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<1>
Accession Number
649547918
Title
Endoscopic versus open vein harvesting for coronary artery bypass: a
systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 21(1) (pp 31), 2025. Date of
Publication: 13 Dec 2025.
Author
Arnaout A.Y.; Aladna A.; Kozum R.; Makki R.; Sabouni A.; Antakli K.;
Raffoul L.; Shabouk M.B.; Nayal S.; Arnaout K.; Amino A.
Institution
(Arnaout) Faculty of Medicine, University of Aleppo, Aleppo University
Hospital, Aleppo, Syrian Arab Republic
(Aladna, Kozum, Makki, Sabouni, Antakli, Shabouk, Nayal, Arnaout, Amino)
Faculty of Medicine, University of Aleppo, Aleppo University Hospital,
Aleppo, Syrian Arab Republic
(Raffoul) Faculty of Medicine, Al Andalus University for Medical Sciences,
Syrian Arab Republic
Abstract
BACKGROUND: A common treatment for coronary artery disease is CABG, which
often involves the use of saphenous veins or internal mammary arteries as
grafts. The selected harvesting technique-open vein harvesting (OVH) or
endoscopic vein harvesting (EVH)-is pivotal for successful graft outcomes,
significantly influencing patient recovery and long-term graft patency
rates. This systematic review aims to analyze and compare these harvesting
methods to inform clinical decision-making. METHOD(S): Our systematic
review and meta-analysis were conducted in accordance with the PRISMA 2020
guidelines, following our registered protocol in PROSPERO (identifier
CRD42024511815). We included full-text studies, encompassing both RCTs and
observational studies, that evaluated the effectiveness of EVH versus OVH
for elective and urgent CABG procedures. A comprehensive literature search
was conducted in PubMed, Scopus, Cochrane Library, and Embase from
inception until December 28, 2023. We applied a Fixed Effect Model for the
meta-analysis, utilizing RR and SMD alongside the inverse variance method.
The I2 statistic assessed heterogeneity, supported by sensitivity analyses
for result robustness, while funnel plots evaluated publication bias. All
statistical analyses were performed using Pythmeta software.
 RESULT(S): From an initial 1,906 records, we removed 841 duplicates
and unrelated studies, resulting in 34 studies included in the review (21
RCTs and 13 observational studies). Quality assessment revealed a high
risk of bias in 11 of 19 RCTs, with multiple concerns across all studies
regarding reported outcomes. The review comprised 7,442 patients, with a
majority (53.05%) in the EVH group, and median ages of 64.09 (EVH) and
64.35 (OVH). EVH demonstrated significantly lower leg wound complications,
including reduced rates of infections (RR = 0.29 95% CI [0.19, 0.43], p <
0.001 (11 studies) and edema (RR = 0.38 95% CI [0.27, 0.55], p < 0.001).
However, graft patency favored OVH at both 6 months (92.9% vs. 80.4%, P =
0.04) and 2 years (90.8% vs. 73.9%, P = 0.01), with EVH showing heightened
acute endothelial damage (51% vs. 29%, P < 0.001). Pain levels were
substantially lower in the EVH group on postoperative day three, while
mortality rates remained comparable. CONCLUSION(S): This systematic
review indicates that while EVH presents significant advantages for
reducing leg wound complications, its efficacy in graft patency appears
less favorable than OVH. Further investigation is essential to explore the
long-term benefits and cost-effectiveness of these techniques, ensuring
optimal practices in vein harvesting for CABG. Copyright © 2025.
The Author(s).

<2>
Accession Number
2042985936
Title
Surgical vs Transcatheter Aortic Valve Replacement for Asymptomatic Severe
Aortic Stenosis- an Updated Meta-Analysis of Reconstructed Individual
Patient Data.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 41(1) (no
pagination), 2026. Article Number: ivaf308. Date of Publication: 01 Jan
2026.
Author
Badran A.S.; Gonnah A.R.; Helmy A.E.; Awad A.K.; Elbahloul M.A.; Alassiri
A.K.; Fatimi A.S.; Talapaneni S.; Khandelwal M.; Hameed I.
Institution
(Awad, Badran, Awad) Department of Cardiothoracic Surgery, Ain Shams
University Hospital, Cairo, Egypt
(Awad, Badran, Awad) Faculty of Medicine, Ain-Shams University, Cairo,
Egypt
(Gonnah) Department of Medicine, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Helmy, Elbahloul) Faculty of Medicine, Kafr El-Shaikh University, Kafr
El-Shaikh, Egypt
(Alassiri) Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Fatimi, Talapaneni, Khandelwal, Hameed) Department of Cardiothoracic
Surgery, Yale University, New Haven Medical Center, CT, United States
Publisher
Oxford University Press
Abstract
Objectives The management of asymptomatic aortic stenosis (AS) is
controversial. We perform a meta-analysis of reconstructed individual
patient data to compare conservative treatment versus transcatheter or
surgical aortic valve replacement (TAVR or SAVR) in asymptomatic AS.
Methods PubMed/MEDLINE, Web of Science, Scopus, and Cochrane CENTRAL were
systematically searched, through 25th September 2025, to
identify any observational or randomized controlled studies that comply
with our inclusion criteria. Our primary outcomes were short
cardiovascular and non-cardiovascular mortality as well as long-term
mortality. We combined aggregate data meta-analysis for dichotomous
outcomes using incidence rate ratio (IRR) with reconstructed time-to-event
data derived from published Kaplan-Meier curves using validated
algorithms. Results Seventeen studies were included. Overall, AVR was
associated with a significantly lower risk of all-cause mortality compared
with conservative management (IRR=0.43; 95% CI, 0.32-0.57; P<.001).
Cardiovascular mortality was also significantly reduced with AVR
(IRR=0.47; 95% CI, 0.29-0.75; P<.01; I2=62%). The risk of heart
failure hospitalization was markedly lower among AVR recipients (IRR=0.39;
95% CI, 0.22-0.67; P<.01), with consistent benefit across study designs.
AVR was further associated with a substantial reduction in sudden cardiac
death (IRR=0.13; 95% CI, 0.04-0.48; P<.01) and myocardial infarction
(IRR=0.11; 95% CI, 0.04-0.31; P=.03). The risk of stroke was not
significantly different between groups (IRR=0.77; 95% CI, 0.58-1.02;
P=.07). Reconstructed Kaplan-Meier analyses demonstrated durable long-term
survival benefit with AVR, consistent across surgical and transcatheter
approaches. Conclusions Patients with asymptomatic AS, managed with either
SAVR or TAVR, were associated with lower short- and long-term mortality
compared to conservative management. Copyright © The Author(s)
2025. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery.

<3>
Accession Number
2041609883
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. 23(1) (pp 59-68), 2026. Date of
Publication: 2026.
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) Department of Medicine, Allama Iqbal Medical College, Lahore,
Pakistan
(ul Abideen, Javed Khan) Department of Medicine, King Edward Medical
University, Lahore, Pakistan
(Cheema) Department of Medicine, UT Southwestern Medical Center, Dallas,
TX, United States
(Osama) Department of Medicine, Hayatabad Medical Complex Peshawar,
Peshawar, Pakistan
(Farid) Department of Medicine, Jinnah Sindh Medical University, Karachi,
Pakistan
(Rehman) Department of Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Aimen) Department of Medicine, Quetta Institute of Medical Sciences,
Quetta, Pakistan
(Thada) Department of Medicine, Sotang Primary Hospital, Sotang, Nepal
Publisher
Taylor and Francis Ltd.
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 TAVI, 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), acute kidney injury (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. Copyright © 2025 Informa UK
Limited, trading as Taylor & Francis Group.

<4>
Accession Number
2042988755
Title
Efficacy and Safety of Clopidogrel Versus Aspirin Monotherapy After
Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.
Source
Clinical Medicine Insights: Cardiology. 20 (no pagination), 2026. Date of
Publication: 01 Jan 2026.
Author
Cheema A.H.; Hassan Waseem M.; Abideen Z.U.; Tahir M.Z.; Saleem F.; Nadeem
A.; Tauseef U.; Qasim T.; Aimen S.; Zahid M.B.; Thada P.K.
Institution
(Cheema) University of Texas Southwestern, Dallas, TX, United States
(Hassan Waseem, Zahid) Allama Iqbal Medical College, Lahore, Pakistan
(Abideen) King Edward Medical University, Lahore, Pakistan
(Tahir) Allied Hospital, Faisalabad, Pakistan
(Saleem, Nadeem, Tauseef, Qasim) Punjab Medical College, Faisalabad,
Pakistan
(Aimen) Quetta Institute of Medical Sciences, Pakistan
(Thada) Sotang Primary Hospital, Solukhumbu, Nepal
Publisher
SAGE Publications Ltd
Abstract
Background: Coronary artery disease (CAD) is the leading cause of death
worldwide. After percutaneous coronary intervention (PCI), dual
antiplatelet therapy (DAPT) is recommended to reduce thrombotic events.
This meta-analysis assesses the effectiveness of clopidogrel compared to
aspirin monotherapy following DAPT post-PCI. Method(s): From
inception to April 2025, an exhaustive literature search was conducted
across electronic databases, including PubMed, Cochrane Library,
ScienceDirect, EMBASE, and Web of Science. Risk ratios (RRs) along with
95% confidence intervals (CIs) were pooled using the random-effects model
in Review Manager. Leave-one-out sensitivity analysis and funnel plots
were used to evaluate heterogeneity and publication bias, respectively.
 Result(s): Six studies, including 3 RCTs and 3 observational studies,
spanning over 19 494 patients, were included in our analysis. Clopidogrel
significantly reduced major adverse cardiovascular events (MACE) (RR =
0.78; 95% CI: [0.69, 0.89]; P = .0002; I2 = 0%) and myocardial
infarction (MI) (RR = 0.73; 95% CI: [0.56, 0.94]; P = .02; I2 =
21%) compared to aspirin. Likewise, the clopidogrel group demonstrated a
substantial advantage in reducing the incidence of any stroke (RR = 0.66;
95% CI: [0.49, 0.89]; P = .006; I2 = 14%), including ischemic
stroke (RR = 0.69; 95% CI: [0.49, 0.97]; P = .04; I2 = 0%). All
other endpoints, including hemorrhagic stroke, all-cause mortality,
cardiac death, major bleeding, stent thrombosis, repeat, and target vessel
revascularization, were comparable between the 2 arms. Conclusion(s):
Clopidogrel significantly reduced the incidence of MACE, MI, and stroke
after DAPT following PCI compared to aspirin, indicating greater
effectiveness. However, the main conclusion of this meta-analysis depends
primarily on the estimates from RCTs. Additional randomized studies are
necessary to confirm these results and support clinical
decision-making. Copyright © The Author(s) 2026. 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).

<5>
Accession Number
2042561179
Title
Heart transplantation for mitochondrial cardiomyopathy and associated
metabolic syndromes: Case series and systematic literature review.
Source
Global Cardiology Science and Practice. 2025(5) (no pagination), 2025.
Date of Publication: 01 Jan 2025.
Author
Mokhtassi S.S.; Bulut H.I.; Salmasi Y.; Khoshbin E.
Institution
(Mokhtassi, Bulut, Salmasi, Khoshbin) Harefield Hospital, Royal Brompton,
and Harefield as part of Guys and St Thomas NHS Trust, London, United
Kingdom
(Mokhtassi) St George's University Hospitals NHS Foundation Trust, London,
United Kingdom
(Salmasi, Khoshbin) National Heart & Lung Institute, Imperial College,
London, United Kingdom
(Salmasi) Hammersmith Hospital as part of Imperial College Healthcare NHS
Trust, London, United Kingdom
Publisher
HBKU Press
Abstract
Introduction: Mitochondrial diseases (MtDs) are a diverse group of
inherited metabolic disorders that frequently involve the heart, leading
to progressive cardiomyopathy and heart failure. In advanced stages,
transplantation may be the only life-saving option, though its role
remains poorly defined due to the rarity and complexity of these
syndromes. This review examines the outcomes of heart transplantation in
patients with MtD and reports two additional cases from our centre. These
represent the first known transplants for maternally-inherited diabetes
and deafness (MIDD) and for a homoplasmic m.4300 mutation syndrome.
Methodology: We systematically searched Medline, Embase, Cochrane Library,
and Web of Science from inception to May 2025 using MeSH and free-text
terms for heart transplantation and mitochondrial disease. Studies with
original patient data and genetically or clinically confirmed
mitochondrial disease were included. Screening, synthesis, and quality
appraisal followed PRISMA 2020 and Joanna Briggs Institute (JBI)
guidelines for case reports and series. Result(s): Sixteen
publications describing 27 patients met inclusion criteria. Most were
single-case reports or small series, predominantly involving MELAS,
Kearns-Sayre, or Friedreich's ataxia. Short-term post-transplant survival
was excellent (100%, 95% CI 86-100) at median two-year follow-up.
Neurological or metabolic complications, including stroke-like episodes,
occurred in approximately 10% of cases. Our two patients with MIDD and
homoplasmic m.4300 mutation achieved stable graft function and complete
neurological recovery at 12 and 24 months, respectively.
 Conclusion(s): Heart transplantation can be effective for carefully
selected patients with mitochondrial cardiomyopathy. Successful outcomes
require meticulous perioperative metabolic management, neurological
monitoring, and multidisciplinary coordination. Broader, collaborative
studies are needed to refine patient selection criteria and establish
structured long-term follow-up protocols. Copyright © (2025),
(HBKU Press). All rights reserved.

<6>
Accession Number
2041169077
Title
Role of multimodality imaging in cardiac implantable electronic devices
related infection and infective endocarditis.
Source
Expert Review of Medical Devices. 23(1) (pp 47-58), 2026. Date of
Publication: 2026.
Author
Khayata M.; Goff Z.; Gordon S.; Callahan T.; Elgharably H.; Unai S.; Xu B.
Institution
(Khayata) Robert and Suzanne Tomsich Department of Cardiovascular
Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic
Institute, Cleveland Clinic, Cleveland, OH, United States
(Goff, Xu) Section of Cardiovascular Imaging, Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Sydell and Arnold Family Heart,
Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United
States
(Gordon) Department of Infectious Diseases, Cleveland Clinic, Cleveland,
OH, United States
(Callahan) Section of Pacing and Electrophysiology, Robert and Suzanne
Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family
Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH,
United States
(Elgharably, Unai) Department of Thoracic and Cardiovascular Surgery,
Sydell and Arnold Family Heart, Vascular, and Thoracic Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Infective endocarditis (IE) is a serious and increasingly
recognized condition, associated with significant morbidity and mortality.
The diagnosis of IE is more challenging in patients with implanted cardiac
devices such as cardiac implantable electronic devices, left ventricular
assist devices, and left atrial appendage occlusion devices. Areas
covered: This review focuses on the contemporary roles and applications of
multi-modality imaging in the evaluation of patients with cardiac
implantable electronic devices related infection and IE. The role of
multi-modality imaging in the diagnosis of patients with native or
prosthetic valve IE is beyond the scope of this review. A literature
search of the PubMed database was performed between 1 June 2024, and 30
June 2025. Relevant articles on the subjects of 'infective endocarditis,'
'multi-modality imaging,' and 'implanted cardiac devices' were utilized in
our review. Expert opinion: The growing utilization of cardiac implanted
electronic devices (CIED) demands improvement in the detection of
CIED-related infections. Contemporary guidelines have considered utilizing
multimodality imaging to diagnose IE. The incremental value of
multimodality imaging remains to be rigorously examined. Large
observational studies from tertiary centers might serve as the starting
point toward building a strong evidence base. Copyright © 2025
Informa UK Limited, trading as Taylor & Francis Group.

<7>
Accession Number
2042525805
Title
A comparative study between ultrasound guided serratus anterior block and
erector spinae block for perioperative analgesia in children undergoing
upper thoracic surgeries: A randomized trial.
Source
Journal of Anaesthesiology Clinical Pharmacology. 42(1) (pp 56-61), 2026.
Date of Publication: 01 Jan 2026.
Author
Arora K.; Reena; Rath A.; Pandey A.R.; Singh A.P.; Sharma K.
Institution
(Arora) Department of Anaesthesiology, Asian Institute of Medical
Sciences, Haryana, Faridabad, India
(Reena, Rath, Pandey, Singh) Department of Anaesthesiology, Critical Care
and Pain Management, Uttar Pradesh, Varanasi, India
(Sharma) Department of Paediatric Surgery, IMS-BHU, Uttar Pradesh,
Varanasi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Post-operative pain has always been neglected in
children. It is only recently that the issue is being given the
much-needed consideration. Even today, the literature is sparse for
paediatric post-thoracotomy pain management modalities. In this era of
ultrasound guided (USG) regional blocks, serratus anterior plane block
(SAPB) and erector spinae plane block (ESPB) seem to offer promising
results. We aimed to compare the ESPB with SAPB in patients undergoing
open thoracotomy. Material(s) and Method(s): Sixty paediatric
patients of age 5-14 years, scheduled to undergo open thoracotomies, were
divided into two groups: Group S (SAPB) and group E (ESPB). Each group
received 0.5 ml/kg of 0.25% bupivacaine under USG blocks. The primary
outcome of the study was to compare the postoperative pain scores using
the Wong-Baker Faces scale. The secondary outcomes were to compare
cumulative fentanyl consumption, time to initiation of chest
physiotherapy, and duration of hospital stays. Result(s): The Faces
score was significantly lower in Group E compared to Group S at 8 h, 12 h,
16 h, 20 h, and 24 h (P < 0.05). The mean cumulative fentanyl requirement
in Group S was higher than in Group E (P = 0.002). Time to initiate chest
physiotherapy and duration of hospital stays were both significantly
shorter in Group E (P < 0.05). Conclusion(s): ESPB is superior to
SAPB in terms of providing better pain control and reduced opioid
requirements in children post-thoracotomy. Copyright © 2025
Journal of Anaesthesiology Clinical Pharmacology.

<8>
Accession Number
2041268652
Title
Left Ventricular Health and TAVR Timing in Asymptomatic Severe Aortic
Stenosis: Analysis From the EARLY TAVR Trial.
Source
Journal of the American College of Cardiology. 87(4) (pp 339-358), 2026.
Date of Publication: 03 Feb 2026.
Author
Lindman B.R.; Pibarot P.; Schwartz A.; Cohen D.J.; Giustino G.; Oldemeyer
J.B.; Strote J.A.; Babaliaros V.; Devireddy C.M.; Fearon W.F.; Fischbein
M.P.; Daniels D.; Spies C.; Chhatriwalla A.K.; Kavinsky C.J.; Shah P.;
Szerlip M.; Dahle T.; Stegman B.; O'Leary J.M.; O'Neill W.W.; Makkar R.R.;
Davidson C.J.; Sheth T.; DeVries J.T.; Southard J.; Depta J.P.; Pop A.;
Leipsic J.; Blanke P.; Li Y.; Hahn R.T.; Leon M.B.; Genereux P.
Institution
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Lindman, O'Leary) Division of Cardiovascular Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
(Pibarot) Department of Cardiology, Quebec Heart and Lung Institute, Laval
University, Quebec, QC, Canada
(Schwartz, Hahn, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Cohen) St Francis Hospital, Roslyn, NY, United States
(Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United
States
(Giustino, Genereux) Gagnon Cardiovascular Institute, Morristown Medical
Center, Morristown, NJ, United States
(Oldemeyer, Strote) University of Colorado Health, Loveland, CO, United
States
(Babaliaros, Devireddy) Structural Heart and Valve Center, Emory
University School of Medicine, Atlanta, GA, United States
(Fearon, Fischbein) Stanford Department of Cardiothoracic Surgery,
Stanford University School of Medicine, Stanford, CA, United States
(Daniels, Spies) 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
(Kavinsky) Beth Israel Deaconess Medical Center/Harvard Medical School,
Boston, MA, United States
(Shah) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, United States
(Szerlip) Baylor Scott and White The Heart Hospital Plano, Plano, TX,
United States
(Dahle, Stegman) CentraCare Heart & Vascular Center, St Cloud, MN, United
States
(O'Neill) Henry Ford Health System, Detroit, MI, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Davidson) Northwestern University Feinberg School of Medicine, Chicago,
IL, United States
(Sheth) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(DeVries) Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
(Southard) UC Davis Health System, University of California-Davis,
Sacramento, CA, United States
(Depta) Sands-Constellation Heart Institute, Rochester Regional Health,
Rochester, NY, United States
(Pop) Alexian Brothers Medical Center, Elk Grove Village, IL, United
States
(Leipsic, Blanke) St Paul's Hospital and University of British Columbia,
Vancouver, BC, Canada
(Li) Edwards Lifesciences, Irvine, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: For patients with asymptomatic severe aortic stenosis (AS),
the EARLY TAVR trial demonstrated that early transcatheter aortic valve
replacement (TAVR) was superior to clinical surveillance (CS).
 Objective(s): In this study, the authors sought to evaluate whether
baseline left ventricular (LV) health altered the treatment effect of
early intervention and to examine longitudinal LV health under different
treatment strategies. Method(s): At 75 centers in the United States
and Canada, 901 patients underwent randomization to TAVR (n = 455) or CS
(n = 446). Echocardiographic measurements were made in a core laboratory.
The protocol defined integrated LV health as the composite of absolute LV
global longitudinal strain (GLS) >=15%, LV mass index (LVMi) <115
g/m2 (men) or <95 g/m2 (women), and left atrial
volume index (LAVi) <=34 mL/m2. Integrated LV health was a
prespecified secondary endpoint and the protocol outlined longitudinal
measurements to be made in the intention-to-treat (ITT) and valve implant
populations. As a stratification variable for effect-modification testing,
LV health was not prespecified, so those analyses are exploratory. The
trial's primary endpoint and 2 secondary composites were examined.
 Result(s): At randomization, in the ITT population, 27% had normal
integrated LV health (64% normal LVMi, 42% normal LAVi, 88% normal GLS).
Abnormal integrated LV health and each component were generally associated
with higher event rates across several composite endpoints. Benefit of
early TAVR, compared with CS, was consistently observed regardless of
whether LV health (evaluated as an integrated measure and as individual
components) was normal or not. In the ITT population, the CS group
exhibited normal LV health less frequently at 2 years than those treated
early according to the integrated LV health measure (35.9% vs 48.1%; P <
0.001) and component measures. Among CS patients undergoing delayed AVR,
LV health tended to decline from randomization to preprocedure (P < 0.10
for all measures except GLS), but baseline LV health did not predict
timing of conversion to AVR nor severity of presentation.
 Conclusion(s): For patients with asymptomatic severe AS, the benefit
of early TAVR, compared with CS, is consistent regardless of baseline LV
health according to integrated or individual measures. These exploratory
findings suggest limited value for measures of LV health to guide the
timing of TAVR in asymptomatic patients. Whether the worsening of LV
health associated with CS and delayed aortic valve replacement underlies
increased clinical events in that treatment arm requires further study.
(Evaluation of TAVR Compared to Surveillance for Patients With
Asymptomatic Severe Aortic Stenosis [EARLY TAVR];
NCT03042104) Copyright © 2026 American College of Cardiology
Foundation

<9>
Accession Number
2037453363
Title
Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative
Delirium: A Cluster Randomized Crossover Trial.
Source
JAMA Surgery. 160(3) (pp 286-294), 2025. Date of Publication: 12 Mar 2025.
Author
Spence J.; Devereaux P.J.; Lee S.-F.; D'Aragon F.; Avidan M.S.; Whitlock
R.P.; Mazer C.D.; Rousseau-Saine N.; Rajamohan R.R.; Pryor K.O.; Klein R.;
Tan E.; Cameron M.J.; Di Sante E.; Deborba E.; Mustard M.E.; Couture E.J.;
Zamper R.P.C.; Law M.W.Y.; Djaiani G.; Saha T.; Choi S.; Hedlin P.;
Pikaluk D.R.; Lam W.; Deschamps A.; Ramasundarahettige C.F.; Vincent J.;
McIntyre W.F.; Oczkowski S.J.W.; Dulong B.J.; Beaver C.; Kloppenburg S.A.;
Lamy A.; Jacobsohn E.; Belley-Cote E.P.
Institution
(Spence, Devereaux, Lee, Whitlock, Di Sante, Deborba, Ramasundarahettige,
Vincent, McIntyre, Beaver, Kloppenburg, Lamy, Belley-Cote) Population
Health Research Institute, Hamilton, ON, Canada
(Spence) Department of Anesthesia and Critical Care, McMaster University,
Hamilton, ON, Canada
(Spence, Devereaux, Lee, Whitlock, Oczkowski, Belley-Cote) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON, Canada
(Spence, Devereaux, Whitlock, McIntyre, Lamy, Belley-Cote) World Health
Research Trust, Hamilton, ON, Canada
(Devereaux, McIntyre, Lamy) Department of Medicine, Cardiology, McMaster
University, Hamilton, ON, Canada
(D'Aragon) Departement d'Anesthesiologie, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Avidan) Department of Anesthesia, Washington University, St Louis School
of Medicine, St Louis, MO, United States
(Whitlock) Department of Surgery, Cardiac Surgery, McMaster University,
Hamilton, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Mazer) Departments of Anesthesiology and Pain Medicine, Physiology, and
Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
(Rousseau-Saine, Deschamps) Departement d'Anesthesie, Institut de
Cardiologie de Montreal, Universite de Montreal, Montreal, QC, Canada
(Rajamohan) Department of Anesthesia, St Paul's Hospital, University of
British Columbia, Vancouver, BC, Canada
(Pryor) Department of Anesthesiology, Weill Cornell Medical College, New
York, NY, United States
(Klein) Department of Anesthesia, Vancouver General Hospital, University
of British Columbia, Vancouver, BC, Canada
(Tan, Dulong) Department of Anesthesia and Critical Care Medicine, Queen
Elizabeth II Health Sciences, Dalhousie University, Halifax, NS, Canada
(Cameron) Department of Anesthesia, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Mustard) St Michael's Hospital, Toronto, ON, Canada
(Couture) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Universite Laval, Quebec, QC, Canada
(Zamper) Department of Anesthesia, University of Western Ontario, London,
ON, Canada
(Law) Department of Anesthesiology, Royal Columbian Hospital, Department
of Anesthesiology, Pharmacology & Therapeutics, University of British
Columbia, Vancouver, BC, Canada
(Djaiani, Choi) Department of Anesthesiology and Pain Medicine, University
of Toronto, Toronto, ON, Canada
(Saha) Department of Anesthesia, Queen's University, Kingston, ON, Canada
(Choi) Department of Anesthesia, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Hedlin, Pikaluk) Department of Anesthesia, University of Saskatchewan,
Saskatoon, SK, Canada
(Lam) Department of Anesthesia, University of Alberta, Mazankowski Alberta
Heart Institute, Edmonton, AB, Canada
(Oczkowski) Department of Medicine, Critical Care, McMaster University,
Hamilton, ON, Canada
(Lamy, Belley-Cote) Department of Medicine, Cardiology and Critical Care,
McMaster University, Hamilton, ON, Canada
(Jacobsohn) Departments of Anesthesia and Perioperative Medicine and
Medicine, Critical Care, University of Manitoba, Winnipeg, MB, Canada
Publisher
American Medical Association
Abstract
Importance: Delirium is common after cardiac surgery and associated with
adverse outcomes. Intraoperative benzodiazepines may increase
postoperative delirium but restricting intraoperative benzodiazepines has
not yet been evaluated in a randomized trial. Objective(s): To
determine whether an institutional policy of restricted intraoperative
benzodiazepine administration reduced the incidence of postoperative
delirium. Design, Setting, and Participant(s): This pragmatic,
multiperiod, patient- and assessor-blinded, cluster randomized crossover
trial took place at 20 North American cardiac surgical centers. All adults
undergoing open cardiac surgery at participating centers during the trial
period were included through a waiver of individual patient consent
between November 2019 and December 2022. Intervention(s):
Institutional policies of restrictive vs liberal intraoperative
benzodiazepine administration were compared. Hospitals (clusters) were
randomized to cross between the restricted and liberal benzodiazepine
policies 12 to 18 times over 4-week periods. Main Outcomes and
Measures: The primary outcome was the incidence of delirium within 72
hours of surgery as detected in routine clinical care, using either the
Confusion Assessment Method-Intensive Care Unit or the Intensive Care
Delirium Screening Checklist. Intraoperative awareness by patient report
was assessed as an adverse event. Result(s): During the trial, 19768
patients (mean [SD] age, 65 [12] years; 14528 [73.5%] male) underwent
cardiac surgery, 9827 during restricted benzodiazepine periods and 9941
during liberal benzodiazepine periods. During restricted periods,
clinicians adhered to assigned policy in 8928 patients (90.9%), compared
to 9268 patients (93.2%) during liberal periods. Delirium occurred in 1373
patients (14.0%) during restricted periods and 1485 (14.9%) during liberal
periods (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.01; P =.07). No
patient spontaneously reported intraoperative awareness. Conclusions
and Relevance: In intention-to-treat analyses, restricting benzodiazepines
during cardiac surgery did not reduce delirium incidence but was also not
associated with an increase in the incidence of patient-reported
intraoperative awareness. Given that smaller effect sizes cannot be ruled
out, restriction of benzodiazepines during cardiac surgery may be
considered. Research is required to determine whether restricting
intraoperative benzodiazepines at the patient level can reduce the
incidence of postoperative delirium. Trial Registration:
ClinicalTrials.gov Identifier: NCT03928236. Copyright © 2025
American Medical Association. All rights reserved, including those for
text and data mining, AI training, and similar technologies.

