = 0.018).
 Conclusion(s): This meta-analysis found no sex-based differences in
short- or long-term mortality, reoperation rates, or procedural
complications following mitral valve surgery. A higher hazard of recurrent
mitral regurgitation was observed in women. Copyright © 2025 The
Authors

<24>
Accession Number
2041717881
Title
Factors influencing patient satisfaction in postoperative pain management:
A systematic review and meta-analysis.
Source
Indian Journal of Anaesthesia. 69(12) (pp 1260-1273), 2025. Date of
Publication: 01 Dec 2025.
Author
Nair A.S.; Afshan G.; Kubricht V.; Chetty S.; Jagannathan B.
Institution
(Nair) Department of Anaesthesiology, Ibra Hospital, Oman
(Afshan) Department of Anaesthesiology, The Aga Khan University, Karachi,
Pakistan
(Kubricht) Department of Anaesthesiology and Intensive Care, Na Homolce
Hospital Prague, Charles University, Third Faculty of Medicine, Prague,
Czechia
(Chetty) Department of Anaesthesiology and Critical Care, Stellenbosch
University, Cape Town, South Africa
(Jagannathan) Department of Anaesthesiology and Perioperative Care, Ganga
Medical Center and Hospital, Tamil Nadu, Coimbatore, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Effective postoperative pain management is pivotal
not only for alleviating discomfort but also for enhancing overall patient
satisfaction and recovery. This systematic review aims to investigate
various factors influencing patient satisfaction due to the postoperative
pain management offered. Method(s): Using relevant keywords, we
searched PubMed, Scopus, and the Cochrane database after registering the
protocol in PROSPERO. A qualitative systematic review was planned using
the Appraisal Tool for Cross-Sectional Studies (AXIS tool) to assess the
risk of bias (RoB). Thereafter, a quantitative meta-analysis of the
transformed proportions was performed using an inverse-variance
random-effects model, and a Freeman-Tukey double arcsine transformation
was applied to all reported proportions. Result(s): From the 1234
articles available after the database search, 21 articles comprising 7289
patients met the inclusion criteria. Among the 21 studies, 12 (57.14%) had
a moderate RoB, while nine (42.85%) had a low RoB. The random effects
model, using the inverse variance method and the Freeman-Tukey double
arcsine transformation, revealed a summarised proportion of 0.8 (95%
confidence interval: 0.74,0.85), with significant heterogeneity (P < 0.01
and I2 statistic of 97%). The various factors influencing
postoperative patient satisfaction were summarised. Conclusion(s):
Based on the results from this systematic review and meta-analysis, we
conclude that the majority of the patients are satisfied with the
postoperative pain management offered (a summarised proportion of 0.8 or
80%). Further studies need to be done to find out optimal strategies to
improve patient satisfaction undergoing various surgeries. Having robust
perioperative pain management policies and an audit of patient
satisfaction for pain management could help in improving institutional
practices. Copyright © 2025 Indian Journal of Anaesthesia.

<25>
Accession Number
2041835204
Title
Dexmedetomidine administration is associated with small haemodynamic
changes in children undergoing cardiac procedures: a systematic review and
meta-analysis.
Source
Cardiology in the Young. (no pagination), 2025. Date of Publication:
2025.
Author
Rose N.; Hassanieh M.A.; Jackson W.M.
Institution
(Rose) Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
(Hassanieh, Jackson) Montefiore Medical Center, Bronx, NY, United States
(Hassanieh, Jackson) Albert Einstein College of Medicine, Bronx, NY,
United States
Publisher
Cambridge University Press
Abstract
Introduction: Dexmedetomidine is frequently used in paediatric
anaesthesia. This includes use in patients with CHD, but detailed analysis
of haemodynamics after administration in these patients has not yet been
published. We performed a systematic review and meta-analyses examining
haemodynamic changes immediately after dexmedetomidine administration in
patients with CHD. Method(s): We conducted a systematic review of
PubMed, Embase, and Medline from inception until May 31, 2024. Inclusion
criteria were studies that contained children with CHD who received
dexmedetomidine for a cardiac procedure and reported at least one
haemodynamic variable before and after administration of dexmedetomidine.
Exclusion criteria were studies of noncardiac procedures. We performed a
meta-analysis on each haemodynamic variable that was reported by at least
four studies. Result(s): We screened 5383 abstracts. We included 85
studies for review, and 16 studies were accepted for four meta-analyses
(heart rate, 16 studies, n = 408; systolic blood pressure, 11 studies, n =
280; diastolic blood pressure, 10 studies, n = 276; mean arterial
pressure, 5 studies, n = 130). Analysis of heart rate, systolic blood
pressure, and diastolic blood pressure showed a statistically significant
reduction (p < 0.001), while there was no significant change in mean
arterial pressure. The clinical difference was minimal with a decrease in
heart rate of 11.3 beats per minute, and a decrease in systolic blood
pressure/diastolic blood pressure of 5.9 and 6.2 mmHg, respectively.
Heterogeneity was high in all analyses. Discussion(s):
Dexmedetomidine is associated with small changes in heart rate, systolic
blood pressure, and diastolic blood pressure in children with CHD. Further
study is warranted. Copyright © The Author(s), 2025. Published by
Cambridge University Press.

<26>
Accession Number
2037354518
Title
Incidence of late-onset hyperlactatemia and association with clinical
outcomes in intensive care patients.
Source
Critical Care Science. 37 (no pagination), 2025. Article Number:
e20250124. Date of Publication: 2025.
Author
Kumar A.; Turner A.G.; Laupland K.B.; Ramanan M.
Institution
(Kumar, Turner) Intensive Care Unit, Logan Hospital, Metro South Hospital
and Health Services-Brisbane, Australia
(Laupland, Ramanan) Intensive Care Services, Royal Brisbane and Women's
Hospital, Metro North Hospital and Health Services-Brisbane, Australia
Publisher
Associacao de Medicina Intensiva Brasileira - AMIB
Abstract
Objective: To perform a systematic literature review to summarise current
evidence of the incidence and clinical impact of late-onset
hyperlactatemia in intensive care patients about case-fatality and
morbidity. Method(s): MEDLINE, EMBASE, and ClinicalTrials. gov were
searched using medical subject headings from database inception to 27
November 2024. Before the search, the protocol was registered on the
International Prospective Register of Systematic Reviews (PROSPERO). Two
independent reviewers screened the search results, and studies were
included if they were original research that assessed late-onset
hyperlactatemia in critically ill patients. Risk of bias was assessed
using the Newcastle-Ottawa Scale, and the data were analysed using a
descriptive approach without meta-analysis. Result(s): Of the 10,388
screened studies, 6 were included in the final manuscript, 5 retrospective
and 1 prospective. All were assessed as good quality studies. Five were
cardiac surgical patients, and one was general intensive care patients.
All six studies reported the incidence of late-onset hyperlactatemia,
which ranged from 8.5 to 70.8%. Two studies reported increased intensive
care unit and/or hospital case-fatality with late-onset hyperlactatemia;
however, small absolute numbers limited the interpretability.
 Conclusion(s): The limited data regarding late-onset hyperlactatemia
make it difficult to draw significant conclusions regarding the
relationship to clinical outcomes. However, the few available studies
suggest that it is a common finding and highlight the need for further
research to assess the underlying aetiologies and association with
clinical outcomes. Copyright © 2025, Associacao de Medicina
Intensiva Brasileira - AMIB. All rights reserved.

<27>
Accession Number
2037352427
Title
Safety and efficacy of glucagon-like peptide 1 receptor agonists in solid
organ transplant recipients with diabetes mellitus: a systematic review
and meta-analysis.
Source
Kidney Research and Clinical Practice. 44(6) (pp 880-898), 2025. Date of
Publication: 01 Nov 2025.
Author
Usman M.; Yu H.; Chen X.; Zhan Y.; Lai C.; Xu K.
Institution
(Usman, Yu, Chen, Zhan, Lai, Xu) Department of Urology, Sun Yat-sen
Memorial Hospital, Guangzhou, China
(Xu) Guangdong Provincial Clinical Research Center for Urological
Diseases, Guangzhou, China
(Xu) Sun Yat-sen University School of Medicine, Shenzhen, China
Publisher
The Korean Society of Nephrology
Abstract
There is limited evidence to support the use of glucagon-like peptide-1
receptor agonists (GLP-1RAs) in solid organ transplants (SOTs). This
systematic review and meta-analysis aimed to assess the safety and
efficacy of GLP-1RAs in this population. PubMed, Embase, and Cochrane
databases were a thorough literature search until July 2024 for SOTs with
pre-and posttransplant diabetes mellitus (DM). Hemoglobin A1c (HbA1c),
weight, and body mass index (BMI) were the primary outcomes. We estimated
odds ratios and standardized mean difference (SMD) or mean difference (MD)
with 95% confidence interval (CI) for dichotomous and continuous outcomes,
respectively. I2 statistics measured heterogeneity. GLP-1RAs
were administered to 806 subjects (99.8%) in 16 trials. Median follow-up
was 12 months (interquartile range, 1-49 months). The mean age was 57.05
+/- 10.24 years, with 64.6% male pa-tients. HbA1c levels (MD, -0.61% [95%
CI, -0.82 to -0.40]; p < 0.01, I2 = 72%), weight, and BMI were
statistically significantly re-duced. Estimated glomerular filtration rate
(eGFR; SMD, -0.38 mL/min/1.73 m2 [95% CI, -1.01 to 0.25]; p =
0.24, I2 = 0%), creati-nine, and blood pressure did not change
significantly. Additionally, total daily insulin dosage, lipid profile,
fasting plasma glucose, and urine albumin-to-creatinine ratio and
tacrolimus levels (MD, -0.40 ng/mL [95% CI, -0.85 to 0.05]; p = 0.08,
I2 = 42%) did not yield statistically significant. GLP-1RAs
caused increased nausea and vomiting (13.9%), urinary tract infections
(21.1%), and drug discon-tinuation (13.4%). In SOT recipients, GLP-1RAs
significantly reduced HbA1c, weight, and BMI without significantly
altering tacrolimus trough levels, eGFR, creatinine, or cardiovascular
outcomes. Gastrointestinal side effects were the most common adverse
events. Copyright © 2025 by The Korean Society of Nephrology.

<28>
Accession Number
2037342942
Title
Perioperative Use of Sacubitril / Valsartan in Rheumatic Heart Disease
Patients with Left Ventricular Dysfunction.
Source
International Journal of Medical and Pharmaceutical Research. 6(5) (pp
2018-2021), 2025. Date of Publication: 2025.
Author
Shendre R.
Institution
(Shendre) Department of Anaesthesiology, DMMC, SMHRC and DBASI, India
Publisher
IASR International LLP
Abstract
Background: Rheumatic heart disease (RHD) continues to be a major
contributor to left ventricular dysfunction even after valvular surgery.
Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI),
is shown to be effective in heart failure management. Objective(s):
To evaluate the perioperative effect of sacubitril/valsartan in improving
left ventricular function in RHD patients undergoing valve surgery.
 Method(s): A randomized open-label study was conducted on 96 patients
undergoing valve surgery. Group A (n=48) received sacubitril/valsartan
perioperatively, while Group B (n=48) did not. Parameters such as LVEF, LV
dimensions, NT-proBNP, and hemodynamic markers were compared.
 Result(s): Group A showed significant improvements in LVEF,
reductions in LV dimensions and NT-proBNP levels postoperatively, compared
to Group B. No significant difference in creatinine or LA size.
 Conclusion(s): Perioperative use of sacubitril/valsartan shows
potential in enhancing cardiac remodeling and function in RHD patients
post valve surgery. Copyright © International Journal of Medical
and Pharmaceutical Research.

<29>
[Use Link to view the full text]
Accession Number
2041696623
Title
Beta-Blockers after Myocardial Infarction in Patients without Heart
Failure.
Source
New England Journal of Medicine. 393(19) (pp 1901-1911), 2025. Date of
Publication: 13 Nov 2025.
Author
Munkhaugen J.; Kristensen A.M.D.; Halvorsen S.; Holmager T.; Olsen M.H.;
Bakken A.; Sehested T.S.G.; Ruddox V.; Maeng M.; Vikenes K.; Jensen S.E.;
Steigen T.; Lambrechtsen J.; Jortveit J.; Bovin A.; Schirmer H.;
Christiansen M.K.; Wiseth R.; Mikkelsen D.; Larsen A.I.; Kjaergaard C.L.;
Andresen K.; Gustafsson I.; Tuseth V.; Larsen M.L.; Deeg P.S.; Veien K.;
Bohmer E.; Botker H.E.; Brattrud A.O.; Bronnum-Schou J.; Pettersen
A.-A.R.; Bang L.E.; Oie E.; Engstrom T.; Borg E.B.; Kristensen K.; Nymo
S.H.; Gislason G.; Vethe N.T.; Abdulla J.A.M.; Dammen T.; Mouridsen M.R.;
Bendz B.; Bertelsen M.L.N.; Hove J.D.; Schierbeck L.; Snoer M.; Davidsen
C.; Egholm G.; Thomsen K.K.; Jadou G.; Poenaru M.; Krarup N.T.; Bottcher
M.; Staehr P.B.; Zwisler A.-D.; Edvardsen T.; Torp-Pedersen C.; Otterstad
J.E.; Lange T.; Fagerland M.W.; Atar D.; Prescott E.
Institution
(Munkhaugen) Department of Medicine, Drammen Hospital, Vestre Viken Trust,
Drammen, Norway
(Munkhaugen) Department of Behavioural Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Kristensen, Holmager, Kjaergaard, Gustafsson, Prescott) Department of
Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen,
Copenhagen, Denmark
(Halvorsen, Bakken, Atar) Department of Cardiology, Oslo University
Hospital Ullevaal, Oslo, Norway
(Halvorsen, Schirmer, Andresen, Oie, Dammen, Bendz, Edvardsen, Atar)
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo,
Oslo, Norway
(Olsen) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
(Olsen) Department of Internal Medicine, Holbaek Hospital, Holbaek,
Denmark
(Sehested, Bang, Engstrom) Department of Cardiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Ruddox, Otterstad) Department for Cardiology, Vestfold Hospital Trust,
Vestfold, Norway
(Maeng) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Vikenes, Tuseth) Department of Heart Disease, Haukeland University
Hospital, Norway
(Vikenes, Tuseth, Davidsen) University of Bergen, Bergen, Norway
(Jensen, Larsen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Steigen) Department of Cardiology, University Hospital of North Norway,
Arctic University of Tromso, Tromso, Norway
(Lambrechtsen) Odense University Hospital Svendborg and Cardiovascular
Research Unit, Odense, Denmark
(Jortveit) Department of Cardiology, Sorlandet Hospital Arendal, Arendal,
Norway
(Bovin) Department of Cardiology, Sygehus Lillebaelt, Vejle, Denmark
(Schirmer) Department of Cardiology, Akershus University Hospital,
Lorenskog, Norway
(Christiansen) Department of Internal Medicine, Horsens Regional Hospital,
Viborg, Denmark
(Christiansen, Krarup) Department of Cardiology, Viborg Regional Hospital,
Viborg, Denmark
(Wiseth) Clinic of Cardiology, St. Olavs University Hospital, Trondheim,
Norway
(Wiseth) Norwegian University of Science and Technology, Trondheim, Norway
(Mikkelsen) Department of Cardiology, Copenhagen University Hospital -
Naestved, Slagelse, and Ringsted, Slagelse, Denmark
(Mikkelsen) Slagelse Hospital, Slagelse, Denmark
(Larsen) Department of Cardiology, Stavanger University Hospital,
University of Bergen, Stavanger, Norway
(Andresen, Bendz, Edvardsen) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Deeg) Department of Cardiology, Ostfold Hospital Trust Kalnes, Gralum,
Norway
(Veien, Egholm) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Bohmer) Innlandet Hospital Trust, Lillehammer, Norway
(Botker) Department of Clinical Medicine, Section of Clinical Epidemiology
and Cardiology,Health, Aarhus University, Aarhus, Denmark
(Brattrud) Innlandet Hospital Trust, Hamar, Norway
(Bronnum-Schou) Department of Cardiology, Copenhagen University Hospital -
Amager and Hvidovre, Amager, Denmark
(Pettersen) Department of Medicine, Vestre Viken Hospital Trust, Ringerike
Hospital, Buskerud, Norway
(Oie) Department of Internal Medicine, Diakonhjemmet Hospital, Oslo,
Norway
(Borg) Innlandet Hospital Trust, Gjovik, Norway
(Kristensen) Department of Internal Medicine, Copenhagen University
Hospital, Ronne, Denmark
(Nymo) Department of Cardiology, Nordland Hospital Trust, Bodo, Norway
(Gislason) Department of Cardiology, Copenhagen University Hospital -
Herlev and Gentofte, Gentofte, Denmark
(Vethe) Department of Pharmacology, Oslo University Hospital, Department
of Pharmacy, University of Oslo, Oslo, Norway
(Abdulla) Department of Medicine, Section of Cardiology, Glostrup
Hospital, Copenhagen, Denmark
(Dammen) Division of Mental Health and Addiction, Department of Research
and Innovation, Oslo University Hospital, Oslo, Norway
(Mouridsen) Department of Cardiology, Copenhagen University Hospital,
Herlev, Denmark
(Bertelsen, Schierbeck, Torp-Pedersen) Department of Cardiology,
Copenhagen University Hospital, North Zealand Hospital, Hillerod, Denmark
(Hove) Department of Cardiology, Copenhagen University Hospital - Amager
and Hvidovre, Hvidovre, Denmark
(Snoer) Department of Cardiology, Zealand University Hospital Roskilde,
Roskilde, Denmark
(Thomsen) Department of Cardiology, Sydvestjysk Sygehus, Esbjerg, Denmark
(Jadou) Department of Cardiology, Sygehus Sonderjylland, Aabenraa, Denmark
(Poenaru) Department of Cardiology, Sygehus Lillebaelt, Kolding, Denmark
(Bottcher) Department of Cardiology, Godstrup Hospital, Herning, Denmark
(Staehr) Department of Cardiology, North Denmark Regional Hospital,
Hjoerring, Denmark
(Zwisler) Clinic for Palliative Medicine, Rehabilitation and
Patient-centered Care, Department of Oncology, Rigshospitalet, Copenhagen,
Denmark
(Zwisler) Department of Clinical Medicine, Faculty of Health and Medical
Sciences, University of Copenhagen, Copenhagen, Denmark
(Lange) Section of Biostatistics, Department of Public Health, University
of Copenhagen, Copenhagen, Denmark
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Oslo, Norway
Publisher
Massachussetts Medical Society
Abstract
The evidence supporting beta-blocker therapy after myocardial infarction
was established before the introduction of modern coronary reperfusion
therapy and secondary prevention strategies. METHODS In an open-label,
randomized trial with blinded end-point evaluation, conducted in Denmark
and Norway, we assigned patients who had had a myocardial infarction and
who had a left ventricular ejection fraction of at least 40%, in a 1:1
ratio, to receive long-term beta-blocker therapy within 14 days after the
event or no beta-blocker therapy. The primary end point was a composite of
death from any cause or major adverse cardiovascular events (new
myocardial infarction, unplanned coronary revascularization, ischemic
stroke, heart failure, or malignant ventricular arrhythmias). RESULTS A
total of 5574 patients underwent randomization and were included in the
main analyses - 2783 in the beta-blocker group and 2791 in the
no-beta-blocker group. After a median follow-up of 3.5 years
(interquartile range, 2.2 to 4.6), a primary endpoint event had occurred
in 394 patients (14.2%) in the beta-blocker group and in 454 patients
(16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence
interval [CI], 0.75 to 0.98; P=0.03). Death from any cause occurred in
4.2% of the patients in the beta-blocker group and in 4.4% of those in the
no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%,
respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned
coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and
1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular
arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes
were observed between the groups. CONCLUSIONS Among patients with a
myocardial infarction and a left ventricular ejection fraction of at least
40%, beta-blocker therapy led to a lower risk of death or major adverse
cardiovascular events than no beta-blocker therapy. Copyright ©
2025 Massachusetts Medical Society.

<30>
Accession Number
2037349751
Title
Effect of early adaptive servoventilation on cardiac repolarisation in
patients with myocardial infarction and sleep disordered breathing: an
ancillary analysis of the randomised controlled trial TEAM-ASV I.
Source
ERJ Open Research. 11(6) (no pagination), 2025. Article Number:
01341-2024. Date of Publication: 2025.
Author
Kohn M.; Stadler S.; Pec J.; Kassim A.; Koller M.; Buchner S.; Arzt M.;
Fisser C.
Institution
(Kohn, Stadler, Pec, Kassim, Buchner, Arzt, Fisser) Department of Internal
Medicine II, University Hospital Regensburg, Regensburg, Germany
(Koller) Center for Clinical Studies, University Hospital Regensburg,
Regensburg, Germany
(Buchner) Internal Medicine II - Cardiology, Sana Clinics of the District
of Cham, Cham, Germany
Publisher
European Respiratory Society
Abstract
Background In patients with acute myocardial infarction, altered cardiac
repolarisation has been linked to ventricular fibrillation and major
adverse cardiac events. Treatment of sleep disordered breathing early
after acute myocardial infarction may normalise the ventricular ectopic
substrate. Therefore, the aim of this ancillary analysis was to assess the
effect of adaptive servoventilation (ASV) on cardiac repolarisation.
Methods This analysis included 42 participants from the prospective
multicentre randomised trial TEAM-ASV I. 22 were randomised to early
treatment with ASV in addition to standard care, and 20 to standard care
only. Cardiac repolarisation was assessed by means of
T-peak-to-end-(TpTe<inf>c</inf>) and QT<inf>c</inf>-intervals and
TpTe/QT-ratios derived from 12-lead ECG before and 4 and 12 weeks after
percutaneous coronary intervention. Results The population was
predominantly male (79%), obese (mean+/-SD body mass index 31+/-6
kg.m-2 ), had severe sleep disordered breathing with an
apnoea-hypopnoea index of 34+/-18 events.h-1 and ASV was
initiated within 2.6+/-1 days. After 4 weeks, QT<inf>c</inf> significantly
decreased in the ASV group compared to the control group (-5.8% versus
-1.2%, p=0.041). A similar trend was observed with respect to
TpTe<inf>c</inf> (-18.0% versus -6.8%, p=0.119) and TpTe/QT (-17.6% versus
-6.6%, p=0.252). After 12 weeks, the decrease in repolarisation times was
similar between the groups. (QT<inf>c</inf> -7.6% versus -4.5%, p=0.400;
TpTe<inf>c</inf> -19.3% versus -18.8%, p=0.400; TpTe/QT -9.7 versus -13.0,
p=0.652). Conclusion In patients with first acute myocardial infarction
and sleep disordered breathing, early treatment with ASV reduced cardiac
repolarisation after 4 weeks, but not after 12 weeks. Thus, ASV may
contribute to preventing ventricular arrhythmias in the vulnerable early
phase after acute myocardial infarction. Copyright © The authors
2025.

<31>
Accession Number
2041788297
Title
Prothrombin Complex Concentrate Versus Fresh Frozen Plasma in Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Clinical Medicine Insights: Cardiology. 19 (no pagination), 2025. Date of
Publication: 01 Jan 2025.
Author
Hassan Waseem M.; Abideen Z.u.; Cheema A.H.; Shoaib A.; Waheed A.; Mukhlis
M.; Sajid B.; Aimen S.; Thada P.K.
Institution
(Hassan Waseem) Allama Iqbal Medical College, Lahore, Pakistan
(Abideen) King Edward Medical University, Lahore, Pakistan
(Cheema) University of Texas Southwestern, Dallas, United States
(Shoaib) Dow Medical College, Karachi, Pakistan
(Waheed) Rawalpindi Medical University, Rawalpindi, Pakistan
(Mukhlis) Ayub Medical College, Abbottabad, Pakistan
(Sajid) Jinnah Sindh Medical University, Pakistan
(Aimen) Quetta Institute of Medical Sciences, Quetta, Pakistan
(Thada) Sotang Primary Hospital, Solukhumbu, Nepal
Publisher
SAGE Publications Ltd
Abstract
Background: Excessive bleeding and coagulopathy frequently occur after
cardiac surgery, and Fresh Frozen Plasma (FFP) remains the standard
treatment. Prothrombin Complex Concentrates (PCC) present a potential
alternative; however, their effectiveness and safety compared to FFP
remain uncertain. Method(s): Electronic databases, including PubMed,
Cochrane Central, and ScienceDirect, were searched from inception till
April 2025. The risk ratios (RR) and mean differences (MD) were pooled
using the random-effects model in Review Manager software for the
dichotomous and continuous outcomes, respectively. Leave-one-out
sensitivity analysis and GRADE assessment were performed to evaluate the
cause of heterogeneity and assess the certainty of evidence, respectively.
Publication bias was evaluated visually through funnel plots and
statistically through Egger's regression test. Result(s): This
meta-analysis included 9 studies-comprising 4 randomized controlled trials
and 5 observational studies-covering a total of 1920 patients. PCC is
associated with a significant reduction in chest tube drainage output
within 24 hours compared to FFP (MD -170.05, 95% CI, -253.54 to -86.56; P
< .0001; I2 = 38%). Similarly, the number of RBC units
transfused (MD -1.06, 95% CI, -1.57 to -0.55, P < .0001; I2 =
45%) and number of patients requiring RBC transfusion (RR 0.84, 95% CI,
0.77-0.92; P < .0001; I2 = 47%) within first 24 hours are both
reduced significantly in the PCC arm. Other outcomes including stroke (RR
1.03, 95% CI, 0.63-1.69; P = .90; I2 = 0%), thromboembolic
events (RR 1.11, 95% CI, 0.76-1.64; P = .59; I2 = 0%), and
all-cause mortality within 30 days (RR 1.03, 95% CI 0.73-1.45; P = .87;
I2 = 0%) were comparable between both groups.
 Conclusion(s): PCC significantly reduced the chest tube drainage
output along with the number of RBC units transfused and the number of
patients requiring RBC transfusion within the first 24 hours. In contrast,
stroke, other thromboembolic events, and all-cause mortality were
comparable between the 2 groups. 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).

<32>
Accession Number
2040260277
Title
Left atrial appendage closure vs oral anticoagulation for stroke
prevention in atrial fibrillation: Long-term outcomes from 4 randomized
trials.
Source
Heart Rhythm. 22(11) (pp e1086-e1096), 2025. Date of Publication: 01 Nov
2025.
Author
Kaisaier W.; Xu Z.; Guo L.; Dong Y.; Chen Y.; Lip G.Y.H.; Zhu W.
Institution
(Kaisaier, Dong, Chen, Zhu) Department of Cardiology, First Affiliated
Hospital of Sun Yat-Sen University, Guangzhou, China
(Xu) Department of Emergency, Third Affiliated Hospital of Sun Yat-sen
University, Guangzhou, China
(Guo) Department of Cardiology, Jiangxi Provincial People's Hospital,
First Affiliated Hospital of Nanchang Medical College, Nanchang, China
(Lip) Liverpool Centre for Cardiovascular Science, University of
Liverpool, Liverpool John Moores University, Liverpool Heart & Chest
Hospital, Liverpool, United Kingdom
(Lip) Department of Clinical Medicine, Danish Center for Health Services
Research, Aalborg University, Aalborg, Denmark
Publisher
Elsevier B.V.
Abstract
Background Left atrial appendage closure (LAAC) is primarily indicated for
stroke prevention in patients with atrial fibrillation (AF) who have
contraindications to long-term oral anticoagulants (OACs). However, the
long-term comparative benefits of LAAC vs OACs in the broader AF
population remain unclear. Objective To study aimed to assess the
long-term efficacy and safety of LAAC compared with OACs in patients with
AF, we conducted a meta-analysis of randomized controlled trials (RCTs).
Methods We systematically searched PubMed, Embase, and Cochrane Library
for eligible RCTs. Risk ratios (RRs) with 95% confidence intervals (CIs)
were calculated using fixed-effects models. Results Four RCTs involving
3116 patients with AF (1736 assigned to LAAC and 1380 to OACs) and
follow-up durations ranging from 36 to 49.6 months were included. Compared
with OACs, LAAC was associated with reduced risks of all-cause death (RR =
0.78; 95% CI: 0.64-0.95) and cardiovascular or unexplained death (RR =
0.69; 95% CI: 0.51-0.94). There were no significant differences between
the 2 groups in stroke or systemic embolism, ischemic stroke, or systemic
embolism, and non-cardiovascular death. LAAC was associated with
significantly lower risk of hemorrhagic stroke (RR = 0.34; 95% CI:
0.16-0.76) and non-procedural clinically relevant bleeding (RR = 0.49; 95%
CI: 0.40-0.61). Major bleeding (including procedural and non-procedural)
risk did not differ significantly between groups. Conclusion In this
meta-analysis of RCTs, LAAC was associated with significantly lower risks
of all-cause and cardiovascular death, hemorrhagic stroke, and
non-procedural clinically relevant bleeding compared with OACs, without
increasing the risk of thromboembolic events or major bleeding. These
findings support the consideration of LAAC as an alternative to OAC in
selected patients with AF. Copyright © 2025 Heart Rhythm Society.

<33>
Accession Number
2040588173
Title
Restrictive versus liberal oxygenation in patients undergoing
cardiopulmonary bypass-assisted heart surgery: a randomised controlled
trial.
Source
British Journal of Anaesthesia. 135(6) (pp 1618-1625), 2025. Date of
Publication: 01 Dec 2025.
Author
Wiberg S.; Moller C.H.; Kjaergaard J.; Mikkelsen A.D.; Sorensen H.-M.;
Kunkel J.B.; Olsen P.S.; Hofsten D.E.; Ravn J.; Ravn H.; Boesgaard S.;
Hassager C.; Kober L.; Nilsson J.C.
Institution
(Wiberg, Sorensen, Nilsson) Department of Cardiothoracic Anesthesiology
and Intensive Care, Copenhagen University Hospital Rigshospitalet,
Copenhagen, Denmark
(Wiberg, Kjaergaard, Mikkelsen, Kunkel, Hofsten, Boesgaard, Hassager,
Kober) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Wiberg, Kjaergaard, Hassager) Department of Clinical Medicine, Faculty of
Health Sciences, University of Copenhagen, Copenhagen, Denmark
(Moller, Olsen, Ravn) Department of Cardiothoracic Surgery, Copenhagen
University Hospital Rigshospitalet, Copenhagen, Denmark
(Ravn) Department of Anesthesiology and Intensive Care, Odense University
Hospital, Odense, Denmark
Publisher
Elsevier Ltd
Abstract
Background: Maintaining adequate oxygen delivery during cardiopulmonary
bypass (CPB)-assisted cardiac surgery is crucial, but hyperoxia has been
suggested to cause organ injury. We compared the effects of restrictive vs
liberal oxygenation during CPB and weaning from CPB on clinical outcomes
in cardiac surgery. Method(s): We conducted a single-centre, patient-
and assessor-blinded randomised trial on adults undergoing CPB-assisted
coronary artery bypass grafting, aortic valve replacement, or both.
Participants were randomly assigned (1:1) to restrictive
(FIO<inf>2</inf>=50%) or liberal (FIO<inf>2</inf>=100%) oxygen therapy
during and for the first hour after weaning from CPB. The primary
composite outcome was the time to death, stroke, renal failure requiring
dialysis, or new-onset or worsening heart failure during follow-up.
 Result(s): Among 1389 participants (mean age, 67 yr [range, 29-85
yr]; 17% female), randomisation to receive FIO<inf>2</inf> 50% resulted in
median PaO<inf>2</inf> levels of 19-23 kPa during CPB, compared with >60
kPa in participants receiving FIO<inf>2</inf> 100%. During a median
follow-up period of 5.9 yr (interquartile range, 2.5-8.3), 167/695 (24%)
participants in the restrictive oxygenation group and 168/694 (24%)
participants in the liberal oxygenation group met the primary endpoint
(hazard ratio, 1.01 [95% confidence interval, 0.8-1.3]; P=0.92). There was
no difference in adverse event rates between restrictive and liberal
oxygen therapy. Conclusion(s): Among patients undergoing elective or
urgent CPB-assisted coronary artery bypass grafting, aortic valve
replacement, or both, no significant differences were observed in
mortality, dialysis-dependent renal failure, stroke, or new-onset or
worsening heart failure between a restrictive oxygenation strategy
(FIO<inf>2</inf> 50%) and a liberal oxygenation strategy (FIO<inf>2</inf>
100%) during CPB and the subsequent weaning period. Clinical trial
registration: NCT02673931 Copyright © 2025 The Author(s)

<34>
Accession Number
2041648509
Title
Evaluation of natriuresis-guided depletion after cardiac surgery: Protocol
for a single-centre, open-label, randomised controlled trial - The EASY-CS
study.
Source
BMJ Open. 15(10) (no pagination), 2025. Article Number: e108600. Date of
Publication: 06 Oct 2025.
Author
Beyls C.; Mollet N.; Gibert L.; Huette P.; Khamari M.; Meynier J.;
Abou-Arab O.; Mahjoub Y.
Institution
(Beyls, Mollet, Abou-Arab, Mahjoub) Chu Amiens-Picardie Pole Coeur Thorax
Vaisseaux, Amiens, France
(Gibert, Huette, Khamari) Centre Hospitalier Universitaire
Amiens-Picardie, Hauts-de-France, Amiens, France
(Meynier) Amiens-Picardy University Hospital, Hauts-de-France, Amiens,
France
Publisher
BMJ Publishing Group
Abstract
Introduction Fluid overload (FO) is a common complication following
cardiac surgery with cardiopulmonary bypass (CPB) and is associated with
increased morbidity and mortality. Loop diuretics, particularly
furosemide, are widely used to promote sodium and water excretion, but
their postoperative use remains largely empirical. International
guidelines recommend early assessment of diuretic response using spot
urinary sodium concentration, traditionally measured by automated
laboratory analysers. Recent advances now enable bedside measurement of
natriuresis using point-of-care (POC) urinary sodium sensors. This trial
aims to determine whether real-time bedside natriuresis monitoring using a
POC device can guide safer and more effective diuretic strategies in the
postoperative management of FO. Materials and methods The EASY-CS trial is
a prospective, single-centre, open-label, randomised controlled trial
designed to evaluate whether a natriuresis-guided furosemide titration
protocol improves diuresis within 48 hours following cardiac surgery with
CPB. A total of 102 adult patients undergoing elective cardiac surgery
with CPB and requiring postoperative intravenous (IV) furosemide for FO
will be randomised in a 1:1 ratio to either standard care (n=51;
furosemide titration based on clinical judgement) or a natriuresis-guided
arm (n=51), in which furosemide dosing is adjusted according to urinary
sodium concentration. All patients will receive an initial 20 mg dose of
IV furosemide. In the intervention group, urinary sodium will be measured
every 6 hours using a POC sodium sensor (LAQUAtwin Na + metre, Horiba,
Japan). If the spot urinary sodium is <70 mmol/L, the furosemide dose will
be doubled at the next administration, up to a maximum of 200 mg per
bolus. The primary endpoint is cumulative urine output at 48 hours
post-randomisation. Secondary outcomes include urinary sodium
concentration and urine output at 24 hours, natriuresis at 48 hours, and
the venous excess ultrasound score at 48 hours, as determined by
transthoracic echocardiography. The study will also assess total loop
diuretic dose administered, cumulative fluid balance over 48 hours and the
incidence of postoperative complications at day 30, including
cardiovascular, renal, respiratory and gastrointestinal events. Safety
endpoints include the presence of hypotension, hypokalaemia or acute
kidney injury before each diuretic administration. Randomisation will be
stratified by EuroSCORE II (<4% vs >=4%) and baseline serum creatinine
(<100 vs>=100 mumol/L). Recruitment has not yet started. Ethics and
dissemination Ethical approval has been obtained from the Institutional
Review Board (IRB) of Amiens University hospital (IRB-ID: 2025-A00925-44).
The study's results will be disseminated through peer-reviewed
publications and presentations at national and international conferences.
Trial registration number ClinicalTrials.gov Identifier:
NCT07077772. Copyright © Author(s) (or their employer(s)) 2025.

<35>
Accession Number
2041269860
Title
High variability in reporting of right ventricle contouring technique and
body surface area methodology in cardiac magnetic resonance studies of
patients with repaired tetralogy of Fallot: A systematic review.
Source
Journal of Cardiovascular Magnetic Resonance. 27(2) (no pagination), 2025.
Article Number: 101942. Date of Publication: 01 Dec 2025.
Author
Grbac A.J.; Naimo P.S.; Russo J.J.; Fogarty S.J.; Wilson W.M.; Zentner D.;
English K.M.; Grigg L.E.; Taylor A.J.; Lui E.H.; Joshi S.B.; Lee M.G.Y.
Institution
(Grbac, Naimo, Russo, Wilson, Zentner, English, Grigg, Taylor, Joshi, Lee)
Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC,
Australia
(Naimo, Zentner, English, Grigg, Taylor, Joshi, Lee) Department of
Medicine, The Royal Melbourne Hospital, The University of Melbourne,
Melbourne, VIC, Australia
(Fogarty) Department of Cardiology, Toowoomba Hospital, Toowoomba, QLD,
Australia
(Fogarty) University of Queensland, Brisbane, QLD, Australia
(Lui) Department of Medical Imaging, The Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Lui) Department of Radiology, The University of Melbourne, Melbourne,
VIC, Australia
(Lee) Heart Research Group, Murdoch Children's Research Institute,
Melbourne, VIC, Australia
Publisher
Elsevier B.V.
Abstract
Background Timing of pulmonary valve intervention (PVI) for pulmonary
regurgitation in patients with repaired tetralogy of Fallot (TOF) is
guided by right ventricle (RV) volumetric/function assessment on cardiac
magnetic resonance (CMR) indexed to actual body surface area (BSA).
However, different RV contouring techniques and BSA formulae exist with
significant variability in reported measurements. We aimed to review the
protocols reported in CMR studies of PVI in TOF. Methods A search of
electronic databases (Embase and MEDLINE) was performed to identify
studies published between February 28, 2010 and February 28, 2025 which
assessed adults with repaired TOF before and after PVI using CMR. RV
contouring methods and BSA formulae were reviewed. Results After screening
610 references, a total of 27 studies met the criteria and were included.
All studies were of only level III or level IV (lowest) levels of
evidence. Most studies (81%, 22/27) did not specify the RV contouring
technique used and none defined the RV basal slice. Of the five studies
describing the RV contouring technique, four excluded
trabeculations/papillary muscles from the RV volume and one included these
structures. No studies reported the formula used to calculate actual BSA.
Conclusion RV contouring technique and BSA methodology utilized in CMR
studies of PVI in TOF is poorly reported. Given the importance of severity
thresholds for RV volumes in triggering intervention in clinical practice,
clear reporting and standardization of RV contouring and BSA methodology
should be mandatory. Further research into the optimal RV thresholds for
PVI based on clear contouring methods is required. Copyright ©
2025 The Author(s).

<36>
Accession Number
2041039063
Title
Impact of propofol or sevoflurane on the renoprotective effect of remote
ischaemic preconditioning in cardiac surgery: the HypnoRenalRIP randomised
clinical trial.
Source
British Journal of Anaesthesia. 135(6) (pp 1626-1634), 2025. Date of
Publication: 01 Dec 2025.
Author
Zarbock A.; Schone L.M.; Kellum J.A.; Gerss J.; Weiss R.; Booke H.;
Meersch M.
Institution
(Zarbock, Schone, Weiss, Booke, Meersch) Department of Anaesthesiology,
Intensive Care Medicine and Pain Medicine, University Hospital Munster,
Munster, Germany
(Zarbock) Department of Anesthesiology, Critical Care and Pain Medicine,
The University of Texas Health Science Center at Houston, Houston, TX,
United States
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
Elsevier Ltd
Abstract
Background: Remote ischaemic preconditioning (RIPC) might reduce acute
kidney injury after cardiac surgery. Protective effects appear to be
restricted to patients with early and transient increases in two cell
cycle arrest markers, tissue inhibitor of metalloproteinases-2 (TIMP-2)
and insulin-like growth factor-binding protein 7 (IGFBP7), in urine.
Studies suggest that propofol can attenuate the preconditioning effect on
the myocardium. This study investigated whether propofol diminishes the
renoprotective effect associated with the early transient increases in
TIMP-2 and IGFBP7. Method(s): This was a single-centre, prospective
randomised double-blind 2x2 factorial clinical trial of high-risk patients
undergoing cardiac surgery. Patients were randomised to receive either
propofol+sham-RIPC, propofol+RIPC, sevoflurane+sham-RIPC, or
sevoflurane+RIPC. The primary outcome measure was the change in the
product of urinary concentrations of TIMP-2 and IGFBP7 ([TIMP-2].[IGFBP7])
from before to after the intervention. Result(s): We enrolled 160
participants in the trial (propofol+sham-RIPC: n=20, propofol+RIPC: n=60,
sevoflurane+sham-RIPC: n=20, sevoflurane+RIPC: n=60). The median change in
[TIMP-2].[IGFBP7] as an indicator of response to RIPC was greater in
participants receiving sevoflurane (0.070; interquartile range, -0.120 to
0.418) compared with those receiving propofol (-0.015; interquartile
range, -0.138 to 0.068; P=0.022). Conversely, elevated [TIMP-2].[IGFBP7]
as a sign of renal stress in response to surgery was detected in all
groups except for sevoflurane+RIPC (P=0.001). There were no statistically
significant differences in patient-centred outcomes between groups.
 Conclusion(s): Transient increases in [TIMP-2].[IGFBP7] induced by
RIPC, which were associated with renoprotective effects, were only seen
with sevoflurane anaesthesia, but not when propofol was used. The
association of biomarker concentrations and choice of anaesthetic agent
suggests that propofol can attenuate the renoprotective effects of remote
ischaemic preconditioning. Clinical trial registration:
DRKS00014989 Copyright © 2025 The Author(s)

<37>
Accession Number
2034180568
Title
Impact of high-fidelity simulation on the performance of oxygenator
change-outs among perfusion students.
Source
Perfusion (United Kingdom). 40(8) (pp 1789-1794), 2025. Date of
Publication: 01 Nov 2025.
Author
Collins J.; Voitik A.; Leonor A.R.; Juricek L.T.; Ellis M.; Kaur R.;
Weinberg A.
Institution
(Collins, Juricek, Ellis, Kaur, Weinberg) Department of Cardiovascular
Perfusion, College of Health Sciences, Rush University, Chicago, IL,
United States
(Voitik) Perfusion Services, University of Washington Medical Center,
Seattle WA, United States
(Leonor) Perfusion Services, UC Health University of Colorado Hospital,
Auroura, CO, United States
(Kaur) Department of Respiratory Care, College of Health Sciences, Rush
University, Chicago, IL, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Simulation is increasingly utilized in the clinical training
of healthcare professionals. Many perfusion programs in the United States
use simulation to teach students both technical skills and effective
communication. However, there is a lack of clarity regarding the optimal
timing for introducing simulation into the curriculum and how to assess
students' competencies. This study aims to evaluate whether combining
simulation with didactic education is more effective than didactic
education alone for learning perfusion-specific tasks, such as oxygenator
changeouts. Method(s): This was a pilot, randomized controlled study
conducted during November 2020. Subjects who were in their first year and
enrolled in a cardiovascular perfusion program at the university were
included. Subjects were randomly assigned to receive didactic education
alone (control) or didactic in combination with the simulation training
(experimental). Both groups received the didactic portion of the
oxygenator change out procedure and the experimental group received
supplemental simulation training. The primary outcome was oxygenator
change-out completion time (recorded in minutes and seconds) to identify
and change-out an oxygenator in a cardiopulmonary bypass circuit. The
secondary outcome was total communication score and subject's overall
performance assessment using the scoring system referenced by Burkhart et
al. Result(s): The experimental group (n = 8) performed the
oxygenator change-out significantly faster (363.63 +/- 87.1 seconds vs
558.11 +/- 185.75 seconds, p = .016) as compared to the control group (n =
9). However, there was no significant difference between the control and
experimental groups in overall communication skills (p = .152) or the
scoring system (p = .053) used to score subjects technical skills.
 Conclusion(s): The study findings revealed that the group receiving
both didactic instruction and simulation performed an oxygenator
change-out significantly faster than the group that received only didactic
instruction. These results suggest that incorporating simulation of
emergency scenarios into perfusion training can enhance students' speed in
performing complex tasks, better preparing them for real clinical
situations. Copyright © The Author(s) 2025

<38>
Accession Number
2040423811
Title
Consequences of reported beta-lactam allergy on perioperative outcomes: a
systematic review and meta-analysis of surgical site infection risk.
Source
Infection Control and Hospital Epidemiology. 46(11) (pp 1140-1150), 2025.
Date of Publication: 01 Nov 2025.
Author
Hanai Y.; Hirai J.; Matsuo K.; Kouzu K.; Shinkawa H.; Shinji S.; Kobayashi
M.; Yamashita C.; Mohri Y.; Nobuhara H.; Suzuki K.; Shimizu J.; Uchino M.;
Haji S.; Yoshida M.; Mizuguchi T.; Mayumi T.; Kitagawa Y.; Ohge H.
Institution
(Hanai, Matsuo) Department of Clinical Pharmacy, Faculty of Pharmaceutical
Sciences, Toho University, Chiba, Funabashi, Japan
(Hirai) Department of Clinical Infectious Diseases, Aichi Medical
University Hospital, Aichi, Japan
(Kouzu) Department of Surgery, National Defense Medical College, Saitama,
Japan
(Shinkawa) Department of Hepatobiliary-Pancreatic Surgery, Osaka
Metropolitan University Graduate School of Medicine, Osaka, Japan
(Shinji) Department of Gastroenterological Surgery, Nippon Medical School,
Tokyo, Japan
(Kobayashi) Department of Anesthesiology, Hokushinkai Megumino Hospital,
Hokkaido, Japan
(Kitagawa) Department of Infection Control, National Center for Geriatrics
and Gerontology, Aichi, Japan
(Yamashita) Department of Anesthesiology and Critical Care Medicine,
Fujita Health University School of Medicine, Aichi, Japan
(Mohri) Department of Surgery, Mie Prefectural General Medical Center,
Mie, Japan
(Nobuhara) Merry Hospital, Medical Corporation Yachiyokai, Hiroshima,
Japan
(Suzuki) Department of Infectious Disease Medicine, University of
Occupational and Environmental Health, Fukuoka, Japan
(Shimizu) Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
(Uchino) Department of Gastroenterological Surgery, Division of
Inflammatory Bowel Disease, Hyogo Medical University, Hyogo, Japan
(Haji) Department of Surgery, Soseikai General Hospital, Kyoto, Japan
(Yoshida) Department of Hepato-Biliary-Pancreatic and Gastrointestinal
Surgery, International University of Health and Welfare, School of
Medicine, Chiba, Japan
(Mizuguchi) Department of Nursing, Division of Surgical Science, Sapporo
Medical University, Hokkaido, Japan
(Mayumi) Department of Intensive Care Unit, Japan Community Healthcare
Organization Chukyo Hospital, Aichi, Japan
(Kitagawa) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
(Ohge) Department of Infectious Diseases, Hiroshima University Hospital,
Hiroshima, Japan
Publisher
Cambridge University Press
Abstract
Objective: To evaluate the impact of reported beta-lactam allergy on the
risk of surgical site infections (SSIs), given that most reported cases
are unverified and may lead to suboptimal antibiotic prophylaxis.
 Design(s): Systematic review and meta-analysis. Method(s): Four
databases were systematically searched for studies reporting SSI rates in
patients with and without beta-lactam allergy. The primary outcome was SSI
incidence; secondary outcomes included mortality, length of hospital stay
(LOS) and adverse events. Subgroup analyses were conducted to explore
potential sources of heterogeneity. Risk ratios (RRs) with 95% confidence
intervals (CIs) were pooled using a random-effects model. Risk of bias was
assessed using the ROBINS-I tool. Result(s): Twenty-five
retrospective observational studies comprising 460,284 patients were
included. Reported beta-lactam allergy was associated with a significantly
increased risk of SSI (RR = 1.55, 95% CI = 1.24-1.94). This association
remained consistent across sensitivity and subgroup analyses, particularly
in studies relying on self-reported allergies. Patients receiving
beta-lactam antibiotics had a significantly lower SSI risk than that of
patients receiving non-beta-lactam alternatives (RR = 0.63, 95% CI =
0.42-0.94). No significant differences were found in LOS or
hypersensitivity reaction rates. Mortality was not reported in any of the
included studies. Conclusion(s): Reported beta-lactam allergy is
associated with an increased risk of SSI, highlighting the importance of
accurate allergy assessment. Selective administration of beta-lactam
agents, such as cefazolin, may offer a safe and effective option for
preoperative prophylaxis in patients without a history of severe
hypersensitivity. Copyright © The Author(s), 2025.

<39>
Accession Number
2041279109
Title
Dabigatran-based versus warfarin-based triple antithrombotic regimen with
a 1-month intensification after coronary stenting in patients with
nonvalvular atrial fibrillation (COACH-AF PCI).
Source
BMC Medicine. 23(1) (no pagination), 2025. Article Number: 643. Date of
Publication: 01 Dec 2025.
Author
Liang M.; Jin J.; Zhao R.; Li H.; Chen S.; Liu L.; Xu P.; Wang W.; Cheng
X.; Chen X.; Tao L.; Zhang Q.; Yang M.; Zeng C.; Li L.; Zheng Y.; Chen H.;
Guo J.; Zhong Z.; Bi Y.; Cheng B.; Zhou Y.; Wang H.; Zhang Y.; Qiu M.;
Zhang P.; Zhang J.; Wang Z.; Li Y.; Han Y.
Institution
(Liang, Zhang, Zhang, Qiu, Zhang, Zhang, Wang, Li, Han) National Key
Laboratory of Frigid Zone Cardiovascular Disease and Department of
Cardiology, General Hospital of Northern Theatre Command, Liaoning,
Shenyang, China
(Jin) Department of Cardiology, Xinqiao Hospital of Third Military Medical
University, Chongqing, China
(Zhao) Department of Cardiology, Baotou Central Hospital, Inner Mongolia,
Baotou, China
(Li) Department of Cardiology, Daqing Oilfield General Hospital,
Heilongjiang, Daqing, China
(Chen) Department of Cardiology, Nanjing First Hospital, Jiangsu, Nanjing,
China
(Liu, Xu) Department of Cardiology, The Second Affiliated Hospital of
Shenyang Medical College, Liaoning, Shenyang, China
(Wang) Department of Cardiology, Teda International Cardiovascular
Hospital, Tianjin, China
(Cheng) Department of Cardiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Hubei, Wuhan, China
(Chen) Department of Cardiology, Peking University International Hospital,
Beijing, China
(Tao) Department of Cardiology, First Affiliated Hospital of Air Force
Military Medical University, Shaanxi, Xi'an, China
(Zhang) Department of Cardiology, Shanghai Oriental Hospital, Shanghai,
China
(Yang) Department of Cardiology, Yingkou Central Hospital, Liaoning,
Yingkou, China
(Zeng) Department of Cardiology, Daping Hospital, Third Military Medical
University, Chongqing, China
(Li) Department of Cardiology, Guangzhou Red Cross Hospital, Guangdong,
Guangzhou, China
(Zheng) Department of Cardiology, Anshan Central Hospital, Liaoning,
Anshan, China
(Chen) Department of Cardiology, Peking University People's Hospital,
Beijing, China
(Guo) Department of Cardiology, The Luhe Hospital Affiliated With Capital
Medical University, Beijing, China
(Zhong) Department of Cardiology, Meizhou People's Hospital, Guangdong,
Meizhou, China
(Bi) Department of Cardiology, The First Affiliated Hospital of Harbin
Medical University, Heilongjiang, Harbin, China
(Cheng) Department of Cardiology, Sichuan Provincial People's Hospital,
Sichuan, Chengdu, China
(Zhou) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, 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
(Wang) Department of Cardiology, Liuzhou Workers Hospital, Guangxi Zhuang
Autonomous Region, Liuzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: To assess the safety and efficacy of dabigatran-based triple
antithrombotic (TAT) regimen in patients after percutaneous coronary
intervention (PCI) with atrial fibrillation (AF). Method(s): A
multicenter, open-label, randomized controlled trial across 50 Chinese
hospitals enrolled nonvalvular AF patients after coronary stenting.
Participants were randomly assigned to receive dabigatran (110 mg
twice/daily) or warfarin-based TAT regimen (dabigatran or warfarin with
aspirin and clopidogrel) for 1 month and then convert to dual
antithrombotic therapy (dabigatran or warfarin with clopidogrel) for 6
months. The primary safety endpoint was the first occurrence of clinically
relevant bleeding (BARC types 2-5). Secondary endpoints included net
adverse clinical events (NACEs) and major or clinically relevant non-major
bleeding (CRNB). And the efficacy endpoint was the major adverse cardiac
and cerebral events (MACCEs). Result(s): The study was terminated
early due to COVID-19 impacting recruitment. A total of 540 patients were
enrolled. BARC types 2-5 bleeding occurred in 8.0% and 4.3% of patients in
warfarin and dabigatran groups, respectively (HR 0.54; 95% CI 0.26-1.09; P
= 0.0861). And total bleeding events (BARC 1-5) were 20.5% and 9.4% (HR
0.44; 95% CI 0.27-0.70; P = 0.0005). Dabigatran showed a lower total
bleeding risk than warfarin, with similar risks for BARC types 2-5
bleeding, NACEs, CRNB, major bleeding, and MACCEs. Conclusion(s):
Among AF patients underwent PCI, the dabigatran-based TAT regimen did not
significantly reduce the rate of BARC types 2-5 bleeding at 6 months
compared with warfarin-based regimen, although the power of the study to
find a difference was low due to early termination (COACH-PCI,
NCT03536611, https://clinicaltrials.gov/show/NCT03536611). Copyright
© The Author(s) 2025.

<40>
Accession Number
2041520183
Title
Effectiveness of cerebral embolic protection during transcatheter aortic
valve replacement: A systematic review and meta-analysis of randomized
trials.
Source
IJC Heart and Vasculature. 61 (no pagination), 2025. Article Number:
101842. Date of Publication: 01 Dec 2025.
Author
Caminiti R.; Ielasi A.; Vetta G.; Parlavecchio A.; Della Rocca D.G.;
Moscardelli S.; Marrone A.; Laterra G.; Tespili M.; Vizzari G.; Barbanti
M.; Micari A.
Institution
(Caminiti, Ielasi, Moscardelli, Marrone, Tespili) U.O. Cardiologia
Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
(Caminiti, Parlavecchio, Vizzari, Micari) Cardiology Unit, Department of
Clinical and Experimental Medicine, University of Messina, Messina, Italy
(Vetta, Della Rocca) Heart Rhythm Management Centre, Postgraduate Program
in Cardiac Electrophysiology and Pacing, UniversitairZiekenhuis
Brussel-Vrije Universiteit Brussel, European Reference Networks
Guard-Heart, Brussels, Belgium
(Laterra, Barbanti) Universita degli Studi di Enna "Kore", Enna, Italy
(Laterra, Barbanti) Division of Cardiology, Umberto I Hospital, ASP 4 di
Enna, Enna, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cerebral embolism remains a concern during transcatheter
aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices
have been developed to mitigate this risk, but their clinical benefit
remains unclear. Method(s): We conducted a systematic review and
meta-analysis of randomized controlled trials comparing TAVR with and
without CEP devices. Primary endpoint was overall stroke; secondary
endpoints included disabling stroke, all-cause mortality, life-treating
bleeding, vascular complications related to CEP access and acute kidney
injury. Result(s): Eight trials comprising 11,625 patients (group
CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5
mean age years) were included. No significant differences were found for
primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82-1.29), and
secondary outcomes between CEP and non-CEP groups at 30 days follow-up.
Complications related to CEP access were minimal, 1.1 % (95 % CI: -0.6 to
2.8). Conclusion(s): CEP devices do not significantly reduce
short-term stroke or major complications after TAVR. However, given the
prevalence of silent cerebral ischemia, further studies are needed to
assess long-term neurological outcomes and identify high-risk subgroups
who may benefit. Copyright © 2025

<41>
Accession Number
2039274554
Title
Etiology-specific survival and reoperation trends following surgical
mitral valve repair and replacement: A meta-analysis of reconstructed
time-to-event data.
Source
Trends in Cardiovascular Medicine. 35(8) (pp 485-494), 2025. Date of
Publication: 01 Nov 2025.
Author
Al-Tawil M.; Sicouri S.; Yamashita Y.; Ramlawi B.
Institution
(Al-Tawil, Sicouri, Yamashita, Ramlawi) Department of Cardiothoracic
Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA,
United States
(Yamashita, Ramlawi) Lankenau Heart Institute, Wynnewood, PA, United
States
Publisher
Elsevier Inc.
Abstract
Current American and European guidelines recommend mitral valve repair
(MVr) over replacement (MVR) whenever feasible. However, these
recommendations are primarily based on data from patients with
degenerative mitral regurgitation (DMR), whereas evidence supporting MVr
in other etiologies, such as infective endocarditis (IE) or ischemic
mitral regurgitation (IMR), remains less conclusive. We systematically
searched for and identified studies published after 2000 that compared MVr
and MVR in patients with specific mitral valve disease etiologies,
including DMR, IE, IMR, and rheumatic heart disease (RHD). A total of 61
records (10 DMR, 21 IE, 18 IMR, and 12 RHD) of 59 studies published
between 2005 and 2024, were included. MVr consistently demonstrated
superior survival compared to MVR in DMR and IE patients. Parametric
time-varying hazard ratios revealed a sustained survival benefit of MVr in
DMR and IE, whereas in IMR and RHD, the survival advantage was
transient-lasting only up to six months and 2.7 years postoperatively,
respectively-after which survival hazards between MVr and MVR became
comparable. This was further corroborated by the results of a two-year
landmark and the propensity-matched subgroup analyses. In DMR, MVr was
associated with lower reoperation rates compared to MVR; however, in IE,
IMR, and RHD, MVr was associated with significantly higher reoperation
rates compared to MVR. Our study supports current guidelines favoring MVr
over MVR, demonstrating sustained survival benefits in DMR. In IE-specific
MR, MVr also showed consistent benefits over MVR, demonstrating that MVr
should be prioritized when feasible. However, in IMR and RHD, there was no
notable survival advantage of MVr over MVR, with higher reoperation rates
observed with MVr. These findings highlight the need for etiology-specific
and individualized surgical planning. Copyright © 2025

<42>
Accession Number
2041334423
Title
Novel Wire-Assisted Mitral Commissurotomy Reduces Valve Crossing Time
Compared to Inoue-Balloon Technique of Treating Mitral Stenosis,
Randomized Controlled Trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Oljira C.F.; Packer E.; Dalen H.; Omdal T.R.; Haaverstad R.; Petros A.;
Yadeta D.; Loha E.; Dolven T.; Flade H.M.; Skagseth A.; Bogale N.
Institution
(Oljira, Petros, Yadeta) Cardiology Department, Addis Ababa University,
College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
(Packer, Omdal, Haaverstad, Bogale) Department of Heart Disease, Haukeland
University Hospital, Bergen, Norway
(Dalen, Flade) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
(Dalen) Clinic of Cardiology, St. Olavs Hospital, Trondheim University
Hospital, Trondheim, Norway
(Dalen) Department of Medicine, Levanger Hospital, Nord-Trondelag Hospital
Trust, Levanger, Norway
(Haaverstad, Loha) University of Bergen, Bergen, Norway
(Dolven) Department of Anesthesia and Intensive Care, Haukeland University
Hospital, Bergen, Norway
(Flade) Clinic of Anesthesia and Intensive Care, St. Olavs Hospital,
Trondheim University Hospital, Trondheim, Norway
(Skagseth) University Hospital of North Norway, Tromso, Norway
Publisher
John Wiley and Sons Inc
Abstract
Background: Percutaneous mitral commissurotomy (PMC) of mitral stenosis is
routinely performed by the Inoue balloon technique (IBT) which may be
challenging with respect to valvular crossing. Using a novel wire-assisted
method (WAM) may improve feasibility and time efficiency. Aim(s): In
a randomized clinical trial, we compared the feasibility and time
consumption by WAM and IBT. Method(s): Twenty mitral stenosis
patients with a Wilkins score <=10 were randomized 1:1 to IBT (n = 11) or
WAM (n = 9). All procedures were performed under general anesthesia and
optimized by in-field and transesophageal echocardiographic guiding. The
IBT balloon catheter was inserted over the coiled wire, and the stylet was
used to advance it to the mitral valve, while WAM was performed by
advancing a commercially available balloon over a stiff coiled wire placed
in the left ventricle. 1st endpoint was time from interatrial septal
puncture to balloon inflation, and 2nd outcomes were failure to double
mitral valve area or severe mitral regurgitation. Result(s): Mean +/-
SD age was 28 +/- 7 years (80% women) with all in NYHA class II or III.
Symptom duration was median (IQR) 7 (4.8) years, Wilkins score was 8.8 +/-
0.9, and mitral inflow gradient was 15.6 +/- 4.6 mmHg. Procedural time
(1st endpoint) was 14.4 +/- 3.4 min and 21.8 +/- 8.3 min in WAM and IBT,
respectively (p = 0.020). Three patients in each group did not double the
valve area by PMC, and no procedure was complicated by severe mitral
regurgitation. Conclusion(s): WAM significantly reduced the time from
interatrial septal crossing to first balloon inflation during equally
optimized PMC in severe mitral stenosis patients compared to
IBT. Copyright © 2025 Wiley Periodicals LLC.

<43>
Accession Number
2041229371
Title
Effect of Qishen Yiqi Dripping Pill on Clinical Outcomes in Patients with
Ischemic Heart Failure: A Post-Hoc Analysis of the CACT-IHF Randomized
Trial.
Source
Drug Design, Development and Therapy. 19 (pp 10163-10174), 2025. Date of
Publication: 2025.
Author
Zhou Z.; Wang S.; Du Y.; Zhao Z.; Bi Y.; Su Q.; Hou Y.; Wang X.; Mao J.
Institution
(Zhou, Wang, Du, Zhao, Bi, Su, Hou, Wang, Mao) Cardiovascular Department,
First Teaching Hospital of Tianjin University of Traditional Chinese
Medicine, National Clinical Research Center for Chinese Medicine
Acupuncture and Moxibustion, No. 88 Changling Road, Xiqing District,
Tianjin, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: This study aimed to evaluate whether the effect of Qishen Yiqi
dropping pills (QSYQ) on the clinical outcome of patients with chronic
ischemic heart failure (IHF) is related to the history of
revascularization. Patients and Methods: An exploratory post-hoc
analysis was conducted using data from the CACT-IHF trial, a multicenter,
randomized, double-blind, placebo-controlled study involving 640 patients
with chronic IHF. Participants were randomized to receive either QSYQ or
placebo for a duration of 6 months in addition to standard therapy, with a
minimum follow-up period of 12 months. Result(s): Among 638 patients
(319 QSYQ, 319 placebo) in modified Intention-to-Treat (mITT) population
(patients receive at least one trial drug or placebo treatment after
randomization), 54.5% had prior revascularization. In the revascularized
subgroup, QSYQ significantly reduced the risk of major adverse cardiac
events (MACEs) (HR: 0.55, 95% CI: 0.36 to 0.82; P=0.003), second composite
endpoint (HR: 0.60, 95% CI: 0.39 to 0.92; P=0.02) and hospitalization for
heart failure (HHF) (HR: 0.57, 95% CI: 0.36 to 0.91; P=0.018) compared to
placebo, while no significant difference was observed in
non-revascularized patients. A significant interaction between
revascularization and QSYQ treatment was noted (Pinteraction=0.009). It is
suggested that the effect of QSYQ on the outcome of IHF patients is
related to the history of revascularization. Adverse event rates were
similar between groups. Conclusion(s): QSYQ reduces MACEs risk in
revascularized chronic IHF patients without increasing adverse events,
suggesting its potential as a safe and effective adjunct therapy.
Registration: Clinical Trial Registry Identifier:
NCT01555320. Copyright © 2025 Zhou et al.

<44>
Accession Number
2039095713
Title
Unilateral access versus bilateral access in transfemoral transcatheter
aortic valve replacement: A systematic review and meta-analysis.
Source
Indian Heart Journal. 77(5) (pp 348-353), 2025. Date of Publication: 01
Sep 2025.
Author
Jain H.; Shahabi M.; Shafiq A.; Agrawal S.P.; Saad M.S.; Sharaf B.L.;
Gordon P.C.; Abbott J.D.; Vallabhajosyula S.
Institution
(Jain) Department of Cardiology, All India Institute of Medical Sciences,
Jodhpur, India
(Shahabi, Shafiq) Department of Internal Medicine, Dow University of
Health Sciences, Karachi, Pakistan
(Agrawal) Department of Internal Medicine, New York Medical
College/Landmark Medical Center, Woonsocket, RI, United States
(Saad, Sharaf, Gordon, Abbott, Vallabhajosyula) Division of Cardiology,
Department of Medicine, Warren Alpert Medical School of Brown University,
Providence, RI, United States
(Saad, Sharaf, Gordon, Abbott, Vallabhajosyula) Brown University Health
Cardiovascular Institute, Providence, RI, United States
Publisher
Elsevier B.V.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) procedures
frequently require a second arterial access to perform aortic root
angiography. In recent times, there has been an increase in the use of
unilateral access, however, the outcomes data are conflicting.
 Method(s): A systematic database search was conducted to retrieve
studies comparing unilateral to bilateral access in TAVR. Risk ratios (RR)
with 95 % confidence intervals (CI) were pooled using the Mantel-Haenszel
random-effects model. Outcomes of interest included minor vascular
complications, major vascular complications, 30-day stroke, and 30-day
all-cause mortality. Result(s): Three studies with a total of 2,181
patients undergoing TAVR (unilateral 368, bilateral 1813) were included in
this meta-analysis. Unilateral access was comparable to bilateral access
for minor vascular complications (RR: 0.88; 95 % CI: 0.48-1.62), major
vascular complications (RR: 0.61, 95 % CI: 0.14-2.75), stroke (RR: 0.95;
95 % CI: 0.42, 2.17) and all-cause mortality (RR: 0.52; 95 % CI: 0.04,
6.93). Conclusion(s): Unilateral access for TAVR was associated with
similar short-term outcomes and safety profiles compared to bilateral
access for TAVR. Copyright © 2025 Cardiological Society of India

<45>
Accession Number
2041335348
Title
Emergency Department Visits Following Transcatheter Cardiac Interventions:
A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Best N.G.; Talla M.; Rafiee F.; Balakumar S.; Moses A.; Akseer S.; Lee
D.S.; Horlick E.M.; Huszti E.; Abrahamyan L.
Institution
(Best, Talla, Rafiee, Akseer, Lee, Huszti, Abrahamyan) Institute of Health
Policy, Management and Evaluation (IHPME), University of Toronto, Toronto,
ON, Canada
(Best, Talla, Rafiee, Akseer, Lee, Abrahamyan) Toronto General Hospital
Research Institute, University Health Network, Toronto, ON, Canada
(Balakumar) Department of Human Biology, University of Toronto, Toronto,
ON, Canada
(Moses) Faculty of Health Sciences, Queens University, Kingston, ON,
Canada
(Lee, Abrahamyan) Institute for Clinical Evaluative Science, Toronto, ON,
Canada
(Lee, Horlick) Peter Munk Cardiac Centre, University Health Network,
Toronto, ON, Canada
(Huszti) Biostatistics Department, University Health Network, Toronto, ON,
Canada
Publisher
John Wiley and Sons Inc
Abstract
While hospital readmission is the most common health system performance
metric after transcatheter cardiac interventions, emergency department
(ED) visits are rarely evaluated. We aimed to synthesize the incidence,
causes, predictors, costs, and outcomes of ED visits following
transcatheter procedures in patients undergoing percutaneous coronary
interventions (PCI), atrial septal defect (ASD) closures, patent foramen
ovale (PFO) closures, and transcatheter aortic valve interventions (TAVI).
Embase and Medline databases were searched from January 01, 2004, to July
25, 2024. We descriptively summarized ED visit outcomes for all studies
and, when relevant, performed a meta-analysis to obtain a pooled mean
cumulative incidence for 30-day ED visits following intervention. Nineteen
studies met the eligibility criteria, nine of which were subsequently
meta-analyzed. The incidence of 30-day ED visits in individual studies
ranged from 2.8% to 22% for PCI patients, 4% to 15.3% for TAVI patients,
and 16.9% to 19.5% for ASD/PFO patients. The pooled mean cumulative
incidence of 30-day ED visits was 9% (95% CI: 3%-18%) for PCI patients and
12% (95% CI: 9%-15%) for TAVI patients. A high degree of between-study
heterogeneity was found in the meta-analysis of these outcomes. Based on
limited reporting, risk factors associated with ED visits varied by
procedure and included factors such as urgency of procedure, length of
stay, sex, age, and dementia. The incidence and predictors of ED visits
post-transcatheter cardiac interventions were noteworthy yet highly
variable and inconsistently reported. Further research into the risk
factors that contribute to ED visits is needed to capture the burden of
this outcome. Copyright © 2025 Wiley Periodicals LLC.

<46>
Accession Number
2041209413
Title
Left Atrial Appendage Occlusion Using the Amplatzer Amulet Device in
High-Risk Patients With Atrial Fibrillation Undergoing Transcatheter
Aortic Valve Intervention: A Randomized Pilot Study.
Source
Structural Heart. 9(12) (no pagination), 2025. Article Number: 100735.
Date of Publication: 01 Dec 2025.
Author
Jakob P.; Heinz P.; Gong Y.; Chen M.; Binder R.K.; Held U.; Taramasso M.;
Paneni F.; Schuetz P.; Haager P.K.; Kasel M.; Pedrazzini G.; Windecker S.;
Moccetti M.; Pilgrim T.; Luscher T.F.; Stahli B.E.; Nietlispach F.
Institution
(Jakob, Gong, Chen, Paneni, Kasel, Stahli) Department of Cardiology,
University Heart Center, University Hospital Zurich and the Center for
Translational and Experimental Cardiology (CTEC), University of Zurich,
Zurich, Switzerland
(Heinz, Held) Department of Biostatistics at Epidemiology, Biostatistics
and Prevention Institute, University of Zurich, Zurich, Switzerland
(Binder) Department of Cardiology and Intensive Care, Klinikum Wels, Wels,
Austria
(Taramasso) Clinic of Cardiac Surgery, HerzZentrum Hirslanden Zurich,
Zurich, Switzerland
(Schuetz) Division of General Internal and Emergency Medicine, Medical
University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
(Haager) HOCH Cantonal Hospital St. Gallen, Department of Cardiology, St.
Gallen, Switzerland
(Pedrazzini, Moccetti) Cardiology Department, Cardiocentro Ticino, Lugano,
Switzerland
(Windecker, Pilgrim) Department of Cardiology, Inselspital, University of
Bern, Bern, Switzerland
(Luscher) Center for Molecular Cardiology, University of Zurich,
Schlieren, Switzerland
(Luscher) Royal Brompton and Harefield Hospitals and King's College and
Imperial College, London, United Kingdom
(Nietlispach) Cardiovascular Center Zurich, Heart Center im Park, Zurich,
Switzerland
Publisher
Cardiovascular Research Foundation
Abstract
Background Patients with severe aortic stenosis and atrial fibrillation
(AF) undergoing transcatheter aortic valve intervention (TAVI) are at
increased risk of bleeding and cerebrovascular events. This
investigator-initiated, randomized, multicenter, open-label pilot study
assessed left atrial appendage occlusion (LAAO) in patients with AF
undergoing TAVI. Methods Patients were randomly assigned to LAAO (TAVI +
LAAO) or standard medical therapy (SMT) (TAVI + SMT). The primary endpoint
was a composite of cerebrovascular events, peripheral embolism,
life-threatening/disabling/major bleeding, or cardiovascular mortality at
1 year. A sensitivity analysis was performed in the per-protocol
population. Results Eighty-one patients (Society of Thoracic Surgeons
score: 9.0% +/- 5.4%) were enrolled. The primary endpoint occurred in 13
patients (33%) in the TAVI + LAAO group and in 15 patients (37%) in the
TAVI + SMT group (adjusted odds ratio [OR], 0.87; 95% CI: 0.32-2.29, p =
0.77). Bleeding rates were comparable between TAVI + LAAO (13%) and TAVI +
SMT (17%), with absent nonprocedural bleeding in the TAVI + LAAO group and
5 gastrointestinal bleedings in TAVI + SMT, and cerebrovascular events did
not significantly differ between groups (10% in TAVI + LAAO vs. 2.4% in
TAVI + SMT). In the per-protocol analysis, occurrence of the primary
endpoint was comparable between groups (adjusted OR, 0.55; 95% CI:
0.18-1.56, p = 0.27) with cerebrovascular events in 5.6% and 2.4%, and
bleeding events in 8.3% and 17% for TAVI + LAAO and TAVI + SMT,
respectively. Conclusions This pilot study suggests that among high-risk
patients with AF undergoing TAVI, a strategy of a combined procedure with
LAAO and early cessation of oral anticoagulation overall showed similar
rates of the primary end point as compared to a single TAVI procedure
(NCT03088098). Copyright © 2025 .

<47>
Accession Number
2041250152
Title
Prehabilitation including psychological interventions reduces overall
postoperative complications following cancer surgery: a systematic review
and meta-analysis of randomised controlled trials.
Source
Supportive Care in Cancer. 33(12) (no pagination), 2025. Article Number:
1070. Date of Publication: 01 Dec 2025.
Author
Hirst N.; Solomon M.J.; McBride K.; Dhillon H.; Bai Z.; Alexander K.; Jeon
S.W.; Steffens D.
Institution
(Hirst, Solomon, Bai, Alexander, Jeon, Steffens) Surgical Outcomes
Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road,
P.O. Box M157, Sydney, NSW, Australia
(Hirst, Solomon, McBride, Bai, Alexander, Jeon, Steffens) Faculty of
Medicine and Health, Central Clinical School, The University of Sydney,
Sydney, Australia
(Solomon) Department of Colorectal Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
(Solomon, McBride, Steffens) Institute of Academic Surgery (IAS), Royal
Prince Alfred Hospital, Sydney, Australia
(Dhillon) Faculty of Science, School of Psychology, University of Sydney,
Sydney, NSW, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: This study aims to assess the effectiveness of psychological
prehabilitation in reducing postoperative complications and length of
hospital stay in patients undergoing cancer surgery. Method(s): A
comprehensive electronic search was conducted in CINAHL, Cochrane Library,
Medline, PsycINFO, AMED and Embase databases from inception to December
2023. Randomised controlled trials assessing the effectiveness of
psychological prehabilitation compared to control in patients undergoing
abdominal, pelvic, and/or thoracic cancer surgery were included. The
primary outcome measures were postoperative complications and length of
hospital stay. Two independent reviewers extracted relevant information
and assessed the risk of bias. Random-effect meta-analyses were used to
pool outcomes, and the quality of evidence was assessed using GRADE.
 Result(s): A total of 18 trials were identified (N = 1612) and 11 (N
= 923) analysed, including eight multimodal (N = 719), one bimodal (N =
90) and two unimodal (N = 189). There was high-quality evidence that
trials including psychological prehabilitation significantly reduced the
incidence of overall postoperative complications in all cancer types
included in the studies (relative risk: 0.73; 95% CI: 0.60 to 0.89) and
abdominal cancer subgroup (relative risk: 0.65; 95% CI: 0.48 to 0.88)
compared to control. Psychological prehabilitation was not effective in
reducing length of hospital stay (mean difference: - 0.78; 95% CI: - 1.72
to 0.17). Conclusion(s): Psychological prehabilitation appears
effective in reducing postoperative complications in cancer patients.
Future studies should investigate the optimal preoperative psychological
interventions according to individual cancer groups undergoing
surgery. Copyright © The Author(s), under exclusive licence to
Springer-Verlag GmbH Germany, part of Springer Nature 2025.

<48>
Accession Number
2041246547
Title
Current Usage of Extracorporeal Photopheresis in Solid Organ
Transplantations in Europe: A Narrative Review.
Source
Transplant International. 38 (no pagination), 2025. Article Number: 14906.
Date of Publication: 2025.
Author
Cashmore S.-J.; Barten M.J.; Diekmann F.; Epailly E.; Fisher A.J.; Gennery
A.R.; Gibbons B.; Gokler J.; Guest J.; Heng A.-E.; Hutchinson J.A.;
Rampino T.; Vos R.; Potena L.
Institution
(Cashmore, Gibbons) Bryter Inc., New York, NY, United States
(Barten) Department of Cardiovascular Surgery, University Heart and
Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
(Diekmann) Department of Nephrology and Kidney Transplantation of the
Hospital Clinic, Barcelona, Spain
(Epailly) Department of Cardiology and Cardiovascular Surgery, Hopitaux
Universitaires de Strasbourg, Strasbourg, France
(Fisher, Gennery) Translational and Clinical Research Institute, Faculty
of Medical Science, Newcastle University, United Kingdom
(Gokler) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Guest) Population Health Sciences Institute, Newcastle University,
Newcastle, United Kingdom
(Heng) Nephrology, Dialysis Department, Clermont-Ferrand University
Hospital, Clermont-Ferrand, France
(Hutchinson) Department of Surgery, University Hospital Regensburg,
Regensburg, Germany
(Rampino) Nephrology, Dialysis and Transplantation Unit, Fondazione
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico
San Matteo, University of Pavia, Pavia, Italy
(Vos) Department of Respiratory Diseases and KU Leuven, Department of
CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery
(BREATHE), University Hospitals Leuven, Leuven, Belgium
(Potena) Heart Failure and Transplant Unit, IRCCS Azienda
Ospedaliero-Universitaria di Bologna, Bologna, Italy
Publisher
Frontiers Media SA
Abstract
Solid organ transplantation (SOT) faces significant challenges in managing
allograft rejection, with current immunosuppressive therapies often
associated with substantial adverse effects. Extracorporeal photopheresis
(ECP) has emerged as a promising adjunctive treatment for rejection
prevention and management in heart and lung transplants, with growing
evidence supporting its use in kidney and liver transplants. Despite this,
the availability of ECP and its place in standard treatment pathway is
widely variable across Europe. This narrative review, supported by a
European survey of 51 transplant clinicians, highlights the current usage
of ECP in SOT. Findings reveal that ECP is primarily used for recurrent
rejection in heart and lung transplants, with limited application
currently in kidney and liver transplants. ECP has shown some efficacy in
managing acute and chronic rejection, and stabilizing graft function.
Barriers including lack of standardized protocols, availability of ECP,
lack of high-quality clinical trial data and lack of a defined mechanism
of action hinder its broader adoption. Future directions include the
development of standardized protocols, multicenter registries, and further
controlled clinical trials to define the role of ECP. Increased awareness,
cost-effectiveness studies, mechanistic studies and equitable access are
essential to integrate ECP into routine SOT management. Copyright
© 2025 Cashmore, Barten, Diekmann, Epailly, Fisher, Gennery, Gibbons,
Gokler, Guest, Heng, Hutchinson, Rampino, Vos and Potena.

<49>
Accession Number
2040578352
Title
Laryngeal reinnervation for unilateral vocal fold paralysis in adults; a
systematic review of the literature for the clinician.
Source
European Archives of Oto-Rhino-Laryngology. 282(11) (pp 5779-5795), 2025.
Date of Publication: 01 Nov 2025.
Author
Mes S.D.; Heijnen B.J.; Hendriksma M.H.; Langeveld A.P.M.; Dronkers
E.A.C.; Sjogren E.V.
Institution
(Mes, Hendriksma, Langeveld, Dronkers, Sjogren) Department of
Otolaryngology and Head- and Neck Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Mes) Department of Otorhinolaryngology, Groene Hart Ziekenhuis, Gouda,
Netherlands
(Heijnen) Department of Clinical Research Unit, Dept. of Internal
Medicine, Leiden University Medical Center, Leiden, Netherlands
(Mes) Department of ENT, Head and Neck Surgery, Leiden University Medical
Center, Albinusdreef 2, Leiden, Postbus, Netherlands
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Unilateral vocal fold paralysis (UVFP), resulting from recurrent
laryngeal nerve injury, significantly impairs phonation and reduces
quality of life. Laryngeal reinnervation, including ansa-to-recurrent
(ansaNSR) and nerve-muscle pedicle reinnervation combined with arytenoid
adduction (NMPR + AA), has gained attention as a durable treatment option.
This systematic review aims to evaluate the outcomes of laryngeal
reinnervation, identify predictive factors and highlight knowledge gaps
relevant to clinical practice. Method(s): A systematic search of
PubMed, Embase, Web of Science, the Cochrane Library and Emcare identified
42 studies. Outcome measures included perceptual, acoustic, aerodynamic,
videostroboscopic and patient-reported outcomes. The risk of bias was
assessed using the Methodological Index for Non-Randomized Studies
(MINORS) tool. Weighted mean improvements were calculated for clinically
relevant parameters. Result(s): We included forty-two studies (N = 1
859 patients) in our review. These studies demonstrated high rates of
voice improvement, primarily based on data from the ansaNSR (N = 1 369)
and NMPR + AA (N = 278) techniques. Age and duration of denervation
emerged as the most influential predictive factor. Younger patients (< 60
years) and those with shorter denervation periods (< 2 years) had better
outcomes, although successful results were also observed beyond these
thresholds. The predictive value of preoperative laryngeal
electromyography (LEMG), etiology of UVFP and clinical presentation
remains inconclusive. Conclusion(s): Laryngeal reinnervation (ansaNSR
and NMPR + AA) is effective for UVFP, offering durable voice improvements
with minimal complication rates. Future research should focus on
standardizing outcome measurements, clarifying predictive factors and
refining patient selection to enhance clinical
decision-making. Copyright © The Author(s) 2025.

<50>
Accession Number
2039599399
Title
Valve in valve transcatheter versus redo surgical replacement of a failing
surgical bioprosthetic aortic valve: An updated systematic review and
meta-analysis.
Source
Journal of Cardiology. 86(5) (pp 474-482), 2025. Date of Publication: 01
Nov 2025.
Author
Dimitriadis K.; Pyrpyris N.; Aznaouridis K.; Soulaidopoulos S.;
Koutsopoulos G.; Beneki E.; Tatakis F.; Adamopoulou E.; Tsioufis P.;
DeBiase C.; Milasinovic D.; De Backer O.; Vanhaverbeke M.; Aggeli K.;
Tsioufis K.
Institution
(Dimitriadis, Pyrpyris, Aznaouridis, Soulaidopoulos, Koutsopoulos, Beneki,
Tatakis, Adamopoulou, Tsioufis, Aggeli, Tsioufis) First Department of
Cardiology, School of Medicine, National and Kapodistrian University of
Athens, Hippokration General Hospital, Athens, Greece
(DeBiase) Clinique Pasteur, Toulouse, France
(Milasinovic) Department of Cardiology, University Clinical Center of
Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
(De Backer) The Heart Centre, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Vanhaverbeke) Department of Cardiology, AZ Delta, Roeselare, Belgium
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background With the aging population, degeneration of surgical aortic
valves is an important clinical scenario. Currently, in most European
countries, both redo surgery [redo-surgical aortic valve replacement
(SAVR)] and valve-in-valve transcatheter aortic valve implantation
(ViV-TAVI) are established alternatives for treating such patients. This
meta-analysis aims to compare redo-SAVR and ViV-TAVI for treating a
failing bioprosthetic aortic valve. Methods A systematic search was
performed from inception to June 2023. After selecting all appropriate
trials according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines, a random effect meta-analysis was performed.
Clinical and echocardiographic outcomes were compared among the groups.
Results Twenty-six studies with a total of population of 17,581 patients
were included [ViV-TAVI ( n = 9163) or redo-SAVR ( n = 8418]. ViV-TAVI was
associated with lower 30-day mortality (RR: 0.55; 95%CI: 0,47 to 0,66) and
1-year mortality (RR: 0.85; 95%CI: 0.75 to 0.96), major bleeding events
(RR: 0.58; 95%CI: 0.42-0.79), and a trend towards lower new pacemaker
implantations (RR: 0.70; 95%CI: 0.49-1.01) at 30 days. On the other hand,
ViV-TAVI resulted in a higher mean transprosthetic gradient and higher
rates of severe patient-prosthesis mismatch (RR: 1.64; 95%CI: 1.01 to
2.65) and paravalvular leak (RR: 2.44; 95%CI: 1.73-3.45) as compared to
redo-SAVR. No significant difference was observed in 30-day myocardial
infarction (RR: 0.90; 95%CI: 0.56 to 1.46) or stroke (RR: 0.77; 95%CI:0.55
to 1.06). Conclusion ViV-TAVI has a satisfying safety profile with better
short-term survival outcomes as compared to redo-SAVR. However, adequate
pre-procedural planning of VIV-TAVI cases is needed, in order to minimize
the risk of a suboptimal hemodynamic outcomes following
ViV-TAVI. Copyright © 2025 The Authors.

<51>
Accession Number
2035198914
Title
Colchicine and cardiovascular events: An updated meta-analysis of
published randomized controlled trials.
Source
Journal of Internal Medicine. 298(6) (pp 711-717), 2025. Date of
Publication: 01 Dec 2025.
Author
Xie S.; Galimberti F.; Olmastroni E.; Catapano A.L.; Casula M.
Institution
(Xie, Olmastroni, Catapano, Casula) Epidemiology and Preventive
Pharmacology Service (SEFAP), Department of Pharmacological and
Biomolecular Sciences, University of Milan, Milan, Italy
(Galimberti, Olmastroni, Catapano, Casula) IRCCS MultiMedica, (MI), Sesto
San Giovanni, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Colchicine shows promise in reducing cardiovascular risk, but
a recent study raised the question whether this is really the case. We
conducted a meta-analysis of randomized controlled trials (RCTs) to assess
its impact on cardiovascular outcomes in secondary prevention.
 Method(s): We systematically searched major databases up to March
2025 for RCTs comparing colchicine to placebo over a treatment duration of
>=12 months, reporting major adverse cardiovascular events (MACEs). Both
fixed- and random-effects models were used to compute pooled risk ratios
(RRs) and 95% confidence intervals. Result(s): Six RCTs comprising
21,774 patients were included. Colchicine significantly reduced the risk
of MACEs (RR 0.74 [0.60-0.92]) and specific components of primary outcome
(myocardial infarction, RR 0.85 [0.73-0.98]; stroke, RR 0.79 [0.65-0.95]),
with no significant effect on cardiac death and revascularization.
 Conclusion(s): These results support the efficacy of low-dose
colchicine in reducing MACEs when added to standard care for at least 12
months. Copyright © 2025 The Author(s). Journal of Internal
Medicine published by John Wiley & Sons Ltd on behalf of Association for
Publication of The Journal of Internal Medicine.

<52>
Accession Number
2040665136
Title
Fetal Surgery for Congenital Heart Diseases: A Systematic Review and
Single-Arm Meta-analysis.
Source
Advances in Therapy. 42(12) (pp 6150-6162), 2025. Date of Publication: 01
Dec 2025.
Author
de Azevedo Teixeira L.K.; Provinciatto H.; Callado G.Y.; de Oliveira
Nieblas C.; Granese R.; Araujo Junior E.
Institution
(de Azevedo Teixeira, de Oliveira Nieblas, Araujo Junior) Discipline of
Woman Health, Municipal University of Sao Caetano do Sul (USCS), SP, Sao
Caetano do Sul, Brazil
(Provinciatto, Araujo Junior) Department of Obstetrics, Paulista School of
Medicine, Federal University of Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
(Callado) Department of Woman Health, Albert Einstein Israelite College of
Health Sciences, Albert Einstein Israelite Hospital, SP, Sao Paulo, Brazil
(Granese) Department of Biomedical and Dental Sciences and
Morphofunctional Imaging, "G. Martino" University Hospital, Messina, Italy
Publisher
Adis
Abstract
Introduction: Congenital heart diseases (CHD) are the most common
congenital anomalies, and fetal cardiac interventions (FCI) have been
developed to improve perinatal outcomes. We aimed to conduct a systematic
review and meta-analysis of observational studies to evaluate the effects
of FCI on CHD. Method(s): We searched PubMed/Medline, Embase, and the
Cochrane Central Register of Controlled Trials from inception to April
2025 without language restrictions. References of included studies and
prior reviews were also screened. The protocol was registered in the
International Prospective Register of Systematic Reviews (PROSPERO; ID
CRD42024599628). Eligible studies included observational cohorts
evaluating intrauterine procedures for CHD. Data were synthesized using
random effects models in RStudio (version 4.2.2), and study quality was
assessed with the Newcastle-Ottawa Quality Assessment Form for Cohort
Studies (NOS). Result(s): Twelve studies including 485 fetuses with
CHD were analyzed. The pooled overall survival rate after fetal cardiac
intervention was 57.4% (95% confidence interval [CI] 39.8-73.3), with
survival ranging from 20.0% to 90.2% across studies. The pooled perinatal
mortality rate was 31.5% (95% CI 21.0-44.2), with estimates ranging from
9.8% to 66.7%. Substantial heterogeneity was observed for both outcomes
(I2 > 75%). Conclusion(s): FCI for CHD are associated with
moderate overall survival but substantial perinatal mortality.
Standardized protocols, refined patient selection, and multicenter
collaboration are needed to improve outcomes and guide clinical
decision-making. Copyright © The Author(s) 2025.

<53>
Accession Number
2041678427
Title
Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Valve
Replacement on Clinical Outcomes in Patients with Aortic Stenosis.
Source
Arquivos Brasileiros de Cardiologia. 122(10) (no pagination), 2025.
Article Number: e20240295. Date of Publication: 2025.
Author
Cordeiro A.L.L.; de Souza Goncalves E.; de Santana R.M.; dos Santos T.S.M.
Institution
(Cordeiro, de Souza Goncalves, de Santana, dos Santos) Centro
Universitario de Excelencia, BA, Feira de Santana, Brazil
(Cordeiro) Escola Bahiana de Medicina e Saude Publica, BA, Salvador,
Brazil
Publisher
Sociedade Brasileira de Cardiologia
Abstract
Aortic stenosis (AS) is one of the most prevalent valve lesions, and
transcatheter aortic valve replacement (TAVI) has emerged as an
alternative to surgical aortic valve replacement (SAVR). TAVI is a
minimally invasive procedure that has proven to be a safer option in
several aspects. The objective is to review the impact of TAVI compared to
surgical aortic valve replacement on mortality, postoperative
complications, hospitalization, and quality of life in patients with AS. A
systematic review was conducted using the PICO strategy, with searches in
the PubMed, Central, and LILACS databases, employing the following
descriptors: aortic stenosis, hospitalization, mortality, clinical trial,
transcatheter aortic valve implantation, quality of life, postoperative
complications, combined with the Boolean operators "AND" and "OR." A total
of 29 articles were found after reading the titles and abstracts. Of
these, nine showed lower mortality in patients undergoing TAVI, while
three reported lower mortality in the SAVR group. Eight articles had
similar findings regarding complications, with six showing a lower
incidence of postoperative complications in TAVI and three in SAVR.
Additionally, three articles showed better quality of life in TAVI
patients, while one study indicated a shorter hospital stay for TAVI
patients. In all studies, the patients analyzed were over 70 years old.
TAVI reduced mortality compared to SAVR in patients with AS. Furthermore,
TAVI was associated with a reduction in hospital stay and improvement in
quality of life. Regarding postoperative complications, the results
indicated that TAVI tends to have a lower complication rate, although
variations exist between studies. Copyright © 2025 Sociedade
Brasileira de Cardiologia. All rights reserved.

<54>
Accession Number
2041694759
Title
Transcatheter or Surgical Treatment of Patients With Aortic Stenosis at
Low to Intermediate Risk: An Individual Participant Data Meta-Analysis.
Source
JAMA Cardiology. 10(11) (pp 1175-1185), 2025. Date of Publication: 12 Nov
2025.
Author
Ludwig S.; Klimek M.; Bay B.; Blankenberg S.; Granada J.F.; Hildick-Smith
D.; Hudson J.; Jorgensen T.Ho.; Leon M.B.; Magnussen C.; Thiele H.;
Horsted Thyregod H.G.; Wendler O.; De Backer O.; Toff W.D.; Ziegler A.;
Seiffert M.
Institution
(Ludwig, Bay, Blankenberg, Magnussen, Ziegler) Department of Cardiology,
University Heart and Vascular Center Hamburg, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Ludwig, Bay, Blankenberg, Magnussen, Ziegler) Centre for Population
Health Innovation, University Heart and Vascular Center Hamburg,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Ludwig, Bay, Blankenberg, Magnussen, Thiele, Seiffert) German Centre for
Cardiovascular Research Partner Site North, Hamburg, Germany
(Ludwig, Granada, Leon) Cardiovascular Research Foundation, New York,
United States
(Klimek, Blankenberg, Ziegler) Cardio-CARE, Medizincampus Davos, Davos,
Switzerland
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals National Health Service Trust, Brighton, United Kingdom
(Hudson) Aberdeen Centre for Evaluation, University of Aberdeen, Aberdeen,
United Kingdom
(Jorgensen, Horsted Thyregod, De Backer) Rigshospitalet, Copenhagen,
Denmark
(Leon) NewYork-Presbyterian Hospital, Columbia University Irving Medical
Center, New York, United States
(Thiele) Department of Cardiology, Heart Center Leipzig at Leipzig
University, Leipzig Heart Science, Leipzig, Germany
(Wendler) Cleveland Clinic, London, United Kingdom
(Toff) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Toff) National Institute for Health Research Biomedical Research Centre,
Glenfield Hospital, Leicester, United Kingdom
(Ziegler) School of Mathematics, Statistics and Computer Science,
University of KwaZulu-Natal, Pietermaritzburg, South Africa
(Seiffert) Department of Cardiology and Angiology, BG University Hospital
Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
Publisher
American Medical Association
Abstract
Importance: Mounting evidence suggests transcatheter aortic valve
implantation (TAVI) as preferred treatment for patients at low to
intermediate surgical risk. However, limitations in study design and
statistical power raise concerns about the generalizability of individual
randomized clinical trials (RCTs) comparing TAVI and surgical aortic valve
replacement (SAVR) to routine clinical practice. Objective(s): To
compare 1-year outcomes of TAVI vs SAVR in patients with severe
symptomatic aortic stenosis at low to intermediate surgical risk applying
a 2-stage individual participant data (IPD) and aggregate meta-analyses.
 Data Sources: MEDLINE databases were searched for RCTs comparing TAVI
and SAVR in patients with aortic stenosis until June 15, 2025. Study
Selection: RCTs were selected comparing TAVI vs SAVR in patients with
severe symptomatic aortic stenosis at low or intermediate surgical risk
with 1-year follow-up. Data Extraction and Synthesis: IPD were obtained
from all investigator-initiated RCTs (DEDICATE, NOTION, NOTION-2, and UK
TAVI) and analyzed in 1- and 2-stage IPD meta-analyses. An overall
meta-analysis was performed by adding aggregate data from
industry-sponsored RCTs. Main Outcomes and Measures: The primary end
point was all-cause death or any stroke 1 year after randomization.
Secondary end points included all-cause death, any stroke, disabling
stroke, cardiovascular death, rehospitalization for cardiovascular cause,
myocardial infarction, new-onset atrial fibrillation, new permanent
pacemaker implantation, and aortic valve reintervention. Result(s):
The IPD meta-analysis included 4 RCTs comprising 2873 patients (mean [SD]
age, 76.7 [5.5] years; 805 [56.1%] male) at low to intermediate surgical
risk randomly assigned to TAVI (n = 1439) or SAVR (n = 1434). At 1 year,
the hazard ratio (HR) for the primary end point for TAVI compared to SAVR
was 0.73 (95% CI, 0.56-0.95) in the 1-stage and 0.79 (95% CI, 0.49-1.27)
in the 2-stage IPD meta-analysis. In the 2-stage overall meta-analysis the
HR for the primary end point was 0.76 (95% CI, 0.60-0.97).
 Conclusions and Relevance: In this IPD meta-analysis of 4 RCTs, and
an overall meta-analysis of 8 RCTs of patients with severe symptomatic AS
at low to intermediate risk, TAVI was associated with a reduction in the
1-year incidence of all-cause death or any stroke. These findings
emphasize TAVI as alternative option in patients at low to intermediate
risk. Long-term follow-up is warranted to evaluate sustainability of these
findings. Copyright © 2025 American Medical Association.

<55>
Accession Number
2041256699
Title
Restarting anticoagulation early versus late in patients with chronic
subdural hematoma and atrial fibrillation (RELACS): a phase III
international multicenter, randomized controlled, two-arm,
assessor-blinded trial.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 515. Date of
Publication: 01 Dec 2025.
Author
Raj R.; Tommiska P.; Kivisaari R.; Korja M.; Luostarinen T.; Virta J.J.;
Taimela S.; Jarvinen T.L.N.; Niemela M.; Koivisto T.; Leinonen V.;
Saemundsson B.; Fletcher-Sandersjoo A.; Korhonen T.; Tetri S.; Rauhala M.;
Laukka D.; Czuba T.; Bartek J.; Danner N.; Knuutinen O.; Luoto T.; Posti
J.P.; Satopaa J.
Institution
(Raj, Tommiska, Kivisaari, Korja, Niemela, Satopaa) Department of
Neurosurgery, University of Helsinki and Helsinki University Hospital,
Helsinki, Finland
(Luostarinen, Virta) Anesthesiology and Intensive Care, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
(Taimela, Jarvinen) Finnish Centre for Evidence-Based Orthopedics
(FICEBO), University of Helsinki and Helsinki University Hospital,
Helsinki, Finland
(Taimela, Jarvinen) Department of Orthopaedics and Traumatology,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Koivisto, Leinonen, Danner) Department of Neurosurgery, Kuopio University
Hospitaland, University of Eastern Finland, Kuopio, Finland
(Saemundsson, Fletcher-Sandersjoo, Bartek) Department of Clinical
Neuroscience, Karolinska Institutet, Stockholm, Sweden
(Saemundsson, Fletcher-Sandersjoo, Bartek) Department of Neurosurgery,
Karolinska University Hospital, Stockholm, Sweden
(Korhonen, Tetri, Knuutinen) University of Oulu and Medical Research
Center, Unit of Clinical Neuroscience, Neurosurgery, Oulu, Finland
(Rauhala, Luoto) Department of Neurosurgery, Tampere University Hospital
and Tampere University, Tampere, Finland
(Laukka, Posti) Department of Neurosurgery and Turku Brain Injury Center,
Turku University Hospital and University of Turku, Turku, Finland
(Posti) Division of Clinical Neurosciences, Neurosurgery, University of
Turku, Turku, Finland
(Czuba) Department of Molecular and Clinical Medicine/The Wallenberg
Laboratory, Institute of Medicine, Gothenburg University and the
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg,
Sweden
(Czuba) Department of Cardiology, Clinical Sciences, Lund University,
Lund, Sweden
Publisher
BioMed Central Ltd
Abstract
Background: Chronic subdural hematoma (CSDH) is a rapidly growing
neurosurgical condition, driven primarily by an aging population and the
increasing use of antithrombotic medications. Approximately 25% of CSDH
patients are on anticoagulants due to atrial fibrillation (AF). The
postoperative management of these patients presents a significant clinical
challenge, as clinicians must balance the risks of thromboembolic and
hemorrhagic complications. Currently, no evidence-based guidelines exist
regarding the optimal timing for resuming anticoagulation therapy after
surgery. This study aims to evaluate the net effect of early versus late
postoperative resumption of oral anticoagulation in CSDH patients with AF.
We hypothesize that early resumption will result in fewer thromboembolic
complications and vascular deaths, without increasing the risk of
hemorrhagic complications. Method(s): This is an
investigator-initiated, international, multicenter, superiority, two-arm,
assessor-blinded, phase 3 trial with 1:1 randomization, comparing early
resumption (defined as 5 days) and late resumption (defined as 30 days) of
oral anticoagulation medication after CSDH surgery in patients with AF.
The primary outcome is a composite outcome that combines thromboembolic
events, hemorrhagic events, and vascular death within 90 days of the
surgery. Secondary outcomes include reoperations, functional outcome, and
adverse events. The estimated sample size is 332 patients to achieve an
80% power and a two-sided alpha of 0.05 for the primary outcome, including
potential dropouts. Discussion(s): This is the first large-scale RCT
addressing the critical evidence gap in anticoagulation timing after CSDH
surgery. If early resumption proves superior, it could transform clinical
practice by reducing thromboembolic complications without increasing
hemorrhagic risk, potentially improving outcomes for the growing
population of CSDH patients with AF worldwide. Trial registration: The
study is registered on June 4, 2025. The EU Clinical Trials Register
(EUCTR) under identifier EUCT 2025-521179-29-00
(https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2025
-521179-29-00). Copyright © The Author(s) 2025.