<10>
Accession Number
2042960950
Title
Efficacy of Ropivacaine Infiltration by Presternal Multi-orifice Catheter
for Post-Sternotomy Pain Relief in Adult Patients Undergoing Cardiac
Surgery-A Prospective, Randomized, Control Study.
Source
Annals of Cardiac Anaesthesia. 29(1) (pp 104-109), 2026. Date of
Publication: 01 Jan 2026.
Author
Swetha L.S.N.; Prakash M.; Hasija S.; Gayatri B.S.; Chauhan S.; Jha P.K.
Institution
(Swetha, Prakash, Hasija, Chauhan) Department of Cardiac Anesthesia and
Critical Care, All India Institute of Medical Sciences, New Delhi, India
(Gayatri, Jha) Department of Cardiothoracic and Vascular Surgery, All
India Institute of Medical Sciences, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Post-sternotomy pain management remains a key concern
in adult cardiac surgery. This study evaluated the efficacy and safety of
ropivacaine infiltration via a presternal multi-orifice catheter for
postoperative analgesia. Design(s): A prospective randomized
controlled trial. Setting(s): A single tertiary care center.
 Material(s) and Method(s): A total of 175 adult patients undergoing
cardiac surgery via median sternotomy were randomized into three groups:
Group A (n = 58): Received 0.375% ropivacaine as continuous infusion at 5
mL/hour, Group B (n = 58): Received 5 mL of 0.375% ropivacaine as
intermittent boluses every 8 hours, and Group C (n = 59): Received
conventional intravenous tramadol. Pain was assessed using the visual
analogue scale (VAS) for 48 hours post-extubation. Intravenous tramadol
was used as rescue analgesia if VAS>=3. Result(s): Group B reported
significantly lower VAS scores and rescue tramadol requirements (56 +/- 35
mg) compared to Group A (155 +/- 32 mg) and Group C (135 +/- 45 mg). No
significant differences were observed among the groups regarding
hemodynamic parameters, catheter-related infections, time to extubation,
or intensive care unit (ICU) stay. Conclusion(s): Presternal
infiltration of 0.375% ropivacaine is safe and effective for
post-sternotomy analgesia. The intermittent bolus technique provides
superior pain relief and reduces opioid consumption compared to continuous
infusion and standard intravenous analgesia. Copyright © 2026
Annals of Cardiac Anaesthesia.

<11>
Accession Number
2042047463
Title
Optimization in long-term survival after multiple arterial grafting in
coronary artery bypass: A systematic review and meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. 34(1) (pp 67-81), 2026. Date of
Publication: 01 Jan 2026.
Author
Abdillah A.H.; Sofian A.; Agustian A.H.; Fadhilah A.; Fatharani A.
Institution
(Abdillah, Agustian) Faculty of Medicine, Universitas Sumatera Utara,
Medan, Indonesia
(Sofian) Department of Thoracic and Cardiovascular Surgery, Pertamina
Pusat Hospital, South Jakarta, Indonesia
(Fadhilah) Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(Fatharani) Faculty of Medicine and Life Sciences, King's College London,
London, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Introduction: Surgical revascularization through coronary artery bypass is
a widely accepted approach for treating diseases affecting multiple
coronary vessels. While the standard approach uses a single arterial graft
combined with vein grafts, using numerous arterial grafts may improve
long-term outcomes. Although supported by observational data and guideline
recommendations, the broader adoption of multiple arterial grafting has
been limited due to a lack of definitive randomized trial evidence and
uncertainties in specific patient subgroups. Method(s): A systematic
review and meta-analysis were conducted to compare long-term survival in
patients receiving multiple versus single arterial grafts during coronary
artery bypass surgery. Twenty-seven studies (including one randomized
trial) involving more than one million patients were included. The primary
outcome was long-term all-cause mortality. Hazard ratios with 95%
confidence intervals were pooled using a random-effects model. Subgroup
analyses were performed based on age, sex, diabetes status, graft conduit
type, extent of arterial revascularization, and left ventricular function.
Meta-regression examined the impact of patient characteristics.
 Result(s): Multiple arterial grafting was associated with a
significant reduction in long-term mortality compared to single arterial
grafting. The pooled hazard ratio indicated an approximate 20% relative
reduction in mortality. This survival benefit was consistent across all
evaluated subgroups. Meta-regression did not identify any patient
characteristic that significantly altered the benefit of multiple arterial
grafting. No significant publication bias was detected.
 Conclusion(s): Multiple arterial grafting is associated with improved
long-term survival in coronary artery bypass surgery. These findings
support the broader implementation of this strategy in suitable patients
while emphasizing the need for individualized surgical
decision-making. Copyright © The Author(s) 2025. This article is
distributed under the terms of the Creative Commons Attribution 4.0
License (https://creativecommons.org/licenses/by/4.0/) which permits any
use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open
Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

<12>
Accession Number
2042203920
Title
Triglyceride-glucose index as a novel predictor of major adverse
cardiovascular events in patients with coronary revascularization: a
meta-analysis of cohort studies.
Source
Annals of Medicine. 58(1) (no pagination), 2026. Article Number: 2607796.
Date of Publication: 2026.
Author
Zhang C.; Li M.; Liu L.; Zhong Y.; Xie Y.; Liao B.; Feng J.; Deng L.
Institution
(Zhang, Li, Liu, Zhong, Feng, Deng) Department of Cardiology, The
Affiliated Hospital of Southwest Medical University, Stem Cell Immunity
and Regeneration Key Laboratory of Luzhou, Luzhou, China
(Xie) School of Rehabilitation, Capital Medical University, Beijing, China
(Xie) Department of Rehabilitation Medicine, Affiliated Hospital of North
Sichuan Medical College, Sichuan, China
(Liao) Department of Cardiovascular Surgery, The Affiliated Hospital of
Southwest Medical University, Metabolic Vascular Diseases Key Laboratory
of Sichuan Province, Luzhou, China
(Deng) Department of Rheumatology, The Affiliated Hospital of Southwest
Medical University, Luzhou, China
Publisher
Taylor and Francis Ltd.
Abstract
Background: The triglyceride-glucose index (TyG) has gained attention as
an alternative indicator for assessing insulin resistance (IR). The
purpose of this study was to comprehensively summarize the correlation
between the TyG index and cardiovascular events in patients with coronary
revascularization. Method(s): PubMed, Web of Science, Embase, and The
Cochrane Library databases were searched to find relevant literature on
the prognostic assessment of TyG index in patients undergoing coronary
artery revascularization. Utilize the risk ratio (RR) and its 95%
confidence interval (CI) as the standard for assessing the correlation
between TyG and major adverse cardiovascular events (MACEs) in patients
undergoing coronary artery revascularization. Conduct sensitivity analysis
and subgroup analysis to detect the sources of heterogeneity and assess
the stability of the results. Result(s): A total of 12 studies
involving 9,973 participants were included. The results of the study
indicate that a high TyG index was related to the major adverse
cardiovascular event in patients undergoing coronary artery
revascularization (RR:2.0,95%CI: 1.71-2.35, I2=76.2%, p <
0.0001). Subgroup analysis reveals that the probability of MACEs occurring
in patients with high TyG index is higher than in those with low TyG index
after two different coronary artery revascularization procedures: CABG
group (RR:2.10, 95%CI:1.80-2.45, I2 = 20.9%, p = 0.0001). PCI group:
(RR:1.94, 95%CI:1.54-2.46, I2 = 84.2%, p < 0.00001). Additionally, we also
demonstrated the prognostic value of the TyG index in all-cause
mortality(p = 0.003), non-fatal myocardial infarction(p = 0.003),
non-fatal stroke(p < 0.0001) and repeat revascularization(p < 0.0001).
 Conclusion(s): Higher TyG index may be independently associated with
higher incidence of MACEs in patients with coronary
revascularization. Copyright © 2025 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<13>
Accession Number
2042542489
Title
Techniques for harvesting the saphenous vein in coronary artery bypass
grafting: a network systematic review and meta-analysis.
Source
Open Heart. 12(2) (no pagination), 2025. Article Number: e003728. Date of
Publication: 18 Dec 2025.
Author
Liu C.; Zhang M.-X.; Guan X.-L.; Jia S.-H.; Tang W.-J.; Wang X.-L.; Jiang
W.-J.; Zhang H.-J.
Institution
(Liu, Guan, Jia, Tang, Wang, Jiang, Zhang) Department of Cardiovascular
Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing,
China
(Liu, Guan, Jia, Tang, Wang, Jiang, Zhang) Beijing Laboratory of
Cardiovascular Precision Medicine, Beijing Municipal Education Commission,
Beijing, China
(Liu, Guan, Jia, Tang, Wang, Jiang, Zhang) Ministry of Education, Key Lab
of Medical Engineering for Cardiovascular Disease, Beijing, China
(Zhang) Department of Epidemiology and Biostatistics, School of Public
Health, Peking University Health Science Center, Peking University,
Beijing, China
Publisher
BMJ Publishing Group
Abstract
Objective The optimal technique for harvesting the saphenous vein (SVG) in
coronary artery bypass grafting (CABG) remains undetermined. This study
aimed to assess the efficacy of open vein harvesting (OVH), endoscopic
vein harvesting (EVH) and no-touch vein harvesting (NT) in CABG using a
network meta-analysis of randomised controlled trials (RCTs). Methods RCTs
evaluating the outcomes in patients undergoing CABG with the SVG using
OVH, EVH or NT were identified through a systematic search of PubMed, Web
of Science and the Cochrane Central Registry up to August 2025. The
outcomes analysed included graft failure, graft occlusion, mortality,
revascularisation, myocardial infarction (MI) and leg wound infection
rates. Results Data from 26 RCTs involving 7254 patients meeting the
inclusion criteria were analysed. The network meta-analysis indicated that
the graft failure rate in the NT group was significantly lower than in the
OVH group (relative risk (RR) 0.62; 95% CI 0.40 to 0.96) and the EVH group
(RR 0.41; 95%CI 0.21 to 0.80). The graft occlusion rate in the NT group
was significantly lower than in the OVH group (RR 0.66, 95%CI 0.52 to
0.84). However, the leg wound infection rate in the NT group was the
highest. No significant differences were observed in mortality,
revascularisation and MI rates among the three groups. Conclusion NT was
associated with lower graft failure and graft occlusion rates, yet it had
higher leg wound infection rates, while mortality, revascularisation and
MI rates remained comparable among the three techniques. These findings
require cautious interpretation, and it is important to balance harvest
site complications and the desirability of long-term graft
patency. Copyright © Author(s) (or their employer(s)) 2025.
Re-use permitted under CC BY. Published by BMJ Group.

<14>
[Use Link to view the full text]
Accession Number
2040034705
Title
Tricuspid transcatheter edge-to-edge repair for severe symptomatic
tricuspid regurgitation: a systematic review and meta-analysis.
Source
Journal of Cardiovascular Medicine. 26(9) (pp 519-526), 2025. Date of
Publication: 01 Sep 2025.
Institution
Division of Cardiology, University Hospital P. Giaccone, Department of
ProMISE, University of Palermo
Facultad Ciencias Biomedicas, Universidad Austral, Av.Juan Domingo Peron,
Buenos Aires, Argentina
Government Medical College Kozhikode, Kerala, India
Department of Cardiology, Louisiana State University, Shreveport, Los
Angeles, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background - Severe tricuspid regurgitation is associated with elevated
morbidity and mortality. In recent years, tricuspid transcatheter
edge-to-edge repair (T-TEER) has emerged as a promising procedure for the
treatment of this valvular disease. We conducted a systematic review and
meta-analysis to compare the effectiveness of T-TEER with optimized
medical therapy (OMT) versus OMT alone for the treatment of severe
tricuspid regurgitation. Methods - PubMed, Scopus, and Cochrane databases
were searched for randomized controlled trials (RCTs) and observational
studies comparing T-TEER plus OMT vs. OMT alone. Heterogeneity was
assessed with I2 statistics, and a random-effects model was
used for all the outcomes. Results - We included two RCTs and four
observational studies with a total of 1805 patients, of whom 849 (47%)
underwent T-TEER plus OMT. We found a trend favoring T-TEER for all-cause
mortality [risk ratio 0.87; 95% confidence interval (95% CI) 0.66-1.13; P
= 0.30] and cardiovascular death (risk ratio 0.77; 95% CI 0.36-1.65; P =
0.50), although without statistically significant difference. Heart
failure hospitalizations (risk ratio 0.72; 95% CI 0.61-0.85; P = 0.0001)
were significantly reduced in patients treated with T-TEER compared with
OMT alone. Tricuspid regurgitation severity 2+ or less was also more
frequently achieved in the T-TEER group (risk ratio 6.42; 95% CI
3.08-13.39; P < 0.001). Functional status and quality of life were
significantly improved, with higher KCCQ scores [(mean difference)
+14.01], longer 6MWT distance (MD +29.35 m), and a greater proportion of
patients in NYHA class I-II (risk ratio 1.39; 95% CI 1.27-1.51; P <
0.00001). Conclusion - In patients with severe symptomatic TR, T-TEER is
associated with significant improvements in tricuspid regurgitation
severity, reduction in heart failure hospitalizations, and enhanced
quality of life and functional status, with no apparent effect on
all-cause mortality and cardiovascular death. Copyright © 2025

<15>
Accession Number
2042732191
Title
Beyond chronological age: use of frailty scales for decision-making in
cardiovascular interventions.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 12(1) (pp
105-106), 2026. Date of Publication: 01 Jan 2026.
Author
Farmakis D.; Elpidoforou M.; Bakalidou D.; Filippatos G.
Institution
(Farmakis, Filippatos) Department of Cardiology, Athens University
Hospital Attikon, School of Medicine, National and Kapodistrian University
of Athens, 1 Rimini St, 124 61, Haidari, Athens, Greece
(Elpidoforou, Bakalidou) Department of Physiotherapy, University of West
Attica, Interdisciplinary Laboratory for Research, Education and
Disability Support, IREDS Lab, Athens, Greece
Publisher
Oxford University Press

<16>
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.

<17>
Accession Number
2042788134
Title
Sutureless versus transcatheter aortic valve replacement in patients with
aortic stenosis: An updated meta-analysis of short- and mid-term outcomes
with trial sequential analysis.
Source
International Journal of Cardiology. 447 (no pagination), 2026. Article
Number: 134116. Date of Publication: 15 Mar 2026.
Author
Obi O.; Ayesha A.; Lajczak P.; Hageen A.W.; Hamza M.; Erzinger G.; Khan
M.; Nweze U.; Eltawansy S.
Institution
(Obi) New York Institute of Technology College of Osteopathic Medicine,
Northern Blvd Old Westbury, United States
(Ayesha) Shifa College of Medicine, Islamabad, Pakistan
(Lajczak) Medical University of Silesia Katowice, Poland
(Hageen) Faculty of Medicine, Tanta University, Tanta, Egypt
(Hamza) Saidu Medical College, Swat, Pakistan
(Erzinger) University of the Region of Joinville (Univille), Joinville,
Brazil
(Khan) Bacha Khan Medical College, Mardan, Pakistan
(Nweze) Kaiser Permanente, Fontana Medical Center, Fontana, United States
(Eltawansy) Jersey Shore University Medical Center, Neptune, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The efficacy and safety of a novel aortic valve replacement
treatment (SAVR) technique, sutureless aortic valve replacement (SU-AVR),
compared to transcatheter aortic valve replacement (TAVR) in the treatment
of aortic stenosis, is unclear in short and mid-term outcomes due to
limited data. Method(s): PubMed, Scopus, Embase, Web of Science, and
the Cochrane Library were systematically searched for studies comparing
SU-AVR with TAVR. Risk ratios (RR) with 95 % confidence intervals (CIs)
were computed for binary outcomes. Trial sequential analysis (TSA) was
performed to assess whether the results in our meta-analysis were
conclusive. Result(s): This systematic review and meta-analysis
included 22 observational studies of symptomatic patients. When comparing
SU-AVR to TAVR, similar risk of in-hospital mortality (RR 0.67, 95 % CI
0.37-1.24, p = 0.20, I2 = 15.1 %) and two-year mortality (RR
0.73, 95 % CI 0.39-1.37, p = 0.32, I2 = 61.5 %) were noted.
However, SU-AVR was associated with significantly lower 30-day mortality
(RR 0.46, 95 % CI 0.28-0.75, p = 0.002, I2 = 0.9 %), total
number of valvular leakages (RR 0.13, 95 % CI 0.05-0.32, p < 0.00,
I2 = 59.5 %), and one-year mortality (RR 0.51, 95 % CI
0.32-0.80, p = 0.003, I2 = 0.0 %). In the TSA analysis, 30-day
mortality, one-year mortality, and total leakage rate showed true-positive
results in the method. The two-year mortality rate yielded false-negative
results due to the too low required information size. Conclusion(s):
In patients with aortic stenosis, SU-AVR was associated with similar
in-hospital mortality and two-year mortality rates compared with TAVR;
however, it was associated with significantly lower 30-day mortality,
total number of valvular leakages, and one-year mortality
rates. Copyright © 2025 Elsevier B.V.

<18>
Accession Number
2042071850
Title
Does Minimally Invasive Valve Surgery Improve Quality of Life Compared to
Sternotomy? A Systematic Review.
Source
Journal of Clinical Medicine. 14(24) (no pagination), 2025. Article
Number: 8660. Date of Publication: 01 Dec 2025.
Author
Marinescu A.D.; Oprea S.A.; Costache V.S.
Institution
(Marinescu, Oprea) Faculty of Medicine, Doctoral Studies, Titu Maiorescu
University, Bucharest, Romania
(Oprea, Costache) Department of Cardiovascular Surgery, Sanador Hospital,
Bucharest, Romania
(Costache) Faculty of Medicine, Department of Cardiovascular Surgery, Titu
Maiorescu University, Bucharest, Romania
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Minimally invasive valve surgery (MIVS) is
increasingly employed as an alternative to conventional median sternotomy
(MS) in the treatment of valvular heart disease. However, its impact on
postoperative quality of life (QoL) remains incompletely understood. This
systematic review and meta-analysis aimed to compare QoL outcomes between
MIVS and MS, focusing on physical, psychological, and social dimensions,
both in the short- and long-term postoperative periods. Method(s): A
comprehensive search was conducted in PubMed, Scopus, Web of Science, and
Wiley Online Library databases for studies published between January 2020
and September 2025. Eligible studies included adult patients undergoing
MIVS or MS and assessed QoL using validated instruments (SF-36, EQ-5D,
MLHFQ, KCCQ). Random-effects models were used for meta-analysis, and
standardized mean differences (SMDs) were calculated to estimate pooled
effects. Result(s): Fifty-six studies with a combined sample of over
10,000 patients were included. MIVS was associated with significantly
better short-term QoL outcomes across physical (SMD = 0.88; 95% CI:
0.74-1.02) and psychological domains (SMD = 0.47; 95% CI: 0.35-0.59).
Patients also experienced earlier social reintegration and improved body
image perception. Although these benefits diminished beyond 12 months,
MIVS maintained a modest but persistent advantage in long-term QoL (>=5
years). Structured psychological support and cardiac rehabilitation
programmes further enhanced physical and emotional recovery.
 Conclusion(s): MIVS confers meaningful benefits in postoperative QoL,
particularly during the early recovery phase. Sustained improvements
depend on comprehensive postoperative care, including rehabilitation and
psychosocial support. Further long-term, standardized research is required
to strengthen evidence and guide patient-centred surgical
decision-making. Copyright © 2025 by the authors.

<19>
Accession Number
2042760329
Title
Albiglutide and atrial fibrillation in patients with Type 2 diabetes and
established cardiovascular disease: insights from the Harmony Outcomes
trial.
Source
European Journal of Preventive Cardiology. 33(1) (pp 30-41), 2026. Date of
Publication: 01 Jan 2026.
Author
Krychtiuk K.A.; Marquis-Gravel G.; Murphy S.; Chiswell K.; Green J.B.;
Leiter L.A.; Lopes R.D.; Del Prato S.; McMurray J.J.V.; Hernandez A.F.;
Granger C.B.
Institution
(Krychtiuk, Marquis-Gravel, Murphy, Chiswell, Green, Lopes, Hernandez,
Granger) Duke Clinical Research Institute, 300 W Morgan Street, Durham,
NC, United States
(Leiter) Li Ka Shing Knowledge Institute, University of Toronto, St.
Michael's Hospital, 38 Shuter St, Toronto, ON, Canada
(Del Prato) Section on Diabetes, Department of Clinical and Experimental
Medicine, University of Pisa, Via Roma 67, Pisa, Italy
(Del Prato) Sant'Anna School of Advanced Studies, Piazza Martiri della
Liberta, 33, Pisa, Italy
(McMurray) British Heart Foundation Glasgow Cardiovascular Research
Centre, University of Glasgow, 126 University Pl, Glasgow, United Kingdom
Publisher
Oxford University Press
Abstract
Aims Atrial fibrillation and flutter (AF) are common in patients with Type
2 diabetes and are associated with worse outcomes. Methods and results
Harmony Outcomes was a multi-centre, event-driven, double-blind,
placebo-controlled trial comparing the effects of albiglutide, a
glucagon-like peptide-1 receptor agonist, with placebo on a composite of
major adverse cardiac events (MACEs; non-fatal myocardial infarction,
non-fatal stroke, and cardiovascular death) in 9463 patients aged >40
years with Type 2 diabetes and established cardiovascular disease. Herein,
the cardiovascular effects of albiglutide in patients with and without AF,
as well as the effects on AF events during follow-up, were analysed.
Patients with a history of AF (8.9%) exhibited a higher event rate for the
primary composite MACE endpoint during 1.6 years of follow-up {12.7 vs.
6.3 events/100 person-years, adjusted hazard ratio [aHR] 1.41 [95%
confidence interval (CI) 1.14-1.74], P = 0.001}. Treatment with
albiglutide reduced the occurrence of the primary endpoint irrespective of
history of AF at baseline (history of AF: aHR 0.83 [0.58-1.19], no history
of AF: aHR 0.77 [0.66-0.90]; Pinteraction = 0.71). During follow-up, 239
patients (2.5%) experienced an AF event. Overall, albiglutide was
associated with numerically fewer AF events [108 vs. 131; hazard ratio
0.82 (0.63-1.06), P = 0.12], irrespective of baseline history of AF
(Pinteraction = 0.92). Conclusion In patients with Type 2 diabetes,
treatment with albiglutide, compared with placebo, reduced the risk of
cardiovascular events irrespective of history of AF. Further, albiglutide
treatment did not increase AF adverse events but was associated with a
trend to a lower rate of AF events during follow-up without reaching
statistical significance Copyright © The Author(s) 2024.
Published by Oxford University Press on behalf of the European Society of
Cardiology. All rights reserved.

<20>
Accession Number
2041546855
Title
Liberal or Restrictive Postoperative Transfusion in Patients at High
Cardiac Risk The TOP Randomized Clinical Trial.
Source
JAMA. 334(24) (pp 2197-2207), 2025. Date of Publication: 23 Dec 2025.
Author
Kougias P.; Sharath S.E.; Zhan M.; Carson J.L.; Norman L.E.; Mi Z.; Pal
R.; Dosluoglu H.; Modrall J.G.; Sarosi G.A.; Nelson P.; Arya S.;
Scrymgeour A.; Ollison J.; Calais L.A.; Nambi V.; Gregg L.P.; Abdullah
S.M.; Tsai S.; Becker N.; Choi J.C.; Chiu L.; Scali S.; Barshes N.R.; Awad
S.; Moursi M.; Koopmann M.C.; Sally M.; Ihnat D.; Ramaswamy A.; Gasper W.;
Tzeng E.; Wilson M.A.; Tang G.; Huang G.; Biswas K.
Institution
(Kougias, Sharath, Ollison, Becker, Choi) Operative Care Line, VA New York
Harbor Healthcare System, Department of Surgery, State University of New
York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United
States
(Zhan, Norman, Mi, Pal, Huang, Biswas) VA Cooperative Studies Program
Coordinating Center, Perry Point, MD, United States
(Carson) Division of General Internal Medicine, Department of Medicine,
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United
States
(Dosluoglu) Operative Care Line, Division of Vascular Surgery, Department
of Surgery, State University of New York at Buffalo, VA Western NY
Healthcare System, United States
(Modrall, Tsai) Operative Care Line, Dallas VA Medical Center, Division of
Vascular Surgery, Department of Surgery, University of Texas Southwestern
Medical Center, Dallas, United States
(Sarosi, Scali) Operative Care Line, Malcolm Randall Veterans Affairs
Medical Center, Department of Surgery, University of Florida College of
Medicine, Gainesville, United States
(Nelson) Division of Vascular Surgery, Department of Surgery, University
of Oklahoma School of Community Medicine, Tulsa, United States
(Arya) Operative Care Line, Palo Alto VA Medical Center, Division of
Vascular Surgery, Department of Surgery, Stanford University School of
Medicine, Vascular Section, Surgery Service Line, Palo Alto, CA, United
States
(Scrymgeour) Cooperative Studies Program, Clinical Research Pharmacy
Coordinating Center, Albuquerque, NM, United States
(Calais) Cooperative Studies Program, Site Monitoring, Auditing, and
Resource Team, Albuquerque, NM, United States
(Nambi) Michael E. DeBakey VA Medical Center, Department of
Medicine-Cardiology, Baylor College of Medicine, Houston, TX, United
States
(Gregg, Chiu) Michael E. DeBakey VA Medical Center, VA Health Systems
Research and Development Center for Innovations in Quality, Effectiveness
and Safety, Baylor College of Medicine, Department of Medicine-Nephrology,
Houston, TX, United States
(Abdullah) Dallas VA Medical Center, University of Texas Southwestern
Medical Center, Department of Medicine-Cardiology, Dallas, United States
(Barshes, Awad) Operative Care Line, Michael E. DeBakey VA Medical Center,
Department of Surgery, Baylor College of Medicine, Houston, TX, United
States
(Moursi) Operative Care Line, Little Rock VA Medical Center, Department of
Surgery, University of Arkansas for Medical Services, Little Rock, United
States
(Koopmann) Operative Care Division, Portland VA Medical Center, Portland,
OR, United States
(Sally) Trauma/Surgical ICU, Oregon Health Sciences University, Portland,
OR, United States
(Ihnat, Ramaswamy) Operative Care Line, Minneapolis VA Medical Center,
Department of Surgery, University of Minnesota Medical School,
Minneapolis, United States
(Gasper) Operative Care Line, Department of Surgery, San Francisco VA
Health System, University of California, San Francisco, United States
(Tzeng, Wilson) Operative Care Line, Pittsburgh VA Medical Center,
Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United
States
(Tang) Operative Care Line, Seattle VA Medical Center, Division of
Vascular Surgery, Department of Surgery, University of Washington,
Seattle, United States
Publisher
American Medical Association
Abstract
Importance Postoperative red blood cell transfusion guidelines recommend
transfusion for hemoglobin levels less than 7 g/dL. However, the safety of
this strategy in patients at high risk of cardiac events undergoing major
operations remains unclear. Objective To evaluate the risk of death or
major ischemic events within 90 days after a liberal transfusion strategy
compared with a restrictive transfusion strategy in patients at high risk
of cardiac events who had undergone major vascular or general surgery
operations and developed postoperative anemia. Design, Setting, and
Participants This parallel, single-blind, randomized clinical superiority
trial included 1428 veterans (>=18 y) at high cardiac risk undergoing
major vascular or general surgery operations. Participants were enrolled
from February 2018 to March 2023 across 16 Veterans Affairs Medical
Centers in the US. Interventions Seven hundred fourteen participants with
postoperative hemoglobin less than 10 g/dL were randomized to a liberal
strategy (transfusion trigger at hemoglobin level <10 g/dL) and 714 to a
restrictive strategy (transfusion trigger at hemoglobin <7 g/dL). Main
Outcomes and Measures The primary end point was a composite of all-cause
death, myocardial infarction, coronary revascularization, acute kidney
failure, or ischemic stroke within 90 days after randomization. Secondary
end points included a composite of cardiac complications other than
myocardial infarction (arrhythmias, heart failure, and nonfatal cardiac
arrest). Results Of the 1424 analyzed veterans (mean age, 69.9 [SD, 7.9]
years; 1393 male [97.8%]; 268 Black [18.8%]; 48 Hispanic [4.1%]; 1071
White [75.2%]), 1297 (91.1%) underwent vascular surgical procedures. The
mean hemoglobin difference between transfusion strategies was 2.0 g/dL on
day 5 after randomization. The primary outcome rate in the liberal group
was 9.1% (61 of 670) compared with 10.1% (71 of 700) in the restrictive
group (relative risk, 0.90; 95% CI, 0.65-1.24). The secondary end point of
cardiac complications without myocardial infarction, which was 1 of 5
secondary end points, occurred in 5.9% (38 of 647) of patients in the
liberal group and 9.9% (67 of 678) of patients in the restrictive group
(relative risk, 0.59; 99% CI, 0.36-0.98). Conclusions and relevance After
major vascular or general surgery operations among patients at high risk
of a cardiac event, a liberal transfusion strategy did not reduce 90-day
death or major ischemic outcome rates compared with a restrictive
strategy. Copyright © 2025 American Medical Association. All
rights reserved, including those for text and data mining, AI training,
and similar technologies. American Medical Association.