<56>
Accession Number
2041206752
Title
Guanxinning tablets plus aspirin versus aspirin monotherapy to reduce
cardiovascular events after percutaneous coronary intervention: A
cluster-randomized controlled trial (GAP trial).
Source
Phytomedicine. 149 (no pagination), 2025. Article Number: 157500. Date of
Publication: 01 Dec 2025.
Author
Xu H.; Li J.; Zhao Y.; Chen Z.; Kantas D.; Zhang G.; Gao R.
Institution
(Xu, Chen) Cardiovascular Diseases Center, Xiyuan Hospital, China Academy
of Chinese Medical Sciences, National Clinical Research Center for Chinese
Medicine Cardiology, Beijing, China
(Li) Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing
University of Chinese Medicine, Beijing, China
(Li, Kantas) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Zhao, Zhang, Gao) Good Clinical Practice Center, Xiyuan Hospital, China
Academy of Chinese Medical Sciences, China
Publisher
Elsevier GmbH
Abstract
Background Prolonged dual antiplatelet therapy (DAPT) after percutaneous
coronary intervention (PCI) lowers thrombotic risk but increases bleeding,
creating a therapeutic dilemma. Guanxinning tablets (GXNT), a traditional
Chinese medicine with antithrombotic and cardioprotective effects, may
offer an alternative strategy. Purpose To evaluate whether GXNT combined
with aspirin reduces cardiovascular events without increasing bleeding in
patients transitioning from DAPT to aspirin monotherapy after PCI. Study
Design An open-label, cluster-randomized controlled trial conducted in 63
tertiary hospitals in China between March 2017 and December 2018. Methods
A total of 3586 patients with coronary heart disease (CHD) who had
completed at least 12 months of DAPT following PCI were enrolled.
Hospitals and participants were randomized in a 2:1 ratio to receive GXNT
plus aspirin or aspirin alone for 12 months, followed by 12 months of
additional follow-up. The primary endpoint was a composite of
cardiovascular death, non-fatal myocardial infarction, stent thrombosis,
revascularization, ischemic stroke, and rehospitalization for unstable
angina. Outcome assessors and data analysts were blinded to treatment
allocation. The intention-to-treat analysis principle was adopted, and ICC
were accounted for in the statistical analysis. Results Of the
participants, 2389 received GXNT plus aspirin and 1197 received aspirin
alone. After a median follow-up of 23 months, GXNT significantly reduced
the primary outcome (11.0 % vs. 13.2 %; adjusted hazard ratio [HR] 0.79,
95 % confidence interval [CI] 0.63-0.98). Rates of revascularization (3.8
% vs 4.7 %) and rehospitalization for unstable angina (7.0 % vs 9.7 %)
were also lower in the GXNT group. Major bleeding events were rare and
similar across groups. Conclusion GXNT combined with aspirin reduced
adverse cardiovascular events after PCI without increasing bleeding,
supporting its potential as an alternative to prolonged
DAPT. Copyright © 2025 The Authors.

<57>
Accession Number
2034981956
Title
Safety and efficacy of routine anticoagulation after primary PCI in STEMI:
a systematic review and meta-analysis.
Source
Journal of Thrombosis and Thrombolysis. 58(7) (pp 962-972), 2025. Date of
Publication: 01 Oct 2025.
Author
Chowdhury A.; Vasoya D.A.; Ima M.J.; Koppula S.R.; Das A.; Dhivakaran
K.K.; Khawar M.M.; Mishra A.; Safiullah M.; Siddique S.; Lee D.S.; Hamza
M.; Tandel H.; Chatterjee A.
Institution
(Chowdhury) Shaheed Suhrawardy Medical College and Hospital, Dhaka,
Bangladesh
(Vasoya) First affiliated hospital of Soochow University, Suzhou, China
(Ima) Uttara Adhunik Medical College, Dhaka, Bangladesh
(Koppula) Kakatiya medical college, Warangal, India
(Das) KPC Medical College and Hospital, Kolkata, Jadavpur, India
(Dhivakaran) Sri Muthukumaran Medical College Hospital and Research
Institute, Chennai, India
(Khawar, Safiullah) King Edward Medical University, KEMU Boys Hostel, Link
McLeod Road Patiala Ground, Lahore, Pakistan
(Mishra) University of Buckingham Medical School, Buckingham, United
Kingdom
(Siddique) Hamdard University of Medicine and Dentistry, Karachi, Pakistan
(Lee) Faculty of Medicine and Health Sciences, University of Barcelona,
Barcelona, Spain
(Hamza) United Medical & Dental College, Karachi, Pakistan
(Tandel) C U Shah Medical College, Surendranagar, India
(Chatterjee) All India Institute of Medical Sciences, Raipur, India
Publisher
Springer
Abstract
Percutaneous Coronary Intervention (PCI) is a widely used minimally
invasive procedure that restores blood flow to the coronary artery,
improving survival in STEMI patients. Despite its widespread application
in clinical settings, the necessity and efficacy of postprocedural
anticoagulation (PPAC) remain contentious. Our study aims to assess the
outcomes of PPAC in STEMI patients who have undergone PCI. A comprehensive
search of Embase, PubMed, and Clinicaltrials was conducted to identify
randomized controlled trials (RCTs) comparing the clinical outcomes
between PPAC and control (placebo or no PPAC) for STEMI after primary PCI.
Statistical analyses were performed using RevMan version 5.4.1, employing
a random-effects model to calculate odds ratios (ORs) and their 95%
confidence intervals (CIs). Risk of Bias Assessment of the articles was
assessed using RoB 2.0 software by the Cochrane Collaboration. A total of
5 RCTs comprising 13,586 patients were included, of which 6,829 patients
(50.26%) received PPAC. Compared to the non-PPAC group, PPAC did not
significantly reduce all-cause mortality (OR 1.08; 95% CI 0.84-1.39; P =
0.54, I2 = 0%), cardiovascular mortality (OR 1.08; 95% CI
0.83-1.39; P = 0.57, I2 = 0%), and MACE (major adverse
cardiovascular events) (OR 1.13; 95% CI 0.92-1.37; P = 0.25, I2
= 22%). Additionally, the odds of stent thrombosis (OR 1.07; 95% CI
0.77-1.47; P = 0.69, I2 = 0%) and stroke (OR 1.50; 95% CI
0.49-4.57; P = 0.48, I2 = 58%) did not differ significantly
between the groups. However, PPAC was associated with higher odds of
bleeding (OR 1.78; 95% CI 1.07-2.97; P = 0.03, I2 = 94%). This
meta-analysis reveals no significant differences in the odds of all-cause
mortality, cardiovascular mortality, stent thrombosis, and stroke between
PPAC and control following PCI for the management of STEMI. However, PPAC
was associated with higher odds of bleeding. Further randomized controlled
trials are warranted to corroborate these findings. Copyright ©
The Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature 2025.

<58>
[Use Link to view the full text]
Accession Number
648733696
Title
Development of a Three-dimensional Spacer Mattress for Pressure Relief in
Cardiac Surgery and Evaluation of Its Efficacy: A Feasibility Study.
Source
Advances in skin & wound care. 38(10) (pp 547-555), 2025. Date of
Publication: 01 Nov 2025.
Author
Isler Isildak Y.; Eti Aslan F.; Korkmaz E.; Comez L.; Toygar I.
Institution
(Isler Isildak) Bahcesehir University, Institute of Postgraduate
Education, Istanbul, Turkey
(Eti Aslan, Korkmaz) Nursing Department, Faculty of Health Sciences,
Bahcesehir University, Istanbul, Turkey
(Comez) Sancaktepe Sehit Prof Dr Ilhan Varank Teaching and Research
Hospital, Istanbul, Turkey
(Toygar) Gerontology Department, Faculty of Health Sciences, Mugla Sitki
Kocman University, Mugla, Turkey
Abstract
OBJECTIVE: To develop a three-dimensional (3D) spacer mattress for
pressure relief and to evaluate its effectiveness during cardiac surgery.
 METHOD(S): This study consisted of 3 phases: development, initial
assessment, and randomized controlled trial (ClinicalTrials.gov,
NCT06071039). Sixty patients underwent cardiac surgery divided into 2
groups, 30 patients each. The data were collected in a public hospital in
Istanbul Provincial Health Directorate Sancaktepe Sehit Prof Dr Ilhan
Varank Training and Research Hospital between February and September 2023.
A 3D spacer mattress was used for the intervention group, and a standard
operating theatre mattress (foam) was used for the control group.
Pressures on the sacrum, left heel, and right heel were measured
throughout surgery using a continuous pressure measurement system.
 RESULT(S): The mean pressure values were 49.73 +/- 17.40, 15.65 +/-
5.19, and 18.01 +/- 9.34 mm Hg for sacrum, left heel, and right heel,
respectively, in the control group, whereas the mean pressure values were
28.21 +/- 11.70, 5.88 +/- 1.88, and 6.56 +/- 2.81 mm Hg for the sacrum,
left heel, and right heel, respectively, in the intervention group. The
means of the maximum pressure values were 90.36 +/- 8.63, 62.51 +/- 13.77,
and 54.19 +/- 16.71 mm Hg for sacrum, left heel, and right heel,
respectively, in the control group, whereas the means of the maximum
pressure values were 49.31 +/- 12.61, 28.82 +/- 13.56, and 31.17 +/- 16.65
mm Hg for the sacrum, left heel, and right heel, respectively, in the
intervention group. There were statistically significant differences
between the groups for mean and maximum pressure on the sacrum, left heel,
and right heel ( P < .05). CONCLUSION(S): The use of a 3D spacer
mattress is an effective method to relieve pressure during cardiac
surgery. Copyright © 2025 Wolters Kluwer Health, Inc. All rights
reserved.

<59>
Accession Number
649342855
Title
From hormone blockade to cardiac blockage: The risk of myocardial
infarction on abiraterone acetate.
Source
Asia-Pacific Journal of Clinical Oncology. Conference: Australian and New
Zealand Urogenital and Prostate Cancer Trials Group Annual Scientific
Meeting, ANZUP 2025. Sydney, NSW Australia. 21(Supplement 2) (pp 79),
2025. Date of Publication: 01 Jul 2025.
Author
Elias J.M.
Institution
(Elias) University Malaya Medical Centre, Malaysia
Publisher
John Wiley and Sons Inc
Abstract
Introduction Abiraterone acetate (AAP), an androgen biosynthesis
inhibitor, has shown survival benefits in high-risk prostate cancer when
added to androgen deprivation therapy (ADT), as demonstrated in the
STAMPEDE trial. However, both ADT and AAP are associated with
cardiovascular toxicities, particularly in patients with underlying
comorbidities. We report a case of significant coronary artery disease in
a patient treated with AAP and ADT for high-risk prostate cancer. Case
summary A 68-year-old man with a history of hypertension, diabetes
mellitus, and dyslipidaemia was found to have a raised prostate-specific
antigen (PSA) of 13 ng/mL. Magnetic resonance imaging revealed bilateral
PIRADS 5 lesions with seminal vesicle involvement. Biopsy confirmed
Gleason 4+3 prostate adenocarcinoma. He was staged as non-metastatic based
on computed tomography and bone scan. Multidisciplinary consensus
recommended curative-intent treatment with ADT, radiotherapy to the
prostate (60 Gy in 20 fractions), and AAP for two years. Results ADT
commenced in December 2022, followed by AAP in January 2023 and
radiotherapy in June 2023. PSA declined to undetectable levels by May
2023. In September 2024, he developed reduced effort tolerance and was
diagnosed with unstable angina. Coronary angiography revealed
triple-vessel disease, requiring coronary artery bypass grafting in
January 2025. AAP and ADT were discontinued in October 2024 after 22
months. PSA remained undetectable as of March 2025. Discussion &
Conclusion Both ADT and AAP are associated with increased cardiovascular
risk. Meta-analyses show AAP increases the risk of high-grade cardiac
events by 84% and nearly doubles the risk of hypertension. ADT
independently increases myocardial infarction risk by up to 31%. This case
underscores the importance of baseline cardiovascular risk stratification
and proactive monitoring during treatment with combined hormonal and
intensification strategies.

<60>
Accession Number
649349079
Title
Risk factors for postoperative acute kidney injury in major non-cardiac
surgery: Systematic review with meta-analysis.
Source
Journal of perioperative practice. (pp 17504589251390407), 2025. Date of
Publication: 27 Nov 2025.
Author
Castro-Crisostomo D.; Caballero-Alvarado J.; Vasquez-Paredes G.;
Rodriguez-Angulo A.; Sarmiento-Falen J.; Zavaleta-Corvera C.
Institution
(Castro-Crisostomo, Caballero-Alvarado, Vasquez-Paredes, Rodriguez-Angulo,
Sarmiento-Falen) Faculty of Medicine, Antenor Orrego Private University,
Trujillo, Peru
(Caballero-Alvarado) Department of Surgery, Regional Hospital of Trujillo,
Trujillo, Peru
(Zavaleta-Corvera) Faculty of Medicine, Universidad Cientifica del Sur,
Lima, Peru
Abstract
INTRODUCTION: Identifying risk factors for acute kidney injury (AKI)
following major non-cardiac surgery is challenging due to heterogeneous
findings and variable relevance across published studies. This complexity
hinders the development of a standardised prognostic model.
 METHOD(S): A systematic review and meta-analysis were conducted based
on an extensive literature search (2002-2022) in PubMed, Scopus, Web of
Science, Cochrane Central, LILACS, and Dart Europe. Studies were
independently screened and selected, with extraction of relevant
preoperative and intraoperative variables. Meta-analysis was performed
using RevMan 5.4. RESULT(S): Out of 533 studies, ten met inclusion
criteria. Significant risk factors for postoperative AKI included diabetes
mellitus (OR: 1.65, CI: 1.20-2.27), hypertension (OR: 1.86, CI:
1.36-2.54), ACE inhibitors or ARBs use (OR: 1.76, CI: 1.48-2.09),
ischaemic heart disease (OR: 1.93, CI: 1.55-2.41), and male sex (OR: 1.28,
CI: 1.07-1.53). Protective factors were female sex (OR: 0.72, CI:
0.54-0.96) and higher preoperative haemoglobin (MD: -0.41, CI: -0.52 to
-0.30). Trends without statistical significance were noted for older age,
low glomerular filtration rate, prolonged operative time, and higher serum
creatinine. CONCLUSION(S): Comorbidities and certain pharmacological
treatments significantly elevate postoperative AKI risk. These findings
underscore the need for vigilant preoperative risk stratification.PROSPERO
registration:CRD420251111455.

<61>
Accession Number
2041416961
Title
Evaluating the comparative efficacy of leg cycle ergometry exercise versus
conventional physiotherapy on scar healing, muscle strength, functional
capacity, and quality of life in coronary artery bypass graft subjects
with saphenous vein graft in phase 1: a protocol for randomised controlled
trial.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 545. Date of
Publication: 01 Dec 2025.
Author
Vinerkar D.; Vardhan V.
Institution
(Vinerkar, Vardhan) Department of Cardiovascular and Respiratory
physiotherapy, Ravi Nair physiotherapy college, Datta Meghe Institute of
Higher Education and Research, Sawangi (Meghe), 442001, Wardha, India
Publisher
BioMed Central Ltd
Abstract
Background: Coronary artery bypass grafting (CABG) is a common surgical
treatment for coronary artery disease. The saphenous vein's advantageous
anatomical features make it a popular choice for graft vessels. However,
saphenous vein harvesting often results in lower limb complications such
as edema, poor scar healing, pain, and reduced functional mobility. These
issues can delay recovery and diminish quality of life. Early
rehabilitation using leg cycle ergometry may improve outcomes, but
comparative evidence with conventional physiotherapy in Phase I post-CABG
care is limited. Aim(s): To determine the relative benefits of leg
cycle ergometry training for CABG patients with saphenous vein graft in
phase 1 in terms of scar healing, muscle strength, functional ability, and
quality of life. Objective(s): To evaluate the comparative efficacy
of leg cycle ergometry exercise versus conventional physiotherapy on scar
healing, muscle strength, functional capacity, and quality of life in CABG
subjects with saphenous vein grafts during Phase I rehabilitation.
 Method(s): A randomized controlled trial will be conducted at Shalini
Tai Meghe Super Speciality Centre with 70 CABG patients aged 45-65 years.
Participants will be randomly allocated to Group A (conventional
physiotherapy) and Group B (leg cycle ergometry with physiotherapy) for a
10-day intervention. Outcome measures include the Vancouver Scar Scale,
Manual Muscle Testing, 6-Minute Walk Test, and Patient Health
Questionnaire-9 (PHQ-9). Data will be analysed using the Mann-Whitney U
test and the Wilcoxon signed-rank test; p<0.05 was deemed statistically
significant. Result(s): As this is a study protocol, no results are
available yet. It is hypothesized that leg cycle ergometry, when added to
conventional physiotherapy, will lead to greater improvements in scar
healing, lower limb strength, functional capacity, and short-term quality
of life during Phase I cardiac rehabilitation following CABG surgery.
Trial registration: Clinical Trial Registry-India (CTRI/2025/03/084291).
Registered on 15 April 2025. Copyright © The Author(s) 2025.

<62>
Accession Number
649342917
Title
The Mitral Valve and The Lungs.
Source
Chest. (no pagination), 2025. Date of Publication: 24 Nov 2025.
Author
Pradhan N.M.; Wessler B.S.; Hill N.; Kurz S.
Institution
(Pradhan, Hill) Division of Pulmonary, Critical Care and Sleep Medicine,
Tufts Medical Center, Boston, United States
(Wessler) Division of Cardiology, Tufts Medical Center, Boston, United
States
(Kurz) Division of Pulmonary, Critical Care and Sleep Medicine, Yale, New
Haven
Abstract
TOPIC IMPORTANCE: Mitral valve disease has a significant impact on the
respiratory system. Present-day pulmonologists must be aware of its myriad
presentations and evolving treatment landscape. REVIEW FINDINGS: Mitral
valve disease can lead to a variety of manifestations in the respiratory
system. Elevated pressures in the pulmonary venous system can lead to
pulmonary hypertension, hemoptysis, pulmonary edema and parenchymal
changes. Clinical presentations range from asymmetric pulmonary edema
mimicking pneumonia to massive pulmonary hemorrhage. The management of
mitral valve disease has changed considerably over the last decade and
warrants review. SUMMARY: This review provides an update on the manifold
presentations and current therapeutic options. Copyright © 2025.
Published by Elsevier Inc.

<63>
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.

<64>
Accession Number
2037380730
Title
A Comprehensive Review of Acute Type A Aortic Dissection: Epidemiology,
Classification, Management Strategies, Mortality Risk Assessment, and
Ethical Considerations for Patients who Refuse Blood Transfusions.
Source
Reviews in Cardiovascular Medicine. 26(10) (no pagination), 2025. Article
Number: 44307. Date of Publication: 01 Oct 2025.
Author
Belyaev A.M.
Institution
(Belyaev) Cardiothoracic Surgical Unit, Auckland City Hospital, 2 Park
Road, Grafton, Auckland, New Zealand
Publisher
IMR Press Limited
Abstract
Acute type A aortic dissection (ATAAD) is a life-threatening
cardiovascular surgical emergency with a mortality of 20-25%. This review
offers an overview of current research on the morphology, taxonomy,
epidemiology, and anesthetic, perfusion, and surgical strategies involved
in ATAAD. Moreover, this review examines methods for predicting mortality
risk and explores clinician-patient interactions, particularly those
involving patients who refuse blood transfusions. The literature search
included PubMed, Google Scholar, Web of Science, and ScienceDirect
databases, as well as any relevant books. This review references 144
sources: 129 peer-reviewed articles and 15 book chapters or books. Modern
classification systems utilize aortic zones based on the location of
intimal tears and the extent of dissection; recent updates have included
coronary artery dissection as an additional mapping criterion.
Socioeconomic factors are linked to higher ATAAD incidence and poorer
long-term survival post-surgery. The duration of global myocardial
ischemia correlates with mortality and is a key element in the surgical
strategy. Compared to deep hypothermic circulatory arrest (HCA), moderate
HCA with cerebral perfusion provides benefits such as reduced bleeding and
improved survival. Standard prediction models may not accurately assess
risks in patients with life-threatening anemia who refuse blood
transfusion. Therefore, incorporating Auckland and Hamilton anemia
mortality risk scores alongside conventional tools can improve prognostic
accuracy and support personalized management. An interpretive-deliberative
model balances patient preferences with surgical outcomes, especially in
bloodless surgery. Advances in surgical and endovascular management, as
well as postoperative strategies for residual aortic disease, have also
been explored. Significant progress has been made in assessing in-hospital
mortality, improving doctor-patient communication, refining anesthetic and
perfusion techniques, and enhancing surgical management of ATAAD. However,
further research is needed to validate these approaches. Copyright
© 2025 The Author(s). Published by IMR Press.

<65>
Accession Number
649347813
Title
Clinical outcomes of transcatheter pulmonary valve replacement versus
surgical pulmonary valve replacement: A meta-analysis.
Source
Cardiovascular revascularization medicine : including molecular
interventions. (no pagination), 2025. Date of Publication: 14 Nov 2025.
Author
Ahmed H.; Ismayl M.; El-Shaer A.; Aboeata A.; Goldsweig A.M.
Institution
(Ahmed, El-Shaer) Department of Medicine, Division of Internal Medicine,
Creighton University School of Medicine, Omaha, NE, United States
(Ismayl) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Aboeata) Department of Medicine, Division of Cardiovascular Disease,
Creighton University School of Medicine, Omaha, NE, United States
(Goldsweig) Department of Cardiovascular Medicine, Baystate Medical
Center, Springfield, MA, United States

<66>
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.

<67>
Accession Number
649344530
Title
Impact of Intoxicated Donors on Recipient Survival in Cardiac
Transplantation: A Systematic Review and Meta-Analysis.
Source
Clinical transplantation. 39(12) (pp e70404), 2025. Date of Publication:
01 Dec 2025.
Author
Souza L.B.; Ximenes G.F.; Filho G.F.B.; Marinho J.D.S.F.; Alencar L.F.T.;
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, Fortaleza,
Ceara, Brazil
(Vieira) Universidade Federal do Ceara, Fortaleza, Ceara, Brazil
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.

<68>
Accession Number
649347842
Title
Cerebral embolic protection devices in transcatheter aortic valve
implantation: a systematic review and meta-analysis of randomized
controlled trials.
Source
Expert review of medical devices. (no pagination), 2025. Date of
Publication: 27 Nov 2025.
Author
Waseem M.H.; Ul Abideen Z.; Cheema A.H.; Osama M.; Javed Khan H.; Farid
R.; Rehman N.; Aimen S.; Thada P.K.
Institution
(Waseem) Allama Iqbal Medical College, Lahore, Pakistan
(Ul Abideen, Javed Khan) King Edward Medical University, Lahore, Pakistan
(Cheema) UT Southwestern Medical Center, Dallas, TX, United States
(Osama) Hayatabad Medical Complex Peshawar, Pakistan
(Farid) Jinnah Sindh Medical University, Pakistan
(Rehman) Dow University of Health Sciences, Karachi, Pakistan
(Aimen) Quetta Institute of Medical Sciences, Quetta, Pakistan
(Thada) Sotang Primary Hospital, Nepal
Abstract
BACKGROUND: This meta-analysis aimed to assess the efficacy and safety of
cerebral embolic protection devices (CEPDs) in patients undergoing
transcatheter aortic valve implantation (TAVI). METHOD(S): PubMed,
Cochrane Central, and ScienceDirect were searched till April 2025. Risk
ratios (RRs) with 95% confidence intervals (CIs) were pooled under a
random-effects model using Review Manager. The Cochrane risk of bias (RoB
2.0) tool was used for quality assessment. Funnel plots were assessed for
publication bias. RESULT(S): Eight randomized controlled trials,
including 11,632 patients undergoing TAVR, were analyzed. Use of CEPDs
showed a non-significant reduction in all strokes (RR 0.92, 95% CI:
0.74-1.15, p = 0.48) and disabling stroke (RR 0.80, 95% CI: 0.57-1.12, p =
0.18). There was no significant difference in all-cause mortality (RR
1.09, 95% CI: 0.71-1.67, p = 0.70), AKI (RR 0.96, 95% CI: 0.44-2.11, p =
0.93), disabling bleeding (RR 0.96, 95% CI: 0.28-3.31; p = 0.94) and major
vascular complications (RR 1.25, 95% CI: 0.56-2.78, p = 0.59).
 CONCLUSION(S): CEPD did not significantly reduce the incidence of
ischemic lesions or neurocognitive decline. Current evidence does not
support a statistically significant clinical benefit of CEPD use during
TAVI. While trends suggest a potential reduction in stroke, larger trials
are needed to establish the significance of these results.

<69>
[Use Link to view the full text]
Accession Number
649345158
Title
Comparative Outcomes of Balloon-Expandable and Self-Expandable Valves in
Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis: A
Systematic Review and Meta-Analysis.
Source
Cardiology in review. (no pagination), 2025. Date of Publication: 09 Oct
2025.
Author
Bacha Z.; Rath S.; Qadri M.; Alam U.; Ali M.A.; Ahmad O.; Sajjad F.; Khan
K.; Noor H.; Javed J.; Henna F.; Tariq M.D.; Ghanim Al-Badri S.; Ahmed R.;
Ahmad H.; Fakhar M.; Mattumpuram J.
Institution
(Bacha, Alam, Ali, Ahmad, Sajjad, Khan, Noor) From the Department of
Medicine, Khyber Medical College, Peshawar, Pakistan
(Rath) Department of Medicine, All India Institute of Medical Sciences,
Bhubaneswar, Odisha, India
(Qadri, Javed) Department of Medicine, Jinnah Sindh Medical University,
Karachi, Pakistan
(Henna) Department of Medicine, Dubai Medical College for Girls, Dubai,
United Arab Emirates
(Tariq, Fakhar) Department of Medicine, Mary Washington Healthcare,
Fredericksburg, VA, United States
(Ghanim Al-Badri) Department of Medicine, College of Medicine, University
of Warith Al-Anbiyaa, Karbala, Iraq
(Ahmed, Ahmad) Department of Cardiology, National Heart and Lung
Institute, Imperial College London, London, United Kingdom
(Mattumpuram) Department of Cardiology, University of Louisville School of
Medicine, Louisville, KY, United States
Abstract
The comparative efficacy and safety of balloon-expandable valves (BEVs)
and self-expandable valves (SEVs) in transcatheter aortic valve
replacement for bicuspid aortic stenosis remain a topic of debate. This
systematic review and meta-analysis aim to synthesize available evidence
to guide clinical decision-making. A systematic search of PubMed, Embase,
and Web of Science was conducted. Risk ratios (RRs) and mean differences
were pooled using a random-effects model. Thirteen studies comprising 2174
patients were included. BEVs were associated with a significantly higher
risk of annulus rupture (RR = 3.00, 95% CI, 1.13-7.94, P = 0.03), while
procedural and 30-day mortality rates were comparable between BEVs and
SEVs. The need for new pacemaker implantation at 30 days was significantly
lower in the BEV group (RR = 0.64, 95% CI, 0.49-0.83, P = 0.0009).
Postdilation was reduced considerably with BEVs following sensitivity
analysis (RR = 0.35, 95% CI, 0.24-0.52, P < 0.0001). In summary, both BEVs
and SEVs demonstrated acceptable safety profiles, with BEVs carrying a
higher risk of annular rupture but potential advantages in device success
and postdilation rates. Large-scale randomized trials remain essential to
refine patient selection and procedural strategies. Copyright ©
2025 Wolters Kluwer Health, Inc. All rights reserved.

<70>
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Accession Number
649342563
Title
Long-Term Outcomes of Synchronous Versus Staged Carotid Endarterectomy and
Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis.
Source
Cardiology in review. (no pagination), 2025. Date of Publication: 20 Nov
2025.
Author
Moawad M.H.E.D.; Alkhawaldeh I.M.; Karawya M.; Abushanap M.M.; Abualnadi
M.; Alkabi A.; Alhamouz L.H.A.; Alkhalili H.B.A.; Zaki M.S.A.; Alattar A.;
Serag I.; Abdul-Hafez H.A.; Gadelmawla A.F.; Abouzid M.; Bisht O.
Institution
(Moawad, Karawya) From the Alexandria Main University Hospital,
Alexandria, Egypt
(Moawad) Faculty of Medicine, Suez Canal University, Ismailia, Egypt
(Alkhawaldeh, Alkabi, Alhamouz) Faculty of Medicine, Mutah University,
Jordan
(Abushanap, Abualnadi) Faculty of Medicine, Hashemite University, Zarqa,
Jordan
(Alkhalili) Prince Hamza Hospital, Hashemite University, Zarqa, Jordan
(Zaki) Department of Anatomy, College of Medicine, King Khalid University,
Abha, Saudi Arabia
(Alattar) King Abdullah Medical City, Makkah, Saudi Arabia
(Serag) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Abdul-Hafez) Department of Medicine, An-Najah National University,
Nablus, West Bank, Palestine
(Gadelmawla) Faculty of Medicine, Menoufia University, Egypt
(Gadelmawla) Medical Research Group of Egypt (MRGE), Arlington, MA, United
States
(Abouzid) Department of Physical Pharmacy and Pharmacokinetics, Faculty of
Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
(Bisht) Coswig (Anhalt)Germany
Abstract
The management of patients with concomitant coronary artery disease and
carotid artery stenosis undergoing coronary artery bypass grafting (CABG)
remains controversial. While synchronous carotid endarterectomy (CEA) with
CABG may reduce perioperative stroke, its long-term benefit compared with
staged procedures is unclear. This study systematically reviewed and
meta-analyzed long-term outcomes of synchronous versus staged CEA with
CABG. Following Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines, was searched up to July 2025. Eligible studies
included randomized controlled trials and cohort studies reporting
long-term outcomes after synchronous or staged CEA/CABG. Pooled risk ratio
(RR) with 95% confidence intervals (CIs) was calculated using a
random-effects model. Twenty-five studies, including 35,781 patients, were
analyzed, of whom 6828 underwent synchronous and 28,953 staged procedures.
Long-term mortality was significantly lower with staged surgery (RR: 1.26,
95% CI: 1.15-1.37, P < 0.00001, I2 = 0%). No significant differences were
observed between synchronous and staged approaches for stroke (RR: 1.16,
95% CI: 0.75-1.77), myocardial infarction (MI) (RR: 0.83, 95% CI:
0.54-1.28), or major adverse cardiovascular events (MACE) (RR: 0.99, 95%
CI: 0.85-1.16). Among patients undergoing synchronous CEA/CABG, pooled
long-term incidences were 14.6% for mortality, 6.2% for stroke, 5.0% for
MI, and 17.5% for MACE. Long-term stroke, MI, and MACE rates are broadly
comparable between synchronous and staged CEA with CABG. However, staged
procedures appear to provide a survival advantage, with significantly
reduced long-term mortality. Further multicenter randomized trials are
warranted to confirm these findings and optimize patient
selection. Copyright © 2025 Wolters Kluwer Health, Inc. All
rights reserved.

<71>
Accession Number
649345928
Title
Pregnancy Outcomes in Heart Transplant Recipients: A Systematic Review and
Meta-Analysis of Maternal and Neonatal Morbidities.
Source
American journal of obstetrics and gynecology. (no pagination), 2025.
Date of Publication: 24 Nov 2025.
Author
Albino Dos Santos Silva R.R.; Batista P.G.; Ribera Chagas C.V.; de
Medeiros Fernandes M.; Giorgi J.M.
Institution
(Albino Dos Santos Silva, Ribera Chagas) Universidade Federal do Ceara,
Fortaleza, Ceara, Brazil
(Batista) Universidade Federal da Paraiba, Joao Pessoa, Paraiba, Brazil
(de Medeiros Fernandes) Universidade Estadual Rio Grande do Norte,
Mossoro, Rio Grande do Norte, Brazil
(Giorgi) Hospital Sirio-Libanes, Sao Paulo, Brazil
Abstract
BACKGROUND: Advances in heart transplant (HT) have increased the number of
reproductive-aged women with grafts considering pregnancy. However, this
remains a high-risk scenario due to the potential for adverse outcomes.
Current literature on comprehensive pregnancy outcomes and long-term graft
implications remains limited OBJECTIVE: To evaluate maternal and neonatal
outcomes of pregnancies in heart transplant recipients. DATA SOURCES: We
searched PubMed, EMBASE, the Cochrane Library, and Web of Science from
their inception to May 2025, and reviewed the reference lists. STUDY
ELIGIBILITY CRITERIA: We included observational cohort studies that
reported maternal and fetal pregnancy outcomes in women with prior heart
transplantation. STUDY APPRAISAL AND SYNTHESIS METHODS: Statistical
analysis was performed using the R software; the pooled proportion was
estimated using random-effects models (DerSimonian-Laird method). Quality
assessment was conducted using a modified version of the Newcastle-Ottawa
scale. RESULT(S): Preeclampsia occurred in 19.32% (95% CI:
14.14-25.82; I2 = 0%). and was associated with increased maternal
mortality 19.70% (95% CI: 14.80-25.75; I2 = 0%). Preterm birth 41.36% (95%
CI: 34.03-49.09; I2 = 0%) and lower birth weights (37.58%, 95% CI:
30.18-45.62; I2 = 0.0%) were expressed. Low rates of graft loss during
pregnancy were observed in 5.56% (95% CI: 3.10-9.75; I2 = 0%). Cesareans
were performed in 43.35% (95% CI:36.70-50.25; I2 = 2.2%), of patients, and
the data of unplanned pregnancy reached 59.45% (95% CI: 38.53-77.43; I2=
79%) CONCLUSION(S): Pregnancy after HT is feasible but high-risk,
with elevated rates of maternal morbidity, preterm birth and neonatal
complications. Preeclampsia significantly worsens neonatal outcomes but
does not impair short-term graft survival. Multidisciplinary care,
individualized immunosuppressive management, and rigorous preconception
counseling are crucial for optimizing outcomes. These findings inform
clinical decision-making and reproductive planning for HT
women. Copyright © 2025 Elsevier Inc. All rights reserved.

<72>
Accession Number
649342856
Title
THE INFLUENCE OF PATIENT-CENTERED NURSING MANAGEMENT MODEL ON THE
PSYCHOLOGICAL STATE OF INPATIENTS IN THORACIC AND CARDIOVASCULAR SURGERY.
Source
Schizophrenia Bulletin. Conference: 3rd International Conference on Mental
Health and Behavioral Medicine, MHBM 2025. Kuala Lumpur Malaysia.
51(Supplement 4) (pp S350), 2025. Date of Publication: 01 Dec 2025.
Author
Chen L.; Yang J.
Institution
(Chen) Thoracic and Cardiovascular Surgery, Feicheng People's Hospital,
Taian, Shandong, China
(Yang) ENT Department, Feicheng People's Hospital, Shandong, Taian, China
Publisher
Oxford University Press
Abstract
Objective: To explore the impact of a patient-centered nursing management
model on the psychological state of inpatients in the thoracic and
cardiovascular surgery. Method(s): Seventy patients who underwent
thoracic and cardiovascular surgeries in our hospital from December 2023
to June 2025 were selected. They were randomly and double-blindly divided
into the observation group and the control group, with 35 cases in each
group. Both groups of patients were given conventional drug treatment. The
control group received routine care, while the observation group received
patient-centered nursingmanagement model on the basis of the control
group. The Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale
(HAMD) were used to compare the psychological states (anxiety and
depression) of the two groups before and after the nursing intervention.
The nursing satisfaction levels were also compared between the two groups.
 Result(s): The comparison of HAMA and HAMD scores between the two
groups before nursing showed no statistically significant difference
(p>.05). The HAMA and HAMDscores of the two groups after nursing were
lower than before nursing, and the HAMA and HAMD scores of the observation
group after nursing were lower than those of the control group (p<.05).
The satisfaction score of the observation group patients with nursing
services was significantly higher than that of the control group (p<.05).
 Conclusion(s): patient-centered psychological care can alleviate the
adverse psychological state of hospitalized patients in thoracic and
cardiovascular surgery, ultimately improving their quality of life.

<73>
Accession Number
2041977675
Title
Temporal Trends in Device-related Thrombosis Following Left Atrial
Appendage Occlusion: A Systematic Review and Meta-Analysis.
Source
Radiology: Cardiothoracic Imaging. 7(5) (no pagination), 2025. Article
Number: e240361. Date of Publication: 01 Oct 2025.
Author
Rajabi T.; Li W.; Nabipoorashrafi S.A.; Chalian H.
Institution
(Rajabi, Li) University of Rochester School of Medicine and Dentistry,
Rochester, NY, United States
(Nabipoorashrafi, Chalian) Department of Radiology, University of
Washington, 1959 NE Pacific St Rm RR215F, Box 357115, Seattle, WA, United
States
Publisher
Radiological Society of North America Inc.
Abstract
Purpose: To perform a systematic review and meta-analysis to evaluate
longitudinal trends in the incidence of device-related thrombosis (DRT)
following left atrial appendage occlusion (LAAO), with the aim of
informing future postprocedural surveillance schedules. Material(s)
and Method(s): PubMed, Embase, and Cochrane Library databases were
retrospectively searched up to May 2023 for clinical trials and
observational studies with at least 20 adults who underwent LAAO and had a
DRT detected with CT or transesophageal echocardiography. DRT events were
stratified by time since procedure, and cumulative incidence rates were
calculated using random-effects and mixed-effects models. Quality
assessments were completed using the Risk Of Bias In Non-randomized
Studies-of Interventions (ROBINS-I) and Strengthening the Reporting of
Observational Studies in Epidemiology (STROBE) guidelines. Result(s):
A review of 2181 records resulted in the inclusion of 96 articles,
encompassing 18 024 patients (mean ages ranged from 63.5 years +/- 7.3
[SD] to 92.9 years +/- 2.8; 61.7% male [11 121 of 18 024]). The total DRT
incidence was 2.65% (478 of 18 024; range, 0%-17.5%). The mean cumulative
DRT incidence rates using the random-effects model were 0.83% (n = 996;
95% CI: 0.23, 2.98; I2 = 0.0%) at 30 days, 1.24% (n = 10 909;
95% CI: 0.90, 1.70; I2 = 37.3%) at 45 days, 2.14% (n = 4559;
95% CI: 1.41, 3.25; I2 = 36.9%) at 90 days, 2.06% (n = 8088;
95% CI: 1.45, 2.92; I2 = 62.5%) at 180 days, and 2.9% (n =
7346; 95% CI: 2.07, 4.06; I2 = 70.6%) beyond 180 days. Similar
results were achieved with the mixed-effects model. Conclusion(s):
DRT incidence changed over time following LAAO. The greatest rise in the
incidence occurred during the first 90 days after the procedure, although
the cumulative rates continued to increase beyond 180 days. Copyright
© RSNA, 2025.

<74>
Accession Number
2041962859
Title
Combining topical and intravenous tranexamic acid in cardiac surgery: does
it really matter? - a systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 62 (no pagination), 2026. Article Number:
101848. Date of Publication: 01 Feb 2026.
Author
Onyeji P.C.; Consoli L.; Kaur A.; Dani S.; Momplaisir-Onyeji S.; Passos
F.S.; Kirov H.; Doenst T.; Caldonazo T.
Institution
(Onyeji) All Saints University School of Medicine, Roseau, Dominica
(Consoli) Faculty of Medicine, Federal University of Bahia, Salvador,
Brazil
(Kaur) The University of Chicago, Chicago, IL, United States
(Dani) GMERS Medical College and Hospital, Sola, Ahmedabad, India
(Momplaisir-Onyeji) American University of Barbados, Wildey, Barbados
(Passos) Department of Thoracic Surgery, MaterDei Hospital, Salvador,
Brazil
(Kirov, Doenst, Caldonazo) Department of Cardiothoracic Surgery, Jena
University Hospital, Jena, Germany
(Caldonazo) Department of Cardiothoracic Surgery, Weil Cornell Medicine,
NY, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The benefit-to-risk ratio of administration of intravenous
(IV) and topical tranexamic acid (TXA) together in cardiac surgery has not
yet been determined. This study aims to evaluate whether the combined
approach (IV plus topical TXA) offers superior bleeding control compared
to IV TXA alone, while maintaining an acceptable safety profile.
 Method(s): We conducted a systematic review and meta-analysis of
randomized controlled trials (RCTs) and observational studies comparing
combined topical and intravenous TXA administration versus IV TXA alone in
patients undergoing cardiac surgery. The primary outcome was cumulative
blood loss. Secondary outcomes included all-cause mortality,
transfusion-free status, and the number of transfused blood products. A
random-effects model was used for all pooled analyses. Result(s): We
included a total of five studies (four RCTs, one observational; n = 880).
Pooled analysis showed that the combined approach significantly, but
modest, reduced total blood loss when compared to an IV-only TXA strategy
(MD -39.84, 95 %CI -74.80 to -4.88; p = 0.03; I2 = 39 %).
However, this benefit did not translate into a significant reduction in
transfusion requirements (OR 1.00, 95 %CI 0.72 to 1.37; p = 0.98;
I2 = 0 %), volume of blood products used (MD -0.01, 95 %CI
-0.04 to 0.02; p = 0.51; I2 = 0 %), or all-cause mortality (OR
0.85, 95 %CI 0.24 to 3.08; p = 0.81; I2 = 0 %).
 Conclusion(s): Combined topical and IV TXA application is associated
with reduced total blood loss after cardiac surgery compared to an IV-only
approach. However, no significant differences were observed in transfusion
rates, blood product utilization, or mortality. Copyright © 2025
The Author(s)

<75>
Accession Number
649344090
Title
Cardiac rehabilitation for elderly patients undergoing coronary artery
bypass grafting: a systematic review and Meta-Analysis.
Source
BMC surgery. 25(1) (pp 574), 2025. Date of Publication: 26 Nov 2025.
Author
Huang J.; Liu C.; Xie J.; Han J.
Institution
(Huang, Xie, Han) Department of Cardiovascular and Vascular Surgery, First
Affiliated Hospital with Nanjing Medical University, No. 300 Guangzhou
Road, Nanjing, China
(Liu) Department of Cardiovascular and Vascular Surgery, First Affiliated
Hospital with Nanjing Medical University, No. 300 Guangzhou Road, Nanjing,
China
Abstract
BACKGROUND: Cardiac rehabilitation (CR) has been shown to improve outcomes
in patients undergoing coronary artery bypass grafting (CABG); however,
its specific effects on elderly CABG patients remain unclear. This
meta-analysis aims to evaluate the benefits of CR for elderly patients
undergoing CABG. METHOD(S): A comprehensive search was conducted
across PubMed, Embase, the Cochrane Library, the Cumulative Index to
Nursing and Allied Health Literature, China National Knowledge
Infrastructure, and Wanfang Data databases for prospective studies on CR
interventions in elderly CABG patients, from study inception through
February 19, 2025. Two independent researchers screened articles that met
the inclusion criteria. Key outcomes included all-cause mortality,
cardiovascular mortality, all-cause hospitalization, health-related
quality of life (HRQoL), and functional capacity. Meta-analysis was
performed using Review Manager 5.3 software. RESULT(S): Six studies
involving 621 patients were included. Interventions lasted between 6 and
12 weeks, with follow-up durations ranging from 6 weeks to 6 months. None
of the studies reported data on all-cause mortality, cardiovascular
mortality, or all-cause hospitalization. Meta-analysis of HRQoL showed no
significant improvements in either the physical component summary (WMD:
5.92 [-0.26, 12.1], p = 0.08) or the mental component summary (WMD: 5.92
[-0.14, 1.80], p = 0.28). However, individual studies suggested potential
benefits of CR in specific functional domains. CONCLUSION(S): This
meta-analysis found no statistically significant improvements in the
physical or mental health components of HRQoL following CR in elderly CABG
patients, based on limited short-term evidence. Some studies indicated
potential benefits in functional capacity and physical activity adherence.
Clinicians should consider individualized CR programs while acknowledging
the existing evidence gaps. SYSTEMATIC REVIEW REGISTRATION: PROSPERO
CRD420251017085. Copyright © 2025. The Author(s).

<76>
Accession Number
2041497136
Title
Patient-Centered Cardiac Surgery: Psychosocial Challenges, Evidence-Based
Interventions, and Future Horizons.
Source
Healthcare (Switzerland). 13(22) (no pagination), 2025. Article Number:
2957. Date of Publication: 01 Nov 2025.
Author
Leivaditis V.; Sepetis A.; Mulita F.; Mitsos S.; Baikoussis N.G.; Koletsis
E.; Assimakopoulos S.F.; Maniatopoulos A.A.; Liolis E.; Nikolakopoulos K.;
Dahm M.; Kontodimopoulos N.
Institution
(Leivaditis, Dahm) Department of Cardiothoracic and Vascular Surgery,
Westpfalz Klinikum, Kaiserslautern, Germany
(Sepetis) Postgraduate Health and Social Care Management Program,
Department of Business Administration, University of West Attica, Athens,
Greece
(Mulita) Department of General Surgery, General Hospital of Eastern
Achaia-Unit of Aigio, Aigio, Greece
(Mitsos) Department of Thoracic Surgery, Attikon General Hospital,
National and Kapodistrian University of Athens, Athens, Greece
(Baikoussis) Department of Cardiac Surgery, Ippokrateio General Hospital
of Athens, Athens, Greece
(Koletsis) Department of Cardiothoracic Surgery, General University
Hospital of Patras, Patras, Greece
(Assimakopoulos) Division of Infectious Diseases, Department of Internal
Medicine, Medical School, University of Patras, Patras, Greece
(Maniatopoulos) Department of Electrical and Computer Engineering,
Democritus University of Thrace, Xanthi, Greece
(Liolis) Department of Oncology, General University Hospital of Patras,
Patras, Greece
(Nikolakopoulos) Department of Vascular Surgery, General University
Hospital of Patras, Patras, Greece
(Kontodimopoulos) Department of Economics and Sustainable Development,
Harokopio University, Athens, Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Psychosocial factors such as anxiety, depression, and lack of
social support are increasingly recognized as critical determinants of
outcomes in cardiac surgery. Up to 32% of patients experience preoperative
anxiety, and nearly 20% experience depression, both of which have been
associated in observational studies with delayed recovery, increased
complications, and higher mortality. Objective(s): This study aimed
to review current evidence on psychosocial aspects of cardiac surgery and
evaluate patient-centered care strategies that address these challenges.
 Method(s): A narrative literature review was performed using PubMed,
Scopus, and ScienceDirect, focusing on recently published studies. The
search covered studies published between January 2009 and June 2024,
yielding 76 eligible studies after screening and thematic synthesis.
Search terms included patient-centered care, psychosocial factors, cardiac
surgery, anxiety, depression, rehabilitation, and telemedicine. Eligible
studies included randomized controlled trials, cohort studies, qualitative
studies, and systematic reviews. Result(s): Key themes included
preoperative psychological preparation, management of anxiety and
depression, promotion of quality of life, effective communication
strategies, and integration of psychosocial support into rehabilitation
programs. Evidence shows that psychological and social interventions
reduce reported pain by up to 33%, as reported in pooled randomized
controlled trials and meta-analyses; shorten hospital stay; improve
adherence to treatment; and enhance long-term quality of life. Emerging
tools such as telemedicine and digital platforms further expand access to
psychosocial care. Conclusion(s): Integrating psychosocial care into
cardiac surgery is essential for achieving holistic outcomes.
Patient-centered models that emphasize communication, shared
decision-making, family involvement, and digital support improve not only
survival but also recovery, well-being, and patient satisfaction.
Redefining success in cardiac surgery requires attention to both clinical
results and the broader human experience of illness and
recovery. Copyright © 2025 by the authors.

<77>
Accession Number
2037380756
Title
The Effects of Surface Gastrointestinal Electrical Stimulation on
Gastrointestinal Function Recovery in Patients After Acute Type A Aortic
Dissection Open-Heart Surgery: A Randomized, Controlled Trial.
Source
Reviews in Cardiovascular Medicine. 26(10) (no pagination), 2025. Article
Number: 39847. Date of Publication: 01 Oct 2025.
Author
Duan W.; Luo Z.; Huang W.; Zhang X.; Su J.; Li Z.; Chen M.; Yu P.
Institution
(Duan, Luo, Huang, Zhang, Su, Yu) Rehabilitation Medicine Center, Sichuan
University West China Hospital, Sichuan, Chengdu, China
(Li, Chen) Department of Cardiovascular Surgery, Sichuan University West
China Hospital, Sichuan, Chengdu, China
(Yu) Key Laboratory of Rehabilitation Medicine in Sichuan Province,
Sichuan, Chengdu, China
Publisher
IMR Press Limited
Abstract
Background: Gastrointestinal (GI) dysfunction is a common postoperative
complication in patients after acute type A aortic dissection (ATAAD)
surgery. Recent evidence suggests that, in addition to early nutrition and
feeding strategies, physiotherapy can help to reduce the incidence of
postoperative GI dysfunction. This study aimed to investigate whether GI
function after ATAAD open surgery can be recovered through surface
gastrointestinal electrical stimulation (SGES). Method(s): This was a
prospective, parallel-group, assessor-blind, randomized controlled trial
(RCT). A total of 74 participants were included and randomly divided into
a control group (CG) and an SGES intervention group (IG) in a 1:1 ratio.
The CG received a standardized perioperative management program developed
by a multidisciplinary team, based on the principles of enhanced recovery
after surgery (ERAS). The IG implemented SGES at ST36, ST25, and two
additional GI pacemakers, as well as ERAS. The primary outcome was GI-2
recovery (tolerance of oral diet and passage of stool). Secondary outcomes
included the Gastrointestinal Symptom Rating Scale (GSRS), acute
gastrointestinal injury ultrasonography (AGIUS), the Gastrointestinal
Quality of Life Index (GIQLI), the incidence of constipation and diarrhea,
length of stay in the intensive care unit (ICU), and duration of
hospitalization. Result(s): Of the 74 patients in this study, 24.32%
were female, with a mean age of 49.61 years. The time to achieve GI-2 in
the IG was significantly shorter, 1.9 days, than in the CG (log-rank test,
p = 0.01). The GSRS scores in the IG were significantly lower than those
in the CG (total scores: 1.2 vs. 1.6; p = 0.001). Moreover, the GIQLI
values at all three follow-up visits were significantly higher in the IG
group than in the CG group. Conclusion(s): To our knowledge, this is
the first RCT to investigate the clinical effects of SGES on GI recovery
after open-heart surgery for ATAAD. The results provide preliminary
evidence supporting the feasibility and therapeutic potential of SGES in a
high-risk population. SGES can promote the recovery of GI function, reduce
GI-related symptoms, and improve the GI-related quality of life after open
heart surgery in patients with ATAAD. Clinical Trial Registration: This
trial was based on the Consolidated Standards of Reporting Trials
(CONSORT) guidelines. This trial was registered in the Chinese Clinical
Trial Registry (identifier ChiCTR2300075265,
https://www.chictr.org.cn/showproj.html?proj=205523). Copyright ©
2025 The Author(s). Published by IMR Press.