<21>
[Use Link to view the full text]
Accession Number
2042947198
Title
Medical Management and Revascularization for Asymptomatic Carotid
Stenosis.
Source
New England Journal of Medicine. 394(3) (pp 219-231), 2026. Date of
Publication: 15 Jan 2026.
Author
Brott T.G.; Howard G.; Lal B.K.; Voeks J.H.; Turan T.N.; Roubin G.S.;
Lazar R.M.; Brown R.D.; Huston J.; Edwards L.J.; Jones M.; Clark W.M.;
Chamorro A.; Llull L.; Mena-Hurtado C.; Heck D.; Marshall R.S.; Howard
V.J.; Moore W.S.; Barrett K.M.; Demaerschalk B.M.; Sangha N.; Aronow H.;
Foster M.; Sternbergh W.C.; Shawl F.; Lanzino G.; Rapp J.; Tran H.S.;
Ecker R.; Mackey A.; Ali V.; Given C.; Teal P.; Kashyap V.S.; Mukherjee
D.; Harrigan M.; Silverman S.; Koopmann M.; Wadley V.G.; Zhang Y.; Rhodes
J.D.; Chaturvedi S.; Meschia J.F.
Institution
(Brott, Barrett, Meschia) Department of Neurology, Mayo Clinic,
Jacksonville, FL, United States
(Howard, Edwards, Zhang, Rhodes) Department of Biostatistics, University
of Alabama at Birmingham, Birmingham, United States
(Lal) Department of Surgery, University of Maryland, Baltimore, United
States
(Voeks, Turan) Department of Neurology, Medical University of South
Carolina, Charleston, United States
(Roubin) CREST-2 Executive Committee, Jackson, WY, United States
(Lazar) Department of Neurology, University of Alabama at Birmingham,
Birmingham, United States
(Brown) Department of Neurology, Mayo Clinic, Rochester, MN, United States
(Huston) Department of Radiology, Mayo Clinic, Rochester, MN, United
States
(Jones) Department of Cardiology, Baptist Health Lexington, Lexington, KY,
United States
(Clark) Department of Neurology, Oregon Health and Science University,
Portland, United States
(Chamorro, Llull) Department of Neurology, Hospital Clinic Barcelona,
Barcelona, Spain
(Mena-Hurtado) Department of Cardiovascular Medicine, Yale University, New
Haven, CT, United States
(Heck) Department of Radiology, Novant Health, Winston-Salem, NC, United
States
(Marshall) Department of Neurology, Columbia University Irving Medical
Center, New York, United States
(Howard) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, United States
(Moore) Department of Surgery, University of California, Los Angeles, Los
Angeles, United States
(Demaerschalk) Department of Neurology, Mayo Clinic, Scottsdale, AZ,
United States
(Sangha) Department of Neurology, Kaiser Permanente Los Angeles Medical
Center, Los Angeles, United States
(Aronow) Division of Cardiovascular Medicine, Henry Ford Hospital,
Detroit, United States
(Foster) Department of Interventional Cardiology, Tennova Healthcare
Turkey Creek Medical Center, Knoxville, TN, United States
(Sternbergh) Department of Vascular Surgery, Ochsner Health, New Orleans,
United States
(Shawl) Department of Interventional Cardiology, White Oak Medical Center,
Silver Spring, MD, United States
(Lanzino) Department of Neurosurgery, Mayo Clinic, Rochester, MN, United
States
(Rapp) Department of Surgery, University of California, San Francisco, San
Francisco, United States
(Tran) Department of Vascular Surgery, Deaconess Heart Group, Newburgh,
IN, United States
(Ecker) Department of Neurological Surgery, MaineHealth Neurosurgery and
Spine, Scarborough, ME, United States
(Mackey) Department of Neurology, Centre Hospitalier Universitaire de
Quebec, Universite Laval, Quebec, QC, Canada
(Ali) First Coast Cardiovascular Institute, Jacksonville, FL, United
States
(Given) Department of Neuroradiology, Baptist Health Lexington, Lexington,
KY, United States
(Teal) Department of Neurology, Vancouver General Hospital, Vancouver, BC,
Canada
(Kashyap) Department of Vascular Surgery, Corewell Health, Grand Rapids,
MI, United States
(Mukherjee) Department of Vascular Surgery, Inova Fairfax Hospital, Falls
Church, VA, United States
(Harrigan) Department of Neurosurgery, University of Alabama at
Birmingham, Birmingham, United States
(Silverman) Department of Neurology, Massachusetts General Hospital,
Boston, United States
(Koopmann) Department of Vascular Surgery, Oregon Health and Science
University, Portland, United States
(Wadley) Department of Medicine, University of Alabama at Birmingham,
Birmingham, United States
(Chaturvedi) Department of Neurology, University of Maryland, Baltimore,
United States
Publisher
Massachussetts Medical Society
Abstract
Background Improvements in medical therapy, carotid-artery stenting, and
carotid endarterectomy call into question the preferred management of
asymptomatic carotid stenosis. Whether adding revascularization to
intensive medical management would provide greater benefit than intensive
medical management alone is unclear. Methods We conducted two parallel,
observer-blinded clinical trials that enrolled patients with high-grade
(>=70%) asymptomatic carotid stenosis across 155 centers in five
countries. The stenting trial compared intensive medical management alone
(medical-therapy group) with carotid-artery stenting plus intensive
medical management (stenting group); the endarterectomy trial compared
intensive medical management alone (medical-therapy group) with carotid
endarterectomy plus intensive medical management (endarterectomy group).
The primary outcome was a composite of any stroke or death, assessed from
randomization to 44 days, or ipsilateral ischemic stroke, assessed during
the remaining follow-up period up to 4 years. Results A total of 1245
patients underwent randomization in the stenting trial and 1240 in the
endarterectomy trial. In the stenting trial, the 4-year incidence of
primary-outcome events was 6.0% (95% confidence interval [CI], 3.8 to 8.3)
in the medical-therapy group and 2.8% (95% CI, 1.5 to 4.3) in the stenting
group (P=0.02 for the absolute difference). In the endarterectomy trial,
the 4-year incidence of primary-outcome events was 5.3% (95% CI, 3.3 to
7.4) in the medical-therapy group and 3.7% (95% CI, 2.1 to 5.5) in the
endarterectomy group (P=0.24 for the absolute difference). From day 0 to
44, in the stenting trial, no strokes or deaths occurred in the
medical-therapy group and seven strokes and one death occurred in the
stenting group; in the endarterectomy trial, three strokes occurred in the
medical-therapy group and nine strokes occurred in the endarterectomy
group. Conclusions Among patients with high-grade stenosis without recent
symptoms, the addition of stenting led to a lower risk of a composite of
perioperative stroke or death or ipsilateral stroke within 4 years than
intensive medical management alone. Carotid endarterectomy did not lead to
a significant benefit. (Funded by the National Institute of Neurological
Disorders and Stroke and others; CREST-2 ClinicalTrials.gov number,
NCT02089217). Copyright © 2025 Massachusetts Medical Society.

<22>
Accession Number
2040584992
Title
Defining the Learning Curve in Minimally Invasive Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 121(2) (pp 480-490), 2026. Date of
Publication: 01 Feb 2026.
Author
Elsebaie A.; Boutros C.S.; Awad A.K.; Sanad M.; Pelletier M.; Abu-Omar Y.;
El-Diasty M.
Institution
(Elsebaie) Faculty of Health Sciences, Department of Medicine, Queen's
University, Kingston, ON, Canada
(Boutros, Awad, Pelletier, Abu-Omar, El-Diasty) Cardiac Surgery
Department, Harrington Heart and Vascular Institute, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
(Awad) Faculty of Medicine, Ain-Shams University, Cairo, Egypt
(Sanad) Cardiothoracic Surgery Department, Mansoura University, Mansoura,
Egypt
(El-Diasty) Department of Biomedical and Molecular Sciences, Queen's
University, Kingston, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background Minimally invasive cardiac surgery (MICS) has become a popular
approach due to its potential benefits, such as improved cosmesis, faster
recovery, shorter hospital stays, and cost-effectiveness, compared with
traditional median sternotomy. However, there have been some concerns
regarding procedural efficiency and surgical outcomes, especially in the
early phase of the learning curve of these procedures. Methods In March
2025, a systematic review was conducted using MEDLINE, Embase, the
Cochrane Library and Google Scholar databases to identify potential
studies that quantitively assessed the learning curve in MICS using
predefined metrics based on surgical times and/or clinical outcomes.
Results There were 28 studies involving 13,257 patients that met the
inclusion criteria, most of which were retrospective, focusing on 3 types
of MICS: minimally invasive mitral valve surgery, aortic valve
replacement, and coronary artery bypass grafting. The learning curve was
assessed using arbitrary (split-group) and nonarbitrary (cumulative sum)
methods. Common perioperative metrics included operative, cardiopulmonary
bypass, aortic cross-clamp times, and postoperative complications. The
reported number of cases needed to overcome the learning curve varied
widely, ranging from 23 to 125 cases (mean, 39 cases [for repair] and 78
[for replacement]) for minimally invasive valve surgery, 40 to 138 cases
(mean, 93 cases) for minimally invasive aortic valve replacement, and 16
to 100 cases (mean, 40 cases) for minimally invasive coronary artery
bypass grafting. Conclusions Differences in surgical process and
postoperative outcomes suggest a learning curve in MICS, although stable
morbidity and mortality rates indicate the safe adoption of these
procedures with appropriate training. Nonetheless, significant
heterogeneity across studies prevents precise learning curve
characterization, highlighting the need for standardized, multivariable
assessment frameworks. Copyright © 2026 The Authors.

<23>
Accession Number
2008363299
Title
Systematic review and consensus definitions for the Standardized Endpoints
in Perioperative Medicine (StEP) initiative: cardiovascular outcomes.
Source
British Journal of Anaesthesia. 126(1) (pp 56-66), 2021. Date of
Publication: 01 Jan 2021.
Author
Beattie W.S.; Lalu M.; Bocock M.; Feng S.; Wijeysundera D.N.; Nagele P.;
Fleisher L.A.; Kurz A.; Biccard B.; Leslie K.; Howell S.; Landoni G.;
Grocott H.; Lamy A.; Richards T.; Myles P.; Gan T.J.; Peyton P.; Sessler
D.; Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.;
Botti M.; Boney O.; Haller G.; Grocott M.; Cook T.; Neuman M.; Story D.;
Gruen R.; Bampoe S.; Evered L.; Scott D.; Silbert B.; van Dijk D.; Kalkman
C.; Chan M.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Bartlett R.J.;
McMonnies R.; Gerstl J.; Jay M.; Kishlyansky D.; Machina M.; Bobcock M.;
Pearse R.; Mythen M.; Canet J.; Moller A.; Gin T.; Schultz M.; Pelosi P.;
Gabreu M.; Futier E.; Creagh-Brown B.; Abbott T.; Klein A.; Corcoran T.;
Cooper D.J.; Dieleman S.; Diouf E.; McIlroy D.; Bellomo R.; Shaw A.;
Prowle J.; Karkouti K.; Billings J.; Mazer D.; Jayarajah M.; Murphy M.;
Bartoszko J.; Sneyd R.; Morris S.; George R.; Moonesinghe R.; Shulman M.;
Lane-Fall M.; Nilsson U.; Stevenson N.; Cooper J.D.; van Klei W.; Cabrini
L.; Miller T.; Pace N.; Jackson S.; Buggy D.; Short T.; Riedel B.;
Gottumukkala V.; Alkhaffaf B.; Johnson M.
Institution
(Beattie) Cardiovascular Anesthesia, University Health Network, University
of Toronto, Toronto, ON, Canada
(Lalu, Bocock, Feng) Department of Anesthesia, University of Ottawa,
Ottawa, ON, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute, St Michaels Hospital,
University of Toronto, Toronto, ON, Canada
(Nagele) Department of Anesthesia and Critical Care, University of
Chicago, Chicago, IL, United States
(Fleisher) Department of Anesthesiology and Critical Care, University of
Pennsylvania Health System, Philadelphia, PA, United States
(Kurz) Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
(Biccard) Department of Anesthesia and Perioperative Medicine, University
of Cape Town, Cape Town, South Africa
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic., Australia
(Howell) University of Leeds School of Medicine, Leeds, United Kingdom
(Landoni) Center for Intensive Care and Anesthesiology, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Richards) University of Western Australia, Perth, Australia
(Myles) Alfred Health and Monash University Department of Anaesthesia and
Perioperative Medicine, Melbourne, Vic., Australia
Publisher
Elsevier Ltd
Abstract
Background: Adverse cardiovascular events are a leading cause of
perioperative morbidity and mortality. The definitions of perioperative
cardiovascular adverse events are heterogeneous. As part of the
international Standardized Endpoints in Perioperative Medicine initiative,
this study aimed to find consensus amongst clinical trialists on a set of
standardised and valid cardiovascular outcomes for use in future
perioperative clinical trials. Method(s): We identified currently
used perioperative cardiovascular outcomes by a systematic review of the
anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase,
and Cochrane Library). We performed a three-stage Delphi consensus-gaining
process that involved 55 clinician researchers worldwide. Cardiovascular
outcomes were first shortlisted and the most suitable definitions
determined. These cardiovascular outcomes were then assessed for validity,
reliability, feasibility, and clarity. Result(s): We identified 18
cardiovascular outcomes. Participation in the three Delphi rounds was 100%
(n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine
cardiovascular outcomes was elicited from the consensus: myocardial
infarction, myocardial injury, cardiovascular death, non-fatal cardiac
arrest, coronary revascularisation, major adverse cardiac events,
pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These
nine cardiovascular outcomes were rated by the majority of experts as
valid, reliable, feasible, and clearly defined. Conclusion(s): These
nine consensus cardiovascular outcomes can be confidently used as
endpoints in clinical trials designed to evaluate perioperative
interventions with the goal of improving perioperative
outcomes. Copyright © 2020 British Journal of Anaesthesia

<24>
Accession Number
2030837434
Title
Six-Year Outcomes of Total Arch Replacement vs Debranching With TEVAR for
Aortic Arch Pathologies: Meta-Analysis of Kaplan-Meier-Derived Data From
Propensity Score-Matched Studies.
Source
Journal of Endovascular Therapy. 33(1) (pp 494-504), 2026. Date of
Publication: 01 Feb 2026.
Author
Sa M.P.; Iyanna N.; Jacquemyn X.; Brown J.A.; Yousef S.; Ahmad D.; Singh
M.J.; Serna-Gallegos D.; Sultan I.
Institution
(Sa, Iyanna, Brown, Yousef, Ahmad, Singh, Serna-Gallegos, Sultan) UPMC
Heart and Vascular Institute, University of Pittsburgh Medical Center,
Pittsburgh, PA, United States
(Sa, Iyanna, Brown, Yousef, Ahmad, Serna-Gallegos, Sultan) Department of
Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United
States
(Jacquemyn) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Singh) Division of Vascular Surgery, University of Pittsburgh,
Pittsburgh, PA, United States
Publisher
SAGE Publications Inc.
Abstract
Background: Total arch replacement (TAR) and debranching plus thoracic
endovascular aortic repair (TEVAR) serve as significant therapeutic
options for aortic arch pathologies. It remains unclear whether one of
these approaches should be considered preferable. Our study aimed to
compare the long-term outcomes of these 2 approaches. Method(s): We
carried out a pooled meta-analysis of time-to-event data extracted from
studies published by December 2023. Eligibility criteria included
populations with any aortic arch pathology who underwent debranching plus
TEVAR or TAR, propensity score-matched (PSM) studies
(prospective/retrospective; single-center/multicentric), and the outcomes
included follow-up for overall survival/mortality and/or reinterventions.
 Result(s): Eleven PSM studies met our eligibility criteria, including
a total of 1142 patients (571 matched pairs). We did not observe any
statistically significant difference in the risk of all-cause death
between the groups (hazard ratio [HR]=1.20, 95% confidence interval
[CI]=0.91-1.56, p=0.202), but patients who underwent TAR had a
significantly lower risk of late aortic reinterventions compared with
patients who underwent debranching plus TEVAR (HR=0.38, 95% CI=0.23-0.64,
p<0.001). Our meta-regression analyses for all-cause mortality identified
statistically significant coefficients for age (coefficient=-0.047;
p=0.012) and type A aortic dissections (coefficient=0.012; p=0.010).
 Conclusion(s): Debranching plus TEVAR and TAR demonstrate no
statistically significant differences in terms of survival in patients
with aortic arch pathologies, but TAR is associated with lower risk of
late aortic reinterventions over time. Although older patients may benefit
more from debranching plus TEVAR rather than from TAR, patients with
dissections may benefit more from TAR. Clinical Impact: Although the 2
strategies seem to be equally valuable in terms of survival, total aortic
arch replacement (when compared with debranching plus TEVAR to treat
patients with aortic arch pathologies) is associated with reduction of
late aortic reinterventions over time in patients with and without aortic
dissections. However, we should consider debranching plus TEVAR in older
patients as it is associated with lower risk of death in this population.
The novelty of our study lies in the fact that, instead of comparing
study-level effect estimates, we analyzed the outcomes with reconstructed
time-to-event data. This offered us the opportunity of performing our
analyses with a mathematically appropriate model which consider events and
time; however, these findings might be under the influence of treatment
allocation bias. Copyright © The Author(s) 2024

<25>
Accession Number
2041658013
Title
Effects of intraoperative higher versus lower positive end-expiratory
pressure during one-lung ventilation for thoracic surgery on postoperative
pulmonary complications (PROTHOR): a multicentre, international,
randomised, controlled, phase 3 trial.
Source
The Lancet Respiratory Medicine. 14(1) (pp 17-28), 2026. Date of
Publication: 01 Jan 2026.
Author
Cohen E.; El Tahan M.R.; Gregoretti C.; Hachenberg T.; Nandor M.;
Nisnevitch-Savarese Z.; Rossaint R.; Severgnini P.; Szegedi L.L.; Tamas
V.; Vazquez de Anda G.F.; Waheedullah K.; Schultz M.J.; Serpa Neto A.;
Abbenhuis J.; Abdulmomen A.; Abdyli A.; Abu Elyazed M.M.; Aguirre Puig P.;
Akbudak I.H.; Aksu C.; Alagoz A.; Alhamdi M.; Almadhati S.; Altorki N.K.;
Aragon Alvarez S.; Arun O.; Azizoglu M.; Baar W.; Balde D.; Balla B.;
Balli Seker M.; Basheer M.; Bauer W.O.; Bence J.; Bernardi M.H.; Bigatello
L.M.; Bignami E.; Bluth T.; Bonney I.; Bouhemad B.; Bradic N.; Brescianini
L.; Bruthans J.; Bulte C.S.E.; Cadar G.; Cakmak G.; Cali P.; Cantatore
L.P.; Chai X.; Chang Y.-T.; Chen J.; Christofaki M.; Cinnella G.; Coelho
Sanches L.; Constantin A.; Contreras V.; Corsi L.; da Silva E.; Defosse
J.; Deluca R.; Diaper J.; Didden L.; Dimitriou E.; do Nascimento Junior
P.; Domi R.; Dorfinger L.; dos Reis Falcao L.F.; Douradinho C.; Drnovsek
Globokar M.; Duran F.M.; Eldawlatly A.; El-Gendy H.M.; Elmazny M.I.;
Elsherif S.-E.I.; Emara M.M.; Enriquez de los Santos S.T.; Farnell-Ward
S.; Ferrufino R.; Gama de Abreu M.; Gao L.; Geyik D.; Gnezda D.; Goeden
S.; Gorjup K.; Granell Gil M.; Guido Guerra R.E.; Guimaraes de Castro
Pereira M.; Guinot P.-G.; Guven A.; Hager H.; Han L.; Hatipoglu Z.;
Hayashi M.; Hell J.; Hofland J.; Hollmann M.W.; Hu J.; Hudacek K.; Huti
G.; Ilic M.; Jankovic R.J.; Jegarl A.; Jimenez Andujar M.-J.; Jin D.;
Kammerer T.; Karadza V.; Kawagoe I.; Kiran Paudel S.I.; Kiss T.; Koch T.;
Kolaric N.; Koning N.J.; Kostopanagiotou K.; Kostroglou A.; Kovac P.;
Kramer T.; Krassler J.; Kreft T.; Kumrular Y.; Kuut M.; Lan L.; Li P.-C.;
Li X.-F.; Li L.-T.; Licker M.; Liu Y.; Longo F.; Loop T.; Lopez-Baamonde
M.; Luise S.; Luo W.; Lv H.; Macias Jimenez M.D.L.A.; Magalhaes D.D.;
Martuscelli M.; Mavko A.; Meco B.C.; Mermer H.A.; Miao C.; Michalek P.;
Mills G.H.; Minana Aragon E.; Mirabella L.; Molyneux M.; Montrano L.;
Mosqueira L.; Mourisse J.; Murrell M.T.; Navarro-Ripoll R.; Negru F.;
Neskovic V.; Nikolic M.; Norberto de la Vega J.A.; Noto A.; Nyktari V.;
Orhan Sungur M.; Ozdemir L.; Ozolina A.; Ozturk T.; Pace M.C.; Pagnussatt
Neto E.; Paloczi B.; Papaioannou A.; Papamichail K.; Patroniti N.; Pektas
Y.; Pereira Matalobos D.; Persec J.; Petrovic S.; Pirc D.; Plismanis G.;
Prata Amendola C.; Prazetina M.; Radovic N.; Rauseo M.; Richter T.; Rivera
Vallejo L.; Rodriguez Ruiz J.J.; Rondovic G.; Rosser J.; Sanchez Garcia
F.J.; Sansone P.; Saracoglu A.; Saracoglu K.T.; Sazak H.; Scharffenberg
M.; Schiavoni L.; Schilling T.; Sediq A.; Semmelmann A.; Senturk N.M.;
Sertac Bingul E.; Sertcakacilar G.; Sfika E.; Shelley B.; Shin S.H.;
Sidiropoulou T.; Silva-Jr J.M.; Socci L.; Socorro T.; Soulioti E.; Spadaro
S.; Spicek-Macan J.; Spray D.; Stamenkovic D.; Stefanakis G.; Stoica R.;
Stojanovic M.; Stopora P.; Sungur Z.; Svareniece-Karjaka E.; Szamos K.;
Tanase N.-V.; Tanriverdi C.; Tempel F.; Terwindt L.E.; Theilen R.; Tipura
D.; Tire Y.; Tomaselli E.; Tsuguie Onari N.; Tunc M.; Turhan O.; Turktan
M.; Ugliola D.; Ulugol H.; Vegh T.; Vetrugno L.; Vitali C.; Volta C.A.;
von Dossow V.; Voyagis G.; Vukovic R.; Vukovic A.Z.; Waeschle R.M.; Wall
D.; Wang H.; Wang D.; Winroth D.; Wittenstein J.; Wu Q.; Xu P.; Yaldir O.;
Yamansavci Sirzai E.; Yang X.; Yapici D.; Yildirim O.; Yildirim Guclu C.;
Yu H.; Yuksel Tanriverdi S.; Zarbock A.; Zeba S.; Zhang Y.; Zhang X.;
Zhang Z.; Zhang J.; Zhang G.-W.; Zhong J.; Ziemann S.
Institution
(Wittenstein, Kiss, Gama de Abreu) Department of Anesthesiology and
Intensive Care Medicine, Pulmonary Engineering Group, Faculty of Medicine
and University Hospital Carl Gustav Carus, Dresden University of
Technology, Dresden, Germany
(Senturk) Department of Anesthesiology, Istanbul Medical Faculty, Istanbul
University, Istanbul, Turkey
(Senturk) Department of Anesthesiology and Reanimation, School of
Medicine, Acibadem University, Istanbul, Turkey
(Kiss) Department of Anesthesiology, Intensive-,Pain- and Palliative Care
Medicine, Radebeul Hospital, Academic hospital of the Technische
Universitat Dresden, Germany
(Schultz) Department of Intensive Care, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Serpa Neto) Department of Intensive Care, Austin Hospital, Melbourne,
VIC, Australia
(Serpa Neto) Department of Critical Care, Melbourne Medical School,
University of Melbourne, Austin Hospital, Melbourne, VIC, Australia
(Serpa Neto) Department of Critical Care Medicine, Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Gama de Abreu) Division of Intensive Care and Resuscitation, Department
of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic,
Cleveland, OH, United States
(Gama de Abreu) Outcomes Research Consortium, Department of
Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Elsevier Ltd
Abstract
Background: The effect of higher positive end-expiratory pressure (PEEP)
and recruitment manoeuvres aimed at lung expansion as compared with lower
PEEP without recruitment manoeuvres aimed at permissive atelectasis on
postoperative pulmonary complications (PPCs) in patients undergoing
one-lung ventilation (OLV) during thoracic surgery is unclear. We aimed to
determine the contribution of an intraoperative lung expansion strategy to
preventing PPCs. Method(s): In this multicentre, randomised,
controlled, international phase 3 trial (PROTHOR) conducted at 74 sites in
28 countries, we enrolled adult patients (aged >=18 years) with a BMI of
less than 35 kg/m2 who were scheduled for open thoracic or
video-assisted thoracoscopic surgery under general anaesthesia requiring
one-lung ventilation with a double-lumen tube, with a planned operative
time of more than 60 min, and an expected duration of one-lung ventilation
longer than that of two-lung ventilation. Patients were randomly assigned
(1:1), using permuted blocks of random size (4, 6, and 8) and stratified
by study site, to receive one-lung ventilation with either a higher PEEP
of 10 cm H<inf>2</inf>O and periodic lung recruitment manoeuvres (high
PEEP group) or a lower PEEP of 5 cm H<inf>2</inf>O without routine
recruitment manoeuvres (low PEEP group). All patients received protective
tidal volumes of 5 mL/kg predicted body weight during one-lung ventilation
and 7 mL/kg predicted body weight during two-lung ventilation.
Postoperative assessors were masked to treatment allocation. The primary
outcome was a composite of PPCs during the first 5 postoperative days,
including aspiration pneumonia, moderate or severe respiratory failure,
acute respiratory distress syndrome (ARDS), pulmonary infection,
atelectasis, cardiopulmonary oedema, pleural effusion, non-operative
pneumothorax, pulmonary infiltrates, prolonged air leak, purulent
pleuritis, pulmonary embolism, and pulmonary haemorrhage. A modified
intention-to-treat analysis was performed, with patients analysed
according to their assigned treatment group, except in cases of withdrawal
of informed consent, cancellation of surgery, and or loss to follow-up.
This trial is registered with ClinicalTrials.gov (NCT02963025) and is
completed. Finding(s): Between Jan 3, 2017, and Feb 12, 2024, 2200
patients were randomly allocated: 1099 to the high PEEP group and 1101 to
the low PEEP group. 43 patients in the high PEEP group and 33 in the low
PEEP group were excluded from the modified intention-to-treat analysis
after randomisation. The primary outcome occurred in 555 (53.6%) of 1036
patients in the high PEEP group and 592 (56.4%) of 1049 patients in the
low PEEP group (absolute risk difference -2.68 percentage points [95% CI
-6.36 to 1.01]; p=0.155). Intraoperative complications occurred in 484
(49.8%) of 972 patients in the high PEEP group and in 305 (31.3%) of 974
patients in the low PEEP group (absolute risk difference 18.09 percentage
points [95% CI 14.41-21.77]), among which hypotension (360 [37.3%] of 966
patients in the high PEEP group vs 140 [14.3%] of 978 in the low PEEP
group) and new arrhythmias (89 [9.9%] of 899 vs 37 [3.9%] of 956) were
more frequent in the high PEEP group, while hypoxaemia rescue manoeuvres
were more frequent in the low PEEP group (29 [3.3%] of 888 vs 86 [8.8%] of
982). The proportions of patients with extrapulmonary postoperative
complications (110 [10.6%] of 1036 vs 107 [10.2%] of 1049 patients), and
the numbers of adverse events (209 vs 204 events), did not differ between
groups. Interpretation(s): In patients with a BMI of less than 35
kg/m2 undergoing thoracic surgery, one-lung ventilation using
higher PEEP with recruitment manoeuvres, compared with lower PEEP without
recruitment manoeuvres, did not reduce PPCs. The choice for intraoperative
lung expansion or permissive atelectasis should take the individual
gas-exchange and haemodynamic conditions into account, which might vary
during the intraoperative period. Funding(s): Clinical Trials Network
of the European Society of Anaesthesiology and Intensive Care; Department
of Anaesthesiology and Intensive Care, University Hospital Carl Gustav
Carus, Technische Universitat Dresden (Dresden, Germany); Conselho
Nacional de Desenvolvimento Cientifico e Tecnologico (Brasilia, Brazil);
and the Association of Anaesthetists of GB and Ireland. Copyright
© 2025 Elsevier Ltd

<26>
Accession Number
2042515087
Title
Comparative efficacy of chest wall fascial plane blocks for cardiac
surgery via median sternotomy: a network meta-analysis.
Source
BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 25. Date
of Publication: 01 Dec 2026.
Author
Bu Y.; Savir S.; Saeed S.; Sharkey A.; Robitaille M.; Mahmood F.; Matyal
R.; Khabbaz K.
Institution
(Bu, Savir, Saeed, Sharkey, Robitaille, Mahmood, Matyal) Department of
Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States
(Khabbaz) Department of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, 1 Deaconess Rd, West Campus, Boston, MA,
United States
Publisher
BioMed Central Ltd
Abstract
Background: To quantitatively evaluate and compare the relative efficacy
of different chest wall fascial plane blocks in cardiac surgery via median
sternotomy. Method(s): This study was conducted according to the
Preferred Reporting Items for Systematic Review and Meta-Analyses for
Network Meta-Analyses (PRISMA-NMA) utilizing a frequentist network
meta-analysis (NMA) method. Conclusions were drawn using a minimally
contextualized framework of the GRADE (Grading of Recommendations
Assessment, Development and Evaluation) approach. Result(s):
Twenty-four randomized controlled trials were retrieved from four
databases. A total of 1366 adult patients were included, of whom 789
(57.8%) received one of five chest wall fascial plane block modalities.
The primary outcome was 24-hour postoperative opioid consumption
(converted as intravenous morphine in mg, n = 1159). With moderate
confidence, erector spinae plane block (ESPB) plus patient-controlled
analgesia (PCA) was more efficacious in reducing 24-hour postoperative
intravenous morphine than PCA alone (Rank based on SUCRA = 1). Secondary
outcomes included postoperative mechanical ventilation time and pain
assessment scores (0, 12, and 24 h after extubation) with 1186, 664, 1054,
and 958 patients analyzed, respectively. Network meta-regression results
across primary or secondary outcomes suggested that local anesthetic type
and volume, injection timing, and a continuous block feature may
contribute to the relative efficacy of chest wall fascial plane blocks.
 Conclusion(s): ESPB plus PCA was found to be more efficacious in
decreasing postoperative opioid requirements for adults undergoing cardiac
surgery via median sternotomy, with moderate confidence in the current
evidence. Modifying the current fascial plane block protocols may be the
direction of future clinical studies. Trial registration: PROSPERO
identifier CRD42022345047. Copyright © The Author(s) 2025.

<27>
Accession Number
2042297298
Title
1-Year Outcomes of Novel Balloon-Expandable vs Contemporary Transcatheter
Heart Valves in Severe Aortic Stenosis: The LANDMARK Trial.
Source
Journal of the American College of Cardiology. 87(4) (pp 362-381), 2026.
Date of Publication: 03 Feb 2026.
Author
Serruys P.W.; Tobe A.; van Royen N.; Amat-Santos I.J.; Hudec M.; Bunc M.;
Van den Branden B.J.L.; Laanmets P.; Unic D.; Merkely B.; Hermanides R.S.;
Ninios V.; Protasiewicz M.; Rensing B.J.W.M.; Martin P.L.; Feres F.; De
Sousa Almeida M.; van Belle E.; Linke A.; Ielasi A.; Montorfano M.;
Webster M.; Toutouzas K.; Teiger E.; Bedogni F.; Voskuil M.; Pan M.;
Angeras O.; Kim W.-K.; Rothe J.; Abdel-Wahab M.; Kristic I.; Peral V.;
Garg S.; Tsai T.-Y.; Thakkar A.; Chandra U.; Smits P.C.; Morice M.-C.;
Onuma Y.; Kraaijeveld A.O.; Oliveira A.; Cervone A.; Cosenza A.; Nagy A.;
Ioannidis A.; Marvaki A.; Kisiczki A.; Ferencz A.B.; Ansari A.; Belini B.;
Baladron C.; Delhaye C.; Valina C.; Vella C.; Czimbalmos C.; Sjoholm D.;
Pellegrini D.; Siqueira D.; van Ginkel D.J.; Westermann D.; Mesa D.; Della
Togna D.; Chen E.; Unic E.; Nedjat F.D.R.; Woitek F.; Russo F.; Vincent
F.; Ereliadou F.; Pontana F.; Versteeg G.; Papadopoulos G.; Gallo I.;
Rudez I.; Ninios I.; Hadzibegovic I.; Jurin I.; Ambrozic J.; Hommel J.;
Vos J.; Novoa Medina J.M.; Brito J.; ten Berg J.M.; Franke K.; Timmers L.;
Koliastasis L.; Molnar L.; Ohe L.N.; Ferri L.A.; Testa L.; Liptak L.;
Vitez L.; Boukantar M.; Fish M.; Belo Costa M.; Ancona M.B.; Drakopoulou
M.; Pellicano M.; Garcia-Gomez M.; Meuwissen M.; Czerny M.; Renker M.;
Tespili M.; van Gameren M.; Dickinson M.G.; Kosowski M.; Uelskaja M.;
Sustersic M.; Ferenc M.; Bechiri M.; Mouden M.; Bercar M.; Zeleznikova M.;
AlChay M.; Mokhles M.M.; Barbe M.; Scientist B.; Diab N.; Brambilla N.;
Bharti N.; Stens N.; Pavlovic N.; Ktenopoulos N.; Loffelhardt N.; Mangner
N.; Katsaros O.; Allahyari P.; Poliacikova P.; Ennezat P.-V.; van der
Harst P.; Kubler P.; Gallet R.; Holc P.; Petursson P.; Prasad R.; Leonora
R.; Papp R.; Teles R.C.; Bramer S.; Joshi S.; Gjorgjievska S.; Bakhtari
S.; Manola S.; Porouchani S.; Andreen S.; Campillo S.; Ojeda S.; Evangelou
S.; Haussig S.; Jaiswal S.; Delamain T.R.B.; Rodriguez Gabella T.; Pamart
T.; Dessing T.C.; Denimal T.; Sipic T.; Quevedo Nelson V.; Bhatt V.;
Balmette V.; Postma W.; Patil Y.; Baumbach A.
Institution
(Serruys, Tobe, Tsai, Onuma) Department of Cardiology, School of Medicine,
University of Galway, Galway, Ireland
(van Royen) Department of Cardiology, Radboud University Hospital,
Nijmegen, Netherlands
(Amat-Santos) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
(Amat-Santos) Department of Cardiology, Hospital Clinico Universitario de
Valladolid, Valladolid, Spain
(Hudec) Department of Acute Cardiology, Middle-Slovak Institute of
Cardiovascular Diseases, Banska Bystrica, Slovakia
(Bunc) Department of Cardiology, University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Van den Branden) Department of Cardiology, Amphia Hospital, Breda,
Netherlands
(Laanmets) Department of Invasive Cardiology, North Estonia Medical
Centre, Tallinn, Estonia
(Unic) Department of Cardiac and Transplant Surgery, University Hospital
Dubrava, Zagreb, Croatia
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Hermanides) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Ninios) Department of Cardiology, European Interbalkan Medical Center,
Thessaloniki, Greece
(Protasiewicz) Department of Cardiology, Institute of Heart Diseases,
Wroclaw Medical University, Wroclaw, Poland
(Rensing) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Martin) Department of Interventional Cardiology, University Hospital of
Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
(Feres) Department of Invasive Cardiology, Instituto Dante Pazzanese, Sao
Paulo, Brazil
(De Sousa Almeida) CHRC, NOVA Medical School, NOVA University Lisbon,
Lisbon, Portugal
(van Belle) Department of Interventional Cardiology, Lille University,
Lille, France
(Linke) Department of Internal Medicine and Cardiology, University Clinic,
Heart Center Dresden, University of Technology Dresden, Dresden, Germany
(Ielasi) Department of Interventional Cardiology, IRCCS Ospedale Galeazzi
Sant'Ambrogio, Milan, Italy
(Montorfano) School of Medicine, Vita-Salute San Raffaele University,
Milan, Italy
(Montorfano) Interventional Cardiology Unit, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Webster) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Toutouzas) Department of Cardiology, Hippokration Hospital, Athens,
Greece
(Teiger) Department of Interventional Cardiology, Henri Mondor University
Hospital, Creteil, France
(Bedogni) Department of Clinical Cardiology, San Donato Hospital, Milan,
Italy
(Voskuil) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Pan) Department of Cardiology, University Hospital Reina Sofia,
University of Cordoba, IMIBIC, Centro de Investigacion Biomedica en Red de
Enfermedades Cardiovasculares, Cordoba, Spain
(Angeras) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Angeras) Department of Molecular and Clinical Medicine, Institute of
Medicine, University of Gothenburg, Gothenburg, Sweden
(Kim) Department of Cardiology and Angiology, University of Giessen and
Marburg, Giesen, Germany
(Kim) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Rothe) Department of Cardiology and Angiology, Campus Bad Krozingen,
University Heart Center-University of Freiburg, Bad Krozingen, Germany
(Rothe) Faculty of Medicine, University of Freiburg, Freiburg, Germany
(Abdel-Wahab) Department of Structural Heart Disease/Cardiology, Heart
Center Leipzig at Leipzig University, Leipzig, Germany
(Kristic) Department of Cardiology, University Hospital of Split, Split,
Croatia
(Peral) Department of Cardiology University Hospital Son Espases, Health
Research Institute of the Balearic Islands, Palma de Mallorca, Spain
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Garg) School of Medicine, University of Central Lancashire, Preston,
United Kingdom
(Thakkar, Chandra) Department of Clinical Research, Meril Life Sciences
Pvt Ltd, Vapi, India
(Smits, Morice) Cardiovascular European Research Center, Massy, France
(Morice) Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques
Cartier, Massy, France
(Baumbach) Centre for Cardiovascular Medicine and Devices, William Harvey
Research Institute, Queen Mary University of London and Barts Heart
Centre, London, United Kingdom
(Baumbach) Cleveland Clinic, London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: In the LANDMARK trial, the Myval balloon-expandable
transcatheter heart valve (THV) series was noninferior to the most
commonly used contemporary SAPIEN and Evolut Series THVs for the 30-day
early safety endpoint in participants with symptomatic severe native
aortic stenosis. Objective(s): The current report from the LANDMARK
trial describes clinical outcomes, hemodynamic performances, and quality
of life at 1 year. Method(s): This open-label, noninferiority trial
enrolled 768 participants across 31 hospitals in Europe, New Zealand, and
Brazil. Participants were randomly assigned (1:1) to receive either a
Myval THV series or a contemporary THV (SAPIEN or Evolut series). The
composite endpoint at 1 year included all-cause mortality, all strokes,
and procedure- or valve-related hospitalizations. Clinical efficacy was
defined as freedom from the composite endpoint. As recommended in Valve
Academic Research Consortium-3, the previous composite endpoint combined
with the assessment of quality of life at baseline and 1 year with the
12-Item Short Form Health Survey was reported as an extended composite
endpoint. The noninferiority hypothesis was prespecified for the
assessment of the primary endpoint at 30 days. Considering the specific
1-year composite endpoints of Valve Academic Research Consortium-3 and the
event rate of 27.23% derived from recent studies, an a posteriori
descriptive and exploratory noninferiority hypothesis was introduced with
a noninferiority margin of 10.89%. The analysis was performed in the
intention-to-treat population. Result(s): The mean age was 80 years,
48% were women, and the median Society of Thoracic Surgeons Predicted Risk
of Mortality score was 2.6%. There was no significant difference in the
Kaplan-Meier estimates of freedom from the composite endpoint at 365 days
(Myval THV 87.0% vs contemporary THVs 86.9%). The Myval THV series was
noninferior to the contemporary THVs for the composite endpoint
(difference: -0.1%; 1-sided 95% CI: 3.9%; P<inf>noninferiority</inf> <
0.0001). Similarly, there were no significant differences in freedom from
the extended composite endpoint (80.5% vs 77.3%; difference: 3.2%; 95% CI:
-2.9% to 9.2%; P = 0.33). Conclusion(s): In the treatment of
symptomatic severe native aortic stenosis, the clinical and hemodynamic
outcomes of the Myval THV series were comparable to those of contemporary
THVs for the 1-year composite of all-cause mortality, all strokes, or
procedure- or valve-related hospitalizations. (LANDMARK Trial: a
Randomised Controlled Trial of Myval THV [LANDMARK];
NCT04275726) Copyright © 2026 The Authors

<28>
Accession Number
2042069577
Title
Left Atrial Appendage Closure Versus Oral Anticoagulants in Atrial
Fibrillation: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiovascular Development and Disease. 12(12) (no pagination),
2025. Article Number: 483. Date of Publication: 01 Dec 2025.
Author
Wang C.; Zhu D.; Nan J.; Zhang D.
Institution
(Wang, Zhu, Nan, Zhang) Department of Cardiology, The Second Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou, China
(Wang, Zhu, Nan, Zhang) State Key Laboratory of Transvascular Implantation
Devices, Hangzhou, China
(Wang, Zhu, Nan, Zhang) Heart Regeneration and Repair Key Laboratory of
Zhejiang Province, Hangzhou, China
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Left atrial appendage (LAA) closure is an alternative to oral
anticoagulants (OAC) for stroke prevention in atrial fibrillation (AF),
but comparative evidence remains inconsistent. This study systematically
evaluates the efficacy and safety of LAA closure versus OAC in AF
patients. Method(s): We systematically searched PubMed, EmBase,
Cochrane Library, and Web of Science for randomized controlled trials
(RCTs) and propensity score-matched (PSM) studies published up to 30
September 2025. Treatment effects were estimated using relative risks (RR)
with 95% confidence intervals (CI), and a random-effects model was applied
for all analyses. Result(s): Fifteen studies (17,116 AF patients)
were included, comprising 4 RCTs, 3 prospective PSM studies, and 8
retrospective PSM studies. Compared with OAC, LAA closure significantly
reduced the composite endpoint (RR: 0.79; 95% CI: 0.66-0.95; p = 0.010),
all-cause mortality (RR: 0.58; 95% CI: 0.49-0.69; p < 0.001), and
cardiovascular mortality (RR: 0.55; 95% CI: 0.44-0.67; p < 0.001). Risks
of any stroke (RR: 1.06; 95% CI: 0.86-1.31; p = 0.555), ischemic stroke
(RR: 1.00; 95% CI: 0.85-1.17; p = 0.972), hemorrhagic stroke (RR: 0.96;
95% CI: 0.54-1.70; p = 0.879), and major bleeding (RR: 0.84; 95% CI:
0.67-1.04; p = 0.112) were not significantly different between groups.
 Conclusion(s): In AF patients, LAA closure significantly reduces
mortality and a composite clinical endpoint compared to OAC, with similar
risks of stroke and major bleeding. It is a favorable alternative for
patients unsuitable for long-term anticoagulation. Copyright ©
2025 by the authors.

<29>
Accession Number
2042575431
Title
Levosimendan vs. Milrinone in cardiac surgery: A GRADE-assessed systematic
review and meta-analysis.
Source
European Journal of Clinical Pharmacology. 82(2) (no pagination), 2026.
Article Number: 34. Date of Publication: 01 Feb 2026.
Author
Emara A.; Ellebedy M.; Aboeldahab H.; Nazir A.; Elgendy M.S.; Hassan A.M.;
Barakat Y.; Saad O.A.; Elawady A.; Elnady M.; Abdelaziz A.
Institution
(Emara, Barakat, Saad, Elawady) Faculty of Medicine, Al-Azhar University,
Cairo, Egypt
(Ellebedy) Faculty of Medicine, Sohag University, Sohag, Egypt
(Aboeldahab) Clinical Research Department, El-Gomhoria General Hospital,
Ministry of Health and Population, Alexandria, Egypt
(Nazir) Department of Internal Medicine, Mercy Health- The Jewish
hospital, Cincinnati, OH, United States
(Nazir) Faculty of Medicine, King Edward Medical University, Lahore,
Pakistan
(Elgendy, Hassan) Faculty of Medicine, Tanta University, Tanta, Egypt
(Elnady) Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh,
Egypt
(Abdelaziz) Division of Cardiology, Montefiore Medical Center/Albert
Einstein College of Medicine, Bronx, NY, United States
(Aboeldahab, Hassan, Barakat, Saad, Elawady, Elnady, Abdelaziz) Medical
Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, United
States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Levosimendan and Milrinone are commonly used inotropic agents
in patients undergoing cardiac surgery; there is a lack of evidence
regarding the comparative safety and efficacy of both drugs. We aim to
compare the clinical efficacy and safety of levosimendan versus Milrinone
in these patients. Method(s): We conducted a systematic review and
meta-analysis following PRISMA guidelines. PubMed, Scopus, Web of Science,
and Cochrane Central were searched up to November 30, 2024, for studies
comparing levosimendan and Milrinone in adult and pediatric cardiac
surgery patients. We used R statistical software to pool dichotomous data
using odds ratio (OR) and continuous data using mean difference (MD) with
a 95% confidence interval (CI). Result(s): Seventeen studies (15 RCTs
and 2 observational) involving 890 patients were included. Across all
efficacy outcomes, including cardiac index (MD 0.02, 95% CI -0.15-0.19),
mean arterial pressure (MAP) (MD -0.09, 95% CI -1.97-1.79), and mPAP (mean
pulmonary artery pressure) (MD -0.88, 95% CI -2.66, 0.89), no significant
differences were found between the two drugs (P > 0.05). Safety outcomes,
including all-cause mortality (OR 0.97, 95% CI 0.48-1.93), acute kidney
injury (OR 0.89, 95% CI 0.55-1.44), and arrhythmias (OR 0.87, 95% CI
0.41-1.88), showed no statistically significant differences (P > 0.05).
 Conclusion(s): Levosimendan and Milrinone showed no significant
differences in efficacy or safety in cardiac surgery patients. However,
wide confidence intervals indicate potential clinically relevant effects.
Current evidence does not favor any single agent universally, supporting
individualized use based on patient phenotype and institutional practice.
Further high-quality trials are needed to confirm. Copyright ©
The Author(s), under exclusive licence to Springer-Verlag GmbH Germany,
part of Springer Nature 2026.

<30>
Accession Number
2041676948
Title
Stroke Mechanism and Severity After Left Atrial Appendage Occlusion
Insights From the LAAOS III Randomized Clinical Trial.
Source
JAMA Neurology. (no pagination), 2025. Date of Publication: 2025.
Author
Katsanos A.H.; Whitlock R.P.; Belley-Cote E.P.; Brady K.; Wang A.;
Srivastava A.; Jacquin G.; Weiss V.; Volny O.; Sramek M.; Peeters A.;
Marto J.P.; Wrona P.; Tsolaki A.; Li L.; Nucera A.; Mikulik R.; Perera K.;
Catanese L.; Shoamanesh A.; Sharma M.
Institution
(Katsanos, Whitlock, Belley-Cote, Brady, Wang, Perera, Catanese,
Shoamanesh, Sharma) Population Health Research Institute, Hamilton Health
Sciences, Hamilton, ON, Canada
(Katsanos, Srivastava, Perera, Catanese, Shoamanesh, Sharma) Division of
Neurology, Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Whitlock) Division of Cardiac Surgery, Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Belley-Cote) Divisions of Cardiology and Critical Care, Department of
Medicine, McMaster University, Hamilton, ON, Canada
(Jacquin) Universite de Montreal, Faculte de Medecine, Departement de
Neurosciences, Montreal, QC, Canada
(Weiss, Mikulik) Department of Neurology, St. Anne's University Hospital,
Masaryk University, Brno, Czechia
(Weiss, Mikulik) Department of Neurology, Tomas Bata Hospital, Zlin,
Czechia
(Volny) University of Ostrava Faculty of Medicine, Department of Clinical
Neurosciences, Ostrava, Czechia
(Sramek) Department of Neurology, Military University Hospital Prague,
Prague, Czechia
(Peeters) Department of Neurology, Cliniques Universitaires Saint Luc,
UCLouvain, Brussels, Belgium
(Marto) Department of Neurology, Centro Hospitalar Lisboa Ocidental,
Lisbon, Portugal
(Wrona) Department of Neurology, Jagiellonian University Medical College,
Krakow, Poland
(Tsolaki) First Department of Neurology, Medical School, Faculty of Health
Sciences, Aristotle University of Thessaloniki, Macedonia, Greece
(Li) Wolfson Centre for Prevention of Stroke and Dementia, Nuffield
Department of Clinical Neurosciences, Oxford University, United Kingdom
(Nucera) Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy
Publisher
American Medical Association
Abstract
IMPORTANCE In the Left Atrial Appendage Occlusion Study III (LAAOS III),
surgical occlusion of the LAA during cardiac surgery for patients with
known history of atrial fibrillation (AF) substantially reduced the risk
of stroke. OBJECTIVE To assess the impact of LAAO on ischemic stroke
subtype and outcome. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc
exploratory analysis of the LAAOS III randomized clinical trial. Data were
adjudicated from June 28, 2023, to November 29, 2023, and the main
analyses took place from December 18, 2023, to April 29, 2024. The LAAOS
III trial recruited participants from 105 centers in 27 countries between
July 2012 and October 2018. Patients with AF and a
CHA<inf>2</inf>DS<inf>2</inf>-VASc score of at least 2 undergoing cardiac
surgery for other indications were included in the analysis. INTERVENTIONS
Surgical LAAO plus standard care vs standard care alone. MAIN OUTCOMES AND
MEASURES For strokes occurring during the trial, the functional outcome as
measured by the modified Rankin Scale (mRS) score at day 7 or discharge,
mortality, the presence of cortical infarcts, and the occurrence of
infarcts of presumed cardioembolic origin were examined. RESULTS Of 4811
participants in the LAAOS III trial followed up for 3.8 years, 273 had a
first ischemic stroke. The mean (SD) age of participants at the time of
the first ischemic stroke was 75 (7) years, 104 were female (38%), and 169
were male (62%). Participants allocated to receive LAAO had reduced
(common odds ratio [OR], 0.80; 95% CI, 0.65-0.99) mRS scores at 7 days or
discharge and a lower risk for mortality at 30 days (16.5% vs 20.1%;
hazard ratio [HR], 0.55; 95% CI, 0.31-0.97) after a stroke event.
Participants allocated to LAAO had fewer cortical infarcts on neuroimaging
(46.2% vs 61.3%; difference in proportions: -15.2%; 95% CI, -26.7% to
-3.7%), as well as a lower proportion of ischemic strokes of presumed
cardioembolic etiology when compared with ischemic strokes in the no-LAAO
group (42.9% vs 57.9%; difference in proportions: -15.1%; 95% CI, -26.5%
to -3.7%). CONCLUSIONS AND RELEVANCE This study found that LAAO in
patients with AF undergoing cardiac surgery was associated with a
decreased risk of presumed cardioembolic stroke, reduced disability, and
mortality from stroke. These findings underscore the benefit of LAAO for
patients with AF undergoing cardiac surgery. Copyright © 2026
Katsanos AH et al.

<31>
Accession Number
2042502909
Title
Multimodal diagnostic imaging for early mitral valve disease: integration
of current and emerging modalities-a narrative review.
Source
Cardiovascular Diagnosis and Therapy. 15(6) (pp 1212-1226), 2025. Date of
Publication: 31 Dec 2025.
Author
AlRahimi J.S.
Institution
(AlRahimi) Department of Cardiology, King Abdulaziz Medical City, Ministry
of National Guard Health Affairs, King Abdullah International Medical
Research Center, College of Medicine, King Saud bin Abdulaziz University
for Health Sciences, Jeddah, Saudi Arabia
Publisher
AME Publishing Company
Abstract
Background and Objective: Mitral valve disease (MVD) is a major
contributor to global cardiovascular morbidity and mortality. Early
identification is critical to prevent progression to heart failure, atrial
fibrillation, and irreversible myocardial remodeling. Existing reviews
have largely focused on advanced MVD, individual imaging modalities, or
guideline summaries, with limited emphasis on early, asymptomatic disease,
quantitative diagnostic thresholds, comparative multimodal imaging, and
recent innovations. This narrative review uniquely synthesizes evidence
published between 2020 and 2025 to provide an updated, modality-integrated
overview of early-stage MVD, emphasizing emerging technologies, global
accessibility considerations, and a practical multimodal diagnostic
framework. Method(s): A comprehensive literature search was conducted
using PubMed, Scopus, and Google Scholar from January 2020 to August 2025.
Original studies, meta-analyses, high-quality narrative or
state-of-the-art reviews, and consensus statements addressing early
diagnosis of MVD were included. Non-English publications, case reports,
and studies focusing exclusively on advanced disease were excluded. Study
selection and data extraction were performed by the author, and
alternative available versions were retrieved when full texts were
unavailable. Key Content and Findings: Echocardiography remains the
cornerstone of early MVD assessment due to its accessibility, dynamic
evaluation capabilities, and cost-effectiveness. Cardiac magnetic
resonance (CMR) offers high precision for quantifying regurgitant volume,
myocardial fibrosis, and early remodeling. Computed tomography (CT)
provides superior spatial resolution for anatomical assessment and
preprocedural planning, while positron emission tomography (PET)
contributes metabolic and inflammatory insights, especially in prosthetic
valve disease. Emerging innovations, such as artificial intelligence (AI),
machine learning (ML), fusion imaging, and four-dimensional (4D) flow CMR,
enhance diagnostic precision and prognostication. In resource-limited
settings, strategies including tele-echocardiography, portable ultrasound,
and global training initiatives are improving accessibility. Integration
of imaging with clinical, functional, and patient-reported outcomes
promotes a holistic, patient-centered approach. Conclusion(s):
Advances in multimodal cardiovascular imaging are transforming early MVD
detection and management. A patient-centered, AI-enhanced imaging
strategy, incorporating echocardiography, CMR, CT, and PET, can
significantly improve diagnostic accuracy, optimize intervention timing,
and enhance long-term outcomes. Broader implementation of telemedicine,
standardized training, and cost-effective imaging technologies will be
essential for equitable global adoption. Copyright © AME
Publishing Company.

<32>
Accession Number
2042517224
Title
Is the superior septal approach a safe alternative to conventional left
atriotomy for mitral valve surgery? Evidence from a systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number:
29. Date of Publication: 01 Dec 2026.
Author
Maali A.; Hausmann H.; Flieger R.; Moawad M.H.E.D.; Ismail M.; Elettreby
A.M.; Abdul-Hafez H.A.; Bisht O.
Institution
(Maali, Hausmann, Flieger, Ismail, Bisht) Evangelisches Herzzentrum
Coswig, Lerchefeld 1, Coswig, Germany
(Moawad) Alexandria Main University Hospital, Alexandria, Egypt
(Moawad) Faculty of Medicine, Suez Canal University, Ismailia, Egypt
(Elettreby) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Abdul-Hafez) Department of Medicine, Faculty of Medicine and Health
Sciences, An-Najah National University, Nablus, Palestine
Publisher
BioMed Central Ltd
Abstract
Background: The superior septal approach (SSA) was developed to improve
mitral valve exposure during surgery, particularly in patients with
complex anatomy. However, concerns regarding prolonged operative times and
rhythm disturbances have limited its widespread adoption. This systematic
review and meta-analysis aimed to compare SSA with conventional left
atriotomy (CLA) in terms of perioperative outcomes, complications, rhythm
disturbances, and mortality. Method(s): A systematic search of
PubMed, Scopus, and Web of Science was performed up to August 2025
according to PRISMA guidelines. Outcomes assessed included postoperative
cardiac rhythm outcomes (primary outcomes), perioperative metrics
(secondary outcomes) -including pacemaker implantation, cardiopulmonary
bypass (CPB) and cross-clamp times, intensive care unit (ICU) stay, and
hospital stay, and complications (safety outcomes). Pooled risk ratios
(RR) and mean differences (MD) with 95% confidence intervals (CI) were
calculated using a random-effects model. Result(s): A total of 12
cohort studies were included. Postoperative sinus rhythm (RR = 0.86, 95%
CI 0.71-1.04) and atrial fibrillation (AF) (RR = 1.12, 95% CI 0.83-1.49)
did not differ between SSA and CLA; junctional rhythm and complete
atrioventricular block (AVB) were also comparable. Within-group (pre-post)
analyses showed sinus rhythm increased after both techniques, more with
SSA (RR = 1.36) than CLA (RR = 1.20), while AF changes were
non-significant. Meta-regression indicated more recent publication year
and higher repair (vs. replacement) proportion were associated with
greater sinus rhythm benefit favoring SSA. Secondary outcomes were similar
overall; pacemaker implantation was borderline higher after SSA and became
significant in sensitivity analysis. Safety endpoints were also comparable
between approaches. Conclusion(s): The SSA provides equivalent
perioperative efficiency and clinical safety compared with CLA in mitral
valve surgery. Concerns about rhythm disturbances and operative burden are
not supported by pooled evidence, suggesting that SSA remains a safe and
valuable option, particularly in cases requiring enhanced exposure.
Further high-quality prospective studies are warranted to define long-term
outcomes and refine patient selection. Copyright © The Author(s)
2025.

<33>
Accession Number
2042970550
Title
Ultrasound-Guided Transverse Thoracic Muscle Plane Block (TTMPB) for
Post-Sternotomy Pain: A Randomised Controlled Trial.
Source
Malaysian Journal of Medical Sciences. 32(6) (pp 165-175), 2025. Date of
Publication: 31 Dec 2025.
Author
Gill N.S.; Mokhtar A.M.; Abidin H.Z.; Eu C.S.; Zahari Y.; Hassan M.H.
Institution
(Gill, Mokhtar, Abidin, Eu, Zahari, Hassan) Department of Anaesthesiology
and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia,
Health Campus, Kelantan, Malaysia
(Hassan) Department of Anaesthesiology and Intensive Care, National Heart
Institute, Kuala Lumpur, Malaysia
(Gill) Department of Anaesthesiology and Intensive Care, Hospital Sultan
Idris Shah, Serdang, Selangor, Malaysia
Publisher
Penerbit Universiti Sains Malaysia
Abstract
Background: Poorly controlled acute surgical pain after cardiac surgery
results from extensive tissue injuries and associated with high pain
intensity and leading to chronic pain and excessive opioid use. The aim is
to analyse the pain scores, patient controlled analgesia (PCA) fentanyl
requirement and spirometry values in Transverse Thoracic Muscle Plane
Block (TTMPB) vs. conventional opioid strategy in patients who underwent
cardiac sternotomy surgeries. Method(s): This is a randomised
controlled trial involving 40 adult patients who underwent elective
cardiac surgery with sternotomy, receiving either TTMPB (B, n = 20) or
control (A, n = 20). We measured mean pain scores at rest and on movement
postextubation using the Visual Analogue Scale (VAS), mean PCA fentanyl
consumption, and incentive spirometry volume at 0, 3, 6, 12, 18, 24, and
48 h postextubation. Analysis was done using the repeated measure ANOVA.
 Result(s): At rest, there was a significant reduction in pain score
across different time points observed between both groups (F [6, 228] =
3.180, P < 0.05). On movement, a significant interaction between the TTMPB
treatment and pain score at movement across different time points (F [6,
228] = 2.249, P < 0.001) was shown. There was also a significant reduction
in PCA fentanyl consumption across different time points (F [6, 228] =
2.080, P < 0.05). Similar outcomes were also observed in spirometry volume
changes across time points between the two study groups (F [6, 228] =
10.855, P < 0.001). Conclusion(s): The administration of the TTMPB
resulted in significantly reduced pain scores at rest and movement,
reduced the mean PCA fentanyl consumption and showed better incentive
spirometry volume postextubation compared to the control group. This study
supports TTMPB as efficient postoperative analgesia for post-cardiac
surgery. Copyright © Penerbit Universiti Sains Malaysia, 2025.