<78>
[Use Link to view the full text]
Accession Number
649342305
Title
Early valve intervention in asymptomatic patients with severe aortic
stenosis: a meta-analysis of randomized-controlled trials.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 26(11) (pp 674-676),
2025. Date of Publication: 01 Nov 2025.
Author
Di Pietro G.; Improta R.; Giordano E.; Birtolo L.I.; Colantonio R.;
Sardella G.; Mancone M.
Institution
(Di Pietro) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome,
Rome, Italy

<79>
Accession Number
2041857753
Title
ONE OF A KIND: A RARE CASE OF THROMBOSIS IN A PATIENT WITH UNICUSPID
AORTIC VALVE AND PATENT FORAMEN OVALE.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A917-A918), 2025.
Date of Publication: 01 Oct 2025.
Author
Weston S.; Woodall J.; Amro A.; Ferraro K.; Patel P.; Spires Z.; Isang E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (I) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am
INTRODUCTION: While bicuspid aortic valve is a common congenital variant,
unicuspid aortic valve (UAV) is a rare anomaly affecting only 0.02% of the
population. Anticipated complications of UAV include aortic stenosis and
left ventricular hypertrophy, but here, we present a case of coronary
thrombosis in a patient with UAV and patent foramen ovale (PFO). CASE
PRESENTATION: A 37-year-old female presented to establish care with
cardiology after a murmur was auscultated. A stress echocardiogram was
performed and revealed aortic valve area 0.68 cm2, mean pressure gradient
43 mmHg, and aortic velocity 4.4 m/s, findings indicative of severe aortic
stenosis, and aortic regurgitation and doming of a valve leaflet, findings
consistent with valvular insufficiency. A cardiac magnetic resonance (CMR)
was ordered to investigate the patient's valvular anatomy further, and not
only confirmed the presence of UAV, but also revealed a PFO. She was
deemed a candidate for the Ross procedure and scheduled for surgery at an
outpatient facility.However, prior to the procedure, she developed chest
pain while at rest and presented to the hospital. The inpatient cardiology
service was consulted for unstable angina and decided to proceed with left
heart catheterization and coronary angiography. While catheterization
provided aortic pressure gradients, angiography revealed a non-occlusive
thrombus in the ostium of the left LAD. There was no evidence of
occlusion, so revascularization was deferred in favor of systemic
anticoagulation. Afterwards, her chest pain gradually resolved, and she
was discharged home to complete a 3-month course of anticoagulation prior
to undergoing the Ross procedure. DISCUSSION(S): The complications of
UAV, such as dystrophic calcification and aortic regurgitation, are
similarly found with bicuspid aortic valve. However, the accelerated
progression of valvular dysfunction with UAV leads to a more rapid
development of left ventricular failure. This highlights the potential for
cardiogenic shock and necessity for prompt surgical intervention to
prevent morbidity and mortality. Fortunately, our patient was able to
avoid this clinical picture and avert temporizing measures to maintain
systemic perfusion, such as vasopressor and inotropic support or
mechanical circulatory support with an intra-aortic balloon pump (IABP),
left ventricular assist device (LVAD), or venoarterial extracorporeal
membrane oxygenation (VA-ECMO).While the potential for cardiogenic shock
is acknowledged in the setting of severe aortic valve disease, thrombosis
is not a documented complication of UAV. However, in theory, significant
stenosis or regurgitation would promote the formation of a thrombus due to
turbulent blood flow within the heart chamber. In our case though, the
cause of thrombosis is not straightforward due to the concomitant presence
of a PFO, which may have acted as a conduit for a paradoxical embolism.
The possibility that a thrombus developed peripherally and embolized to
the coronary circulation cannot be excluded. CONCLUSION(S): Patients
with UAV develop accelerated left ventricular failure, so prompt diagnosis
is warranted for surgical intervention. We propose screening patients with
presumed bicuspid aortic valve with CMR to confirm valvular structure.
Additionally, increased awareness that thrombosis may be a complication of
UAV and PFO individually or as a dual entity is also warranted. REFERENCE
#1: Mookadam, F. et al. Unicuspid Aortic Valve in Adults: A Systematic
Review. Journal of Heart Valve Disease. 2010. 19(1):79-85. REFERENCE #2:
Novaro, G. M., Mishra, M., & Griffin, B. P. Incidence and
Echocardiographic Features of Congenital Unicuspid Aortic Valve in an
Adult Population. Journal of Heart Valve Disease. 2003. 12(6):674-8.
DISCLOSURES: No relevant relationships by Aladen Amro No relevant
relationships by Kirsten Ferraro No relevant relationships by Emmanuel
Isang No relevant relationships by Parth Patel No relevant relationships
by Zachary Spires No relevant relationships by Stefan Weston No relevant
relationships by Jesse Woodall Copyright © 2025 American College
of Chest Physicians

<80>
Accession Number
2041859066
Title
AN UNEXPECTED MONTHLY VISITOR: A CASE OF RECURRENT CATAMENIAL HEMOTHORAX.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4403-A4404),
2025. Date of Publication: 01 Oct 2025.
Author
Dugan K.; Vazquez C.G.; Mallinger L.; Yazdi B.; Morris R.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Report Posters (D) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: For many practitioners, a patient's menstrual history may
not be considered when creating a differential diagnosis for pneumothorax.
Most often, a spontaneous pneumothorax is due to rupture of pleural blebs.
In a woman of reproductive age presenting with shortness of breath whose
imaging is significant for pneumothorax, it is important to consider the
presence of endometrial tissue as a potential causative agent and obtain
information about the patient's menstrual history. CASE PRESENTATION: A
26-year-old female with no past medical history presented with progressive
shortness of breath for a week. On presentation, the patient was
tachycardic but not hypoxic. Labs were significant for a hemoglobin of
7.6. A CT scan of the chest showed a right sided hydropneumothorax for
which a chest tube was placed. Pleural fluid obtained was dark red and
bloody. Pleural fluid studies showed the fluid to be exudative with
458,000 red blood cells. The cytology of the fluid demonstrated scattered
neutrophils and lymphocytes with few macrophages. A diagnosis was not able
to be made based on cytology alone, but endometrial tissue could not be
excluded. Upon visualization of the pleural fluid, clinicians were
prompted to ask the patient about her menstrual history. The patient
endorsed regular periods that were significantly painful and heavy. She
denied a history of endometriosis. During the first admission, the patient
was able to have the chest tube removed without recurrence of a
pneumothorax and was discharged on oral contraceptives. Approximately a
month later during her menses, the patient presented again with complaints
of heavy menstrual bleeding and shortness of breath. A CT of the chest
demonstrated recurrence of a right sided hydropneumothorax as well as
abdominal and pelvic ascites. The patient had another chest tube placed
and was recommended to undergo outpatient exploration of the thoracic
cavity with potential removal of endometrial tissue given the recurrent
pneumothoraces around the time of patient's menses and concern for
catamenial pneumothorax. The patient was also recommended to start a GnRH
agonist. DISCUSSION(S): Endometriosis affects around five to ten
percent of reproductive aged women. The diagnosis of endometriosis can
only be made via laparoscopy, so many women remain undiagnosed. In an
ovulating patient that presents with recurrent pneumothoraces, especially
around the time of menses, it is crucial to consider a catamenial
pneumothorax. A catamenial pneumothorax occurs on the right side 85% of
the time and is thought caused by endometrial implants along the pleura
and diaphragm. Thoracic endometriosis has been associated with
presentations such as pneumothorax, hemoptysis, and hemothorax. Data
suggests that implantations along the pleura are strongly associated with
hemothorax, as seen in this patient. Definitive diagnosis of thoracic
endometriosis requires tissue biopsy obtained by a thoracic surgeon. The
need for thoracic and gynecological procedures to diagnose this disease
process further highlights the importance of keeping endometriosis in the
differential so that proper consultation is made. CONCLUSION(S):
Thoracic endometriosis causing catamenial pulmonary disease processes is a
rare and often under-recognized pathology that should be considered in
menstruating women presenting with spontaneous pneumothorax or hemothorax.
REFERENCE #1: Channabasavaiah, Anitha D. MD; Joseph, Jose Vempilly MD.
Thoracic Endometriosis: Revisiting the Association Between Clinical
Presentation and Thoracic Pathology Based on Thoracoscopic Findings in 110
Patients. Medicine 89(3):p 183-188, May 2010. DOI:
10.1097/MD.0b013e3181df67d5 REFERENCE #2: Maurer ER, Schaal JA, Mendez FL.
CHRONIC RECURRING SPONTANEOUS PNEUMOTHORAX DUE TO ENDOMETRIOSIS OF THE
DIAPHRAGM. JAMA. 1958;168(15):2013-2014.
DOI:10.1001/jama.1958.63000150008012c REFERENCE #3: Korom, Stephan, et al.
"Catamenial pneumothorax revisited: clinical approach and systematic
review of the literature." The Journal of Thoracic and Cardiovascular
Surgery 128.4 (2004): 502-508. DISCLOSURES: No relevant relationships by
Katelyn Dugan No relevant relationships by Carolina Gonzalez Vazquez No
disclosure on file for Laura Mallinger No relevant relationships by Rachel
Morris No relevant relationships by Bayan Yazdi Copyright © 2025
American College of Chest Physicians

<81>
Accession Number
2041858483
Title
TALKING SHOP: USING A DIFFERENT APPROACH TO CHEMICAL PLEURODESIS FOR A
PERSISTENT AIR LEAK.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A6056-A6057),
2025. Date of Publication: 01 Oct 2025.
Author
Davda D.; Desai N.; Heideman B.; Hoyos A.D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Report Posters (C) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
Pleurodesis is a procedure that approximates the visceral and parietal
pleura to reduce or eliminate air and fluid in the pleural space, which
maintains lung expansion and prevents collapse or atelectasis (1). This
intervention is commonly used for recurrent malignant pleural effusions
and secondary pneumothoraces.; Video-assisted thoracic surgery (VATS) is
the most effective recommended pleurodesis modality for pneumothoraces
(2,3). Chemical pleurodesis, while not as effective compared to VATS, is a
safe alternative for patients who cannot undergo surgery (2). Many agents
are available for chemical pleurodesis, but to date, limited evidence
exists comparing efficacy and safety among the different agents. We
present a patient with a secondary pneumothorax treated by chemical
pleurodesis with Povo-iodine, a less commonly used agent. CASE
PRESENTATION: This is a 71-year-old male with a past medical history of
COPD, bullous emphysema, and a 65-pack-year history of tobacco use who
presented to an outside hospital for severe dyspnea and was found to have
a right-sided pneumothorax (PTX). He had a similar PTX three months prior
that resolved with the placement of a temporary chest tube. The need for
additional percutaneous pleural drains and a persistent air leak
complicated his outside hospital course, so he was transferred to our
hospital for consideration of an endobronchial valve. Balloon occlusion
during bronchoscopy failed to resolve his air leak, so he was not deemed a
candidate for endobronchial valves. Thoracic surgery also evaluated him,
and while he was not deemed an appropriate candidate for video-assisted
thoracic surgery, he was trialed on water seal to determine if he could
tolerate pleurodesis. Due to concern talc would lead to pleural fibrosis,
the decision was made to use povo-iodine instead. A solution of 20 ml of
10% iodine in 80 ml of saline was instilled into his chest tube to dwell
for four hours under water-seal. Over the next few days, the right-sided
PTX remained stable in size, and his chest tubes were removed. He was
discharged home in appropriate condition, with a scheduled follow-up at
our pulmonary clinic to monitor his progress and ensure remission.
 DISCUSSION(S): This patient had a recurrent spontaneous secondary
pneumothorax in the context of his bullous emphysema. Secondary
pneumothoraces have a significant risk of recurrence (10 to 50%) after
conservative treatment, progressing potentially into a persistent air
leak. Most society guidelines recommend talc as a first-line agent for
chemical pleurodesis for persistent air leaks. While talc demonstrates a
90-95% efficacy in stopping air leaks, it is associated with increased
pleural thickening and, rarely, pneumonitis (4). In the previous two
decades, several studies demonstrated povo-iodine has comparable efficacy
with minimal side effects as a sclerosing agent (5, 6, 7). However, no
studies have compared povo-iodine to talc in a head-to-head trial for
persistent air leaks. Further research is needed to compare the two agents
in a clinical trial. CONCLUSION(S): Our patient was successfully
treated with an agent not recommended by major guidelines and current
literature. Additional studies directly comparing efficacy and side
effects of chemical pleurodesis using talc versus iodopovidone are needed.
REFERENCE #1: Rodriguez-Panadero F, Montes-Worboys. Mechanisms of
Pleurodesis. Respiration. 1 Jan 2012; 83 (2): 91-98 Tschopp JM, Bintcliffe
O, Astoul P, et al. ERS Task Force Statement: Diagnosis and Treatment of
Primary Spontaneous Pneumothorax. REFERENCE #2: Dugan KC, Laxmanan B,
Murgu S, Hogarth DK. Management of persistent air leaks. CHEST 2017; 152
(02): 417-423 Watanabe T, Fukai I, Okuda K, Moriyama S, et al. Talc
pleurodesis for secondary pneumothorax in elderly patients with persistent
air leak. J Thorac Dis. 2019 Jan; 11 (1): 171-176. REFERENCE #3: Mohsen
TA, Zeid AA, Meshref M, et al. Local iodine pleurodesis versus
thoracoscopic talc insufflation in recurrent malignant pleural effusion: a
prospective randomized control trial. Eur J Cardiothoracic Surg 2011; 40
(02): 282-286. Agarwal R, Aggarwal AN, Gupta D. Efficacy and safety of
iodopovidone pleurodesis through tube thoracostomy. Respirology (2006) 11.
105-108. Agarwal R, Khan A, Aggarwal AN, Gupta D. Efficacy and safety of
iodopovidone pleurodesis: a systematic review and meta-analysis. Indian J
Med Res 2012; 135: 297-304. DISCLOSURES: No relevant relationships by
Darien Davda No relevant relationships by Alberto de Hoyos No relevant
relationships by Nidhi Desai No relevant relationships by Brent
Heideman Copyright © 2025 American College of Chest Physicians

<82>
Accession Number
2041858957
Title
VALVE-IN-VALVE AORTIC VALVE REPLACEMENT IN A PATIENT WITH PRIOR RHEUMATIC
FEVER AND ROSS PROCEDURE WITH AUGMENTATION.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A660-A661), 2025.
Date of Publication: 01 Oct 2025.
Author
Rao Y.A.S.H.; Davenport C.A.T.Y.; Klele A.N.N.A.; Aamir M.; Sanchez B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (V) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: While medicine has advanced significantly, clear data on
long term solutions for young to middle-aged adults who require aortic
valve replacement remains ongoing. The Ross procedure, which provides a
pulmonary autographt replacement, is the only intervention which allows a
provider to replace a diseased aortic valve with an innate, natural
alternative. While this procedure offers unique benefits, over the decades
data has shown increased surgical risk and eventual long-term failure
leading to rehospitalization and necessitating further invasive
procedures. CASE PRESENTATION: A 60-year-old male with a medical history
of rheumatic fever as a child who underwent an initial Ross Procedure in
1996, that was revised with a Medtronic bi-root and pulmonary artery
augmentation in 2009 presented with signs of heart failure. TTE/TEE
imaging showed severe AR, degenerated leaflets, and an EF of 45-50% with
global hypokinesis. He was scheduled for a valve- in-valve (ViV) TAVR
procedure. He underwent a left heart catheterization that did not show any
coronary artery disease. Three attempts were made in the procedure with
difficulty deploying the valve into satisfactory position leading to
procedure to be aborted. Hemodynamics were observed in a cardiac ICU with
a pulmonary artery catheter and blood pressure augmentation with
epinephrine. A second attempt was performed the next day with successful
placement of a 29mm bioprosthetic valve and complete reversal of the
patient's aortic insufficiency visualized on follow up TTE. He was
discharged on a beta blocker and angiotensin receptor blocker.
 DISCUSSION(S): Aortic Valve repair (AVR) is the most common valvular
repair that occurs worldwide. The majority of patients are over the age of
70 which allows for a variety of options for valve type and approaches.
The issue arises in the younger patient population that will require a
valve longer. Mechanical valves are often used for their durability;
however, these valves are prone to clots and require lifelong
anticoagulation. Though bioprosthetic valves remove the need for
anticoagulation, they are associated with higher rates of structural
deterioration. Whether biological or mechanical, all artificial valves
lack the ability to remodel through the body's natural processes.
Currently, all data points toward improved long-term survival, free from
reintervention, after the Ross procedure compared to biological AVR. While
reintervention is rare, this case showcases not only is it sometimes
necessary but also possible. ViV procedures are common and routine
offering a realistic solution to this problem. As it stands augmenting a
native autographt is the gold standard of therapy with a new bioprosthetic
agent in a recurrently symptomatic patient. Further studies should
investigate a ViV approach in prior Ross procedures that need augmentation
or have failure of prior augmentations such as our patient.
 CONCLUSION(S): Successful AVR requires long term planning, especially
in young patients regarding quality of life. This case highlights that
while data can support procedures and show good outcomes our ability to
predict longitudinal outcomes remains limited, leading to increased rates
of readmission, invasive procedures, and complications. REFERENCE #1:
Mazine A, El-Hamamsy I, Verma S, et al. Ross procedure in adults for
cardiologists and cardiac surgeons. Journal of the American College of
Cardiology. 2018;72(22):2761-2777. doi:10.1016/j.jacc.2018.08.2200
REFERENCE #2: Ryan WH, Squiers JJ, Harrington KB, et al. Long-term
outcomes of the Ross procedure in adults. Ann Cardiothorac Surg.
2021;10(4):499-508. doi:10.21037/acs-2021-rp-fs-28 REFERENCE #3: Shimamura
J, Fukuhara S, Yokoyama Y, Takagi H, Ouzounian M, Kuno T. Systematic
review and meta-analysis of time-to-event long-term outcomes following the
Ross procedure. J Thorac Dis. 2023;15(9):4693-4702.
doi:10.21037/jtd-23-326 DISCLOSURES: No relevant relationships by Muhammad
Aamir No relevant relationships by Caty Davenport No relevant
relationships by Anna Klele No relevant relationships by Yash Rao No
disclosure on file for Benjamin Sanchez Copyright © 2025 American
College of Chest Physicians

<83>
Accession Number
2041858170
Title
EXPLORING ALTERNATE INDICATIONS OF ENDOBRONCHIAL VALVES: A CASE SERIES.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A6040-A6041),
2025. Date of Publication: 01 Oct 2025.
Author
Marsh C.; Sain E.; Forte M.; Ramaniuk A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Case Report Posters (B) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
Persistent air leak is a challenging problem to manage in critically ill
patients. Non-surgical options for management include medical pleurodesis,
either by talc or autologous blood patch. Endobronchial valves (EBVs)
provide another option in the management of persistent air leak. There are
currently two approved EBVs; Zephyr EBV (Pulmonx) and the Spiration IBV
(Olympus Respiratory America). These valves have been approved for
non-operative lung volume reduction in patients with emphysema, but
recently have been explored as an option for management of bronchopleural
fistula (BPF) and persistent air leak. We present a series of three cases
of patients managed with EBVs. CASE PRESENTATION: The first patient was a
76-year-old male with a history of granulomatous lung disease and
pulmonary abscess resulting in right lower lobe wedge resection. Due to
persistent infiltrates and new pulmonary nodules, he was referred to
cardiothoracic surgery for right upper lobe resection. He underwent a
right VATS procedure, which was complicated by a persistent air leak,
requiring talc pleurodesis three times without resolution. Repeat imaging
showed a BPF and subcutaneous emphysema (Figure 1a). He then underwent
placement of 5 EBV's in the right lung. Post-procedure CT revealed near
complete lung expansion. When the chest tube was removed from suction,
there was a grade 2 air leak on expiration only. When the chest tube was
placed to water seal, the patient developed subcutaneous emphysema in
chest wall and face which resulted in placement of a wound vac. Repeat CT
approximately 1 month post-discharge revealed resolution of air leak
(Figure 1b).The second patient was a 70-year-old male with history of
hypertension, type 2 diabetes and arthritis who initially presented with
hydropneumothorax (Figure 2a). Originally, he had a left upper and lower
lobe abscess with necrotic tissue and was treated with multiple courses of
antibiotics. He underwent thoracotomy with pleurectomy and decortication.
Ultimately, readmitted due to persistent air leak and underwent redo VATS
and BPF closure, but the air leak persisted. He subsequently underwent EBV
placement x6 with the resolution of the air leak and chest tube removal.
Later imaging revealed the resolution of pneumothorax (Figure 2b).The
third patient is a 68-year-old male who initially presented after being
found unresponsive, requiring intubation. Post-intubation chest x-ray
revealed a pneumothorax, which prompted chest tube placement. Hospital
course was complicated by persistent air leak and subcutaneous emphysema
(Figure 3a) which was initially managed with surgical gill slits. Patient
subsequently underwent placement of 3 EBV's due to a BPF in the RML
following pneumothorax. Air leak resolved post-EBV placement.
Unfortunately, the patient continued to decline and the decision was made
to place the patient temporarily on VV-ECMO. He subsequently underwent
tracheostomy and gastrostomy placement. He was discharged to a LTAC, and
his tracheostomy has since been decannulated. DISCUSSION(S): EBV's
are currently only FDA-approved for use in patients with severe emphysema
for non-surgical lung reduction, however they do seem to show promise with
off-label use in the management of persistent air leaks.
 CONCLUSION(S): Further research should be completed to investigate
EBVs for this indication. REFERENCE #1: 1. Morrison M, Marshall A,
Giavedonni S, Will M, MacKay T, Skwarski K. Case report: Endobronchial
valve placement for treatment of a persistent air leak. Breathe.
2016;12(1):61-64. doi:https://doi.org/10.1183/20734735.013115. 2. Song X,
Gu Y, Wang H, Zhang L. The efficacy of endobronchial valves for the
treatment of bronchopleural fistula: a single-arm clinical trial. J Thorac
Dis. 2022;14(3):712-720. doi:10.21037/jtd-22-258 REFERENCE #2: 3. Fiorelli
A, D'Andrilli A, Cascone R, Occhiati L, Anile M, Diso D, Cassiano F, Poggi
C, Ibrahim M, Cusumano G, Terminella A, Failla G, La Sala A, Bezzi M,
Innocenti M, Torricelli E, Venuta F, Rendina EA, Vicidomini G, Santini M,
Andreetti C. Unidirectional endobronchial valves for management of
persistent air-leaks: results of a multicenter study. J Thorac Dis. 2018
Nov;10(11):6158-6167 REFERENCE #3: 4. Ding M, Gao YD, Zeng XT, Guo Y, Yang
J. Endobronchial one-way valves for treatment of persistent air leaks: a
systematic review. Respir Res. 2017 Nov 6;18(1):186. DISCLOSURES: No
disclosure on file for Michael Forte No relevant relationships by Caleb
Marsh No relevant relationships by Aliaksandr Ramaniuk No relevant
relationships by Elizabeth Sain Copyright © 2025 American College
of Chest Physicians

<84>
Accession Number
2041857741
Title
ENDOBRONCHIAL VALVE PLACEMENT FOR RECURRENT PNEUMOTHORAX FOLLOWING VATS IN
A PATIENT WITH PLEURAL GRANULOMATOSIS WITH POLYANGIITIS.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A405-A406), 2025.
Date of Publication: 01 Oct 2025.
Author
Bommu V.; Gregory B.; Kamel E.M.A.D.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Report Posters (C) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Recurrent spontaneous pneumothorax (SP) is a challenging
complication in patients undergoing video-assisted thoracoscopic surgery
(VATS), particularly in those with underlying lung pathology.
Endobronchial valve (EBV) placement is an emerging, minimally invasive
therapeutic option for bronchoscopy lung volume reduction (BLVR) in
patients with advanced COPD, and it could be a benefit for persistent air
leaks (PAL) and bronchopleural fistula (BPF). We present a case of a
patient with pleural granulomatosis with polyangiitis (GPA), complicated
by recurrent pneumothorax post-VATS, successfully managed with EBV
placement. CASE PRESENTATION: A 56-year-old male with a history of 30-pack
years presented with pleuritic chest pain, dyspnea, myalgia, fever, and
night sweats for five days. Physical examination revealed oropharyngeal
erythema. Initial labs showed mild leukocytosis and elevated creatinine
concerning renal involvement.Chest CT revealed a 4 cm pulmonary mass in
the lingula and multiple pleural-based nodules (figure 1A,1B) in the left
lung base, raising concern for malignancy or granulomatous disease.
Extensive workup, including whole-body bone scan, brain MRI, and flow
cytometry, ruled out metastatic disease and lymphoproliferative disorders.
Initial fine needle aspiration of the pleural mass was nondiagnostic. The
patient underwent robotic-assisted left chest exploration with VATS and
partial pleurectomy, left lobe wedge resection, pleural nodule biopsies,
and chemical pleurodesis. Histopathology confirmed necrotizing vasculitis,
which is consistent with GPA.His postoperative course was complicated by
recurrent left pneumothorax (figure 2), cutaneous chest wall abscess sp
I&D complicated by chest wall hematoma. The fistula tracks through the
serratus muscle posteriorly. A persistent bronchopleural fistula (BPF) was
located at the anterior segmental bronchus B3 (identified by lung
isolation), leading to prolonged hospitalization. Despite conservative
management with a chest tube, air leaks persisted, necessitating an
alternative intervention. 3 EBVs were placed to occlude the air leak,
leading to clinical improvement and successful chest tube removal. A
Heimlich valve was placed in the chest tube to prevent air re-entry.
(figure 3) DISCUSSION(S): Recurrent pneumothorax post-VATS is a
recognized complication, with a reported incidence of 8-12% [2],
particularly in patients with pre-existing lung disease. EBVs are
unidirectional valves placed bronchoscopically to occlude airways,
preventing airflow to the affected segments and facilitating the
re-expansion of atelectatic segments. Common indications of EBV are severe
lung emphysema with FEV1 15-45% for BLVR and an emerging option for PAL
and BPF. EBV placement has shown efficacy in PAL with a 75-88% success
rate [3], reducing the need for prolonged chest tube drainage or
reoperation. A complete resolution was reported within 24 hours of EBV
placement, and there were no deaths [1]. Multiple observational studies
reported that the most common location of PAL is the left upper segment
[2, 3, 4]. The presence of necrotizing vasculitis predisposed our patient
to poor wound healing and air leaks postoperatively. EBV placement
provided a minimally invasive solution, reducing the duration of the air
leaks and facilitating the healing of BPF. CONCLUSION(S): Further
research is needed to establish standardized guidelines for EBV use in
post-VATS pneumothorax management. It optimizes recovery, reduces hospital
stay, and prevents surgical reintervention in patients with underlying
pulmonary pathology. REFERENCE #1: 1. Ding M, Gao YD, Zeng XT, Guo Y, Yang
J. Endobronchial one-way valves for treatment of persistent air leaks: a
systematic review. Respir Res. 2017 Nov 6;18(1):186. doi:
10.1186/s12931-017-0666-y. PMID: 29110704; PMCID: PMC5674238. 2. Huang N,
He S, Chen S, Zhang G, Ruan L, Huang J. Incidence and risk factors for
recurrent primary spontaneous pneumothorax after video-assisted
thoracoscopic surgery: a systematic review and meta-analysis. J Thorac
Dis. 2024 Jun 30;16(6):3696-3710. doi: 10.21037/jtd-24-175. Epub 2024 Jun
11. PMID: 38983166; PMCID: PMC11228730. REFERENCE #2: 3. Damaraju V,
Sehgal IS, Muthu V, Prasad KT, Dhooria S, Aggarwal AN, Agarwal R.
Bronchial Valves for Persistent Air Leak: A Systematic Review and
Meta-analysis. J Bronchology Interv Pulmonol. 2024 May 8;31(3):e0964. doi:
10.1097/LBR.0000000000000964. PMID: 38716831. REFERENCE #3: 4. Bermea RS,
Miller J, Wilson WW, Dugan K, Frye L, Murgu S, Hogarth DK. One-Way
Endobronchial Valves as Management for Persistent Air Leaks: A Preview of
What's to Come? Am J Respir Crit Care Med. 2019 Nov 15;200(10):1318-1320.
doi: 10.1164/rccm.201904-0761LE. PMID: 31310162; PMCID: PMC6857487.
DISCLOSURES: No relevant relationships by Veera Bommu No relevant
relationships by Bryan Gregory No relevant relationships by Emad
Kamel Copyright © 2025 American College of Chest Physicians

<85>
Accession Number
649285003
Title
Sucrosomial iron for health-care improvement in elective cardiac surgery.
Source
Blood Transfusion. Conference: 9th International Multidisciplinary Course
on Iron Deficiency. Palermo Italy. 23(Supplement 3) (pp s444), 2025. Date
of Publication: 01 Jun 2025.
Author
Weltert L.P.
Institution
(Weltert) Department of Heart Surgery, European Hospital, Rome, Italy
Publisher
Edizioni SIMTI
Abstract
Background. The fact that anemia, blood loss and RBC transfusion (RBCT) is
a problem in cardiac surgery (CS) is not matter of discussion nowadays1.
The use of tranexamic acid and lower transfusion thresholds have greatly
reduced RBCT rates. However, the prevalence of low preoperative hemoglobin
(Hb) and impaired iron homeostasis is high among CS patients2,3. A
post-hoc analysis of a large RCT of adult elective CS patients
(No.=1,000)4 receiving 60 mg/day of Sucrosomial iron (SI), for 30 days
before surgery, versus no iron (No.=594), revealed that SI increased
preoperative Hb in both anemic (Hb <13 g/dL) and non-anemic patients.
However, women still have higher RBCT rate (%) and index (units/patient)
than men, despite the SI therapy5. Methods. To get further insight of
which patients benefit the most from this quality improvement strategy, we
reanalyzed data on RBCT rate according to six baseline Hb strata. Results.
As depicted in Table I, preoperative oral SI resulted in reduced RBCT
rates for all baseline Hb strata >11 g/dL, though with differences
according to Hb strata, and possible future actions are suggested (e.g.,
increase SI dose, addition of epoetin). Conclusions. Preoperative SI
administration confirms to be a safe, well tolerated and cost-effective
strategy to increase preoperative Hb and decrease RBCT rates in elective
CS. As such, 2024 EACT/EACTAIC guidelines for Patient Blood Management
recommends preoperative SI administration in anemic adults patients
undergoing CS (Class IIa, Level of Evidence B)6. For those with
moderate-to-severe preoperative anemia, erythropoietin supplementation in
addition to iron is recommended (Class IIa, Level of Evidence A)6. The
positive effects of SI supplementation in non-anemic patients (Hb >13
g/dL) could be attributed to the high prevalence of absolute or functional
iron deficiency among this patient subgroup3. (Table presented).

<86>
Accession Number
2041857793
Title
CAVITARY LEGIONNAIRES' DISEASE IN AN IMMUNOCOMPROMISED HOST.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1455-A1456),
2025. Date of Publication: 01 Oct 2025.
Author
Park S.; Belt H.; Abu-Rmaileh M.; Wu S.S.; Cardenas C.P.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Complex Lung Infections in Immunocompromised Hosts SESSION
TYPE: Rapid Fire Case Reports PRESENTED ON: 10/20/2025 02:35 pm - 03:05 pm
INTRODUCTION: Cavitary pulmonary lesions have a broad differential which
includes malignant, inflammatory, and infectious etiologies. Especially in
immunocompromised patients, Legionnaires' disease (LD) can cause
devastating pulmonary complications leading to prolonged hospitalization.
Here, we present a unique case of Legionella pneumonia with multiple
cavitary lesions complicated by pneumothorax. CASE PRESENTATION: A
45-year-old female with a history of metastatic breast cancer to the brain
and liver presented to the hospital with 3 days of chest pain, dry cough,
and mild shortness of breath. She had been on trastuzumab deruxtecan-pdk
and a 2-month long dexamethasone taper for brain metastasis related
vasogenic edema. Admission chest CT showed bilateral nodular and
spiculated opacities. (Image 1) Pulmonary was consulted and recommended an
initial workup for infectious and inflammatory etiologies which included
blood cultures, sputum cultures, aspergillus galactomannan, fungitell,
cryptococcus antigen, mucor PCR, AFB cultures, MTB PCR, ANCA serologies,
and rheumatoid factor. She received community-acquired pneumonia coverage
for the first three days of admission with ceftriaxone and azithromycin.
However, six days after admission, the patient developed a spontaneous
left-sided pneumothorax. A chest tube was placed which demonstrated a
continuous air leak. The repeat CT chest revealed interval cavitation of
bilateral upper lobe consolidations. (Image 2). The initial workup was
negative, so the patient underwent BAL and transbronchial biopsies of the
left lung. Pathology was negative for neoplasm, granulomas, capilllaritis,
or pathogenic organisms. BAL culture and legionella urine antigen were
positive for legionella pneumophila. The patient was then placed on
azithromycin for a 3-week course. She had a persistent air leak and
required upsizing of her chest tube and chemical pleurodesis. The
pneumothorax ultimately resolved without surgical intervention or
endobronchial valve placement, but she had a chest tube in place for
nearly a month. She completed the azithromycin course with resolution of
her symptoms and improvement of infiltrates (Image 3). DISCUSSION(S):
In most patients with Legionnaire's disease, chest radiographs show patchy
uni-lobular infiltrate progressing to consolidation.1 LD evolving into
cavitary disease is rare and can lead to persistent pneumothorax requiring
multiple interventions. A systematic review article on 29 cavitary
Legionella cases cites the history of hematologic malignancy and high-dose
steroids as risk factors.2 Up to 40% of patients needed ICU admission, and
45% of patients had co-infection with other bacteria. Thoracic surgery was
involved in two cases due to delay in diagnosis and clinical
deterioration.2 As such, delayed Legionella diagnosis can lead to
increased hospital stay and mortality. In our case, full azithromycin
course was delayed until the final diagnosis with BAL. Legionella urine
antigen test (LUA), which is considered diagnostic gold-standard, might
have insufficient sensitivity in case of cavitary LD and may miss
non-pneumophilia Legionella.1 Therefore, early BAL should be considered in
non-diagnostic cavitary lesion in immunocompromised hosts along with LUA
testing. Optimal antibiotic management of cavitary legionella pneumonia
and treatment of entailing pneumothorax are complex and require further
investigation. CONCLUSION(S): Our case emphasizes the importance of
considering legionella as a differential for cavitary pneumonia in
immunocompromised individuals as delayed treatment with appropriate
antibiotics can lead to prolonged hospital stay. REFERENCE #1: Cunha, B.
A., Burillo, A., & Bouza, E. (2016). Legionnaires' disease. The Lancet,
387(10016), 376-385. REFERENCE #2: Moretti, M., De Boek, L., Ilsen, B.,
Demuyser, T., & Vanderhelst, E. (2023). Therapeutical strategies in
cavitary legionnaires' disease, two cases from the field and a systematic
review. Annals of clinical microbiology and antimicrobials, 22(1), 105.
DISCLOSURES: No relevant relationships by Muhammad Abu-Rmaileh No relevant
relationships by Haley Belt No relevant relationships by Carlos Cardenas
No relevant relationships by Sanghoon Park No relevant relationships by
Steven Wu Copyright © 2025 American College of Chest Physicians

<87>
Accession Number
2041858673
Title
TREATMENT OF CULTURE-POSITIVE SPONTANEOUS BACTERIAL EMPYEMA WITH CHEST
TUBE DRAINAGE AND UTILIZATION OF MIST 2 PROTOCOL.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4377-A4378),
2025. Date of Publication: 01 Oct 2025.
Author
Sacco M.; Ali A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Report Posters (C) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Spontaneous Bacterial Empyema is a complication in patients
with cirrhosis and a pre-existing hepatic hydrothorax, diagnosed by an
absolute neutrophil count (ANC) level greater than 500 cells/mm3 with a
negative culture or ANC of 250 cells/mm3 with a positive culture. We
present a case of SBE in a patient who undergoes multiple thoracenteses,
chest tube placements and MIST 2 protocol. CASE PRESENTATION: A
52-year-old male with history of EtOH related cirrhosis complicated by
ascites and hepatic hydrothorax and peptic ulcer c/b bleeding presented
for treatment of spontaneous bacterial peritonitis (SBP) and SBE. Chest
x-ray showed large right sided pleural effusion. Thoracentesis
demonstrated exudative pleural fluid with ANC level of 34,425 cells/mm3,
and culture positive for E.Coli. He was treated with ceftriaxone. A chest
tube was placed for two days. Post-chest tube removal, the patient's white
blood cell count continued to increase and repeat thoracentesis
demonstrated rising ANC and LDH levels, bedside ultrasound demonstrated
new septations. Another chest tube was placed. Computed tomography scan of
the chest demonstrated a loculated effusion (figure 1). Cardiothoracic
surgery was consulted, and the patient was determined to be a high-risk
surgical candidate, given MELD score of 27. The patient underwent MIST 2
protocol without complication, followed by resolution of the effusion and
removal of chest tube. Imaging demonstrated lung entrapment (figure 2).
Since, the patient has undergone successful liver transplantation.
 DISCUSSION(S): There are differing opinions of the optimal treatment
of SBE. One algorithm suggests treatment of patients with diagnosed SBE
with a third-generation cephalosporin and consideration of chest tube
placement with/without fibrinolytics if pleural fluid demonstrates
loculations [10]. Alternatively, repeat thoracentesis can be considered to
monitor treatment efficacy. Chest tubes are controversial given the higher
mortality seen in hepatic hydrothorax patients; however, it is unclear if
this remains true in patients with SBE [8]. Fibrinolytics pose risks
including bleeding, an important consideration in cirrhotics. However, a
study was completed that demonstrated no increased risk of serious
bleeding in patients with cirrhosis compared to their non-cirrhotic
counterparts [1]. This case demonstrates effective use of both chest tube
drainage and MIST 2 protocol in a patient with hepatic hydrothorax with
SBE [10,12]. Our patient was evaluated by CT surgery, and it was decided
not to consider VATs; likely given the patient's Child's Pugh Class C
score [3,15]. Finally, it is critical to reduce complications and
mortality from chest tube placement in patients with cirrhosis and SBE,
which may be mitigated by clamping the tube and resuscitation with albumin
[8,9]. The American Association for the Study of Liver Disease
recommendations are based on experience with SBP and encourages the use of
albumin to prevent renal failure and the use of antibiotics for prevention
of SBE. However, there have been no large studies to evaluate this within
SBE. CONCLUSION(S): Further research is necessary as SBE has limited
evidence-based medicine recommendations for treatment and often
recommendations use studies completed in SBP as guidelines for our
management of SBE. Further research is necessary to assess efficacy of
chest tube drainage in culture positive SBE. REFERENCE #1: 1. Akulian J,
et al. Bleeding Risk with Combination Intrapleural Fibrinolytic and Enzyme
Therapy in Pleural Infection: An international, Multicenter, Retrospective
Cohort Study. Chest. 2022 Dec;16296):1384-1392. 2. Allam NA. Spontaneous
bacterial empyema in liver cirrhosis: an underdiagnosed pleural
complication. Saudi J Gastroenterol. 2008 Jan; 14(1):43-5. 3. Chen KC et
al. Thoracic empyema in patients with liver cirrhosis: clinical
characteristics and outcome analysis of thoracoscopic management. J Thorac
Cardiovasc Surg. 2012 4. Chen T.A., Lo G.H., Lai K.H. Risk factors for
spontaneous bacterial empyema in cirrhotic patients with hydrothorax.
Journal of the Chinese Medical Association. 2003;66(10):579-586. 5. Hou F,
Qi X, Guo X. Effectiveness and Safety of Pleurodesis for Hepatic
Hydrothorax: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2016 Nov.
6. Liu LU, Haddadin HA, Bodian CA, Sigal SH, Korman JD, Bodenheimer HC Jr,
Schiano TD. Outcome analysis of cirrhotic patients undergoing chest tube
placement. Chest. 2004 Jul;126(1):142-8. Doi:10.1378/chest.126.1.142.
PMID: 15249455 REFERENCE #2: 7. Melamed KH, Dai D, Cuk N, Markovic D,
Follett R, Wan T, Lopez RC, Shirali AS, Yanagawa J, Busuttil R, Kaldas F,
Barjaktarevic I. Preoperative Trapped Lung Is Associated With Increased
Mortality After Orthotopic Liver Transplantation. Prog Transplant. 2021.
8. Orman E. S., Lok A. S. F. Outcomes of patients with chest tube
insertion for hepatic hydrothorax. Hepatology International. 2009. 9.
Osman KT, Mehta N, Spencer C, Qamar AA. Spontaneous bacterial empyema: a
tertiary care center experience and a systematic review. Expert Rev
Gastroenterol Hepatol. 2022; 16:487-92. 10. Osman KT, Nguyen JT, Patel AS,
Qamar AA. The clinician's dilemma with spontaneous bacterial empyema. Clin
Liver Dis (Hoboken). 2023 Sep 22;22(5):188-192. 11. Pippard B, Bhatnagar
M, McNeill L, Donnelly M, Frew K, Aujayeb A. Hepatic Hydrothorax: A
Narrative Review. Pulm Ther. 2022 Sep;8(3):241-254. REFERENCE #3: 12.
Rahman NM, et al. Intrapleural use of tissue plasminogen activator and
DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. 13.
Sese E, Xiol X, Castellote J, Rodriguez-Farinas E, Tremosa G. Low
complement levels and opsonic activity in hepatic hydrothorax: Its
relationship with spontaneous bacterial empyema. J Clin Gastroenterol.
2003;36:75-7. 14. Sort P, et al. Effect of intravenous albumin on renal
impairment and mortality in patients with cirrhosis and spontaneous
bacterial peritonitis. N Engl J Med. 1999 Aug 5;341(6):403-9.
Dot:10.1056/NEJM199908053410603. PMID: 10432325. 15. Towe et al. Morbidity
and 30-day mortality after decortication for parapneumonic empyema and
pleural effusion among patients. J Thorac CardioVasc Surg 2019. 16. Xiol
X, et al. Spontaneous bacterial empyema in cirrhotic patients: a
prospective study. Hepatology. 1996; 23:719-723. DISCLOSURES: No relevant
relationships by Alissa Ali No relevant relationships by Matthew
Sacco Copyright © 2025 American College of Chest Physicians

<88>
Accession Number
2041858096
Title
CHASING PROTEUS: A RARE CASE OF TAVR ENDOCARDITIS.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A683-A684), 2025.
Date of Publication: 01 Oct 2025.
Author
Shah M.; Mahajan P.; Stawkoski L.; Batra S.; Davaro R.A.U.L.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiovascular Disease Case Report Posters (V) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Infective endocarditis (IE) is a potentially fatal disease
with a 22% mortality rate, primarily caused by gram-positive bacteria.
Proteus species are gram negative bacteria that rarely cause IE. A 2020
systematic review reported only 16 cases, corresponding to a mortality
rate of 31%. Proteus typically affect native valves with 75% of cases,
while prosthetic valves affect 25%. Moreover, infected prosthetic valves
carry a high risk of mortality, reaching up to 36% in TAVRs. We present a
rare case of transcatheter aortic valve replacement associated IE
(TAVR-IE) due to Proteus mirabilis. CASE PRESENTATION: A 93-year-old man
with chronic urinary retention with Foley catheter, aortic stenosis status
post TAVR (placed four years ago), sick sinus syndrome status post
dual-chamber pacemaker, and chronic kidney disease stage 3b was admitted
for recurrent sepsis. Notably, he had three prior admissions for Proteus
bacteremia attributed to urinary tract infections (UTI) and was treated
with courses of cephalexin, amoxicillin, and cefpodoxime. A transthoracic
echocardiogram (TTE) was unrevealing. A transesophageal echocardiogram
(TEE) was obtained due to recurrence and revealed a 1.1 cm mobile
echodensity on ventricular aspect of the bioprosthetic TAVR valve (Figure
1), with trace regurgitation. Surgical aortic valve replacement was
deferred with shared decision-making due to advanced age, kidney disease,
and high complication risk of surgery. Instead, he received a six-week
course of intravenous ceftriaxone, followed by long-term antibiotic
suppression with trimethoprim/sulfamethoxazole. A repeat TTE for
monitoring was planned, but he has since been lost to follow up.
 DISCUSSION(S): Proteus endocarditis is strongly associated with UTI,
occurring in 44% of cases, likely due to its ability to form biofilms.
Although the pathophysiology of Proteus endocarditis is unclear, it is
likely due to its ability to form biofilms and cause bacteremia. Recurrent
Proteus bacteremia despite appropriate antibiotics should raise suspicion
for IE. There are diagnostic challenges for Proteus associated with
TAVR-IE, especially with imaging as TTE showed vegetations in 35% and TEE
in 37.5%, which is reflective of our case. Furthermore, one study depicted
the inability of TEE to detect vegetations in prosthesis with 25% and
showed potential benefits with CT and PET scan. Surgical intervention may
become necessary when antibiotics fail, as in our case. However, its
benefits may be outweighed by the risk of complications, which have been
reported to be as high as 70%. CONCLUSION(S): Recurrent Proteus
bacteremia should raise concern for IE, especially with prosthetic valves
due to the significant mortality risk. Diagnostics can be challenging,
especially with imaging. When clinical suspicion is high for Proteus
associated IE remains high despite a negative TTE, further imaging with a
TEE, CT or PET should be pursued. REFERENCE #1: 1. Martinez-Selles, M., &
Munoz, P. (2023). Epidemiology, Diagnosis, Treatment, and Prognosis of
Infective Endocarditis. Journal of Clinical Medicine, 12(17), 5705.
REFERENCE #2: 2. Glaser, N., Sartipy, U., & Dismorr, M. (2024). Prosthetic
Valve Endocarditis After Aortic Valve Replacement With Bovine Versus
Porcine Bioprostheses. Journal of the American Heart Association, 13(1),
e031387. REFERENCE #3: 3. Ioannou, P., & Vougiouklakis, G. (2020).
Infective endocarditis by Proteus species: a systematic review. Germs,
10(3), 229. 4. Del Val, D., Panagides, V., Mestres, C. A., Miro, J. M., &
Rodes-Cabau, J. (2023). Infective endocarditis after transcatheter aortic
valve replacement: JACC state-of-the-art review. Journal of the American
College of Cardiology, 81(4), 394-412. 5. Chobufo, M. D., Atti, V.,
Vasudevan, A., Bhandari, R., Badhwar, V., Baddour, L. M., & Balla, S.
(2023). Trends in infective endocarditis mortality in the United States:
1999 to 2020: a cause for alarm. Journal of the American Heart
Association, 12(24), e031589. DISCLOSURES: No relevant relationships by
Sejal Batra No relevant relationships by raul davaro No relevant
relationships by Pranav Mahajan No relevant relationships by Mohammed Shah
No relevant relationships by Lawrence Stawkoski Copyright © 2025
American College of Chest Physicians

<89>
Accession Number
2041859425
Title
VAPING AND SPONTANEOUS PNEUMOTHORAX IN YOUTH: RETHINKING PNEUMOTHORAX
MANAGEMENT IN THE ERA OF E-CIGARETTES.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A7114-A7115),
2025. Date of Publication: 01 Oct 2025.
Author
Balusu M.A.N.U.; Narayana S.H.; Madine M.; Athiyaman S.; Kaushal I.G.;
Matos A.; Joseph J.O.J.I.; Jamil A.S.M.A.; Mahmood N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Tobacco Cessation Case Report Posters SESSION TYPE: Case
Report Posters PRESENTED ON: 10/20/2025 12:30 pm - 01:15 pm INTRODUCTION:
The vaping epidemic in the U.S. is a major public health crisis,
particularly among youth. Marketed as a safer alternative to smoking,
e-cigarettes have surged in popularity due to appealing flavors and sleek
designs, yet they pose serious risks like nicotine addiction, lung injury,
and long-term health issues. The E-Cigarette/vaping Product Use-Associated
Lung Injury outbreak highlighted dangers such as bleb formation and
pneumothorax [1], where air leaks into the pleural space, collapsing the
lung and causing respiratory distress. This report calls for updated
guidelines to better manage pneumothorax in young vaping patients. CASE
PRESENTATION: A 19-year-old female with no significant past medical
history presented to the emergency room with worsening shortness of
breath. Her symptoms began with intermittent sharp left-sided chest pain
during deep inspiration, progressing to shortness of breath on exertion.
She denied any history of medical or surgical issues, recent trauma,
fever, or cough but reported daily vaping and frequent cannabis use. On
presentation, she was hemodynamically stable. A chest X-ray revealed a
moderate left-sided pneumothorax with no other significant findings. A
pigtail catheter was placed in the ER, leading to resolution of the
pneumothorax. A CT scan obtained during admission showed multiple apical
blebs on the left side, the largest measuring 2.5 centimeters.
Cardiothoracic surgery was consulted for possible surgical intervention.
 DISCUSSION(S): This case report examines the link between vaping and
spontaneous pneumothorax in a young patient with a history of significant
vaping and cannabis use. Vaping introduces toxic chemicals like
formaldehyde and acrolein, causing inflammation, oxidative stress, and
damage to alveolar walls, leading to blebs or bullae [1]. Deep inhalation
techniques increase lung pressure (barotrauma), risking rupture of these
weakened structures and air leakage into the pleural space. Vaping also
disrupts pulmonary surfactant and triggers chronic inflammation with
lipid-laden macrophages, markers of lung injury. The patient, who started
vaping at 13, used two 5% nicotine vapes weekly (5000 puffs each). While
guidelines suggest discharging stable first-time pneumothorax cases
without further workup, this case highlights the need for reconsideration.
A CT scan revealed multiple apical blebs, altering management and
necessitating cardiothoracic surgery consultation. Without the scan, these
blebs might have been missed, risking future pneumothorax.
 CONCLUSION(S): In 2023, 10% of high school students (1.56 million)
and 4.6% of middle school students (550,000) reported current e-cigarette
use. Among high school users, 30% vaped daily, 50% used e-cigarettes
frequently (10+ days/month), and 20% used them occasionally (<9
days/month)[5]. These findings highlight widespread e-cigarette use among
youth, with significant daily and frequent use patterns. Current
guidelines from American Thoracic society, European respiratory society,
British thoracic society recommend CT only recommended in recurrent
primary pneumothorax[3]. Infact the guidelines originally published in a
meta-analysis in 2001 showed that 90% of studies did not incorporate the
patient's age into the determination of management decisions[4], there was
no awareness about vaping when that paper was published. Given the
Increased prevalence of vaping further studies are needed to update the
clinical practice guidelines for pneumothorax. REFERENCE #1: 1. Rebuli ME,
Rose JJ, Noel A, et al. The E-cigarette or Vaping Product Use-Associated
Lung Injury Epidemic: Pathogenesis, Management, and Future Directions: An
Official American Thoracic Society Workshop Report. Annals of the American
Thoracic Society. 2023;20(1):1-17. doi:
https://doi.org/10.1513/annalsats.202209-796st REFERENCE #2: 2. Park JA,
Crotty Alexander LE, Christiani DC. Vaping and Lung Inflammation and
Injury. Annual Review of Physiology. 2021;84(1). doi:
https://doi.org/10.1146/annurev-physiol-061121-040014 REFERENCE #3: 3.
Walker S, Hallifax R, Ricciardi S, et al. Joint ERS/EACTS/ESTS clinical
practice guidelines on adults with spontaneous pneumothorax. European
Respiratory Journal. 2024;63(5):2300797. doi:
https://doi.org/10.1183/13993003.00797-20234. Baumann M, Strange C,
Heffner J, et al. Management of Spontaneous Pneumothorax* An American
College of Chest Physicians Delphi Consensus Statement consensus
conference 590 Consensus Conference. Sponsors: The ACCP (CHEST.
2001;119(2):590-602. 5. Navon L, Jones CM, Ghinai I, et al. Risk Factors
for E-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)
Among Adults Who Use E-Cigarette, or Vaping, Products - Illinois,
July-October 2019. MMWR Morbidity and Mortality Weekly Report.
2019;68(45):1034-1039. doi: https://doi.org/10.15585/mmwr.mm6845e1
DISCLOSURES: No relevant relationships by Sreekartthik Athiyaman No
relevant relationships by Manu Balusu No relevant relationships by Ishita
Gupta Kaushal No relevant relationships by Asma Jamil No relevant
relationships by Joji Joseph No relevant relationships by Makarand Madine
No relevant relationships by Nader Mahmood No relevant relationships by
Angela Matos No relevant relationships by SRI HARSHA
NARAYANA Copyright © 2025 American College of Chest Physicians

<90>
Accession Number
2041859420
Title
A RARE CASE OF FEMORAL ARTERY PLEATING DURING TRANSCATHETER AORTIC VALVE
REPLACEMENT (TAVR).
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1138-A1139),
2025. Date of Publication: 01 Oct 2025.
Author
Azhar M.; Naeem H.; Yousaf M.R.; Bangash A.M.; Hashmi A.
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: Despite the success of Transcatheter aortic valve
replacement (TAVR), the procedure can occasionally lead to rare
complications.(1) Pleating in coronary arteries is a well-known artifact
that can be alarming but can also be seen uncommonly in peripheral
vessels. We present a rare case of pleating in the common femoral artery.
CASE PRESENTATION: A 73-year-old male with a history of coronary artery
disease, atrial fibrillation, hypertension, hyperlipidemia, and
gastroesophageal reflux disease presented with shortness of breath,
orthopnea, palpitations, and chronic bilateral lower leg edema. He had
hypoxia with an oxygen saturation of 85%, initially requiring BiPAP but
later switched to a non-rebreather mask. He was admitted for acute hypoxic
respiratory distress due to congestive heart failure exacerbation and
rapid ventricular response from atrial fibrillation. An echocardiogram in
December 2023 showed an ejection fraction of 51-55%, severe aortic valve
stenosis, and moderate mitral valve regurgitation. The patient underwent
Transcatheter aortic valve replacement (TAVR) in February 2024 with a
temporary pacing wire due to intraoperative asystole. During TAVR
evaluation, angiography revealed severe pleating of the common femoral
artery with reduced downstream flow (Figure 1A), which resolved after
sheath removal (Figure 1B). Contralateral angiography showed normal
arteries and flow. DISCUSSION(S): This case highlights the
occurrence, implications, and management of common femoral artery (CFA)
pleating, a rare but clinically relevant complication of transfemoral
transcatheter aortic valve replacement (TAVR). While arterial pleating is
a well-documented phenomenon in coronary interventions, its occurrence in
the femoral artery remains underrecognized.(2) In this case, CFA pleating
resulted in reduced downstream perfusion, which was promptly resolved with
sheath removal. If unrecognized, pleating can compromise distal perfusion,
increase procedural complexity, and predispose to long-term complications
such as thrombosis or restenosis. Early detection through vigilant
intra-procedural imaging, including angiography and intravascular
ultrasound, is essential for timely intervention. CONCLUSION(S):
Recognizing pleating is crucial as it can mimic new lesions, potentially
leading to unnecessary interventions. Removing the wire or sheath can help
confirm pleating. REFERENCE #1: M A, Ghl T. Transcatheter aortic valve
replacement (TAVR): Recent updates. Prog Cardiovasc Dis [Internet]. 2021
Dec [cited 2024 Jun 19];69. Available from:
https://pubmed.ncbi.nlm.nih.gov/34800439/ REFERENCE #2: "Pleating
Artifact" in Circumflex and Left Main Coronary Arteries Resembling
Dissection During PCI [Internet]. [cited 2024 Jun 15]. Available from:
https://www.hmpgloballearningnetwork.com/site/cathlab/articles/pleating-ar
tifact-circumflex-left-main-coronary-arteries-resembling-dissection-during
-pci REFERENCE #3: Kotronias RA, Bray JJH, Rajasundaram S, Vincent F,
Delhaye C, Scarsini R, et al. Ultrasound- Versus Fluoroscopy-Guided
Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A
Systematic Review and Meta-Analysis. Circ Cardiovasc Interv [Internet].
2021 Oct [cited 2024 Jun 19]; Available from:
https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.121.010742
DISCLOSURES: No relevant relationships by Masood Azhar No relevant
relationships by Abdul Mueed Bangash No relevant relationships by Arsalan
Hashmi No relevant relationships by Hamza Naeem No relevant relationships
by Mirza Rehan Yousaf Copyright © 2025 American College of Chest
Physicians

<91>
Accession Number
2041858680
Title
NOT JUST ANOTHER COUGH: FIRST REPORTED CASE OF A GIANT PULMONARY MYXOMA IN
AN ADOLESCENT.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4991-A4992),
2025. Date of Publication: 01 Oct 2025.
Author
Byron N.; Vorla M.; Gnanasambandam B.; Sneed B.; Hou J.A.C.K.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Cancer in Women SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION: Primary
pulmonary myxomas are an extremely rare, benign tumor typically found
incidentally on x-ray or CT. We present the first case of a large primary
pulmonary myxoma in a symptomatic adolescent female. CASE PRESENTATION: A
non-smoking 19-year-old female with a past medical history of
obsessive-compulsive disorder, anxiety, and depression presented with
cough, wheezing, shortness of breath, and nasal congestion for 4-5 days.
The patient had a clinical diagnosis of bronchitis from one month prior,
which was treated with an inhaler and antibiotics. The patient had no
family history of malignancy or exposure to lung carcinogens. Chest x-ray
revealed a large possible right apex mass measuring about 10 x 6 cm (Fig
1). A subsequent computed tomography (CT) chest with contrast showed a
large pleural-based soft tissue mass that measured approximately 9.3 x 4.4
x 6.5 cm located in the right lung apex and had a bilobed morphology with
well-circumscribed margins without evidence of extra-thoracic extension
(Fig 2). A CT abdomen/pelvis showed no evidence of metastatic disease. A
biopsy of the mass confirmed a myxomatous neoplasm. The patient was
treated with three days of azithromycin 500mg and discharged after
clinical improvement with referral to a cardiothoracic surgeon to receive
a PET scan, pulmonary function testing, and surgical resection.
 DISCUSSION(S): While myxomatous tumors of the heart, specifically the
left atrium, or soft tissues are rather common, few cases of primary
pulmonary myxomas have been documented [1-2]. Existing case reports detail
patients with primary pulmonary myxomas to be in their 60s - 70s and have
a history of smoking or other malignancy, making presentation in an
adolescent essentially unheard of [1-4]. Additionally, these previously
studied patients had tumors significantly smaller than this patient,
ranging from 1 - 3 cm, in contrast to this patient's 9.3 cm tumor [1-4].
The primary treatment for pulmonary myxomas is complete surgical
resection, either through lobectomy or wedge resection depending on tumor
size and location. Video-assisted thoracoscopic surgery is also an option
for smaller, well-circumscribed tumors, while open thoracotomy may be
required for larger masses. Prognosis is typically excellent in patients
with complete excision as these tumors are generally not metastatic.
However, recurrence is possible, especially in cases of incomplete
resection. There are currently no studies that have identified the
recurrence rate of pulmonary myxomas, but it is estimated to be between 1
- 14% when there is incomplete resection [5]. Patients typically undergo
continuous surveillance with CT imaging to monitor for recurrence and help
ensure the prevention of long-term sequelae. CONCLUSION(S): Pulmonary
myxomas are rare, benign tumors that are typically incidental findings on
CT imaging in patients in their sixth and seventh decades of life. This
case represents the first report of an exceedingly rare presentation in an
adolescent that also involves a significantly larger tumor burden in
comparison to current case reports. As myxomas tend to increase in size
over time and have a chance of recurrence following resection, this
patient has a need for continued monitoring for evidence of recurrence or
metastasis following surgical removal [3]. REFERENCE #1: Chen CC, Chang
JM. Primary pulmonary myxoma. QJM. 2016 Aug;109(8):549-50. doi:
10.1093/qjmed/hcw079. Epub 2016 May 20. PMID: 27208214; PMCID: PMC4986438.
REFERENCE #2: Matsuoka Hidehito, et al. "Primary Pulmonary Myxoma." The
Annals of Thoracic Surgery, vol. 79, no. 1, Jan. 2005, pp. 329-330. doi:
10.1016/j.athoracsur.2003.08.011. REFERENCE #3: 3. Mutneja Rahul et. al.
"Pulmonary Myxoma: A rare benign tumor of the lung." CHEST, vol. 149,
issue 4, A338. Apr 2016. doi:
https://doi.org/10.1016/j.chest.2016.02.3524. Kalhor N, Marom EM, Moran
CA. Primary myxoma of the lung. Ann Diagn Pathol. 2010 Jun;14(3):178-81.
doi: 10.1016/j.anndiagpath.2009.09.009. Epub 2009 Dec 22. PMID:
20471563.5. Saputra PBT, Jannah AR, Rofananda IF, Al-Farabi MJ, Wungu CDK,
Susilo H, Alsagaff MY, Gusnanto A, Oktaviono YH. Clinical characteristics,
management, and outcomes of pulmonary valve myxoma: systematic review of
published case reports. World J Surg Oncol. 2023 Mar 20;21(1):99. doi:
10.1186/s12957-023-02984-0. PMID: 36941612; PMCID: PMC10026419.
DISCLOSURES: No relevant relationships by Neddie Byron No relevant
relationships by Bhargavee Gnanasambandam No relevant relationships by
Jack Hou No disclosure on file for Bridget Sneed No relevant relationships
by Mounica Vorla Copyright © 2025 American College of Chest
Physicians

<92>
Accession Number
2041488002
Title
Exercise-Based Prehabilitation Before Cardiac Surgery: A Systematic
Review, Meta-Analysis, Meta-Regression, and Proposal for a Clinical
Implementation Model.
Source
Journal of Clinical Medicine. 14(22) (no pagination), 2025. Article
Number: 8195. Date of Publication: 01 Nov 2025.
Author
Hurtado-Borrego J.C.; Bayonas-Ruiz A.; Bonacasa B.
Institution
(Hurtado-Borrego) Physical Medicine and Rehabilitation Service, Virgen de
la Arrixaca University Hospital, El Palmar, Murcia, Spain
(Bayonas-Ruiz, Bonacasa) Department of Physiology, Human Physiology Area,
Edificio LAIB/Departamental, Campus CC Salud-El Palmar, Campus de
Excelencia Internacional de la Universidad de Murcia, Murcia, Spain
(Bayonas-Ruiz, Bonacasa) Research Group of Physical Exercise and Human
Performance, Edificio LAIB/Departamental, El Palmar, Campus de Excelencia
Internacional de la Universidad de Murcia, Murcia, Spain
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Major cardiac surgery is associated with a high
rate of postoperative complications, particularly in older and frail
patients. Prehabilitation-defined as a preoperative intervention based on
structured exercise-aims to enhance patients' physiological and functional
reserve before surgery. To evaluate the effectiveness of prehabilitation
programs on functional capacity and postoperative complications in cardiac
surgery and to propose a clinical exercise-based intervention model
tailored to these patients. Method(s): A systematic search was
conducted in PubMed, Cochrane, PEDro, and LILACS (2005-2025). Randomized
controlled trials investigating preoperative exercise interventions in
adults undergoing cardiac surgery were included. Outcomes assessed
included functional measures (6-Minute Walk Test [6MWT], Timed Up and Go
test [TUG], maximal oxygen uptake [VO<inf>2</inf>max], maximal inspiratory
pressure [MIP]), frailty (Clinical Frailty Scale [CFS], Essential Frailty
Toolset [EFT]), postoperative complications and quality of life.
 Result(s): Nine studies comprising a total of 873 patients were
included. Prehabilitation significantly improved functional capacity
(6MWT: +52.4 m; p < 0.001), reduced respiratory complications (pneumonia,
atelectasis) and shortened hospital stay (-15.2 h; p < 0.001). The
greatest benefits were observed in multimodal programs lasting >=4 weeks.
 Conclusion(s): Exercise-based prehabilitation is an effective and
safe strategy in patients awaiting cardiac surgery. Its systematic
implementation should be considered as part of the perioperative pathway,
reinforcing the role of exercise as a therapeutic tool in this clinical
context. Copyright © 2025 by the authors.

<93>
Accession Number
649323960
Title
Pregabalin versus dexmedetomidine for prevention of delirium after cardiac
surgery: a randomized double-blind non-inferiority trial.
Source
Minerva anestesiologica. (no pagination), 2025. Date of Publication: 26
Nov 2025.
Author
Morsy I.; Bakr D.M.; Abdelwahab E.H.; Abo Elkhier A.E.; Abdallah M.K.;
Rehab O.M.
Institution
(Morsy, Abdelwahab, Abo Elkhier, Abdallah) Department of Anesthesiology,
Surgical Intensive Care and Pain Management, Faculty of Medicine, Tanta
University, Egypt
(Bakr) Anesthesiology, Surgical Intensive Care and Pain Management
Department, Faculty of Medicine, Helwan University, Egypt
(Rehab) Department of Anesthesiology, Surgical Intensive Care and Pain
Management, Faculty of Medicine, Tanta University, Egypt
Abstract
BACKGROUND: The incidence of postoperative delirium (POD) has been
reported to be up to 53% following cardiac surgery. This trial aimed to
determine the effect of perioperative administration of pregabalin versus
dexmedetomidine (DEX) on the POD incidence in elderly patients planned for
cardiac surgery, together with other secondary outcome measures. We
hypothesized that pregabalin, with its sedative analgesic effects, would
be non-inferior to DEX regarding POD prevention. METHOD(S): This
randomized, double-blind, parallel-controlled, non-inferiority trial was
conducted on 60 elderly cases planned for cardiac surgery. The cases were
randomly assigned equally into a pregabalin group (group P) and DEX group
(group D). The non-inferiority margin was set to 20%. The primary outcome
was the POD incidence. Secondary endpoints included analgesic profile,
sedation scale, and adverse events. RESULT(S): Pregabalin was
non-inferior to DEX regarding the reduction in the incidence of POD
(17.86% vs. 21.43%; risk difference, -3.6%; two-sided 95% CI, - 24.25% to
17.41%; meeting non-inferiority criteria). POD onset and duration showed
an insignificant difference between the groups. The total morphine
consumption in the first 48 hours after surgery was significantly lower in
group P (25.64+/-7.04 mg) than in group D (34.66+/-9.25 mg; 95% CI, -13.42
to -4.61; P=0.0001). Both groups were insignificantly different regarding
the visual analog scale score, sedation agitation scale measurements,
recovery time, and adverse events. CONCLUSION(S): Pregabalin is
non-inferior to DEX in terms of delirium prevention after cardiac
surgeries with comparable sedative effects, but it has a superior
analgesic profile in the form of a significantly lower 48-hour opioid
dose.

<94>
Accession Number
2041377203
Title
Fractional Flow Reserve to Guide Revascularization in Patients With
Coronary Artery Disease Undergoing TAVR.
Source
JACC: Cardiovascular Interventions. 18(23) (pp 2925-2936), 2025. Date of
Publication: 08 Dec 2025.
Author
Jorgensen T.H.; Engstrom T.; Jabbari R.; Glinge C.; Sabbah M.; Veien K.T.;
Niemela M.; Freeman P.; Linder R.; Sorensen R.; Holmvang L.; Ioanes D.;
Terkelsen C.J.; Ellert-Gregersen J.; Christiansen E.; Eftekhari A.;
Piuhola J.; Kajander O.; Koul S.; Savontaus M.; Karjalainen P.;
Sondergaard L.; De Backer O.; Lonborg J.
Institution
(Jorgensen, Engstrom, Jabbari, Glinge, Sabbah, Sorensen, Holmvang, De
Backer, Lonborg) Department of Cardiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Veien, Ellert-Gregersen) Department of Cardiology, Odense University
Hospital, Odense, Denmark
(Niemela, Piuhola) Research Unit of Biomedicine and Internal Medicine,
Medical Research Center Oulu, University of Oulu and Oulu University
Hospital, Oulu, Finland
(Freeman, Eftekhari) Department of Cardiology, Aalborg University
Hospital, Aalborg, Denmark
(Linder) Department of Medicine, Karolinska Institute, Stockholm, Sweden
(Linder) Division of Cardiovascular Medicine, Department of Clinical
Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm,
Sweden
(Ioanes) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Terkelsen, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Terkelsen) Danish Heart Foundation, Copenhagen, Denmark
(Kajander) Heart Hospital, Tampere University Hospital, Wellbeing Services
County of Pirkanmaa, Tampere, Finland
(Kajander) Faculty of Medicine and Health Technology, Tampere University,
Tampere, Finland
(Koul) Department of Cardiology, Clinical Sciences, Lund University, Skane
University Hospital, Lund, Sweden
(Savontaus) Heart Center, Turku University Hospital, Turku, Finland
(Karjalainen) Heart and Lung Center, Helsinki University Hospital and
Helsinki University, Helsinki, Finland
(Sondergaard) Abbott Cardiovascular, Santa Clara, CA, United States
(De Backer) Department of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Background The prognostic value of fractional flow reserve (FFR) in
assessing coronary stenosis before transcatheter aortic valve replacement
(TAVR) is unclear. Objectives The aim of this study was to evaluate
cardiovascular risks associated with significant and nonsignificant FFR
values of coronary stenosis prior to TAVR. Methods Patients were enrolled
from the NOTION-3 (Nordic Aortic Valve Intervention-3) randomized trial
and registry, including those with severe aortic stenosis scheduled for
TAVR and >=50% coronary stenosis. Patients with FFR <=0.80 or stenosis
>=90% were randomized to conservative therapy (FFR <=0.80 conservative
group) or percutaneous coronary intervention (PCI; FFR <=0.80 PCI group).
Those with FFR >0.80 were included in the registry (FFR >0.80 defer
group). Outcomes were cardiovascular death, myocardial infarction, and/or
urgent revascularization through 36 months. Results Of 587 patients, 232
were in the FFR <=0.80 conservative group, 220 in the FFR <=0.80 PCI
group, and 135 in the FFR >0.80 defer group. The cumulative incidence
rates of cardiovascular death, myocardial infarction, or urgent
revascularization were 21.6%, 11.5%, and 10.5%, respectively ( P = 0.003).
Excess risk in the FFR <=0.80 conservative group was due mainly to higher
myocardial infarction and urgent revascularization rates compared with the
other groups. At a coronary lesion level, revascularization occurred in
12.6% of conservatively treated FFR <=0.80 segments vs 1.3% of PCI-treated
FFR <=0.80 segments and 0.9% of deferred FFR >0.80 segments ( P < 0.0001).
Conclusions Conservative management of FFR <=0.80 lesions was linked to
higher cardiovascular risk compared with either PCI of FFR <=0.80 lesions
or deferral of FFR >0.80 lesions, which had similar outcomes. These
findings support an FFR threshold of 0.80 to guide coronary
revascularization in patients undergoing TAVR. (Revascularization in
Patients Undergoing Transcatheter Aortic Valve Implantation [NOTION-3];
NCT03058627 ) Copyright © 2025 American College of Cardiology
Foundation.

<95>
Accession Number
2039714758
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
for patients with left ventricular systolic dysfunction: A meta-analysis.
Source
Asian Journal of Surgery. 48(12) (pp 7353-7355), 2025. Date of
Publication: 01 Dec 2025.
Author
Cao S.; Shen Y.; Li D.
Institution
(Cao) Department of Cardiology, Hangzhou Xiaoshan Hospital of Traditional
Chinese Medicine, Zhejiang, Hangzhou, China
(Shen) Department of Surgery, Hangzhou Xiaoshan Hospital of Traditional
Chinese Medicine, Zhejiang, Hangzhou, China
(Li) Department of Cardiology, The First Affiliated Hospital of Henan
University of Science & Technology, Luoyang Key Laboratory of
Cardiovascular Science, Henan Provincial Key Laboratory of Cardiovascular
Disease Medicine, Henan, Luoyang, China
Publisher
Elsevier (Singapore) Pte Ltd

<96>
Accession Number
649321842
Title
The Economics of Cardiac Rehabilitation in North, Central, and South
America: A Narrative Review.
Source
The Canadian journal of cardiology. (no pagination), 2025. Date of
Publication: 06 Nov 2025.
Author
Decker S.R.R.; Kazi D.S.
Institution
(Decker) Richard A. and Susan F. Smith Center for Outcomes Research, Beth
Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of
Medicine (Cardiology), Harvard Medical School, Boston, Massachusetts, USA;
Department of Internal Medicine, Moinhos de Vento Hospital, Porto Alegre,
Brazil. Electronic address: https://x.com/SrgioDecker
(Kazi) Richard A. and Susan F. Smith Center for Outcomes Research, Beth
Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of
Medicine (Cardiology), Harvard Medical School, Boston, Massachusetts, USA
Abstract
Cardiac rehabilitation (CR) is an effective strategy for the secondary
prevention of cardiovascular disease in individuals living with ischemic
heart disease or heart failure, and among patients who have recently
undergone cardiovascular surgery. Although CR is recommended by clinical
guidelines and typically covered by payers, its uptake has been low. This
is in part because of substantial economic barriers to accessing CR.
Understanding the economics of CR from the perspective of various
stakeholders -including patients, clinicians, health systems, and payers -
is critical to developing strategies that optimize CR supply and demand,
and increase uptake among populations most likely to benefit from this
therapy. In this review, we summarize the currently available evidence,
highlight current knowledge gaps, and identify key questions that should
be prioritized in future research to guide the implementation of CR
delivery. Copyright © 2025 The Authors. Published by Elsevier
Inc. All rights reserved.

<97>
Accession Number
2041908231
Title
Economic Outcomes and Quality of Life After CABG or PCI for Multivessel
Disease: The FAME 3 Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 2025.
Author
Hlatky M.A.; Ding V.Y.; Zimmermann F.M.; Piroth Z.; Davidavicius G.;
Mansour S.; Kharbanda R.; Jokhaji F.; Oldroyd K.G.; Wendler O.; Reardon
M.J.; Sreckovic M.; Yeung A.C.; Pijls N.H.J.; De Bruyne B.; Desai M.;
Fearon W.F.
Institution
(Hlatky, Yeung, Fearon) Division of Cardiovascular Medicine and Stanford
Cardiovascular Institute, Stanford University, Stanford, CA, United States
(Hlatky) Department of Health Policy, Stanford University, Stanford, CA,
United States
(Ding, Desai) Quantitative Sciences Unit, Stanford University, Stanford,
CA, United States
(Zimmermann) St Antonius Hospital, Nieuwegein, Netherlands
(Zimmermann, Pijls) Catharina Hospital, Eindhoven, Netherlands
(Piroth) Gottsegen National Cardiovascular Center, Budapest, Hungary
(Davidavicius) Clinic of Cardiac and Vascular Diseases, Institute of
Clinical Medicine, Vilnius University, Lithuania and Vilnius University
Hospital Santaros Klinikos, Vilnius, Lithuania
(Mansour) Centre Hospitalier de l'Universite de Montreal, Montreal, QC,
Canada
(Kharbanda) Oxford University Hospital NHS Trust, Oxford, United Kingdom
(Jokhaji) Department of Clinical Sciences, Danderyd University Hospital
and Karolinska Institutet, Stockholm, Sweden
(Oldroyd) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Wendler) Cleveland Clinic London, London, United Kingdom
(Reardon) Houston Methodist Hospital, Houston, TX, United States
(Sreckovic) Department of Cardiology, University Clinical Centre
Kragujevac, University of Kragujevac, Kragujevac, Serbia
(De Bruyne) Cardiovascular Center Aalst, Aalst, Belgium
(De Bruyne) Lausanne University Centre Hospital, Lausanne, Switzerland
(Fearon) VA Palo Alto Health Care System, Palo Alto, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Previous studies have found coronary artery bypass grafting
(CABG) to be cost-effective compared with percutaneous coronary
intervention (PCI) among patients with multivessel coronary artery disease
(CAD), but their comparative effectiveness and economic outcomes may have
changed. Objective(s): This study sought to compare the economic and
quality of life outcomes of CABG vs PCI and determine their
cost-effectiveness in the FAME (Fractional Flow Reserve vs Angiography for
Multivessel Evaluation) 3 randomized trial. Method(s): FAME 3
randomly assigned 1,500 patients with 3-vessel CAD to either CABG or
fractional flow reserve-guided PCI using zotarolimus drug-eluting stents.
We documented resource use and quality of life over 5 years of follow-up.
We calculated costs by applying Medicare reimbursement rates to resources
used, assessed quality of life using the EuroQOL EQ-5D, calculated
quality-adjusted life-years (QALYs) from EQ-5D utility values, and used
multivariable regression to compare outcomes by treatment assignment. We
calculated the incremental cost-effectiveness ratio based on 5-year
outcomes and also on projected life expectancies, and assessed its
variability in 10,000 bootstrap replications. Result(s): Cumulative
costs over 5 years were 30% higher in patients assigned to CABG (95% CI:
16%-46%; P < 0.001). QALYs over 5 years did not differ significantly
between the PCI (4.05 +/- 0.84) and CABG groups (4.03 +/- 0.82), although
EQ-5D scores improved more rapidly after PCI. Patients <65 years of age at
enrollment assigned to PCI were more likely to be employed at 5 years (56%
vs 47%; P = 0.025). PCI had greater economic value than CABG over 5 years,
with lower costs and higher QALYs in 66% of replications, and incremental
cost-effectiveness ratios for CABG above the $150,000/QALY benchmark in
98% of bootstrap replications. These findings were essentially unchanged
in several lifetime projections based on the outcomes documented within
the trial follow-up period. Conclusion(s): Fractional flow
reserve-guided PCI using zotarolimus drug-eluting stents provides
significantly better long-term value than CABG for treatment of patients
with multivessel CAD, with equivalent clinical outcomes at substantially
lower cost. Copyright © 2025

<98>
Accession Number
2037877489
Title
TO WITHHOLD, OR NOT TO WITHHOLD: THAT IS THE QUESTION - PERIOPERATIVE RAAS
INHIBITORS IN NON-CARDIAC SURGERY:.
Source
American Journal of Kidney Diseases. Conference: National Kidney
Foundation 2025 Spring Clinical Meetings. Boston United States. 85(4
Supplement 1) (pp S162), 2025. Date of Publication: 01 Apr 2025.
Author
Haddad I.; Belal A.; Koratala A.; Kazory A.
Institution
(Haddad, Belal, Kazory) Division of Nephrology, University of Florida
(Koratala) Division of Nephrology, Medical College of Wisconsin
Publisher
W.B. Saunders
Abstract
A significant subset of patients undergoing major surgery have a history
of hypertension (HTN), diabetes, or heart failure (HF) and are often
treated with a renin-angiotensin-aldosterone system inhibitor (RAASi). The
optimal strategy for managing these medications before surgery remains
unknown. We sought to explore contemporary data comparing the two
strategies of withholding or continuing these agents in non-cardiac
surgery. Articles cited in the PubMed database were searched using the
keywords "surgery", "RAASi", and "continuation. Available data from
clinical trials published between January 2014 and November 2024 were
included. The studies were selected if they compared the two strategies of
continuing or withholding RAASi in elective non-cardiac surgery. Pertinent
data on clinical and laboratory parameters (e.g. intra-operative
hypotension or post-operative HTN, acute kidney injury (AKI), and HF) were
extracted and reviewed. A total of 10 studies (5 randomized controlled
trials and 5 cohorts) with 56,592 participants with a mean age of 67 were
included (27,230 withheld, 29,362 continued). The mean age was 67; 18.4%
had a history of coronary artery disease, and 6.3% had HF. Post-op AKI was
reported in 14.6% and 15% of patients in the withheld and continued
groups, respectively, while the incidence of worsening HF was comparable
at 4.7% and 4.3%. Although there was substantial variation across studies
in the explored outcomes and follow-up duration, only one study reported
an increased risk of AKI in the continued RAASi group. Mortality was less
than 1% in both groups and was similar for the two strategies. Most
studies that examined blood pressure changes reported an increased risk of
hypotension with RAASi continuation. While RAASi use is common in a
significant subset of high-risk patients, such as those with diabetes,
HTN, and HF, significant knowledge gaps persist regarding its management
before major non-cardiac surgeries. The findings of our study indicate
that while several potential complications have been attributed to the
peri-operative continuation of RAASi, there is little evidence that
withholding it would confer significant risk. Copyright © 2024
Elsevier Ireland Ltd

<99>
Accession Number
2036993028
Title
Cardiac endocrine function an exciting opportunity for new targeted
therapies.
Source
American Journal of the Medical Sciences. Conference: 2025 Southern
Regional Meeting. InterContinental Hotel, New Orleans United States.
369(Supplement 1) (pp S357-S358), 2025. Date of Publication: 01 Feb 2025.
Author
Keesee J.M.; Shah V.
Institution
(Keesee, Shah) Grand Strand Medical Center/Mercer University, Murrells
Inlet, SC, United States
Publisher
Elsevier B.V.
Abstract
Purpose: Neprilysin inhibitors are one of largest breakthroughs in medical
management of heart failure of the best couple decades. Their primary
mechanism of action is thought to be through decreased natriuretic peptide
breakdown resulting in improved volume control. New studies have shown
that even in patients with end stage renal disease, neprilysin inhibitors
appear to improve both systolic and diastolic cardiac function. The
purpose of this abstract is to examine new evidence on cardiac endocrine
signaling and how this new data might be used to generate novel treatments
for hypertension and heart failure. Method(s): This abstract paper
summarizes the quantitative and qualitative findings obtained from several
landmark publications including meta-analysis, cohort analysis, and RCTs
to examine structural changes in the heart, the utility of Cardiac MRI to
track structural changes, and how hormonal changes associated with cardiac
structural changes may present a new pathway for the future of targeted
treatment. Result(s): Studies have shown that neprilysin inhibitors
improve both diastolic and systolic function even in ESRD patients. Two
new randomized controlled trials, LAA Homeostasis 1 and 2, examined
outcomes of left atrial appendage occlusion (LAAO) devices. The data
demonstrates that modifications to cardiac structure has long term impacts
on not only ANP and BNP, but also many other signaling hormones, including
endothelin, norepinephrine, epinephrine, and leptin. Based on this data it
appears that changes in cardiac structure leads to a decrease in endocrine
signaling which results in a decrease in RAAS activation and in systemic
blood pressure through an as of yet unidentified pathway. New UK biobank
data examining cardiac MRI in over 30,000 patients showed that specific
structural changes are associated with conditions such as high blood
pressure and with changes impacting specific groups of people differently.
 Conclusion(s): The efficacy of neprilysin inhibitors to treat heart
failure in ESRD patients demonstrates that unidentified pathways likely
exist by which the heart regulates RAAS activity and blood pressure. LAA
Homeostasis 1 and 2 trials support this by demonstrating that even in long
term follow up controlled structural changes to the heart result in long
term endocrine modification and reduction in RAAS activity. The question
however remains how to further examine this pathway and how to prevent
structural changes or cardiac remodeling associated with long term
disorders such as hypertension that predispose patients to conditions such
as heart failure or arrhythmias. Large online databases such as the UK
Biobank provide a unique resource which may be helpful in determining the
efficacy of individualized treatment for high blood pressure to prevent
cardiac remodeling. Additionally, the use of UK biobank data including
cardiac MRI, subsequent labs, and treatment may provide data to further
examine this, as of yet unidentified cardiac endocrine
pathway. Copyright © 2025 Southern Society for Clinical
Investigation. Published by Elsevier Inc. All rights are reserved,
including those for text and data mining, AI training, and similar
technologies.. All rights reserved.

<100>
Accession Number
2041858997
Title
RARE LIFE-THREATENING HEMOPTYSIS IN YOUNG MALE WITH FONTAN PHYSIOLOGY FOR
CONGENITAL HYPOPLASTIC LEFT HEART SYNDROME.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A895-A896), 2025.
Date of Publication: 01 Oct 2025.
Author
Ordookhanian C.; Lee H.S.; Abdelmaksoud A.; Tabibian 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 Fontan procedure, performed in 1968 by Dr. Francis
Fontan is a three-phase surgery for congenital heart defects like
hypoplastic left heart syndrome and tricuspid atresia [1]. Surgical
intervention begins with the Norwood procedure in the newborn period,
followed by the Glenn procedure, and concludes with the Fontan procedure
between ages two through four, once pulmonary vascular resistance
decreases [2]. The Fontan procedure creates a circulatory pathway where
oxygenated blood reaches the body without utilizing the underdeveloped
ventricle. A Fontan baffle connects venous drainage from the superior and
inferior vena cava directly to the pulmonary arteries, enabling blood flow
into the lungs. The right atrium then receives oxygenated blood, which
enters the single ventricle via the pulmonary vein to be pumped to the
body. This ensures deoxygenated blood flows directly to the lungs for
oxygenation before being delivered to the systemic circulation, bypassing
the nonfunctional ventricle [3]. CASE PRESENTATION: A 24-year-old male
with congenital hypoplastic left heart syndrome, status post three
corrective surgeries (at 3 months, 1.5 years, and 3 years) and pulmonary
hypertension, presented with chest pain and large-volume hemoptysis. He
had a two-week history of cough and weakness. In the ED, he lost about 1 L
of blood. His vitals showed a heart rate of 79, blood pressure of 161/90,
and oxygen saturation of 86-90% on room air, improving with supplemental
oxygen. Labs were unremarkable except for mild hemoconcentration. ECG
showed atrial fibrillation with rapid ventricular response, and CT
angiogram identified a left lower lobe arteriovenous malformation (AVM).
Suspected bleeding sources included this malformation or an aortopulmonary
collateral vessel. He received nebulized tranexamic acid, antibiotics, and
later required blood transfusion. Due to re-bleeding risk, he underwent
successful left bronchial artery embolization to reduce flow and pressure
to the AVM. Post-procedure, hemoptysis resolved, and he was transferred to
his primary cardiac center for further management. DISCUSSION(S): The
Fontan procedure is not curative but significantly extends life for those
with congenital hypoplastic left heart syndrome, who might otherwise not
survive infancy. Ten-year survival rates reach 79%, with 76% surviving 25
years post-procedure, many live into their fourth or fifth decades [4].
However, Fontan failure and heart failure remain as the leading causes of
death, accounting for 40% of post-procedure mortality. Insufficient Fontan
circulation leads to venous congestion, elevated central venous pressure,
and reduced cardiac output, which can cause fatal organ failure [5].
Arrhythmias, including atrial tachycardia and fibrillation, are also
common [6]. Our case describes a young male presenting with hemoptysis due
to a rare Fontan complication-arteriovenous malformation (AVM), occurring
in ~3% of patients [7]. AVMs form when high-pressure arterial circulation
connects to fragile venous structures, leading to rupture. Management
includes supportive care, blood transfusion, and either direct ablation or
reducing blood flow to the affected vasculature [8]. CONCLUSION(S):
The Fontan procedure prolongs life for patients with fatal congenital
abnormalities but causes significant cardiovascular changes. While common
complications are well-documented, we present a rare case of arteriovenous
malformation bleeding, leading to recurrent hemoptysis, resolved only
through endovascular flow reduction to restore hemodynamic stability.
REFERENCE #1: [1] Gewillig M, Brown SC. The Fontan circulation after 45
years: update in physiology. Heart. 2016 Jul 15;102(14):1081-6. doi:
10.1136/heartjnl-2015-307467. Epub 2016 May 24. PMID: 27220691; PMCID:
PMC4941188.[2] Mainwaring RD, Reddy VM, Hanley FL. Completion of the
Three-Stage Fontan Pathway Without Cardiopulmonary Bypass. World J Pediatr
Congenit Heart Surg. 2014 Jul;5(3):427-33. doi: 10.1177/2150135114536908.
PMID: 24958046.[3] Hagler DJ, Miranda WR, Haggerty BJ, Anderson JH,
Johnson JN, Cetta F, Said SM, Taggart NW. Fate of the Fontan connection:
Mechanisms of stenosis and management. Congenit Heart Dis. 2019
Jul;14(4):571-581. doi: 10.1111/chd.12757. Epub 2019 Feb 25. PMID:
30801968; PMCID: PMC6850024. REFERENCE #2: [4] Poh CL, d'Udekem Y. Life
After Surviving Fontan Surgery: A Meta-Analysis of the Incidence and
Predictors of Late Death. Heart Lung Circ. 2018 May;27(5):552-559. doi:
10.1016/j.hlc.2017.11.007. Epub 2017 Dec 20. PMID: 29402692.[5] Lubert AM,
Cedars A, Almond CS, Amdani S, Conway J, Friedland-Little JM, Gajarski RJ,
Kindel SJ, Lorts A, Morales DLS, O'Connor MJ, Peng DM, Rosenthal DN, Smyth
L, Sutcliffe DL, Schumacher KR. Considerations for Advanced Heart Failure
Consultation in Individuals With Fontan Circulation: Recommendations From
ACTION. Circ Heart Fail. 2023 Feb;16(2):e010123. doi:
10.1161/CIRCHEARTFAILURE.122.010123. Epub 2023 Feb 14. PMID: 36786204.[6]
Laubham M, Blais B, Kamp AN. Atrial Arrhythmias in Adults with Fontan
Palliation. Cardiol Ther. 2023 Sep;12(3):473-487. doi:
10.1007/s40119-023-00326-5. Epub 2023 Jul 26. PMID: 37495769; PMCID:
PMC10423191. REFERENCE #3: [7] Bedard E, Lopez S, Perron J, Houde C,
Couture C, Vaillancourt R, Cote JM, Delisle G, LeBlanc MH, Chetaille P,
Lamarre A, Rodes-Cabau J. Life-threatening hemoptysis following the Fontan
procedure. Can J Cardiol. 2008 Feb;24(2):145-7. doi:
10.1016/s0828-282x(08)70572-5. PMID: 18273490; PMCID: PMC2644573.[8]
Kavarana MN, Jones JA, Stroud RE, Bradley SM, Ikonomidis JS, Mukherjee R.
Pulmonary arteriovenous malformations after the superior cavopulmonary
shunt: mechanisms and clinical implications. Expert Rev Cardiovasc Ther.
2014 Jun;12(6):703-13. doi: 10.1586/14779072.2014.912132. Epub 2014 Apr
23. PMID: 24758411; PMCID: PMC4410694. DISCLOSURES: No relevant
relationships by Ahmed Abdelmaksoud No relevant relationships by HAN SHIN
LEE No relevant relationships by Christ Ordookhanian No relevant
relationships by Benjamin Tabibian Copyright © 2025 American
College of Chest Physicians

<101>
Accession Number
2041857670
Title
STARVED HEART: A CASE OF ANOREXIA NERVOSA LEADING TO PERICARDIAL
TAMPONADE.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A670-A671), 2025.
Date of Publication: 01 Oct 2025.
Author
Rattan K.; Pappas S.; Hamza H.; Allison E.L.; Bukharovich I.N.N.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Systemic Clues, Cardiac Consequences: Rare Causes of
Tamponade and Heart Failure SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/21/2025 12:30 pm - 01:15 pm INTRODUCTION: Anorexia
nervosa (AN) is a severe psychiatric disorder characterized by an intense
fear of weight gain, distorted body image, and self-imposed starvation,
leading to significant malnutrition and multisystem complications [1].
Cardiac manifestations, though rare, can be life-threatening. This case
describes a 21-year-old female with restrictive AN who presented with
syncope and was found to have a large pericardial effusion with tamponade
physiology. CASE PRESENTATION: A 21-year-old female with no past medical
history presented to the emergency department after a witnessed syncopal
episode with associated shortness of breath. Initial vital signs were
significant for a blood pressure of 90/66 mmHg, heart rate of 56 beats per
minute, and a body mass index (BMI) of 16.82 kg/m2. During the assessment,
the patient endorsed an approximate 100-pound intentional weight loss over
the last 12 months due to a highly restrictive diet consisting of beans,
eggs, coffee, and water and daily use of Phentermine weight loss
supplement. Initial ECG showed sinus bradycardia with low-voltage QRS
complexes. A subsequent transthoracic echocardiogram revealed a large
pericardial effusion with right ventricular chamber collapse. She was
emergently taken to the operating room for pericardial window creation and
biopsy, with subsequent draining of 500cc of straw-colored fluid.
Laboratory testing to determine the etiology of her pericardial effusion
returned positive for Coxsackie B1 to B6 viruses and prior Parvovirus B19
infection. Autoimmune screening, vitamin deficiency testing, and
pericardial biopsy all returned unremarkable. DISCUSSION(S): AN is a
severe psychiatric disorder characterized by an intense fear of gaining
weight, resulting in significantly low body weight for the patient's age,
sex, developmental stage, and physical health. Hospitalization may be
necessary when complications arise such as profound hypotension,
electrolyte abnormalities, arrhythmias, severe bradycardia, suicide risk,
or a BMI of <= 15. This case involves a 21-year-old female admitted for
cardiovascular complications of AN. AN is associated with severe
malnutrition and immunodeficiency, increasing susceptibility to
infections, including viral infections such as Coxsackie B viruses and
Parvovirus B19. These viruses are known to cause myocarditis and
pericarditis, potentially leading to pericardial effusion [2,3].
Malnutrition in AN exacerbates the severity of these infections and may
enhance the virulence of Coxsackie B viruses, contributing to severe
cardiac complications. Furthermore, the impaired immune response in
patients with AN may delay infection recognition and treatment,
heightening the risk of complications such as pericardial effusion [4]. In
addition to the combination of immunodeficiency and increased
susceptibility to viral infections, severe malnutrition in AN can also
cause hypoalbuminemia, reducing oncotic pressure and promoting fluid
shifts into the pericardial space, further contributing to pericardial
effusion [5,6]. These elements underscore the complex pathway by which AN
may lead to pericardial effusion and resultant cardiac tamponade,
highlighting the importance of early detection and management of cardiac
complications in this population. CONCLUSION(S): This case highlights
the need for vigilance regarding cardiac manifestations in patients with
AN. Routine echocardiography should be considered namely in patients who
present with syncope. Prompt recognition of hemodynamic instability and
timely echocardiographic assessment is crucial to the diagnosis of
life-threatening conditions such as cardiac tamponade. REFERENCE #1: Attia
E. Anorexia nervosa: current status and future directions. Annu Rev Med.
2010;61:425-35. doi: 10.1146/annurev.med.050208.200745. PMID: 19719398.
REFERENCE #2: Badrinath A, Bhatta S, Kloc A. Persistent viral infections
and their role in heart disease. Front Microbiol. 2022 Nov 24;13:1030440.
doi: 10.3389/fmicb.2022.1030440. PMID: 36504781; PMCID: PMC9730422.
REFERENCE #3: Ho HT, Peischard S, Strutz-Seebohm N, Seebohm G. Virus-Host
Interactions of Enteroviruses and Parvovirus B19 in Myocarditis. Cell
Physiol Biochem. 2021 Nov 18;55(6):679-703. doi: 10.33594/000000470. PMID:
34791861.4) Brown RF, Bartrop R, Beumont P, Birmingham CL. Bacterial
infections in anorexia nervosa: delayed recognition increases
complications. Int J Eat Disord. 2005 Apr;37(3):261-5. doi:
10.1002/eat.20135. PMID: 15822085.5) Sachs KV, Harnke B, Mehler PS, Krantz
MJ. Cardiovascular complications of anorexia nervosa: A systematic review.
Int J Eat Disord. 2016 Mar;49(3):238-48. doi: 10.1002/eat.22481. Epub 2015
Dec 29. PMID: 26710932.6) Smythe J, Colebourn C, Prisco L, Petrinic T,
Leeson P. Cardiac abnormalities identified with echocardiography in
anorexia nervosa: systematic review and meta-analysis. Br J Psychiatry.
2021 Sep;219(3):477-486. doi: 10.1192/bjp.2020.1. PMID: 32026793.
DISCLOSURES: No relevant relationships by Elizabeth Allison No relevant
relationships by Inna Bukharovich No relevant relationships by Hamza Hamza
No relevant relationships by Stephanie Pappas No relevant relationships by
Keston Rattan Copyright © 2025 American College of Chest
Physicians

<102>
Accession Number
2041858571
Title
A CASE OF ACUTE SUBMASSIVE PULMONARY EMBOLISM WITH EXTENSIVE UPPER
EXTREMITY DEEP VEIN THROMBOSIS: PAGET-SCHROETTER SYNDROME.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A407-A408), 2025.
Date of Publication: 01 Oct 2025.
Author
Redemann M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Surgery Case Report Posters (C) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Paget-Schroetter syndrome, also known as effort thrombosis,
is a rare form of venous thoracic outlet syndrome (vTOS) that occurs due
to repetitive upper extremity exertion leading to axillosubclavian vein
thrombosis. It primarily affects young, otherwise healthy individuals
engaged in activities involving significant arm movement. We present a
case of acute submassive pulmonary embolism (PE) associated with extensive
right upper extremity deep vein thrombosis (RUE DVT) in a patient with a
history of recent heavy lifting and weight training, raising suspicion for
underlying Paget-Schroetter syndrome. CASE PRESENTATION: A patient
presented with acute right upper extremity swelling and discomfort
following recent strenuous physical activity, including heavy luggage
handling and weightlifting. There was no history of prolonged
immobilization, intravenous drug use, or steroid/hormone use. Venous
duplex ultrasonography demonstrated thrombus in the right lateral
subclavian, axillary, brachial, and basilic veins, as well as the cephalic
vein in the mid/upper arm, while the right internal jugular vein remained
patent.Further evaluation with CT pulmonary angiography revealed a right
middle lobe subsegmental pulmonary embolism without radiographic evidence
of right heart strain. Electrocardiography showed normal sinus rhythm, and
the patient remained hemodynamically stable and non-hypoxic, classifying
as low risk per the Pulmonary Embolism Severity Index (PESI). Given the
extensive upper extremity thrombosis in the absence of traditional risk
factors, Paget-Schroetter syndrome was considered.Management and
Outcome:The patient was initiated on intravenous heparin infusion and
underwent interventional radiology (IR)-guided venography with suction
thrombectomy of the right arm deep vein thrombosis. An infusion catheter
was left in place due to moderate residual thrombus. Repeat interventions
over the following two days included additional suction thrombectomy and
balloon angioplasty of minimal residual stenotic areas. Intraoperative
heparin was administered, with recommendations for continued therapeutic
anticoagulation and transition to outpatient apixaban therapy.Given the
atypical presentation and possible family history of hypercoagulability,
additional workup included screening for Prothrombin Factor II and Factor
V Leiden mutations. Outpatient hematology follow-up was advised for
further evaluation once the acute clot resolved. A referral to vascular
surgery was made for definitive assessment of venous thoracic outlet
syndrome. The patient was managed with a structured pain regimen and
instructed on the use of compression therapy to prevent post-thrombotic
syndrome. DISCUSSION(S): This case highlights the diagnostic and
therapeutic challenges of Paget-Schroetter syndrome, a rare cause of upper
extremity DVT that can lead to pulmonary embolism if unrecognized. The
lack of clear provoking factors apart from recent exertion underscores the
need for a high index of suspicion in young, active individuals presenting
with upper extremity DVT. Early recognition and intervention, including
catheter-directed thrombolysis, mechanical thrombectomy, and subsequent
evaluation for thoracic outlet decompression, are critical to prevent
recurrence and long-term complications. CONCLUSION(S): Effort
thrombosis should be considered in patients presenting with extensive
upper extremity DVT, particularly in the setting of repetitive physical
activity. Timely diagnosis and intervention can improve outcomes and
reduce the risk of recurrence. Further investigation into underlying
hypercoagulable states may be warranted in select cases. REFERENCE #1:
Karl A. Illig, Adam J. Doyle, A comprehensive review of Paget-Schroetter
syndrome, Journal of Vascular Surgery, Volume 51, Issue 6, 2010, Pages
1538-1547, ISSN 0741-5214, https://doi.org/10.1016/j.jvs.2009.12.022.
(https://www.sciencedirect.com/science/article/pii/S074152140902518X)
REFERENCE #2: Georgios Karaolanis, Constantine N. Antonopoulos, Stylianos
G. Koutsias, Alexandros Giosdekos, Efstathios K. Metaxas, Petros Tzimas,
Gert J. de Borst, George Geroulakos, A systematic review and meta-analysis
for the management of Paget-Schroetter syndrome, Journal of Vascular
Surgery: Venous and Lymphatic Disorders, Volume 9, Issue 3, 2021,Pages
801-810.e5, ISSN 2213-333X, https://doi.org/10.1016/j.jvsv.2021.01.011.
(https://www.sciencedirect.com/science/article/pii/S2213333X21000706)
REFERENCE #3: J. Ernesto Molina, David W. Hunter, Charles A. Dietz,
Paget-Schroetter syndrome treated with thrombolytics and immediate
surgery, Journal of Vascular Surgery, Volume 45, Issue 2, 2007, Pages
328-334, ISSN 0741-5214, https://doi.org/10.1016/j.jvs.2006.09.052.
(https://www.sciencedirect.com/science/article/pii/S0741521406018337)
DISCLOSURES: No relevant relationships by Maximilian
Redemann Copyright © 2025 American College of Chest Physicians