<34>
Accession Number
2042577030
Title
Dexmedetomidine reduces acute kidney injury in high-risk but not low-risk
patients after non-cardiac surgery: secondary analysis of a randomized
controlled trial.
Source
Journal of Anesthesia. (no pagination), 2026. Date of Publication: 2026.
Author
Liang X.-Q.; Li M.-L.; Li C.-J.
Institution
(Liang, Li, Li) Department of Anesthesiology, Peking University First
Hospital, No. 8 Xishiku St., Xicheng District, Beijing, China
Publisher
Springer
Abstract
Purpose: Acute kidney injury (AKI) is a significant postoperative
complication associated with poor long-term outcomes. Dexmedetomidine, a
selective alpha2-adrenergic agonist with anti-inflammatory properties, may
protect the kidney during non-cardiac surgery. This study examined whether
intraoperative dexmedetomidine reduces AKI in both high-risk and low-risk
patients. Method(s): This was a secondary analysis of a randomized
double-blind placebo-controlled trial. Patients aged >= 60 years scheduled
for elective non-cardiac surgery expected to last >= 2 h under general
anesthesia were enrolled and classified as low-risk or high-risk using the
General Surgery Acute Kidney Injury Risk Index. Participants were randomly
allocated to receive intraoperative dexmedetomidine (loading dose 0.6
mug/kg over 10 min before induction, followed by 0.5 mug/kg/h until 1 h
before surgery end) or normal saline. The primary endpoint was AKI
incidence within 7 postoperative days. Result(s): Among high-risk
patients, AKI occurred in 12.6% (13/103) of the dexmedetomidine group
versus 23.4% (25/107) of controls (RR 0.54, 95% CI 0.29 to 1.00, P =
0.043); after multivariable adjustment, dexmedetomidine remained
independently associated with lower AKI risk (OR 0.44, 95% CI 0.20 to
0.98, P = 0.045). In contrast, low-risk patients showed no significant
difference with or without dexmedetomidine (7.9% vs 9.6%; RR 0.82, 95% CI
0.44 to 1.55, P = 0.543; adjusted OR 0.65, 95% CI 0.30 to 1.38, P =
0.260). Urological surgery was an independent predictor of AKI across the
entire cohort. Conclusion(s): Intraoperative dexmedetomidine was
associated with lower risk of AKI in high-risk but not in low-risk
patients undergoing non-cardiac surgery. Copyright © The
Author(s) 2026.

<35>
Accession Number
2042490561
Title
Right Ventricular-Pulmonary Artery Coupling and Clinical Outcomes
Following Mitral Transcatheter Edge-to-Edge Repair: A Systematic Review
and Meta-Analysis.
Source
Echocardiography. 43(1) (no pagination), 2026. Article Number: e70387.
Date of Publication: 01 Jan 2026.
Author
Theofilis P.; Sakalidis A.; Karakasis P.; Vlachakis P.K.; Oikonomou E.;
Mantzouranis E.; Iliakis P.; Dimitriadis K.; Pantelidis P.; Pamporis K.;
Aggeli K.; Tsioufis K.; Tousoulis D.
Institution
(Theofilis, Sakalidis, Vlachakis, Mantzouranis, Iliakis, Dimitriadis,
Pamporis, Aggeli, Tsioufis, Tousoulis) 1st Department of Cardiology,
"Hippokration" General Hospital of Athens, Athens, Greece
(Karakasis) 2nd Department of Cardiology, "Hippokration" General Hospital
of Thessaloniki, Thessaloniki, Greece
(Oikonomou, Pantelidis) 3rd Department of Cardiology, "Sotiria" Chest
Diseases Hospital, Athens, Greece
Publisher
John Wiley and Sons Inc
Abstract
Background: Right ventricular-pulmonary artery (RVPA) coupling is an
emerging prognostic marker in cardiovascular disease, but its predictive
value in patients undergoing mitral transcatheter edge-to-edge repair
(MTEER) remains uncertain. Method(s): We conducted a systematic
review and meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus,
and Web of Science were searched for studies evaluating the prognostic
impact of RVPA coupling in patients undergoing MTEER, using tricuspid
annular plane systolic excursion (TAPSE)/pulmonary artery systolic
pressure (PASP) or related markers. Risk of bias was assessed with the
ROBINS-I tool, and meta-analyses were used to evaluate associations with
clinical outcomes, including all-cause mortality, major adverse
cardiovascular events (MACE), and residual mitral regurgitation (MR).
 Result(s): Nine studies involving 3281 patients were included.
Baseline RVPA uncoupling was significantly associated with an increased
incidence of MACE (risk ratio [RR] 1.75, 95% confidence interval [CI]:
1.40-2.19) and higher all-cause mortality (RR 1.82, 95% CI: 1.53-2.18). No
significant association was observed with post-operative MR (RR 1.17, 95%
CI: 0.83-1.63). Sensitivity analyses did not alter the direction of the
findings. Conclusion(s): RVPA uncoupling is associated with adverse
outcomes after MTEER. Routine assessment may improve pre-procedural risk
stratification. Further studies should refine diagnostic thresholds and
evaluate potential therapeutic strategies in the setting of impaired RVPA
coupling prior to MTEER. Copyright © 2026 Wiley Periodicals LLC.

<36>
[Use Link to view the full text]
Accession Number
2042618220
Title
Sodium-Glucose Cotransporter-2 Inhibitors Following Transcatheter Aortic
Valve Replacement: A Meta-Analysis.
Source
Cardiology in Review. Publish Ahead of Print (no pagination), 2025. Date
of Publication: 2025.
Author
Jain H.; Soni K.; Jain J.; Goyal A.; Passey S.; Goldsweig A.M.
Institution
(Jain) From the Department of Medicine, All India Institute of Medical
Sciences, Jodhpur, India
(Soni) Department of Internal Medicine, SUNY Upstate Medical University,
Syracuse, NY
(Jain) Department of Internal Medicine, Allegheny General Hospital,
Pittsburgh, PA
(Goyal) Department of Internal Medicine, Cleveland Clinic Foundation,
Cleveland, OH
(Passey) Department of Internal Medicine, University of Connecticut Health
Center, Farmington, CT
(Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center
and Division of Cardiovascular Medicine, University of
Massachusetts-Baystate, Springfield, MA
Publisher
Lippincott Williams and Wilkins
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce heart failure
(HF)-associated admissions; however, the data on patients with aortic
stenosis following transcatheter aortic valve replacement (TAVR) is
limited. This systematic review and meta-analysis compares clinical
outcomes in patients with and without SGLT2i following TAVR. Major
electronic databases were systematically searched through April 2025 for
studies evaluating SGLT2i following TAVR. Risk ratios (RR) with 95%
confidence intervals (CI) were pooled using a random-effects model. A P
value of <=0.05 was considered statistically significant. Two studies with
1534 patients undergoing TAVR (679: SGLT2i; 855: no SGLT2i) were included.
SGLT2i therapy led to a significant reduction in HF hospitalization (RR:
0.56; 95% CI: 0.32-0.99; P = 0.05); however, no differences in all-cause
(RR: 0.48; 95% CI: 0.13-1.72; P = 0.26) and cardiovascular mortality (RR:
0.53; 95% CI: 0.19-1.48; P = 0.22) were noted. SGLT2i are associated with
a statistically and clinically significant reduction in HF
hospitalization; however, no reduction in mortality was observed following
TAVR. Further randomized controlled trials are warranted to support future
guideline recommendations regarding SGLT2i following TAVR. Copyright
© 2025

<37>
Accession Number
636571752
Title
Post-thymectomy myasthenia gravis: A case report and systematic review of
literature.
Source
BMJ Case Reports. 14(12) (no pagination), 2021. Article Number: e246005.
Date of Publication: 02 Dec 2021.
Author
Gurowich L.; Yiin G.; Maxwell A.; Rice A.
Institution
(Gurowich) General Surgery, Taunton and Somerset Nhs Foundation Trust,
Taunton, United Kingdom
(Gurowich, Yiin, Maxwell) Neurology, Swindon and Marlborough Nhs Trust,
Swindon, United Kingdom
(Rice) Histopathology, Royal Brompton Hospital, London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Myasthenia gravis (MG) is an autoimmune condition affecting the
neuromuscular junction characterised by weakness and fatiguability,
carrying a high morbidity if treatment is delayed. A clear association
with thymoma has led to management with thymectomy as a common practice,
but MG presenting post-thymectomy has rarely been reported. We present a
case of an 82-year-old woman developing fatigue, ptosis and dysarthria 3
months after thymectomy. After a clinical diagnosis of MG was made, she
responded well to prompt treatment with prednisolone and pyridostigmine.
Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came
back positive. Our systematic review reveals that post-thymectomy MG can
be categorised as early-onset or late-onset form with differing aetiology,
and demonstrated correlation between preoperative anti-AChR titres and
post-thymectomy MG. The postulated mechanisms for post-thymectomy MG
centre around long-lasting peripheral autoantibodies. Clinicians should
actively look for MG symptoms in thymoma patients and measure anti-AChR
preoperatively to aid prognostication. Copyright © BMJ Publishing
Group Limited 2021. No commercial re-use. See rights and permissions.
Published by BMJ.

<38>
Accession Number
2034362640
Title
Everolimus and sirolimus in the treatment of cardiac rhabdomyomas in
neonates.
Source
Pediatric Research. 98(6) (pp 2045-2057), 2025. Date of Publication: 01
Dec 2025.
Author
Hurtado-Sierra D.; Ramos Garzon J.X.; Romero-Guevara S.L.; Serrano-Garcia
A.Y.; Rojas L.Z.
Institution
(Hurtado-Sierra) Pediatric Cardiology Unit, Instituto del Corazon de
Bucaramanga, Bucaramanga, Colombia
(Ramos Garzon, Romero-Guevara) Nursing School, Universidad Industrial de
Santander, Bucaramanga, Colombia
(Serrano-Garcia, Rojas) Research Center, Fundacion Cardiovascular de
Colombia, Floridablanca, Colombia
Publisher
Springer Nature
Abstract
Background and objectives: Cardiac rhabdomyoma (CR) is the principal
cardiac tumor diagnosed in pediatric age and is commonly associated with
tuberous sclerosis complex. In some patients, these masses can cause heart
failure and difficult-to-control arrhythmias. There are multiple case
reports on use of mammalian target of rapamycin (mTOR) inhibitors,
everolimus or sirolimus, in treatment of CRs. We reviewed the current data
regarding effectiveness of everolimus and sirolimus in treating of CRs in
newborns with hemodynamic repercussions. Method(s): This systematic
review was reported according to the PRISMA guidelines. The EBSCO, PubMed,
EMBASE, and Lilacs databases were searched for full-text articles
reporting the use of everolimus or sirolimus in the treatment of CRs in
neonates and infants. Result(s): Thirty-one articles met inclusion
criteria, totaling 48 patients. Hemodynamic instability prompted treatment
in 89.5% of cases. Everolimus was used in 83.3% of cases and sirolimus in
16.6%. The median treatment duration was 67 days, with a 57 +/- 23%
average CR size reduction. Common adverse events included
hypertriglyceridemia, infections, and hematological abnormalities.
 Conclusion(s): mTOR inhibitors appear effective and safe for treating
CRs in neonates and infants. The average daily doses were 1.03 mg/m2/day
for everolimus and 1.37 mg/m2/day for sirolimus. Randomized controlled
clinical trials are necessary to confirm these findings and establish
optimal treatment protocols. Impact: Currently, there are no results from
randomized clinical trials evaluating the efficacy of mammalian target of
rapamycin inhibitors in patients with symptomatic cardiac rhabdomyomas.
This is the first systematic review that evaluates the efficacy and safety
of the use of everolimus and sirolimus in the non-surgical treatment of
cardiac rhabdomyomas with hemodynamic repercussions in neonates.
Everolimus and sirolimus may be particularly useful in the neonatal period
when the hemodynamic complications caused by cardiac rhabdomyomas are more
severe. Copyright © The Author(s) 2025.

<39>
Accession Number
2041424713
Title
Clinical outcomes of drug-coated balloon vs. second-generation
drug-eluting stent for coronary in-stent restenosis.
Source
Clinical Research in Cardiology. 115(1) (pp 121-131), 2026. Date of
Publication: 01 Jan 2026.
Author
Krefting J.; Kruger N.; Friess C.; Grasser C.; Schmieder R.; Starnecker
F.; Schwab M.; Kufner S.; Trenkwalder T.; Voll F.; Sager H.B.; Kessler T.;
Xhepa E.; Offenborn F.; Dreischulte T.; Giacoppo D.; Cassese S.; Kastrati
A.; Schunkert H.; von Scheidt M.; Wiebe J.
Institution
(Krefting, Kruger, Friess, Graser, Schmieder, Starnecker, Schwab, Kufner,
Trenkwalder, Voll, Sager, Kessler, Xhepa, Giacoppo, Cassese, Kastrati,
Schunkert, von Scheidt, Wiebe) Department of Cardiology, German Heart
Center Munich, Technical University of Munich, Munich, Germany
(Krefting, Kruger, Graser, Schmieder, Starnecker, Schwab, Kufner,
Trenkwalder, Voll, Sager, Kessler, Xhepa, Giacoppo, Cassese, Kastrati,
Schunkert, von Scheidt, Wiebe) German Center for Cardiovascular Research
E.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
(Offenborn) Allgemeine Ortskrankenkasse (AOK) Bayern, Munich, Germany
(Dreischulte) Institute of General Practice and Family Medicine, LMU
University Hospital, LMU Munich, Munich, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Current guideline recommendations for the treatment of
coronary in-stent restenosis (ISR) are primarily based on evidence from
smaller, randomized trials comparing drug-coated balloons (DCBs) and
second-generation drug-eluting stents (DES). Purpose(s): The purpose
was to compare clinical outcomes between DCB and DES in routine clinical
practice. Method(s): In this population-based cohort study, we
identified 10,292 patients with ISR who underwent either DCB or DES
intervention. After 1:1 propensity score matching, 3942 patients treated
with either DCB or second-generation DES were included in the analysis.
The composite primary end point was all-cause mortality or myocardial
infarction (MI) at 1 year. Secondary end points included each component of
the primary end point. The safety end point was defined by hospitalization
due to bleeding events. Result(s): At 1-year follow-up, the primary
outcome occurred in 10.4% (n = 206) of the DCB group versus 12.9% (n =
254) of the DES group (HR, 0.77; 95% CI, 0.64-0.93). Among secondary
outcomes, all-cause mortality was lower in the DCB group (6.3%, n = 125)
compared to the DES group (8.1%, n = 160; HR, 0.75; 95% CI, 0.59-0.94), as
was hospitalization for bleeding (2.5%, n = 50 vs. 4.2%, n = 82; HR, 0.65;
95% CI, 0.45-0.96). Rates of MI were similar between groups (HR, 0.83; 95%
CI, 0.63-1.10). Conclusion(s): DCBs were associated with lower rates
of the primary end point all-cause death or myocardial infarction, as well
as secondary end points all-cause death and bleeding compared with
second-generation DES. These findings suggest that DCBs may represent a
safe and effective alternative to DES in selected patient
populations. Copyright © The Author(s) 2025.

<40>
Accession Number
2042277118
Title
Efficacy of prehabilitation interventions on exercise capacity of patients
undergoing major abdominal and cardiothoracic surgery: A systematic review
and network meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 109 (no pagination), 2026. Article Number:
112112. Date of Publication: 01 Feb 2026.
Author
Priego-Jimenez S.; Priego Jimenez P.; Lopez-Gonzalez M.; Lorenzo-Garcia
P.; Contreras-Molina M.; Alvarez-Bueno C.
Institution
(Priego-Jimenez) Hospital Universitario de Cuenca, Camino de El T,
erminillo s/n, 16003 Cuenca, Spain
(Priego-Jimenez, Lopez-Gonzalez, Lorenzo-Garcia, Contreras-Molina,
Alvarez-Bueno) Centro de Estudios Socio-Sanitarios, Grupo de investigacion
Age-ABC, Universidad de Castilla-La Mancha, Edificio Melchor Cano, Campus
Universitario, s/n, Cuenca, Spain
(Priego-Jimenez, Lopez-Gonzalez, Lorenzo-Garcia, Contreras-Molina) Grupo
de Investigacion Age-ABC, Instituto de Investigacion Sanitaria de
Castilla-La Mancha (IDISCAM), 45004, Toledo, Spain
(Priego Jimenez) Servicio de Cirugia General y del Aparato Digestivo,
Hospital Universitario La Paz, Madrid, Spain
(Lorenzo-Garcia) Centro de Fisioterapia FISANA, Orgaz, Toledo, Spain
(Contreras-Molina) Servicio de Salud de Castilla-La Mancha, Albacete,
Spain
(Alvarez-Bueno) Facultad de Ciencias de la Salud, Universidad Autonoma de
Chile, Talca, Chile
Publisher
Elsevier Inc.
Abstract
Background Prehabilitation has reported improvements in exercise capacity,
as measured by the six-minute walking test (6MWT), in people undergoing
major abdominal and cardiothoracic surgery, although there is no evidence
about which component of prehabilitation is most effective for improving
exercise capacity. Methods A network meta-analysis (NMA) was performed to
determine the effects of different components of prehabilitation on
exercise capacity in people undergoing major abdominal or cardiothoracic
surgery. A literature search was performed from baseline to September
2025. Randomized controlled trials on the effectiveness of prehabilitation
programs on exercise capacity presurgery and recovery postsurgery were
included. We assessed the risk of bias via the Cochrane risk of bias (RoB
2.0) tool and the quality of the evidence via the Grading of
Recommendations, Assessment, Development, and Evaluation (GRADE) tool.
Pairwise meta-analyses and NMAs were performed for direct and indirect
evidence. Results Thirty-eight studies were included in this NMA. The
effects associated with improvements in exercise capacity presurgery
scores were greatest for the moderate-intensity exercise group versus
control group (Effect size [ES]: 0.93 95 % CI: 0.46, 1.40), followed by
the multimodal group (exercise+ nutrition + psychological intervention)
versus the control group (ES: 0.50, 95 % CI: 0.15, 0.86). The effects
associated with 6MWT recovery postsurgery score were greatest for the
exercise+ nutrition group versus the control group (ES: 1.08, 95 % CI:
0.00, 2.16), followed by the moderate-intensity exercise group versus the
control group (ES: 0.55, 95 % CI: 0.08, 1.01), and the multimodal group
versus the control group (ES: 0.35, 95 % CI: 0.03, 0.68). Conclusions
Moderate-intensity exercise, followed by multimodal exercise, should be
considered the most effective strategy for improving exercise capacity in
people undergoing major abdominal and cardiothoracic surgery. Exercise
plus nutrition is the most effective intervention to improve 6MWT recovery
postsurgery, followed by moderate-intensity exercise and multimodal
interventions. Owing to the importance of this outcome, as a predictor of
both postsurgical complications and recovery capacity after surgery, it is
essential to know the most effective intervention to improve
it. Copyright © 2025 Elsevier Inc.

<41>
Accession Number
2042560030
Title
One-year versus three-year outcomes of DK-Crush versus Culotte for left
main bifurcation lesions: A systematic review and meta-analysis of RCTs.
Source
Global Cardiology Science and Practice. 2025(5) (pp 1-23), 2025. Date of
Publication: 01 Jan 2025.
Author
Adji A.S.; Komalasari I.; Saisa D.; Billah A.; Nadhifa; Saputra A.D.;
David D.; Oktaviano Y.H.
Institution
(Adji, Komalasari, Nadhifa) Hang Tuah University, Surabaya, Indonesia
(Saisa) Faculty of Medicine, Indonesia University, Jakarta, Indonesia
(Billah, David) Faculty of Medicine, Udayana University, Bali, Indonesia
(Saputra) Faculty of Medicine, University of Jember, Jember, Indonesia
(Oktaviano) Department of Cardiology and Vascular Medicine, Airlangga
University, Surabaya, Indonesia
Publisher
HBKU Press
Abstract
Background: The long-term comparative effectiveness of the Double Kissing
(DK) Crush and Culotte stenting techniques for left main bifurcation
lesions (LMBLs) remains a subject of clinical debate. This meta-analysis
aimed to evaluate and compare the one-year and three-year clinical
outcomes of the DK Crush and Culotte techniques in patients with LMBLs.
 Method(s): A systematic search was performed in PubMed, MEDLINE,
Cochrane, ScienceDirect, and Google Scholar databases up to June 2025.
Three randomized controlled trials (RCTs) comprising 1,188 patients with
LMBLs were included. Pooled risk ratios (RRs) with 95% confidence
intervals (CIs) were calculated using the Mantel-Haenszel fixed-effects
model to assess one- and three-year outcomes, including target vessel
revascularization (TVR), major adverse cardiac events (MACE), myocardial
infarction (MI), cardiac death (CD), and coronary artery bypass grafting
(CABG). Result(s): Across all studies, DK Crush demonstrated
significantly improved outcomes compared with the Culotte technique for
several endpoints. At the one-year follow-up, DK Crush was associated with
a significantly lower rate of target vessel revascularization (RR = 0.42,
95% CI: 0.24-0.75, p = 0.003) and major adverse cardiac events (RR = 0.45,
95% CI: 0.29-0.71, p = 0.0006). There were no significant differences
between the two techniques in cardiac death (RR = 0.83, 95% CI: 0.32-2.12,
p = 0.70), myocardial infarction (RR = 0.60, 95% CI: 0.26-1.39, p = 0.24),
or coronary artery bypass grafting (RR = 2.42, 95% CI: 0.43-13.69, p =
0.32). At the three-year follow-up, DK Crush maintained its superiority,
showing significantly reduced rates of TVR (RR = 0.37, 95% CI: 0.24-0.58,
p < 0.0001), MACE (RR = 0.47, 95% CI: 0.34-0.65, p < 0.0001), and MI (RR =
0.43, 95% CI: 0.21-0.89, p = 0.02). However, no statistically significant
differences were observed in cardiac death (RR = 0.81, 95% CI: 0.45-1.46,
p = 0.47) or CABG (RR = 2.25, 95% CI: 0.46-11.03, p = 0.32).
 Conclusion(s): The DK Crush technique demonstrated superior clinical
efficacy compared with the Culotte technique, with significantly lower
rates of TVR, MACE, and MI at both one and three years. Although no
significant differences were observed in cardiac death or CABG, DK Crush
appeared to provide more favorable long-term vessel patency and reduced
risk of repeat revascularization. Further large-scale randomized trials
are warranted to validate these findings and strengthen the evidence
supporting DK Crush as the preferred strategy for complex left main
bifurcation lesions. Copyright © (2025), (HBKU Press). All rights
reserved.

<42>
Accession Number
2042120723
Title
Open Heart Mitral Valve Replacement Using Transcatheter Heart Valves for
Severe Mitral Annular Calcification-A Literature Review.
Source
Journal of Cardiovascular Development and Disease. 12(12) (no pagination),
2025. Article Number: 491. Date of Publication: 01 Dec 2025.
Author
D'Alonzo M.; Baudo M.; Cabrucci F.; di Muro F.M.; Magouliotis D.E.; Bacchi
B.; Arjomandi Rad A.; Xanthopoulos A.; Caldonazo T.
Institution
(D'Alonzo) Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Via
Bissolati 57, Brescia, Italy
(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, Via Giovanni Paolo II 132, 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
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Mitral annular calcification makes conventional mitral valve surgery
extremely challenging and has led to growing interest in less invasive
alternatives such as transcatheter mitral valve replacement. Alongside
percutaneous approaches, some centers have explored open transatrial
implantation of transcatheter heart valves in patients with heavily
calcified annuli. This systematic review examines the current evidence on
this hybrid "valve-in-MAC" technique, tracing its clinical evolution,
technological refinements, patient outcomes, and ongoing debates. Key
themes emerging from the literature include the adaptation of existing
balloon-expandable and mitral-specific devices to the complex anatomy of
calcified mitral annuli, the open transatrial approach as a safer
alternative to extensive surgical debridement, and advances in imaging and
device design aimed at reducing left ventricular outflow tract obstruction
and paravalvular leak. Persistent uncertainties remain, particularly
regarding patient selection, long-term valve performance, and comparisons
with conventional surgical repair or replacement. Although open
transatrial implantation appears technically feasible and provides
favorable hemodynamic results compared with fully percutaneous procedures,
reported 30-day mortality remains high (approximately 19-27%). This
reflects the advanced age, frailty, and multiple comorbidities typical of
this patient group rather than procedural shortcomings. Current evidence
is limited, with few comparative studies and little data on valve
durability. Future work should prioritize multicenter prospective
registries and well-designed comparative studies to better define the role
of this emerging salvage strategy. Copyright © 2025 by the
authors.

<43>
Accession Number
2039269878
Title
Early Invasive or Conservative Strategies for Older Patients With Acute
Coronary Syndromes A Meta-Analysis.
Source
JAMA Internal Medicine. 185(8) (pp 966-975), 2025. Date of Publication: 01
Aug 2025.
Author
Reddy R.K.; Koeckerling D.; Eichhorn C.; Jamil Y.; Ardissino M.; Braun V.;
Abu Sharar H.; Frey N.; Howard J.P.; Ahmad Y.
Institution
(Reddy, Ardissino, Howard) National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Reddy) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Koeckerling, Abu Sharar, Frey) Department of Cardiology, Angiology and
Respiratory Medicine, Heidelberg University Hospital, Heidelberg, Germany
(Eichhorn) Division of Acute Medicine, University Hospital Basel, Basel,
Switzerland
(Jamil) Inova Heart and Vascular Institute, Inova Fairfax Medical Campus,
Falls Church, VA, United States
(Ardissino) British Heart Foundation Cardiovascular Epidemiology Unit,
Department of Public Health and Primary Care, University of Cambridge,
Cambridge, United Kingdom
(Ardissino) Medical Research Council Laboratory of Medical Sciences,
Imperial College London, London, United Kingdom
(Braun) Medical Faculty Mannheim, University of Heidelberg, Heidelberg,
Germany
(Ahmad) Division of Cardiology, University of California, San Francisco,
United States
Publisher
American Medical Association
Abstract
IMPORTANCE The optimal management strategy for older patients who present
with acute coronary syndrome (ACS) remains unclear due to a paucity of
randomized evidence. New large and longer-term randomized data are
available. OBJECTIVE To test the association of an early invasive strategy
vs a conservative strategy with clinical outcomes for patients 70 years or
older who present with ACS. DATA SOURCES A literature search strategy was
designed in collaboration with a medical librarian. MEDLINE, Embase, and
the Cochrane Central Register of Controlled Trials were systematically
searched,with no language restrictions from inception through October
2024. Bibliographies of previous reviews and conference abstracts from
major cardiovascular scientific meetings were handsearched. STUDY
SELECTION Studies were deemed eligible following review by 2 independent,
masked investigators if they randomly allocated patients 70 years or older
who presented with ACS to early invasive or conservative management and
reported clinical end points. Observational analyses were excluded. No
trials were excluded based on sample size or follow-up duration. DATA
EXTRACTION AND SYNTHESIS Data were extracted independently and in
triplicate. Clinical end points were pooled in meta-analyses that applied
fixed-effects and random-effects modeling to calculate summary estimates
for relative risks (RRs) and hazard ratios, along with their corresponding
95% CIs. MAIN OUTCOMES AND MEASURES The prespecified primary end point was
all-cause death. Secondary end points included recurrent myocardial
infarction (MI), repeated coronary revascularization, major bleeding,
cardiovascular death, death or MI, stroke, heart failure hospitalization,
major adverse cardiac events, major adverse cardiovascular or
cerebrovascular events, and length of hospital stay. RESULTS The sample
size-weighted mean age of participants across included trials was 82.6
years, and 46% were female. In the pooled analysis, there was no
significant difference in all-cause death between the invasive and
conservative strategies (RR, 1.05; 95% CI, 0.98-1.11; P = .15;
I2 = 0%). An early invasive strategy was associated with a
reduced risk of recurrent MI of 22% (RR, 0.78; 95% CI, 0.67-0.91; P =
.001; I2 = 0%) and repeated coronary revascularization during
follow-up of 57% (RR, 0.43; 95% CI, 0.30-0.60; P < .001; I2 =
33.3%). However, an invasive strategy was associated with an increased
risk of major bleeding (RR, 1.60; 95% CI, 1.01-2.53; P = .046;
I2 = 16.7). No differences were observed in secondary end
points. Results in the non-ST-elevation ACS population were consistent
with the overall findings. CONCLUSIONS AND RELEVANCE The results of this
systematic review and meta-analysis suggest that, in older patients with
ACS, an early invasive strategy was not associated with reduced all-cause
death compared with conservative management. An early invasive strategy
was associated with reduced recurrent MI and repeated coronary
revascularization during follow-up but increased risk of major bleeding.
Competing risks associated with an early invasive strategy should be
weighed in shared therapeutic decision-making for older patients with
ACS. Copyright © 2025 American Medical Association. All rights
reserved.

<44>
Accession Number
2042855880
Title
Multicentre Study of Diaphragm Pacing in High-Risk Cardiac Surgery to
Decrease Postoperative Mechanical Ventilation.
Source
European Journal of Cardio-thoracic Surgery. 68(1) (no pagination), 2026.
Article Number: ezaf472. Date of Publication: 01 Jan 2026.
Author
David C.-H.; Vourc'h M.; Guimbretiere G.; Mugniot A.; Lacoste P.; Cadiet
J.; Rozec B.; Arora R.; Pelletier M.; Sabik J.; Onders R.
Institution
(David, Guimbretiere, Mugniot, Lacoste) Nantes Universite, CHU Nantes,
Service de Chirurgie Thoracique et Cardiovasculaire, l'Institut du thorax,
Nantes, France
(Vourc'h, Cadiet, Rozec) Nantes Universite, CHU Nantes, Service
d'Anesthesie-Reanimation, Hopital Laennec, Nantes, France
(Arora, Sabik, Onders) Department of Surgery, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
(Pelletier) Division of Cardiac Surgery, Heart and Vascular Center, Yale
New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: Prolonged mechanical ventilation after cardiac surgery occurs
in 15% of patients and significantly increases morbidity and mortality. We
investigated the potential benefits of diaphragm pacing following cardiac
surgeries to decrease ventilator burden. Method(s): A randomized
controlled pilot study was conducted at 2 centres using diaphragm pacing
in patients undergoing open cardiac surgery by median sternotomy. Enrolled
patients had at least one pre-identified high-risk criterion for requiring
prolonged ventilation. Diaphragm pacing was initiated postoperatively.
 Result(s): Sixty-six patients were randomized into Standard of Care
(34) and Treatment (32) groups. This study provides evidence that
diaphragm pacing may reduce mechanical ventilation time and improve
weaning success prior to 24 hours post-operatively. Treated patients had a
total of 246 hours of mechanical ventilation compared to 670 hours for the
standard of care group. Treatment group patients were more likely to be
successfully weaned at 12 hours post-operatively, 83% compared to 65%,
which represented an 18% absolute and 52% relative risk reduction. For the
subset of 14 Treatment and 19 Standard of Care patients that required
ventilation beyond 6 hours, those receiving diaphragm pacing had a reduced
median time on ventilation: 8.3 hours (95% CI 7.1-12.5) compared to 16.8
hours (95% CI 8.1-23.4). Conclusion(s): Diaphragm pacing may reduce
the time on mechanical ventilation following cardiac surgery in patients
at risk of prolonged ventilation. These results will inform the design of
a prospective, pivotal, randomized controlled trial to assess the ability
of diaphragm pacing to reduce ventilator burden in high-risk cardiac
surgery patients. Copyright © The Author(s) 2025. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<45>
Accession Number
649982272
Title
Tubeless uniportal VATS in thoracic surgery - Indications, ERAS pathways,
and outcomes: A review.
Source
Biomolecules & biomedicine. (no pagination), 2026. Date of Publication:
20 Jan 2026.
Author
Zhang B.; Ye X.-H.; Xiao D.-S.
Institution
(Zhang) Department of Thoracic surgery, First People's Hospital of
Wenling, Taizhou University Affiliated Wenling Hospital, School of
Medicine, Taizhou University, Wenling, Zhejiang, China
(Ye) Department of Anesthesiology, First People's Hospital of Wenling,
Taizhou University Affiliated Wenling Hospital, School of Medicine,
Taizhou University, Wenling, Zhejiang, China
(Xiao) Department of General Surgery, First People's Hospital of Wenling,
Taizhou University Affiliated Wenling Hospital, School of Medicine,
Taizhou University, Wenling, Zhejiang, China
Abstract
Tubeless uniportal video-assisted thoracoscopic surgery (VATS) is an
innovative approach characterized by the use of non-intubated
(spontaneous-breathing) anesthesia, the omission of routine postoperative
chest drainage, and single-port access. This technique has gained traction
in recent years for a variety of thoracic procedures. While practices
reported in the literature may differ, this review primarily examines the
combined non-intubated and drainless approach. This narrative review
provides a comprehensive overview and critical analysis of its current
clinical applications, including sympathectomy, pulmonary wedge resection,
spontaneous pneumothorax, thymectomy, and early-stage lung cancer. It also
addresses essential aspects of perioperative management and procedural
indications within enhanced recovery-oriented pathways. A systematic
literature search of PubMed, Embase, and Web of Science was conducted to
identify pertinent studies published between January 2010 and April 2025.
Current clinical reports indicate potential benefits such as reduced
postoperative pain, shorter hospital stays, and accelerated recovery.
However, the existing evidence largely stems from small, observational
studies with varied methodologies, necessitating cautious interpretation.
The broader implementation of this technique in more complex procedures
depends on the establishment of standardized clinical pathways, the
refinement of multidisciplinary perioperative strategies, and validation
through multicenter prospective studies. Tubeless uniportal VATS shows
promise as a significant advancement in function-preserving and
recovery-oriented thoracic surgery.

<46>
Accession Number
2042973210
Title
Robotic Thoracic Surgery: Current Landscape and Future Directions.
Source
Interdisciplinary Cardiovascular and Thoracic Surgery. 41(1) (no
pagination), 2026. Article Number: ivag009. Date of Publication: 01 Jan
2026.
Author
Patel A.J.; Yasufuku K.; Bille A.
Institution
(Patel, Yasufuku) Division of Thoracic Surgery, Toronto General Hospital,
Toronto, ON, Canada
(Patel) Institute of Immunology and Immunotherapy, University of
Birmingham, Birmingham, United Kingdom
(Bille) Department of Thoracic Surgery, Guy's Hospital, London, United
Kingdom
(Bille) School of Cancer & Pharmaceutical Sciences, London, United Kingdom
Publisher
Oxford University Press
Abstract
Objectives: Robotic-assisted thoracic surgery (RATS) has transitioned from
an emerging adjunct to an established component of minimally invasive
thoracic practice. Advances in multi-platform systems, single-port (SP)
technology, and artificial intelligence (AI)-driven analytics are shaping
the next phase of surgical precision, ergonomics, and patient-specific
approaches. Method(s): We synthesized evidence from randomized
controlled trials (RCTs), observational series, national training
initiatives, and recent technological innovations to assess the current
status, potential benefits, limitations, and future trajectory of RATS.
Data sources included RVlob, ROMAN, and RAVAL-4 RCTs; the SORTS UK
national training survey; our own thymic resection comparative series; and
SP platform feasibility studies. Result(s): RCT data demonstrate
oncological equivalence between RATS and video-assisted thoracoscopic
surgery (VATS), with some evidence for improved lymph node yield. National
survey findings underscore the need for structured training pathways to
meet evolving technical demands. Early SP platform experiences indicate
feasibility and safety in high-volume centres, but widespread adoption is
constrained by limited availability, instrumentation, and independent
validation. AI-enhanced surgical planning and intraoperative navigation
are promising adjuncts, though their clinical impact remains to be
defined. Cost, access inequities, and reproducibility outside expert
centres continue to pose challenges. Conclusion(s): The trajectory of
RATS is towards the integration of precision oncology, less invasive
access strategies, and data-driven surgical intelligence. Realizing this
vision will require rigorous comparative studies, equitable access, and
incorporation into structured training to ensure safe, reproducible, and
patient-centred adoption worldwide. Copyright © The Author(s)
2026. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery.

<47>
Accession Number
2042629038
Title
Management of new-onset postoperative atrial fibrillation after coronary
artery bypass grafting.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2026. Date of
Publication: 2026.
Author
Herrmann F.E.M.; Jeppsson A.; Taha A.
Institution
(Herrmann, Jeppsson, Taha) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Herrmann) Department of Cardiac Surgery, LMU University Hospital, LMU
Munich, Munich, Germany
(Herrmann) DZHK (German Center for Cardiovascular Research) Partner Site
Munich Heart Alliance, Munich, Germany
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Taha) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: New-onset postoperative atrial fibrillation (POAF) is the
most common arrhythmia after coronary artery bypass grafting (CABG).
Traditionally regarded as a benign and self-limiting event, more recent
evidence highlights its association with prolonged hospitalization,
increased healthcare utilization, and a heightened risk of stroke,
recurrent atrial fibrillation, and heart failure. Understanding its
significance is essential for patient care and long-term outcomes. PubMed
was searched using terms related to POAF and CABG, supplemented by the
review of relevant guidelines and key publications. Areas covered: This
narrative review summarizes recent evidence on the epidemiology,
pathophysiology, prophylaxis, and treatment of POAF after CABG. Evidence
for pharmacological prophylaxis (e.g. amiodarone, beta-blockers) and
surgical strategies (e.g. posterior pericardiotomy, atrial pacing) is
summarized, along with current approaches for acute management and stroke
prevention. The literature reveals significant heterogeneity in treatment
strategies, particularly regarding anticoagulation, with emerging trials
expected to refine clinical practice. Expert opinion: Current evidence
suggests that POAF functions more as an indicator of underlying patient
vulnerability than as a direct driver of adverse outcomes. Clinically,
management must balance arrhythmia control, stroke and bleeding risk, and
individualized anticoagulation decisions. Research efforts should
prioritize robust risk stratification tools and randomized evidence to
guide tailored therapy. Copyright © 2026 Informa UK Limited,
trading as Taylor & Francis Group.

<48>
Accession Number
649986964
Title
LEFT ATRIAL APPENDAGE OCCLUSION IN STROKE PREVENTION IN ATRIAL
FIBRILLATION.
Source
European Stroke Journal. Conference: 10th European Stroke Organisation
Conference Abstracts. Basel Switzerland. 9(1 Supplement) (pp 155-156),
2024. Date of Publication: 01 May 2024.
Author
Elsheikh S.; Alobaida M.; Bucci T.; Buckley B.; Gupta D.; Irving G.; Hill
A.; Lip G.; Abdul-Rahim A.
Institution
(Elsheikh, Alobaida, Bucci, Buckley, Gupta, Hill, Lip, Abdul-Rahim)
Liverpool Centre for Cardiovascular Science at University of Liverpool,
Liverpool John Moores University and Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Elsheikh, Alobaida, Lip, Abdul-Rahim) Cardiovascular and Metabolic
Medicine, Institute of Life Course and Medical Sciences, Faculty of Health
and Life Sciences, University of Liverpool, Liverpool, United Kingdom
(Elsheikh, Irving, Hill, Abdul-Rahim) Mersey and West Lancashire Teaching
Hospitals NHS Trust, St Helens, United Kingdom
(Alobaida) Department of Basic Science, Prince Sultan Bin Abdulaziz
College for Emergency Medical Services, King Saud University, Riyadh,
Saudi Arabia
(Bucci) Department of General and Specialised Surgery, Sapienza University
of Rome, Italy
(Buckley) Cardiovascular Health Sciences, Research Institute for Sport and
Exercise Sciences, Liverpool John Moores University, Liverpool, United
Kingdom
(Irving) Health Research Institute, Edge Hill University, Ormskirk, United
Kingdom
(Lip) Danish Center for Clinical Health Services Research, Department of
Clinical Medicine, Aalborg University, Aalborg, Denmark
Publisher
SAGE Publications Ltd
Abstract
Background and aims: Existing randomised controlled trials assessing the
safety and efficacy of left atrial appendage occlusion (LAAO) in atrial
fibrillation (AF) were of relatively small sample size, or included
patients who could receive oral anticoagulant treatment after device
implantation. We compared the outcomes of patients with newly diagnosed AF
who received percutaneous LAAO or direct oral anticoagulants (DOAC)
treatment, in a large population from a global federated health network
(TriNetX). Method(s): Patients with AF treated with percutaneous LAAO
were matched with those treated with DOAC between 1st December 2010 and
1st October 2018. Outcomes were all-cause mortality, ischaemic stroke and
intracranial haemorrhage (ICH) at 5 years. Result(s): We included 200
patients with AF, who received either LAAO or DOAC. The risk of all-cause
mortality, ischaemic stroke and ICH at 5 years was not significantly
different between the two groups (Risk Ratio [RR] for all-cause mortality:
1.52, 95% confidence interval (CI): 0.97- 2.38, RR for ischaemic stroke:
1.09, 95% CI: 0.51- 2.36, and RR for ICH: 1.0, 95% CI: 0.44- 2.30).
 Conclusion(s): Patients newly diagnosed with AF, eligible for DOAC,
showed similar 5-year risk of death, ischaemic stroke, and ICH when
comparing those who underwent percutaneous LAAO to those receiving DOAC.
Future randomised controlled trials are needed to confirm the findings and
advise changes in guidelines.

<49>
Accession Number
649987378
Title
LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH INTRACEREBRAL HAEMORRHAGE
ASSOCIATED WITH CEREBRAL AMYLOID ANGIOPATHY.
Source
European Stroke Journal. Conference: 10th European Stroke Organisation
Conference Abstracts. Basel Switzerland. 9(1 Supplement) (pp 273), 2024.
Date of Publication: 01 May 2024.
Author
Thiankhaw K.; Best J.; Srivastava S.; Prachee I.; Agarwal S.; Calvert P.;
Ang R.; Segal O.; Werring D.
Institution
(Thiankhaw, Best, Srivastava, Werring) Stroke Research Centre, Brain
Repair and Rehabilitation, London, United Kingdom
(Thiankhaw) Chiang Mai University, Internal Medicine, Chiang Mai, Thailand
(Prachee, Ang, Segal) Barts Heart Centre, St. Bartholomew's Hospital,
Cardiac Electrophysiology, London, United Kingdom
(Agarwal) University of Cambridge, Clinical Neurosciences, Cambridge,
United Kingdom
(Calvert) University of Cambridge, Cardiovascular Medicine, Cambridge,
United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background and aims: Cerebral amyloid angiopathy (CAA) is a common cause
of intracerebral haemorrhage (ICH) with a high recurrence risk. Left
atrial appendage occlusion (LAAO) is an alternative method for ischaemic
stroke prevention in patients with atrial fibrillation (AF). We aimed to
determine the outcomes of AF patients with CAA-associated ICH undergoing
LAAO and characterise post-procedure antithrombotic regimens.
 Method(s): We conducted a multicentre study of patients with
CAAassociated ICH and AF treated with LAAO. We pooled findings with data
from a systematic review of relevant published studies that reported CAA
diagnosis. We collected data on peri-and post-procedure antithrombotic
regimens and outcomes of ischaemic stroke and ICH. Result(s): We
included data from 9 published studies (n=107) and our cohort study
(n=37), providing a total of 144 participants (mean age 74.5 +/- 8.3
years, 68% male) with CAA-associated ICH and AF treated with LAAO. The
median follow-up period was 9.4 months (interquartile range (IQR)
4.2-20.6). The post-procedural antithrombotic regimens varied between
single (73.0%) or double antiplatelet therapy (16.2%) or direct oral
anticoagulants (10.8%), with a median duration of 42 days (IQR 35- 74).
Post-procedural complications were uncommon (transient arrhythmias and
non-life-threatening tamponade were the common, occurring in 2.1%). The
pooled incidence rates of ischaemic stroke and ICH during follow-up were
5.16 (95% confidence interval 1.36-17.48) and 2.73 (0.41-13.94) per 100
patient-years, respectively. Conclusion(s): LAAO with short-term
antithrombotic therapy may be safe and effective in people with
CAA-associated ICH and AF; further randomised controlled trials are needed
to determine how LAAO compares to long-term antithrombotic treatment.

<50>
Accession Number
2043015732
Title
Acute normovolaemic haemodilution after cardiac surgery: a meta-analysis
of randomised controlled trials.
Source
British Journal of Anaesthesia. (no pagination), 2026. Date of
Publication: 2026.
Author
Pruna A.; Oriani A.; Monaco F.; Landoni G.; Bonizzoni M.A.; Losiggio R.;
Ajello V.; Beretta L.; Zangrillo A.; Pontillo D.; Teresa Agosta V.;
Carravetta M.; Chiodi B.; Oliva F.M.; Ronca E.; Likhvantsev V.; Farag
A.G.; Bukamal N.A.
Institution
(Pruna, Oriani, Landoni, Bonizzoni, Losiggio, Beretta, Zangrillo,
Pontillo, Teresa Agosta, Carravetta, Chiodi, Oliva, Ronca) Department of
Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Monaco) Department of Medical and Surgical Sciences (DIMEC), Alma Mater
Studiorum - University of Bologna, Bologna, Italy
(Monaco) Cardiothoracic and Vascular Anaesthesia and Intensive Care, IRCCS
Azienda Ospedaliero-Universitaria Sant'Orsola, Bologna, Italy
(Landoni, Beretta, Zangrillo) School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
(Ajello) Department of Cardiothoracic Anaesthesia, University Hospital Tor
Vergata, Rome, Italy
(Likhvantsev) Federal Clinical and Research Centre of Intensive Care and
Rehabilitation, Moscow, Russian Federation
(Likhvantsev) Loginov Moscow Clinical Scientific Centre, Moscow, Russian
Federation
(Farag) Department of Cardiac Anaesthesia, King Abdullah Medical City,
Makkah, Saudi Arabia
(Bukamal) Mohamed Bin Khalifa Specialist Cardiac Centre - Royal Medical
Services, Awali, Bahrain
Publisher
Elsevier Ltd
Abstract
Background: Acute normovolaemic haemodilution (ANH) is a widely adopted
packed red blood cells (pRBC) transfusion sparing strategy after cardiac
surgery. While the intraoperative effect is plausible and likely enhanced
by the lack of blinding, the effect on the overall in-hospital transfusion
rate is unknown. We conducted a meta-analysis of randomised controlled
trials to assess whether ANH reduced the proportion of cardiac surgery
patients who received allogeneic pRBC transfusions during the
postoperative hospital stay. Method(s): We searched for trials on ANH
in adults undergoing elective cardiac surgery. The primary outcome was the
number of patients receiving allogenic pRBC transfusions during the
in-hospital postoperative period (excluding trials which solely reported
observation period <=48 h). Secondary outcomes included the number of
patients transfused within 48 h after surgery, surgical revision, and
all-cause mortality. Result(s): The proportion of patients who
received allogeneic pRBC transfusions was similar in the ANH and standard
groups (755/1899 [40%] vs 831/1914 [43%]; risk ratio [RR] 0.94, 95%
confidence interval, CI 0.85-1.02]; P=0.15; I2=80%), while they
received fewer transfusions in the first 48 postoperative hours (RR 0.64,
95% CI [0.48-0.84]; P=0.001; I2=73%). There was no difference
in surgical revision rate (RR 1.22, 95% CI [0.91-1.65]; P=0.18;
I2=0%;), all-cause mortality (RR 0.73, 95% CI [0.43-1.24];
P=0.25; I2=0%), or other secondary outcomes. Most included
trials had intermediate risk of bias because of lack of outcomes reporting
and blinding. Conclusion(s): Acute normovolaemic haemodilution did
not reduce the proportion of cardiac surgery patients who received
allogeneic packed red blood cell transfusions during the postoperative
hospital stay. This result should be interpreted considering the risk of
bias of the included trials. Systematic review protocol. PROSPERO
(CRD420251054530). Copyright © 2025 British Journal of
Anaesthesia

<51>
Accession Number
649986538
Title
STROKE TYPE AND SEVERITY IN THE LEFT ATRIAL APPENDAGE OCCLUSION DURING
CARDIAC SURGERY TO PREVENT STROKE (LAAOS III) STUDY.
Source
European Stroke Journal. Conference: 10th European Stroke Organisation
Conference Abstracts. Basel Switzerland. 9(1 Supplement) (pp 9-10), 2024.
Date of Publication: 01 May 2024.
Author
Katsanos A.; Whitlock R.; Belley-Cote E.; Brady K.; Wang A.; Srivastava
A.; Jacquin G.; Catanese L.; Shoamanesh A.; Sharma M.
Institution
(Katsanos, Belley-Cote, Srivastava, Catanese, Shoamanesh, Sharma) McMaster
University, Department of Medicine, Hamilton, Canada
(Katsanos, Whitlock, Belley-Cote, Brady, Wang, Shoamanesh, Sharma)
Population Health Research Institute, Hamilton, Canada
(Whitlock) McMaster University, Division of Vascular Surgery, Hamilton,
Canada
(Jacquin) Centre hospitalier de l'Universite de Montreal, Montreal, Canada
Publisher
SAGE Publications Ltd
Abstract
Background and aims: The randomized LAAOS III trial demonstrated that
patients with atrial fibrillation (AF) who underwent left atrial appendage
occlusion (LAAO) during cardiac surgery had a lower risk of stroke than
those who did not. We sought to characterize stroke subtype, mortality,
and topography to assess the impact of LAAO on strokes of different
mechanisms. We hypothesized that LAAO would preferentially reduce
cardioembolic stroke. Method(s): LAAOS III randomly assigned 4811
patients with AF undergoing cardiac surgery for another indication to
undergo LAAO or not. Ischemic/undetermined stroke or systemic embolism was
the primary outcome. For the current analysis, adjudicators blinded to
treatment allocation reviewed clinical records and imaging reports of all
ischemic strokes that occurred in LAAOS III and classified them as
cardioembolic if the acute infarct was not attributed to a competing
mechanism by modified TOAST criteria, or if multiple acute infarcts in
different vascular territories were present. We also classified infarcts
as cortical and determined if infarcts were on multiple or single
territories as additional factors associated with cardioembolic stroke.
 Result(s): Fatal stroke was less likely in the LAAO group (HR=0.55,
95%CI:0.31-0.96), while perioperative ischemic or hemorrhagic stroke risk
was similar. Suspected cardioembolism (43% vs. 58%) and cortical
involvement (45% vs. 60%) on brain imaging was less common in participants
who underwent LAAO. LAAO reduced the risks for cardioembolic stroke by 53%
(HR=0.47,95%CI: 0.33-0.67) and cortical infarction by 49%
(HR=0.51,95%CI:0.36-0.72). Conclusion(s): LAAO decreases the risk for
ischemic stroke related to cardioembolism and reduces stroke fatality
without increasing the risks for perioperative or hemorrhagic
cerebrovascular events.

<52>
Accession Number
2043042375
Title
Comparative efficacy of schroth and core training for early postoperative
recovery in adolescent idiopathic scoliosis: A single blind randomized
controlled trial.
Source
PLOS ONE. 21(1 January) (no pagination), 2026. Article Number: e0340585.
Date of Publication: 01 Jan 2026.
Author
Meng F.; Li K.; Wang W.; Yang R.; Wang C.; Zhao Z.; Chen M.; Ao L.
Institution
(Meng, Li, Yang, Wang, Chen, Ao) School of Rehabilitation, Kunming Medical
University, Yunnan, Kunming, China
(Li) Department of Rehabilitation, Kunming Municipal Hospital of
Traditional Chinese Medicine, Yunnan, Kunming, China
(Wang) College of Mechanical and Electrical Engineering, Harbin
Engineering University, Heilongjiang, Harbin, China
(Zhao) Department of Orthopaedics, The Second Affiliated Hospital of
Kunming Medical University, Kunming, China
Publisher
Public Library of Science
Abstract
Background To evaluate the clinical efficacy of Schroth exercises combined
with core training versus core training alone on early trunk balance
optimization and functional recovery in adolescent idiopathic scoliosis
(AIS) patients following selective thoracic fusion surgery. Methods This
single-blinded randomized controlled trial enrolled 46 AIS patients with
Lenke1 type configuration who underwent selective thoracic posterior
spinal fusion at the Orthopedics Department of the Second Affiliated
Hospital of Kunming Medical University. Participants were randomly
assigned to either the Schroth exercise combined Core Training (SCT, n =
23) or Core training group (CT, n = 23). The SCT group received Schroth
three-dimensional (3D) scoliosis-specific exercises combined with core
stabilization training: during the initial 3 postoperative months, they
performed core exercises, rotational angular breathing, and daily postural
management; during the subsequent 3 months, they engaged in Schroth 3D
corrective exercises targeting surgical correction outcomes. The CT group
exclusively performed core stabilization training throughout the 6-month
postoperative period. Both groups received 40-minute intervention sessions
three to four times weekly from discharge to 6 months postoperatively.
Assessments were conducted at four time points: preoperatively, at the
discharge (postoperative day 7), and at 3 and 6 months postoperatively.
Spinal radiographic parameters, paraspinal muscle surface
electromyography, core muscle strength and endurance, and SRS-22
questionnaire data were analyzed to evaluate early clinical efficacy
across three domains: body structure/function, activities, and
participation in surgically treated AIS patients. Results Analysis of the
primary radiographic outcomes revealed no significant time-by-group
interactions. However, the SCT group demonstrated superior overall
improvement in pelvic balance compared to the CT group (Group main effect:
p=0.032). For secondary exploratory outcomes, significant interactions
were observed for trunk extensor endurance and SRS-22 self-image (p<0.01),
with the SCT group showing greater improvement than the CT group
specifically at the 6-month follow-up (p<0.05). In unadjusted exploratory
comparisons, trunk flexor endurance was also better in the SCT group at 6
months (p=0.046). No other significant between-group differences were
found. Conclusion Compared with isolated core stabilization training,
Schroth 3D scoliosis-specific exercises combined with core training
demonstrate superior efficacy in improving early postoperative muscular
function, pelvic symmetry, and self-image. Nevertheless, comparable
effects were observed between both rehabilitation protocols regarding
early postoperative Cobb angles of major and minor curves, convex-concave
paraspinal muscle balance restoration, pain alleviation, and psychological
status improvement. Copyright © 2026 Meng et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<53>
Accession Number
2043042643
Title
Impact of 3D Printing on Cardiac Surgery in Congenital Heart Diseases: A
Systematic Review and Meta-Analysis.
Source
Arquivos Brasileiros de Cardiologia. 121(12) (no pagination), 2024.
Article Number: e20240430. Date of Publication: 2024.
Author
Shunji Yahiro D.; de Paula Cruz M.; Ficheira Coelho Ribeiro B.; Meireles
Teixeira L.; de Oliveira M.F.R.M.; de Azevedo Grippa de Souza A.L.A.;
Flavia Malheiros Torbey A.; da Silveira J.S.; Tinoco Mesquita C.
Institution
(Shunji Yahiro, de Paula Cruz, Ficheira Coelho Ribeiro, Meireles Teixeira,
de Oliveira, de Azevedo Grippa de Souza, Flavia Malheiros Torbey, Tinoco
Mesquita) Universidade Federal Fluminense, RJ, Niteroi, Brazil
(da Silveira, Tinoco Mesquita) Pro-Cardiaco Hospital, RJ, Rio de Janeiro,
Brazil
Publisher
Sociedade Brasileira de Cardiologia
Abstract
Background: Congenital heart disease (CHD) poses significant challenges in
surgical management due to the complexity of cardiac anatomy.
Three-dimensional (3D) printing has emerged as a promising tool in
preoperative planning, intraoperative guidance, and medical education for
CHD surgeries. Objective(s): We aimed to systematically review the
literature on the utilization and benefits of 3D printing technology in
CHD surgical interventions. Method(s): A systematic search was
conducted across PubMed and EMBASE for studies published up to February of
2024. We included controlled and uncontrolled studies investigating the
surgical role of 3D printing in CHD patients. We conducted a single-arm
meta-analysis estimating the proportion of change in treatment planning
due to the use of 3D printed-models. Moreover, studies that compared 3D
printing to conventional care were included into the meta-analysis. A
p-value < 0.05 was considered statistically significant. Result(s): A
total of 21 studies met the inclusion criteria, comprising 444 patients
undergoing CHD surgeries with 3D printing assistance. Preoperative
planning aided by 3D models led to changing surgical decisions in 35 of 75
cases (51.8%; 95% CI 26.6-77.0%, I2=80.68%, p=0.001) and reduced total
operative time in 22.25 minutes in favor of the 3D printing group (95%CI
49.95; 5.80 min, I2=0%, p=0.817) but without statistical significance.
Albeit in a smaller sample, other endpoints (mechanical ventilation and
ICU time) demonstrated some benefit from the technology but without
statistical significance. Conclusion(s): By providing personalized
anatomical models, 3D printing may facilitate surgical planning and
execution. More studies are needed to investigate the effects of 3D
printing on reducing intervention, hospitalization, and mechanical
ventilation times. Copyright © 2024 Sociedade Brasileira de
Cardiologia. All rights reserved.

<54>
[Use Link to view the full text]
Accession Number
2042046421
Title
Impact of Cerebral Embolic Protection on Cognitive Function After
Transcatheter Aortic Valve Implantation: Data From the BHF PROTECT-TAVI
Randomized Trial.
Source
Circulation. 152(18) (pp 1268-1278), 2025. Date of Publication: 04 Nov
2025.
Author
Kennedy J.; Blackman D.J.; Dodd M.; Poggesi A.; Read L.; Jamal Z.; Evans
R.; Clayton T.; Kharbanda R.K.; Hildick-Smith D.
Institution
(Kennedy, Kharbanda) Radcliffe Department of Medicine, University of
Oxford, Oxford, United Kingdom
(Kennedy, Kharbanda) National Institute for Health and Care Research
Oxford Biomedical Research Centre, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Blackman) Department of Cardiology, Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
(Dodd, Read, Jamal, Evans, Clayton) Clinical Trials Unit, Department of
Medical Statistics, London School of Hygiene and Tropical Medicine,
London, United Kingdom
(Poggesi) NEUROFARBA Department, University of Florence, Florence, Italy
(Kharbanda) Department of Cardiovascular Medicine, John Radcliffe
Hospital, Oxford, United Kingdom
(Hildick-Smith) Sussex Cardiac Centre, University Hospitals Sussex,
Brighton, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: - In addition to the risk of stroke, patients undergoing
transcatheter aortic valve implantation (TAVI) are susceptible to a
decline of neurocognitive function. This may occur because of embolization
of material (eg, valve or calcium) to the brain. Cerebral embolic
protection (CEP) devices are engineered to capture this debris,
potentially mitigating its incidence. METHOD(S): - This is a
secondary analysis of the BHF PROTECT-TAVI trial (British Heart Foundation
Randomized Trial of Routine Cerebral Embolic Protection in Transcatheter
Aortic Valve Implantation), in which participants with aortic stenosis
from across 33 centers in the United Kingdom were randomly assigned at a
1:1 ratio to undergo TAVI with a CEP device (SENTINEL, Boston Scientific;
SENTINEL CEP group) or TAVI without a CEP device (control group). This
analysis is restricted to those who underwent cognitive assessment. The
primary outcome was the mean change in the telephone version of the
Montreal Cognitive Assessment (t-MoCA) between baseline and 6 to 8 weeks
after TAVI. The secondary outcome was a >=3-point drop in total t-MoCA
score between baseline and 6 to 8 weeks after TAVI. RESULT(S): - A
total of 3535 participants, 1763 in the SENTINEL CEP group and 1772 in the
control group (mean age 81.0 years, 37.7% women) randomized in BHF
PROTECT-TAVI were included in the modified intention-to-treat population
for this analysis. The median t-MoCA at presentation was 18 (interquartile
range, 16-20). The median t-MoCA at 6 to 8 weeks was 20 (interquartile
range, 17-21). The mean change in total t-MoCA score between baseline and
6 to 8 weeks adjusted for the baseline score was 0.83 (95% CI, 0.70-0.96)
in the SENTINEL CEP group and 0.91 (95% CI, 0.79-1.04) in the control
group. There was no difference in means between the treatment groups
(-0.07 [95% CI, -0.22 to 0.09], P=0.42). The incidence of a >=3-point drop
in the total t-MoCA score was 154 of 1763 (8.7%) in the SENTINEL CEP group
and 142 of 1772 (8.0%) in the control group. The corresponding risk
difference was 0.72% (95% CI, -1.10 to 2.55; P=0.44). These findings were
robust to sensitivity analyses. There was no evidence of an interaction
between treatment assignment and any of the subgroups assessed.
 CONCLUSION(S): - In the BHF PROTECT-TAVI trial, the use of CEP did
not impact cognition after TAVI. REGISTRATION: - URL:
https://www.isrctn.com; Unique identifier: ISRCTN16665769. Copyright
© 2025

<55>
Accession Number
2042977181
Title
Natural history of unrepaired bicuspid aortic valve at diagnosis:
meta-analysis and reconstruction of time-to-event data.
Source
Journal of Cardiovascular Surgery. 66(6) (pp 517-524), 2025. Date of
Publication: 01 Dec 2025.
Author
Ogami T.; Yokoyama Y.; Sa M.P.; Takagi H.; Fukuhara S.; Sultan I.; Kuno T.
Institution
(Ogami, Sultan) Department of Cardiothoracic Surgery, University of
Pittsburgh Medical Center, PA, United States
(Ogami, Sultan) Heart and Vascular Institute, University of Pittsburgh
Medical Center, PA, United States
(Yokoyama, Fukuhara) Department of Cardiac Surgery, University of
Michigan, MI, Ann Arbor, United States
(Sa) Division of Cardiovascular Surgery, Heart, Vascular and Thoracic
Institute, Cleveland Clinic Florida, FL, Weston, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, MA, Boston, United States
(Kuno) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, MA, Boston, United States
Publisher
Edizioni Minerva Medica
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. Copyright © 2025 EDIZIONI MINERVA MEDICA.