<103>
Accession Number
2041857791
Title
DON'T GO PRESSING MY HEART: A CASE OF SEVERE RIGHT ATRIAL ENLARGEMENT FROM
PECTUS EXCAVATUM.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4165-A4166),
2025. Date of Publication: 01 Oct 2025.
Author
Dunne A.; Watts T.; Gupta N.; Dash C.; Gutierrez L.; Disilvio B.E.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Mediastinum Case Report Posters (B)
SESSION TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm -
01:15 pm INTRODUCTION: Pectus excavatum is a deformity of the anterior
chest wall characterized by posterior displacement of the sternum into the
thoracic cavity. Its prevalence is estimated to be 0.4% of the adult
population. Only 11% of cardiac complications from pectus excavatum result
in right atrial (RA) dilation. If the RA dilation is not causing
significant pulmonary or cardiac compromise, it may be reasonable to treat
the patient with close follow-up and observation. CASE PRESENTATION: A
66-year-old female with a history of pectus excavatum presented to her
Cardiologist for routine follow-up of her hypertension. She complained of
shortness of breath and exercise intolerance. An echocardiogram showed a
severely dilated right atrium (RA); a significant change from a previously
normal echocardiogram performed three years earlier. A subsequent cardiac
MRI revealed heart displacement into the left hemithorax, levo-rotation of
the heart, and a posterolateral shift of the left ventricular apex.
Despite these findings, right heart catheterization showed normal
right-sided pressures, pulmonary artery pressure, wedge pressure, and
cardiac output, with no evidence of intracardiac shunting. The patient's
shortness of breath resolved without treatment, and her RA dilation is
being monitored with annual echocardiograms. DISCUSSION(S): Pectus
excavatum is a chest wall deformity that can compress or displace the
heart, potentially causing symptoms such as dyspnea, arrhythmias, cardiac
insufficiency, and, in severe cases, cardiac arrest. A 2021 study
involving 259 patients found that up to 64% of patients with pectus
excavatum were symptomatic. Treatment options are debated, but the
standard surgical approach is the Nuss procedure, which involves placing a
bar under the sternum to correct the depression. The severity of the
deformity can be assessed using the Pectus Severity Index (PSI), which is
calculated based on the chest's lateral diameter and the distance from the
sternum to the spine at the maximum depression point. A PSI greater than
3.25, along with pulmonary testing showing restrictive disease or cardiac
issues (e.g. displacement, mitral valve prolapse, and arrhythmias), may
indicate the need for surgery. However, the procedure is not without
risks, especially in adults. It can cause complications such as pain from
strain on the costal cartilage, fractures during the surgery, bar
displacement (seen in 10-20% of cases), cardiac perforation, and pleural
effusions (about 3% of cases). CONCLUSION(S): For patients with
severe RA enlargement due to pectus excavatum, close outpatient monitoring
with serial diagnostics can be an appropriate treatment approach,
particularly if there are no significant symptoms or complications from
the deformity. The decision to undergo surgery, such as the Nuss
procedure, should be carefully considered, with a thorough risk-benefit
discussion involving the patient's pulmonary, cardiology, and thoracic
surgery teams. REFERENCE #1: Biavati M, Kozlitina J, Alder AC, Foglia R,
McColl RW, Peshock RM, Kelly RE Jr, Kim Garcia C. Prevalence of pectus
excavatum in an adult population-based cohort estimated from radiographic
indices of chest wall shape. PLoS One. 2020 May 7;15(5):e0232575. doi:
10.1371/journal.pone.0232575. PMID: 32379835; PMCID: PMC7205298.S. Oezcan,
C.H. Attenhofer Jost, M. Pfyffer, C. Kellenberger, R. Jenni, C. Binggeli,
A. Faeh-Gunz, B. Seifert, C. Scharf, O. Kretschmar, E.R. Valsangiacomo
Buechel, Pectus excavatum: echocardiography and cardiac MRI reveal
frequent pericardial effusion and right-sided heart anomalies, European
Heart Journal - Cardiovascular Imaging, Volume 13, Issue 8, August 2012,
Pages 673-679, https://doi.org/10.1093/ehjci/jer284 REFERENCE #2:
Rankovic-Nicic L, Dragicevic-Antonic M, Loncar G, Petrovic M, Antonic Z,
Bojic M. Idiopathic Dilatation of the Right Atrium: Diagnosis and
Management. Tex Heart Inst J. 2023 Dec 13;50(6):e238192. doi:
10.14503/THIJ-23-8192. PMID: 38111176; PMCID: PMC10751474.Hardie W, Powell
AW, Jenkins TM, Foster K, Tretter JT, Fleck RJ, Garcia VF, Brown RL.
Ventilatory limitations are not associated with dyspnea on exertion or
reduced aerobic fitness in pectus excavatum. Pediatr Pulmonol. 2021
Sep;56(9):2911-2917. doi: 10.1002/ppul.25540. Epub 2021 Jun 25. PMID:
34143574. REFERENCE #3: Rshaidat H, Gorgov E, Collins ML, Mack SJ,
Whitehorn GL, Martin J, Meredith L, Nevler A, Okusanya OT. Complication
Rate of the Nuss Procedure in Adults and Pediatric Patients: National
Database Analysis. Ann Thorac Surg Short Rep. 2024 Apr 27;2(3):364-368.
doi: 10.1016/j.atssr.2024.04.013. PMID: 39790407; PMCID:
PMC11708489.Akhtar M, Razick DI, Saeed A, Baig O, Kamran R, Ansari U,
Sajid Z, Rahman JE. Complications and Outcomes of the Nuss Procedure in
Adult Patients: A Systematic Review. Cureus. 2023 Feb 20;15(2):e35204.
doi: 10.7759/cureus.35204. PMID: 36960268; PMCID: PMC10031548.
DISCLOSURES: No relevant relationships by Chandan Dash Speaker/Speaker's
Bureau relationship with Boehringer-Ingelheim Please note: Sept
2021-Present by Briana DiSilvio, value=Honoraria Speaker/Speaker's Bureau
relationship with AstraZeneca Please note: Jan 2023- present by Briana
DiSilvio, value=Honoraria Speaker/Speaker's Bureau relationship with
GlaxoSmithKline Please note: Jan 2024- present Added 02/26/2025 by Briana
DiSilvio, source=Web Response, value=Honoraria Speaker/Speaker's Bureau
relationship with Verona Pharma Please note: Aug 2024 - present Added
02/26/2025 by Briana DiSilvio, source=Web Response, value=Honoraria
Researcher relationship with Regeneron Please note: Oct 2023-Present Added
02/28/2025 by Briana DiSilvio, source=Web Response, value=Grant/Research
Support Researcher relationship with Boehringer-Ingelheim Please note: May
2023 - Present Added 02/28/2025 by Briana DiSilvio, source=Web Response,
value=Grant/Research Support No relevant relationships by Allison Dunne No
relevant relationships by Navneet gupta No relevant relationships by Laura
Gutierrez No relevant relationships by Tristan Watts Copyright ©
2025 American College of Chest Physicians

<104>
Accession Number
2041859173
Title
COMPARING PATENCY OF PULMONARY STENT IMPLANTATION AND BALLOON ANGIOPLASTY
IN PULMONARY VEIN STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A5946-A5947),
2025. Date of Publication: 01 Oct 2025.
Author
Khan A.; Batool I.Z.Z.A.; Siddiqui U.; Hennawi H.A.; Khan M.K.; Zohaib M.;
Khan I.A.; Ahmed Bukhari S.A.; Klugherz B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Procedures Scientific Abstract Posters (C) SESSION TYPE:
Original Investigation Posters PRESENTED ON: 10/22/2025 10:20 am - 11:05
am PURPOSE: Pulmonary vein stenosis (PVS) is an insidious diagnosis
associated with significant morbidity and mortality. Pharmacologic therapy
may suffice initially, but advanced stages demand mechanical intervention.
Pulmonary stent implantation (PSI) and pulmonary balloon angioplasty (PBA)
are common strategies, both carrying restenosis risks. This meta-analysis
compares PSI and PBA to determine the superior revascularization strategy.
 METHOD(S): We systematically searched databases until November 2023,
identifying 11 studies with 780 patients. Studies, including those
involving patients undergoing balloon angioplasty (BA) or stent
angioplasty (SA) for PVS, were selected. Case reports, editorials, and
cross-sectional studies were omitted. The primary outcome of interest in
this study was the risk of restenosis requiring intervention, defined as
the need for repeated BA or SI due to recurrent or residual stenosis of
the pulmonary circulation. The secondary outcomes of interest were 5-year
freedom from restenosis, defined as the absence of restenosis requiring
intervention at 5 years after the initial procedure, and the risk of
procedure-related complications, defined as any adverse events that
occurred during or after the procedure, including bleeding, infection,
arrhythmia, or mortality. Odds ratios (ORs) with 95% confidence intervals
(CIs) were calculated using a random-effects model. Meta-regression
analysis assessed factors like age and stent size and showed that neither
significantly affected the risk of restenosis requiring intervention.
Study quality was evaluated using the Newcastle-Ottawa scale.
 RESULT(S): PSI exhibited a lower risk of restenosis requiring
reintervention (OR 0.34, 95% CI 0.13, 0.87, p = 0.02) and significantly
higher 5-year freedom from restenosis (OR 4.42, 95% CI 1.11, 17.62, p =
0.04) compared to PBA, with no significant difference in procedure-related
complications. Meta-regression analysis showed that age and stent size
insignificantly affected restenosis risk. CONCLUSION(S): Our review
supports PSI as the preferred revascularization strategy for PVS due to
superior patency benefits and long-term outcomes, emphasizing its role as
the initial treatment choice. Still, the two interventions have no
difference in the complication rate, showing that both are safe and
well-tolerated procedures. However, this study has some limitations, such
as the need for RCTs, the heterogeneity among the studies, and the
variation in the follow-up methods. Therefore, future studies with larger
sample sizes, randomized designs, standardized protocols, and longer
follow- ups are needed to confirm and extend the findings of this study.
CLINICAL IMPLICATIONS: PVS is an uncommon yet debilitating condition that
presents significant challenges to both patients and interventionalists.
Without appropriate intervention, PVS can result in severe complications,
including heart failure, pulmonary hypertension, and potentially fatal
outcomes. The search for the best interventional strategy is getting more
intense as PVS diagnoses become more common, especially among children who
have undergone surgery for congenital heart defects. Though the restenosis
rate is generally less with stent angioplasty, there is still a lack of
consensus on which interventions-BA or stent placement-produces better
clinical results and long-term outcomes. Our study addresses this gap in
literature and compares the effectiveness and safety of these two
procedures. It aims to improve patient outcomes and care quality by
offering insightful information about which treatment strategy is best for
patients with PVS. DISCLOSURES: No relevant relationships by Syed Affan
Ahmed Bukhari No relevant relationships by Hussam Al Hennawi No relevant
relationships by Izza Batool No relevant relationships by Aamna Khan No
relevant relationships by Muhammad Khuzzaim Khan No relevant relationships
by Ibrahim Ahmed Khan No relevant relationships by Ibrahim Ahmed Khan No
relevant relationships by Bruce Klugherz No relevant relationships by
Usman Siddiqui No relevant relationships by Muhammad Zohaib Copyright
© 2025 American College of Chest Physicians

<105>
Accession Number
2041859099
Title
SEVERE BLUNT CHEST TRAUMA WITH CHEST WALL FRACTURES AND ACUTE SEVERE
TRICUSPID VALVE REGURGITATION.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A3616-A3617),
2025. Date of Publication: 01 Oct 2025.
Author
Clarke S.; Douglas G.; Yeen W.I.N.G.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (AV) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION:
Sternal fractures present alongside other thoracic injuries resulting from
blunt anterior chest wall trauma (1). Management of the fracture initially
centers around adequate pain management. Operative internal fixation of a
sternal fractures is offered in the setting of an unstable or displaced
fracture (2). We propose a pathway for the care of unstable chest wall
injuries using the case of a 26-year-old man with complex sternal
fractures, concomitant rib fractures and traumatic tricuspid valve injury.
This case highlights the importance of a complete multidisciplinary
assessment of all injuries in the chest prior to definitive operative
management of a sternal fracture (3). CASE PRESENTATION: A 26 y/o man
arrived via ambulance after an electronic scooter crash. Upon arrival he
was tachycardic with an avulsion of the right pectoralis muscle off the
fractured sternum exposing a right chest defect and herniated lung (figure
1). The Trauma surgeons performed an emergent thoracotomy, right internal
mammary artery ligation for hemorrhage control, followed by reduction and
temporary stabilization of the comminuted sternal fracture, and temporary
chest closure.He returned to the OR with Trauma surgery for definitive
repair using a plate for the sternal and rib fractures and mesh for the
chest wall defect. The following day an echocardiogram demonstrated
torrential tricuspid regurgitation with a reduced LVEF. Cardiothoracic
surgery was consulted for operative intervention. Intraoperative findings
included a flailed anterior tricuspid valve leaflet due to a complete
avulsion of the associated papillary muscle complex (figure 2). The valve
was replaced with a 33mm MITRIS RESILIA bioprosthetic valve. The
sternotomy was left open allowing for chest reimaging and a
multidisciplinary approach to chest wall reconstruction.The next day, the
cardiothoracic and trauma surgery teams performed fixation of the sternum
with multiple plates to bridge the sternal defect and stabilize the
fracture (figure 3). He was discharged home on postoperative day ten.
 DISCUSSION(S): The decision for operative management of a chest wall
injury historically relies on clinical assessment of the extent of sternal
displacement, presence of concomitant rib fractures, cardiac, and
mediastinal injuries (4). Displaced chest wall fractures carry an
increased risk for injury to other structures in the thorax (1) and should
prompt chest imaging to rule out additional thoracic injury (5). A high
energy mechanism of injury should prompt early echocardiography to assess
for structural cardiac injury such as the traumatic tricuspid
regurgitation present in our case (6). Our patient's care involved
multiple providers across specialties creating the potential for errors in
hand-off and differences in management. A planned multidisciplinary
approach could have streamlined his care. This case served as an impetus
to develop a pathway for management of chest wall injuries.
 CONCLUSION(S): Complex chest wall injuries should be managed with
multimodal pain control as part of a chest wall fracture pathway. All
concomitant injuries should be identified early to provide clear
objectives for care and avoid treatment delays. An optimal pathway would
allow space for discretion and expedited management in acutely ill
patients, with an integrated checkpoint design that permits reevaluation
as developments occur. REFERENCE #1: 1. Bentley TP, Ponnarasu S, Journey
JD. Sternal Fractures. [Updated 2024 Jun 22]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK507790/. 2. Khoriati AA,
Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg
Trauma Shock. 2013 Apr;6(2):113-6. doi: 10.4103/0974-2700.110763. PMID:
23723620; PMCID: PMC3665058. REFERENCE #2: 3. CHEAH, J. (2000).
Development and implementation of a clinical pathway programme in an Acute
Care General Hospital in Singapore. International Journal for Quality in
Health Care, 12(5), 403-412. https://doi.org/10.1093/intqhc/12.5.403 4.
Klei DS, de Jong MB, Oner FC, Leenen LPH, van Wessem KJP. Current
treatment and outcomes of traumatic sternal fractures-a systematic review.
Int Orthop. 2019 Jun;43(6):1455-1464. doi: 10.1007/s00264-018-3945-4. Epub
2018 Apr 26. PMID: 29700586; PMCID: PMC6525114. REFERENCE #3: 5. Kuo K,
Kim AM. Rib Fracture. [Updated 2023 Aug 8]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK541020/. 6. Eranki A, Villanueva C,
Wilson-Smith A, Seah P. Traumatic tricuspid valve regurgitation: A two
case series. Trauma Case Rep. 2021 Dec 23;37:100593. doi:
10.1016/j.tcr.2021.100593. PMID: 35059490; PMCID: PMC8760512. DISCLOSURES:
No relevant relationships by Shane Clarke No relevant relationships by
Geoffrey Douglas No relevant relationships by Wing Yeen Copyright
© 2025 American College of Chest Physicians

<106>
Accession Number
649318960
Title
Antithrombotic strategies and DOAC dosing following left atrial appendage
occlusion: a network meta-analysis.
Source
European heart journal. Cardiovascular pharmacotherapy. (no pagination),
2025. Date of Publication: 25 Nov 2025.
Author
Samaras A.; Karakasis P.; Feidakis A.; Giannakoulas G.; Fragakis N.;
Nielsen-Kudsk J.-E.; Freixa X.; Nair D.G.; Freeman J.V.; Bergmann M.;
Landmesser U.; Tzikas A.
Institution
(Samaras, Tzikas) School of Medicine, Faculty of Health Sciences,
Aristotle University of Thessaloniki, Thessaloniki, Greece
(Samaras, Karakasis, Fragakis, Tzikas) Second Department of Cardiology,
General Hospital 'Hippokration', Thessaloniki, Greece
(Feidakis) Department of Cardiology, Heart Center, University of Cologne,
Cologne, Germany
(Giannakoulas) First Department of Cardiology, AHEPA University Hospital
of Thessaloniki, Thessaloniki, Greece
(Nielsen-Kudsk) Department of Cardiology, Aarhus University Hospital,
Denmark
(Freixa) Department of Cardiology, Institut Cardiovascular, IDIBAPS,
Hospital Clinic of Barcelona, Barcelona, Spain
(Nair) Department of Cardiac Electrophysiology, St Bernard's Heart and
Vascular Center, Jonesboro, United States
(Freeman) Section of Cardiovascular Medicine, Yale University School of
Medicine, New Haven, United States
(Freeman) Center for Outcomes Research and Evaluation, Yale-New Haven
Hospital, New Haven, United States
(Bergmann) Department of Cardiology and Intensive Care Medicine, Asklepios
Klinik Altona, Hamburg, Germany
(Landmesser) Charite-University Medicine Berlin Corporate Member of Free
University Berlin and Humboldt-University Berlin, Berlin, Germany
(Landmesser) German Centre for Cardiovascular Research (DZHK), Partner
Site Berlin, Berlin, Germany
(Landmesser) Department of Cardiology, Angiology and Intensive Care
Medicine, Campus Benjamin Franklin, Berlin, Germany
(Landmesser) Berlin Institute of Health, Charite-University Medicine
Berlin, Berlin, Germany
(Tzikas) European Interbalkan Medical Center, Thessaloniki, Greece
Abstract
AIMS: The optimal short-term antithrombotic strategy following left atrial
appendage occlusion (LAAO) remains uncertain, with the need to balance
thromboembolic prevention and bleeding risk presenting a critical
challenge. Recent evidence suggests that direct oral anticoagulants
(DOACs) may provide a favourable safety-efficacy profile, with low-dose
regimens showing potential benefits during the device endothelialization
period. This network meta-analysis (NMA) aimed to compare the efficacy and
safety of various antithrombotic strategies, including DOAC dosing,
following LAAO. METHODS AND RESULTS: A systematic review and NMA were
conducted following Cochrane and PRISMA guidelines. Eligible studies
included randomized controlled trials (RCT) and observational studies
comparing at least two antithrombotic regimens in patients with
non-valvular atrial fibrillation undergoing percutaneous LAAO. Primary
outcomes were major bleeding and thromboembolism. Secondary outcomes
included device-related thrombosis (DRT) and all-cause mortality. Pairwise
and network meta-analyses were performed using a random-effects model. A
total of 52 studies (49 observational and 3 RCTs) involving 69 751
patients were included. DOACs were consistently associated with
significantly lower rates of major bleeding and all-cause mortality than
other antithrombotic regimens. Low-dose DOACs showed a potential advantage
over standard-dose DOACs in reducing major bleeding risk (odds ratio 0.45,
95% confidence interval: 0.22-0.92). For thromboembolism and DRT,
standard-dose DOAC significantly reduced risk compared with single
antiplatelet therapy (SAPT) but not with dual antiplatelet therapy (DAPT),
whereas low-dose DOAC significantly reduced both outcomes compared with
SAPT, DAPT, and vitamin K antagonists plus SAPT. In ranking analysis,
DOACs emerged as the most effective and safest antithrombotic strategy,
with low-dose DOACs demonstrating further safety benefits in bleeding
outcomes. CONCLUSION(S): DOACs provide a superior safety-efficacy
profile compared with other antithrombotic strategies following LAAO,
significantly reducing the risks of major bleeding, thromboembolic events,
and mortality. While low-dose DOACs may offer additional bleeding risk
reduction without compromising efficacy, further research is warranted to
confirm their role in clinical practice. Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of European
Society of Cardiology.

<107>
Accession Number
2041857525
Title
A BREATHLESS MENSTRUAL CYCLE: LESSONS FROM THORACIC ENDOMETRIOSIS CASES.
Source
Chest. Conference: Official Publications of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4399-A4400),
2025. Date of Publication: 01 Oct 2025.
Author
Camere M.; Liu F.; Daid A.M.; Ganesh A.; Astua A.J.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Pleura Case Report Posters (D) SESSION
TYPE: Case Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm
INTRODUCTION: Thoracic endometriosis syndrome (TES) encompasses a spectrum
of conditions caused by ectopic endometrial tissue in the thoracic cavity.
It includes catamenial pneumothorax (CP), hemothorax, hemoptysis, and
pulmonary nodules, with CP being the most common manifestation(1). This
case series describes two presentations of TES, illustrating diagnostic
challenges and individualized management strategies. CASE PRESENTATION:
Case 1: A 35-year-old American woman presented with acute right-sided
chest pain and dyspnea on the second day of her menstrual cycle. Vital
signs showed HR 122 bpm, BP 88/60 mmHg, and SpO2 86% on room air.
Auscultation revealed absent breath sounds on the right, and a chest X-ray
showed a large right-sided tension pneumothorax with mediastinal shift.
Emergent needle decompression and chest tube placement stabilized her.
High-resolution computed tomography (HRCT) identified diaphragmatic
fenestrations and right pleural effusion. Video-assisted thoracoscopic
surgery (VATS) revealed pleural endometriosis and blood-stained fluid,
with histopathology confirming endometrial tissue. Pelvic MRI detected
diaphragmatic and hepatic endometriotic implants. Postoperative
gonadotropin-releasing hormone (GnRH) agonists achieved symptom control
with no recurrence at 12 months.Case 2: A 28-year-old woman from rural
Ecuador that had recently immigrated to the USA presented with a two-year
history of cyclic scapular pain and exertional dyspnea coinciding with
menstruation. She had been misdiagnosed with asthma and treated with
inhalers without definitive testing. On presentation, vital signs were
stable, and breath sounds were diminished in the right lower lung. HRCT
revealed diaphragmatic herniation of the liver into the right hemithorax.
VATS showed multiple diaphragmatic defects with liver herniation and
scattered endometrial implants. Histopathology confirmed thoracic
endometriosis. Surgical repair with diaphragmatic mesh placement and
hormonal therapy led to complete symptom resolution with no recurrence
over two years. DISCUSSION(S): TES is underdiagnosed due to its
nonspecific and cyclical presentation(2). Despite accounting for up to 30%
of spontaneous pneumothoraces in reproductive-aged women(3), its
pathogenesis remains unclear, with proposed mechanisms including
diaphragmatic defects, retrograde menstruation, and prostaglandin-mediated
alveolar damage(1-3). These cases illustrate TES's diverse manifestations,
ranging from acute tension pneumothorax to insidious diaphragmatic
herniation. A high index of suspicion is crucial, particularly in women
with recurrent pneumothorax or unexplained pulmonary symptoms(1).Imaging,
particularly HRCT and MRI, plays a key role in detecting diaphragmatic
defects, pleural involvement, and extrathoracic implants(4). VATS remains
the gold standard for diagnosis and treatment, allowing direct
visualization, biopsy, pleurodesis, and diaphragmatic repair(2,4).
Hormonal therapy, including GnRH agonists, is essential for recurrence
prevention, especially in extensive diaphragmatic involvement(5). Recent
studies emphasize multidisciplinary management and advanced imaging in
improving outcomes. CONCLUSION(S): TES is an underrecognized cause of
recurrent thoracic pathology in reproductive-aged women. This case series
highlights the need for awareness among pulmonologists and critical care
specialists, emphasizing advanced imaging, surgical intervention, and
hormonal therapy in TES management. Further research is needed to refine
diagnostic protocols and explore novel therapeutic strategies. REFERENCE
#1: 1. Kardaman N, Nizami M, Marciniak S, Hogan J, Aresu G. Catamenial
Pneumothorax. Ann R Coll Surg Engl. 2022;104(4):e109-e112.
doi:10.1308/rcsann.2021.0164. 2. Gil Y, Tulandi T. Diagnosis and Treatment
of Catamenial Pneumothorax: A Systematic Review. J Minim Invasive Gynecol.
2020;27(1):48-53. doi:10.1016/j.jmig.2019.08.005. REFERENCE #2: 3. Legras
A, Mansuet-Lupo A, Rousset-Jablonski C, et al. Pneumothorax in Women of
Child-Bearing Age: An Updated Classification Based on Clinical and
Pathologic Findings. Chest. 2014;145(2):354-360.
doi:10.1378/chest.13-1284. 4. Ochi T, Kurihara M, Tsuboshima K, Nonaka Y,
Kumasaka T. Dynamics of Thoracic Endometriosis in the Pleural Cavity. PLoS
One. 2022;17(5):e0268299. doi:10.1371/journal.pone.0268299. REFERENCE #3:
5. Ciriaco P, Muriana P, Carretta A, et al. Catamenial Pneumothorax as the
First Expression of Thoracic Endometriosis Syndrome and Pelvic
Endometriosis. J Clin Med. 2022;11(5):1200. doi:10.3390/jcm11051200.
DISCLOSURES: No relevant relationships by Alfredo Astua No relevant
relationships by Maurizio Camere No relevant relationships by Adithan
Ganesh No relevant relationships by Franklin Liu No relevant relationships
by Alexander Mc Daid Copyright © 2025 American College of Chest
Physicians

<108>
Accession Number
649323642
Title
Efficacy and safety of dexmedetomidine infusion without induction dose on
postoperative delirium in geriatric patients undergoing major noncardiac
surgeries: a randomized controlled clinical trial.
Source
Minerva anestesiologica. (no pagination), 2025. Date of Publication: 26
Nov 2025.
Author
Youssef M.M.; Jaccoub V.F.; Atalla M.G.; Alkonaiesy R.M.; Abdelhalim M.A.
Institution
(Youssef) ICU & Pain Management, Department of Anesthesia, Kasr Al
Ainy Faculty of Medicine, Cairo University, Egypt -
mora.magdy.mm@gmail.com
(Jaccoub, Atalla, Alkonaiesy, Abdelhalim) ICU & Pain Management,
Department of Anesthesia, Kasr Al Ainy Faculty of Medicine, Cairo
University, Egypt
Abstract
BACKGROUND: The impact of dexmedetomidine on postoperative delirium (POD)
remains a subject of debate in elderly patients undergoing noncardiac
surgeries. This study aimed to assess the efficacy and safety of
dexmedetomidine infusion without an induction dose in reducing the
incidence of POD while maintaining hemodynamic stability in geriatric
patients undergoing major surgeries. The loading dose was omitted based on
the hypothesis that continuous dexmedetomidine infusion without a loading
dose would lower the incidence of POD while preserving cardiovascular
safety. METHOD(S): This randomized, double-blind clinical trial was
conducted on 122 elderly patients, belonging to the American Society of
Anesthesiologists I or II physical status, who were scheduled for major
noncardiac surgeries. Patients were randomly allocated into two equal
groups. Patients in Group I received 0.5 mug/kg/h of dexmedetomidine,
diluted in 50 mL of isotonic normal saline, while patients in Group II
received 50 mL of isotonic normal saline as a placebo. The primary outcome
was the incidence of POD. Secondary outcomes included intraoperative and
postoperative hemodynamics. RESULT(S): Postoperative delirium was
observed in only one (1.64%) patient in Group I on the first postoperative
day, whereas 21 (34.4%) patients in Group II experienced POD with a
statistically significant difference (P<0.001). Furthermore, patients in
group I exhibited a significant reduction in intraoperative mean arterial
pressure and heart rate, along with a notably high incidence of
intraoperative hypotension but without bradycardia. Postoperatively, the
mean heart rates, the incidence of hypotension, and bradycardia were
comparable between groups without the need for rescue hypotensive
medications (all P>0.05). CONCLUSION(S): In elderly patients
undergoing non-cardiac surgery, dexmedetomidine infusion without an
induction dose effectively and safely reduces the incidence of POD.
Dexmedetomidine significantly preserves postoperative hemodynamics.

<109>
Accession Number
2037369419
Title
Minimally invasive thoracoscopically-guided right minithoracotomy versus
conventional sternotomy for mitral valve repair: the UK Mini Mitral
multicentre RCT.
Source
Health Technology Assessment. 29(55) (no pagination), 2025. Date of
Publication: 2025.
Author
Akowuah E.F.; Maier R.H.; Hancock H.C.; Wagnild J.; Vale L.;
Fernandez-Garcia C.; Kharati E.; Ogundimu E.; Mathias A.; Walmsley Z.;
Howe N.; Graham R.; Ainsworth K.; Zacharias J.
Institution
(Akowuah, Graham, Ainsworth) Department of Cardiac Surgery, The James Cook
University Hospital, South Tees NHS Foundation Trust, Middlesbrough,
United Kingdom
(Akowuah) Newcastle University Translational and Clinical Research
Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
(Maier) Academic Cardiovascular Unit, The James Cook University Hospital,
South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
(Hancock, Mathias, Walmsley, Howe) Newcastle Clinical Trials Unit,
Population Health Sciences Institute, Newcastle University, Newcastle Upon
Tyne, United Kingdom
(Wagnild, Kharati) Department of Anthropology, Durham University, Durham,
United Kingdom
(Vale, Fernandez-Garcia) Health Economics Group, Population Health
Sciences Institute, Newcastle University, Newcastle Upon Tyne, United
Kingdom
(Ogundimu) Department of Mathematical Sciences, Durham University, Durham,
United Kingdom
(Zacharias) The Lancashire Cardiac Centre, Blackpool Teaching Hospitals
NHS Foundation Trust, Blackpool, United Kingdom
Publisher
NIHR Journals Library
Abstract
Background: The safety, effectiveness and cost-effectiveness of mitral
valve repair via thoracoscopically guided minithoracotomy compared with
conventional median sternotomy (Sternotomy) in patients with degenerative
mitral valve regurgitation is uncertain and widely debated.
 Objective(s): To determine if Mini was more effective than Sternotomy
in terms of physical functioning and associated return to usual activities
and was cost-effective compared with Sternotomy. Design(s): A
pragmatic, multicentre, expertise-based, superiority, randomised trial.
 Participant(s): Adults with degenerative mitral valve regurgitation
undergoing mitral valve repair surgery. Setting(s): Ten tertiary care
institutions in the United Kingdom. Intervention(s): Mini or
Sternotomy mitral valve repair performed by an expert surgeon. Blinding:
Primary outcome measure [Short Form 36-item Health Survey, version 2
(SF-36v2) physical functioning score] was measured by an independent
assessor, blinded to allocation. Echocardiographic findings were measured
in a core laboratory, blinded to allocation. Outcome Measures: Primary
outcomes were physical functioning and associated return to usual
activities measured by change from baseline in SF-36v2 physical function
domain at 12 weeks following index surgery. The primary economic measure
was incremental cost per quality-adjusted life-year over the year
following surgery. Secondary outcomes included recurrent mitral
regurgitation grade, physical activity and quality of life measured at
time points to 1 year. Safety outcomes included death, repeat mitral valve
surgery or heart failure hospitalisation up to 1 year. Result(s):
Between November 2016 and January 2021, 330 participants were randomised;
166 to Mini and 164 to Sternotomy. Of these, 309 underwent surgery and 294
reported the primary outcome. Thirty per cent were female. At 12 weeks,
mean difference between groups in the change in SF-36v2 physical function
T-scores was 0.68 (95% confidence interval -1.89 to 3.26). Valve repair
rates (96%) were similar in both groups. Echocardiography demonstrated
mitral regurgitation severity as none or mild for 92% of participants at 1
year in both groups. The composite safety outcome occurred in 5.4% (9/166)
of Mini and 6.1% (10/163) of Sternotomy participants at 1 year. On
average, Mini was more costly 29,424 (95% confidence interval 26,909 to
31,940) versus 27,397 (95% confidence interval 25,172 to 29,620) and more
effective 0.81 quality-adjusted life-years (95% confidence interval 0.78
to 0.84) versus 0.78 (95% confidence interval 0.75 to 0.81) than
Sternotomy. The adjusted incremental cost-effectiveness ratio was 74,863
per quality-adjusted life-year for the comparison between Mini and
Sternotomy. Mini has a probability of < 50% of being cost-effective at the
range of willingness-to-pay values considered. Limitation(s): To
minimise bias, SF-36v2 and all echocardiographic measures were
independently assessed by personnel blinded to allocation. Expertise-based
randomisation was important to address the limitations of previous
studies; however, it is possible that it may have introduced potential
confounders. Conclusion(s): Mini is not superior to Sternotomy in
recovery of physical function at 12 weeks. Mini achieves high rates and
quality of valve repair and has similar safety outcomes at 1 year to
Sternotomy. The balance of probabilities favoured Sternotomy as the
preferred surgical procedure in the base-case analysis over the range of
willingness-to-pay values society might consider worthwhile for a
quality-adjusted life-year. Nevertheless, additional factors such as
equity or patient preferences for one procedure over another may need to
also be taken into account. Results provide high-quality evidence to
inform shared decision-making and treatment guidelines. Future work: Work
is ongoing to disseminate findings and influence guidelines; patients have
consented to longer-term follow-up. From an economics perspective, the
currently available evidence shows that further research into patient
preferences is important to inform the choice of surgical procedure. Trial
registration: This trial is registered as ISRCTN 13930454. Copyright
© 2025, NIHR Journals Library. All rights reserved.

<110>
Accession Number
649320797
Title
Sex Differences in Dilated Cardiomyopathy: Evidence Gaps and Future
Directions.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 17 Nov 2025.
Author
Stroeks S.L.V.M.; Oko-Osi S.; Arasu A.; Hirst J.E.; Tayal U.P.
Institution
(Stroeks) Department of Cardiology, Maastricht University, Cardiovascular
Research Institute Maastricht, Maastricht, the Netherlands; KU Leuven,
Cardiovascular Sciences, Leuven, Belgium; Department of Clinical Genetics,
Maastricht University Medical Center, Maastricht, the Netherlands;
European Reference Network for Rare, Low Prevalence and Complex Diseases
of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
(Oko-Osi, Arasu, Tayal) National Heart Lung Institute, Imperial College
London, London, United Kingdom; Royal Brompton & Harefield Hospitals,
Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
(Hirst) George Institute for Global Health, Imperial College London,
London, United Kingdom
Abstract
Dilated cardiomyopathy (DCM), which affects 1 in 250 people, is a leading
global cause of heart failure and the most common indication for heart
transplantation. Evidence suggests that DCM is more prevalent in men, but
whether this reflects biological differences or underdiagnosis in women
remains uncertain. This review explores the impact of sex on DCM,
examining differences in epidemiology, etiology, clinical presentation,
treatment response, and outcomes. Women often present with less severe
cardiac phenotypes, including lower levels of fibrosis and better left
ventricular function, yet the long-term prognosis of DCM in women is less
clear. Through a systematic review and meta-analysis, we found that male
DCM patients with variants in PLN, DSP, and LMNA had higher arrhythmic
event rates compared with TTNtv and BAG3 carriers. In female patients with
DCM, those with RBM20, DSP, and PLN variants faced the highest arrhythmic
risk, and TTNtv carriers the lowest. PLN and LMNA variants had the highest
heart failure risk in both sexes, whereas BAG3, RBM20, and TTN variants
had lower heart failure rates in female compared with male carriers. These
findings highlight the influence of sex and genotype on clinical outcomes.
Current risk-stratification tools, such as those used for implantable
cardioverter-defibrillators, may undertreat women owing to reliance on
sex-neutral thresholds. We highlight the role of genetic, environmental,
and reproductive factors in shaping these disparities, including the
influence of pregnancy, pregnancy complications, and menopause. This
review identifies key gaps in knowledge and calls for expanded
representation of women in DCM studies and the development of sex-specific
risk models. Addressing these gaps is essential to improving outcomes and
advancing equitable personalized care for all DCM patients. Copyright
© 2025 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<111>
Accession Number
2041463370
Title
Mitral Valve Surgery with and Without Mitral Annular Disjunction: A
Meta-Analysis.
Source
Journal of Cardiovascular Development and Disease. 12(11) (no pagination),
2025. Article Number: 436. Date of Publication: 01 Nov 2025.
Author
Baudo M.; Cabrucci F.; Di Muro F.M.; Magouliotis D.E.; Bacchi B.;
Arjomandi Rad A.; Xanthopoulos A.; Caldonazo T.; D'Alonzo M.
Institution
(Baudo, Cabrucci, Magouliotis) Department of Cardiac Surgery Research,
Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA,
United States
(Cabrucci) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University Health Network, Toronto, ON, Canada
(Di Muro) Department of Medicine, Surgery and Dentistry, University of
Salerno, Salerno, Italy
(Bacchi) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Arjomandi Rad) Department of Cardiothoracic Surgery, John Radcliffe
Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United
Kingdom
(Xanthopoulos) Department of Cardiology, University Hospital of Larissa,
Larissa, Greece
(Caldonazo) Department of Cardiothoracic Surgery, Jena University
Hospital, Jena, Germany
(D'Alonzo) Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Via
Bissolati 57, Brescia, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Despite growing awareness of mitral annular
disjunction's (MAD) clinical significance, robust data regarding the
outcomes of surgical interventions on MAD remain sparse. This
meta-analysis aims to systematically evaluate the current evidence on the
efficacy and safety of mitral valve (MV) surgery in patients with MAD.
 Method(s): A systematic review was conducted from inception until May
2025 for studies comparing patients undergoing MV surgery with and without
MAD and was registered in PROSPERO: CRD42025649821. Result(s):
Patients with MAD were generally younger (59.3 +/- 5.0 vs. 63.4 +/- 2.2
years, standardized mean difference: -0.3073), had fewer comorbidities but
more complex valve lesions (41.0% vs. 13.7%, risk difference: 0.2627)
compared to those without MAD. MV replacement was performed less
frequently in the MAD group than in the No-MAD group (risk ratio, RR:
0.690 [95% confidence interval, CI: 0.508; 0.937], p = 0.017), probably
related to the significant difference in age between the two groups. The
MAD cohort demonstrated a higher incidence of ventricular arrhythmia both
after surgery (RR: 7.255 [95%CI: 1.231; 42.763], p = 0.029) and during
follow-up (incidence rate ratio, IRR: 2.750 [95%CI: 1.372; 5.512], p =
0.004). Although the MAD group experienced more arrhythmic events over
time, this did not translate into a significant difference in overall
mortality compared to patients without MAD (IRR: 0.573 [95%CI: 0.072;
4.555], p = 0.599). Conclusion(s): This meta-analysis revealed
significant baseline differences between the populations. Our findings
suggest that patients with MAD remained at significantly higher risk for
both postoperative and long-term arrhythmias. These results highlight the
need for close arrhythmic surveillance in this population. Copyright
© 2025 by the authors.

<112>
Accession Number
2041496186
Title
Antithrombotic Therapy in Transcatheter Aortic Valve Implantation: Focus
on Gender Differences.
Source
Journal of Cardiovascular Development and Disease. 12(11) (no pagination),
2025. Article Number: 433. Date of Publication: 01 Nov 2025.
Author
De Gregorio M.; Denegri A.; Gurgoglione F.L.; Benatti G.; Tadonio I.;
Solinas E.; Carino D.; Agostinelli A.; Vignali L.; Niccoli G.
Institution
(De Gregorio, Denegri, Gurgoglione, Benatti, Tadonio, Solinas, Vignali,
Niccoli) Division of Cardiology, Parma University Hospital, Parma, Italy
(Carino, Vignali, Niccoli) Department of Medicine and Surgery, University
of Parma, Parma, Italy
(Carino, Agostinelli) Cardiac Surgery Unit, University Hospital of Parma,
Parma, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Antithrombotic therapy plays a pivotal role in reducing thromboembolic
complications, including stroke and valve thrombosis, following
Transcatheter Aortic Valve Implantation (TAVI). However, the benefits of
such therapy must be balanced against the increased risk of major bleeding
events. The optimal antithrombotic strategy in this setting remains a
matter of ongoing debate, given the heterogeneity of patient profiles and
procedural variables. Among TAVI recipients, women represent a growing
proportion and exhibit distinct anatomical, physiological, and clinical
characteristics that influence both thrombotic and bleeding risk. Compared
to men, women more frequently experience vascular complications and major
bleeding events, despite better survival outcomes. These differences are
driven by smaller vessel caliber, higher vascular tortuosity, and altered
platelet reactivity. Consequently, sex-specific risk stratification is
essential when considering antiplatelet or anticoagulant regimens
post-TAVI. This review provides a comprehensive synthesis of current
evidence regarding antithrombotic strategies in the post-TAVI setting,
with a dedicated focus on sex-related differences. Particular emphasis is
placed on the female population, assessing ischemic and hemorrhagic
outcomes and the implications for long-term management. Improving outcomes
in women undergoing TAVI necessitates tailored antithrombotic strategies
that balance efficacy and safety. Ongoing research and dedicated trials
are essential to refine these strategies and to inform future guideline
updates in this expanding patient population. Copyright © 2025 by
the authors.

<113>
Accession Number
2041876960
Title
Tricuspid Valve Repair in Pediatric Patients Using Artificial Neochordae:
Systematic Review of Current Evidence.
Source
World Journal for Pediatric and Congenital Heart Surgery. 17(1) (pp
113-119), 2026. Date of Publication: 01 Jan 2026.
Author
Crea D.; Padalino M.; Bortolotti U.; Stellin G.
Institution
(Crea, Stellin) University of Padova, Padova, Italy
(Padalino) Department of Precision and Regenerative Medicine and Jonic
Area, University of Bari "Aldo Moro", Bari, Italy
(Bortolotti) Cardiothoracic and Vascular Department, University of Pisa,
Pisa, Italy
Publisher
SAGE Publications Inc.
Abstract
Artificial neochordae crafted from expanded polytetrafluoroethylene are
commonly utilized in mitral valve repair. Yet their application in
tricuspid valve repair, particularly in the pediatric demographic, remains
relatively unexplored. Upon reviewing the available literature, we have
identified pediatric patients with tricuspid valve regurgitation,
primarily of congenital origin and diagnosed at birth, who underwent
repair procedures involving artificial neochordal implantation.
Postoperatively, trivial-to-mild tricuspid regurgitation was predominantly
observed in most cases. Operative mortality appears to be low, but a
reliable estimate of operative mortality rates, early failure, and
reoperation was not possible due to incomplete data reporting in the
studies reviewed. Moreover, long-term data are not available since in most
reports, postoperative evaluation was obtained early after repair. Our
review suggests that artificial neochordal repair of the tricuspid valve
may be a feasible surgical option to prosthetic valve replacement in
pediatric patients. However, comprehensive data and further late follow-up
are needed to analyze long-term effectiveness and clinical
outcomes. Copyright © The Author(s) 2025

<114>
Accession Number
2041910473
Title
Continuing versus Withholding Renin-Angiotensin-Aldosterone System
Antagonists Before Noncardiac Surgery: A Systematic Review and
Meta-Analysis.
Source
Tunisie Medicale. 103(9) (pp 1146-1156), 2025. Date of Publication: 01 Sep
2025.
Author
Daghmouri M.A.; Haddad F.; Kammoun E.; Jebali F.; Jeddou H.; Chaouch M.A.
Institution
(Daghmouri) Department of Anesthesiology, Montreuil Intercommunal Hospital
Center, France
(Haddad, Kammoun) Department of Anesthesiology and Critical Care Medicine,
Faculty of Medicine of Tunis, Mongi Slim Teaching Hospital, University of
Tunis El Manar, Tunis, Tunisia
(Jebali) Department of Anesthesiology B, Monastir Teaching Hospital,
University of Monastir, Monastir, Tunisia
(Jeddou) Department of Hepatobiliary and Digestive Surgery, University
Hospital, Rennes 1 University, Rennes, France
(Jeddou) Inserm, EHESP, Irset (Institut de recherche en sante,
environnement et travail)-UMR_S 1085, Rennes 1 University, Rennes, France
(Chaouch) Department of Visceral and Digestive Surgery, Monastir
University Hospital, Monastir, Tunisia
Publisher
Societe Tunisienne des Sciences Medicales
Abstract
Background: It remains unclear whether to continue or withdraw angiotensin
receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors
(ACEI) before noncardiac surgery to reduce perioperative morbidity. This
systematic review and meta-analysis aimed to analyze the consequences of
continuing ARB or ACEi in the incidence of intraoperative hypotension and
postoperative complications. Method(s): This systematic review and
meta-analysis followed the PRISMA 2020 guidelines and was registered in
the PROSPERO database. We conducted a comprehensive search in several
bibliographic databases for studies comparing continuing versus
withholding renin angiotensin aldosterone system antagonists before
noncardiac surgery. Primary outcomes included the incidence of
intraoperative hypotension, while secondary outcomes covered the
intraoperative use of the vasoactive agent, the incidence of severe
hypotension, intraoperative and postoperative hypertension, the incidence
of acute kidney injury (AKI), 30-day postoperative all-cause mortality,
and the incidence of major cardiocerebral events (MACCE). Result(s):
Five randomized controlled trials, three nonrandomized controlled trials,
and four retrospective case-control studies were included that involved
50184 patients. Meta-analysis revealed that continuing ACEI or ARBs before
surgery increased the incidence of intraoperative hypotension (OR = 1.96,
95%CI [1.30, 2.96] p=0.001). Heterogeneity was substantial across studies
but was significantly reduced in subgroup analyses. Furthermore, the use
of vasoactive agents and the incidence of severe hypotension were
significantly higher in the continuing group. No significant differences
in intraoperative hypertension and the incidence of AKI and MACCE at 30
days after the operation. Conclusion(s): Continued ACEI or ARBs
before non-cardiac surgery increases the incidence of intraoperative
hypotension, without reducing the incidence of both AKI and MACCE
postoperatively. More research is necessary to explore the appropriate
perioperative management of ACE-I and ARB. Copyright © 2025,
Societe Tunisienne des Sciences Medicales. All rights reserved.

<115>
Accession Number
649271423
Title
A predictive model for the treatment outcomes of patients with secondary
mitral regurgitation based on machine learning and model interpretation.
Source
BMC medical informatics and decision making. (no pagination), 2025. Date
of Publication: 22 Nov 2025.
Author
Liu K.; Liu T.; Lang Y.; Zhang Q.
Institution
(Liu, Liu, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
(Lang) Xiangya School of Pharmaceutical Sciences, Central South
University, Changsha, Hunan, China
Abstract
BACKGROUND: Secondary mitral regurgitation (SMR) is a common condition,
with typical treatment options including conventional medical therapy and
the latest transcatheter edge-to-edge repair. However, there is currently
a lack of sufficient guidance on how to select the appropriate treatment
approach for SMR patients. SMR is a common condition secondary to ischemic
or non-ischemic heart failure, surgical or interventional therapy is
preserved for those patients who showed no improvement after tailored
guideline-directed medical therapy (GDMT) for heart failure.
 OBJECTIVE(S): Our goal is to develop an interpretable model to
predict SMR improvement after medical treatment in the real-world, i.e. to
find those patients who are candidates for surgical therapy. We employ the
SHapley Additive exPlanations (SHAP) method to interpret the model and
explore factors influencing improvement. METHOD(S): In this
retrospective study, we extracted data on patients diagnosed with moderate
or greater secondary mitral regurgitation. Predictive models were
constructed, with the dataset randomly divided such that 80% was used for
model training and 20% for model validation. We compared the predictive
performance of the XGBoost model with three other machine learning models
by analyzing the area under the curve (AUC). The XGBoost model was
interpreted using the SHAP method, with variable importance assessed and
the impact of key variables evaluated accordingly. RESULT(S): The
study ultimately included 1,572 eligible SMR patients. The XGBoost model
demonstrated the highest predictive performance among the four models,
with an AUC of 0.73. The SHAP method identified and ranked the top 20
predictive factors for SMR, with age being the most significant predictor.
 CONCLUSION(S): We have developed an effective model to predict
whether SMR patients will benefit from non-surgical treatment, which can
help clinicians formulate better treatment plans and achieve optimal
resource allocation. Additionally, the interpretable framework enhances
the transparency of the model and helps doctors understand the reliability
of the predictive model. CLINICAL TRIAL REGISTRATION: Clinical trial
number: not applicable. Copyright © 2025. The Author(s).

<116>
Accession Number
2041854747
Title
Clinical value of bundled care protocols in enhancing postoperative
recovery among lung cancer patients.
Source
Pakistan Journal of Medical Sciences. 41(11) (pp 3281-3287), 2025. Date of
Publication: 01 Nov 2025.
Author
Liu C.; Liu P.; Liang H.; Wang K.; Huang X.; Li Y.
Institution
(Liu, Liu, Liang, Wang, Huang, Li) Department of Thoracic Surgery,
Affiliated Hospital of Hebei University, Hebei, Baoding, China
Publisher
Professional Medical Publications
Abstract
Objective: To evaluate the clinical value of bundled care protocols in
enhancing postoperative recovery among lung cancer patients. Methodology:
This was a retrospective study. A total of 120 patients undergoing radical
lung cancer surgery in the thoracic surgery department of Affiliated
Hospital of Hebei University from November 2022 to November 2024 were
enrolled randomly assigned to the study group and the control group using
a random number table (n=60 each group). The control group received
routine nursing care, while the study group was managed using a bundled
care protocol. Indicators including pulmonary function parameters, immune
status, postoperative complication rates, quality-of-life scores and
satisfaction levels were compared between the two groups before and after
the intervention. Result(s): Post-intervention, the study group
demonstrated significant improvements in FEV1, FVC, FEV1/FVC and PEF
values compared to the control group(P=0.00). Immune indicators, including
CD3+, CD4+ and CD4+/CD8+, in
the study group were also markedly higher than those in the control
group(P=0.00). The incidence of postoperative complications was 8% in the
study group, markedly lower than the 23% observed in the control group
(P=0.02). Post-intervention, KPS scores and SF-36 quality-of-life scores
were significantly higher in the study group compared to the control
group(P=0.00). Patient satisfaction in the study group reached 100%,
compared to 90% in the control group, with a statistically significant
difference(P=0.01). Conclusion(s): Bundled care protocols demonstrate
significant clinical benefits for lung cancer patients undergoing surgical
treatment, including enhanced pulmonary function recovery, improved immune
reconstitution, reduced postoperative complication rates and elevated
quality of life and care satisfaction. Copyright © 2025,
Professional Medical Publications. All rights reserved.

<117>
Accession Number
649275425
Title
Effectiveness of intermittent pneumatic compression cushion in preventing
sacrococcygeal intraoperative acquired pressure injuries during cardiac
surgery: a randomized controlled trial.
Source
Intensive & critical care nursing. 93 (pp 104278), 2025. Date of
Publication: 22 Nov 2025.
Author
Gao W.; Zhang Y.; Lin Y.; Chen N.; Sun C.; Hu Y.; Chen H.; Xu M.; Wang W.
Institution
(Zhang, Chen, Sun, Hu, Chen) Department of the Operating Room, First
Affiliated Hospital of Wenzhou Medical University, Zhejiang Province,
Wenzhou, China
(Gao, Zhang, Lin, Wang) Department of Anaesthesiology, First Affiliated
Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou, China
(Xu) Department of the Operating Room, First Affiliated Hospital of
Wenzhou Medical University, Zhejiang Province, Wenzhou, China
Abstract
BACKGROUND: Intraoperative Acquired Pressure Injury (IAPI) is a common
complications in cardiac surgery, with reported incidence rates of
14.3-30%. Conventional pressure redistribution methods have limited
effectiveness during lengthy procedures. This study evaluated the efficacy
of intermittent pneumatic compression (IPC) cushions in preventing
sacrococcygeal IAPI in cardiac surgery patients and developed a predictive
nomogram for risk assessment. METHOD(S): In this prospective,
single-center randomized controlled trial, patients undergoing cardiac
surgery with cardiopulmonary bypass (CPB) were randomized to receive
either IPC cushion (n = 94) or standard gel pad (n = 95). The primary
outcome was the incidence of sacrococcygeal IAPI. Secondary outcomes
included intraoperative changes in regional tissue oxygen saturation
(rSO2) and postoperative skin temperature differentials (DELTAT). Risk
factors were identified through logistic regression analysis, and a
predictive nomogram was constructed and validated. RESULT(S): The
IAPI incidence was significantly lower in the IPC group compared to the
control group (3.19 % vs. 18.95 %, P = 0.001). The IPC group demonstrated
higher sacrococcygeal rSO2 values during CPB and rewarming phases (P <
0.05). Postoperative sacrococcygeal DELTAT was significantly lower in the
IPC group [0.0 (-0.1, 0.1) vs 0.3 (-0.3, 0.5); P = 0.001]. Multivariate
logistic regression identified lower preoperative sacrococcygeal rSO2 (OR
= 0.94, 95 % CI: 0.90-0.98), absence of IPC intervention (OR = 0.06, 95 %
CI: 0.01-0.28), and diabetes mellitus (OR = 7.98, 95 % CI: 2.20-29.01) as
independent risk factors for IAPI. The nomogram demonstrated excellent
discrimination (AUC = 0.857, 95 % CI: 0.776-0.937) and calibration (chi2 =
1.09, P = 0.997). CONCLUSION(S): IPC cushions effectively reduce IAPI
incidence during cardiac surgery by improving sacrococcygeal tissue
perfusion. Skin temperature differentials correlate with IAPI risk and may
serve as early indicators for prevention. The validated predictive
nomogram offers a practical tool for risk assessment and targeted
preventive strategies in clinical practice. IMPLICATIONS FOR CLINICAL
PRACTICE: This study introduced an innovative application of IPC for
preventing intraoperative IAPI in cardiac surgery patients, demonstrating
its effectiveness in lowering the incidence of IAPI. Copyright ©
2025 Elsevier Ltd. All rights reserved.

<118>
Accession Number
649271864
Title
Cost-utility of point-of-care viscoelastic hemostatic assays in the
management of bleeding during cardiac surgery: a single-blinded
prospective multicenter stepped wedge cluster randomized trial in French
context.
Source
Anaesthesia, critical care & pain medicine. (pp 101704), 2025. Date of
Publication: 20 Nov 2025.
Author
Vourc'h M.; Boissier E.; Lakhal K.; Grosjean S.; Labaste F.; Robin E.;
Bougle A.; Mattei M.; Morel J.; Wurtz V.; Mertes P.-M.; Zlotnik D.; Lagier
D.; Beurton A.; Rineau E.; Fischer M.-O.; May M.-A.; Medard A.;
Guimbretiere G.; Durand-Zaleski I.; Pere M.; Rozec B.; Rigal J.-C.
Institution
(Vourc'h) Anesthesie et reanimation chirurgicale, Hopital Laennec, Centre
Hospitalier Universitaire de Nantes, Nantes Universite, 44093 Nantes,
France; INSERM CIC 0004 Immunologie et infectiologie, Nantes Universite,
France
(Boissier) Laboratoire d'hematologie, Hopital Laennec, Centre Hospitalier
Universitaire de Nantes, Nantes, France
(Lakhal, Rigal) Anesthesie et reanimation chirurgicale, Hopital Laennec,
Centre Hospitalier Universitaire de Nantes, Nantes, France
(Grosjean) Departement d'Anesthesie-Reanimation, Centre Hospitalier
Universitaire de Dijon, Universite Bourgogne Franche Comte, Dijon, France
(Labaste) Anesthesiology and Intensive Care Department, Centre Hospitalier
Universitaire de Toulouse; Inserm U1048, I2MC-Institut des Maladies
Metaboliques & Cardiovasculaires, Universite Paul Sabatier, 31000
Toulouse, France
(Robin) Department of Anesthesia and Reanimation, Centre Hospitalier
Universitaire de Lille, Bd du Pr Jules Leclercq, Lille, France
(Bougle) Department of Anesthesiology and Critical Care, Hopital La
Pitie-Salpetriere, France. GRC 29 - Groupe de Recherche Clinique en
Anesthesie Reanimation medecine Perioperatoire, Sorbonne Universite,
Paris, France
(Mattei) Anesthesie et Reanimation de Chirurgie Cardiaque, Centre
Hospitalier Universitaire de Nancy, Nancy, France
(Morel) Departement d'anesthesie reanimation, CHU St Etienne ,25 boulevard
Pasteur, France
(Wurtz) Departement d'Anesthesie-Reanimation, Centre Hospitalier
Universitaire de Rouen, Hopital Charles Nicolle, Rouen, France
(Mertes) Service d'Anesthesie Reanimation, Nouvel Hopital Civil - Centre
Hospitalier Universitaire de Strasbourg, 83 rue Himmerich, Strasbourg,
France
(Zlotnik) Department of Anesthesiology and Intensive Care, Hopital
Europeen Georges Pompidou, Paris, France
(Lagier) Service d'Anesthesie Reanimation - CHU La Timone - APHM, UR 4264
- Centre Europeen de Recherche en Imagerie Medicale - Aix-Marseille
Universite, Marseille, France
(Beurton) Department of Cardiovascular Anesthesia and Critical Care,
Centre Hospitalier Universitaire de Bordeaux, INSERM, Biology of
Cardiovascular Diseases, Universite de Bordeaux, Pessac, France
(Rineau) Department of anesthesiology and critical care, Angers University
Hospital, Angers, France; Univ Angers, MITOVASC INSERM U1083 - CNRS 6015,
Team CARME, Angers, France
(Fischer) Clinique Saint Augustin, Centre Hospitalier Universitaire de
Caen, Caen, France
(May) Anesthesie - Reanimation Chirurgicale, Centre Hospitalier
Universitaire de Tours, Tours, France
(Medard) Pole Anesthesie Reanimation, Chirurgie Cardio-vasculaire, Hopital
Gabriel Montpied, Centre Hospitalier Universitaire de Clermont Ferrand,
France
(Guimbretiere) Department of thoracic and cardiovascular Surgery,
l'Institut du Thorax, Hopital Laennec, Centre Hospitalier Universitaire de
Nantes, Nantes, France
(Durand-Zaleski) Service d'epidemiologie clinique, URC-Eco AP-HP, Hotel
Dieu. CRESS, Inserm, INRAE, universite Paris Cite, 75004 Paris, France;
Sante Publique hopital Henri-Mondor, Universite Paris Est Creteil, 94000
Creteil, France
(Pere) Plateforme de Methodologie et Biostatistique, Direction de la
Recherche et de l'Innovation, Centre Hospitalier Universitaire, Nantes,
France
(Rozec) Anesthesie et reanimation chirurgicale, Hopital Laennec, Centre
Hospitalier Universitaire de Nantes, Nantes Universite, 44093 Nantes,
France; Nantes Universite, CNRS, INSERM, l'institut du thorax, 44093
Nantes, France
Abstract
BACKGROUND: The IMOTEC study aims to determine whether a point-of-care
viscoelastic hemostatic assay (VHA)-guided algorithm is cost-effective for
the management of ongoing bleeding. METHOD(S): Stepped wedge cluster
randomized trial, patient blinded, conducted at 16 French academic cardiac
surgery centers from 01/2017 to 02/2020. Adults undergoing elective or
urgent cardiac surgery with ongoing bleeding were enrolled during 2
successive inclusion periods: 1) transfusion guided on standard hemostasis
tests (control period), and 2) transfusion using a VHA-guided algorithm.
The primary objective was to estimate the efficiency of VHA based on the
1-year incremental cost-utility ratio (ICUR, primary outcome). Secondary
outcomes included transfusion, postoperative complications, duration of
stay in-hospital, reintervention, and mortality. RESULT(S): 1095
patients were randomized, and 1044 (95.3%) were analyzed. The mean utility
was 0.60 (+/-0.30) in the VHA vs. 0.61 (+/-0.30) in the control period,
adjusted difference, -0.01 [95% CI, -0.09 to 0.07]. The ICUR did not
suggest that the VHA-guided algorithm was cost-effective. One-year
mortality was 12.0% for VHA and 10.9% for control, Hazard Ratio, 1.69 [95%
CI, 0.98 to 2.89], P = .06. The frequency of plasma and platelet
transfusions was significantly lower in the VHA compared to the control
period (respectively, 48.8% vs. 72.4%, P < 0.0001 and 52.3% vs. 74.1%, P =
.0002), whereas fibrinogen administration was more frequent in the VHA
period (58.4% vs. 47.0 %, P = .002). The median in-hospital length of stay
was significantly shorter in the VHA vs. control period: 11.0 days (8.0 to
18.0) vs. 14.0 (9.0 to 22.0), P = .02. CONCLUSION(S): The ICUR did
not suggest that VHA was cost-effective in cardiac surgery patients with
ongoing bleeding, compared with standard tests. TRIAL REGISTRATION:
Clinical trial submission: November 2, 2016 Registry name: Cost-Utility
Analysis of Management of Peri Operative Hemorrhage Following Cardiac
Surgery With Cardiopulmonary Bypass (IMOTEC) ClinicalTrials.gov
Identifier: NCT02972684 URL registry:
https://clinicaltrials.gov/study/NCT02972684. Copyright © 2025.
Published by Elsevier Masson SAS.

<119>
Accession Number
649280146
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
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. MATERIALS AND METHODS: 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 double-cuff 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.

<120>
Accession Number
649281663
Title
Quality of early recovery after ultrasound-guided serratus plane block for
transapical transcatheter aortic valve implantation surgery under general
anesthesia: a single-center randomized controlled trial.
Source
BMC anesthesiology. (no pagination), 2025. Date of Publication: 24 Nov
2025.
Author
Xiao C.; Jing S.; Yang G.; Chen F.; Yang M.; Cao L.; Tan Y.; Lin G.; Li H.
Institution
(Xiao, Jing, Yang, Chen, Yang, Cao, Tan, Lin) Department of
Anesthesiology, Second Affiliated Hospital of Army Medical University,
PLA, No. 83 Xinqiao Road ,Shapingba, Chongqing, China
(Li) Department of Anesthesiology, Second Affiliated Hospital of Army
Medical University, PLA, No. 83 Xinqiao Road ,Shapingba, Chongqing, China

<121>
Accession Number
649279890
Title
Effect of dexmedetomidine on postoperative mortality and prognosis: a
systematic review and meta-analysis of randomized controlled trials.
Source
BMC anesthesiology. (no pagination), 2025. Date of Publication: 24 Nov
2025.
Author
Xu Z.; Wang D.; Sun H.; Zhang W.; Li S.; Su N.; Chen Y.; Jiang C.; Bi C.
Institution
(Xu, Wang, Sun, Li, Su, Chen, Jiang) Department of Anesthesiology, Central
Hospital of Dalian University of Technology, Dalian, Liaoning, China
(Zhang) Department of Anesthesiology, Zhoukou Central Hospital, Zhoukou,
Henan, China
(Bi) Department of Anesthesiology, Central Hospital of Dalian University
of Technology, Dalian, Liaoning, China
Abstract
OBJECTIVE: This meta-analysis aimed to systematically evaluate the impact
of intraoperative dexmedetomidine (DEX) on postoperative mortality and
clinical outcomes in surgical patients, addressing existing controversies
in the literature. METHOD(S): We conducted a systematic review of
randomized controlled trials (RCTs) from PubMed, Embase and Cochrane
Library (inception to October 8, 2024; PROSPERO: CRD42024583524). Included
studies compared intraoperative DEX against controls (placebo/active
comparators) in adults undergoing general anesthesia. Primary outcome was
mortality; secondary outcomes included postoperative delirium (POD),
ICU/hospital stay, mechanical ventilation duration, and safety endpoints.
Risk ratios (RR) or mean differences (MD) with 95% confidence intervals
(CI) were pooled using fixed/random-effects models. RESULT(S): This
meta-analysis included 17 randomized controlled trials (RCTs). In cardiac
surgery patients, DEX significantly reduced all-cause mortality (RR 0.39,
95% CI 0.18-0.85; P = 0.02) and in-hospital mortality (RR 0.23, 95% CI
0.08-0.70; P = 0.01), but not 30-day mortality. In non-cardiac surgery
patients, DEX did not significantly reduce all-cause, 30-day, or
in-hospital mortality. DEX decreased the incidence of POD in both cardiac
(RR 0.61, 95% CI 0.46-0.82; P = 0.001) and non-cardiac surgery patients
(RR 0.56, 95% CI 0.36-0.87; P = 0.01). For other outcomes, significant
reductions in hospital stay, ICU stay, and mechanical ventilation duration
were primarily observed in the cardiac surgery subgroup. Safety analysis
indicated there was no significant difference in intraoperative
bradycardia or hypotension between groups. CONCLUSION(S):
Dexmedetomidine use in cardiac surgery significantly reduces all-cause and
in-hospital mortality, shortens hospital length of stay, decreases ICU
stay duration, and reduces mechanical ventilation requirements. However,
its impact on 30-day mortality is not significant. Additionally, the drug
consistently demonstrates a preventive effect on postoperative delirium
across different surgical types.Clinicians must carefully weigh the
benefits of this medication against the potential risk of transient
hemodynamic instability. Copyright © 2025. The Author(s).

<122>
Accession Number
2041376035
Title
Nordic consensus document on Evolut FX+ transcatheter aortic valve
implantation: optimizing index implantation and longer-term outcomes.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1682714. Date of Publication: 2025.
Author
Khokhar A.A.; Savontaus M.; Al-Ani A.; Terkselsen C.J.; Bieliauskas G.;
van der Heijden A.; Amin A.A.A.; James S.; Russell K.; De Backer O.
Institution
(Khokhar, Bieliauskas, De Backer) Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
(Savontaus) Heart Center, Turku University Hospital, Turku, Finland
(Al-Ani) Department of Cardiology, Ulleval Oslo University
Hospital/Ulleval, Oslo, Norway
(Terkselsen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(van der Heijden) Education & Training, Medtronic, Tolochenaz, Switzerland
(Amin) Department of Cardiology, Uppsala University Hospital, Uppsala,
Sweden
(James) Department of Medical Sciences, Cardiology, Uppsala University,
Uppsala, Sweden
(Russell) Department of Cardiology, Oslo University Hospital, Oslo,
Rikshospitalet, Norway
Publisher
Frontiers Media SA
Abstract
Transcatheter aortic valve replacement (TAVI) is an established treatment
strategy for patients with severe symptomatic aortic stenosis (AS).
Multiple landmark randomized controlled trials have consistently
demonstrated the safety, efficacy, and longer-term durability of the
CoreValve/Evolut (Medtronic, MN, USA) transcatheter aortic valve (TAV)
platform in treating severe AS. These findings have supported the
expansion of TAVI to younger patients with longer life expectancy, in whom
an optimized index valve implantation can significantly impact both acute
procedural results and longer-term outcomes. In this technical narrative,
we aim to describe how iterative changes in the latest-generation Evolut
FX(+) TAV can be utilized to achieve an optimized index valve
implantation. Copyright 2025 Khokhar, Savontaus, Al-Ani, Terkselsen,
Bieliauskas, van der Heijden, Amin, James, Russell and De Backer.

<123>
Accession Number
649280740
Title
Management Strategies for Patients With Atrial Fibrillation-Related
Ischemic Stroke Despite Oral Anticoagulation.
Source
Circulation journal : official journal of the Japanese Circulation
Society. (no pagination), 2025. Date of Publication: 22 Nov 2025.
Author
Chatani R.; Kinosada M.; Kaneda K.; Yamashita Y.; Harata H.; Fujita M.;
Nishiura N.; Mushiake K.; Ono S.; Tasaka H.; Maruo T.; Kadota K.; Chin M.;
Kubo S.
Institution
(Chatani, Harata, Fujita, Nishiura, Mushiake, Ono, Tasaka, Maruo, Kadota,
Kubo) Department of Cardiovascular Medicine, Kurashiki Central Hospital
(Kinosada, Chin) Department of Neurosurgery, Kurashiki Central Hospital
(Kaneda, Yamashita) Department of Cardiovascular Medicine, Graduate School
of Medicine, Kyoto University
Abstract
BACKGROUND: In patients with atrial fibrillation-related ischemic stroke
despite oral anticoagulation (AFIDA), left atrial appendage closure (LAAC)
may be an additional strategy to prevent further stroke events. METHODS
AND RESULTS: AFIDA was defined as ischemic stroke occurring despite >=3
weeks of oral anticoagulation (OAC). We evaluated patients with AFIDA
treated either with OAC alone (n=141; further divided into aggressive OAC
[n=73] and conventional OAC [n=68] subgroups) or with additional LAAC
(+LAAC; n=95; further divided into continued OAC [n=44] and discontinued
OAC within 1 year after LAAC [n=51] subgroups). Patients in the +LAAC
group were younger, had higher HAS-BLED scores, and lower HELT-E2S2scores.
Three-year cumulative incidence rates of ischemic stroke and major
bleeding were comparable between the OAC alone and +LAAC groups (15.2% vs.
14.5% [log-rank P=0.75] and 23.4% vs. 5.3% [log-rank P=0.38],
respectively), whereas those of fatal or disabling stroke and fatal
bleeding were lower in the +LAAC than OAC alone group (3.4% vs. 14.7%
[log-rank P=0.06] and 0% vs. 6.0% [log-rank P=0.03], respectively).
Results of propensity score-matched and subgroup analyses were largely
consistent with those of the main analysis. Notably, fatal bleeding
occurred only in patients switched to aggressive OAC. CONCLUSION(S):
LAAC may potentially prevent fatal or disabling stroke and fatal bleeding
in patients with AFIDA. These hypothesis-generating findings support the
need for randomized controlled trials.

<124>
Accession Number
2041404879
Title
Impact of subthreshold troponin levels and temporal trends on short term
adverse cardiovascular outcomes in patients discharged from the emergency
department: a RACE-IT trial substudy.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Qureshi M.A.; Cook B.; Brennan B.; Miller J.; McCord J.
Institution
(Qureshi) Henry Ford Jackson Hospital, Jackson, MI, United States
(Cook, Brennan, Miller, McCord) Henry Ford Hospital, Detroit, MI, United
States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: High-sensitivity cardiac troponin I assays enable early
exclusion of myocardial infarction in the emergency department. However,
the clinical implications of detectable troponin values below the 99th
percentile upper reference limit (4-18 ng/L) remain unclear.
 Objective(s): To assess the association between subthreshold troponin
levels and 30-day outcomes in patients from the RACE-IT trial, using exact
troponin values when available. Method(s): This post-hoc analysis of
the RACE-IT stepped-wedge randomized controlled trial included patients
with troponin <= 18 ng/L across nine EDs. Patients were stratified by
initial troponin, peak value, absolute change, and percent change. The
primary outcome was a 30-day composite of all-cause death, acute MI,
percutaneous coronary intervention, and coronary artery bypass grafting.
Logistic regression analysis after adjusting for age, sex, race, and
coronary artery disease was performed. Result(s): Among 19,194
patients with troponin <= 18 ng/L, 117 (0.6%) experienced the composite
outcome. Higher troponin levels were associated with increased event rates
in unadjusted analyses. Adjusted analyses showed no independent
associations overall, though patients whose highest troponin values fell
within the >= 11- <= 18 ng/L range continued to demonstrate significantly
worse outcomes than those with lower peak levels. Elevated troponin values
correlated with older age, male sex, and greater comorbidity burden.
 Conclusion(s): In this post-hoc analysis of patients with troponin
values below the 99th percentile URL, absolute levels and temporal changes
were not independently associated with 30-day adverse outcomes. These
findings support the use of subthreshold troponin values in rapid rule-out
protocols, emphasizing the need to consider clinical context and
comorbidities in risk assessment. Copyright © Springer-Verlag
GmbH Germany, part of Springer Nature 2025.

<125>
Accession Number
2041404878
Title
Pericapsular nerve group block reduces fentanyl use in transcatheter
aortic valve implantation: a randomized prospective study.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Gul Y.G.; Alver S.; Ozen V.; Golboyu B.E.; Ciftci B.
Institution
(Gul, Ciftci) Department of Anesthesiology and Reanimation, Istanbul
Medipol University, Istanbul, Turkey
(Alver) Department of Anesthesiology and Reanimation, Istanbul Biruni
University, Istanbul, Turkey
(Ozen) Prof. Dr. Cemil, Department of Anesthesiology, Tascioglu City
Hospital, Istanbul, Turkey
(Golboyu) Department of Anesthesiology, Katip Celebi University, Izmir,
Turkey
(Ciftci) Department of Anatomy, Istanbul Medipol University, Istanbul,
Turkey
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Anesthesia management is crucial for elderly patients
undergoing transcatheter aortic valve implantation (TAVI). Conscious
sedation (CS) is often preferred, but additional methods need to be
utilized. The Pericapsular nerve group (PENG) block is a regional
anesthesia technique that provides analgesia in the hip and groin.
 Objective(s): Our study aimed to investigate the role of PENG block
in CS in patients undergoing TAVI. The primary outcome was the need for
intraoperative additional fentanyl. Secondary outcomes included
postoperative pain scores (NRS), rescue analgesia use (meperidine), and
adverse events. Method(s): Patients with American Society of
Anesthesiologists physical status III-IV scheduled for elective TAVI under
CS were enrolled in the study. The patients were randomized into two
groups PENG group (n = 30) and local infiltration control group (n = 30).
PENG block was performed with 30 ml of 0.25% bupivacaine 20 min before
TAVI. Propofol infusion (1 mg/kg/hour) and fentanyl as a rescue regimen (1
mcg/kg) was used for CS. Result(s): The PENG group required
significantly fewer additional doses of fentanyl for sedation and
analgesia during the intraoperative period compared with the control group
(70 [60-77.5] mug vs. 90 [60-140] mug, p = 0.001). The PENG group also had
significantly lower pain scores at the first postoperative hour (NRS at
rest, 0 (0-1) vs. 3 (2-3), p = 0.001) and reduced the need for
postoperative rescue analgesia use (meperidine) (0 [0-0] mg vs. 35 [30-40]
mg, p = 0.001). Conclusion(s): The PENG block provided effective
analgesia and reduced the fentanyl requirement during TAVI under CS. The
PENG block may be a beneficial choice to improve the quality of CS in
these patients. Trial registration: NCT05904912. Copyright ©
Springer-Verlag GmbH Germany, part of Springer Nature 2025.

<126>
[Use Link to view the full text]
Accession Number
649281577
Title
Pharmacology of thoracic anesthesia.
Source
Current opinion in anaesthesiology. (no pagination), 2025. Date of
Publication: 25 Nov 2025.
Author
Vegh T.; Szamos K.; Balla B.
Institution
(Vegh, Szamos, Balla) Department of Anesthesiology and Intensive Care,
University of Debrecen, Debrecen, Hungary
(Vegh) Outcomes Research Consortium, Houston, TX, United States
Abstract
PURPOSE OF REVIEW: Thoracic anesthesia is one of the most demanding
subspecialties, requiring the integration of surgical conditions with
patient safety. Procedures such as lung resections, video-assisted
thoracic surgery, robotic surgery, and transplantation impose unique
physiologic stress, particularly during one-lung ventilation, which
challenges gas exchange and cardiovascular stability. This review
summarizes current evidence on anesthetic strategies in thoracic surgery,
including induction and maintenance techniques, opioid use, neuromuscular
blockade, and hemodynamic management. RECENT FINDINGS: Thoracic anesthesia
present ongoing debates. No consensus exists on whether total intravenous
anesthesia or volatile anesthesia is superior: propofol may provide
long-term oncologic benefit, whereas volatiles offer pulmonary protection
but raise concerns about tumor progression and impaired hypoxic pulmonary
vasoconstriction. Opioids remain effective but carry risks of respiratory
depression, delirium, hyperalgesia, immune suppression, and persistent
use, fueling opioid-sparing but not opioid-free strategies. Neuromuscular
blockade improves surgical conditions, yet optimal depth outside robotic
surgery and the need for routine reversal remain debated. Hemodynamic
management balances euvolemia against hypovolemia. SUMMARY: Modern
thoracic anesthesia pharmacology combines novel agents with established
drug classes, integrating current evidence to improve intraoperative
stability, reduce complications, and promote recovery. Copyright
© 2025 Wolters Kluwer Health, Inc. All rights reserved.

<127>
Accession Number
649271551
Title
Natural history of unrepaired bicuspid aortic valve at diagnosis:
meta-analysis and reconstruction of time-to-event data.
Source
The Journal of cardiovascular surgery. (no pagination), 2025. Date of
Publication: 24 Nov 2025.
Author
Ogami T.; Yokoyama Y.; Sa M.P.; Takagi H.; Fukuhara S.; Sultan I.; Kuno T.
Institution
(Ogami, Sultan) Department of Cardiothoracic Surgery, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Ogami, Sultan) Heart and Vascular Institute, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Yokoyama, Fukuhara) Department of Cardiac Surgery, University of
Michigan, Ann Arbor, MI, United States
(Sa) Division of Cardiovascular Surgery, Heart, Vascular and Thoracic
Institute, Cleveland Clinic Florida, Weston, FL, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, United States
Abstract
INTRODUCTION: While outcomes after surgical or transcatheter aortic valve
replacement between bicuspid aortic valve (BAV) and tricuspid aortic valve
have been reported, the natural history of unrepaired BAV is sparse in the
literature. EVIDENCE ACQUISITION: The MEDLINE and EMBASE databases were
searched to identify relevant studies. The search was conducted through
February 2024. Time-to-event data was synthesized to reconstruct survival
curves. EVIDENCE SYNTHESIS: A total of 20 studies were identified. Nine
studies were included to reconstruct the Kaplan-Meier survival curves,
enrolling 5819 patients with BAV. Expected survival was 97.6+/-0.2%,
91.9+/-0.4%, 84.3+/-0.6%, and 76.0+/-0.9% at 1-, 5-, 10-, and 15-year,
respectively. Long-term survival was similar between patients with
unrepaired BAV and the general population (HR 1.15, 95% CI: 0.86 to 1.55,
I2=0). Five studies were included to synthesize freedom from cardiac
surgery, enrolling 2962 patients. Expected freedom cardiac surgery were
88.5+/-0.6%, 82.1+/-0.7%, and 70.0+/-1.5% at 1, 5, and 10 years,
respectively. The risk of thoracic aortic dissection was 0.06 per 100
patient years (95% CI: 0.01 to 0.12, I2=30%). CONCLUSION(S): The
estimated survival of patients with BAV was 91.9% at 5 years and 84.3% at
10 years after the diagnosis. Survival of patients with BAV may be
comparable to that of the general population. The need for an intervention
to either aortic valve or thoracic aorta was 30% at 10 years.

<128>
Accession Number
2041844441
Title
Comparison of propofol, etomidate and remimazolam on postinduction
hypotension in older adults undergoing non-cardiac surgery: Protocol for a
randomised controlled trial.
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e10545. Date of
Publication: 21 Nov 2025.
Author
Jin X.-F.; Shen C.-Y.; Dou W.; Liu H.; Ji F.-H.; Peng K.
Institution
(Jin, Shen, Dou, Ji, Peng) Department of Anaesthesiology, First Affiliated
Hospital of Soochow University, Jiangsu, Suzhou, China
(Jin, Dou, Ji, Peng) Institute of Anaesthesiology, Soochow University,
Jiangsu, Suzhou, China
(Shen) Anaesthesia Nursing Unit, Department of Anaesthesiology, First
Affiliated Hospital of Soochow University, Jiangsu, Suzhou, China
(Liu) Department of Anaesthesiology and Pain Medicine, University of
California Davis Medical Center, Sacramento, CA, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Post-induction hypotension (PIH) is a critical concern in
elderly surgical patients and is associated with adverse postoperative
outcomes. This trial aims to compare the effects of propofol, etomidate
and remimazolam on the incidence of PIH in older adults undergoing
non-cardiac surgery. Methods and analysis In this single-centre,
triple-arm, randomised controlled trial, 210 patients aged >=80 years with
American Society of Anaesthesiologists physical status I-III undergoing
elective non-cardiac surgery will be recruited. All patients will receive
general anaesthesia with endotracheal intubation. Patients will be
randomised (1:1:1) to receive propofol, remimazolam or etomidate for
anaesthesia induction (n=70 per group). The primary outcome is the
incidence of PIH (mean arterial pressure (MAP) <65 mm Hg for 1 min) from
induction initiation to surgical skin incision. Secondary outcomes include
time to successful induction, time to tracheal intubation, MAP reduction
>30% from baseline, vasopressor requirements, bradycardia, injection pain,
myoclonus, postoperative delirium, and cardiac, cerebral and renal
complications during hospitalisation. Ethics and dissemination This trial
was approved by the Ethics Committee of the First Affiliated Hospital of
Soochow University (Approval No. 2024-380). The results will be
peer-reviewed for publication in a scientific journal. Copyright
© Author(s) (or their employer(s)) 2025.

<129>
Accession Number
649268121
Title
Reassessing Acute Normovolemic Hemodilution in Cardiac Surgery: Beyond the
Randomized Clinical Trial.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2025.
Date of Publication: 30 Oct 2025.
Author
Saito J.; Hirota K.
Institution
(Saito) Department of Anesthesiology, Hirosaki University Graduate School
of Medicine, Hirosaki, Japan
(Hirota) Department of Anesthesiology, Aomori Prefectural Central
Hospital,Aomori, Japan; Department of Perioperative Stress
Management,Hirosaki University Graduate School of Medicine, Hirosaki,
Japan

<130>
Accession Number
649266705
Title
SEVERE COVID-19 ASSOCIATED MYOCARDITIS SUCCESSFULLY MANAGED WITH HIGH DOSE
STEROIDS: A CASE REPORT.
Source
Journal of General Internal Medicine. Conference: Annual Meeting of the
Society of General Internal Medicine, SGIM 2025. Hollywood, FL United
States. 40(Supplement 1) (pp S316), 2025. Date of Publication: 01 Oct
2025.
Author
Pant A.; Gupta S.; Kicker P.; Soskin B.; Ruck L.
Institution
(Pant, Gupta, Kicker, Ruck) Texas Tech University Health Sciences Center
El Paso Paul L Foster, El Paso, TX, United States
(Soskin) Texas Tech University Health Sciences Center El Paso, El Paso,
TX, United States
Publisher
Springer
Abstract
CASE: A 74-year-old female with underlying HTN and severe aortic stenosis
S/P TAVR presented with epigastric pain radiating to the left jaw. She
denied cough, dyspnea, or palpitations. She tested positive for COVID-19
four days prior and was prescribed Nirmatrelvir-Ritonavir. On arrival, she
was afebrile, tachycardic, and saturating 95% on room air. On examination,
lungs were clear and heart rhythm was irregularly irregular. CXR showed
b/l patchy lower lobe infiltrates. EKG revelaed A-fib with a rapid
ventricular rate. Pertinent labs on admission showed- BNP 38 pg/ml,
high-sensitivity Troponin-I 9108 pg/ml, CRP 23.1 mg/dl, CK 2160 IU/L, IL-6
334.0 pg/ml, Procalcitonin 1.5 ng/ml. Echo and LHC revealed LVEF 50-55%
with inferior wall hypokinesis and mild diffuse disease of LAD without
significant stenosis, respectively. GDMT for NSTEMI was started along with
a 5-day course of Remdesivir and low-dose dexamethasone. Troponin
continued rising to a maximum of >25000 pg/ml between day 1 and day 6
along with progressive pleuritic chest pain and dyspnea. By day 3, she
developed acute respiratory failure, requiring a high-flow nasal cannula.
Therefore, on day 3, low-dose dexamethasone was stopped and switched to a
high-dose Methylprednisolone 500 mg/day in divided doses. Following 5 days
of treatment, CRP normalized (CRP 3.12 mg/dl), Troponin-I downtrend
(Troponin-I 13,000 pg/ml) and she was weaned off the oxygen. She was
discharged with a 4-week oral prednisone taper with serial troponin within
normal limits upon completion of therapy (Troponin-I 38 pg/ml).
IMPACT/DISCUSSION: A CDC study noted a higher prevalence of myocarditis,
150/100,000 in COVID-19 patients versus 9/100,000 in non-COVID patients,
from the same timeline. The ACC and ESC advocate for supportive treatment
of myocarditis while leaving the use of immunosuppression to expert
consensus. Elevated IL-6 and troponin have been strongly and independently
associated with increased severity and in-hospital mortality. Alarming lab
values and clinical deterioration warranted intervention in our patient.
Although the role of immunosuppression in virus-negative myocarditis is
well established by the landmark TIMIC trial and a 20-year follow-up of
the study, immunosuppression in virus-positive myocarditis is still
controversial. Among COVID-19 patients, the RECOVERY trial showed that
using dexamethasone was associated with decreased 28-day mortality. A
systematic review of 14 case reports of COVID-19-related myocarditis by
Sawalha et al. revealed a high survival rate of 85% with steroids. Another
review of 18 case reports by Kamarullah et al. reported clinical
improvement in 72% of cases using steroids. The dose, duration, and choice
of steroid remain physician-dependent. CONCLUSION(S): While the
milder forms may respond to supportive treatment, patients with severe
acute myocarditis may benefit from immunosuppression therapy. This case
advocates for further studies to define the role of immunosuppression in
COVID-19-associated myocarditis.

<131>
Accession Number
2037878049
Title
RISK FACTORS FOR ACUTE KIDNEY INJURY FOLLOWING HEART TRANSPLANTATION: A
SYSTEMATIC REVIEW AND META-ANALYSIS:.
Source
American Journal of Kidney Diseases. Conference: National Kidney
Foundation 2025 Spring Clinical Meetings. Boston United States. 85(4
Supplement 1) (pp S6-S7), 2025. Date of Publication: 01 Apr 2025.
Author
Khawar M.; Sehar A.; Qadeer A.; Shahzad M.; Farooq H.; Khawar M.M.H.;
Rehman S.U.; Haider M.; Leghari M.A.; Villanueva M.N.; Mour G.K.; Kirchoff
R.W.
Institution
(Qadeer, Villanueva, Mour, Kirchoff) Mayo Clinic Hospital
(Khawar, Sehar, Shahzad, Farooq) King Edward Medical University
(Khawar) Services Institute of Medical Sciences
(Rehman) Beth Israel Lahey Health
(Haider) West Virginia University
(Leghari) Lehigh Valley Health Network
Publisher
W.B. Saunders
Abstract
Acute kidney injury [AKI) is a frequent complication after heart
transplantation, increasing morbidity, mortality, and costs. Identifying
modifiable risk factors is vital to improve outcomes and guide care
strategies. Searches were conducted in MEDLINE, Google Scholar,
ScienceDirect, ClinicalTrials.gov, and Cochrane databases until September
1. Included studies were retrospective cohorts and observational studies.
Statistical analysis using RevMan 5.4 reported outcomes as odds ratios
[OR) and mean differences (MD) with 95% confidence intervals [CI).
Thirteen studies involving 3330 heart transplant recipients reported an
AKI incidence of 41.3% (1376/3330). Significant risk factors were older
age [p = 0.04), higher BMI [p = 0.0007), pre-existing CKD [p < 0.00001),
COPD [p = 0.02), diabetes [p = 0.001), prolonged cardiopulmonary bypass
time [p = 0.002), extracorporeal membrane oxygenation [p = 0.008),
mechanical ventilation [p = 0.003), and prior thoracic surgery [p = 0.02).
Non-significant factors included ischemic time, hypertension, intra-aortic
balloon pump use, smoking, male sex, valvular disease, inotropes, left
ventricular assist device use, cardiomyopathy, peripheral arterial
disease, and coronary artery disease. Modifiable factors such as BMI,
diabetes, and prolonged bypass time represent critical targets for
reducing AKI risk in heart transplant recipients. Optimizing perioperative
management by focusing on these factors may improve
outcomes. Copyright © 2024 Elsevier Ireland Ltd

<132>
Accession Number
2041749697
Title
Reduction of the risk of complete sternotomy scar dehiscence in cardiac
surgery: a protocol for a randomised, open-label multicentre clinical
investigation comparing negative pressure wound therapy (NPWT) versus
standard dressing (PRISTER study).
Source
BMJ Open. 15(11) (no pagination), 2025. Article Number: e104226. Date of
Publication: 19 Nov 2025.
Author
Jayle C.; Allain G.; Buono A.; Dang Van S.; D'Ostrevy N.; Kermen S.;
Picardo A.; Pelras A.; Drux J.; Corbi P.; Billot M.; Frasca D.
Institution
(Jayle, Allain, Drux, Corbi) CHU Poitiers, Poitiers, France
(Jayle, Buono, Billot) INSERM, Centre d'Investigation Clinique domaine
d'Innovation Technologique, Universite de Poitiers, CHU de Poitiers, 1402,
Poitiers, France
(Dang Van) service de chirurgie cardiaque, Angers University Hospital,
Angers, France
(D'Ostrevy) service de chirurgie Cardio-Vasculaire, CHU Clermont-Ferrand,
Clermont-Ferrand, France
(Kermen) service de chirurgie cardiaque, CHU de Tours, Tours, France
(Picardo) service de chirurgie thoracique et cardio-vasculaire, CHU
Limoges, Limoges, France
(Pelras) Centre de Recherche sur la Cognition et l'Apprentissage UMR7295,
CNRS, Universite de Poitiers, Poitiers, France
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiac surgical procedures are associated with a high
incidence of postoperative infection, a risk attributed to their
inherently invasive nature and extended duration. The goal of this study
is to evaluate the efficacy of negative pressure wound therapy (NPWT)
compared with standard dressings in preventing sternal scar dehiscence in
patients undergoing cardiac surgery via complete vertical midline
sternotomy, comparing a 3 day change system (NPWT 3/7 d) versus a 7day
wear system (NPWT 7d) versus standard dressings. Methods and analysis The
PRISTER study is a prospective open-label multicentre, randomised,
controlled, three-arm trial. Patients aged >=18 years and meeting all the
following inclusion criteria: patients undergoing scheduled or semiurgent
cardiac surgery, with or without extracorporeal circulation, and patients
managed by complete vertical median sternotomy will be recruited. Total
sample size will consist of 660 patients. The primary outcome, surgical
wound dehiscence after complete median sternotomy, expressed as occurrence
or non-occurrence during the first 30 postoperative days, will be assessed
by tablet calibrated photos analysed by an independent blinded staff. The
secondary outcomes will be the number of dressing repairs between D7
(excluding initial protocol) and D90, length of initial hospital stay,
occurrence of surgical site infection and its classification collected on
day 90 (D90), use of an anti-infectious treatment and its duration,
incidence of postoperative mediastinitis defined by dehiscence of the
sternum with positive sternal samples, incidence of surgical revision for
dehiscence of the surgical wound at D90 and collection of all operations
involving surgical revision of the sternotomy wound, number of
rehospitalisations (including hospital consultations) and their duration
(evaluated at D90). Medicoeconomic assessment will be assessed by
evaluation of hospital and extrahospital costs (number of days in
hospital, consultations, rehospitalisations, imaging, biology and drugs),
dressing costs and patient quality of life by EQ-5D-5L. Ethics and
dissemination The study was approved by the French Agency for the Safety
of Health Products (ANSM, Agence National de Securite du Medicament) as
well as by the Ethics Committee (CPP Ile de France VIII) NdegreeID-RCB:
2023-A01782-43. Recruitment began in April 2024 and ended on 26 May
2025. Copyright © Author(s) (or their employer(s)) 2025. Re-use
permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ Group.

<133>
Accession Number
2036992657
Title
Historical perspective on the evolution and application of therapeutic
hypothermia in neonatology.
Source
American Journal of the Medical Sciences. Conference: 2025 Southern
Regional Meeting. InterContinental Hotel, New Orleans United States.
369(Supplement 1) (pp S283-S284), 2025. Date of Publication: 01 Feb 2025.
Author
Amar P.; Babata K.; Jaiyeola M.; Leon S.; Leon R.L.; Chamarthi S.; Chalak
L.
Institution
(Babata, Leon, Chalak) UT Southwestern, Dallas, TX, United States
(Amar) Loyola University, Chicago, IL, United States
(Jaiyeola) Allen High School, Dallas, TX, United States
(Leon) Sachse High School, Garland, TX, United States
(Chamarthi) Centennial High School, Frisco, TX, United States
Publisher
Elsevier B.V.
Abstract
Purpose: Background: Hypothermia, the reduction of core body temperature,
has been recognized for its therapeutic potential since ancient times. The
Egyptians and Greeks employed cooling methods for various medical
treatments. In modern times, specific compelling cases of improbable
survival in hypothermic conditions have inspired further exploration into
the therapeutic effects of hypothermia on the human body.
 Objective(s): To chronicle the historical progression and clinical
advancements of hypothermia as a treatment, with a focus on its
application to neonatal hypoxic ischemic encephalopathy (HIE).
 Method(s): Analysis of published literature on the history and
clinical use of hypothermia for its therapeutic properties.
 Result(s): Dr. Temple Fay pioneered the modern use of controlled
hypothermia in the 1930s, and by the 1950s, it was adopted as a method to
reduce metabolic tissue demand and improve outcomes from open heart
surgery. Early studies in the 1950s showed promise for the application of
therapeutic hypothermia (TH) to specific neonatal populations, but this
research was discontinued due to safety concerns. Renewed interest in the
1990s led to pivotal animal studies using TH which demonstrated neuronal
protection in piglets following birth asphyxia and prevention of cortical
infarction in rats after experimental brain injury. Pilot studies in the
late 1990s using a compelling model of HIE in the chronically instrumented
ewe laid the groundwork for large-scale clinical trials. These trials
established TH as the standard of care for moderate to severe HIE in
neonates. The TOBY trial (2005-2011) was particularly influential,
demonstrating improved long-term outcomes for those treated with TH. In a
meta-analysis including over 1500 infants, the number needed to treat for
TH was 7 to prevent one case of death or moderate to severe disability,
underscoring the success of TH as an intervention. The COOLPRIME study
nowaddresses the safety and effectiveness of TH in neonates with mild HIE,
potentially expanding the application of this therapy. Conclusion(s):
Hypothermia has evolved from an ancient remedy to a critical intervention
in neonatology, significantly improving outcomes for newborns with HIE.
The COOLPRIME study continues to refine its use, with a focus on a
potential therapeutic role in neonates with mild HIE. Copyright ©
2025 Southern Society for Clinical Investigation. Published by Elsevier
Inc. All rights are reserved, including those for text and data mining, AI
training, and similar technologies.. All rights reserved.

<134>
[Use Link to view the full text]
Accession Number
649268106
Title
Nitric Oxide to Reduce Acute Kidney Injury in Patients with Pre-existing
Endothelial Dysfunction Requiring Prolonged Cardiopulmonary Bypass: A
Randomized Clinical Trial.
Source
Anesthesiology. (no pagination), 2025. Date of Publication: 21 Nov 2025.
Author
Arora P.; Di Fenza R.; Shetty N.S.; Giammatteo V.; Marrazzo F.; Spina S.;
Zadek F.; Gianni S.; Fakhr B.S.; La Vita C.; Shann K.; Zheng H.; Gaonkar
M.; Yu B.; Feelisch M.; Thompson T.B.; Akeju O.; Sundt T.M.; Bonventre J.;
Ichinose F.; Berra L.
Institution
(Arora, Gaonkar) Division of Cardiovascular Disease, University of Alabama
at Birmingham, Birmingham, AL, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
Birmingham, AL, United States
(Di Fenza, Shetty, Giammatteo, Marrazzo, Spina, Zadek, Gianni, Fakhr, Yu,
Akeju, Ichinose, Berra) Department of Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, Boston, MA, United States
(Di Fenza, Shetty, Giammatteo, Marrazzo, Spina, Zadek, Gianni, Fakhr, Yu,
Akeju, Ichinose, Berra) Harvard Medical School, Boston, MA, United States
(La Vita, Berra) Respiratory Care Services Department, Massachusetts
General Hospital, Boston, MA, United States
(Shann) Perfusion Services, Division of Cardiac Surgery, Corrigan Minehan
Heart Center, Massachusetts General Hospital, Boston, MA, United States
(Zheng) Biostatistics, Massachusetts General Hospital, Boston, MA, United
States
(Feelisch) Experimental Medicine & Integrative Biology, Faculty of
Medicine, University of Southampton, United Kingdom
(Thompson) Pulmonary Division Unit, Department of Medicine, Massachusetts
General Hospital, Boston, MA, United States
(Sundt) Division of Cardiac Surgery, Corrigan Minehan Heart Center,
Massachusetts General Hospital, Boston, MA, United States
(Bonventre) Renal Unit, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
Abstract
BACKGROUND: Prolonged cardiopulmonary bypass (CPB) causes hemolysis,
reducing nitric oxide (NO) availability and increasing the risk of acute
kidney injury (AKI) after cardiac surgery. While prior studies suggest
inhaled NO may reduce AKI in certain populations, its effect in patients
with pre-existing endothelial dysfunction, a condition marked by impaired
NO production is unknown. This trial investigates whether perioperative NO
administration reduces AKI in patients with pre-existing endothelial
dysfunction undergoing prolonged CPB. METHOD(S): We conducted a
double-blind, single-center, placebo-controlled, randomized clinical trial
involved 250 adult cardiac surgery patients with pre-existing endothelial
dysfunction undergoing cardiopulmonary bypass lasting more than 90
minutes. Participants were randomized to either receive NO at 80 ppm via
the oxygenator during cardiopulmonary bypass, continuing post-operatively
via ventilator and facemask, or a placebo of nitrogen-oxygen gas mixture
for 24 hours. The primary outcome was the incidence of post-operative AKI,
defined by KDIGO criteria. Secondary outcomes included AKI severity, and
the need for renal replacement therapy (RRT) during hospitalization and at
6 weeks, 90 days, and 1 year. RESULT(S): Of the 250 patients [median
age: 66 (59, 73) years; 56 (22.4%) females], 125 were assigned to each
group. AKI occurred in 55 (44.0%) patients in the NO group and 54 (43.2%)
patients in the control group [OR adj : 1.00 (95%CI: 0.59-1.69)].
Secondary outcomes, including stage 1, 2, or 3 AKI and RRT at all time
points, were also similar between groups. CONCLUSION(S): In cardiac
surgery patients with pre-existing endothelial dysfunction undergoing
prolonged cardiopulmonary bypass, peri-operative administration of 80 ppm
NO for 24 hours did not significantly reduce post-operative AKI. These
findings do not support the routine use of NO in this patient population.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier:
NCT02836899. Copyright © 2025 American Society of
Anesthesiologists. All Rights Reserved.