<56>
Accession Number
649955576
Title
PROthrombin complex concentrate versus fresh frozen Plasma for bleeding in
adults undergoing HEart SurgerY (PROPHESY-2 trial): a phase III,
randomised control trial in England and Wales.
Source
Trials. (no pagination), 2026. Date of Publication: 17 Jan 2026.
Author
Brown-O'Sullivan C.; Agarwal S.; Akowuah E.; Arbon E.; Gardner M.;
Hounslea E.; Hudson C.; Klein A.; Loubani M.; McCullagh J.; Murphy G.;
Murray S.; Rourke C.; Sanders J.; Simpson L.; Smith L.; Stanworth S.;
Tomini F.; Vides N.; Workman J.; Green L.
Institution
(Brown-O'Sullivan, Arbon, Gardner, Hounslea, Hudson, Rourke, Smith, Vides,
Workman) NHS Blood and Transplant Clinical Trials Unit, Cambridge, United
Kingdom
(Agarwal) Manchester University Hospital, Manchester, United Kingdom
(Akowuah) Newcastle University, Newcastle, United Kingdom
(Klein) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United
Kingdom
(Loubani) Hull University Teaching Hospitals, NHS Trust, Cottingham,
United Kingdom
(McCullagh, Green) NHS Blood and Transplant and Barts Health NHS Trust,
London, United Kingdom
(McCullagh, Simpson, Tomini, Green) Queen Mary University of London,
London, United Kingdom
(McCullagh, Green) NHS Blood and Transplant and Queen Mary University of
London, London, United Kingdom
(Murphy) University of Leicester, Leicester, United Kingdom
(Murray) Patient and Public Representative, London, United Kingdom
(Sanders) King's College London, London, United Kingdom
(Stanworth) NHS Blood and Transplant, Oxford University Hospitals NHS
Trust and University of Oxford, Oxford, United Kingdom
Abstract
BACKGROUND: Fresh frozen plasma (FFP) is the standard treatment for severe
bleeding following cardiac surgery. Despite increasing use of prothrombin
complex concentrate (PCC) for coagulopathic bleeding in preference to FFP
in the UK, the evidence comparing FFP versus PCC in this setting is
lacking. HYPOTHESIS: In adults who develop severe bleeding, PCC is
superior to FFP in reducing a composite of mortality, organ failure, or
infection up to 90 days following cardiac surgery, and is more
cost-effective. METHOD(S): Phase III pragmatic, multicentre, parallel
group, superiority, non-blinded, open-label, two-stage group sequential
randomised controlled trial with internal pilot embedded. Participants
will be recruited by the research team at up to 20 hospitals in England
and Wales. Those who have provided informed consent and who develop
bleeding within 24 h of cardiac surgery (elective and urgent procedures)
will be randomised to PCC (1500 IU if <=70 kg or 2000 IU if >70 kg; a
maximum of 2 doses) or FFP (4 units if <=70 kg and 5 units if >70 kg; no
maximum dose). Randomisation will be stratified by site and will allocate
participants using minimisation, with a 1:1 ratio to receive PCC or FFP.
Age (>=70 and <70 years) and planned type of surgery (valve only, major
aortic surgery, coronary artery bypass graft + valve, and complex/combined
procedure) will be the minimisation factors. The primary outcome is a
composite of mortality or new onset of respiratory failure, myocardial
injury, renal failure, liver injury, intestinal injury, focal neurological
deficit, or infection at 90 days. Secondary outcomes will compare safety
(transfusion-related reactions, thrombosis), quality of life, healthcare
costs, and cost-effectiveness. A sample size of 496 participants will have
a 90% power (with a 5% significance level) to detect a relative risk of
0.7 between the two groups at 90 days. The date of the 1st patient
enrolled was 11th February 2025. DISCUSSION(S): This trial will
provide evidence on the clinical/cost-effectiveness of PCC versus FFP in
cardiac surgery patients who bleed post-surgery. Its outcome will provide
high-quality evidence to inform the management of bleeding following
cardiac surgery. TRIAL REGISTRATION: ISRCTN 92114384. Registered on
16/04/2024. ISRCTN-ISRCTN92114384: PROthrombin complex concentrate versus
fresh frozen Plasma for bleeding in adults undergoing HEart SurgerY
(PROPHESY-2 trial). Copyright © 2026. The Author(s).

<57>
Accession Number
2042464193
Title
The Effect of Cognitive Training After Heart Valve Surgery: A Systematic
Review.
Source
Journal of Clinical Medicine. 15(1) (no pagination), 2026. Article Number:
370. Date of Publication: 01 Jan 2026.
Author
Yi Y.G.; Kim Y.; Kwon D.; Yang S.; Chang M.C.
Institution
(Yi, Kim, Yang) Department of Rehabilitation Medicine, College of
Medicine, Ewha Womans University, Seoul, South Korea
(Kwon) Department of Physical Medicine and Rehabilitation, Daegu Myungsung
Medical Center, Daegu, South Korea
(Chang) Department of Physical Medicine and Rehabilitation, College of
Medicine, Yeungnam University, Daegu, South Korea
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Neurocognitive complications are common after cardiac surgery,
and postoperative cognitive decline remains a clinically relevant concern
in patients undergoing heart valve surgery. This impairment may persist
over time and negatively affect quality of life and increase mortality
risk. This review aimed to explore the potential benefits of cognitive
training in patients after heart valve surgery. Method(s): We
systematically searched PubMed, Embase, Cochrane Library, and Scopus to
identify articles published from database inception to 19 June 2025.
Studies that investigated the effects of cognitive training in patients
who underwent heart valve surgery were included. Result(s): A total
of 1506 articles were identified. After title and abstract screening, 1476
articles not meeting the inclusion criteria were excluded. Thirty
full-text articles were assessed for eligibility, of which four studies
were ultimately included in this review. Cognitive training was found to
significantly improve cognitive outcomes and health-related quality of
life, with benefits sustained for up to 12 months postoperatively.
 Conclusion(s): This review highlights cognitive training as a
promising, feasible, and effective intervention for preserving cognitive
function in patients following heart valve surgery. By enhancing
neuroplasticity, cognitive training may prevent or mitigate cognitive
decline across multiple domains. Further large-scale studies are warranted
to confirm the efficacy of this treatment in this patient
population. Copyright © 2026 by the authors.

<58>
Accession Number
649959279
Title
Transcatheter edge-to-edge repair plus guideline-directed medical therapy
versus guideline-directed medical therapy alone for symptomatic functional
mitral regurgitation: a comprehensive, up-to-date meta-analysis of
randomised trials.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
22(2) (pp e101-e112), 2026. Date of Publication: 19 Jan 2026.
Author
Ammirabile N.; Giacoppo D.; Mazzone P.M.; Landolina D.; Spagnolo M.;
Capodanno D.
Institution
(Ammirabile, Giacoppo, Mazzone, Landolina, Spagnolo, Capodanno) Division
of Cardiology, University of Catania, Catania, Italy
(Landolina) Cardiology Unit, Umberto I Hospital, Syracuse, Italy
Abstract
BACKGROUND: Transcatheter edge-to-edge repair (TEER) is among the
treatments for functional mitral regurgitation (FMR), but its benefits
over guideline-directed medical therapy (GDMT) alone are discordant. We
conducted a meta-analysis of randomised trials comparing long-term
outcomes between these treatment strategies. AIMS: We aimed to compare
long-term clinical outcomes between TEER plus GDMT and GDMT alone in
symptomatic moderate-to-severe FMR. METHOD(S): Major electronic
databases were searched for randomised trials comparing TEER plus GDMT
with GDMT alone in FMR. The primary outcome was death or first
hospitalisation due to heart failure at 24 months. The key secondary
outcome was first hospitalisation due to heart failure at 24 months.
Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were
computed by mixed-effects Cox models based on reconstructed time-to-first
event individual patient data and random-effects models based on
study-level data. RESULT(S): Three randomised trials (MITRA-FR,
COAPT, and RESHAPE-HF2) were included, for a total of 1,422 patients
assigned to TEER plus GDMT (n=703) or GDMT alone (n=719). The primary
outcome was significantly lower in the TEER plus GDMT group compared with
the GDMT-alone group by one-stage analysis (HR 0.72, 95% CI: 0.56-0.92;
p=0.010). However, the two-stage analysis marginally failed to confirm
this result (HR 0.72, 95% CI: 0.51-1.00; p=0.052) and showed substantial
heterogeneity (I2=80.3%; p=0.006). Hospitalisation due to heart failure
was significantly lower in the TEER plus GDMT group, regardless of the
statistical method used (one-stage: HR 0.65, 95% CI: 0.48-0.88; p=0.006;
two-stage: HR 0.66, 95% CI: 0.45-0.96; p=0.031). However, heterogeneity
was substantial (I2=81.2%; p=0.005). All-cause death and cardiovascular
death at 24 months were not significantly different between treatment
groups but became significant after excluding MITRA-FR in the
leave-one-out analysis. CONCLUSION(S): In symptomatic
moderate-to-severe FMR, TEER plus GDMT significantly reduces death or
hospitalisation due to heart failure and hospitalisation due to heart
failure at 24 months.

<59>
Accession Number
2043005525
Title
Peripheral Regional Anesthesia Techniques in Pediatric Cardiac Surgery: A
Scoping Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026.
Date of Publication: 2026.
Author
Kataoka K.; Park S.; Shingala D.; Cheng S.; Sumie M.; Niimi N.; Cunningham
J.; Chin V.; Pankiv E.; Hayes J.; Maynes J.T.; Kirsch R.; Aoyama K.
Institution
(Kataoka, Shingala, Sumie, Niimi, Chin, Pankiv, Hayes, Maynes, Kirsch,
Aoyama) Department of Anesthesia and Pain Medicine, The Hospital for Sick
Children, Toronto, ON, Canada
(Kataoka, Park, Cheng, Sumie, Niimi, Cunningham, Chin, Pankiv, Hayes,
Maynes, Kirsch, Aoyama) Temerty Faculty of Medicine, University of
Toronto, Toronto, ON, Canada
(Sumie, Aoyama) Program in Child Health Evaluative Sciences, SickKids
Research Institute, Toronto, ON, Canada
(Sumie) Department of Anesthesiology, St. Mary's Hospital, Fukuoka, Japan
(Sumie) Department of Anesthesiology and Critical Care Medicine, of
Medical Sciences, Kyushu University, Fukuoka, Japan
(Cunningham) Health Sciences Library, The Hospital for Sick Children,
Toronto, ON, Canada
(Maynes) Program in Molecular Medicine, SickKids Research Institute,
Toronto, ON, Canada
Publisher
W.B. Saunders
Abstract
Peripheral regional anesthesia (PRA) techniques have gained increasing
attention as adjuncts to multimodal analgesia and enhanced recovery
pathways. This scoping review aims to summarize the current evidence on
the use of PRA in pediatric patients undergoing cardiac surgery and seeks
to inform clinical practice by answering 10 predetermined research
questions. This scoping review adhered to the Preferred Reporting Items
for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews
guidelines. We searched 6 databases and trial registries up to August
2025. Eligible studies were randomized controlled trials of patients aged
<18 years undergoing cardiac surgery under general anesthesia, with
interventions involving PRA, published in English. We also performed a
post hoc screening to identify evidence synthesis studies relevant to the
current scoping review. We extracted and qualitatively synthesized data on
block techniques, perioperative outcomes, and PRA-related complications.
Twenty-nine randomized controlled trials were eligible, in which 11 PRA
techniques were reported. The post hoc screening identified 5 systematic
reviews with meta-analysis. Compared with placebo, PRA was associated with
reduced intraoperative and postoperative opioid consumption, shorter time
to extubation, decreased intensive care unit length of stay, and lower
pain scores at 8 to 24 hours postoperatively in most studies. PRA-related
complications, such as pneumothorax or block failure, were rare, and the
incidence was not different from placebo. Trials comparing the PRA
techniques were limited, and the findings were inconclusive. In
conclusion, PRA techniques improve perioperative outcomes in pediatric
cardiac surgery, including opioid sparing, earlier extubation, and shorter
intensive care unit stay, with a favorable safety profile. The results are
descriptive, and further trials are needed to standardize dosing and
optimize block selection. Copyright © 2025 Elsevier Inc.

<60>
[Use Link to view the full text]
Accession Number
2042432179
Title
Adoption of a novel biomarker-guided quality improvement treatment bundle
for patients with subclinical acute kidney injury after cardiac surgery.
Source
European Journal of Anaesthesiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Milne B.; Helyar S.; Pellowe C.; Ostermann M.; Lees N.; Donovan J.; Sekhon
M.; Kunst G.
Institution
(Milne, Helyar, Pellowe, Ostermann, Lees, Donovan, Sekhon, Kunst) From the
The Department of Anaesthesia, King's College Hospital NHS Foundation
Trust, Department of Critical Care, King's College Hospital NHS Foundation
Trust, London, UK, United States
Publisher
Lippincott Williams and Wilkins
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 - 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. RESULTS - 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).
CONCLUSIONS - 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.

<61>
Accession Number
649950213
Title
Home-based tele-rehabilitation after myocardial infarction as a secondary
prevention strategy.
Source
Kardiologia Polska. Conference: 29th International Congress of the Polish
Cardiac Society. Krakow Poland. 83(Supplement 1) (pp 205-206), 2025. Date
of Publication: 2025.
Author
Mazur M.; Milewski K.; Malecki A.; Orszulik-Baron D.; Kachel M.; Grajek
M.; Mistarz W.; Nowak K.; Orczyk M.; Janas A.; Nowak Z.; Staron A.;
Kamierczak P.; Buszman P.
Institution
(Mazur, Milewski, Orszulik-Baron, Kachel, Grajek, Janas, Buszman) Center
for Cardiovascular Research and Development, American Heart of Poland,
Katowice, Poland
(Milewski, Orczyk, Buszman, Kamierczak) American Heart of Poland,
Katowice, Poland
(Milewski, Mistarz, Nowak) Akademia Laska, Katowice, Poland
(Malecki) Laboratorium Biologii Molekularnej, Instytut Fizjoterapii i Nauk
O Zdrowiu, Akademia Wychowania Fizycznego W Katowicach, Poland
(Kachel, Buszman) American Heart of Poland, Bielsko-Biala, Poland
(Janas) Polsko-Amerykanskie Kliniki Serca, Tychy, Poland
(Janas, Buszman) Wydzial Lekarski, Krakowska Akademia Im. A.
Frycza-Modrzewskiego, Krakow, Poland
(Nowak) Akademia Wychowania Fizycznego Im. Jerzego Kukuczki W Katowicach,
Poland
(Staron) Gornoslaskie Centrum Medyczne, Katowice, Poland
(Buszman) Cardiology Department, Collegium Medicum, Jan Dlugosz
University, Czestochowa, Poland
Publisher
Via Medica
Abstract
BACKGROUND Cardiac rehabilitation is recognized as a key component of
secondary prevention in patients with coronary artery disease, as
emphasized in the most recent clinical guidelines. Despite its
well-documented benefits, participation rates remain suboptimal, primarily
due to logistical and accessibility barriers. Home-based
telerehabilitation has emerged as a promising strategy to overcome these
limitations and extend the reach of cardiovascular care. AIM This study
assessed whether personalized, home-based telerehabilitation could improve
clinical outcomes profiles in patients following myocardial
revascularization. METHODS This was a prospective, multicenter, randomized
controlled trial in which 650 patients were enrolled. Participants were
evenly allocated to two groups: 49.1% (n = 319) to the intervention group,
receiving home-based telerehabilitation, and 49.9% (n = 331) to the
control group, receiving standard care. The total follow-up duration was
12 months. The evaluation included changes in physical capacity, clinical
parameters (including left ventricular ejection fraction), and mortality
indicators, allowing for a comprehensive assessment of the program s
effectiveness. RESULTS Patients in the intervention group were
significantly younger than those in the control group (62 [55,67] vs. 64
[57,68] years; P = 0.033). Male patients constituted a significant
majority in both groups (P <0.001). No significant baseline differences
were observed between groups in the prevalence of comorbidities. Physical
capacity, assessed by treadmill testing and expressed in METs, was higher
in the intervention group compared to the control group both at baseline
and after rehabilitation. Baseline values were 7 (6 8) vs. 7 (5 8) (P =
0.0031), while after rehabilitation they increased to 10 (10 14) and 10 (7
12), respectively (P = 0.00212), confirming a significant advantage of the
intervention. Left ventricular ejection fraction (LVEF) was significantly
higher in the intervention group at all assessed time points, with a clear
upward trend over time, indicating a sustained and statistically
significant improvement throughout the follow-up period. At baseline, LVEF
was 55 (50 59.2)% vs. 50 (45.8-55)% (P = 0.0326); at 1 month, 55 (55 60)%
vs. 50 (50 60)% (P = 0.0153); at 6 months, 55 (51.5 60)% vs. 55 (50 58.2)%
(P = 0.00209); and at 9 months, 58.5 (54 60)% vs. 55 (50 60)% (P =
0.00399). During the 12-month observation period, all-cause mortality
remained very low, with only three deaths recorded across the entire study
population. CONCLUSIONS Home-based tele-rehabilitation significantly
improved functional capacity (METs) and left ventricular ejection fraction
compared to standard care, supporting its role as a beneficial and
accessible option in the post-cardiac rehabilitation setting particularly
in cases where access to conventional rehabilitation programs is limited
or unavailable.

<62>
Accession Number
2042768532
Title
Heart Rate Variability Metrics In Heart Transplant Recipients-A Narrative
Review.
Source
Journal of Cardiac Failure. Conference: Journal of Cardiac Failure.
Barcelona Spain. 32(1) (pp 336), 2026. Date of Publication: 01 Jan 2026.
Author
Mehdipournamdar Z.; Khanal S.; Pandey P.; Nagai M.; Dasari T.W.
Institution
(Mehdipournamdar, Pandey) University of Oklahoma Health Science Center,
Oklahoma City, OK, United States
(Khanal) University of Oklahoma HSC, okc, OK, United States
(Nagai) The Japanese Circulation Society, Oklahoma City, OK, United States
(Dasari) University of Oklahoma HSC, Oklahoma City, OK, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Heart transplantation (HTx) is associated with vagal
denervation. Heart rate variability (HRV) is useful to assess the balance
between the sympathetic and parasympathetic nervous systems. Changes in
HRV has been reported post heart transplantation and may reflect the
trends in vagal reinnervation of the heart, specifically the sinus node.
This narrative review aims to summarize the existing literature on
temporal changes in HRV post heart transplantation. Method(s): A
comprehensive review of studies published between 1990 and 2024 was
conducted using PubMed and Embase databases. Studies reporting HRV metrics
(both time domain and frequency domain) in orthotopic heart
transplantation patients were included in this review. Commonly reported
time domain metrics were: rMSSD, pNN50% & SDANN-all reflective of the
variability of the RR interval, thereby indicating the tonic vagal
influence over the sinus node in the transplanted heart. Low-frequency
(LF), high-frequency (HF) power, LF/HF ratio and total power were included
in the frequency domain metrics. Results have been summarized in the
figure enclosed. Result(s): A total of 6 studies (2000-2023) were
included in this narrative review. Studies used different time points for
the assessment of HRV ranging from baseline to up to 10 years post
transplantation. Only 2 studies reported the changes in time and frequency
domain metrics over the ensuing 2 to 3 years post HTx. The notable
findings in these 2 studies indicate a slow decline in resting heart rate
and a gradual increase in rMSSD (msec), SDANN and pNN50%. (See figure)
Frequency domain metrics such as high-frequency power and low-frequency
power seem to increase over time up to 36 months (alongside the LF/HF
ratio). Similarly, in 1 study the reported low-frequency ratio also
increased over time. Compared to the previously published data from our
group, involving systolic heart failure, stage A heart failure and healthy
controls, the reported HRV metrics post heart transplantation continue to
be abnormal, indicative of only partial vagal innervation of the sinus
node. Conclusion(s): HRV post HTx, offers insight into the gradual
autonomic reinnervation process shedding light on the variability in both
the time and the frequency domain metrics post HTx. While a gradual
increase in time and frequency domain metrics are noted, they still lag
behind compared to the healthy population thereby indicative of partial to
minimal reinnervation of the sinus node and rest of the myocardium. This
review summarizes the most up-to-date literature examining the utility of
HRV and heart transplantation. Further investigations are warranted to
delineate the differences that may be related to age, gender, race and
other clinical factors. Copyright © 2025

<63>
Accession Number
649942289
Title
A PHASE 3, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER STUDY OF HUMAN
PLASMA DERIVED ANTITHROMBIN (ATENATIV) IN HEPARIN-RESISTANT CARDIAC
SURGERY PATIENTS.
Source
American Journal of Hematology. Conference: Abstract Proceedings of the
Thrombosis & Hemostasis Summit of North America. Chicago, IL United
States. 100(Supplement 1) (pp 120-121), 2025. Date of Publication: 01 Jan
2025.
Author
Solomon C.; Argyle C.; Levy J.H.; Werner S.
Institution
(Solomon, Argyle, Werner) Octapharma AG, Lachen, Switzerland
(Levy) Duke University School of Medicine, Durham, NC, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB) require adequate high-dose anticoagulation to prevent
hemostatic activation and circuit thrombosis. Unfractionated heparin (UFH)
is the mainstay anticoagulant therapy; however, up to 26% of patients
undergoing CPB experience heparin resistance, often associated with
decreased antithrombin levels. Antithrombin concentrate, a treatment
option for managing heparin resistance, is only approved in the US for
congenital but not acquired antithrombin deficiency. Objective(s): To
evaluate the efficacy of two doses of antithrombin concentrate (Atenativ,
Octapharma) versus placebo in restoring and maintaining heparin
responsiveness in adult patients undergoing cardiac surgery necessitating
CPB. Method(s): ATN-108 is an ongoing, prospective, double-blind,
placebo-controlled, three-arm, multicenter Phase 3 study. The study
adheres to the ethical principles outlined in the Declaration of Helsinki.
Patients aged between 18 and 85 years with planned cardiac surgery with
CPB are eligible for inclusion. All patients must be heparin-resistant
(pre-CPB Hemochron activated clotting time [ACT] < 480 s between 2 and 5
min following intravenous administration of 500 U/kg UFH) and provide
voluntarily given written informed consent at the screening visit. All
female patients of childbearing potential will require a pre-existing
negative pregnancy test within 14 days before surgery. Exclusion criteria
include patients who have received anticoagulant therapies directly prior
to the study, including warfarin, direct oral anticoagulants, ticlopidine,
prasugrel, clopidogrel, ticagrelor or a glycoprotein IIb/IIIa antagonist.
Additionally, patients with pre-existing coagulopathy, renal insufficiency
(serum creatinine level > 1.5 mg/dL), history of anaphylactic reaction(s)
to blood or blood components, refusal to receive transfusion of blood or
blood-derived products, hypersensitivity or allergic reaction to
antithrombin or any of the excipients in Atenativ will be excluded.
Participation in another interventional clinical trial or previous
participation in the current trial and treatment with any investigational
product within 30 days is prohibited. Patients will be randomized 2:2:1:1
to receive 15 IU/kg Atenativ, 30 IU/kg Atenativ, 0.3 mL/kg saline, or 0.6
mL/kg saline. The need for additional pre-CPB therapy to restore heparin
responsiveness (i.e., for those patients who do not achieve a Hemochron
ACT measurement of >= 480 s within 2-10 min after administration of
Atenativ or placebo) will be analyzed. The primary endpoint, the
proportion of patients requiring no further therapy containing
antithrombin for restoring pre-CPB heparin responsiveness, and for
maintaining it during CPB, after administration of Atenativ or placebo,
will be compared between groups using a one-sided Fisher's Exact Test.
Secondary and safety endpoints are outlined in Table 1. Result(s):
ATN-108 is expected to start in Q2 2024 and will be performed across ~20
sites in Europe and the United States. Target enrollment is ~120 patients,
assuming a 5% dropout rate. Study completion is anticipated in Q3 2026.
 Conclusion(s): The study findings could confirm the efficacy and
safety of antithrombin concentrate in re-establishing and maintaining
heparin responsiveness in patients undergoing CPB.

<64>
Accession Number
649938528
Title
Angiotensin-converting enzyme inhibitors modulate activation of the tissue
factor-thrombin pathway within aortic valves in patients with aortic
stenosis: Links between blood coagulation and inflammation.
Source
Kardiologia Polska. Conference: 22nd International Congress of the Polish
Cardiac Society. Krakow Poland. 76(Supplement 1) (pp 282-283), 2018. Date
of Publication: 2018.
Author
Natorska J.; Sobczyk D.; Siudut J.; Mazur P.; Undas A.
Institution
(Natorska, Siudut, Mazur, Undas) John Paul II Hospital, Pradnicka 80,
Krakow, Poland
(Natorska, Siudut, Mazur, Undas) Institute of Cardiology, Jagiellonian
University Medical College, Pradnicka 80, Krakow, Poland
(Sobczyk) Krakowski Szpital Specjalistyczny Im. Jana Pawla II, Pradcinka
80, Krakow, Poland
Publisher
Via Medica
Abstract
BACKGROUND The clinical and histological similarities between the active
pathobiology of AS and atherosclerosis have led to the therapeutic concept
that pharmacological strategies effective in atherosclerosis, such as
treat-ment with angiotensin-converting enzyme inhibitors (ACEIs), might
slow the progression of AS. However, available ACEI studies yielded
conflicting results, including negative findings from a large prospective
and randomized trial. The presence of angiotensin-converting enzyme (ACE)
and angiotensin II, which cannot be found in normal valve tissue, has been
demonstrated in sclerotic aortic valves. This observation suggests a role
for the renin-angiotensin system in the pathogenesis of aortic valve
lesions. It is known that ACEIs beside being very effective in the current
treatment of arterial hypertension therapy exert beneficial actions beyond
their blood pressure-lowering effects including anti-inflammatory and
antithrombotic actions. OBJECTIVE To investigate whether
angiotensin-converting enzyme inhibitors (ACEI) might affect the magnitude
of val-vular expression of coagulation proteins and inflammatory proteins
in AS valves. MATERIALS AND METHODS We studied 111 consecutive patients
with advanced AS (62 males, mean age 63.3 years) scheduled for iso-lated
valve replacement . Valvular TF, TF pathway inhibitor (TFPI), prothrombin,
along with C-reactive pro-tein (CRP) andinterleukin-6 (IL-6) expression
was evaluated by immunostaining, and their transcripts were analyzed by
real-time quantitative PCR. In valvular myofibroblast (VICs) cultures, TF
and IL-6 expression was evaluated. Plasma TF, TFPI, CRP and IL-6 were also
determined. RESULTS TF-, TFPI-, and prothrombin expression within valve
leaflets was not related to demographics, concomi-tant diseases or plasma
TF, free-TFPI, IL-6. Unexpectedly, patients treated with ACEIs (n=37)
mainly due to hypertension (n=24, 65%) showed decreased immunoreactive
areas for valvular TF (13.64+-6.43 vs. 18.05+-6.81%, p=0.03), TFPI
(32.6+-7.8 vs. 49.15+-9.5%, p<0.001), prothrombin (23.47+-1.93 vs.
26.61+-1.4%, p<0.001), CRP (0.75 [0-9] vs. 1.4 [0-8]%, p=0.009), and IL-6
(3.2+-0.65 vs. 6.4+-1.83%, p<0.001) (Fig. 1 A, B, C, D). In patients
treated with ACEI valvular mRNA expression of TF (1.22+-0.47 vs.
2.27+-1.42, p=0.041), prothrombin (0.13+-0.07 vs. 0.81+-0.37, p<0.001),
CRP (0.73+-0.29 vs. 1.25+- 0.69, p=0.04), and IL-6 (7.6+-5.16 vs.
13.67+-7.3, p=0.046) was lower (Fig. 1E). The same held true for IL-6 mRNA
expression in VICs cultures treated with candesartan - an angiotensin II
receptor antagonist (4-fold down-regulation), but not with ramipril - an
inhibitor of ACE (Fig. 1 F, G, H). CONCLUSIONS We have shown that in
patients with severe AS, ACEI use is associated with lower expression of
TF, pro-thrombin, CRP, and IL-6 within aortic valves on both protein and
mRNA levels within diseased valve cusps. Our study indicates that
long-term ACEIs therapy could be important in altering
atherosclerosis-like process-es within human stenotic aortic valves.