<135>
Accession Number
649256987
Title
PERCUTANEOUS CORONARY INTERVENTION VS CORONARY ARTERY BYPASS GRAFTING in
LEFT MAIN DISEASE ACCORDING to PATIENTS' SEX: A META-ANALYSIS.
Source
Giornale Italiano di Cardiologia. Conference: 45. Congresso Nazionale
GISE. Milan Italy. 25(Supplement 2) (pp e29-e30), 2024. Date of
Publication: 01 Nov 2024.
Author
Meynet P.; Improta R.; Carbone M.L.; Pecoraro M.; Pagliassotto I.; Di
Pietro G.; Demetres M.; Bruno F.; Comitini G.; Leone A.; Martinengo E.;
D'Ascenzo F.; Chieffo A.; De Ferrari G.M.; Gaudino M.; Mancone M.; Di
Franco A.; De Filippo O.
Institution
(Meynet, Carbone, Pecoraro, Pagliassotto, Bruno, Martinengo, D'Ascenzo, De
Ferrari, De Filippo) Division of Cardiology, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital, Turin, Italy
(Meynet, Carbone, Pecoraro, Pagliassotto, Martinengo, D'Ascenzo, De
Ferrari) Department of Medical Sciences, University of Turin, Turin, Italy
(Improta, Di Pietro, Comitini, Mancone) Department of Clinical Internal
Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome,
Policlinico Umberto I, Rome, Italy
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Leone) Department of Advanced Biomedical Sciences, University of Naples
Federico Ii, Naples, Italy
(Leone) Division of Cardiology, Sg Moscati Hospital, Avellino, Italy
(Chieffo) Interventional Cardiology Unit, Irccs San Raffaele Scientific
Institute, Milan, Italy
(Chieffo) Vita Salute San Raffaele University, Milan, Italy
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction Although coronary artery bypass grafting (CABG) has
consistently demonstrated superior long-term outcomes, percutaneous
coronary intervention (PCI) has gained increasing interest as an
alternative revascularization strategy for unprotected left main (ULM)
disease. In this context, the role of the sex category has gained mounting
interest in the view of a tailored approach for coronary
revascularization. The aim of this meta-analysis was to investigate
outcomes after PCI or CABG for ULM disease according to patients' sex.
Methods Randomized controlled trials (RCTs) and adjusted observational
studies comparing PCI vs CABG in patients with ULM disease and reporting
outcomes according to sex category were included. Major adverse
cardiovascular events (MACE) was the primary composite endpoint. All-cause
mortality and repeated revascularization were the secondary endpoints.
Results Ten studies (3 RCTs, 7 adjusted observational), encompassing 22141
patients with ULM disease (13411 patients in the PCI group and 8730 in the
CABG group) and a median follow-up of 5 years were included. Among male
patients, PCI was associated with an increased risk of MACE (HR 1.18, 95%
CI 1.01-1.38) while no difference was observed for female patients. No
significant differences between PCI and CABG were found in all-cause
mortality for both sex categories. Repeated revascularization risk was
significantly higher in the PCI group for both sexes (HR 3.51, 95% CI
2.21-5.59 and HR 4.20, 95% CI 2.57-6.87 for males and females
respectively) compared with CABG. Conclusions Among male patients with ULM
disease, CABG was associated with a significantly lower risk of MACE,
while no differences between PCI and CABG were observed in females. In
both male and female patients with ULM disease, PCI was associated with a
higher risk of repeated revascularization compared with CABG.

<136>
Accession Number
649245958
Title
Plasma free Hemoglobin, Haptoglobin, and risk of CSA-AKI. A translational
systematic review and meta-analysis.
Source
Nephrology Dialysis Transplantation. Conference: 62nd ERA Congress. Vienna
Austria. 40(Supplement 3) (pp i1757-i1758), 2025. Date of Publication: 01
Oct 2025.
Author
Gonzalez-Jaramillo N.; Saxenhofer M.; Schnell A.; Schaub A.; Gentinetta
T.; Couto D.; Snijder G.J.; Edler M.
Institution
(Gonzalez-Jaramillo) SITEM Insel, Bern, Switzerland
(Saxenhofer, Schnell, Schaub, Gentinetta, Couto, Edler) CSL Behring, Bern,
Switzerland
(Snijder) Vifor Pharma, Zurich, Switzerland
Publisher
Oxford University Press
Abstract
Background and Aims: Patients undergoing cardiac surgery (CS) are at high
risk of developing cardiopulmonary bypass (CPB)-induced hemolysis and
acute kidney injury (AKI). The associations of free Hemoglobin (fHb) and
its scavenger protein Haptoglobin (Hp) with the incidence of cardiac
surgery-associated acute kidney injury (CSA-AKI) remain unclear.
Understanding the role of fHb and Hp in the development of AKI among
patients undergoing CS could help identify individuals at higher risk of
kidney injury, suggest future research and clinical interventions, and
eventually improve preventive care bundles. Therefore, we aimed to
systematically assess the longitudinal changes in fHb and Hp during
cardiac surgery and their pooled associations with the incidence of
CSA-AKI. Method(s): We conducted a Systematic review and
Meta-analysis. PubMed, Embase, and COCHRANE databases were systematically
searched through December 31, 2024. Additionally, the first 200 hits of a
Google Scholar search were screened. We selected observational and
interventional studies analyzing the associations of changes in Hp and fHb
with CSA-AKI. Additionally, studies were selected if they reported fHb and
Hp measurements from at least two different time points. Two reviewers
independently extracted data and assessed data quality. Published
incidence of AKI and mean concentrations of fHb and Hp with their 95%
confidence intervals (CIs) were pooled using random effects models. We
used 'metafor' package in R (version 4.0.0) to synthesize and display
findings from included studies. Result(s): 200 studies were screened
for title and abstract and 13 for full text. Seven studies from four
countries and a total of 547 patients were included and meta-analyzed. In
studies among children, the mean age ranged between 1.3 and 2.5 years. In
adults, the mean age ranged between 61 and 72 years. The overall pooled
incidence of AKI was 31% [95% CI 21-42]. Mean fHb values increased
progressively during CPB, reaching maximum concentrations at the end of
CPB. The pooled maximum mean concentration of fHb was 55 pmol/L heme
equivalents [95% CI 29-103]. Mean Hp values decreased progressively during
CPB, reaching minimum concentrations several hours after CPB. The pooled
minimum mean concentration of Hp was 28 mg/dl [95% CI 23-35]. Both maximum
fHb and minimum Hp concentrations after CPB were significantly associated
with the incidence of AKI. fHb maximum value after CPB was associated with
a 1.1 times fold increase in the incidence of CSA-AKI (OR 1.1 [95% CI
1.02-1.21]). Hp depletion was associated with a 2.5 times fold increase in
the incidence of CSA-AKI (OR 2.5 [95% CI 1.2-5]). The overall risk of bias
was moderate. Conclusion(s): This meta-analysis of seven studies,
encompassing 547 patients, revealed that one-third of the patients
developed CSAAKI. The findings underscore hemolysis and Hp depletion as
significant mechanisms contributing to the incidence of AKI post-CS. Given
the stronger association of Hp with CSA-AKI, future clinical trials should
focus on monitoring Hp levels and evaluating the preventive use of Hp to
reduce the incidence of CSA-AKI.

<137>
[Use Link to view the full text]
Accession Number
649254279
Title
Adoption of a novel biomarker-guided quality improvement treatment bundle
for patients with subclinical acute kidney injury after cardiac surgery:
An implementation study.
Source
European journal of anaesthesiology. (no pagination), 2025. Date of
Publication: 21 Nov 2025.
Author
Milne B.; Helyar S.; Pellowe C.; Ostermann M.; Lees N.; Donovan J.; Sekhon
M.; Kunst G.
Institution
(Milne) From the The Department of Anaesthesia, ACET Research Team, King's
College Hospital NHS Foundation Trust, Royal College of Anaesthetists Lay
Committee (CP), Department of Critical Care, Clinical Biochemistry, Royal
Brompton & Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust,
Population Health Research Institute, School of Health and Medical
Sciences, City St George's, University of London, School of Cardiovascular
and Metabolic Medicine and Sciences, King's College London, London, United
Kingdom
Abstract
BACKGROUND: Evidence-based peri-operative practices can deliver improved
patient outcomes, but their benefits may be limited by obstacles to
implementation into routine practice. A multicentre randomised controlled
trial demonstrated a reduction in the incidence of moderate-severe acute
kidney injury after cardiac surgery using a biomarker-guided renal care
bundle, however these measures are not a routine part of clinical
practice. OBJECTIVE(S): We set out to assess the key implementation
domains of acceptability, feasibility and appropriateness of this
technology-intervention bundle in the cardiac intensive care unit. DESIGN:
Following introduction of the biomarker-guided renal care bundle, the
implementation process was assessed using comprehensive and novel
implementation science metrics: Weiner's adoption metrics and Sekhon's
theoretical framework of acceptability. SETTING: Two tertiary cardiac
surgical centres in London, UK, between July 2021 and February 2022.
PARTICIPANTS: One hundred and seventy-six adult patients underwent urinary
biomarker assessment 2 h after arrival on the cardiac intensive care unit
and 49 respondents, including medical and surgical consultants and nursing
staff, completed our implementation survey. INTERVENTIONS: Patients with a
raised biomarker level ([TIMP-2] x [IGFBP7] > 0.3 (ng ml-1)2 1000-1)
received a renal care bundle. The clinician respondents underwent a survey
designed to provide implementation metrics. MAIN OUTCOME MEASURE: The
primary outcome was the assessment of implementation using Weiner's
adoption metrics and Sekhon's theoretical framework of acceptability.
 RESULT(S): 34.7% (n = 61) of patients had a raised biomarker level
indicating a requirement for the renal care bundle, with a mean delivery
of 4.4 (out of 6) bundle items. Concerning Weiner's adoption metrics, the
median scores for acceptability, appropriateness and feasibility were all
4 (out of a possible 5) indicating a high degree of positivity towards the
intervention. Similarly, all domains of Sekhon's theoretical framework of
acceptability scored a median of 4 (out of 5). The highest scoring domain
was Perceived Effectiveness (mean 4.0), whilst the lowest were Burden
(mean 3.4) and Opportunity Costs (mean 3.4). CONCLUSION(S): This
implementation science study demonstrates that this biomarker-guided renal
care bundle is deliverable after cardiac surgery, outside of a research
setting. Our findings show that the intervention is acceptable, feasible
and appropriate, which is strongly supported by its 'perceived
effectiveness'. We have also demonstrated the more negative aspects to be
addressed to improve concordance in other settings. Copyright ©
2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of
the European Society of Anaesthesiology.

<138>
Accession Number
649256917
Title
LONG-TERM DURABILITY of BALLOON-EXPANDABLE VS SELFEXPANDING TRANSCATHETER
AORTIC VALVE PROSTHESES.
Source
Giornale Italiano di Cardiologia. Conference: 45. Congresso Nazionale
GISE. Milan Italy. 25(Supplement 2) (pp e4), 2024. Date of Publication: 01
Nov 2024.
Author
Continisio S.; Montonati C.; Terzi R.; Boldi E.; Ielasi A.; Silvestro A.;
Munafo A.R.
Institution
(Continisio, Boldi, Silvestro) Istituto Clinico San Rocco, Ome, Italy
(Montonati, Ielasi) Ircss Galeazzi, Milano, Italy
(Terzi) Centro Cardiologico Monzino, Milano, Italy
(Munafo) Ospedale Niguarda, Milano, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Aims To compare long-term durability of balloon-expandable (BEV) and
selfexpanding (SEV) transcatheter aortic valve prostheses in patients
undergoing transcatheter aortic valve implantation (TAVI). Methods In this
systematic review and meta-analysis, all observational studies and
randomized controlled trials comparing long-term durability of SEV and BEV
in patients with severe aortic stenosis (AS) treated with TAVI were
evaluated for inclusion. Electronic databases were searched up to March
2024. Pooled odds ratios (OR) with 95% confidence interval (CI) were used
as summary statistics and were calculated using a random-effects model.
Primary endpoint was the occurrence of all-cause bioprosthetic valve
failure (BVF) at the longest available follow-up. As secondary endpoints,
we considered the rate of moderate and severe structural valve
deterioration (SVD) and the occurrence of all-cause death at the longest
available follow-up. BVF and SVD were defined according to the criteria
used in each included study. Results A total of eighteen studies and 7,132
patients were included in the meta-analysis; 49.2% of patients (n=3,508)
were treated with a BEV, while a SEV was used in 50.8% of cases (n=3,624).
In more than 90% of cases, an old generation bioprosthetic valve was used.
In all included studies, prostheses durability was evaluated during a
follow-up period of at least 5 years (for 12 studies outcomes occurring
after 5 years from TAVI were reported). Overall, the pooled estimate of
allcause BVF was 4% (95% CI: 3-5%), and no difference was observed between
patients treated with BEV and SEV (OR: 1.38; 95% CI: 0.89-2.15; p-value:
0.147). The pooled estimate of moderate and severe SVD in the entire
population was 4% (95% CI: 4-5%), and it mainly occurred due to prosthetic
valve stenosis (50% of cases). When compared to those undergoing TAVI with
a SEV, patients treated with a BEV experienced a significantly higher rate
of any SVD (OR: 1.85; 95% CI: 1.52-2.24; p-value <0.001). Finally, the
risk of all-cause death did not differ between patients who received a BEV
and those who received a SEV (OR: 1.07; 95% CI: 0.74-1.54; p-value: 0.729;
overall pooled estimated 55%, 95% CI: 41-68%). Conclusions In patients
with severe AS undergoing TAVI, the design of the platform used could have
an impact on long-term durability of transcatheter aortic valve
prostheses. After more than 5 years from TAVI procedure, patients treated
with a BEV experienced a higher risk of any SVD compared to those for whom
a SEV was implanted. Nevertheless, no difference in the occurrence of
all-cause BVF and all-cause death was observed.

<139>
Accession Number
649256543
Title
SAFETY and EFFICACY of BEMPEDOIC ACID: A SYSTEMATIC REVIEW of RANDOMIZED
CONTROLLED TRIALS.
Source
Giornale Italiano di Cardiologia. Conference: 44. Congresso Nazionale
GISE. Milan Italy. 24(10 Supplement 1) (pp e31-e32), 2023. Date of
Publication: 01 Oct 2023.
Author
Nebiolo M.; De Filippo O.; Giacobbe F.; Pagliassotto I.; Borzillo I.;
Solano A.; Ravetti E.; Iannaccone M.; Bertaina M.; Leone A.; Monticone S.;
Brizzi M.F.; De Ferrari G.M.; D'Ascenzo F.
Institution
(Nebiolo, Giacobbe, Pagliassotto, Borzillo, Solano, Ravetti, Monticone, De
Ferrari, D'Ascenzo) Department of Medical Sciences, University of Turin,
Turin, Italy
(Nebiolo, De Filippo, Giacobbe, Pagliassotto, Borzillo, Solano, Ravetti,
De Ferrari, D'Ascenzo) Division of Cardiology, Cardiovascular and Thoracic
Department, Citta della Salute e della Scienza Hospital, Turin, Italy
(Iannaccone, Bertaina) Division of Cardiology, San Giovanni Bosco
Hospital, Asl Citta di Torino, Turin, Italy
(Leone) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Brizzi) Division of Internal Medicine and Hypertension, Department of
Medical Sciences, University of Turin, Turin, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction Bempedoic acid (BA) is a novel lipid-lowering therapy (LLT).
We performed a systematic review and metanalysis to assess the efficacy
and safety of BA in patients with hypercholesterolemia. Methods. PubMed,
Scopus, and Cochrane library databases were searched for randomised
controlled trials evaluating the efficacy and/or safety of BA compared
with placebo. Trials investigating dosages other than 180 mg/die were
excluded. Major adverse cardiovascular events (MACE) were the primary
efficacy endpoint. LDL-cholesterol reduction was the primary laboratory
endpoint. Pre-specified safety endpoints included muscle-related adverse
events, new-onset diabetes, and gout. The protocol was registered on
PROSPERO (temporary ID:399867). Results. Study search identified 275
deduplicated results. 11 studies, encompassing 18315 patients (9854 on BA
vs 8461 on placebo/no treatment) were included. BA was associated with a
reduced risk of MACE (OR 0.86, 95%CI 0.79-0.95), myocardial infarction (OR
0.76, 95% CI 0.64-0.88) and unstable angina (OR 0.69, 95% CI 0.54-0.88)
compared to control, over a median follow up of 87 (15-162) weeks. BA was
associated with a reduction of LDL-Cholesterol (mean difference
[MD]-22.42, 95% CI-24.02% to-20.82%), total cholesterol (-16.50%, 95%
CI-19.21% to-13.79%), Apo-B lipoprotein (-19.55%, 95% CI-22.68% to-16.42%)
and high-sensitivity CRP (-27.83%, 95% CI-31.71% to-23.96%) at 12 weeks.
BA was associated with a higher risk of gout (OR 1.55, 95%CI 1.27-1.90) as
compared with placebo. Efficacy on laboratory endpoints was confirmed,
with a variable extent, across patients on statin or ezetimibe background
therapy. Conclusions. The improved cholesterol control achieved with BA
translates into a reduced risk of MACE, including myocardial infarction
and coronary revascularisation. The drug has a satisfactory safety profile
except for an increased risk of gout.

<140>
Accession Number
649253511
Title
Rationales Behind Physiology-Guided Revascularization: Diagnostic Impact
of Quantitative Flow Ratio in the FAVOR III China Trial.
Source
JACC. Cardiovascular interventions. (no pagination), 2025. Date of
Publication: 20 Nov 2025.
Author
Zhang R.; Wang H.-Y.; Song L.; Guan C.; Yin D.; Zhu C.; Feng L.; Jin Z.;
Yu B.; Fu G.; Zhou Y.; Wang J.; Chen Y.; Pu J.; Chen L.; Qu X.; Zhao Y.;
Wang Y.; Liu W.; Qiao S.; Tu S.; Wijns W.; Dou K.
Institution
(Zhang, Wang, Dou) Cardiometabolic Medicine Center, National Clinical
Research Center for Cardiovascular Diseases, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China; Department of
Cardiology, National Clinical Research Center for Cardiovascular Diseases,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China; Coronary Heart Disease Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China; State Key Laboratory of
Cardiovascular Disease, Beijing, China
(Song) Department of Cardiology, National Clinical Research Center for
Cardiovascular Diseases, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China; Coronary Heart Disease Center,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing,
China; Catheterization Laboratories, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Guan) Catheterization Laboratories, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Yin, Zhu, Feng, Qiao) Department of Cardiology, National Clinical
Research Center for Cardiovascular Diseases, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China; Coronary Heart Disease
Center, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Jin) Department of Cardiology, Beijing Tiantan Hospital, Capital Medical
University, Beijing China, China
(Yu) Department of Cardiology, Second Affiliated Hospital of Harbin
Medical University, Harbin, China
(Fu) Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang
University School of Medicine, Hangzhou, China
(Zhou) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Wang) Department of Cardiology, Second Affiliated Hospital, Zhejiang
University School of Medicine, Hangzhou, China
(Chen) Department of Cardiology, Sixth Medical Centre, Chinese PLA General
Hospital, Beijing, China
(Pu) Department of Cardiology, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
(Chen) Department of Cardiology, Fujian Medical University Union Hospital,
Fuzhou, China
(Qu) Department of Cardiology, Huadong Hospital Affiliated to Fudan
University, Shanghai, China
(Zhao, Wang) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases, Beijing, China
(Liu) State Key Laboratory for Complex, Rare Diseases, Peking Union
Medical College Hospital, Chinese Academy of Medical Sciences, Beijing,
China
(Tu) Biomedical Instrument Institute, School of Biomedical Engineering,
Shanghai Jiao Tong University, Shanghai, China
(Wijns) Lambe Institute for Translational Medicine and Curam, University
of Galway, Galway, Ireland
Abstract
BACKGROUND: The optimization of a treatment plan developed on the basis of
coronary angiography alone is recognized as one of the underlying
rationales for the clinical benefits of physiology-guided percutaneous
coronary intervention (PCI). OBJECTIVE(S): The aim of this study was
to investigate the diagnostic impact of quantitative flow ratio (QFR)
through a post hoc analysis of the multicenter randomized FAVOR
(Comparison of Quantitative Flow Ratio Guided and Angiography Guided
Percutaneous Intervention in Patients With Coronary Artery Disease) III
China trial. METHOD(S): In FAVOR III China, operators were required
to declare all target vessels intended for PCI before randomization
(prerandomization declared treatment plan). After randomization, the
actual treatment strategy was performed with online QFR or angiographic
guidance (randomized allocation). In this study, prerandomization
treatment plan and postrandomization treatment strategy were adjudicated
using off-line QFR by independent core laboratory to determine
physiological concordance. The primary outcome of interest for the present
study was major adverse cardiac events. RESULT(S): Among 3,768 pooled
patients with available off-line QFR, 2,601 (69.0%) had prerandomization
physiology-concordant plans, proportions of which were comparable between
the online QFR-guided and angiography-guided groups (70.9% [1,340 of
1,891] vs 67.2% [1,261 of 1,877], standardized mean difference = 0.087).
Physiological concordance was reclassified in 447 (23.6%) and 87 (4.6%)
patients with online QFR and angiographic guidance, respectively, and a
significant between-group difference was identified in terms of achieving
postrandomization physiological concordance (92.3% vs 67.2%, standardized
mean difference = 0.665). A significant interaction was identified between
prerandomization physiological concordance and randomized allocation for
2-year major adverse cardiac events (P for interaction = 0.002). Patients
with older age, multivessel disease, left circumflex or right coronary
artery involved, and lower SYNTAX (Synergy Between PCI With Taxus and
Cardiac Surgery) scores were found more likely to have prerandomization
physiological nonconcordance. CONCLUSION(S): In the FAVOR III China
trial, approximately 30% of patients showed discrepancies between
angiography-based treatment plans and physiological ischemia. The
mechanistic insight underlying the benefits of QFR-guided PCI is
reclassification following online QFR guidance, which leads to a shift
from initially flawed plans toward physiology-concordant decisions. (The
FAVOR III China Study [FAVORIII]; NCT03656848). Copyright © 2025
American College of Cardiology Foundation. Published by Elsevier Inc. All
rights reserved.

<141>
Accession Number
2041797594
Title
Self-expanding or balloon-expandable transcatheter aortic valve
replacement in patients with small aortic annulus: A systematic review and
meta-analysis.
Source
Indian Heart Journal. (no pagination), 2025. Date of Publication: 2025.
Author
Attachaipanich T.; Kaewboot K.; Attachaipanich S.
Institution
(Attachaipanich) Department of Internal Medicine, University of
Missouri-Kansas City School of Medicine, Kansas City, MO, United States
(Kaewboot) Department of Internal Medicine, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Attachaipanich) Department of Drug Discovery Medicine, Kyoto University
Graduate School of Medicine, Kyoto, Japan
Publisher
Elsevier B.V.
Abstract
Background: A small aortic annulus presents unique hemodynamic challenges
during transcatheter aortic valve replacement (TAVR), increasing the risk
of prosthesis-patient mismatch (PPM) and suboptimal valve performance.
This study aimed to compare the efficacy and safety of self-expanding
valves (SEVs) versus balloon-expandable valves (BEVs) in patients with a
small aortic annulus. Method(s): A systematic search using 4
databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL,
was conducted from inception to June 1, 2025. Studies comparing clinical
outcomes of SEVs and BEVs in patients with a small aortic annulus were
included. Result(s): Thirty-eight studies involving 19,421
participants were included. No significant difference in all-cause
mortality was observed between SEVs and BEVs from in-hospital to 5-year
follow-up. SEVs were associated with a significantly lower risk of PPM at
discharge (OR 0.34, 95 % CI 0.28-0.42), 30 days (OR 0.31, 95 % CI
0.21-0.47), and 1 year (OR 0.25, 95 % CI 0.15-0.42). However, SEVs were
associated with a higher risk of in-hospital paravalvular leakage (PVL)
(OR 1.95, 95 % CI 1.39-2.74), moderate-to-severe PVL (OR 2.48, 95 % CI
1.91-3.22), and permanent pacemaker implantation (PPI) both in-hospital
and at 30 days. These findings remained consistent across sensitivity
analyses limited to new-generation valves and propensity score-matched or
randomized studies. Conclusion(s): SEVs offer favorable hemodynamic
advantages and lower risks of PPM and valve dysfunction compared to BEVs,
with no difference in survival. However, these benefits must be weighed
against the increased risks of PVL and PPI. Individualized valve selection
remains essential to optimizing outcomes in TAVR patients. Copyright
© 2025 Cardiological Society of India

<142>
Accession Number
2041791589
Title
Beyond Technical Feasibility in Complex Percutaneous Coronary
Intervention: Lessons From the PROCTOR Trial on Equipoise, Evidence, and
Dogma.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 2025.
Author
Ahmad Y.; Reddy R.K.; Yeh R.W.
Institution
(Ahmad) Division of Cardiology, University of California, San Francisco,
San Francisco, CA, United States
(Reddy) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Yeh) Cardiology Division, Beth Israel Deaconess Medical Center, Boston,
MA, United States
Publisher
Elsevier Inc.

<143>
Accession Number
649256957
Title
CLINICAL FEATURES, MANAGEMENT, and OUTCOMES of LEFT MAIN SPONTANEOUS
CORONARY ARTERY DISSECTION: A PATIENT-LEVEL META-ANALYSIS.
Source
Giornale Italiano di Cardiologia. Conference: 45. Congresso Nazionale
GISE. Milan Italy. 25(Supplement 2) (pp e13), 2024. Date of Publication:
01 Nov 2024.
Author
Morosato M.; Gaspardone C.; Romagnolo D.; Pagnesi M.; Baldetti L.;
Scandroglio A.; Chieffo A.; Godino C.; Margonato A.; Adamo M.; Metra M.;
Beneduce A.
Institution
(Morosato, Gaspardone, Baldetti, Scandroglio, Chieffo, Godino, Margonato)
Universita Vita-Salute San Raffaele, Milano, Italy
(Romagnolo) Istituto Clinico Humanitas, Milano, Italy
(Pagnesi, Adamo, Metra) Spedali Civili di Brescia, Brescia, Italy
(Beneduce) Clinique Pasteur, Toulouse, France
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction Spontaneous coronary artery dissection (SCAD) is an uncommon
cause of acute myocardial infarction (MI) and is associated with
substantial adverse events. SCAD involving the left main coronary artery
(LM) is a rare but potentially life-threatening condition. Currently,
minimal data on LM-SCAD have been reported. This study aimed to
investigate clinical features, contemporary management, and outcomes of
LM-SCAD patients. Methods We conducted a systematic review and
patient-level meta-analysis of literature using <<left main>> and
<<dissection>> as search keywords. We sought to determine if reported
outcomes were associated with initial management strategy. Results We
screened 492 manuscripts in MEDLINE and EMBASE published between 1990 and
2023. The final analysis included 135 patients (40+/-11 years, 80% women)
diagnosed with LM-SCAD. Remarkably, 36% of cases were associated with
pregnancy. Almost all patients (95%) presented with acute coronary
syndrome, two-thirds of which were diagnosed with ST-elevation MI.
Cardiogenic shock was documented in 22% of patients at presentation, while
serious ventricular arrhythmias occurred in 10%. Among published cases,
early revascularization strategy with percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) was superior to
conservative management for the composite endpoint of all-cause death,
left ventricular assist device implantation, heart transplant, recurrent
MI, and urgent myocardial revascularization (adjusted HR 0.37, 95% CI
0.20-0.69, p<0.001). Conclusions LM-SCAD is associated with significant
acute morbidity and mortality. Revascularization (PCI or CABG) was
associated with a lower incidence of early adverse outcomes compared to a
conservative strategy, largely driven by the occurrence of recurrent
myocardial infarction and urgent revascularization.

<144>
Accession Number
649256983
Title
LONG-TERM CLINICAL FOLLOW-UP in PATIENTS UNDERGONE DRUG ELUTING BALLOONS
ANGIOPLASTY.
Source
Giornale Italiano di Cardiologia. Conference: 45. Congresso Nazionale
GISE. Milan Italy. 25(Supplement 2) (pp e28-e29), 2024. Date of
Publication: 01 Nov 2024.
Author
Zimatore F.R.
Institution
(Zimatore) Azienda Ospedaliera Integrata di Verona, Verona, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background So far little is known about long-term follow-up in patients
undergone to drug eluting balloons (DEB) angioplasty. DEB angioplasty
offers a valuable alternative to drug eluting stent (DES), especially in
specific scenarios such as intrastent restenosis (ISR) and small vessel
disease. Its primary advantages include reduced restenosis rates, the
absence of a permanent implant, and a lower risk of late thrombosis.
However, long term positive effects are unknown and studies are needed to
fully establish its role in the treatment of coronary artery disease.
Methods We retrospectively analyzed a consecutive series of patients
undergoing DEB angioplasty for both de novo lesions and ISR in Legnago
Hospital between January 2017 and December 2019. Baseline and procedural
data as well as last available follow-up were collected with the aim to
evaluate long-term safety and efficacy of DEB angioplasty. Primary
endpoint was the rate of major adverse and cerebrovascular events (MACCE)
including death or rehospedalization from myocardial infarction, stroke,
major bleeding or clinical driven target vessel revascularization. All of
our patients were treated with DEB angioplasty, considering both de novo
lesions and in ISR to have a bigger sample. A longterm clinical follow was
made, by evaluating clinical conditions of our patients at 5 years after
angioplasty. We used NYHA classification and Canadian clinical
classification to estimate the clinical status of our patients. Our aim
was to highlight if there is a declination regarding symp-toms and if any
hemodynamic deterioration comes out. Concerning the procedure we used
different type of DEB such as In Pact Falcon, Prevail and Magic Touch,
with different diameters and lenght. Results A total of 68 patients, with
an average age of 65 years old, were treated with DEB angioplasty in the
selected period. 11.7% were women (n=8), 52.4% de novo lesions. The data
showed that DEBs with a 20 mm length were used in 87% of cases and a
diameter of 2mm were applied more frequently. The majority of the lesions
treated with DEB was located on the mid-segment of the left anterior
discending artery, with a 17%. The median follow-up for clinical events
was 56,02 months. The mortality rate was 16,2 % ,11 patients deceased,
just one of them faced the death because of a cardiovascular related
complication. The rate of MACCE was 8% of all the rehospidalizations we
registered. Only one of our patients was rehospidalized because of a
myocardial infarction with ST elevation (STEMI), he also had a clinical
deterioration that led to Heart Failure (HF). There wasn't any episode of
stroke or major bleeding, but 3 patients had respiratory insufficiency.
However 15% of our patient needed to be admitted to our Hospital because
angina or acute coronary syndrome. Twice a positive stress testing was the
reason of a urgent angioplasty. Only for two patients a surgical strategy
was necessary and there was the indication to do a Coronary Artery Bypass
Grafting (CABG). At last clinical follow-up 52 % of the population was
classified as NYHA class 2, overall there wasn't a worsening in term of
clinical status from the one at the discharge. Conclusion In our single
center experience DEB proved to be a valid alternative to stent
angioplasty for both de novo lesions and ISR at long-term follow-up. This
retrospective analysis has many limitations and is not supposed to suggest
new treatment philosophy, but could be a suggestion for ideation of novel
RCT. In conclusion DEBs represent a valuable tool in the interventional
cardiologist's armamentarium, particularly for patients with ISR, small
vessel disease, or those who need to minimize the duration of antiplatelet
therapy. Ongoing research and longer-term follow-up studies are essential
to further define the role of DEBs in different clinical settings and to
compare their performance against the latest generation DES.

<145>
Accession Number
649256480
Title
DIRECT ORAL ANTICOAGULANTS VERSUS PERCUTANEOUS LEFT ATRIAL APPENDAGE
OCCLUSION in ATRIAL FIBRILLATION: 5-YEAR OUTCOMES.
Source
Giornale Italiano di Cardiologia. Conference: 44. Congresso Nazionale
GISE. Milan Italy. 24(10 Supplement 1) (pp e46), 2023. Date of
Publication: 01 Oct 2023.
Author
Melillo F.; Leo G.; Parlati A.; Gaspardone C.; Bellini B.; Bella P.D.;
Montorfano M.; Mazzone P.; Nemola G.; Cozzani G.; Stella S.; Ancona F.;
Ingallina G.; Salerno A.; Cera M.; Agricola E.; Margonato A.; Godino C.
Institution
(Melillo, Leo, Parlati, Gaspardone, Bellini, Bella, Montorfano, Mazzone,
Nemola, Cozzani, Stella, Ancona, Ingallina, Salerno, Cera, Agricola,
Margonato, Godino) Vita-Salute San Raffaele University, Milano, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. LAAO is an emerging option for thromboembolic event prevention
in patients with NVAF. We previously reported data on comparison between
LAAO and DOAC at two-year follow-up in NVAF patients at HBR (HAS-BLED
>=3). Limited data are available on long term follow-up. We aimed to
evaluate the efficacy and safety of DOACs versus LAAO indication after 5
years. Methods. We enrolled 193 HBR treated with LAAO and 189 HBR patients
with DOACs. At baseline, LAAO group had higher HAS-BLED (4.2 vs 3.3,
p<0.001) and lower CHADS-VASc (4.3 vs. 4.7, p=0.005). After 1:1 PSM, 192
patients were included (LAAO n=96; DOACs n=96). Results. At 5-year
follow-up the rate of the combined safety and effectiveness endpoint (ISTH
major bleeding and thromboembolic events) was significantly higher in LAAO
group (p=0.042), driven by a higher number of thromboembolic events
(p=0.047). The rate of ISTH-major bleeding events was similar (p=0.221).
After PSM no significant difference in the primary effectiveness (LAAO
13.3% vs DOACs 9.5%, p=0.357) and safety endpoint (LAAO 7.5% vs DOACs
7.5%; p=0.918) were evident. Overall bleeding rate was significantly
higher in DOACs group (25.0% vs 13.7%, p=0.048), while a non-significant
higher number of TIA was reported in LAAO group (5.4% vs 1.1%, p=0.098).
All-cause and cardiovascular mortality were higher in LAAO group at both
unmatched and matched analysis. Conclusion. We confirmed safety and
effectiveness of both DOAC and LAAO in NVAF patients at HBR, with no
significant differences in thromboembolic events or major bleeding were at
5-year follow-up. The observed increased mortality after LAAO warrants
further investigations in RCTs.

<146>
Accession Number
649256527
Title
SPONTANEOUS LEFT MAIN CORONARY ARTERY DISSECTION: CLINICAL FEATURES,
MANAGEMENT and OUTCOMES.
Source
Giornale Italiano di Cardiologia. Conference: 44. Congresso Nazionale
GISE. Milan Italy. 24(10 Supplement 1) (pp e27-e28), 2023. Date of
Publication: 01 Oct 2023.
Author
Gaspardone C.; Morosato M.; Romagnolo D.; Federico F.; Moroni F.; Godino
C.; Pagnesi M.; Baldetti L.; Beneduce A.
Institution
(Gaspardone, Morosato, Romagnolo, Federico, Godino, Baldetti, Beneduce)
Irccs San Raffaele Scientific Institute, Milan, Italy
(Moroni) Pauley Heart Center, Virginia Commonwealth University, Richmond,
United States
(Pagnesi) Asst Spedali Civili and Department of Medical and Surgical
Specialties, Radiologic Sciences, and Public Health, University of
Brescia, Cardiology Unit, Brescia, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Introduction. Spontaneous coronary artery dissection (SCAD) is a
significant cause of myocardial infarction (MI), particularly in young
women, and is linked to an increased risk of long-term major adverse
cardiovascular events (MACE). Dissection involving the left main coronary
artery (LM) is rare and lacks specific data. The aim of this study is to
investigate clinical features, management, and outcomes of patients
suffering from LM SCAD. Methods. We conducted a systematic review and
patient-level pooled analysis of literature published between 1990 and
2022 using <<left main>> and <<dissection>> as search keywords. Results.
The analysis included 125 patients diagnosed with LM SCAD. The mean
patient age was 40+/-10 years, with women accounting for 80% of the cases.
Cardiovascular risk factors were minimally prevalent. Remarkably, 36% of
cases occurred during pregnancy. Most patients (75%) presented with
flow-limited dissection and 97% manifested acute coronary syndrome: 63%
ST-segment-elevation MI, 28% with non-STsegment-elevation MI, and 9% with
unstable angina. Cardiogenic shock (CS) at presentation was documented in
21% of patients, while serious ventricular arrhythmias in 8% of cases. In
76% of patients, dissections spread to other vessels, most frequently
affecting the left anterior descending artery (LAD) (in 68% of cases), and
less commonly extending to both the LAD and left circumflex artery (in 40%
of cases). In-hospital death occurred in 7% of the cohort. Invasive
management was chosen for most of the patients, with percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) carried out
in 24% and 37% of cases, respectively. Revascularization was associated
with lower rates of the primary composite endpoint of in-hospital death,
MI, and need for urgent myocardial revascularization (OR 0.16, 95% CI
0.06-0.40, p<0.001), both in hemodynamically stable patients and in those
presenting with CS. The advantages of revascularization remained evident
during the follow-up period, leading to a reduction in the primary
composite endpoint (HR 0.23, 95% CI 0.08-0.64, p=0.005). Conclusions. Our
analysis of the most extensive collection of LM SCAD patients showed
considerable in-hospital mortality and post-discharge MACE.
Revascularization significantly improved clinical outcomes regardless
patient's hemodynamic condition.

<147>
Accession Number
649256530
Title
A REAL-WORLD COMPARATIVE ANALYSIS of SURGICAL and TRANSCATHETER APPROACHES
to TRICUSPID REGURGITATION.
Source
Giornale Italiano di Cardiologia. Conference: 44. Congresso Nazionale
GISE. Milan Italy. 24(10 Supplement 1) (pp e54), 2023. Date of
Publication: 01 Oct 2023.
Author
Gaspardone C.; Gramegna F.; Morosato M.; Vetrugno L.; Paci G.; Morciano
D.; Rizza V.; Mula C.; Fuga A.; Fiore G.; Ancona F.; Margonato D.;
Margonato A.; Denti P.; Buzzatti N.; Agricola E.; Maisano F.; Godino C.
Institution
(Gaspardone, Gramegna, Morosato, Vetrugno, Paci, Morciano, Rizza, Mula,
Fuga, Fiore, Ancona, Margonato, Margonato, Denti, Buzzatti, Agricola,
Maisano, Godino) Irccs San Raffaele Scientific Institute, Milan, Italy
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. The management of severe tricuspid regurgitation (TR) remains
a challenge due to significant associated morbidity and mortality,
compounded by limited treatment options. We aimed to compare the
demographic traits, echocardiographic features, and clinical outcomes of
patients undergoing transcatheter tricuspid valve repair (TTVR) versus
those undergoing isolated surgical tricuspid valve repair or replacement
(STVR). Methods. We conducted a retrospective analysis of consecutive
adult patients treated for severe TR using TTVR or STVR at San Raffaele
Hospital between 2017 and 2023. Baseline and follow-up data were obtained
from electronic health records and through telephone interviews. Results.
Among the 79 TTVR patients and 80 STVR patients, the TTVR group was
significantly older (76 vs. 65 years, p<0.001), had higher prevalence of
coronary artery disease (31% vs. 14%, p=0.02) and atrial fibrillation (79%
vs. 57%, p=0.007), and were more symptomatic (NYHA class III/IV, 59% vs.
37%, p=0.01). Moreover, a higher TRI-SCORE was observed in the TTVR group
compared to the STVR group (5.03 vs. 3.04, p<0.007). While there was no
significant difference in baseline TR severity, functional TR etiology was
more common in the TTVR group (86% vs. 63%, p=0.003). This group also
exhibited worsened right ventricle (RV) function and RV
ventriculo-arterial coupling (TAPSE/PASP <0.36, 35% vs. 15%, p=0.01). At a
median follow-up of 1.14 years (IQR 0.41-1.50), the primary endpoint
incidence (including death, TV surgery, or heart failure hospitalization)
and mortality rates were similar in both groups (HR for primary endpoint
0.91; 95% CI, 0.50 to 1.65; p=0.75) (HR for death 0.77; 95% CI, 0.33 to
1.84; p=0.56). Nevertheless, when we employed a landmark analysis at the
discharge time, STVR patients experienced a three-fold increase in
in-hospital mortality rates (HR 3.01; 95% CI, 0.62 to 14.46; p=0.15), but
a three-fold decrease in postdischarge mortality rates (HR 0.29; 95% CI,
0.09 to 0.97; p=0.04) when compared to TTVR patients. Conclusions. This
real-world retrospective study underscores the different characteristics
of patients between TTVR and STVR. Despite a higher surgical risk and
comorbidity burden among TTVR patients, midterm clinical outcomes were
similar to STVR. However, more extensive research within large-scale
randomized control trials is required to validate these findings.

<148>
Accession Number
649244013
Title
A phase 2b dose finding study to assess the efficacy of RMC-035 on renal
function in participants at high risk for kidney injury following
open-chest cardiac surgery (POINTER).
Source
Nephrology Dialysis Transplantation. Conference: 62nd ERA Congress. Vienna
Austria. 40(Supplement 3) (pp i3327), 2025. Date of Publication: 01 Oct
2025.
Author
Zarbock A.; Agervald T.L.; Reusch M.; Laflamme M.; Myjavec A.; Mazer C.D.;
De Varennes B.; Bohm J.
Institution
(Zarbock) Department of Anesthesiology,Intensive Care and Pain Medicine,
University Hospital Munster, Munster, Germany
(Agervald, Reusch) Guard Therapeutics International AB, Stockholm, Sweden
(Laflamme) Universite Laval, Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, Canada
(Myjavec) Charles University, Faculty of Medicine, University Hospital in
Hradec Kralove, Hradec Kralove, Czechia
(Mazer) University of Toronto, St. Michael's Hospital, Department of
Anaesthesia, Toronto, Canada
(De Varennes) Centre universitaire de sante McGill, Royal Victoria
Hospital, Division of cardiac surgery, Montreal, Canada
(Bohm) Technical University of Munich, School of Medicine and Health,
German Heart Center Munich, Munich, Germany
Publisher
Oxford University Press
Abstract
Background and Aims: Acute kidney injury (AKI) is a common and serious
complication of cardiac surgery, potentially leading to the onset or
progression of CKD. There are no approved pharmacotherapies for the
prevention of AKI or the subsequent development or progression of CKD.
RMC-035, a therapeutic variant of The endogenous protein
alpha-1-microglobulin, demonstrates nephroprotective effects in numerous
preclinical disease models l . Results from the Phase 2a AKITA trial2
indicate that RMC-035 improves long-term kidney outcomes after cardiac
surgery. The Phase 2b POINTER trial aims to confirm the findings from
AKITA and identify the optimal RMC-035 dose prior to initiating a pivotal
Phase 3 study. Method(s): POINTER (NCT06475274) is an international,
multicenter, randomized, placebo-controlled, double-blind trial. A total
of approximately 160 high-risk patients scheduled for open-chest cardiac
surgery with cardiopulmonary bypass (CPB) will be recruited in Europe and
Canada. Two RMC-035 dose levels (30 and 60 mg) will be compared with
placebo. Study drug will be administered by IV infusion 10 min before CPB,
and at 6- and 24-h post-surgery. Patients will be followed daily until day
4, and on days 7, 60, and 90. T he primary endpoint is the change in eGFR
at day 90 compared to baseline. A key secondary endpoint is major adverse
kidney events on day 90 (MAKE90). Other secondary endpoints include the
occurrence of AKI, and plasma concentrations of RMC-035. Safety will be
assessed by treatment-emergent adverse events, vital signs,
electrocardiogram and routine blood biochemistry and hematology
parameters. Result(s): Not applicable. Conclusion(s): In the
completed AKITA trial, RMC-035 improved eGFR by day 90 vs placebo, and
fewer patients treated with RMC-035 met the secondary MAKE90 endpoint. The
eGFR benefit was more pronounced in the predefined subgroup of patients
with lower preoperative eGFR ( <60 mL/min/1.73 m2 ) . Herein, we present
the design of the Phase 2b POINTER trial, aimed at determining the optimal
dosing regimen of RMC-035 and confirming its nephroprotective properties
prior to a Phase 3 trial. The results are expected to advance our
understanding of novel therapeutic strategies for the prevention of AKI
and permanent loss of renal function in patients at high risk for AKI
following cardiac surgery.

<149>
Accession Number
2041352043
Title
Understanding Failure to Rescue in Solid Organ Transplantation: A Scoping
Review.
Source
Clinical Transplantation. 39(11) (no pagination), 2025. Article Number:
e70393. Date of Publication: 01 Nov 2025.
Author
Kimura J.; Asassfeh A.; Cooper E.; Prasad K.R.; Cooper M.; Rawashdeh B.
Institution
(Kimura, Asassfeh, Prasad, Cooper, Rawashdeh) Division of Transplant
Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
(Cooper) Medical College of Wisconsin, Milwaukee, WI, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The role of failure to rescue (FTR) in solid organ
transplantation (SOT) is less clear. This scoping review aimed to evaluate
the incidence, complications, and risk factors for FTR in SOT.
 Method(s): We systematically searched PubMed, Scopus, and Web of
Science for studies reporting on FTR in SOT. Data on incidence,
complications, risk factors, and definitions were extracted and
synthesized narratively due to heterogeneity across studies.
 Result(s): Seven studies were identified: four in liver
transplantation, two in lung transplantation, and one in heart
transplantation; none addressed kidney or pancreas transplantation.
Definitions of FTR varied by time window, complication set, and analytic
unit. Reported FTR rates ranged from 4.6% to 39.6% in liver, 19% to 26% in
lung, and 11.5% in heart transplantation. Across organs,
dialysis-requiring acute kidney injury (AKI) was the most frequent
proximate pathway to death. Risk signals spanned patient-level factors
(age, comorbidities, frailty/sarcopenia, functional status), donor factors
(age, sex, race/ethnicity), and system-level factors (center volume,
mortality tertile, insurance coverage). Notably, heart transplantation
data revealed higher adjusted odds of FTR among Hispanic recipients.
 Conclusion(s): Evidence on FTR in transplantation remains sparse and
heterogeneous, but early findings suggest that both patient vulnerability
and system capacity shape rescue outcomes, with AKI consistently emerging
as a cross-organ target. Standardized definitions, multicenter analyses,
and extension to kidney and pancreas transplantation are needed to
establish FTR as a transplant-specific quality metric and to guide
interventions that optimize rescue. Copyright © 2025 John Wiley &
Sons A/S. Published by John Wiley & Sons Ltd.

<150>
[Use Link to view the full text]
Accession Number
649247658
Title
Efficacy of incentive spirometer and diaphragmatic breathing exercise on
the alteration of arterial blood gas measures in patients after coronary
artery bypass grafting: A randomized comparative trial.
Source
Medicine. 104(44) (pp e45538), 2025. Date of Publication: 31 Oct 2025.
Author
Shaphe M.A.; Ali T.; Pandey S.K.; Iqbal A.; Kashoo F.Z.; Alajam R.A.; Khan
M.H.; Alghadir A.H.
Institution
(Shaphe, Alajam) Department of Physical Therapy, College of Nursing and
Health Sciences, Jazan University, Jazan, Saudi Arabia
(Ali) Department of Physical Therapy, Peerless Hospitex Hospital &
Research Center, Kolkata, India
(Pandey) Department of Cardiothoracic and Vascular Surgery, Batra Hospital
& Medical Research Center, New Delhi, India
(Iqbal, Alghadir) Rehabilitation Research Chair, Department of
Rehabilitation Sciences, College of Applied Medical Sciences, King Saud
University, Riyadh, Saudi Arabia
(Kashoo) Department of Physical Therapy & Health Rehabilitation, College
of Applied Medical Science, Majmaah University, Saudi Arabia
(Khan) Department of Diagnostic Radiology, College of Nursing and Health
Sciences, Jazan University, Jazan, Saudi Arabia
Abstract
BACKGROUND: The incidence of lung-related issues after undergoing coronary
artery bypass graft (CABG) surgery is notably significant. Initiating lung
exercises soon after heart surgery plays a crucial role in averting these
issues. The purpose of this research was to examine how the use of an
incentive spirometer (IS) and diaphragmatic breathing exercises (DBE)
impacts changes in arterial blood gas (ABG) levels. METHOD(S): The
study was based on a 2-arm, parallel-group, randomized comparative design.
In this study, 30 individuals who had CABG surgery were selected based on
specific criteria and randomly divided into the IS group and the DBE
group. Each group received targeted chest physiotherapy; the IS Group had
an IS, and the DBE Group had DBE. Key ABG parameters, such as blood pH,
partial pressure of arterial oxygen (PaO2), and partial pressure of
arterial carbon dioxide (PaCO2), were evaluated using an ABG analyzer.
Measurements were taken initially on the first day after extubation and
then again on the second day post-extubation. All statistical analyses
were conducted with a maintained significance threshold of 95%.
 RESULT(S): The results showed no significant differences
between-group and within-group comparisons for PH, PaO2, and PaCO2
outcomes. However, the IS group patients showed a trend in the increase in
PaO2 levels and a decrease in PaCO2 levels compared to those in the DBE
group. CONCLUSION(S): Despite not revealing statistically significant
differences in the alteration of ABG measures between groups, the current
study observed minimal improvements in ABG measures in the IS Group
compared to the DBE Group. Therefore, this study suggests that, in
addition to conventional chest physiotherapy, using an IS might be
superior to DBE in altering ABG measures in patients with post-CABG.
Nonetheless, we may use both intervention and conventional chest
physiotherapy postoperatively as a prophylactic regime. Copyright
© 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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