<65>
Accession Number
649941847
Title
Monoclonal antibodies and fusion proteins in the prevention of myocardial
ischaemia-reperfusion injury: Systematic review of preclinical and
clinical data and meta-analysis of clinical data.
Source
John Wiley and Sons Inc. Conference: Annual Meeting of French Society of
Pharmacology and Therapeutics. Tours France. 38(Supplement 1) (pp 54-55),
2024. Date of Publication: 01 Jun 2024.
Author
Le Tilly O.; Pontois A.E.; Angoulvant D.; Bejan-Angoulvant T.
Institution
(Le Tilly, Bejan-Angoulvant) Service de Pharmacologie Medicale, Chru de
Tours, U1327 Inserm "ischemia", Universite de Tours, Tours, France
(Pontois) Service de Pharmacologie Medicale, Chru de Tours, Tours, France
(Angoulvant) Service de Cardiologie, Chru de Tours, U1327 Inserm
"ischemia", Universite de Tours, Tours, France
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Ischaemia-reperfusion injury is a major cause of morbidity
and mortality in cardiac ischaemia sit-uations such as myocardial
infarction, coronary artery bypass and heart transplantation. Numerous
therapeutic strategies have been tested to prevent these lesions. The aim
was to carry out a systematic review of the liter-ature on the effect of
monoclonal antibodies and fusion proteins in preventing myocardial
ischaemia-reperfusion lesions. The review included clinical studies and
experi-mental preclinical studies (in vivo animal models, ex vivo animal
models and in vitro models). Material(s) and Method(s): We reviewed
all original arti-cles evaluating a therapeutic antibody or a fusion
pro-tein compared with placebo or no treatment in the three situations of
myocardial ischaemia-reperfusion men-tioned above. Articles of interest
were retrieved by two people from Medline, Embase and Cochrane. PICOS
criteria were collected and the assessment criteria were: infarct size
measured by imaging or biomarker release, and clinical events associated
with ischaemia-reperfusion injury (arrhythmias, heart failure, graft loss,
mortality). The data collected included: the pathology and/or preclinical
model, the characteristics of the patients and/or animals included, the
type of drug, its dosage and target, and the design and methodological
quality of the study. A meta-analysis of the clinical datawas carried out
using the standardized mean difference or relative risk, with
random-effect model. Result(s): All the targets from the human
studies had been previously tested in the animal studies. The main targets
were leukocyte adhesion, cell homeostasis, cytokines and apoptosis
pathways. This systematic review and meta-analysis showed that although
preclin-ical models offer promising targets, no clinical benefit was
observed in clinical studies. Publication bias was strongly
suspected.Discussion/Conclusion: Further research is needed to (1) improve
preclinical models and assess the risk of bias in animal studies of
ischaemia-reperfusion and (2) correctly summarize preclinical data in
order to transpose the best pharmacological option at the best dosage for
clinical studies.

<66>
Accession Number
2042446505
Title
Diabetes does not modify the renal-protective effect of intravenous amino
acids infusion after cardiac surgery.
Source
Journal of Endocrinological Investigation. (no pagination), 2026. Date of
Publication: 2026.
Author
Consonni M.; Fresilli S.; Kotani Y.; Garofalo E.; Bradic N.; Scandroglio
A.M.; Ti L.K.; Comis M.; Oriani A.; Pisano A.; Belletti A.; Guarracino F.;
Losiggio R.; Redaelli M.B.; Pontillo D.; Arangino C.; Pruna A.; Federici
F.; D'Amico F.; Silvetti S.; Labanca R.; Ferrod F.; Pittella G.; Corbo F.;
Ranucci M.; Cortegiani A.; Paternoster G.; Bove T.; Longhini F.; Monaco
F.; Zangrillo A.; Piemonti L.
Institution
(Consonni, Fresilli, Scandroglio, Oriani, Belletti, Losiggio, Pontillo,
Pruna, D'Amico, Labanca, Corbo, Zangrillo) Department of Anesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Kotani) Department of Intensive Care Medicine, Kameda Medical Center,
Kamogawa, Japan
(Garofalo, Longhini) Department of Medical and Surgical Sciences, Magna
Graecia University of Catanzaro, Catanzaro, Italy
(Bradic) Clinic of Anesthesiology, Resuscitation and Intensive Care,
University Hospital Dubrava, Zagreb, Croatia
(Bradic) Department of Nursing, University North, Varazdin, Croatia
(Ti) Department of Anaesthesia, National University Hospital, Lower Kent
Ridge Road, Singapore
(Comis, Ferrod) S.C. Anestesia e Rianimazione Cardiovascolare, A.O.Ordine
Mauriziano, Umberto I di Torino, Turin, Italy
(Pisano) Cardiac Anesthesia and ICU, AORN "Dei Colli", Monaldi Hospital,
Naples, Italy
(Guarracino) Department of Cardiothoracic Anaesthesia and IC, Azienda
Ospedaliero Universitaria Pisana, Pisa, Italy
(Redaelli) General and Neurosurgical Intensive Care Units, ASST Sette
Laghi, Ospedale Di Circolo, Varese, Italy
(Redaelli) Department of Biotechnologies and Life Sciences, University of
Insubria, Varese, Italy
(Arangino) Department of Cardiothoracic Anesthesia and Intensive Care,
IRCCS Centro Cardiologico Monzino, Milan, Italy
(Federici) UOC Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria
Sant'Andrea, Rome, Italy
(Silvetti) Department of Cardiac Anesthesia and Intensive Care, Ospedale
Policlinico San Martino IRCCS, IRCCS Cardiovascular Network, Genova, Italy
(Pittella) Cardiovascular Anaesthesia and ICU, San Carlo Hospital,
Potenza, Italy
(Ranucci) Department of Cardiovascular Anesthesia and Intensive Care,
IRCCS Policlinico San Donato, San Donato Milanese, Italy
(Cortegiani) Department of Precision Medicine in Medical, Surgical and
Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy
(Cortegiani) Department of Anesthesia, Intensive Care and Emergency,
University Hospital Policlinico Paolo Giaccone, Analgesia, Palermo, Italy
(Paternoster) Department of Health Sciences, University of Basilicata,
Potenza, Italy
(Paternoster) Anesthesia and ICU, San Carlo Hospital, Potenza, Italy
(Bove) Department of Basic Biotechnological Sciences, Intensive Care Peri-
Operative Clinics, Universita Cattolica del Sacro Cuore, Rome, Italy
(Bove) Department of Emergency, Anesthesiological and Reanimation
Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS,
Rome, Italy
(Monaco) Departement. of Medical and Surgical Sciences (DIMEC), Alma Mater
Studiorum - University of Bologna, Bologna, Italy
(Monaco) Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS
Azienda Ospedaliero-Universitaria Sant'Orsola, Bologna, Italy
(Zangrillo, Piemonti) School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
(Piemonti) Diabetes Research Institute, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Losiggio) Department of Anaesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Via Olgettina, 60, Milan, Italy
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Acute kidney injury (AKI) is a common complication after cardiac
surgery and is associated with increased morbidity and mortality.
Intravenous amino acids (AA) infusion reduces postoperative AKI. Given the
high prevalence of patients with diabetes and their increased
susceptibility to renal injury, this study aimed to assess whether the
renal-protective effect of AA infusion is maintained in this population.
 Method(s): This post-hoc subgroup analysis examined patients with
diabetes included in the multinational, double-blind, randomized,
placebo-controlled PROTECTION trial. Participants were randomized to
receive a continuous intravenous infusion of AA (2 g/kg of the ideal body
weight per day; up to 72 h) or placebo during the perioperative period of
cardiac surgery. Result(s): Among 644 patients with diabetes (AA n =
309; placebo n = 335), the incidence of any-stage AKI was 43.3% in the AA
group versus 47.8% in the placebo group, with no significant interaction
observed compared to patients without diabetes (interaction p = 0.82).
Similarly, stage 3 AKI occurred in 2.3% of patients in AA group versus
4.8% in the placebo group, with no interaction detected (interaction p =
0.65). Conclusion(s): The beneficial effect of perioperative AA
infusion has similar magnitude and direction among patients with or
without diabetes. These findings support the use of AA infusion as a
renal-protective strategy for all patients undergoing cardiac surgery.
Trial registration number: ClinicalTrials.gov NCT03709264 - registered on
October 17th, 2018. Copyright © The Author(s), under exclusive
licence to Italian Society of Endocrinology (SIE) 2026.

<67>
Accession Number
2042742785
Title
Sex Differences in Stroke Following Transcatheter Aortic Valve Replacement
and the Role of Embolic Protection Devices in Women.
Source
Interventional Cardiology: Reviews, Research, Resources. 20 (pp 1-5),
2025. Date of Publication: 2025.
Author
Alasnag M.; Masiero G.; de Biase C.; Paradies V.; Kaluzna-Oleksy M.
Institution
(Alasnag) Cardiac Centre, King Fahd Armed Forces Hospital, Jeddah, Saudi
Arabia
(Masiero) Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padua Medical School, Padua, Italy
(de Biase) Cardiovascular Department, Clinique Pasteur, Toulouse, France
(Paradies) Cardiovascular Department, Maasstad Hospital, Rotterdam,
Netherlands
(Kaluzna-Oleksy) 1st Department of Cardiology, University of Medical
Sciences in Poznan, Poznan, Poland
Publisher
Radcliffe Medical Media
Abstract
Several historical studies reported a higher rate of complications
following transcatheter aortic valve replacement (TAVR) in women compared
with men, especially major bleeding, vascular complications and stroke.
More recent publications have demonstrated lower stroke rates following
TAVR. The growing experience of modern TAVR operators played a crucial
role in the reduction of early postprocedural stroke events. In addition,
the improved transcatheter heart valve technology, the emphasis on a heart
team-based selection process, and the inclusion of intermediate-and
low-risk patients in the latest landmark randomised trials have all
contributed to the lower stroke rates in contemporary trials. It is
important to note, however, that at an individual level, stroke can
significantly affect both quality of life and overall prognosis. Certain
factors that increase the risk of periprocedural stroke include the
distribution of calcification of native aortic valves, small aortic valve
annuli, left ventricular dysfunction and fibrosis, and AF. These tend to
occur more frequently in women. However, the role of cerebral embolic
protection devices has not been shown to reduce procedure-related strokes
in men or women. The overall incidence of factors predisposing to
late-onset stroke is higher in women. Currently, there are no trials that
have identified sex differences in the incidence and management of stroke
following TAVR. This review aims to examine potential sex differences in
the pathophysiology, preventive strategies and therapeutic options for
stroke following TAVR. Copyright © (2025), The Author(s) 2025.
This work is open access and is licensed under CC-BY-NC 4.0. Users may
copy, redistribute and make derivative works for non-commercial purposes,
provided the original work is cited correctly.

<68>
Accession Number
649951457
Title
Robotic-assisted thoracic surgery for resectable lung cancer: efficacy,
safety and surgical approaches - an umbrella review of meta-analyses.
Source
BMC surgery. (no pagination), 2026. Date of Publication: 16 Jan 2026.
Author
Xu Y.; Han Q.; Wang C.; Xu J.; Li X.; Zhang Q.
Institution
(Xu, Wang) Thoracic Surgery Department of Second Affiliated Hospital of
Shandong First, Medical University & Shandong Academy of Medical Sciences,
No.706 Taishan Street, Shandong, China
(Han) Respiratory Medicine Department of Second Affiliated Hospital of
Shandong, First Medical University & Shandong Academy of Medical Sciences,
China
(Xu) Thoracic Surgery Department of Fourth Affiliated Hospital of Harbin
Medical University, Harbin, China
(Li) Thoracic Surgery Department of The First Affiliated Hospital of
Soochow University, No.899 Pinghai Street, Suzhou, Jiangsu, China
(Zhang) Thoracic Surgery Department of Second Affiliated Hospital of
Shandong First, Medical University & Shandong Academy of Medical Sciences,
No.706 Taishan Street, Shandong, China

<69>
Accession Number
2042768410
Title
Infective Endocarditis After Aortic Valve Replacement: Unraveling The
Risks And Realities Of Transcatheter Vs. Surgical Repair - A Systematic
Review And Meta-analysis.
Source
Journal of Cardiac Failure. Conference: Journal of Cardiac Failure.
Barcelona Spain. 32(1) (pp 293-294), 2026. Date of Publication: 01 Jan
2026.
Author
Chaudhri M.; Markovitz R.; Oliver T.; Gill H.; Mahrizi A.A.; Samad A.;
Acquah F.; Raza M.R.
Institution
(Chaudhri, Markovitz, Acquah, Raza) Hackensack Meridian Ocean University
Medical Center, Brick, NJ, United States
(Oliver, Gill) Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ,
United States
(Mahrizi) University of Malta, Swatar, 4, Malta
(Samad) BrickNJUnited States
Publisher
Elsevier B.V.
Abstract
Introduction: Aortic valve replacement is a well-established, effective
intervention for the treatment of valvular heart disease. However,
infective endocarditis (IE) is a rare but serious complication of aortic
valve replacement associated with significant morbidity and high
mortality. As TAVR continues to expand and is increasingly applied for
younger and lower-risk patient populations, it is essential to ascertain
relative risk of IE in comparison to SAVR to improve patient outcomes.
This study evaluates the rate of IE, risk factors and contrasts the
outcomes of TAVR and SAVR. Hypothesis: We hypothesized that TAVR and SAVR
would demonstrate comparable IE incidence rates but distinct risk profiles
influenced by procedural and patient-specific factors. Method(s): The
study was conducted using the PRISMA 2020 guidelines and was registered on
PROSPERO (CRD42025632019). Our search began with a total of 6,088
articles. 2776 duplicates were excluded and 30 studies were included in
the qualitative synthesis, and 8 studies (n = 118,443 patients) were
examined in quantitative analysis. Pooled log risk ratios (Log [RR]) were
obtained using random-effects models to allow for the heterogeneity seen
between studies (I2 = 96%). Subgroup analyses were performed to determine
study design as a potential moderator, and publication bias was tested
using funnel plots and Egger's test. Result(s): There was no
significant difference in IE risk profile between TAVR and SAVR (pooled
log [RR]: -0.006, 95% CI: [-0.198,0.185], p = 0.948). The risk estimates
varied widely across studies (-1.14 to 1.57), with substantial
heterogeneity (I2 = 96%). The asymmetrical funnel plot suggested
publication bias, confirmed by Egger's test (P<0.05). Major risk factors
were valve in valve procedures (RR = 2.88), pacemaker implantation (HR =
1.91), CKD (HR =2.08). Mortality remained high in both groups, with in
hospital death rates 34.4% for TAVR and 31.8% for SAVR. Long term survival
was poor, with over 60% of patients dying within five years. Sensitivity
analysis, which excluded outliers, slightly reduced heterogeneity (I2 =
94.58%) but did not change the overall conclusions. Conclusion(s):
TAVR and SAVR have similar rates of infective endocarditis, but
differences in data highlight the need for consistent reporting and
personalized risk assessment. Better monitoring, especially for patients
with pacemakers or kidney disease, could help improve outcomes. Since
prosthetic valve infections have high death rates, guidelines for removing
infected TAVR valves may need to be reconsidered. Copyright ©
2025

<70>
Accession Number
649938657
Title
Hybrid Coronary Revascularization in Selected Patients with Multivessel
Disease - 5 year clinical outcomes of the Prospective Randomized Pilot
Study - HYBRID.
Source
Kardiologia Polska. Conference: 22nd International Congress of the Polish
Cardiac Society. Krakow Poland. 76(Supplement 1) (pp 333-334), 2018. Date
of Publication: 2018.
Author
Tajstra M.; Hrapkowicz T.; Hawranek M.; Filipiak K.; Gierlotka M.; Gasior
M.; Zembala M.
Institution
(Tajstra, Hawranek, Gasior) IIi Katedra i Oddzial Kliniczny Kardiologii,
Wydzial Lekarski Z Oddzialem Lekarsko-Dentystycznym W Zabrzu, Slaski
Uniwersytet Medyczny W Katowicach, Slaskie Centrum Chorob Serca W Zabrzu,
Curie-Sklodowskiej 9, Zabrze, Poland
(Hrapkowicz) Katedra i Oddzial Kliniczny Kardiochirurgii,
Transplantologii, Chirurgii Naczyniowej i Endowaskularnej SUM, Slaskie
Centrum Chorob Serca, ul. M. Curie-Sklodowskiej 9, Zabrze, Poland
(Filipiak, Zembala) Katedra i Oddzial Kliniczny Kardiochirurgii,
Transplantologii, CNE, Wydzial Lekarski Z Oddzialem Lekarsko-Dentystycznym
W Zabrzu, SUM W Katowicach, Marii Curie Sklodowskiej 9, Zabrze, Poland
(Gierlotka) Slaski Uniwersytet Medyczny W Katowicach, Wydzial Lekarski Z
Oddzialem Lekarsko-Dentystycznym W Zabrzu, IIi Katedra i Oddzial Kliniczny
Kardiologii, Slaskie Centrum Chorob Serca, Sklodowskiej - Curie, Zabrze,
Poland
(Zembala) Katedra i Oddzial Kliniczny Kardiochirurgii, Transplantacji i
Chirurgii Endowaskularnej, Wydzial Lekarski Z Oddzialem
Lekarsko-Dentystycznym W Zabrzu, SUM W Katowicach, Marii Sklodowskiej
Curie 9, Zabrze, Poland
Publisher
Via Medica
Abstract
OBJECTIVES This study aimed to investigate the 5-year clinical follow-up
of the Hybrid Revascularization for Multivessel Coronary Artery Disease
(HYBRID) trial. BACKGROUND Hybrid trial is the only randomized study
involving thorough analysis of outcome after the two procedures, suggested
that hybrid coronary revascularization is feasible in selected patients
with multivessel coronary disease referred for conventional coronary
artery bypass grafting. There are currently no long-term outcome data from
randomized trials in this setting. METHODS A total of 200 patients with
multivessel coronary disease referred for conventional surgical
revascularization, were randomly assigned to undergo hybrid coronary
revascularization or coronary artery bypass grafting. The primary endpoint
was the occurrence of all-cause mortality at 5 years. RESULTS Nine
patients (4 in HCR and 5 in CABG group) were lost to the 5-year follow-up.
Finally, 191 patients (94 in HCR and 97 in CABG group) formed the basis of
this study. The groups were well balanced in terms of pre-procedural
characteristics. All-cause mortality at 5-year follow-up was similar in
the two groups (6.4% for HCR vs. 9.2% for CABG, p=0.69). The rates of
myocardial infarction (4.3% vs. 7.2%, p=0.30), repeat revascularization
(37.2% vs. 45.4%, p=0.38), stroke (2.1% vs. 4.1%, p=0.35), and major
adverse cardiac and cerebrovascular events (45.2% vs. 53.4%, p=0.39) were
also similar in the two groups. CONCLUSIONS Hybrid coronary
revascularization has similar 5-year all-cause mortality when compared
with conventional coronary bypass grafting. (ClinicalTrials.gov number,
NCT01035567).

<71>
Accession Number
649938502
Title
Five-year outcomes in patients hospitalised for acute myocardial
infarction in Poland - Nationwide AMI-PL database.
Source
Kardiologia Polska. Conference: 22nd International Congress of the Polish
Cardiac Society. Krakow Poland. 76(Supplement 1) (pp 276-277), 2018. Date
of Publication: 2018.
Author
Gierlotka M.; Zdrojewski T.; Wojtyniak B.; Ozieranski K.; Gasior M.;
Stokwiszewski J.; Kalarus Z.; Wierucki L.; Chlebus K.; Polonski L.;
Zembala M.; Opolski G.
Institution
(Gierlotka) Department of Cardiology, University Hospital in Opole,
Faculty of Natural Sciences and Technology, University of Opole, Silesian
Centre for Heart Diseases in Zabrze, al. W. Witosa 26, Opole, Poland
(Zdrojewski) Department of Preventive Medicine and Education, Medical
University of Gdansk, Debinki 7, Gdansk, Poland
(Zdrojewski, Wojtyniak, Stokwiszewski) Department-Centre of Monitoring and
Analyses of Population Health, National Institute of Public Health,
National Institute of Hygiene, Chocimska 24, Warsaw, Poland
(Wojtyniak) 1st Department of Cardiology, Medical University of Warsaw,
Banacha 1a, Warsaw, Poland
(Ozieranski) 3rd Department of Cardiology, SMDZ in Zabrze, Medical
University of Silesia in Katowice, Silesian Centre for Heart Disease in
Zabrze, M. Curie-Sklodowskiej 9, Zabrze, Poland
(Gasior, Polonski) Department of Cardiology, Congenital Heart Diseases and
Electrotherapy, Medical University of Silesia, Silesian Centre for Heart
Diseases, Sklodowskiej-Curie 9, Zabrze, Poland
(Kalarus) Department of Preventive Medicine and Education, Medical
University of Gdansk, Debinki 7, Gdans, Poland
(Wierucki) 1st Department of Cardiology, Medical University of Gdansk,
Debinki 7, Gdansk, Poland
(Chlebus) Department of Cardiac Surgery and Transplantology, Silesian
Centre for Heart Diseases, Sklodowskiej-Curie, Zabrze, Poland
(Zembala, Opolski) 1st Department of Cardiology, Medical University of
Warsaw, Banacha 1a, Warszawa, Poland
Publisher
Via Medica
Abstract
BACKGROUND Randomized controlled trials have studied extensively efficacy
of treatment for acute myocardial infarction (AMI). However, in a
real-life setting outcomes depend on different factors incl. health care
system organization. There is still lack of long-term data based on large
nationwide databases regarding outcomes and manage-ment of unselected AMI
patients, especially regarding to age groups. PURPOSE The aim of the
present analysis was to assess 5-year outcomes in relation to age of all
patients discharged after hospitalization for AMI in Poland. METHODS The
study was based on the AMI-PL database which comprises data from the
obligatory health insurer in Poland (National Health Fund). .All patients
who experienced AMI (ICD-10 codes I21-I22) in Poland in years 2009-2010
and survived the index hospitalization, irrespective of AMI history in the
past were includ-ed into analysis. During the 5-year follow-up after
discharge data on all-cause deaths, hospitalizations for cardiovascular
reasons, as well as invasive procedures were registered regarding to four
age groups (<55, 55-64, 65-79 and 80 years). RESULTS The study cohort
comprised 134,602 patients who were discharged after AMI hospitalization.
Median age was 66.8 [Q1 57.4, Q3 76.6] years, 62.8% were males and 57.1%
of patients were hospitalized due to STEMI. Older patients (aged 65-79 and
80 years) required longer hospital stay, were less likely to be
hos-pitalized in a cardiology ward and to receive an invasive treatment
(including coronary angiography, PCI, CABG, thrombolysis and glycoprotein
IIb/IIIa inhibitor) during the index hospitalization than patients aged
<65 years. The all-cause post-discharge mortality at 5-years was 28.1% and
ranged from 8.5% to 60.1% (in patients aged <55 and 80 years,
respectively). Probability of death during the 5-year observation was
higher in older patients, males, in those treated non-invasively,
hospitalized for NSTEMI and in those who were dis-charged from
non-cardiology wards. During the 5-year follow-up 63% of patients required
hospitalization due to cardiovascular causes and following procedures were
performed: coronary angiography in 35.3%, PCI in 24.8%, CABG in 8.5%, and
ICD or CRT-D implantation in 3.3% patients. Older patients, especially
those aged 80 years, were less likely to undergo any invasive procedures
during the 5-year follow-up than younger patients. CONCLUSIONS One of four
discharged patients after AMI died during follow-up. The five year post-MI
survival rate is comparable with some neoplasms. More than 30% of post-MI
patients underwent coronary revascularization. It shows and implies room
for improvement in secondary prevention. Age is the most important factor
affecting treatment and long-term outcomes in post-MI patients.

<72>
Accession Number
649942172
Title
Dynamic computed tomography perfusion for detection of cardiac allograft
rejection: A pilot study.
Source
Kardiologia Polska. Conference: 24th International Congress of the Polish
Cardiac Society. Online. 78(Supplement 1) (pp 88-89), 2020. Date of
Publication: 2020.
Author
Oleksiak A.; Sobieszczanska-Malek M.; Kruk M.; Zielinski T.; Drohomirecka
A.; Komuda K.; Karczmarz M.; Kusmierczyk M.; Kadziela J.; Demkow M.; Kepka
C.
Institution
(Oleksiak) Klinika Intensywnej Terapii Kardiologicznej, Narodowy Instytut
Kardiologii, Warszawa, Poland
(Sobieszczanska-Malek, Zielinski, Drohomirecka, Komuda, Karczmarz) Klinika
Niewydolnosci Serca i Transplantologii, Narodowy Instytut Kardiologii,
Warszawa, Poland
(Kruk, Demkow, Kepka) Klinika Choroby Wiencowej i Strukturalnych Chorob
Serca, Narodowy Instytut Kardiologii, Warszawa, Poland
(Kusmierczyk) Klinika Kardiochirurgii i Transplantologii, Narodowy
Instytut Kardiologii, Warszawa, Poland
(Kadziela) Klinika Kardiologii i Angiologii Interwencyjnej, Narodowy
Instytut Kardiologii, Warszawa, Poland
Publisher
Via Medica
Abstract
BACKGROUND Dynamic CTP may detect myocardial hypoperfusion due to either
ischemia or fibrosis. Since these phenomena are observed in cardiac
rejection, we hypothesized that dynamic CTP may be used for its diagnosis,
but there is no existing evidence confirming this hypothesis. AIMS This
pilot study aimed to determine for the first time the feasibility of
dynamic computed tomography perfusion (CTP) as a non-invasive tool for
identification of cardiac allograft rejection. METHODS 44 patients after
orthotopic heart transplant (OHT) were prospectively screened. The study
group included twelve OHT recipients who underwent CTP and twenty healthy
controls. Cardiac allograft rejection was detected on endomyocardial
biopsies. The distribution of contrast agent in CTP was represented as
absolute or relative: myocardial blood flow (MBF, MBFR) and myocardial
blood volume (MBV, MBVR). RESULTS Of 12 patients, 8 had cardiac allograft
rejection by biopsy. CTP revealed either normal myocardium or irregular
hypoperfused areas, localized mainly in the midwall myocardium, which we
called midwall patchy pattern (MPP) (Figure 1A and 1B). The ROC analysis
showed that presence of >1 segment with MPP was correlated significantly
with rejection GRADE >=1R with 100% sensitivity and 96% specificity (AUC =
0.974; P <0.001) (Figure 1C). Within OHT patients the number of segments
with MPP correlated with the number of biopsies with GRADE >=1R (P
<0.0001) (Figure 1D). In patients after OHT, segments with MPP compared to
the normal segments, differed significantly for MBF 116.3 (104-129.7) vs
179.7 (157.3-209.2) ml/100ml/min (P <0.0001), MBV 13.2 (11.3-15.4) vs 18.5
(16.2-20.3) ml/100ml (P <0.0001) and also for MBFR 0.73 (0.64-0.79) vs
0.99 (0.94-1.02) (P <0.0001), MBVR 0.76 (0.68-0.81) vs 0.98 (0.94-1.02) (P
<0.0001). In patients after OHT segments without MPP did not differ
significantly from normal segments in control group for MBF (P = 0.6) and
for MBV (P = 0.2). Mean DLP for CTP was 349.3 +/-144.2 mGy*cm. CONCLUSIONS
Dynamic CTP perfusion abnormalities in OHT recipients may be correlated
with cardiac allograft rejection, comprising potential non-invasive tissue
biomarker for cardiac allograft rejection..

<73>
[Use Link to view the full text]
Accession Number
2042432233
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: 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
Publisher
Lippincott Williams and Wilkins
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 [ORadj: 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.

<74>
[Use Link to view the full text]
Accession Number
2042617144
Title
Balloon vs. self-expanding valves for transcatheter aortic valve
implantation in bicuspid aortic stenosis: a meta-analysis.
Source
Journal of Cardiovascular Medicine. 26(9) (pp 477-486), 2025. Date of
Publication: 01 Sep 2025.
Institution
Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Graduate School of Science, Osaka University, Osaka, Japan
Division of Rheumatology, Department of Internal Medicine, Faculty of
Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Publisher
Lippincott Williams and Wilkins
Abstract
Aims - Bicuspid aortic valve (BAV) is a common congenital heart disease.
However, pivotal randomized trials of transcatheter aortic valve
replacement (TAVR) have excluded this population. There remains a lack of
consensus on the optimal choice between balloon-expandible valves (BEVs)
and self-expanding valves (SEVs) in this setting. This study aimed to
compare the efficacy and safety of BEVs vs. SEVs in patients with BAV
stenosis. Methods - A systematic search using four databases, including
PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from
inception to 26 November, 2024. Studies comparing the outcome of BEVs and
SEVs in patients with BAV stenosis were included. Results - Nineteen
studies comprising 3794 participants were included in this meta-analysis.
Procedural mortality did not differ significantly between BEVs and SEVs
[odds ratio (OR), 1.06; 95% confidence interval (95% CI) 0.42-2.69, P =
0.91]. Similarly, no differences were observed in all-cause mortality at 1
year or 3 years. BEVs were associated with a lower risk of permanent
pacemaker implantation (OR, 0.60; 95% CI 0.48-0.76, P < 0.01) and moderate
to severe paravalvular leakage (OR, 0.44; 95% CI 0.23-0.85, P = 0.01)
compared with SEVs. However, BEVs were associated with a higher risk of
annular rupture (OR, 2.80; 95% CI 1.05-7.49, P = 0.04). Conclusion - BEVs
and SEVs demonstrate similar survival outcomes from the procedural period
up to 3 years of follow-up. However, the risk profiles for specific
complications differ between the valve types. Valve selection for TAVR in
patients with BAV stenosis should be considered based on individual
anatomical characteristics and the associated risk of specific
complications. Copyright ©

<75>
[Use Link to view the full text]
Accession Number
2042617025
Title
Early valve intervention in asymptomatic patients with severe aortic
stenosis: a meta-analysis of randomized-controlled trials.
Source
Journal of Cardiovascular Medicine. 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, Improta, Giordano, Birtolo, Colantonio, Sardella, Mancone)
Department of Clinical, Internal, Anesthesiology and Cardiovascular
Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
Publisher
Lippincott Williams and Wilkins

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